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Chapter Chapter Name Page No. No. Introduction 1-4 1. Organization & Infrastructure 5-17 2. NRHM, Health & Population Policies 19-49 3. Funding For The Programme 51-61 4. Maternal Health Programme 63-69 5. Child Health Programme 71-74 6. National Programmes Under NRHM 75-112 7. Information, Education And Communication 113-118 8. Partnership With Non-Government Organisations 119-121 9. Family Planning 123-138 10. Training Programme 139-146 11. Other National Health Programmes 147-160 12. International Co-Operation For Health & Family Welfare 161-164 13. Medical Relief And Supplies 165-187 14. Quality Control in Food & Drugs Sector, Medical Stores 189-201 15. Medical Education, Training & Research 203-303 16. Facilities For Scheduled Castes And Scheduled Tribes 305-308 17. Use of Hindi In Official Work 309-310 18. Activities In North East Region 311-322 19. Gender Issues 323-331

Annexure Organisation Chart of Department of Health & Family Welfare, 333 Organization Chart of DGHS & Audit Observation. Introduction

The Ministry of Health and Family Welfare oversees the years. Expenditure in Health Sector on Public Health is implementation of policies and programmes for health about 1% of the GDP. care around the country, within the framework set by the National Rural Health Mission (NRHM) National Health Policy of 2002 and the priorities set in successive Five Year Plans. While the responsibility for The country has a well structured multi-tiered public health the delivery of health care rests largely with the State infrastructure, comprising District Hospitals, Community Governments, the Government of India plays a role in Health Centres, Primary Health Centres and Sub-Centres setting policy and providing resources for the spread across rural and semi-urban areas and tertiary implementation of National Programmes. medical care providing multi-Speciality hospitals and medical colleges. Improvements in health indicators can Despite substantial progress made on many fronts there be attributed, in part to this network of health are still areas of concern. Maternal and Infant Mortality infrastructure. However, the progress has been quite are still unacceptably high in several areas, infectious uneven across the regions with large scale inter-State disease continues to remain a threat to public health. Non- variations. Despite the consistent effort in scaling up Communicable Diseases including cancers, cardio- infrastructure and manpower, the rural and remote areas vascular disease, diabetes and mental illnesses affect continue to be deficit in health facility and manpower. sizeable numbers of our population. India does not as yet have an adequate number of all categories of health Conscious and vigorous efforts continue to be made professionals, whether of doctors, specialist doctors, during the current year to step up funding in the health nurses, nurse practitioners, para-medics and health sector and to increase spending in the public domain, at workers. least to raise it to the level of 3 per cent of the GDP by 2012. The major thrust in the National Rural Health The National Health Policy (NHP) was formulated in Mission (NRHM) has been towards achieving qualitative 2002 to provide prophylactic and curative health care improvements in standards of public health and health services towards building a healthy nation. The NHP- care in the rural areas through strengthening of institutions, 2002 aims to achieve an acceptable standard of good community participation, decentralization and creating a health amongst the general population of the country. This workforce of health workers viz. ASHAs. While the is sought to be done by increasing access to the Mission was formally launched in 2005 and has taken a decentralized public health system by establishing new while to effectively find a firm footing, early indications infrastructure in deficient areas, and by upgrading the reflect its positive impact. Reliable estimate based on infrastructure in the existing areas and institutions. The surveys show an appreciable decline in infant mortality challenge has been to provide the country more equitable (50 per 1000 live births in 2009 as against 60 in 2003), access to health services across the social and decline in total Fertility Rate (from 3.0 children per women geographical expanse of the country. Thus, keeping in in 2003 to 2.6 in 2008) and improvement in the percentage line with this broad objective, several health programmes/ of safe deliveries etc. (from 48.0 in 2004 to 52.7 in schemes have been launched from time to time. There 2007-08). has been a steady increase in the aggregate public health investment, in the country. The contribution of Central A new initiative under NRHM has been taken to identify Government towards public investment for provision of backward districts for ensuring differential financing. health care services has also been enhanced over the Based on health indicators 264 backward districts across

Annual Report 2010-11 1 the country have been identified for providing focused to the People on Health was published in September 2010 attention. Similarly, after many years the agenda of family to generate a debate on the issues presented in the Report. planning is back in mainstream health discourse and has National Council of Human Resources in Health been repositioned for better maternal and child health (NCHRH) apart from population stabilization. The President in her address to the Joint Session of The Reproductive and Child Health (RCH) Programme Parliament on 26th June 2009, announced the is a key element of National Rural Health Government’s intention to set up a National Council of Mission(NRHM). The system strengthening being Human Resources in Health (NCHRH) as an overarching undertaken under the Mission has lent support to the regulatory body for health sector to reform the current Programme towards reducing MMR, IMR and TFR. regulatory framework and enhance supply of skilled Janani Suraksha Yojana(JSY) has resulted in a steep rise personnel. Consequently, a Task Force under the in demand for services in public health institutions with Chairmanship of former Union Secretary (Health & the institutional deliveries registering a substantial Family Welfare) was constituted to deliberate upon the increase. The number of JSY beneficiaries has risen issue of setting up of the proposed National Council. from 7.3 lakhs in 2005-06 to about 1 crore in 2009-10. Facility upgradation on a large scale has been undertaken The National Commission, which will coordinate all to strengthen health care services for mothers and the aspects of medical, dental, nursing, pharmacy & neonates. Establishment of new born corners, new born paramedical education, will in itself consist of senior stabilization units and special care units for new born has professionals and experts of known integrity and social received a special thrust. In addition, capacity building commitment, selected/ nominated by the most stringent initiatives such as IMNCI, FIMNCI SBA, NSSK, EMOC standard. and LSAS have been upscaled. SBA trainings have Accordingly, the following three bodies have been started showing positive results with percentage of skilled proposed to be formed under the ambit of NCHRH – attendants at birth registering an increase. Multi skilling National Board for Health Education, National Evaluation, of doctors in EMOC and LSAS has led to Assessment & Accreditation Committee and National operationalization of First Referral Units providing C- Councils. Section services. Referral Transport for pregnant women has seen considerable progress across States and has Non Communicable Disease: emerged as a key intervention to improve timely access of pregnant women to public health facilities. Family The Ministry of MoHFW has launched two new Planning has again come back to centre stage after several programmes namely (i) The National Programme for decades. Wide political support for voluntary family Prevention and Control of Cancer, Diabetes, CVD and planning has given a new impetus to the Ministry‘s Stroke(NPCDCS) and (ii) The National Programme for initiatives. Health Care of Elderly(NPHCE) to address the menace of Non-Communicable Diseases(NCDs) such as cancer, A name-based tracking of mother and children has been diabetes, cardiovascular diseases and stroke that are major launched whereby pregnant women and children can be factors reducing potentially productive years of human tracked for their Ante-natal Care and immunisation along life and resulting in huge economic loss. Initially, these with a feedback system for the ANM, ASHA etc to two new programmes will be implemented in 100 districts ensure that all pregnant women receive their Ante-Natal of 21 selected states of the country. Care Check-ups (ANCs) and post-natal care (PNCs); and further children receive their full immunisation. All The country is experiencing a rapid health transition with new pregnancies detected are being registered from 1st a rising burden of Non-Communicable Diseases which April, 2010. The states are putting in place systems to are emerging as the leading cause of death in India capture such information on a regular basis. accounting for over 42% of all deaths with considerable loss in potentially productive years of life. The In pursuance of the commitment made by the Government Government of India initiated National Programme for in the address of Hon’ble President of India to the Joint Prevention and Control of Cancer, Diabetes, Session of Parliament on 4th June 2009 an Annual Report Cardiovascular Diseases and Stroke. During the

2 Annual Report 2010-11 remaining part of the 11th Plan, 100 districts across 21 a long way and presently Central Government Health States will be supported under this programme. Main Scheme covers 25 cities. In order to make the CGHS activities would include health promotion, opportunistic user friendly, its functioning has been streamlined and screening of 30+ population and management of common revamped. Important actions in this direction have been NCDs. District Hospitals will be upgraded by setting up the computerisation of the functioning of the CGHS and NCD Clinic, District Cancer Facility and Cardiac care its dispensaries, delegation of enhanced financial powers Units. Besides, 65 Tertiary Cancer Centres will be set to CGHS functionaries and to Ministries / Departments, up to provide comprehensive treatment to common issue of plastic cards to beneficiaries enabling them to cancers across the country. A provision of Rs. 1230 crores take treatment in any dispensary, introduction of direct has been made for this programme during 2011-12. indenting of commonly prescribed medicines by CMOs in charge of dispensaries, empanelment of private In addition, with increasing life expectancy, there is a hospitals and diagnostic centres to provide options, in growing geriatric population who require special health addition to the facilities available in Government hospitals, care. National Programme for Health Care of the Elderly polyclinics and laboratories, outsourcing of sanitary work has also been initiated this year in the same districts. The in dispensaries, outsourcing of dental services, opening programme will provide services to the elderly population of stand-alone dialysis unit in Delhi, appointment of the at various levels. Geriatric Clinic and 10 bedded Geriatric Bill Clearing Agency (BCA) of settlement of bills of wards will be set up in District Hospitals. In addition, 8 hospitals of pensioner beneficiaries treated in hospitals, Regional Geriatric Centres will be set up in selected etc. These measures have resulted in increased medical colleges for tertiary care, training and research satisfaction level of CGHS beneficiaries. activities. A provision of Rs 288 crores has been made during 2010-12. Control of Infectious Disease The Ministry of Health Family Welfare, Government of The upgradation of National Centre for Disease Control India has launched National Programme for Prevention (NCDC) is being taken up to enhance the capabilities of and Control of Deafness (NPPCD) on the pilot phase the Central and State Governments in disease surveillance basis in the year 2006-07(January 2007) covering 25 outbreak investigation and rapid response to disease districts which was extended to another 35 districts, 41 outbreaks. The proposal has been approved by the districts and 75 districts in the year 2008-09, 2009-10 and Cabinet. During the year 2010, about 1000 disease 2010-11 respectively, covering total of 176 districts of 16 outbreaks were reported and responded to under States and 3 UTs. Integrated Disease Surveillance Programme (IDSP). The launch of the dedicated National Tobacco Control Under Externally Aided Projects, scaling up of Long Programme (NTCP) in the 11th Five Year Plan has been Lasting Insecticidal Nets (LLINs), Rapid Diagnostic the major milestone to facilitate the implementation of Tests (RDTs) and Artemisnin Based Combination the tobacco control laws to bring about greater awareness Therapies (ACTs) in high malaria endemic states has about the harmful effects of Tobacco and to fulfil the been taken up. Similarly, for Kala-Azar elimination, RDTs obligation(s) under the WHO-FCTC. The programme and oral drugs are also being scaled up. In view of growing at present is under implementation in 42 districts in 21 threats of other vector-borne diseases like dengue and states in the country. The Global Adult Tobacco Survey chikungunya, institutional surveillance has been (GATS) Report was released by Hon’ble HFM on 19th strengthened and source reduction measures have been October, 2010. An out lay of Rupees 30.00 Crore has taken. In spite of the widespread prevalence of dengue been earmarked for the NTCP in the current financial infection in Delhi before and during Common-wealth year 2010-11, out of which an amount of Rs. 17.17 Crores Games (CWG), members of foreign delegations and other has been spent till date. participants in the CWG were not affected by dengue due to sustained source reduction measures at CWG sites. Central Government Health Scheme The Revised National Tuberculosis Control Programme The Central Government Health Scheme has been in (RNTCP) has moved beyond the case detection rate of existence since 1954, when it started functioning in Delhi. 70% and cure rate of 85% in India and efforts are being The Central Government Health Scheme has since come

Annual Report 2010-11 3 made to further improve the rates. With a view to meeting up to a maximum of Rs.50,000/- is available to the poor the challenge of Multi-Drug Resistant Tuberculosis indigent patients from the Health Minster’s Discretionary (MDR-TB), 43 Culture and Drug Sensitivity Laboratories Grant to defray a part of the expenditure on are being set up and MDR-TB care and management Hospitalization/treatment in Government Hospitals in services scaled up. cases where free medical facilities are not available. The Ministry of Health & Family Welfare is giving financial assistance to the poor patients for treatment at different hospitals in all over the country under the K. Chandramouli following two schemes namely: (i) Rashtriya Arogya Nidhi Secretary (H&FW) and (ii) Health Minister’s Discretionary Grants. Ministry of Health & Family Welfare “Rashtriya Arogya Nidhi is providing financial assistance to patients, living below poverty line, who are suffering from major life threatening diseases to receive medical March 14, 2011 treatment in Government Hospitals. “Financial Assistance New Delhi

4 Annual Report 2010-11 Chapter 1 Organization & Infrastructure

1.1 INTRODUCTION the Department of Health & Family Welfare only facilitates the States in availing of external assistance. In view of the federal nature of the Constitution, areas of All these schemes aim at fulfilling the national commitment operation have been divided between Union Government to improve access to Primary Health Care facilities and State Governments. Seventh Schedule of Constitution describes three exhaustive lists of items, namely, Union keeping in view the needs of rural areas and where the list, State list and Concurrent list. Though some items incidence of disease is high. like Public Health, Hospitals, Sanitation, etc. fall in the The Ministry of Health & Family Welfare comprises the State list, the items having wider ramification at the following four departments, each of which is headed by national level like family welfare and population control, a Secretary to the Government of India:- medical education, prevention of food adulteration, quality control in manufacture of drugs etc. have been included • Department of Health & Family Welfare in the Concurrent list. • Department of AYUSH The Union Ministry of Health & Family Welfare is • Department of Health Research instrumental and responsible for implementation of various programmes on a national scale in the areas of Health • Department of AIDS Control and Family Welfare, prevention and control of major Organograms of the Department of Health & Family communicable diseases and promotion of traditional and Welfare are at Annexure at the end of the Annual Report. indigenous systems of medicines. In addition, the Ministry also assists States in preventing and controlling the spread Directorate General of Health Services (DGHS) is an of seasonal disease outbreaks and epidemics through attached office of the Department of Health & Family technical assistance. Welfare and has subordinate offices spread all over the Expenditure is incurred by Ministry of Health & Family country. The DGHS renders technical advice on all Welfare either directly under Central Schemes or by way medical and public health matters and is involved in the of grants–in–aids to the autonomous/statutory bodies etc. implementation of various health schemes. and NGOs. In addition to the 100% centrally sponsored 1.2 MINISTER IN CHARGE family welfare programme, the Ministry is implementing several World Bank assisted programmes for control of The Ministry of Health and Family Welfare is headed by AIDS, Malaria, Leprosy, Tuberculosis and Blindness in Union Minister of Health and Family Welfare, Shri Ghulam designated areas. Besides, State Health Systems Nabi Azad since 29th May 2009. He is assisted by the Development Projects with World Bank assistance are Ministers of State for Health and Family Welfare – Shri under implementation in various states. The projects are Dinesh Trivedi and Shri S Gandhiselvan. implemented by the respective State Governments and

Shri Ghulam Nabi Azad Shri Dinesh Trivedi Shri S. Gandhiselvan Union Minister of Health and Family Welfare Minister of State for Health and Family Welfare Minister of State for Health and Family Welfare Annual Report 2010-11 5 1.3 ADMINISTRATION (i) General Duty Medical The Department has taken new initiatives and steps to Officer sub-cadre - 2155 ensure that the Government policies and programmes are (ii) Teaching Specialists implemented in a time-bound and efficient manner, as part of Government’s commitment to provide better sub-cadre - 850 healthcare facilities. It has enforced discipline and (iii) Non-Teaching Specialists accountability amongst its officers and staff. sub-cadre - 772 Director (Administration) attends to service related (iv) Public Health Specialists grievances of the staff in the Department of Health and sub-cadre - 078 Family Welfare. Secretary (Health and Family Welfare) also gives personal hearing to staff grievances. In addition to the above there are 19 posts in the Higher Administrative Grade, which are common to all the four Director (Welfare & PG) in the Department is functioning sub cadres. as nodal officer for redressal of public grievances. Under Secretary (Welfare and PG) assists him in the matter. 1.5.1. Recruitment: 1.4 HEALTHY LIFESTYLE CENTRE (YOGA (a) Recruitment of GDMOs: -Dossier of 450 & GYM) candidates has been received from UPSC on the basis A Healthy Lifestyle Centre (Yoga & Gym) duly funded of Combined Medical Service Examination-2009 including by WHO has been functioning in the Ministry since 28th 16 physically handicapped candidates and they were November, 2005. Two well-trained (one male and one allocated to different Ministries/Departments as below: female) Yoga instructors from Morarji Desai National i) Ministry of Railoways - 248 (including 8 PH) Institute of Yoga have been deployed to take yoga classes for male and female employees of the Ministry. ii) Ministry of Defence - 005 (including 1 PH)

1.5 CENTRAL HEALTH SERVICE iii) MCD - 026 (including 1 PH) The Central Health Service was restructured in 1982 to iv) NDMC - 019 provide medical manpower to various participating units like Directorate General of Health Services (DGHS), v) Central Health Service - 152 (including 6 PH) Central Government Health Service (CGHS), Government of National Capital Territory (GNCT) of Delhi, Ministry of Labour, Department of Posts, Assam Government’s policy on reservation for SC, ST, OBC & Rifles, etc. Since inception a number of participating units Physically Handicapped is being followed strictly in the like ESIC, NDMC, MCD, Himachal Pradesh, Manipur, recruitment of Medical Officers of CHS. Tripura, Goa, etc. have formed their own cadres. JIPMER, Puducherry which has become an autonomous body “In order to avoid inordinate delays in issuing offers, w.e.f. 14th July, 2008 has gone out of CHS cadre. The provisional offer of appointment are being issued to the latest in the list of institutions which has gone out of CHS CMSE candidates pending verification of their character cadre is Govt. of NCT of Delhi. Consequent upon the and antecedents from the authorities concerned as per formation of Delhi Health Service 906 posts ( 14 SAG, decision of Committee of Secretaries.” 150-Non-Teaching, 742-GDMO ) belonging to Govt. of 1.5.2. Promotions: NCT of Delhi have been decadred from CHS. At the same time units like CGHS have also expanded. The During the year, the following numbers of promotions Central Health Service now consists of the following four were effected/under process in various sub-cadres of the Sub-cadres and the present strength of each Sub-cadre Central Health Service: is as under:

6 Annual Report 2010-11 Sub- Sr. Designation of posts No. cadre No. G 1. Senior Medical Officers to (Grade Pay Rs. 6600/- in PB-3) to Chief Medical Officers. 01 D (Grade Pay Rs. 7600/- in PB-3) M 2. Chief Medical Officer (Grade Pay Rs. 7600/- in PB-3) to Chief Medical Officer (NFSG)(Regular) O (Grade Pay Rs. 8700/- in PB-4) 89 3. Chief Medical Officer (NFSG) (Grade Pay Rs. 8700/- in PB-4) to Senior Administrative Grade (Grade Pay of Rs. 10000/- in PB-4) 586 T 1. Assistant Professor (Grade Pay Rs. 6600/- in PB-3) to Associate Professor (Grade Pay Rs. 7600/- in PB-3) 55 E A C 2. Associate Professors (Grade Pay Rs. 7600/- in PB-3) to the post of Professor (Grade pay 8700 in PB-4). 34 H I N 3. Professor (Grade Pay Rs. 8700/- in PB-4) Director-Professor(SAG) (Grade Pay Rs. 10000/- in PB-4) 160 G

N 1. Specialist Grade-II (Junior scale) (Grade Pay Rs. 6600/- in PB-3) to Specialist Grade –I 57 O (Grade Pay Rs. 7600/- in PB-3) N 2 Specialist Grade-II (Senior scale) (Grade Pay Rs. 7600/- in PB-3) to Specialist Grade –I T (Grade Pay Rs. 8700/- in PB-4) 17 E 3. Specialist Grade-I officers (Grade Pay Rs. 8700/- in PB-4) promoted to the post of SAG A (Grade Pay Rs. 10000/- in PB-4) under DACP Scheme 219 C 4. A proposal for holding DPC for one post of HAG for 2008- 09 and 5 posts for 2009-10 and 2 H posts for 2010-11 is being sent to UPSC. I 5. Proposal for holding DPC for 1 post of Special DGHS sent to UPSC N G

P 1 Specialists Gr. I officers (Grade Pay Rs. 8700/- in PB-4) to SAG (Grade Pay Rs. 10000/- in PB-4) 14 U B L I C H E L T H

I. Review of CHS-Rules, 1996: A & N Islands could not be filled. Accordingly, from Recruitment Rules, 1996 for Central Health Service has August 2008 onwards, General Duty Medical Officers been revised in consultation with DOP&T and sent to with requisite PG qualification as well as Specialists are UPSC for approval. being deputed to the A & N Islands for a period of 90 days in Specialities of Paediatrics, Medicine, Radiology, II. Posting of doctors to Andaman & Nicobar ENT, and Obstetrics & Gynaecology, Anaesthesia and Islands: Ophthalmology. Requisition for all vacant Non-teaching Despite best efforts on the part of this Ministry, the Specialist CHS posts in A&N Islands have been sent to vacancies of Specialists (Non-Teaching) Sub-Cadre in UPSC with a request to fill up these posts urgently.

Annual Report 2010-11 7 1.5.3. Other Service related matters upgradation of ACRs as per DOP&T’s guidelines are being completed. (i) RTI: The number of RTI cases received in this Division is 548. The process has also been initiated to amend the Dental Posts Recruitments Rules, 1997 to bring them in (ii) Court Cases: There were 79 Court cases conformity with the changes that have since taken place. pending in various CAT/Courts in the beginning of financial year 2010-11. But due to vigorous efforts 1.6 E-Governance Initiatives of the Ministry of by the CHS Division, 14 cases have been disposed Health & FW off by the courts and only 65 cases are pending Health Informatics Division of National Informatics in courts. Centre provides MIS and Computerization support to 1.5.4. Constitution of a Committee for considering Ministry of Health & Family Welfare. More than 1300 the representations of CHS Officers for PCs of the Ministry are connected to the Local Area Upgradation of below bench Mark Grading in the Network (LAN), which in turn, connected to NICNET ACRs: through RF Link and leased line circuits. Salient features of the some of the projects handled by NIC are as follows: Consequent to the instructions contained in Department of Personnel and Training’s O.M. No. 21011/1/ 1.6.1. Web Page 2010-Estt.A dated 13.4.2010 , a Committee under the The updation of Website of the Ministry of Health & Chairmanship of Shri Keshav Desiraju , Additional Family Welfare http://mohfw.nic.in and various other Secretary has been constituted for considering the websites under the Ministry are done on a regular basis, representations of hundreds of CHS officers for as and when the information is provided by the users. upgradation of the below bench mark grading in their Critical information such as notifications of the CGHS, ACRs. Tenders and Advertisements under the Ministry, sanction 1.5.5. Non Medical Scientists 2010-11. details of the Principal Accounts Office & Public Expenditure Management, etc are such areas A proposal has been mooted to amend the ISP Rules, where regular updation takes place. In addition a no. of 1990 to incorporate provisions for inclusion of more posts websites under the MoHFW are being maintained by the within its ambit. Participating Units/Institutes have been respective users on their own. asked to submit proposals in this regard. 1.6.2. Network Maintenance and email, internet A proposal for amendment of UPSC (Exemption from usage Consultation) Regulations, 1958 under Ministry of Health and Family Welfare with the view to do away with the NIC provides new LAN connections; network based Anti- requirement of consultation with the UPSC in the matter virus solution in addition to maintaining existing network of in-situ promotions upto S.IV level has been sent to users. At present over 1300 LAN nodes have been Department of Personnel and Training. provided in the Department of Health & Family Welfare, Directorate General of Health Services and about 100 Action has been taken to fill up Seven posts as S-V level LAN nodes at IRCS Building at Dept of AYUSH. The with UPSC. Pending ACRs and Bio-data are being email and internet usage has grown significantly and collected. officials prefer email communication over other means. 1.5.6. Dental Side - 2010-11 The network maintenance and desktops require constant updation from the operating system service providers and During the year six posts of Dental Surgeons under hence the un-authorized access is controlled effectively. Ministry of Health and Family Welfare have been filled up on regular basis. For one post, administrative formalities 1.6.3. Computerization of Mother and Child are being completed before offer of appointment to be Tracking System (MCTS) issued to recommended candidate by UPSC. It has been decided to have a name-based tracking 13 officers had been considered for promotion to SAG whereby pregnant women and children can be tracked level. 7 were promoted and 6 were not found fit, as for their ANCs and immunisation along with a feedback having below bench mark of ACRs, formalities for system for the ANM, ASHA etc to ensure that all pregnant 8 Annual Report 2010-11 women receive their Ante-Natal Care Check-ups (ANCs) The implementation of the CompDDO package for the and post-natal care (PNCs); and further children receive DDOs of CGHS in Delhi/NCR and 6 cities outside Delhi/ their full immunisation. All new pregnancies detected/ NCR is underway. being registered from 1st December 2009 at the first point of contact of the pregnant mother with the health facility/ The telephone number for the CGHS HELPLINE 011- health provider would be captured as also all Births 66667777 is operational during office hours on all working occurring from 1st December, 2009. The states are putting days and it provides information to the CGHS in place systems to capture such information on a regular beneficiaries. basis. The National Informatics Centre is rolling out their 1.6.5. Intra-Health Portal for the Ministry: software application to other States based on the Gujarat model of e-Mamta. Intrahealth portal is a G2G and G2E application and caters to the needs of employees and Divisions of MoHFW / The master data entry of health facilities is almost DteGHS. It has the following facilities: complete and now states will start entering the names of the mothers and children in the online system. The system 1. Notice Board consisting of circulars/orders issued will help in developing work plan for the ANMs and by various Divisions of MoHFW and DteGHS. ASHAs so as to deliver the health services to all the mothers and children. An offline version of the MCTS 2. Payslips for the employees under Department of system has also been developed for facilities where the Health & FW, AYUSH, DGHS are available online internet connectivity is not there and this can be linked to 3. Office Procedure Automation (OPA) for tracking the online system on a periodic basis. The first cycle of of file movements the system is expected to be completed by March 2011. The URL is http://nrhm-mcts.nic.in . 4. Bulletin Board for exchange of views and comments. 1.6.4. Computerization of Central Govt. Health Scheme (CGHS) 5. Links to various Govt. web-sites. CGHS is high on the agenda of the Government with the 6. Photo gallery relating to important events in Health ultimate objective to provide effective, timely and hassle and FW sector. free healthcare to the CGHS beneficiaries. The computerized system is aimed at computerizing all The portal URL is http://intrahealth.nic.in. functions of the dispensary such as Registration, Doctors’ 1.6.6.Computerisation of Medical Stores prescription, Pharmacy Counter, Stores, Laboratory & Organization (MSO) and General Medical Indent etc. The system has been successfully Stores Depots (GMSDs) implemented in all the 24 cities of CGHS including Delhi/ NCR covering 248 allopathic wellness Centres (WCs). The MSO is a premier organization of the MoHFW, which is involved in procurement and supply of medicines to The introduction of plastic cards for every individual CGHS beneficiary with the barcoded number has been the Central Govt. hospitals across India, CGHS, Para- implemented successfully in Delhi/NCR. Now all the new military forces. MSO does it through its 7 GMSDs located CGHS beneficiary has to have a plastic card in all CGHS across India. Inventory management is therefore, very cities. vital for the MSO so that the medicines are supplied to the indenters in time after proper quality check. Bulk procurement of commonly indented medicines from manufacturers / suppliers has been successfully The web based Inventory management system for the operational in Delhi/NCR and in 6 cities outside Delhi/ MSO & GMSD has been implemented on a full scale NCR. now. All the stakeholders such as MSO, GMSDs, indenters, suppliers; Labs etc are using the online system. The implementation of online MRC Claims module is under The suppliers have been providing the medicine supplies implementation in Delhi/NCR. The AYUSH WCs are with the barcodes (1D) at the tertiary level packaging being computerized in Delhi/NCR and are expected to and secondary level packaging. http:// be completed by March 2011. The URL of the site is http://cghs.nic.in. msotransparent.nic.in Annual Report 2010-11 9 1.6.7. Usage of NIC CompDDO package by 1.PAO(Secretariat) 2.PAO(DteGHS) 3. PAO(Safdarjung various DDOs under the MoHFW Hospital). 4. PAO(Dr RML Hospital) 5. PAO(LHMC) 6. PAO(NCDC) 7. PAO(CGHS) 8. PAO(Mumbai) Composite DDO Package (CompDDO) has been in 9. PAO (Kolkata) 10. PAO(Puducherry) regular usage by Cash(Health) Section, Cash(FW) 11. PAO(Chennai). Section, MoHFW, and Cash Section, DteGHS, Nirman Bhawan, New Delhi, with the technical support from 1.6.10. OncoNET India Project: NIC. The same package has been in use by PPAO, This project envisages connecting of 27 Regional Cancer PAO(Sectt.), PAO(DteGHS), attached with MoHFW/ Centres with associated Peripheral Cancer Centres to DteGHS, Airport Health Office,New Delhi, Rural Health provide early cancer diagnosis/detection, treatment and Training Centre(RHTC),Najafgarh,New Delhi, and follow up for cancer patients. The project has been National Centre for Disease Control(NCDC). implemented successfully in 4 RCCs and 4 PCCs at Recently,the package has also been installed and made present and 3 more sites are under implementation. operational at FSSAI,National Institute of Biologicals,Central Pharmacopia Commission and 1.6.11. Implementation of e-Hospital Solution at the National Institute of Health and FW. The package Sports Injury Centre, Safdarjang Hospital, automates functions of Cash Sections as regards New Delhi: preparation of pay bills, payments of employees’ salaries @NIC - consists of more than 14 core through their bank accounts/ECS, GPF, income tax, etc. The e-Hospital modules that cover major functional areas of the Hospital The staff at all these organizations/sites has been trained viz. Out Patient Department, In Patient Department, to operate the package, and issues that arise from time Casualty, Ward Management, Operation Theatre to time are taken care of by NIC.. Management, Clinic Information, Path Laboratories, 1.6.8. CPGRAMS and E-Service Book Radiology, Blood Bank, MRD, Stores & Inventory control Management, Accounts, Personnel Management have Centralised Public Grievance and Redressal & Monitoring been planned for implementation during this year. System (CPGRAMS) is under implementation in the Implementation support is being provided by NICSI from Ministry and DteGHS. It provides for on-line monitoring, Sep, 2010. processing and disposal of Public Grievances. 1.6.12. Online allotment and Display System of E-service Book project has provision for updation and Central Quota of UG/PG Medical/Dental maintenance of service books of employees seats: electronically. The project is under implementation in the Ministry and DteGHS. DGHS, Ministry of Health & Family Welfare allots 15% of M.B.B.S/B.D.S and 50% M.D/M.S/M.D.S and Post- 1.6.9. Usage of PAO Package of NIC under graduate Diploma seats of recognised Medical Colleges MoHFW to the merit holders as provided by CBSE/AIIMS who PAO-2000 is a software package developed by NIC, conduct competitive examinations on All India basis. The and it monitors details of expenditure by MoHFW, Computerized Allotment and Display System software DteGHS and sub-ordinate organizations through on-line of NIC fully complies with guidelines and orders given transfer of data from various PAOs to PPAO, MoHFW, by Hon’ble Supreme Court of India and various other Nirman Bhawan, New Delhi. The PPAO then transmits High Courts on various occasions over the period of last the compiled data to CGA through the NETWORK for 15 years or so. Salient features of the Scheme are as on-line updation of database at their end. Provision is follows: also there for various reports and queries at different 1.6.13. Under-Graduate Counselling levels. The package is in continued usage by PAOs and PPAO attached with MoHFW / DteGHS and sub- • More than 2250 MBBS and around 200 BDS seats ordinate organizations. are available in 127 colleges across India. All the 11 PAOs attached with MoHFW / DteGHS and • Allotment is done in two or more rounds as per sub-ordinate Organizations have been using the package: court orders.

10 Annual Report 2010-11 • SC, ST, OBC and PH reservations done through accounting matters within the Ministry, as well as to the roster system approved for this purpose. Controller General of Accounts, on whose behalf they function in this Ministry to carry out its designated functions • This system does VC based on-line allotment at under the Allocation of Business Rules. The administration Delhi, Kolkata, Chennai and Mumbai, through of Accounts Officials in Ministry of Health & Family NICNET. Welfare is under the control of the office of the CGA. 1.6.14. Post-Graduate Counselling The Secretary of each Ministry/Department is the Chief • More than 4250 MD/MS/Diploma in 106 disciplines Accounting Authority in Ministry of Health & Family and 154 PG Dental seats in 28 Dental Colleges Welfare. This responsibility is to be discharged by him across India. through and with the help of the Chief Controller of Accounts (CCA) and on the advice of the Financial • Allotment is done in two or more rounds as per court Advisor of the Ministry. The Secretary is responsible for orders. certification of Appropriation Accounts and is answerable • SC, ST, OBC and PH reservations done thro’ roster to Public Accounts Committee and Standing Parliamentary system devised for this purpose. Committee on any observations of the accounts. • This system does VC based on-line allotment at Accounting Set Up In the Ministry: Delhi, Kolkata, Chennai and Mumbai through The Ministry of H&FW has four Departments viz. NICNET. Department of Health & Family Welfare, Department of 1.6.15. Technical Support to AYUSH Ayush (Ayurveda, Yoga, Unani, Sidha & Homeopathy), Department of Health Research & Department of AIDS • NIC AYUSH wing provides necessary IT support Control (NACO). There is a common Accounting Wing including LAN, WAN, web security, anti-virus etc for all the Departments. The Accounting Wing is to all the users of AYUSH at IRCS Building, New functioning under the supervision of a Chief Controller of Delhi. Accounts supported by a Controller of Accounts (CA), 1.6.16.Integrated Disease Surveillance Project Dy. CA and eleven Pay & Accounts Officers (PAOs) (IDSP) and Drawing & Disbursing Officers (DDOs) in the field. The CCA is submitting internal audit observations and NIC has completed establishment of IT centers at all 796 matter related to financial discipline directly to the IDSP sites across the country and handed over the same Secretary in respect of each Department and its to the IDSP wing of NCDC. The URL of the site is http:/ subordinate organizations. The Annual Review Report of /idsp.nic.in. the Internal Audit is also subject to scrutiny by the CGA 1.7 ACCOUNTING ORGANIZATION and Ministry of Finance. The CCA is also entrusted with the responsibility of Budget Division & Official Language As provided in Article 150 of the Constitution, the Division of the Ministry. Accounts of the Union Government, shall be kept in such form as the President of India, may on the advice of In addition, there are fourteen encadred posts of the Comptroller & Auditor General of India prescribe. The Accounts Officers located at various places. There is a Controller General of Accounts (CGA) in the M/o Finance common Internal Audit Wing for all the Departments, shall be responsible to prepare and compile the Annual which carry out the inspection of all the Cheque Drawing Accounts of the Union Government to be laid in and Non-Cheque Drawing Offices, Pr. Accounts Office Parliament. The CGA performs this function through the and all the PAOs. There are 5 Field Inspection Parties Accounts Wing in each Civil Ministry. The Officials of located at Delhi, Chandigarh, Mumbai, Kolkata and Indian Civil Accounts Organization are responsible for Bangaluru. maintenance of Accounts in Ministry of Health & Family Accounting Functions in the Ministry: Welfare. They have dual responsibility of reporting to the Chief Accounting Authority of the Ministry/Department The Accounting function of the Ministry comprises of through the Financial Adviser for administrative and various kinds of daily payments and receipts, compiling

Annual Report 2010-11 11 of daily challans, vouchers, preparation of daily The Right to Information Act, 2005, enacted with a view Expenditures Control Register etc. Monthly expenditure to promote transparency and accountability in the accounts, monthly receipts and monthly net cash flow functioning of the Government by securing to the citizens statements are being prepared for submission to Ministry the right to access the information under the control of of Finance through the CGA’s office. The entire work of public authorities, have already come into effect w.e.f. payment and accounts has been computerized. 12.10.2005. The Pr. Accounts Office prepares Annual Finance Under the Right to information Act, 2005, 32 Central Accounts, Annual Appropriation Accounts, Statement of Public Information Officers( CPIOs) and 17 Appellate Central Transactions, Annual Receipts Budget, Actual Authorities( A/As) have been appointed in the Ministry Receipts and Recovery Statement for each grant of the of Health & Family Welfare (Department of Health & Ministry. The head wise Appropriation Accounts are Family Welfare). submitted to the Parliament by the CGA along with the All CPIOs including autonomous organizations/PSUs have C&AG’s report. placed all obligatory information pertaining to their In addition, the Pr. Accounts Office issues orders of Division/programme, under Section 4(i) of the RTI Act, placement of funds to other civil Ministries, issues advices 2005 in the Website of Ministry. Now RTI Request/ to Reserve Bank of India (RBI) for release of loans/ Appeal Management System (RRAMS) is under grants to State Governments and LOC to the accredited implementing stage. Under this system CPIOs and Bank of the Ministry for placing funds with DDOs. Apart Appellate Authorities (including autonomous from general accounting functions, the Accounts Wing organizations) would create computer Based gives technical advices on various Budgetary, Financial management of RTI requests and appeal. and Accounting matters. Applications under the Act for seeking information are The Accounting Wing also functions as a coordinating accepted at Facilitation Centre, near Gate No.5, Nirman agency on all accounts matters between Ministry and Bhavan & at Coordination-II ( CDN-II) Section, Room the Office of the Controller General Accounts & the No. 215A, ‘D’ Wing, Nirman Bhawan, New Delhi. Comptroller and Auditor General. Similarly it coordinates Applications are also accepted by post through Receipt on all budget matters between Ministry and the Budget & Issue (R&I) Section. During 2009-2010, 1541 Division of the Ministry of Finance. applications and 250 RTI Appeals were received under RTI Act, 2005. Annual return for the year 2009-2010 Internal Audit Wing has already been sent to CIC. During 2010-11, 2419 The Internal Audit Wing of the Department of Health applications and 389 appeals till 31.12.10 have been and Family is handling the internal audit work of all the received. four Departments. There are more than 600 audit units 1.9 VIGILANCE of the Department of Health and Family Welfare, 24 units of Department of AYUSH and 25 units of Department Vigilance Wing of the Department of Health and Family of Health Research. The Internal Audit plays a significant Welfare functions under the overall control of an officer role in assisting the Departments to achieve their aims of the rank of Joint Secretary to the Government of and objectives. India who also works as part time Chief Vigilance Officer (CVO) of the Ministry . The CVO is assisted by a The role of Internal Audit is growing and shifting from part –time Director(Vig.), an Under Secretary(Vig.) and Compliance audit confined to examining the transaction the supporting staff of Vigilance Section. with reference to Government Rules and Regulations to complex auditing techniques of examining the The Vigilance Division of the Ministry deals with vigilance performance and risk factors of an entity. In 2009-10, and disciplinary cases of the Department of Health and 97 audit paras have been raised which include Family Welfare and vigilance cases involving officers of observations to the tune of Rs. 1368.47 crores. A total Dte.GHS and CGHS. The Vigilance wing monitors No. of 851 paras have been settled during 2009-10. vigilance enquiries, disciplinary proceedings in respect of Doctors and non-medical/technical personnel borne on 1.8 IMPLEMENTATION OF RTI ACT, 2005 the Central Health Service (CHS), P&T Dt.GHS

12 Annual Report 2010-11 dispensaries and other institutions like Medical Stores The main function of the Division is to implement the Organizations, Port Health Organizations, Labour Welfare preventive and punitive measures to combat the Organization etc. corruption. Preventive measures adopted are – Examination of Rules and procedure of the organization During 2010-11(till ending December,2010), one charge to eliminate or minimize scope for corruption, identification sheet each for major penalty and minor penalty for alleged of sensitive issues, surprise inspections, surveillance on irregularities were issued. Penalties were imposed in 7 officers and doubtful integrity, scrutiny of property returns cases and charges were dropped in 6 cases. Sanction for etc. prosecution was granted in one case and 2 appeal cases were received/processed. One official was placed under The Division follows rules, regulations and guidelines suspension. Suspension was revoked in 2 cases and issued from time to time in respect of vigilance cases of ongoing cases of suspension were reviewed by the different types and appropriate action is taken in Committee. More than 115 complaints were received from consultation with CVC, UPSC, and DOP&T etc. CVC, 45 miscellaneous complaints were forwarded by wherever necessary. CBI and 75 complaints were received from other sources. 1.10 ACTIVITIES OF THE COMPLAINT 29 references were sent to CVC, 6 to UPSC, 3 references COMMITTEE ON SEXUAL to DOP&T and 6 references were sent to Ministry of HARASSMENT OF WOMEN Law & Justice for advice. Presently there are 2 court EMPLOYEES cases being dealt with in the Division. In pursuance of the directions of Hon’ble supreme Court Central Vigilance Commission guidelines of use in their judgement in the case of Vishakha and other vs. Information Technology for vigilance administration are State of Rajasthan and others, a Complaint Committee being implemented vigorously and major initiatives have has been constituted in the Department of Health & Family been taken regarding use of technology in e-governance Welfare to look into the complaints of sexual harassment for minimising the need of interfacing officials with of women employees in the Department. The SHC is beneficiaries. The entire process of registration of patients, chaired by Smt. Shalini Prasad, Joint Secretary and has maintenance of personal records, prescription, three members Smt. Aparna Sachin Sharma, Smt. Rekha investigation advices, distribution of medicines etc. have Chauhan and Sh. J. P. Pandey. No new case is received been computerised in the CGHS to make the entire for hearing during the period 2010-11. process transparent. In Central Drugs Standard and Control Organization, standard operating procedures and 1.11 PUBLIC GRIEVANCE CELL e-submission has been introduced. The official web-site Public Grievance Redressal Mechanism is functioning in has also been launched giving all details. the Ministry of Health & Family Welfare as well as in Vigilance Division, MOHFW – Organization and the attached offices of the Directorate of Health Services Functions and the other Subordinate offices of CGHS (both in Delhi and other Regions), Central Government Hospitals and The Vigilance Division of the Ministry functions under PSUs falling under the Ministry for implementation of the overall control of the Chief Vigilance Officer (CVO), the various guidelines issued from time to time by the an officer of the rank of Joint Secretary to Government Government of India through the Department of of India, assisted by a Director, an Under Secretary and Administrative Reforms & Public Grievances. a Vigilance Section with supporting staff. The CVO is appointed by the Department with the concurrence of Shri B. Nayak, Joint Secretary in the Department of Chief Vigilance Commission. The CVO is responsible Health & Family Welfare has been designated as Nodal for keeping an eye on the integrity and conduct of public Officer for Public Grievances relating to the Department. servants of the Ministry and also for implementation of Shri R. D. Indora,Under Secretary in the Department of anti corruption measures. He deals with all vigilance Health & Family Welfare is functioning as Public cases and act as a link between the Ministry and agencies Grievance Officer. Similarly other organizations under like CBI, CVC, UPSC, DOP&T, etc. The CVOs of the the Ministry have also senior level officials functioning autonomous organizations and VO’s in attached/ sub- as Public Grievances Officers. ordinate offices under the Ministry are appointed in consultation with CVO. Annual Report 2010-11 13 Pursuant to the instructions of the Govt. for creation of 2. Information and Guidelines to avail of financial Sevottam Compliant system to redress and monitor public assistance from Rashtriya Arogya Nidhi and Health grievances under Results Framework Documents for Minister’s Discretionary Grant. 2010-11 and implementation of Centralised Public 3. Guidelines and instructions regarding issue of NOC Grievance Redress and Monitoring System (CPGRAMS) to Indian Doctors to pursue higher medical studies in the Ministries/Departments, CPGRAMS has been abroad. implemented in the Department, Attached Office, i.e., Directorate General of Health Services,(DteGHS), 4. Information and guidelines relating to CGHS and Central Govt. Health Scheme, and extended to Queries relating to the work of the Ministry. Autonomous Bodies/PSUs. It is being extended to other 5. Receiving Petitions/Suggestions on Public Subordinate Offices of Dte.GHS It is a web based portal Grievances. and a citizen can lodge grievance through this system directly with the concerned Departments. A link of 6. General queries regarding the work of the Ministry CPGRAMS has also been provided on the website of received at the Information and Facilitation Centre the Ministry, i.e., www.mohfw.nic.in. on telephone and personally were disposed of to the satisfaction of all concerned. The number of written Grievance petitions received/ disposed of and pending during 2009 & 2010 are as 1.13. NATIONAL URBAN HEALTH MISSION follows: (NUHM) Year Opening Grievance Grievance Pending The launch of National Rural Health Mission (NRHM) Balance petitions petitions for providing accessible, affordable and accountable received disposed quality health services to the poorest households in the during of during remotest rural regions has changed the health services’ the year the year delivery scenario remarkably in the rural areas of the country, particularly in the high focus/backward States. 2009 102 165 117 150 However, while there is somewhat a uniform public health 2010 150 249 225 174 infrastructure in the rural areas, it is largely non-existent in urban areas except in some large urban centres and metropolitan cities that too mostly focused on reproductive and child health services. Approximately three-quarters The position in regard to grievance received through of urban healthcare is accounted for by private health CPGRAMS is as under (as on 24.01.2011): facilities and therefore, result in substantial out of pocket No. of Disposal Pendency expenses. Grievances received The health indicators for the urban poor are as bad as their rural counterparts and much worse than the urban 2259 1006 1253 average. Poor environmental condition in the slums along with high population density makes them vulnerable to 1.12 INFORMATION & FACILITATION various communicable and vector borne diseases. CENTRE Although, the government has been active in initiating improvements in the living conditions in slums, To strengthen the Public Redressal Mechanism in the unsatisfactory living conditions continue to prevail in most Ministry of Health & Family Welfare, an Information & of the slums. The poor health outcomes can partially be Facilitation Centre is functioning adjacent to Gate No.5, traced to the inadequate services, like water supply and Nirman Bhawan. The Facilitation Center provides the sanitation, and housing facilities. following information to public: The unenviable health indicators of the urban poor along 1. Circulars/ Booklets/ Pamphlets/ Posters/ NGO with not so effective health care service delivery Guidelines and forms for public use. mechanism clearly articulate the need to address the

14 Annual Report 2010-11 growing challenges of urban health in a concerted way. on March 2009 based on the following norms of population Ministry of Health & Family Welfare proposes to launch case load/work load and distance. National Urban Health Mission (NUHM) to address these The population norms for SC/PHC/CHC is as follows : issues with a focus on the slum dwellers and other disadvantaged sections. The proposed NUHM, presently Centre Plain Area Population at consultation stage, aims to improve the health status NormsHilly/ of the urban population by facilitating equitable access to Tribal area quality healthcare with active involvement of the Urban Local Bodies (ULBs) in cities with population of one Sub-Centre 5000 3000 lakh and above and State Capitals. Primary Health Centre (PHC) 30,000 20,000 The NUHM would encourage the participation of the community in planning and management of health care Community Health services. It would promote community leadership in urban Centre (CHC) 1,20,000 80,000 settlements; ensure the participation by creation of community based institutions under the local bodies. It Sub-Centre would proactively reach out to urban poor settlements by Sub-centre is the first peripheral contact point between way of regular outreach sessions and monthly health and Primary Health Care system and the community. It is nutrition day. It would mandate special attention for manned by one Female (ANM) and one Male Health reaching out to other vulnerable sections like construction Worker and one LHV for six such Sub-Centres. Sub- workers, rag pickers, sex workers, brick kiln workers, centres are assigned task relating to maternal and child rickshaw pullers, etc. This could be done through the health, family welfare, nutrition, immunization, diarrhea public healthcare systems or through PPP or other control and control of communicable diseases innovative models deemed suitable by the states. programmes and provided with basic drugs for minor ailments needed for taking care for essential health need Discussions with various stakeholders including the States for women and children. The number of sub-centres and Union Territories, Ministry of Urban Development, functioning in the country present as on March, 2009 is Ministry of Housing and Urban Poverty Alleviation have annexed. been undertaken, to finalise the contours of the Mission and formulation of the framework of its implementation. Govt. of India bears the salary of ANM and LHV besides NHUM would also leverage the reform component of rent liability and contingency whereas, the salary of the JnNURM for promoting public health component among Male Health Worker is borne by the State Governments. Urban Local Bodies. With a view to improving Expenditure per annum for the existing Sub-centres convergence and synergy among various stakeholders, Item Amount NUHM would envisage the active participation of these Salary of ANM and LHVAs per State Govt. pay scale stakeholders in Mission Steering Group, Coordination Rent Rs. 3000 Committees at the national, state and municipal levels. NUHM would also utilize the infrastructure and skill- Medicine To be supplied under RCH Programme sets of other programmes like JnNURM, SJSRY and Contingency Rs. 3200 ICDS etc. to improve the urban health care service Voluntary Worker Rs.1200/- as honorarium delivery system. Under NRHM, Sub-centres are being strengthened by provision of untied funds of Rs.10,000/- per year which 1.14 RURAL HEALTH SERVICES is operated by the ANM and the Sarpanch, supply of The health and family welfare programme in the country allopathic and indigenous medicines and provision of an is being implemented through primary health care system. additional worker (male multipurpose worker or additional In rural areas, primary health care services are provided ANM), Annual maintenance grant of Rs.10,000/- is also through a network of 145894 Sub-centres, 23391 Primary made available to every Sub-centre to undertake and Health Centres and 4510 Community Health Centres as supervise improvement and maintenance of the facility.

Annual Report 2010-11 15 Upgradation of existing Sub-centres, including building the exact requirement of funds in terms of upgrdation of for Sub-centres functioning in rented premises and setting the facility as far as manpower, building, equipments etc. them up as per 2001 census has also been envisaged Funds are being provided every year as requested by the under NRHM. States in their annual Programme Implementation Plan Primary Health Centre (PHC) under NRHM. PHC is the first contact point between village community Strengthening of the Sub-Divisional /Sub-District and and the Medical Officer. It is manned by a Medical District Hospitals Officer and 14 other staff. It acts as a referral Unit for Strengthening of sub-divisional /sub-district and district 6 Sub-Centres and has 4-6 beds for patients. It performs hospitals is an approved activity under NRHM. The funds curative, preventive, promotive and Family Welfare are released to States/UTs Governments as per their services. There are 23391 PHCs functioning in the requirement reflected in their annual PIP. The same is country. examined in this Ministry and funds are released the The PHCs are being strengthened under NRHM to recommendations of NPCC. provide a package of essential public health programmes Indian Public Health Standards (IPHS) and support for outreach services to ensure regular supplies of essential drugs and equipment, round the clock Indian Public Health Standards (IPHS), which detail the services in all PHCs across the country, upgrading single specifications of standards to which institutions of primary doctor PHC to 2 doctors PHC by posting AYUSH health care would have to be raised to so that the citizen practitioners at PHC level, provision of 3 Staff Nurses in is confident of getting public health services in the hospital a phased manner. The States/UTs have to incorporate that can be measured to be of acceptable standards. Indian their proposals and requirement of funds in their Annual Public Health Standards (IPHS for Sub-centres, PHCs, Programme Implementation Plans under NRHM. Untied CHCs, Sub-divisional/Sub-district Hospitals and District Grant of Rs.25,000/- per PHC for local health action and Hospitals lay down Standards not only for personnel and Annual Maintenance Grant of Rs.50,000/- per PHC physical infrastructure, but also for delivery of services, through PHC level Panchayat Committee/Rogi Kalyan and management. A system of performance bench marks Samiti to undertake and supervise improvement and will be introduced to concurrently assess the adherence maintenance of physical infrastructure have been provided. of public hospitals to IPHS, in a transparent manner. Community Health Centre (CHC) Each Hospital would, as part of IPHS, be required to set CHC is established and maintained by the State up a Rogi Kalyan Samitti (RKS)/Hospital Management Governments and as per standards it is supposed to be Committee), which will bring in community control into manned by four Medical specialists i.e. Surgeon, the management of public hospitals. Guidelines for setting Physician, Gynecologist and Pediatrician supported by 21 up of Rogi Kalyan Samiti have been circulated to all paramedical and other staff. It has 30 in-door beds with States/UTs. Based on the registration details of RKSs one OT, X-ray, and Labour Room and Laboratory facilities set up by various States/UTs, funds @ Rs. one lakh per and serves as a referral centre for 4 PHCs. It provides PHC, CHC, Sub-divisional/Sub-district Hospitals and @ facilities for emergency obstaetrics care and specialist Rs.5.00 lakhs per District Hospital have been released consultations. Indian Public Health standards lays down for RKSs to these States/UTs. The objective is to provide that this CHC is to be manned by 6 Medical Specialists sustainable quality care with accountability and peoples including Anaesthetics and an eye surgeon (for 5 CHCs) participation alongwith total transparency. supported by 24 paramedical and other staff with inclusion Mobile Medical Units/Health Camps of two nurse midwives in the present system of seven With the objective to take health care to the door step of nurse midwives. At present 4510 CHCs are functioning the public in the rural areas, especially in under-served in the country. areas, Mobile Medical Units (MMUs), have been For Upgradation of CHCs as per the Indian Pubic Health provided, one per district under NRHM. The States are Standards (IPHS). State/UTs have been requested to however, expected to address the diversity and ensure carry out the facility survey of all CHCs so as to gauge the adoption of more suitable and sustainable model for

16 Annual Report 2010-11 the MMU to suit their local requirements. They are also • Increasing the admission capacity in medical required to plan for long-term sustainability of the colleges for Anaesthesia; intervention. • Reviving the Diploma Course in Anaesthesia; Two kinds of MMUs are envisaged, one with diagnostic • To start one year Certificate Course in Anaesthesia facility for the States other than North-East States, for Medical Officers working in the system at Himachal Pradesh and J&K. In addition, for the North- present to be given by National Board of Eastern States, Himachal Pradesh and J&K, specialized Examination. facilities and services such as X-ray, ECG and ultrasound are proposed to be provided in MMUs due to their difficult • Recognition of five hundred bedded Hospitals to hilly terrain, non-approachability by public transport, long provide the facility for conducting the above course; distances to be covered etc. • Hiring of private practitioners on case-to-case The States are needed to involve District Health Society/ basis. Rogi Kalyan Samiti/NGOs in deciding the appropriate modality for operationalization of the MMUs. The The above recommendation were circulated to All the provision of staff will be considered only for the States State /UT Governments. State/UT Governments have who will run the vehicles with support of NGOs/RKSs taken a number of initiatives to ensure presence of and in case of States out-sourcing the vehicles. States doctors in rural areas such as : are needed to work out numbers of mobile dispensaries/ • Compulsory rural/difficult area posting for admission health camps as a means of mobilizing local communities to post-graduate courses and as a pre-requisite for of health action and for creating demand promotion, foreign assignment or training abroad ; Tackling the problem of lack of manpower in Rural Areas: Compulsory rotation of doctors on completion of prescribed tenure as per classification of locations; The Government is seized of the problem of lack of • skilled manpower in rural health infrastructure. A number Contractual appointment of doctors; of new and innovative steps have been taken by various • Option to forgo non practicing allowance and State/UT Governments to bridge the gap between the undertake practice without compromising on available and required manpower especially for ensuring assigned duties, as per the service rules; offering the availability of Doctors in rural areas. A Task Group incentive in form of allowance etc. constituted under the National Rural Health Mission under the chairmanship of Director General of Health Services • Manning of PHCs by NGOs/ Non Government has recommended the following measures to ensure the Stakeholders; services of doctors in rural areas : • Involvement of Medical colleges. • Increase in the age of retirement of doctors to 65 years preferably with posting near hometown; Apart from doctors, steps have been taken to deploy contractual manpower in all other cadres ie. ANM, • Decentralization of recruitment at district level; MPWs, Pharmacists etc. The funds are being released • Walk-in-interview and contractual appointment of to all States/UTs under NRHM as per their demand doctors; reflected in their NRHM PIPs. There has been significant improvement in manpower after engaging contractual staff • Enhancing the salary for posting in rural areas by under NRHM. one-third;

Annual Report 2010-11 17

Chapter 2 NRHM, Health & Population Policies

2.1 NATIONAL RURAL HEALTH MISSION some of the greatest problems to spend the funds already (NRHM) with them. This is one of the main reasons why a process of reforming and strengthening the state health systems The National Rural Health Mission was launched by the needs to go hand in hand with the increase of fund flows. Hon’ble Prime Minister on 12th April 2005, to provide accessible, affordable and accountable quality health The NRHM is thus also about health sector reform. The services to the poorest households in the remotest rural architectural correction envisaged under NRHM is regions. The detailed Framework for Implementation that organized around five pillars, each of which is made up facilitated a large range of interventions under NRHM of a number of overlapping core strategies. was approved by the Union Cabinet in July 2006. Under a) Increasing Participation and Ownership by the the NRHM, the difficult areas with unsatisfactory health Community: This is sought to be achieved through indicators were classified as special focus States to ensure an increased role for PRIs, the ASHA programme, greatest attention where needed. The thrust of the Mission the village health and sanitation committee, is on establishing a fully functional, community owned, increased public participation in hospital decentralized health delivery system with inter sectoral development committees, district health societies convergence at all levels, to ensure simultaneous action in the district and village health planning efforts and on a wide range of determinants of health like water, by a special community monitoring initiative and sanitation, education, nutrition, social and gender equality. also through a greater space for NGO participation. Institutional integration within the fragmented health sector was expected to provide a focus on outcomes, b) Improved Management Capacity: The core of measured against Indian Public Health Standards for all this is professionalising management by building up health facilities. From narrowly defined schemes, the management and public health skills in the existing NRHM is shifting the focus to a functional health system workforce, supplemented by inculcation of skilled at all levels, from the village to the district. management personnel into the system. The NRHM is about increasing public expenditure on c) Flexible Financing: The central strategy of this health care from the current 0.9% of the GDP to 2 to 3% pillar is the provision of untied funds to every village of the GDP. The corollaries of such a policy directive are health and sanitation committee, to the sub-center, not only has increased Central Government budgetary to the PHC, to the CHC including district hospital. outlay for health, but States are also make a matching increase – at least 10% of the budget annually including d) Innovations in human resources development a 15% contribution into the NRHM plan, and that the for the health sector: The central challenge of center – state financing ratio shifts from the current 80:20 the NRHM is to find definitive answers to the old to at least a 60:40 ratio in this plan period. Another questions about ensuring adequate recruitment for important corollary is that the state health sector develops the public health system and adequate functionality the capacities to absorb such fund flows. There are of those recruited. Contractual appointment route currently many constraints, especially in the High Focus to immediately fill gaps as well as ensure local states to absorb these funds and the poorest performing residency, incentives and innovation to find staff to states which require the largest infusion of resources have work in hitherto underserved areas and the use of

Annual Report 2010-11 19 multi-skilling and multi-tasking options are examples and other Para Medic Staff on contract based on local of other innovations that seek to find new solutions criteria. Even Doctors and Specialists are recruited at to old problems. the district level on contract and based on local criteria. Various form of performance based incentives have been e) Setting of standards and norms with attempted to make money follow the patient and to keep monitoring: The prescription of the IPHS norms the motivation of public health workers in remote areas marks one of the most important core strategies of high. A lot more needs to be done in the sphere for the mission. This has been followed up by a facility performance based incentives in remote and difficult survey to identify gaps and funding is directed to areas in order to ensure availability of skilled human close the gaps so identified. resources where needed. The NRHM approach is summed up in the figures below:

2.1.3. Through formation of registered Societies (Rogi Many path breaking initiatives operationalised Kalyan Samitis) at PHCs, CHCs and District Hospitals, under the NRHM legal entities are created that have far greater flexibility in discharge of their functions. NRHM has provided an 2.1.1. More than 8.3 lakh Accredited Social Health opportunity to provide cashless hospitalised services to Activists (ASHAs) are connecting households to health the poor through the Rogi Kalyan Samiti resources. It facilities. The presence of community volunteers on this has also provided an opportunity to charge a modest fee unprecedented scale has resulted in people’s growing from those who can afford to pay. The Rogi Kalyan pressure on utilization of services from the public sector Samitis have adequate resources for local health action health system. States across the country are reporting and for ensuring a well maintained hospital. Wherever significantly higher utilization of outpatient services, Medical Officers, in-charge of PHCs and CHCs and their diagnostic facilities, institutional deliveries and inpatient RKSs, have taken interest, the face of government hospital care. Large scale demand side financing under the Janani has been transformed with the untied funds available to Suraksha Yojana (JSY) has brought poor households to every institution under NRHM. NRHM is an opportunity public sector health facilities on a scale never witnessed for States to display to the people that fully functional before. Over 348.94 lakh women have been covered quality health care is possible within the existing public under JSY so far since its introduction in 2005. system. 2.1.2. A second ANM in Sub Centres, 3 Nurses in 2.1.4. The untied grants to sub-centres has given a new PHCs for 24X7 services along with diagnostic services, confidence to our ANMs in the field who are far better co-location of AYUSH doctor at PHC and availability of equipped now with Blood Pressure measuring equipment, Specialist Doctors and Nurses on a much larger scale stethoscope, the weighing machine etc. They can actually has been attempted under the NRHM to take undertake a proper ante-natal care and other health care accountability to the people. States are recruiting Nurses services. Sub Centres are now functioning as sub-centres

20 Annual Report 2010-11 providing services of which, many of them were absent by coming to the public system as never before. The on account of lack of regular resources. The constitution challenge of NRHM now is to provide quality health care of the Village Health and Sanitation Committees is taking to the growing number of households whose faith in the a little time in many States as the effort is to set up these government system has been restored. NRHM cannot Committees within the umbrella of Panchayati Raj afford to let down poor households who have come to Institutions. The intention of NRHM is inter-sector the public system with so much hope and aspiration. There convergence and the effort in all the States is to bring is a sense of urgency in improving the facilities for quality Health, Sanitation, Nutrition, Water and Education health care. together on a common platform within the framework of PRIs, at the village level. The untied funds to Village 2.1.8. The journey of NRHM has been crafted by the Committees are a great boon for public health action as responses of the States. It is for the States to decide on was demonstrated in Kerala in Alleppey District where what their priorities are. District and State Programme large scale vector control measures could be taken up Implementation Plans form the basis of approvals. Never with untied funds. before has there been so much flexibility in a programme to suit the diverse needs of States and regions. NRHM 2.1.5. Human Resources is a key issue in the health has set a new standard of partnership with States where sector and, specially, resident health workers in remote it is the States that determine what is needed to resolve areas. Some excellent innovations have been attempted the crisis of the public sector health system. Human in the States to train local women as ANM. West Resources, physical infrastructure, equipment, capacity Bengal’s efforts in this direction has been path breaking building, resources, skill up-gradation resources etc. are where educated women from the 100 most difficult blocks available on an unprecedented scale. The philosophy of of West Bengal are being trained to become ANMs on NRHM is to move from distrust to trust. Within the condition that they go back to the village for performing umbrella of Panchayati Raj Institutions, NRHM has tried duties. The efforts to provide opportunities for ASHAs to formulate an accountability framework that makes and Aanganwadi Workers to become ANMs has also every health facility responsible to the people whose needs been emphasised as ultimately the quest for better health it caters to. Starting from the Village Health and Sanitation care must realize that a locally resident person is the Committees, NRHM has crafted facility specific public best bet to secure a resident health worker. The problems institutions within the framework of PRI to ensure that of absenteeism can be tackled through emphasis on the Health Institutions have the flexibility to deliver in local criteria in such recruitments. partnership with the community. 2.1.6. Many un-served areas have been covered 2.1.9. From the village to the district level all through Mobile Medical Units. The efforts in Gujarat in requirements of the health system can be met through this direction have been commendable. Andhra Pradesh’s the NRHM and States have come up with innovative EMRI system enables people to access well equipped plans to suit their needs. Realizing the need for improved ambulances within no time anywhere in the State. Such management of the Public Sector Health System, NRHM successful models are worthy of replication and NRHM’s has extended management support to States at all levels efforts have been to encourage emulation. Sincere and for all institutions. The thrust on Nursing Institutions, efforts to promote good practices have been made by Nurses and ANMs has been its foremost message to the providing opportunities of all State level teams to visit States considering the need for public sector facilities to such regions that have done good work. There is a lot to provide round the clock services. learn from each other and NRHM promotes the bonding of States through regular inter-State visits to see good 2.1.10. Improved Financial Management: practices. In order to ensure that enhanced fund allocations to 2.1.7. While in some regions government health facilities States/UTs and other institutions under the NRHM are have geared up by utilizing flexible finances under NRHM fully coordinated, managed, and utilized, the Financial to cope with the increased workload, in many other Management Group for NRHM (FMG-NRHM) has been regions there is a long way to go before health facilities set up to operationalize the following financial management fully gear themselves to meet the growing need of people’s arrangements and funds flow processes for release, health care. Poor households have voted with their feet monitoring and utilization of funds under NRHM as per

Annual Report 2010-11 21 recommendations of the Empowered Programme Routine Immunization and (d) National Disease Committee (EPC). Control Programs. Organizational Set up • Monitoring and compilation of Financial Monitoring Reports (FMRs) on quarterly basis. 1. Joint Secretary (Policy) heads the NRHM Division, under him Director, NRHM (Policy) looks after • Claim refund of eligible expenditure from the policy, infrastructure Development, Coordination Development Partners like World Bank, UNFPA, & Human Resource Development functions. DFID etc. 2. NRHM Finance Division under the Director • Statutory Audit arrangements and submission of (NRHM-Finance) is functioning under the direct Audit Reports to Development Partners. control of Special Secretary & Mission Director • Provide Financial Management Formats, monitor (NRHM) and coordinates the financial financial performance indicators and update state- management activities of all NRHM Programmes wise profiles. such as RCH-II, NRHM Additionalities, Routine Immunization and the National Disease Control • Capacity building of finance and accounts personnel Programmes. of States/UTs. 3. NRHM Finance Division is functional since 21.12. • Obtaining UCs for various programs under NRHM. 2006 with ministerial staff i.e Director, Under Generating MIS reports on the basis of FMRs Secretary, Accounts Officer, Section Officer and • received. other financial management staff. The reorganized FMG-NRHM isstaffed also by financial System for Funds Release management personnel on contract basis such as Finance Controllers, Finance Analysts, Financial • Obtaining approval of National Programme Assistants. All sanction orders for release of funds Coordination Committee (NPCC) and under all programmes and pools under NRHM are communicating approved amounts to States/UTs. processed through the FMG. • Release of funds is made on the basis of BEs/REs Objectives of FMG-NRHM approved by the Ministry of Finance, communicated separately to States. • Bring about integration in the financial management of the National Health Programs subsumed under • As per GFRs, up to 75% of the approved BEs are the NRHM. released to States on receipt of provisional UCs/ FMRs for the previous year. • Improve Financial Management Systems at the Centre, State and District levels under the NRHM. • Balance 25% is released after receipt of satisfactory audited accounts with final UCs. • Systematize the funds flow, monitoring utilization, Concurrence of IF is obtained in all cases. accounting and audit of all programmes under NRHM. Training/capacity building of Finance & Accounts Personnel Functions of FMG-NRHM • FMG-NRHM periodically conducts the training of • Release of funds under RCH Flexible Pool and Finance and Accounts personnel of State/District Mission Flexible Pool and clearance of release Health Societies. proposals of all other programmes under NRHM. • State-wise workshops with State Finance and • Centrally transfer funds electronically to State Accounts Managers were organized in August, Health Societies for all programmes under NRHM 2010 to discuss various issues to prepare and update and maintain a centralized data base for all releases the state-wise profiles on financial management. and utilization under all components of NRHM viz. (a) RCH, (b) Additionalities under NRHM, (c) • NRHM Finance Division is actively engaged in preparing E-training Modules, Hand Books for

22 Annual Report 2010-11 State, District and Block level finance personnel Module and 6,75693 up to 2nd Module 6,59037up under NRHM. to 3rd Module, 641421 up to 4th Module and 3,19429 up to 5th Module. • While e-transfers through the accredited bank of the Ministry are taking place to all States, e-banking
5.70 lakhs ASHAs have been provided with drug has been introduced on a pilot basis in Karnataka kit as well. Stae which uses the Core Banking System (CBS) Infrastructure for generation of MIS report to provide information on funds movement, utilization and unspent balances
1.46 lakhs Sub-centres in the country are provided to the management. The Ministry is awaiting the with untied funds of Rs. 10,000 each. 4,82219 Sub- results of the pilot initiated in Karnataka to further centres & VHSC have operational joint accounts implement e-banking in other States/UTs. of ANMs and Pradhans for utilization of annual untied funds. 50,728 Sub-centres are functional with Detailed Operational Guidelines on Financial • second ANM. Management are also being prepared for adoption and implementation at State, District and Block and
Out of 4510 Community Health Centres(CHCs), Village levels under the NRHM to being about 2921 CHCs have been selected for upgradation to efficiency, accuracy and accountability in financial IPHS and facility survey has been completed in processes. 2864 CHCs (includes other also). 2.1.11. Under NRHM, electronic Transfer of Funds
29904 Rogi Kalyan Samitis have been registered (ETF) has been started from GoI to States and also States at different level of facilities. to Districts. This has reduced the time lag in transfer of Manpower funds from 1-2 months to a few hours. E-banking is being operationalized for real time financial reporting and
9856 Doctors and Specialist, 53552 ANMs, 26734 monitoring. Financial Monitoring Reports are now being Staff Nurses,18272 Paramedics have been received from all States. Detailed guidelines for appointed on contract by States to fill in critical Delegation of Administrative & Financial Powers under gaps. NRHM have been given to States. State Finance and Accounts Managers and accounts personnel have been Management Support recruited at State, district and block levels under NRHM.
1784 professionals (CA/MBA/MCA) have been A system for Concurrent Audit has been set up in the appointed in the State and 635 District level SHSs and DHSs. Program Management Units (PMU) and 3529 The National Rural Health Mission represents a major Block level Program Management Units (BPMU) departure from the past, in that central government health have been established to support NRHM. financing is now directed to the development of state Mobile Medical Units health systems rather than being confined to a select number of national health programmes. NRHM is
In 381 districts, the Mobile Medical Units has been therefore, an effort at building a partnership with States operationalised till September,2010. to ensure meaningful reforms with more resources. Immunization Ultimately, success of NRHM will depend on ability of the Mission interventions to galvanize State Governments
Intense monitoring of Polio Progress – Services of into action, pursuing innovations and flexibility in all ASHA useful. spheres of public health action. The progress on several
JE vaccination completed in 11 districts in 4 states key indicators on NRHM has been noticed. – 93 lakh children immunized during 2006-07. JE 2.1.12. Progress under National Rural Health vaccination has been implemented in 26 districts Mission (NRHM) of 10 states in 2007. The 11 districts of 4 states where JE vaccination was carried out in 2006 have ASHAs introduced JE vaccine in Routine Immunization to
Selection of 8,33243 ASHAs have been done in vaccinate new cohort between 1-2 years of age the entire country, out of which 7,82807 up to 1st with booster dose of DPT.

Annual Report 2010-11 23
House tracking of polio cases and intense District and below district level health institutions. monitoring. AYUSH person are part of State Health Mission / Society / RKS / ASHA training as members.
Neonatal Tetanus declared eliminated from 7 states in the country. Trainings
Full immunization coverage evaluated at 43.5% at
Trainings in critical areas including Anesthesia, the national level.(NFHS-III) Skilled Birth Attendance (SBA) taken up for MOs/ ANMs. Integrated Skill Development Training for
Accelerated Immunization Programme taken up for ANMs/ LMV/MOs, Training on Emergency EAG and NE State. Obstetrics care and No Scalpel Vasectomy (NSV) Institutional Delivery for MOs, Professional Development Programme for CMOs is on full swing.
Janani Suraksha Yojana (JSY) is operationalised in all the States, 7.38 lakh women are benefited in
ANM Schools being upgraded in all States. the year 2005-06, 31.58 lakh in 2006-07, 73.28 lakh
New nursing schools taken up. in 2007-08, 90.36 lakh in 2008-2009, 100.78 in the year 2009-2010. Health Resource Centres Neo Natal Care
National Health Systems Resource Centre (NHSRC) set up at the National level.
Integrated Management of Neonatal and Childhood Illnesses (IMNCI) started in 323 districts and
Regional Resource Centre set up for NE. 3,13,783 health personnel trained in IMNCI.
State Resource Centre being set up by States. Convergence Monitoring and Evaluation
Over 35 lakhs in 2006-07, 49 lakhs in 2007-08, 58
Independent evaluation of ASHAs / JSY by lakhs in 2008-2009, 58 lakhs in year 2009-2010, UNFPA / UNICEF / GTZ in 8 States. and 34 lakhs in 2010-11 so far. Monthly Health and Nutrition Days being organized at the village in
Immunization coverage evaluated by UNICEF. various States.
Independent monitoring by identified institutions like
The States have constituted 4,98378 Village Health Institute of Public Auditors of India. and Sanitation Committees. They are being
involved in dealing with disease outbreak. Phase I of community monitoring in 9 states namely Rajasthan, Orissa, Maharashtra, Madhya Pradesh,
Convergence with ICDS/Drinking Water/ Tamil Nadu, Chhattisgarh, Jharkhand, Karnataka Sanitation/NACO/PRIs ground work completed. and Assam has been completed.
School health programmes have been initiated in
Concurrent evaluation by several independent over 26 States. agencies is in progress. Health Action Plans
District wise Annual Health Survey for high focus states are in pipeline. Cabinet approved.
State PIPs have been received from 35 States/UTs during the Plans have been apprised and funds are Surveys being released for the year 2010-11.
NFHS III and DLHS III completed.
The first cut of Integrated District Health Action Plans (IDHAP) has been finalized for 642 districts. Financial Management:-
Mainstreaming of AYUSH Financial Management Group set up under NRHM in the Ministry.
Mainstreaming of AYUSH has been taken up in
the State.14766 AYUSH facilities are available at During the FY 2005-06, out of total allocation of

24 Annual Report 2010-11 Rs. 6,731.16 crore for the ministry, an amount of • Organizing of outreach camps. Rs. 5,862.57 crore was released as part of NRHM. • Incentivizing health workers and pooling of
Against Rs. 9065 crore for NRHM activities during resources. 2006-07, Rs. 7,361.08 crore released. • Cluster based development through Community
During the FY 2007-08, out of total allocation of Health Workers. Rs. 11,010 crore for the ministry, an amount of Rs. 10,189.03 crore was released as part of NRHM. • Creation of separate cadre of Rural Medical Assistance to serve in the conflict prone areas, like
During the FY 2008-09, out of total allocation of Chhattisgarh. Rs. 12,050 crore for the ministry, an amount of Rs. 11,229.47 crore was released as part of NRHM. • Providing reservation of seats in Post Graduation for Medical Studies as an incentive for serving in
During the FY 2009-10, out of total allocation of rural areas. Rs. 14,050 crore for the ministry, an amount of Rs. 11631.39 crore was released as part of NRHM. • Performance based incentives for difficult areas, hard areas, allowances etc. for encouraging doctors
For the FY 2010-11, the total allocation for NRHM and specialists to serve in these areas. is Rs. 15,440 crore for the ministry, an amount of Rs. 4300.13 crore is released so far. • Short term courses for Medical Officers posted in CHCs for comprehensive obstretrics care, 2.1.13. Interventions under NRHM to Address the anesthesis for emergency obstetrics and neo-natal Issues Relating to Left Wing Extremism care. From the directions of the Union Home Minister, 33 High • Providing health care service to inaccessible areas Focus District have been identified by the Planning through Mobile Medical Units. Commission in order to address the critical gaps in these districts in respect of the certain key parameters of the • To increase awareness among women and local concerned Ministries through Integrated Action Plan communities about their health rights and their (IAP) with the support of the respective State public service entitlements. Governments, District Administration, Elected 2.1.14. Supportive Supervision of High Focus Representative and the respective State Holders. An Districts Interministrial Committee has been set up for providing necessary recommendations and suggests possible In order to provide emphasis on evidence based planning, interventions for the purpose of addressing the focused using data triangulation methods in order to include some need of the affected blocks. non-negotiable elements and targeted health outcomes, an attempt has been made to undertake Supportive The necessary steps have been initiated in the Ministry Supervision in 264 pre-identified backward districts for of Health and Family Welfare to fill up the corresponding high focus planning, based on the following criteria:- critical gaps in health infrastructure, human resources, training, immunization, supply of drugs and equipments • 140 backward districts based on ranking of 13 etc. The necessary preventive steps have been formulated indicators from the DLHS III data prepared by the to incentivize the difficult areas. Statistics Division of the Ministry. The indicators inter alia include female literacy, households with The following are some of the Measure taken under low standard of living, percentage of girls married NRHM: below 18 years, use of contraceptives, institutional • A Cadre of supportive and caring ASHA’s created births, full Immunization, proximity to health to stem alienation. facilities, road connectivity etc, among others. • Bridging infrastructure and human resource gaps. • Those districts with SC/ST population above 35%. It is desirable that a certain percentage of allocation • Appointment of Resident Health workers through is earmarked in the District Plans for these pockets local criteria. in the non SC/ST majority districts to minimize

Annual Report 2010-11 25 disparities. Some of the North Eastern States have 2.1.16. Meeting of Inter-Sectoral convergence been excluded in this criterion, as they already have under NRHM with the other departments a high percentage of tribal population and this of the Government of India. earmarking may not be essential. A meeting of the Inter-Sectoral convergence under • 33 highly left wing affected districts as prepared NRHM was held on 7th September, 2010 with the by the Ministry of Home Affairs. departments of HRD, Rural Development, Human and Child Development, Panchayati Raj and the Department The Supportive Supervision intervention consistently of AYUSH. Among the various recommendations of the engages in refinement of the tools and techniques used meetings, one of the recommendations was for better for reporting. It also serves as a channel for horizontal implementations of School Health Programme and Joint communication of ideas and innovations to the state Review of the Programme by the two Ministers. The other through sharing of experiences between consultants. important recommendations include, preparation of Health For the purpose, the Ministry of Health & Family Welfare Education Module for National Literacy Mission; has developed an action oriented monitoring plan in which preparation of Integrated Training Module with inputs from joint teams have been formed to visit the high focus the Ministers of Health (including NACO & AYUSH), districts, in which the Consultants are visiting the states Education, Women and Child Development (WCD), Water in the identified districts and providing assistance to them and Sanitation; preparation of common IEC booklets with for improving the measurable health indicators with the inputs from (including NACO & AYUSH) and objective to bring desired improvements in health preparation of training module for Emergency Medicine indicators. The visits of consultants to the health facilities, for AYUSH doctors at public health facilities; Joint viz. Sub-centers, PHCs/CHCs and DH are relating to Review of the programmes of Health and the Ministry of monitoring of the progress, status and functioning of health Education. facilities in terms of infrastructure, human resources, 2.2. HEALTH POLICY training etc. together with the quality of health care service delivery by interaction with ASHAs, PRIs, Civil The National Health Policy-2002 (NHP-2002) gives prime Society Group etc. importance to ensure a more equitable access to health services across the social and geographical expanse of Consultants interact at various levels such as village, block, the country. The policy outlines the need for improvement district, state and the center. Real time feedback is given in the health status of the people as one of the major to the facility in charge. A detailed report so prepared is thrust areas in the social sector. It focuses on the need shared with district and state authorities and submitted for enhanced funding and organizational restructuring of at respective Programme Directors level for necessary the public health initiatives at national level in order to action. facilitate more equitable access to the health facilities. 2.1.15. Meeting of International Advisory panel on An acceptable standard of good health amongst the NRHM general population of the country is sought to be achieved by increasing access to the decentralized public health A meeting of the International Advisory Panel on NRHM system by establishing new infrastructure in deficient under the chairmanship of the Hon’ble Minister for areas, and by upgrading the infrastructure in the existing th Health & Family Welfare held was on 7 August, 2009. institutions. Emphasis has been given to increase the In this meeting several important issues relating to rural aggregate public health investment through a substantially health were discussed in detail. increased contribution by the Central Government. The last meeting of the Forum held on 4th February, 2010 Priority would be given to preventive and curative had recommended certain issues for implementation. initiatives at the primary health level through increased Among the various recommendations of IAP meeting held sectoral share of allocation. on 7.9.2009 one recommendation was regarding 2.3. NATIONAL COMMISSION ON possibilities to explore the partnership with IAP in POPULATION developing model districts across the country, and adopt the same practices in respect of districts of other States. In pursuance of the objectives of the National Population Policy 2000, the National Commission on Population was

26 Annual Report 2010-11 constituted in May 2000 to review, monitor and give The Registrar General of India (RGI) has been designated directions for the implementation of the National as the Nodal agency. The Mission Steering Group (MSG) Population Policy (NPP), 2000 with a view to meeting of NRHM, in its third meeting had approved the proposal the goals set out in the Policy, to promote inter-sectoral for AHS in 284 EAG districts including Assam. The co-ordination, involve the civil society in planning and Survey is being conducted by RGI at an estimated annual implementation, facilitate initiatives to improve cost of Rs.110 crores. The current status of the Survey performance in the demographically weaker States in is that the field units have been identified, the sample the country and to explore the possibilities of international units selected and the survey schedules/questionnaire cooperation in support of the goals set out in the National finalized in consultation with various stake holders. The Population Policy. survey would be spread over 20252 sampling units in the 9 States and shall cover about 36 lakh households. It is The first meeting of the Commission was held on expected that the first set of results would be available in 22.07.2000 and the then Prime Minister had announced early 2011. the formation of an Empowered Action Group within the Ministry of Health and Family Welfare for paying focused Expert Groups: Five groups of experts were attention to States with deficient national socio- constituted for studying the population profile of the States demographic indices and establishment of National of Bihar, Uttar Pradesh, Rajasthan, Madhya Pradesh and Population Stabilization Fund [Jansankhya Sthirata Kosh] Orissa. The draft reports of the expert groups was to provide a window for canalizing monies from national examined in the Commission for correctness of the voluntary sources to specifically aid projects designed to demographic data and then sent to the concerned five contribute to population stabilization. States for the following: - The National Commission of Population has since been o Commenting on the report of the expert group. reconstituted in April 2005 with 40 members under the o Provide an update on what they are doing for Chairmanship of the Prime Minster. Minister of Health stabilization of population under NRHM. & FW and the Deputy Chairman of the Planning Commission are Vice Chairmen of the Commission. The o Prepare a presentation on their work on Population present membership also includes the Chief Ministers of Stabilization for the next meeting of the NCP. the States of Uttar Pradesh, Madhya Pradesh, Rajasthan, The Commission has been providing policy support to the Bihar, Jharkhand, Kerala and Tamil Nadu. population stabilization efforts under overall framework The reconstituted National Commission on Population had of implementation of NRHM by the states. The decided on the following. Commission has come out with a number of publications in collaboration with Registrar General of India and There should be Annual Health Survey of all • Institute of Economic Growth, which provides valuable districts which could be published annually so that inputs on future demographic trends, challenges and health indicators at district level are periodically suggestive measures for achieving population stabilization published, monitored and compared against as envisaged in NPP 2000 and NRHM goals. benchmarks. The second meeting of the Commission was held on 21st Setting up of five groups of experts for studying • October 2010 under the Chairmanship of Prime Minister. the population profile of the States of Bihar, Uttar The Commission deliberated upon population stabilization Pradesh, Rajasthan, Madhya Pradesh and Orissa issue amongst other issues and after deliberation, the to identify weaknesses in the health delivery Commission adopted the following resolution with broad systems and to suggest measures that would be consensus recommending the key points for the taken to improve the health and demographic status stakeholders as follows: of the States. • According Priority Annual Health Survey: The Ministry is in the process of conducting an Annual Health Survey (AHS) to prepare o Population Stabilization should be accorded high the District Health Profile of all Districts in pursuance to priority. the decisions of the National Commission on Population.

Annual Report 2010-11 27 o Chief Ministers should provide leadership to the o Gender to be included in medical education. promotion of small family norm. o NGOs working among members of Muslim o Social experts, social scientists and communication Community may be actively involved in enhancing experts should be involved. awareness regarding small family norms. o A safe motherhood campaign should be carried out o Emphasis on research to develop more innovative on the lines of pulse polio programme, with focus contraceptives to expand available contraceptive on population issues. choices. • Programmatic Interventions o Availability of funds for heath sector, as well as for family planning should be increased. o IEC Campaign should be revitalized vigorously. 2.4. JANSANKHYA STHIRATA KOSH o Undertake strategy to meet the unmet need for family planning services. The National Population Stabilisation Fund was constituted under the National Commission on Population in July 2000. o Strengthen Public Health services and facilities like Subsequently it was transferred to the Department of clean toilets, water, electricity, etc. Health and Family Welfare in April 2002. It was renamed o Strengthen Post Partum family planning services and reconstituted as Jansankhya Sthirata Kosh (JSK) at all centres where deliveries takes place. under the Societies Registration Act (1860) in June 2003. The General Body of JSK is chaired by the Minister for Focus to be on Delay of age at marriage, delay in o Health and Family Welfare, while the Governing Board birth of first child and promotion of birth spacing is chaired by Secretary (H & FW). The Executive between children. Director is the Chief Executive Officer of the Kosh. Availability of medicines at all Public Health o JSK has undertaken a number of initiatives for population Facilities. stabilization which in brief are as follows: Involve AYUSH Doctors in family planning o GIS Mapping: JSK has taken up the mapping of 485 programmes. districts and its sub divisions in the country through a unique • Inter-Sectoral Co-ordination amalgamation of GIS maps and Census data. The maps identify the basic health infrastructure available and o Ministries of HRD, WCD and Panchayati Raj accessibility in terms of availability of roads. The density should be actively involved in population stabilization of population in each district has now been added as programme. another layer, to provide an in - depth view of the health o Utmost attention to be given for education, services availability in relation to the density of population particularly of girls. in the area. o Education regarding family life including Call Centre: JSK runs a Call Centre (1800-11-6555) to reproductive and sexual health issues at a younger provide reliable and authentic information on issues age be given to adolescents to further related to reproductive and child health. It specifically empowerment of women. cater to adolescents, newly married and about to be married persons from the High Focus states of UP, Bihar, o Interventions to improve nutritional status, MP, Rajasthan, Jharkhand and Chhattisgarh. Till 31st particularly pregnant mothers to be strengthened. October 2010, the Call Centres have received o Institutions and Hospitals run by institutions like ESI, approximately 2,00,000 calls and more than 3,00,000 Railways and Defence Services should be involved enquiries. The maximum numbers of queries being in family planning services. received are on issues related to contraception, pregnancy, sexual health and infertility. Strict quality checks are in • Other Interventions place to ensure high quality service. Extensive publicity o Raising of legal age at marriage of girls to be has been taken up to promote the Call Centre number. considered.

28 Annual Report 2010-11 Prerna Strategy: This strategy identifies and recognizes young married couples from backward districts who have adopted Responsible Parenthood Criteria as role models for other young couples in the district. JSK has instituted Prerna Awards for couples who fulfil basic criteria, which are girls marrying at the age of 19; having first child two years after marriage; and keeping a gap of 3 years between first and second child followed by sterilisation of either parent. The couples are awarded with a certificate and Kisan Vikas Patras at a widely publicized and well attended function in the district. JSK has worked in tandem with Union Ministries/ Departments, district administration, civil society, the community, and corporate Emphasizing the need of population stabilization Shri Azad houses and has identified 378 couples till 31st October reiterated Government’s commitment to promote 2010 to award them with the Prerna Award. population stabilization by making people aware about the Santushti: The Santushti strategy provides private sector benefit of small families and on the need to educate girls. gynaecologists and vasectomy surgeons an opportunity He ruled out coercion completely in the efforts for to conduct sterilisation operations in Public Private population stabilization. Speaking on the occasion, Smt Partnership (PPP) mode under the scheme already Sheila Dikshit stressed the need for empowerment of girls announced by Ministry of Health and Family Welfare in and women to control population growth. The event was September 2007. It offers accredited health facilities a widely covered in both print and electronic media. JSK start up advance for 100 sterilization surgeries and an collaborated with NDTV to highlight Population additional Rs 500 per case to accredited nursing homes Stabilisation efforts of Union Government before a large for conducting 30 sterilization cases in camp mode in a audience through some of its popular shows preceded single day. Under this Scheme, 3331 sterilizations have with week long promos and factoids on the issues. been performed during the period April 2010 to October 2010. Activities in states having high population growth: IUCD 380A: JSK has taken up the promotion of the In partnership with Kendriya Vidyalaya Sangathan and IUCD 380 A as a contraceptive device offering long term DPS society, JSK organized debate, painting and highly effective, reversible protection against pregnancy. photography competition on Population Stabilisation Till dated about 400 senior Obstetricians and themes in schools managed by KVS and DPS Societies Gynaecologists have been trained on NTT for IUCD 380A in states of UP, Bihar, MP, Rajasthan, Jharkhand, Orissa, insertion in different training sessions organized by JSK. Delhi and Chhattisgarh in which approximately 3.5 lakh Presently JSK is pursuing training of more doctors, ANMs children participated. in target States to increase utilization rates of this device. A national level quiz and debate competition was organized Celebration of World Population Day 2010: in Delhi on Population Stabilization for schools from the 6 states. Shri Dinesh Trivedi, the Minister of State for MoHFW, JSK and Govt. of NCT, Delhi jointly organized Health and Family Welfare gave away the prizes to the a run for population stabilization on Raj Path, New Delhi winning teams and participants. on the Population Day in which 3000 adolescents from schools of Delhi participated. In Bihar, competitions were organized in all higher secondary schools in partnership with the State Education The event was flagged up by the Union Minister for Department thereby reaching out to almost 25 lakh Health & Family Welfare, Shri Ghulam Nabi Azad and students. Chief Minister of Delhi, Smt. Shiela Dikshit in presence of Union Minister of State for Health & Family Welfare At university/ higher level institutions, JSK organized and important dignitaries of Govt. of NCT, Delhi. The various competitive events on Population Stabilisation in event was marked with participation of Kumari Saina medical colleges of Bihar and Kalinga Institute of Medical Nehwal, the World acclaimed Badminton star in the run. Sciences (KIMS) Orissa.

Annual Report 2010-11 29 Mid-Media Campaign The Hon’ble Supreme Court of India in its Order dated 1.3.2005 in Civil Writ Petition No. 209/2003 (Ramakant JSK in participation with the Song & Drama Division of Rai V/s Union of India) has, inter alia, directed the Union GOI organized 2000 shows in selected high fertility of India and States/UTs for ensuring enforcement of districts on issues of Population Stabilisation. Union Government’s Guidelines for conducting sterilization Advertisement panels highlighting population issues were procedures and norms for bringing out uniformity with printed and distributed in high fertility states for its display regard of sterilization procedures by - in schools to make the adolescent aware about the impending need of population stabilization. I. Creation of panel of Doctors/health facilities for conducting sterilization procedures and laying down 2.5. FAMILY PLANNING INSURANCE of criteria for empanelment of doctors for SCHEME conducting sterilization procedures. 2.5.1. India is the first country that launched a National II. Laying down of checklist to be followed by every Family Planning Programme in 1952, emphasizing fertility doctor before carrying out sterilization procedure. regulation for reducing birth rates to the extent necessary to stabilize the population at a level consistent with the III. Laying down of uniform proforma for obtaining of socio-economic development and environment protection. consent of person undergoing sterilization. Since then the demographic and health profiles of India have steadily improved. IV. Setting up of Quality Assurance Committee for ensuring enforcement of pre and postoperative 2.5.2. Government of India Scheme to guidelines regarding sterilization procedures. Compensate Acceptors of Sterilization for Loss of Wages: V. Bringing into effect an Insurance Policy uniformly in all States for acceptors of sterilizations etc. With a view to encourage people to adopt permanent method of Family Planning, Government has been The above directions have all been taken into consideration implementing a Centrally Sponsored Scheme since 1981 and consolidated in the updated manuals on Standards to compensate the acceptors of sterilization for the loss and Quality Assurance in Sterilization Services available of wages for the day on which he/she attended the on the Ministry’s website (www.mohfw.nic.in). The medical facility for undergoing sterilization. Family Planning Insurance Scheme is one of the initiatives launched under direction from the Hon’ble Supreme Court Apart from providing for cash compensation to the w.e.f 29th November, 2005. acceptor of sterilization for loss of wages, transportation, diet, drugs, dressing etc. out of the funds released to Under the existing Government Scheme no compensation States/UTs under this scheme, some States/UTs were was payable for failure of sterilization, and no indemnity apportioning some amount for creating a miscellaneous cover was provided to Doctors/Health Facilities providing purpose fund. This fund was utilized for payment of ex- professional services for conducting sterilization gratia to the acceptor of sterilization or his/her nominee procedures etc. There was a great demand in the States in the unlikely event of his/her death or incapacitation or for indemnity insurance cover to Doctors/Health Facilities, for treatment of post operative complications attributable since many Govt Doctors are currently facing litigation to the procedure of sterilization, as under:- due to claims of clients for compensation due to failure of sterilization. This has led to reluctance among the i) Rs. 50,000/- per case of death. Doctors/Health Facilities to conduct sterilization operations. ii) Rs. 30,000/- per case of incapacitation. 2.5.3. First Year of Scheme : With a view to do away iii) Rs.20,000/- per case of cost of treatment of serious with the complicated process of payment of ex-gratia to post operation complication. the acceptors of Sterilisation for treatment of post Any liability in excess of the above limit was to be borne operative Complications, or Death attributable to the by the State/UT/NGO/ Voluntary Organization concerned procedure of sterilization, the Family Planning from their own resources. Insurance Scheme (FPIS) was introduced w.e.f 29th

30 Annual Report 2010-11 November, 2005 with Oriental Insurance Company, The revised package and guidelines are as follows: to take care of the cases of Failure of Sterilization, Section Coverage Limits Medical Complications or Death resulting from I IA Death due to Sterilization Sterilization, and also provide Indemnity Cover to the in hospital or within 7 days Doctor / Health Facility performing Sterilization procedure, from the date of discharge as follows:- from the hospital. Rs. 2 lakh. Section I: IB Death due to Sterilization within 8 - 30 days from the a) Death due to Sterilization in date of discharge from the hospital: Rs.1,00,000/- hospital. Rs. 50,000/-.

b) Death due to Sterilization IC Failure of Sterilisation Rs 25,000/-. within 30 days of discharge ID Cost of treatment upto 60 Actual not from hospital Rs.30,000/- days arising out of Complication exceeding from the date of discharge. Rs 25,000/-. c) Failure of sterilization (including first instance of II Indemnity Insurance per Upto conception after sterilization). Rs.20,000/- Doctor/facility but not more Rs. 2 Lakh than 4 cases in a year. per claim d) Expenses for treatment of medical complications due to sterilization operation (within Total liability of the Insurance Company shall not exceed 60 days of operations Rs.20, 000/-* Rs. 9 crore in a year under each Section.

Total liability of the Insurance Company shall not exceed 2.5.5. Third Year of Scheme : This scheme was Rs. 9 crore in a year under each Section. renewed with ICICI Lombard Insurance Company and (*To be reimbursed on the basis of actual expenditure incurred, improved w.e.f. 01-01-08 with modification in the limits and payment procedure based on 50 lakh sterilization not exceeding Rs.20, 000.) accepters. The revised packages are as follows: Section II: All the doctors/health facilities including Section Coverage Limits doctors/health facilities of Central, State, Local-Self IADeath due to Sterilization in Governments, other public sectors and all the accredited hospital or within 7 days from doctors/health facilities of non-government and private the date of discharge from the sectors rendering Family Planning Services conducting hospital. Rs. 2 lakh. such operations shall stand indemnified against the claims B Death due to Sterilization arising out of failure of sterilization, death or medical within 8 -30 days from the complication resulting therefrom upto a maximum amount date of discharge from the hospital. Rs. 50,000 of Rs. 2 lakh per doctor/health facility per case, maximum upto 4 cases per year. The cover would also include the C Failure of Sterilization Rs 30,000 legal costs and actual modality of defending the D Cost of treatment upto 60 Actual not prosecuted doctor/health facility in Court, which would days arising out of Complication exceeding be borne by the Insurance Company within certain limits. from the date of discharge. Rs 25,000/-. 2.5.4. Second Year of Scheme : This scheme was II Indemnity Insurance per Upto Rs.2 Doctor/facility but not more Lakh per renewed with Oriental Insurance Company w.e.f. than 4 cases in a year. claim 29-11-06 with modification in the limits and payment procedure. Total liability of the insurance Company shall not exceed Rs. 9 crore in a year under each Section.

Annual Report 2010-11 31 For the policy period of 1/1/2008 to 31/12/2008 an amount For the policy period of 1/1/2010 to 31/12/2010 an amount of Rs. 31741700 was paid as premium. 3786 claims, of Rs. 143390000 was paid as premium. 3132 claims, amounting to Rs. 13.63 crore was paid. Out of which Rs. amounting to Rs.10.73 crore was paid by the ICICI upto 9.00 crore was paid by ICICI and Rs. 4.63 crore was Nov, 2010. paid by the Ministry for claims in excess of Insures liability of Rs. 9.00 crore upto Nov, 2010. 2.5.8. Sixth Year of Scheme : This Scheme is renewed 2.5.6. Fourth Year of Scheme : This scheme was with ICICI Lombard Insurance Company w.e.f. renewed with ICICI Lombard Insurance Company based 01.01.2011 based on 50 lakh sterilization accepters; on 45 lakh sterilization accepter’s w.e.f. 01-01-09 with however, total Liability of the Insurance Company is modification in procedure as follows: amended and shall not exceed Rs. 25.00 crore under Section-I Rs. 1.00 crore under Section-II. A Premium Section Coverage Limits amounting Rs. 25,90,05,000 including service tax is paid on 31/12/2010. The benefit under the policy is as follows: I A Death following Sterilization in hospital or within 7 days from Section Coverage Limits the date of discharge from the hospital. Rs. 2 lakh I A Death following Sterilization in B Death following Sterilization hospital (inclusive of death during within 8-30 days from the date process of sterilization operation) or of discharge from the within 7 days from the date of hospital. Rs. 50,000 discharge from the hospital. Rs. 2 lakh C Failure of Sterilization Rs. 30,000 B Death following Sterilization within 8-30 days from the date of D Cost of treatment upto Actual not discharge from the hospital Rs. 50,000 60 days arising out of exceeding complication from the Rs 25,000/- C Failure of Sterilization Rs. 30,000 date of discharge. II Indemnity Insurance per Upto Rs. 2 D Cost of treatment upto 60 days Actual not Doctor/facility but not more Lakh arising out of complication exceeding than 4 cases in a year. per claim following sterilization operation Rs. 25,000 (inclusive of complication during process of sterilization operation) Total liability of the insurance Company shall not exceed from the date of discharge. Rs. 9 crore in a year under each Section. II Indemnity Insurance per Up-to Rs. 2 Doctor/facility but not more lakh per claim For the policy period of 1/1/2009 to 31/12/2009 an amount than 4 cases in a year. of Rs. 49297951 was paid as premium. 3821 claims, amounting to Rs. 14.40 crore was paid. Out of which Note: The Liability of the insurance Company shall not exceed Rs. 9.00 crore was paid by ICICI and Rs. 5.40 crore Rs. 25.00 crore in a year under Section I and Rs. 1.00 crore under Section II. was paid by the Ministry for claims in excess of Insures liability of Rs. 9.00 crore upto Nov, 2010. 2.6. COMPENSATION FOR ACCEPTORS OF 2.5.7. Fifth Year of Scheme : This scheme was STERILIZATION renewed with ICICI Lombard Insurance Company w.e.f. With a view to encourage people to adopt permanent 01-01-10 with all benefits available as mentioned under method of Family Planning, Government has been Policy-2009 above based on 50 lakh sterilization accepters; implementing a Centrally Sponsored Scheme since 1981 however, total Liability of the Insurance Company was to compensate the acceptors of sterilization for the loss amended and shall not exceed Rs. 14.00 crore in total of wages for the day on which he/she attended the inclusive of both under Section-I & II instead of Rs. 9.00 medical facility for undergoing sterilization. crore under each Section.

32 Annual Report 2010-11 Under the Scheme, compensation for loss of wages to and to Rs.1500/- for both Vasectomy and Tubectomy in acceptors of sterilization was revised with effect from accredited private health facilities to all categories in High 31.1-.2006 and has been further improved with effect Focus States and BPL/ SC/ST in Non- High Focus States from 7.9.07 .Revision in the compensation package to with categorization of population as BPL, SC/ST and boost to male participation in family planning i.e. Above Poverty Line (APL) and health facilities at public/ Vasectomy from existing Rs.800/- to Rs.1500/- and accredited private institutions has been approved. The Tubectomy from Rs.800/- to Rs.1000/- in public facilities details of the revised scheme are as under:- A. Public (Government) Facilities:

Category Breakage of Acceptor Motivator Drugs and Surgeon Anaesthetist Staff OT / Refresh- Camp- Total the dressings charges nurse technician ment manage Compensation helper ment package

*High Vasectomy 1100 200 50 100 - 15 15 10 10 1500 focus (ALL) 18 States Tubectomy (ALL) 600 150 100 75 25 15 15 10 10 1000

**Non Vasectomy 1100 200 50 100 - 15 15 10 10 1500 High focus (ALL) 17 States/UTs Tubectomy (BPL + SC/ST only)) 600 150 100 75 25 15 15 10 10 1000

**Non Tubectomy 250 150 100 75 25 15 15 10 10 650 High (NON BPL + focus NON SC/ST 17 States/ only) i.e. APL UTs.

B. Accredited Private/NGO Facilities:

Category Type of operation Facility Motivator Total

*High focus 18 States Vasectomy(ALL) 1300 200 1500

Tubectomy(ALL) 1350 150 1500

**Non High focus Vasectomy (ALL) 1300 200 1500

17 States/UTs. Tubectomy (BPL + SC/ST) 1350 150 1500

Annual Report 2010-11 33 *High Focus States- Bihar, Uttar Pradesh, Madhya The states which are implementing the Health Insurance Pradesh, Rajasthan, Jharkhand, Chattisgarh, Uttrakhand, scheme for BPL population within the NRHM Orissa, Jammu & Kashmir, Himachal Pradesh, Assam, framework, however, piloted and based on the local needs Arunachal Pradesh, Manipur, Mizoram, Meghalaya, are as under: Nagaland, Tripura, Sikkim. Din Dayal Antyoday Upchar Yojana - Madhya **Non-High Focus States- Karnataka, Kerala,Tamil Pradesh Nadu, Andhra Pradesh, Maharashtra, Goa, Gujarat, The Government of Madhya Pradesh is providing free Punjab, Haryana, West Bengal, Delhi, Chandigarh, treatment and investigation facility on hospitalization and Puducherry, Andaman & Nicobar Islands, Lakshadweep investigation facility on hospitalization without any & Minicoy Islands, Dadra & Nagar Haveli, Daman & exclusion up to a limit of Rs. 20,000/- per family per annum Diu. in all government health facilities to the under privileged section of the society i.e. 57 lakh BPL families and 10 No apportioning of the above amount is admissible for creating a miscellaneous purpose fund for payment of lakh other families under Din Dayal Antyoday Upchar th compensation in case of deaths, complications and failures Yojana from 25 September 2004. The benefit is provided as these are already covered under the National Family for all disease and conditions including delivery, without Planning Insurance Scheme. any exclusion. The Department of Public Health and Family Welfare, Government of MP is the Implementing 2.7. HEALTH INSURANCE SCHEME Agency for the Scheme in the state. The average benefit availed is under Rs. 1,000/- per family per annum. A Task Force was established by the MOHFW to explore Mukhya Mantri Raksha Kosh for BPL new health financing mechanisms. The terms of reference Population ñ Rajasthan for this task force included review of existing mechanisms to include health financing, human resource implications Government of Rajasthan has launched the Mukhya to manage health financing and risk pooling schemes, Mantri Jeevan Raksha Kosh with effect from January 1, extent of subsidies required, ensuring equity and non- 2009 and is being implemented to provide free in-patient discrimination, feasibility in various states, suggested care and out-patient care to BPL families. BPL card design of pilots and sites to launch community based health holder will get cash less health care facilities in Medical insurance models, and required modifications of existing Colleges, District hospitals and CHCs of the district for structures to introduce health financing schemes. inpatient care for any ailment and OPD care. Further, if high end care facility not available in the state for such This Ministry had advised the State/UT Governments to ailment, they shall be sent out of the state to AIIMS, New prepare Health Insurance models as per their local Delhi or PGI, Chandigarh for such treatment. prepare Health Insurance models as per their local needs to be run on pilot basis and certain guidelines were sent 2.8. HEALTH MINISTERíS to all States/UTs for preparation of pilot projects on Health DISCRETIONARY GRANT Insurance. Government of India will provide support to State Governments under National Rural Health Mission. Financial assistance up to maximum of Rs.50,000/- is The support from Government of India, for paying available to the poor indigent patients from the Health premium for the Health Insurance Scheme for the BPL Minister’s Discretionary Grant to defray a part of the families has been fixed as per Universal Health Insurance expenditure on Hospitalization/treatment in Government Scheme of the Ministry of Finance, at Rs. 300/- for a Hospitals in cases where free medical facilities are not family of five.

34 Annual Report 2010-11 available. The assistance is provided for treatment of life RIMS, Imphal and NEIGRIHMS, Shillong have been threatening diseases i.e. Heart, Cancer, Kidney, Brain- provided with a revolving fund of Rs.10-40 lakhs. The tumor etc.. During the year 2009-10, financial assistance revolving fund is replenished after its utilization. For cases totaling Rs.30.80 lakh was given to 167 patients. A requiring financial assistance above the Rs.1.00 lakh per provision of Rs.100.00 lakh has been made during the case the applications are processed in the Department of current financial year 2010-11. Till 3rd 0January, 2011, a Health & Family Welfare through a Technical Committee sum of Rs.71.20 lakh has been released to 198 patients. headed by Special Director General (ME), DGHS before being considered for approval by a duly constituted 2.9. RASHTRIYA AROGYA NIDHI (RAN) Managing Committee with Hon’ble Minister for Health & Family Welfare as the Chairman. During the year 2009- Rashtriya Arogya Nidhi was set up under Ministry of 10, financial assistance totalling Rs.710.69 lakh was given Health & Family Welfare in 1997 to provide financial directly to 228 patients under Rashtriya Arogya Nidhi assistance to patients, living below poverty line, who are (Central fund) and further, the revolving fund of amount suffering from major life threatening diseases to receive Rs.325.00 lakhs has been given to the above Hospitals/ medical treatment in Government Hospitals. Under the Institutes. A provision of Rs.700.00 lakh has been made scheme of Rashtriya Arogya Nidhi, grants-in-aid is also during the current financial year 2010-11. Till 3rd January, provided to State Governments for setting up State Illness 2011, a sum of Rs.599.63 lakh has been released to 200 Assistance Funds. Such funds have been set up by the patients, and further, revolving fund of amount Rs.130.00 Governments of Andhra Pradesh, Bihar, Chhattisgarh, lakh has been released to the above Hospitals/ Institutes. Goa, Gujarat, Himachal Pradesh, Jammu & Kashmir, Karnataka, Kerala, Madhya Pradesh, Jharkhand, 2.10. HEALTH MINISTERíS CANCER Maharashtra, Mizoram, Rajasthan, Sikkim, Tamil Nadu, PATIENT FUND Tripura, West Bengal, Uttarakhand, Haryana, Punjab, Uttar Pradesh, NCT of Delhi and Puducherry. The “Health Minister’s Cancer Patient Fund” (HMCPF) Grants-in-aid released to these Funds are at Table-A. within the Rashtriya Arogya Nidhi (RAN) has also been Other States/Union Territories have been requested to set up in 2009. In order to utilize the HMCPF, the set up such Fund, as soon as possible. revolving fund as under RAN, has been established in the various Regional Cancer Centre(s) (RCCs). Such step Applications for financial assistance up to Rs.1.5 lakh would ensure and speed up financial assistance to needy are to be processed and sanctioned by the respective cancer patients and would help to fulfill the objective of State Illness Assistance Fund. Applications for assistance HMCPF. The financial assistance to the cancer patient beyond Rs.1.50 lakh and also of those where State Illness up to Rs.1.00 lakh would be processed by the concerned Assistance Fund has not been set up are processed in Institute on whose disposal the revolving fund has been this Department for release from the Rashtriya Arogya placed. Individual cases which require assistance more Nidhi. than Rs.1.00 lakh but not exceeding Rs.1.50 lakh is to be sent to the concerned State Illness Assistance Fund of In order to provide immediate financial assistance, to the the State/UT to which the applicant belongs or to this extent of Rs.1.00 lakh per case, to critically ill, poor Ministry in case no such scheme is in existence in the patients, who are living below poverty line (BPL) and respective State or the amount is more than Rs.1.50 lakh. undergoing treatment, the Medical Superintendents of Dr. Initially, 27 Regional Cancer Centres (RCC) were RML Hospital, Safdarjung Hospital, Smt. Sucheta Kriplani proposed at whose on proposal revolving fund of Rs.10.00 Hospital, All India Institute of Medical Sciences, New lakh was placed (List of RCCs is at Table B & C). Delhi, PGIMER, Chandigarh, JIPMER, Puducherry, During the current financial year 2010-11 i.e. till 3rd NIMHANS, Bangalore, CNCI, Kolkatta, Sanjay Gandhi January, 2011, a sum of Rs.270.00 lakh have also been Post Graduate Institute of Medical Sciences, Lucknow, released to 14 Regional Cancer Centres.

