Integrated District Health Action Plan: District 2010-11

Prepared by: District Planning Team Dr. Jim King Jajo, Dr. Rubinson, Dr. Nelson Vashum, Dr. Chisti, Dr. Kapanring, , Dr. Manik S, I. Rajeev, Rangam K.

CONTENTS

Preface Message from Deputy Commissioner Message from District Mission Director Executive Summary 1. District Profile 2. Introduction to NRHM About NRHM Components of NRHM Core strategies State Planning Process 3 Situational Analysis 3.1 Public Health Facilities in the state 3.2 Private Health facilities 3.3 Human Resources in the state 3.4 Status of Logistics 3.5 Training Infrastructure 3.6 BCC Infrastructure 3.7 ICDS programme 3.8 Elected representatives of PRI 3.9 NGOs/ CBOs 3.10 District / sub-district variations 3.11 Gender Equity 3.12 HMIS/ M&E 3.13 Convergence/ coordination 3.14 Finance Utilization 3.16 Institutional arrangements 3.17 DP(Door Assisted) 4 Lessons learned: 2005-10 5 Key issues to be addressed 6 Findings from FGD 7 Findings from VHAP 2010-2011 Part “A” --- RCH interventions Part “B” - New Interventions in NRHM Part “C” - Immunisation Strengthening Part “D” - National Disease Control Program and IDSP Part “E” - Inter-sectoral convergence Total Budget for 2008-09

PREFACE

The Integrated Program Implementation Plan (PIP) for of is prepared for the year 2010-11 as per the Government of guidelines and directions. A detailed exercise was undertaken for reflecting the Village, Block and District needs in the PIP. The district conducted Household Survey, Consultation meetings, Open Focus Discussion and Facility Surveys for unearthing the problems and issues in the health sector of the respective blocks. At the District level, workshops were done where all the District Level Officers namely Chief Medical Officer,District Program Manager and the District Program Officers of the various National Disease Control Programs were invited. Also desk reviews, analysis of the available district data and indicators, NFHS-2, NFHS- 3 Survey reports, DLHS-2 reports, SRS reports were done for preparing the Distinct PIP. The requirements of the District for NRHM initiatives are projected reasonably in the PIP. Work Plan for the activities, timeline for completion of the activities and budgeting are done as per the guidelines. The District and Blocks will ensure adequate monitoring and evaluation for assessing the improvement in the progress of activities and for taking corrective measures wherever necessary. Specific activities for the vulnerable groups are also reflected in the District PIP.

The District is thankful to the Government of India officials as well as State Officials for their timely directions and help without which it would have been difficult to frame the District and Blocks PIP. Also, the District is grateful to the Regional Resource Centre for North-east States (RRC-NE) for their technical support and guidelines during preparation of the Integrated District PIP. Further we also thank to PHRN for their valuable training on District Planning.

Message

The National Rural Health Mission was launched all over India in April 2005. It is an endeavor to uplift the health status of rural population in India. It also assumed that the health and well being of the population is basic right of citizen and provisioning of services is done by the District in different levels. There also exist the role and equal participation of people in Health care provisioning including Village Authority involvement. Within this context, we belief that National Rural Health Mission having a holistic approach that will enhance utilization of health services and mitigate the gaps deterimental to accountability, effectiveness, affordable and accessible health care system. I truly judge that the District Health Action Plan 2010-11 described here could not have been under taken without the support and commitment of many people. We wish to take this opportunity to express our gratitude to all the people who have contributed to this work for their patience in improving access to health care and quality services for people living in Ukhrul District. This District Health action Plan would not have been as successful, or thorough, without the attention given by Chief Medical Officer and District Immunization Officer and all the Medical Officers at the periphery. And special thanks should go to District Program Manager, DPMU Team and BPMU Team for their consistent inputs in the planning process. Further we all are grateful to Chief Secretary, Commissioner (H & FW), State Mission Director and State Planning Team for bringing into this stage of implementation of NRHM in Ukhrul District.

-Sd- (N. Ashok Kumar) Deputy Commissioner/Chairman District Health Mission Society Ukhrul District

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Message

The vision of the National Rural Health Mission at District level is to improve the health services system access to rural population, especially the poor women and children to equitable, affordable, accountable and effective primary and secondary health care. The approach under taken in formulation of District Health Action Plan 2010-2011 is designed as Bottom Up Approach from Village to Block and to District. I am happy that DHAP 2010-11 has been brought out in which the existing status of Health and Family Welfare services in the district is highlighted. The Plan has been evolved after incorporating all the Village, Block and District reality and in-depth analysis of the felt needs of the people has been rationally included in the PIP by the District Planning Team with the guidance and consistent efforts of many, whose individual names have not been able to mention here. I express my gratitude and indebtedness to all of them. The DHAP is a document, first of its kind in the entire district to reform the health services system structurally and functionally to uplift the District Health Status through the process of decentralization and commoditization down to the village and block. I hoped that the DHAP will transform into reality so that, by and by, the people of the District will begin to enjoy its fruit.

-Sd- (Dr. Jim King Jajo) District Mission Director/Chief Medical Officer District Health Mission Society Ukhrul District

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Executive Summary

Ukhrul District is one of the 9 Districts in Manipur. It is a hilly District almost 99 per cent populated by Tribal in an area of 4554 sq. Km having a population of 140778 (Census 2001). The District is divided in 5 Sub-divisional Blocks. In the district, there is relatively weak health infrastructure, poor transport and communication facilities and bad law & order situation prevailing in the District. The Health Indicators of the district are very poor than that of the National figure. The second phase of National RCH 2 programme was launched in April 2005. The programme aims to achieve National Population Policy (NPP) goals with reference to IMR, U5MR, MMR and TFR. District RCH PIPs reflect on a set of technical strategies and activities to achieve these goals. RCH components under the National Rural Health Mission (NRHM) was launched to provide effective health care to rural population throughout the District with special focus on rural population and deeper to most vulnerable population in the District with weak public health indicators. It also aim to expedite achievements of policy goals by facilitating enhanced access and utilization of quality health services, with an emphasis on addressing equity and gender dimension. Vision Statement: It is to ‘enhance health care delivery services to rural population, especially to poor mother and child with effective, affordable, accountable and accessible or user friendly services to the community’.

The present DHAP 2010-11 under NRHM have five components: 1. Part A - RCH-II 2. Part B - New Initiatives under NRHM 3. Part C - Immunisation Strengthening 4. Part D - Disease Control Program 5. Part E - Program Convergence.

The summary budget requirement for components for under NRHM (2010-11) is :

Sl. No NRHM Components Rs. In Lakhs 1 Part A - RCH-II 232.285

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2 New Initiatives under NRHM 1069.961 3 Immunisation Stregthening 8.88 4 Disease Control Program 73.16 5 Program Convergence. -

Grant Total 1384.286

1. Ukhrul District Profile

Sl. Background characteristics District State No 1 Geographic Area (in Sq. Kms) 4544 22,327 Number of districts 1 09 (5 hilly 2 districts) Number of blocks 5 36 3 No. of Village as per census 2009 198 No. of Village (As per Survey) 198+87 Size of Villages (Census 2001) 1-500 124 229 4 501-1000 41 1653 Above 1000 33 433 Total Population (Census 2001) 23.88 Lakhs -Urban 5,70,410 -Rural 140778 (23.8%) 5 - SC population 18,18,224 - ST population 134493 (76.2%) Projected population 2010 159273 5% 38% Sex Ratio (Census 2001) 6 • Sex Ratio 916 978 • Under 6 Child Sex Ratio 946 957 7 Decadal Growth Rate (Census 2001) 29 30.02% 8 Density- per sq. km. (Census 2001) 31 107 Literacy Rate (Census 2001) 73 % 9 -Male 50,208 77.87% -Female 37,341 59.7% No. ofvillage with at least one primary 198 4089 10 schools 4501 No. of Anganwadi Centres 11 Length of road per 100 sq. km - 49

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% of villages having access to safe - 32.7 12 drinking water facility (NFHS-3) % of households having sanitation - 95.5 (NFHS-3) 13 facility (NFHS-3) % of household having electricity 78.2 87 (NFHS-3) 14 connection (NFHS-3) 15 % of population below poverty line - 32.1 1DHs, 1 CHC, 1 RIMS,1 SH, 7 6, PHCs, 39 DHs, 16 CHCs, 16 Health Facilities SCs, 2 Pvt. 72, PHCs, 420 Clinics / Hosp. SCs, 33 Pvt. Clinics / Hosp.

1.1 Block Profile

SN Variable Ukhrul Kasom kl. Total Population 1 1991 18536 61444 12124 10830 6341 2001 25151 79191 12937 13293 10206 Decadal Variation % 36 29 7 23 61 1a Projected Population 28456 89619 14637 15029 11548 2010 1b Projected Pregnant 595 1873 306 314 241 Women 1c Projected Infant 541 1703 278 286 219 0-1 yrs 2 PHC/CHC 65 km 20-24 km 81 km 65 km 185 km Distance from DH PHC- 3PHC CHC- PHC- PHC Chingai Kamjong Phungyar Kasom 4 No. of Village Coverage 27 66 41 35 29 by Block PHC 5 No. of SPHC 07 15 06 07 04 6 Size of Villages 1-500 12 27 35 27 23 501-1000 3 20 4 8 6 1000- above 12 19 2 0 0 9 Source of drinking 27 66 41 35 29 water facility* 10 Sanitation facility 11 No. of Village with 9 13 2 35 26 Approach paved road 12 No. of Village with 27 51 20 35 22 Power supply

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13 No. of Village with at 27 66 41 35 29 least one primary school Source: Statistical abstract of Manipur 2005, Village Census data, Census 2001, * mostly spring water

1.2 Data available from the HMIS

ANC Performance for Ukhrul District during April-October 2009 Cumulative Service Number % ANC HIV tested 968 29.60 ANC HIV tested positive out of tested 968 21 2.16 ANC registration within first trimester 666 20.40 ANC third visit 491 15.00 ANC TT1 dose 1124 34.45 ANC TT2/Booster dose 906 27.70 ANC given 100 IFA tablets 229 7.02 ANC having Hb level < 11 (tested cases) 90 2.75 Target for PW = 3262 target for infants=2966 (projected)

Delivery Performance for Ukhrul District during April-October 2009

Cumulative Service Number % Deliveries at accredited Private Institutions 303 10.21 Deliveries conducted at CHCs 23 0.77 Deliveries conducted at PHCs 29 0.97 Deliveries conducted at Sub Centre 6 0.20 Deliveries conducted at District Hospital 116 3.91 Delivery Complicated IV Oxytocics 66 2.22 Delivery complicated -Caesarean Section performed at private facility 50 1.69

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Delivery complicated treated with IV antibiotics 4 0.13 Delivery complicated treated with IV antihypertensive 6 0.20 Delivery home by Non SBA (Trained TBA / Relatives/etc) 202 6.81 Delivery home by SBA (Doctor/Nurse/ANM) 136 4.58 Delivery home receiving JSY incentive 364 20.46 Delivery institutional discharged under 48 hours of delivery 263 72.85 Delivery private & public institutional JSY incentive paid to Mothers 353 97.78 Post partum checkup within 48 hours after delivery 152 42.10 Post-Partum sterilization conducted at Private facilities 8 - Pregnant women identified with obstetric complication and treated at private institution 24 0.80

Target for PW = 3262 target for infants=2966 (projected) Eligible JSY= 1779, No. of Institutional Delivery=361

Immunisation Performance for Ukhrul District during April-October 2009

Cumulative Service Number % BCG dose under 1 year 1636 55.15 DPT 1 dose given under 1year 1616 54.48 DPT 2 dose given under 1year 1494 50.37 DPT 3 dose given under 1year 1468 49.49 Measles 1st dose at 9-12 months 1176 39.64 Measles cases 29 0.97

Target for infants=2966 (projected)

Family Planning Performance for Ukhrul District during April-October 2009

Cumulative Service Number Abortions spontaneous / Induced 8 IUD Inserted at private facilities 27 IUD Insertions CHCs 6 IUD Insertions PHCs 2 IUD Insertions Sub-divisional hospital/District Hospital 31 IUD Removed 2 Mini-Laparoscopic conducted at Private 2

10 facilities Centrchroman (Weekly) pills issused 2 Condoms units distributed 1123 Emergency contraceptive pills issued 10

Other service Performance for Ukhrul District during April-October 2009

Cumulative Service Number Diarrhoea and dehydration cases 810 Eclampsia cases managed 3 Female live birth breastfeeding in first hour 119 Female live births weighed 257 Female live births with less than 2500 grms 2 HIV tested Female-Non ANC 130 Malaria 24 Malaria blood smears examined 2647 Male Live births weighed 303 New RTI/STI cases treatment initiated female 44 New RTI/STI cases treatment initiated male 11 Pneumonia cases / Respiratory infection admited 56 Rogi Kalyan Samiti meetings held 33

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2. Introduction to NRHM and District Planning

The Hon’ble Prime Minister launched the NRHM on 12th April, 2005 throughout the country with special focus on 18 States, including eight Empowered Action Group (EAG) States, the North-Eastern States, Jammu & Kashmir and Himachal Pradesh.

The NRHM seeks to provide accessible, affordable and quality health care to the rural population, especially the vulnerable sections. It also seeks to reduce the Maternal Mortality Ratio (MMR) in the country from 407 to 100 per 1,00,000 live births, Infant Mortality Rate (IMR) from 60 to 30 per 1000 live births and the Total Fertility Rate (TFR) from 3.0 to 2.1 within the 7 year period of the Mission.

2.1 About NRHM

The National Rural Health Mission (NRHM) aims to provide for an accessible, affordable, acceptable and accountable health care through a functional public health system.

It is designed to galvanize the various components of primary health system, like preventive, promotive and curative care, human resource management, diagnostic services, logistics management, disease management and surveillance, and data management systems etc. for improved service delivery.

This is envisioned to be achieved by putting in place an enabling institutional mechanism at various levels, community participation, decentralized planning, building capacities and

12 linking health with its wider determinants. It also aims to expedite achievements of policy goals by facilitating enhanced access and utilization of quality health services, with an emphasis on addressing equity and gender dimension.

2.2 Vision

• To provide effective healthcare to rural population throughout the country with special focus on 18 states, which have weak public health indicators and/or weak infrastructure. • To increase public spending on health from 0.9% GDP to 2-3% of GDP, with improved arrangement for community financing and risk pooling. • To undertake architectural correction of the health system to enable it to effectively handle increased allocations and promote policies that strengthen public health management and service delivery in the country. • To revitalize local health traditions and mainstream AYUSH into the public health system. • Effective integration of health concerns through decentralized management at district, with determinants of health like sanitation and hygiene, nutrition, safe drinking water, gender and social concerns. • Addresses inter State and inter district disparities. • Time bound goals and report publicly on progress. • To improve access to rural people, especially poor women and children to equitable, affordable, accountable and effective primary health care.

2.3 Objectives of NRHM

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

2.4 Components of NRHM

NRHM has the following five components

• Part “A” deals with RCH -II • Part “B” deals with new components / additionalities of NRHM. This part contains Untied funds to Subcentres, Up-gradation of institutions to IPHS, RKS, AYUSH mainstreaming etc. • Part “C” consists of Immunization Strengthening interventions

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• Part “D” contains all the National Health Programs and IDSP • Part “E” deals with Convergence of activities with the Health Determinant Departments whose activities are indirectly connected with Health activities

2.5 Core Strategies of the Mission

• Train and enhance capacity of Panchayati Raj Institutions (PRIs) to own, control and manage public health services. • Promote access to improved healthcare at household level through the female health activist (ASHA). • Health Plan for each village through Village Health Committee of the Panchayat. • Strengthening Sub-centre through better human resource development, clear quality standards, better community support and provision of untied fund to enable local planning and action. • Strengthening existing health facilities through better staffing and human resource development policy, clear quality standards, better community support and an untied fund to enable the local management committee to achieve these standards. • Provision of 30-50 bedded CHC per Lakh population for improved curative care to a normative standard. (IPHS defining personnel, equipment and management standards, its decentralized administration by a hospital management committee and the provision of adequate funds and powers to enable these committees to reach desired levels) • Preparation and implementation of an inter sector District Health Plan prepared by the District Health Mission, including drinking water, sanitation, hygiene and nutrition. • Integrating vertical Health and Family Welfare Programme at National, State, District and Block levels. • Technical support to National, State and District Health Mission, for public health management • Strengthening capacities for data collection, assessment and review for evidence based planning, monitoring and supervision. • Formulation of transparent policies for deployment and career development of human resource for health. • Developing capacities for preventive health care at all levels for promoting healthy life style, reduction in consumption of tobacco and alcohol, etc. • Promoting non-profit sector particularly in underserved areas.

2.6 Approaches of NRHM Communities: The District is having a good convergence with the PRI starting from the Village Authority which is helping in the implementation of the program. Rogi Kalyan Samitis are formed in 1 District Hospital, 1 Community Health Centres, 6 Primary Health Centres and 40 PHSC and are functioning for the improvement of the respective health institutions. All these committees are registered and bank accounts of the concerned committees are also opened. In addition to above 40 VHC at PHSC level and 302 VHSC at Village level were formed having opened their respective Bank Account. For the Village Health Committees formed at the Sub 14 centres, the Headman/Chairman, VA is made the joint signatory with ANMs in the Sub-Centre Village. The Village Health and Sanitation Committees helped in the observance of the Village Health and Nutrition Days with close ties with the PRI and AWWs. Strengthening Management: For strengthening the management capacity throughout the District DPMU and BPMUs were recruited and capacitated for 18 Day training on Health Management. Rreview meetings, workshop on various programmatic areas were done. Flexible Financing: Considering the flexibility of funding the prepared PIP is based on the bottoms-up approach which will help in the sustainability of the National Rural Health Missions activities. Untied funds and Maintenance Grants are given to 40 PHSC to cater the need of the Subcentres in time. The same is provided to PHC and CHC also. Corpus Fund and Grants are also provided to the PHCs, CHCs and DH to use for the developmental activities at the concerned facilities. Monitoring and evaluation: Monitoring is done from time to time for every activity taken up under NRHM. Monitoring and Evaluation team for JSY is formed for the District. Monitoring can also be done from the reports reflected in the monthly M & E format submitted from the Health facilities. Activities taken up by the Village Health Committees are monitor through the proceedings submitted for discussion on taking up the activities. Attending meeting of the RKS is also a means for monitoring the RKS societies. From 2009-10 the monitoring and supervision are being done by the BPMU team too for all program including Monthly Village Health and Nutrition Day.

2.6.1 Management Structure at District level

A. At District level

Deputy Commissioner, Chairman, DHMS

Chief Medical Officer District Mission Director

District Program District Health DFWO / DIO Manager Officers

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District Data District Finance Manager (DPMU) Manager (DPMU)

B. At Block Level

SMO / MO CHC / BLOCK PHC

Block Health Other MOs in the Program Manager Block

Block Finance Block Data Manager Manager

2.6.2 Sampling procedure for preparation of District PIP

For the preparation of the PIP, Village Information System was conducted by ASHAs for rural area. The Blocks were asked to conduct the Facility Survey covering all the health institutions of the District i.e. 40 Sub centres, 6PHCs, 1 CHCs and 1 DH. An Assessment on RCH was conducted through 30X10 sampling method. In addition, Focus Group Discussion was conducted for ASHAs regarding MCH and Immunisation. 17 Village Health Action Plan were prepared.

2.7 District Planning Process

2.7.1 Origin of the Study Preparation of District Health Action Plan is felt an important aspect to facilitate the planning and management components thereby improved the overall health status in the District. It envisages at the Governing Body level that a proper planning starting from Village, Block and

16 consequently to district and has to be empowered through Village Health Planning Team, Block Health Planning Team and District Health Planning Team. District Planning Teams comprising of Deputy Commissioner as Chairperson and others as members District Mission Director, District Program Management Unit staffs, District level Program Officers of Health and Family Welfare, District Head of Health Determinant Departments and representatives of leading NGOs were formed. At Block levels also Block Planning Teams led by SDO/BDO, MOs CHC/PHC, RKS Members with the Block Program Management unit Staffs were formed.

The following activities were done to bring out a comprehensive integrated District PIP for the year 2009-10.

I. District Authority has given Capacity Building on Health Planning and Management and also instructed to blocks and detailed documents are provided to enhance the planning process at the Block level as well as Village level. II. 30X7 cluster survey was done Ukhrul District in January 2008. III. FGD were conducted in 25 villages regarding RCH and Immunisation. IV. 17 villages have done VHAP in the District

The following timeline was followed in the 5 blocks of the district.

TIME LINE FOR VHAP, BHAP, DHAP 200=10-2011

Sl. Dated Activities Responsibility No 1 September & 25 villages were cover for FGD BPMU Facilitated by October in the whole district MO i/c DPM 2009 2 1st to 10th Household Survey by ASHA MO ic , BPMU Team November for 98 villages 2009

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3 28th Selection of Village based on MO ic , BPMU Team November HMIS low health indicator 2009 PHSC Village and Non PHSC Village Population more than 500 4 4th December 1st STEP BPMU 2009 Meeting of the VHSC 2nd STEP Selection of Nodal Officer for Village Planning (ASHA) 3rd STEP Orientation of VHSC members on VHAP by Block facilitator in selected 3 villages

5 5th December Resource Mapping & Disease mapping BPMU 2009 of the village and Analysis of information collected from the field visit, Survey and HMIS

6 6th December Final Visit to Field for finalization of BPMU 2009 VHAP 2010-2011 Approval by VHSC 7 10th Consultative Workshop for BHAP at CMO/DIO/DPMU/DLOs December District Health Quarter 2009 8 15 December Presentation & Finalization of DHAP DC/CMO/DPM 2009 2010-2011, Approval by Deputy Commissioner

3. Situational Analysis

3.1 Public Health Facilities in the District

Number Health Facility Government Total Rented Buildings District Hospital 1 1 0 CHC 1 1 0 PHC 6 2

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Subcentre 40 20 Accredated Private 2 2 Hospital Dispensary 5 0 District Council

The District has 34 building-less Sub-centres out of the total 39 Sub-centres which hampers progress in institutional delivery. Under Part “B” Construction of 14 PHSC has already been sanction during PIP 2007-08 and the work progress is 90 % complete. During 2009-10 5 more PHSC were approved under NRHM. Another 8 PHSC were approved from Health Department under SCA/ACA funding 2009-2010. The remaining 7 building-less Subcentres need to be constructed so it is propose in the PIP 2010-11. At present 40 Additional ANMs are approved and posted in 40 Sub-Centres. For the CHC Kamjong, up-gradation of CHC has been completed during 2008-09 and now additional 6 MOs have seen station under NRHM. There is no regular specialist and Non Specialist MBBS Doctor in the CHC. Again one AYUSH Doctor is posted to look after AYUSH Component. Currently District have 3 PHC without building namely Knagkhui PHC, Lambui PHC and Phungyar PHC. During 2009-2010 2 PHC Building have been approved under NRHM and the remaining 1 PHC is propose in the coming financial year 2010-11. 2 private hospital are accredited for MCH Services in the District. One of the Hospital can perform Caesarian Section.

3.1.1 Current status and target for Public health infrastructure

In Position Target in No. Facility Required Sanctioned (as on 2010-11 (31/12/09) (Cumulative) 1 Sub-centres

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1.1 Sub-centres 51 40 40 2 functional 2 Primary Health 6 6 6 1 Centres 3 PHCs offering 24 hour services 3.1 PHC 6 4 0 2 4 CHCs functioning as FRUs 4.1 0 1 0 0 5 District Hospitals 5.1 DHs functioning as FRUs 0 0

As per standard every 3000 population can have a PHSC. Since Ukhrul projected population is 155795, it can have 51 PHSC. So far 40 PHSC have been sanctioned. 6+14 PHSC are functioning in Government building and remaining 20 PHSC are still in rent. 13 new PHSC building are approved under SCA/ACA/NRHM fund. Construction is in process. The remaining 7 building less PHSC will be propose during 2010-2011.

At present 6 PHC are functional, 3 in Institutional Building and another 2 in rented building. During 2009-2010 2 PHC new building have been approved. During 2010-11, 1 (one) PHC new building will be propose. Out of 6 PHC 4 have been identified as 24X7 PHC. During 2010-11 another 2PHC will be identified as 24x7 PHC so that all the 6PHCs will be functional as 24X7 Plan. PHSC Tolloi is upgraded to PHC status so a new building shall be requested. In addition 2 new PHSCs are proposed for sanctioning at Chinjaroi and Kaziphung as the population for that village is more than 3000.

As for CHC, is has been up-graded during 2008-09 and completed. So far no fund has been approved except Seed fund for District Hospital Ukhrul. Infrastructure for Blood Bank, waste disposal ,OT Functionality and Repairing of District Hospital including Male ward, Female Ward and Child ward are needed through NRHM.

3.2 Private Health Facilities

Private Services Facilities Number and location.

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Multi-Specialty Nursing Homes Nil Solo Qualified Practitioners Nil Practitioners from AYUSH Nil Approved MTP centres in Private sector 2 RMPs (Less than formal qualified Nil practitioner) Number of nursing homes with facilities for Nil comprehensive emergency obstetric care Accredited centres for sterilization service 2 Accredited centres for IUD services 2

2 nursing home (Leishiphung Hospital and Comprehensive Marenal care and Research Organisation) having facilities of Comprehensive Emergency Obstetric Care (CEmOC). Public Private Partnership (PPP) with these institutions has been undertaken on MCH services in 2008- 09. The possibility of establishing partnership in family planning matter has been explored. These institutions have been accredited for JSY Scheme from April 2008.

