Draft

District

Family

Planning

Plan

NAYAGARH

2012-13

District Family Welfare Bureau Zilla Swasthya Samiti ,

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Chapter 1

Background

The , originally was a part of undivided district, is located towards the west and surrounded by district in the North, Phulbani district in the West, district in the South and Khurda district in the East. The west side of Nayagarh is the hilly region, part of eastern Ghats with fertile valleys and the north and eastern part is constituted of agricultural plateaus intersected by small streams and rivers. River flows in the north and brings water for irrigation and calamity during floods. The climate of the District is extreme in nature with high temperature during summer and cooler in winter. Nayagarh is also acknowledged for its leather works, brass and bell utensils and sugar factory.

Spread over an area of 3,890 Sq.Km square kilometers, with forest cover is as high has 2080.97Sq.Km. The population of the district is 9, 62,245 (2011 Census) with 6% Scheduled tribes and 14% Scheduled castes. The literacy rate of the district is 79% and the female literacy is 71% (2011 Census).

Administratively the district has 8 blocks, 180 Grampanchyats and 1694 revenue villages. It has 4 towns and 2 urban local bodies i.e. NAC of Nayagarh and . Out of the 8 blocks, 2 are categorized as RCH difficult or high focus blocks. Both the blocks are the most difficult in terms of accessibility with very low service utilization. The neonatal mortality rate of the district is high & contributes 56 % of total infant death. In addition to this, there is high morbidity and mortality due to communicable diseases (Malaria, ARI and water borne diseases).The institutional delivery is 86% as per HMIS of the total reported deliveries in the district. The major public health issue is malaria and each year the district reports high morbidity and mortality. Malnutrition and Anemia are two other major issues in the district. However, the immunization coverage stands at 86% as per HMIS data (49.2% as per DLHS III).

Though the district has made progress with respect to improving the health of its people over the last two decades and there is significant improvement in the key health indicators in the district, but still there are challenges in health service delivery system. Non availability of doctors at periphery levels is seriously hampering public health delivery services, thus affecting management of complicated cases at facility levels. To tide over the situation, contractual doctors (including O & G & Paed Spl) have been given appointment for operationalisation of MCH Centers.

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District Map of Nayagarh

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DEMOGRAPHIC PROFILE

SL. ITEMS INFORMATION NO. GENERAL 1 Area (sq. km) 3890 2 % in total state’s area 2.50 3 CD Blocks 8 4 Towns 2 5 No. of Village 1694 Inhabited 1151 (OHD Report, 2004) Uninhabited 543 5 No. of Tehsils 8 6 Towns & Urban Areas 2

7 No. of Gram Panchayats 179 (Dist.Panchayat Office, Nayagarh) 8 No. of NACs/Municipality/Corporation 02 (Nayagarh, Khandapara) DEMOGRAPHIC PARTICULARS (CENSUS 2011) 9 Population (Total) 962245 (2.29 % to total population of the State) 9a. Male 502194 (52.19% of Dist. Pop.) 9b. Female 460021 (47.80% of Dist. Pop.) Population in the age group of 0-6 years (2011) 1 Total 101337 (12.75% of dist. Pop.) 2 Male 54759 (10.90% of dist. Pop.) 3 Female 46578 (10.12 % of dist. Pop.) 4 % of 0-6 population to total population 10.53 % Population Density 1. 1991 201 per sq. km 2. 2001 222 per sq. km 3. 2011 247 per sq. km Sex Ratio (Census 2011) Sex Ratio 916 female/1000 male (2011 Census) Child sex ratio in the age group of 0-6 1. 1991 950 2. 2001 904 3. 2011 851 Literacy Rate (Census 2011) Literacy Rate (Total Population) 79.17 Literacy rate (Male) 86.63 Literacy Rate (Female) 71.08

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HEALTH INFRASTRUCTURE

Sl Number No. Type of Institutions 1 District Hospital 01 (DHH, Nayagarh) 2 District Post Partum Centre 01 (PPC, Nayagarh) 3 Block Post Partum Centre 01 (Ranpur PPC) Community Health Centers (CHC) 12 (Nuagadiasahi, Saranakul, Bhapur, Mahipur, , Gania, Badapandusar, 4 Madhyakhanda, Dasapalla, Ranpur, & Khandapada) 5 Single Doctor PHC 36 6 Sub Centres 166 7 Mobile Health Unit 3 Nos 8 Anganwadi Centers 1544 (1142 Main AWC) Ayurvedic 9 Hospitals 0 Dispensaries 13 Homeopathy 10 Hospitals 0 Dispensaries 19 11 Other Hospital BMSN, 12 AIDS Counseling & Testing Centers 5 ICTCs “Shradha” – AFHC Clinic 3 (DHH Nayagarh, CHC 13 & Dasapalla CHC) Blood Bank(BB) / BSUs 1 BB at DHH/ 1 BSU at Dasapalla 14 CHC 15 ANM Training Center, Dasapalla 1 STD Clinic at DHH 1 16 No of ASHA sanctioned 885 17 No of ASHA in-position 884 18 RKS at DHH is formed 1 19 RKS at CHC level 12 20 RKS at PHC (N) level/others 37 21 Physiotherapy Centre (PPP) at DHH 1 22 Tele-Medicine Centre 1 23 Central Drug Warehouse 1 24 Janani Express 12 25 Ambulance 9 26 Accredited Family Planning Center 1 (Krishna Clinic, Nayagarh) 27 Total Bed Strength 650