Annual Report 2010-11 35 Year-wise Budget Estimate State/UT amount to Jammu & Kashmir 0.24 which grant was released (Rs. in crore) Kerala 1.00 TABLE-A Rajasthan 1.01 NCT of Delhi 0.50 Year Budget State/ UTs. Amount Estimate (to which (Rs. in 2004-05 3.20 Chhattisgarh 2.05 (B.E) grant crore) Karnataka 1.00 (Rs. in released) Goa 0.90 crore) NCT of Delhi 0.25 1996-97 25.00 Karnataka 5.00 Pondicherry 0.25 Madhya Pradesh 5.00 Tripura 2.00 2005-06 3.00 Rajasthan 1.00 NCT of Delhi 0.50 Mizoram 0.15 Tamil Nadu 1.05 1997-98 25.00 Andhra Pradesh 5.00 Haryana 0.50 Tamil Nadu 5.00 NCT of Delhi 0.30 Himachal Pradesh 0.25 Jammu & Kashmir 0.25 2006-07 3.00 Andhra Pradesh 0.65 NCT of Delhi 0.25 Jammu & Kashmir 0.125 Kerala 0.275 1998-99 25.00 Maharashtra 2.00 Tamil Nadu 0.95 West Bengal 0.50 Rajasthan 1.00 Kerala 1.00 NCT of Delhi 0.25 Mizoram 0.50 Rajasthan 1.00 2007-08 5.00 West Bengal 1.1025 NCT of Delhi 0.50 Goa 0.30 Himachal Pradesh 0.27 1999-2000 25.00 Goa 0.15 Madhya Pradesh 0.8750 Gujarat 1.00 Rajasthan 1.00 Rajasthan 1.00 Punjab 0.4525 NCT of Delhi 0.70 2000-01 6.50 Sikkim 0.25 Puducherry 0.25 Rajasthan 0.50 J & K 0.125 2008-09 5.00 Punjab 0.0475 Bihar 1.25 Kerala 2.00 Goa 0.15 Uttar Pradesh 2.50 Goa 0.30 2001-02 4.00 Chhattisgarh 0.50 Sikkim 0.4750 Andhra Pradesh 2.50 2009-10 5.00 West Bengal 2.156 2002-03 2.80 NCT of Delhi 0.40 Chhattisgarh 1.8750 Jharkhand 1.50 Haryana 0.25 Rajasthan 1.00 2010-11 5.00 Tamil Nadu 2.50 2003-04 3.50 Uttaranchal 0.25 Goa 0.25 2003-04 3.50 Uttaranchal 0.25 West Bengal 1.25 Jharkhand 0.50 Haryana 0.25

36 Annual Report 2010-11 List of 27 Regional Cancer Centre and Financial 17 Puducherry Regional Cancer Assistance provided to them during the year 2009-2010 Society, JIPMER, Puducherry 10.00 from Health Minister Cancer Patient Fund (HMCPF) within Rashtriya Arogya Nidhi (RAN) Scheme are given 18 Dr. B.B. Cancer Institute, below. Guwahati, Assam 10.00 List of 27 Regional Cancer Centre(s) 19 Tata Memorial Hospital, TABLE-B Mumbai, Maharashtra 10.00 Sl. Name of Institute Rs. in 20 Indira Gandhi Institute of No lakh Medical Sciences, Patna, Bihar 10.00 1. Chittaranjan National Cancer Institute, 21 Acharya Tulsi Regional Kolkata, West Bengal 30.00 Cancer Trust & Research Institute (RCC), Bikaner, Rajasthan. 10.00 2 Kidwai Memorial Institute of Oncology, Bangalore, Karnataka 10.00 22 Regional Cancer Centre, Pt. B.D.Sharma Post Graduate 3. Regional Cancer Institute (WIA), Institute of Medical Sciences, Adyar, Chennai, Tamil Nadu 20.00 Rotan, Haryana. 10.00 4 Acharya Harihar Regional Cancer 23 Regional Cancer Centre, Centre for Cancer Research & Pt. B.D.Sharma Post Graduate Treatment, Cuttack, Orissa. 10.00 Institute of Medical Sciences, Rotan, Haryana. 10.00 5 Regional Cancer Control Society, Shimla, Himachal Pradesh 10.00 24 Civil Hospital, Aizawl, Mizoram 10.00 6 Cancer Hospital & Research 25 Sanjay Gandhi Post Graduate Institute Centre, Gwalior, Madhya Pradesh 10.00 of Medical Sciences,Lucknow 10.00 7 Indian Rotary Cancer Institute, 26 Kamala Nehru Memorial Hospital, (AIIMS), New Delhi 10.00 Allahabad, Uttar Pradesh 10.00 8 R.S.T. Hospital & Research Centre, 27 Govt. Arignar Anna Memorial Nagpur, Maharashtra 10.00 Cancer Hospital, Kancheepuram, Tamil Nadu. 10.00 9 Pt. J.N.M. Medical College, Raipur, Chhattisgarh. 10.00 Total = Rs.280.00 lakh released in 2009-10 10 Post Graduate Institute of *Fund is yet to be released. Medical Education & Research, Chandigarh 10.00 TABLE-C 11 Sher-I Kashmir Institute of List of Regional Cancer Centres and Financial Assistance Medical Sciences, Soura, Srinagar. 10.00 provided to them during the year 2010ó2011 from (HMCPF within RAN) Scheme, are given below. 12 Regional Institute of Medical Sciences, Manipur, Imphal 10.00 (in Rs. lakh)

13 Govt. Medical College & Associated 1. Director, CNCI, Kolkata Rs .60.00 Hospital, Bakshi Nagar,Jammu 10.00 2. Chief, AIIMS, New Delhi Rs. 30.00 14 Regional Cancer Centre, Thiruvananthapuram, Kerala 10.00 3. Director, RCC, Kerala Rs. 40.00 15 Gujarat Cancer Research Institute, 4. Med. Supdt., Rogi Kalyan Samiti, Shimla Rs. 20.00 Ahmedabad, Gujarat 10.00 5. Med. Supdt.,Civil Hos. Aizawl, Mizoram Rs. 20.00 16 MNJ Institute of Oncology, 6. Med. Supdt., Agartala, Tripura Rs.20.00 Hyderabad, Andhra Pradesh 10.00

Annual Report 2010-11 37 7. Med.Supdt., JIPMER, Puducherry Rs.10.00 population. Easy availability of the sex determination tests and abortion services may also be proving to be catalyst 8. Director & Dean, Chennai Rs.10.00 in the process, which may be further stimulated by pre- 9. Hon. Director, Ahmedabad.(Gujarat.) Rs.10.00 conception sex selection facilities. 10. Tata Memo.Centre, Mumbai Rs.10.00 Sex determination techniques have been in use in India 11. Director, Bangaluru Rs.10.00 since 1975 primarily for the determination of genetic abnormalities. However, these techniques were widely 12. Med. Supdt. Kamala Nehru Memorial misused to determine the sex of the foetus and subsequent Hospital, Allahabad. (Uttar Pradesh) Rs. 10.00 abortions if the foetus was found to be female. 13 MS, PGIMER, Chandigarh Rs.10.00 In order to check female foeticide, the Pre-natal Diagnostic Techniques (Regulation and Prevention of 14 Director, RCC Raipur, Chhattisgarh Rs.10.00 Misuse) Act, 1994, was brought into operation from 1st Total= Rs.270.00 lakh January, 1996. The Pre-natal Diagnostic Techniques (as on 03.01.11) (Regulation and Prevention of Misuse) Act, 1994 has since been amended to make it more comprehensive. The 2.11. PRE- CONCEPTION AND PRE-NATAL amended Act and Rules came into force with effect from DIAGNOSTIC TECHNIQUES 14.2.2003 and the PNDT Act has been renamed as “Pre- (PROHIBITION OF SEX SELECTION) conception and Pre-Natal Diagnostic Techniques ACT, 1994. (Prohibition of Sex Selection) Act, 1994” to make it more comprehensive. Adverse Child Sex-Ratio in India The technique of pre-conception sex selection has been Sex ratio (number of females per thousand males) is one brought within the ambit of this Act so as to pre-empt the of the most important indicators used for study of use of such technologies which significantly contribute population characteristics. The declining trend in sex ratio to the declining sex ratio. Use of ultrasound machines has been a matter of concern for all in the country. Sex has also been brought within the purview of this Act more ratio in India has declined over the century from 972 in explicitly so as to curb their misuse for detection and 1901 to 927 in 1991. The sex ratio has since gone up to disclosure of sex of the foetus lest it should lead to female 933 in 2001. foeticide. The Central Supervisory Board (CSB) In contrast the child sex ratio for the age group of 0-6 constituted under the Chairmanship of Minister for Health years in 2001census was 927 girls per thousand boys as and Family Welfare has been further empowered for against 945 recorded in 1991 Census. The encouraging monitoring the implementation of the Act. State level trend in the sex ratio during 1991-2001 was marred by Supervisory Boards on the line of the CSB constituted the decline of 18 points in the sex ratio of children aged 6 at the Centre have been introduced for monitoring and years or below. reviewing the implementation of the Act in States/UTs. The State/UT level Appropriate Authority has been made The Census 2001 figures further reveal that the child sex a multi member body for better implementation and ratio is comparatively lower in the affluent regions, i.e., monitoring of the Act in the States. More stringent Punjab (798), Haryana (819), Chandigarh (845), Delhi punishments are prescribed under the Act so as to serve (868), Gujarat (883), Himachal Pradesh (896) and as a deterrent for minimizing violations of the Act. Rajasthan (909). (These are the seven focus States/ Appropriate Authorities are empowered with the powers UTs for purposes of the PC&PNDT Act, 1994). of Civil Court for search, seizure and sealing the machines, Some of the reasons commonly put forward to explain equipments and records of the violators of law including the consistently low levels of sex ratio are son preference, sealing of premises and commissioning of witnesses. It neglect of the girl child resulting in higher mortality at has been made mandatory to maintain proper records in younger age, female infanticide, female foeticide, higher respect of the use of ultrasound machines and other maternal mortality and male bias in enumeration of equipments capable of detection of sex of foetus and also in respect of tests and procedures that may lead to pre-

38 Annual Report 2010-11 conception selection of sex. The sale of ultrasound generation activities like organising exhibitions, seminars, machines has been regulated through laying down the workshops, trainings / orientations programmes for PRIs, condition of sale only to the bodies registered under the public meetings, debates, essay competitions, nukkad Act. nataks, stage shows etc. Punishment under the Act On 2.10.2007 on the occasion of the Birth Anniversary of the Father of the Nation, Mahatma Gandhi, a signature Imprisonment up to 3 years and fine up to Rs. 10,000/-. campaign was launched to generate awareness regarding For any subsequent offences, imprisonment up to 5 years the evils of female foeticide. H.E. the President of India and fine up to Rs. 50,000 / Rs.1,00,000.The name of the appended her signature first on the scroll as the first citizen registered medical practitioner is reported by the of the country. Rallies were also organised on 4.10.2007 Appropriate Authority to the State Medical Council in every district of the NCT of Delhi to generate concerned for taking necessary action including awareness among the public. suspension of the registration if the charges are framed by the court and till the case is disposed off. The National Level Meeting on ‘Save the Girl Child’ held on 28.4.2008 at Vigyan Bhawan, New Delhi, was Status and Report from States/UTs inaugurated by Dr. Manmohan Singh, Hon’ble Prime As per the reports received from the States and UTs, Minister of India, in the presence of the Hon’ble Union 39854 bodies using ultrasound, image scanners etc. have Minister of Health & F.W., Hon’ble Union Minister of been registered under the Act. 462 ultrasound machines State (I/C) for Women & Child Development and Hon’ble have been sealed and seized for violation of the law. As Minister of State for Health & F.W.. The large turn-out on 30.06.2010, there were 706 ongoing cases in the Courts of Ministers, Members of Parliament and senior Health for various violations of the law. Though most of the officers from the Central and State/UT Governments and cases (223) are for non-registration of the centre/clinic, representatives of various organisations active in the area 216 cases relate to non-maintenance of records, 155 cases of Child welfare at the day long fruitful deliberations of relate to communication of sex of foetus, 36 cases relate the National Meet lent the necessary impetus to the ‘Save to advertisement about pre-natal/conception diagnostic the Girl Child’ mission. All the State/UT Governments facilities and 76 cases relate to other violations of the were requested to replicate such meeting in their Act/Rules. respective States/UTs. The message of the above National Level Meet was disseminated through the The concerned state governments are regularly requested accredited print and electronic media. to take effective measures for speedy disposal of the ongoing cases. Ministry of Health and Family Welfare Medical Audit has taken a number of steps for the implementation of It is proposed to conduct Medical Audit of the ultrasound the Act. The major steps taken are as follows: clinics in the country in a phased manner to spread Meetings of the Central Supervisory Board (CSB) awareness of the Act and required procedural formalities so as to prevent violations of the Act. Scrutinizing ‘Form Meetings of the Central Supervisory Board (CSB) of PC F’ filled in respect of all pregnant women by the clinics & PNDT Act are being held regularly (every six months) will also help in detecting violations, if any. under the Chairpersonship of Union Minister of Health and Family Welfare. So far, 16 meetings have been held. Changing Appropriate Authorities Sensitization through Members of Parliament In place of Chief Medical Officer / District Health Officer, District Collectors / District Magistrates have been Funds were released to the Governments of Chandigarh, nominated as District Appropriate Authorities to Delhi, Gujarat, Haryana, Himachal Pradesh, Punjab and strengthen the implementation of the Act at the ground Rajasthan at the rate of Rs.5.00 lakh per Hon’ble level. States of Maharashtra, Tripura, Gujarat, and Member of Parliament (both Lok Sabha and Rajya Sabha) Chhattisgarh have informed that they have issued the of these States/UTs, considered sensitive from the point necessary notification in this regard. of view of Child Sex Ratio, for undertaking awareness

Annual Report 2010-11 39 Proposed Amendments to PC & PNDT Act. Training of Judiciary To make the implementation of the Act more effective With a view to sensitize the judiciary, the National Judicial and stringent, it is proposed to amend certain provisions Academy, Bhopal provided training to trainers from the of the Act, such as changing the Appropriate Authority State Judicial Academies during 2005-06, who in turn at the State level from Director (H&FW) to Secretary would provide training to the judiciary in the area under (H&FW) to facilitate the reporting of District Appropriate their jurisdiction. The National Law School of India Authority (DAA) to State Appropriate Authority (SAA), University, Bangalore, was provided grants for Training inclusion of an officer of or above the rank of Joint of lower judiciary and public prosecutors from State Director of H&FW in the SAA, and vesting the power Judicial Academies in a phased manner, beginning with the search and seize records to any Group B Gazetted Karnataka during 2007-2008. Officer. Annual Report on implementation of the PNDT Act Funding to the State through RCH - II Implementation of the PNDT Act is being published in Funds have been provided to all States/UTs, as requested Annual Report since 2005 which gives complete by them, in their Programme Implementation Plan under information on the implementation of PC & PNDT Act. RCH – II for undertaking various activities for Frequently Asked Questions (FAQs) booklet implementation of the Act at the State level. The Ministry of Health and Family Welfare, in Inclusion of the issue under NRHM collaboration with the United Nations Population Fund Sensitization on sex ratio issue has been made a part of (UNFPA), have developed a ‘Frequently Asked curriculum for ANMs. For tracking delivery of a pregnant Questions’ booklet about the PNDT Act which has proved woman, ASHAs are now provided a fixed remuneration to be quite useful to the lay persons, medical community at the village level (Keeping a track of the ante-natal and to the Appropriate Authorities in understanding the check-ups and accompanying the pregnant mother to an provisions of the Act for better implementation. institution for delivery). Website on PNDT Constitution of National Inspection and Monitoring In addition to the Union Health & F.W. Ministry’s Website, Committee (NIMC) (www.mohfw.nic.in), an independent website, A National Inspection and Monitoring Committee (NIMC) ‘pndt.gov.in’ for PNDT Division was launched by the has been constituted at the Centre to take stock of the Hon’ble Union Minister of Health & F.W. on 28.4.2008. ground realities through field visits to the problem states. This website, in addition to containing all the relevant During 2006-09, the Committee visited the States of Delhi, information relating to PNDT Act, Rules, Regulations and Haryana, Maharashtra, UP, Rajasthan, Orissa, Karnataka, activities, enables online filing of data right from Clinics Kerala, H.P. and Punjab. It is proposed to strengthen the (including submission of From-F’ online by the Clinics) in National Support and Monitoring Cell with induction of the field to the District and State level and their retrieval appropriate consultants to oversee the implementation of at the District, State and National levels. An exercise is the Act. on to impart training to the user groups on the use of the website in a phased manner beginning with the focused Meeting with the manufacturers of ultrasound states of Punjab, Haryana, Rajasthan, Gujarat, Himachal machines Pradesh, Maharashtra and Delhi This training programme A meeting with all major manufacturers of the ultrasound will be conducted by the experts from National machines was held on 20.7.2007. It was learnt that L&T Informatics Centre. and Wipro GE have developed an effective IEC message Toll Free Telephone: on a sticker to put on all ultrasound machines. Wipro GE has set up a PNDT Audit Cell. All the manufacturers Similarly, the Hon’ble Union Minister of Health & F.W. have since been sensitizing their engineers on this issue, launched a Toll Free Telephone (1800 110 500) on the who in turn, brief the medical practitioners while installing same day under the PNDT Division of the Ministry to the machines. facilitate the public to lodge complaints anonymously

40 Annual Report 2010-11 against any violation of the provisions of the Act by any of Excise & Customs on 1.4.2008 made certain authority or individual and to seek PNDT related general suggestions for consideration of this Ministry for information. (The service is presently suspended, pending interception of the Gender Testing Kits effectively. In resolution of certain operational issues; mainly the light of CBEC’s letter dated 1.4.2008 cited above, unauthorized advertising by the outsourced service two rounds of Inter-Ministerial Meetings were held on provider). 7.5.2008 and 16.5.2008 under the Chairmanship of Joint Awareness Generation Secretary (PK), where the representatives of the Customs Department, DGFT, DGHS and DCG (I) were invited to The problem has its roots in social behaviour and find a solution to the problem posed by the import of prejudices and along with the legislation various activities Gender Testing/Sex-Determination Kits. have been undertaken to create awareness against the practice of pre-natal determination of sex and female It was, inter alia, decided to amend the PC & PNDT foeticide through Radio, Television, and Print Media. Act, 1994 and the Rules/Regulations framed thereunder Workshops and seminars are also organized through suitably to provide for establishment of a registration voluntary organizations at state/regional/district/block mechanism in the matter of import of ‘Gender Testing levels to create awareness against this social evil. Kits’ and other similar medical kits. On the request of Cooperation has also been sought from religious / spiritual the Customs authorities, DCG (I) and DDG (M) have leaders, as well as medical fraternity to curb this practice. been requested to frame the required parameters for The Government of India has launched ‘Save the Girl identification of the ‘Gender Testing Kits’ from among Child Campaign’ with a view to lessen son preference by the similar kits imported into the Country. highlighting achievements of young girls. Shri Kapil Dev, Sting operation carried out of BBC in Delhi and former Captain of the Indian national Cricket Team, has NOIDA: been nominated as the Brand Ambassador for the campaign. The sting operation conducted recently by BBC at NOIDA Advt. over the Internet regarding Gender Testing and New Delhi revealed that illegal sex determination Kits: tests were carried out at Dr. Mangala Telang’ clinics on an NRI couple from the U.K. This was reported in the A new factor which is threatening to adversely impact website of BBC News.The Appropriate Authorities of the PNDT efforts of the Government, i.e. the Uttar Pradesh and NCT of Delhi were requested to inquire advertisements placed on the websites regarding the into the matter and furnish their respective reports Gender Testing Kits. The Hon’ble High Court of Punjab thereon. In their respective reports, the State and Haryana Suo Motu took congnisance of the above Governments indicated that inspection of the facilities of report and issued notices to the State Governments of Dr. Mangala Telang at NOIDA and Delhi were carried Haryana and Punjab and also to the Central Government. out, the Premises and sealed and her registration Affidavit on behalf of UOI has been filed. suspended. In addition to the above, the Government of On 29.11.2007, the Customs Department was requested U.P. has filed a court case against Dr. Mangala Telang by this Ministry to examine the possibility of intercepting at NOIDA. such Gender Determination Kits when imported into the 2.12 IMPROVEMENT IN THE QUALITY OF country under the Customs Act. They were also HEALTHCARE requested to furnish details of such importers to facilitate the Ministry to take appropriate action against them under The improvement in the quality of healthcare over the the PC & PNDT Act. This was followed up at the years is reflected in respect of some basic demographic Secretary level, vide the letter dated 5.1.2007. indicators (Table given below). The Crude Birth Rate (CBR) has declined from 40.8 in 1951 to 29.5 in 1991 In response to the above request of this Ministry, the and further to 22.8 in 2008. Similarly there was a sharp Customs Department informed that it has suitably alerted decline in Crude Death Rate (CDR) which has decreased its field formations to seize the Gender Testing Kits from 25.1 in 1951 to 9.8 in 1991 and further to 7.4 in imported from abroad. Subsequently, the Central Board 2008. Also, the Total Fertility Rate (average number of

Annual Report 2010-11 41 children likely to be born to a woman between 15-44 years The Maternal Mortality Rate has also declined from 437 of age) has decreased from 6.0 in 1951 to 2.6 in the year per one lakh live births in 1992 – 93 to 254 in 2004-06, 2008 as per the estimates from the Sample Registration according to the SRS Report brought out by RGI. Infant System (SRS) of Registrar General India (RGI), Ministry Mortality Rate, which was 110 in 1981, has declined to of Home Affairs. 53 per 1000 live births in 2008. Child Mortality Rate has also decreased from 57.3 in 1972 to 15.2 in 2008.

Table 1 Achievements of Family WelfareProgramme

Sl. Parameter 1951 1981 1991 Current level No.

1 Crude Birth Rate (Per 1000 Population) 40.8 33.9 29.5 22.8 (2008)

2 Crude Death Rate (Per 1000 Population) 25.1 12.5 9.8 7.4 (2008)

3 Total Fertility Rate (Per woman) 6.0 4.5 3.6 2.6 (2008)

4 Maternal Mortality Rate NA NA 437 (1992-93) 254(2004-06) (Per 100,000 live births) NFHS S.R.S.

5 Infant Mortality Rate 146(1951-61) 110 80 53 (2008) (Per 1000 live births)

6 Child (0-4 years) 57.3(1972) 41.2 26.5 15.2 (2008) Mortality Rate per 1000 children

7 Couple protection 10.4(1971) 22.8 44.1 46.5 (2008) Rate (%) $

Source: 1 Office of Registrar General, Ministry of Home Affairs, India. $ (2) Deptt of Health & FW.

Family Planning Methods: The total number of acceptors of different Family the position in regard to family planning achievements Planning methods enrolled in the country during the year during 2009-10 and 2010-11 (up to September 2010) at 2009-10 was 36.29 million. Table 2 below summarizes All India Level.

42 Annual Report 2010-11 Table 2 Family Planning Acceptors by methods

(Figures in million)

Sl.No. Methods Achievement * Achievement *

óóóóóóó óóóóóóó 2009-2010 2010-11 2009-10 (April 2010- (April 2009- Sep 2010) Sep.2009)

1. Sterilisation 5.02 1.60 1.72

2. IUD Insertions 5.79 2.46 2.87

3. Condom Users (Eq.) 17.36 6.49 8.71

i. Under Free Distribution 8.33 6.49 8.71 Scheme (Eq.)

ii. Under Commercial 9.03** NA NA Distribution scheme(Eq.)

4. Oral Pill Users 8.11$ 3.55 4.69

i. Under Free distributionScheme (Eq.) 4.65 3.55 4.69

ii. Under Commercial Distribution 3.47** NA NA Scheme(Eq.)

Total Acceptors 36.29 14.1 17.99

*: Provisional figures Source: HMIS Portal Eq -Equivalent ** Branded full cost commercial sales figures are not included. The data is still awaited from SSM Division of the Ministry. $:- Total does not match due to round off.

Annual Report 2010-11 43 Immunization Performance for the year 2009-10 vis-à-vis 2008-09 is given in Table 3. Table-4 gives the comparative performance during 2010-11 and 2009-10 for the period April-September of the respective years.

Table 3 Assessed Need of Immunisation vis-Ú-vis Achievement during 2009-10 under RCH Programme (All India) (Figures in 000ís) Sl.No. Activity Assessed Achievement* % Change. % Achvt.of Need for óóóóóó Assessed 2009-10 2009-10 2008-09 Need

1 2 3 4 5 6 7

A. Immunisation i. Tetanus Immunisation for 29264 24717 24348 (+) 1.5 84.5 Expectant mothers ii. DPT Immunisation 25187 25070 23345 (+) 7.4 99.5 For Children iii. Polio 25187 24964 23916 (+) 4.4 99.1 iv. B.C.G. 25187 25809 26013 (-) 0.8 102.5 v. Measles 25187 24007 23443 (+)2.4 95.3 vi. DT Immunisation 24748 18171 14204 (+) 27.9 73.4 For Children vii. T.T. (10 Years) 25706 16675 13523 (+) 23.3 64.9 viii. T.T. (16 Years) 25660 14636 11815 (+) 23.9 57.0 B. Prophylaxis against nutritional anaemia among women 29264 25568 22663 (+)12.8 87.4 C. Prophylaxis against Blindness due to Vit. ‘A’ deficiency $ i. 1st dose (below 1 year + above 1 year) 25187 24058 18292 (+) 31.5 95.5 ii. 5th dose 24364 20378 11480 (+) 77.5 83.6 iii 9 th dose 24748 13504 9603 (+) 40.6 54.6

* Provisional figures received through HMIS Portal as on 22nd Oct., 2010.

44 Annual Report 2010-11 Table 4

Assessed Need of Immunisation Vis-Ú-vis Achievement During 2010-11 (April,10 to Sept, 10) under RCH Programme (All India)

(Figures in 000ís) Sl.No. Activity Assessed Achievement* % Change. % Achvt.of Need for Assessed 2010-11 2010-11 2009-10 Need (Apr.2010 to April 2009to Sept.2010) Sept.2009) 1 2 3 4 5 6 7

A. Immunisation

i Tetanus Immunisation for 29678 10846 12212 (-) 11.2 36.5 Expectant mothers

ii DPT Immunisation 25540 10360 12184 (-) 15.0 40.6 For Children

iii. Polio 25540 10285 12210 (-) 15.8 40.3

iv. B.C.G. 25540 11260 12498 (-) 9.9 44.1

v. Measles 25540 10169 11740 (-) 13.4 39.8

vi. DT Immunisation 25092 4665 10484 (-)55.5 18.6 For Children

vii T.T. (10 years) 26065 6801 8427 (-)19.3 26.1

viii. T.T. (16 Years) 26013 6132 7296 (-) 16.0 23.6

B. Prophylaxis against Nutritional Anaemia among Total Women 29678 16629 11436 (+) 45.4 56.0

C. Prophylaxis against blindness due to Vit. ‘A’ deficiency

i. 1st dose (below 1 year+ 25540 11155 12131 (-) 8.0 43.7 above 1 year)

ii. 5th dose 24706 9056 9643 (-) 6.1 36.7

iii 9th dose 25092 5991 6242 (-) 4.0 23.9

* Figures are provisional. Source: HMIS Portal

Annual Report 2010-11 45 2.13 HEALTH MANAGEMENT and it is proposed to integrate the application for a Help INFORMATION SYSTEM Desk that is proposed to be put in place for the health sector. For capturing information on the service statistics from the peripheral institutions, an exercise was undertaken 2.14 SURVEYS AND EVALUATION to rationalize the data capturing format by removing ACTIVITIES redundant information, reducing the number of forms and focused on facility based reporting. The revised forms District level Household Surveys: The Ministry also were finalized in September 2008 and disseminated to coordinated the activities of the District Level Household the States. A web based Health MIS (HMIS) portal was Survey (DLHS)-3 during 2007-08 for assessing the impact also launched in October, 2008 to facilitate data capturing of the health programmes and generating various health at District level. The HMIS portal has led to faster flow related indicators at the District and State level. All India, of information from the district level and about 98% of State and District Fact Sheets for the results of the survey the districts reported monthly data for the fiscal year have been released and hosted on the HMIS Portal for 2009-10. The Provisional Report for the performance of use by the health officials and other stakeholders. The the States for the year 2009-10 (up to March, 2010) as detailed All India and State Reports have also been reported by the States was brought and shared with the released. stakeholders. Soft copy is also available on the HMIS Concurrent evaluation of NRHM: In pursuant to a Portal in public domain. The HMIS portal is now being decision taken by the Empowered Programme Committee rolled out to capture information at the facility level. Now (EPC) of NRHM, Concurrent evaluation of NRHM has that data has started flowing regularly on the HMIS portal, been undertaken by the Ministry in 197 districts of all a workshop on improving the quality of data was States/UTs covering activities and programmes initiated organized in May 2010. Core M&E teams have been under the NRHM through the International Institute of formed in the States to look at the consistency of the Population Science (IIPS), Mumbai. IIPS acted as the HMIS data in finding the gap and providing solutions for nodal agency for conducting the Concurrent Evaluation strengthening the Health MIS system in States. and outsourced the field work to independent agencies 2.13.1. Tracking of Mothers and Children having experience in conducting surveys / research studies. The Fact sheet for 187 districts have been It has been decided to have a name-based tracking disseminated in the Ministry in October 2010. National whereby pregnant women and children can be tracked and State reports are being finalised and expected to be for their ANCs and immunisation along with a feedback released by March, 2011. system for the ANM, ASHA etc to ensure that all pregnant women receive their Ante-Natal Care Check- Regional Evaluation Teams(RETs): There are 7 ups (ANCs) and post-natal care (PNCs); and further Regional Evaluation Teams (RETs) located in the Regional children receive their full immunisation. All new Offices of the Ministry which undertake evaluation of pregnancies detected/being registered from 1st April, the NRHM activities including Reproductive and Child 2010 at the first point of contact of the pregnant mother Health Programme (RCH) on a sample basis by visiting would be captured as also all births occurring from 1st the selected districts and interviewing the beneficiaries. December, 2009. The states are putting in place systems These teams generally visit two adjoining districts in a to capture such information on a regular basis. Mother state every month and see the functioning of health and Child Tracking System require intense capacity facilities and carry out sample check of the beneficiaries building at various levels primarily at the Block and Sub- to ascertain whether they have actually received the Centre levels. The National Informatics Centre (NIC) services. Reports of the RETs are sent to the States for has been requested to modify and adapt the Gujarat model taking corrective measures on issues highlighted in the of e-Mamta software application to other States. This reports. During 2009-10, 114 districts were visited by the application is being hosted on servers that are to be RETs. procured for the purpose and customisation will be carried Annual Health Survey: The Annual Health Survey out by NIC. The roll-out is being monitored centrally for (AHS) launched by the Ministry aims to prepare District which dashboards are being prepared for the purpose Health Profile of the 284 districts in the EAG States and

46 Annual Report 2010-11 Assam on an annual basis. The AHS is being conducting 3) Reproductive Health Status of Adolescent Married through the Registrar General of India (RGI), Ministry girls in Karnataka of Home Affairs. The AHS is a hybrid model where the 4) Convergence of Demographic Indicators in field work has been outsourced to external agencies and Karnataka :An Exploration supervision being done by the RGI staff. The Annual Health Survey aims to provide feedback on the impact of 5) Orientation for Senior-level officials on use of the schemes under NRHM in reduction of Total Fertility Demographic Data for Local Level Planning and Rate (TFR), Infant Mortality Rate (IMR) at the district Monitoring of Development Programmes. level and the Maternal Mortality Ratio (MMR) at the 6) Study on Rapid Appraisal of National Rural Health regional level. These are important indicators of health Mission(NRHM) Implementation in Sambalpur and which are currently being estimated at the national/state Kendrapara districts of Orissa level through the Sample Registration System (SRS) by Registrar General of India. The fieldwork of the Survey 7) Monitoring of Coverage Evaluation Survey (CES) is in progress and reports likely to be available in early 2009 2011. 8) District Human Development Report –Hoshiarpur, 2.15 POPULATION RESEARCH CENTRES Punjab (PRCs) 9) Rapid appraisal of NRHM Ambala District – The Ministry has established 18 Population Research Haryana Centres (PRCs) in various institutions in the country with a view to carry out research on various topics pertaining 10) An Annotated Bibliography and Abstracts of to population stabilization, demographic and other health Research (2002-2007) related programs. While 12 of these PRCs are located 11) Rapid Appraisal of National Rural Health Mission in universities, the remaining six are located in institute of (NRHM) in the State of Punjab: Patiala district national repute. The Ministry of Health & Family Welfare provide 100% financial grant-in-aid to all PRCs as on a 12) A Study of Out-of-pocket Expenditure on Medial year to year basis towards salaries of staff, books and Services and Drugs: An Exploratory journals, TA/DA, data processing/stationary/contingency Analysis of U.P.,Rajasthan and Delhi. etc., and other infrastructure requirement. 13) Gender and forest conservation: The Impact of As a statutory requirement, under Rule 212 (2) of the women’s participation in community forest General Financial Rules 2005, the Annual Reports of 17 governance, Ecological Economics, PRCs for 2009-10 which received Rs. 25 lakhs or above as Recurring Grant during 2009-10, alongwith the audited 14) Does women’s Proportional Strength affect their statement of accounts were laid on the table of both the Participation: Governing local forests in south Asia houses of parliament. The performance of PRC Sagar, 15) ‘Exploring Gender Differences in functional which received less than 25 lakhs as Recurring Grant disabilities among the Old: Are Women at a for 2009-10, was also found to be satisfactory. Disadvantageous Position During the year 2009-10, the studies completed by the 16) Changing Demographic Landscape of South Asia Population Research Centres (PRCs) on some of the and Emerging Issues of Employment, Ageing important topics of research including the studies assigned and Old Age Security. by the Ministry are given below: 17) Challenges for the NRHM: Study of Recent 1) Male Involvement in Reproductive Health Demographic and Health Profile in NRHM States. :Evidence from NFHS-3 and DLHS-2 18) Shortages and surpluses: changing Female-male 2) Rapid Appraisal of Critical components of National Ratios in Younger and Older Ages: Policy Rural Health Mission (NRHM) in Karnataka Implications in south Asia.

Annual Report 2010-11 47 19) Development, Demographic change and Migration: 37) Trends in contraceptive prevalence and fertility A study of Two Hilly States of India. across the different districts of Bihar 20) Women, Empowerment and the State: Enhancing 38) The Demographic Impact of the Partition of India Capabilities Through Employment –Generation – With Special Reference to Eastern India Schemes. 39) Can Beautiful be Backward? Tribes of India in a 21) Sex Differentials in Child Health and Nutritional Long Term Demographic Perspective Status in Punjab. 40) Employment differentials by Social Groups of India 22) Education in MDGs: Is India Expected to Achieve its Targeted Goal and How? 41) Distributional Pattern of Social Groups in Higher Education: An Analysis of Census Data for 23) Rapid Assessment of NRHM in Uttar Pradesh Maharashtra, 1991-2001. 24) Rapid appraisal of National Rural Health Mission 42) Disparities in Higher Education Between and Within (NRHM) implementation in Koppal district, Social Groups: Analysis by Major States of India, Karnataka. 1999-2000. 25) Facility Assessment of Secondary Level Public 43) Rapid Appraisal of National Rural Health Mission: Hospitals in Tamil Nadu Phase – I Gadchiroli District,Maharashtra . 26) Facility Assessment of Medical college Hospitals 44) Rapid Appraisal of NRHM Implementation in and Allied Hospitals in Tamil Nadu Phase – I Madhya Pradesh – district Anuppur 27) Rapid Appraisal of NRHM Implementation in 45) Rapid Appraisal of NRHM Implementation in Bankura District of West Bengal Madhya Pradesh: District Indore 28) Rapid Appraisal of NRHM Implementation in Jorhat 46) Rapid Appraisal of National Rural Health Mission District of Assam in Rajouri District of Jammu and Kashmir. 29) Rapid Appraisal of NRHM Implementation in 47) Rapid Appraisal of National Rural Health Mission Sonitpur District of Assam in Baramulla District of Jammu and Kashmir. 30) Impact of Literacy in infant Mortality Rate in 48) Role of Men in Reproductive Health in Jammu & Assam Kashmir. 31) A study on the Role of Assamese Radio 49) Disability Burden and the Need for Social Action: Programme ‘Sanjog’ in Promoting UEE with The Role of the Family, Community and the NGOs. Special reference to Alternative Schooling 50) National Rural Health Mission Initiatives and 32) Rapid Appraisal of National Rural Health Mission Reproductive Child Health Phase-II: An Evaluation. Implementation on Udham Singh Nagar District of Uttarakhand. 51) Organisation and Functioning of Health Services in Himachal Pradesh. 33) Maternal Mortality in districts of Uttar Pradesh: An Illustration through indirect estimation 52) Reducing Maternal and Child Mortality in Himachal Pradesh 34) Utilisation of Maternal and Child health (MCH) Care services in India with special reference to 53) Unmet Reproductive Health Needs of the Couples EAG states. and the Role of the Male Partner in Meeting the Needs. 35) Improving women’s Health in Bihar 54) National Rural Health Mission: An appraisal of its 36) A Critical Review of Community Participation in rationale, structure and Prospects. Family Welfare Programmes.

48 Annual Report 2010-11 55) Rapid Appraisal of National Rural Health Mission 63) People living with HIV/AIDS in India, Inference Implementation in Kozhikode district, Kerala from NFHS-III. 2008-2009. 64) Reproductive Health Status of Tribal Women in 56) Infertility in India: A Comparative Study by State Rajasthan. 65) Knowledge and Satisfaction of Patients about 57) Suicides in Kerala : What do Trends reveal! NRHM Interventions at Dungarpur district Hospital . 58) A Profile of Adolescence and youth in India . 66) Impact Assessment of Institutional Delivery Care 59) Morbidity among Men and women in India: State Services in Tribal Areas of Rajasthan. wise analysis based on NFHS-III data. 67) Rapid Appraisal of National Rural Health Mission 60) Immunization coverage in EAG states and Assam: (NRHM) Implementation Banaskantha district, A comparative study with Kerala based on Gujarat NFHS-III data. 68) Rapid Appraisal of National rural Heath Mission (NRHM) implementation, Surat district, Gujarat. 61) The use of temporary contraception and Discontinuation in Kerala . 69) District Level Household Survey (DLHS-3) in Andaman and Nicobar Islands 62) Household headship and nutritional status of women and children in Kerala 70) Important RCH Indicators of DLHS-3 of Andaman & Nicobar Islands.

Annual Report 2010-11 49

Chapter 3

Funding For The Programme

The Ministry of Health & Family Welfare consists of since from the 1st Plan. The allocation for this sector four departments viz. the Department of Health & Fam- has been substantially enhanced from Rs. 36378.00 crores ily Welfare, Department of AYUSH, Department of in the 10th plan to Rs.1,36,147.00 crores in the 11th Plan. Health Research and Department of AIDS Control. The table below is captured the financial outlays and expenditure for Health & Family Welfare for the 10th Achieving an acceptable standard of health for general Plan (2002-07) and Health, Family Welfare and Health population has been the objective over the plan era in the Research for the 11th Plan (2007-12). Health sector. In line with this objective, there has been a steady increase in the allocations made for this sector (Rupees in Crores) Approved Outlay Expenditure

Plan Period Health F.W. $ Health Total Health F.W. Health Total Research Research

10th Plan 10252.00 26126.00 X 36378.00 X Outlay

Actual 10521.00 31064.00 X 41585.00 8694.15 26349.23 X 35048.87

Status

2002-03 1550.00 4930.00 X 6480.00 1359.82 3916.63 X 5276.45

2003-04 1550.00 4930.00 X 6480.00 1325.81 4409.27 X 5735.08

2004-05 2208.00 5780.00 X 7988.00 1772.36 4864.21 X 6636.57

2005-06 2908.00 6424.00 X 9332.00 2259.21 5672.53 X 7931.74

2006-07 2305.00 9000.00 X 11305.00 1982.44 7486.59 X 9469.03

11th Plan 41092.92 90558.00 4496.08 136147.00 (2007-12) Outlay 2007-08 2985.00 10890.00 X 13875.00 2183.71 10380.25 X 12563.96 2008-09 3650.00 11930.00 420.00 16000.00 3008.82 11260.18 390.56 14659.56 2009-10 4450.00 13930.00 420.00 18800.00 3260.40 13304.51 399.90 16964.86 (Prov.) (Prov.) (Prov.) 2010-11 5560.00 15440.00 500.00 21500.00 $ :- Figures shown as NRHM from 2006-07 onwards. Prov.:- Provisional F.W. :- Family Welfare. The scheme-wise break up of plan and non plan expenditure during 2009-10 and outlays 2010-11 for Health, NRHM and Health Research is given at statement I and II.

Annual Report 2010-11 51 Statement-I

DEPARTMENT OF HEALTH AND FAMILY WELFARE HEALTH SECTOR Scheme- wise Break- up of Actule Expenditure during 2009-10 and Outlay for 2010-11 (Rs.in crores) Sl. Name of the schemes / 11th Plan Annual Plan 2009-10 Expenditure Outlay for 2010-11 No. Institutes Approved Outlay Plan Non -Plan Total Plan Non- Plan Total 12 3 456 789 A. CENTRALLY SPONSORED PROGRAMMES 23202.50 1202.38 25.09 1227.47 2734.75 22.05 2756.80 1 National AIDS Control Programme and National S.T.D. Control Programme 5728.00 938.06 0.00 938.06 1435.00 0.00 1435.00 2 Cancer 2871.92 69.65 25.09 94.74 225.00 22.05 247.05 (i) National Cancer Control Programme 2400.00 28.25 11.59 39.84 180.00 9.05 189.05 (ii) Tobacco Control Programm 471.92 16.40 0.00 16.40 45.00 0.00 45.00 (iii) Rastriya Arogya Nidhi 0.00 25.00 13.50 38.50 0.00 13.00 13.00 3 National Mental Health Programme 1000.00 51.60 0.00 51.60 120.00 0.00 120.00 4 Assistance to State for Capacity Building(Truma Care) 732.95 52.66 0.00 52.66 115.00 0.00 115.00 (i) Truma Care 0.00 52.66 113.00 0.00 113.00 (ii) Prevention of Burn Injury 0.00 0.00 2.00 0.00 2.00 5 Assistance to States for Drug & PFA Control 260.00 0.00 0.00 0.00 0.00 0.00 0.00 New initiatives under CSS (Others) 12609.63 90.41 0.00 90.41 839.75 0.00 839.75 6 Telemedicine (E- Health) 183.00 0.00 0.00 0.00 17.00 0.00 17.00 7 National Programme for Prevention and Control of Diabetes, Cardiovascular Disease and Stroke 1660.50 3.44 0.00 3.44 100.00 0.00 100.00 8 National Programme for Health for the Elderly 400.00 0.00 0.00 0.00 60.00 0.00 60.00 9 District Hospitals 1500.00 16.00 0.00 16.00 225.00 0.00 225.00 (i) Strengthening of MCH wing/Hospitals and other wing in District Hospitals 0.00 0.00 0.00 0.00 0.00 0.00 0.00 (ii) Upgradation of States Govt. Medical Colleges(NE) 1500.00 16.00 0.00 16.00 225.00 0.00 225.00 10 Human Resource for Health 4000.00 17.22 0.00 17.22 351.00 0.00 351.00 (i) Upgradation/Strengthening of Nursing Services 2900.00 17.22 0.00 17.22 250.00 0.00 250.00 (ii) Strengthening/Creation of Paramedical Institutes 1000.00 0.00 0.00 0.00 100.00 0.00 100.00 (iii) Strengthening/ Upgradation of Pharmacy Schools 100.00 0.00 0.00 0.00 1.00 0.00 1.00

52 Annual Report 2010-11 Statement-I (Rs.in crores) Sl. Name of the schemes / 11th Plan Annual Plan 2009-10 Expenditure Outlay for 2010-11 No. Institutes Approved Outlay Plan Non -Plan Total Plan Non- Plan Total 12 3 456 789 11 Health Insurance (National Urban Health Mission) 4495.00 0.00 0.00 0.00 10.00 0.00 10.00 12 Pilot Projects 371.13 53.75 0.00 53.75 76.75 0.00 76.75 Sport Medicines/Sport Injiry 90.00 40.23 0.00 40.23 30.00 0.00 30.00 Deafness 100.00 7.36 0.00 7.36 11.50 0.00 11.50 Leptospirosis Control 4.48 0.52 0.00 0.52 0.85 0.00 0.85 Control of Human Rabies 8.65 0.67 0.00 0.67 1.60 0.00 1.60 Medical Rehabilitation 50.00 1.12 0.00 1.12 13.30 0.00 13.30 Ogran Transplant 25.00 0.30 0.00 0.30 11.00 0.00 11.00 Oral Health 25.00 0.00 0.00 0.00 3.50 0.00 3.50 Fluorosis 68.00 3.55 0.00 3.55 5.00 0.00 5.00 B. CENTRAL SECTOR SCHEMES 17890.42 2058.02 3055.77 5113.79 2825.25 2438.50 5263.75 1 Oversight Committee 1827.00 30.00 0.00 30.00 300.00 0.00 300.00 Strengthening of the Institutes for Control of Communicable Diseases 531.23 63.21 57.69 120.90 77.48 64.06 141.54 2 National Institute of Communicable Diseases 60.00 16.88 20.49 37.37 18.05 22.48 40.53 National Tuberculosis Institute, Bangalore 9.48 1.16 6.36 7.52 1.95 5.66 7.61 3 Others Research Institutes 461.75 45.17 30.84 76.01 57.48 35.92 93.40 i B.C.G. Vaccine Laboratory, Guindy, Chennai 80.00 0.39 4.35 4.74 5.75 12.50 18.25 ii Pasteur Institute of India, Coonoor 280.00 11.26 0.00 11.26 16.27 0.00 16.27 iii Lala Ram Sarup Institute of T.B. and allied diseases, Mehrauli, Delhi 78.75 30.37 14.41 44.78 30.00 11.00 41.00 iv Central Leprosy Training & Research Institute Chengalpattu (including Integrated Vaccine complex & Media Park) (Tamil Nadu) 10.00 0.48 7.07 7.55 2.73 6.65 9.38

Annual Report 2010-11 53 Statement-I

(Rs.in crores) Sl. Name of the schemes / 11th Plan Annual Plan 2009-10 Expenditure Outlay for 2010-11 No. Institutes Approved Outlay Plan Non -Plan Total Plan Non- Plan Total 1 2 3 4 5 6 7 8 9 v Regional Institute of Training, Research & Treatment under Leprosy Control Programme 13.00 2.67 5.01 7.68 2.73 5.77 8.50 (a) R.L.T.R.I., Aska (Orissa) 3.00 0.03 1.88 1.91 0.50 2.35 2.85 (b) R.L.T.R.I., Raipur (M.P.) 2.00 0.18 3.13 3.31 0.50 3.42 3.92 (c) R.L.T.R.I., Gauripur (W.B.) 8.00 2.46 0.00 2.46 1.73 0.00 1.73 4 Strengthening of Hospitals & Dispensaries: 1162.34 202.68 1231.69 1434.37 241.75 1027.05 1268.80 i Central Government Health Scheme (including Health Insurance) 565.80 57.93 608.89 666.82 67.65 500.00 567.65 ii Medical Treatment of CGHS Pensioners 0.00 0.00 449.74 449.74 1.00 377.87 378.87 iii Central Institute of Psychiatry, Ranchi 100.00 20.73 27.28 48.01 27.25 24.18 51.43 iv All India Institute of Physical Medicine & Rehabilitation, Mumbai 56.00 4.11 7.91 12.02 5.00 8.00 13.00 v Dr. R.M.L. Hospital, New Delhi 351.00 103.07 127.39 230.46 118.00 107.00 225.00 vi Others 89.54 16.84 10.48 27.32 22.85 10.00 32.85 Institute for Human Behaviour & Allied Sciences, Shahdara, Delhi 8.00 0.00 0.00 0.00 1.00 0.00 1.00 Grant to New Delhi TB Centre 0.00 0.00 2.48 2.48 0.00 2.00 2.00 All India Institute of Speech & Hearing, Mysore 81.54 16.84 8.00 24.84 21.85 8.00 29.85 5 Strengthening of Institutions for Medical Education, Training & Research: 2350.95 209.58 140.52 350.10 224.62 132.28 356.90 (a) Medical Education: 1749.67 166.19 75.52 241.71 171.40 59.15 230.55 i Indira Gandhi Institute of Health & Medical Sciences for NorthEast Region at Shilong* 1266.38 65.00 0.00 65.00 67.85 0.00 67.85 ii N.I.M.H.A.N.S., Bangalore 266.38 54.38 71.31 125.69 58.35 55.03 113.38 iii Kasturba Health Society, Wardha 106.91 28.60 0.00 28.60 27.00 0.00 27.00

54 Annual Report 2010-11 Statement-I

(Rs.in crores) Sl. Name of the schemes / 11th Plan Annual Plan 2009-10 Expenditure Outlay for 2010-11 No. Institutes Approved Outlay Plan Non -Plan Total Plan Non- Plan Total 1 2 3 4 5 6 7 8 9 iv National Medical Library, New Delhi 100.00 18.21 4.21 22.42 17.70 4.12 21.82 v National Board of Examinations, New Delhi 10.00 0.00 0.00 0.00 0.50 0.00 0.50 (b) Training: 288.65 18.56 6.32 24.88 22.38 6.77 29.15 i Upgradation/ Development of Nursing Services 280.65 17.55 0.00 17.55 21.00 21.00 ii Nursing Colleges 8.00 1.01 6.32 7.33 1.38 6.77 8.15 (i) R.A.K. College of Nursing, New Delhi 5.00 0.71 4.82 5.53 0.82 4.77 5.59 (ii) Lady Reading Health School 3.00 0.30 1.50 1.80 0.56 2.00 2.56 (c) Research: 10.00 3.12 11.60 14.72 5.00 16.44 21.44 (i) Indian Council of Medical Research, New Delhi # Membership for International Organization 10.00 3.12 11.60 14.72 5.00 16.44 21.44

#- ICMR merged with department of Health Research from 2008-09 (d) Public Health 108.81 7.78 29.30 37.08 10.72 35.19 45.91 i Institute of Public Health (PHFI) 22.00 0.00 0.00 0.00 1.00 1.00 ii All India Institute of Hygiene & Public Health, Calcutta (AIIH&PH) and Serologist and Chemical Examiner, Calcutta 86.81 7.78 29.30 37.08 9.72 35.19 44.91 a. AIIH&PH, Calcutta 85.81 7.59 25.88 33.47 9.22 30.98 40.20 b. Serologist & Chemical Examiner, Calcutta 1.00 0.19 3.42 3.61 0.50 4.21 4.71 (e) Others 193.82 13.93 17.78 31.71 15.12 14.73 29.85 i Indian Nursing Council 10.00 0.15 0.12 0.27 0.25 0.12 0.37 ii V.P. Chest Institute, Delhi 158.00 12.00 17.00 29.00 12.00 13.00 25.00 iii National Academy of Medical Sciences, New Delhi 7.72 0.78 0.37 1.15 0.87 0.42 1.29 iv Medical Council of India, New Delhi 10.00 1.00 0.00 1.00 1.00 0.80 1.80

Annual Report 2010-11 55 Statement-I

(Rs.in crores) Sl. Name of the schemes / 11th Plan Annual Plan 2009-10 Expenditure Outlay for 2010-11 No. Institutes Approved Outlay Plan Non -Plan Total Plan Non- Plan Total 1 2 3 4 5 6 7 8 9 v Medical Grants Commission 8.10 0.00 0.00 0.00 1.00 0.00 1.00 vi Dental Council of India 0.00 0.00 0.19 0.19 0.00 0.19 0.19 viiPharmacy Council of India 0.00 0.00 0.10 0.10 0.00 0.20 0.20 6 System Strengthening including Emergency Medical Relief/ Disaster Management 1106.58 273.36 137.66 411.02 198.71 148.32 347.03 i (a) Health Education, Research & Accounts 32.33 0.56 2.42 2.98 3.28 3.55 6.83 Health Education Bureau, New Delhi 11.65 0.12 2.42 2.54 1.00 2.20 3.20 Health Intelligence and Health Accounts 20.68 0.44 0.00 0.44 2.28 1.35 3.63 a. Intelligence 10.68 0.44 0.00 0.44 1.68 1.35 3.03 b. Accounts 10.00 0.00 0.00 0.00 0.60 0.60 ii Strengthening of D.G.H.S./ Ministry: 25.00 2.84 77.12 79.96 4.23 78.80 83.03 a. Strengthening of Deptts under the Ministry 15.00 2.24 39.76 42.00 2.60 42.05 44.65 b. Strengthening of DGHS 10.00 0.60 37.05 37.65 1.63 35.75 37.38 Other( Discretionary Grant) 0.00 0.31 0.31 0.00 1.00 1.00 iii Emergency Medical Relief 564.82 207.20 0.00 207.20 100.00 0.00 100.00 Health Sector Disaster Preparedness and Management 447.25 2.03 0.00 2.03 38.40 0.00 38.40 Emergency Medical Relief (including Avian Flu) 117.57 205.17 0.00 205.17 61.60 0.00 61.60 iv (d) Others 484.43 62.76 58.12 120.88 91.20 65.97 157.17 i Central Research Institute, Kasauli 292.92 6.51 22.57 29.08 30.00 28.12 58.12 ii National Institute of Biological, NOIDA (U.P.) 62.65 11.00 0.00 11.00 17.25 0.00 17.25 iii Prevention of Food Adulteration (including project of Feasibilities Testing sheme of Vitamins and Mineral ) 25.36 iv Food Safety & Standards Authority of India 21.00 2.80 23.80 12.65 2.54 15.19

56 Annual Report 2010-11 Statement-I

(Rs.in crores) Sl. Name of the schemes / 11th Plan Annual Plan 2009-10 Expenditure Outlay for 2010-11 No. Institutes Approved Outlay Plan Non -Plan Total Plan Non- Plan Total 1 2 3 4 5 6 7 8 9 v Central Drug Standard & Control Organization (CDSCO) 88.50 14.59 11.00 25.59 10.00 13.68 23.68 vi Indian Pharmacopeia Commission 8.82 3.56 12.38 20.00 2.75 22.75 vii National Pharmaccopoeia 0.00 0.00 0.00 0.35 0.35 viii Port Health Authority 15.00 0.84 18.19 19.03 0.95 18.88 19.83 i) Jawaharlal Nehru Port Sheva 8.20 0.55 0.00 0.55 0.60 0.00 0.60 ii) Setting up of offices at 8 newly created international Airports 6.80 0.29 18.19 18.48 0.35 18.88 19.23 7 Pradhan Mantri Swasthya Suraksha Yojana 3955.00 474.49 0.00 474.49 750.00 0.00 750.00 8 New Initiatives under CS 6957.32 804.70 1487.80 2291.64 1032.69 1066.26 2098.95 i Forward Linkages to NRHM (New Initiatives in NE) 900.00 0.86 0.00 0.86 60.00 0.00 60.00 ii National Centre for Disease Control 450.00 0.97 0.00 0.97 18.69 0.00 18.69 iii Advisory Board for Standards 22.00 0.00 0.00 0.00 2.00 0.00 2.00 iv Programme for Blood and Blood Products 450.00 0.00 0.00 0.00 20.00 0.00 20.00 v Medical Store Organisation 0.00 0.00 39.11 39.11 0.00 40.00 40.00 vi Procurement of Meningitis Vaccine for Inoculation of Haj Pilgrims 0.00 0.00 3.76 3.76 0.00 6.00 6.00 9 Redevelopment of Hospitals / Institutions 6035.32 802.87 1444.93 2247.80 992.00 1020.26 2012.26 i All India Institute of Medical Sciences & its Allied Departments, New Delhi 1461.00 250.51 636.00 886.51 400.00 400.00 800.00 ii P.G.I.M.E.R., Chandigarh 625.00 75.00 317.00 392.00 90.00 220.00 310.00 iii J.I.P.M.E.R., Pudicherry 564.00 115.00 160.00 275.00 132.00 120.00 252.00 iv Lady Harding Medical College & Smt. S.K. Hospital, New Delhi 383.83 44.19 114.07 158.26 79.00 97.00 176.00 v Kalawati Saran Children Hospital, New Delhi 74.88 20.29 25.57 45.86 24.00 23.26 47.26

Annual Report 2010-11 57 Statement-I

(Rs.in crores) Sl. Name of the schemes / 11th Plan Annual Plan 2009-10 Expenditure Outlay for 2010-11 No. Institutes Approved Outlay Plan Non -Plan Total Plan Non- Plan Total 12 3 456 789 vi RIMS, Imphal, Manipur 589.92 109.70 0.00 109.70 80.50 0.00 80.50 vii LGBRIMH, Tejpur, Assam 267.07 36.00 0.00 36.00 41.40 0.00 41.40 viii RIPANS, Aizwal, Mizoram 69.62 17.00 0.00 17.00 19.50 0.00 19.50 ix Safdarjung Hospital and College, New Delhi 2000.00 135.18 192.29 327.47 125.60 160.00 285.60 10 Other Schemes (Award of Prizes in Hindi, Treatment of Ex-VIPs, Grants to Indiam Red Cross Society & John’s Ambulance 0.00 0.00 0.41 0.41 0.00 0.53 0.53 TOTAL(HEALTH) 41092.92 3260.40 3080.86 6341.26 5560.00 2460.55 8020.55 III Depart of Health Research 4296.08 399.90 184.07 583.97 500.00 160.00 660.00 Indian Council of Medical Recearch (ICMR) 4296.08 399.90 184.07 583.97 500.00 160.00 660.00 GRAND TOTAL 45389.00 3660.30 3264.93 6925.23 6060.00 2620.55 8680.55

58 Annual Report 2010-11 Statement-II

DEPARTMENT OF HEALTH AND FAMILY WELFARE NRHM AND MEDICAL RESEARCH INSTITUTE Scheme- wise Break- up of Actul Expenditure during 2009-10 and Outlay for 2010-11 (Rs.in crores) Sl. Name of the schemes / 11th Plan Annual Plan 2009-10 Expenditure Outlay for 2010-11 No. Institutes Approved Outlay Plan Non -Plan Total Plan Non- Plan Total 1 2 3 4 5 6 7 8 9 I CENTRALLY SPONSORED SCHEMES 88451.22 13120.72 9.96 10231.41 15127.64 13.16 15140.80 A. Disease Control Programmes 6645.63 971.40 7.53 978.93 1132.32 6.95 1139.27 1 National Vector Borne Disease Control Programme 3190.00 338.20 7.53 345.73 418.00 6.95 424.95 2 National T.B Control Programme 1447.00 311.56 0.00 311.56 350.00 0.00 350.00 3 National Leprosy Eradication Programme 268.70 34.83 0.00 34.83 45.32 0.00 45.32 4 Iodine Deficience Disorder Control Programme (IDDCP) 155.40 21.20 0.00 21.20 45.00 0.00 45.00 5 National Programme for Control of Blindness 1550.00 252.60 0.00 252.60 260.00 0.00 260.00 6 National Drug De-Addiction Control Programme(NDDPC) 34.53 13.01 0.00 13.01 14.00 0.00 14.00 B. Free Distribution & Social Marketing of Condoms for NACO 2200.00 222.85 0.00 222.85 304.00 0.00 304.00 C. Family Welfare 79605.59 11926.47 2.43 9029.63 13691.32 6.21 13697.53 Infrastructure Maintenance 20448.70 3149.98 0.00 3149.98 3781.63 0.00 3781.63 i Direction & Administration 1955.28 281.31 0.00 281.31 375.00 0.00 375.00 (i) Maintenance of State & Distt.FW Bureaus 1955.28 281.31 0.00 281.31 375.00 0.00 375.00 ii Rural Family Welfare Services (Sub Centres) 16865.00 2649.24 0.00 2649.24 3108.06 0.00 3108.06 iii Urban Familiy Welfare Services 958.84 138.17 0.00 138.17 182.00 0.00 182.00 iv Grants to State Training Institutions 669.58 81.26 0.00 81.26 116.57 0.00 116.57 (a) Basic Training for ANM/LHVs 520.48 59.40 0.00 59.40 85.18 0.00 85.18 (b) Maintenance & Strengthening of HFWTCs 93.01 13.61 0.00 13.61 19.05 0.00 19.05 (c) Basic Training for MPWs Worker (Male) 56.09 8.25 0.00 8.25 12.34 0.00 12.34

Annual Report 2010-11 59 Statement-II

(Rs.in crores) Sl. Name of the schemes / 11th Plan Annual Plan 2009-10 Expenditure Outlay for 2010-11 No. Institutes Approved Outlay Plan Non -Plan Total Plan Non- Plan Total 12 3 456 789 2 Free distribution of Contraceptives 330.00 35.39 0.00 35.20 55.00 0.00 55.00 3 RCH Programme (Procurement of Supplies & Materials) 1500.00 159.44 0.00 159.44 200.00 0.00 200.00 4 Routine Immunization (Supply of vaccine etc) 2457.16 350.31 0.00 350.31 450.00 0.00 450.00 5 Pulse Polio Immunization 3994.18 1198.47 0.00 1198.47 1067.08 0.00 1067.08 (a) Procurement of Vaccines 1964.48 605.02 0.00 605.02 581.51 0.00 581.51 (b) Operating cost 2029.70 593.45 0.00 593.45 485.57 0.00 485.57 6 IEC (Inf., Edu. and Communication) 1001.50 155.13 2.43 157.56 204.94 6.21 211.15 7 Area Projects 463.51 17.87 0.00 17.87 31.67 0.00 31.67 (a) USAID assisted Projects 463.50 11.96 0.00 11.96 25.00 0.00 25.00 (b) EC assisted Projects 0.01 0.00 0.00 0.00 0.00 0.00 0.00 (c.) Projects through Vol.Orgns/ Sociaties/Autonomous 0.00 5.91 0.00 5.91 6.67 0.00 6.67 8 Flexible Pool for State PIPs 49410.54 6859.88 0.00 6859.88 7901.00 0.00 7901.00 (i) RCH Flexible Pool 16229.47 3479.11 0.00 3479.11 3850.00 0.00 3850.00 (ii) Mission Flexible Pool 33181.07 3380.77 0.00 3380.77 4051.00 0.00 4051.00 II CENTRAL SECTOR SCHEMES 2106.78 183.79 56.63 240.42 312.36 61.29 373.65 A. DISEASE CONTROL PROGRAMME 300.45 40.02 0.00 40.02 35.00 0.00 35.00 1 Integrated Disease Survillance Project 300.45 40.02 0.00 40.02 35.00 0.00 35.00 B. FAMILY WELFARE 1806.33 143.77 56.63 200.40 277.36 61.29 338.65 1 Social Marketing Area Project 50.00 0.00 0.00 0.00 0.50 0.00 0.50 2 Social Marketing of Contraceptives 450.00 21.86 0.00 21.86 40.00 0.00 40.00 3 F.W Training and Res. Centre, Mumbai 18.80 2.04 1.93 3.97 5.50 2.43 7.93 4 NIHFW, New Delhi 34.00 14.82 19.03 33.85 15.30 20.40 35.70 5 IIPS, Mumbai 24.00 3.00 11.30 14.30 20.00 9.90 29.90 6 RHTC, Najafgarh 23.65 0.00 7.61 7.61 0.02 9.35 9.37 7 Population Research Centres 53.50 9.73 0.00 9.73 14.20 0.00 14.20 8 CDRI, Lucknow 23.15 4.58 0.00 4.58 4.90 0.00 4.90

60 Annual Report 2010-11 Statement-II (Rs.in crores) Sl. Name of the schemes / 11th Plan Annual Plan 2009-10 Expenditure Outlay for 2010-11 No. Institutes Approved Outlay Plan Non -Plan Total Plan Non-Plan Total 1 2 3 4 5 6 7 8 9 9 Travel of Exp./Conf/Meetings etc. 6.00 0.11 0.00 0.11 1.00 0.00 1.00 10 International Cooperation 8.95 2.62 0.00 2.62 3.50 0.00 3.50 11 NPSF/National Commission on Population 30.00 0.59 0.00 0.59 4.00 0.00 4.00 12 NGOs (PPP) 100.00 1.74 0.00 1.74 2.65 0.00 2.65 13 FW Linked Health Insurance Plan 40.00 18.33 0.00 18.33 15.00 0.00 15.00 14 RCH Training 51.62 4.58 0.00 4.58 7.00 0.00 7.00 15 Management Information System (MIS) 750.00 34.49 0.00 34.49 100.00 0.00 100.00 16 Central Procurement Agency 5.00 5.00 17 Other Schemes 142.66 25.28 16.76 42.04 38.79 19.21 58.00 (a) Research & Study 30.00 0.58 0.00 0.58 2.20 0.00 2.20 (b) Role of Men in Planned Parenthood 16.05 0.45 0.00 0.45 3.92 0.00 3.92 (c ) Training in Recanalisation 4.20 0.00 0.00 0.00 0.40 0.00 0.40 ( d) Assistance to I.M.A. 1.00 0.35 0.00 0.35 0.50 0.00 0.50 (e) Testing Facilities for IUD and Fallopian 4.50 1.10 0.00 1.10 1.20 0.00 1.20 (f) Expenditure at HQs (RCH) 30.00 5.19 0.00 5.19 6.22 0.00 6.22 (g) Regional Offices 24.00 14.86 5.87 20.73 20.00 8.75 28.75 (h) Information Technology 20.00 1.17 0.00 1.17 1.30 0.00 1.30 (i) FW Programme in Other Ministries 7.00 0.27 0.00 0.27 1.20 0.00 1.20 (j) Gandhigram Institute 5.91 1.31 0.00 1.31 1.85 0.00 1.85 (k) Technical Wing (HQ) 0.00 10.89 10.89 10.46 10.46 Total (NRHM) 90558.00 13304.51 66.59 13371.10 15440.00 74.45 15514.45 III Depart of Health Research 200.00 0.00 0.00 0.00 ICMR & IRR 200.00 0.00 0.00 0.00 GRAND TOTAL 90758.00 13304.51 66.59 13371.10 15440.00 74.45 15514.45

Annual Report 2010-11 61

Chapter 4 Maternal Health Programme

4.1. INTRODUCTION UNICEF, UNFPA and the World Bank'). Some of the States with high Maternal Mortality as per the RGI-SRS Promotion of maternal and child health has been one of report of 2004-06 are: the most important objectives of the Family Welfare Programme in India. Under the NRHM (2005-2012) and States MMR the Reproductive and Child Health( RCH) Programme Uttar Pradesh/Uttarakhand 440 Phase-II (2005-10) the Government of India is actively pursuing the goals of reduction in Maternal Mortality by Rajasthan 388 focusing on the 4 major strategies of essential obstetric Madhya Pradesh/Chhattisgarh 335 and new born care for all, skilled attendance at every Bihar/Jharkhand 312 birth, emergency obstetric care for those having complications and referral services. The other major Assam 480 interventions are provision of Safe Abortion Services and Causes of Maternal Mortality: The major causes of services for RTIs and STIs. This policy recommends a Maternal Mortality have been identified as haemorrhage holistic strategy for bringing about total intersectoral (both ante and post partum), toxemia (Hypertension during coordination at the grass root level and involving the pregnancy), anemia, obstructed labour, puerperal sepsis NGOs, Civil Societies, Panchayati Raj Institutions and (infections after delivery) and unsafe abortion as given Women's Group in bringing down Maternal Mortality Ratio below: and Infant Mortality Rate. The National Rural Health Mission and the 11th Five Year Plan have set the goal of reducing MMR to less than 100 per 100,000 live births by the year 2010. Accordingly, schemes and programmes have been developed for various interventions focused on reducing maternal deaths. The Maternal Mortality Ratio in India is 254 per 100,000 live births (SRS, RGI: 2004-06 Maternal Mortality Report). 4.2. MATERNAL MORTALITY RATIO (MMR) MMR is defined as the number of maternal deaths per 100,000 live births due to causes related to pregnancy or within 42 days of termination of pregnancy, regardless of the site or duration of pregnancy. Heamorrhage accounts for more than one- third of all MMR India: The national average of MMR is 254 per deaths followed by puerperal sepsis and abortion. Anaemia 100,000 live births ( SRS-2004-06), which in itself is very which has been included in “other conditions” is a major high compared to the international scenario like Sweden contributory factor. Most of these deaths are preventable (5), USA (24), Brazil (58) and even in neighbouring with good ante natal care, timely identification and referral countries like Bangladesh (340), Pakistan (260), Sri Lanka of pregnant women with complications of pregnancy and (39) and Thailand (48) (Source- 'Trends in Maternal timely provision of emergency obstetric care. Moreover Mortality; 1990-2008 -Estimates developed by WHO,

Annual Report 2010-11 63 social factors like Illiteracy, low socio-economic 4.4. SCHEMES FOR IMPROVING OBSTETRIC conditions, poor access to health facilities are also CARE contributing factors leading to higher maternal mortality. 4.4.1 Services: 4.3. MATERNAL HEALTH INDICATORS Under the NRHM, several initiatives are under The estimates of maternal mortality at State/UTs levels implementation to achieve the goal of reduction in not being very robust, MMR can only be used as a rough Maternal Mortality. These interventions are as follows: indicator of the maternal health situation in any given country. Hence, other indicators of maternal health status 4.4.1.a.Essential Obstetric Care: like antenatal checkup, institutional delivery and delivery by trained personnel etc. are used for this purpose. These This includes quality ante-natal care including prevention reflect the status of the ongoing programme interventions and treatment of anaemia, institutional/safe delivery as well as give a reflection on the situation of Maternal services and post natal care. To provide essential obstetric Health. All India figure for these indicators as per the care services Government of India is operationalizing the District Level Household Survey (DLHS II and III) are PHCs for 24 X 7 services and also training the Staff tabled below: Nurses (SNs)/ Lady Health Visitors (LHVs)/ Auxiliary DLHS II DLHS III Nurse Midwives (ANMs) in Skilled Attendance at Birth. (2002-04) (%) (2007-08) (%)

Any Antenatal Checkup 73.6 75.2 4.4.1.b. Quality Ante-natal care: Quality ANC includes minimum of at least 4 ANCs Three or more Antenatal including early registration and 1st ANC in first trimester check-up 50.4 49.8 along with physical and abdominal examinations, Hb Total Institutional Delivery 40.9 47.0 estimation and urine investigation, 2 doses of T.T Immunization and consumption of Iron Folic Acid (IFA) Safe Delivery 48 52.7 tablets for 100 days. IFA tablets Consumed for 100 days 20.5 46.6 4.4.1.c.Prophylaxis and treatment of Nutritional Anemia: PNC within 2 weeks of delivery N.A 49.7 As per NFHS III (2005-06), 55.3% of women aged 15- From November, 2009 - January, 2010 a nationwide 49 years are anaemic in the country. The problem is more survey called the Coverage Evaluation Survey (CES) was conducted by the United Nations Children Emergency severe during pregnancy, with 58.7% of pregnant women Fund (UNICEF) & ORG- Centre for Social Research. (15-49 years) being anemic and 63.2 % of lactating This study was monitored independently by the National women. Under the NRHM /RCH II Programme all Institute of Health and Family Welfare (NIHFW) and pregnant and lactating women are provided with one Population Resource Centre. According to the CES tablet (containing 100 mg of elemental iron and 0.5 mg of report, the maternal health indicators are showing Folic Acid) daily for 100 days. Those who have severe significant improvement as given in table below: anaemia are provided with double dose of these tablets. Major Indicators Achievement (%) IFA in the form of tablets and liquid formulations are CES 2009-10 currently being supplied by the Government of India in 3+ ANC is reported 68.7% RCH Kit A and are distributed through the Sub-Centres and through outreach activities at Village Health and Institutional delivery 73% Nutrition Days (VHNDs) to women and children. These Skilled Birth Attendance are also available at other health facilities like PHCs, (Institutional+ Home) 76.2% CHCs, District Hospitals throughout the country. Details

64 Annual Report 2010-11 regarding interventions for anemia are given below: important components for identification and management Interventions for Anemia under NRHM of emergencies occurring during post natal period. The ANMs, LHVs and staff nurses are being oriented and Children Pregnant and trained for tackling emergencies identified during these lactating women visits. 6mths -5 6-10 years years 4.4.2 Skilled Attendance at Birth:

20 mg elemental 30 mg • 100 mg of Government of India is commited to provide skilled IFA supple- iron and 100 elemental elemental iron attendance at every birth both at community and institution mentation. mcg folic acid iron and and 0.5 mg of level. SNs/ANMs/LHVs are trained in Skilled Attendance per ml of liquid 250 mcg folic acid for at at Birth for a period of 3 weeks. For this curriculum and formulation. folic acid least 100 days technical guidelines have been revised and training is being per child for prevention implemented accordingly in all the States and UTs. per day of Anaemia. 4.4.3. Provision of Emergency Obstetric and Neonatal Care at First Referral Units • Those who (FRUs): have anaemia are provided Provision of Emergency Obstetric and Neonatal Care at with double FRUs is being done by operationalizing all FRUs in the dose of these country. While operationalization the thrust is on the critical tablets components such as manpower, blood storage units and referral linkages etc. Availability of trained manpower (Skill Based Training for MBBS doctors) is linked with • Health & Nutrition operationalization of FRUs. The initiatives being education to undertaken are: promote 4.4.3.a Training of MBBS Doctors in Life Saving dietary Anaesthetics Skills for Emergency Obstetric diversification, inclusion of Care: iron-folate rich Provision of adequate and timely Emergency Obstetric food and food Care (EmOC) has been recognized globally as the most items that important intervention for saving lives of pregnant women promote iron absorption. who may develop complications during pregnancy or childbirth. The operationalization of FRUs, at sub- district i.e. CHC level for providing EmOC to pregnant women Long Lasting Insecticide Nets (LLINs)/Insecticide Treated Bed is a critical strategy of RCH-II, which needs focused Nets (ITBNs) to households in endemic areas particularly to attention. It has not been possible to operationalize these pregnant women and children FRUs till now due to various factors most pertinent being 4.4.1.d Provision of 24 Hrs Delivery Services at shortage of specialist manpower, i.e. Gynaecologist and PHC: Anaesthetist, particularly at district and sub district level. Under RCH – II, all the CHCs and 50% of the PHCs For effective and better management of Emergency are being operationalized for providing round the clock Obstetric needs at the grass root level, Government of delivery services by placing at least 3 -5 Staff Nurses India has taken a policy decision and is implementing 18 and 1 Medical Officer in these facilities. weeks programme for training of MBBS doctors in life saving anaesthetic skills for Emergency Obstetric care 4.4.1.e.Post natal care for Mother and Newborn: at FRU. The training programme is being implemented in Ensuring post natal care within first 24 hours of delivery nearly 100 medical colleges across all the major States and subsequent home visits on 3rd, 7th and 42nd day are including NE Region.

Annual Report 2010-11 65 4.4.3.b Training in Obstetric Management Skills: because of sepsis and other complications associated with it. Eight percent of maternal deaths are attributed to Government of India has introduced training of MBBS complicated abortions. This is a preventable tragedy. This doctors in Obstetric Management & Skills in collaboration is also an indication of the unmet need for safe abortions. with Federation of Obstetric and Gynaecological Society The National Population Policy 2000 underlines the of India (FOGSI). A 16 weeks training programme in provision of safe abortions as one of the important obstetric management & skills including Caesarian operational strategies. Provision of MTP services at 24 Section operation is being implemented at the level of X 7 PHCs, CHCs and FRUs are being strengthened by Medical Colleges and District Hospitals in nearly 25 training of medical manpower in techniques of MTP by medical colleges of the States. the States. The following are the strategies to promote 4.4.3.c Referral Services at both Community and safe abortions: Institutional level: • Community level: Establishing referral linkages between the community and
Spread awareness regarding safe MTP in the FRUs is an essential component for access of services community and the availability of services particularly during emergencies. Since emergencies thereof. during the process of birth cannot be predicted, it is essential to place effective referral linkages which can
Enhance access to confidential counseling for be accessed by all pregnant women in case of emergency. safe MTP; train ANMs, AWWs and link workers/ States have been given the flexibility to establish assured ASHAs to provide such counseling. referral systems.
Promote post-abortion care through ANMs, link 4.4.4. Other Major Interventions are: workers/ASHAs and AWWs while maintaining confidentiality. 4.4.4.a.Safe Abortion Services/ Medical Termination of Pregnancy (MTP): • Facility level: Abortion is a significant medical and social problem in
Provide quality MVA (Manual Vacuum India. An ICMR study (1989) documented that the rates Aspiration) facilities at all CHCs and at least 50% of safe (legal) and unsafe (Illegal) abortions were 6.1 of PHCs that are being strengthened for 24-hour and 13.5 per 1000 pregnancies, respectively. It is evident deliveries. that perhaps two-thirds of all abortions take place outside
Provide comprehensive and high quality MTP the authorized health services by unauthorized, often services at all FRUs. unskilled providers.
Encourage private and NGO sectors to establish The Medical Termination of Pregnancy (MTP) Act was quality MTP services. passed by the Indian Parliament in 1971 and came into force from April 1, 1972. The aim of this Act was to Guidelines for Manual Vacuum Aspiration (MVA) upto 8 reduce maternal mortality and morbidity due to unsafe weeks of pregnancy for Medical Officers for performing abortions. The MTP Act, 1971 lays down the conditions safe abortions at primary health care facilities have been under which a pregnancy can be terminated and the place disseminated to the states for implementation. where such terminations can be performed. A recent Comprehensive safe abortion guidelines including medical amendment to the Act (2003) includes decentralization abortion and providing services for medical abortion of power for approval of places, as MTP centers, from through the peripheral health care infrastructure have also the states to the district level with the aim of enlarging been disseminated. the network of safe MTP service providers. The amendment also provides for specific punitive measures 4.4.4.b. RTI/STI Services for performing MTPs by unqualified persons and in places Reproductive Tract and Sexually Transmitted Infections not approved by the government. (RTI/STI) were not recognized as a public health problem Whether spontaneous or induced, abortion has been a until recently. Research conducted in India to document matter of concern over many decades now, particularly the magnitude of reproductive morbidity, has made the

66 Annual Report 2010-11 incidence of these infections more visible and brought Mission (NRHM) being implemented with the objective them into the reproductive health agenda. Several studies of promoting institutional delivery among the poor conducted in India during the past decade suggest high pregnant women. Launched on 12th April 2005, JSY is prevalence of reproductive morbidity among women. As being implemented in all States and UTs and integrates per DLHS-III (2007-2008), about one-fifth (18.3%) of JSY benefits with delivery and post-delivery care. The women reported some symptoms of RTI/ STI, however scheme focuses on poor pregnant woman with special there is no data regarding the percentage who sought dispensation for states having low institutional delivery treatment. The spread of HIV infection and the role that rate namely, the States of Uttar Pradesh, Uttrakhand, RTI/STI plays in the transmission of HIV have also Bihar, Jharkhand, Madhya Pradesh, Chattisgarh, Assam, brought urgency to the problem. The identification and Orissa, Rajasthan and Jammu & Kashmir. While these management of reproductive tract infections is an states have been classified as Low Performing States important objective of the RCH programme. The (LPS), the remaining states have been named as High following are the strategies under RCH II programme. Performing States (HPS). Besides the maternal care, the scheme provides cash assistance to all eligible mothers • The prevention, early detection and effective for delivery care. management of common lower reproductive tract infections have been included as a component of ASHA, the Accredited Social Health Activist acts as an essential care through the existing primary health care effective link between the Government and the poor infrastructure. pregnant women. Her role is to facilitate pregnant women to avail services of maternal care and arrange referral • Convergence with the National AIDS Control transport. Programme (NACP) is being sought for the provision of these services, in terms of utilization of services In Low performing States, all women including those from for case management, laboratory services, counseling SC and ST families, delivering in Government health services, drugs, equipment’s, blood safety etc. centres like Sub-centre, PHC/ CHC/FRU/general wards of District and State Hospitals or accredited private Under RCH - II RTI/STI services are being • institutions are eligible to receive the cash assistance. In implemented at sub-district level i.e. in at least 50% High Performing States, BPL pregnant women, aged 19 of the PHCs and all FRUs, including drugs, training, years and above and the SC and ST pregnant women disposable equipment, and provision for laboratory are eligible to receive the cash assistance under the technicians. Yojana. • National Guidelines for Management of RTIs/ STIs The scale of Cash Assistance (in Rs.) for Institutional have been developed in coordination with National Delivery is as under:- Institute for Research in Reproductive Health, Mumbai (under ICMR) and have been disseminated Category Rural Area Urban Area to States. Motherís ASHA Motherís ASHA package package 4.4.4.c.Setting up of Blood Storage Centers (BSC) In LPS 1400 600 1000 200 at FRUs: In HPS 700 200* 600 200

Timely treatment of complications associated with * In HPS Tribal area (Notified by Ministry of Tribal Affairs), the pregnancy is sometimes hampered due to non-availability ASHA package is Rs. 600 in Rural Area w.e.f. 15.6.2010. & in North of Blood Transfusion services at FRUs. The Drugs and East States the ASHA package is Rs. 600 in Rural Area w.e.f. September, 2006. Cosmetics Act has been amended to facilitate establishment of Blood Storage Centers at such FRUs. State Eligibility Category 4.5. JANANI SURAKSHA YOJANA (JSY) LPS States In All births, delivered in a health centre 4.5.1. Janani Suraksha Yojana (JSY) is a safe –Government or Accredited Private Health Institutions. motherhood intervention under the National Rural Health HPS States In Up to 02 live births

Annual Report 2010-11 67 The scale of Cash Assistance (in Rs.) for Home Delivery The progress on implementation of JSY during the last is as under:- five years is as reflected in the chart below:-

Category Rural Area Urban Area JSY Physical and Financial progress in past 5 years Motherís ASHA Motherís ASHA package package In LPS & HPS ** 500 Nil 500 Nil

** In LPS and HPS States, all BPL pregnant women, aged 19 years and above, delivery at home are entitled to cash assistance of Rs.500/ -per delivery, up to two live births.

ASHA package of Rs. 600/- available in LPS, NE States and in Tribal Districts of all States/UTs in the rural areas includes the following three components:- • Cash assistance, over and above the mother’s 4.5.2. Village Health and Nutrition Day package, for referral transport to go to the nearest Village Health & Nutrition Day (VHNDs) is organized health centre for delivery. The state will determine at the Anganwadi Centre at least once every month to the amount of assistance (should not be less than provide ante natal/ post-partum care for pregnant women. Rs.250/- per delivery) depending on the topography Promotion of institutional delivery, immunization, family and the infrastructure available in their state. It would, planning & nutrition are the other various services being however, be the duty of the ASHA and provided during VHNDs. the ANM to organize or facilitate in organizing referral 4.5.3. Other simultaneous steps being undertaken transport, in conjunction with Gram Pradhan, Gram are: Sabha etc. • Funds are provided to States to hire staff including • Cash incentive to ASHA should not be less than doctors and nurses, on a contractual basis wherever Rs.200/- per delivery in lieu of her work relating to necessary. facilitating institutional delivery. Generally, ASHA should get this money after her post-natal visit to the • SBA skills have been incorporated in the pre-service beneficiary and that the child has been immunized curriculum of SNs/ANMs/LHVs. for BCG. • Bed strength of health facilities are being increased to cope up with the demand of services. • Transactional cost (balance out of Rs. 600/-) is to be paid to ASHA in lieu of her stay with the pregnant • All Districts and selected high focus blocks have been woman in the health centre for delivery to meet her strengthened with persons with expertise in cost of boarding and lodging etc. Therefore, this managerial skills, data management and financial payment should be made at the hospital/ heath management so that planning and implementation of institution itself. services can be ensured. The Yojana subsidizes the cost of Caesarean Section or • States have identified difficult, most difficult and for the management of obstetric complications, up to Rs. inaccessible areas as per geographical location, tribal 1500/- per delivery to the Government Institutions, where population, underserved area, left wing affected areas etc. or in terms of difficulty in finding human resource Government specialists are not in position. for these areas and special incentives for specialists LPS and HPS States, all such BPL pregnant women, and MOs for such areas have been proposed by the aged 19 years and above, preferring to deliver at home is States to overcome the shortage of medical officers entitled to cash assistance of Rs.500/-per delivery, up to and specialists in these areas. two live births.

68 Annual Report 2010-11 • Flexibility funding to states and districts through untied 4.6.4 Monitoring and Evaluation of Service funds, AMGs and corpus funds. Delivery: 4.5.4. Involvement of professional associations for To monitor the performance and quality of the health skill based training under PPP services being provided for maternal and child health under • The services of private health facilities for providing the NRHM/RCH II program, several mechanisms like reproductive health services are being mobilized under performance statistics, surveys, community monitoring, quality assurance, field visits etc have been placed to various demand side financing schemes through the strengthen the monitoring and evaluation of the key mode of Public Private Partnership (PPP). Many indicators and strategies under these programs. states such as Gujarat (Chiranjeevi Yojana), Jharkhand (Mukhya Mantri Janani Shishu Swasthya 4.6.5. Health Management Information System Abhiyan), West Bengal (Ayushmati Scheme) are (HMIS): being implemented under Public Private Partnership. A web-based system has been established by the M&E For better implementation of this, GOI guidelines have Division of the Ministry for flow of information of both been issued to the states. GOI Guidelines to the States physical and financial progress from District to State and for engaging the services of private health facilities there in up to the national level. Comprehensive set of for up-scaling SBA training for ANMs/ SNs/LHVs formats for reporting by health facilities i.e. SCs/PHCs/ have also been issued. CHCs/DHs are available for monthly/quarterly and annual reporting. Mode of e-governance is being used for quick 4.6. NEW INITIATIVES data sharing and evaluation of key indicators. 4.6.1. Maternal Death Review(MDR): 4.7. CHALLENGES/CONSTRAINTS: It has been decided to review every maternal death both 4.7.1. Human resources for health: There is a huge at the health facilities and in the community through shortfall in the number of human resources formation of MDR Committees at district level and a required and currently in position. task force at State Level. The purpose of the review is 4.7.2. Governance issues:Tenure of key officers, to find gaps in the service delivery which leads to including Principal Secretaries, State NRHM maternal deaths and take corrective action to improve Mission Directors, Directorate officials at the the quality of service provision. The process of Maternal state levels, Chief District Medical Officers and Death Review has been initiated by the states for which Block Medical Officers, is not assured. This guidelines and tools have been disseminated to the states affects programme ownership and continuity of by the Ministry. interventions. 4.6.2 Maternal & Child Health (MCH) Centres: 4.7.3. Decentralized Planning: Decentralized planning capacities are inadequate, including capacity to The Government of India is facilitating the States in utilize locally available data for district planning. identifying the delivery points /MCH centres (for basic Facility surveys have been carried out by most and emergency obstetric management) for quality care states; however these have not been during pregnancy, child birth and in post-natal period and systematically analyzed by the states to map out commensurate family planning services, operationalization the resources and gaps, and prepare facility-wise of these facilities along-with rational deployment of micro plans for operationalization/strengthening. existing manpower, training of doctors and specialists in 4.7.4. Village Health and Sanitation these identified MCH centres/ delivery points and Committees:These need to be strengthened and providing funds for strengthening and up gradation of activated for improved outcomes. these centres. 4.7.5. Monitoring & Supervision:Supervisory 4.6.3 Name Based Tracking of Pregnant Women: structures at the state and district level are weak. At many places, there is no mechanism for Government of India has taken a policy decision to track monitoring and supervision. every pregnant woman by name for provision of timely ANC, institutional delivery, and PNC along-with 4.7.6. Public Private Partnership (PPP): PPP in RCH services are not up to the expected levels immunization of the new- born. and needs to be scaled up.

Annual Report 2010-11 69

Chapter 5 Child Health Programme

5.1. INTRODUCTION and 3.13 lakh personnel have been trained. F – IMNCI launched to multi skill doctors and staff nurses with special 5.1.1 Under the National Rural Health Mission skills required to manage new born and child hood illnesses (NRHM), Child Health Programme comprehensively at facilities. Moreover IMNCI has been introduced in integrates interventions that improve child health and the curriculum of 79 Medical colleges and more than 4000 addresses factors contributing to infant and under–five medical students have been trained on various aspects of mortality. The major components of child health IMNCI. programme are: i) Establishment of New Born Care facilities and Facility Based Integrated Management of 5.2.2 A total of 192 Sick New Born Care Units Neonatal and Childhood Illnesses (F-IMNCI), ii) Navjaat (SNCUs), 366 stabilization units and 1524 new born care Shishu Suraksha Karyakram iii) Integrated Management corners has been established. of Neonatal and Childhood Illnesses (IMNCI) and Pre- 5.2.3 Under the Navajat Shishu Suraksha Service IMNCI iv) Home Based Care of Newborns v) Karyakram (NSSK), 14490 health personnel have been Universal Immunization vi) Early detection and trained. This scheme launched to address issues of care appropriate management of Acute Respiratory Infections, at birth and to reduce neonatal mortality. Diarrhoea and other infections vii) Infant and young child feeding including promotion of breast feeding viii) 5.2.4 Totally, 1898 Nutritional Rehabilitation Management of children with malnutrition ix) Vitamin A Centres (NRCs) have been set up across States for supplementation and Iron and Folic Acid supplementation treatment of acute malnutrition. x) School Health Programme 5.2.5 School Health Programme (SHP) has been 5.1.2 Child Health Goal under RCH II/NRHM: launched nationwide and is currently being implemented in 33 States/UTs. Health check-up, treatment of minor Child HealthCurrent StatusRCH II/NRHM: ailments, health education, micronutrient supplementation MDG and immunization services are being offered in close indicator SRS (2008) 2010-2012 2015 conjunction with the ministry of HRD. IMR (infant 5.2.6 Vitamin A supplementation is being mortality rate) 53 < 30 28 implemented for all children of 9 months to 5 years of Neonatal mortality rate 36 < 20 < 20 age with the objective of decreasing the prevalence of Vitamin A deficiency to levels below 0.5%. During 2009- Under 5 mortality rate 69 - < 39 10 the coverage of 1st, 5th and 9th dose of vitamin A was 80.8%, 71% and 45.9% respectively. The strategies for child health intervention focus on improving skills of the health care workers, strengthening 5.3 UNIVERSAL IMMUNIZATION the health care infrastructure and involvement of the PROGRAMME community through behavior change communication. 5.3.1 Immunization Programme is one of the key 5.2. THE PROGRESS OF VARIOUS interventions for protection of children from life COMPONENTS OF CHILD HEALTH threatening conditions, which are preventable. Under the PROGRAMME ARE AS FOLLOWS Universal Immunization Programme, vaccination is carried out to prevent seven vaccine preventable diseases i.e. 5.2.1 Integrated Management of Neonatal & Childhood Diphtheria, Pertussis, Tetanus, Polio, Measles, severe Illnesses (IMNCI) is being implemented in 323 districts form of Childhood Tuberculosis and Hepatitis B. Since

Annual Report 2010-11 71 2006, 1 dose of SA-14-14-2 JE vaccine has been 5.3.5 Introduction of Measles Second introduced under routine immunization in the high burden Opportunity: Measles immunization directly contributes districts in phased manner. to the reduction of under-five child mortality and hence 5.3.2 The immunization coverage has seen an to the achievement of Millennium Development Goal improvement over the years. However, there is further number 4. In order to accelerate the reduction of measles need for improvement especially in DPT3 & OPV3 related morbidity and mortality, second opportunity for coverage and reducing drop outs. Following table outlines measles vaccination is being implemented. The NTAGI under the programme: has recommended the introduction of another dose of measles vaccine through measles Supplementary

(Figures in %) Source Coverage Evaluation Survey (CES) District Level Household Survey (DLHS) Time Period 2006 2009 DLHS 2 (2002-04) DLHS 3 (2007-08)

Full Immunization 62.4 61.0 45.9 53.5

BCG 87.4 86.9 75.0 86.7

OPV3 67.5 70.4 57.3 65.6

DPT3 68.4 71.5 58.3 63.4

Measles 70.9 74.1 56.1 69.1

No Immunization - 7.6 19.8 4.6

5.3.3 To strengthen routine immunization, some newer Immunization Activity (SIA) for States where evaluated initiatives have been introduced as part of the State coverage for measles vaccine is less than 80% while for Programme Implementation Plan (PIP). These initiatives the remaining States where coverage is more than 80%, are provision of Auto Disable (AD) Syringe to ensure NTAGI recommended a second dose through routine injection safety, support for alternate vaccine delivery immunization. The 14 states with measles coverage of from PHC to Sub-Centres and outreach sessions, less than or equal to 80%, viz. Arunachal Pradesh, provision for deploying additional manpower to carryout Assam, Bihar, Chhattisgarh, Gujarat, Haryana, Jharkhand, Immunization activities in urban slums and underserved Madhya Pradesh, Manipur, Meghalaya, Nagaland, areas where services are deficient and support for Rajasthan, Tripura and Uttar Pradesh are being covered mobilization of children to immunization session sites by through Supplementary Immunization Activity, in a phased Accredited Social Health Activist (ASHA), Women Self manner followed by introduction of second dose at 16-24 Help Groups etc. months in routine immunization. 5.3.4 Expansion of Hepatitis B Vaccine: Hepatitis 5.3.6 Introduction of Japanese Encephalitis (JE) B vaccination was introduced in UIP in the financial year Vaccine: JE vaccination was started in 2006 to cover 2002-03 as a pilot in 33 districts and 15 cities and was 109 endemic districts in phased manner, using SA 14-14 further expanded to all the districts of 10 states namely -2 vaccine, imported from China. Single dose of JE Andhra Pradesh, Himachal Pradesh, Jammu & Kashmir, vaccine was given to all children between 1 to 15 years Karnataka, Kerala, Madhya Pradesh, Maharashtra, of age through campaigns followed by one dose at 16-24 Punjab, Tamil Nadu and West Bengal. Following the months under routine immunization to cover the newer recommendation of National Technical Advisory Group cohort. By the end of 2009-10, 90 districts have been on Immunization (NTAGI), it has been decided to provide covered under the JE vaccination programme; and Hepatitis B vaccination all over the country. remaining 19 districts are being covered in 2010-11. In

72 Annual Report 2010-11 addition, in 2010-11 re campaign has been planned in 9 Table: districts; 7 in Uttar Pradesh and two in Assam, in view of State-wise details of polio cases in 2010 their low coverage as per the coverage evaluation survey (as on 24th December 2010) conducted in 2008. The JE vaccine is being integrated into routine immunization in the districts where campaign S. State WPV-1 WPV-3 Total had already been conducted to immunize the new cohort No of children by vaccinating with single doses at 16 -24 1 Uttar Pradesh 0 10 10 months. 2 Bihar 3 6 9 5.4 PULSE POLIO IMMUNIZATION(PPI) 3 West Bengal 5 2 7 4 Jharkhand 3 5 8 In the pursuance of the World Health Assembly resolution 5 Maharashtra 5 0 5 of 1988, the Pulse Polio Immunization (PPI) Programme was started nation-wide from 1995 to eradicate polio in 6 Haryana 0 1 1 India covering children in the age group 0-3 years. In 7 Jammu & Kashmir 1 0 1 order to accelerate the pace of polio eradication, all Total 17 24 41 children under the age of 5 years were targeted since The major risks to eradication of type 1 polio are 1996-97. The annual strategy on polio eradication is transmission in West Bengal and Jharkhand areas and decided on the basis of recommendation of India Experts re-introduction of type 1 polio from neighboring Nepal or Advisory Group (IEAG) which constituted of Indian West Bengal through extensive migration and population experts and international experts. The National Polio movements. Surveillance Project (NPSP) provides technical support 5.5 INFANT AND YOUNG CHILD FEEDING for high quality Acute Flaccid Paralysis (AFP) surveillance (IYCF) & assists the government in micro planning, training & 5.5.1 Promotion of infant and young child feeding monitoring of polio immunization campaign. (IYCF) practices. The following are emphasized under Since the PPI initiative in 1995, significant success has IYCF: been achieved in reducing the number of polio cases in • Early initiation of breastfeeding within one hour of the country & total cases decline gradually. Of the 3 types delivery of polio causing viruses, type 2 (WPV-2) has already been • Exclusive breastfeeding of the first six months of eradicated in 1999. The bivalent vaccine (bOPV) was life introduced in the country for the first time in 2010. In • Timely and adequate complementary feeding along 2010, two National Immunization Days (NIDs) and six with continuation of breast feeding up to two years sub-national Immunization Days (SNIDs) have been of life conducted. The NID rounds covers approximately 170 Comparison of indicators of child feeding million children and SNID rounds cover 40-80 million practices: children. In addition, large scale multi-district mop-ups NFHS I NFHS II NFHS III have been conducted in response to detection of the (1992-93) (1998-99) (2005-06) WPVs. As a result of these interventions remarkable Indicators Rural Urban Total progress has been made towards polio eradication with only 41 polio cases detected (as on 24th December 2010) Children under compared to 650 cases detected during the same period 3 years breastfeeding within one hour of in 2009. Details are given in the table below. The most birth (%) 9.5 16.0 21.5 28.9 23.4 significant progress is seen in the endemic states with no type 1 case detected in UP since November 2009 and Children aged one type 1 case detected in 2010 in Bihar with onset of 0-5 months exclusively July 2010. breastfeeding (%) N.A N.A 40.7 31.1 38.4

Annual Report 2010-11 73 5.6 IRON AND FOLIC ACID are there in the states for storing the vaccines at various SUPPLEMENTATION levels.

5.6.1 To manage the widespread prevalence of I. Walk ñin Coolers and Walk-in - Freezers anaemia in the country, Iron and Folic Acid Rooms: These are supplied at State/Regional supplementation is provided for at least hundred days in Level to maintain a vaccine stock required for 3 a year for all age groups, i.e infants above six months of months in its catchment area. There are at present age up to adolescence and pregnant and lactating mothers 161 walk in coolers and 36 walk in freezers installed as well as IUD users. at various location of the states in the country. 5.6.2 Infant from the age of 6 months onwards up to II. Ice Lined Refrigerators (Large) and Deep the age of five years shall receive iron supplements in Freezers (Large) at the district Level: 8700 liquid formulation in doses of 20 mg elemental iron and number ILRs (L) and Deep Freezers (L) have been 100 mcg folic acid (per day) for 100 days in a year. Children 6-10 years of age shall receive iron in the dosage supplied. At the district stores Deep Freezers are of 30 mg elemental iron and 250 mcg folic acid for 100 also used for storing Polio Vaccine at below (-) 15 days in a year and adolescents 11-18 years shall receive Centigrade. supplements at the same dosage and durations as adults. III. A Twin Set of ILR/Deep Freezers: These have 5.7 COLD CHAIN SYSTEM VACCINE been supplied in pairs to all PHCs, where a stock STORAGE AT PHC/CHC LEVEL of one month’s requirement of vaccines is maintained. 79000 such units have been supplied 5.7.1 The cold chain system consists of a series of to different health institutions. transportation & storage facilities for vaccines from the manufacturers to the beneficiaries at a recommended IV. Skill based training to cold chain technicians was temperature. Now this year nearly 15000 equipments provided to equip with repair management skills on were procured and are being supplied to states for CFC free equipments. Cold chain stores renovation upgradation of cold chain system in the country. More has also been initiated in the States as per their than 87000 units consisting of the following equipments requirements.

74 Annual Report 2010-11 Chapter 6 National Programmes Under NRHM

6.1 INTRODUCTION (iii) Supportive Interventions including Behaviour Change Communication (BCC), Public‘ Private Several National Health Programmes such as the National Partnership (PPP) & Inter-sectoral Convergence, Vector Borne Diseases Control, Leprosy Eradication, TB Human Resource Development through capacity Control, Blindness Control and Iodine Deficiency Disorder building, Operational Research including studies on Control have now come under the umbrella of National drug resistance and insecticide susceptibility and Rural Health Mission. Monitoring & Evaluation. 6.2. NATIONAL VECTOR BORNE DISEASES CONTROL PROGRAMME (NVBDCP) 6.2.1. Malaria The National Vector Borne Disease Control Programme a. Malaria is an acute parasitic illness caused by is a comprehensive programme for prevention and control Plasmodium falciparum or Plasmodium vivax in of vector borne diseases namely Malaria, Filaria, Kala- India. Nine major species of anopheline mosquitoes azar, Japanese Encephalitis (JE), Dengue and transmit malaria in India. The main clinical Chikungunya which is covered under the overall umbrella presentation is with fever with chills; however, of NRHM. The States are responsible for implementation nausea and headache can also occur. The diagnosis of programme whereas the Directorate of NVBDCP, is confirmed by microscopic examination of a blood Delhi provides technical assistance, policies and smear and Rapid Diagnostic Tests for Pf cases. assistance to the States in the form of cash & commodity, Majority of the patients recover from the acute as per approved pattern. Malaria, Filaria, Japanese episode within a week. Malaria continues to pose Encephalitis, Dengue and Chikungunya are transmitted a major public health threat in different parts of the by mosquitoes whereas Kala-azar is transmitted by sand- country, particularly due to Plasmodium falciparum flies. The transmission of vector borne diseases in any as it is sometimes prone to complications and death, area is dependent on frequency of man-vector contact, if not treated early. which is further influenced by various factors including vector density, biting time, etc. b. There are 9 species of Malaria vectors in India, out of which the major vector mosquito for rural The general strategy for prevention and control of vector malaria viz. Anopheles culicifacies, is distributed borne diseases under NVBDCP is described below: all over the country and breeds in clean ground (i) Disease Management including early case water collections. Other important Anopheline detection and complete treatment, strengthening of species namely An.minimus and An.fluviatilis referral services, epidemic preparedness and rapid breed in running channels, streams with clean water. response. Some of the vector species also breed in forest areas, mangroves, lagoons, etc, even in those with (ii) Integrated Vector Management including organic pollutants. Indoor Residual Spraying (IRS) in selected high risk areas, use of Insecticide Treated Bed Nets c. In urban areas, malaria is mainly transmitted by (ITNs), Long Lasting Insecticidal Nets (LLINs), Anopheles stephensi which breeds in man-made use of larvivorous fish, anti larval measures in urban water containers in domestic and peri-domestic areas including bio-larvicides and minor and situations such as tanks, wells, cisterns, which are environmental engineering. more or less of permanent nature and hence can

Annual Report 2010-11 75 maintain density for malaria transmission throughout Pre-independence estimates of Malaria were about 75 the year. Increasing human activities, such as million cases and 0.8 million deaths annually. The problem urbanization, industrialization and construction was virtually eliminated in the mid sixties but resurgence projects with consequent migration, deficient water led to an annual incidence of 6.47 million cases in 1976. and solid waste management and indiscriminate Modified Plan of Operation was launched in 1977 and disposal of articles (tyres, containers, junk materials, annual malaria incidence started declining. The cases cups, etc.) create mosquitogenic conditions and thus were contained between 2 to 3 million cases annually till contribute to the spread of vector borne diseases. 2001 afterwards the cases have further started declining. During 2009, the malaria incidence was around 1.56 The National Health Policy (2002) has set the goal of reduction in mortality on account of malaria by 50% by million cases, 0.84 million Pf cases and 1144 deaths. 2010. Reduction of malaria morbidity and mortality is also About 92% of malaria cases and 97% of deaths due to important to meet the overall objectives of reducing malaria are reported from high disease burden states poverty and is included in the Millennium Development namely, north eastern (NE) States, Chhattisgarh, Goals (Goal 6 and target 8). Jharkhand, Madhya Pradesh, Orissa, Andhra Pradesh, Maharashtra, Gujarat and Rajasthan, West Bengal and Epidemiological Situation: Karnataka. However, other States are also vulnerable The status of total cases, Pf cases, deaths and API from and have local and focal outbreaks. Resistance in 1996 to 2010 (up to September) is given in the table and Plasmodium falciparum to Chloroquine is being detected the Graph as follows. The state-wise data on malaria from more areas and Artesunate Combination Therapy cases & deaths since 2007 is at Appendix- 1. has been introduced in such areas as first line treatment. For strengthening surveillance, Rapid Diagnostic Test Malaria Situation in the country during 1996-2010* (RDT) for diagnosis of P.falciparum malaria has also been introduced in high endemic areas. In these areas, Year Cases (in million) Deaths API ASHAs have been trained in diagnosis and treatment of Total Pf malaria cases and are thus involved in early case detection and treatment. 1996 3.03 1.18 1010 3.48 1997 2.66 1.01 879 3.01 1998 2.22 1.03 664 2.44 1999 2.28 1.14 1048 2.41 2000 2.03 1.04 932 2.09 2001 2.09 1.01 1005 2.12 2002 1.84 0.90 973 1.82 2003 1.87 0.86 1006 1.82 2004 1.92 0.89 949 1.84 2005 1.82 0.81 963 1.68 The Government of India provides technical assistance and logistics support including anti malaria drugs, DDT, 2006 1.79 0.84 1707 1.66 larvicides, etc. under the National Vector Borne Disease 2007 1.50 0.74 1311 1.39 Control Programme. State Governments have to meet other requirements of the programme and operational 2008 1.53 0.78 1055 1.36 costs and to ensure the implementation of programme. 2009 1.56 0.84 1144 1.36 North-eastern states are provided 100 per cent central assistance for programme implementation that includes 2010* 1.04 0.53 547 operational cost.

* Data for 2010 up to September

76 Annual Report 2010-11 The major externally supported projects:
Human resource such as Consultants and support staff for project monitoring units. Additional support for combating malaria is provided through external assistance in high malaria risk areas.
Capacity building of Medical Officers/Lab. There are two such externally funded projects which are Technicians/ Fever Treatment Depots/Volunteers currently being implemented for malaria control: etc. (i) Global Fund Supported Intensified Malaria Control
Commodities such as Synthetic Pyrethroid liquid Project (IMCP) formulation insecticide for treatment of bednets, (ii) World Bank Supported Project on Malaria Control Long-Lasting Insecticidal Nets (LLINs), Rapid & Kala-azar Elimination. Diagnostic tests for quick diagnosis of Malaria, alternate drugs (Artesunate Combination Therapy, The areas covered under these projects are as under: Inj. Arteether) for treating malaria cases resistant to Chloroquine. TWO PROJECTS WITH EXTERNAL ASSISTANCE

Planning & administration including mobility support, The Global Fund supported Intensified Malaria monitoring, evaluation and operational research Control Project (IMCP) (studies on drug resistance and entomological This project is for a period of 5 years starting from July, aspects). 05 to June, 2010. The total financial outlay of this project This project has ended in June 2010. This Intensified is Rs. 277.20 crores. The project is being implemented Malaria Control Project–II (IMCP-II) will be in 106 districts in 10 States namely, 7 North-Eastern States implemented for a period of five years (2010-2015). and in selected high risk areas of Orissa, Jharkhand and West Bengal covering a population of about 100 million. Achievements of IMCP: (Project end): Under this The goal of the project is to reduce malaria morbidity project in five years followings have been achieved: and mortality in 100 million populations in 10 States by (i) Provision of 5145475 ITNs (including 6,75,004 30% in 5 years. LLINs) to targeted population in project areas Additional Support provided in project area is listed (ii) 2,16,42,050 bed nets treated with insecticides in below: project area during the project period

Annual Report 2010-11 77 (iii) Treatment with SP-ACT in 970450 uncomplicated malaria incidence by 23.4%, with overall declining trend Pf cases in SPR, SfR with improvement in process indicator ABER indicating improved surveillance. (iv) Treatment with artemisinin injections in 343930 severe malaria cases The World Bank Supported Project on Malaria Control & Kala-azar Elimination (v) 4890 medical officers of public and private healthcare sectors trained This project has been approved for 5 years effective from March 2009 to December 2013. The total financial outlay (vi) 137 recruited and trained for the supervision in for this project is Rs.1000 crore. This project is being project areas implemented in 93 malarious districts of eight (8) states (vii) 3261 LTs trained in malaria microscopy namely Andhra Pradesh, Chhattisgarh, Gujarat, Jharkhand, Madhya Pradesh, Maharashtra, Orissa & (viii) 9601 service deliverers of local NGOs/CBOs Karnataka and 46 Kala-azar districts in three states identified and trained namely Bihar, Jharkhand and West Bengal. The project will be implemented in two phases. Phase one is covering (ix) 2,13,997 community volunteers trained in malaria 50 most malaria endemic districts in five States namely control strategies Andhra Pradesh, Chhattisgarh, Madhya Pradesh, Orissa (x) 70860 awareness camps organized at village level and Jharkhand and 46 kala-azar districts in Bihar, for treating bed-nets. Jharkhand & West Bengal. From 3rd year, phase two shall be implemented in remaining (43) malaria districts. The impact in terms of epidemiological indicators for the Additional support provided in this project are: project areas based on the data received up to July 2009 are shown in the following table:

Table: Status of Epidemiological Indicators of malaria In IMCP (2002-09)

Indicator 2002 2003 2004 2005 2006 2007 2008 2009 % Change from 2002 Population (In,000s) Project 83838 89619 90807 93533 101887 103925 106004 105645 26.0

ABER Project 7.76 7.72 7.20 8.87 9.28 8.61 8.47 9.89 27.45

Annual Parasite Incidence (API) 5.25 5.33 4.98 4.88 4.95 4.05 3.43 4.02 - 23.42

Project Slide Positivity Rate (SPR) Project 6.77 6.90 6.79 5.51 5.33 4.70 4.05 4.07 -39.88

Slide falciparum Rate (SfR) Project 3.41 3.33 3.32 2.55 2.79 2.52 2.41 2.63 -22.87

Malaria Mortality Project 478 484 395 426 1124 ** 691 389 563 +17.78

** Due to epidemic situation in Assam i) Provision of Human Resource like Consultants & The enhanced inputs under the project ie, introduction of Support staff at National, State, District & Sub RDT for early diagnosis and complete treatment with District level for surveillance & monitoring. ACT (SP + Artesunate) regimen and injection Artemisinine derivatives along with use of ITN/LLINs as personal ii) Promotion & use of long lasting Insecticide Nets protective measures have helped to achieve decline in (LLINs) in high malaria endemic areas.

78 Annual Report 2010-11 iii) Social mobilization and vulnerable community plan Control Strategy: to address the issues of marginalized sections. Under UMS, Malaria Control strategies are for: (i) iv) Strong BCC/IEC activities at Sub district level through identified agencies. Parasite control & (ii) Vector control v) The project also envisaged the safe guard policies (i) Parasite control: Treatment is done through by undertaking Environmental Management Plan passive agencies viz. hospitals, dispensaries both (EMP) on safe disposal & environmental hazards. in private & public sectors. In mega cities malaria vi) Capacity building of Medical Officers /Lab clinics are established by each health sector/ malaria Technicians/Fever Treatment Depots/Volunteers control agencies viz. Municipal Corporations, etc. Railways, Defence services vii) Supply of rapid kits for Malaria and drug Artesunate combination therapy (ACT) for treatment of PF (ii) Vector control comprises of source reduction, cases. use of larvicides, use of larvivorous fish, space spray, minor engineering and Legislative measures. 6.2.2. Urban Malaria Scheme The Urban Malaria Scheme (UMS) under NVBDCP is The control of urban malaria depends primarily on the being implemented in 131 towns in 19 States and Union implementation of urban bye-laws to prevent mosquito Territories protecting 115.1 million population. breeding in domestic and peri-domestic areas or residential Objectives: blocks and government/commercial buildings, construction sites. Use of larvivorous fish in the water bodies such as The main objectives were reduction of the disease to a natural water bodies, slow moving streams, lakes, tolerable level in which the human population in urban ornamental ponds/fountains etc. is also recommended. areas can be protected from malaria transmission with Larvicides are used for water bodies, which are unsuitable the available means. for use of larvivorous fish. Awareness campaigns are The Urban Malaria Scheme aims at: also undertaken by Municipal Bodies/Urban area a). To prevent deaths due to malaria. authorities.The Bye-laws have been enacted and implemented in Delhi, Mumbai, Chandigarh, Ahmedabad, b). Reduction in transmission and morbidity. Bhavnagar, Surat, Rajkot, Bhopal, Agartala and Goa. Epidemiological Situation Central Cross Checking Organization (CCCO): The About 10% of the total cases of malaria are reported Central Cross Checking Organization of the Directorate from urban areas. Maximum numbers of malaria of National Vector Borne Disease Control Programme cases are reported from Ahmedabad, Chennai, regularly cross check of anti-larval operations in Kolkata, Mumbai, Vadodara, Vishakapatnam, Vijayawada etc. The comparative epidemiological Municipal Corporation of Delhi (MCD), New Delhi profile of malaria during 2008-2010 in all urban towns Municipal Council (NDMC), Northern Railways, of the country is given below: Cantonment Areas as well as Zoological Park, Indian Institute of Technology Delhi, All India Radio, Jawahar Year Population Total P.f P.F % SPR SFR Deaths cases Lal Nehru University and Presidents Estate in NCT Delhi and near by townships /localities of National Capital Region 2008 113334073 113810 18963 13.42 1.66 0.22 102 namely Ghaziabad and Noida in Uttar Pradesh, Faridabad, Gurgaon and Sonepat in Haryana to provide feedback 2009 114699850 166065 31134 18.75 2.98 0.56 213 about the larval density/ breeding indices and remedial *2010 115159555 111486 15332 13.75 2.81 0.39 118 measures to be undertaken by them. The monthly

*Provisional up to October, 2010

Annual Report 2010-11 79 entomological indices of National capital territory of Delhi for Aedes aegypti are as below from 2009 & 2010. Table showing breeding indices of Aedes aegypti in NCT Delhi 2008, 2009 and 2010

S.No. Month 2008 2009 2010* HI CI BI HI CI BI HI CI BI

1. January 0.0 0.0 0.0 0.0 0.0 0.0 0.1 0.1 0.1

2. February 0.04 0.03 0.04 0.02 0.03 0.03 0.03 0.02 0.03

3. March 0.11 0.13 0.14 0.09 0.07 0.0 90.1 0.1 0.2

4. April 0.54 0.48 0.56 0.16 0.13 0.16 0.5 1.00.2 0.6

5. May 1.2 1.1 1.3 0.5 0.4 0.5 1.2 0.81.0 1.6

6. June 4.8 5.0 5.8 1.0 1.1 1.3 0.9 2.80.8 1.2

7. July 4.4 5.2 7.7 1.1 1.1 1.3 1.9 9.82.8 4.6

8. August 4.5 5.2 7.8 3.1 4.1 6.2 6.4 9.79.8 25.0

9. September 4.1 4.4 5.8 3.2 4.9 8.5 7.6 2.9.7 23.9

10. October 2.3 2.3 2.1 1.6 1.7 2.3 2.5 2.1 3.1

11. November 0.5 0.6 0.06 1.1 1.0 1.3

12. December 0.04 0.03 0.04 0.4 0.4 0.6

HI= HOUSE INDEX, CI= CONTAINER INDEX, BI= BRETEAU INDEX *Provisional up to October 2010 Vector Control Strategy Followings are the vector control strategies for NCT • Spray with pyrethrum in and around 50 house of a Delhi: positive malaria case. • Weekly recurrent application of larvicides like • Use of fogging in case of very high density of vector temephos and mosquito larvicides oil in different mosquitoes (Aedes aegypti and An. Stephensi). breeding habitats. 6.2.3. Elimination of LymphaticFilariasis Use of Larvivorous fish Gambusia affinis, and • 6.2.3.a.Lymphatic Filariasis is transmitted mainly by Poecila reticulate (Guppy) in ornamental tanks, mosquito Culex quinquefasciatus which breeds in ponds and other water collections. polluted water in drains, cesspits etc., in areas with • Filling up of unused well and water pools, desilting inadequate drainage, sanitation.However, in some parts and deweeding of the margins of the drains. of Kerala Mansonia annulifera / M.uniformis also transmits the disease and the vector mosquitoes breed • Use of legislative measures and prosecution of in water pools with aquatic vegetation. The disease is defaulters; for creating mosquitogenic conditions reported to be endemic in 250 districts in 20 States and in domestic places. UTs. The population of about 600 million in these districts

80 Annual Report 2010-11 is at risk of lymphatic filariasis. This disease causes 6.2.3.d. To achieve elimination of Lymphatic Filariasis, personal trauma to the affected persons and is associated the Government of India during 2004 launched annual with social stigma, even though it is not fatal. Mass Drug Administration (MDA) with annual single recommended dose of DEC tablets in addition to scaling up home based foot care and Hydrocele operation. The co-administration of DEC+ Albendazole has been upscaled to cover the population at risk. However, Mass States/UTs): 20 Districts: 250 Drug Administration (MDA) - 2009 round was observed Pop.: 600 million in 18 States/UTs except Assam and Uttar

6.2.3.b. The target year for Global elimination of this disease is by the year 2020. Government of India is signatory to the World Health Assembly Resolution in 1997 for Global Elimination of Lymphatic Filariasis. The National Health Policy (2002) has envisaged elimination of lymphatic fialriasis in India by 2015. The Elimination is Pradesh with co-administration of DEC with defined as “Lymphatic Filariasis ceases to be a public Albendazole. The coverage achieved in these states for health problem, when the number of microfilaria carriers MDA is 88.6% against the targeted population. The MDA is less than 1% and the children born after initiation of coverage was 72.4% in 2004, 76% in 2005, 82% in 2006, ELF are free from circulating antigenaemia (presence of 83% in 2007 and 86% in 2008. The state wise coverage adult filaria worm in human body). is indicated in Appendix-2.

6.2.3.c.The strategy of lymphatic filariasis th elimination is through: The MDA 2010 round has started from 11 November, 2010. • Annual Mass Drug 6.2.3.e. The line listing of lymphoedema and Hydrocele Administration cases were initiated since 2004 by door to door survey (MDA) of single in these filaria endemic districts. The enlisted cases are dose of antifilarial regularly being updated by state health authorities and tablets i.e. DEC + more cases Albendazole for 5 are being years or more to recorded. the eligible This population (except increase is pregnant women, mainly due children below 2 to years of age and incomplete seriously ill surveys persons) to during initial interrupt transmission of the disease. years and • Home based management of lymphoedema cases reluctance and up-scaling of hydrocele operations in identified on part of CHCs/ District Hospitals /Medical Colleges.

Annual Report 2010-11 81 community to reveal their manifestations of lymphoedema World Bank is providing assistance in 46 districts in 3 and Hydrocele. The updated figure till 2009 revealed that states namely Bihar, Jharkhand and West Bengal. 7.62 lakhs lymphoedema and 3.93 lakhs Hydrocele cases Kala-azar is endemic in 52 districts (31 in Bihar, 4 in have been enlisted. The initiatives have also been taken Jharkhand, 11 in West Bengal and 6 in UP). The Kala- to demonstrate the simple washing of foot to maintain azar Control Programme was launched in 1990-91. The hygiene for prevention of secondary bacterial and fungal annual incidence of disease came down from 77,099 infection in chronic lymphoedema cases so that the cases in 1992 to 33598 cases in 2008 and deaths from patients get relief from frequent acute attacks. The states 1419 to 151 in 2008 respectively. In the year 2009, 24212 regularly update the list and intensify the hydrocele cases and 93 deaths were reported, whereas in 2010 operations in their respective states. upto October, 23375 cases and 78 deaths have been 6.2.3.f. The microfilaria survey in all the implementation reported - Appendix 3. units (districts) is being done through night blood survey 6.2.4.b. To realize the goal of elimination of Kala-azar, before MDA. The survey is done in 4 sentinel and 4 the Govt. of India is providing 100% support to endemic random sites collecting total 4000 slides (500 from each states since 2003-04. site). There is definite evidence of microfilaria reduction in the MDA districts. However, the coverage of 6.2.4.c. Initiatives undertaken for Kala-azar elimination population with MDA should be above 80% persistently are as follows: for 5-6 year which would reduce microfilaria load in community and thereby, interrupting the transmission. • Active Case Search: The frequency of case searches has been increased, from a single annual case search to quarterly case searches. The active case searches are carried out during a fortnight designated as the ëKala-azar Fortnightí, during which the peripheral health workers and volunteers are engaged to make door-to-door search and refer the cases conforming to case definition of kala- azar and PKDL to the treatment centres for definitive diagnosis and treatment.

• Institutional Surveillance through passive case detection: Majority of the Kala-azar cases are reported from PHC’s and district hospitals.

6.2.4. Kala-Azar 6.2.4.a.Kala-azar is caused by a protozoan parasite Leishmania donovani and spread by sandfly, which breeds in shady, damp and warm places in cracks and crevices in the soft soil, in masonry and rubble heaps, etc. Proper sanitation and hygiene are critical to prevent sand fly breeding. The National Health Policy (2002) of GoI has set the goal for elimination of Kala-azar from the country by 2010. In pursuance to achieve the elimination goal, case detection and treatment compliance has been strengthened and Rapid Diagnostic Test for Kala-azar and oral drug miltefosine have been introduced.

82 Annual Report 2010-11 Many private practitioner, NGO, FBO’s have also been advised to report cases to the district health authorities.

• Treatment: To ensure complete treatment compliance a patient coding scheme has been put in place in all the treatment cetnres.

• Vector Control: Two rounds of DDT spray are undertaken in affected villages of the endemic district, at a dosage of 1g/m2.

• A health education programme with personal contacts as well as through mass media has been initiated to create awareness of the disease amongst the public, emphasizing the need for early case detection, acceptance of a full course of treatment and other control measures.

• Intensive training programme for all levels of health staff has been undertaken including one inter- 6.2.5.b. Case definition of AES: Clinically, a case of country training and one inter-country training on AES is defined as a person of any age, at any time of the Standard Operation Procedures (SOP). year with the acute onset of fever and a change in mental status (including symptoms such as confusion, • Introduction of rapid diagnosis test for Kala-azar disorientation, coma or inability to talk), and/or new onset and oral drug miltefosine in 10 pilot districts of 3 of seizures (excluding/simple febrile seizures). Other endemic states. early clinical findings may include an increase in irritability, somnolence or abnormal behaviour greater than that seem • An incentive for an amount of Rs.200/- is being with usual febrile illness. provided to the Health Workers/ASHAs for referring a susceptive case of kala-azar and to A simple febrile seizure is defined as a seizure that occurs ensure complete treatment after confirmation. in a child aged 6 months to less than six years old, whose only findings is fever and a single generalized convulsion • The kala-azar activist/ Accredited Social Health lasting less than 15 minutes and who recovers Activist (ASHA) under the National Rural Health consciousness within 60 minutes of the seizure. Mission (NRHM) will be provided incentives to (Reference – Guidelines for surveillance of Acute involve them in the various activities for control of Encephalitis Syndrome with special reference to Japanese kala-azar. Encephalitis, Dte. of NVBDCP, Dte. General of Health 6.2.5. Japanese Encephalitis (JE) Services, MOH&FW, November, 2006).

6.2.5.a.Japanese Encephalitis is a zoonotic disease which 6.2.5.c. Epidemiological Situation: JE has been is transmitted by vector mosquito mainly belonging to reported from different parts of the country. The disease Culex vishnui group. The transmission cycle is maintained is endemic in 14 states of which Assam, Bihar, Haryana, in the nature by animal reservoirs of JE virus like pigs and Uttar Pradesh have been reporting outbreaks. During and water birds. Man is the dead end host, i.e. JE is not the year 2008, the reported AES figures indicated 3839 transmitted from one infected person to other. Outbreaks cases and 684 deaths. In the year 2009, 4482 cases and are common in those areas where there is close interaction 774 deaths were reported. In 2010 (upto November, 2010) between animals/birds and human beings. The vectors 4686 cases and 645 death were reported. State-wise JE of JE breed in large water bodies such as paddy fields. cases and deaths are given in Appendix - 4. The population at risk is about 300 million.

Annual Report 2010-11 83 6.2.6. Dengue Fever/Dengue Haemorrhagic Fever 6.2.6.a.Dengue Fever is an outbreak prone viral disease, transmitted by Aedes aegypti mosquitoes. Aedes aegypti mosquitoes prefer to breed in manmade containers, viz., cement tanks, overhead tanks, underground tanks, tyres, desert coolers, pitchers, discarded containers, junk materials etc, in which water stagnates for more than a week. This is a day biting mosquito and prefers to rest in hard to find dark areas inside the houses. The risk of dengue has shown an increase in recent years due to rapid urbanization, life style changes and deficient water 6.2.5.d. There is no specific cure for this disease. management including improper water storage practices Symptomatic and early case management is very important in urban, peri-urban and rural areas, leading to proliferation to minimize risk of death and complications. Govt. of India of mosquito breeding sites. The disease has a seasonal launched JE vaccination programme as an integral pattern i.e., the cases peak after monsoon and it is not component of Universal Immunization Programme (UIP) uniformly distributed throughout the year. Dengue is a with single dose live attenuated JE (SA- 14-14-2) in 11 endemic districts of 4 States namely Uttar Pradesh, Assam, West Bengal and Karnataka for children between 1 and 15 years of age and 88.39% coverage was achieved. During 2007, 28 more districts were covered with 84.28% coverage and during 2008 and 2009 children between 1-15 years in 21 and 70 districts respectively vaccinated bringing the total number vaccinated districts to 90. During 2010 out of 19 districts, 5 districts in Manipur, 2 districts in Assam and 1 district in uttarakhand have been covered under vaccination campaign. In addition 7 districts in Uttar Pradesh under special JE vaccination campaign during 2010-11.

6.2.5.e.In addition, implementation of public health measures such as, Health Education through different media like radio, TV including cable network, miking, inter- personal communication, etc for disseminating appropriate self limiting acute disease characterized by fever, messages in the community is crucial. The emphasis is headache, muscle & joint pains, rash, nausea and vomiting. Some infections results in Dengue Haemorrhagic Fever given on keeping pigs away from human dwellings or in (DHF) and in its severe form Dengue Shock Syndrome pigsties particularly during dusk to dawn which is the biting (DSS) can threaten the patient’s life primarily through time of vector mosquitoes. Sensitization of the community increased vascular permeability and shock due to bleeding regarding avoidance of man-mosquito contact by using from internal organs. Though during last 2 years numbers bet nets and fully covering the body are also advocated. of cases are increasing the deaths are declining. The case Since early reporting of cases is crucial to avoid any fatality rate which was 3.3 % in 1996 had come down to complication and mortality, community is given full 0.6 in 2009 and 0.4 till November 2010 because of better information about the signs and symptoms as well as availability of health services at health centres/hospitals. Besides, the states are advised fogging with malathion (technical) as an outbreak control measure in the affected areas.

