GOVERNMENT OF JAMMU & KASHMIR
NATIONAL RURAL HEALTH MISSION
DISTRICT HEALTH ACTION PLAN
District: Ramban
December 2007
1 2 Map of the District
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
4 and also for provision of the technical support. The DPT is the standing body and will take charge of ensuring implementation of the plan. Thus the DPT not only owns the plan but will also be responsible for monitoring the progress of implementation to achieve the objectives of the plan. The members of the DPT are:
# Name Designation Department 1. Sourav Bhagat DC Doda DC Office 2. A A Malik Chief planning officer DC Office 3. I A Shapu CMO Doda Health 4. Dr M I Zargar Dy. CMO Health 5. Kamlesha Kumar TSWO SWO
6. Shayesta Sultana CDPO Social welfare 7. Dr Kuldeep Kumar MO (ISM) ADMO 8. J M Tharmta DEPO Education 9. Dr M S Wani DHO Health 10. Waseem Raja District program manager Health 11. Ashok kumar District account manager Health 12. Surnnder Singh PMA Health 13. Tariq Hussan Data assistant Health The orientation of DPT, facilitated by EPOS Health India, was held on 12 th July 2007. This enabled the DPT members to not only understand NRHM approach, key components and strategies of NRHM, but also manage the planning process and develop the District Action Plan. The DPT met a number of times and the individual members reviewed the situation of their respective sectors/areas and collectively developed the strategic vision for improving the health status of the district population.
We the members of the DPT on behalf of the entire Planning Team reiterate and certify that this District Action Plan has been prepared through participatory processes. It has been developed by integrating the Block Action Plans prepared by integrating health facility surveys and village health plans in each block of the District. This plan also incorporates the needs and plans from -47 Sub health centres, 15 PHCs, 3 CHCs in the District.
Name of Chief Medical Officer Signature Date
5
CONTENTS PREFACE ...... 4 EXECUTIVE SUMMARY ...... 7 BUDGET AT A GLANCE ...... 8 PRIORITY MATRIX OF THE DISTRICT ...... 10 1. SITUATION ANALYSIS ...... 16 SOCIO ECONOMIC AND HEALTH INDICATORS OF THE DISTRICT ...... 22 SOCIO-ECONOMIC INDICATORS ...... 22 HEALTH INDICATORS ...... 23 2. PLANNING PROCESS ...... 35 3. PRIORITIES AS PER BACKGROUND AND PLANNING PROCESS ...... 38 4. GOALS ...... 40 5. TECHNICAL COMPONENTS ...... 41 PART A: REPRODUCTIVE AND CHILD HEALTH (RCH) II ...... 41 Access for the quality IUD insertion at all the subcentres...... 56 Strengthening linkages with ICDS programme and ISM (Ayurveda) ...... 56 PART B: NEW NRHM INITIATIVES ...... 61 PART C: IMMUNIZATION ...... 79 PART D: NATIONAL DISEASE CONTROL PROGRAMME ...... 84 6. INTER SECTORAL CONVERGENCE ...... 98 7. COMMUNITY ACTION PLAN ...... 104 8. PUBLIC PRIVATE PARTNERSHIP ...... 106 9. GENDER AND EQUITY ...... 109 10. CAPACITY BUILDING...... 112 11. HUMAN RESOURCE PLAN ...... 120 12. PROCUREMENT AND LOGISTICS ...... 126 13. DEMAND GENERATION - IEC ...... 128 14. FINANCING OF HEALTH CARE ...... 131 15. PROGRAMME MANAGEMENT ...... 133 16. BIO- MEDICAL WASTE MANAGEMENT ...... 138 17. MONITORING & INFORMATION SYSTEM ...... 140 DETAILED NRHM BUDGET (IN LAKHS) ...... 143 ANNEXURE: ...... 162
6 Executive Summary Since Ramban district has been recently formed from its parent district Doda and 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. Also 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. The health status of district Ramban is very poor since the district ranks 530 out of 593 districts in the country in terms of RCH indicators especially for the contraceptive prevalence rate for which the district is 543 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, workplan 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 14358.31 lakhs with an allocation of Rs 4076.37 Lakhs for the current year .
7 Budget at a glance District Ramban 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 41 13.298 14.10 16.18 16.37860 100.96 2 DPMU 226.01 83.161 92.49 102.58 113.5188 617.76 3 Maternal health 100.07 99.486 108.82 85.82 99.90333 494.10 4 Child Health 24.875 23.502 14.20 15.40 16.6 94.58 5 Family Welfare 47.95 45.33 33.86 38.81 43.23 209.18 Adolescent 29.66 30.53 31.94 36.1167 155.36 6 Health 27.116 8 Gender & Equity 22.17 24.42 26.87 29.65 32.378 135.49 Capacity 38.0125 40.7288 37.81 41.78 39.18580 197.51 9 Building 10 HR 933.241 1216.533 1224.36 1230.95 1238.777 5839.11 11 IEC 118.881 130.9731 144.07 158.48 423.9743 976.38 HMIS & 82.192 25.6562 28.54 31.68 35.08413 203.16 12 Monitoring Total 1664.06148 1730.20413 1755.66 1783.25 2095.146623 9023.57 B NRHM 1 ASHA 30.3 10.2 10.51 10.82 11.14 72.97 SC Untied Fund 14 14.4 14.8 15.2 15.6 74 2 & Maintenance PHCUntied 11.25 11.25 11.25 11.25 11.25 56.25 Fund & 3 Maintenance CHC Untied 4.5 4.5 4.5 4.5 4.5 22.5 Fund & 4 Maintenance 5 MMU 39.15 13.53 14.883 16.3713 18.00843 101.943 Upgradation of 6 DH & CHC 751.8828 333.10 28.2758 28.4639 28.67081 1170.398 Upgradation of 7 PHC 560.0948 226.58 27.4838 27.5927 27.71249 869.469 Upgradation of 505.0945 243.30 64.4999 65.7026 66.9053 945.4995 8 SC 9 VHWSC 22.4 22.5 22.6 20.42 22.8 88.32 Community 11.771 12.9481 14.24291 15.667201 17.2339211 71.863132 10 Action Plan 11 PPP 30 27.7 28.975 29.3295 30.82845 146.83295 Health Care 23.36 18.646 18.6856 18.72916 18.777076 98.197836 12 Financing 13 Logistics 138.1 5.56 3.808 4.19 4.618 156.276 Biomedical 14 Waste 18.34 20.174 22.1964 24.41304 26.831344 111.95478 Total 2160.2431 964.39 286.71041 292.649401 304.8758211 3986.4736 C Immunization 1 Immunization 65.034 75.5254 79.93564 84.786244 90.1085684 395.38985
D NDCP
8 1 RNTCP 51.25 35.642 39.2163 43.13893 47.40 216.64255 2 Leprosy 5.40 5.75 6.15 6.55 7.15 31 3 Malaria 57.60 35.64 39.83 44.59 49.44 227.09063 4 Vector Borne 1.93 2.12 2.34 2.57 2.83 11.800293 Blindness 19.45 12.40 13.64 15.01 16.51 77.00943 5 Control 6 IDSP 10.26 28.09 14.38 15.73 17.19 85.649172 7 IDD 3.72 4.09 4.50 4.94 5.44 22.680447 Total 149.6028 123.7263 120.05203 132.534233 145.9571563 671.87252 E Others 1 Inter-Sectoral 37.436 58.7636 60.09796 61.550956 63.1516516 281.00017
Grand total 4076.3774 2952.6143 2302.451 2354.7756 2699.23982 14358.31
Overall Rank of District Ramban
590
The above chart showing the status of the district in the country (Source- JSK, New Delhi-2007). Out of 593 districts ranked on selected RCH indictors, Ramban district has got an overall rank of 530. Among the four indicators of the study, the family planning related indicators were the poorest, resulted in overall low ranking. This indicates the urgent need for improving these services and their coverage in the district.
9
Priority Matrix of the District
S.No Thematic Critical Issues of the District Specific Priorities Area 1. District Health Being a new district, there Constitution of DHS Management: is no district health society Societies need functional constituted till date. integration and strengthening. Functional integration of Capacity building of the DHS vertical societies like members regarding the Blindness Control Society, programme, their roles, various TB Control Society, District schemes and mechanisms for Malaria Society etc. monitoring and regular reviews and also operational guidelines for running the District Health Society. Monitoring and evaluation. Monitoring of health activities by health personnel only. Members from other departments and also from the elected representatives need to become members for better monitoring and implementation. Strengthening the functioning of the DHS. 2. District & Need for providing more Recruitment of DPM, DAM, DDA Block technical support to the and consultants. Programme CMO office for better Development of total clarity at the Management implementation especially district and the block levels in light of the increased amongst all the officials and volume of work in NRHM. Consultants about NRHM Strengthening the activities monitoring and reporting Training of district officials and especially in the areas of BMOs for programme Maternal and Child Health, management Civil works Behaviour Streamlining Financial change and accounting management and systems right from the level of the Strengthening the CMO office with Subcentre. DPMU with extra computers,
10 telephone system and human resources. Capacity building of the DPMU personnel for monitoring Strengthening the Block Management Units by establishing BPMUs. 3. Reducing Lack of 24X7 facilities for Increase coverage of full ANC and maternal and safe deliveries in Postpartum Care to pregnant child deaths subcentres and PHCs. women and Lack of authentic data Increase in Institutional deliveries Population regarding the maternal and by operationalsing 24X7 PHCs stabilization infant deaths in the district. Strengthen FRUs for Emergency Equipments are not Obstetric Care services along with working properly or not minimum basic infrastructure, available as per the need Blood Storage facilities, Facilities in subcentres, PHCs & for Neonatal Care, drugs and CHCs to provide quality equipments. services. Increase availability of safe Lack of facilities with for abortion services at all block level emergency obstetric care. CHCs/ PHCs. Non-availability of Increased coverage under JSY Specialists for an Strengthening the Village Health aesthesia, obstetric care, Day paediatric etc. To increase awareness among Lack of referral transport mothers and communities about systems. the importance of institutional Lack of Blood Storage deliveries facilities at FRUs Improved behaviour practices in Lack of Neonatal care the community facilities at FRUs Operationalization of all the sanctioned Anganwadis 4. 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 one to counsel them. Yojana in coordination with ICDS Teenage pregnancies also and NGOs. emerging as a problem Operationalise Adolescent
11 and unsafe abortion & Friendly Health services at the premarital sex trend are on health facilities rise.
5. Mobile Remote population is not Coverage of the tribal populations Medical Units covered due to lack of in the blocks. (MMUs) required staff, Provide one-MMU equipped with infrastructure. GPRS services. Communications system is Contract MOs and staff nurses for poor. MMUs 6. Upgrading None of the CHCs are as Following CHCs needs to be CHCs to IPHS per the IPHS standards; upgraded as per IPHS Standards in however the condition of the first year:- CHC Banihal is deplorable CHC Batote and needs to be upgraded. CHC Ramban CHC Banihal 7. Upgrading None of the PHCs are as Construction of 11 PHC buildings PHCs for 24 per the IPHS standards. Construction of staff quarters in 12 hr Services Out of 15 PHCs + ADs, PHCs (Names of PHCs given in and IPHS only 4 PHCs are housed in Annexure) standards government buildings and rest 11 are running in rented accommodations. 12 PHCs/ADs are without staff quarters 8. Upgrading None of the Subcentres Need to construct 38 Subcentre Sub Centres are as per IPHS norms. buildings ( Names of SCs are to IPHS Out of 47 subcentres, 38 enclosed as Annexure) standards subcentres are running in Construction of staff quarters in all rented buildings and 9 subcentres for ANM’s stay. subcentres are running (Names of subcentres given in from government owned Annexure) buildings. Construction of Labour rooms at There are no labour rooms all Subcentres for promoting in any of the Subcentres institutional deliveries for Institutional deliveries. There is no staff quarter in any of the subcentres of the district Ramban.
12 9. Immunisation Lack of awareness to Strengthening the District Family mothers Welfare Office Alternate vaccine delivery Enhancing the coverage of Lack of Cold storage Immunization Efficient monitoring and Alternative Vaccine delivery supervision mechanisms in place Gaps in difficult, flung Effective Cold Chain Maintenance areas & inaccessible areas upto sub centre level Reporting and Zero Polio cases and quality documentation surveillance for Polio cases Large number of cold Close Monitoring and chain equipment are not documentation of the progress functional and need repair Repair and replacement of cold or need to be replaced chain equipment as per the need 10. Inter Sectoral Lack of coordination b/w ICDS Linkages to be developed between Convergence and health department ICDS workers and health workers for timely diagnosis of malnourished children and their management (detailed activities under thematic heads) Lack of coordination b/w RDD Linkages to be developed between and health department the 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.
13 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 organizations formed under various programmes/sectors will be engaged by a team of frontline workers – health, ICDS and PHE departments.
Mainstreaming of AYUSH • Introduction and placement of ISM Doctors at the Block Headquarters and PHCs. 11. Human Lack of manpower at all levels • All staff to be in place as IPHS Resource starting from sub centres to norms by 2012 PHCs to CHCs to DH in district • Increased salaries for contractual Ramban doctors and Specialists • Special allowances for Regular Sub centre level staff • The requirement of ANM • Increase in the number of training will be around 94 in centres for LHV, ANM, Staff Government as per IPHS Nurses, Lab Technicians norms of 2 ANMs per Sub • Rational placement of Specialists centre but there is and trained staff availability of only 18 • Recruitment of staff on contract ANMs. where vacancies
• PHC level Recruitment of staff for new • As per IPHS 2 MOs per facilities as per the infrastructure PHC will be required requirements. whereas at resent there is • Computers at all PHC and for only one MO per PHC. each MO and Specialist at the
14 • For IPHS norms 45 Staff CHC. Nurses for PHC [3 per • Allowing Specialists and MOs for PHC] are required. At developing special skills as per present there are just 4 SN their needs by attending special • There are only 4 Lab courses anywhere in India. Technicians as against the • Proposal for Staff Nurse College required 15 today. and other Paramedical training CHC Level college. Similarly there is vacancies for specialist and other support staff at CHC level
15 1. SITUATION ANALYSIS
District Ramban has been recently been carved out from old Doda district and consists of three Medical Blocks Ramban, Ukheral and Banihal which covers an area starting from Patnitop to Tunnel top it borders with district Anantnag from one side and with district Udhampur from other side the district is totally hilly and dangers interms of road and geographic conditions there is a good proportion of BPL backward Class and Scheadule tribe population living on hill tops of this peerpanjal range there is no road connectivity to the surrounding areas of each block even block Head Quarter of Ukheral is not having telephone facility the block is neglected and backward in terms of every developmental aspect.
Ramban District is one of the newly formed districts of the State of Jammu & Kashmir. It has 3 CD blocks. District headquarters is situated at Ramban .The District Ramban has population 2, 25,138 which lives in 143 villages and 65 Gram Panchayats.
1. Identifying information
Name of District Ramban
Name of District Headquarters Ramban
No. of Blocks in the District 3
No. of Gram Panchayats in the District 65
No. of Villages 143 1-500 48 501-1500 59 Size of Villages 1500-2000 29 2001-5000 4 5000+ 3 Villages without motorable roads 70%
Villages without electricity 25%
No. of Towns 3 Municipal Corporation Municipality Urban Local Bodies (ULB) Municipality: 3 Notified Area Committee Others
16
Un-served / undeserved / vulnerable areas, population in the District -
There is 4.42% are Scheduled Caste (SC) and 12% are Tribal (ST)out of the total population The total population of Scheduled caste is 1,18,13 The total population of Scheduled caste is 27,917
ASHA Status of the District Ramban (Block wise).
To be Trained in Already To be Name of Trained in Selected 06-07 Trained in Trained in Block 07-08 (Module I) Mod II Mod II (Module I) Banihal 45 45 0 0 45 Ukheral 52 52 0 0 52 Ramban 65 65 0 0 65 Total 162 162 0 0 162
District Data (Old) on Population Population Population Total Male Female ratio Sex 06Years tion Popula- 06Years Population Male 06Years Population Female 06Years ratio Sex Rate Literacy hold House of Number
District Ramban Total 86343 46127 40216 872 16169 8280 7889 953 43.4 13846 Ramban Rural 78215 41422 36793 888 15192 7765 7427 956 39.2 12399 Ramban Urban 8128 4705 3423 728 977 515 462 897 80.2 1447 Banihal Total 94487 49791 44696 898 15936 8094 7842 969 42.2 15300 Banihal Rural 91692 48150 43542 904 15611 7917 7694 972 41.2 14827 Banihal Urban 2795 1641 1154 703 325 177 148 836 74.2 473 Source: census of India 2001
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District Data (Old) on SC & ST Population
SC Population ST Population on' on' Populati SC 'Total on' Populati SC 'Male on' Populati SC SC' ratio 'Sex SC' % on' Populati ST 'Total on' Populati ST 'Male on' Populati ST ST' ratio 'Sex ST' %
District 469 10. 1509 Ramban Total 9064 0 4374 933 5 1 8005 7086 885 17.5 441 10. 1483 Ramban Rural 8534 4 4120 933 9 5 7858 6977 888 19 Ramban Urban 530 276 254 920 6.5 256 147 109 741 3.1 Banihal Total 14 13 1 77 0 8343 4466 3877 868 8.8 Banihal Rural 5 4 1 250 0 8343 4466 3877 868 9.1 Banihal Urban 9 9 0 0 0.3 0 0 0 0 0
Source: census of India 2001
Related to Pregnancy And Maternal Health DLHS-RCH-II Survey, 2004
Issue % Issue % Mean age at marriage for boys 24.9 Mean age at marriage for girls 20.7 Boys married below legal age at marriage 21 years 22.5 Girls married below legal age at marriage 18 yrs 22.9 Any antenatal check up 56.5 Antenatal check up at home 0.0 3 or more antenatal check ups 52.7 Who had one TT injection during pregnancy 17.6* Who had two or more TT injection during pregnancy 34.0 Who had no TT injection during pregnancy 39.8 Who received 100 or more IFA tablets during Who consumed two or more IFA tablets regularly pregnancy 32.7 during pregnancy 27.5 Received adequate IFA tablets/syrup 33.9 Who consumed one IFA tablet regularly 22.6 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) 22.6 delivery attendant -Doctor/Nurse/TBA) 31.1 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) 22.6 delivery attendant by Doctor/Nurse) 2.9* Institutional delivery 34.0 Home delivery 34.0 Institutional delivery - government 31.1 Women who had pregnancy complications 34.8 Institutional delivery - private 2.9* Women who had delivery complications 44.1
Related to Family Planning Issue % Issue % Women aware of RTI/STI 0.0* Birth order 3+ 22.6* Women aware of HIV/AIDS 46.0 Unmet need for limiting-1 59.6 Knowledge of any modern family planning method 99.9 Unmet need for spacing-1 3.1* Knowledge of any modern spacing family planning method 99.5 Unmet need -total-1 62.7 Knowledge of all modern family planning methods 39.8 Unmet need -total-1 59.6 Knowledge of any traditional method 0.0* Unmet need for spacing-2 6.3 Current use of any family planning method 16.4 Unmet need -total-2 65.9 Current use of any modern family planning method 16.2 Unmet need -total-2 43.5 Current use of any traditional family planning method 0.1* Current use - Male sterilization 0.3* Current use - Female sterilization 7.5 Current use - PILLS 1.6*
18 Current use - Male sterilization 0.4* Current use - CONDOM 5.5 Women had side effects due to use of female sterilization 8.9* Women had side effects due to Pills 0.0* Sought treatment abnormal vaginal Women had side effects due to use of IUD 11.4* discharge 0.0 * Women who utilized government health facility for treatment of RTI/STI (vaginal discharge) NA * Women who had any symptom of RTI/STI 2.1
Related to Child Health Issue % Issue % Breastfeeding within 2 hours (children age below 36 Percentage of children age 12-35 months months) 37.5 received BCG 89.9 Percentage whose mother squeezed out the first breast Percentage of children age 12-35 months milk (children age below 36 months) 2.9 received DPT 3 25.4 Exclusive breastfeeding at least 4 months (children age Percentage of children age 12-35 months 4-12 months) 0.0 received Measles 81.2 Percentage of children age 12-35 months received Polio Percentage of children age 12-35 months 0 65.6 received Full Immunization 16.2 Percentage of children age 12-35 months received Percentage of children age 12-35 months not POLIO 3 16.2 received any vaccination 0.0 Awareness of diarrhoea 58.6 Knowledge of ORS 49.6 Who had diarrhoea (two weeks prior to survey) 15.9 Given ORS to children during Diarrhoea 39.3* Sought treatment for Diarrhoea 40.4* Aware of danger signs of Pneumonia 33.8 Who had Pneumonia (two weeks prior to survey) 21.5 Sought treatment for Pneumonia 46.6
DISTRICT RAMBAN - Maternal Health Distt. Achievement Distt. Target Doda (Old) Activities 2006-07 2007-08 Achievement Banihal Ukhral Ramban Total estimated Population 812094 828335 43101 68332 113565 ANC Registration 15827 24850 63.69 1291 2049 3406 No. of Deliveries 8120 24850 32.68 1291 2049 3406 No. of Deliveries by Skilled Staff 7890 9607 82.13 499 792 1316 T.T (Preg. Women) 15491 24850 62.34 1291 2049 3406 IFA. Tabs (Nos) 989300 2485000 39.81 124300 192200 319300 MTP Cases 766 1685 45.46 52 52 208
DISTRICT RAMBAN - Family Planning Distt. Name of CHC Achievement Distt. Target Doda (Old) activities 2006-07 2007-08 Achievement Banihal Ukheral Ramban Total estimated Population 812094 828335 43101 68332 113565 Sterilization 797 3017 26.42 104 104 312 I.U.D. 1283 2080 61.68 208 52 364 Condom Pieces 136537 222645 61.32 11444 16646 27050 O.P Cycles 4198 22784 18.43 2080 1664 2601
19
DISTRICT RAMBAN - Child Health Name of CHC Distt. achi Distt. Target Doda(Old) activities 2006-07 2007-08 Achievement Banihal Ukheral Ramban Total estimated Population 812094 828335 43101 68332 113565 Infant Immunization 20606 22099 93.24 1149 1822 3029 Vitamin A ( All Doses) 14896 66548 22.38 3462 5489 9123 D.T (5 years) 25833 107683 23.99 5602 8883 14763 T.T (10 years) 8733 6876 127.01 358 567 942 T.T (10 years) 5854 5768 101.49 299 475 798 Source: CMO Office
ICDS Data Name of ICDS Number of AWC's Number of AWC's Number of AWC's S.No Project Sanctioned Operational Reporting 1 Banihal 134 123 114 2 Ukheral 138 102 102 3 Ramban 130 112 107 Total 402 337 323 Source: Director social Welfare, July 2007
MONTHLY PROGRESSNREPORT FOR THE MONTH OF 7/2007 DISTT, DODA FORMAT 2nd Total population with in the project No. of SNP Beneficiaries Number of Pregnan Childre Children Name of ICDS AWC's Children t n 3-6 Pregnant S. No Project (R/T/U) Reporting 3-6 years women 0-3 yrs years women 1 Banihal 114 5091 1006 538 434 245 2 Ukheral 102 3415 767 1063 1040 592 3 Ramban 107 6576 1408 1023 779 528 Total 313 15082 3181 2624 2253 1365
Classification of Nutrition status Total No of Name of Reporte No of No of Children ICDS d Live Deaths Deaths Grad Grad Grad Grad weighte S.No Project birth 0-1 yrs 1-5yrs Normal e Ist e 2nd e 3rd e 4th d 1 Banihal 15 ------2 Ukheral 9 ------3 Ramban 3 -- -- 442 75 42 -- -- 539 Total 27 -- -- 442 75 42 -- -- 539
20 Development Indicators of the District
SN Indicators State District 1 Crude Birth Rate 18.7Srs-06 23.5 2 Crude Death Rate 5.6 DNA 3 Infant Mortality Rate 49.0 DNA 5 TFR 2.4 NFHS III DNA 6 Couple Protection Rate 53 % NFHS III DNA 7 Sex Ratio (General) 900 Census 2001 904 8 Sex Ratio (0 – 6 years) 937 Census 2001 31667 9 Sex Ratio at birth DNA DNA 10 Literacy rate (overall) 54.46 Census 2001 55% 11 Literacy rate (male) 65. 75 Census 2001 50% 12 Literacy rate (female) 41.82 Census 2001 35% 13 Enrolment of students elementary T 18481 education M 12438
F 6979
Source: Census, 2001; DLHS-RCH-II Survey, 2004
21 Socio Economic and Health Indicators of the District
Total for Name of Block District Name of Health Blocks Banihal Ukheral Ramban Demographic indicators Total Population 70000 60342 94796 225136 Population of males 36750 31502 52137 120389 Population of females 33284 28840 42659 104783 Population of children less 2100 532 3900 6532 than a year old Population of children in age 9800 4371 14900 29071 group between 1 and 6 years % Scheduled Castes 0 5% 4.42% 4.50% % Scheduled Tribes 7.38% 13% 14.25% 12% Number of Inhabited Villages Nil Nil Nil Nil
Socio-economic indicators No. of <3 children benefiting 2412 1026 1085 4523 from the ICDS scheme No. of children aged 2 years 1608 1382 1190 4180 and above benefiting from the ICDS scheme No. of BPL households 7011 11150 13110 32031 No. of girls enrolled in primary 389 2030 307 2726 schools last year No. of girls dropping out of 150 150 primary schools last year Number of overhead tanks or 46 10 25 81 hand pumps Number of functional hand Nil Nil Nil Nil pumps in sub centres Number of wells currently Nil Nil Nil Nil being used for drinking water purposes Number of households with 1721 942 1988 4651 access to toilets No. of private health Nil Nil Nil Nil facilities/clinicians No. of women who have 120 91 135 346 benefited through the JSY Scheme till now 1 No. of girls who got married DNA 130 DNA 130 last year No. of girls who got married DNA DNA DNA DNA last year and were <18 years at the time of marriage
1 No. of pregnant women with the following mandatory characteristics: Belonging to BPL family Should be 19 years or older Up to two live births
22 Total for Name of Block District Name of Health Blocks Banihal Ukheral Ramban
Health Indicators No. of Tubectomy conducted 6 NA 236 242 in the last reporting year No. of IUD insertions done in 110 130 106 346 the last reporting year No. of vasectomies done in the 0 43 43 last reporting year No. of pregnant women 2044 1908 3650 7602 No. of pregnant women 2036 1730 2480 6246 registered for ANC during the last reporting year No. of pregnant women who 2026 1690 2400 6116 received both TT1 and TT2 during pregnancy in the last reporting year No. of institutional deliveries in 298 130 242 670 the last reporting year No. of women operation of Nil 146 146 MTPs in the last reporting year No. of RTI/STI cases reported 32 20 40 92 in the last reporting year No. of children given measles 1241 1976 1154 4371 vaccine in the last reporting year No. of outpatients (monthly 941 824 3500 5265 average) No. of inpatients (monthly 90 70 200 360 average) Prevalent 1 Anemia ARI ARI Diseases 2 Tuberculoses Gastrointestinal Skin disease 3. Skin disease Skin disease anemia TUBERCULOSIS and LEPROSY
No. of patients currently 50 175 DNA 225 undergoing DOTS therapy in the block Number of new leprosy cases 5 DNA DNA 5 reported in last reporting year
NVBDCP No. of slides examined for 326 290 410 1026 malaria in last reporting year
No. of notified malaria cases 0 0 0 0 (last reporting year) No. of new kala-azar cases in the 0 0 0 0 block in the last reporting year
23 Total for Name of Block District Name of Health Blocks Banihal Ukheral Ramban No. of microfilaria cases reported 0 0 0 0 in the last reporting year
No. of JE cases reported in the 0 0 0 0 last reporting year Blindness Control No. of cataract operations 0 0 0 0 conducted in the block last year School Health Programme
No. of schools covered under 18 119 DNA 137 in the last reporting year
24 Health Institutions, Population Coverage Ratios and Health Functionaries in the District
Name of Block Total for
District Name of Health Blocks Banihal Ukheral Ramban Health Institutions No. of Speciality Hospitals 0 0 0 0 No. Referral Hospitals 0 0 1 1 No. of CHC/BPHCs 1 0 2 3 No. of Blood Banks 0 0 1 1 No. of CHCs (IPHS Standards) 1 0 2 3 No. of Blood Storage Units 0 0 0 0 No. of PHCs in the Block 1 6 8 15 No. of MOs in Positions 6 0 0 6 No. of 24 hrs. PHCs 0 2 0 2 No. of MTP Centres 0 0 0 0 No. of Sub Health Centres 10 19 18 47 No. of ANMs in Position 5 7 6 18 No. of AYUSH Dispensaries 4 0 7 11 No. of Private Hospitals 0 0 0 0 No. of Beds in Govt. Institutions DNA 22 30 52 No. of Beds in Pvt. Institutions 0 0 0 0 No. of Anganwari Centres 110 117 119 346 No. of Govt. 1 0 2 3 Ultrasound Pvt. 0 0 0 0 Clinics Unregistered Population covered
No. of Sub-centres covering more than the current norm (3000) No. of Govt. 0 0 0 0 Obstetricians Pvt. 0 0 0 0l No. of Govt. 1 0 1 2 Gynaecologists Pvt. 0 0 0 0 No. of Govt. 1 0 2 3 Paediatricians Pvt. 0 0 0 0 Govt. 1 0 2 3 No. of Surgeons Pvt. 0 0 1 1 1 0 2 3 No. of Govt. Anaesthetists Pvt. 0 0 0 0 No. of Govt. 0 0 0 0 Orthopaedists Pvt. 0 0 0 0 Govt. 1 1 1 3 No. of Dentists Pvt. 0 0 0 0 Govt. 0 0 0 0 No. of Eye 0 0 0 0 Surgeons Pvt. No. of Gen. Govt. 1 0 1 2 Physicians Pvt. 0 0 0 0 No. of Govt. 0 0 0 0
25 Name of Block Total for
District Name of Health Blocks Banihal Ukheral Ramban Health Institutions Radiographers Pvt. 0 0 0 0 No. of Public Health Nurses 0 0 0 0 No. of Staff Nurses 4 2 9 15 No. of LHVs 0 0 1 1 No. of Pharmacists 13 15 19 47 No. of Lab. Technicians 1 2 2 5 No. X Ray Technicians 1 0 1 2 No of Ophthalmic Assts. 1 1 1 3 1 0 2 3 No. Dental Mechanics/Hygienists No. of Male Health Supervisors 0 0 0 0 No. of ANMs 7 10 18 35 No. of Male Health Workers 1 1 3 4 No. of AW Workers 110 117 119 347 No. of UDCs No. of LDCs 0 0 0 0 No. of Computer/Statistical Assts.