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MCH CENTER/ DELIVERY POINTS LINKAGES:

Human Resource: (A) Sanctioned Staff (Regular) Sl. Name of the Sanctioned In position Post 1 O & G 15 06 2 Pediatrics Spl 13 04 3 Anesthetist 2 01 Blood Bank 1 01 Officer 1 Asst. Surgeon 44 17 Total Doctors 127 62 2 Staff Nurse 91 79 3 Pharmacist 89 88 3 MPHW(M) 139 86 4 MPHW(F) 187 184 5 MPHS(M) 48 37 6 MPHS(F)/LHV 30 24 7 L.T. 20 18 8 Radiographer 8 8

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The above table clearly indicates that there are high vacancies in technical human resources. More over the vacancies in FRU & 24 x 7 institutions are largely high. Most of the Specialist, especially O & G and Paed Spl. are lying vacant in FRU and 24x7 Institutions. However to operationalise the MCH Center the district has initiated steps by giving Contractual O&G & Paed Spl. At Gania (L2) & in Rajsunakhala CHC (L3) and Retd MBBS doctors at MCH centres/ delivery points for utilization of Maternal and child health services. it has been experienced in the year2011-12 that contractual doctors have also been engaged in providing family planning services at designated facilities at Mahipur and Daspalla( L2 and L3 facilities) (B) Contractual staff engaged by NRHM: Sl. Name of the Post Sanctioned In position

1. Staff Nurse 47 26 2. Additional ANM 32 32 3. LT 4 3 4. AYUSH doctor 40 36 5. Work Consultant 3 3 6. Assistant Engineer 1 1 7. Immunization (computer Asst) 1 1 8 System Incharge-cum-DEO 1 1 9 BPO 8 7 10 Block Accountant 8 7 11 DPM 1 1 12 DAM 1 1 13 DHIO 1 1 14 District ASHA Coordinator 1 1 15 DMCH 1 1 16 DPMU Accountant 1 1 17 Hospital manager 1 1 18 DHH Accountant 1 1 19 Vaccine & Logistics Manager 1 1 20 MIS Cum Field Coordinator 8 8 21 Office Asst. DPMU 1 1 22 Accountant, Area Hospital 4 3

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Chapter- 02

Family Planning performance in the Nayagarh in percentage Family planning Achievement Vs Target

F.W. 2009-2010 2010-2011 2011-12 Activities Sterilization 3767 1970 52.30 3782 3274 86.57 3787 3829 101.11 IUD 9175 4769 51.98 6104 5130 84.04 4572 3991 87.29 CC 19876 9685 48.73 14087 5763 40.91 9161 7727 84.34 Oral Pill 10702 5893 55.06 7043 5260 74.68 5398 5122 94.88

It has been experienced from the 3 years family planning data that there has been a remarkable progress with regards to achievement of ELA, particularly in the year 2011-12. Besides achieving district target some blocks like Ranapur, Gania, and Mahipur have demonstrated 100% achievement with regards to sterilization. There has been a remarkable increase in sterilization achievements from 57% to 87% and from 87% to 100% (2011-12). The interventions by district heealth administration for this success are 1. Adherence to Fixed day Family planning services at all L3 centers and selected L2 centers.

2. Regular and focused Block wise review at district health review meeting by CDMO and ADMO (FW).

3. Capacity building of technical and paramedics personnel’s (on Minilap and IUCD) from MCH centers on priority.

4. Support to poor performing blocks with regardds to instruments and equipments availability, regular monitoring by Wing officers and district 8

nodal officers, diverting of trained surgeons to poor performing blocks on Parivar Kalyan Diwas.

5. Maximum emphases at ASHA sector meeting for mobilization of cases to FDS.

6 .Strategic utilization of 4 Camp cost budget

Situation Analysis: Population stabilization and reduction of TFR (total fertility rate) are the goals of NRHM which contributes significantly to improve the maternal and child health outcomes. Though family planning has been one of the major components of the RCH program, yet it has been out of focus in the last couple of years for one reason or the other. The performance in family planning processes is seasonal with most of the achievements occurring during October to March. However from 2011 July Population week , district has accelerated Family Planing interventions like( Fixed day static services, up gradation of OT for operation at L2 institutions , accelerating training program of personnels from 43 MCH Centres and procurements of Family planning instruments, which has shown result in the year 2011-12.