84 Annual Report 2010-11 management of Dengue cases in the country following covered and cleaning the water coolers at least once a National guidelines. The risk of Dengue has been week before re-filling. Since early reporting of cases is increased in recent year. crucial to avoid any complication and mortality, the community is given full information about the signs and 6.2.6.b. Epidemiological Situation: Dengue is symptoms as well as availability of health services at endemic in 29 States/UTs. After 1996, Outbreak with a health centres/ hospitals. Alerting the Hospitals for making total number of 16517 cases and 545 deaths upsurge of adequate arrangements for management of Dengue/ cases were recorded in 2003, 2005 and 2008. In 2009 Dengue Haemorrhagic Fever cases have also been total 15535 cases and 99 deaths have been reported. advised. During 2010, till November 25725 cases and 99 deaths have been reported (Appendix-5). Maximum cases were The Directorate of National Vector Borne Disease Control reported by Delhi (6221) followed by Punjab (4022), has provided detailed guidelines for the prevention and Kerala (2501), Gujarat (2269) and Karnataka (2177). control of dengue to the affected states. Intensive health education activities through print, electronic and inter- personnel media, outdoor publicity as well as an inter- sectoral collaboration with civil society organization (NGOs/CBOs/Self-Help Groups), PRIs and Municipal bodies have been emphasized. Regular supervision and monitoring is conducted. The Government of India in consultation with States has identified 182 sentinel surveillance hospitals with laboratory support for augmentation of diagnostic facilities in the endemic states. Further, for advanced diagnosis and backup support 13 Apex Referral Laboratories (Appendix-7) have been identified and linked with sentinel surveillance hospitals. To make these functional, test kits are provided through National Institute of Virology, Pune free of cost. Contingency grant is also provided to meet the operational 6.2.6.c. There is no specific anti-viral drug or vaccine costs. against dengue infection. Mortality can only be minimized by early diagnosis and prompt symptomatic management 6.2.7. Chikungunya of the cases. A strategic action plan has been developed Chikungunya is a debilitating non-fatal viral illness caused for prevention and control of Dengue and issued to the by Chikungunya virus. The disease re-emerged in the endemic States for implementation. Guidelines for clinical country after a gap of three decades. In India a major management of dengue fever/ dengue haemorrhagic fever epidemic of Chikungunya fever was reported during earlier and dengue shock syndrome cases have been developed 60s & 70s; 1963 Kolkata; 1965 (Pondicherry and Chennai and sent to the states for wider circulation. Advisories in Tamil Nadu, Rajahmundry, Vishakapatnam and have been sent to the endemic areas for effective vector Kakinada in Andhra Pradesh; Sagar in Madhya Pradesh control through inter-sectoral collaboration and active and Nagpur in Maharashtra) and 1973, (Barsi in community involvement, regular monitoring of Dengue Maharashtra). This disease is also transmitted by Aedes cases as well as entomological parameters to forecast mosquito. Both Ae. aegypti and Ae.albopictus can likely outbreaks and to take timely remedial measures. transmit the disease. Humans are considered to be the The States have been communicated to undertake major source or reservoir of Chikungunya virus. widespread campaigns for community awareness and Therefore, the mosquitoes usually transmit the disease mobilization through different media like mass media, by biting infected persons and then biting others. The miking, inter-personal communication, etc. The emphasis infected person cannot spread the infection directly to is on elimination of mosquito breeding sources like other person (i.e. it is not contagious disease). Symptoms avoidance of water collection in and around houses, of Chikungunya fever are most often clinically removal of all discarded and disposed/junk materials, indistinguishable from those observed in dengue fever. keeping all water containers/storage facilities tightly

Annual Report 2010-11 85 However, unlike dengue, hemmorrhagic manifestations 6.2.7.b. As already mentioned, Aedes mosquitoes bite are rare and shock is not observed in Chikungunya virus during the day and breed in a wide variety of man-made infection. It is characterized by fever with severe joint containers which are common around human dwellings. pain (arthralgia) and rash. Chikungunya outbreaks These containers such as discarded tyres, flower pots, typically result in large number of cases but deaths are old water drums, family water trough, water storage rarely encountered. Joint pains sometimes persist for a vessels and plastic food containers collect rain water and long time even after the disease is cured. become the source of breeding of Aedes mosquitoes. Ae.aegypti played the major role in transmitting the Deaths already occur in Chikungunya infection?(plz. disease in all the states except Kerala, where Ae. check it) albopictus played the major role. Ae. albopictus breeding was detected in latex collecting cups of rubber plantations, shoot-off leaves of areca palm, fruit shells, leaf axils, tree holes etc.

There is neither any vaccine nor drugs available to cure the Chikungunya infection. Supportive therapy that helps to ease symptoms, such as administration of non-steroidal anti-inflammatory drugs and getting plenty of rest are found to be beneficial.

6.2.7.c.Government of India is continuously monitoring the situation, sending guidelines and advisories for prevention and control of Chikungunya fever to the states. Since same vector is involved in the transmission of Dengue and Chikungunya strategies for transmission, risk reduction by vector control are also same. A comprehensive Long Term Action Plan for prevention & control of Chikungunya and Dengue/Dengue 6.2.7.a.During 2006, total 1.39 million clinically suspected Haemorrhagic Fever has been prepared and disseminated Chikungunya cases reported in the country. Out of 35 for guidance to the states. Support in the form of logistics States/UTs 16 were affected: Andhra Pradesh, Karnataka, and funds are provided to the states. The central teams Maharashtra, Tamil Nadu, Madhya Pradesh, Gujarat, Kerala, are deputed to the affected states for technical guidance Andaman & Nicobar Islands, Delhi, Rajasthan, Puducherry, of the state health authorities. As most transmission Goa, Orissa, West Bengal, Lakshadweep and Uttar Pradesh. occurs at home, therefore, community participation and There are no reported deaths directly related to Chikungunya. co-operation is of paramount importance for successful In 2007, total 14 states were affected and reported 59535 implementation of programme strategies for prevention suspected Chikungunya fever cases with nil death. and control of Chikungunya. Therefore, considerable Subsequently in 2008, 95091 suspected Chikungunya fever efforts have been made through advocacy and social cases and nil deaths have been reported. In 2009 73288 mobilization for community education and awareness. For Suspected Chikungunya fever cases and Nil death have been effective community participation, people are informed reported. During 2010, 24364 Suspected Chikungunya fever about Chikungunya and the fact that major epidemics can cases have been reported. Maximum cases were reported from be prevented by taking effective preventive measures by Karnataka (35.01%) followed by Maharashtra (24.26) (Appendix-6). community itself. For carrying out proactive surveillance and enhancing diagnostic facilities for Chikungunya, the 182 Sentinel Surveillance hospitals involved in dengue (Appendix-8) in the affected states also carries Chikungunya tests. Both Dengue and Chikungunya Diagnostic kits to these institutes are provided through National Institute of Virology, Pune and cost is borne by GOI. Further, rapid response by the concerned health

86 Annual Report 2010-11 authorities has been envisaged on report of any suspected civil society organizations (NGOs/CBOs/ Self Help case from the Sentinel Surveillance Hospitals to prevent Groups), PRIs. further spread of the disease. 4. Provision of larvicides and adulticides to affected 6.2.7.d. The overall strategies for prevention and states. control are same as in Dengue such as symptomatic management of cases, reduction of breeding sources, 5. Identification and strengthening of Apex Referral personal protection and intensive IEC and capacity Laboratories and sentinel surveillance hospitals for building. Initiatives undertaken by Govt. of India for diagnosis and regular surveillance. prevention and control of Dengue/Chikungunya are as follows: 6. NIV, Pune has been entrusted for supply of test kits to the identified institutions free of cost. 1. Continuous monitoring of Chikungunya and Dengue situation in states. 7. Contingency grant provided to the Apex Referral Laboratories and sentinel surveillance hospitals to 2. Circulation of guidelines and advisories for meet the operational cost. prevention and control of diseases to affected states. 8. Training is imparted on various aspects of prevention and control of Dengue and Chikungunya to 3. Launch of intensive IEC and Behaviour Change programme personnel, Medical Officers on Case Communication activities through print, electronic Management and laboratory personnel on case media, interpersonal communication, outdoor diagnosis. publicity as well as inter sectoral collaboration with

Annual Report 2010-11 87 Appendix-1 State-wise Malaria situation in the Country

STATEs/UTs. 2007 2008 2009 2010(till September) updated on 28.08.10) Cases Deaths Cases Deaths Cases Deaths Cases Death Andhra Prd. 27803 2 26424 0 25152 3 25511 20 Arunachal Prd. 32072 36 29146 27 22066 15 12818 0 Assam 94853 152 83939 86 91413 63 52004 30 Bihar 1595 1 2541 0 3255 21 916 1 Chhattisgarh 147525 0 123495 4 129397 11 77553 10 Goa 9755 11 9822 21 5056 10 1753 1 Gujarat 71121 73 51161 43 45902 34 36603 6 Haryana 30895 0 35683 0 30168 0 7286 0 Himachal Prd. 104 0 146 0 192 0 139 0 J&K 240 1 217 1 346 0 504 0 Jharkhand 184878 31 214299 25 230683 28 128452 9 Karnataka 49355 18 47344 8 36859 0 31298 4 Kerala 1927 6 1804 4 2046 5 1756 4 Madhya Pradesh 90829 41 105312 53 87628 26 52828 0 Maharashtra 67850 182 67333 148 93818 227 102822 149 Manipur 1194 4 708 2 1069 1 770 4 Meghalaya 36337 237 39616 73 76759 192 34866 66 Mizoram 6081 75 7361 91 9399 119 12049 18 Nagaland 4976 26 5078 19 8489 35 3744 4 Orissa 371879 221 375430 239 380904 198 279519 161 Punjab 2017 0 2494 0 2955 0 2990 0 Rajasthan 55043 46 57482 54 32709 18 29007 26 Sikkim 48 0 38 0 42 1 32 0 Tamil Nadu 22389 1 21046 2 14988 1 11308 1 Tripura 18474 51 25894 51 24430 62 19941 4 Uttarakhand 953 0 1059 0 1264 0 1097 0 Uttar Pradesh 82538 0 93383 0 55437 0 36155 0 West Bengal 87754 96 89443 104 141211 74 67920 29 A&N Islands 3973 0 4688 0 5760 0 2089 0 Chandigarh 340 0 347 0 430 0 290 0 D & N Haveli 3780 0 3037 0 3408 0 4307 0 Daman & Diu 99 0 115 0 97 0 132 0 Delhi 182 0 253 0 169 0 191 0 Lakshadweep 0 0 0 0 8 0 6 0 Puducherry 68 0 72 0 65 0 97 0 All India Total 1508927 1311 1526210 1055 1563574 1144 1038753 547

88 Annual Report 2010-11 Appendix-2 Population Coverage (%) during Mass Drug Administration (MDA)

Sl. No. States/UTs 2004 2005 2006 2007 2008 2009

1 Andhra Pradesh 84.78 81.05 89.66 89.13 91.96 91.85

2 Assam 25.42 42.94 67.33 78.32 81.34 ND

3 Bihar 81.64 77.82 79.77 77.23 ND 85.17 (partial) 4 Chhattisgarh 84.17 82.80 ND 89.53 91.30 91.53 5 Goa 97.92 95.33 97.17 97.83 97.46 96.32 6 Gujarat 45.47 98.23 69.60 92.11 93.25 97.63 7 Jharkhand 42.25 74.16 72.75 79.03 84.64 84.32 8 Karnataka 85.22 89.31 90.20 89.67 90.53 89.30 9 Kerala 86.10 90.15 ND 92.19 93.67 77.81 10 Madhya Pradesh 73.74 79.29 88.01 88.48 90.14 87.59 11 Maharashtra 78.68 86.48 87.80 88.39 89.71 89.51 12 Orissa 90.11 90.60 87.40 88.47 85.43 89.81 13 Tamil Nadu 95.18 ND ND 77.22 87.61 94.1 14 Uttar Pradesh 66.40 71.03 75.97 79.87 81.67 ND 15 West Bengal 39.58 51.24 ND 76.63 77.79 86.93 16 A&N Islands 85.85 88.31 93.17 98.73 94.10 91.40 17 D & N Haveli 91.13 98.26 94.93 94.16 96.67 95.84 18 Daman & Diu 94.96 73.23 87.17 93.27 91.85 91.56 19 Lakshadweep 64.53 88.23 80.00 86.83 86.32 89.00 20 Puducherry 94.76 96.63 ND 96.30 97.01 96.02

Total 72.41 75.99 81.61 82.75 86.03 88.57

ND: - Not Done YD: - Yet to do RN: - Report not received

Annual Report 2010-11 89 Appendix-3 State-wise Kala-azar Cases & Deaths

Sl. No State 2007 2008 2009 2010 (upto Oct. updated on 29.11.10) †† CD CDCDCD

1 Bihar 37819 172 28489 142 20519 80 18738 69

2 W. Bengal 1817 9 1256 3 756 0 1146 4

3 UP 69 1 26 0 17 1 12 0

4 Jharkhand 4803 20 3690 5 2875 12 3426 4

5 Delhi* 19 0 34 0 12 0 33 0

6 Assam 0 0 98 0 26 0 12 0

7 Uttarakhand 2 0 0 0 2 0 0 0

8 Sikkim 0 0 4 1 5 0 3 0

9 Gujarat* 4 1 0 0 0 0 0 0

10 M.P 0 0 1 0 0 0 0 0

11. Himachal Prd. 0 0 0 0 0 0 5 1

INDIA 44533 203 33598 151 24212 93 23375 78 C: Cases D: Deaths *Imported

90 Annual Report 2010-11 Appendix-4 STATE-WISE CASES AND DEATHS DUE TO SUSPECTED AES/JE

Sl. Affected 2007 2008 2009 2010 No. States/UTs (till 30.11.10) CD CD CD C D 1 Andhra Pradesh 22 0 6 0 14 0 132 5 2 Assam 424 133 319 99 462 92 562 125 3 Bihar 336 164 203 45 325 95 50 7 4 Goa 70 0 39 0 66 3 58 0 5 Haryana 85 46 13 3 12 10 0 0 6 Karnataka 15 3 3 0 246 8 82 1 7 Kerala 2 0 2 0 3 0 19 5 8 Maharashtra 2 0 24 0 1 0 34 17 9 Manipur 65 0 4 0 6 0 116 14 10 Tamil Nadu 42 1 144 0 265 8 290 5 11 Uttarakhand 0 0 12 0 0 0 0 0 12 Uttar Pradesh 3024 645 3012 537 3073 556 3331 460 13 West Bengal 16 2 58 0 0 0 1 0 14 Nagaland 7 1 0 0 9 2 11 6 Grand Total 410 995 3839 684 4482 774 4686 645

C : Cases D : Deaths

Annual Report 2010-11 91 Appendix-5 State-Wise Dengue Cases And Deaths

Sl. No. State 2007 2008 2009 2010* Cases Deaths Cases Deaths Cases Deaths Cases Deaths 1 Andhra Pd. 587 2 313 2 1190 11 728 3 2 Assam 0 0 0 0 0 0 158 2 3 Bihar 0 0 1 0 1 0 287 0 4 Chhattisgarh 0 0 0 0 26 7 1 0 5 Goa 36 0 43 0 277 5 219 0 6 Gujarat 570 2 1065 2 2461 2 2269 0 7 Haryana 365 11 1137 9 125 1 1079 20 8 J & K 0 0 0 0 2 0 0 0 9 Jharkhand 0 0 0 0 0 0 11 0 10 Karnataka 230 0 339 3 1764 8 2177 6 11 Kerala 603 11 733 3 1425 6 2501 17 12 Madhya Pd. 51 2 3 0 1467 5 171 1 13 Meghalaya 0 0 0 0 0 0 1 0 14 Maharashtra 614 21 743 22 2255 20 1116 6 15 Manipur 51 1 0 0 0 0 5 0 16 Nagaland 0 0 0 0 25 0 0 0 17 Orissa 4 0 0 0 0 0 19 0 18 Punjab 28 0 4349 21 245 1 4022 13 19 Rajasthan 540 10 682 4 1389 18 1253 6 20 Sikkim 0 0 0 0 0 0 0 0 21 Tamil Nadu 707 2 530 3 1072 7 1662 8 22 Uttar Pradesh 132 2 51 2 168 2 941 8 23 Uttrakhand 0 0 20 0 0 0 21 0 24 West Bengal 95 4 1038 7 399 0 612 1 25 A&N Island 0 0 0 0 0 0 25 0 26 Chandigarh 99 0 167 0 25 0 163 0 27 Delhi 548 1 1312 2 1153 3 6221 8 28 D&N Haveli 0 0 0 0 0 0 25 0 29 Puducherry 274 0 35 0 66 0 38 0 TOTAL 5534 69 12561 80 15535 96 25725 99

*provisional upto November

92 Annual Report 2010-11 Appendix-6 Epidemiological Profile Of Chikungunya Fever In The Country

2009 2010* Sl.No Name of Total No. of No. of No. of Total No. of No. of the State Suspected Samples confirmed deaths Suspected Samples confirmed No. of Chikungunya tested cases Chikungunya tested cases deaths fever cases fever cases

1 Andhra Pd. 591 297 117 0 107 107 41 0

2 Goa 1839 1525 685 0 1312 1312 595 0

3 Gujarat 1740 453 169 0 1353 586 248 0

4 Haryana 2 2 0 0 26 26 1 0

5 Karnataka 41230 7714 3164 0 8550 3460 1359 0

6 Kerala 13349 2761 711 0 1521 460 209 0

7 Madhya Pd. 30 30 5 0 31 31 14 0

8 Meghalaya 0 0 0 0 16 16 8 0

9 Maharashtra 1594 766 443 0 5913 1569 768 0

10 Orissa 2306 41 2 0 425 10 4 0

11 Rajasthan 256 256 106 0 365 365 110 0

12 Tamil Nadu 5063 2873 1053 0 4299 3478 736 0

13 Uttar Pradesh 0 0 0 0 1 1 1 0

14 West Bengal 5270 816 338 0 305 305 69 0

15 A&N Island 0 0 0 0 59 0 0

16 Delhi 18 18 18 0 70 70 70 0

17 Lakshadweep 0 0 0 0 0 0 0 0

18 Puducherry 0 0 0 0 11 11 3 0

Total 73288 17552 6811 0 24364 11807 4236 0

*provisional upto November

Annual Report 2010-11 93 Appendix - 7

APEX REFERRAL LABORATORIES

(i) All India Institute of Medical Sciences, New Delhi,

(ii) National Institute of Communicable Diseases, Delhi

(iii) National Institute of Virology, Pune,

(iv) National Institute of Mental Health and Neuro-Sceinces, Bangaluru,

(v) Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow,

(vi) Postgraduate Institute of Medical Sciences, Chandigarh,

(vii) ICMR Virus Unit (NICED), Kolkata,

(viii) Kings Institute of Preventive Medicines, Chennai,

(ix) Institute of Preventive Medicine, Hyderabad,

(x) B.J. Medical College, Ahmedabad,

(xi) Kerala State Institute of Virology and infectious diseases, Alleppey,

(xii) Defence Research Development and Establishment, Gwalior.

(xiii) Regional Medical Research Centre (ICMR), Dibrugarh, Assam.

94 Annual Report 2010-11 Appendix-8 List of the Sentinel Hospitals for Dengue and Chikungunya

Name of the State Sentinel Hospitals/Institutes Name of the State Sentinel Hospitals/Institutes Andhra Pradesh 1. MGM Hospital, Warangal, 14. Sion Hospital, Mumbai 2. Ruya Hospital,Tirupathi, 15. District Hospital, Thane 3. Govt.Hospital,Guntur, Gujarat 1. N.H.L. Municipal Med. College, Ahmedabad. 4. Govt.Hospital,Vijayawada, 2. Govt. Medical College, Vadodara, 5. Govt. Hospital,Karimnagar, 3. Govt. Medical College,Surat, 6. Govt. Hospital,Nizamabad, 4. Municipal Med. College,Surat, 7. Govt.Hospital,Annanthpur. 5. M.P. Shah Med. College, 8. VBRI,Hyderabad. Jamnagar, 9. Medical College, Kurnool 6. Govt. Med. College, Rajkot, 10. Medical College, Mahboobnagar 7. Govt. Medical College, Bhavnagar. Goa 1. Hospicio Hospital, Margoa, South Goa. 8. General Hospital, Palanpur 2. Goa Medical College, Goa 9. General Hospital, Dahod 3. Asilo Hospital (North Goa), 10. General Hospital, Bhuj Mapusa Madhya Pradesh 1. Gandhi Medical College, Bhopal, Maharashtra 1. Govt. Medical Vollege, 2. G.R.Medical College,Gwalior Nagpur, 3. S.S. Medical College, Rewa, 2. B.J. Medical College, Pune, 4. N. S.C.B Medical college, 3. Govt. Medical College, Jabalpur Aurangabad 5. M.G.M. Medical College, Indore 4. District Hospital, Akola 6. Khandwa district hospital 5. District Hospital, Nashik 7. Betul district hospital 6. Govt. Medical College, Nanded 8. Sagar district hospital 7. J.J.Hospital, Mumbai 9. Guna district hospital 8. District Hospital, Chandrapur 10. Chhindwara district hospital 9. Govt. Medical College, Yavatmal 11.Satna district hospital 10. District Hospital, Beed 12. District Malaria Office, Bhopal 11. Govt. Medical College, Kolhapur Haryana 1. B.K. Hospital, Faridabad. 12. Govt. Medical College, Dhule 13. K.E.M. Hospital, Mumbai 2. General Hospital, Ambala

Annual Report 2010-11 95 Name of the State Sentinel Hospitals/Institutes Name of the State Sentinel Hospitals/Institutes 3. State Bacteriological Laboratory, 18.Lady Hardinge Medical College Karnal and its associated hospital Sucheeta Kriplani Hospital 4. General Hospital, Gurgaon 19.Army Hospital R & R Dhaula 5. General Hospital, Panchkula Kaun 6. Medical College, Agroha 20.Central Hospital, Northern Delhi 1. Swami Daya Nand Hospital, Railway Shahadra, Delhi 21.Guru Govind Singh Govt. 2. Raja Harish Chand Hospital, Hospital, Raghuvir Nagar, Delhi Narela, Delhi 22.Babu Jagjivan Ram Memorial 3. Hindu Rao Hospital , Delhi Hospital, Jahangirpuri, Delhi 4. Sanjay Gandhi Memorial 23.Bhagwan Mahavir Hospital, Hospital, Mangol Puri, Delhi Pitampura, Delhi 5. Baba Sahib Ambedkar Hospital, 24.Jag Parvesh Chander Hospital, Rohini, Delhi (JPC) , Shastri Park Hospital 6. Safdarjung Hospital, New Delhi 25.NC.Joshi Memorial Hospital, Karolbagh, Delhi 7. Malviya Nagar Hospital, Malviya Nagar, Delhi 26.Kasturba Hospital, Near Jama Masjid, Delhi 8. SVB Patel Hospital Patel Nagar 27.Aruna Asaf Ali Hospital, Rajpur 9. ABG Hospital, Moti Nagar, Delhi, Road, Delhi 10.Ram Manohar Lohia Hospital, 28.NDMC Charak Palika Hospital, New Delhi Moti Bagh, New Delhi 11.Lok Nayak Hospital, Jawahar Lal 29.Rao Tula Ram Memorial Nehru Marg, Delhi Hospital,Jaffarpur, Delhi 12.Deen Dayal Upadhyay Hospital, 30.G.B.Pant Hospital, Jawahar Lal Hari Nagar, Delhi Nehru Marg, Delhi 13.GTB Hospital, Dilshad Garden, 31.Base Hospital Delhi Cant., Delhi 32.Kalawati Saran Children 14.Chacha Nehru Children Hospital, Hospital Geeta Colony, Delhi 33. ESI Hospital, Basai Darapur 15.Lal Bahadur Shastri Hospital, Khichirpur, Delhi Punjab 1. Civil Hospital, Ludhiana 16.Maharishi Balmiki Hospital, 2. Govt. Medical College, Amritsar Pooth Khurd, Delhi 3. Govt. Medical Colelge, Patiala 17. Dr. Hedgewar Arogya 4. Civil Hospital, Bathinda Sansthan, Karkardooma, Delhi 5. Civil Hospital, Jalandhar

96 Annual Report 2010-11 Name of the State Sentinel Hospitals/Institutes Name of the State Sentinel Hospitals/Institutes 6. Civil Hospital, S.A.S.Nagar 6. R.G.Kar Medical College & (Mohali) Hospital, Kolkata Rajasthan 1. SMS Hospital, Jaipur 7. National MCH, Kolkata 2. J.K. Lone Hospital 8. Midnapore Medical College & Hospital, Midnapur 3. Umaid Hospital,Jodhpur 9. Bankura Sammilani Medical 4. SMDM, Jaipur College & Hospital, Bankura 5. M.B. Hospital, Kota, 10.North Bengal Medical College & 6. S.P. Medical College, Bikaner Hospital, Siliguri 7. RNT Medical College, Udaipur Karnataka 1. Central Lab. (Hqrs), Bangaluru 8. JLN Medical College, Ajmer 2. Virus Diagnostic Lab, Shimoga 9. General Hospital Bharatpur 3. Vijay Nagar Institute of Medical Science, Bellary Kerala 1. Govt. Medical College, Kozhikode 4. District Surveillance Unit, SNR 2. Medical College, Kottayam hospital, Kollar 3.Medical College, 5. District Surveillance Unit, Thiruvanthapuram Belgaum 4.Public Health Lab, 6. District Surveillance Unit, Thiruvanthapuram Mangalore, D Kanada 5. District Hospital, Kollam 7. Medical College, Hubli 6. THQHThodupuzha, Dist. Idukki 8. District surveillance Unit 7. Regional Public Health Chitradurga Laboratory, Ernakulam 9. District Surveillance Unit Hassan 8. District Hospital, Palakkad 10. District Surveillance Unit 9. District Hospital, Manjeri, Mysore11. District Malappuram Surveillance Unit Bidar 10. District Hospital, Mananthavady, 12. District Surveillance Unit Dist. Wyanad Raichur West Bengal 1. Burdwan Medical College 13. District Surveillance Unit Bijapur Hospital. 14. District Surveillance Unit 2. School of Tropical Medicine, Tumkur Kalkata 15. NIV Field Station, Bangaluru 3. Medical College, Kolkata 16. Indira Gandhi Institute of Child 4. Nil Ratan Sircar Medical College Health (IGICH) & Hospital, Kolkata 17.National Center for Disease 5. SSKM Medical College & Control (NCDC) Hospital, Kolkata

Annual Report 2010-11 97 Name of the State Sentinel Hospitals/Institutes Name of the State Sentinel Hospitals/Institutes Tamil Nadu 1. Kanniyakumari Medical College 9. K.G.M.U., Lucknow. 2. Tirunelveli Medical College 10. Authority Hospital, Noida 3. Thoothukudi Medical College Orissa 1. S.C.B. Medical College, Cuttak 4. Thanjavur Medical College 2. VSS Medical College, Burla, Sambalpur 5. Mohan Kumaramangalam Medical College, Salem 3. MKCG, Medical College, Berhampur, Ganjam 6. Coimbatore Medical College A&N Islands 1.GB Pant Hospital, Port Blair 7. K.A.P.Viswanathan Medical College, Trichy Lakshadweep 1.Indira Gandhi Hospital, Kavaratti 8. Theni Medical College Manipur 1. Regional Institute of Medical Sciences, IMPHAL 9. Chengalpattu Medical College Puducherry 1. JIPMER, Puduchery 10. Madurai Medical College 2. General Hospital, Puduchery 11.Vellore Medical College Jammu & Kashmir 1.Govt. Medical College, Jammu 12. Madras Medical College 13.Institute of Vector Control and Chattishgarh 1. Pt. J.N.M Medical College, Zoonoses, Hosur Raipur, Bihar 1.Patna Medical college & Hospital 2. Sardar Vallabh Bhai Patel District Hospital, Bilaspur Uttar Pradesh 1. Regional Lab. Swasthya Bhawan, Lucknow. Jharkhand 1.Rajendra Institute of Medical Science (RIMS), Ranchi 2. District Hospital, Ghaziabad, 2. MGM Medical College, 3. L.L.R.M., Medical College, Jamsedpur Meerut, Assam 1. Gauhati Medical College, 4. M.L.B. Medical College, Jhansi, Guwahati 5. M.L.N.,Medical College, 2. Assam Medical College, Allahabad. Dibrugarh 6. Institute of Medical Sciences, Uttarakhand 1. Doon Hospital, Dehradun B.H.U., Varanasi. 2. Susheela Tiwari Medical College, 7. S.N., Medical College, Agra. Haldwani, Nainital 8. G.S.B.M., Medical College, Total 182 Kanpur.

98 Annual Report 2010-11 6.3. NATIONAL LEPROSY ERADICATION • Out of 1,47,642 leprosy cases discharged during PROGRAMME (NLEP) the year, 1,33,822 cases (90.6%) were released as cured after completing treatment. The National Leprosy Control Programme was launched by the Govt. of India in 1955. Multi Drug Therapy came • 2856 reconstructive surgeries were conducted in into wide use from 1982 and the National Leprosy 2009-10 for correction of disability in leprosy Eradication Programme was introduced in 1983. Since affected persons. then, remarkable progress has been achieved in reducing the disease burden. India achieved the goal of elimination The declining trend of Prevalence and Annual New Case of leprosy as a public health problem, defined as less than Detection Rate per 10,000 population since 1991-1992 is 1 case per 10,000 population, at the National level in the shown in the diagram below: month of December 2005 as set by the National Health Policy, 2002. The National Leprosy Eradication Programme is 100% centrally sponsored scheme. MDT is supplied free of cost by WHO. Following are the programme components – (i) Decentralized integrated Leprosy services through General Health Care System. (ii) Training in Leprosy to all General Health Services functionaries. (iii) Intensified Information, Education & Communication (IEC). 6.3.1. Activities under NLEP: (iv) Renewed emphasis on Prevention of Disability and 6.3.2.a.Diagnosis and treatment of leprosy- Services Medical Rehabilitation and for diagnosis and treatment (Multi Drug Therapy) are (v) Monitoring and supervision. provided by all primary health centres and govt. dispensaries throughout the country free of cost. Difficult 6.3.1. Epidemiological Situation to diagnose and complicated cases and cases requiring • 32 States/UTs have achieved leprosy elimination reconstructive surgery are referred to district hospital for status. Only 3 States/UT viz. Bihar, Chhattisgarh further management. ASHAs under NRHM are being and Dadra & Nagar Haveli are yet to achieve involved to bring out leprosy cases from villages for elimination. Further, out of 633 districts, 510 diagnosis at PHC and follow up cases for treatment (80.57%) have also achieved elimination level. completion. ASHAs are being paid incentive for this activity from the programme budget. • At the end of March 2010, there were 87,190 leprosy cases on record (under treatment). 6.3.2.b. Training: Training of general health staff like medical officer, health workers, health supervisors, • In 2009-10, total 1,33,717 new leprosy cases were laboratory technicians and ASHAs are conducted every detected and put under treatment as compared to year to develop adequate skill in diagnosis and 1,34184 leprosy cases detected during management of leprosy cases. Training of State & District corresponding period of previous year giving Annual Leprosy Officers organized at schieffline Institute of New Case Detection Rate (ANCDR) of 10.93 per Health Research & Leprosy Centre Vellore, Tamil Nadu 1,00,000 population. and RLTRI Raipur. • Among the new cases detected in 2009-10, the 6.3.2.c.Urban Leprosy Control: To address the proportions were- MB cases (54.43%), female complex problems in urban areas, the Urban Leprosy (35.42%), children (9.97%) and grade II disability Control activities are being implemented in 422 urban (3.08%). areas having population size of more than 1 lakh. These activities include MDT delivery services & follow up of

Annual Report 2010-11 99 patient for treatment completion, providing supportive activities are carried through mass media, outdoor media, medicines & dressing material and monitoring & rural media and advocacy meetings. More focus is given supervision. on inter personnel communication. Intensive IEC Campaign with a theme ‘Towards Leprosy Free India’ is 6.3.3. Involvement of NGOs being carried out towards further reduction of leprosy Non Governmental Organizations (NGOs) have been burden in the community, early reporting of cases & their involved in the programme for many decades and have treatment completion, provision of quality leprosy services provided valuable contribution in reducing the burden of and reduction of stigma & discrimination against leprosy leprosy. NGOs serve in remote, inaccessible, uncovered, affected persons. Mass media campaign during the period urban slums, industrial / labour population and other October, 2010 and January-February 2011, have been marginalized population groups. IEC, Prevention of planned through the Prasar Bharati to spread awareness impairments and disabilities, Case Detection & referral about leprosy in the General Public. and follow-up for treatment completion are some 6.3.7 Disability Prevention and Medical important activities undertaken by NGOs. Under SET Rehabilitation scheme, Rs. 2.10 crores have been allocated to NGOs in 2010-11 and Grant-in-Aid to NGOs is routed through For prevention of disability among persons with insensitive State Leprosy Societies. hands and feet, they are given dressing material, supportive medicines and micro-cellular rubber (MCR) 6.3.4. ILEP Agencies footwear. The patients are also empowered with self care The International Federation of Anti-leprosy Associations procedure for taking care of themselves. (ILEP) is actively involved as partner in NLEP. In India, More emphasis is being given on correction of disability ILEP is constituted by 10 Agencies viz. The Leprosy in leprosy affected persons through reconstructive Mission, Damien Foundation of India Trust, Netherland surgery (RCS). To strengthen RCS services, GOI has Leprosy Relief, German Leprosy Relief Association, recognized 83 institutions for conducting RCS based on Lepra India, ALES, AIFO, Fontilles – India, AERF - India the recommendations of the state government. Out of and American Leprosy Mission. these, 42 are Govt. institutions and 41 are NGO ILEP is providing support in the form of planning, institutions. monitoring & supervision of the programme, capacity 6.3.8 Supervision and Monitoring building of GHC staff, IEC, providing re-constructive surgery services and socio economic rehabilitation of Programme is being monitored at different level through persons affected with leprosy. 36 NGOs conducting re- analysis of monthly progress reports, through field visits constructive surgeries for disability correction in leprosy by the supervisory officers and programme review affected persons are also supported by ILEP. meetings held at central, state and district level. For better 6.3.5 WHO Support epidemiological analysis of the disease situation, emphasis is given to assessment of New Case Detection and WHO support the programme in the form of providing Treatment Completion Rate and proportion of grade II financial assistance for conducting annual review disability among new cases. Independent Programme meetings at national level and technical support through evaluation is also been conducted through an independent State/Zonal NLEP Coordinators in the high endemic agency. states. WHO continues to provide requirement of anti- leprosy MDT drugs to the country free of cost with 6.3.9 Initiatives: assistance from NOVARTIS. 6.3.9.a.An amount of Rs. 5000/- is provided as incentive 6.3.6 Information, Education & Communication to leprosy affected persons from BPL family for (IEC) undergoing per major reconstructive surgery in identified Intensive IEC activities are conducted for awareness Govt./NGO institutions to compensate loss of wages generation and particularly reduction of stigma and during their stay in hospital. Support is also provided to discrimination against leprosy affected persons. These Government institutions in the form of Rs. 5000/- per RCS

100 Annual Report 2010-11 conducted, for procurement of supply & material and other (i) Six States/UTs viz. Arunachal Pradesh, Gujarat, ancillary expenditure required for the surgery. Rajasthan, Manipur, Sikkim and D&N Haveli started in May 2010. Arunachal Pradesh, Sikkim 6.3.9.b.Involvement of ASHAñ A scheme to involve & D&N Haveli reported completion of the Survey. ASHAs was drawn up to bring out leprosy cases from their villages for diagnosis at PHC and follow up cases (ii) Twenty States/UTs viz. Andhra Pradesh, Assam, for treatment completion. To facilitate the involvement Chhattisgarh, Goa, Himachal Pradesh, Jharkhand, of ASHA, they are being paid an incentive as below: J&K, Karnataka, Madhya Pradesh, Kerala, Meghalaya, Mizoram, Nagaland, Orissa, Punjab, (i) On confirmed diagnosis of case brought by them – Tamil Nadu, Tripura, Uttarakhand, Chandigarh and Rs. 100/- Daman & Diu started in June 2010. Goa, Chandigarh, Uttarakhand and Daman & Diu (ii) On completion of full course of treatment of the reported completion of the Survey. case within specified time- PB leprosy case – Rs. 200/- and MB Leprosy case – Rs. 400/- (iii) Six States/UTs viz. Uttar Pradesh, West Bengal, Maharashtra, Haryana, A&N Islands and 4,22,638 ASHAs have been trained in leprosy and Puducherry started in July 2010. Maharashtra, involved in leprosy work 4572 ASHAs received A&N Islands and Puducherry reported completion incentive for the above said activity during of the Survey. 2009-10. (iv) Delhi and Bihar have started survey in August 6.3.9.c. Discriminatory laws relating to leprosy– 2010. There are certain provisions under laws / acts which are The final report of National Sample Survey is expected discriminatory in nature against leprosy affected persons. by July 2011. The Ministry of Health & Family Welfare has taken up the matter with concerned Ministries/Departments/State 6.3.11 Budget: Budget allocation under NLEP for for Governments for their consideration and action on various 2009-10 was 44.50 crores and expenditure of 35.12 crores such discriminatory acts/laws. These Acts and Laws are was incurred during the year. Budget allocation under being modified or repealed, which will help the persons NLEP for 2010-11 is 45.32 crores. 26.85 crores affected by leprosy live a dignified life. expenditure has been incurred till date. 6.4 REVISED NATIONAL TB CONTROL 6.3.10 National Sample Survey PROGRAMME (RNTCP) The 131st report of the Committee on Petitions of Rajya Tuberculosis is a major public health problem in India. Sabha, 2008, recommended that “the final survey, The burden of TB in India (Prevalence) as in the year involving Panchayati Raj Institutions (PRI) may be 2000 was 8.5 million total cases of which 3.8 million were undertaken, so that the Government can have realistic bacillary pulmonary cases, 3.9 million abacillary cases figures of Leprosy Affected Persons (LAPs) to devise a and 0.8 million extra-pulmonary cases. national policy. The Ministry of Health & Family Welfare informed the Committee that a multi – centric study to India accounts for nearly one-fifth of the global incidence. assess the burden of active leprosy cases, leprosy persons In 2009, out of the global annual incidence of 9.4 million with grade - I & II disability and the magnitude of stigma TB cases, 2 million were estimated to have occurred in & discrimination prevalent in the society, will be carried India. In the year 2009, India reported a total case out. The National JALAMA institute Agra (an ICMR notification of 1.3 million (all forms of TB), of which 0.62 instt.) has been entrusted with the above task. million were reported as sputum positive cases which are infectious. The house to house survey was started in States/UTs as An infectious case if not treated on an average infects below, which was preceded by training of the survey team 10-15 persons in a year. Annual risk of becoming infected member and IEC campaign in the concerned Block and with TB is 1.5% and once infected there is 10% life-time Urban areas.

Annual Report 2010-11 101 risk of developing TB disease. About one person dies • Since its inception, the programme has initiated nearly from TB in India every two minutes; ~ 760 people every 1.24 million patients on treatment, thus saving more day and almost 2.8 lakh every year. than 2.2 million additional lives. In 2009 over 1.53 million TB patients have been initiated on treatment. In 2010, 1.17 million patients have been registered for treatment till 30th September. • India has contributed to approximately 24% of the total global new cases detection during the year 2009 as per the WHO Global Report 2010. • Treatment success rates have tripled from 25% in the pre-RNTCP era to 87% presently.

HBC: High burden countries Source: WHO Geneva; WHO Report 2010: Global Tuberculosis Control; Surveillance, Planning and Financing.

Revised National TB Control Programme, an application in India of the WHO-recommended Directly Observed Treatment, Short Course (DOTS) strategy to control TB with the objective of curing at least 85% of new sputum positive TB patients and detecting at least 70% of such patients, was launched in the country in March 1997 and was implemented in a phased manner. By March 2006, • TB death rates have been cut 7-fold from 29% in the entire population (1114 million) of the country in all 632 pre-RNTCP era to 4% presently. districts had been covered under the Programme.

6.4.1. Achievements of RNTCP

102 Annual Report 2010-11 as a pie chart

• The programme has consistently maintained the treatment success rate >85% and new sputum positive (NSP) case detection rate more than the global target of 70%. • Involvement of other sectors: Over 3000 NGOs, 30,000 Private practitioners, and 200 corporate • All states are currently implementing the ‘Supervision houses have been involved in the provision of RNTCP and Monitoring strategy’ – detailing guidelines, tools services. Presently, 282 medical colleges (including and indicators for monitoring the performance from private colleges) have been involved in RNTCP and the PHI level to the national level. The programme is are estimated to contribute nearly 10-15% of case detection in the districts that have medical colleges. focusing on the reduction in the default rates amongst Health facilities in government sectors outside Health all new and re-treatment cases and is undertaking Ministry have been involved viz. ESI, Railways, Ports steps for the same. and the Ministries of Mines, Steel, Coal, etc. Collaboration for increased participation of all sectors • Quality assured Sputum Microcopy diagnostic in RNTCP is being strengthened through constant facilities are available through more than 12,700 interaction with all stake holders, including laboratories across the country. To ensure quality, professional bodies like the Indian Medical external quality assurance of sputum microscopy is Association, and Faith Based Organisations such as being routinely conducted throughout the country. This Catholic Bishops Conference of India. includes onsite evaluation, panel testing and blinded Drug Resistance Surveillance: crosschecking. • To estimate the prevalence of drug resistance • To improve access to tribal and other marginalized amongst new cases and re-treatment cases, state groups the programme has developed a Tribal action wide community based surveys have been carried plan which is being implemented with the provision out in the states of Gujarat and Maharashtra. These of additional TB Units and DMCs in tribal/difficult surveys estimate the prevalence of Multi-drug areas, additional staff, compensation for resistant TB (MDR-TB) to be ~3% in new cases transportation of patient & attendant in tribal areas and 12-17% in retreatment cases. These surveys also and higher rate of salary to contractual staff etc. indicate that the prevalence of MDR-TB is not increasing in the country. Two more surveys are The latest treatment outcome under RNTCP for the underway in the states of AP and western UP and patients’ registered in 2009 (Jan – Sept) is represented there is a plan to undertake a survey in Orissa in near future.

Annual Report 2010-11 103 • DOTS Plus for management of Multidrug • Advocacy, Communication and Social Mobilization Resistant TB (MDR-TB): (ACSM): o The programme is in the process of establishing o RNTCP has ACSM Strategicic framework that a network of 43 accredited Culture and Drug clearly identifies:- Susceptibility testing laboratories (DST) across • Objectives (Communication needs) the country in a phased manner for diagnosis and follows up of MDR TB patients. • Target Groups (Communication players) i.e.(i) Patients and Communities; (ii) Health care providers, o Currently, 14 Culture and DST Laboratories in public and private; and (iii) Influencers and opinion government sector are accredited under RNTCP makers including- • Media options to reach target groups (Communication
4 National Reference Laboratories (NRLs) that tools) includes TRC Chennai, LRS Delhi, NTI Bangalore o ACSM strategy has been modified for including and JALMA Agra, and addressing newer thrust areas as MDR- TB,
10 State level Intermediate Reference Laboratories TB HIV co-infection, and Infection control. These areas has been identified as important (IRLs) at Gujarat, Maharashtra, Andhra Pradesh, areas to be addressed by the media agency at Kerala, Delhi, West Bengal, Tamil Nadu , Rajasthan, the national level . Orissa and Jharkhand have been accredited; and o ACSM is integral part of planning at national, state
Another 11 IRLs are under the accreditation process. and district levels, and annual action plans. The remaining IRLs will be accredited in 2011. • Format for development of ACSM Annual Action o To supplement and support the IRL network the Plan has been modified to included monitoring programme is also involving Mycobacteriology indicators (outcome and output). laboratories of Government Medical Colleges as • Quarterly reporting of ACSM activities by the districts well as laboratories in the NGO and Private and states Sector. Till date, five such labs (CMC-Vellore; BPRC-Hyderabad, Hinduja Hospital- Mumbai, o Six national level ACSM capacity building SMS-Jaipur and RMRCT-Jabalpur) have been trainings workshops organized for State TB accredited and another 9 are under the Officers, State IEC Officers and Communication accreditation process. Facilitators are currently going. o Partnership developed with the other donor and o DOTS Plus services for management of MDR bilateral agencies to strengthen Center’s capacity TB have been rolled out in the 10 states of for ACSM Gujarat, Maharashtra, Andhra Pradesh, Haryana, Delhi, Kerala, West Bengal, Tamil Nadu, o Formative research for development of Rajasthan and Orissa. Services are available in communication material on MDR TB, TB HIV 136 districts covering a population of 281 million. and Infection control completed. Till 30th September 2010, ~15700 MDR suspects • Impact of the programme: were examined and a total of 2975 patients were initiated on treatment in these states. o TB mortality in the country has reduced from over 42/lakh population in 1990 to 23/lakh o The State of Jharkhand, Uttar Pradesh, Madhya population in 2009 as per the WHO global report Pradesh, Uttarakhand, Karnataka and Himachal 2010. Pradesh are in advanced stage of preparation o The prevalence of TB in the country has reduced and will initiate identification of MDR suspects from 586/lakh population in 1990 to 249/lakh shortly. DOTS Plus services in the remaining population by the year 2009 as per the WHO states will be initiated in 2010-11. global TB report, 2010

104 Annual Report 2010-11 o Programme is currently undertaking repeat ARTI guidelines have been revised with enhanced financial survey (2007-09), disease prevalence surveys outlays. The programme has entered into a memorandum (2007-09) to additionally monitor the progress of understanding with large NGOs/Professional towards MDGs. Associations like RK Mission, World Vision, Christian Medical Association of India, Catholic Health Association 6.4.2. RNTCP Phase II of India, Indian Medical Association etc. In addition, many The RNTCP Phase II of the World Bank project has local NGOs support programme activities to improve been approved by the Government for the period Oct access of RNTCP in difficult and uncovered areas. 2006 to Sep 2011 for a total outlay of Rs 1,156 crore 6.4.3.c.Medical colleges/TB Hospitals and others: (USD 256.9 million) which includes credit from World Medical colleges are being provided with manpower and Bank of Rs 765 crore (USD 170 million) and commodity logistic support to facilitate their participation in the assistance of anti-TB drugs from DFID through WHO programme. The involvement of medical colleges is for Rs 287 crores (USD 63.7 million) with balance of RS monitored by the Task Force mechanism at the State/ 191 crore (USD 42.5 million) will be given by GoI. In Zonal and National levels. addition, 215.81 million US dollars is available for six years (2009 – 2015) through GFATM RCC mechanism (Global 6.4.3.d.Other sectors: - All the 16 centrally owned ESI Fund for AIDS, Tuberculosis, Malaria – Rolling hospitals, Zonal Railway Hospitals, Coal, Steel and Mines Continuation Channel) for 27 districts of Uttar Pradesh, health facilities, Port trust hospitals, CGHS hospitals and and states of Bihar, Andhra Pradesh, Orrisa, Chattisgarh, 200 corporate hospitals are involved in RNTCP services. Jharkhand, Uttarakhand and Haryana. GFATM RCC will Four regional workshops were conducted by also cater through CBCI (Catholic Bishop Conference Confederation of Indian Industry (CII) to sensitise and of India) in 19 states and in 11 states through IMA (Indian promote about workplace interventions in RNTCP at Medical Association). Chandigarh, Mysore, Ranchi and Pune . The second phase of the RNTCP is consolidating, 6.4.3.e.Urban TB for slum dwellers†:- Recognizing maintaining and further improving the achievements of the problem and impact of TB on urban slum population the first phase. Phase II of the RNTCP is a step towards RNTCP intends to provide greater levels of access to its achieving the TB-related Millennium Development Goal services to the urban slum population. In addition, a special (MDG) targets. DOTS remain the core strategy. In PPM scheme for Urban Slum dwellers has been addition to the ongoing activities, the following new activities have been envisaged in the second phase. introduced under the recently revised PPM schemes. 6.4.4 Other initiatives-  the scaling up of the State-level intermediate referral laboratories (IRL) capacity for nation-wide The IMA has formed a National Working Group for implementation of external quality assessment (EQA) RNTCP and has selected National and State coordinators. of sputum smear microscopy services and provision National, State and Local workshops are being organized of culture and drug sensitivity testing. by the IMA to sensitize the private practitioners. The PPM project assisted by GFATM under RCC is being  Implementation of DOTS-Plus for multi-drug implemented in 16 States - Andhra Pradesh, Chandigarh, resistant TB cases will occur in a phased manner. Haryana, Maharashtra, Punjab, Uttar Pradesh, Bihar, 6.4.3. Major Initiatives Chhattisgarh, Gujarat, Jharkhand, Kerala, Orissa, Rajasthan, Tamil Nadu, Uttaranchal, and West Bengal . 6.4.3.a.Public Private Mix in RNTCP: The RNTCP employs the Public Private Mix (PPM) which is the There has also been a professional coalition against TB strategy to diagnose and treat TB patients reporting to all by IMA with IAP(Indian Academy of Paediatrics),NCCP sectors of health care under RNTCP through a mix of (National College of Chest Physicians),ICS (Indian Chest different types of health care providers. Society),FPAI (Federation of Family Physicians Association Of India ) as its members. 6.4.3.b. NGO/PPs: Currently, for enhancing the involvement of NGOs and PPS under RNTCP, the

Annual Report 2010-11 105 The RNTCP has adopted the recently published Since 2001, Government has been implementing a joint “International Standards for TB Care” (ISTC) document action plan in co-ordination with National AIDS Control to improve the standards of TB management across all Programme (NACP), to counter the growing incidence sectors of health care in India, and to recruit and involve of the HIV-TB co-infection, initially in the six high HIV additional health care providers in RNTCP activities. As prevalence States of Maharashtra, Tamil Nadu, Andhra the RNTCP conforms to all standards laid down in the Pradesh, Karnataka, Manipur and Nagaland. Services ISTC, the central government has urged all providers of for HIV infected TB patients are provided through health care to adopt RNTCP to ensure adherence to the linkages between the Integrated Counseling and Testing internationally recognized standard of care for TB. Centre (ICTC) supported by the HIV/AIDS Programme The Revised National TB Control Programme has signed and Designated Microscopy Centres (DMCs) supported a MOU with the Catholic Bishops Conference of India, by RNTCP, joint IEC activities and infection control for the involvement of Catholic Health Institutions under measures. RNTCP in 19 states - Andhra Pradesh, Assam, Bihar, In 2007, the national action plan for TB/HIV was revised. Chhattisgarh, Jharkhand, Karnataka, Madhya Pradesh, Orissa, Rajasthan, Uttar Pradesh ,West Bengal , Kerala, RNTCP & NACP have formulated a National Tamil Nadu, Gujarat, Maharashtra, Goa, Meghalaya, framework for joint TB/HIV Collaborative activities Manipur and Nagaland .The Catholic Healthcare network which replaces the action plan. The document elaborates is the largest in the NGO sector with more than 5,500 the various activities that need to be undertaken at the health care facilities. National, State & district level and provides the guidelines for the same. Under the National framework there is Global Fund has also approved the Round 9 Grant for TB enhanced focus on the provision of HIV care including to the three Principal Recipients, namely Central TB ART, for all known HIV infected TB patients in order to Division , the Union and World Vision India (WVI) for a reduce mortality in this group of TB patients. With the period of 5 years (starting 1st April 2010) with the formulation of National framework, the TB/HIV following objectives: collaborative activities are being extended to the entire 1. Establish and enhance capacity for quality assured country. The framework looks to establishing mechanisms rapid diagnosis of Drug Resistant-TB in 43 Culture for coordination between the two programmes at all levels. and DST laboratories in India by 2015; Technical working groups with the key staff of both the 2. Scale-up care and management of DR-TB in 35 programmes as members have been established at the States/Union Territories of India resulting in the National and State level which are meeting on a periodic initiation of treatment of 55,350 additional cases of basis. The framework was revised in 2008 and an Drug Resistant TB (DR-TB) by 2015; “Intensified HIV-TB Package” of services which give opportunity to all TB patients to know their HIV status 3. Improve the reach, visibility and effectiveness of and linking of all HIV+TB patients to HIV care and RNTCP through civil society support in 374 districts support for ART and Cotrimoxozole prophylaxis therapy across 23 states by 2015; and (CPT), was rolled out to offer these additional services 4. Engage communities and community-based care in states with the higher burden of HIV-TB. providers in 374 districts across 23 states by 2015 The 2009 revision of the National Framework establishes to improve TB care and control, especially for uniform activities at ART centers and ICTCs nationwide marginalized and vulnerable populations including for intensified TB case finding and reporting, and set the TB-HIV patients. ground for better monitoring and evaluation jointly by the 6.4.5 TB/HIV coordination: Globally, the HIV epidemic two programmes. The HIV-TB performance indicators is worsening the TB situation, by increasing the number and performance targets act as a guide to channelize the of tuberculosis cases and accelerating the spread of the HIV-TB interventions in the right direction at all the levels. disease. HIV increases a person’s susceptibility to TB In addition to this, the revised reporting formats and infection and Tuberculosis increases morbidity and mechanisms have been incorporated in the National mortality in HIV infected persons. HIV is the most potent Framework to develop a common understanding on the risk factor for progression of TB infection to disease. monitoring system.

106 Annual Report 2010-11 In 2010, “Intensified TB-HIV package” of services has 6.4.7 The IEC strategy in RNTCP envisages that: been rolled out in 11 more states totalling to 29 States 1. IEC is a long term commitment where in IEC is a &UTs in which this package of services has already been process and not product oriented. Implementing IEC rolled out with the vision to scale up Intensified TB-HIV activities is based on analysis of the needs, and package in the entire country by 2012 developing strategy to plan need based, locally ART- DOTS linkages are being established at all the ART appropriate activities. Communication strategies for centres of the AIDS control programme to ensure optimal TB control takes care of opportunities for interactive communication, such as engaging cured access to TB diagnostic and treatment services to the patients to convince and support others, group HIV positives at advanced stage of disease. A new TB/ meetings to discuss all aspects of TB control, HIV module for ART centre staff has been created and including the social aspects. ART staff have been trained in this module. In addition, joint training modules on TB/HIV have been formulated 2. It focuses on decentralized planning, choice of for various categories of staff of RNTCP and NACP communication channels and monitoring to ensure and the training activities are being scaled up. TOTs have contextual relevance and wide reach of information. been conducted for State and District level trainers and The states and districts have to take active part in the training of field staff is on-going and is at various this process while Centre continues to provide stages in the different States. IEC materials regarding leadership, develop core messages, mass media and TB are being made available at NACP facilities. advocacy events. Selective IEC material on HIV is displayed at RNTCP 3. IEC takes care to address social issues related to facilities. TB such as stigma and gender, and special communication initiatives to address the needs of 6.4.6 MDR-TB: Another challenge to TB control in the special groups and ‘hard to reach populations’ India is the MDR-TB. The data available to date shows that levels of MDR-TB remain relatively low, at around RNTCP emphasizes on decentralized planning and 3% amongst new patients and 12-17% in re-treatment implementation of health communication initiatives. cases. However, these relatively low percentage figures States and districts develop need based annual translate into large absolute number of MDR-TB cases, action plans and implement activities using local which increase the magnitude and severity of TB epidemic popular media. To support the districts in planning and pose a major threat to TB control. Guidelines for and implementing, Communication Facilitators have been engaged who identify opportunities and management of MDR TB cases (DOTS Plus) have been network through which communication activities formulated and published. The Programme Division has are undertaken to spread information about TB and an ambitious plan to scale up services for management availability of free diagnosis and DOTS treatment. of MDR-TB patients in the country and is in the process Other important role of Communication Facilitators of securing funding for the same. DOTS Plus services is to integrate communication about TB within the for management of MDR TB have been rolled out in the context of other health programmes and NRHM. ten states presently i.e. in the states of Gujarat, Maharashtra, Andhra Pradesh, Haryana, Delhi, Kerala, RNTCP encourages states to: i) systematic planning West Bengal, Tamil Nadu, Rajasthan and Orissa. Till date and implementation of communication activities based on a total of over 2975 MDR-TB patients are on treatment the needs, knowledge of target groups, using the local appropriate media; ii) to undertake IEC activity for in these states. maintaining desired level of awareness, motivation, support Information, Education and communication (IEC) or and services in patient friendly environment; and iii) Advocacy, Communication and Social Mobilization monitor IEC activities regularly like other components of (ACSM) continue to be an important component of the the programme. programme. In line with the stop TB strategy, replacement RNTCP is also working to increase in state and district of the terminology with ‘Advocacy, Communication, and level capacity to plan and execute IEC activities. For Social Mobilization’ (ACSM) is being promoted, as the this purpose, each state has undertaken an IEC audit to term ACSM has advantage over IEC as it clearly defines take stock of its current capacity. This was done with a the components and initiatives. standardized format and procedure.

Annual Report 2010-11 107 The objective is to assess the existing capacity in states 6.4.10 Research activities: The RNTCP encourages and districts for planning and implementing IEC activities. Operational Research (OR) and has provision for funding In many case IEC planning and implementation is such studies. Funds have also been made available to individual driven depending upon the leadership role taken States for inviting proposals and funding research activities by the programme manager or the designated person. in their respective States. The OR priority research areas There is need to institutionalize these processes and IEC as well as formats for the proposals are available on the capacity audit is a step in this direction to document that RNTCP websitewww.tbcindia.org. The aim of the exists at this point of time. research is to improve DOT services to make them more patient- friendly, ensure that treatment is directly observed 6.4.8 Web-based Resource Centre for IEC: A and increase detection of smear positive cases. A number web-based resource Centre for IEC is being used by the of studies have been done in this field. Some of these States and Districts for reproduction of material. The have been and are being initiated/sponsored and funded Resource Centre is available on the Programme’s by the Central TB Division, some have been undertaken web site:www.tbcindia.org by the States and National/Central institutes, and others 6.4.9 Quality Control of diagnosis and drugs: A have been carried out by the teaching and training protocol for External Quality Assurance (EQA) of sputum institutes. microscopy of slides by different level of staff at the 6.4.11 Physical Performance: Microscopy Centres (MCs), Districts, Intermediate Reference Laboratories and National Reference Comparative statement of achievements under RNTCP Laboratories have been operationalised. Similarly, an during the last 8 years. independent agency had been contracted to test quality of RNTCP drugs at various points.

Indicators 2002 2003 2004 2005 2006 2007 2008 2009 2010 (Jan-Sep) Population coverage, (millions) 530 775 947 1080 1114 1 1131 1148 11642 1176

Total number of cases put on DOTS 622873 906472 1187353 1293083 1397498 1475587 1517333 1533309 1173992

New smear positive patients put on treatment 245051 358496 465331 506193 553660 592635 616016 624617 485018

Cure rate (expected 85% 84% 86% 86% 84% 84% 84% 84% 85% 85%

No. of NGOs involved (approx) 410 650 1011 1600 2263 2400 2524 2291 3000

1Entire country covered under RNTCP in March 2006 2 Projected populations in 2009

108 Annual Report 2010-11 6.4.12 Financial Performance d) to improve quality of service delivery;

Year Outlay as Actual e) to secure participation of Voluntary Organizations/ budgeted expenditure Private Practitioners in eye care; (Rs. in Crores) (Rs. in Crores) f) to enhance community awareness on eye care. 2006-07 202.17 220.97 6.5.2.Salient features/strategies adopted to achieve 2007-08 267.00 262.12 the objectives:

2008-09 275.00 279.90 • Provision of assistance to make eye care 2009-10 312.25 233.43 programme comprehensive by covering diseases (till 30.09.2010) other than cataract like diabetic retinopathy, glaucoma, corneal transplantation, vitreo-retinal surgery, treatment of childhood blindness etc. 6.5 NATIONAL PROGRAMME FOR CONTROL OF BLINDNESS (NPCB) • Reduction in the backlog of blind persons by active National Programme for Control of Blindness (NPCB) screening of population above 50 years, organizing was launched in the year 1976 as a 100% centrally screening eye camps and transporting operable sponsored scheme with the goal of reducing the cases to fixed eye care facilities prevalence of blindness to 0.3% by 2020. Rapid Survey • Coverage of underserved area for eye care services on Avoidable Blindness conducted under NPCB during through public-private partnership. 2006-07 showed reduction in the prevalence of blindness from 1.1% (2001-02) to 1% (2006-07). • Capacity building of health personnel for improving Main causes of blindness are as follows: - Cataract their skill, enhancing their knowledge in delivery of (62.6%) Refractive Error (19.70%) Corneal Blindness high quality eye services (0.90%), Glaucoma (5.80%), Surgical Complication • Community awareness/information education (1.20%) Posterior Capsular Opacification (0.90%) communication (IEC) activities for creating Posterior Segment Disorder (4.70%), Others (4.19%) awareness on eye- care. Major events include eye Estimated National Prevalence of Childhood Blindness / donation awareness fortnight (25th August to 8th Low Vision is 0.80 per thousand. September) and World Sight Day (2nd Thursday of The Pattern of Assistance for National Programme for October) each year in addition to ongoing activities. Control of Blindness during the 11th Five Year Plan has been approved by the Cabinet Committee on Economic • Screening of children for identification and Affairs. The Pattern of Assistance for the 11th Five Year treatment of refractive errors and provision of free Plan is effective from 16th October, 2008. glasses to those affected and belonging to poor socio-economic strata. The allocation for the 11th Plan (2007-12) is Rs.1250.00 crore. The allocation for the current financial year (2010- • Development of regional institute of ophthalmology 11) is Rs.260.00 crore. and medical colleges in a phase manner to be centre of excellence in retina units/low vision units/ 6.5.1. Main objectives of the programme: paediatric eye units. a) to reduce the backlog of blindness through identification and treatment of blind; 6.5.3. New Initiatives introduced during 11th Plan b) to develop Comprehensive Eye Care facilities in • Construction of dedicated Eye Wards & Eye OTs every district; in District Hospitals in North-Eastern States, Bihar, Jharkhand, J&K, Himachal Pradesh, Uttarakhand c) to develop human resources for providing Eye Care and few other States where dedicated Operation Services; Theaters are not available as per demand.

Annual Report 2010-11 109 • Appointment of Ophthalmic manpower Cataract Operations: (Ophthalmic Surgeons, Ophthalmic Assistants and Eye Donation Counsellors) in States on Year Target Cataract % surgery contractual basis. operations with IOL • Grant-in-aid to NGOs for management of other Eye performed diseases other than Cataract like Diabetic 2006-07 45,00,000 50,40,089 93 Retinopathy, Glaucoma Management, Laser Techniques, Corneal Transplantation, Vitreoretinal 2007-08 50,00,000 54,04,406 94 Surgery, Treatment of childhood blindness etc. The assistance would be upto Rs. 750 per case for 2008-09 60,00,000 58,10,336 94 Cataract/IOL Implantation Surgery and Rs.1000 2009-10 60,00,000 59,06,016 95 per case of other major Eye diseases. 2010-11(as on • Development of Mobile Ophthalmic Units in NE 30.11.2010) 60,00,000 23,11,000 95 States, Hilly States & difficult terrains for diagnosis and medical management of eye diseases. School Eye Screening Programme: • Involvement of Private Practitioners in Sub District, Blocks and Village level. Year No. of free spectacles provided to • Maintenance of Ophthalmic Equipments supplied school age group children with to Regional Institutes of Ophthalmology, Medical refractive errors Colleges, District/Sub-District Hospitals, PHC/ Vision Centres. Target Achievement 6.4.7 Major events during 2010-11: 2006-07 70,000 4,56,634 • Annual review meeting of NPCB with State 2007-08 3,00,000 5,12,020 Programme Officers was held on 8-9 April, 2010 2008-09 3,00,000 10,21,082 as a part of review of the programme at the central level. 2009-10 4,73,472 5,05,843 • Meetings of Technical Committee to formulate 2010-11 revised duties of Ophthalmic Assistants under (as on NPCB were held on 1.9.2010 and 8.11.2010. 30.11.2010) 3,00,000 85,000

Budget Allocation and expenditure: Collection of donated Eyes:

(Rs. in crore) Year Collection of donated eyes Year Budget Expenditure Target Achievement allocated (BE/FE) 2006-07 45,000 30,007 2006-07 111.87 111.53 2007-08 40,000 38,546 2007-08 171.87 164.95 2008-09 50,000 41,780 2008-09 250.00 249.49 2009-10 55,000 46,589 2009-10 250.00 252.89 2010-11 (as on 20010-11 30.11.2010) 60,000 14,481 (as on 30.11.2010) 260.00 125.00

110 Annual Report 2010-11 Training of Eye Surgeons: 6.6.2.c.The Ministry of Health & Family Welfare has issued notification (with effect from 17th May, 2006 under Year Target No. of eye the Prevention of Food Adulteration (PFA) Act 1954) surgeons banning the sale of non-iodized salt for direct human trained consumption. 2006-07 250 250 6.6.2.d. For effective implementation of National Iodine 2007-08 400 300 Deficiency Disorders Control Programme 31 States/UTs have established Iodine Deficiency Disorders Control 2008-09 400 450 Cells in their State Health Directorate. 2009-10 400 400 6.6.2.e. In order to monitor the quality of iodated salt and urinary iodine excretion, 28 States/UTs have already 2010-11(as on set up Iodine Deficiency Disorders monitoring laboratories 30.11.2010) 400 300 while the remaining States are in the process of establishing the same. 6.6 National Iodine Deficiency disorders Control Programme (NIDDCP) 6.6.2.f. During the year 2010-11, to ensure the quality of iodated salt at consumption level, a total of 17426 salt 6.6.1 Iodine an essential micronutrient required daily at samples were analyzed out of which 16239 (93%) salt 100-150 micrograms for normal human growth and samples were found confirming to the standard ( as per development. Deficiency of iodine can cause physical the report - till October 2010). and mental retardation, cretinism, abortions, stillbirth, deaf mutism, squint & various types of goiter. 6.6.2.g. Urine samples were collected and analyzed for estimation of urinary iodine excretion for bio-availability The sample surveys conducted in 325 districts covering of iodine 6581, out of which 6173 samples were found all the States/Union Territories have revealed that 263 confirming to the standard (94%). districts are endemic as the prevalence of Iodine Deficiency Disorders is more than 10%. It is also 6.6.2.h. Global IDD Prevention day was observed st estimated that in the country more than 71 million persons throughout the country on 21 October, 2010. On Global are suffering from goiter and other Iodine Deficiency IDD Prevention Day messages on benefits of Disorders. consumption of iodated salt in prevention and control of IDD were published in National & Regional newspapers. The objectives of the programme is to (a) survey to assess A two day national workshop on National Iodine the magnitude of the Iodine Deficiency Disorders, (b) Deficiency Disorders Control Programme was also supply of iodated salt in place of common salt, (c) organized at New Delhi resurvey to asses iodine deficiency disorders and impact of iodated salt after every 5 years, (d) health education 6.6.2.i. Visible goitre and cretinism has reduced and publicity (Information, Education & Communication, significantly in the country. IEC), (e) laboratory monitoring of iodated salt and urinary 6.6.2.j. Information, Education & Communication iodine excretion. Activities 6.6.2. Initiatives and Progress • In 16 States song and drama division through their 6.6.2.a.Salt Commissioner has issued licenses to 824 salt field units have been carrying out special interactive manufacturers out of which 532 units have commenced programmes/ activities. production. These units have an annual production • The Directorate of Field Publicity through their 207 capacity of 120 lakh metric tonnes of Iodated salt. regional units in 29 States have carried out 6.6.2.b. Production of iodated salt of 45.90 lakh metric extensive IEC campaigns in the country regarding tonnes was recorded during the period from April 2010 consumption of iodated salt for prevention and to August 2010 against 55.00 lakh metric tonnes target control of IDDs. The activities include film shows, for the year 2010-11. group discussion and other special programmes.

Annual Report 2010-11 111 • IDD spots containing messages on consequences consuming iodated salt are broadcast by the All of Iodine Deficiency Disorders and benefits of India Radio through its 40 regional channels, 133 consuming iodated salt are being telecast through primary channels and 22 FM channels from April the National Network of Doordarshan daily. In 2010. Kalyani Programme the IDD messages are State Governments have also been provided grants telecasted thrice a week in regional languages from • for undertaking IEC activities at the local level in 8 regional Kendras of Doordarshan. their regional languages that includes celebration • IDD spots containing messages on consequences of Global IDD Prevention Day in all districts. of iodine deficiency disorders and benefits of

112 Annual Report 2010-11 Chapter 7

Information, Education And Communication

7.1. INTRODUCTION which people live. The strategy views recipients of health services as not merely users of services but key Public policy and communication strategies influence both participants in generating demand for services. individual and collective change. The interface between these two components provides the framework to position During the year, the communication strategy has focused behavior change. In other words, the balance between on sustaining behavior change on key health issues communication and policy facilitates health seeking through multimedia tools. This implies that it was not behavior. Over the years the thrust of the Department enough to just give information and raise awareness about has been to place IEC as an intervention tool to generate a particular health issue. Awareness and information demand for the range of services under National Rural dissemination should be used as tools to provide tools to Health Mission (NRHM) and various schemes under the community to press for changes to improve access to public health being undertaken by the Government of India. health service provisions. The Communication Strategy aims to facilitate awareness, For making health care accessible to the general public disseminate information regarding availability of and and to spread awareness on health issues, norms have access to quality health care within our Public Health also been outlined for supporting IEC activities. The System. The key objective of the strategy is to encourage framework incorporates a variety of activities involving a health seeking behavior that is doable in the context in communities and also the media.

Panels inside Delhi Metro Trains

highlighting health issues as a part of the

IEC campaign.

Annual Report 2010-11 113 Major IEC initiatives undertaken during the year : • Grass-root functionaries • Integration of various IEC activities • Other Govt. Departments, e.g. Panchayati Raj, WCD, Water & Sanitation • MOU signed with NFDC to scale up communication interventions in NE states. • NGOs, Civil society stake holders and Media • A series of press advertisements released in During the year, the following issues were being national dailies across the country highlighting highlighted through multi-media tools: achievements of the Ministry • Janani Suraksha Yojana • A magazine based programme, Kalyani-1 and 2 • ASHA telecast in eight states and also all NE states. • Age At Marriage • Awareness campaign on Delhi Metro trains highlighting preventive and curative aspects of • Routine Immunization various health issues. • PNDT and Girl Child • Capacity building workshops organized in states to • Contraceptive choice and spacing build capacities of state IEC personnels • Breast Feeding • Health Pavilion at India International Trade Fair wins gold medal for best display. • Use of Iodized Salt • Close monitoring of actual media utilization and • Care of New born behavioral outcomes along with financial allocations • Institutional delivery • Presented a tableau on ‘Healthy Living ‘ at the Annual Republic Day Parade, 2011 • Maternal Care, Positioning of ASHA, Village and Health Nutrition Day, JSY, IMNCI and also • National Immunization Day (NID) held in Jan.-Feb. awareness campaign on age at marriage, PNDT, 2011. spacing and contraception. The following tools were used during the year: • Adolescent health • Interpersonal Communication • RCH and HIV/AIDS • Community Channels • Communicable and non communicable diseases platform for integration • Mass Media A Budget allocation of Rs. 204.94 Crores was provided • Folk and Traditional Media for IEC activities for the year 2010-11. • Outdoor Media Major achievements during 2010-11 were as under: • Advocacy - Reinforcing the brand identity for NRHM. • Events, Image management, PR and Publicity - Innovations at State level for NRHM advocacy. The target audiences included: - Intra Communication strategies for implementation * Citizens of India in various age groups at State level • Direct Healthcare Providers (ANM, ASHA, - New content for multi-media tools. AWW) - Integrated IEC management through Kalyani • Healthcare Managers/Administrative functionaries Programme News Magazine format through Prasar Bharati being telecast from EAG States and Health Communicators • Assam.

114 Annual Report 2010-11 - Special publications on achievements under health programmes - Reinforced presence in Cable and Satellite TV channels and Private FM Radio. - Special theme based issues for NRHM Newsletter. The IEC strategy of the Department has undergone a strategic shift. The communication challenge today is not only demand generation, creating awareness, but at the same time initiating a comprehensive understanding of behavior change communication in the socio-cultural Facade of the health pavilion with ‘Population Stabilisation’ theme. The pavilion won the framework of our Public Health Gold Medal among Central Government pavilions for its thematic display. System. A number of initiatives were taken to professionalize IEC activities and emphasis was of Kalyani-I and II from North-East are also in the laid on intensive media planning and inter-personal pipeline. techniques for effective rollout of programmes and iv. The spots in regional languages of north-east region messages. were also dubbed for telecast for a special 7.2. ACTIVITIES THROUGH MEDIA UNITS OF campaign.Video Spots on emergency contraceptive I & B MINISTRY pill, NSV and CuT-380-A were also telecast. The Media Units of the Ministry of Information and 7.4. DAVP Broadcasting provide communication support to the FW DAVP has produced video/ audio spots on NRHM for Programmes as per the requirements and guidelines of telecast/broadcast. The programme proposed by DAVP the IEC Division of MOHFW. The focus is on mother for broadcast through AIR was also approved by the and child health issues, population growth, status of Ministry of Health & Family Welfare to propagate the women, small family norms, the Community Needs messages on maternal health, child health and family Assessment Approach and also other issues related to planning and other critical issues of NRHM. The agency health programmes such as Ophthalmology, Cancer, was also engaged in putting up exhibition during IITF- Tobacco etc. 2010 at Pragati Maidan in the capital on November 14 this year which won the Gold Medal in its category. 7.3. DOORDARSHAN 7.5. NFDC i. Doordarshan telecast video spots at prime time on NRHM, RCH issues through its National Network i. An MOU has been signed between Department as well Regional Kendras of Doordarshan, Prasar of Health & Family Welfare and NFDC, a public Bharati. sector company under the Ministry of Information & Broadcasting for telecast of Audio/Video spots ii. Doordarshan has also telecast programmes through satellite channels as well as private FM including panel discussions, interviews etc. from Channels in the North Eastern region. These time to time related with NRHM. programmes were dubbed in regional languages through NFDC for distribution in the states. iii. A half an hour Kalyani-I and II magazine based programme was also telecast in 9 States including ii. The approved spots were also telecast through all North-Eastern-States twice a week. Kalyani also satellite channel as well as FM Channels in north- repeated on DD Bharati. The proposal for telecast eastern states.

Annual Report 2010-11 115 iii. NFDC is also conducting radio programmes based regional media. A number of campaigns were launched on all issues of maternal health including Janani through the national and regional press. Especially Suraksha Yojana. They are also producing folk designed half page colour advertisement on the occasion music programme in local dialect in EAG States. of and World Population Day was released in the 7.6. ALL INDIA RADIO newspapers all over the country to generate mass awareness toward stabilization of population. Colourful i. The spots approved were telecast through national advertisements highlighting various achievements on network at 7:59 AM before the National News at National Rural Health Mission were also released to the 8.00 AM and before the evening national news at newspapers on the occasion of World Health Day, 8.45 PM. Independence Day, Sadbhavana Divas, Children’s Day, ii. AIR is broadcasting 15 minutes programme based achievements of five years of NRHM, Immunization, on NRHM through 189 primary channels, 42 Vivid Dengue, Chickungunya etc. Bharati stations once a week on every Sunday at The most intensive print media campaign was for the 7.00 PM. The programme are based on true national/sub-national rounds of Pulse Polio Programme successful stories as well as questions and answers which was done systematically through a series of press through telephone as well as e-mail. advertisements in major newspapers all over the country. iii. A contract has also been signed with AIR, Mumbai The IEC Division also released advertisements based on for broadcast of the spots on NRHM 3-4 times focused theme such as Maternal & Child Health Care, daily in each popular programme ( film music, rural Health & Family Welfare Pavilion in IITF- 2010 etc. The programme, woman’s programme) and also before Division as part of an integrated IEC campaign covered and after regional news in 18 high focused stations. a range of issues on NRHM related themes which iv. Department of Health & Family Welfare, Govt. of provided a platform for information dissemination , India has also supported kendras like AIR, Patna awareness building and advocacy through the print media. for telecast of the spots in their popular programme Printed Publicity Material: like Munshi Prem Chand and special radio serial titled “Cine Profile”. In order to highlight the Ministry’s consistent efforts, a series of documents were published. Each document v. AIR, Munbai also telecast spots on NRHM in the reflected critical areas of NRHM and related North-Eastern States from the fund available under programmes. These documents were distributed at major RCH budget. advocacy meeting and programmes to all stake-holders 7.7. SONG AND DRAMA DIVISON in States/UTs. The prominent documents published during the year were: To educate the people about Family Welfare issues, Song & Drama Division organized live entertainment i) Book on ‘Five years of NRHM’ programmes like puppet shows, dance, dramas, folk ii) Book on ‘Comprehensive Abortion Care’ shows, during India International Trade Fair 2010. iii) Booklet on Achievement of one year of New 7.8. PRESS INFORMATION BUREAU Government It provided media coverage on important occasions, iv) Bulletin of Rural Health Statistics in India events, activities, policies and programmes of the Department. PIB arranged coverage of Family Welfare v) Book on Family Welfare Statistics in India Melas, World Population Day functions, Pulse Polio vi) Training Module for ASHA on NCD Programme and other important events. vii) Operational Guidelines for promotion of Menstrual 7.9. PRINT MEDIA/PRINT PUBLICITY Hygiene Press Advertisement: viii) Training Module for ASHA on Menstrual Hygiene The IEC Campaign through Press Advertisement enabled ix) Reading Material for AHSA on Menstrual Hygiene the division to highlight key initiatives in both national and

116 Annual Report 2010-11 x) Flip Book on Menstrual Hygiene from different regions. A number of health related issues, in the form reader’s response have been discussed xi) Book on ‘Hospital Housekeeping Guidelines’ through these Newsletter editions. xii) Folders on Family Planning methods (multi- Annual Wall Calendar: languages) Special efforts were made to publish the Wall Calendar a) “Hamara Ghar” an established house journal of 2011 of the Ministry on integrated themes with poster the Department of Health & FW is being published value. The Calendar has come out with innovative designs for the last 39 year for promotion of Health and highlighting initiatives taken on various health and family Family Welfare programmes for grass root level welfare issues. Special efforts were also made through workers. visual publicity like this year’s Calendar for spreading b) “Gagar Me Sagar” is a selected slogans booklet in message on health issues as an integrated theme of the Hindi being brought out as supportive material for Ministry. The Calendar was distributed to various health Health and Family Welfare workers for publicity set ups. of Health & FW programmes to grass root level. Outdoor Publicity Campaign: NRHM Newsletter: An awareness campaign was launched in Delhi Metro The NRHM Newsletter is now established as an important trains through panels inside train compartments publication for promotion of the programmes under highlighting various issues like – New born care, Spacing National Rural Health Mission. The NRHM Newsletter methods, Population Stabilization, Female feticide, Small is being published in Hindi, English, Assamese, Urdu, family, Right age of marriage, Emergency Contraception, Oriya, Punjabi, Marathi, Kannada, Tamil & Bengali for Hand washing, T.B., Anti Tobacco etc. The IEC Division NGOs and health functionaries working at the Sub- also conducted an outdoor publicity campaign by installing Centre, PHC, CHC and District level. The Newsletter hoarding, unipole on various health issues like – Dengue, publishes view points of all development partners, viz. Chikungunya, Swine-flue, Maternal & Child Health, NGOs, donor agencies etc. Immunization etc. A special issue of newsletter on ‘Population Stabilization’ was brought out during the year. This issue highlighted the discussions in the lower house of the Parliament on ‘Population Stabilization’. Other important issue of newsletter published in the year was ‘Operational Plan for Mother & Child Tracking System’. There has been tremendous response to the Newsletter, especially from the grass root health workers The MOHFW tableau during the Republic Day Parade, 2011

Annual Report 2010-11 117 Mass Mailing Unit(Press) 7.12. HEALTH PAVILION AT IITF-2010

The Mass Mailing Unit’s ( Direct Mail Communication) The main theme of the Annual Health & Family Welfare main objective is to build up an effective mailing list of Pavilion at Pragati Maidan in the capital was “Population opinion leaders from different parts of the country with a view to utilize their services to bring awareness and Stabilization”. The Ministry has renewed and stepped attitudinal change among common people. up its focus on this issue and used various forums to highlight the importance of the theme. The Pavilion won At present, Mass Mailing Unit, Department of Health & the Gold Medal for its display in its category. Family Welfare is disseminating the Ministry’s regular journals, NRHM newsletter in English, Hindi and several Like every year, free health check-ups, i.e. Cancer regional languages on a quarterly basis and wall calendars detection, Blood test, Eye Test, Height and weight on an Annual Basis. Apart from this regular dispatch, the Mass mailing Unit has mailed various types of publicity measurement, Family Planning counseling and services materials like posters, leaflets, pamphlets on Health and for male with various family spacing methods, treatment Family Welfare programmes provided by various divisions for communicable and non-communicable diseases were of the Ministry to the Health Functionaries at grass root arranged by the Deptt. of AYUSH through its Councils level all over the country. of Ayurveda, Unani & Homeopathy and allopathic clinic 7.10. IEC WORKSHOP of CGHS. During the year, Capacity Building IEC Workshops were Folk Dance/Nukkad Natak were organized by the Song organised for the District IEC Officers/District & Drama Division to spread health and social messages. Community Mobilizers in two phases in Uttar Pradesh A small amphitheatre was also established to educate covering all the 80 districts. The purpose of the workshop people through showcasing documentary films. Painting organised at Allahabad and Agra was to enhance the skills of the officers. The workshops stressed on prioritizing Competition was organized for the Children in two age the health issues according to the need of the districts, groups and first three entries were awarded with prizes budgeting exercise, preparing IEC material and stressed and certificate. NACO, JSK, HSCC, HLL, Rajiv Gandhi Inter-Personal Communication to spread Behaviour Cancer Research Hospital, Heart Care Foundation & Change messages to the general public etc. VHAI etc also participated in the exhibition. 7.11. WORLD POPULATION DAY 7.13. REPUBLIC DAY TABLEAU-2011 Like every year, the World Population Day was observed on 11th July, 2010. On this occasion, a population run The Ministry of Health & Family Welfare presented a was organized jointly by the Ministry and Jansankya tableau at the Republic Day Parade, 2011. The theme of Sthirtha Kosh at New Delhi in which the Union Health the Tableau was HEALTHY LIVING with emphasis & Family Welfare Minister Ghulam Nabi Azad, Chief on preventive and curative health care including Yoga, Minister of Delhi,Smt Sheila Dikshit and Common Wealth regular exercise and healthy food. Games Gold Medalist Saina Nehwal participated along with school children to create awareness about population The tableau also highlighted the adverse effects of tobacco stabilization. use and substance abuse.

118 Annual Report 2010-11 Chapter 8 Partnership With Non- Government Organisations

8.1 INTRODUCTION 8.3 NEW GUIDELINES The National Rural Health Mission (NRHM) seeks to According to the guidelines of NGO Scheme, the States build greater ownership of the program among the have been given an important role in selection/approval community through involvement of Non-Government of the NGOs and overseeing implementation of the Organizations. Promotion of Public Private Partnership projects undertaken by them. An inbuilt mechanism of for achieving public health goals is one of the strategies monitoring the working of the NGOs and various activities initiated by the department in this regard. This partnership undertaken under the project, in addition to the mid-term will reinforce the strategy of involvement of NGOs appraisal, etc. by the designated evaluating agencies/ already spelt out in the National Population Policy 2000. organizations has been built into the guidelines: The Government of India is committed to voluntary and The key features are: - informed choice in family planning, reproductive and child • Decentralization of the schemes to the State and health care services. Towards this end, the Government, District level. the corporate sector, voluntary and non-voluntary sector are expected to work together in partnership. The • Integration with National Rural Health Mission. professional bodies like Indian Medical Association, Federation of Obstetrician & Gynecologist are also • Training of ASHA involved in the partnership to achieve the desired goal. • Activities relating to various National Disease 8.2 PARTNERSHIP WITH NON- Control Programme. GOVERNMENT ORGANIZATIONS • Awareness relating activities concerning PNDT The Government of India envisages collaboration with Act. NGOs through enhanced participation by the State • Shift from exclusive IEC and awareness generation Government also. Under RCH-II, the ownership of the to Service Delivery. program has been decentralized to the State Governments. The planning process now starts from the district level. • Delivery of RCH services by NGOs in un-served The scheme has been included in the State PIP for NRHM and under served areas. under RCH II. • Clearly defined eligibility criteria for Registration, NGOs in particular, have been assigned supplementary Experience, Assets and jurisdiction. or complementary role to that of the Government health • Rationalization of the jurisdiction area serviced by care delivery, thus aiding them in reaching the masses the NGO to provide in depth service and optimize meaningfully. They have a comparative advantage of resources. flexibility in procedures, rapport building with communities and are at the cutting edge of program implementation. • Mainstreaming gender issues in all intervention NGOs will be involved in ASHA’s training, activities areas. relating to National Disease Control Programmes, PNDT • Enhanced male participation and involvement in related activities and service delivery in addition to health delivery of all RCH services. education and awareness programme.

Annual Report 2010-11 119 • Emphasis on measurable qualitative and quantitative implementation of Janani Suraksha Yojana (JSY) are some performance indicators. of the salient features. Currently, 310 existing Mother NGOs are working in all the States of the Country. • Selection, approval, funding and monitoring of Mother NGO/Service NGO projects by State and 8.5 SERVICE NGO (SNGO) SCHEME District RCH Committees. The Service NGOs (SNGOS) are, those, who are • Increased interface of NGOs with local expected to provide clinical services and other specialized government bodies. aspects such as Dai training, MTP, male involvement, covering 1,00,000 populations, contributing to achieving 8.4 MOTHER NGO (MNGO) SCHEME the RCH objectives. The underlying philosophy of the Mother NGO (MNGO) NGOs with an established institutional and infrastructure Scheme is one of nurturing and capacity building through for service delivery are encouraged to compliment the partnership. In accordance with the National Population public health care delivery system in achieving the goals Policy 2000, National Health Policy (NHP) 2002 and 10th of RCH-II program. These SNGOs will cover an area plan document that places emphasis on decentralization co-terminus to that of a CHC/block PHC with of program management and RCH service delivery using approximately 1,00,000 population or around 100 villages. a gender sensitive approach, the NGO guidelines were Service NGOs are expected to provide a range of clinical revised in accordance with the RCH II approach. and non-clinical services directly to the community as an The objectives of the MNGO scheme, are to improve integrated package of RCH-II services. Some of the RCH indicators in the under served and unserved areas, services expected to be provided by Service NGOs include with specific focus on Mother & Child Health, Family safe deliveries, neo natal care, treatment of diarrhoea Planning, Immunization, Institutional delivery, RTI/STI and and ARI, abortion and IUD services, RTI/STI etc. adolescent reproductive health care. It is expected that 8.6 INSTITUTIONAL FRAMEWORK FOR the gender concerns and male involvement will be PROGRAM MANAGEMENT addressed across all the interventions. The program management under the revised scheme is The un-served areas specifically include hilly, desert and decentralized to the State and district Authorities. The mountainous regions, SC/ST habitats, urban slums and in State Government forms State RCH society, which has areas where the government infrastructures are the responsibility for the overall management of the functioning sub optimally. Under the revised mode, NGOs scheme. The State NGO Selection committee will be are expected to facilitate RCH service delivery in addition responsible for MNGO selection, recommendation of to addressing the awareness, education and advocacy projects for GOI approval, fund disbursement, capacity requirement. building, monitoring and evaluation. The District RCH The overall approach has shifted from a project to a society is responsible for all the operational aspects of program mode (from one-year cycle to 3-5 year cycle). the program management at the district level. The district Rationalization of NGO jurisdiction (reducing coverage NGO committee holds the responsibility for from 5-8 districts or more to 1-2 only), and each Mother recommendation of MNGO composite proposals to State NGO to work with only 3-4 Field NGOs (FNGOs) from RCH Society, facilitating the signing of MOU with the each district, encouraging each Mother NGO to identify MNGO and passes it on for fund release to state RCH the un-served and under served pockets within the districts society. The State RCH society undertakes review in consultation with District Health Officials, identification meetings and periodic monitoring in the field for assessing of Field NGOs from the same pockets to serve populations Field NGO/Mother NGO performance. covering 1-2 sub centers in the provision of RCH service Role of Government of India is related to provision of delivery related to NRHM Family Planning, Immunization, policy guidelines, final approval of proposals, and technical Mother & Child Health and access to institutional delivery. support for capacity building of NGOs and fund release RTI/STI, adolescent reproductive health care, to State governments.

120 Annual Report 2010-11 8.7 STATE NGO COORDINATORS 11 RRCs covering the programme all over the country. (SNGOCs) NGOs with expertise and experience in Reproductive Child Health (RCH) and having national level stature are The SNGOCs are responsible for monitoring the identified as RRCs. implementation, facilitating timely submission of NGO reports to the state government, providing government The RRCs are playing an important role to be a catalyst, feed back to NGOs, communicating government policies advocacy and net working with state governments, and programs and facilitating NGO dialogue with the strengthen managerial and technical competencies of the district health system. Presently there are 15 selected Mother NGOs, support and oversee Field NGO training, Service NGOCs are in position. document and disseminate best practices, collect and 8.8 INSTITUTIONAL FRAMEWORK FOR disseminate RCH policies, laws, and program from the NGO CAPACITY BUILDING respective states where they work and for maintenance of database on technical and human resources related to The Regional Resource Centres (RRCs) is the institutional mechanism available to support this program. There are RCH.

Annual Report 2010-11 121

Chapter 9

Family Planning

9.1 INTRODUCTION 17% of the world population. Even a cursory look at following figure will give a broad idea of the demographic In 1952, India launched the world’s first national scenario of India, where population of each state is programme emphasizing family planning to the extent equivalent to one major country in the world. India has necessary for reducing birth rates “to stabilize the been showing a slow but steady decline in population population at a level consistent with the requirement growth. India’s annual population growth rate during of national economy”. Since then, the family planning 1991-2001 decade was 1.93%, a decrease of over 15% programme has evolved and the program is currently being from the previous decade. Similarly, Total Fertility Rate repositioned to not only achieve population stabilization (TFR) in the country has recorded a steady decline to but also to promote reproductive health and reduce the current levels of 2.6 (SRS 2008), a 42% decline from maternal, infant & child mortality and morbidity. mid-1960s. Table.1. Stated goals in recent National Population and Health Policies related to Family Welfare and their current status

Program/Policy X Five Year NPP NRHM MDG Current Status Goals Plan(by 2007) (by 2010) (by 2012) (by 2015) (Reference Year)

Infant Mortality Rate 45 <30 30 27 53 (2008)

MaternalMortality Ratio 200 <100 100 100 254(2005)

Total Fertility Rate NA 2.1 2.1 NA 2.6(2008)

The objectives, strategies and activities of the Family 9.2.2. Family Planning Scenario: Planning division are designed and operated towards Nationwide, the small family norm is widely accepted achieving the family welfare goals and objectives stated (the wanted fertility rate for India as a whole is 1.9: in various policy documents (NPP: National Population NFHS-3) and the general awareness of contraception is Policy 2000, NHP: National Health Policy 2002, and NRHM: National Rural Health Mission) and to honour the commitments of the Government of India (including ICPD: International Conference on Population and Development, MDG: Millennium Development Goals and others) (see Table 1). 9.2. CURRENT SCENARIO OF POPULATION AND FAMILY PLANNING IN INDIA 9.2.1 Demographic Scenario: India’s population as per 2001 census was 1.028 billion, second only to China in the world. India which accounts for 2.4% of the land area is already supporting around

Annual Report 2010-11 123 almost universal (98% among women and 98.6% among determinants of fertility like age at first marriage and age men: NFHS-3). Both NFHS and DLHS surveys showed at first childbirth (which are societal preferences) are that contraceptive use is generally rising (see adjoining also showing good improvements at the national level and figure). Contraceptive use among married women (aged adjoining figure indicates the current position of social 15-49 years) was 56.3% in NFHS-3 (an increase determinants of fertility in the country. 9.3 CURRENT FAMILY PLANNING EFFORTS The Family Planning (FP) Division is involved in the development, implementation and monitoring of strategic interventions for fulfilling the twin objectives of population stabilization and promoting reproductive health within the wider context of sustainable development. The interventions, activities and performance in the area of family planning over the year 2010-11 are as follows: 9.3.1. Contraceptive services under the National Family Welfare Programme: The public sector provides a wide range of contraceptive of 8.1 percentage points from NFHS-2) while services for limiting and spacing of births at various levels corresponding increase between DLHS-2 & 3 is relatively of health system as described in Table 2: lesser (from 52.5% to 54.0%). The proximate Table 2: Family Planning Services in Public Health Sector

Family Planning Service Service Location Service Strategy* Method Provider & Promotional Schemes LIMITING METHODS Minilap Trained & certified MBBS PHC & higher levels • FDS: Fixed Day Doctors & Specialist • Static Approach Doctors Laparoscopic Sterilization Trained & certified Specialist CHC & • Camp Approach Usually Doctors (OBG & higher levels • Revised Compensation Scheme General Surgeons) NSV: No Scalpel Trained & certified MBBS PHC & • National Family Planning Vasectomy Doctors & Specialist higher levels • Insurance Scheme Doctors SPACING METHODS IUD 380 A Trained & certified ANMs, Sub centre & • On demand LHVs, SNs and Doctors higher levels • Camp Approach • Revised Compensation Scheme Oral Contraceptive Trained ASHAs, ANMs, Village level Sub centre • On demand Pills (OCPs) LHVs, SNs and Doctors & higher levels • VHNDs: Village Health Nutrition Days Condoms Trained ASHAs, ANMs, Village level Sub centre • On demand LHVs, SNs and Doctors & higher levels • VHNDs EMERGENCY CONTRACEPTION Emergency Contraceptive Trained ASHAs, ANMs, Village level Sub centre • On demand Pills (ECPs) LHVs, SNs and Doctors & higher levels • VHNDs

Legends: ANM: Auxiliary Nurse Midwife; LHV: Lady Health Visitor; SN: Staff Nurse; ASHA: Accredited Social Health Activist Note: * extensive IEC is key component of all the strategies of Family Planning Programme

124 Annual Report 2010-11 The salient features of the family planning services are This decline could be because of incomplete data as follows: uploaded by most states and it is assumed that once complete data is entered an improved performance would Counselling, access to and provision of good quality • be reflected. However, anecdotal evidences suggest that services and follow-up care. another reason for declining performance could be • ‘Fixed Day Static Services’ (FDS) approach in attributed to better quality of data entered in HMIS web sterilization services to increase access. portal. • Continuation of sterilization camps in the states with 9.3.2.Increasing male participation in Planned high fertility till the time FDS is implemented Parenthood, including ëNo Scalpel Vasectomyí effectively. (NSV): • Revised compensation scheme for sterilization • Increasing male participation in ‘Planned acceptors. Parenthood’ is one of the major strategic themes • ‘National Family Planning Insurance Scheme’ of NPP-2000. (NFPIS) to cover service providers in both public • Promotion of NSV acceptance is one of the most and accredited private facilities, where the clients important & visible component of increasing male are insured in the eventualities of deaths, participation in RCH towards addressing the gender complications and failures in sterilization and the providers/ accredited institutions are indemnified equity issues. against litigations in those eventualities. • The No Scalpel Vasectomy (NSV), a modified male • ‘Quality Assurance Committees’ (QACs) have sterilization technique, was introduced in 1997. been constituted at state and district levels. • Camp approach for male sterilization was adopted • The division has repositioned IUD as short and long initially to re-popularize male sterilization method. term spacing method. Based on the experiential lessons from male sterilization camps in certain states a strategy on Guidelines have been developed and disseminated • advocacy and community mobilization for regarding use of Emergency Contraception Pills increasing NSV acceptance through camps was (ECPs). introduced in 2005. Achievements in 2010-11: • Human resource development with a three pronged The performances of family planning services are showing strategy for training surgical faculty from Medical a marginal decline in all methods (refer Annex-1 for colleges, district NSV trainers and service providers details) for the year 2010-11 compared to the is in place. corresponding period in 2009-10. Achievements in 2010-11: • The camp approach was continued in most states across India (http://mohfw.nic.in/NRHM/FP/ Revised_Budget_ Guidelines_CSS.pdf) • Training in NSV, was continued on a priority basis. As on September 2010: o As per the latest report (HMIS) there are 9239 facilities in the country with trained NSV providers. o Most districts in the country have district NSV trainer/s. o Surgical faculty training is being continued in 2010-11 across five regional training centres and Source: Report from HMIS web portal as on 25th November 2010 funds for the same are being disbursed. Annual Report 2010-11 125 • The annual ‘National NSV Review Workshop’ was • From above figure, it is evident that NSV as a held in September 2009 to review states’ percentage of total sterilization is increasing across performance in NSV, and top three performing the country and more and more states are moving states for the year 2008-09 (West Bengal, Punjab in the positive direction. & Maharashtra) were felicitated. • NSV performance has continued its positive trend and has shown an increase in 2009-10: Table 3: Achievements in Male Sterilization, Nationwide

Period† April ñ March* April-September^

Contraception 2008-09 2009-10 Annual 2010-11 (lakhs) (lakhs) Change (%) (lakhs)

Male Sterilizations 2.52 2.74 8.7 0.77 Male Sterilization as % of Total Sterilization 5.2 5.5 4.7

Source: * MIS for NRHM as on November 2010 ^ HMIS RCH Reports accessed on 25th November 2010

• Male sterilization as a percentage of total 9.3.3. Promotion of IUDs as a short & long term sterilization had reached a low of 1.89% in 1999 spacing method: and was hovering around 2.5% until 2006 without In 2006, GOI launched “Repositioning IUCD in National much improvement. As a result of intensive efforts Family Welfare Programme” ( http://mohfw.nic.in/ to increase male participation, the proportion of NRHM/FP/Repositioning_IUCD.pdf) with an objective male sterilization rose to 4.3% in 2007-08 and 5.5% to improve the method mix in contraceptive services and in the year 2008-09 and it has further improved to has adopted diverse strategies including advocacy of 5.6% in 2009-10. Number of NSVs for the period IUCD at various levels; community mobilization for ending September 2010-11 is 4.7%. IUCD; capacity building of public health system staff starting from ANMs to provide quality IUCD services and intensive IEC activities to dispel myths about IUCD. ìAlternative Training Methodology in IUCDî using anatomical, simulator pelvic models incorporating adult learning principles and humanistic training technique was started in September 2007 to train service providers in provision of quality IUCD services. It was started in twelve districts across twelve states of India on a pilot basis and based on the success of the pilot phase and lessons learned it was expanded to cover the entire country in 2008-09. Achievements in 2010-11: • As on September 2010: Source: 2006-2009: MIS for NRHM as on 30th April 2009 - GOI has trained state trainers from all the states 2009-10 & 2010-11: HMIS Standard RCH Reports at the National level

126 Annual Report 2010-11 - Anatomical simulator pelvic models have been 9.3.4.b.Camp approach for sterilization services is distributed to all the districts continued in those states where operation of regular fixed day static services in sterilization takes longer time - All the states have started district trainers’ and duration. service providers’ trainings. 9.3.4.c.Training of service providers for full - Approximately 35,000 service providers (MOs, operationalization of FDS is continued across all the states SNs, LHVs, & ANMs) have been trained till for all sterilization services (NSV, minilap abdominal date. tubectomy and laparoscopic tubectomy) and IUD • Rapid assessment of the IUCD training is almost services. complete (final report awaited). 9.3.4. d. Rational placement of trained providers at • In order to increase basket of contraceptives in the peripheral facilities for provision of regular family spacing methods, decision to introduce Multi Load planning services. Copper 375 has been taken and an operations Achievements in 2010-11: research study has been completed in 6 states. The report/ recommendations of the study is • FDS guidelines have been disseminated to all the awaited. Requirement for Multi Load IUD to be states. launched in the programme is being worked out. • Most states have operationalized FDS in sterilization 9.3.4. Addressing the unmet need in contraception at the district level and few states like Andhra through assured delivery of family planning Pradesh and Tamil Nadu have opertaionalized FDS services: up to the PHC level. 9.3.4.a Fixed Day Static Services in Sterilisation at • Guidelines for “Standard Operating Procedures for facility level: sterilization services in camps” were developed, printed and disseminated to all the states. • Operationalization of FDS has following objectives (http://mohfw.nic.in/NRHM/FP/ • “Guidelines for Clinical Skill Building Trainings in Fixed_Day_Static_ Guidelines.pdf): Male and Female Sterilization Services” was (http:/ /mohfw.nic.in/NRHM/FP/Scan_Clinical_Skill_ - To make a conscious shift from camp approach Building. pdf) developed and disseminated to all to a regular routine services. states. - To make health facilities self sufficient in Analysis of the data available from HMIS under provision of sterilization services. • - To enable clients to avail sterilization services on any given day at their designated health facility. Table 4: FDS Guidelines for sterilization services Health Facility Minimum frequency of sterilization services District Hospital Weekly Sub District Hospital Weekly CHC / Block PHC Fortnightly 24 7 PHC / PHC Monthly

Note: Those facilities providing more frequent services th already must continue to do so Source: Data accessed from HMIS on 25 November, 2010 and analyzed in-house

Annual Report 2010-11 127 NRHM for the period April-September 2010-11 • Another workshop was conducted in Bihar to orient reveals that around 60% of NSV, Minilap and even the newly appointed district nodal officers of family laparoscopic sterilization (which requires specialist planning. training and expensive instruments) procedures and approximately 42% of postpartum sterilizations are • Almost all states have reported the constitution of being conducted at PHC and CHC level, indicating the “SQACs” and of ‘DQACs”. that FDS approach in sterilization is taking root in 9.3.6. Post-partum Family Planning (PPFP) the country (See figure). services: • Expert committee meetings have been convened • Institutional deliveries in India have increased to standardize trainings in female and male significantly since the launch of NRHM which gives sterilization services. an opportunity to offer family planning counselling 9.3.5. Quality Assurance in Family Planning: and contraceptive services.

Quality assurance in family planning services is the • PPFP services are not being offered uniformly at decisive factor in acceptance and continuation of all levels of health system across different states contraceptive methods and services. of India resulting in missed opportunities. The guidelines for ‘Quality Assurance and Standards’ in Achievements in 2010-11: place. The Quality Assurance Committees (QACs) set up at • The division has undertaken advocacy for the State and District level, following the Supreme Court strengthening PPFP services, at all levels; further, directives. At the Central level, these activities are it was ensured that PPFP is included in PIP for monitored through reports and field visits. 2010-11 under NRHM. Up-to-date guidelines on quality of services are now • Training of Trainers for immediate PPIUCD have available for been organised in medical colleges and district hospitals of 18 states. • Male and female sterilization services: (http:// mohfw.nic.in/NRHM/FP/Quality_Assurance.pdf) • PPS is showing increasing trends at the National level. The proportion of PPS out of total female • Sterilization services in camps (http://mohfw.nic.in/ sterilization has recorded an impressive 8.1 NRHM/FP/SOP_Book.pdf) percentage points increase for the period April- • IUCD services(http://mohfw.nic.in/NRHM/FP/ March 2009-10 (32.1%) compared to the period medical_ officer.pdf & April-March 2008-09 (24%). Further, this remains static during the corresponding period of 2010-11 • http://mohfw.nic.in/NRHM/FP/nursing.pdf) at 32.2%. • ECP administration (http://mohfw.nic.in/NRHM/ FP/ECP_Book_Final.pdf), the division has • Hand book on Post- partum family planning has developed reference manuals on: been developed. • Minilap tubectomy 9.3.7. Promotion of Emergency Contraceptive Pills (ECPs): • Post partum family planning ECPs are effective for preventing conception due to • Immediate post partum insertion of IUCD unplanned/ unprotected sex. This helps to reduce • Guidelines for training in female sterilisation unwanted pregnancy and associated abortions, maternal mortality and morbidity. Achievements in 2010-11: • ECPs have been included in National Family • Divisional workshops (5) on “Quality Assurance Welfare Programme and efforts are being made in Family Planning” were held in the high focus to utilize them at all levels of public health system. state of Uttar Pradesh.

128 Annual Report 2010-11 • ECP has been included in the ASHA kits to address • RISUG is an indigenously developed intra-vasal the issue of unwanted pregnancy at the community male contraceptive. It is under Phase 3 clinical trial level. which is funded by the ministry. 9.3.8. Assisted Reproductive Technologies (ART) • A 3 year pre-introductory study on Net-EN, for infertility: Cyclofem and hormonal Implants is in progress. ICMR is conducting the research study in HRRCs As per WHO data, the incidence of infertility in various and Medical Colleges prior to its introduction in countries including India is around 10-15% which has the National Programme. created demand for assisted reproduction. In order to ensure quality in ART services and for regulating and 9.3.10. Other promotional schemes: supervising the functioning of ART clinics, the National Guidelines on ART has been developed by ICMR and 9.3.10.a. Revised compensation scheme for acceptors National Academy of Medical Sciences for GOI. of sterilization: Achievements in 2010-11: GOI has been providing compensation to the acceptors of sterilization for their loss of wages for availing the • The Draft bill on ART has been updated by services as per the revised rates since September 2007 incorporating comments from various stakeholders and all the states are covered under this scheme. Funds including the Law Commission and general public. in the scheme have also been earmarked for the The draft Bill has been sent to the Law Ministry compensation for sterilization in accredited private health for examination.. facilities and empanelled private healthcare providers. 9.3.9. New contraceptive methods and The detailed scheme is available on the ministry’s website contraceptive services: at http://mohfw.nic.in/NRHM/FP/ It has been documented worldwide that introduction of a Revised_compensation.pdf . new contraceptive method increases the CPR by approximately 3%. The division is taking proactive 9.3.10.b.National Family Planning Insurance Scheme approach to introduce new contraceptive methods and (NFPIS): services in family welfare programme. GOI launched the NFPIS Scheme in November 2005 to compensate for the acceptors of sterilization or his/her Achievements in 2010-11: nominee in the unlikely event of failure or complications or his/ her death, following a sterilization operation. The • Post- Partum IUCD (PPIUCD) has been scheme also provides for indemnity insurance cover to introduced as a contraceptive technique in the the medical officers and the health facilities for up to programme. Training of service providers and four cases of litigations per year that the healthcare trainers has been done in 18 states – 32 provider or the facility may face as a consequence of Gynaecologists and 30 (as state trainers) have performing sterilization operations. trained more than 100 Gynaecologists and nurses at the district level who will be further train medical • The Insurance scheme has been renewed with the officers from FRUs. 2000 anatomical pelvic models ICICI Lombard Insurance company for the year with post-partum uterus procured with the support 2009-10 of UNFPA and distributed to the states. • The manual for NFPIS is available on the ministry’s • Decision to introduce Multi Load Copper 375 has website at http://mohfw.nic.in/NRHM/FP/ been taken and operation research study for the FP_Manual_ 2008-Final.pdf introduction of the same in National Family Welfare Programme has been completed and the final report/ 9.3.10.c.Public Private Partnership (PPP): recommendation is awaited. • PPP in family planning services are intended to utilize the reach of private sector in increasing the • Funds have been released to ICMR for Post Marketing Surveillance study in Centchroman (a access to family planning services. In order to non steroidal oral contraceptive developed promote PPP in family planning services, indigenously by CDRI, Lucknow). accredited private facilities and empanelled private

Annual Report 2010-11 129 healthcare providers are covered under revised districts) to generate awareness about population compensation scheme for sterilization and NFPIS. issues. • Accreditation and empanelment of private health • At the central level the Hon’ble Union Minister of facilities /healthcare providers is decentralized to Health and Family Welfare Shri Ghulam Nabi Azad districts. flagged off a ‘Population Run’ from Vijay Chowk to India Gate. The gathering was also addressed However, PPP in family planning has not been • by the Hon’ble Chief Minister of Delhi Smt. Sheila adequately promoted. The division is addressing this Dixit. issue by increasing advocacy for PPP at all forums including Indian Medical Association (IMA). Nearly • Similar functions were also held not only in all the 100 workshops have been conducted for private 9 high focus states’ capital but also in all their practitioners through funding to IMA. districts. In all the states two days’ district level melas were also held where stalls were set up for 9.3.11. Some major activities during the year: RCH services including counselling, IUD services, 9.3.11.a.National consultation on Repositioning other spacing methods and enlisting for clients for Family Planning for Maternal & Child Health sterilisation. in Addition to Population Stabilisation (May Key findings: 05, 2010): • During the population week over 90,000 sterilisations were performed; this was a result of concerted IEC/BCC efforts and provision of quality services. • With meticulous micro planning the available service providers could be judiciously distributed to make more facilities functional and thereby provide service to the clients nearer their place of residence. Further, it was observed that those states showed better performance where top bureaucratic leadership was actively involved. 9.3.11.c.Debate on Population Stabilisation in Parliament (August 04, 2010): • The Hon’ble Minister of Health and Family Welfare, Shri Ghulam Nabi Azad, piloted a debate in Parliament – “That this house consider the issue • The consultation was inaugurated by the Hon’ble Minister of Health and the key note address was of Population Stabilisation in the country” delivered by Hon’ble Member of Parliament Shri • It was a historic debate as the subject was debated M S Swaminathan. in Parliament after 33 long years. The debate lasted almost 7 hours and more than 34 members spoke • Various experts from across the globe & from various international organisations like UNFPA, in the debate. Cutting across party lines all members UNICEF, DFID, USAID, WHO, World Bank and appreciated the gravity of the subject and urged representatives from lead NGOs participated in the the government to take all necessary steps to consultation. contain the rising population. 9.3.11.b.Celebration of World Population Day & 9.3.11.d. Meeting of the National Commission on Week (July 11 – 17, 2010): Population (October 21, 2010) : The second meeting of the National Commission • World Population Day was celebrated for the first • time in all districts of the high focus states (304 on Population (NCP) chaired by Hon’ble Prime

130 Annual Report 2010-11 Minister, Shri Manmohan Singh was held on October levels is restricted due to poor implementation of 21, 2010. FDS approach, especially so in high focus states with high TFR and high unmet need due to: • The meeting was attended by Chief Ministers of high focus states, health ministers of the states and - lack of trained service providers specially in members of the NCP. minilap & NSV at the CHCs and PHCs 9.4. KEY CHALLENGES & OPPORTU- - poor facility readiness NITIES High seasonal variation in sterilisation services is evident 9.4.1. Demographic challenges: in high focus states (84% sterilization in last 6 months and 42% in last three months) compared to a more uniform • It has been estimated that with current trends, the performance throughout the year in non-EAG states (see population in India will increase from 1.029 billion adjoining figure). This reflects the lack of regular service to 1.4 billion during the period 2001-2026, an provision rather than the ‘acceptors preference’, as increase of 36% in twenty-five years at the rate of frequently claimed by many service providers. 1.2% annually. • There are substantial differences in TFR in between and within states and the national progress must be seen in the context of these striking differences e.g. Kerala, Tamil Nadu, Andhra Pradesh & Karnataka with TFR at or below replacement levels and states like Uttar Pradesh, Bihar, Madhya Pradesh, Chhattisgarh, Uttarakhand, Rajasthan, Jharkhand and Orissa, with an estimated combined TFR of 4.2 in 2000. Table 5 gives the estimated year by which some selected HFS will reach replacement fertility if the current trends continue and it will delay the attainment of replacement level of fertility in India until 2021: Source: Data accessed as on November 25, 2010 from HMIS web Table 5 Projected Year to reach • Heavy reliance on expensive, technically and Replacement-level Fertility logistically high-demanding laparoscopic Sl. No. Name of the State Year sterilizations: As evidenced by adjoining figure, 1 Uttar Pradesh 2027 the southern states (blue bars), except Karnataka, 2 Madhya Pradesh 2025 3 Chhattisgarh 2022 4 Uttarakhand 2022 5 Bihar 2021 6 Rajasthan 2021 7 Jharkhand 2018 INDIA 2021

Source: Report of the technical group on population projections commissioned by the National Commission on Population, May 2006 9.4.2. Programmatic and service delivery challenges in family planning: Unavailability of regular sterilization services: • Source: Data accessed as on November 25, 2010 from HMIS The access to sterilization services at sub-district web portal

Annual Report 2010-11 131 show a high proportion of minilap sterilizations (75 FDS in sterilization is picking up. However, the to 89% out of total female sterilization). However, quality of training, post-training follow-up and in most of the high focus states (green bars), with support for adherence to standard service delivery the exception of Bihar and Jharkhand, laparoscopic protocols are poor. More importantly, there is a lack female sterilization remains the predominant of rational human resource development plan in the procedure. Laparoscopic sterilization services can states where selection of trainees, post-training be provided by trained gynaecologists/surgeons placement and post-training infrastructure & logistic only; the procedure requires expensive instruments support are not given adequate importance leading with high maintenance and sophisticated to loss of trained service providers to the system infrastructure including basic OT. Hence, heavy and wasted resources. reliance on it would limit service provision in these • Lack of regular contraceptive updates at state/ states where the availability of specialists and district level for all categories of service providers facility readiness is still low. Promoting the simpler, is limiting the service providers’ knowledge level safer and easy-to-provide minilap would be a better and skills to provide quality contraceptive services proposition for increasing the access to sterilization according to the latest service delivery protocols. services and reduce the unmet need in limiting methods in high focus states.

• The huge potential for post-partum contraception offered by the increasing number of institutional deliveries has not been tapped adequately due to lack of planning, lack of trained post-partum family planning service providers and lack of infrastructure in most of the high focus states. This is evident

• Inadequate attention to spacing methods is evident by consistently low use of spacing methods across most states of India, despite high unmet need in spacing. According to DLHS 3, all the spacing methods together account for just around 25.5% of the current contraceptive use compared to 74.5% by female & male sterilizations put together as evidenced in adjoining pie chart.

