SPECIMEN DRAFT RESTRICTED USE FOR EPOS STAFF UNDERCONTRACT
NATIONAL RURAL HEALTH MISSION
DISTRICT HEALTH ACTION PLAN
DISTRICT KATHUA
December 2007
1 2
3 PREFACE
The Hon’ble Prime Minister launched the NRHM on 12 th April 2005 throughout the country with the basic objective of providing accessible, affordable and accountable health care in rural areas. Its primary focus is on making the public health system fully functional at all levels. While detailing the functioning of the NRHM, the present planning process initiated in the State provides the entire framework for making the Public Health System fully functional and standardized upto the Indian Public Health Standards at all levels. In doing so, it emphasizes the need for communitisation of the Public Health System, improved financing and management of public health, human resource innovations, and a long-term financial commitment to enable the state and districts to undertake programmes aimed at achieving the Mission goals.
National Rural Health Mission envisages the planning process to be participatory and decentralized starting with the Village. It seeks to empower the community by placing the health of the people in their own hands and determine the ways they would like to improve their health. This is the only way to ensure that health plans are local specific and need based. The State should facilitate the processes by providing enabling environment and required financial and technical support. NRHM was launched in April 2005 and is being implemented by the Department of Health and Medical Education, Government of Jammu & Kashmir.
In accordance with the National Rural Health Mission, Jammu & Kashmir. The district has constituted the District Health Mission and significant progress has been made since it’s beginning. As per the NRHM guidelines, it has merged multiple societies at the district level. The District Action Plan was the most important aspect of the NRHM and to make District Plan more meaningful and address local health problems, preparation of Block Health Plans was considered essential. The decentralized planning process involved village consultations and preparation of Village Health Plans by the Village Health Water and Sanitation committees; followed by development of Block Action Plans through integration of Health Facility Surveys and block specific needs. The Block Action Plans were then integrated to form District Action Plan.
As result of this exercise, the district now has developed capacity for preparing the need based health action plans following participatory processes. A District Planning Team (DPT) was set up for this purpose in the month of May 2007 with representation from various sectors concerned with NRHM. This group was responsible for management of the entire planning process in the district and also for provision of the technical support. The DPT is the standing body and will take charge of ensuring implementation of the plan. Thus the DPT not only owns the plan but will also be
4 responsible for monitoring the progress of implementation to achieve the objectives of the plan. The members of the DPT are:
# Name Designation Department 1 Ms. Sarita Chauhan Deputy commissioner District Administration 2 Dr. Jagdish Chander Bhagat Chief Medical Officer Health Dept 3 Dr. Bharat Bhushan Dy. Med. Suptt Health Dept 4 Bharat Bhushan Ex Engineer PHE Dept 5 Sushma Gupta CDPO Social Welfare 6 Ms.Jyoti Balla Distt Prog manager NRHM 7 Yograj Bassam DEPT Education 8 Dr. Bharat Bhushan ADMO ISM 9 Sant Ram C.P.O Distt Com Office 10 H.C Katoch District Coordinator EPOS Health India 11 Ranjeet Sharma District Coordinator EPOS Health India 12 Ghulam Mehdi District Coordinator EPOS Health India 13 Arif Latief District Coordinator EPOS Health India 14 Walayat Ali District Coordinator EPOS Health India 15 Mohd Shafeeq District Coordinator EPOS Health India 16 Rajan Mahajan Regional Head – North India EPOS Health India 17 Sanjeev Arora State Coordinator EPOS Health India
The orientation of DPT, facilitated by EPOS Health India, was held on 30 th May 2007. This enabled the DPT members to not only understand NRHM approach, key components and strategies of NRHM, but also manage the planning process and develop the District Action Plan. The DPT met a number of times and the individual members reviewed the situation of their respective sectors/areas and collectively developed the strategic vision for improving the health status of the district population. We the members of the DPT on behalf of the entire Core Group reiterate and certify that this District Action Plan has been prepared through participatory processes. It has been prepared by integrating the Block Action Plans, Health Facility Surveys and Village Health Plans of the District. This plan also incorporates the facility improvement needs of 152 Sub health centres, 27 PHCs, 4 CHCs & 1 District in the District.
Name of Chief Medical Officer Signature Date
5 CONTENTS
PREFACE...... 4 Executive Summary ...... 7 ABBREVIATIONS ...... 9 Introduction ...... 10 Mission Statement ...... 10 Priority Matrix of District Jammu: ...... 11 1. SITUATION ANALYSIS ...... 17 Socio Economic and Health Indicators ...... 32 Socio-economic indicators ...... 32 2. PLANNING PROCESS ...... 65 3. PRIORITIES AS PER BACKGROUND AND PLANNING PROCESS ...... 70 4. GOALS ...... 72 5. TECHNICAL COMPONENTS ...... 74 Part A : Reproductive and Child healthII……………………………………………………74 Part B: NRHM Initiatives…………………………………………………………………..107 Part C: Immunization ……………………………………………………………………...125 Part D : National Disease Control Program ……………………………………………….130 6: Inter-Sectoral Convergence ...... 151 7. COMMUNITY ACTION PLAN ...... 162 8. Public Private Partnerships...... 164 9. GENDER AND EQUITY ...... 167 11. HUMAN RESOURCE PLAN...... 177 12. PROCUREMENT AND LOGISTICS ...... 180 13. DEMAND GENERATION - IEC ...... 182 14. FINANCING OF HEALTH CARE ...... 187 15. HMIS, MONITORING AND EVALUATION ...... 189 Annexure: ...... 216
6 Executive Summary Kathua district comprises of large unserved and underserved areas due to difficult hilly terrain. Hence there has been very little development including lack of health facilities, poor transport network and communication. Although the number of CHCs and PHCs is adequate as per the population norms there is a need to increase their numbers of CHCs, PHCs and Subcentres considering the difficult terrain of Subcentres. Not even one of the facilities is as per the IPHS standards. There is a huge population of Scheduled castes and scheduled tribes are one thirds of the total population and need to be addressed. 70 most difficult villages especially in blocks Bani, Bilawar and Basohli have been identified for which special outreach sessions are required.
The health status of district Rajouri is very poor since the district ranks 322 out of 593 districts in the country in terms of RCH indicators especially the CPR for which the district is 358 in rank. The data collection and analysis needs strengthening. Regarding the HR status there are huge vacancies especially of some critical posts like ANMs, MOs, Staff Nurses.
The District Action Plan was developed in a participatory manner with EPOS as a facilitator. There was wide participation from all the related departments. A District Planning Team was constituted who carried out the block consultations and the Subcentre level consultations. Facility Survey was carried out for each facility. The consultations focussed on each of the thematic areas with the present situation, the bottlenecks, strategies and how to achieve the goals. The hot spots were identified from the village plans and the Block plans after incorporating the Facility survey reports, were consolidated to form the district plan. These were approved by the District Health society and the District Action Plan was finalized after incorporation of the DHS suggestions.
The District Action Plan comprises of the situational analysis, goals and objectives for each of the defined indicators, strategies, activities, support required from the state, work-plan and the budget for each of the thematic areas. All the aspects of health have been incorporated including the NRHM additionalities of ASHA, Untied funds, Mobile Medical Unit, Facilities as per IPHS norms, the National Disease control programmes, and Intersectoral Coordination and Community involvement. Capacity building and Human Resources have been dealt with in details. The other Cross cutting issues of Gender, Logistics and Warehousing, HMIS, IEC and Biomedical Waste management have been also incorporated.
The priorities of the district include providing services for the unreached, accurate data collection, strong district management, developing facilities as per IPHS norms and thereby meeting the national goals of NRHM. The total budget for 5 years is Rs 28451.596 lakhs with an allocation of Rs 6212.821 Lakhs for the current year .
7 District Kathua NRHM BUDGET - AT- A GLANCE (in lakhs) S. 2007-08 2008-09 2009-10 2010-11 2011-12 Total No . Components A RCH-II 1 DHS 7.800 8.580 9.438 10.382 19.820 56.020 2 DPMU 370.110 265.711 293.250 323.359 356.327 1608.758 3 Maternal health 211.235 246.471 282.612 328.619 371.943 1440.880 4 Child Health 49.661 8.800 3.700 3.700 3.700 69.561 5 Family Welfare 95.023 91.515 119.101 151.566 202.090 659.293 6 Adolescent Health 65.130 67.018 75.512 82.067 90.815 380.542 7 Gender & Equity 98.100 91.310 100.439 110.359 121.358 521.566 8 Capacity Building 85.168 122.094 124.769 134.020 135.335 601.387 9 HR 1402.646 1568.041 1702.124 1792.803 1883.482 8349.096 10 IEC 309.894 340.883 374.972 412.469 1097.342 2535.560 11 HMIS 115.012 33.621 36.878 40.407 44.235 270.152 Total 2809.779 2844.045 3122.793 3389.751 4326.448 16492.815 B NRHM 1 ASHA 98.400 85.600 86.980 89.565 91.610 452.155 SC Untied Fund & 35.000 40.000 43.400 44.400 45.400 208.200 2 Maintenance PHC Untied Fund 29.250 29.250 29.250 29.250 29.250 146.250 3 & Maintenance CHC Untied Fund 7.500 9.000 10.500 12.000 13.500 52.500 4 & Maintenance 5 MMU 83.510 36.201 39.821 43.803 48.184 251.519 Upgradation of 6 CHCs 836.576 153.698 129.949 130.226 130.531 1380.980 Upgradation of 7 PHCs 840.828 1704.428 297.647 180.909 183.836 3207.648 Upgradation of 449.130 720.500 516.731 156.884 117.292 1960.537 8 SCs 9 VHWSC 74.350 75.600 76.450 76.700 76.950 380.050 Community Action 22.421 24.663 27.129 29.842 32.827 136.882 10 Plan 11 PPP 20.000 27.700 28.975 29.330 30.828 136.833 Health Care 49.880 46.218 47.315 48.421 49.538 241.372 12 Financing 13 Logistics 122.350 5.560 3.808 4.190 4.618 140.526 Bio-medical 14 Waste 18.340 20.174 22.196 24.413 26.831 111.955 Total 2687.535 2978.591 1360.152 899.933 881.195 8807.408 C Immunization 305.866 294.194 306.009 317.228 329.224 1552.522 D NDCP 1 RNTCP 30.69 27.875 30.6736 33.74596 37.112056 160.096616 2 Leprosy 2.48 2.48 2.48 2.48 2.48 12.4 3 Malaria 195.52 70.897 76.7637 82.29307 87.188377 512.662147 4 Vector Borne 7.37 8.107 8.9227 9.81397 10.798367 45.012037 5 Blindness Control 43.916 17.3126 19.04686 20.952546 23.0468006 124.2748066 6 IDSP 42.218 23.1768 28.90948 31.861428 35.0995708 161.2652788 7 IDD 5.935 6.5285 7.18135 7.899485 8.6894335 36.2337685 Total 328.129 156.3769 173.97769 189.046459 204.4146049 1051.944654 E Others 1 Inter-Sectoral 81.512 106.902 112.810 119.282 126.400 546.907 Grand total 6212.821 6380.109 5075.743 4915.241 5867.682 28451.596
8 ABBREVIATIONS ANC Ante natal Care ANM Auxiliary Nurse and Midwife ASHA Accredited Social Health Activist BPHC Block Primary Health Centre CBO Community Based Organizations CHC Community Health Centre CMO Chief Medical officer DoHFW Department of Health and Family Welfare DH Block Hospital ENMR Early Neo-natal Mortality Rate EmOC Emergency Obstetric Care EAP Externally Aided Projects FRU First Referral Unit HMIS Health Management Information System HIV Human immuno-deficiency syndrome IPHS Indian Public Health Standards ISM Indian System of Medicine IMNCI Integrated Management Neo-natal of Child Illness JSY Janani Suraksha Yojana IMR Infant Mortality Rate NMR Neo-natal Mortality Rate MTP Medical Termination of Pregnancy MMR Maternal Mortality Rate MNGO Mother NGO MO Medical Officer MH Maternal Health NNMR Neo-natal Mortality Rate NGO Non-Government Organization NRHM National Rural Health Mission NAMP National Anti Malaria Programme NLEP National Leprosy Eradication Programme NKAP National Kala-Azar Programme NFP National Filaria Programme NIDDP National Iodine Deficiency Disorder Programme NBCP National Blindness Control Programme OPD Out Patient Department PNMR Primary Neo-natal Mortality Rate PHC Primary Health Centre RH Rural Hospital RCH II Reproductive and child Health Programme-II RI Routine Immunization RNTCP Revised National Tuberculosis Control Programme SDH Sub-divisional Hospital SHSDP II State Health System Development Project-II SGH State General Hospitals SRHM State Rural Health Mission
9
Introduction
Jammu and Kashmir initially had 14 districts namely Kupwara, Baramulla, Srinagar, Budgam, Pulwama, Anantnag, Leh (Ladakh), Kargil, Doda, Udhampur, Poonch, Rajouri, Jammu and Kathua. But their number has now been increased to 22 by Government Order. The newly added districts in Jammu Division are: Ramban, Kishtwar, Samba & Reasi and in Kashmir Division are: Ganderbal, Shopian, Kulgam and Bandipora. These districts are in the process of boundary demarcation. Total population of the State was 1,00,69,917 in 2001. The decadal growth rate was 29.04 during 1991- 2001. Overall density of population in the State was 90 persons per square Kilometre. Sex ratio was 900 females per thousand males.
Mission Statement
The Mission of the department of Health and Family Welfare is to work in active partnership with the community to ensure health and well being of all its citizens.
Vision
The vision of the government of J & K is to achieve the goals and objectives envisaged in the NPP- th 2000, NHP-2002, and the 10 Plan and those under NRHM. We envision path breaking progress and development in healthcare delivery in all the districts in the state. We plan, making available the necessary health care for improving the primary health care services, secondary health care, specialised medical care through an integrated, focused and participatory programme.
Based on earlier lessons learnt from implementation of various health programmes and projects, the project incorporates certain changes such as adopting a uniform structure of the program; strong supervision and monitoring with advanced analytical tools; and greater inter-sectoral convergence at all levels.
The Road Map
The Road Map to achieve the aforesaid vision is that the State would strive for achieve various indicator in a rising trend mode , that is, in the earlier years (say FY 2007 and FY 2008) the objectives are to be achieved a bit slow initially but picking up in FY 2009 through to FY 2011. There is a need to schedule extension and up gradation of services over five years period keeping in view growth in population and absorptive capacity of the State in general and district in particular .
The support and resources made available through NRHM initiatives and through convergence would be utilised for the purpose.
In order to propel and sustain the desired progress, there is an urgent need to construct, upgrade and renovate health infrastructure and health facilities to make them fully functional. Consequently, more investment is needed upfront on creation of the necessary infrastructure, construction, civil works, renovation and maintenance. There is a need for increased investment in this respect in earlier years (say FY 2007 and FY 2008) in this respect.
Also, a lot of activities cannot materialise due to the shortage of human resources in the state health services. Thus, there is an urgent need to recruit professionals and support staff on a priority basis. In the short term, this may be achieved by filling vacancies on contract basis. However, to attract requisite staff, compensation needs to be based on reasonable calculations. It needs to be attractive enough for persons to join and continue.
10
Priority Matrix of District Jammu:
S.No Thematic Area Critical Issues of the District Specific Priorities 1. District Health Functional integration of Societies need functional integration Management: vertical societies like and strengthening. Blindness Control Society, Capacity building of the DHS TB Control Society, District members regarding the programme, Malaria Society etc. their roles, various schemes and mechanisms for monitoring and Monitoring and evaluation. regular reviews and also operational guidelines for running the District Health Society. Monitoring of health activities by health personnel only. Members from other departments and also from the elected representatives need to become members for better monitoring and implementation. Strengthening the functioning of the DHS. 2. District & Block Need for providing more Development of total clarity at the Programme technical support to the district and the block levels amongst Management CMO office for better all the officials and Consultants about implementation especially NRHM activities in light of the increased Training of district officials and Block volume of work in NRHM. SMOs for programme management Strengthening the Streamlining Financial management monitoring and reporting and systems especially in the areas of Strengthening the CMO office with Maternal and Child Health, DPMU with extra computers, Civil works, Behaviour telephone system and human change and accounting resources. right from the level of the Capacity building of the DPMU Subcentre. personnel for monitoring Strengthening the Block Management Units by establishing
11 BPMUs. 3. Reducing Lack of 24X7 facilities for Increase coverage of full ANC and maternal and safe deliveries in Postpartum Care to pregnant women child deaths subcentres and PHCs. Increase in Institutional deliveries by and Population Lack of authentic data operationalsing 24X7 PHCs stabilization regarding the maternal and Strengthen FRUs for Emergency infant deaths in the district. Obstetric Care services along with Equipments are not minimum basic infrastructure, Blood working properly or not Storage facilities, Facilities for available as per the need in Neonatal Care, drugs and subcentres, PHCs & CHCs equipments. to provide quality services. Increase availability of safe abortion Lack of facilities with for services at all block level CHCs/ emergency obstetric care. PHCs. Non-availability of Increased coverage under JSY Specialists for an Strengthening the Village Health Day aesthesia, obstetric care, To increase awareness among paediatric etc. mothers and communities about the Lack of referral transport importance of institutional deliveries systems. Improved behaviour practices in the Lack of Blood Storage community facilities at FRUs Operationalization of all the Lack of Neonatal care sanctioned Anganwadis facilities at FRUs 4. Family Planning Low level of FP acceptance Increased awareness for Emergency due to lack of awareness or Contraception and 10 yr Copper T motivation and low male Decreasing the Unmet Need for participation Family Planning Ensure availability of all FP methods at block level facilities. Train more MOs for NSV and promote the same. Partner with private doctors for FP and RCH services Increasing Access to Emergency Contraception and spacing methods through Social marketing
12 Building alliances with other departments, PRIs, Private sector providers and NGOs 5. Adolescent Adolescents especially the Implement ASRH programme to Health boys are exposed to increase the knowledge levels of smoking, addictions, peer Adolescents on RH and Life skills pressure and there is no Implement of Kishori Shakti Yojana one to counsel them. in coordination with ICDS and NGOs. Teenage pregnancies also Operationalise Adolescent Friendly emerging as a problem and Health services at the health facilities unsafe abortion & premarital sex trend are on rise.
6. Mobile Medical Remote population is not Coverage of the tribal populations Units (MMUs) covered due to lack of which are migratory in blocks. required staff, Provide one-MMU equipped with infrastructure. GPRS for services. Communications system is Contract MOs and staff nurses for poor. MMUs 7. Upgrading None of the CHCs are as Following CHCs needs to be upgraded CHCs to IPHS per the IPHS standards but as per IPHS Standards in the first year:- condition of CHC Bani and CHC Hiranagar CHC Basoli is deplorable CHC Bilawar needs to be upgraded. The other 3 CHCs also need to be brought to IPHS standards 8. Upgrading None of the PHCs are as Construction of 16 buildings PHC PHCs for 24 hr per the IPHS standards. buildings as per IPHS standards. Services and Out of 39 PHCs and Names of PHCs are enclosed as IPHS standards Allopathic Dispensaries, 26 Annexure-1 PHCs are housed in Construction of staff quarters in 11 government buildings and govt. PHC (Names of PHCs given 13 are still functioning from in Annexure – 1) rented accommodation with out sufficient facilities.
13 9. Upgrading Sub None of the Subcentres are Need to construct 91 Subcentre Centres to as per he norms of IPHS buildings ( Names of SCs are IPHS standards Out of 152 subcentres, 91 enclosed as Annexure-2) subcentres are running in Construction of staff quarters in all rented buildings and 61 subcentres for ANM’s stay. (Names subcentres are running of subcentres given in Annexure) from government owned Construction of Labour rooms at all buildings. Subcentres for promoting institutional There are no labour rooms deliveries in any of the Subcentres for Institutional deliveries The numbers of Subcentres is also inadequate 10. Immunisation Lack of awareness to Strengthening the District Family mothers Welfare Office Alternate vaccine delivery Enhancing the coverage of Lack of Cold storage Immunization Efficient monitoring and Alternative Vaccine delivery supervision mechanisms in place Gaps in difficult, flung Effective Cold Chain Maintenance areas & inaccessible areas upto sub centre level Reporting and Zero Polio cases and quality documentation surveillance for Polio cases Large number of cold chain Close Monitoring and documentation equipment are not of the progress functional and need repair Repair and replacement of cold chain or need to be replaced equipment as per the need 11. Inter Sectoral Lack of coordination b/w ICDS Linkages to be developed between ICDS Convergence and health department workers and health workers for timely diagnosis of malnourished children and their management (detailed activities under thematic heads)
14 Lack of coordination b/w RDD Linkages to be developed between the and health department Health Department and the Rural Development department • Improving the health standard & general quality of life of rural community. • Awareness on sanitation/ Hygiene & health education. • Covering of school/ Anganwari in rural areas with sanitation facilities & promote Hygiene education & sanitary habits among students. • Promote & encourage cost effective construction of household latrine & their proper use. • Elimination of open defection to minimise the risk of contamination of water source & food. Lack of coordination b/w PHE • Bleaching powder and chlorine and health department tablets will be provided by PHE and distributed by field functionaries to households • Joint communication strategy. • Copy of water quality monitoring reports generated by IPH department will be shared with the Health Department at block, district and state levels • Community based organisations formed under various programmes/sectors will be engaged by a team of frontline workers – health, ICDS and PHE departments. 12. Human Lack of manpower at all levels • All staff to be in place as IPHS norms Resource starting from sub centres to by 2012 PHCs to CHCs to DH in district • Increased salaries for contractual Kathua
15 doctors and Specialists Sub centre level • Special allowances for Regular staff • The number of sub centres • Increase in the number of training will have to be increased centres for LHV, ANM, Staff Nurses, from 152 to 227 Lab Technicians • The requirement of ASHAs • Rational placement of Specialists will be around 680 and trained staff • The requirement of ANM • Recruitment of staff on contract will be around 304 in where vacancies Government as per IPHS • Recruitment of staff for new facilities norms of 2 ANMs per Sub as per the infrastructure centre. requirements PHC level • Computers at all PHC and for each • The PHC are adequate MO and Specialist at the CHC • As per IPHS 2 MOs per • Allowing Specialists and MOs for PHC will be required developing special skills as per their whereas at resent there is needs by attending special courses only one MO per PHC anywhere in India. CHC Level Likewise there are many vacancies of specialists and support manpower at CHCs
16
1. SITUATION ANALYSIS
Profile of the District Kathua District is situated at 32 0 17' to 32 0 55’ North Latitude and 75 0 70' to 76 0 16’ East longitude. The District is surrounded by Punjab in the South-East, Himachal Pradesh in North-East, District Doda and Udhampur in North and North-West, Jammu in the West and Pakistan in the South-West. It has an area of 2651 Sq kms. The district can be conveniently divided into three distinct Agro-climatic regions. The area falling South of Pathankote-Jammu-Srinagar National Highway consists of deep alluvial soils. The area is mostly irrigated and quite productive. This area touches Pakistan and Punjab border and it is also popularly called Border Area. The second zone falling north of the National Highway extends upto foothills of Himalayas and falling mostly in Shivalik ranges is called Kandi area. It is characterized by shallow soils full of boulders with negligible natural water resources. The area faces acute shortage of water and the productivity of the land is very marginal. Part of Kathua, Barnoti, Hiranagar, Ghagwal, Basohli and Billawar block falls in this category. The third area falls beyond Shivalik ranges and extends upto to Peer Panjal ranges. This area is mountainous in nature with little potential for agriculture.
The district has a reporting area of 2.65 lakhs Hectare as per revenue records out of which 0.45 lakhs Hectare is agricultural use, 0.36 lakhs Hectare constitutes barren and uncultivable land excluding follow land, 0.12 lakhs Hectare accounts for culturable waste, 0.13 lakhs Hectare is under misc. trees, 0.10 lakhs Hectare forms permanent pastures, 0.01 lakhs Hectare is fallow land other than current fallows, 0.14 lakhs is the area under current fallows and 0.61 Hectare is net area sown. According to the agricultural census of 1991-92, the district had 69508 number of land holding of different sizes. Out of these 60.15% were of below one Hectare and only 39.85% were of the sizes of one Hectare and above which indicates that large number of land holding are very small.
Though there is no detailed and fully documented history of Kathua district. It is believed that Jodh Singh a famous Rajput of Andotra clan migrated from HASTINAPUR to KATHUA nearly 2000 years ago and settled here. The three Hamlets of Taraf Tajwal, Taraf Manjali and Taraf Bhajwal were established by his three sons Viz. Teju, Kindal and Bhaju. Their descendent are now called as Tajwalia, Bhajwalia and Khanwalia Rajputs of Andotra sub-caste. The conglomeration of these three hamlets was loosely called “KATHAI” in earlier times which with the passage of time came to be called as KATHUA.
Greek historians, who provide an insight into the ancient history of JAMMU HILLS prominently, record the existence of two powerful empires of Abhisara (Present day POONCH) and KATHAIOI at
17 the time of invasion of India by ALEXANDERA, Strabo describes KATHAIOI as a mighty republic of that era located in the foot hills along river RAVI. The topography of KATHAIOI corresponds with the present day KATHUA. Starbo describes the people of the republic as epitone of bravery and courage and records that they gave a tough fight to invading Army of ALEXANDERA.
Kathua District is broadly comprises three distinct zones Viz. Border, Kandi and Hilly. Billawar, Bani, Basohli and Lohai –Malhar Blocks of the district comes under HILLY Area, The culture of this area is PAHARI which resembles the culture of Himachal Pradesh. The other part of the district has DOGRA Culture.
Dogri is the main language spoken by the people of the district. Though the Dogri spoken in some parts of the district has the influence of Punjabi tone also but the rural areas specially the Hilly areas are free from Punjabi. Their other main language is Pahari. However a very small section of the Population residing in Lohai-Malhar and BANI Blocks also speaks Kashmiri. GOJRI is also spoken by the Gujjar Community settled here and there. Hindi, English and Urdu are the main medium of education. Official language is Urdu. The district is culturally an integrated part of Jammu region and all important religious fairs like Lohri, Maha Shivratri, Id-ul-Fitr, Holi, Ramnavmi, Baisakhi, Basantpanchami, Martyr’s day of Guru Arjun Dev, Raksha Bandhan, Janam Ashtami, Mahanavami, Dussehra, Diwali, id-ul-zuha, Guru Ravi Dass’s b’day, Mahatma Gandhi’s b’day Guru Govind Singh’s b’day, Chacha Nehru’s birthday. Above all, the Independence Day and Republic Day are celebrated with great enthusiasm. Holy Navratras also provide special occasion for worship and pilgrimage to holy places culminating into small to big fairs. Ram Lilas are organized in every town as well as in every village of the district. The most famous Ram Lila is performed in BASOHLI.
The most important Minerals in the district are Cement Grade Lime Stone in Basohli area. Low Grade Iron deposits in Lohai-Malhar block, Gypsum deposits in village Daulla in Basohli tehsil and Slates in Duggan nallah and near Sewa Nallah in Bani block. Another mineral found near siare in Bani block is Quartzide used in glass making. Bentonite is available in Surrara area of Hiranagar tehsil. Fullersearth, useful in drugs, cement and plaster is also available in the district. Alum exists in Serai nallah near Ramkote and Ujh River. Clay of various colours and varieties is also found at many places. Kathua District is spread over an area of 2651 Sq. Kms constituting 1.9 percent of the total area of the State. The District has a population of over 5,44,206 comprising 2,85,308 Males and 2,58,898 females as per 2001 census. The density of population of the district has gone upto 205 persons per Square Km. Sex ratio is 907 females per 1000 male. Literacy Rate in Kathua district is 65.29%. The literacy percentage in case of Males is 75.73% and in case of Females is 53.92%. As regards
18 the main ethnic groups, Hindus constitutes 91% of the district while Muslims form 7% and Sikhs 2 %. SC Population is 22.83%.
Out of total population of the district, 28.82% were main workers, 14.58% marginal workers while as 56.60% were non-workers. However among the main workers, cultivators and agricultural labourers accounted for 60.74% and 5.67 % respectively which obviously indicates that dependence on agricultural is of much more significance than any other sector/ occupation.
In district Kathua, there are 152 subcentres, 39 PHCs, 4 functional CHCs and one district hospital
As perAs IIPS, per IIPS, the districtthe district Kathua Kathua ranks ranks 322 322 out out of of 559393 districts in in the the country country in the in theRCH RCH INDICATORS,indicators, 279279 onon thethe basisbasis ofof Women women havinghaving threethree oror more more children, children, 358 358 on on the the CPR, CPR, 279 279 on the Basison ofthe under Basis 5 of mortality Under 5and mortality 358 on and the 358 basis on of the 3 orba moresis of ANC3 or more visits. ANC visits.
19 Distinguishing features There are certain features in respect of J and K State in general, and Kathua district in particular, which have affected the availability and reliability of data. Some of the useful features of the district are as under.
Parts of the districts are hilly. In certain CD Blocks most of the portion is inaccessible and hilly. Further, forest covers good proportion of the area of the districts. Consequently, depending upon topography, all the districts consist of difficult and inaccessible areas. While it is difficult for the people to access services, on one hand, on the other, it is also difficult for health services to extend, upgrade and improve services. It is difficult to organise outreach activities and maintain regular supplies, especially in the context of essential medicines, vaccines, etc.
Due to the lack of amenities, it is very difficult to attract and retain human resources. There are significant number of vacancies in respect of various professional (specialists, surgeons, GDMOs), nursing, technical and support staff. This necessitates development of human resources policies and strategies appropriate to the region. In this connection modes like PPP and contracting may be used but after proper elaboration of the terms and conditions and payment system
There seems to be different administrative units prevalent in respect of different agencies (Census, Revenue Department, Medical and Health, etc.). The Medical and Health department has Medical Blocks. There are Tehsils, Community Development Blocks, Medical Blocks, Panchayats, Patwar Halqas, Gram Sabha and Villages. The units, which are conventional and are adopted by Agencies like Census and Rural Development Department may be taken as popular units than inventing or adopting different administrative units (for example Medical Blocks). It is some time difficult to reconcile geographical areas covered by them, which renders it impossible to compare data emanating from different units.
Even at the lowest level, the concept of village is a bit misleading. Excepting some, most of the villages do comprise a number of settlements with different names than the overall village; commonly known as ‘Modas’. Usually it takes considerable time to travel from one settlement to another, especially in hilly areas. This aspect is particularly important, inter alia, when we chose Anganwadi Worker or ASHA or conduct immunisation sessions.
20 As motorable roads do not connect all settlements, travelling on foot and local modes of transport becomes necessary. At some hilly and inaccessible places, mules are resorted to for transportation of supplies as well as ill or incapacitated persons. Consequently while tackling about the issues of accessibility (from the side of community) as well outreach and ensuring timely supplies (on the part of Health Department and other agencies), these factors need to be taken into account and provided for in the future plans.
Administrative Structure: Structure Details Sub Divisions ( 3) Basohli, Bani, Lohai-Malhar Tehsils ( 4) Kathua, Hiranagar, Billawar, Basohli 1. Bani 2. Barnoti 3. Basohli Community Development and NES Blocks ( 9 ) 4. Billawar 5. Duggan 6. Ghagwal 7. Hiranagar 8. Kathua 9.Lohai-Malhar Health department Blocks (5) Hiranagar, Billawar, Basholi, Bani, Parole 1. Kathua 2. Barnoti 3. Marheen 4. Sallan 5. Hiranagar 6. Ghagwal Educational Zones (13) 7. Lakhanpur 8. Basohli 9. Billawar 10. Bani 11. Lohai- Malhar 12. Mahanpur 13. Bhaddu Municipal Council (1) Kathua Municipalities 1. Lakhanpur, 2. Parole 3. Hiranagar 4. Basohli 5. Billawar No. of CHC 4 No. of PHC 39 No. of Sub-Centres 152
Panchayati Raj Institution: 3 Tier Setup
Total Villages : 588 Village Level : Panchayat Total Gram Panchayats : 183 Block Level : Panchayat Samiti District Level : Zila Parishad
21 Number of villages by Blocks 2001 Blocks Number of villages / Panchayats by Blocks No. of Panchayats Inhabited Uninhabited Total Kathua 22 101 3 104 Barnoti 31 131 6 137 Hiranagar 24 106 5 111 Ghagwal 18 77 4 81 Basohli 24 43 0 43 Bani 10 20 -- 20 Billawar 32 49 -- 49 Lohai - Malhar 14 16 -- 16 Duggan 8 13 1 14 Total 183 556 19 575 Source: District Statistical Handbook Kathua
Medical Administrative Sectors Block No of Names of Sectors Sectors 1 Parole 9 Barwal,Budhi,Lakhanpur,Dhanni,Kharote,Basantpur,Ghati,Float,Parole 2 Hiranagar 8 Rattanpur, Ghagwal, Sanoora, Hariachak, Dinga Amb, Marheen, Bhaiya, Chakra 3 Billawar 12 Badnota, Hakwal, Sukral, Kohag, Malhar, Uchapind, Goduflal, Ramkote, Marhhedi , Bhaddu, Lohai, Banjal Bhadwal 4 Basoli 7 Saranghat,Mahanpur,Plassi,Karanwara,Sandhar, Bhoond,Hutt 5 Bani 3 Kati Chandyar, Dhaggar, Sandroon Total 39 Source: CMO Office
Educational Institutions NAME Units No. of Degree Colleges 1 (Kathua) No. of High/ Hr Sec. Schools 91 No. of Middle Schools 229 No. of Primary Schools 682 No. of ITI Colleges 5 No. of Police Training School 1 (Kathua) No. of DIET Institutes 1 (Basohli) Source: District Website
22
NAME REF.YEAR MAGNITUDE Total Population 2001 Census 5,44,206 Male Population 2001 Census 2,85,308 Female Population 2001 Census 2,58,898 Rural Population 2001 Census 4,66,870 Urban Population 2001 Census 77,336 SC Population 1981 Census 0.84 Sex Ratio 2001 Census 907 Females per 1000 Males Literacy 2001 Census 65.29 % Male Literacy 2001 Census 75.73 % Female Literacy 2001 Census 53.92 % No. of House Holds 1981 Census 0.61 Occupied Residential 1981 Census 0.58 Source: District Website
Status of ICDS Programme as on 13.4.07 Block No of AWCs Sanctioned Operational Reporting Kathua 203 202 202 Hiranagar 145 145 145 Billawar 214 214 214 Basohli 130 127 127 Bani 76 76 76 Barnoti 191 191 191 Ghagwal 115 115 115 Lohi Malhar 72 72 72 Duggan 44 44 44 Total 1190 1186 1186 Source: Director Social Welfare Jammu Tehsil wise population of district Kathua as per 2001 census Tehsil Males Females Total Basohli 49355 45431 94786 Billawar 61665 57000 118665 Hiranagar 80124 74156 154280 Kathua 94164 82311 176475 Total 285308 258898 544206 Source: District Website
23 Population as per Census 1961 1971 1981 2001 Persons Male Female Persons Male Female Persons Male Female Persons Male Female Total 207430 108899 98531 274671 142989 131682 369123 192570 176553 550084 289391 160693 Rural 191895 100598 91297 249586 129843 119743 327133 170406 156727 471356 246478 124878 Urban 15535 8301 7234 25085 13146 11939 41990 22164 19826 78728 42913 35815 Source: Census. (1991 census not carried out only estimates available)
Population Growth Decade Decadal Growth Of Population Percentage Kathua District Jammu & Kashmir 1901-11 1.60 7.16 1911-21 1.59 5.75 1921-31 4.64 10.14 1931-41 0.27 10.36 1941-51 8.40 10.42 1951-61 7.75 9.44 1961-71 30.29 29.65 1971-81 34.39 29.69 1981-91 21.94 30.34 1991-2001 22.21 29.98 Source: Census Deptt
Population by Religions - 1981-2001
Pop. Muslim Hindu Sikh Budhist Christian Others Total Scheduled Caste 1981 25699 336503 6082 15 820 4 369123 84308 2001 44793 493966 9152 138 1458 577 550084 127364 Source: Directorate of Economics & Statistics
No. of births & deaths Mid year Year Births Deaths Population Birth rate Death rate Natural Growth rate 2005 16788 829 575126 29.19 4.092 24027 Source: Directorate of Economics & Statistics
24 Month Wise Position Of Births & Deaths Recorded By The Registration Units During January 2006 To December 2006 No. of Registration Units 22 BIRTHS Month Jan Feb March April May June July Aug Sep Oct Nov Dec Total Total 1189 953 249 554 791 735 810 1085 948 782 949 960 10005 Deaths Month Jan Feb March April May June July Aug Sep Oct Nov Dec Total Total 228 157 27 62 153 195 294 226 138 157 182 219 2038 Source: Birth & Death Registration
Identifying Information
Name of District Kathua Name of District Headquarters Kathua No. of Blocks in the District 9 No. of Gram Panchayats in the District 183 No. of Villages 587 No of Uninhabited villages 32 No. of Households 96393 1-199 105 200-499 163 500-999 110 1000-1499 78 Size of Villages 1500-1999 46 2000 – 3000 39 3001-5000 13 5000+ 2 Villages without motorable roads 97 Villages without electricity 37 Villages given Potable drinking water 555 No. of Towns 6 Municipal
Corporation Municipality 1 Urban Local Bodies (ULB) Notified Area
Committee Others
25 Un-served / underserved / vulnerable areas, population in the District
There are a large number of Underserved populations and areas in the district Kathua. The Total Population of Scheduled Caste is 127364 (23.2%) and is mainly in Blocks Kathua and Hiranagar. The total ST population is 34174 (6.2%) with predominance in the block of Basholi. The tribes are mainly Bakarwal and Dhodhi Gujjars. These are comprised of Nomadic tribes and are mainly involved in livestock. During winters they migrate to the low lying areas for grazing of animals The total no. of BPL families in district are 28064 and is distributed in all the blocks.
Year No. of BPLFamilies Surveyed Identified Below Poverty line Selected for Uplifting During Year 2005-06 72032 28064 292 Source: District Statistical Handbook Kathua
The National Highway 1A passes through the district Kathua hence giving rise to accidents.
In the rainy season large number of areas get affected by floods causing Jaundice, skin problems, allergies, waterborne diseases and injuries:
Tarnah nala, a stretch having 22 KM Arial distance is vulnerable for seasonal floods. A sizeable population get adversely affected by floods every year. The nearest Allopathic dispensary is AD Chakrah. The team of Medical officer along with one pharmacist caters to the medical needs of affected population to the extent possible. The team does not have any govt. vehicle to provide services in the area during flood.
The surrounding area near PHC Haria Chak is often affected by seasonal floods in rivulet known as Bhag Nala.
In Gaghwal and PHC Rattanpur area another rivulet i.e. Behinala affects the local area with flood. This area also touches the international boarder with Pakistan. Normally the above mentioned areas get afflicted in Period of June to August. The department of Health constitutes a mobile team and normally govt. buildings are used for transit camps. But this is very inadequate.
Brick line sites/ construction labour/ Crasher/ Rice mills are another source of concern. Many small and medium industries are operational leading to huge populations of migrant labour. The
26 air pollutants released by these units leads to respiratory disorder (Asthma, ARI etc) among the community living nearby. Due to inadequate health facilities for the labour working at these sites there is a huge problem of RTIs/ STDs, Tuberculosis. Last year there was a large number of children afflicted with Measles migrant labour.
Pilgrimage sites are also cause of concern in relation with health of the pilgrims especially hygienic food, water and sanitation. In general pilgrimage takes place round the year but heavy influx of pilgrims is there from June to August. Three prominent sites have been identified where the food is served free of cost to pilgrims. These are Shanrodyan, Mela mode, Nonath Ashram. For tackling the health issues in the pilgrimage sites the Health department constitutes a team of three pharmacists to cater to the health needs of the pilgrims .
Scattered population in district Kathua: The hilly areas in Bani, Basholi, Kandi (Karote) & along the Indo Border have scattered population and these areas are not easily accessible.