No. of Drivers 2 3 3 8 No. of ASHAs selected 45 52 65 162 No. of Trained Dais 30 20 30 80
26 Workforce Vacancy Position * Given below is the information about Workforce Vacancy Position in the District
Total Banihal Ukheral Ramban Name of Blocks Gaps
IPHS Requ Existi Identi Requir Existi Identifi Requir Existi Identi
Norm ired ng fied ed ng ed ed ng fied staff Staff Gaps staff Staff Gaps staff Staff Gaps No. of Sub- 10 19 18 Centres 47 ANM 2 20 5 15 38 7 31 36 6 30 76 N0. Of PHC's 1 8 6 15 MO 2 2 0 2 16 7 9 12 4 8 19 Pharmacist 1 1 1 0 8 9 0 6 1 5 5 Nurse 3 3 1 2 24 2 22 18 1 17 41 Female Health Worker 1 1 1 0 8 6 2 6 1 5 7 Health Educator 1 1 1 0 8 0 8 6 1 5 13 Health Assistant (one male and one Female) 2 2 0 2 16 0 16 12 0 12 30 Clerks 2 2 1 1 16 3 13 12 1 11 25 LT 1 1 1 0 8 2 6 6 1 5 11 Driver 2 _ 3 _ 2 _ Class lV 4 4 4 0 32 12 20 24 4 20 40 No. of CHC's 1 NA 2 A.CLINICAL MANPOWER General 1 Surgeon 1 1 1 2 1 1 1 2 Physician 1 1 0 1 2 0 2 3 Obstetrician / Gynaecologis 3 t 1 1 0 1 2 1 1 2 4 Paediatrics 1 1 0 1 2 0 2 3 5 Anaesthetist 1 1 0 1 2 2 0 1 Public Health Programme 6 Manager 1 1 1 0 2 1 1 1 7 Eye Surgeon 1 1 0 1 2 0 2 3 Other specialists (if 8 any) 1 1 0 General duty officers (Medical 9 Officer) 6 2 1 1 1 B. SUPPORT MANPOWER 1 Nursing Staff 7+2 3 6 0
27 Public Health a Nurse 1 1 0 1 2 0 1 2 b ANM 1 1 2 1 2 0 1 2 c. Staff Nurse 7 0 14 4 17 Nurse/Midwif d. e 7 7 10 0 6 Dresser 1 1 1 0 2 1 1 1 Pharmacist / 7 compounder 1 1 6 0 2 6 0 0 Lab. 8 Technician 1 1 1 0 2 2 0 0 9 Radiographer 1 1 0 1 2 0 2 3 1 Ophthalmic 0 Assistant 1 1 1 0 2 1 1 1 Ward boys / 1 nursing 1 orderly 2 2 7 0 4 13 0 0 1 2 Sweepers 3 3 6 0 6 11 0 0 1 3 Chowkidar 1 1 0 1 2 1 1 2 1 OPD 4 Attendant 1 1 0 1 2 0 2 3 Statistical Assistant / 1 Data entry 5 operator 1 1 0 1 2 0 2 3 1 6 OT Attendant 1 1 0 1 2 0 2 3 1 Registration 7 Clerk 1 1 0 1 2 0 2 3 1 Any other 8 staff (specify)
28 Workforce Vacancy Position * Given below is the information about Workforce Vacancy Position in the District
Category Sanctioned In position Vacant MOs [Gen] 18 Specialists No. of Public Health Nurses 3 Staff Nurses 4 Male Supervisor Female Supervisor/LHV ANMs 18 MHWs Pharmacists 45 Lab Techs 3 No. X Ray Technicians / 3 Radiographer No of Ophthalmic Assts. 2
No. Dental Mechanics/Hygienists No. of Upper Division Clerks No. of Lower Division Clerks 0 No. of Computer/ Statistical Assts. No. of Drivers Any other category
Analysis of status of manpower [NRHM provides support for man power at sub-centre, PHC, CHC and FRU level]:
29 INFRASTRUCTURE PLANNING
District Ramban Facility Existing 2007-08 2008-09 2009-10 2010-11 2011-12
Projected Population 691291* 210124** 215860 221753 227807 234026 General Hospital 0 CHC 3 3 3 3 3 3 PHC 15 15 15 15 15 15 Subcentre 47 70 72 74 76 78 ASHA 162 210 216 222 228 234 AWC sanctioned 402 - 350 402 402 402 402 *Total population of Doda before division into three districts ** Population of District Ramban as per the block data
Status of Health Centre Buildings in the District
Sub-Centre (SC) Status:-
Sub Centres No. Overall Status Sub-Centres in own building 9 All SCs need major repair and staff Qtrs Sub-Centre in Panchayat Bldg / rented 38 Needs new buildings with staff Qtrs building SC without Electricity connection 47 No electricity available SC without Water Supply 47 SCs dependent on natural source of water SC without Toilets 47 Most of the SCs don’t have sanitation facilities
Number of Institutions Requiring New Buildings
# Category of Institution Numbers 1 PHCs 6 2 SCs 38 3 CHCs 0 Source: CMO office
Number of Buildings Requiring Additions/Expansion (staff quarters)
# Category of Institution Numbers 1 SCs 47 2 PHCs 6 3 CHCs 3
30 Number of Buildings Requiring Repairs
# Category of Institution Numbers 1 SCs 9 2 PHCs 6 3 CHCs 3
Status of Staff Quarters attached to CHCs, PHCs and SCs in the District
Building Staff Quarters Condition (G: Good, NMR: Needs Minor Repairs, MR: Needs Major Repairs, NAD: Needs Additions CHCs Only one CHC have two staff Needs Major repairs. Quarters.
PHCs 2 NA
SCs No NA
Average Percentage Availability of Medicine District: Ramban Average Name of Blocks Banihal Ukheral Ramban % of the District IPHS Norm 10 19 18 47 SC’s Recommended Name of Drug Quantity ( Kit- A ) 5 80 0 20 33.33
Name of Drug Quantity ( Kit- B ) 9 0 0 78.4 26.13
Drugs required by ANMs and LHVs 6 50 0 0 16.67
Other Drugs and Vaccines 8 75 50 37.5 54.17 Medicines required for NDCP 7 14.28 42.85 14.0 23.71 Contraceptives required for F.Plang. 4 50 50 0 33.33
Proposed Drug List for A.Wadi Centres 12 16.66 8.33 8.33 11.11
Total 106 29.98 1.426226 1.49 15.97
IPHS Norm 1 8 6 15 PHC's Recommended
31 Essential & emergecy obstetrics care drugs 38 7.89 5.26 13.15 8.77
Antidots 4 25 25 25 25.00 Anticonvulsant / Antiepileptics 4 0 10 0 3.33
Antiinfective Medicines 5 40 40 40 40.00 Antifilarials 1 0 0 0 0.00 Antibacterials 16 12.5 12.5 0 8.33 Dermatological medicine 14 28.57 21.42 28.57 26.19 Antileprosy & Antitubercullar 2 100 100 0 66.67
Antifungal medicine 4 25 25 25 25.00 Antiprotozoal medicine 5 40 40 60 46.67 Blood Products and Plasma Substitutes 13 15.38 15.38 15.38 15.38 Antiseptics 6 33.3 33.3 33.3 33.30 Disinfectants 3 33.3 33.3 33.3 33.30 Diuretics 2 30 30 0 20.00 Gastrointestinal 22 36.36 44 40.9 40.42 Hormones, Endocrine & Contraceptives 10 20 20 20 20.00
Ophthalmological preparation 12 16.66 16.66 16.66 16.66
Psychotic Disorders 15 6.66 33.3 6.66 15.54 Solutions correcting water 9 77.77 77.77 55.55 70.36 Electrolyte and Acid- Base Disturbances Vitamins & Minerals 3 0 0 33 11.00 Drugs under RCH 1 10 10 0 6.67 Product Strength formulation Units 31 9.67 0 0 3.22
RTI / STI Drugs 10 30 30 30 30.00 Drugs and Consumable for MVA 6 50 50 33 44.33
TOTAL 236 20.76 IPHS Norm 3 CHC's 1 NA 2
Essential drugs 70 64.24 67.14 44.28
32
Percentage availability if Infrastructure (Ramban District) Indicators SC (47) PHC (15) CHC (3) DH
1 Building (Govnt. + Donated) 20 40 100 Building (Rented) 80 60 0 2 Condition of Building (Good + Fair) 10 16.5 100 3 Water Supply (Tap, borewell/ 8.88 16.5 100 4 handpump/tubewell, well)
4.1 Tap water supply 8.88 16.5 100 5 Electricity 0 16.5 100 5.1 In all parts of hospital 0 16.5 100 Electric supply (power generation 0 0 100 stablization)
6 Separate Toilet 0 0 100
6.1 Sep.Toilet with running water 16.5 100
7 Furniture 0 0 100
8 Labor Room 0 0 100 Aseptic labor room 8.1 0 10 100
9 Avail. of Quater for staff 0 2 10
10 Number of beds available (Average) 16.5 100
11 Laboratory 0 100 12 Operation Theatare 100 100 13 Waste Disposal (Burnt+Dump) 0 0 Availability of incenator 0 100 14 15 Telephone 0 100
16 Computer 0 17 Generator/Invertor 0 100 18 Vehicle 20 100
19 Emergency Room / Casualty 100 Separate wards for males and females 10 20 (Yes/No) 21 No. of beds : Male 10
33 22 No. of beds : Female 100 23 Availability of ECG facilities 100 24 X-Ray facility 100 Ultrasound facility 100 25
26 Cardiac Monitor for OT 0 27 Blood Storage Unit available 0 28 Blood Bank Facility 29 Other Investigative Facility 30 Heating ventilatoin & air conditioning 31 Lift & vertical transport 32 Refrigeration
34
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 /Planning Team 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. SCs, PHC and, CHC were surveyed using the templates developed by Government of India. The inputs from these facility surveys were taken into account while developing the Block Action Plan.
The District Planning Team (DPT) provided technical oversight and strategic vision for the process of development of District Action Plan.
The members of the 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.
35 HEALTH SERVICE INDICATORS FOR THE DISTRICT BASIC HEALTH SERVICES Goal Posts & Sl Indicator Criteria SCORE IMMUNIZATION Maximum No. completely % of fully immunized COVERAGE No. <3 years 100% 1 immunized children < 3 YEAR OF Minimum 0% AGE 6000 5220 87 Total no. of No of women who % of women getting Maximum ESSENTIAL pregnant got full antenatal antenatal care as 100% 2 ANTENATAL women care as defined defined Minimum 0% CARE 7602 6246 82% Total no. of Total no of women % of pregnant Maximum INSTITUTIONA pregnant who had institutional women who had 100% 3 L DELIVERY women delivery institutional delivery. Minimum 0% 7602 670 8.81% WEIGHING OF Total no. of No. of newborn Percentage of Maximum NEWBORN births in the weighed within three newborn weighed 100% 4 WITH IN year days within three days Minimum 5% THREE DAYS 7602 670 8.81%
Percentage of BREASTFEEDI Total no of No of newborns who Maximum newborns who were NG IN FIRST births in the last were breastfed in the 100% 5 breastfed within an HOUR year first hour Minimum 0% hour 7602 7602 100% Approx no of Maximum over REPORTING blood slides Average time taken for reporting of blood 30 days OF BLOOD 6 sent in last 3 slide Minimum 1 SLIDE months day
DNA DNA DNA No. who No of target Total no. of wanted to % of unmet couples for couples with at get FP Maximum ACCESS TO demand for sterilization least one of them operation 100% 9 STERILISATIO FP services wanting FP done last Minimum 0% N SERVICES operation ( > 2 children) operation: year but could not DNA DNA DNA DNA HEALTH RELATED SERVICES WATER & SANITATION 1 USE OF Total no. of Total no. of families Percentage of families Max imum : 50 5 DOMESTIC/ families where all members are where all members are % COMMUNITY using domestic/ using domestic/ Minimum 0% TOILET community toilet community toilet 37522 13132 35% FOOD SECURITY RELATED Total no. of Percentage of ANGANWA Actual No. getting diet children eligible Anganwadi 16 DI regularly for Anganwadi beneficiaries
16080 14472 90% MIDDAY Total no. of Total no. of schools Percentage of schools 17 MEAL primary and giving cooked midday giving midday meals middle schools meals
36 285 285 100% Total no. of PDS BPL families No. of families getting Percentage of FUNCTIONI eligible for 18 grains from PDS shop beneficiaries NG lower cost grains DNA DNA DNA Total no. of No. of families getting ANTYODAY BPL families Percentage of free grains from PDS 19 A YOJNA eligible for free beneficiaries shop grains DNA DNA DNA SCHOOL Total no. of No. of children in age Percentage of school ENROLME children in 6-14 group not going to 20 going children age group school NT DNA DNA DNA HEALTH STATUS Total no. of CHILD children below no. of children with gr I % of children Max 200% MALNUTRI 21 3 with wt or above malnutrition** malnourished Minimum 0% TION record.
DNA DNA DNA
Total no. of LOW newborn who Total no. of babies with Percentage of babies Max 100% BIRTH 22 were weighed LBW with LBW Min 10% WEIGHT last year
670 15 2.5% Total no. of 100% - % of married No. of girls married Max 100% AGE OF girls married women below 19 year 23 below 19 year of age Mim 0% MARRIAGE last year of age DNA DNA DNA Total number of births last No. of children born with % of unspaced second Max 100% year which more than 36 months 24 SPACING or third children born Minimum 0% were second or difference > child DNA DNA DNA Total number Any deaths of any child Maximum 20% INFANT of births last % of infant deaths 25 below one year Minimum 0% DEATHS year 7602 DNA Diarrhoeal OUTBREAK outbreaks(Mor OF WATER e than three jaundice outbreaks (as Sum of water borne Maximum 4 26 BORNE cases of a defined) disease outbreaks Minimum 0 DISEASE disease in same week ) DNA DNA DNA
37 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.
Based on the background and the planning process following are the overall priorities of this District:
1. Formation and functioning of District Health Society and DPMU 2. Strengthening CMO and Dy CMO office 3. Providing services to the difficult and unreached population 4. Alternative provisions of transport to reach the far-flung and difficult areas 5. Availability of programme Officers, Specialists, Doctors and Staff Nurses and retaining the staff 6. Quality services at all levels 7. Capacity building of functionaries at all levels 8. Increase in the number of facilities as per the population norms and developing them as per IPHS 9. Developing and strengthening HMIS and monitoring system for data collection and reports. 10. Formation of Disaster Management Unit.
SPECIFIC PRIORITIES OF THE DISTRICT
1. Programme Management : Formation and better functioning of the District Health Society and a strengthened CMO office 2. Intersectoral Convergence: Fixing Responsibilities of each sector for their accountability and hence better Intersectoral Coordination 3. Demand Generation, IEC/BCC: Nutrition, Health & RCH Education to Adolescents, behaviour change in the difficult populations and for improving the adverse sex ratio. 4. Human Resources: Filling of the vacancies as per the population based norms for the year 2007, increased mobility, motivational issues, provision of quarters at all facilities, availability of well trained ASHAs for each 1000 population
38 5. Capacity Building: Focused capacity building in Emergency Obstetric Care, Continuous skill building of all personnel as per needs expressed and also the new job responsibilities under NRHM, opening an ANM Training College. To equip the whole workforce i.e. ASHA, ANMs, including VHWSC with new techniques and update their skills. 6. Infrastructure : Increase in the number of Subcentres, PHCs, CHCs to cater the whole population . 7. Procurement and Logistics: Construction of a scientific Warehouse for Drugs 8. Monitoring and Evaluation: Data validation and computerized data availability upto PHCs with district linkages 9. Maternal Health: Well managed system of institutional deliveries through Emergency Obstetric Care services, JSY extended to all poor categories of persons, Blood Storage Units at all CHCs, All CHCs to be developed as FRUs, PHCs to be developed as 24x7 facilities, good referral mechanisms. 10. Neo Natal and Child Health: Provision of Neonatal services at CHCs, PHCs, Training on IMNCI and IMCI, addressing Anaemia and Malnutrition 11. Immunization: Total coverage for immunization 12. Family Planning: Improving the coverage for Spacing methods and NSV 13. Adolescent Health: The focus is on provision of Adolescent Reproductive and Sexual health education through schools and also awareness building on good health practices, responsible family life, harmful effects of drug abuse & Alcoholism, 14. National Disease Control Programmes: Prevention of Mosquito transmitted diseases 15. Public-Private Partnership: Accreditation of private facilities with the Government for providing services like immunization, RCH, Adolescent.
39 4. GOALS
The District will strive to improve the availability of and access to quality health care by people, especially for those residing in rural areas, the poor, women and children and will achieve the following goals: Goals INDICATOR Current J&K Ramban 07-08 08-09 09-10 10-11 11-12 50 DNA Reduction in Infant Mortality Rate 10% 20% 30% 40% 50% (SRS 2005) (IMR) Baseline Baseli Baselin Baseli Baseline ne e ne 2/3 rd of IMR DNA Reduce Neo-natal Mortality Rate 10%Basel 20%B 30%Ba 40%B 50%Bas (NMR) ine aseline seline aselin eline e DNA Reduction Maternal Mortality Ratio 10%Basel 20%B 30%Ba 40%B 50%Bas (MMR) ine aseline seline aselin eline e 18.9(SRS- 23.3 Est Reduction in Birth Rate 10%Basel 20%B 30%Ba 40%B 50%Bas 2006) ine aseline seline aselin eline e 2.4 DNA Reduction in Total Fertility Rate 2.3 2.3 2.2 2.1 2.1 (NFHS-3) 5.5(SRS— DNA Reduction in Death Rate 5.4 5.3 5.2 5.0 4.75 2006) 22.6%** Increase Ante-Natal Care as defined 25% 40% 60% 75% 90%
Increase three Ante-Natal Checkups 52.7%* 60% 70% 80% 90% 100% * 32.7%** Increase Proportion of Women getting 40% 60% 80% 90% 100% IFA tablets 34%** Increase Proportion of Women getting 40% 60% 80% 90% 100% 2 TT Injections 54 34%** Increase Institutional Deliveries 40% 50% 60% 70% 80% (NFHS-3) Increase Delivery by Skilled Birth 60.5 2.9%** 40% 50% 60% 70% 80% Attendants (NFHS-3) 53(NFHS-3) 16.2%** Increase Contraceptive Prevalence 30% 50% 70% 75% 80% Rate 66.7 16.2%** Increase Complete Immunisation of 40% 60% 75% 90% 100% (NFHS-3) Children (12-23 month of age) 42.3 0.0%** Increase Proportion of Children 20% 30% 50% 70% 80% (NFHS-3) Exclusively Breastfed 2.1%** Reduce Prevalence of STI/RTI 35%Basel 40%B 50%Ba 60%B 70%Bas ine aeline seline aselin eline e Source:** DLHS
There is no data available from CMO office and the DLHS data seems to be inadequate, hence a detailed baseline is mandatory
40 5. TECHNICAL COMPONENTS
PART A: Reproductive and Child Health (RCH) II
A-1. Strengthening of District Health Management Situation The district Ramban is one of the newly formulated districts of Jammu and Kashmir. Analysis Only DC and CMO has been appointed recently. There is no district health society formulated in the district Contractual appointments of various staff with provision are yet to made. Objectives To formulate district health society Benchmarks To strengthen it. To make district health societies fully functional and effective. To equip the district health society with knowledge skills and other necessary things. To provide DHS with all necessary things Strategies District health society needs to be formulated in district Ramban as soon as possible. There should be quick establishment of CMO office and other offices in line with the health department. Creating infrastructure to run the DHS Periodic orientation and training of members. 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 Establishing Monitoring mechanisms Activities Orientation Workshop of the members of the District health Mission and society. Issue based orientation in the monthly Review and Planning meetings as per needs. Exposure visits of members of the District health Society to well functioning Panchayats Improving the Review and planning meetings through a holistic review of all the programmes under NRHM and proper planning. Formation of a monitoring Committee from all departments. Development of a checklist for the Monitoring Committee. There should be a separate room for meetings of DHS and its regular maintenance. There is need of one more person for maintaining the building. Arrangements for travel of the Monitoring Committee Sharing of the findings of the committee during the Field visits in each Review Meeting with follow-up of the recommendations. Support District level inter sectoral departments required State to provide support for building the capacity of the DHS through participation in DHS meetings 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. 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- 2008- 2009- 2010- 2011- 2008 2009 2010 2011 2012
41 Orientation Workshops x x
Formation of DHS x
Issues based workshops x x x x Formation of the monitoring Committee x
Reorientation Workshops x
Bimonthly meetings x x x X x
Exposure visits for various issues. x x Budget Activity / Item 2007- 2008- 2009- 2010- 2011- Total 08 09 10 11 12 Orientation Workshops 0.5 0.55 0.6 0.65 0.7 3 Issues based workshops 0.5 0.6 0.7 0.8 0.9 3.5 Formation of the 0.12 0.13 0.15 0.16 0.18 0.74 monitoring Committee Reorientation Workshops 0 0.55 0.6 0.65 0 1.8 Bimonthly meetings 0.6 0.66 0.73 0.8 0.88 3.67 Exposure visits for various 1.72 2.492 2.17 3.06 2.65 12.092 issues. Construction of NRHM cell 25 0 0 0 0 25 (DC Office) Staff cost NRHM Cell (DC 7.56 8.316 9.1476 10.062 11.069 46.155 Office) Infrastructure costs, 5 0 0 0 0 5 furniture, computer systems, fax, UPS, Printer, Digital Camera, Total 41 13.29 14.09 16.18 16.37 100.95
42 A-2. MATERNAL HEALTH Situation Analysis Indicator No. Pregnancies 7602 Maternal Deaths DNA Block consolidate data %
ANC registration 6246 82% Full ANC coverage DNA TT1 &TT2 6116 80.4% Institutional Deliveries 670 26% Estimated total deliveries * 2484 Estimated Home deliveries* 1814 74% JSY Beneficiaries 346 14% No. of pregnancy related DNA complications referred to FRU level No of MTPs last year 146 * Calculation based on district Doda (old) achievement 32.68% of pregnancy As the District Ramban is a newly formed district so the data specific for the district is not available. All the data is merged in District Doda data. The above mentioned data is based on information collected from block and estimation based on Doda (old) district data.
Institutional deliveries: the rate of institutional deliveries has been very low that is 670 only 26 % this is because of lack of accessibility to govt. services and lack of awareness. Institutional deliveries are very low because people live on hilltops and in far-flung areas and there they do not have access to Govt. services. Referral: There is no data available for referral of complicated cases during pregnancy / delivery. Anemia: Anemia in the area is prevailing at high rates IFA tablets are not present at Grass root levels for community. More over communities do not have a good idea of health education and iron + vitamin diet Exclusive breast feeding: Colostrums and exclusive breast feeding related information is not available but as per the DLHS data, knowledge regarding benefits of breastfeeding is satisfactory among the eligible women. Awareness of Mother and Child Days: There is no awareness of mother and child hood days. Maternal Mortality: There is no data available regarding the Maternal deaths in the districts as well as the State. ANC: Out of the total pregnancies 82 % pregnancies had been registered. There is no data available on full ANC checkups. There are only 26% institutional deliveries and data
43 A-2. MATERNAL HEALTH needs to be validated. IFA: There is no data available regarding the consumption of IFA. As per DLHS 2004 only 22.6% of the pregnant women were given 100 or more iron and folic acid tablets TT: 80.4% of the pregnant women had received TT1&TT2 as per District data. MTP: There were 146 MTPs carried out last year Male participation : There is no data available for the level of male participation and also on what issues does male participation occur Janani Surakha Yojana : Under JSY scheme there are 346 women benefited last year. This low uptake has been due to poor awareness and also due to the fact that the data of BPL families needs to be updated. Services: in the government facilities staff is not always available especially Lady MOs are not there in any PHCs and also inadequate infrastructure, equipment and drugs. The private facilities also are not available. The government has started intensive efforts to improve the facilities through 24 hour PHCs, development of CHCs as per IPHS standards. Three CHCs are in process to upgraded as per IPHS norms. Training: regular staff training programmes on SBA, EmOC and MTP need to be arranged. Fixed Village Health Days (VHD days) are being organized but there is little awareness amongst the community about the days RCH Camps: RCH camps be organized by the department .These camps provide specialist services with simple diagnostic tests. They also serve for screening of RTI and STDs.