Unmet Need

DLHS II

DLHS III Unmet Need

0 5 10 15 20 25

A comparison of DLHS-II and DLHS- III data on family planning indicators shows a mixed scenario of the district. DLHS-II & DLHS-III comparison

Indicators DLHS - 3 DLHS - 2 Marriage and Fertility, (Jan 2004 to 2007- 08) Total Rural Total Rural Percentage of girl's marrying before completing 18 years 33.1 34.4 35.0 41.8 Percentage of Births of Order 3 and above 19.6 20.3 37.4 42.6 Sex Ratio at birth 101 100 - - Percentage of women age 20-24 reporting birth of order 2 & above. 46.3 48.0 - - Percentage of births to women during age 15- 19 out of total births 15.0 15.0 - - Family planning (currently married women, age 15-49)

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Current Use : Any Method (%) 49.9 49.5 63.2 58.9 Any Modern method (%) 33.1 33.4 44.0 44.0 Female Sterilization (%) 24.3 24.4 33.0 36.0 Male Sterilization (%) 1.3 1.4 0.0 0.0 IUD (%) 0.1 0.1 0.3 0.5 Pill (%) 6.3 6.4 8.2 6.2 Condom (%) 1.1 1.0 2.2 1.0 Unmet Need for Family Planning: Total unmet need (%) 23.8 24.4 17.9 18.1 For spacing (%) 7.8 8.1 4.8 4.9 For limiting (%) 16.0 16.3 13.1 13.3

DLHS data Analysis

• Percentage of girls marrying before 18 years of age has shown a marginal reduction from 35.0% in DLHS-II to 33.1% in DLHS-III which indicates that there is a gradual increase in the level of awareness on mean age of marriage and people have gradually started internalizing the benefits of delaying the marriage of the girls so as to ensure a better reproductive life. • A birth of order 3 and above has witnessed a decrease from 37.4% in DLHS-II to 19.6% in DLHS-III which indicates an increased awareness among the target audience about the benefits of small family. • Unmet need for the district has gone up from 18.1% in DLHS II to 23.8% in DLHS III which indicates the wider acceptance and willingness among beneficiaries for FP program in the district and warrants for more comprehensive approach to promote various contraceptive methods with follow up activities by skilled personnels, both at sub centre level and facility level. Potential beneficiaries’ needs to be shared with basket of family planning choices with popularization of designated MCH centres for utilizing FP services by faroff beneficiaries. District health administration will be focusing on ensuring family planning services at inaccessible pockets of the districts with functionalisation of 6 more FDS centers in the district. • CPR has also shown a fall down from 63.2% in DLHS-II to 49.9% in DLHS-III which is in fact a matter of concern for the district. Female sterilization, being the most accepted method in Family Planning has gone down from 33% to 24.3%.

SERVICE DELIVERY FP SERVICES –FDS AND ACHIEVEMENT IN FDS CENTERS

District has achieved 100% sterilization during 2011-12 due to operationalisation and mandatory availability of FP services on PARIVAR KALYAN DIWAS i.e. on Monday at designated L3 and L2 institutions of the district. Due to continuous & regular monitoring by wing officers and Nodal officers, designated for 8 blocks, the FP services at designated 9 FDS centers could be accelerated with achievement of block target. 9 facilities (8 CHC and PPC Nayagarh) are currently providing FP services on PKD against the target of 12. From this year i.e. (2012-13) District has planned to extend it to another 7 MCH centers/ delivery points of the 10

district which includes (3 L2 institutions and 4 L1 institutions) . In addition to this, district has started ground work for providing IUCD services at TB hospital Chandpur from this year. District has trained all ANM and selected SN from 43 MCH centers of the district on IUCD and the post training skill utilization has started showing result at 2 L1 facilities( i.e. at PHC Lathipada and Golapokhari Sub centre) .In the year 2011-12 district has trained 3 new surgeons on Minilap ( Dr Banamali Pradhan MOI/C Mahipur(L2) Dr Pramila Dash, CHC Daspalla(L3), and Dr Sanjit Mishra, DHH Nayagarh(L3)in view of their strategic posting at MCH centres and district will start utilizing their services from June onwards. At present all the ASHA i.e. 884 are engaged in Social Marketing of Contraceptives, which is further bridging the gap between service providers and service acceptor with increased emphasis on availability, accessibility and affordability of contraceptives. The scheme is having good impact at 3 blocks like Bhapur, Khandapada and Mahipur. ELCO survey, which is going to be started in Ist week of June will further help in accurate targeting of potential eligible couple with basket of choices and sector and block level need based planning for quality family planning services. Post Partum & Post abortion Contraception With the strengthening of Assured referral linkage support system (plying of Janani Express, Ambulances, and MHUs) and free services availability in (JSSK), institutional delivery has increased tremendously in the district. District is committed to utilize the golden moment of 48 hours hospital staying and will further extend PP IUCD and PP Sterilization to 3 L3 institutions and one L2 institutions (CHC Daspalla, CHC Sarankul, CHC Rajsunakhala and CHC Khandapada). Two persons ( Dr. PK Swain, O&G Spl. of CHC, Khandapada and Sr. Staff Nurse Rasmitabala Jena from DHH Nayagarh ,have already received state level TOT on PP IUCD and the services will be further extended to periphery facilities from the year 2012-13. PP IUCD training at district level will start from June, 2013 onwards.

Service Environment

Institution wise/ Delivery point wise availability of critical equipments status. District has initiated efforts for procurement of FP instruments (such as 16 Minilap, 26 IUCD and 7 NSV Kits) as per the budget earmarked in 2011-12 NRHM PIP. Due to quick efforts of district level officials, the instruments could be distributed to selected MCH centres during peak season of family planning program i.e. Oct- December, 2011. The table provides the availability of functional instruments at MCH centres, which has been distributed based on the case load.

