Government of Jammu & Kashmir

DISTRICT HEALTH ACTION PLAN

BUDGAM

December 2007

CONTENTS

PREFACE ...... 5 EXECUTIVE SUMMARY ...... 7 PRIORITIES OF THE DISTRICT ...... 9 BUDGET SUMMARY ...... 13 1. SITUATION ANALYSIS ...... 17 Development Indicators of the District ...... 18 Socio Economic and Health Indicators of the District ...... 19 2. PLANNING PROCESS ...... 34 3. PRIORITIES AS PER BACKGROUND AND PLANNING PROCESS ...... 39 4. GOALS ...... 41 5. TECHNICAL COMPONENTS ...... 42 PART A: Reproductive and Child Health (RCH) II ...... 42 PART B: New NRHM Initiatives ...... 56 PART C: Immunisation ...... 69 PART D: National Disease Control Programme ...... 77 6.INTER-SECTORAL CONVERGENCE ...... 87 7. COMMUNITY HEALTH ACTION ...... 92 8. PUBLIC PRIVATE PARTNERSHIP ...... 94 9. GENDER AND EQUITY ...... 95 10. CAPACITY BUILDING ...... 96 11.HUMAN RESOURCE PLAN ...... 102 12.PROCUREMENT AND LOGISTICS ...... 108 13. DEMAND GENERATION – IEC ...... 110 14. FINANCING OF HEALTH CARE ...... 112 16. BIO-MEDICAL WASTE MANAGEMENT ...... 115

PREFACE

The National Rural Health Mission envisages the planning process to be participatory and decentralized starting with the Village. It seeks to empower the community by placing the health of the people in their own hands and determine the ways they would like to improve their health. This is the only way to ensure that health plans are need based. The state would play a facilitators role.

NRHM was launched in April 2005. Department of Health, Government of J & K is implementing the NRHM in right earnest. A number of enabling actions were taken by the State Health Society. This created environment conducive for decentralized planning by the district.

District Action Plans is the most important unit of the planning process as the Government of India and the state government would monitor the progress of implementation district wise. The district is also the key administrative unit for most of the development activities. To make District Plans more meaningful and address local health problems, preparation of Block Health Plans is considered essential.

The decentralized planning process involved village consultations and preparation of Village Health Plans by the Village Health Water and Sanitation committees; followed by development of Block Action Plans through integration of Health Facility Surveys and block specific needs. The Block Action Plans were integrated to form District Action Plans.

We now have the capacity for preparing the need based plans following participatory processes. A District Planning Team (DPT) was set up for this purpose in the month of June, 2007. It has representation from various sectors concerned with NRHM. This group was responsible for management of the entire planning process in the district and also for provision of the technical support. The DPT is the standing body and will take charge of the implementation of the plans thus prepared. Thus the DPT not only owns the plans but will also be responsible for monitoring the progress of implementation to achieve the objectives of the plan. The members of the DPT are:

S. No. Name Designation Department 1 Mr.Farooq Ahmad Ranzoo Deputy Commissioner Headquarter 2 Dr. Mushtaq Ahmad Kichloo Chief Medical Officer Health 3 Dr. Bashir Ahmad Janawari Dy. Chief Medical Officer Health 4 Basharat Ahmad Makhdoomi Chief Planning Officer D.C Office 5 Ahmad Ullah Owaise Chief Education Officer Education 6 Dr.Mahmood Ahmad ADMO(ISM) Health 7 Dr. Riyaz Hamdani Medical Superintend(DH) Health 8 Manzoor Ahmad Sofi District Panchayat Officer 9 Yasmeen Akhter DSWO Social Welfare 10 Javid Sofi Assistant Executive Engineer PHE 11 Er.Altaf Ahmad Executive Engineer PHE 12 Rizwan Alam Thakur DPM Health

The orientation of DPT, facilitated by the Dr. Abu Altamash Faizi, Head, Kashmir Division form EPOS, New Delhi, and Mr. Abdul Latif Dar District Co-ordinator Budgam was held on 27 th June

2007. This enabled the DPT members to not only understand NRHM approach, key components and strategies of NRHM, but also manage the planning process and develop the District Action Plan. The DPT met a number of times and the individual members reviewed the situation of their respective sectors/areas and collectively developed the strategic vision for improving the health status of the district population.

We the members of the DPT on behalf of the entire Planning Group reiterate and certify that this District Action Plan has been prepared through participatory processes. It has been developed by integrating the Block Action Plans prepared by integrating health facility surveys and village health plans in each block of the District. This plan also incorporates the needs and plans from 134 Sub health centres, 45 PHCs, 9 CHCs and a district hospital in the District.

DR.MUSHTAQ AHMAD KICHLOO (CHIEF MEDICAL OFFICER

EXECUTIVE SUMMARY

Budgam district covering an area of 1,371 sq and situated at an average height of 5,281 ft above sea-level. Budgam is formed of three tehsils namely Budgam, Chadoora, Beerwah. The district is divided into 10 medical blocks. District headquarters is situated at Budgam. The district has recorded a population of 5, 93,768, (2001 Census) with a decadal growth rate of 26.5 per cent and a Sex-Ratio of 940 females per 1,000 males. The overall literacy rate has been recorded at 39.54 %, With a predominantly rural outlook, 86 % of the population in Budgam district live in its villages and are primarily involved in agricultural operations.

The NRHM seeks to provide accessible, affordable and quality health care to rural population, especially the vulnerable sections. It also aims at reducing 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 Total Fertility Rate (TFR) from 3.0 to 2.1 within the 6 year span of the Mission (2006-07 to 2011-12).

The District health Action Plan has been prepared using decentralized planning process. Village and block plans converged to form the district plan. It is also based on the data collected during the block consultation “Facility Survey” in July 2007 covering 134 Sub Centres, 45 PHCs, 9 CHCs and a District hospital. These facilities are providing Health care to about 6.8 lakh population living in 622 villages and 10 urban towns in the district.

International Institute For population Sciences, Mumbai ranked 593 districts in the country on the basis of children parity, contraceptive prevalence rate (CPR), under five child mortality and ANC. The overall ranking of the district Budgam is 338. In this ranking system, the lower is the rank, the better the district.

In terms of major challenges, the district needs to increase institutional deliveries and deliveries by skilled personnel which are currently at 43% and 67% respectively. The share of male participation in use of family planning methods is almost negligible. Prevalence of anaemia amongst pregnant women is quite high as per DLHS report. These issues have to do both with demand and supply of health services. This is a district where average literacy levels are below 40%. The plan has put emphasis on inter sectoral convergence. The highlight is convergence with education and women and child department for provision of life skills education to both in and out of school adolescent girls and boys.

On the supply side, 143 posts of ANM, 103 posts of Nurse, 28 posts of MOs, 9 posts of pediatrician and 8 posts of obstetricians/ gynecologist are vacant. Over all 143 posts at SCs, 449 posts at PHCs, and 102 posts at CHC level are vacant. Role Ob/Gyne and Pediatricians is crucial for comprehensive emergency obstetric care and high risk cases of neo natal health. To meet the above mentioned and many others crucial health indicators, the plan provides for filling gaps in the area of human resources by hiring key staff including medical doctors and specialists on contract and converging with AYUSH department.

The basic infrastructure in the district has many gaps. Out of total 134 sub centres, 103 are running in rented building without labour room electricity and water supply. Most of the SCs do not have electricity, water supply connection and toilets which adversely impacts utilization of services from SCs.Out of 45 PHCs, 12 PHCs are functioning in rented building and water supply is available only in 41% and electricity in 63%. Facility survey Report (Anex-1& II) giving clear picture of gaps in infrastructure, equipment, drugs and human resources and considering IPHS standards.

In order to increase institutional delivery attention has been given to functioning of 24x7 PHCs in phased manner and construction of rented SC & PHC building with all facilities. A total of Rs. 10074.774 Lakh has been fixed for RCH II budget.

Under NRHM special focus has been given to Village Health Water and Sanitation Committee, Rogi kalayan committee, Upgradation of health facilities as per IPHS, selection and training of ASHA, functioning of quality assurance committee, infrastructure development etc. A total of Rs. 13692.033 Lakh has been planned for NRHM budget.

"National Disease Control Programme include RNTCP, leprosy control programme, Malaria control programme, Blindness control programme, vector born disease, integrated disease surveillance and iodine deficiency disorder. A total budget for this is 677.619532 Lakh.

A total budget of the district for the mission period (2008-2012) costing Rs. 27652.82919 Lakh (276 crores 32 lakhs 82 thousand 9 hundred and 19 rupees).

PRIORITIES OF THE DISTRICT

S. Thematic Critical Issues of the District Specific Priorities No Area 1. District Health Societies for different vertical Integrate all district societies into Management programme function in District Health society and function isolation without coordinated as one unit. efforts in the district. Capacity building of the DHS Lack of human resource for members for effective management management and their of District Health Society. training Programmatic and financial Monitoring and evaluation. progress monitoring by health personnel only. Strengthening the functioning of the District Health System. 2. District & Support to CMO office Clarity amongst officials and Block Strengthening monitoring and Consultants about NRHM goals Programme reporting and activities Management Training of district officials and Block SMOs Streamlining financial management system Strengthening the CMO office Capacity building of the DPMU personnel for monitoring Strengthening the Block Management Units 3. Improving Increasing Institutional 24 hour service delivery in all maternal and deliveries PHCs child health Improving postnatal services Labour room facility at all SCs. Ensuring availability of personnel especially specialists and Public Health Nurses for 24 hour PHC, CHC and ANMs at the sub centres Increased coverage under JSY To increase IEC/BCC activities • Strengthen FRUs for Emergency Obstetric Care services by providing minimum basic infrastructure, drugs and equipments. 4. Family Low level of FP acceptance. Decreasing the Unmet Need for Planning Family Planning Ensure availability of all FP methods at block level facilities. Vacant positions to be filled in on a contractual basis. Lack of awareness on FP Partnership with private doctors for methods & low level of FP and RCH services male participation Increasing access to Emergency Contraception and spacing

methods through social marketing Building alliances with other departments, PRIs, Private sector providers and NGOs 5. Adolescent Adolescent boys are exposed Implement ASRH programme to Health to smoking, drug addictions, increase the knowledge levels of and alcoholism. Adolescents on RH and Life skills Teenage pregnancies also Operationalize Adolescent Friendly emerging as a problem and Health services at the health unsafe abortion & premarital facilities sex trend are on rise. 6. Mobile Remote population is not Provide 1 MMUs equipped with Medical Units covered GPRS for services in remote (MMUs) Insufficient staff and logistics. areas. Contract MOs and staff nurses for MMUs 7. Upgrading All the CHC are housed in All CHCs needs to be upgraded CHCs to govt building however the as per IPHS IPHS condition of CHC needs to be Additional 02 CHCs to be built as upgraded as per IPHS per population standard. Manpower be recruited 8. Upgrading 50% PHCs need to be 28 PHCs require new buildings PHCs for 24 upgraded to IPHS as per IPHS standards hr Services Out of 45 only 9 PHCs are 17 PHCs require repairs, additions and IPHS working 24hors & expansion as per IPHS standards 28 PHCs require new Additional 07 PHC’s to be built as buildings and 5 PHCs require per population additions and expansion and Construction of staff quarters in all 12 PHCs need repairs 45 PHCs Manpower Equipments and drugs To be functional 24x7 Equipped Labour rooms 9. Upgrading Out of 134 subcentres, 102 Need to construct 102 Subcentre Sub Centres subcentres are in rented building to IPHS buildings and 32 subcentres Additional 134 SCs are required standards are in government buildings. Delivery rooms in SCs for There is no staff quarter in institutional deliveries any of the subcentres Drugs and equipments as per IPHS Manpower Construction of staff quarters for all SCs. 10. Immunisation Lack of awareness to Strengthening the District Family mothers Welfare Office Alternate vaccine delivery Enhancing the coverage of Lack of Cold storage Immunization Efficient monitoring and Alternative Vaccine delivery supervision mechanisms in place Gaps in difficult, flung areas Effective Cold Chain Maintenance

& inaccessible areas upto sub centre level Reporting and documentation Zero Polio cases and quality surveillance for Polio cases Close Monitoring and documentation of the progress 11. Inter Sectoral Lack of coordination b/w ICDS Linkages to be developed between Convergence and health department ICDS workers and health workers for timely diagnosis of malnourished children and their management (detailed activities under thematic heads) Lack of coordination b/w RDD Linkages to be developed between the and health department Health Department and the Rural Development department • Improving the health standard & quality of life • Awareness on sanitation/ Hygiene • Covering of school/ Anganwari • Education & sanitary habits among students. • Promote & encourage cost effective construction of household latrine & their proper use. • Elimination of open defection to minimize the risk of contamination of water source & food. Lack of coordination b/w PHE • Provision of Bleaching powder and and health department chlorine tablets • Joint communication strategy. • Sharing quality monitoring with the Health Department at block, district and state levels • Community based organizations will be engaged by a team of frontline workers – health, ICDS and PHE departments. 12. Human Lack of manpower at all levels • All staff to be in place as IPHS Resource starting from Sub centres to norms by 2012 PHCs to CHCs to DH • Increased salaries for contractual doctors and Specialists • Special allowances for Regular In the CHC there should be at staff least 7 specialists, 3 MOs, 10 • Increase in the number of training Staff Nurses, I PHN, 1 Computer centres for LHV, ANM, Staff clerk, 1 Dresser, 1Pharmacist, 1 Nurses, Lab Technicians Lab technician, 1 BEE, 1 • Rational placement of Specialists radiographer, 1 UDC, 1 and trained staff Accountant, 1 LDC, 1 • Recruitment of staff on contract Epidemiologist, and Ancillary where vacancies staff on contract.

• Recruitment of staff for new facilities as per the infrastructure requirements • Computers at all PHC and for each MO and Specialist at the CHC • Allowing Specialists and MOs for developing special skills as per their needs by attending special courses anywhere in India.

BUDGET SUMMARY Component Year wise Budget in Lacs 2008-09 2009-10 2010-11 2011-12 Total A-1Strengthening of District Health Management Unit 17.96 8.512 5.369 5.661 37.502 A 2. DPMU 160.811 164.113 180.928 199.379 705.2306 A-3Maternal Health 291.696 306.456 286.352 286.9856 1171.4896 A-4Neborn & Child Health 24.88 3.4 0 0 28.28 A-5Family Planning 129.382 109.007 111.0901 122.1991 471.67826 A-6Adolescent Health 16.41 14.555 8.6065 9.35015 48.92165 B-1 ASHA – Accredited Social Health Activist 226.37 209.73 176.45 176.45 789 B-2. Provision of Untied Funds SC 46.2 80.4 80.4 80.4 287.4 B-3 Provision of Untied Funds at CHCs 59.55 40.82 40.84 40.86 182.07 B-4 Provision of Untied Funds at PHCs 669.96 616.3316 40.84476 44.92924 1372.065596 B-5 Mobile Medical Units 53.26 26.44 26.47 26.5 132.67 B-6 Upgrading CHCs to IPHS 669.96 616.3316 40.84476 44.92924 1372.065596 B-7 Upgrading PHCs to 24 Hour Service 2001.63 2044.988 511.7868 505.0121 5063.36688 B-8 Upgrading SCs 1657.882 1651.818 31.1168 32.32548 3373.14228 B-9. VHWSC 44 55.77 61.347 67.4817 228.5987 C-1 Cold Chain Maintenance 126.75 45.21 27.786 28.5846 228.3306 C-2 IEC and Social Mobilization 55.92 57.6976 61.46136 65.6015 240.680456 C-3 Alternate Vaccine Delivery Mechanism 54.71 71.4292 74.49512 77.86763 278.501952 C-4 Supervisory Support & Vaccine Transport. 1.27 1.27 1.27 1.27 5.08 C-5 HMIS 115.752 163.797 43.1369 47.7306 370.4167 C-6 Supplies & Logistics 567.5862 413.178 326.7798 326.9976 1634.5416 D-1 RNTCP 56.254 53.8374 59.2382 65.1591 234.4887 D-2 Leprosy 15 16.5 18.15 19.965 69.615 D-3 National Malaria Control Programme 31 22 24.2 26.62 103.82 D-4 Other Vector Borne Diseases 8.86 8.86 9.41 10.015 37.145 D-5 Control Of Blindness 54.202 28.6272 31.4929 34.6432 148.9653 D-6 Integrated Disease Surveillance Programme 17.7 10.87 11.515 11.6965 51.7815 D-7 Iodine Deficiency Disorders 7.31 7.71 8.15 8.634 31.804 Inter Sectoral Convergence 88.926 93.418 98.36 103.794 384.4994 7-Community Health Action 25.2932 27.8225 30.6048 33.6653 117.3857 8- Public Private Partnership 125 53 56.3 59.93 294.23 9- Gender And Equity 26.44 27.984 30.7824 33.8606 119.067 10- Capacity Buildings 102.964 123.229 131.264 134.785 492.2414 11- Human Resource Plan 864.7 1460.209 1460.209 1460.205 5245.32212 12- Procurement & Logistics 140.83 15.38 13.609 13.979 183.798 13- Demand Generation - IEC 298.346 328.181 360.998 397.1 1384.624 16. School Health 180.75 183.6 34.485 37.9335 436.7685

17 Financing Health Care 60.1 64.46 70.881 77.932 273.373 18 Bio Medical Waste Management 8.85 4.235 4.6585 5.12415 22.86765 TOTA 9104.46 9231.18 4591.68 4725.56 27652.8287

BUDGET 2008-12 Series1

10000

9231.1771 9000 9104.4644

8000

7000

6000

5000 4591.6827 4725.55589

Rs. IN LACS 4000

3000

2000

1000

0 2008-09 2009-10 2010-11 2011-12 YEARS

District Budgam BUDGET - AT- A GLANCE (In Lakhs) S. 2008-09 2009-10 2010-11 2011-12 Total No . Components A RCH-II 1 DHS 17.96 8.512 5.369 5.661 37.502 2 DPMU 160.811 164.113 180.928 199.3786 705.2306 3 Maternal health 291.696 306.456 286.352 286.9856 1171.4896 4 Child Health 24.88 3.4 0 0 28.28 5 Family Welfare 129.382 109.007 111.0901 122.1991 471.67826 6 Adolescent Health 16.41 14.555 8.6065 9.35015 48.92165 7 Gender & Equity 26.44 27.984 30.7824 33.86064 119.06704 8 Capacity Building 102.9636 123.2288 131.2644 134.7847 492.2414006 9 Human Resource 864.7 1460.209 1460.209 1460.205 5245.32212 10 IEC 298.346 328.1808 360.998 397.0995 1384.6243 11 HMIS & Monitoring 115.752 163.7972 43.13692 47.73061 370.416732 Total 2049.341 2709.443 2618.736 2697.255 10074.774 B NRHM 1 ASHA 226.37 209.73 176.45 176.45 789 SC Untied Fund & 2 Maintenance 46.2 80.4 80.4 80.4 287.4 PHC Untied Fund & 3 Maintenance 59.55 40.82 40.84 40.86 182.07 CHC Untied Fund & 4 Maintenance 669.96 616.3316 40.84476 44.92924 1372.065596 5 MMU 53.26 26.44 26.47 26.5 132.67 6 Up gradation of CHC 669.96 616.3316 40.84476 44.92924 1372.065596 7 Up gradation of PHC 2001.63 2044.988 511.7868 505.0121 5063.36688 8 Up gradation of SC 1657.882 1651.818 31.1168 32.32548 3373.14228 9 VHWSC 44 55.77 61.347 67.4817 228.5987 Community Action 10 Plan 25.2932 27.82252 30.60477 33.66525 117.3857412 11 PPP 125 53 56.3 59.93 294.23 12 Health Care Financing 60.1 64.46 70.881 77.932 273.373 13 Procument & logistics 140.83 15.38 13.609 13.979 183.798 14 Biomedical Waste 8.85 4.235 4.6585 5.12415 22.86765 Total 5788.885 5507.527 1186.153 1209.518 13692.03344 C Immunization Cold Chain 126.75 45.21 27.786 28.5846 228.3306 1 Maintenance IEC & Social 55.92 57.6976 61.46136 65.6015 240.680456 2 Mobilization Alternate Vaccine 54.71 71.4292 74.49512 77.86763 278.501952 3 Delivery Supervisory Support 1.27 1.27 1.27 1.27 5.08 4 & Vaccine Supplies and 567.5862 413.178 326.7798 326.9976 1634.5416 5 Logistics

Total 806.2362 588.7848 491.7923 500.3213 2387.134608 D NDCP 1 RNTCP 56.254 53.8374 59.23824 65.15906 234.4887 2 Leprosy 15 16.5 18.15 19.965 69.615 National Malaria 31 22 24.2 26.62 103.82 3 Control Program Other Vector Born 8.86 8.86 9.41 10.015 37.145 4 Diseases Blind Control 54.202 28.6272 31.49292 34.64321 148.965332 5 Programme Integrated Disease 17.7 10.87 11.515 11.6965 51.7815 6 Surveillance Iodine Deficiency 7.31 7.71 8.15 8.634 31.804 7 Disorders Total 190.326 148.4046 162.1562 176.7328 677.619532 E Others 1 InterSectoral 88.926 93.418 98.36 103.7944 384.4994 2 School Health 180.75 183.6 34.485 37.9335 436.7685 Total 269.676 277.018 132.845 141.7279 821.2679 Grand total 9104.46 9231.18 4591.68 4725.55 27652.8292

BUDGET COMPONENT WISE 2008 - 12

RCH

Others 3% NRHM NDCP 2%

Immunization Immuniza 9% tion RCH 36% NDCP

Others

NRHM 50%

1. SITUATION ANALYSIS

District Profile

Budgam district covering an area of 1,371 sq and situated at an average height of 5,281 ft above sea-level and at 75 degree E longitude and 34 degree N latitude, the district was known as Deedmarbag in ancient times. The topography of the district is mixed with both mountainous and plain areas. The climate is of the temperate type with the upper-reaches receiving heavy snowfall in winter. The average annual rainfall of the district is 585 mm. Budgam leads Valley in cultivation of vegetables while a good quantity of fruit is also grown in selected pockets

Budgam is formed of three tehsils namely Budgam, Chadoora, Beerwah. Budgam district is divided in to 8 Community Development Blocks. District headquarters is situated at Budgam. District comprises of 622 Villages. The district has recorded a population of 5, 93,768, (2001 Census) which is 6% of the State’s population. The population comprises 3, 09, 574 males (52.1 %) and 2, 84,194 females (47.9 %). The population density has been recorded at 433 persons per square kilometer, as compared to 99 persons per square km for the entire state. Projected population of Budgam District for the year 2007 is 6, 82,833 which live in 622 villages and 199 Gram Panchayat.

Budgam district has registered a decadal growth rate of 26.5 per cent, which is slightly less than 29.04 per cent for the State as a whole. With a Sex-Ratio of 918 females per 1,000 males, the figure is comparatively better than that for the State, which is 900. The overall literacy rate has been recorded at 39.54 %, which is considerably less than the figure of 54.46% for the J&K State. While the male literacy rate is 51.23% as compared to 65.25% for the state, the female literacy rate trails at 26.60 % as against the state figure of 41.82 %. The abysmal literacy rate for the district despite its proximity to the capital is a cause of serious concern. With a predominantly rural outlook, 86 % of the population in Budgam district live in its villages and are primarily involved in agricultural operation.

Name of District Budgam

Name of District Headquarters Budgam

District population (census- 2001) 5,93,768

Projected Population for 2007 6,82,833

No. of Medical Blocks in the District 10

No. of Gram Panchayats in the District 199

No. of Villages 622

Villages without motor able roads 0

Villages without electricity 0

No. of Towns 10

Notified Area Committee 5

Development Indicators of the District

SN Indicators State District

1 Crude Birth Rate 18.7 (SRS 2004) 16.1

2 Crude Death Rate 5.6 (SRS 2004) 6.0

3 Infant Mortality Rate 49.0 (SRS 2004) 49

5 Total Fertility Rate 2.4 (SRS 2004) NA

6 Couple Protection Rate 61.4 NA

7 Sex Ratio (General) 948 SRS-2005 940/ 1000

8 Sex Ratio (0 – 6 years) 937 (2001 Census) NA

9 Literacy rate (overall) 54.46 % 39.54 %

Literacy rate (male) 10 68.8% 51.23 %

Literacy rate (female) 11 41.82 % 26.60 %

Socio Economic and Health Indicators of the District

Name of Block Total Khag* Khag* Nagam Nagam Soibuh Soibuh Magam Magam Berwah Berwah Budgam Budgam Chadoora Chadoora Khansahib Khansahib Chrarsharif Chrarsharif Chatergam Chatergam Demographic indicators Total Population 73556 50024 82756 106909 56066 104121 39861 84041 125304 722638 Population - Males 37528 25522 42222 54545 28605 53129 20337 42878 63930 368693 Population-Females 36028 24502 40533 52364 27460 50992 19523 41162 61373 353945 Population 0 - 6 yrs. 10300 9032 16553 18032 9550 24297 15573 25515 20653 149505 % Scheduled Caste 0 0 0 0 0 0 0 0 0 0 Number of Villages i 34 72 52 112 42 109 41 112 48 622 No of Panchayats Na NA NA NA NA NA NA NA NA NA Socio-economic indicators ICDS beneficiaries <2 11105 Na 5678 1924 NA NA 11232 1308 NA 31247 Yrs. children ICDS beneficiaries 2 9137 NA 6813 4181 NA NA 9854 2658 NA 32643 years and above No. of BPL households 3080 4119 NA NA NA 9012 22991 1400 NA 40602 Girls enrolled last yr in 1628 2291 8073 4131 4131 NA 1845 1998 NA 24097 primary School Girls dropped out of 0 0 0 79 79 NA 0 76 NA 158 primary schools last year Number of hand pumps 0 0 0 NA NA 01 0 NA 0 01 Number of functional 0 Na NA NA NA NA 0 NA 0 0 hand pumps No. of wells being used for drinking water 0 Na NA NA NA NA 0 NA 0 0 purposes Number of households 635 NA NA NA NA NA 956 90% 115 750 with access to toilets

Name of Block Total Khag* Khag* Nagam Nagam Soibuh Soibuh Magam Magam Berwah Berwah Budgam Budgam Chadoora Chadoora Khansahib Khansahib Chrarsharif Chrarsharif Chatergam Chatergam No. of private health 0 15 NA 0 06 38 0 NA 0 59 facilities/clinicians No. of women who have benefited through the 122 129 101 145 91 263 291 600 NA 1742 JSY Scheme till now 1 No. of girls who got NA NA NA NA NA NA NA NA NA NA married last year No. of girls who got married last year and NA NA NA NA NA NA NA NA NA NA were <18 years at the time of marriage No. of Tubectomies 05 148 217 0 21 82 0 51 103 627 conducted in last year No. of IUD insertions in 50 283 52 201 436 214 71 85 56 1448 last reporting year No. of vasectomies done 0 19 52 0 0 0 0 0 0 71 in last year No. of pregnant women NA 2216 2685 3620 3298 2346 2400 2334 5176 24075 No. of pregnant women registered for ANC in last 828 2112 2558 3536 3208 1776 2276 2150 5176 23620 year No. of pregnant women received TT1 and TT2 in 752 2045 2558 2348 2371 1776 2593 1361 2387 18191 last year No. of institutional 349 605 1360 272 242 1776 116 2696 1088 8538 deliveries in last year No. of women referred 0 0 114 0 233 26 23 58 0 454 for MTPs in last year

Name of Block Total Khag* Khag* Nagam Nagam Soibuh Soibuh Magam Magam Berwah Berwah Budgam Budgam Chadoora Chadoora Khansahib Khansahib Chrarsharif Chrarsharif Chatergam Chatergam No. of RTI/STI cases 201 192 1202 272 0 224 0 2814 0 4905 reported in last year No. of children given 993 1899 2067 2805 2186 3430 1771 2579 2056 19786 measles vaccine in last yr Prevalent Disease in District

TUBERCULOSIS & LEPROSY No. of patients currently undergoing DOTS 05 12 48 NA 14 16 0 0 02 97 therapy in the blockas on July 2006 Number of new leprosy cases reported in last 01 0 0 0 0 01 0 0 0 2 reporting year NVBDCP No. of Blood smears examined for malaria in 0 0 32 0 0 0 0 0 0 32 last year No. of malaria + ve cases 0 0 0 0 0 0 0 0 0 0 in last year No. of new kala-azar cases 0 0 01 0 0 0 0 0 0 1 in last year No. of microfilaria cases in 0 0 0 0 0 0 0 0 0 0 last year No. of JE cases reported 0 0 0 0 0 0 0 0 0 0 in last year Blindness Control No. of cataract operations conducted in NA 161 0 0 15 0 0 0 151 327 last yr.