Block-wise Data on Population Total Numb Popul Total Male Female er of ation Femal Sex Populati Populat Populat Sex House 06 Male 06 e 06 ratio 06 Literac Block on ion ion ratio hold Years Years Years Years y Rate Billawar Total 118444 61254 57190 934 19486 19366 10216 9150 896 55.9 Billawar Rural 113804 58747 55057 937 18596 18783 9881 8902 901 55 Billawar Urban 4640 2507 2133 851 890 583 335 248 740 76.3
Basohli Total 94921 49519 45402 917 15532 16329 8575 7754 904 52.1 Basohli Rural 88976 46310 42666 921 14407 15618 8192 7426 906 49.7 Basohli Urban 5945 3209 2736 853 1125 711 383 328 856 86.2
Kathua Block Total 181852 97876 83976 858 32688 24425 13369 11056 827 71.5 Kathua Block Rural 122146 65663 56483 860 21533 17411 9477 7934 837 67.6 Kathua Block Urban 59706 32213 27493 853 11155 7014 3892 3122 802 79.3
Hiranagar Total 154867 80742 74125 918 28687 21182 12008 9174 764 73.6 Hiranagar Rural 146430 75758 70672 933 27222 20253 11475 8778 765 73 Hiranagar Urban 8437 4984 3453 693 1465 929 533 396 743 83.6
Kathua Total 550084 289391 260693 901 96393 81302 44168 37134 841 65.6 Kathua Rural 471356 246478 224878 912 81758 72065 39025 33040 847 63 Kathua Urban 78728 42913 35815 835 14635 9237 5143 4094 796 80.1 Source: Census of India 2001
27
Block-wise Data on SC & ST Population SC Population ST Population Sex Perce Sex Perce Block Total Male Female ratio ntage Total Male Female ratio ntage Billawar Total 24575 12681 11894 938 20.7 8978 4652 4326 930 7.6 Billawar Rural 23649 12193 11456 940 20.8 8868 4589 4279 932 7.8 Billawar Urban 926 488 438 898 20 110 63 47 746 2.4
Basohli Total 14710 7653 7057 922 15.5 14098 7304 6794 930 14.9 Basohli Rural 13871 7200 6671 927 15.6 14097 7303 6794 930 15.8 Basohli Urban 839 453 587 852 14.1 1 1 0 0 0
Kathua Block Total 51231 27214 24017 883 28.2 8526 4528 3998 883 4.7 Kathua Block Rural 36557 19453 17104 879 29.9 7812 4085 3727 912 6.4 Kathua Block Urban 14674 7761 6913 891 24.6 714 443 271 612 1.2
Hiranagar Total 36848 19333 17515 906 23.8 2572 1285 1287 1002 1.7 Hiranagar Rural 35447 18589 16858 907 24.2 2537 1266 1271 1004 1.7 Hiranagar Urban 1401 744 657 883 16.6 35 19 16 842 0.4
Kathua Total 127364 66881 60483 904 23.2 34174 17769 16405 923 6.2 Kathua Rural 109524 57435 52089 907 23.2 33314 17243 16071 932 7.1 Kathua Urban 17840 9446 8394 889 22.7 860 526 334 635 1.1 Source: Census of India 2001
28 Literacy Rate Sub-districts Area Literates Literacy rate Persons Males Females Persons Males Females Billawar Total 55,400 35,107 20,293 55.9 68.8 42.2 Rural 52,303 33,228 19,075 55.0 68.0 41.3 Urban 3,097 1,879 1,218 76.3 86.5 64.6 Basholi Total 40,983 27,126 13,857 52.1 66.3 36.8 Rural 36,471 24,516 11,955 49.7 64.3 33.9 Urban 4,512 2,610 1,902 86.2 92.4 79.0 Kathua Total 112,569 66,645 45,924 71.5 78.9 63.0 Rural 70,765 42,585 28,180 67.6 75.8 58.0 Urban 41,804 24,060 17,744 79.3 85.0 72.8 Hiranagar Total 98,418 56,776 41,642 73.6 82.6 64.1 Rural 92,138 52,723 39,415 73.0 82.0 63.7 Urban 6,280 4,053 2,227 83.6 91.1 72.8 District Kathua Total 307,370 185,654 121,716 65.6 75.7 54.4 Rural 251,677 153,052 98,625 63.0 73.8 51.4 Urban 55,693 32,602 23,091 80.1 86.3 72.8 Source: Census of India 2001
Development Indicators of the District SN Indicators State District as per District data 1 Crude Birth Rate 18.7 SRS -05 29.19 (Dir of Eco & Stat 2005) 2 Crude Death Rate 5.6 SRS -05 4.092(Dir of Eco & Stat 2005) 3 Infant Mortality Rate 49.0 SRS -05 50 (DLHS) 5 TFR 2.4 NFHS III 3.1(IIPS) 6 Couple Protection Rate 53 % NFHS III 45.6% ( DLHS-II) 7 Decadal Growth Rate 29.93 29.98 Census 2001 8 Population Density 99/ sq. km 207 Census 2001 9 Sex Ratio (General) 900 Census 2001 901 Census 2001 10 Sex Ratio (0 – 6 years) 937 Census 2001 841 Census 2001 11 Sex Ratio at birth DNA DNA 12 Literacy rate (overall) 54.46 Census 2001 65.29% Census 2001 13 Literacy rate (male) 65. 75 Census 2001 75.73% Census 2001 14 Literacy rate (female) 41.82 Census 2001 53.92% Census 2001 Enrolment of T 66841 15 students elementary M 37013 education F 29828 Source: Census, 2001; DLHS-RCH-II Survey, 2004, CMO office
29 District Kathua Composite Index for RCH based on Selected Variables Source: National Commission on Population 2001 Abbreviated Description and Source Value RCHI Reproductive and Child Health Status Index, Present Study 0.77 PBO3P Percent of Births of Order 3+ During 3 Years Prior to Survey, RHS-RCH 24.6 CWR Children 0-6 years to Women 6 and Above, Census 2001 363.91 CUAM Percent Couples Using Any Contraceptive Method, RHS-RCH Reports 63.70% PGMB18 Percent Girls Married Below Age 18 Years, RHS-RCH Reports 0 PPANC Percent Pregnancies During Last 3 Years Availing Antenatal Care, RHS-RCH 65.50% PDHI Percent Deliveries in Health Institutions During Last 3 Years, RHS-RCH 30.50% PCWCI Percent Children Completely Immunized, Aged 1+ & Born During Last 3 Yrs. 75.10% COMI Composite Index, Present Study 0.63 RCHR District’s rank as per RCH-status Indices (RCHI) in Ascending Order 370 COMR District’s rank as per composite indices (COMI) in Ascending Order 359
CBR and TFR District Kathua Indicator Religion Hindu Muslim CBR 24.9 22.9 32.3 TFR 3.1 2.8 4.3 Source: EPW Jan 29, 2005 Year TFR Percent 1& 2 births DLHS 2001 1981 5 1991 NA IIPS 2001 2.9 66% Source: IIPS DLHS-RCH-II Survey, 2004 Related to Pregnancy and Maternal Health Issue % Issue % Mean age at marriage for boys 27.4 Mean age at marriage for girls 22.5 Boys married below legal age at marriage 21 years 0.9 Girls married below legal age at marriage 18 yrs 3.0 Any antenatal check up 73.7 Antenatal check up at home 0.00 3 or more antenatal check ups 39.4 Who had one TT injection during pregnancy 19.8 Who had two or more TT injection during pregnancy 52.8 Who had no TT injection during pregnancy 17.7 Who received 100 or more IFA tablets during Who consumed two or more IFA tablets regularly pregnancy 7.6 during pregnancy 26.6 Received adequate IFA tablets/syrup 7.6 Who consumed one IFA tablet regularly 23.3 Full ANC1 - (At least 3 visits for ANC + at least one Safe Delivery (Either institutional delivery or home TT injection + 100 or more IFA tablets) 6.6 delivery attendant -Doctor/Nurse/TBA) 60.8 Full ANC2 - (At least 3 visits for ANC + at least one Safe Delivery (Either institutional delivery or home TT injection + 100 or more IFA tablets/syrup) 6.6 delivery attendant by Doctor/Nurse) 29.9 Institutional delivery 26.8 Home delivery 71
30 Institutional delivery - government 17.4 Women who had pregnancy complications 3.6 Institutional delivery – private 9.4 Women who had delivery complications 22.3 Women who had post delivery complications 5.4 Sought treatment for Pregnancy complications 76.1 Women visited by ANM/Health worker Sought treatment for Post delivery 0.00 complications 75.0 Women who satisfied with service/advice given Women who had said health worker spent by health worker NA enough time with them NA Women who utilized government health facility Women who utilized government health facility for treatment of pregnancy complications 100 for antenatal care 61.3 Women who had Menstruation related problems Women who utilized government health facility 5.0 for treatment of post delivery complications 79.3 Related to Family Planning Issue % Issue % Women aware of RTI/STI 0.6 Birth order 3+ 34.0 Women aware of HIV/AIDS 39.9 Unmet need for limiting-1 7.8 Knowledge of any modern family planning method 95.7 Unmet need for spacing-1 5.4 Knowledge of any modern spacing family planning method 54.0 Unmet need -total-1 13.2 Knowledge of all modern family planning methods 13.2 Unmet need -total-1 7.8 Knowledge of any traditional method 8.2 Unmet need for spacing-2 22.1 Current use of any family planning method 48.4 Unmet need -total-2 29.9 Current use of any modern family planning method 45.6 Unmet need -total-2 25.4 Current use of any traditional family planning method 2.8 Current use - Male sterilization 0.9 Current use - Female sterilization 30.6 Current use - PILLS 0.8 Current use - Male sterilization 0.8 Current use – CONDOM 12.5 Women had side effects due to use of female sterilization 17.3 Women had side effects due to Pills 0 Women had side effects due to use of IUD 15.9 Sought treatment abnormal vaginal discharge 80.3 Women who utilized government health facility for treatment of RTI/STI (vaginal discharge) 57.6 Women who had any symptom of RTI/STI 4.4 Related to Child Health Issue % Issue % Breastfeeding within 2 hours (children age below 36 Percentage of children age 12-35 months months) 9.7 received BCG 97.0 Percentage whose mother squeezed out the first breast Percentage of children age 12-35 months milk (children age below 36 months) 64.2 received DPT 3 44.3 Exclusive breastfeeding at least 4 months (children age Percentage of children age 12-35 months 4-12 months) 40.3 received Measles 85.6 Percentage of children age 12-35 months received Percentage of children age 12-35 months Polio 0 70.8 received Full Immunization 38.7 Percentage of children age 12-35 months received Percentage of children age 12-35 months not POLIO 3 47.7 received any vaccination 3.0 Awareness of diarrhoea 28.2 Knowledge of ORS 19.0
31 Who had diarrhoea (two weeks prior to survey) 1.1 Given ORS to children during Diarrhoea 10.6 Sought treatment for Diarrhoea 100 Aware of danger signs of Pneumonia 8.3 Who had Pneumonia (two weeks prior to survey) 26.0 Sought treatment for Pneumonia 98.4
Socio Economic and Health Indicators of the District
Name of Block
Name of Health Blocks Total for Nagri Hiranagar Billawar Basoli Bani DH District Parole Demographic indicators Total Population 1,78,802 1,74,904 1,28,504 64,444 44,300 - 6,23,388 Population of males 97,268 91,475 66,565 33,704 23,169 - 3,12,181 Population of females 81,534 83,429 61,939 30,740 21,131 - 2,78,773 Population of children in age group between 1 and 15,760 10,400 8,560 5,160 7,680 - 47,560 6 years % Scheduled Castes 29.45 20.8 22.7 15.6 15.4 - 23.15 % Scheduled Tribes 4.1 1.2 3.4 9.5 31.6 - 6.2 Number of Villages 185 366 132 50 33 588 Socio-economic indicators No. of <3 children benefiting from the ICDS 6346 4893 2777 955 2562 - 17,533 scheme No. of children aged 3 years and above benefiting 2979 1723 1670 1287 1935 - 9594 from the ICDS scheme No. of women who have benefited through the JSY 462 672 238 199 177 1748 Scheme till now Health Indicators No. of Tubectomy 408 408 371 241 86 124 1,638 conducted in the last reporting year No. of IUD insertions done 142 384 297 162 166 82 1,233 in the last reporting year No. of vasectomies done 0 8 3 33 40 2 86 in the last reporting year
32 Name of Block
Name of Health Blocks Total for Nagri Hiranagar Billawar Basoli Bani DH District Parole No. of pregnant women 5,627 1,181 2,258 516 271 1,640 11,493 (treated for anaemia) No. of pregnant women 1,687 6,551 3,093 2,205 1,322 2,006 16,864 registered for ANC during the last reporting year No. of pregnant women 1,613 4,775 2,353 1,952 624 1242 12,559 who received both TT1 and TT2 during pregnancy in the last reporting year No. of institutional 878 2,715 672 179 204 1,855 6,503 deliveries in the last reporting year No. of women operation of 0 88 110 85 33 212 528 MTPs in the last reporting year No. of RTI/STI cases 630 2,878 220 590 650 514 5,482 reported in the last reporting year No. of children given measles vaccine in the last reporting 2,317 4,430 3,401 2,134 1,069 261 13,612 year No. of outpatients (daily 423 385 547 952 193 150 2650 average) No. of inpatients (daily Nil 11 7 5 2 20 45 average) Prevalent 1. Diaharea Malaria Hyperten Diahar Skin Diseases sion ea allergy 2. Skin allergy Jaundice Diaharea Skin Diahar allergy ea 3. Snake bite Tuberculo Snake Jaundi Hypert sis bite ce ension NVBDCP No. of slides examined for malaria in last reporting 14,641 16,359 9,791 6,010 5,801 1,829 54,431 year
33 Name of Block
Name of Health Blocks Total for Nagri Hiranagar Billawar Basoli Bani DH District Parole No. of notified malaria 15 cases (last reporting year) 12 2 1 0 0 0
Health Institutions, Population Coverage Ratios and Health Functionaries in the District
Name of Block Total for Nagri Hiranagar Billawar Basoli Bani DH District Parole
Name of Health Blocks Health Institutions No. of Speciality Hospitals 0 0 No. Referral Hospitals 1 1 No. of CHC/BPHCs 0 1 1 1 1 4 No. of Blood Banks 0 1 1 No. of CHCs (IPHS Standards) 0 1 1 No. of Blood Storage Units 0 1 1 No. of PHCs in the Block 5 6 8 6 3 - 28 No. of MOs in Positions 9 8 10 5 0 4 No. of 24 hrs. PHCs 1 1 2 No. of MTP Centres 1 1 No. of Sub Health Centres 33 45 38 19 17 - 152 No. of ANMs in Position in - 115 SCs 28 42 29 6 10 No. of AYUSH Dispensaries 45 No. of Beds in Govt. 23 56 55 32 8 174 Institutions No. of Anganwadi Centres 394 260 214 129 192 - 1,189 No. of Govt. 1 1 Ultrasound Pvt. 2 Clinics Unregistered Population Coverage Population covered 1,78,802 1,74,904 1,28,504 64,444 44,300 - 6,23,388 No. of Sub-centres covering more than the current norm 2 0 1 0 0 - 3 (5000)
34 Name of Block Total for Nagri Hiranagar Billawar Basoli Bani DH District Parole
Name of Health Blocks Health Institutions Health Personnel & Support Staff No. of Govt. - 1 - 1 1 2 5 Obstetricians ------and Pvt. Gynaecologists No. of Govt. - 1 - 1 1 2 5 Gynaecologists Pvt. ------No. of Govt. - 1 - - 1 1 3 Paediatricians Pvt. ------Govt. - - 1 1 1 2 5 No. of Surgeons Pvt. - No. of Govt. - 1 1 - - 2 4 Anaesthetists Pvt. - No. of Govt. - - - - - 1 1 Orthopedician Pvt. ------Govt. 1 2 2 1 1 3 10 No. of Dentists Pvt. ------No. of Eye Govt. ------Surgeons Pvt. ------No. of Gen. Govt. - 1 1 - 1 2 5 Physicians Pvt. ------No. of Govt. - - - - - 1 1 Radiographers Pvt. ------No. of Public Health Nurses - - - - 1 - 1 No. of Staff Nurses 4 13 13 11 2 12 55 No. of LHVs 2 2 4 3 2 1 14 No. of Pharmacists 35 52 54 20 14 8 183 No. of Lab. Technicians 6 9 8 7 4 4 38 No. X Ray Technicians 3 6 4 4 2 3 22 No of Ophthalmic Assts. 1 2 1 1 1 1 7 No. Dental Mechanics/Hygienists ------No. of Male Health ------Supervisors No. of ANMs 42 55 48 27 20 5 197
35 Name of Block Total for Nagri Hiranagar Billawar Basoli Bani DH District Parole
Name of Health Blocks Health Institutions No. of AW Workers 393 260 214 199 120 - 1186 No. of UDCs 6 8 9 5 2 2 32 No. of LDCs 1 4 1 - - 1 7 No. of Computer/Statistical - 0 1 0 0 0 1 Assts. No. of Drivers 5 7 4 5 2 4 27 No. of ASHAs selected 148 208 137 84 53 - 630 No. of Trained Dais
Workforce Vacancy Position * Given below is the information about Workforce Vacancy Position in the District
Identified Gaps of Manpower
Name of Blocks Total Staff BANI No. No. 0f No. ofNo. BASOLI PAROLE Required BILLAWAR HIRANAGAR Existing Staff No. of Sub- Centres IPHS Norm 33 45 38 19 17 152 ANM 2 38 48 47 32 24 304 115 189 N0. Of PHC's 9 8 12 7 3 39 MO 2 9 8 14 9 6 78 32 46 Pharmacist 1 1 0 2 1 0 39 35 4 Nurse 3 20 18 28 18 9 117 24 93 Female Health Worker 1 2 0 3 1 2 39 31 8 Health Educator 1 8 8 11 7 3 39 2 37 Health Assistant 2 18 16 23 14 6 78 1 77 (one male, one Female) Clerks 2 16 12 24 14 6 78 6 72 LT 1 3 2 8 4 1 39 21 18 Driver _ Class lV 4 27 8 37 16 9 156 59 97 No. of CHCs IPHS Norm 0 1 1 1 1 4 A. CLINICAL MANPOWER 1 General Surgeon 1 0 0 1 0 4 3 1 2 Physician 1 0 0 1 0 4 3 1
36 Obstetrician / 3 1 0 4 3 1 Gynaecologist 0 0 1 4 Paediatrics 1 0 0 1 1 4 2 2 5 Anaesthetist 1 0 0 1 0 4 3 1 Public Health 6 Programme 1 1 4 0 4 Manager 1 1 1 7 Eye Surgeon 1 1 1 1 0 4 1 3 Other specialists (if 8 any) General duty 9 officers (Medical Officer) B. SUPPORT MANPOWER 1 Nursing Staff 7+2 Public Health a 1 1 3 Nurse 1 1 1 0 4 b ANM 1 -3 0 -7 0 4 14 -10 c. Staff Nurse 7 1 4 0 4 28 19 9 d. Nurse/Midwife 6 Dresser 1 1 1 1 1 4 0 4 Pharmacist / 7 1 15 -11 compounder -5 -2 -4 0 4 8 Lab. Technician 1 0 -4 1 0 4 7 -3 9 Radiographer 1 1 0 1 0 4 2 2 Ophthalmic 10 1 2 2 Assistant 0 0 1 1 4 Ward boys / 11 2 3 5 nursing orderly 1 2 2 0 8 12 Sweepers 3 -3 1 -1 0 12 15 -3 13 Chowkidar 1 1 0 1 1 4 7 3 14 OPD Attendant 1 1 0 1 0 4 6 2 Statistical Assistant 15 / Data entry 1 7 3 operator 1 0 1 1 4 16 OT Attendant 1 0 1 1 1 4 7 3 17 Registration Clerk 1 0 1 1 1 4 7 3 Any other staff 18 (specify) Note: ( - ) Surplus staff
37 DISTRICT HOSPITAL – MANPOWER GAPS IPHS Norm Current Identified Gaps S.No Personnel Recommended Availability 1 Hospital Superintendent 1 1 0 2 Medical Specialist 2 2 0 3 Surgery Specialists 2 1 1 4 O&G Specialist 2 2 0 5 Dermalogist/Venereologist 1 0 1 6 Paediatrician 2 1 1 7 Anesthetist 2 3 -1 8 Opthalmologist 1 0 1 9 Orthopedician 1 1 0 10 Radiologist 2 1 1 11 Casualty Doctor/General Duty Doctor 9 4 5 12 Dental Surgeon 1 1 0 13 Public Health Manager 1 0 1 14 Forensic Specialist 1 0 1 15 ENT Surgeon 1 1 0 16 Ayush Physician 2 0 2 17 Pathologist 1 0 1 Total 32 18 14 (B) Para Medical Staff 1 Staff Nurse 50 12 38 2 Attendant 1 0 1 3 Opthalmic Assistant/Refractionist 1 1 0 4 ECG Technician 1 1 0 5 Audiometry Technician 1 0 1 6 Laboratory Technician 5 2 3 7 Laboratory Attendant 3 2 1 8 Radiographer 3 0 3 9 Pharmacist 5 10 -5 10 Matron (Including Assistant Matron) 2 2 0 11 Physiotherapist 1 0 1 12 Statistical Assistant 1 0 1 13 Medical Record Officer /Technician 1 0 1 14 Electrician 1 1 0 15 Plumber 1 1 0 Total 77 32 45
38 © Administrative Staff 1 Junior Administrative Officer 1 1 0 2 Accountant 2 0 2 3 Computer Operator 6 0 6 4 Driver 2 5 -3 5 Peon 2 1 1 6 Security Staff 2 0 2 Total 15 7 8 (D) Operation Theatre 1 Staff Nurse 5 0 5 2 OT Assistant 6 2 4 3 Safai Karamchari 3 0 3 Total 14 2 12
(E) Blood Storage 1 Staff Nurse 1 1 0 2 MNA /FNA 1 0 1 3 Blood Bank /Storage Technician 5 2 3 4 Safai Karamchari 3 2 1 5 Attendant 2 0 2 Total 12 5 7
39 STATUS OF RKS DISTRICT KATHUA (As of June 2007) Date of Date of Block Facility Formation Block Facility Formation Kathua DH 27th April 07 Hiranagar CHC Hiranagar 27th April 07 Parole PHC Parole 0 PHC Sanoora 27th April 07 PHC Dhani 27th April 07 PHC Ghagwal 27th April 07 PHC Budhi 27th April 07 PHC Dinga Amb 27th April 07 PHC Barwal 27th April 07 PHC Marheen 27th April 07 PHC Lakhanpur 27th April 07 PHC Hariachak 27th April 07 PHC Kharote 27th April 07 PHC Rattanpur 27th April 07 Bani CHC Bani 27th April 07 Billawar CHC Billawar 27th April 07 PHC Dhaggar 27th April 07 PHC Ramkot 27th April 07 PHC Koti Chandyar 27th April 07 PHC Bhaddu 27th April 07 Basholi CHC Basholi 27th April 07 PHC Machedi 27th April 07 PHC Mahanpur 27th April 07 PHC Kough 27th April 07 PHC Karanwara 27th April 07 PHC Ucha Pind 27th April 07 PHC Sananghat 27th April 07 PHC Guddu Flail 27th April 07 PHC Hutt 27th April 07 PHC Lohai 27th April 07 PHC Sandhar 27th April 07 PHC Bhoond 27th April 07
Status of Deliveries (MPR March 2006) Home Deliveries Numbers S.No Place of Delivery Numbers attended by Subcentre ANM 1517 PHC/CHC/FRU 1767 LHV/Nurse/Doctor 1250 District Hospital 2064 TBA 3232 Untrained birth 307 Private Institution - Attendant Home 3506 Others 1905 Others 2604 Total 6110 Source: CMO office
40
Status of ASHAs S.No Name of the Block No. Of ASHAs 1 Parole 148 2 Hiranagar 208 3 Billawar 137 4 Basholi 84 5 Bani 53 Total 630 Source: CMO office
Immunization Status for 2005-2006 ( MPR Form 9) Vaccine Male Female Total TT (1st ) 12250 12250 TT (2 nd ) 10047 10047 TT (Booster) 1369 1369 DPT and OPV 1 st dose 8273 7687 15960 DPT and OPV 2 nd dose 7813 8150 15963 DPT and OPV 3 rd dose 7500 6994 14494 BCG 7401 6791 14192 Measles 7765 7262 15027 D.T. 2 nd dose 431 T.T. 10 years 380 T.T. 16 years 475 Vitamin A 1st dose 15130 Vitamin A (2 nd to 5 th dose) 23359 IFA tablets to Mothers 2354834 Full Immunization 2961 2826 5787 Source: CMO office
41 Blockwise Status – ANC Registration Complica No. of Deliver ANC ted Risk Pregnant ies at in 12 Pregnanc Women PHC Delive Pvt. S.N Name of Week ies Treate Referre treated /CHC/ ries at Nursing O. Block ANC s Detected d d (Anaemia) FRU SDH Homes 1 Parole 1687 317 - - - 5627 136 551 68 2 Hiranagar 6551 3462 - - - 118100 149 20 - 3 Billawar 3093 2591 66 36 30 2258 154 223 - 4 Bani 1322 1322 77 67 10 271 13 58 3 5 Basholi 2205 485 236 213 23 516 30 79 D.H 6 Kathua 2006 749 - - - 1640 - 1855 - M.G.H 7 Kathua ------ADMO 8 (ISM) ------Total 16864 8926 8926 316 63 128412 482 2786 71 Source: Dy CMO Office, Kathua
Blockwise Status- Deliveries Attended Home Home Deliveries by Sub Deliveries attended by Untrained Name of Home Centre Attended LHV Attended Birth S.NO. Block Deliveries Deliveries by ANC (Doctor/Nurse) by TBA attendants 1 Parole 641 123 171 142 358 80 2 Hiranagar 1974 2546 334 29 604 860 3 Billawar 1397 295 238 4 1002 40 4 Bani 605 130 56 38 111 380 5 Basholi 1901 70 385 302 570 375 D.H 6 Kathua ------M.G.H 7 Kathua - - - 529 - - ADMO 8 (ISM) ------Total 6510 3164 1184 1044 2390 1735 Source: Dy CMO Office, Kathua
42
Blockwise Status - Births Recorded
Name of S.NO. Block Live Births Still Births Weight recorded <2500Gm Male Female Male Female Male Female Male Female 1 Parole 829 690 - - - - 9 12 2 Hiranagar 2453 2346 - - 2656 2530 - - 3 Billawar 1038 998 16 17 992 951 62 63 4 Bani 407 400 3 4 121 93 15 12 5 Basholi 1035 1037 7 11 495 393 142 96 6 D.H Kathua ------7 M.G.H Kathua 923 845 14 16 - - 15 9 8 ADMO (ISM) ------Total 6685 6316 40 48 4264 3967 243 192 Source: Dy CMO Office, Kathua
Blockwise Status - High Risk Born children
High Risk in New S.NO. Name of Block born Detected Treated Referred Male Female Male Female Male Female 1 Parole ------2 Hiranagar ------3 Billawar 27 21 17 13 10 8 4 Bani 23 14 22 14 1 - 5 Basholi 174 139 165 132 9 7 6 D.H Kathua ------7 M.G.H Kathua 3 2 3 2 - - 8 ADMO (ISM) ------Total 227 176 207 161 20 15 Source: Dy CMO Office, Kathua
43 Blockwise Status - Immunization
Name of S.NO. Block Immunization I Dose II Dose III Dose DPT OPV DPT OPV DPT OPV DPT OPV Male Female Male Female Male Female Male Female 1 Parole 1091 1001 1391 1282 1326 1231 1344 1239 2 Hiranagar 2408 2271 2277 2151 2252 2147 2353 2268 3 Billawar 1858 1796 1839 1781 1852 1790 1795 1734 4 Bani 566 487 690 641 683 631 707 618 5 Basholi 1133 1058 1149 1082 1107 1054 1101 1050 6 D.H Kathua 762 639 691 615 714 628 667 603 M.G.H 7 Kathua 530 466 190 148 162 140 130 101 8 ADMO (ISM) 220 183 377 319 376 322 345 291 Total 8568 7901 8604 8019 8472 7943 8442 7904 Source: Dy CMO Office, Kathua
No. of Clients Name of No. of Infant of RTI /STI S.NO. Block Measles Vit. A (0-1) deaths <1 year (detected) Male Female Male Female Male Female Male Female 1 Parole 1217 1118 689 633 - - 245 285 2 Hiranagar 2265 2165 577 561 - - 846 2032 3 Billawar 1732 1670 575 547 18 19 114 106 4 Bani 575 494 575 494 10 10 207 443 5 Basholi 1092 1033 689 613 - - 186 404 6 D.H Kathua 660 584 426 369 - - - - M.G.H 7 Kathua 143 114 64 54 - - 177 337 8 ADMO (ISM) 296 246 425 356 - - - - Total 7980 7424 4020 3627 28 29 1775 3707 Source: Dy CMO Office, Kathua
44 Blockwise Status of Diaharea and ARI S.NO. Name of Block Diarrhoea ARI Male Female Male Female 1 Parole 248 230 143 112 2 Hiranagar 4 3 14 13 3 Billawar 321 343 288 335 4 Bani 185 152 361 348 5 Basholi 206 190 182 156 6 D.H Kathua - - - - 7 M.G.H Kathua 108 99 27 30 8 ADMO (ISM) - - - - Total 1072 1017 1015 994 Source: Dy CMO Office, Kathua Blockwise Status – Sterlization TT- S.NO. Block Male Female IUD Nirodh OPU TT-1 TT-2 Booster IFA 1 Parole - 408 142 39558 2674 1687 1539 217 356250 2 Hiranagar 8 408 384 28306 3579 3462 6089 - 293912 3 Billawar 3 371 297 54840 3122 2591 2116 475 279200 4 Basoli 33 241 162 22710 2418 2205 1699 147 101830 5 Bani 40 86 166 21974 4763 629 620 262 161235 MGH 6 Kathua - - - 10500 77 263 187 21 53800 DH 7 Kathua 2 124 82 19500 1330 1375 1109 37 83000 8 ADMO - - - 2775 414 746 600 3 103400 Total 86 1638 1233 200163 18377 12958 10959 1162 1432627 Blockwise Status – MTP S.NO. Block MTP 1 Parole - 2 Hiranagar 88 3 Billawar 110 4 Basoli 85 5 Bani 33 6 MGH Kathua 212 7 DH Kathua - 8 ADMO - Total 528
45 ICDS Beneficiaries 2006-2007 Block No Target Achievement Pregnant Lactating 6 mths –6 yr AWCs Women Women Target Achiev Target Achiev Target Achiev
Kathua 202 16984 5979 772 446 1282 637 14930 4896 Hiranagar 145 7471 4303 481 360 569 419 6421 3524 Billawar 214 12626 5494 643 463 842 584 11141 4447 Basohli 127 7278 3761 492 309 642 428 6144 3024 Bani 76 4263 1404 276 116 415 178 3572 1110 Barnoti 191 13169 5478 777 486 988 563 11404 4429 Ghagwal 115 6662 3720 407 305 492 323 5763 3092 Lohi Malhar 72 3540 1795 220 140 280 182 3040 1473 Duggan 44 2535 1339 158 89 191 118 2186 1132 Total 1186 74228 33373 3926 2814 5701 3432 64601 27127 Source: ICDS Reports 13.4.07 ICDS Data on Malnutrition MONTHLY PROGRESS REPORT FOR THE MONTH OF 3 / 2007 DISTRICT. KATHUA FORMAT 2nd Total population with in the project No. of SNP Beneficiaries Classification of Nutrition status Preg Rep No of Name of Preg & orte Dea Dea Childr ICDS & Lact 6m - Lact d ths ths III en Project 0-6 wome 3 3 - 6 wome live 0-1 1- Nor & weigh (R/T/U) Yrs n yrs years n birth yrs 5yrs mal I II IV ed Kathua 772 1282 772 1282 1083 75 2 1 1377 865 258 -- 2500 Hiranagar 481 569 481 569 779 58 -- -- 1143 568 101 -- 1812 Billawar 643 842 643 842 1047 97 5 1 1209 955 454 -- 2618 Basohli 492 642 492 642 737 60 -- -- 676 536 140 -- 1352 Bani 276 415 276 415 294 26 -- 1 977 572 44 -- 1593 Barnoti 777 988 777 988 1049 86 2 -- 1674 847 146 1 2668 Ghagwal 407 492 407 492 628 51 -- -- 547 207 10 -- 764 Lohi Malhar 220 280 220 280 322 15 -- -- 73 65 10 -- 148 Duggan 158 191 158 191 207 27 2 -- 483 368 78 -- 929 Total 3926 5701 3926 5701 6246 495 11 3 8159 4983 1241 1 14384 Source: ICDS Department as on 13.4.07
46 Availability of Facilities
PAROLE S.No. Name of CHC Name of PHC Name of SC Name of SC
1 Parole Barwal Padyari Nanan 2 Budhi Rajbagh Janglote 3 Lakhanpur Kumri Budhi 4 Dhanni Jarai AD Ghati 5 PHC Kharote Sample Sapla Khokhyal 6 Basantpur Sumwan Tarda 7 Ghati Jandore H Dhanore 8 Float Bhallar Palli 9 Parole Tridwan Goodhi 10 Badala Dhanna 11 Jasrota Thorsi 12 Jakhbar Mahichak 13 Airwan Hatli 14 Utteri Maloo 15 Gaiterwan Logate 16 Dilwan Bhed Balod 17 Jandore
BILLAWAR S.No. Name of CHC Name of PHC Name of SC Name of SC 1 CHC Billawar Badnota Surara Dher 2 Makwal Tharakalwal Koti 3 Sukral Sathar Maggain 4 Kohag Marhoon Dhanu Parole 5 Uchapind Plail Roukhla 6 Godu Falal Nongala Chunera 7 Ramkote Kalna Kashid 8 Machhedi Barota Pid 9 Bhaddu Malhid Sarla 10 Lohai Dehota Sadrota 11 Malhar Amwala Issu
47 12 Rajwalta Mooni 13 Najote Tumboo 14 Sukrala) Nagrota Gujroo 15 Pallan Phinter 16 Beril KishanPur 17 Rampur Upper Dharalta 18 Dhar Dugnoo Durang 19 Dharmkote Rukhla
BANI S.No. Name of CHC Name of PHC Name of SC Name of SC 1 Bani Duggan Bhakoga Kanthal 2 Koti Chandyor Sitti Banjal 3 Sandrool Mandrara Bhakoga 4 Dumeya Backon 5 Dullangle Doulka 6 Siara Tapper 7 Lowang Barmota 8 Barmota Dhaman 9 Chandal
48 HIRANAGAR Name of S.No. CHC Name of PHC Name of SC Name of SC 1 Rattanpur Ladhwal Amala 2 Ghagwal Sanyal Bannu Chak 3 Sanoora Kadayal Mela 4 Harichak Nonath Magloor 5 Dinga Amb Sagal Kheri 6 Marheen Satoora Sangwali 7 A/D Bhaiya Naran Rai 8 A/D Chakra Hira Nagar Tanda 9 Phalpur Fattu.Chak 10 Ragal Thakerpura 11 Mangu Chak Subachak 12 Chhan Lal Din Chadwal 13 Panjgrain Jatwal 14 Chandwan Chhan.Kanna 15 Chachwal Dhamyal 16 Danoh Chaan.Khatrian 17 Bann Surara 18 Mawa Saida 19 Bobiya Chhan.Rorian 20 Pansar Chaan.Morian 21 Odh Sandhi 22 Gurha Mundian Kattel.Brahmana 23 Chandare.Chak
49
Status of Health Centre Buildings in the District
Sub-Centre (SC) Status: Sub Centres No. Overall Status Sub-Centres in own building 61 Some of the subcentres are running in dilapidated buildings, Sub-Centre in Panchayat Bldg / rented 91 needs immediate repair and renovation building SC without Electricity connection 108 No generator or any backup in any Subcentres SC without Water Supply 136 Water supply not available in 136 subcentres SC without Toilets 143 No toilets with water supply
Primary Health Centres: Block Nagri Parole Status Name Of PHC Barwal Budhi Lakhanpur Dhanni Kharote Basantpur Ghati Float Parole 24 hour PHC Nil Yes Yes Nil Nil Nil Nil Nil Yes Total beds 2 4 3 1 3 Nil Nil Nil 5 No. of OPD 30-35 40 70-80 40 40-50 35 25 18 50 cases No. of indoor Nil 1 1 Nil 1 Nil Nil Nil 1 cases Rogi Kalyan Yes Yes Nil Yes Yes Nil Nil Nil Yes Samiti
Status Name of SC of Parole Block SC SC SC SC SC SC SC 1 2 3 4 5 6 7 Residential Facility Nil Nil Nil Available Nil Nil Availab Available le
Name of SC in Parole Block 1. Rajbagh, Karndi, Suraj bagh, Rakh Hariyar 2. (Kumari) (Androd.Jasser.Neter) 3. Jarai 4. Sample Sapla 5. Sumwan 6. Jandore
50 Status Names of SC of Parole Block SC SC SC SC SC SC SC 8 9 10 11 12 13 14
Residential Facility Nil Available Available Nil Nil Nil Nil Available
Name of SC in Parole Block 7. Bhallar 8. Tridwan 9. Badala 10. Jasrota, Chanipura 11. Jaknbar 12. Airwan 13. Utteri Status Names of SC of Parole Block SC SC SC SC SC SC SC 15 16 17 18 19 20 21 Residential Facility Available Available Nil Available Nil Nil Nil Available
Name of SC of Parole Block 14. Gaiterwan 15. Dilwan 16. Nanan 17. Janglote 18. Budhi 19. Ghati 20. Khokhyal Name of SC of Parole Block
SC SC SC SC SC SC SC SC SC SC SC SC 22 23 24 25 26 27 28 29 30 31 32 33 Residential Availabl Nil Availa Ni Availa Avail Availa Availa Nil Nil Nil Nil Facility Available e ble Availa ble able ble ble ble
Name of SC of Parole Block 21. Trada 22. Dhanore 23. Palli 24. Goodhi
51 25. Dhanna 26. Thorsi 27. Mahichak 28. Hatli 29. Maloo 30. Logate 31. Bhed Balod 32. Jandore B
Block Basholi Status Names of PHC Saranghat Mahanpur Plassi Karanwara Sandhar Bhoond Hutt 24 hour PHC Nil Nil Nil Nil Nil Nil Nil Total beds Nil 4 2 3 4 Nil 5 No. of OPD 20 30 40 15 349 200 156 cases No. of indoor Nil 2 Nil 1 2 Nil 2 cases Rogi Kalyan Yes Yes Nil Nil Nil Yes Nil Samiti
Status Names of SC Basohli Block SC SC SC SC SC SC SC 1 2 3 4 5 6 7 Residential Facility Nil Nil Nil Nil Nil Nil Nil available for Staff
Name of SC of Basohli Block 1. Jandrot 2. Dodla 3. Mannu 4. Thanger 5. Nagrota Prehta 6. Adhat 7. Danna
52 Status Name of SC of Basohli Block SC SC SC 8 9 10 Residential Facility for Nil Nil Nil staff
Name of SC of Basohli Block 8. Poonda ( Kothi ) 9. Plakh 10. Sialge
Block Billawar Status Name of PHC Badnota Hakwal Sukral Kohag Malhar Uchapind Goduflal Ramkote Marhhedi Bhaddu Lohai 24 hour Nil Nil Nil Nil Nil Nil Nil Yes Nil Nil Nil PHC Total Nil Nil Nil 2 1 2 1 5 2 5 2 beds No. of 15 15 250 20 20 10 15 60 12 15 15 OPD cases No. of Nil Nil Nil Nil Nil Nil Nil 1 Nil 1 Nil indoor cases Rogi Nil Nil Nil Nil Nil Nil Nil Nil Yes Nil Nil Kalyan Samiti
Status Name of SC of Billawar Block SC SC SC SC SC SC SC SC SC SC 1 2 3 4 5 6 7 8 9 10 Residential Availabl Nil Nil Nil Available Availabl Nil Nil Nil Nil Facility for Staff e e
Name of SC of Billawar Block 1. Surara 2. Tharakalwal 3. Sathar 4. Marhoon 5. Plail 6. Nongala 7. Kalna
53 8. Brota 9. Malad 10. Dehota
Status Name of SC of Billawar Block SC SC SC SC SC SC SC SC SC SC 11 1 2 13 14 15 16 17 18 19 20 Residential Available Nil Nil Available Nil Nil Nil Nil Nil Nil Facility for Staff
Name of SC of Billawar Block 11. Amwala 12. Rajwalta 13. Najota 14. Kishanpur 15. Mahavir Temple 16. Beril 17. Rampur 18. Dhar Dugnoo 19. Dharamkote 20. Dher
Status Name of SC of Billawar Block SC SC SC SC SC SC SC SC SC SC 21 2 2 23 24 25 26 27 28 29 30 Residential Nil Nil Nil Nil Nil Nil Nil Nil Nil Nil Facility for Staff
Name of SC of Baillawar Block 21. Koti 22. Maggani 23. Dhanu Parole 24. Roukhla 25. Chunera 26. kasheer 27. Bhaid 28. Mandi 29. Sadrota 30. Issu
54
Status Name of SC of Billawar Block SC SC SC SC SC SC SC SC 31 3 2 33 34 35 36 37 38 Residential Nil Nil Nil Nil Available Nil Nil Nil Facility for Staff
Name of SC of Billawar Block 31. Mooni 32. Tumboo 33. Nagrota Gujroo 34. Phinter 35. Kishanpur 36. Upper Dharalta 37. Sarang Block Bani
Status Name Of PHC PHC PHC PHC Kati Chandyar Dhaggar Sandrool 24 hour PHC Nil Nil Nil Total beds Nil Nil Nil No. of OPD cases 12-23 75 15 No. of indoor cases Nil Nil Nil Rogi Kalyan Samiti Yes Yes Yes
Status Name of SC of Bani Block SC SC SC SC SC SC SC SC SC SC 1 2 3 4 5 6 7 8 9 10 Residential Available Nil Nil Nil Available Nil Nil Nil Nil Nil Facility for Staff
Name of SC of Bani Block 1. Bhakoga 2. Sitti
55 3. Mandrara 4. Dumeya 5. Dullangle 6. Siara 7. Lowang 8. Barnota 9. Chandal 10. Kanthal Status Name of SC of Bani Block SC SC SC SC SC SC SC 11 12 13 14 15 16 17 Residential Nil Nil Nil Nil Nil Nil Nil facility for staff
Name of SC of Bani Block 11. Banjal 12. Bhakoga 13. Backon 14. Doulka 15. Tapper 16. Barmota 17. Dhaman Block Hiranagar Status Name of PHC Rattanpu Ghagwa Sanoora Hariachak Dinga Amb Marheen Bhaiya Chakra r l 24 hour PHC Yes Nil Yes Nil Nil Yes Nil Nil
Total beds 2 4 1 Nil 2 5 2 Nil No. of OPD cases 10-15 40-50 20-25 20-25 35 120-30 20 40-60 No. of indoor Nil 2 Nil Nil Nil 2 Nil Nil cases Rogi Kalyan Nil Nil Nil Nil Yes Yes Nil Nil Samiti
Name of SC of Hiranagar Block Status SC SC SC SC SC SC SC SC SC SC SC 1 2 3 4 5 6 7 8 9 10 11 Residential Available NIL Available Availa Nil Availa Availa Nil Availa Availa Nil Facility for ble ble ble ble ble Staff
56
Name of SC of Hiranagar Block 1. Amala 2. Bannu Chak 3. Mela 4. Magloor 5. Kheri 6. Somgwali 7. Rai 8. Tanda 9. Fattu Check 10. Thakerpura 11. Gurh Mundian
Status Name of SC of Hiranagar Block SC SC SC SC SC SC SC SC SC SC 11 12 13 14 15 16 17 18 19 20 Residential Availab Nil Availabl Availa Availabl Nil Availa Availabl Nil Nil Facility for Staff le e ble e ble e
Name of SC of Hiranagar Block 12. Subachak 13. Chadwal 14. Jatwal 15. Chhan Kanna 16. Dhamyal 17. Chhan Khatrian 18. Surara 19. Saida 20. Chhan Roricu 21. Chhan Morian
Name of SC of Hiranagar Block Status SC SC SC SC SC SC SC SC SC SC 21 2 2 23 24 25 26 27 28 29 30 Residential Nil Nil Nil Nil Nil Nil Nil Nil Availa Availabl Facility for Staff ble e
Name of SC of Hiranagar Block
22. Sandhi
57 23. Kattal Bharmana 24. Chandare Chak 25. Ladhwal 26. Sanyal 27. Kadyala 28. Nonath 29. Sagal 30. Satoora 31. Naran
Status Name of SC of Hiranagar Block SC SC SC SC SC SC SC SC SC SC 31 32 33 34 35 36 37 38 39 40 Residential Nil Availab Nil Availab Nil Nil Nil Availa Nil Nil Facility for le le ble Staff
Name of SC of Hiranagar Block 32. Hiranagar Morh 33. Phalpur 34. Ragal 35. Mangu Chack 36. Chhan-Lal- Din 37. Panjgrain 38. Chandwan 39. Chachwal 40. Danoh 41. Bann Thathi
Status Name of SC of Hiranagar Block SC SC SC SC 41 42 43 43 Residential Facility for Staff Nil Nil Available Available
Name of SCs of Hiranagar Block
42. Mawa 43. Bobiya 44. Pansar 45. Odh
58 Community Health Centre (CHC) District Kathua (B PHC )/ CHC Status CHC CHC CHC Old PHC CHC Billawar Bani Basholi Parole Hiranagar Total no. of beds 35 8 14 5 40 Total no of OPD 100 100 140 80 120 cases Total no. of indoor 5 5 10 Nil 10 admissions Bed occupancy rate Less than 40% 60% 60% 40-60% Less than 40% Up gradation of RKS Yes Yes Yes Yes Yes Vehicle/Ambulance Yes Yes Yes Yes Yes Ambulance with NGO Nil Nil Nil Nil Nil partner Rogi Kalyan Samiti Yes Yes Yes Yes Yes
Number of Institutions Requiring New Buildings with Staff Quarters
# Category of Institution Numbers 1 SC 91 2 PHC 13 3 CHC 0 Source: CMO office and Facility survey Number of Buildings Requiring Additions/Expansion (staff quarters)
# Category of Institution Numbers 1 SC 61 need additional staff quarters for additional ANM and 24 need for the first ANM 2 PHC 31 and 39 for additional MO and Staff nurses 3 CHC All need additional staff quarters for the doctors and specialists and staff nurses Source: CMO office and Facility survey Number of Buildings Requiring Repairs
# Category of Institution Numbers 1 SC 33 2 PHC 24 3 CHC All Source: CMO office and Facility survey
59
Table:1 Percentage Availability of Infrastructure District: Kathua
Indicators SC (152*) PHC+ADs(39) CHC(4) DH
1 Building (Govt. + Donated) 40.15 67.62 100 100
2 Building (Rented) 57.18 32.38 0.00 0 Condition of Building (Good 46.55 56.66 100 3 + Fair) 100 Water Supply (Tap, borewell/ 16.05 47.85 100 4 handpump/tubewell, well) 100 4.1 Tap water supply 10.80 35.36 100 100 5 Electricity 28.65 72.54 100 100 5.1 In all parts of hospital 2.35 69.19 100 100 Elertic supply (power 0 0 100 0 generation stablization) 6 Separate Toilet 5.78 13.57 100 100 Sep.Toilet with running 0.00 0.00 100 6.1 water 100 7 Furniture 54.88 85.00 90 100 8 Labor Room 0.61 9.60 100 100 8.1 Aseptic labor room 0.00 1.67 100 100 9 Avail. of Quater for staff 24.30 20.55 100 100 Number of beds available 1 15 80 10 (Average)
Laboratory 18.41 100 11 100 12 Operation Theatare 2.22 100 100 Waste Disposal 30.08 100 13 (Burnt+Dump) 100 14 Availability of incenator 0.00 100 0 15 Telephone 2.22 100 100 16 Computer 0.00 50 100 17 Generator/Invertor 2.22 100 100 18 Vehicle 9.52 100 100 19 Emergency Room / Casualty 100 100 Separate wards for males 100 20 and females (Yes/No) 100
60 21 No. of beds : Male 10 30 22 No. of beds : Female 10 30
23 Availability of ECG facilities 100.00 100
24 X-Ray facility 100.00 100
25 Ultrasound facility 100.00 100
26 Cardiac Monitor for OT 100.00 100
27 Blood Storage Unit available 0.00 0 28 Blood Bank Facility 0 29 Other Investigative Facility 86.20 Heating ventilatoin & air 0.00 30 conditioning 31 Lift & vertical transport 0 32 Refrigeration 100 Source: CMO office and Facility survey as on July 2007 (*)one subcentre in Hiranagar unsanctioned
61
Average Percentage Availability of Medicine
District Name of Blocks PAROLE HIRANAGAR BILLAWAR BASOLI BANI Average %
SCs IPHS 33 45 38 19 17 152
Kit- A 5 0 0 0 0 0 0.00
Quantity 9 44.44 44.44 55.56 55.56 33.33 46.67
Drugs required by ANMs and LHVs 6 50 50 83.33 66.67 50 60.00
Other Drugs and Vaccines 8 50 50 62.5 62.5 50 55.00
Medicines required for NDCP 7 42.86 42.86 57.14 42.86 42.86 45.72
Contraceptives required for F.Plang. 4 75 75 100 75 75 80.00
Proposed Drug List for A.Wadi Centres 12 50 50 50 41.67 41.67 46.67
Total 106 45.1 45.1 56.86 23.58 19.81 38.09
PHCs IPHS Norm 9 8 12 7 3 39 Essential & EmOC care drugs 38 52.63 50 52.63 39.47 52.63 49.47 Antidote 4 0 0 50 0 50 20.00 Anticonvulsant / Antiepileptics 4 50 36 50 50 0 37.20 Antiinfective Medicines 5 40 40 60 80 60 56.00 Antifilarials 1 0 0 0 0 0 0.00 Antibacterials 16 75 75 62.5 62.5 43.75 63.75 Dermatological medicine 14 71.43 60 71.43 35.71 42.86 56.29 Antileprosy & Antitubercullar 2 0 0 0 0 50 10.00 Antifungal medicine 4 50 45 50 50 75 54.00 Antiprotozoal medicine 5 40 35 60 20 60 43.00 Blood Products and Plasma Substitutes 13 38.46 38.46 38.46 23.08 15.38 30.77 Antiseptics 6 50 58 83.33 66.67 66.67 64.93 Disinfectants 3 100 90 66.67 33.33 100 78.00 Diuretics 2 0 0 100 50 0 30.00 Gastrointestinal 22 54.55 54.55 68.18 45.45 54.55 55.46 Hormones, Endocrine & Contraceptives 10 50 45 50 30 30 41.00 Ophthalmological preparation 12 50 50 41.67 41.67 33.33 43.33 Psychotic Disorders 15 40 33 33.33 20 33.33 31.93 I/V Fluids 9 33.33 33.33 88.89 33.33 55.56 48.89 Vitamins & Minerals 3 100 100 100 66.67 100 93.33 Drugs under RCH 1 64.52 60 64.52 38.71 35.48 52.65 Product Strength formulation Units 31 48.39 45 48.39 38.71 25.81 41.26 RTI / STI Drugs 10 50 50 60 40 50 50.00 Drugs and Consumable for MVA 6 33.33 30 66.67 33.33 83.33 49.33
62 TOTAL 236 58.47 59.95 64.4 44.07 48.73 55.12
CHCs IPHS Essential drugs 70 0 57.14 78.5 35.71 64.29 47.13
Average Percentage Availability of Equipment
Average Name of Blocks Parole Hiranagar Billawar Basoli Bani % District
IPHS SC’s 33 45 38 19 17 norm Equipment kit ( kit- C ) 55 54.54 63.64 12.70 36.36 21.82 37.81 No. of PHC's (39) 9 8 12 7 3 39 Suggested equipments 36 41.67 69.44 25.00 50.00 41.67 45.56 Operational labour room 10 50.00 80.00 0.00 50.00 20.00 40.00 Pap Smear 11 45.45 72.73 0.00 27.27 36.36 36.36 Laboratory Reagents 10 70.00 80.00 30.00 40.00 60.00 56.00 Glassware and other 7 85.71 100.00 71.40 57.14 42.86 71.42 equipment Furniture 25 81.25 100.00 68.80 68.75 75.00 78.76 TOTAL 99 64.65 88.89 39.39 56.57 54.55 60.81 CHC's IPHS 0 1 1 1 1 4 Standard Surgical Set-1 32 0.00 78.13 31.30 71.88 25.00 41.26 Standard Surgical Set - II 33 0.00 75.76 45.50 60.61 45.45 45.46 IUD Insertion Kit 19 0.00 78.95 63.20 63.16 63.16 53.69 Standard Surgical Set - III 17 0.00 88.24 70.60 70.59 82.35 62.36 Normal Delivery 12 0.00 83.33 83.30 66.67 50.00 56.66 Standard Surgical Set - IV 16 0.00 62.50 81.30 62.50 37.50 48.76 Standard Surgical Set - V 21 0.00 85.71 71.40 52.38 47.62 51.42 Standard Surgical Set - VI 11 0.00 72.73 63.60 45.45 45.45 45.45 Equip. for Anaesthesia 17 0.00 88.24 70.60 58.82 29.41 49.41 Equip.for Neo-natal 10 0.00 60.00 30.00 30.00 20.00 28.00 Resuscitation Materials Kit for Blood trans. 15 0.00 80.00 66.70 33.33 40.00 44.01 Equip. for OT 11 0.00 90.91 72.70 45.45 63.64 54.54 Equip. for Labour room 13 0.00 76.92 76.90 46.15 61.54 52.30 Equip. for Radiology 9 0.00 55.56 55.60 33.33 55.56 40.01 TOTAL 236 0.00 77.97 63.50 56.36 46.19 48.80
63
Non-Governmental Organization [NGOs]
NGOs working in district Kathua in the fields of health, education, livelihood and other community development initiatives are listed below:
• Shiva gramodyog mandal, Kathua • Grameen Kalyan Sangathan society, Nagri parole (Kathua) • Regional educational society • All India center for urban & rural development • Kandi Shivalik Vikas Sangathan, Nari Shakti Sangathan society ore vidhyarathi Parishad • Nehru Yuva Sangathan • National youth project • Bhartiya kissan sangh • Besahara society • Aware • Youth club, Rajpura • Bama youth club • All J&K Mahila sangh mandal • Friends housing society • Mohd. Jabar memorial sports club • Gramodyog hastakala Kendra
64 2. PLANNING PROCESS
A decentralized participatory planning process has been followed in development of this District Action Plan. This bottom-up planning process began with consultations with block stakeholder groups, Block /core Group members and village communities in all villages of each Block of the District. Block Action Plans were developed based on the inputs gathered through village action plans prepared by Village Health Water Sanitation Committees. The health facilities in the block viz. SC, PHC and, CHC were surveyed using the template developed by Government of India. The inputs from these facility surveys were taken into account while developing the Block Action Plan.