In district Ramban 34 VHND held in first quarter of 2007,which shows the status of maternal health services Objectives 1. CHC Ramban to be developed as DH Benchmarks 2. To decrease Maternal Mortality ratio to 50 by 2012 3. 100% pregnant women to be given two doses of TT by 2012 4. 90% pregnant women to consume 100 IFA tablets by 2010 and 100% by 2012 5. 80% Institutional deliveries by 2010 and 90% by 2012 6. 80% deliveries to be carried out by trained /Skilled Birth Attendant by 2012 7. 90% women to get complete ANC by 2010 Strategies 1. Provision of quality Antenatal and Postpartum Care to all pregnant women 2. Increase in Institutional deliveries 3. Quality services in the health facilities 4. Availability of safe abortion services at all CHCs and PHCs 5. Increased coverage under JSY 6. Strengthening the Fixed village Health Days (VHD) days
44 A-2. MATERNAL HEALTH 7. Improved behaviour practices in the community through BCC and IEC activities. 8. Construction of S/Cs and PHCs where ever required and service delivery for 24 hour in all PHCs 9. To improve quality services in all PHCs especially for institutional delivers. 10. Training should be given to more skill birth attendants, in district Ramban the number of ASHAs should be doubled. 11. More incentives for ASHAs and ANMs for increasing institutional deliveries 12. Capacity building of ASHAs ANMs and other ground level staff. Activities 1. Identification of all pregnancies through home visits by ANMs, AWWs and ASHAs 2. Fixed Village Health Days followed with IEC sessions. • Publicizing VHD day by AWWs and ASHAs • Registration of all pregnancies • Ensuring 3 ANCs, 2 TT injections and 100 IFA tablets 3. 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 4. Tracking bags • Provision of tracking bags for dropout Pregnant mothers 5. Provision of Weighing machines at all Subcentres and AWCs 6. Availability of IFA tablets • ASHAs to be developed as depot holders for IFA tablets 7. Training of personnel for Safe motherhood and Emergency Obstetric Care (Details in Component on Capacity building) 8. Developing the CHCs and PHCs for quality services and IPHS standards (Details in Component Upgradation of CHCs & PHCs and IPHS Standards) 9. Developing CHC Ramban as DH and FRU 10. Availability of Blood at the District Hospital and CHCs • Establishing Blood storage units at all CHCs 11. Improving the services at the Subcentres (Details in Component on Upgradation of Subcentres and IPHS) 12. Behaviour Change Communication (BCC) efforts for awareness and good practices Increasing the Janani Suraksha coverage • Wide publicity of the scheme (Details in Component on BCC …) • Availability of advance funds with the ANMs and timely payments to the beneficiary 13. Provision of Mobile Phones to all the ANMs, PHC MOs and one CHC Incharge
45 A-2. MATERNAL HEALTH • Display of the Mobile numbers at all Subcentres, AWCs, Panchayat Bhawans, PHCs and CHCs 14. Training of TBAs focusing on their involvement in VHD days, motivating clients for registration, ANC, institutional deliveries, safe deliveries, post natal care, care of the newborn & infant, prevention and cure of anaemia and family planning 15. Safe Abortion: • Provision of MTP kits and necessary equipment and consumables at all PHCs • Training of the MOs in MTP • IEC regarding the MTP services and the danger sign 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 • Promotion of Emergency contraceptive. 16. Improvement of monitoring of ANM tour programme and Fixed village Health days • Fixed village Health days and Tour plan of ANM to be available at the PHCs 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 17. Use of the Village Chowkidar and Numberdar as social Mobilizers for getting data on Maternal deaths, abortions, Pregnancies 18. RCH Camps: These will be organized once each quarter through NGOs/Rotary/Lions clubs to provide specialist services especially for RTI/STD cases 19. Involvement of Rahber-e-sehat/Rahber –e-Talem in motivating and mobilizing the women for VH days. Support 1. Issue of joint letters from Health & WCD department for joint working required 2. Ensuring availability of personnel especially specialists and Public Health Nurses for the 24 hour PHCs, CHCs and two ANMs at the subcentres 3. Ensuring availability of formats and funds with the ANM for JSY and timely payments 4. Certification of PHCs as MTP centres 5. Developing CHC Ramban as FRU and additional cost to make it DH 6. Creating Blood Bank at CHC 7. Ensuring smooth flow of Blood to the Blood Storage units. 8. The State should closely monitor the progress of all the activities
46 A-2. MATERNAL HEALTH Timeline 2007- 2008- 2009- 2010- 2011- 2008 2009 2010 2011 2012 Strengthening of the Fixed VH days x X x X x
Developing the CHC for CEmOC CHC CHC CHC
Establishing Blood Storage Unit CHC CHC CHC 2PHC 2PHC
Mobile phones to ANMs, MOs at PHCs 3CHC 3CHC 3CHC 3CHC 3CHC and CHC Drs,15 Drs,15 Drs,15 Drs,15 Drs,15 PHC PHC PHC PHC PHC MO,20 MO,40 MO,50 MO,60 MO,78 SC SC SC SC SC Developing MTP centres 5 5PHCs 5PHCs PHCs
Tracking Bags Operational All All All All All AWCs AWCs AWCs AWCs AWCs JSY beneficiaries 1000 2000 5000 7000 8000
Promoting Medical Abortion - CHCs All CHCs RCH Camps x X x
47 A-2. MATERNAL HEALTH Budget Activity / Item 2007- 2008- 2009- 2010- 2011-12 Total 08 09 10 11 Consultancy for 1 2.2 2.42 2.66 2.93 11.21 support for developing Microplan for VH days Tracking Bags @ Rs 1.05 0.156 1.05 0.156 1.05 3.46 300/ bag x AWCs Adult Weighing 2.8 0.7 0.32 0.35 0.4 4.57 machines @ Rs 800 per machine x AWCs & Maintenance Establishing Blood 35 35 35 105.00 Bank @35 lakh Establishing blood 3 3 3 9.00 storage units Mobile phone 2.8 0.08 0.08 0.08 0.08 3.12 instrument to ANM @ Rs 2000 Mobile Phones 8.4 8.64 8.88 9.12 9.36 44.40 recurring cost to ANMs @ Rs 6000/annum Mobile phone 2.15 0 0 0 0 2.15 instrument to MOs & Supervisory staff @ Rs 5000 (43x5000) Mobile Phones 2.58 2.58 2.58 2.58 2.58 12.90 recurring cost to MOs & Supervisory staff @ Rs 6000/annum One day training 1 1.1 1.21 1.32 1.45 6.08 workshop on Tracking bags at the district level and each sector Janani Suraksha 28 35 42 56 67.2 228.20 Yojna @1400 X no.of inst. deliveries (apprrox) Janani Suraksha 5 5.5 5.5 5.5 5.5 27.00 Yojna @500 X 1000 (BPL - home delivery)(approx) RCH Camps @ Rs 1 1.1 1.21 1.32 1.45 6.08 25000 per camp x 4 Delivery kits to 4.29 1.43 1.573 1.730 1.903 10.92 TBA's@3000and refilling @ 1000 Incentives to TBA @ 2 3 4 5 6 20.00 100 per delivery by skilled birth attendant Total 100.07 99.486 108.82 85.816 99.903 494.09 3
48
A-3. NEWBORN & CHILD HEALTH Situation Analysis SNo Indicator Total Rate% 1 Live Births Estimated 6811 2 Total number of children under 6 years 31667 As per 2001Census data 3 Children covered under ICDS 11771 4 Neonatal Deaths DNA 5 Infant Deaths DNA 6 Child Deaths (1-5 years) DNA 7 Still birth in the last year DNA 8 Low birth weight newborns (less than 2.5 kgs) DNA 9 Complete Immunization 12-23 months age DNA 10 Measles vaccination 1729 25.38% 11 Total number of children malnourished DNA 12 Severely malnourished children (Grade III & IV) 0 13 Malnutrition Grade I&II 3195 2.7% 14 Pneumonia cases upto Oct 06 DNA 15 Deaths in the last year due to pneumonia in children DNA 16 Diarrhoea cases upto Oct 06 DNA 17 Deaths in last year due to Diarrhoea in children DNA
Due to new formation of the District, specific data is not available as the systems development is under progress. For systematic and accurate information a detailed baseline is needed. Only one third children are under the coverage of ICDS project. All though as per the data malnutrition percent is only 2.7% but as per the other indicators related to health the percentage must be much higher. It needs validation. Immunization status is not up to the mark. As measles vaccination is only 25.38%. Without full immunization the goal cant be achieved. There is lots of myths and misconceptions regarding immunizations also exists. Acute Respiratory Tract infections: The problem of new born and child health has a very high rate. Due to lack of proper staff (or) other problems there is no exact data maintained in all the institutions. People are living at far-flung places and it is not possible to ensure complete immunization coverage with out proper facilities. There is a big number of malnourished children and children suffering from Anemia As the area is totally hilly and cold and the outreach of govt. services is seriously effected Objectives 1. To reduce IMR to 50% by 2012 Benchmarks 2. Reduction in Neonatal mortality to 50% by 2012 3. To increase proportion of women for exclusive breast feeding for 6 months to 80% by 2007-2008 4. To promote 100% immunization and vaccination awareness on child health 5. To get all birth /death registered 6. To increase the use of ORS in Diarrhoea to 100% by 2010-2012
49 A-3. NEWBORN & CHILD HEALTH 7. Treatment of 100% cases of Pneumonia in children by 2010-2012 Strategies Improving feeding practices for the infants and children including breast feeding Promotion of health seeking behaviour for sick children Community based management of Childhood illnesses Improving newborn care at the household level and availability of Newborn services in all CHCs & hospitals Enhancing the coverage of Immunization Activities 1. 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 2. 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 3. Improving newborn care at the household level • Adaptation of the home based care package of services and scheduling of visits of all neonates by ASHA/AWW/ANM on the 1st, 2nd, 7th, 14th and 28th day of birth. • In case of suspicion of sickness the ASHA /AWW must inform the ANM and the ANM must visit the Neonate • Referral of the Neonate in case of any symptoms of infection, fever and hypothermia, dehydration, diarrhoea etc; • Training on IMNCI of ASHA/AWW/ANM/MOs on the home based Care package • Supply of medicine kit and diagnosis and treatment protocols (chart booklets) for implementation of the IMNCI strategy • Strengthening the neonatal services and Child care services in and all CHCs and
50 A-3. NEWBORN & CHILD HEALTH PHC : This will be done in phases • In all of these units, newborn corners would be established • Provision and supply of the equipment required for establishing a newborn corner • Training of staff in Newborn Care, IMNCI and IMCI (MOs, Nurses) including the management of sick children and severely malnourished children. • Availability of Pediatricians in all the General hospitals and CHCs • Ensuring adequate drugs for management of Childhood illnesses. 4. Strengthening the fixed Village Health days (Also discussed in the component on Maternal Health) • Developing a Microplan in joint consultation with AWW • Organize Mother and Child protection sessions twice a week to cover each village and hamlet at least once a month • Use of Tracking Bag • 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 VH days 5. Strengthening Immunization (Discussed in Component C) 1. ASHAs and ANMs to conduct by-weekly survey (door to door) to ensure the condition of nursing mothers and children. 2. ASHAs and ANMs and other ground level workers to provide necessary education to mother (or) parents of newly born babies and guide them. 3. Training of ASHAs and ANMs and other ground level staff to ensure group work and communities organization in the rural communities. 4. To ensure weighing of new born weighing machine must be present in every health institution Anganwari centers and school of elementary education. 5. Generally every child should be sponsored from with in the womb of the mother by ensuring nutritious diet complete immunization and safe delivery 6. Child groups to be formulated in each village and counseling sessions and group work to be done in order to understand the problems of children related to health and hygiene. 7. Promotion of healthy diet and hygiene of children to in community Support 1. Availability of trained staff including Pediatricians required 2. Technical Support for training of the personnel 3. Timely availability of vaccines, drugs and equipment
51 A-3. NEWBORN & CHILD HEALTH 4. Good cooperation with the ICDS and PRIs Timeline Activity 2007-08 2008-09 2009- 2010- 2011- 10 11 12 Health Education of the families x x x including mothers on breast feeding, weaning, ORS and good practices by the ASHA/ANM/AWW Identification of the malnourished x x x x x children Availability of ORS at ORS depots x x x x x with ASHA Identification of the nearest referral x x x x x centre with yearly updation Transport arrangements for x x x x x emergencies by the PRIs and community leaders Display of the referral centres and x x x x x relevant telephone numbers at prominent place Training of the LHV, ANM and MOs on x x x x x IMCI and IMNCI including referral Training on IMNCI of x x x ASHA/AWW/ANM/MOs on the home based Care package Supply of medicine kit & diagnosis and x x x x x treatment protocols
Development of Referral system & x referral cards Establishing Newborn Corner in CHC 2 CHC hospitals and CHCs Equipment and drugs for management x x x of Childhood illnesses Provision of generator 3CHCs, 1 DH 15 PHCs, Budget Activity / Item 2007- 2008- 2009- 2010 2011- Total 2006-07 08 09 10 -11 12 Study on the feeding and Care practices for the 2 0 0.000 0.00 0.000 2.000 infants and children 0
Innovative activities based on the study 0 2 2.000 2.00 2.000 8.000 0 Orientation of Staff Nurse and MOs on Baby 1.5 2 0 0 0 3.500 Friendly Hospital at all the CHCs (one day orientation) ORS, nutrients, vaccines, medicines for children 0.5 5.5 6.1 6.7 7.3 26.100
52 Newborn Corner furnished with equipment @ Rs 1.4 2.8 0.000 0.00 0.000 4.200 1.40 lakh per facility 0
Examination table, chair, stool, table, other 10.5 1.56 0 0 0 12.060 equipment @ Rs. 3000 x No of AWCs Infant Weighing Machines @ Rs. 800/AWCx No 2.8 3.616 0 0 0 6.416 of AWCs Foetoscope @ Rs.50 x No AWCs 0.175 0.026 0 0 0 0.201 1 0.5 0.000 0.00 0.000 1.500 Malnutrition Corners @ Rs 50,000 per CHC 0 Massive IEC 5 5.5 6.1 6.7 7.3 30.600 24.875 23.50 15.4 16.600 94.577 Total 2 14.200 00
53 A-4. FAMILY WELFARE Situation Indicators No. or Rate Analysis Eligible Couple 39511 (17% of Block data) Couple Protection Rate 6321 couples – 16.1% (DLHS Data) Female Sterilization operations 797(CMO, combined Doda data) Vasectomies DNA Using Copper -T 1283(CMO, combined Doda data) Conventional contraceptives Users DNA Oral Pills Users DNA Couples using temporary method DNA Prevalence of RTI /STDs last year 106
As per the DLHS 2002 survey (Doda old) 84% of eligible couples are not using any Family Planning method. Female sterilization is 8% and male sterilization is 0%. The Couple Protection Rate (DLHS 2002) is 16.3%, out of which 8% have adopted permanent methods. Currently the unmet need in family planning is 62.8%% (DLHS) 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 and 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 Objectives 1. Reduction in Total fertility Rate to 2.1 by 2012 Benchmarks 2. Increase in Contraceptive Prevalence Rate to 80 % by 2012 3. Decrease in the Unmet need for modern Family Planning methods to 0% by 2012 4. Increase in the awareness levels of Emergency Contraception 100% by 2012 5. To increase the percentage of tubectomy and vasectomy 6. To increase male participation 7. To reduce the prevalence of RTI/STD to 70% by 2012 Strategies Increased awareness for Emergency Contraception and popular IUD 380- A as an alternative to sterilization.
54 A-4. FAMILY WELFARE Decreasing the Unmet Need for Family Planning Availability of all methods at all places to increase the basket of choice Increasing access to terminal methods of Family Planning Promotion of NSV Expanding the range of Providers Increasing Access to Emergency Contraception and spacing methods through Social marketing Building alliances with other departments, PRIs, Private sector providers and NGOs Monitor progress, quality and utilization of services Activities • Expanding the range of Public Sector providers for Terminal/spacing methods • Each CHC and PHC will have one MO trained in any sterilization method. • All the CHC/PHC will have at least one MO posted who can be trained for abdominal Tubectomy and NSV. • Specialists from District hospitals and CHCs will be trained in Laparoscopic Tubal Ligation. • 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 PHCs come under the catchments area of CHCs and the camps will be organized on fixed days in each of the PHCs. • Equipments and supplies will be provided at CHCs and PHCs 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/CHCs/PHCs, Inventory of equipment, consumables and waste disposal facilities and the condition, location and ownership of the building. • At least three functional Laparoscopes will be made available per team, as will the equipment and training necessary to provide IUD and emergency contraception services. The existing 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.
• Organization of Sterilization camps on fixed days at all CHCs • NSV camp every quarter in all CHCs and PHCs • Access to non-clinical contraceptives increased in all the villages • AWWs and ASHAs as Depot holders
55 A-4. FAMILY WELFARE • Training in Spacing methods, Emergency Contraceptives and interpersonal communication for effective dissemination.
Access for the quality IUD insertion at all the subcentres. • Training to all the ANMs on insertion of IUD • Diagnosis and treatment of RTI/STI as per syndromic approach. • IUD 380 A will be used as an alternative for sterilization . • Empowering women • Increasing male involvement in family planning through use of condoms for safer sex and also in Vasectomy. • Service delivery sites for male methods by training health providers in NSV and conventional vasectomy
Improving and integrating contraceptives/RCH services in PHCs and Sub-centres • Skill-based clinical training • Training in infection prevention, counselling and follow up for different family planning methods. • MIS training
Strengthening linkages with ICDS programme and ISM (Ayurveda)
• A detailed action plan need to be prepared. • technical training and training in communication skills, non-clinical methods and record keeping Role of ASHAs: • Training to Act as depot holders for the supplies of pills and condoms by the ANMs for free distribution • Provide referral services for methods available at medical facilities • Assist in community mobilization and sensitization. Support • Availability of a team of master trainers/ANM tutors required • A training cell will be created in the medical college for the training of the medical officers in the area of various sterilization methods • Availability of equipment, supplies and personnel • Improvement of quality of services. • Introduction of the concept of quality care in family planning Programmes Timeline 2007- 2008- 2008- 2008- 2009- 08 09 09 09 12
56 A-4. FAMILY WELFARE Training of MOs for NSV 5 MOs 15 10 MOs MOs Training of MOs for Minilap 5 MOs 5 MOs 5 MOs Training of Specialists for 1 CHC 2CHC Laparoscopic Sterilization and DH
Development of Static Centres 2 CHC 1 CHC at District hospitals and all DH CHCs Sterilization camps (Persons) 5000 7500 10000 15000 20000 NSV Camps 600 700 800 1000 1200 Supply of Copper T – 380 and 3000 4500 6000 9000 12000 Emergency Contraception Emergency Contraception 2000 6000 8000 10000 12000 Budget Activity / Item 2007- 2008- 2009- 2010- 2011-12 Total 08 09 10 11 NSV camps @ Rs.50000 x 10 5 5.5 6.05 6.66 7.32 camps 30.53 Sterilization Camps @ 410 per 20.5 22.6 24.805 27.29 30.01 case(Including medicine and compensation) 125.20 Development Static Centres 3 6 0.000 0.000 0.000 @ Rs 3 lakh 9.00 Copper T-380 @ Rs 45 / piece 1.35 2.03 2.700 4.060 5.400 15.54 EmergencyContraception@Rs 0.1 0.2 0.3 0.8 0.5 10/2 tabs 1.90 Laparoscopes 3 per CHC @ 18 9 0.000 0.000 0.000 Rs 3.00 lakhs x 3 27.00 Total 47.95 45.33 33.855 38.810 43.230 209.17
57 A-5 Adolescent Health Situation Reaching out to adolescents will help to break the inter-generational cycle of early Analysis marriage, ill health, high mortality/morbidity and low contraception prevalence. It is important to influence the health seeking behavior of adolescents. An operational plan for improving the adolescent sexual and reproductive health to achieve the said goals spelled under RCH-II. Adolescents do not have any special services for them in the district on the other hand they have a lot of problems. RTI, STI cases are there in abundance but in most of the cases they are not detected due to unavailability of services. There are no programs for sex education, personal health and hygiene etc in far flung areas of district There are no Adolescent health camp at school level Unsafe abortion and unsafe sex are on rise Objectives To detect and treat cases of RTI/STIs Benchmarks To provide Adolescent Friendly Health Services (ARSH) at CHC /PHC/ dispensaries To reduce the Anemia among adolescent girls and boys. To make Special service available for in school and out of school adolescents. To ensure counseling for high risk behavior and unsafe sex practices. Strategies Disseminate ARSH guidelines Prepare operational plan for ARSH services across districts Implement ARSH services in district hospitals. Awareness amongst all the adolescents regarding Reproductive health Capacity building on Life skills Provision of Adolescent Friendly Health services with counseling services Activities Provide service standards and guidelines The Adolescent Health package will consist of the following activities: Research study involving quantitative and qualitative aspects Workshop to develop an understanding regarding the Adolescent health and to finalize the operational Plan Provision of Adolescent friendly health services at PHCs, CHCs, FRUs and district hospitals in a phased manner. Training of the MOs, MPHWF 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 anemia, Easy and confidential access to medical termination of pregnancy, Antenatal care and advice regarding child birth, RTIs/ STIs detection and treatment, HIV detection and counseling,
58 A-5 Adolescent Health Awareness building amongst the PRIs, Women’s groups, ASHA, AWWs Provision of IFA tablets to all Adolescents, de-worming every 6 months, Vitamin A administration and Inj TT. Carrying out the services at the Fixed Village Health days. Involvement of NGOs for Environment building, selection of Peer Educators, Counselors and their training and follow-up. One NGO per Block will be selected. Selection of Peer Educators, one for each village in a phased manner, and their training for three days. Initially Block Ramban will be taken up with all the villages, and training of all the health personnel in the Sub centers, PHCs and CHC in this block. Selection of Counselors for Peer Educator workshops and carrying out counseling clinics. These will be selected one per PHC. There will be equal number of Male and female counselors and will alternate between two PHCs – one week the male counselor is in one PHC and the female counselor in the other and they switch PHCs in the next week so that both the boys and girls benefit. The counselor will be Providing ongoing training to the Peer Educators, Facilitating group meetings Organizing Counseling session once per week at the PHC. Organization of counseling sessions at PHCs with wide publicity regarding the days of the sessions Collecting data and information regarding the problems of Adolescents Close monitoring of the adolescent pregnancies, prevalence of RTI/STDs. Quarterly three-day health camps for Adolescent boys and girls at block level for De addiction, mental health and problems of adolescents. Support Approval by State for Life skill education to be initiated in all schools required
59 A-5 Adolescent Health Timeline Activity 2007- 2008- 2009- 2010-11 2011-12 08 09 10 Research x Awareness generation x x x Workshop of all the partners x x x Training a district pool of Master x trainers Selection of Peer Educators Ramba Banihal Ukheral n Counsellor though NGOs 5 PHC 5 PHC 5 PHC Training of Peer Educators 100 100 Retraining of Peer Educators 0 200 200 200 200 Orientation of the Health x x x personnel Counselling Clinics 5 PHC 5 PHC 5 PHC Three day health camps for x x x Adolescents
BudgetActivity Research 2007- 2008- 2009- 2010-11 2011- Total 08 09 10 12 Awareness generation @ Rs 2000 per 5 0 0 0 0 5 village x 143 villages Workshop of all the partners 2.86 3.146 3.4606 3.8067 4.18733 17.46 Training of Adolescent Mentoring Group 0.5 0.55 0.605 0.6655 0.73205 3.05 and other expanses@1 Lakh Counsellors@ Rs 8000 per month x 1 1 1 1 1 5 PHCs x12 mths Training of Peer Educators @ Rs 50 per 14.4 15.84 17.424 19.166 21.083 87.91 person x 3 days x No of Peer Educators Re-Training of Peer Educators @ Rs 50 0.15 0.15 0 0 0 0.3 per person x 3 days x peer Educators Orientation & Reorientation Health 0 0.3 0.3 0.3 0.3 1.2 personnel Counselling sessions @ Rs 1000/yr/peer 0.25 0.28 0.31 0.34 0.37 1.55 Educator Counselling Clinics renovation, furnishing 1 2 2 2 2 9 and Misc expenses @ Rs 50000.00 Health camps for Adolescents once per 1.5 1.65 1.815 1.9965 2.19615 9.15 quarter x 4 x 50000 per camp Joint Evaluation by an agency & Govt 2 2.2 2.42 2.662 2.9282 12.21 Total Total 29.66 27.116 30.534 31.9367 36.116 155.36 6
60 PART B: New NRHM initiatives
B-1. ASHA – Accredited Social Health Activist Situation The area is totally hilly and people are living at far flung places on hill tops and in such Analysis areas at 1000 population the coverage of activities are difficult for ASHA. There were 294 out of pregnant ladies facilitated by ASHA in the month of Aug 2007. Still as per the population the number of ASHA’s is not sufficient. The motivational allowances for ASHA are not sufficient as the coverage is very difficult. Number of ASHA selected : 162 Training of ASHA: 1 st phase of training As per the population the district need 234 ASHA by 2012 for catering 1000population/ ASHA. Objectives 1. To provide a link between the health workers & public for improving the basic health Benchmar care, Ante Natal & Post Natal care, safe deliveries & registration of Death & birth ks cases & to educate mothers for breast feeding etc, Promotion of Household toilets under T.S.C. & completion of DOTS treatment under National TB Control Programme etc. 2. To generate demand for health services through ASHA (to act as communication resources, service provider, guide, mobilizer and an escort to village people to access health services 3. To address the unmet needs Strategies Selection of a woman from the community & Capacity building of ASHA Activities Constant mentoring, monitoring and supportive supervision by district Mentoring group Support Strengthening of the existing ASHAs through support by the MPWs and their required involvement in all activities. Reorientation of existing ASHAs Selection of new ASHAs to have one ASHA in all the villages Training of these ASHAs and selected ASHAs who have not received any training. Provision of a kit to ASHAs Formation of a District ASHA Mentoring group to support efforts of ASHA and problem solving Review and Planning at the Monthly sector meetings Periodic review of the work of ASHAs through Concurrent Evaluation by an independent agency
61 B-1. ASHA – Accredited Social Health Activist Timeline 2007- 2008- 2009-10 2010- 2011- 08 09 11 12 Selection of additional ASHAs 48 8 6 6 6
Total ASHAs 210 216 222 228 234 Training of new & untrained ASHAs 48 8 6 6 6
Reorientation of the initial ASHAs 162 216 222 228 234
District ASHA Mentoring group x x x x x
Budget Activity / Item 2007-08 2008- 2009- 2010- 2011- Total 09 10 11 12 Training & kit @ Rs 10000/ 21 0.6 0.6 0.6 0.6 23.4 ASHA Training of ASHA in 4.2 4.32 4.44 4.56 4.68 22.2 Module II,III,IV @ 2000/ASHA Reorientation @ Rs 1000/ 2.1 2.16 2.22 2.28 2.34 11.1 ASHA Expenses for the District 0.6 0.66 0.73 0.8 0.88 3.67 mentoring group – meetings, travel @ Rs 5000 per month x 12 months ASHA Performance Diary 0.3 0.3 0.3 0.3 0.3 1.5 @ 100/ASHA Compensation to ASHA 2.1 2.16 2.22 2.28 2.34 11.1 @1000/ASHA Total 30.3 10.2 10.51 10.82 11.14 72.97
62 B-2. Provision of Untied Funds at Sub Centres Situation Under NRHM provision of untied grants and maintenance grants are being kept at Analysis/ Sub Centre level. Keeping such important provisions, the services of facilities e.g. maintenance, minor repair, electricity, water, any fund for consumables, hiring transport in emergencies, travel, IEC and cleanliness can be improved. There are 47 sub centers in the district out of which the untied grants have been given to 33 sub centers There is a need to increase the SCs so this provision is also needed for the new SCs. Objectives To improve condition of sub centers at grass root level. To have a decentralized direct flow of funds so as to have money in time. To improve over all status of health institution at the grass root level. Strategies Provision of Untied funds of Rs 10000 each year to the Sub centres at the disposal of the ANM for local needs Provision of Rs 10000 for construction and annual maintenance Activities Only 33 accounts opened for 33 sub centers 14 more sub centers need to have their own VWHSC and their separate accounts for carrying out various activities. There must be increases in the untied funds for use of referral transport of complicated cases. From villages. Maintenance of sub centers building. Maintenance of safe drinking water and sanitation facilities in block. Delete the long process chain for meeting small expenses at the sub centre level Discretion of ANM and VWHSC member or the joint account holder for utilization of the funds makes it easier for quick decision making for petty expenses like providing transportation for emergency cases, employment of Safai karamchari for up-keep and maintenance of sub centre Purchase of medicines and medical provisions like ORS, bandages, large scale remedial measures like Albendazole for de-worming etc. Money for referral transport Money for JSY when not available will be adjusted here. Support effective implementation of various village level schemes required Timely release of money
63 B-2. Provision of Untied Funds at Sub Centres Timeline Activities 2007- 2008 2009- 2010 2011- 08 -09 10 -11 12 Untied Fund of Rs 10000/subcentre 70 72 74 76 78
Annual Maintenance grant of Rs x x x X x 10000/SC Plan for maintenance to be developed x x x X x and approved by Gram Panchayat
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 0.10 Lakh 7 7.2 7.4 7.6 7.8 37 X SCs Annual Maintenance Grant of 7 7.2 7.4 7.6 7.8 37 Rs 0.10 Lakh X SCs
Total 14 14.4 14.800 15.200 15.60 74 0
64 B-3. Provision of Untied Funds at PHCs Situation Under NRHM provision of untied grants and other grants namely maintenance grants, Analysis support money for Rogi Kalian Samiti (RKS) are being kept. Keeping such important provisions, the services of facilities e.g. maintenance, minor repair, electricity, water, any fund for consumables, telephone, hiring transport in emergencies, travel, IEC and cleanliness can be improved. There are 15 PHCs in district Ramban out of which only 7 PHCs have got registered and their accounts have been opened Each PHC is to have untied funds to the tune of Rs 25,000/- per PHC Objectives Strengthening of the PHC through financial support Strategies Training for maintenance of books for accounts Exact guidelines for utilization of the funds Provision of Untied funds of Rs 25000 each year to the PHCs at the disposal of the Rogi Kalyan Samities Provision of an Annual Maintenance grant of Rs 50,000 to the PHCs. Activities 8 more PHCs yet to get registered as RKS. Untied Fund, Maintenance Grant and Support Money will be provided to all PHCs including Allopathic Dispensaries. Such funds will be used as per the need after due approval of RKS. Proper accounts will be maintained for such funds. Timely submission of Utilisation Certificate to DHS through BMOs will be ensured by the facility In- Charge Making an action plan on a quarterly basis for the utilization of funds for maintenance works besides emergency expenses e.g short term purchase of drugs etc. RKS will be registered at all the PHCs . Support Timely release of funds required Meetings of the RogiKalyan Samitis to be regularly held District level State level support. Convergence with other link departments Timeline Activity 2007-08 2008-09 2009-10 2010-11 2011-12 Untied Fund of Rs x x x x x 25000/PHC Annual Maintenance x x x x x grant of Rs 50000/PHC Plan for maintenance x x x x x to be developed and approved by the Rogi Kalyan Samitis
65 B-3. Provision of Untied Funds at PHCs Plan for use of untied x x x x x funds Rogi Kalyan Samitis to x x x x x identify mode of construction and repair
Budget Activity 2007- 2008 2009- 2010- 2011- Total 08 -09 10 11 11
Untied Fund of Rs 25000/PHC 3.75 3.75 3.75 3.75 3.75 18.75
Annual Maintenance grant of Rs 7.5 7.5 7.5 7.5 7.5 37.5 50000/PHC
Total 11.25 11.2 11.25 11.25 11.25 56.25 5 0 0
66 B-4. Provision of Untied Funds at CHCs Situation Under NRHM provision of untied grants and other grants namely maintenance grants, Analysis support money for Rogi Kalian Samiti (RKS) are being kept. Keeping such important provisions, the services of facilities e.g. maintenance, minor repair, electricity, water, any fund for consumables, telephone, hiring transport in emergencies, travel, IEC and cleanliness can be improved. CHC Ramban, Batote and Banihal have got registered and their accounts have been opened. Societies still do not have a clear vision and not working up to that level. Objectives Strengthening of CHCs through financial support Strategies 1. Provision of Untied funds of Rs 50000 each year to the CHCs at the disposal of the Rogi Kalyan Samities 2. Provision of an Annual Maintenance grant of Rs 100,000 to the CHCs Activities Untied Fund, Maintenance Grant and Support Money will be provided to all CHCs, including additional CHCs Such funds will be used as per the need after due approval of RKS. Proper accounts will be maintained for such funds. Support • Meetings of the Rogi Kalyan Samitis to be regularly held required • Timely release of funds Timeline Activity 2007 2008- 2009 2010- 2010- -08 09 -10 11 12 Untied Fund of Rs 50000/CHC 3 3 3 3 3 Annual Maintenance grant of Rs x x x x X 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- 2008 2009- 2010- 2011- Total 08 -09 10 11 12 Untied Fund of Rs 50000/CHC 1.5 1.5 1.5 1.5 1.5 7.5 Annual Maintenance grant of Rs 3 3 3 3 3 15 100000/CHC Total 4.5 4.5 4.500 4.500 4.500 22.5
67 B- 5. Mobile Medical Units Situation District Ramban is located in hilly terrain with tiny villages scattered all around. With such a Analysis topographic condition it is not feasible to establish Health Centre at every nook and corner of the District. So, it will be much convenience and cost effective projects to ensure mobile medical units in the cut-off, remote, far flung areas of the District. So, that a comprehensive Health Care services to the people living in the remote areas at their door steps is required. Such mobile Medical Units can be used during natural disaster also. Medical mobile units are envisaged under NRHM. Apart from providing health care to the far flung areas and the areas where desirable quality services could not be provided due to lack of staff, there mobile units would be viable option. Mobile Medical unit Ramsoo in Ukheral is working but it only provides more or less first aid kind of facilities. There are not specialist available There are not vehicles available for MMU MMU keeps on changing the place in the district to cover wide population. As the district is hilly and cold climatic conditions and unavailability of road makes it more difficult to reach the beneficiaries. People living in hilltops usually (Scheduled Tribes) migrate from place to place and thus MMU also needs to be changing the positions. 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 . 5. Mapping of unserved and underserved areas in the District. 6. Monthly plan of activities to be detailed out (the villages that will be covered, the services that will be rendered etc 7. MMU with essential accessories, basic laboratory facilities, semi-auto analyzer and generator etc. 8. Wide publicity before the arrival of the MMU 9. Periodic Review. Support Govt Order from the State for exemption of the Regular Staff from providing services in the required MMU, Funds for purchase of MMU and its maintenance. Manpower
68 Time line Activities 2007- 2008- 2009- 2010- 2011- 08 09 10 11 12 Operationalizing the MMU 1 1 1 1 1 Orientation & reorientation of the X X X X X staff Wide Publicity X X X X X Strengthening the MMU X X X X X Addition of services X X X X X Budget Activity / Item 2007-08 08-09 09-10 10-11 11-12 Total Cost of Vehicle, equipment and accessories 26.85 0 0.000 0.000 0.000 26.85 Hiring staff 9.9 10.89 11.979 13.177 14.495 60.44 Recurring Cost of Drivers, Drugs, supplies, Mobile phones, POL, Maintenance 1.9 2.090 2.299 2.529 2.782 11.60 Orientation of the staff 0.25 0.275 0.3025 0.333 0.366 1.52 Joint Workshop for finalizing modalities 0.25 0.275 0.3025 0.333 0.366 1.526 Total 39.15 13.53 14.883 16.371 18.008 101.94 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 ) 10,000 6. Computer system with Printer 30,000 Total 26,85,000 Budget of Personnel S.No Head Unit Unit Cost Amount • Emoluments to MOs -1 12 months 25000 300000 • Emoluments to Specialists –2 (Part 12 months 40000 480000 time) • Lab Technician 12 months 5000 60000 • Pharmacist 12 months 5000 60000 • Nurse 12 months 7500 90000 Total 990000 Budget for Recurring Expenses S.No Head Unit Unit Amount Cost 1. Salary of Drivers –2 12 months 8000 96000 2. Drugs 50000 3. POL & Maintenance of Vehicles 40000 4. Maintenance of equipment 10000 5. Mobile Phone bill -2 12 months 500 12000 Total 190000
69
B – 6. Upgrading CHCs to IPHS Situation There are 3 CHCs (Ramban, Banihal and Ukheral) are functioning in the district, Analysis There is no District Hospital in Ramban. Since Ramban District is having large hill area, these centers needs to be strengthened. These facilities are the only source for medical facilities in the area. Especially for Maternal and Child Health related issues. All the Facilities need to be strengthened as IPH Standard. Presently only one CHC have only two staff qtrs. and the qtrs. are also in bad shape, rest PHCs don’t have any residential facilities for the staff so that the all staff can stay .Hence All the CHCs needs staff qtrs. Ramban CHC to be developed as District Hospital Two CHCs to be upgraded to the level of IPHS and need to be strengthened for FRUs i.e Banihal and Ukehral One more CHC at Banihal required in project period. Whole district is hilly and roads are two narrow result is high prevalence of road accidents. So casualty services need to be strengthened at CHCs Objectives To Strengthen all the CHCs as per Indian Public Health Standards Opening new Community Health Centres to cater to the entire population Upgradation of Ramban CHC to District Hospital for the newly formed district. Strategies Availability of all personnel as per IPHS Proper building Adequate Laboratory, Blood Storage Unit, Equipment and Drugs Activities Hiring of additional staff as per IPHS and filling of Vacancies Building to be built for New CHC with staff quarters Repair of CHC Equipment as per IPHS norms Support State to sanction posts as per IPHS required Allowing Contractual Personnel at Market Rates Timeline Activities 2007- 2008- 2009- 2010 2011- 08 09 10 -11 12 Ramban CHC to be developed as 1 FRU/DH Banihal and Ukheral CHCs will be X X strengthened as per IPHS. Hiring of required number of staff will be X done.