Health Institutions, Population Coverage Ratios and Health Functionaries in the District

Name of Block Total Total Khag Khag Nagam Nagam Magam Magam Berwah Berwah Soibugh Soibugh Budgam Chadoora Chadoora Khansahib Khansahib Chatergam Chatergam Chrarsharif Chrarsharif No. of Speciality 0 0 0 0 0 0 0 0 0 0 Hospitals No. Referral Hospitals 01 01 0 0 0 06 0 0 0 8 No. of CHC/BPHCs 01 01 1 02 0 0 02 01 01 9 No. of Blood Banks 0 01 0 0 0 1 0 0 1 3 No. of CHCs IPH- 0 01 0 0 0 0 01 0 01 3 Standards No. of Blood Storage 0 01 0 0 0 1 0 0 0 2 Units No. of PHCs in the Block 2 06 1 09 02 07 03 4 11 45 No. of MOs in Positions 12 17 NA 09 05 14 NA 11 NA 68 No. of 24 hrs. PHCs 0 0 0 01 01 0 0 0 0 2 No. of MTP Centres 0 0 01 0 0 0 0 0 1 2 No. of Sub Health 8 17 14 16 06 19 14 17 23 134 Centres No. of ANMs in Position 9 30 16 22 08 30 11 27 25 178 No. of AYUSH 01 03 03 03 03 05 02 0 0 20 Dispensaries No. of Private Hospitals 0 0 01 0 0 04 0 01 0 6 No. of Beds in Govt. 10 42 30 70 4 18 10 10 70 264 Institutions No. of Beds in Pvt. 0 0 10 0 0 NA 0 NA 0 10 Institutions No. of Anganwari 74 137 96 175 72 119 58 184 122 1037 Centres Population covered 51500 69483 92240 112700 69708 129577 57675 135000 114735 832618

No. of SCs covering more than the norm 4 0 06 04 04 1 0 6 13 38 (5000/3000)

Govt. 0 01 0 0 0 0 0 0 1 No. of 0 Obstetricians Pvt. 0 0 0 0 0 0 0 0 0 0

Govt. 0 0 0 0 0 0 0 0 0 No. of 0 Gynaecologists Pvt. 0 0 0 0 0 0 0 0 0 0

Govt 0 0 0 0 0 0 0 0 0 No. of 0 Paediatricians Pvt. 0 0 0 0 0 0 0 0 0 0

Govt 01 01 01 0 0 0 0 0 3 No. of 0 Surgeons Pvt. 0 0 0 0 0 0 0 0 0 0

Govt 0 01 01 0 0 0 0 0 2 No. of 0 Anaesthetists Pvt. 0 0 0 0 0 0 0 0 0 0

Govt 0 0 0 0 0 0 0 0 0 No. of 0 Orthopaedists Pvt. 0 0 02 0 0 0 0 0 2 0

Govt 2 2 1 02 01 0 1 3 12 0 No. of Dentists

Pvt. 0 0 05 0 0 0 0 0 0 0

Govt 0 0 0 0 0 0 0 0 0 No. of Eye 0 Surgeons Pvt. 0 0 0 0 0 0 0 0 0 0

Govt 12 0 01 26 0 0 0 0 39 No. of Gen. 0 Physicians Pvt. 0 0 0 0 0 0 NA 0 10 0

Govt 0 0 01 0 0 0 0 0 1 No. of 0 Radiographers Pvt. NA 0 10 0 0 0 NA 0 10 NA No. Of Public Health 0 10 0 0 0 0 0 NA 0 10 Nurses No. Of Staff Nurses 0 07 0 06 0 05 04 NA 05 27 No. Of LHVs 0 0 02 02 NA 03 NA 01 0 8

No. Of Pharmacists 11 18 16 27 08 21 04 21 05 131

No. Of Lab. Technicians 1 2 4 0 03 06 02 05 0 23

No. X Ray Technicians 0 0 2 06 NA 03 01 03 01 16 No of Ophthalmic Assts. 01 01 01 02 0 0 0 01 01 7 No. Dental Mechanics/ 03 0 01 0 01 0 0 0 0 5 Hygienists No. of Male Health 0 0 04 01 0 0 0 0 0 5 Supervisors No. of ANMs 9 24 17 22 08 30 18 26 15 169 No. of Male Health 0 06 04 03 NA 10 2 0 01 26 Workers No. of AW Workers 74 137 96 175 72 150 199 184 118 1205 No. of UDCs 3 04 0 03 0 NA 0 0 03 13 No. of LDCs 2 04 0 0 0 NA 0 0 0 6 No. of Computer/Statistical 1 0 01 0 0 0 0 0 0 2 Assts. No. of Drivers 03 04 3 07 NA 05 NA 3 02 20 No. of ASHAs selected 58 62 89 100 80 116 60 113 86 764 No. of Trained Dais 20 20 49 20 30 40 30 09 20 238

Workforce Vacancy Position as per IPHS Table: 2 Identified Gaps of Manpower District- Budgam

Name of Blocks Khansahib Gap Total Total Khag Khag Nagam Nagam magam Budgam Budgam Soibugh Chadora Chadora Beerwah Chattergam Chattergam Chiarshrief No.of Exis Staff No.of Staff Exis No. 0f Req.Staff No. Req.Staff 0f IPHS No. of Sub- Norm 19 8 17 14 16 14 17 6 15 8 Centres (134)

ANM 2 20 10 18 14 16 15 22 5 10 13 268 125 143 N0. Of PHC's(45) 7 2 4 1 9 3 6 2 8 3 MO 2 -1 2 3 0 7 3 5 -4 11 2 90 62 28 Pharmacist 1 0 0 0 0 0 0 0 0 0 0 45 45 0 Nurse 3 18 4 3 0 22 3 18 4 22 9 135 32 103 Female Health 1 -2 0 3 0 9 3 0 0 8 1 45 23 22 Worker Health Educator 1 5 2 3 0 7 3 3 2 8 3 45 9 36 Health Assistant 2 9 3 6 2 18 6 12 3 14 6 90 11 79 Clerks 2 13 3 6 2 17 6 11 1 16 6 90 9 81 Lab. Technician 1 4 2 3 0 6 3 4 0 8 1 45 14 31 Driver _ 6 2 3 1 9 3 6 0 4 0 Class lV 4 9 6 5 2 14 5 7 1 19 1 180 111 69 10 11 Total 61 24 35 7 35 66 7 765 316 449 9 0 No. of CHC's (9) N N N A. CLINICAL 1 1 1 2 2 1 1 A A A MANPOWER General Surgeon 1 0 0 0 0 0 0 0 9 9 0 Physician 1 1 1 0 1 1 0 1 9 4 5 Obstetrician / 1 1 1 1 2 2 0 1 9 1 8 Gynaecologist Paediatrics 1 1 1 1 2 2 1 1 9 0 9 Anaesthetist 1 1 1 0 2 1 0 0 9 4 5 Public Health 1 1 1 1 2 2 1 0 9 1 8 Programme Mgr. Eye Surgeon 1 1 1 1 2 2 0 1 9 1 8 Other specialists

(if any) General duty

officers (M O) B. SUPPORT

MANPOWER Nursing Staff 7+2 Public Health 1 1 1 1 2 2 1 0 9 1 8

Nurse ANM 1 0 -2 0 0 1 0 -3 9 13 -4 Staff Nurse 7 5 7 4 14 7 0 -1 63 27 36 Nurse/Midwife Dresser 1 1 1 0 2 2 1 0 9 2 7 Pharmacist / 1 0 -1 -5 0 1 -1 -1 9 16 -7 compounder Lab. Technician 1 1 0 -1 2 0 0 -2 9 9 0 Radiographer 1 1 0 1 2 1 0 1 9 3 6 Ophthalmic 1 0 0 0 1 0 0 0 9 8 1 Assistant Ward boys / 2 -1 0 -6 2 2 0 -2 18 23 -5 nursing orderly Sweepers 3 1 0 -1 0 3 0 -5 27 29 -2 Chowkedar 1 1 0 1 2 1 0 -1 9 5 4 OPD Attendant 1 1 0 1 2 1 0 -1 9 5 4 Statistical 1 0 1 0 0 2 0 0 9 6 3 Assistant / DEO OT Attendant 1 1 1 1 1 1 0 0 9 4 5 Registration Clerk 1 1 0 0 2 0 0 0 9 6 3 Any other staff

(specify) Total 19 14 0 43 34 3 0 -11 279 177 102 Note: ( - ) Surplus staff

Table 2A Man power at District Doctors Para-Medicals Identified Identified Current Current Current Avail. Avail. Avail. Norm Norm Norm Gaps Gaps Gaps IPHS IPHS Personnel Personnel

75 to Hospital Superintendent 1 1 0 Staff Nurse* 0 75 100 Hospital worker (OP/ward Medical Specialist 3 1 2 20 15 5 +OT+ blood bank)

Surgery Specialists 2 2 0 Sanitary Worker 15 6 9 Ophthalmic Assistant / O&G specialist 4 1 3 1 1 0 Refractionist Social Worker / Psychiatrist 1 0 1 1 0 1 Counsellor Dermatologist / 1 0 1 Cytotechnician 1 0 1 Venereologist Paediatrician 2 0 2 ECG Technician 1 1 0 Anesthetist (Regular / 2 2 0 ECHO Technician 1 0 1 trained) ENT Surgeon 1 1 0 Audiometrician 0 0 Lab. Tech. ( Lab + Blood Opthalmologist 1 1 0 12 0 12 Bank) Orthopedician 1 1 0 Lab. Attendant (H W) 4 0 4 Radiologist 1 0 1 Dietician 1 0 1 Microbiologist 1 0 1 PFT Technician - 0 0 Casualty Doctors / 6 6 0 Maternity assistant (ANM) 6 1 5 General Duty Doctors Dental Surgeon 1 2 -1 Radiographer 2 0 2 Forensic Expert 1 0 1 Dark Room Assistant 1 0 1 Public Health Manager 1 1 0 1 Pharmacist 1 5 5 0 AYUSH Physician 2 2 0 2 Matron 1 0 1 Pathologists 2 1 1 Assistant Matron 2 0 2 Total 34 19 15 Physiotherapist 1 0 1 1 May be a P.H. Specialist or mgt. specialist Statistical Assistant 1 0 1 trained in public health 2 Provided there is no AYUSH hospital / Medical Records Officer / 1 0 1 dispensary in the district headquarter Technician * 1 Staff Nurse for every eight beds with 25% Electrician 1 1 0 reserve 1 One may be from AYUSH Plumber 1 1 0 Total 154 31 123

Administrative Staff Operation Theatre Identified Identified Current Identified Norm Norm Avail. Gaps Gaps IPHS Current Gaps Gaps IPHS Avail Personnel Staff Norm

Manager (Administration) - . - Junior Administrative 1 0 1 Staff Nurse 8 0 8 Officer Office Superintendent 1 0 1 OT Assistant 4 1 3 Assistant 2 0 2 Sweeper 3 1 2 Junior Assistant / Typist 2 0 2 Total 15 2 13 Accountant 2 0 2 Record Clerk 1 0 1 Office Assistant 1 0 1 Blood Bank / Blood Storage Identified

IPHS Current Avail. Computer Operator 1 0 1 Staff Gaps Norm Blood Driver 2 2 0 Bank Peon 2 0 2 Staff Nurse 3 1 2 Security Staff* 2 0 2 MNA / FNA 1 0 1 Total 17 2 15 Lab Technician 1 0 1 Note: Drivers post will be in the ratio of 1 Driver per 1 vehicle. Driver will not be Safai Karamchari 1 1 0 required if outsourced * The number would vary as per requirement Total 6 2 4 and to be outsourced.

Workforce Vacancy Position * Manpower analysis as per state approval Since Category Sanctioned In position Vacant When/Rem arks Medical Officers [Gen] 149 68 81 Specialists 8 6 2 No. of Public Health Nurses 10 Staff Nurses 68 27 41 Male Supervisor 22 5 18 Female Supervisor/LHV 16 8 8 ANMs 146 169 + 23 MHWs 97 26 71 No 0f Pharmacists 49 126 + 77 No. of Lab Techs 149 23 126 No. X Ray Technicians 24 16 8 No of Ophthalmic Assts. 10 7 3 No. Dentist 31 2 29 No. of UDCs 32 13 19 No. of LDCs 28 6 22 No. of Computer/ Statistical 2 8 10 Assts. No. of Drivers 34 27 7 Any other category 107

Status of Buildings in the District

Sub-Centres: Total 134

Sub Centres No. Percentage Overall Status No. of Sub-Centres 134 Sub-Centres in own building 31 24% But the condition of a building is very fair. Sub-Centre in Budget required Rented/Panchyat Building./ 103 76 % rented building. SC without Electricity Funds for electricity connection required 130 97 % SC without Water Supply 115 86 % Drinking water collected form near by houses SC without Toilets 134 100 % Budget required

Primary Health Centres: Total 45

No Name of PHC . 24 hour PHC Total No. of beds in RKS Staff beds use functionin quarter g 1 Arigam No 7 7 Yes 0 2 Dobipora No 3 3 Yes 0 3 Rayar No 6 6 Yes 0 4 Hardpanzoo Yes 6 6 Yes 0 5 Waerhail No 3 3 Yes 0 6 Kralnewa No 4 4 Yes 0 7 Shamasabad No 4 4 Yes 0 8 Kachwari No 3 3 Yes 0 9 Nuner No 3 3 Yes 0 10 Dadompora No 4 4 Yes 0 11 Bugam No 2 2 Yes 0 12 Sursyar No 3 3 Yes 0 13 Hanjora No 1 1 Yes 0 14 Ranger No 2 2 Yes 0 15 Sogam No 4 4 Yes 0 16 Hafroo No 5 5 Yes 0 17 Hayatpora No 2 2 Yes 0 18 Soibugh Yes 4 4 Yes 0 19 Wadwan No 2 2 Yes 0 20 Narbal No 4 4 Yes 0 21 Puhroo No 5 5 Yes 0 22 Lasjan No 2 2 Yes 0 23 Nowgam No 8 8 Yes 0 24 Chanpora No 5 5 Yes 0 25 Chariwari No 3 3 Yes 0

26 Dalwan No 2 2 Yes 0 27 Chalyan No 3 3 Yes 0 28 Rathson No 2 2 Yes 0 29 Aipanthan No 1 1 Yes 0 30 Chermujro No 4 4 Yes 0 31 Alpora No 4 4 Yes 0 32 Gondipora No 3 3 Yes 0 33 Utterpora No 3 3 Yes 0 34 Pathkoot No 3 3 Yes 0 35 Poshker No 3 3 Yes 0 36 Lassipora No 2 2 Yes 0 37 Khag No 5 5 Yes 0 38 Ompora No 3 3 Yes 0 39 N.U.Pora No 4 4 Yes 0 40 Parisabad No 5 5 Yes 0 41 Sholipora No 5 5 Yes 0 42 Ichgam No 5 5 Yes 0 43 Bemina No 4 4 Yes 0 44 Laloo No 2 2 Yes 0 45 Parisabad No 5 5 Yes 0

Block Primary Health Centre (BPHC)/CHC: 8

No Name of CHC . rate Bad Bad beds beds indoor partner Vehicle with NGO with NGO deliveries admission admission occupancy occupancy OPD cases Total no. of of Total no. of Total no. of Total no. Ambulance Ambulance Staff Staff quarter Up Up gradation Average no. of of Average no. 1 Chadoora 30 NA NA 100 % NA NA 2 0 0 2 Berwah 30 NA NA 100 % NA NA 1 0 0 3 Nagam (1) 30 NA NA 100 % NA NA 3 0 0 4 Magam (2) 30 NA NA 5 % NA NA 1 0 0 5 khansahib (1 ) 30 NA NA 5 % NA NA 1 0 0 6 Kremshare (1 ) 30 NA NA 10 % NA NA 1 0 0 7 Chrarsharif (1) 30 NA NA 40 % NA NA 3 0 0 8 Pakherpora (1) 30 NA NA 90 % NA NA 3 0 0

Number of Institutions requiring new buildings/addition/expansion/repair

N0. Institution Requiring new Requiring addition or Requiring repairs building expansion 1 PHCs 33 10 17 2 SCs 103 18 27 3 CHCs 0 7 9

Status of Staff Quarters attached to CHCs, PHCs and SCs in the District

No. of Size in No Sub Centres Condition SCs sq. mts. SHCs having 2 staff Qtrs. in addition 1 to clinic, examination and delivery 00 0 0 room area SHCs having 1 staff Qtr. in addition 2 to clinic, examination and delivery 00 0 0 room area 3 SHCs having no staff Quarters 134 0 0

Non-Governmental Organization [NGOs]

MNGO is not identified in the district so far. There is no partnership with NGOs.

2. PLANNING PROCESS

A decentralized participatory planning process has been adopted in development of this District Action Plan. To begin with bottom-up planning process, consultations were held with block stakeholder groups, Block /core Group members and village communities in all villages of each block of the District. Block Action Plans were developed based on the inputs gathered through village action plans prepared by Village Health, Water & Sanitation Committees. The health facilities in the block viz. SCs, PHC and, CHC were surveyed using the templates developed by Government of India. The inputs from this facility’ surveys were taken into account while developing the Block Action Plan.

The District Planning Team (DPT) provided technical oversight and strategic vision for the process of development of District Action Plan. The members of the DPT also contributed to select thematic areas such as RCH, Newer initiatives under NRHM, immunization etc. Assessment of overall situation of the district and development of broad framework for planning was done through a series of meetings of the District Planning Team.

This District Action Plan has been prepared through a long process of integration of Block Action Plans including Health Facility Surveys. Current status of the District Action Plan was presented and suggestions / feedback were taken in initial meeting. The membership, roles and responsibilities of District Core Group and the chapter wise contents were discussed. Based on the inputs received from the Blocks and discussions with stake holders, a draft of each chapter was developed. These were further improved upon through individual consultations with groups and nodal officers. Time schedule was prepared for all activities. A meeting was also planned to discuss each chapter in detail and approval there after

S. Criteria Indicator No. IMMUNIZATION No.of children <3 No. completely % of fully immunized COVERAGE years immunised children 1 < 3 YEAR OF 43178 29795 87% AGE No of women who got % of women getting ESSENTIAL Total no. of full antenatal care as antenatal care as 2 ANTENATAL pregnant women defined 2defined CARE 25267 12550 50% Total no of women % of pregnant women Total no. of INSTITUTIONAL who had institutional who had institutional 3 pregnant women DELIVERY delivery delivery. 15,883 6830 43% WEIGHING OF No. of newborn Percentage of Total no. of births NEWBORN WITH weighed within three newborn weighed 4 in the year IN THREE DAYS days within three days 7830 NA NA Percentage of BREASTFEEDIN No of newborns who Total no of births newborns who were G IN FIRST were breastfed in the 5 in the last year breastfed within an HOUR first hour hour NA NA NA REPORTING OF Approx no of blood BLOOD slides sent in last 3 Average time taken for reporting of blood slide 6 SLIDE months NA NA No. of hamlets with AVAILABILITY OF Total number of shop/person having % Villages 7 CHLOROQUINE villages unbroken supply of chloroquine last year NA NA NA No. of hamlets with shop AVAILABILITY Total number of / person having OF SPACING % of hamlets 8 villages unbroken supply of OCP METHODS + condoms last year

NA NA N.A No of target Total no. of couples No. who wanted to get ACCESS TO couples for with at least one of FP operation done last 9 STERILISATION sterilisation services them wanting FP year but could not SERVICES ( > 2 children operation: NA NA NA Number of hamlets FIRST DAY VISIT/ where ASHAs make CONSULTATION Total hamlets with % of functional ASHA 10 first day visits/or are OF ASHAs ASHAs hamlets consulted at least 50% IN 4 CONTEXTS of the time

NA NA NA PANCHAYAT No. of panchayat level health committee meetings held in the last 11 LEVEL HEALTH year COMMITTEE 0 % of hamlets with No. of hamlets with active women’s active women’s WOMEN HEALTH Total no. of committee that committee that 12 COMMITTEE villages discusses health and discusses health or developmental issues issues NA NA NA 13 STAGNANT No. of hand pumps No. of hand pumps % WATER without stagnant water NA NA 14 SAFE DRINKING Total no. of Total no. of Villages Percentage of villages WATER Villages using safe drinking using safe drinking water as defined water NA NA Na 15 USE OF Total no. of Total no. of families / Percentage of families DOMESTIC/ families / household where all where all members are COMMUNITY household members are using using domestic/ TOILET domestic / community community toilet toilet NA NA NA Total no. of Percentage of Actual very few are children eligible for Anganwadi 16 ANGANWADI .getting diet regularly anganwadi beneficiaries NA NA NA Total no. of schools Total no. of Percentage of schools MIDDAY MEAL giving cooked midday 17 primary schools giving midday meals meals 1255 1255 100% Total no. of BPL PDS No. of families getting Percentage of families eligible for 18 FUNCTIONING grains from PDS shop beneficiaries lower cost grains

NA NA Total no. of BPL No. of families getting ANTYODAYA Percentage of families eligible for free grains from PDS 19 YOJNA beneficiaries free grains shop

NA NA Total no. of No. of children in age Percentage of school children in 6-14 group not going to SCHOOL going children 20 age group school ENROLLMENT

NA NA NA Total no. of CHILD no. of children with gr I % of children children below 3 21 MALNUTRITION or above malnutrition** malnourished with wt record.