Source: Data accessed as on November 25, 2010 from HMIS web • Inter-State variation in access to and use of portal family planning services: The access to and use from above figure which shows that in high focus of family planning services shows wide inter-state states like Uttar Pradesh, Bihar, Madhya Pradesh, variations. The performance of HFS in family Rajasthan, Jharkhand, Chhattisgarh, Uttarakhand planning services, though improving, remains much and Orissa postpartum sterilization accounts for a below expected levels and needs to be stepped up very lowly 3-19% of total female sterilization as considerably. Adjoining chart shows the gap compared to 75-90% in non-high focus states like between the ELA (Expected Level of Kerala and Tamil Nadu. Achievement) and actual performance in 2009-10 in sterilization services in select HFS and the gaps • Human resource development for minilap, range from of 3.44 lakhs in UP and 1.92 lakhs in laparoscopic sterilization & NSV to operationalize Bihar to 8 thousands in Chhattisgarh. The data on

132 Annual Report 2010-11 • Community based family planning services (including counselling, contraceptive distribution, referral services) utilizing ASHAs, VHNDs and VHSCs have not yet been opertaionalized effectively. 9.5. FUTURE STRATEGIES The ministry has set in motion new approaches to sustain the momentum gained in the sphere of family planning and population stabilization this year, some of which are as follows: • Advocacy for repositioning the Family Planning Program at all levels, for achieving population Source: Data accessed as on November 25, 2010 from HMIS web portal stabilization and reducing the maternal, infant and child mortality and morbidity. sterilizations per 10,000 unsterilized couples exposed to higher birth order of 3 and 3+ further highlights • Ensuring the Fixed Day Static Services round the the poor performance of HFS. The sterilization rate year. for 10,000 unsterilized couples exposed to high birth • Rolling out the comprehensive training plan for order ranges from a lowly 35 in Uttar Pradesh, 56 development of trained human resources in family in Bihar & 59 in J&K to a high of 1,399 in Tamil planning services which has been an area of Nadu and 3,493 in Andhra Pradesh as shown in concern for a long time. the figure. • Promoting male participation • Increasing the thrust on Post-partum Family Planning services. • Organizing state Family Planning dissemination workshops countrywide. • State wide dissemination of IEC/BCC and advocacy materials. • Increasing the basket of choices in contraceptives offering more options to the clients. • Strengthening contraceptive logistics (Decentralization of procurement): allowing state/ districts to procure NSV instruments / IUD kits/ • The demand from the states for contraceptives and Laparoscopes through the flexi pool survey findings on contraceptive use are in variance. Revised monitoring strategy is being put in place To address this issue, the logistics of procurement • with a clear road map for states to achieve dual and supply of contraceptives has to be rationalized goals of population stabilisation and better to reflect the actual requirement and usage. reproductive health: • Public Private Partnership (PPP) in family a. Development of key performance indicators for planning has not been adequately promoted across input, process and output most states in India and there is a reluctance to accredit private providers at state/district level b. Categorisation of states based on TFR which is adversely affecting the widest possible access of family planning services to clients. c. Analysing states’ performance on the basis of

Annual Report 2010-11 133 information available through survey, HMIS, Quantities supplied to States/UTs review mission reports etc. Contraceptives 2008-09 2009-10 2010-11 d. Conducting visit to states to corroborate the (upto findings of above analysis and analysing Nov. 10) underlying causes for poor performance which Condoms(In million pieces)) 320.322 642.427 389.030 would lead to the way forward. Oral Pills(In lakh cycles) 616.677 123.000 255.000 e. Analysis of information with implication for follow-up action. IUDs (In lakh pieces) 41.686 31.000 72.510 9.6 CONTRACEPTIVES IN THE NATIONAL Tubal Rings (In lakh pairs) 16.32 13.744 15.470 FAMILY WELFARE PROGRAMME ECP(in lakh packs) 6.59 45.000 21.540 The Department of Health and Family Welfare is Pregnancy Test Kits(in lakhs) 217.48 217.48 78.500 responsible for implementation of the National Family Welfare Programme by interalia, encouraging the Budget Utilization utilization of contraceptives and distribution of the same (Rs. in Crore) to the States/UTs through Free Supply Scheme and Public-Private Partnership (PPP) under Social Marketing Contraceptives 2008-09 2009-10 2010-11 Scheme. Under Free Supply Scheme, contraceptives, (up to namely, Condoms, Oral Contraceptive Pills, Intra Uterine Nov.,10) Contraceptive Device (IUCD), Emergency Contraceptive Condoms 170.30 98.79 60.54 Pills and Tubal Rings are procured and supplied free to the States/UTs. Oral Pills 11.90 4.12 8.54 9.6.1. The channel for supply of these contraceptives IUDs 6.48 6.13 14.28 under Free Supply Scheme is Government network Tubal Rings 1.50 1.07 1.97 comprising Sub-Centers, Primary Health Centres, Community Health Centres and Govt. Hospitals, State ECP 0.44 3.60 1.72 AIDS Control Societies throughout the country. Pregnancy Test Kits 24.47 24.47 8.4460 9.6.2. Procurement procedures: Orders are placed on HLL Life Care Ltd. and IDPL (both PSUs) for 9.7 SOCIAL MARKETING SCHEME procurement of contraceptives being manufactured by them as per Govt. instructions. For the remaining The National Family Welfare Programme initiated the Social Marketing Programme of Condoms in 1968 and quantities, tenders are solicited from the firms through that of Oral Pills in 1987. Under the Social Marketing advertisement of Tender Enquiries for concluding Rate Programme, both Condoms and Oral Pills are made Contracts. Rate Contracts are concluded with the available to the people at highly subsidized rates, through manufacturers and Supply Orders are placed upon them diverse outlets. The extent of subsidy ranges from 70% as per their competitive rates and the capacity to to 85% depending upon the procurement price in a given manufacture the items. year. Both these contraceptives are distributed through 9.6.3. Quality Assurance: Manufacturers do in-house Social Marketing Organizations (SMOs). testing of stores before offering them for inspection. At The SMOs are given Deluxe Nirodh condom at Rs.2.00 the time of acceptance of stores, all the batches are tested per packet of 5 pieces and this is sold @ Rs.3/- per packet and thereafter, stores are supplied to the consignees. of 5 pieces to the consumer. One cycle of Oral Pills, 9.6.4. The quantities given to the States under Free which is required for one month, is given to the SMOs @ Supply Scheme during the last two years and the current Re.1.60/- and it is sold to the consumer @ Rs.3/- per year (upto November, 2010) along with the budget utilized strip (cycle) under the brand name-”Mala –D”. Under are given in the following tables: the Social Marketing programme, currently three

134 Annual Report 2010-11 Government brands and fourteen different SMOs brands 9.10. SALE OF ORAL CONTRACEPTIVE of condoms are sold in the market. Similarly for Oral PILLS (QUANTITY IN LAKH CYCLES) Pills, one Government brand and seven SMOs brands of Pills are sold. Based on the recommendation of the Sl. Social Marketing 2008-09 2009-10 2009-10 No. Organisation (Up to Working Group on Social Marketing of Contraceptives, Nov. 2010) SMOs have the flexibility to fix the price of branded condoms and OCPs within the range fixed by the 1. HLL Lifecare Ltd, Government. 9.8. AREA SPECIFIC PROJECTS FOR Thiruvananthapuram 122.00 66.21 58.01 SOCIAL MARKETING 2. Population Services

With a view to providing impetus to Social Marketing in International, Delhi 69.01 63.40 54.17 selected regions/districts, area specific projects are initiated under the Social Marketing Programme. This 3. Parivar Seva Sanstha, endeavour has been undertaken in the States of Madhya Delhi 30.66 25.00 7.86 Pradesh, Haryana, Andhra Pradesh, Bihar, Jharkhand and Orissa. During the year 2010-11, till November, 2010 no 4. World Pharma, Indore 15.86 4.00 0.00 project under the scheme could be approved. 5.. DKT, India, Mumbai 102.54 120.50 30.08 9.9. SALE OF CONDOMS (QUANTITY IN MILLION PIECES) 6. Eskag Pharma (Pvt.) Sl. Social Marketing 2008-09 2009-10 2010-11 Ltd., Kolkata 62.51 75.68 0.00 No. Organisation (upto Nov., 7. Janani, Patna 21.43 22.90 7.58 2010) 8. Population Health

1. HLL Lifecare Ltd, Services, Hyderabad 51.62 45.30 33.31 Thiruvananthapuram 223.54 185.50 105.41 9 Sanskar Shiksha 2. Population Services International, Delhi 176.87 189.41 50.77 Samiti, Bhopal 0.10 0.00 0.00

3. Parivar Seva Sanstha, 10 PCPL, Kolkata 19.40 10.05 0.00 Delhi 61.19 34.32 11.95 Total 495.13 433.04 191.01 4. DKT, India, Mumbai 114.36 105.62 25.50

5. World Pharma, Indore 11.60 3.60 0.00

6. Janani, Patna 25.19 29.23 8.95 9.11. CENTCHROMAN (ORAL PILLS)

7. Pashupati Chem. and Since December 1995, a non-steroidal weekly Oral Pharmaceutical Ltd., Contraceptive Pill, Centchroman (Popularly known as Kolkata 10.57 4.96 0.00 Saheli & Novex), to prevent pregnancy is also being subsidized under the Social Marketing Programme. The 8. Population Health weekly Oral pill is the result of indigenous research of Services( India) 75.71 97.34 21.68 CDRL, Lucknow. The pill is now available in the market at Rs.2.00 per tablet. The Government of India provides 9. Sanskar Shiksha Samiti, a subsidy of Rs.2.59 per tablet towards product and Bhopal … … … promotional subsidy.

Total 699.03 649.98 224.26

Annual Report 2010-11 135 9.12. PERFORMANCE OF SOCIAL Quantity procured (in lakh packs) MARKETING PROGRAMME IN THE Item 2008-09 2009-10 2010-11 SALE OF CONTRACEPTIVES (Nov.2010) Contraceptives 2008-09 2009-10 2010-11 ECP 5.50 45.000 21.54 (Upto Nov., 2010) 9.14. PREGNANCY TEST KITS Condoms(Million pieces) 699.03 649.98 224.26 Orders have been placed on HLL Lifecare Ltd, (a PSU Oral Pills (lakh cycles) 495.13 433.04 191.01 under the Ministry), for procurement of 2,17,48,200 Pregnancy Test kits each during the year 2008-09, 2009- Centchroman (Saheli/ 10 and 2010-11 for free-of-cost supply for timely and Novex) Weekly Oral Pills early detection of pregnancy. The kits are home-based (lakh tablets) 181.07 203.94 32.94 and easy to use. 9.15 COPPER-T 9.13. EMERGENCY CONTRACEPTIVE Under the National Family Welfare Programme, Cu-T- PILLS[ECP] 200B was being supplied to the States/UTs. From 2003- Department of Health &Family Welfare introduced 04, advanced version of Intra Uterine Contraceptive ‘Emergency Contraceptive Pills’ (E- pills) in the National Device i.e.IUCD-380-A has been introduced in the Family Welfare Programme during the year 2002-03. Programme. This Cu.-T has longer life of placement in This contraceptive is used within 72 hours of un-protected the body and thus provides protection from pregnancy sex. The following quantities of E-pills were procured for a period of about 10 years. Now the advanced version during the years 2008-09, 2009-10 & 2010-11 (upto of IUCDs i.e.IUCD-380A is being procured and supplied Nov.2010). to the States/UTs.

136 Annual Report 2010-11 ANNEXURE 1: Number and percentage of family planning users, by states: 2010-11 State/UT/ Total Sterilization IUD Insertions during OCP Users during Condom Users during Agency acceptors during April to September April to September April to September April to September 2010-11 % Change 2010-11 % Change 2010-11 % Change 2010-11 % Change from from from from 2009-10 2009-10 2009-10 2009-10 I. High Focus North-East Arunachal Pradesh 528 46.7 1,277 4.8 1317 20 679 57 Assam 28,544 32.5 18,664 14.5 65,821 25 52,680 44 Manipur 640 79.8 2,490 -6.5 3,904 103 2442 -8 Meghalaya 1,033 6.3 1,777 62.6 5,446 9 3,756 3 Mizoram 1,359 -2.2 1,625 56.6 6,909 17 4,801 26 Nagaland 643 -10.4 781 -32 575 -5 706 93 Sikkim 71 . 1,017 52.7 4,406 -1 2383 -36 Tripura 1,540 -15.3 822 -47.1 4,245 -70 6,770 -8

II. High Focus Non North-East Bihar 38,035 12.5 93,454 9.4 48,083 15 81,918 31 Chhattisgarh 28,077 5.3 50,659 1.4 98346 -16 159,055 -23 Himachal Pradesh1,821 -10.8 10,140 -13.8 23,282 -19 81,908 -21 Jammu & Kashmir3,287 -8.7 9,216 -14.4 16,338 24 25,921 7 Jharkhand 26,665 118.1 59,460 35.1 92560 7 134,974 -16 Madhya Pradesh112060 77.8 175876 -24.7 400672 -16 664511 -33 Orissa 29,300 62.4 58,283 -5.1 136736 -25 178,024 -30 Rajasthan 86,725 -1.4 258264 3.8 700969 -19 1,326,489 -18 Uttar Pradesh 53,377 -25.6 575094 -25.3 249664 -66 580,930 -41 Uttarakhand 3,939 -26.7 31,907 -39.1 20,181 -58 38,591 -44

III. Non-High Focus Large Andhra Pradesh391607 -8.4 177431 -11.2 301685 -9 701091 -12 Goa 1954 -18.2 1088 0.6 3903 17 1598 10 Gujarat 87879 -13 256110 -9.8 255353 -12 660135 -35 Haryana 37210 -3.6 85784 -5.6 54337 -38 132796 -56 Karnataka 166709 -16.4 113211 -17.6 117126 -28 227275 -2

Annual Report 2010-11 137 State/UT/ Total Sterilization IUD Insertions during OCP Users during Condom Users during Agency acceptors during April to September April to September April to September April to September 2010-11 % Change 2010-11 % Change 2010-11 % Change 2010-11 % Change from from from from 2009-10 2009-10 2009-10 2009-10 Kerala 52544 4 29418 -4.2 10071 -61 83478 -24 Maharashtra 163432 -24.9 153529 -14.8 190143 -32 308440 -29 Punjab 43044 12.6 105769 -22.9 78100 -22 388956 -3 Tamil Nadu 169890 -2.5 172911 10.1 107647 -3 169734 3 West Bengal 88523 -11.6 34269 -15.7 586412 -4 516323 -6

IV. Non-High Focus Small & UTs A &N Islands 224 -43.1 80 -85.7 416 -76 203 -90 Chandigarh 1024 15.4 1,727 -11.6 699 -32 13,064 -9 Dadra & Nagar Haveli 250 -51.7 71 14.5 183 -16 1162 39 Daman & Diu 55 . 39 . 118 . 457 . Delhi 8,522 3.3 21,680 41.7 16,540 17 106,266 6 Lakshadweep 14 366.7 10 -50 3 . 76 -35 Puducherry 5,604 11.9 1,143 -21 2,280 -11 9,006 -12 V. Other Agencies M/O Defence 1,279 -69.1 1,127 -59.2 1,128 -65 8,448 -69 M/O Railways 1,466 -14.2 1,123 -20.1 2,354 -30 17,584 -32 All India 1,638,874 -4.8 2,507,326 -12.8 3,607,952 -23.2 6,692,630 -23.2

Note: Collated from HMIS Periodic RCH Reports (accessed on 29th November 2010), Provisional Figures (Status as on: Oct 28, 2010)

138 Annual Report 2010-11 Chapter 10

Training Programme

10.1 INTRODUCTION experience, community health worker programmes have the potential to make a significant, if not massive, positive One of the key components of the “architectural contribution to community health and awareness and to correction” envisaged under the NRHM is to strengthen impact favourably on major MDG indicators like child community participation in all health programmes. survival. There is a need, therefore, to strengthen the Community participation is not to be limited to the ASHA programme and other communitisation initiatives community acting only as beneficiaries, but rather playing so that much greater outcomes are realized. an active role in the design, implementation and monitoring of health programmes. All reports and evaluations show that the ASHA programme appears to be making a positive impact. The major schemes through which community processes However most assessments also show that there are are strengthened are: significant gaps in the implementation of each of these programmes in the states and some process of active a. ASHA programme; support to address these gaps is essential. b. Village Health and Sanitation Committee (VHSC); 10.3 SELECTION OF ASHAS c. Un-tied fund provided to the sub-center and VHSC; The general norm for selection is ‘one ASHA per 1000 d. Rogi Kalyan Samitis (RKS) (or Hospital population’. In tribal, hilly and desert areas the norm may management committees) as a vehicle for public be relaxed to one ASHA per habitation. participation in facility management and the ASHAs are necessarily a woman resident in the village, provision of un-tied funds for this purpose; preferably married and in the age group of 25 to 45 yrs. e. District health societies and the district health ASHA should have effective communication skills, planning process; leadership qualities and be able to reach out to the community. She should be a literate woman with formal f. Community monitoring programme and education up to Eighth Class, which can be relaxed if suitable women with this qualification are not available. g. Involvement of NGOs/private sector in the mother Selection of ASHAs are done by the community, and NGO programme and public- private partnerships. actively facilitated to ensure that weaker sections participate in the selection. Selection has to be endorsed 10.2 ASHA UNDER NRHM by the gram panchayat.

The National Rural Health Mission initiated in 2005, rolled 10.4 PROGRESS MADE IN SELECTION OF out the ASHA programme in a ‘Mission Mode’, scaling ASHAS up simultaneously in several states. Of the targeted 8,99,986 ASHAs in the country; 8,42,654 Of the community based programmes, NRHM’s most (93.6%) ASHAs have been selected. Progress made in well known and talked about face, is undoubtedly the selection and training of ASHAs (as on December 2010) ASHA programme. Going by national and international is given in table-1.

Annual Report 2010-11 139 Table-1: State wise status of ASHA selection and training of ASHAs up to Dec. 2010

Name of Selection ASHA Percentage ASHA Training states Target of selected of selection ASHA † Module Module Module Module Module Module I II III IV V VI EAG Bihar 87,135 78,973 90.63 69402 52859 52859 52859 TOT Done States Chhattisgarh 60092 60092 100.00 60092 60092 60092 60092 60092 Jharkhand 40964 40964 100.00 40115 39482 39214 35675 40964 TOT Done MP 52117 50113 96.15 48159 44938 44518 42426 808 TOT Done Orissa 41,102 40932 99.59 40765 40763 40763 40763 39657 TOT Done Rajasthan 48372 43787 90.52 40310 33811 32652 35499 TOT TOT Done Done UP 136268 136182 99.94 135130 128434 128434 128434 TOT Done Uttarakhand 11086 11086 100.00 11086 11086 11086 11086 8978 8750 NE Arunachal 3862 3629 93.97 3426 3305 3324 2906 2497 756 States Assam 29693 28798 96.99 26225 26225 26225 26225 23271 Manipur 3878 3878 100.00 3878 3878 3878 3878 3878 TOT Done Meghalaya 6258 6258 100.00 6175 6175 6175 6175 3427 Mizoram 987 987 100.00 987 987 987 987 987 TOT Done Nagaland 1700 1700 100.00 1700 1700 1700 1700 1700 TOT Done Sikkim 666 666 100.00 666 666 666 666 666 TOT Done Tripura 7367 7367 100.00 7367 7367 7367 7367 7362 TOT Done Non- EAG Andhra Pradesh 70700 70700 100.00 70700 70700 70700 70700 70700 TOT Done Delhi 5400 3200 59.26 2680 2138 2075 1276 0

140 Annual Report 2010-11 Name of Selection ASHA Percentage ASHA Training states Target of selected of selection ASHA † Module Module Module Module Module Module I II III IV V VI

Gujarat 31438 29675 94.39 28809 28052 26373 24201 13589 TOT Done Haryana 14000 13098 93.56 12825 12169 12169 12169 5097 Himachal Pradesh 18248 16888 92.55 16888 0 0 0 0 J & K 9764 9500 97.30 9500 9000 9000 9000 5711 TOT Done Karnataka 39195 32939 84.04 32939 32939 32939 32939 32939 TOT Done Kerala 32854 31868 97.00 30719 29223 25534 20544 697 Maharashtra 60457 58954 97.51 56854 46580 8464 8038 7029 TOT Done Punjab 17360 17014 98.01 15481 14026 14026 14026 0 Tamil Nadu 6850 2650 38.69 2650 2650 0 0 0 West Bengal 61008 39736 65.13 29552 25465 21666 19663 17195 TOT Done UTs Andman & Nicobar 407 407 100.00 407 407 184 49 49 Chandigarh 423 423 100.00 - - - 0 Dadra and Nagar Haveli 250 107 42.80 85 85 85 85 85 Lakshadweep 85 83 97.65 83 83 0 0 Daman & Diu NA Goa NA Pondichery NA Total † 8,99,986 8,42,654 93.60 8,05,655 7,35,285 6,83,155 6,69,428 3,47,378 9,506

As one can see from the above Table-1, high focus states entire process being complete and with much better has selected over 90% of proposed number of ASHAs. densities as appropriate to the low population density. The lower figure in MP is as a result of a recent Chhattisgarh has a widely dispersed population and had modification to one ASHA per Anganwadi centre (AWC) therefore, opted for one Mitanin per habitation- a total of instead of previous one ASHA per thousand populations. 54,000 habitations. This gives a ratio of one per just 300 In the north east the figures are even better with the population. GOI agreed to finance the programme using

Annual Report 2010-11 141 29347 as the number of ASHAs – as this was the number Nodal Officer. The job of the Nodal Officers at of anganwadis in place. the District and Block are to facilitate the selection process by involving the Gram Sabha and Gram In other states and union territories till the beginning of Panchayat, holding of training for ASHA and for 2009, ASHAs were sanctioned only for tribal areas, which trainers as per the guidelines of the scheme. were less than 10% of the blocks. Since January 2009, the programme has been expanded to the whole nation. (2) At the village level- women’s committees (like Some states have availed of this and others have not. It self help groups or women’s health committees), is worth noting that Tamilnadu and Himachal Pradesh Village Health & Sanitation Committee of the Gram which had not opted for this scheme so far have done so Panchayat, peripheral health workers especially this year –leaving only Goa and a couple of Union ANMs and Anganwadi workers, and the trainers territories without the ASHA programme. of ASHA and in-service periodic training are major source of support to ASHA. 10.5 TRAINING OF ASHAS (3) District ASHA training team/resource centre. There Capacity building of ASHA is critical in enhancing her are full time staff hire to play this role. effectiveness. It has been envisaged that training will help to equip her with necessary knowledge and skills resulting (4) Block coordinators and sub-block facilitators: For in achievement of scheme’s objectives. Training of ASHA every 15-20 ASHAs one facilitator is deployed and is thus a continuous process. ASHAs are trained by block to coordinate 10 such facilitators a block coordinator trainers who mostly are women- who are chosen at block is deployed. level are trained by a district training team who in turn are trained by the state training team. District mobilisers are in place in Orissa, Uttarakhand, UP and Jharkhand and almost there in Rajasthan and Considering the range of functions and tasks to be Madhya Pradesh. Rest of the states are yet to start, Sub- performed, induction training is imparted over in 23 days district facilitators are in place in Uttarakhand and Orissa spread over a period of 18 months. After the induction only. training, periodic refresher training is planned for about 12 to 24 days per year. In many states, existing NGOs, State ASHA Resource Centers or equivalent institution especially those working on community health issues at has been established in Uttarakhand, Jharkhand, Orissa the district / block level, have been entrusted with the Assam, Jharkhand and Rajasthan. Chhattisgarh has the responsibility for identifying trainers and conducting of SHRC playing this role. Other states have to start this up TOTs. Progress in Training varies across the states. Most and there is a long way to go to make it effective. states have completed an average 16 to 19 days of 10.7 ASHA MENTORING GROUP training, and few states are working on the sixth round of training. The Government of India has set up an ASHA Mentoring Group comprising of leading NGOs and well known 10.6 ASHA SUPPORT STRUCTURE experts on community health. The success of ASHA scheme depends upon how well There are 17 members in National ASHA Mentoring the scheme is implemented and monitored. It is also Group representing renowned NGOs across the country. depends crucially on the motivational level of various Each member of National Mentoring Group has designated functionaries and the quality of all the processes involved for particular states where they are making visit and in implementing the scheme. It is therefore, necessary providing guidance and advice on matter related to that well defined and yet flexible and participatory selection, training, payment of incentives etc. National institutional structures are put into place at all levels from Health Systems Resource Centre is secretariat for state to village. National ASHA mentoring group. Similar mentoring groups (1) The District Health Society under the chairmanship at the State level has been to provide guidance and advise of the District Magistrate/President Zila Parishad on matter relating to selection, training and support for oversees the selection process. The Society had ASHA designated a District Nodal Officer and a Block

142 Annual Report 2010-11 State ASHA mentoring group is functional in Uttarakhand, 10.10 ASHA DRUG KITS Chhattisgarh, Orissa, Madhya Pradesh, Uttar Pradesh, In almost all states, drug kits have been distributed to Jharkhand, Rajasthan, Kerala, Assam, Arunachal Pradesh, ASHAs. Across the country, 6, 11,821 ASHAs have Manipur, Mizoram, Meghalaya, Nagaland, Sikkim, and received drug kit till Dec. 2010. States are now moving Tripura. The administration has to recognize the need for on mechanisms of drug kit replenishment. Govt. of India bureaucracy to be guided by the best of civil society in has recently issued a guideline for regular refilling drug theory and practice of community health worker kits and maintaining stock card. programmes. 10.11 VILLAGE HEALTH & NUTRITION DAY 10.8 PERFORMANCE BASED INCENTIVES Monthly Health and Nutrition day is expected to be Responsibilities of ASHAs that currently are incentivized organized in every village (Anganwadi centers) with the includes; promoting institutional delivery, promoting help of AWW/ANM. ASHA along with AWW mobilizes immunization, DOT provider, Malaria slide collection. women, children and vulnerable population for the monthly Most states have an integrated list of incentive package health day activities like immunization, careful assessment for ASHAs with information on various activities of of nutritional status of pregnant/lactating women, newborn ASHAs with amount of incentive attached to it. In most & children, ANC/PNC and other health check-ups of States, the bulk of ASHAs’ incentive are from JSY and women and children, taking weight of babies and pregnant immunisation. It has been suggested to the States to women etc. and all range of other health activities. A expand the activities and attached incentive to it. The total of 23619245 monthly village health and nutrition days mode of payment by cheque has been operationalise in has been organized till September 2010 across the country. most of the states. The major reason for success in 10.12 ASHA INNOVATIONS streamlining ASHA incentive payment in some states are ; payment by cheque, a designated point person at There is a wide variety of state specific innovations in district, block and sector level reviews to handle issues this programme. To name a few; ASHA gruha (rest house relating to ASHA incentive payment, and tight monitoring, in Orissa), Mitanin help desk (in Chhattisgarh), ASHA and certification of those PHCs having no backlog of Diwas (monthly review meeting- in UP), ASHA radio incentive payment to ASHAs. programme (in Assam, Chhattisgarh, Manipur and Tripura), bicycles for ASHA, Swasth Chetan Yatra (in 10.9 ASHA DIARY & VILLAGE HEALTH Rajasthan) and so on. REGISTER 10.13 COMMUNITY MONITORING Two simple tools essential for strengthening the ASHA PROGRAMME programme, which all states are putting in place are the ASHA diary and the other is the village health register. Community-based Monitoring of health services is a key The ASHA diary is a simple record of all the works she strategy of National Rural Health Mission (NRHM) to does, as and when she does it. It is a useful tool for ensure that the services reaches to those for whom they supportive supervision of her work, a data source for are meant for, especially for those residing in rural areas, village health planning and an important tool for the poor, women and children. Community Monitoring is performance. also seen as an important aspect of promoting community led action in the field of health. The provision for The Village Health Register (VHR) is an important tool Monitoring and Planning Committees has been made at for ensuring access and completion of service delivery, Primary Health Centre (PHC), Block, District and State and a major source of information for village level health levels. Community monitoring is to review the progress planning. The Village Health Register provides household to ensure that the work is moving towards the decided and family level data. The VHR is a vehicle for tracking purpose. Community monitoring helps in identifying and eligible couples, children below 3 (for immunization) and meeting the challenges in the field. The process of pregnant women to ensure that they receive the services Community Monitoring is taking place across nine states they need. It can also record incidents of serious illness (Assam, Jharkhand, Chhattisgarh, Madhya Pradesh, in each family. Rajasthan, Maharashtra, Tamil Nadu, Karnataka and Orissa).

Annual Report 2010-11 143 10.14 CENTRALLY SPONSORED SCHEME OF 10.15 CENTRALLY SPONSORED SCHEME OF ìBASIC TRAINING OF ANM/LHVî ìBASIC TRAINING FOR MULTI PURPOSE HEALTH WORKER (MALE)î ANMs/LHVs play a vital role in MCH and Family Welfare Service in the rural areas. It is therefore, essential The Basic Training of Multi Purpose Health Worker that the proper training to be given to them so that quality (Male) scheme was approved during 6th Five-Year Plan services be provided to the rural population. and taken up since 1984, as a 100% Centrally Sponsored Scheme. This training is provided through forty nine basic For this purpose 319 ANM/Multipurpose Health Worker training schools of Multipurpose Health Workers (Male). (Female) schools with an admission capacity of The training is of one-year duration and on successful approximately 13,000 & 34 promotional training schools completion of the training, the Male Health Worker is for LHV/ Health Assistant (Female) with an admission posted at the sub-centre along with an ANM/Health capacity of 2600 are imparting pre-service training to Worker (Female). prepare required number of ANMs and LHVs to man the Sub centres, Primary Health Centres, Community The financial pattern of assistance for this scheme has Health Centres, Rural Family Welfare Centres and Health been revised since 7.2.2001. Under the scheme the salary posts in the country. The duration of training programme of the staff, rent for school and hostel, stipend for of ANM is one and half years and minimum admission trainees, educational aids and training material, requirement for this course is 10th pass. Senior ANM transportation and contingency are supported.The financial with five years of experience is given six months norms are as follows: promotional training to become LHV/ Health Assistant Item Norm (Female). Health Assistant(Female) provides supportive supervision and technical guidance to the ANMs in sub- Rent (for basic schools) Rs. 10,000 / month centres. Curricula of these training courses are provided Rent for hostel (for basic schools) Rs. 250 / month by the Indian Nursing Council. per candidate

The staffing pattern of the school for, which financial Stipend Rs. 300 / month / assistance is provided by the Department of Family candidate Welfare, varies according to the annual admission capacity of the school. The financial pattern of assistance has Educational Aids and Training been revised w.e.f. 7.2.2001. Other approved costs Material Rs. 15,000 besides salary to staff are stipend to trainees, contingency per annum and rent. Transportation (for hiring bus) Rs. 30,000 per annum Item Norm (in Rupees) Contingency Rs. 50,000 1. Salary & allowances per annum of staff As per State Government 2. Stipend for trainees 500/- per month/trainee Funds under the scheme are released by Family Welfare 3. Contingency 10,000/- per annum /school Budget Section on the basis of audited accounts submitted by States and unspent balance with states. Under the 4. Rent* 60,000/- per annum/school scheme during 2010-11 under BE Rs.1233.97 lakhs were * Rent payable in respect of such schools, which are func- available. tioning in rented buildings 10.16 MAINTENANCE OF HEALTH AND FAMILY WELFARE TRAINING CENTRE Funds under the scheme are released by Family Welfare Budget Section on the basis of audited accounts submitted 49 Health and Family Welfare Training centres were by States and unspent balance with states. Under the established in the country in order to improve the quality scheme during 2010-11 under BE Rs.8517.95 lakhs were and efficiency of the Family Planning Programmes and available. to bring the changes in the attitude of the personnel

144 Annual Report 2010-11 engaged in the delivery of health services through in Item Norms service training programmes. These training centres are supported under Centrally Sponsored Scheme of Contingency Rs. 15,000 per annum “Maintenance of Health and Family Welfare Training Rent* Rs. 40,000 per annum Centre”. Payment to Guest Faculty Rs. 50,000 per annum These training centres are now conducting various in- service training programmes of Department of Family *Rent payable in respect of such centres that are functioning Welfare. Apart from in-service education some of the from rented buildings. selected centres are also responsible for conducting the Funds under the scheme are released by Family Welfare basic training of Male Health Worker’s course of one Budget Section on the basis of audited accounts submitted year. by States and unspent balance with states. Under the Apart from the salary of the staff of the training centres, scheme during 2010-11 under BE Rs.1905.00 lakhs were other assistance under the scheme includes contingency available. for purchase of educational material, rent for training 10.17 TRAINING ACHIEVEMENT centres and payment to guest faculty. The financial pattern of assistance for this scheme has been revised Details regarding the total number of persons trained since 7.2.2001. The details of the financial norms are as since beginning of the programme under each of the above follows: training activities reported up to 31 December 2010 are given in the consolidated table below:-

Type of Training Cumulative Progressup to 31/12/2010 Integrated Service Delivery National Level 280 under NRHM State Level 393 PDC National & State 1366 PMU National Level 305 State Level 2606 Workshop 324 SBA National Level 121 State Level 6528 District Level 40182 BEmOC State and District Level 351 Contraceptive Update National Level 133 State Level 13506 IUD – 380 A Training National Level 164 State & Dist. Level 23789 NSV Dist. Level 2220 Laparoscopic sterilization State Level 4259 Minilap District Level 9617 MTP State and District Level 8886

Annual Report 2010-11 145 Type of Training Cumulative Progressup to 31/12/2010 IMNCI State & District Level 191249 F-IMNCI State Level 648 District Level 2418 NSSK State Level 519 District Level 21217 SNCU District Level 168 RTI\STI State & District Level 4372 Anesthesia State Level 1140 District Level 193 EmOC State & District Level 2584 Blood Storage 785 Immunization State Level 774 District Level 22648 ARSH District Level 6351 Specialized Clinical Skill Training National Level 91 State and District Level 64643 Other Disease Control Programme NVBDCP MOs 10089 Lab. Techns. 1779 Other Paramedical Staff 40653 RNTCP MOs 42454 Lab. Techns. 7471 Other Paramedical Staff 123887 NLEP MOs 6227 Other Paramedical Staff 3106 NCBP MO 1479 Pharma & GNM 150 Teacher 1062 IDSP MOs 20126 Lab. Techns. 5302 Other Paramedical Staff 2272 Routine Immunization MOs 887 Others paramedical staff 41921 Other Trainings State and District Level 10711

146 Annual Report 2010-11 Chapter 11 Other National Health Programmes

Several National Health Programmes are now under the Programme for Prevention and Control of Diabetes, umbrella of NRHM. Details of other National Health Cardiovascular Diseases and Stroke (NPDCS). Programmes are in this chapter. Government of India has approved the programme at an estimated outlay of Rs. 1230.90 crore for the remaining 11.1. NATIONAL PROGRAMME FOR period of the 11th Five Year Plan. The programme focuses CONTROL OF CANCER, DIABETES, on health promotion, capacity building including human CVD AND STROKE (NPCDCS) resource development, early diagnosis and management 11.1.1 India is experiencing a rapid health transition of these diseases and integration with the primary health with a rising burden of Non Communicable Diseases care system. (NCDs). According to a WHO report (2002), The major objectives of the NPCDCS are briefly listed cardiovascular diseases (CVDs) will be the largest cause below: of death and disability in India by 2020. Overall, NCDs are emerging as the leading causes of death in India • Prevent and control common NCDs through accounting for over 42% of all deaths (Registrar General behaviour and life style changes, of India). NCDs cause significant morbidity and mortality both in urban and rural population, with considerable loss • Provide early diagnosis and management of in potentially productive years (aged 35–64 years) of life. common NCDs, It is estimated that the overall prevalence of diabetes, • Build capacity at various levels of health care for hypertension, Ischemic Heart Diseases (IHD) and Stroke prevention, diagnosis and treatment of common is 62.47, 159.46, 37.00 and 1.54 respectively per 1000 NCDs. population of India. There are an estimated 25 Lakh cancer • Train human resource within the public health setup cases in India at any point of time. The leading sites of viz doctors, paramedics and nursing staff to cope cancer are oral cavity, lungs, oesophagus and stomach with the increasing burden of NCDs, and among men and cervix, breast and oral cavity amongst women. Non-communicable diseases – especially • Establish and develop capacity for palliative & cardiovascular diseases, cancers, chronic respiratory rehabilitative care. diseases and diabetes caused 60% of all deaths globally 11.1.2 Strategies: in 2005. Total deaths from NCDs are projected to increase by a further 17% over the next 10 years. These diseases The programme will be implemented in 20,000 Sub-Centres are largely preventable by modifying the four common and 700 Community Health Centres (CHCs) in 100 risk factors: tobacco use, unhealthy diet, physical inactivity Districts across 21 States/UTs and the strategies are as and harmful use of alcohol. under: To address Non-communicable diseases, Ministry has (i) Promotion of healthy lifestyle through massive formulated a National Programme for Prevention and health education and mass media efforts at country Control of Cancers, Diabetes, Cardiovascular Diseases level regarding increased intake of healthy foods, and Stroke (NPCDCS) after integrating the National increased physical activity through sports, exercise, Cancer Control Programme (NCCP) with National etc., avoidance of tobacco and alcohol and stress

Annual Report 2010-11 147 management through awareness generation using is a severe constraint for scaling up these services community education and interpersonal to rural areas. communication methods and social mobilization (vi) Strengthening of Tertiary level health facilities: through NGOs. 65 Government Medical Colleges/ Government (ii) Opportunistic screening of persons above the Hospitals will be strengthened as Tertiary Cancer age of 30 years at the point of primary contact Centres (TCC) to provide comprehensive cancer with any health care facility, be it the village, care services, training and research. 20 TCCs in community health centre, district hospital, tertiary 2010-11 and 45 TCCs in 2011-12 will be care hospital etc. Such screening involves simple strengthened. These centres will have a high clinical examination comprising of relevant questions degree of specialization and comprehensive and easily conducted physical measurements (such provision of all of the facets of cancer care as history of tobacco consumption and necessary in modern cancer management. These measurement of blood pressure etc.) to identify will also be centres of Human Resource those individuals who are at a high risk of developing Development in the field of Cancer e.g. Capacity cancer, diabetes and CVD, warranting further building for initiating/strengthening of courses in investigation/ action. Screening at the community Medical/ Surgical/ Radiation/ Gynaecology level will be done by the frontline health workers - Oncology etc. ANM and Male Health Worker in sub-centres (vii) Monitoring & Evaluation: Monitoring and located for every 5000 population. supervision of the programme will be carried out (iii) ëNCD clinicí will be established at the Community at different levels through NCD cell through reports Health Centre (CHC) located at block headquarter from the state, regular visits to the field and periodic for every 1, 00,000 population for comprehensive review meetings. A NCD cell will be established examination of patients to rule out common NCDs. at the National, State and District levels. This cell Screening, diagnosis and management (including will be responsible for overall planning, coordination, diet counselling, lifestyle management) and home implementation and monitoring of the programme. based care and referral will be the key services During the 11th Five Year Plan, the NPCDCS will be provided at this level of care. implemented in 100 Districts. 30 districts will be taken (iv) At all selected 100 District hospitals a ëNCD up in 2010-11 and 70 will be added in 2011-12. List of clinicí will be established for prevention and the 21 States along with the list of 30 districts selected management of cancer, diabetes, hypertension and for the year 2010-11 is given below:- acute cardiovascular diseases including emergency care. District level health facilities will be S. States Districts CHCs Sub strengthened for early diagnosis, prompt treatment, No. Centres chemotherapy (including day care facilities), 1 Andhra Pradesh Nellore 6 481 palliative care and rehabilitative measures including Vijayanagaram 7 470 the required level of blood banking and laboratory support. District hospitals will also be strengthened 2 Assam Dibrugarh 6 240 for early detection of cervix cancer, breast cancer Jorhat 4 142 and other common cancers. 3 Bihar Vaishali 2 336 (v) Development of trained manpower with Rohtas 1 186 required skills and competencies by providing customised short term training in diabetology, cancer 4 Chhattisgarh Bilaspur 10 379 management, cardiovascular diseases, etc. to 5 Gujarat Gandhi Nagar 6 171 existing doctors, in the departments of medicine surgery and gynaecology and training in cytology Surendranagar 11 200 to the pathologist. Non availability of these 6 Haryana Ambala 3 102 subspecialties in district level hospitals and below

148 Annual Report 2010-11 11.1.3. New Initiatives: 7 Himachal Pradesh Chamba 7 170 (i) Urban Health Check-up Scheme for Diabetes 8 Jammu & and High Blood Pressure: Kashmir Leh (Ladakh) 3 24 th Udhampur 2 97 14 November every year, is being observed as World Diabetes Day as an official United Nations Day since 9 Jhankhand Bokaro 8 116 2007. The day marks the birthday of Frederick Banting 10 Karnataka Shimoga 11 307 who discovered insulin in 1922. An Urban Health Kolar 6 201 Check-up Scheme for Diabetes and High Blood 11 Kerala Pathanathitta 13 230 Pressure in Urban Slums was launched on 14th November, 2010 at Baba Ramdev Park, New Delhi. In the first phase, 12 Madhya Pradesh Ratlam 5 158 the scheme will be initiated in seven metros, viz. Delhi, 13 Maharashtra Washim 7 153 Bangaluru, Hyderabad, Kolkata, Mumbai, Chennai and Wardha 6 181 Ahmedabad. 14 Sikkim East Sikkim 0 48 The scheme has the following objectives: 15 Orissa Naupada 4 95 1. To screen urban slum population for diabetes and 16 Punjab Bhatinda 9 136 high blood pressure 17 Rajasthan Bhilwara 16 415 Jaisalmer 6 136 2. To create database for prevalence of diabetes and 18 Uttrakhand Nainital 4 136 high blood pressure in urban slums 19 Tamil Nadu Theni 6 162 3. To sensitize the urban slum population about healthy 20 Uttar Pradesh Rae Bareli 11 377 lifestyle. Sultanpur 14 403 The Blood sugar and Blood pressure will be checked for 21 West Bengal Darjeeling 11 230 all > 30 years and all pregnant women of all age.

TOTAL 30 Districts 205 6482

Annual Report 2010-11 149 11.1.4. Ongoing Activities: provide treatment for mental illnesses. Treatment gap for severe mental disorders is approximately 50% and in (i) Membership of IARC: International Agency for case of Common Mental Disorders it is over 90%. Research on Cancer is a specialized agency of WHO to coordinate International Cooperation in National Mental Health Programme(NMHP) was started Cancer Research. India has become a member of in 1982 with the objectives to ensure availability and IARC at the 48th Session of the governing Council accessibility of minimum mental health care for all, to of IARC held in May 2006 at Lyon, France, which encourage mental health knowledge and skills and to shall provide a fillip to cancer research in the promote community participation in mental health service country. IARC has extended technical and financial development and to stimulate self-help in the community. support for several cancer research and preventive Gradually the approach of mental health care services projects in India. has shifted from hospital based care (institutional) to community based mental health care, as majority of (ii) National Cancer Awareness Day: The birth anniversary of Nobel Laureate Madam Curie, 7th mental disorders do not require hospitalization and can November is being observed as National Cancer be managed at community level. Awareness Day since 2001, to create more NMHP evaluation undertaken in 2008 identified following awareness about cancer. Like the previous years, constraints for the effective implementation of NMHP - this year too awareness generation activities were carried through from 6th November to 13th • Lack of an inbuilt and dedicated monitoring and November 2010 through All India Radio (AIR), implementing mechanism for programme. Doordarshan, News Papers, Delhi Metro Rails and • Shortage of skilled manpower in Mental Health DTC Bus Shelters. i.e. Psychiatrists, Clinical Psychologists, Psychiatric (iii) ‘Kalyani’ is a health programme telecast in 9 capital Social Workers & Psychiatric Nurses. This is a Doordarshan stations and 12 sub regional stations major constraint in meeting the mental health needs by Prasar Bharti targeting especially those living in and providing optimal mental health services at the the most populous States. It is an interactive community level. Due to shortage of manpower in programme which provides an interface to the mental health, the implementation of DMHP people with experts on various health and social suffered adversely in previous years. issues including that of cancer. • Lack of awareness /stigma about Mental Illness. (iv) Awareness generation for cancer, diabetes and Lack of facilities for treatment of mentally ill. healthy life style was also done during the Common • Wealth Games 2010 through live broadcast in AIR. • Lack of coordination between implementing Budget Allocation: The budget allocation during 2010- departments of DMHP i.e. Medical Education and 11 for NPCDCS is Rs. 326.76 crore. Health in the states. 11.2. NATIONAL MENTAL HEALTH • Lack of Community involvement. PROGRAMME Taking into account these constraints, consultations were 11.2.1 Burden of mental health disorders: held with relevant stakeholders and components of NMHP were revised for XI five year plan. Prevalence of mental disorders as per World Health Report (2001) is around 10% and it is predicted that 11.2.2 District Mental Health Programme- burden of disorders is likely to increase by 15% by 2020. During IX five year plan, District Mental Health According to various community based surveys, Programme was initiated (1996) based on Bellary Model prevalence of mental disorders in India is 6-7% for developed by NIMHANS, Bangaluru. During the plan common mental disorders and 1-2% for severe mental period, 27 districts were covered under DMHP. At present disorders. With such a magnitude of mental disorders it DMHP is covering 123 districts in 30 states and UTs. In becomes necessary to promote mental health services addition to early identification and treatment of mentally for the well being of general population, in addition to

150 Annual Report 2010-11 ill, District Mental Health Programme has now 11.2.4 Spill Over of X plan schemes- incorporated promotive and preventive activities for A. Modernization of State-run Mental Hospitals – A positive mental health which includes: one time grant of up to Rs 3 crore per mental - School Mental Health Services: Life skills hospital is available under the scheme to old education in schools, counselling services custodial pattern mental hospital for their modernization. A total of 29 mental hospitals/ - College Counselling services: Through trained institutes have been supported under this scheme. teachers /councillors B. Upgradation of Psychiatric wings in the government - Work Place Stress Management: Formal & medical colleges/general hospitals. Some of the Informal sectors, including farmers, women etc. deserving areas where there is no well established government medical colleges, government general - Suicide Prevention Services- Counselling hospitals/district hospitals could be funded for Center at District level, sensitization workshops, establishment of psychiatry wing. A one time grant IEC, Help lines etc. of Rs. 50 lacs per college is available for up- 11.2.3 Manpower Development Schemes : gradation of facilities and equipments. Preference would be given to colleges and hospitals planning A. Establishment of Centre of Excellence in Mental to start or increase seats of PG courses in Health- Centre of excellence in the field of mental psychiatry. A total of 88 psychiatry wings have health are being established by upgrading and availed grant under this scheme. strengthening identified existing mental health hospitals/ institutes for addressing acute manpower 11.2.5 Research and Training- gap and provision of state of the art mental health There is a gap in research in the field of mental health in care facilities in the long run. Eleven such Centre the country. Funds will be provided to institutes and of excellence are envisaged for total budgetary organizations for carrying basic, applied and operational support of up to Rs 338 crore (Rs 30 crore per research in mental health field. In order to address center ) for undertaking capital work, equipment, shortage of skilled mental health manpower a short term library, faculty induction and retention for the plan skill based training will be provided to the DMHP teams period. As of now 9 Mental Health institutes have at identified institutes. Standard Treatment Guidelines, been funded for developing as centers of excellence Training Modules, CME, Distance Learning courses in in Mental Health. mental Health, surveys etc will also be supported. Total B. Establishment/up-gradation of Post Graduate allocation is Rs. 6.5 crore for the plan period. Training Departments -To provide an impetus to 11.2.6 Information, Education & Communication- development of Manpower in Mental Health other training centers( Government Medical Colleges/ It has been observed that there is low awareness regarding Government General Hospitals/ State run Mental mental illness and availability of treatment. There is also Health Institutes) would also be supported for lot of stigma attached to mental illness leading to poor starting PG courses or increasing the intake utilization of available Mental Health resources in the capacity for PG training in Mental Health. Support country. The awareness regarding provisions under would be provided for setting up/strengthening 30 Mental Health Act, 1987 is also very low among the public units of Psychiatry, 30 Departments of Clinical and implementing authorities. These issues are addressed Psychology, 30 Departments of PSW and 30 through IEC activities at the District level by the District Departments of Psychiatric Nursing. Total budget Mental Health Programme. In addition to the district level allocated for this scheme is Rs 70 crores during activities, National Mental Health Programme Division plan period with a limit of Rs 51 lacs to Rs 1 crore conducts nationwide mass media campaign through audio- per PG Department. As of now, 23 PG departments video and print media. Awareness activities are also th have been taken up during the XI plan period. conducted during World Mental Health Day, 10 October, 2010.

Annual Report 2010-11 151 Print Media Campaign on World Mental Health Day 10th October,2010..

11.2.7 Support for Central and State Mental Health 11.2.8 Monitoring & Evaluation Authorities In order to strengthen the monitoring and improve As per Mental Health Act,1987, there is provision for implementation of existing NMHP schemes in states constitution of Central Mental Health Authority (CMHA) support has been approved under the program during XI at Central level and State Mental Health plan period. Total allocation is Rs. 8.0 crore for the plan Authority(SMHA) at state level. These statutory bodies period. are entrusted with the task of development, regulation and coordination of mental health services in a state/UT 11.2.9 Mainstreaming NMHP into NRHM and are also responsible for the implementation of Mental Efforts are being made to mainstream the components Heath Act,1987 in their respective states and union of NMHP under the overall umbrella of National Rural territories. States are required to have functional SMHAs Health Mission so that the States are able to plan to operationalize the mental health program activities. requirements concerning mental health services as part However in most of the states, there is no financial of their respective PIPs. support for these bodies and as such they function in an ad-hoc manner and are unable to do justice to their 11.2.10 Expenditure statement under National statutory role of implementation of Mental Health Mental Health Programme Act,1987 and development of Mental Health services. Rs 1000 crore has been approved as XI plan outlay for Support under NMHP has been approved for SMHAs the National Mental Health Program. Year wise financial during the 11th Plan period. Total allocation is Rs. 5 crores.

152 Annual Report 2010-11 allocation for the NMHP and expenditure incurred is as 2. Ban on direct/indirect advertisement of tobacco given in the table below – products. (Section -5) Financial Year Allocation Expenditure 3. Ban on sale of tobacco products to children below (Rs. In crore ) (Rs. In crore) 18 year. (Section – 6a) 2007-08 38 14 .57 4. Ban on sale of tobacco products within 100 yards of the educational institution. (Section – 6b) 2008-09 70 23.45 5. Mandatory depiction of Specified health warnings 2009-10 55 52.27 on tobacco products. (Section - 7). 2010-11 120 (including 58.80 (Till date Rs. 53 crore GIA including 6. Testing of tobacco products for tar and nicotine. ad Rs. 17 crore for Rs. 52.63 The rules related to prohibition of smoking in public places NE) crore for GIA) came into force from the 2nd October, 2008. As per the rules, it is mandatory to display smoke free signages at all public places and labeling and 11.3. TOBACCO CONTROL LEGISLATION packaging rules mandating the 11.3.1 Tobacco is the foremost preventable cause of depiction of specified health death and disease in the world today. Globally approx. warnings on all tobacco product 5.4 million people die each year as result of diseases packs came into force from the 31st resulting from tobacco consumption. More than 80% of May, 2009. these deaths occur in the developing countries. Tobacco 11.3.2. WHO-Framework Convention on Tobacco is a risk factor for 6 of the 8 leading causes of death. Control Nearly 8-9 lakhs people die every year in India due to diseases related to tobacco use. Nearly 30% of cancers The WHO Framework Convention on Tobacco Control in India are related to tobacco use. The majority of the (WHO FCTC) is the first global health treaty negotiated cardio vascular diseases and lung disorders are directly under the auspices of the World Health Organization. India attributable to tobacco consumption. ratified the FCTC on 5 February 2004 and is now a party India is the second largest consumer (after China) of to the Convention and has to implement all provisions of tobacco products in the world. As per Global Adult this international treaty. It enlists key strategies for Tobacco Survey, India (GATS), 2009-10, 47.8% men and reduction in demand and reduction in supply of tobacco. 20.3% women consume tobacco in some form or the Some of the demand reduction strategies include price other. The Global Youth Tobacco Survey (GYTS), 2009 and tax measures & non price measures (statutory also indicates that 14.6% children in the age group of 13- warnings, comprehensive ban on advertisement, 15 years are consuming tobacco in some form. promotion and sponsorship, tobacco product regulation etc). The supply reduction strategies include combating In order to protect the illicit trade, providing alternative livelihood to tobacco youth and masses from farmers and workers & regulating sale to / by minors. the adverse harm effects of tobacco usage, second 11.3.3. National Tobacco Control Programme hand smoke (SHS) and (NTCP) discourage the Launch of the dedicated National Tobacco Control consumption of tobacco, th the Govt. of India enacted Programme in the 11 Five Year Plan has been the major the comprehensive milestone to facilitate the implementation of the tobacco tobacco control laws namely “Cigarettes and other control laws to bring about greater awareness about the Tobacco Products (Prohibition of Advertisement and harmful effects of Tobacco and to fulfill the obligation(s) Regulation of Trade and Commerce, Production, Supply under the WHO-FCTC. NTCP was launched in 2007- and Distribution) Act, 2003”. The Act is applicable to all 08 in 18 Districts covering 9 States. In the 2008-09 it has tobacco products and extends to whole of India. The been upscaled to 24 New Districts covering 12 States. specific provisions of the Anti Tobacco Law include: The programme at present is under implementation in 42 districts in 21 states in the country. The main components 1. Ban on smoking in public places. (Section -4) of NTCP are:-

Annual Report 2010-11 153 a. National level b. State level i. Public awareness/mass media campaigns for i. Dedicated State Tobacco Control Cells for effective awareness building & for behavioral change. Ministry implementation of the national programme and of Health has launched comprehensive mass media monitoring of anti tobacco initiatives. campaign (both print and electronic) in 2010-11. A series of public notices on tobacco control laws were c. District level issued in leading National & regional dailies all over the country. A half page coloured advertisement was i. Training of health and social workers, NGOs, school also issued in the leading National & regional dailies teachers etc. st all over the country on World No Tobacco day, 31 ii. Local IEC activities. May, 2010. iii. School Programme ii. Establishment of tobacco product testing laboratories, to build regulatory capacity, as required under iv. Provision of tobacco cessation facilities COTPA, 2003. v. Monitoring of tobacco control laws. iii. Mainstreaming the program components as a part of the health delivery mechanism under the NRHM 11.3.4. Other initiatives in collaboration with WHO/ framework. BGI iv. Mainstream Research & Training – on alternate I. Advocacy Workshops crops and livelihoods with other nodal Ministries. • Ministry of Health & Family Welfare had organized v. Monitoring and Evaluation including surveillance e.g. one National Workshop and five Regional Advocacy Adult Tobacco Survey. Workshops for Western, Central, Southern, Eastern & North-eastern and Northern region of the country to sensitize various stakeholders on tobacco control laws and related issues in India in the collaboration with WHO. The purpose of these workshops was to build awareness about tobacco control issues including the existing legislations and to improve enforcement capacity of the provisions of the India Tobacco Control Act, 2003. Through these workshops nearly 800 key personnel in the Government(s) and civil society groups were sensitized on the anti-tobacco laws and its related enforcement strategies. • Subsequent to the successful national and regional level workshops, 11 State Advocacy Workshops were held and nearly 1200 key personnel in the Government(s) and civil society groups were sensitized on the anti-tobacco laws and its related enforcement strategies. Extensive list of recommendations were generated for preparation of national and state-wise enforcement action plans for effective implementation of tobacco control laws at district level. • Through these workshops, the key stakeholder ministries / departments such as Police, Education, Custom & Excise, Information and Broadcasting, Tourism, Transport, Labour, Agriculture, etc were sensitized on their role in tobacco control. In addition,

154 Annual Report 2010-11 various advocacy materials were developed and • Among minors (age 15-17), 9.6% consumed tobacco disseminated through these workshops. in some form and most of them were able to purchase tobacco products • A workshop for developing media strategy for the north-east region was organized at Guwahati, Assam • Five in ten current smokers (46.6%) and users of and participants were from all the seven north-east smokeless tobacco (45.2%) planned to quit or at least states. thought of quitting II. Global Adult Tobacco Survey (GATS): • Among smokers and users of smokeless tobacco who The Global Adult Tobacco visited a health care provider, 46.3% of smokers and Survey (GATS) is the 26.7% of users of smokeless tobacco were advised global standard for to quit by a health care provider systematically monitoring • About five in ten adults (52.3%) were exposed to adult tobacco use second-hand smoke at home and 29.0% at public (smoking and smokeless) places (mainly in public transport and restaurants) and tracking key tobacco control indicators. Global • About two in three adults (64.5%) noticed Adult Tobacco Survey- advertisement or promotion of tobacco products. India was carried out in all 29 states of the country • Three in five current tobacco users (61.1%) noticed and 2 Union Territories of the heath warning on tobacco packages and one in Chandigarh and Puducherry, covering about 99 percent three current tobacco users (31.5%) thought of of the total population of India. The major objectives of quitting tobacco because of the warning label on the survey were to obtain estimates of prevalence of tobacco products package. GATS India Report is tobacco use (smoking and smokeless tobacco); exposure available on the website at www.mohfw.nic.in to second-hand smoke; cessation; the economics of III. Intervention related to alternative crops/ tobacco; exposure to media messages on tobacco use; alternative vocations. and knowledge, attitudes and perceptions towards tobacco use. • A pilot project for alternatives to tobacco/bidi crops The Global Adult Tobacco Survey, India (GATS), Report in collaboration with Central Tobacco Research was released on 19th October 2010. The key highlights Institute, Andhra Pradesh (Ministry of Agriculture) of the survey are: was launched in 6 agro-climatic zones of the country. This project costing Approx Rs. 3.28 crores will be • Current tobacco use in any form: 34.6% of adults; completed in three years. 47.9% of males and 20.3% of females • The Ministry of labour also undertook a pilot project • Current tobacco smokers: 14.0% of adults; 24.3% to provide alternative vocations to bidi rollers in the of males and 2.9% of females regions where bidi is produced viz Karnataka, Madhya Pradesh, Maharashtra, West Bengal and • Current cigarette smokers : 5.7% of adults; 10.3% Rajasthan. of males and 0.8% of females • Ministry of Rural Development has taken up the Current bidi smokers: 9.2% of adults; 16.0% of males • matter of rehabilitation of bidi rollers in 10 States and 1.9% of females where bidi roller are concentrated. The State • Current users of smokeless tobacco: 25.9% of adults; Government were advised to work out special 32.9% of males and 18.4% of females projects for developing alternative livelihood options for bidi rollers under Swarnjayanti Gram Swarozgar • Average age at initiation of tobacco use was 17.8 Yojana (SGSY) and other similar schemes of the with 25.8% of females starting tobacco use before Ministry. the age of 15

Annual Report 2010-11 155 11.4 NUTRITION accidents leading to Road Traffic Injuries (RTIs) and fatalities as major public health concern. Today road 11.4.1 Introduction and Initiatives traffic injuries are one of the leading causes of deaths, The Nutrition Cell in the Directorate General of Health disabilities and hospitalization with severe socio-economic Services provides technical advice in all matters related costs across the world. to policy making, programme implementation, monitoring & evaluation, training content for different levels of In view of the above, the Ministry of Health & FW has Medical and Para Medical workers. It also provides been implementing a project for upgradation & technical inputs on standards and labels for foods, strengthening of Emergency Trauma Care Facility in State fortification of foods, nutrition related proposals, project Government Hospitals located on National Highways evaluation, review of research project etc. under the scheme “Assistance for Capacity Building” with a view to provide immediate treatment to the victims of 11.4.2. Initiatives and Progress road traffic injury. Financial assistance was provided up 11.4.2.a. The cell has been making efforts in creating to a maximum of Rs.1.5 crores per hospital or actual awareness regarding prevention of micro-nutrient requirement of the hospital whichever was less, during deficiency disorders, diet related chronic disorders and the 9th & 10th five year plan periods. During the 9th Five promotion of healthy life style. This has been done by year plan, 18 Hospitals/ Medical Institutions in 13 States/ disseminating posters and pamphlets on the above UTs received grant @ Rs. 1.5 crores each for mentioned issues. In addition to this video films and radio strengthening of emergency facilities of State hospitals programme have been developed on National Iodine of cities located on National Highways. During the 10th Deficiency Disorders Control Programme (NIDDCP), Plan Rs. 110 crores have been allocated. 85 Hospitals/ diet related Non Communicable Diseases (NCD) and Institutions in 30 States received the grants during 10th promotion of healthy life style including micro-nutrient deficiency. The cell has also developed, published and Plan. In total about 139.00 crores has been released to th th disseminated a handbook on “Current Nutritional Therapy 103 institutes during 9 & 10 Plan. Guidelines, in Clinical Practices” for Physicians, Dieticians The scheme was subsequently evaluated by the Ministry and Nurses. and certain deficiencies were observed like shortage of 11.4.2.b. National & Regional levels workshops and required manpower, inadequate funding for civil work etc. meetings were conducted on core issues related to nutrition In the light of the facts, a revised new scheme at a total (i.e micro-nutrient, hospital diets, fluorosis, diet related outlay of Rs.732.75 crores has been approved for chronic disorders & promotion of healthy life style, fast/ developing a network of 140 trauma care centres along junk food etc). the Golden Quadrilateral covering 5,846 Kms connecting 11.4.2.c. At national level the nutrition cell coordinates, Delhi-Kolkata-Chennai-Mumbai-Delhi, North-South & monitors all administrative and technical issues related East-West corridors covering 7,716 Kms connecting to implementation of the new health initiative namely Kashmir to Kanyakumari and Silchar to Porbandhar “National Programme for Prevention & Control of respectively of the National Highways during the 11th five Fluorosis (NPPCF)” which was launched in the year year plan period. 2008-09. The programme was launched to address The scheme provides for 3-category of trauma care fluoride related health problems in the country. centres viz. L-III, L-II and L-I. The level-III trauma 11.4.2.d. In 17 States/UTs Nutrition Division have been centre is designed to stabilize the patients and to manage established to provide updates on development in the field the trauma victim and to refer the trauma victim to level- of nutrition, micro-nutrient deficiencies, diet related II and Level-I centers as per the requirement for further chronic non-communicable diseases, ill effects of junk/ management. The level-II would provide definite care to fast foods etc. severe trauma victim while the L-I would provide the 11.5. STRENGTHENING OF EMERGENCY highest level of definite and comprehensive care patients FACILITIES OF STATE HOSPITALS with complex injuries. LOCATED ON NATIONAL HIGHWAYS So far 113 trauma care centers have been provided Expansion in road network, motorization and urbanization financial assistance in 15 states which are at various stages in the country has been accompanied by a rise in road of progress. 156 Annual Report 2010-11 The financial assistance amounting to Rs. 4.8 crores, 9.65 Hearing loss is the most common sensory deficit in crores and 16 crores are provided to level-III, level-II humans today. As per WHO estimates in India, there are and level-I respectively, to strengthen the manpower, approximately 63 million people, who are suffering from building, equipments, communication network and legal Significant Auditory Impairment; this places the estimated services and data entry operator of existing State Govt. prevalence at 6.3% in Indian population. As per NSSO Hospitals. survey, currently there are 291 persons per one lakh population who are suffering from severe to profound One advances life support ambulance is augmented by hearing loss (NSSO, 2002). Of these, a large percentage Ministry of Surface Transport at each of the trauma care is children between the ages of 0 to 14 years. With such centers, while NHAI is providing one basic life support a large number of hearing impaired young Indians, it ambulance at every 50 kms of the highways. amounts to a severe loss of productivity, both physical The total outlay and the year wise budget allocation viz- and economic. An even larger percentage of our a-viz the expenditure incurred on the scheme is as under: population suffers from milder degrees of hearing loss and unilateral (one sided) hearing loss. Total outlay for the scheme during the 11th five year plan - Rs. 732.75 crores. 11.6.1. Objectives of the Programme Year Funds allocated Allocated Funds released 1. To prevent the avoidable hearing loss on account (Rs. in crores) for NE States (Rs. in crores) of disease or injury. (Rs. in crores) 2. Early identification, diagnosis and treatment of ear 2007-08 Rs. 42 Rs. 5 Rs. 37 problems responsible for hearing loss and deafness.

2008-09 Rs. 120 Rs. 14 Rs. 110.34 3. To medically rehabilitate persons of all age groups, (including suffering with deafness. Rs. 10 crores for NE States) 4. To strengthen the existing inter-sectoral linkages for continuity of the rehabilitation programme, for 2009-10 Rs. 120 but at persons with deafness. FE Stage reduced to 5. To develop institutional capacity for ear care Rs. 55 Rs. 14 Rs. 55 services by providing support for equipment and 2010-11 Rs.113 Rs. 15 Rs. 75.63 material and training personnel. 11.6.2. Components of the Programme: Subsequently and after evaluation of the project, National • Manpower Training & Development Highways (other than Golden Quadrilateral, North- • Capacity Building South and East-West corridor) with substantial number of accidents and considering the following parameter • Service Provision including Rehabilitation another 160 Trauma care centres could also be added • Awareness Generation through IEC Activities to the existing network of trauma care centres during the 12th five year plan: • Monitoring and Evaluation
Connecting two capital cities 11.6.3. Programme Execution & Expansion
Connecting major cities other than capital cities The programme has been launched in 25 districts of 10 states and 1 union territory in Jan, 2007 on the pilot phase
Connecting ports to major cities till March 2008. The programme was extended to another
Connecting industrial townships with capital cities. 35 districts in the year 2008-09, 41 districts in the year 2009-10 and 75 districts in the year 2010-11 making it a 11.6. NATIONAL PROGRAMME FOR total of 176 districts of 15 States and 4 Union Territories. PREVENTION AND CONTROL OF It is proposed to expand the programme to 203 districts DEAFNESS by the end of eleventh five year plan. The programme

Annual Report 2010-11 157 has got into fourth year of implementation in the year 11.6.8. Under the 11th Five Year Plan, it is proposed to 2010-11. upscale the NPPCD to 203 districts all over the country. 11.6.4. Training activities under NPPCD The EFC of Rs.94.77 crore for NPPCD has already been approved in the year 2008. In the current year 2010-11 the funds amounting for conducting training has been released to the states to carry 11.7. NATIONAL PROGRAMME FOR out the trainings prescribed under the programme. PREVENTION & CONTROL OF FLUOROSIS 11.6.5. Capacity building of PHCs/CHCs/Distt. Hospitals Fluorosis, a public health problem is caused over a long period by excess intake of fluorosis through drinking water/ i) Manpower capacity building: Launched one year food products/industrial pollutants. Besides inducing DHLS(Diploma in Hearing Language and Speech) ageing it also results in major health disorders like dental programme to address the issue of shortage of fluorosis, skeletal fluorosis and non-skeletal fluorosis. audiometric manpower at 11 centres in the country i.e. JIPMER Puducherry, AIIPMR Mumbai, 11.7.1. Initiatives and Progress RIMS Imphal, RML, N. Delhi, IGMC Shimla, In the 11th Five Year Plan with a goal to prevent & control JLNMC Ajmer, KGMC Lucknow, GMC Jabalpur, SRBMC Cuttack, RIMS Ranchi along fluorosis in the country “National Programme for with the nodal centre AIISH Mysore with the total Prevention and Control of Fluorosis” have been launched. intake capacity of 220 students annually. The The programme was with a financial allocation of Rs. programme was officially launched on 25th August 68.00 crore for implementation in 100 districts of the 2007. country. ii) Infrastructure capacity building of District The objectives of the programme is to (a) collect, assess Hospitals/CHCs/PHCs: – Funds for 75 new and use the baseline survey data of fluorosis from districts have been released for procurement of Department of Drinking Water & Supply, (b) ENT/Audiology equipments and construction of comprehensive management of fluorosis in the selected sound proof room for audiology at the district areas and (c) capacity building for prevention, diagnosis hospitals (Rs. 9.50 lakh per district) and CHC/PHC and management of fluorosis cases. Kit (Rs. 10000 per kit). The strategies under the porogramme are (a) imparting The States/U.Ts are in the process of procurement of training to health personnel for preventive health promotion, above stated equipments for their respective district (b) early diagnosis and prompt intervention (c) capacity hospitals, CHC and PHC. building of district and medical college hospital for 11.6.6. IEC and awareness campaign: reconstructive surgery and rehabilitation (d) establishment of diagnostic facilities in the district hospitals, (e) health IEC material in the form of 6 different posters in English, education for prevention and control of Fluorosis cases. Hindi and regional languages have been printed and distributed to various health centers, hospitals. 6 video As per the plan, the programme will be implemented in spots and 3 audio spots were prepared and telecast/ phased manner in the 100 fluoride affected districts of broadcast through national TV and satellite to facilitate the country. Presently the programme is being wider outreach of the programme. implemented in 20 Districts of 16 States and in the financial year 2010-11 another 40 districts of the country 11.6.7. Distribution of Hearing aids have been selected. Funds for distribution of hearing aids were given to 25 11.8. NATIONAL PROGRAMME FOR districts in which approximately 2484 Hearing aids (BTE) HEALTH CARE OF ELDERLY (NPHCE) have been given to the hearing impaired children who belong to families having monthly income of less than Rs According to 2001 census, there were 76.62 million 6500/- per month. Indians above the age of sixty years. The projections for

158 Annual Report 2010-11 next five censuses till the year 2051 are: 96.30 million in District hospitals, CHCs, PHCs and sub centres in the (2011), 133.32 million (2021), 178.59 (2031), 236.01 100 identified districts, covering 21 States of the country. million (2041) and 300.96 million (2051). Along with rising numbers, the expectancy of life at birth is also consistently The 8 Regional Medical Institutions and 100 districts have increasing indicating that a large number of people are been identified. 30 districts will be taken up in 2010-11 likely to live longer than before. On the medical front an and 70 will be added in 2011-12. epidemiological transition is underway whereby as a result List of the 21 States along with the list of 30 districts and of longer survival of man, more and more chronic the number of CHC/PHC/Sub Centres to be covered degenerative diseases will have to be handled. This will under these districts for the year 2010-11 is given below:- also be accompanied by medical, psychological, social and Sl. States Districts CHCs PHC Sub economic problems for the burgeoning population of older No. Centres persons. At present elderly persons are sharing health care with general public which is causing severe problem 1 Andhra Nellore 6 65 481 to the elderly people. Pradesh Vijayanagaram 7 59 470 2 Assam Dibrugarh 6 26 240 Considering the growing number of elderly population Jorhat 4 39 142 accompanied by changes in society & economy and its impact on the morbidity pattern, Government of India 3 Bihar Vaishali 2 53 336 declared National Policy on Older Persons (NPOP) in Rohtas 1 36 186 1999 and enacted “The Maintenance & Welfare of Parents 4 Chhattisgarh Bilaspur 10 74 379 & Senior Citizen’s Act, 2007". 5 Gujarat Gandhi Nagar 6 24 171 Keeping in view the recommendations made in the Surendranagar 11 31 200 “National Policy on Older Persons” as well as the State’s 6 Haryana Ambala 3 17 102 obligation under the “Maintenance & Welfare of Parents & Senior Citizens Act 2007”, the Ministry of Health & 7 Himachal Family Welfare has formulated a “National Programme Pradesh Chamba 7 42 170 for the Health Care of Elderly” (NPHCE) during the 11th 8 Jammu & Leh (Ladakh) 3 13 24 Plan period to address various health related problems of Kashmir Udhampur 2 21 97 elderly people. The Planning Commission had allocated Rs.400 crore for the 11th Plan period for this Programme. 9 Jhankhand Bokaro 8 16 116 10 Karnataka Shimoga 11 88 307 Broad guidelines on the National Programme were Kolar 6 60 201 decided by the “Working group on communicable and non communicable diseases” for 11th Five Year Plan set up 11 Kerala Pathanathitta 13 37 230 in September, 2006. Based on these guidelines, National 12 Madhya Programme for Health Care of Elderly (NPHCE) was Pradesh Ratlam 5 25 158 formulated and the EFC was approved in May 2010 for an amount of Rs. 288 crore for the remaining period of 13 Maharashtra Washim 7 25 153 Wardha 6 27 181 11th five year plan, out of which Rs. 48 crore will be shared by the state Government towards 20% contribution 14 Sikkim East Sikkim 0 8 48 of the total expenditure. The programme will cover 100 15 Orissa Naupada 4 17 95 identified districts covering 21 states 16 Punjab Bhatinda 9 17 136 Main objective of the programme is to provide preventive, curative and rehabilitative services to the elderly persons 17 Rajasthan Bhilwara 16 63 415 at various level of health care delivery system of the Jaisalmer 6 14 136 country. Other objectives are, to strengthen referral 18 Uttrakhand Nainital 4 18 136 system, to develop specialized man power and to promote 19 Tamil Nadu Theni 6 23 162 research in the field of diseases related to old age. 20 Uttar Rae Bareli 11 71 377 Major components of the NPHCE programme are, Pradesh Sultanpur 14 77 403 establishment of 30 bedded department of Geriatric in 8 identified Regional Medical Institutes in different regions 21 West Bengal Darjeeling 11 21 230 of the country, providing dedicated health care facilities

Annual Report 2010-11 159 Operational guidelines have been developed for the being established at various levels under the National implementation of the programme. Monitoring of the programme for Cancer, Diabetes, Cardiovascular programme will be done by the common NCD Cells, Diseases and Stroke.

160 Annual Report 2010-11 Chapter 12 International Co-Operation For Health & Family Welfare

12.1. INTRODUCTION The 63rd WHA was held in May, 2010 at Geneva and a high level delegation comprising of technical officials of Various International Organisations and United Nations this Ministry under the leadership of Shri Ghulam Nabi Agencies continued to provide significant technical and Azad, Hon’ble Minister of Health & Family Welfare material assistance for many Health and Family Welfare attended. The 63rd WHA has, inter-alia, discussed the programmes in the country. The status of international following agenda items and the resolutions were adopted assistance from various agencies is discussed in this on some of the agenda items – chapter. • Pandemic influenza preparedness: sharing of 12.2 WORLD HEALTH ORGANIZATION influenza viruses and access to vaccines and other (WHO) benefits. World Health Organisation (WHO) is one of the main • Implementation of the International Health UN agencies collaborating in the Health Sector with the Regulations (2005) Ministry of Health & Family Welfare, Government of India. WHO provides technical support in the major areas • Public health, innovation and intellectual property: of Health & Family Welfare programmes and health care global strategy and plan of action facilities in the country. • Monitoring of the achievement of the health related Activities under WHO are funded through two sources: Millennium Development Goals - The Country Budget which comes out of contributions • International recruitment of health personnel: draft made by member countries and Extra Budgetary global code of practice Resources which comes from (a) donations from various sources for general or specific aspects of health; and (b) • Infant and young child nutrition: quadrennial funds routed through the WHO to countries by other progress report. member countries or institute agencies. India is the largest beneficiary of the country budget within the SEA Region. • Birth defects The budget is operated on a biennium basis, calendar year • Food safety wise. • Prevention and control of non-communicable 12.2.1. Nodal Functions of WHO: disease: implementation of the global strategy World Health Assembly: The World Health Assembly • Viral hepatitis (WHA) is the most important annual event of the World Health Organisation. The WHA is held once every year • Tuberculosis Control and deliberates various draft resolutions that are put up • Leishmaniasis control for its approval by the Executive Board of WHO. It is the highest policy making body of World Health • Chagas disease: control and elimination Organisation where all member countries are represented • Global eradication of measles by high-level delegations (led by Hon’ble Health Ministers).

Annual Report 2010-11 161 • Smallpox eradication: destruction of variola virus For the biennium 2010-11, the total Assessed Contribution stocks (AC) and Voluntary Contribution (VC) to the working capital of WHO, to be paid by Government of India was • Availability, safety and quality of blood products US $ 45,69,900 and US $ 1,20,000 respectively. The first • Strategic Approach to International Chemicals installment of the contribution AC & VC for the year Management 2010 amounting to US $ 20,89,890 and US $ 60,000 respectively, have already been paid in 2009. The second • WHO’s role & responsibilities in health research installment of US $ 24,80,010 and US $ 60,000 have also • Counterfeit medical products been paid on 21.12.2010. • Human organ and tissue transplantation 12.2.3. GOI/WHO collaborative Activities: • Strengthening the capacity of governments to WHO funding is available for taking services of the constructively engage the private sector in providing experts on contractual basis on specific terms and essential health-care services references; training within and outside the country; holding of workshops, seminars and meetings for raising • Treatment and Prevention of Pneumonia awareness or exchange of information and medical • Progress Report on Poliomyelitis, human African supplies of equipment, viz: (i) Technical Services trypanosomiasis, Reproductive health, Health of Agreement; (ii) Fellowship; (iii) Agreement for migrants, Climate Change and health etc. Performance of Work; (iv) DFC; and (v) Supplies and Equipment etc. Meeting of Ministers of Health and Regional Committee of WHO South East Asia Regional Countries: The Since the biennium 2010-11, 11 Strategic Objectives have Health Ministers’ Meeting (HMM) and the Regional been introduced under which the GOI/WHO collaborative Committee (RC) Meeting of WHO SEAR countries are activities are being implemented. Monitoring the activities held annually. HMM provides a forum for Health for timely and effective utilization of funds and their proper Ministers to discuss important health issues in the region accounting is one of the main tasks. The areas of work as well as for forging bilateral arrangements and the financed by WHO, inter alia cover HIV/AIDS, Regional Committee is a forum to review progress made communicable and non communicable diseases, mental on health issues and to lay down the roadmap for future health, drug abuse, environment, food safety, maternal action. The 28th HMM and the 63rd Session of RC held and child health besides health policy, health financing & in Bangkok, Thailand during 7-10 September, 2010 and a social protection as well as emergency preparedness & high level delegation of this Ministry under the leadership response. For the biennium 2010-11, under the Country of Hon’ble Minister of Health & Family Welfare attended. Budget an amount of US $ 7,852,000 was allocated for During the 28th HMM the following agenda items have carrying out various GOI/WHO collaborative activities. come up for discussion viz. All the programme are being implemented efficiently with close monitoring and approx. 30% funds have been utilized i) Review of Kathmandu Declaration on Protecting till 30th November, 2010. Health Facilities from Disasters/follow up actions on the decisions and recommendations of the 12.3. SPECIAL ACHIEVEMENT twenty-seventh meeting of Ministers of Health, During the last World Health Assembly held in May 2010, ii) Urbanization and Health, India have presented successful intervention on the agenda “Counterfeit Medical Products” which was iii) Decentralization of health lower case care almost accepted by WHO and a resolution was adopted services. accordingly. The brief of India’s achievements in this 12.2.2. GOI contribution to WHO: regard is as under: As a member country of WHO, India makes regular “On the opening day of the World Health Assembly contribution to WHO for each biennium. A WHO biennium (WHA) Hon’ble Minister of Health & FW raised the commence in January of the first year of the biennium issue counterfeit medicines in his statement. He urged and ends in December of the second year of the biennium. countries to steer clear from the commercially motivated

162 Annual Report 2010-11 debates over the ‘counterfeit’ issue which have hampered regulations. Accordingly, both Indian Air craft Public public health by preventing access to good quality and Health Rules as well as the Indian Port Health Rules low cost generic drugs. The resolution submitted by India have been framed in agreement with these International on behalf of South East Asia Region (SEAR) on Health Regulations. ‘Measures to ensure access to safe, efficacious, quality and affordable medical products’ contextualized the Main objective of the APHO/PHSs is to prevent spread problem in the public health arena and sought World Health of infectious disease of epidemic proportion from one Organization’s (WHO’s) support in strengthening the country to another with minimum interference to the national drug regulatory authorities to ensure the international traffic. Some of the important functions of availability of quality, safe and efficacious medical this organization are - Health Screening of International products. It requested the Director General (DG) to passengers, Quarantine, Clearance of dead bodies, replace WHO’s involvement in IMPACT and the Supervision of airport sanitation, clearance for imported programme on ‘counterfeit medical products’ with an food items, vaccination to international passengers, vector effective member driven programme to address the issues control etc. of quality, safety and efficacy. The resolution also Apart from this, issuance of deratting exemption certificate requested the WHO not get involved with Intellectual is another major responsibility at international ports. Property (IP) enforcement and other measures that could potentially undermine availability of quality, safe, WHO has notified a list of yellow fever endemic countries efficacious and affordable medical products and under IHR and any person coming to India from these production of generic medical products. As a result WHA notified endemic countries is required to possess valid has adopted a resolution establishing a time limited and yellow fever vaccination certificate, failing which such result oriented working group on substandard/ spurious/ passengers are quarantined for a maximum period of six falsely-labelled/falsified/counterfeit medical products days. In the light of changing global health scenario, comprised of and open to all Member States. The Working existing IHRs have been revised by WHO and these new Group will examine, from a public health prospective, IHRs have come to effect from June, 2007. excluding trade and intellectual property considerations.” 12.5. CUSTOM DUTY EXEMPTION CER- 12.4. AIRPORT HEALTH ORGANISATIONS/ TIFICATE PORT HEALTH ORGANISATIONS During 2010-2011 (i.e. upto November, 2010) this Airport and Port Health organizations (APHO/PHOs) Ministry has issued one time Custom Duty Exemption are subordinate offices of Directorate General of Health Certificates in favour of Additional Director Medical Store Services. At present, there are 9 PHOs and 5 APHOs established at all major international Airports and Ports Depot, CGHS, New Delhi. of the country. There is also one border quarantine centre 12.6. FOREIGN TRAVEL BY SENIOR at Attari border, Amritsar. In addition to these, the health OFFICERS offices at Bangalore and Hyderabad Airports have also been established and started functioning in full swing and For the year 2010-2011, a provision of Rs.200.00 lakhs action has been taken to set up the health offices at has been made against Foreign Travel Expenses under Ahmadabad, Lucknow and Trivendrum Airports. The Non-Plan. Out of this, the expenditure till November, Budget Division of the Ministry has been requested to 2010 is Rs. 105,09,493 (approx.) provide sufficient budget so that contractual staff could 12.7. VISIT ON FELLOWSHIP/CONFERENCE be recruited at these 3 APHOs during the financial year ABROAD 2010-2011. These are statutory organizations and are discharging their regulatory functions as delineated under During the period under report (Upto November, 2010), Indian Aircraft (Public Health) Rules 1954 and Port 116 medical personnel were permitted to participate in Health Rules 1955 respectively. International conference/symposia etc. abroad. This Apart from this, India is also signatory to International includes 20 medical personnel from CHS cadre who have Health Regulations (IHR), 2005 framed by WHO and been granted financial assistance subject to a maximum therefore, it is obligatory on our part to implement these of Rs.1.00 lakh- each to attend International Conference

Annual Report 2010-11 163 abroad under the scheme which provides financial 12.9. MEETINGS/CONFERENCES UNDER assistance to attend seminars/conferences abroad in order THE AEGIS OF INTERNATIONAL to acquaint themselves with the latest developments in COOPERATION the field of medicine and surgery in other countries and (i) An Indo-Swedish Health Week was organized in to exchange views with their counterparts. New Delhi and Hyderabad to commemorate the completion of one year of the Memorandum of 12.8. AGREEMENTS/MOUS Understanding on Health between India and In the year 2010-2011, this Ministry has signed the Sweden and to explore and enhance the potential following Agreements/MoUs:- for strengthened collaboration between various stake holders in the public and private health care I. An MOU on Cooperation in the field of Health sector in India and Sweden. between the Ministry of Health and Family Welfare (ii) The Joint Working Group (JWG) set-up under the of the Republic of India and the Ministry of Social Memorandum of Understanding MOU on Protection of the Republic of Colombia was signed cooperation in the field of Health Care and Public on 19th January, 2010. Health between the Government of India and Sweden held its third joint meeting in New Delhi II. An MOU between the Government of the Republic on 8th February, 2010, in which issues of mutual of India and the Government of the Republic of interest in health sector were discussed. the Croatia on Cooperation in the field of the Health and Medicine was signed on 9th June, 2010. (iii) An Indian delegation led by Hon’ble HFM visited Bangladesh from 13-16th February, 2010 to attend III. An MOU between the Government of India and the meeting of the Executive Committee of Partners the Government of Malawi in the field of Health in Population and Development (PPD) and Medicine was signed on 3rd November, 2010. (iv) The Joint Working Group (JWG) constituted under the Agreement on bilateral cooperation in the field IV. An MOU between the Government of the Republic of Health and Medicine between India and Fiji held of India and the Government of the Republic of its first Joint meeting in New Delhi. Rwanda in the field of Health and Medicine was signed on 12th November, 2010 at New Delhi. Ministerial/Official bilateral meeting between India and Turkey, Nigeria, Australia, Pakistan, China, U.K., Iraq, V. An MOU on the Establishment and Operation of Sweden, Armenia were held with a view to improving Global Disease Detection- India Center between the bilateral relations in the Health Sector during the year National Centre for Disease Control, Delhi 2010-2011 (upto November, 2010.) (Ministry of Health and Family Welfare, 12.10. PERMISSION FOR INTERNATIONAL Government of India) and Centres for Disease CONFERENCES Control and Prevention, Atlanta (The Department In the year 2010-2011 (upto November, 2010), of Health and Human Services of the United States permissions were granted to 70 Organizations/ of America) has been concluded on 6th November, Instsitutions for holding health related international 2010. Conferences in India.

164 Annual Report 2010-11 Chapter 13

Medical Relief And Supplies

13.1 CENTRAL GOVERNMENT HEALTH family members and certain other categories like Members SCHEME (CGHS) of Parliament and ex Members of Parliament, freedom fighters etc. Employees of some select autonomous bodies Central Government Health Scheme has been in as also PIB accredited journalists have also been existence since 1954, when it started functioning in Delhi. extended CGHS facilities on cost-to-cost basis in Delhi. Central Government Health Scheme has since come a long way and presently Central Government Health 13.1.1. Membership Profile Scheme covers 25 cities. In order to make the CGHS As on 31st March 2009, CGHS had 9.34 lakh members user friendly, its functioning has been streamlined and with coverage of over 31.81 lakh beneficiaries. The revamped. Important actions in this direction have been break-up of the current membership profile is given in the computerisation of the functioning of the CGHS and the table below: its dispensaries, delegation of enhanced financial powers to CGHS functionaries and to Ministries / Departments, Membership profile (31.3.2009) issue of plastic cards to beneficiaries enabling them to take treatment in any dispensary, introduction of direct Category Card Holders Beneficiaries indenting of commonly prescribed medicines by CMOs Serving 627004 2518805 in charge of dispensaries, empanelment of private hospitals and diagnostic centres to provide options, in Pensioners 290880 634167 addition to the facilities available in Government hospitals, Freedom Fighters 13068 18293 polyclinics and laboratories, outsourcing of sanitary work MPs 609 2437 in dispensaries, outsourcing of dental services, opening of stand-alone dialysis unit in Delhi, appointment of the Ex-MPs 1010 2593 Bill Clearing Agency (BCA) of settlement of bills of Journalists 128 220 hospitals of pensioner beneficiaries treated in hospitals, etc. These measures have resulted in increased Others 1452 3235 satisfaction level of CGHS beneficiaries. General Public 674 1969 The Central Government Health Scheme (CGHS) is a Total 9,34,825 31,81,719 scheme for providing health care to serving Central Government employees and their dependant family COVERAGE members. Over the years, the scheme has been extended CGHS was started initially in Delhi. Today it covers 25 to cover central government pensioners, their dependant cities as indicated below:

Ahmedabad Allahabad Bangaluru Bhubaneshwar Bhopal Chennai Chandigarh Delhi Dehradun Guwahati Hyderabad Jaipur Jabalpur Kanpur Kolkata Lucknow Meerut Mumbai Nagpur Patna Pune Ranchi Shillong Jammu Thiruvananthapuram

Annual Report 2010-11 165 There is no CGHS coverage in the States of Himacjhal empanelled private hospitals / diagnostic centers. There Pradesh, Chattisgarh, Punjab, Haryana, Tripura, Manipur, are special facilities for the convenience of pensioners Mizoram, Nagaland, Sikkim, Goa and Union Territory of and senior citizens. CGHS Pensioner beneficiaries can Puducherry. obtain a CGHS pensioner card with life-time validity, by paying an amount equivalent to ten years’ subscription. 13.1.2. CGHS Infrastructure The pensioners living in areas not covered by the CGHS The beneficiaries are being provided health service have the option to get their CGHS pensioner cards from through a huge network of: the nearest CGHS covered city. Credit facilities are also available to the pensioners for treatment taken in private A) Dispensaries (247 Allopathic, 82 AYUSH), hospitals /diagnostic centers empanelled under CGHS by B) Yoga Centres (4), obtaining a permission / referral letter from CGHS. In such cases, the hospitals are directed to send the bill for C) Polyclinics (19), the treatment to the CGHS and not to charge from the pensioners. Pensioner beneficiaries are being allowed D) Laboratories (65)+ 1(Hind lab) to get medicines for chronic ailments up to three months E) Dental Units (21) at a stretch. F) Gynae– maternity Hospital (1) Two Geriatric Clinics have been established and are functioning at CGHS Timarpur and Janakpuri in Delhi. G) Dialysis Centre (Sadiq Nagar, New Delhi). 13.1.4. Computerisation of CGHS In addition, beneficiaries are offered medical facilities in private hospitals and diagnostic centres empanelled by The computerisation of CGHS and its’ dispensaries which the CGHS by following an open tender system. was initiated in 2005 has been completed in all cities. Computerisation of CGHS Wing in Dr. Ram Manohar CGHS was finding it difficult to fill up the vacancies of Lohia Hospital in Delhi has also been completed. medical officers as the majority of the doctors recommended by the Union Public Service Commission 13.1.5. Issue of Plastic Cards did not assume charge in the CGHS for various reasons. All the new cards in Delhi and other cities are made only To overcome the problem of unfilled vacancies, it has in the form of Plastic Cards to each beneficiary with a been decided to appoint, on contract basis, doctors who distinct beneficiary identification number. Each card will had retired from Government service. As a result of this have a bar code. In Delhi so far 8.5 lakh cards have decision, 79 retired doctors have been appointed on a been printed and distributed to CGHS beneficiaries.The contract basis in the CGHS. benefit of having a plastic card is that the beneficiaries, 13.1.3. Facilities provided under CGHS while on tour to any CGHS city, can go to the wellness centre in that city and obtain treatment in case of need. Facilities of outpatient care in all systems and emergency services in allopathic system, supply of necessary drugs, 13.1.6. Subscription to CGHS laboratory and radiological investigations, domiciliary visits Serving Government servants residing in areas covered to the seriously ill patients, specialists consultation both by the CGHS are compulsorily covered by the CGHS. at the dispensary and hospital level, family welfare In order to avail the CGHS facility, they have to contribute services, treatment in specialised hospitals, both on a monthly basis at the rates brought into force from Government and CGHS empanelled private hospitals etc. st are being provided to the beneficiaries through 1 June, 2009, which are as below: dispensaries, polyclinics and Government / CGHS S. No. Grade pay drawn by the officer Contribution(Rupees per month) 1 Upto Rs. 1,650/- per month 50/- 2 Rs. 1,800/-; Rs. 1,900/-; Rs.2,000/-; Rs.2,400/-; and Rs.2,800/- per month 125/- 3 Rs. 4,200/- per month 225/- 4 Rs. 4,600/-; Rs.4,800/-; Rs.5,400/-; and Rs. 6,600/- per month 325/- 5 Rs. 7,600/- and above per month 500/-

166 Annual Report 2010-11 Central Government pensioners can avail CGHS facilities (vi) Minor brothers by depositing the applicable subscription rates. Pensioners 13.1.8. Dependency Criteria have the option of either subscribing on an annual basis or pay a lump sum equivalent to 10 years’ contribution Members of the family (other than one spouse) whose and avail CGHS facilities for life time alongwith dependent income from all sources is less than Rs.3,500/- plus an family members. amount equivalent to the DA announced by the Government from time to time will be treated as dependent 13.1.7. Definition of Family on the Government servant and hence are entitled to avail A. Family for purposes of availing CGHS facilities has CGHS facilities. been defined as under: 13.1.9. Empanelment of private hospitals and (i) Husband / wife diagnostic centres (ii) Parents and stepmother As CGHS does not have adequate facilities to offer medical treatment to its beneficiaries in Government (iii) Female employee has a choice to include her hospitals, it empanels private hospitals and diagnostic parents or her parents-in-law and option exercised centers in all CGHS covered cities. For this purpose can be changed once during the service period tenders were floated in 2009 calling for private hospitals (iv) Children (including legally adopted children) subject and diagnostic centers interested in being empanelled to the conditions that: under CGHS to offer their rates for various procedures / tests, etc. Based on the rates quoted by the private (a) Son – till he starts earning or attains the age of 25 hospitals and diagnostic centers, the lowest rates in respect years, whichever is earlier. A son, if married, even of each procedure / test were offered to the private if he is dependent on his parents and is below 25 hospitals and diagnostic centers and those private hospitals years’ of age will not be part of the family for CGHS and diagnostic centers which accepted the rates have purposes been empanelled under CGHS in Delhi and most of other Son, even if he is more than 25 years of age, but is cities. It is expected that with the completion of the tender suffering from permanent disability [as defined in (i) process and introduction of continuous empanelment Disabilities defined in Section 2(i) of “The Persons with scheme, almost all the cities will have private hospitals/ Disabilities (Equal Opportunities, Protection of Rights diagnostic centres in the CGHS panel. and Full Participation) Act, 1995 (No: 1 of 1996)”, Private hospitals and diagnostic centers which were and in Clause (j) of Section 2 of National Trust for empanelled under CGHS have signed MOAs with the Welfare of Persons with Autism, Cerebral Palsy, CGHS. Any violation of the provisions of the MOA meant Mental Retardation and Multiple Disabilities Act, that fines would be levied on these private hospitals and 1999 (No: 44 of 1999)] and is fully dependent on his diagnostic centers and bank guarantee could also be parents will be entitled to CGHS facility. utilised. The matter regarding ineligibility of sons above the age 13.1.10.Procedure for referral to empanelled of 25 years has been challenged in Delhi High Court and hospitals & diagnostic centres final orders of the Court are awaited. The CGHS beneficiary first visits the dispensary (now (b) Daughter – Till she starts earning or gets married, renamed as Wellness Centre) for treatment of an ailment. whichever is earlier, irrespective of age-limit. The CMO in the wellness centre will refer to the patient Widowed dependent daughters, divorced / to a specialist in a Government hospital for suggesting separated daughters if dependent on her parents the procedure / tests, etc., to be undergone by the patient. will be entitled to CGHS facility irrespective of age- If the CGHS beneficiary is a pensioner, then the wellness limit. centre will issue a referral letter to the private hospital (v) Sisters including unmarried / divorced / abandoned and diagnostic centre where the beneficiary wants to be or separated from husband / widowed sisters, if treated. The private hospitals and diagnostic centres will dependent on the Government servant will be provide credit facility to the beneficiary and raise their entitled to CGHS facilities irrespective of age-limit. bill on the CGHS.

Annual Report 2010-11 167 If, however, the CGHS card holder is a serving Central done on the basis of the highest rebate offered by the Government servant, then he / she will have to obtain chemist on the printed MRP. Before the chemist is permission from his / her Ministry / Department. appointed, his premises are inspected to ensure that he has the capacity to handle the volume of indents that will 13.1.11.Change in procedure for payment of be placed by the wellness centre on the chemist. hospitals / diagnostic centres’ bills: 13.1.14. Treatment for Cancer Private hospitals and diagnostic centres have to provide credit facility to pensioner CGHS beneficiaries referred As there is no private hospital empanelled (both old and to them by the CGHS. Due to paucity of funds and new) under CGHS for treatment of cancer patients, ad- procedural bottlenecks, settlement of the bills of private hoc arrangements for treatment of cancer patients have hospitals and diagnostic centers got delayed with the result been made in view of the hardships faced by CGHS that many private hospitals and diagnostic centers refused beneficiaries undergoing treatment for cancer. Patients to extend credit facility without receiving payment towards can be referred to any hospital offering treatment to CGHS the bills already submitted. To overcome the problem, a beneficiaries suffering from cancer. Third Party Administrator (TPA) (the Bill Clearing Agency – UTI – TSL) has been engaged for processing In addition, orders have been issued for treating the of bills and release of payments electronically. CGHS following Regional Cancer Centres as empanelled under will then carry out medical audit of the bills passed for CGHS / CS (MA) Rules. payment by the TPA. 13.1.15.Regional Cancer Centres deemed to be 13.1.12. Supply of medicines to beneficiaries empanelled under CGHS:- Medicines for CGHS are procured by HSCC / Medical 1. Kamla Nehru Memorial Hospital, Allahabad, Uttar Stores Depot and Medical Stores Organisation, on the Pradesh; basis of the indents made by different wellness centres, 2. Chittaranjan National Cancer Institute, Kolkata, and supplied to the wellness centres. The medicines West Bengal; prescribed by the treating doctor, if available in the store of the wellness centre, are supplied to the beneficiary. 3. Kidwai Memorial Institute of Oncology, Bangaluru, If, however, the prescribed medicine is not available by Karnataka; the brand name but in another brand name or there is 4. Regional Cancer Institute (WIA), Adyar, Chennai, another medicine with the same active ingredients, then Tamil Nadu; the same is supplied to the beneficiary. 5. Regional Cancer Centre, Thiruvananthapuram; 13.1.13. Local indenting of medicines 6. Gujarat Cancer Research Institute, Ahmedabad, Each wellness centre holds certain quantity of branded Gujarat; and generic drugs, which are distributed to the beneficiaries on the basis of prescriptions of specialists. 7. MNJ Institute of Oncology, Hyderabad, Andhra If any drug is not available in stock, then the wellness Pradesh; centre places an indent on the locally authorised chemist 8. Dr. B.B. Cancer Institute, Guwahati, Assam; for the wellness centre for the supply of the drugs. 9. Indian Rotary Cancer Institute (AIIMS) , New As it is not possible for the wellness centers to keep in Delhi; stock all the drugs that are prescribed by the specialists and if drugs with the same active ingredients are also not 10. RST Hospital & Research Centre, Nagpur, available, then the wellness centre is authorised to place Maharashtra; an indent on the local authorised chemist for the supply 11. Tata Memorial Hospital, Mumbai, Maharashtra; and of the drug prescribed by the specialist. 12. Indira Gandhi Institute of Medical Sciences, Patna, Authorized local chemists for wellness centres are Bihar. appointed on the basis of tenders floated by the CGHS for such appointment. The selection of the chemist is

168 Annual Report 2010-11 13.1.16. Regional Cancer Centres deemed to be 13.1.18. Grievance Redressal Mechanism empanelled under CS(MA) Rules, 1944 13.1.18.a. Local Advisory Committees 1. Acharya Harihar Regional Cancer Centre for Instructions have already been issued to all CGHS cities Cancer Research & Treatment, Cuttack, Orissa; that meetings of Local Advisory Committees should be 2. Puducherry Regional Cancer Society, JIPMER, held on Second Saturday of every month in each Puducherry; dispensary. The meetings are held under the chairmanship of CMOs in charge of the dispensaries, in 3. Regional Cancer Control Society, Shimla, Himachal which Area Welfare Officers and representatives of Pradesh; pensioners’ associations are members to discuss local 4. Cancer Hospital and Research Centre, Gwalior, problems faced by the beneficiaries and dispensaries and Madhya Pradesh; to resolve such issues. All wellness centers have been directed to keep a 5. Pt. JNM Medical College, Raipur, Chhatisgarh; complaints / suggestions Box and also to maintain a 6. Acharya Tulsi Regional Centre Trust and Research complaints / suggestions register. The complaints Box Institute (RCC), Bikaner, Rajasthan; and will be opened at the time of the meeting of the Local Advisory Committee. 7. Regional Cancer Centre, Pt. B. D. Sharma Post Graduate Institute of Medical Sciences, Rohtak, CGHS Help Lines (No. 011-66667777 & 155224), are in Haryana. operation between 9.30 A.M. to 5.30 P.M. There is also a e-mail help line – cghs @ nic.in where readily available 13.1.17. Other facilities information is provided E-mails are addressed. Otherwise, CGHS beneficiaries in Kolkata can avail treatment / beneficiaries are directed to contact the concerned nodal facilities in the Afternoon Pay Clinics run by the officers to get the desired information. Government of West Bengal, with a provision for 13.1.18.b. Holding of Caims Adalats under CGHS reimbursement of the consultation fee. The OPD Complaints were received in the CGHS and in the consultation fee charged by the Pay Clinics will be Ministry that old cases of reimbursement of medical reimbursed at the rate of Rs. 100/- (Rupees one hundred expenses incurred by pensioners had been pending for only) for the first visit and Rs. 60/- (Rupees Sixty only) settlement for a long time. It was decided that Claims for subsequent visits. The reimbursement of the Adalats be held in each CGHS city under the chairmanship expenditure will be made by the concerned Department / the Additional / Joint Directors of the respective city. For Ministry in case of serving employees and by CGHS in holding of the Adalats, advertisements were released in case of pensioner beneficiaries. local leading newspapers requesting aggrieved pensioners to apply to the respective Additional Directors by Beneficiaries under CGHS possessing a valid CGHS card furnishing the details of their long pending claims. A good can avail treatment / investigation facilities at Nizam’s number of long pending cases could be settled in Delhi Institute of Medical Sciences, Hyderabad, for which prior and in outside CGHS cities through this mechanism. referral / permission / approval will not be necessary from Instructions have been issued for holding such Adalats in the concerned Department / CGHS Dispensary. Similarly, 2011 also. beneficiaries under Central Services (Medical 13.1.18.c. Expenditure: Attendance) Rules, 1944 can also avail treatment / Over the years, expenditure under CGHS has been investigation facilities at Nizam’s Institute of Medical showing an increasing trend. The details of actual Sciences, Hyderabad without prior referral / permission expenditure since 2005 – 06 are as under:- / approval. ( Rs. In crores) S. No. Year PORB Head Other heads Total Expenditure 1. 2006-07 349.47 397.86 747.39 2. 2007-08 438.45 470.69 909.14 3. 2008-09 498.00 547.91 1045.91 4. 2009-10 617.00 532.00 1149.00 5. 2010-11 600.00 Proposed (RE) 568.65 811.07 (Till 22-12-10) 6 2011-12 Proposed (BE) 604.00 680.81 1,284.81

Annual Report 2010-11 169 13.1.19.Status in respect of North East: Based on the success of a pilot project which was started The CGHS is in operation in two cities in the North Eastern in 10 WCs in Delhi to procure these commonly indented States viz. Guwahati and Shillong since 1996 and June medicines directly from manufacturers / suppliers on a 2002 respectively. One Ayurvedic and one Homeopathy monthly basis, the same has been replicated in 16 cities dispensary in Guwahati have since started functioning. namely Ahmedabad,, Allahabad, Bengaluru, Bhubaneswar, There were 12,008 card holders with 45,427 beneficiaries Chennai, Guwahati, Hyderabad, Jabalpur, Jaipur, Kolkata, in Guwahati and 1,857 card holders with 6,544 Lucknow, Mumbai, Nagpur, Patna, Pune, and Ranchi..The beneficiaries in Shillong as on 31-3-09. advantage being that medicines are readily available for issue to beneficiaries instead of indenting through ALC. 13.1.19.a. Recent initiatives taken Manufacturers / suppliers offer a better discount on rates 1) Strengthening of administrative set up of as compared to ALCs. CGHS: To further improve the functioning of 5) Health Check-Up of Beneficiaries above 40 CGHS, a senior position at the level of Additional years in Delhi Secretary & Director General (CGHS), to be filled up under the Central Staffing Scheme has been A pilot project is being implemented in 2 Wellness Centres, newly created. The full administrative control of namely Sector 8 and Sector 12 in Ramakrishna Puram, the entire CGHS staff has been vested with for the Health Check-up of all beneficiaries above the Additional Secretary & Director General (CGHS). age of 40 years in Delhi. 2) Simplification of procedures under referral 30 beneficiaries per day would be registered in advance System and Reimbursement : – online and would undergo a list of identified investigations. Beneficiaries would have a clinical check a. Submission of Medical claims has been simplified up on the date of appointment along with investigation by doing away with the requirement of verification report. The health check-up is proposed to identify risk of bills by the treating doctor and Essentiality factors including Life –style related diseases for Certificate. prevention / early identification for further follow-up and b. Specific guidelines have been issued for examining treatment, if required. So far, 1200 beneficiaries have requests for full reimbursement of claims. The availed of this facility. power for relaxation of rules is vested with the Ministry of Health & Family Welfare, except in 6) Outsourcing of Dental Services: Dental case of Hon’ble Members of Parliament and Sitting services in eight dispensaries in Delhi have so far Judges and Former Judges of Hon’ble Supreme been outsourced though Public Private Partnership Court of India. (PPP). These are at Moti Bagh, Ramakrishna Puram Sector 12, Kidwai Nagar, Sadiq Nagar, 3) Reimbursement from two-sources: Instructions Srinivas Puri, Kalkaji I, Pushp Vihar Sector IV and were issued in February 2009 regarding Faridabad. reimbursement under CGHS and Health Insurance Scheme. As per the revised guidelines beneficiaries 7) Delegation of Financial Powers to settle have the option to submit the original bills under reimbursement claims in CGHS: Powers for the Health Insurance Scheme and claim the balance settlement of reimbursement claims by pensioner amount from CGHS / Department subject to the beneficiaries by CGHS were last delegated in 1999. condition that the reimbursement (balance amount) This resulted in delay in settlement of claims by from CGHS/ Department shall be as per CGHS CGHS. Instructions have been issued on 24th rates and regulations. January, 2011, delegating enhanced financial powers to AS & DG (CGHS), Director CGHS and all 4) Bulk Procurement of Commonly Indented Additional Directors / Joint Directors of CGHS. Medicines from Manufacturers/ Suppliers: This is expected to ensure speedy settlement of Based on the Data generated by Computers a list reimbursement claims of all hospitals and individual of 272 medicines commonly indented through beneficiaries. Authorised Local Chemists (ALCs) was prepared.

170 Annual Report 2010-11 8) Increasing the level of Imprest Money at dispensary level: Imprest money available with the Chief Medical Officer in charge of dispensaries were very low resulting in CMOs not being able to attend to minor items of work. In order that minor items of work do not get delayed, the quantum of Imprest Money available with CMO in charge of each dispensary has been increased to Rs. 20,000/ - (Rupees Twenty thousand only) per annum. Instructions have been issued to declare Chief Medical Officers in charge of dispensaries as Heads of Office under provisions of the Delegation of Financial Power Rules. 9) Engagement of Bill Clearing Agency (BCA): The major grouse of private hospitals and diagnostic NEW OPD BUILDING AT SAFDARJANG centres empanelled under CGHS was that HOSPITAL settlement of bills sent to CGHS in respect of treatment given to pensioner CGHS beneficiaries started in 1942 had only 204 beds, which has now took unduly long time, which was one of the reasons increased to 1531 beds. The hospital provides medical why hospitals and diagnostic centres were showing care to millions of citizens not only of Delhi but also the their unwillingness to provide credit facility to neighboring states free of cost. Safdarjung Hospital is a CGHS beneficiaries. In order to overcome this Central Government Hospital under the Ministry of Health difficulty, CGHS has appointed UTI – TSL as the & Family Welfare and is receives its budget from the Bill Clearing Agency, by signing a MOA with it. Ministry. Safadarjung Hospital has a Medical College Under the procedure, hospitals and diagnostic associated with it named Vardhman Mahavir Medical centres are required to submit their bills College. electronically to UTI – TSL after discharge of the patient, followed by forwarding of bill physically. 13.2.2. Vardhman Mahavir Medical College was UTI – TSL is required to pay to the hospitals the established at Safdarjung Hospital in November 2001 and applicable amount as per package rates for the on 20th November 2007, the Vardhman Mahavir Medical treatment within ten days of receipt of the bill College building was dedicated to the nation. The first physically. To enable UTI – TSL to make batch of MBBS students joined the college in February payments to hospital, an advance of Rs. 70.00 2002. crores has been forwarded to it by the CGHS. After UTI-TSL makes payments to the hospitals, it will submit the bills to CGHS periodically for recouping the money paid to hospitals. 13.2 SAFDARJANG HOSPITAL &VMMC 13.2.1. Introduction of the Hospital Safdarjang Hospital was founded during the Second World War in 1942 as a base hospital for the allied forces. Vardhman Mahavir Medical College It was taken over by the Government of India, Ministry of Health in 1954. Until the inception of All India Institute The college has recognition from the Medical Council of of Medical Science in 1956, Safdarjang Hospital was the only tertiary care hospital in South Delhi. Based on the India. The college is affiliated to Guru Govind Singh I P needs and developments in medical care the hospital has University, Delhi. From 2008 onwards the post graduate been regularly upgrading its facilities from diagnostic and courses are also affiliated to GGSIP University which therapeutic angles in all the specialties. The hospital when were with Delhi University.

Annual Report 2010-11 171 13.2.3. The Services Available: The hospital provides services in various Specialties and Super Specialties covering almost all the major disciplines like Neurology, Urology, CTVS, Nephrology, Respiratory Medicine, Burns & Plastics, Pediatric Surgery, Gastroenterology, Cardiology, Arthroscopy and Sports Injury clinic, Diabetic Clinic, Thyroid Clinic. Further, it has two Whole Body CT Scanner, MRI, Colour Doppler, Digital X-ray, Cardiac Cath. Lab. A Homoeopathic OPD and Ayurvedic OPD are also running within this hospital premises. 13.2.5. Sports Injury Centre (SIC) : The Government of India has established the Sports Injury Centre (SIC) 13.2.4. OPD Services at Safdarjang Hospital, New Delhi at an approved cost OPD Services are running in New OPD Building of V.M.M.C & Safdarjang Hospital. Patients coming to OPD of Safdarjang Hospital find a congenial and helpful atmosphere. Various Public Friendly Facilities exist in the OPD registration area of the New OPD Building like the ‘May I help You’ Counter, Computerized Registration Counters, which are separately marked for Ladies, Gents , Senior Citizens and Physically Challenged. The hospital has an ever increasing attendance of 23,21,526 in the year 2010 i.e. @ 7790 per working day of patients in the OPD. To cater to this load and for convenience of the patients a new OPD Block was commissioned in August, 1992. All Departments run their OPD in the new OPD block. There are several disciplines for which the OPD services are provided daily. The OPD of Rs. 70.72 crores with an objective of providing complex has a spacious registration hall with 18 Comprehensive Surgical, Rehabilitative and Diagnostic registration windows. The OPD registration services services under one roof for specialized treatment of Sports have been computerized and the new system is functional and related Joint disorders. The benefits would not be since mid February 2005. The first floor of the OPD limited only to the sports persons but will also be extended complex caters to the Department of General Medicine to other patients sustaining similar and related joint injuries. and allied Super-specialties; the second floor caters to The Centre has become functional from 26.9.2010 after the Department of General Surgery and allied super- its inauguration by the Hon’ble Prime Minister. The Centre specialties; the third floor is occupied by Pediatrics and also aims to develop the specialty of sports medicine in Homeopathy; the fourth floor houses the ENT & Eye due course. OPD’s and the fifth floor is occupied by the Department of Skin & STD. The out – patient attendance for the last 5 years are as under :-

YEAR OPD ATTENDANCE 2006 21,17,201 2007 21,19,980 2008 22,18,294 2009 23,13,585 2010 23,21,526

172 Annual Report 2010-11 Besides the OPD and emergency services, the Centre strengthen the Security System. Safdarjang Hosptial has an in-patient capacity of 35 beds in single bed, two successfully managed the Epidemics of Swine Flu and bed, 4 bed wards and is expected to take care of about Dengue. Waste management training has been made 2500 cases pertaining to Arthroscopic & specialized joint compulsory for casualty. The guidelines for referral of surgical procedures every year. The SIC building poor patient to other hospital have been strengthened. comprising of seven floors apart from the basement has Large display board in Hindi regarding Poor Patient been equipped with state of the art Operation Theatres referral to Pvt. Hospital were put at several prominent and Physiotherapy Centre with all latest facilities adhering places. to the global standards. The Centre, as part of providing diagnostic services under one roof is housing all modern Several New Super Speciality Departments diagnostic facilities such as MRI and CT scan, Ultrasound, (Endocrinology, Medical Oncology, Nephrology, Nuclear Bone Densitometer, Colour Doppler, etc. and laboratory Medicine and Haematology) are also being run in this services which have been wet-leased under PPP mode hospital. on revenue sharing basis. The centre will have its own The hospital also provides the services for cardiac facilities of CSSD and laundry which are being catheterisation, lithotripsy, sleep studies, endoscopies, outsourced. arthroscopies, video EEG, spiral CT, MRI, colour Doppler, 13.2.6. In-Patient Services mammography and BAC T ALERT microbiology rapid diagnostic system. The hospital has total bed strength of 1531 including bassinets. There are in addition observation beds for Total No. of In-Patients admitted and operations Medical (Ward A) and Surgical (Ward B) patients in the conducted in this hospital for the last 5 years are as first and second floor of the main causality building. There under :- are 10 beds in the causality for observation. As a policy the hospital does not refuse admission if indicated to any OPERATIONS patient in the causality. As a major shift in policy decision, the casualty is now run by post graduate doctors. Senior Years Admissions Major Minor Total Residents from the disciplines of Medicine, Surgery, 2006 1,15,441 21,385 57,827 79,212 Paediatrics, Orthopaedics and Neuro-Surgery are 2007 1,18,923 19,638 61,847 81,485 available round the clock in the causality to provide emergency care. 2008 1,29,271 21,604 69,640 91,244 The administrative requirements of the causality are taken 2009 1,28,175 23,354 69,091 92,445 care of by a chief medical officer and a specialist (nodal 2010 1,25,192 23,096 70,544 93,650 officer) who are also posted in the causality from various Departments by rotation. There is a 24 hour laboratory facility besides round the clock ECG, Ultrasound, X-ray ADMISSION:- & CT Scan services. The Departments of Obst. & Gynaecology and the burns have separate, independent causalities. 13.2.7. Casualty Services CMO I/c Casualty- Dr. Veer Bhushan, was nominated as the Nodal Officer for CWG 2010 for SJH. He successfully coordinated & managed two venues at Sirifort Stadium & also provided medical facility at JLN Stadium, SJH was supplementary response hospital for many stadium. One Defibrillator for casualty procured for Patient care. Surveillance Cameras were installed to

Annual Report 2010-11 173 OPERATIONS:- The Significant Achievements during the year 2010 1. The transport Deptt. VMMC & Safdarjang Hospital intent to purchase 16 new vehicles. out of which presently 9 (Nine) Ambulances including (2 Advance Life Support & 4 Basic Life Support) and 3 normal ambulances have been procured and put on service. 2. Two Ultrasound machines, Multi load CR system, Digital OPG X-ray Machine, Bone Mineral Density Measurement Equipment & HD 11 XE High Definition U/S system (Color Doppler Machine) have been installed in the Deptt. of Radiology. The total number of deliveries conducted in the 3. The construction of residential hostel for MBBS Department of Obst. & Gynae during the year 2010 Student, VMMC was started in 18.01.2008 and the was 25439. same has completed on May 2010, 254 MBBS students have been accommodated since August The details of Lab Examination and X-ray examinations 2010. since 2006 are given below:

2006 2007 2008 2009 2010 Daily Average 2010 Lab. examination 3392554 3431028 3354439 3698191 4239160 11614 X-Ray examination 214802 225793 230530 248211 256432 703

4. The hospital has successfully completed Community Based Rehabilitation, Pilot Project sponsored by WHO at District Gurgoan in selected rural area. A rural rehabilitation programme is being run in the selected areas of Gurgaon district by the Deptt. of Physical Medicine and Rehabilitation. Regular rehabilitation services are being given at the door steps at selected rural communities. 5. Hematology OPD in the H Block extension has been started. 6. Blood Bank and Transfusion Medicine has 25005 donations and 14,241 components (from Jan’09 to Nov.09) and it has issued 31,988 units of blood and components to hospital. 7. A Museum has been built up in VMMC Pathology. Fluid cytology on cytospin has been introduced and

174 Annual Report 2010-11 DNB course has been started in the Pathology 19. A 360 bedded new Super specialty building Department. proposal has been sent to Min. of Health & Family Welfare Site earmarked. 8. Three new tests 1) VMA 2) Anti HBs 3) 13.2.8. Transport Services Parathyroid Hormone have been introduced in the Lab. Medicine Deptt. of Clinical Pathology. Safdarjang Hospital has 21 Ambulances which are available for emergency services round the clock. Out of 9. A total no. of 156 CCTV cameras have been 21 ambulances six ambulances were purchased during installed on approved locations and are functional. C.W.G. 2010, of which 4 are Basic Life support ambulance 10. A special counter for senior citizens, physically and 2 Advance Life Support ambulance. Three other handicapped patients and hospital staff was opened newly acquired ambulances will be used as patient in Central Dispensary to avoid inconvenience to transport ambulances for needy patients. these patients. Additional counter for Clinic patients Besides this 8 other vehicles are available which include was opened with in the existing strength of 2 Buses, 1 STD Van, 1 Truck and 4 Staff cars. Pharmacists in order to minimize waiting time of the patients. 13.2.9. Right To Information Cell (RTI) 11. M.Sc. Perfusion Training Course has been started An R.T.I. Cell is also functioning on the guidelines of w.e.f. 01.08.2009. Ministry of Law & Justice, as per the RTI Act 2005, in the Gazette of India on 15th June 2005. 12. A total of 6399 poor patients were given free sanction for various tests. 13.2.10. Hindi Section: 13. A “Dual Head Gamma Camera with integrated It is constant endeavor of Hospital to regularly monitor Multislice CT”, Turnkey works has already been and see the progressive use and implementation of the installed and is functional in the Deptt. of Nuclear Official Language in the functioning of hospital. Due to Medicine . the constant efforts, the use of official language has reached to approximately 60%. 14. Blood Gas & Electrolyte Analyzer Model ABL800 Basic Radiometer-Copenhagen: was installed in the 13.2.11. Web Site Deptt. of Respiratory Medicine in January 2009. VMMC & Safdarjang Hospital had launched its web site A Tyco-sleep lab was established in the Deptt in (www.vmmc-sjh.nic.in) which was inaugurated on February 2009. 17.09.2002 by the then Union Health Minister. The 15. A new pharmacokinetic lab has been established website is a user friendly and reveals all the necessary in the Deptt. of Pharmacology. Animal house facility information about hospital and its activities. too has been created in the Department. 13.2.12. Training And Teaching 16. The Casualty Deptt. has been equipped with Teaching of Post-graduate Degree & Diploma to the Tracked overhead IV system. students enrolled through GGSIP University are 17. The Deptt. of Burns, Plastic and Maxillofacial conducted in the Departments of Medicine, Surgery, Surgery has been equipped with Scrub station in Orthopaedics, Obst. & Gynae, Paediatrics, Anaesthesia, Plastic & Burn O.T., Transport ventilator in Burn Radio-Diagnosis, Radiotherapy, Opthalmology, ENT, I.C.U. & Deep Freezer in Burn O.T. to store skin Dermatology, PMR, Physiology, Anatomy, Community graft for longer period and Six Vital monitor have Medicine, Microbiology, Biochemistry, Pathology, also been procured in the Deptt. for managing Pharmacology. In the year 2010, 10 students have been seriously ill patients. enrolled for M.Ch. Plastic surgery course & 1 student for M.Ch. CTVS course. Out of 173 seats sanctioned 18. Mother & Child care 100 bedded satellite hospital for PG Degree courses, 130 students have joined for the in Gurgaon Sec. 10 has been taken over by session 2010-11 & PG Diploma courses are abolished Safdarjang Hospital. from the 2010-11 session.

Annual Report 2010-11 175 The regular courses are also being run for Nurses Training, Safdarjang Hospital. The research activities are often in Medical Lab. Technology (MLT) apprenticeship; Diploma coordination with ICMR, DST& WHO. in Lab Technology; Pre-hospital trauma technician course and courses in pharmacy. Medical Record Technician o ICMR Research Project “Multi Centric National (MRT) and Medical Record Officer training, Task Force Project on Epidemiology of Physiotherapy training, O.T. Assistants training and Short Musculoskeletal conditions in India” is being term laboratory training programs for all MLT are being followed in Rehabilitation Section. conducted regularly. o WHO Project “Community Based Rehabilitation- The proposal for starting MDS course in prosthodontis Pilot Project- Gurgaon” has been completed by was approved by Ministry of H.& F.W and extra space Rehabilitation Deptt. for that purpose has been allotted to Dental Department. o Comparative efficacy of Novamin vs Potassium The branch of Prosthodontics deals with replacement of Nitrate in treatment of Dentinal Hyper-sensitivity. teeth and associated structures. With starting of this course this hospital will be able to provide facilities of o Comparative efficacy of Tacrolimus vs crowns, bridges and dentures to common OPD patients Triamcinalone in treatment of Lichen Planus. in large scale. The post graduate course will start in near o Effect of gum disease in pregnant patients on future. incidence of preterm low birth weight babies. 13.2.13. Research Activities 13.2.14. Construction Activities Besides the regular clinical work various research Two additional theatres for general surgery have been activities are undertaken on a regular basis in the different started on 1st floor OT. Departments of the hospital. A number of those have been published in national and international medical One theatre has been added for Cancer surgery and journals. A few journals have been also published from Urology services. The microsurgery operational theatre is under up-gradation .

