CONTENTS
EXECUTIVE SUMMARY
CHAPTER-1 Outcome analysis of PIP 2009-10 and 2010-11
CHAPTER-2 Policy and Systemic reforms in strategic areas
CHAPTER-3 Conditionalities
CHAPTER-4 Scheme/Program
A. RCH Flexi Pool
B. NRHM Flexi pool
C. Immunization
D. Disease Control Programs
E. Inter-sectoral Convergence
CHAPTER-5 Monitoring and evaluation
CHAPTER 6 Financial Management
CHAPTER-7 State Resources and other sources of funds for health sector
Priority Projects that can be considered if additional resources CHAPTER-8 are available
Nagaland SPIP 2011-12 1
EXECUTIVE SUMMARY: There had been a tremendous impact in the Health sector since the implementation of NRHM in the state. In the earlier days, Health sector had never been a priority in the state. And at the time of attainment of statehood in 1963, Nagaland was only fortunate to inherit the legacy of a few hospital infrastructure in the then District Headquarters. The spread of health infrastructure in the state had always been in a slow pace mostly due to negligence and fund constraints in the State. Human resource in the health sector also had a setback with the blanket ban on post creation since 1990. This may be due to poor socio - economic status of the State which might have been responsible for the dismal Health Services. Thus, quality Health care has always been an elusive dream for the people in this part of the country. The need for quality Health care has been obvious giving the increasing number of patients from the state going out to the far and wide places in search of better services. But with the coming of NRHM, the health sector in the State has boost up, be it be in the infrastructure developments, capacity building or filling of manpower shortages and Health activities. The state seeing the impact on the Health sector under the flagship of NRHM has been contributing the state share without hesitation even with the financial crunches in the State.
For the year 2011-12, the state has taken an extensive exercise for developing the action plan right from the grass root level. It began with the development of the village health plan involving the village health committee (VHCs) and the communities in all the districts. The block health action plans were also done basing on the needs from the village health action plans, ground realities and priorities. The District action plans had been brought about with the accumulation of all the block health action plans and the district’s specific needs.
Table: District wise distribution of PHIs as on 30.09.2010. District DH CHC PHC SHC BD SC Total Kohima 1 3 14 0 0 40 58 Mokokchung 1 3 14 0 2 51 71 Tuensang 1 2 11 1 0 39 54 Phek 1 3 24 1 0 44 70 Mon 1 2 15 0 0 50 68 Wokha 1 2 12 0 0 37 52 Zunheboto 1 2 13 0 0 47 63 Dimapur 1 2 8 0 1 47 59 Peren 1 1 8 0 0 16 26 Kiphire 1 1 4 0 0 19 25 Longleng 1 0 3 0 0 8 12 State Total 11 21 124 2 3 398 558
Table: Health Scenario: Indicator Nagaland SRS 2006 SRS 2007 SRS 2008 SRS 2009 Birth rate 16.4 17.3 17.4 17.5 Death rate 3.8 4.8 5.0 4.6 IMR 18 20 21 26 Indicator NFHS I NFHS II NFHS III DLHS II (1992-93) (1998-99) (2005-06) (2002-04) Total Fertility rate 3.3 3.8 3.7 Full ANC 15.0 21.9 31.6 33.1 Institutional Delivery 6 12 12.2 17.8 Assisted Delivery 18.9 32.8 25.9 81.8 Full Immunization 4 14 21 14.4 Contraceptive Use 13 30 30 33.0 Total Unmet Need 26.7 30.2 26.3 33.8 MMR - - - -
Nagaland SPIP 2011-12 2
Table: Performance of Major Activities over the years
Year 2005-06 2006-07 2007-08 2008-09 2009-10 2010-2011 (upto Oct’10) Patient Turnover Out-patient Load 226957 295963 478078 523090 336959 341265 In-patient Load 18500 29158 34460 63805 54532 346683 Maternal Health Institutional Delivery* 1182 5696 9943 12606 10765 9455 Child health ** BGG 35024 52450 49917 26799 35159 22345 DPT3 29912 60257 50441 23717 32373 19376 OPV3 30614 62653 52904 24586 33175 20067 Measles 27876 50180 51618 23157 34253 20693 Full immunization - 50180 51618 23157 34253 20693 *As per RCH/JSY Report as on Dec’10 **As per UIP division
PROGRESS OF THE STATE SINCE LAUNCH OF NRHM:
1. Output Indicators: Indicator 2010-11(April- 2008-09 2009-10 October) BCG 76.0% 100.0% 63.8% DPT 67.0% 92.4% 55.3% OPV 70.0% 94.7% 57.3% Measles 66.0% 97.8% 59.1% Fully immunised 66.0% 97.8% 59.1% 1. Immunisation* Prophylaxis Against Blindness – 1st Dose 48.4% 45.0% 38.1% Prophylaxis Against Blindness – 2ndose 35.2% 23.5% 21.1% Prophylaxis Against Blindness – 3rdDose 30.4% 17.8% 15.0% ANC Registration against Expected Pregnancies 56.3% 88.0% 43.5% TT1 given to Pregnant women against ANC Registraion 23.4% 41.1% 20.0% Tetanus Immunisation (Expectant Mothers) 22.4% 35.0% 17.0% 3 ANC Check ups against ANC Reigtrations 14.0% 26.0% 14.0% 100 IFA Tablets given to Pregnant 2. Maternal and Child women against ANC Registraion 6.5% 23.0% 19.1% Health Pregnant women detected with hypertension 0.0% 1.1% 0.4% Pregnant women detected with anaemia 0.0% 2.5% 1.8% HOME Deliveries( SBA& Non SBA) against Estimated Deliveries 9.0% 13.4% 7.5% Institutional Deliveries against Estimated Deliveries** 27.9% 33% 25.8% C Section Deliveries against Institutional Deliveries( Pvt & Pub) 0.7% 2.4% 1.0% Live Births Reported against 3.Births & Neonates Care Estimated Live Births 26.5% 44.0% 22.4% Still Births (Reported) 1% 1% 0%
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Sex Ratio at Birh 993 928 947 New borns weighed against Reported Live Births 57.4% 74.1% 68.1% New borns weighed less than 2.5 kgs against newborns weighed 12.3% 9.0% 5.0% New borns breastfed within one hr of Birth against Reported live Births 0.8% 51.0% 62.0% Post-partum check-up within 48 hrs 4.Post Natal Care after delivery 9.3% 30.0% 32.2% Post-partum check-up between 48 hrs and 14 days after delivery 17.1% 18.3% 23.5% Condom-User 36.0% 96.0% 84.4% Oral Pill Users 15.2% 25.5% 12.1% IUD Insertions 2.0% 6.5% 2.7% 5. Family Planning Sterilisation 1.4% 4.0% 2.0% Tubectomy 1.2% 3.8% 2.0% Vasectomy 0.1% 0.1% 0.0% OPD 523090 336959 341265 IPD 63805 54532 346683 Major Operations 158 853 1482 6.Other Services Minor Operations 124 4474 6074 Number of villages 1278 No. of VHND Conducted 5 329 997 Number of times the Ambulance was used for transporting patients 15 424 457 7.Childhood Diseases Pertussis 0 2 7
2. Civil works: Table: List of various civil works under NRHM Total Units S. No Name of Work Approved Completed Under process 1 Sub Centre 135 85 50 2 PHC 19 6 13 3 CHC 8 5 3 4 DistrictHospital (Upgradation) 11 11 0 5 Staff Quarters (CHC) 19 8 11 6 Staff Quarters (CHC) 30 8 22 7 Drug Warehouse 5 2 3 8 NursingSchool Strengthening 2 2 0 9 NursingSchool Dimapur 2 2 0 10 Up Gradation Of NursingSchool To College 1 1 0 11 Upgradation Of NursingSchool Tsg 1 0 1
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3. Manpower development Table: Manpower Appointment and Institutional Strengthening at State and District Programme Management Units: No. Manpower Grand Total 1 Medical Officer (Specialist) 7 2 Medical Officer (General) 55 3 Medical Officer (AYUSH) 21 4 Dental Surgeon 26 5 Additional Staff Nurse 162 6 Additional ANM 364 7 Additional PHN 41 8 Pharmacist 4 9 Lab Technician 48 10 CT Scan Technician 1 11 ECG Technician 0 12 X-ray Technician 1 13 Telemedicine Operator 1 14 District Programme Manager 11 15 Media Officer 11 16 Block Programme Manager 45 17 ASHA Coordinator 40 18 Accountant 11 19 Data Entry Operator 10 20 Computer Operator 11 21 Driver for Medical Mobile Units 22 Total 892 22 ASHA (Voluntary Link Worker) 1700
4. Procurement & Supply of Medicines: The NRHM is supplementing the medicine supply under state procurement and RCH to all the health units as stated under.
No. Unit Total no. of Units 2008-09 Rs. In Lakhs 2009-10 Rs. In Lakhs 1 SC 397 34.62 143.99 2 PHC 123 38.34 36.80 3 CHC 21 87.12 86.24 4 DH 11 103.59 110.00 TOTAL 263.61 377.03
5. Procurement & Supply of Equipments and Instruments: The following amount was incurred for Procurement & Supply of Equipments and Instruments for various health units as per approved RoP over the years. No. Unit Total no. of Units 2008-09 Rs. In Lakhs 2009-10 Rs. In Lakhs 1 SC 397 50.00 0.00 2 PHC 123 69.39 138.55 3 CHC 21 216.78 31.95 4 DH 11 53.66 0.00 TOTAL 389.83 170.50
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6. Procurement & Supply of Ambulance: No. Unit No. of Health Units No. of Ambulances provided 2008-09 2009-10 Rs. In Lakhs 1 SC 397 - - - 2 PHC 123 28 - 182.00 3 CHC 21 20 147.00 0 4 DH 11 9 70.00 0 TOTAL 57 217.00 182.00
7. Financial Management System: The Mission has appointed qualified personnel in accounts at the State and District Health Management Units. In order to maintain proper records, computerized financial management and monitoring system is being introduced. The districts have started reporting the FMR monthly and are being uploaded into the web portal.
Internal audit, concurrent audit and annual external audit is a regular feature apart from monthly financial management reports.
Table: Allocation of Fund under NRHM: Year GOI 15% state Amount Amount Amount Allocation Share received received spent from GOI from State 2005-06 372.00 NA 372.00 NA 372.00 2006-07 2103.00 NA 1587.00 NA 1587.00 2007-08 4753.00 553.00 4753.00 600.00 4753.00 2008-09 5511.04 826.66 5541.04 900.00 6441.00 2009-10 8552.15 1175.00 4425.00 921.77 4260.54 2010-11 (till Oct ’10) 9810.00 1262.00 2341.00
Table: State Plan Outlay (Rs. in lakhs):
State Plan Outlay 6000 5000 4000 3000 8.14% 2000 45.19% 37.24% 1000 0 2007-08 2008-09 2009-10 2010-11
Table: State Non-Plan Expenditure (Rs. in lakhs): Year Allocation Medicine Salary 2005-06 7350.62 16.63 6288.55 2006-07 8058.85 20.00 6897.72 2007-08 9822.76 20.00 8606.43 2008-09 10624.06 20.00 9403.42 2009-10 12573.37 120.00 11026.36 2010-11 17247.22 20.00 15699.79
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8. ASHA (Accredited Social health Activist) Some achievements under ASHA programme are as follows: a. All the 1700 ASHA so far sanctioned are in position. b. Development of ASHA diary completed and distributed to all ASHAs. c. Regular featuring of ASHA in State’s NRHM quarterly Newsletter. d. Regular monthly thematic meeting initiated in most of the blocks by ASHA Coordinators. e. Radio sets provided to all the ASHAs. f. Translation of ASHA Reading Materials into 3 major local dialects viz. Ao, Tenydie and Phom completed. g. ASHA Drug Kit despatched to Districts to be distributed during the Block level trainings. h. Hand Weighing machines and thermometers procured for ASHAs. i. Training of ASHA Coordinators completed. (21st – 23rd Oct. 2009). j. Training of ASHA on 5th Module completed. k. State Trainer for modules 6 and 7 trained at SEARCH, Gadchiroli, Maharashtra. l. Training of District/ Block Trainers on 6th and 7th Modules completed.
9. IEC/BCC ACTIVITIES: Year-wise Activities implemented: Capacity training of MSS (Women Health 1617 members from 539 units in 5 districts of Committee) members Kohima, Mokokchung, Tuensang, Wokha and Dimapur were given training at their local PHCs. Orientation Training (OTC) of Community A total of 3123 community leaders (men, leaders women, youth) participated in 110 OTCs 2006-07 organized in 11 districts School-based IEC/BCC activities on topics of 161 programs in 165 schools in all 11 districts hygiene, immunization, drug abuse, HIV/AIDS covering 7990 students were held. etc. Group meetings with mothers on maternal 330 sessions in as many villages were held health, (ANC, INC, JSY, PNC) child health, where 7329 mothers participated home sanitation etc. Major activities carried out during the year: Routine activities of general awareness; collaboration with MSS and VHCs in organizing village health days and village sanitation drives; observance of 2007-08 health-related important days/events; orientation of IEC officials on micro planning and preparation/maintenance of monthly/daily calendar of activities. Training on capacity building of IEC/BCC 2 batches for 11 districts officials Newspaper Advertisements on RCH themes In all local newspapers and and NRHM goals of reducing TFR/MMR/IMR Dailies 2008-09 Radio jingles on NRHM goals and RCH In Nagamese and all Naga dialects themes Group interaction with women from eligible In 474 selected villages in stabilization couples on maternal health, child health and population all 11 districts
Health Melas organized in 10 districts. Exhibition stalls set up during State Road shows where IEC/BCC materials were displayed and distributed. Capacity building done for all district IEC/BCC officials. Regular advertisements published in local papers (including local dialect papers) under RCH themes, H1N1 flu, Tobacco control. 2009-10 IEC materials (pamphlets, posters) made under RCH themes, H1N1 flu, Tobacco control. Radio programme series (15 minutes, 12 episodes) and 5 jingles under RCH theme produced and aired in All India Radio Kohima and FM Mokokchung. Radio talks given on AIR, Kohima during important health days. TV spots on H1N1 flu telecast on Doordarshan Kohima and local cables in various districts.
Nagaland SPIP 2011-12 7
10. Other activities being performed under NRHM: a. Village Health & Nutrition Day (VHND): b. ARSH Clinic established in District Hospital Dimapur c. Assessment/Evaluation of NRHM • Grass root level evaluation by Dept of Evaluation in 2009. • Need Assessment of Doctors by CIHRS initiated during current FY. • Community Need Assessment by NU initiated during current FY. d. Name Based Tracking System (NBITS) / Mother & Child Tracking System (MCTS): Completed training of district trainers for MCTS, nodal officers at district and state identified and notified, designing and printing of MCTS registers and formats completed and dissemination to districts underway. To operationalise by Mar 2011. e. Maternal Death Review (MDR) Training of district trainers for Maternal Death Review (MDR) is completed and the district/state nodal officers identified and notified, designing and printing of registers and formats completed and dissemination to districts underway. To operationalise by March 2011. f. Communization Outcome: Compulsory check-up of pregnant mothers & delivery at hospitals/should be attended by trained health personnel. Compulsory immunization of children and participation in health programs. Health Education on Sanitation and various health issues such as Confinement of pet animals. Active participation in Village Health and Nutrition Day. g. Public Private Partnership (PPP): Signing pf MoU for establishment of North East Regional Paramedical Institute at Dimapur wherein the MoU was jointly signed on 22nd September 2010 between the Ministry of DoNER, Government of India and the Nagaland Government and the Christian Institute of Health Sciences and Research (CIHSR) in the presence of the Union Minister of DoNER and Mines, Shri B.K. Handique. Under the CIHSR tripartite Memorandum of Association (MoA), CHC Dhansaripar was adopted by CIHSR To augment the training programmes, the CIHSR Dimapur has been designated as a Training Centre under the tripartite of MoA CIHSR. Through this initiative the CIHSR will be providing its technical support in various training programmes beginning from the current FY. The training cost will be borne by NRHM as per GoI guideline. Another important milestone is the partnership with the Medecins Sans Frontieres (MSF) on the other for collaboration to improve access and provision of quality health care services in Mon District through the DistrictHospital. Under ‘Weaving a Dream: a People’s Initiative for Health Care’, the MoU between DoHFW and Eleutheros Christian Society (ECS) for the management of the Langpong Health Centre to promote and provide universally acceptable, accessible, equitable and quality health care services for the population of Changsang Range and Tuensang district in general was signed. Remarkable community participation in promotion health is exemplary under this project. The Department of Health & Family Welfare (DoHFW) also entered into a partnership with the Police Department for effective and collective utilization of its available manpower which resulted strengthening the Central Hospital Chumukedima to a First Referral Unit (FRU) for delivery of quality health care. The PoliceCentralHospital was inaugurated on 17th December 2010. This partnership will also incorporate the National Disease Control Programmes in the services delivery and participation in the Health Information Management System (HMIS) in all the Health Units under Police Department. The facility has started to function as FRU.
Nagaland SPIP 2011-12 8
Vision for the Current Year for the state of Nagaland: 1. Operationalization of facilities:
A. FRU Facilities: 5 CHCs in 5 districts would be operationalized as FRU’s. These facilities have been chosen on the following criteria: Good patient load Remoteness Availability of trained manpower These facilities are: Jalukie in Peren, Bhandari in Wokha, Medzephema in Dimapur, Pungro in Kiphire, and Noklak in Tuensang. B. 24x7 Facilities: CHCs – 16 CHCs currently functioning as 24X7 health facility need strengthening in terms of equipment. To meet this demand state has planned to establish NBSU at these CHCs. PHCs – Out of 33 designated 21 are functioning as 24x7 facilities with complete supplement of required equipment and manpower. The state proposes to strengthen the remaining 12 designated 24X7 PHCs by ensuring provision of NBCC. These PHCs are: Mezoma, Alongkima, Longchem, Nuiland, Chare, Chukidong, Wuzhuru-Ralan, Akuluto, Suruhoto, Chizami, Athibung and Tamlu.
2. Training outsourcing: In order to meet the acute shortage of skilled manpower and overcome the limited training capacity of the state the trainings under F-IMNCI, LSAS, EMOC, MiniLap, Laproscopic sterilization would be outsourced. One of identified partner in this activity is CMC Vellore, and rest of the agencies would be identified with help of RRC NE.
3. Intensive thrust on Family Planning: To have an impact on the current level of TFR state has planned to put intense thrust towards FP activities. Some of the components of this approach are: Increasing number of FP camps’ Focusing on FDS approach Taking services from outside specialists to conduct camps, in order to overcome shortage of specialist in state. Dedicated FP component in quality assurance plan. Regularizing flow of incentives to the beneficiaries.
4. Judicious planning of infrastructure development: Infrastructure planning of the state has been done keeping three objectives in mind, a. Strengthening of grass-root level facilities i.e. SC b. Ensuring 24X7 availability of skilled manpower at CHCs and PHCs. c. Need based infrastructure strengthening of health facility. Thus state has proposed construction of 50 SC buildings and construction of 28 staff quarters at the FRU CHCs and 24x4 Facilities and construction of 1 new building for Pungro CHC.
5. Strengthening of district hospitals: Mon and Dimapur DH are proposed for upgradation this year. Under Forward Linkage the budget has been asked.
6. Holistic IEC Plan IEC plan for this year has been made to meet specific demands of different programmes. Also methods that have found more acceptance have been given priority over others. To reach maximum population new activities have also been proposed on pilot basis.
7. Prioritizing retention of skilled manpower: State has decided to follow a three pronged approach (as demonstrated below) to retain the skilled manpower. Train
Facilitate Incentivise Nagaland SPIP 2011-12 9
The components of training and facilitating the stay have been ensured and to cover the component of incentives state proposes to revise the remunerations of all cadres of health workers.
8. Strengthening of Referral Transport System: Referral transport has been an area of concern for state due to non-availability of adequate number of ambulances and difficult terrain. To mitigate this challenge state plans to procure 19 ambulances and place them at strategic areas so as to reduce response time and optimize the utilization.
9. Integrating Communitization and ASHA functionality: ASHA basically being a community mobiliser, the state will mainstream the ASHA by integrating with the Communitization process launch in 2002.
10. Strengthening Monitoring and Evaluation: To ensure quality implementation of the various programme components overall M&E would be strengthened by providing timely support for mobility, regular sensitization of workforce, and strict follow up of the suggested interventions.
Nagaland SPIP 2011-12 10
EXECUTIVE BUDGET SUMMARY Budget Amount (Rs in S.No Main Heads Components Lakh) ANMs 716.40 GNM/ Staff Nurse 544.80 GNM for MCH activities in 11 DH 0.00 GNM for NBSU 48.00 Laboratory Technicians 70.20 X-ray technician 9.00 Lab Tech (of Blood Component) 9.00 Ophthalmic Assistants NPCB 4.80 Refrigerator Mechanics UIP 2.88 Specialists (Anesthetists, Pediatricians, Ob/Gyn,Surgeons, Physicians, Radiologist,Sonologist, Pathologist,Specialist for CHC) 106.08 PHNs at CHC, PHC level 129.60 Medical Officers at PHCs 465.60 Medical Officers at 24 x 7 PHCs 158.40 Medical Officers at CHCs 100.80 GDMO for MCH activities in 5 FRU CHC 24.00 GDMOs for NBSU for MCH activities in 11 DH 52.80 Additional Allowances/ Incentives to M.O.s of PHCsand CHCs 0.00 1 Human Resources Others - Computer Assistants/ BCC Co-ordinator etc 0.00 Support Staff 0.00 Incentive/ Awards etc. to SN, ANMs etc. 0.00 FP Performance based rewards to institutions 0.00 Pharmacists 25.20 Other Incentives Schemes (Pl.Specify) 0.00 Staff/Supervisory nurses (AYUSH) Medical Officers at CHCs/ PHCs (for AYUSH) 69.60 Dental Doctors 50.40 Strengthening of SHS/SPMU(Including HR Management Cost of SHP & M&E), Mobility Support, field visits ) 87.00 Strengthening of DHS/DPMU(Including HR, ManagementCost of SHP & M&E,Mobility Support, Field Visits ) 165.00 Strengthening of Block PMU(Including HR, ManagementCost,Mobility Support, Field Visits ) Payment to AYUSH Other Staffs Other Programme Management Costs (Audit Fees, Concurrent Audit etc) 30 Mobility Support, Field Visits to BMO/MO/Others Strengthening (Others)/Cold chain maitenance/Operational cost of RI 13.19 HR for NDCPs 771.10 Training under Maternal Health 95.40 Training under Child Health 11.66 Training under Family Planning Services 39.89 Strengthening Training Institutions 0.00 Development of training packages 0.00 IMEP Trainings 4.12 2 Training ARSH Training 13.81 Programme Management Training 10.00 Training (Other health personnels) 16.71 Training (NDCPs) 83.50 Training for Cold Chain Handlers/refrigerator mechanics 0.00 Training of M.O.s /Other Staffs on R.I. 11.84 Upgradation of CHCs, PHCs, Dist. Hospitals to IPHS) 0.00 Strengthening of District, Sub-divisional Hospitals, CHCs, PHCs (Mon & Dimapur DH) 0.00 3 Infrastructure New Constructions/ Renovation and Setting up CHCs, PHCs, HSCs, 0.00 Construction (Others) Regional Warehouse 0.00 Minor civil works for operationalisation of FRUs 85.00 Minor civil works for operationalisation of 24 hour services at PHCs 3.00
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Civil Work under RNTCP 23.51 Civil Work NPCB 77.50 Other Civil Works 55.00 NPCC RoP Approval for 2009-10 & 10-11 to be released in 2011-12 under civil works CHCs - Construction of 3 new CHCs (Chiephobozou, Noklak & Tobu) 175.50 @ Rs. 117.00 L as per Nagaland SOR Construction of 11 CHC Staff quarters @ 21.00 L (Annexure CW1) 115.50 PHCs - 13 PHC for new Construction @ Rs. 65.68 L as per Nagaland 426.92 SOR (Annexure CW1) Construction of 22 PHC Staff quarters @ Rs. 21.0 L (Annexure CW1) 231.00 Sub Centers - 50 Sub Centres for new construction @ Rs. 12.33 L, 216.50 totalling to Rs. 616.50 L. (Annexure CW1) Construction of 3 Drug Warehouse (Longleng, Tuensang & Zunheboto) vide GoI letter No: M-11011/4/09-NRHM-III dt 433.00 21st Dec 2009 Procurement of Drugs & Supplies 229.18 4 Procurement Procurement of Equipment 237.65 Procurement of Others (NDCP)s 148.54 Development of State BCC/IEC strategy Implementation of BCC/IEC strategy 366.97 5 IEC/BCC Health Mela 55.00 Creating awareness on declining sex ratio issue 0.00 Other activities NDCPs) 152.39 Untied funds for,VHSC, SC CHC,PHC 213.70 6 Untied funds Annual Maintenance Grants for CHCs, PHCs 122.80 Panchayati Raj Initiatives 24.82 ASHA Payments under NRHM Additionalities Selection & Training of ASHA 184.99 Procurement of ASHA Drug Kit 20.67 Incentive to ASHAs under JSY 1.56 Incentive under Family Planning Services 0.00 ASHA resource centre 51.20 Incentive to ASHA's for motivating families for Sanitary Toilets/Other 7 ASHA Incentives (award & ASHA resouce centre) 0.00 Awards to ASHA's/Link workers 0.00 ASHA Incentive under Immunisation 0.00 ASHA Incentive under NLEP 0.50 ASHA Incentive under NVBDCP 50.00 ASHA Incentive under NBCP 1.58 ASHA Incentive unde NIDDCP 6.60 ASHA Incentive under RNTCP 8 RKS Corpus grants to RKS 215.00 Home Deliveries 65.00 9 JSY Institutional Deliveries 195.00 Others 45.59 Compensation for Male sterlisation 0.45 Compensation for Female sterlisation 25.00 NSV Camps 0.00 Female Sterlisation Camps 0.00 10 Sterlisation IUD Services 0.50 Social Marketing of contraceptives 0.00 POL for Family Planning 6.60 Repairs of Laparoscopes 0.00 Other Expenses/VHND 6.95 11 Referral Transport Referral Transport 217.18 ARSH 6.00 Maternal Death Audit 0.00 12 Other RCH Activities Maternal Health 37.14 Child Health 18.86 Tribal RCH 0.00 13 Vulnerable Group Vulnerable Groups 0.00
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Research Studies, 9.00 New Initiatives 124.31 Support to other programmes 30.00 District Health Action Plan 60.00 Mainstreaming of AYUSH 18.52 Other Mission MMU 226.60 14 Activities PROMIS 0.00 SHSRC 0.00 School Health Programme 16.12 Health Insurance 0.00 M & E 439.50 Planning , Implementation, Monitoring 99.57 NGO activities, PPP under NRHM Additionalities 553.06 15 PPP/NGO Other NDCPs (RNTCP, NPCB etc) 31.98 Mobility, Review Meeting ,field visits, formats & reports,Communication etc Operational Cost 16 for NDCPs 740.12 (NDCPs) Lab consumables, AMC etc for NDCPs/IDSP 0.00 Financial aid/grant to 17 Institutions(NDCPs) Strengthening NPCB (Opthalmic Assistants) 0.00 Strengthening of IDSP (power backup for Edusat) 0.00 Strengthening of UIP (R/Mechanic) 0.00 Strengthening of NSACS (Blood Component, Blood Bank Dimapur) 0.00 Strengthening of Oral Health 61.84 Strengthening of NTCP 45.64 Strengthening of NMHP 52.82 Strengthening of NPPCD 122.64 Grand Total 11092.34
SUMMARY OF BUDGET (Rs. In Crores) Approved Amount (2010- Amount Proposed (2011- Scheme/Programme 11) 12 1 RCH Flexible Pool 32.34 36.24 NRHM Mission Flexible 2 40.86 54.43 Pool 3 Immunization 1.27 1.44 4 NVBDCP 5.33 9.79 5 RNTCP 3.03 4.13 6 NPCB 1.68 2.1 7 NIDDCP 0.36 0.42 8 IDSP 0.98 1.76 9 NLEP 0.52 0.61 1 PPI Operational Cost 0.87 0 1 Infrastructure Maintenance 11.53 1 Total 98.77 110.92
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CHAPTER 1: OUTCOME ANALYSIS OF PIP OF 2009-10 AND 2010-11 Physical and financial outcomes in respect of various parameters of the PIP of 2009-10 and 2010-11 (30.09.2010): (Rs. In Lakhs) Activity Financial Physical 2009-10 2010-11 2009-10 2010-11 Appro Expen Expec Approve ved diture ted Achie d Expen Amou pto outpu veme Expected Achievem Amount diture nt Dec'10 t nts output ents A.1 MATERNAL HEALTH A.1.1 Operationalise facilities (only dissemination, monitoring, and quality) A.1.1.1 Operationalise FRUs A.1.1.2 Operationalise 24x7 PHCs A.1.1.3 MTP services at health facilities A.1.1.4 RTI/STI services at health facilities A.1.1.5 Operationalise Sub-centres A.1.2 Referral Transport A.1.3 Integrated outreach RCH services A.1.3.1 RCH Outreach Camps 0.50 A.1.3.2 Monthly Village Health and Nutrition Days A.1.4 Janani Suraksha Yojana / JSY 0.00 A.1.4.1 Home Deliveries ( NMBS ) 12.34 100.00 41.52 1116 20000 15625 0 A.1.4.2 Institutional Deliveries 234.00 116.98 260.00 160.84 2000 1013 20000 9336 upto 0 7 Dec'10 A.1.4.3 Other Activities 2.00 2.53 67.07 A.1.5 24 Hours Deliveries A.1.5.1 Maternal Death 16.80 0.29 Ongoing A.2 CHILD HEALTH A.2.1 IMNCI 42.40 20.22 35.40 Ongoing A.2.2 Facility Based Newborn Care/FBNC A.2.3 Home Based Newborn Care/HBNC A.2.4 School Health Programme A.2.5 Infant and Young Child Feeding/IYCF A.2.6 Care of Sick Children and Severe Malnutrition A.2.7 Management of Diarrohea, ARI and Micronutrient Malnutrition A.2.8 Other strategies/activities A.3 FAMILY PLANNING A.3.1 Terminal/Limiting Methods 5.01 7.65 A.3.1.1 Dissemination of manuals on 1.00 sterilisation standards & quality assurance of sterilisation services A.3.1.2 Female Sterilisation camps 6.60 44 27 A.3.1.3 NSV camps 15.40 15.40 A.3.1.4 Compensation for female 20.00 25.00 2000 938 2500 1302 upto sterilisation Nov'10 A.3.1.5 Compensation for male 0.75 0.98 36 18 65 6 sterilisation A.3.1.6 Accreditation of private providers 7.50 25 Male 2 Male & for sterilisation services & 25 18 Female Female upto Nov 10
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A.3.2 Spacing Methods A.3.2.1 IUD camps A.3.2.2 IUD services at health facilities A.3.2.3 Accreditation of private providers for IUD insertion services A.3.2.4 Social Marketing of contraceptives A.3.2.5 Contraceptive Update seminars 2.75 A.3.3 POL for Family Planning A.3.4 Repairs of Laparoscopes A.4 ADOLESCENT REPRODUCTIVE AND SEXUAL HEALTH / ARSH A.4.1 Adolescent services at health 12.50 24.50 5.40 7 7 29 ARSH Ongoing facilities. Units Units clinics;pri ngting of training manuals A.4.2 Other strategies/activities 3.00 Monit Done Monitori Done oring ng of of services servic es A.5 URBAN RCH A.6 TRIBAL RCH A.7 VULNERABLE GROUPS A.8 INNOVATIONS/ PPP/ NGO A.8.1 PNDT and Sex Ratio A.8.2 Public Private Partnerships A.8.3 NGO Programme 264.50 22.43 333.36 A.8.4 Other innovations( if any) A.9 INFRASTRUCTURE & HUMAN RESOURCES A.9.1 Contractual Staff & Services A.9.1.1 ANMs 76.56 69.35 76.56 48.83 1 1 1 9 16 16 16 9 A.9.1.2 Laboratory Technicians 11.88 10.37 11.88 8.20 1 1 1 1 8 8 8 8 A.9.1.3 Staff Nurses 70.20 30.36 136.80 21.63 4 1423 SN & 3 6 3 10 PHN 9 A.9.1.4 Specialists (Anesthetists, 193.80 43.15 255.00 17 7 Pediatricians, Ob/Gyn, Surgeons, Physicians) A.9.1.5 M. Salary 24.20 61 46 85 9 A.9.1.6 Others/Refrigerators 24.84 1.09 A.9.1.7 Incentive/Awards 6.71 A.9.2 Major civil works (New constructions/ extensions/additions) A.9.2.1 Major civil works for operationalisation of FRUS A.9.2.2 Major civil works for operationalisation of 24 hour services at PHCs A.9.3 Minor civil works 42.50 A.9.3.1 Minor civil works for 17.42 49.50 Ongoing operationalisation of FRUs A.9.3.2 Minor civil works for 25.00 189.75 24.17 10 10 Ongoing operationalisation of 24 hour NBCC NBCC services at PHCs A.9.4 Operationalise Infection 51.10 23.27 29.74 Burial 49 Training, TOT Management & Environment Plan pit at procure done,proc at health facilities SC ment & urement
Nagaland SPIP 2011-12 15
100 civil work Done & civil work ongoing A.9.5 Other Activities (RCH-I Civil Works) A.10 INSTITUTIONAL STRENGTHENING A.10.1 Human Resources Development A.10.2 Logistics management/ improvement A.10.3 Monitoring & Evaluation / HMIS 18.00 5.38 160.27 55.46 A.10.4 Sub Centre Rent and Contingencies A.11 TRAINING A.11.1 Strengthening of Training Institutions A.11.2 Development of training packages A.11.3 Maternal Health Training A.11.3.1 Skilled Birth Attendance / SBA 23.46 30.00 140 60 26 till Dec Mos '10 & Nurse s A.11.3.2 EmOC Training 8.33 0.80 8.84 0.54 7 2 5 6 and 2 SNs undergoin g training A.11.3.3 Life saving Anesthesia skills training 2.78 9.93 1.84 5 5 (3 5 4 and 2 resig SNs ned) undergoin g training A.11.3.4 MTP training 19.49 60 26 30 18 A.11.3.5 RTI / STI Training 6.21 0.70 316 280 90 90 A.11.3.6 Dai Training A.11.3.7 Other MH Training (ISD Refresher ) 0.77 A.11.4 IMEP Training 14.59 32.55 4 ToT 4 ToT A.11.5 Child Health Training A.11.5.1 IMNCI 14.48 54.50 A.11.5.2 Facility Based Newborn Care A.11.5.3 Home Based Newborn Care A.11.5.4 Care of Sick Children and severe malnutrition A.11.5.5 Other CH Training (pl. specify) A.11.6 Family Planning Training A.11.6.1 Laparoscopic Sterilisation Training 8.80 32 0 20 9 A.11.6.2 Minilap Training 5.33 48 28 24 9 A.11.6.3 NSV Training 1.59 12 8 24 0 A.11.6.4 IUD Insertion Training 6.33 19.20 A.11.6.5 Contraceptive Update/ISD Training A.11.6.6 Other FP Training (pl. specify) A.11.7 ARSH Training 5.31 4.77 27.65 2.24 28 22 Training ongoing Mos, Mos, of 120 28 16 Mos,120 Ns,14 Ns,8 ANMs,55 Coun Coun LHVs cellor cellor s s A.11.8 Programme Management Training A.11.8.1 SPMU Training 1.25 4.40 1.25 A.11.8.2 DPMU Training A.11.9 Other training (pl. specify) 12.07 18.55 40.86 8.00 A.12 BCC / IEC A.12.1 Strengthening of BCC/IEC Bureaus
Nagaland SPIP 2011-12 16
(state and district levels) A.12.2 Development of State BCC/IEC 7.10 strategy A.12.3 Implementation of BCC/IEC 120.00 59.12 444.57 139.19 strategy A.12.3.1 BCC/IEC activities for MH A.12.3.2 BCC/IEC activities for CH A.12.3.3 BCC/IEC activities for FP A.12.3.4 BCC/IEC activities for ARSH 4.45 A.12.4 Other activities (Media Officer 15.36 11.58 Salary) A.13 PROCUREMENT A.13.1 Procurement of Equipment A.13.1.1 Procurement of equipment: MH 49.50 49.50 108.58 109.45 33 Done PHCs A.13.1.2 Procurement of equipment: CH 73.17 68.90 8.73 8.73 21 Done CHCs, 11 DH A.13.1.3 Procurement of equipment: FP 56.06 55.90 A.13.1.4 Procurement of equipment: IMEP A.13.2 Procurement of Drugs and 89.94 supplies A.13.2.1 Drugs & supplies for MH 107.39 107.39 RTI/STI Done kits A.13.2.2 Drugs & supplies for CH A.13.2.3 Drugs & supplies for FP A.13.2.4 Supplies for IMEP 38.27 37.20 Done A.13.2.5 General drugs & supplies for health 47.20 47.20 facilities A.14 PROGRAMME MANAGEMENT 129.08 A.14.1 Strengthening of State 30.48 45.08 35.85 118.85 society/State Programme Management Support Unit A.14.2 Strengthening of District 146.98 40.34 183.70 57.32 society/District Programme Management Support Unit A.14.3 Strengthening of Financial 13.40 17.50 Management systems A.14.4 Other activities (Prog. 98.52 158.60 Management Expenses, Mobilty support to state, district, block for all staff).
B TIME LINE ACTIVITIES - Additinalities under NRHM 3068.5 (Mission Flexible Pool) 8 B1 ASHA B1.1 Selection & Training of ASHA 43.13 27.32 B1.2 Procurement of ASHA Drug Kit 27.00 34.47 B1.3 Radio Sets to ASHAs ASHA Co ordinator/Nodal 170.00 170.00 B1.4 Officer/Mentor Salary 19.81 17.80 B1.5 ASHA Dairy 3.87 B1.6 ASHA Radio Set 13.60 B1.7 ASHA Resource Centre 0.70 4.92 B2 Untied Funds B2.1 Untied Fund for CHCs 10.50 2.70 10.50 8.63 B2.2 Untied Fund for PHCs 21.00 18.35 21.50 7.47 B2.3 Untied Fund for Sub Centers 39.70 21.27 39.70 56.93 B2.4 Untied fund for VHSC 127.80 98.51 131.70 151.18 B3 Hospital Strengthening
Nagaland SPIP 2011-12 17
Upgradation of CHCs, PHCs, Dist. B3.1 Hospitals to IPHS) B3.1.1 District Hospitals B3.1.2 CHCs 117.00 B3.1.3 PHCs B3.1.4 Sub Centers B3.1.5 Others Strengthening of District and Sub- B3.2 divisional Hospitals 509.18 B4 Annual Maintenance Grants B4.1 CHCs 21.00 7.32 21.00 18.33 B4.2 PHCs 42.00 36.24 43.00 13.08 B4.3 Sub Centers 34.20 21.75 30.90 40.94 New Constructions/ Renovation B5 and Settingup 173.20 B5.1 CHCs 131.36 175.50 55.13 B5.2 Staff Quarter 115.50 B5.3 PHCs 328.40 142.68 426.92 194.70 B5.4 Staff Quarter 231.00 B5.5 SHCs/Sub Centers 308.25 400.00 25.39 Staff Quarter PHC/CHC (2008-09) B5.6 approval 83.32 Drug Warehouse (2008-09 B5.7 Approval) 75.47 Govt. Dispensaries/ others B5.8 renovations Construction of BHO, Facility improvement, civil work, BemOC B5.9 and CemOC centers B6 Corpus Grants to HMS/RKS B6.1 District Hospitals 55.00 21.28 55.00 50.36 B6.2 CHCs 21.00 10.44 21.00 18.52 B6.3 PHCs 84.00 98.96 86.00 26.16 B6.4 Other or if not bifurcated as above 19.73 District Action Plans (Including B7 Block, Village) 55.00 37.47 60.00 12.23 B8 Panchayti Raj Initiative Constitution and Orientation of Community leader & of B8.1 VHSC,SHC,PHC,CHC etc 51.12 30.67 66.20 27.88 Orientation Workshops, Trainings and capacity building of PRI at State/Dist. Health Societies, B8.2 CHC,PHC B8.3 Others B9 Mainstreaming of AYUSH B10 IEC-BCC NRHM B10.1 Health Mela 55.00 34.15 55.00 12.32 Creating awareness on declining B10.2 sex ratio issue B10.3 Other activities (Posters & Printing) 26.00 10.00 9.98 B10.4 IEC for special Immunisation 11.48 Mobile Medical Units (Including B11 recurring expenditures) 218.57 85.12 260.81 136.16 B12 Referral Transport B12.1 Ambulance 182.00 63.00 B12.2 Operating Cost (POL) B13 School Health Programme 15.00 14.99 50.44 25.24 Additional Contractual Staff (Selection, Training, B14 Remuneration)
Nagaland SPIP 2011-12 18
Additional Staff/ Supervisory Nurses PHC,CHC (Including Ayush B14.1 Stream) 61.20 101.8 94.50 81.70 B14.2 Additional ANM, ,LHV, MPW 165.00 116.71 244.20 94.10 B14.3 PHNs at PHC level 48.60 48.60 Medical Officers at PHCs & CHC B14.4 (Including AYUSH stream) 167.40 150.49 234.60 107.42 Additional Allowances to MOs PHC, B14.5 CHC Lab technicians, Gynecologists, Anesthetists, Pedisterian, Specialist CHC, Radiologist, Sonologist, Pathologist, Dental B14.6 Surgeons & Pharmacist. 105.30 78.68 87.30 73.23 B15 PPP/ NGOs Non governmental providers of B15.1 health care RMPs/TBAs 15.00 15.00 B15.2 Grant in Aid to NGOs Weaving a dream a Peoples B15.3 innitiative for Health Care 36.17 B16 Training Strengthening of Existing Training B16.1 Institutions/Nursing School 374.00 200.00 100.00 B16.2 New Training Institutions/School Training and Capacity Building B16.3 Under NRHM Promotional Trg of health workers B16.3.1 females to lady health visitor etc. Training of AMNs,Staff B16.3.2 nurses,AWW,Anganbadi Other training and capacity B16.3.3 building programmes B17 Incentives Schemes 10.60 B17.1 Incentives to Specialists (CHCs) Incentives to Medical Officers B17.2 (PHCs) B17.3 Other Incentives Schemes Alternate Delivery System - B17.3 Overheads 63.36 0.80 72.15 Planning, Implementation and B18 Monitoring Community Monitoring (Visioning workshops at state, Dist, Block B18.1 level) B18.1.1 State level 1.00 1.00 B18.1.2 District level 1.00 1.00 B18.1.3 Block level 11.00 11.00 B18.1.4 Other (NGO & Village level) 11.00 48.10 B18.2 Quality Assurance B18.3 Monitoring and Evaluation B18.3.1 Computerization HMIS and e- governance, e-health B18.3.2 Other M & E (PROMIS) 10.82 0.36 B19 Procurements B19.1 Drugs 377.03 377.00 B19.2 Equipments (2009-10 approval) 15.88 15.00 B19.4 Dental Equipments 32.40 31.96 29.16 28.76 B19.5 Bed Nets 144.47 144.46 B19.6 Ambulance for PHC (2009-10 approval) 186.99 B20 PNDT Activities
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B21 Regional drugs warehouses 304.87 B22 New Initiatives/ Strategic Interventions (As per State health policy)/ Innovation/ Projects (Telemedicine, Hepatitis, Mental Health, Nutition Programme for Pregnant Women, Neonatal) NRHM Helpline) as per need (Block/ District Action Plans) B22.1 Study Allowance to ANMs 7.20 B22.2 Study Allowance to GNM 10.80 B23 Health Insurance Scheme B24 Research, Studies, Analysis B25 State level health resources center(SHSRC) B26 Support Services B26.1 Support Strengthening NPCB B26.2 Support Strengthening Midwifery Services under medical services B26.3 Support Strengthening RNTCP B26.4 Contingency support to Govt. dispensaries B26.5 Other Support Programmes IDSP 13.74 B26.6 Review Meeting on Implementation status 35.10 4.12 1.43 B27 NRHM Management Costs/ Contingencies 260.00 148.57 B27.1 Block Level PMU B27.2 District level 117.92 B27.3 State level 106.08 B27.4 Audit Fees 11.84 3.55 B27.5 Concurrent Audit system B27.6 Other Management expenses 266.00 91.60 B27.7 Telephone and Mobile phone, Contingencies expenses 9.00 B27.8 Mobility Support to BMO/MO/Others B.28 Other Expenditures (Power Backup, Convergence etc) Telemedicine / CT Scan Tech. Salary 68.8 66.68
C IMMUNISATION 154.46 C.1 RI strengthening project (Review meeting, Mobility support, Outreach services etc) 74.82 124.97 84.77 C.2 Cold chain maintenance 37.63 1.82 C.3 Pulse Polio operating costs 42.01 3.46 D IDD E IDSP 13.74 E.1 Surveillance preparedness, training & staff 3.39 25.65 E.2 salary 38.37 30.02 98.00 26.17 E.3 Outbreak investigation 0.74 4.00 E.4 Analysis & use of data 0.33 1.00 E.5 F NVBDCP Malaria 408.37 430.87 528.65 270.93 a) ABER= ABER=10% ABER=9.2 J.E Nil Nil 3.5 Nil ABER 7.88% IRS=100% 2% Dengue/Chikungunya Nil Nil 3.5 Nil = 10% IRS=6 Training: IRS=80.50 b) IRS 6% Mos, LTs, Cash assistance for decentralized %
Nagaland SPIP 2011-12 20
Decentralized commodities 29.08 14.83 10.47 Nil = Ird=63 H. Ird=63.3% Commodity support by GoI 100% .30% II Supervisor II rd room rd MPW, =37 trg covera =39 ASHAs, course ge c) trg Communit Trainin course y Carried g: Carrie volunteers out as Mos, d out IEC/ BCC: planned LTs, H. as Poster/ Superv plann Banner , isor ed campaign, MPW, handout ASHAs distributio , n through Comm print unity media volunt communit eers d) y level IEC/ awareness BCC: camps Poster / Banne r , campa ign, hando ut distrib ution, advert iseme nt throug h print media comm unity level aware ness camps G NLEP H NBCP H.1 Cataract Performance H.1.1 Grant in aid (for Cataract Operations) 17.98 17.98 11.25 11.25 1500 1046 1500 678 H.1.2 Vision Centre (50X50,000) 2.50 2.50 2.50 2.50 5 5 5 5 H.1.3 Medical Colleges (3X40) Nil Nil Nil Nil Nil Nil Nil Nil H.1.4 Strengthening of District Hospital Nil Nil 40.00 40.00 Nil Nil 2 2 H.1.5 Sub District Hospital H.1.6 Eye Donation Centre (Non Recurring 3X1) Nil Nil Nil Nil Nil Nil Nil Nil H.1.7 Remuneration (SBCS) & Staff Salary/ Other Activities/Post 5.00 1 1 1 1 Requirement 7.00 7.00 7.00 H.1.8 IEC Activities (50X20 Thousand + SBCS 1 Lacs) X X 5.00 5.00 X X X X H.1.9 Proposal for Sutures /(Per Pieces 10.0)/Ophth. Equipments X X X X X X X X
H.3 Eye Donation H.3.1 No. of Eyes collected H.3.2 No. of Eyes utilized I RNTCP I.1 Civil Works
Nagaland SPIP 2011-12 21
I.2 Laboratory Materials I.3 Honorarium I.4 IEC I.5 Equipment maintenance I.6 Training I.7 Vehicle Maintenance I.8 Vehicle Hiring I.9 NGO/PP Support I.10 Medical College I.11 Miscellaneous I.12 Contractual Services I.13 Printing I.14 Research & Studies I.15 Salary of regular staff I.16 Procurement of drugs I.17 Procurement of vehicles I.18 Procurement of Equipment J NPPCD 53.77 GT Grand Total (A+B+C+D+E+F+G+H+I)
Certified that the above amount of expenditure is duly reconciled with the amount recorded in the relevant ledger heads.
(Finance Manager/Finance Controller/ Finance Officer)
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CHAPTER 2: POLICY AND SYSTEMIC REFORMS IN STRATEGIC AREAS:
Several management imperatives has been addressed already and discussed in details against the respective activities. The State is still working on recurring policies and systematic reforms in strategic areas in conformity with GoI norms. Hence, the information as & when the issue is addressed.
CHAPTER 3: CONDITIONALITIES a. Release of the first tranche of funds: To facilitate the release of first tranche of funds from GoI, the State has carried out the following conditions:- The State has appointed a full-time Mission Director of IAS Cadre, who is fully dedicated for the activities of NRHM without any additional charges. The State has also appointed a full-time Deputy Director (Finance) from the State Finance Service without any other additional charges. The Department is on negotiation for increase of State Plan Budget for 2011-12 regarding the 15% state share for NRHM. b. Release of second tranche of funds: Action taken:- In regards to HR POLICIES & SYSTEMS, the Department has taken an exercise for the rational deployment of all categories of Health Workers to ensure Health Care Delivery Services at all levels. This exercise is being taken even for the regular employees of the Department. DRUG POLICY & SYSTEMS; The Department has constituted a Procurement Board and a Verification Board with an objective of minimizing out-of-pocket expenses and quality assurance. c. Compliance of the laid down conditionality are as stated below:- Sl. Conditionality Compliance Status No 1 All posts under NRHM are on contract and based on local criteria. The contract should be done by the Rogi Kalyan Samiti /District Health Society. The stay of person so contracted at place of posting Agreed is mandatory. All such contracts are for a particular institution and non transferable. The contracted person will not be attached for any purpose at any place. 2 The state agrees to credit 15% of the State share to the account of the State Health Society in two installments. The State also Negotiation is on with the State aggresses to enhance the over-all expenditure on health by the State Government Government by a minimum of 10 percent per year. 3 Blended payments comprising of a base salary and a performance Agreed based component, should be encouraged. 4 State Government must fill up its existing vacancies against Completed sanctioned posts, preferably by contract. Top most priority in contractual recruitments should be for backward districts and for difficult, most difficult and inaccessible health facilities. 5 Delegation of administrative and financial powers should be Agreed completed during the current financial year. If not already done. 6 State shall set up a transparent and credible procurement and Agreed Supply chain management system and Procurement Management Information System (PROMIS) [on the lines of the Tamil Nadu Medical Services Corporation]. State agrees to periodic procurement audit by third party to ascertain progress in this regard. 7 The State shall undertake institution specific monitoring of Agreed performance of Sub Centre, PHCs, CHCs, DHs, etc. 8 The State shall operationalise an on-line HMIS in partnership with Agreed MOHFW.
Nagaland SPIP 2011-12 23
9 The State shall take up capacity building exercise of Village Health Agreed and Sanitation Committees, Rogi Kalyan Samiti and other community /PRI institutions at all levels. 10 The State shall ensure regular meetings of all community Agreed Organizations/District /State Mission with public display of financial resources received by all health facilities. 11 The State Govts. shall also make contributions to Rogi Kalyan Agreed Samiti and transfer responsibility for maintenance of health institutions to them. 12 The State shall prepare Essential Drug lists of generic drugs and Agreed Standard treatment Protocols, and give it wide publicity. 13 The State shall focus on the health entitlements of vulnerable social Agreed groups like SCs, STs, OBCs, Minorities, Women, migrants etc. 14 The State shall ensure timely performance based payments to Agreed ASHAs/Community Health Workers. 15 The State shall encourage in patient care and fixed day services for Agreed family planning. 16 The State shall ensure effective and regular organization of Agreed Monthly Health and Nutrition Days and set up a mechanism to monitor them. 17 All performance based payments/incentives should be under the Agreed supervision of Community Organizations (PRI)/RKS. 18 The State agrees to follow all the financial management systems under operation under NRHM and shall submit Audit Reports, Agreed FMRs, Statement of Fund Position, as and when they are due. State also agrees to undertake Monthly District Audit and periodic assessment of the financial system. 19 The State agrees to fast track physical infrastructure upgradation by Agreed crafting State specific implementation arrangements. State also agrees to external evaluation of its civil works programmes. 20 The State Govt. agrees to co-locate AYUSH in PHCs/CHCs, Agreed wherever feasible. 21 The State agrees to focus on quality of services and accreditation of Agreed government facilities. 22 The State/UT agrees to undertake community monitoring on pilot Agreed basis, wherever not tried out as yet, and scale up with suitable model wherever piloted earlier. 23 The State/UT agrees to undertake continuing medical and Agreed continuing nursing education. 24 The State agrees to make health facilities handling JSY, women and Agreed child friendly to ensure that women and new born children stay in the facility for 48 hours. 25 The State Governments shall, within 45 days of the issue of the Agreed Record of proceedings, issue detailed District wise approvals and place them on their website for public information. 26 The State agrees to return unspent balance against specific releases N/A made in 2005-06, if any. 27 The State is entitled to engage a second ANM to the extent that it Agreed provides for MPW (Male) or the contractual amount of 2nd ANM be paid out of State Budget and Third functionary may be engaged from NRHM Fund. 28 The State shall put in place a transparent and effective human Agreed resource policy so that difficult, most difficult and inaccessible areas attract human resources for health. 29 The State agrees to fast track physical infrastructure up-gradation by crafting State specific implementation arrangements. State also agrees to external evaluation of its civil works programmes. The State shall provide names of all facilities where civil works are undertaken and also certify that the Agreed
Nagaland SPIP 2011-12 24
location of these facilities is such that poor households can seek services from them. Prior approval of place of construction by GoI will be mandatory before taking up new construction under NRHM. Thrust must be on meeting infrastructure gap in backward districts and difficult, most difficult and inaccessible facilities. 30 The State agrees that the provision for EMRI operational cost to N/A States will be on declining basis. For first year operational cost will be 60%, 2nd year 40%, 3rd year 20% and nil thereafter. 31 The State agrees to comply with the following over a period of six months: System for assured and affordable referral transport for pregnant -Agreed women and sick children/infants. Facility upkeep (including maintenance of building – sanitation, -Agreed laundry, water, electricity, kitchen) and grievance redressal mechanisms. Performance benchmarks for staff prior to renewal of contracts and -Agreed incentives. Availability of functional equipments at all facilities. -Agreed
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CHAPTER 4A: RCH II FLEXIPOOL Introduction: Since the implementation and introduction of RCH-II and NRHM major progress in several areas has been made which have impacted upon Reproductive Child Health. A distinct focus of RCH II has been, overall proactive measures undertaken to improve health sector and innovations in the health sector are some of the key contributions. Chiefly the major improvements can be categorized as follows:
At the outcome level Increase in full ante natal care in the state. Increase in full immunization in the state. Increase in institutional delivery in the State.
At the output level a. Facility up-gradation To improve the existing facilities efforts are being made to upgrade infrastructure and equipments. Micro Planning for FRUs and 24x7 facilities has been undertaken to identify the gaps and enable full fictionalization. For improving access to facilities the emergency referral transport scheme, has been initiated in the state across the 11 districts. b. Human Resource To palliate the unavailability of specialists, short term EmOC and Anesthesia course for MBBS Doctors has been initiated and 5 EmOC and 5 LSAS doctors have been trained and 2 EmOC are undergoing training at Assam Medical College Dibrugarh. 4 MO in EmOC and 4 MO in LSAS and 2 nurses to undergo the same training at Vellore Christian Medical College from 1st Feb. 2011. As a part of the State initiative, enhancement in remuneration of contractual doctors and increase in remote area allowance for doctors has been some proactive steps undertaken to improve the availability of doctors. The annual program implementation plan for 2011-12 has been made on needs, evidence, and feedback from the stakeholders. The plan also addressed adequately gender issues including facility sites, training and participation. Adequate emphasis has been included. Assurance of quality services, systematic plan on women, child and family planning action plan has been made for necessary consideration.