NA NA

Total no. of LOW BIRTH Total no. of babies with Percentage of babies newborn who were 22 WEIGHT LBW with LBW weighed last year

NA NA NA 100% - % of married Total no. of girls No. of girls married AGE OF women below 19 year 23 married last year below 19 year of age MARRIAGE of age NA NA SPACING Total number of No. of children born % of un spaced (April,06 to births last year with more than 36 second or third 24 Sept.06 which were months difference children born second or > child 2500 1250 15% INFANT DEATHS Total number of Any deaths of any % of infant deaths 25 (April –07) births last year child below one year 7830 390 5% Diarrhoeal Jaundice outbreaks Sum of water borne OUTBREAK OF outbreaks disease outbreaks 26 WATER BORNE

DISEASE 0

Health Facilities as per Norms for District Budgam:-

Block:-Magam Population :-82756 ( 92687 projected population for 2012) Health Recommended Required Existing New to be constructed Facility SC’s 1/3000 31 14 17 PHC’s 1/20000 05 01 04 CHC’s 1/80000 01 01 00 Block:-Khag Population :-54003 (60483 projected population for 2012) SC’s 1/3000 20 08 12 PHC’s 1/20000 03 03 00 CHC’s 1/80000 01 00 01 Block:- Beerwah Population :-71331 (79857 projected population for 2012) SC’s 1/3000 26 15 11 PHC’s 1/20000 04 08 00 CHC’s 1/80000 01 01 00 Block:- Nagam Population :-73556 (82383 projected population for 2012) SC’s 1/3000 27 08 19 PHC’s 1/20000 04 02 02 37

CHC’s 1/80000 01 01 00 Block:-Khanshaib Population :-106909 ( 119738 projected population for 2012) Health Recommended Required Existing New to be constructed Facility SC’s 1/3000 40 16 24 PHC’s 1/20000 06 09 00 CHC’s 1/80000 01 02 00 Block:-Chattergam Population :-84041 (94126 projected population for 2012) SC’s 1/3000 31 17 14 PHC’s 1/20000 04 04 00 CHC’s 1/80000 01 01 00 Block:-Budgam Population :-104121 ( 116615 projected population for 2012) SC’s 1/3000 39 19 19 PHC’s 1/20000 06 07 00 CHC’s 1/80000 DH 00 00 Block :- Soibugh Population :-56066 (62793 projected population for 2012) SC’s 1/3000 21 06 15 PHC’s 1/20000 03 02 01 CHC’s 1/80000 01 00 01 Block:Chadoora Population :-50024 ( 56027 projected population for 2012) SC’s 1/3000 19 17 02 PHC’s 1/20000 03 06 00 CHC’s 1/80000 01 01 00 Block :- Chararisherif Population :-39861 (44644 projected population for 2012) SC’s 1/3000 15 14 01 PHC’s 1/20000 02 04 00 CHC’s 1/80000 01 01 00

3. PRIORITIES AS PER BACKGROUND AND PLANNING PROCESS

National Rural Health Mission encompasses a wide range of health concerns including the determinants of the good health. Though there is a significant increase in resource allocation for the NRHM, there can never be adequate resources for all the health needs and all that needs to be done for ensuring good health of all the people. It is therefore necessary to prioritize the areas where appropriate emphasis needed. Based on the background and the planning process following are the overall priorities of Budgam District: 1. HMIS Monitoring & Evaluation: Availability of computerized data up to PHCs, facility for online data transmission and data validation is need of the hour. 2. Human Resources: There is a need for more staff in district. Vacant positions need to be filled up and more new staff positions need to be sanctioned and recruited. Residential quarters require to be constructed and incentives given to attract medical practitioners. 3. Capacity Building: All newly recruited staff requires to be trained. Existing staff needs refresher training regularly to both maintain and upgrade their skills. The existing staff and staff to be recruited in future need skill up gradation training to ensure that maternal and child health improves in the rural areas. Training need assessment needs to be carried out for all categories of staff against their job descriptions. Appropriate training programmes have to be developed and implemented in shortly. Such training must also include health education on alcohol addictions, drugs, harmful sexual practices, nutrition etc to be given to adolescents and children. Skills need to be developed in the staff to face the newer needs and challenges that are coming up in the district. 4. Family Planning: Improving the coverage for Spacing methods and NSV. 5. Demand Generation, IEC/BCC- Nutrition, Health & RCH Education to Adolescents and behavior Change in the resistant populations. 6. Procurement and Logistics: Construction of well planned Warehouse for storage drugs, medicines and equipments. 7. Adolescent Health: The focus is on provision of Adolescent Reproductive and Sexual Health education through schools and also awareness campaigns on good health practices, responsible family life, harmful effects of Alcoholism,

Based on the Village Health Action Plan following are the priorities of Budgam District:

Complete awareness on maternal health issues, provisions of Iron folic tablets, Calcium, Vitamin A at sub-centres have been recommended in the village plans. Also facilities for institutional delivery at sub-centres and transportation of the pregnant women for referrals have been suggested.

Vigorous awareness campaign has been suggested in the village plans and has been urged to be taken seriously. Guidance and counseling facility at sub centre, proper scrutiny of RTI/STI cases and awareness regarding AIDS and STD has been recommended in village level plans..

T.B is prevalent throughout the district. Therefore highly organized DOTS programme, random checking of sputum and blood samples among the vulnerable group anti- smoking campaign suggested.

Timely remuneration to mothers at delivery is essential. Proper monitoring of JSY funds has been recommended. Other issues like gender equity, IEC, capacity building, intersectoral convergence, untied funds to VWHSC have also been emphasized to be improved and properly applied.

4. GOALS

The District will strive to improve the availability of and access to quality health care services to people, especially residing in rural areas, the poor, & other marginalized sections including women and children. The proposed goals are following:

Goals INDICATOR Current 07-08 08-09 09-10 10-11 11-12 Reduction in Infant Mortality Rate (IMR) 49 44 40 36 33 30

Reduction Maternal Mortality Rate (MMR) 303 270 24096 205 175 150

Reduction in Birth Rate 24.5 24 23.5 22.5 22 21

Reduction in Total Fertility Rate 2.1 2.0 1.95 1.92 1.9 1.8

Reduction in Death Rate 7.3 7.2 7.1 7 6.5 6.0

Increase Proportion of Women 43.5% 44.5 % 45.5% 50% 55.5% 60% getting IFA tablets Increase Proportion of Women 82.7 % 84% 87% 90% 92% 95% getting 2 TT Injections Increase Institutional Deliveries ( Including 43.2 % 48% 52% 54% 58% 60% Deliveries in Pvt. Institutions) Increase Complete Immunisation of Children (12- 87% 89% 91% 93% 95% 96 % 23 month of age)

5. TECHNICAL COMPONENTS PART A: Reproductive and Child Health (RCH) II

A-1. Strengthening of District Health Management Situation • District Health Society constituted under the Chairmanship of the Deputy Analysis Commissioner • Regular meeting of District Health Society being held • Provisions for contractual appointments of various categories of staff have been made. • Societies for vertical Health Program have been integrated into single society at district level except Blindness Control Society, TB Control Society, District Malaria Society, and society for IDSP. These societies need functional integration and strengthening. Objective • District Health Society to be made functional and as per GOI guidelines Strategies • Vertical societies have been dissolved officially but functional integration is yet & Activities to take place. • The periodic orientation of personnel associated with functioning and management of society as per prescribed guide lines Activities 1. Developing systems for proper management, governance and functioning through: • Effective Planning – Annual, quarterly, monthly and as per needs • Supervision mechanisms • Convergence systems • Procedures, • Reporting systems, • Regularity of meetings, • Agenda of meetings, Maintaining minutes and its timely circulation • Decentralization, • Delegation of decision-making power • Rational decision making 2. Orientation Workshop of the members of the District health Mission and society. 3. Issue based orientation in the monthly Review and Planning meetings as per needs. 4. Ensuring provision of Technical Assistance at the district and block levels and their ongoing capacity building. 5. Exposure visits of members of the District health Society in two states 6. Improving the Review and planning meetings through a holistic review of all the programmes under NRHM and proper planning. 7. Formation of a monitoring Committee from all departments. 8. Development of a Checklist for the Monitoring Committee. 9. Arrangements for travel of the Monitoring Committee 10. Sharing of the findings of the committee during the Field visits in each Review Meeting with follow-up of the recommendations. 11. Vehicles for DHMU &CMO & contractual appointment of two drivers Support • Technical assistance needs to be imparted for orientation and integration of required societies. Timeline Activity Plan 2008-09 2009-10 2010-11 2011-12 Developing systems x x x x

Orientation Workshop of the members x x x x Issue based orientation x x x x Ensuring provision of Technical Assistance at the district, block level. x x Exposure visits of DHS members Formation of a monitoring Committee from all departments. Development of a Checklist for the Monitoring Committee. Two vehicles for DHMU &

CMO Budget Activity / Item 2008-09 2009-10 2010-11 2011-12 Total ( In Lacs) Orientation Workshop 0.55 0.605 0.666 0.732 2.553 Exposure visit 3.1 3.41 0.000 0.000 6.51 Issues based Workshops 0.55 0.605 0.666 0.732 2.553 Mobility for Monitoring 1.32 1.452 1.597 1.757 6.126 Vehicle @ 5.lac * 2 10.00 0.00 0.00 0.00 10.00 POL for 2 vehicles @ 1.00 1.00 1.00 1.00 4.00 50000/ per vehicle/ year Salary for 2 drivers @ 0.96 0.96 0.96 0.96 3.84 4000/M Salary of 1 Peon @ 0.48 0.48 0.48 0.48 40000 / M Total 17.48 8.032 4.889 5.181 35.582

Detailed Calculations

# Description Amount Exposure Visit 1 Airfare and travel expenses (Taxi, Bus, etc ;) 200000/- 2 Lodging, Boarding, Food 100000/- 3 Misc. 10000/- Total 3,10,000/-

A- 2 District Programme Management Unit Status In NRHM a large number of activities have been introduced with very definite outcomes. The cornerstone for smooth and successful implementation of NRHM depends on the management capacity of District Programme officials. District programme management unit will be operational very soon.

In order to strengthen the district PMU, three skilled personnel i.e. Programme Manager, Accounts Manager and Data Assistant have being provided in each district. These personnel are there for providing the basic support for programme implementation and monitoring at district level.

There is a need for providing more support to the CMO office for better implementation especially in light of the increased volume of work in NRHM, monitoring and reporting especially in the areas of Maternal and Child Health, Civil works, Behavior change and accounting right from the level of the Sub centre. Objectives To make District Programme Management Unit functional and strengthened. Strategies 1. Support to the CMO for proper implementation of NRHM. 2. Capacity building of the personnel Development of total clarity at the district and the block levels amongst all the district officials and Consultants about all activities 3. Provision of infrastructure for the personnel 4. Training of district officials and MOs for management 5. Use of management principles for implementation of District NRHM 6. Streamlining Financial management 7. Strengthening the CMO office 8. Strengthening the Block Management Units 9. Convergence of various sectors Activities 1. Support to the CMO for proper implementation of NRHM through involvement of more consultants for support in data analysis, trends, timely reports and preparation of documents for the day-to-day implementation of the district plans so that the CMO and the other district officers: • Finalizing the TOR and the selection process • Advertisements for Management unit team members and consultants, one each for Maternal Health, Civil Works, Child health, and Behaviour change. If properly qualified and experienced persons are not available then District Facilitators to be hired which may be retired persons. • Selection of the DPMU/BPMU staff and consultants. • Provision of dealing assistant NRHM in DHS chairman office for better coordination between Chairman, Management Units and other allied departments of DHS. 2. Capacity building of the personnel • Joint Orientation of the District officers and the consultants • Induction training of the DPM and consultants • Training on Management of NRHM for all the officials • Review meetings of the District Management Unit to be used for orientation of the consultants. 3. Development of total clarity in the Orientation Workshops and review meetings at the district and the block levels amongst all the district officials and Consultants about the set of activities:

4. Provision of infrastructure for officers , DPM, DAM, DDM and the consultants of the District Project Management Unit and Provision of office space with furniture and computer facilities, photocopy machine, printer, Mobile phones, digital camera, fax etc.

5. Use of Management principles for implementation of District NRHM • Development of a detailed Operational manual for implementation of the NRHM activities in the first month of approval of the District Action Plan including the responsibilities, review mechanisms, monitoring, reporting and the time frame. This will be developed in participatory consultative workshops at the district level and block levels. • Financial management training of the officials and the Accounts persons • Provision of Rs. 500,000 as untied funds at the district level under the jurisdiction of the CMO. • Compendium of Government orders for the DC, CMO, district officers, hospital, CHCs, PHCs and the Sub centres need to be taken out every 6 months. Initially all the relevant documents and guidelines will be compiled for the last two years.

6. Strengthening the Block Management Unit : The Block Management units need to be established and strengthened through the provision of : • Block Programme Managers (BPM), Block Accounts Managers (BAM) and Block Data Assistants (BDA) for each block. These will be hired on contract. For the post of BPM and the BAM retired persons may also be considered. • Office setup will be given to these persons • Accountants on contract for each PHC since under NRHM Sub centres have received Rs 10,000 also the village committees will get Rs 10,000 each, besides the funds for the PHC. • Provision of Computer system, printer, Digital Camera with date and time, furniture.

7. Convergence of various sectors at district level • Provision of Convergence fund for workshops, meetings, joint outreach and monitoring with each CMO. 8. Monitoring the Physical and Financial progress by the officials as well as independent agencies. 9. Yearly Auditing of accounts Support 1. State should ensure delegation of powers and effective decentralization. required 2. State to provide support in training for the officials and consultants. 3. State level review of the DPMU on a regular basis. 4. Development of clear-cut guidelines for the roles of the DPMs, DAM and District Data Manager. 5. Developing the capacities of the CMOs and other district officials to utilize the capacities of the DPM, DAM and DDA fully. 6. Each of the state officers Incharges of each of the programmes should develop total clarity by attending the Orientation workshops and review meetings at the district and the block levels for all activities. 7. If qualified persons for the posts of DPM, DAM are not available then State should allow the appointment of facilitators or Coordinators or retired qualified 45

persons by the District Health Society. Time 2008 2009- 2010- 2011-12 Activity / Item Frame -09 10 11 Establishment of DPMU and Consultants x x x x Infrastructure, furniture, computer systems, x fax, UPS, Printer, Digital Camera Workshops for development of the x x x x operational Manual at district and Block levels Compendium of Govt orders x x x x Joint Orientation of Officials and DPM, x x x x DAM, DDM Management training workshop of Officials Establishment of BPMU x Training of DPM and Consultants x x x x Review meetings x x x x Computer systems with printer and Digital x Camera & furniture for DPMU, BPMUs, District, block personnel Monitoring of the progress x x x x Budget (In Lakhs) 2008- 2009- Total Activity / Item 2010-11 2011-12 09 10 Honorarium DPM,DAM,DDA 32.34 35.57 39.13 43.04 150.08 and Consultants Travel Costs for DPMU @ Rs 1.32 1.452 1.597 1.757 6.1260 10,000/ per month x 12 mths Infrastructure costs, furniture, computer systems, fax, UPS, 5.00 0.000 0.000 0.000 5.000 Printer, Digital Camera, Telephone. Workshops for development of the operational Manual at 1.10 1.21 1.33 1.46 5.1000 district and Block levels Untied Fund 6.00 7.000 8.000 9.000 30 Compendium of Govt orders 0.550 0.605 0.666 0.732 2.553 Joint Orientation of Officials and DPM, DAM, DDM 0.275 0.303 0.333 0.366 1.277 Management training 0.55 0.605 0.666 0.732 2.553 workshop of Officials Personnel for BPMU 72.60 79.86 87.846 96.6306 336.9366 Training of DPM and 0.75 1.000 1.250 1.500 4.500 Consultants Review meetings @ Rs 1000/ 0.132 0.145 0.160 0.176 0.613 per month x 12 months Office Expenses @ Rs 10,000/month x 12 months for 1.3 1.5 1.6 1.8 6.200 DPMU Computer systems (12) with 7.20 0.000 0.000 0.000 7.20

printer and Digital Camera and furniture for DPMU, BPMUs and District and block personnel Annual Maintenance Contract 0.594 0.653 0.719 0.791 2.757 for the equipment Travel costs for BPMU 24.00 26.4 29.04 31.944 111.384 Monitoring of the progress by independent agencies 1.100 1.210 1.331 1.464 5.105 Office expenses for Blocks @ Rs 5000 x 10 blocks 6.00 6.6 7.26 7.986 27.846

Total 160.8 164.11 180.928 199.3786 705.2306

Detailed calculation for Personnel at DPMU for one year S.No Details Units Unit Cost Amount for 12 months Personnel at District level District Programme manager 1 18000 216000 District Accounts Manager 1 15000 180000 District Data Assistant 1 12000 144000 Consultant for Maternal Health 1 40000 480000 Consultant for Child Health 1 40000 480000 Consultant for Civil Works 1 40000 480000 Consultant for HMIS 1 40000 480000 Consultant for Behaviour Change 1 40000 480000 Sub Total 2940000 Personnel at Block level Block Programme manager 10 15000 1800000 Block Accounts Manager 10 12000 1440000 Block Data Assistant 10 10000 1200000 Part Time Accountant at PHC 47 5000 2820000 Sub Total 7260000

Hiring of vehicles at block level @ Rs 10 20000 2400000 2000 x 10days /mth x10 blocks x 12 mths Office Automation with Furniture, 10 for 60,000 720000 Computer system, Camera, Printer, BPMU etc 1 for DPM 1 for DAM

A-3. MATERNAL HEALTH Situation Indicator No. Analysis/ Maternal Deaths (April to Sept. NA Current 06 ) Status Pregnant women who delivered No. % 15883 Full ANC coverage 12550 50% Institutional Deliveries 6830 43% Home deliveries 5475 Skilled Unskilled Deliveries by skilled birth % % attendants 67% 33% Objectives/ To reduce the MMR Milestones/ To increase ANC coverage to 100% in 5 years Benchmark To increase institutional delivery to 75 per cent in 5 years s To reduce anemia to less than 20 per cent in five years. To elicit awareness among people about mother and child day Strategies To promote institutional deliveries at the village level through delivery huts. IEC & Activities campaign for quality and comprehensive services. Construction of Sub centres and PHCs wherever required.24 hours deliveries in all the PHCs in 5 years Improve quality of services for institutional deliveries in the PHCs. To increase awareness among mothers and communities about the importance of institutional deliveries. AWWs with the sub centre ANMs will build awareness on importance of birth preparedness and institutional deliveries integrate the cash assistant with antenatal care during the pregnancy period, institutional care during delivery and immediate post-partum period in a health centre by establishing a system of co-ordinated care by field level health worker.. Support IEC activities required Registration of babies – control of population Timeline Activity Plan 2009- 2008-09 2010-11 2011-12 10 Construction of Delivery X x - - Huts Printing of Referral Cards x x x x Supply of Mobile phones X - - - Mothers’ Meetings x x x x Budget-in Activity / Item 2009- 2008-09 2010-11 2011-12 Total Lacs 10 Budget Delivery Huts @ Rs 1 lakhs 9.00 18.00 0.0 0.0 27.00 /hut x 3/Block JSY 2 %OF TPX1400 233.13 233.13 233.13 233.13 932.52 (16652X1400) Ref. Transport- 10%of2.5%pop.x300- 6.25 6.25 6.25 6.25 25.00 (2082x300) Referral Cards @ Rs 2 per 0.10 0.10 0.10 0.10 0.400 card x 2082 Mother’s meeting-No. of villages @ Rs. 500 / meeting 37.32 37.32 37.32 37.32 149.28 /month- (622x500x12) 48

Mobile phone instrument @ 2.68 0.0 0.0 0.0 2.68 Rs 2000/SC (1 ANM) Mobile Phones recurring cost to ANMs @ Rs 2400 x 3.216 3.216 3.216 3.216 12.864 SC(I ANM) Mobile phone instrument @ 0 2.68 0 0 2.68 Rs 2000/SC (1 ANM) X 134 Mobile Phones recurring cost to ANMs @ Rs 2400 x 0 5.76 6.336 6.9696 19.0656 SC(I ANM) X 134 Total 286.985 1171.48 291.696 306.456 286.352 6 96

A-4. NEWBORN & CHILD HEALTH Situation Indicator Total No. Analysis/ Live Births 7830 Current Status Neonatal Deaths 257 Infant Deaths 390 Still birth in the last year Low birth weight newborns (less than NA 2.5 kgs.) Child Vaccination: completed ( 12-23 87% months age ) Objectives/ • To reduce IMR from existing 49 to 30 in 5 years Milestones/ • To reduce the prevalence of anaemia from 50% to 45 Benchmark • To ensure functioning of 24 X 7 facility in PHCs. s • 95 % children completely vaccinated • Promote exclusive breast-feeding to increase up to 60% • To provide 5 doses of Vitamin A to all children under 3 years • Incidence of LBW/pre maturity to be reduced to 20% Strategies Training of doctors and ANMs. & Activities FRUs Operationalisation, increase in institutional delivery ,ORT Depots in villages or with ASHAs or AWWs etc Support 1. Promote early and exclusive breastfeeding up to 6 months of age and required complementary feeding thereafter 2. Integrated management of neonatal and childhood illnesses (IMNCI) • IMNCI training will be carried out for the health workers • Assess the FRUs with reference to IPHS developed by GOI and identify the gaps • Provide necessary instruments and equipment needed to ensure CEmOC • Training of MO in CEmOC, newborn care and lifesaving saving anesthesia skills as per the models developed per GOI. Also resuscitation skills. • Blood storage facilities will be operationalized in all 6 FRUs to be proposed (only district hospital working as FRUs) by 2007 • Transport facility for referrals will be provided to all health facilities for bringing the patients to FRUs. • Nursery set-up is required at all the GADs • Training neonatal nurses (one month at medical college) 3. Promote birth spacing Timeline Activity Plan 2008- 2009- 2010- 2011-

09 10 11 12 Furnishing of Newborn X X - - Corner Providing Malnutrition Corner x X - - in CHCs Procurement- x - - - Foetoscope/Weighing Machine

Budget-In 2008- 2009- 2010- 2011- Activity / Item Total Lacs 09 10 11 12 Budget Newborn Corner furnished with equipment @ Rs 1.40 12.6 2.8 0.0 0.0 15.4 lakh per CHC & 2 new CHCs Foetoscope @ Rs.50 x 1137 0.57 0.0 0.0 0.0 0.57 AWCs Infant Weighing Machines @ 9.01 0.0 0.0 0.0 9.01 Rs. 800 x 1137 AWCs Malnutrition Corners @ Rs 30,000 per CHC x 9 CHCs & 2.70 0.60 0.0 0.0 3.30 2 new CHCs Total 24.88 3.4 0.0 0.0 28.28

A-5. FAMILY PLANNING Situation Indicators No. Analysis/ Eligible women 1,23.594 Current Couple Protection Rate NA Status Female Sterilization operations during 660 last year Vasectomies during the last year 25 NSV operation 69 IUD inserted 1616 Couples using temporary method NA Objectives Goal: To reduce the TFR to 1.9 % by 2010 To increase percentage of vasectomy Objectives: 1. To improve male participation from 12 % to 25 % in next 5 years 2. To eliminate unmet need in family planning by 2010 3. To increase the number of graduate doctors performing family planning operations 4 To improve the sex ratio (0-6) from 839 to 927 in next 5 years Strategies Promote birth spacing & Activities 1. Counseling of newly married couples on importance of birth spacing 2. IEC campaign on importance of birth spacing 3. Enhance availability and access to birth spacing contraceptive methods through social marketing Improve access to family planning services 4. Skilled development training for the graduate doctors in conducting family planning operations among both sexes. 5. Increase sterilization facilities in all PHCs. 6. Improve the availability of spacing methods in villages through all possible deport holder. 7. Training o doctor in sterilization, MTP and counseling. 8. Training of Health workers, ASHAs and AWW in FP- counseling Support Improvement of quality of services required Introduction of the concept of quality care in family planning programmes Timeline Activity Plan 2008- 2009- 2010- 2011- 09 10 11 12 Training of MOs & Specialists 18 - - - MOs NSV x - - - Equipment/Laparoscopes Upgradation of static centers x - - - Procurement of Copper T/ EC x x x x Pills Budget Activity / Item 2008- 2009- 2010- 2011- Total ( In Lacs) 09 10 11 12 Training of MOs & Specialists in NSV @ Rs 7500 x 2 1.5 0 0 0 1.5 persons/Block NSV camps @ Rs. 359750 x 95.7654 71.95 79.145 87.0595 333.92 2 camps/ Block 5

Sterilization Camps @ 436 X 4.36 4.796 5.2756 5.80316 20.23476 1000 cases Copper T-380 @ Rs 45 / 4.5 4.95 5.445 5.9895 20.8845 piece x 10000 users Emergency Contraception @ 1 1.1 1.21 1.331 4.641 Rs 10 per 2 tabs x 10000 Development of Static Centres @ Rs 1 lakh x 9 9 2.0 0 0 11.00 CHCs & 02 new CHCs NSV Equipment @ Rs 800 x 0.072 0.016 0 0 0.088 9 CHC & 02 new CHCs Laparoscopes for 9 CHC @ Rs 3.00 lakhs x 9 CHCs & 27.00 6.0 0 0 33.00 02 new CHCs NSV Incentives- 100 cases /block @1000per case x 10 10 11 12.1 13.31 46.41 blocks Total 129.38 109.00 111.090 122.199 471.6783 2 7 1 1

Requirements for organizing one camp (600 cases)

S. No Head Unit Unit Cost Amount 1. District Workshop 1 4000 2. Block workshops 4 7500 30000 3. TA/DA for NSV surgeons 5 2000 10000 4. IEC activities 93250 5. TA to Acceptor for Semen Analysis 600 50 30000 6. Payment to NSV Advocate/motivator and 600 327.5 196500 Drugs & Dressings Total 359750

Budget for sterilization per case

S. No Head Unit Cost 1. Payment to acceptor 198 2. Mobilization/Transport cost 50 3. Payment to Service Provider 50 4. Payment to IEC advocate/Motivator 35 5. Payment to Assistant/OT Nurse etc; 10 6. Drugs and Dressing 93.5 7. Total 436.5

A - 6. ADOLESCENT HEALTH Situation • Adolescence have unmet needs regarding nutrition, reproductive health, mental Analysis/ health and require appropriate counseling • Teenage pregnancies also emerging as a problem • Unsafe abortion & premarital sex trend is on rise. Objectives • To reduce high risk taking Behaviour including unsafe sex, alcohol, substance abuse and teenage pregnancy among adolescents. • To reduce prevalence of anaemia among adolescent girls from 43.4% to less then 20% by 2010. • To improve the awareness of the importance of spacing methods Strategies • Start programme on adolescent health – to deal with common stresses (Career, & physical body change, hormone changes), depression, nutritional disorders Activities including anaemia and obesity • School based programmes. • Separate team for school health • Specialists for school adolescence health • Opening of counseling centres for adolescents. Support 1. Manpower: team of psychologist, counselor, psychiatrist, pediatrician (one day per required week) Resources: 2. Room/ space required in existing health facility buildings 3 School health programme Timeline Activity Plan 2008- 2010- 2011- 2009-10 09 11 12 Research x - - - Joint evaluation by independent - x - - agency Awareness Generation Camps - x - - Healthcare Check up camps x x x x Mental Health Camps x - - - Budget Activity / Item 2008- 2010- 2011- 2009-10 Total (in Lacs) 09 11 12 Research 5.00 0.0 0.0 0.0 5.00 Mental health camps for Adolescents twice in a year/PHC 4.2 0.0 0.0 0.0 4.20 @ 5000 per camp Joint Evaluation after one year by independent agency and 0.0 0.5 0.0 0.0 0.50 Govt Awareness generation @ Rs 0.0 6.22 0.0 0.0 6.22 1000 per village Heath care checkups / Camps 2 camps per block @ 15000 / 3.00 3.3 3.63 3.993 13.923 camp- 2X10X15000 Psychiatrist-1 visit

per week @1000/ visit 0.52 0.54 0.59 0.61 2.26 Psychologist- 1 visit per week (1X52X1000) @1000/visit 0.52 0.54 0.59 0.61 2.26 (1X52X1000)

Counselor- 1 visit per week @1000/ visit 0.52 0.54 0.59 0.61 2.26 (1X52X1000) Traveling allowance No. of visits 3.5271 12.2986 of Psy.Syc.&coun.@ 500/visit - 2.65 2.915 3.2065 5 5 (53X10X500) 9.3501 48.9216 Total 16.41 14.555 8.6065 5 5