The District Planning Core Group (DPT) provided technical oversight and strategic vision for the process of development of District Action Plan. The members of the DPT had also taken the responsibility of contributing to the selected thematic areas such as RCH, Newer initiatives under NRHM, immunization etc. Assessment of overall situation of the District and development of broad framework for planning was done through a series of meetings of the DPT.
This District Action Plan has been prepared through a long process of integration of Block Action Plans including Health Facility Surveys. An initial meeting was held in which the current status of the District Action Plan was presented and suggestions and feedback taken. The membership and roles and responsibilities of DPT and the chapterization plans were discussed. Based on the inputs received from the Blocks, a draft of each chapter was developed after discussions. These were further improved upon through individual consultations with groups and nodal officers. Specific dates and times were fixed for this purpose. A date was also proposed for a meeting during which the individual chapters would be discussed and approved before the final DAP was prepared for presentation to the District Health Society for approval.
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HEALTH SERVICE INDICATORS FOR THE DISTRICT BASIC HEALTH SERVICES Goal Posts & S.No Indicator Criteria SCORE No. IMMUNIZATION % of fully immunized Maximum 100% No. <3 years completely 1 COVERAGE children Minimum 0% immunised < 3 YEAR OF AGE 46230 5787 12.52% 100% No of women Total no. of who got full % of women getting Maximum 100% ESSENTIAL pregnant antenatal antenatal care as 2 Minimum 0% ANTENATAL CARE women care as defined defined 18197 DNA DNA 100% Total no of Total no. of women who % of pregnant women Maximum 100% INSTITUTIONAL pregnant had who had institutional 3 Minimum 0% DELIVERY women institutional delivery. delivery 18197 3831 21% No. of WEIGHING OF Total no. of newborn Percentage of newborn Maximum 100% NEWBORN WITH IN births in the weighed weighed within three 4 Minimum 5% THREE DAYS year within three days days 16377(est) 324 1.98% 100% No of Percentage of Total no of newborns BREASTFEEDING newborns who were Maximum 100% births in the who were 5 IN FIRST HOUR breastfed within an Minimum 0% last year breastfed in hour the first hour DNA DNA DNA 100% Approx no of Maximum over 30 REPORTING OF blood slides Average time taken for reporting of days 6 BLOOD SLIDE sent in last 3 blood slide Minimum 1 day months 54431 DNA DNA
66 No. who Total no. of No of target wanted to % of couples with couples for get FP unmet ACCESS TO at least one Maximum 100% sterilisation operation demand 9 STERILISATION of them Minimum 0% services done last for FP SERVICES wanting FP ( > 2 children) year but operation operation: could not DNA DNA DNA DNA HEALTH RELATED SERVICES WATER & SANITATION 15 USE OF Total no. of Total no. of Percentage of families Maximum : 50 % DOMESTIC/ families families where all members are Minimum 0% COMMUNITY where all using domestic/ TOILET members are community toilet using domestic/ community toilet 96393 DNA DNA DNA FOOD SECURITY RELATED Total no. of Actual No. Percentage of children ANGANWADI getting diet Anganwadi 16 eligible for regularly beneficiaries Anganwadi 92521 9627 10.01% Total no. of Total no. of schools primary and giving Percentage of schools MIDDAY MEAL 17 middle cooked giving midday meals
schools midday meals 911 DNA DNA Total no. of No. of BPL families families Percentage of PDS FUNCTIONING eligible for getting 18 beneficiaries lower cost grains from grains PDS shop DNA DNA DNA
67 No. of Total no. of families ANTYODAYA BPL families Percentage of getting free 19 YOJNA eligible for free beneficiaries grains from grains PDS shop DNA DNA DNA No. of Total no. of children in Percentage of school SCHOOL children in 6- age group 20 going children ENROLMENT 14 age group not going to school DNA DNA DNA HEALTH STATUS no. of Total no. of CHILD children with % of children Max 200% children with 21 MALNUTRITION gr I or above malnourished Minimum 0% wt record. malnutrition 14384 6225 43.28% Total no. of Total no. of LOW BIRTH newborn who Percentage of babies Max 100% babies with 22 WEIGHT were weighed with LBW Min 10% LBW last year DNA 324 DNA No. of girls Total no. of 100% - % of married married Max 100% girls married women below 19 year 23 AGE OF MARRIAGE below 19 Min 0% last year of age year of age DNA DNA DNA DNA No. of Total number children born of births last with more % of unspaced second Max 100% year which 24 SPACING than 36 or third children born Minimum 0% were second months or > child difference DNA DNA DNA Any deaths Total number of any child Maximum 20% of births last % of infant deaths 25 INFANT DEATHS below one Minimum 0% year year 16377 37 0.23
68 Diarrhoeal outbreaks(Mor OUTBREAK OF Jaundice e than three Sum of water borne Maximum 4 WATER BORNE outbreaks 26 cases of a disease outbreaks Minimum 0 DISEASE (as defined) disease in
same week ) DNA DNA DNA DNA
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3. PRIORITIES AS PER BACKGROUND AND PLANNING PROCESS
National Rural Health Mission encompasses a wide range of health concerns including the determinants of the good health. Though there is a significant increase in resource allocation for the NRHM, there can never be adequate resources for all the health needs and all that needs to be done for ensuring good health of all the people. It is therefore necessary to prioritize the areas where appropriate emphasis needs to be given.
Kathua need to be given preferential treatment on all the aspects to achieve the goals of NRHM. Extra resources, innovative schemes, adequate personnel infrastructure is required for reaching the people. Based on the background and the planning process following are the overall priorities of this District:
1. Providing services for the Unreached population 2. Providing services during floods and at pilgrimage sites 3. Addressing the health of the migrant workers and SC population. 4. Quality services at all levels 5. Availability of Programme Officers, Specialists, Doctors and Staff Nurses and retaining the staff 6. Improving the condition of the facilities as per the IPHS norms including provision of quarters for the personnel 7. Strengthening CMO office with good Infrastructure and technical assistance 8. Strengthening the HMIS especially availability of correct data and its use 9. Capacity building of functionaries at all levels 10. Improved monitoring for improved services 11. Improving the image of the health services within the community
SPECIFIC PRIORITIES OF THE DISTRICT
1. Availability of Primary health care services: Providing services of ANC, Safe delivery, PNC, Immunization, DOTS, Anaemia prevention, prevention of Malaria at the village level 2. Programme Management: Efficient functioning of the District Health Society, a strengthened CMO’s office with efficient district and Block programme managers and the district technical support. 3. Demand Generation, IEC/BCC: Behaviour Change for utilization of services,
70 4. Human Resources: Filling of the vacancies as per the population based norms, increased mobility, Increased emoluments for retaining the personnel, motivational issues, provision of quarters at all facilities, Availability of well trained ASHAs for each 1000 population 5. Capacity Building: Focussed capacity building in Emergency Obstetric Care, Management, Continuous skill building of all personnel as per needs expressed and also the new job responsibilities under NRHM, opening a Staff Nurse Training College and Paramedical Staff training 6. Maternal Health: Well managed system of deliveries by Skilled birth attendants, promotion of institutional deliveries Emergency Obstetric Care services, JSY extended to all the pregnant women, Blood Storage Units at all CHC , All CHC to be developed as FRUs, PHC to be developed as 24x7 facilities with good referral mechanisms. 7. Neonatal and Child Health: Provision of Neonatal services at CHC, PHC, with trained personnel on IMNCI and IMCI and addressing Anaemia and Malnutrition 8. Immunization: Total coverage for immunization of children, pregnant women and adolescents 9. Family Planning: Improving the coverage for Spacing methods, NSV and Tubectomy. 10. Adolescent Health: Adolescent Reproductive and Sexual health education through schools and also awareness building on good health practices, responsible family life, marriage at right age. 11. National Disease Control Programmes: Prevention of Mosquito transmitted diseases especially Malaria 12. Infrastructure : Increase in the number of Subcentres, PHC, CHC and General hospitals catering to the entire population and developing all the facilities as per IPHS norms. 13. Procurement and Logistics: Construction of a scientific Warehouse for Drugs 14. Monitoring and Evaluation: Data validation and computerized data availability upto PHC with district linkages 15. Public-Private Partnership: Involvement of the private facilities for providing services and NGOs. 16. Intersectoral Convergence: Involving the related departments as members in the District Health Society, Fixing Responsibilities of each sector for their accountability and hence better Intersectoral Coordination
71 4. GOALS
The District will strive to improve the availability of and access to quality health care by people, especially for those residing in rural areas, the poor, women and children and will achieve the following goals:
INDICATOR Current Goals 07-08 08-09 09-10 10-11 11-12 Reduction in Infant Mortality Rate (IMR) 50** 10% 20% 30% 40% 50% Baseline Baseline Baseline Baseline Baseline Reduce Neo-natal Mortality Rate (NMR) DNA 10% 20% 30% 40% 50% Baseline Baseline Baseline Baseline Baseline Reduction Maternal Mortality Ratio (MMR) DNA 10% 20% 30% 40% 50% Baseline Baseline Baseline Baseline Baseline Reduction in Birth Rate( per)1000 29.19 30 27 25 20 15 Reduction in Total Fertility Rate 2.9 (IPHS) 2.8 2.7 2.5 2.3 2.1 Increased Full Ante-Natal Care as defined 6.6%** 25% 40% 60% 75% 90% Increased Ante-Natal Care – 3 ANC checkups 39.4** 60% 70% 80% 90% 100% Increased Proportion of Women getting IFA tablets 7.6** 55% 65% 80% 90% 100% Increased Proportion of Women getting 2 TT 52.8%** 65% 75% 90% 100% 100% Injections Increased Institutional Deliveries 26.8%** 25% 40% 60% 75% 90% Increased Delivery by Skilled Birth Attendants 29.9%** 40% 60% 75% 90% 100% Increased Contraceptive Prevalence Rate 45.6%** 40% 50% 60% 70% 80% Increased Complete Immunisation of Children (12-23 38.7%** 40% 60% 80% 100% 100% month of age) Increased Proportion of Children Exclusively 30.4%** 50% 70% 85% 100% 100% Breastfed Reduce Prevalence of STI/RTI 4.4** 35% 40% 50% 60% 70% Source: (*) CMO Office data (**) DLHS 2002-2004 data (***) Dir of Eco & Stat 2005 DNA means data not available
The data regarding IMR, NMR, MMR is not available and hence a baseline survey is indicated.
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INFRASTRUCTURE PLANNING Facility 2001 2007- 08 2008-09 2009-10 2010-11 2011-12
Projected Population 5,50,084 6,23,388 6,37,234 6,51,387 6,65,854 6,80,642 (Calculated Decadal Growth rate of 30 as per the Pop. of 2007) General Hospital 1 1 1 1 1 1 CHCs 4 5 6 7 8 9 PHCs 39 39 39 39 39 39 Subcentres 151 175 200 217 222 227 ASHAs 630 630 640 650 665 680 AWCs 1186 1186 1186 1186 1186 1186
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5. TECHNICAL COMPONENTS
PART A: Reproductive and Child Health (RCH) II
A-1. Strengthening of District Health Management Situation The District Health Society Kathua has been formed under the Chairmanship of Analysis/ the District Development Commissioner. Quarterly meetings of the District Health Current Society are being held regularly. The members are from health, AYUSH, Status Education, SDM, PHE, ICDS, Rural Development etc. There is a need to add one representative from each block. The Societies under the vertical Health Programmes like Blindness Control Society, TB Control Society, District Malaria Society, and society for IDSP have not been integrated into single society at the district level yet. Thus societies need functional integration and strengthening. Contractual appointments of various categories of staff have been made by the District Health Society. A district project management unit has been set up to provide technical support to the CMO for efficiently carrying out the programmes. Recently the Block Management Units have been established for providing technical support to the Block Medical Officers (BMOs). Monitoring of the activities of the health department is carried out by the DHS but it is comprised of members of the health department only. Members from other departments and also from the elected representatives need to become members for better monitoring and implementation. Objectives Empowered District Health Society to effectively plan, implement and monitor the progress of the health status and services in the district Kathua and achieve the goals of the District action Plan. Strategies Functional Integration of all the vertical Societies Capacity building of the members of the District Health Mission and District Health Society regarding the programme, their role, various schemes and mechanisms for monitoring and regular reviews and also on GoI / Go JK guidelines for running the District. Health & FW Society Strengthening the functioning of the DHS Establishing Monitoring mechanisms Activities 1. Developing systems for proper management, governance and functioning through: • Effective Planning – Annual, quarterly, monthly and as per needs
74 • Supervision mechanisms • Convergence systems • Procedures • Reporting systems • Regularity of meetings, • Agenda of meetings, Maintaining minutes and its timely circulation • Decentralisation • Delegation of decision-making power • Rational decision making 2. Orientation Workshop of the members of the District health Mission and society. 3. Issue based orientation in the monthly Review and Planning meetings as per needs. 4. Ensuring provision of Technical Assistance at the district, block levels and sector levels and their ongoing capacity building. 5. Exposure visits of members of the District health Society to well functioning Panchayats in two states 6. Improving the Review and planning meetings through a holistic review of all the programmes under NRHM and proper planning. 7. Formation of a monitoring Committee from all departments. 8. Development of a Checklist for the Monitoring Committee. 9. Arrangements for travel of the Monitoring Committee 10. Sharing of the findings of the committee during the Field visits in each Review Meeting with follow-up of the recommendations. Support 1. State to provide support for building the capacity of the DHS through required participation in DHS meetings 2. A GO should be taken out that at the district level each department should monitor the meetings closely and ensure follow-up of the recommendations. 3. Instructions should be issued to the DHS that all approvals should be done in the DHS Governing board meetings and the CMO should implement them instead of sending each file to the DC for approval. Timeline 2007-08 2008-09 2009-10 2010-11 2011-12 Developing systems x Orientation Workshop of the members x x x x x Issue based orientation x x x x x Ensuring provision of Technical Assistance at the district, block levels x x x x x
75 and sector levels Exposure visits of DHS members x x x x x Formation of a monitoring Committee from all departments. x Development of a Checklist for the Monitoring Committee. x
Budget Activity / Item 2007- 2008-09 2009-10 2010- 2011- Total ( In Lakhs) 08 11 12 Orientation Workshop 0.5 0.55 0.605 0.666 1.271 3.591 Exposure visit 6.2 6.82 7.502 8.252 15.754 44.528 Issues based Workshops 0.5 0.55 0.605 0.666 1.271 3.591 Mobility for Monitoring 0.6 0.66 0.726 0.799 1.525 4.309 Total 7.8 8.58 9.438 10.382 19.820 56.020
Detailed Calculations # Description Amount Exposure Visit 1 Airfare and travel expenses (Taxi, Bus, etc;) 400000/- 2 Lodging, Boarding, Food 200000/- 3 Misc. 20000/- Total 6,20,000/- Mobility for Monitoring by the DHS members 1 Vehicle on Rent/ Mules trips @ Rs 1000 per visit x 5 days visit per 60,000 month x 12 months
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A- 2 District Programme Management Current In NRHM a large number of activities have been introduced with very definite Status outcomes. The cornerstone for smooth and successful implementation of NRHM depends on the management capacity of District Programme officials. The officials in the districts looking after various programmes are overworked and there is immense pressure on the personnel. There is also lack of capacities for planning, implementing and monitoring. The decisions are too centralized and there is little delegation of powers.
In order to strengthen the district PMU, three skilled personnel i.e. Programme Manager, Accounts Manager and Data Assistant have being provided in each district. These personnel are there for providing the basic support for programme implementation and monitoring at district level.
The District Programme Manager is responsible for all programmes and projects in district and the District Accounts Manager (DAM) is responsible for the finance and accounting function of District RCH Society including grants received from the state society and donors, disbursement of funds to the implementing agencies, preparation of submission of monthly/quarterly/annual SoE, ensuring adherence to laid down accounting standards, ensure timely submission of UCs, periodic internal audit and conduct of external audit and implementation of computerised FMS.
The District Data Assistant (DDA) has to work in close consultation with district officials, facilitate working of District RCH Society, maintain records, create and maintain district resource database for the health sector, inventory management, procurement and logistics, planning and monitoring & evaluation, HMIS, data collection and reporting at district level.
In Kathua District Programme Manager, District Accounts Manager and District Data Assistant are in place. The Block Management Unit also has been constituted.
The PMU officers should be allowed to visit field areas to monitor at their level since presently they are only doing paper work in their respective offices.
77 There is a need for providing more support to the CMO office for better implementation especially in light of the increased volume of work in NRHM, monitoring and reporting especially in the areas of Maternal and Child Health, Civil works, Behaviour change and accounting right from the level of the Subcentre.The CMO’s office needs to be built. Objectives Strengthened District Management Unit Strategies 1. Support to the CMO for proper implementation of NRHM. 2. Capacity building of the personnel 3. Development of total clarity at the district and the block levels amongst all the district officials and Consultants about all activities 4. Provision of infrastructure for the personnel 5. Training of district officials and MOs for management 6. Use of management principles for implementation of District NRHM 7. Streamlining Financial management 8. Strengthening the CMO’s office 9. Strengthening the Block Management Units 10. Convergence of various sectors Activities 1. Support to the CMO for proper implementation of NRHM through filling up of existing vacancies & involvement of more consultants for support to CMO for data analysis, trends, timely reports and preparation of documents for the day- to-day implementation of the district plans so that the CMO and the other district officers are able to function properly: a. Finalizing the TOR and the selection process b. Advertisements for consultants, one each for Maternal Health, Civil Works, Child health, Behaviour change. If properly qualified and experienced persons are not available then District Facilitators to be hired which may be retired persons. c. Selection of the consultants for Maternal Health, Child Health, Civil Works, IEC
2. Capacity building of the personnel d. Joint Orientation of the District officers and the consultants e. Induction training of the DPM and consultants f. Training on Management of NRHM for all the officials g. Review meetings of the District Management Unit to be used for orientation of the consultants
78 3. Development of total clarity in the Orientat ion workshops and review meetings at the district and the block levels amongst all the district officials and Consultants about the following set of activities: • Disease Control • Disease Surveillance • Maternal & Child Health • Accounts and Finance Management • Human Resources & Training • Procurement, Stores & Logistics • Administration & Planning • Access to Technical Support • Monitoring & MIS • Referral, Transport and Communication Systems • Infrastructure Development and Maintenance Division • Gender, IEC & Community Mobilization including the cultural background • Block Resource Group • Block Level Health Mission • Coordination with Community Organizations, PRIs • Quality of Care systems
4. Provision of infrastructure for officers , DPM, DAM, DDM and the consultants of the District Project Management Unit. h. Provision of office space with furniture and computer facilities, photocopy machine, printer, Mobile phones, digital camera, fax, etc;
5. Use of Management principles for implementation of District NRHM i. Development of a detailed Operational manual for implementation of the NRHM activities in the first month of approval of the District Action Plan including the responsibilities, review mechanisms, monitoring, reporting and the time frame. This will be developed in participatory consultative workshops at the district level and block levels. j. Financial management training of the officials and the Accounts persons k. Provision of Rs. 500,000 as Untied funds at the district level under the jurisdiction of the Civil Surgeon l. Compendium of Government orders for the DC, Civil surgeon, district officers, hospitals, CHC, PHC and the Subcentres need to be taken out
79 every 6 months. Initially all the relevant documents and guidelines will be compiled for the last two years.
6. Development of a District Health Complex • Construction of a District Health Complex for housing the CMO and all the officials and their staff. There will be pooling of funds available for office expenses, personnel and better utilization of resources. • This complex will also have a modern Conference Hall with speaker systems and facilities for LCD projector and a meeting hall along with a common Computer Cell. There will be a Control Room, Consultant Unit, Library, Waiting room, a record room, • The Swasthya complex will be furnished and partitions will be made as per the modern offices to give each one of the staff a separate working area. • Office Automation will be done through installation of PABX system, Computers systems with UPS, Printer and Scanner for each district office section, Laptop for Civil surgeon, District Family Welfare Officer, Fax machines, Photocopy machine, Broadband Internet connectivity, Digital Camera with date and time etc;
7. Strengthening the Block Management Unit : The Block Management units need to be established and strengthened through the provision of : • Block Programme Managers (BPM), Block Accounts Managers (BAM) and Block Data Assistants (BDA) for each block. These will be hired on contract. For the post of BPM and the BAM retired persons may also be considered. • Office setup will be given to these persons. • Accountants on contract for each PHC since under NRHM Subcentres have received Rs 10,000 also the village committees will get Rs 10,000 each, besides the funds for the PHC. • Provision of Computer system, printer, Digital Camera with date and time, furniture
8. Convergence of various sectors at district level Provision of Convergence fund for workshops, meetings, joint outreach and monitoring with each CMO. 9. Monitoring the Physical and Financial progress by the officials as well as independent agencies 10. Yearly Auditing of accounts
80 Support from 1. State should ensure delegation of powers and effective decentralization. state 2. State to provide support in training for the officials and consultants. 3. State level review of the DPMU on a regular basis. 4. Development of clear-cut guidelines for the roles of the DPMs, DAM and District Data Manager. 5. Developing the capacities of the Civil Surgeons and other district officials to utilize the capacities of the DPM, DAM and DDA fully. 6. Each of the state officers Incharge of each of the programmes should develop total clarity by attending the Orientation workshops and review meetings at the district and the block levels for all activities. 7. If qualified persons for the posts of DPM, DAM are not available then State should allow the appointment of facilitators or Coordinators or retired qualified persons by the District Health Society. Time Frame 2007- 2008- 2009 2010 2011 Activity 08 09 -10 -11 -12 DPM,DAM,DDA and Consultants x x x x x Infrastructure, furniture, computer systems, fax, UPS, x x Printer, Digital Camera Workshops for development of the operational Manual x x x x x at district and Block levels Construction of District Health Complex x x Furnishing and Office Automation, Conference Hall x with speakers, ACs Compendium of Govt orders x x x x x Joint Orientation of Officials and DPM, DAM, DDM x x x x x Management training workshop of Officials x Establishment of BPMU x x Training of DPM and Consultants x x x x x Review meetings x x x x x Computer systems with printer and Digital Camera & x x furniture for DPMU, BPMUs, District, block personnel Monitoring of the progress x x x x x
Budget Activity / Item 2007- 2008- 2009- 2010- 2011 Total In Lakhs) 08 09 10 11 -12 Honorarium DPM,DAM,DDA and 29.4 32.34 35.574 39.131 43.04 179.49 Consultants 5 0 Travel Costs for DPMU @ Rs 10,000/ 1.2 1.32 1.452 1.597 1.757 7.326 per month x 12 mths Infrastructure costs, furniture, computer 5 5.5 6.050 6.655 7.321 30.526
81 systems, fax, UPS, Printer, Digital Camera, Workshops for development of the 1 1.1 1.210 1.331 1.464 6.105 operational Manual at district and Block levels Untied Fund 5 6 7.000 8.000 9.000 35.000 Construction Cost of District Health 88 0 0.000 0.000 0.000 88.000 Complex @ Rs 800 /sq.ft x 11000sq ft Furnishing and Office Automation, 15 0 0.000 0.000 0.000 15.000 Conference Hall with speakers, ACs Maintenance of the District Health 0 1.000 1.500 2.000 7.000 Complex 2.500 Compendium of Govt orders 0. 50 0.55 0.610 0.670 0.730 2.560 Joint Orientation of Officials and DPM, 0.25 0.275 0.303 0.333 0.366 1.526 DAM, DDM Management training workshop of 0.5 0.55 0.605 0.666 0.732 3.053 Officials Personnel for BPMU 92.4 101.64 111.80 122.98 135.2 564.11 4 4 83 1 Training of DPM and Consultants 0.5 0.75 1.000 1.250 1.500 5.000 Review meetings @ Rs 1000/ per 0.12 0.132 0.145 0.160 0.180 0.737 month x 12 months Office Expenses @ Rs 10,000/month x 1.2 1.32 1.450 1.600 1.800 7.370 12 months for district Computer systems with printer and 27.6 0 0.000 0.000 0.000 27.600 Digital Camera and furniture for DPMU, BPMUs and District and BPMU Annual Maintenance Contract for the 2.7 2.97 3.267 3.594 3.953 16.484 equipment Travel costs for BPMU @ Rs 5000 per 12.36 13.596 14.955 16.451 18.09 75.459 month per block 6 16 6276 Hiring of vehicles at block level @ Rs 74.88 82.368 90.604 99.665 109.6 457.15 800 x 20 days /mth x 39 PHCs x 12 8 28 3181 0 mths Monitoring of the progress by 1 1.1 1.200 1.300 1.400 6.000 independent agencies Office expenses for Blocks & Sectors 12 13.2 14.52 15.972 17.56 73.261 @ Rs 5000 x 5 blocks x 12, Rs 92 2000X39 SectorsX12 Total 370.11 265.71 293.25 323.35 356.3 1608.7 1 0 9 27 58
82 Detailed calculation for Personnel at DPMU for one year S.No Details Units Unit Cost Amount for 12 months Personnel at District level District Programme manager 1 18000 216000 District Accounts Manager 1 15000 180000 District Data Assistant 1 12000 144000 Consultant for Maternal Health 1 40000 480000 Consultant for Child Health 1 40000 480000 Consultant for Civil Works 1 40000 480000 Consultant for HMIS 1 40000 480000 Consultant for Behaviour Change 1 40000 480000 SubTotal 2940000 Personnel at Block level Block Programme manager 5 15000 900000 Block Accounts Manager 5 12000 720000 Block Data Assistant 5 10000 600000 Retired Accountants for each PHC @ Rs 39 10000 4680000 5000 per month x 39 PHC x 12 months Sectoral Managers 39 5000 2340000 Subtotal 9240000
Hiring of vehicles at block level @ Rs 800 x 39 192000 7488000 39 PHCs x 4 blocks x12 months Office Automation with Furniture, Computer 5 for BPMU 60,000 2760000 system, Camera, Printer, etc 1 for DPM 1 for DAM 39 sectors
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A-2. MATERNAL HEALTH Situation Analysis/ Indicator CMO Percentage data No of Pregnancies 18197 Maternal Deaths 4 ANC registration during the first 15713 86% trimester TT-2 10047 55% Institutional Deliveries 3831 21% Deliveries by skilled birth attendants 5999 33% Home deliveries 6110 Home deliveries Skilled Unskilled No. % No. % 3232 52.90 2878 47.10 No. of pregnancy related 231 1.27 complications No. of pregnancy related 61 0.34 complications referred to FRU level MTP 363 2.0 Source: MPR Form 9 : 2005-2006
Maternal Mortality: Only 4 Maternal deaths have been reported and there is no authentic data available regarding the Maternal deaths in the district since there is a lot of under reporting due to lack of personnel and improper supervision.
Age of marriage: The mean age of marriage for boys is 27.4 years as per DLHS 2002- 2004. Similarly for girls the mean age of marriage is 22.5 years. This is a good indication for RCH.
ANC: Out of the estimated pregnancies 86 % pregnancies had been registered of which 50 % were administered TT2. This data needs to be validated since the institutional deliveries are only 21%. The data regarding Full ANC is not available. As per DLHS 2002, full ANC is only 6.6%, and 3.6 % women had pregnancy complications. The reasons for low ANC coverage are the shortage of staff, socio-cultural beliefs, large areas and populations unreached and the unmotivated staff. There is late detection of
84 pregnancy in rural areas:-probably due to ignorance on the part of the women or other prevailing local superstitions.
Anaemia: There is no data available regarding the actual consumption of IFA. As per DLHS 2002 only 7.6 % of the pregnant women received 100 IFA tablets percent and among them 23.3 % had consumed it daily. A number of times there is non availability of Iron & folic acid tab:-partly because they are out of stock. As per the CMO office acceptance of IFA is on the rise.
TT: 50 % of the pregnant women had received TT2. As per DLHS 2002, 52.8 % of the pregnant women had received two doses of TT. This hence carries a grave risk for the pregnant women. Immunization needs to be strengthened with thrice a week sessions.
Deliveries: Institutional deliveries are 19 % with only 30 % of all the deliveries being done by Skilled Birth Attendants. As per DLHS 2002 only 26.8% were institutional deliveries. 60.8% were safe deliveries by Doctor/Nurses/TBA and 29.9 % by Doctor/Nurses. This is a reflection of the availability of services, accessibility and also the perception of people.
Referrals: There is no adequate data for referrals during complications. As per DLHS- 2002, 22.3% women had complications during delivery. Although there is a Referral Transport Scheme but there is no provision for their Running, repair & maintenance. There is no uniform referral slip should be printed for implementation of the same throughout the State. The drivers for referral transport are not available round the clock.
MTP: There were 363 MTPs carried out last year which is 2 % of the total pregnancies.
Malnutrition: There is no data available but malnutrition is prevalent 5701 mothers received Supplementary nutrition at the AWCs out of a total 9627 mothers registered at the AWCs.
Male participation : There is no data available for the level of male participation and also on what issues does male participation occur.
Janani Suraksha Yojana : The JSY scheme has been launched in J & K and 1064 women have benefited last year and from April 06 to March 07. The Govt. has assigned 4% of the funds for JSY out of which 1% is reserved for State monitoring & 3% is left for District & blocks, which is not sufficient This low uptake has been due to poor awareness
85 and also due to the fact that the data of BPL families needs to be updated. The JSY form is very lengthy & most of the time difficulties are faced in filling of this form. There is no column for Blood Group. The cash should be provided in the hand of the mother with instructions to use it for the purpose it is meant. Most of the sub centers in are in far flung areas without proper roads hence if delivery takes place during night it is practically not possible for ASHA who is a female to take the patient to the subcentres. There are other issues regarding non availability of ASHA for PPC although she may have given full ANC and support during delivery. There are many pending claims of last year.
Services: The Community does not have enough confidence in the government facilities since the personnel are not always available and also adequate infrastructure, equipment and drugs. The private facilities also are not available. There is lack of coordination among AWW, ANM & ASHA since they are not clear regarding their roles. In block Parole, there are areas like Karian Gandyal which are nearer to Punjab than their respective Subcentres; as a result they prefer to go to the nearer subcentre Sujanpur, Punjab.
Training : Regular training programmes on SBA, EmOC and MTP need to be arranged for the personnel. Also the TBAs need to be trained and equipped.
Village Health Day (VHD days) 1414 VHDs had been organized from the beginning but there is little awareness amongst the community about the days when these are held and also regarding the services being provided. Also staff is inadequate to cover all the AWCs.
RCH Camps: RCH camps are organized by the department to reach the community and provide services at the doorsteps. These camps provide specialist services with simple diagnostic tests. They also serve for screening of RTI and STDs.
Anganwadis: A total of 1190 AWCs are sanctioned, only 1186 are functional. The RCH programme is dependent on the ICDS programme for effective implementation and this is a serious gap of 373 centres.
Accessibility: Difficult terrain & non availability of roads & transport: Many subcentres in Bani are at the places where one has to walk a lot for accessing services & pregnant ladies are forbidden to climb at their crucial stages , most of the time complications occurs during transportations during pre delivery time, so they prefer local Dais who are easily available at their doorsteps.
86 Objectives 1. Decrease in the Maternal Mortality ratio to 50% of the baseline by 2012 2. 100% ANC coverage by 2012 3. 100% pregnant women administered two doses of TT by 2012 4. 80% pregnant women to consume 100 IFA tablets by 2010 and 100% by 2012 5. 60% Institutional deliveries by 2010 and 90% by 2012 6. 75% deliveries to be carried out by trained /Skilled Birth Attendant by 2010, 100% by 2012 7. 100% women to get improved Postnatal care by 2010 8. 50 % increase the safe abortion services by 2010 9. Reduction in Anaemia to less than 20 per cent by 2012 Strategies 1. Provision of quality Antenatal and Postpartum Care to all pregnant women 2. Increase in Institutional deliveries 3. Provision of Quality services in the health facilities and availability of Emergency Obstetric Care services 4. Availability of safe abortion services at all CHC and PHC 5. Increased coverage under JSY 6. Strengthening the Village Health Day 7. To increase awareness among mothers and communities about the importance of institutional deliveries 8. Improved behaviour practices in the community 9. Increase accessibility to services 10. Operationalization of all the sanctioned Anganwadis Activities 1. Identification of all pregnancies through house-to-house visits by AWWs, ASHAs and TBAs 2. Operationalizing the Village Health Day m. Once a week ANC clinic at all PHC and CHC n. Weekly ANCs at all AWCs wherever possible o. Development of a microplan for the ANMs in a participatory manner with the ICDS at the level of PHC to cover all the AWCs. In the beginning it is expected that there should be 100% coverage at the population covered by the AWCs and later each hamlet need to develop its microplan. p. Wide publicity regarding the VHD day by AWWs and ASHAs and their services q. A day before the VHD day the AWW and the ASHA should visit the homes of the pregnant women needing services and motivate them to attend the VHD day r. If the pregnant women do not attend the VHD day then they should be brought from their homes to the AWC s. Registration of all pregnancies
87 t. Each pregnant woman to have at least 3 ANCs, 2 TT injections and 100 IFA tablets u. Nutrition and Health Education session with the mothers at each of the mother’s meetings 3. Improving accessibility to care • Monthly Outreach sessions at each of the 96 difficult area villages • Pooling of resources at the PHC for conducting sessions for all services • Team to consist of MO PHC, LS, LHV, ANM, AWW, ASHA, Rehbar-e-Sehat teachers • Wide publicity for these outreach sessions by the ANMs/ AWWs/ ASHAs 4. Postnatal Care • The AWW along with ANM will use IMNCI protocols and visit neonates and mothers at least thrice in first week after delivery and in total 5 times within one month of delivery. They will use modified IMNCI charts to identify problems, counsel and refer if necessary. There is a need to train the AWWs intensively since initially till the posts are filled the ANM cannot do joint visits 5. Active involvement of TBAs: • Training to all TBAs focussing on their involvement in VHD days, motivating clients for registration, ANC, institutional deliveries, safe deliveries, postnatal care, care of the newborn & infant, prevention and cure of anaemia and family planning , on the 5 cleans, danger signs and timely referral • Delivery kits to be given to all TBAs • TBA to be attached with the ANM • Incentive of Rs 100 per delivery should be given to TBAs for promoting safe and institutional delivery through Skilled Birth Attendant • The recruitment of new ASHAs should be from the TBA taskforce. 6. Reduction of Anaemia • Wider distribution of IFA tablets and overseeing their consumption • ASHAs to be developed as depot holders for IFA tablets • ASHA to ensure that all pregnant women take 100 IFA tablets Promotion of kitchen gardens to promote intake of iron rich vegetables. Attractive packaging and Ayurvedic preparations of Iron and Folic Acid as an alternative to persons not consuming IFA tablets for increasing acceptance • Availability of IFA tablets 7. Operationalization of the non functional AWCs in a phased manner 8. Tracking bags
88 a. Provision of tracking bags for all the Pregnant mothers b. Training of ANM and AWWs for the use of Tracking bags 9. Provision of Weighing machines to all Subcentres and AWCs 10. Training of personnel for Safe motherhood and Emergency Obstetric Care (Details in Component on Capacity building) 11. Training for skilled birth attendant 12. Developing the CHC and PHC for quality services and IPHS standards (Details in Component Upgradation of CHC& PHC and IPHS Standards) 13. Increase accessibility of 24-hour delivery services (BEmoC) in 13 PHC. Repairs and renovations of PHC to be carried out. 14. Availability of Blood at the CHC 1. Establishing Blood storage units at all CHC 2. Certification of the Blood Storage centres 15. Improving the services at the Subcentres (Details in Component on Upgradation of Subcentres and IPHS) 16. Behaviour Change Communication (BCC) efforts for awareness and good practices in the community (Details in Component on IEC) 17. Increasing the Janani Suraksha coverage • Wide publicity of the scheme (Details in Component on BCC) • List of BPL pregnant women to be part of each month’s report • Advance Funds for JSY should be available with the ANMs • Timely payments to the beneficiary should be ensured • Starting of Janani Suraksha Yojana Helpline in each block through Rogi Kalyan Samitis • Funds for JSY should be kept aside for the disbursement and a proper action plan for this distribution should be made. • The cash should be provided in the hand of the mother with instructions to use it for the purpose it is meant. 18. Provision of Mobile Phones to all the ANMs, PHC MOs and CHC personnel • Provision of Mobile phone instrument to all personnel • 0Display of the Mobile numbers at all Subcentres, AWCs, Panchayat Bhawans, PHC and CHC • Plan of Rs. 225 per month of BSNL, which includes facility for 50 free calls 19. Provision of Safe Abortion: • Provision of MTP kits and necessary equipment and consumables at all PHC • Training of the MOs in MTP
89 • Wide publicity regarding the MTP services and the dangers of unsafe abortions • Encourage private and NGO sectors to establish quality MTP services. • Promote use of medical abortion in public and private institutions: disseminate guidelines for use of RU-486 with Mesoprestol 20. Development of a proper referral system with referral cards 21. Improvement of supervision and monitoring of ANM tour programme, Fixed VHD days, outreach sessions, payment of JSY, EmOC services, referral • Fixed VHD days and Tour plan of ANM to be available at the PHC with the MOs • Checklist for monitoring to be developed • Visits by MOs and report prepared on basis of checklist filled • Findings of the visits by MOs to be shared by MO in meetings 22. Use of the Village Chowkidar and Numberdar as Social Mobilizers for getting data on Maternal deaths, abortions, Pregnancies 23. Involvement of Rehbar-e-Sehat teachers for IEC, reporting and community mobilization • Training of RIS teachers • Regular meetings for progress and follow-up • Increase of emoluments to Rs 500 per mot for motivation of families, giving some safe drugs, promotion of good health practices and disease control 24. RCH Camps: These will be organized monthly to provide specialist services especially for RTI/STD cases. 25. Build public-private partnership in this area. Support 1. Issue of joint letters from Health & WCD department for joint working and ensuring required its implementation 2. The Social Welfare department should ensure operationalization of no functional Anganwadis 3. Ensuring availability of personnel especially specialists and Public Health Nurses for the 24 hour PHC, CHC and two ANM at the subcentres 4. Ensuring availability of formats and funds with the ANM for JSY and timely payments 5. Certification of PHC as MTP centres 6. Ensuring smooth flow of Blood from the Blood Bank at District Hospital to the Blood Storage units 7. The State should closely monitor the progress of all the activities 8. JSY should be extended to all the pregnant women irrespective of BPL and APL Timeline 2007- 2008- 2009- 2010- 2011-12 08 09 10 11
90 Identification of all pregnancies through house- to-house visits x x x x x Operationalizing the VHDs x x x x x Once a week ANC clinic at All PHC and CHC Weekly ANCs All AWCs wherever possible Microplan for ANMs x x x x x Monthly Outreach sessions x x x x x Delivery kits to be given to all TBAs 587 587 587 587 587 Incentive for TBA referral @Rs 100 per referral 2000 3000 4000 5000 6000 Incentive to RIS teachers @ Rs 500/mth x x x x x Provision of tracking bags for all the AWCs & SC 1361 1587 1403 14081 1413 Provision of Weighing machines to all Subcentres and AWCs 1361 1587 1403 14081 1413 Regular meetings for progress and follow-up x x x x x 2 2 2 Establishing Blood storage units at all CHC CHCs CHCs 1 CHC CHCs 2 CHCs Increasing the Janani Suraksha coverage 10000 12000 14000 16000 18000 2 3 4 Janani Suraksha Yojana Helpline 1 Block Blocks Blocks Blocks 5 Blocks 115 189 46 50 54 ANMs ANMs ANMs ANMs ANMs 6 PHC MO , 32 PHC 46 PHC 6 PHC 6 PHC 14 SMOs MO, MO, MO , MO , CHC 15 CHC 13 CHC 14 14 SMOs SMOs Provision of Mobile Phones CHC CHC Provision of MTP kits and necessary equipment 39 39 39 39 and consumables at all PHC PHC PHC PHC PHC 39 PHC Training of the MOs in MTP x x x x x RCH Camps 12 12 12 12 12 Training of personnel for Safe motherhood and Emergency Obstetric Care x x x x x Training of the MOs in MTP x x x x x Training for skilled birth attendant x x x x x Training of RIS teachers x x x x x Training to all TBAs x x x x x Training of ANM and AWWs for the use of Tracking bags x x x x
91 Budget Activity / Item 2007 2008- 2009- 2010- 2011- Total ( In Lakhs) -08 09 10 11 12 Consultancy for support for developing 1 1.1 1.210 1.331 1.464 6.105 Microplan for Village health Day Tracking Bags @ Rs 300/ bag x AWCs + SCs 4.083 4.158 4.209 4.224 4.239 20.913 Adult Weighing machines @ Rs 800 per 10.88 11.088 11.22 11.26 11.30 55.768 machine x 600AWCs & Maintenance(10% cost 8 4 4 4 of machine) Monthly special outreach session in 100 difficult 2 2.2 2.42 2.662 2.928 12.210 villages@2000/session 2 Blood Storage @ Rs 3 lakhs per unit 6 6 3.000 6.000 6.000 27.000 Referral Cards @ Rs 2 per card x 10,000 0.2 0.22 0.242 0.266 0.293 1.221 MTP kits @ Rs 15000 Per kit 5.85 6.435 7.078 7.786 8.564 35.715 5 35 985 One day training workshop on Tracking bags at 1 1.1 1.210 1.320 1.450 6.080 the district level and each sector JSY beneficiaries @ Rs 1400/person 140 168 196.0 224.0 252.0 980.000 00 00 00 JSY Helpline through RKS 9.99 19.98 29.97 39.96 49.95 149.850 0 0 0 Mobile phone instrument to personnel @ Rs 3.24 4.96 1.320 1.400 1.480 12.400 2000 Mobile Phones recurring cost to personnel @ Rs 4.374 11.07 12.85 14.74 16.74 59.778 2700 2 2 0 Delivery kits to TBA's@3000and refilling @ 1000 17.61 3.86 4.246 4.671 5.138 35.524 Incentives to TBA @ 100 per delivery by skilled 2 3 4 5 6 20.000 birth attendant RCH Camps @ Rs 25000 per camp x 12 3 3.3 3.630 3.993 4.392 18.315 Total 211.2 246.47 282.6 328.6 371.9 1440.88 35 1 12 19 43 0
Detailed Calculations JSY Helpline through Rogi Kalyan Samiti S.No Details of one block helpline Amount (Lakhs) 1. Personnel @ Rs 4500 x 4 x 12 months 2.16 2. Travel of personnel Rs 2500 per person/mth x 12 mths 3.6 3. Mobile Phones @ Rs 2000/ mth x 90 sets 1.8 4. Rec cost of mobile @ Rs 225 x 12 x 90 persons 2.43 Total 9.99
92
A-3. NEWBORN & CHILD HEALTH Situation Indicator No. Rate /% Analysis No. of births 12401 Neonatal Deaths DNA Infant Deaths( as per CMO data) 57 0.45 Child Deaths DNA Still birth in the last year 88 Low birth weight newborns (less than 2.5 kgs.) 435 3.50 Child Vaccination: completed ( 12-23 months age ) 5787 Severely malnourished children ( Grade III & IV ) As 1 per ICDS Grade I and II malnutrition (As per ICDS) 6224 22.94 ARI cases in the last year 2009 Deaths in the last year due to pneumonia in children 4 Diarrhoea cases in the last year 2089 Deaths in last year due to Diarrhoea in children 4 Coverage by ICDS 27127 29.32 Total No of children 0-6 yrs ( Calculated from census and growth rate) 92521 Source: CMO office, ICDS 13.4.07
Anaemia in children : There is no data available `with the CMO or the ICDS regarding the levels of anaemia in children. Children are given IFA tablets for iron supplements under the national programme.
Malnutrition: Undernutrition is a cause of serious concern amongst the children of the 0-6 years age group. In the ICDS programme Supplementary nutrition is provided to children below 6 yrs. The coverage of ICDS is only 29.32 %. Nutrition is being provided at the AWC and 23 % of the children at the AWCs are malnourished and there is only one severely malnourished child as per the data from the MPR of ICDS programme. The data for the severely malnourished appears unrealistic. The reasons for malnutrition are related to repeated diarrhoeal episodes, feeding practices of not giving colostrums, late weaning, poor sanitation and worm infestation.
Breast feeding: There is no data regarding exclusive breast feeding. As per DLHS 40.3 % children were breastfed exclusively for the stipulated period of 4 months . There is lack of knowledge regarding the significance of Colostrum and the socio-cultural factors
93 A-3. NEWBORN & CHILD HEALTH associated with it since 64.2 % of mothers squeezed out the first breast milk as per DLHS.
Childhood illnesses Diarrhoea: Undernutrition is associated with diarrhea, which further leads to malnutrition. There is no data on diarrhoea but according to the district MOs it is common. According to the DLHS 2002 28.2 % of the women were aware of what was to be done when a child got diarrhea and only 19% were aware about Oral Rehydration Solution (ORS) and 10.6% gave ORS to the children and a negligible percentage gave more fluids to drink. Also all sought treatment for Diarrhoea. This shows that there is a need for more knowledge regarding the use of ORS and increased intake of fluids and the type of food to be given.