Safdarjang Hospital & VMMC 13.2.15. Budget Allocation Funds Budget Allocated (Rs. In crores) (2006-2007) (2007-2008) (2008-2009) (2009-2010) (2010-2011) Plan 48.00 70.00 70.00 84.00 132.53 Non – Plan 74.40 79.90 95.70 157.00 160.00 Total 122.40 149.90 165.70 241.00 292.53

VMMC (Revenue) (Rs. in crores) Budget allocated Expenditure incurred 2004-05 5.00 4.66 2005-06 BE 28.76 FE 32.25 32.24 2006-07 (plan) 4.00 FE 4.20 4.03 2007-08 (Plan) 1.00 FE 2.50 2.49 2007-08 (Non-Plan) 0.01 - 2008-09 Nil Nil 2009-2010 Nil Nil 2010-2011 2.00 2.00 (till mid Dec-2010)

176 Annual Report 2010-11 Plan Revenue (SJH) (Rs. in crores) 4216(SJH) Year Allocation (Year wise) Expenditure BE Expenditure incurred 2006-07 48.00 47.66 2009-10 5.00 0.78 2007-08 30.00 FE 37.22 37.08 2010-11 5.00 0.10 (till mid Dec 2010) 2008-09 30.00 63.12 13.2.16. Library 2009-2010 44.00 101.68 The library in SJH has all the basic essential tools including 2010-2011 77.00 63.03 Photostat, computers (in computer lab) and Internet facilities. Book bank facilities are given to poor students. Non – Plan Revenue (SJH) It has electronic security system of books and journals (Rs. in crores) for safety purpose. The library has latest and international books and journals. A total number of 360 books were Year Allocation Expenditure purchased during the last year. (Year wise) 13.2.17. Telephone Exchange 2006-2007 The Telephone Department is located in a double storey (non plan) 74.40 FE 81.41 81.33 building near Gate No.1 next to Dental Surgery 2007-2008 79.89 F.E 95.79 95.65 Department. Ground floor of the building has an Operator room with console of Exchange and Administrative office. 2008-2009 95.70 141.81 On the first floor is the EPABX Electronic Exchange 2009-2010 157.00 189.89 with other Machinery and Equipments. It interconnects the various Deptts. of SJ Hospitals and also to the medical 2010-2011 160.00 146.18 college through telephonic services. One hundred lines (till mid Dec-2010) for V.M.M.C are operational for the benefit of many Departments of VMMC. One Mini Intercom Exchange with capacity of 100 lines also has been made operational VMMC(4210) Construction (Rs. in crores) in casualty recently so as to avoid any interruption in BE Expenditure Emergency Services due to power failure or any other incurred circumstance. 13.3.18. Staff Strength as at the end of November 2006-07 26.00 25.32 2010 2007-08 20.00 FE 15.00 15.00 S. No. Name of the Group No. of In 2008-09 20.00 19.99 Post Position Sanctioned 2009-10 15.00 04.73 1. Group A Gazetted 382 314 2010-11 05.00 04.30 (till mid Dec 2010) 2. Group A Non Gazetted 95 94 3. Group B Gazetted 56 28 4210 (SJH) 4. Group B Non Gazetted 1362 1199 BE Expenditure incurred 5. Group C 961 807 2007-08 19.00 16.06 6. Group D 1234 1076 2008-09 20.00 37.08 7. Resident Doctors/ 2009-10 20.00 29.62 PG/DNB/Intern 1279 1096 2010-11 43.53 22.20 (till mid Dec-2010) Total 5369 4614

Annual Report 2010-11 177 13.3 DR. RAM MANOHAR LOHIA HOSPITAL 50000 indoor patients. About 1.99 lacs patients are attended in the Emergency and Casualty Department 13.3.1. Background annually. The hospital has round-the-clock emergency services and does not refuse any patient requiring The Hospital, originally known as Willingdon Hospital and emergency treatment irrespective of the fact that beds Nursing Home, renamed as Dr. Ram Manohar Lohia are available or not. All the services in the hospital are Hospital, was established by the British Government in free of cost except Nursing Home treatment and some the year 1933. The hospital has thus surpassed over 75 nominal charges for specialized tests. years of its existence and also emerged as a Centre of Excellence in the Health Care under the Government 13.3.2. The Services Available Sector Hospitals. Its Nursing Home was established The hospital provides services in the following Specialties during the year 1933-35 out of donations from His and Super Specialties covering almost all the major Excellency Marchioner of Willingdon. Later, its disciplines: administrative control was transferred to the New Delhi Municipal Committee, now Council (NDMC). In the year Clinical Services 1954, this hospital was taken over by the Central • Government. In the recent past, the Old Building portion Accident & Emergency Services of the hospital has been declared as a Heritage Building. • Anaesthesia Services Starting with 54 beds in 1954, the hospital has been • Dermatology expanded to meet the ever-increasing demand on its • services and now is a 1055 bedded hospital, spread over Eye an area of 37 acres of land. The hospital caters to the • ENT needs of C.G.H.S. beneficiaries and Hon’ble MPs, Ex- MPs, Ministers, Judges and other V.V.I.P. dignitaries • Family Welfare besides other general patients. The mandate of the hospital • General Medicine is to provide utmost patient care and the hospital authorities are making all out efforts to fulfill the mandate for which • General Surgery it has been set-up. The hospital is providing • Gynaecology & Obstetrics comprehensive patient care including specialized treatment to C.G.H.S. beneficiaries and General Public. Nursing • Orthopedics Home facilities are available for entitled CGHS • Paediatrics beneficiaries. The Nursing Home, including Maternity Nursing Home , is having 75 beds for the CGHS and • Psychiatry other beneficiaries • Physiotherapy The hospital is one of the most prestigious Government • Hospitals not only because of its central location, near Dental the Parliament House and in close proximity to North Super Speciality Departments / Units and South Block where most of the V.V.I.Ps stay but • also because of availability of expertise and super Neuro-Surgery specialties. The Government of India has chosen this • Burns & Plastic Surgery Hospital for NABH accreditation, an international hallmark for health care service provider, through the • Cardiology Quality Council of India (QCI). The accreditation • Cardio Thoracic & Vascular Surgery application has already been made to QCI for undertaking inspection to get the accreditation and to become the first • Gastroenterology NABH accredited Central Government Hospital. • Neurology The hospital annually provides health care services to • Paediatrics Surgery approximately 16 lacs outdoor patients and admits around

178 Annual Report 2010-11 • Urology • Psycho-Sexual Clinic • • Nephrology Geriatric Psychiatry Clinic Yoga Centre for cardiac and other patients Unani • Endocrinology OPD (Daily) Departmental Special Clinics Ayurveda clinic has been started and • Diabetic Clinic Homeopathy clinic has been planned • Asthma Clinic Blood Bank Services • Pre Anaesthetic Clinic Dental • ART Clinic • Dental Fracture • ARC Clinic DIAGNOSTIC SERVICES Paediatrics & Neonatology Specialty Clinics • Hematology • Neonatology & Well Baby Clinic • Pathology • Follow – up clinic • Microbiology • Neurology Clinic • Histopathology & Cytology • Nephrology Clinic • Biochemistry • Rheumatology Clinic • Radiology including CT Scan, digital X-ray, Color • Asthma Clinic Doppler, Ultrasound & MR • Thalassemia clinic SUPPORT SERVICES • Nutrition Clinic • State of the art Library Gynaecology & Obstetrics • C.S.S.D • Antenatal Clinic • Laundry • Infertility Clinic • Pharmacy Skin • Bank • Leprosy Clinic • Post Office • Leukoderma • ISD, STD, PCO Booth Eye • Mortuary including Hearse Van • I.O.L • Hospital Waste Management Facilities • Glaucoma • Departmental Canteen • Retina • Ambulance Services Psychiatry 13.3.3. Emergency & Trauma Care Services • Child Guidance Clinic This hospital has well- established Emergency services • including round- the-clock services in Medicine, Surgery, Drug De-addiction Clinic Orthopedic and Paediatrics while other specialties are • Marriage counselling also available on call basis. All services like laboratory,

Annual Report 2010-11 179 X-Ray, CT-Scan, Ultra-sound, Blood Bank and are 143 rooms in the Doctors Hostel and 100 rooms in Ambulances are available round the clock. A well the Nurses Hostel. established Coronary Care Unit (CCU) and an Intensive 13.4.6. Benefits/Activity for person with disability: Care Unit (ICU) exist in the hospital for serious Cardiac The Hospital has facilitated for setting up ramps and wheel and Non-Cardiac patients. The Coronary Care Unit of chair service through porters for the person with disability. the hospital has been completely renovated recently with new equipments and infrastructure. The hospital has a 13.4.7. Recent Achievements of the Hospital well laid down disaster action plan & disaster beds, which are made operational in case of mass casualties and The following are the latest additions of the patient care disasters. facilities in the hospital; A Disaster Management Unit is also functioning in the 1. Sanction of General Maternity Ward and Neo- Casualty Department to attend the serious patients with natal Ward in the Hospital: The Hospital has the desired care. received the approval for sitting up of a General Maternity and Neo-natal Ward at a total cost of An H1N1 Screening centre has been started since June, Rs. 2.45 Crores for which 79 posts have been 2009 to screen the patients round–the-clock which is provided to support the General Maternity and Neo- supported with Information Cell & Call Centre to inform natal Services. Till now, the Maternity services were & follow up the treating patients. A separate H1N1 confined to entitled CGHS beneficiary in the Isolation Ward & a 5- bedded ICU has also been set up Maternity Nursing Home having 25 beds with the in the Hospital on the need basis for treatment of H1N1 approval of General Maternity Ward. It is expected patients. that with the start of extended Maternity Services in the year 2010, the quality Maternity services The Hospital has comprehensive trauma care facility with would be available to all CGHS beneficiaries. 74 beds at the Trauma Care Centre in readiness to shoulder the added responsibility of providing 2. College of Nursing: The Hospital’s School of comprehensive & timely emergency medical care to Nursing set up in 1963 with 25 students capacity victims of trauma in the event of any accidents occurring per year has been upgraded into College of Nursing in Delhi especially in Lutyen’s Delhi. with intake capacity of 50 students per year. Two batches of B. Sc (Nursing) have since been 13.3.4. Sanitation & Enviournmental Concern in admitted. The estimated cost of the project is Hospital Campus Rs.3.00 crores. The Construction work of the new The hospital has given high importance to the sanitation campus of college has been completed by HSCC and beautification of entire campus to create a nature and the teaching classes have been started in the friendly ambience. Under a Special Drive, remodeling New Campus in the year 2010. of Plants, landscaping of Central Park Lawns, relaying 3. Dharamshala: A Dharamshala for attendants of of grass, creation of Artificial Water Falls with colorful patients has been planned to be constructed on one lights & fountains and a beautiful Herbal Garden in the acre of land allotted to hospital near the Birla Mandir Nursing Home Block have been under taken to give a to help the attendants/relatives of the outpatients refreshing look to the visitors and the patients alike. coming from different parts of the country. The Special Sanitation Drives are undertaken at regular designs /clearances have been approved & Govt.’s intervals to ensure proper cleanliness and hygienic approval on the estimates of Rs. 6.14 crores has atmosphere in the hospital. The Hospital has been been received. The detailed estimates and drawings adjudged by the FICCI as the best Hospital under the have been got approved from NDMC. The enviourrnental concern category in 2010. construction activity is planned to be started by 13.4.5. Resident Hostels for Doctors & Nurses: CPWD during the current Financial Year itself. The hospital has provided accommodation to Resident 4. Computerization: The computerization of Doctors as well as Nurses/Nursing students to improve centralized OPD Registration was started from the Health Care Services by ensuring their availability on 2005 to facilitate the outdoor patients to get their duty in the campus at the time of requirement. There

180 Annual Report 2010-11 registration done from any of the 20 Counters in Development Office. This will considerably the OPD Block. There are separate Registration improve the patient care services and also reduce Counters opened for Senior Citizens, physically the waiting time for the patients. Several new handicapped persons and the staff. The disciplines are also planned to be aided in proposed computerization of Administration & Accounts and new Super Specialty Block. cash handling work has also been started for easy 8. Citizen Charter & Public Grievance retrieval of information/record. Only recently, NIC Redressal: The Hospital has adopted a Citizen has undertaken the comprehensive E-Hospital Charter since 1998 and as per the directives of Project with approved cost of 3.50 crores to cover Hon’ble High Court of Delhi, Public Grievance all the activities under its umbrella. OPD registration Redressal Machinery has also been set up to inform & repeat visits, IPD registration & ward allotment, the patients about the facilities available and also casualty registration, transfer and discharges under for redressal of their grievances, if any. There are E-Hospital software had been implemented. E- 19 Complaint & Grievance Boxes placed at Hospital implementation covering all aspects of various strategic locations which are opened patient care, Labs, Human Resources of the periodically and put up before a High Powered Hospital, Inventory control System for the Hospital Committee headed by a Consultant & HOD & and IT induction . The online monitoring of lab tests reviewed by a Designated Addl MS and also by has since been made operational. the Medical Superintendent. The complainants are 5. Construction of New Casualty Building: In given an opportunity to speak in person to the CMO order to provide state of the art Emergency Medical in charge and a written reply of the outcome of the Care, a new Casualty Building is under construction complaint is also sent to the complainant. The with a provision of 280 beds. The estimated cost Hospital is revising the Citizen Charter under the of the project is about Rs. 26 crores. Moreover, 16 scheme “Sarvotam”. VIP Rooms in the Nursing Home are also under 9. Advance Trauma Life Support (ATLS) complete renovation, out of which 6 Rooms have Training: The Hospital started an intensive ATLS since been renovated for patients care. Training Programme for the Senior Doctors to train 6. Medical Care Arrangements during the them on latest advancement in the Trauma life Commonwealth Games-2010: The Hospital support systems. Ten batches, each with 16 was designated as Nodal Hospital for Medical Care trainees have since been conducted in the Hospital Arrangements for SPM Swimming Center and training centre equipped with latest equipments Boxing Center at Talkatora Stadium and National required for ATLS. In India this course is Stadium. Moreover, the Hospital had created conducted only at Lok Nayak Jai Prakash Narayan, necessary infrastructure in the Nursing Home for Apex Trauma Centre of AIIMS and at Trauma delegates, Sports person and their families for Care Centre of Dr. Ram Manohar Lohia Hospital. Medical Care during the Commonwealth Games- 2010. 10. Distance Education Learning Programme: The Hospital has started e-diploma course DHLS 7. Improvements in the Super Specialty (Diploma in Hearing and Learning Speech) in Services: The hospital has focused attention association with All India Institute of Speech and towards the patient care and improved services. Hearing (AIISH) Mysore in which 20 students are Many new and sophisticated types of equipments trained each year. Till now, the Hospital has have been procured in the hospital to update the conducted three courses. hospital services. In order to strengthen the super specialty services to the patients, the Hospital has The Hospital has also started a PG Diploma in planned to construct a new Multi-story Super Hospital Administration (PGDHA) in collaboration Specialty Block on the land available at G- point, with IGNOU on distance learning basis. This is adjacent to Trauma Center which has been recently one year diploma course in which 30 students are handed over to the Hospital by the Land and admitted. This is third course in a row.

Annual Report 2010-11 181 11. A New Modular Operation Theaters Complex. The 13.4.1. Disaster Management: Hospital has proposed for setting up of a New modular OT complex comprising new State of the During the reporting period, a flash flood instigated by Art 20 modular Operation Theaters in X-ray Block cloud burst occurred at Leh (Jammu & Kashmir) in the th th Building with an estimated cost of intervening night of 5 and 6 August 2010. About 400 Rs. 36.00 crore. On execution, the OT complex families were badly affected due to the flash flood and will provide relief to the patients in getting operation done and reducing the waiting time. Financial Allocations: -The financial allocations made to the hospital during the last five financial years are given below:

Final Estimate Expenditure ( Figures in lakhs) 2006-2007 Plan 5673.50 5672.95 Non Plan 5801.05 5794.82

2007-2008 subsequent massive landsliding made the situation worse. Plan 7071.12 7078.33 The Secretary General accompanied the Hon’ble Non Plan 6381.00 6360.73 Chairman IRCS, (Union Health Minister) Shri Ghulam Nabi Azad to assess the needs and formulate a response 2008-2009 strategy for the affected . Indian Red Cross was the only Plan 8364.01 8400.26 organization that deployed water purification unit for Non Plan 9315.00 9313.47 providing clean drinking water to the affected population.

2009-2010 Plan 9430.00 7441.88 Non Plan 12738.00 11990.56

2010-2011 Plan 13397.00 9037.00 Non Plan 12347.00 9516.00 (up to Jan,2011)

13.4 INDIAN RED CROSS SOCIETY The Indian Red Cross is the largest independent humanitarian organization in India. It has always been at the forefront to alleviate suffering at the time of any man Along with the drinking water, IRCS provided shelter made or natural disaster. It is a huge family of 12 million ,relief material and non-food items . Entire relief consisted volunteers and members and staff exceeding 3500. It of 2 Nomad Water purification units, 123 pairs of gum reaches out to the community through 700 branches spread boots, 1000 woollen blankets, 1000 kitchen sets, and 300 through out the country. Its attempt to reduce vulnerability family tents. The total estimated cost for the non food and empower the community for disaster mitigation is items released was Rs 76, 74 600. highly commended. The last Managing Body meeting was Relief activities were undertaken also in Andhra Pradesh, held on14th June 2010 under the chairmanship of Haryana , Punjab , Uttar Pradesh and Tripura which Shri Ghulam Nabi Azad.

182 Annual Report 2010-11 were affected by storm , rainfall, and flooding. From The and Karnataka. TB Project has been successful and IRCS National Headquarters, the Hon’ble Chairman, through Programme Integration TB as an opportunistic IRCS,(Union Health Minister) Shri Ghulam Nabi Azad infection has been addressed. H2P Programme supported flagged off relief supplies for Bihar cyclone on 23-4-2010. by USAID is implemented in 9 districts of the state of WatSan units deployed served 60,000 people with safe Punjab, AP and Maharashtra with the total budget drinking water during AP floods. Total Relief sent across amounting to INR 1.62 crores. Community preparedness to the states during the adverse times amounted to for influenzas programme supported by WHO is being Rs 7 crores. implemented in 9 target states i.e., West Bengal, Tripura, Orissa, Uttarakhand, J&K, Chhattisgarh, Gujarat, Dadra 13.4.2. DRR & Livelihood Disaster Risk Reduction (DRR) & Nagar Haveli and Andhra Pradesh. Total Budget INR 20.00 lakhs. The health maternity and child welfare The purpose of the programme, “Community centered services continued throughout the services under the Red Disaster Risk Reduction” in India is based on the Cross banner at its 440 centres. approaches founded in the Indian Red Cross Society strategic development plan. This plan of the National Indian Red Cross blood banks contribute 10% of the Society addresses practical DM strategic measures to total blood requirement in the country. The IRCS NHQ minimize vulnerability and risk of affected communities. Blood Bank collects 85% blood from voluntary donors For IRCS this means working with vulnerable against the national average of 62%.The(NHQ) Blood communities, identifying their capacities, plan for actions Bank is fully equipped with infrastructure to provide blood that reduce specific risks and “build safer communities”. services and training facilities of the highest standards, IRCS seeks to implement its DM strategic measures by as per national guidelines. IRCS,NHQ Blood Bank is the addressing locally based risks, vulnerabilities, community’s first Red Cross Blood Bank in the non governmental set coping capabilities, and required institutional capacities up in the country to be designated as Model Blood Bank to manage disaster events. IRCS being efficient in by NACO.The upgraded Model Blood Bank was disaster response and rehabilitation activities has also inaugurated by Hon’ble Minister of Health& Family implemented successfully community based disaster Welfare ,(Chairman of IRCS )Shri Ghulam Nabi Azad preparedness programmes. on 14th June 2010. During the period 2009-10 the blood bank collected were 26486 units of blood and 293 blood IRCS is implementing Disaster Risk Reduction (DRR) program in 3 states - Maharashtra, AP and Orissa donation camps held. supported by Hong Kong & Canadian RC. DRR 13.4.5. Family News Service (FNS) program implementation guidelines have been developed. FNS is provided to the anguished families and its 13.4.3. Livelihood Projects members separated due to conflicts, disasters, migration The project supported by Spanish Red Cross has been and other socio-economic situations. During the last completed in the states of Andhra Pradesh and Tamil financial year 560 Red Cross Messages were exchanged, Nadu to benefit fisher folk community, at a total cost of and 21 tracing cases were successfully solved. Rs.4.72 crores for 11,000 beneficiaries. 13.4.6. Post Graduate Diploma Course in Disaster 13.4.4. Health: During the reporting period, the Society Preparedness and Rehabilitation continued its HIV/AIDS activities under which Youth Peer Education, Stigma & Discrimination and care for children This course has been initiated by the Indian Red Cross of HIV positive parents were covered. The Red Cross Society to develop knowledge on disaster preparedness, India HIV Consortium has 11 members with German and rehabilitation, and sustainable development including Hungarian Red Cross as new members and Italian Red framework and skills for addressing anticipated hazards, Cross also joining the HIV activities.Tuberculosis Project disaster and complex emergencies with an emphasis on India is a Pilot Project to take care of 200 CAT II patients either post development or majority world context. Four who are defaulters or likely to default .The Project has batches have successfully completed the course and been implemented in the states of Punjab, Uttar Pradesh process for enrollment for the 5th batch has started.

Annual Report 2010-11 183 Following facilities have been added and upgraded: The Emergency Support Function Plan was circulated to all concerned and it contains the emergency support • Ham Radio functions assigned to the MOHFW which includes details • GIS lab of nodal officers for coordination, crisis management & quick response at Hqrs. and field level, resource inventory • Emergency operation centers etc. This plan also contains instructions regarding • Facilities for computer training. deployment of resources in the event of disasters. Advance Trauma Life Support training were institutionalized in two 13.4.7. Health Promotion through Ayurveda & Yoga Central Government Hospitals. About 200 doctors from Delhi & Central Government Hospitals were trained in IRCS in collaboration with Department of Ayush, Ministry Advance Trauma Life Support. of Health and Family Welfare, has started 50 hours certificate course (3 month part-time programme). 13.6.1.b. Response Due to drug resistance in the post antibiotic era this course Ministry of Health and Family Welfare was represented shall initiate people to discover alternate ways of in the central assessment teams of the Ministry of Home medication, recovery and better health. The first batch Affairs that visited Leh (flash floods), Uttarakhand (flood) was started on 2-2-2010 with 50 students. Most of the and Uttar Pradesh (flood) for Rapid Health Assessments. course participants reported enhanced level of energy, Relief were recommended in terms of norms under cure from ailments and overall better health. Due to Calamity Relief Fund /National Calamity Contingency overwhelming response and excellent feedback more Fund. Public Health Expert teams were deputed to batches are being started on regular basis. investigate disease outbreaks in the States of Gujarat, Uttar Pradesh, Orissa, Bihar and Kerala during the current year. 13.5 ST. John Ambulance India The concerned State Governments were advised on The National Council of St John approved the upgraded prevention and containment measures. version of the First Aid Manual for use by the St John 13.6.2. Public Health Emergencies Ambulance (India) as well as the Indian Red Cross, which would be available from January 2011.The National 13.6.2.a. Pandemic Influenza –Preparedness and Council also approved the establishment of fourteen St Response. John Centers in Tamil Nadu besides one centre each in Jharkhand, S.E.C.R Railway Chattisgarh ,Bilaspur. During Influenza like Illness caused by Influenza A [H1N1], a the period April 2010 to November 2010, National re-assorted influenza virus, was reported from Mexico th Headquarters computerized, printed and issued 3,93,187 on 18 March, 2009 and rapidly spread to affect 214 proficiency certificates to the eligible candidates who have countries. World Health Organization raised the pandemic qualified for First Aid, Home Nursing, Hygiene and alert level to 6, declaring pandemic of influenza H1N1 of Sanitation, Mother Craft and Child Care. moderate severity. 13.6 EMERGENCY MEDICAL RELIEF The preparedness measures undertaken for avian influenza came handy. The existing measures were scaled up and Health Sector Disaster Management: additional measures put in place to limit the entry / spread of disease into India and to mitigate the impact of the Emergency Medical Relief Division (EMR) of Directorate evolving pandemic. General of Health Services, Ministry of Health & Family Welfare, Govt. of India is mandated for prevention, 13.6.2.b. Action Taken by Govt. of India preparedness, mitigation and response on health sector disaster management activities and coordinates health Government of India took a series of action to prevent/ activities in terms of manpower and material logistics limit the spread of Pandemic Influenza A H1N1 and to support to the states. mitigate its impact. Surveillance to detect clusters of influenza like illness is being done through Integrated 13.6.1. Preparedness and Response for Disasters Disease Surveillance Project. Laboratory network has been strengthened, from the then existing two laboratories 13.6.1.a. Preparedness for disasters: to forty five laboratories (26 in Govt. Sector and 19 in

184 Annual Report 2010-11 Private Sector) for testing the clinical samples. undertaken under NRHM. In most hard to reach areas Government of India procured 40 million capsules of which of the country, the telemedicine technology has the about 28 million have been given to the States/UTs which potential to transform the quality and range of services is also used for preventive chemoprophylaxis. initiated through health sector reforms under National Government of India supported State Government/UTs Rural Health Mission. Many other agencies are also by strengthening of logistics (medicine, PPE, diagnostic undertaking e-Health initiatives like Department of kits, etc.). Retail sale of Oseltamivir was allowed under Information Technology, Indian Space Research Schedule X of Drugs & Cosmetic Act. Number of retail Organization, Sanjay Gandhi Post Graduate Institute, outlets have been increased to improve access to anti- Lucknow, All India Institute of Medical Sciences, New virals. Three Indian manufacturers of Vaccine are being Delhi, Post Graduate IInstitue of Medical Education and supported to manufacture H1N1 vaccine. 1.5 million Research, Chandigarh. doses of vaccine have been imported to vaccinate health care workers. Training of State/District level rapid As part of the e-Health initiative in the Ministry of Health response teams are supported by Ministry of Health and & Family Welfare, Government of India, has initiated a Family Welfare. Indian Medical Association has been also scheme for establishing National Medical College provided funds to train private practitioners. All States Network for Rs.60 crores. The National Medical College were requested to gear up the State machinery, open large Network will be used for the educational needs of medical number of screening centres and strengthen isolation students, teachers & healthcare professionals. The facilities including critical care facilities at district level. Telemedicine Centre at SGPGI, Lucknow would be the A task force in the I&B Ministry is implementing the National Resource Centre and network hub. The National media plan. Travel advisory, do’s and don’ts and other Resource Centre and the Regional Resource Centres pertinent information has been widely published to create identified under National Medical College Network would awareness among public. Senior Officials and Public be strengthened/upgraded and linked through a network health teams were deployed to monitor the situation from to various medical colleges and medical institutes to time to time. Necessary guidelines were issued to the undertake a capacity building exercise and bridge the States from time to time. All informations were made knowledge and resource gap. available on dedicated website www.mohfw-h1n1.nic.in. Tele-Ophthalmology 13.6.3. Medical Care Arrangements on Special Occasions Tele-ophthalmology is a new approach for ensuring connectivity and data transfer. With the objective to Medical care arrangements were organised by the provide health care services in the rural areas and to Dte.G.H.S. for Republic Day and Independence Day nullify the shortage of ophthalmologist in the country, celebrations and important International Conferences etc. National Program Control of Blindness launched Tele- Medical care arrangements were also made during the ophthalmology project in India. It is important in the view State Visits of Heads of States. EMR Division has been of the fact that most of the health facilities are centered the focal point in monitoring the medical care arrangements on big cities and towns and significant no. of patients for the Commonwealth Games 2010. Regular meetings from rural/tribal areas can be managed with some advice were held and progress reviewed. It also supported the and guidance from specialists and super specialist in the Delhi Government in providing medical care at 7 cities and towns. This technology is helpful in elimination competition and 3 training venues. Ministry of Health & of preventable blindness from the rural, tribal and un- FW supported the State of Uttarakhand in terms of served area in the country. manpower, drugs, equipments to the Maha Kumbh held between January to April 2010. OncoNET India Project 13.7 E- HEALTH (TELEMEDICINE) Under this project 2 Regional Cancer Centers (RCCs) and two associated Peripheral Cancer Centers (PCCs) E-Health/Telemedicine can expand the reach, range and have been connected. These are: quality of Primary Health care services available in Public Health system. The efforts would seamlessly synergize 1. PGIMER, Chandigarh (RCC) with Civil Hospital, with the overall health sector rejuvenation being Bhatinda

Annual Report 2010-11 185 2. KMIO, Bangaluru (RCC) with District Hospital, Mandya These four centers are using this facility for early diagnosis and treatment of patients and further referring of patients to the respective RCC. At present, the following are in the process of being connected with the network and these are: 1. JIPMER Puducherry (RCC) with Government Hospital, Yanam (PCC) 2. Govt. Arignar Anna Memorial Cancer Hospital, Shri Ghulam Nabi Azad, Hon’ble Union Minister of Health & Kancheepuram (RCC) with Govt. Hospital Family Welfare honoring a relative of deceased organ donor Arakkonam (PCC) on the occasion of inauguration of ‘Organ Donation Congress 2010. 3. SKIMS, Srinagar (RCC) with District Hospital, Poonch (PCC). (Geneva), Fair Transplant (Geneva), The Transplantation Society (USA), German Organ Procurement 13.8. CLINICAL ESTABLISHMENTS ACT, 2010 Organisation (Germany), National Transplant Organization (Spain), Red Cross Society (Thailand), The Clinical Establishments (Registration & Regulation) International Society of Nephrology (Australia) and Bill, 2010 which aims at providing registration and various other international societies from China, South regulation of clinical establishments in the country with a Africa etc. participated in these two day events. Various view to prescribing the minimum standards of facilities national associations related to organ transplantation like and services for them, has been passed by both Houses Indian Society of Organ Transplantation, Indian Society of Parliament. This Act has been notified in the Gazette of Nephrology, Indian Society of Urology, of India on the 19th August, 2010. The Act will initially Gastroenterology Society of India, Cardiothoracic Society take effect in four states viz., Arunachal Pradesh, etc were co-partners of the event. Private sector and Himachal Pradesh, Mizoram, Sikim, and all union NGOs also extended their support and participated. Nine territories. Subsequently, the Act may be adopted in other deceased organ donors were also honoured by States also. The Ministry is now in the process of Shri Ghulam Nabi Azad, Hon’ble Union Minister of Health formulating Rules under the Act. This is a progressive, & Family Welfare with silver plated plaques at Vigyan pro-public and user friendly legislation which will enable Bhawan. a national data base for all clinical establishments including the Government hospitals in the country. A painting competition and slogan competition on the theme of ‘organ donation’ was also held at Delhi 13.9 INDIAN ORGAN DONATION DAY University before the main event was held. A rally and The 6th World and 1st Indian Organ Donation Day and painting competition was also organised at India Gate on Organ Donation Congress 2010 was organized on 27-28 27th November 2010. About 2500 children and others November 2010 at New Delhi. Scientific meeting of participated in the rally and painting competition. Mrs. ‘Organ Donation Congress 2010’ was held at Vigyan Sheela Dixit, Hon’ble Chief Minister of Delhi was chief Bhawan and inaugurated by Shri Ghulam Nabi Azad guest at India Gate function. Shri Ghulam Nabi Azad, Hon’ble Union Minister of Health & Family Welfare. Shri Hon’ble Union Minister of Health & Family Welfare Dinesh Trivedi, Hon’ble Union Minister of State Health presided over the function. The evening function was & Family Welfare was the guest of honour on the attended by about 5000 people including eminent invited occasion. experts, faculty, international and national delegates of the conference and general public. The winners of various About 500 delegates and invited guests participated in activities and distinguished international delegates were the scientific event. Experts in the field of organ transplant also honoured in the evening function. This event has from various organizations like World Health Organization taken the agenda of deceased organ donation to the

186 Annual Report 2010-11 forefront and increased awareness in the general public approved in November 2010. An amount of Rs. 25 crores which is likely to change the attitude in increasing the for 2010-11 & 2011-12 has been allocated for 11th plan organ availability. for this purpose which will be utilized for Tissue bank, Model Organ procurement & distribution organization Action plan for implementation of THOA amendments (MOPDO), transplant coordinators training and IEC/ to initiate National Organ Transplant Program, was media purpose for mass awareness.

A view of painting competition on the occasion of Organ Donation Day on 27th November 2010.

Annual Report 2010-11 187

Chapter 14 Quality Control in Food & Drugs Sector, Medical Stores

14.1 FOOD SAFETY AND STANDARDS Shri P.I. Suvrathan, former Secretary to Ministry of Food AUTHORITY OF INDIA Processing Industries, is the Chairperson of FSSAI. Shri V. N. Gaur in the rank of Additional Secretary to The Food Safety and Standards Authority of India (FSSAI) Government of India, is the Chief Executive Officer of has been established under the Food Safety and Standards the Authority. Act, 2006 as a statutory body for laying down science based standards for articles of food and regulating FSSAI has been mandated by the FSS Act, 2006 for manufacturing, processing, distribution, sale and import performing the following functions: of food so as to ensure safe and wholesome food for
Framing of Regulations to lay down the Standards human consumption. and guidelines in relation to articles of food and Highlights of the Food Safety and Standards Act, 2006 specifying appropriate systems of enforcing various aims to establish a single reference point for all matters Standards thus notified. relating to Food Safety and Standards, by moving from
Laying down mechanisms and guidelines for multi-level, multi-departmental control to a single line of accreditation of certification bodies engaged in command. Various Acts and Orders that have hitherto certification of food safety management systems handled food related issues in various Ministries and for food business. Departments have been integrated in the Food Safety and Standards Act, 2006. Thus, the Central Acts like
Laying down procedure and guidelines for Prevention of Food Adulteration Act, 1954, Fruits Products accreditation of laboratories and notification of the Order, 1955, Meat Food Products Order, 1973, Vegetable accredited laboratories. Oil Products (Control) Order, 1947, Edible Oil Packaging
To provide scientific advice and technical support (Regulation) Order, 1998, Solvent Extracted Oil, De-oiled to the Central Government and State Governments Meal and Edible Flour (Control) Order, 1967, Milk and in matter s of framing the policy and rules in areas Milk Products Order, 1992 etc will be repealed after which have a direct or indirect bearing on food commencement of the FSS Act, 2006. safety and nutrition. Notification
Collect and collate data regarding food Ministry of Health and Family Welfare, Government of consumption, incidence and prevalence of food India is the administrative ministry for FSSAI which is hazards, contaminants in food, identification of the agency for implementation of the new law. The emerging risks, food surveillance, introduction of Authority was notified on 5th September, 2008 with 22 rapid alert system etc. members. The head office of the Authority is at Delhi.
Creating an information network across the country The Authority has started its operations with Chairperson so that the public, consumers, Panchayats etc and Chief Executive Officer who are in the rank of receive rapid, reliable and objective information Secretary and Additional Secretary to Government of about food safety and issues of concern. India respectively, and the staff who were implementing the various food related orders.

Annual Report 2010-11 189
Provide training programmes for persons who are • The second meeting of the scientific panel for involved or intend to get involved in food businesses. functional foods, nutraceuticals, and dietetic products, genetically modified organisms and foods
Contribute to the development of international were held on 29th March, 2010 and 5th April, 2010 technical standards for food , sanitary and phyto- respectively. sanitary standards. The third meeting of the scientific panel for
• Promote general awareness about food safety and genetically modified organisms and foods was held food standards. on 20th December, 2010. Composition of FSSAI 4. Consultation meetings on the draft Rules and The FSSAI consist of a Chairperson, Member Secretary Regulations under Food Safety and Standards Act, and 22 members which includes representative of Food 2006 including process for Registration and industry (Small Scale & Large), Food technologists, States Licensing were held region wise across India during & UTs, Farmer’s orgn etc. 2009 with State Government/UTs Food Safety Commissioners, stakeholders. A notification on the Steps Taken By FSSAI till December, 2010 draft Food Safety and Standards Regulations 1. Six meetings of the Authority have been held so (including Draft Regulations for Licensing far in which various rules and regulations have been Registration) had been published in part III Section st approved. 4 of Extraordinary Gazette of India dated the 21 October, 2010 for the information of all persons 2. The Central Advisory Committee (CAC), as per like to be affected thereby inviting objections and Section 11 of the Food Safety and Standards Act, suggestions within thirty days. It has also been 2006, was constituted and notified on 5th October, notified by the Ministry of Commerce and Industry 2009. The CAC comprises of 44 members and to WTO as per the requirements of SPS and TBT the Chief Executive Officer of FSSAI is the ex- agreements. officio Chairperson. Two meetings of Central Advisory Committee have been held so far. 5. An Integrated IT-enabled food import information system is required to be established to facilitate 3. Food Authority has constituted a Scientific FSSAI to regulate safety of food imports into the Committee and eight Scientific Panels for providing country an efficient, transparent and hassle free scientific opinion to the Food Authority on various manner. For this purpose, the project of issues consisting of independent scientific experts: ëStructuring and Implementation of Integrated a) Panel for food additives, flavourings, processing aids IT-enabled Imported Food Safety Systemí by and materials in contact with food. Food Safety and Standards Authority of India (FSSAI) was assigned to the National Institute of b) Panels for pesticides and antibiotic residues. Smart Government (NISG). National Visioning workshop and Regional workshop to discuss on the c) Panel for genetically modified organisms and foods. preparation of a Blue Print for Structuring and d) Panels for functional foods, nutraceuticals, dietetic Implementation of integrated IT enabled Imported products and other similar products. Food Safety System under FSSAI were held during 2010. e) Panel for biological hazards. Based on the reports submitted by NISG and in active f) Panel for contaminants in the food chain consultation with all stake holders, the imported food g) Panel for labelling and claims/Advertisements. clearance process is being taken over by FSSAI in a phased manner to ensure that safe food is imported into h) Panel for method of sampling and analysis. the country. FSSAI has since taken over the function of • Two meetings of the Scientific Committee have PHO in the ports of Kolkata, Haldia, Chennai, Mumbai, been held so far. Jawahar Lal Nehru Port Trust in Aug-Sep, 2010.

190 Annual Report 2010-11 6. The Food Authority is now the National Codex of the food made available to children in school Contact Point (NCCP) for maintaining contact with premises and to develop guidelines/manual for the Codex Alimentarius Commission, exchanging improvement in quality of food served in schools. information, responding to queries, participating in In this regard FSSAI have received a proposal from meetings etc. IIM Bangaluru which is being evaluated. The expected outcome of the study would be The Food Authority has approved the guidelines for development of guidelines for safety of food participation in codex meetings and preparation of available to children in schools. response to Codex matters and also guidelines for the Codex Contact Point, the National Codex Committee and • Diet Study titled, “Assessment of consumption of National Shadow Committees. The Food Authority has processed and non-processed foods in India” by also established the various Shadow Committees for NIN. reviewing the agenda of the Codex Alimentarius Commission and its subsidiary committees and finalizing • Laboratory Gap Study by QCI is under process. India’s comments on the various agenda items before QCI has submitted interim report containing they are sent for approval of the government. assessment of 35 laboratories, which has been duly approved by the Authority. During the year 2009-10, Food Authority had participated in the 26th Session of Codex Committee on General 12. Draft framework for interim arrangements of GM Principles (CCGP) held in April, 2010 in Paris, 34th processed food was earlier approved by FSSAI Session of Codex Alimentarius Commission (CAC) held but now it would be regulated under Biotechnology in July, 2010 in Geneva, 17th Session of Coordinating Regulatory Authority of India (BRAI) Bill, 2010 Committee for Asia (CCASIA) held in November, 2010 moved by Department of Biotechnology. in Indonesia. 13. Training programmes have been held for Food 7. FSSAI constituted the following Expert Groups to Safety Commissioners, Food Safety Officers and handle specific assignments for a specific duration: Designated Officers during June- September, 2010 with a view to prepare them for transition from • Amaze Brain Food PFA to FSSA regime. • Energy Drinks 14. An International Conference on Best Practices in Food Safety Implementation was organised in Delhi • Fats and Oils in November, 2010 in collaboration with TERI and • Food for special purpose and nutritional uses. MSU. 8. Meeting with State Food Commissioners and other 15. Following drafts for Consultation have been stakeholders have been organised for obtaining prepared: feedback on transition to FSSA. • Draft on Regulation of Trans Fatty Acids, TFAs, in 9. Workshops have also been conducted across India Partially Hydrogenated Vegetable Oils, PHVOs. inviting suggestions on transition from PFA to FSSA. • Draft Regulation on Foods for Special Nutritional 10. Advisories have been issued on hazards from or Dietary Uses Melamine contamination in Chinese milk products, 16. Guidelines on the following have been prepared: Salmonella contamination in Peanut Butter, antibiotics in honey. • Scheme of Research and Development for Food Quality and Safety. 11. The following studies which were initiated by FSSAI are in various stages of operation as • Guidelines and Application Forms Meat Food enumerated below: Product Order- MFPO • To review the present status of safety and quantity • Setting up of unit under Fruit Products Order. of food as well as sanitary and hygiene conditions

Annual Report 2010-11 191 17. The following are being finalised keeping in view • Laboratory upgradation policy recommendations of stakeholders: • Consumer food safety scheme/ competitive grant • The draft of Code of Self Regulation in Food for R&D projects Advertisement • Scheme for Centre of Excellence and Food Safety • The draft document for Food Safety in Eating Centres Establishments. • Strategy for revision of standards 18. New structure of the Authority has been approved. • Communication strategy as a part of the risk analysis and awareness generation 19. Portal of FSSAI is in place. Public notices and various drafts for public consultation are posted on • Pilot project on traceability and recall web through this portal. • Manuals and guidelines for implementing the rules and regulations 20. Modernisation of the existing offices has been undertaken by hiring new offices, providing • Finalization of voluntary code on advertising computers and internet, installing various software • Regulation on labelling & claim and advertising packages for office automation like com- ddo package, file tracking system, e- office etc. • Accreditation mechanism and procedure for the food testing laboratories 21. A Pilot project called “Safe Food, tasty Food” a • A system for accreditation of food safety audit first of its kind for upgrading the safety and quality personnel and organisations. of food served in eating establishments across the country has been prepared and circulated to all the • Fixation of limit on Trans Fatty Acids State Govts. /UTs for guidance. • Implementation of IT enabled import monitoring system related to food safety in major entry points What to expect in the near future of imported food in the country • Implementation of FSS Act and repeal of the PFA • Regulation of GM Foods, Alcoholic drinks, Olive Act & other Orders, relating to Fruits & Vegetables, oil and Energy drinks. Edible Oil, and Meat & Milk. • Continuation of capacity building programmes for • Draft paper on surveillance of food & food borne food safety personnel all over the country. disease. 14.2 CENTRAL DRUGS STANDARD CONTROL • A framework for Food Safety Management System ORGANIZATION(CDSCO) comprising of : Public Health is one of the major objectives of the
Competency framework for food safety Government of India and to achieve this it is important professionals to ensure that they retain the skill and that drugs available to the public are safe, potent and competence requirements needed. efficacious. Regulatory control over the quality of drugs in the country is exercised through the Drugs and
Framework for Certification bodies / Registration Cosmetics Act, 1940 and Rules made there under. The bodies manufacture and sale of drugs is looked after by the State Governments while imports, permissions for marketing
Procedure for recognizing equivalence of food of New Drugs in the country, Clinical Trials on New safety system with national standards. Drugs are the responsibility of the Central Government.
Guidance document for implementation of GMP/ At the Central level these functions are performed by GHP. the Central Drugs Standard Control Organization (CDSCO) headed by the Drugs Controller General • Training policy for FSSAI (India).

192 Annual Report 2010-11 A. CDSCO Organization 7. Prescribing regulatory procedures for regulating quality of drugs, cosmetics, diagnostic reagents and The Central Drugs Standard Control Organization medical devices. (CDSCO) has its head quarters at Food and Drug Bhawan, Kotla Road, Near ITO, New Delhi-110002. 8. Approval of Licence as Central License Approving CDSCO has under its control Zonal/Sub-zonal offices, Authority for manufacture of large volume Port offices and Drugs Testing Laboratories to perform parenterals, sera and vaccines, biotechnology various regulatory functions in respect of quality control products, medical devices and operation of blood of drugs. banks and manufacture of blood products. CDSCO has six zonal offices situated at Mumbai, 9. Coordinating the activities of the States and advising Ghaziabad, Kolkata, Chennai and Ahmadabad and three them on matters relating to uniform administration sub-zonal offices at Bangaluru, Chandigarh and Jammu. of the Act and Rules in the country. These offices are involved in the GMP audits and B. Drug Industry inspection of manufacturing units of large volume parental, sera and vaccine, recombinant DNA (r-DNA) Indian pharmaceutical industry is one of the most vibrant derived drugs, blood banks and blood product sectors of Indian industry and has maintained a growth manufacturing units. Zonal offices also coordinate with of 11-12%. It is 3rd largest in the world by volume. The the State Drugs Control Organizations situated under the total size of the Indian Pharmaceutical Industry is about respective zone or subzone in matters of quality control Rupees 1,00,000 crore out of which exports account for of drugs in the country. Rupees 42,000 crore and the rest is the size of the domestic market. It is 8% of global Production and 2% Regulatory control over the quality of drugs, cosmetics of world Pharma market. A large number of bulk drug and medical devices imported into the country is exercised units from India are exporting drugs to the US and Europe. by the Port offices situated at Sea ports/Airports in Delhi, India has the highest number of USFDA approved plants Mumbai, Nhava Sheva, Chennai, Kolkata, Cochin and outside USA. There are 169 USFDA approved Ahmadabad. manufacturing facilities in India. Indian pharma companies are filing highest Abbreviated New Drugs Approval There are Six laboratories functioning under CDSCO. (ANDA) applications in the USA. Further, there are 153 Four Central Drug Testing Laboratories are situated at manufacturing facilities in the country which have been Kolkata, Mumbai, Chennai and Kasauli and two regional certified by European Directorate of Quality Medicine Drug Testing Laboratories are situated at Guwahati and (EDQM) for export of drugs to the European Union. Chandigarh. These laboratories are engaged in testing of samples of drugs in the country. Such excellent growth in the Pharma sector has resulted in high expectations from the office of Drugs Controller Functions of CDSCO General (India). There is significant increase in the 1. Approval of new drugs including vaccines to be workload of CDSCO in the last few years as shown in introduced in the country. the graph given below:- 2. Grant of permission to conduct clinical trials in the country. 3. Registration and grant of import licenses for drugs, cosmetics and notified medical devices. 4. Regulation of quality of drugs, cosmetics and notified medical devices imported into the country. 5. Meetings of the statutory committees like Drugs Technical Advisory Board and Drugs Consultative Committees. 6. Laying down regulatory measures and recommend amendments to the Drugs and Cosmetics Act and Rules made there under.

Annual Report 2010-11 193 The number of applications received and processed in ‘No Objection Certificates’ for dual use items and shelf life extension for export purposes in the year 2010. CDSCO has increased from around 10,000 in 2005 to 23,000 by 2010. Drugs and Cosmetics Rules have been amended to incorporate a system of registration of cosmetics imported C. Strengthening of CDSCO into the country and the registration will become In view of this scenario, the Ministry of Health and Family mandatory for import of cosmetics from April 2011. Welfare has taken initiatives to strengthen the manpower 2. Quality Control Over Notified Medical at CDSCO to cope up with the increased workload. The Devices Government of India sanctioned 216 new posts in the CDSCO to strengthen the headquarters as well as zonal Medical Devices notified by the Government of India and port offices of CDSCO. The present strength of under the Drugs and Cosmetics Act, 1940 are regulated CDSCO is 124 and by filling of the vacant posts the by CDSCO under the provisions of the Drugs and strength would rise to 327. The posts are being filled Cosmetics Rules. The quality control over these devices through UPSC. 63 New Drug Inspectors have already is regulated through the system of registration and import joined while the remaining vacant posts are at various licences as applicable for drugs. stages of recruitment process through UPSC. The Government is also providing additional manpower to During the year 2010 the office of DCG(I) has granted CDSCO through the appointment of contractual staff to 301 registration certificates of the manufacturers of the assists the Department in handling the workload. Medical Devices who intended to export their products to India and has granted 680 licences for import of New Sub-zonal offices have been created at Bangalore, Medical Devices into the country. Apart from this, in 150 Jammu and Chandigarh for better coordination with the cases permissions for import of Medical Devices for test State Drugs Regulatory Authorities in these regions. and analysis have also been granted. D. Regulatory Activities at the Headquarters The manufacture of the notified devices is approved by the DCG(I) as Central Licence Approving Authority. 1. Quality Control over import of drugs and During the year 2010, 37 manufacturing licences were cosmetics approved by DCG(I). The CDSCO regulates the quality of drugs and cosmetics The Office of DCG(I) also processes the applications imported in to the country through the system of for grant of permissions for clinical trials in the country. registration and licensing as provided under the Drugs The office of DCG(I) has processed 40 such applications and Cosmetic Rules, 1945. This includes registration of for grant of permissions for clinical trials on Medical overseas manufacturing sites and of drugs, both bulk Devices and granted permission for clinical trials in three drugs and finished formulations. Import licences are then cases. granted to the Indian importers for import of the drugs from these manufacturers. The quality of imported drugs 3. Grant of permission for introduction of new is, however, further regulated at the port offices when drugs in the country the drugs are actually imported. New Drugs are permitted to be marketed in the country During the year 2010-11, the office of DCG(I) has granted in accordance with the permission granted by the Drugs 391 registration certificates of the manufacturers of the Controller General (India) after ensuring that these are drugs who intended to export their drugs to India and safe and efficacious and comply with the requirements have granted 2509 licences for import of drugs into the of Schedule Y of the Drugs and Cosmetics Rules. The country. applicants are required to provide technical data in respect of safety and efficacy before these could be permitted to The Office of DCG(I) also grants no objection certificates be marketed in the country. The definition of the new for dual use items (drugs) which may not be imported for drug also includes Fixed Dose Combinations which are use as a drug and extension of shelf life on the basis of required to be marketed for the first time in the country. stability studies conducted by the manufacturer for the purpose of export. The office of DCG(I) granted 241

194 Annual Report 2010-11 During the year 2010-11, the office of DCG(I) granted b. Guidelines for conducting Clinical Trials inspections 1057 permissions for manufacture or import of new drugs. have been posted on the website of CDSCO (i.e. Apart from this, 180 permissions for additional indications cdsco.nic.in). / additional strength in already approved drugs were also granted. c. Dugs and Cosmetics Rules are being amended to make mandatory the registration of Clinical In case of vaccines each manufacturing process is Research Organizations. required to be approved as a new drug and is evaluated for safety and efficacy before permission for marketing d. The Drugs and Cosmetics Act is proposed to be is granted. amended to include a separate Chapter on Clinical Trials. During the year 2010-11, permission for manufacture of vaccine as New Drugs was granted in 17 cases. 5. National Pharmacovigilance Programme 4. Clinical trials A Pharmacovigilance Programme of India (PVPI) has been launched on 14.07.2010 to capture Adverse Drug Clinical research is gaining momentum in the country as Reactions data in Indian population in a systematic way. there is an increased level of acceptance of Indian The programme will be coordinated by the Department research in the developed countries. The availability of of Pharmacology, All India Institute of Medical Sciences, highly developed infrastructure of clinical research has New Delhi which will act as the National Coordinating made India a destination for global clinical research. Multi Centre (NCC). The Centre will operate under the centric trials are conducted by pharma companies supervision of a Steering Committee, under the simultaneously in different parts in the world to assess chairmanship of Director, AIIMS, New Delhi with the safety and efficacy of the drug in different ethnic DCG(I) as one of the members of the Committee. groups and these are termed as Global Clinical Trials. The office of DCG(I) is receiving a large number of The objectives of the programme are as under: applications for grant of permissions for conducting global  clinical trials in India. During the year 2010, the office of To monitor Adverse Drug Reactions (ADRs) in DCG(I) has granted permissions for 239 Global clinical Indian population trials.  To create awareness amongst health care Clinical Trials are also permitted to be conducted in the professionals about the importance of ADR country to examine the safety and efficacy of the drugs reporting in India proposed to be marketed in the country. The protocols of  To monitor benefit-risk profile of medicines such trials are examined by the office of DCG(I) before these permission are granted. 272 permissions for  Generate independent, evidence based conducting such clinical trials in the country were granted in 2010. In case of vaccines, permissions for clinical trials recommendations on the safety of medicines were granted in 26 cases.  Support the CDSCO for formulating safety related The Office of DCG(I) also grants permissions for regulatory decisions for medicines conducting bioequivalence studies in chemically equivalent  Communicate findings with all key stakeholders drug formulations to study whether they produce identical therapeutic response in patients. Permissions for 443 such  Create a national centre of excellence at par with studies were granted to conduct of bioequivalence studies global drug safety monitoring standards in 2010. In the first phase of the programme, ten medical colleges Various initiatives have been taken for further streamlining spread across the country will collect the data of Adverse the regulatory control over the conduct of clinical trials. Drug Reactions (ADRs) in Indian population, and subsequently it will be expanded to other medical colleges a. Registration of clinical trials has been made also. These medical colleges will act as peripheral Adverse mandatory with the Centralized Clinical Trial Drug Reaction Monitoring and Reporting (ADR) Centres. Registry of ICMR with effect from 15th June 2009.

Annual Report 2010-11 195 These ADR Centres will be responsible for collecting the sale in the country vide Gazette Notification GSR 910(E) ADR reports, performing the follow up with the dated 12.11.2010. complainant to check completeness of the ADR reports as per Standard Operating Procedures (SOP’s) prescribed 9. Training Programmes for the purpose. The Data so collected will be forwarded Training Programmes for updating the skills of the to the National Coordinating Centre (NCC) at AIIMS, personnel working in CDSCO were held during the period New Delhi. in various fields. Workshops were held on clinical trial The Medical Colleges involved in the programme will be inspections, Medical Devices, training of New Drug provided Technical, Administrative & financial support Inspectors, Regulatory affairs and Pharmacovigilance. by CDSCO. This support will have the following 10. Transparency in the functioning components: The approvals granted by the CDSCO are regularly posted 1) Providing contractual Manpower in the form of one on the website www.cdsco.nic.in for the purpose of Technical Associate (TA) to each of the ADR transparency and accountability. The licences and Centre. approvals granted are put on display daily on two LCDs 2) Administrative & financial support in the form of for the information of the general public at FDA Bhavan, Computers, Printers, Photocopiers, internet services Kotla Road, New Delhi. File tracking system has been etc. introduced in the CDSCO headquarters. The approval letters in respect of Clinical trials and registrations of 6. Drugs Technical Advisory Board imports have also been started to be posted on the Drugs Technical Advisory Board is a statutory body under website. the Drugs and Cosmetics Act, 1940 to advise the Central E. Port Offices Government on technical matters arising out of the administration of the said Act and Rules made thereunder The regulatory control over the quality of imported drugs and to recommend amendments to the Drugs and and cosmetics is exercised at the port of entries at Sea Cosmetic Rules. ports/Airports situated at Delhi, Mumbai, Nhava Sheva, Chennai, Kolkata, Cochin and Ahmadabad. The quality 7. Drugs Consultative Committee is checked through random sampling of drugs from The Drugs Consultative Committee is another statutory consignments, for test and analysis. committee consisting of Central and State Drug Initiatives have been taken for creation of pharmaceutical Controllers to advise the Government on matters relating zones at Delhi and other air ports for providing dedicated to uniform implementation of the Drugs and Cosmetics areas for storage of drugs and sampling of drugs meant Act and Rules made thereunder throughout the country. for import or export to ensure that the quality of drugs The 41st meeting of the DCC was held on 28th October, does not deteriorate at the ports because of inappropriate 2010. storage. 8. Banning of Drugs F. Zonal Offices The Drugs and Cosmetics Act, 1940 provides powers to Six Zonal offices located at Ghaziabad, Mumbai, Kolkata Central Government to prohibit manufacture etc., of any Chennai, Ahmadabad, Hyderabad and three sub zonal drug or cosmetic in public interest. Drugs about which offices at Chandigarh, Jammu and Bangaluru, co-ordinate reports are received that these are likely to involve risk with State Drug Control Authorities under their jurisdiction to human beings or animals in the present context of the for uniform standards of inspection and enforcement. The knowledge are examined for their safety and rationality zonal offices are involved in the GMP audits and inspection through the expert committees and DTAB. Manufacture of manufacturing units of large volume parental, sera and and sale of the drug if considered necessary is prohibited vaccine, recombinant DNA (r-DNA) derived drugs and by Central Government in public interest through a gazette blood banks and blood product manufacturing units and notification. During the year 2010 the Drug Rosiglitazone, coordination with the State Drugs Control Organizations an anti-diabetic drug, was prohibited for manufacture and situated under the respective zone or subzone.

196 Annual Report 2010-11 G. Central Drugs Testing Laboratories these laboratories. An amount of Rs. 6.39 Crore for procurements of essentials laboratory equipments through There are six Central Drug Testing Laboratories engaged HSCC has been sanctioned and 50% of this amount i.e. in the testing of drugs and cosmetics in the country. Rs. 3.195 crore has already been released to HSCC for 1. Central Drug Laboratory, Kolkata procurement of equipments. Further requirements of equipments for various laboratories for upgrading their 2. Central Drug Testing Laboratory, Mumbai testing facilities are also under consideration of the 3. Central Drug Testing Laboratory, Chennai Government. 4. Central Drug Laboratory, Kasauli For the purpose of strengthening of manpower in the Central Drug Testing Laboratories, a proposal for the 5. Regional Drug Testing Laboratory, Guwahati creation of 397 additional posts is under consideration in the Ministry of Finance, Department of Expenditure. 6. Regional Drug Testing Laboratory, Chandigarh. For strengthening of State Drug Testing facilities The Central Drug Laboratory, Kolkata is the National assistance was provided to establish or upgrade testing statutory laboratory for quality control of Drugs and laboratories in the State to enhance testing facility in the Cosmetics in the country. It is an appellate laboratory in State laboratories under capacity building project through matters of dispute regarding testing of drugs. The World Bank. States have been further requested to laboratory is NABL accredited laboratory for chemical strengthen infrastructure in the State laboratories so as and biological sections. The Central Drug Testing to increase the testing facilities in the country. Laboratory, Mumbai is a statutory laboratory involved in testing of samples of drugs from the ports, new drugs 3. Common Technical Documents for New Drug and oral contraceptive pills. It is an appellate laboratory for copper T – intrauterine contraceptive device and tubal It is proposed to introduce Common Technical Documents rings. The Central Drug Testing Laboratory, Chennai is for submission of technical information for new chemicals an appellate laboratory for condoms and is testing, as entities by the applicants. Draft guidelines have been Government analyst, samples of cosmetics and drugs. placed on the website of CDSCO. Common Technical The laboratory has been granted NABL accreditation for Documents for submission of information for biological both chemical and mechanical sections. Central Drug products was earlier introduced in October, 2008. Laboratory, Kasauli is Government testing laboratory for 4. Guidance Documents sera and vaccines. Regional Drug Testing Laboratory, Guwahati is testing samples of drugs received especially Guidance documents for applications for approval of Fixed from States in the East Zone. The laboratory is NABL Dose Combinations have been put on website for the accredited laboratory for both chemical and biological benefit of the applicants in providing necessary technical testing. The Regional Drug Testing Laboraotry, data along with the applications. A system of preliminary Chandigarh which has been recently established is scrutiny at the time of the receipt of the applications has involved in testing of survey samples. also been introduced to expedite the processing of applications. H. New Regulatory Initiatives 14.3 INDIAN PHARMACOPOEIA 1. Overseas Inspections COMMISSION DRUG AND ALCOHOL Overseas inspections of drug manufacturing sites would DE-ADDICTION PROGRAMME be initiated from the year 2011. The inspections would In order to full-fill its main objectives, the commission be carried out in the first place in certain units located in has to focus on its priority works with limited resources Italy and China. being the formative years. By accepting these challenges, 2. Strengthening of Drugs Testing Laboratories during the period, the one of the important work to be accomplished was updating of the Indian Pharmacopoeia, The testing capacities of the Central Drugs Testing the book of standards for drugs by ways of bringing out Laboratories are being strengthened by increasing the the 6th edition. This work was completed within the manpower as well as equipments available for testing at stipulated time schedule. The book was released by

Annual Report 2010-11 197 Shri Ghulam Nabi Azad, Union Health & Family Welfare and economic burden caused by substance use and due Minister. The book comprises three volumes. The salient to its establishment linkage with HIV/AIDS. The onus features are 287 new monographs are included, 1/3rd of of responding to the problems associated with drug use the existing monographs of IP 2007 have been updated, lies on the central and state governments. The constitution harmonized the monographs on vaccines and sera, special of India under Article 47, enjoins that the state shall emphasis on herbal drugs monographs, added monographs endeavor to bring about prohibition of the consumption, of commonly used exciepents are included, the except for medical purposes, of intoxication drinks and Appendices and general chapters are updated, special of drug, which are injurious to health. The activities to emphasis on Liposomal drugs, 8 new and upgraded existing reduce the drug use related problems in the country could monographs related to Veterinary products have been broadly be divided into two arms supply reduction and added. It is getting overwhelming response from the demand reduction. The supply reduction activities which stakeholders for it’s scientific content and presentation. aim at reducing the availability of illicit drugs within the country come under the purview of the Ministry of Home Affairs with at the Department of Revenue as the nodal agency and are executed by various enforcement agencies. The demand reduction activities focus upon awareness building, treatment and rehabilitation of drug using patients. These activities are run by agencies under the Ministry of Health and Family Welfare, and the Ministry of Social Justice and Empowerment. The role of Ministry of Health & Family Welfare in the area of Drug De-addiction is demand reduction by way of providing treatment services. The Drug De-addiction The other mandate of IPC is publication of the National Programme in the Ministry of Health & Family Welfare Formulary of India. The process has made substantial was started in the year 1987-88 which was later modified progress as the compendium is under printing and could in 1992-93. The programme was initiated as a scheme be published during 2010. As the compendium had been with funding from the central government and last published in 1979, a lot of data had to be collected for implementation through the states. Under the scheme, a compilation of the new publication and the task was one time grant in aid of Rs. 8.00 lakhs was given to states accomplished with concerted efforts. for construction of each Drug De-addiction Centre and In the matter of infrastructure development also the a recurring grant of Rs. 2.00 lakhs was given to Drug Commission has made substantial progress. The existing De-addiction Centres established in North Eastern buildings are redesigned and renovated to accommodate Regions to meet the expenses on medications and other the new task of ‘Reference Substances’ production and requirements. At present 122 such Centres have been supply to the Regulatory Bodies and Industry including established across the country including centres in Central private drugs testing laboratories. The Commission has Government hospitals and institutions of which 43 Centres made available reference substances in respect of 51 have been established in the North Eastern Region. Under active pharmaceutical ingredients during 2010 and more this programme, a national nodal centre, the “National are to be added in the coming times. Drug Dependence Treatment Centre”, has been Scientists have been recruited in place of those who left established under the All India Institute of Medical the organization and in the posts created to take up the Sciences (AIIMS), New Delhi which is located in task of Reference Substances manufacture. Ghaziabad while two centres i.e. NIMHANS, Bangaluru and PGI, Chandigarh have also been upgraded by this 14. 4 DRUG AND ALCOHOL DE-ADDICTION Ministry. The purpose of these centres would not only to PROGRAMME provide de-addiction and rehabilitation services to the Drug addiction in India has of late emerged as a matter patients but also to conduct research and provide training of great concern both concerned both due to the social to medical doctors in the area of drug de-addiction.

198 Annual Report 2010-11 14. 5 NATIONAL DRUG DEPENDENCE addition to functioning as the nodal centre for monitoring CENTRE, AIIMS the functioning of these centres. The centre has a thrust on community interventions primarily workplace National Drug Dependence Treatment Centre, AIIMS interventions. which was established during the year 1987-88 and functioning at Deen Dayal Upadhyay Hospital, Hari Patient care: The Centre has seen 1514 new patients Nagar has now shifted in its own building constructed at and 4132 patients have come for follow up during the CGO complex, Kamla Nehru Nagar, Ghaziabad started period from April 2010 to October 2010. indoor facilities. Community Clinic of this centre at Training: The centre has conducted the following training Trilokpuri has been functioning from August, 2003 and a programmes: mobile clinic in an urban slum area of Delhi w.e.f. March, 2007. Apart from rendering patient-care services, the 1. One day workshop for medical officers on 26th centre, engaged in a number of research projects has an September 2010 at Bidar well equipped laboratory for both clinic and pre- clinical 2. Two day workshop for medical officers and lay research and CME activities. counselors at South Central Railways, Secunderabad on 24th and 25th September 2010. 3. One month orientation program on Substance Use Disorders in the month of November 2010. 4. Conducted Workshop on tobacco cessation for dentists from Indian Dental Association conducted by “National Resource Centre for Tobacco Control”, Department of Psychiatry, NIMHANS, Education: Bangaluru at Deaddiction Centre, NIMHANS, during the months of April, August and September Undergraduate and Post graduate medical and nursing 2010. students undergo formal training. This includes attendance to Journal discussions, seminars, case conferences and Toxicology tests: staff presentations held every week apart from clinical training. The toxicology lab has conducted more than 3000 tests for Urine by HPTLC, Urine kits both single and poly kits 14. 6 DE-ADDICTION CENTRE, NATIONAL during the above period. INSTITUTE OF MENTAL HEALTH AND NEURO SCIENCES (NIMHANS), BANGALURU Activities at the De-addiction Centre The De-addiction Centre has entered into its 20th year of functioning. In addition to expanded inpatient facilities, the centre has been actively providing in-house post- graduate training in substance use management for postgraduates in psychiatry, psychology, psychiatric social work and psychiatric nursing. Short-term training has been provided for deputed medical officers and social work trainees from several parts of the country. This includes WHO fellows from the Asian region and DMHP trainees. As the regional centre for South India, the DAC has carried out training programmes in substance abuse One month Orientation programme on Substance Use management for de-addiction centres in South India in Disorders.

Annual Report 2010-11 199 6. A Centre doctor addressed Punjab Armed Police (PAP) on the various aspects of drug and alcohol related problems. 7. Center organized three drug deaddiction awareness and treatment camps in the villages of Tehsil Kharar of Distt. Mohali of Punjab. B. The center commissioned 500 SQMT expansion for Outpatient services. This expansion included spacious Waiting Halls for patients and their relatives, larger Record Room cum Registration room. 8 rooms for Consultant, Senior Residents, Release of Information Booklet, ‘Addiction-What to know & Junior Residents and Medical Social Workers, and How to get Help’ toilets for OPD visitors and staff members. The facility became operational from 21st October 14. 7 DE-ADDICTION CENTRE, PGI, 2010. CHANDIGARH C. The Outpatient facility has incorporated a ramp for The Drug De-addiction and Treatment Center was actively the disabled patients. involved in various extramural activities during this period. This was aimed at making the general population and, D. The center has started well equipped 2-bed isolation special and high risk groups aware of various types of facility from the existing beds of inpatient for addictive substances, their harmful effects, myths acutely ill intoxicated patients from 6th December involved, and various treatments options and accessibility. 2010. A. Following were the activities and achievements of 14. 8 REGIONAL DE-ADDICTION CENTRE the center during the period. (UNDER DEPARTMENT OF PSYCHIATRY), JAWAHARLAL 1. International Day against Drug Abuse and Illicit INSTITUTE OF POSTGRADUATE Trafficking was celebrated by the Youth Affairs rd MEDICAL EDUCATION AND Organization in their 3 State Level function in the RESEARCH(JIPMER) , PUDUCHERRY Red Cross Bhawan, Sector-16 Chandigarh. Doctor from the Drug Deaddiction Center gave a talk on Background medical, psychological, social aspects of drug and Department of Psychiatry came into existence at JIPMER alcohol abuse. from 1962. The clinical services provided by the 2. The Faculty of the Center participated in the department in the area of substance use disorder was Doordarshan program on the problem of addiction, upgraded and designated as a Regional De-addiction its prevention and treatment. Centre in 1991 by Ministry of Health and Family Welfare, Government of India. 3. Doctors of the center held two interactive programmes with NSS Volunteers of Chandigarh This centre has inpatient facilities for the management region. of substance abuse disorders. Drug De-addiction Clinic is conducted on every Saturday (forenoon) which offers 4. Doctors from the Center participated in three comprehensive psychosocial assessment and Chandigarh Administration sponsored lectures and management of substance abuse disorders. The services interactive sessions with the students of Government for Tobacco cessation facility are also available in this and Private Colleges Chandigarh. clinic. 5. The Center also organized 3 interactive programmes This centre is mainly involved in : with school children and women on various aspects of drug abuse in the Villages of Tehsil Kharar of 1. Providing clinical care of patients through the Distt. Mohali of Punjab. hospital, community based out-reach care. Services offered have been daily OPD, in-patient care. 200 Annual Report 2010-11 2. Health education-talks on radio and talks in school Journal discussion- Once in two weeks on substance use disorders delivered by our faculty Case Conference- Once in two weeks 3. Manpower development-training of several categories of staff Continuing Medical Education  4. Overall quantification of health damage as all Our faculty attends regularly conferences, specialities of medicine are available at JIPMER workshops, seminars, symposium, training courses related to this field 5. Documentation and creation of data base to facilitate  research in this area. Training by Trainers programme  The services and facilities at the Centre include the Lectures delivered by faculty for workers in following: transport services, state of Puducherry and to nursing students from different medical colleges  Clinical Service: (out patients department, In-  patient, brief intervention, community care in urban International Conferences and rural areas through community health camps)  Effectiveness of Yoga in reduction of stress in  Teaching/ training: (Junior Residents, General primary caregivers of patients with alcohol Duty Medical Officers from various states, Nursing dependence. staff and Anganwadi workers) Patient Care (Statistics 2010-11)  Laboratory Service: (Biochemical, General Information haematological tests and screening for HIV/AIDS as a part of assessment of health). 1. Total No. of beds : 07  Information and Library: (for substance abuse 2. OPD Attendance : 1715 related health education various pamphlets, videos 3. Admission : 118 are available in local languages). 4. Discharges : 100 Education: A) Under Graduate-During their posting in the department of Psychiatry, they are posted for a day OPD & Specialty New Old Total in the de-addiction clinic. Clinics Attendance Cases Cases B) Post Graduate-Residents doing MD (Psychiatry) General OPD: are posted for 6 months during their entire course (Follow –up-cases) 315 1400 1715 duration. Admitted C) Post graduate teaching patients 118 - 118 Seminar- Weekly Total: 433 1400 1833

Annual Report 2010-11 201

Chapter 15

Medical Education, Training & Research

15.1 INTRODUCTION Council Act, 1933, which was later, replaced by the Indian Medical Council Act, 1956 (102 of 1956). The main The Centre has set up regulatory bodies for monitoring functions of the Council are (1) Maintenance of uniform the standard of medical education, promoting training the standard of Medical Education at undergraduate and research activities. This is being done with a view to postgraduate level; (2) Maintenance of Indian Medical sustain the production of medical and para-medical Register; (3) Reciprocity with foreign countries in the manpower to meet the requirements of health care delivery matter of mutual recognition of medical qualifications; system at the Primary, Secondary and Tertiary levels in (4) Provisional/permanent registration of doctors with the country. This chapter discusses the status of these recognized medical qualifications, registration of additional activities conducted by the various bodies and institutions. qualifications, and issue of good standing certificate for 15.2 MEDICAL COUNCIL OF INDIA doctors going abroad (5) Continuing Medical Education, etc. The Medical Council of India was established as a statutory body under the provisions of the Indian Medical

Inspections: A) Undergraduate: 1) Inspections for establishment of new medical colleges = 25 2) Inspections for renewal of permission = 50 3) Compliance Verifications Inspections +Esst. + 11(2) + Surprise Inspections (Esst.(10+25+3+1) = 39 4) Inspections for Approval of the colleges = 02 5) Inspections for Increase of seats = 03 6) Inspections for renewal of permission for increase of seats = 14 7) Compliance verification inspections for renewal of Increase of seats+ increase+ 11(2) Surprise (14+ 0+0) = 14 8) Inspections for approval of the colleges for increase of seats = 01 9) Pre-PG inspection = 01 10) Compliance Verification Inspection for Pre-PG = 00 11) As per Court Order = 00 12) Periodical Inspection + Compliance verification (7+20) = 27 Total 176

Annual Report 2010-11 203 B) Postgraduate: colleges in the country out of which 237 medical colleges have been recognized under Section 11(2) of the IMC (i) 279 inspections for approval of starting various Act, 1956 by Medical Council of India. The remaining postgraduate medical courses at Medical Colleges 77 colleges have been permitted under section 10A of were carried out subsequent to request received the IMC Act, 1956 for starting MBBS course. u/s 10A of the IMC Act, 1956 through Central Government, Ministry of Health &family Welfare. The provisions of IMC (Amendment) Act, 1993 whereby Section 10A was introduced and came into deemed effect (ii) 288 inspections for recognition (including from 27th August, 1992 (initially promulgated as an compliance verification) of postgraduate medical ordinance). As per the amended Act prior permission of qualification u/s 11(2) of the IMC Act, 1956 were the Central Government is mandatory for opening of a carried out. new medical college, increase in admission capacity and (iii) 223 inspections for increase of seat in various starting of new or higher course of studies. The eligibility course u/s 10A of the IMC Act, 1956 were carried and qualifying criteria for opening of a new medical college out. is laid down in Establishment of Medical College Regulations, 1999. The minimum requirement for 50/100/ Registration: 150/200/250 students admission are contained in the Various types of Registration Certificate issued from minimum standard requirements for the medical college 1.04.2010 to 30-11-2010 by this Council during the year Regulations, 1999. under review are as under: As per the newly inserted Section 3B (b) (ii) in Indian (i) Permanent Registration Certificate - 1387 Medical Council (Amendment) Act, 2010, the Board of Governors shall grant independently permission for (II) Provisional Registration Certificate - 1222 establishment of new medical colleges or opening a new (III) Additional Qualification Certificate - 0332 or higher course of study or training or increase in admission capacity in any course of study or training (IV) Good Standing Certificate - 0804 referred to in Section 10A without prior permission of (V) Eligibility Certificate - 1054 Central Government including exercise of power to finally approve or disapprove the same. Continuing Medical Education: During the year 2010- 2011, the Council has planned to hold 200-250 CME At present, there are 314 medical colleges in the country programmes. Till November, 2010, 200 CME programmes out of which 238 medical colleges have been recognized have been approved are likely held at various medical under Section 11(2) of Indian Medical Council Act, 1956 institutions in the country. by Medical Council of India. The remaining 76 medical colleges have been permitted under Section 10(A) of Accounts & Establishment: The following outlay has Indian Medical Council Act, 1956 for starting MBBS been approved by the Central Government as Grant-in- course. Out of these 314 Medical colleges, 149 medical aid (Plan & Non-Plan) for the year 2010-2011: colleges with annual admission capacity of 17382 students Out lay approved (Rs.) are in Government Sector and 165 medical colleges with annual admission capacity of 19645 students are in Private Plan (including CME) 100 Lakhs Sector. The admission capacity both in Government and Private medical colleges is about 37027 students per year. Non –Plan Nil During the academic year 2010-11, 08 new medical A sum of Rs. 67,19,66,154/- has been received by the colleges in private sector and 06 medical colleges in Council till December, 2010 from other resources. A sum government sector with admission capacity of 1650 of Rs. 50,00,000/- was received so far under plan Grants- students were granted permission. Out of these, 03 in- aid (plan) till December 2010 from the Central medical colleges were granted permission by the Central Government. Government and rest 11 medical colleges were granted permission by the newly constituted Board of Governors, Policy regarding Establishment of Medical College: Medical council of India in view of the Indian Medical As on date November, 2010 there are 314 medical Council (Amendment) Act, 2010. The Central

204 Annual Report 2010-11 Government/Board of Governors has also granted MDS Courses in 40 specialities in 14 Dental Colleges permission for increase in seats of 175 students in existing and starting of PG Diploma Course in 01 speciality at 01 medical colleges during the academic year 2010-11. The Dental College. Post Graduate intake capacity of these colleges is about The Central Govt. on the recommendations of the Council 18625 students annually. had allowed / renewed its permission for 2nd/3rd/4th/5th/ The Central Government has a Centrally Sponsored 6th year BDS course in 83 Dental Colleges and renewed Scheme for Strengthening and Up-gradation of State its permission for increase of seats for 2nd/3rd/4th/5th/6th Government Medical Colleges for starting/increasing post year BDS Course at 27 Dental Colleges, renewed its graduate seats in existing disciplines with priority given permission in MDS Course for 2nd/3rd/4th year at 83 Dental to the disciplines like Anatomy, Forensic Medicine, Obst. Colleges in 323 specialities and with increased intake & Gynaecology, Paediatrics, Anaesthesiology, General capacity at 17 Dental Colleges in 56 specialities and also Medicine, General Surgery, Microbiology, Paediatrics, renewed its permission in PG DiplomaCourse for 2nd/3rd Anaesthesiology, General Medicine, General Surgery, year at 03 Dental Colleges in 13 specialities. 1012 Microbiology, Physiology, Pharmacology, Community Inspections of the various Dental Colleges in the country Medicine, Geriatric, Transfusion Medicine and Bio- had been carried out by the Council’s Inspectors/Visitors Chemistry. Under this scheme, an amount of Rs. 1350 during this period. The Council had granted its permission crores has been earmarked for this purpose. With the to start Dental Mechanic Courses at 07 Dental Colleges implementation of the scheme, approximately 4000 more & Dental Hygienist Course at 03 Dental Colleges. The PG seats would be available. applications for starting of MDS courses / increase of MDS seats / renewal of MDS course for 2011-12 will be Till December 2010, 44 State Government Medical finalised in February/March, 2011 after considering the Colleges from Bihar, Chandigarh, Himachal Pradesh, recommendations of DCI. Jharkhand, Kerala, Madhya Pradesh, Orissa, Punjab, Rajasthan, Uttarakhand, Uttar Pradesh and West Bengal The Govt. of India on the recommendation of the Council including 03 medical colleges from Assam have been had issued 87 notifications of recognition of BDS/MDS covered under this scheme. qualifications awarded by the 34 Indian Universities & 02 Foreign Universities under Section 10(2) & 10(4) of 15.3 DENTAL COUNCIL OF INDIA (DCI) the Dentists Act, 1948. The Council had recognized the The Dental Council of India is a statutory body constituted Dental Mechanic Course at 05 Dental Colleges and Dental by an Act of Parliament viz. Dentists Act, 1948 (XVI of Hygienist Course at 04 Dental Colleges. A sum of 1948) with the main objective of regulating the Dental Rs.19.00 Lakhs has been provided as grant-in-aid to the Education, Dental Profession, Dental ethics in the country Council during the year 2010-2011. and recommend to the Govt. of India to accord permission 15.4 PHARMACY COUNCIL OF INDIA to start a Dental College, start higher course & to increase of seats. For this purpose the Council periodically carries The Pharmacy Council of India (PCI) is a body constituted out inspection to ascertain the adequacy of courses and under section 3 of the Pharmacy Act, 1948 to regulate facilities available for the teaching of Dentistry. the profession and practice of Pharmacy. The objectives of the Council is to be prescribe minimum standards of The Council had received 348 applications in prescribed education required for qualification as a pharmacist, form/scheme from the Central Govt. for (i) establishment uniform implementation of educational standards, of new Dental colleges (ii) starting of MDS Courses approval of course of study and examination for (iii) increase of seats in BDS/MDS Courses, and (iv) pharmacists, withdrawal of approval, approval of starting of P.G. Diploma Course, for evaluation & qualifications granted outside India and maintenance of recommendations in accordance with the provisions of Central Register of pharmacists. the Section 10A of the Dentists Act, 1948. During the said period, the Central Govt. on the recommendations The Council arranged 775 inspections of diploma and of the Council had permitted for 01 new Dental College degree institutions and held a number of meetings of the and increase of admission capacity in BDS course in 01 Executive Committee and central council during the last Dental College, starting of MDS Courses in 114 one year as a result of which approval of 80 Diploma & specialities at 43 Dental Colleges, increase of seats in Degree institutions was extended u/s 12 of the Pharmacy

Annual Report 2010-11 205 Act; 32 new Diploma & Degree institutions were granted • Reduction in regional imbalances in availability of approval u/s 12 of the Pharmacy Act; 16 new Pharm. D. Paramedics institutions were granted approval for the conduct of Introduction of courses in New/Cutting Edge course and 5 new Pharm. D. (Post Baccalaureate) • Disciplines institutions were granted approval for the conduct of course. • Augmentation of Capacity for Planning, Monitoring, Evaluation etc. At present 561 institutions with 33635 admissions for Diploma in Pharmacy and 383 institutions with 22,715 • Provision of quality assured services through admissions for degree in Pharmacy has been approval in-service training, action research, onsite support by the Pharmacy Council of India. etc. Continuing Education Programmes (CEP) play an 15.6 INDIAN NURSING COUNCIL (INC) important role in the growth of the knowledge bank of the pharmacist. The PCI from its own resources is giving The Indian Nursing Council is an autonomous body under a financial assistance of Rs. 10,000/- per course subject the Government of India, Ministry of Health and Family to ceiling of 12 courses to the State Pharmacy Councils Welfare. Indian Nursing Council Act, 1947 enacted by, for the conduct of CEP for pharmacists. PCI further giving statutory powers to maintain uniform standards and decided to give a financial assistance of Rs. 10,000/- to regulation of nursing education all over the Country. one pharmacy institution per state once in a year for Indian Nursing Council prime responsibility is to set the conduct of orientation programme for pharmacy teachers. norms and standards for education, training, research and The Council has taken up the matter with the State Govts./ practice with in the ambit of the relevant legislative State Pharmacy Councils for setting up of Drug framework. First Inspection is conducted to start any Information Centres for dissemination of knowledge. The nursing program prescribed by Indian Nursing Council. Council is constantly pursuing with the State Governments Periodic inspections are conducted as per the requirement for appointment of inspectors to ensure implementation of the institution for new programmes as well as of section 42 of the Pharmacy Act, 1948. enhancement of seats. A new initiative for strengthening/upgradation of A sum of Rupees 3,67,32,530.00 has been received from Pharmacy institutions and continuing education the training institution as inspection/affiliation fees upto programme for pharmacy teachers and practicing 30th November 2010. pharmacists has been approved by Govt. for Rs. 85.00 crores during the 11th Five year plan. Institutions recognized by Indian Nursing Council 15.5 DEVELOPMENT OF PARAMEDICAL Number of Nursing Institutions recognized upto 30th SERVICES November 2010 is as follows: A Centrally Sponsored Scheme for establishment of one Programme Total National Institute of Paramedical Sciences (NIPS) at ANM 944 Delhi and eight Regional Institutes of Paramedical Sciences (RIPS) as well as developing the existing GNM 2287 RIPANS, Aizawal as the 9th RIPS and manpower development to support State Government Medical B.Sc. (Nursing) 1502 Colleges through one time grant has been initiated by P.B.BSc. (Nursing) 462 M/o H&FW during the 11th Plan period at the cost of Rs. 1156.43 crores to be shared in the ratio 85:15 between M.Sc. (Nursing) 432 Centre and the State Governments. Post Basic Diploma Programme 173 The Scheme aims to augment the supply of skilled Number of Registered Nurses paramedical manpower and promote paramedical training through standardization of such education/courses across 11,28,116 Nurses, 5,76,810 ANM’S and 52,490 Health the country. This Capacity Building scheme will also lead Visitors have been registered with various State Nursing to:- Council upto 31st December 2009. 206 Annual Report 2010-11 New Initiatives (iv) Establishment of College of Nursing at JIPMER, i) National consortium for Ph.D. in Nursing : National Puducherry. Consortium for Ph.D. in Nursing has been constituted by Indian Nursing Council to promote (v) Upgradation of Schools of Nursing into Colleges research activities, in various fields on Nursing in of Nursing attached to Dr. R.M.L. Hospital, S.J. collaboration with Rajiv Gandhi University of Health Hospital and Lady Hardinge Medical College, New Science, supported by WHO. Total 153 students Delhi. have been enrolled under National consortium of (vi) National Florence Nightingale Award for Nursing Ph.D. in Nursing. Personnel. ii) Indian Nursing Council has initiated pro active Training of Nurses: measures to relax certain norms with regard to student patient ratio, student teacher ratio, The pattern of assistance for conducting Continuing experience, having constructed building instead of Nursing Education Programme on the following areas five acre land, allowing sharing of physical and in order to update the knowledge and skills of the clinical facility to run different programmes. Nursing personnel has been revised from Rs. 75,000 /- to 1,65300/- iii) Relaxing of Govt. order for opening of Additional Category of Nursing Area of continuing Programme in institutions which are running already Personnel Education INC recognized programme. Staff Nurses - Different clinical specialty iv) Syllabus for different speciality nursing programme one year post basic has been developed for Training Nurse Administrators - Management Technique of Nurses in various speciality courses. Nursing Educators - Educational Technology v) 14 Speciality courses have been developed. Duration of training - 7 days vi) Nurse Practitioner programme: The council has No. of Participants - 30 per training developed Nurse Practitioner programme and under programme implementation in various states. A sum of Rs. 1.00 crore has been allocated for the year vii) Recipient of Global Funding (GFATM) for training 2010-11 for conducting 60 courses to train 1800 Nursing of 90,000 Nurses in HIV/AIDS and capacity personnel. building of 55 nursing educational institutions in India. Strengthening of Schools / Colleges of Nursing: In order to improve the quality of training imparted at the The website of Council is www.indiannursingcouncil.co.in existing Schools and Colleges of Nursing, a sum of & www.indiannursingcouncil.org is being updated Rs.25.00 lakhs as revised pattern of assistance has been regularly. approved towards procurement of A.V Aids, improvement 15.7 DEVELOPMENT OF NURSING of library, additions and alterations of School/College/ SERVICES Hostel building. In order to improve the quality of Nursing Services, the A sum of Rs. 50.00 lakhs have been released during the following activities are being implemented under the year 2010-11 for strengthening two institution during the scheme of Development of Nursing Services: - year 2010-11. (i) Training of Nurses. Upgradation of Schools of Nursing attached to Medical Colleges into Colleges of Nursing: (ii) Strengthening of existing Schools/Colleges of Nursing. A revised one time assistance of Rs. 6.00 crores has been approved for upgrading a School of Nursing into (iii) Upgradation of Schools of Nursing attached to College of Nursing in order to increase the availability of Medical Colleges into Colleges of Nursing graduate nurses. The funds are released to the Institute subject to the condition that State Government/Institution

Annual Report 2010-11 207 will bear the recurring expenditure. The financial scheme of opening of ANM /GNM Schools to the states assistance is meant for civil works including addition and as per details given below :- alteration of school and hostel building and for furniture, audio- visual aids. Sl.No Name of the State No. of No. of Districts Districts for 20 institutions in the states of Rajasthan (5), Jharkhand for opening opening (3) Gujarat (2). Tamil Nadu (2), West Bengal (2) ANM GNM Himachal Pradesh (1), Manipur (1) , Mizoram (1),& Uttar Schools Schools Pradesh (3) have been released grant-in aid during the year 2010-11. I. Arunachal Pradesh 3 2 II. Bihar 9 5 Establishment of College of Nursing at JIPMER, Puducherry and Upgradation of Schools of Nursing III. Haryana - 1 into Colleges of Nursing attached to Dr. R.M.L. IV. J&K 6 5 Hospital, S.J. Hospital and Lady Hardinge Medical College, New Delhi: V. Manipur - 6 College of Nursing at JIPMER, Puducherry has been VI. Puducherry 2 - established during 2006-07 and the School of Nursing at VII. Orissa 2 1 Lady Hardinge Medical College, New Delhi has been VIII. Rajasthan 1 1 upgraded into College of Nursing during 2007-08. The School of Nursing at Dr. RML Hospital and Safdarjung IX. Sikkim 2 - Hospital has bee upgraded during the year of 2008-09. X. Uttarakhand 5 4 National Florence Nightingale Award for Nursing Total 30 25 Personnel: II. Faculty Development Scheme: National Awards for Nurses are given as a mark of highest recognition for the meritorious services of the nurses and In order to meet the shortage of qualified Post Graduate teachers in nursing to improve the quality of nursing nursing profession in the country. From 2007 onwards education in the high focused States, a faculty this award has been revived with the consent of Hon,le Development programme has been approved and 22 President of India and named as National Florence nominations have been received from 7 States for Nightingale Award”. 27 nursing personnel had been undergoing training in M.Sc (Nursing) at the identified honored with this prestigious award. Each award carries Institutions wiz. SNDT College of Nursing, Mumbai, a Certificate of Merit and Cash Award of Rs. 50,000/- . PGIMER, Chandigarh and Govt. College of Nursing, A sum of Rs. 80.00 lakhs has been earmarked during the SSKM Hospital, Kolkata. year 2010-11. 15.8. RAJKUMARI AMRIT KAUR COLLEGE New scheme of strengthening/upgradation of OF NURSING nursing services under human resource: The Rajkumari Amrit Kaur College of Nursing, New Delhi, I. Opening of ANM /GNM Schools: a subordinate organization of the Ministry of Health and A sum of Rs. 250.00 crore have been allocated for the Family Welfare was established in 1946 with the object year 2010–11 for implementing the new scheme. CCEA of developing and demonstrating model programmes in has approved this Ministry’s proposal for opening of 132 Nursing Education. The College works in close ANM Schools and 137 GNM Schools in those districts association with health centres, hospitals, medical centres of the states where there are no such schools. 154 districts and allied agencies for teaching undergraduates, post- in 23 High Focus States have been identified having no graduates and also for continuing education of nursing ANM and GNM schools. A Sum of Rs. 123.00 crore personnel. The college provides advisory and consultative has been approved so far for release under the new services on nursing education matters to the States, Union Territories and some developing countries.

208 Annual Report 2010-11 The admissions & graduations to B.Sc. (Hons) Nursing, 15.9. ALL INDIA ENTRANCE EXAMINATION Master of Nursing and M.Phil in Nursing are made on FOR ADMISSION TO MBBS/BDS the basis of merit in the selection test as laid down by the COURSES, 2010 CONDUCTED BY CBSE Academic Council of the University of Delhi. The All India Pre-Medical/Pre-Dental Entrance Total admissions made in July, 2010 = 92 Examination was conducted in two stages (Preliminary & Final) by Central Board of Secondary Education st B.Sc. (H) Nursing 1 year = 68 (CBSE) on 3.4.2010 and 16.5.2010 for 15% All India Master of Nursing 1st Semester = 24 Quota seats in Medical/Dental courses all over the country. Total 1,46,230 candidates appeared for No. of foreign students admitted Preliminary Examination. On the basis of the result of during 2010-11: Preliminary Entrance Examination, 14,218 candidates had B.Sc. (H) Nursing = 02 been declared qualified for final stage examination. The final result was declared on 23.5.2010 and 2434 Master of Nursing = Nil candidates were placed in the merit list and 2238 in No. of participants in Short term courses: = 60 waiting list. Allotment was made upto rank UR- 3467 in 120 Government Medical and 27 Dental Colleges on 2012 Community Services: During B.Sc. (Hons.) Nursing MBBS and 238 BDS courses seats respectively. programme the major emphasis was to develop primary health care competencies in the family and community Allotment of Colleges and courses to the successful setting by utilizing local resources and achieve community candidates were made as per their rank by Video participation. Students actively participated in the national Conferencing at three centers AIIH&PH, Kolkata, health programmes. AIIPMR, Mumbai, NIS, Chennai and CHEB Building, New Delhi in two rounds. The whole admission process Continuing Education: During the period under review, for 15% All India Quota of MBBS/BDS seats was continuing education courses were conducted for nursing successfully completed by 11.8.2010. personnel. One national level short-term course on “Quality Assurance in Nursing” was conducted during 15.10. ALL INDIA ENTRANCE EXAMINATION the year 2010-11. FOR ADMISSION TO 50% POST- GRADUATE SEATS-2010 CONDUCTED Rural Field Teaching Centre, Chhawla: The Rural BY A.I.I.M.S. NEW DELHI. Field Teaching Centre was established in 1950 for the purpose of providing objective oriented Rural Community In compliance with directions of the Hon’ble Supreme Health Nursing experience to the students. It covers 7 Court of India, the All India Institute of Medical Sciences, villages with approximately population of 17000 and is New Delhi conducted the All India Entrance Examination situated 35 Kms. away from the College. The Centre for admission to 50% All India Quota PG Medical/Dental provides an integrated comprehensive health and family courses on all India basis. welfare services to the community in MCH services, The Entrance Examination was held at 126 Centers in 15 family planning, immunization, nutrition and health capital cities in the country on 10.1.2010. A total 62,161 education programme. candidates were registered and 56,826 candidates The Centre also has DOTS and Microscopic Centre for appeared in the examination for admission to MD/MS/ screening and treatment of T.B . Patients. Chief Medical Diploma and MDS courses. The result was declared on Officer of the R.A.K. College of Nursing is the In-charge 15.2.2010 for enabling the allotment of seats for the merit/ of the R.F.T.C. and DOTS Centre. In addition, the Centre wait list candidates in 102 Medical and 24 Dental Colleges provides mobile Van clinic services to seven villages with all over India. There were 3850 recognized/approved seats special emphasis on Primary, secondary and tertiary level. in MD/MS/Diploma Courses and 155 approved seats in R.F.T.C. is a team movement point for Pulse Polio MDS course under the 50% All India PG Quota for 2010. Programme. The allotments were made to the successful candidates by personal appearance from 23.2.2010 to 17.3.2010 (1st round) & 22.4.2010 to 12.5.2010 (2nd round for merit

Annual Report 2010-11 209 and wait listed candidates for unallotted seats) and 15.12 NATIONAL BOARD OF 2.6.2010 to 12.6.2010 (Extended 2nd round). The whole EXAMINATIONS admission process to All India Quota PG/Diploma seats The National Board of Examinations established in 1975, was successfully completed by 12.6.2010. functioned as a wing of the National Academy of Medical 15.11 ALLOCATION OF MEDICAL/DENTAL Sciences upto 1982 Government of India, after a review, SEATS FROM CENTRAL POOL took a policy decision to make it an independent autonomous body with effect from March 1, 1982 under MBBS and BDS Seats: the Ministry of Health and Family Welfare. A Central Pool of MBBS and BDS is maintained by the The Diplomate qualifications awarded by the National Ministry of Health and Family Welfare by seeking Board of Examinations have been equated with voluntary contribution from the various States having postgraduate degree and post-doctoral level qualifications medical colleges and certain other Medical Education of universities by the Government of India Ministry of Institutions. In the academic session 2010-11, 261 MBBS Health and Family Welfare. Considering the fact that and 28 BDS seats were contributed by the States and India has the expertise in various sub-specialty areas with medical institutions. These seats were allocated to the centers having high tech equipment and trained manpower beneficiaries of the Central Pool, viz., States/Union performing exceptional quality work and also keeping in Territories, which do not have medical/dental colleges of mind the need to increase manpower that can render their own, Ministry of Defence (for the wards of Defence highest degree of professional work,the National Board Personnel), Ministry of Home Affairs (for the children is also conducting Fellowship programme in 16 sub- of para-military personnel and Civilian Terrorist Victims), specialties. Cabinet Secretariat, Ministry of External Affairs (for meeting diplomatic/ bilateral commitments and for the The 16th Convocation of National Board of Examination children of Indian staff serving in Indian Mission abroad), was held on 5th April 2010 at Vigyan Bhawan, Maulana Ministry of Human Resource Development (for Tibetan Azad Road, New Delhi to confer the Prestigious Refugees) and Indian Council for Child Welfare (for “Diplomate of National Board” Degrees to the successful National Bravery Award winning children). candidates during the session from Dec, 2008 to June 2009. On that occasion Dr. Montek Singh Ahluwalia, MDS Seats: Deputy Chairman, Planning Commission, would be the There are 4 MDS seats in the Central Pool contributed Guest of Honour. Prof. K Srinath Reddy, President of by Government of Uttar Pradesh, which are allotted to National Board of Examination presided the Ceremony. the in-service doctors sponsored by the States/Union In the convocation, 1500 candidates were awarded Territories without MDS teaching facility on a rotational “Diplomate of National Board” Degrees from December basis. For the academic session 2010-11, in-service 2008 to June 2009 sessions. Approximately 700 doctors sponsored by the States of Uttranchal, Tripura, candidates in 46 specialties were awarded the degrees in Nagaland and Manipur were nominated against these person and 800 candidates were awarded their degrees seats. inabsentia. Dr. Montek Singh Ahluwalia awarded Gold Medals to the candidates for their outstanding Post Graduate Medical Seats for Foreign Students: performance in various broad and super specialities. There are 5 P.G. medical seats in the Institute of Medical Interactive teleconferencing sessions for DNB candidates Sciences, Banaras Hindu University, Varanasi, reserved using facilities of IGNOU are being done every Thursday for foreign students in a calendar year. The foreign from 2.30 PM to 7.30 PM at IGNOU. Interactive radio students against these seats are nominated by the Ministry counseling sessions for DNB candidates using facilities of Health & Family Welfare on the advice of Ministry of of IGNOU are being done every Thursday from 5.00 External Affairs. During the year 2010, these seats were allocated to the candidates from Nepal (1 seat), Maldives PM to 6.00 PM at IGNOU. (1 seat) and Mauritius (3 seats).

210 Annual Report 2010-11 The NBE conducted 33 CME programmes for DNB Emeritus Professors of NAMS: In order to strengthen candidates and 5 CMEs for consultants during the year the intramural CME Programmes, the Academy has under report. appointed 43 eminent Fellows of the Academy for Emeritus Professorship. The Emeritus Professors have 15.13. NATIONAL ACADEMY OF MEDICAL been assigned the responsibilities viz. (i) to identify one SCIENCES (INDIA) or more medical colleges where intramural CMEs of The National Academy of Medical Sciences (India) NAMS can be organized and where lectures can be given established in 1961 is a unique institution which fosters by designated emeritus Professors who will also and utilises academic excellence as its resource to meet strengthen the Postgraduate Medical Education through the medical and social goals. Over the years, the clinical rounds, case discussion or laboratory exercises, Academy has recognized the outstanding achievements (ii) to suggest topics/subjects related to their expertise of Indian scientists in the field of medicine and allied for intramural CME and would assist in organizing and sciences and conferred Fellowship and Memberships. conducting these with NAMS support, (iii) to undertake Fellows and Members are chosen through a peer review travel to any part of the country at least once a year and process consisting of screening by the Advisory Panel of visit one or two medical institutions to deliver lectures, Experts and the Credentials Committee, election through seminars and also contribute towards academic activities voting by the Council and by all the Fellows. and training of Postgraduates. The Directory of the Emeritus Professors is being updated during the Golden As on 31st October, 2010, the Academy has on its roll, 6 Jubilee Year of the Academy. Honorary Fellows, 830 Fellows and 4950 Members (including 1625 MAMS and 3325 MNAMS). Intramural CME Programmes: The CME Programme Committee identifies, from time to time, topics of national The 50th Annual Meeting of the Academy was held at and academic relevance for funding as intramural CME the Govt. Medical College, Patiala on 29th, 30th and 31st Programmes. The Academy provides TA/DA and October, 2010. The Governor of Punjab, Shri Shivraj Patil honorarium to Fellows who attend the CME programmes was the Chief Guest. Professor J.S. Bajaj, Emeritus as Observers. During the year 2010-2011, an intramural President and Chairman- Academic Committee, NAMS CME programme-NAMS-PGI National Symposium on was the Guest of Honour. “Acute Coronary Syndromes” is being held at the Seventy Five candidates were given Scrolls of Fellowship Postgraduate Institute of Medical Education and and Membership of the Academy at the ceremonial Research, Chandigarh. occasion of the Annual Convocation of the Academy held NAMS has made a major effort to improve the outreach at Govt. Medical College, Patiala. of CME programme by establishing tele-linkages between The Annual General Body Meeting was held on 30th medical colleges so that more medical colleges can October, 2010. Ten Orations and Six Awards were participate and benefit from CME programmes. The awarded to eminent Bio-medical Scientists of the Country NAMS-PGI Centre for Tele-education in the Health for the year 2010-2011. Sciences at Chandigarh was established in November 2005. The centre is connected to the medical colleges in The Academy has been recognized by the Government Punjab, Haryana and Himachal Pradesh and also to some of India as Nodal Agency for Continuing Medical district hospitals in Punjab and Himachal Pradesh. Education for medical and allied health professionals. Encouraged by these successful outcomes, NAMS Since 1982, CME programmes are an important activity proposes to intensify such tele-education activities by of the NAMS to keep medical professionals abreast with developing the NAMS JSB Centre for Multi-professional newer/current medical problems of the country and to Education and Research at Delhi as the major in-house update their knowledge for better delivery of medical facility for tele-education. education, patient care and health care at large. The Annals of National Academy of Medical Sciences In this financial year, financial assistance has been (India), which is published quarterly, is the flagship provided to various Medical Institutions to conduct publication of the NAMS and serves as an important tool seminars/workshops/CMEs on topics of interest and for dissemination of recent advances to fellows and relevance to India.

Annual Report 2010-11 211 members of the Academy. The NAMS web site http:// 15.14.1.Medical Education nams-india.in serves as the window to the global medical community and provides information on the major events Undergraduate Medical Education at NAMS. This year the Institute has admitted 77 students to its A highlight of this year’s Annual Conference at Patiala MBBS course. 26 students to B.Sc Nursing (post- has been the Continuing Medical Education Programme certificate) course, 62 students to B.Sc (Hons) in Nursing on “Modern Multi-Disciplinary Care for Breast Cancer” Course, 15 students to B.Sc. (Hons.) in Ophthalmic and the Scientific Symposium on “High Altitude Techniques and 09 students to B.Sc (Hons.) in Medical Medicine”. Technology in Radiography. The CME programme of NAMS (India) also covers The MBBS course is spread over 5 ½ years, dividing the Human Resource Development by sending Junior period to 1 year for pre-clinical, 1 ½ year for para-clinical, Scientists to Centres of Excellence for providing training 2 year for clinical and 1 year rotating internship. Para- in advanced methods and techniques. Twenty two medical courses like B.Sc (Hons) in Nursing, Ophthalmic Scientists/Teachers have been selected for advanced Techniques, Medical Technology in Radiography training at specialized centres during 2010-2011. continued to be popular and attracted students from other countries also. The curricula of these courses are under During 2010-2011, the budget provision is 87.00 lakhs constant scrutiny by the faculty of the Institute for and 42.00 lakhs under Plan and Non-Plan respectively. purposes of improvement. 15.14. ALL INDIA INSTITUTE OF MEDICAL This year AIIMS has admitted OBC seats in SCIENCES (AIIMS) undergraduate courses as indicated against each: 19 seats All India Institute of Medical Sciences (AIIMS) was in MBBS, 03 seats in B.Sc (H) Ophthalmic Techniques, established in 1956 by an Act of Parliament as an 02 seats in B.Sc (H) Radiotherapy, 10 seats in B.Sc (H) institution of national importance. Nursing, 06 seats in B.Sc (PC) Nursing. The institute has been entrusted to develop patterns of Post-Graduate Medical Education teaching in undergraduate and postgraduate medical education in all its branches so as to demonstrate a high A total of 448 students, including 24 state-sponsored and standard of medical education to all medical colleges and 12 foreign nationals were admitted to the above- other allied institutions in India, to bring together at one mentioned courses during the year under review. The place educational facilities of the highest order for the total number of postgraduate and doctoral students on 31 training of personnel in all important branches of health March 2010 was 1134. activity, and to attain self sufficiency in postgraduate A total of 294 postgraduate students MS/MS/MDS/DM/ medical education. MCh/PhD/MSc/M.Biotech passed out during the year For pursuing academic programmes, the AIIMS has been 2009–2010. kept outside the purview of the Medical Council of India. The Institute provide full time post-graduate and post- The Institute awards its own degrees. The AIIMS doctoral courses in 57 disciplines. In the year under continues to be a leader in the field of medical education, review, many post-graduate students qualified for various research and patient-care in keeping with the mandate degrees and qualified for various superspeciality degrees. of the Parliament. The guiding principle in post-graduate training is to train The Institute is fully funded by the Government of India. them as teachers, researchers and above all as competent However, for research activities, grants are also received doctors to manage and treat the patients independently. from various sources including national and international Continuing Medical Education agencies. While the major part of the hospital services are highly subsidized for the patients coming to the AIIMS The institute organized a number of workshops, symposia, hospital, certain categories of patients are charged for conferences and training programme in collaboration with treatment/services rendered to them. various national and international agencies during the year. Professionals from various institutions all over the country

212 Annual Report 2010-11 participated in these seminars and workshops and specialty clinics of the main hospital and other centres of benefited with update knowledge. Guest and Public AIIMS. A total of 88,486 patients were admitted during lectures were organized by visiting experts and faculty the year in the various clinical units of the Main Hospital of AIIMS. and other centers at AIIMS. A total of 82,474 of surgical procedures performed during the year in different surgical Training for long term/short term, WHO-in-Country disciplines at AIIMS from 01.04.2009 to 31.03.2010 Fellowship and Elective Training to the Foreign Nationals Students: 15.14.5. Cardio-Thoracic Centre The institute is also providing short/long term training, The Cardiothoracic Centre at AIIMS continued to be in WHO-in-Country Fellowship and Elective training to the the forefront in maintaining the tradition of patient care, Foreign Nationals students. teaching and research encompassing a wide range of surgical, interventional imaging and laboratory procedures, Training for Scheduled Castes (SC) and the stem cell therapy and organ retrieval and banking in Scheduled Tribes (ST) Candidates: addition to medical therapy for a wide range of ailments The SC and ST candidates are given due consideration related to disease of the cardiovascular system. and weightage in accordance with the Govt. of India New facilities were added to strengthen patient care guidelines in all selections. During this year 36 SC/ST including two new surgical operating rooms, one of which candidates were selected for various undergraduate is a hybrid operating room which combines surgery and courses. 11 SC and 6 ST candidates were selected to interventional therapy; A 10-bedded neonatal intensive the MBBS course, 2 SC and 1 ST candidates were care unit to take care of extremely small babies & a new admitted to B.Sc (Hons) Ophthalmic Technique, 2 SC CT6 ward. A new outpatient clinic (Aortic Clinic) has and 3 ST candidates admitted to B.Sc Nursing (Post- been started on Wednesday and Thursday morning to certificate) course and 7 SC, 4 ST candidates have been cater to patients suffering from diseases of the aorta under selected for B.Sc (Hons) Nursing course. one roof. The faculty of the cardiothoracic center was 15.14.2. International Role actively involved in delivering lectures at national and international meetings and projecting AIIMS as a leader The Institute continued to provide consultancy services in this field. In addition several conferences were in several neighbouring countries under bilateral organized by the various departments of the center and agreements or under the aegies or international agencies. many observers and specialists were imparted training. During 2009-2010 the institute trained many Important areas of continuing research include stem cell WHO-Sponsored candidates to fulfill its international research, applications of advanced cardiovascular CT and obligations. MRI genetic polymorphism studies in coronary artery 15.14.3. Research disease patients, nuclear cardiology studies related to stem cell labeling cardiac dyschrony evaluation, assessment of As per the mandate given to the All India Institute of myocardial viability and various projects funded by ICMR. Medical Sciences, research forms an important In addition to this, community health and stress component. AIIMS has been at the forefront of management programs are being actively promoted. conducting high quality research, both in the fields of basic and applied sciences. During the year under review, the The stem cells facility at AIIMS has initiated clinical faculty of the AIIMS drew extramural grants for various research in degenerative disorders like heart muscle cells research projects from national and international agencies. regeneration, ocular surface reconstruction, peripheral vascular disease, stroke, myocardial infarction, dilated 15.14.4. Patient-Care Services cardiomyopathy, non union of fracture, extrahepatic biliary The hospital has maintained its tradition of services and atresia & spina bifida. The Organ Retrieval & Banking quality of patient care, in spite of ever increasing number Organization (ORBO) has been instrumental in procuring of patients that come to this hospital from all over the organs and tissues for transplantation & in spreading the country as well as from abroad. A total of 14,40,254 knowledge of importance of donating organs. patients attended the general outpatient department and

Annual Report 2010-11 213 15.14.6. Dr. Rajendra Prasad Centre For services, with 19498 more patients registered in Eye Ophthalmic Sciences Casualty alone during this period. Our workload continues to escalate. The Centre is providing eye care services to Dr. Rajendra Prasad Centre for Ophthalmic Sciences for urban slum populations, including eye OPDs, provision of now more than 43 years is the oldest Centre at the AIIMS subsidized spectacles, free surgeries and investigations. functioning on the tenets and guidelines issued from the Cataract surgery is being provided totally free of cost to MHFW and the GB/ IB, on which norms all the subsequent patients identified and brought in from the rural areas. superspeciality Centres here at AIIMS have been developed. The Centre carries about 25% of the total At the Centre several specialized procedures in AIIMS patient care load. Dr. R.P. Centre is the first major ophthalmoplasty, corneal and refractive areas are being continuously reaccredited WHO Collaborating Centre for carried out, along with newer vitreoretinal and macular Prevention of Blindness (PBL) in the South East Asian procedures including intravitreal drugs especially for SEARO region since 1973. The Centre continues to be ARMD and DR, and newer investigations and techniques the initial member of INTERSUN (WHO’s International in glaucoma, squint, and neuro-ophthalmic disorders being Sun Monitoring Project) – efforts are under way to set undertaken with gratifying results. up the UV monitoring units with Project ISUVRA (Indian Solar Ultra-Violet Radiation Assessment). The Chief of For further upgradation of patient care services, newer the Centre is the Director of this WHO Collaborating facilities have been initiated in Ocular Biochemistry, Centre for PBL, & also continues to be the Honorary Ocular Microbiology, Ocular Pathology, and Ocular Advisor Ophthalmology to the Ministry of Health & Pharmacology. A DNA chip for diagnosis of eye infections Family Welfare, Govt. of India, the RPC remaining the has been developed and commercially launched by the Apex Centre under the NPCB, GOI. Industrial partner of the recently concluded CSIR (NMTLI) multicentric project. Newly established Stem The Faculty of this premier Eye Centre have been cell/ Tissue and Cell culture facility, PCR and Molecular honoured by several international and national awards and Biology laboratories are fully functional. The advanced published numerous scientific works in international and bioanalytical system with LC-MS/MS has completed national peer reviewed journals and, even residents and installation at RPC. research associates have presented their research works in various international conferences, authored books and Community Ophthalmology services and projects continue delivered lectures besides attending scientific meetings to form a major part of the activities of RPC along with and providing specialized training and filing patents. Many NPCB (National Programme for Control of Blindness) such research projects in various fundamental aspects and WHO. Inculcating awareness of disease among the are ongoing at the Eye Centre. public has been given a suitable fillip with the recent ADR monitoring, Glaucoma Awareness, and Drug Monitoring Efforts are under way to secure an upgraded and programmes. Dr. R.P. Centre has extended its exemplary integrated 4-year programme for Bachelor of Optometry and unique Eye Centre services spread far afield, and and Visual Sciences at RPC along with a 1-year continuing as in the North Eastern state of Meghalaya, internship, and also Fellowships for both this Course as with several speciality eye camps under the NRHM, and well as in the specialities of Clinical Ophthalmology, etc. also closer to home as in the state of Uttarakhand. Over 110 junior and senior residents at any one time, constitutes the world’s largest ophthalmology residency The Centre organized several conferences/ workshops/ training programme. symposia during this period including live surgeries in Ophthalmic superspecialities. The XXVth National Eye Dr. R.P. Centre has 15 clinical and paraclinical Donation Fortnight was held from 25 Aug – 08th Sep 2010 departments with numerous state-of-the- art Investigative where Awareness Drive for Eye Donation was launched and Clinical Service labs. During this period, 113712 and charts and pamphlets distributed. Dr. R.P. Centre is patients in OPD and 91165 in our Speciality Clinics were in constant collaboration with ORBIS International and attended to [total 224375], 17512 indoor patients admitted, major INGOs especially with regard to childhood 13564 operations performed, and more than 200,000 blindness activities, and the National Forum of Vision 2020: laboratory and other investigations were carried out. The The Right to Sight-India. The Chief RPC continues as Centre also provides round-the-clock Eye Casualty the active Vice President of Vision 2020: India.