3.3 Human Resource

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3.3 Human Resources in the District

Sl.N Sanctione Existin Actu Categor Remar o. Name of Post/Designation d g al y ks Strength Strengt Reg/Co h n OFFICE OF THE CHIEF MEDICAL OFFICER, AND VERTICAL PROGRAM, UKHRUL DTO i/c as 1 CHIEF MEDICAL OFFICER (CMO) : 1 0 0 R CMO 2 DISTRICT PROGRAM OFFICER: 5 5 5 5R 3 DISTRICT EXT. MEDIA OFFICER 1 0 0 0 4 DPHNO 1 1 1 R DISTRICT MALARIA TECHNICAL 5 SUPERVISOR 1 1 1 C 6 DOCTOR IN RNTCP 1 1 1 C 7 EXTENSION EDUCATOR 2 1 1 R 8 HEAD CLERK 1 1 1 R 9 MEDICAL STORE OFFICER (MSO) : 1 0 0 R 10 DISTRICT FOOD INSPECTOR (DFI) : 1 0 1 R 11 PHARMACIST (ALLO) : 7 5 5 R 12 HEALTH EDUCATOR 1 1 1 R 13 STAFF NURSE 1 1 1 R 14 NMS 1 1 1 R 15 NMA 1 1 1 R 16 BCG TECHNICIAN 1 1 1 R 17 PHYSIOTHERAPIST TECHNICIAN 1 1 1 R 18 SENIOR TREATMENT SUPERVISOR 1 1 1 C 19 SENIOR TB LAB SUPERVISOR 1 1 1 C 20 LAB TECHNICIAN 1 1 1 C 21 PRIMARY INVESTIGATOR (PI) : 1 1 1 R 22 DATA ENTRY CUM ACCOUNTANT 1 1 1 C 23 COMPUTERS : 2 1 1 R 24 STATISTICAL ASSISTANT (SA) : 2 0 1 R 25 PROJECTIONIST : 1 1 0 U

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Sl.No Sanctione Existing Actua Categor Remarks . Name of Post/Designation d Strength Strengt l y h Reg/Con OFFICE OF THE CHIEF MEDICAL OFFICER, AND VERTICAL PROGRAM, UKHRUL UPPER DIVISIONAL CLERKS 1U 26 (UDCS) : 3 3 4 R LOWER DIVISIONAL CLERKS 1U 27 (LDCS) 3 3 4 R 28 DISTRICT M 29 MALE HEALTH SUPERVISOR 4 3 2 R 30 FEMALE HEALTH SUPERVISOR 1 1 1 R 1U 31 MALE HEALTH WORKER 3 3 3 R 32 FEMALE HEALTH WORKER 1 1 2 R 1U 33 FIELD WORKER 5 3 3 R 34 LAB TECHNICIAN 1 1 2 R 35 MICROSCOPIST 2 2 2 R 36 DRIVERS (LIGHT) : 7 2 4 R 37 GRADE IVS : 9 7 7 R 38 PEONS (MESSENGERS) : 3 2 2 R 39 CLEANER : 1 1 1 R 40 CHOWKIDARS (WATCHMEN) : 2 2 1 R 41 SWEEPER : 3 3 3 R 42 STRETCHER BREARER : 1 1 1 R

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Sl.No. Sanctioned Existing Remarks Name of Post/Designation Actual Category Strength Strength Reg/Con VI. A. DISTRICT HOSPITAL, UKHRUL

1 MEDICAL SUPERINTENDENT 1 0 1 R

2 ANAESTHETIST 1 1 1 R

3 OBS & GYNAECOLOGIST 1 0 0 R

4 ORTHOPAEDICS 1 0 0 R

5 PAEDIATRICIAN 1 1 1 R

6 PATHOLOGIST 0 1 1 R

7 RADIOLOGIST 1 0 0 R

8 SENIOR MEDICAL OFFICERS 2 1 0 R

9 MEDICAL OFFICERS 8 3 7 R

10 MEDICAL OFFICER (AYUSH) 1 1 1 R

11 DENTAL SURGEONS: 2 1 1 R

12 MATRON : 1 0 0 R

13 NURSING SISTERS 5 1 1 R

14 MEDICAL RECORD OFFICER 1 0 0 R

15 STEWARD 1 0 0 R

16 PHARMACISTS (ALLO) 4 3 3 R

17 PHARMACISTS (HOMEO) 2 1 1 R

18 STAFF NURSES 29 18 16 R

19 MEDICAL RECORD TECHNICIAN: 1 0 0 R

20 LABORATORY TECHNICIANS: 4 4 2 R

21 LABORATORY ASSISTANT: 1 1 0 R CENTRAL STERILIZATION ROOM 22 TECHNICIAN: 1 1 1 R

23 OPHTHALMIC ASSISTANT: 1 1 1 R

24 AUDIOMETRIC ASSISTANT - 1 1 R

25 DRESSER: 1 0 0 R

26 DRIVERS (LIGHT): 2 1 1 R

27 LOWER DIVISIONAL CLERKS (LDC) 3 2 1 R

28 RADIOGRAPHER 1 1 1 R

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29 CHOWKIDARS (WATCHWO/MEN): 2 2 2 R

30 CLEANERS: 2 2 1 R

31 COOKS : 3 3 3 R

32 DHOBIS (WASHER WO/MEN): 2 1 1 R

33 PEONS/MESSENGERS : 2 2 2 R

34 SWEEPERS: 6 4 4 R

35 MASSALCHI: 1 1 1 R

36 AYAHS: 3 2 2 R

37 WARD ATTENDANTS: 17 13 14 R

38 MALI-cum-WATER CARRIER: 1 1 1 R

Sl.No. Sanctioned Existing Remarks Name of Post/Designation Actual Category Strength Strength Reg/Con

VI. B. RURAL FAMILY WELFARE CENTRE (RFWC), DH

1 MEDICAL OFFICER: 1 1 0 R

2 EXTENSION EDUCATOR: 1 1 1 R

3 FEMALE HEALTH SUPERVISORS: 1 1 2 R

4 COMPUTER : 1 1 1 R

5 FEMALE HEALTH WORKERS (FHWs)/ANMs: 1 1 2 R

6 COMMUNITY ORGANIZER: 1 1 0 R

7 DRIVER (LIGHT) : 1 1 0 R

8 GRADE IV : 1 1 1 R

Sl.No. Sanctioned Existing Remarks Name of Post/Designation Actual Category Strength Strength Reg/Con

DISTRICT HEALTH SOCIETY, UKHRUL DISTRICT MEDICAL MOBILE UNIT:

1 DPM 1 1 1 C

2 DAFC 1 1 1 C

3 MNMEO 1 1 1 C

4 Computer Operator 1 1 1 C

5 LABORATORY TECHNICIAN: 1 1 1 C

6 X-RAY TECHNICIAN: 1 1 1 C

7 DRIVERS (HEAVY) : 1 2 2 C

8 GRADE IV/MESSENGER/PEON: 1 1 1 C

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Sl.No. Sanctioned Existing Remarks Name of Post/Designation Actual Category Strength Strength Reg/Con

VII. A. COMMUNITY HEALTH CENTRE : KAMJONG

1 MEDICAL OFFICERS: 6 0 6 6C 2U AT JNIMS 2 STAFF NURSES: 8 8 7 7R1U & Kasom Kl.

3 COMMUNITY HEALTH OFFICER : 1 0 0 -

4 FEMALE HEALTH SUPERVISOR (FHS) : 1 0 0 -

5 PUBLIC HEALTH NURSE (PHN): - 0 1 C

6 MALE HEALTH SUPERVISOR (MHS): 2 2 2 R DH 7 HEALTH EDUCATOR : 1 1 1 1R1U CMO 8 MICROSCOPIST : 1 1 0 U

9 OPTHALMIC ASSISTANT : 1 1 1 R SC 10 PHARMACIST (ALLO): 2 2 2 1R1U

11 LABORATORY TECHNICIAN: 1 1 1 R CMO 12 UPPER DIVISIONAL CLERK: 1 1 0 1U

13 LOWER DIVISIONAL CLERK: 1 1 1 R

14 FEMALE HEALTH WORKERs/ANMs: 2 2 3 2R1C

15 DRIVER (LIGHT): 1 0 0 -

16 CHOWKIDAR (WATCHWO/MEN): 1 0 0 -

17 DHOBI (WASHERWO/MEN): 2 2 2 R

18 GRADE IVs: 3 3 3 R

19 PEONS/MESSENGERS: 2 1 1 R DH 20 SWEEPERS: 2 2 1 1R 1U

21 WARD ATTENDANTS: 4 2 2 R

22 MALI-cum-WATER CARRIER: 1 1 1 R DH 23 MEDICAL OFFICERS: 1 1 0 1U

24 EXTENSION EDUCATOR : 1 1 1 R

25 FEMALE HEALTH SUPERVISOR (FHS) : 1 1 1 R

26 COMPUTER: 1 1 1 R

27 COMMUNITY ORGANIZER 1 1 1 R

28 DRIVER: 1 0 0 -

29 FEMALE HEALTH WORKER/ANM: 1 1 1 R

30 GRADE IV: 1 1 1 R

31 BPM 1 1 1 C

32 BAFC 1 1 1 C

33 BDM 1 1 1 C

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Sanctioned Existing Remarks Name of Post/Designation Actual Category Sl.No. Strength Strength Reg/Con

VIII. A. PHC PHUNGYAR

1 MEDICAL OFFICERS: 2 1 1 R

2 MEDICAL OFFICER (AYUSH) : - 1 1 C

3 STAFF NURSE : 1 1 2 1R1C

4 MICROSCOPIST: 1 1 1 R

5 FEMALE HEALTH SUPERVISOR: 1 1 0 R

6 MALE HEALTH SUPERVISOR : 1 1 1 R

7 PHARMACIST (ALLO): 1 1 1 R

8 UPPER DIVISIONAL CLERK (UDC): 1 0 0 -

9 LOWER DIVISIONAL CLERK (LDC): 1 0 0 - SC 10 FEMALE HEALTH WORKERs/ANMS: 2 1 0 U

11 CHOWKIDAR (WATCHWO/MEN): 1 1 1 R

12 WARD ATTENDANT : 1 1 1 R

13 GRADE IV : 1 1 1 R

14 MALI-cum-WATER CARRIER : 1 1 1 R VIII. B. RURAL FAMILY WELFARE CENTRE : PHUNGYAR

15 MEDICAL OFFICER 1 0 0 -

16 EXTENSION EDUCATOR : 1 0 0 - RFWC, 17 FEMALE HEALTH SUPERVISOR (FHS): 1 1 0 U Ukl

18 COMPUTER : 1 1 1 R

19 COMMUNITY ORGANIZER : 1 1 1 R

20 FEMALE HEALTH WORKER/ANM: 1 0 0 - DLO, Ukl 21 DRIVER : 1 1 0 RU

22 GRADE IV : 1 1 1 R VIII. C. BLOCK MANAGEMENT UNIT (BMU) : PHUNGYAR

23 BLOCK PROGRAMME MANAGER (BPM): 1 1 C

24 BLOCK ASSISTANT FINANCIAL CONSULTANT (BAFC): 1 1 C

25 BLOCK DATA MANAGER (BDM): 1 1 C

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Sl.No. Sanctioned Existing Remarks Name of Post/Designation Actual Category Strength Strength Reg/Con

X. A. PRIMARY HEALTH CENTRE :

1 MEDICAL OFFICERS: 2 1 1 R

2 MEDICAL OFFICER (AYUSH) : - - 1 C

3 STAFF NURSEs : 1 1 2 1R1C RFWC. 4 FEMALE HEALTH SUPERVISOR (FHS): 1 0 0 U UKL

5 MALE HEALTH SUPERVISOR (MHS): 1 1 1 R DMO, 6 MICROSCOPIST: 1 0 0 U UKL

7 PHARMACIST (ALLO): 1 1 1 R

8 PHARMACIST (AYUSH): - - 1 C

9 UPPER DIVISIONAL CLERK (UDC): 1 0 0

10 FEMALE HEALTH WORKER (FHW)/ANMS: 2 2 2 1R1C

11 LABORATORY TECHNICIAN : 1 0 2 C

12 LOWER DIVISIONAL CLERK: 1 0 0 -

13 CHOWKIDAR (WATCHMAN): 1 1 1 R

14 GRADE IV: 1 1 1 R

15 WARD ATTENDANT: 1 1 1 R PHC 16 MALI-cum-WATER CARRIER: 1 1 0 U Lambui

17 PHARMACIST (ALLO): 1 1 1 R

18 FEMALE HEALTH WORKER (FHW)/ANM: 1 1 1 R

19 MALE HEALTH WORKER (MHW) : 1 1 1 R

20 GRADE IV: 1 1 1 R X. C. BLOCK MANAGEMENT UNIT (BMU) : SOMDAL Dual 21 BLOCK PROGRAMME MANAGER (BPM): - 1 C charge

22 BLOCK FINANCIAL ASSISTANT CONSULTANT (BFAC): - 1 C Dual 23 BLOCK DATA MANAGER (BDM): - 1 C charge

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Sl.No. Sanctioned Existing Remarks Name of Post/Designation Actual Category Strength Strength Reg/Con

XI. A. PRIMARY HEALTH CENTRE :

1 MEDICAL OFFICERS: 2 0 0 -

2 MEDICAL OFFICER (AYUSH): - 1 1 C CHC 3 STAFF NURSES: - 3 2 2R1U Kamjong

4 FEMALE HEALTH SUPERVISOR (FHS) : 1 1 1 R DMO, UKL 5 MALE HEALTH SUPERVISOR (MHS): 1 2 0 2U

6 MICROSCOPIST: 1 1 1 R

7 PHARMACIST (ALLO): 1 1 1 R

8 LABORATORY TECHNICIAN (NVBDCP): - - 1 C

9 UPPER DIVISIONAL CLERK: 1 0 0 -

10 FEMALE HEALTH WORKERs(FHW)/ANMs: 2 1 1 R

11 LOWER DIVISIONAL CLERK: 1 0 0 -

12 CHOWKIDAR (WATCHMAN): 1 1 1 R

13 WARD ATTENDANT : 1 1 1 R

14 MALI-cum-WATER CARRIER: 1 1 1 R XI. B. RFWC KASOM KHULLEN DH, UKL 15 MEDICAL OFFICER: 1 1 0 U

16 FEMALE HEALTH SUPERVISOR (FHS): 1 0 0 -

17 EXTENSION EDUCATOR: 1 1 1 R

18 COMPUTER: 1 1 1 R

19 COMMUNITY ORGANIZER: 1 0 0 - SC 20 FEMALE HEALTH WORKER (FHW)/ANM: 1 2 0 2U

21 DRIVER (LIGHT): 1 0 0 -

22 GRADE IV: 1 1 1 R XI. C. BLOCK MANAGEMENT UNIT (BMU) : KASOM KHULLEN

23 BLOCK PROGRAMME MANAGER (BPM): 1 1 C

24 BLOCK FINANCIAL ASSISTANT CONSULTANT (BFAC): 1 1 C

25 BLOCK DATA MANAGER (BDM): 1 1 C

Sl.N Sanction Existi Actu Catego Remar o. Name of Post/Designation & ed ng al ry ks Strength Streng Reg/C Name of Staff/ Employee th on IX. A. PRIMARY HEALTH CENTRE, CHINGAI 1 MEDICAL OFFICERS : 2 0 1

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2 MEDICAL OFFICERS (AYUSH) : - - 1 3 MICROSCOPIST : 1 1 1 4 STAFF NURSE : 1 1 0 5 MALE HEALTH SUPERVISOR (MHS) : 1 1 1 6 FEMALE HEALTH SUPERVISOR (FHS) 1 1 1 7 PHARMACIST (ALLO) 1 0 0 FEMALE HEALTH 8 WORKERs(FHW)/ANMs 2 2 2 9 LOWER DIVISION CLERK (LDC) 1 0 0 10 GRADE IV : 1 1 1 11 WARD ATTENDANT: 1 1 1 12 MALI-cum-WATER CARRIER: 1 1 1 13 CHOWKIDAR/ (WATCHWO/MEN) : 1 1 1 IX. B. RURAL FAMILY WELFARE CENTRE (RFWC), CHINGAI: PHC CHINGAI 14 MEDICAL OFFICER: 1 1 1 15 EXTENSION EDUCATOR: 1 1 1 16 FEMALE HEALTH SUPERVISOR (FHS): 1 1 1 17 FEMALE HEALTH WORKER (FHW): 1 1 1 18 COMPUTER: 1 0 0 19 COMMUNITY ORGANIZER: 1 1 1 20 DRIVER: 1 1 0 21 GRADE IV: 1 1 1 IX. C. BLOCK MANAGEMENT UNIT : CHINGAI 1 BLOCK PROGRAMME MANAGER (BPM) - - 1 BLOCK ASSISTANT FINANCIAL 2 ASSISTANT (BAFC) - - 1 3 BLOCK DATA MANAGER (BDM) - - 1

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Sl.No. Sanctioned Existing Remarks Name of Post/Designation Actual Category Strength Strength Reg/Con

XII. A. PRIMARY HEALTH CENTRE : LAMBUI

1 MEDICAL OFFICERS: 1 1 1 R

2 MEDICAL OFFICER (AYUSH): 1 1 1 C

3 STAFF NURSES: 1 1 2 1R1C DTC, UKL 4 FEMALE HEALTH SUPERVISOR (FHS) : 1 1 0 U

5 MALE HEALTH SUPERVISOR (MHS): 1 1 1 R

6 MICROSCOPIST: 1 1 1 R

7 PHARMACIST (ALLO): 1 1 1 R

8 LABORATORY TECHNICIAN: 1 0 1 C

9 FEMALE HEALTH WORKERs (FHW)/ANMs: 3 3 4 2R2C

10 LOWER DIVISIONAL CLERK: 1 0 0 -

11 CHOWKIDAR (WATCHWO/MEN): 1 1 1 R

12 WARD ATTENDANT : 1 1 1 R PHC, Somdal 13 MALI-cum-WATER ATTENDANT: 1 1 0 R EXPIRED 14 GRADE IV: 1 1 0 R

15 BLOCK FINANCIAL ASSISTANT CONSULTANT (BFAC): 1 1 C

Sl.No. Sanctioned Existing Remarks Name of Post/Designation Actual Category Strength Strength Reg/Con

XIII. A. PRIMARY HEALTH CENTRE : KHULLEN DH, UKL 1 MEDICAL OFFICERS: 2 1 1 U

2 MEDICAL OFFICER (AYUSH): - - 1 C

3 STAFF NURSES: 1 1 1 R

4 FEMALE HEALTH SUPERVISOR (FHS) : 1 1 1 R

5 MALE HEALTH SUPERVISOR (MHS): 1 1 1 R

6 MICROSCOPIST: 1 1 1 R

7 PHARMACIST (ALLO): 1 1 1 R DTC, 8 FEMALE HEALTH WORKER/ANM: 3 2 1 2R1U UKL

9 LOWER DIVISIONAL CLERK: - - - -

10 CHOWKIDAR (WATCHWO/MAN): 1 1 1 R

11 GRADE IV: 1 1 1 R

12 WARD ATTENDANT : 1 1 1 R

13 MALI-cum-WATER ATTENDANT: 1 1 1 R XIII. B. BLOCK MANAGEMENT UNIT (BMU) : KHANGKHUI KHULLEN

14 BLOCK FINANCIAL ASSISTANT CONSULTANT (BFAC): - 1 C

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Sl.No. Sanctioned Existing Remarks Name of Post/Designation Actual Category Strength Strength Reg/Con

XIV. PRIMARY HEALTH SUB-CENTRE : 40 SC STAFFs

1 MALE HEALTH WORKER (MHW): 40 33 R

2 PHARMACIST (ALLO): - 9 R 12 ANMs 3 FEMALE HEALTH WORKER/ANM: 80 68 33R 35C required

4 GRADE IV: 40 18 R

5 MALI-cum-WATER ATTENDANT: - 2 R

3.4 Status of Logistics

Logistics Elements Description Availability of a dedicated District There is no proper warehouse in the district warehouse for health department Stock outs of any vital supplies in last Vitamin A solution, Iron and Folic Acid, year. measles, OPV, essential drugs and kit are not supplied. Indenting Systems (from districts to Indenting is done from Sub-Centers, PHCs, state) CHCs, RFWCs to the Dstrict Family Welfare, CMO, DPM Existence of a functional system for Maintenance of Cold Chain is problematic assessing Quality of Vaccine due to irregular supply of electricity. To maintain the quality of vaccine one generator is provided now for each 2 PHC & 1CHC Vehicle functionality 1 Vaccine Van is very old but still working for vaccine delivery

The warehouse for the District is in poor condition and causing difficulties in storage and distribution of medicines, consumables, instruments, equipments etc. The District is proposing 01 District Warehouse to be built during 2010-11.

Districts collect their required items from the State Headquarters. Other peripheral units again collect their quota from the District Headquarters. The provision of computerized indent and supply is proposed during 2010-11. Currently, District does not have vehicle on-road to sent the items to block.. As new purchase is not possible with the RCH-Flexi pool, hiring of vehicles is the only option left for indent and supply and expenditure are borne by RKS.

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3.5 Training Infrastructure

There is no Training Centre in the District. It has been proposed in Part “B” under NRHM. Status of Training in respect of Maternal Health and propose during 2010-11

No. to be No. trained Sl. No. Key Indicators trained during 2010-11 1 EmOC 0 1 2 RTI/STI training of MO 4 4 3 RTI/STI of SN 0 30 4 RTI/STI of ANMs 0 60 3 SBA training for Staff Nurse 9 9 SBA (ANM) 14 20 4 IMEP for MO 0 8 IMEP for Nursing 0 0 Sisters at 6PHCs and 1 CHC and 1 DH 5 IMEP for ANMs 0 0 6 School Health Teachers 0 200 7 LSA 0 1 8 SBA for Dai/TBA 0 10 9 Blood storage MO 7 0 10 Lab Technician Blood storage 2 2

Status of Training in respect of Child Health and propose during 2010-11

No. to be trained Sl. No. Key Indicators No. trained during 2009-10 1 IMNCI 10 4 2 IMNCI for SN 0 12 3 IMNCI for ANMs 0 18 4 FBNC for ANMs 0 30 5 HBNC for ASHAs 0 120

Status of Training on Family Planning and propose during 2010-11

No. to be trained Sl. No. Key Indicators No. trained during 2009-10 1 MTP/MVA for 2 5 Doctor 3 IUCD for doctor 2 2 4 Minilap for doctor 0 2

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5 NSV for doctor 2 6 6 IUCD for SN 0 12 7 IUD for ANMs 24

Status of Training in respect of Maternal Health and propose during 2010-11

No. to be trained Sl. No. Key Indicators No. trained during 2009-10 1 ARSH for MO 0 4 3 ARSH for 0 9 Paramedics 4 ARSH for ANMs 0 60

Status of Other Training in the District

No. to be Sl. No. Key Indicators Categories trained No. trained during 2010-11 1 Workshop on NRHM (Center) DPMU 3 3 2 Web Data Capturing (State) DPMU 3 3 3 DHIS (State) DDM 1 1 4 Workshop on Web Data BPMU, PHC Accountant, 16 17 Capturing (District) Statistical Asst. 5 DHIS (District) BPMU, PHC Accountant, 15 17 Statistical Asst. 6 Capacity Building (District) MOs 8 15 7 Capacity Building (District) BPMU 16 17 8 Blood Storage (State) MOs 2 2 9 Blood Storage (State) Lab. Tech. 2 2 10 IEC/BCC (State) DPM, Dist. Media Officer 2 4 11 IEC/BCC (District) BPMU, MOs, Health 15 30 Supervisor, Educators 14 P D C MOs/DPMU 0 1

3.6 BCC Infrastructure in the District

• Human Resources There is No District Extension and Media Officer • Any trainings the staff in past five years Yes BCC Training were done up to Block Level

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• Any functional Mass media audio- visual aids such as 16 mm projectors, Video Proposed for procurement. cameras, VCD/DVD players • Did the district prepare a BCC plan in Yes as per the availability of fund the past year? - Wall painting • BCC activities undertaken in Districts - Printing of leaflets - Advocacy meeting - BCC skill building - Workshop & awareness program in 20 villages

At present the District does not have a Media Officer but at the Block level we have Extension Educators/Block Extension Educators/Health Educators. These officials have trained in BCC Capacity Development Trainings so that they can bring forward more effective ways of changing the health behavior of the community. We have plan for training of village level communicators to provide BCC/IEC activities. The targets are Communicator like ASHA, AWW and Community leaders.

3.7 ICDS Programme

SL Name of Number of CDPOs and Supervisors AWWs AW helpers the block AWCs ACDPOs with ICDS Programme S F F IP S IP S IP S IP 1 Ukhrul 350 350 1 1 9 9 350 350 350 350 2 Chingai 114 114 1 1 3 3 114 114 114 114 3 Kamjong 127 125 1 1 3 3 125 125 125 125 4 Phungyar 144 144 1 1 3 3 144 144 144 144 5 Kasom 126 126 1 1 3 3 126 126 126 126 Khullen Total 861 861 5 5 21 21 861 861 861 861

In the District there are 861 AWWs at the Village level who have help during Immunisation and other activities. To enhance this participation we required training of ICDS Officials and AWW on NRHM. With reference to the above table all the sanctioned AWCs are in position with one AWW and one Helper each. Additional AWCs are not included here.

3.8 Elected representatives of the Village

Number Of Sl. No. Block Village Headman/ Chairman

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1 Kamjong 57 2 Chingai 35 3 Ukhrul 85 4 Phungyar 36 5 Kasom Khullen 37 Total 250

As per our Household survey we have 250 villages in the District. In every village we have Village Authority Committee who look after the affairs of the Village particularly development issues. There is also a traditional lineage Authority known as Headman. This can be a potential resource for village planning and other health activities.

3.9 NGOs & CBOs

Names of NGOs Key Activities Blocks of operations TMNL Health All PASDO Health -do- BAFALLO Sanitation -do-

The table indicates the names of NGOs mainly working on the issues of related to Health and Community Development. The beneficiaries are mainly the children, adolescent girls, women and old age.

3.10 Blocks variations

The services accessibility in the 04 hilly blocks like Kamjong, Chingai, Kasom Khullen and Phungyar are poor as it is far from the main district hospital at Ukhrul. Such vulnerable populations which have no connection with health system are to be given adequate services under special health program like TB, MCH, Malaria, AIDS etc. special attention will be given to this villages

Sl. Kamjong Block Ukhrul Chingai Kasom Block Phungyar No Block Block Block 1 Maokot Ronshak Ngahurrum Zingsou Sorbung PHSC 2 Khanou Roni Paoyi Shangpuram Nongman 3 Chatric Khullen Sahamphung Paori Lairam Phungka Louphong PHSC 4 Chahong Khanou Zingsui .Kangoi Patbung PHSC PHSC 5 Chahong Khullen PHSC Luireishimphung Makan Sorbung PHSC 6 Chahong Pushing PHSC villages Wangli Chadong 7 Chahong Khullen Sihai Varangalai Kamo Ashang Ngayophung Khullen

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8 Kultup Khamasom T. Hundung kl PHSC 9 Molvailup K. Phungtha Poi PHSC Lamlai PHSC Khunou 10 Phaikot Leisen PHSC PHSC 11 Konkan Maichon Soraphung Thawai 12 Phungthar New Shingta PHSC 13 Zingshophai PHSC Tusom CV Muiri 14 Tora Old New canan 15 Choro Tora Changta New Wahong Loushing 16 Nimbisha Mulam Razai Khullen Chungka PHSC 17 Kachaophung Pheilen S. Tusom

18 Khayang T. Sanakeithel PHSC 19 Khayang K. 20 Kashung 21 Gampal 22 T Kaphung 23 K. Kaphung 24 Maiti 25 Aishi

3.11 Gender Equity

To stream line gender equity we have ensure in all the RKS, VHC and VHSC committees to have 50 % members are from women. In any activities at the District Health Mission Society shall monitor for any gender bias.

3.12 M&E

The District Data Manager is the key person of this. At the Blocks too we have the team headed by the Block Data Manager. The District has internet facility connection through phone line and also Blocks have started the process for connectivity from BSNL.

3.13 Convergence/ coordination Intersectional convergence of line departments which deals with wider determinants of health like nutrition (ICDS), sanitation & safe drinking water (PHED, PWD), female literacy (Education) at District level under DHMS are reflected in the DHAP.

To bring about better Sanitation and Safe Drinking Water Supply available to the community and also to overcome transport problems regarding approach roads to the health institutions, the PHED/PWD representatives are to be made members in all the Societies and Committees starting from District level to Village level. Thus joint planning and implementation of relevant activities will be sought.

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3.14 Finance Utilization

Part A RCH Fund Utilisation Status for the District.(As on 30/11/2009).