Sl Name of the Cat Name of the Units Status Remark/Steps

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. institutions/Delivery ego equipment (Functional/ taken (if any) N points ry (IUCD/NSV/Mi non- o. (L1, nilap Kit functional L2, /Lap. L3) Machine) 1 DHH, Nayagarh L3 IUCD, NSV, Functional Minilap kit. 2 CHC Dasapalla L3 IUCD kit, Functional Minilap kit 3 CHC Rajsunakhala L3 IUCD kit, Functional Minilap kit 4 CHC Saranakul L3 IUCD kit, Functional Minilap kit 5 CHC Bhapur L2 IUCD kit, Functional Minilap kit 6 CHC Khandapada L2 IUCD kit, Functional Minilap kit 7 CHC Mahipur L2 IUCD kit, Functional Minilap kit 8 CHC Gania L2 IUCD kit, Functional Minilap kit 9 CHC Ranapur L2 IUCD kit, Functional Minilap kit 10 CHC Madhyakhanda L2 IUCD kit, Functional Minilap kit 11 PHC(N) L2 IUCD kit, Functional Minilap kit 12 PHC(N) L2 IUCD and Majhiakhand Minilap kits will be provided in 2012-13 13 PHC(N) Lathipada L1 IUCD kit Functional 14 PHC(N) Godipada L2 IUCD Functional 15 CHC Badapandusar L2 IUCD & Functional Minilap Kit 16 CHC Odagaon L2 Miniulap kit Functional 17 SC Golapokhari L1 IUCD kit Functional 18 SC Darpnarayanpur L1 It will be provided IUCD kits in 2012-13 Besides the above distribution, Kits have been provided to other delivery points like Nuagaon PHC (N) and Bahadjhola PHC (N) of Mahipur block and LHV of these 2 facilities have been trained on IUCD .

QUALITY ASSURANCE PROCESS : 12

Government of places utmost importance to the Quality assurance Committee in family Planning aspects. The Honorable Supreme Court directives clearly outline the structure, institutional arrangement, role and responsibility and significance of the Quality Assurance Committee. The QAC has been activated in the district with settlement of failure cases and monitoring by ADMO(FW) and other wing officers for maintaining quality and standard procedure at selected facilities. However more efforts are required for further strengthening the roles and responsibilities of QAC. From this year district is planning to review the empanelled surgeon’s performance particularly of O&G Spl. and encourage them for achieving their institution specific targets with timely district support. Private Sector Partnership & Accredited Institutions

Only one private institution, Krishna Clinics,Nayagarh, has been accredited to provide family planning services exclusively for Minilap services. The targets are spread over the year and the concerned clinic is providing services satisfactory. As per the data available the clinic has provided Sterilization services to 414 beneficiaries and district is planning to accredit another institution for family planning services.

Human Resource Development District has 31 empanelled surgeons in the year 2011-12 and some of the surgeon’s performance has been spectacular.Surgeons like Dr S Jibrail O&G Spl of Rajsunakhala CHC has performed well with regards to sterilization operation. Similarly Dr AP Tripathy of Gania CHC has performed well with regards to sterilization operation, particularly after receiving Minilap training by district. The below mentioned table clearly provides institution wise surgeons posting at L3 and L2 institutions. Sl. Name of the Surgeon Presently posted Category No Of Institute (L1/L2/L)

Dr. Balaji Shankar Ray, “O & G” Spl. CHC Sarankul 1 L3 2 Dr. Panchanan Moharana, Sur. Spl CHC Sarankul L3 Dr. Bhagaban Sahoo, Contractual PHC(N) Godipada 3 L2 Dr. Ashwani Ku. Mishra, Asst. Surgeon PHC(N) Magarbandha 4 Non MCH

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5 Dr. Lochan Ku. Kata, Asst. Surgeon CHC ODAGAON L2 Dr. Arun Ku. Mohapatra, Asst. PHC(N) Kural 6 Surgeon Non MCH

Dr.Bachaspati Dash “O & G” Spl. CHC Bhapur 7 L2 8 Dr. Sekh Jibrail, “O & G” Spl. CHC Rajsunakhala L3 Dr. Sadananda Mishra, Sur. Spl CHC Ranapur 9 L2 Dr. Radhakanta Nath, “O & G” Spl. CHC Ranapur 10 L2 Dr. Panu Charan Mandal, Asst. L2 CHC Madhyakhanda 11 Surgeon

Dr. N.K.Mohanty, Sur. Spl CHC Daspalla 12 L3 Dr. R.K.Moharana, “O & G” L3 CHC Daspalla 13 Contractual

14 Dr. Baidya Nath Nanda, Asst. Surgeon PHC(N) Takera Non MCH Dr. Akashya Kumar Das, Asst. Surgeon CHC Khandapada 15 L2 16 Dr. Paresh Ku. Swain, “O & G” Spl. CHC Khandapada L2 Dr. Tarun Ku. Satapathy, “O & G” L2 CHC-II, Mahipur 17 Spl

Dr. Somanath Mishra, Contractual CHC-II, Mahipur 18 L2 Dr. Basanta Kumar Barik, Asst. Non MCH PHC(N) 19 Surgeon