70 Adequate medicines, furniture, and X equipment will be procured and supplied to the CHCs. Vehicle will be hired for S/MOs. X X X X X Repair and renovation of building, and X equipment will be made from maintenance and untied funds in the existing CHCs as per the requirement. Purchase of generator sets & their X maintenance for ensuring the 24 hours electricity supply in existing 3 CHCs. Construction of New CHC in Banihal block X with residential facilities X Construction of new staff Qtrs for the staff. (2MO and 2 Staff Nurse Qtrs) X X X X X Activities, which are routine in nature, will be carried out every year. Budget Activity 2007-08 2008-09 2009- 2010-11 2011-12 Total 10 Upgradation of 500 0 0.000 0.000 0.000 500 Ramban CHC to DH@ 5 crore Upgradation of 0 250 0.000 0.000 0.000 250 Subsidiary Health Centre Ramsoo to Trauma Hospital (20 Bedded) @ 2.5 crore CHC Building Repair, 20 Alteration and Edition @ 10 Lakh 20 0 0.000 0.000 0.000 Construction of Staff 72 Qtrs of MO/ Specialist @ 12 lakh 72 0 0.000 0.000 0.000 Construction of Staff 48 Qtrs of SN @6 lakh 48 0 0.000 0.000 0.000 Construction of Staff 4.8 Qtrs of class [email protected] 4.8 0 0.000 0.000 0.000 Furniture @0.5 X No 1.5 of CHCs 1.5 0 0.000 0.000 0.000 Equipment @ 11 X 33.000 No of CHCs 33 0 0.000 0.000 0.000 Reccuring cost of 131.974 CHC excluding Man Power 26.395 26.395 26.395 26.395 26.395 Generator & 80 stabilizer @ Rs. 3 lakhs for PHC 3x15 PHC ( 2lakhs+1 lakh) 30.000 50.000 0.000 0.000 0.000 Generator & 12 stabilizer @ Rs. 4 lakhs for CHC 4x3 CHCs (3lakhs+1 8.000 4.000 0.000 0.000 0.000
71 lakh) Generator & 5 stabilizer @ Rs.5 lakhs for DH 4x1 DH (4lakhs+1 lakh) 5.000 0.000 0.000 0.000 0.000 Recurring & 8.02 Maintenance cost of generator sets Rs. 140 X 30 days X 12 months X 3 No of CHCs 1.008 1.512 1.66 1.83 2.01 Computer ,printer,fax 3 @1 lakh X 3 CHC 2 1.00 0.00 0.00 0.00 AMC of computer @ 1.09 6000 X3 CHC 0.18 0.20 0.22 0.24 0.26 Total 751.88 333.10 28.27 28.46 28.67 1170.39
72 B – 7. Upgrading PHCs for 24 hr Services Situation There are 6 PHCs running in govt. building and 9 in rented/ Panchayat buildings. Analysis Majority of PHCs running in govt. buildings in spite of this do not have facilities and condition of building not as per IPHS. These building needs addition and repair for making them 24X7 PHCs, There is no residential facility available at the PHC. This is the main reason behind the staff is not staying at PHCs. Objectives Provide round the clock Emergency services at the PHC level Strengthening, PHCs as per IPH Standard. Strategies Availability of all personnel as per IPHS Proper building with staff quarters in all PHCs Adequate Laboratory, Equipment and Drugs Activities Hiring of additional staff as per IPHS with 2 MOs( maybe Ayush), in each of the facilities, 3 staff nurses, 1 PHN, 1 Lab Technician, Part time Pharmacist, 1UDC, 1 Accountant, and Class IV and filling of Vacancies( Budget mentioned in the HR section) Building addition /Expansion, Repairing and Construction of staff quarters for the existing PHCs which are running in government buildings. Upgrading the Laboratory for tests necessary for 24 hour PHCs Furniture, Drugs and Equipment as per IPHS norms Existing PHCs will be upgraded as per IPH Standards. New buildings with staff qtrs for the PHCs running in rented/ Panchayat buildings. Support State to sanction posts as per IPHS required Allowing Contractual Personnel at Market Rates Timeline Activity / Item 2007- 2008- 2009- 2010- 2011- 08 09 10 11 12 No of PHCs 15 0 0 0 0 New Buildings with equipment, Furniture and 5 4 Staff quarters as per IPHS
Equipment and furniture for existing facilities as 6 per IPHS Repair/Additions of PHCs 6 Staff Quarters as per IPHS 6
73 Budget Activity / Item 2007-08 2008-09 2009-10 2010-11 2011-12 Total Construction of Building with 189 151.2 0 0.000 0.000 340.2 staff Qtrs for building less PHCs @ 37.80 PHC Building Repair, Alteration and Edition @ 4Lakh 24 0 0.000 0.000 0.000 24 Construction of Staff Qtrs for PHCs having own building 172.8 0 0.000 0.000 0.000 172.8 Furniture @1 X No of PHCs 11 4 0.000 0.000 0.000 15 Equipment @ 11 X No of 121 44 0.000 0.000 0.000 PHCs 165 Recuring cost of PHCs excluding Man Power 26.4 26.4 26.4 26.4 26.4 131.974 Computer with scanner, 15 0 0.000 0.000 0.000 printer, UPS ,Fax@100000 /PHC 15 AMC of computer @ 6000 X 0.9 0.99 1.089 1.198 1.318 No of PHC 5.495 Total 560.09 226.58 27.48 27.59 27.71 869.46
74 B – 8. Upgrading Sub Centres Situation In District Ramban out of 47 sub centers 38are in rented/ panchayat building and 9 Analysis are in govt. building. The 9 govt. buildings needs repair. Not a single sub center having staff qtrs. There are no proper water supply, electricity and sanitation facilities available. All the sub centers fully dependent on natural water sources. No regulars supply of kit A+B moreover the supplies like IFA, condoms and other necessary medicines are falling very short since last year. There is huge gap of adequate man power as per IPHS. As per the population norms and as per the population growth the district needs additional sub health centers. Objectives Up gradation of Sub centers as per IPHS standards Residential facilities for the staff. Opening of 31 Additional Sub centers to cater to the entire population Strategies Construction of new buildings including staff qtrs. for building less Sub centers & Activities Additional sub center as per the population norms. Provision of Electricity, water storage and sanitation facilities to all sub centers Filling the gap of staff as per IPHS (Budget is mention in HR section) Support State to sanction posts as per IPHS required Allowing Contractual Personnel at Market Rates Timeline Activity / Item 2007- 2008- 2009- 2010- 2011- 08 09 10 11 12 Construction of new buildings with staff 20 18 0 0 0 quarters, equipment and furniture for existing SCs (38) Repair of SCs (9) 9 2 Staff Quarters (9) 9 Additional Sub centers with staff Qtrs 20SC 5 SCs 2 SCs 2 SCs 2 ,Furniture and Equipment s SCs Electricity Connections Water Connections Managed by untied funds and Toilets
75 Budget Activity / Item 2007-08 2008- 2009-10 2010-11 2011-12 Total 09
New buildings with quarters, equipment and Furniture 200.000 180 0.000 0.000 0.000 380.00 Additional Subcentres with staff quarters,furniture and equipment 200.000 20 20 20 20 280.00 Repair,Addition and Alteration of Subcenter @2lakh 18 0 0.000 0.000 0.000 18 Staff Quarters @ Rs 5 lakhs per Quarter for 2 ANMs 45 0 0.000 0.000 0.000 45 Recurring costs of the 42.0945 43.297 44.500 45.703 46.905 Subcentres excluding 2 man power 222.50 Total 243.29 505.095 72 64.500 65.703 66.905 945.50
76 B-9 Untied Funds and Incentive Fund for the Village Health and Water Sanitation Committees Situation NRHM has placed a lot of stress on Community involvement and formation of Analysis/ Village Health & Water Sanitation Committees (VHWSC) in each village. These Current Status committees are responsible for the health of the village. In most of the villages these 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 Village Health and Water Sanitation Committees.
In Ramban there are 48 villages with population less than 500. There are 59 villages with population between 1501 and 5000. There are 3 villages with population more than 5000. Objective 1. Strengthening the Village Health & Water Sanitation Committees through s financial support Strategies 1. Provision of annual Untied funds of Rs 10000 each year to the villages up to a population of 1500 2. Provision of Rs 5000 as permanent advance fund for Incentives for ASHA to each sub center. Activities 1. Provision of annual untied funds of Rs 10000 each year to the villages’ up to a population of 1500. Villages with more than 1500 population up to 3000 will get twice the funds. Villages with population more than 3000 will get three times the funds, hence the district have 189 units. This untied fund is to be used for household surveys, health camps, sanitation drives, revolving fund etc; 2. Orientation of the ANMs for the utilization of the untied funds and she in turn will orient the Village, Health & Water Sanitation committee. 3. Provision of Rs 5000 as permanent advance fund for Incentives for ASHA based on performance norms. 4. Monthly meetings of the VHWSC for reviewing the funds and activities. This is to be facilitated by the ANMs 5. Monthly review at the PHC level regarding the VHWSC functioning and utilization of funds. Support 1. State should ensure the orientation procedure for the VHWSC required 77 2. Funds to be transferred on time to the ANMs 3. PRIs to ensure proper usage and accounts Timeline 2007 2008 2009 2010- 201 -08 -09 -10 11 1-12 Untied Fund of Rs 10000/unit for Pop x X x x x 1500/unit x 240 units Orientation and reorientation of the x x x x x VHWSC Provision of Rs 5000 as permanent x x x x x advance for incentives to ASHA Monthly meetings of the VHWSC x x x x x Review of the VHWSC functioning at x x x x x PHC level Budget Activity / Item 2007- 2008- 2009- 2010- 2011- Total 08 09 10 11 12 Untied Fund of Rs 18.9 18.9 18.9 18.9 18.9 75.6 10000/unit 1500/unit x 189 units Permanent Advance to 3.5 3.6 3.700 1.520 3.900 12.72 VHWSC for ASHA incentive @ Rs5000/SC Total 22.4 22.5 22.600 20.420 22.800 88.32
78 PART C: Immunization
C-1. Strengthening Immunization Current As per the Combined District Doda data, 20606 children (0- 1) were immunized. 14896 Status children received all doses of vitamin A. As per DLHS full immunization is 16.2%, BCG 89.9%, DPTIII 25.4%, and There are no children who do not receive any vaccine. The main reasons of incomplete immunization because of poor accessibility. There appears to be a gap between in the reported coverage and the DLHS survey. The dropout rate is also high.
District Ramban is hilly and very tough area in the whole country. Here Govt. services are seriously impaired especially complete vaccination is one of the biggest challenge moreover people are living at hilltops and at very far places. In August only 43% infants from 0-11 mothers were given DPT.
The reasons for low immunisation 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 drop given repeatedly at the time of Pulse Polio campaign is equivalent to the complete immunization.
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.
IEC session have been started the district manages presently up to Aug 2007 there is record of since camps which includes RCH and camp and 2 health meals at through yet electronic media has not been involved due to various financial and staff problems.
In District Doda (old) cold chain is being maintained at some places Out of 34 PHCs and 108 sub centers following maintain cold chain RH Ramban, Batote, Banihal 5ILR+ 4 Deep freezer. PHC Rajgarh, AD Ramsoo, AD Neel, PHC Khari, PHC Ukheral, 5 ILR + 4 Deep freezer 5 Sub centers in Baniahl with 5ILR Although the District Doda have more or less sufficient equipment for cold chain maintenance. Now Ramban is bifurcated from district Doda it is still not clear how many equipments will come under the new District Ramban’s account.
79 There are far-flung areas which take seven to eight hours to go by foot from block head quarter and in these areas the cold chain maintenance with out generator ILR and Deep freezer is very difficult. There is a Shortage of Refrigerator Mechanics .
Objectives/ Reduction in the IMR to 25 by 2012 Milestones 100 % Complete Immunization of children (12-23 month of age) by 2010 / Benchmar 100 % BCG vaccination of children (12-23 month of age) by 2008 ks 100% DPT 3 vaccination of children (12-23 month of age) by 2009 100% Polio 3 vaccination of children (12-23 month of age) by 2009 100% Measles vaccination of children (12-23 month of age) by 2010 100% Vitamin A vaccination of children (12-23 month of age) by 2008 Strategies Strengthening the District Family Welfare Office Enhancing the coverage of Immunization Alternative Vaccine delivery Effective Cold Chain Maintenance Zero Polio cases and quality surveillance for Polio cases Close Monitoring of the progress Activities • Strengthening the District Family Welfare Office Support for the mobility District Family Welfare Officer for supervision and monitoring of immunization services and VH Days One computer assistant for the District Family Welfare Office will be provided for data compilation, analysis Training for all the health personnel will be given including ANMs, LHVs, MPWs, Cold chain handlers and statistical assistants for managing and analyzing data at the district.
Alternative vaccine delivery system (mobility support to PHCs for vaccine delivery) For Alternative vaccine delivery, Rs.50 to the ANM will be given per session, two sessions per week per Sub centre Mobility support (hiring of vehicle) is for vaccine delivery from PHC to VH Days site where the immunization sessions are held for 8 days in a month • 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. • Contingency fund for each block Rs. 1000/ month per block will be given as contingency fund for communication.
80 • 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. • Outbreak investigation Rapid Action Team for epidemics will be formed • Dissemination of guidelines Training of Rapid Action Team for investigating outbreaks who will in turn orient the ANMs during Sector meetings • 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. • IEC & Social Mobilization Plans Discussed in details in the Component on IEC • Cold Chain Repairs of the cold chain equipment at PHC & CHC each year Electricity & POL for Genset & preventive maintenance (Running Cost) of Walk in Coolers (WICs) & Walk in Refrigerators (WIF) • POL & maintenance of vaccine delivery van Where there is no motorable road available mules could be hired for vaccine delivery. Selection and training of volunteers from each of the far-flung area for delivering the vaccines. They can be paid Rs 50 per carriage.
Support • Regular supply of vaccines and Autodestruct syringes required • Reporting and Monitoring formats • 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 and middle level managers Timeline Activity 2007- 2008- 2009- 2010- 2011- 08 09 10 11 12 Alternative Vaccine delivery x x x x x Mop up Round x x x x x IEC activities x x x x x Tracking bags x x x x x Orientation on 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
81 Mobility support for 1.68 1.728 1.776 1.824 1.872 8.88 alternative vaccine delivery Rs. 70 per session for 1 planned session per week at each Subcentre village for 12 months = Rs. 70 x 1 session x4 weeks/mthx12 monthsx SCs Vehicle for distribution of 5.76 6.336 6.970 7.668 8.435 35.16 vaccines in remote areas @ Rs 800 per PHC per week x 4 weeks x 12 months x PHCs Mobility Support Mop up 9 9.9 10.89 11.979 13.176 54.94 campaign @ Rs 10000 per 9 PHC ( Including travel, vaccine delivery, IEC) x 6 rounds/ year x PHCs Mobilization of Children by 6.864 7.5504 8.3054 9.1359 10.049 41.90 Social Mobilizers @ Rs. 100/ 4 84 5824 session x1 session per week x 4 weeks/mth X 365village x12 mths Contingency fund for each 0.36 0.396 0.4356 0.4791 0.5270 2.19 block @ Rs.1000/month x 3 6 76 blocks x 12 months Pit Formation for disposal 28.6 28.6 28.6 28.6 28.6 143 of AD Syringes and broken vials (@ Rs. 2000 per pit per village Printing of Immunisation 0.75 0.825 0.908 0.999 1.099 4.58 cards @1.50 per card x 50000 cards each year Maintenance of Cold Chain 2.12 1.58 1.58 1.58 1.58 8.44 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 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 & 0 7.72 8.490 9.340 10.270 35.82 WIF (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 2.19 Family Welfare Officer@
82 3000/month
Computer Assistant for 0.54 0.594 0.653 0.719 0.791 3.29 District Family Welfare Office @ 4500 Mobility support for 7.2 7.92 8.712 9.583 10.542 43.95 Monitoring Immunization sessions for MO's PHC @1000/session Total 65.034 75.525 79.936 84.786 90.109 395.38
83 PART D: National Disease Control Programme
D-1. RNTCP Situation Separate data of District Ramban is not available. As per the district Doda (Old) the TB Analysis control program is running satisfactory. Still the data related to drop outs , failure cases and new positive cases is not available separately. For making effective of the RNTCP program it needs to be strengthening in terms of infrastructure and capacity building.
Objectives Reduction in the cases of Tuberculosis by 25% 1. 100 % detection of Cases 2. 85 % Cure rate in New Cases 3. Detection of 70% new smear positive cases once cure rate of 85% is achieved 4. Reduction in the defaulter rate to less than 5% Strategies 1. Development of infrastructure 2. Improvement in the quality of the intervention 3. Increasing the outreach of the programme • Increasing the awareness regarding Tuberculosis Activities 1. Development of infrastructure • Construction of DTC building with a computer room • Improved MC centres and TC centre 2. Improvement in the quality of testing of sputum • Training to the RNTCP staff in the district • Equipment maintenance – Microscope, Computer and Others • Adequate supply of drugs 3. Increasing the outreach of the programme by Increasing the DOTS providers through involvement of ASHAs who will be paid Rs. 500 per year for providing services. She will be oriented regarding DOTS. Also the AWH should be involved in reporting suspicious cases. Training will be given to ASHA for identifying the suspects. 4. Increasing the awareness regarding the various issues of Tuberculosis through involvement of Community leaders, NGOs, Ex-servicemen. Special drive for detection of cases on World TB day through the involvement for all departments 5. DOTS regime to be strictly monitored through the VHWSC, the PRIs and the PHC MO 6. Orientation of PRIs and Rehbar-e-sehat for early detection of TB.
84 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.