214 Annual Report 2010-11 • CCTV in the OTs has been improved to long
Two Training Programmes on Agonist Maintenance distance transmissions in the city – Telemedicine
Development of Minimum Standards of Care is being augmented for better patient care, teaching and research.
Managing of Alcohol and Drug Dependence in Primary Care Settings • A newer Digital TV system with direct transmission has been initiated at RPC Private Wards etc. for
Assessment of substance use among out of school the first time at AIIMS. children The Centre has taken significant steps in improving the
Peer based Intervention in out of school children quality of services delivered to all patients (including
Daycare services), despite several constraints. All our District based monitoring system Investigative and Clinical Service Labs are being
Training by Trainers (TBT) Programme constantly upgraded as far as practicable.
Drug Abuse Monitoring System-data on new Various expansion plans for RPC are also under way, treatment seekers in Govt. De-addiction Centres especially under the XI Five Year Plan. This is a nodal
referral Centre for Tribunals, Commissions, all Courts, Collaboration with NACO and UNODC on starting Consumer forum, etc. not to mention innumerable legal OST and evaluation of Centres providing OST and notices and RTI, which have all increased our multifarious their accreditation. workload tremendously.
Control of alcohol abuse and development of Policy, 15.14.7. Dr. BRA Institute Rotary Cancer Hospital carried out with support from WHO-SEARO, WHO-HQ, Indo-Swedish collaboration and of Expansion project of Dr. BRA Institute Rotary Cancer course India’s /Ministry’s contribution towards Hospital has been completed, and the floor are functional. development of Global Strategy to Reduce Harmful 15.14.8. National Drug Dependence Treatment Use of Alcohol (WHO-HQ activity). Centre The current (2010-11) ongoing projects being supported Besides the Professor and Chief, currently the Centre by WHO-I are: has 3 Professors, 2 Associate Professors and 1 Assistant • Convergence of services with special emphasis Professor. on management of substance among adolescents During this period (2009-10), a total of 34570 (new and • Addressing alcohol use in diverse settings including old) patients in the OPD, 20401 (old & new) in the E-health Trilokpuri Community clinic, 8692 in Sundar Nagari mobile clinic, 72 patients in the Adolescent Drug Abuse clinic, • Developing a network of De-addiction and 791 patients in the Tobacco Use Cessation clinic and services between the government, NGO and 251 patients in the Dual Diagnosis clinic were seen. A private sectors. total of 957 patients were admitted in the ward. The Chief of the Centre was nominated by the WHO as During this period, the following laboratory investigations member of the International Narcotics Control Board were carried out: Drugs of abuse screened (20733), (INCB), 2010-2015 and also appointed as Head and various biochemical tests to assess health damage Member of the Expert Group to finalise National Policy (19739), haematology (5109), and HIV screening (340). on Prevention of Alcoholism and Substance Abuse and Rehabilitation, Ministry of Social Justice & Last 2 years (2008-09) activities supported by the Ministry Empowerment, Govt. of India, January 2010. and WHO-I supported were: In this period seven research projects on ‘Substance Use
Workshop: Revisiting the Current Situation and Disorder” are ongoing which is being funded by national Planning Ahead and International agencies. Besides these, five funded
Workshop: Curriculum Development on Agonist research projects have been completed. The faculty Maintenance published twelve research articles in indexed national and

Annual Report 2010-11 215 international journals and seven chapters in books\manuals • National Iodine Deficiency Disorders Control Reports\Proceedings\Manuals\monographs. Programme; Some faculty also received national as well as international • National Rural Health Mission; awards in recognition. The faculty of the centre acted as a resource person in national and international meetings • National AIDS Control Organization (NACO) for as well as in various training programmes held in Delhi HIV sentinel surveillance Uttar Pradesh, as well as in various states of the country. Uttarakhand, Bihar, Jharkhand, and Delhi; The faculty of the department of Psychiatry and the centre • National Programme for Prevention and Control jointly carry out post-graduate teaching that includes of Cancer, Diabetes, Cardiovascular Diseases and journal discussion, seminar, and case conference and Stroke; research/academic presentations once every week. • National Urban Health Mission and 15.14.9. Department Of Neurology • Revision of the Indian Public Health Standards The new imitates four the department of neurology is (IPHS). use of stem cells in Parkinson’s disease, subacute stroke New Initiatives: and chronic ischeamic cerebral damage. Pilot project in this area has been completed or going on a multi centre • Started an innovative program “Pre-Marriage study is on going in patient with subacute stroke. Orientation & Counseling for Happy Married Life”. Seven courses have been conducted so far with 15.14.10. Centre for Community Medicine great success. The Centre for Community Medicine carries out teaching • Started a series of regular, monthly lecture training and research activities keeping in view the discussions on health topics for general public mandate of AIIMS. There are 20 post graduates and 2 “HELPs” (Health Education Lecture-discussions PhD students. Currently, 11 research projects are for Public) at AIIMS for important public health underway through intra mural and extramural funding, problems like Diabetes, Swine Flu etc. and 26 papers were published. • Setting up of delivery huts in the Primary Health Rural Programme: The Comprehensive Rural Health Centres as recommended under the National Rural Services Project, Ballabgarh Haryana which is the rural Health Mission where about 350 deliveries were programme of the Centre provides secondary and primary conducted last year. level care through a 50 bedded hospital and 2 PHCs. About 138,894 patients are seen in various outpatient 15.14.11. Department Of Nephrology clinics in CRHSP Ballabgarh annually. Department of nephrology is providing integrated best Urban Health Programme: The UHP is located at care for nephrology patients in a government set-up in Dakshinpuri Extension [Dr. Ambedkar Nagar] in South the country. Department has done 80 renal transplants Delhi and apart from providing health care to the during this period including cadaver transplants. Increasing inhabitants, acts as a training & teaching centre for chronic ambulatory peritoneal dialysis and hemodialysis MBBS, MD, Nursing and other students. A mobile health facilities are being provided at cheapest cost. Department clinic provides primary care daily, and about 23,712 is providing bed side facility of hemodialysis to large patients are seen annually. number of departments within the institute inspite of limitation of staff. Nationally and internationally recognized The telephone helpline on HIV/AIDS, Sex related issues work is being done on tuberculosis and hepatitis patients and contraception (“Shubhchintak”) and Internet based with kidney disease. Department is the only centre helpline “E-shubhchintak” continued to be operated with contributing to world largest transplant registry; usual popularity, attracting a good number of calls and Collaborative Transplant Study, Germany. Department mails daily. faculty is awarded grant by the World Health Contribution to various National programmes: Organization, International Society of Nephrology and Japanese Society of Dialysis Therapy. Faculty is regularly

216 Annual Report 2010-11 invited for Guest Lectures at various meetings. has done a pioneering work in establishing Pre Peritoneal Department has ten publication during this period. Dr. approach for doing Radical Prostatectomy with the robot SK Agarwal, professor and head has been appointed for the first time in the country besides other advanced chairman of nephrology specialty by MCI and National procedures. Board of Nephrology. Dr SK Agarwal is organizing 15.14.13. Department of Orthopaedics secretary of 6th World Organ Donation Day being observed at Vigyan Bhawan under Ministry of Health “The Department of Orthopaedics at AIIMS continues and Family Welfare on 27th Nov 2010. Dr Agarwal is to be the best in the country and occupies an eminent also coordinator for a multicentric study to find out position in the field of Orthopaedics in the country. Newer prevalence of CKD being funded by ICMR. Faculty had and highly complex surgeries in the field of trauma, tumor, regularly conducted patient education program in print hand, spine, joint replacement, arthroscopic surgery and and electronic media particularly in U.P. Sahara Samay paediatric orthopaedics are done on a regular basis. The on series of education program on chronic kidney disease Department has facility for comprehensive physiotherapy for lay public. Department also had visiting faculty from and rehabilitation of the patients. We also have facility USA and Australia during this period. for Bone banking including cadaver bone banking. A number of research projects funded by ICMR, DST, DBT 15.14.12. Department Of Urology and CSIR are being carried out in the Department. The The Department of Urology is equipped with the state- Department continues to publish articles in indexed of-art devices and provides a wide range of services, journals of repute. The faculty members have actively specializing in minimally access techniques, microsurgery, contributed in many CMEs at national and international robotics and oncology. It organized a Mock Examination levels. The Department has also served the country at for post graduate trainees (M Ch and DNB) in Urology various health camps at far-flung remote areas. The for the Urological Society of India in March 2010. 80 department continues to enjoy the trust and faith of millions PG students of urology attended this three day program of countrymen and is the best testimony to its character”. and over 15 faculty members from all over the country 15.14.14.Department of Forensic Medicine & conducted exams in the standard pattern. A live operative Toxicology demonstration was also given on common urological procedures. The department of Urology, AIIMS jointly Routine Work:- The Department of Forensic Medicine organized an “International Uro-oncology Workshop” & Toxicology continued to provide medicolegal services with Rajiv Gandhi Cancer Institute & Research Centre to the South Zone and South East Zone of Delhi along and RML Hospital PGIMER, New Delhi on October 1- with round the clock coverage to the casualty. 3, 2010. During this Workshop a wide variety of surgical Department also provided consultation in complicated procedures (open, laparoscopic and robotic) were medicolegal cases to the CBI, NHRC, Crime Branch, demonstrated by International and national faculty. The Delhi Police and other investigating agencies. faculty of the department delivered numerous lectures Forensic Pathology:- Total 1775 postmortems were and live operative demonstrations at various meetings performed during this period including at trauma centre. nationally and abroad. It continues to conduct research Department also participated in exhumation as ordered in basic and clinical aspects of Urology in collaboration by competent authorities and guided the investigating with various departments in the Institute with both agencies to arrive at logical conclusion. intramural and extramural funding. The department published over 40 articles in peer reviewed journals over Casualty Services: About 500 calls were attended from the last one year and the faculty received a number of casualty pertaining to cases of various natures. awards and honors. Over 7500 surgical procedures Department is also looking after medicolegal records of including 130 robotic surgeries were performed during casualty. the last year. Clinical Forensic Medicine:- Clinical Forensic Major achievement and success of the department has Medicine services were provided by the Department in been ‘computerisation of discharge summaries and other cases of injury, age estimation, paternity dispute etc. 20 related data’.The Department of Urology has taken new such cases were dealt during this period. initiatives in the field of Advanced Robotic Surgery and

Annual Report 2010-11 217 Expert Opinion: Department gave expert opinion in • Patient care laboratory of the department is various cases referred by Honorable Courts, CBI and providing clinical service for a number of tumor other investigating agencies. markers, free of cost. Court Summons: 380 summons were received by the • Have applied for two patents. Department to appear as an expert from various courts • Prof. N. Singh conferred fellowship of National of law in Delhi and other states. Academy of Medical Sciences. DNA-Finger Printing: Department is running DNA- 15.14.16. Department Of Cardiac Radiology Fingerprinting Laboratory where training is provided to short term trainees referred from all over India. This During this year, the Department of cardiac radiology laboratory of the Department performs tests for continued to be at the forefront of providing advanced medicolegal cases referred by Delhi Police, SDM of cardiovascular imaging and vascular interventional neighboring States, CBI and Honourable Courts of India. services to the the Cardiothoracic center as well as other allied Departments within the AIIMS. These include Toxicology Laboratory: The Department provides only cardiovascular CT and MRI, vascular Doppler and hospital services for toxicology analysis or cases referred fluoroscopic procedures as well as percutaneous by courts. Tests were done for various poisons and heavy techniques for vascular recanalization, reconstruction and metals in this laboratory. occlusion of diseased vessels for all organ systems. CME:- Departmental faculty and officers participated Among educational activities, the Department organized in various CME programmes. Lectures were delivered the Annual Registry meet cum CME of Indian Society to the officers of CBI, Forensic Scientist, Judicial officers of Vascular and Interventional Radiology on 17-18th April, and medical officers. CME Programmes organized by 2010. The Departmental faculty was also involved in the Department include Workshop on Crime Scene delivering lectures, presenting papers and participating Investigation, DNA-Finger printing and International in workshops dealing with this subspecialty.at various conference- INPALMS-2010 in collaboration with national and international forums. Besides, the faculty PGIMER, Chandigarh and Amity University, Noida (UP) members are also reviewers for many reputed cardiology/ radiology journals. On the research front, the department Research Publications: 08 research papers have been completed participation in 8 research projects, and published in various scientific journals during this period. initiated/contributed to starting 4 others, dealing with 15.14.15. Department Of Biochemistry various diagnostic and interventional aspects of cardiovascular diseases. At the forefront are projects • The Department has innovative teaching programs dealing with stem cell research and applications of involving problem based learning and case oriented advanced cardiovascular CT and MRI. There were 6 small group discussions for MBBS students. research papers and one book chapter that were published • The Department has provided short-term research with the involvement of this Department. training to many post-graduate students. 15.14.17. Department Of Cardiology • Provided research exposure to undergraduate In the current year, the Department of Cardiology has students, leading to some of them being successful catered to over 1,00,000 outpatients. Over 20,000 patients in obtaining KVPY fellowship of DST. had undergone echocardiography, and over 4000 cardiac • Research grants/ funding amounting to Rs.3.57 catheterizations were performed. Overall around 1000 crores obtained from DBT, DST, CSIR, DRDO, patients had undergone interventional procedures ICMR and Indo-US, Indo-Canadian collaborations. including coronary angioplasty, balloon valvuloplasty and device implantations. • There are forty ongoing research projects with departmental faculty. Department of cardiology has been renovating its existing facilities to cope with its ever increasing demands. The • Forty seven publications in indexed National and Echo, Holter, and TMT have been renovated and started International Journals. functioning with added capacity. A new state-of the art

218 Annual Report 2010-11 Department is actively involved in many intramural and 15.14.20. Department Of Gastroenterology And extramural research projects. Newer projects including Human Nutrition stem cell research in dilated cardiomyopathy and ischemic Established a New Molecular Biology Laboratory In heart disease are underway. Efforts have been made to The Department With State Of Art Facility. refocus the educational activities of the Department to Continuing Medical Education address the changing needs of current cardiology practice. The Department has organized a successful CME and 1. The department organized an “International ‘Professor Philip Poole Wilson Heart Failure Research Workshop on Micronutrients and Child Health” held Symposium’ in collaboration with Imperial College /Royal on October 20-23, 2009 at AIIMS, New Delhi. Brompton Hospital London. 2. The department organized a “National Consensus The Faculty of our department has authored 60 papers in Workshop on Management of SAM Children through indexed medical journals and some prestigious books. Medical Nutrition Therapy on November 26-27, They have participated and contributed in various national 2009. and International conferences/committees. 3. The department organized Current perspective in 15.14.18. Department Of Physiology Liver Diseases (Oct 14-15, 2010) The Department provided about 400 hours of teaching to Lectures delivered in CMEs, national and international the first year MBBS students and about 60 hours of conferences: All faculty members of the department teaching to students of B.Sc. Nursing and allied courses, delivered 42 lectures at the international and national besides conducting M.Sc. (Physiology) and MD meetings. (Physiology) courses and guiding Ph.D. students. 15.14.21. Department Of Pathology 15.14.19. Department Of Biostatistics During the period of 01.04.2010 to 30.11.2010 the Faculty The Department was actively involved in teaching of the Department has published 64 publications in “Biostatistics and Essentials of Research Methods” for reputed national and international journals. the undergraduate, paramedical and postgraduate courses, Laboratory Services: viz. MBBS, BSc (Hons) in Medical Technology in Radiology, M. Biotech, B.Sc. & M.Sc. Nursing and MD Surgical Pathology Laboratory: Community Medicine. The Department organised a series No. of specimens processed 28,588 of fourteen evening classes on “Essentials of Biostatistical Methods and Research Methodology” for the new Cytopathology Laboratory: residents, Ph.D. students and other researchers in the No. of specimens processed 15,449 Institute. On request, for statistical methods in specific areas of medical research, Departmental faculty members Immunohistochemistry Laboratory: delivered series of lectures for the residents, Ph.D. No. of cases processed 4,357 students and faculty members in several departments in the Institute. Also, departmental faculty and scientists 15.14.22. Department Of Cardiac-Anaesthesia delivered invited talks outside the institute throughout the Faculty & Residents of the Department of country. On request, the faculty and scientists also Cardiac-Anaesthesia are involved in providing participated in departmental scientific presentations in Anaesthesia care in 7 operation theater, 5 catheterization most of the departments in the Institute. Besides guiding labs, CT angiography and MRI Cardiac-Anaesthesia Ph.D. students in the department, faculty members Department is also involved in resuscitation & ventilatory contributed to the academic activities of other departments care in CTVS-ICU-A & B, ICCU, all the general wards in the Institute as Co-Guides and DC Members of Ph.D. and C.N.Tower. students. Both faculty members and Scientists contributed to the academic activities of most of the departments as 9-DM-Candidates including two sponsored LT.Col. from co-guides for MD/MS, DM, MCH students. Army and 8 other post MD-Senior resident doctor are undergoing superspeciality training in Cardiac-Thoracic-

Annual Report 2010-11 219 Anaesthesia. Dr.Mulidharan from Shree Chitra Institute for the athletes, the teams and the VIPs at the medical of Medical Sciences, Triventhapuram & 3 centre located at the Jawaharlal Nehru Stadium and M.D.Candidates from Lady Hardinge Medical College Thyagraj Stadium. were imparted short term training in the specialty of Dr. Sanjay Wadhwa, Additional Professor, Department Cardiac-Anaesthesia. of Physical Medicine and Rehabilitation received the Researh: - The Departmental faculty is involved in 5 following awards during this period. extramural 3 AIIMS funded research projects as chief 1. Distinguished Services Award by the Geriatric investigator/co-investigators.The Departmental faculty is Society of India, New Delhi involved in 06 non-funded (Departmental) research projects as chief investigator/co-investigators. Dr. S.L. Yadav, Associate Professor of the Department was deputed as acting Venue Medical Scientific Presentation Officer for JLN Stadium Faculty of the Department delivered twenty-nine lectures Dr. Gita Handa, Associate Professor of the Department in different national & International forums and Resident was awarded Standford India Biodesign fellowship doctors & DM students presented- Six papers in national (Pioneering initiative by Department of Biotechnology, conferences, topics:- Govt. of India in collaboration with IIT Delhi and AIIMS Thalasamia & heart surgery, Chest trauma, aortic injury to promote Medtech Innovation) and worked as visiting management, PDA ligation in 900gm child. Associate Professor at Standford University for 6 months Percardectomy management in 3mths old child. Post stent from January to June 2010. inschaenic TAPVC stent blocked. 15.14.24. Department of Dermatology And New Initiatives Taken & Community Progamme Venereology 1). Department is running stress management clinic Department Achievements for cardiac and neuro patient in CT5 meditation 1. National CME Dermatology AIIMS, 2010 was room. organized on April 10-11, 2010. 2). Research initialed on sonoclot and pharmacological 2. Renovation of D-1 ward was undertaken. preconditioning youth. 3. Procurement of laswers (Pulsed dye laser, Diode 3). Nine Community health programme, stress Laser, Q-Switched Nd-YAG laser) was done. management and health awareness for children are Laser OT was set up providing free laser services conducted as part of the project My India, healthy to the patients. India at GT Karnal Road, Industrial Area. Invited by Nepal, govt. for participation in “Healthy Nepal” Faculty Achievements a mega project. Dr. M. Ramam elected as President, Indian Association 4). Quit tobacco awareness programme for Rural area of Dermatologists, Venereologists and Leprologists, Delhi of Panipat. State Branch, 2010. 5). Mind body intervention for heart patients and their Dr. Sujay Khandpur award as ICMR International attendants. Fellowship for Biomedical Scientists 2010-2011. 15.14.23. Department of Physical Medicine and 15.14.25. Department of Paediatrics Rehabilitation 1. A life saving drug for newborn babies, namely, The Department of Physical Medicine and Rehabilation pulmonary surfactant derived from goat lungs was actively involved in providing medical cover for developed by the Department of Paediatrics has Commonwealth Games 2010 held at Delhi been licensed for clinical use. Dr. U Singh, Professor and Head was Nodal Officer 2. The Department continues to provide technical Incharge from AIIMS. AIIMS provided medical cover support on child health in areas of IMNCI, ASHA

220 Annual Report 2010-11 training, Neonatal resuscitation, Pediatric HIV and • World Bank supported ‘Regional Influenza tuberculosis. Laboratory ‘for the surveillance of human, avian and swine Influenza has been set up in Microbiology 3. Department developed package for training of department. neonatal nurses working at district and sub-district hospitals. • Orthopaedics Department has started doing Total Knee Replacement. 4. The Department conducted telemedicine training with medical colleges at newborn health. It also • Clinical Immunology has been made an independent established sub-speciality training knowledge division and diagnostic and therapeutic services are exchange using telemedicine with the Department being offered by this division. of Pediatrics at PGIMER, Chandigarh. • Yoga therapy OPD has been started and 15.15JAWAHARLAL INSTITUTE OF POST generalized yoga therapy consultation is provided GRADUATE MEDICAL EDUCATION AND for diabetes mellitus, hypertension, respiratory RESEARCH (JIPMER) disorders, and for other chronic ailment thereby providing holistic health care. Jawaharlal Institute of Post Graduate Medical Education and Research (JIPMER), was declared an Institution of • Crisis Intervention Clinic has been started in the National Importantance on 14.7.2008 through an Act of Psychiatry Department to cater to the needs of Parliament. The primary functions of this Institute are cases of attempted suicide. patient care, teaching, training and research. During Academic Activities: the year under review, the Institute has made all round progress in all its activities. The admission to first year MBBS course in JIPMER is through All India Entrance Examination. A total of 22,674 JIPMER Hospital has total bed strength of 1591. The applications were received and 17,389 candidates daily average number of outpatients treated in the year appeared in the Entrance Examination for the first year 2009-2010 was 4,760 .Under the Rashtriya Arogaya Nidhi MBBS Course, 2009-2010 session. Out of the 11,966 (RAN) 22 patients were benefited and Rs. 10,59,277/- candidates who qualified in the Entrance Examination, was utilized during the year. Rs.10 Lakhs was allotted 82 candidates were admitted based on their category merit under special Rastriya Arogya Nidhi for the treatment of rank. Eighteen candidates were nominated for the cancer patients. 09 patients were benefited by this scheme Academic Session 2009-2010 by the Government of India. and one patient is under treatment. In the year 2009- College of Nursing was started by JIPMER during the 2010, a total of 14, 04,389 outpatients were treated in year 2006 with an annual intake of 75 students. JIPMER Hospital. In the year 2009-2010, a total of 64,331 Admissions were made to the B.Sc (Nursing) course admission were made in the Hospital .A total of 19,48,543 based on an Entrance Examination for 2009-10 session. investigation were carried out in the year 2009-2010. Total Post graduate courses (M.D /M.S ) are conducted in 21 number of deliveries conducted was 16,363. Total disciplines. A total of 88 seats are available for the 21 numbers of operations perfomed were 35,195. The total postgraduate courses. Thirty-four new PG seats will be attendances in Emergency Medical Service (Main added from the academic session 2011-12. At present, Casualty) were 1,17,517 and the total attendance in OG Super Specialty Programmes (D.M./M.Ch) are (Obstetrics & Gynaecology) Casualty was 18,267. conducted in 7 disciplines. A total of 10 seats are available JIPMER caters to people from the states of Puducherry, in these 7 Super Specialty Programmes. Tamil Nadu, Andhra Pradesh, Karnataka and Kerala and other States. PhD programmes are conducted in 8 disciplines and a total of 18 seats are available for these 8 PhD New Services Started: programmes. JIPMER has been conducting M.Sc • An Acute Stroke and Neuro Intensive Care Unit (Medical Biochemistry) course for the last 32 years. For has been set up in the Nerurology department the academic year 2009-2010, nine students were .Neuro Surgery department has started doing admitted on the basis of the entrance examination to this Stereo tatic biopsy for deep seated brain lesions. 3 years course.

Annual Report 2010-11 221 New Courses: Medical Oncology, Surgical Oncology, Medical Gastroenterology, Surgical Gastroenterology, Nephrology, The Central Government has accorded its approval to Neuro Surgery and Endocrinology Departments have the starting of the following courses from the academic started functioning in the new super specialty block. year 2010-11: B.Sc (Dialysis Technology), B.Sc (Perfusion Efforts are being made to start post doctoral training Technology), B.Sc (Medical Radiation Technology). B.Sc programmes in all these Departments. (Operation Theatre Technology) and M.Sc (Medical Lab Technology-Microbiology). Besides, several new courses Action has also been initiated for second phase of such as D.M.in Clinical Pharmacology, Clinical development which includes construction of a 400 bedded Immunology, Neurology, Neonatology,MD Radiotherapy Women and Children hospital, a Teaching Block, Hostel and post doctoral fellowship in Diabectology have been Complex and upgradation of all the departments. started. The total budget provision as per BE 2010-11 is Rs.252 First Convocation: crores (Plan – Rs.132.00 crore & Non-Plan – Rs.120.00 crore). Besides awarding its own degrees, the Institute is now empowered to start various new courses and develop its 15.16. POST GRADUATE INSTITUTE OF own curriculum.The first Convocation of JIPMER as an MEDICAL EDUCATION AND Institute of National Importance was held under the RESEARCH (PGIMER), CHANDIGARH Chancellorship of Prof. N.K. Ganguly, the president of The postgraduate Institute of Medical Education and the Institute on 22nd March 2010 in which Shri. Ghulam Research, Chandigarh was declared as an Institute of Nabi Azad, Hon’ble Union Minister of Health and Family “National Importance” and became an Autonomous Body Welfare was the Chief Guest and Shri V. Narayanasamy, by an Act of Parliament (Act 51 of 1966), on 1st April, Hon’ble Union Minister of State for Planning, 1967. The Institute in fully funded by the Government of Parliamentary Affairs and Culture was the Guest of India. The main objectives of the Institute are:- Honour. A total of 154 degrees were awarded to the MBBS, PG (MD/MS), B.Sc. (MLT) and Super Specialty o To develop pattern of teaching of undergraduate students who had successfully completed the course. and postgraduate medical education in all its branches so as to demonstrate a high standard of Faculty Recruitment: medical education; The Institute on becoming an autonomous body conducted To bring together as far as may be in one place the interviews and selected about 100 Assistant o educational facilities of the highest order for training Professors in various disciplines and almost all of them of personnel in important branches of health have joined. activity; and Projects: o The attain self-sufficiency in postgraduate medical Department of Radiotherapy got the status of Regional education to meet the country’s need for specialists Cancer Centre in the year 2002.A new building has been and medical teachers. constructed with bed strength of 82 .Medical Oncology, Academic Activities Radiation Oncology and Cancer Registry, Day Care Centre have been commissioned along with the Super Postgraduate Institute of Medical Education & Research, specialty Block & Trauma Care Centre. A 360 bedded Chandigarh has been empowered to grant medical, dental Super Specialty Block housing all the super specialty and nursing degrees, diplomas and other academic departments under one roof has been constructed at a distinctions and titles under the PGIMER, Chandigarh Act, cost of Rs.93.04 crores. A Trauma Care Centre has been 1966 (No.51 of 1966 and thereafter amended from time constructed over the existing Emergency Medical to time). For attaining self-sufficiency of postgraduate Services Department at a cost of Rs.13 crores. This medical education and to meet the country’s needs to centre has state-of –the –art equipments such as Multi have highly qualified and skilled medical teachers in Slice CT Scanners, high profile Operating Tables, Micro- medical sciences and to undertake basic community based Vascular Instruments etc. and 2 high tech Ambulances. research, the Institute has been striving hard and achieving

222 Annual Report 2010-11 the desired goals in this direction too. The Institute d) D.M. in Paediatric Neurology in Paediatrics conducts various Postgraduate courses viz. MD/MS, Department. DM/M.Ch, Ph.D. and other paramedical courses viz. e) M.Sc. in Respiratory course in Pulmonary Medicine B.Sc. MLT and M.Sc. etc. The number of candidates passing various courses is increasing day by day with the Department. increase of new centres at the Institute. A total of 116 f) M.D.S. in Oral & Maxillofacial Surgery in Oral candidates passed the MD/MS examinations in 2010 – Health Sciences. 97 in the June batch and 59 in the December batch, Similarly, 20 candidates passed their DM/M.Ch. g) A.P.G. Diploma in Public Health Management examination in May 2010 whereas 29 candidates passed (PGDPHM) in the School of Public Health. DM/M.Ch. examination in December 2010 session. A Hosptial Services total number of 2994 candidates have passed their MD/ MS course and 1291 candidates have passed DM/M.Ch. The Nehru Hospital attached to the Postgraduate Institute Course upto 31.12.2010 and 30.06.2010 respectively. of Medical Education & Research, Chandigarh provides Apart from above, 56 candidates passed various other tertiary care in all the medical and surgical specialties to examinations viz. MHA, MPH (Part I & II), M.Sc. (Part the patients, who came not only from the adjoining States I & II) and M.Sc. Nursing Part I examinations in May but also from far off States like West Bengal and Bihar. 2010 session whereas there were 65 candidates who passed out in December 2010 session. Similarly, in the The total bed strength of the PGI has increased to 1612 examination held in August, 2010 for various paramedical beds. The number of patients who attended the courses like B.Sc. MLT, B.Ph., B.Sc.MT (OT) and B.Sc. Outpatients Departments and those admitted during the Nursing etc., there were 261 candidates passing out above last three years is as under:- courses. 2007-08 2008-09 2009-10 Candidates for MD/MS courses come from all parts of the country and also from abroad. At present the number OPD Attendance 13,19,973 14,13,796 15,46,639/- of such candidates is 549 as on 31.07.2010. Similarly, for Admissions 56,078 58,496 62,330/- DM/M.Ch. Courses, there were 194 candidates on roll as on 31.07.2010. Besides, there were 144 candidates on Emergency and critical patients were attended to round rolls of the Institute as on 31.07.2010 pursuing Ph.D. the clock. A total number of 50,943 patients were attended courses. Lists showing above position are attached for in the emergency and 30,845 were admitted. In the showing no. of candidates from different States pursuing emergency operation theatres, a total of 10,766 operations different courses at PGI, Chandigarh. were performed including 9,535 major operations (which Since 2007, PGI has introduced three new courses in the includes Labour Room operations) and 1,231 minor super-specialties viz. D.M. (Paediatric Critical Care and operations. During the financial year 2009-10, Paediatric Haematology Oncology) in the Department 2,09,24,201/- was spent for subscription of 530 Journals of Paediatrics and D.M. in Neuro-Radiology in the Rs.23,23,1809 lacs was spent for online Medical Database Department of Radiodiagnosis. Besides, Postgraduate and, Rs. 86543/- has been spent for the purchase of books. course of M.Sc. (Anatomy) has also been started. A new Central Animal House facility and clean room for There are also other courses which are proposed in the Stem Cell Research have been established in the Institute near futute:- during the year, 178 Research Schemes were completed and 324 Research Schemes funded by ICMR, DST.U.T., a) D.M. in Haemato-Pathology in Haematology New Delhi, international agencies etc. were under Department. progress. There were 569 publications in indexed and b) D.M. in Cardiac-Anaesthesia in Anaesthesia non indexed national and international journals, 10 visiting Department. Professors, from all over the World, visited the Institute. 293 students were conferred various doctoral/post c) D.M. in Clinical Haematology in Internal Medicine doctoral degrees. 29 faculties members were conferred Department. various awards/honours during the year.

Annual Report 2010-11 223 15.17 LADY HARDINGE MEDICAL COLLEGE Microbiology. Surveillance facilities for meningococcal & SMT. S. K. HOSPITAL NEW DELHI and Dengue fever are also in place in view of frequent occurrences of these diseases. Facilities for Advanced The Lady Hardinge Medical College (LHMC), New Delhi Laparoscorpic Surgery using High Definition Camera and was established in the year 1916 with a modest beginning 24 hours Ambulatory Esophageal PH Monitoring for of just 14-16 students. Over the years, the Institute has diagnostic and research purpose are also available in the matured as a pioneering Institute for Medical Education Deptt. Of Surgery a number of “Rainwater harvesting and now it has the existing strength of 150 admissions wells” have been constructed and Solar panels installed. per year for MBBS girl students. The 95th Academic Separation of Eye Operation Theatre and ENT Operation Year (2009-10) of the College began with 724 Theater is under process and is likely to be completed undergraduates and 128 interns on the rolls. The College, during the current financial year. which is affiliated to the University of Delhi since the year 1949, has continued to admit students from all over A number of research projects have been going on in India, as well as from foreign countries. A separate out many Departments of the institution. The total numbers patient block was started in 1958 to cater the needs of of papers published during the year are 131. ever increasing population of Delhi. The total budget provision as per BE 2010-11 is Rs.176 The hospital statistics for the period 2008-09 is as under:- crores (Plan – Rs.79.00 crore & Non-Plan – Rs.97.00 crore). Bed Strength 1247 15.18 KALAWATI SARAN CHILDRENíS OPD Attendance 541240 HOSPITAL, NEW DELHI Indoor Admissions 31145 Kalawati Saran Children’s Hospital (KSCH) is a premier Sterilization 1295 referral Children’s Hospital of national importance. The Hospital started functioning in the year 1965 for imparting Bed Occupancy 65.7% medical care service exclusively for Paediatrics patients Surgeries upto 18 years of age. At present it has 370 beds. Under performed:- the (JICA) scheme for the improvement of KSCH, the bed strength of this Hospital is being increased to 500. Minor 6891 Kalawati Saran Children’s Hospital is one of the busiest Major 8077 children hospitals in the country and caters to a daily OPD Total 14968 attendance of 800-1000 children, and 80-100 new admissions per day from Delhi and neighbouring states. The necessary follow up action is going on to implement The hospital is a Sentinel Centre for Poliomyelitis, Tetanus the comprehensive re-development plan of LHMC& and Measles. It has the unique distinction of having a Associated Hospitals approved by Cabinet Committee of separate Pediatric Emergency with direct inflow of Economic Affair at the total cost of Rs. 387.31 crore. patients. It also houses the Diarrhoea Training and Treatment Unit, the first such unit in the country, which A modern intensive Coronary unit has been established. has also been recognized by WHO and Govt. of India as Rheumatology Clinic and Adult Thalassemia Clinic have a training centre for diarrhoeal diseases. The hospital has been started under the Deptt. of Medicine. H1N1 also served as a training centre for ARI, UIP and other Infuenza screening OPD and in-patient ward have also National Health Programmes. been established under the Deptt. of Medicine. Voluntary Counseling Test Centre (VCTC) and Prevention of parent The Institution is a super speciality hospital in real sense to child transfer (PTCT) for HIV patients under the with its fully developed subspecialities like Neurology, supervision of National Aids Control Organization Nephrology, Gastroenterology & Nutrition, Hematology, (NACO) are part of the Department of Microbiology. Pulmonology and Endocrinology. HIV DNA PCR Lab under National Pediatric HIV Indo-Japan Friendship Block of Kalawati Saran Children’s initiative to diagnose HIV infection in newborns up to 18 Hospital has been constructed with an expenditure of months has also started functioning in the Deptt. of over Rs.54 crores for the building and the latest equipment

224 Annual Report 2010-11 for various sections of the Hospital which has been helpful Centre for adolescent Health was established in March in easing the problem of inadequate space and 2009 with the objectives of providing special services to technological upgrading of the Institution. adolescents , to teach and train medical and nursing students, and to conduct research relevant to the needs Kalawati Saran Children’s Hospital was designated as of adolescents of India. “Nodal Centre for Pre-service IMNCI (Integral Management of Neonatal and Childhood Illness) Kalawati Saran Children’s Hospital has developed the implementation in NIPI States”. The Hospital organized training modules on Facility Based Care-Integrated National Training of Trainers Course of IMNCI with Management of Neonatal and Childhood Illness (IMNCI). support of Govt. of India/ WHO/UNICEF. Kalawati Saran Children’s Hospital also developed training modules on Facility Based Care of Severe Acute Infant and Young Child Feeding (IYCF) Counseling Malnutrition. Centre was started in Kalawati Saran Children’s Hospital to strengthen IYCF practices. Autism evaluation cell was Clinical Epidemiology Unit was established in Lady started in the Hospital. Hemophilia follow-up clinic Hardinge Medical College in November 2009 with the facilities are provided on first Wednesday (afternoon) of objectives of felicitating research activities, and for every month in the Department of Physical Medicine & teaching and training of undergraduates, postgraduates Rehabilitation Department. Once a month After and faculty in clinical epidemiology. Completion of Therapy (ACT) clinic for follow-up of children treated for lymphoma and leukemia was started The total budget provision as per BE 2010-11 is Rs 47.26 in the first Monday of every month. Kalawati Saran crore (Non-Plan-Rs 3.26 crore & Plan- Rs 24 crore. Children’s Hospital organized a sensitization workshop 15.19 MAHATMA GANDHI INSTITUTE OF on “Infant and Young Child Feeding” in collaboration with MEDICAL SCIENCES/KASTURBA Govt. of NCT Delhi from 24th to 26th March 2009. HEALTH SOCIETY, SEVAGRAM, An advanced centre of pediatrics care has been set up at WARDHA the Hospital. This Centre is poised to be one of the premier The Mahatma Gandhi Institute of Medical Sciences center of Paediatrics care in the country. The Hospital (MGIMS), Sevagram is India’s first rural medical college. statics for 2009-10 are as under :- Nestled in the karmabhoomi of Mahatma Gandhi, in Sevagram, this Institute was founded by Dr Sushila Nayar. Total No. of sanctioned beds 370 (340 + 30 Started in the Gandhi Centenary Year 1969, it was at Nursery designed to be an experimental model institute where Smt SK Hospital) medical education will be reoriented to meet the needs of the rural areas. In the spirit of its founder, the mission Total OPD attendance 3,09,398 of MGIMS today continues to be committed to the pursuit No. of admissions 27,951 of professional excellence by evolving an integrated pattern of medical education and seeks to provide Bed occupancy rate 110.6% accessible and affordable health care primarily to Minor operations 1427 underprivileged rural communities. It has completed 41 successful years in the service of this mission and is now Major operations 2519 one among the best rated medical colleges in the country. Casualty attendance 62,339 The expenditure of MGIMS is shared by the Govt of India, Govt of Maharashtra and the Kasturba Health Neonatal & Nursery Care 7,200 Society in the proportion of 50:25:25 as per the agreed No. of patients admitted in ICU 1228 pattern. This Government of India released the grant-in- aid of Rs.27.21 crores during the year 2009-10. Patients attended in PMR Deptt. 80,115 The students at MGIMS are drawn from all parts of the Gross Death Rate 9.0 country and come from all kinds of social backgrounds. Every effort is made to acquaint the medical student to the real rural India. The approach to medical education

Annual Report 2010-11 225 with spotlight on rural community oriented education also from adjoining parts of Andhra Pradesh, Madhya makes the doctors coming out of the Institute be sensitive Pradesh and Chhatisgarh. It acts as a tertiary care to the felt needs of the underprivileged. The entrance hospital with all the modern health care amenities but examination to the MBBS course includes a separate provides health services at affordable cost and with qualifying paper on Gandhian Thought. The students and compassion. It has a unique insurance scheme in which staff of the Institute adhere to a unique code of conduct, 20345 families were insured this year. where they are expected to wear khadi, participate in In 2009-10, 528184 patients attended the hospital as shramdan, attend all-religion prayer and abstain from non- outpatients and 40256 patients were admitted for various vegetarian food, alcohol and tobacco. ailments. The Hospital has state-of-the-art intensive care The Institute offers degrees and diplomas in 19 units in Medicine, Surgery, Obstetrics and Gynecology postgraduate disciplines of which 18 are MCI recognized and Paediatrics which provide excellent critical care. A and 19th in Skin and VD has just started this year. Seven well equipped hemodialysis unit is available for patients of its Departments are recognized for PhD. It has a well of renal failure. The Sri Satya Sai Accident and equipped fully computerized digital library which is a Emergency Unit provides succour to patients of trauma. recognized resource library for HELLIS network in With the grant from Govt. of India for Emergency and Western India.Since 1991, the Institute follows a unique Accident Ward the Institute has a fully equipped high Rural Service Scheme through its graduates. The students tech Trauma Ambulance alongwith wireless system. The are posted in these NGOs and regularly monitored. Two Institute has the only Blood Component Unit in the district years rural service is mandatory eligibility criteria for which provides components not only to patients in admission to post-graduation and this is achieved through Kasturba hospital, but also to private hospitals in the 96 non-governmental organizations who have joined hands district. Facilities for MRI, CT scan and Mammography with the institute to fulfill this dream. are available. The Alcohol and Drug De-addiction centre seeks to rehabilitate patients who are addicted to drugs At present 95 extramural research projects are on going. and alcohol. The Hospital has also been providing Geriatric Each year, the large numbers of national and international services to address to the needs of older people. Its peer reviewed publications from this Institute provide Radiation Oncology Department has received a grant- evidence of excellence in research. Based on its recent in-aid of Rs. 2 crore from the Govt of India to develop research the Department of Forensic Medicine had the Oncology wing under the National Cancer Control submitted a 258 pages report to Union Ministry of Health Programme and the Department is fully equipped with and Law highlighting the lacunae in examination reports state of the art radiotherapy equipments including Linear of victims of sexual assault resulting in the lack of Accelerator, HDR Brachytherapy Machine, 3D documentary evidence to implicate the assaultees. Based treatment Planning system and Simulator. The Pathology, on this report the Centre and State Governments have Microbiology and Biochemistry laboratories have in- come up with various guidelines for medical officers to house facilities and automation to conduct a battery of ensure proper forensic examination of victims of sexual diagnostic tests. All Departments of the hospital are assault. connected by an advanced Hospital Information System. The Department Community Medicine has adopted many The Govt. of India has sanctioned grant-in-aid for villages over 60 in number, where they have constituted infrastructural facility to accommodate additional 192 number of Women‘s Self Help Groups in order to promote indoor patients to Kasturba Health Society at MGIMS, women to play pro-active role in health care delivery in Sewagram. The building is under construction. their villages. A total of 149 Groups have been created The Department of Obstetrics and Gynaecology offers and more than 98% of these groups are linked with banks expert obstetric care to the unwed, the divorced, and the and have updated account books. widowed women with advanced pregnancy and ensures Hospital Services that they deliver safely in the hospital. Till date 289 women have been helped under this project. This year eight Kasturba Hospital of the Institute has the distinction of unwed mothers have availed themselves of this being the only hospital in the country which was started assistance. The project also supports babies born out of by the Father of the Nation himself. The patient load such pregnancies and keeps them in “Aakanksha” till they comes to us not only from Vidarbha in Maharashtra, but

226 Annual Report 2010-11 can be legally adopted. This year legal adoption of 10 Objectives: babies has been facilitated. • To strengthen the disease surveillance in the country The total budget provision as per BE 2010-11 is Rs 27.00 by establishing a decentralized State based crore. surveillance system for epidemic prone diseases to detect the early warning signals, so that timely 15.20 NATIONAL CENTRE FOR DISEASE and effective public health actions can be initiated CONTROL (NCDC) in response to health challenges in the country at The Institute in under administrative control of the the Districts, State and National level. Director General of Health Services, Ministry of Health Project Components: and Family Welfare, Govt. of India. The Director, an officer of the Public Health subcadry of Central Health • Integration and decentralization of surveillance Services, is the administrative and technical head of the activities through establishment of surveillance units institute. The Institute has its headquarters in Delhi and at Centre, State and District level. had 8 branches located at Alwar (Rajasthan), Bengaluru • Human Resource Development – Training of State (Karnataka), Kozhikode (Kerala), Coonoor (TamilNadu), Surveillance Officers, District Surveillance Jagdalpur (Chattisgarh), Patna (Bihar), Rajahmundry Officers, Rapid Response Team and other Medical (Andhra Pradesh) and Varanasi (Uttar Pradesh). and Paramedical staff on principles of disease There are several technical Divisions at the headquarters surveillance. of the institute i.e. Centre for Epidemiology and Parasitic • Use of Information Communication Technology for Diseases (Dept. of Epidemiology, Dept. Parasitic collection, collation, compilation, analysis and Disease), Division of Microbiology, Division of Zoonosis, dissemination of data. Centre for HIV/ AIDS and related diseases, Centre for Medical Entomology and Vector Management, Division • Strengthening of public health laboratories. of Malariology and Coordination, Division of Biochemistry Data Management: and Biotechnology. In each division there are several sections and Under IDSP data is collected on epidemic prone diseases laboratories dealing with different communicable diseases. on weekly basis (Monday–Sunday). The information is The divisions have well equipped laboratories with modern collected on three specified reporting formats, namely equipments, capable of undertaking tests using latest “S” (suspected cases), “P” (presumptive cases) and “L” technology. The activities of each division are supervised (laboratory confirmed cases) filled by Health Workers, by an officer in –charge, supported by medical and non- Clinicians and Laboratory staff respectively. The weekly medical scientists, research officers and other technical data gives information on the disease trends and and paramedical staffs. The branches are also well seasonality of diseases. equipped and staffed to carry out field studies, training Whenever there is a rising trend of illnesses in any area, activities and research. it is investigated by the Rapid Response Teams (RRT) to 15.20.1. Integrated Disease Surveillance Project diagnose and control the outbreak. Data analysis and actions are being undertaken by respective State/District Background: Surveillance Units. Emphasis is now being laid on reporting of surveillance data from Major Hospitals and Integrated Disease Surveillance Project (IDSP) was also from Infectious Disease Hospitals. Overall 85% launched by Hon’ble Union Minister of Health & Family Districts are reporting weekly disease surveillance data Welfare in November 2004 for a period upto March 2010. under IDSP. The Project has been extended for two years up to March 2012 by Government of India. Outbreak Surveillance and Response: A Central Surveillance Unit (CSU) at Delhi, State CSU, IDSP receives disease outbreak reports from the Surveillance Units (SSU) at all State/UT head quarters States/UTs on weekly basis. Even NIL weekly reporting and District Surveillance Units (DSU) at all Districts in is mandated and compilation of disease outbreaks/alerts the country have been established.

Annual Report 2010-11 227 is done on weekly basis. On an average 10-20 outbreaks Training Centre (NIC): are reported to CSU weekly. A total of 553 outbreaks Training Centre Equipments have been installed at 378 were reported in 2008 and 799 outbreaks in 2009. In 2010, out of 400 sites. State to District communication is possible 871 outbreaks have been reported from January to by NICs E-Learning Portal (http://e-learning.nic.in/lms), October 2010. Majority of the reported outbreaks were which has facility in managing live virtual classrooms for of Acute Diarrhoeal diseases, Food poisoning, Measles training (State/Area specific discussion on disease and Chickenpox. surveillance activities), e-learning, interactive electronic Contribution of IDSP in Influenza A H1N1 discussion (Chat rooms, Boards, Mailing Lists) and reviewing and monitoring project related activities. Outbreak Monitoring Cell on 24x7 basis has been established at National Centre for Disease Control Training Centre (ISRO): (NCDC) for monitoring the situation. Community, Private Indian Space Research Organization (ISRO) has installed Practitioners, Nursing homes and Hospitals have been training centre at 367 out of 400 sites (EDUSAT/VSAT). requested to report to IDSP Call Centre on 1075 (Toll free number) in case of any occurrence of clusters of Call Centre: Influenza like illness in the community. 12 Laboratories A 24X7 call centre has been established to receive disease are strengthened out of which 10 laboratories are alerts from anywhere across the country on a toll free functional and 2 are in process of strengthening under number 1075 for verification and initiating appropriate IDSP for testing clinical samples of Influenza A H1N1 in public health actions. The call centre has a response different regions of the country. 11 strains have been mechanism by informing respective health officials at sequenced at NCDC Laboratory. State and District RRTs concerned Districts for early response. A total of 51496 have been alerted to investigate and manage suspected calls were received from January - October 2010, out of outbreaks. which 3663 calls were related to Influenza A H1N1. Media Scanning and Verification Cell: IDSP Portal: Media scanning is an important component of surveillance The IDSP portal is a one stop portal (www.idsp.nic.in) to detect the early warning signals. Media scanning and which has facilities for data entry, view reports, outbreak verification cell daily receives an average of 4-5 media reporting, data analysis, training modules and resources alerts of unusual health events which are detected and related to disease surveillance. Overall 55% of Districts verified. A total of 1298 health alerts have been detected reported in the portal from January to October 2010. since its establishment in July 2008. In 2010, 388 media alerts were reported from January to October 2010; Training: majority of them were Acute Diarrhoeal diseases, Food The training in IDSP is three-tiered: poisoning and Malaria.
Master Trainers State and District Surveillance Information & Communication Technology Network Officers and RRT members are trained at identified (ICT): 9 National level institutes. ICT plays an integral and most powerful role in
The Medical Officers and District Lab Technicians implementing IDSP across the country. One of the are trained by Master Trainers at State level. important components of the project is data management, analysis and rapid communication in case of outbreaks.
Health Workers & Lab Technician/Assistants at peripheral institutions are trained by District Data Centre: officers/Medical Officers at District level. National Informatics Centre (NIC) has installed Data Training of State/District Surveillance Teams has been Centre Equipment at 776 out of 800 sites. The objective completed for 27 States/UTS and partially completed in of Data Centre is online data entry for speedy data 4 States. transmission.

228 Annual Report 2010-11 The main focus of training for State level participants is services for epidemic prone diseases during outbreaks. on basics of disease surveillance, concepts of The plan for all 9 States has been finalized through State epidemiology and data management, whereas the District level meetings and the network is functional in 3 States training focuses on correct procedures of data collection, namely Gujarat, Punjab and Rajasthan. The network plan compilation and reporting and outbreak response. A need is in process of implementation in the remaining 6 States. based special two-week Disease Surveillance and Field Epidemiology Training Programme (FETP) have been Entomological Surveillance on Vector Borne initiated for the District Surveillance officers. A total of Diseases: 288 District Surveillance Officers have been trained for Vector borne diseases like Malaria, Japanese Encephalitis, 2- week FETP in which 44 District Surveillance Officers Dengue, Kala-azar etc. are of major public health were trained from January to October 2010. concern. Every year outbreaks/ epidemics occur in State Health Societies were requested in May 2010 to different parts of the country leading to high morbidity recruit technical manpower under IDSP. 246 and mortality. Entomologists have joined in 16 out of 35 Epidemiologist, 34 Microbiologists and 16 Entomologists States/UTs. Entomological surveillance and monitoring have joined in States and Districts till October 2010. States of vector borne diseases are being carried out by the has been requested to expedite the filling up the remaining Entomologists. contractual positions at the State/Districts levels. Tribal and Social Plan: Induction training to 191 Epidemiologists, 15 Microbiologists and 7 Entomologists has been completed. Gujarat, Maharashtra and Karnataka are piloting community surveillance as part of the Tribal Action Plan. Infectious Disease Hospital Surveillance Network: West Bengal is planning to prepare a community 7 Infectious Disease Hospitals, one each in Delhi, surveillance strategy involving Panchayat representatives Mumbai, Chennai, Kolkata, Bangaluru, Ahmedabad and and community volunteers. Hyderabad have been given funds for strengthening Gujarat has started planning the tribal action plan (TAP) epidemic-prone disease surveillance under IDSP. (community surveillance among tribal communities) in two EDUSAT network has been installed at these Hospitals. Taluks of the Nizar block of the Tapi district, where over Infectious Disease Hospitals of Mumbai, Chennai, Delhi, 90 percent are tribal and live in remote locations. The Ahmedabad and Kolkata have started reporting weekly Gujarat TAP pilot will involve participation of community disease surveillance data. volunteers, health workers, and NGOs. The Tapi DSU is Strengthening of Laboratories: collecting baseline data on health service, access, disease incidence and outbreak reporting patterns so as to be able 50 priority District laboratories are being strengthened in to prioritize outreach and monitor outcomes. the country for diagnosis of epidemic prone diseases. The guidelines and procurement of certain deficient lab Karnataka and Maharashtra have started working on their equipment were communicated to the States in February TAP pilots in two select blocks each involving community 2009. Till date 18 States i.e. 26 labs have completed the health workers and volunteers. Maharashtra is piloting process of procurement. These labs are also being community surveillance as part of the TAP in Taloda and supported by a trained manpower to mange the lab and Akkalkowa blocks of Nadurbar district; and Karnataka an annual grant of Rs 2 lakhs per annum per lab for in Gundulpet and Kollegal blocks of Chamrajnagar district. reagents and consumables. 13 laboratories are functional Prevention and Control of Avian/H1N1 Influenza: at present. A networking model has been developed with 12 In 9 States, a referral lab network is being established by laboratories, out of which 10 labs are functional. The utilizing the existing functional labs in the medical colleges Animal Component of Avian Influenza is being looked and various other major centers in the States and linking after by Ministry of Agriculture (Dept. of Animal them with adjoining Districts for providing diagnostic Husbandry).

Annual Report 2010-11 229 Finance:

Budget and Expenditure for IDSP is as under:

Sl. No. Year Budget Estimates Expenditure % of expenditure (Rs. in crores) (Rs. in crores) w.r.t. BE 1 2009-10 48.50 39.95 82.37 2 2010-11(upto October 2010) 35.00 27.24 77.82

Achievements of Integrated Disease Surveillance • Outbreak Monitoring Cell on 24x7 basis has been Project (IDSP) established at National Centre for Disease Control (NCDC) for monitoring the situation. Community, A Central Surveillance Unit (CSU) at Delhi, State Private Practitioners, Nursing homes and Hospitals Surveillance Units (SSU) at all State/UT head quarters have been requested to report to IDSP Call Centre and District Surveillance Units (DSU) at all Districts in on 1075 (Toll free number) in case of any the country have been established. occurrence of clusters of Influenza like illness in • Central Surveillance Unit, IDSP presently receives the community. 12 Laboratories are strengthened weekly disease surveillance data from 527 districts out of which 10 laboratories are functional and 2 (85%) in the country. are in process of strengthening under IDSP for testing clinical samples of Influenza A H1N1 in A total of 335 (55%) districts are accessing one • different regions of the country. 11 strains have stop portal for data transmission, trend analysis and been sequenced at NCDC Laboratory. State and resources like guidelines, advisories for health District RRTs have been alerted to investigate and personnel related to disease surveillance, etc. manage suspected outbreaks. • On an average, 10-20 outbreaks are reported to • Training of State/District Surveillance Teams has CSU weekly by States. In 2010, 871 outbreaks have been completed for 27 States/UTS and partially been reported from January to October 2010. completed in 4 States. Majority of the reported outbreaks were of Acute Diarrhoeal diseases, Food poisoning, Measles and • A total of 288 District Surveillance Officers have Chickenpox. been trained in special 2- week FETP of which 44 District Surveillance Officers were trained from Media scanning and verification cell detects an • January to October 2010. average of 4-5 media alerts of unusual health events daily. In 2010, 388 media alerts were reported from • State Health Societies were requested in May 2010 January to October 2010; majority of them were to recruit technical manpower under IDSP. 246 Acute Diarrhoeal diseases, Food poisoning and Epidemiologist, 34 Microbiologists and 16 Malaria. Entomologists have joined in States and Districts till October 2010. States has been requested to IT network has been established for data entry, • expedite the filling up the remaining contractual training, video conferencing and outbreak positions at the State/Districts levels. Induction discussions. Data centre has been established in training to 191 Epidemiologists, 15 Microbiologists 776 out of 800 sites, and training centre has been and 7 Entomologists has been completed. established in 745 out of 800 sites with video conference facility. • Procurements of deficient equipments completed in 9 more Sates (16 labs); making it a total of 18 A 24X7 call center has been established to receive • States (26 labs). Expenditure guidelines for the disease alerts from across the country on a Toll annual grant of Rs. 2 Lakhs per District priority free number 1075. A total of 51496 calls were lab communicated to the States. Hand holding of received from January - October 2010 out of which the States via video conferencing and on site lab 3663 calls were related to Influenza A H1N1.

230 Annual Report 2010-11 visits for making the District lab functional. 13 Integrated Disease Surveillance Project - North laboratories are functional at present. Eastern States:- • Referral lab network plans were finalized through Background: State level meetings with the stakeholders for Integrated Disease Surveillance Project (IDSP) is a remaining 3 States namely Maharashtra, Andhra decentralized State based programme to strengthen Pradesh and Rajasthan. Implementation guidelines, surveillance system for epidemic prone diseases for early prototype MoU for the referral lab network and detection and control of outbreaks. As on date, all States expenditure guidelines for the grant for the referral and Union Territories including North Eastern States are labs under the network communicated to the States. implementing IDSP. The component wise details of status Specimen collection and transport guidelines for use / achievements in North East states are as under: at the district level during outbreaks communicated to the States for further communication to the IT Networking: Districts. In N.E States, IDSP has established linkages with all • Entomology unit has been established with the States/Districts HQ & all Govt. Medical colleges on a objective of updating the entomological surveillance Satellite Broadband hybrid network. The State wise details of vector borne diseases in the country. are as under: Sl. No. State Data Broadband Video Conference Centre Connectivity Facility 1. Arunachal Pradesh 14/14 11/14 13/14 2 Assam 27/27 27/27 26/27 3. Manipur 11/11 4/11 11/11 4. Meghalaya 9/9 7/9 9/9 5. Mizoram 10/10 4/10 10/10 6. Nagaland 12/12 9/12 12/12 7. Sikkim 6/6 6/6 4/6 8. Tripura 6/6 5/6 4/6 Total 95/95 73/95 89/95 Manpower status: Since July 2010, manpower recruitment has been decentralized and State wise break up of technical manpower is as under. Sl. No. States Epidemiologists Microbiologists Entomologist in position in position in position i) Arunachal Pradesh 15/17 1/2 1/1 ii) Assam 4/24 2/2 0/1 iii) Manipur 7/10 1/2 0/1 iv) Meghalya 0/8 2/2 1/1 v) Mizoram 0/9 1/3 0/1 vi) Nagaland 0/12 0/3 0/1 vii) Sikkim 1/4 1/2 0/1 viii) Tripura 0/5 0/2 0/1 Total 27 / 90 8/18 1/8

Annual Report 2010-11 231 Training Status:

Training of Trainers (ToT) of State and District Rapid Response teams (RRT) has been completed for eight North Eastern States. State wise details are as under:

Sl. No. States Master Medical Health District Peripheral Trainers Officers Workers Laboratory Laboratory Trained Technicians Technicians in ToT i) Arunachal Pradesh 61 Trainings to be initiated ii) Assam 85 1792 1032 iii) Manipur 41 300 0 0 0 iv) Meghalya 38 123 515 17 102 v) Mizoram 43 106 767 34 8 vi) Nagaland 20 158 683 159 35 vii) Sikkim 29 43 380 33 5 viii) Tripura 20 131 658 14 36 Total 337 2653 4035 257 186

Data Management Status: the State has detected a total of 57 outbreaks till October 2010 which is as follows: IDSP presently receives weekly disease surveillance reports from about 96% of the Districts of NE region (80 Sl.No. States No. of Outbreaks out of 83 districts). Data analysis and action are being in 2010(up to taken by respective Districts. October) Strengthening of Laboratories: i) Arunachal Pradesh 5 In North East States, strengthening of 10 identified district ii) Assam 44 laboratories for diagnosis of epidemic prone diseases is iii) Manipur 2 in progress. These labs are being supported under IDSP for procurement of certain deficient equipments and iv) Meghalaya 2 posting of a trained Microbiologist to manage the lab. In v) Mizoram 0 addition these labs have been allocated Rs 2 Lakhs per annum per lab for reagents and consumables. Guidelines vi) Nagaland 2 related to procurements, manpower recruitment and vii) Sikkim 1 expenditure guidelines for Rs 2 Lakhs per annum have already been communicated to the States. viii) Tripura 1 Total 57 Outbreaks detected:

The major component of the project is to detect and Finance: respond to outbreaks in the early rising phase. In 2010, The Grants-in-aid released and expenditure incurred in

232 Annual Report 2010-11 last 5 years i.e starting from the year 2003-04 of the the existing health care system. The number of reported project till 24 November 2010 is as under: cases has come down from 3751 to nil during the period from 1996 to 2004 and subsequently no case has been Sl. States Amount Amount reported from any of the states till October, 2010. No. released expenditure (In Lakhs) (In Lakhs) The programme envisages achieving its objective through adoption of following strategies: i) Arunachal • Case finding: active case search, passve Pradesh 282.08 244.44 surveillance, rumour reporting; • ii) Assam 295.39 288.99 Treatment of cases and contacts; • Manpower development; iii) Manipur 94.20 22.28 • IEC activities and iv) Meghalaya 162.63 120.72 • Multisectoral approach. v) Mizoram 358.49 375.91 Around 10000 sera samples collected from 1-5 years vi) Nagaland 365.31 321.71 children till October, 2010 tested negative for Yaws by RPR/TPHA test. Funds in the form of “Grant-in-aid” vii) Sikkim 96.20 67.8 are being provided to the states for operational cost to viii) Tripura 113.39 86.2 undertake activities under YEP. Total 1767.69 1528.05 B. Guinea Worm Eradication Programme (GWEP) in India 15.20.2. Division of Parasitic Diseases In 1983-84, National Centre for Disease Control was made the nodal agency by the Minsitry of Health & Family The Department is a nodal agency for planning, Welfare, Govt. of India for planning, co-ordination, implementation, monitoring and evaluation of Yaws guidance and evaluation of Guinea Worm Eradication Eradication Programme (YEP) and Guinea Worm Programme (GWEP). At the beginning of the Programme Eradication Programme (GWEP) in the country. It i.e. in 1984, about 40,000 GW cases were reported in undertakes surveys, manpower development and 12,840 guinea worm endemic villages 89 districts of seven research. On request, it also provides teaching materials endemic states, viz. Andhra Pradesh, Gujarat, Karnataka, like filarial slides to various colleges in the country and Madhya Pradesh, Maharashtra and Rajasthan. The State contributes to training of post graduate, undergraduate of Tamil Nadu remained free from GW disease since and nursing medical students who visit NCDC. The 1982. department also provides advice to states and districts in the control of parasitic diseases. The last guinea worm case in India was reported in July 1996 in Jodhpur district of Rajasthan. World Health A. Yaws Eradication Programme (YEP) in India Organization certified India as guinea worm disease free Yaws Eradication Programme (YEP) was launched as a country in February 2000. However, routine surveillance centrally sponsored scheme in 1996-97 in Koraput district continues till the disease is eradicated from the globe. of Orissa, which was subsequently expanded to cover all C. Lymphatic Filariasis: Manpower Development the 51 Yaws endemic districts in ten states (Andhra Pradesh, Orissa, Maharashtra, Madhya Pradesh, The Department is imparting training course on lymphatic Chhattisgarh, Tamil Nadu, Uttar Pradesh, Jharkhand, filariasis at its three Regional Filaria Training and Reseach Assam and Gujarat). The programme aimed to reach Centres (RFT&RC) functioning at Kozhikode in Kerala, the un-reached tribal areas of the country. Rajahmundry in Andhra Pradesh and Varanasi in Uttar Pradesh. National Centre for Disease Control has been identified as the nodal agency for the planning, monitoring and Training courses for Medical Officers/Biologist/ evaluation of the Programme. The Programme is Programme Officers for 5 days on lymphatic Filariasis implemented by the State Health Directorates through organized during the reported period at NCDC branches

Annual Report 2010-11 233 Varanasi from 23-27 August, 25-29 September, Kozhikode Viral Conjunctivitis: Twenty-five (25) eye swab were 19-23 July, 4-8 October and Rajahmundry 6-10 September tested for enteroviruses. Four were found positive for 2010. Coxsackie A24 and EV-71 viruses. Training course on filariology for Fialria Inspectors/ National Polio Surveillance: Technicians for 10 days organized during the reported AFP Surveillance: The Virology laboratory of NCDC period at NCDC branch Varanasi 12-23 April, 13-14 has been accredited as WHO National Polio Lab to assist Sepember, Kozhikode 2-13 August and Rajahmundry 15- NPSP on lab based surveillance of Acute Flaccid 26 November 2010. Paralysis. In this regard, 3000 stool specimens, 1500 15.20.3. Microbiology Division cases were received and tested. 150 isolates found positive for polio virus were sent to ERC, Mumbai for Coxsackie B Virus: To find out the association between further typing and intratyping characterization. myocarditis and Coxsackie B virus, paired serum samples from 36 cases from different hospitals were received and Supplementary Environmental Surveillance: tested. All the samples were found negative to Coxsackie B group (B1-B6) virus infection. As per Govt. of India, Ministry of Health & FW, NCDC has been selected to carry out supplementary surveillance Measles: Sixty-two (62) clinically suspected cases of by collecting sewage samples on weekly basis from 7 SSPE were reported to the laboratory. Twenty-four (24) sites selected by NPSP to see the presence of any wild of these cases were confirmed by laboratory tests poliovirus in the sewage. In this regard, 118 sewage showing of high titre anti measles antibodies in serum samples have been collected and tested at NCDC and and CSF samples. No such case, so far, is reported ERC, Mumbai in parallel. 18 samples were found to be following measles vaccination. Twenty-four (24) serum positive for wild polio virus (P1-5. P3-7 and P1+P3 – 46) samples from suspected measles cases were received. indicating that the wild virus is still circulating in the Thirteen (13) were positive for anti measles IgM community. antibodies. Tuberculosis: Viral Hepatitis A total of 731 clinical samples (mainly serum samples A total of 1216 serum samples were received and tested and a few other samples like CSF pleural, other fluids, for various markers of viral hepatitis. 28 cases showed obtained from suspected cases of tuberculosis were tested evidence of hepatitis A, 32 of hepatitis E and 148 of for the presence of anti A60 mycobacterial antibodies by acute and chronic hepatitis B. ELISA test. 287 samples were found to be positive. In addition, 150 clinical samples obtained from suspected Congenital Viruses: These viral infections result in cases of tuberculosis were subjected to mycobacterial abortions and congenital malformation in infants. A total culture 6 mycobacterial isolates were subjected to drug of 495 samples from women having bad obstetric history sensitivity test using BACTEC as well as Conventional and congenitally malformed babies and viral encephalitic method. cases were tested for antibodies against Rubella, Cytomegalo virus & Herpes simplex virus infections. 229 Bacteriology serum and 203 CSF were tested for HSV encephalitis. 148 samples (including CSF, blood and slides) obtained Viral Encephalitis: 26 cases from viral encephalitis from from suspected cases of pyogenic meningitis were Delhi hospitals were received and tested for anti-measles subjected to culture examination and rapid latex anti HSV, anti Rubella, Vericella, mumps, EBV IgM and agglutination test for antigen detection. 365 clinical EV-71 antibodies. samples from suspected diphtheria cases in Delhi were processed for diphtheria cases in Delhi were processed ILI Surveillance for diphtheria culture. 347 urine samples were subjected A total of 879 ILI Surveillance samples have been to culture examination. Blood culture was carried out in 98 samples from cases of enteric fever. 89 pus, throat processed by Multiplex PCR from May, 2008 to till date swabs and other samples were subjected to culture out of which 31 are positive for Influenza A, 10 positive examination. 15 samples were processed for Legionella for influenza B, 8 for Influenza A H1N1 and 5 for para culture and IFA test. Influenza.

234 Annual Report 2010-11 Diarrheoal Diseases Laboratory were supplied in this period. 2000 plates of specialized/ selective media (e.g. XLD, SSA, TCBS, etc) were A total No. of 642 rectal swab/stool samples from supplied. Around 5000 tubes, 550 vials and 300 flasks of gastroenteritis cases in and around Delhi from Infectious liquid media (e.g. Peptone water, Selenite broth, Diseases Hospital, and Aruna Asaf Ali Hospital, Delhi McConkey broth etc.) were supplied. 600 vials of processed for the presence of enteropathogens Vibrio transport media eg (Cary-Blair medium were supplied cholerae 01 and non-agglutinating cholera, Shigella and by Media room. 1000 nutrient agar stabs were supplied Salmonella sp. Out of 642 samples, 187 positive for as preservative media. 5000 tubes of biochemical test V.cholerae 01, 3 NAG, 8 Shigella, 31 Salmonella, 6, E.coli media (e.g. PPA, TSI Agar, Simmon’s citrate, RCUT pure culture, 1 Clostridium difficile and 3 Rota virus. media etc.) were supplied. Twenty-nine (29) referral diagnostic samples were Mycology Laboratory received, out of which 2 VCO1, 2 Shigella, 4 Clostridium difficile were diagnosed. It provides Diagnostic mycology services to the referred cases from Delhi Hospitals. The important mycotic A total No. of 31 samples received from various parts of infections that were diagnosed: Cryptococcusis- 6, India, as pert of outbreak investigation, 9 positive for Aspergillusis - 9 Candida albicans – 2, Candida sp.p-1, VCO1, 5 EFC 1 Rota virus. 100 isolates processed for Alternaria spp.-1, Nocardia spp-1. This involved Antimicrobial sensitivity. processing of 105 clinical specimens such as CSF, sputum, Following new diagnostic services are added during the blood, serum, skin scrapings and tissue biopsies. reporting year. In addition assisted in disease outbreaks and carried out i. Diagnosis of viral diarrheoa: Rotavirus and teaching and training activities. Norovirus detection by ELISA test. 15.20.4. Centre for Medical Entomology and Vector ii. Diagnosis of antibiotic associated diarrheoa: Management Clostridium difficile toxin detection by ELISA test. Centre for Medical Entomology and Vector Management iii. Molecular diagnosis of Traveller’s diarrheoa: is reorganized to develop it as a National Centre par Enterotoxigenic E.coli (ETEC); Enteropathogenic excellence for undertaking research, providing technical E. coli (EPEC) and Enteroaggresive E.coli (EAEC) support and to develop trained manpower in the field of detection by multiplex PCR. vector-borne diseases and their control. The centre provides technical guidance, support and advice to various Environmental Laboratory: states and organizations on outbreak investigations and A total of 351 (Three hundred and fifty-one) drinking entomological surveillance of vector-borne diseases and water samples belonging to different drinking water their control. Major achievements are highlighted below: sources (collected during outbreak investigations of water Major achievements borne diseases, samples from air-line caterers serving VVIP flights, referred samples from schools, hospitals, 1. Based on the detection of Dengue virus antibodies domestic sources etc.) were tested for bacteriological in vector mosquitoes early warning signals were standards by the MPN Coliform method. 233 (66.38%) issued to Municipal Health Officer, MCD, Delhi, of these were found satisfactory, while the remaining 118 Chief Medical Officers of district Sonipat & (33.6%) were unsatisfactory. Other than this, 123 Panipat (Haryana) for possible outbreak of sewage water samples were collected and processed for Dengue. polio virus surveillance in Delhi. Concentrated samples 2. Officers and staff members of CME&VM were sent to ERC, Mumbai for polio virus isolation. 2500 monitored dengue surveillance activities in Central H2S strip bottles prepared were supplied for polio Zone, Shahadra Zone & South Zone of Delhi during surveillance in other outbreaks. current Dengue/Chikungunya epidemic. Media Room 3. Laboratory evaluation of two Transfluthrin based Approximately 4000 plates of routine plate media (Blood mosquito repellent liquid (RDE/LV/A-165) and agar, MacConkey agar, Chocolate agar, MH agar etc.) 1.6% Transfluthrin (RDE/LV/A-166) vaporizer was

Annual Report 2010-11 235 carried out in Peet Grady chamber against Culex Disease” at Gwalior (M.P.), w.e.f. 1st to 3rd quinquefasciatus mosquitoes and house flies December 2010. (Musca domestica). • Title “Prevalence of different species of Aedes 4. Field evaluation of six insecticide compounds in mosquitoes in urban localities of National Capital respect of its residual efficacy under field condition Territory of Delhi, India and detection of Dengue is being carried out in Bastar district, Chhattisgarh virus.” submitted to DRDO for conference on state. “International Symposium on Recent Advances in Ongoing Research Projects Ecology & Management of Vector Born Disease” at Gwalior (M.P.), w.e.f. 1st to 3rd December 2010. 1. Studies on the presence of Dengue/JE Virus in Title “Effectiveness of Diflubezuron (IGR) vector mosquitoes. • formulations against four vector species of 2. Japanese Encephalitis /Dengue virus detection in mosquitoes.” submitted to DRDO for conference mosquitoes of some endemic areas. on “International Symposium on Recent Advances in Ecology & Management of Vector Born 3. Entomological surveillance of vector of Yellow Disease” at Gwalior (M.P.), w.e.f. 1st to 3rd Fever, dengue and chickungunya mosquitoes in and December 2010. around international airports and sea ports and vector control measures thereof. 15.20.5.Division of Malariology & Coordination 4. Studies on rodent-flea association at major Sea A. The division has a malaria clinic to check/cross Ports of India. check blood smears of clinically diagnosed cases for the presence of malarial parasites, referred by 5. Studies on the role of certain anophelines in the various hospitals of Delhi and surrounding districts transmission of malaria in Arunachal Pradesh and of Uttar Pradesh and Haryana state. During the other parts of the country. year 2010 upto 31st October,10 a total of 1227 6. Entomological surveillance of vectors of Scrub blood smears were examined, of which 91 were typhus in selected urban, peri-urban and rural set found to be positive. 72 for P vivax and 19 for P up of Delhi, NCR and other parts of the country. falciparum. Clinic also checks the slides brought from field by various divisions during Research & Research abstracts submitted & accepted for survey. A total of 11 blood smears were examined presentation: and all were found negative. • Title “Malaria in rural foot hill of Aravali hill mountain B. A total of 582 students from different institutes were range, India” submitted to DRDO for conference on “International Symposium on Recent Advances given short term training as follows: in Ecology & Management of Vector Born

S.No Month Institutions No. of participants 1 18-1-10 to MD Microbiology students of Delhi University of MAMC, LHMC, 20-1-10 UCMS & VPCI 6 2 4-2-10 to 5-2-10 5 senior veterinary Army officers of RVC Centre and College Meerut under the aegis of Indian Vet. Research Institute, Izatnagar, Bareilly 5 3 05-2-10 B.Sc Nursing Students of St. Ann’s group of Institutions, Mulki, Mangalore 37 4 8-2-10 to 12-2-10 Post Graduate students from Department of Community Medicine of MAMC, LHMC, UCMS New Delhi 5

236 Annual Report 2010-11 S.No Month Institutions No. of participants 5 15-2- 10 Trainees of ‘diploma in health promotion Education” & PG Diploma in community Health care (PG- DCHC) from Health & Family Welfare Training and Research centre, Mumbai 30 6 17-2-2010 Medical officers of Himachal Pradesh under going “Professional Development Course in Management public health & Health sector reforms for the mid level Medical Officers” at State Health and Family Welfare Training Centre, Pari Mahal, Shimla 17 7 18-2-2010 B.Sc III yr life science students of Sri Aurobindo College(University of Delhi), Malviya Nagar, New Delhi 9 8 23-2-2010 Newly appointed CGHS and CHS officers undergoing induction training course at NIHFW, Munirka 22 9 11-3-2010 BHMS students of Dr. Padiar Memorial Hoemopathic Medical college, Ernakulum, Kerala 38 10 22& 23-3-10 DNB Students 3 11 27-4-10 2nd year MBBS students of Army college of medical sciences, Delhi cantt. 19 12 11-5-10 2nd year MBBS students of Army college of medical sciences, Delhi cantt 9 13 13-5-10 4th year B.Sc Nursing students of Vidyarathana college of Nursing, Udupi 34 14 25-5-10 2nd year MBBS students of Army college of medical sciences, Delhi cantt 14 15 28-5-10 Visit of 4th year B.Sc Nursing students of VidyarathanaNitte Usha Institute of Nursing Sciences, Deralakatte, Karnataka 102 16 8-6-10 2nd year MBBS students of Army college of medical sciences, Delhi cantt 14 17 15-6-10 MD (CHA) & DHA Final Year students from National Institute of Health & Family Welfare, Munirka 12 18 23-6-10 Senior Medical officers of BSF Academy, Tekanpur, Gwalior 11 19 13-7-10 Visit of 2nd year M.Sc Nursing students of K. Pandyarajah Ballal Nursing Institute , Ullal, Karnataka 27 20 19-8-10 Visit of Class XIIth students of lady Irwin Senior Secondary school Shrimant Madhav Rao Scindia Marg, New Delhi 34 21 13-9-10 Medical officers of Department of community medicine, AFMC, Pune 10 22 23—9-10 Visit of M.Sc Nursing students of Bombay Hospital College of Nursing, Bombay 32 23 5 -10-106- 10-10 7-10-10 Visit of Final year BHMS students of Nehru Homeopathic Medical College and Hospital, Defence Colony, New Delhi 92 582

Annual Report 2010-11 237 15.20.6. Centre for AIDS & Related Diseases sentinel surveillance centres in four states viz. Delhi, Haryana, Rajasthan and J&K Introduction • Preparation and characterization of panel for kit The Division of AIDS was established at National Centre evaluation (HIV, HBV & HCV) for Disease Control (NCDC) in the year 1995. Prior to this it had existed as AIDS Reference Laboratory in • HIV, HBV and HCV test kits evaluation. Division of Microbiology (since 1985), one of the first Testing of blood products referred by DCGI for reference centers in India, which initiated surveillance of • various infectious markers (HIV, HBV and HCV) HIV-infection in the country. In December 2004, it was upgraded as Centre for AIDS & Related Diseases. • CD4 cell estimation for samples referred from linked ART and PPTCT centers The Centre has the following laboratories/units Diagnosis of common opportunistic infections i.e. i. National Reference Laboratory • Cryptosporidium spp. Microsporidium spp. and ii. HIV Serology Laboratory P. jeroveci in stool and sputum respectively. iii. Quality Control Laboratory • Serological diagnosis of syphilis iv. Immunology Laboratory • Participation in EQAS for CD4 cell estimation conducted by National AIDS Research Institute v. STI and Opportunistic Infections Laboratory (NARI), Pune in collaboration with QASI, Canada. vi. Molecular Virology Laboratory • Participation in EQAS for HIV serology conducted vii. Integrated Counselling and Testing Centre (ICTC) by the National AIDS Research Institute, Pune. viii. HIV Test Kits Distribution Unit • Participation in EQAS for VDRL/RPR testing conducted by Regional STD Teaching, Training & ix. Central Blood Collection Unit Research Center, VM Medical college & Safdarjung Hospital, New Delhi. • Manpower development for 1. Laboratory investigations for HIV/AIDS 2. Development of Quality management System in HIV testing laboratories • Centralized sample collection for different Divisions of NCDC. • HIV test kits storage facility to DSACS.

Brief overview of the activities of the Centre Activities performed in various laboratories/units of the Centre • Serological testing and confirmation of HIV infection for referred samples. A. Participation in International and National EQAS • Counselling and HIV testing for direct walk-in clients • This Center regularly participates in an EQAS for HIV serology conducted by National AIDS • Panel preparation and delivery of EQAS to SRLs Research Institute, Pune. The Centre has of 4 linked states i.e. Delhi, Haryana, Rajasthan consistently given 100% concordant results as and J&K. part of the proficiency testing programme. • Quality Control of HIV testing performed by linked • Centre regularly participates in EQAS for CD4 cell state reference laboratories (SRLs) and linked estimation conducted by National AIDS Research

238 Annual Report 2010-11 Institute, Pune in collaboration with QASI, Canada. C. Serology / Quality Control Laboratory The Centre has consistently performed satisfactorily during the period. • A total of 609 serum samples were tested for diagnosis and conformation of HIV infection. • This centre regularly participates in External Quality Assessment Scheme (EQAS) for VDRL/ RPR test • A total of 2186 samples were tested during last conducted by Regional STD Teaching, Training & round of HIV Sentinel surveillance as part of Research Centre, VMM College & Safdarjung Quality Control of HIV testing performed linked Hospital. The centre has consistently given 100% sentinel surveillance centers in four states viz. concordant results for qualitative RPR. Delhi, Haryana, Rajasthan and J&K. B. National Reference Laboratory • A total of 6325 Dried Blood Spot (DBS) specimens received from Twenty eight high risk group (HRG) • A total of 52 blood products referred from Drugs sentinel sites spread across four states namely Controller General of India (DCGI), Govt. of India Jammu & Kashmir, Haryana, Rajasthan & Delhi have been tested for various infectious markers were tested for anti-HIV antibodies. i.e. HIV, HBV and HCV (a total of 624 tests were performed during the testing of these blood products). • A total of 05 HIV kits were evaluated at NRL (a total of 2500 tests were performed during the evaluation of these kits). • A total of 272 samples have been tested for HIV as part of Quality Control of HIV testing performed by liked SRLs (a total of 408 tests performed) . • EQAS programme was conducted twice in this year for all the 13 SRLs and their associated ICTCs o A panel comprising of 08 members for each of the SRLs and a bulk panel comprising of 04 members for ICTCs was sent after getting them validated D. Immunology Laboratory from NARI, Pune. • CD4/CD3 cell estimation was performed on 1148 o Report of testing conducted on panel by SRLs was samples referred from anti retroviral treatment compiled and feedback was given to the respective (ART) centre, Deen Dayal Upadhyay Hospital, SRLs. New Delhi and 08 PPTCT centers of Delhi. E. Molecular Virology Laboratory • HIV viral load assay by quantitative RT-PCR performed on 200 samples as part of collaborative research project entitled “Comparative study on HIV/AIDS with anti-retroviral and add on Homoeopathy drugs” with Central Council for Research in Homoeopathy, Department of AYUSH, MoH&FW, GoI. F. Opportunistic Infections/STI Laboratory • A total of 359 sera samples from suspected cases of Syphilis were tested by RPR card test and TPHA test (A total of 779 tests performed).

Annual Report 2010-11 239 • A total of 10 samples were tested for various Reference Laboratories from 18th - 19th March opportunistic infections. 2010.

G. Integrated Counselling & Testing Centre 3. Practical demonstration of “ HIV – Testing (ICTC) Methodologies” to 25 participants from South East • A total of 293 direct walk-in-clients were provided Asia Region during the 3 months FETP Programme pre test counseling while 260 subjects were given on 20th August, 2010, at NRL (CA&RD) of post test counselling. NCDC, Delhi.

H. Central Blood Collection Unit 15.20.7. Epidemiology Division:- This unit acts as a central sample collection facility • A. Activities of the Division for the institute. During the period a total of 2262 samples were collected and distributed to the • Organization and coordination of training courses respective laboratories for testing. in Epidemiology to develop trained health I. Kits Distribution Unit manpower. Development of teaching materials such as Modules, Manuals etc. on disease surveillance • A total of 8843 HIV, HBV and HCV kits were and outbreak investigation of epidemic prone received and distributed by DSACS to various communicable diseases. Centers of Delhi. J. On going Research Projects • Investigation of outbreak of diseases of known / unknown etiology and recommend measures for 1. Collaborative research project “Comparative study its prevention and control to the States / UTs of the on HIV/AIDS with anti retroviral and add on country. Provision of technical support to State Homoeopathy drugs” with CCRH, New Delhi. government for investigation and control of disease outbreaks.

• Provision of administrative and technical supervision to three branches of the Institute viz., Alwar (Rajasthan), Jagdalpur (Chhattisgarh) and Conoor (Tamil Nadu).

• Provision of technical support to various National Health Programmes in the form of developing guidelines for control, manpower development, evaluation of different components / indicators.

• Assisting the Director for publication of monthly Bulletin “CD Alert”.

K. Training Activities • Carry out field research on different aspects of communicable diseases. 1. Organized two days workshop on “External Quality Assessment Scheme (EQAS) for HIV testing” for B. Outbreaks Investigated/ Rapid Health Officers of the linked State Reference Laboratories Assessment. from 16th - 17th March 2010. During the period, officers from the division of 2. Organized two days workshop on “External Quality Epidemiology carried out investigations of outbreaks in Assessment Scheme (EQAS) for HIV testing” for the country and suggested containment measures to the Laboratory Technicians of the linked State

240 Annual Report 2010-11 authorities. Some of the outbreak investigations are as • Four week Regional Training Programme on follows: Prevention and Control of Communicable Diseases from 9th November 2010 to 6th December 2010. Avian Influenza in Murshidabad district of West • A total of seven participants from Maldives, Bhutan Bengal. and Nepal attended the said training. Reported wild polio virus cases in Ghaziabad district • E. Training/ Meetings & Workshops Attended of Uttar Pradesh on 9th Feb. 2010 • Meeting on Public Health Bill 2009 in the Ministry Reported cases of blindness among infants and • of Law and Justice at New Delhi on 22.1.10. children in village Shivpur of Gauri bazaar, Deoria district of Uttar Pradesh from 12 – 14 May 2010. • Meeting on South-East Asia Regional conference on Epidemiology organized by WHO and IAE at Dengue outbreak in the districts of Idukki, • Hotel Taj, New Delhi from 8 – 10 March 2010. Kottayam, Pathanamthitta and Thiruvuanan thapuram in Kerela state from 20 – 24 July 2010 . • Ethical Committee meeting at NCDC on 25.05.2010 to look for the ethical issues of the long Malaria in Mumbai (Maharashtra) from 29 – 30 • projects of MPH Scholars. July, 2010. • Meeting for revision of Indian Public Health After cloud burst leading to flash floods causing • Standards held at NCDC on 5 – 6 May 2010. damage to human life and provided Disease control facilities in Leh from 7- 15 August and from 13- 28 • Expert Group Meeting on Firming of Sentinel August. Surveillance for Vaccine Preventable Diseases under the chairmanship of Dr. L.M. Nath at Reported cases of wild poliovirus in Motihari (East • N.C.D.C., Delhi on 28th June, 2010. Champaran) District of Bihar from 13-17 October 2010. • Sixth World Organ Donation Day on 27 – 28 November 2010 at Vigyan Bhawan, New Delhi • Reported cases of wild poliovirus in Beed district of Maharashtra from 12-25 October 2010. 15.20.8. Zoonosis Division

C. Manpower Development The objectives of the division is to provide technical support for outbreak investigations, conduct operational National Centre for Disease Control (NCDC), Delhi is a research and trained manpower development in the field WHO Collaborating Center for Epidemiology and training. of zoonotic diseases and their control in the country. The division of Epidemiology conducts regular training Diagnostic support is provided to State Governments for programmes and numerous other short-term training laboratory diagnosis of zoonotic infections of public health activities every year. The course curricula of these training importance. programmes are designed and tailor-made to develop the necessary need-based skills for the health professionals. The Division has Reference Laboratory for Plague. It The participants to these courses come from different has also been recognized by the World Health States/ Union Territories of India. In addition, trainees Organisation as WHO Collaborative Centre for Rabies. from some of the neighbouring countries like Bangladesh, Currently the work is being carried out on following Bhutan, Sri Lanka, Myanmar and Nepal also participate Zoonotic diseases: Plague, Rabies, Kala-azar, Arboviral in some of the training programmes. infections (Dengue, JE & Chikungunya), Toxoplasmosis, Brucellosis, Leptospirosis, Rickettsiosis, Hydatidosis, D. The Training Courses Organized Neurocysticercosis and Anthrax. 15th Regional Field Epidemiology Training • The Central Animal Facility for breeding & maintenance Programme (FETP) from 2nd August 2010 to 29th of different species of laboratory animals is being October 2010. A total of 25 participants from 10 supervised by the Division. countries participated in this training.

Annual Report 2010-11 241 Major Role and Activities of Division during 2010 are as follows: A. Referral diagnostic services for the years 2010 (01.01.2010 ñ 30.11.2010)

Rabies

(a) Post-mortem diagnosis in animal brain samples by Negri body, FAT, BT 15

(b) Diagnosis in hydrophobia cases by 16

(c) Assessment of antibodies by ELISA test

(i) Human 617

(ii) Animal 28

Kala-azar

(a) Parasitological diagnosis by smear examination and culture 96

(b) Serological diagnosis by IFA test 228

Toxoplasma

Serological and diagnosis by IFA test 390

Brucellosis

Serological diagnosis by tube agglutination test 76

Rickettsiosis

Serological diagnosis by Weil Felix test 156

Hydatidosis

Serological diagnosis by ELISA 32

Arboviral diseases

Serological diagnosis by IgM ELISA test for Japanese Encephalitis.

(i) Human sera samples 29

(ii) Human CSF 72

IgM ELISA test for Dengue 742

IgM ELISA test for Chikungunya 292

Plague

Serological diagnosis by PHA and PHI in rodent Sera 1204

Culture for isolation of Y.pestis from rodent organs 846

Neurocysticercosis

Serological diagnosis by ELISA 187

242 Annual Report 2010-11 2010 (01.01.2010 ñ 30.11.2010)

Leptospirosis

Serological diagnosis by ELISA 292

Anthrax Nil

Viral isolation

Chikungunya 60

Dengue 280

JE Nil

Rabies 4

Lymes Disease Nil

Hanta virus Nil

B Training courses/Expert group meetings • Molecular characterisation of strains of Leishmania. • Joint Orientation Workshop on Zoonotic infections for medial and veterinary professionals from 17th • Sero-epidemiology of Brucellosis in high risk to 21st May, 2010 population in Delhi • Training Course on laboratory diagnosis of Dengue • Standardization of appropriate diagnostic methods & Chikungunya for doctors & paramedicals of for sero-diagnosis and sero-epidemiology of human sentinel hospitals of Delhi from 8th to 11th June 2010. and animal leptospirosis • Training of core trainers in appropriate animal bite • Surveillance of arboviral infections in man and management including intra-dermal inoculation of animals cell culture anti-rabies vaccine, August, 2010. • Isolation of rabies virus in-vitro (Neuroblastoma 2A C (1). Research projects undertaken cell lines). • To study the epidemiological profile of Kala-azar • Study of prevalence of Rabies in peridomestic and patients in Delhi wild rodents. • Serological studies in Toxoplasmosis in different • Standardization of Rapid Fluorescent Focus Delhi Hospitals. Inhibition Test (RFFIT) for rabies antibody titer. • Comparative analysis of various serological tests • Isolation of Chikungunya virus in mouse in diagnosis of Toxoplasmosis. neuroblastoma cell lines. • Surveillance of Plague in different parts of the • Serological studies in clinically suspected cases of country. hydatid disease • Specificity of Passive haemagglutination Test for • Sero-epidemiological studies for rickettsial diseases Y.pestis. (scrub typhus & Indian tick typhus) in patient with pyrexia of unknown origin. • Use of ELISA in serological diagnosis of Neurocysticercosis. C (2) Pilot Projects on Prevention and Control of Human Rabies and Control of Leptospirosis.

Annual Report 2010-11 243 The Zoonosis division is presently undertaking two 15.20.9.Division of Biochemistry & Biotechnology:- projects as “New initiative” under 11th five year plan namely:- The division is actively involved in disease diagnosis during various epidemics and outbreak, operational research, o Pilot Project on Prevention and Control of Human manpower development, advisory role and other Rabies multifarious activities towards prevention and control of a cascade of epidemic-prone diseases of larger public o Pilot Project on Control of Leptospirosis. health importance. Pilot project on Prevention and Control of Human The division provides laboratory support to epidemiological Rabies studies, surveys and outbreaks and also participates in teaching, training, conference, workshops, seminar, To prevent human deaths due to rabies a pilot project has symposia and other academic related activities organized been initiated as a ‘New Initiative’ in the 11th Five Year by the Institute from time to time. The division conducts Plan since March 2008, to be completed by March 2010. applied research activities leading to Ph.D degree from NICD is the nodal agency to coordinate various activities GGSIP University, Delhi. It also imparts project training under the project. It is being carried out in five cities viz: to M.Sc/B.Tech students from different Universities and Ahemdabad, Bangaluru, Delhi, Pune & Madurai. The Institutes. focus of the pilot project is on training of health professionals about rabies and animal bite management, The division has two laboratory wings: ensuring timely and adequate post-exposure treatment to A. Biotechnology/ Molecular Biology Wing all animal bite victims, creating awareness in the community regarding rabies, animal bites and its i) Biotechnology & Molecular Biology Laboratory prevention, strengthening laboratory diagnostic ii) Molecular Diagnostics & Gene Cloning capabilities, facilitating introduction of intradermal route Laboratory of vaccination and sensitizing veterinarians. A total amount of Rs. 3.26 crore has been allocated for the project. An • Molecular Diagnosis & Molecular Epidemiology of amount of Rs. 1.81 crore was released during 2008-2009 over 25 epidemic-prone diseases viz. Polio, to pilot project cities to carry out various activities. Dengue, Hepatitis, HIV, SARS, Avian influenza,Swine flu, Anthrax, MDR TB, Malaria, Pilot Project on Control of Leptospirosis Kala-azar etc of greater public health importance. To prevent morbidity and mortality due to Leptospirosis
PCR/RT-PCR & DNA Fingerprinting/Gene in human a pilot project has been initiated as a ‘New Sequencing for ultimate diagnosis of pathogens. Initiative’ in the 11th Five Year Plan for two years (March
Tracking the source of infection of emerging/re- 2008 to March 2010). NCDC is the nodal agency and emerging diseases. the three states under the project are Gujarat, Kerala and Tamil Nadu. The focus of the project is on early
Molecular differentiation of strains, detection of diagnosis and treatment of Leptospirosis cases, virulent/drug resistant forms. Strengthening of Laboratory and patient management
Genotyping and Sub-typing of strains. facilities, trained manpower, awareness in the community and inter-sectoral co-ordination. A total amount of Rs.
Maintenance of “Gene Bank” of important disease 2.05 crore has been allocated for the project. An amount pathogens. of Rs 99 Lakhs was released during the year 2008-09.
Molecular typing of drug resistant M. tuberculosis, Rs 95.50 lakhs was allocated to pilot project states to S.aureaus and K.pneumoniae. carry out various activities. Utilization Certificate and Statement of expenditure of Tamil Nadu (Rs 30.00 Lakhs) B. Biochemistry & Environmental Biochemistry and Gujarat (Rs 35.50 lakhs) has been obtained. In the Wing current financial year 2009-10, a sum of Rs. 80.00 Lakhs has been allocated.

244 Annual Report 2010-11 i) Clinical Biochemistry & Toxicology Laboratory • Molecular studies of Chikungunya virus isolates in different parts of the country. ii) National Reference Lab for Iodine Deficiency Disorders • Monitoring of thyroid hormones in sera from suspected cases and iodine levels in urine and salt
Referral services/support to outbreak investigations. samples under NIDDCP.
Analysis of iodine in salt and urine samples in Iodine Outbreak Investigations deficiency disorders (IDD) analysis. Pandemic Influenza A (H1N1) : In view of the major
Thyroid function test (FT3, FT4 & TSH) in referred pandemic Influenza A (H1N1) virus outbreak in the serum samples. country, clinical samples of more than 34285 suspected
Chemical analysis of water for fluoride toxicity, cases of swine flu were tested at NCDC, Delhi using CDC recommended protocol for Real Time RT-PCR,
Imparts training under NIDDCP for manpower alongwith PCR and gene sequencing. Till date, over 7966 development. confirmed cases of Influenza A (H1N1) were reported Significant achievements: by NCDC alone. Further regular lab-testing is going on to detect new cases of pandemic Influenza A (H1N1).
Department of Biotechnology, NCDC has been recognized as Regional Reference Laboratory of 15.20.10. Proposed upgradation of NICD to NCDC NACO for DBS-based HIV-DNA PCR for early NICD, a premier public health institute in the country infant diagnosis (EID). MOU between NACO and tasked to meet the challenges of emerging and re- NCDC signed by Director, NCDC on 27.11.2010. emerging diseases. The upgradation was considered
Four Ph.D students of the division have been essential as no major upgradation had taken place since awarded Ph.D. Degree from GGSIP University, long. The institute got its independent appraisal done as Delhi. advised by the Planning Commission in July, 2007. The Department of Management Studies, IIT Delhi carried Research Projects: out evaluation during November 2007 and submitted its • Genomic characterization of circulating strains of report in May 2008. M/s. HSCC was appointed as Influenza A Virus including H5N1/H1N1. Consultant for preparing Detailed Project Report (DPR). They submitted the DPR. Based on the above inputs and • Molecular characterization of Dengue virus isolates also detailed consultations at different levels, including in the Cpre-M, M and Env/NS1 gene of region of with technical officers, a draft Memo for Expenditure the virus isolates from DF outbreaks. Finance Committee (EFC) was prepared and circulated in December 2009. EFC Memo was finalized after incorporating response from the concerned Ministries/ • Genotyping of HBV Strains from Gujarat HBV outbreak and typing of HCV from Delhi isolates. Departments. The estimated cost includes capital cost for civil and services works, furniture, equipment and • Molecular typing of HIV-1 subtype-C and drug additional manpower. resistance gene in Indian strains. EFC has since recommended the project at a total cost • Molecular characterization of M.tuberculosis in estimates of Rs.382.41 crore. A draft note for Cabinet endometrium obtained from infertile women Committee on Economic Affairs (CCEA) was prepared undergoing infertility management. and sent to MOH&FW for further necessary action. In addition, it has since been decided to engage National • Studies on drug resistance gene(s) in Salmonella Building Construction Corporation (NBCC) as an agency species. for construction works. Further action to execute an MoU • 7. Characterization of DNA repair enzymes in with them is being taken. Simultaneously approvals from MDR and XDR M. tuberculosis and their role in local authorities on the site plan and master plan are also drug resistance. being taken.

Annual Report 2010-11 245 15.21 LADY READING HEALTH SCHOOL University, Coimbatore and M.D (Microbiology) (LRHS), DELHI affiliated to Tamilnadu Dr. M. G. R Medical University, Chennai. Lady Reading Health School, Delhi is established in 1918 ,is imparting the following courses:-
Breeding of Mice and Guinea pigs for Experimental purpose like Quality Control of DPT and TCAR I. Diploma in Nursing Education and Administration vaccine and stability study of such vaccines. (Elective in Community Health Nursing). Quality Control Division II. Certificate Course for Health Workers (Female) under Multipurpose Workers Scheme. The Quality Control Division comprises the following divisions. III. Auxiliary Nurse-cum-Midwife Course under (10+2) Vocational Scheme. 1. Quality Control Department

Ram Chand Lohia Infant Welfare Centre, under Lady 2. Rabies Diagnostic Laboratory Reading Health School provides field practice area for Urban Health experience for the students and gives 3. Sterility Media Section integrated M.C.H. Family Welfare Services to over The following processes were carried out in Quality 39,000 populations. Control Division. Staff and students actively participated in ‘Pulse Polio a) Quality Control Tests on Bacterial Vaccines ( DPT Programme’, Reproductive Child Health Programme and group of vaccines) and Tissue Culture Anti Rabies Perfect Health Mela etc. during the year. Vaccines 15.22 PASTEUR INSTITUTE OF INDIA (PII) b) Sterility media preparation COONOOR c) Rabies Diagnostic Tests The Institute registered as Society under the Societies Registration Act, 1960, started functioning as Pasteur a. Quality Control Tests Institute of Southern India, on 6th April 1907 and the Institute took a new birth as the Pasteur Institute of India IPQC tests for 9 batches BPDT, 7 batches of BPTT and and started functioning as an autonomous body under the 13 batches of B.P. pool samples were carried out in QCD. Ministry of Health and Family Welfare, Government of Aluminium Phosphate Gel samples (63 Nos) were tested India, New Delhi from the 10th of February, 1977. for Aluminium Phosphate content and the Sterility test was conducted for 40 samples. Estimated Thiomersal Activities undertaken during 2010-11 were:- content for 3 samples and 1 batch of 5 ml tubular glass
Institute has a Rabies Diagnostic Lab and treatment vials tested for measurement and hydrolytic resistance center to cater the need of the general public. (Raw Material Testing). Growth Promotion Test was carried out for 1 batch of FTM. Analysed 40 water
Clinical Laboratory service samples and performed Lf test for 20 samples. The Present Activities Standard Microbial ATCC Strains and SP2/O Ag 14 Mouse Myeloma cell line have been received and stored.
Production of DPT vaccine and TCAR vaccine b. Sterility Media Preparation Division keeping in view of Supply Order received from the Ministry. During this period the Sterility Media section was engaged
Training Programmes to Post-Graduate and in the preparation of sterility media to rule out the microbial Graduate students. contamination on various samples and also for the checking of microbes in the classified sterile area in
Academic programmes like Ph. D. (Microbiology vaccine production. The following table shows the figures – Part time & Full time) affiliated to Bharathiar of various bacteriological media prepared and utilized.

246 Annual Report 2010-11 Nutrient Agar 42 Litres Prepared in Petri dishes and used for various testings Sabourauds Agar 32 Litres Prepared in Petri dishes and used for various testings Alternate Thioglycollate broth fluid medium 795 Litres Used in the sterility testings as per I.P. Soyabean Casein Digest broth 840 Litres Used in the sterility testings as per I.P. Fluid Thioglycollate Broth 85 Litres To use in the sterility test as per I.P. Nutrient Broth 15 Litres Used in various tests c. Rabies Diagnostic Lab Plan scheme upto October, 2010. While releasing the Grant-in-Aid, the Ministry has, vide above letter informed 48 sera samples both from Human, Domestic animals that the normal expenditure of the Plan scheme including were subjected to Rapid Fluorescent Focus Inhibition Test the administrative expenses of grantee institutions may (RFFIT) for the detection and quantification of Rabies be met from the above amount. Neutralizing Antibodies using Murine Neuroblastoma-2A cells and 96 well flat bottom Micro titre plates. This Academic activities: includes the samples received from our Dispensary from the Patients reporting for consultation and to assess the The Industrial visit of Graduate and Post Graduate post vaccination sero conversion for the protection against students of different college/universities were rabies infection. discontinued due to the revival of vaccine production. Two students underwent training for 15 days during May 2010. Laboratory Animal Division The Institute has a well stocked library with 4183 books Number of animal weaned: Mice : 14091 Nos and 12414 bound volumes, 4 International journals, 13 Indian Journals and WHO publication (Global Guinea pig : 468 Nos subscription). The Library is connected with 31 E-books Number of animal supplied to internal users: (Print form) and rest of the E-Books are stored in the CD. The Library is connected with internet to utilize the Mice : 3386 Nos E-journal service to the maximum. Journal Club activities Guinea Pig : 159 Nos are revived and decided to have two scientific presentation per month. Number of Animals Supplied to neighbouring Institute: Quality Assurance Mice : 2350 Nos “Quality Assurance” is a wide – ranging concept covering Guinea pig : 25 Nos. all matters that individually or collectively influence the Details of grant-in-aid received from the Ministry quality of a product. It is the totality of the arrangements of Health and Family Welfare, and the expenditure made with the object of enduring that pharmaceutical incurred, etc., during 2010-11: products are of the quality required for their intended use. Quality Assurance therefore incorporated GMP and other The Ministry of Health and Family Welfare, New Delhi, factors, including those outside the scope of this guide out of the annual budget of Rs.20.00 Crores has released such as product design and development. a total sum of Rs.5.00 Crores to this Institute during the financial year 2010-11 vide the Sanction Order The following activities were carried out in Quality No.V.11011/12/2010/V-I dated 02.08.2010- Assurance Section.  As against the Grant-in-Aid amount of ‘9.91 Crores (i.e., Regular monitoring of cold storage of bacterial seed 5.00 crores + 4.91 crores unutilized Grant-in-Aid available copies (DTP group of vaccine) and issued to as on 01.04.2010), this Institute has already spent a sum concerned section for vaccine production purpose of Rs.7.46 crores during the financial year 2010-11 under based on their request.

Annual Report 2010-11 247  Issuing of approved and Authorized copies of BPR stages of preparation. The tentative schedule of supply to the concerned section (DTP production, is as follows: formulation & Sterility Media Section) based on January, 2011 50.00 LDs their request and reviewed the same when their submitted to quality Assurance Section. February, 2011 50.00 LDs  Organogram and Responsibilities prepared for all March, 2011 50.00 LDs the sections of this organization based on source data from the respective section and issued back April, 2011 50.00 LDs the approved copies. May, 2011 60.00 LDs  SOP revision work carried out for the following June, 2011 60.00 LDs sections : Tetanus Section, Diphtheria Section, pertussis Section, gel and mixing section, DTP TOTAL 320.00 LDs Containerization and filling section, labeling and 15.23 ALL INDIA INSTITUTE OF PHYSICAL packing Section, sterility media Section, Quality MEDICINE AND REHABILITATION control section, Administration section, Account (AIIPMR), MUMBAI Section, purchase and Stores section, Library, Dispensary, laboratory Animal division, Quality 15.23.1 About the Institute Assurance Section and TCARV section. The All India Institute of Physical Medicine and  Preparation of site master file completed. Rehabilitation, Mumbai, established in the year 1955 is an apex Institute in the field of Rehabilitation Medicine  Viable and non viable particle count as part of under DGHS. environmental monitoring carried at Gel and Mixing Section, DTP Filling Section, TC ARV Section, Objectives Quality Control Section, Sterility Media and report To provide need based Medical Rehabilitation Services generated and issued to concern section. including provision of Prosthetic & Orthotic appliances  Verification of In-house training records and for persons with neuro-musculo-skeletal (locomotor) documentation of the reports from all the sections disorders. is being carried out periodically. • To provide training at Under Graduate and Post Revocation of suspension of licence: Graduate level to all categories of Rehabilitation professionals. The Drugs Controller General (India), Central Licence approving Authority, Drugs Control Division, DGHS, New • To conduct research in the field of Physical Delhi has vide Office Memorandum No.X-11026/1/06-D Medicine and Rehabilitation (P.M.R.). dated 15.01.2008 informed that the Drug Licence has • To provide and promote community based been suspended till such time all the deficiencies pointed programmes of Disability Prevention & out by the Inspection team of NRA Assessment are Rehabilitation for the rural disabled. rectified. Accordingly, the production of all vaccines stopped since January 2008 in this Institute. However, 15.23.2. The Institute has initiated several steps for Central Government vide order numbers V.12011/1/2009- commencing new service lines to meet the challenges VI/DFQC dated 12.02.2010 and F.No.X.11035/2/2010- arising from increasing incidence of disability due to non DFQC dated 26.02.2010 revoked the suspension to the communicable disorders. Rehabilitation team meets above licence. periodically and confer on rehabilitation management in the following special clinics for the PWD. DPT production: CP Clinics – 295, Prosthetic & Orthotic Clinics – To comply with the Ministry’s order the production activity 208, Case Conference –103, Disability Certificate initiated and different components like Diphtheria Toxoid, Evaluation –1585. Pertussis component and Tetanus Toxoid are at different

248 Annual Report 2010-11 Types of disability managing in the Institute. 15.23.4.d Post-graduate students were conducted following projects in the Department of Birth anomalies affecting musculo-skeletal system,Post P & O. Polio Residual Paralysis, Cerebral Palsy, Stroke, Amputee, Spinal Cord Injury , Neuropathies, Myopathies, • Gait Evaluation of a Swing Phase Assist Orhtotic Occupational Disability. Knee Joint in Patients with Poliomyelitis. 15.23.3.a Community Based Rehabilitation Projects • Performance study of anatomic versus Quadrilateral socket design (CBR): Following project is now completed by this Institute and report is submitted to WHO – A Pilot Project • Design and evaluation of multi purpose walker for on CBR, in Mumbai urban slum of S-Ward, Bhandup, Elderly people sponsored by WHO (Country office, India) in- • A comparative study between supracondylar socket collaboration with Municipal Corporation of Greater and Anatomical Contoured Socket for Trans-Radial Mumbai. Amputee. 15.23.4.b “Mobile Domiciliary Rehabilitation Project” in 15.23.5. Academic Activities collaboration with Rotary Club of Mumbai- Worli in H ward of Municipal Corporation of Greater Mumbai. This • The institute had received permission to start MD project is ongoing project for last Five years, which (Physical Medicine & Rehabilitation) course from the academic year 2010-11 from Ministry of Health represents exemplary collaboration between Government & Family Welfare, Government of Maharashtra, of India, NGO and MCGM i.e. local self Government. Maharashtra University of Health Sciences, Highlights: - Nashik.

• Persons with disability belonging to below poverty Sr. No. Name of Courses Intake Capacity line living in the urban slums are targets for 1 MD (Physical Medicine & intervention under this project. Population living in Rehabilitation) 2 Santacruz belongs to H (East) ward, Mumbai are being covered by outreach services. Those who require referral services to the Institute are • Under graduate and post graduate counselling provided transport facilities which are modified to centre - Institute is recognized as one of the center ease the boarding and the alighting of the individual for UG & PG counseling for admission to MBBS, by customized hoist attachable to the entrance. MD, Dental Courses through Video Conference Mode. Counselling was held during the month of • Schools children in the locality are periodically February and March. screened and provided counseling and intervention services. • Diploma in Hearing Languages and Speech Programme is ongoing training programme on During this period 161 PWD’s have been screened • video conference mode. 14 students enrolled for in the urban slums. the Academic year 2009-10. All the passed out 15.23.4.c Intervention-wise distribution ñ (Under students have obtained jobs at various organizations. the Project) 15.23.6. Implementation of Right to Information Therapeutic intervention Exs Therapy - 128 Act. (RTI) Electrotherapy - 26 Institute is responding to information sought by the Referrals visit to AIIPMR for applicants. Nominated Central Public Information Officer (CPIO) duly assisted by the committee members provides reconstructive surgeries - 13 such information. No of Aids & Appliances delivered - 7

Annual Report 2010-11 249 15.24 All India Institute of Speech and Hearing Dr. Rajendra Institute of Medical Sciences, Baritayu, (AIISH), Mysore Ranchi, Jharkand, Netaji Subhash Chandra Bose Medical College, Jabalpur, Madhya Pradesh, Jawaharlal Nehru The All India institute of Speech and Hearing is a pioneer Medical College and Hospital, Mayaganj, Bhagalpur, institute in the country imparting professional training, Bihar. clinical services, conduct of research and education of the public on various communication disorders. An annual meet of the All India DHLS Coordinators was held on 1st and 2nd July, 2010 at the institute. The 15.24.1.Academic Issues coordinators of the 12 DHLS centers from all over India AIISH has been conducting courses in the area of participated in the meeting along with their counterparts communication disorders from its inception. The institute from AIISH. which started offering one PG course in 1965 is now Courses conducted and admission details: offering 14 courses. The student strength has increased The admission details for different courses conducted at from 15 in 1965 to 583 as on today. The admission to all the institute for the academic year 2010-11 are as follows: the courses is made on All India basis duly following reservation policies of Government of India. Sl Name of the course Nos. No. Besides one certificate course, AIISH conducts 14 Academic courses, which include, three Diploma, UG / 1 Diploma in Hearing Aid and Earmold PG programs of B.Sc (Speech and Hearing), B.S.Ed Technology 04 (Hearing Impairment), M.Sc (Audiology), M.Sc (Speech- 2 Diploma in Hearing, Language and Language Pathology), and M.S.Ed (Hearing Impairment). Speech (DHLS) at AIISH, Mysore 06 It has Ph.D and Post-doctoral fellowship programs both 3 DHLS at other 11 study centres in Audiology and Speech Language Pathology. (through quasi distance mode) 182 In addition to the existing two post graduate diploma 4 DTYHI (Diploma in Training Young programs Viz., PG Diploma in Clinical Linguistics for Hearing Impaired) 08 Speech Language Pathologist and Forensic Speech 5 BASLP (Bachelors in Audiology & Sciences and Technology, a new Post-graduate Diploma Speech Language Pathology) Program in Neuro-Audiology has been introduced at this I Year - 61 institute from this academic year 2010-11. On 1st Oct. II Year - 62 2010, this program was launched by Sri V G Talwar, Vice III Year - 44 Chancellor, University of Mysore and Dr. Mewasingh, Internship - 36 203 Professor and Dean, Dept. of Psychology, University of 6 B.S.Ed (Hearing Impairment) 03 Mysore was the guest of honour on this occasion. 7 M.S.Ed (Hearing Impairment) 03 DHLS Program: 8 M.Sc (Speech-Language Pathology) I Year 36 This Diploma program introduced through quasi distance II Year 35 71 mode in the year 2007-08 has been continued. At present, the institute has 11 study centers spread over 11 different 9 M.Sc (Audiology) I Year 36 states covering all the zones in the country, as follows, II Year 35 71 with AIISH, Mysore as nodal center ; 10 Ph.D 15 Jawaharlal Institute of Post-graduate Medical Education and Research (JIPMER), Puducherry, Regional Institute 11 Post-doctoral fellowship 01 of Medical Sciences (RIMS), Imphal, Manipal, Dr. Ram 12 P.G. Diploma in Forensic Speech Manohar Lohia Hospital, New Delhi, All India Institute Sciences & Technology (PGDFSST) 04 of Physical Medicine and Rehabilitation (AIIPMR), Haji 13 P.G. Diploma in Clinical Linguistic for Ali, Mumbai, Indira Gandhi Medical College, Himachal Speech Language Pathologists Pradesh University, Shimla, Himachal Pradesh, Shri (PGDCLSLP) 03 Chathrapathi Sahuji Maharaj Medical College, Lucknow 14 P.G Diploma in Neuro University Chowk, Lucknow, Uttar Pradesh, Jawahar Audiology(PGDNA) 08 Lal Nehru Medical College, Ajmer, Rajasthan, Srirama Chandra Bhanj Medical College, Cuttack, Orissa, Total 583

250 Annual Report 2010-11 Short-term Training Program h. A program on ‘Staff enrichment on application MATLAB’ held on 15.9.2010. Short term training programs were conducted on the following topics: i. An orientation program on use of Hearing Aid analyzers and tester by Special Educator. a. Assessment of Communication Disorders on 20.4.2010 Library and Information Center

b. Identification of language problems in school A total of 210 books were procured during the year children on 6.5.2010, 10.6.2010 and 16.7.2010 making the total number of books to 17045. Besides this, 69 Journals are being subscribed, out of which 13 are e- c. Speech and language disorders on 9.6.2010 journals.

Workshops/Seminars/Symposia/Orientation 15.24.2.Research: Programs Five research projects with extra mural funding (WHO, Ten workshops/orientation programs were conducted in DST, CIIL, SBMT and Society of Bio Medical these seven months on the following topics: Technology) and 6 projects from AIISH Research Fund are in progress. Additionally, 36 research projects were a. A program on Communication Disorders: Early approved under AIISH Research Fund during the report Identification and Prevention held on 18.5.2010 and period. 19.5.2010 to Social workers and Health workers. A collaborative project on ‘Design and Development of b. A program on practical observation of pre-school Speech Enhancer with Vellore Institute of Technology training for children with communication disorders sponsored by Society for Biomedical Technology, was held on 4.6.2010 to 30.6.2010 to 14 trainees Bangalore is being carried out at the institute. of C4D2 batch. Publications / Releases: c. Orientation regarding activities of speech language 29th Volume (No.1 2010) of Journal of All India Institute sciences and its activities to nurses on 14.6.10 of Speech and Hearing (JAIISH) was released on 9th th d. An orientation program on Speech, Hearing and August 2010 on the 45 Anniversary Day of the institute. Language Disorders and Training on Survey for Proceedings of the International Symposium on Early Identification and Prevention Communication “Bilingual Aphasia”, Seminar on “Cochlear Dead Disorders held on 2.9.2010 to AHSA Workers of Regions” and “Auditory Dys-Synchrony” were released Gumballi and Volunteers of Home Makers from during the period under report. A book on “Train Your Hullahalli and Akkihebbal. Child Level I” was also released for Care-givers of e. A workshop on ‘Fine tuning of digital hearing children with hearing impairment during the period aids – Individuals with hearing impairment’ was 15.24.3. Clinical Services: conducted on 2.9.2010. The institute continued to provide clinical services for f. Workshop on “Preparing young children with clients with communication disorders through the Autism to learn language” on 10.9.2010 Departments of Audiology and Clinical Services with its specialized clinical units and Department of Prevention g. Orientation program on Professional Voice Care – of Communication disorders. A total of 11,912 new clients causes and management of voice disorders to and 19,176 repeat clients registered during the period from students BGS Apollo Hospital on 14.9.2010. 1.4.2010 to 31.10.2010.