Pneumonia: There is no data on childhood Pneumonia but as per the district official there is a need to create awareness regarding the danger signs of Pneumonia.. As per DLHS 2002, 8.3% persons were aware of danger signs of Pneumonia, 26 % had Pneumonia 2 wks prior to survey and 98.4%persons sought treatment for Pneumonia
Newborn and Neonatal Care: There is very little data available for the newborns and the neonates. The District data shows that a negligible percentage of newborns and neonates died which is doubtful. Reporting regarding these deaths is not done properly. The various health facilities also are poorly equipped to handle newborn care and morbidity. The TBAs and the personnel doing home deliveries are unaware regarding the neonatal care especially warmth, prevention of infection and feeding of Colostrum.
Training: IMCI and IMNCI training is essential for the MOs, Staff Nurses, ANMs. Training on the home based care package is required for the ANMs/AWWs/ASHAs/TBAs. However some portion is being covered under SBA trainings.
Data: There is no data available for childhood diseases, Prenatal mortality, Low birth weight at birth, deaths due to various causes.
Services: There are only 3 Paediatricians as against the required 6 in the whole district. The infrastructure for providing services for Childhood morbidity and Neonatal care is not there even at the District hospital.
94 A-3. NEWBORN & CHILD HEALTH Objective 1. Reduction in IMR to 50% from baseline by 2012 2. Reduction in Neonatal mortality to 50% from baseline by 2012 3. Increased proportion of women who exclusively breastfeed for 6 months to 100% by 2010-2012 4. Increased in Complete Immunization to 100% by 2010-2012 5. Increased use of ORS in diarrhoea to 100% by 2009-2010 6. Increase in the Treatment of 100% cases of Pneumonia in children by 2010-2012 7. Increase in the utilization of services to 100% by 2012 Strategies 1. Improving feeding practices for the infants and children including breast feeding 2. Promotion of health seeking behaviour for sick children 3. Community based management of Childhood illnesses 4. Improving newborn care at the household level and availability of Newborn services in all CHC & hospitals 5. Improving the care for Malnourished children(Discussed under Component on Immunization) 6. Enhancing the coverage of Immunization 7. Zero Polio cases and quality surveillance for Polio cases Activities 1. Promote early and exclusive breastfeeding up to 6 months of age and complementary feeding thereafter. 2. Promoting Integrated management of neonatal and childhood illnesses (IMNCI) • IMNCI training will be carried out for the health workers • Assess the FRUs with reference to IPHS developed by GOI and identify the gaps • Provide necessary instruments and equipment needed to ensure CEmOC • Training of MO in CEmOC, newborn care and lifesaving saving anaesthesia skills as per the models developed per GOI. Also resuscitation skills. • Blood storage facilities will be operationalized in all 7 CHC/ PHC/ FRUs to be proposed (only district hospital working as FRU) • Referral transport facility will be provided to all health facilities for bringing the patients to FRUs. • Training neonatal nurses (one month at medical college) • Strengthening the neonatal services and emergency Child care services in District hospital and at all CHC. This will be done in phases • In all of these units, newborn corners would be established and staff trained in
95 A-3. NEWBORN & CHILD HEALTH management of sick newborns and immediate management of newborns. For all the equipment for establishing newborn corners, a five year maintenance contract would be drawn with the suppliers. The suppliers would also be responsible for installing the equipment and training the local staff in basic operations • The equipment required for establishing a newborn corner would include Newborn Resuscitation trolley, Ambubag and masks (including newborn sizes), Laryngoscopes, Phototherapy units, Room warmers, Inverters for power back-up, Centralized oxygen and Pedal suctions . i. Improving feeding practices for the infants and children including breast feeding • Study on the feeding practices for knowing what is given to the children • Education of the families for provision of proper food and weaning • Educate the mothers on early and exclusive breast feeding and also giving Colostrum • Introduction of semi-solids and solids at 6 months age with frequent feeding • Administration of Micronutrients – Vitamin A as part of Routine immunization, IFA and Vitamin A to the children who are anaemic and malnourished ii. Promotion of health seeking behaviour for sick children and Community based management of Childhood illnesses • Training of LHV, AWW and ANM on IMCI including referral • BCC activities by ASHA, AWW and ANM regarding the use of ORS and increased intake of fluids and the type of food to be given • Availability of ORS through ORS depots with ASHA • Identification of the nearest referral centre and also Transport arrangements for emergencies with the PRIs and community leaders with display of the referral centre and relevant telephone numbers in a prominent place in the village iii. Improving newborn care at the household level • Adaptation of the home based care package of services and scheduling of visits of all neonates by ASHA/AWW/ANM on the 1st, 2nd, 7th, 14th and 28th day of birth. • In case of suspicion of sickness the ASHA /AWW must inform the ANM and the ANM must visit the Neonate • Referral of the Neonate in case of any symptoms of infection, fever and hypothermia, dehydration, diarrhoea etc; • Training on IMNCI of ASHA/AWW/ANM/MOs on the home based Care package
96 A-3. NEWBORN & CHILD HEALTH • Supply of medicine kit and diagnosis and treatment protocols (chart booklets) for implementation of the IMNCI strategy • Training of staff in Newborn Care, IMNCI and IMCI (MOs, Nurses) including the management of sick children and severely malnourished children. • Availability of Paediatricians in all the CHC • Ensuring adequate drugs for management of Childhood illnesses. iv. Strengthening the fixed Village Health Days (Also discussed in the component on Maternal Health) • Use of Tracking Bag for Tracking of Left-outs and dropouts by ASHA, AWW and contacting them a day before the session • Information of the dropouts to be given by ANM to AWW and ASHA to ensure their attendance • Wide publicity regarding the VHD days v. Developing Malnutrition Centres for the care and treatment of malnourished children at all CHC vi. Strengthening Immunization (Discussed in Component C) Support 1. Availability of trained staff including Paediatricians Required 2. Technical Support for training of the personnel 3. Timely availability of vaccines, drugs and equipment 4. Good cooperation with the ICDS and PRIs Timeline 2007-08 2008-09 2009-10 2010-11 2011- 12 Promoting (IMNCI) x x x x x
IMNCI training x x x x x Assessment of FRUs with reference to IPHS for NB Care x x x Newborn corners – All CHCs 1 CHC 4 CHCs 1 CHC 1 CHC 1 CHC Malnutrition Corners – DH and all CHCs DH , 1 CHC 4 CHCs 1 CHC 1 CHC 1 CHC Study on the feeding practices for knowing what is given to the children x Education on early and exclusive breast feeding and Colostrum x x x x x Promotion of health seeking behaviour for sick children x x x x x Improving newborn care at the household level x x x x x
97 A-3. NEWBORN & CHILD HEALTH Training on the home based Care IMNCI of ASHA/AWW/ANM/MOs x x x x x Training of MO in CEmOC, IMNCI x x x x x Training of LHV, AWW and ANM on IMCI including referral, Tracking Bags x x x x x Wide publicity regarding VHD days x x x x x
Budget Activity / Item 2007- 2008- 2009 2010- 2011- Total 2006-07 08 09 -10 11 12 Study on the feeding and Care 2 0 0.000 0.000 0.000 2.000 practices for the infants and children Innovative activities based on the study 0 2 2.000 2.000 2.000 8.000 Newborn Corner furnished with 1.4 5.6 1.4 1.4 1.4 11.200 equipment @ Rs 1.40 lakh per facility Examination table, chair, stool, table, 35.58 35.580 other equipment @ Rs. 3000 x No of AWCs Infant Weighing Machines @ Rs. 9.488 9.488 800/AWCx No of AWCs Foetoscope @ Rs.50 x No AWCs 0.593 0.593 Malnutrition Corners @ Rs 30,000 per 0.6 1.2 0.300 0.300 0.300 2.100 CHC and District Hospital
Total 49.661 8.8 3.700 3.700 3.700 68.961
98
A-4. FAMILY PLANNING Situation Indicators No. Analysis Eligible Couple 105975 Couple Protection Rate 45.6% DLHS 2002 Female Sterilization operations during last year 1638 Vasectomies during the last year 86 Couples using IUD 1233 Source: CMO data and Block Data
The Couple Protection Rate (DLHS 2002) is 45.6%, out of which 31.5% have adopted permanent methods; However 29.9% are still outside the coverage of family planning methods.
The TFR (IIPS data) is 2.9%. Currently the unmet need in family planning is 43% (DLS) The government has relied very heavily on outreach camp approach for sterilisation.The monetary incentive of 1000 - per NSV operation has helped in promoting male participation.
However overall status of sterilization has not changed much, figures are more or less the same. The reasons for the low use of permanent methods and Copper -T are due to inadequate motivation of the clients, inadequate manpower, limited skills of the ANM for IUD insertion, prevalence of RTI and STDs and also their irregular availability. The rejection rate is high since proper screening is not done before prescribing any spacing method.
Copper T-380 has been recently introduced but there is very little awareness regarding its availability. There is a need to promote this 10 yr Copper-T. Some socio-cultural groups have low acceptance for Family Planning. Promotion efforts for Vasectomy have been very infrequent and only 258 men have undergone Vasectomy.
The age of marriage for girls has increased to 21 years which is a very good indicator. This needs to be validated. The State has also developed a module for quality care in family planning based on the GOI guidelines. There is disproportionate distribution of incentive for ASHA as compared to other workers. An ASHA worker is paid @Rs.150/- per NSV whereas the other workers paid@ Rs. 10/- as a result they don’t show much interest. Objectives 1. To reduce the TFR to 2.1% by 2010
99 A-4. FAMILY PLANNING 2. To decrease the unmet need in family planning to 10 % by 2010 3. Increase in Contraceptive Prevalence Rate to 80 % by 2012 4. Increase in the awareness levels of Emergency Contraception to 100% by 2010 Strategies 1. Increased awareness for Emergency Contraception and 10 yr Copper T 2. Decreasing the Unmet Need for Family Planning 3. Availability of all methods at all places 4. Increasing access to terminal methods of Family Planning 5. Promotion of NSV 6. Expanding the range of Providers 7. Increasing Access to Emergency Contraception and spacing methods through Social marketing 8. Building alliances with other departments, PRIs, Private sector providers and NGOs Activities 1. Counselling of couples for Family Planning • Establishment of Family Planning Counselling Unit at SC/PHC/CHC level for improvement of quality services of Planning • Engage one trained person on contractual basis for Family Planning Counselling to the couple. • Training of MOs and Specialists counselling. • Training of Health Supervisors, Health workers, ASHAs, Ayush doctors, AWW in FP- counselling • Counselling of newly married couples on importance of birth spacing 2. Improving t he quality of services of Public Sector providers for Terminal methods • Specialists from District hospitals and CHC will be trained in Laparoscopic Tubal Ligation. • At CHC, one medical officer will be trained in NSV • Each CHC will be a static center for the provision of sterilization services on regular basis. The Static centers will be developed as pleasant places, clean, good ambience with TV, music, good waiting space and clean beds and toilets. • About 4 -7 PHC come under the catchments area of CHC and the camps will be organized on fixed days in each of the PHC. • Equipments and supplies will be provided at CHC for conducting sterilization services. • A systemic effort will be made to assess the needs of all facilities, including staff in position and their training needs, the availability of electricity and water, Operation theatre facilities for District hospitals/CHC/PHC, Inventory of
100 A-4. FAMILY PLANNING equipment, consumables and waste disposal facilities and the condition, location and ownership of the building. • At least three functional Laparoscopes will be made available per team, as will the equipment and training necessary to provide IUD and emergency contraception services. The existing non-functional Laparoscopes need to be replaced. For effective coverage 4 teams are required with minimum three Laparoscopes for each team. • Vacant positions will be filled in on a contractual basis. • Provision of Sterilization services every day in the hospital and at CHC 3. NSV • Formation of District implementation team consisting of DC, CMO, District MEIO, District NSV trainer • One day Workshop with elected representatives, Media, NGOs, departments for sensitisation and implementation strategy, fixing pre-camp, camp and post- camp responsibilities • Development of a Microplan in one day Block level workshops • NSV camp every quarter in all hospitals initially and then CHC • IEC for NSV • Trained personnel • Follow-up after NSV camp on fixed days after a week and after 3 months for Semen analysis 4. Access to non-clinical contraceptives increased in all the villages • AWWs and ASHAs as Depot holders • Training in Spacing methods, Emergency Contraceptives and interpersonal communication for dissemination of information related to the contraceptives in an effective manner. • Supply of Emergency Contraceptives to all facilities • IEC campaign on importance of birth spacing • Improving the availability of spacing methods in villages through all possible deport holder. 5. Access for the quality IUD insertion improved at all the subcentres. • All the ANMs at 152 subcentres will be given a practical hands on training on insertion of IUD • Diagnosis and treatment of RTI/STI as per syndromic approach. The various screening protocols related to the IUD insertion enabling her to screen the
101 A-4. FAMILY PLANNING cases before the IUD insertion. This will result in longer retention of IUDs. • Counselling of the cases • Repair of subcentres so that the IUD services can be provided and ensuring privacy and confidentiality. • IUD 380 will be used due to its long retention period and can be used as an alternative for sterilization. 6. Awareness on the various methods of contraception for making informed choices Discussed in the Component on IEC 7. Increasing the gender awareness of providers and increasing male involvement • Empowering women • Increasing male involvement in family planning through use of condoms for safe sex • BCC activities to focus on men for Vasectomy. • Gender sensitization training will be provided for all health providers in the CHC/PHC and integrated into all other training activities. ( Component on Gender) • Service delivery sites for male methods by training health providers in NSV and conventional vasectomy will be expanded so that each CHC and Block PHC in the district has at least a provider trained in NSV. 8. Improving and integrating contraceptives/RCH services in PHC and Sub- centres • Skill-based clinical training for spacing methods including IUCD insertion and removal, LAM, SDM and EC of Health Supervisors and Auxiliary Nurse Midwives (ANM). • Training in infection prevention and follow up for different family planning methods. • MIS training to the health workers to enable them to collect and use the data accurately. • Health supervisors training for facilitative supervision and MIS. • Follow up of trained Health Supervisors and ANMs after one month and six months of training and provide supportive feedback to the service providers 9. Strengthening linkages with ICDS programme of women and child development department and ISM (Ayurveda)
102 A-4. FAMILY PLANNING • A detailed action plan will be produced in co-ordination with the ICDS department for involvement of the AWWs and their role in increasing access to contraceptive services. • Department of health officials and ICDS officers will be orientated to the plan. • AWWs and their supervisors will receive technical training and training in communication skills and record keeping by Medical Officer of the PHC and LHV. • Staff of ISM department will be trained in communication and non-clinical methods to promote and increase the availability of FP methods. 10. Role of ASHAs: • Training for provide counselling and services for non-clinical FP methods such as pills, condoms and others. • Act as depot holders for the supplies of pills and condoms by the ANM for free distribution • Procurement of pills and condoms from social marketing agencies and provide these contraceptives at the subsidized rate • Provide referral services for methods available at medical facilities • Assist in community mobilization and sensitisation 11. Proper Supervision and Monitoring and reporting • Each Health Supervisor to be trained for supportive supervision and monitoring • Developing Microplans for each personnel with their participation to ensure maximum coverage. • Ensuring proper filling of formats ad meaningful review and planning meetings • Followup as per the action plans Support 1. Ensuring Timely payments to ASHA, other stakeholders required 2. Availability of a team of master trainers/ANM tutors and State trainers for follow up of trained Supervisor and ANM after one month and six months of training and provide supportive feedback to the service providers 3. A training cell will be created in the medical college for the training of the medical officers in the area of various sterilization methods 4. Availability of equipment, supplies and personnel Timeline Activity 2007-08 2008-09 2009-10 2010-11 2011-12 Training of MOs for NSV 4 MOs 16 MOs 20 MOs 20 MOs 20 MOs Training of MOs for Minilap 4 MOs 16 MOs Training of Specialists for Laparoscopic DH 2 CHC 2 CHC 2 CHC 1 CHC Sterilization
103 A-4. FAMILY PLANNING Development of Static Centres at General DH, 2 CHC 2 CHC 1 CHC 1CHC hospitals and all CHC 2 CHC Sterilization camps (Persons) 5000 6000 7000 8000 10000 NSV Camps 600 700 800 1000 1200 Supply of Copper T – 380 3000 4500 6000 9000 12000 Emergency Contraception 2000 6000 8000 10000 12000 Laparoscopes DH, 2 CHC 1 CHC 1 CHC 3 CHC 2 CHC
Budget Activity / Item 2007 2008-09 2009- 2010- 2011- Total -08 10 11 12 NSV camps @ Rs. 359750 8.647 5 9.9973 11.361 13.952 25.313 69.2698
Sterilization Camps @ 19.50 for 45.92 65.2875 84.740 122.754 160.877 479.583 5000 cases 5 5 Development Static Centres @Rs 1 3 2 2.000 1.000 1.000 lakh 9.0000 Copper T-380 @ Rs 45 / piece 1.35 2.03 2.700 4.060 5.400 15.5400 EmergencyContraception@Rs10/2 0.1 0.2 0.3 0.8 0.5 tabs 1.9000 Laparoscopes 3per CHC&DH @ 36 12 18 9 9 Rs3.00 lakhs x 3 84.0000 Total 95.02 91.51475 119.101 151.566 202.090 659.293 25
Detailed Calculations Calculations per Case of NSV S.No Head Unit Cost 1. Payment to NSV acceptor 1000 2. Mobilization/Transport cost 50 3. Payment to Service Provider 50 4. Payment to IEC advocate/Motivator 25 5. Payment to Assistant/OT Nurse etc; 10 6. Drugs and Dressing 27.5 Total 1162.5
Requirements for organizing one camp (600 cases) Head Unit Unit 2007- 2008- Cost 08 09 2009-10 2010-11 2011-12 Total District Workshop 1 4000 4000 4400 4840 5324 10164 28728 Block workshops 4 7500 30000 33000 36300 39930 76230 215460 TA/DA for NSV surgeons 5 2000 10000 11000 12100 13310 25410 71820
104 IEC activities 93250 102575 112832.5 124116 236948 669722 TA to Acceptor for Semen 600 50 30000 Analysis 35000 40000 50000 90000 245000 Payment to NSV Advocate/ 600 1162.50 697500 motivator, Drugs & Dressings 813750 930000 1162500 2092500 5696250 Total 864750 999725 1136073 1395180 2531252 6926980
Budget for IEC activities for NSV camp S.No Head Unit Unit Cost Amount 1. Hand Bills 100000 0.15 15000 2. NSV booklets 10000 2 20000 3. Banners 250 54 13500 4. Posters 11000 2.50 27500 5. DA for Driver & 2 persons 45 Man-days 50 2250 6. Electronic Media Publicity for 15 days 5000 7. Wall writing & publicity 1000 8. Other Innovative activities 9000 9. Total 93250
Budget for sterilization per case S.No Head Unit Cost (Rs) 1. Payment to acceptor 500 2. Mobilization/Transport cost 50 3. Payment to Service Provider 50 4. Payment to IEC advocate/Motivator 35 5. Payment to Assistant/OT Nurse etc; 10 6. Drugs and Dressing 93.5 Total 738.5
Budget for sterilization camps benefiting 5000 cases S.No Head Unit Unit 2007- 2008- 2011- Cost 08 09 2009-10 2010-11 12 Total 1. Medicines 500000 5 5.5 6.05 6.655 7.3205 30.5255 2. Per Case @ 738.50 5000 738.5 36.925 55.3875 73.85 110.775 147.7 424.638 3. IEC activities 100000 1 1.1 1.21 1.331 1.4641 6.1051 4. Other activities & OE 300000 3 3.3 3.63 3.993 4.3923 18.3153 Total 45.925 65.2875 84.74 122.754 160.877 479.583
105 A-5. ADOLESCENT HEALTH Situation The adolescents are very vulnerable since the awareness levels for various issues of RCH are low Analysis Adolescents have unmet needs regarding nutrition, reproductive health, mental health and require appropriate counselling. No efforts have been made for any counselling of the adolescents. There is hence a great lacuna in the knowledge of the Adolescents. Adolescents especially the boys are exposed to smoking, addictions, peer pressure and there is no one to counsel them. Teenage pregnancies also emerging as a problem ad Unsafe abortion & premarital sex trend is on rise. The Kishori Shakti Yojana for Adolescent girls in AWCs is not functional. In this scheme they are given IFA tablets, Deworming, Supplementary Nutrition and also given vocational training. Adolescents need to be brought under the ambit of this programme so that the levels of anaemia are reduced due to IFA and deworming The School Health programme and the school AIDS education programme and school sanitation programme are covering the entire state Some degree of anaemia and severe anaemia is reported but the data needs to be validated. As per DLHS 2002, 0.9 % of boys got married before the legal age of marriage and 3% girls got married before the legal age of marriage , Data regarding the perceptions and practices of girls and boys is lacking especially in the context of rural setting. Objectives 1. Increase the knowledge levels of Adolescents on RH and Life skills 2. Enhance the access of RH services to all the Adolescents 3. Improvement in the levels of Anaemia to 50% by 2012 Strategies 1. Implementation of Kishori Shakti Yojna 2. Awareness amongst all the adolescents regarding Reproductive health and Life skills 3. Provision of Adolescent Friendly Health package at the health facilities 4. Provision of Adolescent Health Counselling services Activities 1. Research study involving quantitative and qualitative aspects on the perceptions and practices of girls and boys in the context of rural setting and also the age of marriage and consummation. 2. Operationalization of Kishori Shakti Yojna • Adolescent Mentoring group consisting of Master Trainers for carrying out trainings, mentoring, monitoring the process of formation of Kishore - Kishori groups • Set up Kishore-Kishori Groups in all villages and family life education and IEC on high risk behaviour 3. School based programmes. • The district of Kathua will be covered for anaemia prophylaxis programme during 2006/2007 to be scaled to all districts by 2012 • Specialists for school adolescence health 4. The Adolescent Health package will consist of the following activities: • Formation of a Subcommittee as part of District Partnership for Adolescent Health (DPAH) consisting of representatives of: Health department, Education department, Social Welfare
106 department, ICDS, NGOs, PRIs, National Service Volunteers, other youth organizations, local chapters of Indian Academy of Paediatricians & FOGSI and other stakeholder groups. • Workshop to develop an understanding regarding the Adolescent health and to finalize the operational Plan • Provision of Adolescent friendly health services at PHC, CHC, FRUs and district hospitals in a phased manner. Training of the MOs, ANMs on the needs of this group, vulnerabilities and how to make the services Adolescent friendly. • Adolescent Health Clinics will be conducted at least once every week by the MO to provide Clinical services, Nutrition advice, Detection and treatment of anaemia, easy and confidential access to medical termination of pregnancy, Antenatal care and advice regarding child birth, RTIs /STIs detection and treatment, HIV detection and counselling, • In the 100 difficult villages the clinics will be part of the monthly Outreach session • Carrying out the services at the fixed VHD days • Provision of IFA tablets to all Adolescents, deworming every 6 months, Vitamin A administration and Inj. TT 5. Awareness building amongst the PRIs, Women’s groups, ASHA, AWWs 6. Developing a cadre of Peer Educators • Selection of Peer Educators, two for each village in a phased manner, and their training for three days. • Selection of Counsellors for Peer Educator workshops and carrying out counselling clinics. These will be selected one per PHC. There will be equal number of Male and female counsellors and will alternate between two PHC – one week the male counsellor is in one PHC and the female counsellor in the other and they switch PHC in the next week so that both the boys and girls benefit. The counsellor will be • Providing ongoing training to the Peer Educators, • Facilitating group meetings • Organizing Counselling session once per week at the PHC. Organization of counselling sessions at PHC with wide publicity regarding the days of the sessions • Collecting data and information regarding the problems of Adolescents 7. Close monitoring of the under 18 marriages, pregnancies, prevalence of RTI/STDs. 8. Three-day health camps for Adolescent boys and girls at block level for Deaddiction, Mental health and problems of adolescents quarterly 9. Involvement of NGOs for awareness generation, Appointment of Counsellors, Peer Educator Support Approval by State for Life skill education and Life skill education to be initiated in all schools required
107
Timeline Activity 2007- 2008- 2009- 2010- 2011-12 08 09 10 11 Research x Awareness generation x x x Formation of Adolescent Mentoring x Group Workshop of all the partners x x x Training a district pool of Master trainers x Selection of Peer Educators 1 block 2 1 Block 1Block Blocks Counsellor through NGOs All PHC Training of Peer Educators 200 200 100 87 Retraining of Peer Educators 0 200 400 500 587 Orientation of the Health personnel x x x Counselling Clinics All PHC All All All PHC All PHC PHC PHC Three day health camps for Adolescents x x x
108 Budget Activity 2007 2008- 2009- 2010- 2011- Total -08 09 10 11 12 Research 5 0 0.000 0.000 0.000 5.000 Awareness generation @ Rs 2000 per 11.74 12.914 14.2054 15.6259 17.188 71.674 village x 587 villages 4 534 Workshop of all the partners 0.5 0.55 0.605 0.6655 0.7320 3.053 Training of Adolescent Mentoring Group 1 1 1.000 1.000 1.000 5.000 and other expanses@1 Lakh Counsellors @ Rs 8000 per month x 37.44 41.184 45.3024 49.8326 54.815 228.57 PHC x12 mths 4 904 5 Training of Peer Educators @ Rs 50 per 0.3 0.3 0.150 0.131 0.000 0.881 person x 3 days x No. of Peer Educators Retraining of Peer Educators @ Rs 50 0 0.3 0.600 0.750 0.881 2.531 per person x 3 days x peer Educators Orientation & Reorientation Health 0.25 0.28 0.310 0.340 0.370 1.550 personnel Counselling sessions @ Rs 1000/yr/peer 2 4 5.000 5.870 5.870 22.740 Educator Counselling Clinics renovation, furnishing 3.9 4.29 4.719 5.1909 5.7099 23.810 and Misc. expenses @ Rs 10000.00 9 Health camps for Adolescents once per 2 2.2 2.42 2.662 2.9282 12.210 quarter x 4 x Rs 50000 per camp Joint Evaluation by an agency & Govt 1 0 1.200 0.000 1.320 3.520 Total 65.13 67.018 75.512 82.067 90.815 380.54 2
109 Part B: NRHM Initiatives B-1. ASHA – Accredited Social Health Activist Situation The Subcentre caters to a population of approximately 3000 spread over an average of 5 villages. Analysis Hence keeping in view the difficulties faced by the ANM to provide health and family welfare services in all the villages and also carry out effective community contact, under NRHM a village level community based functionary has been brought in all villages and will be trained for meeting the health-related demands of people and will create awareness on health and its social determinants and mobilize the community towards local health planning and increased utilization and accountability of the existing health services indicators in the villages.
ASHA is an honorary worker and will be reimbursed on performance-based incentives and will be given priority for involvement in different programmes wherever incentives are being provided (like institutional delivery being promoted under Janani Suraksha Yojana, motivation for sterilization, DOTS provider, etc.). It is conceived that she will be able to earn about Rs. 1,000.00 per month In district Kathua 630 ASHAs have been selected and 600 have received training in module 1. In module 2, no ASHAs have been trained.
All the villages should have an ASHA by 2008. Objectives 1. Availability of a Community Resource, service provider, guide, mobilizer and escort of community 2. Provision of a health volunteer in the community at 1000 population for healthcare 3. To address the unmet needs Strategies 1. Selection of a woman from the community 2. Capacity building of this worker 3. Constant mentoring, monitoring and supportive supervision by district Mentoring group Activities 1. Strengthening of the existing ASHAs through support by the ANM. . and their involvement in all activities. 2. Reorientation of existing ASHAs 3. Selection of new ASHAs to have one ASHA in all the villages 4. Training of these ASHAs and those selected ASHAs who have not received any training. 5. Training for Module 2,3,4 6. Provision of a kit to ASHAs 7. Formation of a District ASHA Mentoring group to support efforts of ASHA and problem solving 8. Review and Planning at the Monthly sector meetings 9. Periodic review of the work of ASHAs through Concurrent Evaluation by an independent agency 10. ASHA Performance Diaries is to be printed Support • Timely Payments to ASHA required • Advance of Rs. 5000 always with ASHA for prompt payments to the women Timeline 2007- 2008-09 2009-10 2010-11 2011-12 08 Selection of additional ASHAs 0 10 ASHAs 10 ASHAs 15 ASHAs 15 ASHAs
110 Total ASHAs 630 640 650 665 680 Training of new & untrained ASHAs 30 10 10 15 15 Training of ASHAs for module 2,3,4 630 10 10 15 15 Reorientation of the initial ASHAs 600 630 640 650 665 ASHA Performance Diaries 600 640 650 665 680 District ASHA Mentoring group x x x x x
Budget Activity / Item 2007- 2008- 2009- 2010- 2011- Total 08 09 10 11 12 Training & kit @ Rs 10000/ ASHA 3 1 1.000 1.500 1.500 8 Training of ASHA in Module II,III,IV @ 12.6 0.2 0.2 0.3 0.3 13.6 2000/ASHA Reorientation @ Rs 1000/ ASHA 6 6.3 6.400 6.500 6.650 31.85 Expenses for the District mentoring 0.6 0.66 0.730 0.800 0.880 3.67 group – meetings, travel @ Rs 5000 per month x 12 months ASHA Performance Diary @ Rs. 100/ 0.6 0.64 0.650 0.665 0.680 3.235 ASHA Compensation to ASHA @1000/ASHA 75.6 76.8 78 79.8 81.6 391.8 Total 98.4 85.6 86.980 89.565 91.610 452.155
Compensation to ASHA ASHA will be paid double the amount prescribed so that she gets a package of at least Rs 1000.00 per month Activity Compensation Cases per Amount/ ASHA ASHA Full ANC & 3 PN Cs Rs 25/case 2/mth 50 Facilitating Institutional delivery Rs 100/case 2/mth 200 Providing essential newborn Care & Rs 25/case 2/mth 50 counselling Counselling mothers for safe MTPs Rs 50/case 1/2mths 25 Counselling women for RTIs/STDs Rs 5/case 6/mth 30 Birth & death registration Rs 15/case 3/mth 45 Total per ASHA 400
111
B-2. Untied Funds and an Annual Maintenance grant for Sub Centres Situation Till NRHM was launched there was no provision for any fund for the subcentres for Analysis/ maintenance, electricity, water, any fund for consumables and cleanliness of the subcentre. Current Status Rs 2000 was given as contingency funds, which were totally inadequate to meet any demands. Due to this the Subcentres were in a pathetic condition and the ANM worked alone for deliveries sometimes helped by the family members. A number of equipment needed some repair due to which they were lying unutilized. The Gram Panchayat members were never involved in any activities of the Subcentre.
Untied fund @ Rs 10000/- have been paid to ANMs for opening joint accounts with sarpanchs in 2006-07 in their respective sub centre village for carrying out various health activities and they have all been utilized. Objectives 1. Strengthening of the Subcentre through financial support for immediate needs and maintenance Strategies 1. Provision of Untied funds of Rs 10000 each year to the Subcentres at the disposal of the ANM for local needs 2. Provision of Rs 10000 for construction and annual maintenance Activities 1. Besides the usual recurring cost support to the sub-centres, each Subcentre would be given an untied support of Rs. 10,000 per annum. The fund would be kept in a joint account to be operated by the ANM and the local Sarpanch. 2. Rs 25000 will be given as annual maintenance grant to each Subcentre. This will be under the mandate of the Gram Panchayat SHC Committee for undertaking construction and maintenance. This will bring in greater community control and the sub-centres would be brought fully under the Panchayati Raj framework. 3. Activities suggested for the untied funds include minor modifications, cleanliness of premises, transport of emergencies, transport of samples, purchase of consumables, etc; 4. This fund will not be used for salaries, vehicle purchase and recurring expenses of Gram Panchayat 5. Monthly and quarterly expenditure statement will be submitted along with UC Support 1. Funds to be transferred on time to the ANM required 2. Sarpanch to ensure proper usage and accounts Timeline 2007- 2008-09 2009-10 2010-11 2011-12 08 Untied Fund of Rs 10000/subcentre 175 200 217 222 227 Annual Maintenance grant of Rs 175 200 217 222 227 10000/SC Plan for maintenance to be developed x x x x x and approved by Gram Panchayat
112 Plan for use of untied funds x x x x x Gram Panchayat to identify mode of x x x x x construction and repair
Budget Activity / Item 2007 2008 2009- 2010- 2008 - Total -08 -09 10 11 12 Untied Fund of Rs 10000/subcentre 17.5 20 21.7 22.2 22.7 104.1 Annual Maintenance grant of Rs 17.5 20 21.7 22.2 22.7 104.1 10000/SC Total 35 40 43.400 44.400 45.40 208.2
113 B-3. Provision of Untied Funds an Annual Maintenance grant at PHCs Situation Till NRHM was launched there was no provision for any fund for the PHCs for maintenance, Analysis/ electricity, water, any fund for consumables, telephone, hiring transport in emergencies and Current cleanliness PHC. Due to this the PHC were in a bad shape. They were unable to provide services Status as per the needs of the patients. A number of equipment needed some repair due to which they were lying unutilized. Objectives 1. Strengthening of the PHCs through financial support Strategies 1. Provision of Untied funds of Rs 25000 each year to the PHC at the disposal of the Rogi Kalyan Samitis 2. Provision of an Annual Maintenance grant of Rs 50,000 to the PHC Activities 1. These funds will be routed through the Rogi Kalyan Samitis who will approve the yearly activities and the related budgets and also undertake and supervise improvement and maintenance of physical infrastructure. 2. An untied fund of Rs 25000 will be provided each year for activities as per the local needs including minor modifications, cleanliness of premises, transport of emergencies, transport of samples, purchase of consumables, etc; 3. This fund will not be used for salaries, vehicle purchase and recurring expenses of Gram Panchayat or any other facility. 4. An Annual Maintenance grant of Rs 50,000 will be given to the PHC for water, toilets,, maintenance of building. 5. Monthly and quarterly expenditure statement will be submitted along with UC Support 1. Timely release of funds required 2. Meetings of the Rogi Kalyan Samitis to be regularly held Timeline Activity 2007-08 2008-09 2009-10 2010-11 2011-12 Untied Fund of Rs 25000/PHC 39 PHC 39 PHC 39 PHC 39 PHC 39 PHC Annual Maintenance grant of Rs 39 PHC 39 PHC 39 PHC 39 PHC 39 PHC 50000/PHC Plan for maintenance to be x x x x x developed and approved by the Rogi Kalyan Samitis Plan for use of untied funds x x x x x Rogi Kalyan Samitis to identify mode x x x x x of construction and repair
Budget Activity 2007-08 2008-09 2009-10 2010-11 2011-11 Total Untied Fund of Rs 9.75 9.75 9.75 9.75 9.75 48.75 25000/PHC Annual Maintenance grant of 19.5 19.5 19.5 19.5 19.5 97.5 Rs 50000/PHC x 12 PHC Total 29.25 29.25 29.250 29.250 29.250 146.25
114 B-4. Provision of Untied Funds an Annual Maintenance grant at CHC Situation Till NRHM was launched there was no provision for any fund for the CHCs for maintenance, Analysis/ electricity, water, any fund for consumables, telephone, hiring transport in emergencies, travel Current and cleanliness of CHC. Although the Rogi Kalyan Samitis were formed still more funds were Status required on a regular basis. Due to this the CHCs were in a bad shape. They were unable to provide services as per the needs of the patients. A number of equipment needed some repair due to which they were lying unutilized. Objectives 1. Strengthening of the CHCs through financial support Strategies 1. Provision of Untied funds of Rs 50000 each year to the CHC at the disposal of the Rogi Kalyan Samitis 2. Provision of an Annual Maintenance grant of Rs 100,000 to the CHC Activities 1. These funds will be routed through the Rogi Kalyan Samitis who will approve the yearly activities and the related budgets and also undertake and supervise improvement and maintenance of physical infrastructure. 2. An untied fund of Rs 50000 will be provided each year for activities as per the local needs including minor modifications, cleanliness of premises, transport of emergencies, transport of samples, purchase of consumables, etc; 3. This fund will not be used for salaries, vehicle purchase and recurring expenses of Panchayat or any other facility. 4. An Annual Maintenance grant of Rs 100,000 will be given to the CHC for water, toilets, maintenance of building. 5. Monthly and quarterly expenditure statement will be submitted along with UC Support 1. Timely release of funds required 2. Meetings of the Rogi Kalyan Samitis to be regularly held Timeline Activity 2007- 2008-09 2009- 2010- 2010- 08 10 11 12 Untied Fund of Rs 50000/CHC 5 6 7 8 9 Annual Maintenance grant of Rs 5 6 7 8 9 100000/CHC Plan for maintenance to be developed x x x x x and approved by the Rogi Kalyan Samitis Plan for use of untied funds x x x x x Rogi Kalyan Samitis to identify mode of x x x x x construction and repair
Budget Activity / Item 2007-08 2008-09 2009-10 2010-11 2011-12 Total Untied Fund of Rs 50000/CHC 2.5 3 3.5 4 4.5 17.5 Annual Maintenance grant of Rs 5 6 7 8 9 35 100000/CHC Total 7.5 9 10.500 12.000 13.500 52.5
115 B- 5. Mobile Medical Units Situation There are many underserved areas in the district. Analysis/ There is also shortage of staff due to which all the areas are not covered. Current There is no Communications system either. Status The district is divided in Hilly (Bani, Basholi), & Border belt which are difficult areas in terms of outreach and accessibility. Also during floods and pilgrimages it is difficult to provide services to all. .
Objectives/ Meeting the unmet health needs of the people residing in difficult and underserved areas, through provision of healthcare at their doorstep Strategies Operationalizing a Medical Mobile Unit (MMU) Activities 1. Joint meeting of the District Health Society and the Rogi Kalyan Samiti (RKS) to decide the appropriate modality for Operationalization of the MMU. 2. Formation of a Monitoring Committee 3. The RKS will operate the MMU for long-term sustainability of the intervention. 4. Staff will be hired on contract by the RKS – MO, male and Female Nurse, Lab Technician, Pharmacists, Members of Ayush, private providers, IMA members, NGOs, two drivers, Specialist from District Hospital and Medical Colleges, etc; 5. Need Analysis to be carried out for determining the areas of MMU. 6. Development of a monthly roster for operationalizing MMU 7. Services will be given from 9 am to 4 pm from Monday to Friday. Saturday is for the maintenance of the vehicle. 8. Services to be provided: • ANC, PNC, Immunization • Diagnostic – Haemoglobin, Urine, Blood Sugar, Blood slide for Malaria, etc; • Treatment of minor ailments • Referral of cases needing Specialist care • Provision of Emergency services • Dissemination of information through the use of TV/DVD player • Holding meetings of Village water and Sanitation Committees • Maintenance of Records 9. Wide publicity before the arrival of the MMU 10. Communication support for the personnel 11. Periodic Review. Support Govt Order from the State for exemption of the Regular Staff from providing services in the required MMU Timeline 2007-08 2008-09 2009-10 2010-11 2011-12 Operationalizing the MMU 1 Orientation of the staff x x x x x Wide Publicity x x x x x
116 Strengthening the MMU x x x x Addition of services x x x x
Budget Activity / Item 2007- 2008- 2009- 2010- 2011- Total 08 09 10 11 12 Cost of Mobile van 26.85 0 0 0 0 26.85 Cost of Diagnostic Van 23.75 0 0 0 0 23.75 12.7376 Personnel 8.7 9.57 10.527 11.5797 7 53.11437 31.5580 34.7138 Recurring cost 23.71 26.081 28.6891 1 11 144.751921 0.36602 Orientation 0.25 0.275 0.3025 0.33275 5 1.526275 0.36602 Joint workshop 0.25 0.275 0.3025 0.33275 5 1.526275 Total 83.51 36.201 39.8211 43.8032 48.1835 251.518841
Detailed Calculations
Budget for Vehicles, Equipment and Accessories S.No Head Unit Cost 1. Cost of Vehicle for staff to MMU 5,00,000 2. Cost of Vehicle for carrying A/V aids, equipment etc 18,00,000 3. Prefabricated tents & Furniture 1,50,000 4. Equipment 2,00,000 5. Mobile Phone (one for each Driver) 10,000 6. Computer system with Printer 30,000 Total 26,85,000
117 Budget of Personnel
S.No Head Months Unit Units Amount Cost
1. Emoluments to MOs -1 12 21005 1 252060 2. Emoluments to Specialists –2 12 20000 480000 (Part time) 2 3. Lab Technician 12 9900 1 118800 4. Pharmacist 12 12810 1 153720 5. Nurse 12 12810 2 307440 6. Class IV 12 3500 2 84000 Total 1396020
Budget for Recurring Expenses
S.No Head Months Unit Cost Units Amount
1. Salary of Drivers –3 12 6800 3 244800 2. Drugs 12 15000 1 180000 3. POL & Maintenance of Vehicles 12 35000 1 420000 4. Maintenance of equipment 100000 5. Mobile Phone bill -5 12 500 5 30000 Total 974800
118
B – 6. Upgrading CHCs to IPHS Situation 1. All the 4 CHCs are running in government buildings owned by Health Department. Analysis/ 2. Tap water supply is available in all the 4 CHCs of the district Kathua. Current 3. Facility survey reveals that residential facility all the CHCs need additional staff quarters for all categories of personnel as per IPHS standards. Status 4. Required furniture is not available in any of the CHCs. 5. In CHCs, out of 236 recommended equipments, 48.80% are available in the district 6. In CHCs only 47% of the drugs recommended as per IPHS are available in district Kathua Objectives To upgrade all the CHCs as per IPHS standards Strategies 1. Availability of all personnel as per IPHS 2. Proper building 3. Adequate Laboratory, Blood Storage Unit, Equipment and Drugs Activities All CHCs to be equipped having facilities of FRUs as per IPHS standards • Hiring of additional staff as per IPHS with 7 Specialists and 4 MOs, in each of the facilities, 10 staff nurses,! PHN, 1 Computer clerk, 1 Dresser, 1 Pharmacist, 1 Lab Technician, 1 BEE, 1 Radiographer, 1UDC, 1Accountant, 1Clerk, 1Epidemiologist and ancillary staff like Aya, Chowkidar, Dhobi, Sweepers, Peon and filling of Vacancies • Building to be built for CHC with staff quarters Support State to sanction posts as per IPHS required Allowing Contractual Personnel at Market Rates Timeline Activity / Item 2007-08 2008-09 2009-10 2010-11 2011-12 New buildings with staff quarters 1 1 1 1 1 Repair /alterations/additions of CHCs 4 Repair /alterations/additions of Staff 4 Quarters Construction of Staff Quarters 4 Equipment 4 1 1 1 2 Medicines, 4 5 6 7 8 Furniture 4 1 1 1 2 Generator 4 1 1 1 2 Computer 4 1 1 1 2 Maintenance x x x x x
Budget 2007- 2008 2009- 2010- 2011- Total 08 -09 10 11 12 New buildings with quarters, 79.2 79.2 79.2 79.2 79.2 396 CHC Building Repair, Alteration and Addition @ 10 Lakh 40 0 0.000 0.000 0.000 40 Construction of Staff Qtrs of MO/ Specialist @ 7.2 86.4 0 0.000 0.000 0.000 86.4
119 Construction of Staff Qtrs of SN @6 96 0 0.000 0.000 0.000 96 Construction of Staff Qtrs of class [email protected] 19.2 12 0.000 0.000 0.000 31.2 Repairing of Staff Qtrs @ 10 Lakh/CHC 40 0 0.000 0.000 0.000 40 Furniture @1.2 X No of CHCs 4.8 1.2 1.2 1.2 1.2 9.6 Equipment @ 22.9 X No of CHCs 177.5 88.76 22.19 22.19 22.19 22.19 20 Recurring cost of CHC excluding Man 375.16 35.39 23.39 23.39 23.39 480.7 Power 2 Purchase of generator sets @ 0.6 lakh x No of CHCs 2.4 0.6 0.6 0.6 0.6 4.8 Recurring & Maintenance cost of generator sets Rs. 140 X 30 days X 12 12.30 months X 7 No of CHCs 2.016 2.22 2.44 2.68 2.95 8 Computer ,printer,fax @60000 X CHC 2.4 0.6 0.6 0.6 0.6 4.8 AMC of computer @ 6000 X CHC 0.24 0.30 0.33 0.36 0.40 1.632 Total 153.6 129.949 130.226 130.530 1380. 836.576 976 36 3 93 980
120 B – 7. Upgrading PHCs for 24 hr Services and IPHS norms Current 1. Out of 39 PHCs, 26 of the PHCs are running in government buildings owned by Health Status Department. 2. Water supply is very critical indicator of health delivery system but unfortunately this facility is available only in 19 PHCs. 3. Electricity supply is very essential for safe deliveries and only 29 PHCs have electric supply. 4. Sanitation facility for males and females is available only in 6 PHCs. 5. Labour room is available only in 3 PHCs. 6. Facility survey reveals that residential facility is available in 8 PHCs. 7. Required furniture is available in 32 PHCs but needs to be repair and maintenance. 8. MOs in existing PHCs in district Kathua are 32 and required number of MOs is 78 with an identified gap of 46 MOs. 9. Identified gaps for pharmacists, nurses, female health worker, Health Educator clerks and class IV are 46, 4, 93, 37, 72 and 97 respectively as per IPHS standards. 10. In PHCs, out of recommended 106 types of equipment, 60.81% equipments are available in district Kathua. 11. In PHCs only 55% of the drugs recommended as per IPHS are available in district Kathua. Objectives To establish all the PHCs for 24 hour delivery and IPHS Strategi 1. Availability of all personnel as per IPHS es 2. Proper building with staff quarters in all PHCs 3. Adequate Laboratory, Equipment and Drugs 4. Additional PHCs Activitie 1. Hiring of additional staff as per IPHS with 2 MOs( maybe Ayush), in each of the facilities, 3 s staff nurses, 1 PHN, 1 Lab Technician, Part time Pharmacist, 1UDC, 1 Accountant, and Class IV and filling of Vacancies 2. Building with adequate quarters in all the PHCs 3. Upgrading the Laboratory for tests necessary for 24 hour PHCs 4. Furniture, Drugs and Equipment as per IPHS norms
Support State to sanction posts as per IPHS required Allowing Contractual Personnel at Market Rates Time Activity / Item 2007-08 2008- 2009-10 2010- 2011-12 Frame 09 11 New buildings with quarters 3 7 3 Repair/ additions/ alterations of PHCs 10 11 3 Repair/ additions/ alterations of Staff 3 5 Quarters Staff Quarters at PHCs 5 21 Additional staff quarters @ 19.2/PHC 5 21 Furniture 12
121 Electricity connections 10 Equipment 20 19 Water Connections 29 Generator 39 Computer System 39 Toilets 6
Budget Activity / Item 2007- 2008- 2009- 2010- 2011- Total 08 09 10 11 12 Construction of Building with staff Qtrs for 113.4 264.6 113.4 0.000 0.000 491.4 building less PHCs @ 37.80 PHC Building Repair, Alteration and Edition @ 2Lakh 20 22 6 0.000 0.000 48 Construction of Staff Qtrs for PHCs have own building 144 604.8 0.000 0.000 0.000 748.8 Additional Staff quarters for PHCs have own building 96 403.2 0.000 0.000 0.000 499.2 Repairing of Staff Qtrs @ 5Lakh/PHC 15 25 0.000 0.000 0.000 40 Furniture @1 X No of PHCs 12 0 0.000 0.000 0.000 12 Equipment @ 11 X No of PHCs 220 209 0.000 0.000 0.000 429 Recurring cost of PHCs excluding Man 151.632 151.63 151.63 151.63 151.63 758.16 Power 2 2 2 2 Purchase of generator sets @ 0.6 lakh x 23.4 0 0.000 0.000 0.000 No of PHCs 23.4 Recurring & Maintenance cost of 19.656 21.621 23.784 26.162 28.778 generator sets Rs. 140 X 30 days X 12 6 months X No of PHCs 120.002 Computer with scanners, printers, UPS , 23.4 0 0.000 0.000 0.000 Fax@60000 /PHC 23.4 AMC of computer @ 6000 X No of PHC 2.34 2.574 2.831 3.115 3.426 14.286 Total 1704.4 297.64 180.90 183.83 840.828 28 7 9 6 3207.648
122 B – 8. Upgrading Sub Centres to IPHS norms Situation Out of 152 Subcentres only 61 Subcentres are functioning in Govt. buildings. Analysis Water supply is very critical indicator of health delivery system but unfortunately this facility is available only in 39 of the Subcentres. Electricity supply is very essential for safe deliveries at Subcentre but status of electricity is poor in Subcentres. Only 25 SCs have electric supply. Sanitation facility for males and females is available only in 9 of the Subcentres. Labour room is available only in one Subcentre. Facility survey reveals that residential facility is available only in 38 Subcentres, Required furniture is available in 76 Subcentres. The Staff, Drugs, Equipment, Cold Chain, Accommodation for smooth functioning of Sub- Centres is insufficient. For running 152 Subcentres in the district, only 115 ANMs are in position and delivering health care services at grassroots level. As per IPHS standards, 2 ANMs are required for one SC and accordingly district Kathua will be requiring 304 ANMs and at present total identified gap is 189 ANMs. Out of 55 recommended equipments at Subcentre level, only 37.81% of the equipments are available in Subcentres of the district Kathua. Most commonly available equipments are stethoscope, Weighing machine, BP Apparatus, Thermometer, micro glass slides, scissor, syringe, torch etc. Facility analysis of the district Kathua reveals that kit A is not available in the Subcentres at all, 46% of the kit B is available. There is irregular supply of Kit A&B. The supply of Kit A&B is not in proportion of population. In general out of 106 recommended drugs at Subcentre level only 38% of the total medicines are available in the district Kathua. None of the Subcentres are according to IPHS norms. Objectives Upgrading of Subcentres as per IPHS standards Strategies 1. Filling up vacancies and hiring additional staff 2. Quarters for the ANMs 3. Opening Additional Subcentres to cater to the entire population Activities 1. 91 sub centres must be constructed and additional 55 Sub-Centres are required. 2. Additional ANMs, Safaiwalas for each Sub-Centres must be recruited in each sub centre whose population is more than 6000 3. Electricity, Water facilities in every Sub-Centre 4. 61 Sub-Centres require addition and alteration 5. Sufficient drugs, machinery equipments, cold chain unit for each sub-centre, etc. Support Smooth flow of Funds. required
123 Time line Activity / Item 2007-08 2008-09 2009-10 201 2011- 0-11 12 Total Subcentres 160 180 200 220 220 New buildings with quarters, equipment 23 25 17 5 5 and Furniture for new centres New buildings with quarters, equipment 10 50 31 and Furniture for existing centres Repair/Addition/Alteration 20 13 2 Staff Quarters 30 31 Staff Quarter for additional ANM 20 41 Electricity connections 40 87 Water Connections 40 73 Toilets 40 103
Budget Activity / Item 2007- 2008- 2009- 2010- 2011- Total Details 08 09 10 11 12 New buildings with quarters, 370.26 equipment and Furniture 113.546 123.42 83.926 24.684 24.684 0
New Subcentres @ Rs. 4,93,680/SC 192.535 488.74 non recurring for existing SC 49.368 246.84 2 0.000 0.000 3 Repair, Addition and Alteration of Subcentre @2lakh 40 26 0.000 0.000 66 Staff Quarters @ Rs 3 lakhs per Quarter for 2 ANMs 90 93 120.000 0.000 0.000 303 Additional Staff Quarters @ Rs 3 lakhs per Quarter for additional ANMs 60 123 0.000 0.000 0.000 183
Recurring costs of the additional 96.216 108.24 120.270 132.200 92.608 549.53 Subcentres 4 Total 117.29 1960.5 449.130 720.5 516.731 156.884 2 37
124 B-9 Untied Funds and Incentive Fund for the Village Health and Water Sanitation Committees Situation Block No of VHWSC formed in District Kathua Analysis/ Hiranagar 174 Current Parole 130 Status Basholi 96 Bani 68 Billawar 87 Total 555
NRHM has placed a lot of stress on Community involvement and formation of Village Health & Water Sanitation Committees (VHWSC) in each village. These committees are responsible for the health of the village. In District Kathua 555 committees have been formed but need strengthening to improve their functioning. The selection of ASHA, her working, progress of the village is part of the responsibilities of the Gram Panchayat.