Timeline Activities 2007 2008 2009 2010 2011- -08 -09 -10 -11 12 Construction of DTC building and improvement of 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 x x x x x
Budget Activity / Item 2007- 2008- 2009-10 2010-11 2011-12 Total 08 09 Civil Works DTC building 15 15 0 0.000 0.000 0.000 15 lakhs MC 2.8 0 0.000 0.000 0.000 2.8 0.28/MC TU 1.05 0 0.000 0.000 0.000 1.05 0.35/Tu 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 14.03 15.433 16.976 18.674 20.541 85.655 Awareness drive on 1 1.1 1.210 1.330 1.460 6.1 World TB day IEC activities 1 1.1 1.210 1.330 1.460 6.1 Salaries of 11.19 12.31 13.540 14.890 16.330 68.26 contractual staff Vehicle maintenance 1 1.1 1.210 1.330 1.460 6.1 inc POL 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 0.085 0.094 0.103 0.113 0.124 0.519 maintenance Miscellaneous – 0.195 0.215 0.247 0.272 0.300 1.229 TA/DA, Telephone, Meetings, Electricity repair etc Total 51.25 35.642 39.216 43.139 47.395 216.64
85 Training Personnel Unit Cost Units 2007-08 DTO State MOTC 23320 3 69960 MO 15580 40 623200 STS 6726 2 13452 STLS 16720 2 33440 LT 5972 10 59720 MPW 2875 70 201250 ANM 2875 140 402500 Total 1403522
Salaries of Contractual Staff Personnel Unit Cost Units Months Amount TB health 6750 6 12 486000 visitor STS 7000 2 12 168000 STLS 7000 2 12 168000 LT 6500 2 12 156000 Data Entry 6000 1 12 72000 Operator Accountant 1250 1 12 15000 Driver 4500 1 12 54000 Total 1119000
86 D-2. LEPROSY Situation Leprosy cases are not visible in the newly formed district Ramban. Analysis As per the estimation there are 0.5 cases per 10,000 hence 3-5 new cases per month are detected each month. These cases are from outside the district and not from within the district itself). A total of 40 cases are on treatment per month for treatment A & B40 cases on treatment per month = 480 per year (treatment costs 480 x 393.01 and 480 x 1167.53)
Objectives Eradication of Leprosy by 2012 Maintain the gain achievements. Provide quality leprosy services with integrated health care system. Strategies 1. Institutional development: Expand the service availability from CHC to PHC level. & Activities 2. Strengthening and Integration of Service Delivery: Diagnosis and treatment facilities will be made available closer to the people through daily outreach. 3. IEC for awareness regarding the symptoms and effects of Leprosy 4. Prompt treatment to all cases with effective referral system. 5. Trainings programs of MOs on general health care & IEC, Lab Tech and Pharmacist. 6. POID Camps. Support Availability of drugs Required Inter sectoral coordination for identifying new cases and rehabilitation of disabled. Adequate funds for various activities Timeline 2007-2008 House to house detection Wide publicity Training Programs POID Camps 2008-2009 Rigorous follow-up Budget Activity / Item 2007- 2008- 2009- 2010- 2011- Total 08 09 10 11 12
Routine Budget for Leprosy 1.45 1.6 1.8 2 2.2 9.05 control programme Monitoring & Supervision 1 1.1 1.2 1.3 1.5 6.1 Additional medicines 1 1 1 1 1 5 IEC Activities 1 1.1 1.2 1.3 1.5 6.1 POID Camps one per year 0.75 0.75 0.75 0.75 0.75 3.75 @5000 XPHC Celebration of world Anti 0.2 0.2 0.2 0.2 0.2 1 Leprosy day@20000
TOTAL 5.4 5.75 6.15 6.55 7.15 31
87 D-3. NATIONAL MALARIA CONTROL PROGRAMME Situation Issues No. Analysis Total Blood Slides Examined (BSE) Jan 2006 –Dec 2006 1026 Total Positive Cases: Plasmodium Vivax (Pv): NIL Plasmodium Falciparum (Pf): NIL Slide Positivity Rate (SPR) Slide Positive plasmodium falciparum Rate (PFR) 0
Annual Blood Examination Rate (ABER) NIL Deaths NIL
The District is cold one and usually the malaria cases are not noticed here. It is negligible although slides are examined regularly in District Ramban slides have been examined last year out of which no slide has been found positive. Objectives To prevent the malaria Too aware community and educate them about anti malaria operations and seek their support. Strategies IEC activities regarding the malaria prevalence and public awareness. & Activities Health education to the community through the ANM, AWW, ASHAs, RMPs, Ayush personnel Formulating community groups and seeking solution of cleanliness quarterly. Support • Availability of supplies required • Filling up of vacancies • Supply of health Education material Timeline Activities 2007- 2008- 2009- 2010- 2011-12 08 09 10 11 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
88 Budget Activity / Item 2007- 2008 2009- 2010 20011- Total 08 -09 10 -11 12 Salary Contractual staff 6.45 7.09 7.805 8.58 9.443 39.378 5 5
Travel expenses @ Rs 4000/ 3.36 3.69 4.066 4.47 4.919 20.513 month for jeep x 12 months 6 2 Office expenses @ Rs 5000 per 0.6 0.66 0.730 0.80 0.880 3.67 month x 12 0 Jeep and maintenance 6 0.6 0.660 0.73 0.800 8.79 0 Training 13.84 15.2 16.74 18.4 20.263 84.495 0 24 6 21 1small Fogging machines for 23 2.3 2.53 2.78 3.061 33.674 each PHC @ Rs 1.00 lakh and 3 one at District HQ Pulse Fog Machines @ Rs.8.00 lakh per unit and maintenance
Misc @ Rs 1.00 and Rs 20000 2.1 2.31 2.541 2.79 3.075 12.821 per CHC, and for PHC Rs 10000 5 Board hoarding:8’x 12’ at the 0.75 1.25 1.750 2.50 3.000 9.25 CHCs and District hospitals @ 0 Rs 25,000/- Board hoarding: 5’x3’ initially at 1.5 2.5 3.000 3.50 4.000 14.5 the PHCs@ Rs 10,000/- 0 Total 57.60 35.6 39.82 44.5 49.442 227.091 0 35 8 86
Malaria personnel on contract
Personnel Unit Cost Units Months Amount Spray and Fogging staff 4000 4 12 192000 LT 6500 4 12 312000 Data Entry Operator 6000 1 12 72000 Accountant 1250 1 12 15000 Driver 4500 1 12 54000 Total 645000
Training Malaria
Personnel Unit Cost Units Amount DTO State MO 15580 40 623200 LT 5972 18 107496 MPHS 1925 15 28875 MPW 2875 70 201250 ANM 2875 140 402500 ASHA 100 210 21000 Total 1384321
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D-4. OTHER VECTOR BORNE DISEASES Situation Other VBDs No. Analysis Kalazaar NIL Dengue NIL Lymphatic Filariasis NIL Japanese Encephalitis NIL
Generally the area is cold and such diseases are very less or negligible. It is expected that intensive efforts should be made to prevent emergence of vector borne diseases in District Ramban. Objectives Decrease in incidence of Dengue to nil 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 through Identification of breeding sites, Fogging and spraying . 2. Mosquito-man contact reduction by promotion of mosquito net 3. Preparedness for new infections • 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 4. Community awareness as part of the IEC for Malaria and IDSP Support Support from State Laboratory and the NICD for diagnosing Dengue, Chikingunya, JE etc; required Support from District Administration, PRIs, WCD, PHEd, Timeline All the routine activities to be carried out in the project period
Budget – Activity / Item 2007- 2008- 2009- 2010 - 2011- Total 08 09 10 11 12 Budget for activity 1,2,3 is mentioned in Malaria Unforeseen expenses 0.5 0.55 0.610 0.670 0.740 3.07 Kala Jathas for Malaria, 1.43 1.573 1.730 1.903 2.094 8.730 Dengue and Chikingunya @ Rs 1000 per village x 179 Total 1.93 2.123 2.340 2.573 2.834 11.800
90 D-5. BLINDNESS CONTROL PROGRAMME Situation There is no proper facility for blindness control program neither people have neither check Analysis ups nor the treatment facility in district. Before bifurcation Eye Care is being provided through the DH Doda. There is no Ophthalmologist in the district and only 3 Ophthalmic Assistant. `The norm for GOI is 1 Ophthalmologist for a population of one lakh. Hence in this district at least 3Ophthalmologist are required. The norm for Ophthalmologist to Ophthalmic Assistant is 1: 3-4 hence a minimum of 10 are required. The private sector too is inactive in the district. 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 Rajouri. The nearest Eye Bank is at Jammu Medical College Objectives 1. Reduction in the Prevalence Rate of blindness to 0.5 % by 2012 2. Decrease in the Prevalence Rate of Childhood blindness to 0.6 % per 1000 children by 2010 3. Usage of IOL in 95% of Cataract operations Strategies • Provision of high quality Eye Care • Expansion of coverage • Reduce the backlog of blindness • Development of institutional capacity for eye care services Activities • Increase in number of cataract camps by strengthening existing infrastructure and by involving private sector/NGO/Trust. • Strengthening the CHCs, and proposed new District Hospitals (DH) for cataract operation by equipping them with operation theatre, vision box, colour vision, ophthalmoloscope and required medicines • Eye OT at CHC Ramban and CHC Banihal will be contracted to meet the demand. • Ophthalmologist surgeon, ophthalmologic assistant will be posted at all the CHCs, • All the PHCs will be equipped with vision box, colour vision, ophthalmoloscope and required medicines. • NGOs/private agencies/trusts will be encouraged to participate in the National Blindness Control Programme. • Eye checkup and early detection and prompt treatment of ophthalmologic infections/diseases among children will be done during School Health Programme (Details is given in the School Health Component)
91 • Training in IOL to Ophthalmologists • Training of Paramedical staff and Teachers, NGOs, Patwaris and AWW for screening and IEC activities. • Procurement of new Equipment • AMC for all equipment will be done. • Blind Register to be filled up by the AWW, together with PRIs • School Eye Screening sessions • IEC activities Support Procurement of latest equipment for hospitals by GOI required Timely Repair of equipment Timeline Activity 2007- 2008- 2009- 2010- 2011- 08 09 10 11 12 Health mela X X X X X School Screening X X X X X Cataract camps X X X X X Development of Eye units at 2CHC 1CHC 1CHC CHC IEC Campaign X X X X X • Budget for development of Eye units is mentioned in Up gradation of CHCs, IPHS • School screening budget is mentioned in school health . Budget Activity / Item 2007- 2008- 2009- 2010- 2011-12 Total 2008 09 10 11 Health Mela @50000 / CHC 3.5 3.85 4.235 4.659 5.124 21.368 IEC @1lakh 1 1.1 1.210 1.331 1.464 6.105 School Eye Screening 1 1.1 1.210 1.331 1.464 6.105 @1000 X100 school Blind Register 0.2 0.220 0.242 0.266 0.293 1.221 Observance of Eye 0.15 0.17 0.190 0.210 0.230 0.95 Donations Cataract Camps @ Rs 20000 3 3.3 3.630 3.993 4.392 18.315 per camp x PHC POL fro Eye Camps @ Rs 0.3 0.33 0.363 0.399 0.439 1.832 2000/camp x PHC 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 VHWSC members 0.2 0.22 0.242 0.266 0.293 1.221 @ Rs 100/head x 200 Repair and purchase of s 2 2.200 2.420 2.662 9.282 equipment and maintenance Total 19.45 12.40 13.64 15.00 16.50 77.00
92 D-6. Integrated Disease Surveillance Program
Situation Integrated Disease Surveillance Programme is to provide essential data to monitor Analysis/ 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 namely Thyroid diseases, Cutaneous Leishmaniosis, Acid Peptic Diseases, Rheumatic Heart Diseases. Surveillance is ineffective due to Number of parallel systems existing under various programs which are not integrated. Programs not covering 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. Unavailability of laboratory infrastructure in the district Presently, surveillance is sometimes reduced to routine data gathering with sporadic response systems thereby leading to slow response to Epidemics, For strengthening the IDSP in district Ramban the following are necessarily required. Establishing of District Surveillance unit. Establishment of Rapid response teams at District levels. Establishment of DSUs (District Surveillance Units) Computers with installed software, provided by the GoI and one data operator and one data manager. Objectives To fully develop the Integrated Disease Surveillance System for Communicable and Non- Communicable disease 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) • Hiring of 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
93 • WEN connectivity to be operationalized • Provision of software of GOI 2. Setting up of Peripheral Surveillance Units at DH 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 sensitization and prompt reporting of cases 4.Improvement in the Laboratories at the district at CHCs through provision of equipment and consumables Support Timely trainings for the Nodal persons required Government Order for involvement of teachers in Disease Surveillance Timeline Activity / Item 2007- 2008- 2009- 2010 2011- 08 2009 2010 - 12 2011 Renovation of Labs with provision of 2CHC CHC
equipment, furnishings, material Ukheral Training x X x x x
Contractual staff 3 3 4 4 x
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 x x x x Chowkidars
94 Budget Activity / Item 2007- 2008- 2009- 2010- 2011- Tota 08 09 10 11 12 l Renovation of Labs at CHCs a@ Rs 0.6 0.2 0.000 0.000 0.000 0.8 20,000 Renovation of Lab at District 0 1.4 0.140 0.180 0.200 1.92 Hospital @ Rs 140,000 and maintenance Equipment for Lab at PSU at CHC 0.8 0.4 0.000 0.000 0.000 1.2 and @ Rs 40,000 Equipment for Lab at District @ Rs 0 8.5 0.000 0.000 0.000 8.5 850,000 Computer and Accessories at CHC 1 0.5 0.000 0.000 0.000 1.5 @50000 Office for PSU at Maintenance 0.2 0.3 0.330 0.363 0.399 1.59 CHC @ Rs 10,000 per unit 23 Office Maintenance for DSU @ Rs 0 0.1 0.100 0.100 0.100 0.4 10,000 Software for DSU@ Rs 335000 0 3.35 0.000 0.000 0.000 3.35 Furnishing of Lab at PSU at CHCs 0.2 0.1 0.000 0.000 0.000 0.3 and @ Rs 10,000 Furnishing of Lab at DSU @ Rs 0 0.6 0.000 0.000 0.000 0.6 60,000 Material and supplies at Lab at PSU 0.16 0.24 0.240 0.240 0.240 1.12 at CHCs @ Rs 8,000 Material and supplies at Lab at DSU 0 0.75 0.75 0.75 0.75 3 @ Rs 75,000 Contract Staff at District level @ 0 2 2.200 2.420 2.662 9.28 200000/yr for 4 staff yr wise 2 IEC activities 1 1.1 1.210 1.330 1.460 6.1 Training and retraining 1.916 2.430 2.673 2.940 3.234 13.1 92 WEN connectivity 0.5 0.55 0.610 0.670 0.730 3.06 Operational costs at PSU for 0.45 0.495 0.545 0.599 0.659 2.74 Surveillance @ Rs 15000/year x 3 7295 Operational costs at DSU for 0 1.300 1.430 1.573 1.730 6.03 Surveillance @ Rs 130000/year 3 Honorarium to Numberdars and 3.432 3.775 4.153 4.568 5.025 20.9 Chowkidars for reporting @ Rs 53 100pm x 143 Numberdars and 143 Chowkidars x12 Total 10.25 28.08 14.38 15.73 17.18 85.6 8 3 4
95 D-7. Iodine Deficiency Disorders Situation Iodine is one of the essential micronutrients. Minimum requirement is 150 microgram per Analysis day. The main source of Iodine is from soil and water. 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 since 1986. There is a ban on the sale on non Iodized salt in J&K.
In district Ramban exact data is not available of Iodine deficiency disorders but as per the medical departments assumption there might be possibility of one –two cases in each village. Objectives/ 1. Prevention of Iodine Deficiency diseases 2. Consumption of Iodized salt by 100% families Strategies 1. Supply/monitor quality of Iodized salt 2. Assessment of the magnitude of the problem 3. Laboratory Monitoring of Iodized salt and urine samples 4. Health Education Activities 1. Supply/monitor quality of Iodized salt • Monitoring is done through Food Inspectors who collect two samples of salt per month per district and send it to a laboratory. • The Health workers have been supplied with Kits to test samples at least five per month. • Review is done in the monthly meetings • Monitoring through School health programme – Testing of samples and awareness • Supply of Testing kits to AWCs, Schools, SHGs 2. Assessment of the magnitude of the problem This will be done by the Central Survey team 3. Laboratory Monitoring of Iodized salt and urine samples The samples are collected by MPHW and sent for analysis . 4. 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, sensitization of shopkeepers for keeping Iodized salt. 5. Testing of salt at shops and homes Support 1. Regular Supply of Testing Kits required 2. Regular Supply of Iodized salt
96 3. Regular supply of IEC material Timeline Activity / Item 07-08 08-09 09-10 10-11 08-2012
Large Village meetings for awareness x x x x X on 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 Awareness programme with the SHGs 143 143 143 143 143 and shopkeepers village village village village villages s s s s
Budget Activity / Item 2007 2008 2009 2010 2008 Total -08 -09 -10 -11 - 2012 Large Village meetings for awareness 1 1.100 1.210 1.331 1.46 6.105 on IDD and consumption of Iodized salt 4 Programme in schools – 100 Primary, 2 2.200 2.420 2.662 2.92 12.21 Upper Primary, Secondary- Govt and 8 0 Private by School health team Awareness programme with the SHGs 0.715 0.787 0.865 0.952 1.04 4.365 and shopkeepers @ Rs 500 per village 7 x 143 villages Total 3.715 4.087 4.495 4.945 5.43 22.68 9 0
97 6. INTER SECTORAL CONVERGENCE
6.1 Partnership with AYUSH department
Issues / Areas Areas of cooperation Areas of convergent action
Curative ; Traditional treatment For outreach and coverage of areas not Patient care, Surveillance, Notification of diseases covered by MOs referral outbreak Joint training in Surveillance Joint meetings Preventive; Immunization, Traditional treatment to Joint planning for BCC Promotive & Prophylaxis increase the immunity services IEC for prevention Specific issues in Participation in Pulse Polio, • District AYUSH Officer to sit in the Implementation of national Family Welfare, school same CMO office premises. programmes Like- health, Malaria, Skin • Joint Review and joint planning -Maternal & Child care diseases • Joint participation and monitoring -Adolescent health Participation in all national • Participation in Fixed Village Health -School Health programmes days -Leprosy • Provision of medicine kits -IDD • DOTS providers -Tuberculosis • Diseases Surveillance -IDSP -HIV / AIDS
6.2 ICDS projects Issues / Areas Areas of cooperation Areas of convergent action There are 323 AWCs in the • Fixed VHD days • Training for counseling clients, district but there is scarcity of • Joint CNAA • Provision of spacing methods including Infant weighing machine, • Common data oral pills, condoms, LAM and SDM examination table. Also there • Common sectors and community mobilization. are not enough medicines • Collecting children and • Convergence of services at the with the AWW. pregnant women grassroots would ensure increasing At the fixed VHD day the the access to and demand for AWWs work closely with the services MPHWF • Provision of Examination table and Infant weighing machine to all AWCs • Joint sector meetings, block and district meetings • DDCs; DOTS providers • Diseases Surveillance
98
6.3 Rural Development Department Issues / Areas Areas of cooperation Areas of convergent action 1. In the district, only a Formation of a Core group at Joint action for electricity and water, number of people are having the gram Panchayat level for Latrines in Health facilities also. sanitary latrines facilities joint action Roads to be developed to the health School Sanitation and IEC are facilities important components of Total Maintenance of buildings through joint Sanitation Campaign. The reviews and plans performance is relatively poor DOTS providers on sanitation Diseases Surveillance 2. Roads, Maintenance of buildings, Electricity and water supply is the domain of the rural development.
6.4 Public Health department Issues / Areas Areas of cooperation Areas of convergent action Provision of safe drinking Safe Water supply to all Provision of GLRs, tanks water. As majority of the households and all health Periodic Chlorination population of district Leh is facilities Health facilities dependent on traditional Ensuring the proper drainage Proper drains to be built source of water. of stagnant water Covering all open drains and puddles of water. Notification of diseases in villages Diseases Surveillance
6.5 PRIs Issues / Areas Areas of cooperation Areas of convergent action The PRIs have been envisaged to play a Motivating the Joint plans very important role in NRHM community Joint review and monitoring At the village level they are part of the Availability of Mobilization of the community for VHWSC.\ personnel and action and fund raising At the Gram Panchayat level they are part services of the Gram Panchayat health committee. Participation in the Similarly at the Block and the District they VHD days are part of the Block and District health Giving importance to mission. issues of health in the At the Subcentre the Sarpanch/ Numbardar Gram Panchayat is the joint signatory to the bank account for meetings
99 the operation of the Untied funds of Rs 10000. In the Gram Panchayat meetings held twice each month the PRIs review the activities of the health department along with the ICDS
6.6 Education Department Issues / Areas Areas of cooperation Areas of convergent action 1. For regular check up of school children Co-operation with health 1. Strengthening of school there should be a provision for a doctor department PHED, RDD, health programme. (physician specialist) & expert team which ICDS department. 2. Promotion of yoga in the will assist the doctor. school. 2. Mid day meal in school is being 3. Launching of Adolescent successfully carried. Cooks are engaged . Health programme 3. The message of balanced diet is not 4. Regular school health being successfully carried out. programmes 4. School health education programme is not taking place regularly. 5. There is no Adolescent Health programme in the district.
100
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 Status 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 will consist members of various departments. Block health societies will be formed and also at the sector, and village level. The Village health and Water Sanitation Committees also consist of various sectors and the community.
These committees need to be formulated and 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 only on the Fixed Village Health Day. This needs to be strengthened and streamlined. The community is not aware regarding this day. The forum of the fixed health day each week has a lot of potential and has not been used properly . Objectives 1. Providing Primary and basic quality health care services at the village level 2. Providing quality RCH services 3. Optimal utilization of RCH services by community especially women 4. Empowering women to facilitate them to seek and demand quality RCH services. Strategies 1. Strengthening the various Committees and Societies 2. Strengthening the VHD days 3. Joint action for various issues Activities 1. Joint workshops for Planning and Review at all levels • Orientation programmes • Monthly meetings 2. Strengthening the VHD days • Wide participation of all the sectors in preparation of the community and in the actual activities, in health education • Each Wednesday during Immunization sessions joint orientations by all sectors and problem solving for each of the sectors 3. Joint Action for Sanitation, provision of safe water, provision of services and personnel at facilities
101 4. Joint review at the Gram Panchayat meetings 5. Joint efforts for education of the girls, improving the sex ratio, raising age of marriage, improving the nutritional status, identifying the correct BPL families, income generation. 6. Joint CNAA to determine the needs and thereby developing the plans jointly 7. Realignment of the Health and the ICDS sectors for common data and common work boundaries. 8. ASHA to participate in all the meetings of the ICDS held twice in 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 12. Chiranjeevi Scheme to involve Public Representatives for promoting safe deliveries for rural BPL women through PPP initiative by involving the private sector Support Govt orders for intersectoral coordination with clear roles and responsibilities and If the required various sectors do not attend the meetings then the decisions will be taken and will be binding for all the sectors. Strict follow-up at the State level for ensuring coordination. Timeline Activity / Item 2007- 2008- 2009- 2010- 2011-12 08 09 10 11 Meetings of the Block Committees x x x x x Meetings of the Village groups x x x x x Joint CNAA training ( 559 AWW, 320 x x x x x ANM, 570 ASHAs, 40 Supervisors, 80 MOs, 7 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 Yearly joint Planning Workshops at x x x x x the Block level for development of the Action Plans Yearly joint Planning Workshops at x x x x x the District level for development of the Action Plans Yearly joint Workshops to consolidate x x x x x the 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 0.36 0.396 0.436 0.479 0.527 2.198 @ Rs 1000 /meeting x 3 blocks x 12 months
102 Meetings of the Village groups @ 1.716 1.888 2.076 2.284 2.512 10.47 Rs 100 per village x 143villages x 6 12 Joint CNAA training @ Rs 200 per 1.56 1.7 1.728 1.744 1.764 8.496 person X780 (AWW, ANMs, ASHAs, Supervisors, MOs, CDPOs) Joint monitoring at the block level Hiring of vehicle @ RS 1000/ day x 1.8 1.98 2.178 2.396 2.635 10.98 5 days/month x 3 blocks x 12 9 months Yearly joint Planning Workshops at 3 3.3 3.63 3.993 4.392 18.31 the Block level for development of 5 the Action Plans @ Rs 1.00 lakhs per block x 3 blocks Yearly joint Planning Workshops at 1 1.1 1.21 1.331 1.464 6.105 the District level for development of the Action Plans @ Rs 1.00 lakh Yearly joint Workshops to 3 3.3 3.63 3.993 4.392 18.31 consolidate the plans from the 5 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 3blocks 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 Chiranjeevi Scheme for PPP 24 44 44 44 44.00 200.0 0 00 Total 37.43 58.76 60.09 61.55 63.15 281.0 6 3 8 1 2 00
103 7. COMMUNITY ACTION PLAN
Community Health Action Situation • Constitution of 143 Village Health and Sanitation Committees in three Analysis/ Current medical blocks by the concerned Block Medical Officers in consultation Status with District Rural Health Society. Each committee comprises of Concerned ANM, AWW and Village Representatives (Nambardar etc) • As per CMO , Doda data till August 07 ,there was plan for three meetings but not held • Training of these committee members has not been taken up. • Because of prevailing circumstances PRIs could not be involved. The said committees have facilitated the process of selection of ASHAs and are actively involved in utilization in untied funds ear marked for subcentres. • The members have not been trained so far through the core trainers at district level although the block trainers have received training. • Meetings are not held regularly under the current scenario. • The village health registers have not been prepared by the concerned ANMs though village health days are being conducted by concerned medical officers. Objectives Ensuring availability of quality health services to the community Motivating the community for good health seeking behaviour Strategies Formation and Strengthening the VHWSC and the Gram Panchayat meetings Monitoring the progress of the Village health Action Plan and also the village morbidity and mortality Activities 1. Facilitation of the process with the support of an external agency 2. Trainings of the VHWSC 3. Regular meetings of the committee, twice a month, shall be held. 4. Regular meetings with the SHGs and formation of Emergency Fund through the collections. Also developing a microplan for the Women SHG 5. Local Gram Panchayat shall review the functioning of VHSC Based on village plans, sub-centre action plan shall be formulated. 6. Joint CNA and development of the Village health register by ANM assisted by ASHA and AWW 7. Tour plan of ANM to be shared with local Gram Panchayat
104 8. 9. Verbal autopsy for Maternal and Child deaths by the members for each mortality 10. District level team to support household survey and survey of health facilities Support 1. District Collector/DDC to ensure that meetings of Gram Panchayats are held required and to review what issues of health are being discussed . 2. State officials to provide the capacity building of the District officials for village health action 3. State to develop the training module for the members of VHSC and also the TOTs Timeline Activity / Item 2007- 2008- 2009- 2010- 2011-12 08 09 10 11 Formation of Block Committees x Orientation of Committee members x at all 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- 2010- 2008- Total 08 09 10 11 12 Training of the VHWSC @ Rs 4.29 4.719 5.191 5.710 6.281 11.472 200 per person x 15 persons/village x143villages Meetings of the VHWSC @ Rs 0.858 0.9438 1.038 1.142 1.256 2.294 50 per village x 143 villages x 12 months Meetings of Women Groups @ 0.143 0.1573 0.173 0.190 0.209 0.382 Rs 100 per year x143villages Honorarium for MOs for 6.48 7.128 7.841 8.625 9.487 17.328 promoting Community health Action @ Rs 1000 pm and travel charges Rs 800 pm Total 11.771 12.948 14.24 15.667 17.23 71.863 3 4
105
8. PUBLIC PRIVATE PARTNERSHIP
Public Private Partnerships Situation The concept of public private partnership is very new for the district Ramban, still no Analysis activity has been done under this program.
The PPP is going to be tried on pilot basis only there is no mother NGO and SNGO identified yet under RCH scheme. Objectives To initiate innovative pilot interventions on priority issues to be addressed under PPP. To develop the capacity of RKS members and private partners eg NGOs, CBO, Pvt health care providers' etc. Strategies Incentives and training to encourage private providers to provide sterilization services Activities Involve private players including NGOs/Trusts by providing a conducive environment for accessing quality and affordable health care services to the community. Partnership for Services for Training: Lot of capacity building activities are envisaged under NRHM, but departments neither have that much of expertise nor sufficient time to carry out the capacity building activities properly. Therefore, all such training programme will be outsourced to a capable agency selected by the DHS. Partnership for Services for IEC: For implementing and managing IEC activities (mela, shows, campaign, rally, Village Contact Drives etc) including designing and printing of IEC material, a technical and Technical Support Agency will be hired. Partnership for Services for Transportation: One agency will be hired for getting services of vehicles with drivers for field monitoring by the officers at District and below level, for transportation of drugs, equipment, linen and others up to the Sub Centre level. Drivers for department’s vehicles and ambulances will also be hired from such agency. Annual contract will be done for this purpose.
This kind of partnership will much effective for the unreached and far flung areas where there no motorable roads available. Alternate transport like Mules can be hired from the private sector. Partnership for Services for conducting Studies, survey and evaluations: For understanding the trends of diseases, impact of programs being implemented, assessing the health scenario, a technical support agency will be 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
106 organizations especially local NGOs will be involved. Partnership for Security: As Doda district (Ramban) is affected with the militancy, security of health personals and institutions is a major concern of the district. For providing security to all PHCs 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 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 required formulating a workable PPP Policy.
Timeline All the activities will be initiated in the year 07-08 and will carry on through out the mission period.
107 Budget Activity / Item 2007 2008 2009- 2010- 2011- Total -08 -09 10 11 12 Feasibility study on PPP issues 10 0 0.000 0.000 0.000 10 Innovative activities based on the 0 20 20.00 20.000 20.00 80 study 0 0 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 Feasibility study on PPP issues 10 0 0.000 0.000 0.000 10 5 Workshops for involvement of 2.5 0 0 0 0 2.5 the Private sectors (one each with NGOs/Trusts/Private institutions; Media; Ex-servicemen association, transportation ,HR agencies) @ 25000 per workshop Sharing Workshops with Private 0 0.55 0.61 0.67 0.74 2.57 players Admin and overhead Charges for 2 2.2 2.42 2.67 3 12.29 hiring the agencies TOTAL 30 27.7 28.97 29.33 30.8 146.83
108
9. GENDER AND EQUITY
Gender and Equity Situation Gender discrimination is a common phenomenon. It has a direct bearing on the Analysis health status of women and children. Some of the parameters are the Sex Ratio, Age at marriage, enrolment of girls in schools, Male sterilization etc. Gender Based Violence, 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. Objectives To improve the decline in sex ratio in 0-6 years of age group. To reduce the domestic violence. To empower women in all age groups for gender equity. Increasing male involvement in RCH activities Strategies To enhances male participation in ensuring the gender balance and equity in the community. 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. To ensure implementations of PC-PNDT and MTP act in the district. To establish strong mechanism for monitoring of sex ratio and implementations of various acts to ensure gender balance and equity in the society. To control explosion of population. To prevent child marriage female infanticide genders based violence and keep in tune the sex ratio. To conduct health check ups in schools monthly. Activities 1. Addressing Adverse Sex ratio • Workshops with private providers, IMA members, Religious leaders, Caste leaders, PRIs, MLAs • Early registration of pregnancies • Educational activities in all schools and colleges and generating discussions in schools and colleges through debates • Regular meetings of the Appropriate Authorities • Registration of all Ultrasonography machines • Review of the monthly format to be filled by the Ultrasonography machines
109 providers 2. Increasing male involvement in family planning • Use of condoms for safe sex • Couple Counseling for contraceptive choices • Counselling for planned parenthood • BCC activities to focus on men for Vasectomy. Service delivery sites for male methods by training health providers in NSV and conventional vasectomy will be expanded so that each CHC and Block PHC in the district has at least a provider trained in NSV. • Demand for male contraceptive methods, men’s reproductive health services through designing and implementing male-focused BCC activities. 3. Gender sensitization training for all health providers in the CHC/PHC/SC and integrated into all other training activities. 4. Increasing the age of marriage • IEC activities for the harmful effects of early marriage • Registration of marriages • All the printing press people who print wedding cards should send one card to the CMO’s office 5. Health card would be provided to all girl children upto the age of 18 years. 6. Improving the Literacy status and promotion of education upto 10 th standard. 7. The Panchayats shall be granted incentives for ensuring 100 % enrolment of girls in the age group of 6-14 years in schools. 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 Support Govt. directives to other deptt. for collaboration required Budgetary provisions Timeline 2007- 2008- 2009- 2010- 2008 2009 2010 2012 Workshops with all stakeholders x x x x
Incentives for early registration of x x x x Pregnancy Promoting male involvement through x x x x Vasectomy IEC for Vasectomy x x x x Health Card for girl Child x Advisory group meetings x x x x
110 Budget Activity / Item 2007- 2008- 2009- 2010- 2011- Total 08 09 10 11 12 Orientation and sensitization programmes 10 11 12.1 13.3 14.6 61 Media workshops 2 2.2 2.4 2.7 2.9 12.2 Incentives for early registration of pregnancies @Rs 50 x 6100 3.05 3.38 3.718 4.09 4.498 18.736 Monitoring and supervision 2 2.2 2.4 2.7 2.9 12.2 Health cards for girl [email protected]*No. of pregnancies 0.12 0.14 0.15 0.16 0.18 0.75 IEC campaigns 5 5.5 6.1 6.7 7.3 30.6 TOTAL 26.86 32.37 22.17 24.42 8 29.65 8 135.486
111 10. CAPACITY BUILDING
Capacity Building
Status Training is an essential part of human development. Although the personnel have the basic skills necessary for carrying out their duties there is a need to upgrade the skills as well as to keep pace with the new developments under NRHM. There is a skill gap for managing safe deliveries, Abortions, Newborn Care, managing Childhood illnesses, Obstetric and Paediatric emergencies, morbidity and epidemics. There is no system for continuing education of the personnel.
The management skills are also lacking resulting in poor management of programmes including financial management.
Most of the personnel are unable to use computers and internet. 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 specialists leave very rapidly since the payment to the specialists is very low as compared to Delhi and Punjab.
The staff who have received trainings are not placed in the facilities where they can utilize their skills. The monitoring of the trainings is not done hence the quality of trainings is in question. Also there is no monitoring of the work output of the personnel for which they have received the trainings.