PART B: New NRHM Initiatives

B-1. ASHA – Accredited Social Health Activist Situation • 800 ASHA’s have been selected so far and trained in module first and yet to be Analysis/ trained for module second. Status • All 800 ASHA’s are working and mobilize people for health care, immunization and institutional deliveries. Objectives • Generate demand and to communicate to the public in their own language and / rightly through ASHA’s. • To extend the limit of health volunteers to people living in hilly and villages without transport facility. • To increase the prospectus for immunization and institutional deliveries. • To educate people to maximum about health services and their benefits. Strategies • To engage ASHA’s more so as to cater the population living in hilly areas. & • To boost appraisal system among health volunteers i.e., ASHA’s. Activities • To set targets and reward system Support • Fund to be released in time. required • Training of ASHA’s with new trends

Timeline Activity Plan 2008 2009- 2010- 2011- -09 10 11 12 Training of ASHAs 500 332 - - ASHA ASHA Supply of Drug Kits x x x x Budget Activity / Item 2008- 2009- 2010- 2011- Total (in lacs) 09 10 11 12 Incentive to ASHA under JSY 2 % of total population @ Rs. 99.91 99.91 99.91 99.91 399.64 600 (16652 cases X Rs.600) ASHAs to be DOTS provider-No. of ASHAs @ Rs. 500 Pop /1000 4.16 4.16 4.16 4.16 16.64 X 500 (832X500) Training of ASHAs- No. of ASHAs @ 10000/ASHAS- 49.92 33.28 - - 83.2 (832X10000)(60:40) Drug Kit support TA No. of ASHAs @ 8700/kit per year 72.38 72.38 72.38 72.38 289.52 832X8700 Total 226.37 209.73 176.45 176.45 789

B-2. Provision of Untied Funds at Sub Centres Situation Out of 134 Sc’s only 131 Sc’s have been received funds and for all 131 Sc’s Analysis/ VHWSC has been formed .An amount of Rs. 10000 were paid to every SC in last financial year. Objectives To provide better quality health care. / To increase the mother as well as child care. To have basic medical facilities available at SC level. Strategies • To have Govt. SC buildings. & • Improve the infrastructure, repair the old buildings and construct new ones Activities also. • Quarter facility for ANM’s. • To provide electricity, water supply, toilets, Medicines, equipments to Sc’s. • Provision of availability of referral transport and communication with Block Headquarters. Support • Funds to be released in good amount and in time. required • Smooth medical supply. • Communication facility. Timeline Activity Plan 2008-09 2009-10 2010-11 2011-12

Annual Maintenance grants x x x x

Repairs of Sub centre x - - - buildings Release of Untied Fund x x x x Release of funds to New - - - x Sub centres Budget Activity / Item 2008-09 2009-10 2010-11 2011-12 Total ( In Lacs) Untied funds @ Rs.10000 x 13.4 13.4 13.4 13.4 53.60 134 Annual Maintenance grants @ 20000/SCs 26.8 26.8 26.8 26.8 107.20

Non – Repair works -No. of Govt. recurring SCs in bad condition X 10 % 6.00 0 0 0 6.00 of building cost 15 X10% of 400000 Untied Fund for new 134 0 13.4 13.4 13.4 40.20 SC’s @ Rs. 10000 Annual Maintenance grants 0 26.8 26.8 26.8 80.40 @ 20000/SCs Total 46.20 80.40 80.40 80.40 287.40

B-3. Provision of Untied Funds at PHCs Situation • Out of 43PHC’s 43 PHC’s have been registered under RKS and their joint Bank Analysis Accounts have been opened and funds have been released to all PHC’s under RKS. • The registration documents for another 3 unregistered PHC’s are in process. • Objectives • To improve the facilities to patients as well as Medical Staff. • To attract more and more institutional deliveries and provide best care for them i.e., mother as well as child. • Strategies • To utilize the funds to optimum level to attain the remarkable results. & • To correct any loopholes in repairment, medicines etc by use of untied funds. Activities Support • Funds will be provided in time and in optimum proportion required • To expand the means of utilization of untied funds. Timeline Activity Plan 2008-09 2009-10 2010-11 2011-12

Supply of Account Books x x x x Training on use of Account x x x x books Repairs of PHC buildings x - - - Release of Untied Fund x x x x Release of funds to New - - - x PHCs Annual Maintenance grants x x x x Budget Activity / Item 2008-09 2009-10 2010-11 2011-12 Total (In Lacs) Untied Funds No. of 11.25 11.25 11.25 11.25 45.00 PHC@25000 Acc. Books No. of PHC’s @ 0.90 0.92 0.94 0.96 3.72 2000 (45x2000) Training on use of Account book No. of PHC 45 @ Rs. 0.90 0.9 0.9 0.9 3.60 2000 (45X2000) Repair works- No. of PHC (govt building) in bad 24.00 0 0 0 24.00 condition @ 10%of Building cost (16x1500000) Untied funds for 07 new 0 1.75 1.75 1.750 5.25 PHC’s from 2010 Annual Maintenance grants 22.5 22.5 22.5 22.50 90.00 50000 / PHC Annual Maintenance 07 PHCs grants 50000/ for 0 3.50 3.50 3.50 10.50 new PHC from 2010

182.0 59.55 40.82 40.84 40.86 Total 7

B-4. Provision of Untied Funds at CHCs Situation • 9 CHC’s have been registered under RKS Analysis • Untied funds have been received under untied funds for CHC’s . Objectives/ • To improve infrastructure, basic facilities in CHC’s. • To increase institutional deliveries. • To reduce the minor obstacles faced by doctors by providing them equipments, medicines, accommodation etc easily Strategies & • To utilize the fund for procurement of medicine, equipments, and necessary Activities infrastructure. • To utilize funds to optimum level. Support • Budget / funds smoothly and in time. required • Releasing of funds on surveying / feedback basis. Timeline Activity Plan 2009- 2010- 2011- 2008-09 10 11 12 Supply of Account Books x x x x Training on use of Account x x x x books Repairs of CHC buildings x - - - Release of Untied Fund to x x x x DH/ CHCs Preparation of reference x - - - manual Budget Activity / Item 2009- 2010- 2011- 2008-09 Total 10 11 12 Untied funds No. of CHCs 4.5 4.5 4.5 4.5 18.00 @ 50000 Account Books-No. of 0.45 0.47 0.49 0.51 1.92 CHCs@(5000)9 x 5000 Training on use of these acc. Books 0.18 0.18 0.18 0.18 0.72 No. of CHC @2000 (9x2000) Annual Maintenance grant 5 5 5 5 20.00 of Rs 500000/ DH Non- Preparation of reference 0.15 0 0 0 0.15 Recurring manual @15000/Distrct Repair work No. of CHC @10% of building cost 36.00 0 0 0 36.00 (9x400000) Annual Maintenance grant 9.0 9.0 9.0 9.00 36.00 of Rs 100000/ CHC Untied funds for new 02 0 1.0 1.00 1.00 3.00 CHCs @ 50000 Annual Maintenance grant of Rs 100000/ CHC * 02 0 2.00 2.0 2.00 6.00 new CHCs Total 55.28 22.15 22.17 22.19 121.79

B- 5. Mobile Medical Units Situation • No Mobile Medical Unit is available in the District. Analysis/ Objectives • To visit or render services of medical staff in far flung areas which cannot access hospital often. • To take specialists to the areas where they could never go and perform their duty, attend the patients due to lack of posts/ hospital infrastructure in those areas. Strategies & • 9 MMU’s to be procured for 9 Medical Blocks of the District Activities • The posts shall be sanction for these MMU’s. Support • The funds shall be released to procure / purchase these MMU’s. required • Staff for these MMU’s . Timeline Activity Plan 2009- 2010- 2011- 2008-09 10 11 12 Procurement of MMU x - - - Recruitment of Pharmacist, LHV, x - - - Driver etc Organizing Mobile Medical x x x x Camps Budget Activity / Item 2008- 2009- 2010- 2011- Total ( in Lacs) 09 10 11 12 MMU @ 26.85 lac 26.85 0.00 0.00 0.00 26.85 Manpower MO- 2 @ 25000x12 6.00 6.00 6.00 6.00 24.00 Pharmacist -1 @ Rs. 6000x12 0.72 0.72 0.72 0.72 2.88 LHV – 1 @ Rs.8000 x 12 0.96 0.96 0.96 0.96 3.84 Councillor-1 @Rs.10000 x 12 1.20 1.20 1.20 1.20 4.80 Driver -1 1@ Rs. 4000 x 12 0.48 0.48 0.48 0.48 1.92 Lab technician1@ Rs.5000x 12 0.60 0.60 0.60 0.60 2.40 Mobile Medical Camps- 25 camp /block @ Rs. 6000 /camp x 25 x 15.0 15.0 15.0 15.0 60.00 10 (25x10x6000) POL @ Rs. 500/visit x 250 1.25 1.28 1.31 1.34 5.18 Maintenance@ Rs.20000/year 0.20 0.20 0.20 0.20 0.8 Total 53.26 26.44 26.47 26.5 132.67

B – 6. Upgrading CHCs to IPHS Situation • Four CHC’s have been recommended for Upgradation to IPHS , but the Analysis/ infrastructure , Staff and other necessary facilities are not available in them ( as directed by IPHS). Objectives • To have infrastructure, medical staff and facilities as per guaranteed by IPHS. • To upgrade all CHC’s (8) to IPHS. • To have staff quarters, medical equipments, Ambulances, doctors, OPD facilities up to norm. Strategies & • To provide friendly environment to patients. Activities • To have three more CHC’s in the District. • To have equipments of FRU’s as per IPHS standards and all specialist medical staff shall have training to operate all those equipments. • MO’s to be trained for basic needs. • Specialists MO’s ( at least 7 ) required. • Residences for every hospital employee • Mobile phones and vehicles for doctors needed in emergency and living outside hospital • One general OPD is a must • Separate wing for civil, electrical and public health Support • Funds and resource of Staff. required • Rest more and more powers in the hands of CMO. Timeline Activity Plan 2008- 2009-10 2010-11 2011-12 09 Renovation of buildings X x x - Recruitment of manpower x - - - Procurement of furniture/ x- - - - computer etc Budget Activity 2008- 2009-10 2010-11 2011-12 Total 09 Renovation of Dist. 50.00 0.0 0.0 0.0 50.00 Hospital @ Rs.50 lac Staff quarters for Dist. 27.2 27.2 0.0 0.0 54.4 Hospital Construction of 02 new CHCs @ 40.0 lacs (Rs. 40.0 40.0 0.0 0.0 80.00 1000 / sft. 4000 sft. / CHC) Staff Quarter for MO @ Rs. 48.00lac x 9 CHCs & 02 264.00 264.00 0.0 0.0 528.00 new CHCs ( RS. 1000 / sft.) Staff Quarter for staff nurses @ Rs. 40 lac x 9 220.00 220.00 0.0 0.0 440.00 CHCs & 02 new CHCs (RS. 1000 / sft.) S.Q for chowkedar @ Rs.4.00 lac x 9 CHCs 7 02 22.00 22.00 0.0 0.0 44.00 new CHCs (RS. 1000 / sft.)

Furniture- 5%of CHC building Cost-% available – 9.36 4.0 0.0 0.0 13.36 2.00-48% x 9 CHCs & 02 new CHCs Computer/ printer/fax@ Rs. 50000 x 9 CHCS & 02 4.50 1.0 0.0 0.0 5.50 new CHCs Mechanical laundry @ Rs. 50000 x 9 CHCs & 02 new 4.50 1.0 0.0 0.0 5.50 CHCs (50000X9) Traveling allowance- @ 75 / day X 24 visits / mon.X 1.94 2.6136 2.87496 3.16246 10.591016 No. of CHCs & 02 new CHCs (75X24X12X9) Telephone @ Rs.2000 / mon. / CHC & 02 new 2.16 2.904 3.1944 3.51384 11.77224 CHCs (2000X12X9) Internet @ Rs.500/ mon./ CHC & 02 new CHCs 0.54 0.726 0.7986 0.87846 2.94306 (500X9X12) Other expenses @ 4000 / mon. / CHC & 02 new 4.32 5.808 6.3888 7.02768 23.54448 CHCs (4000X9X12) Maintenance grant of CHC water-electricity) @ 10000 10.8 14.52 15.972 17.5692 58.8612 / mon. / CHC & 02 new CHCs (10000X12X9) Staff for Mech. Laundry 2 persons/ CHC @4000 / 8.64 10.56 11.616 12.7776 43.5936 month- & 02 new CHCs (18X4000X12) Total 669.96 616.332 40.8448 44.9292 1372.0656

B – 7. Upgrading PHCs for 24 hr Services Situation • At present out of 45 PHC’s majority of them don’t have enough accommodation Analysis/ facilities and also MO’s are very less in number • In majority of the PHCs there are no accommodation facilities. • The transport facilities are also limited and are also short to Para medical Staff. Objectives/ • To render services to more and more people. Milestones/ • To up grade the infrastructure and staff to optimum level in more than 50% of Benchmark PHC’s. s • Need for Gynecologists in each PHC , Labour room, Operation theatre , Electricity , Water facility etc. Strategies • 5 more PHC’s required especially AD Wadder ( Up gradable to PHC Wadder) & Activities • 4 MO’s and one Gynaecologist are urgently required. • Para medical staff and ministerial staff are also required. • Ambulances. Support • Funds , Manpower resource , transport, Buildings, Operation Theatre and required Labour Room at PHC’s Timeline Activity plan 2008-09 2009-10 2010-11 2011-12

Upgradation of buildings x - - - Construction of new PHC x x - - buildings Procurement of furniture, x - - - computer etc Construction of staff - x x - quarters Recruitment of manpower x - - - Budget Activity / Item 2008-09 2009-10 2010-11 2011-12 Total ( in lacs) All PHCs to be upgraded to 24X7 as per IPHS- 25 PHC in 2008, 20 PHCs in 2009, 93.75 75.00 26.25 0.00 195.00 07 PHCS in 2010 @ 25%of building cost ( 3.75 lac) Construction of PHCs in rented buildings 28 PHCs @ 15 lac/ PHC & 7 new 262.50 262.50 0.0 0.0 525.00 PHCs (Rs. 1000 / sft 1500 sft. / PHC.) Staff Quarters-45 PHCs @48.00lac/PHC & 7 new 1248.00 1248.00 0.0 0.0 2496.00 PHCs (Rs. 1000 / sft.1200 sft. / S.Q.) Furniture- 5% of building cost X no. of PHC- % 17.55 5.25 0.0 0.0 22.80 available-(5% of 15lacX 45) 48% (For 07 new PHCs ) Invertors for staff quarters @ 15000 / PHC For 07 new 6.75 1.05 0.0 0.0 7.75 PHCs )

Computer @ 40000 / PHC 18.0 2.80 0.0 0.0 20.80 For 07 new PHCs ) Vehicle- 23 PHCs @ 3 69.0 21.00 0.0 0.0 90.00 lac/per vehicle Washing machines- 1/PHC @ Rs. 10000 x 45 PHCs 4.50 0.70 0.0 0.0 5.20 For 07 new PHCs ) Recurring 24X7 PHC Extra Man Expenses Power for 1 PHC / 9 Block as per MO-1 / block @ Rs. 139.8 251.64 290.784 290.784 973.008 21000/M-Nurses-2 / Block @ 12800 / M Telephone expenses- @ Rs. 2000/month/ 45 PHC x 10.8 13.728 15.1008 16.6109 56.23968 12 m For 07 new PHCs ) Internet expenses-@ 500. month /PHC (500X12X45) 2.7 3.432 3.7752 4.15272 14.05992 For 07 new PHCs ) Electricity charges- 5000X12X45 For 07 new 27 34.32 37.752 41.5272 140.5992 PHCs ) POL- 80cases / year / PHC @ 300 /Case (80X45X300) 10.8 13.728 15.1008 16.6109 56.23968 For 07 new PHCs ) Driver-1/PHC @4000/month 14.88 18.24 20.064 22.0704 75.2544 (31X4000X12) For 07 new PHCs Laundry staff- 1/PHC @ 4000 / month 21.6 24.96 27.456 30.2016 104.2176 (4000X12X45) For 07 new PHCs ) Maintenance & other expenses @ Rs.10000/moth / PHC !2 54 68.64 75.504 83.0544 281.1984 (10000*12*45) For 07 new PHCs Total 2001.63 2044.99 511.787 505.012 5063.3669

B – 8. Upgrading Sub Centres Situation • The District has 134 Sc’s out of which majority of Sc’s are running in private or Analysis/ rented buildings. Current • No Quarter facility is available at SC level. Status • More than 50 ANM’s are required. • No water source or pump in most sub-centres • There is irregular supply of Kit A&B • Sub centre building is not according to IPHS norms Objectives/ • To register ANC and PNC patients. Milestones/ • To ensure full immunization of new born child and mothers. Benchmark • To construct Government own buildings for all SC’s. s • To recruit 50 more ANM’s. • To promote institutional deliveries Strategies & • Register more Sc’s. Activities • Fill up staff, and construct Govt. buildings have medical facility available. Support • Funds, Communication, equipments, Medicals Supply, Kits. required Timeline Activity Plan 2011- 2008-09 2009-10 2010-11 12 Up gradation of buildings- - - - - Water supply, electricity, sanitary toilets Construction of new Sub x x - - center buildings Procurement of furniture, x x - - computer etc Construction of staff quarters x x - - in SCs Recruitment of voluntary - - - - workers Amount for backlog rent X - - - Budget Activity / Item 2011- 2008-09 2009-10 2010-11 Total 12 Construction of Sc’s in rented building-102 Sc’s @ 5.00 lac/ Sc’s-102X5.00 lac 255.00 255.00 0.0 0.0 510.00 (Rs. 5.00 lac includes provision of Water supply, electricity, sanitary toilets ) Staff quarter- 134 SC’s @ 1005.0 7.50lac / SCs (134X7.50 502.50 502.50 0.0 0.0 0 Lac) Furniture-5% of Building cost X no. of SCs - % 23.852 0.0 0.0 0.0 23.852 available- 5% of 4.00 lac X 134-11% Traveling allowance @ 100/visit X10 visits /SC 1.34 1.34 1.34 1.34 5.360 (100X10X134)

Electricity charges & other Expenses @1000/month/ 16.08 16.08 16.08 16.08 64.320 SC-(1000*12*134) Voluntary worker @ 1.61 1.61 1.61 1.61 6.440 1200/SC-(1200X134) Amount for Backlog Rent 20.00 0 0 0 20.00 New SC’s to be const. as per pop. norms of IPHS 3000/SC 134 SC’s @ 5.00Lac (Rs. 5.00 lac includes provision 335.0 335.00 0 0 670.00 of Water supply, electricity, sanitary toilets ) Staff quarters @ 7.50 lac / 1005.0 SC- 7.50 lacX134 (Rs. 1000 502.5 502.5 0 0 0 / sft. 750 sft. / S.Q.) Furniture @ 20000/SC 0 26.80 0 0 26.80 Voluntary worker @1200 / 1.9456 5.3224 0 1.608 1.7688 SC X134 8 8 Traveling & other expenses 11.349 31.047 0 9.38 10.318 @ 7000/SCX 134 8 8 Total 32.325 3373.1 1657.88 1651.82 31.1168 5 423

B-9 Untied Funds and Incentive Fund for the Village Health and Water Sanitation Committees Situation NRHM has placed a lot of stress on Community involvement and formation of Analysis/ Village Health & Water Sanitation Committees (VHWSC) in each village. These Current committees are responsible for the health of the village. In District Budgam these Status committees have been formed but need strengthening to improve their functioning. The selection of ASHA, her working, progress of the village is part of the responsibilities of the Gram Panchayat.

In Budgam there are 373 villages with population less than 1500. There are 50 villages with population between 1500 and 3000. Hence these amount to 117units of 1500 population. Objectives Strengthening the Village Health & Water Sanitation Committees through financial support Strategies 1. Provision of annual Untied funds of Rs 10000 each year to the villages upto a population of 1500 2. Provision of Rs 5000 as permanent advance fund for Incentives for ASHA Activities 1. Provision of Annual Untied funds of Rs 10000 each year to the villages’ upto a population of 1500. Villages with more than 1500 population upto 3000 will get twice the funds. Villages with population more than 3000 will get three times the funds. Hence there will be 373 units of population 1500 or less to get the funds annually of Rs 10,000.00.This untied fund is to be used for household surveys, health camps, sanitation drives, revolving fund etc; 2. Orientation of the MPHWF for the utilization of the untied funds and she in turn will orient the Village, Health & Water Sanitation committee. 3. Provision of Rs 5000 as permanent advance fund for Incentives for ASHA based on performance norms. 4. Monthly meetings of the VHWSC for reviewing the funds and activities. This is to be facilitated by the MPHWF 5. Monthly review at the PHC level regarding the VHWSC functioning and utilization of funds. Support 1. State should ensure the orientation procedure for the VHWSC required 2. Funds to be transferred on time to the MPHWF 3. PRIs to ensure proper usage and accounts Timeline 2008- 2009- 2010- 2011- 09 10 11 12 Untied Fund of Rs 10000/unit for Pop x x x x 1500/unit x 373 units Orientation and reorientation of the x x x x VHWSC Provision of Rs 5000 as permanent x x x x advance for incentives to ASHA Monthly meetings of the VHWSC x x x x Review of the VHWSC functioning at PHC x x x x level

Budget Activity / Item 2008- 2009- 2010- 2011- Total 09 10 11 12 Untied Fund of Rs 10000/unit 1500 Population / unit x 373 37.3 41.03 45.133 49.6463 173.1093 14.7 units Permanent Advance to VHWSC for ASHA incentive @ 6.7 14.74 16.214 17.8354 55.4894 Rs5000/SC Total 44.00 55.77 61.347 67.4817 228.5987

PART C: Immunisation

C-1. Cold Chain Maintenance Situation More defreeze are required and also some more Vaccine carriers are also Analysis required Objectives • To maintain cold chain during storage and distribution of vaccines so that potent vaccines are used for immunization. Strategies • Maintain uninterrupted power supply by hotline & • Supply of cold chain equipments Activities Support • Budget for repair of minor defects of refrigerators required • Waste disposal pits are required in every village for safe disposable of biomedical waste • Additional DF/ILR, 500 ice packs and 70 vaccine carriers required for buffer stock. Timeline Activity Plan 2008- 2009- 2010- 2011- 09 10 11 12 Procurement of DG set, ILR, DF, x - - - Cold boxes Construction of Cold Chain room x - - - Recruitment of Cold Chain x - - - Manager Budget Activity / Item 2009- 2011- 2008-09 2010-11 Total 10 12 District Hospital- DG set @ Rs. 1.00 0.0 0.0 0.0 1.00 1Lac ILR @ Rs. 20000 for DH 0.20 0.0 0.0 0.0 0.20 Deep freezer @ 1Rs. 5000 for 0.15 0.0 0.0 0.0 0.15 DH CHC- DG set @ Rs.1 Lac /CHC 9.00 2.0 0.0 0.0 11.00 x 9 & 02 new CHCs One I LR @ Rs. 20000 x 9 1.80 0.4 0.0 0.0 2.20 CHCs & 02 new CHCs Stabilizer @ Rs. 10000 x 9 0.90 0.2 0.0 0.0 1.10 CHCs & 02 new CHCs Deep freezer@ Rs.15000 x 9 1.35 0.3 0.0 0.0 1.65 CHCs & 02 new CHCs PHC-DG Set @ Rs. 45000 / 20.25 3.15 0.0 0.0 23.40 PHC x 45 (07 new PHCs ) I LR @ Rs.20000/PHC 9.00 1.40 0.0 0.0 10.40 x45PHC’s ( 07 new PHCs ) Stabilizer@ Rs. 10000/ PHC x 4.50 0.70 0.0 0.0 5.20 45 ( 07 new PHCs ) SC- ILR at one SC/ Block @ 2.0 0.0 0.0 0.0 2.0 Rs. 20000 / block x 10 Ice pack boxes 1 / SC @ Rs. 9 10.00 0.0 0.0 0.0 10.00 lacs

Construction of cold chain maintenance room with air 45.0 10.00 0.0 0.0 55.00 condition at CHC @ Rs.5lac / CHC x 9 Staff for C.C.M:-CCM engineer 75.6 at CHC @ Rs.15000/month / 16.20 19.80 19.80 19.80

CHC x 12 x 9 & 02 new CHCs Annual maintenance @ Rs. 5000/ month x12 m x 9 5.4 7.26 7.986 8.7846 29.4306 CHC& 02 new CHCs Total 28.584 228.330 126.75 45.21 27.786 6 6

C-2. IEC & Social Mobilization Situation • Good coverage reported but percentage of fully immunized children is very low Analysis/ • Demand for health services is very poor Objectives/ • To impart health awareness ,health education on all National Health Milestones/ Programmes so that utilization of various services is increased Benchmark s Strategies • To give new look to IEC activities by using multimedia and audio visual & Activities methods, Support • Personal at district and CHC level required • IEC Staff ,IEC Artist ,multimedia personnel

Timeline Activity Plan 2008- 2009- 2010- 2011- 09 10 11 12 IEC activities in villages x x x x Mass media activities like TV x x x x ads/NEWS Procurement of Audio visual aids x - - - Recruitment of IEC unit staff x - - - Budget Activity / Item 2008- 2009- 2010- 2011- Total ( In Lacs) 09 10 11 12 IEC programme for target group on Maternal, Child Health & FW One 7.46 7.46 7.46 7.46 29.84 programme/ village/month @ Rs.100 X 622 X 12 X 100 Adolescent Health-one prog. / SC 3.8913 13.319 1.61 3.5376 4.2805 /month @ Rs.100x134X12X100 6 456 Drama & film shows @ Rs 10000 / 1.00 1.1 1.21 1.331 4.641 block x 10 blocks Local T.V Ads. @60000/district 0.6 0.6 0.6 0.6 2.4 LCD player @ 1 lac/dist 1.00 0 0 0 1.00 VCD player @ Rs5000/PHCx45 2.25 0 0 0 2.25 News paper messages 1.2 1.2 1.2 1.2 4.8 12 messages/year @ Rs.10000 Establishment of IEC unit At district level-ICE prog. Manager @ 2.4 2.4 2.4 2.4 9.6 Rs.20000/month x12 month Artists Two @15000/mnoth- 3.6 3.6 3.6 3.6 14.4 2X15000X12 Health Educators-4 @ Rs10000 4.8 4.8 4.8 4.8 19.2 /month x12x4 ICE activity RNTCP & VBD @ Rs;3 lac / block 10 blocks 30.0 33.00 36.3 39.93 139.23 Total 57.697 61.461 65.601 240.68 55.92 6 4 5 046