OVERVIEW OF RCH-NRHM PERFORMANCE (2005-11): a. Facility Operationalisation and Trained Service Providers: Service utilization* (average Number of facilities/HR per month per facility/ trained
provider)
-
Area Indicator -
11) 11, till
- - 12
-
2010
Planned (2005 Achievemet (2005 30.11.10) Percentage (%) Achievement Plan for 2011 2012 Services Based on performance during Apr Nov Projection for 2011 Facility No. of FRUs 11 DHs 11 85% 5 C-sections 320 600 Operationalisatio Operationalise and 4 MTPs 1390 1500 n d CHCs Male 2 50 sterilizations Female 1302 2500 sterilizations No. of 24x7 33 33 100% 33 Normal 3245 5000 PHCs deliveries Operationalise MTPs d Male sterilizations
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Female sterilizations IUD 575 1000 insertions No. of sub- Not 5 - 10 Normal 39 900 centres Planne deliveries operationalised d IUD as insertions delivery points No. of NBSUs Not 2 5 Newborns operationalised Planne (Phototherap FRU treated d y Unit for 21 CH CHCs and 11 C DH has been procured and would be commissione d soon) EmOC training 15 2 (4 more 13% 10 C-sections 10 ongoing) LSAS training 15 2 (6 13% 10 C-sections 10 undergoing training) SBA 60 44 73% 30 Deliveries 60 nurses conducted MTP 30 18 53% 30 MTPs 30 RTI/STI 90 90 100% 130 300 IMNCI 548 163 29% 135 300 F-IMNCI Not - - 6 Children planne and Capacity d infants Building treated NSSK Not 123 - 240 Newborns 400 planne resuscitated d Minilap 30 9 30% 15 Sterilization 24 s NSV 90 8 8% 10 Sterilization 30 s Laparoscopic 30 9 30% 16 Sterilization 24 sterilization s IUD 1217 137 11% 80 IUD 150 insertions
NOTES: * - No. of cases / no. of facilities (or trained providers) / 8 (months) e.g. Average FRU utilisation for C-sections = Total No. of C-sections at FRUs during April – November 2010, divided by Total no. of FRUs operational as at November 2010, divided by 8 (no. of months)
b. MONITORABLE INDICATORS 1 (Against each indicator, States are to provide consolidated quarterly targets for high focus districts and for the State)
2010 - 11 2011-12 Baseline SN INDICATOR (till the 2nd Annual Q1 Target Q2 Target Q3 Target Q4 Target qtr) Target (Apr-Nov
Nagaland SPIP 2011-12 27
2010)
HF Districts HF State Total Districts HF State Total Districts HF State Total Districts HF State Total Districts HF State Total Districts HF State Total A Maternal Health A.1 Service Delivery A.1. % Pregnant 1 women registered 17.5 17.5 17.5 17.5 for 43.5% 70% % % % % ANC in the quarter A.1. % PW registered 2 for ANC in the 27.29 first 15% 15% 15% 15% 60% % trimester, in the quarter A.1. Institutional 3 deliveries (%) in 12.5 12.5 12.5 12.5 15% 50% the % % % % quarter
A.2 Quality A.2. % unreported 1 deliveries in the 11.3% 5% 5% 10% quarter A.2. % high risk 2 pregnancies identified 0.4% (a) % women having hypertension (b) % women having low Hb 1.8% 0.2% 0.2% 0.2% 0.2% 0.8% level A.2. % of Home 3 Delivery by SBA (i.e. 73.7% 20% 20% 20% 20% 80% assisted by doctor/ nurse/ ANM) A.2. C-sections 4 performed (%) 1.0% (a) in Public facilities (b) in private accredited 5% 5% 5% 5% 20% facilities A.2. % of deliveries 5 discharged after at least 48 hours of 12.5 12.5 12.5 12.5 32.2% 50% delivery (out of % % % % public institution deliveries) A.2. % of still births 0% 0% 6 A.2. %age of maternal 0% 0% 7 deaths audited
A.3 Outputs
Nagaland SPIP 2011-12 28
A.3. % of 24x7 PHCs 1 operationalised as 100 85% 5% 5% 5% per the GoI % guidelines A.3. % of FRUs 2 operationalised as 100 80% 5% 5% 5% 5% per the % GoI guidelines A.3. % of Level 1 3 MCH centres 3 9.5 9.5 9.5 9.5 38 operationalised A.3. % of Level 2 4 MCH centres 3 3 3 3 12 operationalised A.3. % of Level 3 5 MCH centres 64 operationalised A.3. % ANMs/ LHVs/ 6 SNs trained as 44% 15 15 15 15 60 SBA A.3. % doctors trained 100% 4 4 8 5 as EmOC A.3. % doctors trained 100% 4 4 8 6 as LSAS A.4 HR productivity A.4. % of LSAS 1 trained doctors 100 100% giving % spinal anaesthesia A.4. Average no. of c- 2 sections assisted 100 by 100% % LSAS trained doctors A.4. % of EmOC 3 trained doctors 100 20% conducting c- % sections. A.4. Average no. of c- 4 sections performed 20% by EmOC trained doctor A.4. Average no. of 5 deliveries 100 performed by 100% % SBA trained SN/LHV/ANM A.4. % of SBA trained 100 6 ANMs conducting 100% % deliveries
A.5 Facility utilization A.5. % of FRUs 1 conducting C- 72.7% 80 section A.5. Average no. of c- 64 2 sections per FRU A.5. Average no. of 174 300
Nagaland SPIP 2011-12 29
3 MTPs performed in FRUs A.5. Average no. of 116 200 4 deliveries per 24x7 PHCs A.5. Average no. of 5 MTPs performed per 24x7 PHC A.5. % of SC 0% 6 conducting at least 5 deliveries per month
B Child Health B.1 Service Delivery B.1. Children 9-11 22.1% 1 months age fully immunised (%) B.1. % children 62% 80% 2 breastfed within 1 hour of birth B.1. % of low birth 5% 2% 3 weight babies B.2 Quality B.2. %age of women 23.5% 50% 1 receiving PP check up to 48 hrs to 14 days B.2. % drop out from 1% .5% 3 BCG to measles
B.3 Outputs B.3. % of SNCUs 0% 1 1 operationalised B.3. % of stabilisation 1 2 units operationalised B.3. % of new born 48% 52% 3 baby care corners operationalised B.3. % of personnel 44% 75 75 75 75 300 4 trained in IMNCI B.3. % of personnel NA 5 trained in F- IMNCI B.3. % of personnel 107 75 75 75 75 300 6 trained in NSSK
B.4 Facility utilization B.4. Average no. of 1 children treated in SNCUs B.4. Average no. of
Nagaland SPIP 2011-12 30
2 children treated in NBSUs
C Family Planning C.1 Service Delivery C.1. % of total 52% 2500 1 sterilization against ELA C.1. % post partum 3.16% 500 2 sterilization C.1. % male 3% 30 3 sterilizations C.1. % of IUD 1482 2500 4 insertions against planned C.1. % IUD retained 100% 100 5 for 6 months % C.1. % Sterilization 61% 80% 6 acceptors with 2 children C.1. % Sterilisation 39% 20% 7 acceptors with 3 or more children
C.2 Quality C.2. % of 0% 1 complications following sterilization
C.3 Outputs C.3. % doctors trained 25% 24 1 as minilap C.3. % doctors trained 0% 2 as NSV C.3. % doctors trained 25% 24 3 as laparoscopic sterilization C.3. % 45% 200 4 ANM/LHV/SN/M O trained in IUD insertion
C.4 HR productivity C.4. Average no. of 2 20 1 NSVs conducted by trained doctors C.4. Average no. of 8 500 2 minilap cases sterilizations per conducted by traine minilap trained d doctors doctor s C.4. Average no. of 6 500 3 laparoscopic cases sterilizations per
Nagaland SPIP 2011-12 31
conducted by lap traine Facility sterilization d Operatio trained doctors doctor s nal C.4. Average no. of 280 500 Status: 4 IUDs inserted by MO trained in IUD insertion C.4. Average no. of 5 IUDs inserted by MO trained in IUD insertion C.4. Average no. of 24% 400 6 IUDs inserted by SN/ LHV/ ANM trained in IUD insertion
C.5 Facility utilisation C.5. Average no. of 1302 2500 1 sterilizations performed in FRUs C.5. Average no. of 0 2 sterilizations performed in 24x7 PHCs District wise DH facility and manpower status
Functioning Under process Gaps
Sl. NHA MK WK PR No Indicators DMR Mon TSG ZBO PHK LLG KRE K G A N .
1 Sanctioned Bed Strength 300 150 150 50 100 100 50 75 50 50 50
2 No. of Functional Bed 300 100 150 50 75 75 50 50 40 40 40
383 1748 3 Average Monthly OPD 5933 897 470 661 685 580 418 543 410 6 4 107 4 Average Monthly IPD 1608 2478 194 164 159 93 70 68 78 91 0
Average Monthly institutional 5 204 34 226 52 30 68 57 18 10 5 19 deliveries
6 Average Monthly C/Section 104 19 43 8 3 2 4 4 0 0 1
Number of Doctors with
Specialization in
EmO EmO EmO Obs & Gynea 3 1 2 1 1 1 1 1 C C C 7 Pediatrician 2 1 1 No No No 1 1 No No No
LSA EmO EmO Anaesthetist 3 2 3 1 1 1 1 1 S C C
Nagaland SPIP 2011-12 32
Doctors
8 MBBS 12 2 3 3 4 1 1 2 5 1 3
9 GNM 72 32 39 14 23 14 17 15 7 8 5
10 Pharmacist 8 8 6 3 3 2 2 1 1 1 1
11 Lab. Tech. 13 11 11 4 6 5 3 3 4 3 3
12 Radiographer 5 2 1 1 1 2 1 2 1 1 1
Functional Laboratory
Availability of Room Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes 13 Functional Laboratory performing assured laboratory services of the Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Health Institutions. (YES/ NO)
Safe Blood Facility
BS Availability of Room BB BB BB BB BB BB BB BB BSU BSU U
Whether Licensed (YES/ NO) Yes Yes Yes Yes Yes Yes Yes Yes No No No
Blood Bag Refrigerators, 30 or 50 Yes Yes Yes Yes Yes Yes Yes Yes No No No units of Blood.
Deep Freezers for freezing ice packs. Yes Yes Yes Yes Yes Yes Yes Yes No No No
Cold chain boxes/Insulated Carrier 14 Yes Yes Yes Yes Yes Yes Yes Yes No No No boxes with ice packs.
Binocular Microscope Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes
Bench top centrifuge. Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes
Provision of backup Generator Yes Yes Yes No No No No Yes No No No
Lab Technician trained in Blood safety, etc. looking after Blood Bank/ Yes Yes Yes Yes Yes Yes Yes Yes No No No storage Centre
MO trained in Blood safety, etc. Yes Yes Yes Yes Yes Yes Yes Yes No No No
Functional Labour Room
Availability of Room Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes
Labour table with Mattress, pillow Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes and Kelly’s pad 15 Examination Table with stirrup Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes
Suction machine Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes
Facility for Oxygen administration Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes
Nagaland SPIP 2011-12 33
Shadow less lamp Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes
Sterilization equipment Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes
24-hour running water Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes
Electricity supply Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes
Attached toilet facilities Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes
Emergency drug tray Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes
Delivery kits, including those for normal delivery and assisted Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes deliveries.
Functional Operation Theatre
Availability of Room Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes
Availability of Room Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes
Standard Surgical Set - I Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes (Laparatomy) Standard Surgical Set – II (Mini Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Laparatomy) Standard Surgical Set – III (IUD Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Insertion) Standard Surgical Set – IV Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes (Vasectomy) Standard Surgical Set – V (Normal Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Delivery)
Standard Surgical Set – VI (Vacumm Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Extractor)
Laproscope Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes 16 Equipment for Anaesthesia
Diathermy machine Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes
Table operation, hydraulic (Major) Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes
Table operation, hydraulic Minor Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes
Lamps shadowless (Ceiling) Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes
Lamps shadowless (Portable) Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes
Suction Apparatus Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes
Stand with wheel for single basin Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes
Dressing drum all sizes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes
Sterilizer Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes
Nagaland SPIP 2011-12 34
X-ray view box Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes
Trolley for patients Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes
Trolley for instruments Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes
Wheel chairs Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes
Newborn Care Facility
Availability of Room Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes
Open care system on trolley with drawers, with radiant warmer, O2- Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes provision Phototherapy unit, single head, high Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes intensity
Resuscitator/ambu bag/self inflating Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes bag, hand-operated, neonate, 500ml
Resuscitator/ambu bag/self inflating Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes bag, hand-operated, neonate, 250ml
Laryngoscope set, neonate No No No No No No No No No No No
Pump/Suction machine, portable, Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes 220V, w/access Pump/Suction machine, foot- operated (refer to material Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes S0760640) Oxygen hood, S and M, set of 3 each, No No No No No No No No No No No including connecting tubes
17 Oxygen concentrator, elec 220V No No No No No No No No No No No (refer to material S0002047)
Pulse oxymeter, bedside, neonatal No No No No No No No No No No No
Infantometer, plexi, 3½ft/105cm No No No No No No No No No No No
Monitor, vital sign, NIBP, HR, SpO2, No No No No No No No No No No No ECG, RR, Temp
ECG unit, 3 channel, portable/SET No No No No No No No No No No No (refer to material S0002062)
X-Ray, mobile No No No No No No No No No No No
Irradiance meter for phototherapy No No No No No No No No No No No units
Oxygen Cylinder with flow meter Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes
Weighing Scale, spring Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes
Thermometer, clinical, digital, 32-34 Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes 0C
Light examination, mobile, 220-12 V Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes
Nagaland SPIP 2011-12 35
Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Hub Cutter, syringe
22 Referral Services avialable (YES/NO) Yes No Yes No No Yes Yes No Yes Yes Yes
23 Waste Disposal System No No No No No No No No No No No
District wise CHC FRU (Designated & Proposed) facility and manpower status Under Functioning Gaps Process Sl. DMR TSG WKA PRN KRE No. District Name of the Facility Medziphema Noklak Bhandari Jalukie Pungro
Indicators 1 Sanctioned Bed Strength 30 30 30 30 30 2 No. of Functional Bed 24 28 26 30 24 3 Average Monthly OPD 714 486 297 485 370 4 Average Monthly IPD 71 50 30 44 19 Average Monthly institutional 5 12 5 7 15 10 deliveries 6 Average Monthly C/Section No No No No 1 Number of Doctors with 7 Specialization in Obs & Gynea O & G No No EmOC EmOC EmOC EmOC EmOC EmOC Pediatrician Pead No No No No F-IMNCI No No No No Anaesthetist No No No No No LSAS LSAS LSAS LSAS No LSAS 8 Doctors MBBS 4 3 2 2 1 AYUSH 1 1 1 1 1 9 NURSE 14 11 5 12 5 10 Pharmacist 1 1 1 1 1 11 Lab. Tech. 2 3 3 3 2 12 Radiographer No No No No No 13 Functional Laboratory Availability of Room Yes Yes Yes Yes Yes Functional Laboratory performing assured laboratory Yes Yes Yes Yes Yes services of the Health Institutions. (YES/ NO) 14 Safe Blood Facility Availability of Room Yes Yes Yes Yes Yes Blood Bag Refrigerators, 30 or Yes Yes No Yes Yes 50 units of Blood. Deep Freezers for freezing ice Yes Yes No Yes Yes packs.
Nagaland SPIP 2011-12 36
Cold chain boxes/Insulated Yes Yes No Yes Yes Carrier boxes with ice packs. Binocular Microscope Yes Yes Yes Yes Yes Bench top centrifuge. Yes Yes Yes Yes Yes Provision of backup Generator Yes Yes Yes Yes Yes Lab Technician trained in Blood safety, etc. looking after Blood Yes Yes Yes Yes Yes Bank/ storage Centre MO trained in Blood safety, etc. Yes Yes Yes Yes Yes 15 Functional Labour Room Availability of Room Yes Yes Yes Yes Yes Labour table with Mattress, Yes Yes Yes Yes Yes pillow and Kelly’s pad Examination Table with stirrup Yes Yes Yes Yes Yes Suction machine Yes Yes Yes Yes Yes Facility for Oxygen Yes Yes Yes Yes Yes administration Shadow less lamp Yes Yes Yes Yes Yes Sterilization equipment Yes Yes Yes Yes Yes 24-hour running water Yes No No Yes Yes Electricity supply Yes Yes Yes Yes Yes Power back-up facility Yes Yes Yes Yes Yes Attached toilet facilities Yes Yes Yes Yes Yes Emergency drug tray Yes Yes Yes Yes Yes Delivery kits, including those for normal delivery and assisted Yes Yes Yes Yes Yes deliveries. 16 Functional Operation Theatre Availability of Room Standard Surgical Set - I No No No No No (Laparatomy) Standard Surgical Set – II (Mini Yes Yes No No Yes Laparatomy) Standard Surgical Set – III (IUD Yes Yes Yes Yes Yes Insertion) Standard Surgical Set – IV Yes Yes Yes Yes Yes (Vasectomy) Standard Surgical Set – V Yes Yes Yes Yes Yes (Normal Delivery) Standard Surgical Set – VI No No No No No (Vacumm Extractor) Laproscope Yes Yes Yes Yes Yes Equipment for Anaesthesia No No No No No General Equipment for
operation Theatre Diathermy machine No No No No No Table operation, hydraulic Yes Yes Yes Yes Yes (Major) Table operation, hydraulic Yes Yes Yes Yes Yes Minor
Nagaland SPIP 2011-12 37
Lamps shadowless (Ceiling) No No No No No Lamps shadowless (Portable) Yes Yes Yes Yes Yes Suction Apparatus Yes Yes Yes Yes Yes Sterilizer Yes Yes Yes Yes Yes 17 Newborn Care Facility Availability of Room Yes Yes Yes Yes Yes Open care system on trolley with drawers, with radiant Yes Yes Yes Yes Yes warmer, O2-provision Phototherapy unit, single head, Yes Yes No Yes Yes high intensity Resuscitator/ambu bag/self inflating bag, hand-operated, Yes Yes Yes Yes Yes neonate, 500ml Resuscitator/ambu bag/self inflating bag, hand-operated, Yes Yes Yes Yes Yes neonate, 250ml Laryngoscope set, neonate No No No No No Pump/Suction machine, Yes Yes Yes Yes Yes portable, 220V, w/access Pump/Suction machine, foot- operated (refer to material Yes Yes Yes Yes Yes S0760640) Oxygen hood, S and M, set of 3 No No No No No each, including connecting tubes Oxygen concentrator, elec 220V No No No No No (refer to material S0002047) Irradiance meter for No No No No No phototherapy units Oxygen Cylinder with flow Yes Yes Yes Yes Yes meter Weighing Scale, spring Yes Yes Yes Yes Yes Hub Cutter, syringe Yes Yes Yes Yes Yes Referral Services avialable 22 Yes Yes Yes Yes Yes (YES/NO) 23 Waste Disposal System Yes Yes Yes Yes Yes
District wise CHC 24x7 facility and manpower status
Functioning Gaps Under process
Sl. No DM TS WK
. District KMA MKG R ZBO PHK Mon G A
Name of the
Facility
Viswema Viswema Changtongya Dhansiripar Aghunato Pughoboto Meluri Chozuba Aboi Tobu Longkhim Sanis Tseminyu Chiephobozou Mangkolemba Tuli Pfutsero
Nagaland SPIP 2011-12 38
Sanctioned Bed
Strength 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 No. of Functional
Bed 22 21 24 28 28 17 26 28 28 28 22 28 24 22 26 24 Average Monthly 18 18 16 26 36 37 19 21 19 22 25 24 16 OPD 4 1 2 7 5 2 398 5 6 3 0 8 3 9 203 177 Average Monthly
IPD 11 14 13 16 27 21 28 11 13 52 16 17 18 9 19 11 Average Monthly institutional deliveries 4 6 5 5 5 7 14 5 4 7 8 9 4 3 11 5
Doctors
MBBS 2 2 3 2 3 2 3 2 2 1 1 1 2 2 2 2
AYUSH 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
NURSE 8 10 7 10 9 6 9 6 6 7 7 8 5 5 9 5
Pharmacist 1 1 1 2 1 1 1 1 1 1 1 1 1 1 1 1
Lab. Tech. 2 3 2 3 3 3 3 2 2 4 3 3 3 3 2 2 Functional
Laboratory Availability of
Room Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Functional Laboratory performing assured laboratory services of the Health Institutions. (YES/ NO) Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Functional
Labour Room Availability of
Room Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Labour table with Mattress, pillow and Kelly’s pad Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Examination
Table with stirrup Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Suction machine Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Facility for Oxygen administration No Yes Yes No Yes Yes No Yes No Yes Yes No No No No No Shadow less lamp Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Sterilization
equipment Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes 24-hour running
water Yes Yes No Yes Yes Yes Yes No No Yes Yes Yes No No Yes No Electricity supply Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Power back-up
facility Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Attached toilet
facilities Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Emergency drug
tray Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes
Nagaland SPIP 2011-12 39
Delivery kits, including those for normal
delivery and assisted deliveries. Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Newborn Care
Facility Availability of
Room Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Open care system on trolley with drawers, with radiant warmer, O2-provision Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Resuscitator/amb u bag/self inflating bag, hand-operated, neonate, 500ml Yes Yes Yes Yes Yes Yes Yes Yes No Yes Yes Yes No No No No Resuscitator/amb u bag/self inflating bag, hand-operated, neonate, 250ml Yes Yes Yes Yes Yes Yes Yes Yes No Yes Yes Yes No No No No Pump/Suction machine,
portable, 220V, w/access Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Pump/Suction machine, foot- operated (refer to material S0760640) Yes Yes Yes Yes Yes Yes Yes Yes No Yes Yes Yes No No No No Oxygen Cylinder
with flow meter No Yes Yes No Yes Yes No Yes No Yes Yes Yes No No No No Weighing Scale,
spring Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Hub Cutter,
syringe Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Referral Services avialable (YES/NO) Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Waste Disposal
System Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes
District wise PHC 24X7 (Designated & Proposed) facility and manpower status Functioning Under Process Gaps
S.N. KMA MKG
District
PHC
Name of the Facility
Botsa PHC
Mezoma PHC Mezoma
Longjang
Sabangya PHC
Khonoma Khonoma PHC
Chunlikha PHC
Longchem Longchem PHC
Alongkima PHC TsurangkongPHC
Indicators
1 Sanctioned Bed Strength 6 6 6 6 6 6 6 6 6
Nagaland SPIP 2011-12 40
2 No. of Functional Bed 6 6 6 6 6 6 6 6 6
3 Average Monthly OPD 144 211 199 187 158 187 178 193 191
4 Average Monthly IPD 5 4 6 4 6 9 6 3 3
Average Monthly institutional 5 2 3 2 2 2 3 3 3 2 deliveries
Doctors 8
MBBS 1 2 2 1 1 1 1 1 2
9 Nurse 4 3 4 3 3 6 8 8 4
10 Pharmacist 1 1 1 1 1 1 1 1 1
11 Lab. Tech. 1 1 1 1 1 1 1 1 1
Functional Laboratory Availability of Room Yes Yes Yes Yes Yes Yes Yes Yes Yes 13 Functional Laboratory performing assured laboratory Yes Yes Yes Yes Yes Yes Yes Yes Yes services of the Health Institutions. (YES/ NO) Functional Labour Room Availability of Room Yes Yes Yes Yes Yes Yes Yes Yes Yes Labour table with Mattress, Yes Yes Yes Yes Yes Yes Yes Yes Yes pillow and Kelly’s pad Examination Table with stirrup Yes Yes Yes Yes Yes Yes Yes Yes Yes Suction machine Yes Yes Yes Yes Yes Yes Yes Yes Yes Facility for Oxygen No No No No No No No No No administration Shadow less lamp No Yes No No No No Yes No No 15 Sterilization equipment Yes Yes Yes Yes Yes Yes Yes Yes Yes 24-hour running water Yes Yes Yes Yes Yes Yes Yes Yes Yes Electricity supply Yes Yes Yes Yes Yes Yes Yes Yes Yes Power back-up facility Yes Yes Yes No No No Yes Yes No Attached toilet facilities Yes Yes Yes Yes Yes Yes Yes Yes Yes Emergency drug tray Yes Yes Yes Yes Yes Yes Yes Yes Yes Delivery kits, including those for normal delivery and Yes Yes Yes Yes Yes Yes Yes Yes Yes assisted deliveries. IUD Insertion Kit Yes Yes Yes Yes Yes Yes Yes Yes Yes Normal Delivery Kit Yes Yes Yes Yes Yes Yes Yes Yes Yes NSV Kit Newborn Care Facility Availability of Room Yes Yes Yes Yes Yes Yes Yes Yes Yes Open care system on trolley 17 with drawers, with radiant Yes Yes Yes No No No Yes Yes Yes warmer, O2-provision Resuscitator/ambu bag/self inflating bag, hand-operated, Yes Yes Yes No No No Yes Yes No neonate, 500ml
Nagaland SPIP 2011-12 41
Resuscitator/ambu bag/self inflating bag, hand-operated, Yes Yes Yes No No No Yes Yes No neonate, 250ml Pump/Suction machine, Yes Yes Yes Yes Yes Yes Yes Yes Yes portable, 220V, w/access Pump/Suction machine, foot- operated (refer to material Yes Yes Yes No No No Yes Yes No S0760640) Oxygen Cylinder with flow No No No No No No No No No meter Weighing Scale, spring Yes Yes Yes Yes Yes Yes Yes Yes Yes Hub Cutter, syringe Yes Yes Yes Yes Yes Yes Yes Yes Yes Referral Services avialable 22 Yes Yes Yes Yes Yes Yes Yes Yes Yes (YES/NO)
23 Waste Disposal System Yes Yes Yes Yes Yes Yes Yes Yes Yes
District wise PHC 24X7 (Designated & Proposed) facility and manpower status Functioning Under Process Gaps
S.N. District DMR Mon TSG KRE
Name of the Facility
Shamator
Tizit PHC
Chen PHC
Chare PHCChare
SitimiPHC
Noksen PHC
Nuiland PHC Molvom PHC PHCKuhuboto Indicators Sanctioned Bed Strength 6 6 6 6 6 6 6 6 6 No. of Functional Bed 6 6 6 6 6 6 6 6 6 Average Monthly OPD 213 234 217 208 196 192 171 208 147 Average Monthly IPD 3 8 3 5 5 4 8 7 2 Average Monthly institutional 4 7 1 6 1 3 4 1 1 deliveries Doctors
MBBS 3 2 2 1 2 1 1 2 1 Nurse 5 3 4 3 4 4 3 3 3 Pharmacist 1 1 1 1 1 1 1 1 1 Lab. Tech. 1 1 2 1 1 1 2 1 1 Functional Laboratory Availability of Room Yes Yes Yes Yes Yes Yes Yes Yes Yes Functional Laboratory performing assured laboratory Yes Yes Yes Yes Yes Yes Yes Yes Yes services of the Health Institutions. (YES/ NO) Functional Labour Room Availability of Room Yes Yes Yes Yes Yes Yes Yes Yes Yes Labour table with Mattress, Yes Yes Yes Yes Yes Yes Yes Yes Yes pillow and Kelly’s pad
Examination Table with stirrup Yes Yes Yes Yes Yes Yes Yes Yes Yes Suction machine Yes Yes Yes Yes Yes Yes Yes Yes Yes Facility for Oxygen No No No No No No No No No administration
Nagaland SPIP 2011-12 42
Shadow less lamp No No No Yes No No No No No Sterilization equipment Yes Yes Yes Yes Yes Yes Yes Yes Yes 24-hour running water Yes Yes Yes Yes Yes Yes Yes No No Electricity supply Yes Yes Yes Yes Yes Yes Yes Yes Yes Power back-up facility Yes Yes No Yes No Yes Yes Yes No Attached toilet facilities Yes Yes Yes Yes Yes Yes Yes Yes Yes Emergency drug tray Yes Yes Yes Yes Yes Yes Yes Yes Yes Delivery kits, including those for normal delivery and Yes Yes Yes Yes Yes Yes Yes Yes Yes assisted deliveries. IUD Insertion Kit Yes Yes Yes Yes Yes Yes Yes Yes Yes Normal Delivery Kit Yes Yes Yes Yes Yes Yes Yes Yes Yes NSV Kit Newborn Care Facility Availability of Room Yes Yes Yes Yes Yes Yes Yes Yes Yes Open care system on trolley with drawers, with radiant No Yes Yes Yes No Yes Yes No Yes warmer, O2-provision Resuscitator/ambu bag/self inflating bag, hand-operated, No No Yes No No No No No No neonate, 500ml Resuscitator/ambu bag/self inflating bag, hand-operated, No No Yes No No No No No No
neonate, 250ml Pump/Suction machine, Yes Yes Yes Yes Yes Yes Yes Yes Yes portable, 220V, w/access Pump/Suction machine, foot- operated (refer to material No No Yes No No No No No No S0760640) Oxygen Cylinder with flow No No No No No No No No No meter Weighing Scale, spring Yes Yes Yes Yes Yes Yes Yes Yes Yes Hub Cutter, syringe Yes Yes Yes Yes Yes Yes Yes Yes Yes Referral Services avialable Yes Yes Yes Yes Yes Yes Yes Yes Yes (YES/NO)
Waste Disposal System Yes Yes Yes Yes Yes Yes Yes Yes Yes
Nagaland SPIP 2011-12 43
District wise PHC 24X7 (Designated & Proposed) facility and manpower status Functioning Under Process Gaps
S.N. District WKA ZBO
Name of the Facility
Ralan PHC Ralan -
Chukidong PHC NyiroPHC Sungru PHC Wuzhuru AkulutoPHC Sataka PHC Satoi PHC Suruhoto PHC Indicators Sanctioned Bed Strength 6 6 6 6 6 6 6 6 No. of Functional Bed 6 6 6 6 6 6 6 6 Average Monthly OPD 258 168 192 141 231 199 97 209 Average Monthly IPD 8 6 4 2 11 10 2 10 Average Monthly institutional 3 2 2 1 2 6 2 2 deliveries Doctors
MBBS 1 1 1 2 1 1 1 1 Nurse 3 3 3 5 5 3 6 3 Pharmacist 1 1 1 1 1 1 1 1 Lab. Tech. 1 2 2 2 2 1 1 1 Functional Laboratory Availability of Room Yes Yes Yes Yes Yes Yes Yes Yes Functional Laboratory performing assured laboratory Yes Yes Yes Yes Yes Yes Yes Yes services of the Health Institutions. (YES/ NO) Functional Labour Room Availability of Room Yes Yes Yes Yes Yes Yes Yes Yes Labour table with Mattress, Yes Yes Yes Yes Yes Yes Yes Yes pillow and Kelly’s pad Examination Table with stirrup Yes Yes Yes Yes Yes Yes Yes Yes Suction machine Yes Yes Yes Yes Yes Yes Yes Yes Facility for Oxygen No No No No No No No No administration Shadow less lamp Yes No No No No No No No
Sterilization equipment Yes Yes Yes Yes Yes Yes Yes Yes 24-hour running water Yes Yes Yes No Yes Yes No Yes Electricity supply Yes Yes Yes Yes Yes Yes Yes Yes Power back-up facility Yes Yes Yes No No Yes No Yes Attached toilet facilities Yes Yes Yes Yes Yes Yes Yes Yes Emergency drug tray Yes Yes Yes Yes Yes Yes Yes Yes Delivery kits, including those for normal delivery and Yes Yes Yes Yes Yes Yes Yes Yes assisted deliveries. IUD Insertion Kit Yes Yes Yes Yes Yes Yes Yes Yes
Normal Delivery Kit Yes Yes Yes Yes Yes Yes Yes Yes
Nagaland SPIP 2011-12 44
NSV Kit Newborn Care Facility Availability of Room Yes Yes Yes Yes Yes Yes Yes Yes Open care system on trolley with drawers, with radiant Yes Yes No No Yes Yes No Yes warmer, O2-provision Resuscitator/ambu bag/self inflating bag, hand-operated, Yes No No No Yes Yes No Yes neonate, 500ml Resuscitator/ambu bag/self inflating bag, hand-operated, Yes No No No Yes Yes No Yes
neonate, 250ml Pump/Suction machine, Yes Yes Yes Yes Yes Yes Yes Yes portable, 220V, w/access Pump/Suction machine, foot- operated (refer to material Yes No No No Yes Yes No Yes S0760640) Oxygen Cylinder with flow No No No No No No No No meter Weighing Scale, spring Yes Yes Yes Yes Yes Yes Yes Yes Hub Cutter, syringe Yes Yes Yes Yes Yes Yes Yes Yes Referral Services avialable Yes Yes Yes Yes Yes Yes Yes Yes (YES/NO) Waste Disposal System Yes Yes Yes Yes Yes Yes Yes Yes
District wise PHC 24X7 (Designated & Proposed) facility and manpower status Functioning Under Process Gaps
S.N. District PHK LLG PRN
PHC
Name of the Facility
Tamlu PHC
Tening PHC
Weziho PHC
Chizami
Chetheba PHC Athibung PHC
Yongnyah PHC Indicators Sanctioned Bed Strength 6 6 6 6 6 6 6 No. of Functional Bed 6 6 6 6 6 6 6 Average Monthly OPD 163 189 161 214 87 188 184 Average Monthly IPD 8 10 3 11 2 2 10 Average Monthly 3 2 2 1 2 4 2 institutional deliveries Doctors
MBBS 2 2 1 1 1 1 2 Nurse 3 3 5 4 4 5 4 Pharmacist 1 1 1 1 1 1 1 Lab. Tech. 1 1 3 2 1 2 1 Functional Laboratory
Availability of Room Yes Yes Yes Yes Yes Yes Yes
Nagaland SPIP 2011-12 45
Functional Laboratory performing assured laboratory services of the Yes Yes Yes Yes Yes Yes Yes Health Institutions. (YES/ NO) Functional Labour Room Availability of Room Yes Yes Yes Yes Yes Yes Yes Labour table with Mattress, Yes Yes Yes Yes Yes Yes Yes pillow and Kelly’s pad Examination Table with Yes Yes Yes Yes Yes Yes Yes stirrup Suction machine Yes Yes Yes Yes Yes Yes Yes Facility for Oxygen No No No No No No No administration Shadow less lamp No No No No No No No Sterilization equipment Yes Yes Yes Yes Yes Yes Yes 24-hour running water Yes Yes No No No No Yes Electricity supply Yes Yes Yes Yes Yes Yes Yes Power back-up facility Yes Yes Yes Yes No Yes Yes Attached toilet facilities Yes Yes Yes Yes Yes Yes Yes Emergency drug tray Yes Yes Yes Yes Yes Yes Yes Delivery kits, including those for normal delivery Yes Yes Yes Yes Yes Yes Yes and assisted deliveries. IUD Insertion Kit Yes Yes Yes Yes Yes Yes Yes Normal Delivery Kit Yes Yes Yes Yes Yes Yes Yes NSV Kit Newborn Care Facility Availability of Room Yes Yes Yes Yes Yes Yes Yes Open care system on trolley with drawers, with radiant No Yes No Yes No Yes Yes warmer, O2-provision Resuscitator/ambu bag/self inflating bag, hand- No Yes No No No Yes Yes operated, neonate, 500ml Resuscitator/ambu bag/self inflating bag, hand- No Yes No No No Yes Yes
operated, neonate, 250ml Pump/Suction machine, Yes Yes Yes Yes Yes Yes Yes portable, 220V, w/access Pump/Suction machine, foot-operated (refer to No Yes No No No Yes Yes material S0760640) Oxygen Cylinder with flow No No No No No No No meter Weighing Scale, spring Yes Yes Yes Yes Yes Yes Yes Hub Cutter, syringe Yes Yes Yes Yes Yes Yes Yes Referral Services avialable Yes Yes Yes Yes Yes Yes Yes (YES/NO) Waste Disposal System Yes Yes Yes Yes Yes Yes Yes
Nagaland SPIP 2011-12 46
Information on technical interventions (MH, CH, Immunisation, FP, ARSH, etc.) A2.Maternal Health Maternal Health is one of the major focus areas under Reproductive Child Health which the state of Nagaland has been working to provide best services. Over the years though maternal health indicators have improved substantially yet keeping the vision of NRHM and the Millennium Development Goals in view, significant efforts is required to achieve the desired objectives, in the State. In the state of Nagaland, the continuum of care approach in Maternal Health has been laid down as the strategy under this component. Care of Adolescent, focus on Adolescent girls, health and well being of women, newborn and children are the different parts of this continuum of care. Maternal Health strategic objective for 2011-12 Objective: Reduction of MMR from 240 (ISP 2007) to < 150 and increased Institutional Delivery through Janani Suraksha Yojana (JSY) from 32.9 to 50 during 2011-12. Illustrative Activities: a. To identify institutions and strengthening them to the capacity of basic and comprehensive obstetric care. b. Short courses multi skilling training of MOs on EmOC & LSAS to overcome shortage of specialist. c. Equipping PHCs to undertake non-emergencies deliveries (forceps deliveries, manual removal of placenta etc.). d. Ensuring complete ANC (Registration, 2 dose of TT, three check-ups and 100 IFA tablets) and PNC (three visits by health workers/ASHA for domiciliary deliveries). e. Ensuring provision for referral services for high risk pregnancies to higher institutions. f. Ensuring regular supply of medicines and vaccine etc. g. Strengthening the tie with private service providers, VC /NGOs /SHGs through PPP agreement for facilitating the service delivery system. h. Regular conduct of Village Health and Nutrition Day (VHND).
Maternal Health Action Plan 2011-12 Core Activities Activities and targets 2011-12 Timeframe Budget 1. FRU Operationalisation: Lack of requisite manpower could not operationalise the 4 CHC designated as FRU. CHC Pungro started providing CEmOC services Target: 5 (5CHC - Jalukie, Pungro, Bhandari, Medzephema, Noklak proposed for FRU) Construction:
Manpower 10 LSAS- Under support 2 CHC- Medziphema,Pungro, Training 8 DH- Longleng, Mon, Kiphire, Zunheboto, Peren, Phek,Wokha & Dimapur. 10 EmOC- Under 2 CHC- Medziphema,Pungro, Training 8 DH- Longleng, Mon, Kiphire, Zunheboto, Peren, Phek,Wokha & Dimapur. 2 OT trained GNM each- Bandhari,Jalukie, Under CH Medziphema, Noklak,Pungro. Flexipool. 1LT & 1 MO Blood Bank Trained each- Will be Bandhari,Jalukie, Medziphema, Noklak,Pungro. conducted by NSACS 1 Addl GDMO each for 11 DH and 5 prorposed FRU. Under Manpower Equipments: Anaesthesia, Caesarean Section &BSU Equipment: 70.73 FRU & MCH Level 3: 15 Water Supply Pipe line for CHC FRU/ MCH Level 2: 5 15.00 Rain water harvest CHC FRU/ MCH Level 2: 10 30.00 Bore well CHC FRU/ MCH Level 2: 5 25.00 Power supply Procurement & commissioning of 25 KVA Generator 32.5
Nagaland SPIP 2011-12 47
for 5 CHC/FRU @ Rs.6.5 Lakhs
2. MCH Centres Operationalisation for MH Target: MCH level 3: 5
Extension & renovation: the work will be executed by 2nd to 4th Qtr. the VHC, 5 SC @ Rs. 3.00 Lakhs 15.00 2nd to 4th Qtr. Under NRHM 3. Provision of of equipments and essential lab consumables: To be provided to 398 SC and 56 PHCs without lab: Hb Color scale (Starter 500 units @ Rs. 23.93 1885/unit,& Refill pack 500 units @ Rs. 2900/unit) 3.83 RDK for Urine sugar 500 units @ Rs. 765/unit 3.93 RDK for Urine Protein 500 units @ Rs. 31.68 785/unit Total 4. Increase Institutional and home delivery Tracking of pregnant women by the ASHA and ANMs M & E at the village level. Up skilling and capacity building training for 30ANM Under trg on SBA Conduct VHND monthly on every second Friday of the 1.00 Month. ASHA to be the depot holder of IFA and 90+IFA to be ASHA administered through the tracking of pregnant mother. Skill up gradation of 10 MOs in EmOC and 10 MO in Under LSAS Training Head Ensure active participation and commitment by the VHC by regular monitoring activities at all levels. Capacitate ASHA on MCH services through continuing Under training Training Head Timely provision of ASHA incentives and maternal Under JSY benefits. IPC, folk media, mass media activities to be carried out Under IEC as per IEC/BCC Plan Head 5. Improve PNC with admission of at least 48hrs post delivery in the Institution Increase awareness campaign through IEC-BCC Under IEC activities Head Providing baby essential kits for those who stay for 7.50 48hrs in the institution after delivery. Baby kit @ Rs. 200 x3750 kits Free Drop Back Home RTS for at least 48hrs post Budgeted delivery stay at hospital and immunization of the new under Referral born. transport 6. Safe abortion Training of 9 MO on MTP Under Training Procurement of 33 D&C set for 24x7 PHCs 0.99 7. RTI/STI Skill up gradation on management of RTI/STI-MO=60, Under this training to be conducted in collaboration with Training NSACS Skill upgradation of nurses on management of RTI/STI Under
Nagaland SPIP 2011-12 48
70 Nurses, this training to be conducted in Training collaboration with NSACS Procurement of RTI/STI kit for 11 District Hopsital, 21 77.60 CHCs and 65 functional PHCs Strengthening of 11 DHs, 21 CHCs and 65 PHCs to operationalize RTI/STI services through convergence with NSACS ICTCs 8. JSY Target of institutional delivery for 2011-12 is 15000to 195.00 increase performance of Institutional Delivery through JSY including ASHA incentive.@ 1300 Building partnership with 5 Private Health Institutions 3.36 for JSY @ 700 for mother x 8 delivery P.M x 12x5. Home Delivery delivered by SBA @ Rs. 500 for 65.00 mother as per the JSY Guideline GoI x expected 13000 Home Delivery Tracking of pregnant women by the ASHA and ANMs budgeted at the village level will be done for reaching JSY under HMIS benefit to the mother especially in the rural areas
JSY helpline is mentioned under innovation in the PIP 53.11 2011-12 (carried over from 2010-11) Display of names of JSY beneficiaries prominently in a 7.944 board in 1324 villages Supervisory handholding visit to all health units (552) budgeted half yearly by the DPMU under M & E Monitoring of JSY will be carried out under State M&E plan 9. VHND Regular monthly conduct of VHND in all the On going recognized villages in the state 10. Referral transport Maternal Referral Transport for 3 categories of 45.00 beneficiaries 11. RCH Camps 44 RCH camps/sterilization camps will be undertaken 22.00 during 2011-12 @ Rs. 50000. The rate per camp is projected based on the needs as most of the RCH camps are conducted in the far flung and remote villages and blocks in the state.Most of the acceptors are Females so State want to re consider the no. Of male Sterilization camp & increase the Female Sterilization The state proposes to observe Population week as State 5.50 Family Planning Week in 11 districts where sterilization will be conducted along with CUTInsertion and distribution of OCP, Condoms and IEC/BCC activities. The cost of the week is worked out in 11x 50000= 550000 12. Maternal Death Review(MDR) This is carried forward activities of 2010-11. Budget approved
Nagaland SPIP 2011-12 49
during 2010- 11 A1.4: JSY: A1.4.1: Home Delivery- by SBA
As per GOI Guideline Home Delivery conducted by SBA shall be given Rs. 500/- the expected Home Delivery is 13000 @ Rs. 500/-= 65.00 Lakhs
A1.4.2: Institutional deliveries 1. Total Institutional deliveries achieved during the year: 9475 up to Oct 2010. 2. The state proposes to target 15000 Institutional deliveries @ Rs. 1300 per unit amounting to Rs. 195.00 Lakhs Institutional deliveries No of Units Rate Total amount (Rs in lakhs) Mother 15000 700 105.00 ASHA 15000 600 90.00 Grand Total 195.00 Rupees one hundred ninety five Lakhs only
Operational Expenses/Administrative Cost: 1. Printing & distribution of JSY Guidelines, Cards Registers and Reporting. Printing & distribution of JSY Implementation Guidelines, JSY Cards, JSY Registers and Reporting formats would require an amount of Rs. 7.52Lakhs Total amount (Rs in Printing & Distribution Unit required Unit Cost lakhs) a. JSY Implementation Guidelines 2000 30 0.60 b. JSY Cards 30000 5 1.50 c. JSY Registers 800 150 1.20 d. Reporting formats Form 1 (Annexure I) in triplicate 23557 2 0.47 Form 2 (Annexure II) in triplicate 3000 3 0.09 Form 3 (Annexure III) in duplicate 2000 3 0.06 Grand Total 3.92 Rupees three lakhs ninety two thousand only
2. Provision of JSY Display boards in each health unit and villages: a. To promote good governance and publicity, JSY Display boardswill be provided to each health unit (554) villages (1278)and the accredited private institutions. The total requirement is estimated at 2500 units. Health units with more beneficiaries will be provided with larger size. b. The list of beneficiaries of JSY (both institutional and home deliveries) along with the date of disbursement should mandatorily be displayed on the display board of the health unit and the local panchayat/local body office, being updated regularly on month-to-month basis as per JSY guideline. c. The JSY Display boards will be maintained by the Staff i/c of JSY at the health unit level and ASHA at the village level. d. The budget requirement for provision and distribution of 1324 villages nos of JSY Display boards@ Rs. 600 per unit to each health unit and villages amounts to Rs. 7.944 lakhs. 3. Monitoring and Evaluation a. JSY scheme i/c has been designated in each health unit (ANM), block (ASHA Coordinator), district (DIO) and state level (JSY Coordinator SPMU). b. Monthly Meeting of ASHA for JYS scheme in all Health Units: There will be a mandatory meeting of all ASHA on the third Friday of every month, at the Health Units. If Friday is a holiday, meeting should be held on following working day. In the Friday meeting, the ANM will prepare a Monthly Work Schedule of each village level worker: Possible number of pregnant women under JSY to be taken to the health centre/Anganwadi for ANC,
Nagaland SPIP 2011-12 50
Possible number of pregnant women registered under JSY to be taken to the health centre for delivery, Possible number of children/pregnant women to be taken to the health centre/Anganwadi for immunization, Ensure that the compensation, incentive and referral money is ready for disbursement and the due official process has been set in motion, Feedback on following points should be taken: (a) number of children immunized, (b) number of pregnant women visited, (c ) number of post natal visits and (d) cases referred in the month. Participants: Key block officialsand ASHA Mentor/ASHA. The JYS scheme i/c of the health unit in consultation with the i/c of the health unit will be responsible for organising the meeting. The budget requirement for the month meeting amounts to Rs. 30.37Lakhs.
No of No of Total per Total amount Health Unit Level Units Meeting year Rate (Rs in lakhs) ASHA 1700 12 20400 100 20.40 Operational cost @ Rs. 150/meeting 554 12 6648 150 9.97 Grand Total 30.37 Rupees thirty lakhs thirty seven thousand only
The total budget requirement for JSY activity amounts to Rs. 302.2341lakhs JSY Activity Total amount (Rs in lakhs) 1.4.1: Home deliveries 65.00 1.4.2: Institutional deliveries 195.00 1.4.3: Other JSY related activities 1.4.3.1: Printing & distribution of JSY Guidelines, Cards Registers and Reporting 3.92 1.4.3.2: Provision of JSY Display boards in each health unit and villages 7.944 1.4.3.3: Monitoring and Evaluation 30.37 Grand Total 302.234 Rupees three crore two lakhs two thousand thirty four only
Mother and Child Protection (MCP) Card Background The Mother and Child Protection (MCP) Card is a unique initiative in convergence between the Ministry of Health and Family Welfare and the Ministry of Women and Child Development for provision of care during pregnancy, child birth and during early child hood. This was prepared after extensive deliberations between the program officers of both the Ministries.
Salient Features The MCP card is a counselling and empowerment tool to track the mother and child cohort. It strengthens tracking of pregnant women for ANC/ PNC, identifying high risk pregnancies and their timely referral. It also strengthens tracking of infants for immunization and newborn care services. It helps to provide continuum of care for the pregnant mother (from pregnancy to child birth) and the child (from newborn till the age of 3 years). It links critical contact points for continuum of care and helps in improving utilization of key services under ICDS and NRHM. It incorporates the new WHO Child Growth and Development Standards and delivers health and nutrition messages to the mother and the child. Being an entitlement card, it ensures greater inclusion of the unreached groups to essential services as well as universalizes access to key maternal and child care services. The MCP card enables the network of ASHAs, AWWs and ANMs to utilise the critical contact opportunities like VHND, individual and group counselling sessions more effectively.
1. Printing and distribution of Mother and Child protection (MCP) Card a. MCP Card will be given to each pregnant woman at the time registration. The ammonal requirement of the card as per need assessment is 39683 (say 40000). b. The total budget for printing and distribution of 40000 cards @ Rs. 3 per card amounts to Rs. 1.20 lakhs.
Nagaland SPIP 2011-12 51
2. Orientation training on MCP Card: a. One-day State level Orientation training of State Officials. Participants: Addl Directors, Jt Directors/SPOs and DD/SPOs, and senior officers from the department of Social Welfare. Resource person will be from MoHFW, NIFHW and RRC. The Director (FW) will be the Nodal Officer. Budget requirement @ Rs. 2000/- per head for 40 persons amounts to Rs. 0.80 lakhs. b. One-day State level Orientation training of key State and District Officials. Participants: Chief Medical Officers, Medical Superintendent of DHs & DIOs and DWO and CDPOs. Resource person will be from MoHFW, NIFHW and RRC. The Director (FW) will be the Nodal Officer. Budget requirement @ Rs. 2000/- per head for 60 persons amounts to Rs. 1.20 lakhs. c. One-day District level Orientation training of key District and Block Officials. Participants: key District and Block Officials from DoHFW & department of Social Welfare. Resource person will be State official from both departments. The Addl. Director (Trg) will be the Nodal Officer. Budget requirement @ Rs. 2000/- per head for 160 persons amounts to Rs. 3.20 lakhs. d. One-day Block level Orientation training of key Block Officials and Health staff and AWW. Participants: key Block Officials from DoHFW & department of Social Welfare. Resource person will be State & District official from both departments. The CMO will be the Nodal Officer. Budget requirement @ Rs. 1400/- per head for 160 persons amounts to Rs. 2.24 lakhs.
The total budget requirement for rolling out of MCP Card amounts to Amount (Rs in Activity lakhs) 1. Printing and distribution of Mother and Child protection (MCP) Card 1.20 2. Orientation training on MCP Card: One-day State level Orientation training of State Officials 0.80 One-day District level Orientation training of key District and Block Officials 1.20 One-day District level Orientation training of key District and Block Officials 3.20 One-day Block level Orientation training of key Block Officials and Health staff and AWW 2.24 Grand Total 8.64 Rupees Eight Lakhs sixty four thousand) only
To provide Home Delivery Kit for Skilled Birth Attendant (HD by SBA): Provision of safe delivery is one of the major concerns of the state with very low institutional delivery. Besides improving the institutional delivery coverage with depends of many factors such as availability of health infrastructure and motivating behavioural change of the age old practice of home delivery on one side, we need to explore avenues to promote safe delivery at home.
1. In this regards, the state proposes to provide to all expectant women opting for Home Delivery despite counselling a Home Delivery Kit to enable safe delivery by SBA on fulfilment of the following conditions: a. The service will be provided only to those expectant mothers who have completed at least 3 ANCs and her birth preparedness plan in position. For those with partial ANC will insist for institutional delivery. b. The Home Delivery Kit will be given to the expectant woman only at the time of 3rd ANC visit. c. The SBA must ensure drawing up birth preparedness plan during the ANCs. Both the expectant mother and SBA should clearly understand the birth preparedness plan. d. The SBA should compulsorily observe the standard protocol as per SBA guideline including maintenance of partogram and apgar score for every case. e. Home Birth Checklist The SBA preparing the birth preparedness plan must counsel the expectant mother on birth hygiene ‘five cleans’ i. Clean home ii. Clean surface in room where women will give birth Light for birth attendant (flashlight) iii. Clean gowns for mother sanitary napkins and Bath towels
Nagaland SPIP 2011-12 52
iv. Clean sheets Plastic sheeting to protect mattress (to be placed under sheets during delivery – can cut up large plastic bags in necessary) v. Disinfectant soap Cord clamp/ Thread which can be boiled. vi. Disposable single – use gloves vii. One trash can (preferably lined with plastic bags) for trash and / or waste products viii. Clean cotton blankets to receive newborn Diapers ix. Clean cloths for newborn If it is cold, x. A source of heat should be provided so that the newborn is not born into a clod environment. A 200 watt bulb is appropriate. A traditional heating option, which generates minimal smoke, in case there is no electricity, may be used.
2. The Home Delivery Kit will consist of the following: The delivery kit should contain disposable items, as well as supplies and essential drugs required for conducting a home delivery. a. Packet 1: To be provided to the expectant woman only at the time of 3rd ANC visit. Disposable Delivery kit will contain the following articles: soap; new blade; clean thread; clean sheet; gloves; plastic apron; cotton and gauze piece, Syringes with needle (2 ml, 5 ml, 10 ml Needles 22 G & Intravenous set)Trash bag.
b. Packet 2: To be collected by the SBA from the health unit stock. Gentamicin injection Magnesium sulphite injection 50% Oxytocin injection, Ampicillin capsules, Metronidazole tablet, Misoprostol tablet, Paracetamol tablets and ORS
c. Packet 3: To be collected by the SBA from the health unit stock. Ringer Lactate solution, 500 ml Adhesive tape, Blood pressure apparatus with stethoscope, Foetoscope, Measuring Tape, Partographs & apgar score, Dipsticks for testing sugar and proteins in urine, Puncture- proof box, Thermometer, Spirit, antiseptic solution, Torch, Foley’s catheter, Mucus sucker, Ambu bag and mask, Mouth gag,
3. The budget requirement for 20000 estimated home delivery amounts to Total Amoun Activities to provide Home Delivery Kit for Skilled Birth Attendant (HD by Unit t (Rs in SBA) Units cost lakh) a. Packet 1: To be provided to the expectant woman only at the time of 3rd ANC visit.
Disposable Delivery kit 13000 800 104.00 b. Packet 2: To be collected by the SBA from the health unit stock. 0.00 Emergency Medicine supplies 13000 0 0.00 c. Packet 3: To be collected by the SBA from the health unit stock. 0.00 Other supplies 13000 0 0.00 Grand Total 104.00 Rupees one crore four lakhs only
Strengthening the Village Health and Nutrition Days: As a strategic step to strengthening sub-centres and sub-centre level activities, strengthening the already happening Village Health and Nutrition days shall be a mechanism to improve maternal health indicators at the village level. Village Health and Nutrition Day is conducted on a fixed day every month (decided jointly by the health committees and community) in all the villages with the help of ANMs and ASHAs. A regular monitoring and HMIS mechanism shall record attendance and services provided. Reporting format for VHND is in the process of printing developed by the state. For the regular monitoring and handhold support in carrying the Village Health and Nutrition Day by the district authority and Medical Officers of CHCs and PHCs a mobility support is required. Therefore; it is proposed to provide to the districts authorities an amount of Rs. 660000/- which is divided in Rs. 5000 per district monthly. (5000 x12x11=660,000).
Nagaland SPIP 2011-12 53
A1.2: Maternal Referral Transport Assistance: Proposal as per MCH Referral Transport Policy: a. Beneficiary A: Pregnant Women residing more than 3kms away from the any 24x7 health institution for institutional Delivery will be entitle for free ambulance services to enable them reach the nearest health unit for institutional Delivery. About 4000Pregnant Women (40% of 40000) are expected to be residing more than 3kms away from the any 24x7 health
b. Beneficiary B: Critically sick Women with complications of pregnancy and childbirth or within 42 days of termination of pregnancy, irrespective of the duration and site of pregnancy are entitled for free ambulance services to enable them reach the nearest 24x7 health unit or from Health Institution-To- Health Institution for appropriate care. About 3000 pregnancies (10% of 40000) are expected to develop complication.
c. Beneficiary C: Women who have stayed atleast 48 hours in the hospital following delivery and has immunized their child with relevant vaccines unless contraindicated are entitled for free ambulance services to return home (Drop-Back-Home Referral Transport Assistance). The state is targeting 50% ( 2000 cases) of 20000 (approx) institutional deliveries for 48 hours hospital stay post-delivery and immunization of the child with relevant vaccines unless contraindicated for the immunization.
d. Instead of providing cash benefit, the state proposed to provide the ambulance service which promote optimal utilization of the ambulance. Also the beneficiary will be relieved of the burden arrangement and high cost of hiring vehicle. The budget requirement for Maternal Referral Transport for the 3 categories of beneficiaries amounts to Rs. 45.00 lakhs to be projected under Maternal Health.
Maternal RTS Units Unit Cost Total Amount (Rs. in lakhs) Beneficiary A 4000 500 20.00 Beneficiary B 3000 500 15.00 Beneficiary C 2000 500 10.00 Grand Total 45.00 Rupees forty five lakhs only
A1.7: Maternal & Infant Death Audit: To enhance accountability for maternal deaths, every maternal death will be made fortifiable and to be followed by review/verbal autopsy at different levels to ensure identification of maternal deaths, investigation of cause of death and to take appropriate and corrective measures. The details are given in Chapter 5: M & E.
A2C: QUALITY ASSURANCE (Budgeted in B15.2): Issues/ Challenges Lack of proper institution for Quality Assurance. Lack of awareness on adequate Quality Management measures Absence of standard treatment guidelines (STG) and Standard Operating Procedures (SOPs)
Proposed activity: 1. To strengthen and institutionalise Quality Assurance Cell: The composition of the state QAC: a. Secretary, Medical and Health (Chairperson) b. Principal Director (Co-Chairperson) c. Director Health (Convener) d. SPO RCH e. SPO UIP f. Joint Director Nursing g. One Empanelled Gynaecologist h. One Empanelled Vasectomy Surgeon i. One Anaesthetist j. One member from an accredited private sector
Nagaland SPIP 2011-12 54
The composition of the District QAC (DQAC): a. Deputy Commissioner, Chairperson b. Chief Medical Officer (convener) c. DIO/DRCHO/DMCHO d. One empanelled gynaecologist DH e. One empanelled vasectomy surgeon DH f. One anaesthetist DH g. Nursing Supdt DH h. Any other as determined by the Department of Health and Family Welfare (state government).
2. Development of standard treatment guidelines (STG) and Standard Operating Procedures (SOPs) a. To constitute an Expert Committee for drafting and adopting the standard treatment guidelines (STG) and other quality assurance literatures. b. The budget requirement for this activity amounts to Rs. 1.00 lakh.
3. Publication and Distribution of QA literatures: a. Quality Management in Public Health Facilities Traversing Gaps (NHSRC) 1500 copies @ Rs. 600 per unit amounting to Rs. 9.00 lakhs. b. Standard Treatment Guidelines 2000 copies @ Rs. 700 per unit amounting to Rs. 15.00 lakhs. The total budget requirement for Publication and Distribution Rs. 24.00 lakhs.
4. Training of health staff on Quality Assurance: a. Workshop on Quality Assurance in health management for senior officers from directorate, and district. One-day Orientation training of State and District Officials comprising of Addl Directors, Jt Directors/SPOs and DD/SPOs, Chief Medical Officers and Medical Superintendent of DHs/TB Hospitals/Mental Hospital. Resource person will be from MoHFW, NIFHW and RRC. Venue: Directorate Budget requirement for the Orientation training of State Officials, Chief Medical Officers and Medical Superintendents on integrated supportive supervision and monitoring for action @ Rs. 2000/- per head for 57 persons amounts to Rs. 1.14 lakhs.
b. Workshop on Quality Assurance in health management for officers from district and block. One-day Orientation training of officers from district and block comprising of District Programme Officers (48), SMO CHC (21), MO i/s PHCs (21) designated as BHU, DPM (11), DFM (11), BPM (52), BFM (52). Resource person will be from RRC, State HIB and SPMU. Batch size: 50-55 No of Workshop: 4 Venue: Directorate Budget requirement for the Orientation training for officers from district and block @ Rs. 1400/- per head for 216 persons amounts to Rs. 3.14 lakhs.
Budget requirement for Training of health staff on Quality Assurance amounts to Rs. 29.28 Total amount (Rs. In Training of health staff on Quality Assurance amounts lakhs) Workshop on Quality Assurance in health management for senior officers from directorate, and district 1.14 Workshop on Quality Assurance in health management for officers from district and block 3.14
Grand total 4.28 (Four Lakhs Twenty eight thousand Only)
Budget summary of Quality Assurance amounts to Rs. 29.28 Lakhs Quality Assurance activity Total amount (Rs in lakhs) a. Development of standard treatment guidelines (STG) 1.00
Nagaland SPIP 2011-12 55 b. Publication and Distribution of QA literatures 24.00 c. Workshop of health staff on Quality Assurance 4.28 Grand total 29.28 (Twenty nine lakhs twenty eight thousand only)
This budget is reflected in Part ‘B’
A3. Child Health
Child Health is one of the important health indicators of human development. Child mortality being the result of complex web of determinants at many levels like poverty, characteristics of physical environment, yet the State focuses on more proximal determinants those that can be addressed though the health and child development sector. Strategic Objective under RCH II for New Born & Child Health a. Increase coverage of skilled care at birth for newborns in conjunction with maternal care. b. Implement, by 2010-11, a newborn and child health package of preventive, promotive and curative interventions using a comprehensive IMNCI approach. c. Strengthen and augment existing services (care at birth/Essential new born /care, ARI and diarrhea control) in areas where IMNCI is yet to be implemented. d. Implement the multiyear strategic plan for the UIP (Universal Immunization Program)
1. IMR (SRS 2008) 26 Goal: Overall NRHM 2012 Goal: Annual 2011-2012 22
2. SITUATION ANALYSIS: 2.1: Mortality Indicators NFHS 2 NFHS 3 SRS 2007 SRS 2008 Trend Analysis 2009 Neo Natal Mortality Rate Infant Mortality Rate 42 38 20 21 26 (increasing) Under Five Mortality 63.8
PROCESS INDICATORS 2.2: ANAEMIA (6-35 months) NFHS 2 NFHS 3 Coverage Evaluation Survey Trend (CES) 2009 Analysis % of children (under 5 years) of 43.7 NA age with anemia
2.3: INFANT & YOUNG CHILD FEEDING Coverage Evaluation Trend NFHS 2 NFHS 3 DLHS 2 DLHS 3 Survey (CES) Analysis 2009 Children under 3 years breastfed within one hour 24.5 51.5 42.1 49.4 of birth Children age 6 months and above exclusively NA 29.2 40.2 breastfed Children age 6 - 24 months received NA 71.0 solid/semisolid foods and
Nagaland SPIP 2011-12 56 are still breast fed
3: DIARRHOEA & ARI Coverage Evaluation Trend NFHS 2 NFHS 3 DLHS 2 DLHS 3 Survey Analysis (CES) 2009 Children with Diarrhoea in the last 2 weeks who 29.7 17.1 57.5 received ORS Children with Diarrhoea in the last 2 weeks who 23.3 19.5 were given treatment at facilities. Children with ARI or fever in the last 2 weeks NA 23.2 50.6 who were given treatment at facilities.