162 ASHAs have been trained.
Some of the skill birth attendants are already trained and rest are required training in plan period Objective Reduction in the MMR and IMR from 310 and 42 to 25 respectively by 2015 Fully skilled personnel at all levels in the Health sector, ICDS, PRIs, NGOs and private sector for provision of services Strategy 1. Development of training plan and methodology for all the personnel on
112 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 Activity 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. In 2007, 10 Lady MOs will be trained. Refresher trainings on MVA to be given • Training in Obstetric management & skills for Operationalization of 24x7 PHCs 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 PHCs • Integrated skill training for Urban Medical Officers for 12 days at Jammu Medical College • Training on Blood transfusion for MOs and Lab Technicians for CEmOC centres with Blood storage facilities for 3 days • Training in Life saving/Anaesthesia for EmOC at FRUs for MOs for 18 weeks • Integrated skill training of all SN • Integrated skill training for ANMs • Training of ASHAs • Training in management of newborns and sick children at Medical College Jammu of the MOs, SN, • Training in BCC for MOs, LHVs, ANMs • 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 ANMs & LHVs for 5 days • Orientation on contraceptive devices for MOs of Govt facilities as well as private facilities
113 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, SMOs 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, LHVs, ANMs, 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 for 10 days • Convergence for Sanitation and hygiene under NRHM • One day orientations of VHWSCs for total sanitation Disease Control Programme – Blindness Control, Malaria, IDSP, IDDM • MPW • LT training PRIs • Training on NRHM and their roles of the members of the Zila Parishad, Panchayat Samitis, Gram Panchayat members, VHWSCs for 1 day NGOs • Training in BCC • Training of Field NGOs
114 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. State • RIHFW to develop the training calendar and organize the trainings as per Support schedule • Medical colleges to be prepared for providing trainings on EmOC, MTP, Neonatal Care • Monitoring by the State the quality of trainings and the work output through the development of a format and checklist • Placement of the personnel trained in various specialized issues at the right facilities • Ensuring staff at the District training centre Activities Activity 2007-08 2008 –09 2009-10 2010-11 2011- 12 TBA training x x x x x MVA MTP training to all 30 30 PHC MOs for 15 days Training on Blood 3MO 1MO transfusion for MOs and 5 LT 1 LT Lab Technicians for CEmOC centres with Blood storage facilities for 3 days Training in Obstetric 6 MOs 6 MOs 6 MOs 6 MOs 6 management & skills for 6 SN 6 SN 6 SN 6 SN MOs
115 24x7 PHCs for 16 weeks 6 SN Training in skilled Birth 5Batch 5Batch 5Batch 5Batch 5Batc attendants for 15 days: h IMNCI training to 15ANMs 15ANMs 16ANMs 16ANMs 16AN ANM/LHV, SN, ASHA for 15SN 15 SN 15 SN 15SN Ms 8 days 40 ASHA 50 ASHA 60ASHA 60ASHA 15 SN 5 LHV 5 LHV 5 LHV 34AS HA
IMNCI training to MOs 15MOs 15 MOs Integrated skill training 6 MOs 6 MOs 6 MOs 6 MOs 6 for MOs MOs Training of MOs, SN in 3MOs 3MOs 3MOs 3MOs 3MOs Mgt of Newborns & sick 3 SN 3 SN 3 SN 3 SN 3 SN children at Medical College Jammu / Srinagar for 15 days Training in BCC for MOs, 30MOs 30MOs All LHVs, ANMs for 5 days 15 LHV 15 LHV MOs, 30ANM 40 ANM LHV and ANM Training of Ayush 15 Ayush 15 Ayush 15 15 personnel on issues of Ayush Ayush RCH and reporting for 3 days Training on NSV for MOs 8MOs 8 MOs 8MOs 8 MOs at NSV camps Training on Minilap - 8MOs 12 MOs 10 MOs Training for Laproscopic 5 S/MO 5 S/MO 5 S/MO 5 S/MO Sterilization for 5 SN 5 SN 5 SN 5 SN Surgeons, 5 OT 5 OT 5 OT 5 OT Gynaecologists, SN, OT attendant attendant attendan attendan attendants for 12 days t t Orientation on 42 42 42 42 42 contraceptive devices for MOs Training on Medico-legal 42 MOs & 42 MOs & 42 MOs 42 MOs 42 aspects to MOs 5SMOs 5SMOs & & MOs 5SMOs 5SMOs & 5SM Os Orientation on PCPNDT X x x x x Act for DCs, CSs, doctors both Govt and private, members of
116 District Appropriate authority NGOs in a workshop General & Financial rules 50Distt 50Distt 50Distt 50Distt 50Dis (G & FR) for Officials, officials officials officials officials tt MOs, clerical staff for 3 and MOs and MOs and and officia days 50 Clerks 50 Clerks MOs MOs ls and 50 50 MOs Clerks Clerks 50 Clerk s Financial management 20 20 20 20 20 training for Accounts Persons Persons Persons Persons Perso Officers, Accountants for 2 days ns Computer training to all 42 MOs the MOs, Clerical staff, and 18 accounts personnel @ Rs 200 per person x 15 Office staff days CNAA for MOs, LHVs, 535 591 595 599 601 ANMs, AWW Total sanitation orientation and reorientation of VHWSCs 143 x 1 day @ Rs 143 143 143 143 villag 200/person/day villages villages villages villages es Training of NGOs in BCC 30 30 30 30 30 @ Rs 300 per person x 6 Persons Persons Persons Persons Perso days ns MDP for DPM,BPM, 1DPM 1DPM From State Senior district officials, 3 BPM 3 BPM Budget SMOs for 10 weeks 5 SMO 6SMO Training in Life 0 2 MOs 4 MOs 4 MOs 6 Mos saving/Anaesthesia for From State Budget EmOC at FRUs for MOs for 18 weeks Budget Activity 2007-08 2008– 2009- 2010- 2011- Total 09 10 11 12 TBA training @ Rs 10100 14.443 15.887 17.476 19.224 21.146 88.176 /TBA 3 MVA MTP training to all 2.25 2.25 0.000 0.000 0.000 4.500 PHC MOs for 15 days @ Rs 500 x 15 days x MOs Training on Blood 0.000 transfusion for MOs and Lab Technicians for CEmOC centres with Blood storage facilities for 3 days
117 MOs @ Rs 500/day/person 0.045 0.015 0.000 0.000 0.000 0.060 x 3 days Lab Technicians @Rs 0.03 0.006 0.000 0.000 0.000 0.036 200/person x 3 days Training in Obstetric 0.000 management & skills for 24x7 PHCs for 16 weeks MOs: Rs 500/day x 112 3.36 3.36 3.36 3.36 3.36 16.800 days x 2 MOs StaffNurses:Rs200/dayx112 1.344 1.344 1.344 1.344 1.344 6.720 daysx 2 SNs Training in skilled Birth 0 0.000 0.000 0.000 0.000 attendants for 15 days: One batch of 4 persons: Rs. 5 5 5 5 5 25.000 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 1.8 2.04 2.304 2.184 1.56 9.888 participant x 8 days IMNCI training to MOs @ 0.8085 0.889 0 0.000 0.000 1.698 Rs 5390 /participant Integrated skill training for 0.22098 0.243 0.267 0.294 0.324 1.349 MOs @ Rs 3683 Training of MOs, SN in Mgt 0.36 0.396 0.436 0.479 0.527 2.198 of Newborns & sick children at Medical College Jammu @ Rs 7500/MO, Rs 4500 ( Rs 300 x 15 days)/SN Training in BCC for MOs, 1.425 1.7175 0.000 2.1 0 5.243 LHVs, ANMs MOs: Rs 500/MO x 5 days 0.000 LHVs & ANMs: Rs 0.000 300/person x 5 days Training of Ayush personnel 0.135 0.1485 0.163 0.180 0.198 0.824 on issues of RCH and reporting for 3 days Rs 300/person x 3 days 0.000 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 0.000 camps, Rs 3000 per camp for 0.000 trainer x 12 camps Training on Minilap @ Rs 0 1.2 1.8 1.5 0.000 4.500 500 per day for 15 days and during camps Training for Laproscopic 0.6 0.66 0.726 0.799 0.000 2.785 Sterilization for Surgeons, Gynaecologists, SN, OT attendants for 12 days Specialist: Rs 0.000
118 500/Specialist x 12 days SN: Rs 300/SN x 12 days 0.000 OT Attendant: Rs 200 x 12 0.000 days Orientation on contraceptive 0.21 0.231 0.254 0.280 0.307 1.282 devices for MOs - Govt as well as private facilities Rs 500 /MO x 1 day 0.000 Training on Medico-legal 0.235 0.0055 0.006 0.007 0.007 0.261 aspects to MOs @ Rs 500/MO x 1 day 0.000 Orientation on PCPNDT Act 0.5 0.55 0.605 0.666 0.732 3.053 for, doctors both Govt and private, members of District Appropriate authority NGOs in a workshop General & Financial rules 1.05 1.155 1.271 1.398 1.537 6.410 (G & FR) for Officials, MOs, clerical staff for 3 days Rs 500/official and MOs x 3 0.000 days Rs 200 /clerical staff x 3 0.000 days Financial management 0.08 0.088 0.097 0.106 0.117 0.488 training for Accounts Officers, Accountants for 2 days Rs 200/Accounts persons x 0.000 2 days Computer training to all the 1.8 0.99 0.000 0.000 0.000 2.790 MOs, Clerical staff, accounts personnel @ Rs 200 per person x 15 days CNAA for MOs, LHVs, 1.07 1.182 1.19 1.198 1.202 5.842 ANMs, AWW @ Rs 200/person x 1 day 0.000 each year Total sanitation orientation 0.286 0.3146 0.346 0.381 0.419 1.746 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 38.01248 40.728 37.806 41.775 39.186 197.50 82
119 11. HUMAN RESOURCE PLAN
Human Resource Plan Situation The personnel have necessary basic skills for carrying out their duties; there is a need to Analysis 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 Pediatric 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. 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.
162 No. ASHAs in district Ramban are already in place more 431. ASHAs including imposition will be required far-flung areas where out of govt services is seriously effected needs to have more skilled birth attendants, some have been already trained but still there are some uncovered areas.
There are 18 ANMs working in 47 sub centers which is showing a big gap similarly PHCs and CHCs are also showing the same problem. More as per population records more institutions are needed to be opened in the project period so it needs additional ANMs.
Many areas, which are uncovered pocket, need medical mobile unit.
Gap analysis of PHCs and CHCs is shown in the facility survey.
District Hospital is no where in existence and it requires whole staff.
Similarly the district level officers for the new district are yet not in position.
DPMU also to be in position in District Ramban form next financial year. Objectives To equip health system with adequate manpower especially as per IPHS to meet the Benchmarks
120 NRHM goals. Strategies Ensuring the quality of trainings To induct new ASHAs as per requirement one ASHA/ 500 population. To recent and trained specialists, Mos, Staff nurse, ANMs and other persons identified in gap analysis. 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
Activities Ensuring the quality of trainings To induct new ASHAs as per requirement. To recent and trained specialists, MOs, Staff nurse, ANMs and other persons identified in gap analysis. 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 Support The State must approve and give sanctions for the necessary personnel for each facility required before actually starting the facilities. Contractual staff should be allowed recruitment as and when required. Permission from State should not be taken each time. Timeline Activity / Curren 2007 2008 2009 2010 2011 20 20 20 2010 2011- Item t -08 -09 -10 -11 -12 07- 08- 09- -11 12 Status 08 09 10 Total requirements(IPHS Norms) Additional requirement - Contractual Subcentr e 47 70 72 74 76 78 23 25 27 29 31
ANM 12 12 18 140 144 148 152 156 130 134 138 2 6 MPW(M) 0 70 72 74 76 78 70 72 74 76 78 PHC 15 15 15 15 15 15 0 0 0 0 0 MO 11 30 30 30 30 30 19 19 19 19 19 Staff Nurse 4 45 45 45 45 45 41 41 41 41 41
Health worker (F) 8 15 15 15 15 15 7 7 7 7 7
Health Educator 2 15 15 15 15 15 13 13 13 13 13
Health Assistant 0 30 30 30 30 30 30 30 30 30 30
Clerk 5 15 15 15 15 15 10 10 10 10 10
121 Pharmacis t 11 15 15 15 15 15 4 4 4 4 4
Lab.Tech 4 15 15 15 15 15 11 11 11 11 11 Class IV 20 60 60 60 60 60 40 40 40 40 40 CHC 3 3 3 3 3 3 0 0 0 0 0 Specialist 8 21 21 21 21 21 13 13 13 13 13 MO 12 12 12 12 12 5 5 5 5 5 General Duty 7 PHN 0 3 3 3 3 3 3 3 3 3 3 ANM 2 3 3 3 3 3 1 1 1 1 1 SN 11 21 21 21 21 21 10 10 10 10 10 Dresser 2 3 3 3 3 3 1 1 1 1 1 Pharmacis 12 3 3 3 3 3 -9 -9 -9 -9 -9 t
Lab. Tech 3 3 3 3 3 3 0 0 0 0 0 Radiograp 0 3 3 3 3 3 3 3 3 3 3 her
Ophthalmi 2 3 3 3 3 3 1 1 1 1 1 c Assistant
Class IV 38 24 24 24 24 24 -14 -14 -14 -14 -14 Statistical 0 3 3 3 3 3 3 3 3 3 3 Assistant
Registratio 0 3 3 3 3 3 3 3 3 3 3 n clerk
Accountan 0 3 3 3 3 3 3 3 3 3 3 t
Epidemiol 0 3 3 3 3 3 3 3 3 3 3 ogist
BEE 0 3 3 3 3 3 3 3 3 3 3
Budget Activity / Item 2007- 2008- 2009- 2010-11 2011-12 Total 08 09 10 Subcentre ANM 166.2 171. 177.19 182.642 188.094 885.95 86 738 MPW(M) 83.16 85.5 87.912 90.288 92.664 439.56 36 PHC MO 59.88 59.8 59.888 59.888 59.888 299.44 8 88 Staff Nurse 63.01 63.0 63.017 63.017 63.017 315.085 7 17 Health worker (F) 10.75 10.7 10.759 10.759 10.759 53.795 9 59 Health Educator 19.98 19.9 19.981 19.981 19.981 99.905
122 1 81 Health Assistant 51.33 51.3 51.33 51.33 51.33 256.65 3 Clerk 11.88 11.8 11.88 11.88 11.88 59.4 8 Pharmacist 6.12 6.12 6.12 6.12 6.12 30.6 Lab.Tech 13.06 13.0 13.068 13.068 13.068 65.34 8 68 Class IV 28.8 28.8 28.8 28.8 28.8 144 CHC Specialist 47.97 47.9 47.97 47.97 47.97 239.85 7 MO s 15.76 15.7 15.76 15.76 15.76 78.8 6 PHN 5.136 5.13 5.136 5.136 5.136 25.68 6 ANM 1.188 1.18 1.188 1.188 1.188 5.94 8 SN 15.37 15.3 15.37 15.37 15.37 76.85 7 Dresser 0.69 0.69 0.69 0.69 0.69 3.45 Lab. Tech 0 0 0 0 0 0 Radiographer 3.564 3.56 3.564 3.564 3.564 17.82 4 Ophthalmic 1.188 1.18 1.188 1.188 1.188 5.94 Assistant 8 Statistical 3.564 3.56 3.564 3.564 3.564 17.82 Assistant 4 Registration clerk 3.564 3.56 3.564 3.564 3.564 17.82 4 Accountant 5.79 5.79 5.79 5.79 5.79 28.95 Epidemiologist 8.25 8.25 8.25 8.25 8.25 41.25 BEE 4.59 4.59 4.59 4.59 4.59 22.95 DH Hospital Superintendent 3.69 3.69 3.69 3.69 3.69 18.45 11.0 11.07 11.07 11.07 11.07 55.35 Medical Specialist 7 Surgery Specialists 7.38 7.38 7.38 7.38 7.38 36.9 14.7 16 16 14.76 14.76 76.28 O&G specialist 6 Psychiatrist 3.69 3.69 3.69 3.69 3.69 18.45 Dermatologist / Venereologist 3.69 3.69 3.69 3.69 3.69 18.45 Paediatrician 7.38 7.38 7.38 7.38 7.38 36.9 Anesthetist (Regular / trained) 7.38 7.38 7.38 7.38 7.38 36.9 ENT Surgeon 3.69 3.69 3.69 3.69 3.69 18.45 Opthalmologist 3.69 3.69 3.69 3.69 3.69 18.45 Radiologist 3.69 3.69 3.69 3.69 3.69 18.45 Microbiologist 3.69 3.69 3.69 3.69 3.69 18.45 Casualty Doctors / General Duty 18.9 18.91 18.912 18.912 18.912 94.56 Doctors 12 2 3.15 3.152 3.152 3.152 3.152 15.76 Dental Surgeon 2 Forensic Expert 3.69 3.69 3.69 3.69 3.69 18.45
123 Public Health Manager1 3.69 3.69 3.69 3.69 3.69 18.45 AYUSH Physician2 7.38 7.38 7.38 7.38 7.38 36.9 Pathologists 7.38 7.38 7.38 7.38 7.38 36.9 Paramedical Staff Nurse* 0 236.4 236.4 236.4 236.4 945.6 Hospital worker (OP/ward +OT+ 63.0 63.04 63.04 63.04 63.04 315.2 blood bank) 4 Ophthalmic Assistant / 23.0 23.05 23.055 23.055 23.055 115.27 Refractionist 55 5 5 1.53 1.537 1.537 1.537 1.537 7.685 Social Worker / Counsellor 7 1.71 1.711 1.711 1.711 1.711 8.555 Cytotechnician 1 ECG Technician 0.92 0.92 0.92 0.92 0.92 4.6 ECHO Technician 1.53 1.53 1.53 1.53 1.53 7.65 1.18 1.188 1.188 1.188 1.188 5.94 Audiometrician 8 Laboratory Technician ( Lab + 0.72 0.72 0.72 0.72 0.72 3.6 Blood Bank) Laboratory Attendant (Hospital 0 37.82 37.824 37.824 37.824 151.29 Worker) 4 6 3.15 3.152 3.152 3.152 3.152 15.76 Dietician 2 9.22 9.222 9.222 9.222 9.222 46.11 Maternity assistant (ANM) 2 2.37 2.376 2.376 2.376 2.376 11.88 Radiographer 6 3.07 3.074 3.074 3.074 3.074 15.37 Dark Room Assistant 4 Pharmacist1 7.65 7.65 7.65 7.65 7.65 38.25 1.18 1.188 1.188 1.188 1.188 5.94 Matron 8 Assistant Matron 3.06 3.06 3.06 3.06 3.06 15.3 1.18 1.188 1.188 1.188 1.188 5.94 Physiotherapist 8 1.53 1.537 1.537 1.537 1.537 7.685 Statistical Assistant 7 Medical Records Officer / 1.18 1.188 1.188 1.188 1.188 5.94 Technician 8 1.53 1.537 1.537 1.537 1.537 7.685 Electrician 7 1.53 1.537 1.537 1.537 1.537 7.685 Plumber 7 Administrative Staff 1.53 1.537 1.537 1.537 1.537 7.685 Junior Administrative Officer 7 1.71 1.711 1.711 1.711 1.711 8.555 Office Superintendent 1 2.37 2.376 2.376 2.376 2.376 11.88 Assistant 6 2.37 2.376 2.376 2.376 2.376 11.88 Junior Assistant / Typist 6 Accountant 3.86 3.86 3.86 3.86 3.86 19.3
124 Record Clerk 0.72 0.72 0.72 0.72 0.72 3.6 1.18 1.188 1.188 1.188 1.188 5.94 Office Assistant 8 1.18 1.188 1.188 1.188 1.188 5.94 Computer Operator 8 3.07 3.074 3.074 3.074 3.074 15.37 Driver 4 3.07 3.074 3.074 3.074 3.074 15.37 Peon 4 3.07 3.074 3.074 3.074 3.074 15.37 Security Staff* 4 Operation Theatre 10.6 10.69 10.692 10.692 10.692 53.46 Staff Nurse 92 2 7.12 7.128 7.128 7.128 7.128 35.64 OT Assistant 8 Sweeper 2.88 2.88 2.88 2.88 2.88 14.4 Blood Bank 4.75 4.752 4.752 4.752 4.752 19.008 Staff Nurse 2 2.37 2.376 2.376 2.376 2.376 11.88 MNA / FNA 6 1.18 1.188 1.188 1.188 1.188 5.94 Lab Technician 8 Safai Karamchari 0.72 0.72 0.72 0.72 0.72 3.6 Total 933. 1216. 1224.3 1230.9 1238.7 5839.1 241 533 61 49 77 09
125 12. PROCUREMENT AND LOGISTICS
Procurement and Logistics Situation Majority of equipment, drugs and supplies are made available on requisition from State Analysis/ Govt and GoI. Current Status Currently there is no warehouse facility for storage of medicines, contraceptive and cold chain storage of vaccines. One warehouse is needed at district headquarter of Ramban including the facility of cold chain.
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. Most of the supplies stored in District Doda’s ware house. Record Keeping is done manually.
For proper inventory system and management proper human resources also needed. Objectives Development of a Scientific Warehouse system by 2008 Strategies 1. Developing a Warehouse 2. Capacity building of the personnel for stores and also record keeping 3. Computerization of all the stocks Activities 1. Construction of a scientific Warehouse 2. Procurement of software and computer hardware for the Warehouse from TNMSC 3. Proper Equipment and hardware 4. Availability of Pharmacist, Assistant Pharmacist, Packers 5. Training of personnel 6. Appointment of an agency for Operationalization of the Scientific Warehouse Support State to develop a scientific and transparent Procurement, Logistics and Warehousing required system with quality control Timeline Activity / Item 2007 2008- 2009 2010 2011 2006-07 -08 09 -10 -11 -12 Construction of Warehouse x Software x Computer system with UPS, Printer, x Scanner, Equipment & Hardware x Pharmacist x x x x Assistant Pharmacist x x x x Packers -2 x x x x Security Staff x x x x Training of personnel x x x x Consultancy to agency for x x Operationalization of the Warehouse
126 Budget Activity / Item 2007-08 2008-09 2009-10 2010-11 2011-12 Total Construction of 100 0 0.000 0.000 0.000 100 Warehouse Software 1 0 0.000 0.000 0.000 1 Computer system with 0.6 0 0.000 0.000 0.000 0.6 UPS, Printer, Scanner, Equipment & 34.5 0 0.000 0.000 0.000 34.5 Hardware Pharmacist @ Rs 0 1.08 1.190 1.310 1.440 5.02 9000/mth Assistant Pharmacist 0 0.6 0.660 0.726 0.799 2.785 @ Rs 5000/mth Packers -2 @ Rs 0 0.96 1.056 1.162 1.278 4.456 4000/mthx2 Security Staff @ Rs 0 0.72 0.792 0.871 0.968 3.351 6000/mth Training of personnel 0 0.1 0.110 0.121 0.133 0.464 Consultancy to agency 2 2.1 0.000 0.000 0.000 4.1 for Operationalization of the Warehouse Total 138.1 5.56 3.808 4.190 4.618 156.276
127 13. DEMAND GENERATION - IEC
IEC Status There is lack of awareness and good practices amongst the community due to which they neither avail the services nor take any positive action. There is lack of awareness regarding the services, schemes including the Fixed Village Health days.
The following issues need special focus: • Spacing methods, ideal interval between births, no scalpel vasectomy, information about FP facilities and MTP facilities available at different levels • Importance of 3 visits for ANC, advantages of institutional delivery, Post natal care, availability of skilled birth attendants, balanced diet during pregnancy, anaemia, misgivings about IFA, kitchen garden • Importance of complete immunization, disadvantages of drop outs, nutritional requirements of infants and children, malnutrition, exclusive breastfeeding • Problems of adolescents, drugs addiction, malnutrition, problems of sexuality, age at marriage, tendency to take risks in sexual matters • DOTS programme for TB, location of microscopy centres, cardinal symptoms of TB, • High risk behaviour in the community in relation to water born diseases, heart diseases and lung diseases, and HIV/AIDS, STDs • Ill effects of drugs addiction affecting adolescents, • High prevalence of RTIs, including STDs, • Issues of malaria spread and prevention and also other diseases • JSY, Fixed Health days , availability of services The personnel have had no training on Interpersonal communication. Objective Widespread awareness regarding the good health practices Knowledge on the schemes, Availability of services Strategy 1. Information Dissemination through various media, 2. Interpersonal Communication 3. Promoting Behaviour change Activity 1. Awareness on • Fixed VHD days • JSY • Services available 2. Designing of BCC messages on exclusive breast feeding and complimentary feeding, ANC, Delivery, PNC, FP, Care of the Newborn, Gender, male involvement in the local language
128 3. Consistent and appropriate messages on electronic media – TV, radio 4. Use of the Folk media, Advertisements, hoardings on highways and at prominent sites 5. Training of ASHA/AWW/ANM on Interpersonal communication and counselling on various issues related to maternal and Child health 6. Display of the referral centres and relevant telephone numbers in a prominent place in the village 7. Promoting inter-personal communication by health and nutrition functionaries during the Village Health days 8. Orientation and training of all frontline government functionaries 9. Integration of these messages within the school curriculum 10. Kit for the newly married and during first pregnancy to be given at the time of marriage and during pregnancy 11. Mothers meeting to be held every month to address issues and for community action 12. Kishore Kishori groups to be formed in each village 13. Meetings of adult males to be held in each village to discuss issues related to males in each village every month and for community action. 14. Village Contact Drives and providing services, drugs, one to one counselling and talks with the Village Health & Water Sanitation Committee and the Mother’s groups. 15. quarterly 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. 16. Bal Nutrition Melas 4 times at each Subcentre 17. Wall writings 18. 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 Folk Media shows x x x x x Hoardings on highways x x x x x and prominent places Display boards x x x x x Pamphlets x x x x x Orientation & training of all x frontline govt functionaries and elected representatives
129 VCD in each village x x x x x quarterly 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 Budget Activities 2007- 2008- 2009- 2010- 2011- 08 09 10 11 12 Total Hiring of an agency for carrying 40 44 48.40 53.240 145.6 331.28 out the intensive IEC and 0 40 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 18.20 41.41 5 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 0.143 0.157 0.173 0.190 0.521 1.18 2000/vill 3 Hoardings @ Rs 10000/hoarding 10 11 12.10 13.310 36.41 82.82 0 0 Display boards @ Rs 1.8 1.98 2.178 2.396 6.554 14.90 2000/board Pamphlets @ Rs 10/pamphlets 10 11 12.10 13.310 36.41 82.82 x 100000 0 0 Orientation of Community key 4 4.4 4.840 5.324 14.56 33.12 persons / PRIs@ Rs 200 x 2000 4 persons x1 day Village campaign @ Rs 69.132 38.68 42.54 46.80 51.483 140.8 320.34 lakhs per Campaign / Per year 8 3 34 Bal Nutrition Melas @ Rs 300 x 4.2 4.824 5.306 5.8370 6.420 26.58 4 times x AWCs 4 4 744 Kishori Shakti meetings @ Rs 0.143 0.157 0.173 0.190 0.521 1.184 100 per group x 143 villages 3 Community and religious leaders 1.2 1.32 1.452 1.597 4.369 9.938 workshops @ Rs 300 /person x 100 x 4 times Wall writings @ Rs 500 x 143 0.715 0.786 0.865 0.952 2.603 5.9216 villages 5 Total 118.88 130.9 144.0 158.47 423.9 976.37 7 7 7
130 14. FINANCING OF HEALTH CARE
Financing Health Care Situation For sustainability and needs based care, health financing is the key. In District Ramban An alysis Rogi Kalyan Samitis (RKS) have been formed in most of the CHCs and PHCs , rest facilities are in progress to form RKS and in upcoming months all the PHCs and CHCs will have their RKS registered.
RKS are hospital autonomous societies which are allowed to take user fees for services provided at the facilities. Formation of these RKS has resulted in great satisfaction amongst the patients and also the staff since now funds is available with the facilities to care for the people. 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 Jammu who have developed modules and conducted trainings for the management of these Societies. 4. Provision of Seed money to each RKS at CHCs and PHCs 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 Timely meetings of Rogi Kalyan Samitis required 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 20 20 21 21 21 lakh per CHC and PHC Training of the Incharges and second 20 20 21 21 21 in command Development of Software for RKS x x x x x and training for the software Budget Activity 2007- 2008- 2009 2010 2011- Total
131 08 09 -10 -11 12 Provision of Seed money @ Rs 1 18 18 18.00 18.00 18.000 90 lakh per CHC and PHC @ Rs 0 0 1.00 lakhs Training of the Incharges and 0.36 0.396 0.436 0.479 0.527 2.198 second in command @ Rs 1000 per person x 1 day Development of Software for SKS 5 0.25 0.250 0.250 0.250 6 with training of personnel on the use Total 23.36 18.64 18.68 18.72 18.777 98.198 6 6 9
132
15. PROGRAMME MANAGEMENT
Program Management Situation District Ramban is a newly formed district. Before formation of new district it came under Analysis the District Doda. Till date the District Health society has not been formed nor the separate District Program Management Unit formed. Although at block levels the block account managers are working since they have been appointed before the new district formation.