C-3. Alternate Vaccine Delivery Mechanism Situation • Outreach sessions for Immunization by ANM’s and ASHA’s under NRHM. Analysis/ • Adequate supply of Vaccine should be available . • Objectives/ • Increase coverage of routine immunization to 100% Milestones/ • To deliver the Vaccine to immunization sites through utility vans. Benchmark s Strategies • Provide and ensure vaccine delivery at outreach session & Activities • Special scheme to convey children for Regular Immunization required • Mobile vaccination team to visit each slum area at least once a month • Support • POL for vehicle required • Social mobilization helper • IEC activities • Timeline Activity Plan 2008- 2009-10 2010-11 2011-12 09 Vaccine supply at session site x x x x through vehicles/ couriers

Social mobilization by ASHAs x x x x

Budget Activity / Item 2008- 2009-10 2010-11 2011-12 Total ( In Lacs) 09 POl for vehicles @ Rs.200 per session x 52 x 134 SCs & 134 115.421 13.94 30.6592 33.7251 37.0976 new SCs 95

Incentives to ASHAs @ Rs.100/sessionx52x800ASHA 40.77 40.77 40.77 40.77 163.08

278.501 Total 54.71 71.4292 74.4951 77.8676 95

C-4. Supervisory Support and Vaccine Transportation

Situation • Vaccine is collected from regional centres or Budgam HQ and distributed to Analysis/ various units. • Poor coverage due to lack of supervision

Objectives/ • To achieve 100 % immunization in district including migrant population Milestones/ • To provide potent vaccines, increase coverage and prevent AEFI through Benchmarks supportive supervision

Strategies & • To maintain the cold chain through timely transportation/ supplies Activities

Support Mobile Van, Motor cycles and Horses for out reach Villages. required

Timeline 2008- 2009- 2010- 2011- Activity Plan 09 10 11 12 Vaccine Potenct testing x x x

Training of health workers x x x

Budget 2008- 2009- 2010- 2011- Activity / Item Total ( In Lacs) 09 10 11 12 Potency testing of vaccine Provision for POL to MO in charge immunization or 0.60 0.60 0.60 0.60 2.4 assistant @ 60000/ district

Training of Health worker & ANM @ 250/H. W & ANM- 0.67 0.67 0.67 0.67 2.68 250X268

Total 1.27 1.27 1.27 1.27 5.08

C5 HMIS Situation • At present the monitoring and supervision of various activities under NRHM Analysis/ are being carried out as under Current o Periodic visits by CMO / BMOs / DIO / DTO and MOs during out Status reach sessions. o Monthly / weekly reporting on prescribed formats. o Monthly meetings. Objectives/ • To implement all the components of NRHM as per the guidelines, time Milestones/ frame and to make necessary corrections as and when needed Strategies & • Due to the overload on the officers/officials separate monitoring staff needs Activities to be engaged. They must be well qualified and trained in their respective fields. • Provision of separate vehicles with POL/Driver for the supervisory staff at District and block head quarters. • Incentive for Medical officers for hiring the vehicles for purpose. • Full logistic support. • The Block and District Headquarters should be connected via Intranet. Support Checklist for monitoring required Time Line Activity / Item 2008- 2009- 2010- 2011- 09 10 11 12 Survey for practices, coverage, behavior etc x through independent agency Software development x x Data Entry of each household x x Internet connectivity x Provision of computers for each CHC and x x x x PHC AMC for computers x x x x GIS for the district, training and updating x x x x Printing monitoring Charts Activities 2008- 2009- 2010- 2011- Total 09 10 11 12 Survey for practices, coverage, behaviour etc 15.0 0 0 0 15.00 through independent agency Software development 20.0 0 0 0 20.00 Data Entry of each household’s health card @ Rs 1.80 0.4 0.8 1.2 4.20 2 per card x 90000 cards (aprox.) Internet connectivity @ Rs 900 6.415 7.0567 7.7623 5.832 27.06631 /mth x No of facilities x12 mths 2 2 92 Provision of computers for each CHC and PHC @ Rs 32.4 0 0 0 32.4 60,000/computer system with UPS and printer

AMC for computers @ Rs 5000 /computer /year x 54 2.7 2.97 3.267 3.5937 12.5307 computers Consumables for computers 28.51 31.363 34.499 @ Rs 4000/mth/facility x 12 25.92 120.2947 2 2 52 mths GIS for the district, training 12.00 0.5 0.5 0.5 13.5 and updating Printing monitoring Charts @ 0.10 125 0.15 0.175 125.425 Rs. 5 per monitoring chart Total 115.7 163.7 43.136 47.730 370.4167 52 972 92 61

C-6. Supplies and Logistics Situation • All vaccines are being supplied by GOI. Analysis • Requirement is 3 % of total population. Objectives • 100% immunization by 2010 • Procure Vaccine in time and set target and set of guidelines to accomplish target. Strategies & • Procure sufficient stock of vaccines and AD syringes Activities Support • Kits for the staff. required • AD syringe (0.5ml), AD syringe (0.1ml) Timeline Activity Plan 2008-09 2009-10 2010- 2011-12 11 Supply of equipment in x - - - District Hospital Supply of equipment in CHCs x - - - Supply of equipment in PHCs x x - - Supply of equipment in Sub x x - - centres Supply of Drugs in DH, x x x x CHCs, PHCs, SCs Maintenance of equipment x x x x Budget Activity / Item 2008-09 2009-10 2010- 2011-12 Total ( in Lacs) 11 Equipments at district 22.19 0 0 0 22.19 hospital @ Rs. 22.19lac Equipment at CHC’s @ Rs. 22.19 lac X 9 CHC & 02 new 199.71 44.38 0 0 244.09 CHCs Equipments at PHC’s & (7 new PHCs from 2010) @ 50.175 7.805 0 0 57.98 Rs. 111500 X 45 PHC Equipments at SCs & 134 new SCs from 2010 @ Rs. 34.4112 34.4112 0 0 68.8224 25680 X 134 Maintenance of equipments @ Rs. 20000/ block x 10 1.8 1.98 2.178 2.3958 8.3538 blocks Drugs at district hospital @ 10.00 10.00 10.00 10.00 40.00 Rs. 10.00 lac Drugs at CHC @ 10.00 lac X 90 110.00 110.00 110.00 420.00 9 & 02 new CHCs Drugs at PHC & 07 new PHCs from 2010 @ Rs.3.0 135 156.0 156.0 156.0 603.00 lac X 45 Drugs at SC & 134 new SCs 48.601 170.105 24.3 48.6018 48.6018 from 2010 @ Rs18135 X 134 8 4 Total 1634.54 567.586 413.178 326.78 326.998 16

PART D: National Disease Control Programme

D-1. RNTCP Situation Indicators No. / Rate Analysis New Sputum Positive cases (ACDR) 326 (49%) Annual total case detection rate per one lakh population 536 Total new pulmonary TB cases 410 Proportion of new sputum positive out of total new pulmonary 93% cases Cure rate 93% Smear Conversion Rate (%) 90% Treatment success rate (%) Defaulter cases (%) 03 Failure cases (%) 01 Objectives • 85%cure rate and 70% new detection. Strategies • IEC activities will be conducted in the district, seminars in schools, sensitization & Activities sessions at District /sub –district / Block level, community meetings, patients, provider group interaction meetings, Hoardings at prominent public places in the district. • Awareness through print and electronic media. • Rallies on different occasions like World T.B Day. Support • MO at DTC and all DMC’s exclusively for RNTCP. required • Data entry operator, Driver, Junior Assistant. • Internet connectivity with DMC’s. • 4 LT’s for over busy DMC’s. • Table cum Locker, stools, Chairs, for DOT centres. • Incentives for LT’s • Telephones and computers Persons carrying the sputum to DMC Timeline Activity Plan 2008- 2009-10 2010- 2011-12 09 11 Improving the DTC building, MC Centres and TC centres x Increasing the DOT providers through ASHAs x x x x Training to RNTCP staff and ASHA x x x x Awareness drives x x x x Mask Provision Budget Activity / Item 2008- 2009-10 2010-11 2011-12 Total 09 Civil Works DTC building 1.5 lakhs 1.5 0 0 0 1.5 MC 0.28/MC 4.76 0 0 0 4.76 TU 0.35/Tu 1.05 0 0 0 1.05 except DTC Material and supplies 1.32 1.45 1.6 1.76 6.13 Laboratory material 1.1 1.21 1.33 1.46 5.1 Training 26.924 29.6164 32.5780 35.8358 124.9543

Awareness drive on World 1 1.1 1.21 1.33 4.64 TB day IEC activities 1 1.1 1.21 1.33 4.64 Vehicle hiring for STS/STLS 1 1.1 1.21 1.33 4.64 in winter @ 1 lakh Salaries of contractual staff 13.62 14.982 16.480 18.128 63.2104 Vehicle maintenance inc 1 1.1 1.21 1.33 4.64 POL 4 wheeler Hiring of vehicle 1.7 1.87 2.06 2.27 7.9 DTO MO TC @ Rs 0.42lakh/yr Equipment and 0.085 0.094 0.103 0.113 0.395 maintenance Microscope @

Rs1000/yr/microscope Computer@ Rs 5000/yr Photocopier/Fax Rs2500/

machine Miscellaneous – TA/DA, Telephone, Meetings, 0.195 0.215 0.247 0.272 0.929 Electricity repair etc Total 56.254 53.8374 59.23824 65.15906 234.4887

Detailed Calculations

Training in RNTCP Personnel Unit Cost Units 2007-08 DTO State MOTC 23320 9 209880 MO 15580 90 1402200 STS 6726 2 13452 STLS 16720 2 33440 LT 5972 45 268740 ANM 2875 266 764750 2692462

Personnel RNTCP Personnel Unit Cost Units Months Amount TB health visitor 6750 9 12 729000 STS 7000 2 12 168000 STLS 7000 2 12 168000 LT 6500 2 12 156000 Data Entry Operator 6000 1 12 72000 Accountant 1250 1 12 15000 Driver 4500 1 12 54000 Total 1362000

D-2. LEPROSY Situation Balance New cases Cases Balance Per 10,000 Proportion Analysis/ Cases at detected in Discharged in Cases at Population of beginning year year end of year Deformity of year Ratio PB MB PB MB RFT O.D PB MB PR NC among DR casesN NIL NIL Nil NIL Nil Nil Nil NIL Objectives • To undertake IEC on major scale. / • To organise P.O.D camps at block level • To train newly appointed health care staff. • To provide patients supportive medicines.

Strategies • IEC through cultural programmes Quiz programmes at education institutions, & seminars wall paintings hoardings print and electronic media. Activities • Training of newly appointed health care staff. • To organise prevention 0of depmity camps at block level. • Provide supportive medicines MCR footwear blankets utensils etc. to patients

Support • Supervisory vehicle for district Leprosy Officer. required • Bike two Wheeler for PMA to see healthy contacts in un approachable and far flung areas. • Personnel Computer with Accessories for maintaining records at district H.Q.s.

Timeline Activity Plan 2008- 2009- 2010- 2011- 09 10 11 12 Detection of new cases x x x x

IEC activity for awareness / x x x x Early detection

Budget Activity / Item 2008- 2009- 2010- 2011- Total 09 10 11 12 IEC activity for Leprosy @ Rs. 100000 / block x 10 10.0 11.00 12.1 13.31 46.41

Treatment @ 50000/ block 5.0 5.50 6.05 6.655 23.205

Total 15.00 16.50 18.15 19.965 69.615

D-3. NATIONAL MALARIA CONTROL PROGRAMME Situation Issues No. % Analysis/ Total Blood Slides Examined (BSE) NIL NIL Total Positive Cases: Plasmodium Vivax cases (Pv): Nil NIL Plasmodium Falciparum (Pf): NIL NIL Slide Positivity Rate (SPR) NA NA Slide Positive plasmodium falciparum Rate NIL NIL (PFR) Annual Blood Examination Rate (ABER) NIL NIL Deaths NIL NIL Objectives • Till date no malaria cases have been identified in the District. • As the disease is not prevalent in the district, objective is to protect migratory population who are going outside the state for job, business etc. to endemic state and coming to district from outside state. Training of staff for identifying such groups and treatment.

Strategies • Active supervision, active and passive surveillance for fever cases & Activities Support • Safety measures taken if found any where in the District. required

Timeline Activity Plan 2008- 2009- 2010- 2011-

09 10 11 12 Procurement of fogging-spray x - - - machine Recruitment of spraying staff x - - - Procurement of Phenyl x x x x Budget Activity / Item 2008- 2009- 2010- 2011- Total 09 10 11 12 Fogging machine for each block & D.H @ Rs. 10.00lac/ district 10.0 0 0 0 10.00 Two spray machines for each 1.0 0 0 0 1.00 block @ Rs.5000/ block x 2 x 10 Staff- 2 persons/block @ Rs. 12.0 13.20 14.52 15.972 55.692 5000/ monthx12 x2 x 10 Phenyl @ Rs.30000 / block x 10 3.00 3.30 3.63 3.993 13.923 IEC activities @ Rs 50,000 / 5.00 5.50 6.05 6.655 23.205 block Total 31.00 22.00 24.2 26.62 103.82

D-4. OTHER VECTOR BORNE DISEASES Situation Analysis Other Vector Number Borne Disease Kala Azar Nil Dengue Nil Lymphatic Nil Filariasis Japanese Nil Encephalitis Others Nil Objectives To reduce cases and death due to JE (and Dengue if there is any in the future)

Strategies & Activities • Public awareness (IEC activities) by group meetings, pamphlets/ handbills/ public announcements etc • Reduction of vector density by fogging and spraying as well as by other methods of covering piggeries • Reduction in mosquito-man contact through IEC

Support required Mobile medical team with Van for monitoring purposes.

Timeline Activity Plan 2008-09 2009-10 2010-11 2011-12 Detection of x x x x cases Recruitment of - - - - staff Supply of - - - - computers

Budget Activity / Item 2008-09 2009-10 2010-11 2011-12 Total

Preventive measures Prog. Officer @ 2.4 2.4 2.4 2.4 9.6 Rs.20000/month

Data entry operator @ Rs. 8000 /month x 0.96 0.96 0.96 0.96 3.84 12

Computer etc @ 0.5 0 0 0 0.5 50000/ district IEC activities @ Rs 50,000 / 5.00 5.5 6.05 6.655 23.205 block

Total 8.86 8.86 9.41 10.015 37.145

D-5. BLINDNESS CONTROL PROGRAMME Situation Indicator Number Analysis/ Total cataract surgery performed 385 Cataract surgery with IOL NA Children detected with refractive error NA Children provided with free NA spectacles Objectives To treat all cataract patients. To provide health check ups to all school going children. To undertake IEC activities To provide free Spectacles medicines and diet to patients.

Strategies To conduct surgery for cataract and other eye diseases & Activities To conduct periodic screening of school children To procure and supply essential material to community having blindness such as spectacles etc

Support Supervisory vehicle for supervising the area. required Personal computer for maintaining the records. Free spectacles for children.

Timeline Activity Plan 2008- 2009-10 2010-11 201-12 09 H-H Survey for Vision defects x IEC activities x x x School Eye Screening X X X Blind Register x x x Observance of Eye Donations x x x Cataract Camps X X X Development for CHC for Eye X X X Unit Training of School teachers X X X 200 Repair and purchase of x x x equipment and maintenance Budget Activity / Item 08-09 09-10 10-11 11-12 Total Health Mela @100000 / 10.00 11.00 12.1 13.31 46.41 block IEC @1lac 1.00 1.1 1.21 1.331 4.641 School Eye Screening 2.00 2.2 2.42 2.662 9.282 @1000 X 200 school Blind Register 0.8678 3.02593 0.652 0.7172 0.78892 12 2 Observance of Eye Donation 0.15 0.17 0.19 0.21 0.72 Cataract Camps @ Rs 20000 9.00 9.9 10.89 11.979 41.769 per camp x 45 PHC POL fro Eye Camps @ Rs 0.9 0.99 1.089 1.1979 4.1769 2000/camp x1

House to house survey for 10.00 0 0 0 10.00 vision defects @ 10 lak Training of School teachers 0.5 0.55 0.605 0.6655 2.3205 @ Rs 100/head x 500 Repair and purchase of 20.00 2.00 2.2 2.42 26.62 equipment and maintenance Total 34.643 148.965 54.202 28.6272 31.49292 21 3

D-6. Integrated Disease Surveillance Programme Situation There is a system of routine collection of data on morbidity and mortality of Analysis/ communicable diseases on monthly basis in vertical disease control programme. Integrated Disease Surveillance Project is yet to be implemented in the state as per GoI guidelines.

Objectives To develop and sustain integrated disease surveillance system by using existing resources which can forecast outbreaks early so that timely actions are taken to control/prevent outbreak. To monitor the incidence, prevalence and mortality due to major communicable and non-communicable diseases especially their sources, geographical distribution, magnitude of disease, treatment and actions to prevent its reoccurrence.

Strategies &Health Workers, Anganwadi workers, government and private health facilities and Activities NGO’s may be involved in to conduct regular on going disease surveillance on weekly basis. Training of staff: MPHWs, MPHS, LTs, pharmacists, MOs, data manager etc. in disease surveillance Regular monthly meeting of district level programme officers of all departments under Chairpersonship of Deputy Commissioner IEC activities for all communicable and non-communicable diseases Surveillance, data collection, compilation, analysis and feedback To get first information about the occurrence of outbreak of a disease, investigate and take containment measures.

Support Guidelines on IDSP and basic training to all categories of staff. required Additional budget for vehicle, staff, office buildings, up gradation of laboratories and training

Timeline Activity Plan 2008- 2009- 2010-11 2011-12 09 10 Procurement of furniture, x - - - computer etc Printing of registers/ formats x x x x Training of staff x x x x Recruitment of Microbiologist, x - - - Epidemiologist Conducting active/passive x x x x surveillance Budget Activity / Item 2008- 2009- Total 2010-11 2011-12 (in Lacs) 09 10 Furniture @ 1.00lac / district 1.00 0.0 0.0 0.0 1.00 Computer etc @ 50000/ 0.0 0.0 0.0 0.50 district 0.5 Vehicle @ 5.00lac 5.00 0.0 0.0 0.0 5.00 Epidemiologist-1@ Rs.23000/ 2.76 2.76 2.76 2.76 m x12 m 11.04 Micro biologist-1 @ rs.23000/ 2.76 2.76 2.76 2.76 m x12 m 11.04

Data operator @ Rs. 8000/ m 0.96 0.96 0.96 0.96 x 12 m 3.84 Lab. Technician 2@ 9900/ m 2.38 2.38 2.38 2.38 x 12 m 9.52 Register & formats etc @ 1.00 1.1 1.21 1.331 4.641 10000/ block Training of staff @ 0.5 0.55 0.605 0.6655 2.3205 50000/district POL for vehicle @ 0.36 0.36 0.36 0.36 3000/month x12 months 1.44 Driver @ 4000/ month x 12 0.48 .0.48 0.48 0.48 months 1.44 Total 17.7 10.87 11.515 11.6965 51.7815

D-7. Iodine Deficiency Disorders Situation Iodine deficiency is prevalent in hilly areas but there are no data available on level of Analysis/ deficiency and its effect on health of the community in the district.

Objectives To detect iodine deficiency cases as early as possible To make the people aware about the iodine deficiency disease To carry out mass survey to determine incidence of goitre in the district To decrease incidence of Cretinism i.e. hypothyroidism among rural masses. Make selling of iodized salt mandatory Strategies Health education may be provided to population. & Salt is to be spot tested for contents of iodine by health workers in the field Activities Early detection of disease to treat hypothyroidism, Cretinism. To carry out mass survey IEC through mass media seminar, quiz, rallies etc. Support IEC material may be proved throughout year smoothly. required Support of medical and Para medicals Timeline Activity / Item 08-09 09-10 10-11 2011-

12 Large Village meetings for x x x x awareness on IDD and consumption of Iodized salt Programme in schools – 100 x x x x Primary, Upper Primary, Secondary- Govt and Private by School health team Awareness programme with the 662 662 662 662 SHGs and shopkeepers villages villages villages villages Budget Activity / Item 2008- 2009- 2010- 2011- Total 09 10 11 12 Large Village meetings for awareness on IDD and 1.00 1.1 1.21 1.331 4.641 consumption of Iodized salt Programme in schools – 100 Primary, Upper Primary, 2.00 2.2 2.42 2.662 9.282 Secondary- Govt and Private by School health team Awareness programme with the SHGs and shopkeepers @ Rs 3.31 3.31 3.31 3.31 13.24 500 per village x 662 village IEC activity @ 50000/ district 0.5 0.55 0.605 0.6655 2.3205 Treatment cost @ 50000/ district 0.5 0.55 0.605 0.6655 2.3205 Total 7.31 7.71 8.15 8.634 31.804

6.INTER-SECTORAL CONVERGENCE

Health structure is providing necessary preventive, promotive and curative services to the community with ultimate goal of improving health status of population. Various other departments like AYUSH, IDS, and Rural Development etc are working in the community. Health department can give optimum output without using additional resources if coordination of various government and private sectors is sought. There are areas of coordination among various sectors which are suggested below.

6.1 Partnership with AYUSH department Integration of Health and AYUSH

Situation The Ayurvedic Medical Officers are permitted to use allopathic medicines in case of Analysis emergencies. However their participation in providing round-the-clock health services is negligible. The entire AYUSH workforce has been actively participating in polio eradication programme and another community health education programme. The AYUSH department also has a large force of frontline workers in the form of Dais. However, the contribution of the AYUSH department in promoting institutional deliveries, facilitating emergency obstetric care, immunisation and other health services is negligible. Involvement of Ayurvedic dispensaries in implementation of national health programmes. Objectives Joint meetings of Ayurvedic and Allopathic doctors to be held at block level for planning and monitoring Strategies State IEC strategy for Allopathic and Ayurvedic should be jointly prepared .and & Activities shared. Both the systems should participate in implementing the IEC strategy. Regular monthly meetings at Block and District levels (Provisions for TA/DA for these meetings for AYUSH). Promotion of institutional deliveries, Dais under AYUSH department will be oriented on need for institutional deliveries Optimise the utilisation of healthcare infrastructure through sharing among AYUSH and allopath Combined drug kits Activity Plan 2008-09 2009-10 2010-11 2011-12 Recruitment of AYUSH MOs - - - - Regular monthly review meetings x x x x Time line Immunization sessions in x x x x Ayurvedic Disp. Training to AYUSH MOs x x x x 2008- 2009- 2010- 2011- Budget Activity Total 09 10 11 12 Salary for 18 AYUSH MO’s- 2 AYUSH Doctor (1 male /1 female) 22.74 22.74 22.74 22.74 90.96 x 9 CHCs @ Rs.2, 52,660 per year Total 22.74 22.74 22.74 22.74 90.96

6.2 ICDS

Integration of Health and ICDS Situation ICDS scheme is operational in the district. There is good contribution of AWWs i Analysis health education and motivation of community members to avail health services. There is effective convergence between ICDS and Health at village level in service delivery. However, there is little or no convergence in planning, monitoring and reviews. Joint review meetings to be held at block level Objectives To provide better facility at grass root level. Strategies Communication facilities & Activities Medicine Kit with Iron folic Acid tablets, Vitamin B, Chlorine tablets may be provided to all AW centres. Depot holder for Nirodh (condoms) and ORS Joint review meetings to be held at the block level 2011- Activity Plan 2008-09 2009-10 2010-11 12 Celebration of Health & Nutrition Day x x x x Time line Supply of medicine kit to AWWs x x x x Join review meetings of Health/ICDS x x x x staff Budget No budget required

6.3 Rural Development Department

Integration of Health and Rural Development Situation School Sanitation and IEC are important components of Total Sanitation Campaign. Analysis Maintenance of sanitation at Panchayat level Objectives Sharing of information among ANM and AWW and Initiate monthly reporting system Strategies The frontline workers’ team should share information about the sect oral & Activities programmes and their operational strategies. The team will identify and prioritise the locations and thus jointly plan. 2011- Activity Plan 2008-09 2009-10 2010-11 12 Monthly reporting on sanitation x x x x facilities Sharing of information-Rural x x x x Development No budget required

6.4 Public Health Department

Integration of Health and PHD Situation As perceived by the community, quality of water is not satisfactory; people are Analysis still dependant on water sources which are not potable. Water from hand-pumps is perceived to be unfit for consumption in some areas. W ater availability is falling short of requirement . The practice of boiling water for drinking purpose is not prevalent Objectives Provision of potable drinking water to all. Strategies Bleaching powder and chlorine tablets will be provided by IPH and distributed by & field functionaries to household Activities Joint communication strategy Information sharing Copy of water quality monitoring reports generated by IPH department will be shared with the Health Department at block, district and state levels Community based organisations formed under various programmes/sectors will be engaged by a team of frontline workers – health, ICDS and IPH departments. Time line Activity Plan 2008-09 2009-10 2010-11 2011-12 Water quality monitoring x x x x Sharing of information-Rural x x x x Development Formation of community based x x x x organizations Budget No budget required

6.6 Education Department

Issues / Areas Areas of cooperation Areas of convergent action Health checks up at primary / middle - Health department Maintenance of hygiene and school - Education sanitation, toilets. Identification of susceptible children. department. Monitoring of health programs Registration and Medical care. - PHE department by health department in Immunization against vaccine - Panchayat / Block collaboration with education preventable diseases Dev. Officers. department especially at Awareness regarding hygiene/ drugs. - Rehbari- Sehat primary / middle school levels. Provision of separate toilets with Maintenance of neat and clean scientific sanitary system. school class rooms, play Provision of safe drinking water facility. grounds etc by mean of good relationship between school and community Strengthen School Health Programme Promotion of YOGA in the schools