Management Childhood Diarrhoea Program: The National Diarrhoea Management guidelines recommends ORS along with a dose of 20mg/day for 14 days for every case of diarrhoea (irrespective of how long the diarrhoeal episode lasts) for children above six months of age and 10 mg/day for children 2-6 months of age (vide letter no Z.28020/06/2005-CH dated 08-05- 10). Zinc should be given along with ORS whenever the child has diarrhoea- even if it was given for an earlier recent episode. Strategy: 1. Increase awareness among health personnel at all levels, on the importance and use of ORS & Zinc in diarrhoea management. 2. Make ORS & Zinc easily available at all health facilities (DH/CHC/FRU/PHC & SC) 3. ORS and Zinc be made part of ANM/ASHA kits. Promote use of ORS & Zinc among families and communities to reduce diarrhoeal deaths through IEC/BCC. Unit Total Budget Head Cost Unit Cost (Rs (Rs.) No. in lakhs) 1. Provision of Zinc Tablet to all Health Units Zinc tablet 20mg/day for 14 days for every case of diarrhoea for children above six months of age 1.75 168000 2.94 Zinc tablet 10 mg/day for 14 days for every case of diarrhoea for children 2-6 months of age 1.75 112000 1.96 Subtotal A 4.90 2. Advocacy Workshops/ Project Launching/dissemination workshop 3. Training Printing Training Modules 150 1500 2.25 State Level TOT of district health officials @ 3 persons per district 2500 33 0.83 Training of MOs and Supervisors at district HQ @ 2 per block 1500 104 1.56 Training of Health Workers @ 2 per health unit 1000 1122 11.22 Subtotal B 18.86 Grand total (A+B) 23.76 Rupees twenty three lakhs and seventy six thousand only
The total budget requirement for management of diarrhoea Rs. 23.76 lakhs budgeted under CH.
TRAINING UNDER CHILD HEALTH 4.1 Progress till date - no. of trainings conducted/ health persons trained / districts covered Planned For 2010-11 Held/ Trained (til Nov / Dec 2010)
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IMNCI - No. of trainings 548 163 trainees - No. of persons trained 163 - No. of Districts implementing 6 districts · Pre- Service IMNCI (3 School of Nursing) - No. of trainings - - No. of persons trained - - - No. of Districts implementing - - · F-IMNCI - No. of trainings NIL NIL - No. of persons trained NIL NIL - No. of Districts implemented NIL NIL · Navjaat Shishu Suraksha Karyakram (NSSK) Not planned in PIP, but was conducetd by state as Master - No. of trainings Trainer was 123 trainees. available. Fund utilized from RCH Flesipool. - No. of persons trained 123 - No. of Districts implemented 11 · Any other -
KEY CHILD HEALTH PERFORMANCE INDICATORS Progress on CH interventions Planned Held/ Trained For 2010-11 (til Nov / Dec 2010) IYCF No. of Newborn breastfed within one hour 6740 till Jan No. of children 6 months and above exclusive breastfed Mgmt of Acute Respiratory Infection No. of children below (5 years) with ARI screened/detected 2317 No. of children (below 5 years) with ARI treated at facilities. Mgmt of Diarrhoea No. of children below 5 years with Diarrhoea in the last 2 7367 weeks who received ORS and Zinc. No. of children with Diarrhoea in the last 2 weeks who were 5733 given treatment at facilities. Iron Folic Acid supplementation No. of children below 5 years provided IFA Syrup/Tablet Vit A supplementation No. of children below 5 years provided Vitamin A Syrup 2299 Mgmt of Malnutrition / Severe Acute Malnutrition No. of children with SAM detected No. of children referred to NRC/facilities for Mgmt. Key Programme indicators Home visits for newborn by IMNCI trained person No. of newborn children visited on 1st Day/ 3rd Day/ 7th Day. Number of Low Birth Weight babies visited on 14th, 21st & 28th day. No. of Sick Children Screened/detected & managed at home. No. of Sick Newborn & Children treated at facilities for Sepsis,
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Asphyxia, Severe dehydration, Pneumonia etc. No. of NSSK trained person conducting deliveries at facilities.
5. Establishment of newborn and child care facilities at Maternal and Child Health (MCH) Centres MCH Centre Level Newborn and child care facilities Existing Level III- MCH Centre Special Newborn Care Units (SNCU) at district hospitals 0 Level II -MCH Centre Newborn and Child Stabilization Units at FRUs (District Hospitals) 11 Newborn Care Corner at 24x7 PHCs/CHC 42 32 PHC Non 24x7 PHC & SC providing Institutional Delivery but without NBCC 5SC Level I MCH Centre 59 PHC Non 24x7 PHC & SC not providing Institutional Delivery and do not have NBCC 393 SC
Nutritional Rehabilitation centres 0
PAGE 41 – TABLE NO.6
Planning for the year 2011-12 1st Qtr 2nd Qtr 3rd Qtr 4th Qtr Total Target 9. IMNCI No. of districts planned for IMNCI 11 implementation.
No. of IMNCI training planned. MO- 15 MO- GNMs- GNM- MO- 30 ANMs - 20 15 15 15 GNMs- 45 GNMs- ANMs - 60 15 ANMs ANM- - 20 20 10. F-IMNCI No. of persons planned to be trained F- 3 6 MO 6 MO 6 MO Master Trainer IMNCI Paediatrician 6 6 6 -3 GNM GNM GNM MOs - 18 GNM- 18 The state has planned to collaborate with CMC Vellore and train 3 doctors this year as Master Trainers.
No. of districts facilities Planned for 5 6 11 implementing F- IMNCI No. of persons (MO/SN) planned to be 6 MO 6 MO 6 MO trained 6 6 6 GNM GNM GNM
11. Navjaat Shishu Suraksha Karyakram (NSSK) No. of districts facilities planned for 11 District implementing NSSK No. of persons (MO/SN) planned to be MO- 20 MO- 80 trained in NSSK GNM- 40 MO- MO- MO- GNM- 160 20 20 20 GNM- GNM- GNM-
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40 40 40 12. Pre- Service IMNCI Training Number of medical colleges/ nursing 3 (Government colleges planned for implementing Pre- Nursing Service IMNCI School) Number of medical/nursing students The students passing from 3 Nursing 100 planned to be trained Schools would be trained before joining service. In order to not disturb the academic schedule of the Nursing School, the State plans to give them free hand in deciding the time of training.
Planning for the year 2011-12 1st Qtr 2nd Qtr 3rd Qtr 4th Qtr Total Target 13. Establishment of newborn and child care facilities at Maternal and Child Health (MCH) Centres Level III MCH Special Newborn Care Units 1 Centre (SNCU) at district hospitals Level II MCH Strengthening of Newborn and Centre child Stabilization units at 2 existing DH Newborn and child Stabilization 5 units at proposed FRU CHC Newborn Care Corner at 24x7 12 PHC SC 5 Nutritional Rehabilitation 0 centres
13. Community based initiatives : 15888 number of VHNDs in 1324 Organization of VHNDs villages. State has 1298 notified villages, but VHNDs are targeted for villages which are not yet notified. 15. School Health Scheme: Number of children screened for illness. 50080 Number of children provided IFA Tablet. 33000 Number of children provided Albendazole Tablets. 1300 16. Budget: Budget allotted (2010-11) 35.40 17. Budget utilized (Dec 2010) Nil 18. Budget proposed for Child Health for the year 2011- 12 41.6
Action plan and Target for 2011-12 under Child Health No. Core Activities Activities to be undertaken to achieve Time Budget targets 2011-12 Frame 1 Provision of 1 SNCU Provision of 1 SNCU at NHAK to be 3rd -4th Qtr projected to DPR 2 Provision of NBSU Detail description given in the text below Budgeted below 3 Provision of NBCC Detail description given in the text below Budgeted below 4 Improvement in Zinc tablet to all childhood diarrheas On going 4.90 management of IEC/BCC in home based diarrhea care to 2nd -3rd qtr. & as per IEC Diarrheal diseases. STG plan
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5 Breast feeding IEC/BCC on importance and advantages of On going As per IEC breast feeding through mass media plan
6 Improve Immunization As per UIP plan As per UIP plan 7 Routine Deworming As per SHAP As per SHAP (albendazole and mebendazole 8 Management of As per convergence plan with ICDS As per malnutrition program under social welfare. convergence plan 9 Monitoring & Activities will be clubbed together with Budgeted evaluation of quality of M & E part ‘B’. under M & E service and utilization part ‘B’. 10 Training and capacity IMNCI , F-IMNCI, and NSSK On going building IMNCI -30 MOs, 45 GNMs, 60 ANMs Budgeted F-IMNCI-3 Master Trainer, 18 MOs, under Training 18GNMs 11 Referral Transport Proposal as per referral Transport policy 22.5 @750 for transport for approximately 3000 children who would need referral to a higher facility.
Establishment of newborn and child care facilities at Maternal and Child Health (MCH) Centres: 1. SNCU at MCH Level 3: There is not a single SNCU and dedicated neonatal ward in the entire state till date. Therefore, it is proposed that a new 12-bed unit SNCU with proper building and equipments as per IPHS be established at NHAK (State Referral Hospital). Given the limited land/space availability, it is proposed that the existing maternity ward including the labour room complex being in a rundown condition be replaced with a new multi-storey structure which would include the SNCU, labour rooms, maternity ward and neonatal ward. This exercise though with high investment would address the demand on the land/space and most of all the complex would be user friendly as the entire target benefiaciaries will be catered under a single roof. DPR will be submitted later under Chapter 8.
2. NBSU at MCH Level 2: With the introduction of newborn and child care facilities at the MCH Centres, the DHs ought to have SNCUs. However, with the limited resources, the state is not in a position to provide SNCUs in all the DHs. Therefore it is proposed that the NBCC established in the DHs & CHCs (designated earlier and proposed during the year) as FRUs be upgraded to NBSU by strengthening the infrastructure through minor civil works, water & power supply and providing necessary equipment as per IPHS. The cost estimation for minor civil works, water & power supply etc is projected under A.9.2. Amount (Rs in Activity Budget Head lakhs) 1. Manpower 11 GDMOs @ Rs. 40000/- pm 52.80 RCH 20 GNM @ Rs. 20000/- pm 48.00 Subtotal A 100.8 5 GDMO @ Rs. 40000/- pm (5 CHCs) 24.00 RCH Subtotal B 24.00 Total for Manpower 124.8 2. Equipment NRHM
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9 nos Phototherapy at 2 DH & 5 FRU CHC @ Rs 30000/unit 1.20 4 Radiant warmer at 2 DH @ Rs 60000/unit 2.40 11 nos Laryngoscope (Neonate) at 11 DH @ Rs. 3500/unit 0.39 Subtotal C 3.99 Grand Total (A+B+C) 128.79 Rupees one hundred twenty eight lakhs and seventy nine thousand only
3. NBCC at MCH Level 1: It is proposed to strengthen the existing MCH level 1facility (mostly PHCs) and the network of MCH level 1facility be extended only to the SC as selecting PHC which would require more resources than that of SC. The cost estimation for minor civil works, water & power supply etc is projected under A.9.2.
Budget Activity Amount (Rs in lakhs) Head 1. Radiant warmer @ Rs 60000/unit 24x7 PHC (12 nos) 7.20 Sub Total A 2. Resuscitator/ambu bag/self inflating bag, hand-operated, neonate, 500ml @ Rs 3500/unit 24x7 CHC (5 nos) 0.18 24x7 PHC (12 nos) 0.42 SC (5 nos) 0.18 3. Resuscitator/ambu bag/self inflating bag, hand-operated, neonate, 250ml @ Rs 2500/unit 24x7 CHC (5 nos) 0.13 24x7 PHC (12 nos) 0.30 SC (5 nos) 0.13 Sub Total B 1.32 4. Foot Operated suction machine @ Rs. 4000/unit 24x7 CHC (5 nos) 0.20 24x7 PHC (12 nos) 0.48 SC (5 nos) 0.20 Sub Total C 0.88 Grand Total 2.38 Rupees Two lakhs thrity eight thousand only
A.3.8: Child Referral Transport Assistance (Budgeted in A.2.8): Proposal as per MCH Referral Transport Policy: 1. Child Referral Transport Assistance for Critically sick infants: a. Critically sick infants will be entitle to avail ambulance services free of cost to enable them reach nearest 24x7 health unit and from Health Institution-To-Health Institution for appropriate care. Of the 30000 estimated infants, about 3000 (10%) of the infants would require the assistance. b. Instead of providing cash benefit, the state proposed to provide the ambulance service which promote optimal utilization of the ambulance. Also the beneficiary will be relieved of the burden arrangement and high cost of hiring vehicle. The budget requirement for Child Referral Transport for the above mentioned beneficiaries amounts to Rs. 15.00 lakhs to be projected under Child Health.
Children RTS Units Unit Cost Total Amount (Rs. in lakhs) Critically Sick Infants 3000 500 15.0 Grand Total 15.00 Rupees fifteen lakhs only
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A.7: PRENATAL DIAGNOSTIC TECHNIQUE ACT (Budgeted in B.17) Objective: 1 To strengthen the Institutional framework for implementing the PNDT Act Implementation of PNDT Act not strong and requires regular Issues/ Challenges monitoring and a strong regulatory framework Necessary staffing and logistics to be in place Legal guidance lacking Strategies/ Services Activities/ Inputs Institutionalising State and Operationalise State level PNDT Cell with members derived from District level ‘PNDT Cells’ various govt. departments, Judiciary, NGOs/ CBOs/ FBOs Schedule regular structured review meetings of this cell Operationalise District Level PNDT cell with the district administration, judiciary having important stake At the state level, Secretary Health to be the Member Secretary while at the district level, the Civil Surgeon/ CMO Regular meetings held to assess the implementation of the Act All the Government Departments, especially the Home Affairs and the Judiciary Support needed for implementing From NGOs/ CBOs/ FBOs etc changes From the community From the private health care providers Proper documentation of all the activities/ meetings of these cells Benchmarks Awareness among the community to the existence of the Act and the Cell Objective: 2 To Orient Programme Managers & Service Providers on the PC & PNDT Act Violations under the PNDT Act are committed by the medical fraternity. Now as per GOI directive, Deputy Commissioner will be appointed as District Appropriate Authority & likewise Sub-Divisional Magistrates may be appointed Sub-Divisional Appropriate Authorities. Issues/ Challenges All these Officers & Nodal Officers to be appointed will require
sensitization to the PC & PNDT Act District/ Sub-divisional Officers, Politicians, Opinion leaders, Religious leaders, Lawyers, NGOs etc. need to be sensitized on the declining female sex ratio & enforcement of the PNDT Act Strategies/ Services Activities/ Inputs Orienting the private sector Seminars/ workshops need to be conducted at state/ district/ sub- service providers on the PNDT divisional levels for repeated sensitization of the private practitioners Act to the stringent regulatory mechanisms under the Act and the penal actions laid therein To enlist the support of professional bodies like IMA, FOGSI etc To disseminate printed guidelines to the private sector Orienting the designated One-to-one interaction with the Deputy Commissioner and the Judicial Authorities on the Act and their Magistrate on the norms of the Act and their roles envisaged roles Get the necessary circulars/ notices issued from these officials informing the services providers and the community about the norms of the Act Orienting the community on the Intensive awareness campaign in the community informing about the Act Act and the penalising actions envisaged therein for defaulters To circulate brief handouts within the community informing about the Act To use all the media channels for creating community awareness Enlist the support of political, community and religious leaders State and District Administrations Support needed for implementing From NGOs/ CBOs/ FBOs etc changes From the community, religious and political leaders From the private health care providers Community, officials and service providers aware of the Act Benchmarks Reduction in female foeticide Health sex ratio
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Objective: 3 To Implement the PNDT Act and ensure balanced sex ratio Lack of stringent implementation of the Act leading to defaulters misusing the diagnostic techniques to determine sex of the foetus Issues/ Challenges Lack of awareness among the masses
Lack of understanding of the core social issues underlying the violations of the Act Strategies/ Services Activities/ Inputs Licensing and monitoring of all All the diagnostic/ USG centres in the district shall be registered and the diagnostic centres, especially regularly monitored by the Appropriate Authority the ultrasonography centres Defaulters will be penalised and public notification regarding the same shall be displayed Conducting sex determination test shall be propagated as a crime and a shameful act Awareness drive on issues related to cause of the girl child shall be undertaken through NGOs/ CBOs/ FBOs/ religious leaders etc using all the channels of communication, with a stress on local folk theatre etc thorugh IEC Bureau. Areas/ zones with poor sex ratios shall be targeted on a priority Funds for prize/ incentive for informers reporting violations of the PNDT Act Funds for arranging decoy patients to nab violators of the PNDT Act From the Judiciary, Police and other concerned departments Support needed for implementing From all the NGOs/ CBOs/ FBOs/ PPs etc changes From the medical fraternity and their professional bodies like IMA/ FOGSI Strict implementation of the Act Benchmarks Penalising the defaulters publicly Cooperation from all the stakeholders in propagating the Act norms
Table: Budget summary of PNDT Activities. B.17: PNDT Activities Total Amount Unit Cost (Rs in lakhs) 1. To strengthen the Institutional framework for implementing the PNDT Act PNDT Cell at the State HQ PNDT Cell at the District level Office expenses @ Rs. 2000 pm per district 2000 2.64 2. Orienting & sensitizing the service providers on the PNDT Act State level (1 no) 150000 1.50 District level (11 no) 100000 12.00 3. Mobility support for enforcement of PC & PNDT Act State level @ Rs. 1 Lakh pa (1 no) 100000 1.00 District level @ Rs. 0.50 Lakh pa (11 no) 50000 5.50 Grand Total 22.64 Rupees twenty two lakhs sixty four thousand only
The Total budget requirement for PNDT Activities amounts to Rs. 22.64 lacs.
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Annexure: I
REFERRAL SLIP
1. Name of the Referring Facility Address Contact No
2. Name of the patient Age Sex Husband’s/ Father’s name Address
3. Referred on ..... /...... /...... (dd/mm/yy) at ...... (time) to ...... (Name of the the facility) for further Management.
4. Provisional Diagnosis: ......
5. Admitted at the Referring Facility on (dd/mm/yy) at ...... (time) with chief complaints of: a...... b...... c...... d...... e......
6. Summary of Management (Procedure, Critical Interventions, Drugs given for management):
7. Investigations done: 1. Blood Group...... 2. Hb%...... 3. Urine RE...... 4...... 5......
8. Condition at time of Referral:...... Consciousness Temperature Pulse BP
9. Other (Specify):......
10. Information on Referral provided to the Institution referred to: Yes/No
11. If yes, then Name of the person spoken to:......
12. Mode of Transport for referral: Govt/Outsourced/EMRI/Personal/Others/None
13. Particulars of the Referring Health Personnel Name Designation Signature Stamp
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A4. Family Planning Family Planning is another key component of RCH II and also an important indicator of development index. The scenario of family planning program is one difficult activity in Nagaland due to various reasons such as Myths and misconception attached to the concept of family planning method especially among the men. Knowledge gaps, fear of side effects in the remote villages are one such example.
Strategic Object of Family Planning: Unmet need for contraceptives is about 26.03% in the state and the unmet need for spacing is higher compared to that of limiting. It is proposed to reduce this unmet need for contraceptives to 20% by 2011-12. Illustrative Activities: a. Access to non-clinical contraceptives increased in all villages in the state through community based distribution system and distribution by ASHAs in the villages. b. Promote accessibility to FP service facility at level Promotion of 10 year IUD as an alternative to sterilization. Accredition of Private Institutions: Promotion of NSV and male responsibility in family planning in the state. Increasing sterilization camps for female and NSV camps in difficult areas. c. Skill upgardation of HWs: Equipping the ANMs with skills to provide IUD services. Increasing the access for sterilization methods by training MOs in Minilap and d. To generate demands and service availability through IEC/BCC/IPC information dessimination.
PIP (2010-12) for Family Planning: Scheduled/ Budget Strategy / Activity Planned Achieved Work Plan Trg.Load (In lakhs) 2010-11 2011-12 1. FAMILY PLANNING MANAGEMENT 1.1 Review meetings on Family Quarterly at the 4 at the 2.0 Planning performance and state level and state initiatives at the state and district in the district level. level (periodic) level along 11 at with usual district No budget monthly level is meetings clubbed required. with monthly review meetings 1.2 Monitoring and supervisory visits This activity to districts/ facilities will be Budgeted undertaken as under M & per the state E Head monitoring and supervision plan. 1.3 Orientation workshops on technical Detailed plan is 2nd No manuals of FP viz. standards, QA, proposed under quarter additional FDS approach, SOP for camps, QA write up. Budget Insurance etc. required. 1.4 Printing Dissemination of manuals For distribution 1st -2nd 1 on standards, QA, FDS approach, to MOs, quarter SOP for camps, Insurance etc. CMOs, other district officials, state
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officials. Total number required : 800 2 TERMINAL/LIMITING METHODS (Providing sterlisation services in districts) 2.1 Plan for facilities providing On going Ongoing On going and On going 25.00 FEMALE sterilisation services the target is on fixed days at health facilities 2500 cases in districts 2.2 Plan for facilities providing NSV Limited 2 30 cases On going 0.45 services on fixed days at health acceptors facilities in districts 2.3 Number of FEMALE 44 44 +5 44 RCH On going Budget Sterilization camps in districts camps Camps+ 11 reflected during camps to be under world conducted maternal population during world health for day population RCH week camps. Rs. 11.00 for world population week for 11 camps 2.4 Number of NSV camps in Due to very districts. minimal number of acceptors the state has decided to club this activity with 2.3 activity under Family Planning. 2.5 Compensation for sterilisation 2500 1302 (till 2500 On going Already (female) november budgeted 2010) under 2.1 2.6 Compensation for sterilisation 30 2 30 Ongoing Already NSV budgeted (male) under 2.2 2.7 Mobility support to surgeon’s 22 @ 30,000 On going 6.6 team Due to high rates of vehicle hire and difficult terrain, state has noticed that logistics cost go up to 20,000 for a 4day camp (2
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days are spent in round journey to the districs). In addition due to lack of sufficient numbers of skilled manpower the plan is to hire surgeons team from outside the state and incentivise them appropriately. 2.8 Accreditation of private - - - - centres/NGOs for sterilization State doesn’t services plans to accreditate any private facility/NGO for providing FP services as intensive activities are taken up by NRHM and they would be sufficient to meet the case load for FP. 2.9 Plan for post partum sterilisation Under . 1st and This is club intergration 2nd with of activity 2.5 Counselling Family services Planning under one roof at District hospitals in coordination with NSACS, counsellors would be trained to provide PP sterilization
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counselling to mothers. 3 SPACING METHOD (Providing of IUD services by districts) 3.1 Plan for providing IUD services at 1482 Trained 2500 0.50 health facilities in districts MOs, GNMs will be providing IUD insertion services at all DH, CHCs and 24x7 PHCs. 3.2 No. of IUD camps in districts 44 27 This activity No extra will club with funds are 44 required. sterilization camps 3.3 Compensation to ASHA for Not 2500 @ Rs. On going 0.25 ensuring retention of IUD by planned 10 clients 4 SOCIAL MARKETING OF CONTRACEPTIVES 4.1 Setting up CBD Outlets This is carried out under state AIDS control society. 5 FAMILY PLANNING TRAINING Note: State intends to outsource the training of laproscopic Sterilization and Minilap Sterilization training. In order to ensure optimal utilization of the resources these two training s would be clubbed together. The framework for implementing this training would be finalized with the help of NE- RRC, Guwahati. 5.1 Laparoscopic Sterilisation Training 5.1.1 TOT on laparoscopic sterilisation Not Not required planned as of now 5.1.2 Laparoscopic sterilisation training 24 9 15 2nd - 4th qtr for service providers Under (gynecologists /surgeons) training 5.2 Minilap Training for MOs/ MBBS 5.2.1 TOT on Minilap Not Not planned planned 5.2.2 Minilap training for service 24 8 16 2nd - 4th qtr providers (medical officers Under training 5.3 Non-Scalpel Vasectomy (NSV) Training 5.3.1 TOT on NSV Not Not planned 0 planned 5.3.2 NSV training for medical officers 30 Nil 10 doctors Under trg from DH will be sent for training at Guwahati
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with assistance from RRC- NE. 5.4 IUD Insertion training 5.4.1 TOT for IUD insertion Not Two district 1st quarter Under trg planned trainers from each of 11 districts numbering to 22 will be trained for 2 days. This training would be refresher training. 5.4.2 Training of Medical officers in 0 0 20 1st -4th qrt. IUD Under insertion training 5.4.3 Training of staff nurses in IUD 40 25 40 SNs. This 1st -4th qrt. insertion would Under include SNs training who were to get trained last year but are yet to be trained. 5.4.4 Training of ANMs / LHVs in IUD 80 45 60 ANMs. 1st -4th qrt. insertion This would Under include training ANMs who were to get trained last year but are yet to be trained. 5.5 No. of Contraceptive Update 40SNs would 2nd qtr. trainings for health providers in be trained for Under the districts 2 days. training 5.7 Other FP trainings (please specify) 5.7.1 MTP for MOs 30 8 9 2nd and 3rd Under training 5.7.2 RTI/STI for MOs 90 90 60 MO and Under 70 Nurses training 6 BCC/IEC activities/campaigns/ Melas for family planning e.g. Budgeted Funds earmarked for district under and block level activities during IEC/BCC ‘World Population Day’ celebration week
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7 PROCUREMENT of DRUGS/MATERIALS 7.1 NSV Kits 100 100 State already has enough stock. 7.2 IUD insertion Kits 500 65 State already has enough stock. 7.3 Minilap Set 46 4 32 2nd and 3rd 5.78 quarter 2nd and 3rd 7.4 Procurement of laparoscopes 9 9 9 54.00 quarter 1 lac per 1st -2nd district per quarter year for 11 districts is required by the state to curb the out of pocket expenditures made by Procurement of drugs & supplies patients to 7.5 11.00 for FP buy medicines, consumables etc. This amount will be exclusively utilized on supporting FP program beneficiaries. 8 Innovatory schemes for Not Plnned promoting FP at state or district level 9 Performance based rewards to 3 @ Rs. 3.70 institutions and providers for FP 30000/unit, performance at state and district CHC:3 @ Rs. level DH 20000/unit, PHC:11 & SC:11@ Rs. 10000/unit)
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A5. Adolescent Reproductive and Sexual Health (ARSH) Adolescent Reproductive and Sexual Health is a means to increase in the health indicator especially under RCH II main focus areas. The state has rolled out ARSH program in all the 11 districts such as Kohima, Mokokchung, Dimapur, Longleng, Peren, Zuhneboto, Kiphere, Wokha, Phek, Tuensang and Mon. The ARSH program will continue to all the 11 districts. Nagaland is one of the HIV/AIDS high prevalent states in the country, this is the parameter which the state considered to extend ARSH program to all the districts. During 2011-12 the strategic step the state will be undertaking would be to ensure and to promote healthier youth in the state in the issues related adolescent reproductive and sexual health.
Achievement during 2010-11 Activities Achievement
ARSH Talks in 55 schools, 1 day seminar with film 55 Schools were covered under ARSH activity, 5 show in 5 colleges, 9 Street play, TV shows in local colleges and IPCs sessions were conducted. Some of cable channel and 3 radio talks the activities components were essay writing competitions, painting, adolescent parliament, extempore speech, radio talks, etc.
Strategic Objective of Adolescent Reproductive and Sexual Health: Improved access to reproductive health of Adolescent.
Illustrative Activities: a. Ensure that reproductive health of adolescents are met b. Establishing Adolescent clinic in the 24x7 PHCs, CHCs and DHs to offer FDS once in a week on every Tuesday. c. Training on ARSH will be given to MOs/Nurses/School Teachers. d. The trained Teachers will in turn train the Adolescent Group in the Schools/churches/community level in incorporation with the state level trainers. e. All the training activities on ARSH will be converged with NSACS. f. BCC/IEC/IPC will focus on ARSH.
Check-list for ARSH activities S. Activity Status as on Planned for Achievement Planning Remarks No. 01.04.2010 2010-11 against plan For 2011-12 till 31.12.2010 1 1-day State Orientation 1 1 1 1 1st qtr Workshop for ARSH 2 State level Training of 0 0 0 1 2nd qtr Trainers (3 days) 3 Printing of Training 1 1st-2nd qtr. Modules 4 IEC for ARSH 55 Schools Achieved Plan as On going were covered 2010-11 under ARSH plan. activity, 5 colleges and IPCs sessions were conducted. Some of the activities components
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were essay writing competitions, painting, adolescent parliament, extempore speech, radio talks, etc. 5 Helpline for ARSH 6 Convergence with other During programmes / 2011-12 departments ARSH (WCD, SACS, MoYAS, activities HRD) will converge with NSACS and School Health program. 7 Other activities (pls Under Budgeted specify) ASRH there under IEC will be Adolescent Club in all the districts.
ARSH Training Name of Training Training Status as Training Planned Achievement against plan till district Center on 01.04.2010 for 2010-11 31.12.2010 MO ANM/LHV MO ANM/LHV MO ANM/LHV Kohima, Dimapur 29 26 SN 8 Tuensang and Councilors Mokokchung Dimapur Dimapur 16 8 SNs, 6 ANMs Zuhneboto, Kohima 120 120 ANMs, Number Number trained till Wokha, Mon, 80 SNs trained till now., 36 Nurses & 22 Kiphere, now. 31 concellors On the Phek, Peren, MOs On going Longleng going as on November 2010.
Planning of ARSH training for 2011-12
For the year 2011-12 reshuffling of training centres for ARSH is proposed in order to overcome the accesss barrier for the trainees and trainers due to difficult terrain. As the existing DH would be used as training centre, there is no requirement of additional funds.
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Name of Training Center Planning for 2011-12 district MO ANM/LHV
Longleng Mokokchung ANM- 30 (10 from each ,Tuensang and district) Mokokchung LHV- 9 (3from each district) Counsellors - 7 Dimapur, Peren Dimapur ANM – 40 (30 from Dimapur and 10 from Peren) LHV – 6 (4 from Dimapur and 2 from Peren) Counsellors - 5 Zuhneboto, Kohima ANM- 30 (10 from each Wokha, Kohima district) LHV – 6 (2 from each district) Counsellors - 10 Mon, Mon ANM- 30 LHV- 4 Counsellors - 3 Kiphere, Kiphere ANM- 30 LHV- 4 Counsellors - 2
11 districts ANM- 150 LHV- 29 Counsellors - 27
AFHS clinics
Total District Hospital: 11 District hospital with AFHS clinic: 1 Planned AFHS clinic in DH in 2010-11: 10 DHs and 19 CHCs (this is under process and will be completed by March 2011)
A Name of District Total no. PHC/CHC with AFHS Planned Achievement till AFHS Clinics PHC/CHC AFHS Clinics as in 2010 31.12.2010 Planned for on 01.04.10 2011-12 Kohima 17 Nil 2 Not yet No plan to Mokokchung 17 2 commissioned develop AFHS Tuensang 13 2 But expected to during the year Phek 24 2 be completed the State Plan Mon 17 2 by 31-3-11 to strenghthen Wokha 14 1 which was Zunheboto 15 1 planned during Dimapur 10 1 DH 3 2010-11 Peren 9 Nil 1 Kiphire 5 2 Longleng 3 1
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Since there is no financial support to sustain the AFHS clinic it is proposed to provide financial assistant to maintain the clinic @ Rs. 20000/- per year/clinic X 30 = 6.00 lakhs as operational cost.
Any other AFHS clinic at CHC/SDH
Utilization of Adolescent services in AFHS clinics Name of Number Adolescent RTI/ Anaemi Pregnanc Condom Counsellin Mental district of attending STI/ a/ y/ MTP / OCP/ g disorders/ AFHS AFHS HIV Under ECP provided sexual clinics clinics cases nutritio abuse n Dimapur 1 175 5 0 0 Data Not 175 0 Available
B. Training
Introduction: One of the key components of Public Health Management is the capacity building and multi skill building for the in-service personnel. However, in Nagaland due to lack infrastructure, lack specialist and lack of case load many training designed to implement under RCH/NRHM could not impart quality training. This has been a key reason for state not achieving the annual target. Therefore, during 2011-12 the state will outsource the training component to private hospitals so as to fill the gap of specialist manpower in the state. The following table shows the detail of outsource plan for the training.
Sl. No. Name of the Training Name of the Institute/ Partner 1. EmOC and LSAS training will be outsourced GoI allocation, Christian Medical College, Vellore. 2. Minilap and Laparoscopic, NSV training The state will look out one of the competent Govt./Private Hospital in Guwahati-Assam (in collaboration with RRC-NE) 3. BEmOC The state will look out one of the competent Govt./Private Hospital in Guwahati-Assam (in collaboration with RRC-NE) 4. SBA training Christian Institute of Health Sciences & Research Center (CIHSRC) and Zion Hospital in Dimapur 5. IMINCI, F-IMINCI, NSSK, IUCD, RTI/STI Will be conducted in all the 11 district hospitals in training the State 6. MTP training To be conducted in the zonal training centers at Kohima, Dimapur and Mokokchung districts.
STATUS OF ANAESTHESIA TRAINING No of No of Total No of Total No of No of Target Nos. Target Medical District MBBS MBBS trained MOs for trained for Colleges Hospitals Doctors Doctors posted at 2010- in 2010-11 2011- conducting conducting to be trained trained in FRU till 11 (till 12 LSAS LSAS in LSAS till December December Training Training LSAS till 2010 (till 2010 2010) 2012 Dec. 2010 (cumulative) (cumulative) cumulative) 0 0 15 4 5 0 (2 5 undergoing
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training)
STATUS OF EMOC TRAINING No of Medical No of District Total No of Total No No of Targe Nos. Targe Colleges Hospitals MBBS of MBBS trained t for trained t for conducting conducting Doctors Doctors MOs 2010- in 2010-11 2011- EMOCTrainin EMOCTrainin to be trained in posted at 11 (till 12 g g trained in EMOC till FRU till December EMOCtill 2010 (till December 2010) 2012 Dec. 2010 2010 (cumulativ cumulative (cumulativ e) ) e) 0 0 15 5 1 (3 have 5 4 10 resigned undergoin and 1 is g traing at posted at a CMC non FRU Vellore. CHC) Date of completio n: April 2011
No of No of No. Of distric No. Of No. Of No. Of Targe Nos. Targe Districts institution hospitals/trainin Master SNs/ANMs/LH SNs/ANMs/LH t for trained t for conductin s g instittutes trainers Vs to be trained Vs trained till 2010- in 2010- 2011- g including practicing SBA trained till 2012 2010 (till Dec 11 11 12 SBA District protocols (Both (cumulative) 2010) (till Training Hospitals particularly State Decembe conductin partograph and r g Districts 2010) SBA ) Training 3 out of 3 DH 4 (Kohima, 3 397 194 60 26 30 11 Mokokchong, Dimapur, Mon)
STATUS OF SBA TRAINING
STATUS OF MTP TRAINING No. of No. of No of Total No of Targets No. of No. of No. of Govt. Private doctors doctors for doctors 24x7 DH/FRUs health Health planned trained 2010-11 trained in PHCs Providing facilities Facilities to be till 2010 (No. of 2010-11 providing Comprehensiv conducting accredited trained (till Dec. doctors (till at least 1st e Safe MTPs for in MA/ 2010 planned December Trimester, Abortion conducting MVA/ cumulative to be 2010) Safe services MTPs EVA till trained Abortion 2012 in Services 10-11) 11 DH 0 65 48 30 18 0 11
ALLOCATION AND EXPENDITURE UNDER MH AND JSY
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Budget Allocated under Budget Utilized under Budget Allocated under Budget Utilized under MH MH in JSY JSY in (excluding JSY) 2010-11 2010-11 (excluding JSY) 2010-11 2010-11 (Till December, Till December, 2010 2010) 77.87 0.79 366 202
C. Quality Assurance: To provide quality services in the state especially with focus to MCH services both in the state and district level. Under Maternal Health the state has proposed for expansion of MCH centers. The Quality Assurance component will be link with the MCH centers in the state. To ensure the quality of services in the state and district level and at MCH center facility level, the quality assurance committee at the state and district level will be responsible.
The Quality Assurance Committee will be meet half-yearly at the state level and the at the district level the district quality assurance committee will meet monthly along with the monthly meetings. The following are the composition of Quality Assurance Committee at the state and district level. The composition of the state QAC will be as follows: Commissioner & Secretary, H&FW (Chairperson) Director, Family Welfare (Convener) Director, Health Services, One Empanelled Gynecologist One Empanelled Vasectomy Surgeon One Anaesthetist State Nursing Adviser Joint Director, (FW)/RCH SPO/Deputy Director (FW) or any other as determined by the Department of Health and Family Welfare One member from an accredited private sector One representative from the legal cell
The terms of reference for the state QAC are as follows: Visit both public and private facilities providing family planning services in the state to ensure the implementation of national standards. Review and report deaths/complications following sterilization in the state. Review and report cases of conception due to failure of sterilization in the state. Give directions on the implementation of measures for improving the quality of sterilization services in the state. Review the implementation of the National Family Planning Insurance Scheme/payment of compensation in the state. Meet once every six months. A minimum of three members shall constitute the quorum. The procedures to be followed are: The state government will issue a notification on the constitution of the committee and its institutional arrangements. District-level committees will submit quarterly reports in the prescribed formats to the state committee. The state committee will meet every six months to review the reports being received from the districts. The committee may ask for additional information from the district committees if needed. The state committee will also have a supervisory role in the functioning of the district-level committees. If needed, the state committee may organize orientation programmes for the members of the district-level committees on a periodic basis. It would be ideal to have at least one professional responsible for coordinating the state committee’s activities, preparing reports, and conducting selective investigations. The Joint Director (FW) or the Deputy Director may be the designated officer responsible for this activity.
The composition of the District QAC (DQAC) shall be as follows: District Collector, Chairperson Chief Medical Officer/District Health Officer (convener)
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One empanelled gynaecologist One empanelled vasectomy surgeon One anaesthetist District Family Welfare Officer/RCH One representative from the nursing cadre Any other as determined by the Department of Health and Family Welfare (state government) One representative from the legal cell
The terms of reference of the District QAC will be as follows: Conducting medical audit of all deaths related to sterilization and sending reports to the State QAC office. Collecting information on all hospitalization cases related to complications following sterilization as well as sterilization failure. Processing all cases of failure, complications requiring hospitalization, and deaths following sterilization for payment of compensation, and pursuing these cases with the insurance company or otherwise. Reviewing all static institutions, i.e. government and accredited private/NGOs and selected camps providing sterilization services, for quality of care as per the standards laid down, and recommending remedial action for institutions not adhering to the standards. Meeting once every three months. A minimum of three members shall constitute the quorum.
Procedures In the event of a sterilization death, it will be the responsibility of the medical officer at the institution where the death occurred to inform the convener of the District QAC within 24 hours of the event. The convener of the District QAC should inform the convener of the state committee immediately. The District QAC should conduct a medical audit and submit the final audit report to the State-Level Committee (i.e. to the Director of Family Welfare) within one month from the date of reporting the death. In case no deaths have been reported during the quarter, the committee should meet at least once in three months and send a nil report. The committee should also thoroughly investigate and ascertain details of each case of complication/failure of sterilization in the district, review the reasons, and take/recommend appropriate measures. The committee should also suggest measures for improving the quality of sterilization services in the district. The committee will have access to reports and records being maintained by private providers for sterilization services in accredited centres.
Activity Plan: Sl.No Core Activities Time Frame Budget
1. Formation and notification of Quality Assurance 2nd qtr. Committee both at the state and district level. 2. Monitoring and Evaluation On going Mentioned in the M&E budget head. 3. Printing of Quality Assurance manual and 2nd to 3rd Qtr. Already budgeted under dissemination of Quality Assurance. A.3.1.1
D. Miscellaneous:
Infection Management and Environment Plan (IMEP): (this activity is ongoing and this is carried forward from last year 2010-11)
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Strategic Objective for Infection management and Environment Plan: To reduce the hazard of medical waste and to create and enabling environment in the hospitals and various health unit in the state. Illustrative Activities: Safe containment of infectious and non-infectious waste. Separation of waste into categories. Safe and prompt transport of contained waste. Proper processing of waste according to recommended practices.
Action Plan for 2011-12 No. Core Activities Activities and target Timeline Budget (laks)
Liquid waste Construction of liquid waste management t 2nd -4th Qtr. 3.00 management plant at, Dimapur DH @ Rs. 3 laks.Creating green belt in all the health units in the state by the respective Health Committees. Lack of logistic Identification of nodal officer in the state and 2nd Qtr and awareness district level for logistic support in the solid and in segregation liquid waste management. of wastes Capacity building on IMEP by convergence 2nd -3rd Qtr. Under Training with NSACS: Identification & training of TOTs at state and district level. Training on IMEP for 43 MOs (22 MOs covering all 11DHs, and 21 MOs from 21 CHCs).. Provision of chemical disinfectants through 1st -3rd qtr Money has RKS already been Provision of PEP through RKS apporoved in Construction of 1each secured Deep Burial the year 2010- pits, Sharp Disposal Pits and Waste dump in 11 and is still the 11 DH unutilized. Thus state would use the same fund. To construct of H/T waste storage facility as 2nd - 3rd qtr Money has per specification of BMW Rules @ Rs. 8 lakhs already been inclusive of proper sanitation, water supply apporoved in and 3 phase power supply provision for 3 DHs the year 2010- . 11 and is still unutilized. Thus state would use the same fund. Provision of autoclave for 3 DHs. 1st-qtr The autoclave Specification as prescribed in the BMW Rules has already been @ Rs. 6 lakhs/unit inclusive of installation and procured and is commissioning. waiting
installation. Provision of IMEP supplies to PHC & SC 1st qtr This is a carried over activity and supplies has already been procured but their supply to
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health institutes is awaiting. Convergence with municipality of Kohima, On going Dimapur and Mokokchung for disposal of domestic (green) waste in their dumping ground.
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F. RCH Felxipool Budget: CONSOLIDATED BUDGET SHEET -RCH FLEXIBLE POOL Required Physical fund under Sl.No. Activity Unit Cost Targets NRHM RCH Flexible Pool A.1 MATERNAL HEALTH Operationalise facilities(only dissemination, monitoring, and A.1.1 quality) A.1.1.1 Operationalise FRUs 5 0.00 A.1.1.2 Operationalise 24x7 PHCs 33 A.1.1.3 MTP services at health facilities 0.00 A.1.1.4 RTI/STI services at health facilities 0.00 A.1.1.5 Operationalise Sub-centres A.1.1.6 Printing of ANM Dairy 0 0 0.00 A.1.1.7 Printing &Dessimination of Partogram & Apgar Score Card 0 0 0.00 A.1.1.8 Rolling out of MCP Card 8.64 A.1.2 Referral Transport 45.00 A.1.3 Integrated outreach RCH services A.1.3.1 RCH Camps 50000 44 22.00 A.1.3.2 Population Week/ Sterilization Camp 50000 11 5.50 A.1.3.3 Monthly Village Health and Nutrition Days 1.00 A.1.4 Janani Suraksha Yojana / JSY A.1.4.1 Home Deliveries 500 13000 65.00 A.1.4.2 Institutional Deliveries 1300 15000 195.00 A.1.5 24 Hours Deliveries 0.00 A1.6 Payment to Link Workers/AWW/AWS (other than ASHA) 0.00 A1.7 PPP 700 480 3.36 A1.8 JSY Related activities 42.23 A.1.7 Maternal Death Audit 0.00 A.2 CHILD HEALTH 0.00 A.2.1 IMNCI 0.00 A.2.2 Facility Based Newborn Care/FBNC 0.00 A.2.3 Home Based Newborn Care/HBNC 0.00 A.2.4 School Health Programme 0.00 A.2.5 Infant and Young Child Feeding/IYCF 0.00 A.2.6 Care of Sick Children and Severe Malnutrition 0.00 A.2.7 Management of Diarrohea, ARI and MicronutrientMalnutrition 18.86 A.2.8 Other strategies/activities/ Referral Transport A.2.8.1 Child Referral Transport 22.50 A.2.8.2 SNCU Op Cost 0.00 A.2.9 Infant Death Audit 0.00 A.3 FAMILY PLANNING 0.00 A.3.1 Terminal/Limiting Methods 0.00 Dissemination of manuals on sterilisation standards &quality A.3.1.1 assurance of sterilisation services 100000 1 1.00 A.3.1.2 Female Sterilisation camps (Budgeted under MH camp) 75000 0 0.00 A.3.1.3 NSV camps 0.00 A.3.1.4 Accreditation of private providers for sterilisation services 100000 0 0.00 A3.1.5 Female Sterilization Compensation 1000 2500 25.00 A.3.1.6 Compensation for NSV male 1500 30 0.45 A.3.2 Spacing Methods 0.00 A.3.2.1 IUD services at health facilities 20 2500 0.50 A.3.2.2 IUD Compensation (Camp) A.3.2.3 Accreditation of private providers for IUD insertion services 25000 0 0.00 A.3.2.4 Social Marketing of contraceptives 0.00 A.3.2.5 Contraceptive Update seminars 75000 0 0.00 A.3.2.6 Compensation for ASHA 10 2500 0.25 Performance based rewards to institutions & providers 3.70 A.3.3 POL for Family Planning 30000 22 6.60 A.3.3.1 Review Meeting, Orintation Workshop (As per B 5) 2.00
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ADOLESCENT REPRODUCTIVE AND SEXUAL HEALTH / A.4 ARSH 0.00 A.4.1 Adolescent services at health facilities. 6.00 A.4.2 Other strategies/activities A.5 URBAN RCH 0.00 A.6 TRIBAL RCH 0.00 A.7 VULNERABLE GROUPS 0.00 A.8 OTHER RCH ACTIVITIES 0.00 A.9 INFRASTRUCTURE & HUMAN RESOURCES 0.00 A.9.1 Contractual Staff & Services 0.00 A.9.1.1 ANMs 15000 398 716.40 A.9.1.1.1 GNM/ Staff Nurse 20000 227 544.80 A.9.1.1.2 GNM for MCH activities in 11 DH 0 0 0.00 A.9.1.1.3 GNM for NBSU 20000 20 48.00 A.9.1.2 Laboratory Technicians 15000 39 70.20 A.9.1.2.1 X-ray technician for DH 15000 5 9.00 A.9.1.2.2 Lab Tech (Blood Component Separation at Blood Bank Dimapur) 15000 5 9.00 A.9.1.2.3 Ophthalmic Assistants NPCB 8000 5 4.80 A.9.1.2.4 Refrigerator Mechanics UIP 8000 3 2.88 Specialists (Anesthetists, Pediatricians, Ob/Gyn,Surgeons, A.9.1.3 Physicians, Radiologist,Sonologist, Pathologist,Specialist for CHC) 52000 17 106.08 A.9.1.3.1 SNCU Manpower support A.9.1.3.2 Pediatrician 0.00 A.9.1.4 PHNs at CHC, PHC level 20000 54 129.60 A.9.1.5.1 Medical Officers at PHCs 40000 97 465.60 A.9.1.5.2 Medical Officers at 24 x 7 PHCs 40000 33 158.40 A.9.1.5.3 Medical Officers at CHCs 40000 21 100.80 A.9.1.5.4 GDMO for MCH activities in 5 FRU CHC 40000 5 24.00 A.9.1.5.5 GDMOs for NBSU for MCH activities in 11 DH 40000 11 52.80 A.9.1.6 Additional Allowances/ Incentives to M.O.s of PHCsand CHCs 0.00 A.9.1.7 Others - Computer Assistants/ BCC Co-ordinator etc 0.00 A.9.1.7.1 Support Staff 0 0 0.00 A.9.1.8 Incentive/ Awards etc. to SN, ANMs etc. 0.00 A.9.1.8.1 FP Performance based rewards to institutions 0 0 A.9.1.9 Pharmacists 15000 14 25.20 A.9.1.10 Other Incentives Schemes (Pl.Specify) 0.00 A.9.1.11 Staff/Supervisory nurses (AYUSH) A.9.1.12 Medical Officers at CHCs/ PHCs (for AYUSH) 20000 29 69.60 A.9.1.13 Dental Doctors 20000 21 50.40 A.9.2 Minor civil works 0.00 A.9.2.1 Minor civil works for operationalisation of FRUs A.9.2.1.1. Extension & Renovation SC 500000 3 15.00 A.9.2.1.2. Water supply Pipe line CHC 300000 5 15.00 A.9.2.1.3. Water supply Rain Harvest CHC 300000 10 30.00 A.9.2.1.4. Water supply Bore well CHC 500000 5 25.00 A.9.2.2 Minor civil works for operationalisation of 24hour services at PHCs A.9.2.2.1 Ext & Renovation PHC 500000 0 0.00 A.9.2.2.2 Water supply 300000 0 0.00 A.9.2.2.3 Power Supply PHC 300000 0 0.00 A.9.2.2.4 Power backup PHC 400000 0 0.00 A.9.2.3 Minor civil works for operationalisation of MCH level 1 in SC 300000 0 0.00 A.9.2.4 Liquid Waste Management under IMEP 300000 1 3.00 A.9.2.5 Construction of Deep Burial pits in CHC 75000 0 0.00 A.9.2.6 Construction of H/T storage facility in DH 800000 0 0.00 A.10 TRAINING 0.00 A.10.1 Strengthening of Training Institutions 0.00 A.10.2 Development of training packages 0.00 A.10.3 Maternal Health Training 0.00 A.10.3.1 Skilled Birth Attendance for Nurses 30 15.44 A.10.3.2 EmOC Training 10 17.98 A.10.3.3 Life saving Anesthesia skills training (LSAS) 10 20.16
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A.10.3.4 MTP training 9 3.26 A.10.3.5 RTI / STI Training M.Os 60 35.04 A.10.3.5.1 RTI / STI Training Nurse 70 3.52 A.10.3.6 Dai Training 0.00 A.10.3.7 Other MH Training (ISD Refresher ) 0.00 A.10.3.8 BEmOC training for Mos 0.00 A.10.3.9 OT Technique training for GNM 0.00 A.10.3.10 Orientation training on MCP Card 0.00 A.10.4 IMEP Training (Training/Capacity Building for MOs) 43 4.12 A.10.5 Child Health Training 0.00 A.10.5.1 IMNCI (Training M.O) 30 4.27 A.10.5.1.2 FIMNCI MO 18 1.88 A.10.5.1.3 Master Trainer MO 4.37 A.10.5.2 Facility Based Newborn Care 0.00 A.10.5.3 Home Based Newborn Care 0.00 A.10.5.4 Care of Sick Children and severe malnutrition 0.00 A.10.5.5 (IMNCI) (60 S/Nurse,45 ANM 18 1.14 A.10.5.6 SNCU Training (National Neonatology Forum) 0.00 A.10.5.7 Pre- Service IMNCI Training 0.00 A.10.6 Family Planning Training 0.00 A.10.6.1 Laparoscopic Sterilisation Training 16 3.11 A.10.6.2 Minilap Training 15 12.59 A.10.6.3 NSV Training 10 2.62 A.10.6.4 IUD Insertion Training (MO) 42 8.66 A.10.6.5 IUD Insertion Training (Staff Nurse) 100 11.28 IUD Insertion Training (ANM/LHV) A.10.6.6 Contraceptive Update/ISD Training 40 1.63 A.10.6.7 Other FP Training (pl. specify) 0.00 A.10.7 ARSH Training for NGOs & Staff 0.00 A.10.7.1 ARSH Training for 150 ANM &29 LHV & 27 concellors 206 13.81 A.10.8 Programme Management Training 0.00 A.10.8.1 SPMU Training 4.00 A.10.8.2 DPMU Training 6.00 A.10.9 Other training (pl. specify) in collaboration with PHFI 0.00 A.10.9.1 Management Tools to improve District Health services under NRHM 0.00 A.10.9.2 Health Communication and Advocacy 0.00 A.10.10 Training (Nursing) 0.00 A.10.10.1 Strengthening of Existing Training Institutions/Nursing School 0.00 A.10.10.2 New Training Institutions/School 0.00 A.10.11 Training (Other Health Personnel) 0.00 A.10.11.1 Promotional Trg of health workers females to ladyhealth visitor etc. 0.00 A.10.11.2 Training of AMNs, Staff nurses, AWW, AWS 0.00 A.10.11.3 NSSK M.O 80 7.29 A.10.11.3.1 NSSK Nurse 160 5.42 Other training and capacity building programmes worshop/Training A.10.11.3 IEC Staff 2 4.00 A.11 PROGRAMME / NRHM MANAGEMENT COSTS 0.00 Strengthening of SHS/SPMU(Including HR Management Cost of A.11.1 SHP & M&E), Mobility Support, field visits ) 87.00 Strengthening of DHS/DPMU(Including HR,Management Cost, A.11.2 Mobility Support, field visits ) 165.00 Strengthening of Block PMU(Including HR,Management Cost A.11.3 of SHP & M&E, Mobility Support, field visits ) 0.00 A.11.4 Strengthening (Others) 0.00 A.11.5 Audit Fees 12.00 A.11.6 Concurrent Audit 18.00 A.11.7 Mobility Support to BMO/MO/Others 0.00 Total 3623.74 Note Reimbursable activities are shown in Green
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CHAPTER 4B: NRHM FLEXIPOOL
B.1.1. NON NEGOTIABLE COMPONENTS:
Allocation of Fund: Every Health Committees of Recognized Village,,SC, PHC, CHC & DH duly constituted and oriented would be entitled to an annual grant as mentioned below subject to approval by Government of India. Amount per unit (Rs.) per annum as per guidelines: Facility Untied Fund Maintenance Fund RKS Fund Total Village (Recognized) 10000.00 0.00 0.00 10000.00 SC 10000.00 10000.00 0.00 20000.00 PHC 25000.00 50000.00 100000.00 175000.00 CHC 50000.00 100000.00 100000.00 250000.00 DH 0.00 0.00 500000.00 500000.00
Decentralised Innovative Fund: Progress made so far: 1. Framing of Guideline for utilization of Innovative Decentralized Fund under NRHM such as Untied Fund (UF) to VHCs of Recognized Village and Health Committees of SC/PHC/CHC, Maintenance Fund (MF) to Health Committees of SC/PHC/CHC and RogiKalyanSamati (RKS) Fund to Health Committees of PHC/CHC/DH (Annexure: IDF 1) 2. Disbursement of Innovative Decentralized Fund through Communitization Cell for better implementation and monitoring to strengthen the process of Communitization. 3. Utilization: a. Over the year, major portion of the funds were used for carrying out development activities of the hospital to revamp the rudimentary infrastructure. b. With the settling of acute infrastructure need, many health units are now concentrating in the improvement in service delivery and increasing the range of service basket. For instance, since last year in the several district all PHC and CHC have now laboratory service, all SC have basic investigation- HB estimation, RDK for Urine sugar and protein. The fund is also used to procure basic equipment c. Besides, the funds also supportshealth preventive and promotive activities.
As per the guideline available and downloadable from http://www.mohfw.nic.in/NRHM/Guidlines_index.htm of the Ministry of Health & Family Welfare, GoI web site- www.mohfw.nic.in. Hardcopies were circulated to all units for compliance.
The fund released by state to the district must be released to the peripheral units within seven days of receipt of the fund and the ATR to be intimated to the Additional Director (Planning and Communization).
The detailed write up along with budgeting is in B.1.3 – B.1.6.
B.2: ASHA (Accredited Social Health Activist)
With the completion of the training of ASHAs on module 5, visible changes could be observed among the ASHAs. The ASHAs are now more confident and their level of sincerity has improved. Equipped with effective communication and counseling skills, the ASHAs are now able to more easily motivate the community in seeking health services.
The need for skill up-gradation for ASHAs to be able to function, not only as a link worker but also as a service provider without replacing the ANM is felt as an urgent requirement. It is hoped that with the completion of the training of ASHAs on modules 6 and 7, they will be able to provide the basic services for ANC and new born home based care.
Some achievements under ASHA programme are as follows: • Development of ASHA diary completed and distributed to all ASHAs.
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• Regular featuring of ASHA in State’s NRHM quarterly Newsletter. • Regular monthly thematic meeting initiated in most of the blocks by ASHA Coordinators. • Radio sets provided to all the ASHAs. • Translation of ASHA Reading Materials into 3 major local dialects viz. Ao, Tenydie and Phom completed. • ASHA Drug Kit dispatched to Districts to be distributed during the Block level trainings. • Hand-held Weighing machines and thermometers procured for ASHAs. • Training of ASHA Coordinators completed. (21st – 23rd Oct. 2009). • Training of ASHA on 5th Module completed. • State Trainer for modules 6 and 7 trained at SEARCH, Gadchiroli, Maharashtra. • Training of District/ Block Trainers on 6th and 7th Modules completed.
ASHA Resource Centre/ Support Structure • Nodal Officer appointed w.e.f. June 2009. • ASHA section set up within NRHM office at State level. • AMG constituted with representatives from Govt., Civil and Academia sectors. • ASHA Coordinators appointed in 48 blocks to give handholding support to ASHAs. • Supportive supervision done at regular intervals.
Implementation of recommendations of the parliamentary Committee on “Working Conditions of ASHAs” i. Opening of bank accounts for ASHAs: All ASHAs are not account holders and there are practical difficulties to make it mandatory for compulsory opening of bank accounts. However, database of ASHAs not having bank accounts will be created and effort will be made to ensure that all ASHAs heve bank accounts. ii. Rest Rooms for ASHAs: Construction of rest rooms at district health centres will not be possible under the fund allocated for ASHA programme. Instead, The district hospitals will be requested to allot a room for the same. iii. ASHA sammelans and ASHA divas: Monthly block meetings are being facilitated by the Block ASHA Coordinators where discussions on various issues are done. iv. ASHA Awards: ASHA award is being proposed in the PIP 2011-12. One ASHA from each block will be recognized through documentation and certificate. v. Identity cards for ASHA: Identity cards have been issued from the level of the Chief Medical Officers of the Districts. vi. Career progression for ASHAs: The nursing section of the department will be requested to give preferential treatment to ASHAs who have required qualification for admissions into nursing schools/ colleges. vii. Innovative Communication Tools: the IEC section of NRHM is in the process of developing and producing IPC materials on various subjects for ASHAs.
1. Strategies/ activities to address projected issues No. Issues Strategies/ activities
1 Streamlining delays in Reminders to be sent out to all levels of facilities with instruction payment of performance for timely submission of status of utilization to enable timely release incentives to ASHAs. of fund in turn. Log book to be maintained by all ASHAs whereby timely payment is checked. 2 Regular upgradation of Training of ASHA at block levels. skill/ completion of Regular refresher training of ASHA at Block levels. training in all prescribed Handholding and supportive supervision by ANM and Block ASHA modules. Coordinators.
3 Timely and sustainable Refilling at Block levels. availability of drug kits. Timely submission of indents. Refilling of basic first aid kits from nearest health centres. This is to be facilitated by ANMs and Block ASHA Coordinators.
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4 Supervisory and supportive Existing support structure to be strengthened by selecting additional structure for ASHAs. Block ASHA Coordinators. Supportive supervision to be provided by the ANMs and other health personnel at block level. 5 Attrition of ASHAs. To keep the ASHAs motivated and avoid effects of burn-out, innovative activities like conventions, provision of badges, commodities (torch/ cell phones) etc. will be taken up. Thematic meetings at regular intervals. Documentation of success stories. Recognition of ASHA at District and Block levels. 6 Enhancement of ASHAs’ Relevant IPC materials to be developed. performance Translation of ASHA Reading Materials into the major local dialects. 7 Capacity building of State Exposure tours to sites of best practices/ trainings to be conducted ASHA Resource Centre by RRCs/ NHSRC.