Op. % Expenditur Closing Balance Reciept Total Utilisatio Sl.No e Balance . Particulkars (1/4/09) n A RCH A.1 MATERNAL HEALTH A1.2 Referral Transport 0 270,000 270,000 270,000 100% Integrated Outreach A1.3 RCH services RCH Outreach Camp 35,000 240,000 275,000 55,000 220,000 20% Monthly Village Health & nutrition Days 0 0 0 0 Janani Suraksha A.1.4 Yojana/JSY 286,648 800,000 1,086,648 565,974 520,674 52% Home Deliveries 236,500 Institutional Deliveries 239,400 Paid to ASHA 6,600 Admt. & other Expenses 83,474 A.2 CHILD HEALTH School Health Program 0 0 0 0 A.3. FAMILY PLANNING Compensation & Motivation for FP 140,000 0 140,000 0 140,000 0% IUCD Training 0 149040 149040 0 149040 0% A.4. BCC/IEC Erection & Maintenance of Hoarding 5,000 50,000 55,000 0 55,000 0% BCC/IEC Survey in Block Level 225,000 0 225,000 195,985 29,015 87% BCC Activities 0 450,000 450,000 0 450,000 0% PROGRAM A.5 MANAGEMENT Strengthening of District Society/ District Program Management Support Unit 121,333 240,000 361,333 391,417 -30,084 97% 2,199,04 1,533,64 TOTAL A. 812,981 0 3,012,021 2,044,350 5 67%

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Part B: NRHM Additionality

Fund Utilisation Status for the District.(As on 30/11/2009).

Op. % Expend Closing Balance Reciept Total Utilisatio iture Balance Sl.No. Particulkars (1/4/09) n TIME LINE ACTIVITIES- Additionalities under NRHM (Mission B Flexible pool) B.1 ASHA BTT Training for ASHA 3rd & 4th Module -17,279 0 -17,279 0 0 Training of ASHA 18,865 335,500 354,365 353,300 1,065 100% B.2 Untied Funds Untied fund for CHC 25,000 25,000 50,000 36,500 13,500 73% Untied fund for PHCs 75,000 75,000 150,000 89,446 60,554 59.00% Untied fund for Sub- Centers 597,467 0 597,467 246,126 351,341 41.00% 1,615,00 Untied fund for VHSC 4,239,887 0 4,239,887 2,624,887 0 61% Other Untied funds Annual Maintenance B.3. Grants CHCs 50,006 50,000 100,006 75,786 24,220 75.00% PHCs 212,366 150,000 362,366 261,403 100,964 72.00% Sub-Centers 573,158 0 573,158 278,413 294,745 48.00% Others New Construction/Renovatio B.5 n & Settingup B.5.1 Repairing of Sub-Centre 0 300,000 300,000 100,000 200,000 33% Corpus Grants to B.4. HMS/RKS District Hospital 536,719 0 536,719 511,004 25,715 95% CHC 100,413 0 100,413 90,206 10,207 89% PHCs 322,355 300,000 622,355 479,727 142,628 77.00% District Action Plan (including Block , B.5. Village) 99,200 0 99,200 42,229 56,971 42.00% Additional Contractual Staff (Selection, Training, B.6 Remuneration) Block program Manager (salary) 138,000 225,000 363,000 369,750 -6,750 100% Block Asst. Financial Consultant 133,750 232,500 366,250 388,750 -22,500 100%

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Block Data Manager (salary) 123,250 187,500 310,750 297,000 13,750 95% AYUSH doctors salary 435,000 540,000 975,000 891,700 83,300 91% MBBS Doctors Salary 340,000 90,000 430,000 149,500 280,500 34% AYUSH Pharmacist Salary 80,200 36,000 116,200 59,800 56,400 51% General Pharmacist Salary 9,005 0 9,005 0 9,005 0% PHN 27,402 42,000 69,402 69,767 -365 90% GNM salary 229,962 108,000 337,962 176,400 161,562 52% Lab. Atechnician Salary 82,073 90,000 172,073 125,332 46,741 72% 1,230,00 Additional ANM 1,526,516 0 2,756,516 1,833,685 922,831 66% Grade -IV salary 27,282 0 27,282 36,000 -8,718 AYUSH Specialist Salary 72,000 0 72,000 0 72,000 Audiometric Asst. 0 81,500 81,500 88,500 -7,000 100% DMMU Driver 18,300 36,600 54,900 59,275 -4,375 100% X-Ray Technician 0 4,833 4,833 9,200 -4,367 100% District Mobile Medical Unit 0 150,000 150,000 54,000 96,000 36% Monitoring & B.18.3 Evaluation B.18.3. Strengthening HMIS 1 0 452,000 452,000 78,000 374,000 17% NRHM Management B.7. costs/Contingencies 229,073 400,000 629,073 258,221 370,852 41% B.8 Other Expenses buildingless Sub-Center Rent 18,000 0 18,000 6,000 12,000 33% 10,322,97 5,141,43 15,464,40 5,341,77 TOTAL B. 0 3 3 10,139,907 6 65.00%

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Part C : Immunisation Fund Utilisation Status for the District.(As on 30/11/2009).

Op. % Expenditur Closing Balance Reciept Total Utilisatio Sl.No e Balance . Particulkars (1/4/09) n C. IMMUNISATION RI strengthening project (Review meeting, Mobility support, C.1 Outreach services etc. 52,491 0 52,491 51,625 866 98.80% C.2 Cold chain maintenance 750 0 750 750 0 100% Pulse Polio Operating C.3 Costs 883 0 883 0 883 99.90% Computer operator C.4 salary 26,136 42,000 68,136 68,830 -694 100% TOTAL C 80,260 42,000 122,260 121,205 1,055 99% Others 3,400 3,400 0 3,400 0% 2,199,04 1,533,64 TOTAL A. 812,981 0 3,012,021 2,044,350 5 67% 10,322,97 5,141,43 15,464,40 5,341,77 TOTAL B. 0 3 3 10,139,907 6 65% TOTAL C 80,260 42,000 122,260 121,205 1,055 99% 11,219,61 7,382,47 18,602,08 6,879,87 TOTAL 1 3 4 12,305,462 6 66%

3.16 Institutional arrangements and organizational development: issues and gaps

Sl No Program Nodal Responsible Officer at District 1 Janani Suraksa Yojana DFWO

2 RCH-II DFWO 3 Behaviour Media officer Change Communication 4 Monitoring & DPMU Information System 5 Human Resource CMO Management 6 Infrastructure Development DC Management 7 Training Management DPM 8 Departmental Coordination CMO 9 Logistics & Procurement CMO 10 Financial analysis of program and reporting DAFC 11 District Plan DPM

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12 Part B DPM 13 Part C DFWO

Convergence activities with PWD, PHED, DWCD, PRIs, private sector, could not be implemented effectively due to non-convergence at the State level.

3.17 DP (donor assisted) programmes in the District:

So far no information for DP assisted program in health sector.

4 Lessons learned: 2006-07

Successes:

NRHM was launched in NE States on 9th Nov 2005. Actual implementation of NRHM in the District could be undertaken only by Aug 2006. NRHM implementation helped the District in decentralizing the program activities. There is a close convergence with the PRI from the Sub- center level institutions to the District-level institutions. This communization has helped in making the people work with the health providers. Rogi Kalyan Samitis (RKS) are functional in all Health Institutions. Funds of RKS are utilized for development of the respective institutions and in managing situation like shortage of medicine etc. There is an increase in the number of ANC and institutional deliveries. This is due to the JSY Scheme, and mobilization /awareness through by ASHA, under NRHM. Number of OPD patients is increasing day by day in health facilities centers .Public awareness in AYUSH system is also increasing.

The BPMUs are in place to strengthen the management capacity at the block level. Improvement in the management capacity isseen by 2009-10. District Health Planning Team has been capacitated to able to plan for the District. In the Block Level, Block Planning Team had been formed and capacitate. District could up-grade the infrastructure facilities of the Health Institutions in terms of building, manpower, consumables etc. The decentralization of financial delegation has motivated people in the Districts to involve in planning and monitoring of the activities taken up under NRHM.

Constraints:

Frequent transfer and posting of the staffs affect in the programme implementation. If the ANMs who are the Member secretary of the VHC get transferred the adjustment by the new ANM takes time and implementation is also delay. Non-joining of the posted Doctors will take another year for filling up the vacant post.

5 Key issues to be addressed as per VHAP

1) Operationalizing Health Facilities by up-grading Infrastructure including availability of trained manpower

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a. Multi-skilling training of MBBS/AYUSH Doctors on CEmOC, Life Saving, Anesthesia, MTP( MVA), RTI/STI, NSV,Tubectomy, FBNC 2) SBA Training a. GNM, ANM, TBA 3) Other trainings a. Capacity Development for Program Managers b. IMNCI, Blood Storage, IUCD, BCC,HBNC, ARSH,IMEP 4) Training from the Vertical Health Programme- a. RNTCP,Malaria, PPTCT. 5) Capacity Building for CDPOs, PRI, ASHAs and AWWs 6) Human Resource vacancies filled 7) Three ANC services a. Quality of care with IFA supply 8) Home Delivery a. SBA Trained staffs , SBA Trained TBA 9) Functionality of Institutional delivery by closing gaps at PHCs 10) Post Partum Care up to 48 Hrs & PNC visits 11) Functionality of RTI/STI clinic 12) Functionality of MTP services 13) Functionality of Lab facility 14) Health Mela for each Block 15) Innovation 16) Strengthening HMIS 17) ASHA Scheme 18) School Health Program 19) DMMU to Difficult Places greater involvement of RKS & VHC 20) Camps to Most Difficult places and greater involvement of VHC & VHSC 21) Increasing awareness of the Health Facilities available to the people and motivating them to utilize the service provisions through effective BCC. 22) Decentralized planning and implementation of activities through Rogi Kalyan Samitis Village Health Committee and Village Health and Sanitation Committees 23) Procurement of Equipments/Furniture. 24) Referral support for identified Hard Reach areas a. from JSY Fund for Institutional Delivery, from RKS Fund for Malaria, From RKS for Child Survival 25) Intra/Intersectoral Convergence with Line Departments 26) Procurement of Kits for Subcentres a. Equipment, Furniture, HMIS, Drug & Medicine (Consumable & Non Consumable Items), Ambulance for PHCs and CHC 27) Monitoring against the plan

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6. Findings from Focus Group Discussion

CHINGJAROI C.V:

Chingjaroi Village lies in the north-western part of Chingai Block. The distance from PHC,Chingai is about 43 kms. The village is made up of 247 households with a population of two thousand fifty six approximately as per 2008-2009 census. The village has more female (1063) than male (983). The Village Health Care is covered by the Autonomous District Council, Ukhrul. Our Medical team went on 9th August, 2009 to conduct BCC/IEC focus group discussion on “IMPORTANCE OF IMMUNIZATION”. The focus group discussion was held in the Pastor’s quarter. There were 26 participants mostly from middle aged women. The meeting was started with an introduction and highlight on importance of immunization by Ms. Ringyuichon Sira, Block Programme Manager, PHC Chingai. Thereafter, the discussion was started with the participant’s. Many questions were raise to the participants such as:

After the discussion, Ms. Daisy Tamang, ANM elaborated the importance of Immunization. Some of the points are:- a) Six Killer Disaeases b) Importance of IFA and Vitamin A. c) Vaccines to be immunised both mother and pregnant women. d) When to Immunized and minor illness, slight fever should not prevent them from from immunization e) Why the Child should be immunized f) When it is fully immunised

Findings:

a) Villagers heard about immunization but they are not aware of its importance. b) The villagers heard about immunization from the Anganwadi worker. c) Villagers are not aware of the type of vaccines, when to vaccinate and when it is fully immunised d) Villagers have the myths e) No knowledge of ANC and ANC was not given in their village f) No ANM’s visit their village g) Villagers doesn’t have any knowledge on IFA tablets h) Villagers are willing to be immunized

Suggestions:

a) Availability of ANM’s b) Timely Immunization programmes c) Awareness programme like workshop, seminar etc from time to time d) Appointment of ANM’s from Health and Family Welfare Department e) Most of the villagers request to provide IFA tablets in time

CHALLOU

The Challou Village lies in the northern part of PHC, Chingai Block. The distance from PHC, Chingai to Challou is about 15 kms. The Village is made up of 55 Households and the total population of the Village is 276 (two hundred seventy six) Male-151 and Female-125, as per the year 2007-2008 census. Most of the villagers depend on agriculture products. It is a highly malaria prone area.

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Our team went to the village on 13th September, 2009 to discuss on MALARIA, CAUSES AND CONTROL under BCC/IEC programme. The team was led by our Medical Officer i/c Dr. Manik Shaiza. They were 48 participants from the village and the meeting was held in the village Community Hall. Ms. Ringyuichon Sira started the meeting with an introduction and thereafter many question were put up to the participants.

After much question and discussion, Our Medical Officer i/c explained in length. The discussion ended up with a saying “PREVENTION IS BETTER THAN CURE”. Participants are provided with light refreshment.

FINDINGS:

a) Villagers are aware of the disease and its spread by mosquitoes but they do not know the different type of Malaria b) ASHA do not collect Blood sample and the Rapid Test Kit is available in the Pastor’s quarter c) Common malaria drugs in the village are CHLOROQUINE and PREMAQUINE but the villager are unaware of it. d) DDT was sprayed till last year e) Delta- Methrine is not available anymore f) Single Bed nets are provided to the family but the size of the bed net is too small g) Rapid Test Kit is hardly used in the village h) This year till date there is no case of malaria i) April – June is the peak season of Malaria

SUGGESTIONs:

a) Availability of medicines and Rapid Test Kit in the village b) Availability of bigger size of Bed nets c) Awareness programme to be conducted from time to time

LOREE KAJUI

The Village Loree Kajui lies in the Southern part of PHC, Chingai Block. The village is famous for its pottery pots. The village comprises of 325 households with a population of 2366 as per 2008-2009 census. The male and female population are 1640 and 726 respectively. The sex ratio is of big difference in this village. The distance from PHC, Chingai is about 36 kms.

The medical team led by the Medical Officer i/c reach the Village on 15th September, 2009 to held focus group discussion on “BREAST FEEDING AND ITS IMPORTANCE” under BCC/ IEC programme. The Focus Group Discussion was held in the Village Community Hall. 27 Villagers participated the group discussions. The meeting was started with self introduction. Thereafter Ms Ringyuichon, BPM, PHC Chingai raise questions to the participants such as

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The discussion programme ended with the saying “The Best –fed baby is the Breast- fed baby”. Light refreshment was provided to the participants.

FINDINGS:

a) Most of the Villagers are aware of Breast-feeding but they do not know its importance properly b) No proper breast- feeding because of work in paddy field c) Some fed colostrums while others did not d) Most of the mother fed their Child in a sleeping position e) If there is a sore nipple, they squeeze out the pus and clean it with hot water f) Some fed 2-3 times a day while others fed 6-7 times g) No proper balance diet h) Babies are given artificial feeds like Everyday, Amul, Lactogen etc if they go to the paddy field

SUGGESTIONS:

a) Awareness programme is in need b) If possible, provision of supplement diet to the lactating mother

NAMREI

Namrei village lies in the north- western part of PHC, Chingai. The village is made up of 75 households with a population of 409 as per 2007-2008 census. The sex ratio of male and female is 208 and 201 respectively. The distance between PHC and the village is 28 kms and most of the population depends on agricultural products.

The medical team went to the village on 22nd September, 2009 to conduct focus group discussion on “ANC” under BCC/IEC programme. The focus group discussion was held in Village Community Hall. 20 villagers participated in the programme. The programme was started with an introduction by our Medical Officer i/c Dr. Manik Shaiza. Thereafter the discussion was started with a question such as

The programme was concluded with the saying “HEALTHY MOTHER, HEALTHY CHILD”. Light refreshment was provided to the participants.

FINDINGS:

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a) The villager heard ANC i.e ante natal care from Male Health Worker and the ANM’s b) They heard ANC but they doesn’t know why ANC is necessary c) Most of the villagers do not go for ANC d) The Villagers go for ANC only when the ANM’s visit their village e) ANM’s hardly visit their village f) Blood pressure, weight of the body and abdominal changes are not check by the ANM’s during ANC g) No pregnant women are provided any supplement diets from the Anganwadi worker and are unaware of it.

SUGGESTIONS:

a) Awareness programme is in need b) Timely visit by the ANM’s for proper ANC and explain its importance too to the Villagers. c) ASHA must play an active role

MAREM:

Marem village is also lies in the north-western of PHC, Chingai block. The village has 66 households with a population of 459 according to 2007-2008 census. The sex ratio of male and female is 253 and 206 respectively. The distance between PHC and the village is about 23 kms. The villager also depends on agriculture products.

The medical team led by Medical Officer i/c, PHC Chingai visit their village on 23rd September, 2009 to discuss on “FAMILY PLANNING” under BCC/IEC programme. The programme was held in Pastor’s Quarter. 19 villagers participated in the Focus Group Discussion. The meeting was started with self introduction. As soon as the introduction is over the Block Programme Manager starts questioning to the participant’s. Some of the important questions are as follows

The session was ended up with the saying “A SMALL FAMILY IS A HAPPY FAMILY”. Light refreshment was provided to the participants.

FINDINGS: a) The villager presume that family planning is to stop child birth b) Heard about family planning through books, radio, Doctor’s, ANM’s etc c) Most of the villagers accept 4 children as the right number of children in the family d) Villagers considered family planning is good from the economic point of view but it is not supported according to the religion e) Most of the Villagers considered many children as a blessings and it also maintain prestige in the Society according to their concept

47 f) According to the villagers either Husband or Wife can go for family planning if needed g) Only Condoms , pills, and IUD is available h) No knowledge on incentives i) Surprisingly woman wants to adopt family planning

SUGGESTIONS: a) To promote family planning through Awareness programme b) ASHA should be sensitized on the use of family planning of spacing methods c) Condoms, pill etc should be available all the time with the ASHA’s

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Topic: Immunization Introduction:

Rain was pouring down heavily and as Adummei and myself reach the parking, Jeep driver was ready with his heavy jacket and as we were buying necessary things, we saw doctor coming down with his big black umbrella. Since everyone was ready because Yengtem Village is our last FGD, so we don’t want to delay and all of us are getting more excited since no want has seen or gone to Yengtem Village. Yengtem (Another name Yidah) Village is a small village with only 180 populations under PHSC which is located 20 km. away from Yengtem. After travelling for 50 minutes from Kamjong and reach Yengtem Lamkhai, we have to keep our Jeep on main road and walk on foot because no vehicle can go inside their village, the road is small, muddy and very slippery. To reach the Headman house, it takes 30 minutes, so one woman help us to find the Headman house which we came to know that she is an AWW. As we walk down the village, we can not see any houses because of foggy. It was very cold as we reach Headman house, he came outside and welcome us warmly, we were given small wooden seat to warm ourselves near the fire. After having tea the AWW & ASHA help us to mobilise the group. After one hour of discussion with the headman about the functioning of VHSC, and he told us that with the fund he and ASHA buy medicine and supply it to the villagers. He also told us that the villages

49 committee is planning to make the road through NREGS so that the Jeep and other vehicle can reach their village. We targeted 20 members out of which only 13 turn up because most of the villagers stay in Ukhrul and some have gone for child immunization to Ukhrul for the Health Worker MHW/ANM never comes on immunization schedule. As we begin our Focus Group Discussion (FGD). I welcome them all and explain our purpose of our visit and why we have choose immunization as our topic.

Topic : Institutional Delivery

Introduction :

Pihang village is under Ningthi PHSC which is 60 km. away and from CHC Kamjong its just 13 km. So, most of the pregnant women comes to CHC for health checkup. Pihang village is a Kuki village with only 173 population. Before we reach Pihang village is popular for having good climate and soft water. As we reach Pihang village ASHA was waiting for us. As we were having tea, a group of womens with 4 pregnant women also came along with their husband.

FOCUS GROUP DISCUSSION (FGD) I welcome all the participant and explain our purpose to visit their village and why we have call only the newly married couples, pregnant women and youth leader. We communicated in Manipuri dialect and village ASHA help us in explaining in their own dialect (Kuki Language). The discussion was very interesting as only the women participated and so they open up their view and share their problems. After a round of introduction our facilitator starts with the questionnaires prepared by our team.

Topic : Institutional Delivery

Introduction : Pihang village is under Ningthi PHSC which is 60 km. away and from CHC Kamjong its just 13 km. So, most of the pregnant women comes to CHC for health checkup. Pihang village is a Kuki village with only 173 population. Before we reach Pihang village is popular for having good climate and soft water. As we reach Pihang village ASHA was waiting for us. As we were having tea, a group of womens with 4 pregnant women also came along with their husband.

FOCUS GROUP DISCUSSION (FGD) I welcome all the participant and explain our purpose to visit their village and why we have call only the newly married couples, pregnant women and youth leader. We communicated in Manipuri dialect and village ASHA help us in explaining in their own dialect (Kuki Language). The discussion was very interesting as only the women participated and so they open up their view and share their problems. After a round of introduction our facilitator start with the questionnaires prepared by our team.

At the end doctor explain the importance of ANC and Institutional delivery because during ANC checkup, identification of high-risk pregnancies and supplement of iron & folic

50 acid, injection of tetanus toxoid, examination of BP, Anaemia, height and weight, etc. will be done by the doctor/staff nurse/ANM, counselling on diet and rest will also be given according to the pregnant mother health. One of the village elder express his happiness saying that no doctor/nurse has visited our village for the past 10 years. So, they were very happy. The discussion was ended with vote of thanks from MO I/c & BPM CHC Kamjong.

Topic : Malaria

Introduction : village is under PHSC . As usual we decided to start our day early at 05:30, but we were delay as our vehicle (Jeep) got breakdown on the way. We reach Ningchou late at around 01:15 p.m. by the time we reach the village and it look deserted as all the villagers has gone to field, after they have waited for us as told by headman son. So, we have to wait for them and at 03:30 p.m. they came at the Headman house.

FOCUS GROUP DISCUSSION (FGD) I apologized all the members present and explain why we got delay after that a round of introduction was done. I explain the purpose of our visit, we were accompanied by 3 Multi- Purpose Worker (MPW) from malaria department. It was an co-incident that our team member meet their team, they came to instruct the villagers and how to prevent themselves from malaria sickness. They stay in Ningchou village for just 35 minutes because they have to covered Kangpat Khunou, Kangpat Khullen, Skipe, Phaikhok villages. There present in our FGD help us a lots to give them proper instruction of malaria disease during our question.

The session ended with having a cup of tea and vote of thanks from BPM & MO I/c, CHC Kamjong. Topic : Antenatal Care (ANC)

Introduction : We begin our journey at 05:30 Am. from Kamjong to Molvailup it was just 1 hour and 30 minutes but due to muddy and narrow road, it took us 3 and half hour to reach our destination. As we reach, we were warmly welcome by ASHA and village elders though the Headman has gone to Ukhrul for some village work. After having our lunch we proceed to the community hall for discussion. I welcome them all and as I introduce my team name and designation they were very happy to hear ‘Doctor’. I can see the smile on their face. So, I inform them that we brought some medicine and after the discussion, the doctor and PHN can examine some sick patient. As I explain the purpose of our visit and reason why we chose the topic Antenatal Care (ANC) for their village. TEA BREAK That is the end of our questionnaire asked to 20 targeted group mostly comprise of pregnant women, newly married couple and women with 0 – 5 years child. Dr. Athui Gangmei gave a brief explanation to all the questions to the targeted group and help them to clarify their doubt regarding the to’s and don’s during pregnancy. After the discussion was over we thanks all the participant for coming despite of their hectic work (Paddy

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Field). Dr. Athui and PHN Adummei did a health checkup of all the pregnant women and children and other cases. A medicine was also given to patients who came for checkup. The session ended with having a cup of tea and vote of thanks from BPM, MO I/c CHC Kamjong. We left the village at 03:20 p.m, we bide them good-bye and thank them for their hospitality that have provided us.

Topic : Malaria Introduction : Village has been upgraded recently by the Health Minister as Primary Health Sub-centre under CHC Kamjong. Grihang is a small village with a 561 population, a plain view neat and clean wooden houses can be seen. We start late for Grihang Village at around 03:00 pm. as our jeep got break down we reach at 04:45 pm, we were warmly welcome by the village ASHA and village elders.

FOCUS GROUP DISCUSSION (FGD) The Church leaders, women leaders, Youth leaders and village elders were our targeted group for FGD, huge crowd came it was beyond our expectation and we got good response from them. They were very open minded to share all their view and ancient believe of how malaria spread. As our facilitator start with the questionnaires they listen attentively.

Our discussion endup with a short speech from MO I/c and BPM CHC Kamjong.

Findings from all :

a) Lack of awareness to most of the programmes as these areas is very difficult places. b) Health seeking behaviour is very low due to poor health services c) Health workers presence is low to negligible d) ASHA’ activities is very low as no facilitator e) Most of the villagers are illiterate and poor f) Malaria cases were very high g) Poor road connectivity only by foot is the means h) Poor functionality of PHSC and CHC Kamjong

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GROUP DISSCUSSION AT PUSHING ON ANTE-NATAL CHECH-UP INTRODUCTION Zingsui Village was selected for Focus Group Discussion on the topic ANC. The Team started at 6:00 am, hoping to reach the Village at 11:00 am and to return back early. But the road was blocked by the landslide and the team had to return back empty handed. Not to waste the day, the Team decided to hold FGD at Pushing. Pushing village has a total population of 896 and the Total number of Household is 141 as per the report of the ASHA. The PHSC Pushing covers three villages and comes under PHC Khangkhui

Khullen in Ukhrul Block. The distance from PHC is 68 Kms through motor able road and 12 KMs on foot path. The number of participants participated in the Group Discussion is fourteen (14). SURVEY TEAM

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The team for the Survey was led by Miss Wontharla, BPM Ukhrul as Facilitator, R. Ramkahao, BAFC Khangkhui KL as Recorder, and Miss Bliss as documenter and Miss T. Ningamla(ANM) as Medical Staff. At first the participants were asked to share their views regarding pregnancy and Ante- Natal Check-up One of the participants says that she knows that she is pregnant when monthly period stops, morning sickness and stomachache. Many of the pregnant women didn’t go for ANC Check-up because they are busy in the field work even when ANM/Medical Staffs comes to their village. The main reason is that, they don’t know the benefits of ANC. One of the participants says that the best time for ANC is in the 5th Month of pregnancy and subsequently in the 7th month and 9th month. Some says it is in the 3rd Month and subsequently in the 6th month and 9th month. Some of them didn’t go for ANC simply because they are afraid of TT injection. Some says that they have to get three times TT injection at first pregnancy and two in the subsequent pregnancy. But they go many times for ANC to ANM

REPORT OF FOCUS GROUP DISCUSSION AT On the Topic: Institutional Delivery INTRODUCTION Shangshak PHSC comes under PHC Lambui in Ukhrul District. The PHSC is 10 km away from PHC and 25 kms from District Hospital, Ukhrul. The Block Program Management Unit decides to take up BCC/IEC survey at Shangshak due to low report Institutional Delivery. SURVEY TEAM The team is led by Mrs. Wontharla, BPM, Ukhrul as Facilitator, R.Ramkahao, BAFC, Khangkhui as Recorder, Miss Tamsingla, Staff Nurse as Medical Staff. The Team reach Shangshak at 12:00 noon and started the Discussion at 12:30 pm with self Introduction. At first, the participants were ask to share their views with regard to the Topic: (Institutional Delivery). A participant name Ngathingwon Raihing, who had gone for Institutional Delivery at , Nagaland, shares the

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advantages of Institutional delivery. She says that if she had not gone to Hospital for Delivery, she may not be able to deliver; even her life itself is at risk. She was satisfied by the services rendered by the Medical Staff. Many of the pregnant women didn’t go for Institutional delivery because of the following reasons: 1. Economic problem 2. Operation 3. Shyness

REPORT ON FOCUS GROUP DISSCUSSION AT TORA CHANGTA VILLAGE ON THE TOPIC IMMUNIZATION INTRODUCTION Tora Aheng village comes under PHSC Leisan of PHC Somdal in Ukhrul Block. The distance from PHC is 68 Kms. The number of participants participated in the Group Discussion is nineteen (19). SURVEY TEAM The team for the Survey was led by Miss Wontharla, BPM Ukhrul as Facilitator,R. Ramkahao, BAFC Khangkhui Khullen as Recorder, and Mrs Unice (ANM) as Medical Staff. The Discussion begins at 06:30 pm with self introduction. The participants were asked to share their opinions with regard to the Topic. IMMUNIZATION A participant name Z. Leishiwon says that giving a vaccine by ANM or MHW to the children is Immunization. They do not know what is BCG, DPT1/2/3, OPV1/2/3, DT5 and Measles Vaccine what is call six killer diseases. They simply go to the ANM/MHW for the Immunization. 17th of every month is scheduled for Immunization and the ANM/MHW comes regularly for the Immunization. The participants says that none of the children is fully immunized because a child get sick after injection, parents are in the paddy field, it is also says that the child will no bear children and also after injection bleeding of blood has occur repeatedly. The probable solutions of the problems as expressed by the participants were: 1. Orientation to medical Staffs in the field of Immunization. 2. Awareness program.