6.7 Inter Sectoral Convergence

Inter Sectoral Convergence Situation 50 % of households having access to potable drinking water Analysis 50 % of households having sanitary toilets Objectives To ensure functional convergence of Health & Health determinants Strategies Construction of filtration plants. & Monthly coordination meeting Activities Support Health Department. State government directives / guidelines for intersector required convergence Timeline Meetings of the Block Committees x x x x

Meetings of the Village groups x x x x Budget Joint CNAA training x x x x (1205,573ANM,823ASHAs, 90 Supervisors, 90 MOs, 10 CDPOs) Joint monitoring at the sector level x x x x Total Hiring of vehicle x x x x Joint monitoring at the block level x x x x Yearly joint Planning Workshops x x x x at the Block level for development of the Action Plans Yearly joint Planning Workshops x x x x at the District level for development of the Action Plans Yearly joint Workshops to x x x x consolidate the plans from the village to the Gram Panchayats to

the Sectors and then Blocks at the Block level for Annual Action Plans Budget 2008- 2009- 2010- Total Activity / Item 2011-12 09 10 11 Meetings of the Block Committees @ Rs 1000 /meeting x 10 blocks x 1.20 1.32 1.452 1.5972 5.5692 12 months Meetings of the Village groups @ Rs 100 per village x 662 villages x 7.944 8.738 9.612 10.573 36.868 12 Joint CNAA training @ Rs 200 per person ( 1205AWW, 573 ANMs, 5.582 6.14 6.754 7.43 25.906 823 ASHAs, 90 Supervisors, 90 MOs, 10CDPOs) x 2791 Joint monitoring at the sector level Hiring of vehicle @ RS 1200/ day x 5 days/month x 10 blocks x 12 7.20 7.92 8.712 9.5832 33.4152 months Joint monitoring at the block level

Hiring of vehicle @ RS 1000/ day x 5 days/month x 10 blocks x 12 6.0 6.60 7.26 7.986 27.846 months Yearly joint Planning Workshops at the Block level for development 5.0 5.50 6.05 6.655 23.205 of the Action Plans @ Rs 0.5 lakhs per block x 10 blocks Yearly joint Planning Workshops at the District level for 1.0 1.10 1.21 1.33 4.64 development of the Action Plans @ Rs 1.00 lakh Yearly joint Workshops to consolidate the plans from the village to the Sectors and then 10.00 11.00 12.1 13.31 46.41 Blocks at the Block level for Annual Action Plans @ Rs 1.00 lakhs per block x 10 blocks Yearly joint Workshops to consolidate the findings at the block levels at the District level for 1.0 1.10 1.21 1.33 4.64 development of the Action Plans @ Rs 1.00 lakh Training of PRIs/,VHWS committee members under 22.0 22.00 22.00 22.00 88.00 Chiranjeevi Scheme @22 lakhs Regular monthly meetings under 12.0 12.0 12.00 12.00 48.00 Chiranjeevi Scheme @12 lakhs Development of Education material and hands on 10.0 10.00 10.00 10.00 40.00 trainingunder Chiranjeevi Scheme @ 10 lakhs Total 88.926 93.418 98.36 103.7944 384.4994

7. COMMUNITY HEALTH ACTION

Community Health Action Situation Village level Analysis/ 1. Village Health Water and Sanitation Committees have been constituted in all villages. A training module for the training of members of VHSC shall be prepared. Members of VHWSC shall be trained. Regular meetings of the committee, twice a month, shall be held 2. Local Gram Panchayat shall review the functioning of VHSC Sub-centre action plan shall be formulated on the basis of village action plan 3. Village health register shall be prepared by ANM and she will be assisted by ASHA and AWW. Tour plan of ANM shall be shared with local Gram Panchayat

Block level 1. Block Health Planning process shall continue 2. Block Development Committee shall review the implementation of Village and Block Health plans 3. State may decide on the constituting Block Health Mission

District level District Health Mission shall oversee the implementation of NRHM activities, in addition to acting as a watchdog for total health sector. Some initial activities for community action 1. Organization of Health Camps in every Sub Health Centre feeder area 2. Organization of a Public hearing in every cluster ( PHC area)within a block 3. Putting in place Block level team with a mandate for holding health camps and public hearings. 4. District level team to support household survey and survey of health facilities

Objectives Active participation of community in preparation and implementation of health plans at block and district To make community responsible. Encourage to provide information and suggestion. To review the accomplishment of targets in time.

Strategies .Set review meetings & Training to be provided to the members of all the committee members Activities Support Funds shall be made available fpr conduction meetings required Involvement of concerned departments, NGOs and civil society representatives

Timeline 2008- Activity Plan 2009-10 2010-11 2011-12 09 Orientation of SHG X X X X members Orientation of Committee

members at all levels Joint Community action x x x X

Joint Annual Action Plan x x x X Sector Alignment x Reorientation of the x x x X Committees and Societies Strengthening the Gram Panchayat meetings and x x x X Gram Sabhas Budget Activity / Item 2008- 2009-10 2010-11 2008-12 Total 09 Training of the VHWSC @ Rs 200 per person x 15 19.56 21.516 23.6676 26.03436 90.77796 persons/village x 652llages Meetings of the VHWSC @ Rs 50 per village x 652 3.912 4.3032 4.73352 5.206872 18.15559 villages x 12 months Meetings of Women SHG @ Rs 100 per year x 652 0.652 0.7172 0.78892 0.867812 3.025932 villages Honorarium for MOs for promoting Community health Action @ Rs 1000 1.1692 1.28612 1.414732 1.556205 5.426257 pm and travel charges Rs 800 pm Total 25.293 27.8225 30.60477 33.66525 117.3857 2 2

8. PUBLIC PRIVATE PARTNERSHIP

Public Private Partnerships Situation No prominent NGOs are working in the district in health sector. Public private Analysis/ partnership seems difficult as district is not industrialized. Possibilities of outsourcing services of canteen, cooperative medical shops. Objectives To identify new areas for PPP and explore opportunity for it. To collaborate with NGOS from other districts To provide better health facilities at all the levels through public private partnership Strategies To explore and analyses the various PPP opportunities in the district & To prepare a framework and contact the prospective private partners. Activities Support Adequate provision of funds, approval of government, support from other required departments for study of various available opportunities. Timeline Activity Plan 2008-09 2009-10 2010-11 2011-12 Study to assess PPP x - - - opportunities Preparing operational x - - - framework Innovative activities based on X - - - the study Innovative PPP pilots x - - - Establishment of TSA x - - - Preparation of resource x - - - directory Budget Activity / Item 2008-09 2009-10 2010-11 2011-12 Total (In Lacs ) Flexibility study @ Rs.9.00 lac 9.00 0.0 0.0 0.0 9.00 Operational frame work @ Rs 0.0 0.0 0.0 9.00 9.00 9.0 lac Innovative activities based on 20.00 20.00 20.00 20.00 80.00 the study Operationalisation of 10.00 0.0 0.0 0.0 10.00 [email protected] lac Cost of establishment of 0.0 0.0 0.0 27.0 27.00 [email protected] lac Preparation of directories of resource agencies & Pvt. 10.00 0.0 0.0 0.0 10.00 Partners @ 10.00 lac TNA for Pvt. Partners 1.00 lac 10.00 0.0 0.0 0.0 10.00 Innovative interventions @ 30.0 33.00 36.30 39.93 139.23 3.00 lac / block x 10blocks Total 125.00 53.00 56.30 59.93 294.23

9. GENDER AND EQUITY Gender and Equity Situation General sex ratio for the district is 1000 :930 Analysis The Sex ration in 0-6 yrs age group is satisfactory but needs improvement. Objectives To make improvements in respect of sex ratio. To lower down the female drop outs in schools. To reduce the child marriage.. Strategies & Awareness programs should be conducted at village level. Activities To educate community on disadvantages of child marriage. Registration of all institutions having facilities for sex determination and abortions Monitoring of registered bodies A multimedia IEC campaign coupled with community dialogue on the issues pertaining to adverse sex ratio Gender sensitisation training for service providers Support Funds for conducting fresh survey on Sex ratio required If possible remuneration to parents having female children’s for continuing their studies. Training of Medical officers and ANMs in gender IEC on male responsibility IEC on declining sex ratio Regular monitoring of sex ratio at birth, village wise, block wise and district wise half yearly Timeline Activity Plan 2008- 2009- 2010-11 2011-12 09 10 IEC campaign through print x x x x audio visual and folk media Capacity building x x x x Orientation and re-orientation of public and Pvt health care providers including NGOs on x x x x various laws related to health specially PC-PNDT & MTP act Budget Activity / Item 2008- 2009- 2010-11 2011- 12 Total 09 10 IEC Campaign @2000 17.3562 60.5186 13.04 14.344 15.7784 X652llages 4 4 Periodic Advisory committee 0.4 0.44 0.484 0.5324 1.8564 meetings @ 10000 Development of Trg. Modules 1.00 0 0 0 1.00 Training of MO's &,ANM’s 2.00 2.20 2.42 2.662 9.282 Workshops with private providers, IMA members, Religious leaders, Caste 10.00 11.00 12.10 13.31 46.41 leaders, Community leaders and women groups Total 33.8606 26.44 27.984 30.7824 119.067 4

10. CAPACITY BUILDING Capacity Building Situation Skilled manpower is essential for optimum output of health care services. Although Analysis technically qualified persons are recruited in health system, they require developing special skills including human skills. This is generally lacking in employees. Similarly village level functionaries including members of Panchayati Raj Institutions require to be trained for increasing community participation to achieve NRHM Goals. Poor knowledge and skills of employees in health department has affected health services output. Following training programme are currently conducted in Budgam district Trainings of M.O in IMNCI Orientation of TBAs on RCH. Refresher training course is needed Training for Skill Birth Attendants Training of staff nurses on newborn care Training on mini lap Training of 410 ASHAS Induction training of MOs All above training are conducted by RIHFW, Regional training centres and the district training centres. The monitoring of the trainings needs to be done for the quality of trainings. Also monitoring of the work output of the personnel for which they have received the trainings should also be done. 410 ASHAs have been trained in module 1. Objectives To put skilled manpower in place for better output To upgrade existing training institutions with modern IT equipments like V.Set, Computers, LCD Projectors, Servo (50 KV) stabilizer for maintaining power supply. To conduct training programmes for various categories of staff like MO’s, ANM’s, Birth attendants etc. Involve NGO’s, Pvt. Health providers to conduct various activities for behavior change among community. To enhance the capacity of M.O’s Para medical staff &VWHSC by imparting training on Gather technique, IMNC Leprosy MTP IUD etc to them so that they can handle any situation. Strategies & Capacity building for the reduction in Maternal and Neonatal mortality Activities • TBA training for 15 days, Five clean approach in deliveries, danger signs, early referral, Newborn care and family planning, communication, • MTP training on MVA to all PHC MOs for 15 days. • Training in Obstetric management & skills for Operationalisation of 24x7 PHC for 16 weeks • Training of skilled Birth attendants (ANM, LHV, SN) for 15 days • IMNCI training to ANM/LHV, SN, MO, CDPO for 8 days in the area covering the 24 x 7 PHC • 3 days training of MOs and laboratory technicians of CEmOC on Blood transfusion • 18 d ays training in Life saving/Anaesthesia for CEmOC at FRUs for MOs • Integrated skill training of all SN, MPHWF • Training of ASHAs • Training in BCC for MOs, MPHS, MPHWF • Training of Ayush personnel on issues of RCH and reporting for 3 days

Capacity building to meet the unmet needs • Training on NSV for MOs for 5 days • Training for Laparoscopic Sterilization for Surgeons, Gynaecologists, SN, OT attendants for 12 days • Skill up gradation of MPHWF & MPHS for 5 days • Orientation on contraceptive devices for MOs of Govt facilities as well as private facilities Training on Medico-legal aspects Continuing Medical Education sessions for doctors each month during the monthly meetings on current topics. An expert from a reputed institution will be invited on the current topics and Certificates will be given. Capacity building for Gender equality • Orientation on Gender equality & PCPNDT Act for doctors both Govt and private, members of District Appropriate authority NGOs Capacity building for good programme management • Professional Development course for District Programme Managers, Senior district officials, MOs for 10 weeks • Management Development course for MOs for 5 days • General and Financial rules (G & FR) for the district officials, MOs, clerical staff for 3 days • Financial management training for Accounts Officers, Accountants for 3 days • Computer training to all the MOs, Clerical staff, accounts personnel • CNAA for MOs, MPHS, MPHWF, AWW Capacity building for managing the other components of NRHM RNTCP • Reorientation Training of DOT providers for 1 day • Orientation of MOs on revised Pediatrics & PWBs under Pediatrics management for 1 day Convergence for Sanitation and hygiene under NRHM • One day orientations of VHWSC for total sanitation Disease Control Programme – Blindness Control, Malaria, IDSP, IDDM-MPW and LT training PRIs • Training on NRHM and their roles of the members of the Zila Parishad, Panchayat Samitis, Gram Panchayat members, VHWSC for 1 day NGOs • Training in BCC, Training of Field NGOs Private Sector Training on Family Planning issues, PCPNDT Act, Reporting Ensuring the quality of trainings • A district quality training team will be formed to ensure the organization of trainings as per schedule, arrangements and monitoring the quality of all the trainings on the basis of checklists to be developed by the state. • Ensure the availability of trainers and the staff at the District Training Centre. • Post training evaluation of work output of the trained personnel • A list of Resource persons will be developed from the State for specialized issues. Support • RIHFW to develop the training calendar and organize the trainings as per required schedule for district staff

• Cooperation of Medical colleges for providing trainings on EmOC, MTP, Neonatal Care • Monitoring of training quality and assessment of post training work output • State support for placement of the personnel trained in various specialized issues at the right facilities • Ensuring staff at the District training centre Timeline Activity Plan 2008-09 2009-10 2010-11 2011-12 Construction of Training Hall X - - - TBA training X X X X MVA / MTP training to all X X X X PHC MOs Training on Blood transfusion for MOs and Lab Technicians X X X X of CEmOC centres - 3 days Training in Obstetric management & skills for 24x7 X X X X PHC for 16 weeks Training in Skilled Birth X X X X attendants for 15 days IMNCI training to ANM/LHV, X X X X SN, ASHA for 8 day IMNCI training to MOs X X X X Training in Life saving/ Anesthesia for EmOC at CHC X X X X for MOs (State Budget ) Integrated skill training of X X X X Staff Nurses Integrated skill training for X X X X ANMs Integrated skill training for X X X X MOs Training of MOs/ SN in Mgt of Newborns & sick children at X X X X Medical College Training in BCC for MOs, X X X X LHV, ANM Training of Ayush personnel on issues of RCH and X X X X reporting Training on NSV for MOs at X X X X NSV camps Training on Minilap X X X X Training for Laparoscopic Sterilization- Surgeons, X X X X Gynaecologists, SN, OT attendants-12 days Orientation on contraceptive devices for MOs - Govt as X X X X well as private facilities

Training on Medico-legal X X X X aspects to MOs CME sessions for doctors each month during the X X X X monthly meetings on current topics Orientation on PCPNDT Act for Dy. CMO, CMOs, doctors both Govt and private, X X X X members of District Appropriate authority NGOs in a workshop General & Financial rules (G & FR) for Officials, MOs, X X X X clerical staff for 3 days Financial management training for Accounts Officers, X X X X Accountants for 2 days Computer training to all the MOs, Clerical staff, accounts X X X X personnel CNAA for MOs, LHV, ANM & X X X X MPW, AWW Total sanitation orientation and reorientation of VHWSC X X X X x 1 day Training of NGOs in BCC X X X X Professional Development course for District Prog. X X X X Managers, Senior Officers, MOs- 10 weeks Training of ASHAs X X X X Budget Activity / Item 2008-09 2009-10 2010-11 2011-12 Total Construction of training hall 10.0 0.0 0.0 0.0 10.00 @ Rs. 10.00lac Training of VHWSC@ 2.62 2.62 2.62 2.62 10.48 Rs.2000x131Committe ANMS @ 2000/ ANM 5.36 5.36 11.08 11.08 (268*2000) 32.88 Nurses @ 2000/ 3.8 3.8 3.8 3.8 15.2 nurse(190*2000) MO @ 20000/ MO(94*20000) 18.8 18.8 18.8 18.8 75.2 Specialists @ 20000/ 14.4 14.4 14.4 14.4 57.6 specialists (72*20000) Lab. Technician (69)@ 6.9 6.9 6.9 6.9 27.6 10000/L.t. TBA @ 1000/TBA(1000*622) 6.22 6.22 6.22 6.22 24.88 MVA MTP training to all PHC 32.7190 MOs for 15 days @ Rs 500 x 7.05 7.755 8.5305 9.38355 5 15 days x MOs

MOs @ Rs 500/day/person x 1.41 1.551 1.7061 1.87671 6.54381 3 days Lab Technicians @Rs 200 0.189 0.189 0 0 0.378 /person x 3 days MOs: Rs 500/day x 112 days 1.12 11.2 11.2 11.2 34.72 x 2 MOs StaffNurses:Rs200/dayx112d 0.448 4.48 4.48 4.48 13.888 aysx 2 SNs One batch of 4 persons: Rs. 7500 as hon. to participants, Rs 13500 hon. to training 4 16 16 16 52 team, 15% institutional charges, = Rs 25000/batch - 16 batches Rs 300 as hon. to participant 1.032 2.1912 2.41 2.651 8.2842 x 8 days IMNCI training to MOs @ Rs 5.0666 5390 /participant Integrated skill training of all 0.408 0.8976 1.4688 1.5912 4.3656 SN @ Rs 4080/person Integrated skill training for 0.2048 0.5632 0.6144 0.6656 2.048 ANMs @ Rs 2048/person Integrated skill training for 0.18415 0.203 0.223 0.245 0.85515 MOs @ Rs 3683 Training of MOs, SN in Mgt of Newborns & sick children at Medical College Srinagar @ 0.24 0.264 0.29 0.319 1.113 Rs 7500/MO, Rs 4500 ( Rs 300 x 15 days)/SN Training in counseling for 0.76 0.836 0.92 1.012 3.528 MOs, LHVs, ANMs Training of Ayush personnel on issues of RCH and 0.459 0.5049 0.555 0.611 2.1299 reporting for 3 days Training on NSV for MOs at 0.42 0.462 0.508 0.559 1.949 NSV camps Training on Minilap @ Rs 500 per day for 15 days and 0.6 2.64 2.904 3.194 9.338 during camps Training for Laparoscopic Sterilization for Surgeons, 0.24 0.264 1.162 1.278 2.944 Gynaecologists, SN, OT attendants for 12 days Orientation on contraceptive devices for MOs - Govt as 0.4 0.44 0.484 0.532 1.856 well as private facilities Training on Medico-legal 0.5 0.825 0.908 0.998 3.231 aspects to MOs

100

Continuing Medical Education sessions for doctors each month during the monthly 2.5 2.75 3.025 3.328 11.603 meetings on current topics @ Rs 25000 per CME Orientation on PCPNDT Act for DCs, CSs, doctors both Govt and private, members of 0.5 0.55 0.605 0.666 2.321 District Appropriate authority NGOs in a workshop General & Financial rules (G & FR) for Officials, MOs, 1.05 1.155 1.271 1.398 4.874 clerical staff for 3 days Financial management training for Accounts Officers, 0.2 0.22 0.242 0.266 0.928 Accountants for 2 days Computer training to all the MOs, Clerical staff, accounts 3 1.65 0 0 4.65 personnel @ Rs 200 per person x 15 days CNAA for MOs, LHVs, ANMs, 1.57 0.5214 0.22 0.22 2.5314 AWW Total sanitation orientation and reorientation of VHWSCs 0.772 0.8492 0.934 1.028 3.5832 x 1 day @ Rs 200/person/day Training of NGOs in BCC @ 0.54 0.594 0.653 0.719 2.506 Rs 300 per person x 6 days Total 102.963 123.228 131.264 134.784 492.241 6 8 4 7 4

101

11.HUMAN RESOURCE PLAN

Human Resource Plan Situation 800 ASHA’s have been recruited so far. Additional ASHA needs more to be Analysis/ recruited. Adequate no. of posts of MO’s and specialists doctors are sanctioned but availability is very small Out of 82 sanctioned posts only 30 posts are filled up and there is shortage of 52 specialist’s doctors. Objectives All vacant positions of specialists, MO’s and other Para medical staff shall be filled and trained. Para medical staff shall be imparted training on basic needs and other national programs To have trained and highly capable staff by 2012. Strategies & Procure equipments for carrying out work creatively. Activities Impart training on need basis to doctors and Para medical staff Request to government for additional MO’s and specialists from Govt. Support Funds for training required Recruitment of Doctors and other Para medical staff by GOI and State Govt. Timeline Activity Plan 2008-09 2009-10 2010-11 2011-12 Recruitment of Contractual - - - - Manpower Staff- Obstetrician 8 /Gynecologist Pediatrician 9 Anesthetic 5 Public health Programme 9 Manager Eye surgeon 8 Public Health Nurse 8 Staff Nurse 36 Dresser 7 Sweeper, Chowkedar, 9x5 OPD& OT Attendant Statistical Assistant 3 Registration Clerk 3 Medical Officer -PHC 29 Pharmacist 3 Staff Nurse 77 CHC staff for 02 new CHCs as per norms Clinical manpower Supportive Manpower Staff for new PHCs Medical Officers for new 14 PHCs Pharmacist for new PHCs 07 Staff Nurse for new PHC 21 Lower Division Clerk for new 07 PHCs 102

Laboratory Technicians for 07 new PHCs ANMs at Subcentres 143 For DISTRICT HOSPITAL Specialist 2 Surgeon specialist 2 Obstetrician / Gynecologist 3 Psychiatrist 1 Dermatologist 1 Pediatrician 2 Radiologist 1 Microbiologist 1 Forensic Expert 1 Public Health Manager 1 AYUSH physician 2 Pathologist 1 Staff Nurse 70 OT Blood Bank 5 Sanitary Worker 9 Social Worker / Counselor 1 Cytotechnician 1 ECHO technician 1 Laboratory. Technician 12 Laboratory. Attendant 4 Dietician 1 ANMs 5 Radiographer 2 Dark room assistant 1 Pharmacists 1 Pharmacist ISM 3 Matron 1 Assistant Matron 2 Physiotherapist 1 Statistical Assistant 1 Medical record officer 1 Jr. Administrative Officer 1 Superintendent 1 Junior Assistant / Typist 2 Accountant 2 Record Clerk 1 Office Assistant 1 Computer Operator 1 Peon / Security Staff Safai 4 karamchari Operation Theatre Staff 8 Nurse Blood Bank Staff Nurse 2 MNA/FNA 1 Sweeper 2

103

Dietician 1 1 Budget in 2009- 2010- 2011- 2008-09 Total Lacs 10 11 12 CHC Staff :----- Obs /Gyn 8@ 26270 per 25.22 25.22 25.22 25.22 100.88 month Paediatrician9@ 28.37 28.37 28.37 28.37 113.48 26270/month) Anesthetic- (5@ 26270 / 15.76 15.76 15.76 15.76 63.04 Môn.) Public health P M- 28.37 28.37 28.37 28.37 113.48 (9@26270 / Môn.) Eye surgeon- (8@26270/ 25.22 25.22 25.22 25.22 100.88 Môn.) Public health nurse-8 @ 13.69 13.69 13.69 13.69 54.76 14265/ Môn.) Staff nurse- (36@ 12800/ 55.3 55.3 55.3 55.3 221.2 Môn.) Dresser- (7@5777/mon.) 4.85 4.85 4.85 4.85 19.4 Sweeper, Chowkedar, OPD & OT Attendant- (9 @5777/ 6.23 6.23 6.23 6.23 24.92 Môn.) Statistical assistant- (3@ 2.73 2.73 2.73 2.73 10.92 7610/ Môn.) Registration clerk- (3@8000/ 2.88 2.88 2.88 2.88 11.52 Môn.) Salary for 18 AYUSH MO’s- 2 AYUSH Doctor (1 male /1 22.74 22.74 22.74 22.74 90.96 female) x 9 CHCs @ Rs.2, 52,660 per year CHC STAFF for 2 new

CHCs:- 14 specialists viz., Gen. surg., Phy., O/G., Pead., 44.133 0 44.1336 44.1336 132.4008 Anaest., PHPM.,Eye surg.@ 6 26270/ M Staff nurses 20 @ 12800 / M 0 30.72 30.72 30.72 92.16 Public Health nurse @14265 0 3.4236 3.4236 3.4236 10.2708 / M Computer Clerk 2 @ 7610 / 0 1.8264 1.826 1.8264 5.4788 m Pharmacist 2 @ 12810 / m 0 3.0744 3.0744 3.0744 9.2232 Lab. Tech. 2 @ 9900 / M 0 2.376 2.376 2.376 7.128 Block extension educator 2 0 3.0744 3.0744 3.0744 9.2232 @ 12810 / M Radiographer 2 @ 9900 / M 0 2.376 2.376 2.376 7.128 UDC 4 @ 8057 / M 0 3.8673 3.8673 3.863 11.5976 LDC 2 @ 6650 / M 0 1.596 1.596 1.596 4.788

104

Epidemiologist medical 0 5.5164 5.5164 5.5164 16.5492 doctor 2 @ 22985 Dresser1, Ward Boy2, Dhobi1, Sweeper3, 7.6256 0 7.62564 7.62564 22.87692 Chowikdar1, Aya1, Peon1& 4 Mali1 / CHC @ 5777 / M X 2 PHCS STAFF:- PHC-MOs 29 @ 21000 / 73.08 73.08 73.08 73.08 292.32 month Pharmacist 3@ 12800/ 4.61 4.61 4.61 4.61 18.44 month Staff nurse 77 @ 12800 118.27 118.27 118.27 118.27 473.08 PHCS STAFF for new 07