2. Selection The population coverage per ASHA, as of now, is higher than is commonly followed which is one per 1000. Increasing the number of ASHAs will mean reduced income from incentives in proportion to the quantum of work. However, keeping in mind the problems faced by ASHAs, in serving a higher population in areas where there are difficulties in communication, it is proposed for additional number of ASHAs for the State of Nagaland. Based on the population and reconsidering the norm of proportion, the proposal for selection of additional ASHAs is put up as follows:
No. District Population Existing no. of Proposed ideal Proposed no. of new ASHAs density (1:800) ASHAs 1 Kohima 219318 120 274 154 2 Mokokchung 227230 171 284 113 3 Tuensang 164361 153 205 52 4 Phek 148246 132 185 53 5 Mon 260652 210 326 116 6 Wokha 161098 160 201 41 7 Zunheboto 189191 194 236 42 8 Dimapur 345237 242 432 190 9 Peren 97068 130 130 0* 10 Kiphire 127448 103 159 56 11 Longleng 121581 85 152 67 2061430 1700 2584 884 * Peren will continue with the same number of ASHAs.
3. Training Since initiation of the conduction of training ASHAs at block level, percentage of ASHA attendance has become almost 100%. All trainings of ASHA will continue to be conducted at the Block levels. The status of ASHA training is shown below:
Sl. No. District Total ASHAs trained (module-wise) Mod 1 Mod 2 Mod 3 Mod 4 Mod 5 1 Mon 210 210 210 210 210 2 Dimapur 242 242 242 242 242 3 Zunheboto 175 175 175 175 194 4 Mokokchung 171 171 171 171 171 5 Wokha 45 45 45 95 160 6 Tuensang 144 144 144 144 153 7 Phek 69 132 132 132 132 8 Peren 130 130 130 130 130
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9 Kiphire 103 103 103 103 103 10 Kohima 98 98 98 98 110 11 Longleng 85 85 85 85 85 1507 1570 1538 1588 1690 NB: the total strength of 1700 was not in place during the training on modules 1, 2 and 3.
Along with the multi-tasking role of the ASHA, the training load, in terms of number of days, of ASHA has also increased. A host of other programmes like the Vector Borne Disease Control, Blindness Control, Tuberculosis etc. conduct trainings for ASHAs from time to time leading to ASHAsbeing overtaxed. To avoid excess beyond what is appropriate,all trainings of ASHA need to be integrated. Training load for ASHA under various programme components is as follows:
Sl. No. Name of Programme No. of ASHAs to be trained Number of Days of training 1 NLEP 2584 ½ 2 UIP 2584 1 3 AYUSH 330 3 4 NIDDCP 2584 1 5 NPCB 550 1 6 RNTCP 200 1 7 NVBDCP 550 1 8 ARSH 2584 2
4. Support Structure To further strengthen the existing support structure of ASHA programme, it is envisaged to put in place 7 more Block ASHA Coordinators. The new Block ASHA Coordinators will be placed at Wakching, Mon, Wokha, Tuensang blocks and additional Block ASHA Coordinators at Dhansiripar, Niuland and Zunheboto Blocks where the number of ASHAs is 73, 74 and 76 respectively.
Status of Manpower and requirement: Sl. No. Catergory No. in place Place of No. proposed Total posting 1 Nodal Officer 1 SPMU 0 1 2 Support staff 1 SPMU 1 2 Block ASHA 3 Coordinator 48 Block 7 55
5. Drug Kit The State will continue to procure and supply ASHA kit containing basic first aid medicines and consumables. The content of the ASHA kit distributed during 2010-11 consisted of the following drugs and supplies. The quantity indicated below is being proposed for the year 2011-12.
Sl. Item Quantity SL. Item Quantity No. No. 1 Tab. Paracetamol 4 strips 10 Thermometer Provided 2 Tab. Antacid 4 strips 11 Weighing scale Provided 3 Tab. Analgesic 4 strips 12 Tab. Chloroquine CMO’s supply 4 Disposable Gloves 5 nos. 13 Tab. Iron Folic Acid CMO’s supply 5 Povidine Ointment Tube 10 nos. 14 Condoms CMO’s supply 6 G. V. Paint 2 vials 15 Contraceptive Oral CMO’s supply Pills 7 Bandage 8 nos. 8 ORS packets 20 pkts. 9 Sterilized Cotton 4 rolls
Nagaland SPIP 2011-12 87
During 2010-11, Sl. No. 1 to 11 has been procured under the provision allotted for ASHA programme. Sl. No. 12 to 15 is to be provided by the Chief Medical Officer’s office.
To see and ensure that ASHAs are never without basic first aid items, ANMs/ Block ASHA Coordinators will facilitate the replenishment of the same from the nearest health centres.
6. Incentive There is much to be done towards proper and timely disbursement of incentive to ASHAs. This could be partly achieved by bringing about a mechanism wherein logbooks are maintained by both ASHA and Block ASHA Coordinators. It is envisaged that with this activity in place, payment of incentives will be streamlined and thus delays and leakages will be avoided. Block ASHA Coordinators will also be made responsible for facilitating correct and timely payment of incentives to the ASHAs.
Compensation package for ASHA Sl. No. Head of Compensation Amount (in `)/ per case 1 JSY-Institutional Delivery 600 2 Motivation for Tubectomy/Motivation for Vasectomy/NSV 150/200 3 Immunization Session 150 4 Pulse Polio Day-if it is full day work it should be Rs. 75 75 5 Organizing Village Health &Nutrition Day 150 6 DOTS (on completion of treatment) 250 7 Household toilet promo, Fee 75 8 Detection, referral, confirmation and registration of Leprosy case/after 100/200/400 complete treatment for PB Leprosy cases/after complete treatment for MB Leprosy cases 9 Cataract Surgery 175 10 Reporting death of women (15-49 years) by ASHA to the Block PHC MO 50 within 24 hours of occurrence of death by phone
7. Budget Based on the projected number of ASHAs i.e. 2584 for 2011-12, the budget for various activities is worked out as follows: i. Training a. Training of District/ Block Trainers:
Sl. No. Activity Batch 1 Batch 2 1 No. of Trainees 36 30 2 Number of Days 10 10 3 DA @ `400 144000 120000 4 TA @ `300 10800 9000 5 Resource person honorarium @ `1000/ day for 3 30000 30000 nos. 6 Working lunch @ `150 60000 52500 7 Tea/ Snacks &`50/day 20000 17500 8 Incidental expenditure @ `150/ day 54000 45000 9 Venue Hiring/ Supervision @ `8000 8000 8000 Total 1 326800 282000 10 Institutional overhead (15%) 49020 42300 Total 2 375820 324300 Overall total (Batch 1+2) 700120 (Rupees Seven Lakhs One Hundred Twenty) only.
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b. Training of new ASHAs:
Sl. No. Activity Total cost in ` 1 No. of Trainees 884 2 Number of Days 2 3 No. of batches 30 4 DA @ ` 200 530400 5 TA @ `300 265200 6 Resource person honorarium @ `1000/ day 6000 7 Working lunch @ `150 267000 8 Tea/ Snacks &`50/day 89000 9 Incidental expenditure @ `150/ day 265200 10 Supervision/ Venue hiring @ `3000 58000 Total 1480800 11 Institutional overhead (15%) 222120 Overall total 1702920 (Rupees Seventeen Lakhs Two Thousand Twenty) only.
c. Training of ASHAs (new+old):
Sl. No. District Total no. No. of ASHA No. of Cost per Total cost (in `) of ASHAs per batch Batches batch
1 Kohima 274 30 9 192000 1753600 2 Mokokchung 284 30 9 192000 1817600 3 Tuensang 205 30 6 192000 1344000 4 Phek 185 30 6 192000 1184000 5 Mon 326 30 10 192000 1920000 6 Wokha 201 30 7 192000 1152000 7 Zunheboto 236 30 8 192000 1536000 8 Dimapur 432 30 14 192000 2688000 9 Peren 130 30 4 192000 768000 10 Kiphire 159 30 5 192000 960000 11 Longleng 152 30 5 192000 972800 Total 16096000 (Rupees One Hundred Sixty Lakhs Ninety Six Thousand) only. ii. ASHA Drug Kit: Sl. No. District Total no. of ASHAs Cost per Kit (in `) Total cost (in `) 1 Kohima 274 800 219200 2 Mokokchung 284 800 227200 3 Tuensang 205 800 164000 4 Phek 185 800 148000 5 Mon 326 800 260800 6 Wokha 201 800 160800
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7 Zunheboto 236 800 188800 8 Dimapur 432 800 345600 9 Peren 130 800 104000 10 Kiphire 159 800 127200 11 Longleng 152 800 121600 Total 2067200 (Rupees Twenty Lakhs Sixty Seven Thousand Two Hundred) only.
iii. Awards to ASHAs: Sl. No. District No. to be awarded (one Unit Cost (in `) Total cost (in `) per block) 1 Kohima 5 3000 15000 2 Mokokchung 4 3000 12000 3 Tuensang 6 3000 18000 4 Phek 4 3000 12000 5 Mon 7 3000 21000 6 Wokha 5 3000 15000 7 Zunheboto 5 3000 15000 8 Dimapur 6 3000 18000 9 Peren 4 3000 12000 10 Kiphire 3 3000 9000 11 Longleng 3 3000 9000 Total 52 156000 (Rupees One Lakh Fifty Six Thousand) only.
iv. ASHA Resource Centre (ARC): Sl. No. Activity Number Unit Cost (in Total cost (in `) `) 1 Salary for ASHA Coordinator @ 7000/ 55 Budgeted under month Programme Management 2 Meeting of ASHA mentoring Group 4 10000 40000 3 Supportive supervision at State/ District 11 25000 275000 level by AMG 4 Supportive supervision at Block level by 55 5000 275000 ASHA coordinators 5 Quarterly review of Block ASHA 4 75000 300000 Coordinators at State level 6 Monthly meeting of ASHAs at block level 660 3000 1980000
7 Printing/ logistics 1 700000 700000 8 Provision of commodities to ASHA (cell 2584 600 1550400 phone/ badges etc.) Total 5120400 (Rupees Fifty One Lakhs Twenty Thousand Four Hundred) only.
v. Summary of proposed budget under ASHA Programme: Sl. No. Component Total Cost (in `)
Nagaland SPIP 2011-12 90
1 Training of District/ Block Trainers 700120 2 Training of new ASHAs (884) 1702920 3 Training of ASHAs 16096000 4 ASHA Drug Kit 2067200 5 Awards to ASHA 156000 6 ASHA Resource Centre 5120400 Total 25842640 Say 25840000 (Rupees Two Hundred Fifty Eight Lakhs Forty Thousand) only.
B.1.3: Village Health & Sanitation Committee/Village Health Committee (VHC): All the 1278 recognised villages have constituted VHCs and opened saving bank account to be operated jointly. VHCs are actively participating in the health programs. In total we need to provide 46 (Tuensang-10, Wokha-1, Zunheboto-6, Peren-10, Kiphire-11 and Longleng-8) more untied funds to these newly formed Villages, notified by the State Government. It is also the endeavor of the Society that all these VHCs become fully functional and actively hold VHND in their respective villages.
Activity Cumulative Achievements so far Number of Villages during 09 – 10 1278 Number of Village Health & Sanitation committees constituted 1278 No. of Joint Account opened 1278 Total funds released to VHSCs (Rs in lakh) 314.90 Total amount spent by VHSCs so far (Rs in lakh) 154.41 Total unspent balance 321.67 No of VHSCs members trained 10865
Table: The requirement of fund for 1324 VHC Untied fund is as follows: No. District R/Village till R/Village since 2010- Unit Cost Total amount 2009-10 12 1 Kohima 94 94 100000 94.00 2 Mokokchung 102 102 100000 102.00 3 Tuensang 146 121 100000 121.00 4 Phek 104 104 100000 104.00 5 Mon 110 110 100000 110.00 6 Wokha 128 130 100000 130.00 7 Zunheboto 187 198 100000 198.00 8 Dimapur 216 216 100000 216.00 9 Peren 86 106 100000 106.00 10 Kiphire 81 103 100000 103.00 11 Longleng 24 40 100000 40.00 Total 1278 1324 100000 1324.00 Rupees one thousand three hundred and twenty four lakhs only
B.1.4: Untied Fund (Budgeted in B2): 1. Financial Achievement(Rs in lakh): Facility level No of facilities Total amount Total amount Unspent balance released so far utilized UF for SC 397 (398) 162.80 101.97 58.31 UF for PHC 86 (124) 64.500 61.10 3.15 UF for CHC 21 (21) 31.50 20.86 10.64
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Total 540 (543) 258.80 183.93 72.10
2. Proposal for Untied Fund for Health Facilities during the year 2011 – 12: Facility level No of facilities Amount per unit Total UF for SC 398 10000 3980000.00 UF for PHC 124 25000 3100000.00 UF for CHC 21 50000 1050000.00 Total 558 21370000.00 Rupees two croresthirteen lakhs and seventy thousand
B.1.5: Annual MaintenanceGrant (Budgeted in B3): 1. Financial Achievement: Facility level No of facilities Total amount Total amount Unspent balance released so far utilised AMG for SC 397 (398) 115.80 64.26 56.74 AMG for PHC 86 (124) 127.70 121.64 5.36 AMG for CHC 21 (21) 62.00 41.67 20.33 Total 504 (543) 304.80 227.57 82.43
2. Proposal for Annual Maintenance Grant: All the 398 sub centres are housed in government building, constructed by the department. Only 88 buildings were donated to the dept. of H&FW by the communities for running 88 sub centres. As these 88 buildings are at present govt. property, responsibility of maintenance of these buildings lies with the dept. All these buildings are atleast more than one year old to qualify to get AMG. No of In In Rented Rent Free facilities GovtBuilding Building Community Building handed over to
Facility level Health
Department
11 11 11 11
- - - -
20010 2009 RHS 20010 2009 RHS 20010 2009 RHS 20010 2009 RHS No of facilitiesproposed for AMG Amount per unit Total AMG for SC 398 397 309 309 0 0 88 88 398 10000 3980000.00 AMG for PHC 124 123 115 115 0 0 8 8 124 50000 6200000.00 AMG for CHC 21 21 21 21 21 21 21 21 21 100000 2100000.00 AMG for DH 11 11 11 11 11 11 11 11 11 0 0.00 Total 558 558 12280000.00 Rupees one crore twenty two lakhs and eightythousand only
B.1.6: RogiKalyanSamitis (Health Centre/Hospital Management Committee) (Budgeted in B6) 1. Financial Achievement: Facility Number Total amount Total amount Unspent ofRKS released so far utilized balance RKS Fund for DistrictHospital 11 (11) 215.00 164.55 50.40 RKS Fund for CHC 21 (21) 42.00 21.48 20.51 RKS Fund for PHC 86 (124) 84.00 71.07 12.93 Other facilities 37 113.75 343.77 27.08
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Total 454.75 343.77 110.93
2. Proposal for RKS Fund: Facility level No of facilities Amount per unit Total RKS Fund for PHC 124 100000 12400000.00 RKS Fund for CHC 21 100000 2100000.00 RKS Fund for DH 11 500000 5500000.00 RKS Fund TB Hospitals 2 500000 1000000.00 RKSFundStateMental Hospital 1 500000 500000.00 Total 558 21500000.00 Rupees two crores Fifteen lakhs only
B.2: HEALTH CARE INFRASTRUCTURE:
The requirement and the existing status of Health Infrastructure development in Nagaland are as follows;
States’ Requirement of Infrastructure DH CHC PHC SC Required as per population norms 11 26 103 687 Existing Facilities 11 21 124 398 Shortfall 0 5 -20 289 Mapping of facilities undertaken 11 21 124 398 Requirement of new facilities after mapping exercise 0 5 0 289 Requirement of facility up gradation after mapping 2 5 12 50 exercise as per IPHS New construction proposed under NRHM after gap 2 1 20 50 analysis for 2011-12 Facilities proposed for up gradation after gap analysis 0 5 12 5 for 2011-12
Table: Civil Works Cumulative Achievements Activity Cumulative Achievements so far Physical Financial Sub-Centres Construction of new sub centre buildings 85 122.648 Renovation of sub centre buildings Setting up of new Sub centre Upgradation of sub centre PHC New Construction of PHC building 7 39.326 Renovation of PHC buildings 14 195.68 Setting up of new PHCs Upgradation of PHCs Availability of 24x7 services CHC New Construction of CHC building 4 131.36 Renovation of CHC buildings 7 Setting up of new CHCs Upgradation of CHCs 25 305.36 Blood storage unit SDH/DH Strengthening of District & Sub divisional 11 17.32 Hospitals Upgradation of SDH Renovation of SDH
Nagaland SPIP 2011-12 93
Renovation of DH 37 509.18 Total : 1320.874
B.2.1: Civil Construction: 1. New Construction of health units Approved in Principle as per RoP 2010-11. Proposing for release of the Balance amount during 2011-12. Total Amount Amount Balance Approved in Approved Amount to Name of the Facility Principle as and Released be released Remarks per RoP during 2010- during 2011- 2010-11 11 12 CHCs - Construction of 3 new CHCs Work in (Chiephobozou, Noklak & Tobu) @ Rs. 351.00 175.50 175.50 progress 117.00 L as per Nagaland SOR Work in Construction of 11 CHC Staff quarters @ 231.00 115.50 115.50 progress 21.00 L (Annexure CW1)
PHCs - 13 PHC for new Construction @ Rs. Work in 65.68 L as per Nagaland SOR (Annexure 853.84 426.92 426.92 progress CW1) Work in Construction of 22 PHC Staff quarters @ Rs. 462.00 231.00 231.00 progress 21.0 L (Annexure CW1)
Sub Centers - 50 Sub Centres for new Work in construction @ Rs. 12.33 L, totalling to Rs. 616.50 400.00 216.50 progress 616.50 L. (Annexure CW1) Grand Total 2514.34 1348.92 1165.42
2. Construction of Drugware house: Approved as Additional Approval of SPIP 2009-10vide GoI letter No: M-11011/4/09-NRHM-III dt 21st Dec 2009. Proposing for release of the Balance amount during 2011-12.
Amount Approved Balance Additional and Amount to Approval of Name of Work Released be released Remarks SPIP 2009- during during 10 2009-10 & 2011-12 2010-11 Work in progress and Rs.150.0 L has Construction of 3 Drug Warehouse been released to EE (Longleng, Tuensang & Zunheboto) Med Engineering vide GoI letter No: M-11011/4/09- Wing for payment NRHM-III dt 21st Dec 2009 out of the MFP fund 433.00 0.00 433.00 for the year 2010-11
Total amount to be released during 2011-12: Rs. 1598.42 lakhs (Rupees one thousand five hundred ninety eight lakhs and forty two thousand only)
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3. Proposal for new construction projected under Forward Lingkage: The followings are the immediate requirement of the States on the basis of facility utilization and on the conditions of the existing infrastructure. Because of the budget stricture, some of the following proposals are proposed in Chapter 8 for consideration under other resources, if available. a. Construction of New building of health units: i. SC: 50 nos (List in Annexure CW2) @ Rs. 13.57 L per unit amounting to Rs. 678.15 L. ii. PHC: 10 nos (List in Annexure CW2) @ Rs. 72.25 L per unit amounting to Rs. 722.48 L. iii. CHC: 5 nos (Pongru, Chazuba, Dhansaripar, Longkhim and Sanis) @ Rs. 128.70 L per unit amounting to Rs.643.50 L. b. Construction of staff quarters of health units: i. CHC Staff Quarters: 10nos of 1000 sq. ft each in the newly proposed FRUs in CHCs – Jalikie in Peren, Medziphema in Dimapur, Pungro in Kiphire, Bandhari in Wokha and Noklak in Tuensang, to accommodate 2 nos. of Medical Officers and three nurses per unit as bachelors’ accommodation. Per Unit:Rs. 23.1 Lakhs x 2 units x 5 location = Rs. 231.00 Lakhs
ii. PHC Staff Quarters: 18 nosof 1000 sq. ft each in the existing 24*7 PHCs, where the staff accommodation are either absent or in dilapidated condition and rented buildings are also not available to accommodate 2 nos. of Medical Officers and three nurses per unit as bachelors’ accommodation. Locations are Khonoma in Kohima, Tsurangkong in Mokokchung, Chare in Tuensang, Suruhoto in Zunheboto, Sungru in Wokha, Tamlu in Longleng, Tening in Peren, Chizami in Phek,and Tizit in Mon. Per Unit:Rs. 23.1 Lakhs x 2 units x 9 location = Rs. 415.80 Lakhs c. Upgradation to IPHS: i. District Hospital: 2 nos (Mon and Dimapur)@ Rs. 250.00 L per unit amounting to Rs. 500.00 d. Expansion of BHO - Expansion of the administrative block of the existing health facilities (CHCs/ PHCs) located at the Block HQ, to accommodate additional support manpower, both regular and contractual @ Rs. 5.0 L in 11 (Eleven) blocks, out of total 52 blocks. The following eleven Block Health Units (BHUs) are short listed on the basis of present case load and utilization of the facilities. Total Financial requirement: Rs. 55.0 L e. Construction of Drug Warehouse: Out of the 5 district drug warehouses sanctioned @ Rs. 152.00 lakhs per unit under NRHM, the construction in 2 districts (Phek& Mon) is completed while the progress in the other 3 (Tuensang, Zunheboto&Longleng) is expected to complete by July 2011. The state is still short of drug warehouses in the remaining 6 districts. To strengthen the network of drug warehouses, the state proposes to construct: i. District drug warehouses in 4 districts viz: Kiphire, Peren, Wokha and Mokokchung @ Rs. 152.00 lakhs per unit ii. State warehouse @ Rs. 200.00 lakhs per unit. f. Upgradation of GNM Nursing School Mokokchung: Presently the annual intake of the school is 25 students. To reduce the HR gap, owing to ever increasing need of GNMs, it is proposed that the annual intake be upgraded to 50 seats per annum. To address the shortage of manpower in the high focus districts, 50% of the seats will be reserved for the candidates with requisite qualification from these prioritized districts (Mon, Kiphire, Tuensang and Longlen). The expansion of capacity needs additional hostel accommodation, class rooms, etc. The cost estimate for the upgradation of GNM Nursing School Mokokchung is Rs. 500.00 lakhs. The proposal may be recommended by NPCC and may be sent to the Nursing Division, MoHFW, GOI for consideration.
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Annexures CW 1: List of Construction in Progress Under NRHM (2010-11) (District-Wise) 1. Sub Centre Building
Kohima Dimapur Mokokchu Tuensang Zunhebo Wokha Mon Phek Longlen Peren Kiphir ng to g e Dihoma Sangtamti Kelingmen Tonglongso Saptimi Morokj Tamkong Phugi Yangchi Benru Chomi la re o ng Kijumetou Pukhato Yajang C Sangchen Hoshepu Hanku Wangla Chozub Sakshi Mpai Kiseton ma a g Tsiesema Tenyiphe Meyilong Waphur Chisholi Ambot Yannu Losami Yongsh Mhainamt Salum mi o ei si i Khuzama Mongchen Sanglao Kivikhu Akuk Chenloish Matikhr o u Seiyhama Khensa Chingmei Tsowa Chepoke ta Sungkome Ngangchi Suthots n ng u Tsudikong Chintang 2. PHC Building
Kohima Dimapur Mokokchung Tuensang Zunheboto Wokha Mon Phek Longleng Peren Kiphire Chunglikha Kuhuboto Alongkima Thonokyu V.K Town Bhaghty Thuvopisu Yongya Athibung Akuluto Thetsumi Satakha Chetheba 3. CHC Building
Kohima Dimapur Mokokchung Tuensang Zunheboto Wokha Mon Phek Longleng Peren Kiphire Chiephobozou Noklak Tobu 4. Quarter for PHC Staff
Kohima Dimapur Mokokchun Tuensan Zunhebot Wokh Mon Phek Longlen Peren Kiphir g g o a g e Mezom Ruzaphema Longsa Noksen Kilomi Baghti Shangy Khuza 2 Yanchen Athibun a u Nos g Kohima Medziphem Kangtsung Pangsha Nyiro Thuvopisu Village a Phugwi Razieba Lopzaphuh u Sothozu Old
Quarter for CHC Staff
Kohima Dimapur Mokokchung Tuensang Zunheboto Wokha Mon Phek Longleng Peren Kiphire Dhansiripar Changtongya Noklak Pughoboto Tobu Pfutsero District District District Hospital Hospital Hospital Chazuba District Hospital
Nagaland SPIP 2011-12 96
B.2.2: Mobile Medical Units: B.2.2:1: Medical Mobile Units (MMUs)
The state in its endeavor to take health care to the doorsteps of unreach and underserved areas, the state has established a fleet of 11 MMUs each unit comprising of 2 vehicles manned by 1 MO, 1 SN, 1 LT and 2 drivers in all the districts as per MMU scheme under NRHM.
1. Operational Manual was developed to address the diversity and ensure the adoption of the most suitable and sustainable model for the MMU as per local requirements.Each MMU will conduct 3-4 camps once every month.The MMU activity is strictly linked with the VHND. Priority is given to those villages where there is no health unit and those are remote and hard to reach villages.
2. During the year 10 – 11, 223 Camps wereattended by the MMUs and catered services to17075 beneficiaries. Activity April May Jun Jul Aug Sep Total Camps Held 28 35 41 40 43 37 223 Pts attended 1881 2802 3040 2729 3732 2891 17075
3. Proposed activity:
a. Activity: District Total no of Habitats No of VHND No of MMU Visit Kohima 97 1164 48 Mokokchung 106 1272 48 Tuensang 126 1512 48 Phek 108 1296 48 Mon 113 1356 48 Wokha 133 1596 48 Zunheboto 201 2412 48 Dimapur 219 2628 48 Peren 109 1308 48 Kiphire 105 1260 48 Longleng 42 504 48 Total 1355 16260 528
b. Budget: Unit cost B" Districts "C" Total "A" Districts (4 nos- Districts (4 amount (3 nos-KMA, WKA, PRN, nos-TSG, per year DMR & PKH & MON, KRE (Rs in Recurring Cost No of Units MKG) ZBO) & LLG) lakhs) MO 11 35000 40000 45000 53.40 GNM 11 15000 20000 25000 27.00 Lab Tech 11 10000 15000 20000 20.40 Driver 22 7000 8500 10000 11.40 Sub Total A 112.20 Drugs 11 500000 55.00 Training of manpower 11 15000 1.65 Maintenance and repair of vehicle 11 275000 30.25 Fuel 11 250000 27.50
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Sub Total A 114.40 Grand Total A+B 226.60
B.2.2:2: Emergency Referral Transport (B12)
Referral Transport Policy All health facilities accredited for safe delivery or institutional delivery should necessarily have an assured referral transport linkage and an assured referral facility linkage.
Assured Referral Transport:
1. A transport service that could become available within 30 minutes and be able to take the woman or newborn to a referral site within one hour. 2. This may be: a) an ambulance with the facility, b) an ambulance called from the higher facility, c) an ambulance service, or d) a private or commercial transport vehicle. 3. Communication contact with the vehicle driver directly or routed through a call centre. 4. The ambulance service should be free of cost at the time of need.
Assured Referral Facility Linkage An assured referral facility linkage is a facility which provides management of complications including surgical emergencies and blood transfusion (what is termed comprehensive emergency obstetric and newborn care) and which agrees to provide these services on a cashless basis to any patient referred from the referring facility. This may be a public hospital or an accredited private hospital through a public-private partnership arrangement.
The effort should be to have a network of referral centres within one or two hours of any facility providing institutional delivery or any sort of skilled birth assistance. The facility referred to has been intimated by phone about the referral with a brief history of the patient, so that on arrival the women is received and treatment started immediately.
Guideline for Referral Transport: Since life threatening complications may arise in any delivery, every sustained efforts must be made for all women to deliver in an institution where most maternal and newborn complications can be promptly and effectively managed, and with the means to transport a patient safely and quickly to an institution where complications that require surgical care and blood transfusion can also be managed.
To ensure availability of reliable, assured and affordable Ambulance Services and Referral Transport for critical patients to facilitate accessibility and delivery of emergency medical care. 1. Ambulance Service: a. The state will strive to provide ambulance to strategically located health units across the state. b. The health committee will realise users’ fee for utilization of the ambulance from the users for vehicle maintenance in addition to the support from the department. However, Ambulance service shall be free of cost at the time of emergency and patients belonging to BPL category will be exempted to enable them to reach the nearest health unit.
c. The users’ fee will be as per the prevailing hire charges approved by the local administration or local hire charges fixed by the concerned Health Committee. d. The rates of the users’ fee must be widely disseminated and displayed prominently in the Citizens’ Charter.
2. MCH Referral Transport Assistance:
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a. Pregnant Women residing more than 3kms away from the any 24x7 health any institution (public and accredited private facility) will be entitled for free ambulance services to enable them for institutional Delivery. b. Critically sick infants and Women with complications of pregnancy and childbirth or within 42 days of termination of pregnancy, irrespective of the duration and site of pregnancy will be entitled for free ambulance services to enable them reach nearest 24x7 health unit and from Health Institution-To-Health Institution for appropriate care. c. Drop-Back-Home Referral Transport Assistance: Referral Transport Assistance to return home/Drop Back Home for expectant mother who has delivered in any institution (public and accredited private facility) will be entitled for free ambulance services on fulfilment of at least 48 hours hospital stay post-delivery and immunization of the child with relevant vaccines unless contraindicated for the immunization.
3. Birth Waiting Rooms: To promote institutional delivery and post-delivery hospital stay, each health unit with indoor facility but without designated maternity ward must earmark/designate certain beds as per case load for expectant mothers.
4. 24x7 Health Helpline: To prevent any delay in reaching the health facility (high costs, lack of transportation, poor roads and in receiving adequate treatment once a woman has arrived at the health facility (poor organisation or lack of skilled doctors and nurses, gaps in supply of equipment, shortfall of blood), a Call Centre at the state level will be established to coordinate and facilitate in organizing transport promptly and to ensure timely service delivery.
5. Referral Slip/Card: The local health worker or ASHA will mandatorily prepare the Referral Slip (Annexure: I) which will be retained by the head of the institution where medical care was rendered, for further reference.
6. Micro Birth Prepared Plan: Each pregnant woman at the time of registration, the ANM besides filling up the Maternal and Child Health Card (MCH Card) should mandatorily prepare a Micro Birth Prepared Plan assisted by the ASHA to enable provision of quality maternity services, monitoring Antenatal Check-up and post-delivery care and is a tool for efficient coordination of all the activities.
7. Assured Referral Facility Linkage: Each habitation (village or a ward in an urban area) shall be linked to a functional health centre-public or accredited private institution where 24x7 service would be available.
AMBULANCE SERVICE (B12.1): 1. Performance of Ambulance over the years: Patients Transported Utilization Ambulances available / Amb / O & G Paediatric Others Total No of Year Cases cases Year added Cumulative 2006-07 5 5 240 120 360 720 144 2007-08 9 14 571 504 1126 2201 157 2008-09 17 31 1860 744 2306 4910 158 2009-10 26 57 2052 1368 5472 8892 156 2010-11 9 66 1584 1188 3168 5940 90 Grand Total 66 6307 3924 12432 22663
2. Proposed Activity: a. To provide ambulance to strategically located health units (DH/CHC/PHC). Till date The department is compelled to opt for government owned ambulances in view of the lack of private/NGO transport operators, high cost of hiring vehicle even if available etc.
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Proposal: With projected 19 MCH Basic Centres at identified PHCs coupled with introduction of Health Institution-To-Health Institution and Drop-Back-Home Referral Transport system, the state proposes to procure 19 ambulances @ Rs. 7.00 lakhs equipped with necessary equipment. The total cost for the proposed procurement amounts to Rs.133.00 lakhs. The list of health units where the proposed ambulance will be stationed given in Annexure RTS 1.
Particulars Total No Unit cost Total Amount (Rs. in lakhs) Procurement of Ambulance 19 700000 133.00 Rupees One Hundred Thirty Three lakhs
b. Operating Cost (POL) B12.2: Ambulance service is free of cost in time of emergency and patients belonging to BPL category will be exempted to enable them to reach the nearest health unit. Also the fund is required for the vehicle maintenance-POL, repair and replacement of parts etc. Drivers will be provided by the Department of Health & FW, Govt. of Nagaland. Proposal: To provide POL to 66 ambulance at differential rates as mentioned below.
Total Amount Particulars Total No Unit cost p/a (Rs. in lakhs) POL for 19 new ambulances, if approved. 19 7500 1.43 Vehicle 1 year old @ Rs. 15000/year 9 15000 1.35 Vehicle 2 years old @ Rs. 20000/year 26 20000 5.20 Vehicle 3 years old @ Rs. 25000/year 17 25000 4.25 Vehicle 4 years old @ Rs. 30000/year 9 30000 2.70 Vehicle 5 years old @ Rs. 35000/year 5 35000 1.75 Grand Total 85 16.68 Rupees Sixteen lakhs Sixty Eight thousand only
The budget requirement for POL of Ambulance service amounts to Rs. 15.25 lakhs
Budget summary for Ambulance service: Total Amount (Rs. in Particulars Total No Unit cost lakhs) 1. Procurement of Ambulance 19 700000 133.00 2. Operating Cost (POL) + maintenance 16.68 Grand Total 149.68 Rupees two hundred and sixty seven lakhs and twenty five thousand The total budget requirement for provision of Ambulance service amounts to Rs. 149.68lakhs to be projected under NRHM Flexipool
Total Budget requirement for B.2: MMUs 11 MMUs @ Rs. 23.71 L Rs.226.80 L Referral Services to the patients Capex Rs.133.00 L Opex Rs. 16.68 L Total Rs. 376.48 L
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B.3: MANPOWER: NRHM has led to augmentation of considerable contractual human resources at all levels. Current status is provided in the following format: State Requirement of HR Specialists Doctors Nurses ANMs Pharmacists Lab Tech Required staff as per IPHS for the 257 354 594 683 58 221 existing facilities Sanctioned staff 120 99 195 145 172 66 In Position 120 99 195 145 172 66 Vacancy against sanctioned Nil Nil Nil Nil Nil Nil Vacancy against IPHS 41 166 436 538 155 Vacancies already filled up by the Nil Nil Nil Nil Nil Nil State Proposed filling up vacancies by the 6 53 50 State for 2011-12 Contractual engagement so far 7 55 203 364 4 48 through NRHM Additional contractual engagement proposed under NRHM for 2011-12
B.4: TRAINING AND CAPACITY BUILDING: Achievements given in respective activities. Due to lack of teaching institutions, lack of adequate specialist and low case load in the designated training centres, besides the GoI allocation of seats, the state will be outsourcing most of the training that requires high technical skills viz: EmOC, LSAS, BEmOC, Lap St, Mini lap, NSV, State TOT for F-IMNCI etc. 4. PRI Initiative (Budgeted in B4): Achievement: The Communitization of Health has improved the condition of public health system by harnessing the community spirit. Impact Assessment of the project revealed dramatic all round improvements in service delivery outcomes.
Highlights of the Impact Evaluation Study of Communitization in the Health sector: Undertaken by the Department of Evaluation and published by Department of Health & family welfare (2009) page:28. a. Discernable improvement and changes in the health centres. This has been acknowledged by the village community. b. Participation and involvement of the community in the management and functioning of the health centre is a reality. c. Better coordination and cooperation between VHC and village council for improvement of the health centres. d. Improved attendance of staff in the health centres. e. Improved maintenance of records. f. Increase in number of patients availing treatment in the health centres. g. Availability of medicine affirmed by beneficiaries. h. Community contributions towards improvement of health centre was in terms of cash, land and labour. i. There is discernable change in the attitude of the staff of health centres and health committee members, village functionaries and beneficiaries. j. There is visible participation of community in government programmes to improve community health through cleanliness drive and social works. k. Sense of ownership is clearly visible through maintenance of health centres, contribution of community, maintenance of flower/vegetable gardens and other ventures. l. Improved health care for children and expectant mothers has been affirmed. m. There is involvement of different village functionaries in the implementation of programme.
“In the exercise carried out, Sub Centre at Mopungchuket in Mokokchung district has been assessed as the best performing health centre, followed by Community Health Centre Viswema in Kohima district. Sub Centre at Kumlong in Mokokchungdistricthas been assessed as the third best performing health centre”.
Sharing of success stories and best practices. Mopungchuket village is one case in point which has fascinated many with its story of how a progressive community can do so much to itself to uplift education and the health system within the limited resources.
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With the introduction of the communitisation bill in 2002, the wisest decision resolved by the Mopungchuket village council was to engage a responsible and respectable member in the village to head the village health committee. The unbiased decision by the council proved that for change to happen within a ‘community driven’ structure, the social values that govern a structure should become the essence of development. Rev. PunaJamir, who formally served as the Education Secretary of the Ao Baptist Church Council, had since inception been serving as the Chairperson of the Village Health Committee of the sub-centre. Besides being a respectable community leader, he is hard working and passionate about his vision. His primary mission and the first step in ushering community participation was to conscientize the entire village, re-ignite the principles of traditional ‘community building’, and the role each stakeholder had in the health sub centre. The Church was the first to respond followed by the Village council and thereafter the student bodies in the village. The centre produces a news bulletin twice every year; besides health related news, every bulletin carries information and names and donations received from both local and government sources. It is very transparent in its management and this practice according to the health committee serves two purposes - one it encourages people to donate towards the centre and secondly it gains the trust of the community which in turn engages all in its noble pursuits. During the course of interview with villagers, one of the common key words expressed repeatedly by them was “yaasenmozuki” which is ‘OUR medical centre meant for you as well’.
Observations: a. One striking observation is that because the centre is now being fully run by the community, the staff has became answerable to the community and as a consequence there is consistent accountability by the medical staff. They not only limit their service to the centre but even undertake outreach activities within the vicinity. In the records of the sub-centre not a paisa has been deducted by the committee of any staff member for negligence in or absence from work. b. The other worth mentioning outcome of community ownership is their enthusiasm to develop the centre. They do not appear restricted by the ‘sub-centre’ profiles set by the Medical department but pursue to meet all health requirements of the village. In 2006, the committee decided to attach a six bedded unit to the sub- centre. The Church donated Rs 2 lakhs to supplement the fund for the construction of the SC building under NRHM. In addition, the community also pitched-in their donation in cash and in kind. They abandoned the old Government building and shifted to the newly built RCC structure. Unlike the earlier remote location, the centre is now at the heart of the village and easily accessible by all. c. The third observation is that because of the quality service in terms of medicine and referral linkages, the contribution of the village toward medicine fund has increased. What the government provides is just one third of the people’s contribution. Table: Local contribution towards medicine fund:
Year Amount (Rs) 2003 14485.00 2004 21550.00 2005 29928.00 2006 25820.00 2007 29016.00 2008 37516.00 2009 41210.00 2010 58435.00
d. Today every progressive manager speaks of convergence of services. The community comprises of people representing all constituencies within the village and as such what is observed here is that when the centre was seen as a ‘community asset’, all stakeholders in the community began to participate in its growth. The Public Health Department built a water tank and set up a water filtering unit. The School contributed stretchers and beds. The students union helped in its up-keep by setting flower pots and by cleaning its surrounding. The Church, both the women and the general, contribute each year toward maintenance of the sub-centre. e. The potential of a dynamic and a living community knows no bounds. It strives to continuously re-invent itself and define unmarked roles and responsibility. In the last five years, the centre has organized exposure tours, Health melas, seminars, trainings and even invited other centres to visit their set-up. The villagers say the sub-centre has become central to the core activities of the village life. f. Unlike other medical set-ups in the state, the extension service of the centre is observed to be tailored according to the requirements of the community. In the discussion, the villagers expressed that greater care
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for women is required and for which the centre has been pressed to cater more to women in general and more-so for pregnant mothers and also lactating mothers. Immunization of children at the school is done as a regular routine programme. Family welfare and RCH Antenatal check up, control of vector born control programme, blindness control and all other generalized diseases are taken care of in the extension service of the sub-centre. g. The centre has been awarded the prestigious Governor’s Commendation Award. The extracts from the sub centre inspection register of officials and national dignitaries who visited the centre appear to have all been impressed by the community awareness to support the centre. Ongoing activities under Communitization: a. Provision of Decentralised Funds- Medicine & Emergency Funds. b. Infrastructure strengthening. c. Training and capacity building of the various Committees to sustain Communitisation d. Annual Convention of Health Committees being organised. e. Award for Best performing Communitised village has been budgeted f. Monitoring & Evaluation of the implementation of the Communitisation process
Proposal for Panchayati Raj Initiative: The State has conducted Capacity Building Programme for members of Health Committee of various health facilities and Community leaders/PRI from about 860 Villages and 195 Health Units till July. But these workshops need to be continued as many new members are inducted in the places of already trained PRI functionaries and also for the re-orientation of the existing members.
B8.1. Budget requirement for Capacity Building Programme for members of Health Committee of various
health facilities and Community leaders/PRI
Health Committee of various Community leaders/PRI health facilities
District
HU HU PHC/ / (SC CHC/ DH/ SHC/BD) No of participants per unit Total no of participants Village No of participants per unit Total no of participants Total no participantsof (Health Committee +PRI) Inclusive per Cost participant Total Cost Kohima 58 4 232 94 3 282 514 400 205600
Mokokchung 71 4 284 102 3 306 590 400 236000
Tuensang 54 4 216 121 3 363 579 400 231600 Phek 70 4 280 104 3 312 592 400 236800 Mon 68 4 272 110 3 330 602 400 240800 Wokha 52 4 208 130 3 390 598 400 239200
Zunheboto 63 4 252 198 3 594 846 400 338400
Dimapur 59 4 236 216 3 648 884 400 353600 Peren 26 4 104 106 3 318 422 400 168800 Kiphire 25 4 100 103 3 309 409 400 163600 Longleng 12 4 48 40 3 120 168 400 67200 Total 558 4 2232 1324 3 3972 6204 400 2481600 Rupees Twenty Four lakhs Eighty One thousand and six hundred only
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Budget Summary for PRI Initiative: Capacity Building Programme for members of Health Committee of various health 2481600.00 facilities and Community leaders/PRI Grand Total 2481600.00 Rupees Twenty Four lakhs Eighty Six thousand and six hundred Only
B.5: INNOVATIONS:
B.5.1: NRHM HELPLINE/HEALTH HELPLINE (B.19) During 2010-11, the NPCC has approved a sum of Rs. 33.11 lakhs as per the RoP 2010-12. The following activity under JSY Helpline is underway:
Framing of operational guideline completed. The department decided to outsource the operator. Selection of Operator is under process. Development of software is awaited from the state IT department. Procurement of hardwares is under process
The expected timeframe for rolling out services is March 2010. In order to widen the utility of the JSY Helpline, the state has decided to rename the JSY Helpline to Health Helpline. 1. To organise prompt referral services. 2. To facilitate prompt delivery of appropriate care. 3. To provide easy access to reliable health information. 4. To facilitate Grievance Redressal 5. To report any unusual event such as outbreaks, accidents or disaster. 6. To obtain hospital information such as availability services, specialists, reservation for consultation or cabins. 7. To facilitate networking between health units.
Activities proposed: 1. To continue support recurrent expenditure amounting to Rs. 26.80 lakhs. No. Components Units Rate Amount (Rs. required (Rs) In lakhs) Recurrent: 1 Salary for 3 facilitators 36 6000 25.92 2 Phone bill @ Rs 2 per call 30000 2 0.60 3 AMC of computer & inverter systems 2 5000 0.10 4 Stationeries @ Rs 500pm 12 500 0.06 5 Contingency @ Rs 1000pm 12 1000 0.12 Sub Total A 26.80 6 M & E Cost (1% of Sub total A & B) Sub Total B 3.29 Grand Total (A + B) 30.09 (Rupees Thirty Lakhs and nine Thousand) only
The budget for recurrent activity amounts to Rs. 30.09 lakhs.
2. To link with JansankhyaSthirataKosh" (JSK) for providing easy access and availability of reliable information on Reproductive, Sexual Health, Family Planning and mother and Child Health. No budget is required for this activity.
3. To install GPS/GSM vehicle tracking system in all the ambulance: For effective fleet management such as prompt dispatch, routing, fleet tracking, monitoring of schedule adherence and driving behavior, on-board information and security. Vehicle tracking systems benefits: Increasing productivity of ambulance, monitoring employee driving habits and activities, locating the ambulances are on-the-road, verifying the ambulance time sheet, timely delivery of service, tracking the movement of vehicles on the road etc.
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The budget for procurement and installation of amounts to GPS/GSM vehicle tracking system in all the ambulance Rs. 20.06 lakhs.
Units Rate Amount (Rs. required (Rs) In lakhs) GPS/GSM vehicle tracking system including installation 85 20000 17.00 Connectivity charges @ Rs.300/unit/month 85 3600 3.06 Grand Total 20.06 Rupees twenty lakhs and six thousand only
Budget summary for Health Helpline: Activity Amount (Rs. In lakhs) Recurrent: 30.09 GPS/GSM vehicle tracking system including installation 17.00 Connectivity charges @ Rs.300/unit/month 3.06 Grand Total 50.15 Rupees fifty lakhs and fifteen thousand only
B.5.2: Medical Equipment Maintenance Unit (B.19): Equipments, instruments and hospital furniture are procured every year. After utilizing for some period of time, many of such articles become unusable prematurely due to want of timely repair and replacement of parts, causing not only huge loss to the exchequer but also disrupts functioning of the hospital and compromising the quality of care. Besides some components such as mercury etc due to lack of proper collecting system and storage are hazardous to the environment and can cause poisoning.
There is no such facility in the department till date. Therefore, the state proposes Establishment of Medical Equipment Maintenance Unit in the following manner:
1. To establish Medical Equipment Maintenance Unit at 3 District Hospitals (DH) viz: Kohima, Mokokchung and Dimapur. a. Medical Equipment Maintenance Unit at DH Kohima will responsible for the districts of Kohima, Wokha, Phek and Kiphire. b. Medical Equipment Maintenance Unit at DH Mokokchung will responsible for the districts of Mokokchung, Longleng, Tuensang and Zunheboto. c. Medical Equipment Maintenance Unit at DH Dimapur will responsible for the districts of Dimapur, Peren and Mon.
2. The Medical Equipment Maintenance Unit will cater to the needs of the health units of the allocated districts. Every quarterly the team will collect the serviceable articles from the respective districts. The Unit should intimate to the directorate for issues requiring specific service of technicians from the manufacturer.
3. The directorate will designate a Nodal Officer to coordinate and monitor the functioning of the Medical Equipment Maintenance Units. Each Medical Equipment Maintenance Unit will function under the direct supervision of the Medical Superintendent of the Hospital. The concerned officers shall submit monthly activity report along with SOE/UC to the MD NRHM. Regular and timely submission of the same will be linked with further release of fund. The department to issue necessary circular to designate the officers at the state and district level and necessary instruction/guideline to all districts.
4. The CMO and MS will be responsible for collecting at the district Hq preferably at a single point all the articles requiring repair and replacement from various health units under their respective jurisdiction and to inform the MS DH of the concerned the Medical Equipment Maintenance Unit for transporting repair and replacement /reporting the
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Requirements: 1. Manpower Requirement: a. 1 Overseer each for the 3 Centres, with minimum qualification of Diploma in Mechanical/Electrical/Electronics from recognized institutions as per prevailing norms. The total remuneration @ Rs. 15,000.00 pm. Travel expenses as per prevailing govt norms. b. 2 Technician each for the 3 Centres, with minimum qualification of Certificate course in Mechanical/Electrical/Electronics from recognized institutions as per prevailing norms. The total remuneration @ Rs. 8,000.00 pm. Travel expenses as per prevailing govt norms.
2. Building for Workshop cum Office: As there is no vacant building and rooms cannot be spared in all the 3 centres, a Hill Type building of 50sqm plinth area with 4ft brick wall & CGI sheet roof will be constructed at a cost of Rs. 10 lakhs per unit as per NPWD SOR 2010 which is inclusive of provision of 3-phase power supply, water supply and sanitation.
3. Provision of tools and machineries: A sum of Rs. 5.00 lakhs per unit is proposed to procure tools of ISO certified quality for each unit as indicated below: a. 1 set of single phase portable wielding machine with accessories. b. 1 set of portable drilling machine with accessories for drilling both metal and concrete walls. c. 1 set of assorted Mechanical tools. d. 1 set of assorted Electrical tools. e. 1 set of assorted Electronic tools. f. 1 set of assorted general tools. g. 1 set of assorted office furniture
4. Maintenance cost: A sum of Rs. 0.50 lakhs per month per unit is proposed to procure spare parts and other items required for functioning of the unit.
5. Travel expenses as per prevailing govt norms and necessary stationeries for record keeping and documentation will be borne from the PMC.
Budget Summary: Activity Unit Rate (Rs) Total (Rs in lakh) Recurring 1. Manpower Requirement Overseer salary (1 per unit) 3 15000 5.40 Technician salary (2 per unit) 6 8000 5.76 2. Maintenance cost 3 50000 18.00 Total Recurring Cost 29.16 Non-recurring 3. Building for Workshop cum Office 3 1000000 30.00 4. Provision of tools and machineries 3 500000 15.00 Total Non Recurring Cost 45.00
Grand Total 74.16 (Rupees seventy four lakhs and sixteen thousand only)
B.6: FUNDS FOR IMPACT ASSESSMENT OF NRHM AND ASSESSMENT OF VARIOUS COMPONENTS:
B.6.1: Study on ASHA Intervention and JSY (B 21) The ASHA receives performance-based incentives for motivating women and children to receive services under the Reproductive and Child Health (RCH) programme and other such programmes. As such, they have a vital role to play in implementation and success of the JSY scheme at the grassroots level.
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During 2011-12, it is proposed to conduct a study on the ASHA and JSY. The Objectives of the Study will be as under:
1. Assess the current status of the ASHA intervention in JSY scheme. 2. Assess community perceptions about the ASHA and JSY schemes. 3. Analyze support of health system to ASHA in her endeavour towards implementing the JSY scheme. 4. Assess satisfaction of ASHAs with the delivery of JSY scheme. 5. Analyze nature and scope of IEC interventions for raising awareness of JSY. 6. Assess program implications that need to be addressed in order to further improve JSY. 7. Bring out useful information for policy makers and programme managers.
Rationale for the Study Since the JSY has been in operation for over six years and ASHA has been one of the key components at the community level to mobilise women for availing JSY, it is appropriate to review and assess its performance and to further strengthen it based on concrete evidence.
Study area The study will be taken up, initially, in at least 3 districts of the State. The rest of the districts will be taken up in phase manner in the years to follow.
Implementing agency The study will be out-sourced to some agency which already has experience in conducting such studies and would be handed over the responsibility for implementation of the project.
Budget The cost anticipated to occur during the project’s implementation is Rs. 9.00 Lakhs (Rupees Nine Lakhs) only
B.7: Additional Funds for Communicable Diseases (B23): Details in respective activities 1. IDSP- Power Backup for EDUSAT: Rs. 30.00 lakhs. 2. NCBP- Ophthalmic Asst: Rs. 4.80 lakhs and Budgeted under HR (Part A) 3. NSACS- Lab technician for Blood Component Separation Unit at Dimapur: Rs. 9.00 lakhsand Budgeted under HR (Part A). 4. School Health Programme
School Health Programme 2011-2012. As envisaged in the previous PIP 2010-11 for implementation of the School Health Programme (SHP), the state has carried forward the following aims and objectives. Screening and detection of health related problems in the school going children. Provision of referral facilities. Promotion healthy lifestyles awareness through school visits and IEC. Training of health workers (LHVs, GNMs, ANMs) and school teachers as part of capacity building. Augmenting man-power to monitor and record SHP activities in all districts.
For screening children with health related problems, 988 primary schools have been covered (till Nov 2010). The main diseases screened were for 1) Anaemia 2) Skin infection and infestation. 3) Oro- dental problems 4) Night blindness 5) Visual acuity 6) Worm infestation. Immunization with DPT and TT at age related doses, Vit-A supplementation, deworming and Iron and folic acid tablets were provided. Over 1105 cases were referred for further investigation and treatment at CHCs or hospitals. Identification of children with special needs (CWSN) in collaborating with the Education Block Resource Centres (EBRC) of the education department were also carried out. Convergence of activities with departments like Social Welfare, ICDS, Sarva Shiksha Aabhiya (SSA), Women and Child Development are also in process. Counseling
Nagaland SPIP 2011-12 107 services under ARSH is being made available to students at Dimapur, Kohima & Mokokchung. Health clubs in school being encourage i.c. coverage by resource person. Training:- 69 ANMs, 5 LHVs and 125 teachers have been trained so far in the implementation of School Health programme. The focus of training in 2011-12 will be to train more teachers in identification of health related problems in the school-going children since they are in closer contact with the children. Printing of training manual for the health workers and teachers on identification of health related problems has been done and distribution under process. Quarterly visit to schools by doctors have not been regular due to shortage of doctors specially in villages with no health centres. Man-power:- All the DIOs in the 11 (eleven) districts have been appointed as Nodal SHP officers of their respective districts. A LHV has been assigned to assist the DIO to plan and monitor SHP. Contractual appointment of 11 (eleven) SHP co-ordinators with MA (sociology) qualification have been done to monitor and record and report all SHP activities in the districts. One SHP co-ordinator at state HQ has been appointed, to assist in monitoring, recording and analysis of all SHP reports in the districts. Every district in 2011-12 will carry out a census of the following 1. No. of primary schools with enrollment. 2. No. of teachers available. 3. No. AWW centres, AWWs and ASHAs in the school vicinity. 4. Identification of health units and health workers available for health check-up. (Ophthalmic assistants, LHVs, ANMs/GNM, Dental surgeons, MOs) AWWs, ASHAs. 5. NGOs/FBOs willing to participate in the programme 6. VEC, VHCs will oversee the exercise of census. This will ensure better planning, management, training and referral services. IEC:- Awareness generation on healthy lifestyles, prevention of communicable diseases, benefits of full immunization through print media to all schools will be provided to all the primary schools Posters and handouts in local dialects will also be printed. 1. Convergence for delivery of service packages form health, Social welfare, ICDS, SAA, Women & Child development departments. a) Planning at block levels i.e. CDPO, SI, EBRCs, SHP Co-ordinators, MOs. b) Pooling of resources, logistics at block. c) Implementation by health workers, AWWs, Teachers. d) Each school to be visited twice a year between exams. e) Supervision by MOs, SDPO, SI and SHP co-ordinators.
Budget Requirement under School Health Programme 2011-2012.
1. Continuation of Existing Contractual Staff Remuneration. Sl.No. Item Rate/Month Per Annum Total Contractual salary of 11(eleven) SHP Rs 15,000 15000x11x12 Rs. 19,80,000.00 1 Co-ordinators in 11 districts =19,80,000 Contractual salary of 1(one) SHP at Rs 25,000 25000x11x12 Rs. 3,00,000.00 2 state HQ. =3,00,000 Mobility support to 11 (eleven) SHP 5000x11x12 Rs. 6,60,000.00 3 co-ordinators for 11 districts. Rs 5000 =6,60,000 Mobility support to 1(one) SHP co- 15000x11x12 Rs. 60,000.00 4 ordinator at state HQ. Rs 5000 =60,000 Total = Rs. 30,00,000.00
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2. Training:- Two teachers each, (male, female) from the targeted 3039 primary schools will be trained on the conduct and implementation of the SHP. Due to their closer contact with the school children, the teachers will be trained to identify health related problems among the students, and advice referral if necessary. The resource persons will be the DIO/SMO/MO of the District/blocks.
A Sl.no. Activity No. of teachers 3039 x 2 Total 1 TA – @ Rs.100 100 x3039=303900x2 Rs. 607800.00 2 Refreshment @ Rs. 100 100 x3039=303900x2 Rs. 607800.00 3 Stationary @ Rs.50 50 x3039=151950x2 Rs. 303900.00 Total = Rs. 15,19,500.00
B Batches of 30 for 6078 teachers = 202 batches. Honorarium to resource persons @ Rs 1000 = 202x1000 = 202000.00 (Grand Total A+ B = 15,19,500 + 202000 = 17,21,500.00) 3. IEC:-
Printing of IEC materials on healthy lifestyle, personal hygiene, sanitation and pamphlets/leaflets in English and local dialects are planned for wide distribution to targeted schools.
Sl.no. Activity Unit Cost Total 1 Posters (4 posters/school @ Rs 3039x10x4 Rs. 121560.00 10/poster 2 Pamphlet/leaflet (200/school 3039x200x0.50 Rs. 303900.00 @ 0.50/each Total = Rs. 425460.00 4. Medical supply:- (for a unit of 250 students/annum.
Sl.no. Activity Unit Cost Total 1 Albendazole – 200mg 250 Rs. 250000.00 2 IFA tablets 547 Rs. 547000.00 3 Medical Kit 140 Rs. 140000.00 Travel cost of referral(1% of all 4 screened) @ 250 Rs. 250000.00 Rs. 100/referral Total = Rs. 11,87,000.00
Budget Overview Sl Activity Amount (in Rs.) 1 Contractual Staff Remuneration. Rs. 30,00,000.00 2 Training Rs. 15,19,500.00 3 IEC Rs. 4,25,460.00 4 Medical Supplies Rs. 11,87,000.00 Grand Total = Rs. 61,31,960.00 (Rupees Sixty one lakhs thirty one thousand nine hundred sixty) only
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B.8: ACTIVITIES TAKEN UP WITH SUPPORT UNDER OTHER PROGRAMMES: B.8.1: PUBLIC PRIVATE PARTNERSHIP (PPP)
B14.3: PUBLIC PRIVATE PARTNERSHIP (PPP) Recognizing the importance of Health in the process of economic and social development and improving the quality of life of our citizens, the State Government, in spite of many constraints, is putting in sustained effort in augmentation of health manpower, accelerating infrastructure development and strengthening of monitoring and handholding supervision to enhance quality of care and accountability. Besides, the Government has also taken major initiatives in the Public Private Partnerships to tap the much needed resources and technical assistance to ensure adequate health services are available, accessible, affordable and acceptable to all at the right time and right place.Under the PPP venture, several significant projects have been undertaken by the state during 2010-11, which as follows: a. The setting up of the North East Regional Paramedical Institute at Dimapur wherein the MoU was jointly signed on 22nd September 2010 between the Ministry of DoNER, Government of India and the Nagaland Government and the Christian Institute of Health Sciences and Research (CIHSR) in the presence of the Union Minister of DoNER and Mines, Shri B.K. Handique. b. Under the CIHSR tripartite Memorandum of Association (MoA), CHC Dhansaripar was adopted by CIHSR a. For innovative community health programmes b. Conducting periodic training programmes to all categories of the staff. c. To improve the quality of data collection and its utilization for effective management. d. To conduct health education in schools and community. e. To assist in the implementation of all the National health programmes. f. To use the Health Centre as centre for field work for various training programmes of the CIHSR. c. To augment the training programmes, the CIHSR Dimapur has been designated as a Training Centre under the tripartite of MoA of CIHSR. Through this initiative the CIHSR will be providing its technical support in various training programmes beginning from the current FY. The training cost will be borne by NRHM as per GoI guideline. The first activity of this partnership will be short term multi-skilling training for doctors on LSAS &EmOC and nurses OT Techniques at CMC Vellore for a period of 3 months and 2 months respectively. Also to take the opportunity, the following programmes- Lap ST, Mini Lap, NSV, Safe abortion & IUCD insertion for the doctors and SBA and & IUCD insertion for the Nurses will be incorporated in the training programme. A team of doctors and nurseswillbe selected from identified CHCs so that on completion of the training a readymade team will be in position for immediate operationalization of the health facility. The training for the first batch will commence from 1st Feb 2011.