In Kathua there are 456 villages with population less than 1500. There are 85 villages with population between 1500 and 3000. There are 13 villages with population more than 3000. Hence these amount to 656 units of 1500 population.
Objectives 1. Strengthening the Village Health & Water Sanitation Committees through financial support Strategies 1. Provision of annual Untied funds of Rs 10000 each year to the villages upto a population of 1500 2. Provision of Rs 5000 as permanent advance fund for Incentives for ASHA Activities 1. Provision of Annual Untied funds of Rs 10000 each year to the villages upto a population of 1500. Villages with more than 1500 population upto 3000 will get twice the funds. Villages with population more than 3000 will get three times the funds. Hence there will be 539 units of population 1500 or less to get the funds annually of Rs 10,000.00 2. This untied fund is to be used for household surveys, health camps, sanitation drives, revolving fund etc; 3. Orientation of the MPHWF for the utilization of the untied funds and she in turn will orient the Village, Health & Water Sanitation committee. 4. Provision of Rs 5000 as permanent advance fund for Incentives for ASHA based on performance norms. 5. Monthly meetings of the VHWSC for reviewing the funds and activities. This is to be facilitated by the MPHWF 6. Monthly review at the PHC level regarding the VHWSC functioning and utilization of funds. Support 1. State should ensure the orientation procedure for the VHWSC required 2. Funds to be transferred on time to the MPHWF 3. PRIs to ensure proper usage and accounts Timeline 2007- 2008- 2009- 2010- 2011
125 08 09 10 11 -12 Untied Fund of Rs 10000/unit for Pop x x x x x 1500/unit x 656 units Orientation and reorientation of the VHWSC x x x x x Provision of Rs 5000 as permanent advance x x x x x for incentives to ASHA Monthly meetings of the VHWSC x x x x x Review of the VHWSC functioning at PHC x x x x x level
Budget Activity / Item 2007- 2008- 2009- 2010- 2011- Total 08 09 10 11 12 Untied Fund of Rs 10000/unit 65.6 65.6 65.6 65.6 65.6 328 1500/unit x 656 units Permanent Advance to VHWSC 8.75 10 10.85 11.100 11.350 52.05 for ASHA incentive @ Rs5000/SC 0 Total 74.35 75.6 76.45 76.700 76.950 380.05 0
126 PART C: Immunisation C-1. Strengthening Immunization Situation Vaccine Numbers immunized Percentage Analysis DPT Polio 1st dose 15960 97.45 DPT Polio 2nd dose 15963 97.47 DPT Polio 3rd dose 14494 88.50 BCG 14192 86.66 Measles 15027 91.76 DT 2nd dose 431 2.63 Vitamin A 1st dose 15130 92.39 Vitamin A 2nd to 5th dose 23359 Full Immunization 5787 35.34 Source: CMO office 2005-2006
1. As per the District data for 2006, 88% children had received 3rd dose DPT, 88% 3rd dose Polio vaccination, 87% BGC had been given to the children and Measles to 92 %. Complete Immunization is present in 35.34 % children in the age group 24-35 months.
2. As per DLHS 2002, 97 % children were immunized against BCG, 44.3 % against all the three doses of DPT 3, 47.7 % against all the three drops of polio and 85.6 % against Measles. Overall, only 38.7 % of the children were fully immunized. The availability of health facilities in villages definitely affected and increased the immunization of children.
3. The reasons for children not being Immunized are related to the ignorance of the mothers on the importance of immunization, the place and time of Immunization sessions and fear of side effects. The community perceives that the Polio drops given repeatedly at the time of Pulse Polio campaign, is equivalent to complete immunization.
4. The ANMs have to take the vaccines from the PHC headquarters resulting in them not reaching the hamlets and also the difficult areas and also the Pulse Polio campaign. Supervision is not done properly at PHC level. Also there is large gap between reported and evaluated coverage.
Objectives Reduction in the IMR to 50% of baseline (2007) by 2012 1. 100 % Complete Immunization of children (12-23 month of age) by 2012 2. 100 % BCG vaccination of children (12-23 month of age) by 2012 3. 100 % DPT 3 vaccination of children (12-23 month of age) by 2012 4. 100 % Polio 3 vaccination of children (12-23 month of age) by 2012 5. 100 % Measles vaccination of children (12-23 month of age) by 2012 6. 100 % Vitamin A vaccination of children (12-23 month of age) by 2012 Strategies 1. Strengthening the District Family Welfare Office
127 2. Enhancing the coverage of Immunization 3. Alternative Vaccine delivery 4. Effective Cold Chain Maintenance 5. Zero Polio cases and quality surveillance for Polio cases 6. Close Monitoring of the progress Activities 1. Strengthening the District Family Welfare Office • Support for the mobility District Family Welfare Officer (@ Rs.3000 per month (towards cost of POL) for supervision and monitoring of immunization services and VHD Days • One computer assistant for the District Family Welfare Office will be provided for data compilation, analysis and reporting @ Rs 4500 per month. 2. Training for effective Immunization Training for all the health personnel will be given including ANM, Health Supervisor, MPWs, Cold chain handlers and statistical assistants for managing and analyzing data at the district. 3. Alternative vaccine delivery system (mobility support to PHC for vaccine delivery) • For Alternative vaccine delivery, Rs. 50 to the ANM will be given per session. It is proposed to hold two sessions per week per Subcentre • Mobility support (hiring of vehicle) is for vaccine delivery from PHC to VHD days site where the immunization sessions are held for 8 days in a month 4. Immunization sessions to be carried out at each VHD day weekly 5. For 100 difficult villages the monthly outreach sessions will be used for Immunization. The ANM, ASHA, AWW will inform the parents a day in advance. 6. Incentive for Mobilization of children by Social Mobilizers • Rs.100 per month will be given to Social Mobilizers for each village for mobilization of children to the immunization session site. This money will be provided to ASHA wherever possible but if there is no ASHA then it will be given to someone nominated from the village by the PRIs. This could be given to the Numberdars and Chowkidars. 7. Incentive to for each child ( 12 – 23 months) completely immunized • Rs 150 will be given for each child completely immunized including Vitamin A two doses – Mothers, ASHAs / SHG groups, Numberdars and Chowkidars. This will be verified by the AWW and ANM. 8. Contingency fund for each block • Rs. 100/ month per block will be given as contingency fund for communication. 9. Disposal of AD Syringes • For proper disposal of AD syringes after vaccination, hub cutters will be provided by Govt. of India to cut out the needles (hub) from the syringes. Plastic syringes will be separated out and will be treated as plastic waste. Regarding the disposal of needles, Pits will be formed at at every village as per CPCB guidelines. For construction of the pits at PHC, SC and villages a sum of Rs. 2000/ pit has been provisioned. 10. Outbreak investigation • Rapid Action Team for epidemics will be formed
128 • Dissemination of guidelines • Training of Rapid Action Team for investigating outbreaks who will in turn orient the ANM during Sector meetings 11. Adverse effect following Immunization (AEFI) Surveillance: • Standard Guidelines have been developed at national level and will be disseminated to the district officials and block levels in Review meetings. 12. IEC & Social Mobilization Plans • Rs 25 per session of Immunization fro IEC activities ( 96 villages once a month and In 290 villages 4 times a month) (Discussed in details in the Component on IEC) 13. Cold Chain • Repairs of the cold chain equipment (@ 750/- per PHC & CHC will be given each year • For minor repairs, Rs. 10,000 will be given per year. • Electricity & POL for Genset & preventive maintenance (Running Cost) of Walk in Coolers (WICs) & Walk in Refrigerators (WIF) () @ 15000/equipment per two months plus Rs. 1000 per machine for POL for Genset. • Payment of electricity bills for continuous maintenance of cold chain for the PHC @ 300 per month PHC (vaccine distribution centres) has been budgeted under this head. • POL & maintenance of vaccine delivery van @ Rs. 3000/month for maintenance and POL for Vaccine delivery van for regular supply of vaccine to the PHC. 14. Effective Supervision and monitoring: For increasing the immunization supervision and monitoring are very important. • The number of LHVs and Male Health Supervisors need to be adequate hence vacancies need to be filled up. • Mobility support for MOs @ Rs 1000/session for hiring a vehicle/ mules 15. HMIS The formats for Immunization should be properly filled for each child. The data should be shared in each review meeting for further planning. Support State to ensure the following: required • Regular supply of vaccines and Autodestruct syringes • Reporting and Monitoring formats • Availability of Monitoring charts • Cold Chain Modules and monitoring formats • Temperature record books • Polythene bags to keep vaccine vials inside vaccine carrier • Polythene for the vaccines to avoid labels being damaged • Training of Cold Chain handlers • Training of Mid level managers Timeline Activity 2007-08 2008-09 2009-10 2010-11 2011-12 Alternative Vaccine delivery x x x x x
129 Children for Immunization 5000 7500 10000 12000 14000 Incentive Mop up Round x x x x x Pit formation 587 587 587 587 587 MCH Cards 50000 50000 50000 50000 50000 IEC activities x x x x x Tracking bags x x x x x Orientation in Tracking bags x x x x x Maintenance of Cold Chain x x x x x Provision of Generator x
Budget Activity 2007- 2008- 2009- 2010- 2011- Total 08 09 10 11 12 Mobility support for alternative vaccine 7.296 9.6 10.416 10.656 10.896 48.864 delivery Rs. 50 per session for 2 planned sessions per week at each Subcentre village for 12 months = Rs. 50x2 sessionsx4 weeks/mthx12 monthsx SCs Vehicle for distribution of vaccines in remote 29.952 32.94 36.242 39.874 43.861 182.876 areas @ Rs 800 per PHC for 2 times per 72 week x 4 weeks x 12 months x PHCs Mobility Support Mop up campaign @ Rs 23.4 23.4 23.4 23.4 23.4 117 10000 per PHC ( Including travel, vaccine delivery, IEC) x 6 rounds/ year x PHCs Mobilization of Children by Social Mobilizers 56.352 56.35 56.352 56.352 56.352 281.76 @ Rs. 100/ session x2 sessions per week x 4 2 weeks/mth X 587 village x12 mths Incentives to mothers @Rs 150 per child for 7.5 11.25 15.000 18.000 21.000 72.75 full immunization Contingency fund for each block @ 0.6 0.6 0.6 0.6 0.6 3 Rs.1000/month x 5 blocks x 12 months Pit Formation for disposal of AD Syringes and 117.4 117.4 117.4 117.4 117.4 587 broken vials (@ Rs. 2000 per pit per village Printing of Immunisation cards @1.50 per 0.75 0.825 0.908 0.999 1.099 4.581 card x 50000 cards each year Special IEC session @25/session X100 1.2 1.320 1.452 1.597 1.757 7.326 villages 4 times a yearn Maintenance of Cold Chain Equipments 4.46 3.2 3.260 3.320 3.380 17.62 (funds for major repair) (@ Rs.750 per PHC/CHC for the first year then Rs. 500 per PHC/CHC per month) and 50,000 for minor repairs
Provision of Generator at all facilities upto 23.5 0.5 0.5 0.5 0.5 25.5 PHC DH: Rs 1.5 lakhs x 1, CHCs – 7x 0.50,
130 PHCs – 40x 0.5 in first year
Recurring & Maintenance cost of generator 22.176 24.39 26.833 29.516 32.468 135.387 sets Rs. 140 X 30 days X 12 months X No of 4 PHCs & CHCs POL & maintenance for Vaccine delivery van 1.8 1.98 2.180 2.400 2.640 11 at district level @ Rs.15000/month x 12 mths Running Cost of WICs & WIF (Electricity & 7.02 7.72 8.490 9.340 10.270 42.84 POL for Genset & preventive maintenance) Rs. 90000 for electricity @ 15000 equipment per two months plus Rs.8000 per annum @1000 for POL for genset at DH Mobility support to District Family Welfare 0.36 0.396 0.436 0.479 0.527 2.198 Officer@ 3000/month Computer Assistant for District Family 0.54 0.594 0.653 0.719 0.791 3.297 Welfare Office @ 4500 Mobility support for Monitoring Immunization 1.56 1.716 1.888 2.076 2.284 9.524 sessions for MO's PHC @1000/session 305.866 294.1 306.00 317.22 329.22 1552.522 Total 94 9 8 4
131 PART D: National Disease Control Programme D-1. RNTCP Situation Data for the Year Jan 2006 to Dec 2006 TU Kathua TU Billawar District Analysis Indicator Value Value Value Slides examined 63810.00 76724.00 140534.00 No. Suspect Examined 2449.00 1861.00 4310.00 Suspects per Lakh Population 629.00 785.00 687.00 No. Smear Positive Diagnosed 295.00 176.00 471.00 % Smear Positive among suspects 12.00 9.00 10.93 % Smear Positive Put on DOTS 99.00 100.00 99.00 Total Patients Put on treatment 674.00 374.00 1048.00 ACDR 693.00 374.00 669.00 New Smear positive Treatment 178.00 374.00 303.00 Annulized New Smear Positive Case Detection Rate 182.00 210.00 194.00 % New Smear positive of Total New Pulmonary Cases 39.00 54.00 44.00 3 Months Conversion rate 91.00 81.00 85.00 Cure Rate of New Sputum Positive Patients 77.00 71.00 74.00 Success Rate of New Sputum Positive Patients 77.00 75.00 76.00
A total of 140534 slides were examined. There were 4310 patients suspected of TB687 per lakh. Of these 471(10.93%) had smear positive for TB. A total of 1098 cases were put on DOTS in 2006. The Cure rate is 74% and smear conversion rate is 85%. To fight Tuberculosis the revised National Tuberculosis Control Programme based on the DOTS regime was launched in 1993. Under this programme in District Kathua 2 Tuberculosis Units have been established with microscopic centres. Objectives Reduction in the cases of Tuberculosis by 25% 100 % detection of Cases 85 % Cure rate in New Cases Detection of 70% new smear positive cases once cure rate of 85% is achieved Reduction in the defaulter rate to less than 5% Strategies 1. Improvement in the infrastructure 2. Improvement in the quality of the intervention 3. Increasing the outreach of the programme 4. Increasing the awareness regarding Tuberculosis Activities 1. Improvement in the infrastructure • Improved DTC building with a computer room • Improved MC centres and TC centre 2. Improvement in the quality of testing of sputum
132 • Training to the RNTCP staff in the district • Equipment maintenance – Microscope, Computer and Others • Adequate supply of drugs 3. Increasing the outreach of the programme by Increasing the DOTS providers through involvement of ASHAs who will be paid Rs. 500 per year for providing services. She will be oriented regarding DOTS. Also the AWH should be involved in reporting suspicious cases. Training will be given to ASHA for identifying the suspects. 4. Incentive scheme (prizes of 1000, 2000, 3000) to various people (sweeper, DOT provider, LTs) 5. The patient will be given an incentive of Rs 250 on completion of the treatment. Increasing the awareness regarding the various issues of Tuberculosis through involvement of Rehbar-e-Sehat teachers and NGOs. Special drive for detection of cases on World TB day through the involvement for all departments 7. DOTS regime to be strictly monitored through the VHWSC, Rehbar-e-Sehat teachers, the PRIs and the PHC MO 8. Address verification system to be developed 9. Electronic information sharing to be initiated 10. Strengthen prevention – wearing of masks by patient Support • Persons carrying the sputum to DMC required • Every health centre should be a collecting centre • Private DOT provider may be paid as a Govt allowed payment to 25% payment • Supervisory Vehicles is being required for monitoring purpose. • POL/Maintenance of vehicle is being required. • Telephones and computers Persons carrying the sputum to DMC Timeline 2007- 2008- 2009- 2010- 2011- 08 09 10 11 12 Improving the DTC building, MC Centres and TC centres x x Increasing the DOT providers through ASHAs x x x x x Training to RNTCP staff and ASHA x x x x x Awareness drives x x x x x Mask Provision
133 Budget Activity / Item 2007- 2008- 2009-10 2010-11 2011- Total 08 09 12 Civil Works DTC building 1.5 lakhs 1.5 0 0.000 0.000 0.000 1.5 MC 0.28/MC 2.8 0 0.000 0.000 0.000 2.8 TU 0.35/Tu except 1.05 0 0.000 0.000 0.000 1.05 DTC Material and supplies 1.2 1.32 1.450 1.600 1.760 7.33 Laboratory material 1 1.1 1.210 1.330 1.460 6.1 Training 10.45 11.495 12.645 13.909 15.300 63.79829 5
Awareness drive on World TB day 1 1.1 1.210 1.330 1.460 6.1 IEC activities 1 1.1 1.210 1.330 1.460 6.1 Salaries of contractual staff 7.71 8.481 9.329 10.262 11.288 47.07032 1 Vehicle maintenance inc POL 1 1.1 1.210 1.330 1.460 6.1 2 wheeler 4 wheeler Hiring of vehicle 1.7 1.87 2.060 2.270 2.500 10.4 DTO MO TC @ Rs 0.42lakh/yr Equipment and maintenance 0.085 0.094 0.103 0.113 0.124 0.519 Microscope @ Rs1000/yr/microscope
Computer@ Rs 5000/yr Photocopier/Fax Rs2500/ machine Miscellaneous – TA/DA, 0.195 0.215 0.247 0.272 0.300 1.229 Telephone, Meetings, Electricity repair etc Total 30.69 27.875 30.674 33.746 37.112 160.097
134 Detailed Calculations
Training in RNTCP Personnel Unit Units 2007-08 Cost DTO State MOTC 23320 2 46640 MO 15580 32 498560 STS 6726 2 13452 STLS 16720 2 33440 LT 5972 10 59720 MPW 2875 22 63250 ANM 2875 115 330625 1045687
Personnel RNTCP Personnel Unit Units Months Amount Cost TB health visitor 6750 2 12 162000 STS 7000 2 12 168000 STLS 7000 2 12 168000 LT 6500 2 12 156000 Data Entry Operator 6000 1 12 72000 Accountant 1250 1 12 15000 Driver 4500 1 12 54000 Total 795000
135
D-2. LEPROSY Situation Balance New cases Cases Balance Per 10,000 Proportion Analysis Cases at detected in Discharged in Cases at Population of Deformity beginning of year year end of year Ratio year among PB MB PB MB RFT O.D PB MB PR NCDR cases 2 8 6 5 4 - 6 11 0.27 0.17 -
There are 1-2 new cases per month detected each month. These cases are from outside the district and not from within the district itself). A total of 17 cases are on treatment for treatment A & B Objectives Eradication of Leprosy by 2012
Strategies 1. Detection of New cases & 2. House to house visit for detection of any cases Activities 3. IEC for awareness regarding the symptoms and effects of Leprosy 4. Prompt treatment to all cases 5. Rehabilitation of the disabled persons Timeframe 2007-08 2008-09 2009-10 2010-11 2011-12 House to house detection x x x x x Wide publicity x x x x x Rigorous follow-up x x x x x Treatment x x x x x
Budget Activity / Item 2007-08 2008- 2009-10 2010- 2011- Total 09 11 12 Contractual Staff 0.462 0.462 0.462 0.462 0.462 2.310 Honorarium 0.048 0.048 0.048 0.048 0.048 0.240 Office Expenses 0.150 0.150 0.150 0.150 0.150 0.750
POL & maintenance 0.360 0.360 0.360 0.360 0.360 1.800 Supportive drugs 0.120 0.120 0.120 0.120 0.120 0.600 Consumables/Stationery 0.120 0.120 0.120 0.120 0.120 0.600 3 Day training of Mos 0.500 0.500 0.500 0.500 0.500 2.500 1 day refresher training 0.120 0.120 0.120 0.120 0.120 0.600
TA for contractual staff and NLEP 0.100 0.100 0.100 0.100 0.100 0.500
IEC activities 0.5 0.5 0.5 0.5 0.5 2.500 Total 2.480 2.480 2.480 2.480 2.480 12.400
136
D-3. NATIONAL MALARIA CONTROL PROGRAMME Situation Analysis Issues No. Total Blood Slides Examined (BSE) Jan 2006 –Dec 2006 54431 Total Positive Cases: 16 Plasmodium Vivax (Pv): 15 Plasmodium Falciparum (Pf): 1 Slide Positivity Rate (SPR) 0.028% Slide Positive plasmodium Falciparum Rate (PFR) 0.002 Annual Blood Examination Rate (ABER) NIL Deaths NIL Source: CMO office Malaria is a serious health problem due to many reservoirs of stagnant water. Each year there are many epidemics and these result in a lot of morbidity. In J & K disease surveillance for Malaria was introduced under National Malaria Eradication Programme. Now the programme is known as National Vector Borne Disease Control programme. Under this District malaria Working Committee has been constituted and representatives from various departments are there but there is very little help from these departments. In the DDCs 54431 slides were taken due to fever during the year. The main bottlenecks are related to shortage of manpower especially for the remote areas. Also there is lack of skills for taking blood slides, record keeping and there is lack of motivation. Objective Reduction in SPR, API, PFR death rate to 10% by 2012 s Strategies 1. Provision of additional Manpower 2. Training of personnel 3. Strengthening of Malaria clinics 4. Addressing Disease outbreak 5. Health education 6. Involvement of Private sector 7. Innovative methods of Mosquito control Activities 1. Provision of additional Manpower • The posts of MPW Male and the MPHS need to be filled up • Hiring of personnel till regular staff in place 2. Training of personnel The MOs, Laboratory Technicians, MPWs and Health Supervisors, ANMs, ASHAs will be trained in various techniques relating to the job 3. Strengthening of Malaria clinics • Provision of Proper equipment and reagents – 3 small Fogging machines for each
137 PHC, sprayers, • Pulse Fog Machine at District HQ • Provision of Jeep, Truck, 4. Addressing Disease outbreak • District Outbreak teams will be created at the district headquarter • In the team MO, LT, one MPW, one field worker • Provision of mobility, Lab equipments, spray equipment 5. Health education to the community through the ANM, AWW, ASHAs, RMPs, Ayush personnel Involvement of Private sector: The private practitioners will be closely involved Hoardings at each CHC, PHC and DH Support • Availability of supplies required • Filling up of vacancies • Supply of health Education material • Regular Supply of Gambusia fish Timeline Activity / Item 2007-08 2008-09 2009-10 2010-11 2011-12 Hiring Contractual Staff x x x x x Purchase of Jeep and Trucks x x x x x Fogging & Spraying x x x x x Hoardings 5 CHC & 39 PHC 39 PHC 39 PHC 39 PHC 39 PHCs 6 CHC, 7 CHC, 8CHC, 9CHC, IEC activities x x x x x
Budget Activity / Item 2007- 2008- 2009-10 2010-11 2008- Total 08 09 12 Salary Contractual staff 7.71 8.481 9.329 10.262 11.288 47.070 Travel expenses @ Rs 4000/ 3.36 3.696 4.066 4.472 4.919 20.513 month for jeep x 12 months, @6000/month for Truck Office expenses @ Rs 5000 0.6 0.66 0.730 0.800 0.880 3.67 per month x 12 Jeep and maintenance 6 0.6 0.660 0.730 0.800 8.79 Trucks – 6 and maintenance 32 3.2 3.52 3.872 4.259 46.851 Training 10.800 30.970 33.130 34.610 35.080 144.590 3 small Fogging machines for 125 12.5 13.75 15.125 16.638 183.013 each PHC @ Rs 1.00 lakh and one at District HQ Pulse Fog Machines @ Rs.8.00 lakh per unit and maintenance Misc @ Rs 1.00 and Rs 4.9 5.39 5.929 6.522 7.174 29.915 20000 per CHC, and for PHC Rs 10000
138 Board hoarding:8’x 12’ at the 1.25 1.5 1.750 2.000 2.250 8.75 CHC and District hospitals @ Rs 25,000/- Board hoarding: 5’x3’ initially 3.9 3.9 3.9 3.9 3.9 19.5 at the PHC@ Rs 10,000/- Total 195.520 70.897 76.764 82.293 87.188 512.662
Detailed calculations
Contractual Staff Personnel Unit Cost Units Months Amount Spray and Fogging staff 4000 5 12 240000 LT 6500 5 12 390000 Data Entry Operator 6000 1 12 72000 Accountant 1250 1 12 15000 Driver 4500 1 12 54000 Total 771000
Training Malaria Personnel Unit Cost Units 2007-08 units 2008-09 units 2009-10 units 2020-11 units 2011-12 DTO State MO 15580 32 498560 78 1215240 78 1215240 78 1215240 78 1215240 LT 5972 21 125412 39 232908 39 232908 39 232908 39 232908 MPHS 1925 31 59675 39 75075 39 75075 39 75075 40 77000 MPW 2875 1 2875 175 503125 200 575000 217 623875 222 638250 ANM 2875 115 330625 350 1006250 400 1150000 434 1247750 444 1276500 ASHA 100 630 63000 640 64000 650 65000 665 66500 680 68000 1080147 3096598 3313223 3461348 3507898
139 D-4. OTHER VECTOR BORNE DISEASES Situation Other VBDs No. Analysis Kalazaar NIL Dengue 2 Lymphatic Filariasis NIL Japanese Encephalitis NIL
During the year 2006-07 there were 2 cases of Dengue in District Kathua. There were no suspected cases of Chikingunya. It is expected that intensive efforts should be made to prevent emergence of Chikingunya in District Kathua. Objectives No incidence of Dengue by 2012 Prevention of JE, Chikingunya and other new infections Strategies 1. Reduction of vector density 2. Mosquito-man contact reduction 3. Community awareness Activities 1. Reduction of vector density • Identification of breeding sites • Fogging and spraying • Covering of any breeding sites 2. Preparedness for new infections • Increase in Manpower • Training of personnel for identification of new infections • Preparation of Laboratories in the district and State to diagnose the new diseases • Preparedness of dealing with the epidemic outbreak 3. Community awareness as part of the IEC for Malaria and IDSP • Group meetings • Pamphlets/ handbills • Public announcements • Kala Jathas 4. One jeep for Entomologist (already covered in malaria budget) 5. One truck for shifting manpower and drums /equipment (in malaria budget) Support Support from State Laboratory and the NICD for diagnosing Dengue, Chikingunya, JE etc; required Support from District Administration, PRIs, WCD, PHEd, Time Frame Activity / Item 2007- 2008-09 2009- 2010 - 2011-12 08 10 11 Fogging and Spraying x x x x x Pamphlets x x x x x Kala Jathas for Malaria, Dengue and x x x x x Chikingunya
140
Budget Activity / Item 2007- 2008- 2009- 2010 2011- Total 08 09 10 -11 12 Unforeseen expenses 0.5 0.55 0.610 0.670 0.740 3.07 Pamphlet, poster @1lakh 1 1.1 1.210 1.331 1.464 6.105 Kala Jathas for Malaria, Dengue 5.87 6.457 7.103 7.813 8.594 35.837 and Chikingunya @ Rs 1000 per village x 587 Total 7.37 8.107 8.923 9.814 10.798 45.012
141 D-5. BLINDNESS CONTROL PROGRAMME Situation Indicators No. Analysis Total Cataract surgery performed Cataract surgery with IOL School going children screened Children detected with refractive error Children provided with free corrective spectacles Villages having no register
Eye Care is being provided through the DH but there is one Ophthalmologist in the district and two Ophthalmic Assistants. `The norm for GOI is 1 Ophthalmologist for a population of one lakh. Hence in this district at least 6 Ophthalmologists are required. The norm for Ophthalmologist to Ophthalmic Assistant is 1: 3-4 hence a minimum of 18 are required. The private sector too is inactive in the district. In 2006-07 a total of Operations of cataract were carried out. The norm for the cataract operations is 700 operations per year per Ophthalmologist. There is a need to urgently tackle the cataract cases and hold eye camps each month. There is no Eye Bank or Eye donation centre in District Kathua. The nearest Eye Bank is at Jammu Medical College. Objective 1. Reduction in the Prevalence Rate of blindness to 0.5 % by 2012 s 2. Decrease in the Prevalence Rate of Childhood blindness to 0.6 % per 1000 children by 2010 3. Usage of IOL in 100 % of Cataract operations Strategie 1. Provision of high quality Eye Care s 2. Expansion of coverage 3. Reduce the backlog of blindness 4. Development of institutional capacity for eye care services Activities Determining the prevalence of Cataract through a study by an external agency. One time house-to-house survey for study of prevalence of vision defects and Cataract of entire population leading to referrals and appropriate case management including cataract surgeries Increasing the number of Ophthalmologists either by hiring or through involvement of Private Sector. Training in IOL to private Ophthalmologists Training of Paramedical staff and Teachers, NGOs, Patwaris and AWW for screening of school children and IEC activities. AMC for all equipment will be done. Equipment: Purchase of latest equipment for regular surgeries Construction of Eye Unit in Hospitals and later CHC Supply of basic Eye medicines like eye drops, eye ointments and consumables for Primary Eye Care in PHC/CHC.
142 All PHC and CHC to be developed for vision screening and basic eye care Eye Care centre Vision Centre Screening Eye Surgeon Primary Eye Care Identify Blind Treatment of eye conditions & follow-up Vision Test Maintain Blind Register Training Screening Eye Camps Motivator Supervision Referral for surgery Referral Blind Register to be filled up by the AWW, together with PRIs Health Mela at each CHC Eye Camps with the involvement of Private sector and NGOs from other districts if no agency is available in Kathua. School Eye Screening sessions IEC activities Support Procurement of latest equipment for hospitals by GOI required Timely Repair of equipment
Timeline Activity / Item 2007- 2008-09 2009-10 2010-11 2011- 2008 12 H-H Survey for Vision defects x Health Mela 5 CHCs 6CHCs 7 CHCs 8 CHCs 9 CHCs IEC activities x x x x x School Eye Screening 100 100 100 100 100 Blind Register x x x x x Observance of Eye Donations x x x x x Cataract Camps 39 PHCs 39 PHCs 39 PHCs 39 PHCs 39 PHCs Development of PHC and CHC as 5 PHCs 20 PHCs 14 PHCs 1CHC 1CHC Vision Centres 2 CHCs 4 CHCs 1CHC Development for CHC for Eye Unit 1 1 Training of School teachers 200 100 100 100 100 100 Training of PRIs 200 200 200 200 200 Repair and purchase of equipment and x x x x x maintenance
143 Budget Activity / Item 2007- 2008- 2009- 2010- 2011- Total 2008 09 10 11 12 Health Mela @50000 / CHC 2.5 2.75 3.025 3.328 3.660 15.263 IEC @1lakh 1 1.1 1.210 1.331 1.464 6.105 School Eye Screening @1000 X100 1 1.1 1.210 1.331 1.464 6.105 school Blind Register 0.587 0.425 0.467 0.514 0.565 2.357 Observance of Eye Donations 0.15 0.17 0.190 0.210 0.230 0.95 Cataract Camps @ Rs 20000 per 7.8 8.58 9.438 10.382 11.420 47.620 camp x 40 PHC POL fro Eye Camps @ Rs 0.78 0.858 0.944 1.038 1.142 4.762 2000/camp x40 House to house survey for vision 10 0 0.000 0.000 0.000 10 defects @ 10 lakhs Training of School teachers @ Rs 0.1 0.11 0.121 0.133 0.146 0.611 100/head x 100 Training of PRIs @ Rs 100/head x 0.2 0.22 0.242 0.266 0.293 1.221 200 Repair and purchase of equipment 20 2 2.200 2.420 2.662 29.282 and maintenance Total 43.916 17.313 19.047 20.953 23.047 124.275
144
D-6. Integrated Disease Surveillance Programme Current The programs with major surveillance components include: Status • The National Anti-Malaria Control Program • National Leprosy Elimination Program • Revised National Tuberculosis Control Program • Nutritional Surveillance • National AIDS Control Program • National Polio Surveillance Program as part of the Polio eradication initiative • National Programme for Control of Blindness (Sentinel Surveillance)
Surveillance activities of all these vertical programs of Malaria, Tuberculosis, Polio, HIV are functioning independently leading to duplication of Surveillance efforts. Surveillance has been ineffective due to There are a number of parallel systems existing under various programs which are not integrated. The existing programs do not cover non-communicable diseases. Medical colleges and large tertiary hospitals in the private sector are not under the reporting system as well as for utilization of laboratory facilities. The laboratory infrastructure and maintenance is very poor Presently, surveillance is sometimes reduced to routine data gathering with sporadic response systems thereby leading to slow response to Epidemi cs , Information technology has not been used fully for information and to analyze and sort data so as to predict epidemics based on trends of the reported data.
In response to these issues the Integrated Disease Surveillance Programme was launched in J & K to provide essential data to monitor progress of on going disease control programs and help in optimizing the allocation of resources. IDSP includes 15 diseases/ conditions (Malaria, Acute diarrhoeal disease-Cholera, Typhoid, Jaundice, Tuberculosis, Acute Respiratory Infection, Measles, Polio, Road Traffic Accidents, Plague, Yellow Fever, Meningoencephalitis /respiratory distress, etc., HIV, HCB, HCV) ) and 5 state specific diseases (Thyroid diseases, Cutaneous Leishmaniosis, Acid Peptic Diseases, Rheumatic Heart Diseases).
Establishing of District Surveillance unit Upgradation of PSU Labs Water testing labs are in place V-Sat is been installed but training is required Rapid response teams are being established at District levels. DSUs (District Surveillance Units) are being established in all districts One Computer, Printer and Scanner has been received
145 Objectives 1. Improving the information available to the government health services and private health care providers on a set of high-priority diseases and risk factors, with a view to improving the on- the-ground responses to such diseases and risk factors. 2. Establishing a decentralized state based system of surveillance for communicable and non- communicable diseases, so that timely and effective public health actions can be initiated in response to health challenges in the country at the state and national level. 3. Improving the efficiency of the existing surveillance activities of disease control programs and facilitate sharing of relevant information with the health administration, community and other stakeholders so as to detect disease trends over time and evaluate control strategies. Strategies 1. Strengthening data quality, analysis and links to action; 2. Improving the laboratories 3. Training of all the stakeholders in disease surveillance and action 4. Coordinating and decentralizing surveillance activities 5. Intersectoral Coordination and involvement of communities and the private sector Activities 1. Strengthening of the District Surveillance Unit (DSU), established under the project, • Training of the Unit Incharge for epidemiology – {DMO) • Administrative Assistant • Training of contract staff on disease surveillance and data analysis and use of IT • Providing support for collection and transport of specimens to laboratory networks • Provision of computers and accessories • WEN connectivity to be operationalized • Provision of software of GOI 2. Setting up of Peripheral Surveillance Units at CHC 3. Sensitizing the Community for • Notifying the nearest health facility of a disease or health condition selected for community- based surveillance • Supporting health workers during case or outbreak investigations • Using feedback from health workers to take action, including health education and coordination of community participation. • Meetings with the SHGs, school teachers, Numberdar and Chowkidars for sensitisation and prompt reporting of cases 4. Improvement in the Laboratories at the district and at CHC through provision of equipment and consumables Support Provision of supplies on time required Time Activity / Item 2007-08 2008- 2009- 2010- 2011- Frame 2009 2010 2011 12 Renovation of Labs with provision of 1 District Hosp, PSU at equipment, furnishings, material 2 CHC 5 CHC Training x x x x x Contractual staff
146 Software for DSU & training of staff x x x x x WEN connectivity x x x x x Sensitization of Community x x x Meetings with SHGs x x x x x Meetings with teachers x x x x x Meetings with Numberdar and Chowkidars x x x x x
Budget Activity / Item 2007 2008- 2009- 2010 2011- Total -08 09 10 -11 12 Renovation of Labs at CHC a@ Rs 20,000 1 0.000 0.00 0.000 1 0 Renovation of Lab at District Hospital @ Rs 1.4 0.14 0.180 0.20 0.220 2.14 140,000 and maintenance 0 Equipment for Lab at PSU at CHC and @ Rs 2 0.4 0.4 0.4 0.4 3.6 40,000 Equipment for Lab at District @ Rs 850,000 8.5 0 0.000 0.00 0.000 8.5 0 Computer and Accessories at CHC @50000 2.5 0.5 0.5 0.5 0.5 4.5 Office for PSU at Maintenance CHC @ Rs 0.5 0.1 0.1 0.1 0.1 0.9 10,000 per unit Office Maintenance for DSU @ Rs 10,000 0.1 0.1 0.100 0.10 0.100 0.5 0 Software for DSU@ Rs 335000 3.35 0 0.000 0.00 0.000 3.35 0 Furnishing of Lab at PSU at CHC and @ Rs 0.5 0.1 0.1 0.1 0.1 0.9 10,000 Furnishing of Lab at DSU @ Rs 60,000 0.6 0 0.000 0.00 0.000 0.6 0 Material and supplies at Lab at PSU at CHC @ 0.4 0.08 0.08 0.08 0.08 0.72 Rs 8,000 Material and supplies at Lab at DSU @ Rs 75,000 0.75 0.83 0.910 1.00 1.100 4.59 0 Contract Staff at District level @ 200000/yr for 4 2 2.2 2.920 3.71 4.580 15.41 staff yr wise 0 IEC activities 1 1.1 1.210 1.33 1.460 6.1 0 Training and retraining 0.98 3,02 3.030 3.04 3.050 10.100 0 0 WEN connectivity 0.5 0.55 0.610 0.67 0.730 3.06 0 Operational costs at PSU for Surveillance @ Rs 0.75 0.15 0.15 0.15 0.15 1.35 15000/year x 7 Operational costs at DSU for Surveillance @ Rs 1.3 1.430 1.573 1.73 1.903 7.937 130000/year 0 14.0 15.49 17.04 18.7 20.62 86.009 Honorarium to Numberdars and Chowkidars for
147 reporting @ Rs 100pm x 587 Numberdars and 88 7 6 51 6 587 Chowkidars x12 Total 42.2 23.17 28.90 31.8 35.10 161.265 18 68 9 61 0
Detailed Budget for Trainings
Unit 2007-08 2008- 2009- 2020- 2011- Personnel Cost Units units 09 units 10 units 11 units 12 MPW 785 1 785 152 119320 152 119320 152 119320 152 119320 Lab Assistant 905 5 4525 6 5430 7 6335 7 6335 7 6335 (CHC) Lab Assistant at 3110 2 6220 2 6220 2 6220 2 6220 2 6220 District MOs 1835 32 58720 78 143130 78 143130 78 143130 78 143130 DST 4 members 6950 4 27800 4 27800 4 27800 4 27800 4 27800 98050 301900 302805 302805 302805
148
D-7. Iodine Deficiency Disorders Situation Iodine is one of the essential micronutrients. Minimum requirement is 150 microgram per day. Analysis The main source of Iodine is from soil and water. Iodine is taken from food grown in iodine rich soil. At present there is a depletion of Iodine in the soil due to which there is a deficiency of Iodine. Deficiency result in a variety of disorders ranging from Abortion, stillbirths, Goitre, impaired mental function, retarded growth.
In J & K the National Iodine Deficiency Programme is being implemented. People in J & K consume rock Salt and crystal salt Objectives/ 1. Prevention of Iodine Deficiency diseases 2. Consumption of Iodized salt by 100% families Strategies 1. Supply/monitor quality of Iodized salt 2. Assessment of the magnitude of the problem 3. Laboratory Monitoring of Iodized salt and urine samples 4. Health Education Activities 1. Supply/monitor quality of Iodized salt 2. Monitoring is done through Food Inspectors who collect two samples of salt per month per district and send it to a laboratory. 3. The Health workers have been supplied with Kits to test samples at least five per month. 4. Review is done in the monthly meetings 5. Monitoring through School health programme – Testing of samples and awareness 6. Supply of Testing kits to AWCs, Schools, SHGs 7. Assessment of the magnitude of the problem 8. This will be done by the Central Survey team 9. Laboratory Monitoring of Iodized salt and urine samples 10. Health Education: An IEC strategy is essential to promote the consumption of Iodized salt through AWWs, PRIs, NGOs, ASHA, SHGs etc; Demonstration of Iodized salt by school children through testing, Rallies, sensitisation of shopkeepers for keeping Iodized salt. 11. Testing of salt at shops and homes Support 1. Regular Supply of Testing Kits required 2. Regular Supply of Iodized salt 3. Regular supply of IEC material Timeline Activity / Item 2007- 2008- 2009- 2010- 2008- 08 09 10 11 2012 Large Village meetings for awareness on x x x x x IDD and consumption of Iodized salt Programme in schools – 100 Primary, x x x x x Upper Primary, Secondary- Govt and Private by School health team
149 Awareness programme with the SHGs and 587 587 587 587 587 shopkeepers villages villages villages villages villages
Budget Activity / Item 2007- 2008- 2009- 2010- 2008- Total 08 09 10 11 2012 Large Village meetings for 1 1.100 1.210 1.331 1.464 6.105 awareness on IDD and consumption of Iodized salt Programme in schools – 100 2 2.200 2.420 2.662 2.928 12.210 Primary, Upper Primary, Secondary- Govt and Private by School health team Awareness programme with the 2.935 3.229 3.551 3.906 4.297 17.918 SHGs and shopkeepers @ Rs 500 per village x 587 villages Total 5.935 6.529 7.181 7.899 8.689 36.234
150
6: Inter-Sectoral Convergence
6.1 Partnership with AYUSH department
In District Kathua there are twenty ISM (AYUSH) Dispensaries in which 45 dispensaries are sanctioned & 6 dispensaries are working with internal arrangements. Majority of the dispensaries are situated in far-flung areas & along with actual line of control.