PHCs:---- MOs @ Rs. 21000/M x 12 x14 0 35.28 35.28 35.28 105.84 (for new PHCs from 2010) Pharmacist 07 @ 12800/M 0 10.752 10.752 10.752 32.256 (for new PHCs from 2010) Staff Nurse 21 @ 12800/M 0 32.256 32.256 32.256 96.768 (for new PHC from 2010) LDC 07 @ 7610/M 0 6.3924 6.3924 6.3924 19.1772 (for new PHCs from 2010) UDC / Com. Clerk 07 @ 0 8.316 8.316 8.316 24.948 9900 / M Lab. Tech 07 @ 9900/M 0 8.316 8.316 8.316 24.948 (for new PHCs from 2010) Class IV 28 @ 5777 / M 0 19.41 19.41 19.41 58.23 Sub Centres STAFF:- ANMS @ Rs11355x12x143 194.85 194.85 194.85 194.85 779.4 Sub Centres STAFF for new 134 SCs:------ANM’s for new 134 SC’s 365.17 1095.530 from 2010 @ 11355/ 0 365.177 365.177 7 4 month(268*11355*12) DISTRICT HOSPITAL :- Specialist 2 @ 26270/ month Surgeon specialist @ 6.31 6.31 6.31 6.31 25.24 26270/ month OG Specialist 3 @ 26270/ M 9.46 9.46 9.46 9.46 37.84 Psychiatrist 1 @ 26270/ M 3.15 3.15 3.15 3.15 12.6 Dermatologist 1 @ 26270/ M 3.15 3.15 3.15 3.15 12.6 Pediatrician 2 @ 26270/ M 6.31 6.31 6.31 6.31 25.24 Radiologist 1 @ 26270 / M 3.15 3.15 3.15 3.15 12.6 Microbiologist 1 @ 26270/ M 3.15 3.15 3.15 3.15 12.6 Forensic expert 1 @ 26270/ 3.15 3.15 3.15 3.15 12.6 M Public health manager 1 @ 3.15 3.15 3.15 3.15 12.6 26270/ M

105

AYUSH physician 2 @ 6.31 6.31 6.31 6.31 25.24 26270/ M Pathologist 1 @ 26270/ M 3.15 3.15 3.15 3.15 12.6 Staff nurse 70 @ 12800/ 107.52 107.52 107.52 107.52 430.08 month OT blood bank 5 @ 9900 / M 5.94 5.94 5.94 5.94 23.76 Sanitary worker 9 @ 5777/ 6.24 6.24 6.24 6.24 24.96 M Social worker Councillor- 1.8 1.8 1.8 1.8 7.2 1@15000/ M Cytotechnician 1 @ 9900/ M 1.19 1.19 1.19 1.19 4.76 ECHO technician 1 @ 9900/ 1.19 1.19 1.19 1.19 4.76 M Lab. Technician 12 @ 9900/ 14.26 14.26 14.26 14.26 57.04 M Lab. Attendant 4 @ 5777/ M 2.77 2.77 2.77 2.77 11.08 Dietician 1 @ 10000/ M 1.2 1.2 1.2 1.2 4.8 ANM 5 @ 11355/ M 6.81 6.81 6.81 6.81 27.24 Radiographer 2 @ 9900/ M 2.38 2.38 2.38 2.38 9.52 Dark room assistant 1 @ 0.91 0.91 0.91 0.91 3.64 7610/M Pharmacists Pharmacist ISM 3 @ 12800/ 4.61 4.61 4.61 4.61 18.44 M Matron 1 @ 8000/ M 0.96 0.96 0.96 0.96 3.84 Assistant Matron 2 @ 5000/ 1.2 1.2 1.2 1.2 4.8 M Physiotherapist 1 @ 15000/ 1.8 1.8 1.8 1.8 7.2 M Statistical Assistant 1 @ 0.91 0.91 0.91 0.91 3.64 7610/ M Medical record officer 1@ 1.8 1.8 1.8 1.8 7.2 15000/M Jr. Administrative officer 1@ 0.96 0.96 0.96 0.96 3.84 8000/M Superintendent 1@ 10000/ 1.2 1.2 1.2 1.2 4.8 M Junior Ass. Typist 2.38 2.38 2.38 2.38 9.52 2@9900/month Accountant 2@ 10000/M 2.4 2.4 2.4 2.4 9.6 Record Clerk 1@9900/M 1.19 1.19 1.19 1.19 4.76 Office Assistant 1@ 7610/M 0.91 0.91 0.91 0.91 3.64 Computer Operator 0.72 0.72 0.72 0.72 2.88 1@6000/ M Peon Security staff Safai karamchari @ Rs.4000 / 1.92 1.92 1.92 1.92 7.68 Month x 12 x 4 O.T ,Staff Nurse 8 @ 12800 12.29 12.29 12.29 12.29 49.16 / M

106

Blood Bank Staff Nurse 3.07 3.07 3.07 3.07 12.28 2@12800/M MNA/FNA 1@7000/M 0.84 0.84 0.84 0.84 3.36 Sweeper 2@3000/M 0.72 0.72 0.72 0.72 2.88 Total 1460.2 5245.322 864.7 1460.21 1460.2 1 12

107

12.PROCUREMENT AND LOGISTICS Procurement and Logistics Situation Warehousing facility for storage of medicines and equipment is not available in the Analysis/ district. Need of warehouse at District Level Cold Chain facility will be required for new CHCs/PHCs that are to be constructed. . Current system of Inventory Management, indenting, receipt and issue records, stock taking and tallying, wastage control, replacements etc is inadequate Personnel required at District – Data Entry Operator/ Store Keeper, Watchman numbers, training. Block Level – Store keeper and watchman. Distribution to PHC, SCs by way of indenting. Objectives Create facility for storage of drugs, medicines and equipments. Construct a fully equipped Warehouse Recruitment of skilled staff- warehouse Manager, 2 or 3 Computer operators, Store keepers, night watchman. Strategies Allocation of funds construction of Warehouse, procurement of computers and other & peripherals and Cold Chain Maintenance Activities Requirement of staff like Warehouse manager, Computer knowing person, peon, Night watchman. Support Funds to construct Warehouse and other equipments. required Recruit staff and train them. Timeline Activity Plan 2008- 2009- 2010- 2011- 09 10 11 12 Construction of Warehouse x Software x Computer system with UPS, x Printer, Scanner, Equipment & Hardware x Pharmacist @ Rs 9000/mth x Assistant Pharmacist @ Rs x 5000/mth Security Staff @ Rs 6000/mth x Training of personnel x Consultancy to agency for x Operationalisation of the Warehouse Budget 2008- 2009- 2010- 2011- Activity / Item Total 09 10 11 12 Construction of Warehouse and 100.00 10.00 10.00 10.00 130.00 maintenance Software 0.25 0.00 0.00 0.00 0.250 Computer system with UPS, 0.60 0.00 0.00 0.00 0.600 Printer, Scanner, Equipment & Hardware 34.5 0.00 0.00 0.00 34.50 Pharmacist @ Rs 9000/mth 1.08 1.19 1.31 1.44 5.020 Assistant Pharmacist @ Rs 0.6 0.66 0.726 0.799 2.785 5000/mth Packers -1 @ Rs 4000/mthx1 0.48 0.528 0.581 0.639 2.228 Security Staff @ Rs 6000/mth 0.72 0.792 0.871 0.968 3.351

108

Training of personnel 0.1 0.11 0.121 0.133 0.464 One washing machine 20 Kg @ 0.5 0.00 0.00 0.00 0.50 Rs 50000 Consultancy to agency for Operationalisation of the 2.00 2.10 0.00 0.00 4.10 Warehouse Total 140.83 15.38 13.609 13.979 183.798

109

13. DEMAND GENERATION – IEC

Demand Generation - IEC Situation In spite of availability and accessibility of health services in all parts of the district, Analysis community is not fully utilizing the services due to lack of information on availability and need for health services. There i low demand for health services. Objectives To create demand for utilization of available health services through audio/video shows, print and electronic media for communication at mass level. To make employees (ANM’s, ASHA’s, and MO’s) responsible for organizing meetings at village level for demand generation through mass communication and IPC. Mothers meeting to be held in each village every month to address the above mentioned issues and for community action. Meetings of adult males to be held in each village to discuss issues related to males in each village every month and for community action Strategies To train / recruit the M.O’s, ANM’s, AWW’s, teachers etc for conducting meetings at & village level for mass communication and IPC. Display of hoardings and banners. Activities Support Funds for CD players, LCD projector, printing material, radio and TV advertisement. required Transport facility for MO’s, ANM’s, ASHA’s, and AWW’s for conducting meetings. Timeline Activity / Item 2008-09 2009- 2010-11 2011-12

10 Finalizing the messages x x x x

Advertisements x x x x TV spots x x x x Radio Jingles x x x x Budget Folk Media shows x x x x Hoardings on highways and x x x x prominent places Total Display boards x x x x Pamphlets x x x x Developing Nirdeshika for x holding VHD days Monthly Swasthya Darpan x x x x Orientation & training of all frontline govt functionaries and elected representatives VCD in each village quarterly x x x x Bal Nutrition Melas x x x x Adolescent meetings x x x x Opinion leaders workshops x x x x Wall writings x x x x Budget Activities 2008-09 2009- 2010-11 2011-12 Total 10 Hiring of an agency for carrying out the intensive 40.00 44.00 48.4 53.24 185.64 IEC & behavior change activities

110

Finalizing the messages in 1.0 1.1 1.21 1.331 4.641 local language Advertisements 5.0 5.5 6.05 6.655 23.205 TV spots 1.0 1.1 1.21 1.331 4.641 Radio Jingles in local 1.0 1.1 1.21 1.331 4.641 language Folk Media shows @ Rs 6.22 6.8420 7.5262 8.2788 28.867 1000/village Hoardings @ Rs 10.00 11.00 12.1 13.31 46.41 10000/hoarding Display boards @ Rs 1.8 1.98 2.178 2.396 8.354 2000/board Pamphlets @ Rs 10.0 11.0 12.1 13.31 46.41 10/pamphlets x 10000 Nirdeshika for Fixed Health Nutrition days @ Rs 20/ 1.6 1.76 1.936 2.13 7.426 Nirdeshika x 8000 Swasthya Darpan @Rs.10 0.8 0.88 0.968 1.065 3.713 /copy/mth x 8000 Orientation of elected rep and PRIs@ Rs 200 x 2000 4.00 4.4 4.84 5.324 18.564 persons x1 day Village campaign @ Rs 227.889 69.132 lakhs per Campaign 207.172 250.678 275.746 961.4852 2 x 4 times in a year Bal Nutrition Melas @ Rs 5.688 6.257 6.882 7.571 26.398 300 x 4 times x AWCs Adolescent meetings @ Rs 0.6220 0.6842 0.7526 0.8279 2.8867 100 per group x 622 villages Community and religious leaders workshops @ Rs 1.2 1.32 1.452 1.597 5.569 300 /person x 100 x 4 times Wall writings @ Rs 200 x 1.244 1.3684 1.5052 1.6558 5.7734 622 villages Total 328.180 397.099 298.346 360.998 1384.624 8 5

111

14. FINANCING OF HEALTH CARE Financing Health Care Situation Financial support is needed for implementation of NRHM activities and its Analysis/ sustainability. The main source of finance is budget provided by the state government. Additional flexi pool budget is allocated by Government of India. Small contribution through levy of user charges is also introduced in hospitals. Rogi Kalyan Samitis (RKS) have been formed in each of the hospitals, CHC and PHC in District Budgam District. RKS are autonomous societies empowered to take local decision to collect user fees for services provided at health facilities. Formation of these RKS has resulted in great satisfaction amongst the patients and staff as additional fund is available with health facilities to care for the people. Members of RKS have little information on powers, responsibilities and functions of Rogi Kalyan Samitis. Objectives Availability of sufficient fund for providing quality health care services and implementation of NRHM activities. Decentralization of powers for local level decision on flexibility for use of funds as per local needs. Strategies 1. Generation of funds from user charges & 2. Excepting donations from individuals Activities Efficient management of Rogi Kalyan Samitis Support Regular periodic meetings of RKS for better implementation of NRHM activities and required solving of local issues. Training of RKS members and guidelines. Timeline Activity 2008-09 2009- 2010- 2011- 10 11 12 Provision of Seed money @ Rs 1 x x x x lakh per CHC and PHC Training of the Incharges and x x x x second in command Development of Software for x x x x RKS with training of personnel on the use

Budget Activity 08-09 09-10 10-11 11-12 Total Provision of Seed money @ Rs 1 lakh per CHC and PHC @ Rs 54.00 63.00 69.30 76.23 262.53 1.00 lakhs Training of the Incharges and second in command @ Rs 1000 1.1 1.21 1.331 1.452 5.093 per person x 1 day Development of Software for RKS with training of personnel on 5 0.25 0.25 0.25 5.75 the use Total 60.1 64.46 70.881 77.932 273.373

112

15. SCHOOL HEALTH School Health

Situation At present school health checkups are being carried out by existing medical Analysis staff where in addition to health checkups the health education activities are being carried out. Treatment of minor ailments, referrals, dental checkups and refractions are being carried out. The monthly reports of work done are submitted to Block Headquarters / District Headquarters. Objectives/ Regular Health check up of school children, identification of sick children, Milestones/ providing treatment to these children including surgical interventions with Benchmarks ultimate objective of reducing child mortality Strategies & Engagement of dedicated contractual staff to conduct health check ups of all Activities the school children on monthly basis under supervision of District Programme as existing staff cannot carry out the school health activities in all educational institutions on regular basis. Provision of drugs, supplies and transport facilities. • Provision of IEC material- posters, pamphlets, hand bills and audio visual aids for carrying out Health education activities on Nutrition, Hygiene, Sanitation, Adolescent health, Drug Addiction, immunization and National Health Programmes Provision of supplementary nutrition Training of doctors / paramedics regarding school health. Provision of spectacles for children having refractive errors. Training of teachers in batches for carrying out health education on preventive measures for both communicable and non communicable diseases. Signs and symptoms of common health problems prevalent in school children and their referral. Extensive school health camps. Provision of Vehicles for logistic support. Usage of Mobile Medical Unit and appointment of staff thereto for exclusive school health team. On spot diagnosis and corrections. Follow up of Identified abnormal children through ASHAs/ANMs Making one Health Checkup compulsory before joining a new class. Support Govt. Support required School Education Deptt. School Managing committees, Village Health Committees. Timeline Activity Plan 2008-09 2009-10 2010-11 2011-12 Organizing health check up x x x x camps Supply of sanitary pads x x x x IEC activities x x x x Training of Teachers x x x x Construction of toilets in x x x x school Budget Activity / Item 2008- 2009- 2010- 2011-12 Total 09 10 11

113

Health checkups @ 25000 / 2.50 2.75 3.025 3.3275 11.6025 block Supply of sanitary pads for girls 12 above age @ 1.00 10.0 11.0 12.1 13.31 46.41 lac / block IEC programme @ 1.00 / 10.0 11.0 12.1 13.31 46.41 block Training of teachers @ 2.50 2.75 3.025 3.3275 11.6025 25000 / x10 School health camps @ 2.50 2.75 3.025 3.3275 11.6025 25000 x 10 Construction of toilets in schools 152.25 152.25 0 0 304.5 @ Rs.75000 x 406 schools Inter school competition 1.0 1.1 1.21 1.331 4.641 Total 180.75 183.6 34.485 37.9335 436.7685

114

16. BIO-MEDICAL WASTE MANAGEMENT

Bio-Medical Waste Management Situation As per the Bio-Medical Waste Rules, 1998, indiscriminate disposal of hospital Analysis / waste was to be stopped with handling of Waste without any adverse effects on the Current health and environment. In response to this the Government has taken steps to Status ensure the proper disposal of Biomedical waste from all Nursing homes, hospitals, Pathological labs and Blood Banks.

The District Health Officer is the Nodal Person in each district for ensuring the proper disposal of Biomedical Waste.

For effective disposal of Biomedical waste in the district; Trainings to the personnel for sensitizing them, Pits. Segregation of Waste is taking place though Separate Colour Bins/containers it has to be done more systematically. Proper Supervision is lacking.

The treatment (incineration) of waste is suppose to handled by a company selected at the State level but till date the company has not been selected. There is a monopoly of these companies so their charges are very high. Objectives 1. Stopping the indiscriminate disposal of hospital Waste from all the facilities by 2008 2. Ensuring proper handling and disposal of Biomedical Waste in each Facility

Strategies 1. Capacity Building of personnel 2. Proper equipment for the disposal and disposal as per guidelines 3. Strict monitoring and Supervision

Activities 1. Review of the efforts made for the Biomedical Waste Interventions 2. Development of Microplan Plan for each facility in District & Block workshops 3. Capacity Building of personnel. Biomedical Waste management to be part of each training in RCH and IDSP 4. Proper equipment for the disposal Installation of the Separate Colour Bins/containers and Plastic Bags for the bins 5. Segregation of Waste as per guidelines 6. Partnering with Private providers for waste disposal 7. Proper Supervision and Monitoring Formation of a Supervisory Committee in each facility by the MOs and the Supervisors

Timeline 2008 2009 2010- 2011 Activity - 09 -10 11 -12 Orientation and Reorientation for the personnel for Biomedical Waste Management at District x x x x and Block levels Consumables x x x x Payment for the incinerators x

115

Budget 2008- 2009- 2010- 2011- Activity Total 09 10 11 12 Orientation and reorientation for 1.996 2.1961 Biomedical Waste Management 1.65 1.815 7.65765 5 5 at District and Block levels Consumables 2.2 2.42 2.662 2.928 10.21 incinerators 5.0 00.00 00.00 0.00 5.00 4.658 5.1241 22.8676 Total 8.85 4.235 5 5 5

116

Annexure – I Facility Survey

117

Table:1 Percentage Availability of Infrastructure District: Budgam SC Indicators PHC (45) CHC (9) DH (134) 1 Building (Govtt. + Donated) 24 36 100 100 2 Building (Rented) 76 64 0 0 3 Condition of Building (Good + Fair) 72 100 100 100 Water Supply (Tap, bore well/ hand 16 41 100 100 4 pump / tube well, well) 4.1 Tap water supply 14 33 100 100 5 Electricity 3 63 100 100 5.1 In all parts of hospital Na 19 100 100 Electric supply (power generation Na Na Na 100 5.2 stabilization) 6 Separate Toilet Na Na 44 100 6.1 Sep. Toilet with running water Na Na Na 100 7 Furniture 11 48 48 58 8 Labour Room 0 8 100 100 8.1 Aseptic labour room Na Na Na 100 9 Avail. of Quarter for staff Na Na Na 10 Number of beds available (Average) 6 NA 11 Laboratory 43 100 100 12 Operation Theatre 6 89 100 13 Waste Disposal (Burnt Dump) 100 100 100 14 Availability of incenator Na 0 0 15 Telephone 0 85 100 16 Computer 0 0 100 17 Generator / Invertors 0 100 100 18 Vehicle 49 100 100 19 Emergency Room / Casualty 57 NA Separate wards for males and females 100 100 20 (Yes/No)

21 No. of beds : Male 12 NA 22 No. of beds : Female 13 NA 23 Availability of ECG facilities 88 100 24 X-Ray facility 77 100 25 Ultrasound facility 66 100 26 Cardiac Monitor for OT 57 100 27 Blood Storage Unit available 0 100 28 Blood Bank Facility 100 29 Other Investigative Facility 48 30 Heating ventilation & air conditioning 100 31 Lift & vertical transport 0 32 Refrigeration 100 Na = Not Applicable

118

Table: 2 Identified Gaps of Manpower District- Budgam

Name of Blocks Gap Staff Total Total Khag Khag No. 0f No. 0f Nagam Nagam magam Budgam Budgam Soibugh Chadora Chadora Beerwah Req.Staff Req.Staff Khansahib Khansahib No.of Exis No.of Exis Chattergam Chattergam Chiarshrief IPHS No. of Sub- Centres Norm 19 8 17 14 16 14 17 6 15 8 (134)

ANM 2 20 10 18 14 16 15 22 5 10 13 268 125 143 N0. Of PHC's(45) 7 2 4 1 9 3 6 2 8 3 MO 2 -1 2 3 0 7 3 5 -4 11 2 90 62 28 Pharmacist 1 0 0 0 0 0 0 0 0 0 0 45 45 0 Nurse 3 18 4 3 0 22 3 18 4 22 9 135 32 103 Female Health 1 -2 0 3 0 9 3 0 0 8 1 45 23 22 Worker Health Educator 1 5 2 3 0 7 3 3 2 8 3 45 9 36 Health Assistant 2 9 3 6 2 18 6 12 3 14 6 90 11 79 Clerks 2 13 3 6 2 17 6 11 1 16 6 90 9 81 Lab. Technician 1 4 2 3 0 6 3 4 0 8 1 45 14 31 Driver _ 6 2 3 1 9 3 6 0 4 0 Class lV 4 9 6 5 2 14 5 7 1 19 1 180 111 69 Total 61 24 35 7 109 35 66 7 110 765 316 449 No. of CHC's (9) A. CLINICAL NA 1 1 1 2 2 1 NA 1 NA MANPOWER General Surgeon 1 0 0 0 0 0 0 0 9 9 0 Physician 1 1 1 0 1 1 0 1 9 4 5 Obstetrician / 1 1 1 1 2 2 0 1 9 1 8 Gynaecologist Paediatrics 1 1 1 1 2 2 1 1 9 0 9 Anaesthetist 1 1 1 0 2 1 0 0 9 4 5 Public Health 1 1 1 1 2 2 1 0 9 1 8 Programme Mgr. Eye Surgeon 1 1 1 1 2 2 0 1 9 1 8 Other specialists (if any) General duty officers

(M O) B. SUPPORT

MANPOWER Nursing Staff 7+2 Public Health Nurse 1 1 1 1 2 2 1 0 9 1 8 ANM 1 0 -2 0 0 1 0 -3 9 13 -4 Staff Nurse 7 5 7 4 14 7 0 -1 63 27 36 Nurse/Midwife Dresser 1 1 1 0 2 2 1 0 9 2 7 Pharmacist / 1 0 -1 -5 0 1 -1 -1 9 16 -7

119 compounder Lab. Technician 1 1 0 -1 2 0 0 -2 9 9 0 Radiographer 1 1 0 1 2 1 0 1 9 3 6 Ophthalmic Assistant 1 0 0 0 1 0 0 0 9 8 1 Ward boys / nursing 2 -1 0 -6 2 2 0 -2 18 23 -5 orderly Sweepers 3 1 0 -1 0 3 0 -5 27 29 -2 Chowkedar 1 1 0 1 2 1 0 -1 9 5 4 OPD Attendant 1 1 0 1 2 1 0 -1 9 5 4 Statistical Assistant / 1 0 1 0 0 2 0 0 9 6 3 DEO OT Attendant 1 1 1 1 1 1 0 0 9 4 5 Registration Clerk 1 1 0 0 2 0 0 0 9 6 3 Any other staff

(specify) Total 19 14 0 43 34 3 0 -11 279 177 102 Note: ( - ) Surplus staff

120

Table 2A Man power at District Doctors Para-Medicals Identified Identified Current Current Current Avail. Avail. Avail. Norm Norm Norm Gaps Gaps Gaps IPHS IPHS Personnel Personnel

75 to Hospital Superintendent 1 1 0 Staff Nurse* 0 75 100 Hospital worker (OP/ward Medical Specialist 3 1 2 20 15 5 +OT+ blood bank)

121

Administrative Staff Operation Theatre Identified Identified Current Identified Norm Norm Avail. Gaps Gaps IPHS Current Gaps Gaps IPHS Avail Personnel Staff Norm

122

Table:3 Percentage Availability of Equipments

Name of Blocks Khag Khag Nagan Nagan Magam District Budgam Budgam Beerwah Chadora Avg.% inAvg.% Soibuigh Khansihab Khansihab Chattergam Chattergam Charersharief Charersharief IPHS No. of SC's (134) 19 14 17 16 14 17 6 8 15 8 Norm

56 89 25 16 11 11 13 16 7 13 13 22 kit- C No. of PHC's (45) 7 1 4 9 3 6 2 2 8 3 Suggested 36 23 22 31 52 31 11 67 49 52 52 37.6 equipments Operational labour 10 30 50 10 90 10 20 70 75 90 90 49.4 room Pap Smear 11 36 36 36 67 36 36 82 70 67 67 51.8 Laboratory Reagents 10 10 10 10 80 10 10 80 12 80 80 33.6 Glassware and other 10 7 90 14 7 7 28 100 0 100 100 49.6 equipment 0 Furniture 25 60 40 44 60 44 12 58 44 60 60 46.9 TOTAL 99 42 29 23 75 23 20 76 42 75 75 47.8 No. of CHC's (9) NA 1 1 2 2 1 NA 1 1 NA Standard Surgical 32 16 38 0 41 94 38 40 38.1 Set-1 Standard Surgical Set 33 6 12 0 33 91 12 25 25.6 - II IUD Insertion Kit 19 0 37 0 89 100 37 42 43.6 Standard Surgical Set 17 41 12 0 0 88 12 25 25.4 - III Normal Delivery 12 75 33 0 67 100 33 55 51.9 Standard Surgical Set 16 50 0 0 0 100 0 30 25.7 - IV Standard Surgical Set 21 5 0 0 0 100 0 19 17.7 - V Standard Surgical Set 11 0 9 0 0 100 9 25 20.4 - VI Equip. for 17 35 6 0 59 88 6 38 33.1 Anaesthesia Equip.for Neo-natal 10 4 0 0 0 100 0 21 17.9 Resuscitation Materials Kit for Blood 15 0 0 0 0 100 0 20 17.1 trans. Equip. for OT 11 81 18 0 36 82 18 43 39.7 Equip. for Labour 13 85 46 0 62 15 46 42 42.3 room Equip. for Radiology 9 78 33 0 44 67 33 44 42.7 TOTAL 236 34 17 0 31 87 17 34 31.5

123

Table: 4 Percentage Availability of Medicine District: Budgam

Khag Khag Nagam Nagam Magam District % of the % the of Average Budgam Budgam Beerwah Chadora Soibuigh Khansihab Khansihab Chattergam Chattergam