In the Second phase beginning from 2011-12, CIHSR will also provide the following in-service training programmes on SBA, Lap ST, Mini Lap, NSV, Safe abortion and IUCD insertion. Besides, the Institute will also support the state in the induction training of various categories of health personnel. All the training programmes under this Institution will be residential. d. Another important milestone is the partnership with the Medecins Sans Frontieres (MSF) on the other for collaboration to improve access and provision of quality health care services in Mon District through the DistrictHospital. The MoU was signed between the two on 21st July 2010.The highlight of the MoU is as follows: Commitment of MSF:
• To support the DoHFW in running the Mon district hospital. MSF would eventually extend its medical actions outside the DH to complement its services based on current and future needs. • MSF will operationalise any existing buildings, instruments &equipments which is required for the functioning of the hospital. • Provide technical support including coaching to improve the quality of care offered at the hospital and for the capacity building of DoHFW hospital staff • MSF will supply medicines and medical/surgical materials to complement the regular medical supply coming from the State, aiming to avoid shortage at any moment. • Provide additional human resources (specialists) for the optimal running of the medical activities depending on MSF capacity. • MSF will provide all their services free of charge for the patients.
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Commitment of DoHFW:
• To make available all the existing hospital resources to the hospital management. • Endorse MSF recommendations in terms of patients flow and better optimization of the hospital’s structure. • To ensure availability of enough human resources (in quantity and quality) as per the staffing pattern of existing bed strength. • To ensure continuous provision of existing resource allocation. • To make necessary guideline and provide full support for the functioning of the management committee of the hospital between the medical authorities in Mon district and MSF. • To actively support to facilitate all equipment, supplies, services and drugs provided by MSF for the programme in made available to patents free of charge. Management of MonDistrictHospital:
• To oversee general management and overall implementation and follow up of this project, both parties agree in the creation of a Governing Council at the State level and a Hospital Management Committee at the district level in line with the provisions of the Comunitization of Public Institutions and services Act 2002. The composition and Terms of Reference of the said bodies will be jointly prepared in a separate letter of agreement which will be integrated into the present MoU. e. As approved by NPCC in the RoP 2010-11 under ‘Weaving a Dream: a People’s Initiative for Health Care’, the MoU between DoHFW and Eleutheros Christian Society (ECS) for the management of the Langpong Health Centre was signed on……….. 2010.The highlight of the MoU is as follows: i. General Objective: The purpose of the collaboration between and ECS is to collaborate in the management of the Langpong Health Centre presently managed by ECS, as a 24x7 PHC facility to promote and provide universally acceptable, accessible, equitable and quality health care services for the population of Changsang Range and Tuensang district in general.
ii. Service Delivery: All “Assured Services” as envisaged in the IPHS for PHC should be available, which includes routine, preventive, promotive, curative and emergency care and statutory services in addition to all the national health programmes.
iii. Management of Langpong Health Centre: To oversee general management and overall implementation and follow up of this project, both parties agree in the creation of a Health Centre Management Committee at the facility level in line with the provisions of the Comunitization of Public Institutions and services Act 2002. The composition and Terms of Reference of the said bodies will be jointly prepared in a separate letter of agreement which will be integral part of the MoU.
iv. Responsibilities of each Partners: Commitment of ECS:
The ECS will be responsible for the construction of the Health Centre building and staff quarters conforming IPHS for PHC. The ECS will ensure timely and regular submission of activity reports & returns as per existing guidelines. The ECS will abide by the prevailing laws and ensure maintenance of congenial environment for smooth functioning of the Health Centre. Commitment of DoHFW:
The DoHFW will provide annual Grand-in-Aid for non-recurring recurring and costsubject to approval of GoI. Human Resources Development: The DoHFW will be responsible for skill upgradation of the critical staff of the Health Centre as per prevailing integrated training policy.
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Logistic Support: The DoHFW depending on its available resources will provide necessary logistic support in terms of data management eg: reporting formats/registers etc, specialized equipments and instruments relevant to the facility to enable provision of quality services for RCH and other NDCPs. f. The Department of Health & Family Welfare (DoHFW) also entered into a partnership with the Police Department for effective and collective utilization of its available manpower which resulted strengthening the Central Hospital Chumukedima to a First Referral Unit (FRU) for delivery of quality health care. The PoliceCentralHospital was inaugurated on 17th December 2010. This partnership will also incorporate the National Disease Control Programmes in the services delivery and participation in the Health Information Management System (HMIS) in all the Health Units under Police Department. Nagaland Police department is providing basic health services to its personnel through a network of 15 BattalionHospitals and 1 Central Hospital. These health units cater to the health needs of about 26000 police personnel and their family members comprising more than thrice the number of police personnel. These health units also extend services to the needy public from adjoining villages and localities. However, these health units are inadequately equipped in terms of manpower and infrastructure to provide a reasonable quality care. Also the service package is deficient of services under various National Health Programmes. Lack of access to the various health programmes can be detrimental to the health status of the people of the state as the Police personnel and their family members live with the community and also in contact with the community like any other citizen. On the other hand, the department of Health & Family Welfare is unable to expand its health network to every corner of the state and universal accessibility & equitable distribution of health services still remains an issue to address due to limited resources. Expanding the network of health service delivery and tapping of health data in the process by partnering with agencies outside the health department would be an invaluable asset for better inclusive planning and universalization of health delivery in the state. With this strategy, a partnership between Department of Health & Family Welfare and Police Department was conceived in order ‘To Universalize Health Care Delivery’. The ToR between the two Departments was signed on 29th Sept 2010 based on the following objectives: i. To jointly strengthen the Central Hospital Chumukedima as a First Referral Unit (FRU) for delivery of quality health care. ii. To incorporate the National Disease Control Programmes (NDCPs) in the services delivery of all the Health Units under Police Department. iii. The Police Department to participate in the Health Information Management System (HMIS) of the State. iv. To provide health care services to all. NB: Chumukedima though it is closed to Dimapur (15 km), it has a population of …………… . There are 2 health units (1 PHC under DoHFW and 1 Police Central Hospital). Unfortunately both of them are not 24x7 facility and unable to provide even basic care to the people mostly due to lack of desired manpower and resources. All emergency case particularly for expectant women and sick children has to go Dimapur. In view of this, the Police Central Hospital Chumukedima was identified as beneficial for both the parties. Though being designated as Police Central Hospital, the hospital is manned by 2 GDMOs, 4 nurses, 1 LT, 1 X-ray Tech and 2 Pharmacist. The extract of the ToR is given below:
Responsibilities of the Stakeholders:
1. Manpower strengthening: a. The Police Department will redeploy the existing 7 nos of specialist doctors (O&G, Paediatrician, Anaesthetist, Cardiologist, Pathologist, Chest Specialist and Surgeon) presently posted in various battalion hospitals to the Central Hospital Chumukedima. b. DoHFW will provide General Duty Medical Officers (GDMOs) in place of the specialist doctors thus redeployed. c. DoHFW will provide additional General Nursing & Midwifery (GNMs) as per Indian Public Health Standard (IPHS) of FRU Community Health Centre (CHC). d. The Nagaland Police Department will recruit and deploy above-mentioned manpower while DoHFW will provide grand in aid to meet the salary expenditure for the same. e. The Police Department is expected to develop necessary manpower of the said Hospital at the earliest for self-sufficiency. f. The human resource support from the DoHFW will be initially for a period of 2 (two) years.
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2. Infrastructure & Logistic support: a. The Nagaland Police department will develop the physical infrastructure and equip the said hospital with relevant equipments and instruments conforming IPHS for CHC (FRU). b. DoHFW depending on its available resources will provide necessary logistic support in terms of data management eg: reporting formats/registers etc, specialized equipments and instruments relevant to the facility to enable provision of quality services for RCH and other NDCPs. 3. Human Resources Development: a. The DoHFW will be responsible for skill upgradation of the critical Health staff of the Nagaland Police Department as per prevailing integrated training policy. Guaranteed Service Delivery:
1. All “Assured Services” as envisaged in the IPHS of CHC will be delivered by Central Hospital Chumukedima and of the PHC by all the BattalionHospitals, which will also include preventive, promotive, curative and emergency care and statutory services in addition to all the national health programmes. 2. The Central Hospital Chumukedima should have the following facilities as a fully functional FRU: a. 24-hour delivery services including normal and assisted deliveries b. Emergency Obstetric Care including surgical interventions like Caesarean Sections (*) and other medical interventions c. New-born Care (*) d. Emergency Care of sick children e. Full range of family planning services including Laproscopic Services f. Safe Abortion Services g. Treatment of STI / RTI h. Blood Storage Facility (*) with scope for upgradation for Blood Banking facility. i. Essential Laboratory Services j. Referral (transport) Services (*): Critical determinants of functionality
3. All health units under the Police department: a. To participate in the implementation of various NDCPs including HMIS. b. To extend health care services to civilian population.
ACTIVITIES PROPOSED FOR 2011-12: 1. State PPP Cell: With the increasing development of PPP ventures for to tap the much needed resources and technical assistance to ensure adequate health services are available, accessible, affordable and acceptable to all at the right time and right place, the state has established a PPP Cell headed by 1 Addl Director to explore and assess engagement partnership for PPP activities and to coordinate, facilitate and monitor/evaluate the activities. a. Procurement of 1 Desktop PC with accessories @ Rs. 60000.00 b. Review Meeting to held quarterly with all the partners @ Rs. 10000.00 per meeting amounting to Rs. 40000.00 per year. c. Mobility Support @ Rs. 10000.00 per month amounting to Rs. 120000.00 per year. d. Operational Cost for Consumables @ Rs. 2500 per month and Phone/Electricity bills etc @ Rs. 2500 per month amounting to Rs. 60000.00 per year. The total budget towards support to the State PPP cell amounts to Rs. 2.80 lakhs.
2. Partnership with Medecins Sans Frontieres (MSF) to improve access and provision of quality health care services in Mon District through the DistrictHospital. Highlights of Progress made so far:
a. Constitution of Hospital Management Committee b. Improvement of structure and infrastructure underway. c. Besides the MSF Administrative Personnel, the following technical staff has arrived:- Paediatrician, Hospital Nurse Pharmacist, Laboratory technician, Logistic Specialist and WATSAN specialist d. Development of plan for hospital pharmacy system, improving the existing a water supply, waste management system and training plan to increase the quality of care provided to patients. e. DoHFW has recruited 7 nurses on contractual basis and to deploy 1 anaesthetist by February 2011. f. Performance:
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Particulars No of Cases 2008-09 2009-10 2010-11 (June to Dec) OPD 5735 5194 6277 IPD 2062 1915 1360 ER Consultation NA NA 1854 ID NA NA 270
Proposed Activity:
a. To provide manpower support: 5 GDMOs,12 GNMs, 2 PHN and 1 Statistical Asst for MDR. b. To provide 1 ambulance for Referral Transport. Total amount Partnership with Medecins Sans Frontieres (MSF) Units Unit cost (Rs in lakhs) To provide manpower support GDMO 5 45000 27.00 GNM 12 25000 36.00 PHN 2 25000 6.00 Statistical Asst for MRD 1 15000 1.80 Sub total A 70.80 Referral Transport To provide 1 ambulance 1 900000 9.00 Sub total B 9.00 Grand total (A+B) 79.80 Rupees seventy nine lakhs and eighty thousand only
The total budget requirement for the proposed activity amounts to Rs. 79.80lakhs
1. Partnership with Eleutheros Christian Society (ECS) for the management of the Langpong Health Centre Highlights of Progress made so far:
a. The Health Centre has just started functioning from the existing building. The construction of the labour room complex is completed. b. Manpower as per MoU has been recruited and in-place. c. Performance during the last three months: Particulars No of Cases OPD 576 IPD 309 ID 29
d. Community members from 16 villages have helped in the site development, construction of staff quarter Canteenand patient rest room. e. Members from the 280 Women SHS contributed Rs. 30/head towards establishment of the health centre. f. 21 churches contribute Rs.2,000/- each annually for canteen services g. Every household in the 16 villages contribute Rs.10/- each annually (8,000 households) and 21 Village Council Rs500 annually. h. PHED provided a 200w "hydroger" i. Community Care Centre for PLHAs established. j. Convergence of Services initiated: PWD to construct 10km all-weather approach road. Science & Technology department to provide Community Information Centre. NABARD: Oranges for health.
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500 acres of citrus plantation.Earning from 1 tree (total 5 acres) to be contributed to the Health Centre. Micro-financing ‘Edou Banks’: 280 Women SHS groups having a saving corpus of Rs.2 crores. Birla Sunlife Insurance: Insuring a future. Every member each household ensured for Rs 20,000/- RBSY: Insuring Health. SSA: Health through awareness. To revive the traditional ‘morung’ or ‘sochum’ as centre for learning skills for progressive living. NEPEED Energy Team: Power for Health. To setup 700 kw hydro unit. Bamboo Mission: A Healthy alternative. To provide alternative forest resources and livelihood.
Proposed Activity:
1. To continue Manpower support as specified in the budget sheet. The budget requirement for proposed activity towards manpower support:Rs. 67.08 lakhs
2. To continue support towards operational cost as specified in the budget sheet. The budget requirement for proposed activity towards operational cost:Rs. 3.89 lakhs
3. Equipment support: Propose to provide 1 set of equipment for NBCC equipment,MVAkit and IUD insertion kit.
The budget requirement for proposed activity towards procurement of equipment:Rs. 1.12lakhs
4. Propose to provide 1 Ambulance @ Rs. 9.00 lakhs which will be managed as per the existing RT policy. The budget requirement for proposed activity towards procurement of ambulance with necessary equipment:Rs. 9.00 lakhs
5. CapacityBuilding: Skill upgradation on MCH services, HMIS and NCDPs for the health personnel from police department has been incorporated in the training programme respectively.
Total Budget Requirement for supporting Longpang Health Centre amounts to Rs. 81.09Lakhs. Weaving a Dream: a People’s Initiative for Health Care at Sangsangyo (ChangsangRange) S. N Particulars No of unit Cost/unit Total amount (Rs in lakhs) Remarks A Capital / Non-recurring 1 Radiant warmer with Trolley 1 70000 0.70 2 Neonatal Ambu bag with face mask 1 1500 0.02 3 Mucus Extractor: Foot operated 1 4000 0.04 4 Oxygen Cylinder, trolley & Regulator 1 25000 0.25 5 MVA 1 4200 0.04 6 MTP 1 3000 0.03 7 IUD insertion kit 1 4000 0.04 Sub-total A 1.12 8 Ambulance for RTS 1 900000 9.00 Sub-total B 9.00 B Recurring Staff 1 Medical Officer @ Rs 45000pm 2 90000 21.60 2 Pharmacist @ Rs 20000pm 1 20000 2.40 3 Staff Nurse @ Rs 25000pm 3 75000 27.00 Health Worker (F)/ANM @ Rs 4 1 20000 2.40 20000pm 5 Health Educator 0 0 0.00 Not
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relevant Not 6 Health Assistant (Male) 0 0 0.00 relevant Not 7 Health Assistant (F)/LHV 0 0 0.00 relevant Not 8 Acct cum UDA 0 0 0.00 relevant 9 DEO cum LDA @ Rs 8000pm 1 8000 0.96 10 Laboratory Technician @ Rs20000pm 1 20000 2.40 11 Driver @ Rs 6000pm 1 6000 0.72 12 Class IV @ Rs 5000pm 4 20000 9.60 Sub-total C 67.08 Operational Cost Drugs ( As per IPHS norms and 1 1 300000 3.00 standards) Travel Allowance @ 12 visits/mth X 2 24 1200 0.29 2 persons 3 Telephone @ Rs.1000/mth 12 1000 0.12 For hiring transport in emergency @ 4 80 300 0.24 Rs.300/case X 80 cases 5 Other expenses @ Rs.2000/mth 12 2000 0.24 Sub-total D 3.89 Grand Total (A+B+C+D) 81.09 Rupees eighty one lakhs and nine thousand only
2. Partnership between Department of Health & Family Welfare and Police Department ‘To Universalize Health Care Delivery’ Achievement so far: 1. The Police department has completed redeployment of the following specialist- O&G specialist, Anaesthetist and Paediatrician as only 3 GMDOs came forward for the replacement till Dec 2010. With the recruitment of 5 GNMS the hospital has 9 nurses. The 2. Service Delivery performances during the last three months: Particulars No of Cases OPD 7736 IPD 673 ID 142
Proposed Activity:
1. Manpower support: a. NRHM to bear the remuneration of 7 GDMOs in place of the redeployed specialist and 5 SNs to cover the deficient nursing staff at the Central Hospital Chumukedima. The budget requirement for proposed activity towards recruitment of 7 GDMOs @ Rs. 35000/- per month and 5 GNMs @ Rs. 15000/- per month amounts to Rs. 38.40 lakhs.
The budget requirement for proposed activity towards manpower support:Rs. 38.40 lakhs
2. Equipment support: a. Propose to provide 1 set of equipment for MVA, MTP, IUD insertion kit, Mini lap kit, laparoscope, NSV kit, NBSU and BSU to the Central Hospital Chumukedima. The budget requirement for proposed activity towards procurement of equipment:Rs. 10.63lakhs
3. CapacityBuilding: a. Skill upgradation on MCH services, HMIS and NCDPs for the health personnel from police department has been incorporated in the training programme respectively.
Total Budget Requirement for supporting CentralHospitalChumukedima amounts to Rs. 49.03 lakhs
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Equipment Unit Rate Total Amount MVA kit 1 4200 4200.00 MTP kit 1 3000 3000.00 IUD insertion kit 1 4000 4000.00 Mini lap kit 1 3400 3400.00 Laparoscope 1 600000 600000.00 NSV kit 1 500 500.00 New Born Stabilization Unit Radiant warmer with Trolly 1 70000 70000.00 Neonatal Ambu bag with face mask 1 1500 1500.00 Mucus Extractor: Foot operated 1 4000 4000.00 Oxygen Cylinder with trolley & regulator 1 25000 25000.00 Blood Storage Unit 0.00 Blood Bag Refrigerators (50 units of Blood). 1 200000 200000.00 Deep Freezers 1 75000 75000.00 Insulated Carrier boxes with ice packs 1 7500 7500.00 Microscope 1 55000 55000.00 Electric centrifuge 1 10000 10000.00 Grand Total 1063100.00 Rupees ten lakhs sixty three thousand only
Total budget requirement for PPP amounts to Rs. 193.52 lakhs PPP Activity Total Amount (Rs in lakhs) State PPP Cell 2.80 Subtotal A 2.80
Partnership with Medecins Sans Frontieres (MSF) to improve access and provision of quality health care services in Mon District through the DistrictHospital To provide manpower support 70.80 To provide 1 ambulance for Referral Transport 9.00 Subtotal B 79.80
Partnership with Eleutheros Christian Society (ECS) for the management of the Langpong Health Centre To continue Manpower support 67.08 To continue support towards operational cost 3.89 Equipment support 1.12 To provide 1 ambulance for Referral Transport 9.00 Subtotal C 81.09 Partnership between Department of Health & Family Welfare and Police Department ‘To Universalize Health Care Delivery’ Manpower support 38.40 Equipment support 10.63 Subtotal D 49.03 Grand Total (A+B+C+D) 212.72 Rupees two crores twelve lakhs seventy two thousands only
B.8.2: HEALTH INSURANCE SCHEME:
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For people living below poverty line, an illness not only represents a permanent threat to their income earning capacity, in many cases it could result in the family falling into a debt trap. When the need to get the treatment arises for poor families they often ignore it because of lack of resources, fearing wage loss, or wait till the last moment when it’s too late. Even if they do decide to get the desired health care it consumes their savings, forces them to sell their assets and property or cut other important spending like children’s education. Alternatively they have to take on huge debts. Ignoring the treatment may lead to unnecessary suffering and death while selling property or taking debts may end a family’s hope of ever escaping poverty.
These tragic outcomes can be avoided through a health insurance which shares the risk of a major health shock across many households by pooling them together. A well designed and implemented health insurance may both increase access to healthcare and may even improve its quality over time.
RashtriyaSwasthyaBimaYojana (RSBY): RSBY a health insurance scheme for BPL families was launched in 2008 under the department of Labour and Employment. Around 3,700 beneficiaries were already availing free access to health aids, amounting to more than Rs 1.73 crore, through the empanelled hospitals in the State. In 2010, the state was awarded the best state under RastriyaSwasthyaBimaYojana (RSBY) for enrolling highest percentage (80% of the BPL families). Besides, the state has also earned the distinction of being the best performing state in North- East in this regard.
Recognising Health insurance for the unorganised workers BPL (Below Poverty Line) is the key to bring about social prosperity in the economy the state government decided by to extend the scheme to the Public Health Institution wef 2010 in phase manner. Accordingly, the department has constituted a technical committee headed by 1 Addl Director to oversee and coordinate the effective implementation of the scheme. 1. All the district hospitals will be empanelled in the first phase. 2. Necessary arrangements are being made for smooth rolling out of the scheme. Filling of critical gaps of infrastructure, equipment and staff of all these institutions based of the facility survey report as per IPHS is taken up on priority. The nodal department is responsible for Capacity building and provision of hardwares for biometrics, fingerprint readers, smartcard readers etc. The department is responsible for desktop PC with accessories, 64kbps internet connection and power backup.
B.8.3: NGO Programme/ Grant in aid to NGO (B14):
1. MNGO Scheme During the year 2011-12, The MNGO scheme will continue to supplement and complement the programme by addressing the gaps in information dissemination and providing RCH services. In addition to capacity building and nurturing FNGOs, the scheme focuses on addressing the unmet RCH needs. This is possible by involving NGOs in delivery of RCH services, in areas which are underserved or un-servedby the government infrastructure. Accordingly, NGOs are expected to move from exclusive awareness generation to actual delivery of RCH services. This will be done by utilising and strengthening the existing government infrastructure and human resources and not creating a parallel structure.
In the absence of any type of monitoring tools in the past, the impact of MNGO scheme could not be determined or analysed in a more tangible manner. To address this issue, monthly reporting formats have been developed which will be instrumental in regular monitoring of the performances of the MNGOs and FNGOs.
Various trainings which have been done for MNGOs are:
A two-day Induction training of the 7 new MNGOs under NRHM/RCH started from the 28th of January till the 29th of January 2010 at Jubilee Memorial Centre, Lerie Colony, Kohima. The resource persons were Ms.Jyotika, Coordinator, Regional Resource Centre (RRC-MNGO), Assam and Mr.PranjalDutta, Training Coordinator, VHAA, RCC-MNGO. Topics discussed during the training: . Strengthening GO-NGO partnership. . National Programmes & Policies of Reproductive Health- NPP 200, RCH-II. . Key Features of National Rural Health Mission.
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. Overview of the MNGO Scheme. . Understanding MNGO guidelines. . Management of Grant-in-aid during preparatory phase and Financial Systems. Training on Baseline Survey and proposal development was conducted during 3rd -5th March 2010 at the Training Hall of VHA of Assam, East Jyoti Nagar, BamuniMaidam, Guwahati. Training of MNGOs on Baseline Survey Data Entry was held on 8th –9th September 2010 at ATI Kohima. Mr.Pranjal, Training Coordinator VHAI, Guwahati was the resource person for this training.
The key service delivery areas under the MNGO Scheme are:
Maternal and Child Health Family Planning Adolescent Reproductive Health Prevention and Management of RTI
In accordance with these areas of service delivery, some of the activities undertaken by MNGOs/ FNGOs are:
Sl. No. Activities No. 1 Community meetings 44 2 Field visits 132 3 RCH Camps 4 4 Health Melas 2 5 Youth Camps 2 6 Outreach activities 528 7 Capacity building of support staff 11 8 Capacity building of FNGOs 11
With the pulling out of Woodland Multipurpose Cooperative Society, selection of new MNGO and FNGOs is yet to be done for Mokokchung District. The following MNGOs and FNGOs are already in place:
Sl. No. District MNGO FNGO 1 Kohima Nagaland Voluntary Health 1 Action For Women Development & Association Empowerment 2 Entrepreneur Development & Integrated Training Institute 3 Environmental Society of Nagaland D. Block, Kohima 2 Phek Eureka Life Foundation 4 Chakhesang Women Welfare Society 5 Social Welfare Society for Rural Development 6 Rukizumi Welfare Society 3 Mokokchung Yet to be selected 7 8 9 4 Mon KonyakNgupuhShekokhong 10 Kengpang Society Wakching, Mon 11 Konyak Women And Child Welfare Society Mon town, Mon 12 Ellen Welfare Society Mon 5 Zunheboto Society of Aborigines 13 Emloto Women Welfare Society 14 Aghile Society 15 Akoqivi Society 16 Nikito Society 6 Kiphire International Border Area 17 Eastern Multi-Purpose Society, People’s Welfare Organisation Kiusam Block
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18 Eastern Nagaland Social Service Society, Seyochung Block 19 Ngarhang Cultural Society, Mimi, Pungro Block, 7 Longleng 20 Committee on Development of Rural Women (CODRW) 21 Committee on Social Action, Health, Rural Community Services Environment and Development (COSAHED) 22 Yingli Mission Society (YMS) 8 Wokha Women Welfare Society 23 Centre for Youth and Social Action 24 Rural Youth Welfare Society 25 Phyohayi Welfare Society 9 Peren 26 NamzinChame Child and Women Development Association of Welfare Society, Peren Nagaland 27 Cultural Club of Athibung 28 Integrated Rural Development Society, Jalukie 10 Dimapur 29 Mother's Hope, Chumukedima 30 Western Sumi Baptist Prodigal’s Home AkukuhouKughakulu, Dhansiripar 31 Eco-Generation (Agency for Integral Development), Niuland 11 Tuensang 32 Regional Development Agency Frontier Development Services 33 Changsang Hills Development Agency 34 Youth Club Society
The funding for the MNGO scheme will be on an annual basis. Upon receipt of Sanction letter and signed MOU, MNGOs are sanctioned a project for a period of 1 year. The fund is released in 2 installments. The MNGO has the responsibility to further disburse the funds to the FNGOs.
Budget break-up of Grant-in-aid to MNGO Sl. No. Programme activities No. of MNGOs Unit cost (in `) Total Cost (in `)
FNGO Budget: 1 Maternal and Child Health 11 540000 5940000 2 Family Planning 11 150000 1650000 3 Adolescent Reproductive Health 11 75000 825000
4 Prevention and Management of RTI 11 75000 825000 5 CapacityBuilding 11 180000 1980000 6 Community Events 11 324000 3564000 7 Monitoring and Evaluation 11 75000 825000 8 Data Management 11 30000 330000 9 Administration 11 450000 4950000 Total (1) 1899000 20889000 10 Institutional Overheads 10% of total (I) 11 189900 2088900 Total (II) 2088900 22977900 11 MNGO Budget (total III) 11 500000 5500000 Overall total (II+III) 2588900 28477900
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Budget Summary
Sl. No. Activities Number Unit cost Total cost (in `) 1 Grant to Existing MNGOs/ FNGOs 11 2588900 28,477,900 2 Evaluation of FNGOs 34 15000 510,000 3 Evaluation of MNGOs 11 30000 330,000 4 Training of MNGOs / FNGOs on programme 2 300000 600,000 management 5 Quarterly review meetings at State and district 4 300000 1,200,000 level. 6 Salary for NGOs Coordinator at SPMU 1x12 28000 336,000 7 Salary of Support staff at SPMU 1x12 15000 180,000 8 SPMU Office Expenses and documentation 1 200000 200,000 9 Travel / Conveyance (Vehicle for NGO 1 500000 500,000 coordinator for monitoring and handholding support to MNGOs) 10 Contingencies (Unseen expenses to cover 1 200000 200,000 visiting officials from center and regional) Total 32,533,900
(Rupees Three Hundred Twenty Five Lakhs Thirty Three Thousand Nine Hundred) only
2. Mission Hospitals Maintaining the rationale that health goals could be achieved in a more wholesome manner by the involvement of all sectors of the population, the State proposes continued support to the on-going PPP arrangements of NRHM, Department of Health & Family Welfare and the 3 mission hospitals viz. Impur Mission Hospital at Mokokchung, Christian Medical Centre, Vankhosang at Wokha and Aizuto Mission Centre at Zunheboto.
The experience of working in partnership with the private sector has been a good one wherein lessons were learnt from each other in aspects of health activities as well as programme management.
To more effectively have an oversight on the response generated towards the services provided by these private health centres and also to monitor the performances, the centres were provided with HMIS formats and accordingly registered in the HMIS web portal.
The status of performance during 2010-11 (till Dec.) against some indicators are shown below:
Sl. Name of Hospital No. of No. of ANC No. of Institutional No. OPD IPD registered deliveries 1 ImpurMissionHospital, Mokokchung, 2971 98 29 19 2 Christian Medical Centre, Vankhosang, Wokha 3065 126 35 27 3 Aizuto Mission Centre, Zunheboto. 2249 74 19 10
One of the most important constraints that these institutions have to overcome is the scarcity of physicians. The hospitals employ their own staff consisting of physicians, laboratory technician, nurses, pharmacist and others. The PPP arrangement requires the hospital to already have the physical/ financial resources to complement the government’s contributions.
Manpower position: Sl. No. Name of Hospital Doctor Nurse Lab. Others Full- Part- Tech.
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time time 1 Impur Mission 1 2 2 2 Manager-1 Hospital, Pharmacist - 1 Mokokchung Dhai – 2 Counsellor - 1 Helpers – 2 X-Ray Tech. - 1 2 Christian Medical 1 2 2 1 Chaplain/ Office Asst.–1 Centre, Vankhosang, Female Attendants–3 Wokha Helpers - 2 3 Aizuto Mission 0 1 2 0 Manager-1 Hospital, Zunheboto Compounder - 1 Helpers – 1
The funding will continue with the same pattern as follows: Sl. No. Name of Hospital Total Amount (` in lakhs) 1 ImpurMissionHospital, Mokokchung 5.00 2 Christian Medical Centre, Vankhosang, Wokha 5.00 3 AizutoMissionHospital, Zunheboto 5.00 Total 15.00 (Rupees Fifteen Lakhs) only
B7: Additional Funds for Communicable Diseases (B23): Details in respective activities 1. B.6:1: IDSP- Power Backup for EDUSAT: Rs. 30.00 lakhs. 2. B.6:2: NCBP- Ophthalmic Asst: Rs. 4.80 lakhs 3. B.6.3: NSACS- Additional Lab technician for Blood Component Separation Unit at Dimapur: Rs. 9.00 lakhs. 4. B.6.4: UIP- Refrigerator Mechanics: Rs. 2.88 lakhs.
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B.9: INTEGRATED IEC/BCC PLAN FOR 2011-12 (BUDGETED IN B10)
Background:
One of the most challenging tasks in planning health promotion for the rural pockets of Nagaland is to take all the 16 official tribal languages into consideration to ensure maximum reach of IEC/BCC activities. During the last financial year 2010-11, the State Health Society, NRHM has undertaken a Communication Needs Assessment study to assess the Knowledge, Attitudes and Practices of the rural populace in order to plan better media interventions. However, since the study is still under progress, evidence based media planning is not possible at this point of time. On the other hand, printed materials have been developed in English for RCH and other Health programmes. Besides, short films and TV spots have been developed. In the PIP 2011-12, besides upscaling of IPC activities, stress is being given to the translation of these materials into the local tribal dialects.
Strategic Objective: Translation of IEC materials into local dialects and creating enabling environment to improve health status and indicators.
Illustrative Activities:
Thrust will also be given on intensified Inter Personal Communication activities and FGDs specially during VHNDs.
It is also proposed to upscale the frequency of training for IEC/BCC personnel at all levels.
A new initiative of the state is the proposal for 11 IHCC (Integrated Health Counselling Centres) at the District Hospitals in co-ordination with Nagaland SACS whereby existing counsellors appointed under NSACS and other Health Programmes will provide integrated health counselling to visiting patients. A major component of this initiative is to train these counselors on RCH components. These IHCCs will be equipped with audio visual equipment where short films and TV spots developed during the past years will be screened.
Another area is to converge with other state departments like Transport & Taxi unions for transit media for creating awareness. It is also proposed to utilize electricity bills to provide information about the nearest health services available within the specific area. For this, a pilot project is being initiated in the districts of Kohima and Dimapur.
We also propose to utilize 3 women tribal organizations for sensitization of the target population especially in maternal health issues.
Another initiative is to have intensified media campaigns during observance of health days such as Safe Motherhood Day, Breastfeeding Week, New Born Care Week, World Population Week.
It is also proposed to strengthen and revive 189 Mahila Swasthya Sangh units in the 3 districts of Mokokchung, Peren & Kiphire on pilot basis. This will be done through reorientation & training of these units.
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Integrated IEC/BCC Plan 2011-12
No. Issues in planning Activities Time frame IEC/BCC
1 RCH -MH To avail 3 ANCs, Target audience: Pregnant women, mothers, eligible couples. 1st-4th quarter PNC and institutional Methods: deliveries To promote JSY IPC: incentive. To avail TT FGDs with target audience during VHNDs focusing on injections & IFA importance of complete ANC checkup, immunization, tablets nutrition for pregnant women, Importance of Institutional Delivery. One to one Counselling by health workers in health units on importance of complete ANC checkup, immunization, nutrition for pregnant women, Importance of Institutional Delivery. Sensitization of 3 tribal women organizations. The process will be done through group setting on importance of complete ANC, Immunization and Institutional Delivery. Utilise the existing 10MNGOs by providing them developed IEC materials to aide them in their field activities. Mass media:
Continuation of NRHM weekly radio programme (15 minutes) Production of 2 Public Service Advertisements (PSA) on Nutrition for pregnant mother and Immunisation. Dubbing of 2 PSAs into 5 dialects. Translation and production of developed Maternal Health materials (1 booklet, 3 posters,1 hoarding). Flex boards in Health units on JSY, services to be asked for in ANC (2 nos). Transit advertisement in community buses & local taxis on Institutional Delivery& JSY and 3 ANC. Information about the nearest available Health facility to be printed in electricity bills. On pilot basis contact number of PHC/SC/CHC/ ASHA to be printed in telephone bills. Newspaper advertisements on complete ANC, JSY, Institutional Delivery, Immunisation for pregnant Women, Nutrition for pregnant women and Safe Motherhood. Media campaign:
Media campaign to coincide with safe motherhood day: repeated broadcast of radio & TV spots, newspaper advertisements, district & block level IPC activity i.e FGD to be done by District level Media Officers (NRHM) . 2 RCH -CH Management of Target audience: Mothers, parents. 1st-4th quarter ARI & diarrhoea. Full & timely Methods: immunization. Newborn care IPC: Promotion of
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exclusive FGDs with target audience during VHNDs: demonstration breastfeeding of correct way of breastfeeding, On demand feeding, Burping, signs and symptoms of common ARI, ORS, Common effects after immunization – eg., fever, the diseases that can be prevented etc. Counselling by health workers like ANMs and GNMs in health units to lactating Mothers. Mass media:
Continuation of NRHM weekly radio programme (15 minutes). Production of 2 PSAs on measles and ARI. Dubbing of 4 CH PSAs into 5 major dialects. Translation and production of developed CH materials (1 booklet, 3 posters, 1 hoarding). Flex boards on demonstration of correct way of breast feeding, on demand feeding and Care for New born in health units. Transit advertisement – Importance of Immunization and breastfeeding in community buses & local taxis. Newspaper advertisements on timely immunization, Importance of Breast feeding, Care for New Born. Media campaign:
Media campaigns to coincide with breastfeeding week & new borne care week: repeated broadcast of radio & TV spots, newspaper advertisements, district & block level IPC activity. 3 RCH -FP To avail family Target audience: Pregnant women, mothers, eligible couples 1st-4th quarter planning services. To promote Methods: sterilization services, IUCD… IPC: To address misconceptions FGDs with target audience during VHNDs on Importance about FP methods. of Family Planning, Advantages of Small Family, different methods of FP. Counselling by health workers in health units. Sensitization of women leaders & organizations.]
Mass media:
Continuation of NRHM weekly radio programme (15 minutes) Production of 2 PSAs on importance of family planning and promotion of IUCD-380A. Dubbing of 2 PSAs into 5 major dialects. Translation and production of developed FP materials (1 booklet, 2 posters, 1 hoarding). Flex boards in health units on Importance of Family planning and methods. Transit advertisement in community buses & local taxis on Importance of family planning and advantages of Small Family. Newspaper advertisements, especially during World Population Day, Family welfare fortnight etc. IEC activities, especially counselling during 11 Family Planning camps.
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Media campaign:
Media campaigns to coincide with World population day/week: repeated broadcast of radio & TV spots, newspaper advertisements, district & block level IPC activity. 4 RCH -ARSH To create awareness Target audience: Adolescents, youth leaders. 1st-4th quarter about RTI/ STI & HIV/ AIDS. Methods: Address Adolescent Health issues. IPC To promote right age of marriage Continuation of Adolescent school & college programme (55 Schools and 5 Colleges). Adolescent clubs in five districts to promote Adolescents Health through poster campaign and having periodical meetings to discuss adolescent specific issues. Organizing Competitions and debates in Schools and Colleges.
Mass media:
Continuation of NRHM weekly radio programme (15 minutes) 2 PSAs on Right age of Marriage and Teenage Pregnancy. Dubbing of 2 PSAs into 5 major dialects. Translation and production of developed ARSH materials (1 booklet and 2 posters). Sponsoring/co – sponsoring of youth related sports and music events at district & block level. Pens, T-Shirts, caps & bookmarks with health messages. Newspaper advertisements.
5 Health Melas Health melas in all 11 districts (block level) 2nd-3rd quarter 6 Additional Activities (Initiatives) Continuation of NRHM newsletter “Reaching the grassroots’. Translation & production of ‘Where there is no Doctor’ by David Werner in local dialects, which will be utilized by 1700 ASHAs, ANMS and IEC/BCC personnel and also placed in all health units. SMS campaign through cellular service providers for health messages. 7 Other activities : Integrated Health Counselling Centres (IHCCs)
To give quality To set up 11 IHCCs in 11 District Hospitals in 2nd quarter holistic health coordination with NSACS. Convergence with SACS in counseling. training their Counsellors in RCH components. Regular monitoring to be done. Strengthening of Reviving 189 units of MSS in 3 districts of Mokokchung, nd MSS Peren, Kiphire. 2 quarter 8 Routine Immunization Promote routine & Target audience: Mothers, eligible couples. 1st – 4th full immunization. quarter Address
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misconceptions & Methods: myths. Mass media: Continuation of NRHM weekly radio programme (15 minutes) Dubbing of and 1 PSAs into 5 major dialects. Translation and production of developed materials (1 booklet, 2 posters, 1 hoarding). Flex boards in health units on the Immunization schedule. Newspaper advertisements on Timely Immunisation, and on special days like Polio Sundays. 9 NVBDCP Educate people on Target audience : General public 1st – 4th vector borne control quarter measures. Methods: Early diagnosis and prompt treatment. Mass media: Acceptance of IRS and usage of ITBN. Continuation of NRHM weekly radio programme (15 minutes). Dubbing of 1 PSA into 5 major dialects. 10 NLEP Early detection of Target audience : General public 1st – 4th leprosy. quarter Promote MDT. Methods:
Mass media:
Continuation of NRHM weekly radio programme (15 minutes) Production of 1PSA. 11 NPCB To clear Target: Rural population 1st – 4th misconceptions quarter about cataract Methods: operations. Encourage school Mass media: children to go for vision tests. Continuation of NRHM weekly radio programme (15 minutes). Dubbing of 2 PSA into 5 major dialects. Newspaper advertisements, especially during prevention of Blindness Week, Eye Donation Fortnight & World Sight Day. 12 RNTCP To encourage Target audience : Rural population 1st – 4th people for AFB test quarter To reinforce that Methods: TB is Curable To create awareness Mass media: about completion of DOTS treatment. Continuation of NRHM weekly radio program (15 minutes) Production of 1 film and dubbing of 1 PSA into 5 major dialects. 13 IDSP Awareness about Target audience : General population 1st – 4th disease outbreak. quarter
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Methods:
Mass media:
Continuation of NRHM weekly radio program (15 minutes) Production and dubbing of 1 PSA into 5 major dialects. Translation and production of developed materials (1 leaflets, 1 hoarding). Newspaper advertisements (2 nos). 14 NIDDCP To use only Methods: 1st – 4th iodized salt & quarter store in airtight Mass media: container. Continuation of NRHM weekly radio program (15 minutes) Translation and production of developed materials (1 leaflet & 1 poster). Newspaper advertisements, especially during Global IDD Prevention Day. 15 NTCP Information about Target : General Public, school children 1st – 4th prohibition of quarter smoking in public Method: places. Discourage youth in Mass media: tobacco consumption. Continuation of NRHM weekly radio programme (15 minutes) Production of 1 PSA. Dubbing of 1 PSAs into 5 major dialects. Translation and production of developed materials (1 leaflet, 2 posters). Newspaper advertisements. 16 AYUSH To promote Target : General Public. 1st-4th quarter AYUSH services Method:
Mass media:
Continuation of NRHM weekly radio programme (15 minutes) Production & dubbing of 1 film and 2 PSAs. Newspaper advertisements. 18 Capacity building 2 Workshops on (i) reorientation of Communication Skills Half yearly and (ii) orientation of all Health Programmes for 3 days each. 19 M&E To strengthen M&E M&E at SPMU, DPMU & BPMU levels. Monthly activities. 20 Review Meetings Review meetings of District Media Officers at SPMU Quarterly
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Budget for Integrated IEC/BCC Activities 2011-12
No. Activity Number Proposed Rate Proposed Total Remarks Amount (in lakhs) 1.1 RCH - MH IPC Follow up in 1324 2000 26.48 Avg. cost per implementation of IPC village for FGDs. strategy Sensitization of three 1 x 3 30000 0.90 Tribal Women Organisations Mass Media: Production of PSA 2 100000 2.00 Print media (with 1 booklet x 5000 20 1.15 Avg. cost per translation) copies + 15000 item. (translation) for ASHAs ANMs and IEC/BCC Personnel. 3 Posters x 5000 + 3000 (translation) 30 4.53 copies each for Health Units and Health Workers.
Flex boards in Health 2 x 160 3600 11.52 Units on JSY & Services (4x6 feet) Outdoor media (with 11 25000 2.75 translation) Newspaper Advertisement 6 15000 0.90 6 half page advertisements MH Media Campaign: Publicity & district level 11 50000 5.50 Average cost per activities during safe district motherhood day
1.2 RCH - CH IPC
Development & 1324 2000 26.48 Avg. cost per implementation of IPC village for FGDs. strategy Mass Media: Production of PSA 2 100000 2.00 Print media (with 1 booklet x 5000 20 1.15 Avg. cost per translation) copies + 15000 item (translation) for ASHAs ANMs and IEC/BCC Personnel 3 Posters x 5000+ 3000 (translation) 30 4.53 copies each for Health Units and
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Health Workers. Outdoor media (with 11 25000 2.75 translation) Newspaper Advertisement 6 15000 0.90 6 half page advertisements Flex boards on correct way 2 x 160 3600 11.52 of breast feeding & care for new born (4x6 feet) CH Media Campaign: Publicity & district level 11 50000 x 2 events 11.00 Average cost per activities during newborn district care week & breastfeeding week
1.3 RCH - FP IPC Development & 1324 2000 26.48 Avg. cost per implementation of IPC village for FGDs. strategy Mass Media: Production of PSA 2 100000 2.00 Print media (with 1 booklet x 5000 20 1.15 Avg. cost per translation) copies + 15000 item (translation) for ASHAs, ANMs and IEC/BCC Personnel. 2 Posters x 5000+ 30 3.02 2000 (translation) copies each for Health Units and Health Workers. Outdoor media (with 11 25000 2.75 translation) Newspaper Advertisement 6 15000 0.90 6 half page advertisements Flex boards on various FP 1 x 160 3600 5.76 methods (4x6 feet) FP Media Campaign: Publicity & district level 11 50,000 5.50 Average cost per activities during World district Population day/week
1.4 RCH - ARSH IPC Adolescent clubs 11 25000 2.75 Formation & activities Debates, competitions etc 60 10000 6.00 1 day session in in schools & colleges 55 schools & 5 colleges Mass Media: Production of PSA 2 100000 2.00 Print media (with 1 booklet x 5000 20 1.15 Avg. cost per translation) copies + 15000 item (translation) for ASHAs, ANMs and IEC/BCC Personnel
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2 Posters x 5000+ 2000 (translation) 30 3.02 copies each for Health Units and Health Workers Outdoor media (with 11 25000 2.75 translation) Newspaper Advertisement 3 15000 0.45 3 half page advertisements Sponsoring/ co-sponsoring 11 50000 5.50 Sports & Music Events at Districts Pens, T-Shirt, Caps & 1100 x 4 80 3.52 Average cost per Book marks item
2. NRHM - Health Melas 11 500000 55.00
3. Additional Activities (Initiatives taken up) NRHM weekly radio broadcast Programme production 52 20000 10.40 Includes all DCPs cost Programme broadcast cost 52 2240 4.66 Weekly in 2 stations of AIR Kohima & FM Mokokchung Jingles broadcast cost 52 5040 10.48 Thrice weekly in AIR Kohima & FM Mokokchung. NRHM TV programmes & PSAs Programme telecast cost 12 2500 3.00 PSA telecast cost 24 13440 3.23 Twice a month in Doordarshan Kendra & local cables. Other initiatives: Integrated Health 11 4.00 44.00 Includes counseling Centres infrastructural (IHCCs) extension in DHs, furnishings, equipment. Newsletter 2 400000 8.00 Half-yearly Translation & dubbing of 24 15000 18.00 24 PSAs into 5 local dialects Translation & dubbing of 40 5000 10.00 40 radio jingles into 5 local dialects ‘Where there is no doctor’ 3000 x 4 languages 200 24.00 200 Rs/copy x 4 (translation & printing) local dialects into 4 languages (total 12000 copies) Print media booklets on 3 x 5000 copies 30 4.65 Avg. cost per NRHM, Roles & each + 15000 item Responsibilities of (translation)
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ASHAs, VHND (with translation) Transit media 220 3000 6.60 20 buses and taxis per district Utility bills advertisement 12 months x 40000 1 rupees 4.80 1 Advt/pm x 12 x in Kohima & Dimapur bills 1 rupee/bill Districts Newspaper Advertisement 3 15000 0.45 3 half page advertisements SMS Campaign 24 sms x 5 lac 8 paisa 9.60 SMS cost at 8 subscribers paise per/SMS for 24 SMS per/year to 5 lac subscribers. Strengthening of MSS 189 6530 12.34 Rs. 1530/unit x units in 3 districts 189 units x 5000 (maintenance & training) (for training)/unit
4. RI Mass media: Print media (with 1 booklet x 5000 20 1.15 Avg. cost per translation) copies + 15000 item (translation) for ASHAs ANMs and IEC/BCC Personnel 2 Posters x 5000+ 2000 (translation) 30 3.02 copies each for Health Units and Health Workers Outdoor media (with 11 25000 2.75 translation) Newspaper Advertisement 2 15000 0.30 2 half page advertisements Flex board in Health Units 1x160 3600 5.76 on Immunisation Schedule (4x6 feet)
5. NVBDCP
6. NLEP Mass Media: Production of 1 PSA 1 100000 1.00
7. NPCB Mass Media: Newspaper Advertisement 2 15000 0.30 2 half page advertisements
8. RNTCP short film 1 2.0 2.00 Production of 1 PSA 1 1.0 1.00
9. IDSP Mass Media:
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PSA 1 1.0 1.00 Print media (with 1 leaflets x 5000 + 10 0.55 Avg. cost per translation) 5000 (translation) item copies each for ASHAs ANMs and IEC/BCC Personnel
1 Poster x 5000 + 2000 (translation) 30 1.52 copies for ASHAs, ANMs and IEC/BCC Personnel Newspaper Advertisement 2 15000 0.30 2 half page advertisements
10. NIDDCP Mass Media: Print media (with 1 leaflets x 5000 + 10 0.55 Avg. cost per translation) 5000 (translation) item copies each for ASHAs ANMs and IEC/BCC Personnel 1 Poster x 5000 + 30 1.52 2000 (translation) copies for ASHAs, ANMs and IEC/BCC Personnel. Outdoor media (with 11 25000 2.75 translation) Newspaper Advertisement 2 15000 0.30 2 half page advertisements
11. NTCP IPC Anti tobacco awareness in 55 schools & 5 0.00 0.00 Integrated in the schools & colleges colleges ARSH school & College programme Mass Media: Production of 1 PSA 1 1.0 1.00 Print media (with 1 leaflets x 5000 + 10 0.55 Avg. cost per translation) 5000 (translation) item copies each for ASHAs ANMs and IEC/BCC Personnel. 2 Poster x 5000 + 4000 (translation) 30 3.04 copies for ASHAs, ANMs and IEC/BCC Personnel. Newspaper Advertisement 2 15000 0.30 4 half page advertisements
12. AYUSH
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Short film 1 3.0 3.00 PSA 1 1.0 1.00 Newspaper Advertisement 2 15000 0.30 2 half page advertisements
13. Capacity Building of existing and New IEC/BCC staff Quarterly Review 4 50000 2.00 Meetings
14. Special Needs as assessed to strengthen District & State IEC Units M & E 11 0.00 0.00 As per M&E framework in the state PIP
(Rupees Four Hundred Fifty Six Lakhs Ninety Three Thousand) only 456.93
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CONSOLIDATED BUDGET SHEET FOR MISSION FLEXIBLE POOL Required Physical Fund under Sl. No. Activity Unit Cost Targets NRHM Mission Flexible Pool B1 ASHA 10000 2584 B1.1 Selection & Training of ASHA 184.99 B1.2 Procurement of ASHA Drug Kit 20.67 B1.3 Incentive to ASHAs under JSY B1.4 Incentive under Family Planning Services B1.5 Incentive under Child Health B1.6 Other Incentives to ASHAs B1.7 Awards to ASHA's/Link workers 1.56 B1.8 ASHA resource center 51.20 Sub Total 258.43 B2 Untied Funds B2.1 Untied Fund for CHCs 50000 21 10.50 B2.2 Untied Fund for PHCs 25000 124 31.00 B2.3 Untied Fund for Sub Centers 10000 398 39.80 B2.4 Untied fund for VHSC 10000 1324 132.40 B.3 Annual Maintenance Grants B3.1 CHCs 100000 21 21.00 B3.2 PHCs 50000 124 62.00 B3.3 Sub Centers 10000 398 39.80 B.4 Hospital Strengthening B.4.1 Upgradation of CHCs, PHCs, Dist. Hospitals to IPHS) B4.1.1 District Hospitals B4.1.2 CHCs Pungro B4.1.3 PHCs B4.1.4 Sub Centers B4.1.5 Others Strengthening of District, Sub-divisional Hospitals,CHCs, B 4.2 PHCs B.4.3 Sub Centre Rent and Contingencies B.4.4 Logistics management/ improvement(PROMIS) 0.00 B5 New Constructions/ Renovation and Setting up CHCs ( Chozuba in Phek & Dhansiripar, Dimapur District B5.1 Longkhim in Tuensang & SANIS in Wokha Dist) B5.2 PHCs B5.3 Sub Centers B5.4 CHC Staff Quarters B5.5 PHC Staff Quarters B5.6 Setting up Infrastructure wing for Civil works B5.7 Govt. Dispensaries/ others renovations Construction of BHO, Facility improvement, civil work,BemOC B5.8 and CemOC centers 500000 11 55.00 B5.9 Major civil works for operationalisation of FRUS Major civil works for operationalisation of 24 hour services at B5.10 PHCs Civil Works for Operationalise Infection Management& B5.11 Environment Plan at health facilities B.6 Corpus Grants to HMS/RKS B6.1 District Hospitals 500000 11 55.00
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B6.2 CHCs 100000 21 21.00 B6.3 PHCs 100000 124 124.00 B6.4 Other for 2 TB hospitals & 1 Mental Hospital 500000 3 15.00 B7 District Action Plans (Including Block, Village) 60.00 B8 Panchayati Raj Initiative Constitution and Orientation of Community leader & of B8.1 VHSC,SHC,PHC,CHC etc 2232 400 8.93 Orientation Workshops, Trainings and capacity buildingof PRI at B8.2 State/Dist. Health Societies, CHC,PHC 3972 400 15.89 B8.3 Others B9 Mainstreaming of AYUSH B9.1 Activities other than HR 0 0 18.52 B10 IEC-BCC NRHM B.10 Strengthening of BCC/IEC Bureaus(state and district levels) 2.00 B.10.1 Development of State BCC/IEC strategy B.10.2 Implementation of BCC/IEC strategy B.10.2.1 BCC/IEC activities for MH 55.73 B.10.2.2 BCC/IEC activities for CH 60.33 B.10.2.3 BCC/IEC activities for FP 47.56 B.10.2.4 BCC/IEC activities for ARSH 27.14 B.10.2.5 Other activities (please specify) Details as per Text 174.21 B.10.4 Health Mela 500000 11 55.00 B.10.5 Creating awareness on declining sex ratio issue B.10.6 Other activities Integrated IEC of NDCP 34.96
B11 Mobile Medical Units (Including recurringexpenditures) 2060000 11 226.60 B12 Referral Transport B12.1 Ambulance/ EMRI 700000 19 133.00 B12.2 Operating Cost (POL) 16.68 B13 School Health Programme B 13.1 IEC 4.25 B 13.2 Drugs 11.87 B14 PPP/ NGOs B14.1 Non governmental providers of health care RMPs/TBAs B14.2 PNDT and Sex Ratio Public Private Partnerships (Continuing support to 3 Mission B14.3 Hospitals in Wokha Mokokchung & Zunheboto) 500000 3 15.00 B14.4 NGO Programme/ Grant in Aid to NGO 11 325.34 Othet innovations Partnership with Medecins Sans Frontiers B14.5 (MSF) for Mon District Hospital 7980000 1 79.80 Other innovations(Continuing support for Weaving a Dream- B14.6 Peoples Initiative) 8109000 1 81.09 B14.7 State PPP cell 280000 1 2.80 B14.8 Partnership with Police Department 4903000 1 49.03 B15 Planning, Implementation and Monitoring Community Monitoring (Visioning workshops at state, Dist, B15.1 Block level) B15.1.1 State level 6.81 B15.1.2 District Level 32.52 B15.1.3 Block Level 60.24
B15.2 Quality Assurance
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B 15 .2.1 Development of Standard Treatrment Guideline 1.00 B 15 .2.2 Publication & distribution of QA literature 24.00 B 15 .2.3 Workshop of health staff on QA 4.28 B15.3 Monitoring and Evaluation B15.3.1 Monitoring & Evaluation / HMIS Workshops 69.29 B15.3.2 Computerization HMIS and e-governance, e-health 56.52 B15.3.3 Other M & E (MCTS) 74.24 B15.3.3.1 Mobility Support (99.57+28.69) 128.62 B15.3.3.2 Forms & Registers 35.79 B15.3.3.3 M & E Studies 45.76 B.16 PROCUREMENT B16.1 Procurement of Equipment B16.1.1 Procurement of equipment: MH 111.72 B16.1.2 Procurement of equipment: CH 66.15 B16.1.3 Procurement of equipment: FP 59.78 B16.1.4 Procurement of equipment: IMEP 0.00 B16.1.5 Procurement of Others Dental Equipments for CHC 0.00 B16.1.6 Procurement ofXRay equipments & installation for CHC 0.00
B.16.2 Procurement of Drugs and supplies B.16.2.1 Drugs & supplies for MH 213.28 B.16.2.2 Drugs & supplies for CH 4.90 B.16.2.3 Drugs & supplies for FP 11.00 B.16.2.4 Supplies for IMEP 0.00 B.16.2.5 General drugs & supplies for health facilities 0.00 B.17 PNDT Activities 22.64 B.18 Regional drugs warehouses 0 0 0.00 B.18.1 State Warehouse 0 0 0.00 B.19 New Initiatives/ Strategic Interventions (As per State health policy)/ Innovation/ Projects(Telemedicine,Hepatitis, Mental Health, Nutition Programme for Pregnant Women, Neonatal) as per need (Block/ District Action Plans) B.19.1 NRHM Health Helpline 50.15 B.19.2 Medical Equipment Maintenance Unit 74.16 B.20 Health Insurance Scheme B.21 Research, Studies, Analysis (ASHA Intervention & JSY) 9.00 B.22 State level health resources center(SHSRC) B23 Support Services B23.1 Strengthening NPCB (Opthalmic Assistants) 0 0 0.00 B23.2 Strengthening of IDSP (power backup for Edusat) 250000 12 30.00 B23.3 Strengthening of UIP (R/Mechanic) 0 0 0.00 Strengthening of NSACS (Blood Component, Blood Bank Dimapur) 0 0 0.00 B23.4 Strengthening of Oral Health 61.84 B23.5 Strengthening of NTCP 45.64 B23.6 Strengthening of NMHP 52.82 B23.7 Strengthening of NPPCD 122.64 B23.8 B.24 Other Expenditures (Power Backup, Convergence etc) GRAND TOTAL (A) 3845.44
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NPCC RoP Approval for 2009-10 & 10-11 to be released in 2011-12 under civil works CHCs - Construction of 3 new CHCs (Chiephobozou, Noklak 175.5 & Tobu) @ Rs. 117.00 L as per Nagaland SOR Construction of 11 CHC Staff quarters @ 21.00 L 115.5 (Annexure CW1) PHCs - 13 PHC for new Construction @ Rs. 65.68 L as per 426.92 Nagaland SOR (Annexure CW1) Construction of 22 PHC Staff quarters @ Rs. 21.0 L 231 (Annexure CW1) Sub Centers - 50 Sub Centres for new construction @ Rs. 216.5 12.33 L, totalling to Rs. 616.50 L. (Annexure CW1) Construction of 3 Drug Warehouse (Longleng, Tuensang & Zunheboto) vide GoI letter No: M- 433 11011/4/09-NRHM-III dt 21st Dec 2009 Total (B) 1598.42 GRAND TOTAL (A+B) 5443.86
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CHAPTER 4C: IMMUNISATION
C.1: Situation analysis of the State Immunization Program The coverage analysis and comparison of all antigens in the state in the corresponding periods of April 2010 to November 2010 and reported coverage from April 2009 to November 2009 Verses April 2010 November 2010 has not shown any significant increase. The main reasons for these are (1) Sessions not being held per microplan (2) Less outreach session in the SCs and (3) Low awareness of benefits of immunization.