Building Status: Running in Government buildings– 20 Rented – 31
Status of AYUSH in the integration with NRHM ( CMO data 31.5.07) Parameter of Integration with AYUSH Status No. of PHCs where AYUSH practitioners have been co Expected nil located (05-06) Achieved nil No. of PHCs where AYUSH practitioners are being co Expected nil located (06-07) Achieved nil Health Society yes Whether AYUSH officer included in (Y/N) Rogi Kalyan Samities yes ASHA Training yes No. of AYUSH Doctors Posted on contractual CHCs nil appointment in PHCs nil No. of AYUSH Paramedics posted on contractual CHCs nil appointment in PHCs nil DH 1 No. where AYUSH facilities is co-located PHCs nil CHCs nil
Separate funds have not been provided to this department for creation of infrastructure as per the IPHS including staff quarter accommodation, requisite medicines (including emergency Medicines) & manpower.
ISM doctors are fully trained & competent to conduct deliveries & can contribute a lot in implementing the concept of institutional deliveries .But it is unfortunate that these services are not being utilized maybe out of bias or some other reasons. Without any special facility the ISM Doctors are conducting deliveries where they are posted & no alternative facility is available with the people. For implementation of national programme hundred all ISM (AYUSH) staff is involved in the field. But there is no cold chain facility, lab facility & other incentives.
There are no guidelines for conducting of joint meetings between ISM (Ayurvedic/ Unani) & allopathic at District & block levels. However an informal meeting is held once in a year. There is no binding by way of
151 govt. orders from the higher authorities. The status IEC strategy for Ayurveda & allopathic should be jointly prepared & planned by director ISM & Director health (Allopathic).The IEC funds & material should be jointly shared & should be at the disposal of director ISM & director Health separately.
1. Constitution of RKS in ISM 2. CHC and PHC will provide AYUSH services 3. Involvement of Ayurvedic dispensaries in implementation of national health programmes.
Issues / Areas Areas of cooperation Areas of convergent action Curative ; In order to provide medicare facilities The ISM doctors are providing the Patient care, to the masses there is a vast health Medicare facilities by the way Surveillance potential for cooperation with health of providing Ayurvedic / Unani referral department so as to implement all medicine but as the dispensaries of the national programes like National AYUSH are located in the Isolation / Malaria eradication Programme, T.B. far flung areas where there is no control programme (DOTS), HIV / existence of any health facility Aids awareness programme, (Allopathic) in the form of primary implementation of institutional health centres / community health deliveries. centres or even allopathic dispensaries. Here people come The cooperation is also needed from across emergencies which are the department of social welfare, supposed to be attended by (ICDS) Anganwadi centres located in Ayurvedic / Unani doctors or staff. the areas where the ISM Therefore there is dire need of dispensaries are functioning by the emergency drugs, life saving drugs, way that the staff of these centres bandaging material, antiseptic (Anganwadi workers) can bring the lotions, antibiotics which are not unvaccinated children to the nearest supplied in ISM dispensaries. Due to ISM institutions so that their non availability of these drugs in complete vaccination should be some cases precious lives are lost done. Old routine is that medical and wrath of people falls on the staff officer of the concerned ISM of ISM institutions. Therefore life institution visits the Anganwadi saving drugs, antiseptic lotions & centre once in a month should be dressing materials need to be started for general health check up of supplied to avoid suffering of the the children of Anganwadi centres. ailing masses. Preventive; Immunization, Health department’s cooperation is As the facility of cold chain in the Prophylaxis services needed in providing ILR, Deep form of ILR’s & deep freezers is Promotive, IEC freezers to the ISM dispensaries .As provided to ISM institutions. Routine in District. Kathua only one ISM vaccination as well as out reach dispensary is functioning along with vaccination camps should be
152 District Hospital . Rest of the ISM organised easily in remotest & far Dispensaries are without flung areas. For IEC funds should be immunization facility as these are kept at the disposal of the Asstt. lacking cold chain facility , so twelve District. Medical officer so as it ISM dispensaries which are working should be used for awareness in Pucca buildings having electric Programmes. supply should be immediately provided cold chain facility in the form of ILR’s & deep freezers . Specific issues in Health Department to assist ISM Kits of Iron folic acid tablets should Implementation of national institutions & to provide kits of iron be provided to ISM institutions. ISM programmes Folic acid tablets directly to the Doctors can treat Pregnant women Maternal care dispensaries through the Asstt. as well as cases of iron deficiency District. Medical officer. All ASHAs anaemia is better way. In present operational in the areas of ISM situation only Ayurvedic / Unani institutions should be given training medicines which contain iron are on providing emergency health care given to pregnant women for services. deficiencies of Iron Child care Health department should cooperate As it contains Iron, Septran (Paed) & with Assistant District. Medical officer Antihelminthics tabs be provided ISM Kathua & kits containing Iron small & dispensaries better care of children folic acid, Septran (Paed) & suffering from iron deficiency Antihelminthics tabs should be anaemia, worm infestation & other supplied to ADMO office & then it is diseases. supplied to all the ISM institutions. As far as social welfare department As Anganwadi workers / helpers will is concerned Anganwadi workers can bring the children to the ISM bring unvaccinated children to the Dispensaries on a fixed date the goal dispensaries. of 100 % immunization could be achieved. Adolescent health Health department & education Some funds should be kept at the department organised camp far the disposal of the concerned ADMO for awareness of adolescent health age procuring IEC materials like banners group. Ayurvedic / Unani doctors / posters etc. for organising should be invited to give awareness awareness camps. With this people lectures & these camps should be living in remotest & far flung areas organised at ISM institution also. particularly adolescent age groups Education department can cooperate children can be benefited from this with ISM institutions in a particular awareness campaign as most of the areas & through chief education ISM institutions are in remotest & far officers or Zonal education officers, it flung areas.
153 should be made mandatory that medical officer of that area should visit schools & give awareness lectures to the adolescent children on different issues. School Health Education department’s help is When approached by the concerned needed for the health check up of chief education officer/ Zonal children as done as a routine matter education officers, the ISM Doctors few years back. are willing to provide these services for general health check up of children of different schools. Leprosy Cooperation from health department After diagnosis of a case of leprosy is needed to train ISM doctors/ the anti-Leprotic drugs should be Paramedical staff. All ISM doctors, made available directly to ISM paramedical staffs should be given institution so that patients can avail training to address sensitive health the medicines from the nearest issues like Leprosy. dispensary IDD Health department cooperation is Only IEC activities are done on our needed own to aware the masses about the iodine deficiency diseases. Tuberculosis Health department should cooperate Anti tuberculosis drugs Dots therapy with ISM department & all ISM should be provided directly to ISM doctors /paramedical staff should be dispensaries so that patient of trained through regular training / Tuberculosis can avail the facility workshop from to time laboratory from the nearest dispensary as in facility with laboratory technician some far flung areas. There is no should be provided existence of allopathic institutions & only ISM institutions are catering the health needs of the areas HIV/AIDS Cooperation from health department Funds for AIDS awareness camps is needed for training of ISM Doctors should be kept at the disposal of / Paramedical staff for AIDS. Regular Asstt. District. Medical officer at workshops training Programmes District. Level so that IEC material should be organised so that like Banners , pamphlets etc should knowledge of the staff is updated be disturbed to the masses so that about the disease. exact cases of the disease its sign & symptoms are known to the people or IEC material from health (allopathic ) department should be supplied to the ADMO’s Water borne diseases PHE department & health If the cases of the particular disease
154 departments’ cooperation is needed. on particular area rises. In order to As water born disease are due to the check it chlorine tablets & other infected water chlorine tablets should drugs should be supplied to the ISM be supplied. institutions so that Medical officers / officials can treat the cases. IEC materials for water born diseases should be kept at the disposal of ADMO .So that according to need it should be distributed about the masses & awareness camps about the staff drinking water should be organised as in rural areas major source of drinking water is well, springs, & the water is often polluted in rainy season. RTI/ STI Health department to provide As antibiotics are provided to ISM medicines, antibiotics as to check institutions, Medical officers of these RTI / STI. One laboratory technician institutions can treat the patients of with laboratories should be given to RTI /STI in a better way & by dispensaries providing laboratory facilities in these institutions which are situated in remotest areas , the diagnosis of diseases Is made in initial stage that helps in treatment of the patient.
6.2 ICDS projects Issues / Areas Areas of Areas of convergent action cooperation Linkages to be AWW share information/records of pregnant mothers and Coordination with allied developed between newborns with ANMs. departments ICDS workers and AWW help in tracking beneficiaries and bring them for health workers for immunization. timely diagnosis of They keep community informed of next session’s date of malnourished health checkup camp and immunization. children and their AWW should reports disease outbreaks in the village to management. ANM. IEC to be developed and disseminated to the community regarding food and nutrition. Health Department For proper management of malnourished cases,
155 medicines will be supplied along with the PHC and CHC drug kits annually.
6.3 Rural Development Department
Issues / Areas Areas of cooperation Areas of convergent action Linkages to be developed • Demand driven approach with During the initial base line survey between the Health Department increased emphasises on conducted in district Kathua for and the Rural Development awareness assessment of the hygienic department • Subsidy for individual household behaviour and knowledge about units replaced by incentive the sanitation in the rural population, it • Improving the health standard poorest of poor household. was observed that barely 5% of the & general quality of life of rural • Rural school sanitation is major rural population has basic sanitary community. component for wider related facilities like household • Awareness on sanitation/ acceptance of children who can toilets & rest of the population nearly Hygiene & health education. encourage their parents for 95% go for open defecation. The • Covering of school / sanitation environment. (KAP) study conducted revealed that Anganwadi in rural areas with • Awareness generation amongst the basic hygiene behaviour of the sanitation facilities & promote the A.P.L families for general public was very poor. Hygiene education & sanitary construction of toilet by their habits among students. own. Since inception of the total sanitation • Promote & encourage cost • Amount of Rs Four thousand Per campaign project in district Kathua effective construction of school toilet to be added from rigorous (IEC) campaign has been household latrine & their NRHM as the twenty thousand taken up in all the community proper use. is not sufficient for construction development blocks in district • Elimination of open defection of school toilet in hilly belt . Kathua .as a result as of today the to minimise the risk of • Anganwadi toilet in private basic hygiene behaviour of the contamination of water source houses with a cost of Rs Five public improved considerably. As a & food. thousand for each Anganwadi result of sustained (IEC) campaign • Toilet facility at PHC, CHC, DH, around 30427 families including • Toilet construction at all Bus have been motivated to use & stands, District offices, blocks, constructed house hold toilet (4862). all departments. Also around three hundred no of • Services of doctor & paramedical school toilets (293 out of sanctioned staff for awareness for 800) have been constructed under sanitation condition & the project. Out of 50 sanctioned environment.
156 sanitary complexes 10 have been • For IEC constructed. • For Solid Waste Disposal in towns and cities
6.4 Public Health department Issues / Areas Areas of cooperation Areas of convergent action People of the district Kathua are still Health and ICDS Bleaching powder and chlorine dependant on traditional water sources, Departments tablets will be provided by IPH and in certain areas water from hand-pumps distributed by field functionaries to is perceived to be unfit for consumption, households and water availability is falling short of Joint communication strategy. requirement. Copy of water quality monitoring The practice of boiling water for reports generated by IPH department drinking purpose is not prevalent will be shared with the Health Department at block, district and state levels Community based organisations formed under various programmes/sectors will be engaged by a team of frontline workers – health, ICDS and IPH departments.
6.5 PRIs Issues / Areas Areas of cooperation Areas of convergent action The PRIs have been envisaged to play a very Motivating the Joint plans important role in NRHM. community Joint review and monitoring Availability of Mobilization of the community for At the village level they are part of the VHWSC. personnel and action on health care issues, safe At the Gram Panchayat level they are part of the services drinking water and sanitation. Gram Panchayat health committee. Similarly at Participation in the VH Advocacy at village, Gram the Block and the District they are part of the Days panchayat, block and district level. Block and District health mission. Giving importance to issues of health in the At the Subcentre the Sarpanch is the joint Gram Panchayat signatory to the bank account for the operation of meetings the Untied funds of Rs 10000.
In the Gram Panchayat meetings held twice each month the PRIs review the activities of the health department along with the ICDS
157 Convergence –PRI system and capacity building, NGO coordination, Public Private Partnership, Training and Meetings of committee members Problem Identified 1. Non Existence of PRI and systems. & Core Issues. 2. Lack of quality conscious private health service providers for partnership 3. Need for strengthening Village health, water and sanitation committees and training them 4. Difficult to communitize health services due to non-availability of good NGOs and community organisations. 5. Lack of formal institutional mechanisms for convergent actions with NRHM related sectors Solutions • PRI systems need to be in place proposed (Activity • PPP need to be developed and CME to be provided to private providers plan) • All the members especially the members of PRIs need to be imparted training in primary health care delivery system, which can be imparted at the PHC/ CHC level by the block MO or Medical Officers. • For joint efforts, monthly meetings of the committee as constituted above must be held and the meeting should be fixed in advance and the local panjayath leaders and MPHWs of the sub centres should arrange the meeting at sub centres. The local Medical Officer and Health Supervisors can also attend the monthly meeting. • MNGOs scheme need to be strengthened to communitise health services. • At the policy level formal mechanisms need to be put in place for convergent actions with other NRHM sectors. Support needed for Policy and funding support implementing changes Cost of • PPP initiative ( Chiranjeevi) has been proposed under RCH implementing • For training of PRI and VHWS committee members: Rs. 22 Lakhs changes • For regular monthly meetings: Rs.- 12 Lakhs • Educational materials-Rs 10 lakhs • Total Rs. 44 lakhs for one year and Rs 2 crores for 5 years Time needed to Three months after constitution of the committees. implement changes Sustainability of capacity of the committee members with decentralised powers. the changes Benchmark(s) Reduction in IMR & MMR and improvement in sex ratio by 10 points 2012. derived from this component
158 6.6 Education Department Issues / Areas Areas of cooperation Areas of convergent action For regular check up of school children Co-operation with health Strengthening of school there should be a provision for a doctor department PHED, RDD, health programme. (physician specialist) & expert team ICDS department. Promotion of yoga in the which will assist the doctor. school. Mid day meal in school is being Launching of Adolescent successfully carried. Cooks are Health programme engaged at Rs 500/mth Regular school health The message of balanced diet is not programmes being successfully carried out. School health education programme is not taking place regularly. There is no Adolescent Health programme in the district.
Inter Sectoral Convergence Situation Health is a social responsibility and is not the domain of the health department only. Analysis/ Unfortunately the total responsibility has fallen on the health department. The various Current departments have been involved in the Pulse Polio campaign which has led to the massive Status mobilization and success of the campaign. The District Health Society has been formed consisting of members of various departments. Block health societies will be formed and also at the sector, and village level. At the Gram Panchayat level under the Sarpanch Gram Panchayat committees have been formed consisting of various sectors. The Village health and Water Sanitation Committees also consist of various sectors and the community. In reality these committees need to be strengthened since they are not functional. All the various sectors are working separately although for the same cause. Hence there is a lot of duplication and wastage of resources. Although orders have been issued for convergence but other sectors do not participate readily. Joint working of the ICDS and health is happening on the Fixed Maternal Child Health and Nutrition day. This needs to be strengthened and streamlined. The community is not aware regarding this day. The forum of the fixed health day each week has a lot of potential and has not been used properly. Objectives 1. Providing Primary and basic quality health care services at the village level 2. Providing quality RCH services 3. Optimal utilization of RCH services by community especially women 4. Empowering women to facilitate them to seek and demand quality RCH services. Strategies 1. Strengthening the various Committees and Societies 2. Strengthening the VHD days
159 3. Joint action for various issues Activities 1. Joint workshops for Planning and Review at all levels • Orientation programmes • Monthly meetings 2. Strengthening the VHD days • Wide participation of all the sectors in preparation of the community and in the actual activities, in health education • Each Wednesday during Immunization sessions joint orientations by all sectors and problem solving for each of the sectors 4. Joint Action for Sanitation, provision of safe water, provision of services and personnel at facilities 5. Joint review at the Gram Panchayat meetings 6. Joint efforts for education of the girls, improving the sex ratio, raising age of marriage, improving the nutritional status, identifying the correct BPL families, income generation. 7. Joint CNAA to determine the needs and thereby developing the plans jointly 8. Realignment of the Health and the ICDS sectors for common data and common work boundaries. 9. ASHA to participate in all the meetings of the ICDS held each month. 10. At the CHC level monthly meetings are organized. This should be jointly organized with the ICDS 11. At the monthly meetings of the CMO, the officers of all the departments should come 12. Annual action Plans to be developed jointly through meetings at the village, Gram Panchayat, Sector and culminating in Block workshops and District workshops 13. Chiranjeevi Scheme to involve PRIs for promoting safe deliveries for rural BPL women through PPP initiative by involving the private sector 14. Upgrading Ayush at all levels from PHC to DH. 15. Involvement of the RDD for construction of toilets in all health facilities and public places Support Govt orders for intersectoral coordination with clear roles and responsibilities and If the various required sectors do not attend the meetings then the decisions will be taken and will be binding for all the sectors. Strict follow-up at the State level for ensuring coordination. Timeline Activity / Item 2007-08 2008-09 2009-10 2010-11 2011-12
Meetings of the Block Committees x x x x x Meetings of the Village groups x x x x x Joint CNAA training ( 1086 AWW, 152 ANM, x x x x x 630 ASHAs, 39 Supervisors, 39 MOs, 9 CDPOs) Joint monitoring at the sector level x x x x x Hiring of vehicle x x x x x Joint monitoring at the block level x x x x x
160 Yearly joint Planning Workshops at the Block x x x x x level for development of the Action Plans Yearly joint Planning Workshops at the District x x x x x level for development of the Action Plans Yearly joint Workshops to consolidate the x x x x x plans from the village to the Gram Panchayats to the Sectors and then Blocks at the Block level for Annual Action Plans
Budget Activity / Item 2007- 2008- 2009- 2010- 2011- Total 08 09 10 11 12 Meetings of the Block Committees @ Rs 1.08 1.188 1.307 1.437 1.581 6.594 1000 /meeting x 9 blocks x 12 months Meetings of the Village groups @ Rs 50 3.522 3.874 4.262 4.688 5.157 21.502 per village x 587villages x 12 Joint CNAA training @ Rs 200 per person 4.11 4.16 4.194 4.204 4.214 20.882 ( 1186AWW, 152ANMs, 630ASHAs, 39 Supervisors, 39 MOs, 9CDPOs) x 2055 Joint monitoring at the sector level Hiring of vehicle @ RS 1000/ day x 5 23.4 25.74 28.314 31.145 34.260 142.859 days/month x 39sectors x 12 months 4 Joint monitoring at the block level Hiring of vehicle @ RS 1000/ day x 5 5.4 5.94 6.534 7.187 7.906 32.968 days/month x 9 blocks x 12 months Yearly joint Planning Workshops at the 9 9.9 10.89 11.979 13.177 54.946 Block level for development of the Action Plans @ Rs 1.00 lakhs per block x 9 blocks Yearly joint Planning Workshops at the 1 1.1 1.21 1.331 1.464 6.105 District level for development of the Action Plans @ Rs 1.00 lakh Yearly joint Workshops to consolidate the 9 9.9 10.89 11.979 13.177 54.946 plans from the village to the Gram Panchayats to the Sectors and then Blocks at the Block level for Annual Action Plans @ Rs 1.00 lakhs per block x 9 blocks Yearly joint Workshops to consolidate the 1 1.1 1.21 1.331 1.464 6.105 findings at the block levels at the District level for development of the Action Plans @ Rs 1.00 lakh
PRIs
Chiranjeevi Scheme 24 44 44 44 44 200 Total 81.512 106.90 112.81 119.28 126.39 546.907 22 042 206 987
161
7. COMMUNITY ACTION PLAN
Community Health Action Situation Health is a social responsibility and is not the domain of the health department only. Analysis Unfortunately the total responsibility has fallen on the health department. The various departments have been involved in the Pulse Polio campaign which has led to the massive mobilization and success of the campaign. The District Health Society has been formed consisting of members of various departments. Block health societies will be formed and also at the sector, and village level. At the Gram Panchayat level under the Sarpanch Gram Panchayat committees have been formed consisting of various sectors. The Village health and Water Sanitation Committees also consist of various sectors and the community. A training module for the training of members of VHSC e prepared. Training of members has been carried out and regular meetings of the committee, twice a month, is held In reality these committees need to be strengthened since they are not functional. All the various sectors are working separately although for the same cause. Hence there is a lot of duplication and wastage of resources. Although orders have been issued for convergence but other sectors do not participate readily. Joint working of the ICDS and health is happening on the Fixed Maternal Child Health and Nutrition day. This needs to be strengthened and streamlined. The community is not aware regarding this day. The forum of the fixed Village health day each week has a lot of potential and has not been used properly Objectives 1. Providing Primary and basic quality health care services at the village level 2. Providing quality RCH services 3. Optimal utilization of RCH services by community especially women 4. Empowering women to facilitate them to seek and demand quality RCH services. Strategies 1. Strengthening the various Committees and Societies 2. Strengthening the VHD days 3. Joint action for various issues Activities 1. Joint workshops for Planning and Review at all levels • Orientation programmes • Monthly meetings 2. Strengthening the VHD days • Wide participation of all the sectors in preparation of the community and in the actual activities, in health education • Each Wednesday during Immunization sessions joint orientations by all sectors and problem solving for each of the sectors 3. Joint Action for Sanitation, provision of safe water, provision of services and personnel at facilities
162 4. Joint review at the Gram Panchayat meetings 5. Joint efforts for education of the girls, improving the sex ratio, raising age of marriage, improving the nutritional status, identifying the correct BPL families, income generation. 6. Joint CNAA to determine the needs and thereby developing the plans jointly 7. Realignmant of the Health and the ICDS sectors for common data and common work boundaries. 8. ASHA to participate in all the meetings of the ICDS held between the 20 th and 22 nd of each month. 9. At the CHC level monthly meetings are organized. This should be jointly organized with the ICDS 10. At the monthly meetings of the CMO the officers of all the departments should come 11. Annual action Plans to be developed jointly through meetings at the village, Gram Panchayat, Sector and culminating in Block workshops and District workshops Support Govt orders for inter-sectoral coordination with clear roles and responsibilities and If the various required sectors do not attend the meetings then the decisions will be taken and will be binding for all the sectors. Strict follow-up at the State level for ensuring coordination. Timeline Activity / Item 2007-08 2008-09 2009-10 2010- 2011-12 11 Formation of Block Committees x Orientation of Committee members at all x levels Joint Community action x x x x x Joint Annual Action Plan x x x x x Sector Alignment x x Reorientation of the Committees and x x x x x Societies Strengthening the Gram Panchayat x x x x x meetings and Gram Sabhas
Budget Activity / Item 2007- 2008- 2009-10 2010- 2008- Total 08 09 11 12 Training of the VHWSC @ Rs 200 per 17.61 19.371 21.308 23.439 25.783 107.511 person x 15 persons/village x587 villages Meetings of the VHWSC @ Rs 50 per 3.522 3.8742 4.262 4.688 5.157 21.502 village x 587 villages x 12 months Meetings of Women SHG @ Rs 100 per 0.587 0.6457 0.710 0.781 0.859 3.584 year x587 villages Honorarium for MOs for promoting 0.702 0.7722 0.849 0.934 1.028 4.286 Community health Action @ Rs 1000 pm and travel charges Rs 800 pm Total 22.421 24.663 27.129 29.842 32.827 136.882
163 8. Public Private Partnerships
Public Private Partnerships Situation The private sector includes NGOs, Private Practitioners, Trade and Industry Organisations, Corporate Analysis Social Responsibility Initiatives. / Current Status The private sector is the major provider of curative health services in the country. 43% of the total IUD clients obtain their services from the private sector. Engaging with it to provide family planning services has the potential to significantly expand the coverage of quality services. Public-private partnerships can stimulate and meet demand and have a synergistic impact of the RCH. To ensure efficient services of good quality from the private and public sectors, robust monitoring and regulatory mechanisms need to be developed so that the private sector can come forward and cooperate in all the National programmes and also in sharing its resources.
At present, no Public Private Partnership activity is going on in the District. MNGO and FNGO for implementing RCH not identified yet.
Various schemes have been tried out as pilots under of Govt. of Jammu & Kashmir under external aided projects.
Other services (Diet, scavenging, security, laundry, canteen, etc.) have also been piloted in few facilities.
Objectiv 1. Increasing the coverage of the health services and also increasing the accessibility for health es services 2. Widening the scope of the services to be provided to the clients Strategie Incentives and training to encourage private providers to provide sterilization services s Activitie Involve private players including NGOs/Trusts by providing a conducive environment for accessing s quality and affordable health care services to the community.
Partnership for Services for Training: Lot of capacity building activities are envisaged under NRHM, but departments neither have that much of expertise nor sufficient time to carry out the capacity building activities properly. Therefore, all such training programme will be outsourced to a capable agency selected by the DHS. Partnership for Services for IEC: For implementing and managing IEC activities (mela, shows, campaign, rally, Village Contact Drives etc) including designing and printing of IEC material, a technical and Technical Support Agency will be hired. Partnership for Services for Transportation: One agency will be hired for getting services of vehicles with drivers for field monitoring by the officers at District and below level, for transportation of drugs, equipment, linen and others up to the Sub Centre level. Drivers for department’s vehicles and ambulances will also be hired from such agency. Annual contract will be done for this purpose.
164
This kind of partnership will much effective for the unreached and far flung areas where there no motorable roads available. Alternate transport like Mules can be hired from the private sector. Partnership for Services for conducting Studies, survey and evaluations: For understanding the trends of diseases, impact of programs being implemented, assessing the health scenario, a technical support agency will be hired for conducting surveys, evaluation, Data analysis, HMIS etc. Partnership for School Health Programme: For covering all the primary schools both government and private and strengthening School Health Programme private organisations especially local NGOs will be involved. Partnership for Security: As some parts of the district are affected with the militancy, security of health personnel and institutions is a major concern of the district.
For providing security to all PHC and some selected Sub Centers , Ex-servicemen council or committees can be hired. Annual contract will be done for this purpose.
The following activities will be carried out: • To conduct Feasibility study for various PPP options in the district. • To develop detailed operational framework and schemes for various feasible options in the district. • To identify technical support agency for studies on above activities • To initiate one pilot innovative intervention based on the priority in each block of district. under PPP • To prepared resource directory of all active NGOs involved in health and development issues in the district. • To prepared a list of all private health care providers including Practitioners of alternative system of medicine in the district. • To conduct training need assessment (TNA) for all the identify private partners • To orient all identified privet partners on NRHM and various national health programmes • To strengthen the VIKALP scheme in the district. • To develop detailed framework or monitoring and evaluation of various PPP interventions • To conduct exit polls at General and Civil hospitals CHC, PHC from OPD IPD patients to improve the condition of the health facilities • Workshops for involvement of the Private sectors (one each with NGOs/Trusts/Private institutions; Media; Ex-servicemen association, transportation ,HR agencies) • Sharing Workshops with Private players Support Support required form the State to allow PPP; to develop a conducive environment by formulating a required workable PPP Policy.
165 Timeline Activity / Item 2006-07 2007-08 2008- 2009- 2010- 2011- 09 10 11 12 Feasibility study x Operational Frame work x x Operationalization of PPP x x x x x x Innovative interventions x x x x x x Advertisement for hiring technical support agency x for assisting for achievement of objective of PPP mentioned above Establishing technical support agency x Preparation of directories of resource agencies x x and privet partners TNA for private partners x x Capacity building x x x x x x NGOs, CBOs, ToT 2 batches x 25per batch on national health programme Training of pvt. Health care providers 2 batches x x x x x x x 25per batch on national health programme Capacity building of PRIs, VHWSC, SHGs and x x x x x x other field functionaries Area specific training modules x Monitoring and evaluation of PPP initiative x x x x x x
Budget Activity / Item 2007- 2008- 2009- 2010-11 2011-12 Total 08 09 10 Feasibility study on PPP issues 10 0 0.000 0.000 0.000 10 Innovative activities based on the study 0 20 20.00 20.000 20.000 80 Capacity Building of NGOs 0.5 0 0.500 0.000 0.500 1.5 Establishing Tech. Support Agency 2 2.2 2.420 2.662 2.928 12.210 Capacity Building of PRIs, SHGs, VHWSCs 0.5 0.55 0.605 0.666 0.732 3.053 Area specific Modules 0.5 0 0.000 0.000 0.000 0.5 Exit poles 2 2.2 2.420 2.662 2.928 12.210 5 Workshops for involvement of the Private sectors 2.5 0 0 0 0 2.5 (one each with NGOs/Trusts/Private institutions; Media; Ex-servicemen association, transportation ,HR agencies) @ 25000 per workshop Sharing Workshops with Private players 0 0.55 0.61 0.67 0.74 2.57 Admin and overhead Charges for hiring the 2 2.2 2.42 2.67 3 12.29 agencies TOTAL 20 27.7 28.975 29.330 30.828 136.83 3
166
9. GENDER AND EQUITY
Gender and Equity Situation Gender discrimination is a common phenomenon. It has a direct bearing on the health status of Analysis women and children. Some of the parameters are the Sex Ratio, Age at marriage, enrolment of girls in schools, Male sterilization. The main reasons are dowry.
The Sex Ratio shows a disturbing trend in district Kathua. The Sex Ratio as per Census of 2001 is 901.The Sex Ratio for 0-6 years as per 2001 census is 841. The Sex Ratio for 0-1 year and the Sex Ratio at birth is not available.
Kathua’s sex ratio is influenced by the neighboring states, because of the easy availability of MTP services, people prefer to go to Pathankot rather than coming to Jammu.
Advisory committees have been constituted in the district and their meetings are held periodically. The orientation of various stake holders has taken place last year for sensitising on PC-PNDT act There is only one MTP facility and that too at the district hospital only in the Govt. Sector in the district.
The status of implementations of PCV-PNDT, MTP act especially in private sector needs to be more intensively addressed. There is one Ultrasonography machines in Govt facilities and two in the private sector.
The topics of PNDT Act, Gender issues and Declining Sex ratio have been included in RCH training for Medical Officers conducted at RIHFW.
The Age at marriage for boys is 27.4 years and 22.5 for girls as per DLHS 2002 and that only 3 % girls in the rural areas were married below 18 years. There is no specific data on Gender Based Violence but women take it as part of marriage and hence undermine the facts.
Male involvement in Family Welfare is minimal since there are very few Vasectomies as against Tubectomies.The indicators for morbidity and mortality also show differential values for boys and girls. The service providers are also not gender sensitive . Objectives 1. To improve the decline in sex ratio in 0-6 years of age group 2. To reduce the domestic violence 3. To empower women in all age groups for gender equity 4. To enhances male participations in ensuring the gender balance and equity in the community 5. To develop capacities of various stake holder in Govt. and privet sectors on gender issues and various laws and acts related to establishing gender balance in the society 6. To ensure implementations of PC-PNDT and MTP act in the district.
167 7. To establish strong mechanism for monitoring of sex ratio and implementations of various acts to ensure gender balance and equity in the society Strategies Addressing Adverse Sex ratio Increasing male involvement in family planning Increasing male involvement in family planning Gender sensitization Activities 1. Addressing Adverse Sex ratio • Workshops with private providers, IMA members, Religious leaders, Caste leaders, PRIs, MLAs • Early registration of pregnancies through TBAs, ASHAs, AWWs, Numberdar and Chowkidar and any of these to get Rs 50 per case for early registration of pregnancy • Rallies in all schools and colleges and generating discussions in schools and colleges through debates • Regular advertisements in the newspapers • Swearing-in-ceremonies at the time of marriages regarding female foeticide • Regular meetings of the Appropriate Authorities • Registration of all Ultrasonography machines • Review of the monthly format to be filled by the Ultrasonography machines providers 2. Increasing male involvement in family planning • Use of condoms for safe sex • Vasectomy and NSV are safer and easier to perform in primary health centres than Tubectomy. • BCC activities to focus on men for Vasectomy. 3. Service delivery sites for male methods by training health providers in NSV and conventional vasectomy will be expanded so that each CHC and Block PHC in the district has at least a provider trained in NSV. • Demand for male contraceptive methods, men’s reproductive health services through designing and implementing male-focused BCC activities. 4. A Research Study on the sex ratio to understand the increase in the sex ratio for 0-6 yrs age. 5. Gender sensitization training will be provided for all health providers in the CHC/PHC and integrated into all other training activities so that they will have greater awareness of factors that influence women’s decision making and thereby help them respond better to the needs of women and support her in exercising her choice. 6. Health card would be provided to all girl children upto the age of 18 years. 7. Improving the Literacy status and promotion of education upto 10 th standard. 8. Treatment of anaemia in girls and also improving their nutritional status through Supplementary food at the AWCs 9. Reporting of Gender Based Violence cases by all the departments 10. Promotion of Samoohic Vivahs 11. Affidavit in court should be given regarding the dowry given to prevent false cases. 12. Preparation of GIS maps as planning tool to monitor and control decline sex ratio 13. IEC activities to raise the awareness regarding gender discrimination
168 14. Development of training modules Support Strict enforcement of the PCPNDT Act required Timeline Activity / Item 2006- 2007- 2008- 2009- 2010- 2011-12 07 08 09 10 11 Research study for the increase in sex ratio for x 0-6 years Preparation of GIS maps as planning tool to x monitor and control decline sex ratio Up gradation of GIS x x x x x IEC campaign through print audio visual and folk x x x x x x media Capacity building x x x x x x Orientation of public and Pvt health care x x x x x x providers including NGOs on various laws related to health specially PC-PNDT & MTP act Reorienttion x x x x x x Development/procurement training modules x Monitoring x x x x x x Periodic advisory committee meeting and field x x x x x x monitoring @ Rs.5000 x 4(this includes meeting, travel and other contingencies) Panchayat level vigilance committees to check x x x x x x decline in sex ratio and violence against women Training of all MOs, ANMs on gender issues x x x x x x
169 Budget Activity / Item 2007- 2008- 2009- 2010- 2011- Total 08 09 10 11 12 Research Study 10 0 0.000 0.000 0.000 10 Preparation of GIS maps for monitoring 5 1 1.000 1.000 1.000 9 IEC Campaign @2000 X587 villages 57.87 63.657 70.023 77.025 84.727 353.302 Periodic Advisory committee meetings @ 5000 0.2 0.22 0.242 0.266 0.293 1.221 Development of Trg. Modules 1 0 0.000 0.000 0.000 1 Traning of MO's &,ANMs 2 2.2 2.420 2.662 2.928 12.210 Panchayat level vigilance committees 1.83 2.013 2.214 2.436 2.679 11.172 @1000X183 Workshops with private providers, IMA members, 10 11 12.100 13.310 14.640 61.05 Religious leaders, Caste leaders, PRIs, MLAs in every block and Gram Panchayat and with SHGs Rallies in all schools and colleges and generating 5 5.5 6.100 6.700 7.400 30.7 discussions in schools and colleges through debates Regular advertisements in the newspapers 5 5.5 6.100 6.700 7.400 30.7 Health Card for Girl Child @ Rs 2 /card x 10,000 0.2 0.22 0.240 0.260 0.290 1.21 cards Total 98.1 91.31 100.43 110.35 121.35 521.566 9 9 8
170
10. CAPACITY BUILD ING
Capacity Building Situation Training is an essential part of human development. Although the personnel have the basic skills Analysis necessary for carrying out their duties there is a need to upgrade the skills as well as to keep pace with the new developments under NRHM. There is a skill gap for managing safe deliveries, Abortions, Newborn Care, managing Childhood illnesses, Obstetric and Paediatric emergencies, morbidity and epidemics. There is no system for continuing education of the personnel.
The management skills are also lacking resulting in poor management of programmes including financial management. Most of the personnel are unable to use computers and internet.
Status of trainings in Distt Kathua: 1. Trainings of M.O in IMNCI is required for MOs and other staff including refresher trainings 2. Orientation of TBAs is going on under RCH but there is a need for refresher training 3. Some of the Skill Birth Attendants needs to be regularly carried out so that all the ANMs
The trainings are carried out by the RIHFW along with the Regional training centres and the district training centres. There is a shortage of staff and also rapid turnover.
The monitoring of the trainings needs to be done for the quality of trainings. Also monitoring of the work output of the personnel for which they have received the trainings should also be done.
Objectives 1. Reduction in the MMR and IMR from baseline to 50% of baseline by 2012 2. Fully skilled personnel at all levels in the Health sector, ICDS, PRIs, NGOs and private sector for provision of services Strategies 1. Development of training plan and methodology for all the personnel on various issues of RCH to reduce the Maternal and Neonatal mortality, meeting the unmet needs, building Gender perspective, good programme management and managing various components of NRHM 2. Ensuring the quality of trainings Activities 1. Capacity building for the reduction in Maternal and Neonatal mortality • TBA training for 15 days in the concept of clean deliveries, danger signs, early referral, Newborn care and family planning, communication, • MTP training on MVA to all PHC MOs for 15 days. • Training in Obstetric management & skills for operationalization of 24x7 PHC for 16 weeks • Training in skilled Birth attendants (ANM, LHV, SN) for 15 days • IMNCI training to ANM/LHV, SN, MO, CDPO for 8 days in the area covering the 24 x 7 PHC • Training on Blood transfusion for MOs and Lab Technicians for CEmOC centres with Blood storage facilities for 3 days
171 • Training in Life saving/Anaesthesia for EmOC at FRUs for MOs for 18 weeks • Integrated skill training of all SN • Integrated skill training for MPHWF • Training of ASHAs • Training in management of newborns and sick children at Medical College Jammu of the MOs, SN, • Training in BCC for MOs, MPHS, MPHWF • Training of Ayush personnel on issues of RCH and reporting for 3 days 2. Capacity building to meet the unmet needs • Training on NSV for MOs for 5 days • Training for Laproscopic Sterilization for Surgeons, Gynaecologists, SN, OT attendants for 12 days • Skill upgradation of MPHWF & MPHS for 5 days • Orientation on contraceptive devices for MOs of Govt facilities as well as private facilities 3. Training on Medico-legal aspects 4. Continuing Medical Education sessions for doctors each month during the monthly meetings on current topics. An expert from a reputed institution will be invited on the current topics and Certificates will be given. 5. Capacity building for Gender equality • Orientation on Gender equality & PCPNDT Act for doctors both Govt and private, members of District Appropriate authority NGOs 6. Capacity building for good programme management • Professional Development course for District Programme Managers, Senior district officials, CMOs for 10 weeks • Management Development course for MOs for 5 days • General and Financial rules (G & FR) for the district officials, MOs, clerical staff for 3 days • Financial management training for Accounts Officers, Accountants for 3 days • Computer training to all the MOs, Clerical staff, accounts personnel • CNAA for MOs, MPHS, MPHWF, AWW
7. Capacity building for managing the other components of NRHM
RNTCP • Reorientation Training of DOT providers for 1 day • Orientation of MOs on revised Paediatric & PWBs under Paediatric management for 1 day • Training of newly appointed MOs (1) under RNTCP – MO TU, for 10 days
Convergence for Sanitation and hygiene under NRHM • One day orientations of VHWSC for total sanitation Disease Control Programme – Blindness Control, Malaria, IDSP, IDDM
172 • MPW • LT training PRIs • Training on NRHM and their roles of the members of the Zila Parishad, Panchayat Samitis, Gram Panchayat members, VHWSC for 1 day NGOs • Training in BCC • Training of Field NGOs Private Sector Training on Family Planning issues, PCPNDT Act, Reporting 8. Ensuring the quality of trainings • A district quality training team will be formed to ensure the organization of trainings as per schedule, arrangements and monitoring the quality of all the trainings on the basis of checklists to be developed by the state. • They will ensure the availability of trainers and the staff at the District Training Centre. • The team will also monitor the work output of the trained personnel and give recommendations regarding improvements in the training and the future requirements. • For ensuring the availability of trainers a District Resource team and Block Resource teams will be formed for various issues. • A list of Resource persons will be developed from the State for specialized issues. 9. Establishing a Staff Nurse training College: due to shortage of staff there is a need to open a Staff Nursing College in General Hospital with a batch of 60. 10. There is a need of Hostel and Mess/ Kitchen and dining hall facilities of the training centre. Currently there is no hostel facility. Support • RIHFW to develop the training calendar and organize the trainings as per schedule required • Medical colleges to be prepared for providing trainings on EmOC, MTP, Neonatal Care • Monitoring by the State the quality of trainings and the work output through the development of a format and checklist • Placement of the personnel trained in various specialized issues at the right facilities • Ensuring staff at the District training centre Time Line Activity 2007-08 2008 – 2009-2010 2010-2011 2011- (Numbers) 2009 (Numbers) (Numbers) 2012 (Numbers) (Number s) TBA training 587 587 587 587 587 MVA MTP training to all PHC MOs 39 MOs 39 MOs and retraining Training on Blood transfusion for 1MO 6 MO MOs and Lab Technicians for 1LT 6 LT CHCs with Blood storage facilities for 3 days
173 Training in Obstetric management 2 MOs Staff of 10 Staff of 10 Staff of 10 Staff of 8 & skills for 24x7 PHC for 16 weeks 2 Staff PHC PHC PHC PHC Nurses Training in Skilled Birth attendants 16 64 64 64 64 for 15 days IMNCI training to ANM/LHV, SN, 10 ANM 25 ANM 25 ANM 25 ANM 25 ANM ASHA for 8 days 4 SN 4 SN 4 SN 4 SN 4 SN 25 ASHA 50 ASHA 50 ASHA 50 ASHA 50 ASHA 4 LHV 4 LHV 4 LHV 4 LHV 4 LHV IMNCI training to MOs 6 MOs 20 MOs 25 MOs 25MOs 25 MOs Training in Life saving/Anaesthesia 2 MOs 4 MOs 4 MOs 6 MOs for EmOC at CHC for MOs (State Budget ) Integrated skill training of all SN 10SNs 20 SNs 30 SNs 30 SNs 40 SNs Integrated skill training for ANMs 10 ANMs 25 ANMs 25 ANMs 25 ANMs 25 ANMs Integrated skill training for MOs 5 MOs 5 MOs 5 MOs 5 MOs 5 MOs Training of MOs, SN in Mgt of 2 MOs 2 MOs 2 MOs 2 MOs 2 MOs Newborns & sick children at 2 SN 2 SN 2 SN 2 SN 2 SN Medical College Jammu Training in BCC for MOs, LHV, 13 MOs 13MOs 13 MOs 13 MOs 13 MOs ANM 4 LHV 4 LHV 4 LHV 4 LHV 4 LHV 25 ANM 25 ANM 25 ANM 25 ANM 25 ANM Training of Ayush personnel on 51 Ayush 51 Ayush 51 Ayush 51 Ayush 51 Ayush issues of RCH and reporting Training on NSV for MOs at NSV 4 MOs 16 MOs 16 MOs 16 MOs 16 MOs camps Training on Minilap 4 MOs 4 MOs 4 MOs 4 MOs 4 MOs Training for Laproscopic 2 Specialists 2 Sp 2 Sps 2 Sps 2 Sps Sterilization for Surgeons, 2 SN 2 SN 2 SN 2 SN 2 SN Gynaecologists, SN, OT attendants 2 OT 2 OT 2 OT 2 OT 2 OT for 12 days attendants attendants attendants attendants attendant s Orientation on contraceptive 80 MOs 100 MOs 100 MOs 100 MOs 100 MOs devices for MOs - Govt as well as private facilities Training on Medico-legal aspects to 100 MOs & 150 150 150 150 MOs Specialities Continuing Medical Education 10 CME 10 CME 10 CME 10 CME 10 CME sessions for doctors each month sessions sessions sessions sessions sessions during the monthly meetings on current topics
174 Orientation on PCPNDT Act for x x x x x DCs, CMOs, doctors both Govt and private, members of District Appropriate authority NGOs in a workshop General & Financial rules (G & FR) 50 Distt 50 Distt 50 Distt for Officials, MOs, clerical staff for 3 officials and officials officials days MOs and MOs and MOs 50 clerks 50 clerks 50 clerks Financial management training for 25 persons 50 persons 50 persons 50 persons 50 Accounts Officers, Accountants for persons 2 days Computer training to all the MOs, 100 50 Clerical staff, accounts personnel CNAA for MOs, LHV, ANM & MPW, 39 MOs 39 MOs 25 ANMs 17 ANMs 5 ANMs AWW 39 LHV 39 LHV 152 ANM 175 ANM 1086 AWWs 1086 AWWs Total sanitation orientation and 587 587 587 587 587 villages reorientation of VHWSC x 1 day villages villages villages villages Training of NGOs in BCC 30 30 40 40 30 persons persons persons persons persons
Budget
Activity 2007-08 2008–09 2009-10 2010-11 2011-12 Total TBA training @ Rs 10100 /TBA 59.287 65.2157 71.737 78.911 86.802 361.953 MVA MTP training to all PHC MOs for 15 days @ Rs 500 x 2.925 2.925 0.000 0.000 0.000 5.85 15 days x MOs Training on Blood transfusion for MOs and Lab Technicians for CHCs with Blood storage facilities for 3 days MOs @ Rs 500/day/person x 3 days 0.015 0.075 0.015 0.015 0.015 0.135 Lab Technicians @Rs 200/person x 3 days 0.006 0.03 0.006 0.006 0.006 0.054 Training in Obstetric management & skills for 24x7 PHCs for 16 weeks MOs: Rs 500/day x 112 days x 2 MOs 1.12 11.2 11.2 11.2 4.48 39.200 StaffNurses:Rs200/dayx112daysx 2 SNs 0.448 4.48 4.48 4.48 1.792 15.680 Training in skilled Birth attendants for 15 days: 0 0.000 0.000 0.000 One batch of 4 persons: Rs. 7500 as hon. to participants, Rs 4 16 16 16 16 68.000 13500 hon. to training team, 15% institutional charges, = Rs 25000/batch - 16 batches IMNCI training to ANM/LHV, SN, ASHA - 8 days 0.000 0.000 0.000 0.000 Rs 300 as hon. to participant x 8 days 1.032 2.1912 2.410 2.651 2.916 11.201 IMNCI training to MOs @ Rs 5390 /participant 0.3234 1.186 1.617 1.779 1.957 6.861 Integrated skill training of all SN @ Rs 4080/person 0.408 0.8976 1.4688 1.5912 2.2848 6.650 Integrated skill training for ANMs @ Rs 2048/person 0.2048 0.5632 0.6144 0.6656 0.7168 2.765 Integrated skill training for MOs @ Rs 3683 0.18415 0.203 0.223 0.245 0.270 1.124 Training of MOs, SN in Mgt of Newborns & sick children at 0.24 0.264 0.290 0.319 0.351 1.465
175 Medical College Jammu @ Rs 7500/MO, Rs 4500 ( Rs 300 x 15 days)/SN Training in BCC for MOs, LHVs, ANMs 0.76 0.836 0.920 1.012 1.113 4.640 MOs: Rs 500/MO x 5 days LHVs & ANMs: Rs 300/person x 5 days Training of Ayush personnel on issues of RCH and reporting 0.459 0.5049 0.555 0.611 0.672 2.802 for 3 days Rs 300/person x 3 days Training on NSV for MOs at NSV camps 0.42 0.462 0.508 0.559 0.615 2.564 Rs 500/MO /camp x 12 camps, Rs 3000 per camp for trainer x 12 camps Training on Minilap @ Rs 500 per day for 15 days and during 0.6 2.64 2.904 3.194 3.514 12.852 camps Training for Laproscopic Sterilization for Surgeons, 0.24 0.264 1.162 1.278 1.406 4.349 Gynaecologists, SN, OT attendants for 12 days Specialist: Rs 500/Specialist x 12 days SN: Rs 300/SN x 12 days OT Attendant: Rs 200 x 12 days Orientation on contraceptive devices for MOs - Govt as well 0.4 0.44 0.484 0.532 0.586 2.442 as private facilities Rs 500 /MO x 1 day Training on Medico-legal aspects to MOs@ Rs 500/MO x 1 0.5 0.825 0.908 0.998 1.098 day Continuing Medical Education sessions for doctors each 2.5 2.75 3.025 3.328 3.660 4.329 month during the monthly meetings on current topics @ Rs 25000 per CME Orientation on PCPNDT Act for DCs, CMOs, doctors both 0.5 0.55 0.605 0.666 0.732 Govt and private, members of District Appropriate authority NGOs in a workshop General & Financial rules (G & FR) for Officials, MOs, clerical 1.05 1.155 1.271 1.398 1.537 15.263 staff for 3 days Rs 500/official and MOs x 3 days 3.053 Rs 200 /clerical staff x 3 days 6.410 Financial management training for Accounts Officers, 0.2 0.22 0.242 0.266 0.293 1.221 Accountants for 2 days Rs 200/Accounts persons x 2 days Computer training to all the MOs, Clerical staff, accounts 3 1.65 0.000 0.000 0.000 4.650 personnel @ Rs 200 per person x 15 days CNAA for MOs, LHVs, ANMs, AWW 2.632 2.682 0.05 0.034 0.01 5.408 @ Rs 200/person x 1 day each year Total sanitation orientation and reorientation of VHWSCs x 1 1.174 1.2914 1.421 1.563 1.719 7.167 day @ Rs 200/person/day Training of NGOs in BCC @ Rs 300 per person x 6 days 0.54 0.594 0.653 0.719 0.791 3.297 Total 85.1683 122.0944 124.769 134.020 135.335 601.387 5
176 11. HUMAN RESOURCE PLAN
Human Resource Plan Situation The Human Resources in district Kathua is not as per IPHS norms. The motivation levels for the Analysis doctors to work is very low and promotions do not occur. No doctors and Specialists want to work in the rural areas.