Annual Report 2010-11 251 Details of clinical services provided at AIISH, Mysore Total Hearing Evaluation 6408 Hearing Aid Trial 4994 Ear Mould Impression 1902 Clients provided with Speech, Language Therapy 4227 Clinical Psychology 3174 ENT cases evaluated at AIISH and KR Hospital 26201 Major and Minor operations conducted 183 Physiotherapy 489 Occupational Therapy 516 Special Clinics Augmentative and Alternative Communication Unit: Evaluation 11 Therapy 108 Autism Spectrum Disorders Unit: Evaluation 103 Therapy 178 Craniofacial Unit 45 Listening Training Unit 877 Professional Voice Care centre 01 Tele-diagnosis and Tele-Rehabilitation to DHLS study centers No. of Clients provided Tele-diagnosis and Tele-intervention 16 Clients attended Educational Guidance 126 Preschool Training Center Total No. of groups 42 Total No. of languages 04 Total No. of children 1224 Hearing Aid dispensing: Under ADIP Scheme of Ministry of Social Justice and Empowerment, 3055 Govt. of India Issued at Camps 257 Issued under AIISH Hearing aid dispensing scheme 596 Hearing Aid Repaired 612

252 Annual Report 2010-11 Outreach Services Neurologists, Audiologists and Nurses. The facilities available in the Vertigo Clinic are Microscopic I. Hearing Screening: Hearing Screening at the examination of the ear, Electro Nystagmography, Vestibulo Hospitals at Mysore, wherein new born and infant hearing Spinal tests, neurological evaluation, Audiological tests screening was carried out on 7577 babies during the period for Cochlear and Retrocochlear Pathology. from 1.4.2010 to 31.10.2010. The babies were referred for confirmation of hearing loss, if any, to AIISH. The 15.24.4. Public Education babies with confirmed hearing loss were taken for management intervention. (i) Public Lecture Series: The monthly lecture series was continued and seven lectures on II. Outreach Service Centers: All India Institute various topics related to communication disorders of Speech and Hearing has established Outreach Service were conducted on the following topics during centers at Akkihebbal, Hullahalli and Gumballi, wherein the period. a speech and hearing unit has been established at the Public Health Centers. Between 1st April 2010 and a. Public lecture on identification of hearing 31.10.2010, 161 cases were seen at Akkihebbal, 274 at problems in school going children on 24.4.2010. Hullahalli and 192 at Gumballi villages. b. Physiotherapeutic Aspects in Communication III. Camps disorders on 29.5.2010. Five camps were conducted in Karnataka and Kerala c. Inclusive Education for Children with hearing where 1242 were examined, 112 hearing aids were issued impairment on 26.6.2010. and 164 certificates were provided. d. Early Identification and Intervention of Hearing IV. AIISH-SSA Project Impairment on 31.7.2010. A collaborative project with Govt. of Karnataka under e. Stuttering in Children on 28.8.2010. Sarva Shikshana Abhiyaan was continued and around f. Hearing Aids – Care and Maintenance on 95 teachers underwent training in the detection of 25.9.2010. academic difficulties of school children in the report period. g. Augmentative and Alternative Communication on Two New Special units were launched namely: 30.10.2010. 1. Fluency Unit. Inaugurations: On 9th August 2010, Prof. V N Rajashekaran Pillai, Vice- ‘Bodhi’, the New Mens Hostel was and this new hostel Chancellor, Indira Gandhi National Open University situated at Panchavati Campus of the institute (IGNOU), New Delhi, inaugurated the Fluency Unit. accommodates 94 number of students. Fluency unit cater to the academic, clinical and research ‘Ashoka’, the newly constructed International Guest and public education needs. Clients with stuttering, House with 15 number of guest faculty suites recently neurogenic stuttering, cluttering, and fast rate of speech started with a total living area of 63 sq. mtrs. and parking are offered clinical services. Approximately 40 to 50 space with a lounge. persons with stuttering avail the therapeutic services and 250 number of therapy sessions are provided in a month Financial Achievements: Funds from the Ministry in this unit. (` in crores) 2. ëVertigo Clinicí Grants for the Grants received Internal Vertigo Clinic was inaugurated in the Department of ENT year 2010-11 April-October Revenue at the institute on 22.10.2010. 2010 This clinic was launched to benefit the patients with peripheral and central vertigo problems. The Plan 21.85 9.70 Multidisciplinary team comprises of ENT surgeons, Non-Plan 8.00 5.64 1.67

Annual Report 2010-11 253 15.25. CENTRAL INSTITUTE OF (3015 Male, 807 Female) discharged and only Three (03) PSYCHIATRY, KANKE, RANCHI deaths occurred during the period. The average bed occupancy rate was 87%. The Central Institute of Psychiatry, Ranchi covers a sprawling area of about 210 acres and has the bed 15.25.3. Special Clinics: Special clinics include chronic capacity of 643. All beds in this hospital are paying. Some Schizophrenia Clinic, Skin & Sex Clinic, Neurology Clinic, beds are reserved for the patients sponsored by the Sleep Clinic, Epilepsy Clinic, Staff OPD, Headache Clinic, Central Government, Railways, Coal India and some for De-addiction Clinic, Child Guidance Clinic; Mood Clinic, the state Governments. There are 17 Wards, Nine wards OCD Clinic etc. are also run here. Attendance of patients for the Male and six for the Female patients, one Family in Special Clinics during the period from January -October Unit and one Emergency Ward. Each ward is at some 2010 was 16413 which is given below: distance from other wards. Each ward has well laid out roads and lawns around it. Male and Female sections are Clinics No. of Patients separated by a high wall. All the wards are named after Epilepsy clinic 2435 eminent psychiatrists. It may be worth noting that unlike other mental hospitals, CIP, Ranchi has never been a Emergency service 2268 custodial care facility. It has always been an open hospital Sleep clinic 58 and the patients are never confined to rooms. They are Skin clinic 2102 free to roam within the hospital. Headache clinic 169 Apart from drug therapy various psychotherapies, behavior therapy, group therapy and family therapy are Staff OPD 7534 routinely employed. A milieu therapy approach exists Mood clinic 601 where patients participate in running the ward and help in looking after other patients. Regular physical exercise, De-addiction 531 outdoor and indoor games and Yoga are available for the Chr. Schiz. Clinic 456 patients. A very well stacked library having books in English, Hindi, Urdu and Bengali as well as a number of Ocd clinic 212 newspapers and magazines is freely accessible to the Neurology 40 patients. Sex clinic 7 Main objectives of CIP have been Patient care, Total 16413 Manpower development and Research for which the institute has the facilities of: 15.25.4. Centre for Addiction Psychiatry: This is a 15.25.1. Adult Inpatient Services: The Inpatient new and modern De-addiction Center with capacity of Psychiatry Unit provides services for acutely ill psychiatric 30 patient beds for the treatment of the person suffering patients, including those requiring extensive care for from problems of alcohol & drugs addiction. It is also the concurrent medical disorders. The entire gambit of mental nodal Center for the eastern India for the manpower health expertise is available for the care of in-patients. training and research in the field of alcohol and drugs 15.25.2. Patient OPD- Attendance, Admission and abuse. During the period from January -October 2010, Discharge: During the period from January -October 531 patients suffering from the problem of Alcohol and 2010 the total number of OPD cases was 55334 (20478 Drug addiction were seen in the OPD in De-addiction New and 34856 Old) [including Psychiatric Cases Clinic, 539 patients were admitted, 526 discharged. (Adult & Child), Staff OPD, Clinical Psychiatry, 15.25.5. Centre for Child & Adolescent Psychiatry: Extension Clinics, Skin Clinics & School Mental Child psychiatry has been an important discipline at CIP, Health Programme, Epilepsy Camps]. New Cases Ranchi. A child guidance clinic was started in 1950 and (Psychiatry) were 9730 (6647 Male, 3083 Female); old an independent 50-bed child psychiatry unit in 1975. This cases were 32900 (23669 Male, 9231 Female); 3864 unit also imparts training to resident doctors and (3045 Male, 805 Female) patients were admitted, 3822 postgraduate students in the field of child and adolescent

254 Annual Report 2010-11 mental health. It caters the needs of grossly psychotic management of the patients. The lab has these tests children, children with development disorders and mental designed for use with both children as well as adult retardation. The parents are required to stay with their population. There are in total 13 equipments and children for the duration of the treatment. During the apparatuses, 43 tests for the assessment of cognitive period from January -October 2010, 5150 (New-1286, functions, 19 tests for the assessment of personality which Follow-up-3864) patients attended OPD for treatment. includes projective and objective tests and there are 44 various scales. These tests are for use with both child- 15.25.6. Department of Clinical Psychology hood as well as adult population. There are also 66 new The Clinical Psychology Department at the Central tests which the lab has acquired which assess various Institute of Psychiatry was established in 1948 and is the domains of personality and cognition. oldest independent Department of Clinical Psychology in Departmental Activities India. Over a period of years the Department has gained excellence in the field of teaching, training, research and Apart from management of the patients, the Department clinical services. holds weekly academic exercises in the form of departmental seminars and psychotherapy meetings. 15.25.7. Teaching and Training Further, regular classes are taken for M.Phil and Initially, the Department was involved in the patient care Ph.D. students as well as for the students of other only; however, later in the year 1962 a teaching course in disciplines such as Psychiatry, Psychiatric Social Work Clinical Psychology was also started. The course was and Nursing. known as Diploma in Medical and Social Psychology (now Research Activities known as M.Phil in Medical and Social Psychology). In 1972 Ph.D. in Clinical Psychology was started. Presently, Research is an integral part of the Department. Faculty there are 18 seats in M.Phil. (M&SP) and 04 seats are in members and the students of the Department are involved Ph.D. (Clinical Psychology). Our faculty includes 2 in research activities on a regular basis. Major focus of assistant professor, 2 assistant psychologists and 1 lab the current research is psychological assessment, assistant. cognitive neurosciences and psychotherapy. Research papers have been published in various international and 15.25.8. Clinical Services national journals. The Department is growing every year The Department provides non-pharmacological and is contributing significantly to the field of mental health. management for the patients of wide ranging psychiatric 15.25.10. Department of Psychiatric Social Work problems with the help of psychotherapy, counseling, group meetings, psycho-education, psycho-diagnostic The Department of psychiatric social work came into testing, intelligence testing and so forth. Apart from the existence in the decade of 1950s although the family patients coming to the hospital, the Department is also psychiatry can be dated back to 1922 when patients were involved in providing services at various extension clinics admitted in specially made cottages with their family as well as schools. There is a separate out-patient unit of members for multi-dimensional treatment. Training of the the Department. The out-patient unit either gets referral students and professionals who were aspiring to be trained from the general OPD of the hospital or people can “psychiatric social worker started in the year 1970. Since directly come and seek help for their psychological then various achievements have been attained by this problems. The psychosocial OPD, as it is called, caters Department. Training of psychiatric social work started to the needs of those patients who suffer from minor as the “Diploma in Psychiatric Social Work (DPSW)” psychological problems and who can be below exclusively firstly and in the year 1985 it was upgraded to M.Phil. by psychological methods viz counseling, behaviour Presently, 12 seats are available for M. Phil trainees. therapy or biofeedback or relaxation therapy. 15.25.11. Outreach Program: Extension Clinics include 15.25.9. Psychology Labaratory General Psychiatry Clinic at West Bokaro, Hazaribagh and CCL Gandhi Nagar Clinic, Ranchi and Epilepsy Clinic The clinical psychology lab was established for the first at Deepshikha, Ranchi. These Units are conducting these time in India in 1949. It has various psychological tests, programmes regularly. We also arrange regular Camps rating scales, instruments and apparatus which aid in the for awareness program, workshop with teachers, parents

Annual Report 2010-11 255 etc. School mental health programme also runs in two pathological specimens of rare cerebral disease. This schools details of which have been shared in the table Department is also engaged in high level of research. below: 15.25.14. Emergency Services: A 24 hours Total No. of Patients emergency service is available in the OPD of the institute with bed strength of 16 patients (8 for male and 8 for Clinics No of Patients female patients). West Bokaro 328 15.25.15. 24 Hours Services of Telephonic CCL Gandhi Nagar 74 Helpline & E-Mail Helpline: During January – October 2010, 761 helpline calls and 124 e-mails were Hazaribagh Clinic 731 attended. Deepshikha Epilepsy Clinic 173 15.25.16. Training Programme: In the training Deepshika, ICD & H 212 program, Case conference, Seminar, journal clubs were regularly held every week. Seminar-27 (1284 Epilepsy Camp Baripada, Orissa 84 participants), Case Conference-29 (1283 participants), Total 1602 Journal Club-20 (626 participants) Visiting Nursing Students from other centers (402 participants). 15.25.17. Medical Library 15.25.12.Centre for Cognitive Neurosciences In accordance with the objectives of the institute to The Centre for Cognitive Neurosciences had its humble become a “Centre of Excellence Medical Library is to beginning as Electro-encephalography (EEG) Department provide the information services and access to in 1948 with 6 channels and then 8 channels EEG bibliographic and full text digital and printed resources in equipment. The Department was rechristened as the field of Mental Health and Allied Sciences to the Psychophysiology and Neurophysiology Labs in 1995 and scholarly and informational needs to the institute recently as the Centre for Cognitive Neurosciences; each community. It also support the educational and research new name representing the phenomenal growth that this programme of the institute by providing physical and department has witnessed. Presently the centre has two intellectual access to information, consistent with the sections; a clinical section and a research section. The present and anticipated educational and research clinical section contains a 21 channels paper EEG, 32 programmes of the institute. channels QEEG and 40 channels video EEG. The research section includes Dense array EEG acquisition systems Library provide a wide range of current , accurate and (64, 128 and 192 channels), ERP acquisition units (40 authoritative information from a vast selection of print channels), a polysomnography unit (40 channels) and a and electronic resources using State of the art technology repetitive Transcranial Magnetic Stimulation (rTMS) unit. at it’s newly constructed three storied building. The library The centre has acquired advanced signal processing collection focused primarily on Psychiatry, Psychology, softwares like ASA, BESA, Neuroscan, Curry, Matlab Neurosciences, Psychiatric Social Work and Psychiatric and Mathematica. Nursing. The collection of the library which includes Books, Journals, Weekly Magazines, Newspapers, VHS, The Centre runs a weekly Epilepsy Clinic in the Outpatient VCDs, Reports, Dissertation, Thesis, WHO publication, Department of the institute (Thursdays) and at Microfilms, Atlas and electronic databases is regarded Deepshikha, Ranchi (Wednesdays). one of the richest collection of its kind in the country. It 25.15.13 Department of Pathology and has some rarest collection of reference materials dating Biochemistry back from pre independent (1910) and onwards. It has collection of nearly 55,000 books, bound volumes of Department of Pathology and Biochemistry performs journals and WHO publication. Nearly 2000 books from number of pathological test in clinical pathology, different world wide publishers have been added every microbiology, bacteriology and biochemistry, serology and year to make the library collection richer. The library immunology. The Department has innumerable currently subscribes 318 print journals and has access of

256 Annual Report 2010-11 almost more than 2000 e-journals by using different The joint venture of homeopathy and modern approach platform such as Science Direct, Wiley’s Online Library, to mental health generated new knowledge that is useful OvidSP, Cambridge Online, Sage Online, Springer link for the field of mental health. etc. Library is also a member of the ERMED – India 15.25.19. The 36th Annual Conference of Indian consortia which is run by National Medical Library, New Delhi. ERMED provides full text access of almost 1800 Psychiatric Society, Eastern Zone Branch journals on its platform. It is no exaggeration to state that (CEZIPS 2010) & World Mental Health the CIP Library is the largest and finest of its kind in the Day country. The 36th Annual Conference of Indian Psychiatric Society, The library has been using the KOHA an Integrated Eastern Zonal Branch (CEZIPS 2010) was held at Central Library Management Software package for library Institute of Psychiatry (CIP) on 8th and 9th October, 2010 housekeeping operations. All the holdings of the library which was jointly organized by Central Institute of have been indexed and users can search the database by Psychiatry and Indian Psychiatric Society, Jharkhand using KOHA OPAC online from any computer in the State Branch. The theme of the conference was “Child institute’s LAN and from anywhere of the world by using and Adolescent Mental Health”. Over 350 delegates and Web OPAC as usual. All the holdings of the library are accompanying persons were registered who attended the equipped with RFID Tags which help the users in Self conference. Issue and renewal of the library holdings by using Bio- Metric system based Self Issue KIOSK and also help in 15.25.20. Major Achievement finding any books on the self by using Handheld Reader. • Centre for Cognitive Neurosciences Block, Central RFID tags also helps in library’s self management and Store Building, 16 nos. of Type IV and 8 nos. of security of the library holdings. Type V residential quarters are at the verge of Apart from the above library offers Reference Services, completion and will be handed over to CIP shortly. Photocopying, User Guiding Services, Display of New • Construction of new boundary wall in place of old Arrivals, Document Delivery Service, Current Awareness damaged boundary wall is in progress. Service etc. Library is well connected with institute’s LAN and has 10 Mbps Leased Line connectivity. • 50 candidates out of total 79 seats were admitted for the various courses conducted by CIP, Ranchi Library is equipped with Wi-Fi to provide Internet access to it’s users on their own Laptops. Anyone can contact in the session starting from 1st May, 2010 the library for any type of information needed in their • Digtal X-ray, Haematology Analyzer, Bio Chemistry academic/research work by using the e-mail address auto analyzer, Coils for Magnetic Stimulator [email protected]. Machine, Radio Frequency identification system 15.25.18. Homoeopathy Interventional Research for Books & Journals for Medical Library, Project in CIP Digitization of Medical Records, EEG Records, Office Records, Fiber-Optic networking of the On 17 September 2007 CIP launched two Homoeopathic Campus and heavy duty switches for Campus interventional Research Projects entitled “To Assess the Server have been added to the Institute. Feasibility of Add on Homeopathic Therapeutic Intervention in Schizophrenia: an Open Trial” and “To • Installation of 380 KVA DG set, 400 KVA Assess the Feasibility of Add on Homeopathic transformer & underground electric cabling and Therapeutic Intervention in Depression: an Open development of lawns in the hospital. Trial”. These projects are funded by Central Council for • Research in Homoeopathy, Ministry of Health and Family Chapatti making machine, Flour kneading machine, Welfare New Delhi. The launch of this project widened Steam cooking system, 150 ltrs. cooker, Three the horizon in the mental health intervention. This project burner and Two burner Gas Chulha, Potato Piller gave an impetus to the general belief toward alternative and Veg. cutting machine have been added to the therapy and thus opened new avenues for the treatment kitchen. of mental health problems.

Annual Report 2010-11 257 15.25.21. Clinical & Research of research journal- Indian Journal of Social Psychiatry (Official Journal of Indian Association of Social Marked increase in the number of cases attending OPD, Psychiatry), increase in the number of students admitted inpatient admission and sharp decline in mortality rates, to various courses, conversion of microfilms into digital expansion of community outreach programme, increase formats. in the number of research paper publication, publication 15.5.22. Budgetary Provision (Rs. in thousand)

FINANCIAL YEAR PLAN NON-PLAN

BUDGET REVISED FINAL EXPENDITURE BUDGET REVISED FINAL EXPENDITURE ESTIMATE ESTIMATE ESTIMATE ESTIMATE ESTIMATE ESTIMATE

2009-10

Revenue 100000 72300 74092 73858 262000 266600 273700 272537

Capital 50000 144100 139600 135800 — — — —

Total 150000 216400 216392 209658 262000 266600 273700 272537

2010-11 (Up to Oct. 10)

Revenue 120000 — — 53767 241800 — — 153351

Capital 152500 — — 103500 — — — —

Total 272500 — — 157267 241800 — — 153351

15.25.23. Workshop on the Amendments to the part of several regional workshops organized by the Mental Health Act. Ministry of Health and Family Welfare across the country A workshop was held in the Central Institute of Psychiatry to gather opinion regarding the proposed amendments to on 17th July, 2010 to discuss the proposed amendments the Act. The Central Institute of Psychiatry was the venue to the Mental Health Act, 1987.This workshop was a for eastern India.

258 Annual Report 2010-11 15.26. CENTRAL RESEARCH INSTITUTE are 148. The Vacant position of group A,B,Cand D are (CRI) KASAULI 34,8,27and 79 respectively. Central Research Institute was established on 3rd May, Budget Provisions 2010-11 1905 as Pasteur Institute for North India. It is a (Rs. in Lakh) subordinate office of Directorate general of Health Services, under the Ministry of Health & F.W. Govt. of Budget Provisions Plan Non Plan Total India. The Institute has a huge complex which divided in seven sub-sections i.e. Establishment, Academic, Auxiliary BE 2010-11 1200.00 2812.00 4012.00 Facilities, Production Division, Quality Control Division, Expenditure Animal House and Research & Surveillance Division. It Oct, 2010 234.00 1313.00 1547.00 has a network of large number of laboratories engaged in manufacturing vaccines/sera and research activities. RE 2010-11 3232.00 2589.00 5821.00 Central Research Institute is engaged in production of (i) BE 2011-12 4568.00 3312.00 7880.00 Bacterial and Viral Vaccines & Sera on large scale. (ii) Production & Supply of diagnostic reagents. (iii) Research Manufacturing Demand and Supply of Vaccine and and Development in the field of immunology and anti-sera : vaccinology. (iv) Teaching and training in vaccinology and Microbiology. (v) Quality Control of immunologicals. Since its inception the institute has developed into a premier institute in research and production of a number Staff Strength: immunobiologicals. The order suspending the production There are 725 sanctioned posts in CRI-Kasauli. The license was revoked by the Govt. of India in February, number of sanction posts of group A,B, C and D are 2010. Production has been restarted and work on 50,32,213 and 430 respectively. The total staff in – upgrading all the facilities to meet cGMP standards is Position is 577. The staff in-position of group A,B,Cand underway. The quantity of vaccines and anti-sera supplied D is 16,24,186 and 351 respectively. Total Vacant posts during the last three years is given in the table No. 1.

Table No.1 Details of vaccine supplied during the period:-

(Quantity in lakh of doses)

Sl . Vaccines and Anti Sera Installed 2008-2009 2009-2010 2010-2011 Balance Stock No. Capacity Demand Supply Demand Supply Demand Supply as on (31.10.2010)

1 DPT(Doses) 312 260 206.23 00 00 53.50 53.50 16.84

2 DT(Doses) 144 140 37.49 00 00 0.006 00 00

3 TT(Doses) 264 400 116.08 300.00 0.33 1.94 3.98 0.0018

4 Typhoid (AKD) (Doses) 20 20 1.96 1.42 00 00 00 00

5 J.E. (doses) Not Definite 4.00 00 00 00 0.0011 00 2.91

6 Yellow Fever (Doses) 0.40 1.32 0.84 1.07 1.06 0.75 0.75 0.89 Quantity in lakh of ml

7 ARS 2.00 0.38 0.38 0.1 00 1.52 0.22 0.0125

8 ASVS 3.00 0.04 0.04 0.0006 00 1.20 1.20 0.53

9 DATS(Lakh Vials) 0.10 00 00 0.01 00 0.03734 0.00054 0.00013

10 NHS As per Demand 00 00 0.279 0.253 0.035 0.035 0.05

11 Diag. AG. 2.50 0.243 0.243 0.714 0.714 0.443 0.443 0.07

Annual Report 2010-11 259 Other activities of the institute: graduates (D.T.C.D., M.D., Ph.D.) in Pulmonary Medicine and allied subjects, to develop new diagnostic In addition to manufacturing of the vaccine and sera the technology and disseminate scientific knowledge related Institute is engaged in a large number of the activities to Chest Medicine to other institutions in the country and such as : to provide specialized clinical and investigative services • Quality Assurance and Quality control to patients. • National Salmonella and Escherichia Coli Center. Patient Management Services • National influenza surveillance center The Viswanathan Chest Hospital (VCH), is the hospital wing of the Institute which provides the patient • Rabies research center management services with the following facilities; • National Polio laboratory for surveillance Outpatient Department, Inpatient Facility with 60 beds, 24 hours Respiratory Emergency, 8 bedded Respiratory • Experimental animal House Intensive Care Unit (with facilities of 7 ventilators), Sleep • Medical treatment Centre & Diagnostic section Laboratory, Tobacco Cessation Clinic, National Yoga Therapy Centre, Cardio-pulmonary Rehabilitation Clinic, • Academic & Research Activities Picture Archiving and Communication Systems (PACS), For developing DPT group of vaccine manufacturing Medical Records Section, Oxygen Plant. facility at CRI, Kasauli, Ministry has engaged M/s HLL During the year 2009-10 the VCH enrolled 10426 new Life care Limited, a Public Sector Enterprises under the patients, 54386 old patients. A total number of 3956 Ministry as Project management Consultant and to utilize patients were admitted as Indoor cases. A total number the services of M/s NNE Pharmaplan as their Detailed of 19531 were provided 24 hours Respiratory Emergency Engineering Consultant for revival of CRI Kasauli. Services and 429 patients were provided ventilator Conceptual layout plan of the project has been approved (invasive and non-invasive) treatment in ICU. A number by WHO and DCG (I) and further activities are also of specialized investigations done were as follows; being undertaken. The project is likely to be completed Pulmonary function tests: 20444, Arterial blood gases: by May-June, 2011. 2046, Bronchoscopy: 261, Bronchoalveolar lavage: 28, 15.27. VALLABHBHAI PATEL CHEST CT scans: 2462, Ultrasound examinations: 569, X-rays: INSTITUTE (VPCI), UNIVERSITY OF 20834, Electrocardiograms: 5919, Polysomnograms: 67, DELHI, DELHI HIV testing: 218, Serum IgE tests: 622, Skin tests: 758, Clinical biochemistry: 26742. Brief Background During the year under review, the Institute has played a The Vallabhbhai Patel Chest Institute (VPCI) is a unique vital role in conducting investigations for the pandemic post graduate medical institution devoted to the study of influenza H1N1 virus as per the directive of the chest diseases. It is a University of Delhi maintained Government of India. institution under ordinance XX (ii). The Institute is administered by a Governing Body constituted by Research Activities Executive Council of the University and is funded entirely The Institute continued its thirst for research in Respiratory by Grants-in-Aid from the Ministry of Health and Family Diseases and allied sciences. These research projects Welfare, Government of India. The Institute fulfills the were sponsored by different agencies of Government of national need for providing relief to large number of India, World Health Organization, etc. The notable patients in the community suffering from chest diseases. contributions during the period on research include: It has eminently discharged its role and has earned a Development of novel therapeutics based upon natural unique place in the field of Chest Medicine. products from Indian Medicinal plants, Pulmonary function Main Objectives in normal children in Delhi region: development of reference standards for spirometry, Heart rate variability The main objectives of VPCI are to conduct research on in chronic obstructive pulmonary disease: associations basic and clinical aspects of Chest Medicine, to train post with systemic inflammation and clinical implications,

260 Annual Report 2010-11 Systemic mycoses in HIV positive patients: a study of Publication species spectrum of etiologic agents, antifungal susceptibility pattern and epidemiologic aspects, The Institute has been publishing a quarterly periodical, Functional characterisation of lspA gene of The Indian Journal of Chest Diseases and Allied Sciences Mycobacterium tuberculosis: cloning, expression and and continues its effort to disseminate the recent advances its role during pathogenesis, Prospects for the in Chest Diseases and allied sciences. It is available online development of anti-tubercular drugs based on at the website address; . Further, transacetylase function of glutamine synthase, Studies 46 research papers authored by Institute’s faculty on the possible mechanisms involved in the effects of members were published in reputed national and UNIM-352, a polyherbal, anti-asthmatic unani preparation international journals and book chapters. in experimental animals, Brain nitric oxide and high Budget During the Year 2009-10 altitude stress, To study the prevalence of obstructive sleep apnoea amongst middle aged chronic obstructive Plan Rs. 12.00 crores airway disease (COPD and asthma) patients by a home Non Plan Rs. 17.00 crores based sleep study and atopy, and Multi-site epidemiological and virological monitoring of human Infrastructure Development influenza virus surveillance network in India –Phase II. As part of continuing efforts in upgrading and Post Graduate Teaching and Training modernization of the Institute, various equipments relating to patient care and diagnostic and for research and A total of 9 MD students for academic year 2008-11 and development were procured. Major equipments added 10 DTCD students for academic year 2008-10 were are: Whole Body Multi Slice Helical CT Scanner (64 enrolled. In addition, 48 students were given training Slices/Rotation), CCTV, Non Invasive Ventilator UV-VIS under the MD and DTCD programmes. Sixteen research Double Beam Spectrophotometer, Spectrum Monitor, scholars pursued their PhD programmes. As a part of Hardware & Software for Archiving & Networking imparting updated knowledge regarding various System, HPLC System, Body Composition Analyzer, developments in respiratory diseases, the Institute had Portable Aerosol Spectrometer, Nikon Ten Header conducted 9th CME course on, “Pneumonia” on 13th, th Trinocular Microscope, Electrophoresis & Trans Blot February 2010 and the 35 Workshop on “Respiratory Unit, Biosafety Cabinet, Nikon Trinocular Research Allergy: Diagnosis and Management”, Delhi on Microscope, Refrigerated Incubator cum Shaker, NIBP March 8th-12th March 2010. Training in Behavioural nd Recording System, Blood Gas Analyser, Biosafety Counselling – Tobacco Cessation on 22 July 2010. Cabinet, Whole Body Plethysmograph, Water Purification An important milestone during this year is the approval System, etc. to start DM course in Pulmonary and Critical Care In addition, most of the renovation works are done with Medicine with an intake of two students every year by an eye on Persons with Disabilities (PWD). Ramps are the University of Delhi. provided for easy access to OPD, Doctors’ Room, ICU, Conferences/ Workshops during the year Medical Investigation Rooms, Wards, Parking places, etc. Exclusive parking places are provided (with proper “National Symposium on Sleep Apnea: An Update”, held signage markings) for PWD. In the Auditorium of our th th st on 5 - 6 April 2010 on the occasion of the 61 Institute, special toilets have been provided exclusively Foundation Day Celebrations of the VPCI, Delhi. for PWD. Ramps are also provided for easy access for The 12th “Prof. R. Viswanathan-VPCI Oration” was PWD to enter the Auditorium seats and stage. delivered by Prof. M.K. Bhan, Secretary, Government Renovations/upgradations of Biochemistry, Physiology, of India, Department of Biotechnology, New Delhi, on Pharmacology and Respiratory Allergy and Applied th 6 April 2010. Immunology Departments of the Institute were The 6th “Prof. A.S. Paintal Memorial Oration” was completed. Renovations/upgradations of Microbiology, delivered by Prof. Chulani Tissa Kappagoda, Professor Medical Mycology, Clinical Biochemistry Departments of Medicine, University of California, Davis, U.S.A., on as well as Staff Quarters are going on. 24th September 2010.

Annual Report 2010-11 261 15.28. CENTRAL BUREAU OF HEALTH 15.28.2. Organization INTELLIGENCE (CBHI) (a) In Dte. GHS / GOI, the CBHI headed by Dy. 15.28.1. Introduction Director General & Director has four divisions Established in 1961, CBHI is the National Nodal Institution viz. (i) Policy & Infrastructure, (ii) Training, for Health Intelligence in India, with the broad Collaboration & Research, (iii) Information & objectives to: Evaluation, and (iv) Administration. (1) Maintain and Disseminate the (i) National Health (b) Six Health Information Field Survey Units (FSUs) Profile (NHP) of India, (ii) Health Sector Policy of CBHI are located in different Regional Reform Options Database (HS-PROD), (iii) Offices of Health and Family Welfare (ROHFW) Inventory and GIS Mapping of Govt. Health of GOI at Bangalore, Bhopal, Bhubaneswar, Facilities in India, etc. Jaipur, Lucknow & Patna; each headed by a Dy. Director with Technical & Support staff, who (2) Review the Progress of Health Sector function under the supervision of Sr. / Regional Millennium Development Goal (MDG) in India, Director (HFW/GOI). (3) Annual Road Safety Profile of India, (c) Regional Health Statistics Training Center (RHSTC) of CBHI at Mohali, Punjab (near (4) Facilitate Capacity Building & Human Resource Chandigarh), CBHI-FSUs and Medical Record Development, Department & Training Centers (MRDTC) of (5) Need Based Operational Research for Efficient Safdarjung Hospital New Delhi & JIPMER Health Information System (HIS) as well as use Puduchery; conduct various CBHI In-service of Family of International Classification(FIC- Training Courses. ICD-10 & ICF) in India and 15.28.3. Major Activities of CBHI (6) Function as WHO-CC on FIC in India, closely 15.28.3.a Maintain and Disseminate the National links with WHO – CCs on FIC in the World, Health Profile of India on ñ Asia Pacific FIC Network & South East Asian Countries.

262 Annual Report 2010-11 Demography HS-PROD website (www.hsprodindia.nic.in) till date has documented more then 260 reform options from a varied
Population Statistics range of fields and stakeholders like the States/UT
Vital Statistics governments, development partners, non-government organizations and categorized them under 16 key Socio-Economic management areas.
Education, Social Indicators, Economic Indicators, 15.28.3.c.Inventory & GIS Mapping of Government Employment, Housing & Amenities, Drinking water Health Facilities in India: & Sanitation, Health Legislation in India, Survey on Morbidity, Health Care and Condition of the For creation of an electronic database of government Aged. health facilities, educational institutions, training centres, and other health care establishments in India, CBHI has Health Status prepared a database of the Govt. health facilities for their
Morbidity & Mortality mapping using Geographical Information System (GIS) for its wider dissemination through the CBHI website. It i. Communicable Diseases ii. Non Communicable is an ICT based approach to strengthen the health care Diseases resources management and planning for efficient health
Incidents of Deaths due to Accidents, Major services delivery as envisaged under NRHM. Data has Outbreaks Investigated by NICD , Reproductive been collected from all the 35 States/UTs from the & Child Health, Disability, Mental Health periphery and other source agencies including Statutory Councils and GIS mapping of the Govt. health facilities Health Finance uploaded on the national website www.cbhighf.nic.in
Five Year Plan Outlays during February 2008. All the States/UTs are in process of data validation & updating the Govt. health facilities
Health Expenditure & Financing Agents online. Keeping in view the census 2011 village/area codes. Once the updation is done, the GIS view will be Human Resources in Health Sector, including AYUSH opened for web surfer’s access for public. Health Infrastructure, including AYUSH 15.28.3.d. Millennium Development Goals.
Education Infrastructure (Medical, Nursing & The Millennium Declaration adopted by the General Paramedical) Assembly of the United Nations in its Fifty-fifth session
Service Infrastructure during September 2000 reaffirmed its commitment to the right to development, peace, security and gender equality,
Vaccine-wise and Institution-wise status of to the eradication of many dimensions of poverty and to production, demand and supply overall sustainable development. These are intended for
Directory of Health Research Institution in India the Member Countries to take efforts in the fight against poverty, illiteracy, hunger, lack of education, gender 15.28.3.b. Health Sector Policy Reform Option inequality, infant and maternal mortality, diseases and Database (HS-PROD) of India. environmental degradation. The Millennium Declaration Though States / UTs of India have undertaken adopted 8 development goals, 18 time-bound targets and reforms in the health sector, a lot of this goes unnoticed 48 indicators to be achieved by 2015, of which 3 MDGs and hence not documented. Thus,MOHFW/GOI under are directly related to health sector viz. reduce child its Sector Investment Programme (SIP) funded by mortality, improve maternal health and combat HIV/ European Commission, entrusted CBHI to develop and AIDS, malaria and other diseases; for which CBHI is maintain HS-PROD. It is a web-enabled database that responsible for compilation in Dte.GHS/MOHFW/GOI. documents and further creates a platform for sharing of 15.28.3.e.National Level In-service Man-power information on good practices, innovations in health Development Training Programs per services management while also highlighting their failures year: that are very important for the success of NRHM. The

Annual Report 2010-11 263 Training Course (and Batch size) Duration and Frequency CBHI Training Center (Details Over-leaf) Medical Record Officers (15) One Year Medical Record Department & 02 batches a year Training Centers at

Medical Record Technicians (15) 6 months 4 batches a year (i) Safdarjung Hospital, New Delhi Training Course of Master Trainers on (ii) JIPMER, Puduchery Family of International Classification One week (5 days) (ICD-10 & ICF), 9 States/UTs per batch 2 batches in a financial year CBHI/RHSTC, Mohali (Near Chandigarh) Orientation Training Course on One week (5 days) Health Information Management for Officers (15) 2 batches in a financial year CBHI/RHSTC, Mohali Orientation Training Course on Health Information One week (5 days) Management for Non-medical Personnel (20) 14 batches in a financial year (i) CBHI/RHSTC, Mohali, and (ii) CBHI/FSUs at Bangalore, Bhopal, Bhubaneswar, Jaipur, Lucknow & Patna Orientation Training Course on Medical Record & One week (5 days) (i) CBHI/RHSTC Mohali, and International Management (20) 14 batches in a financial year (ii) CBHI-FSUs at Bangalore, Bhopal, Bhubaneswar, Jaipur, Lucknow & Patna. Orientation Training course on Medical Record & One Week (5 Days) (i)CBHI/ RHSTC, Mohal Information Management (20) 8 batches in a financial year. (ii)CBHI,FSUs Bangaluru Bhopal Bhubaneswar, Jaipur Lucknow & Patna

On regular basis more than 40 batches of training courses Lucknow and Patna help CBHI in getting the validated covering more than 800 candidates are held every health information from States/UTs and facilitate in financial year. Training Calendar, Eligibility Criteria, capacity building of health care Guidelines and Application Forms for all the above courses can be downloaded from the CBHI website delivery functionaries as well as operational research www.cbhidghs.nic.in keeping in view the objectives of CBHI. The CBHI regularly undertakes half yearly meetings to review During 2010-11 (up to 10.12.2010), 521 Personnel from functioning of all the FSUs and Training Centres and all over the country have been trained in various in-service during 2010-11, 12th & 13th half yearly review meeting training courses viz. Medical Record Officer, Medical was held during 7-8 July 2010 at FSU Lucknow and 14th Record Technician, Health Information Management for such meeting is tentatively scheduled during January 2011 Officers, Health Information Management for Non- in Rajasthan. The Multicentric Study on the Organisation medical Personnel, Family of International Classification & Functioning of Medical Record Department and use (ICD-10 & ICF) for Non-medical Personnel, Master of ICD – 10 in Secondary and Tertiary Level Allopathic Trainers on Family of International Classification (ICD- Hospitals in Different Regions of India has been 10 & ICF) and Medical Records and Information undertaken during 2010-11 in 12 State/UTs including 72 Management through CBHI Training Centres and 13 hospitals with the following objectives: batches of trainings are still to be conducted up to 31st March, 2011. (1) Situation Analysis of infrastructure in terms of the organisation, functioning, logistics and human In 2011-12, 46 batches of in-service training courses are resources along with their training & skills in a expected to train more than 900 functionaries. Medical Record Departments/Units in the hospital 15.28.3.f. Capacity Building, Operational from CHC through tertiary level. Research & Reviews (2) To study the present system of record generation, CBHI FSUs located in Regional Offices of Health & compilation, analysis, storage and retrieval of FW/GOI at Bangalore, Bhubaneswar, Bhopal, Jaipur, medical records in the hospitals.

264 Annual Report 2010-11 (3) To study the usage of ICD-10 for morbidity & the development, testing, implementation, use, mortality coding along with major constraints and improvement, updating and revision of the member feasible solutions. components of the WHO-FIC. (4) To recommend the improvisation and strengthening (b) Studying aspects related to the structure, of Medical Record Department (MRD) and use interpretation and application of contents those of FIC (ICD-10 & ICF), in terms of optimal concerning taxonomy, linguistics, terminologies and requirement on the: (a) Functions, (b) Organisation nomenclatures. with regard to human resources and their training as well skill needs (c) Logistics including physical (c) Participating in the quality assurance procedures space and ICT and (d) Development of pool of of the WHO-FIC classifications regarding norms trained manpower for efficient functioning of of use, training and data collection and application MRD. rules. 15.28.3.g.CBHI As WHO Collaborating Centre on (3) Network with current and potential users of the Family of International Classification WHI-FIC and act a reference centre (e.g. (FIC) clearinghouse for good practice guidelines and the resolution of problems) by: CBHI with due approval by MOHFW the Dte. GHS/ MOHFW, GOI has been (Sept., 2008) officially declared (a) assisting WHO Headquarters and the Regional to function as “WHO Collaborating Centre on Family of Offices in the preparation of member components International Classifications (ICD-10, ICF & ICHI)” for of the WHO-FIC and other relevant materials. coding morbidities, mortality, related health aspects, (b) Participating actively in updating and revising the function and disabilities in India, while closely, linking with member components of the WHO-FIC. South East Asia Pacific network on FIC. (c) Providing support to existing and potential users 15.28.3.h.CBHI Functions as WHO Collaborating of the WHO-FIC and of the data derived in India Centre on Family of International and SEARO Region. Linkage will also be made Classifications (ICD-10 & ICF) in India, with other countries of Asian pacific Region for with major Terms of References to: seeking status on FIC implementation. (1) Promote the development & use of the WHO (4) Work in at least one related and / or derived area Family of International Classifications (WHO- of the WHO-FIC: Specialty based adaptations, FIC) including the International Statistical primary care adaptations, interventions/ Classification of Diseases and Related Health procedures, injury classification (ICECI), and Problems (ICD), the International Classification of Functioning, Disability and Health (ICF), and (5) Present periodic reports of the centre’s activities other derived and related classifications and to to the annual meetings of heads of WHO contribute to their implementation and Collaborating Centres for the WHO Family of improvement in the light of the empirical International Classifications (WHO-FIC). experience by multiple parties as a common i. Director (CBHI) attended WHO – FIC Network language. Annual Meetings, 16-22 Oct. 2010 at Toronto, (2) Contribute to the development of methodologies Canada. for the use of the WHO-FIC to facilitate the 15.28.3.i. Maintenance of Three CBHI National measurement of health states, interventions and Web Sites. outcomes on a sufficiently consistent and reliable basis to permit comparisons within and between CBHI with the assistance of NIC, has recently (2008- countries at the same point in time by: 09) redesigned & reformatted its three websites viz. (i) www.cbhidghs.nic.in (ii) www.hsprodindia.nic.in (iii) (a) Supporting the work of the various committees www.cbhighf.nic.in, for online data transmission and and work groups established to assist WHO in public viewing.

Annual Report 2010-11 265 (i) CBHI website www.cbhidghs.nic.in contains State/UT HFW directorates are responsible for punctually general information about CBHI, National Health and regularly furnishing the (i) Monthly Communicable Profile, Mortality Statistics in India (2006), Right Diseases (ii) Monthly Non-Communicable Diseases, to Information Act, National Recommendations on and (iii) Annual Data on Medical/Nursing/Para-Medical improving and strengthening Health Information education & infrastructure in the prescribed formats to System, as well as use of ICD 10 in country, CBHI CBHI/ Dte.GHS. Based on this information from all the case study & recommendations on human health States/UTs and other reporting agencies, provide up-to- resource requirement, CBHI in-service training date data related to morbidity & medical/health programmes/ calendar along with application forms, infrastructure for framing reply to the Parliament Module & Work Book on ICD 10, Reporting Questions. CBHI also brings out annual publication formats for health data from States/UTs to CBHI, “National Health Profile” which serves as National etc., Reference Document for policy, planning and evaluation now of health related activities in the country. The above (ii) CBHI Website www.hsprodindia.nic.in contain requisite health information are being sent by the States / entries related to Health Sector Policy Reform UTs On-line through CBHI webside www.cbhidghs. Data Base of India and being updated from time to nic.in. time. 15.28.4.CBHI Linkages and Coordination (iii) CBHI’s third website www.cbhighf.nic.in containing inventory & GIS mapping of the Govt. 1. All 35 States/UTs of India health facilities, was launched by DGHS/GOI. 2. All 20 Regional Offices of Health & FW of GOI 15.28.3.j. Major Publications of CBHI (2010) 3. National Rural Health Mission (NRHM) and (1) Trained Manpower Document on Family of National Health Programmes in India International Classification Cation (ICD-10 & ICF): Indian Experiences (2004-2010),October, 4. Medical, Nursing & Paramedical Councils & 2010 Educational Institutions (2) National Health Profile (NHP) 2009, March20, 5. Public Health/Medical Care Organizations and ‘2010. Research Institutions under Department of Health Research including ICMR and Various other 15.28.3.k.CBHI Activities under WHO/GOI, Ministries (Biennium 2010 & 2011) are as under 6. Census Commissioner & Registrar General of India 1. National Review on the use of ICD-10 in 6 different Regions of India & to recommend on further 7. Planning Commission, Government of India improvisation and strengthening. 8. Union M/o Statistics & Programme (1) Development of Advocacy & Training kit well as Implementation Simplified coding manual for family of International 9. Union Ministries of Railways, Labour, HRD, Rural classifications (ICD-10 & ICF) Development, Communication & Information (2) National consultation to update the framework and Technology, Shipping Road Transport & Highways, guidelines for disability certification to principles of Home Affairs, Defence, Social Justice & ICF in India, Empowerment etc. (3) National Review on updation of data on GIS 10. Non-Government Organizations in Health & related mapping of all the Government Health Facilities in sector s in India all the 35 States/Uts. 11. WHO and other UN Agencies Concerned with 15.28.3.l. CBHI ñ On Line Data Entry System Health and Socio-economic Development through website www.cbhidghs.nic.in. 12. European Commission

266 Annual Report 2010-11 13. All the WHO – Collaborating Centres on Family 15.30. NATIONAL INSTITUTE OF of International Classification (FIC) in the world, BIOLOGICALS (NIB), NOIDA Asia Pacific Network on FIC and countries of South East Asia Region The Ministry of Health & Family Welfare has established the National Institute of Biologicals (NIB) as an Apex 15.28.5. Budget Scientific institution in the country at an estimated cost of Rs. 269.24 crores. The Institute shall be a National CBHI under this budget head “Health Information and Control Laboratory (NCL) for assuring availability of high Monitoring System” has been allocated an amount of standards and good quality of biological products namely Rs.16850000 BE Rs.15770000 RE Rs 15000000 BE for Vaccines, Blood products, Recombinant DNA products, 2011-12 proposed in plan for the financial year 2011-12. Reagents, Immunodiagnostic kits, Therapeutic Enzymes 15.29.NORTH EASTERN INDIRA GANDHI & Hormones, Glucometers, Allergens, etc. that are REGIONAL INSTITUTE OF HEALTH AND manufactured indigenously or imported into the country. MEDICAL SCIENCES (NEIGRIHMS), The scientific activities of the Institute are performed by SHILLONG Laboratories carrying out the Quality Control Evaluation/ North Eastern Indira Gandhi Regional Institute of Health testing of different batches of various types of Biologicals and Medical Sciences (NEIGRIHMS) has been as under : established in Shillong, on the lines of AIIMS, New Delhi, a) Critical immunodiagnostic kits (ELISA, rapid, and PGIMER, Chandigarh, with the objective of providing confirmatory and automated kits) for diagnosis of advanced specialized Health-care to the people of North HIV, HCV and HBsAg & Syphilis. East Region. An amount of Rs. 1266.38 crore has been allocated for the Institute in the 11th Plan. (b) All categories of Blood Grouping Reagents like Monoclonal, Polyclonal, blend and type like Anti- This Institute has been planned to include a 500 bedded A, Anti-B, Anti-AB, Anti-D (lgM), Anti-D referral hospital with 35 teaching departments at (igM+igG), Anti-D(lgG), Anti-C, Anti-c, Anti-E, postgraduate level in various specialties and super- Anti-e, Anti-H (Lectin), Anti Human Globulin specialties. A fifty seat Nursing College and Under (AHG) and Bovine Serum Albumin (BSA), Anti- Graduate MBBS College has already started functioning K, etc. In addition evaluation of Blood Grouping from the Institute. kits are also done.
PG Courses in Anesthesiology, Obst. & (c) Blood Products like Human albumin, normal and Gynecology, Microbiology and Pathology have specific immunoglobulin, coagulation factors started in 2009-10 (factor-VIII & IX), Plasma Protein fraction & Total staff strength in the Institute Fibrin Sealent. Sl. Total Staff Post Filled Vacancy (d) Biotherapeutics Enzyme and Hormones like No. sanctioned up position Streptokinase, hCG&FSH 1 NEIGRIHMS 1524 850 674 (e) Viral and Bacterial Vaccines – OPV, MMR, CCRV, HRIg, TAT, Alib, Meningococcal, etc.

Budget Allocation & Expenditure for the years (f) Recombinant products like Insulin Analogs, 2010-11 is indicated below:- Interferon and Erythropoietin. (g) Biochemical test kits like for Glucose, Cholesterol, Name of the Institute Allocation Amount Triglycerides, HDL & LDL 2010-11 released as on (h) Allergens like House dust mites & cockroaches 17.01.2011 (i) Preparation of National Reference Standards and NEIGRIHMS 102.85 67.85 well characterized Sera Panels with traceability.

Annual Report 2010-11 267 In addition to the above mentioned main laboratories, there (b) The Blood Grouping Reagents Laboratory is a are other supporting laboratories/units like the Bioassay, notified CDL under the Drugs & Cosmetics Act animal facility, Sample Receipt & Report Despatch for Quality Control Evaluation and Batch Release Section, Quality Management Unit, etc. Certification of Blood Grouping Reagents. The Performance Report Institute, besides dealing with legal samples referred by CDSCO, also certifies the quality of (a) Since 1997, NIB has been doing Quality Control Blood Grouping Reagents for safe blood Evaluation of various batches of critical transfusion services. The Institute during the year immunodiagnostic kits for HIV, HCV, HBsAg and tested and reported 55 batches of Blood Grouping Syphilis. The main functions of the Diagnostic reagents Division is to certify the quality of diagnostic kits for assuring the safety of blood from the viral (c) The Blood Products samples in the Institute are diseases at blood banks resulting in Safe Blood received from and through the Port Offices of Transfusion. The types of kits evaluated are the DCG (I) for Quality Control Evaluation and Enzyme Linked Immunosorbant Assay (ELISA), pre-release certification. A total of 53 batches of Enzyme Immunofluorescent Assay (ELFA), Chemi such blood products received for evaluation during Lumniescence Immuno Assay (CLIA), Rapid & the year were Human Albumin, Coagulation Confirmatory (Western Blot, RIBA & Factor (Factor VIII & IX), Fibrin Sealant Kit, Neutralization antibody). These kits are either Plasma Protein, Plasma Protein Fraction, and indigenously manufactured or imported, and human normal IgG (Immunoglobulin) IV & IM, referred by the port offices and CDSCO offices Specific Immunoglobulin (Anti D IgG). of DCG(I). The total number of kits evaluated (d) The Enzymes and Hormones Laboratory has during the year was 177 out of which 55 kits were been set up to evaluate the Quality Control testing for HIV, 53 kits for HBsAg, 60 kits for HCV & 4 of Biotherapeutic Enzymes and Hormones each for Syphilis and HIV-HCV combo kits. namely Streptokinase, Urokinase. The work has Evaluation was done as per Standard Operating been initiated on Human Chorionic Gonadotropin. Procedures based on WHO guidelines. The During the year 3 batches of streptokinase were Laboratory has prepared characterized sera panel tested and reported. Standardization of for evaluation of HIV, HCV and HBsAg and have parameters for Q.C. evaluation of heparin is also been supplied to indigenous licensed diagnostic kits in progress. manufacturing 165 Laboratory Technicians from CHCs, PHCs, IECS, Blood Banks, District & (e) The Bacterial Vaccine Laboratory was Private Hospitals and Medical Colleges from established to initiate the Quality Control Testing various districts of U.P. and Uttarakhand have been of Bacterial Vaccines for pre-release trained in HIV testing. The lab has participated in certification. The laboratory have standardized International and External Quality Assessment quality control test parameters to take up the Programme (EQAS) for HIV & HCV with testing of BCG vaccine (live attenuated) and National Serology Reference Laboratory Australia. polysaccharide vaccine viz. Haemophilus The lab has also conducted EQAS for NACO State Influenza type ‘b’ conjugate vaccine. The viral Reference Laboratories of Uttar Pradesh and Vaccine Laboratory of the Institute, during the Uttarakhand. Under NACO’s HIV Sentinal year, have (i) standardized the quality control Surveillance (HSS) in 45 Targeted Interventure parameter of Live Attenuated MMR Vaccine and (T.I.) based high risk group based in the States of Cell culture Rabies Vaccine. 6 batches of MMR U.P., Bihar and Assam. 12000 dried blood spot and 4 batches of Rabies vaccine have been tested. (DBS) testing was done. In addition to Evaluation The approval for the safety test has been taken of kits for its quality, a total number of 60 batches up. The testing of Rabies Immune-globulin and of Blood Products, Human albumin Immunoglobulin Tetanus Antitoxin is ready to be taken up. Factor VIII Fibrin Sealant, Hepatitis B (f) Recombinant Products Laboratory has been Immunoglobulin were tested for Transfusion established for Quality Evaluation of Transmitted Infection (TTI). 268 Annual Report 2010-11 Recombinant Products derived by recombinant Plasma and 3 batches of Streptokinase. Potency DNA technology. Laboratory has standardized Assay for LCG Hormone and abnormal toxicity 12 parameters for testing of rh-Insulin and Insulin assay for polysacctraride vaccine viz. analog formulations and during the year 86 Haemophilies influenza type B conjugate vaccine batches from 11 different formulations of Insulin has been standardized and Progen test on rabbies and Analogs have been tested and reported upon. is under standardization. This includes Insulin formulations namely Regular. (j) Nucleic acid testing laboratory has been NPH, biphasic (50:50, 25:75, 30:70), Lispro, established for Nucleic acid based detection of Aspart, glargine, Glucagon like peptide. Transfusion Transmitted Viruses (HBV, HCV, Developed Pharmacopoeia specifications for Human Insulin to be incorporated as addendum and HIV1) in human plasma samples. During the in insulin monograph. Preparation of National year 07 samples were tested on plasma and Reference Standard for Insulin Human was taken albumin for HBV, 02 samples for HIV and 06 up by Inter- laboratory collaboration at National samples for HCV by viral RNA extraction. & International level. Newer products are ready (k) Reference standard Unit maintains a repository to be taken up are hematopoiteic factors, and of traceable Standards procured from NIBSC, Analogs –Detemir, Glulisine. USP, EDQM, BBI, Paul Ehrlich and WHO. (g) Biochemical laboratory for evaluation of test kits These are for diagnostic Kit, blood grouping is in the initial phase of its establishment to reagents, blood products, enzymes and hormones, develop methodology for routine biochemical kits recombinant products, bacterial and viral for Glucose by collection of fresh left over blood vaccines. samples from various reputed hospitals. Similarly (l) Quality Management Unit has prepared the Glucometers and test strips have been studied quality manual document as per requirements of as per the method developed for it. The process ISO 17025. It has taken up the process of filing of standardization of the other biochemical kits application to NABL for accreditation of viz., Cholesterol, Triglycerides, HDL & LDL have laboratories as per chemical and biological tests. been initiated. To include in the 1st phase testing of various (h) Bioassay Lab for Sterility test has performed Biologicals like Immunodiagnostic Kits, Blood the test as per Pharmacopoeia requirements given Products, Blood Grouping Reagents, Enzyme & in USP, BP and IP by 3 methods viz., direct Hormones and Recombinant products, sterility inoculation, membrane filtration and closed tests and Animal tests were included. The unit system membrane. Total of 134 samples have conducted an Internal Quality Audit Management been tested for sterility test on samples of insulin Review Meetings for compliance of actions and formulations and blood products referred by the pre- inspection by the NABL Lead Auditor respective laboratories. for the same was held in April 2010. (i) Animal Facility registered with CPCSEA in BUDGET 2004 is fully functional to perform mandatory in vivo tests for the Quality Control Evaluation of The funds of the Institute are received as Grant-in-aid Biologicals as given in Pharmacopoeia. During from the Ministry of Health & Family Welfare. The B.E. the pre-view period, IAEC approval has been & R.E. of the Institute are as under: taken for mandatory regulatory tests on Human Rs. in crore Albumin, Streptokinase, Immunoglobulin, hCG Year B.E. R.E. Expenditure Hormone, live attenuated Measles Vaccine, Cell Culture Rabies Vaccine and Hyperimmune 09-10 15.00 11.00 10.98 Rabies serum. 10-11 17.25 15.00* 8.38 # Abnormal toxicity assay has been performed on 11-12 17.80 * —- —— 21 batches of Human Albumin, 2 batches of * proposed # up to Nov. 2010

Annual Report 2010-11 269 15.31. BCG VACCINE LABORATORY, (BCGVL) Performance of Laboratory at Present: GUINDY After revocation of suspension of manufacturing licence Activities vide Ministry of Health & Family Welfare Order No.X.11035/2/2010-DFQC dated 26.2.2010, the The BCG Vaccine Laboratory was engaged in the manufacturing of BCG Vaccine 10 doses has started. following activities : BCG Cancer Vaccine (40mg): Production of BCG Vaccine
Production of BCG Vaccine (10 doses per vial) for (40 doses) has yet to start. control of childhood Tuberculosis and supply to Expanded Programme of Immunization (EPI) since Total Revenue Earned: Total revenue earned is 1948. Rs.2,73,233 from Sale of Guinea Pigs, Sale of condemned items, Licence fee for Community Hall and Guest House.
Production of BCG Therapeutic (40 mg.) for use in Chemotherapy of Carcinoma Urinary Bladder Important Achievements during 2010-11: After the since 1993. revocation of suspension of manufacturing licenses, production process has been initiated.

Budgetary Details: Budget Grant- 2010-11-Non-Plan (Actual Expenditure as on 31.10.2010)

Sl. Sub-head Budget Grant 2010-11 Expenditure Balance available No. incurred from 1.4.2010 to 31.10.2010 1 Salaries 6,00,00,000 2,39,29,527 3,60,70,473 2 Medical Treatment 12,00,000 1,12,660 10,87,340 3 Overtime Allowance 20,000 14,667 5,333 4 D.T. E 5,00,000 99,001 4,00,999 5 Office Expenses 37,00,000 20,57,564 16,42,436 6 Supplies & Materials 3,00,00,000 1,07,87,656 1,92,12,344 7 Advt. & Publicity 2,50,000 81,718 1,68,282 8 Minor Works 35,00,000 12,10,456 22,89,544 9 Mach. & Equipment 2,58,30,000 31,42,859 2,26,87,141 TOTAL 12,50,00,000 4,14,36,108 8,35,63,892

Budget grant ñ 2010-11- Plan (Revenue) Sl. Sub-head Budget Grant 2010-11 Expenditure Balance available No. incurred from 1.4.2010 to 31.10.2010 1 Office Expenses 50,00,000 18,83,419 31,16,581 2 Materials & Supplies 1,40,00,000 4,94,910 1,35,05,090 3 Machinery & Equipment 2,85,00,000 2,00,226 2,82,99,774 TOTAL 4,75,00,000 25,78,555 4,49,21,445

270 Annual Report 2010-11 Budget Grant-2010-11-4210 Capital Outlay on medical and Public Health (Major Head)

Sl. No. Sub-head Budget Expenditure Balance grant 2010-11 incurred from Available 1.4.2010 to 31.10.2010 1 Motor Vehicles 1000000 0 1000000 2 Machinery & Equipment 4000000 0 4000000 3 Major Works 5000000 0 5000000 TOTAL 1,00,00,000 0 1,00,00,000

Group Wise Staff Position of BCG Vaccine Laboratory, Guindy, Chennai

Group Sanctioned Abolished Present Filled Vacant Excess Strength Strength Incumbent Group-A 3 - 3 2 1 - Group-B Gazetted 4 - 4 - 4 - Group –B Non-Gazetted 14 5 9 5 4 - Group-C 160 63 97 122 3 28 Total 181 68 113 129** 12 28 ** The filled posts include excess incumbents whose appointments were made after receipt of various recommendations of MHFW for abolition of posts/abolition orders under optimization Scheme/IWSU.

15.32 ALL INDIA INSTITUTE OF HYGIENE • To conduct research directed towards the solution AND PUBLIC HEALTH (AIIH & PH), of various problems of health and diseases in the KOLKATA community; Background • To undertake fundamental and operational research to develop methods for optimum utilization of health The All Institute of Hygiene and Public Health resources and application of the findings for (AIIH&PH), Kolkata was established on 1932 with the protection and promotion of health care services. assistance of Rockefeller Foundation. This institute is pioneering in Post-Graduate Teaching and Research in Institutional set up various disciplines of health intelligence and health services. The Institute continues to pursue with its mandate The Institute has eleven academic Departments and two for development of human resources in the field of Public (2) field practice areas, one at Urban Health Centre, Health since its inception. The primary objectives of the Chetla, Kolkata and the other at Rural Health Unit & Institute are: Training Centre, Singur, Dist. Hooghly. Under the aegis of these departments and field practice units, various • To develop health manpower by providing teaching/ training courses, field programs and workshops post-graduate training facilities of the highest order; are conducted. The Institute also houses a reference

Annual Report 2010-11 271 library especially on health sciences to cater to the needs • ‘Life skill education for Adolescent health’ of the students, faculty and other users. Two hostels, one for men and another for women, are located in the vicinity • Institutional Capacity Enhancement Training in of the main building of the Institute to accommodatre Health Promoyion to train a group of master trainers students and guests. Hostel facilities are also available at from Bhutan in collaboration with WHO SEARO, Rural Unit & Training Centre, Singur. Work on August 09. construction of the Institutional Block in the Bidhan Nagar • Behavioral change in Public Health. campus of the Institute coming up at Salt Lake, Kolkata is almost complete. Construction of 44 residential quarters, Important Projects/Research Activities substation building, international hostel and guest house • Public Health Problems Particularly on Public along with associated services has already been Nutrition , Community Nutrition , Micronutrients, completed. Malnutrition & street food. Budget Allocation • Prevalence of Arsenicosis in West Bengal. The Institute has been allocated the following Budget • Monitoring & surveillance activities in HIV / AIDS Grant during the financial year 2010-11: surveillance in West Bengal & North Eastern States Budget Head Plan Non-Plan Total supported by NACO. Grant(Rs. Crores) 7.22 16.87 24.09 • Conducted WHO (FIP) on Epidemiological concepts in Malariology and its prevention and Besides, international agencies like WHO, UNICEF etc. control & Epidemiology of Comuincable/Non- Other central and state agencies also provided funds to communicable Diseases. this Institute to carryout various projects/research activities in Public Health & Hygiene. Other Important Activities Teaching and Training Activities a. The Department of PHA, as the Nodal department, has conducted Professional Development Course During the year 2010-11, the Institute conducted MD/ (PDC) for District level officers, which is sponsored Community Medicine and Masters degree Course in by Govt. of India and European Commission. Veterinary Public Health, Post Graduate Diploma Courses viz., DPH, DMCW, DIH, DHE, Dip- Diet, DPHM, b. The Department of Epidemiology organized two DNEA, DHS, M. Sc. in Applied Nutrition , MPH and Pre-Surveillance Training Workshops for the MEPH. participants from 11 States under HIV Sentinel Surveillance (HSS). The Institute organized the following courses: c. The Department of Microbiology along with the  Training on Trainers in Immunization for MOs For Department of Epidemiology of this Institute has NE States supported by NIHFW, New Delhi been identified by NACO as the Departments of  FETP course for District Surveillance Officers of Regional Institute (RI) for the HIV Sentinel the IDSP of Nagaland, Mizoram, Tripura and West Surveillance Programme. Bengal. d. The Department of Sanitary Engineering Provides • ‘Communicable Disease Epidemiology & its services of water/ waste water analysis to various application in Health Promotion Prevention and Government organizations, municipal authorities, Control’ NGOs etc. • ‘Advance Methods in Epidemiology, Bio-Statistics e. The Sanitary Engineering Department, Govt, of and Research’ West Bengal & UNICEF in various ways for the mitigation of arsenic problems in West Bengal. • ‘PLA for Health Promotion & Education’ f. 30 trainees have so far been nominated by WHO • Health Risk Behavior, Surveillance & Promotion for training in different courses in the biennium for NCOs’ 2009-10.

272 Annual Report 2010-11 g. The Department of Microbiology is conducting Library Services: IDSP training programmes for District Medical The Institute has a large reference library, offering Officers for the 3rd phase of the training in the North excellent services on health information and other related Eastern States of India. matters to various users. The Library is having about h. Counseling through video-conferening of MBBS/ 65000 (approx) books and Journals. The stock of the BDS(15%) seats, MD, MS/MDS (50%) under ALL library is constantly being enlarged and enriched every India UG/PG quota, AIIH&PH has been one of year through acquisition of latest books & journals, the counselling venue. periodicals, etc. Field Practice Units: Implementation of official language policy Two Field Practice Units viz. Urban Health Centre, The Praveen / Pragya training under Hindi Teaching Chetla, Kolkata and Rural Health Unit & Training Centre, Scheme has been started in the Institute itself. Staff and Singur, Hooghly (West. Bengal) are operating smoothly officers nominated for Prveen /Pragya. Officers/staff under the direct control of AIIH & PH. Besides the field successfully completed the Praveen / Pragya training Practice services offered to the students of the Institute, under Hindi teaching Scheme. the field units are also providing excellent clinic based Details of the courses are being conducted at AIIH&PH, preventive, promotive & curative services to the Kolkata are given below. community.

SI. Name of Course Session Duration Sanctioned Student Vacant No strength admitted

1. Doctor of Medicine (Community Medicine) 2010-13 3 years 11 06 05 2. Diploma In Public Health 2010-12 2 years 92 71 21

3. Diploma in Maternal & Child Welfare 2010-12 2 years 46 45 01

4. Diploma in Industrial Health 2010-12 2 years 15 11 14 5. Master of Veterinary Public Health 2010-12 2 years 15 02 13

6. Master in Public Health 2010-12 2 years 31 18 13 7. Diploma In Nursing Education & Admn. (Child Health) 2010-11 1 years 62 08 54

8. Diploma in Public Health Management 2010-11 1 years 25 04 16 9. Diploma in Dietetics 2010-11 1 years 31 09 22

10. Diploma in Health Education 2010-11 1 years 46 39 07

11. M.Sc(Applied Nutrition) 2010-12 2 years 31 16 15 12. Master of Engineering Public Health 2010-12 2 years 23 00 23

13. Diploma in Health Statistics 2010-11 1 years 08 00 08

15.33. CENTRAL LEPROSY TRAINING AND 1955 by the Government of India under a Governing Body RESEARCH INSTITUTE, by taking over Lady Wellington Leprosy Sanatorium CHENGALPATTU, TAMIL NADU established in 1924. Later, in 1974, Govt. of India had made CLT&RI as a subordinate office of Directorate Introduction: General of Health Services, Ministry of Health & Family The Central Leprosy Teaching and Research Institute Welfare with an objective to provide diagnostic, treatment (CLT&RI), Chengalpattu was originally established in and referral services to leprosy patients, trained

Annual Report 2010-11 273 manpower development for leprosy, control / elimination Total number of cases besides, research on various aspects of leprosy and its (for Exercise, Therapy, etc) : 4110 control. It has separate wings of Epidemiology and Radiography Section: Statistics, Clinical, Medicine, Microbiology and Bio- chemistry laboratories with Animal House facilities, Total Number of Ski grams taken = 168 Surgery and Physiotherapy. This institute caters to both (as on indoor and outdoor patients. The hospital has bed capacity 30-11- of 124 patients. This Institute is also recognized as one 2010) of the nodal centers by Central Bureau of Health Intelligence (CBHI), Dte.GHS, Govt. of India for Micro-Cellular Rubber Mill: conducting Health Statistics training course for Medical MCR Sheet Production = 920 Officers. (as on During 2010-11 till 30th November, 2010 following 30-11- activities were carried out in the Institute. 2010)

Inpatients services Division of Laboratories

Total patients treated = 554 Clinical pathology & Skin Smear 831

Total Discharges = 399 Haematology & Serology 3000 Microbiology 100 Patients remain at the end of the year = 37 Histopathology & Molecular Biology 71 Out patients: Total patients treated = 5541 Bio Chemistry 3130 Surgery 2010-2011 (till 30-11-2010) Training Section Reconstructive Surgery: All four Divisions, Clinical, Surgical, Epidemiology & Statistics & Laboratories are actively taking part in the Claw finger correction 11 various teaching and training programmes conducted by Claw thumb correction 6 the Institute. The details of the programmes are as on 30-11-2010 follows:- Wrist Correction 1 S.No Category of service Number Drop Foot Correction 3 of participants Surgical Decompression of Nerves: attended the training Ulnar Nerve 3 1 Non Medical Health Ulcer Surgery 5 Supervisor’s Training Course 83 Miscellaneous like ear lobe repair, 2 Medical Officer Skin Smear Biopsy, SSG Knee disorganization, Training (10 days) 1 MTH resection, Calcaneal shaving etc 5 3 PG Medical students from Total 34 CMC & CRRI 53 Physiotherapy Section: 4 Lab technician Skin smear New Case Registration : 40 raining (5 days ) 5

274 Annual Report 2010-11 15.34. REGIONAL LEPROSY TRAINING AND procedures are carried out regularly and RCS RESEARCH INSTITUTE, RAIPUR, (Reconstructive Surgery) camps have been done in the CHHATTISGARH past. It also works as a nodal training and research center for the cause of leprosy elimination. Brief activities RLTRI, Raipur is under the DGHS, continuously serving performed by this Institution 1. OPD Attendance - 954 is having 75 beded indoor patient services and is providing (Leprosy -728 , Non-Leprosy -226 ). 2) Indoor - Total daily OPD services. It is also having well equipped admission -280 3) Reaction cases Managed -63 with Laboratory and well trained technical manpower in the Thalidomide’s 5. 4. Major Surgeries :- 41 5) DPMR - laboratory for skin smear examination and other 153 ( exercise, POP-37, splint-Nil, Crape Bandage -03) laboratory investigation. The Institute has well equipped MCR Chappals -436) Lab:- Total Inv. - 1426 ( Clinical - Operation Theatre and an expert Orthopaedic Surgeon 740, Microbiology (Skin Smear ex).- :- 80, Parasitology to undertake various kind of Re-constructive surgery for & haematology :- 588 Bio- Chem.-18) 7) Training:— leprosy related deformity. Faculty of this institute is going as resource person to As per the existing guidelines of the Government of India, impart modular trg. in NLEP to doctors and Paramedical the treatment of Leprosy is now available in every health staffs of state and also participate in NLEP review and facilities and in the changed scenario after integration planning meeting of states. the Institute provides only technical guidance as and when 15.36. REGIONAL LEPROSY TRAINING AND required. RESEARCH INSTITUTE, GOURIPUR, Need based training program for all categories of medical BANKURA, WEST BENGAL personnel in the field of leprosy are organised. Condensed Regional Leprosy Training and Research Institute, training program for Medical Officers as well as for the Gouripur, Bankura, a 50 bedded leprosy hospital set up field level workers has been developed. The Institute has by Central Govt. in 1984. all the facilities and expertise to conduct the training program. The performance report up to 31st October, 2010 during the year 2010-11 is as detailed below- The Institute is also having well equipped indoor facility. A total of 356 cases were admitted in the indoor wards i. One day orientation training given to Homeopathy which includes 116 patients having ulcers, 58 patients Student nos. 45 having ENL reaction. The average monthly bed occupancy ratio of indoor wards during the year 2009- ii. Admission-97 Discharge-100, New Case-35 Other 2010 was 50% and average duration of stay of the patient case-1916 MDT given-314, Staff Treatment- Other was 38 days. Leave against Medical Advice (LAMA) cases attended-2551 rate was less than 1%. 118 new and old RCS cases were iii. Group Discussion- 249 Leaflet distribution-699, also admitted in the indoor wards for Physiotherapy and School Survey-0 nos., Student exanubed-0, treatment. Suspected Case-0, Film Show 0, IEC 15.35. REGIONAL LEPROSY TRAINING & programme-47 RESEARCH INSTITUTE ASKA, ORISSA iv. Plastering – 19 pts, Ray-220 pts, Wax Therapy- This institute was established in the year 1977. At present 325 pts, Exercise and massage for indoor there is 47(Gr.A-2, Gr.C-23, Gr.D-20) staff in position pts – averagely 8 pts daily out of 67 sanctioned posts. It has a 50 beds hospital and v. 140 nos exposure average bed occupancy is about 52%. The institute provides both Outdoor and Indoor services to leprosy vi. Slit Skin Smear – 571, Bio-chemistry-184, Clinical patients. The institute also works as a referral center for Pathology-235. management difficult to diagnose leprosy cases, Skin 15.37.NATIONAL MEDICAL LIBRARY smear examination and problematic, complicated and intractable cases of reaction and ulcers. Physiotherapy Introduction measures and MCR chapples are provided to the needy National Medical Library (NML) provide valuable library patients. Amputation and various other surgical information services to support the academic, research

Annual Report 2010-11 275 and clinical work Health science professionals in the medical college libraries. The project aims to develop country. It occupies important position in country’s health information communication technology capability among care information delivery system. Some of the significant the participating colleges to be able to access the online services provided by NML are: information resources available in NML. 15.37.1. Reference services & collection building Reference and Documentation Services One of the greatest strengths of NML is its richest The library remains open on 359 days of the year from collection of books, reports, serials, bound volumes of 0900 - 2000 hrs on weekdays and from 0930 - 1800 hrs journals and computer databases. This invaluable treasure on holidays. Over 150 users visit the library every day of biomedical and health science information, which is for reference, consultation, obtaining photocopies of often the only source,is widely used by professionals from required articles and information retrieval service. Library all parts of the country. It has collection of over 1.35 has been visited by information seekers to avail following lakhs books and over 5.2 lakhs bound journals. The Library services: subscribed 1510 print journals worth Rs. 7.44 crore in 2010. Library follows Open-Access system for shelf • Queries answered 4798 arrangement. Library added 390 volumes (books • New Membership 74 purchased 1035+ serials purchased 90+Gift books 30) by spending over 34.57 lakhs in the year 2010. The books • Issue/return of documents 1270 and journals acquired during the year have been classified • Inter Library loan (Print documents) 14 and catalogued by using LIBSYS library software package. Library developed database of over 6000 medical thesis/ dissertation submitted to medical colleges across the 15.37.2. Local Area Network (LAN) and Online country. The same is available at

at Public www.nml.nic.in. The library also developed a database Access Catalogue (OPAC): Servers and computers in of over 4000 medical articles published in Indian Medical the library are networked to form a LAN having an journals in the country in MARC21 software under the integrated Library Management Software Package – ìIndex Medicus-Indiaî project. The library also LIBSYS. About 40,500 records of books are now developed the database of over 6000 medical thesis available through OPAC computer search by library submitted to different medical colleges across the country. users. Leased lines of (100 mbps) and broad band internet The database is widely used through the NML website. facilityis available to provide Internet services including Library brings out a quarterly “List of New books Added access to full-text of the journals. to NML”. It is also bringing out a weekly ìIndian Press Index on Healthî which covers important press release Information Retrieval Services on topics related to health science in prominent Indian NML has been offering the service using MEDLINE newspapers. since 1990. Besides, it has about 500 CDs on different Document Delivery Service subjects. The biomedical information sources available on Internet, namely PUBMED, PUBMED Central, The Document Delivery Service provides access to the ERMED etc. were also accessed to meet the requirement full text of documents needed by various medical of library users. Many articles were searched through specialists. This service is in fact used more widely than MEDLINE service for getting references and abstracts any other service of the library and caters predominantly for research scholars during the year. A Work station to requests for copies of articles in journals (current as having the facility of 10 terminals fitted with CD writer is well as back files). A large number of request for being developed for on-line access of foreign medical photocopy of articles are received from outside Delhi by journals. Scheme to “Inter-linking of Government Medical post, e-mail and fax through Government as well as College Libraries with the NML”. Government colleges private photocopy counters. Photocopies of about 7089 are provided with financial assistance to acquire (approx.) articles per month are provided to medical hardware, software, Internet connectivity and to hire research scholars across the country, in which postal contractual staff. This scheme has already covered 78 charges are free for delivery of articles to outside Delhi states. 276 Annual Report 2010-11 ERMED-India e-journal consortium Consultancy services provide to followingHospitals/ Institutes: Over the years the National Medical Library (NML) has been providing a wide variety of Health Information • National Institute of Health & Family Welfare, dissemination activities focused on reaching out Health New Delhi Care Professionals of the country. NML disseminates • Institute of Human Behaviour and Allied Sciences over 8000 ( 8000 x 5 =40,000 pages) photocopy of articles (IHBAS), Delhi. from medical journals per month to medical scholars across the country. The system involves sizeable • Safdarjung Hospital, New Delhi. photocopy machines + man power + maintenance of back Branch Library: National Medical Library maintains a ,volumes of medical journals, their shelving and repeated branch library in the Nirman Bhawan to cater to the library binding due to extensive use of journals.Despite above and information needs of staff and officers in the tedious efforts the end user does not get efficient Directorate General of Health Services and the Ministry document delivery service due to delay in postal services of Health and Family Welfare. Steps are being taken to and human handling. renovate the present library set up and to improve library In 2010 ERMED purchased 1180 e-journals at the cost collection and services at Branch Library. of Rs 10.20 crores for 98 members (2 private members 15.38. LALA RAM SARUP TB HOSPITAL have made their own payment for per site e-journals). The consortium recorded over 1,92,082 download of LRS Institute of Tuberculosis (TB) & Respiratory full text of articles from Jan- Jun 2010, which shows Diseases has been engaged in the service of the Nation optimum utilization of ERMED resources . since 1952. From a TB Hospital, It became an autonomous Institute in 1991 with specific objectives of developing NML envisions that the availability of latest knowledge tertiary care facilities for patients suffering from and skills through global Medical Literature to Indian respiratory diseases and for supporting the National Medical Fraternity will be able to improve Medical Tuberculosis Control Programme (NTCP). The Institute Research output of the country and ensure effective is engaged in the management of patients through its state Health Care System for All. of the art Out Patient Department (OPD), Indoor wards, Training: Operation Theatre, Respiratory Intensive Care Unit, Emergency Ward and quality assured Lab. Diagnostic The Training cum Orientation programme for ERMED facilities. at National/Regional/State level has been conducted to create awareness and make the system more user friendly The institute has various departments and sections which at the following Institutions mentioned below: are as follows:- (i) For Chandigarh, Haryana and Himanchal Pradesh, Departments: at PGIMER, Chandigarh, on 9th April 2010. Department of Anaesthesia, Department of Bio- (ii) For Gujrat and Madhya Pradesh, at BJMC, Chemistry, Department of Epidemiology & Public Health, Ahmedabad on 20th April 2010. Department of Hospital Administration, Department of Internal Medicine, Department of Microbiology, (iii) For Tamil Nadu, Puducherry and Port Blair at Department of Molecular Medicine & Bio-technology, th Dr.MGRMU on 27 April 2010. Department of Paediatrics, Department of Pathology, (iv) For Uttar Pradesh, at SGPIMS, on 21st May 2010 Department of Physiology ,Department of Radiology, Department of TB & Respiratory Diseases, Department (v) For West Bengal, at PGMER & SSKM on 19th of TB Control & Training, Department of Thoracic April 2010. Surgery and Surgical Anatomy. NML also provided sufficient number of “Users Manuals” Sections and “ Posters” to each participant to enhance awareness for ERMED. It is expected that the search skill of the Respiratory intensive care unit (ICU), Sleep lab, Health users will be more efficient in future to make use of the education section, Biostatistics section, Voluntary ERMED resources. Annual Report 2010-11 277 Counselling and Testing Centre (VCTC), Fibre-optic therapy, free CD4 testing, treatment and prophylaxis of Bronchoscopy Unit , Lung Cancer section , Physiotherapy opportunistic infections, patients and family counseling section, Library, Computer section , ART Centre, Yoga as well as pre ART support and care services. As on 31st Centre, Allergy and Immunotherapy Clinic. December-2010, a total of 855 patients are on HIV care and 523 patients are on ART treatment. The sanctioned staff of the Institute is 610 and present staff strength is 495. Surgical Clinic is held on Tuesday/Friday afternoon for patients requiring surgical treatment and follow up post- Out Patient Management: operative patients. A total of 424 Major and 2850 minor A total of 28438 patients were registered in OPD procedures were done during this period. registration counter. These are considered as chest The Institute runs various specialised clinics, which are symptomatic at the LRS-OPD. Out of these 6384 (22.4%) held periodically. A total of 4303 patients attended these came from the LRS RNTCP specified area, 14218 clinics during this period. (50.0%) from Non-Area and 7836 ( 27.6%) from outside Delhi. Indoor Management: A total of 20469 patients were diagnosed. Out of them A total of 4114 patients were admitted. They included 12971 (63.4%) were diagnosed as TB cases and 7498 482 patients admitted to Respiratory Intensive Care Unit. (36.6%) were diagnosed as Non TB cases. After Of these, 4027 (98%) were admitted on free and 87 (2%) diagnosis, a total of 5682 TB cases were referred out on paid beds. Many patients who were admitted came at from LRS to LRS DOTS centres / other chest clinics in terminal stage. A total of 3816 patients were treated and Delhi or outside Delhi for further treatment from DOTS 708 died during this period. centres. Training of Medical & Paramedical personal: The total number of patients who attend the LRS OPD Several training programmes have already being constitute mainly four groups (i)New registration (ii) conducted by the institute for Doctors, paramedical Subsequent visits for diagnosis (iii) Follow up visits of personnel (Lab Tech.,Sr. Lab Tech., Treatment organisers, TB cases and (iv) Follow up Visits of Non-TB patients. Sr.Treatment supervisors and programme officers, During the period, a total of 83561 patients attended the Administrators) of several states. The training is also OPD with an average of total 373 patients per day imparted in the management of tuberculosis to the nursing including 128 per day as new registrations. students from Rajkumari Amrit Kaur College of Nursing A total of 5119 chest symptomatic directly attended the and the trainee health visitors from New Delhi TB Centre DOTS centres under the specified area of the LRS every year. A total of 762 trainees were imparted training institute. Besides these, 6384 symptomatic came directly during this period. at LRS OPD from the RNTCP area of the institute. This DNB course: comprised a total of 11503 symptomatic under RNTCP. Out of these, a total of 1405 TB cases were registered The Institute is recognized centre for post-graduate DNB under RNTCP for DOTS treatment. All of them were (Respiratory Diseases) degree course since 1999. Now, put on DOTS treatment with none on conventional. w.e.f. 2009, the institute has been accredited for ten DNB seats per year. Regular teaching activities such as A daily OPD for children is being carried out in the seminars, journal club, faculty lectures, grand case morning. A total of 2551 children were newly registered presentation, mortality meetings, pathological conference, in the OPD. 213 were diagnosed as suffering from radiological conference, bed-side clinical round are tuberculosis and referred to respective DOTS centres. routinely carried out. A centre for Integrated counselling for HIV testing has Organising the CME & Conferences: been operational in the institute. During the period, a total of 3122 patients were imparted counseling and tested for The institute is actively involved in organising Continuing HIV. A total of 130 (4.2%) cases were found HIV Medical Education programme (CME) on different positive during this period. aspects of diagnosis and management of tuberculosis and respiratory diseases. Comprehensive HIV care facilities are provided at the ART centre. These include free of cost antiretroviral

278 Annual Report 2010-11 Research Activities: • A number of high end equipments for patient care and research were procured for various In addition to 20 on going DNB researches, 10 more were departments. under taken during the period. Similarly in addition to 43 ongoing other than DNB researches, 18 more were • Institute is now admitting 10 students for DNB undertaken during the period. degree course following approval as against the 6 students earlier. Publications: • Emergency services have been functioning round During the period 11 faculty members of the Institute the clock now along with facilities for X-ray, ECG contributed chapters in the recently released NCCP Text and laboratory services. Book of Respiratory Medicine(Editor in chief Dr. D. Behera) under the aegis of National College of • Digital X-ray is being provided free of cost to the Chest Physicians, India. In addition to this, there were 10 patients through computed radiography system publications by the faculty in renowned National and installed in Radiology Department. International Journals. • Institute is responsible for conducting the national Achievements: Annual Risk of T.B. infection Survey in eastern region of the country. • A new diagnostic facility called Line Probe Assay (LPA) has been established in new research block • A block of 30 staff quarters (Type-A) has been to detect resistance to Rifampicin in 48 hours. This constructed. is likely to help in rapid diagnosis of TB Patients. A 15.39. NATIONAL INSTITUTE OF MENTAL training was conducted under FIND project in this HEALTH AND NEURO SECIENCES, regard following which internal proficiency test has (NIMHANS), BANGALURU been completed. The National Institute of Mental Health and • Institute facilitated the process of the National Neurosciences, a multidisciplinary Institute for patient care DOTS-PLUS guidelines for programmatic and academic pursuit in the frontier areas of Mental management of MDR-TB patients. Health and Neurosciences has strived too hard to maintain • A first of its kind in the country, New MDR-TB the mission of delivering prompt and appropriate patient wards have been constructed with latest technology care, develop man power and carryout the research in and have started functioning. areas of natural relevance in behavioral, clinical and basic neuroscience. During this period of review from April The Institute has now become a regular DOTS- • 2009 to 31st March 2010, Dr.D.Nagaraja was the Plus site for the state of Delhi under the National Director/Vice Chancellor till 31st January 2010. After Programme. The Institute is extending its services completing his terms of appointment, Ministry of Health and activities to become one of the four DOTS- and Family Welfare, Govt. of India has appointed Plus sites under RNTCP that will cover nearly 40 Dr.S.K.Shankar, Dean Clinical Neurosciences as In- lakh population of Delhi and the national reference charge Director/Vice Chancellor, till the appointment of laboratory of the Institute will extend logistic support full time Director/Vice Chancellor. Dr.Shankar ensured for the culture and DST facilities for half of the continuity of service, academic and scientific philosophy population of Delhi to detect MDR TB patients. of the Institute with equal opportunity to all. The Institute, being one of the NRLs, is supervising the IRL activities over 8 states of India that includes Hospital Services areas in the North East. Under its guidance, the NIMHANS as a secondary and tertiary care hospital in NDTB center was accredited as an IRL. the fields of Psychiatry, Neurology and Neurosurgery and • A state of art BSL-III laboratory, MGIT system allied diagnostic specialities, rendered service to the and RT-PCR machine have been functioning. patients from all over the country as well as neighbouring developing SAARC, Arabic and African Countries. A newsletter of the Institute is being published • During the year 2009-10, patients numbering 3,97,666 regularly every three months for circulation among have been treated. the professional colleagues.

Annual Report 2010-11 279 YEAR 2009-2010 Summary of patient care and hospital statistics

Screening 89,498 Discharges Psychiatry 4,896 Registrations Neurology 2,841 Neurosurgery 3,864 Psychiatry 11,291 Emergencies Neurology 17,095 Psychiatry 2,229 Neurosurgery 14,470 Neurology 13,037

Follow Ups Neurosurgery 14,871 Psychiatry 105,045 Extension Services Neurology 50,359 Gunjur 2,620 Neurosurgery 23,921 Gouribidnur 10,414 Admissions Maddur 3,181 Psychiatry 5,216 Kanakapura 2,762 Neurology 3,098 Madhugiri 2,794 Neurosurgery 4,182 Sakalawara 8,910 Turuvekere 180

Salient services provided by various departments during is provided for patients with work related problems the year 2009-10 are reflected below. through vocational counseling and placement referrals. Department of Psychiatry The centre developed a manual for people who want to start a Tobacco Cessation Centre. Six specialty clinics are run for the evaluation and Obsessive Compulsive Disorder Clinic management of patients. – New Cases – 257: Follow up cases 1288. De-addiction Centre - New cases – 2231 Geriatric Clinic – (elderly above age of 60 with Follow up cases – 5430 Neuropsychiatric disorders, Dementia, Late onset Psychosis and Depression) New cases – 200, During the year the De-addiction Centre services have screened – 3010. moved to an out patient facility. Three training programme for medical officer in the field (110 medical officers) and Schizophrenia clinic – 1800 patients were treated and one month orientation programme on Substance Abuse Integration of Yoga therapy for patient attending for management conducted for medical and non medical schizophrenia clinic was initiated. professionals and lay counselors. During the current year Metabolic Clinic the centre trained 320 professionals. A toxicology – 400 patients were comprehensively laboratory to monitor the drug levels is functioning clearing assessed in the metabolic clinical of Psychiatry. out 20 different screening tests. Employment assistance

280 Annual Report 2010-11 Pre-natal and Post natal psychiatry clinic – This clinic Department of Epidemiology has been managing is devoted to women in the reproductive age group with helpline to prevent suicide and is active in policy planning psychiatric problem related to pregnancy and post partum. related to road traffic accidents. Intervention procedure is carried out for training mothers to improve mother infant bonding, infant stimulation and Department of Neuropathology continued round the psychological education. clock autopsy services and has co-ordinated the work at Human Brain Tissue Repository (Human Brain Bank). Yoga Services – An advance centre for Yoga offer yoga Transfusion Medicine Centre has been offering plasma therapy for the patient suffering from psychiatric and pheresis facility all the days including holidays. During neurological disorders and their care givers. The total the year more than 1200 plasma pheresis procedure has 692 new and 9284 old patients were treated. The centre been carried out. The Transfusion Medicine Centre has conducted 4 workshops and came out with a quarterly provided 4110 blood and blood products to other hospitals news letter. in the city. The work load in all the laboratory section has increased significantly. Psychiatric Neurological Rehabilitation – New cases – 5869, follow up – 425 Departments of Neuropathology Department of Neurovirology department was Neuromicrobiology, Neurovirology, and Neurochemistry recognized as nodal centre for H1N1 testing by the have provided comprehensive diagnostic facilities to the Ministry of Health and Family Welfare, Govt. of India patients. for the state of Karnataka. During the outbreak of H1N1, Department of Mental Health and Social Psychology Dept of Neurovirology under the leadership of Prof V.Ravi conducted testing round the clock to meet the continued psychological evaluation, behavioral/cognitive crisis for the management of the patients. Prof Ravi has therapy, mentally handicapped counseling, family and been called upon by the Govt. of Karnataka as an expert marital therapy, learning and disability treatment. to plan, assist and direct the outbreak management Department of Psychiatric Social Work carried out services for the entire state of Karnataka. The department regular rehabilitation and placement services. The faculty continues to be WHO referral centre for the diagnosis of is actively involved in psychosocial rehabilitation as a part rabies. of disaster management and training of the manpower Manpower Development from time to time. NIMHANS has 23 departments in various specialties. Department of Neurosurgery has round the clock The Institute is offering PhD Courses in Clinical emergency surgical team to treat trauma. The department Psychology, Neurophysiology, Psychiatry Social Work, is conducting special clinics like Post Trauma Clinic, Spinal Speech Pathology & Audiology, Clinical Neurosciences Clinic, Spina Bifida, Gamma Knife Radiosurgery and (ICMR Fellowships), DM degree in Neuroradiology, DM Functional Neurosurgery. During the year more than 5000 degree in Neurology, M.Ch degree in Neurosurgery,MD neurosurgical procedures have been conducted. degree in Psychiatry, Diploma in Psychiatry, Post doctoral Department of Neuroanaesthesia assisted in carrying fellowship in Neuropathology, Neuroanesthesiology and out 3623 neurosurgical operations and managed 1200 Neuroinfections and Child and Adolescence Psychiatry, cases in medical ICU. The department has acute M.phil in Biophysics, Clinical Psychology, Psychiatric shortage of faculty thus hampering service delivery from Social Work, Neurophysiology and Neurosciences. time to time. NIMHANS has pioneered in Psychiatric nursing, Department of Neurology in addition to routine patient neurological and neurosurgical nursing with enhanced care has been conducting Refractory Epilepsy Clinic, intake of students to meet the requirements. These Neuromuscular Clinic and Movement Disorder Clinic. services need further augmentation to meet the national The department has been managing state of the art Stroke needs. To enhance the services NIMHANS is planning unit. to commence new courses – Post doctoral fellowship in movement disorder, epilepsy, Post Certificate Course – Department of Health Education has developed a B.Sc Nursing. For the first time in the country NIMHANS range of education materials to educate the public about is imitating a new course – DM Child Psychiatry in an H1N1 epidemic and preventive strategies.

Annual Report 2010-11 281 effort to enhance positive mental health in children and on various components of TB Control, mainly carried out also offered and evolved treatment modalities for by the Epidemiology and Control Sections. The psychiatric disorders in children. This is in line with the Bacteriological Wing of the Institute has been recognised philosophy of enhancing trained manpower in specialized as a National Reference Laboratory for External Quality areas in the country. Assessment in the TB Control activity. It also assists in establishing Intermediate Reference Laboratory for Particulars Total Culture and Drug Sensitivity tests, across the country. 1 Students joined for various post Major Activities Undertaken During the Year graduate degree/diploma, undergraduate A. Research courses and certificate courses during 2009-10 219 The research studies/projects taken up by the institute were Nodal centre for carrying TB Disease Prevalence 2 No. of Trainees undergone training at Survey under RNTCP, Nodal Centre for Repeat Zonal this Institute from April 2009 to ARTI Surveys, Study on “Routine Referral of TB patients March 2010 3535 to integrated Counselling & Testing Centre”, Tobacco 3 Total number of projects: Cessation Intervention among the Pulmonary TB cases in selected treatment units of Bangalore District, -Ongoing 87 Assessment of documentation of HIV related information -Completed 4 on TB treatment card & relevant records, Review of Articles for journals – 10Nos, Prospective Multi-centric -Sanctioned 2 cohort study to asses risk factors for unfavourable treatment outcomes, including recurrent TB, among Degrees awarded sputum positive Pulmonary Tuberculosis Patients treated with CAT-1 regimen of RNTCP, Disease Prevalence Ph.D – 26, DM Neurology and Neuroimaging – 10, Survey in Nelamangala Taluk. M.Ch – 6, M.phil – 35, MD-Psychiatry – 16, Post Doctoral Fellow -3. B. Training Research The Institute has pioneered in the field of Human Resources Development. It is involved in conducting the Various Basic Sciences Departments are actively following training programmes to the TB Programme investigating genetic basis of Stroke, advanced Managers positioned at different parts of the country. methodologies in Neuroimaging, proteomic and genomic studies in Neuropsychiatric disorders, Neuroinfections, Five (5) RNTCP & TB-HIV Modular training Programme Brain plasticity following stimulation of cutaneous nerves, were conducted at NTI where STDCs, STOs, DTOs, neural correlates behavior, high altitude physiology, MO-TCs and faculty of Medical Colleges participated. physiological basis of stress, behavioral alterations in fear learning and memory following early maternal separation Managing Information for Action (MIFA) Training - One. in rats, biology of Schizophrenia, analysis of metabolic Training in Preventive maintenance and minor repairs of disorders in Neuromuscular disorders with special Binocular Microscopes – One.EPI Centre Training references to mitochondrial genome. Genetic basis of Workshop – One.Workshop for Microbiologist for Epilepsy has been described in collaboration with updating training material guidelines for National Jawaharlal Nehru Centre for Advanced Scientific Reference Laboratories - One. SAARC Regional Research and National Brain Research Centre. Training of Microbiologist on Culture & DST of MTB – One. TB Operational Research Workshop – One. PCR 15.40. NATIONAL TUBERCULOSIS based LPA Training – One. Thirty (30) orientation INSTITUTE, BANGALURU programme of one day duration were organized for about Introduction 1181 undergraduate Medical, Microbiology and Nursing and Pharmacy students sponsored by different Institute National Tuberculosis Institute (NTI), Bangalore, under across the country.External Quality Assessment (EQA) DGHS, is involved in carrying out Operational Research has been given importance under RNTCP in the recent

282 Annual Report 2010-11 years. One training on the procedures of EQA was D. Monitoring Section imparted to the Laboratory personnel of different parts With full coverage of RNTCP in the country, the Institute of the country. Three training in Culture & DST / Smear is not compiling the reports on NTP. At present, the Microscopy were imparted to Microbiologists/Lab monitoring activity is being carried out by the Central TB technicians. Division under DGHS. C. Bacteriology Section E. Publication Activities I. Operationalise the EQA for sputum smear The faculty of the Institute published about 5 research microscopy network in the states in conjunction papers in the leading journals on TB. Five presentations with /STDCs or IRLSs. Carry out NRL and two poster sessions on the basis of the research responsibilities of EQA such as Onsite Evaluation studies conducted by the institute were presented in the (OSE). Panel testing (proficiency testing of lab National Conference on TB and Chest Disease, held at staff) to ten states at least once in a year for 3-4 Bangaluru during 10th, 11th & 12th January 2011.The in- days (including one to two districts visits), and make house publications, NTI Bulletin of Volume 43-1 & 2 and visits as and when required depending on the Volume 3 & 4 have been released priorities /necessity to improve and help the F. Other Activities performance of labs. Eight visits of EQA on site I. The Faculty and the technical staff participated in evaluation were undertaken to five states. Prepared the appraisal and Central Evaluation of RNTCP slides were used for panel testing during the visits. districts as and when called upon to do so and given II. Conducting quality improvement workshops for the the technical support for implementation of RNTCP. state level programme managers with a view to II. The Scientific Gallery was established to find solutions to EQA related operational and disseminate the general information on TB the technical problems faced in the field. evolution of the programme and achievements of III. To implement and verify Random Blinded the Institute since its inception. Considering the needs of various categories of trainees, two Rechecking (RBRC) producers and improve the methods of display units vis., Photo Display and performance of labs based on analysis of the RBRC Projection facility and Information Kiosk are data in conjunction with STDCs. available. IV. Capacity building and strengthening the ten state The Director, faculty and the technical staff participated level TB laboratories (STDCs) with respect to in about 23 Meetings/Seminars conducted by Central TB proficiency in culture and Drug Susceptibly Testing Division and other TB related activities. including second line drugs. Up-gradation of Infrastructure V. Conducting Anti-TB Drug résistance surveillances of priority states involving processing of On a proposal submitted by FIND on behalf of UNIT AID the Govt. of India decided to establish an International representative sample of the states to obtain Centre for Excellence in Laboratory Training (ICELT) information of prevalence of drug resistance, with at the National Tuberculosis Institute, Bangalore with the a view to support logistics of DOTS – Plus following Vision and Mission. programme under expansion of DOTS and RNTCP and conduct/participate in National Level disease Vision: Establish a state of the art teaching and training prevalence studies/surveys. facility for imparting quality laboratory practices for tuberculosis and other opportunistic infections and VI. The Lab team of the Institute carries out on site promote a healthier India and Asia. evaluation of STDC laboratories of different states and provides necessary guidelines to establish Mission: To support the scaling up of laboratory capacity building in India and Asia by providing hands-on training quality laboratory to undertake EQA and DRS courses in the diagnosis and monitoring of major infectious studies. diseases such as TB, HIV/AIDS and Malaria.

Annual Report 2010-11 283 of civil, electrical, mechanical, information technology and International Centre for Excellence in Laboratory Training auxiliary medical service areas. Its important clients (ICELT) will provide Training to the personnel who are include: Ministry of Health & Family Welfare and its working in about 43 Culture Laboratories in different parts Hospitals / Institutes, Ministry of External Affairs and of the Country in Newer Diagnostic Tools for Diagnosing other Ministries, State Governments and their Hospitals / TB & Drug resistant TB. The ICELT was inaugurated Institutes, PSUs / Other Institutes. on 20th January 2011. Two training programme of five days each was held from 24th January – 4th February Financial Performance 2011. During the Year 2009-10 the Company has attained the F. Financial Outlay & Expenditure highest ever total income of Rs. 3355.77 Lakhs in its existence. The Company has declared a dividend of @ The details of budget allocation for NTI during the year 72% of the paid-up share capital amounting to Rs. 172.81 2010-11 and 2011-12 are as follows:

Category 2010-2011 2011-12 Budget Revised (Rs. in crore ) estimate estimate (Rs. in crore ) (Rs. in crore ) Non-Plan 5.66 6.16 6.83 Plan Revenue 0.50 0.48 0.50 Capital 1.45 1.45 1.45 Total 7.61 8.09 8.78

15.41. HOSPITAL SERVICES CONSULTANCY Lakhs. This was the 25th consecutive year in which the CORPORATION (HSCC) Company has paid dividend and with this the cumulative Background dividend till 2009-10 stands at Rs. 2117.33 lakhs. Over the years, HSCC’s net worth has grown to Rs.7238.87 HSCC was set up in March 1983 as Public Sector lakhs as on 31st March 2010 which is more than 30 times Enterprise under the administrative control of Ministry of its paid-up capital. of Health & Family Welfare. As on 31.03.2010, the Authorised Capital of the Company was Rs. 500 Lakhs Quality System (divided into 5,00,000 equity shares of Rs. 100/- each) The Company is an ISO 9001 accredited Company. The and the Paid-up Capital of the Company was Rs.240.018 Company has from time to time, taken steps to upgrade Lakhs (including Bonus Shares of Rs. 200 Lakhs). Since quality assurance system and degree of clients’ inception the total business of the Company has been satisfaction. The Company is “ISO 9001:2008” certified managed without any borrowing either from the Company and has internal quality control as required for Government or from other sources. HSCC has been its various projects and assignments. declared ‘Mini Ratna’ Company in September 2002. Corporate Governance Service Spectrum Corporate Governance Practices in the Company focus HSCC is a multi-disciplinary renowned consultancy and on transparency, integrity, professionalism, accountability procurement management service organization in the and proper disclosure. health care and other social infrastructure development sectors. Its service spectrum covers feasibility studies, Recognition design engineering, detailed tender documentation, HSCC has been signing MOU with the Ministry of Health construction supervision, comprehensive project & Family Welfare and rated “Excellent” for the year management, procurement support services in all areas 2009-10.

284 Annual Report 2010-11 Companyís Affairs - Nizam Institute of Medical Sciences (NIMS), Hyderabad – 300 Bed Super Specialty Block and HSCC had adopted an integrated approach to projects, 50 Bed Emergency & Trauma Block drawing on its pool of expertise to provide the best combination to evolve client specific, cost effective and - Sanjay Gandhi Post-Graduate Institute of Medical innovative solutions. HSCC being the knowledge based Sciences (SGPGI), Lucknow – 160 bed Super Company, its real strength lies in its manpower. The Specialty Block Company employs competitive and highly skilled cadre of architects, engineers, Chartered Accountants, Cost - Kolkata Medical College, Kolkata – OPD & Accountants, MBAs and a pool of Consultants in the areas Academic Block and Super Specialty Block of medicines and corporate planning etc. The employee • Residential Complex for AIIMS like institutes at :- management relationship was excellent throughout the year. In line with changing market requirements, the - Raipur knowledge and skill of HSCC employees are continuously - Bhubaneshwar upgraded. • DPR for Chitaranjan National Cancer Institution, A list of the major on-going projects where HSCC is Kolkata rendering Consultancy Services is as under: • Project Management Consultancy for All India A. Architectural Planning, Design Engineering Institute of Ayurveda, Department of Ayush, New & Project Management Services ñ Delhi Consultancy Services • Veterinary Ayurveda Research Institute, Deptt. of • Up gradation and development of Government Ayush, Lucknow. Medical College and associate hospitals consisting of Bebe Nanki Mother & Child Health Care Centre, • Regional Institute of Medical Sciences (RIMS), Diagnostic Block, Drug Dependence Centre, Imphal Nursing College and Service Block at Amritsar • Master Plan and Renovation & Repair of existing • Design Engineering for the construction of Laundry and OPD and associated Works at AIIMS, Academic Block, Senate Campus and Guru Gobind New Delhi Singh Medical College for Baba Farid University • Sports Injury Centre at Safdarjung Hospital, New of Medical Sciences, Faridkot Delhi North Eastern Institute of Ayurveda & • • Design & Engineering of New Hospital Building Homoeopathy (NEIAH), Shillong at Oil India Ltd. Hospital, Duliajan, Assam Up gradation of Lokpriya Gopinath Bardoloi • • BSL – 4 Lab for MCC, ICMR, Pune Regional Institute of Mental Health, Tezpur • Lab & Animal House – Regional Medical Research • Nurses Hostel and other works / services for North Centre, Dibrugarh Eastern Indira Gandhi Regional Institute of Health & Medical Sciences, Shillong, Meghalaya • Indian Institute of Chemical Biology, Kolkata • Comprehensive Redevelopment Plan for Lady • BSL-3 Lab for NRCE, Ministry of Agriculture. Hardinge Medical College, New Delhi Hissar • Up gradation of Health Care facilities in the State • NARI-Bhosari, ICMR, Pune of Punjab • Animal BSL-3 facility at ICPO, Noida • Prime Minister’s Swasthay Suraksha Yojna • Science Centre & National Institute of Medical (PMSSY) for:- Statistics (NIMS) under ICMR at ICPO Campus, Noida

Annual Report 2010-11 285 ABROAD It has been decided to set up 6 AIIMS-like institutions, one each in the States of Bihar (Patna), Chhattisgarh 200 bedded Emergency and Trauma Centre for Bir • (Raipur), Madhya Pradesh (Bhopal), Orissa Hospital, Kathmandu, Nepal (Bhubaneshwar), Rajasthan (Jodhpur) and Uttaranchal • District General Hospital at Dickoya, Sri Lanka (Rishikesh) at an estimated cost of Rs 840 Crores per institution. These States have been identified on the B. Procurement Management Services basis of various socio-economic indicators like human • Medical Equipment for NEIGRIHMS, Shillong development index, literacy rate, population below poverty line and per capital income and health indicators like • Drugs and Equipments for Central Government population to bed ratio, prevalence rate of serious Health Scheme communicable diseases, infant mortality rate etc. Each • Medical Equipments for ONGC institution will have a 960 bedded hospital (500 beds for the medial college hospital; 300 beds for Speciality/Super • Medical Equipments for Ethiopia, MEA Speciality; 100 beds for ICU/Accident trauma; 30 beds for Physical Medicine & Rehabilitation and 30 beds for • Medical Equipments Liberia, MEA Ayush ) intended to provide healthcare facilities in 42 • Medical Equipments for Bir Hospital, Kathmandu, speciality/super-speciality disciplines. Medical College MEA will have 100 UG intake besides facilities for imparting PG/doctoral courses in various disciplines, largely based • Lab Equipments for CDSCO on Medical Council of India (MCI) norms and also nursing • Medical Equipments for Sports Injury Centre, college conforming to Nursing Council norms. Safdarjung Hospital, New Delhi. In addition, it has also been decided to upgrade the 13 C. Studies and Training Services existing medical institutions spread over in 10 States, with an outlay of Rs.120 crores (Rs.100 Crores from Feasibility Reports for the Super Specialty Hospitals • Government of India and Rs.20 crores from State at Sibasagar, Assam and Ankleshwar, Gujarat for Government) for each institution. In so far as SVIMS, ONGC Tirupati, Government of India share is limited to Rs.60 • Detailed Project Report for up gradation of National crores and Rs.60 crores would be borne by the TTD Institute of Communicable Diseases (NICD) to Trust. National Centre for Disease Control (NCDC), Delhi The medical college institutions being upgraded under • Detailed Project Report for the Proposed Medical PMSSY Phase-I are as under:- College at Thimpu, Bhutan for Bhutan Institute of 1. Govt. Medical College, Jammu (J&K) Medical Sciences (BIMS) 2. Govt. Medical College, Srinagar (J&K) 15.42. PRADHAN MANTRI SWASTHYA SURAKSHA YOJANA 3. Kolkata Medical College, Kolkata (W.B.) Government of India has approved the Pradhan Mantri 4. Sanjay Gandhi Post Graduate Institute of Medical Swasthya Suraksha Yojana (PMSSY) in March, 2006 Sciences, Lucknow (U.P) with the objective of correcting regional imbalance in the 5. Institute of Medical Sciences, BHU, Varanasi (UP), availability of affordable/reliable tertiary healthcare services and also to augment facilities for quality medical 6. Nizam Institute of Medical Sciences, education in the country. Hyderabad(A.P) I. PMSSY ñ 1ST PHASE 7. Sri Venkateshwara Institute of Medical Sciences,Tirupati (A.P) (50% cost of upgradation PMSSY has two components in its first phase - (i) setting will be borne by the TTD Trust) up of six AIIMS-like institutions and (ii) upgradation of 13 existing Government medical college institutions. 8. Govt. Medical College, Salem (T.N.)

286 Annual Report 2010-11 9. B.J. Medical College, Ahmedabad (Gujarat) 4. Patna 8.0% 10. Bangalore Medical College, Bangaluru(Karnataka) 5. Raipur 7.05% 11. Medical College, Thrivananthapuram, (Kerala) 6. Rishikesh 10.0% 12. Rajendra Institute of Medical Sciences (RIMS), (c) Construction of residential complex Ranchi Construction of residential complexes has been taken up 13. Grants Medical College & Sir J.J. Group Of separately. The civil work at Jodhpur has been completed Hospitals, Mumbai, (Maharashtra ) in April, 2010 and at Raipur in June, 2010. The progress of civil work at the 4 remaining sites is as under:- A. STATUS S.No Name of site % of work Likely date (i) Setting up of six AIIMS-like institutions completed of completion (a) Package-I - Medical College/Hostel :Civil 1 Rishikesh 81 March, 2011 work for construction of medical college/hostel was awarded in April, 2010 and work started the last 2 Patna 67.50 June, 2011 week of May, 2010. Completion period of the work is 15 months in all sites except Patna where duration 3 Bhopal 48 June, 2011 is 18 months. The site-wise progress is as under:- 4 Bhubaneshwar 18 September, 2011 S.No Name of site Percentage of Progress (d) Human Resource Planning for the six AIIMS- 1. Bhopal 15.86% like institutions 2. Bhubaneswar 12.03% Manpower requirement for medical college, hospital 3 Jodhpur 22.0% complex and nursing college for the AIIMS-like 4. Patna 22.04% institutions has been worked out by a Committee headed by Dr. K.K. Talwar, Director, PGIMER, Chandigarh and 5. Raipur 10.46% got vetted further by premier medical institutions in the 6. Rishikesh 17.86% country, e.g. AIIMS, PGIMER, JIPMER, Tata Memorial Hospital etc. Proposal for creation of 4047 posts for (b) Package-II ñ Hospital Complex each of the six AIIMS-like institutions to be recruited in three phases has been submitted to Ministry of Finance. Tenders floated earlier were rejected due to exorbitant Ministry of Finance has approved creation of 1145 posts price offered by the bidders. Retender issued on 30.5.2010. for each AIIMS-like institution to be filled up in first phase Closing date for receipt of tender was 15.7.2010. of recruitment. Contractors were selected for construction of hospital complex at all the six sites. Letters of Intent were issued (e) Formation of society for each of the AIIMS- to all the six selected contractors on 23.7.2010. On receipt like institutions of confirmation from contractors, work for Bhopal, Patna, Cabinet approved the proposal for formation of a society Raipur and Rishikesh sites has been awarded on 28.7.2010 for each of the AIIMS-like institutions to facilitate faster and for Bhubaneswar and Jodhpur on 2.8.2010. The civil execution and expeditious implementation of the projects, work is expected to start by end of August, 2010 and is till the institutions are brought under an Act of Parliament. scheduled to be completed in 24 months. Society has been registered for all the six AIIMS. S.No Name of site Progress of work(%) 2. Strengthening and up-gradation of medical college institutions 1. Bhopal 3.64% 2. Bhubaneswar 5.56% (a) 13 existing Government medical college institutions were taken up for up-gradation in Phase I of 3 Jodhpur 8.0%

Annual Report 2010-11 287 PMSSY. Out of this, 10 institutions involve both civil work and procurement of medical equipment and the remaining 3 involve mainly procurement of equipment. Status of civil work in the 10 medical college institutions are as under:- S. Name of medical college Name of Project Percentage of Likely date of No Consultant Progress completion 1. Trivandrum Medical College HLL 100% Completed 2. Govt. Mohan Kumaramangalam Medical College, Salem HLL 100% Completed 3. Bangaluru Medical College HLL 100% Completed 4. SGPGIMS, Lucknow HSCC 100% Completed 5. NIMS, Hyderabad HSCC 100% Completed 6. Kolkata Medical College HSCC OPD completed Academic Block - 68% Mar., 2011 7. Jammu Medical College CPWD 97.5% Mar., 2011 8. IMS, BHU, Varanasi CPWD 60% June, 2011 9. Srinagar Medical College CPWD 42% Dec., 2011 10. RIMS, Ranchi CPWD 40% June, 2011

Progress of other 3 medical colleges which involve mainly procurement of equipment is as under:-

S.No Name of medical college Percentage of Likely date of Progress completion 1. SVIMS, Tirupati 70% May, 2011 2. B.J. Medical College, Ahmedabad 70% May, 2011 3. Grants Medical College, Mumbai 84% May, 2011

(a) Procurement of equipments In the case of procurement of common and high end equipment, MoHFW, through Hindustan Latex Ltd. is Low end and uncommon equipment would be procured doing central procurement of equipment. An amount of by the beneficiary institutions/State Governments. About Rs.351.51 Crore has been earmarked for high end Rs.100 Cr has also been released to State Governments/ equipments and out of this, equipment worth Rs. 289.65 medical college institutions for purchase of low end and Crore has been procured. Procurement of balance uncommon equipment. equipment worth Rs.61.86 Crore is under process and it will be completed by March, 2011. 288 Annual Report 2010-11 II. Phase-II Medical College/State Government for procurement of medical equipments. They are in the process of Government has approved setting up of two more AIIMS- procurement of equipments. Tenders for civil work at like institutions, one each in the States of West Bengal Government medical college, Amritsar is under and Uttar Pradesh and upgradation of following six finalizaation. medical college institutions in the second phase of PMSSY. DPRs for Rajendra Prasad Government Medical College, Tanda and Jawaharlal Nehru Medical College, Aligarh - Government Medical College, Amritsar, Punjab; Muslim University, Aligarh have been approved by PMC - Government Medical College, Tanda, Himachal on 25.10.2010. DPRs of Pt. B.D. Sharma Postgraduate Pradesh; Institute of Medical Sciences, Rohtak and Government Medical College, Madurai were discussed in the PMC - Government Medical College, Madurai, Tamil meeting held on 25.10.2010 and the State Governments Nadu; have been asked to provide clarifications on the up- - Government Medical College, Nagpur, gradation plan submitted by them. Maharashtra 15.43. INTERNATIONAL INSTITUTE FOR - Jawaharlal Nehru Medical College of Aligarh POPULATION SCIENCES (IIPS) Muslim University, Aligarh and MUMBAI - Pt. B.D. Sharma Postgraduate Institute of Medical 15.43.1. Introduction: Sciences, Rohtak. International Institute for Population Sciences, Mumbai, The estimated cost for each AIIMS-like institution is was established in 1956 as the Demographic Training and Rs.823 Crore. For upgradation of medical college Research Centre. The Institute is a “Deemed University” institution, Central Government will contribute Rs.125 functioning under the administrative control of the Crore each. Ministry of Health and Family Welfare, to impart training, conduct research and provide consultancy services in the Status field of Population Studies. The Institute has six (a) AIIMS-like institutions departments viz. Department of Mathematical Demography and Statistics, Department of Fertility Government of West Bengal has identified land at Raiganj, Studies, Department of Public Health and Mortality Uttar Dinajpur District for the proposed institution in the Studies, Department of Migration and Urban Studies, State. Central team visited the site on 12.10.2010 to Department of Population Policies and Programmes, and ascertain suitability of the land and submitted an inspection Department of Development Studies. In addition, report. Department of Extra Mural Studies is functioning since State Government of Uttar Pradesh has been requested August 1993 on yearly project basis. Apart from the to identify land at Lalganj, Raebareli District for the Director & Senior Professor, the faculty consists of 33 proposed institution in the State of UP. Communication members, who are engaged in both teaching and research. from the State Government is yet to be received in the 15.43.2.Training: matter. During the year 2009-10, the Institute offered the following (b) Up- gradation of six medical college institutions 5 four regular courses:- (a) Diploma in Health Promotion institutions involve both civil work and procurement Education (DHPE), (b) Post Graduate Diploma in of equipments except Nagpur Medical College Community Healthcare (PGDCH), (c) Master of which involves procurement of equipments only. Population Studies (MPS), and (d) Master of Philosophy Concept plans/Detailed Project Reports (DPR-I) in Population Studies (M.Phil.). The courses (a) and (c) for Government Medical College, Nagpur and are of one year duration, the course (b) is of fifteen months Government Medical College, Amritsar were approved duration, and the course (d) is of eighteen months duration. by Project Management Committee (PMC) of PMSSY Apart from the above regular courses, the Institute also on 6.8.2009. Rs. 40 Crore has been released to Nagpur offers Master of Population Studies (MPS) and Diploma in Population Studies (DPS) through correspondence. Annual Report 2010-11 289 During 2009-2010, 23 students qualified for award of Diploma study tour was undertaken from 21st March to 1st April in Health Promotion Education, 19 students qualified for 2010.This tour provided an opportunity to the students to award of degree in Master of Population Studies (MPS), 13 have direct interaction and exposure to two premier social students qualified for the award of M.Phil degree, 20 students science research institutions Insitute for Social and had qualified for the award of Ph.D degree, 6 students Economic Changes (ISEC), Bangalore and Center for qualified for the award of the degree of DPS (Distance Development Studies, Thiruvananthapuram, two Learning) and 18 students had qualified for the award of the Population Research Centers, one social action Institute, degree of MPS (Distance Learning). Indian Social Institute (ISI), Demography department in Short-term training/instructional courses Kerala University and three NGOs working in the areas of health, HIV prevention, tribal welfare and social The following seven short-term training programmes were development. organized at the institute during the year 2009-2010. These short-term training programmes are conducted either at Apart from this, the students were given an opportunity the request of funding institutions or as part of resource to actively participate in the National Conference on mobilisation academic activities: ‘Demographic Dividend and Fertility Transitions’ held at Chennai, which had many scientific sessions and (i) One month training on ‘Demography, Gender and deliberations on demographic issues. Besides participating Reproductive Health’ was conducted for 15 in this conference, the students had interaction with a students from Nordic countries, from 12 July to 8 large number of demographers and social scientists who August 2009 at the request of Nordic center. attended the national conference. (ii) Training on ‘Demographic Techniques and 15.43.4. Research Consultancy Services: Application of Software Packages’ was conducted during 7-25 December, 2009. Of the four The Institute had completed 6 Research Projects during 2009- participants, three were from Myanmar and one 2010. There are 13 on-going research projects funded by from Malawi. the Institute which are at different stages of completion. Also, 3 new research projects are being taken up during the (iii) Training on ‘Application of SPSS for Data Analysis’ year 2009-2010. There are 6 on-going research project was conducted during 14-18 December, 2009 for funded by external agencies, and 4 new projects have been eight participants. undertaken funded by external agencies. During the year (iv) A ‘Refresher Course on Demography’ was the Institute provided consultancy services to various conducted for fifteen Senior level ISS officers during institutions in India in the field of Population. 4-8 January 2010. 15.43.6. Publications (v) A ‘Training Programme on Large Scale Sample The Institute brings out quarterly Newsletter, which publishes Survey (LSSS) in Demographic and Health information about various ongoing activities of the Institute. Research’ was conducted during 18-29 January, During the year 2009-10, the Institute published two issues 2010 for eight participants. covering four numbers of IIPS News- Letter. In addition (vi) Training on ‘Application of SPSS for Data Analysis’ Publication Unit brings out research briefs and working paper was conducted during 22-26 February, 2010 for series based on different research projects completed by twenty participants. the Institute as part of dissemination of IIPS research findings. (vii) Training on ‘Application of Qualitative Methods of 15.43.7. Library Data Collection in Population Research’ was The Institute maintains an excellent library with most conducted from 22 March to 2 April, 2010 for recent books on population and related topics. There are twelve participants. 78,855 books, 13,794 bound volumes of periodicals, 16,157 15.43.3. Study Tour: reprints and 170 CD’s in the library. The library receives about 325 Indian as well as foreign journals, out of which Every year as a part of the academic programme, all the 175 are received by way of subscription and another 150 students of Master of Population Studies are taken for a are received by gift/exchange. More than 20,000 journal study tour to different parts of the country. This year’s

290 Annual Report 2010-11 articles have been indexed and added in the library The computer center has a 2 Mbps Leased Line connection operation software. The library has books on different which is distributed among the different users through Local disciplines such as Demography, Statistics, Public Health, Area Network. Another 2 Mbps backup line to provide Family Planning, Anthropology, Mathematics, Economics, wireless internet facilities is being established. To secure the Sociology, Psychology, Health Education, Political internet access Fortigate Firewall is installed in the computer Science, Geography, Computer Programming, etc. centre. There are a total 260 desktop computers in the published by the Union Government, State Governments, institute and the computer center looks after providing the Corporate Bodies, International Agencies and Commercial services like installation of software, configuration for the Publishers of India as well as abroad. The library provides internet and local mail access and giving the technical support abstracts and current awareness services, documentation, as and when required. reference, inter-library loan and Xeroxing facilities. The library has a special collection of all the census publications Recently a second classroom has been established in of India and other countries, indexed journals/edited computer center with 14 computers to meet the books’ articles which are made available through OPAC. requirement to run the Short Term courses and regular The Institute’s library provides bibliographic and reference classes simultaneously. This second class room can also services to other libraries, organizations and researchers be used by students and research scholars for their and also fulfils information requests from libraries outside research data entry and analysis. India. 15.43.9.Data Centre The library is fully automated with the help of SLIM-21 The Data Center of the institute acquired the data set of software which offers Online Public Access Catalogue Census of 1991 and 2001, National Family Health Survey (OPAC) through a network of computers. The databases 1, 2 and 3, DLHS (RCH) 1, 2 and 3, Demographic Health offered in the library are POPLINE, JSTOR, Survey (DHS) and National Sample Survey (NSS) data INDIASTAT.COM, SCIENCE DIRECT (Social on CD-ROM media, which are available to the Sciences) and SCOPUS. Digital conversion of Census researchers. An E-book in the CD-ROM media of India 1881-1941, 1991-2001 is special collection and containing the full papers of DPS/MPS/M.Phill students’ made available in the library. All these databases are seminar has been prepared and six e-books on topic accessible through all the computers on the campus. related to the reproductive health, child and maternal Metadata access work is in progress. Mapping module mortality are also prepared. Data sets from National Family has been introduced and integrated with OPAC to provide Health Survey and DLHS are provided to researchers easy library access. Each title of the online database has who request them. weblinked with OPAC too. To promote the National Language Hindi, a bibliographical database has been made At present, the users are directly accessing resources available in Devnagiri script, and is accessible through such as Demographic data sets and databases, which OPAC. are stored on the server. Further, server based software like GIS and OPAC (Library Information) can be 15.43.8. Computer Centre accessed through campus network including the internet. The Computer Centre of the institute is well equipped The users can also access Bibliographic Data Bases such with the latest computers and statistical software required as Popline, Jstor, Science Direct, Scopus, etc. for data analysis. The computer center is having one main The Institute has a website :http://www.iipsindia.org classroom/lab room with 37 Pentium – IV and higher having a storage capacity of 10 GB which has recently generation computers. The software packages installed been upgraded and redesigned. Information regarding on these computers are SPSS, STATA, Spectrum, Mortpac the institute as per UGC norms is being updated regularly and GIS and are used by the research scholars and on the website and is in the process of being uploaded in students for analyzing their data. Of the 37 computers, Hindi. Efforts are also on to make the website interactive. 12 computers are configured for internet access. The computer center has a network attached storage ( Nasstor 15.43.14. Notable achievements of the institute: ) server which stores the data from Census, NFHS, RCH I. District level household project under etc. and one email server for providing the internal email Reproductive and Child Health (RCH) project facility to the institute. & Facility survey-3, India

Annual Report 2010-11 291 Introduction: Health Centres (CHCs) and District Hospital (DH) were The District Level Household and Facility Survey (DLHS) covered. Further, all Sub-centres (SC) and Primary Health was initiated in 2007 with a view to assess the utilization Centres (PHC) which were expected to serve the of services provided by government health care facilities population of the selected PSU were also covered. There and people’s perception about the quality of services. The were separate questionnaires for SC, PHC, CHC and DLHS-3 is the third in the series of district surveys, DH. They broadly include questions on infrastructure, preceded by DLHS-1 in 1998-99 and DLHS-2 in human resources, supply of drugs & instruments, and 2002-04. performance. The sample size among the districts in the country varies DLHS-3 covered about seven lakh sample households according to their performance in terms of Ante-Natal from 612 districts of the country. Care (ANC), institutional delivery, immunization, etc. and Progress:- it was fixed based on information related to such indicators from DLHS-2. For low performing districts, 1500 The progress of DLHS-3 is listed below:- Households (HHs), for medium performing districts, 1200 i) The data collection work for 601 districts of 34 HHs and for good performing districts, 1000 HHs were States & Union territories in DLHS-3 have already fixed as sample size. completed in 2008. The survey used two-stage stratified random sampling in ii) State Fact Sheets of all 34 States of DLHS-3 have rural and three-stage stratified sampling in urban areas been printed & dispatched to the concerned of each district. The information from 2001 Census was officials as well as to Ministry. used as sampling frame for selecting primary sampling units (PSUs). In rural areas, all the villages in the district iii) District Facts Sheets of 599 districts of 34 States were stratified into different strata based on population / of DLHS-3 have been printed & dispatched to the HH size, percentage of SC/ ST population, female literacy concerned officials as well as to Ministry. The (7+), etc. The required number of villages from each printing work of remaining 2 districts of Andaman strata were selected with probability proportional to size & Nicobar Island is under progress. (PPS). In selected primary sampling units (villages), iv) Reports containing fact sheet of India & 34 States household listing was done and required numbers of and Union Territories have been printed. households were selected using systematic random sampling. v) DLHS-3 data are ready for use. For larger villages (more than 300 HHs) segmentation vi) All key indicators of district, state and national level was carried out. In case of 300 to 600 HHs, two segments are ready. of equal size were made and one was selected using PPS. vii) State Level Report of Punjab, Haryana, Andhra For PSUs having more than 600 HHs, segments of 150 Pradesh, Madhya Pradesh, Jharkhand, Chhattisgarh HHs were created depending on the size and then two have been printed. State Level Report of Bihar, segments were selected using PPS. Uttarakhand and Jammu & Kashmir are in the press In case of urban areas, numbers of wards were selected for printing. using PPS at first stage. In a selected ward, one viii) One national seminar on preliminary results of enumeration block from 2001 census was selected again DLHS-3 had been conducted on 8th December using PPS. Procedure for segmentation, household 2008 at New Delhi. One State Level Dissemination selection, etc., was same as in the case of rural PSUs. Workshop for Andhra Pradesh of DLHS-3 had The uniform bilingual questionnaires, both in English and been conducted on 4th November 2009 at Tirupati in local language, were used in DLHS-3 viz., Household, during IASP Conference. One more State Level Ever Married Women (age 15-49), Unmarried Women Dissemination Workshop for Punjab & Chandigarh (age 15-24), Village and Health facility questionnaires. of DLHS-3 had been conducted on 27th November 2009 at Chandigarh. The DLHS-3 dissemination For the first time, population-linked facility survey has for remaining states will be conduct after printing been conducted in DLHS-3. In a district, all Community of State Reports respectively. 292 Annual Report 2010-11 Expected date of completion: - State wise compendium project is sponsored by the Ministry of Health and Family will be completed before 31st March 2011. The draft Welfare, Government of India and WHO SEARO, New National Report, hard copies of 6 State Reports (Punjab, Delhi with technical support from CDC, Atlanta, U.S.A Haryana, Andhra Pradesh, Madhya Pradesh, Jharkhand, and Research Triangle Institute (RTI), North Carolina. Chhattisgarh) sent to Ministry. The State Report of remaining states will be ready by March 2011. Under the overall umbrella of the GATS project mentioned above, the main aim of the GATS-India is to carry out an II. Youth in India: situation and needs study Adult Tobacco Survey in India at regional levels which include all the 29 states and union territories of Chandigarh The Institute is collaboration with the Population Council and Puducherry covering about 99.92 percent of the total has undertaken a pioneering research to document young population according to the 2001 Census of India. The people’s transition to adulthood in six states namely major objectives of the survey are to obtain sufficiently Maharashtra, Andhra Pradesh, Tamil Nadu, Rajasthan, reliable estimates of prevalence of tobacco use (smoking Jharkhand and Bihar. Both qualitative and quantitative and smokeless tobacco as well), exposure to secondhand approaches are used covering behaviors and experiences smoke, cessation etc., for both males and females at the ranging from schooling to marriage and sexual behavior. national level and for each of the six regions classified by Gender role attitudes and relations with parents will also place of residence of the respondents (urban/rural). be studied. The MacArthur and Packard Foundations provide the funding for this project. The specific objectives of GATS-India are as follows: Publication and dissemination of fact Sheet: The key • Provide estimates of the levels of tobacco use, and indicators of the study are being prepared in a fact sheet for smoking, second hand exposure, and cessation the states. The fact sheets for all six states have been printed attempts among men and women separately for and disseminated. Some of the findings have been widely urban and rural areas of India, a country as a whole. disseminated in various news papers and television programs. • Provide estimates of the levels of tobacco use, and Dissemination Seminars of Youth in India: Situation smoking, second hand exposure, cessation attempts and Needs Study among men and women in each geographical region for urban and rural areas. The Youth in India: Situation and Needs study is a sub- nationally representative study undertaken for the first • Provide estimates of the levels of tobacco use, and time in India to understand the key transitions experienced smoking, second hand exposure, cessation attempts by young people in six states of India. With the funding among men and women for all 29 States and two of Packard and MacArthur Foundation, IIPS & Population Union Territories. Council conducted this study. The findings of this study for India and the states of Jharkhand, Tamil Nadu, Bihar, • Provide estimates of the levels of tobacco use, and Rajasthan and Andhra Pradesh were released during the smoking, second hand exposure, cessation attempts dissemination seminars held in their respective states. among men and women by selected background characteristics at national, and regional level IV. Global Adult Tobacco Survey (GATS) Like other large scale surveys conducted in India, entire The main aim of the Global Adult Tobacco Survey (GATS) country has been grouped in the following 16 groups. is to establish systematic surveys to monitor adult tobacco Each group will be assigned to one Research Agency for use and to evaluate progress in implementing tobacco conducting fieldwork. In addition, keeping in view the control interventions under the Bloomberg Global Initiative weather condition prevailing during the data collection to reduce tobacco use. Since there is no standard global (October 2008 to February 2009), fieldwork has been adult tobacco survey that consistently tracks prevalence phased out. Around 17 States/UTs will be included in first of tobacco use (smoking and smokeless as well), phase and around 16 States/UTs to be covered in second exposure to secondhand smoke, cessation, risk Phase. It may be mentioned that Uttar Pradesh and perceptions, knowledge and attitudes, exposure to media Assam which a sample size of around 5000 in each state and price and taxation issues, which are critical measures will be covered in two phases, an identified portion in for tobacco control program and policy development. The each phase.