Sl. Name of Districts Yearly Target BCG Coverage OPV 1st Dose OPV 3rd Dose No (2010-11) (in numbers) Coverage Coverage
(in numbers) (in numbers)
- - -
2012 2012 2012
- - -
Infants Pregnant Women Aprl 10 10Nov 2011 Aprl 10 10Nov 2011 Aprl 10 10Nov 2011 1 Kohima 6711 7382 2615 2535 2313 2 Dimapur 9456 10400 4701 9359 3182 3 Mon 7975 8774 4019 4502 4205 4 Mokokchung 7102 7812 1121 1087 1082 5 Wokha 4933 5426 1405 1495 1344 6 Tuensang 5917 6508 2051 2445 2042 7 Phek 4534 4987 1590 1608 1594 8 Zunheboto 4710 5182 2476 3006 2006 9 Peren 2777 3054 773 1215 984 10 Kiphire 3055 3361 603 820 761 11 Longleng 3719 4092 991 752 553 TOTAL 60895 66984 22345 28824 20067
Sl. DPT 1st Dose DPT 3rd Dose Measles TT 2 + Booster Vita A -1st Dose JE-routine No Name Coverage Coverage (in Coverage Coverage (Wherever
of Districts (in numbers (in numbers) numbers) applicable)
- - - -
2012
-
Aprl 10 Aprl 10 Nov 2011 2012 10 Aprl 10 Nov 2011 2012 10 Aprl 10 Nov 2011 10 Aprl 10 Nov 2011 2012 10 Aprl 10 Nov 2011 2012 10 Aprl 10 Nov 2011 2012 1 Kohima 2535 2326 2189 1208 837 - 2 Dimapur 4678 3182 3539 1675 1387 127045 3 Mon 4479 4199 4080 2871 3855 - 4 Mokokchung 1086 1092 975 884 850 33118 5 Wokha 1409 1258 1028 680 993 - 6 Tuensang 2455 2042 2719 1512 2520 - 7 Phek 1612 1576 1390 824 1306 - 8 Zunheboto 2436 1556 2295 1570 1215 - 9 Peren 1124 847 721 554 297 - 10 Kiphire 884 745 765 242 82 - 11 Longleng 752 553 992 242 0 - TOTAL 23450 19376 20693 12020 13342 160163
Comparative performance of Routine Immunization for NagalandState Coverage Coverage Antigens April 2009 - April 2010 - Percentage Percentage Nov-09 Nov 2010 BCG 24709 41.30 22345 34.40
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DPT 1 27186 45.50 23450 39.20 DPT 2 25347 42.40 20834 34.80 DPT 3 23494 39.30 19376 32.40 DPT BD 17485 29.20 15066 25.20 OPV 0 0 0 8190 13.70 OPV 1 28870 48.30 28824 48.20 OPV 2 25569 42.80 21394 35.80 OPV 3 23961 40.10 20067 33.60 OPV BD 17708 29.60 15302 25.60 Measles 24160 40.40 20693 34.60 TT (P.W) 1 11813 17.90 12003 18.20 TT (.W) 2 11002 16.70 8045 12.20 TT (.W) BD 3980 6.00 3975 6.20 DT 5yrs 16530 28.10 14042 23.90 TT 10 yrs 20918 36.80 23752 41.80 TT 16 yrs 19190 35.40 22655 41.80 Vit A 1 9610 16.00 13342 22.30 Vit A 2 4957 8.30 7409 12.40 Vit A 3 4161 6.90 5265 8.80 Total Population=1990036, Infant = 59701, P.W = 65671, 0-5 yrs=278605, At 5 yrs = 58745, At 10 yrs= 56748, At 16 yrs = 54137.( 2001 Census )
Graphical representation over the years State comparative performance of R.I from April - Nov 2009 & April- Nov 2010. 35000
30000 28870 28824 27186 25347 25569 24709 23961 24160 25000 23450 23494 22345 21394 20834 20693 19376 20067 20000 17485 17708
15066 15302 15000
10000 8190
5000
0 0 BCG DPT1 DPT2 DPT3 DPT BD OPV 0 OPV1 OPV2 OPV3 OPV BD Measles
April 09 - Nov 09 Drop-out rate April 2009-Nov 2009 BCG - Measles = 2.2% April 2010- Nov 2010
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State comparative performance of R.I. from April - Nov 2009 & April - Nov 2010 25000 23752 22655
20918 19190 20000
16530
15000 14042 13342
11813 12003 11002 9610 10000
8045 7409
5265 4957 5000 3980 3975 4161
0 TT1 TT2 TT BD DT 5yrs TT10yrs TT16yrs VitA 1 VitA 2 VitA 3 April 2009-Nov 2009 April 2010- Nov 2010
To overcome these, the state plans to intensify the Village Health and Nutrition Days in every village with active co-operation from the Social Welfare, ICDS and School Education Departments. Awareness generation through mass media on the need and benefits to full immunization, where to avail immunization facilities, dispel doubts and misconceptions on immunization, will be taken up through the IEC Wing.
The districts will be set a specific target to achieve against each antigen and to reduce the drop-out rates by half. The target set will be double the coverage of the previous year. Compulsory field checks, supervision and monitoring by the DIOs will be mandatory to check false reporting.
To address the issue of drop-outs and left outs, the ASHAs, ANMs and AWWs will be mobilized to conduct house-to-house search of theses groups and mobilize them to the immunization sites. The Village Health Committees will be given the responsibility to oversee the exercise of tracking of drop-outs and left-outs.
C.1.1: Alternate Vaccine Delivery (AVD):- The health staffs of the sub-centres collect vaccines from the ILR storage points and return the unused vaccines back to the CHC/PHC. But some health units which have domestic refrigerators bought or donated, resort to storing the vaccines in them.
C.1.2: Routine Immunization Monitoring System (RIMS):- RIMS have not been installed in the state, but reports are being collected through the HMIS. Reports are inaccurate since validations at the reporting centres are not regularly done. Though all the health units have prepared microplans, many units are not carrying out the activities as per plan. Supervision and monitoring by the district nodal officers will be increased. All the DIOs have been provided with vehicles for this purpose. Over and above this an officer in the rank of Jt. Director has been assigned a district each to periodically monitor the district activities. The convergence and co- ordination with other departments is improving with the participation of the ICDS and school health departments during conduct of Village Health and Nutrition days. From the past experience in 2006-07 & 2007-08 when 13 Immunization Weeks were conducted and had shown an increase in coverage of all antigens since it was in a campaign mode. It
Nagaland SPIP 2011-12 141 is therefore proposed the six Immunization Weeks be conducted in alternate months in 2011-12 for which funding is required. The state has successfully conducted the JE vaccination campaign in the district of Dimapur and Mokokchung from 4th -14th October 2010 covering a target population of 177721. The coverage percentage of this campaign is 90.1%. Microplans for coverage of the cohorts under R.I. in 2011 are prepared. The state has also conducted the H1N1 vaccination covering 6687 health personnels in both the rounds. The state has planned to carry out the Measles catch-up campaign from 7th to 26th February 2011 in the district of Phek covering a target population 31031in the 9 months to 10yrs age group. Necessary training of ToTs, health workers have been completed at RRC Guwahati and district levels. Microplans for conduct of this exercise have been completed.
C.1.3: Status of Cold Chain:-
The walk –in-cooler (WIC) and the silent generator set supplied with it have been installed at the New Directorate Building by Blue Star company. But it has not been made functional / Operational by the company inspite of repeated reminders. It is requested that the MoHFW GoI take up the issue with Blue Star Company to make the WIC functional at the earliest. The state has also received the following cold chain equipments from the MoHFW. Plans for installation of these equipments are in place. Priority for installation of solar refrigerators is being given to CHCs & PHCs with frequent interruption of power supply. A technical assistant has been trained at Pune for installation of solar refrigerators. For want of resource persons, training of cold chain handlers is inadequate. Therefore it is requested that MoHFW depute resource persons in 2011-12 to carry out state level and district-level training for the cold chain staff. The state has only 9 (nine) Refrigerator Mechanics. Therefore it is proposed to recruit 3 (Three) qualified Refrigerator Mechanics two for newly created districts and one at state HQ with contractual pay of Rs. 10,000/month. This is necessary since some districts have frequent break-downs compounded by erratic power supply.
Table: Cold Chain Equipments Received in 2010-11 Sl.no Items Quantity 1 WIC 01 No 2 ILR (S) 25 Nos 3 ILR (L) Nil 4 DF (S) 25 Nos 5 DF (L) 15 Nos 6 Solar Refrigerator 20 Nos 7 Voltage Stabilizer 59 Nos 8 Freeze Tag 11 Nos 9 Rolson Pockets Tool Bag 4 Nos
C.2: Basic information of the State/UT related to Immunization Programme Position Name & Designation Contact No./Email State Immunization Officer Dr.M.Kire 9436004145 State Immunization Officer [email protected] State Cold Chain Officer Er. M.I.Yaden 9436208024 State Cold Chain Officer State Level Data Assistant Miss. Voseno 9774648904 Computer Assistant [email protected] District Immunization Officers No. of Districts - 11 No. of DIOs in position - 11 (DIO)
C.3: Beneficiaries details of pregnant women and children
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Sl.No Beneficiaries Target 2009-10 2010-11 2011-12 1 Pregnant women 66984 73854 74712 2 0 to 1 yr infants 60895 67140 67920 3 1-2 yr 46686 51477 52072 4 2-5 yr - - - 5 5 yr 59921 66065 66833 6 10 yr 57884 63819 64560 7 16 yr 55221 60883 61591
C.4: Details of Routine Immunization Sessions
Sl.No Routine Immunization Sessions 2009-10 April – Nov 2011-12 2010-11 1 Total Sessions planned 26544 26544 28542 2 Total Sessions Held NA 13681 28000 3 No. of Outreach Sessions NA NA 4776 4 No. of Fixed site sessions 553 560 560 5 No. of Sessions in Urban Areas 5712 7440 7500 6 No. of Sessions in Rural Areas 19056 19056 20000 7 No. of sessions in hard to reach areas 178 178 178 8 No. of session with hired vaccinators* NA NA 2136 9 No. of hired vaccinators* NA NA 2136 10 No. of villages where sessions are held 398 398 398 monthly 11 No. of villages (smaller) where sessions NA NA NA are held on alternate months 12 No. of villages where sessions are held NA NA NA quarterly
C.5: Existing Support to the States
Sl. Item Stock (functional) as on Requirement Remarks No 31st Dec’10 2009-10 2010-11 2011-12 1 Cold Chain Equipments - a WIC 1 No 1 No b WIF 1 No c ILR 134 Nos 30 Nos 20 Nos d) DF 145 Nos 20 Nos 20 Nos e Cold Boxes 40 Nos Nil Nil Nil f Vaccine Carrier 1000 Nos Nil Nil Nil g Ice Packs 3000 Nos Nil Nil Nil h Vaccine Van 1 No 9 Nos 11 Nos
2 Vaccine stock and requirement (including 25% wastage and 25% buffer) a TT 4994 vials 44762 vials 45288 vials 45814 vials b BCG 20 vials 8826 vials 11162 vials 11292 vials c OPV 630 vials 20777 vials 21022 vials 21266 vials d DPT* 3890 vials 52410 vials 53027 vials 53643 vials e Measles 2545 vials 22065 vials 22324 vials 22583 vials f Hep B - g JE (Routine) 3136 vials 22583 vials 3 Syringes including wastage of 10% and 25 % buffer
Nagaland SPIP 2011-12 143 a 0.1 ml 40225 Nos 89586 Nos 90639 Nos 91629 Nos b 0.5 ml 9356 Nos 895860 Nos 906390 Nos 916920 Nos c Reconstitution 127103 Nos 179172 Nos 81278 Nos 183384 Nos Syringes 4 Hub Cutters Nil 500 500 *Note: DPT is to be given instead of DT at 5 yrs once the current stock of DT Vaccine is exhausted
Additional Support required by the State UNIVERSAL IMMUNIZATION PROGRAMME (Rs. In lakhs) Expenditure & Achievement 2011-12 2010-11(till 15 Service 2009-10 Norms* jan’2011) Fund Delivery: require Target Remarks Exp Exp Achievement Achievement ment d d Mobility @Rs.50,000 per No of sessions No of sessions supportfor District for district Supervised Supervised supervision level officers (this 2.75 2.75 5.5 includes POL and Supervisory maintenance) per year CHC+PHC visits by state =144 + 11 and district No of districts No of districts DH + 398 level officers visited for RI visited for RI SC for monitoring By state level officers 11 1 review 0.5 review 1 and @ Rs.100,000 /year District supervision of RI 8 11 CHC+P @ Rs 500 per % Funds used % Funds used HC Cold Chain PHC/CHC per year =144 1.67 1.82 1.82 maintenance District Rs 10,000 per +11 year 100% 100% District s Hiring an ANM @Rs.300/session for No of sessions No of sessions four with hired with hired sessions/month/slum of vaccinators vaccinators Focus on slum 10000 178 & Population and 22.4 19.9 High underserved 29.9 Rs.200/- per month as 3 4 Risk areas in contingency per slum Areas urban areas: of i.e. total expense of NA NA Rs. 1400/- per month per slum of 10000 population. Mobilization of children No. of sessions No. of sessions @ Rs 150/session (for 17.2 15.3 through with ASHA with ASHA 23.8 all states/UT.s) 5 4 ASHA/ mobilizers Geographically hard to reach areas (eg. Session site>30 kms from No of sessions No of sessions
vaccine delivery point, with AVD with AVD river crossing etc.) @ Alternative Rs 100 per RI session Vaccine NE States and Hilly Delivery: 14.2 terrains @100 per RI 12.7 19.05 398 SCs 9 session For RI session in other areas @ Rs.50 per session. Support for State @Rs 12,000- @ 13200/ 0.72 1 1.59 1 Computer 15,000 p.m. Assistant for month 9.2 RI reporting Districts @ Rs 8000- No of C.A. in No of C.A. in @ 8800/ (with annual 9.68 11.6 11 increment of 10,000 p.m position position month
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10% w.e.f. 12 11 from 2010-11) Printing and dissemination of @ Rs 5 per beneficiary immunization 3.12 2.98 3.73 cards, tally sheets, monitoring 74712 (0-1yr) forms, etc. Support for QuarterlyState level Review Meetings of No of meetings No of meetings 4 Review district officers @ Rs Review held 1.65 held 1.65 Meetings 1250/participant/day Meetin for 3 persons g (CMO/DIO/Dist Cold Chain Officer) 0.92 3 4 Quarterly Review & feedback meeting for exclusive for RI at district level with one Block MO.s, ICDS CDPO and other 0.44 0.44 0.44 stakeholders@ Rs 100/- per participant for meeting expenses (lunch, organizational expenses) Quarterly review meeting exclusive for RI 10 at Block level @Rs 50/-pp as honorarium participant for ASHAs (travel) and Rs 25 per person at 1.56 1.08 1.98 s / blocks the disposal of MO-I/C for meeting expenses(refreshments, stationery and (21 CHC + misc. expenses) 123 PHC) No of persons No of persons Trainings trained trained District level As per orientationtraining for 2 revised daysANM, Multi Purpose norms for @ 350 / Health Worker (Male), Nil 1.75 1.75 trainings 500 HWs LHV, Health Assistant 48 under (Male / Female), Nurse RCH Mid Wives, BEEs & other specialist ( as per RCH norms) No of As per persons Three day training of revised No of persons No of persons trained Medical Officers on RI norms for 6.51 trained trained 6.75 using revised MO training trainings 450 @ module under 1500/ RCH 117 day As per One day refresher training of revised District RI Computer norms for Assistants on RIMS/HMIS 0.2 12 0.2 12 trainings and Immunization formats under under NRHM RCH One day Cold Chain As per handlers training for block No of revised No of persons No of persons level cold chain handlers by persons norms for trained trained 350/partici State and District Cold Chain Nil 1.1 1.1 trained trainings pant Officers and DIO for a batch under of 15-20 trainees and three 15/bloc RCH trainers k One day Training of block As per No of level data handlers by DIO revised persons and District Cold chain norms for No of persons No of persons 650/partici Nil 2.04 2.04 trained Officer to train about the trainings trained trained pant reporting formats of under 15 / Immunization and NRHM RCH block
Nagaland SPIP 2011-12 145
@ Rs 100/- per subcentre Microplanning (meeting 0.4 0.4 0.398 at block level, % of % of logistic) SC/PHC/CHC/D SC/PHC/CHC/D CHC+PHC For istricts have istricts have =144 + 11 consolida updated updated DH + 398 tion of microplans this microplans this SC micropla year year n at 0 1.66 1.66 PHC/CH To develop sub-center and C level PHC microplans using @ Rs bottom up planning with 1000/- participation of ANM, block ASHA, AWW & at district level @ 85% 100% Rs 2000/- per district Rs100,00 POL for vaccine delivery % Funds used % Funds used 0/ from State to District and 7.5 6.5 11 district/y from district to PHC/CHCs 68% 59% ear Consumables for computer @ 400/ - including provision for month/ 0.52 100% 0.52 100% 0.52 100% internet access for RIMS district
% %
Fun Fun Injection ds ds Safety used used
Red/Black @ Rs 100 100 Plastic bags 2/bags/ses 0.53 100% For % % etc sion 0.48 0.53 26544 sessions @ Rs 500 Bleach/Hypoc per 100 100 0.54 0.72 0.72 100% hlorite solution PHC/CH % % C per year @ Rs 400 per Twin bucket 0.43 1 0.57 1 0.57 1 PHC/CH C per year Any State 10 % of Specific Need % % total with Fun Fun For 144 amount of justification ds ds units approved (Please used used PIP provide a separate write- 3. R.M Ref up on @ mechanic 0 0 0 0 2.88 objective, Rs.8000 s strategy, /m expected output and @ Rs. 500/SC outcomes, I.Ws 0 0 0 0 11.9 basis for cost x 398 estimates etc.) SC Total fund projected = Rs. 144.07 Lakhs Proposal put up as per GOI publication of Revised Operating Manual for Preparation and Monitoring of RCH-II & Immunization component of NRHM State Program Implementation Plan (PIP).
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C.6 Consolidated Budget of Routine Immunisation Sl. Activity Unit Physical Required No. Cost Targets fund under
Routine Immunization C IMMUNISATION C.1 RI strengthening project (Review 114.348 meeting, Mobility support, Outreach services etc) C.2 Salary of Contractual Staffs 16.07 C.3 Training under Immunisation 11.84 C.4 Cold chain maintenance 1.82 C.5 Pulse Polio operating costs 0 TOTAL 144.078
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CHAPTER 4D: DISEASES CONTROL PROGRAMS
CHAPTER 4D-1: NATIONAL VECTOR BORNE DISEASE CONTROL (NVBDCP) Overview of diseases prevalence in the state: Table – 1 Disease situation in the state: Year Malaria Malaria Dengue Dengue Chikunkunya AES/JE AES/JE Microfilaria cases deaths cases deaths cases cases deaths rate 2009 8489 35 25 nil 0 9 2 0 2010 4959 14 0 0 0 24 6 0
Major VBD in the State: Malaria is endemic in 11 districts viz; Kohima, Dimapur, Peren, Mon, Kiphire, Phek, Mokokchung, Tuensang, Longleng, Wokha, Zunheboto. Dengue is endemic in 1 district viz; Dimapur AES including JE is endemic in 8 districts viz; Dimapur, Kohima, Peren, Wokha, Zunheboto, Longleng, Tuensang, Mokokchung The general strategy for prevention and control of Vector Borne diseases are:
Integrated vector control (IRS, Fish, Chemical and bio-larvicide, source reduction) Early diagnosis and complete treatment Behaviour Change Communication Vaccination only against J.E. Malaria National target: Annual Parasite Incidence of 1.3 and reduction in malaria mortality by 50% taking the base year of 2006.
1. Situation analysis of the disease: Population of the State: 1980597 Infrastructure Number
District 11 CHC 21 PHC 126 HSCs 398 Villages 1381 FTD 724 Rapid Response Team 4
2. District wise status of manpower (sanctioned & vacant) 2.1 Regular post: Regular post sanctioned In position Vacant
District malaria officer 11 10 1 Assistant malaria officer 4 4 0 Medical officer CHC – 42 42 0 PHC – 82 82 0 Other MO- 272 272 0 Senior malaria inspector 4 4 0 Malaria inspector 28 28 0 Surveillance inspector 40 40 Multipurpose health supervisor / Surveillance Worker 347 347 0
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Multipurpose health assistant or multipurpose worker
Lab tech 29 29 0 Zonal Entomologist 1 1 0 Asstt Entomologist 2 2 0 Insect Collector 8 8 0
2.2. Contractual:
Position Number Remarks
MPW (Contractual) 200 NVBDCP Lab tech 11 NVBDCP Consultants (district & state level) State - 2 NVBDCP District – nil Malaria technical supervisor 10 NVBDCP Project monitoring unit staff both at state and district level 4 NVBDCP
3. Epidemiological data for 2010: District wise
District Person positive pf No of ABER API PF % SPR SFR examined death
BSE RDT
KMA 22918 3265 540 160 0 10.32 2.43 29.62 2.3 0.69 PHK 14835 1314 157 4 0 10.89 1.15 2.5 1.05 0.02 WKA 17402 10270 367 126 0 10.15 2.14 34.3 2.1 0.72 MKG 24711 1388 1118 158 0 11.60 5.25 13.6 4.52 0.61 ZBT 20014 6072 129 23 0 15.44 0.99 17.8 0.64 0.1 MN 15166 2009 297 118 0 6.98 1.36 39.7 1.95 0.77 TSG 11812 57 127 21 0 5.98 0.64 15.5 1.07 0.17 DMP 24658 5813 1460 755 1 11.02 6.52 51.7 5.92 0.30 UMS 1631 0 304 209 11 0.94 1.76 68.75 18.63 12.81 KPH 3537 413 72 6 0 3.56 0.72 8.3 2.03 0.16 LNG 11923 1245 291 162 0 9.74 2.37 55.6 2.4 1.3 PRN 11619 6605 97 96 2 15.27 1.27 98.9 0.83 0.82 Total 180226 38451 4959 1838 14 9.09 2.5 37.0 2.75 1.01
3.1. Prioritization areas for intervention like deployment of RDK, ACT, IRS, LLIN which shown in the tables below:-
(a) IRS:
cide
-
District (No) PHCs for selected IRS Section SC/ (no) Village (no) selected Ppn Total selected Ppn Tribal squad Spray required (no) Training of batches squads spray Equipment (no) required (no) of Name insecti Insecticide required (MTs) DDT KOHIMA 13 17 35 82079 82079 13 3 26 DDT 18 MOKOKCHUNG 11 50 119 182873 182873 15 3 30 DDT 20 PEREN 4 8 11 14006 14006 4 1 8 DDT 6 MON 7 18 51 84204 84204 13 3 26 DDT 18
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WOKHA 8 13 58 78395 78395 9 2 18 DDT 12 TUENSANG 6 11 11 91412 91412 5 1 10 DDT 7 LONGLENG 3 11 13 42523 42523 4 1 8 DDT 6 ZUNHEBOTO 9 14 83 73101 73101 7 2 14 DDT 8 DIMAPUR 4 10 170 233971 233971 21 4 42 DDT 30 KIPHIRE 2 2 11 27976 27976 6 1 12 DDT 7 PHEK 14 17 27 23490 23490 6 1 12 DDT 8 TOTAL 81 171 589 934030 934030 103 22 206 140
(b) Bed nets: Number of Total bednets Required Total planned to be available in in the planne distributed in Total community current d to be Eligi- Eligi- the year as Trib Bednet based on year treated ble ble Eligibl per Name of al require household 2011 SC/ Villag e allocation the district popn d (No.) Sectio e popn. survey (No.) . n (no) (No) ITN LLIN ITN LLIN s s D=A- s s G=B+ (B+C) E A B C E F
KOHIMA 17 35 82079 82079 32832 5465 2800 24567 - 24567 5465 MOKOKCHU 18287 2630 - NG 50 119 182873 3 73150 2 2800 44048 44048 26302 PEREN 8 11 14006 14006 5602 1500 2800 1302 - 1302 4540 1289 2800 - MON 18 51 84204 84204 33682 2 17990 17990 12892 WOKHA 13 58 78395 78395 31358 859 2800 27699 - 27699 859 TUENSANG 11 11 91412 91412 36564 5224 2800 28540 - 28540 5224 LONGLENG 11 13 42523 42523 17010 3342 2800 10868 - 10868 3342 ZUNHEBOTO 14 83 73101 73101 29240 4918 2800 21522 - 21522 4918 23397 3244 - DIMAPUR 10 170 233971 1 93588 3 17000 44145 44145 32443 KIPHIRE 2 11 27976 27976 11190 761 2800 7629 - 7629 761 PHEK 17 27 23490 23490 9396 1080 2800 5516 - 5516 1080 93403 9478 TOTAL 171 589 934030 0 373612 6 45000 248226 - 248226 94786
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(c) ACT: Allocation of ACTS for Next Plan Year
Data latest complete year Allocation for Next plan year
District/ Total Pf. Cases Adults Children (40% of Pf cases)= B= (Ax0.40) PHC Population reported (60% of in Pf cases previous year Adult 9-14Yrs 5-8Yrs 1-4Yrs Under 1 yr ACT (38%) (30%) (22%) (10%) Blister
A Ax1.5 x B x 0.38 x B x 0.30 x B x 0.22 x B x 0.10 x 0.60 1.5 1.5 1.5 1.5
Kohima 221949 335 302 76 60 44 20 Mokokchung 212849 686 617 156 116 85 40 Dimapur 223621 721 648 164 129 95 43 UMS 172694 142 128 32 26 19 8 Peren 76063 63 57 14 11 8 4 Phek 136161 4 3 2 2 2 2 Wokha 171423 503 452 114 90 66 30 Zunheboto 129563 34 31 8 6 5 5 Mon 217214 266 239 60 47 35 15 Longleng 122313 76 68 17 14 10 5 Tuensang 197525 32 29 7 6 4 2 Kiphire 99222 5 3 2 2 2 1 TOTAL 1980597 2893 2577 652 509 375 176
(d) RDT District No. PHCs No. Sub-centre No. blood Expected RDTs for Total No.s to be where areas with examinations RDT buffer stock annual distributed RDTs are SFR>2% and in those sub- requirement in and RDT in to be used no. microscopy centre/PHC remote high distribution supply prioritized in result within 24 areas last Pf areas and to other [B+C] areas emergency h year (A) PHCs and [Ax areas: [B hours 1.25] (B) x0.20] (C) 75%
Kohima 14 7 1327 1662 335 1997 1497 Mokokchung 14 3 4065 5082 1026 6108 4581 Dimapur 8 12 19185 23978 4796 28774 21580 UMS 8 2390 2987 597 3584 2688 Peren 8 7 3756 4696 940 5636 4227 Phek 23 1 1595 1994 399 2393 1795 Wokha 12 5 3309 4136 827 4963 3702 Zunheboto 13 12 2393 2991 598 3589 2691 Mon 15 18 5779 7229 1450 8679 6510 Longleng 3 12 6259 7823 1564 9387 7040 Tuensang 11 20 826 1032 165 1197 897 Kiphire 4 4 1364 1705 341 2046 1534 Total 125 109 52248 65315 13038 78353 58742
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Dengue & Chikungunya:
1. Disease Situation: Dengue Chikungunya
Name Suspected Blood Positive deaths Suspected Blood Positive deaths remarks of cases sample cases cases sample cases district tested tested
KMA 0 0 0 0 0 0 0 0 PHK 0 0 0 0 0 0 0 0 WKA 0 0 0 0 0 0 0 0 MKG 0 0 0 0 0 0 0 0 ZBT 2 2 0 0 0 0 0 0 MN 6 6 0 0 0 0 0 0 TSG 10 10 0 0 0 0 0 0 DMP 2 2 0 0 0 0 0 0 KPH 0 0 0 0 0 0 0 0 LNG 3 3 0 0 0 0 0 0 PRN 0 0 0 0 0 0 0 0 Total 23 23 0 0 0 0 0 0
2. Specific constraints, newer strategy and innovations proposed for implementation of the programme: 2.1: Constraints Strategy Innovation proposed
Lack SS Lab. Surveillance for case detection. Setting up of SS Lab. at Dimapur District Hospital. Lack of facility for blood Training of lab. Technician Procurement of equipment for component separation in blood separation of blood component. bank.
2.2: Sentinel surveillance hospital (SSH) Name of Name of SSH Kits received from Samples received/ Found positive district Identified NIV, Pune/utilised tested
dng chk dng chk dng chk
Dimapur District Nil Nil Nil Nil Nil Nil Hospital Dimapur
2.3. Requirement for commodity: Sl Commodities required Requirement Balance Net required
1 Test Kits 2 nos Nil 2 nos 2 Hand operation fogging machine 2 nos Nil 2 nos 3 Pyrethrum extract 2% 100 lt Nil
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2.4: Financial Requirement for Dengue and Chikungunya: ( in lakh) Sl PARTICULARS 2010-11 Expenditure upto Balance 2011-12 2nd Qr Proposed
1 Capacity building & management 3.50 Nil 6.50 2 Sentinel surveillance at Dimapur Nil Nil 10.00 3 Epidemic preparedness Nil Nil 1.00 4 Integrated Vector management Nil Nil 2.00 5 Monitoring & Evaluation Nil Nil 1.00 6 Contingency grant for one lab Nil Nil 0.50 7 Contingency for emergency Nil Nil 1.00 hospitalization in case of out breaks for SSH. TOTAL 3.5 22.00
Acute encephalitis syndrome including Japanese Encephalitis: 1. Disease situation: Sl Name of district No of AES No of death No of sera/CSF No confirmed cases tested for JE
1 KMA 8 1 8 1 2 PHK 3 0 3 0 3 WKA 3 0 3 2 4 MKG 2 0 2 0 5 ZBT 2 0 2 1 6 MN 6 0 6 0 7 TSG 11 0 11 5 8 DMP 21 5 21 14 9 KPH 0 0 0 0 10 LNG 3 0 3 1 11 PRN 3 0 3 0 Total 62 6 62 24
2. Specific constraints, newer strategy and innovations proposed : Sl Name of Implementation Types of constraints Suggested Any new district level at which solutions innovations in the constraints light of constraints observed ( village, PHC, CHCs)
1 KMA Isolation of Pigs away Strengthening of More awareness of from human dwellings is awareness. community in the 2 DMA a problem inspite of endemic districts. 3 PRN CHC, PHC, awareness 4 WKA Villages Lack of facility for Incentive for 5 ZBT transportation of Transportation of transportation of
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6 LNG patients. patients to health patients through 7 TSG units for case NRHM flexi pool. management. Procurement by 8 MKG Difficulty to procure Procurement GOI from the insecticide larvicide by concerned firm State
3. Monitoring of functions of sentinel surveillance hospitals separately for Japanese encephalitis: NIL
a. Financial performance 2010-11 Disease Balance Committed Cash Cash State from expenditure assistance assistance resources previous from from NRHM years NVBDCP flexi fund
Malaria Domestic Budget Support 5.63 35.13 179.35 World Bank fund for project states - - Nil Nil GFATM fun for project States 8.96 104.78 156.04 Dengue Nil - Nil Nil Nil Chikungunya Nil - Nil Nil Nil AES including JE Nil - 10.00 Nil Nil Total 14.59 139.91 345.39
Annexure – I b. Financial Proposal for Vector Borne Diseases for 2011-12 Component (Sub-Component) Financial To be place in functional requirement (in Rs) head as per NRHM 2.1. Malaria : DBS MPW (200x7000x12) 168.00 Human Resources ASHA Honorarium (1195x350x12) 50.00 Hon. & Incentive Planning & Administration 44.00 Operating Cost IRS Indoor Residual Spray Operational Cost Spray Wages (515x2000x5 months) 51.50 Operating Cost Impregnation of Bed-nets Monitoring, Evaluation & Supervision & Epidemic 162.00 Operating Cost Preparedness including mobility Procurement of Bed-nets/LLIN IEC/BCC 57.70 IEC/BCC PPP/NGO activities Training/Capacity Building 6.60 Training Drugs Chloroquine phosphate tablets Primaquine Tablets Quinine Sulphate Tablets 10.00 Procurement Quinine Injections Sulphadoxine + Pyremethamine tablets RDT Malaria ACT GOI Supply N.A Insecticides DDT 50% wdp UMS- Larvicides Temephos, Bti (WP), Bti (AS), Pyrethrum extract 2% 4.00 Procurement
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Maintenance of Vech/Machines/M&E 6.00 Operating Cost Additional support under GFATM States State Project Management Unit Consultant (M&E)(1x0.40x12) 4.80 Human Resources Consultant (Finance) (1x0.30x12) 3.60 Human Resources Procurement & supply manager (1x0.35x12) 4.20 Human Resources Statistical Assistant (1x0.15x12) 1.80 Human Resources Secretarial Assistant (2x0.10x12) 2.40 Human Resources DEO (17x0.10x12) 20.40 Human Resources District Malaria Technical Supervisor (MTS) (51x0.15x12) 91.80 Human Resources LT (33x0.10x12) 39.60 Human Resources DVB Consultant (17x0.30x12) 61.20 Human Resources Training/ Capacity Building (MO & other staff) 20.90 Training Planning and Administration 34.39 Operating Cost Infrastructure and other Equipment (Computer Laptops, 38.20 Infrastructure printers, Motor cycles for MTS) Mobility support for Monitoring Supervision & review 43.40 Operating Cost meetings (including travel expenses, operational research, project evaluation etc) IEC/BCC activities 12.95 IEC/BCC Total Malaria (DBS+GFATM) 939.44 2.2: Activities for Dengue & Chikungunya Strengthening surveillance 5.00 Operating Cost Test kits(Nos) GOI Supply N.A Monitoring/Supervision and Rapid Response 2.00 Operating Cost Epidemic Preparedness 8.50 Operating Cost IEC/BCC/Social Mobilization 4.00 IEC/BCC Training/ Workshop 2.50 Training Total Dengue / Chikungunya 22.00 Activities for AES/JE Sentinel Sites which will include diagnostics and 6.50 Procurement management as well as supply of Elisa kits IEC/BCC specific to J.E.in endemic areas 2.00 IEC/BCC Training specific for JE prevention and management 1.80 Training LT/ JE Lab. 1.92 Human Resources Monitoring 2.20 Operating Cost Procurement of insecticides (Technical Malathion) 3.00 Procurement Total AES/JE 17.42
c. Total Functional head-wise breakup (NVBDCP) Human Resource 399.72 Training 30.00 Infrastructure 38.20 Procurement 23.50 IEC 84.65 Untied funds Honorarium & incentives 50.00 RKS Other Mission PPP/NGO Operating Cost 352.79 Financial aid/grant to institutions Grand Total 978.86
Nagaland SPIP 2011-12 155 d. Statement showing the budget District-wise breakup 2011-12 in respect of NVBDCP
4.1. DBS (Rs. In lakhs) Name of Contractual Incentives to IEC Training Epi Total Districts MPWs ASHAs for preparedness & identified districts M&E Kohima 38.64 2.13 2.50 0.55 8.0 51.82 Phek 26.88 5.52 2.50 0.55 6.0 41.45 Wokha 15.96 6.26 2.50 0.55 7.0 32.27 Mokokchung 16.30 7.54 2.50 0.55 8.0 34.89 Zunheboto 8.40 4.60 2.50 0.55 6.0 22.05 Mon 9.24 8.00 2.50 0.55 8.0 28.29 Tuensang 4.20 1.34 2.50 0.55 8.0 16.59 Dimapur 27.72 3.84 2.50 0.55 8.0 42.61 Kiphire 4.20 2.10 2.50 0.55 6.0 15.35 Longleng 5.04 3.23 2.50 0.55 6.0 17.32 Peren 10.92 5.44 2.50 0.55 6.0 25.41 UMS Dimapur - - 2.50 0.55 3.0 6.05 Total 167.50 50.00 30.00 6.60 80.00 334.10
4.2. GFATM: Name of Districts Human Resources M&E Others Total Kohima 25.20 2.20 3.36 30.76 Phek 10.80 2.20 3.36 16.36 Wokha 18.00 2.20 3.36 23.56 Mokokchung 21.00 2.20 3.36 26.56 Zunheboto 21.60 2.20 3.36 27.16 Mon 23.40 2.20 3.36 28.96 Tuensang 23.40 2.20 3.36 28.96 Dimapur 14.40 2.20 3.36 19.96 Kiphire 17.40 2.20 3.36 22.96 Longleng 17.40 2.20 3.36 22.96 Peren 17.40 2.20 3.36 22.96 UMS Dimapur 1.20 0.60 3.29 5.09 Total 211.20 24.80 40.25 276.25
JE Constraints Strategy Innovation proposed Isolation of Pigs away from human Strengthening of awareness. More awareness of community in dwellings is a problem inspite of the endemic districts. awareness. Lack of transportation of patients. Transportation of patients to health Incentive for transportation of units for case management. patients through NRHM flexi pool. Difficulty to procure insecticide Procurement Procurement by GOI from the larvicide by State concerned firm Dengue Lack SS Lab. Surveillance for case detection. Setting up of SS Lab. at Dimapur District Hospital. Lack of facility for blood Training of lab. Technician Procurement of equipment for component separation in blood separation of blood component. bank.
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CHAPTER 4D.2.: REVISED NATIONAL TUBERCULOSIS CONTROL PROGRAM
RNTCP performance indicators: Performance for the last 4 quarters i.e. July 08 to June 09
Annualized Total No of new Cure rate for Annualized New smear Plan for the next number smear cases total case positive year Proportion of TB of positive detected in detection case patients tested patients cases put the last 4 rate (per detection Cure for HIV put on on corresponding Annualized lakh pop) rate (per rate treatment treatment quarters NSP CDR lakh p op) (85%) 3809 172 1358 61/81% 91% 80% 90% 3809/1447(38%)
Section B – List Priority areas at the State level for achieving the objectives planned:
S.No Priority areas Activity planned under each priority area
1. ACSM 1 a) More Community Participation at local level through involvement of Women Groups 1 b) Generating Awareness of availability of DOT Plus treatment through various Media 2. Civil works 2 a) State Drug Store for Dots Plus 2 b) Dots Plus site at Dimapur and Kohima 2 c) 11 nos of District Drugs Stores for DOTS Plus 3. Training 3 a) Training and Retraining of MOs, LTs, DOT Providers, PHIs, PTA and DEOs and other staff 3 b) Training/Sensitization of Partner NGOs
Priority Districts for Supervision and Monitoring by State during 2011-12
Sl. No District Reason for inclusion in priority list
1. Longleng Poor Performing District 2. Phek Poor Performing District 3. Zunheboto Poor Performing District
Section C – Consolidated Plan for Performance and Expenditure under each head, including estimates submitted by all districts, and the requirements at the State Level 1. Civil Works No. No. No. Pl provide Estimated required already planned justification Expenditure Quarter in which the as per upgraded/ to be if an on the Planned activity Activity the present in upgraded increase is activity expected norms the state during planned in to be completed in the next excess of state financial norms (use year separate sheet if required) STDC/ 1 1 0 97,500 As per guidelines
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SDS 1 1 1 1,95,000 For Dots Plus DTCs 11 11 0 1,00,000 As per guidelines TUs 13 13 0 30,000 As per guidelines DMCs 46 43 3 2,00,000 Teninig, Woziho and Satakha Dist.Drug 11 0 11 4,29,000 For DOTS Plus Stores DOTS Plus Site 1 1 13,00,,000 As per Guidelines TOTAL: 23, 51,500
2. Laboratory Materials Amount Amount Procurement Estimated Justification/Remarks Activity permissible actually planned Expenditure for for as per the spent in the during the the next (d) norms in last 4 qrts current Financial year for the state financial year which plan is (in Rupees) being Submitted (Rs.) Purchase of Lab 18,59,775 23,65,000 25,00,000 Materials by Districts
3. Honorarium Amount Amount Expenditure (in Estimated Justification/ Permissible as actually Rs) planned for Expenditure for Remarks for(d) Activity per the norms spent in the current the next financial in the state last 4 financial year year for which quarters plan is being submitted (Rs.)
Honorarium for 15,53,750 20,00,000 DOT Providers 25,00,000 (both tribal and non tribal districts
No. presently involved in Additional enrolment proposed for the RNTCP next fin. year Community volunteers in all the 1200 300 districts*
4. ACSM
Annual Action Plan Format Advocacy, Communication and Social Mobilization (ACSM) for RNTCP 1) Information on previous year’s Annual Action Plan a. Budget proposed in last Annual Action Plan: Rs.10,64,600 b. Amount released by the centre: Rs.8,60,000/- c. Amount Spent by the State- Rs.8,58,460/- 2) Permissible budget as per norm : …………………… 3) Budget for next financial year for the district as per action plan detailed below: Rs.13,57,600
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These community volunteers are other than salaried employees of Central/State government and are involved in provision of DOT e.g. Anganwadi workers, trained dais, village health guides, ASHA, other volunteers, etc. Program WHY For WHAT When By WHOM Budget challenges ACSM WHO ACSM Activities Time Frame Monitoring and as to be Objectiv M Evaluation tackled by e Target Evidence that the ACSM Audien activities have during the ce been done year 2010- 11 Based on Desired Activiti Media/ Q Q Q Q Key Outcom Total existing TB behavior es Materi 1 2 3 4 outputs, es: expendit indicator & or action al impleme ure analysis of (make Requir nter & Evidenc during communica SMART: ed RNTCP e that it the tion specific officer has financial challenges measurea responsib been year (Maximum ble, le for done 3 achievabl supervisi Challenges e realistic on. ) & time bound objectives Evidence that the activities have been done
Challenge 1. Treatment Adherence
State Garner School World Power 1 no WHO Press More Cost on support teacher TB point consulta Release attention world TB Level from s, Day/ Presen nt STO, Documen to TB in day Rs education college Senziti IEC ts, Photo Education 70,000 al Lectur z Tation, Officer al institutio es Files Cirricula ns in ation m Fact fighting sheet the Prizes disease Appeal Letters, Flip Charts, Pamphle ts
Distric Garner School World Power 1X11 DTO & Press More Cost on ts support teacher TB point Dsitric staff, Release attention World TB from s, Day/ Documen to TB in day
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education college Senziti Presen ts STSs ts, Photo Education 20,000X1 al Lectur z al 1= Rs institutio es Tation, Cirricula 2,20,000 ns in ation Files m fighting Fact the sheet disease Prizes Appeal Letters, Flip Charts, Pamphle ts
Communication Activities:
Informat Audio Cable TV 12 12 12 12 STO, Photo Decrea Cost of ion Visual Local IEC s, se in prod + Commun Channels O News Defaul Cost of ities at paper t cases transmissi large Clipp by on = about ings, atleast 15,000 + importan docu 3% (250x624) ce of ments among = Rs completi Retire 2,20,000/- on of TB ment Treatme & EP nt cases (Quart erly Report Genera s) l Print Newspaper 1X2 1X 1X 1X Cost per public Media Adv, Mag paper 2 2 2 Decrea Adx No Adv s pap pap pap se in of times= ers ers ers Defaul 7000x10= t cases Rs.70,000 Photo by s, atleast News 3% Print Booklets 11 paper among Cost per Media distri Clipp Retrea Booklet x cts ings, tment No of docu and EP copies= ments cases( 50x1000= Quarte 50,000 rly Bus Panel 30 DTO Report No of Hoardi Hoarding buses & s) busesx Staff, Cost per
Nagaland SPIP 2011-12 160
ng CF bus= 30x2500 =Rs75.00 0
Seek support Cost of & Early activityx commit Report No of ment Power ing of Districts from Wome point DTO Chest 2x11x500 various n folk, presentatio s, Pics, sympt 0 = women Church Senziti n,pamphlet STSs Docu omatic Rs.1,10,0 groups leaders zations s 1 1 , CFs ments s 00/-
Private Practiti Powe Early oners/ r Reporting 1. NGOS point of Chest Sensiti /Ward , Newsp symptoma se Key leaders Book STO, aper tics, More person of lets, IECO Clippi involvem nel at differe Pamp , ngs, ent of State& nt CMEs/ hlets, DTOs Photos NGOS in District localiti Sensitizatio Poste ,CFs, ,docu various level es ns rs 1 STSs ments Schemes
1. Active Motivate partici Patients/ pation Relatives 3x 3x 3x of for No No No patient treatmen of of of Quart and IPC= No t Patient IPC/ 3x D D D erly relativ cost Adheren s, Patient No M M M Repor es in Patient ce Relativ s of CS CS CS ts, spread Provider es, Provid DMC per per per Photo ing Meeting = DOT er Booklets, S per Dis Dis Dis DTO s, messa 300x46x1 provid Meetin Information Distri tric tric tric ,STS Minut ge on 2= Rs. ers g Brochure ct t t t s es TB 1,65,600/-
Social Mobiliz ation
1. Increa Cost of Mobilise Quart se in Communi Support NGOs, erly Aware ty from PRIs, Comm White DTO Repor ness Meetings Commun Local unity boards,Mar s, ts, level = ity Comm Meetin ker, STSs Photo among 2000x11x unity gs Pamphlets 3 3 3 3 ,CFs s the 2= Comm Rs.44,000
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unity /-
2.Partici More pation as Health volunt DOT worker ary Cost of provider s, Quart DOT Meetings s Cured erly provid = patient Comm DTO Repor er in 1000x11x s, unity Booklets, s, ts, the 2= Volunt Meetin Information STSs Photo Comm Rs.22,000 eers gs Brochure 1 1 ,CFs s unity /-
Communication Facilitator 2 Nos No of CFsx12 months x salary=2x12x10,000=2,40,000
TOTALRs.13,57,600/-
5.Equipement Maintenence Estimated Expenditure Amount Amount for the next No. actually actually Proposed for Justification/ financial year Item present in spent in Maintenance Remarks for for which plan the district the last 4 during current (d) is being quarters financial yr. submitted (Rs.) (a) (b) (c) (d) (e) Office Equipment 17 computer 5,89,575 8,39,700 9,50,000 As per (Maintenance includes sets guidelines computer software and 8 OHP hardware upgrades, repairs of photocopier, fax, 8 Photostats OHP etc) 1 Fax
Binocular Microscopes ( 57 1,11,150 85,500x1.3 RNTCP) Total 10,61,150
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6. Training Training No. No. No. planned to be Expenditure (in Estimated Justification/ Activity in the already trained in RNTCP Rs) planned for Expenditure for remarks state trained in during each quarter of current the next RNTCP nextQ1 FYQ2 Q3 Q4 financial year financial year (c) for which plan (a) (b) (d) is(e) being (f) Training of submitted DTOs/STO ( 4 2,00,000(Rs.) National Level) Training of 11 40,000 MOTC Training of 25 30 24 5,00,000 MOs of DMCs- TrainingGovt + Non of LTs 10 15 10 1,00,000 ofGovt DMCs - Govt + Non Govtg of MPWs 30 30 30 33 2,00,000 Training of 50 50 50 50 2,00,000 MPHS, Trainingpharmacists, of 30 30 30 30 3,00,000 Commnursing staff, TrainingVolunteersBEO etc of Pvt 15 15 1,00,000 Practitioners Re- training of 11 11 80,000 Part Time ReAccountants- training of& 28 28 1,60,000 MOsDEOs Re - Training of 11 30,000 LTs of DMCs Re- Training of
MPwS Re- Training of 25 25 100,000 Pharmacists Re- Training of 50 50 50 50 3,00,000 nursing staff, ReBEO- Training of
CVs Re-training of 13 13 60,000 STLS&STS TB/HIV 30 30 1,20,000 Training of TB/HIVMOs
Training of TB/HIVSTLS, LTs ,
TrainingMPWs, MPHS, of STS TrainingNursing Staff,of 50 50 50 50 3,00,000 DOTCommunity provider Review&Volunteers ASHAS etc 1 1 1 1 2,00,000 Meetings at State Level Total 29,90,000
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7. Vehicle Maintenance:
Type of Number Number Amount Expenditure Estimated Justification/
Vehicle permissiblea actuallyb spentc on (ind Rs) Expendituree remarksf
Four Wheelers as per the present POL and planned for for the next Two Wheelers 11 8 14,02,580 23,79,000 As per norms13 in 13 Maintenance current19,82,500 financial year Guidelines
the state in the financial for23,79,000 which plan 8. Vehicle Hiring*: TOTAL previous 4 year is being Hiring of Four Number Number Amount Expenditure(in Estimated Justification/ permissible actually quarters spent Rs) submitted Wheeler a b requiring c inthe d eExpenditure f remarks For STC/ 1 as per the hiredvehicles 10,72,280 19,42,000planned for 2,55,000(Rs.) for STDCFor DTO 3norms in the prev. current 9,18,000 For MOTC 13 state 4qtrs 11,13,840the next STC for Drugs financial year 7,00,000financial transportation 29,86,840 toTOTAL DTCsVehicle Hiring permissible only where RNTCP vehicles have not been provided year for which
9.NGO/ PP Support: NGO/ PP Support: (New schemes w.e.f. 01-10-2008) plan is being
No. Of Additional Amount Expenditure (in Estimatedsubmitted Activity currently enrolment spent in Rs) planned for Expenditure for Justification/ (Rs.) Involved in planned for the current the next remarks RNTCP this year previous 4 financial year financial year quarters for which plan is being submitted (Rs.) ACSM Scheme: 1 million 3 3 45,000 90,000 1,20,000 TB advocacy, population communication, andSC Scheme: Additional 3 14 3 84,000 84,000 socialSputum mobilization Collection 10,20,000 NGOs for next Centre/s year Transport Scheme: Additional 3 Sputum Pick-Up 14 3 3,36,000 3,36,000 4,08,000 NGOs for next and Transport year ServiceDMC Scheme: Additional 2 1 2 1,50,000 1,50,000 4,50,000 Designated next year Microscopy CumLT Scheme: Treatment CentreStrengthening 0 0 0 0 (ARNTCP & B) diagnosticCulture and services DST Scheme: Providing 0 0 0 0 Quality Assured CultureAdherence scheme: andPromoting Drug 0 0 0 0 Susceptibilitytreatment TestingadherenceSlum Scheme: Services Additional 2 Improving TB 1 2 1,00,000 1,00,000 3,00,000 (1,00,000 control in Urban population) SlumsTuberculosis Unit Model
TB-HIV Scheme: 1,20,000x5 1 4 1,20,000 1,20,000 6,00,000 Delivering TB-HIV NGOs interventions to highTOTAL HIV Risk groups (HRGs) 28,98,000
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10. Miscellaneous: Activity*e.g.TA/DA, Amount Amount Expenditure (in Estimated Justification/ permissible as spent in Rs) planned for Expenditure remarks Stationary, etc per the norms previous 4 current for the next in the state qrts financial year financial year (Rs.)
a b c d e 27,99,760 30,00,000 33,00,000 Total 33,00,000
11. Contractual Services: Category of Staff No. No. No. Amoun Expenditur Estimated Justification permissibl actuall planned to t spent e (in Rs) Expenditure / remarks (a)e as per (b)y (c)be in the (d)planned for (e)for the next the norms present additionall previou current fin. financial year Asst. Program Officer 1in the state in the 1y hired s 4 year 5,04,000(Rs.) state during this quarters TB/HIV Coord. 1 year1 4,41,000 MO-STCS 2 1 1 7,74,000 MO-STC Accounts Officer 1 1 2,46,600 +Sr.M.O for DOTS IEC Officer 1 1 2,46,600 Plus Ste Pharmacist/Storekeep 1 1 1,51,200 Storeer Assistant(SDS) 1 1,00,800 Secretarial Asst 1 1 1,15,200 MO-DTC 2 1 1 7,39,200 STS 13 22,15,200 STLS 13 13 22,15,200 TBHV 13 2 2,29,200 DEO 2 12 13,66,200 Accountant – part 12 11 4,35,600 Contractualtime LT 11 11 12,34,200 Driver 8 8 7,39,200 Statistical Asst 1 1,80,000 DOTS Sr.DOT Plus&TB-HIV 11 11 19,80,000 DOTSPlus Ste TotalSupervisors 1,39,13,40 Plus Ste 0 12. Printing: Activity Amount Amount Expenditure (in Rs) Estimated Justification/ spentin the planned forcurrent Expenditure permissible financialyear forthe next remarks as previous 4 financial
per the quarters year for which norms plan is being
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in the state submitted(Rs.)
a b c d e Printing- 3,74,620 11,25,000 12,00,000 State level:* Printing- District level:* Total 12,00,000/-
13. Procurement of Vehicles:
Equipment No. actually present No. planned for Estimated Justification/ (a) in the state (b)procurement this (c)Expenditure for the (d) remarks year (only if next financial year 4-wheeler ** 8 0 permissible as per 0 for which plan is norms) being submitted 2-wheeler 13 0 0 (Rs.)
14. Procurement of Equipment Equipment No. actually No. planned for Estimated Justification/ remarks present in this year (only Expenditure for the the state as per norms) next financial year for which plan is being submitted (Rs.)
Office Equipment Replacement is urgently (Computer, required to cater to the modem, scanner, needs of all official works printer, UPS etc.) Photostat 16 11 50,000 X 11= Replacement of Old Machines 5,50,000 Photostat Machines i.e 7Disricts and STC as Modi Xerox XD100 model is out dated LCD 8 8 12,00,000 Replacement 1,50,000 x 8 nos. 1 1 1,00,000 Total 18,50,000
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Section D: Summary of proposed budget for the state: Category of Expenditure Budget estimate for the coming FY 2011 - 2012 (To be based on the planned activities and expenditure in Section C) 1. Civil works 23,51,500 2. Laboratory materials 25,00,000 3. Honorarium 25,00,000 4. IEC/ Publicity 13,57,600 5. Equipment maintenance 10,61,150 6. Training 29,90,000 7. Vehicle maintenance 23,79,000 8. Vehicle hiring 29,86,840 9. NGO/PP support 28,98,000 10. Miscellaneous 33,00,000 11. Contractual services 1,39,13,400 12. Printing 12,00,000 13. Research and studies 0 14. Medical Colleges 0 15. Procurement –vehicles 0 16. Procurement – equipment 18,50,000 Total 4,12,87,490
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CHAPTER 4. D.3: NATIONAL PROGRAM FOR BLINDNESS CONTROL
Nagaland state is located in the north Eastern part of India between 25º6 to 27º 40 latitude north of equator and 93º20 to 95º 15 East. It has a area of 16579 Sq.km with a population of 19, 88,636 (2001 census).The density of population is 120/sq.km with 82.26% of rural and 17.74% of Urban population. Literacy rate of the state is 67.11% (2001). State has eleven district namely Kohima, Mokokchung, Tuensang, Mon, Zunheboto, Wokha, Phek, Dimapur Kiphire, Longleng and Peren district. Prevalence of Blindness in the State of Nagaland is 1.05% (Rapid assessment of Blindness in the States of North East India 2003).
NagalandState is hilly with difficult terrain and communication in most part of the State is difficult. Connectivity between the State capital and the District Headquarter has improved considerably in recent times, but District Headquarter like Mon has to pass through more than 300 Km of the neighboring State of Assam to reach the State capital. Inter district communication is bad and connectivity between the District Headquarter and the villages are poor.
Situation Analysis of: (a) Health Units (b) Ophthalmic Manpower (c) Infrastructure and (d) Equipments.
Health Units in Nagaland.
District Hospital - 11 Nos Community Health Centre - 21 Nos Primary Health Centre - 124 Nos Sub Centre - 398 Nos
Ophthalmic Man Power:
Out of eleven District Hospital Nine District Hospital has got one Eye Surgeon and one Para Medical ophthalmic Assistant each (Annexure -I). There are DistrictHospital which does not have eye surgeon and only manned by PMOA. Eye Surgeon are not available for contractual employment in the state. Out of 21 CHC all CHC are having PMOA except Aghanato CHC. 7 PHC are having PMOA out of 128 PHC. (Annexure ii).
More Para Medical Ophthalmic Assistant are required to covered the uncovered /unreached area for screening of Cataract and other major Blinding Eye Diseases. NRHM is requested to provide some PMOA on contractual basis in places like Niuland, Tening, Tsurangkong, Aghanato and Noksen.( Annexure iii).
Infrastructure:
District Hospital Mokokchung and DH Dimapur has got dedicated eye O.T and 10 (ten) bedded Eye ward and in District Hospital Phek another Eye O.T and Eye ward is completed and is going to inaugurated soon . Another Eye O.T and Ten bedded ward is under construction in District Hospital Tuensung. One more Eye O.T. and ward is required at District Hospital Mon which is a backward District in Nagaland .All the periphery Health Units where PMOA is posted are not having dark for refraction.
Equipments:
Ophthalmic equipments and instruments for Cataract surgery and basic Eye operation are available in most of the DistrictHospital where Eye Surgeon are posted. But due to not having separate Eye O.T and Eye ward service delivery is not satisfactory.
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Achievement of National Programme for Control of Blindness Nagaland during 2008-09, 2009 -10, 2010-11. Sl. Activity 2008-09 2009-10 2010-11 (upto no nov’10)
1 Total no. of Cataract surgery 1048 (69.86 1046 (69.73%) (1500 target 621 done %) given) 2 Total no. of Cataract IOL 1031 1027 (98.18%) 606 done (98.37%) 3 Total no. of School children 16, 904 10,222 14,800 examined 4 Total no. of School children 2,217 1721 2369 with ref. error 5 No. of children provided with 389 x 185 glass 6 Total no. of Teachers trained 150 88 156 7 Total no. of Ophthalmic x 24 x Assistant trained in Refresher Course 8 Total no. of Ophthalmic 4 4 x Nurses trained 9 Total no. of ASHA trained x 200 174 10 Total no. of Minor Surgery 874 751 460 11 Total no. of Major Surgery 49 28 32 12 Total no. of Refractive Error 5899 4,676 3, 690 detected 13 Total no. of Eye Cases 27,157 24,226 18,591
Physical Target during 2011-2012
(A). Cataract Surgery: Target 1750, (IOL= 1575, Woman = 962, Bilat. Cataract = 875, SC / ST= 875)
District wise Cataract Surgery target during 2011- 2012 Districts Hospital Eye Camp Total Kohima 250 50 300 Mokokchung 100 50 150 Tuensang 100 50 150 Mon 100 50 150 Zunheboto 100 50 150 Wokha 100 50 150 Phek 100 50 150 Dimapur 250 50 300 Kiphire x 50 50 Longleng x 50 50 Peren 100 50 150 1200 550 1750
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(B) Other Eye diseases: Eye diseases like Glaucoma, Diabetic, Retinopathy and Laser Techniques, Childhood Blindness (Squint) at least 10 cases of the above mentioned diseases will be targeted in all the District Hospital where Eye Surgeons are posted.
(C) School Eye Screening: All eleven District will Screen at least 3000 Student during the year 2011-2012 (3000X11=33,000). At least 1500 Spectacles will be given to the students having refractive error.
(D) Trainings- Eye Surgeons: At least 3 (three) Eye Surgeon will be train in different sub speciality of ophthalmology like ECCE, IOL, SICS, Phaco- emulsification, Retina, Low vision etc which will be conducted by GOI. District Programme manager: Programme specific DPM training will be made to attend if such training is conducted by GOI. Training of Medical Officers in Community Ophthalmology: 54 MOs from 24x7 CHC/PHC in 2 batches will be trained for 3 days in Community Ophthalmology. Training of Staff Nurses in Ophthalmic Technique – 2 Staff Nurses from each district will be trained in ophthalmic technique. (2 x 11= 22 Nurses) for 1 month at NHAK. Orientation Training of Ophthalmic Assistant: Para Medical Ophthalmic assistant (Regular +Contractual) will be trained for 6 days (29 + 12 = 41) as per GOI guideline. Teachers Training on School Eye Screening for 1 day : 50 Teachers per District will be train during 2011- 2012 (50 x11 = 550) Health Worker Training for 1day: At least 50 Health workers like ANM, MPW ASHA, AWW will be train during 2011-2012 (50 x 11 = 550)
(E). Information Education and Communication: Electronic Media (20%): Local cable operator at Kohima, Mokokchung and Dimapur or any District Headquarter where such facilities are available will be utilized for telecasting Eye Health awareness programmes. Print Media (20%): During important occasion like Prevention of Blindness week (April 1-7), Eye donation fortnight ( 25 Aug- 8 Sept ) and World Sight Day (Second Thursday of every year). Print Media advertisement will be utilize in local dailies like Nagaland Post, Eastern Mirror, Morung etc.
Out Door Publicity (30%) : Like wall Painting , Hoardings, unipole etc at prominent places, Local Level IEC (30%): IEC activities involving NGO, Health Workers, Private practitioners ASHA, School Teacher and Folk dances.