Subcentre level • The number of subcentres will have to be increased from 152 to 227 by 2012 • The requirement of ASHAs will be around 680 • The requirement of ANM will be around 454 in Government as per IPHS norms of 2 ANMs per Subcentre.
PHC level • The PHCs are adequate in number • As per IPHS 2 MOs per PHC will be required whereas at present there is only one MO per PHC • For IPHS norms 117 Staff Nurses for PHC [3 per PHC] are required. At present there are just 24 SN • There are only 21 Lab Technicians as against the required 39 today. • At present there are 35 Pharmacists in the PHC as against 39.
CHC Level • There will be a requirement of 9 CHCs in 2012 as per the population norms • There are a total of 15 specialists in position in CHC as against 28 sanctioned posts. In the CHC there should be at least 7 specialists, 3 MOs, 10 Staff Nurses, I PHN, 1 Computer clerk, 1 Dresser, 1Pharmacist, 1 Lab technician, 1 BEE, 1 radiographer, 1 UDC, 1 Accountant, 1 LDC, 1 Epidemiologist, and Ancillary staff on contract. Objectives 1. All staff to be in place as IPHS norms by 2012 Benchmarks 2. Increased salaries for contractual doctors and Specialists 3. Special allowances for Regular staff 4. Increase in the number of training centres for LHV, ANM, Staff Nurses, Lab Technicians Strategies & 1. Rational placement of Specialists and trained staff Activities 2. Recruitment of staff on contract where vacancies 3. Recruitment of staff for new facilities as per the infrastructure requirements 4. Computers at all PHC and for each MO and Specialist at the CHC 5. Allowing Specialists and MOs for developing special skills as per their needs by attending special courses anywhere in India. Support 1. The State must approve and give sanctions for the necessary personnel for each facility required before actually starting the facilities.
177 2. Contractual staff should be allowed recruitment as and when required. Permission from State should not be taken each time. Timeline Activity Current 2007- 2008- 2009- 2010- 2011- 2007- 2008- 2009- 2010- 2011 Status 08 09 10 11 12 08 09 10 11 -12 Total requirements(IPHS Norms) Additional requirement - Contractual Subcentre 152 175 200 217 222 227 23 48 65 70 75
ANM 115 350 400 434 444 454 235 285 319 329 339 MPW(M) 0 175 200 217 222 227 175 200 217 222 227 PHC 39 39 39 39 39 39 0 0 0 0 0 MO 32 78 78 78 78 78 46 46 46 46 46 Staff Nurse 24 117 117 117 117 117 93 93 93 93 93 Health worker 31 39 39 39 39 39 8 8 8 8 8 (F) Health 2 39 39 39 39 39 37 37 37 37 37 Educator Health 1 78 78 78 78 78 77 77 77 77 77 Assistant Clerk 6 78 78 78 78 78 72 72 72 72 72 Pharmacist 35 39 39 39 39 39 4 4 4 4 4 Lab.Tech 21 39 39 39 39 39 18 18 18 18 18 Class IV 59 156 156 156 156 156 97 97 97 97 97 CHC 4 5 6 7 8 9 1 2 3 4 5 Specialist(7) 15 35 42 49 56 63 20 27 34 41 48 MO General 15 18 21 24 27 15 18 21 24 27 Duty (3) 0 PHN 1 5 6 7 8 9 4 5 6 7 8 ANM 14 20 24 28 32 36 6 10 14 18 22 SN 19 35 42 49 56 63 16 23 30 37 44 Dresser 0 5 6 7 8 9 5 6 7 8 9 Pharmacist 15 15 15 15 15 15 0 0 0 0 0 Lab. Tech 7 7 7 7 8 9 0 0 0 1 2 Radiographer 2 5 6 7 8 9 3 4 5 6 7 Opthalmic 2 5 6 7 8 9 3 4 5 6 7 Assistant Class IV 38 40 48 56 64 72 2 10 18 26 34 Statistical 7 7 7 7 8 9 0 0 0 1 2 Assistant Registration 7 7 7 7 8 9 0 0 0 1 2 clerk Accountant 0 5 6 7 8 9 5 6 7 8 9 Epidemiologist 0 5 6 7 8 9 5 6 7 8 9 BEE 0 5 6 7 8 9 5 6 7 8 9
178 Budget Activity / Item 2007-08 2008-09 2009-10 2010-11 2011-12 Total Subcentre ANM 320.305 388.455 434.797 448.427 462.057 2054.041 MPW(M) 207.9 237.6 257.796 263.736 269.676 1236.708 PHC MO 144.992 144.992 144.992 144.992 144.992 724.96 Staff Nurse 142.941 142.941 142.941 142.941 142.941 714.705 Health worker (F) 12.296 12.296 12.296 12.296 12.296 61.48 Health Educator 56.869 56.869 56.869 56.869 56.869 284.345 Health Assistant 131.747 131.747 131.747 131.747 131.747 658.735 Clerk 85.536 85.536 85.536 85.536 85.536 427.68 Pharmacist 6.12 6.12 6.12 6.12 6.12 30.6 Lab.Tech 21.384 21.384 21.384 21.384 21.384 106.92 Class IV 69.84 69.84 69.84 69.84 69.84 349.2 CHC Specialist(7) 73.8 99.63 125.46 151.29 177.12 627.3 MO General Duty (3) 47.28 56.736 66.192 75.648 85.104 330.96 PHN 6.848 8.56 10.272 11.984 13.696 51.36 ANM 7.128 11.88 16.632 21.384 26.136 83.16 SN 24.592 35.351 46.11 56.869 67.628 230.55 Dresser 3.45 4.14 4.83 5.52 6.21 24.15 Pharmacist 0 0 0 0 0 0 lab.Tech 0 0 0 1.188 2.376 3.564 Radiographer 3.564 4.752 5.94 7.128 8.316 29.7 Opthalmic Assistant 3.564 4.752 5.94 7.128 8.316 29.7 Class IV 1.44 7.2 12.96 18.72 24.48 64.8 Statistical Assistant 0 0 0 1.188 2.376 3.564 Registration clerk 0 0 0 1.188 2.376 3.564 Accountant 9.65 11.58 13.51 15.44 17.37 67.55 Epidemiologist 13.75 16.5 19.25 22 24.75 96.25 BEE 7.65 9.18 10.71 12.24 13.77 53.55 Total 1402.646 1568.041 1702.124 1792.803 1883.482 8349.096
179
12. PROCUREMENT AND LOGISTICS
Procurement and Logistics Situation In district Kathua there is no proper Warehouse. There are rooms in which drugs are stored but Analysis/ it is not a scientific Warehouse. Most of the drugs are supplied by the State but some drugs are Current locally procured. Status Inventory Management is not very scientific and the records are not computerized. There is no system of wastage control, replacements, transfer of stocks from one centre to the other. Record Keeping is done manually.
There is one storekeeper in the General hospital Kathua and two in the District Malaria Office. Requirements are also not made scientifically. Objectives Development of a Scientific Warehouse system by 2008
Strategies 1. Developing a Warehouse 2. Capacity building of the personnel for stores and also record keeping 3. Computerization of all the stocks Activities • Construction of a scientific Warehouse • Procurement of software and computer hardware for the Warehouse from TNMSC • Proper Equipment and hardware • Availability of Pharmacist, Assistant Pharmacist, Packers • Training of personnel • Appointment of an agency for Operationalization of the Scientific Warehouse Support State to develop a scientific and transparent Procurement, Logistics and Warehousing system required with quality control Timeframe Activity / Item 2007- 2008- 2009- 2010- 2011 08 09 10 11 -12 Construction of Warehouse x Software x Computer system with UPS, Printer, Scanner, x Equipment & Hardware x Appointment of Pharmacist x Appointment of Assistant Pharmacist x Appointment of Packers -2 x Appointment of Security Staff x Training of personnel x Consultancy to agency for Operationalization of x x the Warehouse
180 Total Budget Activity / Item 2007- 2008- 2009-10 2010-11 2011-12 Total 08 09 Construction of Warehouse 85 0 0.000 0.000 0.000 85 Software 0.25 0 0.000 0.000 0.000 0.25 Computer system with UPS, Printer, 0.6 0 0.000 0.000 0.000 0.6 Scanner, Equipment & Hardware 34.5 0 0.000 0.000 0.000 34.5 Pharmacist @ Rs 9000/mth 0 1.08 1.190 1.310 1.440 5.02 Assistant Pharmacist @ Rs 5000/mth 0 0.6 0.660 0.726 0.799 2.785 Packers -2 @ Rs 4000/mthx2 0 0.96 1.056 1.162 1.278 4.456 Security Staff @ Rs 6000/mth 0 0.72 0.792 0.871 0.968 3.351 Training of personnel 0 0.1 0.110 0.121 0.133 0.464 Consultancy to agency for 2 2.1 0.000 0.000 0.000 4.1 Operationalization of the Warehouse Total 122.3 5.56 3.808 4.190 4.618 140.526 5
181
13. DEMAND GENERATION - IEC IEC Status There is lack of awareness and good practices amongst the community due to which they neither avail the services nor take any positive action. There is lack of awareness regarding the services, schemes including the Fixed Village Health days.
The following issues need special focus:
• Spacing methods, ideal interval between births, no scalpel vasectomy, information about FP facilities and MTP facilities available at different levels • Importance of 3 visits for ANC, advantages of institutional delivery, Post natal care, availability of skilled birth attendants, balanced diet during pregnancy, anaemia, misgivings about IFA, kitchen garden • Importance of newborn care, complete immunization, disadvantages of drop outs, nutritional requirements of infants and children, malnutrition, exclusive breastfeeding • Problems of adolescents, drugs addiction, malnutrition, problems of sexuality, age at marriage, tendency to take risks in sexual matters • DOTS programme for TB, location of microscopy centres, cardinal symptoms of TB, • High risk behaviour in the community in relation to water born diseases, heart diseases and lung diseases, and HIV/AIDS, STDs • Ill effects of drugs addiction affecting adolescents, • High prevalence of RTIs, including STDs, • Issues of malaria spread and prevention and also other diseases • JSY, VHD , availability of services • Effects of the Adverse Sex Ratio and PCPNDT Act
The personnel have had no training on Interpersonal communication. Objectives Widespread awareness regarding the good health practices Knowledge on the schemes, Availability of services Strategy 1. Information Dissemination through various media, 2. Interpersonal Communication 3. Promoting Behaviour change Activity 1. Awareness on • Fixed VHD days • JSY • Services available • Designing of BCC messages on exclusive breast feeding and complimentary feeding, ANC, Delivery, PNC, FP, Care of the Newborn, Gender, male involvement in the local language
182 • Consistent and appropriate messages on electronic media – TV, radio • Use of the Folk media, Advertisements, hoardings on highways and at prominent sites • Training of ASHA/AWW/ANM on Interpersonal communication and Counselling on various issues related to maternal and Child health • Display of the referral centres and relevant telephone numbers in a prominent place in the village • Promoting inter-personal communication by health and nutrition functionaries during the Fixed health & Nutrition days • Orientation and training of all frontline government functionaries and elected representatives • Integration of these messages within the school curriculum • Kit for the newly married and during first pregnancy to be given at the time of marriage and during pregnancy • Mothers meeting to be held in each village every month to address the above mentioned issues and for community action • Kishore Kishori groups to be formed in each village and issues relevant to be addressed in the meetings every month • Meetings of adult males to be held in each village to discuss issues related to males in each village every month and for community action. • Village Contact Drives with the whole staff remaining at the village and providing services, drugs, one to one counselling and talks with the Village Health & Water Sanitation Committee and the Mother’s groups. The whole district administration will get geared up for 33 days quarterly to carry out this massive drive in which registration of birth, death, Immunization of each child, ANC of each pregnant woman, growth monitoring of each child, disinfection of wells, spraying of houses and fogging, treatment of the stagnant water sites, detection of TB and Leprosy, treatment of all ailments, eye conditions through massive publicity. This will be carried out in each village through Rath Yatra. • Monthly Swasthya Darpan describing all the forthcoming activities and also what happened in the month along with achievements • Bal Nutrition Melas 4 times at each Subcentre • Wall writings • Pamphlets for various issues packed in an envelope State State to give guidelines for the good practices and also training module on BCC Support Timeline Activities 2007-08 2008-09 2009-10 2010-11 2011-12 Finalizing the messages x x x x x Advertisements x x x x x TV spots x x x x x Radio Jingles x x x x x
183 Folk Media shows x x x x x Hoardings on highways and prominent places x x x x x Display boards x x x x x Pamphlets x x x x x Developing Nirdeshika for holding VHD days x x Monthly Swasthya Darpan x x x x x Orientation & training of all frontline govt x functionaries and elected representatives VCD in each village quarterly x x x x x Bal Nutrition Melas x x x x x Kishori Shakti meetings x x x x x Opinion leaders workshops x x x x x Wall writings x x x x x
184 Budget Activities 2007- 2008- 2009- 2010- 2011-12 Total 08 09 10 11 Hiring of an agency for carrying out the 40 44 48.40 53.24 145.640 331.28 intensive IEC and behaviour change 0 0 activities Finalizing the messages in the local 1 1.1 1.210 1.331 3.641 8.282 language Advertisements 5 5.5 6.050 6.655 18.205 41.41 TV spots 1 1.1 1.210 1.331 3.641 8.282 Radio Jingles in local language 1 1.1 1.210 1.331 3.641 8.282 Folk Media shows @ Rs 1000/vill 0.587 0.645 0.710 0.781 2.137 4.86153 7 4 Hoardings @ Rs 10000/hoarding 10 11 12.10 13.31 36.410 82.82 0 0 Display boards @ Rs 2000/board 1.8 1.98 2.178 2.396 6.554 14.9076 Pamphlets @ Rs 10/pamphlets x 100000 10 11 12.10 13.31 36.410 82.82 0 0 Nirdeshika for Fixed Health Nutrition days 1.6 1.76 1.936 2.130 5.826 13.2512 @ Rs 20/ Nirdeshika x 8000 Swasthya Darpan @Rs.10 /copy/mth x 0.8 0.88 0.968 1.065 2.913 6.6256 8000 Orientation of elected rep and PRIs@ Rs 4 4.4 4.840 5.324 14.564 33.128 200 x 2000 persons x1 day Village campaign @ Rs 53.9875 lakhs per 215.91 237.5 261.2 287.3 786.143 1788.19 Campaign x 4 times in a year 4 054 56 82 975 Bal Nutrition Melas @ Rs 300 x 4 times x 14.232 15.65 17.22 18.94 20.8370 86.8877 AWCs 52 072 2792 71 832 Kishori Shakti meetings @ Rs 100 per 0.587 0.645 0.710 0.781 2.137 4.86153 group x 587 villages 7 4 Community and religious leaders 1.2 1.32 1.452 1.597 4.369 9.9384 workshops @ Rs 300 /person x 100 x 4 times Wall writings @ Rs 200 x 587 villages 1.174 1.291 1.421 1.563 4.275 9.72306 4 8 Total 309.89 340.8 374.9 412.4 1097.34 2535.56 4 834 72 69 2 047
185 Details of Village Campaign Drive
Activity Unit Cost Units Description Calculation Mule Rath 48000 39 Raths 1872000 Mobility 800 183 Gram Panchayat 146400 Kala Jatha 1000 183 Gram Panchayat 183000 Prabhat Pheri 400 183 Gram Panchayat 73200 Slogan Writing 50 587 Villages 29350 Tent, Generator, Electricity 1700 183 Gram Panchayat 311100 Banner 300 183 Gram Panchayat 54900 Mike 300 183 Gram Panchayat 54900 Opening Ceremony 50000 1 District level 50000 Closing ceremony 8000 39 Facilities 312000 Medicines @ Rs 35 /patient x 200 patients 7000 183 Gram Panchayat 1281000 Outdoor publicity 100000 1 District level 100000 IEC material 500000 1 District level 500000 Hiring of experts 10000 33 days 330000 Untied funds 100000 1 District level 100000 Budget for 1 Village Campaign 5397850 Budget for 4 Village Campaigns 21591400
186
14. FINANCING OF HEALTH CARE
Financing Health Care Situation 1. For sustainability and needs based care, health financing is the key. District Kathua Rogi Analysis/ Kalyan Samitis (RKS) have been formed in the District hospital, 4 CHCs and in 27 PHCs till Current June 2007. These are hospital autonomous societies which are allowed to take user fees for Status services provided at the facilities. Formation of these RKS has resulted in great satisfaction amongst the patients and also the staff since now funds is available with the facilities to care for the people.
2. No trainings have been given for the skill building of the Incharges of these facilities. There is no standardized reporting format and information regarding these RKS is not there. Objectives Availability of sufficient funds for meeting the needs of the patients Strategies 1. Generation of funds from User charges 2. Donations from individuals 3. Efficient management of the RKS 4. Provision of Seed money to each RKS Activities 1. Generation of funds from User charges : User charges are taken for Registration, IPD, Laboratory investigations from persons who can afford to pay. 2. Donations from individuals : Donations are to be generated from individuals. For the betterment of hospitals, equipment, additions to the buildings, etc 3. Efficient management of the RKS : Training will have to be given for efficient management and utilization of the funds for activities that generate funds. Computerization of data and all the parameters need to be carried out preferably through customized software. Trainings can be organized with the help of RIHFW Rajasthan who have developed modules and conducted trainings for the management of these Societies. 4. Provision of Seed money to each RKS at CHC and PHC of Rs 100000 each year for repair, purchase of new equipment, additions, alterations, etc’; 5. Development of customized software and training of staff for the use of this software 6. Regular filling of formats Support 1. Timely meetings of Rogi Kalyan Samitis required 2. SIHFW Rajasthan to agree for providing trainings on the management of the RKS Timeline Activity 2007- 2008- 2009- 2010- 2011- 08 09 10 11 12 Provision of Seed money @ Rs 1 lakh per CHC x x x x x and PHC Training of the Incharges and second in x x x x x command Development of Software for RKS with training of x x x x x personnel on the use
187 Budget Activity 2007- 2008- 2009- 2010- 2011- Total 08 09 10 11 12 Provision of Seed money @ Rs 1 lakh 44 45 46.000 47.000 48.000 230 per CHC and PHC @ Rs 1.00 lakhs Training of the Incharges and second in 0.88 0.968 1.065 1.171 1.288 5.372 command @ Rs 1000 per person x 1 day 488
Development of Software for RKS with 5 0.25 0.250 0.250 0.250 6 training of personnel on the use Total 49.88 46.218 47.315 48.421 49.538 241.3 72
188
15. HMIS, MONITORING AND EVALUATION
HMIS Current • HMIS is a monitoring tool for the performance that provides information to support planning, Status decision-making and executive control for managers in the Health & FW department.
• In this sector Data collection is ongoing for more than 60-90 different conditions. The basis of HMIS is the data collected by the ANM who is over burdened with a substantial amount of her time being spent on surveillance related activities. Each year a CNAA exercise is carried out but the set procedures under the CNAA are generally not followed in development of annual action plans and in their utilization in planning the activities of health workers. The action plans are prepared more as a normative exercise rather than as a management tool for estimation of service needs and monitoring the programme outputs. • There is no horizontal integration of surveillance activities of existing disease control programmes. Absence of clear case definitions and poor supervision or crosschecking of the data collected hampers the quality of reporting. Non-Communicable diseases are not included in surveillance even though the burden due to them is high. Absence of formats for reporting diseases also affects quality of the data collect. • The data from the ANM is sent upto the district level with no analysis done at any of the higher levels. There is no system of feedback to the lower levels in the health system. The transmission of data is affected by poor communication facilities available. • Data is not collected from private practitioners, private laboratories and private hospitals both in rural and urban setting. • Data collected during emergencies and epidemics is of better quality • The response system at the District level is activated only in times of outbreaks. • There is lack of coordination between departments. Discrepancy between the data of the Health department and the ICDS. There is large gap between reported and evaluated coverage. • The District administrative system not able to make use of the health data. • In District Kathua there is a dearth if authentic baseline data especially on IMR, MMR, NMR and TFR. There is inadequate understanding regarding the classification of diseases. • HMIS software consisting of all the data collected right from the Subcentres with online facilities is not available • Computers need to be supplied at each PHC. Objectiv 1. Integration of several parallel running programme software e 2. HMIS is used for decision making on regular basis 3. Inclusion of RCH indicators monitoring 4. Linkage to decision making at Central level 5. Refresher training
189 6. Make it more useful for State level officials Strategy 1. Research on various issues related to RCH to get a correct baseline 2. Improvement in the CNAA 3. Computerized HMIS Activity 1. Survey for Data on • Newborn deaths, births, maternal deaths, Infant deaths, Level of malnutrition in Pregnant women, Adolescents and children at birth, one year, two years and six years • Newborn Care and practices at home for the newborn and neonate • Male participation in Maternal and Child health • Actual poor people who need free treatment • Coverage of hamlets • Access to services • Health Care practices and behaviour patterns • Number of Eligible couples, data on all the RCH parameters and indicators 3. One time house to house survey for correct data through 50 youth employed on contract. Each youth will survey 20 houses per day for 90 days each. 4. Joint CNAA by the ANM, AWW, ASHA along with the PRIs so that there is one data validated by the PRIs 5. Printing of Reporting & Monitoring Formats 6. Data entry of each Household, Eligible couples, Adolescents 7. Computerization of all the formats and software for the various programmes and finances 8. Computer training for data entry 9. Internet connectivity upto all PHC for online transfer of data. The MPHWF will get the data entered each month after the household and Eligible Couple entries have been made 10. GIS for the district covering all the parameters 11. Computers at all CHC and PHC including AMC for all computers State Provision of software for data entry Support Time Activities 2007- 2008- 2009- 2010- 2011- line 08 09 10 11 12 Survey house-to-house by youth x Survey for practices, coverage, behaviour etc x through independent agency Software development x Data Entry of each household x x x x x Internet connectivity x x x x x Provision of computers for each CHC and PHC r x x x x x AMC for computers x x x x x GIS for the district, training and updation x x x x x Printing monitoring Charts x x x x x
190 Budget Activities 2007-08 2008-09 2009-10 2010-11 2011-12 Total Survey house-to-house by youth @ Rs 14.4 0 0.000 0.000 0.000 14.4 6000 pm x 3 months x 80 persons Survey for practices, coverage, behaviour 15 0 0.000 0.000 0.000 15 etc through independent agency Software development 20 0 0.000 0.000 0.000 20 Data Entry of each household @ Rs 2 per 2 0.4 0.800 1.200 1.600 6 household x 100000 HH Internet connectivity @ Rs 900 /mth x No 4.752 4.86 4.968 5.076 5.184 24.840 of facilities x12 mths provision of computers for each CHC and 22 0.5 0.5 0.5 0.5 24 PHC @ Rs 50,000/computer system with UPS and printer AMC for computers @ Rs 5000 /computer 2.2 2.42 2.662 2.928 3.221 13.431 /year x 44 computers Consumables for computers @ Rs 22.56 24.816 27.298 30.027 33.030 137.73 4000/mth/facility x 12 mths 1 GIS for the district, training and updation 12 0.5 0.500 0.500 0.500 14 Printing monitoring Charts @ Rs. 5 per 0.1 0.125 0.150 0.175 0.200 0.75 monitoring chart Total 115.012 33.621 36.878 40.407 44.235 270.15 2
191
BUDGET SUMMARY for 2007 - 2008 District Kathua BUDGET - AT- A GLANCE (in lakhs)
S. No . Components 2007-08 2008-09 2009-10 2010-11 2011-12 Total A RCH-II 1 DHS 7.8 8.58 9.438 10.3818 19.8198 56.0196 2 DPMU 370.11 265.711 293.2499 323.3594 356.3273 1608.758 3 Maternal health 211.235 246.471 282.6115 328.6192 371.9431 1440.88 4 Child Health 49.661 8.8 3.7 3.7 3.7 69.561 5 Family Welfare 95.0225 91.51475 119.1007 151.5658 202.0895 659.2933 6 Adolescent Health 65.13 67.018 75.5118 82.06748 90.81518 380.5425 7 Gender & Equity 98.1 91.31 100.439 110.3589 121.3578 521.5657 8 Capacity Building 85.16835 122.0944 124.7687 134.0198 135.3354 601.3866 9 HR 1402.646 1568.041 1702.124 1792.803 1883.482 8349.096 10 IEC 309.894 340.8834 374.9717 412.4689 1097.342 2535.56 11 HMIS 115.012 33.621 36.8776 40.40656 44.23512 270.1523 Total 2809.779 2844.045 3122.793 3389.751 4326.448 16492.81 B NRHM 1 ASHA 98.4 85.6 86.98 89.565 91.61 452.155 SC Untied Fund & 35 40 43.4 44.4 45.4 208.2 2 Maintenance PHCUntied Fund & 29.25 29.25 29.25 29.25 29.25 146.25 3 Maintenance CHC Untied Fund & 7.5 9 10.5 12 13.5 52.5 4 Maintenance 5 MMU 83.51 36.201 39.8211 43.80321 48.18353 251.5188 6 Upgradation of CHCs 836.576 153.6976 129.9494 130.2263 130.5309 1380.98 7 Upgradation of PHCs 840.828 1704.428 297.6472 180.9087 183.8363 3207.648 8 Upgradation of SCs 449.1304 720.5 516.7308 156.884 117.2919 1960.537 9 VHWSC 74.35 75.6 76.45 76.7 76.95 380.05 10 Community Action Plan 22.421 24.663 27.129 29.842 32.827 136.882 11 PPP 20 27.7 28.975 29.3295 30.82845 136.833 12 Health Care Financing 49.88 46.218 47.3148 48.42128 49.53841 241.3725 13 Logistics 122.35 5.56 3.808 4.19 4.618 140.526 14 Biomedical Waste 18.34 20.174 22.1964 24.41304 26.83134 111.9548 Total 2687.535 2978.591 1360.152 899.9334 881.1955 8807.408 C Immunization
192 1 Immunization 305.866 294.1938 306.0095 317.2283 329.2244 1552.522 D NDCP 1 RNTCP 30.69 27.875 30.6736 33.74596 37.11206 160.0966 2 Leprosy 2.48 2.48 2.48 2.48 2.48 12.4 3 Malaria 195.52 70.897 76.7637 82.29307 87.18838 512.6621 4 Vector Borne 7.37 8.107 8.9227 9.81397 10.79837 45.01204 5 Blindness Control 43.916 17.3126 19.04686 20.95255 23.0468 124.2748 6 IDSP 42.218 23.1768 28.90948 31.86143 35.09957 161.2653 7 IDD 5.935 6.5285 7.18135 7.899485 8.689434 36.23377 Total 328.129 156.3769 173.9777 189.0465 204.4146 1051.945 E Others 1 Intersectoral 81.512 106.9022 112.8104 119.2821 126.3999 546.9066
Grand total 6212.821 6380.109 5075.743 4915.241 5867.682 28451.6
193
ANNUAL WORKPLAN for 2007 - 2008
Sl. Activity Indicators Planned for 2007-2008` No. No. Basis of Denomi % Denominator nator Basis of % 1 ANC registration 18197 Yearly data last 16377 90% calculated as per CMO data during the first year but DLHS should be used if no trimester increased to surety and then as per goal 2 Complete ANC 4549 Yearly data last 18197 25% As per Goals for 2007-08 coverage increased to year based on DLHS 3 Institutional Deliveries 4549 Yearly data last 18197 25% As per Goals for 2007-08 increased to year based on DLHS 4 Deliveries by skilled 7279 Yearly data last 18197 40% As per Goals for 2007-08 birth attendants year based on DLHS increased to 5 No. of women 10000 Yearly data last 18197 55% Calculations based on the no. benefited under JSY year of pregnancies and the Work plan numbers 6 Low birth weight new 3275 Total preg 16377 20% based on assumption that born reduced to minus 10% 33% children are LBW at birth hence goal is used 7 Complete Child 6551 Total preg 16377 40% As per Goals for 2007-08 Vaccination( in 12-23 minus 10% based on DLHS months age ) increased to 8 Severely 1378 Total preg 19688 7% based on assumption that 8-9 malnourished ( III & minus 10% % children are Gr II & IV IV ) decreased to hence goal is used 9 Use of contraception 38844 Eligible couples 97110 40% As per Goals for 2007-08 increased to based on DLHS 10 Female sterilization 5000 Last years operations to be sterilization performed during the data year 11 Vasectomies to be 600 Last years performed in the year sterilization
194 data 12 Tuberculosis – 298 Based on norm 993 30% Detection of New of 180/qtr/lakh cases pop of distt Goal for 2007-08 13 Tuberculosis- No. of NA defaulters reduced to 14 No. of Malaria Deaths Nil Total cases of 50% Goal for 2007-08 reduced to malaria 16 15 Total No. of OPD 120 Goal for 2007-09 from the cases % block OPD data 16 Total no. of indoor 120 Goal for 2007-09 from the admissions % block OPD data 17 No. of cases referred DNA 20% Goal for 2007-08 from CHC/DH 18 No. of PPPs 1 0 Infrastructure planning operational
195
RCH II Suggested Activities / Annual Responsi Time Frame Issues Suggested Sub-activities Plan bility strategies Q1 Q2 Q3 Q4 Maternal Encourage - No. of ANMs conducting 60 DFWO 40 45 50 60 Health ANMs for sub-centre and home PHC MOs conducting deliveries sub-centre - Follow up of necessary and home infrastructure and deliveries equipment. Participation of ANMs in 16 DTO 6 10 Skilled Birth Attendants PHC MOs training 24 hours PHC – infrastructure / 3 DFWO 1 1 1 delivery equipment – identify and PHC MO follow-up Behaviour Awareness Generation for Training on DFWO √ √ √ √ Change Early registration, complete IPC, IPC, Block Communicatio ANC , birth preparedness VHWSC MOs, n and complication readiness Mtgs, Using PHC MOs all media Improvement Identify means and Meeting of DFWO √ √ of referral operational aspects of all PHC PHC MOs transport Referral transport MOs, All ANMs to identify and submit transport facilities Improve RCH camps 4 DFWO 1 1 1 1 Access Implement JSY scheme 5000 cases PHC MOs 1000 125 150 125 0 0 0 Ongoing Maternal death Audit Orientation PHC MOs 5 25 30 40 situational on analysis Maternal death audit during monthly mtgs 100 audits
196 Child ANM training Training of ANMs on 10 ANMs DTO 2 2 4 2 Health Nutrition, ARI, Diarrhoea & PHC MOs RTI / STI Care of New Community level care 10 PHC MOs √ √ √ √ born Subcentres ANMs Stabilization Unit at CHC – 1 General Med √ space/ equipment follow-up hospitals Superinte ndent of GH Bi-annual Implement project At all AWCs CDPO √ √ strategy for Vitamin A Family Promote Organize Vasectomy camps 1 camp per DFWO √ √ √ √ Planning Vasectomy month Continue Organize Sterilization camps 1 camp/mth DFWO √ √ √ √ Sterilization at GH and MS programme CHCs CHC I/C Behaviour Conduct special IEC VCD in DFWO √ √ √ √ Change campaigns each village PHC MOs Communicatio ANMs n Partnership Follow-up on NGO partners MNGO DFWO √ √ √ √ with NGOs in RCH-II Scheme MNGO Adolesc Focus on Distribution of IFA and Monthly at CDPO √ √ √ √ ent adolescent Albendazole to adolescent each AWC AWW Health girls girls Access Reaching out RCH camps 12 DFWO 1 1 1 1 to difficult MMU 1 DFWO √ √ √ areas Commu Community PRI functionaries to 564 villages DFWO √ √ nity Health Care participate in training PHC MO Manage Management Involve Self Help Groups in 564 villages PHC MO, √ √ √ ment Initiative programme activities ANM, AWW NRHM Manage Untied Funds Utilization of Untied funds All CHCs, Facility √ √ √ ment PHCs, SCs Incharges and PRIs fro SCs
197 Annual Repair and maintenance of 20 PHCs PHC MOs √ √ Maintenance PHCs of PHC Annual Repair and maintenance of 4 CHCs CHC √ √ Maintenance CHCs Incharges of CHC Human Engagement Assist in selection of 187 ANMs CMHO √ √ Resourc of second second ANMs and filling e ANM vacancies Training of Motivation of AYUSH 15 AYUSH DFWO √ √ Ayush and practitioners and Non practitioners other Non Government providers 20 Non Government Government providers providers Infrastru Up-gradation Follow up on construction / 10 SCs PHC MOs √ √ √ √ cture of Sub- renovation and ensuring Centres equipment, manpower placement Up-gradation Follow up on construction / 4 PHCs Block √ √ √ √ of PHC renovation and ensuring PHC I/C equipment, manpower placement Up-gradation Follow up on construction / GH -1 MS √ √ √ √ of CHC and renovation and ensuring GH equipment, manpower placement ROUTINE IMMUNIZATION Human Social Involvement of ASHAs and 630 ASHAs DTO √ √ √ √ Resourc Mobilization AWWs 1186 AWWs PHC MOs e ANMs, LS Re-orientation Participate in orientation 115 ANMs DTO √ √ √ √ of Health 15 MOs PHC MOs workers Material Cold Chain Ensure proper storage of 152 SCs DTO √ √ √ √ s & and storage vaccines at SC. PHC MOs Infrastru Waste Construction of waste 152 SCs DTO √ √ cture Disposal pits disposal pits at Sub PHC MOs Centres Support for Ensure supply of kerosene 152 SCs DTO √ √ √ √ SC oil PHC MOs
198 Access Support to Alternate Vaccine delivery 152 SCs DTO √ √ √ √ difficult areas PHC MOs NATIONAL DISEASE CONTROL PROGRAMME Leprosy Case Identification of new cases 40 Distt TB √ √ √ √ detection Officer Follow up of Identification of cases for ( Cases to be Distt TB √ √ √ √ old cases Re-constructive / identified Officer Physiotherapy services(RCS) Provision of preventive Cases to be Distt TB √ √ √ √ devices identified Officer Counselling services for 80 Distt TB √ √ √ √ self care Officer Behaviour Awareness generation and In all villages Distt TB √ √ √ √ Change advocacy Officer Communicatio n Vector Malaria Identify and contain In all villages Distt √ √ √ √ borne control outbreak Health diseases Officer PHC MO Participate in training on In all villages PHC MO √ √ √ √ insecticide treated nets ANM PRIs Awareness generation In all villages PHC MO √ √ √ √ ANM PRIs Mass Drug administration In all villages PHC MO √ √ √ √ ANM PRIs Dengue and Identify and contain In all villages Distt √ √ √ √ Chikingunya outbreak Health Officer PHC MO Awareness generation In all villages PHC MO √ √ √ √ ANM PRIs TB Revised Identification and follow up 600 PHC MO 150 150 150 150 National on cases ANM
199 Tuberculosis Partnership with NGO 20 BPHC I/C 10 10 Control partners and private Programme practitioners for Microscopy centres and DOT providers Ensure availability of drugs In all SCs, Distt √ √ √ √ and supplies PHCs and Health CHCs Officer Awareness generation In all villages Distt √ √ √ √ Health Officer PHC MO Surveilla Integrated Data gathering and linkage In all villages Distt √ √ √ √ nce Disease Health Surveillance Officer Programme PHC MO Involving private sector in 20 Private Distt √ √ √ √ disease surveillance facilities Health Officer Blindnes National Maintaining records in Blind All SCs Distt √ √ √ √ s Blindness register Health Control Officer Programme PHC MO Case referral for cataract All PHCs Distt √ √ √ √ surgery and others Health Officer PHC MO Other Untied funds Utilization of Untied fund In all villages DFWO √ √ √ √ Activities to Village PHC MO Health Water, ANMs Sanitation Committee Computerizati Follow up and proper use Of all the CMHO √ √ √ on of each HH ensured households PHC MO data ANMs
200
Detailed Budget District Kathua Strengthening of District Health Management S.No Activity / Item 2007-08 2008-09 2009-10 2010-11 2011-12 Total Orientation Workshop 0.5 0.55 0.605 0.666 1.271 3.591 Exposure visit 6.2 6.82 7.502 8.252 15.754 44.528 Issues based Workshops 0.5 0.55 0.605 0.666 1.271 3.591 Mobility for Monitoring 0.6 0.66 0.726 0.799 1.525 4.309 Total 7.8 8.58 9.438 10.382 19.820 56.020 District Programme Management Activity / Item 2007-08 2008-09 2009-10 2010-11 2011-12 Total Honorarium DPM,DAM,DDA 29.4 32.34 35.574 39.131 43.045 179.490 and Consultants Travel Costs for DPMU @ Rs 1.2 1.32 1.452 1.597 1.757 7.326 10,000/ per month x 12 mths Infrastructure costs, furniture, 5 5.5 6.050 6.655 7.321 30.526 computer systems, fax, UPS, Printer, Digital Camera, Workshops for development of 1 1.1 1.210 1.331 1.464 6.105 the operational Manual at district and Block levels Untied Fund 5 6 7.000 8.000 9.000 35.000 Construction Cost of District 0 88 0.000 0.000 0.000 88.000 Swasthya Bhawan @ Rs 800 /sq.ft x 11000sq ft Furnishing and Office 0 15 0.000 0.000 0.000 15.000 Automation, Conference Hall with speakers, ACs Maintenance of the Zila 0 1.000 1.500 2.000 7.000 Swasthya Bhawan 2.500 Compendium of Govt orders 0. 50 0.55 0.610 0.670 0.730 2.560 Joint Orientation of Officials 0.25 0.275 0.303 0.333 0.366 1.526 and DPM, DAM, DDM Management training 0.5 0.55 0.605 0.666 0.732 3.053 workshop of Officials Personnel for BPMU 92.4 101.64 111.804 122.984 135.283 564.111 Training of DPM and 0.5 0.75 1.000 1.250 1.500 5.000 Consultants Review meetings @ Rs 1000/ 0.12 0.132 0.145 0.160 0.180 0.737 per month x 12 months Office Expenses @ Rs 1.2 1.32 1.450 1.600 1.800 7.370 10,000/month x 12 months for district Computer systems (46) with 27.6 0 0.000 0.000 0.000 27.600 printer and Digital Camera and furniture for DPMU, BPMUs and District and BPMU Annual Maintenance Contract 2.7 2.97 3.267 3.594 3.953 16.484 for the equipment Travel costs for BPMU @ Rs 12.36 13.596 14.9556 16.45116 18.096276 75.459 5000 per month per block Hiring of vehicles at block 74.88 82.368 90.6048 99.66528 109.63181 457.150 level @ Rs 800 x 20days /mth x39PHCsx12 mths Monitoring of the progress by 1 1.1 1.200 1.300 1.400 6.000 independent agencies Office expenses for Blocks & 12 13.2 14.52 15.972 17.5692 73.261 Sectors @ Rs 5000 x 5 blocks x 12, Rs 2000X39 SectorsX12
201 Total 267.11 368.711 293.250 323.359 356.327 1608.758 Maternal Health Activity / Item 2007-08 2008-09 2009-10 2010-11 2011-12 Total Consultancy for support for 1 1.1 1.210 1.331 1.464 6.105 developing Microplan for Village health Day Tracking Bags @ Rs 300/ bag 4.083 4.158 4.209 4.224 4.239 20.913 x AWCs + SCs
Adult Weighing machines @ 10.888 11.088 11.224 11.264 11.304 55.768 Rs 800 per machine x 600AWCs & Maintenance(10% cost of machine) Monthly special outreach 2 2.2 2.42 2.662 2.9282 12.210 session in 100 difficult villages@2000/session Blood Storage @ Rs 3 lakhs 6 6 3.000 6.000 6.000 27.000 per unit Referral Cards @ Rs 2 per 0.2 0.22 0.242 0.266 0.293 1.221 card x 10,000 MTP kits @ Rs 15000 Per kit 5.85 6.435 7.0785 7.78635 8.564985 35.715 One day training workshop on 1 1.1 1.210 1.320 1.450 6.080 Tracking bags at the district level and each sector JSY beneficiaries @ Rs 140 168 196.000 224.000 252.000 980.000 1400/person JSY Helpline through RKS 9.99 19.98 29.970 39.960 49.950 149.850 Mobile phone instrument to 3.24 4.96 1.320 1.400 1.480 12.400 personnel @ Rs 2000
Mobile Phones recurring cost 4.374 11.07 12.852 14.742 16.740 59.778 to personnel @ Rs 2700 Delivery kits to 17.61 3.86 4.246 4.671 5.138 35.524 TBA's@3000and reffeling @ 1000 Incentives to TBA @ 100 per 2 3 4 5 6 20.000 deliveryby skilled birth attendent RCH Camps @ Rs 25000 per 3 3.3 3.630 3.993 4.392 18.315 camp x 12 Total 211.235 246.471 282.612 328.619 371.943 1440.880 Newborn and Child Health Activity / Item 2007-08 2008-09 2009-10 2010-11 2011-12 Total 2006-07 Study on the feeding and Care 2 0 0.000 0.000 0.000 2.000 practices for the infants and children Innovative activities based on 0 2 2.000 2.000 2.000 8.000 the study Newborn Corner furnished 1.4 5.6 1.4 1.4 1.4 11.200 with equipment @ Rs 1.40 lakh per facility Examination table, chair, stool, 35.58 0 0 0 0 35.580 table, other equipment @ Rs. 3000 x No of AWCs Infant Weighing 9.488 0 0 0 0 9.488 Machines@Rs. 800/AWCx No of AWCs Foetoscope @ Rs.50 x No 0.593 0 0 0 0 0.593 AWCs Malnutrition Corners @ Rs 0.6 1.2 0.300 0.300 0.300 2.100 30,000 per CHC and District Hospital Total 49.661 8.8 3.700 3.700 3.700 69.561