Annual Report 2010-11 293 The total target sample size at national level is 70,802, IIPS ENVIS Website (http://www.iipsenvis.nic.in) including 42,647 in rural areas and 28,155 in urban areas. With the assumption of target sample size of average 30 o The Website contains Newsletters and archives completed interviews per Primary Sampling Unit (PSU), back issues from 2004, along with Database, GATS-India will cover 2,366 PSUs nationwide (1,423 rural Publications of the Centre, Picture Gallery, Query and 943 urban). It has been decided that this survey would Form, Web Links etc. be conducted on digital formats through HP iPAQs I. Longitudinal Ageing Study in India (LASI ñ handheld devices. It has been considered by the Pilot) Project Government and agreed that though handheld devices are being used for the first time on large scale surveys in The International Institute for Population Sciences, India, it would have several advantages. Mumbai and the Harvard School of Public Health are undertaking a collaborative study entitled, ‘Longitudinal Data collection work for GATS-India is already completed Ageing Study in India (LASI).The short-term goal of in all the 31 States/UTS. The National fact sheet and LASI is to carry out a pilot survey to assess the health national report and dissemination already completed. and wellbeing of the elderly population in Karnataka, Five zonal dissemination to be completed before March Kerala, Punjab and Rajasthan in India. The timeline for 31, 2011. pilot survey is October 2008-December 2010. A full-scale V. ENVIS Centre on Population and nationally representative LASI is envisioned with the first Environment wave starting from 2011. The full-scale LASI is expected to cover a national sample of 30,000 elderly The Ministry of Environment and Forests, Government persons in age45+ and to follow them every two years of India under the Environmental Information System for up to 25 years. No thorough study of this type (ENVIS) Centre on population and Environment at IIPS. has ever been carried out in India. The centre collects, collates and disseminates data on various aspects of population and environment relationship LASI is modelled on similar surveys carried out in china, such as population growth and land use, urbanisation and Korea, several European countries and the United States. air pollution, household environment and morbidity and These Health and Retirement Studies (HRSs) provide mortality etc. The centre maintains a website http:// longitudinal data for researchers, policy analysts and www.iipsenvis.nic.in connected to NIC server. It also program planners making policy decisions related to labor brings out a quarterly bulletin on population and supply and savings behavior, the disease burden and environment. The centre is in existence since 2004. demand for health and utilization and social and economic Apart from regular activities of web based dissemination well-being of the elderly and their families. and publishing of bulletins, the centre has published a The HRSs are collectively designed to facilitate direct book on Population and Environment Linkages and an e- and close comparisons of the health and the retirement book containing extensive abstracts for about 500 behavior of relatively old populations in different research articles in the areas of population and countries. With the percentage of individuals over the environment. age of 50 in India projected to grow at a 2.7% compound ENVIS Publications annual growth rate over the next 45 years, an understanding of health, retirement and population aging o ENVIS Newsletter is a matter of critical policy importance. ENVIS newsletter is being published regularly on quarterly The sampling plan and survey instrument are currently basis since 2004 which provides information on population being developed. LASI-pilot fieldwork is expected to be and environment related issues. undertaken during March-April, 2010. o Books/ Bibliography LASI-pilot is funded by the National Institute on Aging of the United States National Institutes of Health and The ENVIS Centre has published a book and compiled a National Institute of Ageing (NIA) of the national Institute bibliography of research articles in the areas on Population of Health, USA. and Environment.

294 Annual Report 2010-11 VII. Study of global Ageing and Adult (SAGE) - responsible for the in-service training in the key health India 2007 areas for different categories of health personnel all over the country. Training related to Primary Health Care, The International Institute for Population Sciences, Mumbai in collaboration with the World Health Family Welfare, R.C.H., HIV/AIDS and other integrated organization, Geneva is undertaking the Study on Global National Health Programmes are imparted to various Ageing and Adult Health (SAGE), 2007 in India. SAGE categories of health professionals of state and district is part of global longitudinal study implemented in six levels, i.e. DHOs, DEMOs, Key-trainers etc. from countries – China, India, Ghana, Mexico, Russia and Health & F.W. Training Centres. Centre is also South Africa. In India, SAGE is being conducted in six conducting a one year academic Post-graduate Diploma states – Assam, Karnataka, Maharashtra, Rajasthan, in Health Education (Renamed as Diploma in Health Uttar Pradesh and West Bengal. SAGE will cover a Promotion Education) for the candidates deputed from sample of 10600 households across the six states. all-over-the country and also for candidates sponsored SAGE will follow-up the same PSUs and the sample by WHO/UNICEF/UNDP/DANIDA etc. The first households covered across these six states in the World course of D.H.P.E. was started in the year 1987-88. At Health Survey (WHS), India, 2003. SAGE is expected present the 24th course is in progress, with 23 trainees. to run for up to 10 years with follow-up waves for every two years. 15.44.2. With the launch of Government of India’s National Rural Health Mission and the present health The primary objective of SAGE is to assess health and care services, FWTRC Mumbai is also conducting a well-being of the elderly persons in age 50 and above Post-graduate Diploma in Community Health Care, for and their social determinants. SAGE aims to gather the para-medicals working in family welfare in Health evidence base on socioeconomic background, health state description, burden of disease, health care utilization, Departments, NGOs and Private Sectors to improve quality of life and well-being. Besides these self-reported their efficiency to cope up with the work under the information based on interview, SAGE adopt improved NRHM for better delivery of health care services. The health measurement techniques by using a range of first course of this has been started at F.W.T. & R.C., biomarkers-blood pressure, lung-function, vision, grip Mumbai from October 2007. The duration of the course strength, time walk, a battery of cognitive tests, is 15 months. The third batch of P.G. D.C.H.C. is in anthropometry and blood test for anaemia, diabetes, heart progress. At present a total of 8 trainees are undergoing disease, and hepatitis-B. the above course. SAGE Field work and data entry have been completed 15.44.3. Apart from training, Centre is also involved in during 2007-08. Currently, data processing is underway Community-based Research work in the field of Health and the report for first wave is expected to be completed & F.W., Population, AIDS etc. in rural as well as in the by June 2011. urban areas. Institute is also conducting training Funding for SAGE is being provided by the World Health programmes, workshops and seminars in the key health Organization, Geneva and USAID, New Delhi. areas like RCH, HIV/AIDS, Population, Immunization and Communication for the medical and para-medical VIII Concurrent evaluation of NRHM personnel from the Governmental and Non-governmental Results were disseminated/presented to Ministry of Organizations, including Fellows sponsored by Health & Family Welfare chaired by Secretary, MOHFW international organizations like UNFPA/UNDP, WHO etc. on 25th October 2010. 15.44.4.Looking towards the future developments of the 15.44. FAMILY WELFARE TRAINING & Institute and organizing more and more training RESEARCH CENTRE (FWTRC), programmes for medical and para-medical personnel to MUMBAI. deliver better health care services, it has been proposed to shift this Institute to a new Institutional premises at 15.44.1 Family Welfare Training & Research Centre New Panvel, Navi Mumbai. With this view, a piece of (F.W.T. & R.C.), Mumbai, is a Central Training Institute, land admeasuring 5000 Sq.Mtrs. for the construction of

Annual Report 2010-11 295 office premises, with training infrastructure including Warangal, Kadappa, West Godawari, Karnool and hostel has been purchased to shift the activities of the Shrikakulam in Andhra Pradesh as part of Field Training. Institute to a new premises. Apart from this, land of area 1700 sq.mtrs. has also been purchased for residential Seminars/Workshops purpose, near the Institutional complex at Navi Mumbai. An Audio-visual Workshop was organized during Jan. The Institute is having the vision to develop it as one of 2011, at the Institute for the DHPE and PGCHC students the leading Central Training Institutes (CTIs) for training, for preparation of Audio-visual material in collaboration operational research and policy decision for the medical with J.J. School of Architecture, Mumbai, so that the and para-medical personnel to meet the goal under the specialized input of artistic Communication could be National Health Policy, National Rural Health Mission integrated to enhance the impact of health Education and RCH. The construction of the new Institutional material. Trainees prepared the audio-visuals and later premises of FWTRC, Mumbai at New Panvel, Navi on they used the same for organizing the health exhibition Mumbai is progressing well and likely to be completed. in the FPDA. 15.44.5.During the year 2010-2011, training, education, 15.44.6. Education: research and clinic services of the institute were continued and expanded in accordance with its objectives. The Diploma in health promotion education: activities of the Centre for the year 2010-11 are as Centre is conducting its 24th course of Diploma in follows:- Health Promotion Education Course, which is a one Contact Classes:- academic year Post-graduate Diploma course, with a total strength of 23 students from Maharashtra and Andhra Centre has been identified by NIHFW, New Delhi for Pradesh and Madhya Pradesh. The 1st Semester conducting two (2) Contact classes for the students of Examination is conducted in the month of Nov.-Dec. the Post-graduate “Certificate Course in Health & F.W. 2010. The observational tour to Delhi is being scheduled Management” and “Hospital Management” through for this month. A work-shop on preparation of Audio- distance learning (conducted by NIHFW, New Delhi). visual Aids was organized at the Centre. The trainees During the year Contact Classes programme on “Hospital have already started their assigned concurrent field work Management” from 29-11-10 to 3-12-10, for 28 in the field area, i.e. Kendriya Vidyalaya, Antop Hill. A participants has been conducted by FWTRC. health exhibition and medical camp was also organized th th W.H.O. Fellowship Programmes:- at Kendriya Vidyalaya on 24 and 25 Jan. 2010. All the trainees were actively involved in the above activity. Centre has been identified by WHO and Ministry of Health & F.W., New Delhi, as a Collaborative Institute The Second Semester examination will be conducted in for conducting training programmes for international March 2011. Later on the students will be posted/placed Students under the WHO Fellowship programme. for Supervisory Field Training (SFT) in their respective states. Research/Evaluation Activities:- Post Graduate Diploma in Community Health Care: The regular Evaluation activities and research work has been continued during the year 2010-11. During the With the launch of Government of India’s National Rural year under report, routine activities were conducted at Health Mission and the present health care services, the FPDA area, i.e. Khumbarwada area, which is half FWTRC Mumbai started a Post-graduate Diploma in Km. away from the Centre, by the DHPE as well as Community Health Care, for the para-medicals working PGCHC trainees. The students undergoing the formal in family welfare in Health Departments, NGOs and training courses of the Institute regularly visit F.P.D.A. Private Sectors to improve their efficiency to cope up area for training purposes and health educational with the work under the NRHM for better delivery of activities/concurrent field work activities.The students health care services. The first course of this has been also conducted field activities in their respective districts, started at FWTRC, Mumbai from October 2007. The namely Satara, Aurangabad ,Latur, Beed, Barshi, Solapur duration of the course is 15 months, which includes 3 rd and Thane in Maharashtra and East Godawari, Nellore, months field placement. At present the 3 course is going

296 Annual Report 2010-11 on with a total of 8 trainees. All the trainees were actively 15.45.2. Educational Activities involved in the health exhibition and medical camp was Teaching Activities: organized at Kendriya Vidyalaya on 24th and 25th Jan. 2010. The educational activities of the Institute are planned to impart basic education and promote academic excellence I.E.C. Training/Programmes in The Community: in the areas having a bearing on the health and family Organized audio-visual aids workshop for D.P.H.E .and welfare programmes in the country. PGCHC trainees, wherein trainees prepared projected M.D. (Community Health Administration) and non-projected aids and utilized them during their field placement; Organized Health Exhibitions and Health NIHFW conducts a three year Post-graduate Degree Education meetings in urban slums of Mumbai for creating Course in Community Health Administration. This course awareness amongst people, on various topics related to is recognised by MCI and affiliated to University of Delhi. health and Family Welfare, HIV/AIDS, R.C.H. etc; Sixteen students are undergoing the M.D. (CHA) course Organized Health Camp at Kendriya Vidyalaya, Antop during the year 2010-2011. Six (6) students are in final Hill for the school children on 24th & 25th Jan. 2011. year; three (3) in second year and seven (7) in the first year. Clinical and Laboratory Services: Diploma in Health Administration (DHA) Service delivery to mothers and children continued at the Centre during the year 2010-2011, through its Clinic and NIHFW conducts two years Post Graduate Diploma in Laboratory. Medical and Health Care services were Health Administration and this course is recognised by delivered to the patients attended the Clinic during the MCI and affiliated to University of Delhi. Seven (7) year. Along with MCH services, counseling in Family students are undergoing the DHA course during the year Welfare is also done by this institute. Apart from this, 2010-2011. Two (2) students are in first year and five Centre is also running an Immunization Centre/Clinic (5) in the final year. (once in a week) for the infants/children and a daily Post Graduate Diploma in Public Health Dispensary/OPD for the community. The institute has a Management (PGDPHM) patient attendance of approximately around 100/per month including immunization beneficiaries. This course, in collaboration with Public Health Foundation of India and supported by MoHFW under NRHM is being 15.44.7. Research: run by nine reputed Institutions in the country. The said The Officers participated in the discussions of the course started in the year 2008, with the objective to Consultative Group of I.I.P.S. to Finalize around 10 enhance the capacity of Public Health managerial Research Projects and also reviewed the progressive workforce through conduct of a specially designed course. projects. Total 30 seats are allotted to NIHFW. In the year 2010- 2011, which started from 2nd August 2010, 29 students 15.44.8. Out-Reach Activities: are enrolled, out of which 9 students are international A Medical Check-up Camp in collaboration with the, students facilitated by Partners in Population Development CGHS, was conducted Mumbai for approximately 2500 (PPD). The International students are from Bangladesh children comprising of Medical Officers from FWTRC, (2), China (2), Gambia (1), Nigeria (1), Thailand (1), CGHS and other Hospitals. Tunisia (1), and Vietnam (1). The course fee of this programme is Rs.2.50 lakh per candidate and is met from 15.45. NATIONAL INSTITUTE OF HEALTH NRHM funds of the respective State Governments. AND FAMILY WELFARE (NIHFW), NEW Students from Uttar Pradesh, Uttarakhand, Rajasthan, DELHI Jammu & Kashmir and Haryana are also attending this The National Institute of Health and Family Welfare course. (NIHFW) is an autonomous, apex technical institute under Distance Learning Courses Ministry of Health and Family Welfare, Government of India working for the promotion of Public Health in the One year Certificate Course in ‘Health and Family country. Welfare Management’ through distance learning. In the

Annual Report 2010-11 297 year 2010-2011, 181 students have been enrolled for the and a cumulative total of 1671 officers have been trained course. from various states. One year Certificate Course in Hospital Management Immunization Training through distance learning. In the year 2010-2011, 403 students have been enrolled for the course. NIHFW has been designated as the apex nodal agency for Immunization Training for Medical Officers, Vaccine One year Certificate Course in Health Promotion. This and Cold Chain Handlers and for states conducting is the new course in Distance Learning mode started with Measles SIA catch-up rounds. the approval of Directorate General of Health Services, Govt. of India. 235 students have already been enrolled • Immunization Training for Medical Officers for the course. A graduate in any discipline can be In 2010-11, 27 trainers from 4 states were trained. enrolled in this course. NIHFW is also tracking the progress of immunization st Ph.D. Programme training of Medical Officers in the states. As on 1 November 2010, 16665 (27.5%) of Medical Officers have Under the Ph.D. programme, 8 students are pursuing their been trained across the country. Doctoral work from different Universities. The Institute has became the approved Research Centre affiliated with • Training of Vaccine and Cold Chain Handlers Chhatrapati Shahuji Maharaj Medical University, During June 2010, two national trainings (one for State Lucknow, U.P. and 7 students are pursuing their Doctoral Immunization Officers and one for regional master work. 15 students are pursuing their Doctorate in various trainers) were conducted by NIHFW. Following this, disciplines like - Social Sciences, Demography, Public two regional level TOTs for training teams from 6 states Health and Reproductive Biomedicine. have been conducted. During 2010, 105 national and Summer Training: state trainers have been trained for further trainings in the regions and states. A total of 14 students from different Universities of the Country completed Summer Training Course. Four • Measles SIA Trainers students from National Institute of Epidemiology, Chennai, NIHFW has conducted a National Measles SIA TOT in have also joined recently. August 2010 to train 44 master trainers. During August 15.45.3. Training Activities and Workshops and September, 2010, 284 district trainers were further trained directly by NIHFW through 9 states/regional level NIHFW conducts various short term training courses, TOTs for 13 states conducting Measles SIA catch up ranging from one to ten weeks duration.From April 2010 rounds. till 20th November, 70 training courses were held and 3383 participants were trained. • Training on Stress and Conflict Management for Health Professionals. Professional Development Course (PDC) in Management, Public Health and Health Sector • Sensitivity Training of the Health Professionals Reforms for District Medical Officers posted at the Common Wealth Games. It was started with the objective of training middle level Foundation Courses for Basic Emergency Medical medical officers with 12-16 years of service, to be able Obstetrics Care (BEmOC) in Collaboration with the to function effectively for service delivery. This integrated Government of India, Liverpool School of Tropical training incorporates management, public health and Medicine (LSTM) and the Royal College of Obstetricians ongoing reforms in the country including NRHM in a ten and Gynaecologists, UK”. This training package named weeks programme. The course has been evaluated Prasuta is initially being piloted in seven states. In two twice. The course was started by NIHFW (Nodal rounds of training, 390 doctors and staff nurses have been Institute) in 2001 and has been rolled out to 17 CTIs of trained along with 46 Master trainers. which three are in the private sector - IIHMR, Jaipur, Uttarakhand BPMU training - On the request of IISW&BM, Kolkata & AMCHSS Trivandrum, Kerala. government of Uttarakhand, NIHFW had taken up the During the year 2010-11 (till 15th Nov, 10), a total of 118 responsibility of training of Block Public Health managers

298 Annual Report 2010-11 in Uttarakhand. Six courses of two days were organised attended and total of 132 papers were presented in 15 at Almora, Dehradun, Pauri and Nainital for the BPHMs scientific sessions along with 7 invited talks. and Block level Accountants. A total of 198 participants Research Studies were trained. The Rapid Appraisal of Health Interventions The first course in Asia on Managing Programme to (RAHI-III) Improve Child Health was organized at NIHFW by the faculty from WHO Headquarter, Geneva. Data Analysis The Rapid Appraisal of Health Interventions, a Using SPSS for Health and Demographic Research. collaborative activity with the United Nations Population Fund (UNFPA), has been a unique initiative taken under Training for Health Care Providers of Uttar Pradesh the wider umbrella of the Public Health Education and On request of Uttar Pradesh Govt., NIHFW conducted Research Consortium (PHERC) of NIHFW. The first the following training courses for their health care phase with 12 health system research projects on various providers: components of NRHM in five low-performing states and second phase, RAHI-2, again, 12 health system research “Enhancing Capacity of District Project Officer (DPOs) projects on various components of NRHM in 6 low- of Uttar Pradesh under NRHM” - thirty three (33) performing states were completed and published. participants attended the training. During the training, a field visit was conducted at Udaipur, Rajasthan, to give The third phase of RAHI has three research projects the participants first hand information regarding the cleared by the Institutional Review Board. The research District Health System, Basic Laparoscopic Skill Training projects are mainly for the EAG states and are funded (BLSP) – 12 Medical Officers posted at various District by NIHFW. Hospitals were trained on Basic Laparoscopic Skill Ongoing Training at Surgery Department of AIIMS, New Delhi, Advance Life Support Training – 32 Doctors and 31 Staff • “WHO-CONRAD funded multi-country, Nurses of Uttar Pradesh were trained in three days on multicentric project on Sperm suppression and Advance Life Support at Trauma Centre of AIIMS, New contraceptive protection provided by norethisterone Delhi, Training Courses on Hospital Administration for enantate (Net-en) combined with testosterone Chief Medical Superintendents (CMS) Working in undecanoate (TU) in healthy men”. The study is in Hospitals under Govt. of Uttar Pradesh. Total 78 CMSs progress. were trained ,Role of NGO’s in National Rural Health Mission. • “A Study on Integration of PPTCT Services with RCH and Other Components of Primary Health 15.45.4. Workshops Care System in States of Andhra Pradesh and Karnataka”. The data collection is completed. Indo-US Workshops in Partnership With ICMR Approved Indo-US workshops were organised in partnership with Indian Council of Medical Research on: • “Evaluation of National Cancer Control Programme”. The study is approved by the Workshop on Maternal & Neonatal Sepsis on 25-26 MoHFW. Oct.,2010, Workshop to develop a social and behavioural research agenda to prevent spread of HIV/STD in India MD-CHA Thesis on 27-28 Oct.,2010, A Grantsmanship and Peer review workshop on 29-30 Oct.,2010. • Six(6) MD-CHA thesis have been completed and three (3) are ongoing studies. 15.45.5. Conferences Health Financing Unit ñ Research study 28th Annual Conference of Indian Society for Medical Statistics (ISMS) This unit was established in the Institute with financial support from WHO in the year 2009. The Institute has The conference was jointly organized by NIHFW and continued this unit with its internal funding. The ICMR National Institute of Medical Statistics (NIMS), New Delhi has sponsored Research Study on Evaluation of Rashtriya during November 11-13, 2010. More than 200 participants

Annual Report 2010-11 299 Suraksha Bima Yojana (RSBY) in Delhi which will be clinic also providing family planning services , MCH conducted by Health Financing Unit. services, conducting adolescents and youth clinic. 15.45.6. National Child Health Resource Centre 15.45.10. NRHM/RCH-II Project (NCHRC) MOHFW has given an approval for extension to National The centre established aims at strengthening the focus Institute of Health & Family Welfare to act as the Nodal on child health and related maternal health, mainstreaming Agency for training under the RCH programme and child health agenda in public health. Ongoing tasks include NRHM till the year 2012. It has been pursuing the analysis of the data collected from the field on Home- responsibility of coordinating and monitoring the training based care of newborns and mothers by ASHAs, activities under both RCH & Diseases Control development of digital gallery of IEC/BCC materials, and Programme, with the help of 18 collaborating training holding national workshop on prioritizing areas of institutions (CTIs) in various parts of the country: operational research in maternal, newborn and child health. RCH Unit 15.45.7. Public Health Education & Research Consortium (PHERC) Network and • Central Training Plan (CTP) Partnership A Central Training Plan has been developed by NIHFW 638 institutions are the members in this consortium which on the six thematic areas - Maternal Health, Child Health, includes 179 Medical Colleges, 173 Nursing Colleges, 51 Family Planning, ARSH, Disease Control and other SIHFWs/CTIs, and 214 NGOs and 21 other institutes/ Programmes based on the state’s PIPs & ROPs. The organizations. CDs along with relevant material has been CTPs has been developed for the purpose of development distributed to them for information sharing. They are of training curriculum, monitoring of trainings and data working in collaboration with NIHFW in studies on health analysis under NRHM and is available on the system research. Twenty four studies had been Website – www.nihfw.org. conducted by the Partner Institutions and three are in • MCH Centres Mapping progress. This is helping in the capacity building of the partner institutions. Consultants from RCH unit, NIHFW participated in mapping of MCH centres in 261 high focuss districts 15.45.8. NIHFW: A Part of Global Development around 22 states of India along with representatives of Learning Network MOHFW & NHSRC. The exercise was undertaken with NIHFW has now become a part of the Global the objective of upgrading & strengthening the identified Development Learning Network (GDLN), initiated by the facilities, to provide maternal and neonatal care services World Bank. The GDLN is a global partnership consisting round the clock to improve maternal and child health status of more than 100 learning centres (GDLN Affiliates) that of the district. The teams did the gap analysis in terms of offer the use of advanced information and communication infrastructure, human Resources, equipments & technologies to the people working in development sectors Instruments and training status of health personnel and around the world. Through videoconferencing, high-speed prepared the plan for additional inputs including budget internet resources, and interactive facilitation and learning for developing these centres as L-1, L-2 and L-3 centres. techniques, GDLN enables their members to hold co- Monitoring Visit ordination, consultation, and training events in a timely • and cost-effective manner. GDLN clients include Ten different checklists have been developed by NIHFW academic institutions offering distance learning courses in consultation with MOHFW for monitoring the health on development issues; development agencies seeking facilities, trainings and identifying the gaps at state, district dialogue with key partners across the globe; and non- and block level. governmental organizations co-ordinating with their partners world-wide. NIHFW’s RCH consultants visited 60 districts in the 9 High Focus States with the aim of monitoring and mid – 15.45.9. Clinical Services course correction. The Institute is providing clinical services on infertility • Navjat Shishu Suraksha Karyakaram (NSSK) management along with adequate laboratory support. The

300 Annual Report 2010-11 NIHFW assisted MOHFW, GoI in developing module articles on research studies conducted all over the country for NSSK training. So far 135 participants have been and it has been abstracted/indexed by national and trained in 4 batches in collaboration with Indian Academy international abstracting agencies. The Journal is indexed/ of Paediatrics (IAP). abstracted by 9 National and International abstracting agencies. The journal is also available on the Institute’s 15.45.11. National Nodal Agency for Specialized web site i.e., www.nihfw.org. The Institute published the Projects quarterly Journal - Indian Journal of Community Medicine Annual Sentinel Surveillance for HIV Infection (IJCM), an official publication of Indian Association of Preventive & Social Medicine, on line with articles on NIHFW is coordinating and supervising the Annual research studies on Public Health and it has been Sentinel Surveillance for HIV Infection in the country in abstracted/indexed with Pubmed. Prof. Deoki Nandan, 2010 through identified Regional Institutes, Central team Director, NIHFW is the Chief Editor of the Journal. members and SACS. NIHFW have been involved in doing Dhaarna the Hindi Publication of the Institute which data triangulation exercise assigned by NACO, for the continues with articles contributed by faculty and staff states of Gujarat and Jharkhand. District wise reports members of the Institute on the issues related to Health were prepared about the vulnerability of HIV for 25 & Family Welfare. Now it will be published half-yearly. Districts and 2 Municipalities of Gujarat. Reports are under preparation for the 25 districts of Jharkhand. 15.45.17. The Transcendence: The quarterly newsletter is informative, educative and useful to the 15.45.13. National Health Information readers. Recently, NIHFW has published quarterly Collaboration Newsletter Vol.XII No.3, July-September, 2010. Also The National Health Information Collaboration (NHIC) available on the Institute’s website i.e. www.nihfw.org. is a National Health Information Repository, designed to 15.45.18. Upgraded Facilities in the Institute serve as a one-point source for authentic and relevant Computer Facilities health information on all health topics. It is targeted to serve health professionals viz. health service providers, The Institute has provided computer access to all its researchers and policy makers. The portal has been faculty, research staff, students and administrative staff. facilitated by WHO which jointly with Indian Council of About 250 Pentium IV Desktops and 50 Laptops are Medical Research is hosted at www.nhicindia.org and is provided to staff of the Institute. The Institute has a being administered by the National Institute of Health computer lab facility. and Family Welfare, New Delhi. 15.45.19. National Documentation Centre 15.45.14. Publications NDC has developed a computerised, well balanced and During the year, the Institute has come up with up-to-date collection of over 60,000 documents; including publications, such as: books, periodicals, technical reports, annual reports, statistical reports, conference proceedings, modules, non- • National Iodine Deficiency Disorders Control book materials i.e. CD-ROM, online databases etc. Programme 15.46. RURAL HEALTH TRAINING CENTRE, • National leprosy Eradication Programme NAJAFGARH, NEW DELHI • National Mental Health Programme Rural Health Training Centre, Najafgarh, New Delhi was set up as a health unit in 1937 and evolved for the next • Modules of Health Promotion Course. 50 years to become a national Scientific institute. The Institute has made efforts for digitization of various Committtee’s Reports in Health Sector and uploaded on The Major Activities of RHTC Najafgarh are as follows: its Website. Training Activities:- 15.45.15. Journals of Institute There are a number of training activities going on RHTC, The Institute like every year published its quarterly journal, Najafgarh i.e. Training to Medical Interns under ROME ‘Health and Population: Perspectives and Issues’, with Scheme. Around 350 unpaid Medical Interns undergone

Annual Report 2010-11 301 rural posting from this Centre. Training to ANM 10+2 15.47. GANDHIGRAM INSTITUTE OF RURAL (Voc.) Students is with intake capacity of 40 students per HEALTH AND FAMILY WELFARE academic session. Community Health Nursing Training TRUST (GIRHFWT) to BSc/MSc/GNM students of various Nursing Institutions Established in 1964 the Health and Family Welfare like College of Nursing, Safdarjung Hospital, RML Training Centre at GIRHFWT is one of 49 such training Hospital, Lady Hardinge Medical College, Holy Family centres in the country. It trains Health and Health related Hospital, Batra Hospital, Apollo Hospital and various other functionaries working in Primary Health Centres, Govt./State Govt./Pvt. Institutions. Nearly 1000 trainees Corporations / Municipalities, Tamil Nadu Integrated were trained during the period, Promotional Training for Nutrition Projects. The type of training programmes Nursing Personnel, Health Education to the PGDHE included – orientation training, refresher training, skill Students & One Day Observation Visit. training on different Health & Family Welfare issues for RHTC Najafgarh has been providing Health Services various categories of health personnel which is affiliated to the low socio-economic group of people of 64 villages to Tamil Nadu Dr. M.G.R Medical University. and 9 town of Najafgarh through it’s three Primary Health 15.48. HINDUSTAN LATEX LTD (HLL) Centre and 16 Sub-Centre including 24x7 Emergency Services in PHC Najafgarh. Introduction It conducts field studies aspects of Health & Family HLL Lifecare Ltd. (formerly Hindustan Latex Ltd.) is a Mini Ratna (Category I-PSE) Schedule B enterprise under Welfare, RCH, Nutrition, Health Education and the Ministry of Health and Family Welfare Government Communicable Diseases and also provides field services of India, operating in the area of Contraceptives, Hospital for research work to the various health institutions, i.e. products and Healthcare services. NIHAI, AIIMS in public health. Capital Structure There are a number of additional programme under NRHM implemented by RHTC, Najafgarh. RHTC The issued and paid-up share capital of the Company Najafgarh has implemented the NRHM in its three PHCs was Rs. 15.53 Crore as on 31st March 2010. The reserves and 16 sub-centres in collaboration with CDMO and surplus of the Company as on that date was (South-West), Govt. of NCT Delhi. The following Rs. 124.71 Crore and the capital employed Rs. 221.08 programmes had organized/conducted in RHTC Crore. Najafgarh. Marketing and Exports Village Health Nutrition Days were organized in different Revenue from direct marketing (excluding Govt. sales) sub-centres under PHC Najafgarh and PHC Ujwa. was Rs.200.68 cr contributing to 45% of the total turnover VHNDs were organized with the help of Anganwari and achieved 22% growth compared to last year. workers at Sub-centre level. Key services provided by RHTC Najafgarh in the VHND: (i) Maternal Health Consumer Business Division: check up, (ii) Check up of Child Health Infant upto 1 Division’s flagship brand ‘MOODS’ is now one of the year, Children aged 1-3 yrs. and all children below 5 yrs. strongest consumer brands in India and contributes to (iii) Family Planning, RTI/STDs, (iv) Sanitation (v) 55% of the total revenue. The consumer business division Communicable Disease (vi) Health Promotion (vii) special also launched ‘Herbs & Berries’ – Chyavanules (granular emphasis on Nutritional Demonstration-Diseases due to chyavanprash) in Kerala and Delhi. malnutrition and its precaution (viii) Hygienic & correct cooking practice (ix) weighing of infants & children and Hicare Division: (x) Importance of nutritional supplement. Nutritious food HCD has achieved sales revenue of Rs. 336.36million of items also demonstrated to the community keeping in view which Blood bag contributed to 67% of the total revenue the above points. So far 21 VHND camps have been .Blood bag achieved a value growth of 27% and unit organised. growth of 11%.Surgical sutures registered revenue of Rs.44.51million. Traded products contributed 64.14 million of total Turnover.

302 Annual Report 2010-11 International Business Division: Joint Venture Company

International Business Division has achieved sales LifeSpring Hospitals Pvt. Ltd. revenue of Rs. 582.86 million contributing 13% of the During year 2009-10, LifeSpring Hospitals Private Limited company’s turnover. – the 50:50 joint venture company formed by HLL and Acumen Fund Inc., USA had set up three more Consultancy Services hospitals, one each at Boduppal (Hyderabad), Bowenpally Procurement Consultancy Services: and Chilkalguda (both in Secunderabad) raising the total number of LifeSpring Hospitals to nine (9). The present HLL is acting as Procurement Consultant in the field of paid up capital of the company is Rs.15.67 Cr held equally medical equipment, analytical & research equipment, between HLL and Acumen Fund Inc. insecticides, larvicides, drugs, vaccines, hospital furniture Hindustan Latex Family Planning Promotion Trust etc. with reputation and satisfaction to our esteemed group (HLFPPT) of clients from the government sector. A not-for profit organisation promoted by HLL, HLLPPT Research & Development has been supporting implementation of reproductive and child health and HIV/AIDS prevention and care The R&D projects are carried out as stand-alone projects programmes in partnership with international development at HLL, or as collaborative projects with institutions of agencies, state governments and MOHFW. repute. HLL R&D is presently engaged in researches that range from novel and path breaking to incremental 15.49. REGIONAL OFFICES progression in nature. Projects are also in progress to There are 19 Regional Offices of Health & Family improve existing product lines such as condoms, blood Welfare functioning under the DGHS. Located in various bags and diagnostic kits. State Capitals and headed by a Regional Director. The essential units of the ROH & FW are: (i) Malaria operation Modernisation of Blood Bag manufacturing unit: The field Research Scheme (MOFRS), (ii) Entomological capacity of blood bag production increased to 11.75 M. Section, (iii) Malaria Section, (iv) Health Information Field Pcs from the present 6 M. Pcs. Unit (HIFW) and (v) Regional Evaluation Team (RET). New projects Roles and Responsibilities of ROH & FW:

• Medipark - an exclusive industrial park for the • Liaison of Centre-State activates in the medical technology sector implementation of National Health Programme. • Cross-Checking of the quality of the Malaria work, • Integrated Vaccine Complex Maintenance of free Malaria Clinic in the Office • Revival of DPT Vaccine manufacturing facility at Premises and review/analysis of the technical Central Research Institute, Kasauli, Himachal reports related to NVBDCP. Pradesh • Checking of the Records in respect of Family Welfare Acceptors and other registers maintained • Sanitary Napkin (SN) Manufacturing Project during the tour and provide feed back related to • HINDLABS -Diagnostic Services Family Welfare Programme activities. • Organizing training for laboratory technicians, • Hindlabs MRI Scan Centres medical and Para-medical Staff as well as other HLL had set up Hindlabs MRI Scan Centre in three categories of staff on Orientation in various Medical College Hospitals at Thrissur, Kottayam and National Health Programmes. Alappuzha in accordance with a MoU inked with • Specified responsibilities are undertaken by Government of Kerala. Regional Evaluation Team (RET), Health Information Field Unit (HIFU) Malaria Operational Field Research Scheme (MOFRS).

Annual Report 2010-11 303

Chapter 16 Facilities For Scheduled Castes And Scheduled Tribes

16.1 INTRODUCTION 8. Assistant Drugs Controller (I) Kolkata The Scheduled Castes and Scheduled Tribes Cell in the 9. Central Drugs Laboratory Kolkata Ministry continued to look after the service-interests of 10. Serologist & Chemical Examiner Kolkata these categories of employees during 2010-2011. The Cell assisted the Liaison Officer in the Ministry to ensure that 11. Central Food Laboratory Kolkata representation from Scheduled Castes/Scheduled Tribe, 12. Central Government Health Scheme Kolkata OBCs and Physically Handicapped Persons in the establishment/services under this Ministry received proper 13. Chittaranjan National Cancer Institute Kolkata consideration. The salient aspects of the scheme of reservation were The Cell circulated various instructions/orders received emphasised to the participating units/offices. Suggestions from the Department of Personnel and Training on the were made to streamline the maintenance and operation subject to the peripheral units of the Ministry for guidance of rosters in these Institutes/Organizations. The defects and necessary compliance. It also collected various types and procedural lapses noticed were brought to the of statistical data on the representation of Scheduled attention of the concerned authorities, for immediate Castes/Scheduled Tribes/OBCs/Physically Handicapped rectification. Persons from the Subordinate Offices/Autonomous/ The representation of Scheduled Castes, Scheduled Statutory Bodies of Deptt. of Health & Family Welfare Tribes and Other Backward Classes in (i) the Central as required by the Department of Personnel and Training, Health Services Cadre (administered by Deptt. of Health National Commission for Scheduled Castes and Scheduled & Family Welfare) and (ii) the Department of Health & Tribes etc. The Cell also rendered advice on reservation FW its Attached and Subordinate Offices as on 1.1.2010 procedures and maintenance of reservation particularly is as follows:- post based rosters.

During 2010-2011 inspection of rosters was carried out Name of Cadre Total SC ST OBC in respect of thirteen offices namely:- Employees 1. Central Government Health Scheme Jaipur (i) Central Health Services : (All Group A Posts) 3610 358 134 218 2. Regional Office for Health & F.W, Jaipur (ii) Deptt. of Health &FW- its 3. Port Health Organisation Kolkata Attached and Subordinate 4. Airport Health Organisation Kolkata Offices. 16350 5468 1023 1344 5. Government Medical Store Note: This statement relates to persons and not to posts. Posts vacant etc. have not, therefore, been taken into account. Organisation Kolkata 6. Central Drugs Standard Control 16.2. PRIMARY HEALTH CARE Organisation Kolkata INFRASTRUCTURE: 7. All India Institute of Hygiene & 16.2.1 Given the concentration of Tribal inhabitation in Public Health Kolkata far-flung areas, forest lands, hills and remote villages,

Annual Report 2010-11 305 the population norms have been relaxed at different levels 16.3.3 The NRHM also provides an overreaching of health facilities for better support infrastructure umbrella to the existing programmes of Health & Family development as under: Welfare including RCH-II, Vector Borne Disease Control Programme, Blindness, Iodine deficiency, Leprosy and Centre Population Norms Integrated Disease Surveillance Programme. It addresses Plain Areas Hilly/Tribal/ the issue of health in the context of sector-wide approach Difficult Areas with focus on sanitation and hygiene, nutrition and safe Sub- Centre 5, 000 3, 000 drinking water. Primary Health Centre 30, 000 20, 000 16.3.4 The Primary Health care Services in Primary Community Health Rural Health Care Services are provided through a Centre 1, 20, 000 80, 000 network of 145920 Sub Centres, 23391 Primary Health Centres, 4510 Community Health Centres across the 16.2.2: Under the Minimum Needs Programme: country as on September, 2010. The services being provided through the above centres are available to all 24952 Sub Centres, 3504 Primary Health Centres and sections of population including SC/ST. 750 Community Health Centres have been established in tribal areas as on 31.03.2009. 16.4. NATIONAL VECTOR BORNE DISEASE CONTROL PROGRAMME (NVBDCP): 16.3 NATIONAL RURAL HEALTH MISSION (NRHM) Under National Vector Borne Disease Control Programme, the service for prevention and control of 16.3.1 In order to provide effective health care to the Malaria, Kala-Azar, Filaria, Japanese Encephalitis, rural population throughout the country with special focus Dengue/Dengue Hemorrhagic Fever (DHF) and on 18 States with poor health indicators and weak health Chikungunya are provided to all sections of the infrastructure, the Government launched the National community without any discrimination, however, since Rural Health Mission (NRHM) in April, 2005. The vector borne diseases are more prevalent in low social Mission adopts a synergistic approach by relating health economic group , the focused attention is given to areas to determinants of good health.The Mission seeks to dominated by the tribal population in North Eastern states establish functional health facilities in the public domain and some parts of Andhra Pradesh, Chhattisgarh, Gujarat, through revitalization of the existing infrastructure and Jharkhand, Madhya Pradesh, Maharashtra Orissa & Karnataka. The additional inputs under externally fresh construction or renovation wherever required. The assisted projects from Global Fund to N.E states and Mission also seeks to improve service delivery by putting World Bank to other States especially for control of in place enabling systems at all levels addressing issues malaria is provided. For Kala-azar elimination in the states relating to manpower planning as well as infrastructure of Bihar, Jharkhand and West Bengal World Bank strengthening. support is also being provided. In addition, the N.E. states 16.3.2 The Mission also aims at bridging the gap in Rural are being provided 100% central assistance for Health care services through a cadre of Accredited Social implementation of the programme from domestic budget. Health Activists (ASHA) and improved hospital care, 16.5. NATIONAL LEPROSY ERADICATION decentralization of programme to district level to improve PROGRAMME (NLEP): intra and inter-sectoral convergence and effective 16.5.1 Under the NLEP, free leprosy diagnosis and utilization of resources. The ASHA would reinforce treatment services are provided uniformly to all sections community action for universal immunization, safe of the society irrespective of caste and religion including delivery, newborn care, and prevention of water-borne Scheduled Castes and Schedules Tribes population. and other communicable diseases, nutrition and sanitation. Intensified IEC activities are carried out through the ASHA is provided in each village in the ratio of one per rural media to cover population residing in remote, 1000 population. For tribal, hilly, desert areas, the norm inaccessible and tribal areas as one of the target Groups could be relaxed for one ASHA per habitation depending where awareness generation activities are more focused. on the workload.

306 Annual Report 2010-11 Dressing material, supportive medicines and Micro- • Provision of TBHVs for urban areas Cellular Rubber (MCR) footwear are provided for 16.7. NATIONAL PROGRAMME FOR prevention of disability among persons with insensitive CONTROL OF BLINDNESS (NPCB) hands and feet. Re-constructive Surgery (RCS) services are being provided for correction of disability in leprosy 16.7.1 The NPCB was launched in the year 1976 as a affected persons. An amount of Rs. 5000/- is also 100% centrally sponsored scheme with the goal of provided as incentive to each leprosy affected persons reducing the prevalence of blindness to 0.3% by 2020. from BPL families for undergoing re-constructive surgery The Scheme is being implemented uniformly throughout in identified Govt./NGO institutions to compensate loss the country. However, following initiatives have been of wages during their stay in hospital. Medical facilities introduced under the programme during the 11th Five Year are provided to leprosy affected persons throughout the Plan, keeping in view NE States, which are tribal country residing in self settled colonies. Funds are also predominate. allocated to NGOs under Survey Education Treatment (SET) scheme, most of which are working in tribal areas • Construction of dedicated Eye Wards & Eye OTs for providing services like IEC, prevention of disability in District Hospitals in North-Eastern States, Bihar, and follow up of cases for treatment completion. Jharkhand, J&K, Himachal Pradesh, Uttarakhand and few other States where dedicated Operation 16.5.2 Disaggregates data on SC and ST population is Theaters are not available as per demand. also collected under the programme through monthly reports from States/UT’s. During the year 2009-10, the • Appointment of Ophthalmic manpower population of SC and ST cases among newly detected (Ophthalmic Surgeons, Ophthalmic Assistants cases was 18.54% and 13.33% respectively at national and Eye Donation Counsellors on contractual basis) level. During the year 2010-11 (up to Sept., 2010) SC to meet shortage of ophthalmic manpower. 18.88% and ST 13.71% cases were detected among the • Development of Mobile Ophthalmic Units with tele- new cases. network in NE Stats, Hilly States & difficult Terrains 16.6. REVISED NATIONAL TUBERCULOSIS for diagnosis and medical management of eye CONTROL PROGRAMME (RNTCP) diseases. 16.6.1 Under RNTCP, the benefits of the programme • Grant-in-aid to NGOs for management of other Eye are available to all sections of the society on a uniform diseases (other than Cataract) like Diabetic basis irrespective of caste, gender, religion. etc. The Retinopathy, Glaucoma Management, Laser sputum microscopy and treatment services including Techniques, Corneal Transplantation, Vitreoretinal supply of anti TB drugs are provided free of cost to all Surgery, Treatment of childhood blindness etc. The for full course of treatment. However, in large proportion reimbursement would be up to Rs. 750 per case of tribal and hard to reach areas, the norms for establishing for Cataract/IOL Implantation Surgery and Rs.1000 Microscopy centres has been relaxed from 1 per 100,000 per case of other major Eye Diseases. population to 50,000 and the TB Units for every 250,000 • Involvement of Private Practitioners in Sub-District, (as against 500,000). To improve access to tribal and Blocks and Village level. other marginalized groups, there is also provision for: 16.8. BUDGET ALLOCATION • Additional TB Units and DMCs in tribal/difficult Allocations are made for implementation of health areas programmes across all segments of the society. However, • Compensation for transportation of patient & Programme Officers have been directed to ensure attendant in tribal areas allocation of funds to an extent of 8.2% and 16.2% towards Tribal Sub-Plan (TSP) and Scheduled Caste • Higher rate of salary to contractual staff posted in Sub-Plan (SCSP) respectively. Under NRHM, State tribal areas Governments have been advised to earmark certain • Enhanced vehicle maintenance and travel percentage of allocation to districts with SC/ST population allowance in tribal areas above 35% and propose the same in the Programme Implementation Plan (PIP) of 2011-12.

Annual Report 2010-11 307 The allocation under Scheduled Caste Sub-Plan (SCSP) of major health schemes / programmes is given in the and Tribal Sub-Plan (TSP) for the year 2010-11 in respect table below. (Rs. in crores)

Sl. Name of the Scheme SCSP TSP No.

1 National Vector Borne Diseases Control Programme 67.72 34.28

2 National Programme for Control of Blindness 42.12 21.32

3 Revised National TB Control Programme 56.70 28.70

4 National Leprosy Eradication Programmme 7.34 3.72

5 Infrastructure Maintenance 612.62 310.09

6 Supply of Drugs & Contraceptive 47.79 24.19

7 Immunization 245.77 124.40

8 IEC 33.20 16.81

9 Area Projects 5.13 2.60

10 Flexible Pool for State PIPs 1279.96 647.88

Total 2398.35 1213.98

308 Annual Report 2010-11 Chapter 17

Use of Hindi In Official Work

The Ministry of Health and Family Welfare is also taking A scheme for promotion of the books, orginally written necessary steps for promoting the use of Hindi in Offical in Hindi or translated into Hindi on various medical and Work. public health subjects is in operation under which the authors and translators of such books are awarded There is arrangement in the Ministry for undertaking cash prizes by the Ministry. The following prizes are translation work relating to Department of Health and provided under the scheme for useful books originally Family Welfare and Department of Ayurved, Yoga & written in Hindi in the field of medical science and public Naturopathy, Unani, Sidha & Homoeopathy (AYUSH). health, a first prize of Rs. 25,000/-, a second prize of Steps are taken for implemetation of official language Rs. 20,000/-, a third prize of Rs. 15,000/-, a fourth policy of the Union in the Ministry and its attached/ prize of Rs. 10,000/- and three consolation prizes of subordinate offices, public sector undertakings and other Rs. 5,000/- each are given. For Hindi translation of institutions under the Ministry. medical text books written in English or in any Indian Language by eminent doctors/authors, there are three More than 95 percent officers and employees of the prizes viz. a first prize of Rs. 20,000/-, a second prize of Ministry possess working knowledge of Hindi and the Rs. 15,000/- and a third prize of Rs. 10,000/-. The books Ministry is notified under rule 10(4) of the Official should be any one of the following subjects :- Language Rule, 1976. (1) Primary Health Care During the year, a number of officials have been imparted training in Hindi under Hindi Teaching Scheme in order (2) Community Medicine to see that they possess working knowledge of Hindi. (3) Maternity and Child Health Letters received in Hindi were replied to in Hindi and (4) Public Health directions were issued to make maximum use of Hindi in official correspondence. (5) Hygiene and Sanitation (6) Prevention of Communicable Diseases Efforts were made to achieve the targerts set in the Annual Progremme of the year 2010-11 issued by the (7) Manuals/Text books for Para Medical Workers Department of Official Language. An incentive scheme (8) Nutrition for providing cash prizes for writing original noting and drafting in Hindi is in operation. (9) Prevention of Disabilities Hindi fortnight was organised in the Ministry and its (10) Mental Health attached and subordinate offices during September, 2010. (11) Indian Systems of Medicine The messages from Secretary, Health & Family Welfare and Minister of Home Affairs were circulated. A number (12) Population Control of steps were taken to promote the use of Hindi during (13) Immunization Programme the fortnight. Hindi competitions were organized in which a number of officers/employees participated. Hindi (14) AIDS Control Programme Fortnight was also organized in AYUSH Vibhag whereas On Expiry of its term of three years, the Hindi Salahkar Hindi fortnight was observed from 14.9.2010 to 28.9.2010 Samiti of the Ministry is being reconstituted and after in the Department of Health and Family Welfare. reconstitution its meeting will be convened.

Annual Report 2010-11 309 As far as use of Hindi in the attached/subordinate offices, institutions. 25 offices falling under the control of Ministry public sector undrtakings and autonomous institutions etc. of Health and Family Welfare were inspected up to under the Ministry is concerned, the Hindi Division of December, 2010 to find out the position of the use of the Ministry monitors the progress by reviewing the Hindi. quarterly progress reports of these offices. After reviews The Committee of Parliament on Official Language of quarterly reports, shortcomings found therein are conducted inspection of 3 offices under the Ministry of brought to the notice of the concerned offices and Health & Family Welfare.

310 Annual Report 2010-11 Chapter 18

Activities In North East Region

18.1 INTRODUCTION 18.2. NATIONAL RURAL HEALTH MISSION (NRHM) IN NORTH EAST A separate North East Division in the Ministry and a Regional Resource Centre at Guwahati, to provide The National Rural Health Mission (NRHM) has been capacity building support to the NE States, has been set launched with a view to bringing about dramatic up. NACO has also opened NERO for the NE States. improvement in the health system and the health status Flexibilities have been provided under the RCH and of the people, especially those who live in the rural areas NRHM Flexi pools to take care of the specific of the country. The Mission provides special focus to 18 developmental requirements of the NE Region while states, which include the 8 North Eastern states, which ensuring that the national framework is also kept in view. have weak public health indicators and/or weak A scheme under the nomenclature ‘Forward Linkages infrastructure. for NRHM in NE’ has been specifically launched to take The Mission seeks to provide universal access to equitable, care of the tertiary care, infrastructure requirements of affordable and quality health carewhich is accountable the NE. at the same time responsive to the needs of the people, Problems in the Health Sector in the North East reduction of child and maternal deaths as well as States. population stabilization, gender and demographic balance. In this process, the Mission would help achieve goals set • Shortage of trained medical manpower, under the National Health Policy and the Millennium • Providing access to sparsely populated, remote, far Development Goals. flung areas, Achievements under NRHM (2010-11): • Improvement of Governance in the Health sector, • Total number of ASHAs selected in the NE States • Need for improved quality of health services comes to 53237 (2005-06 -10673, 2006-07-29639, rendered, 2007-08-5677, 2008-09-3323, 2009-10- 3925). • Making effective and full utilization of existing • 551 PHCs functioning as 24X7 basis in the NE facilities, States. • Effective and timely utilization of financial resources • 206 CHCs functioning as 24X7 basis in the NE available, States. • Morbidity and Mortality due to Malaria, • 59 District Hospitals (DH) taken up for upgradation. • High level of tobacco consumption and the associated high risk to cancer and • 99 centres operational as First Referral Units (FRU), including DHs, SDHs, CHCs & other • High incidence of HIV/AIDS in Nagaland, Manipur levels. and the increasing incidence in Mizoram and Meghalaya. • 87 Districts are having working Mobile Medical Unit(MMU).

Annual Report 2010-11 311 • Ayush facilities is available in 402 Centres, 5. Janani Suraksha Yojana (JSY). including DHs, CHCs, PHCs and other health facilities above SCs but below block level. 6. Innovative interventions including Public Private Partnerships, Incentives, etc. • 2.39 Lakh Institutional Deliveries done. 7. Infrastructure strengthening, including for PHSCs, • 1.94 Lakh beneficiaries of JSY recorded. PHCs, CHCs, DHs and Drug Warehouses. This • 3.95 Lakh Children fully immunized. includes construction of new facilities also. Initiatives under NRHM for the Year 2010-11 8. Procurement of drugs and equipments and improvement of logistics. An amount of Rs.1838.37 crores has been approved for the State PIPs of all the eight NE States for various 9. Training and Orientation of Medical Personnel as activities under NRHM. State-wise & programme –wise well as other stakeholders. details of funds approved under NRHM State PIP is given 10. Mobile Medical Units. below:- (Rs. in crores) Sl. No. Component/Scheme Arunachal Pradesh Assam Manipur Meghalaya Mizoram Nagaland Sikkim Tripura

1 Part A: RCH Flexible Pool (incl. JSY, FP) 19.47 317.39 25.20 27.16 16.04 32.34 6.76 30.11 2 Part B: NRHM Flexible Pool 30.23 734.12 42.69 72.34 24.23 40.86 15.63 54.30 3 Part C: Immunization 1.78 11.67 1.19 2.04 0.99 1.27 0.36 0.36 4 NVBDCP(incl. kind grants) 6.3 14.20 3.97 4.18 4.37 5.53 0.17 4.46 5 RNTCP 3.13 8.82 2.91 2.10 1.30 3.03 0.93 1.38 6 NPCB 2.44 13.32 0.72 1.75 3.76 1.68 1.15 1.34 7 NLEP 0.65 1.20 0.46 0.41 0.42 0.52 0.33 0.31 8 NIDDCP 0.38 0.42 0.36 0.36 0.36 0.36 0.38 0.38 9 IDSP 1.27 1.77 0.81 0.67 0.85 0.98 0.48 0.48 10 Infrastructure Maintenance 8.44 107.91 17.65 10.77 16.86 11.53 10.04 22.01 11 PPI operation cost 0.81 10.67 1.18 1.48 0.45 0.87 0.23 1.40 Total 74.9 1221.49 97.13 123.26 69.63 98.97 36.46 116.53

11. Contractual employment and co-location of The approvals include, broadly the following AYUSH. interventions. 12. Specific Disease Control Programme interventions. 1. ASHAs. 13. Strengthening of Programme Management. 2. Untied Funds at the VHSC and PHSC levels. Forward Linkages to NRHM in the NE for the Year 3. Fund transfer to Rogi Kalyan Samitis at PHC, CHC, 2010-11 SDH and DH levels. With a view to complement the initiatives under the 4. Annual Maintenance Grants for PHSC, PHCs and NRHM Programme, the Scheme for Forward Linkages th CHCs. to NRHM in NE has been introduced during the 11 Plan with an outlay of Rs. 900 crore, to be financed from likely

312 Annual Report 2010-11 savings from other Health Schemes. This aims at (Rs. In crore) improving the Tertiary and Secondary level Health Name of the Allocation released as Infrastructure of the region in a comprehensive manner. Institute 2010-11 on 17.01.2011 During 2010-11, Rs.60.00 crore has been allocated under Forward Linkages Scheme to NRHM in NE States and NEIGRIHMS 102.85 67.85 Rs. 26.82 crore has been released to Government of Nagaland for up-gradation of District Hospital at Phek 18.4. REGIONAL INSTITUTE OF MEDICAL and Kiphire. An amount of Rs.9.96 crore has been SCIENCE (RIMS) released for the up-gradation of Koloriang CHC to 50 bedded FRU to the State Government of Arunachal Regional Institute of Medical Science, Imphal, has Pradesh and also an amount of Rs. 86.03 lakhs has been been taken over by the Ministry of Health and released to M/s HSCC for the consultancy fees for Family Welfare from North Eastern Council in preparation of DPR of Naharlagun Civil Hospital in 2007. The Institute has an intake capacity of 100 undergraduate and 73 + 77 post graduate Degree/ Arunachal Pradesh. Diploma seats. The 11th Plan Allocation for this 18.3. NORTH EASTERN INDIRA GANDHI Institute is Rs. 589.92 crore. REGIONAL INSTITUTE OF HEALTH This Institute has a 1074 bedded teaching hospital AND MEDICAL SCIENCES with 104 graduates, 67 specialists, 4 M.Phil and 1 (NEIGRIHMS) Ph.D scholar were produced. The Institute has so far produced 2394 medical graduates and 630 North Eastern Indira Gandhi Regional Institute of specialists therby richly contributing in bridging the Health and Medical Sciences (NEIGRIHMS) has gap of health manpower in the region. been established in Shillong, on the lines of AIIMS, New Delhi, and PGIMER, Chandigarh, with the The Phase II project for Up-gradation of RIMS at objective of providing advanced specialized Health- an estimated cost of Rs.129.36 crores has been care to the people of North East Region. An amount approved by the Expenditure Finance Committee of Rs. 1266.38 crore has been allocated for the (EFC) Institute in the 11th Plan. Department of Transfusion Medicine has been set This Institute has been planned to include a 500 up in the Institute and two posts of Professor and bedded referral hospital with 35 teaching Associate Professor have been sanctioned. departments at postgraduate level in various PG course in Transfusion Medicine has started. specialties and super-specialties. A fifty seat Nursing College and Under Graduate MBBS Total staff strength in the Institute is as under: College has already started functioning from the Institute. Name of the Post Filled up Vacancy Institute sanctioned position PG courses in Anesthesiology, Obst. & Gynecology, Microbiology and Pathology have started in RIMS 1050 795 255 2009-10 Total staff strength in the Institute is as under: The Annual Plan Allocation and expenditure for the current financial year 2010-11 is indicated Name of the Post Filled Vacancy below:- Institute sanctioned up position NEIGRIHMS 1524 850 674 Name of the Allocation Amount Institute 2010-11 released as on 17.01.2011 Budget Allocation & Expenditure for the years 2010-11 is indicated below:- RIMS 130.50 80.50

Annual Report 2010-11 313 th 18.5. LOKOPRIYA GOPINATH BORDOLOI 01.04.2007. The 11 Plan Allocation for this Institute is Rs. 69.62 Crore. REGIONAL INSTITUTE OF MENTAL HEALTH, TEZPUR, ASSAM The Institute is having 162 seats each year with total strength of 479 students during the academic Lokopriya Gopinath Bordoloi Regional Institute of Mental year of 2009-10 for the following different Health (LGBRIMH) is a premier tertiary mental health courses – B.Sc(N), B.Sc(MLT), B.Pharm, Diploma care facility in Northeast India. It was established in the in Opthalmic Technology and Radio Imaging and year 1876 under the imperial British rule. This hospital Cardio Instrumentation Technology (RICIT)). has been particularly serving the entire Northeast region since its inception. After the Institute was taken over by Total staff strength in the Institute is as under: the Government of India in 1999, new developments in Name of the Post Filled Vacancy the form of academic and research activities were Institute sanctioned up position initiated. RIPANS 85 79 6 One of the primary agenda of the Institute is to undertake research activities with special emphasis in mental health issues prevalent in the Northeast region. Over the years The Annual Plan Allocation and expenditure for the Institute has received wide recognition in provision the current financial year 2010-11 is indicated of mental health services across the country. During the below:- year 2010-11, an amount Rs. 46.40 crores has been Name of the Allocation Amount released allocated of which an amount of Rs. 20.70 crores has Institute 2010-11 as on 17.01.2011 been released. RIPANS 29.50 5.00 18.6. REGIONAL INSTITUTE OF PARAMEDICAL AND NURSING 18.7. NATIONAL PROGRAMME FOR SCIENCES (RIPANS). CONTROL OF BLINDNESS (NPCB) IN NORTH EAST STATES National Programme for Control of Blindness (NPCB) Regional Institute of Paramedical and Nursing was launched in the year 1976 as a 100% centrally Sciences (RIPANS), Aizwal was set up by the sponsored scheme with the goal of reducing the Government of India, Ministry of Home Affairs in prevalence of blindness to 0.3% by 2020. NE States 1992—93 to develop adequate paramedical including Sikkim has remained a focus area for manpower to provide the much needed basic development of eye care infrastructure and coverage of paramedical health care facilities in the health eye care services under the Programme. institutions of the North Eastern Regions. The Institute came under the administrative control of Performance of Cataract Surgeries in NE States Ministry of Health and Family Welfare w.e.f. during 11th Plan State 2007-08 2008-09 2009-10 2009-10 (as on 30.11.2010) Tar. Ac. Tar. Ach. Tar. Ach. Tar. Ach. Arunachal Pradesh 2000 1364 2000 1172 2000 1578 2000 391 Assam 47000 43490 50000 47749 50000 50426 50000 26787 Manipur 1200 642 2000 1744 2000 2,393 2000 494 Meghalaya 2000 1064 2000 2308 2000 1936 2000 576 Mizoram 2000 1739 3000 2397 3000 2156 3000 1027 Nagaland 2000 823 1500 1048 1500 1046 1500 400 Sikkim 600 530 800 690 800 609 800 231 Tripura 8000 6732 7000 8429 7000 6316 7000 2980 Total 64800 56384 68300 65537 68300 66460 68300 32886

314 Annual Report 2010-11 New Initiatives introduced during 11th Plan keeping Implantation Surgery and upto Rs.1000 per case for other major Eye Diseases as mentioned above. in view NE Region: 4. Development of Mobile Ophthalmic Units with Various new initiatives have been introduced under the Tele-network in NE States, Hilly States & difficult National Programme for Control of Blindness during 11th Terrains for diagnosis and medical management of Five Year Plan. The following schemes have been eye diseases. introduced mainly keeping in view NE States including Sikkim and other hilly States:- 18.8. NATIONAL VECTOR BORNE DISEASE CONTROL PROGRAMME IN NORTH 1. Assistance for construction of dedicated Eye EASTERN STATES Wards & Eye OTs in District Hospitals in North- Eastern States, Bihar, Jharkhand, J&K, Himachal Malaria situation in Northeastern States Pradesh, Uttarakhand and few other States where dedicated eye OTs are not available as per demand. The North-Eastern region is prone to malaria transmission mainly due to 2. Assistance for appointment of Ophthalmic manpower on contractual basis (Ophthalmic topography and climatic conditions that largely Surgeons, Ophthalmic Assistants and Eye Donation facilitate perennial malaria transmission, Counsellors) to meet shortage of ophthalmic prevalence of highly efficient malaria vectors, manpower. pre-dominance of Pf as well as prevalence of 3. Assistance for grant-in-aid to NGOs for chloroquine resistant pf malaria. management of other Eye diseases (other than The North-Eastern states namely Arunachal Pradesh, Cataract) like Diabetic Retinopathy, Glaucoma Assam, Meghalaya, Mizoram, Manipur, Nagaland, Sikkim Management, Laser Techniques, Corneal and Tripura together contribute about 4% of the country’s Transplantation, Vitreoretinal Surgery, treatment of population 15% of malaria cases, 22% of Pf cases and Childhood Bindness etc. The grant-in-aid would 43% of malaria deaths reported in the country in the year be upto Rs. 750 per case for Cataract/IOL 2009. The epidemiological and malario-metric indicators for the last 13 years are given at Table-A. TABLE-A Malaria Situation in the NE States during 1996-2009 Year Cases (in million) Deaths API Total Pf 1996 0.28 0.14 142 8.01 1997 0.23 0.12 93 6.51 1998 0.19 0.09 100 5.12 1999 0.24 0.13 221 6.40 2000 0.17 0.08 93 4.49 2001 0.21 0.11 211 5.29 2002 0.18 0.09 162 4.57 2003 0.16 0.08 169 3.93 2004 0.14 0.08 183 3.36 2005 0.15 0.09 251 3.64 2006 0.24 0.15 901 5.67 2007 0.19 0.12 581 4.58 2008 0.19 0.13 349 4.38 2009 0.23 0.18 488 5.19

Annual Report 2010-11 315 The state-wise situation of malaria in year 2009 is given at Table –B. State-wise situation of Malaria in NE states-2009

TABLE- B.

SN STATES/UTS Pop. B.S.C. B.S.E. Positive P.f. P.f.% ABER API SPR SfR Deaths (in 000) Cases Cases

1 Arunachal Pradesh 1238 213893 213893 22066 6602 29.92 17.28 17.82 10.32 3.09 15

2 Assam 31274 3021920 3021920 91413 66557 72.81 9.66 2.92 3.02 2.20 63

3 Manipur 2953 114720 114720 1069 620 58.00 3.88 0.36 0.93 0.54 1

4 Meghalaya 2734 501419 501419 76759 74251 96.73 18.34 28.08 15.31 14.81 192

5 Mizoram 874 171793 171793 9399 7387 78.59 19.66 10.75 5.47 4.30 119

6 Nagaland 1981 156259 156259 8489 2893 34.08 7.89 4.29 5.43 1.85 35

7 Sikkim 180 6688 6688 42 16 38.10 3.72 0.23 0.63 0.24 1

8 Tripura 3812 361848 361848 24430 22952 93.95 9.49 6.41 6.75 6.34 62

Total 45046 4548540 4548540 233667 181278 77.58 10.10 5.19 5.14 3.99 488

The table shows that Arunachal Pradesh, Meghalaya, Mizoram and Tripura are having API more than 5. Assistance to States: Government of India provides (iii) to enhance awareness about malaria control and 100% central assistance for programme implementation promote community, NGO and private sector to the Northeastern States including Sikkim. The Govt. participation. of India also supply commodities like drugs, LLINs, insecticides/ larvicides as per approved norms to all NE For strengthening early case detection and prompt States as per their technical requirements. The treatment more than 53454 ASHAs are engaged in these assistance provided since 2007-08 is at Table-C & areas. Out of them, 43517 have been trained and involved Table-D. in high malaria endemic areas along with Fever Treatment Depots (FTDs) and Malaria clinics. This is in addition to The additional support under Global Fund for AIDS, the treatment facilities available at the health facilities Tuberculosis and Malaria (GFATM) is provided to all NE and hospitals. Anti malaria drugs and funds for training States except Sikkim for implementation of intensified are provided by Gol under the programme. Malaria Control Project (IMCP), with following the objectives: As per the National Drug Policy, Cholorquine is used for treatment of all P.vivax cases. However, at present (i) to increase access to rapid diagnosis and treatment Artemesinin Combination Therapy (ACT) with in remote and inaccessible areas through community Sulfadoxine Pyrimethamine (AS+SP) combination is being participation, implemented for the treatment all Pf cases. (ii) malaria transmission risk reduction by use of Indoor Residual Spraying (IRS): Under integrated insecticide treated bed nets (ITNs/LLINs) and vector control initiative, IRS is implemented selectively

316 Annual Report 2010-11 only in high risk pockets as per district-wise Micro Action providing consultants at the state and national level is also Plans from domestic budget. The Directorate has issued provided under the project. GFATM Round – 9 project Guidelines on IRS to the States for technical guidance. for malaria control in seven north eastern states has been Guidelines on uniform evaluation of insecticides have also approved as a continuation of Round – 4 project. The been developed in collaboration with National Institute EFC of the same has been prepared and circulated. of Malaria Research (NIMR), Delhi. Over the years, there is a reduction in IRS covered population in view of Japanese Encephalitis(JE) is mainly endemic in Assam paradigm shift to alternative vector control measures such which is regularly reporting JE/AES cases. The state as extensive use of Insecticide Treated Nets (ITNs) and has reported, 424 cases and 133 deaths in 2007, 319 cases Long Lasing Insecticide Treated Nets (LLINs). and 99 deaths in 2008, 462 cases and 92 deaths in 2009. However in 2010 (upto November) 562 cases and 125 The strategies of the project are: deaths have been reported. (i) Early diagnosis and prompt treatment with special Manipur reported only 2 cases and 1 death in 2002 and reference to the drug resistant pockets, only 1 case of suspected JE during 2003 followed by 65 cases of AES in 2007, 4 in 2008 and 6 in 2009. However (ii) integrated vector control, including promotion of in 2010 (upto November) 116 cases and 14 deaths have ITN/LLINs, intensive IEC and capacity building and been reported. efficient public-private partnership among, CBO, NGO, and other voluntary sectors and Nagaland reported only 7 cases and 1 death in 2007 and 9 cases and 2 deaths in 2009. However in 2010 (upto (iii) Training the health workers and community November) 11 cases and 6 deaths have been reported. volunteers For control of J.E., Government of India has identified five sentinel sites in Assam and one in Manipur for diagnosis of J.E. cases. Besides, nine districts in Assam have been covered under J.E. vaccination programme since 2006. Two additional districts in Assam and four in Manipur have been identified for J.E. immunization during 2010. Dengue: NE States till few years back did not have problem of Dengue. Manipur has reported for the 1st time in 2007 followed by Nagaland in 2009, Assam and Meghalaya in 2010 as detailed below: Assam:- The state has reported Dengue cases since July 2010. Till November 158 cases and 2 deaths have been reported. Total 20 districts are affected. Maximum cases were reported from Kamrup (Metro) district. Manipur:- In the year 2007, 51 dengue cases and 1 death was reported. In the year 2008 and 2009 no case had been reported. During 2010 till November 2010, 5 cases The GFATM has been supporting the programme under and no death have been reported from Imphal district. round - 4 (2005-06 to 2009-10). Inputs under Project is provided by the Global Fund in the form of financial Meghalaya:- The state has reported only 1 case and no support for drugs like artemisinine injections, Sulpha- death have been reported from West Garo Hills district pyrimethamine Artesunate Combination Therapy (SP- till November 2010. ACT) and rapid diagnostic kits (RDKs), and other Nagaland:- In the year 2009, 25 dengue cases and no materials for vector control such as bed nets (LLINs), death was reported. During 2010 till November no case insecticide for the treatment of bed nets (ITNs). The has been reported. support for enhancing supervision and monitoring by

Annual Report 2010-11 317 Arunachal Pradesh, Mizaoram, and Tripura are not Lymphatic Filariasis is endemic in 7 districts of Assam, whereas other states in NE region are not reported to be endemic for Dengue. filaria endemic. The strategy of Elimination of Lymphatic Chikungunya : Assam, Arunachal Pradesh, Manipur, Filariasis with annual single dose Mass administration of Mizaoram, Nagaland, and Tripura are not endemic DEC is being implemented since 2004. The coverage of for Chikungunya. However in Meghalaya for the first population is 25.42% in 2004, 42.94% in 2005, 67.33% in time, the state has reported 16 Clinically Suspected 2006, 78.32% in 2007 and 81.34% in 2008. The Chikungunya cases from West Garo Hills district till microfilaria rate in the state has come down from 1.46 in November 2010. No death has been reported due to 2007 to 0.88 in 2008. MDA could not be observed during Chickungunya. 2009 in Assam. However, during 2010, MDA has been observed on 11th November and the reports on coverage is awaited from the state.

TABLE-C Statement Showing Central Assistance provided to North Eastern States Under NVBDCP (Rs in lakhs)

State 2007-08 2008-09 2009-10 Cash Kind Total Cash Kind Total Cash Kind Total Arunachal Pradesh 306.20 260.79 566.99 647.21 237.36 884.57 742.05 221.19 963.24 Assam 1042.00 2540.09 3582.09 910.87 2724.21 3635.08 700.16 2505.90 3206.06 Manipur 133.18 235.95 369.13 238.05 85.8 323.85 195.31 44.44 239.75 Meghalaya 142.91 399.60 542.51 229.86 267.77 497.63 96.36 514.93 611.29 Mizoram 138.73 359.79 498.52 276.56 142.22 418.78 316.52 310.60 627.12 Nagaland 214.28 334.99 549.27 381.15 228.89 610.04 434.45 238.12 675.57 Tripura 138.97 766.68 905.65 319.88 307.43 627.31 238.23 526.92 765.15 Sikkim 4.00 0.98 4.98 6.5 4.27 10.77 7.97 3.86 11.83 Total 2120.27 4898.87 7019.14 3014.08 3997.95 7008.03 2731.05 4365.96 7100.01

TABLE-D Allocation and Releases made to N.E. States during 2010-11 (Rs in lakhs) State Allocation Releases (as on 30.11.10) Cash Kind Total Cash Kind Total Arunachal Pradesh 502.17 256.75 758.92 347.35 166.16 513.51 Assam 1238.92 3155.69 4394.61 817.00 619.04 1436.04 Manipur 353.63 154.15 507.78 256.55 55.08 311.63 Meghalaya 352.20 507.76 859.96 150.88 153.56 304.44 Mizoram 396.35 280.28 676.63 252.23 75.55 327.78 Nagaland 479.97 314.19 794.16 345.39 130.92 476.31 Tripura 370.68 960.49 1331.17 173.85 230.30 404.15 Sikkim 16.23 5.12 21.35 10.91 126.80 137.71 Total:- 3710.15 5634.43 9344.58 2354.16 1557.41 3911.57

318 Annual Report 2010-11 for implementation of External Quality Assessment 18.9. REVISED NATIONAL TB CONTROL (EQA) of sputum smear microscopy services and PROGRAMME (RNTCP) IN NORTH provision of culture and drug sensitivity testing: EASTERN STATES Guwahati, Assam, Sikkim and Manipur The entire population of the North Eastern states including o Sikkim has been covered under the Revised National TB Implementation of DOTS-Plus for multi-drug Control Programme (RNTCP). resistant TB cases will occur in a phased manner • o Over the years, a strong network of RNTCP Involvement of Medical Colleges: All medical diagnostic and treatment services has been colleges in the NE have been involved in the established in NE States through the general health programme. A separate Zonal Task Force has been system. 136 sub-district TB Units and 601 RNTCP established for the NE region, which holds regular Designated Microscopy centres have been annual meetings. upgraded till date. As the NE region has large To improve access to tribal and other marginalized groups, proportion of tribal and hard to reach areas, the there is also provision for: norms for establishing Microscopy centres has been relaxed from 1 per 100,000 population to 50,000 I. Compensation for transportation of patient & and the TB Units for every 250,000 (as against attendant in tribal areas. 500,000). II. Higher rate of salary to contractual staff posted in o The states have shown considerable improvement tribal areas. in programme performance, and in 2010, the new III. Enhanced vehicle maintenance and travel smear positive case detection rate for the region allowance in tribal areas. was 79%, treatment success rate has been consistently maintained over 86%. As a special case, transportation of drugs by air from GMSDs to the North Eastern states is allowed under the o RNTCP has initiated over 61 thousand patients on programme, full requirement of anti TB drugs of the States treatment in 2009, thus saving over 13 thousand and Binocular Microscopes for quality diagnosis are additional lives in the North East Region. provided by the Centre as commodity grant. For o The programme has collaborated with private and undertaking various activities for implementation of the public sector health institutions in the area. RNTCP, cash assistance as grants-in-aid is released to Innovative methods have been successfully the State TB Societies for onward transmission to the implemented with the tea gardens in Assam. District TB Societies. Funds are provided for purchase Collaboration with the defence health services has of four wheelers and two wheelers for effective also been achieved in some of the states. supervision; computer with internet facility; fax and photocopier for each district for facilitation of work and o HIV-TB coordination activities have been for information storage, retrieval and quick implemented in all the North Eastern states. Cross communication. All the districts have been electronically referral activities are being reported by all the states. connected and reports are received through email. The o New activities under RNTCP are: manpower has been strengthened by providing essential staff on contractual basis. o Procurement and distribution of paediatric drug boxes for improved care of paediatric cases is The performance of the States is also monitored regularly currently in progress. at CTD through analysis of quarterly performance reports from the districts and addl. feedback is given for necessary o Quality sputum microscopy is an important corrective action, if required. For assisting the States in component of RNTCP. All the states in North East implementation and supervision of the programme, have implemented the External Quality Assurance technical assistance is provided by way of appointment (EQA) protocol. Scaling up of the State-level of WHO consultants in the North Eastern States. The Intermediate Referral Laboratories (IRL) capacity programme is also monitored at the state level meetings and meetings at the Centre from time to time.

Annual Report 2010-11 319 Performance Performance of the programme in the region based on the quarterly reports of 3rd quarter of 2010 is as below:

State Population Total patients Annualized New smear Annualized 3 month conversion Success rate (in lakh) registered for total case positive patients new smear rate of newof new smear covered by treatment detection registered positive case smear positive positive RNTCP rate for treatment detection patients patients rate (%) Arunachal Pradesh 12 644 210 177 58 77% 93% 88% Assam 302 10435 138 4462 59 79% 87% 83% Manipur 24 1098 181 291 48 64% 88% 86% Meghalaya 26 1421 219 436 67 90% 82% 82% Mizoram 10 584 235 102 41 55% 90% 90% Nagaland 22 1010 182 373 67 89% 93% 93% Sikkim 6 430 284 125 83 110% 90% 86% Tripura 36 745 83 409 46 61% 89% 91%

Overall performance of the programme in Aunachal Funds Status Pradesh, Assam, Nagaland, Meghalaya and Sikkim is Funds released and utilized by NE States are as follows: good. In other States (Manipur, Mizoram and Tripura) also the programme performance is gradually improving. State-wise statement of NE States for the financial year 2009-10 is as follows

(Rs. in lakhs) 2010-11 Sl.No. Name of the Op. Bal. Cash Expenditure Unspent State / UT 01.04.2010 Release as Reported Balance (as per SOE) till 30.09.2010 by States As 30.09.2010 on 30.09.2010 High Focus States - NE 1 Arunachal Pradesh 14.44 145.00 83.99 75.45 2 Assam 35.40 550.00 353.56 231.84 3 Manipur * 9.86 140.00 7.52 142.34 4 Meghalaya * 27.53 140.00 22.85 144.68 5 Mizoram 1.99 60.00 60.86 1.13 6 Nagaland 12.22 140.00 123.86 28.36 7 Sikkim 1.93 46.00 32.28 15.65 8 Tripura 20.05 65.00 37.97 47.08 Total 123.42 1286.00 722.89 686.53

• SOE from the State of Manipur and Meghalaya received only for the Qtr. April – June 2010.

320 Annual Report 2010-11 18.10 NATIONAL LEPROSY ERADICATION 1) Training of Nurses PROGRAMME IN NORTH EASTERN STATES 2) Strengthening / Up gradation of Existing Schools/Colleges of Nursing The States of north east region have achieved leprosy elimination. The region contributed to 3.83% of country’s 3) Providing recurring assistance to Schools of Nursing population and only 1.06% of country’s new cases that were opened during detected in 2009-10. At the end of December 2010, there were 1605 leprosy cases on record in these states and XIth plan period 1135 new leprosy cases were detected from April to Training of Nurses: December, 2010. Leprosy services have already been integrated with General Health Care system in all NE In order to update the knowledge and skills of the nursing states and leprosy diagnosis and treatment (MDT) personnel, Continuing Nursing Education Programme was services are available in all the PHCs and Government started in the area of Nursing Specialty for the Staff hospitals/dispensaries free of cost. All the Medical Nurses, Education Technology for the faculty of the Officers and GHC staff have been trained in leprosy. Schools and Colleges of Nursing, Management The district nucleus teams are being actively involved in Techniques for the Nursing Administrators. The pattern programme monitoring and supervision. Medical College of assistance for conducting Continuing Nursing Guwahati in Assam and RIMS Imphal have been identified Education Programme has been revised from Rs. 75,000 for conducting Reconstructive Surgery in person affected /- to 1,65300/ per course with a duration of 7 days to with leprosy disability. train 30 Nurses. A sum of Rs. 23.142 lakhs has been released during the year 2010-11 to conduct 14 courses 18.11 NATIONAL IODINE DEFICIENCY to train 420 nursing personnel in NE Regions. DISORDERS CONTROL PROGRAMME (NIDDCP) IN NORTH EASTERN STATES Up gradation of Schools of Nursing into Colleges of Nursing: The National Iodine Deficiency Disorders Control Programme (NIDDCP) is being implemented in all the It is proposed to upgrade Schools of Nursing, which are North Eastern States. IDD prevalence surveys have attached to the Medical Colleges into Colleges of Nursing. been conducted in all the states. State level IDD Control The objective of the scheme is to train more Graduate Cell has been set up, in all the NE States. However, Nurses. One time assistance of Rs. 6.00 crores is IDD monitoring laboratory is yet to be set up in the state provided to the State Govt/Institution subject to the of Assam. condition that State Govt. gives an undertaking that they will bear the recurring assistance of the College of Resurveys done in the State of Arunachal Pradesh, Nursing. So far a grant of Rs. 6.75 crores has been Manipur and Mizoram have indicated a decline in the released to 2 institutions in the N.E. States for upgrading prevalence of IDD as a result of iodated salt School of Nursing into College of Nursing at Aizwal, consumption. Mizoram and School of Nursing at Manipur. 18.12. DEVELOPMENT OF NURSING SERVICE & UP-GRADATION/STRENGTHENING Strengthening of Existing Schools/Colleges of OF NURSING SERVICES IN NORTH Nursing: EASTERN STATES In order to improve the quality of training imparted at the Development of Nursing Service & Up-gradation/ existing Schools and Colleges of Nursing grant is released Strengthening of Nursing Services under Human towards procurement of A.V Aids, furniture, improvement Resource (Health): of library, additions/alterations of building and transport. it has been proposed to strengthen 2 Institutions in NE Under the Programme of Development of Nursing regions during the year 2009-10. A grant of Rs. 50.00 Services following schemes are implemented. lakhs is being proposed for the year 2009-10.

Annual Report 2010-11 321 New Scheme: Strengthening /Upgradation of Nursing details given below :- Services: Sl.No Name of No. of Districts No. of Districts the State for opening for opening Opening of ANM /GNM Schools: ANM Schools GNM Schools A sum of Rs. 25.00 crore have been allocated for the I. Arunachal year 2010–11 for implementing the new scheme. CCEA Pradesh 3 2 has approved this Ministry’s proposal for opening of 132 II. Manipur - 6 ANM Schools and 137 GNM Schools in those districts III. Sikkim 2 - of the states where there are no such schools. 154 districts Total 5 8 in 23 High Focus States have been identified having no ANM and GNM schools. A Sum of Rs. 47.50 crore has Faculty Development Scheme: been approved so far for release under the new scheme 6 candidates have been nominated for undergoing M.Sc of Opening of ANM /GNM Schools to the states as per in (N) under the scheme of Faculty Development Scheme.

322 Annual Report 2010-11 Chapter 19

Gender Issues

19.1 INTRODUCTION Services at PHCs/CHCs, safe Motherhood Consultants, Safe Abortion Services, Essential Obsetetric Care, Major component of Health & Family Welfare emergency Obstetric Care, skilled manpower on Programme is related to Health problems of women and contractual and hiring basis, Training of Dais, Training of children, as they are more vulnerable to ill health and MBBS doctors in Anesthetic Skills for Emergency diseases. Since women folk constitute about half of Obstetric Care at FRUs, operationalisation of FRUs population, it is essential to health status of women so through supply of drugs in the form of emergency obstetric that the causes of ill health are identified, discussed and drug kits, Blood Storage Centers (BSC) at FRUs and misconceptions removed. Ill health of women is mainly Prevention and management of RTI/STI. Details of these due to poor nutrition due to gender discrimination, low interventions are given in the Maternal Health Chapter age at marriage, risk factors during pregnancy, unsafe, of this Report. However some points on these Programme unplanned and multiple deliveries, limited access to family is given below: planning methods and unsafe abortion services. 19.2 JANANI SURAKSHA YOJANA (JSY) In order to overcome these problems, the women need to be educated, motivate/persuaded to accept the Family Janani Suraksha Yojana (JSY) is a safe motherhood Welfare Programme to increase demand for services. intervention under the National Rural Health Mission Accordingly, the Government seeks to provide services (NRHM) being implemented with the objective of in a life cycle approach, under the RCH Programme the promoting institutional delivery among the poor pregnant need for improving women health in general and bringing women. Launched on 12th April 2005, JSY is being down maternal mortality rate has been strongly stressed implemented in all states and UTs and integrates JSY in the National Population Policy 2000. This policy benefits with delivery and post-delivery care. The scheme recommends a holistic strategy for bringing about total focuses on poor pregnant woman with special dispensation intersectoral coordination at the grass root level and for states having low institutional delivery rate namely, involving the NGOs, Civil Societies, Panchayati Raj the states of Uttar Pradesh, Uttrakhand, Bihar, Jharkhand, Institutions and Women’s Group in bringing down Madhya Pradesh, Chattisgarh, Assam, Orissa, Rajasthan Maternal Mortality Rate and Infant Mortality Rate. and Jammu & Kashmir. While these states have been classified as Low Performing States (LPS), the remaining In order to improve maternal health at the community states have been named as High performing States (HPS). level a cadre of community level skilled birth attendant to Besides the maternal care, the scheme provides cash attend to the pregnant women in the community is also assistance to all eligible mothers for delivery care. bring considered. The Maternal Health Programme, which is a component of the Reproductive and Child ASHA, the Accredited Social Health Activist acts as an Health Programme, aims at reducing maternal mortality effective link between the Government and the poor to less than 100 by 2010. pregnant women. Her role is to facilitate pregnant women to avail services of maternal care and arrange referral The Development of Health & FW has taken several transport. new initiatives to make the maternal health programme broad based and client friendly to reduce maternal In LPS (Low Performing States) States, all women mortality. The major interventions include provisioning of including those from SC and ST families, delivering in additional ANMs and Public Health/Staff Nurses in Government health centres like Sub-centre, PHC/ CHC/ certain sub-centres, PHCs/CHCs, Laboratory FRU/general wards of District and State Hospitals or Technicians, Referral Transport, 24-Hours Delivery accredited private institutions are eligible to receive the

Annual Report 2010-11 323 cash assistance. In HPS (High Performing States) States, and the infrastructure available in their state. It BPL pregnant women, aged 19 years and above and the would, however, be the duty of the ASHA and the SC and ST pregnant women are eligible to receive the ANM to organize or facilitate in organizing referral cash assistance under the Yojana. The scale of Cash transport, in conjunction with Gram Pradhan, Gram Assistance (in Rs.) for Institutional Delivery is as under:- Sabha etc. Category Rural Area Urban Area • Cash incentive to ASHA should not be less than Mother’s ASHA Mother’s ASHA Rs.200/- per delivery in lieu of her work relating to package package facilitating institutional delivery. Generally, ASHA should get this money after her post-natal visit to In LPS 1400 600 1000 200 the beneficiary and that the child has been immunized for BCG. In HPS 700 200* 600 200 • Transactional cost (Balance out of Rs. 600/-) is to * In HPS Tribal area (Notified by Ministry of Tribal Affairs), be paid to ASHA in lieu of her stay with the pregnant the ASHA package is Rs. 600 in Rural Area w.e.f. 15.6.2010. & in North East States the ASHA package is Rs. 600 in Rural woman in the health centre for delivery to meet her cost of boarding and lodging etc. Therefore, Area w.e.f. September, 2006. this payment should be made at the hospital/ heath The Limitations of Cash Assistance for Institutional institution itself. Delivery are as under:- The Yojana subsidizes the cost of Caesarean Section or State Category Eligibility for the management of obstetric complications, up to Rs. 1500/- per delivery to the Government Institutions, where LPS States In All births, delivered in a Government specialists are not in position. Health Centre –Government or Accredited Private LPS and HPS States, all such BPL pregnant women, Health Institutions. aged 19 years and above, preferring to deliver at home is entitled to cash assistance of Rs.500/-per delivery, up to HPS States In Up to 02 live births two live births

The scale of Cash Assistance (in Rs.) for Home Delivery The progress on implementation of JSY during the last is as under:- five years is as reflected in the chart below:-

Category Rural Area Urban Area Mother’s ASHA package Mother’s ASHA package In LPS & HPS ** 500 Nil 500 Nil

** In LPS and HPS States, all BPL pregnant women, JSY Physical and Financial progress in past 5 years aged 19 years and above, delivery at home are entitled to cash assistance of Rs.500/-per delivery, up to two live births. ASHA package of Rs. 600/- available in LPS, NE States and in Tribal Districts of all States/UTs in the rural areas includes the following three components:- • Cash assistance, over and above the mother’s package, for referral transport to go to the nearest health centre for delivery. The state will determine the amount of assistance (should not be less than Rs.250/- per delivery) depending on the topography

324 Annual Report 2010-11 19.3 PRE –CONCEPTION AND PRE- NATAL conception and Pre-Natal Diagnostic Techniques DIAGNOSTIC TECHNIQUES (Prohibition of Sex Selection) Act, 1994” to make it more (PROHIBITION OF SEX SELECTION comprehensive. ACT, 1994) The technique of pre-conception sex selection has been Adverse Child Sex-Ratio in India brought within the ambit of this Act so as to pre-empt the use of such technologies which significantly contribute Sex ratio (number of females per thousand males) is one to the declining sex ratio. Use of ultrasound machines of the most important indicators used for study of has also been brought within the purview of this Act more population characteristics. The declining trend in sex ratio explicitly so as to curb their misuse for detection and has been a matter of concern for all in the country. Sex disclosure of sex of the foetus lest it should lead to female ratio in India has declined over the century from 972 in foeticide. The Central Supervisory Board (CSB) 1901 to 927 in 1991. The sex ratio has since gone up to constituted under the Chairmanship of Minister of Health 933 in 2001. and Family Welfare has been further empowered for In contrast the child sex ratio for the age group of 0-6 monitoring the implementation of the Act. State level years in 2001census was 927 girls per thousand boys as Supervisory Boards on the line of the CSB constituted against 945 recorded in 1991 Census. The encouraging at the Centre have been introduced for monitoring and trend in the sex ratio during 1991-2001 was marred by reviewing the implementation of the Act in States/UTs. the decline of 18 points in the sex ratio of children aged 6 The State/UT level Appropriate Authority has been made years or below. a multi member body for better implementation and monitoring of the Act in the States. More stringent The Census 2001 figures further reveal that the child sex punishments are prescribed under the Act so as to serve ratio is comparatively lower in the affluent regions, i.e., as a deterrent for minimizing violations of the Act. Punjab (798), Haryana (819), Chandigarh (845), Delhi Appropriate Authorities are empowered with the powers (868), Gujarat (883), Himachal Pradesh (896) and of Civil Court for search, seizure and sealing the machines, Rajasthan (909). (These are the seven focus States/UTs equipments and records of the violators of law including for purposes of the PC&PNDT Act, 1994). sealing of premises and commissioning of witnesses. It Some of the reasons commonly put forward to explain has been made mandatory to maintain proper records in the consistently low levels of sex ratio are son preference, respect of the use of ultrasound machines and other neglect of the girl child resulting in higher mortality at equipments capable of detection of sex of foetus and also younger age, female infanticide, female foeticide, higher in respect of tests and procedures that may lead to pre- maternal mortality and male bias in enumeration of conception selection of sex. The sale of ultrasound population. Easy availability of the sex determination tests machines has been regulated through laying down the and abortion services may also be proving to be catalyst condition of sale only to the bodies registered under the in the process, which may be further stimulated by pre- Act. conception sex selection facilities. Punishment under the Act Sex determination techniques have been in use in India Imprisonment up to 3 years and fine up to Rs. 10,000/-. since 1975 primarily for the determination of genetic For any subsequent offences, imprisonment up to 5 years abnormalities. However, these techniques were widely and fine up to Rs. 50,000 / Rs.1,00,000. misused to determine the sex of the foetus and subsequent abortions if the foetus was found to be female. The name of the registered medical practitioner is reported by the Appropriate Authority to the State Medical Council In order to check female foeticide, the Pre-natal concerned for taking necessary action including Diagnostic Techniques (Regulation and Prevention of suspension of the registration if the charges are framed st Misuse) Act, 1994, was brought into operation from 1 by the court and till the case is disposed off. January, 1996. The Pre-natal Diagnostic Techniques (Regulation and Prevention of Misuse) Act, 1994 has Status and Report from States/UTs since been amended to make it more comprehensive. The As per the reports received from the States and UTs, amended Act and Rules came into force with effect from 39854 bodies using ultrasound, image scanners etc. have 14.2.2003 and the PNDT Act has been renamed as “Pre-

Annual Report 2010-11 325 been registered under the Act. 462 ultrasound machines of Ministers, Members of Parliament and senior Health have been sealed and seized for violation of the law. As officers from the Central and State/UT Governments and on 30.06.2010, there were 706 ongoing cases in the Courts representatives of various organisations active in the area for various violations of the law. Though most of the of Child welfare at the day long fruitful deliberations of cases (223) are for non-registration of the centre/clinic, the National Meet lent the necessary impetus to the ‘Save 216 cases relate to non-maintenance of records, 155 cases the Girl Child’ mission. All the State/UT Governments relate to communication of sex of foetus, 36 cases relate were requested to replicate such meeting in their to advertisement about pre-natal/conception diagnostic respective States/UTs. The message of the above facilities and 76 cases relate to other violations of the National Level Meet was disseminated through the Act/Rules. accredited print and electronic media. The concerned state governments are regularly requested Medical Audit to take effective measures for speedy disposal of the It is proposed to conduct Medical Audit of the ultrasound ongoing cases. Ministry of Health and Family Welfare clinics in the country in a phased manner to spread has taken a number of steps for the implementation of awareness of the Act and required procedural formalities the Act. The major steps taken are as follows: so as to prevent violations of the Act. Scrutinizing ‘Form Meetings of the Central Supervisory Board (CSB) F’ filled in respect of all pregnant women by the clinics will also help in detecting violations, if any. Meetings of the Central Supervisory Board (CSB) of PC & PNDT Act are being held regularly (every six months) Changing Appropriate Authorities under the Chairpersonship of Union Minister of Health In place of Chief Medical Officer / District Health Officer, and Family Welfare. So far, 16 meetings have been held. District Collectors / District Magistrates have been Sensitization through Members of Parliament nominated as District Appropriate Authorities to strengthen the implementation of the Act at the ground Funds were released to the Governments of Chandigarh, level. States of Maharashtra, Tripura, Gujarat, and Delhi, Gujarat, Haryana, Himachal Pradesh, Punjab and Chhattisgarh have informed that they have issued the Rajasthan at the rate of Rs.5.00 lakh per Hon’ble necessary notification in this regard. Member of Parliament (both Lok Sabha and Rajya Sabha) of these States/UTs, considered sensitive from the point Proposed Amendments to PC & PNDT Act. of view of Child Sex Ratio, for undertaking awareness To make the implementation of the Act more effective generation activities like organising exhibitions, seminars, and stringent, it is proposed to amend certain provisions workshops, trainings / orientations programmes for PRIs, of the Act, such as changing the Appropriate Authority public meetings, debates, essay competitions, nukkad at the State level from Director (H&FW) to Secretary nataks, stage shows etc. (H&FW) to facilitate the reporting of District Appropriate On 2.10.2007 on the occasion of the Birth Anniversary Authority (DAA) to State Appropriate Authority (SAA), of the Father of the Nation, Mahatma Gandhi, a signature inclusion of an officer of or above the rank of Joint campaign was launched to generate awareness regarding Director of H&FW in the SAA, and vesting the power the evils of female foeticide. H.E. the President of India of search and seize records to any Group B Gazetted appended her signature first on the scroll as the first citizen Officer. of the country. Rallies were also organised on 4.10.2007 Funding to the State through RCH - II in every district of the NCT of Delhi to generate awareness among the public. Funds have been provided to all States/UTs, as requested by them, in their Programme Implementation Plan under The National Level Meeting on ‘Save the Girl Child’ held RCH – II for undertaking various activities for on 28.4.2008 at Vigyan Bhawan, New Delhi, was implementation of the Act at the State level. inaugurated by Dr. Manmohan Singh, Hon’ble Prime Minister of India, in the presence of the Hon’ble Union Inclusion of the issue under NRHM Minister of Health & F.W., Hon’ble Union Minister of Sensitization on sex ratio issue has been made a part of State (I/C) for Women & Child Development and Hon’ble curriculum for ANMs. For tracking delivery of a pregnant Minister of State for Health & F.W.. The large turn-out

326 Annual Report 2010-11 woman, ASHAs are now provided a fixed remuneration Toll Free Telephone: at the village level (keeping a track of the ante-natal Similarly, the Hon’ble Union Minister of Health & F.W. check-ups and accompanying the pregnant mother to an launched a Toll Free Telephone (1800 110 500) on the institution for delivery). same day under the PNDT Division of the Ministry to Constitution of National Inspection and Monitoring facilitate the public to lodge complaints anonymously Committee (NIMC) against any violation of the provisions of the Act by any authority or individual and to seek PNDT related general A National Inspection and Monitoring Committee (NIMC) information. (The service is presently suspended, pending has been constituted at the Centre to take stock of the resolution of certain operational issues; mainly ground realities through field visits to the problem states. unauthorized advertising by the outsourced service During 2006-09, the Committee visited the States of Delhi, provider). Haryana, Maharashtra, UP, Rajasthan, Orissa, Karnataka, Kerala, H.P. and Punjab. It is proposed to strengthen the Awareness Generation National Support and Monitoring Cell with induction of The problem has its roots in social behaviour and appropriate consultants to oversee the implementation of prejudices and along with the legislation various activities the Act. have been undertaken to create awareness against the Annual Report on implementation of the PNDT Act practice of pre-natal determination of sex and female foeticide through Radio, Television, and Print Media. Implementation of the PNDT Act is being published in Workshops and seminars are also organized through Annual Report since 2005 which gives complete voluntary organizations at state/regional/district/block information on the implementation of PC & PNDT Act. levels to create awareness against this social evil. Frequently Asked Questions (FAQs) booklet Cooperation has also been sought from religious / spiritual leaders, as well as medical fraternity to curb this practice. The Ministry of Health and Family Welfare, in The Government of India has launched ‘Save the Girl collaboration with the United Nations Population Fund Child Campaign’ with a view to lessen son preference by (UNFPA), have developed a ‘Frequently Asked highlighting achievements of young girls. Shri Kapil Dev, Questions’ booklet about the PNDT Act which has proved former Captain of the Indian national Cricket Team, has to be quite useful to the lay persons, medical community been nominated as the Brand Ambassador for the and to the Appropriate Authorities in understanding the campaign. provisions of the Act for better implementation. Advt. over the Internet regarding Gender Testing Website on PNDT Kits: In addition to the Union Health & F.W. Ministry’s Website, A new factor which is threatening to adversely impact (www.mohfw.nic.in), an independent website, the PNDT efforts of the Government, i.e. the ‘pndt.gov.in’ for PNDT Division was launched by the advertisements placed on the websites regarding the Hon’ble Union Minister of Health & F.W. on 28.4.2008. Gender Testing Kits. The Hon’ble High Court of Punjab This website, in addition to containing all the relevant and Haryana Suo Motu took congnisance of the above information relating to PNDT Act, Rules, Regulations and report and issued notices to the State Governments of activities, enables online filing of data right from Clinics Haryana and Punjab and also to the Central Government. (including submission of From-F’ online by the Clinics) in Affidavit on behalf of UOI has been filed. the field to the District and State level and their retrieval at the District, State and National levels. An exercise is On 29.11.2007, the Customs Department was requested on to impart training to the user groups on the use of the by this Ministry to examine the possibility of intercepting website in a phased manner beginning with the focused such Gender Determination Kits when imported into the states of Punjab, Haryana, Rajasthan, Gujarat, Himachal country under the Customs Act. They were also Pradesh, Maharashtra and Delhi. This training programme requested to furnish details of such importers to facilitate will be conducted by the experts from National the Ministry to take appropriate action against them under Informatics Centre. the PC & PNDT Act.

Annual Report 2010-11 327 In response to the above request of this Ministry, the that contraceptive use is generally rising (see adjoining Customs Department informed that it has suitably alerted figure). Contraceptive use among married women (aged its field formations to seize the Gender Testing Kits 15-49 years) was 56.3% in NFHS-3 (an increase of 8.1 imported from abroad. Subsequently, the Central Board percentage points from NFHS-2) while corresponding of Excise & Customs on 1.4.2008 made certain increase between DLHS-2 & 3 is relatively lesser (from suggestions for consideration of this Ministry for 52.5% to 54.0%). The proximate determinants of fertility interception of the Gender Testing Kits effectively. In like age at first marriage and age at first childbirth (which the light of CBEC’s letter dated 1.4.2008 cited above, are societal preferences) are also showing good two rounds of Inter-Ministerial Meetings were held on improvements at the national level and adjoining figure 7.5.2008 and 16.5.2008 under the Chairmanship of Joint indicates the current position of social determinants of Secretary (PK), where the representatives of the Customs fertility in the country. Department, DGFT, DGHS and DCG (I) were invited to find a solution to the problem posed by the import of Gender Testing/Sex-Determination Kits. It was, inter alia, decided to amend the PC & PNDT Act, 1994 and the Rules/Regulations framed thereunder suitably to provide for establishment of a registration mechanism in the matter of import of ‘Gender Testing Kits’ and other similar medical kits. On the request of the Customs authorities, DCG (I) and DDG (M) have been requested to frame the required parameters for identification of the ‘Gender Testing Kits’ from among the similar kits imported into the Country. Sting operation carried out of BBC in Delhi and NOIDA: The sting operation conducted recently by BBC at NOIDA and New Delhi revealed that illegal sex determination tests were carried out at Dr. Mangala Telang’ clinics on an NRI couple from the U.K. This was reported in the website of BBC News.The Appropriate Authorities of Uttar Pradesh and NCT of Delhi were requested to inquire into the matter and furnish their respective reports thereon. In their respective reports, the State Governments indicated that inspection of the facilities of Dr. Mangala Telang at NOIDA and Delhi were carried out, the Premises and sealed and her registration suspended. In addition to the above, the Government of U.P. has filed a court case against Dr. Mangala Telang at NOIDA. 19.4 FAMILY PLANNING Background: Current family planning efforts: Nationwide, the small family norm is widely accepted (the wanted fertility rate for India as a whole is 1.9: The Family Planning (FP) Division is involved in the NFHS-3) and the general awareness of contraception is development, implementation and monitoring of strategic almost universal (98% among women and 98.6% among interventions for fulfilling the twin objectives of population men: NFHS-3). Both NFHS and DLHS surveys showed stabilization and promoting reproductive health within the wider context of sustainable development.

328 Annual Report 2010-11 The salient features of the family planning services are • The No Scalpel Vasectomy (NSV), a modified male as follows: sterilization technique, was introduced in 1997. • • Counselling, access to and provision of good quality Camp approach for male sterilization was adopted services and follow-up care. initially to re-popularize male sterilization method. Based on the experiential lessons from male • ‘Fixed Day Static Services’ (FDS) approach in sterilization camps in certain states a strategy on sterilization services to increase access. advocacy and community mobilization for increasing • Continuation of sterilization camps in the states with NSV acceptance through camps was introduced in high fertility till the time FDS is implemented 2005. effectively. • Human resource development with a three • Revised compensation scheme for sterilization pronged strategy for training surgical faculty from acceptors. Medical colleges, district NSV trainers and service providers is in place. • ‘National Family Planning Insurance Scheme’ (NFPIS) to cover service providers in both public Achievements in 2010-11: and accredited private facilities, where the clients • The camp approach was continued in most states are insured in the eventualities of deaths, across India (http://mohfw.nic.in/NRHM/FP/ complications and failures in sterilization and the Revised_Budget_Guidelines_CSS.pdf) providers/ accredited institutions are indemnified against litigations in those eventualities. • Training in NSV, was continued on a priority basis. • ‘Quality Assurance Committees’ (QACs) have As on September 2010: been constituted at state and district levels. o As per the latest report (HMIS) there are • The Division has repositioned IUD as short and long 9239 facilities in the country with trained term spacing method. NSV providers. • Guidelines have been developed and disseminated o Most districts in the country have district regarding use of Emergency Contraception Pills NSV trainer/s. (ECPs). o Surgical faculty training is being continued Increasing male participation in Planned in 2010-11 across five regional training Parenthood, including ‘No Scalpel Vasectomy’ centres and funds for the same are being (NSV): disbursed. • Increasing male participation in ‘Planned • The annual ‘National NSV Review Workshop’ was Parenthood’ is one of the major strategic themes of held in September 2009 to review states’ NPP-2000. performance in NSV, and top three performing • Promotion of NSV acceptance is one of the most states for the year 2008-09 (West Bengal, Punjab important & visible component of increasing male & Maharashtra) were felicitated. participation in RCH towards addressing the gender • NSV performance has continued its positive trend equity issues. and has shown an increase in 2009-10:

Achievements in Male Sterilization, Nationwide April –March* 2009-10 Annual April-September^ Contraception Period 2008-09 (lakhs) Change 2010-11 (lakhs) (%) (lakhs)

Male Sterilizations 2.52 2.74 8.7 0.77 Male Sterilization as % of Total Sterilization 5.2 5.5 4.7 Source: * MIS for NRHM as on November 2010 ^ HMIS RCH Reports accessed on 25th November 2010 Annual Report 2010-11 329 19.5. REVISED NATIONAL TB CONTROL Revised National TB Control Programme, facilities are PROGRAMME (RNTCP) provided free of cost to the TB patients. Thus the benefits of the Programme are uniformly available for all including For creating mass awareness, facts related to women and girls. For providing DOTS to the TB patients, Tuberculosis and Dos and Don’ts have been developed women self-help groups are encouraged to work as DOT and are available on the programme website providers. ASHAs, Anganwadi workers, Mahila Mandals (www.tbcindia.org). For IEC activities at States and etc are particularly involved for this purpose. District level, funds are released to them from the centre. The states are advised to publish information material on Under the Revised National TB Control Programme, tuberculosis in their local languages for distribution to the gender based data in respect of TB cases detected and masses particularly the weaker segment of the society. put on treatment and their outcome is monitored. TB affects all irrespective of age and sex. Under the Information on male to female ratio in different types of cases and treatment outcome is given below: Male to female ratio of different types of cases Patients registered 1q 2010 M:F Ratio 2q 2010 M:F Ratio 3q 2010 M:F Ratio MF M F M F NSP 106313 47569 2.2 : 1 120990 52780 2.3 : 1 109463 47897 2.3 : 1 Relapse 19705 6935 2.8 : 1 22470 7523 3.0 : 1 21526 7107 3.0 : 1 NSN 57338 34133 1.7 : 1 62101 37592 1.7 : 1 57336 35246 1.6 : 1 NEP 29407 27981 1.1 : 1 33670 31568 1.1 : 1 30023 28103 1.1 : 1 Total 212763 116618 1.8 : 1 239231 129463 1.8 : 1 218348 118353 1.8 : 1

NSP – New Sputum Positive Total cases (NSP, NSN, NEP & Relapse) put on NSN – New Sputum Negative treatment in the year 2010 (Jan – Sept) NEP – New Extra Pulmonary Male Female M:F Ratio 670342 364434 1.8

Treatment Outcome (NSP cases) in Males and Females, 3rd Quarter, 2009

Male % Female % Total % Cured 92664 83.8% 41633 87.1% 134297 84.8% Treat. Compl. 2968 2.7% 1229 2.6% 4197 2.6% Died 4941 4.5% 1631 3.4% 6572 4.1% Failure 2237 2.0% 763 1.6% 3000 1.9% Defaulted 6909 6.2% 2221 4.6% 9130 5.8% Transferred 920 0.8% 341 0.7% 1261 0.8% Total 110639 47818 158457

330 Annual Report 2010-11 19.6. DEVELOPMENT OF NURSING SERVICES Himachal Pradesh (1), Manipur (1) , Mizoram (1),& Uttar Pradesh (3) have been released grant-in aid during the Nursing Personnel are the largest workforces in a year 2010-11. The admission capacity has been kept as Hospital. They play an important role in the health care minimum 60 per institution. delivery system. 95% of the beneficiaries of this program are women only. Nursing Personnel are better equipped Allocation of Budget through this program to provide quality patient care in A sum of Rs.21.00 crores have been allocated in the the Hospitals and other settings also. Budget under the Development of Nursing Services during Activities undertaken under the Program for the year 2010-11 . Women Up Gradation/Strengthening of Nursing Services The activities under the programme of Development of under Human Resources Nursing Services are: Nursing Personnel are the largest workforces in a 1. Training of Nurses under in-services training Hospital. They play an important role in the health care scheme to update the knowledge and skills of delivery system. 95% of the beneficiaries of this program Nursing Personnel, are women only. Nursing Personnel are better equipped through this program to provide quality patient care in 2. Strengthening of Schools and Colleges of the Hospitals and other settings also. Nursing to improve the quality of Nursing education and basic Training Program. About Activities undertaken under the Program for 95 % of the candidates opting for Nursing Women Courses are females only. The activities under the programme of up gradation/ (1) Training of Nurses. strengthening of Nursing Services under Human Resources include; In order to update the knowledge and skills of the nursing personnel, Continuing Nursing Education Programme was Opening of ANM / GNM Schools started in the area of Nursing Specialty for the Staff Faculty Development programme. Nurses, Education Technology for the faculty of the Schools and Colleges of Nursing, Management Allocation of Budget Techniques for the Nursing Administrators. It is conducted A sum of Rs.250.00 crores have been allocated in the for 7 days. The venue will be in the selected College of Budget under the Upgradation/ Strengthening of Nursing Nursing in the state. The pattern of assistance for Services during the year 2010-11 conducting Continuing Nursing Education Programme has been revised from Rs. 75,000 /- to 1,65300/- to train 30 CCEA has approved this Ministry’s proposal for opening Nurses. of 132 ANM Schools and 137 GNM Schools in those districts of the states where there are no such schools. (2) Strengthening / Upgradation of Schools/ 154 districts in 23 High Focus States have been identified Colleges of Nursing. having no ANM and GNM schools. A Sum of Rs. 123.00 In order to improve the quality of training imparted at the crore has been approved so far for release under the existing Schools and Colleges of Nursing grant is released new scheme of Opening of ANM /GNM Schools to ten towards procurement of A.V Aids, furniture, improvement (10) states. of library, additions/alterations of building and transport. In order to meet the shortage of qualified Post Graduate A grant of Rs. 10.00 lakhs is provided per institution during teachers in nursing to improve the quality of nursing the Xth Plan period. education in the high focused States a faculty 3. Upgradation of Schools of Nursing attached Development programme has been approved and 22 nominations have been received from 7 States for under to Medical Colleges into Colleges of going training in M.Sc (Nursing) at the identified Nursing. Institutions wiz. SNDT College of Nursing, Mumbai, 20 institutions in the states of Rajasthan (5), Jharkhand PGIMER, Chandigarh and Govt. College of Nursing, (3) Gujarat (2). Tamil Nadu (2), West Bengal (2) SSKM Hospital, Kolkata.

Annual Report 2010-11 331 ORGANISATION CHART OF DEPARTMENT OF HEALTH & FAMILY WELFARE

ANNEXURE

a v a t s a v i r S n i v a r P i r h S

) s t a t S ( l a r e n e G r o t c e r i D . y D

Annual Report 2010-11 335

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, i t h a B . K . R . h S

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h g n i S . P . V . h S a t p u G

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. r i D . t t s s A

, r a m u K . P . G . r D

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. l d d A

a t p u g n e S . K . N . h S

336 Annual Report 2010-11

g n a r a N . P . R . h S

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h s i h s a b e D . h S

Annual Report 2010-11 337

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. S h U S

338 Annual Report 2010-11 Annual Report 2010-11 339 u r u l a g n a B

340 Annual Report 2010-11 l a . p R a . r t G

e . h h K S , r a m r a P

Annual Report 2010-11 341 342 Annual Report 2010-11 . s M

Annual Report 2010-11 343

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344 Annual Report 2010-11 Annual Report 2010-11 345 346 Annual Report 2010-11 Annual Report 2010-11 347 348

Organisation Chart of Directorate General of Health Services (Channel of Submission of Technical Matters) (As on 1st January, 2011) Annual Report2010-1 1 No. of Paras/ PA/Reports on which ATNs have been submitted to PAC after vetting by Audit

Annual Report 2010-11 349