(F) Strengthening of facilities 1. Dedicated eye OT and 10 bedded wards -1 Nos, where Eye surgeons are posted and are working without proper operation theatre for eye so it is proposed to construct One Eye O.T+10 bedded ward at DH Mon during 2011-2012. 2. DistrictHospital strengthening for cataract surgery (ECCE, SICS, Phaco-emulsification) with IOL implantation- It is proposed to strengthen two (2) DistrictHospital namely – Tuensang .and Mon. 3. Vision Centre: Five (5) more vision centre is proposed to set up during 2011-2012 – Namely 1. Niuland PHC - District Dimapur 2. Tenning PHC – District Peren 3. Aghanato CHC – District Zunheboto 4. Tsurangkong PHC – District Mokokchung 5. Noksen PHC – District Tuensang
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NATIONAL PROGRAMME FOR CONTROL OF BLINDNESS GRANT IN AID TO STATES FOR VARIOUS COMPONENTS DURING 2011-2012 ( Rupees in Lakhs)
Physical Fund Target Required i. Cataract Operation @ Rs. 750/- 1750 13. 125 ii. Other Eye diseases @ Rs. 1000/- 100 1 .00 iii. SES Spectacle @ Rs. 200/- 1500 3 .00 iv. Management of state Health Society NPCB 7 .00 v. Management of District Health Society (A) a) Mobility support to DPM Rs. 2000 x 12 x11 Recurring = Rs. 2. 64 Grant in Aid b) Consumables @ Rs. 2000 x 12 x11= Rs. 2. 64 11 District c) Field visits / Screening @ Rs.20,000 x 11 = Rs. 2.20 d) Formats & Reports @ Rs. 10,000 x 11 = Rs. 1.10 e) Remuneration & Contingency Rs. 1.00 x 11 = Rs. 11.00 19 . 58 vi. Trainings. Training of 50 Health Personal per District.@ Rs 50,000 x 11= Rs. 5.50 550 Training of 50 teachers district @ Rs. 40,000 x 11 = Rs. 4.40 550 Training of other personal PMOA ect. Rs. 1.00 2 Times 10. 90 Rs 20 vii. Procurement of Equipment @ lakhs 2 District Hospital 40. 00 viii. Asha incentive @ Rs 175 for Cataract 900 1. 575 ix. NGO/ PP. Payment for Programme activities 2 NGO 1. 00 x. IEC/ BCC activities on cataract , other eye disease and 1 10. 00 eye donation in the state xi. Maintenance of ophthalmic equipment for whole state 1 5 .00 112. 18 (B) Non Vision centre @ Rs 50. 000/- 5 2 . 50 Recurring Grant in Aid Eye ward & Eye O.T @ Rs 75 lakhs 75 . 00 77 . 50
(C)Contract Ophthalmic Surgeon salary Rs. 25000/- 3 9. 00 ual manpower Ophthalmic Assistants salary Rs. 8000/- 12 11. 52 Will be reflectedin Ophthalmic assistants from NRHM Rs. 8000/- 5 NRHM budget Grand Total (A + B+ C) 112.18 + 77.50 + 20. 52 210. 20 ( Rupees Two Hundred Ten Lakhs & Twenty Thousand ) Only
(*) = Recurring Grant-in-Aid for Free Cataract Operations and various other schemes which include: Other Eye Diseases @ Rs 1000/-, School Eye Screening Programme @ Rs 200/- per pair of spectacles, Private Practitioners @ as per NGO norms , Management of State Health Society and District Health Society @ Rs 14 lakhs/ 7 lakhs, Recurring GIA to Eye Donation Centres @ Rs 1000/- pair of Eye Ball collection and Eye Banks @ Rs 1500/- per pair of Eye Ball collection Rs 1500, Training, IEC, Procurement of Ophthalmic Equipment, Maintenance of Ophthalmic Equipments, Remuneration, Other Activities & Contingency.
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CHAPTER 4.D.4: NATIONAL LEPROSY ERADICATION PROGRAMME Situation analysis- Nagaland has been successfully implementing the NLEP since its inception of MDT in the sate in 1995 keeping in mind all the instruction s and guidelines received from GOI from time to time which culminated in bagging the first prize in the country for being the first state in achieving the elimination target of below 1 per 10000 during the year 1998. Our achievements in 2007-08 are maintenance pf PR below 1 per 10000 all though the year, increase in voluntary self reporting cases, successful awareness drive in far flung areas, maintenance of records at all levels. Our financial achievements are maintenance of financial discipline in state as well as district levels. Our shortcomings are inability to undertake anti-leprosy activities in some inaccessible hostile hilly terrains in bordering areas with Myanmar. An intensified special action drive is suggested during 2011-12 to work in the bordering areas of Myanmar. Another action plan is also to prepared to overcome the problem of migratory cases especially in Dimapur, the commercial hub of the State and other urban areas affected by the menace. Special initiative will be taken for the involvement of all the churches and other social organisations in the state to propagate the messages of leprosy.
ACTIVITIES 2010-11 1. National Sample Survey in Zunheboto and Dimapur Districts covering 4 (Four) blocks. 2. Training of MOs / PMW / NMS in 5 (Five) Districts. 3. IEC covering 7 (Seven) Districts. 4. Special awareness training programme conducted in international border near Myanmar i.e. Wazeho PHC.
ACTIVITIES: Survey in 2(Two) Districts & 4 (Four) Blocks during 2010-11.
Sl Villag Househ Tota No. of No. of Docto Healt Conti . District es old l Populati Examinati confirm deform rs h ng- N cover covere pop. on of on ed ity case involv Work ency o ed d cases Grade ed ers invol- ST SC Do Ab PB M I II involv ved ne st B ed Dimapur
Medziph 50 5238 25,38 20,8 45 24,7 620 0 1 0 1 1 50 3 ema 0 28 52 60 Block
Niuland 68 5920 27,84 25,8 19 27,7 109 0 2 0 2 2 55 7 Block 8 57 91 39 Zunheboto
Satakha 40 3012 25,30 25,3 0 20,5 4,7 0 0 0 0 1 43 2 Block 3 03 35 68 2 Akuluto 36 2046 25,01 25,0 0 25,0 0 0 0 0 0 1 35 Block 9 19 19
TOTAL 194 16,216 1,03,5 97,0 65 98,0 549 0 3 0 3 5 183 14 50 07 43 53 7
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ACHIEVEMENT
Sl. District Old Total Grand Total Present cases under treatment till Dec.2010 N cases new Total R.F.T o from cases from 2009- from April Chil SC / ST Male / Deformit 10 April to PB - to d Femal y Dec.201 MB Dec. case e PB - PR/10,00 PB - 0 2010 s Gr Gr MB 0 MB PB - – I - II MB PB - PB - MB MB 1. Kohima 1 - 3 0 - 0 1 - 3 0 - 0 0 - 3 - 1 4 - 0 0 1 1 - 3 0.10 0 2. Dimapur 7 - 62 5 - 41 12 – 2 - 3 - 64 – 43 – 14 15 10 – 67 1.53 103 36 3 13 34 3. Mokokchun 0 - 2 0 - 1 0 - 3 0 - 2 0 - 0 - 1 1 - 0 0 0 0 - 1 0.2 g 0 4. Wokha 2 - 5 0 - 0 2 - 5 2 - 1 0 - 2 - 2 2 - 2 0 2 0 - 4 0.16 0 5. Zunheboto 0 - 0 0 - 0 0 - 0 0 - 0 0 - 0 - 0 0 - 0 0 0 0 - 0 0 0 6. Tuensang 1 - 5 1 - 4 2 - 9 0 - 2 0 - 0 - 9 8 - 1 0 0 2 - 7 0.24 0 7. Peren 1 - 2 0 - 0 1 - 2 0 - 0 0 - 0 - 3 3 - 0 1 0 1 - 2 0.28 0 8. Mon 1 - 28 0 - 0 1 - 28 0 - 0 - 0 - 13 8 - 5 0 2 1 - 12 0.32 16 0 9. Longleng 1 - 6 1 - 0 2 - 6 0 - 2 0 - 1 - 5 4 - 2 0 1 2 - 4 0.42 0 10 Kiphire 0 - 0 0 - 0 0 - 0 0 - 0 0 - 0 - 0 0 - 0 0 0 0 - 0 0 . 0 11 Phek 0 - 0 0 - 0 0 - 0 0 - 0 0 - 0 - 0 0 - 0 0 0 0 - 0 0 . 0 TOTAL 14– 7-46=57 21- 4- 3 - 70– 73- 15 21 17- 0.38 113=12 159=18 59=6 3 = 6 47=11 44=11 100=11 7 0 3 7 7 7
Performance under NLEP District-wise achievement from April’2010 to December’2010.
Indicators 2006-07 2007-08 2008-09 2009-10 (till date) No. of new cases detected 0.20% 0.20% 0.22% 0.20% (ANCDR) No. of cases on record at year 0.22 0.26 0.32 0.37 end (PR) No. of Grade II disability among 21.5% 24% 26.5% 12.2% new cases (%) Treatment Completion Rate 80.3% 75.9% 68.7% 72.4% Re-constructive Surgery Nil Nil Nil Nil Conducted
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Additionality Funds from NRHM- Details of the activities with justification for which Additionality Funds are proposed to be sought. Sl. no Description Budget estimate Funding source 1 Contractual services Rs.10,000,00 2 Office expenses/consumable Rs.6,00,000 3 POL/Vehicle ops Rs.10,000,00 4 DPMR Rs.5,000,00 5 ASHA services Rs.50,000 6 Materials & supply (Sup Rs.6,00,000 drugs) 7 IEC (Behaivour changes) Rs.8,000,00 8 Urban Leprosy Control Rs.1,000,00 9 Review meetings Rs.2,50,000 10 Training (capacity building_) Rs.4,00,000 11 Cash assistance Rs.3,50,000 12 Equipments Rs.2,000,00 13 NGO services Rs.2,000,00 Total Rs.60,50,000 (Rupees sixty lacs fifty thousands oly)
CHAPTER 4: D.5: NATIONAL IODINE DEFICIENCY CONTROL PROGRAMME
I. Background:
Nagaland was among the IDD endemic State in our country which was declared in the early part of 1960s with IDD prevalence rate of 34.3%.However with the establishment of IDD Cell in the State Directorate of Health and Family Welfare department, IEC activities on the consequences, control and preventive measures adopted by the government etc. were conducted through the programme division. Information on IDDs were also discriminated to all sections of the population through various departments and medias. The most significant feature in its control measure is the introduction and supply of iodised salt in place of common salt. All these health education activities and control measures has a significant impact in changing the behavior and attitude of the State.
II. Current IDD scenario in the State:
Through a household survey conducted by the programme division in the recent past it is recorded among the rural population that 83% has heard about IDDs; 85% uses iodised salt; 91% uses packet salt and on testing the salt in their kitchen 89% of the sample were found above 15ppm. The IDD prevalence among children of 6-12 years age group as recorded in the recent past is about 1%.
III. Strategies and Activities:
1. Establishment of IDD control cell. → Sate IDD cell Staff – For strengthening and effective implementation state has appointed One Statistical Assistant and One LDC computer Assistant.
→ Monitoring and Evaluation – The SPO and his staff will monitor the programme implementation in the entire State on quarterly basis.
→ Strengthening IDD control set up – Provision will be made for effective maintenance of the state IDD set up.
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2. Establishment of IDD monitoring laboratory: The State has One Lab. Technician and One Lab. Assistant appointed on contract basis to train the IDD monitoring Lab. Chemical reagent, glassware’s and Lab. Disposable feed provisions will be made for lab. maintenance. Fund provisions will be made for purchase of salt samples, Vials for urine sample collection, transportation and mobility of staff for urine sample collection. 3. Health Education and Publicity: Consultative machine of stake holders department and agencies at various levels will be conducted for effective advocacy. Orientation workshops for health workers will be conducted at various health centre levels. Training and orientation will be organized for ASHAs for conducting salt testing with STK following which incentives will be released on submission of salt testing reports. Various health awareness activities will be conducted in the rural schools where posters, pamphlets and other IEC materials will be distributed. Observe Global IDD Prevention Day by organizing various health education activities in schools and villages. 4. IDD Survey: Resurveying to asses the sincerity of IDD and also the impact of the programme will be conducted in 4 (four) selected districts. 5. Financial target:
Sl. Section Activities Unit Total No 1 A. Salary: 1. Statistical Asst. 1.08 2. LDA 0.78 1.86 B. Strengthening State IDD set up 1.00 1.00 C.Monitoring and supervision of programme 1.76 1.76 implementation by SPO and IDD staff on quarterly basis. 2. Establishment of IDD Salary 1. Lab Technician 1.08 Monitoring laboratory 2. Lab. Asst. 0.804 1.884 B. Chemical reagents, glassware’s and Lab. disposables 1.036 1.20 C. Cost of salt sample, urocan for urine sample, transportation and mobility cost of the staff. 1.20 1.20 3 Health Education and 1. Stakeholders’ Consultative and advocacy workshop at Publicity various levels including PHC level for ASHA’s 15.30 2. Incentives to ASHA for monitoring quality of iodised salt with STK at household level 6.60 3. Health education activities in 44 rural schools 4.40 31.1 4. Global IDD Prevention Day in schools and rural health 4.40 centers. 5. Press Advertisement in major local papers. 0.40 4. IDD Survey IDD Re-survey of 4 Districts. 2.00 2.00 G.Total = Rs. 42.004 Rupees Forty Two Lakhs four hundred only.
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CHAPTER 4: D.6: INTEGRATED DISEASE SURVEILLANCE PROGRAMME
Ever since its implementation in 2006, the Integrated Disease Surveillance Project in Nagaland has one (1) State Surveillance Unit (SSU) based at the Directorate of Health & Family Welfare and eleven (11) District Surveillance Unit (DSU) at the District Headquarter.
Health & Family Welfare as in-charge of IDSP; assisted by the State surveillance Officer (SSO), OSD, IDSP and the SSU Staffs consisting of the one state Epidemiologist, one Consultant Training, one Entomologist, one Financial Consultant, one Microbiologist, one Data Manager and one Data Entry Operator. While at the District Unit, IDSP is manned by the District Surveillance Officer and the DSU Staffs. Presently there are two Priority Laboratory (the State IDSP Lab. and District Hospital Laboratory. Dimapur) against which Microbiologists are appointed.
1. ACHIEVEMENT:
With the implementation of IDSP in Nagaland, the disease Surveillance system in the state has improved to a large extent over the years. Through analysis of weekly report many early warning signals have been detected and appropriate responses initiated. Some of the outbreaks detected and investigations done and timely response initiated for their control are listed below: -
Sl. Outbreak No. of Area of Remarks No detected Case outbreak/Date Dimapur/Kohima Serum Sample sent to RMRC, Dibrugarh. 9+ve 1 JE 15 middle week of *Appropriate response undertaken by NVBDCP September 2010 Sample sent to RMRC, Dibrugarh Dimapur,1st week of 2 Dengue 2 * Both sample Negative September 2010 *Appropriate response undertaken by NVBDCP Serum Sample sent to RMRC, Dibrugarh for confirmation 7 sample tested positive. Health camp conducted to treat cases. Vitamin-A Kikruma, Phek 3 Measles 8 supplementation given to all susceptible children in 1st Week Aug 2010 the affected area. IEC activities undertaken regarding providing proper nutrition and isolation of cases. Fogging DDT Spray + Awareness Undertaken by 4 AES 1 Dimapur 1/July/2010 NVBDCP. Trigger level II response initiated wherein a Kohima/Mokokchung/ Medical team lead by DSO IDSP Tuensang on 24th Fever with 5 20 Tuensang July 2010.All together 201 cases of different Rash/convulsion 23/7/2010 disease were detected and treated. Further action taken by NVBDCP.
District wise performance District 2008 2009 2010 DIMAPUR 31% 53% 53% KOHIMA 80% 100% 100% KIPHIRE 50% 75% 75% LONGLENG 67% 67% 90% MOKOKCHUNG 57% 78% 80% MON 40% 60% 60%
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PEREN 40% 60% 60% PHEK 50% 85% 85% TUENSANG 50% 60% 70% WOKHA 55% 73% 73% ZUNHEBOTO 53% 70% 70%
3. OBJECTIVE The Action Plan of IDSP, Nagaland 2011-2012 has been prepared keeping in mind the need to put more weightage on the following: i) Strengthening of existing IDSP Laboratory ii) Addition of more Priority Laboratories and provision of computer network capability to laboratory iii) Improvement of Disease Surveillance System iv) To initiate weekly reporting of datas through IDSP portals
IDSP-Budget-Sheet for States (26) not Funded by World Bank
No. Proposed Unit cost of Activity Sub-activity Budget for (₹) Unit 2011-2012 s as per NRHM 50 1,91,742 Training One day training of Hospital Doctors guidelines as per One day training of Hospital Pharmacist / NRHM 150 4,25,662 Nurses guidelines as per One day training of Data Manager & Data NRHM 24 72,800 Entry Operator guidelines Sub total 6,90,204 Staff State Epidemiologists 40,000 1 4,80,000 remuneratio State Microbiologists 20,000 1 2,40,000 n* Entomologist 20,000 1 2,40,000 Consultants Finance 14000 1 1,68,000 Surveillance Consultants Training 28000 1 3,36,000 Preparedne Data Managers 14000 1 1,68,000 ss Data Entry Operators 8500 1 1,02,000 Sub total 17,34,000 Operational Cost Transport/Mobility Support 100000 1 1,00,000 Office Expenses 250000 1 2,50,000 Consumables for State Labs 200000 1 2,00,000 Collection & transportation of samples 150000 1 1,50,000 Printing of Reporting Forms 300000 3,00,000 Quarterly Review Meeting 60,000 Broadband Expenses 50,000 1 50,000 Sub total 11,10,000 New Innovations For 2 Priority Laboratory Equipments 7,50,000 2 15,00,000 (Phek & Mokokchung Dists)
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Power Back-Up for EDUSAT (5 KVA 250,000 1 250,000 GENSET) Outbreak Investigation Kit 100000 1 1,00,000 Entomological Kit 80000 1 80,000 Computer for Priority Loboratory 50,000 1 50,000 Sub Total 19,80,000
Sub total (Surv. 55,14,204 Preparedness=Training+Remuneration+O perational Cost+New Innovations) Outbreak investigatio Priority Laboratory (State IDSP n and 2,00,000 1 2,00,000 response Laboratory)
Sub Total (OB Investigation & Resp.) 2,00,000
Grand 57,14,204 Total
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CHAPTER 4.D.7: NATIONAL TOBACCO CONTROL PROGRAMME (NTCP)
The state of Nagaland was included in the second phase of pilot project under NTCP covering two districts ie. Kohima & Dimapur. Activities of NTCP took off only in the month of June 2009 under MoHFW. New Delhi. Since then the department has conducted various workshop to sensitize the enforcement agencies, NGOs and School teachers. The awareness program for the students is going on in two districts ie. Kohima & Dimapur.
State Tobacco Control Cell has been constituted ,but due to lack of separate fund from the Ministry it is difficult to monitor the activities at state level. Therefore it is requested that the authority may please sanction separate fund for State Tobacco Control Cell. Also for more coverage and wider sensitization the state would like to propose inclusion of two more districts ie. Mokokchung & Zunheboto during 2011-2012.
Prevalence of Tobacco use in Nagaland.
1 Tobacco user 57% 2 Male tobacco user 64 % 3 Female tobacco user 32 % 4 Tobacco smoking 32% 5 Male tobacco smoking 49% 6 Female tobacco smoking 12% 7 Smokeless tobacco user. 45% 8 Male smokeless tobacco user 53% 9 Female smokeless tobacco user 37% Source :- GATS - 2009 -10
Prevalence of Tobacco use in Nagaland Students: 1 School children smoking 37% 2 Male school children smoking 55% 3 Female school children smoking 18% 4 School children tobacco users 41% 5 Male school children smokeless form users 50% 6 Female school children smokeless form users 33% Source:- Global School Personal Survey (GSPS ) 2003, DH&FW Oral Disease Surveillance -2007, NFHS -2(1998- 1999 & NSS (1993-1994)
Prevalence of Tobacco use in North Eastern States. Sl. State Tobacco % Smoking % Smokeless % No.
1 Arunachal Pradesh 48 29 36 2 Assam 39 14 33 3 Manipur 54 26 45 4 Meghalaya 55 36 28 5 Mizoram 67 40 41 6 Nagaland 57 32 45 7 Sikkim 42 26 26 8 Tripura 56 27 41 Source : GATS 2009-10.
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Prevalence of Smokeless tobacco in North Eastern by Gender. Sl. State Male % Female % No.
1 Arunachal Pradesh 45 28 2 Assam 40 25 3 Manipur 52 37 4 Meghalaya 21 36 5 Mizoram 33 49 6 Nagaland 53 37 7 Sikkim 28 23 8 Tripura 39 44 Source : GATS 2009-10.
Daily use of tobacco in N.E. Region
Sl. No. State Smokers % Smokeless %
1 Arunachal Pradesh 72 61 2 Assam 74 72 3 Manipur 65 48 4 Meghalaya 84 68 5 Mizoram 89 87 6 Nagaland 81 70 7 Sikkim 66 58 8 Tripura 84 76 Source : GATS 2009-10.
Dual use of smoking and smokeless tobacco in N.E. Region.
Sl. State Male % Female % No.
1 Arunachal Pradesh 45 23 2 Assam 25 8 3 Manipur 39 16 4 Meghalaya 20 8 5 Mizoram 27 11 6 Nagaland 47 14 7 Sikkim 29 18 8 Tripura 31 12 Source : GATS 2009-10.
GOAL: - TOBACCO FREE NAGALAND.
OBJECTIVES:
1. To implement National Tobacco Control Act 2003. 2. To reduce Tobacco/Cigarette/Biddi smoking prevalence by 50% in the State by 2020. 3. To reduce the prevalence rate of smokeless Tobacco consumption by 50% in the State by 2020. 4. To create Tobacco-free School. 5. To reduce the mortality and morbidity of Tobacco related diseases.
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COMPONENTS:
Tobacco Control Programme will consist of the following components:- 1. State Nodal Officer. 2. State Tobacco cell. 3. District Tobacco cells. 4. State monitoring committee. 5. District monitoring committee. 6. Capacity building/ training. 7. School programme 8. IEC. 9. Monitoring & Reporting. 10. Networking. 11. NGOs. 12. Budget.
ACTIVITIES:
Capacity building/ training will be given to the following groups of people: 1. State Monitoring Committee members. 2. District Monitoring Committee members 3. State & District Tobacco Cell members. 4. All Medical Officers in the Dist. Hospital/CHC/PHC/Sub-Centre etc. 5. Health Workers (GNM/ANM/ASHA) etc. 6. Law enforcers. 7. NGOs. 8. Legislators. 9. Bureaucrats. 10. Technocrats. 11. VHC/SHG etc.
SCHOOL PROGRAMME.
To create Tobacco-free School, the State and District Tobacco Control cells will initiate the following action. The State will take up at least 30 schools in three different districts.
1. Training/Capacity building to all school teachers. 2. Awareness campaign for the students. 3. Painting/Drama competition related to tobacco control. 4. Painting/Drama competition related to ill-effects of tobacco. 5. Advocacy programme to the students. 6. Ban/prohibition of sale of Tobacco and Tobacco products within 100 yards of school premises. 7. Inclusion of ill-effects of Tobacco & Tobacco products in the elementary School curriculum. 8. Placement of anti- tobacco signage in all schools.
IEC:
1. Posters. 2. Radio talk. 3. Short TV play. 4. Mass media campaign. 5. Display of boards. 6. Advertisements. 7. Print media.
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Monitoring & Reporting.
1. To ensure that all the enforcement personnel know the implementation of Section 4,5, 6& 7 of COTPA 2003. 2. To review the activities on monthly basis at state & district level. 3. State Tobacco Control Cell & District Tobacco Control Cells will have a quarterly review meeting. 4. To compiled quarterly report from district cells and send to the authority.
NETWORKING:
The following departments will be directly/indirectly involved in Tobacco control: 1. Home. 2. Law & Justice. 3. School Education. 4. Health & Family Welfare. 5. Transport. 6. IPR. 7. Industry. 8. Agriculture. 9. Excise. 10. Taxes. 11. Municipal council.
ACTION TAKEN:
1. Conducted Advocacy Workshop on NTCP during 24rd & 25th Sept. 2008 for Law Enforcers & NGO’s supported by NRHM and AFTC New Delhi. 2. Conducted advocacy workshop for Law enforcers & NGOs on 27th May 2009 sponsored by WHO. 3. Conducted advocacy workshop for in-service Dental Surgeons on 30thy June 2009 under state capacity building scheme. 4. Conducted advocacy workshop for Kohima & Dimapur School Teachers on 24th & 31st July 2009 respectively. 5. Commemorate World No Tobacco Day on 31st May 2010 with support from NRHM. 6. Placement of Anti-Tobacco warning signboards at strategic points in Kohima and Dimapur. 7. Developed Leaflets and distributed. 8. Developed posters and distributed. 9. Issued press released and in all electronics print media in all local dialects for public awareness on ban of smoking in all public places. 10. Issued directives to all Health Authorities in the State for total ban of smoking in all Health Centers. 11. Obtained permission for placement of Tobacco warning signboards Municipal Council/Town Council in the State. 12. Issued press released on revised specified public places in all print media in the state. 13. Conducted awareness [program on ill-effects of Tobacco for the students covering 92 schools in Kohima and Dimapur Districts. 14. Sensitized Medical personnel and community. 15. TV talk on ill-effects of Tobacco.
Proposed Budget for state & district Tobacco Control Programme(2010-11) SI. Components Calculation Total No INR INR I Salaries 1. Psychologist : Rs. 10,000/- 10000 x 12 2. Social Worker : Rs. 8000/- 8000 x 12 216,000.00 II. Training 200,000.00 200,000.00
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III IEC activity 200,000.00 200,000.00 IV School Activity 400,000.00 400,000.00 V Monitoring of Tobacco Control Laws & 100,000.00 100,000.00 Reporting VI Contingency 100,000.00 100,000.00 VII TOTAL 1,216,000.00 Total budgetary allocation for 2 districts @ Rs. 12, 16,000.00 per State is Rs.24, 32,000.00 (Rs. Twenty Four Lacs and sixteen thousand only) Budgetary estimate for a District as per Govt. of India directives. (For ongoing two districts, ie. Kohima & Dimapur)
Sl.No. Details Sub-Total Amount (Rs.) 1. Psychologist/Counselor @Rs.12,000/- 1,44,000 x1personx12months Social worker @Rs.8,000/-x 1person x12months 96,000 Data entry operator 3,12,000.00 @ Rs.6000/- x 1 person x 12 months 72,000 2. Training activities 2,00,000.00 3. IEC 2,00,000.00 4. School Programme 4,00,000.00 5. Monitoring the Tobacco Control laws & reporting violation 2,00,000.00 6. Contingency 2,00,000.00 Total:- 15,12,000.00 Total for one district = Rs.15.12 lakhs
Total for 2 districts = Rs.15.12 x 2 =Rs.30.24 lakhs. ……….. (A)
(Rupees thirty lakhs twenty four thousand only).
Budgetary estimates for one State Tobacco Cell as per Govt. of India directives.
Infrastructure/Administrative Recurring Costs Budgeted amount (Rs.) Staff salaries: Consultant 1,44,000 @ Rs.12,000 x 1 person x 12 months Programme Assistant@ Rs.8,000/- x 1 person x 12 months 96,000
IEC Materials. 400,000 Training. 200,000 Contingency Expenditure/Monitoring the implementation of Programme 200,000 Total 10,40,000 Estt. of office furniture including Computer etc. (non-recurring) 5,00,000 Grand Total 15,40,000 Total for one State Tobacco Cell = Rs.15.40 lakhs …..(C)
(Rupees fifteen lakhs forty thousand only).
Total Budgetary requirement for State and 4 districts Cells.
Tobacco Cells for 2010-2011………(A+ B + C)
Sl. No. Particulars Budget requirement
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1. State Tobacco cell Rs.15,40,000 2. Kohima District Rs.15,12 ,000 3. Dimapur District Rs.15,12,000 Total:- Rs. 45.64 lakhs (Rupees forty five lakhs sixty four thousand only).
CONCLUSION.
As mentioned earlier MoHFW is financing only two districts in the state under NTCP ie. Kohima & Dimapur. The consumption of Tobacco increased from 48% to 57% in the state as per GATS 2009-10 reports. Therefore in order to educate and sensitize the general public in the state regarding health hazards of Tobacco and also protect non-smoker from second hand smoke, it is kindly requested that NRHM, Nagaland may provide budgetary provision for State Tobacco Control Cell amounting to Rs.15.40 lakhs (Fifteen lakhs forty thousand) only, as there is no budget available from MoHFW, Delhi for State Tobacco Control Cell.
CHAPTER 4. D.8: NATIONAL MENTAL HEALTH PROGRAMME It is estimated that 6-7% of population suffers from mental disorders. These disorders account for 12% of the Global Burden of Disease and it is likely to increase to 15% by 2020 (World Health Report ‘2001). Most of them (>90%) remain untreated. Reasons for not seeking treatment :-
. Poor awareness of mental illness . Myths & stigmas related to mental illness . Lack of knowledge on availability of treatment
National Mental Health Programme (NMHP) being started in 1982 with the following aims/ objectives:- 1) To ensure availability and accessibility of minimum Mental Health Care for all in the near foreseeable future, particularly to the most vulnerable sections of the population. 2) To encourage mental health knowledge and skills in general health care and social development, 3) To promote community participation in mental health service development and to stimulate self-help group in the community.
The Ministry of Health & Family Welfare, GoI is administering the Mental Health Act ‘1987, which aims for the promotion of Mental Health Care in the country and provides to safeguard for mentally ill patients in addition to protecting them against Human Rights abuse, stigmatization and discrimination.
In line with the National Health Policy ‘2002, the objectives of the NMHP and Global Trend of Community Care of mentally ill, a community based Mental Health Care at the district level was initiated as District Mental Health Programme (DMHP) in Phek District on 1/4/2004. For this purpose, a grant-in aid amounting to ₹ 26,20,000/- (Rupees twenty six lacs twenty thousand) only was sanctioned by the Ministry of Health & Family Welfare during ‘2003-04 after which, no further release of funds were made.
Status of NMHP in Nagaland:
Under DMHP, assistance has been provided for upgradation of Psychiatric Wing in Naga Hospital Authority Kohima (NHAK). An amount of ₹ 36,28,000/- (Rupees thirty six lacs twenty eight thousand) only has been granted and with that amount, a new building was constructed at NHAK.
Further, for upgradation of Mental Hospital, Kohima; a sum of ₹ 1.60 crores was released on 11/09/07 and utilized for construction of a new OPD Block, renovation of Wards, Office and one M.O Quarter.
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Strategies for implementation of NMHP during ‘2011-12 has been redefined and are enumerated below:-
As envisaged in the National Health Policy ‘2002 and following the globally accepted trend of community care of mentally ill, it is proposed to extend DMHP to 200 more under served districts. Under this scheme, support will be provided to the districts to implement DMHP and provide basic mental health services at the community level. The scheme consists of support staff, medicines, IEC activities, training and contingency for running DMHP. Moreover, the scheme is being revised to include Life Skills Education and Counselling in schools, counseling services in colleges, workplace stress management, District Counselling Centre and crisis helpline with an enhanced outlay.
Programme Execution & Expansion:
District Mental Health Programme (DMHP): Presently, DMHP is being implemented in Phek District. It is proposed to include two more districts in the year ‘2011-12 under the programme. The selected districts for the programme are:-
District Hospital, Dimapur: Dimapur is a rapidly developing commercial hub of Nagaland. The District Hospital is providing health care services to a large number of patients from all communities. Dr. Imkongliba Memorial Hospital, Mokokchung: This Hospital is an ideally located hospital, which can provide mental health care services to other neighbouring districts like; Longleng, Zunheboto and Tuensang Districts. A Psychiatric Wing in this Hospital is a necessity for the area.
OBJECTIVES:
To provide sustainable basic mental health services by integrating with other health services.
Early detection and treatment of patients within the community itself.
To remove the stigma/ discrimination attached towards mental illness through IEC activities.
The scheme consists of support staff, medicines, IEC activities, training and contingency for functioning of DMHP
RECURRING EXPENDITURE ON STAFF FOR THE TWO PROPOSED DISTRICT HOSPITALS:
Sl. Name of post Salary /month No. of Post Annual Budget No. (in Rs) Required (in Rs) 1 Psychiatrist 30,000/- 2 7,00,000/- 2 Clinical Psychologist 15,000/- 2 3,60,000/- 3 Psychiatric Nurse 10,000/- 8 9,60,000/- 4 Record Keeper 5000/- 2 1,20,000/- 5 Nursing (orderly/ safai) 1,500/- 4 72,000/- GRAND TOTAL : 22,32,000/-
NON-RECURRING EXPENDITURE FOR MACHINERY & EQUIPMENTS FOR THE TWO PROPOSED DISTRICT HOSPITALS:
Sl. No. Particulars Amount (in Rs) 1 ECT Machine (2 nos) 1,00,000/- 2 Computer & Printer (2 nos.) 1,00,000/-
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3 Resusciation equipments (Section machine, Ambu bag, Boyles 8,00,000/- Apparatus, Oxygen Cylinders) 4 Ten-Bed Unit one Refrigerator (2 nos.) 2,00,000/- 5 Vehicle (2 nos.) 10,00,000/- GRAND TOTAL : 22,00,000/-
RECURRING EXPENDITURE PER YEAR ON MEDICINES, OFFICE EXPENSES, ETC FOR 11 (ELEVEN) DISTRICTS:
Sl. Particulars Amount No. (in Rs) 1 Medicines, disposables, cotton, etc. 3,00,000/- 2 Contingency, Stationery, etc 50,000/- 3 IEC 1,00,000/- 4 Training 1,00,000/- 5 Maintenance of equipments, vehicles, etc 2,00,000/- 6 POL 50,000/- GRAND TOTAL : 8,50,000/-
Financial implication for implementation of NMHP in Nagaland:
(22,32,000 + 22,00,000 + 8,50,000) = Rs. 52,82,000/-
(Rupees fifty two lakhs eighty two thousand) only.
To provide an impetus for development of Manpower in Mental Health other training centers (Government Medical Colleges/ Government General Hospitals/ State run Mental Health Institutes) will also be supported for starting PG courses or increasing the intake capacity for PG training in Mental Health. The support involves physical work for establishing/improving department in specialties of mental health (Psychiatry, Clinical Psychology, PSW, and Psychiatric Nursing), equipments, tools and basic infrastructure (hostel, library, department etc.), support for engaging faculty etc. It is targeted to support setting up/strengthening 30 units of Psychiatry, 30 departments of Clinical Psychology, 30 departments of PSW and 30 departments of Psychiatric Nursing during the plan period. Budgetary support available is up to Rs. 30 crores per center. At least 11 Centres of Excellence under the Scheme will be taken up during the plan period.
OTHER PROGRAMMES:- CHAPTER 4. D.9: ORAL HEALTH SERVICES
Govt. of India is yet to come out with the clear concept of Oral Health Service delivery system in the country. The basic minimum services so far provided till the emergence of NRHM was purely under the state initiatives. Statistics shows that there is a need to take this service down to the rural bases but due to continuous fund constraints, this need is limited to the District Hospitals only. More than 70% of population is rural based, hence the service demand is higher in this sector, for which more emphasis needs to be focused to this higher target population. With the coming of NRHM all aspects of services i.e preventive, curative, pediatric care, rehabilitative and geriatric service are expected to be available soon.
Distribution of Dental Surgeons in India.
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Urban Population covered Rural Population covered 80% 30% 20% 70%
Oral disease status in Nagaland.
Sl. Age group Dental carries Oral disease Dental/skeletal Oral cancer No disease 1. Children 80% - 30% - 2. Adult 60% 90%(above 35yrs) - >40%
Before the emergence of NRHM
Oral Health Service was available only in the District Hospitals. No infrastructure upgradation in District Hospitals. Only 26 manpower Dental Surgeons were available in 11 District Hospital without any paradental staff. Only preventive and curative services were available.
Oral Health Service status before NRHM.
Sl.No. Particulars Dist.Hospital CHC PHC 24x7 PHC SC 1. Manpower 26 Nil Nil Nil Nil 2. Basic and incomplete 11 Nil Nil Nil Nil equipments
Status of Oral Health under NRHM; 2008-2010 (service coverage).
Sl.No. Particulars District CHC PHC 24x7 PHC SC Total Hospitals 1. Man power 3 21 1 Nil Nil 25 2. Equipment coverage 2 21 1 Nil Nil 24
Proposal during 2011-2012.
1. Mapower support (Budget projected under A9): a. To continue the exusting 21 Dental Suregeon at 21 CHCs @ Rs. 0.20 L per month per unit. 2. Oral Health Unit upgradation in 11 District Hospitals by providing (Budget projected under B23): a. Equipments: Sl. Particulars Required Approved Amount Total No Nos. 1. Electrically control Dental Chair with the following facilities: 11 Rs.3,50,000 x 11 Rs.38,50,000 Airotor Micromotor Motorised suction High & low intensity Halogen light 3 way syringe 2. Dental X-ray 11 Rs.38,000 x 11 Rs.4,18,000 3. Airotor Hand piece (NSK) 11 Rs.10,000 x11 Rs.1,10,000
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4. Light curing machine (Dentsply) 11 Rs.25,000 x11 Rs.2,75,000 5. Peizon scalar (Dentsply) 11 Rs.40,000 x11 Rs.4,40,000 6. Complete set of elevators & criers and crossbar 11 Rs.20,000 x 11 Rs.2,20,000 elevator (ASH) 7. Air compressor 11 Rs.25,000 Rs.2,75,000 8. Glass slab (3x6”) 11 Rs.100 Rs.1,100 9. Cement spatula 11 Rs.100 Rs.1,100 10. Cement carrier 11 Rs.100 Rs.1,100 11. Ball barnisher 11 Rs.100 Rs.1,100 12. Composite carrier 11 Rs.150 Rs.1,650 13. Tungsten carbide cutting bar 50x11=550 Rs.500x550=Rs.2,75,000 Rs.2,75,000 14. Diamond Dental bars 50x11=550 Rs.300x550=Rs.1,65,000 Rs.1,65,000 Grand Total:-Rs.60,34,050 (Rupees sixty lakh thirty four thousand and fifty only)
b. Chemical compounds and consumables: Sl. Name of items Rate Quantity Amount No 1 Light cure composite (Syringe) 1 set Rs.3,000 11 Rs.33,000 2. Light cure Bonding Rs.2,500 11 Rs.27,500 3. Glass Ionomer cement Rs,3,000 11 Rs.33,000 4. Silver Alloy (30gm) Rs.2,000 11 Rs.22,000 5. Mercury (225gm) Rs.1,500 11 Rs.16,500 6. Zinc Phosphate Cement (P/L) Rs.500 11 Rs.5,500 7. Zinc Oxide powder (110gm) Rs.200 11 Rs.2,200 8. Eugenol Liquid (110ml) Rs.500 11 Rs.5,500 Grand Total:- Rs.1,45,200 Rupees one lakh forty five thousand two hundred only)
Total financial requirement: Activity Rate Units Total To continue the existing 21 Dental Suregeon at 21 CHCs 0.20 21 50.40 Sub Total A Oral Health Unit upgradation in 11 District Hospitals by providing Equipments 5.49 11 60.39 Medicines and consumables 0.132 11 1.45 Sub Total B 61.84 Grand total (A+B) 112.24 Rupees one hundred and twelve lakhs and twenty four thousand only
CHAPTER 4. D.10. NATIONAL PROGRAMME FOR PREVENTION AND CONTROL OF DEAFNESS
Nagaland with a population of 1988636, it is estimated to be having about 125284 persons with hearing impairment, if prevalence rate of WHO is considered. Nagaland with difficult terrains and very bad/nil public transportation, have made it more difficult for the people to access the health facilities. Therefore, it is expected
Nagaland SPIP 2011-12 188 that many of the preventable and curable hearing disabilities are been left unattended. Therefore the number of people with hearing impairment could be more than the estimated number.
Therefore keeping in mind the need of the State to carry out the activities outline by the National Programme for Prevention and Control of Deafness. GOI and to achieve the objectives as given below. The NPPCD Directorate of Health & Family welfare Government of Nagaland is putting up the PIP for approval and this will enable the State to continue to reach out the needy people.
OBJECTIVES OF THE PROGRAMME.
1. To prevent the avoidable hearing loss account of disease or injury. 2. Early identification, diagnosis and treatment of ear problems responsible for hearing loss and deafness. 3. To medically rehabilitate persons of all age groups, suffering with deafness. 4. To strengthen the existing inter-sectoral linkages for continuity of the rehabilitation programme, for person with deafness. 5. To develop institutional capacity for ear care services by providing support for equipment and material and training personnel.
Activities under taken:
A) Identification and notification of State Nodal Officer and District Nodal officers including the State Co- ordinator by the government. B) Appointment of audiologist/hearing instructor for all eleven districts. C) In the process of acquiring the equipments for District Hospitals, CHC and PHC. D) Training of the District Nodal officers and Audiologist done. E) Training of MOs at CHC and PHC on going
Manpower Position: List of the districts where the man power is placed:
1. Kohima - (2). 2. Mokokchung - (1). 3. Tuesang - (1). 4. Mon - (1). 5. Wokha - (1). 6. Dimapur - (1). 7. Phek - (1). 8. Zunheboto - (1). 9. Peren - (1). 10. Kiphiri - (1). 11. Longleng - (1).
BUDGETARY REQUIREMENT: Sl.No Activities Unit cost Total Cost 1 Salary for Audiologist/Instructors 12000.00x12x12 1728000 2 Salary for Computer asst. 7,500.00 x2x12 90000 3 Training of Manpower 4,00,000 x 11 4400000 4 Screening Camps 1,00,000x 6 months 600000 6 Miscellaneous/Contingency 1,00,000.00 100000 7 Hearing Aids 2430x2200 units 5346000 TOTAL 12264000 Rupees one hundred and twenty two lakhs & sixty four thousands only
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CHAPTER 4E: INTERSECTORAL CONVERGENCE E.1: Mainstreaming of AYUSH Overview of AYUSH Activities:
1. Manpower at district level S.No Health Centre System No Appointment 1 Naga Hospital, Kohima Ayurveda 1 State employee 2 -do- Naturopathy 1 State employee 3 District Hospital, Dimapur Ayurveda 1 State employee 4 District Hospital, Tuensang Homoeopathy 1 State employee TOTAL 4
2. AYUSH doctors appointed under NRHM ((21 CHCs, 1 Homoeopathic Treatment Centre) S.No Posting District Manpower Stream 1 Viswema CHC Kohima 1 Ayurveda 2 Tseminyu CHC Kohima 1 Ayurveda 3 Chiephobouzuo CHC Kohima 1 Homoeopathy 4 Medziphema CHC Dimapur 1 Ayurveda 5 Dhansiripar CHC Dimapur 1 Homoeopathy 6 Changtongya CHC Mokokchung 1 Ayurveda 7 Mangkolemba CHC Mokokchung 1 Homoeopathy 8 Tuli CHC Mokokchung 1 Homoeopathy 9 Longkhim CHC Tuensang 1 Homoeopathy 10 Noklak CHC Tuensang 1 Ayurveda 11 Pfutsero CHC Phek 1 Homoeopathy 12 Chozuba CHC Phek 1 Homoeopathy 13 Meluri CHC Phek 1 Homoeopathy 14 Tobu CHC Mon 1 Homoeopathy 15 Aboi CHC Mon 1 Homoeopathy 16 Sanis CHC Wokha 1 Ayurveda 17 Bhandari CHC Wokha 1 Homoeopathy 18 Phughoboto CHC Zunheboto 1 Homoeopathy 19 Aghunato CHC Zunheboto 1 Homoeopathy 20 Pungro CHC Kiphiri 1 Homoeopathy 21 Jalukie CHC Peren 1 Homoeopathy 22 Homoeopathic Treatment Centre Dimapur 1 Homoeopathic TOTAL = 22
3. Year wise report in OPD & IPD in AYUSH AYUSH System 2005-06 2006-07 2007-08 2008-09 2009-10 Ayurveda 1105 1270 3102 3950 5661 Homoeopathy 4038 6004 7200 8420 12688 Yoga& Naturopathy 63 102 302 198 959 TOTAL 5206 7376 10604 12568 19308
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AYUSH OPD & IDP
Ayurvedic Homoeopathy Naturopathy
12688
8420 7200 6004 5661 4038 3950 3102 1105 1270 959 63 102 302 198
2005-06 2006-07 2007-08 2008-09 2009-10
Trainings:
S.No Training Participants Total Dates Place Trainers 1 State Level AYUSH M.Os 30 22-27 Naga Hospital Allopathic Training of Feb. Authority doctors Trainers on 2010 Kohima (gynecologist, Homoeopathy (NHAK), pediatrician, for Mother and Nagaland. psychiatrist, Child Care dentist, nutritionist, surgeon, homoeopath. 2 District level Allopathic 17th Wokha Homoeopaths one day doctors, Nov. orientation on AYUSH doctors, 2010 Homoeopathy Administrators, for Mother and Social welfare, Child Care Paramedics, Municipals officials, NGOs 3 -do- -do- 70 18th Mokokchung -do- Nov. 2010 4 -do- -do- 70 23rd Phek -do- Nov. 2010 5 District Level Homoeopathic 20 25-27 Dimpur Homoeopaths Training of doctors Nov. Trainers on 2010 Homoeopathy for Mother and Child Care
4. Other Activities 1. AYUSH garden growing medicinal plants are being maintained in some CHCs. 2. Observation of ‘Homoeopathic Month’ in Mangolemba CHC under Mokokchung district in the month of August 2010.
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The AYUSH MO visited two PHCs where orientation on basics of Homoeopathy was given to the allopathic doctors, administrators, health workers, church leaders and village council. In two SCs the AYUSH MO participated in the VHD and conducted homoeopathic health camps. Basics on homoeopathic was translated in local dialect of Ao tribe and distributed to the public as health education and awareness materials 3. All the AYUSH doctors participates in the national programs.
Proposed Activity: 1. AYUSH Manpower support: Continuing from Component previous New proposed during 2011-12 Cumulative for 2011-12 year (2010- 11) Financial Amount (Rs. In Manpower Institution Number Number (Rs. in Lakhs) Lakhs) 1 doctor @ CHCs 21 Nil 20,000 x 12 21 50.40 months= 240000
8 doctors @ DHs Nil 8 20,000 x 12 8 19.20 months=1920000 Paramedical PHCs Nil Nil Nil Staff CHCs Nil Nil Nil (AYUSH) DHs Nil Nil Nil TOTAL 21 8 29 69.60
2. Training of AYUSH Manpower Name of Training Category Trained Year 2010-11 till date No. of Duration Training Financial (in Batches Load Lakhs) Training on SBA MO Nil 4 21 days 27 458450 FP Methods MO Nil 3 5 days 27 111450 Trainings Neonatal Services MO Nil 2 8 days 27 188700 and Child Care Capacity building on MO 2 1 5 days 25 193950 district health action plan General Financial MO Nil 1 3 days 27 122950 rules/ Computer applications Training of ASHAs/Health Nil 4 3 days 330 776600 ASHA/health workers workers on AYUSH TOTAL 18.52 L
3. Over All Budget Summarry: Sl.No Component Financial Recurrent Non-recurrent Man Power- 29 MOs (Budgeted under Part A) 69.60 R Nil Training component (Budgeted under Part B) 18.52 R Nil
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TOTAL= 88.12 Rupees Eighty eight lakhs, twelve thousand only
E.2: Intersectoral Convergence with Line Departments Strategy to carry out the convergence:
Coordination with Panchayat /Village Council: Village Council is the apex body and placed at all the Villages in the state. The State is fortunate to communitized all the Villages for decentralisation of the departments of Health & Family Welfare, School education, Rural Development, Power and PHE. Through the process of communitisation convergence are happening at all level down to Village level. The Village Council and all the other CBOs including Women are actively participating Village health planning also. The Village Health action plan clearly spells out the convergence of various departments in the promotion of health, sanitation, safe drinking and power supply etc. Coordination with ICDS: At the village level AWWs, ASHA and ANMs are the main force to carry out various health activities. Apart from conducting VHND, they will be visiting school for school check up. Mobility support has been already projected in the School Health Program. They will support immunisation program and also ARSH program. Coordination with Rural and Urban Development: Rural Development board can bring out a lot of activities in bringing about the following: Drainage: Through the help of VDB with the support of RD, drainage system can be developed. Garbage disposal: Safe garbage disposal through VDB. Emergency Transportation: In most of the remote Villages, emergency transportation facility is non existence. Through various advocacy meeting with Village Council members and Village Development Board members, this facility can be made available in the needy villages Coordination with PHE Department: The department so far having good convergence with PHE department where water supply and sanitation is concerned. More effort needs to be put in for rain water harvesting. This can be done through WATSAN committee in the Villages.
Proposed activities: The state has constituted a State Coordination Committeeunder the Chairmanship of Chief Secretary/ Development Commissioner during 2010-11 for coordination among various line departments. 1. Convergence meeting: To continue Convergence Meeting once quarterly with representative from line departments. To includein the Committee representative from Planning & Machineries, Home, Urban Development, Economics and Statisticsand Census Operation. The budget for this activity amounts to Rs. 0.60 lakhs. 2. Convergence Workshop at state, district and Blocklevel: Integrated approach for control of malaria. This activity will be spearheaded by State NVBDCP. Resource Person will be from School of Tropical Medicine Kolkata & NICR New Delhi. 100% registration of births and deaths. This activity will be spearheaded by Director (Health), SPMU and Department of Economics and Statistics.
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CHAPTER 5: MONITORING AND EVALUATION
A. MONITORING AND EVALUATION Introduction: Recognising the importance of robust supervision and monitoring is key to reap the fruit of tremendous investment under NRHM, the state has been striving to develop a comprehensive and integrated supportive supervisionand monitoring system for optimum utilization of the limited resource and to ensure delivery of quality health care.
Integrated Supportive supervision:Supportivesupervision promotes quality outcomes by strengthening communication, focusing on problem solving, facilitating teamwork and providing leadership and support to empower health providers to monitor and improve their own performance.
Integrated Monitoring: Generating basic information and using it to direct the programme planning, measuring progress, identifying areas needing specific interventions and, revision of plan including IDSR strategy to generate information. Timely and reliable data is crucial! It is essential to collect high quality data and make adequate use of the generated data. Monitoring for action that is effective for the management of the integrated services requires the following: A functioning health information system that provides quality data – accurate, timely and consistent. Adequate resources – human, materials and financial. Regular analysis and review of collected data. Feed forward and feedback of information according to established deadlines. Taking appropriate action when required
Progress made so far: For the first time, financial assistance was granted in the RoP 2010-11 amounting to Rs. 49.31 lakhs for Monitoring Service delivery. Supportive supervision has also lead to ensuring maintaining a minimum quality standard and improvement in the service delivery. The major outcome of this activity is as follows: 1. Integrated Check list for Monitoring and supervision developed and being utilized at all level. 2. Designated state and district level monitoring teams a. State Level: Each Addl. Director was made responsible for supervision of 2 districts and each Jt Director was made Nodal Officer for supervision of 1 district. b. District level: Each District Programme Officer of various NDCPs were made responsible for supervision of 1-2 blocks in the district. c. Sub-District level: The MO i/c of the Block health Unit (BHU) is responsible for the block, while the Health Unit i/c was made responsible of their respective jurisdiction. 3. The State Level Monitoring team has visited about 760 Villages and 195 Health Units till July. Similarly supportive supervisory activity is also being taken up at district and sub-district levels. 4. Achievements made under HMIS during the year 2010-11 a. The reporting system in the State has streamlined over the years with the facilities reporting to the Blocks; Blocks after validation and verification, send the reports to the District Level where it is further validated and forwarded to the State. b. The State has shifted to facility-based reporting into the portal during the current financial year 2010-11. c. The percentage of reports being uploaded by the Districts into the portal has increased from 20% during the first quarter to 72% during the second quarter. d. The State is in the process of uploading the FMRs, infrastructure details and NVBDCP reports into the portal. e. Initiatives have been taken to review the data on a bi-monthly basis both at the District level and the State level with the active involvement of all the Programme Officers. f. As per the recommendation of RRC, Guwahati, training on HMIS formats was conducted in Peren District, where the mobile project has been piloted, for the ANMs and SNs during the month of February 2010. The sole purpose of the training was to improve the quality of data in the health facilities which was an issue in the district. Data quality being a huge concern in the State, intensive training for all service providers from Sub-centre level and above is soon to be conducted. g. Training on facility-level data entry into the web-portal was conducted for the District and Block personnel during the month of April ’10 in three batches. The resource persons were from the MOHFW, New Delhi and RRC-NE Guwahati.
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h. TOT for District and Block level Personnel on HMIS, MCTS, and MDR was conducted in the month of July’10 with resource persons from NHSRC, New Delhi. i. The HMIS data is being used in the District Health Action Plans and Block Health Action Plans. j. State has notified State Nodal Officer for HMIS at block, district and State level.
Level Nos Required Nos Present Remarks HMIS MCTS HMIS MCTS HMIS MCTS State 1 1 1 1 District 11 11 11 11 Block 52 52 52 52
k. Manpower Status: State has notified Nodal Officers for M&E, HMIS and MCH Tracking. Besides the contractual manpower support under NRHM, deployment of Regular staff for HMIS and MCTS is under process. The manpower under IDSP at the state and district as being utilised for HMIS related activities such as data entry, compilation, analysis and IT maintenance. l. Strategies undertaken during the current year (2010-11) are as follows:
Component Proposed Activities (2010-11) Current Remarks/justification Status Yes No 1. Strengthening of Mobility support for BPMU,DPMU & Yes Funds released M&E/HMIS SPMU Activity ongoing /MCTS
2. Procurement of Additional Computers for Block level No Procurement under process HW/SW and other equipment Provision of Mobile phones to health No Procurement under Process units Customization of DHIS application & Yes formats as per state requirement Internet District level Yes District level entry at present connectivity Due Poor connectivity at the Block level No block. Procurement of generators for difficult No Procurement under process districts Implementation of Hospital No Awaiting Software from NIC. Management System Training of personnel yet to be conducted> under correspondence with Tripura NIC. 3. Operationalising Customization of registers for all Yes HMIS/MCTS at health units block level Printing of new registers & forms Yes Designing and printing of Registers & formats as per MCTS requirement (printing was delayed due to frequent power failures) has been completed and dissemination to all health units started.
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Training of health personnel Yes Two rounds of training already conducted upto the block level Training soon to be conducted from block level and below
Guideline for Integrated Supportive Supervision & Monitoring:
Elements of Supportive Supervisory & Monitoring Visit:
Supportive Supervision & Monitoring Visit (SSMV) creates a vital link between service management and service delivery. In order to sustain this linkage, the SSMV needs to focus on a number of key areas during an onsite visit. These areas include:
1. Clinic Administration Review SSMV should review certain administrative aspects related to the health unit. This would include staff matters, financial matters, infrastructural aspects of the clinic (building, water supplies, electricity, grounds), equipment, supplies and legal issues (Health Related Acts requirement, collection of vital statistics). 2. Information System Review A functioning health information system is essential for the effective management of Health Services.TheSSMV plays a very important role in ensuring the accuracy and validity of the information system. The SSMV concentrates on ensuring the proper use of the clinic registers, the correct completion of the monthly PHC report, the correct graphing of important data and the use of data for health service planning and monitoring accomplishments at the clinic level. 3. Referral System Review Dealing with referral problems is an important element of the supervisory visit. Any problems with referrals, both in terms of patient movement as well as communication between clinics and higher levels will be investigated and facilitated. 4. Quality of Clinical Care Review The correct application of standard treatment guidelines and use of the approved list of essential drugs is of great importance to ensure high quality care. The SSMV will concentrate on the correct use of Standard Treatment Guideline (STG) by health staff, reinforcing correct practises and insuring adherence to established standards. 5. Community Involvement Review TheSSMV will enquire about issues related to community involvement during each visit. Should assert regularity and participation in health committee meetings. Concerns of the health committee which should be brought to the attention of the District Management and any community problems which need urgent attention (malnutrition, disease outbreaks, etc) will be noted. SSMV should also encourage health staff to plan and conduct specific community outreach activities on a regular basis. 6. In-depth Program Review During the course of the year the SSMV will conduct in-depth reviews of all important health programmes. All National Health Programmes are to be reviewed. Standard Review Manuals/Check List are available with the respective Programmes. 7. Training The SSMVcarries a major responsibility to ensure that health staff are updated, trained and appropriately coached. SSMV will conduct hands-on educational sessions during each visit designed to address specific needs of the health staff, covering elements of clinical service provision (updating and implementing programmatic changes), staff management (new rules and regulations related to government service) and administration. 8. Problem solving Solving problems related to all aspects of the health unit is an integral part of the supervisory process. The SSMV should engage with health staff around problems, which are being experienced. Many problems can be dealt with on the spot whilst others will have to be taken to the District or other responsible areas. A note will be made of problems requiring solutions at a higher level and actions taken will be reviewed at the subsequent SSMV visit. The SSMV is authorised to contact relevant authorities on behalf of the health unit. 9. Other
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Health staff often have personal issues/problems which need to be addressed. The SSMV should be available to sympathetically listen to these issues and support and assist staff as far as she can in dealing with personal problems/issues.
Composition of Supportive Supervisory & Monitoring Team at various level 1. State Supportive Supervisory & Monitoring Team: i. Coordinator : Director (Health). ii. Members 1 Additional Director for 2 districtsas District Supervisor. 1 Jt Director for each district as District Nodal Officer. 2. District Supportive Supervisory & Monitoring Team: i. Coordinator : Chief Medical Officer ii. Members 1 District Programme Officer for 1-2 blocksas Block Supervisor. District Programme Manager, Media Officer, Finance/Accounts Manager, Data Manager etc 3. Block Supportive Supervisory & Monitoring Team: i. Coordinator : Officer i/c of the Block Health Unit of the Identified DHs, CHCs & PHCs. ii. Members Officer i/c of the Block Health Unit of the Identified DHs, CHCs & PHCs. MO i/c PHCs within the block. LHV,BEE,Sanitary Inspector, Malaria Inspector, etc Block Programme Manager and Block Media Officer
Terms of Reference for Supportive Supervisory & Monitoring Team: 1. The Coordinator will be responsible smooth implementation of the activity. 2. The Coordinator to closely monitor the progress of performance of the District, Block, Health Unit respectively. 3. Each level to develop Plan to conduct regular supervisory & monitoring visits monthly/bimonthly or quarterly incorporating a supervision map of the district showing the different supervision routes with their distances, durations frequency and dates, the types of vehicle to be used, the number of people who should go, the total cost of each route, etc. 4. Each level to submit the Plan to the immediate higher authority. 5. Each Team to submit the Tour Report along with the Checklist for Assessment after every visit to claim mobility support as per GoI norms. 6. Arrange for more visits to lesser performing health facilities; 7. The Health Units must take corrective steps as per the observation and remedial measures suggested by the team. 8. To initiate prompt disciplinary action for any instance of non-compliance by any Health Staff. The ATR of the same to be intimated to the Principal Director, Directorate of Health & Family Welfare.
Activities during Integrated supportive supervision 1. Observe a service session (see if standard procedures are followed), a. Interview clients to get their views on quality of services as they leave the facility (exit interview), b. Observe the interaction between health workers and caretakers at the health center (quality of the dialogue: are key messages on immunization and other integrated interventions given, how these messages are given); c. Arrange meetings with staff as well as with Health committee without adding extra burden to the health facility staff or disrupting the services, d. Follow up on recommendations made during previous visits, e. Check the availability of stock of vaccines and other supplies (ITN, IPT, ORT) state of the equipment, and quality of the cold chain – restock, take immediate corrective actions whenever possible and note any problems for further action (Annex 1.4 integrated supervision check list ) f. Review health center records, coverage charts, and log books and discuss with health facility staff g. Note in the “Visitor/Supervision Book” (provide each health facility with one) your observations, as well as problem areas and recommendations to implement before next visit. 2. Use supervisory visit to distribute updates and supplies for the health facility 3. During the visit organize onsite training, structured according to observed weaknesses and new information 4. Introduce a self-assessment/feedback system
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Activities during Integrated Monitoring 1. Collecting high quality data a. Establish best estimate of the target population of the district, each health facility service area and by village. b. Provide adequate tally sheets that contain all the needed variables to all health facilities and monitor each strategy (fixed, outreach, mobile) separately c. Keep a checklist to track report submission by facility and record date report received for follow up with facilities not/or submitting late. d. Check records and discuss with health facility staff during supervisory visit. e. Keep a back up file of reports at district and facility levels for verification when needed. f. Investigate cases and outbreaks of vaccine preventable diseases according to national procedures.