Name of Blocks Charersharief IPHS 19 14 17 16 14 17 6 8 15 8 Sc's ( 134) Norm Kit- A 5 60 0 0 0 0 0 0 0 20 20 8.9 Kit- B 9 89 33 11 44 11 44 44 0 33 33 34.4 Drugs required by 6 100 17 17 17 0 17 17 0 17 17 22.4 ANMs and LHVs Other Drug&Vacci. 8 90 38 13 13 13 25 12 0 13 13 24.1 Med.req. for NDPC 7 90 14 14 14 11 14 14 14 14 14 22.1 Contracep. Req.for 4 100 75 50 25 50 25 25 50 25 25 47.2 F.Plang. Drug List for AWC 12 90 42 0 8 0 0 8 0 17 17 18.3 Total 51 88 31 15 17 12 18 17 9 20 20 24.8 PHC's (45) 7 1 4 9 3 6 2 2 8 3 Essen. & emerg. 38 21 55 34 21 34 18 60 84 61 61 43.1 obstetrics care drugs Antidots 4 25 25 25 25 25 25 62 0 63 63 30.6 Anticonvul./ 4 25 0 0 50 0 0 50 0 50 50 19.4 Antiepileptics Antiinfective Medicines 5 20 40 28 0 28 20 50 70 50 50 34.0 Antifilarials 1 90 0 0 0 0 0 50 0 50 50 21.1 Antibacterials 16 25 25 19 30 19 19 66 66 56 56 36.1 Dermatological 14 21 29 1 16 0 21 57 75 57 57 30.8 medicine Antilep.& 2 50 0 0 0 0 50 50 0 50 50 22.2 Antitubercullar Antifungal medicine 4 0 25 0 0 0 0 50 52 50 50 19.7 Antiprotozoal medicine 5 0 40 20 0 20 0 50 60 50 50 26.7 Blood Products and 13 0 8 6 0 6 0 50 77 50 50 21.9 Plasma Substitutes Antiseptics 6 33 0 7 0 7 0 50 75 50 50 24.7 Disinfectants 3 0 0 0 0 0 0 50 83 50 50 20.3 Diuretics 2 0 0 0 50 0 0 50 50 50 50 22.2 Gastrointestinal 22 18 27 16 60 16 18 68 77 50 50 38.9 Hormones, Endocrine 10 10 0 10 10 10 10 55 80 50 50 26.1 & Contraceptives Ophthalm. preparation 12 0 50 0 0 0 0 50 71 50 50 24.6 Psychotic Disorders 15 13 40 13 0 13 13 50 50 50 50 26.9 Sol. correcting water 9 44 44 39 0 39 44 56 50 56 56 41.3 Electrolyte and Acid- Vitamins & Minerals 3 67 0 43 0 43 67 67 67 67 67 46.8

124

Drugs under RCH 1 0 0 0 ## 0 0 50 60 50 50 28.9 Product Strength 31 10 55 32 2 32 13 60 68 58 58 36.7 formulation Units RTI / STI Drugs 10 20 60 15 30 15 20 60 63 58 58 37.9 Drugs & Consumable 6 50 0 0 17 0 0 58 42 58 58 25.0 for MVA TOTAL 236 23 22 13 17 13 14 55 55 54 54 29.4 CHC's (9) NA 1 1 2 2 1 NA 1 1 NA Essential drugs 70 41 41 85 39 90 47 39 54.6

125

ANNUXERE II Detailed Infrastructure

126

Table: 1 A Block :Chadoora District : Budgam

Ownership Condition Water Separate Labor Staff Name of SC of the of the Electricity supply toilet room Quarter Building Building

1 Bonen Govt. Good N N N N N

2 Checksarder Govt. Good N N N N N

3 Shumnag Govt. Good N N N N N

4 Wadipora Govt. Fair Y N N N N

5 Zuhama Rent. Fair Y N N N N

6 Gundmaqsood Rent Fair. Y N N N N

7 Namthal Rent Good N N N N N

8 Khathergund Rent Good Y N N N N

9 Hushroo Rent. Fair N N N N N

10 Buchroo Rent Fair N N N N N

11 Kaisermula Rent Fair N N N N N

12 Bugam Rent. Fair Y N N N N

13 Nowbugh Rent Fair N N N N N

14 Gowerpora Rent Good Y N N N N

15 Kultreh Rent. Fair N N N N N

16 Gopalsaif Rent Good N N N N N

Panzan 17 Rent Good Y N N N N

127

Table: 1 B Block :Chadoora District : Budgam water room Aseptic labor Laborroom / Staff Quarter Laboratory Theater Operation incilator disposal/ Waste Telephone Generator Vehicle Roomlity Emerg./Causua ECG /USG X-RAY Monitor Cardiac unit Bloodstorage Name of Buildingthe Ownershipof Watersupply allParts Electricity/In /withrunning Separate toilet PHC/CHC

Burn/ 1 Bugam Rent N N/N N/N N/N N Y N N N N N

Burn/ 2 Sursyar Rent Y N/N N/N N/N N Y N N N N N

Dump/ 3 A/D Hanjora Rent N N/N N/N N/N N N N N N N N

Dump/ 4 A/D Ranger Rent N N/N N/N N/N N N N N N N N

Burn/ 5 A/D Sogam Rent Y N/N N/N N/N N N N N N N N

Burn/ 6 Dadompora Govt N Y/Y N/N N/N N Y N N N N N

CHC Govt Dump/ 1 Y Y/Y N/N Y/N N Y Y Y Y Y Y/Y Y/Y Y Y N Chadoora . N

128

Table: 1 A Block: Soibugh Distric : Budgam

Ownership Conditio Water Separate Labor Staff Name of SC of the n of the Electricity supply toilet room Quarter Building Building

1 Arath Govt. Good N N N N N

2 Russoo Rent. Good N N N N N

3 Pymus Rent. Fair N N N N N

4 Wahabpora Rent. Fair N N N N N

5 Hajibagh Rent. Fair N N N N N

6 Khoshipora Rent. Fair. N N N N N

129

Table: 1 B Block: Soibugh Distric : Budgam room Staff Quarter Laboratory Theater Operation incilator disposal/ Waste Telephone Generator Vehicle ualityRoom Emerg./Caus ECG/USG X-RAY Monitor Cardiac storageunit Blood Name of Buildingthe Ownershipof Watersupply allParts Electricity/In runningwater toilet/with Separate Asepticlabor Labor room/ PHC/CH C

Burn/ 1 Soibugh Govt Y Y/N N/N Y/N N Y Y N Y Y N

Dump/ 2 Wadwan Rent N Y/N N/N N/N N Y N N N Y N

130

Table: 1 A Block : Chattergam District : Budgam

Ownership Condition Water Separate Labor Staff Name of SC of the of the Electricity supply toilet room Quarter Building Building

1 Shilina Govt Fair. Y N N N N

2 Rakshalina Govt Good N N N N N Natipora 3 Govt Good Y N N N N

4 Wagoora Govt. Fair N N N N N

5 Mochwa Govt. Fair Y N N N N

6 Sanatnagar Govt. Good N N N N N

7 Mehjornagar Rent. Fair N N N N N

8 Shankerpora Rent. Fair N N N N N

9 Checkpora Rent. Fair N N N N N

10 Samerbugh Rent. Good N N N N N

11 Khanda Rent. Fair N N N N N

12 Rambagh Rent. Good Y N N N N

13 Kralpora Rent. Fair N N N N N

14 Zolwa Rent. Good Y N N N N

15 K.P.Bagh Rent. Fair Y N N N N

16 Rawalpora Rent. Good Y N N N N

17 Dooniwari Rent. Good N N N N N

131

Table: 1 B Block : Chattergam District : Budgam allParts water running toilet/with Separate room Asepticlabor Labor room/ Staff Quarter Laboratory Theater Operation incilator disposal/ Waste Telephone Generator Vehicle ualityRoom Emerg./Caus ECG/USG X-RAY Monitor Cardiac storageunit Blood Name of Buildingthe Ownershipof Watersupply Electricity/In PHC/CHC

1 Govt Dump/ Chanpora N Y/Y N/N N/N N Y N N N N . N 2 CHC Burn/ Y Y/ Y N N Govt Y Y/Y Y/N Y/N N Y Y Y Y Y Chattergam N N 3 Dump/ Nowgam Rent Y Y/Y N/N N/N N Y N N N N N 4 Dump/ Puhro Rent N N/N N/N N/N N N N N N N N 1 Dump/ Lasjan Rent Y Y/Y N/N N/N N N N N N Y N

132

Table: 1 A Block : Magam District: Budgam

Ownership Condition of Water Separate Labor Staff Name of SC of the Electricity the Building supply toilet room Quarter Building

1 Mazhama Govt. Good N N N N N

2 Bedran Govt. Poor. N N N N N

3 Palpora Govt. Good N N N N N

4 Karhama Govt Fair N N N N N

5 Hanjibugh Rent. Poor N N N N N

6 Lalpora Rent. Good N N N N N

7 Batpora Rent. Good N N N N N

8 Ahmadpora Rent. Fair N N N N N

9 Nooripora Rent. Poor Y N N N N

10 Shipora Rent. poor N N N N N

11 Makhama Rent. Fair N N N N N

12 Kawoosa Rent. good N N N N N

13 Dhobiwan Rent. Fair N N N N N

14 Kanihama Rent. Fair N N N N N

133

Table: 1 B Block: Magam District: Budgam

Name of Buildingthe Ownershipof Watersupply allParts Electricity/In water /with running Separate toilet roo Asepticlabor Labor room/ Staff Quarter Laboratory Theater Operation incilator disposal/ Waste Telephone Generator Vehicle alityRoom Emerg./Causu ECG /USG X-RAY Monitor Cardiac unit Bloodstorage

PHC/CHC m

Burn/ 1 Narbal Govt Y Y/N N N N Y N N N N N

Burn/ 1 CHC Magam Govt Y Y/Y Y/N Y/N N Y Y Y Y Y Y/Y Y/Y Y Y N N

134

Table: 1 A Block: Berwah District: Budgam

Ownership Condition Water Separate Labor Staff Name of SC of the of the Electricity supply toilet room Quarter Building Building

1 Ichama Govt. Good N N N N N 2 Iskanderpora Govt. Fair N N N N N 3 Sail Rent. Fair N N N N N 4 Kandhama Rent. Fair N N N N N 5 Boneth Rent. Fair N N N N N 6 Mulshulla Rent. Good N N N N N 7 Charangam Rent.. Good N N N N N 8 Bonhama Rent. Fair N N N N N 9 Merpora Rent. Poor Y N N N N 10 Kandoora Rent. Fair N N N N N 11 Hard Malpora Rent. Fair N N N N N 12 Sonpah Rent. Fair N N N N N 13 Check Dewan Rent. Good N N N N N 14 Gamboora Rent Poor N N N N N 15 Dragger Rent Fair N N N N N

135

Table: 1 B Block : Berwah District : Budgam

Name of Building Ownershipof the Watersupply Parts Electricity/In all water /with running Separate toilet room Asepticlabor Labor room/ Staff Quarter Laboratory Theater Operation incinator Wastedisposal/ Telephone Generator Vehicle Room ty Emerg./Causuali ECG/USG X-RAY CardiacMonitor unit Bloodstorage PHC/CHC

Dump/ 1 Lalpora Rent N Y/N N/N N/N N N N N N N N Dump/ 2 CHurmujroo Rent N Y/N N/N N/N N N N N N N N Dump/ 3 Utterpora Rent N Y/N N/N N/N N N N N N N N Dump/ 4 Pethkoot Rent N Y/N N/N N/N N N N N N N N Dump/ 5 Aripathan Rent N Y/N N/N N/N N N N N N Y N Burn/ 6 Rathson Govt. Y Y/N N/N N/N N N N N N Y N Dump/ 7 Gondipora Govt. Y Y/N N/N N/N N N N N N N N Dump/ 8 Chewdara Govt. N Y/N N/N N/N N N N N N Y N Burn/ Y/ 1 CHC Berwah Govt. Y Y/N N/N Y/N Y Y Y Y Y Y Y/Y Y Y N N Y

136

Table: 1 A Block : Budgam District: Budgam

Ownership Condition Water Separate Labor Staff Name of SC of the of the Electricity supply toilet room Quarter Building Building

1 Humhama Govt Good Y N N N N

2 Hyderpora Govt. Fair Y Y N N N

3 Peerbagh Govt. Good Y Y N N N

4 Nadirgund Rent. Fair N Y N N N

5 Choon Rent. Fair N Y N N N

6 Razwan Rent. Good N N N N N

7 Kargam Rent. Good N N N N N

8 Ichkoot Rent. Fair N N N N N

9 Chitro Rent. Poor N N N N N

10 Gudsathu Rent. poor N N N N N

11 Sebdan Rent. Fair N N N N N

12 Galwanpora Rent. poor N N N N N

13 Labertal Rent. poor N N N N N

14 Batpora Rent. Good N N N N N

15 Waterwani Rent. Good N N N N N

16 Gariend Rent. Good Y N N N N

17 Shogpora Rent. Good N N N N N

18 Chandpora Rent. Good N N N N N

19 Kulbugh Rent. Good N N N N N

137

Table: 1 B Block: Budgam District: Budgam Quarter Staff Laboratory Theater Operation incinator disposal/ Waste Telephone Generator Vehicle Room usuality Emerg./Ca ECG/USG X-RAY Monitor Cardiac storage Blood Name of Building of the Ownership supply Water all In Parts Electricity/ water running toilet/with Separate labor Aseptic / Labor room PHC/CHC room

1 Burn/ Ompora Govt Y Y/Y N N/N N Y N N N N N

2 Dump/ Sholipora Govt. N N/N N N/N N Y N N N Y N

3 Dump/ Ichgam Rent Y N/N N N/N N N N N N N N

4 Dump/ N.U.Pora Rent N Y/Y N N/N N N N N N Y N

5 Dump/ Laloo Rent Y Y/Y N N/N N Y N N N N N

6 Dump/ Bemina Rent Y Y/N N N/N N Y N N N N N

7 A/D Dump/ Rent N N/N N N/N N N Y N N N Parisabad N 1 No CHC in the block.

138

Table: 1 A Block: Chrarsharif District: Budgam

Ownership Condition Name of Water Separate Labor Staff of the of the Electricity SC supply toilet room Quarter Building Building

1 Nowgam Govt. Fair N N N N N

2 New colony Govt. Good N N N N N

3 Braripathri Govt. poor N N N N N

4 Zinpanchal Govt. Poor. N N N N N

5 Charipora Govt. Poor N N N N N

6 Tilsar Rent. Good N N N N N

7 Dardpora Rent. Fair N N N N N

8 Karapora Rent. Fair N N N N N

9 Malipora Rent. Poor N N N N N

10 Nagbal Rent. poor N N N N N

11 Kakanwari Rent. Fair N N N N N

12 Rakhay Rent. Fair N N N N N

13 Fotlipora Rent. poor N N N N N

14 Peerdel Rent. poor N N N N N

139

Table: 1 B Block: Chararsherif District: Budgam Bloodstorage Name of Buildingthe Ownershipof Watersupply allParts Electricity/In water /with running Separate toilet room Asepticlabor Labor room/ Staff Quarter Laboratory Theater Operation incinator disposal/ Waste Telephone Generator Vehicle alityRoom Emerg./Causu ECG/USG X-RAY Monitor Cardiac unit

PHC/CHC

1 CHC Burn/ Y N/ N N N Govt Y Y/Y N Y/N N Y N N N Y Pakherpora N N

2 CHC Dump/ Y Y/ Y Y N Chrarsharif Govt Y Y/N N/N Y/N N Y Y N Y Y N Y 1 Dump/ Chalayan Rent N N/N N N/N N N N N N N N

1 Dump/ Chariwari Rent N N/N N N/N N N N N N N N

2 Dump/ Dalwan Rent N N/N N N/N N N N N N N N

140

Table: 1 A Block: Khanshab District: Budgam

Ownership Condition Water Separate Labor Staff Name of SC of the of the Electricity supply toilet room Quarter Building Building

1 Falchal Govt. Good N N N N N

2 Shalnar Rent. Fair N N N N N

3 Kaitch Rent. Fair N N N N N

4 Fruswar Rent. Poor. N N N N N

5 Dragger Rent. Fair N N N N N

6 Raithan Rent. Good N N N N N

7 Lanoora Rent. Fair N N N N N

8 Mujpathri Rent. Fair N N N N N

9 Malnoora Rent. Poor N N N N N

10 Talpora Rent. Fair N N N N N

11 Hariwani Rent. Fair N N N N N

12 Rawalpora Rent. Fair N N N N N

13 Zanigam Rent. poor N N N N N

14 Huklater Rent Fair N N N N N

15 Bugroo Rent Fair N N N N N

16 Hardwel Rent Fair N N N N N

141

Table: 1 B Block : Khansahib District : Budgam Name of Building of the Ownership Watersupply allParts Electricity/In water running toilet/with Separate room Asepticlabor Labor room/ Staff Quarter Laboratory Theater Operation incinator disposal/ Waste Telephone Generator Vehicle ualityRoom Emerg./Caus ECG/USG X-RAY Monitor Cardiac storageunit Blood PHC/CHC

1 Dump/ Kralnewa Rent N N/N N N/N N N N N N Y N 2 Dump/ Shamasabad Rent Y N/N N N/N N Y N N N Y N 3 Dump/ Kachwari Rent N N/N N N/N N N N N N N N 4 Dump/ Nuner Rent N Y/N N N/N N N N N N Y N 5 Arigam Govt Y Y/N N N/N N Y N Burn/N N N Y 6 Dump/ Rayar Govt N N/N N N/N N N N N N Y N 7 Dump/ Hardpanzoo Govt. Y N/N N Y/N N Y N N N Y N 8 Dump/ Waterhail Govt N N/N N N/N N Y N N N Y N 9 Dump/ Dobipora Rent N N/N N N/N N N N N N Y N 1 CHC Govt Y Y/N Y/N Y/N Y Y Y Dump/ Y Y Y Y/Y Y/ Y Khanshab N Y

142

Table: 1 A Block: NAGAM District: Budgam

Ownership Condition Name of Water Separate Labor Staff of the of the Electricity SC supply toilet room Quarter Building Building

1 Tangnar Rent Fair N N N N N

2 Badipora Rent Fair N N N N N

3 Brinjan Rent Poor N N N N N

4 Borwah Rent Good N N N N N

5 Nowpora Rent Fair N N N N N

6 Buzgo Rent Fair Y N N N N

7 Kutbal Rent Fair N N N N N

8 Lolipora Rent Fair N N N N N

143

Table: 1 B Block: NAGAM District: Budgam water room Asepticlabor Labor room/ Staff Quarter Laboratory Theater Operation incinator disposal/ Waste Telephone Generator Vehicle ualityRoom Emerg./Caus ECG /USG X-RAY Monitor Cardiac storageunit Blood Name of Building of the Ownership Watersupply allParts Electricity/In running toilet/with Separate PHC/CHC

Burn/ 1 Hafroo Govt Y Y/N N/N N/N N N N N N Y N

Dump/ Y/ 2 CHC Nagam Govt Y Y/Y N/N N/N N Y N Y Y Y N/N Y Y N N Y

Dump/ 1 Hayatpora Rent N Y/N N/N N/N N N N N N Y N

144

Table: 1 A Block: Khag District: Budgam Ownership Condition Water Separate Labor Staff Name of SC of the of the Electricity supply toilet room Quarter Building Building 1 Trapy Govt. Fair N N N N N

2 Hamchipora Govt. Poor N N N N N

3 Khandipora Govt. Fair N N N N N

4 Lokipora Govt. Fair N N N N N

5 Malpora Govt. Fair N N N N N

6 Hard Souresh Govt. Poor N N N N N

7 Sugen Rent. poor N N N N N

8 Sutharan Rent Poor N N N N N

145

Block : Khag District : Budgam Table: 1 B

room Staff Quarter Laboratory Theater Operation incinator disposal/ Waste Telephone Generator Vehicle lityRoom Emerg./Causua ECG/USG X-RAY Monitor Cardiac unit Bloodstorage Name of Buildingthe Ownershipof Watersupply Parts Electricity/In all water /with running Separate toilet Asepticlabor Labor room/

PHC/CHC

Burn/ 1 Khag Govt. N Y/N N/N N/N N Y N N N Y N Dump/ 2 Poshker Govt. Y Y/N N/N N/N N Y N N N Y N Burn/ 3 Lassipora Rent. N Y/N N/N N/N N N N N N Y N No CHC

146

Annexure III Appraisal Criteria

147

Assessment of District Health Action Plan (DHAP) Appraisal Criteria to be used by State & District Planning & Appraisal Team

Sl. Criteria Remarks No. Yes/ No

A. OVERALL 1 Has the DHAP been reviewed in detail by the District authorities Yes to ensure internal consistency? If yes, by whom? This means that Situation analysis, goals, strategies, activities, work plan budget are in line with the proposed interventions and are evidence based. 2 Has Account Person from the Department reviewed the budget in Yes detail? 3 Executive summary /At a Glance have been enclosed in the Yes beginning of the document. 4 Has plan developed in all inclusive and participatory process by Yes involving representatives of health, water and sanitation, ISM, ICDS, Rural Development, NGOs and community members? 5 Funds requirement matches with the absorption capacity and has Yes judicious increase over the years (The planning should be based on past experiences in implementing interventions and realistic time frame/ workplan ) 6 The Plan caters needs of vulnerable groups (SC/ST, BPL, Yes Women and Children, others) (Activities proposed to cover SC/ST population for Immunization coverage, JSY scheme etc.) 7 Inter-department coordination and convergence mechanism is Yes clearly mentioned for multi-sectoral inputs/elements. (Planned joint sector ,block and dist level meetings with ICDS, education and local self Govt. etc and joint circulars for implementing intervention) 8 The findings of the facility survey/ assessment has been Yes integrated in the Plan 9 Plan has been approved by appropriate district authority District Yes (District Health Society) 11 Training Plan Yes The training strategy to strengthen existing HR. The training plan has indicated target groups (e.g. MO, ANM, ASHAs, AWW etc), training load and broad details e.g. duration, quality assurance for training, etc 12 BCC /IEC strategy Yes A service oriented BCC strategy based on assessment of the current status of issues with MMR, IMR, TFR, awareness of PNDT, etc. has been narrated in the plan 13 Work Plan Yes Is the work plan consistent with stated components/objectives, strategies and activities? And whether the proposed phasing of activities would lead to increase in delivery/utilization of

148

Sl. Criteria Remarks No. Yes/ No

services? 14 COSTS/BUDGET Key criteria are: Does the budget follow the prescribed formats? Yes

The justification column has break-up of total amount Yes 1. Absorptive capacity: If very ambitious utilization of funds is Yes envisaged compared to performance of 05-06/06-07, then key steps have been proposed to achieve plan expenditure? B RCH-II PROGRAM PROGRAM MANAGEMENT ARRAGEMENTS 1 Steps to establish financial management system including fund Yes flow mechanisms to blocks and downward level and accounting system including timely reporting expenditure 2 Steps to establish quality assurance committees/system in the Yes district. 3 Step to ensure systems for holistic monitoring (Outputs, Yes activities, costs) against DHAP .( Dist level review meeting and DHS meetings) 4 Strengthening of HMIS with emphasis on timely availability of Yes reliable and relevant information at appropriate level e.g. community, SC, PHC, Block and district, analysis and feedback system, steps to ensure implementation of revised HMIS system. 5 Provision of logistics management of drugs and medical supplies Yes in order to ensure continuous availability of essential supplies at S/C, PHC and CHC level. TECHNICAL STRATEGIES A. Reproductive & Child Health 1 Maternal Health A. Interventions for 100% ANC coverage, Yes B. 24x7 for EmOC services at selected institutions C. Skill birth attendance during labour (ANM) D. Provision for availability of safe blood in FRUs/CEmOCs, E. Intervention for anesthesia training for MOs, F. Provision of Safe abortion services and, G. Management of RTI/STI Cases H. Provision for Janani Suraksha Yojana 2 Child Health A. Organizing MCHN days for complete immunization Yes coverage, B. Interventions for IMNCI services (Optional) C. Provision for new born care at institutions and, D. Promotion of breast feeding E. School Health Programme

149

Sl. Criteria Remarks No. Yes/ No

3 Family Planning A. Interventions to provide regular FP services in everyh Yes block facilities, B. Increase number of service providers for vasectomy, NSV, Tubectomy, and Laproligation , C. Intervention to improve quality of camps, D. Quality IUD insertion services, E. Increased availability of OP, Condoms through community workers, ASHA, AWW, NGOs 4 ARSH A. Intervention for training of MOs, paramedic for ARSH Yes services ( optional) B. Provision of AFHS services at selected institutions (optional)

5 Gender Mainstreaming Activities planned for awareness generation of gender, PCPNDT Yes Act and strengthening implementation of PCPNDT Act. B NRHM ADDITIONALITIES Whether provision made for- Yes 1 ASHA Training in the district Yes 2 PRI Trainings (Block/Village health & Sanitation Committees) Yes 3 Untied Funds at SC & Yes Untied funds to RKS at PHC/CHC/District Hospitals 4 Civil Works as per IPHS (CHC/PHC/SC) Yes Hospital Building- Staff Quarters 5 Strengthening Field Monitoring and Supervision (Enhance the Yes provision of POL, Maintenance and of vehicle) 6 Need assessment done for-Procurements as per IPHS Yes CHC/PHC/SC) 7 Appropriate provision made for-Programme Management Units Yes at Divisional, District and Block levels-Adequate salary and OE provisions ( District PMU is a part of RCH II and Block level PMUs are part of NRHM) 8 Adequate provision made for-Additional Manpower Yes Specialists at CHCs ANMs at SCs Divisional/Block Programme Managers 9 Provision made for-Drug Kits at different institutions Yes 10 Plan for management of Mobile Medical Units at districts Yes 11 No of Ambulances available and required Yes, District specific innovative activities to address local needs have Yes been incorporated

150

Sl. Criteria Remarks No. Yes/ No

12 Public private partnerships ( optional) Yes 12 Provision of hiring of vehicle for BMOs (as per requirements) Yes C IMMUNIZATION PROGRAM Whether provision made for- 1 Social mobilization Yes 2 Alternative vaccine delivery Yes 3 Cold Chain Maintenance Yes 4 PoL & Maintenance requirement for vehicles Yes D National Disease Control Programme 1 Water Borne Diseases Yes Clear strategy prepared for combating Water Borne Diseases like Malaria, dengue etc 2 TB Whether Separate section on TB with operational details and Yes budget prepared

151

152