Dr. Akashya Ku. Sahoo, Asst. Surgeon PHC(N) Lathipada 20 L1 Dr. Ananda Prasad Tripathi, M.O.I/c CHC Gania 21 L2 Dr. Sukanta Ku. Jena,“O & G” Spl L3 PPC Nayagarh 22 SMO

Dr. Sanghamitra Dash, ,“O & G” Spl PPC Nayagarh 23 L3 Dr. L.N.Bisoi, Asst. Surgeon DHH Nayagarh 24 L3 25 Dr. Raghunath Nayak, Sur. Spl DHH Nayagarh L3 Dr. Nilamadhaba Mishra, ADMO(FW) DHH Nayagarh 26 L3 27 Dr. Sachidananda Mishra, ADMO(PH) DHH Nayagarh L3 Dr. Ajit Kumar Nath, Asst. Surgeon PTS Nayagarh 28 Non MCH Dr. Ramesh Ch. Naik, Retd. Sur. Spl 29 Accrediated Nurshing Home Non MCH Krishna Clinic Nayagarh 30 Dr. Raj Kishore Sarangi, Retd. Non MCH

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“O&G”Spl

Dr. Umesh Ch. Mishra, Retd. Paed Spl 31 Non MCH

Monitoring and Evaluation

District has delegated supervisory power to all Nodal officers assigned for each block and family planning review occupies an important agenda at each block health review meeting. It has been decided to strengthen Family planning monitoring by QAC members. Block wise and surgeon wise review will be taken up in monthly district health review meeting. ADMO (FW) and ADPHCO will monitor the delivery points regularly.

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Chapter-03

Plan for 2012 – 2013 District has provided ELA to all blocks, based on the figure provided by state and planning to achieve 100% with induction of more trained surgeons in empanelled list for the year 2011-12. Sl. Name of the ELA No Block CHC/PPC Sterilization IUCD CC OP

1. PPC, Nayagarh 75 71 135 79 2. CHC Badapandusar 593 686 1296 762 3. CHC Bhapur 422 491 928 546 4. CHC Gania 157 182 344 202 5. CHC Khandapada 488 515 971 571 6. CHC Madhyakhanda 414 498 940 553 7. CHC Mahipur 376 430 811 477 8. CHC Sranakul 691 770 1456 857 9. CHC Rajsunakhala 685 746 1409 829 10. Total 3901 4389 8290 4876

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A. Service Delivery Plan Facility & Community Level (Spacing & Limiting) Functional FDS

Delivery Points MCH centers

SC PHC (N) CHC DHH Remark

As on 8 1 01.04.12 Plan 12-13 2 4 2 0

DPS non-MCH(strategic Locations)

SC PHC (N) CHC DHH Remark

As on 01.04.12 0 0 0 0

Plan 12-13 1 1 0 0

As per the decisions taken at monthly health review meeting of April,2012, all the FDS centre should start providing services including( OP, CC and IUCD) from April onwards . ASHA sector meeting forum will be utilized for further mobilizing potential beneficiaries to Parivar Kalyan Diwas with display of PKD charter at all L3, L2 and L1 institutions. Sector MO has also started reviewing ASHA on their incentivised performance for Family Planing activities. Monitoring Supervisory plan for FDS functionalisation Sl. Name of the Institution Nodal officer for block & micro level FDS No. monitoring

1 DHH, Nayagarh Hospital Manager & ADMO (Medical)

2 CHC Dasapalla ADMO(FW)

3 CHC Rajsunakhala DF,UNFPA & DPM, NRHM

4 CHC Saranakul ADMO (PH)

5 CHC Bhapur DMCH & DAC, NRHM

6 CHC Khandapada DTO,Nayagarh

7 CHC Mahipur ADMO(FW)

8 CHC Gania DHIO, NRHM

9 CHC Ranapur DF,UNFPA & DPM, NRHM

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10 CHC Madhyakhanda ADMO(FW)

11 PHC(N) Kantilo DTO

12 PHC(N) Majhiakhand DF,UNFPA & DPM, NRHM

13 PHC(N) Lathipada ADPHCO

14 PHC(N) Godipada ADMO(PH)

15 CHC Badapandusar ADPHCO

16 CHC Odagaon ADMO(PH)

17 SC Golapokhari DMCH & DAC, NRHM

18 SC Darpnarayanpur DF,UNFPA & DPM, NRHM

ACTIVITIES TO BE TAKEN UP FOR QUALITY FDS SERVICE DELIVERY. District has planned to review PHC (N) ANM and sub centre ANM in health sector meeting for of FDS centre at micro-level. Emphasis will be given on quality reporting, attendance to complication cases and quick referral of patients to FRUs for higher level of treatment. Nodal officers will also emphasize upon quality of Family planning services through addressing gaps with regards to utilization of trained manpowers, availability of instruments and required drugs at each FDS centres.