REPORT ON FOCUS GROUP DISSCUSSION AT HOOMI VILLAGE ON THE TOPIC ANTE-NATAL CHECK-UP (ANC)

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INTRODUCTION Hoomi village comes under PHSC Tolloi of PHC Somdal in Ukhrul Block. The distance from PHC is 39 Kms. The number of participants participated in the Group Discussion is eighteen (18) SURVEY TEAM: The team for the Survey was led by Miss Chochon, BPM Chingai as Facilitator (as the BPM of Ukhrul was ill). The team comprises O.Pushpa, DPM,Ukhrul, Ramkahao, BAFC Khangkhui Kl and Mrs. Esther(ANM) as Medical Staff. At first the participants were asked to share their views regarding Ante Natal Check-up and how do they know that they are pregnant.

One of the participants says that she know that she is pregnant when monthly period stops, morning sickness, Urinal problem and drowsiness. Many of the pregnant women didn’t go for ANC Check-up because they are busy in the field work even when ANM/Medical Staffs comes to their village. The main reason is that, they don’t know the benefits of ANC. One of the participants says that the best time for ANC is in the 5th Month of pregnancy and subsequently in the 7th month and 9th month. Some says it is in the 3rd Month and subsequently in the 6th month and 9th month. Some of them didn’t go for ANC simply because of TT injection.

EPORT ON FOCUS GROUP DISSCUSSION AT HALANG VILLAGE ON THE TOPIC: FAMILY PLANNING INTRODUCTION Halang village has a total population of 2147 and the Total number of Household is 470. As per the report of the ASHA. The village comes under PHSC Lamlang Gate of PHC Khangkhui Khullen in Ukhrul Block. The distance from PHC is 44 Kms. The number of participants participated in the Group Discussion is Fifty two (two). The number of participants is beyond expectation. SURVEY TEAM

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The team for the Survey was led by Miss Chochon, BPM Chingai as Facilitator (as the BPM of Ukhrul was ill). The team comprises Ramkahao, BAFC Khangkhui Khullen as Recorder, Miss Bliss as Documenter and Miss K.Songamla(ANM) as Medical Staff. Miss Chuichui Chalhang, BPM, PHC Phungyar and Mr. Wungreipam BAFC, PHC Phungyar were also there in the team.

The Discussion begins at 01:30 pm with self introduction. The participants were asked to share their opinions with regard to the Topic: FAMILY PLANNING. A participant name Mr. Shangam says that it is not accepted in the religious term and the advantages of having many children is that, they get both Financial and Physical support from the Children. S.Leima says that she felt happy to hear the topic and wants to learn more about Family Planning. Some of the participants says that it is good to go for family planning. Family Planning just not meant the limitations of number of children but to have number of children as they like it or as much as parents can support. Regarding the decisions about the number of children in the family, the decision is taken by both Husband and wife. Family Planning should be done according to social Status, living standard and economic condition of the family. But in Tangkhul Custom, only men inherit the property of the family/forefathers. So in order to get a baby Boy, the number of children increases. Leima S Says that, there are three (3) methods of family planning. They are (i) Operation (ii) Copper-T (ii) Pills. One of the Male participants also says that there are three Methods/ Types. They are (i) Operation (ii) Safe time (iii) Condom With regard to Operational Method, one of the participants says that, his wife had gone for operation and there was no side effect till date and the family is satisfied having five children only. About Condom, a participant name Mr. Ngaranpam says that there is no pleasure while using condom. Mrs Leishimi says that condom had brought side effect because it is used by young boys and girls. About IUD/Copper-T, a participant name Mr. Weiypah says that, there is side effect. The IUD stuck in the womb with the blood. But he was unknown of the time when it is inserted. Some says there is back pain on inserting Copper-T. Mrs Teresa says that there is no side effect at all. She had used for two years. The probable solutions of the problems as expressed by the participants were: 1. Awareness Campaign 2. Training/ Orientation program to the Medical Staffs’ 3. To conduct NSV program

Topic: ANC

Profile of the Village: Name of the Village : Koso Total Population (Actual head count) : 367 PHSC : Leiting PHC : Phungyar

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Distance from PHC : 35 kms Distance from District Head Quarter : 30 kms

Reason for selecting the village:

As per the Monthly report and Monitoring we found that ANC check-up were neglected by the pregnant women. Also lack of knowledge about ANC.

Survey Team: 1. Chuichui Chalhang, BPM as Facilitator 2. Wungreipam Shangchiri, BAFC as Recorder 3. Chuimeingam Keishing, BDM as Documenter 4. Dr. H. Hungyo, M.O. I/c as Medical staff

Target Group: Pregnant Women and Young Women. Introduction: The first FGD of Phungyar Block was conducted at this village and also it’s the first time for the survey team to conduct. There were 17 (seventeen) participants in total both men and women. Dr. H. Hungyo M.O. I/c of PHC Phungyar brief about the FGD and importance of the discussion. He requested the group to participate the discussion without any fear.

Problems and Findings: 1. ANM not on time 2. Do not know the importance of ANC and TT vaccine. 3. Even after knowing the importance, they just ignore it/does not have faith in government department.

Conclusion: From the questionnaire that was asked to the group, the following results and problems were discussed and all the queries from the participants were cleared by the team. The participants assured the team that they will go for the check up.

Topic: Family Planning Profile of the Village: Name of the Village : Khambi Total Population (Actual head count) : 491 PHSC : Phungyar PHC : Phungyar Distance from PHC : 4 kms Distance from District Head Quarter : 67 kms

Reason for selecting the village:

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The villagers were heard about family planning but they don’t have the confident to do the planning. So, to encourage and feeding knowledge of family planning is necessary.

Survey Team 1. Dr. H. Hungyo MO I/c 2. Chuichui Chalhang, BPM as Facilitator 3. Wungreipam Shangchiri, BAFC as Recorder 4. Chuimeingam Keishing, BDM as Documenter

Target Group Village Leaders and married women age between 20-40.

Introduction: There were 22 twenty two participants both men and women in the discussion. Chuichui Chalhang, BPM of PHC Phungyar briefing about FGD and importance of it by elaborating how it is going to conduct and encourage the participants to participate in the fullest. The main Problems and Findings of the Team were as follows:- 1. Heard that after Permanent Family Planning, they have physical weakness like Backache, etc. 2. Due to pressure from in-laws they end-up with many children. 3. Some of them say that, after spacing there were afraid to get pregnant and give birth. 4. They were afraid of few children due to uncertainty of life/losing the only child. 5. Lack of knowledge of proper Family planning, they were afraid of side effects for going any method of Family Planning. 6. Condoms were available but they feel shy / guilty of using it. 7. Vasectomy was not encouraged because they heard that after Vasectomy, men were more lustful and women were not secure by feeling that the husband may go for other women. Conclusion: The discussion was very successful up to the expectation of the Team. Though most of their doubts were cleared, and one mother who has done permanent family planning has assured of no side effect, still most of the villagers are just not confident and willing to take up Family Planning. Therefore, need to take up more awareness camp.

Topic: Breast Feeding Profile of the Village:

Name of the Village : Shingkap and Muirei Total Population (Actual head count) : 691/311 PHSC : Shingkap PHC : Phungyar Distance from PHC : 80 kms/90kms Distance from District Head Quarter : 55 kms/60 kms

Reason for selecting the village: 60

Lack of proper Knowledge Survey Team :

1. Chuichui Chalhang, BPM as Facilitator 2. Wungreipam Shangchiri, BAFC as Recorder 3. Chuimeingam Keishing, BDM as Documenter 4. Tamsingla GNM as Medical staff Target Group: Pregnant Women, Nursing mothers and Young women. Introduction: After self introduction, Chuichui Chalhang, BPM briefly share about the Focus Group discussion and how to participate in the discussion and taking concern from the participant. There were total participant of 17 (seventeen) at Shingkap Village and 13 (Thirteen) at Muirei Village.The discussion was progress by asking the prepared question. Most of the participants have awareness and knowledge of colostrums but they cannot fulfill exclusive breast feeding.

The main difficulties and findings of the survey team were as under.

1. Exclusive Breast feeding is a must but as a cultivator they may not be able to do that. 2. They don’t take enough nutrition during nursing period due to financial problem. 3. As a cultivator and busy house wife, feed her baby only when they think that the baby need feeding and when baby cries. 4. No proper position and attention while feeding e.g. like feeding during sleep. 5. Right after birth some of the mother cannot produce breast milk so give the baby some drops of water. 6. In-laws insist them to feed local food after three month so that the baby will be stronger and better resist to any diseases. 7. A mother, according to her experience that one of her son was only ok after feeding local food. Before that her son always has a kind of dysentery problem.

Conclusion: Above problems were discussed and all the queries from the participants were cleared by the team. Now the participant knows exactly what Exclusive Breast Feeding means and the benefits of it. Topic: Institutional Delivery

Profile of the Village:

Name of the Village : Phungyar Total Population (Actual head count) : 644 PHSC : Phungyar PHC : Phungyar Distance from PHC : 01 kms Distance from District Head Quarter : 65 kms

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Reason for selecting the village:

Safety of Institutional Delivery.

Survey Team

1. Chuichui Chalhang, BPM as Facilitator 2. Wungreipam Shangchiri, BAFC as Recorder 3. Chuimeingam Keishing, BDM as Documenter 4. Dr. Shamananda M.O. AYUSH as Medical staff

Target Group Pregnant Women, Young Women and Village Leaders.

Introduction: Survey team reaches the village at 12 noon. The FGD started at 12:30 PM with an introduction, there were 22 (Twenty two) participants. As the participant eager to know, the facilitator without wasting time brief about FGD and took their consent by starting the first question, what do you know about Institution delivery and Home delivery? FGD-Phy 1 of 2 The difficulties and findings after discussing the topic in details were as follows: Problems and Findings: 1. No proper delivery institution 2. Financial problem 3. Depends on luck and grace of God 4. No preparation for delivery

Conclusion: The above problems were discussed and all the queries from the participants were explained and cleared by the team. The participants enjoyed the discussion and thank the survey team for giving them the opportunity. They assured the team that they will opt for the safe delivery if government provides facilities at the nearest in future.

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6.1 Areas of Concern from FGD findings

a) Irregularity of staffs at CHC/PHC and even more worse in PHSCs.

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b) Women in the village are not aware of TT Vaccination, Measures of weight, BP and intake of IFA Tablets & Vitamin A c) Limited supply of IFA d) Most of the Women depend on TBAfor hopme delivery. e) ANC are done but drop out by most of the women as they think that TT vaccines are given to stop giving births. f) They seek for institutional deliveries only when it is complicated. Poverty and connectivity problem is the reason for low ANCs and institutional delivery. Even if institutional, PW are also afraid of caesarean section. g) So far no PHCs are functional as 24X7 facilities too. h) No PNC visit by most of the ASHA’s. i) Most of the women are unaware regarding the family planning practices and those who are aware have a lot of fear. Some of them have heard that even if the husband uses condoms the woman can get pregnant and that Copper T and Mala- D tablets have a lot of side effects. j) Most of the women did not know about the weight of their children during birth. k) Immunization is very low because of fear, misconception and lack of awareness. l) Most of the villagers have knowledge on breast-feeding but they do not know its importance. m) Some ASHAs in Chingai have work hard very much. They know how to give TT injection to mothers. n) Some ASHA’s activities is very low due lack of awareness and for not paying incentives o) Some of the villagers consider having many children is a God’s gift. p) Some Villagers are willing to do family planning but feel shy to express. q) Non functionality of VHC and VHSC let to low ownership of the program.

7. Findings from the VHAP in 17 Villages

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Health Action Plan 2010-2011 For KaziphungVillage, Ukhrul Block

Submitted by CS. Reisangmi (Chairman VHSC), ML. Merry Grace (ASHA/Secy. VHSC), ML. Philachon (AWW), C. Kharmi (Social Worker), ML. Hopeson (Asst. Pastor), KYS Chipemmi (Member VHSC), CS. Lingmiwon (ASHA), KYS Ningkhanwon (ASHA), KS. Chuihaola (WHSA ChairPerson) Village Health & Sanitation Committee, Kaziphung Village, Ukhrul Block, Ukhrul District

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Contents

Summary of the Plan Acknowledgement Chapter One : Background of the Kaziphung Village Chapter Two : Methodology of the Plan Chapter Three : Process of the VHAP 2010-2011 Chapter Four : Findings of the Village Health Action Plan Chapter Five : Issues of Concern, Proposed Activities, timeline and Source of Fund

Chapter One

1. Background of the Kaziphung Village a. General Information of the selected village

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1. Community toilet is not available 2. Source of drinking water is from pond only 3. Functional AWC = 13 4. 3 primary school buildings b. Village Demographic Profile 1. Total No. of Household = 311 2. Household headed by male = 276, female = 35 3. Population = 1880, Male = 862, Female = 1018 4. Infant (0-1 yr) = 35, Male = 17, Female = 18 5. Children (1-5 yrs) = 195, Male = 85, Female = 110 6. Children (6-14 yrs)= 620, Male = 300 , Female = 320 7. No. of Birth April- Nov 2009 = 11, Male = 7, Female = 4 8. No. of Marriage April – Nov 2009 = 7 9. Average Age of person at marriage: Male = 30, Female = 25 c. Village Household Profile 1. 19, 13 & 279 household had Pucca, Semi-Pucca and Kuccha respectively 2. All the household are owned 3. Household with 3 rooms = 300 & more than 3 rooms = 11 4. Separate room for kitchen in the village = 291 & Combine with kitchen = 20 5. All the household had cover pit with one chamber toilet only 6. There is irregular electricity in the village so they used Kerosene 7. Fuel for cooking is firewood & 50 household used both gas and firewood 8. Main occupation is agriculture 9. Average monthly income in the household is between Rs. 2000-3000 10. Average No. of earning member in the household = 2 11. Food availability is difficult during summer & autumn Season 12. Villagers communicate by foot, two wheeler, jeep and Shaktiman 13. 160 household had TV and 200 household had radio 14. 20 Acres of land belong to village and 16 acres were all irrigated areas 15. Livestock rear in the village were hen, Pig and buffalo

d. Basic Health profile 1. 35 deliveries were done during April – Nov 2009 in Public & Private hospital 2. No. of currently Pregnant Women = 3 3. No. of death during April – Nov 2009 = 6

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4. No maternal death during April – Nov 2009 5. 80 % of the villagers chew pan with tobacco 6. 10 % of the villagers smoke 7. 10 % of the villagers drink alcohol 8. Villagers go to District Hospital for treatment 9. Average amount of money spend on primary care = Rs. 1,000/- 10. Average amount of money spend on tertiary care = Rs.18,200/-

Chapter Two

2. Methodology of the Plan

The planning approach that has been adopted under National Rural Health Mission is bottom up approach in which three tiers of planning levels were done namely Village level plan by VHSC and Block Health Action plan by Block planning Team and similarly District Planning Team compiled the same Block Health Action Plan. To actualize the VHAP 2010-2011, the tools that were followed to bring out a comprehensive plan is as: 1. HMIS information from DHIS2 2. Basic village information collected by HH survey 3. FGD at the village level on Maternal Health 4. Mapping of the village 5. Seasonal Mapping on Diseases profile

The whole planning process at the Kaziphung village is facilitated by Th. Radhakanta Singh, DCO, Ukhrul Block and it took 9 days to complete the plan at the village. The facilitators are advised by the Block Nodal Officer on VHAP to make three visits.

Chapter Three 3. Process of the VHAP 2010-2011.

Sl. Dated Activities Responsibility

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No 1 1st to 10th Household Survey by ASHA BPMU Nov. 09 2 28th Nov. ‘09 Selection of the Village based on HMIS, low indicator, PHSC Village and non PHSC village population more than 500 3 29th Nov. ‘09 1st Step BPMU Meeting of the VHSC 2nd Step Selection of Nodal Officer for the Village Planning(ASHA) 3rd Step Orientation of VHSC members on VHAP by Block Facilitator in selected Village 4 30th 1st STEP MOi/c/BPMU November Resource Mapping & Disease mapping of the 2009 village 2nd STEP FGD of eligible couples on ANC, Breast Feeding, Family Planning, JSY, Early Marriage 5 4th Analysis of information collected from the field MOi/c, BPMU November visit, Survey, FGD and HMIS 2009 , 6 5th -6th Final Visit to Field for finalization of VHAP MO i/c,BPMU, December 2010-2011 by BPMU Team DPM 2009 1st STEP Presentation of VHAP by facilitator 2nd STEP Approval by VHSC

CHAPTER FOUR : Findings of the Village Health Action Plan

Data Source/information Situational Analysis

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Findings from the HHD Survey Low ANC,PNC Low observance of VHND Need to introduce Family Planning Finding From the HMIS data from April to Immunization session to be held regularly October 2009 in PHSC where the village belong Findings from the FGD Conducted in the Much information regarding the severity in village on MCH pregnancy cases is still lacking still going to TBAs private practitioners for Delivery Most of the women are unaware regarding the family planning

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CHAPTER FIVE

Concern, Activities, responsibility, timeline and Source of Fund Depart Issues of Concern Proposed responsibility timeline Estimated ment Activities cost & Source of Fund Health VHND Regular VHND ANM,ASHA, Every 300 x12 = No PNC AWW month Rs.3600 Low 3 ANC (VHSC U/F) Immunisation Referral vehicle High Home Delivery Headman, -do- 1500 x 20= Diarrhoea ASHA 30000 IMR (VHSC U/F, MMR VHC U/F, IFA RKS) Home visits by Doctors/Sup/ANMs

ICDS Nutrition PW giving AWW Every ICDS nutrition month 0-6 yrs childs giving nutrition

SSA Education 6-14 yrs needs V.A Every SSA to be given month education, nutrition, Proper distribution of Books PHED No. Safe drinking Needs cleaning V.A 1st Qtr. PHED water materials Water source connection TSC Poor sanitation activity New toilets VA Annual TSC And toilets Awareness on hygiene

Annexure 1. Diseases Mapping Resource Mapping List of Participants in the FGD conducted in the Village List of members in Village Planning Team Photos of Planning Process

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SEASONAL DISEASE MAPPING: Discuss with VHSC

Name of the Village: Kaziphung, Sl.No Name of the Type of Diseases Probable causes Solutions Month faced by the of the diseases Villagers 1 January cold Dusty compounds 2 February Cold, Diarrhea Water impurities Proper water supply 3 March Cold, Diarrhea Water impurities Proper water supply 4 April 5 May 6 June 7 July Diarrhoea, Water impurities, Proper water Dysentry, Fever, supply etc 8 August 9 September 10 October Cold, cough Climate change Medicine 11 November 12 December Cold, Fever, Etc Lack of self medicine resistance

List of members in the Planning Team: Sl.No. Name Designation 1 CS.Reisangmi VHSC Chairman 2 ML.Merry Grace VHSC Secretary ASHA 3 ML.Philachon AWW 4 C.Kharmi Social Worker 5 ML.Hopeson Asst.Pastor 6 KYS. Chipemmi Member VHSC 7 CS.Lingmiwon ASHA 8 KYS Ningkhanwon ASHA 9 KS. Chuihaola WHSA Chairperson

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Village Health Action Plan 2010-2011 For Litan Sareikhong Village, Ukhrul Block

Submitted by

Village Planning Team; Hamkothang, Shanti, shomring, Poinu, Esther, R. Ngalung, Angaritsing( facilitator) Village Health & Sanitation Committee, Litan Sareikhong Village

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Outlook about litan Sareikhong

Litan is typically a mixed community comprises of many Tangkhul villages, Baita, Nepalies and mayangs. The ukhrul- highway plies through the heart of the village. It is surrounded by the river. Most of the houses are build by the road and therefore the village looks like a line village. It is ideal for business like hotel; tea, meals, lodging, small shops and so on. Though all busses and other vehicle pass through the village, it doesn’t have any functioning public toilet. The village comes to live early in the morning; people cleaning the streets and collecting water. Then the place is filled by public carriers, private vehicles, local busses and the ukl-imp busses. The village stays busy the whole day, people buying and selling goods. The streets, apart from shops are filled by alien villagers selling vegetables and fruits. As soon as I reached litan sareikhon, I was welcomed by the asha and the shanao long (women organization) chairperson which was followed by a brief conversation. In the eve of the first day I, along with the chief, who is also the king and the chairman, chairman of the shenao long and the 2 ashas had a brief conversation about the ways of working to bring development to this village through NRHM. We discussed about the possible developments as well as the reasons of constrains. The next day was followed by data collection and survey, sketching Litan Sareikhong village, seasonal disease maping and working on problems and strategies. Next day: verification and finalization with the concern authorities.

Attachments: 1. Litan Sareikhong map 1 2. Litan Sareikhong map 2 3. seasonal disease map 4. problems and strategies chart

Done by: ANGARITSING ZIMIK Account manager PHC Lambui

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Contents

Summary of the Plan

Chapter One : Background of the Litan Sareikhong Village. Chapter Two : Methodology of the Plan

Chapter Three : Process of the VHAP 2010-2011

Chapter Four : Findings of the Village Health Action Plan

Chapter Five : Issues of Concern, Proposed Activities, timeline and Source of Fund

Summary of the Litan Village Health Action Plan 2010-2011

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Chapter One

4. Background of the Litan Sareikhong Village

a. General Information of the selected village

1 No Community Toilet is available in the village. 2 Source of Drinking water in the village is from Thoubal river 3 No AWW centre 4 2 primary school is there in the village

b. Village Demographic Profile

1 Total number of HHD is 183. 2 Head of the household headed by male is 147 and female is 9 3 Population = 625 (male is 425 and female 200) 4 Children less than 1 yrs is 33 (male=15 and female=18) 5 Children 1-5 yrs is 166 (male= 82 and female=84) 6 Children less than 6-15 yrs is 65(male=31 and female=34) 7 Number of birth April -November 2009= 10 (M= 5 & F=5) 8 Number of marriage April- November 2009= 10 9 Average age of marriage (Male=23-27, Female=18-20)

c. Village Household Profile

1 There are 172 simi-pucca household and 11 kuchha houses 2 Type of ownership is 116 own and 22 rented. 3 Household with 1 room=26, 2 rooms =120, 3 rooms=60, more than 3 rooms=61 4 Household with toilet facility=3 and 180 does not have toilets. 5 Electricity is there but irregular and most of the 183 household use kerosene & candle 6 Fuel for cooking is firewood and LPG only. 7 Main occupation of the villagers is agriculture and self employed in small shops. 8 Average monthly income in the households = Rs. Less than 1000-2000. 9 Food availability is difficult from April to June season 10 Various private and public vehicles including busses are available for villagers to commute 11 No household have TV and 30 household have radio in their house 1. Livestock reared in the village are hen, duck, pig, cow, and buffalo.

79 d. Basic Health profile

1 Deliveries are done only at home 2 Currently pregnant women = 6 3 Number of Deaths reported in the village=2 4 No Maternal Deaths from April -November 2009 5 65 % of the villagers chew pan with tobacco 6 60 % smoke 7 43 % drink alcohol 8 Some villagers go to Monkot Chepu PHSC for treatment. 9 Average amount spent for primary care 1. Doctor fee= No 2. Mobility = 20 3. Medicine= 200 4. Others=140 10 Average amount spent for secondary care 1. Doctor fee= No 2. Mobility = 20 3. Medicine= 500 4. Others=300 11 Disable person =3 e. HMIS data April-October 2009 1 ANC registration= 80 2 TT2/Booster = 7 3 BCG dose under 1 yrs =15 4 Measles 1st dose 9-12 months=97 5 Breastfed within 1 hours =5 6 PNC within 48 hrs=5 7 Home delivery non-SBA=9 8 Home delivery by SBA=1 9 Diarrhea and dehydration cases reported=5

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Chapter Two

5. Methodology of the Plan

The planning approach that has been adopted under National Rural Health Mission is bottom up approach in which three tiers of planning levels were done namely Village level plan by VHSC and Block Health Action plan by Block planning Team and similarly District Planning Team compiled the same Block Health Action Plan. To actualize the VHAP 2010-2011, the tools that were followed to bring out a comprehensive plan is as: 6. HMIS information from DHIS2 7. Basic village information collected by HH survey 8. FGD at the village level on Maternal Health 9. Mapping of the village 10. Seasonal Mapping on Diseases profile

The whole planning process at the Litan Sareikhong village is facilitated by Mr.Angaritsing Zimik PHC, Lambui A/C manager, Ukhrul Block and it took 9 days to complete the plan at the village. The facilitators are advised by the Block Nodal Officer on VHAP to make three visit.

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Chapter Three

6. Process of the VHAP 2010-2011

Litan is typically a mixed community comprises of many Tangkhul villages, Baita, Nepalies and non-Manipuri. The ukhrul-imphal highway plies through the heart of the village. It is surrounded by the Thoubal river. Most of the houses are build by the road side and therefore the village looks like a line village. It is ideal for business like hotel; tea, meals, lodging, small shops and so on. Though all busses and other vehicle pass through the village, it doesn’t have any functioning public toilet. The village comes to live early in the morning; people cleaning the streets and collecting water. Then the place is filled by public carriers, private vehicles, local busses and the ukl-imp busses. The village stays busy the whole day, people buying and selling goods. The streets, apart from shops are filled by neighbouring villagers selling vegetables and fruits. As soon as I reached litan sareikhon on my first vist, I was welcomed by the asha and the shanao long (women organization) chairperson which was followed by a brief conversation. In the eve of the first visit I, along with the chief, who is also the king and the chairman, chairman of the shenao long (women organization) and the 2 ashas had a meeting about VHAP and brief conversation about the ways of working to bring development to this village through NRHM. VHSC Litan have selected ASHA, Ester R as the nodal person for VHAP. A half day orientation on Village planning way done and the ASHA has been asked to give the information of the village. During the Orientation also discussion about the possible developments as well as the reasons of constrains were highlighted. On the second visit, resource mapping, disease mapping and group discussion were done with women folk. On the third visit the VHSC discussed on various issues regarding health and other determinants of health. It was followed by working on problems/concerns of the village and it can be mitigated and what are the possible actions that can be proposed in the coming financial year 2010-2011. Next process was verification and finalization of the plan and submitted to Block Authority.