202 Family Welfare Activity / Item 2007-08 2008-09 2009-10 2010-11 2011-12 Total NSV camps @ Rs. 359750 8.6475 9.9973 11.361 13.952 25.313 69.2698 Sterilization Camps @ 19.50 45.925 65.2875 84.740 122.754 160.877 for 5000 cases 479.5835 Development Static 3 2 2.000 1.000 1.000 Centres@Rs 1 lakh 9.0000 Copper T-380 @ Rs 45 / piece 1.35 2.03 2.700 4.060 5.400 15.5400 EmergencyContraception@Rs 0.1 0.2 0.3 0.8 0.5 10/2 tabs 1.9000 Laparoscopes 3per CHC&DH 36 12 18 9 9 @ Rs3.00 lakhs x 3 84.0000 Total 95.0225 91.51475 119.101 151.566 202.090 659.293 Adolescent Health Activity 2007-08 2008-09 2009-10 2010-11 2011-12 Total Research 5 0 0.000 0.000 0.000 5.000 Awareness generation @ Rs 11.74 12.914 14.2054 15.62594 17.188534 71.674 2000 per village x 587 villages Workshop of all the partners 0.5 0.55 0.605 0.6655 0.73205 3.053 Training of Adolescent 1 1 1.000 1.000 1.000 5.000 Mentoring Group and other expanses@1 Lakh Counsellors@ Rs 8000 per 37.44 41.184 45.3024 49.83264 54.815904 228.575 month x PHCs x12 mths Training of Peer Educators @ 0.3 0.3 0.150 0.131 0.000 0.881 Rs 50 per person x 3 days xNo of Peer Educators ReTraining of Peer Educators 0 0.3 0.600 0.750 0.881 2.531 @ Rs 50 per person x 3 days x peer Educators Orientation & Reorientation 0.25 0.28 0.310 0.340 0.370 1.550 Health personnel Counselling sessions @ Rs 2 4 5.000 5.870 5.870 22.740 1000/yr/peer Educator Counselling Clinics 3.9 4.29 4.719 5.1909 5.70999 23.810 renovation, furnishing and Misc expenses @ Rs 10000.00 Health camps for Adolescents 2 2.2 2.42 2.662 2.9282 12.210 once per quarter x 4 x Rs 50000 per camp Joint Evaluation by an agency 1 0 1.200 0.000 1.320 3.520 & Govt Total 65.13 67.018 75.512 82.067 90.815 380.542 ASHA Activity / Item 2007-08 2008-09 2009-10 2010-11 2011- 12 Total Training & kit @ Rs 10000/ 3 1 1.000 1.500 1.500 8 ASHA Training of ASHA in Module 12.6 0.2 0.2 0.3 0.3 13.6 II,III,IV @ 2000/ASHA Reorientation @ Rs 1000/ 6 6.3 6.400 6.500 6.650 31.85 ASHA Expenses for the District 0.6 0.66 0.730 0.800 0.880 3.67 mentoring group – meetings, travel @ Rs 5000 per month x 12 months ASHA Performace Diary @ 0.6 0.64 0.650 0.665 0.680 3.235 100/ASHA Compensation to ASHA 75.6 76.8 78 79.8 81.6 391.8 @1000/ASHA Total 98.4 85.6 86.980 89.565 91.610 452.155 Untied Funds and an Annual Maintenance grant for Sub Centres
203 Activity / Item 2007-08 2008-09 2009-10 2010-11 2008- 12 Total Untied Fund of Rs 17.5 20 21.7 22.2 22.7 104.1 10000/subcentre Annual Maintenance grant of 17.5 20 21.7 22.2 22.7 104.1 Rs 10000/SC Total 35 40 43.400 44.400 45.400 208.2 Untied Funds and an Annual Maintenance grant for PHCs Activity 2007-08 2008-09 2009-10 2010-11 2011-11 Total Untied Fund of Rs 25000/PHC 9.75 9.75 9.75 9.75 9.75 48.75 Annual Maintenance grant of 19.5 19.5 19.5 19.5 19.5 97.5 Rs 50000/PHC Total 29.25 29.25 29.250 29.250 29.250 146.25 Untied Funds and an Annual Maintenance grant for CHCs Activity / Item 2007-08 2008-09 2009-10 2010-11 2011-12 Total Untied Fund of Rs 50000/CHC 2.5 3 3.5 4 4.5 17.5 Annual Maintenance grant of 5 6 7 8 9 35 Rs 100000/CHC Total 7.5 9 10.500 12.000 13.500 52.5 Mobile Medical Unit Activity / Item 2007-08 2008-09 2009-10 2010-11 2011-12 Total Cost of Mobile van 26.85 0 0 0 0 26.85 Cost of Diagnostic Van 23.75 0 0 0 0 23.75 Personnel 8.7 9.57 10.527 11.5797 12.73767 53.11437 recurring cost 23.71 26.081 28.6891 31.55801 34.713811 144.751921 Orientation 0.25 0.275 0.3025 0.33275 0.366025 1.526275 Jt workshop 0.25 0.275 0.3025 0.33275 0.366025 1.526275 Total 83.51 36.201 39.8211 43.80321 48.183531 251.518841
Upgrading CHCs to IPHS 2007-08 2008-09 2009-10 2010-11 2011-12 Total New CHC buildings with 79.2 79.2 79.2 79.2 79.2 396 staff quarters CHC Building Repair, Alteration and Addition @ 10 Lakh 0 40 0.000 0.000 0.000 40 Construction of Staff Qtrs of MO/ Specialist @ 7.2 0 86.4 0.000 0.000 0.000 86.4 Construction of Staff Qtrs of SN @6 96 0 0.000 0.000 0.000 96 Construction of Staff Qtrs of class [email protected] 19.2 12 0.000 0.000 0.000 31.2 Repairing of Staff Qtrs @ 10 Lakh/CHC 40 0 0.000 0.000 0.000 40 Furniture @1.2 X No of CHCs 4.8 1.2 1.2 1.2 1.2 9.6 Equipment @ 22.9 X No of CHCs 88.76 22.19 22.19 22.19 22.19 177.520 Reccuring cost of CHC 248.76 161.79 23.39 23.39 23.39 480.72 excluding Man Power
Purchase of generator sets @ 0.6 lakh x No of CHCs 2.4 0.6 0.6 0.6 0.6 4.8 Recurring & Maintenance cost of generator sets Rs. 140 X 30 days X 12 months X 7 No of CHCs 2.016 2.22 2.44 2.68 2.95 12.308 Computer ,printer,fax @60000 X CHC 2.4 0.6 0.6 0.6 0.6 4.8 AMC of computer @ 6000 X CHC 0.24 0.30 0.33 0.36 0.40 1.632 Total 583.776 406.4976 129.94936 130.2263 130.53093 1380.980
204 Upgrading PHCs for 24 hr Services, IPHS and additional requirements of PHCs Activity / Item 2007-08 2008-09 2009-10 2010-11 2011-12 Total Construction of Building with 113.4 264.6 113.4 0.000 0.000 491.4 staff Qtrs for building less PHCs @ 37.80 PHC Building Repair, Alteration and Addition @ 2Lakh 20 22 6 0.000 0.000 48 Construction of Staff Qtrs for PHCs have own building 144 604.8 0.000 0.000 0.000 748.8 Additional Staff qaurters for PHCs have own building 96 403.2 0.000 0.000 0.000 499.2 Repairing of Staff Qtrs @ 5Lakh/PHC 15 25 0.000 0.000 0.000 40 Furniture @1 X No of PHCs 12 0 0.000 0.000 0.000 12 Equipment @ 11 X No of 220 209 0.000 0.000 0.000 PHCs 429 Recuring cost of PHCs 151.632 151.632 151.632 151.632 151.632 excluding Man Power 758.16 Purchase of generator sets @ 23.4 0 0.000 0.000 0.000 0.6 lakh x No of PHCs 23.4 Recurring & Maintenance cost 19.656 21.6216 23.784 26.162 28.778 of generator sets Rs. 140 X 30 days X 12 months X No of PHCs 120.002 Computer with 23.4 0 0.000 0.000 0.000 scanner,printer,UPS ,Fax@60000 /PHC 23.4 AMC of computer @ 6000 X 2.34 2.574 2.831 3.115 3.426 No of PHC 14.286 Total 840.828 1704.4276 297.647 180.909 183.836 3207.648 Upgrading Sub Centres and additional Subcentres Activity / Item 2007-08 2008-09 2009-10 2010-11 2011-12 Total New buildings with quarters, equipment and Furniture 113.546 123.42 83.926 24.684 24.684 370.260 New Subcentres @ Rs. 4,93,680/SC non recurring for existing SCs 49.368 246.84 192.5352 0.000 0.000 488.743 Repair,Addition and Alteration of Subcenter @2lakh 40 26 0.000 0.000 66 Staff Quarters @ Rs 3 lakhs per Quarter for 2 ANMs 90 93 120.000 0.000 0.000 303 Staff Quarters @ Rs 3 lakhs per Quarter for 1 ANMs 60 123 0.000 0.000 0.000 183 Recurring costs of the 96.216 108.24 120.270 132.200 92.608 additional Subcentres 549.534 Total 449.130 720.5 516.731 156.884 117.292 1960.537 Untied Funds and Incentive Fund for the Village Health and Water Sanitation Committees Activity / Item 2007-08 2008- 09 2009- 10 2010- 11 2011- 12 Total Untied Fund of Rs 10000/unit 65.6 65.6 65.6 65.6 65.6 328 1500/unit x 656 units Permanent Advance to 8.75 10 10.850 11.100 11.350 52.05 VHWSC for ASHA incentive @ Rs5000/SC Total 74.35 75.6 76.450 76.700 76.950 380.05 Immunisation Activity 2007-08 2008-09 2009-10 2010-11 2011-12 Total
205 Mobility support for alternative 7.296 9.6 10.416 10.656 10.896 48.864 vaccine delivery Rs. 50 per session for 2 planned sessions per week at each Subcentre village for 12 months = Rs. 50x2 sessionsx4 weeks/mthx12 monthsx SCs Vehicle for distribution of 29.952 32.9472 36.242 39.874 43.861 182.876 vaccines in remote areas @ Rs 800 per PHC for 2 times per week x 4 weeks x 12 months x PHCs Mobility Support Mop up 23.4 23.4 23.4 23.4 23.4 117 campaign @ Rs 10000 per PHC ( Including travel, vaccine delivery, IEC) x 6 rounds/ year x PHCs Mobilization of Children by 56.352 56.352 56.352 56.352 56.352 281.76 Social Mobilizers @ Rs. 100/ session x2 sessions per week x 4 weeks/mth X 587 village x12 mths Iincentives to mothers @Rs 7.5 11.25 15.000 18.000 21.000 72.75 150 per child for full immunization Contingency fund for each 0.6 0.6 0.6 0.6 0.6 3 block @ Rs.1000/month x 5 blocks x 12 months 117.4 117.4 117.4 117.4 117.4 587 Pit Formation for disposal of AD Syringes and broken vials (@ Rs. 2000 per pit per village Printing of Immunisation cards 0.75 0.825 0.908 0.999 1.099 4.581 @1.50 per card x 50000 cards each year Special IEC session 1.2 1.320 1.452 1.597 1.757 7.326 @25/session X100 villages 4 times a yearn Maintenance of Cold Chain 4.46 3.2 3.260 3.320 3.380 17.62 Equipments (funds for major repair) (@ Rs.750 per PHC/CHC for the first year then Rs. 500 per PHC/CHC per month) and 50,000 for minor repairs Provision of Generator at all 23.5 0.5 0.5 0.5 0.5 25.5 facilities upto PHC DH: Rs 1.5 lakhs x 1, CHCs – 7x 0.50, PHCs – 40x 0.5 in first year Recurring & Maintenance cost 22.176 24.394 26.833 29.516 32.468 135.387 of generator sets Rs. 140 X 30 days X 12 months X No of PHCs & CHCs POL & maintenance for 1.8 1.98 2.180 2.400 2.640 11 Vaccine delivery van at district level @ Rs.15000/month x 12 mths Running Cost of WICs & WIF 7.02 7.72 8.490 9.340 10.270 42.84 (Electricity & POL for Genset & preventive maintenance) Rs. 90000 for electricity @ 15000 equipment per two months plus Rs.8000 per annum @1000 for POL for genset at DH Mobility suppot to District 0.36 0.396 0.436 0.479 0.527 2.198 Family Welfare Officer@ 3000/month
206 0.54 0.594 0.653 0.719 0.791 3.297 Computer Assistant for District Family Welfare Office @ 4500 1.56 1.716 1.888 2.076 2.284 9.524 Mobility support for Monitoring Immunization sessions for MO's PHC @1000/session Total 305.866 294.194 306.009 317.228 329.224 1552.522 RNTCP Activity / Item 2007-08 2008-09 2009-10 2010-11 2011-12 Total Civil Works DTC building 1.5 lakhs 1.5 0 0.000 0.000 0.000 1.5 MC 0.28/MC 2.8 0 0.000 0.000 0.000 2.8 TU 0.35/Tu 1.05 0 0.000 0.000 0.000 1.05 except DTC Material and supplies 1.2 1.32 1.450 1.600 1.760 7.33 Laboratory material 1 1.1 1.210 1.330 1.460 6.1 Training 10.45 11.495 12.645 13.909 15.300 63.798 Awareness drive on World TB 1 1.1 1.210 1.330 1.460 6.1 day IEC activities 1 1.1 1.210 1.330 1.460 6.1 Salaries of contractual staff 7.71 8.481 9.329 10.262 11.288 47.0703 Vehicle maintenance inc POL 1 1.1 1.210 1.330 1.460 6.1 2 wheeler 4 wheeler Hiring of vehicle 1.7 1.87 2.060 2.270 2.500 10.4 DTO MO TC @ Rs 0.42lakh/yr Equipment and maintenance 0.085 0.094 0.103 0.113 0.124 0.519 Microscope @ Rs1000/yr/microscope Computer@ Rs 5000/yr Photocopier/Fax Rs2500/ machine Miscellaneous – TA/DA, 0.195 0.215 0.247 0.272 0.300 1.229 Telephone, Meetings, Electricity repair etc Total 30.69 27.875 30.674 33.746 37.112 160.097 Leprosy Activity / Item 2007-08 2008-09 2009-10 2010-11 2011-12 Total
Contractual Staff 0.462 0.462 0.462 0.462 0.462 2.310 Honorarium 0.048 0.048 0.048 0.048 0.048 0.240 Office Expenses 0.150 0.150 0.150 0.150 0.150 0.750 POL & maintenance 0.360 0.360 0.360 0.360 0.360 1.800 Supportive drugs 0.120 0.120 0.120 0.120 0.120 0.600 Consumables/Stationery 0.120 0.120 0.120 0.120 0.120 0.600 3 Day training of Mos 0.500 0.500 0.500 0.500 0.500 2.500 1 day refresher training 0.120 0.120 0.120 0.120 0.120 0.600 TA for contractual staff and 0.100 0.100 0.100 0.100 0.100 0.500 NLEP IEC activities 0.5 0.5 0.5 0.5 0.5 2.500 Total 2.480 2.480 2.480 2.480 2.480 12.400 National Malaria Control Programme Activity / Item 2007-08 2008-09 2009-10 2010-11 2008-12 Total Salary Contractual staff 7.71 8.481 9.329 10.262 11.288 47.070 Travel expenses @ Rs 4000/ 3.36 3.696 4.066 4.472 4.919 20.513 monthfor jeep x 12 months, @6000/month for Truck Office expenses @ Rs 5000 0.6 0.66 0.730 0.800 0.880 3.67 per month x 12
207 Jeep and maintenance 6 0.6 0.660 0.730 0.800 8.79 Trucks – 6 and maintenance 32 3.2 3.52 3.872 4.259 46.851 Training 10.800 30.970 33.130 34.610 35.080 144.590 3 small Fogging machines for 125 12.5 13.75 15.125 16.638 183.013 each PHC @ Rs 1.00 lakh and one at District HQ Pulse Fog Machines @ Rs.8.00 lakh per unit and maintenance Misc @ Rs 1.00 and Rs 4.9 5.39 5.929 6.522 7.174 29.915 20000 per CHC, and for PHC Rs 10000 Board hoarding:8’x 12’ at the 1.25 1.5 1.750 2.000 2.250 8.75 CHCs and District hospitals @ Rs 25,000/- Board hoarding: 5’x3’ initially 3.9 3.9 3.9 3.9 3.9 19.5 at the PHCs@ Rs 10,000/-
Total 195.520 70.897 76.764 82.293 87.188 512.662 Other Vector Borne diseases Activity / Item 2007-08 2008-09 2009-10 2010-11 2011-12 Total Unforeseen expenses 0.5 0.55 0.610 0.670 0.740 3.07 Pamphlet, poster @1lakh 1 1.1 1.210 1.331 1.464 6.105 Kala Jathas for Malaria, 5.87 6.457 7.103 7.813 8.594 35.837 Dengue and Chikingunya @ Rs 1000 per village x 587 Total 7.37 8.107 8.923 9.814 10.798 45.012 Blindness Control Programme Activity / Item 2007- 2008 2008-09 2009-10 2010-11 2011-12 Total
Health Mela @50000 / CHC 2.5 2.75 3.025 3.328 3.660 15.263 IEC @1lakh 1 1.1 1.210 1.331 1.464 6.105 School Eye Screening @1000 1 1.1 1.210 1.331 1.464 6.105 X100 school Blind Register 0.386 0.425 0.467 0.514 0.565 2.357 Observance of Eye Donations 0.15 0.17 0.190 0.210 0.230 0.95 Cataract Camps @ Rs 20000 7.8 8.58 9.438 10.382 11.420 47.620 per camp x 39 PHC POL fro Eye Camps @ Rs 0.78 0.858 0.944 1.038 1.142 4.762 2000/camp x39 House to house survey for 10 0 0.000 0.000 0.000 10 vision defects @ 10 lakhs Training of School teachers @ 0.1 0.11 0.121 0.133 0.146 0.611 Rs 100/head x 100 Training of PRIs @ Rs 0.2 0.22 0.242 0.266 0.293 1.221 100/head x 200 Repair and purchase of 20 2 2.200 2.420 2.662 29.282 equipment and maintenance Total 43.916 17.313 19.047 20.953 23.047 124.275 Integrated Diseases Control Programme Activity / Item 2007-08 2008-09 2009-10 2010-11 2011- 12 Total Renovation of Labs at CHCs 1 0.000 0.000 0.000 1 a@ Rs 20,000 Renovation of Lab at District 1.4 0.14 0.180 0.200 0.220 2.14 Hospital @ Rs 140,000 and maintenance Equipment for Lab at PSU at 2 0.4 0.4 0.4 0.4 3.6 CHC and @ Rs 40,000 Equipment for Lab at District 8.5 0 0.000 0.000 0.000 8.5 @ Rs 850,000 Computer and Accessories at 2.5 0.5 0.5 0.5 0.5 4.5 CHC @50000
208 Office for PSU atMaintenance 0.5 0.1 0.1 0.1 0.1 0.9 CHC @ Rs 10,000 per unit Office Maintenance for DSU 0.1 0.1 0.100 0.100 0.100 0.5 @ Rs 10,000 Software for DSU@ Rs 3.35 0 0.000 0.000 0.000 3.35 335000 Furnishing of Lab at PSU at 0.5 0.1 0.1 0.1 0.1 0.9 CHCs and @ Rs 10,000 Furnishing of Lab at DSU @ 0.6 0 0.000 0.000 0.000 0.6 Rs 60,000 Material and supplies at Lab at 0.4 0.08 0.08 0.08 0.08 0.72 PSU at CHCs @ Rs 8,000 Material and supplies at Lab at 0.75 0.83 0.910 1.000 1.100 4.59 DSU @ Rs 75,000
Contract Staff at District level 2 2.2 2.920 3.710 4.580 15.41 @ 200000/yr for 4 staff yr wise
IEC activities 1 1.1 1.210 1.330 1.460 6.1 Training and retraining 0.980 3,02 3.030 3.040 3.050 10.100 WEN connectivity 0.5 0.55 0.610 0.670 0.730 3.06 Operational costs at PSU for 0.75 0.15 0.15 0.15 0.15 1.35 Surveillance @ Rs 15000/year x No of CHCs Operational costs at DSU for 1.3 1.430 1.573 1.730 1.903 7.937 Surveillance @ Rs 130000/year Honorariun to Numberdars 14.088 15.497 17.046 18.751 20.626 86.009 and Chowkidars for reporting @ Rs 100pm x 587Numberdars and 587 Chowkidars x12 Total 42.218 23.1768 28.909 31.861 35.100 161.265 IDD Activity / Item 2007-08 2008-09 2009-10 2010-11 2008- Total 2012 Large Village meetings for 1 1.100 1.210 1.331 1.464 6.105 awareness on IDD and consumption of Iodized salt Programme in schools – 100 2 2.200 2.420 2.662 2.928 12.210 Primary, Upper Primary, Secondary- Govt and Private by School health team Awareness programme with 2.935 3.229 3.551 3.906 4.297 17.918 the SHGs and shopkeepers @ Rs 500 per village x 587 villages Total 5.935 6.529 7.181 7.899 8.689 36.234 Intersectoral Coordination Activity / Item 2007-08 2008-09 2009-10 2010-11 2011-12 Total Meetings of the Block 1.08 1.188 1.307 1.437 1.581 6.594 Committees @ Rs 1000 /meeting x 9 blocks x 12 months Meetings of the Village groups 3.522 3.874 4.262 4.688 5.157 21.502 @ Rs 50 per village x 587villages x 12 Joint CNAA training @ Rs 200 4.11 4.16 4.194 4.204 4.214 20.882 per person ( 1186AWW, 152ANMs, 630ASHAs, 39 Supervisors, 39 MOs, 9CDPOs) x 2055 Joint monitoring at the sector level
209 Hiring of vehicle @ RS 1000/ 23.4 25.74 28.314 31.1454 34.260 142.859 day x 5 days/month x 39sectors x 12 months Joint monitoring at the block level Hiring of vehicle @ RS 1000/ 5.4 5.94 6.534 7.187 7.906 32.968 day x 5 days/month x 9 blocks x 12 months Yearly joint Planning 9 9.9 10.89 11.979 13.177 54.946 Workshops at the Block level for development of the Action Plans @ Rs 1.00 lakhs per block x 9 blocks Yearly joint Planning 1 1.1 1.21 1.331 1.464 6.105 Workshops at the District level for development of the Action Plans @ Rs 1.00 lakh Yearly joint Workshops to 9 9.9 10.89 11.979 13.177 54.946 consolidate the plans from the village to the Gram Panchayats to the Sectors and then Blocks at the Block level for Annual Action Plans @ Rs 1.00 lakhs per block x 9 blocks Yearly joint Workshops to 1 1.1 1.21 1.331 1.464 6.105 consolidate the findings at the block levels at the District level for development of the Action Plans @ Rs 1.00 lakh PRIs Chiranjeevi Scheme 24 44 44 44 44 200 Total 81.512 106.9022 112.81042 119.28206 126.39987 546.907
Community Health action Activity / Item 2007-08 2008-09 2009-10 2010-11 2008-12 Total
Training of the VHWSC @ Rs 17.61 19.371 21.308 23.439 25.783 107.511 200 per person x 15 persons/village x587 villages Meetings of the VHWSC @ Rs 3.522 3.8742 4.262 4.688 5.157 21.502 50 per village x 587 villages x 12 months Meetings of Women SHG @ 0.587 0.6457 0.710 0.781 0.859 3.584 Rs 100 per year x587 villages Honorarium for MOs for 0.702 0.7722 0.849 0.934 1.028 4.286 promoting Community health Action @ Rs 1000 pm and travel charges Rs 800 pm Total 22.421 24.663 27.129 29.842 32.827 136.882 Public Private Partnership Activity / Item 2007-08 2008-09 2009-10 2010-11 2011-12 Total
Fesiability study on PPP 10 0 0.000 0.000 0.000 10 issues Innovative activities based on 0 20 20.000 20.000 20.000 80 the study Capacity Building of NGOs 0.5 0 0.500 0.000 0.500 1.5 Establishing Tech. Support 2 2.2 2.420 2.662 2.928 12.210 Agency Capacity Building of 0.5 0.55 0.605 0.666 0.732 3.053 PRIs,SHGs,VHWSCs Area specific Modules 0.5 0 0.000 0.000 0.000 0.5 Exit poles 2 2.2 2.420 2.662 2.928 12.210
210 5 Workshops for involvement 2.5 0 0 0 0 2.5 of the Private sectors (one each with NGOs/Trusts/Private institutions;Media; Ex- servicemen association, transportation ,HR agencies) @ 25000 per workshop Sharing Workshops with 0 0.55 0.61 0.67 0.74 2.57 Private players Admin and overhead Charges 2 2.2 2.42 2.67 3 12.29 for hiring the agencies TOTAL 20 27.7 28.975 29.330 30.828 136.833 Gender and Equity Activity / Item 2007-08 2008-09 2009-10 2010-11 2011- 12 Total Research Study 10 0 0.000 0.000 0.000 10 Preparation of GIS maps for 5 1 1.000 1.000 1.000 9 monitoring IEC Campaign @2000 X587 57.87 63.657 70.023 77.025 84.727 353.302 villages Periodic Advisory committee 0.2 0.22 0.242 0.266 0.293 1.221 meetings @ 5000 Development of Trg. Modules 1 0 0.000 0.000 0.000 1 Traning of MO's &,ANMs 2 2.2 2.420 2.662 2.928 12.210 Panchayat level vigilence 1.83 2.013 2.214 2.436 2.679 11.172 committees @1000X183 Workshops with private 10 11 12.100 13.310 14.640 61.05 providers, IMA members, Religious leaders, Caste leaders, PRIs, MLAs in every block and Gram Panchayat and with SHGs Rallies in all schools and 5 5.5 6.100 6.700 7.400 30.7 colleges and generating discussions in schools and colleges through debates Regular advertisements in the 5 5.5 6.100 6.700 7.400 30.7 newspapers Health Card for Girl Child @ 0.2 0.22 0.240 0.260 0.290 1.21 Rs 2 /card x 10,000 cards Total 98.1 91.31 100.439 110.359 121.358 521.566 Capacity Building Activity 2007-08 2008–09 2009-10 2010-11 2011-12 Total TBA training @ Rs 10100 59.287 65.2157 71.737 78.911 86.802 361.953 /TBA MVA MTP training to all PHC 2.925 2.925 0.000 0.000 0.000 5.85 MOs for 15 days @ Rs 500 x 15 days x MOs Training on Blood transfusion for MOs and Lab Technicians for CHCs with Blood storage facilities for 3 days MOs @ Rs 500/day/person x 0.015 0.075 0.015 0.015 0.015 0.135 3 days LabTechnicians@Rs 0.006 0.03 0.006 0.006 0.006 0.054 200/person x 3 days Training in Obstetric management & skills for 24x7 PHCs for 16 weeks MOs: Rs 500/day x 112 days x 1.12 11.2 11.2 11.2 4.48 39.200 2 MOs StaffNurses:Rs200/dayx112da 0.448 4.48 4.48 4.48 1.792 15.680 ysx 2 SNs
211 Training in skilled Birth attendants for 15 days: One batch of 4 persons: Rs. 4 16 16 16 16 68.000 7500 as hon. to participants, Rs 13500 hon. to training team, 15% institutional charges, = Rs 25000/batch - 16 batches IMNCI training to ANM/LHV, 0.000 SN, ASHA for 8 days Rs 300 as hon. to participant x 1.032 2.1912 2.410 2.651 2.916 11.201 8 days IMNCI training to MOs @ Rs 0.3234 1.186 1.617 1.779 1.957 6.861 5390 /participant Integrated skill training of all 0.408 0.8976 1.4688 1.5912 2.2848 6.650 SN @ Rs 4080/person Integrated skill training for 0.2048 0.5632 0.6144 0.6656 0.7168 2.765 ANMs @ Rs 2048/person Integrated skill training for 0.18415 0.203 0.223 0.245 0.270 1.124 MOs @ Rs 3683 Training of MOs, SN in Mgt of 0.24 0.264 0.290 0.319 0.351 1.465 Newborns & sick children at Medical College Jammu @ Rs 7500/MO, Rs 4500 ( Rs 300 x 15 days)/SN Training in BCC for MOs, 0.76 0.836 0.920 1.012 1.113 4.640 LHVs, ANMs MOs: Rs 500/MO x 5 days LHVs & ANMs: Rs 300/person x 5 days Training of Ayush personnel 0.459 0.5049 0.555 0.611 0.672 2.802 on issues of RCH and reporting for 3 days Rs 300/person x 3 days Training on NSV for MOs at 0.42 0.462 0.508 0.559 0.615 2.564 NSV camps Rs 500/MO /camp x 12 camps, Rs 3000 per camp for trainer x 12 camps Training on Minilap @ Rs 500 0.6 2.64 2.904 3.194 3.514 12.852 per day for 15 days and during camps Training for Laproscopic 0.24 0.264 1.162 1.278 1.406 4.349 Sterilization for Surgeons, Gynaecologists, SN, OT attendants for 12 days Specialist: Rs 500/Specialist x 12 days SN: Rs 300/SN x 12 days OT Attendant: Rs 200 x 12 days Orientation on contraceptive 0.4 0.44 0.484 0.532 0.586 2.442 devices for MOs - Govt as well as private facilities Rs 500 /MO x 1 day Training on Medico-legal 0.5 0.825 0.908 0.998 1.098 4.329 aspects to MOs @ Rs 500/MO x 1 day Continuing Medical Education 2.5 2.75 3.025 3.328 3.660 15.263 sessions for doctors each month during the monthly meetings on current topics @ Rs 25000 per CME
212 Orientation on PCPNDT Act 0.5 0.55 0.605 0.666 0.732 3.053 for DCs, CSs, doctors both Govt and private, members of District Appropriate authority NGOs in a workshop General & Financial rules (G & 1.05 1.155 1.271 1.398 1.537 6.410 FR) for Officials, MOs, clerical staff for 3 days Rs 500/official and MOs x 3 days Rs 200 /clerical staff x 3 days Financial management 0.2 0.22 0.242 0.266 0.293 1.221 training for Accounts Officers, Accountants for 2 days Rs 200/Accounts persons x 2 days Computer training to all the 3 1.65 0.000 0.000 0.000 4.650 MOs, Clerical staff, accounts personnel @ Rs 200 per person x 15 days CNAA for MOs, LHVs, ANMs, 2.632 2.682 0.05 0.034 0.01 5.408 AWW @ Rs 200/person x 1 day each year Total sanitation orientation 1.174 1.2914 1.421 1.563 1.719 7.167 and reorientation of VHWSCs x 1 day @ Rs 200/person/day
Training of NGOs in BCC @ 0.54 0.594 0.653 0.719 0.791 3.297 Rs 300 per person x 6 days Total 85.16835 122.09437 124.769 134.020 135.335 601.387 Human Resources Activity / Item 2007-08 2008-09 2009-10 2010-11 2011-12 Total Subcentre ANM 320.305 388.455 434.797 448.427 462.057 2054.041 MPW(M) 207.9 237.6 257.796 263.736 269.676 1236.708 PHC MO 144.992 144.992 144.992 144.992 144.992 724.96 Staff Nurse 142.941 142.941 142.941 142.941 142.941 714.705 Health worker (F) 12.296 12.296 12.296 12.296 12.296 61.48 Health Educator 56.869 56.869 56.869 56.869 56.869 284.345 Health Assistant 131.747 131.747 131.747 131.747 131.747 658.735 Clerk 85.536 85.536 85.536 85.536 85.536 427.68 Pharmasist 6.12 6.12 6.12 6.12 6.12 30.6 Lab.Tech 21.384 21.384 21.384 21.384 21.384 106.92 Class IV 69.84 69.84 69.84 69.84 69.84 349.2 CHC Specialist(7) 73.8 99.63 125.46 151.29 177.12 627.3 MO General Duty (3) 47.28 56.736 66.192 75.648 85.104 330.96 PHN 6.848 8.56 10.272 11.984 13.696 51.36 ANM 7.128 11.88 16.632 21.384 26.136 83.16 SN 24.592 35.351 46.11 56.869 67.628 230.55 Dresser 3.45 4.14 4.83 5.52 6.21 24.15 Pharmacist 0 0 0 0 0 0 lab.Tech 0 0 0 1.188 2.376 3.564 Radiographer 3.564 4.752 5.94 7.128 8.316 29.7 Opthalmic Assistant 3.564 4.752 5.94 7.128 8.316 29.7 Class IV 1.44 7.2 12.96 18.72 24.48 64.8 Statistical Assistant 0 0 0 1.188 2.376 3.564 Registration clerk 0 0 0 1.188 2.376 3.564 Accountant 9.65 11.58 13.51 15.44 17.37 67.55
213 Epidemiologist 13.75 16.5 19.25 22 24.75 96.25 BEE 7.65 9.18 10.71 12.24 13.77 53.55 Total 1402.646 1568.041 1702.124 1792.803 1883.482 8349.096 Logistics and Warehousing Activity / Item 2007-08 2008-09 2009-10 2010-11 2011-12 Total Construction of Warehouse 85 0 0.000 0.000 0.000 85 Software 0.25 0 0.000 0.000 0.000 0.25 Computer system with UPS, 0.6 0 0.000 0.000 0.000 0.6 Printer, Scanner, Equipment & Hardware 34.5 0 0.000 0.000 0.000 34.5 Pharmacist @ Rs 9000/mth 0 1.08 1.190 1.310 1.440 5.02 Assistant Pharmacist @ Rs 0 0.6 0.660 0.726 0.799 2.785 5000/mth Packers -2 @ Rs 4000/mthx2 0 0.96 1.056 1.162 1.278 4.456 Security Staff @ Rs 6000/mth 0 0.72 0.792 0.871 0.968 3.351 Training of personnel 0 0.1 0.110 0.121 0.133 0.464 Consultancy to agency for 2 2.1 0.000 0.000 0.000 4.1 Operationalization of the Warehouse Total 122.35 5.56 3.808 4.190 4.618 140.526 IEC Activities 2007-08 2008-09 2009-10 2010-11 2011-12 Total Hiring of an agency for 40 44 48.400 53.240 145.640 331.28 carrying out the intensive IEC and behaviour change activities Finalizing the messages in the 1 1.1 1.210 1.331 3.641 8.282 local language Advertisements 5 5.5 6.050 6.655 18.205 41.41 TV spots 1 1.1 1.210 1.331 3.641 8.282 Radio Jingles in local 1 1.1 1.210 1.331 3.641 8.282 language Folk Media shows @ Rs 0.587 0.6457 0.710 0.781 2.137 4.861534 1000/vill Hoardings @ Rs 10 11 12.100 13.310 36.410 82.82 10000/hoarding Display boards @ Rs 1.8 1.98 2.178 2.396 6.554 14.9076 2000/board Pamphlets @ Rs 10 11 12.100 13.310 36.410 82.82 10/pamphlets x 100000 Nirdeshika for Fixed Health 1.6 1.76 1.936 2.130 5.826 13.2512 Nutrition days @ Rs 20/ Nirdeshika x 8000 SwasthyaDarpan @Rs.10 0.8 0.88 0.968 1.065 2.913 6.6256 /copy/mth x 8000 Orientation of elected rep and 4 4.4 4.840 5.324 14.564 33.128 PRIs@ Rs 200 x 2000 persons x1 day Village campaign @ Rs 215.914 237.5054 261.256 287.382 786.143 1788.19975 53.9875 lakhs per Campaign x 4 times in a year Bal Nutrition Melas @ Rs 300 14.232 15.6552 17.22072 18.942792 20.837071 86.8877832 x 4 times x AWCs Kishori Shakti meetings @ Rs 0.587 0.6457 0.710 0.781 2.137 4.861534 100 per group x 587 villages Community and religious 1.2 1.32 1.452 1.597 4.369 9.9384 leaders workshops @ Rs 300 /person x 100 x 4 times
Wall writings @ Rs 200 x 587 1.174 1.2914 1.421 1.563 4.275 9.723068 villages Total 309.894 340.8834 374.972 412.469 1097.342 2535.56047
214 Financing of Health Care Activity 2007- 08 2008-09 2009-10 2010-11 2011-12 Total Provision of Seed money @ 44 45 46.000 47.000 48.000 230 Rs 1 lakh per CHC and PHC @ Rs 1.00 lakhs Training of the Incharges and 0.88 0.968 1.065 1.171 1.288 5.372488 second in command @ Rs 1000 per person x 1 day Development of Software for 5 0.25 0.250 0.250 0.250 6 SKS with training of personnel on the use Total 49.88 46.218 47.315 48.421 49.538 241.372 HMIS Activities 2007-08 2008-09 2009-10 2010-11 2011-12 Total Survey house-to-house by 14.4 0 0.000 0.000 0.000 14.4 youth @ Rs 6000 pm x 3 months x 80 persons Survey for practices, 15 0 0.000 0.000 0.000 15 coverage, behaviour etc through independent agency Software development 20 0 0.000 0.000 0.000 20 Data Entry of each household 2 0.4 0.800 1.200 1.600 6 @ Rs 2 per household x 100000 HH Internet connectivity @ Rs 900 4.752 4.86 4.968 5.076 5.184 24.840 /mth x No of facilities x12 mths provision of computers for 22 0.5 0.5 0.5 0.5 24 each CHC and PHC @ Rs 50,000/computer system with UPS and printer AMC for computers @ Rs 2.2 2.42 2.662 2.928 3.221 13.431 5000 /computer /year x 44 computers Consumables for computers 22.56 24.816 27.298 30.027 33.030 137.731 @ Rs 4000/mth/facility x 12 mths GIS for the district, training 12 0.5 0.500 0.500 0.500 14 and updation 0.1 0.125 0.150 0.175 0.200 0.75 Printing monitoring Charts @ Rs. 5 per monitoring chart Total 115.012 33.621 36.878 40.407 44.235 270.152 BioMedical Waste management Activity 2007-08 2008- 09 2009-10 2010-11 2011-12 Total Orientation and reorientation for Biomedical Waste Management at District and Block levels 1.5 1.65 1.820 2.000 2.200 9.17 Consumables 1 1.1 1.210 1.330 1.440 6.08 Payment for incinerators@ Rs. 17.424 19.166 21.083 23.191 8 per bed 12 mths 15.84 96.705 Total 18.34 20.174 22.196 24.413 26.831 111.955
Grand Total 5857.021 6735.909 5075.743 4915.241 5867.682 28451.596
215 Annexure:
SC Buildings need to be Staff Quarters Needs to be Block constructed Constructed For SC Hiranagar Amala Kheri Bannu Chak Rai Magloor Tanda Rai Fattu.Chak Tanda Thakerpura Fattu.Chak Subachak Jatwal Chadwal Chhan.Kanna Jatwal Dhamyal Chhan.Kanna Chaan.Khatrian Dhamyal Chaan.Morian Chaan.Khatrian Sandhi Surara Kattel.Brahmana Chhan.Rorian Ladhwal Chaan.Morian Sanyal Sandhi Kadayal Kattel.Brahmana Nonath Chandare.Chak Sagal Ladhwal Satoora Sanyal Hira Nagar Kadayal Mangu Chak Nonath Chhan Lal Din Sagal Panjgrain Satoora Chandwan Hira Nagar Bann Ragal Mawa Chhan Lal Din Odh Chandwan Danoh Bann Mawa Bilawar Tharakalwal Tharakalwal Nongala Sathar
216 kalna Marhoon Barota kalna Malhid Barota Dehota Malhid Rajwalta Dehota Pallan Rajwalta Beril Najote Rampur kishan Pur (billawar) Dhar Dugnoo Pallan Dharmkote Beril Dher Rampur Maggain Dhar Dugnoo Dhanu Prole Dharmkote Bhid Dher MAC Mandli Koti Mooni Dhanu Prole Tumboo Roukhla Phinter Chunera Upper Dharalta Kashid Tumboo Bhid Nagrota Gujroo MAC Mandli Phinter Sadrota KishanPur Issu Upper Dharalta Mooni Sarang Tumboo Nagrota Gujroo Phinter Upper Dharalta Sarang Bani Bhakoga Sitti Sitti Mandrara Mandrara Dumeya Dumeya Siara Dullangle Lowang Chandal Barmota
217 Kanthal Chandal Bhakoga Kanthal Doulka Banjal Dhaman Bhakoga Backon Doulka Tapper Barmota Dhaman Basoli Jandrota Jandrota Dodla Dodla Nagrota Mannu Adhat Thanger Danna Nagrota Poonda Adhat Silage Danna Poonda Prey Silage Parole Padyari Padyari Rajbagh Rajbagh Kumri Kumri Sample Sapla Sample Sapla Jandore H Sumwan Badala Bhallar Jasrota AD Ghati Khokhyal Khokhyal Dhanore Dhanore
218 Status of PHC Buildings and Staff Quarters
S.No Block Buildings need to be constructed 1 Billawar Hakwal Sukral Kohag Malhar Uchapind Godu Flal Bhaddu 2 Bani Gud Duggan Dhaggar 3 Basoli Mahanpur Karanwara
S.No Block Staff Quarters need to be constructed 1 Hiranagar Rattanpur Ghagwal(available only for M.O) Sanoora (available only for M.O) Harichak Dinga Amb A/D Bhaiya A/D Chakra(available only for M.O) 2 Billawar Badnota Hakwal
Sukral(available only for Pharmacist) Kohag Malhar Uchapind Godu Flal Ramkote(available only for M.O) Maehhedi
Bhaddu(available only for M.O & other Staff) Lohai 3 Bani Gud Duggan
Kati Chandyar(available only for other Staff) Dhaggar
4 Basoli Saranghat(available only for Pharmacist) Mahanpur
Sandhar(available only for M.O & other Staff)
219 5 Parole Barwal Budhi
Lakhanpur(available only for M.O) Kharote Dhanni
220 Assessment of District Health Action Plan (DHAP) Appraisal Criteria to be used by State/ District Planning & Appraisal Team
District Kathua Sl. Criteria Remarks No. Yes/ No
A. OVERALL 1 Has the DHAP been reviewed in detail by the District Yes authorities to ensure internal consistency? If yes, by whom? This means that Situation analysis, goals, strategies, activities, work plan budget are in line with the proposed interventions and are evidence based. 2 Has Account Person from the Department reviewed the Yes budget in detail? 3 Executive summary /At a Glance has been enclosed in the Yes, beginning of the document. 4 Has plan developed in all inclusive and participatory Yes process by involving representatives of health, water and sanitation, ISM, ICDS, Rural Development, NGOs and community members? 5 Funds requirement matches with the absorption capacity Yes and has judicious increase over the years (The planning should be based on past experiences in implementing interventions and realistic time frame/ workplan ) 6 The Plan caters needs of vulnerable groups (SC/ST, BPL, Yes Women and Children, others) (Activities proposed to cover SC/ST population for Immunization coverage, JSY scheme etc.) 7 Inter-department coordination and convergence Yes, mechanism is clearly mentioned for multi-sectoral inputs/elements. (Planned joint sector ,block and dist level meetings with ICDS, education and local self Govt. etc and joint circulars for implementing intervention) 8 The findings of the facility survey/ assessment has been Yes, integrated in the Plan 9 Plan has been approved by appropriate district authority Yes, attached after the cover District (District Health Society) page 11 Training Plan Yes, The training strategy to strengthen existing HR. The training plan has indicated target groups (e.g. MO, ANM, ASHAs, AWW etc), training load and broad details e.g. duration, quality assurance for training, etc 12 BCC /IEC strategy Yes A service oriented BCC strategy based on assessment of the current status of issues with MMR, IMR, TFR, awareness of PNDT, etc. has been narrated in the plan 13 Work Plan Yes, Is the work plan consistent with stated components/objectives, strategies and activities? And whether the proposed phasing of activities would lead to increase in delivery/utilization of services? 14 COSTS/BUDGET Key criteria are:
221 Sl. Criteria Remarks No. Yes/ No
Does the budget follow the prescribed formats? Yes The justification column has break-up of total amount 1. Absorptive capacity: If very ambitious utilization of Yes funds is envisaged compared to performance of 05- 06/06-07, then key steps have been proposed to achieve plan expenditure? B RCH-II PROGRAM PROGRAM MANAGEMENT ARRAGEMENTS 1 Steps to establish financial management system including Yes, fund flow mechanisms to blocks and downward level and accounting system including timely reporting expenditure 2 Steps to establish quality assurance committees/system in Yes the district. 3 Step to ensure systems for holistic monitoring (Outputs, Yes activities, costs) against DHAP .( Dist level review meeting and DHS meetings) 4 Strengthening of HMIS with emphasis on timely availability Yes, of reliable and relevant information at appropriate level e.g. community, SC, PHC, Block and district, analysis and feedback system, steps to ensure implementation of revised HMIS system. 5 Provision of logistics management of drugs and medical Yes, supplies in order to ensure continuous availability of essential supplies at S/C, PHC and CHC level. TECHNICAL STRATEGIES A. Reproductive & Child Health 1 Maternal Health A. Interventions for 100% ANC coverage, Yes, B. 24x7 for EmOC services at selected institutions C. Skill birth attendance during labour (ANM) D. Provision for availability of safe blood in FRUs/CEmOCs, E. Intervention for anesthesia training for MOs, F. Provision of Safe abortion services and, G. Management of RTI/STI Cases H. Provision for Janani Suraksha Yojana 2 Child Health A. Organizing MCHN days for complete immunization Yes, coverage, B. Interventions for IMNCI services (Optional) C. Provision for new born care at institutions and, D. Promotion of breast feeding E. School Health Programme 3 Family Planning A. Interventions to provide regular FP services in every Yes, block facilities, B. Increase number of service providers for vasectomy, NSV, Tubectomy, and Laproligation , C. Intervention to improve quality of camps, D. Quality IUD insertion services, E. Increased availability of OP, Condoms through community workers, ASHA, AWW, NGOs
222 Sl. Criteria Remarks No. Yes/ No
4 ARSH A. Intervention for training of MOs, paramedic for ARSH Yes services ( optional) B. Provision of AFHS services at selected institutions (optional)
5 Gender Mainstreaming Activities planned for awareness generation of gender, Yes, PCPNDT Act and strengthening implementation of PCPNDT Act. 7 Urban RCH Interventions for provision of MH/CH/FP services in urban NA slums and urban areas. 8 Tribal Health Interventions to cover tribal population for FP/MH/CH. NA B NRHM ADDITIONALITIES Whether provision made for- 1 ASHA Training in the district Yes 2 PRI Trainings (Block/Village health & Sanitation Yes Committees) 3 Untied Funds at SC & Yes Untied funds to RKS at PHC/CHC/District Hospitals 4 Civil Works as per IPHS (CHC/PHC/SC) Yes Hospital Building- Staff Quarters 5 Strengthening Field Monitoring and Supervision (Enhance Yes the provision of POL, Maintenance and of vehicle) 6 Need assessment done for-Procurements as per IPHS Yes CHC/PHC/SC) 7 Appropriate provision made for-Programme Management Yes, Units at Divisional, District and Block levels-Adequate salary and OE provisions ( District PMU is a part of RCH II and Block level PMUs are part of NRHM) 8 Adequate provision made for-Additional Manpower Yes Specialists at CHCs ANMs at SCs Divisional/Block Programme Managers 9 Provision made for-Drug Kits at different institutions Yes 10 Plan for management of Mobile Medical Units at districts Yes 11 No of Ambulances available and required Yes District specific innovative activities to address local needs Yes, addressed in all the have been incorporated technical chapters 12 Public private partnerships ( optional) Yes, 12 Provision of hiring of vehicle for BMOs (as per Yes requirements) C IMMUNIZATION PROGRAM Whether provision made for- 1 Social mobilization Yes 2 Alternative vaccine delivery Yes 3 Cold Chain Maintenance Yes
223 Sl. Criteria Remarks No. Yes/ No
4 PoL & Maintenance requirement for vehicles Yes, D National Disease Control Programme 1 Water Borne Diseases Yes Clear strategy prepared for combating Water Borne Diseases like Malaria, dengue etc 2 TB Whether Separate section on TB with operational details Yes, and budget prepared 3 Leprosy Separate section on Leprosy with detailed operational Yes, guidelines and budget
4 Blindness 1 Separate section on Blindness Control with detailed targets Yes, and budget 2 Monitoring mechanism for NGO E CONVERGENCE/ INTER-DEPARTMENTAL Yes, COORDINATION Whether interventions in the following areas have been planned 1 ISM Integration Activities Yes 2 Department of Social Welfare (ICDS) Yes 3 PHED Yes
224