B. Human Resource Development Plan(Training Plan)

Training Calendar for Family Planning Services -2012-13: Q1 Q2 Q3 Q4 Total Person target responsible IUCD 0 1 1 1 3 DMCHC/ADPHCO (batches) PPIUCD 0 0 1 0 1 DMCHC/ADPHCO (batches) NSV/CV 0 0 0 0 0 DMCHC/ADPHCO (batches) Minilap 1 0 0 1 2 DMCHC/ADPHCO (batches) Contraceptive update(doctors) 0 0 0 0 0(batch) DMCHC/ADPHCO Contraceptive update(paramedics) 0 1 0 0 1 DMCHC/ADPHCO (batches)

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C. QUALITY ASSURANCE PLAN

This year it is planned to have regular QAC meeting to update the empanelled surgeons list for sterilization operation and perform the assigned duty of facility audit, exit interview, access quality relating to prudent clinical practices. Action: DMCH Coordinator & ADMO (FW)

D.Plan for promoting Public Private Partnership for Family Planning : Only one private nursing home i.e Krishna clinic, Nayagarh is accredited to provide the Family Planning services. It is proposed to expand the facility to another 1 institutions during this year by critical assessment by end of second quarter. Action: DMCHC, DPM & ADMO (FW) C. ELCO Survey : Eligible Couple serves the basis of the family planning programme and interventions. The last headcount and detail assessment of the eligible couples was done in 2005. Since then there was only annual updation. This year it is proposed to conduct the Eligible Couple survey during the first quarter by involving the ASHA, AWWS and Health Worker (Male and Females). The activity is approved as per the Programme Implementation plan-NRHM for the year-2012-13. In addition to that for a qualitative approach of the survey, it is planned to take the support of UNFPA to roll out the block level trainings for the principal stakeholders of the survey i.e. ANM, Sector level supervisors and Block supervisors etc. Action: DPM, DMCHC, ADMO (FW), MOI/C D. Monitoring & Supervision plan Besides the regular IEC and other folk media activities, other formal programmatic intervention will be initiated in the year 2012-13 1. Orientation of RKS and GKS members on advantages of family planning and change their mindset towards facility up gradation for fixed day static center services. 2. Display boards in front of the PPCs and other selected L3 and L2 facilities on family planning services and methods as an information kiosk. 3. Wide publicity through banner, poster, wall paintings about the FDS centers, provisions and incentives in family planning programmes. 4. Periodic monitoring and field visit by the district officials and QAC members to assess facility with other activities like exit interview and verification of records and registers. 5. Tracking the progress through facility based reporting and action towards non- reporting from functional FDS Centres. 6. Quarterly review of Family planning programmes and regularizing the QAC meeting in every quarter.

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MONITORABLE INDICATORS FOR FAMILY PLANNING 2012-13 (Against each indicator, Districts are to provide consolidated quarterly targets and trace month wise achievements) Baseline Q1 Target Q2 Target Q3 Target Q4 Target Annual (1st April 2012) C Family Planning C.1 Service Delivery C.1.1 % of total sterilization against ELA 101.11% 481 2000 820 600 3901 C.1.2 % post partum sterilization 2% C.1.3 % male sterilizations 3.53% 5 58 29 25 117 C.1.4 % of IUD insertions against planned 87.29% 500 2194 1097 598 4389 C.1.5 % IUD retained for 6 months C.1.6 % Sterilization acceptors with 2 51.73 % 240 1950 1000 410 300 children C.1.7 % Sterilization acceptors with 3 or 30.84% 144 1170 600 246 180 more children

C.2 Quality

C.2.1 % of complications following 8% 0 0 0 0 0 sterilization C.3 Outputs C.3.1 % doctors trained as minilap 1.61 % 3 0 0 0 3 C.3.2 % doctors trained as NSV 0 0 0 0 0 0 C.3.3 % doctors trained as laparoscopic 0 0 0 0 0 0 sterilization

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% ANM/LHV/SN/MO trained in IUD 12 % 0 3 batch C.3.4 1 1 1 insertion C.4 HR productivity C.4.1 Average no. of NSVs conducted by 2 0 0 0 0 0 trained doctors C.4.2 Average no. of minilap sterilizations 95

conducted by minilap trained doctors C.4.3 Average no. of laparoscopic 0 sterilizations conducted by lap sterilization trained doctors C.5 Facility utilization C.5.1 Average no. of sterilizations performed 45.40% 218 1771 908 372 272 in FRUs C.5.2 Average no. of sterilizations performed 54.60% 263 2130 1092 448 328 in 24x7 PHCs

MONITORING AND SUPPORTIVE SUPERVISION TEMPLATE FOR DISTRICTS ON FIXED DAY STASTIC CENTRES Activities Time Line Responsible Reviewing Achiev If No Person/Officer Officer ed Reasons and Yes/N Corrective action O Sterilization operations conducted in Each assigned L2 & L3 institutions 1st Qtr ( Delivery points, non –MCH Center ) May 30th

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2012 IUCD insertion & Services in another 1st quarter Designated block nodal specific day ( in all L2 & L1 centers and officer CDMO,ADMO(F delivery points) W) The performance in Fixed day sites ( SA and ICA to prepare ADMO(FW) for all methods)analysis and Every Month and share with DHIO in MOI/c to take presentation to the District Team( each month and DHIO corrective measure, ADMO(FW),CDMO, DPM – at District & SA collectively BPO /BEE for Level responsible for proceedings & presenting it to CDMO, In block level the concern SA/the meetings. person in charge of reporting (regular ADMO(FW) & DPM incumbent) to share with BPO & BEE Each fortnight and present before the MOI/c PHEO of the block Camp scheduled after the quarter to ADMO (FW), ADPHCO & address the backlog – organizing camp s PHEO and other details as per guideline IEC/BCC activities regarding the ADMO(FW) a. Fixed Day Static Centers Fixed Days b. Camps After each ADPHCO & PHEO MOI/c quarter/Deci sions Monitoring visit to the Fixed Day Static Continuous ADMO(FW)/ Wing CDMO & ADMO(FW) Centers officers and nodal to review and officers assigned for rectify each block.