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Sl. Dated Activities Responsibility No 1 1st to 10th Household Survey by ASHA DPMU/BPMU November 2009 2 28th November Selection of Village based on 2009 HMIS low health indicator PHSC Village and Non PHSC Village Population more than 500 3 29th November 1st STEP BPMU 2009 Meeting of the VHSC 2nd STEP Selection of Nodal Officer for Village Planning (ASHA) 3rd STEP Orientation of VHSC members on VHAP by Block facilitator in selected 3 villages

4 30th November 1st STEP MOi/c/BPMU 2009 Resource Mapping & Disease mapping of the village 2nd STEP FGD of eligible couples on ANC, Breast Feeding, Family Planning, JSY, Early Marriage 5 4th November 2009 Analysis of information collected from the field visit, MOi/c, BPMU Survey, FGD and HMIS , 6 5th -6th Final Visit to Field for finalization of VHAP 2010-2011 MO i/c,BPMU, December 2009 by BPMU Team DPM 1st STEP Presentation of VHAP by facilitator 2nd STEP Approval by VHSC

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Chapter Four : Findings of the Village Health Action Plan Experiences from the field through observation & Discussion The street: LitanVillage Street stays busy the whole day, busses plying, public carriers carrying goods followed by private vehicles on their own ventures as it connects to almost all the villages of Ukhrul District.

Sources of water: During my entire stay there I fetched water for my basic needs like washing face, brushing etc. seen below and the entire village depends on three main points of collecting water without proper pipe line. 1. Broken pipe near the drainage

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2. Garbage spread all over near the street and women standing near the broken pipeline to fetch drinking water

3. A point to fetch water

4. River just a 10-20 min walk

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Sanitary toilet: though the village is a public market place, the only public sanitary toilet available is not functional. Most of the villagers go down to the river for toilet, bathing, washing clothes and even as a source of drinking water, thus making the river polluted. Despite my busy schedule I had to run down the river for necessities.

People: the people are poor, shy and ignorant. Most of the women wanted to go for institutional delivery but could not because of poverty and ignorance. Even the ASHAs are de-motivated because they are not given honorarium and they are not recognized. And though there are 3 AWW there are no AWC. Even immunization is done in the ASHA’s home.

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Diseases mapping

Sl. Name of Type of diseases Probable causes of the solution No. the month faced by the diseases villagers 1 January Common cold Water impurities Water tank and hand Cold diarrhea Dusty compounds pump 2 February -do- Communicated disease First aid and preventive measures. 3 March Skin diseases Impure water Water tank and hand Lack of hygiene pump, proper drainage and toilet, preventive measures. 4 April Conjunctivitis Heavy and dusty storm Water tank and hand Skin diseases Impure water pump, proper Red eye communicated drainage and toilet, diarrhea preventive measures. 5 May Conjunctivitis, Lack of drainage, no Water tank and hand Diarrhea sanitary toilet, impure pump, proper Red eye, malaria, water, lack of education drainage and toilet fever. 6 June -Do- -do- 7 July -do- -do- 8 August Cold, viral fever. Dry and dusty, change Proper drainage and in season toilet preventive measures. 9 September Viral Fever Communicated, lack of Preventive measures. Worm infestation hygiene and sanitary proper drainage and toilet. toilet 10 October Viral fever, cold Seasonal climatic proper drainage and diarrhea changes, lack of toilet hygiene and sanitary toilet. 11 November Viral fever, lack of hygiene and proper drainage and Common cold, sanitary toilet. toilet cold diarrhea 12 December Cold diarrhea, lack of hygiene and proper drainage and common cold sanitary toilet. toilet

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CHAPTER FIVE

Concern, Activities, responsibility, timeline and Source of Fund

89 Concern, Activities, responsibility, timeline and Source of Fund

Issues of Concern Causes Proposed Activities responsibility timeline Source of Fund Poor Community Sanitary No community Construction of public toilet Headman 1QTR TSC/PHED provision toilet at lityan Functional AWW centre No Building Construction of AWW HeadMan 1QTR ICDS Available centre Poor infrastructure Primary Dilapidated Reparing of Primary School Headman 1QTR SSA School building Building at Litam Low age of marigae below ignorance Awareness on the benefits of ASHA/ANM 1QTRS UF 18 yrs late marriage 180 with no facility of Poverty Construction of 180 sanitary Headman 1QTRS TSC/PHED sanitary toilet for toilet for household Househiold Low Power supply No regular power Regular provision for Headman Whole FCS/PDS supply Kerosene from PDS year Food supply from april to Availability of Regular supply of rice from Headman Whole FCS/PDS june food PDS yrs NREGA Ensure NREGA work during this months Poor communication Poverty Provision from NIC Headman - NIC facility Poor Veterinary activity Encourage Projects on livestock Headman/SHG - Veterinary livestock management Dept. management High Home delivery Non functional Ensure staff stay at their Headman DHS PHSC/PHC place of posting RKS Poor knowledge of Close infrastructural gaps NRHM VHC Institutinal Delivey Logistics ASHA VHS Referral transport Awareness on the benefits of AWW VHSC Linkage between institutional delivery ANM and ASHA

High use of Stress on work Street play on the demerits tobacco/smoke/ackohol of toxicity of tobacco/smoke/alkohol Look after for disability Education for Support from Social welfare headman Whole SW deptt. Disable persons program yrs UF Support from ASHA through VHSC Low ANC & PNC Economic, Social BCC on benefits of ANC & ANM/BPMU 1 & 3 &4 VHC & Cultural barrier PNC QTR VHSC RKS Low breast feeding No time Ensure at least 6 months ANM/Doctors Whole VHC breast feeding Visits to yrs RKS village Diarrhoea & Dysentry Poor knowledge on Ensure full knowledge on ANM/Doctors Whole VHC hygiene & Dietary child health yrs RKS habits Poor dranage system Accountability Ensure proper drainage Headman Whole NREGA sysem yrs

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Resource Mapping

Photos of Planning Process

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Village Health Action Plan 2010‐2011 For H. Godah Village, Phungyar Block

Submitted by Village Planning Team; Village Health & Sanitation Committee, H. Godah Village, Phungyar Block, Ukhrul District

Seasonal Disease Mapping:

97 Sl. No. Types of Diseases faced by Probable causes of the Solutions the villagers disease Jan. Acute respiratory infection Pollution of air. Proper sanitation. Eye infection Feb. Eye infection Lack of proper hygiene. Sanitation Worm infection Fever Mar. Dysentery, Tonsillitis Garbage Proper drainage. Apr. Enteric fever, Dysentery Garbage Use of disposal pit May Diarrhea, scabies Stagnant water Use of disposal pit Jun Malaria , Diarrhea. Stagnant water, Proper drainage unavailability of bed net. around the compound. Unhygienic source of Maintenance and water development of clean drinking water source. Jul. Malaria , Diarrhea. Stagnant water, Proper drainage unavailability of bed net. around the compound. Unhygienic source of Maintenance and water development of clean drinking water source. Aug. Malaria , Diarrhea. Stagnant water, Proper drainage unavailability of bed net. around the compound. Unhygienic source of Maintenance and water development of clean drinking water source. Sep. Worm infestation, diarrhea Lack of sanitation Proper use of drainage Oct. Acute respiratory infection Air pollution Proper use of water and foods Nov. Rhinitis, sinusitis, cold Unproper care of health Proper sanitation diarrhea Dec. Cold diarrhea, ARI, PUS Air pollution, unproper Proper maintenance of maintenance of health health

CONCERN, ACTIVITIES, RESPONSIBILITY, TIMELINE AND SOURCE OF FUND

Area of Cause of Proposed activities Person Timeline Estimate cost & concern problem responsible Source

Safe No reservoir Construction of PRI 1 year 2 lacs NREGS drinking Reservoir water

98 Toilet Lack of Construction of TSC 1 year 50 lacs sanitation septic tank TSC & Local awareness & Contrn. Poverty Eye Viral/Bad Air Check up by Medical PHC Staffs January 7000 RKS, VHC Infection Team & VHSC Untied F

Malaria Lack of Awareness & MO & BPMU April 10,000 BCC awareness Workshop

Cold & Viral Check up by Medical PHC Staffs September 7000 RKS, VHC Cough Team & VHSC Untied F Home Non availability SBA Training of ANM M.O & BPMU 1st District/State Delivery of facilities Quarter

Diarrhoea viral & Source of Safe drinking water PHED, PRI, April & 2 lacs NREGS drinking water & Awareness on Health May and BCC enviromental/ Facilitators personal hygiene Poor Maximum no Pit latrine with cover VA All months TCS sanitary proper loilet needed

Food Irregular Rice VA ‐do‐ FCS availability from PDS to pregnant women and BPL family

Village Health Action Plan 2010-2011 For Village, Kasom Khullen Block

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Submitted by Dr. Kh. Gopeshwor, Phungreiyo Duidang , Masowon(ASHA) Village Planning Team; Village Health & Sanitation Committee, Khamlang.

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Information about the village 1. Community Toilet is not available in the village. 2. Source of Drinking water in the village is available throughout the season from spring water

101 3. Function 3 AWW centre 4. 1 primary school, one pvt. High school existed. Village Demographic Profile 7. Total number of HHD is 61 8. Head of the household headed by male is 57 and female is 4 9. Population = 463 (male is 228 and female 235) 10. Children less than 1 yrs is 3 (male=1 and female=2) 11. Children 0-5 yrs is 29 (male= 13 and female=16) 12. Number of birth april-november 2009= 1 (M= 1 & F=0) 13. Number of marriage april-november 2009= 0 14. Average age of marriage (Male=, Female=) Village Household Profile 1 There is 4 pucca house in the village but there are 51 simi-pucca household and 6 kuchha houses and type of ownership is own. 2 Most of the Household built with more than 3 room 3 Household with toilet facility : few of them 4 Electricity is there but irregular and to supplement they used kerosene, candle as alternative. most of the 128 household use kerosene & resin 5 LPG Gas and dried wood were uses as fuel for cooking 6 Agriculture and self entrepreneurship were the main source of occupation. 7 Average monthly income of the households ranges from 1000 – 2000. 8 Food could not be made available throughout the four season 9 Used private two wheelers and aboard public buses for transportation. 10 Own TV and Radio for communication. 11 Possessed 40 acre of land for cultivation(terrace) non acre of land were irrigated 12 Livestock rare in the village are hen, pig, mithun.

Basic Health profile

1 Home Delivery were done by non-SBA trained in the village 2 Currently pregnant women = 1 3 Number of Deaths reported in the village = 1(f) 4 No Death (Children) less than 1 yrs, less than 5 yrs reported. 5 No Maternal Deaths from april- november 2009 6 80 % of the villagers chew pan with tobacco 7 60 % smoke 8 45% drink alcohol 9 Villagers go to PHC for treatment 10 Average amount spent for primary care= 300 above spent on drugs buying and special food intake. 11 Average amount spent for Secondary care = 3000 above spent on doctor fee, drugs buying, special food intake, and transportation. 12 Average amount spent for tertiary care = 30000 above spent on doctor fee, drugs buying, special food intake, transport, and others (essentials).

Photos for planning process

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Concern, Activities, responsibility, timeline and Source of Fund Issues of Concern Proposed responsibility timeline Source of Fund Activities No PNC Activate ASHA 2010-11 NRHM Low 3 ANC ASHS AWW Referral vehicles ASHA VHSC High Home Del incentives in BPMU Low JSY time Diarrhea No health Dysentery staffs always Immunization Irregular IFA

103 No Meeting with ASHAs at PHSC Health and hugiene Water problem Toilet problem

Village Health Action Plan 2010-2011 For Yeasom Village, Kasom Khullen Block

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ACKNOWLEDGEMENT

Yeasom Village situated more than 25 km. away from PHC Kasom. Settled touching the line of district highway en masse with around 250 population on 40 household. Villagers willfully welcome BPMU team and gradually forwarded for VHAP. Whatever the reasons, villagers provide best cooperation exclusively by VAs, Youths, Women society leaders, and available intellectuals.

15. Background of the Yeasom Village

105 a. General Information of the selected village

1 Community Toilet (temporary) is available in the village. 2 Source of Drinking water in the village is available throughout the season through pipeline system 3 Function 2 AWW centre 4 1 primary school, no High school existed. b. Village Demographic Profile

1 Total number of HHD is 40 2 Head of the household headed by male is 37 and female is 3 3 Population = 235 (male is 115 and female 120) 4 Children less than 1 yrs is 8 (male=4 and female=4) 5 Children 0-5 yrs is 32 (male= 15 and female=17) 6 Number of birth april-november 2009= 5 (M= 2 & F=3) 7 Number of marriage april-november 2009= 0 8 Average age of marriage (Male=, Female=)

c. Village Household Profile

1 All of them live in Kuchha built home and type of ownership is own.

106 2 Most of the Household built with 3 room, few of it to 2 & 5 room. 3 Household with toilet facility : none of them 4 Electricity is there but irregular and to supplement they used kerosene, candle as alternative 5 dried wood were uses as fuel for cooking 6 Agriculture was the main source of occupation. 7 Average monthly income of the households ranges from 1000 – 2000. 8 Food could not be made available throughout the four season 9 Used private two wheeler, and aboard public buses for transportation. 10 Own TV and Radio for communication. 11 Possessed 50 acre of land for cultivation (terrace) 30 acre of land was used through irrigation. 12 Livestock rare in the village are hen, pig, duck, cow buffalo

Basic Health profile

13 Home Delivery were done by non-SBA trained in the village 14 Currently pregnant women = 2 15 Number of Deaths reported in the village = 2 16 No Death (Children) less than 1 yrs, less than 5 yrs reported. 17 No Maternal Deaths from april- november 2009 18 Most of the adult both men and women in the village chew pan with tobacco 19 65 % of adult (m) smoke 20 35% of adult mostly male drink alcohol 21 Villagers go to local healers, and PHC for treatment 22 Average amount spent for primary care= 300 above spent on drugs buying and special food intake. 23 Average amount spent for Secondary care = 3000 above spent on doctor fee, drugs buying, special food intake, and transportation.

107

108

Seasonal Mapping on Diseases profile

Sl no. Name of the Type of diseases Probable causes Solution month faced by the of the diseases villagers 1 January Common cold & Lack of personnel coryza, cough, hygiene 2 February Cold & coryza, fewer, cough 3 March Cold & coryza, fewer, cough 4 April Typhoid, fewer 5 May Typhoid, fewer Lack of sanitation fewer, malaria and frequent visits to jungle by mostly male 6 June Skin diseases Transmitted from nearby villagers 7 July Fewer, skin Transmitted from diseases nearby villages 8 August Diarrhea, Transmitted from dysentery, skin nearby villages disease 9 September Eye disease and Harvesting cough 10 October Conjunctivitis, Harvesting eye disease, cough 11 November Cough, flue, body ache 12 December Cold & coryza, Prolonged fewer exposure to cold at night

The whole planning process at the Yeasom village is facilitated by Mr. Phungreiyo Duidang, BAFC, Kasom Block and it took days to complete the plan at the village.

109

Photos of Planning Process

110

Village Health Action Plan 2010-2011 For Tarong Village, Kasom Khullen Block

ACKNOWLEDGEMENT

Tarong Village situated 14 km. away from PHC Kasom. Settled touching the line of district highway en masse with around 300 above population on 50 household. Villagers willfully welcome BPMU team and gradually forwarded for VHAP. Whatever the reasons, villagers provide best cooperation exclusively by VAs, Youths, Women society leaders, and available intellectuals .

111

Background of the Tarong Village

General Information of the selected village

Community Toilet is not available in the village. Source of Drinking water in the village is not available throughout the season Function 3 AWW centre 1 primary school, no High school existed.

Village Demographic Profile

Total number of HHD is 50 Head of the household headed by male is 48 and female is 2 Population = 339 (male is 169 and female 170) Children less than 1 yrs is 6 (male=3 and female=3) Children 0-5 yrs is 31 (male= 14 and female=17) Number of birth april-november 2009= 4 (M= 4 & F=0) Number of marriage april-november 2009= 0 Average age of marriage (Male=, Female=)

112 Village Household Profile

All of them live in Kuchha built home and type of ownership is own. Most of the Household built with more than 3 room, few of it to 3 room. Household with toilet facility : none of them Electricity is there but irregular and to supplement they used kerosene, candle as alternative LPG Gas and dried wood were uses as fuel for cooking Agriculture and self entrepreneurship were the main source of occupation. Average monthly income of the households ranges from 1000 – 2000. Food could not be made available throughout the four season Used private jeep , shaktiman, and aboard public buses for transportation. Own TV and Radio for communication. Possessed acre of land for cultivation(terrace) non acre of land were irrigated Livestock rare in the village are hen, pig.

Basic Health profile

Home Delivery were done by non-SBA trained in the village Currently pregnant women = 1 Number of Deaths reported in the village = 1 No Death (Children) less than 1 yrs, less than 5 yrs reported. No Maternal Deaths from april- november 2009 Most of the adult both men and women in the village chew pan with tobacco 60 % of adult (m) smoke 45% of adult mostly male drink alcohol Villagers go to local healers, and PHC for treatment Average amount spent for primary care= 300 above spent on drugs buying and special food intake. Average amount spent for Secondary care = 3000 above spent on doctor fee, drugs buying, special food intake, and transportation. Average amount spent for tertiary care = 30000 above spent on doctor fee, drugs buying, special food intake, transport, and others (essentials).

113

Seasonal Mapping on Diseases profile

114

Sl no. Name of the Type of diseases Probable causes Solution month faced by the of the diseases villagers 1 January Common cold, Lack of cough, diarrhea personnel hygiene 2 February Dysentery, flue, Due to change in diarrhea, headache season 3 March Fewer, headache -do- 4 April Conjunctivitis - do - fewer, headache, diarrhea, dysentery 5 May Diarrhea, Lack of dysentery, fewer, sanitation and malaria frequent visits to jungle by mostly male 6 June - do - 7 July - do - 8 August lurmatitus, boil, flue, fewer, malaria 9 September -do- 10 October Body ache, headache, fewer 11 November Common cold, cough, fewer 12 December Flue, ringworm, Lack of cough, common personnel cold hygiene

The whole planning process at the Tarong village is facilitated by Mr. Phungreiyo Duidang, BAFC, Kasom Block and it took days to complete the plan at the village.

115

Photos of Planning Process

116

PART - A

117

A Reproductive and Child Health - II A.1 Maternal Health With the implementation of the RCH programmed in the district Maternal care services like ANC (99 %), delivery by trained hands (94%), institutional delivery (82%).

Current status and goals of RCH-II by 2011 STATE INDIA RCH II Current Target GOAL status Target Current 10-11 11-12 status 10-11 MMR 374 (SRS 200 <100 301(SRS) <100 2001) IMR 12 (SRS 2007) <10 <5 58 (SRS 2005) <30 TFR 2.8 (NFHS-3) 2.4 2.1 2.9 (SRS 2004) 2.1

A. Maternal Health Targets Outcome Indicators Current Status 10-11 11-12 % of pregnant women receiving full ANC coverage 7.02 (HMIS) District 1 April-Oct 2009 State 12.5% DLHS-3 % of home delivery assisted by a SBA only 4.54 % (HMIS) District 2 April-Oct 2009 State 24.6% DLHS-3 Institutional delivery assisted by Health Personals at Health Institutions Private+ Public 16.66 % (HMIS) District 3 April-Oct 2009 State 41.1 % DLHS-3 % of mothers who received post partum care from a doctor/ nurse/ LHV/ ANM/ other health personnel within 2 days of delivery 4 District (No PNC=152, No. Delivery= 18.65 % (HMIS)

815) Institution.+Home, Priv+Pub April-Oct 2009 State 49.1 % NFHS-3

118 Ba. Child Health

Targets Outcomes indicators Current status 10-11 11-12 % of neonates who were breastfed within 1 hour of life 48.70 % (HMIS) 1 District April-Oct 2009 State 57.7% DLHS-3 % of infants who were breastfed exclusively till 6 months of age 2 District - 85 95 State 42.8 % DLHS-3 % of infants receiving complementary feeds apart from breast feeding at 9 months 3 District - 85 95 State 78.1 (NFHS-3) % of children 12-23 months of age fully immunized District 13.38 % HMIS 65 80 4 April-Oct 2009 State 48.5 % DLHS-3

Bb Child Health Targets Outcome Indicators Current Status 10-11 11-12 % of children 6-35 months of age who are anemic

5 District - 40 20

State 52.8 (NFHS-3) % of children under 5 years age who have received all nine doses of Vitamin A 6 District NA - - State NA - - % of children under 3 years age with diarrhea in the last 2 weeks who received ORS

District 70 90 7 - State 36.8 (NFHS-3) % of children under 3 years age who are underweight District - 15 10

State 23.8 (NFHS-3)

C. Family Planning Targets Outcome indicators Current status 10-11 11-12

119 Contraceptive prevalence rate (any modern method) 1 District - 60 75 State 44.9 % DLHS-3 Contraceptive prevalence rate (limiting methods) Male Sterilization (District) 15 number

2 Male Sterilization (State) 0.3 % DLHS-3 1.0 2.0

Female Sterilization ( District) 2 number

Female Sterilization (State) 5.0 % DLHS-3 12 17

Contraceptive prevalence rate (spacing methods) Oral Pills (State) 5.4 DLHS-3 10 22 3 IUDs (State) 5.3 DLHS 10 20 Condoms (state) 3.2DLHS-3 10 15 Unmet need for spacing methods among eligible couples 4 District - <15 <10 State 8.1 % DLHS-3 Unmet need for terminal methods among eligible couples 5 District - 10 5 State 17.5 % DLHS-3

A.1.1.1Operationalize DH/CHC as FRUs Activities:

District Hospital Ukhrul up-gradation to FRU status

120 a. Dissemination workshop of 1 District Hospital as FRU b. Repairing of Child, Female & Male Wards c. Repairing of Minor OT d. Repairing of OT for CS e. Construction of Blood Bank facility with supportive staffs f. Construction of one Public Toilet needed g. Extension of OPD section needed as it is congested h. Construction of staffs quarters for Doctors and staffs i. Construction of a new Warehouse j. Construction of a new Training Centre in the premises of District Hospital k. Construction of 20 bedded Maternal Hospital attached to District Hospital. l. AYUSH – 10 Bedded Hospital (Ayurvedic) hospitals is proposing during 2010-11 m. Strengthening of general laboratory (including ICTC, VCTC) integrate with MACS/TB n. PPP proposal with two private hospitals with CS facility & family planning services. o. Manpower request for the District Hospital a. 1 Gynecologist, 1 Surgeon, 1 Physician, 1 Radiologist p. Training requested for the District Hospital a. 2 Doctor for MVA, 2 Doctors IUCD, 3 SN for IUCD, 1 Doctor for EmoC, 2 SN IMEP q. Procurement of 1 407 Vehicle for indent, r. Procurement of 1 vaccine van for supply of vaccine to lower health centres s. Procurement of Drug & Medicine a. Essential drugs for 50 bedded Hospital t. Equipment and furniture a. OT equipment Sterilizer for OT, OT cate/fumigation apparatus, Infusion Pump, EMO Machine, Gloves & Dusting Machine, Auto analyzer, ECG, Ultrasound, Photo-Theraphy machine, Suction machine for MTP, Suction machine, Kit b to Kit P, Instrument/medicine Cabinet, Dressing/mayo/Instrument Trolleys, Bed side Cabinet/ Attendant Chair u. Installation of Solar Lamps for DH v. Quality Assurance is ensured by Monitoring and Evaluation through RKS

Community Health Centre Kamjong up-gradation to FRU status

a. Fencing for CHC Kamjong b. Strengthening of general laboratory (including ICTC, VCTC) c. integrate with MACS and TB d. Manpower request for the District Hospital a. 1 Gynecologist, 1 Surgeon, 1 Physician, 1 Radiologist e. Training requested for the District Hospital a. 1 Doctor for MVA, 1 Doctors IUCD, 2 SN for IUCD, 2 Doctor for IMNC, 1 Doctor EmoC,

121 i. Doctor for LSA, 1 Doctor for IMEP f. Procurement of 1 Ambulance for CHC g. Procurement of Drug & Medicine a. Essential drugs for 30 bedded CHC h. Office furniture i. Installation of Solar Lamps for CHC

The budgets for the above proposals are reflected in their respective head under Part A & B.

Sl Activity Quantity Unit Rate Total Amount in No (Rs) lakhs (Rs) 1 Dissemination Workshop for District 2 5000 0.10 Hospital & CHC Kamjong 2 M&E 1 2500 0.025 Total 0.125

A.1.1.2 Operationalize 24/7 PHC Activities:

a. 4 PHCs out of 6PHCs are identified for functioning as 24x7 delivery service and up gradation works for 2 PHCs completed and another 2 PHC are under progress to achieve IPHS Standard. b. 2 more PHCs will be identified as 24X7 during 2010-2011. For these 2 PHC, i.e Khangkhui PHC and Phungyar PHC, 2 New buildings was approved in 2009-2010 PIP and the work is done by MDS. c. As far as staff Quarters are concern, 2 Barrack type Qtrs and type III Qtrs are available for 3 PHCs (24x7) except Chingai PHC. So during 2010-2011, 1Barrack type quarter and 1 type IV quarter is propose for Chingai PHC. d. To close infrastructure gaps for 6PHCs, 1 new PHC Building for Lambui PHC is also propose during 2010-2011. e. There is need for AYUSH - OPD Room extension for the 1 (one) PHC Somdal as the old building is too congested to run as 24X7. f. Manpower requirement for 6 PHCs identified as 24X7 a. MBBS Doctors= 1+1+1+1+1 for Lambui, Kasom, Somdal, Phungyar b. Staff Nurse for 24X7 =2+1+1+1+1 KKL, Phungyar, lambui, somdal, c. Lab Tech=1+1+1 Phungyar, Chinagai, KKL g. 6 PHCs functional with AYUSH services. h. AYUSH Doctors need furniture and Medicines for proper functioning. i. Training of Staffs a. SBA for 10 Staff Nurse b. SBA for 15 ANMs c. NSV for 2 Doctors d. IMNCI for 4 AYUSH Doctors e. IMNCI for 8 SN f. IMNCI for 20 ANMs g. IMEP for 8 SN h. RTI/STI for 5 Doctors

122 i. RTI/STI for 5 AYUSH Doctors j. MVA for 4 Doctors k. IUCD for 6SN l. IUCD for 12 ANMs j. Lab Functionality k. Procurement of 6 Ambulance for 24X7 6PHCs l. Procurement of Essential drugs for PHCs m. Office furniture for 6PHCs n. Installation of Solar Lamps for, 6PHC Citizens Charters are install to all the PHCs o. Quality Assurance is ensured by Monitoring and Evaluation/RKS

The budgets for the above proposals are reflected in their respective head under Part A & B.

Sl No Activity Quantity Unit Rate Total Amount in lakhs (Rs) (Rs) 1 Dissemination Workshop 6 5000 0.30 2 M&E 6 2500 0.15 Total 0.45

A.1.1.3 Operationalize MTP services Activities:

a. Dissemination Workshop at 1DH, 6PHC on availability of MTP services b. Training of MBBS Doctors reflected in MVA discussed in Training Head c. Drug Requirement reflected in Drug procurement section d. BCC through ASHA/AWW for MTP of the services availability in 1CHCs, 6 PHCs reflected in BCC section. e. Quality Assurance will be ensure by Monitoring and evaluation

The budgets for the above proposals are reflected in their respective head under Part A & B.

Sl No Activity Quantity Unit Rate Total Amount in lakhs (Rs) (Rs) 1 Dissemination once a year 7 3000 0.21 2 M&E 6 2500 0.15 Total 0.36

A.1.1.4 Operationalize RTI/STI services Activities:

a. Dissemination Workshop at 1DH, 6PHC on availability of MTP services b. Operationalisation RTI/STI Clinics on every Wednesday at 1CHC and 5 PHCs c. Training of MBBS Doctors reflected in training head.