The District needs to form District Health Society first and to established the District Program Management Unit (DPMU) and Block Program Management Unit (BPMU) for strengthening and smooth running the program Objectives To formulate District Planning Team / District Health Society Benchmar To establish fully equipped DPMU and BPMU ks To orient the required team about NRHM.. Strategies 1. Recruitment of manpower as per norms 2. Capacity building of the personnel 3. Developing clarity at the district / block levels officials and Consultants on 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. Stream lining Financial management 8. Strengthening the CMOs office 9. Strengthening the Block Management Units 10. Convergence of various sectors Activities 1. Support to the CMO : • Finalizing the TOR and the selection process • Hiring of consultants, one each for Maternal Health, Civil Works, Child health, Behaviour change. • If properly qualified and experienced persons are not available then District Facilitators to be hired which may be retired persons. • Selection of personal for DPMU and BPMU 2. Capacity building of the personnel • Joint Orientation of the District officers and the consultants • Training of the DPM and consultants on Management of NRHM for all the officials • Induction, Training and Review meetings of the District Management Unit to be used for orientation of the consultants
133 3. Development of total clarity in the Orientation workshops and review meetings at the district and the block levels amongst all the district officials and Consultants about the following set of activities: • Disease Control • Disease Surveillance • Maternal & Child Health • Accounts and Finance Management • Human Resources & Training • Procurement, Stores & Logistics • Administration & Planning • Access to Technical Support • Monitoring & MIS • Referral, Transport and Communication Systems • Infrastructure Development and Maintenance Division • Gender, IEC & Community Mobilization including the socio cultural background of the district. • Block Resource Group • Block Level Health Mission • Coordination with Community Organizations, PRIs 4. Man power and Infrastructure for DPMU & BPMU : DPM, DAM, DDM and the consultants of the District Project Management Unit. • In order to strengthen the CMO office and to smooth running of the program it is necessary that all the concerned health department should work under one roof so that the better coordination made possible . A health complex with the capacity to accommodate all the concerned department offices , equipped with computers, furniture modern Audio visual aids ,training hall , accommodation during training is proposed for this purposed. 5. Use of Management principles for implementation of District NRHM • Development of a detailed operational manual for implementation of the NRHM activities in the first month of approval of the District Action Plan including the responsibilities, review mechanisms, monitoring, reporting and the time frame. This will be developed in participatory consultative workshops at the district level and block levels. • Financial management training of the officials and the Accounts persons • Provision of Rs. 500000 as Untied funds at the district level for DPMU • Compendium of Government orders for the DC, CMO, district officers, hospitals, CHCs, PHCs and the Subcentres need to be taken out every 6 months. Initially all
134 the relevant documents and guidelines will be compiled for the last two years. 6. Strengthening the Block Management Unit : The Block Management units need to be established and strengthened through the provision of : • Block 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 PHCs. • Provision of Computer system, printer, Digital Camera with date and time, furniture 7. Convergence of various sectors at district level • Provision of Convergence fund for workshops, meetings, joint outreach and monitoring with each CMO 8. Monitoring the Physical and Financial progress by the officials as well as independent agencies Support 1. State should ensure delegation of powers and effective decentralization. required 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 . Timeline 2007- 2008- 2009- 2010 2011 Activities 08 09 10 -11 -12 Selection of District level consultants, their capacity building and infrastructure x x Development of an operational Manual x Selection of Block management units and provision of Office setup x x Strengthening of Block Management Units x x Capacity building of District and Block level Management Units x x x x x Provision of adequate infrastructure and office automation for the Block Management Unit x x Development of Operational Manual for 08-09 x x Reorientation of personnel x x x Ongoing Capacity building of District and Block level Management Units x x x x Development of Operational Manual for 09-10 x Reorientation of personnel x x x All the routine activities will be implemented x x x x
135 Budget Activity / Item 2007- 2008- 2009- 2010- 2011-12 Total 08 09 10 11 Honorarium DPM, DAM, 29.4 32.34 35.57 39.131 43.045 179.49 DDA and Consultants 4 Travel Costs for DPMU 1.2 1.32 1.452 1.597 1.757 7.32 @ Rs 10,000/ per month x 12 mths Infrastructure costs, 5 0 0.000 0.000 0.000 5.00 furniture, computer systems, fax, UPS, Printer, Digital Camera, Workshops for 1 1.1 1.210 1.331 1.464 6.10 development of the operational Manual at district and Block levels Untied Fund 5 6 7.000 8.000 9.000 35.00 Construction Cost of 110 0 0.000 0.000 0.000 110.00 Health complex @ Rs 1000 /sq.ft x 11000 sq ft Furnishing and Office 25 0 0.000 0.000 0.000 25.00 Automation, Conference Hall with speakers, ACs Maintenance of the 0 0.5 1.000 1.500 2.000 5.00 Health Complex Compendium of Govt 0. 50 0.55 0.610 0.670 0.730 2.56 orders Joint Orientation of 0.25 0.275 0.303 0.333 0.366 1.52 Officials and DPM, DAM, DDM Management training 0.5 0.55 0.605 0.666 0.732 3.05 workshop of Officials Personnel for BPMU 22.32 24.552 27.00 29.708 32.679 136.26 7 Training of DPM and 0.5 0.75 1.000 1.250 1.500 5.00 Consultants Review meetings @ Rs 0.12 0.132 0.145 0.160 0.180 0.73 1000/ per month x 12 months Office Expenses @ Rs 1.2 1.32 1.450 1.600 1.800 7.37 10,000/month x 12 months for district Computer systems (12) 12 0 0.000 0.000 0.000 12.00 with printer and Digital Camera and furniture for DPMU, BPMUs and District and block personnel Annual Maintenance 0.72 0.792 0.871 0.958 1.054 4.396 Contract for the 2 equipment Hiring of vehicles at 5.4 5.94 6.534 7.1874 7.90614 32.968 block level @ Rs 1000 x 5 days /mth x 3 blocksx12 mths+ @2000X12/Sector
136 (PHC)
Monitoring of the 1 1.1 1.200 1.300 1.400 6.000 progress by independent agencies Office expenses for 5.4 5.94 6.534 7.1874 7.90614 32.968 Blocks @ Rs 5000 x 4 blocks x 12, Rs 2000 x 15 Sectors x 12 Total 226.01 83.161 92.49 102.57 113.519 617.76 5
Detailed calculation for Personnel at DPMU for one year
Details Units Unit Cost Amount for 12 months Personnel at District level District Programme manager 1 18000 216000 District Accounts Manager 1 15000 180000 District Data Assistant 1 12000 144000 Consultant for Maternal Health 1 40000 480000 Consultant for Child Health 1 40000 480000 Consultant for Civil Works 1 40000 480000 Consultant for HMIS 1 40000 480000 Consultant for Behaviour Change 1 40000 480000
SubTotal 2940000 Personnel at Block level Block Programme manager 3 15000 540000 Block Accounts Manager 3 12000 432000 Block Data Assistant 3 10000 360000 Retired Accountants for each PHC @ 15 5000 900000 Rs 5000 per month x PHCs x 12 months Subtotal 2232000 Hiring of vehicles at block level @ Rs 20 12000 2880000 800 x 15days /mth x20(17PHCs+3Blocks)x12 mths Office Automation with Furniture, 3 for 100,000 500000 Computer system, Camera, Printer, etc BPMU 1 for DPM 1 for DAM
137 16. Bio- Medical Waste Management
Bio-Medical Waste Management Current As per the Bio-Medical Waste Rules, 1998, indiscriminate disposal of hospital waste was to Status be stopped with handling of Waste without any adverse effects on the health and environment. In response to this the Government has taken steps to ensure the proper disposal of Biomedical waste from all Nursing homes, hospitals, Pathological labs and Blood Banks.
The District Health Officer is the Nodal Person in each district for ensuring the proper disposal of Biomedical Waste. Trainings to the personnel for sensitizing them have been imparted, Pits have been dug, Separate Colour Bins/containers and Segregation of Waste is taking place though has to be done more systematically. Proper Supervision is lacking. GOI has sanctioned a Plasma Pyrolysis Plant. Plasma Pyrolysis is a state-of-the-art technology for safe disposal of medical waste. It is an environment friendly technology, which converts organic waste into commercially useful by-products in a safe and reliable manner. The plant will soon be installed and training will be imparted to two persons from the district. Objectives 1. Stopping the indiscriminate disposal of hospital Waste from all the facilities by 2008 2. Ensuring proper handling and disposal of Biomedical Waste in each Facility Strategies 1. Capacity Building of personnel 2. Proper equipment for the disposal and disposal as per guidelines 3. Strict monitoring and Supervision Activities 1. Review of the efforts made for the Biomedical Waste Interventions 2. Development of Microplan Plan for each facility in District & Block workshops 3. Capacity Building of personnel • One day orientation workshops for District & Block levels • Training to two persons for Plasma Pyrolysis Plant. The company persons will impart this training. • Biomedical Waste management to be part of each training in RCH and IDSP 4. Proper equipment for the disposal • Plasma Pyrolysis Plant to be installed • Installation of the Separate Colour Bins/containers and Plastic Bags for the bins 5. Segregation of Waste as per guidelines 6. Partnering with Private providers for waste disposal 7. Proper Supervision and Monitoring • Formation of a Supervisory Committee in each facility by the MOs and the 138 Supervisors
2007- 2008- 200 2010- 2011- Activity 08 09 9-10 11 12 Orientation and Reorientation for the personnel for Biomedical Waste x x x x x Management at District and Block levels Consumables x x x x x Maintenance of the Plasma Pyrolysis plant x x x x x 550 550 550 550 Payment for the incinerators 550 Budget 2007 2008 2009 2010 2011 Activity -08 - 09 -10 -11 -12 Total Orientation and reorientation for Biomedical Waste Management at 1.82 2.00 2.20 District and Block levels 1.5 1.65 0 0 0 9.17 1.21 1.33 1.44 Consumables 1 1.1 0 0 0 6.08 Payment for incinerators@ Rs. 8 per 15.8 17.4 19.1 21.0 23.1 bed 12 mths 4 24 66 83 91 96.705 18.3 20.1 22.2 24.4 26.8 Total 4 7 0 1 3 111.96
139
17. MONITORING & INFORMATION SYSTEM
HMIS Status The data from the ANMs is sent up to 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.
The District administrative system not able to make use of the health data. Due to rapid urbanization the Infrastructure for urban surveillance is very weak and much worse than in the rural areas.
There is inadequate understanding regarding the classification of diseases. HMIS software consisting of all the data collected right from the sub centres with online facilities is not available Monthly monitoring or meetings of all BMOs held at CMO office similarly all ANMs monthly meetings are held at block head quarter.
The data from each block is collected manually and then tabulated at district level by computer. The information system at district is very weak Objective Integration of several parallel running programme software HMIS is used for decision making on regular basis Inclusion of RCH indicators monitoring Linkage to decision making at Central level Refresher training Make it more useful for State level officials Strategy Research on various issues related to RCH to get a correct baseline Improvement in the CNAA Computerized HMIS Activity 1. Base line Survey on RCH parameters and indicators. The Baseline survey will be conducted by and external agency. 2. Joint CNAA by the ANM, AWW, ASHA along with the Key Community Leaders so that there is one data validated by the Key Community Leaders
140 3. Printing of Reporting & Monitoring Formats 4. Data entry of each Household, Eligible couples, Adolescents 5. Computerization of all the formats and software for the various programmes and finances 6. Computer training for data entry 7. Internet connectivity up to all PHCs for online transfer of data. The ANMs will get the data entered each month after the household and eligible couple entries have been made 8. GIS for the district covering all the parameters 9. AMC for all computers State Provision of software for data entry Support Time line Activities 2007- 200 2009 2010 2011-12 08 8- -10 -11 09 Survey house-to-house by youth x Survey for practices, coverage, x behaviour etc through independent agency Software development x Data Entry of each household x x x x x Internet connectivity x x x x x Provision of computers for each CHC x x x x x and PHC AMC for computers x x x x x GIS for the district, training and up x x x x x gradation
141 Budget Activities 2007-08 2008-09 2009- 2010- 2011- Total 10 11 12 Survey house-to- 0.9 0 0.000 0.000 0.000 0.9 house by youth @ Rs 6000 pm x 3 months x 50persons Survey for practices, 15 0 0.000 0.000 0.000 15 coverage, behaviour etc through independent agency Software 20 0 0.000 0.000 0.000 20 development Data Entry of each 2.8 0.4 0.800 1.200 1.600 6.8 household @ Rs 2 per household x 90000 HH Internet connectivity 12.852 14.137 15.551 17.106 18.817 78.46 @ Rs 900 /mth x No of facilities x12 mths Provision of 9 0 0 0 0 9 computers for each CHC and PHC @ Rs 50,000/computer system with UPS and printer AMC for computers 0.9 0.99 1.089 1.198 1.318 5.49 @ Rs 5000 /computer /year x 25 computers Consumables for 8.64 9.504 10.454 11.500 12.650 52.74 computers @ Rs 4000/mth/facility x 12 mths GIS for the district, 12 0.5 0.500 0.500 0.500 14 training and updation Printing monitoring 0.1 0.125 0.150 0.175 0.200 0.75 Charts @ Rs. 5 per monitoring chart Total 82.192 25.656 28.544 31.679 35.084 203.15
142
District Ramban
Detailed NRHM Budget (in lakhs) Strengthening of District Health Management S.No Activity / Item 2007-08 2008- 2009-10 2010-11 2011- Total 09 12 Orientation Workshops 0.5 0.55 0.6 0.65 0.7 3 Issues based workshops 0.5 0.6 0.7 0.8 0.9 3.5 Formation of the monitoring 0.12 0.13 0.15 0.16 0.18 0.74 Committee Reorientation Workshops 0 0.55 0.6 0.65 0 1.8 Bimonthly meetings 0.6 0.66 0.73 0.8 0.88 3.67 Exposure visits for various 1.72 2.492 2.17 3.06 2.65 12.092 issues. Construction of NRHM cell (DC 25 0 0 0 0 25 Office) Staff cost NRHM Cell (DC 7.56 8.316 9.1476 10.062 11.069 46.155 Office) Infrastructure costs, furniture, 5 0 0 0 0 5 computer systems, fax, UPS, Printer, Digital Camera, Total 41 13.298 14.0976 16.182 16.379 100.957 District Programme Management Activity / Item 2007-08 2008- 2009-10 2010-11 2011- Total 09 12 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 0 0.000 0.000 0.000 5.000 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 Health 110 0 0.000 0.000 0.000 110.000 complex @ Rs 1000 /sq.ft x 11000 sq ft Furnishing and Office 25 0 0.000 0.000 0.000 25.000 Automation, Conference Hall with speakers, ACs Maintenance of the Health 0 0.5 1.000 1.500 2.000 5.000 Complex Compendium of Govt orders 0. 50 0.55 0.610 0.670 0.730 2.560 Joint Orientation of Officials and 0.25 0.275 0.303 0.333 0.366 1.526 DPM, DAM, DDM Management training workshop 0.5 0.55 0.605 0.666 0.732 3.053 of Officials Personnel for BPMU 22.32 24.552 27.007 29.708 32.679 136.266 Training of DPM and 0.5 0.75 1.000 1.250 1.500 5.000
143 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 (12) with 12 0 0.000 0.000 0.000 12.000 printer and Digital Camera and furniture for DPMU, BPMUs and District and block personnel Annual Maintenance Contract 0.72 0.792 0.8712 0.958 1.054 4.396 for the equipment Hiring of vehicles at block level 5.4 5.94 6.534 7.1874 7.9061 32.968 @ Rs 1000 x 5 days /mth x 3 4 blocksx12 mths+ @2000X12/Sector (PHC) Monitoring of the progress by 1 1.1 1.200 1.300 1.400 6.000 independent agencies Office expenses for Blocks @ 5.4 5.94 6.534 7.1874 7.9061 32.968 Rs 5000 x 4 blocks x 12, Rs 4 2000 x 15 Sectors x 12 Total 226.01 83.161 92.495 102.579 113.51 617.764 9 Maternal Health Activity / Item 2007-08 2008- 2009-10 2010-11 2011- Total 09 12 Consultancy for support for 1 2.2 2.42 2.66 2.93 11.210 developing Microplan for VH days Tracking Bags @ Rs 300/ bag x 1.05 0.156 1.05 0.156 1.05 3.462 AWCs Adult Weighing machines @ Rs 2.8 0.7 0.32 0.35 0.4 4.570 800 per machine x AWCs & Maintenance Establishing Blood Bank @35 35 35 35 105.000 lakh Establishing blood storage units 3 3 3 9.000 Mobile phone instrument to 2.8 0.08 0.08 0.08 0.08 3.120 ANM @ Rs 2000 Mobile Phones recurring cost to 8.4 8.64 8.88 9.12 9.36 44.400 ANMs @ Rs 6000/annum Mobile phone instrument to 2.15 0 0 0 0 2.150 MOs & Supervisory staff @ Rs 5000 (43x5000) Mobile Phones recurring cost to 2.58 2.58 2.58 2.58 2.58 12.900 MOs & Supervisory staff @ Rs 6000/annum One day training workshop on 1 1.1 1.21 1.32 1.45 6.080 Tracking bags at the district level and each sector Janani Suraksha Yojna @1400 28 35 42 56 67.2 228.200 X no.of inst. deliveries (apprrox)
144 Janani Suraksha Yojna @500 X 5 5.5 5.5 5.5 5.5 27.000 1000 (BPL - home delivery)(approx) RCH Camps @ Rs 25000 per 1 1.1 1.21 1.32 1.45 6.080 camp x 4 Delivery kits to 4.29 1.43 1.573 1.730 1.903 10.927 TBA's@3000and reffeling @ 1000 Incentives to TBA @ 100 per 2 3 4 5 6 20.000 deliveryby skilled birth attendent Total 100.07 99.486 108.823 85.816 99.903 494.099 Newborn and Child Health Activity / Item 2007-08 2008- 2009-10 2010-11 2011- Total 2006-07 09 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 0 2 2.000 2.000 2.000 8.000 the study Orientation of Staff Nurse and 1.5 2 0 0 0 3.500 MOs on Baby Friendly Hospital at all the CHCs (one day orientation) ORS, nutrients, vaccines, 0.5 5.5 6.1 6.7 7.3 26.100 medicines for children Newborn Corner furnished with 1.4 2.8 0.000 0.000 0.000 4.200 equipment @ Rs 1.40 lakh per facility Examination table, chair, stool, 10.5 1.56 0 0 0 12.060 table, other equipment @ Rs. 3000 x No of AWCs Infant Weighing Machines@Rs. 2.8 3.616 0 0 0 6.416 800/AWCx No of AWCs Foetoscope @ Rs.50 x No 0.175 0.026 0 0 0 0.201 AWCs Malnutrition Corners @ Rs 1 0.5 0.000 0.000 0.000 1.500 50,000 per CHC Massive IEC 5 5.5 6.1 6.7 7.3 30.600 Total 24.875 23.502 14.200 15.400 16.600 94.577 Family Welfare Activity / Item 2007-08 2008- 2009-10 2010-11 2011- Total 09 12 NSV camps @ Rs.50000 x 10 5 5.5 6.05 6.66 7.32 camps 30.5300 Sterilization Camps @ 410 per 20.5 22.6 24.805 27.29 30.01 case(Including medicine and compensation) 125.2050 Development Static 3 6 0.000 0.000 0.000 Centres@Rs 3 lakh 9.0000 Copper T-380 @ Rs 45 / piece 1.35 2.03 2.700 4.060 5.400 15.5400 EmergencyContraception@Rs1 0.1 0.2 0.3 0.8 0.5 0/2 tabs 1.9000
145 Laparoscopes 3 per CHC @ 18 9 0.000 0.000 0.000 Rs 3.00 lakhs x 3 27.0000 Total 47.95 45.33 33.855 38.810 43.230 209.1750 Adolescent Health Activity 2007-08 2008- 2009-10 2010-11 2011- Total 09 12 Research 5 0 0 0 0 5 Awareness generation @ Rs 2000 2.86 3.146 3.4606 3.8067 4.18733 17.46063 per village x 143 villages Workshop of all the partners 0.5 0.55 0.605 0.6655 0.73205 3.05255 Training of Adolescent Mentoring 1 1 1 1 1 5 Group and other expanses@1 Lakh Counsellors@ Rs 8000 per 14.4 15.84 17.424 19.166 21.083 87.913 month x PHCs x12 mths Training of Peer Educators @ Rs 0.15 0.15 0 0 0 0.3 50 per person x 3 days xNo of Peer Educators ReTraining of Peer Educators @ 0 0.3 0.3 0.3 0.3 1.2 Rs 50 per person x 3 days x peer Educators Orientation & Reorientation Health 0.25 0.28 0.31 0.34 0.37 1.55 personnel Counselling sessions @ Rs 1 2 2 2 2 9 1000/yr/peer Educator Counselling Clinics renovation, 1.5 1.65 1.815 1.9965 2.19615 9.15765 furnishing and Misc expenses @ Rs 50000.00 Health camps for Adolescents once 2 2.2 2.42 2.662 2.9282 12.2102 per quarter x 4 x 50000 per camp Joint Evaluation by an agency & 1 0 1.2 0 1.32 3.52 Govt Total 29.66 27.116 30.5346 31.9367 36.116 155.3640 73 3 ASHA Activity / Item 2007-08 2008- 2009-10 2010-11 2011- Total 09 12 Training & kit @ Rs 10000/ ASHA 21 0.6 0.6 0.6 0.6 23.4 Training of ASHA in Module II,III,IV 4.2 4.32 4.44 4.56 4.68 22.2 @ 2000/ASHA Reorientation @ Rs 1000/ ASHA 2.1 2.16 2.22 2.28 2.34 11.1 Expenses for the District mentoring 0.6 0.66 0.73 0.8 0.88 3.67 group – meetings, travel @ Rs 5000 per month x 12 months ASHA Performance Diary @ 0.3 0.3 0.3 0.3 0.3 1.5 100/ASHA Compensation to ASHA 2.1 2.16 2.22 2.28 2.34 11.1 @1000/ASHA Total 30.3 10.2 10.51 10.82 11.14 72.97 Untied Funds and an Annual Maintenance grant for Sub Centres Activity / Item 2007-08 2008- 2009-10 2010-11 2008- Total 09 12 Untied Fund of Rs 7 7.2 7.4 7.6 7.8 37 10000/subcentre Annual Maintenance grant of 7 7.2 7.4 7.6 7.8 37 Rs 10000/SC
146 Total 14 14.4 14.800 15.200 15.600 74 Untied Funds and an Annual Maintenance grant for PHCs Activity 2007-08 2008- 2009-10 2010-11 2011- Total 09 11 Untied Fund of Rs 25000/PHC 3.75 3.75 3.75 3.75 3.75 18.75 Annual Maintenance grant of 7.5 7.5 7.5 7.5 7.5 37.5 Rs 50000/PHC Total 11.25 11.25 11.250 11.250 11.250 56.25 Untied Funds and an Annual Maintenance grant for CHCs Activity / Item 2007-08 2008- 2009-10 2010-11 2011- Total 09 12 Untied Fund of Rs 50000/CHC 1.5 1.5 1.5 1.5 1.5 7.5 Annual Maintenance grant of 3 3 3 3 3 15 Rs 100000/CHC Total 4.5 4.5 4.500 4.500 4.500 22.5 Mobile Medical Unit Activity / Item 2007-08 2008- 2009-10 2010-11 2011- Total 09 12 Cost of Vehicle, equipment and accessories 26.85 0 0.000 0.000 0.000 26.85 Hiring staff 9.9 10.89 11.979 13.177 14.495 60.440 Recurring Cost of Drivers, Drugs, supplies, Mobile phones, POL, Maintenance 1.9 2.090 2.299 2.529 2.782 11.600 Orientation of the staff 0.25 0.275 0.3025 0.333 0.366 1.526 Joint Workshop for finalizing modalities 0.25 0.275 0.3025 0.333 0.366 1.526 Total 39.15 13.53 14.883 16.371 18.008 101.943 Upgrading DH & CHCs to IPHS Activity 2007-08 2008- 2009-10 2010-11 2011- Total 09 12 Upgradtion of Ramban CHC to 500 0 0.000 0.000 0.000 500 DH@ 5 crore Upgradation of Subsidary 0 250 0.000 0.000 0.000 250 Health Centre Ramsoo to Trauma Hospital (20 Bedded) @ 2.5 crore CHC Building Repair, Altration 20 and Edition @ 10 Lakh 20 0 0.000 0.000 0.000 Construction of Staff Qtrs of 72 MO/ Specialist @ 12 lakh 72 0 0.000 0.000 0.000 Construction of Staff Qtrs of SN 48 @6 lakh 48 0 0.000 0.000 0.000 Construction of Staff Qtrs of 4.8 class [email protected] 4.8 0 0.000 0.000 0.000 Furniture @0.5 X No of CHCs 1.5 0 0.000 0.000 0.000 1.5 Equipment @ 11 X No of 33.000 CHCs 33 0 0.000 0.000 0.000 Reccuring cost of CHC 131.974 excluding Man Power 26.395 26.395 26.395 26.395 26.395 Generator & stabilizer @ Rs. 3 80 lakhs for PHC 3x15 PHC ( 2lakhs+1 lakh) 30.000 50.000 0.000 0.000 0.000
147 Generator & stabilizer @ Rs. 4 12 lakhs for CHC 4x3 CHCs (3lakhs+1 lakh) 8.000 4.000 0.000 0.000 0.000 Generator & stabilizer @ Rs.5 5 lakhs for DH 4x1 DH (4lakhs+1 lakh) 5.000 0.000 0.000 0.000 0.000 Recurring & Maintenance cost 8.025 of generator sets Rs. 140 X 30 days X 12 months X 3 No of CHCs 1.008 1.512 1.66 1.83 2.01 Computer ,printer,fax @1 lakh 3 X 3 CHC 2 1.00 0.00 0.00 0.00 AMC of computer @ 6000 X3 1.099 CHC 0.18 0.20 0.22 0.24 0.26 Total 751.88 333.1 28.67 1170.39 28 05 28.276 28.464 1 81 Upgrading PHCs for 24 hr Services, IPHS and additional requirements of PHCs Activity / Item 2007-08 2008- 2009-10 2010-11 2011- Total 09 12 Construction of Building with 189 151.2 0 0.000 0.000 340.2 staff Qtrs for building less PHCs @ 37.80 PHC Building Repair, Altration and Edition @ 4Lakh 24 0 0.000 0.000 0.000 24 Construction of Staff Qtrs for PHCs having own building 172.8 0 0.000 0.000 0.000 172.8 Furniture @1 X No of PHCs 11 4 0.000 0.000 0.000 15 Equipment @ 11 X No of 121 44 0.000 0.000 0.000 PHCs 165 Recuring cost of PHCs excluding Man Power 26.4 26.4 26.4 26.4 26.4 131.974 Computer with 15 0 0.000 0.000 0.000 scanner,printer,UPS ,Fax@100000 /PHC 15 AMC of computer @ 6000 X No 0.9 0.99 1.089 1.198 1.318 of PHC 5.495 Total 560.094 226.58 8 48 27.484 27.593 27.712 869.469 Upgrading Sub Centres and additional Subcentres Activity / Item 2007-08 2008- 2009-10 2010-11 2011- Total 09 12 New buildings with quarters, equipment and Furniture 200.000 180 0.000 0.000 0.000 380.000 Additional Subcentres with staff quarters,furniture and equipment 200.000 20 20 20 20 280.000 Repair,Addition and Alteration of Subcenter @2lakh 18 0 0.000 0.000 0.000 18 Staff Quarters @ Rs 5 lakhs per Quarter for 2 ANMs 45 0 0.000 0.000 0.000 45 Recurring costs of the 43.297 Subcentres excluding man 42.0945 44.500 45.703 46.905 222.500 2 power Total 505.09 243.2 64.500 65.703 66.90 945.500
148 5 97 5 Untied Funds and Incentive Fund for the Village Health and Water Sanitation Committees Activity / Item 2007-08 2008- 2009- 10 2010- 11 2011- Total 09 12 Untied Fund of Rs 10000/unit 18.9 18.9 18.9 18.9 18.9 75.6 1500/unit x 189 units Permanent Advance to VHWSC 3.5 3.6 3.700 1.520 3.900 12.72 for ASHA incentive @ Rs5000/SC Total 22.4 22.5 22.600 20.420 22.80 88.32 0 Immunisation Activity 2007-08 2008- 2009-10 2010-11 2011- Total 09 12 Mobility support for alternative 1.68 1.728 1.776 1.824 1.872 8.88 vaccine delivery Rs. 70 per session for 1 planned session per week at each Subcentre village for 12 months = Rs. 70 x 1 session x4 weeks/mthx12 monthsx SCs Vehicle for distribution of 5.76 6.336 6.970 7.668 8.435 35.1684 vaccines in remote areas @ Rs 800 per PHC per week x 4 weeks x 12 months x PHCs Mobility Support Mop up 9 9.9 10.89 11.979 13.176 54.9459 campaign @ Rs 10000 per 9 PHC ( Including travel, vaccine delivery, IEC) x 6 rounds/ year x PHCs Mobilization of Children by 6.864 7.5504 8.30544 9.13598 10.049 41.90540 Social Mobilizers @ Rs. 100/ 4 5824 64 session x1 session per week x 4 weeks/mth X 365village x12 mths Contingency fund for each 0.36 0.396 0.4356 0.47916 0.5270 2.197836 block @ Rs.1000/month x 3 76 blocks x 12 months Pit Formation for disposal of 28.6 28.6 28.6 28.6 28.6 143 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 Maintenance of Cold Chain 2.12 1.58 1.58 1.58 1.58 8.44 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 1.8 1.98 2.180 2.400 2.640 11