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Activities Time Line Responsible Reviewing Achieved If No Officer Person/Officer Yes/NO Reasons and

Corrective action

MONITORING AND SUPPORTIVE SUPERVISION TEMPLATE FOR DISTRICTS ON LOGISTICS & SUPPLY CHAIN

Assessment of stock /Contraceptive Commodity Store Pharmacist ADMO Security for free supply & ASHA (FW)/CDMO U pdation in CLMIS/ProMIS Store Pharmacist ADMO (FW)/CDMO

Transportation of Family Planning Supplies Store Pharmacist ADMO (FW)/CDMO Dist.to Block Block to Sector/SC

MONITORING AND SUPPORTIVE SUPERVISION TEMPLATE FOR DISTRICTS QUALITY ASSURACE PLAN Periodic QAC meeting Every quarter ADMO(FW),ADPHCO CDMO Facility audit/Exit Interview /verification Every month All designated nodal of records officer ADMO(FW), CDMO Failures/Complications At QAC meeting ADMO(FW),ADPHCO CDMO Insurance Claims etc. At QAC meeting ADMO(FW),ADPHCO CDMO

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RESOURCE ALLOCATION Family Planning Budget- 2012-13 Base Unit line Officer/Person PIP Rate/R Total Budget head Of Curren Target Budget Responsible Code s/Unit Target measure t

status A3.1 Terminal/Limiting Methods Q1 Q2 Q3 Q4

Dissemination of manuals on sterilization A3.1.1 standards & quality assurance of sterilization 15000 1 0 0 0 1 0.15 services

Quarterly Female Sterilization Camps to address Per camp

A3.1.2 backlogs - 2 camp per qtr per district in the low per 2 2 2 2 8 1.20 15,000 performing zone quarter

NSV camp - one camp per qtr per district in 10 Per camp districts ( , Rayagada, Malkanagiri, A3.1.3 per 0 0 0 0 0 0 Nabarangpur, Kalahandi, Nuapada, Bolangir, 35,000 quarter Sonepur, Mayurbhnaj and Kandhamal) Per

A3.1.4 Compensation for Female sterilization Beneficiar 925 925 925 925 3700 37.00 1,000 y Per

A3.1.5 Compensation for Male sterilization Beneficiar 20 20 20 20 80 1.20 1,500 y Total of Sterilization Budget for Sterilization (85% of Total

Sterilizations Budget)

Accreditation of private providers for A3.1.6 sterilization services Regional level orientation of accredited private A3.1.6.1 Per inst. providers on service protocols & reporting 2,500 Sub-total A3.1 (excluding Sterilization & NSV) A3.2 Spacing Methods

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A3.2.1 IUD Camps

A3.2.2 IUD services at health facilities/ compensation

For Beneficiary (to be utilized to meet essential Per A3.2.2.1 1143 1143 1180 1180 4646 0.93 requirements on IUD services at institution level) beniciary 20 Incentive to ASHA for ensuring retention of IUD A3.2.2.2 Per case 30 30 30 30 120 0.12 by beneficiary for 1yr 150 Incentive to private accridated institutions for A3.2.3 Per case IUD insertion services 75 A3.2.4 Social Marketing of contraceptives A3.2.4. Delivery of contraceptics by ASHA at door step

1 in 18 high focus district A3.2.4.1 Per Sensitisation workshop at district level .1 district A3.2.4.1 ToT for ASHA training .2 A3.2.4.1 Training of ASHA on operational modalities Per ASHA .3 (except dist) 275 A3.2.4. Eligible copule survey 1.4 At District level (MO I/c, BPO, PHEO, SA, HQ LHV per UNFPA support A3.2.4.1 from block level, 2 staff from PPC, district level participan .4.1 500 participants - CDMO, SI, MCH, DHIO, ICA, DPHEO) t At Sub district level - Orientation to programme UNFPA support A3.2.4.1 officer, supervisor & ASHA at existing meeting .4.2 platforms A3.2.4.1 Distribution of contraceptives .5 Sub-total A3.2 POL for FP/Others - Trasportation of FW A3.3 materials A3.3.1 State to district A3.3.2 District to Block Block to Sector (ASHA to be provided A3.3.3 contraceptives at sector meeting)

A3.4 Repair of laparoscopes

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Sub-total A3.3 & A3.4 - - - - - A3.5 Other strategies/activities Strengthening of Family Welfare Bureau for A3.5.1 quality implementation of family planning 2500 1 1 1 1 4 0.10 programe A3.5.1. At State level 1 A3.5.1. At District level 2