123 d. Training of Lab technician required for 1CHC and 6 PHCs e. Procurement of lab materials f. Requirement of drugs are reflected in procurement section. g. BCC activities at the Block level a. Involvement of PRI/NGOs/ASHA/AWW/School teachers/Local leaders/church b. RTI/STI related BCC Workshop/Camp at the Block once in a quarter c. Involvement of RKS and VHSC d. Awareness on RTI/STI service availability in health centres in VHND e. Develop Street play by ASHAs at the PHSC level. h. Monitoring progress and quality of services at 1DH, 1CHC, 6PHCs

The budgets for the above proposals are reflected in their respective head under Part A & B.

Sl No Activity Quantity Unit Rate Total Amount in lakhs (Rs) (Rs) 1 Dissemination once a year 7 3000 0.21 2 M&E 6 2500 0.15 Total 0.36

A.1.1.1.5 Operationalize Sub-centres Activities:

a. There are 40 PHSCs sanctioned for Ukhrul District. b. Infrastructure gaps for 27 PHSC will be completed by this financial year. c. Propose for repairing of 6 PHSCs Government building by VHC. d. Another 7 new construction for 7 PHSCs propose during 2010-11 e. 39 Add. ANMs in place so Propose for recruiting 1 Add. ANM f. Increase Incentives for ANMs for heard reach areas. g. 24 ANMs needed SBA Training, h. 24 ANMs needed IUCDs Training i. 24 ANMs needed training on ARSH Training for ANMs. j. Orientation on HMIS for 40 PHSCs ANM staffs k. Procurement of Furniture and Solar Lamps for 33 PHSCs l. Propose Rent for 6 PHSCs requested. m. Proper water supply facility for 33 PHSCs n. Fencing by Local Resource for 33 PHSCs o. Monitoring & Supervision for progress and quality of service by BMO/PHC MO i/c or BPMU

The budgets for the above proposals are reflected in their respective head under Part A & B.

124 Sl No Activity Quantity Unit Rate Total Amount in lakhs (Rs) (Rs) 1 Water facility 33 10000/- 33.00 2 Fencing of PHSC 33 30000/- 9.90 4 M&E 33 1000/- 0.33 Total 43.23

A.1.2 Referral transport through outsourcing Activities:

A.1.3 Integrated Out-reach RCH services

A.1.3.1 RCH Outreach Camps

a. RCH Camps (General Camps and Specialty Camps) in difficult, most difficult and inaccessible 63 villages in the District. b. Monitoring against the program by DPMU.

Sl. No Name of the Institution Number Unit Rate Amount Of villages (Rs ) (Rs in lakhs) 1 Ukhrul 20 20,000 4.00 2 Kamjong 20 4.00 3 Chingai 10 2.00 4 Phungyar 13 2.60 5 Kasom Khullen 7 1.40 Total 63 14.00

A.1.3.2 VHND

a. Target for VHND : 1 ANMs to visit 2 Villages in a month X 12 months =1920 b. VH&ND at Anganwadi Centers on 1st Sunday & 3rd Sunday at 1920 AWC at 8:00 a.m. c. Strengthening of VHND through Community participation (NGOs, PRIs, Social Workers, Women’s organization, Church leaders at the village d. Micro plan for VHND activities collated with routine immunization e. Travelling support for ANMs f. Lending Community Hall for conducting VHND. g. Health Talk by ANMs/Supervisor h. Refreshment arrangement. i. Medicine Support for Other aliment other than Immunisation. j. Ensure monitoring by BPMU.

Budget for VHND:

125 Sl. No Activity Number Unit Amount per Amount VHND organised (Rs in lakhs) (Rs) 1 Organized VHND by ASHA/AWW 1920 100 UF,VHSC 2 80 ANM’s Travelling 1920 200 3.84 Support for 2 village visits per month X12 4 Medicine support for MCH 1920 500 9.60 Services like IFA per visits 5 Honorarium for ASHA support 1920 50 UF, VHSC 6 Monitoring Support for BPMU - - 0.40 Total 13.84

A.1.4 J.S.Y Activities

Estimated number of deliveries in 2010-11

Sl. Targets Key Indicators No. 2010-2011 1 Population (District) 159277 2 Eligible Couple 37349 2 Preg. Women 3329 3 Delivery 3026 4 Institutional 55 % of 3026 1725 5 Home 40 % of 3026 1211 6 CS 5% of 1815 90

A.1.4.1 Home deliveries

a. Provisions for coverage of Home deliveries to JSY b. Ensuring early registration & at least 3 ANC c. Encouraging at least 14 PNC visits within 2 days and 14 days d. If all the activities of ASHAs are fulfilled even in home delivery and also delivery done by not less than ANM, payment of ASHA shall be given. e. Ensure PNC by Activating of ASHA and ANMs at PHSC f. Performance based reward for Staffs at PHSC

Budget for Home deliveries:

Sl. No Activity Qty Rate (Rs) Amount (Rs) In lakhs 1 Home delivery 1211 700 8.477

126 2 Payment to ASHA fulfilling 1211 600 7.266 All criteria except Ins. Delivery. Also has to ensure 2 PNCs visits 3 Incentive for ANMs for Home delivery 1211 200 2.422 Total 18.165

A.1.4.2 Institutional Deliveries

a. Promoting Full ANC b. Encouraging at least 2 PNC d. Availability of Normal delivery at CHCs/PHCs is essential f. SBA /Neonatal care Training for MOs/SN/ANMs g. Ensure 24hrs institutional delivery facilities at CHCs h. Ensure Emergency Obstetric care facility at CHCs i. Ensure OT/Neonatal care/Blood storage facilities operationalize for CHCs

Budget for Institutional Deliveries:

Sl. No Activity Qty Rate (Rs) Amount (Rs) In lakhs 1 Ins. Delivery payment to mothers 1725 700 12.075 2 Payment to ASHA fulfilling 1725 600 10.35 All criteria except Ins. Delivery. Also has to ensure 2 PNCs visits 3 Referral services @ Rs. 500/- for Ins. Delivery 1725 500 8.625 4 CS cases 2 % of the Total delivery 90 1500+ 2200 700 5 Ensure 2 PNC visits by ASHA within 14 days 1725 200 3.45 Total amount for Inst Delivery 36.48 Total amount for Home Delivery 18.165 Total amount 54.645 6 4 % of the budget for IEC & Others 2.00 7 1 % of the budget for Administrative expenses 0.50 8 Monitoring support for Home & Inst. Delivery 1.50 Total Amount 58.645

A.1.5 Other Strategies/Activities

A1.5.1 Ensuring early registration and ANC (at least 3) for all Pregnant women

(i) Ensuring that ANMs stay at their place of posting by promoting the environment of the Sub-centres through provision of untied funds.

127 (ii) Ensure full ANCs as one of the criteria for claiming financial assistance under JSY. (iii) Provision of 100 IFA to all Institutions as per projected Birth outcomes. (iv) Mobilization by ASHA to Pregnant women stating the benefits of health services available in PHSC. (v) Activate VHSC every month in every village or designated ASHA location at AWW. (vi) Ensure Dispensing of Drug Depot centre like IFA, Metronidazol, First Aid, and others at notified AWC. Ensure Stock Register by AWW/ASHA (iii) District Mobile Medical Units to hold regular sessions in difficult to be accessible areas

A1.5.2 Maternal Death Auditing:

(i) Formation of a District level Committee under the Chairmanship of Deputy Commissioner for Maternal Death Auditing. Last year we were reported 04 cases of Maternal Death. It can also be assumed that the number of cases; Home delivery are directly responsible to Maternal Death. A sum of Rs. 0.005 lakhs each may be sanctioned for supporting to those mothers. We have received applications to DHS asking help to those affected families. Provision of this short will rejuvenate accountability on health services system. A sum of Rs. 0.50 lakhs may be given during 2010-11.

A1.5.3 Strengthening PNC

(i) Promoting at least 03 PNC (1st day, 1st week, 6th week) viits through ASHAs, AWWs, ANMs (ii) Making at least 2 PNC visit a pre-requisite for JSY benefit to ASHA. (iv) BCC activities at BCC Head

A1.5.4 Strengthening PPP

(i) Accreditation for 2 Private Hospital inside the District done for MCH services. (ii) Accreditation of at least 06 Pvt. Hospitals outside the district is require as some of the delivery take place in those clinics like Shanti Hospital, Shija Hospital, Imphal Hospital, Langal View, MM Hospital, Subha Hospital. (iii) Ensure proper orientation of RIMS, JNH and other Accredited Clinic on JSY Program. Lot of problems is face presently much of the Institutional deliveries are done outside the District also.

A.2 CHILD HEALTH

A.2.1 IMNCI Activities:

a. Training Doctors and Staffs on IMNCI b. IEC/BCC through ASHAs/AWWs/ANMs/NGOs

128 c. Promote Child Clinic on Monday visited by specialist Doctors on CHC/PHCs d. Referral support for sick children to FRUs

A.2.2 Facility Based Newborn Care/FBNC Activities: a. Preparation and Dissemination of Guidelines on FBNC b. BCC/IEC for FBNC through ASHAs, AWWs, ANMs, NGOs c. Training-Doctors-MBBS/AYUSH, PHN, ANM, d. Ensure Neonatal care facilities at PHSC e. Ensure availability of Drugs and Medicine at CHC, PHC and PHSC. A.2.3 Home Based Newborn Care/HBNC

Activities: a. Preparation and Dissemination of Guidelines for HBNC b. Promotion of HBNC on VHND c. Training of Doctors / PHNs /ANMs/ Health Educators/Health Supervisors On HBNC d. Ensure Neonatal care facilities at referral centers including PHSC e. Early referral from ASHA to PHSC/PHC after First Aid. f. Ensure availability of Drugs and Medicine at CHC, PHC and PHSC.

A.2.4 School Health Programme Activities:

Reflected in part B

A.2.5 Infant and Young Child Feeding/IYCF Activities: a. Training on IYCF on ASHAs / AWWs / ANMs b. BCC/IEC; As per out FGD report 80% of the mothers do not Know feeding practice of their children, an awareness program on IYCF is needed in each PHSC targeting Mothers.

A.2.6 Care of Sick Children and Severe Malnutrition Activities: a. Training of Doctors, Nurses, drug supply at health facilities centre b. Identification by ASHA/AWW c. Special - nutrition food programs (organized with ICDS). d. M.Os/ANMs Visit to such identified Houses e. BCC/IEC

A.2.7 Management of Diarrohea, ARI and Micronutrient Malnutrition Activities: a. Drug supply to ASHAs and health facilities centre b. Awareness on sanitation and save drinking water through IPC by ASHA. c. BCC/IEC Activities

129

A.3 Family planning

A.3.1 Terminal/Limiting Methods A.3.1.1 Dissemination of manuals on sterilisation standards & quality assurance of sterilization services Activities:

a. Quality assurance committee on sterilization services at the District level to monitor the sterilization services at the block b. A block level Quality assurance committee is proposed at the block level c. Dissemination workshop in health facility where manpower are trained.

Budget for Dissemination of manuals on sterilisation standards & quality assurance of sterilization services

Sl Activity Quantity Unit Rate Total Amount No (Rs) in lakhs (Rs) 1 Dissemination of guidelines and 32 2000 RKS Observation of Sterilization Day at Fund DH/CHC/PHC

A.3.1.2 Female Sterilisation camps. Activities: a. 2 Camps to be organized to DH/CHC b. Capacity: 50 c. IEC/BCC d. Other components

A.3.1.3 NSV camps Activities: a. 6 Camps to be organized to 1DH, 2CHC/2 PHC with ASHAs/AWWs/ANMs/NGOs at the blocks b. Capacity: 250 c. IEC/BCC

A.3.1.4 Compensation for female sterilization Activities: a. Tubectomy compensation for ASHA b. Compensatory for Beneficiaries per case for Tubectomy c. Incentive for ANMs and Doctors for female sterilisation

A.3.1.5 Compensation for male sterilization Activities: a. Vasectomy compensation for ASHA b. For Beneficiaries per case for Vasectomy c. Incentive for Doctors

130

A.3.1.6 Accreditation of private providers for sterilization service Activities: a. Promoting in Private Hospital. a. Propose for accreditation 6 private hospitals at Imphal. A.3.2 Spacing Methods A.3.2.1 IUCD camps A.3.2.2 IUCD services at health facilities Activities: a. Awareness is to be organized to all the DH/ CHC/PHC/PHSC b. Training of IUCD insertion for Doctors/SN/ANMs c. Supply of Drugs and other supply. d. IEC/BCC activities will be done on acceptance of the program. e. Incentives for Doctors/SN/ANMs for conducting IUD services. f. Motivation fee to ASHA

A.3.2.3 Accreditation of private providers for IUCD insertion service Activities: a. Already accreditation done for 2 private Hospital at the District. b. Propose for accreditation of 6 private hospitals outside the district.

A.3.2.4 Social Marketing of contraceptives Activities: a. Provisions for distribution of contraceptives through ASHA in the community b. Establishment of ASHA Drama Unit based on Folk Lore. c. Social Marketing of Pills, Condoms and other traditional Methods through ASHA & AWW. A.3.2.5 Contraceptive Update seminars Activities: a. Contraceptive update seminars at block level. b. Target groups: SN/ANMs/ASHAs/PRIs

A.3.3 Other strategies/activities Activities: a. Documentary Film on Family Planning at the Grass root. A sum of Rs. 0.50 is requiring for the above film.

Budget for FAMILY PLANNING Sl. Particulars/Activity Unit rateQty Amount

131 No. (Rs) in Lakhs 1 Female Sterilization Camps at DH/CHC - 2 3.00 1 Quarterly NSV Megacamps in three blocks 0.50 7 3.50 Compensation & motivation fee 2.1 For Tubectomy (Acceptor-1100, Motivator-150, Drugs & dressings-100, Surgeon’s charge-75, 1500 200 3.0 Anesthetist’s charge-25, Staff Nurse-15, OT Tech-15, 2 Refreshment-10, Camp Mngt-10 in Public facilities; 2.2 For Vasectomy (Acceptor-600, Motivator-200, Drugs & dressings-100, Staff Nurse-15, OT Tech-15, 1000 500 5.0 Refreshment-10, Camp Mngt-10 in Public facilities; 3.2 Motivators’ fee for Cu-T 20 3624 0.7248 Establishment of ASHA Drama Unit based on family 4 20000 5 1.00 planning 3 Monitoring & supervision by District 0.50 Total 16.72

A.4 Adolescent Reproductive And Sexual Health / ARSH A.4.1 Adolescent services at health facilities. Activities:

a. Training of ANMs on ARSH & Counseling skills b. Observation of Adolescent Health at 1CHC, 6PHC, 40PHSC c. Tele Counseling centre in 1CHC and 1DH d. Strengthening of BCC/IEC in the Block e. IPC through ASHA/AWW/CDPOs/School Teacher f. Basic Medicines for ARSH =IFA

Budget for ARSH

Sl. No Activity Qty Unit Rate(Rs) Total Amount (Rs) Setting up Tele counseling 1 2 20000 0.40 centre 2 CHC & DH Total 0.40

A.7 VULNERABLE GROUPS Activities:

a. Propose RCH Health Camps and DMMU visits to these villages b. VHC and VHSC will participate in organizing the Health Camps

132 c. RKS will also take responsibility for DMMU deployment.

Sl. Kamjong Block Ukhrul Chingai Kasom Block Phungyar No Block Block Block 1 Maokot Ronshak Ngahurrum Zingsou Sorbung PHSC 2 Chatric Khanou Roni Paoyi Shangpuram Nongman 3 Chatric Khullen Sahamphung Paori Lairam Phungka Louphong PHSC 4 Chahong Khanou Zingsui Phungcham .Kangoi Patbung PHSC PHSC 5 Chahong Khullen Mapum PHSC Luireishimphung Makan Sorbung PHSC 6 Chahong Pushing PHSC Chingjaroi villages Wangli Chadong Pharung 7 Chahong Khullen Sihai Varangalai Kamo Ashang Ngayophung Khullen 8 Kultup Khamasom Khamasom T. Hundung kl PHSC 9 Molvailup K. Phungtha Poi PHSC Lamlai PHSC Khunou 10 Phaikot Leisen Huishu Shingkap PHSC PHSC 11 Konkan Maichon Soraphung Thawai 12 Skipe Phungthar New Tusom Shingta PHSC 13 Zingshophai Kachai PHSC Tusom CV Muiri 14 Kangpat Tora Old Wahong New canan 15 Choro Tora Changta New Wahong Loushing 16 Nimbisha Mulam Razai Khullen Chungka PHSC 17 Kachaophung Pheilen S. Tusom

18 Khayang T. Sanakeithel PHSC 19 Khayang K. 20 Kashung 21 Gampal 22 T Kaphung 23 K. Kaphung 24 Maiti 25 Aishi

A.8 INNOVATIONS/ PPP/ NGO A.8.1 PNDT and Sex Ratio a. PNDT guidelines Disseminated to Blocks. b. Observation of Workshop at Block level. c. Monitoring of the activities against the Plan

Budget for PNDT AND SEX RATIO

Sl. Activity Qty Unit Total Amount

133 No Rate(Rs) (Rs) Observation of Workshop at Block 1 5 10000 0.50 level. Total 0.50

A.8.2 Public Private Partnerships Activities: a. Promoting MCH and Family Planning services at Private Hospitals by giving JSY fund for delivery mothers b. Support fund for Family planning program c. Awareness about such facility to Communities through inviting ASHA/AWW/NGOs/PRI.

A.8.3 NGO Programme Activities: a. NGOs should be include to all the RKS/VHC/VHSC and Block level committees in the Block b. Encourage to Participate in the IPPI and RCH programs in the Block

A.8.4 Other innovations( if any) Activities:

a. Encourage Woman Self help groups to actively participate in health programs in the block b. Encourage prominent woman personalities to participate in Health related issues and must be include in all the Block level committees, especially in CHC/PHC level committees.

Budget for Orientation of Self Help Groups (SHG)

Activity Unit Sl. Total Amount Number Rate No (Rs) in lakhs (Rs) Orientation of SHG on NRHM and its benefits to people (30 participants in a 100 1 5000 5.00 batch) SHG

Total 5.00 A.9 INFRASTRUCTURE & HUMAN RESOURCES

Infrastructure reflected in Part B

134 A.9.4 Operationalise Infection Management & Environment Plan at health facilities Activities:

a. Construction of waste Disposable system

Budget

Sl. Name of the Activity Qty Unit Amount No Institution Amount (Rs in (Rs) lakhs) 1 PHSC Construction of Waste 40 5000 2.00 Disposal System 2 PHC/CHC Construction of Waste 7 10,000 0.70 Disposal System 3 District Hospital Construction of Waste 1 50000 0.50 Disposal System Total 3.20

A.10 INSTITUTIONAL STRENGTHENING A.10.1 Human Resources Development

Reflected in Part B

A.10.2 Logistics management/ improvement

Status of Logistics at the Block

Logistics Elements Description

Stock outs of any vital Vitamin A solution, Iron and Folic Acid, essential drugs and kit are supplies in last year. stock out some time Indenting Systems Indenting is done from Sub-Centers → PHCs, → CHCs, →RFWCs to (from districts to state) the →District Family Welfare Bureau/CMO office.

135 Existence of a Maintenance of Cold Chain is a problem now due to irregular functional system for electricity to 1CHCs, 6PHCs. Generators for 4PHCs are requested. assessing Quality of Vaccine Vehicle functionality Propose 1 Vaccine van top transport Vaccine to periphery

A.10.3 Monitoring & Evaluation / HMIS A.10.3.1 MIS officer available in the District

Status of Nodal Monitoring & Evaluation Officers in the District

Number Key Indicators Existing Require Total Dist. Nodal M&E Officer 1 0 1 Block Nodal M&E Officer 5 0 3 CHC Nodal M&E Officer 0 1 1 PHC Nodal M&E Officer ** 2 5 0 ** The PHC accountant at 2 PHCs are utilizing as PHC Nodal M&E Officer.

a. The Block M&E Officer is presently responsible for both report compilation of the CHCs and Block report compilation. b. There are 2 PHC accountants. They are presently utilizing as PHC Nodal M&E Officers. There should be separate Nodal M&E Officers at each PHCs for streamlining the reporting system.

A.10.3.2 Reporting System in the District.

a. The reporting system in the district is at the initial stage of streamlining. b. The 5 Blocks compile the Block aggregated data from the Block CHC, PHCs and SCs and forwarded it to the District. c. At the district level, the district aggregated data is compiled from the block reports. d. There are no Telephone and Internet connections at the Blocks HQ, CHCs and PHCs, e. It will be more convenient for the reporting system if all the Blocks HQ, CHCs and PHCs are connected with Internet. And Telephone connection for all the Sub-Centers is a much.

A.10.3.3 Equipment/ Computer System available in the District

a. There are Computer system at District and 5 Blocks and 2 PHCs. The Computer system available at the District HQ is of old/ lower configuration, it needs to be upgraded or procurement of new ones so as to enable the Internet connectivity and other data management works. b. The reports are not available on time from the Health Centers. c. Some Data elements are not correctly reported and the reports are almost incomplete.

136 d. Problems in printing and distribution of reporting formats.

A.10.3.4.1 To operationalized Monitoring and Evaluation in the District and Block Levels.

1. Monitoring and Evaluation teams at District and Block Levels will be formed. The team will comprised of a. at District level : 1 SMO or M.O, DNM&EO, Statistical Asst., Computers (post) and/or BNM&EO and b. at Block levels : Block M.O., BNM&EO, Statistical Asst. at CHCs & PHCs, Computer (post), Health Supervisors. 2. Regular meeting of the M&E Team at District and Block Levels to analyze and evaluate the quality of reports. 3. Monitoring and Evaluation be done by the M&E Team as per need. 4. Monthly Review meeting at the district will be organized at which Blockwise achievements will be presented by the Blocks and the District level achievement will also be presented.

A.10.3.4.2 To operationalized Technical Support for strengthening Monitoring and Evaluation Activities.

1. At the District Level the up gradation of existing computer system or procurement of a new higher configuration computer system is required. And procurement of another computer system is also required to enhance the data compilation and data maintenance. The internet connection is proposing. A power back up is much require as the present power supply is very irregular and of low voltage. 2. Procurement of necessary equipment (e.g. Laptops, Faxs, Projectors, Internet connections, Power Backups, up-gradation of existing or new procurement of Computer systems with higher configuration) is required. As reflected in the situation analysis three PHCs do not have computer systems and procurement of computer system for these PHCs is much necessary. 3. District Health Care Center to be opened at the District Headquarter to response to any query made by health seeking community. A10.3.4.3 To ensure Availability of Reports in time from the Health Centers.

1. The reporting formats should be made available on time to all the Health Centers by means of printing at Block levels of Health center levels. 2. Regular Meeting of the staff responsible for reporting will be held every month on a fixed day at which reports should bring with them.

A.10.3.4.4 Strategy: To ensure Maintenance of Quality Data at District and Block Levels.

1. Proper orientation on reporting formats should be given at District and Block Levels on every quarter (regarding incomplete and incorrect reports). 2. For ensuring proper maintenance of reports/ database at all levels, regular monitoring and evaluation should be done and require feedback will be given to the centers. 3. Workshops to be organized at District and Block Levels as per need (twice in a year at District Level and twice in a year at Block Levels)

137

The total budget needed during 2009-10 for strengthening HMIS is given below

Budget

S. No. Activity Unit No of Units Unit Rate (Rs) Total Amount in Lakhs 1 Internet connectivity District 1 30000 0.30 +Maintenance Block 5 30000 1.50 2 Power supply District 1 150000 1.50 Blocks 5 40000 2.0 3 Training /workshop District - - 1.20 4 Printing report District - - 1.00 7 Up-gradation 6 4000 0.24 of computers Total 7.74

A.11 TRAINING

A.11.1Strengthening of Training Institutions A.11.2 Development of training packages A.11.3 Maternal Health Training

Status of Training in respect of Maternal Health and propose during 2010-11

No. to be No. trained Sl. No. Key Indicators trained during 2010-11 1 EmOC 0 1 2 RTI/STI training of MO 4 4 3 RTI/STI of SN 0 30 4 RTI/STI of ANMs 0 60 3 SBA training for Staff Nurse 9 9 SBA (ANM) 14 20 4 IMEP for MO 0 8 IMEP for Nursing 0 0 Sisters at 6PHCs and 1 CHC and 1 DH 5 IMEP for ANMs 0 0 6 School Health Teachers 0 200 7 LSA 0 1 8 SBA for Dai/TBA 0 10 9 Blood storage MO 7 0 10 Lab Technician Blood storage 2 2

138

Status of Training in respect of Child Health and propose during 2010-11

No. to be trained Sl. No. Key Indicators No. trained during 2009-10 1 IMNCI 10 4 2 IMNCI for SN 0 12 3 IMNCI for ANMs 0 18 4 FBNC for ANMs 0 30 5 HBNC for ASHAs 0 120

Status of Training on Family Planning and propose during 2010-11

No. to be trained Sl. No. Key Indicators No. trained during 2009-10 1 MTP/MVA for 2 5 Doctor 3 IUCD for doctor 2 2 4 Minilap for doctor 0 2 5 NSV for doctor 2 6 6 IUCD for SN 0 12 7 IUD for ANMs 24

Status of Training in respect of Maternal Health and propose during 2010-11

No. to be trained Sl. No. Key Indicators No. trained during 2009-10 1 ARSH for MO 0 4 3 ARSH for 0 9 Paramedics 4 ARSH for ANMs 0 60

Status of Other Training in the District

No. to be Sl. No. Key Indicators Categories trained No. trained during 2010-11

139 1 Workshop on NRHM (Center) DPMU 3 3 2 Web Data Capturing (State) DPMU 3 3 3 DHIS (State) DDM 1 1 4 Workshop on Web Data BPMU, PHC Accountant, 16 17 Capturing (District) Statistical Asst. 5 DHIS (District) BPMU, PHC Accountant, 15 17 Statistical Asst. 6 Capacity Building (District) MOs 8 15 7 Capacity Building (District) BPMU 16 17 8 Blood Storage (State) MOs 2 2 9 Blood Storage (State) Lab. Tech. 2 2 10 IEC/BCC (State) DPM, Dist. Media Officer 2 4 11 IEC/BCC (District) BPMU, MOs, Health 15 30 Supervisor, Educators 14 P D C MOs/DPMU 0 1 A.11.8 Programme Management Training A.11.9 Other training (pl. specify)

Status of Other Training in the District

No. to be Sl. No. Key Indicators Categories trained No. trained during 2010-11 1 Workshop on NRHM (Center) DPMU 3 3 2 Web Data Capturing (State) DPMU 3 3 3 DHIS (State) DDM 1 4 Workshop on Web Data BPMU, PHC Accountant, 15 15 Capturing (District) Statistical Asst. 5 DHIS (District) BPMU, PHC Accountant, 15 15 Statistical Asst. 6 Capacity Building (District) MOs 8 15 7 Capacity Building (District) BPMU 17 11 8 Blood Storage (State) Mos 2 2 9 Blood Storage (State) Lab. Tech. 2 2 10 IEC/BCC (State) DPM, Dist. Media Officer 2 4 11 IEC/BCC (District) BPMU, Mos, Health Supv 15 23 14 Personal Development MOs/DPMU 0 2

140

A.12 BCC / IEC Activities:

BCC Infrastructure in the District

Human Resources Any trainings of the staff in past Yes five years

Any functional Mass media audio- visual aids such as 16 mm No projectors, Video cameras, VCD/DVD players Yes And other activities like Did the District prepare a BCC plan Wall painting in the past year? Printing of leaflets BCC activities undertaken in Advocacy meeting Blocks Awareness prog. etc. are done Survey done Private sector for conducting communication activities using No Private involved but SONG & Drama Division , modern media or folk media Manipur, GOI has been involved for last 3 years (jatrawali)

A.12.1 Strengthening of BCC/IEC Bureaus (District level) A.12.2 Development of BCC/IEC strategy A.12.3 Implementation of BCC/IEC strategy

Propose a BCC committee Organogram of the committee At the District CMO : Chairman

141 Media Officer : Convenor Members : All DLOs for Health & family welfare

At the Block level SMO : Chairperson Extension Educator : Member secretary Members : MOs/Supervisors/LHVs /RKS

Activities: 1. To find out areas where BCC is needed 2. Situational analysis 3. Assessment of RCH components of all programs 4. Plan process and quality maintenance of the BCC activities in the Blocks 5. Meeting at least once a quarter

A.12.3.1 BCC/IEC activities for maternal Health , Child Health & Family planning

Budget

Sl . Activity Qty Unit rate Budget (Rs) NO (Rs) in lakhs 1 FGD/ Interview by BPMU in 40 PHSC Villages on 40 8000/- 3.20 MCH including family planning 2 One workshop/Training of ANMs and Block 2 30000/- 0.6 0 Supervisor on BCC 3 Awareness organized by VHC &VHSC to vulnerable 40 15000/- 6.00 villages on MCH including family planning is needed 4 Monitoring and supervision 0.50 5 Others IEC/BCC in different mediums - - 0.50 Total 10.80

A.12.3.2 BCC/IEC activities for ARSH

Budget

Sl . Activity Qty Unit rate Budget (Rs) in NO (Rs) lakhs 1 FGD/In-dept interview by BPMU in each Block 3 5000/- 0.15 at identified schools 2 Awareness organized to locations where BCC is 20 5000/- 0.50 needed 3 Monitoring against the Plan By DPMU/BPMU 4 Monitoring and supervision 1.00 Total 1.65

142

A.3 PROCUREMENT A.13.1 Procurement of Equipment

Equipments required to be purchase for 40 PHSC level:

Sl.no Item

1 Examination Table 2 Writing Table 3 Armless chairs 4 Medicine chest 5 Labour table 6 Wooden screen 7 Foot step 8 Coat rack 9 Bed side table 10 Stool 11 Almirahs 12 Lamp 13 Side wooden racks 14 Fans 19 Gas stove 20 Sauce pan with lid 21 Water receptacle 22 Rubber / plastic shutting 23 Talquist Hb scale

2. Equipments required to be purchase at the 4 PHCs level

List of suggested equipments and furniture

Sl. Normal Delivery Kit No. 1 Equipment for assisted vacuum delivery 2 Equipment for assisted forceps delivery 3 Standard Surgical set (for minor procedures like episiotomies stitching) 4 Equipment for Manual Vacuum AspirationEquipment for New Born Care and Neonatal Resuscitation 5 IUD insertion kit 6 Equipment / reagents for essential laboratory investigations 7 Refrigerator. 8 ILR/Deep Freezer 9 Ice box

143 10 Computer with accessories including internet facility 11 Baby warmer/incubator. 12 Binocular micr 13 Equipments for Eye care and vision testing: 14 Tonometers (Schiotz), direct 15 opthalmoscope, illuminated vision testing drum, trial lens sets with trial frames, snellen and near vision charts, Battery operated torch 16 Equipments under various National Programmes 17 Radiant warmer for new borne baby 18 Baby scale 19 Table lamp with 200 watt bulb for new borne baby 20 Phototherapy unit 21 Self inflating bag and mask-neonatal size 22 Laryngoscope and Endotracheal intubation tubes (neonatal) 23 Mucus extractor with suction tube and a foot operated suction machine 24 Feeding tubes for baby 25 Sponge holding forceps – 2 26 Valsellum uterine forceps – 2 27 Tenaculum uterine forceps – 2 28 MVA syringe and cannulae of sizes 4-8 (2 sets; one for back up in case of technical problems) 29 Kidney tray for emptying contents of MVA syringe 30 Trainer for tissues 31 Torch without batteries – 2 32 Battery dry cells 1.5 volt (large size) – 4 33 Bowl for antiseptic solution for soaking cotton swabs 34 Tray containing chlorine solution for keeping soiled instruments 35 Residual chlorine in drinking water testing kits 36 H2S Strip test bottles 37 Equipment for Pap smear 38 Laboratory Reagents 39 Glassware and other equipment 40 Furniture (including surgical) at PHC 41 Equipment of a functional labor room

Equipments required to be purchase for DH

Sl. No. Equipment for DH 1 Normal Delivery Kit 2 IUD Insertion Kit 3 Standard Surgical Set - I (Instruments) FRU 4 Standard Surgical Set – II 5 Standard Surgical Set – III

Equipments Required to be purchase for Dental at DH

144 Sl. No Equipment for Dental Services Quantity 1 Extraction Forcep Set 3 2 Ultra Sonic Scalip instrument 3 3 Light cum Machine+ material 3 4 Hand instrument scalling 3 5 Zinc oxide + cugenol liquid 3 6 Zinc phosphate cement 3 7 Silver Amalgan Material 3 8 Filliing instrument set 3 9 Air motor hand piece wire brus 3 10 Contra hand piece wire brus 3 11 Autoclave 12 Sterilizer Total

A.13.2 Procurement of Drugs and supplies

DRUGS FOR 40 PHSCs

Sl. No Drugs for PHSCs 1 DRUG KIT ‘A’ for Sub -Centre 2 DRUG KIT ‘B’ for Sub- Centre 3 Additional Drugs required for responsibility under Skilled Attendance at Birth by ANMs and LHVs 4 Other Drugs and vaccines 5 Medicines and other consumables required for responsibilities regarding 6 Different national disease control programmes 7 Contraceptive supplies required for duties regarding Family Planning 8 List of Drugs to be supplied to helpers at Aanganwadi Centres/ASHA 9 IFA

DRUGS FOR 5 PHCs, 1CHCs and 1 DH

Sl. No Drugs for PHC, CHC, DH 1 Local Anaesthetics 2 Preoperative Medication and Sedation for Short Term Procedures

145 3 Analgesics, antipyretics and Non-Steroidal Anti-inflammatory Medicines, 4 Antiallergics and Medicines used in Anaphylaxis Antidotes and Other Substances used in Poisonings 5 Anticonvulsants/Antiepileptics 6 Antiinfective Medicines 7 Antifilarials 8 Antibacterials 9 Cardiovascular Medicines 10 Antianginal Medicines 11 Antihypertensive Medicines 12 Dermatological Medicines (Topical) 13 Antileprosy Medicines and Anti-tubecullar medicines as per national programmes 14 Antifungal Medicines 15 Antiprotozoal Medicines 16 Blood Products and Plasma Substitutes 17 Plasma Subsitutes 18 Disinfectants and Antiseptics 19 Disinfectants 20 Diuretics 21 Gastrointestinal Medicines 22 Hormones, other Endocrine Medicines and 23 Contraceptives 24 Antidiabetics and Hyperglycaemics 25 Ophthalmological Preparations 26 Solutions correcting Water, Electrolyte and Acid-Base Disturbances 27 Drugs under RCH for Primary Health Centre 28 RTI/STI Drugs under RCH Programme 29 Drugs and Consumables for MVA 30 Drugs for AYUSH services as per the list of Department of AYUSH 31 Other Drugs for CHCs and DH.

A.14 PROGRAMME MANAGEMENT

A.14.1 Strengthening of State society/State Programme Management Support Unit A.14.2 Strengthening of District society/District Programme Management Support Unit

Existing DPMU sraffs

Sl. Particulars Unit Honorarium (Rs) Annually Amount

146 Budget (Rs. In lakh) 1 DPM 1 25000/ 3.00 2 DAFC 1 20000/- 2.40 4 DDM 1 15000/- 1.80 7.20

A.14.2.1 Strengthening of Block Programme Management Support Unit

Existing BPMUs Staffs

Sl. Particulars Unit Honorarium (Rs) Annually Amount Budget (Rs. In lakh) 1 BPM 5 10000/- 3.60 2 BAFC 5 10000/- 3.60 4 BDM 5 10000/- 3.60 5 PHC Accountant 2 10000/- 2.40 13.20

Propose status of the DPMU & BPMU and others during 2010-11.

Sl. Particulars Unit Honorarium Annually Amount Budget (Rs. In lakh) 1 ASHA District 1 22000/- 2.64 Program Manager 2 ASHA Block 3 (1 for , 10000/- 3.60 Program 1for & 1 Manager for Bishnupur Block)

147 4 ASHA 15 5000/- 9.60 Facilitator 5 One Office 1 3000/- Assistant Total Amount : 16.20

A.14.3 Strengthening of Financial Management systems

• Short term course for financial skill on NRHM for DPMU & BPMUs staffs. • Timely Concurrent Audit • Timely submission of FMR and SOEs

148 PART - B

B1. ASHA

B1.1 Selection & Training of ASHA

. Existing Number of ASHAs Block Wise

Sl. No. Block Number of ASHA

1 Kamjong 54 2 Chingai 43 3 Ukhrul 120 4 Phungyar 48 5 Kasom Khullen 37 Total 302

Training of for 252 had been completed up to 5th module. The periodic training for 252 ASHAs has been approved in 2008-09. Additional 50 ASHAs have been allotted for the year 2008-09. The selection process been completed and given induction training for 7 days. Further training of ASHAs is being requested to state.

149

B1.2 Procurement of ASHA drug kit

Drug kit @ Rs. 5000/- for 302 ASHA = 9.06 lakhs

B1.3 Performance related incentives to ASHAs

Sl. No Activity Incentives Case load Amount in lakhs (Rs) 1 Full ANC & 600 Refer to JSY delivery day 2 PNC 5 times 200 4174 8.35 visits to homes 3 Referral 500 Refer to JSY Arrangement for mothers 4 Report of 10 2966 0.37 Death & Birth 700

5 Family 150 Refer Family Planning Planning 200 20 6 Immunisation 150 Part C 7 VHND 50 Refer VHND Total 8.72 B1.4 other ASHA

As per field data during our 20 FGD conducted in the villages most of the ASHA felt that they required the following items for their functionality.

Accessories for ASHAs

Sl. No Activity Amount for 2009-10 In lakhs 1 A mobile for 12.08 302 ASHA @ Rs. 4000/- 2 Torch light 0.453 @Rs. 150 for 302 nos 3 Sport shoe 1.208 @Rs. 400 for 302 nos 4 Recharge 1.18 coupon for 330 ASHA @ Rs. 30 per month X 12 months Total 14.921

150 B2. Untied Funds

B2.1 Untied Fund for CHCs

Sl. No Name of Number of Unit Amount for 2009-10 the Block CHC Amount (Rs) In lakhs 1 CHC 1 50000 0.50 Kamjong Total 0.50

B2.2 Untied Fund for PHCs

Sl. No Instituiton Number of Unit Amount for 2009-10 PHC Amount (Rs) In lakhs 1 PHC 6 25000 1.50 Total 2 1.50

B2.3 Untied Fund for PHSCs

Sl. No Institution Number of Unit Amount for 2009-10 PHSC Amount (Rs) In lakhs 1 PHSC 40 10000 4.00 Total 2 4.00

B2.4 Untied Fund for VHSCs

Sl. No Institution Number of Unit Amount for 2009-10 PHC Amount (Rs) In lakhs 1 VHSC 302 10000 30.20 Total 2 30.20

B3. Hospital strengthening B3.1 Up gradation of CHCs/PHCs/ District Hospitals to IPHS B3.1.1 District Hospitals

Budget for up-gradation of DH

Sl. No Activity Amount (Rs) in Lakhs 1 Repairing of Child, Female & Male Wards 3.00 2 Repairing of Minor OT 0.50 3 Repairing of OT for CS 1.50 4 Construction of Blood Bank 2.50

151 facility with supportive staffs 5 Construction of one Public Toilet needed 3.00 6 Extension of OPD section needed as it is congested 9.00 7 Construction of a new Warehouse 20.00 8 Construction of 20 bedded 67.00 Maternal Hospital attached to District Hospital.

9 AYUSH – 10 Bedded Hospital 10.00 Total 116.50

B3.1.2 CHCs

Budget for up-gradation of CHC Kamjong

Sl. No Activity Amount (Rs) in Lakhs 1 Fencing of CHC Compound 30.00 2 Repairing of approach road to Hospital RKS Fund Total 30.00

B3.1.3 PHCs

Sl. No Activity Amount (Rs) in Lakhs 1 Up-gradation of PHSC Tolloi to PHC 100.00 Propose construction of New Building 2 Staff Quarter type IV 27.00 Total 127.00

B4. Annual maintenance grants B4.1 CHCs

Sl. No Institution Number of Unit Amount for 2009-10 CHC Amount (Rs) In lakhs 1 CHC 1 50000 5.00 Total 5.00

B4.2 PHCs

Sl. No Institution Number of Unit Amount for 2009-10

152 CHC Amount (Rs) In lakhs 1 PHC 6 50000 3.00 Total 3.00

B4.3PHSCs

Sl. No Institution Number of Unit Amount for 2009-10 CHC Amount (Rs) In lakhs 1 PHC 40 10000 4.00 Total 4.00

B4.4 Others

B5. New constructions, Renovations & Setting up B5.1 CHCs B5.2 PHCs

New construction of PHC Building of Kumbi

a. 4 PHCs out of 6PHCs are identified for functioning as 24x7 delivery service and up gradation works for 2 PHCs completed and another 2 PHC are under progress to achieve IPHS Standard. b. Barrack type qtrs and type III Qtrs are available for 5 PHCs and no for Chingai PHC. So during 2010-2011 one barrack type quarter and one type four quarter is propose for chingai PHC. c. 2 new PHC building for Khangkhui PHC and Phungyar PHC approved in 2009-2010 PIP. To close infrastructure gaps for PHCs one new PHC Building for lambui PHC is propose during 2010-2011. d. AYUSH - OPD Room extension for the 1 (one) PHC Somdal needed.

Sl. No Activity Amount (Rs) in Lakhs 1 Construction of New building for Lambui PHC 100.00 2 Construction of Barrack Type Qtrs for Chingai 47.00 3 Construction of Type IV Qtrs for Chingai 27.00 4 Extension of AYUSH OPD room for Somdal PHC 5.00 Total 179.00

B5.3 PHSCs Infrastructure gaps for 27 PHSC will be completed by this financial year and another 7 new construction for 6 PHSC propose during 2010-11. a. Also need repairing of 6 PHSC. b. The location of PHC Chingai is a problem for accessibility so Awang kasom PHSC can act as PHC where institutional Delivery can take place. It required a labour room and type IV staff quarter. c. Propose new sanction PHSC for Chingjaroi and Kaziphung PHSC

153 Sl. Activity Qty Unit Amount No Amount(Rs) (Rs) in Lakhs 1 Construction of new PHSC building 7 17.00 119.00 2 Construction of labour room 1 3.00 3.00 3 Construction of Type IV 1 27.00 27.00 Staff Quarter at Awang Kasom so that Doctors can stay there Construction of 2 new PHSC building for 2 15 30.00 chingjaroi and kaziphung Total 179.00 B5.4 Setting infrastructure wing for civil works B5.5 Govt. Dispensaries / Other Renovations B5.6 construction of BHO, facility improvement civil works

Proposed new office building for all BHO at 3 Blocks as first phase during 2010-2011 with the cost of Rs. 15.00 lakhs in each block. So the propose amount would be Rs. 75.00 lakhs

B5.7 Others

B6. Corpus grants to HMS/RKS

B6.1 District Hospitals

Sl. No Institution Number Amount for 2009-10 Remark In Lakhs 1 District 1 5.00 Hospital Total 1 5.00

B6.2CHCs

Sl. No Institution Number Amount for 2009-10 Remark In Lakhs 1 CHC 1 1.00 Total 1.00

B6.3 PHC

Sl. No Institution Number Amount for 2009-10 Remark In Lakhs 1 PHC 6 6.00 Total 6.00

154

B7. District Health action plan (including Block, Village)

Sl. No Activity Amount for 2009-10 Remark In Lakhs 1 DHAP 10.00 For five blocks Total 10.00

B8. Panchayati Raj initiatives

B8.1 Constitution and orientation of Community leaders and of VHSCs/PHCs/CHCs

•Awareness on various NRHM activities •Orientation on planning ( Village health plan)

Sl. No Activity No of batches Unit Rate per batches Amount for 2009-10 In Lakhs 1 Orientation 6 20000/- 1.20 of new 180 PRI members for 3 days on NRHM & Planning Total 1.20

B8.2 Re-Orientation workshops on PRIs at District Health Society, CHCs/PHCs

• There is lack of Coordination between PRI & ASHA/AWW in most of the VHSC, PRI and ANMs and PRI and MOs as found out during FGD with ASHA, interview with ANMs. So Reorienation on Functionality of Various committees are required. •Reorientation of PRI members = 155 members •VHC/RKS = 23VHC X2 + 5PHCx2+ 2CHCX2+ 1DHx5 =65 ( RKS members) •Total =220

Sl. No Activity No of batches Unit Rate Amount for per batches 2009-10 In Lakhs 1 Re-Orientation of new 7 20000/- 1.40

155 220 PRI members for 3 days Total 1.40

B9. Mainstreaming of AYUSH

B10. IEC- NRHM

B10.1 Health Mela

Every year one Health Mela is conducted in the District. It will be more fruitful to organized one each in each Block. The budget propose per block is Rs. 3.00 lakhs. Total Budget requirement is Rs. 15.00 lakhs.

B10.2 Creating awareness on declining sex ratio issue

• House to house visit by ASHA and spread the benefits of having a Single Girl Child provided by Constitution of India.

B10.3 Other IEC activities B11. Mobile Medical units including recurring expenditures B12. Referral transport B12.1 Ambulance

Proposed a Ambulance for 1CHC, 6 PHCs an a budget of Rs. 35.00/- may be sanctioned during 2010-2011

B12.2 Operating cost POL

POL required for Ambulance. An amount of Rs. 25,000/- annually shall be require and a chargeable amount will be fixed by the RKS to cover extra expenditure. So total amount of Rs 25000x 7 centres = Rs. 1.75.

B13. School Health program School Health Program

a. Proposed a Block Nodal Officer for School Health Program b. Required training of School teacher at the District once in a Quarter c. Target group: 210 School teachers required to be trained

Sl. No Activity No of batches Unit Rate Amount for per batches 2009-10 In Lakhs 1 Orientation of 7 20000/- 1.40 Teachers 210 members for 3 days Total 1.40

156

B14. Additional contractual staffs (selection training and remuneration)

B14.1 Existing staffs Status under NRHM in the District

Unit rate (Rs) Annually Sl. amount in No Particulars Qty lakhs 1 ALO MO 4 15000 7.20 2 MO AYUSH 7 15000 12.60 AYUSH 0.72 3 Pharmacist 1 6000 4 Audiometric Asst 1 7500 0.90 5 PHN 1 7000 0.84 6 SN/GNM 12 6000 8.64 7 Lab Tech 5 6000 3.60 8 ANM 40 6000 28.08 9 X-Ray Tech 1 6000 0.72 10 Driver DMMU 2 4500 1.08 Grant Total 64.38

B 14.2 Propose NRHM Staffs under NRHM during 2009-10

Unit rate (Rs) Annually Sl. amount in No Particulars Qty lakhs 1 ALO MO 4 15000 7.20 AYUSH 4.32 3 Pharmacist 6 6000 6 SN/GNM 6 6000 4.32 7 Lab Tech 3 6000 2.16 8 ANM 1 6000 0.72 10 Office Assitant 1 3000 0.36 Grant Total 19.08

B15.3 Other PPP/NGOs

157 c. NGOs should be include to all the RKS/VHC/VHSC and Block level committees in the Blocks d. Encourage to Participate in the IPPI and other health related programes in the Blocks

b. Encourage prominent woman personalities to participate in Health related issues and must be include in all the Block level committees, especially in CHC/PHC level committees.

EMERGENCY MANAGEMENT AND REFERRAL INSTITUTE on PPP

Background - In the changing life styles, an integration of multiple services to provide quick and comprehensive emergency response is required. Further, with increase in the emergencies cases occurring throughout the state there is demand for emergency care. Although there are referral transports available in the health facility but then it only caters to only the emergency pertaining to delivery cases. Further, it can be seen that there are instances which need emergency care and also require pre-hospitalization care which is not possible through the existing ambulances as they do not have Advance Life Supporting equipments. Hence, the present ambulances will be used within the periphery of the hospital. Therefore, looking at the demand for comprehensive emergency system the District proposes implementing Emergency Management Service through public private partnership. These ambulances will be launched for the first time in district implementing in District with partnership with some NGO in PPP model.

The EMRI will function 24 x 7 with dedicated team members. It will have toll free emergency number which will land at Emergency Response Centre (ERC), this centre will be located in Ukhrul as CS facility is not provided at District Head Quarter. One ambulances functioning will be required. To manage the emergency the EMRI will be divided into three teams; Information (call taking, call processing and call dispatch), Response (Ambulance) and Care (Pre – hospital medical care).

Goal: To provide emergency response services in Imphal under Public Private Partnership

Objective: To provide 24 x7 emergency services by addressing pre hospitalization care with emergency care

Strategies 1. Setting up of Emergency Management and Research Institute (EMRI) 2. Building Partnership with reputed hospitals/clinics 3. Effective IEC to inform the community 4. Organizing appropriate referral and provide emergency care to the victim 5. Monitoring the functioning of EMRI

Activities 1. Procurement of Ambulances and equipments 2. Operationalizing Emergency Response Centre with a toll free number

158 3. Selection of dedicated staffs for EMRI 4. Training of the team in managing emergency service 5. Broadcasting of EMRI in radio, TV through AIR,DDK, ISTV 6. Monitoring through monthly report 7. Formation of Program Committee for reviewing quarterly

Budget

Total cost Sl.No Item Unit Unit cost (in lakh) 1 Cost of ambulance 1 15.00 15..00 2 Fabrication works 2 3.50 7.00 3 Medical equipment 2 7.00 14.00 4 Cost of call centre 1 4.00 4.00 Registration 5 2 0.05 0.10 approximate cost Insurance 6 2 0.25 0.50 approximate cost 0.60 Transportation 7 2 0.30 approximate cost 12(2 drivers, Remuneration for the 8 4technician,04helper 0.72 8.64 staffs & 2 MBBS Doctors) Maintenance of the 9 2 0.50 1.00 ambulance TOTAL 50.84

B16. Training B16.1 Strengthening of existing training institutions/Nursing Schools B16.2 New Training institutions/Schools

Propose a Training Instituions at Ukhrul District

Sl. No Activity Amount (Rs) in Lakhs

159 1 Main building 30.00 2 Residential Block 47.00 3 toilet complex 5.00 4 Mess complex 12.00 Equipment & Furniture 5 Staff support 1.44 6 Land compensation 6.00 Total 101.44

B16.3 Training & Capacity building under NRHM B16.3.1 Promotional training of Health worker (F) to LHVs

Promotional training of 60 Health Workers from CHC/PHC/PHSC on CME

B16.3.2 Training of ANMs, Staff Nurses, AWW

Training of 64 ANMs on reporting/HMIS Training of 303 AWWs on NRHM and NRHM Village Planning

B16.3.3 Other Training and capacity building programs

ƒ Capacity building of Health Supervisor on BCC Project Management. ƒ Capacity Building on planning for District and Block.

B16.3.4 Other trainings

ƒ Program Management skill enhancement training for Block Program Manager ƒ Research methodology skill training for Block Program Management Unit ƒ Financial Skill enhancement training for BPMU ƒ Data management skill enhancement training for BPMU

B17. Incentive Schemes

B17.1 Incentive fo specialist for DH & CHC

Sl. No. Activity Number Maximum Total Amount propose performance in Lakhs (Rs) During based incentive 2009-10 1 Gyne &O for CS 2 25000/- per 6.00 months 2 Anesthesia for 1 25000/- per 3.00 any surgery months

160 3 Pediatrician 1 25000/- per 3.00 months 4 Surgery 2 25000/- per 6.00 months 5 Physician 2 25000/- per 6.00 months Other 35.00

B17.2 Incentives to MOs (PHCs)

Sl. No. Activity Rate for Maximum Total Amount performance performan (Rs) in lakhs Rs ce based incentive 1 MTP cases 5 4000/- X 19 2 RTI/STI cases 10 M.O. X 12 3 ARI cases 5 Months= 9.12 4 IUD cases 30 8000/- per 5 NSV cases 50 months 6 Female sterilisation cases 100 7 IMNCI cases 50

B17.3 ANMs Incentive schemes

Sl. No. Activity Rate for Maximum Total performance performance based Amount in Rs incentive Lakhs (Rs) 1 Early registration 5 2 Full ANC 230 3 Intra-natal care 300 4 PNC 250 Child health 6 BCG 10 7 DPT1 5 4500 4500 X 40 8 DPT2 10 ANMs X 9 DPT3 20 12 months 10 OPV123 5 = 21.60 11 Measles 10

161 12 Vit A 5 13 Diarrhoea 5 14 ARI 5 Family Planning 15 IUD 20 16 CC beneficiaries 20 17 ECP users 20 18 Follow up visit to EC adopting 20 permanent method 19 Referral for MTP tp 20 PHC/CHC/DH Adolescent Health 20 Counseling for Adolescent 10 21 Attemdqnce on School health 50 service 11 Frabile cases from which P.S. 20 for MP taken and presumptive therapy given

B25. Research studies, Analysis

Further research & study require at 2 Blocks; Bishnupur and Moirang in the following issues:

a. JSY b. PNC c. Adolescent Health d. Family Planning

Sl. No. Activity Unit Rate (Rs) Total Amount (Rs) 1 Research on 0.50 0.50 MCH Total 0.50

B27.5 Mobility Support to BMO/MO/Others

162

Sl. Number of Field Unit Amount (Rs) in lakhs No visits annually rate by PHC/CHC Moi/c (Rs) 1 Medical Officer visit to VHC meeting once in every 500 9.60 quarter 40 PHSC x 4Qtrs X 12= 1920 Total 9.60

B27.6 Other support programs B28. NRHM management costs/ contingencies B28.1 Block Level PMU

Sl. No Number of Block Unit Amount (Rs) in lakhs rate (Rs) 1 5 300000 15.00 Total 15.00

B28.2 District Level PMU

Sl. No Number of District Unit Amount (Rs) in lakhs rate (Rs) 1 1 500000 5.00 Total 5.00

163

Part C

164

BUDGET FOR IMMUNIZATION STRENGTHENING 2010-2011

Particulars 2010-11 Alternate Vaccine delivery: Porter charge for Vaccines @ Rs. 600/- 2.88 per Sub centre per month for 40 PHSC Mobilization of children on 900 out-reach sessions @Rs. 150 for 1.35 ASHA/AWW for Special provision for under-served areas 200 sessions to be held 1.60 Porter charge Rs.150X200=Rs.0.30 lac/- Mobilisation=Rs. 0.30 lac Hiring Alternate Vaccinator @Rs 500/-=Rs1.00 lac Mobility support for Strengthening Monitoring, Supervision & 1.20 Surveillance at district ( POL) Proposal for Solar Cold chain strengthening - Training on UIP for ANMs & HWs on micro plan 0.60 Training of MOs on Micro Plan for Immunization 0.30 Printing of Immunization Card and other logistics 0.10 Including unpaid printing charge

Waste disposal pits in the PHC/CHCs/PHSC 40 PHSC UF

Tools for improving immunization coverage (Tickler Box for all 0.50 health centres, achievement display boards for PHCs and CHCs, Presto graph for districts, sub districts

165 Office furniture 0.15

Other office contingency for District Immunisation Unit 0.20

Salary for Computer Operator @Rs. 10000/- per month 1.20

Total 8.88

Part D

166

ANNUAL PLAN FOR PROGRAMME PERFORMANCE & BUDGET FOR THE YEAR 1ST APRIL 2010 TO 31ST MARCH 2011

District _Ukhrul_ ___ State __Manipur______

This action plan and budget have been approved by the DTCS.