POL & maintenance for Vaccine delivery van at district level @ Rs.15000/month x 12 149 mths
Running Cost of WICs & WIF 0 7.72 8.490 9.340 10.270 35.82 (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 2.197836 Family Welfare Officer@ 3000/month Computer Assistant for District 0.54 0.594 0.653 0.719 0.791 3.296754 Family Welfare Office @ 4500 Mobility support for Monitoring 7.2 7.92 8.712 9.583 10.542 43.95672 Immunization sessions for MO's PHC @1000/session 65.034 75.52 79.936 84.786 90.10 395.389 Total 5 9 85 RNTCP Activity / Item 2007-08 2008- 2009-10 2010-11 2011- Total 09 12 Civil Works DTC building 15 lakhs 15 0 0.000 0.000 0.000 15 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 14.03 15.433 16.976 18.674 20.541 85.655 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 11.19 12.31 13.540 14.890 16.330 68.26 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 51.25 35.64 39.216 43.139 47.39 216.642 2 5 55
150 Leprosy Activity / Item 2007-08 2008- 2009-10 2010-11 2011- Total 09 12 Routine Budget for Leprosy 1.45 1.6 1.8 2 2.2 9.05 control programme Monitoring & Supervision 1 1.1 1.2 1.3 1.5 6.1 Additional medicines 1 1 1 1 1 5 IEC Activities 1 1.1 1.2 1.3 1.5 6.1 POID Camps one per year 0.75 0.75 0.75 0.75 0.75 3.75 @5000 XPHC Celebration of world Anti 0.2 0.2 0.2 0.2 0.2 1 Leprosy day@20000 Total 5.4 5.75 6.15 6.55 7.15 31 National Malaria Control Programme Activity / Item 2007-08 2008- 2009-10 2010-11 2008- Total 09 12 Salary Contractual staff 6.45 7.095 7.805 8.585 9.443 39.378 Travel expenses @ Rs 4000/ 3.36 3.696 4.066 4.472 4.919 20.513 month for jeep x 12 months Office expenses @ Rs 5000 per 0.6 0.66 0.730 0.800 0.880 3.67 month x 12 Jeep and maintenance 6 0.6 0.660 0.730 0.800 8.79 Training 13.840 15.224 16.746 18.421 20.263 84.495 1small Fogging machines for 23 2.3 2.53 2.783 3.061 33.674 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 20000 2.1 2.31 2.541 2.795 3.075 12.821 per CHC, and for PHC Rs 10000 Board hoarding:8’x 12’ at the 0.75 1.25 1.750 2.500 3.000 9.25 CHCs and District hospitals @ Rs 25,000/- Board hoarding: 5’x3’ initially at 1.5 2.5 3.000 3.500 4.000 14.5 the PHCs@ Rs 10,000/- Total 57.600 35.63 39.828 44.586 49.44 227.091 5 2 Other Vector Borne diseases Activity / Item 2007-08 2008- 2009-10 2010-11 2011- Total 09 12 Unforeseen expenses 0.5 0.55 0.610 0.670 0.740 3.07 Kala Jathas for Malaria, 1.43 1.573 1.730 1.903 2.094 8.730 Dengue and Chikingunya @ Rs 1000 per village x 386 Total 1.93 2.123 2.340 2.573 2.834 11.800 Blindness Control Programme Activity / Item 2007- 2008- 2009-10 2010-11 2011- Total 2008 09 12 Health Mela @50000 / CHC 3.5 3.85 4.235 4.659 5.124 21.368 IEC @1lakh 1 1.1 1.210 1.331 1.464 6.105
151 School Eye Screening @1000 1 1.1 1.210 1.331 1.464 6.105 X100 school Blind Register 0.2 0.220 0.242 0.266 0.293 1.221 Observance of Eye Donations 0.15 0.17 0.190 0.210 0.230 0.95 Cataract Camps @ Rs 20000 3 3.3 3.630 3.993 4.392 18.315 per camp x PHC POL fro Eye Camps @ Rs 0.3 0.33 0.363 0.399 0.439 1.832 2000/camp xPHC 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 VHWSC members 0.2 0.22 0.242 0.266 0.293 1.221 @ Rs 100/head x 200 Repair and purchase of s 2 2.200 2.420 2.662 9.282 equipment and maintenance Total 19.45 12.40 13.643 15.008 16.50 77.009 0 8 Integrated Diseases Control Programme Activity / Item 2007-08 2008- 2009-10 2010-11 2011- Total 09 12 Renovation of Labs at CHCs 0.6 0.2 0.000 0.000 0.000 0.8 a@ Rs 20,000 Renovation of Lab at District 0 1.4 0.140 0.180 0.200 1.92 Hospital @ Rs 140,000 and maintenance Equipment for Lab at PSU at 0.8 0.4 0.000 0.000 0.000 1.2 CHC and @ Rs 40,000 Equipment for Lab at District @ 0 8.5 0.000 0.000 0.000 8.5 Rs 850,000 Computer and Accessories at 1 0.5 0.000 0.000 0.000 1.5 CHC @50000 Office for PSU atMaintenance 0.2 0.3 0.330 0.363 0.399 1.5923 CHC @ Rs 10,000 per unit Office Maintenance for DSU @ 0 0.1 0.100 0.100 0.100 0.4 Rs 10,000 Software for DSU@ Rs 335000 0 3.35 0.000 0.000 0.000 3.35 Furnishing of Lab at PSU at 0.2 0.1 0.000 0.000 0.000 0.3 CHCs and @ Rs 10,000 Furnishing of Lab at DSU @ Rs 0 0.6 0.000 0.000 0.000 0.6 60,000 Material and supplies at Lab at 0.16 0.24 0.240 0.240 0.240 1.12 PSU at CHCs @ Rs 8,000 Material and supplies at Lab at 0 0.75 0.75 0.75 0.75 3 DSU @ Rs 75,000 Contract Staff at District level @ 0 2 2.200 2.420 2.662 9.282 200000/yr for 4 staff yr wise IEC activities 1 1.1 1.210 1.330 1.460 6.1 Training and retraining 1.916 2.430 2.673 2.940 3.234 13.192 WEN connectivity 0.5 0.55 0.610 0.670 0.730 3.06 Operational costs at PSU for 0.45 0.495 0.545 0.599 0.659 2.747295 Surveillance @ Rs 15000/year x 3
152 Operational costs at DSU for 0 1.300 1.430 1.573 1.730 6.033 Surveillance @ Rs 130000/year Honorarium to Numberdars and 3.432 3.775 4.153 4.568 5.025 20.953 Chowkidars for reporting @ Rs 100 pm x 143 Numberdars and 143 Chowkidars x12 Total 10.258 28.08 14.380 15.733 17.18 85.649 98 9 IDD Activity / Item 2007-08 2008- 2009-10 2010-11 2008- Total 09 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 0.715 0.787 0.865 0.952 1.047 4.365 SHGs and shopkeepers @ Rs 500 per village x 143 villages Total 3.715 4.087 4.495 4.945 5.439 22.680 Intersectoral Coordination Activity / Item 2007-08 2008- 2009-10 2010-11 2011- Total 09 12 Meetings of the Block 0.36 0.396 0.436 0.479 0.527 2.198 Committees @ Rs 1000 /meeting x 3 blocks x 12 months Meetings of the Village groups 1.716 1.888 2.076 2.284 2.512 10.476 @ Rs 100 per village x 143 villages x 12 Joint CNAA training @ Rs 200 1.56 1.7 1.728 1.744 1.764 8.496 per person X (AWW, ANMs, ASHAs, Supervisors, MOs, CDPOs) Joint monitoring at the block level Hiring of vehicle @ RS 1000/ 1.8 1.98 2.178 2.396 2.635 10.989 day x 5 days/month x 3 blocks x 12 months Yearly joint Planning 3 3.3 3.63 3.993 4.392 18.315 Workshops at the Block level for development of the Action Plans @ Rs 1.00 lakhs per block x 3 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
153 Yearly joint Workshops to 3 3.3 3.63 3.993 4.392 18.315 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 3 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 Chiranjeevi Scheme for PPP 24 44 44 44 44.000 200.000 Total 37.436 58.76 60.098 61.551 63.15 281.000 36 2 Community Health action Activity / Item 2007-08 2008- 2009-10 2010-11 2008- Total 09 12 Training of the VHWSC @ Rs 4.29 4.719 5.191 5.710 6.281 11.472 200 per person x 15 persons/village x143 villages Meetings of the VHWSC @ Rs 0.858 0.9438 1.038 1.142 1.256 2.294 50 per village x 143 villages x 12 months Meetings of Women Groups @ 0.143 0.1573 0.173 0.190 0.209 0.382 Rs 100 per year x143villages Honorarium for MOs for 6.48 7.128 7.841 8.625 9.487 17.328 promoting Community health Action @ Rs 1000 pm and travel charges Rs 800 pm Total 11.771 12.94 14.243 15.667 17.23 71.863 8 4 Public Private Partnership Activity / Item 2007-08 2008- 2009-10 2010-11 2011- Total 09 12 Fesiability study on PPP issues 10 0 0.000 0.000 0.000 10 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 Fesiability study on PPP issues 10 0 0.000 0.000 0.000 10 5 Workshops for involvement of 2.5 0 0 0 0 2.5 the Private sectors (one each with NGOs/Trusts/Private institutions;Media; Ex- servicemen association, transportation ,HR agencies) @ 25000 per workshop
154 Sharing Workshops with Private 0 0.55 0.61 0.67 0.74 2.57 players Admin and overhead Charges 2 2.2 2.42 2.67 3 12.29 for hiring the agencies TOTAL 30 27.7 28.975 29.330 30.82 146.833 8 Gender and Equity Activity / Item 2007-08 2008- 2009-10 2010-11 2011- Total 09 12 Orientation and sensitisation programmes 10 11 12.1 13.3 14.6 61 Media workshops 2 2.2 2.4 2.7 2.9 12.2 Incentives for early registration of pregnancies@Rs 50 x 6100 3.05 3.38 3.718 4.09 4.498 18.736 Monitoring and supervision 2 2.2 2.4 2.7 2.9 12.2 Health cards for girl [email protected]*No.of pregnancies 0.12 0.14 0.15 0.16 0.18 0.75 IEC campaigns 5 5.5 6.1 6.7 7.3 30.6 TOTAL 32.37 22.17 24.42 26.868 29.65 8 135.486 Capacity Building Activity 2007-08 2008– 2009-10 2010-11 2011- Total 09 12 TBA training @ Rs 10100 /TBA 14.443 15.887 17.476 19.224 21.146 88.176 3 MVA MTP training to all PHC 2.25 2.25 0.000 0.000 0.000 4.500 MOs for 15 days @ Rs 500 x 15 days x MOs Training on Blood transfusion 0.000 for MOs and Lab Technicians for CEmOC centres with Blood storage facilities for 3 days MOs @ Rs 500/day/person x 3 0.045 0.015 0.000 0.000 0.000 0.060 days LabTechnicians@Rs 0.03 0.006 0.000 0.000 0.000 0.036 200/person x 3 days Training in Obstetric 0.000 management & skills for 24x7 PHCs for 16 weeks MOs: Rs 500/day x 112 days x 3.36 3.36 3.36 3.36 3.36 16.800 2 MOs StaffNurses:Rs200/dayx112day 1.344 1.344 1.344 1.344 1.344 6.720 sx 2 SNs Training in skilled Birth 0 0.000 0.000 0.000 0.000 attendants for 15 days: One batch of 4 persons: Rs. 5 5 5 5 5 25.000 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 1.8 2.04 2.304 2.184 1.56 9.888 8 days
155 IMNCI training to MOs @ Rs 0.8085 0.889 0 0.000 0.000 1.698 5390 /participant Integrated skill training for MOs 0.22098 0.243 0.267 0.294 0.324 1.349 @ Rs 3683 Training of MOs, SN in Mgt of 0.36 0.396 0.436 0.479 0.527 2.198 Newborns & sick children at Medical College Jammu @ Rs 7500/MO, Rs 4500 ( Rs 300 x 15 days)/SN Training in BCC for MOs, LHVs, 1.425 1.7175 0.000 2.1 0 5.243 ANMs MOs: Rs 500/MO x 5 days 0.000 LHVs & ANMs: Rs 300/person 0.000 x 5 days Training of Ayush personnel on 0.135 0.1485 0.163 0.180 0.198 0.824 issues of RCH and reporting for 3 days Rs 300/person x 3 days 0.000 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, 0.000 Rs 3000 per camp for trainer x 0.000 12 camps Training on Minilap @ Rs 500 0 1.2 1.8 1.5 0.000 4.500 per day for 15 days and during camps Training for Laproscopic 0.6 0.66 0.726 0.799 0.000 2.785 Sterilization for Surgeons, Gynaecologists, SN, OT attendants for 12 days Specialist: Rs 500/Specialist x 0.000 12 days SN: Rs 300/SN x 12 days 0.000 OT Attendant: Rs 200 x 12 0.000 days Orientation on contraceptive 0.21 0.231 0.254 0.280 0.307 1.282 devices for MOs - Govt as well as private facilities Rs 500 /MO x 1 day 0.000 Training on Medico-legal 0.235 0.0055 0.006 0.007 0.007 0.261 aspects to MOs @ Rs 500/MO x 1 day 0.000 Orientation on PCPNDT Act for 0.5 0.55 0.605 0.666 0.732 3.053 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 0.000 days Rs 200 /clerical staff x 3 days 0.000
156 Financial management training 0.08 0.088 0.097 0.106 0.117 0.488 for Accounts Officers, Accountants for 2 days Rs 200/Accounts persons x 2 0.000 days Computer training to all the 1.8 0.99 0.000 0.000 0.000 2.790 MOs, Clerical staff, accounts personnel @ Rs 200 per person x 15 days CNAA for MOs, LHVs, ANMs, 1.07 1.182 1.19 1.198 1.202 5.842 AWW @ Rs 200/person x 1 day each 0.000 year Total sanitation orientation and 0.286 0.3146 0.346 0.381 0.419 1.746 reorientation of VHWSCs x 1 day @ Rs 200/person/day Training of NGOs in BCC @ Rs 0.54 0.594 0.653 0.719 0.791 3.297 300 per person x 6 days Total 38.012 40.72 37.806 41.775 39.18 197.509 48 88 6 Human Resources Activity / Item 2007-08 2008- 2009-10 2010-11 2011-12 Total 09 Subcentre ANM 166.286 171.73 177.19 182.642 188.09 885.95 8 4 PHC MO 59.888 59.888 59.888 59.888 59.888 299.44 Staff Nurse 63.017 63.017 63.017 63.017 63.017 315.085 Health worker (F) 10.759 10.759 10.759 10.759 10.759 53.795 Health Educator 19.981 19.981 19.981 19.981 19.981 99.905 Health Assistant 51.33 51.33 51.33 51.33 51.33 256.65 Clerk 11.88 11.88 11.88 11.88 11.88 59.4 Pharmacist 6.12 6.12 6.12 6.12 6.12 30.6 Lab.Tech 13.068 13.068 13.068 13.068 13.068 65.34 Class IV 28.8 28.8 28.8 28.8 28.8 144 CHC Specialist 47.97 47.97 47.97 47.97 47.97 239.85 MO s 15.76 15.76 15.76 15.76 15.76 78.8 PHN 5.136 5.136 5.136 5.136 5.136 25.68 ANM 1.188 1.188 1.188 1.188 1.188 5.94 SN 15.37 15.37 15.37 15.37 15.37 76.85 Dresser 0.69 0.69 0.69 0.69 0.69 3.45 lab.Tech 0 0 0 0 0 0 Radiographer 3.564 3.564 3.564 3.564 3.564 17.82 Opthalmic Assistant 1.188 1.188 1.188 1.188 1.188 5.94 Statistical Assistant 3.564 3.564 3.564 3.564 3.564 17.82 Registration clerk 3.564 3.564 3.564 3.564 3.564 17.82 Accountant 5.79 5.79 5.79 5.79 5.79 28.95 Epidemiologist 8.25 8.25 8.25 8.25 8.25 41.25 BEE 4.59 4.59 4.59 4.59 4.59 22.95
157 DH Hospital Superintendent 3.69 3.69 3.69 3.69 3.69 18.45 Medical Specialist 11.07 11.07 11.07 11.07 11.07 55.35 Surgery Specialists 7.38 7.38 7.38 7.38 7.38 36.9 O&G specialist 14.76 16 16 14.76 14.76 76.28 Psychiatrist 3.69 3.69 3.69 3.69 3.69 18.45 Dermatologist / Venereologist 3.69 3.69 3.69 3.69 3.69 18.45 Paediatrician 7.38 7.38 7.38 7.38 7.38 36.9 Anesthetist (Regular / trained) 7.38 7.38 7.38 7.38 7.38 36.9 ENT Surgeon 3.69 3.69 3.69 3.69 3.69 18.45 Opthalmologist 3.69 3.69 3.69 3.69 3.69 18.45 Radiologist 3.69 3.69 3.69 3.69 3.69 18.45 Microbiologist 3.69 3.69 3.69 3.69 3.69 18.45 Casualty Doctors / General 18.912 18.912 18.912 18.912 18.912 94.56 Duty Doctors Dental Surgeon 3.152 3.152 3.152 3.152 3.152 15.76 Forensic Expert 3.69 3.69 3.69 3.69 3.69 18.45 Public Health Manager1 3.69 3.69 3.69 3.69 3.69 18.45 AYUSH Physician2 7.38 7.38 7.38 7.38 7.38 36.9 Pathologists 7.38 7.38 7.38 7.38 7.38 36.9 Paramedical Staff Nurse* 0 236.4 236.4 236.4 236.4 945.6 Hospital worker (OP/ward 63.04 63.04 63.04 63.04 63.04 315.2 +OT+ blood bank) Ophthalmic Assistant / 23.055 23.055 23.055 23.055 23.055 115.275 Refractionist Social Worker / Counsellor 1.537 1.537 1.537 1.537 1.537 7.685 Cytotechnician 1.711 1.711 1.711 1.711 1.711 8.555 ECG Technician 0.92 0.92 0.92 0.92 0.92 4.6 ECHO Technician 1.53 1.53 1.53 1.53 1.53 7.65 Audiometrician 1.188 1.188 1.188 1.188 1.188 5.94 Laboratory Technician ( Lab + 0.72 0.72 0.72 0.72 0.72 3.6 Blood Bank) Laboratory Attendant (Hospital 0 37.824 37.824 37.824 37.824 151.296 Worker) Dietician 3.152 3.152 3.152 3.152 3.152 15.76 Maternity assistant (ANM) 9.222 9.222 9.222 9.222 9.222 46.11 Radiographer 2.376 2.376 2.376 2.376 2.376 11.88 Dark Room Assistant 3.074 3.074 3.074 3.074 3.074 15.37 Pharmacist1 7.65 7.65 7.65 7.65 7.65 38.25 Matron 1.188 1.188 1.188 1.188 1.188 5.94 Assistant Matron 3.06 3.06 3.06 3.06 3.06 15.3 Physiotherapist 1.188 1.188 1.188 1.188 1.188 5.94 Statistical Assistant 1.537 1.537 1.537 1.537 1.537 7.685 Medical Records Officer / 1.188 1.188 1.188 1.188 1.188 5.94 Technician Electrician 1.537 1.537 1.537 1.537 1.537 7.685 Plumber 1.537 1.537 1.537 1.537 1.537 7.685 Administrative Staff Junior Administrative Officer 1.537 1.537 1.537 1.537 1.537 7.685
158 Office Superintendent 1.711 1.711 1.711 1.711 1.711 8.555 Assistant 2.376 2.376 2.376 2.376 2.376 11.88 Junior Assistant / Typist 2.376 2.376 2.376 2.376 2.376 11.88 Accountant 3.86 3.86 3.86 3.86 3.86 19.3 Record Clerk 0.72 0.72 0.72 0.72 0.72 3.6 Office Assistant 1.188 1.188 1.188 1.188 1.188 5.94 Computer Operator 1.188 1.188 1.188 1.188 1.188 5.94 Driver 3.074 3.074 3.074 3.074 3.074 15.37 Peon 3.074 3.074 3.074 3.074 3.074 15.37 Security Staff* 3.074 3.074 3.074 3.074 3.074 15.37 Operation Theatre Staff Nurse 10.692 10.692 10.692 10.692 10.692 53.46 OT Assistant 7.128 7.128 7.128 7.128 7.128 35.64 Sweeper 2.88 2.88 2.88 2.88 2.88 14.4 Blood Bank Staff Nurse 4.752 4.752 4.752 4.752 4.752 19.008 MNA / FNA 2.376 2.376 2.376 2.376 2.376 11.88 Lab Technician 1.188 1.188 1.188 1.188 1.188 5.94 Safai Karamchari 0.72 0.72 0.72 0.72 0.72 3.6 Total 850.08 1131 1136.44 1140.66 1146. 5399.54 1 9 1 113 9 Logistics and Warehousing Activity / Item 2007-08 2008- 2009-10 2010-11 2011- Total 09 12 Construction of Warehouse 100 0 0.000 0.000 0.000 100 Software 1 0 0.000 0.000 0.000 1 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 138.1 5.56 3.808 4.190 4.618 156.276 IEC Activities 2008- 2009-10 2010-11 2011- Total 2007-08 09 12 Hiring of an agency for carrying 40 44 48.400 53.240 145.64 331.28 out the intensive IEC and 0 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 language 1 1.1 1.210 1.331 3.641 8.282
159 Folk Media shows @ Rs 0.143 0.1573 0.173 0.190 0.521 1.184326 2000/village 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/pamphlets 10 11 12.100 13.310 36.410 82.82 x 100000 Orientation of Community key 4 4.4 4.840 5.324 14.564 33.128 persons / PRIs@ Rs 200 x 2000 persons x1 day Village campaign @ Rs 69.132 38.68 42.548 46.803 51.483 140.83 320.3477 lakhs per Campaign / Per year 4 6 Bal Nutrition Melas @ Rs 300 x 4.2 4.824 5.3064 5.83704 6.4207 26.58818 4 times x AWCs 44 4 Kishori Shakti meetings @ Rs 0.143 0.1573 0.173 0.190 0.521 1.184326 100 per group x 143 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 500 x 143 0.715 0.7865 0.865 0.952 2.603 5.92163 villages Total 118.881 130.97 144.070 158.477 423.97 976.3762 31 4 26 Financing of Health Care Activity 2007- 08 2008- 2009-10 2010-11 2011- Total 09 12 Provision of Seed money @ Rs 18 18 18.000 18.000 18.000 90 1 lakh per CHC and PHC @ Rs 1.00 lakhs Training of the Incharges and 0.36 0.396 0.436 0.479 0.527 2.198 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 23.36 18.646 18.686 18.729 18.777 98.198 HMIS Activities 2007-08 2008- 2009-10 2010-11 2011- Total 09 12 Survey house-to-house by 0.9 0 0.000 0.000 0.000 0.9 youth @ Rs 6000 pm x 3 months x 50persons Survey for practices, coverage, 15 0 0.000 0.000 0.000 15 behaviour etc through independent agency 20 0 0.000 0.000 0.000 20 Software development Data Entry of each household 2.8 0.4 0.800 1.200 1.600 6.8 @ Rs 2 per household x 90000 HH Internet connectivity @ Rs 900 12.852 14.137 15.551 17.106 18.817 78.46274 /mth x No of facilities x12 mths 52
160 Provision of computers for each 9 0 0 0 0 9 CHC and PHC @ Rs 50,000/computer system with UPS and printer AMC for computers @ Rs 5000 0.9 0.99 1.089 1.198 1.318 5.49459 /computer /year x 25 computers Consumables for computers @ 8.64 9.504 10.454 11.500 12.650 52.74806 Rs 4000/mth/facility x 12 mths 4 GIS for the district, training and 12 0.5 0.500 0.500 0.500 14 updation Printing monitoring Charts @ 0.1 0.125 0.150 0.175 0.200 0.75 Rs. 5 per monitoring chart Total 82.192 25.65 28.544 31.679 35.08 203.155 6 4 4 Bio-Medical Waste management 2008- 2011- Activity 2007-08 09 2009-10 2010-11 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@ 17.424 19.166 21.083 23.191 Rs. 8 per bed 12 mths 15.84 96.705 26.83 Total 18.34 20.174 22.196 24.413 1 111.955
4076.3 2952.6 2302.45 2354.77 2699. 14358.3 Grand Total 77 1 1 6 240 06
161 ANNEXURE:
Status of Subcentre Buildings:
S.No . Block Building Govt. Building Rented 1. Ukheral Batroo Hochak 2. Gujrarah 3. Derzi Pura 4. Morchagali 5. Neli Jawri 6. Sarbagni 7. Perhinder 8. Trana 9. Gagernag 10. Buzla 11. Paristan 12. Basan 13. Derdahai 14. Fagmulla 15. Bawa Almirag 16. Banagara 17. Maligam 18. Dhanmasta 19. Ramban Bradgali Gatgali 20. Pernote Sawni 21. Maitra Batli 22. Gamsoli 23. Chabba 24. Bajmasta 25. Ganote 26. Thopar 27. Digdool 28. Kanga 29. Dalwas 30. Kanthi 31. Banihal Kaskout Dooligam 32. Amkoot Nowgam 33. Tethar Ragow 34. Chamalwas Chapnari 35. Chachnarwah 36. Lamber
*Staff quarters for all subcentres of district Ramban need to be constructed.
162 Status of PHC Buildings:
S.No . Block Building Govt. Building Rented 1. Ukheral Ukheral Woodhala Trigam 2. Ramsoo Senabathi 3. Khari Batroo 4. Neel 5. Banihal Mangit 6. Ramban AD Chanderkot Rajgarh 7. Batni 8. AD Halla 9. AD Sanasar 10. AD Dharamkund
Status of Staff Quarters
Staff Quarters need to be constructed in following PHCs: S.No . Block Name of PHC/AD 1. Ukheral Khari 2. Woodhala Trigam 3. PHC Ramsoo 4. A/D Senabathi 5. A/D Batroo 6. A/D Neel 7. A/D Pogal 8. Banihal Mangit 9. Ramban Rajgarh 10. A/D Chanderkot 11. Bhatni 12. A/D Halla 13. A/D Sanasar 14. A/D Dharamkund
Assessment of District Health Action Plan (DHAP) Appraisal Criteria to be used by State/ District Planning & Appraisal Team
163 Appraisal Criteria District Ramban Sl. Criteria Remarks No. Yes/ No
A. OVERALL 1 Has the DHAP been reviewed in detail by the District Yes, authorities to ensure internal consistency? If yes, by whom? This means that Situation analysis, goals, strategies, activities, work plan budget are in line with the proposed interventions and are evidence based. 2 Has Account Person from the Department reviewed the Yes budget in detail? 3 Executive summary /At a Glance has been enclosed in the Yes, beginning of the document. 4 Has plan developed in all inclusive and participatory Yes process by involving representatives of health, water and sanitation, ISM, ICDS, Rural Development, NGOs and community members? 5 Funds requirement matches with the absorption capacity Yes and has judicious increase over the years (The planning should be based on past experiences in implementing interventions and realistic time frame/ workplan ) 6 The Plan caters needs of vulnerable groups (SC/ST, BPL, Yes Women and Children, others) (Activities proposed to cover SC/ST population for Immunization coverage, JSY scheme etc.) 7 Inter-department coordination and convergence Yes, mechanism is clearly mentioned for multi-sectoral inputs/elements. (Planned joint sector ,block and dist level meetings with ICDS, education and local self Govt. etc and joint circulars for implementing intervention) 8 The findings of the facility survey/ assessment has been Yes, integrated in the Plan 9 Plan has been approved by appropriate district authority Yes, attached after the District (District Health Society) cover page 11 Training Plan Yes The training strategy to strengthen existing HR. The training plan has indicated target groups (e.g. MO, ANM, ASHAs, AWW etc), training load and broad details e.g. duration, quality assurance for training, etc 12 BCC /IEC strategy Yes A service oriented BCC strategy based on assessment of the current status of issues with MMR, IMR, TFR, awareness of PNDT, etc. has been narrated in the plan 13 Work Plan Yes, Is the work plan consistent with stated components/objectives, strategies and activities? And
164 Sl. Criteria Remarks No. Yes/ No
whether the proposed phasing of activities would lead to increase in delivery/utilization of services? 14 COSTS/BUDGET Key criteria are: Does the budget follow the prescribed formats? Yes The justification column has break-up of total amount 1. Absorptive capacity: If very ambitious utilization of Yes funds is envisaged compared to performance of 05- 06/06-07, then key steps have been proposed to achieve plan expenditure? B RCH-II PROGRAM PROGRAM MANAGEMENT ARRAGEMENTS 1 Steps to establish financial management system including Yes, 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
165 Sl. Criteria Remarks No. Yes/ No
A. Organizing MCHN days for complete Yes, immunization 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 Yes, every block facilities, B. Increase number of service providers for vasectomy, NSV, Tubectomy, and Laproligation , C. Intervention to improve quality of camps, D. Quality IUD insertion services, E. Increased availability of OP, Condoms through community workers, ASHA, AWW, NGOs 4 ARSH A. Intervention for training of MOs, paramedic for ARSH Yes, services ( optional) B. Provision of AFHS services at selected institutions (optional)
5 Gender Mainstreaming Activities planned for awareness generation of gender, Yes, PCPNDT Act and strengthening implementation of PCPNDT Act. 7 Urban RCH Interventions for provision of MH/CH/FP services in urban NA slums and urban areas. 8 Tribal Health Interventions to cover tribal population for FP/MH/CH. NA B NRHM ADDITIONALITIES Whether provision made for- 1 ASHA Training in the district Yes, 2 PRI Trainings (Block/Village health & Sanitation Yes, Committees) 3 Untied Funds at SC & Yes, Untied funds to RKS at PHC/CHC/District Hospitals 4 Civil Works as per IPHS (CHC/PHC/SC) Yes, Hospital Building- Staff Quarters 5 Strengthening Field Monitoring and Supervision (Enhance Yes, the provision of POL, Maintenance and of vehicle) 6 Need assessment done for-Procurements as per IPHS Yes, CHC/PHC/SC) 7 Appropriate provision made for-Programme Management Yes, Units at Divisional, District and Block levels-Adequate
166 Sl. Criteria Remarks No. Yes/ No
salary and OE provisions ( District PMU is a part of RCH II and Block level PMUs are part of NRHM) 8 Adequate provision made for-Additional Manpower Yes Specialists at CHCs ANMs at SCs Divisional/Block Programme Managers 9 Provision made for-Drug Kits at different institutions Yes 10 Plan for management of Mobile Medical Units at districts Yes 11 No of Ambulances available and required Yes District specific innovative activities to address local needs Yes, addressed in all the have been incorporated technical chapters 12 Public private partnerships ( optional) Yes, Page 143-145 12 Provision of hiring of vehicle for BMOs (as per Yes requirements) C IMMUNIZATION PROGRAM Whether provision made for- 1 Social mobilization Yes 2 Alternative vaccine delivery Yes 3 Cold Chain Maintenance Yes 4 PoL & Maintenance requirement for vehicles Yes D National Disease Control Programme 1 Water Borne Diseases Yes Clear strategy prepared for combating Water Borne Diseases like Malaria, dengue etc 2 TB Whether Separate section on TB with operational details Yes and budget prepared 3 Leprosy Separate section on Leprosy with detailed operational Yes guidelines and budget
4 Blindness 1 Separate section on Blindness Control with detailed targets Yes and budget 2 Monitoring mechanism for NGO E CONVERGENCE/ INTER-DEPARTMENTAL Yes COORDINATION Whether interventions in the following areas have been planned 1 ISM Integration Activities Yes 2 Department of Social Welfare (ICDS) Yes 3 PHED Yes
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