A3.5.1.2 Manpower .1

A3.5.1.2 Mobility cost for supportive supervision including

.2 QAC members Operational cost for Dist. FW Bureau for meeting Per A3.5.1.2 exp., reporting, internet, telephone, postage district .3 - etc. per month Operationalization of fixed day static services - A3.5.2 Family welfare day A3.5.2. Contingency for Fixed day static FP services 1 Per inst. A3.5.2.1 At L3 FRU Per 4 4 4 4 16 0.192 .1 1,200 quarter Per inst. A3.5.2.1 At L2 24x7 Per 11 11 11 11 88 0.52 .2 600 quarter A3.5.2.1 At Other DPs .3 Promote postpartum and post abortion family A3.5.3 planning services including sterilization in facilities having high institutional deliveries Remuneration of Family Planning Counsellor (32 A3.5.3.1 DHH + SCB MCH) @Rs.10,000/- + PI Rs.1500/- Per month (max 20%) Sensitization of service providers on PP A3.5.3.2 sterilization

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Sensitizing ASHA & AWW to motivate the A3.5.3.3 beneficiary Orientation to PPC SN & ANM on FP counseling & A3.5.3.4 on PP A3.5.5 Trainings A3.5.5. Laparoscopic sterilization training 1 A3.5.5. Minilap training 2 A3.5.5.2 Minilap training for MO (Asst Surgeon of L3 & L2): 3/batch 41625 1 0 0 1 2 0.83 .1 twelve working days at District level A3.5.5. NSV training 3 A3.5.5.3 NSV training for MOs five working days. State 0 5/batch 0 0 0 0 0 0 .1 level TOT - A3.5.5.3 NSV training for MOs five working days. District 5/batch .2 level - A3.5.5.3 NSV TOT training for surgery specialist or PG 5/batch .3 holder in surgery at National Level . - A3.5.5. IUD insertion training 4 A3.5.5.4 12/batch, 1.52 Six days Dist level IUCD training for MO and SN 76210 0 0 1 1 2 .1 person - A3.5.5.4 Six days Block level IUCD training for ANM, LHV 10/batch 48530 0 1 0 0 1 .2 0.485 Three days Postpartum IUCD Training for O&G A3.5.5.4 Spl and Staff Nurses of Respective Districts 10/batch 50000 0 0 1 0 1 0.50 .4 (5MOs+5SNs) A3.5.5.4 1 day district level Orientation to Block MO I/C 10/batch .7 & PHEO on IUCD 375-A - A3.5.5.4 1 day Orientation to ANM, SN on IUCD 375-A at 30/batch 30000 1 0 0 0 1 0.30 .8 Block Level of L2 & L1 Institution A3.5.5. Contraceptive update training 5 A3.5.5.5 One Day Contraceptive update & family planning 30/batch .1 guideline trg. for MOs (District) -

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Contraceptive update Trg. To Paramedics A3.5.5.5 (SN,LHV,HWF,HWM,HSM) per Dist. One batch at 30/batch 26000 0 1 0 0 1 0.26 .2 District level A3.5.5. Other FP Training 6 A3.5.5.6 Orientation training of newly trained surgeons on 30/batch .1 standards & protocols of FP methods (State) A3.5.5.6 Orientation training of FP Counsellor on 30/batch .2 standards & protocols of FP methods (State) A3.5.6 Printing A3.5.6.1 Printing of sterilization case cards Per card Procurement of equipment & instrument for A3.5.7 operationalistion of FP services A3.5.7.1 NSV kit Per kit 0 0 0 0 0 0 A3.5.7.2 Minilap kit Per kit 6000 2 0 0 0 2 0.12 A3.5.7.3 IUCD kit Per kit 2000 13 0 0 0 0 0.26 Per A3.5.7.4 Laprosocpe machine mechine A3.5.8 Performance Based Awards A3.5.8.1 Best performing districts (3 districts)/block Lump sum Best performing Surgeon (Female & Male A3.5.8.2 Lump sum sterilization) A3.5.9 Monitoring Per District level QAC meeting (Integrated with district 0.40 A3.5.9.5 1000 1 1 1 1 4 general QAC meeting) per - quarter

Quarterly family planning review by District A3.5.9.6 Authorities

A3.5.10 IEC/BCC Production of AV resource materials, A3.5.10. broadcasting & telecasting in mass media 1 channels A3.5.10. Advertisement of local dailies on FP 2 A3.5.10 Observation of World Population Fortnight .3

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A3.5.10 At State level .3.1 A3.5.10 At District level .3.2 A3.5.10. Per District level function 3.2.1 district 5,000 A3.5.10. Per Documentation 3.2.2 district 5,000 A3.5.10 At Block & sub-block level .3.3 A3.5.10. Block level function Per block 3.3.1 1,500 Per van A3.5.10. IEC Van for 2 3.3.2 15,000 block A3.5.10. Poster, leaflet, hoarding etc Per block 3.3.3 10,000 A3.5.10. Village contact drive Per block 3.3.4 10,000 A3.5.10. Documentation Per block 3.3.5 1,000 A3.5.10. Sensitizing Kalyani Club members/ NYKs Youth Per block 4 volunteers on FP issues 1,000 A3.5.10. Board for Designated FP Day at designated

5 institution (Promotion of Fixed day approach) - - - Wall painting - promotion of ASHA contraceptive 4nos per A3.5.11 in 18 high focus districts block Sub-total A3.5 42.707

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