Signature of the DTO: ______

Name_ Dr. Jim King Jajo Designation : District TB Officer, Ukhrul.

Section‐A – General Information about the District

1 Population (in lakh) please give projected population 2009 1.5 lakh 2 Urban population 0 3 Tribal population 1.5 4 Hilly population 5 Any other known groups of special population for specific interventions ‐ (e.g. nomadic, migrant, industrial workers, urban slums) (These population statistics may be obtained from Census data /District Statistical Office)

167 Does the district have a DTC__Yes______

ORGANIZATION OF SERVICES IN THE DISTRICT:

S. No. Name of the TU Population (in Please indicate if the TU is‐ No. of MCs Lakhs) Govt NGO Govt NGO Private 1 Ukhrul 1.5 1 0 4 1

DISTRICT 1.5 1 0 4 1

RNTCP performance indicators: Important: Please give the performance for the last 4 quarters i.e. October 2008 to September 2009

Annualized No of Total New Cure rate for Annualized new number smear cases Plan for the next year total case smear Proportion of of positive detected in TB Unit detection positive TB patients patients case the last 4 rate (per cases put tested for HIV put on detection corresponding lakh pop) on Annualized Cure rate treatment rate (per quarters treatment NSP CDR (85%) lakh pop) Ukhrul 171 114 61 54.23 70% 75% 85% 26.32%

Section B – List Priority areas for achieving the objectives planned:

S.No. Priority areas Activity planned under each priority area

168 1 Community Awareness 1 a) Awareness Campaign in venerable villages through churches and other organizations. 1 b) 2 Awareness of students/Youth 2 a) PHC wise Quiz/Drawing/Essay Competition for students/Youth in consultation with Primary & Secondary Schools in each Blocks (5). Awareness among Adults 2 b) TB Awareness Campaign in Angangwadi Centres in each village through Angangwadi workers, helpers, Headman including Village Health & Sanitation Committee Members. 3 Contractual Staff 3 a) Recruitment of a TBHV (1) 3 b) 4 Strict DOTS 4 a) Motivate DOTS providers through training/re‐ training of (AWH, AWW, Volunteer) for DOTS compliance. 4 b) 5 Defaulters retrieval 5 a) ASHAs and Community Volunteers for patients retrieval. 5 b) 6 Capacity Building 6 a) Training of Doctors and Medical Staffs required for management of TB and TB‐HIV Co‐infection. 7 Sputum Collection Setting up of Sputum Collection Centres in venerable areas.

169

Section C – Plan for Performance and Expenditure under each head:

Civil Works

Activity No. No. No. Pl provide justification if an Estimated Quarter in required actually planned increase is planned (use Expenditure which the as per present for this separate sheet if required) on the planned the in the year activity activity norms in district expected to the be completed district (a) (b) (c) (d) (e) (f) DTC 1 1 0 10000 Maintenance of DTC and DMCs TUs 1 1 0 DMCs 4 3 1 30000 3rd Quarter TOTAL 40000

Laboratory Materials

Activity Amount Amount Procurement Estimated Expenditure Justification/ Remarks for (d) permissible actually planned for the next financial as per the spent in during the year for which plan is norms in the the last 4 current being submitted district quarters financial year (Rs.) (in Rupees) (a) (b) (c) (d) (e) Purchase of Lab Rate of Materials has 30000 35000 15000 35000 Materials increased

Honorarium

Expenditure Amount Amount (in Rs) Estimated Expenditure for the permissible actually planned for next financial year for which Justification/ Remarks Activity as per the spent in current plan is being submitted for (d) norms in the the last 4 financial (Rs.) district quarters year (a) (b) (c) (d) (e) Honorarium for 20000 60000 25000 65000 DOT providers (both tribal and non tribal districts) Honorarium for DOT providers of Cat IV patients

170 Annual Action Plan Format Advocacy, Communication and Social Mobilization (ACSM) for RNTCP 1) Information on previous year’s Annual Action Plan a) Budget proposed in last Annual Action Plan: Rs.68000/‐ b) Amount released by the state: Rs. 78700/‐ c) Amount Spent by the district : Rs. 71175/‐ 2) Permissible budget as per norm : Rs. 15000/‐ 3) Budget for next financial year for the district as per action plan detailed below: Rs. 70700/‐ Program WHY For WHAT When Challenges to WHOM By WHOM Monitoring and Budget be tackled by ACSM ACSM Activities Time Frame Evaluation ACSM during Objective Target the Year Audience 20010-11 Based on Desired Activities Media/ Q Q Q Q Key Outputs; Outcomes: Total existing TB behavior or Material 1 2 3 4 implementer expendit and RNTCP indicators and action (make Required officer Evidence Evidence ure for analysis of SMART: responsible that the that it has the communication specific, for activities been activity challenges measurable, supervision have been effective during achievable, done the realistic & time financial bound year objectives) Challenge 1. Advocacy Activities Low Case 54% in the DLOs Sensitization 1. Publications 1 STO, DTO, Banners Increase of 9000 Detection last Quarter MO i/c CMEs 2. TB Booklets 1 Consultant, Photos Chest 5000 3. Posters DMCs 4. Pamphlets IEC Minutes Symptomati PP Sensitization 5. LT Modules 1 Officer, Attendanc c patients in 5000 Church Workshop 6. Fact Sheets 1 1 STS, STLS e Sheet OPD 4000 Leaders 7. Success Stories Communication Activities Low Case 54% in the NGOs Sensitization 1. Publications 1 DTO/ MO/ Banners Self testing 2000 Detection last Quarter 2. TB Booklets STS/CF Photos of TB in 3. Posters Minutes OPD 4. Pamphlets 171 5. Fact Sheets Attendanc 6. Success e Sheet Stories School Quiz/Essay/Pai TB Messages 1 DTO/ MO/ Submissio 4000 Activities nting STS/ STLS n of competitions Participan ts

Para- Training 1. MPW 1 1 DTO/ MO/ Banners Increase of Refer to Medical Module, STS /STLS Report Case training staff of 2. Photos referral to head PHSCs Poster/leaflets Attendanc OPD of e Sheet DMCs DP/Patient/ Inter Personal 1. TB Booklets - - - - DTO/ MO/ Photos Understandi 100 x 30 Family Communicatio 2. STS/ STLS ng relative = 3000 member n Leaflets/posters risk, Less default Social Mobilization activities Low Case 54% in the Women Community 1 2500 Detection last Quarter based Awareness Organizatio ns Banner, General Ex- -do- 1 Photos, Public 2000 Servicemen DTO, MO, Reports, Awareness Association Leaflets, STS, STLS Minutes Vehicle -do- Posters 1 2600 Unions NREGs -do- - - - - 2000 Workers Health Mela -do- 1 1000 Village One-one - - - - 3600 Nutrition Interaction Day Local -do- 1 1 5000 Festivals/ 172 Events/ Celebration s World TB -do- Banner, Poster, 1 20000 Day Leaflets, Mike publicity,

Comments, if any:‐ Prepared by:‐ Dr Jim King Jajo, DTO, Ukhrul.

173 Equipment Maintenance:

Amount Estimated No. Amount Proposed for Expenditure for the actually actually Maintenance next financial year Justification/ Item present in spent in during for which plan is Remarks for (d) the the last 4 current being submitted district quarters financial yr. (Rs.) (a) (b) (c) (d) (e) Office Equipment 1 24885 20000 40000 With both the (Maintenance includes computer computer and software and hardware upgrades, Xerox being repairs of photocopier, fax, OHP etc) outdated, cost for maintenance and availability of spares is very high and difficult (needs replacement) Binocular Microscopes ( RNTCP) 4 State level Total 40000

Training:

Activity No. in No. No. planned to be Expenditure Estimated Justification/ the already trained in RNTCP (in Rs) Expenditure remarks district trained during each quarter of planned for for the next in next FY current financial RNTCP (c) financial year for year which plan Q1 Q2 Q3 Q4 is being submitted (Rs.) (a) (b) (d) (e) (f) Training of MOs 23 19 Training of LTs of DMCs- 23 5 Govt + Non Govt Referred from ACSM Head 60 - 24 24 10000 20000 Training of Para-Medical Staff of PHSCs Training of MPWs Training of MPHS, pharmacists, nursing staff, BEO etc Training of Comm Volunteers 250 145 25 25 10000 21000 Training of Pvt Practitioners 6 0 Other trainings #

Re- training of MOs 23 0 5 5 5 5 Re- Training of LTs of DMCs 23 0 5 Re- Training of MPWs Re- Training of MPHS Re- Training of Pharmacists Re- Training of nursing staff, BEO Re- Training of CVs Re-training of Pvt Practitioners TB/HIV Training of MOs 23 19 TB/HIV Training of STLS, LTs , MPWs, MPHS, Nursing Staff, Community Volunteers etc TB/HIV Training of STS 1 1 Training of MOs and Para medicals in DOTS Plus for management of MDR TB Provision for Update Training at Various Levels(key staff & MO- PHIs) Any Other Training Activity (Key staff & MO-PHIs) 20000 41000

# Please specify

174 Vehicle Maintenance:

Type of Vehicle Number Number Amount spent Expenditure (in Estimated Justification/ permissible actually on POL and Rs) planned for Expenditure for the remarks as per the present Maintenance in current financial next financial year norms in the the previous 4 year for which plan is district quarters being submitted (Rs.) (a) (b) (c) (d) (e) (f) Four Wheelers 2 2 244670 150000 325000 Two Wheelers Total 325000

Vehicle Hiring:

Number Number Amount Expenditure (in Estimated Justification/ Hiring of Four permissible as actually spent in the Rs) planned for Expenditure for remarks Wheeler per the norms in present previous 4 current financial the next financial the district quarters year year for which plan is being submitted (Rs.) (a) (b) (c) (d) (e) (f) For DTO For MO-TC 1 1 0 25000 70000 One contract 2nd MO need hire vehicle for the supervisory visit. Total 70000

NGO/ PP Support: (New schemes w.e.f. 01‐10‐2008)

Activity No. of Additional Amount Expenditure Estimated Justification/ currently enrolment spent in the (in Rs) Expenditure for the remarks involved planned previous 4 planned for next financial year in for this quarters current for which plan is RNTCP year financial being submitted in the year (Rs.) district (a) (b) (c) (d) (e) (f) ACSM Scheme: TB advocacy, communication, and social 2 - 5000 25000 mobilization SC Scheme: Sputum 3 - 10000 20000 Collection Centre/s Transport Scheme: Sputum Pick-Up and Transport 3 - 12000 12000 Service DMC Scheme: Designated Microscopy Cum Treatment 1 - 25000 40000 150000 Centre (A & B) LT Scheme: Strengthening

RNTCP diagnostic services Culture and DST Scheme: Providing Quality Assured Culture and Drug Susceptibility Testing Services Adherence scheme: Promoting 3 - 5000 10000 20000 treatment adherence Slum Scheme: Improving TB

control in Urban Slums Tuberculosis Unit Model TB-HIV Scheme: Delivering TB-HIV interventions to high HIV Risk groups (HRGs) TOTAL 227000

175 Miscellaneous:

Activity* Amount Amount Expenditure Estimated Expenditure for the Justification/ remarks permissible spent in (in Rs) next financial year for which as per the the planned for plan is being submitted norms in the previous current (Rs.) district 4 financial year quarters (a) (b) (c) (d) (e) TA/DA 57700 24000 10000 Stationery and 30000 17074 15000 35000 other Misc items Total 45000

Contractual Services:

Activity No. required as No. No. planned to Amount Expenditure Estimated Justificati per the norms actually be additionally spent in the (in Rs) Expenditure on/ in the district present in hired during previous 4 planned for for the next remarks the this year quarters current financial year district financial for which plan year is being submitted (Rs.) (a) (b) (c) (d) (e) Medical Officer------DTC STS 1 1 - 115500 60000 120000 STLS 1 1 - 115500 60000 120000 TBHV - 0 - - DEO 1 1 - 82800 43200 86400 Driver 2 2 - 124200 64800 129600 Accountant – part 1 1 - 27600 14400 28800 time Contractual LT 2 1 203400 105600 211200 Total 696000

Printing:

Activity Amount Amount Expenditure (in Estimated Expenditure for Justification/ permissible as spent in the Rs) planned for the next financial year for remarks per the norms in previous 4 current financial which plan is being the district quarters year submitted (Rs.) (a) (b) (c) (d) (e) Printing* 22500 25000 20000 25000 For Printing ACSM Materials

* Please specify items to be printed Research and Studies:

Any Operational Research project planned (Yes) (Post Graduate grant for one research paper from each Medical College)

Estimated Budget (to be approved by STCS).______

176

Medical Colleges

Activity Amount permissible Estimated Expenditure for Justification/ as per norms the next financial year(Rs.) remarks (a) (b) (c) Contractual Staff: ƒ MO (In place: Yes/No) ƒ STLS (In place: Yes/No) ƒ LT (In place: Yes/No) ƒ TBHV (In place: Yes/No)

Research and Studies: ƒ Thesis of PG Student ƒ Operations Research* Travel Expenses for attending STF/ZTF meetings IEC: Meetings and CME planned

Procurement of Vehicles:

Equipment No. actually No. planned Estimated Expenditure for the next Justification/ remarks present in the for this year financial year for which plan is being district submitted (Rs.) (a) (b) (c) (d) 4-wheeler ** 2 2 1100000 2 vehicles are already becoming unserviceable. Both the vehicle were purchase in 2001and 2002. Maintenance and POL consumption is also very high due to the hilly area and bad road. 2-wheeler - - - - ** Only if authorized in writing by the Central TB Division

Procurement of Equipment:

Equipment No. actually No. planned Estimated Expenditure for Justification/ remarks present in the for this year the next financial year for district which plan is being submitted (Rs.) (a) (b) (c) (d) Office Equipment 1 computer and 1 1 computer 160000 Both the machine was (computer, modem, Xerox and 1 Xerox purchase in 2001 and it has scanner, printer, UPS become difficult for etc) servicing, as parts and spares for both the machine is hardly available at Imphal. Any Other 1 OHP - -

177 Section D: Summary of proposed budget for the district –

Budget estimate for the coming FY 2010- 11 S.No. Category of Expenditure (To be based on the planned activities and expenditure in Section C) 1 Civil works 40000 2 Laboratory materials 35000 3 Honorarium 65000 4 IEC/ Publicity 70700 5 Equipment maintenance 40000 6 Training 41000 7 Vehicle maintenance 325000 8 Vehicle hiring 70000 9 NGO/PP support 227000 10 Miscellaneous 45000 11 Contractual services 696000 12 Printing 25000 13 Research and studies - 14 Medical Colleges - 15 Procurement –vehicles 1100000 16 Procurement – equipment 160000 TOTAL 2939700

** Only if authorized in writing by the Central TB Division

NATIONAL VECTOR BORNE DISEASE CONTROL PROGRAM

1 Introduction Ukhrul District is one of the Districts in Manipur in the North Eastern region. It is situated at the eastern part of Manipur sharing its border stretching 200 km long with Myanmar. It is a hilly district almost 99 per cent populated by Tribal in an area of 4554 sq. Km having a population of 140778 (Census, 2001). According to NVBDCP, 2005, 1,76,968 persons spread across 232 villages populates the district. The District is divided in 5 Sub- divisional Blocks having relatively weak health infrastructure, poor transport and communication facilities and bad law & order situation prevailing in the District. The District enjoys a temperature of maximum 27° C and humidity ranges from 60-70 in the District. 2. Situational Analysis of District NVBDCP The success of the NVBDCP in the District is determine by the availability of require inputs like manpower, logistics, equipments, supplies, Health infrastructure, transport and communication etc. Apart from this inputs, it is also vital to understand the field positions in the district. One of the example ingredients is location of the population size, vulnerable population and other variable that may enhance the program. Further it is

178 also important to know what are the demographic and socio-economic profile of the villages and blocks in the District. 2.1. District Profile Already discuss. 2.2. Health Infrastructure Status Already discuss.

179 2.3. Human Resource Status

Sl. No. Designation Number of Staffs 1 DMO 1 2 Supervisor 8 3 Microscopist 7 4 Male Health Worker 29 5 Female Health Worker 1 6 Field Health Worker 1 7 Driver 1

2.4. Vulnerable Villages

Discussed at Situational Analysis

180

181

182 2.5. Logistics Status

The existing situation of logistics management practices is very poor. These needs to be strengthen for high performance of various program under health and family welfare departments. This is essential because, several studies have pointed out poor storage practices resulting in high wastage of commodities. Even though training on logistics management has been imparted, this seems to be a neglected area and the mechanism operating at present is more of a push system rather than need-based supplies. Streamlined logistics systems can help provide various products for Disease program and other consumables to service providers in adequate quantity at right time and place and also help to reduce wastage.

SL Logistics Elements Description 1 Availability of a dedicated store Yes except PHC Lambui room 2 Stock outs of any Yes vital supplies in last year 3 Indenting Systems (from districts From state to district and to PHC, sometimes direct to CHC/PHC) to PHSC from District. 4 Existence of a functional system Yes for assessing Quality product.

Computerized MIES is made available in DMO office, Ukhrul district in 1 Quarter of 2005-06. A Computer operator is in need in the District to enhance the M & E system. Qualitative Research program are enhanced to give quality services to the population in the District. No Internet facility available. 2.7. IEC/BCC In the District the existing capacity is very poor without district level media officer in IEC activities. The activities are handled mostly by staffs and NGOs. The District does not have any training facility Centre for IEC/BCC.

2.8. Training Status

In the District the Training Status during the last year is represented by training 300 Village Volunteers in 2005-07 and in the years to come the program will train ASHA and self- help groups in the District 2.9 Status of Early Diagnostic & Prompt Treatment Centre

Sl.No. Nature of EDPT Centre Number 1 Public including DH/CHC/PHC 58 2 Private Hospital 2 3 NGOs 3 4 FBOs 11 Total 74

183 2.10. Epidemiological Data of Ukhrul District

(i) Annual epidemiological analysis block wise 2005 & 2006

Sl. No. Year *Pop BSE +ve PF PV API 2005 101031 3889 184 93 90 1.82 Ukhrul 2006 101031 2627 120 93 25 1.19 2005 35809 1379 139 35 104 3.88 Chingai 2006 35809 936 113 57 56 3.15 2005 15060 1052 51 36 15 3.38 Kamjong 2006 15060 1124 54 37 16 3.58 2005 17235 669 19 7 8 1.10 Phungyar 2006 17235 686 19 8 11 1.04 2005 13869 1085 20 10 10 1.44 Kasom Kl 2006 13869 364 23 12 11 1.65 * Census of NVBDCP, 2005

3. GOAL OF THE NVBDCP

(i) To prevent and control malaria in the District.

4. OBJECTIVES

(i) To reduce Malaria Mortality rate in the District.

5. STRATEGIES

(i) Increase access to Early Diagnosis & prompt Treatment by strengthening Active and Passive Surveillance system and upgradation of health facility and use of second line drug in chloroquin reisitant area. (ii) Involvement of community participation through capacity building, IEC/BCC, NGO activities. (iii) Constant monitoring and evaluation activities. (iv) Focus on high riskpopulation. (v) Vector Control measures.

WORK PLAN AND BUDGET FOR 2008-09 (QUARTERLY WISE)

184 Sl. Work plan/activity Quatity Rate Quarter Total No. (Rs.) Q1,Q2,Q3,Q4 Amount (Rs. In Lakhs) A EDPT 1 Disposable lancet 10000 1.25 Q1 1.50 2 Microslides 10000 1.50 Q1 0.15 3 Cotton roll-500 G 500 90 Q1 0.90 4 Spirit bottle ½ litre 500 80 Q1 0.40 5 Towel/Torch light 300 250 Q1 0.75 6 Kig Bag 350 600 Q1 2.10 7 Rain Coat 350 400 Q1 1.40 8 Rain boot 350 400 Q1 1.40 9 Sign board for DDC, 350 700 Q1 2.45 FTD, NGOs Private 10 Printing formate, 4000 1 Q1 0.04 register, paper others 11 Bucket & others 350 80 Q1 0.28 12 Rapid Diagnostic Kit with transport 60 6500 Q1 3.90 Sub-Total - - - 15.27 B Vector Control Measures - - - - 1 DDT transportation - Q1 1.00 From Sate to district and district to CHC/PHC/PHSC/villages 2 Spray wages of 1st and 2nd round 20X120 days 100 Q1 2.40 3 Procurement of spray pumps & spare part 10 2500 Q1 0.25 4 Procurement of DDT 1.50 metric - Q1 - ton 5 IEC/Community Meeting at each village 232 5000 Q1 1.16 6 Cost of Treatment of Community owned 20000 10 Q1 2.00 bed-nets Sub-Total - - - 6.81 C IEC/BCC - - - - 1 Media campaign through DDK, cable, AIR, 4 2000 Q1-Q4 0.08 news paper 2 Awareness camps schools & 350 5000 Q1-Q4 1.75 3 Drama, folk play 10 4 KAP study 1 1.00 Q1 1.00 5 Anti-Malaria month observation up to 350 1000 Q1-Q4 0.35 village level Sub-Total - - - 3.18 D Capacity Building - - - - 1 ASHA 252 200 Q1 0.54 2 MHW 29 200 Q2 0.60 3 Spray Man 20 200 Q! 0.04 4 ANM 80 200 Q1 0.16 5 CHC/PHC Lab 11 200 Q1 0.03 Sub-Total - - - 1.37 E HMIS/ME - - - - 1 Computor Operator 12 7500 Q1 0.90 Sub-Total - - 0.90 F Mobility Support for ME - - - 1 Medical officer CHC/PHC 4 10000 Q1-Q4 0.40 2 Supervisor 4 6000 Q1-Q4 0.24

185 3 Rapid out break team - Q1-Q3 0.30 Sub-Total - - - 0.94 G Infrastructure - - - - 1 Construction of District Malaria Office with 1 - Q1 12.00 stoor room, garage Sub-Total - - - 12.00 H Laboratory Support for DH/CHC/PHC - - - - 1 DH 1 10000 Q1 0.10 2 CHC 1 10000 Q1 0.10 3 PHC 6 10000 Q1 0.60 Sub-Total - - - 0.80 I Office Expenses - - - - 1 Office Expenses 1 - Q1-Q4 4.00 2 Telephone, Etectricity, internet, journels - - Q1-Q4 0.50 etc. 3 Stationary - - Q1-Q4 0.50 4 TA/DA - - Q1-Q4 0.50 5 Contingency including incentive award to - - Q1-Q4 1.00 staffs Sub-Total - - - 2.50 Total Budget for 2010-11 - - - 43.77

186

Part E

WITH DEPARTMENT OF WOMEN AND CHILD DEVELOPMENT

1. Village Health Day

Anganwadi Centres (AWC) will serve as the focal point for all health and nutrition services. A Health Day (Wednesday) is fixed every month at the AWC to provide antenatal, postnatal, family planning and child health services, including immunization. On that day, an ANM and preferably an MO from the PHC will be in attendance. AWW and VLLW/ASHA (and other community volunteers) would be responsible for ensuring that all children 0-6 years, pregnant women and lactating women, and children needing immunization and other health services are brought to the AWC on that fixed day.

187 2. Coordination between AWW and ASHA

AWWs will be mentors of ASHA and will work in tandem for counseling Pregnant Women to have institutional delivery, attend home deliveries as second attendant, motivate newly married on family planning, participate in Routine Immunization Strengthening and NIDs and facilitate referral for institutional delivery.

3. Interdepartmental coordination

Representatives from WCD are to be made members in all the Societies and Committees starting from State level to the Village level. Monitoring and Supervision of the different activities may be facilitated through joint review meetings and common reporting formats.

1. Empowerment of PRIs through assured availability of adequate funds: Untied funds may be made available to Village Health Committees and all Subcentres to be deposited in a joint Account operated by ANM and PRI representative.

2. Partnership with PRIs PRI representatives are to be made members in all Societies and Committees viz. State and District Health Mission Societies, Rogi Kalyan Samitis, Subcentre Committees and Village Health Committees.

3. Empowerment during selection of ASHA ASHA are to be selected by the PRI after facilitating by a trained facilitator.

There is yet no separate Department of AYUSH in the State. An AYUSH Cell exists under the Directorate of Health Services, Manipur.

4 Mainstreaming AYUSH

All the CHCs and 24/7 PHCs are to have AYUSH manpower with AYUSH drugs. 14 CHCs and 20 24/7 PHCs are identified to be up-graded in 2006-07; and they are provided with AYUSH Doctors including specialist and pharmacists along with necessary drugs. The AYUSH staffs are to be multi-skilled so as to enable them to attend deliveries. In 2008-09, additional 40 AYUSH Centres are going to be opened in PHCs. The budget needed for support of Manpower is already reflected under Part “B” of NRHM.

188 The Civil works needed, other infrastructure up-gradation, medicine etc of the AYUSH Centres will be supported by AYUSH under CSS.

1. Propose for establishment of AYUSH Herbal Garden at PHSC/PHC/CHC 2. AYUSH Health Mela 3. AYUSH Health Camps 4. Collation of AYUSH with Allophatic 5. Discourage prescription of allophatic by AYUSH Doctor 6. Extension of OPD AYUSH to Somdal PHC.

2. Manipur Aids Control Society (Macs)

The services of MACS counselors posted at District Hospitals, CHCs and 24/7 PHCs are to be utilized for the common goal of MACS and MCH and Adolescent Health. Also in places where trained counselors under MACS are not available, ANMs or Female Health Supervisors will be trained for counseling. The District Mobile medical Units will have trained counselors provided by MACS. The Integrated RCH out-reach camps also will have trained counselors.

Lab. Techs recruited under MACs as well as recruited under NRHM will be used both for RTI/STI and HIV testing services. RTI/STI Clinics in District Hospitals and identified CHCs will also be run in a coordinated manner along with MACS. Also the Blood Storage Centres at the FRUs will be made functional with coordination with MACs e.g. consumables may be supplied by MACS. Trainings of SBAs and health providers for Adolescent Health/ School Health and ASHAs will also have components under HIV/AIDS. Further IEC activities at Districts will be planned in an integrated manner with MACS. Finally, coordination meetings will be held monthly.

3. With public health engineering department/public works department To bring about better Sanitation and Safe Drinking Water Supply available to the community and also to overcome transport problems regarding approach roads to the health institutions, the PHED/PWD representatives are to be made members in all the Societies and Committees starting from State level to Village level. Thus joint planning and implementation of relevant activities will be sought.

Total Budget for 2010-11 (Rs. in lakhs)

189

Sr. No. Part of NRHM Budget 1 Part “A” 232.285

2 Part “B” 1069.961

3 Part “C” 8.88

4 Part “D” 73.16

5 Part “E” -

Grand Total Rs. 1384.286

190