2. Using generated data Generated data from the weekly (IDSP) and monthly (HMIS) reports of the Health Unit should be analyzed and shared with stakeholders. Key variables and indicators to be analyzed include the following: a. Service Delivery Indicators. b. Vaccination coverage and dropout rates by strategy (fixed, outreach) and month, c. Morbidity and mortality data of prevalent communicable andnon communicable diseases, other epidemic prone diseases. d. Stock position of Drugs and other Supplies. e. Use maps, graphs and charts to illustrate performance, as required f. Ensure a wall chart for monitoring coverage and dropout is kept by each health facility and is updated monthly. g. Check if health facility uses monitoring charts and interpret them correctly using indicators & epidemic thresholds, where applicable. h. Conduct regular (monthly/quarterly) reviews of analyzed data: During the reviews, the Health facilities should involve community focal points, and Districts should involve facility staff, other programme officers and local nonhealth authorities. i. Use the opportunity of review meetings to compare trends of administrative coverage of services with disease incidence/deaths to see if the corresponding reduction is achieved, and use the conclusions of the reviews for any necessary corrective measures and planning. Always commend good performance.
Bottlenecks identified: 1. Lack of means of transportation: Except for NVBDCP and RNTCP etc procurement of vehicle is not permitted. Whereas, vehicle for hiring even if available is very expensive. For instance, the minimum rental charge per day is Rs. 2500.00 plus POL and hospitality of the driver while hiring of vehicle as and when required is more costly and hard to get. Also no pool vehicle is available in the department. 2. Shortage of Supervisory staff (LHV, DPHNO etc): At present the department has 59 LHVs and 3 DPHNOs for supervision of field activities/performance and handholding. 3. Inadequate financial support: Due to financial constraints, the state is unable to supplement the travel expenses granted under the NRHM. Therefore, the available fund is very low as vis-a-vis the prevailing government norms. 4. Insufficient supervisory skills: The purpose of supportive supervision is for handholding of the health staff, to assess &monitor the performance of the health units and also to involve in the service delivery wherever applicable. This demandsa high standard of skills for the supervisory staff- well conversantof the activities being carried out-entire health system.
Proposed Activities: STRENGTHENING OF M&E/HMIS/MCH TRACKING: 1. Manpower Support for MCTS at DPMU and BPMU: a. Blocks being the DAU HMIS data collection, entry, compilation and analysis is done by the Block Programme Manager. However with the introduction of MCTS additional manpower is required for proper implementation of the activity.Therefore, it is proposed to recruit 1 DEO each in all the 52 blocks for MCTS. Manpower Existing under Requirement Remarks
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NRHM Unit Total 1. State
HMIS Consultant 1 0 0 Deployment of IT Consultant 1 0 0 Regular staff under process Data Manger (IDSP) 1 0 0 HMIS DEO 3 0 0 2. District (per district) · At the district level, DEO Data Manager (IDSP) 1 0 0 (NRHM) and DEO (IDSP) will DEO 1 0 0 look after MCTS. DEO (MIS) at 5 DHs 5 0 0 The details are reflected under 3. Block (per Block) MCTS. · Deployment of DEO 0 1 52 Regular staff under process
b. Budget for deployment of 52 Blocks amounts to Rs. 66.96 Lakhs. District Total No of Unit Salary/-pm Requirement pm Requirement pa BHU/BPMU (Rs. in lakhs) Kohima 4 8000 32000 3.84 Mokokchung 5 8000 40000 4.80 Tuensang 8 12000 96000 11.52 Phek 5 10000 50000 6.00 Mon 6 12000 72000 8.64 Wokha 5 12000 60000 7.20 Zunheboto 5 12000 60000 7.20 Dimapur 5 8000 40000 4.80 Peren 4 12000 48000 5.76 Kiphire 3 12000 36000 4.32 Longleng 2 12000 24000 2.88 Total A 52 118000 6136000 66.96 DPMU 11 0 0 0 Total B 11 0 0 0 Grand Total (A+B) 63 118000 6136000 66.96
2. Supervisory field staff for Integrated Supportive Supervision and Monitoring: The state has Nursing Superintendent/Asst Nursing Superintendent in all the District Hospitals while only 3 District Public Health Nurse (DPHNO) available for district level management of the nurses serving in CHC, PHC & SC. A total of 113 supervisory staff consisting of 59 LHVs (Regular) and 54 PHNs under NRHM for supervision of 21 CHCs, 124 PHCs and 398 SCs: a. To recruit 8 District Public Health Nurse (DPHNO)for deployment in DPMU where there is no DPHNO due to lack of post. Available only in the districts of Kohima, Mokokchung and Tuensang. b. To deploy 33 regular LHVs for deployment in BHU/BPMU where there is no LHVs due to lack of post.
c. Recruitment plan: o DPHNO: On deputation from in-service nurses with requisite qualification holding equivalent post and in-service nurses PHNson merit cum seniority basis.
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o LHV: There is gap in LHV (1:5 ANMs) in the State, though the salary component of LHVs is 100% re-imbursable by GOI. HFW dept. will persue further the related department for creating these posts and to promote already experienced qualified ANMs for filling these posts. New recruitment of ANMs also will be initiated to firm up the situation further.
d. The total budget requirement of Manpower Support for Integrated Supportive Supervision and Monitoring for Action is Rs. 28.80 lakhsto be projected under RCH
Table: Budget requirement of Manpower Support for Integrated Supportive Supervision and Monitoring
DPHNO LHV
-
pm
-
Supervisory to Staff deploy in No of Units In position Requirement Salary 30000/ Rs @ pm Total Amount/Year(Rs in lakhs) In position Requirement Salary Rs. @ Rs 25000/ Total Amount/Year(Rs in lakhs) Total Amountrequired for DPHNO & LHV per Year in(Rs lakhs)
DPMU 11 3 8 240000 28.80 0 0 0 0 28.80 Grand Total 28.80 Rupees twenty eight lakhs and eighty thousand.
3. Mobility Support for M & E Officers for Integrated Supportive Supervision and Monitoring 1. Mobility Support for M & E OfficersIntegrated Supportive Supervision and Monitoring for Health Unit Level. The budget requirement for the proposed activity is Rs. 99.57 Lakhs.
Table: Mobility Support for Integrated Supportive Supervision and Monitoring for Health Unit Level
Unit
Implementing Agency (From) Health (To) Nos of Units Nos of Units eligible for mobility support Target Frequencyof Visit No of visits p.a No of visits p.a eligible for mobility support Avg Inclusive Rate (Rs) / visit Total in (Rs lakh)
Block Level BHU/BPMU SC 397 397 100% Monthly 4764 4764 1000 47.64 BHU/BPMU PHC 124 105 100% Monthly 1488 1260 1000 12.60 Sub Total A 521 502 6252 6024 60.24
District/DPMU Level District/DPMU SC 397 397 100% Quarterly 1588 1588 1500 23.82 District/DPMU PHC 124 124 100% Quarterly 496 496 1500 7.44 District/DPMU CHC 21 21 100% Quarterly 84 84 1500 1.26 District/DPMU DH 11 11 100% Quarterly 44 0 1500 0.00 Sub Total B 553 553 2212 2168 32.52
State/SPMU Level State/SPMU SC 1324 397 25% Annually 331 100 3000 3.00 State/SPMU PHC 397 124 50% Annually 199 62 3000 1.86 State/SPMU CHC 124 21 50% Half yearly 124 21 3000 0.63 State/SPMU DH 21 11 100% Half yearly 42 22 3000 0.66
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State/SPMU DPMU 11 11 100% Half yearly 22 22 3000 0.66 Sub Total C 1877 564 227 6.81 Grand Total A+B+C 99.57 (Rupees Ninety nine Lakhs and fifty seven thousand) only
2. Integrated Supportive Supervision and Monitoring for VHND. The budget requirement for the proposed activity is Rs.28.69 lakhs.
Table: Mobility Support for Integrated Supportive Supervision and Monitoring for VHND
ive Rate
Implementing Agency (From/To) No of Health Unit Nos of Habitat Nos of Habitat eligible for mobility support Target Frequencyof Visit No of p.a visits No of p.a visits eligible for mobility support Avg Inclus (Rs) visit / Total in (Rs lakh)
HU to Habitats 558 1355 797 100% Monthly 16260 9564 300 28.69 Total 558 1355 797 100% Monthly 16260 9564 300 28.69
4. Workshops/Training on M & E a. Orientation training of State Officials, Chief Medical Officers and Medical Superintendents for Integrated Supportive Supervision and Monitoring: One-day Orientation training of State and District Officials comprising of Addl Directors, Jt Directors/SPOs and DD/SPOs, Chief Medical Officersand Medical Superintendent of DHs/TB Hospitals/Mental Hospital. Resource person will be from MoHFW, NIFHW and RRC. Budget requirement for the Orientation training of State Officials, Chief Medical Officers and Medical Superintendents on integrated supportive supervision and monitoring for action @ Rs. 2000/- per head for 57 persons amounts to Rs. 1.14 lakhs, to be projected under training component of RCH.
b. Training of State & District trainers and Supervisory field staff. i. The budget requirement of Training of the Supervisory field staff for Integrated Supportive Supervision and Monitoring for Action is Rs. 12.68 lakhs to be projected under training component of RCH. Table: Budget requirement of Training of the Supervisory field staff for Integrated Supportive Supervision and Monitoring for Action
Particulars State TOT District TOT District level Total
DPOs, DPOs, DPHNO, Nursing Supdt/Principal Nursing Schools, DPM/DFM 7/district@ DPOs, Doctors, LHV, PHN, BEE, Media Officers, BPM, etc of@ 5/DPMU, 3/Block & 2/PHC (Non BHU) Category of trainees DD/Nursing, PMTI
Total Trg load 6 66 449 521 No of Trainees for 2011-12 6 66 225 297 Duration of Trg (Working days) 4 3 3 10 Batch size 6 25 20 51
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No of Trainings proposed 1 3 11 15 NHSRC, RRC, State TOT/ RRC Trainers SPO/NDCPs NE District TOT Venue PMTI PMTI District Hq Organizational Responsibility Principal PMTI Principal PMTI CMO Addl Director (Trg) Addl Director (Trg) Addl Director (Trg) Training Quality Control & SPMU & SPMU & SPMU Total Training Cost State TOT @ Rs.2000 per 48000.0 trainee per day 48000 0.00 0.00 0 District TOT @ Rs.1400 per 277200. trainee per day 0.00 277200.00 0.00 00 District level @ Rs.1400 per 942900. trainee per day 0.00 0.00 942900.00 00 126810 Total Amount 48000.00 277200.00 942900.00 0.00 (Rupees twelve lakhs sixty eight thousand and one hundred)
M&E STUDIES: Coverage Evaluation Survey: Rationale: Promotion of maternal and child health has been a major objective of the family welfare programmes. In order to achieve this objective, the Govt. of India is making persistent efforts at improving the quality of maternal and child health care services on the one hand and making these services available throughout the length and breadth of the country, more particularly in the remotest areas and among the vulnerable sections of the society, on the other.
The periodic coverage evaluation is necessitated by the fact that availability of appropriate and accurate information about maternal and child care services, status and quality of such services, shortfalls or bottlenecks are essential for improving these services. This will help to protect mother and child against various preventable morbidities and also mortality,thereby, promoting their health status.
As Nagaland was not covered by DLHS-III, the only available data to Nagaland is NFHS 3 and DHLS 2 and recently the CES 2009. Hence the need of latest status to enable the way forward beyond the current edition of NRHM. Objectives of the present study: The present studies have two major objectives- To assess the routine immunization of child in Nagaland. To assess the availability and utilization of maternal health care services in Nagaland.
In order to achieve the above mentioned main objectives, the study have the following specific objectives: To assess the immunization status of children aged 12+ to 23+ months. To assess the ante natal care, intra natal care and post natal care coverage. To assess the bottlenecks in utilization and delivery of these services. To find out association between various factors so as to take necessary corrective measures to improve the health status of the mothers.
Study Area: The study will attempt to conduct coverage evaluation survey covering 11 districts of Nagaland. The study will be conducted by the Regional Resource Centre for NorthEasternStates and the Population Research Guwahati.
Study Population: Children aged 12+ to 23+ months for immunization coverage study. Mothers who delivered during the last one year preceding the survey and having infants, dead or alive, at the time of the study.
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Methodology, sampling design and sample size: To conduct the study, sample survey is considered fit for evaluation of vaccination coverage as well as maternal health. To conduct coverage evaluation, the WHO suggested cluster sampling technique with 30 selected clusters will be use, considering design effect to be 3, 300 children in the specified age group & 300 mother are to be studied.
The present study will collect information on various indicators on child immunization and maternal health care services in the schedules. The questions will be mostly structured questions having only a few open ended questions.
Survey Instruments: Necessary data on immunization and maternal health would be collected in pre-tested schedules. For Immunization and maternal health, few primary information about caste, religion, age, parity, full immunization, ANC, place of delivery etc would be obtained.
Mode of Data collection: For collecting field data, investigators and supervisors from the evaluation agencies will be used for which each of the investigator and supervisors will get lump sum honorarium along with per diem fees. Supervisors will guide them during all levels of project implementation (data collection). The investigators will be oriented on survey design and activities to be taken up in the field
Time Period: Time period for the proposed study including preparation of report will be around 150 days. The steps, which will be done to do the tasks are as follows: Finalization of the study design and preparation of instruments and its approval by Mission Director, Nagaland; Pre-testing, finalization of instruments and training of field investigators; Field data collection; Data processing, analysis & tabulation; Preparation of draft report & Submission of Final Evaluation Reports
Budget: Budget requirement for Coverage Evaluation Survey amounts to Rs. 25.76lakhs Sl. No. Particulars Amount Part A Field Survey of one district 1 Per diem for investigator @ Rs. 1000/- per day for 8 persons for 10 days 80000.00 Travel cost for team @ Rs. 4000/- per day for two vehicles including fuel for 12 2 days 96000.00 3 Honorarium for supervisors @ Rs. 1,000/- for 10 days 10000.00 4 Expenditure for field work 10000.00 5 Total Expense of the district 196000.00 6 Total Expense for 11 district 2156000.00 Total Part A 2156000.00 Part B Other Expenses 1 Printing of Formats 15000.00 2 Training Expenditure 25000.00 3 Data Entry & Analysis 50000.00 4 Report Writing ( District wise) 22000.00 5 Printing of Reports (200 copies) 125000.00 6 Honorarium For RRC – Officials @ Rs. 2000/- for 35 days 70000.00 Honorarium for Chief Investigator / Statistical Person visiting each district @ Rs. 7 3000/- 33000.00 8 Contingency 80000.00 Total Part B 420000.00 Grand Total (A+B) 2576000.00 (Rupees Twenty five lakh seventy six thousand only only)
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Estimation of MMR and IMR: Rationale: Nagaland like other small state does not have MMR data in any from any established and reliable source. The IMR from SRS collected from various sampling units across the state is implemented under Census Department. Alarmed by the increasing trend of IMR over the years, all available records were closely examined. It is evident that the quality and regularity of data collection and reporting is not as desired. As Nagaland was not covered by DLHS-III, the only available data to Nagaland is NFHS 3 and DHLS 2 and recently the CES 2009. Hence the need of latest status to enable the way forward beyond the current edition of NRHM.
Study Protocol The study will cover all11 districts of Nagaland. Standard Methodology, sampling design and sample size will be followed. The study will be conducted by the Regional Resource Centre for NorthEasternStates and the Population Research Guwahati.
Budget: The estimated budget for the proposed estimation of MMR & IMR amounts to Rs. 20.00 lakhs.
c. Others: Mobile Based e-data transmission: It is a huge burden for the health personnel to travel to the DAU for submission of the reports owing to lack of or poor transport and communication services. Even in the places where it is available, the services is between the habitat and district hq. The communication service between the habitat and block hq is almost nonexistence till today. Therefore, for most health personnel the only option to submit the reports is to travel on foot. Given the frequency of the reporting- weekly (IDSP) and monthly, it is very difficult for the health personnel to fulfil the timelines of MEIS.
Tocircumvent the problems related to difficult terrainand lack of or poor transport and communication services, the state is ambitiously planning to capitalise on IT particularly for HMIS and other reporting system of various national health programmes.
Thus, in collaboration with NHSRC, New Delhi a pilot project for mobile-data transmission has been launched in six Sub-Centres under Jalukie block of Peren district in 2009-10.
Base on the experience gained, the proposal to extend the service to cover the entire health units was approved during 2010-11. Software development incorporating HMIS and IDSP format of different facility level as well as MCTS is nearing completion. Procurement of IT hardware to support the system in collaboration NIC as well procurement of Mobile phones is under process. Health Information Systems Programme Technical (HISP) New Delhi has been outsourced for technical assistant and capacity building of this activity. The project is expected to roll out by March 2011.
No additional budgetary provision is for this project is projected for 2011-12.
Development, Printing and Dissemination of Check List for Assessment for Integrated Supportive Supervision and Monitoring: i. Rs. 1.00 lakh per district for Development, Printing and Dissemination of Check List for Assessment. ii. The total budget requirement of Development and Printing of Check List for Assessment for Integrated Supportive Supervision and Monitoring for Action is Rs. 11.00 lakhs.
PROCUREMENT OF HARDWARES/SOFTWARES AND OTHER EQUIPMENTS FOR STRENGTHENING IT INFRASTRUCTURE AT APPROPRIATE LEVELS:
Nagaland SPIP 2011-12 204
1. Hardware/Software Procurement: b. Replacement of old Desktop PC and accessories: i. Computers and accessories of 4-5 years old procured at the beginning of NRHM needs to be replaced. The state proposes to replace 2 PCs from each district and 10 PCs. All the blocks were givrnonr pc each during 10-11. ii. Budget for procure of PC at district and state level amounts to Rs. 19.20 lakhs Units Rate Total Activity Block District State Total 1. Replacement of Old PC and accessories 0 22 10 32 60000 1920000.00 Rupees nineteen lakhs twenty thousand
c. Software Procurement: i. To procure antivirus for PCs for State, District and Block level. ii. To procure SPSS software for statistical propose at State and district level. iii. To procure Windows7OSforState and district level. iv. To procure File Converter software for State and district level. v. Total budget for procurement of Software amounts to Rs. 3.90Lakhs Units Activity Block District State Total Rate Total Antivirus (3 users/copy) 17 11 8 37 2500 91666.67 SPSS 0 11 2 13 7000 91000.00 File Converter 0 11 2 13 7000 91000.00 OS Windows 7 professional 0 11 2 13 9000 117000.00 Grand Total 390666.67
2. Providing Internet Connectivity through NIC to all district Hqs. Rationale: a. Broadband Internet Connectivity coverage is very low in many areas. b. Broadband Internet Connectivity is unreliable even in those districts where service providers are available. c. The only widely Internet Connectivity is the BSNL Data Card but the capacity is very low to operate the HMIS software. d. Power supply is erratic with high frequency and long duration of load shedding. e. No internet facility is available in the IDSP EDUSAT installed in all the district Hq. f. The CSC facility is also unreliable due to the same reasons. g. NIC service is available but is congested as it caters to all the departments. h. Due to poor transport and communication facility, traveling long distance frequently to upload the offline copy is not only cumbersome and inconvenient for the personnel but also affects the functioning of the office.
In view of poor IT connectivity, timely and regular uploading of HMIS with the stipulated timeframe is compromised, which is affecting the monitoring processand detrimental to the overall service delivery.
Proposal: In order to have a reliable and dedicated internet service at the district Hq, IT connectivity will be tapped from the NIC through OFC. Some of the main issues for choosing the OFC are as follows: Wireless connections- RF, Wifi, Wimax etc cannot provide 2Mbps which is required for operating the HMIS software as the infrastructure at the district NIC cannot support the specified speed. Tapping connection from NIC through lease line of BSNL is another option but the services of the BSNL is not reliable.
The proposed project was conceived in consultation with the State NIC after a feasibility survey by the Technical Consultancy firm of state NIC. The project will be implemented under the supervision of the state NIC.
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a. IT connection to all the district hq/DPMU and State Hq (11+1units). b. Adequate power backup (a set of 2 KVA ONLINE UPS with 3Hrs Backup as well as Silent Genset 2.2KVA) will be installed in all stations to address the severe electricity problem. c. The technical support for maintenance will be provided by the NIC. d. Block Health Units will also utilise this facility for uploading the offline copy. e. The budget for providing IT connectivity in all the district amounts to Rs. 71. 38 Lakhs. S/ Uo Product Description Make Qty Unit Price Total N M Digilink O.F Cable 6F outdoor Duct-UnamoureedPE 1000 1 Digilink Mtr 115 11,50,000.00 jacket SM 0 Digilink LIU 06 Port Rack Mount BLK with Splice 2 Digilink 20 Nos 5,700.00 1,14,000.00 Tray and Cable spool 3 Digilink 1x6 SC Adaptor Module Panel-Simplex Digilink 20 Nos 450 9,000.00 4 Digilink Adaptor SC SM-ZR-SLEEVE Digilink 120 Nos 550 66,000.00 5 Digilink Pigtail SC SM Simplex Length-1m Digilink 120 Nos 650 78,000.00 6 Digilink Patch Cord LC-SC SM Duplex Length-2m Digilink 20 Nos 2,750.00 55,000.00 Digisol 24Port 10/100Mbps layer 2 Switch with 7 Digilink 20 Nos 23,500.00 4,70,000.00 Gigabit Combo Ports 8 Digisol 1000Base-LX SFP Transceiver LC Type Digilink 20 Nos 17,500.00 3,50,000.00 9 CISCO 1841 Router with accessories CISCO 3 Nos 85,000.00 2,55,000.00 10 2Mbps Lease Modem 6 Nos 45,000.00 2,70,000.00 Total 28,17,000.00 VAT 5% 1,40,850.00 In-State 13.5% 3,80,295.00 Sub Total A 33,38,145.00 11 2 KVA ONLINE UPS with 3Hrs Backup 12 Nos 90,000.00 10,80,000.00 12 Silent Genset 2.2KVA 12 Nos 95,500.00 11,46,000.00 Total 22,26,000.00 VAT 5% 1,11,300.00 In-State 13.5% 300510.00 Sub Total B 26,37,810.00 1000 13 OFC Laying Charges Mtr 55 5,50,000.00 0 14 ODC Termination and Spliceing Charge 120 Nos 1,700.00 2,04,000.00 15 Installation and Commissioning Charges 12 Nos 25,000.00 3,00,000.00 Total 10,54,000.00 Service Tax 10.3% 108562.00 Sub Total C 11,62,562.00 Grand Total (A+B) 71,38,517.00 Rupees seven one lakhs thirty eight thousand five hundred and seventeen
3. Annual Maintenance of IT HW/SW: a. The details of the AMC are given below. b. Budget for AMC IT HW/SW at block, district and state level amounts to Rs. 8.21 lakhs Units Activity Block District State Total Rate Total 1. Desktop PC and accessories 52 33 25 110 5000 550000.00
Nagaland SPIP 2011-12 206
2. Internet Hardware 0 11 1 12 15000 180000.00 Total 730000.00 Rupees seventy three thousand only
4. Operational Cost for the HMIS and MCTS: a. Budget for Operational Cost for the HMIS and MCTS amounts to Rs. 25.21 lakhs Units Activity Block District State Total Rate/ annum Total 1. Consumables Block per annum 52 0 0 52 15000 780000.00 District per annum 0 11 0 11 25000 275000.00 State per annum 0 0 1 1 50000 50000.00 2. Phone/Electricity bills Block pa 52 0 0 52 12000 624000 District pa 0 11 0 11 20000 220000 State pa 0 0 1 1 20000 20000 3. Internet bills (Data card) pa 52 11 5 68 6000 408000.00 4. Internet bills (Broadband) pa 0 11 1 12 12000 144000.00 Grand Total 2521000.00 Rupees twenty five lakhs twenty one thousand
OPERATIONALISING HMIS AT SUB DISTRICT LEVEL: During 2010-11, the state has completed review/revision of existing registers to make them compatible with National HMIS.
Proposal: 1. Printing of New Registers/Forms: a. Printing & distribution of HMIS forms for SC, PHC, CHC/DH. The formats for district to state and state to GoI will be printed from the office. Hence not projected. b. The budget requirement for Printing & distribution including VAT etc of HMIS forms for SC,
PHC, CHC/DH amounts to Rs. 2.38 lakhs.
ed ed
Facility No of Units No of per pages Monthly Report No of copiesper month No of per pages copy per month No of requir pages per month 10%Wastage factor Actual Requirement per month Actual Requirement per year Printing, binding in bookform & Distribution costper page Total Amount SC 398 4 3 12 4776 478 5254 63043 2 126086.40 PHC 124 8 3 24 2976 298 3274 39283 2 78566.40 CHC 21 12 3 36 756 76 832 9979 2 19958.40 DH 11 16 3 48 528 53 581 6970 2 13939.20 Grand Total 238550.40 Rupees two lakhs thirty eight thousand five hundred and fifty
2. Training of health staff on HMIS: c. Workshop on HMIS application in health management for senior officers from directorate, and district.
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One-day Orientation training of State and District Officials comprising of Addl Directors, Jt Directors/SPOs and DD/SPOs, Chief Medical Officersand Medical Superintendent of DHs/TB Hospitals/Mental Hospital. Resource person will be from MoHFW, NIFHW and RRC. Venue: Directorate Budget requirement for the Orientation training of State Officials, Chief Medical Officers and Medical Superintendents on integrated supportive supervision and monitoring for action @ Rs. 2000/- per head for 57 persons amounts to Rs. 1.14 lakhs.
OPERATIONALISING &STRENGTHENING OF MOTHER AND CHILD TRACKING SYSTEM: 1. Status of MCTS implementation a. Roll out plan for operationalisingMCTS in position. b. Development, adoption & printing of MCTS Registers and Form for Pregnant Women and Children completed and under distribution to all health units. c. Redesigning and printing of key registers- ANC/INC/PNC & Immunization as per data requirement of MCTS completed. Dissemination of registers and formats to various health units started. The timeline for printing was affected due to frequent power failure. d. Identification and designation of Data Aggregation Unit (DAU) completed. Considering the availability of Internet connectivity, regular power supply, case load and requirement of skilled manpower as well as limited resources, instead of stationing the DAU upto PHC level, the state has identified Block Health Units (which includes all CHC, several strategically placed PHCs and DHs due to shortage of CHCs) as DAU which will be the hub for HMIS and MCTS activities. e. CapacityBuilding: f. Training of State and District level TOT completed, while training of block level and below functionaries is underway. g. Procurement of IT logistic support to all DAUs under process. h. Incorporation of MCTS in the Mobile e-data transmission is under process through the technical support of HISP. i. Delay in rolling out: Following the directives from Ministry on NBITS for pregnant women and children, the state has initiated developed the Implementation Plan. Accordingly, demarcation of jurisdiction for each health unit, Eligible Couple listing,Codification of UID Number & field testing was undertaken and at the same time the state IT department was outsourced to develop the software based on the above mentioned exercise. However, on the verge of implementation following the Bhopal Meeting, the states were directed to adopt the eMamta/MCTS developed by Gujarat NIC. Therefore, the state was compelled to abandon the activities so far carried out. One area which is still yet to solve is the health unit jurisdiction as per Census 2011, which is critical for the generation of the UID number. The NIC is yet to solve the problem The health units are tracking the beneficiary but Reporting to DAU and uploading to web portal is not started as reporting/uploading without UID number would create more confusion at all levels. Field testing of MCTS without UID number using the health unit registration number was initiated several health units. However, due to the GoI direction for verification of Mobile numbers has led to disconnection of many mobile numbers. The state government has asked the central government for extension of the verification for another 6 months. Also due to extensive damage of power lines during the monsoon this year, printing of the registers and formats were unduly delayed. j. Timeframe: Though the infrastructure is in place, it is not worthwhile to immediately roll out without UID number generation and mobile phone number. However, the state is positive to start that the tracking by March.
2. Manpower support for MCTS is projected under ‘Strengthening of M&E/HMIS/MCTS’
3. IT infrastructure support for MCTS: a. Provision of Desktop PC with accessories and BSNL Data Card to all the Blocks has been approved during 2010-11 and procurement is under process. b. IT infrastructure support is projected under ‘Strengthening IT infrastructure at appropriate levels’.
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4. Printing and Reproducing of Registers and Forms:
a. Printing and Reproducing of Registers Budget requirement for Printing and Reproducing of Registers amounts to Rs. 17.91Lakhs. No of No of Registers Printing, binding in book page per as per need form & Distribution cost Register Register assessed per page Total Amount Maternal Health Register 1 50 1032 150 154800.00 Maternal Health Register 2 50 1032 150 154800.00 Child Health Register 50 1032 150 154800.00 EC Register 50 8844 150 1326600.00 Grand Total 1791000.00 Rupees seventeen lakhs ninety one thousand
b. Printing and Reproducing of Forms: Budget requirement for Printing and Reproducing of Forms amounts to Rs. 4.50Lakhs.
Remarks
Assessed
Form
Expected Beneficiary as per Need No of Form Required (in duplicate) per month No of Form Required (in duplicate) peryear 10%Wastage factor Actual Requirementper year Inclusive per Cost page Total Amount Maternal Tracking 39683 7937 95239 9524 112700 2 225399.44 This amount is to Child Tracking (U1 ) 39683 7937 95239 9524 112700 2 225399.44 be provided to BHU for in- 450798.88 house Printing Rupees four lakhs fifty thousand seven hundred and ninety eight only
5. Capacity Building of Teams/Training on MCTS and HMIS: a. Workshop on MCTS and HMIS application in health management for senior officers from directorate, and district. One-day Orientation training of State and District Officials comprising of Addl Directors, Jt Directors/SPOs and DD/SPOs, Chief Medical Officersand Medical Superintendent of DHs/TB Hospitals/Mental Hospital. Resource person will be from MoHFW, NIFHW and RRC. Venue: Directorate Budget requirement for the Orientation training of State Officials, Chief Medical Officers and Medical Superintendents on integrated supportive supervision and monitoring for action @ Rs. 2000/- per head for 57 persons amounts to Rs. 1.14 lakhs.
b. Workshop on MCTSand HMIS application in health management for officers from districtandblock. One-day Orientation training of officers from districtandblock comprising of District Programme Officers (48), SMO CHC (21), MO i/s PHCs (21) designated as BHU, DPM (11), DFM (11), BPM (52), BFM (52). Resource person will be from RRC, State HIB and SPMU. Batch size: 50-55 No of Workshop: 4 Venue: Directorate Budget requirement for the Orientation training for officers from district and block @ Rs. 1400/- per head for 216 persons amounts to Rs. 3.14 lakhs.
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c. Training on MCTSand HMIS for staff from Directorate, SPMU, DPMU and BPMU. One-day training of staff from Directorate, SPMU, DPMUand BPMU comprising of 2 regular staff (statistical asst and 1 ministerial staff) from State HIB, DEOs (3) from SPMU, and from each DPMU & BPMU- 1 DEO under NRHM and 1 regular staff (statistical asst or 1 ministerial staff). Resource person will be from RRC, State HIB and SPMU. Batch size: 20-25 No of Training: 6 Venue: Directorate Budget requirement for the Orientation training of staff from Directorate, SPMU, DPMU and BPMU @ Rs. 1400/- per head for 130 persons amounts to Rs. 1.82 lakhs.
d. Training on MCTSand HMIS for staff from health units- SC, PHC, CHC& DH. One-day training of staff from health units- SC, PHC, CHC&DH comprising of 1 ANM and 1 Pharmacist form each SC (2*398), 1 ANM and1 regular staff(pharmacist, statistical asst or 1 ministerial staff who will be involved in the HMIS)identified by the incharge of the HU from each PHC, CHC&DH (2*124+21+11). Resource person will be from DPMU, State HIB and SPMU. Batch size: 20-25 No of Training: 55 Venue: District Hq Budget requirement for the Orientation training of staff from Directorate, SPMU, DPMU and BPMU @ Rs. 1400/- per head for 1108 persons amounts to Rs. 15.51 lakhs.
6. Ongoing Review of MCTSactivities: a. Proposed for quarterly meeting at state and monthly meeting at district and block levels The budget for quarterly meeting at state and monthly meetingat district and block levels amounts to Rs. 32.72 Lakhs.
Particulars State District Block a. No of Units 1 b. Frequency Quarterly Monthly Monthly c. No of Review Meeting per year 4 132 624 d. Cost per meeting State @ (1500*11CMO) + 3000 19500.00 0.00 0.00 District @ (800*50BHU)+(2000*11District) 0.00 63600.00 0.00 Block (300*502HU)+(1000*52BHU) 0.00 0.00 202600.00 e. Cost per Year 78000.00 763200.00 2431200.00 f. Responsibility for Organization Director (FW) CMO i/c of BHU Senior Officials from directorate, SPMO & CMO District level Block level from each officials and i/c officials and I/c g. Participants district of BHU of HU Grand Total 3272400.00 Rupees thirty two lakhs seventy two thousand and four hundred
Budget Summary for Monitoring& Evaluation: Activity Amount Manpower Support Deployment of 52 Block DEOs 66.96
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28.8 Deployment of 8 DPHNOs for Integrated Supportive Supervision and Monitoring Sub Total A (Budgeted under PMC) 95.76 Mobility Support for M & E Officers Integrated Supportive Supervision and Monitoring 99.57 of facilities Integrated Supportive Supervision and Monitoring for VHND 28.69 Workshops/Training on M & E Orientation training of State Officials, Chief Medical Officers and Medical Superintendents for 1.14 Integrated Supportive Supervision and Monitoring Training of State & District trainers and Supervisory field staff 12.68 M&E Studies Coverage Evaluation Survey 25.76 Estimation of MMR and IMR 20 Mobile Based e-data transmission 0 Development, Printing and Dissemination of Check List for Assessment for Integrated 11 Supportive Supervision and Monitoring PROCUREMENT OF HARDWARES/SOFTWARES AND OTHER EQUIPMENTS FOR STRENGTHENING IT INFRASTRUCTURE AT APPROPRIATE LEVELS Hardware/Software Procurement 19.2 Software Procurement 3.9 Providing Internet Connectivity through NIC to all district Hqs 71. 38 Annual Maintenance of IT HW/SW 8.21 Operational Cost for the HMIS and MCTS 25.21 OPERATIONALISING HMIS Printing of New Registers/Forms 2.38 Workshop on HMIS application in health management for senior officers 1.14 OPERATIONALISING &STRENGTHENING OF MCTS Printing and Reproducing of Registers 17.91 Printing and Reproducing of Forms 4.5 Capacity Building of Teams/Training on MCTS and HMIS Workshop on MCTS application in health management for senior officers 1.14 Workshop on MCTSand HMIS application in health management for officers from 3.14 districtandblock Training on MCTSand HMIS for staff from Directorate, SPMU, DPMU and BPMU 1.82 Training on MCTSand HMIS for staff from health units- SC, PHC, CHC& DH 15.51 Ongoing Review Meetings 32.72 Sub Total B (Budgeted under Part B) 335.62 Grand Total A+B 431.38
Work Plan/Timeline for M & E: Activity Q1 Q2 Q3 Q4 1. STRENGTHENING OF M&E/HMIS/MCH TRACKING a. Manpower Support for MCTS BPMU FOR deployment of 52 Blocks b. Supervisory field staff for Integrated Supportive Supervision and Monitoring To recruit 8 District Public Health Nurse (DPHNO)
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for deployment in DPMU c. Mobility Support for M & E Officers for Integrated Supportive Supervision and Monitoring Mobility Support for M & E Officers Integrated Supportive Supervision and Monitoring for Health Unit Level Integrated Supportive Supervision and Monitoring for VHND d. Workshops/Training on M & E Orientation training of State Officials, Chief Medical Officers and Medical Superintendents for Integrated Supportive Supervision and Monitoring e. M&E Studies Coverage Evaluation Survey Estimation of MMR and IMR f. Others: Mobile Based e-data transmission Development, Printing and Dissemination of Check List for Assessment for Integrated Supportive Supervision and Monitoring 2. PROCUREMENT OF HW/SW AND OTHER EQUIPMENTS FOR STRENGTHENING IT INFRASTRUCTURE AT APPROPRIATE LEVELS: a. Hardware/Software Procurement Replacement of old Desktop PC and accessories Software Procurement Providing Internet Connectivity through NIC to all district Hqs b. Annual Maintenance of IT HW/SW c. Operational Cost for the HMIS and MCTS 3. OPERATIONALISING HMIS AT SUB DISTRICT LEVEL a. Printing of New Registers/Forms b. Training of health staff on HMIS Workshop on HMIS application in health management for senior officers from directorate, and district Workshop on HMIS application in health management for officers from district and block Training on HMIS for staff from Directorate, SPMU, DPMU and BPMU Training on HMIS for staff from health units- SC, PHC, CHC & DH 4. OPERATIONALISING & STRENGTHENING OF MOTHER AND CHILD TRACKING SYSTEM a. Printing and Reproducing of Registers and Forms Printing and Reproducing of Registers Printing and Reproducing of Forms b. CapacityBuilding of Teams/Training on MCTS Workshop on MCTS application in health management for senior officers from directorate, and district Workshop on MCTS application in health management for officers from district and block
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Training on MCTS for staff from Directorate, SPMU, DPMU and BPMU Training on MCTS for staff from health units- SC, PHC, CHC & DH c. Ongoing Review of MCTS activities Quarterly meeting at state and monthly meeting at district and block levels
B. Community Monitoring: B15.1: Community Monitoring (Visioning workshop at state, district and block level) Community Monitoring plan was approved amounting to Rs. 48.40 lakhs @ Rs. 44.00 lakhs for districts and Rs. 4.40 lakhs for state level activities) under M & E component of Part B (NRHM) of RoP 2010-1. Some of the main achievements are highlighted below: 1. Roll out plan for operationalising Community Monitoring in position. 2. Community Monitoring Committee at state, district and block level notified and constituted. 3. Preparation, adaptation and printing of manuals, protocols, checklist and formats completed and distribution of the same to various units underway. 4. State level sensitization and advocacy and training of district trainers for Community Monitoring is completed, while Block level training is underway. 5. Selection of NGOs as Framework of Implementation is under process. 6. To operationaliseCommunity Monitoring by March 2011. 7. Given the limited human resources particularly at the grass root level, instead for constituting another Monitoring committee and availability of competent NGO for Implementation, the Organogram for Community Monitoring committee & Nodal NGO (Implementing Agency) has been modified as follows: a. The Executive Committee of the DHS and SHS and the HCMC of the block health unit may be given the additional responsibility of the Mentoring team/group respectively. b. The existing VHC at the Village level, Health Centre Committee at SC/PHC/CHC/DH level, the Executive Committee of the DHS and SHS may be given the additional responsibility of the Community Monitoring Committees respectively. c. Instead of having 3 tier of implementing agency NGOs at State, District and Block, NGOs will at district and state level only. 8. Proposed Community Monitoring Activity & Budget Break up: a. Block level & Sub block activity: i. Village level activity by NGO @ 2 village/block/district for capacity building and public hearing in 104 villages. The NGO will select 2 villages/block half yearly in consultation with the District. ii. Block level activity @ 2 blocks per district for capacity building and public hearing in 22 blocks. The NGO will select 2 blocks half yearly in consultation with the District. b. District level activity i. The NGO will be responsible for conducting at the district level Capacity building once a year and Public hearing half yearly. ii. The Executive Committee DHS will be responsible for conducting at the district level Review Meeting half yearly. c. State level activity i. The NGO will be responsible for conducting at the state level Capacity building once a year and Public hearing half yearly. ii. The Executive Committee SHS will be responsible for conducting at the state level Review Meeting half yearly. iii. The SPMU will be responsible for Printing & timely distribution of Formats etc.
District and block level could not be undertaken during 10-11. Therefore, unspent balance will spill over to 11-12 activities.
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CHAPTER-6: FINANCIAL MANAGEMENT
1. Budgeting for various Activities The financial budget of the SPIP for the year 2011-12 has been based strictly as per the financial norms prescribed by the Govt. of India and in accordance with the Financial Monitoring Report (FMR) Format wherein the progressive utilization of funds have been analyzed. The Program management cost is well within the prescribed ceiling of 6% of the total budget both for the RCH Flexi pool and Mission Flexi pool. The program management costs include the costs for Strengthening of SHS/SPMU (Including HR, Management Cost, Mobility Support, field visits) Strengthening of DHS/DPMU (Including HR, Management Cost, Mobility Support, field visits ) Strengthening of Block PMU(Including HR, Management Cost, Mobility Support, field visits, Strengthening of financial management systems and training on program and financial management, workshops, seminars, review meetings hiring of vehicles, Audit Fees, Concurrent Audit fees, Mobility Support to BMO/MO/Others, introduction of financial accounting software. The proposal for civil works, construction/ infrastructure constitute more than the ceiling of 33% of the total budget which is in consonance with the suggestions and advice of the Hon’ble Minister of H&FW Govt. of India so as to strengthen the rural health delivery facilities.
2. Financial Management Staff:
Status of financial management Staff as on 01.01.2011 No. of posts Sanctioned Reason for Action taken & Deputation / No. of vacant and Posts of F & A & vacant tentative date for filling Contract Staff Vacant Since Designation position up the vacancy (date) State Deputy Director Accounts 1 NA NA NA F&A Service State Finance Manager Contract 1 NA NA NA State Accounts State manager contract 1 NA NA NA Level Accounts Manager contract 2 NA NA NA Accountant contract 2 NA NA NA Finance Consultant contract 1 NA NA NA District Appointment shall be Accounts Posts completed within Manager contract 8 3 advertised February 2011 Appointment shall be Posts completed within District Accountants contract 6 5 advertised March 2011 Level They will be perform (Includin the function of as block g Blocks) accountant Data Assistants Appointment shall be cum Posts to be completed within June Accountant contract 0 11 advertised 2011
3.Statutory Audit
Status of Statutory Audit 2009-10
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Financial Year Process of Date of Date of Date of Appointment completion of Submission to submission of Audit & Approval Govt. of India reply to audit by EC FMG NRHM deficiencies intimated by FMG 2009-10 Open Tender System 16.07.2010 & 30.07.2010 30.11.2010 22.07.2010
4. Concurrent Audit Concurrent Audit process has been implemented in the State Health Society and all the District Health Societies with effect from the financial year 2009-10 on a quarterly time period and the quarterly audit reports have been submitted. The concurrent audit for the financial year 2010-11 has been appointed and the audit report of the first two quarters have been submitted and has been put up for approval to EC,. The Executive summary shall be submitted on approval by EC. The third quarter Audit is in progress as on date.
5. Implementation of Tally Accounting software Tally ERP9 licenses have been procured on 24th September 2009 for the State Health Society and 11 District Health Societies as per advisory issued by Govt. of India vide DO letter No. G.27034/1/2009-NRHM (F) dated 12th August 2009 from the Mission Director NRHM, Govt. of India. The software training was imparted during November 2009 and subsequently two follow-up trainings were conducted during the current financial year. The software was implemented and made operational from the 1st of April 2010 at State and district level. However on operationalisation of the Tally ERP9 numerous problems in data entry and reporting formats have been observed and the matter has been taken up with the vendors as well as the local support center. But the response has been negative and till date no solutions were provided by the vendors Tally Solutions Pvt. Ltd. Bangalore. Moreover the licenses were not provided by Tally Solutions Pvt. Ltd. Bangalore. Hence the software cannot be restored in two systems at the Districts ( Mokochung & Kiphire) and one at the State which had to be formatted.
6. Mode of Fund Transfer
Status of Funds transfer Mode of transfer Reasons for mode of transfer Timeframe for achievement State Health E-transfer 100% NA NA Society to District Health Society District Health E-transfer wherever there is NA NA Society to sub presence of banking facility district health and in other cases through A/c facilities payee cheque or DD District Health E-transfer in the districts of All the villages do not have 30th June 2011 Society to Village Mon, Kiphire, Kohima, presence of scheduled level Dimapur where the commercial banks communitised centers have opened bank accounts and in other cases through A/c payee cheque or DD
7. Uploading of FMRs on HMIS Portal The uploading of Financial Monitoring Report (FMR) on the HMIS web portal has not been done by all the districts. This was primarily due to the following reasons: The implementation of TallyERP9 and the reporting formats to be generated wherefrom has not yet been fully done due to the software problems which have to be rectified by the vendors.
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The internet connectivity of BSNL and other ISP are not available or available with limited connectivity in all the districts. However steps are being taken to for total implementation of the uploading of financial data on HMIS web portal so that the same is done from the next financial year. Further Govt. of India FMG NRHM has discouraged the further procurement of Tally software and the same shall be shall be discontinued. In lieu the State Health Society shall implement the software being currently developed by Govt. of India with State Bank of India for e-transfer of funds, accounting and reverse data capturing from the user facility.
8. Financial reporting under NRHM Quarterly FMR prepared accurately as per guidelines along with bank reconciliation statements are being submitted regularly and within the stipulated time to Govt. of India FMG NRHM up to second quarter 2010-11. The third quarter FMR shall be submitted within the 31st January 2011. During the financial year 2009-10 Nagaland State Health Society had a zero default in submission of financial reports to Govt. of India.
9. MIS The monthly MIS/FSP up to November 2010 has been submitted to Govt. of India FMG NRHM, the quarterly MIS along with head wise and age wise details of advances up to 31.12.2010 will be submitted within 31.01.2011.
10. Statutory Audit A separate audit reports for the account of 2009-10 including all NDCPs along with reply to audit deficiencies 2009-10, intimated by FMG has been submitted to GOI, FMG on 30.11.10. The State Health Society is in the process of formation of FMG at the State level consisting of finance personnel & program heads of all NDCP. Thereby it will streamline the financial management and preparation of audit reports for accounts of the financial year 2010-11 including all NDCPs.
11. RCH-I Unspent Balance The unspent balance of RCH-I in respect of 24 hour Delivery service has been refunded to Govt. of India on 20th March 2009 vide cheque No. 163261 and sent through demand draft. There are no further unspent balances refundable to Govt. of India.
12. Key Areas for Priority during 2011-12 The Difficult area Allowance scheme formulated for identified backward districts on the basis of backward and difficult areas for special incentives to medicos and para-medicos for performing duties in such difficult areas was prepared and submitted for approval in the SPIP 2010-11. However the same was not approved. During the discussions with the Department related Parliamentary Standing Committee on H&FW to North East and also discussions with NHSRC it was observed that rationalization of compensation packages of contractual manpower should be undertaken to sustain the progress of implementation. In view of this for the financial year 2011-12 it has been proposed to increase the remuneration/ fee payable to the medical and non medical staff on the basis of categorization the Districts into three categories based strictly on degree of accessibility and difficult terrain. This has become pertinent due to the high attrition rate of medical professionals and their refusal to work in those difficult areas and also in view of the parity with the current pay of regular staff consequent on pay revision. This will ensure effective implementation and optimal utilization of human resources. The revised compensation to contractual manpower as detailed in the annexure enclosed has been approved in principle by the Executive Committee of the State Health Society and accordingly the same has been projected in the SPIP 2011-12.
13. Committed and Uncommitted Unspent balances
As per details annexed RCH II PIP 2010-11
Sl. Activity Approved Funds Amount Committed Uncommitted Remarks No. Amount released Utilised as unspent balances as (Rs. In (Rs. In on balance as on Lakh) lakhs 31.12.2010 on 31.12.2010 (Rs. In 31.12.2010
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lakhs) 1 Maternal Health 77.87 0.00 0.79 0.00 (excluding JSY) JSY 366.00 0.00 202.36 136.93 0.00 2 Child Health 35.40 0.00 0.00 0.00 3 Family Planning 7.60 0.00 7.65 0.00 4 Sterilisation & 48.88 0.00 0.00 59.87 0.00 IUD compensation & NSV camps 5 ARSH 27.50 0.00 5.40 27.50 0.00 6 Innovations/ 333.36 0.00 0.00 315.00 0.00 PPP/ NGO 7 Infrastructure & 742.76 0.00 156.77 545.00 0.00 HR 8 Institutional 160.27 0.00 55.46 95.22 0.00 Strengthening 9 Training 227.93 0.00 14.57 101.80 0.00 10 BCC / IEC 444.57 0.00 162.32 215.33 0.00 11 Procurement 366.23 0.00 365.87 0.00 0.00 12 Program 395.65 0.00 176.17 122.01 0.00 Management GRAND TOTAL RCH II 3234.02 0.00 1147.36 1618.66 0.00
MISSION FLEXI POOL 2010-11
Sl. Activity Approved Funds Amount Committed Uncommitted Remarks No. Amount released Utilised as unspent balances as (Rs. In (Rs. In on balance as on Lakh) lakhs 31.12.2010 on 31.12.2010 (Rs. In 31.12.2010 lakhs) 1 ASHA 170.00 2455.00 88.38 41.22 0.00 2 Untied Funds 203.40 224.21 220.29 0.00 3 Hospital Strengthening 100.00 0.00 4 Annual Maintenance 94.90 72.35 87.13 0.00 Grants 5 New Constructions/ 1348.92 434.01 1621.26 0.00 Renovation and setting up 6 Corpus Grant to 162.00 95.04 55.04 0.00 HMS/RKS 7 District Action Plan 60.00 12.23 8.61 0.00 8 Panchayat Raj 66.20 27.88 0.00 Initiative 9 IEC-NRHM 65.00 22.30 10.70 0.00 10 Mobile Medical Units 260.81 136.16 0.00 11 Referral Transport 63.00 186.99 0.00
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12 School Health 50.44 25.24 0.00 Programme 13 Additional Contractual 709.20 356.45 0.00 Staff 14 PPP/NGOs 51.17 33.00 0.00 15 Community 61.10 0.36 17.77 0.00 Monitoring 16 Procurement 39.98 43.76 0.00 17 New Initiatives 90.15 0.00 18 NRHM Management 490.00 163.26 42.33 0.00 Costs/ Contingencies NRHM Flexi Pool (Total) 4086.27 2455.00 1888.62 2137.35 0.00
CHAPTER 7: STATE RESOURCES AND OTHER SOURCES OF FUNDS FOR HEALTH SECTORS: 1. Resources from state govt: Details discussed in respective activities. 2. Others Sources: Details discussed in respective activities.
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CHAPTER 8: PRIORITY PROJECTS THAT CAN BE CONSIDERED IF ADDITIONAL RESOURCES ARE AVAILABLE.
Considering the huge infrastructure gap coupled with scarce internal resources, the state would like to submit the following priority projects for consideration. The DPR of the proposal will be submitted for forward linkage if the NPCC approves in principle. 1. Construction of SC building: 50 nos (List in Annexure: CW1) 2. Construction of PHC building: 10 nos (List in Annexure: CW1) 3. Construction of CHC building: 5 nos (Pungru in Kiphire, Chazuba in Phek, Dhansaripar in Dimapur, Longkhim in Tuensangand Sanis in Wokha) 4. Upgradation of District Hospitals to IPHS: 2 nos (Mon and Dimapur) 5. Construction of Drug Warehouse: a. Out of the 5 district drug warehouses sanctioned @ Rs. 152.00 lakhs per unit under NRHM, the construction in 2 districts (Phek & Mon) is completed while the progress in the other 3 (Tuensang, Zunheboto & Longleng) is expected to complete by July 2011. b. The state is still short of drug warehouses in the remaining 6 districts. c. To strengthen the network of drug warehouses, the state proposes to construct: District drug warehouses in 4 districts viz: Kiphire, Peren, Wokha and Mokokchung @ Rs. 152.00 lakhs per unit State warehouse @ Rs. 200.00 lakhs per unit. 6. Upgradation of GNM Nursing School Mokokchung: Presently the annual intake of the school is 25 students. To reduce the HR gap, owing to ever increasing need of GNMs, it is proposed that the annual intake be upgraded to 50 seats per annum. To address the shortage of manpower in the high focus districts, 50% of the seats will be reserved for the candidates with requisite qualification from these prioritized districts (Mon, Kiphire, Tuensang and Longlen). The expansion of capacity needs additional hostel accommodation, class rooms, etc. The cost estimate for the upgradation of GNM Nursing School Mokokchung is Rs. 500.00 lakhs. The proposal may be recommended by NPCC and may be sent to the Nursing Division, MoHFW, GOI for consideration. 7. Establishment of SNCU at NHAK (State Referral Hospital) 8. Mobile Telemedicine Unit: Considering the problems associated with difficult terrain, poor road network, lack of proper health infrastructure and manpower in rural and remote areas where people are living in rural areas devoid of proper health care the state proposes to introduce Mobile Telemedicine Unit in partnership with Indian Space Research Organisation (ISRO. Mobile Telemedicine Unit will be placed at 3 districts- Dimapur, Mokokchung and Kohima. Each unit will be responsible for 3-4 districts for delivery of the services to the entire state. The unit consisting of health personnel and medical equipment along with Telemedicine hardware, software and VSAT system mounted in a Bus/Van can establish a Mobile Telemedicine centre at any place. 9. Establishment of SIHFW at Kohima:
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Functional Head Wise Classification of the Budget Requi red Physi fund cal under Unit Targ NRH Sl.No. Activity Cost ets M Human Resources A RCH 1 Contractual Staff & Services 1 Contractual Staff & Services(Excluding AYUSH) A.9.1.1 ANMs 15000 398 716.40 A.9.1.1.1 GNM/ Staff Nurse 20000 227 544.80 A.9.1.1.2 GNM for MCH activities in 11 DH 0 0 0.00 A.9.1.1.3 GNM for NBSU 20000 20 48.00 A.9.1.2 Laboratory Technicians 15000 39 70.20 A.9.1.2.1 X-ray technician 15000 5 9.00 A.9.1.2.2 Lab Tech (Blood Component Separation at Blood Bank Dimapur) 15000 5 9.00 A.9.1.2.3 Ophthalmic Assistants NPCB 8000 5 4.80 Refrigerator Mechanics UIP 8000 3 2.88 Specialists (Anesthetists, Pediatricians, Ob/Gyn,Surgeons, A.9.1.3 Physicians, Radiologist,Sonologist, Pathologist,Specialist for CHC) 52000 17 106.08 A.9.1.3.1 SNCU Manpower support A.9.1.3.2 Pediatrician 0.00 A.9.1.4 PHNs at CHC, PHC level 20000 54 129.60 A.9.1.5.1 Medical Officers at PHCs 40000 97 465.60 A.9.1.5.2 Medical Officers at 24 x 7 PHCs 40000 33 158.40 A.9.1.5.3 Medical Officers at CHCs 40000 21 100.80 A.9.1.5.4 GDMO for MCH activities in 5 FRU CHC 40000 5 24.00 A.9.1.5.5 GDMOs for NBSU for MCH activities in 11 DH 40000 11 52.80 A.9.1.6 Additional Allowances/ Incentives to M.O.s of PHCsand CHCs 0.00 A.9.1.7 Others - Computer Assistants/ BCC Co-ordinator etc 0.00 A.9.1.7.1 Support Staff 0 0 0.00 A.9.1.8 Incentive/ Awards etc. to SN, ANMs etc. 0.00 A.9.1.8.1 FP Performance based rewards to institutions 0 0 A.9.1.9 Pharmacists 15000 14 25.20 A.9.1.10 Other Incentives Schemes (Pl.Specify) 0.00 A.9.1.11 Staff/Supervisory nurses (AYUSH) A.9.1.12 Medical Officers at CHCs/ PHCs (for AYUSH) 20000 29 69.60 A.9.1.13 Dental Doctors 20000 21 50.40
A.11 PROGRAMME / NRHM MANAGEMENT COSTS 0.00 Strengthening of SHS/SPMU(Including HR Management Cost of A.11.1 SHP & M&E), Mobility Support, field visits ) 87.00 Strengthening of DHS/DPMU(Including HR,Management Cost, A.11.2 Mobility Support, field visits ) 165.00 Strengthening of Block PMU(Including HR,Management A.11.3 Cost, Mobility Support, field visits ) 0.00 A.11.4 Strengthening (Others) 0.00 A.11.5 Audit Fees 12.00 A.11.6 Concurrent Audit 18.00 A.11.7 Mobility Support to BMO/MO/Others 0.00 B NRHM Additionalities B.9 Contractual Staff & Services(Only AYUSH) B.9.1 Staff/ Supervisory Nurses/ other staffs for PHCs, CHCs B9.2 Medical Officers at CHCs/ PHCs 0 0 0.00 C Routine Immunisation C.2 A) Computer Assistants Salary 1.59 C.2 B) Other HR Personnels(Technicians, Cold Chain Mechanics 11.60 Other National Disease Control Programme
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D NVBDCP 168.0 (a) Remuneration to Contractual MPWs 7000 200 0 (b) Contractual LTs (c) Wages for Spray Workers 2000 515 51.50 (d) M&E Consultant 40000 1 4.80 (e) Finanmce & Accounts Officer 30000 1 3.60 (f) Procurement & Supply Manager 35000 1 4.20 (g) Statitical assistant 15000 1 1.80 (h) secretarial Asstant 10000 2 2.40 (i) District VBD (Main) Project Officer 30000 17 61.20 (j) MTS 15000 51 91.80 (k) Secretarial Assistant cum DEO 10000 17 20.40 (l) Contractual Lab Tech. 10000 33 39.60 (m) Salary for Lab Tech under J.E. 8000 2 1.92 E NLEP Contractual Services (State SMO, BFO cum (a) AO,Admn.Assttistant, DEO) 10.00 (b) State Driver (c) District Drivers F NBCP (a) Ophthalmic Surgeon 25000 3 9.00 (b) Ophthalmic Assistant 8000 12 11.52 (c) Eye Donation Counsellor (d) Remuneration and Contingency 11.00 G) RNTCP (a) Honarium to DOT Providers 25.00 139.1 (b) Contractual Staff Payments 34 H) IDSP (a) Remuneration of Epidemiologists 40000 12 57.60 (b) Remuneration of Microbiologists 20000 5 12.00 (c) Remuneration of Entomologists 20000 1 2.40 (d) Consultant-Finance 14000 1 1.68 (e) Consultant-Training 28000 1 3.36 (f) Data Managers 13500 12 19.44 (g) Data Entry Operators 8500 12 12.24 I) NIDDCP IDD Control Cell- (i) Technical Officer (ii) Statistical Assistant 9000 1 1.08 (iii) LDC Typist 6500 1 0.78 IDD Monitoring Lab- (i) Lab Technician 9000 1 1.08 (ii) Lab. Assistant 6700 1 0.804 (iii) Others 1.76 Training I RCH Flexible Pool A.10 TRAINING A.10.1 Strengthening of Training Institutions 0.00 A.10.2 Development of training packages 0.00 A.10.3 Maternal Health Training 0.00 A.10.3.1 Skilled Birth Attendance for Nurses 30 15.44 A.10.3.2 EmOC Training 10 17.98 A.10.3.3 Life saving Anesthesia skills training (LSAS) 10 20.16 A.10.3.4 MTP training 9 3.26 A.10.3.5 RTI / STI Training M.Os 60 35.04 A.10.3.5.1 RTI / STI Training Nurse 70 3.52 A.10.3.6 Dai Training 0.00
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A.10.3.7 Other MH Training (ISD Refresher ) 0.00 A.10.3.8 BEmOC training for Mos 0.00 A.10.3.9 OT Technique training for GNM 0.00 A.10.3.10 Orientation training on MCP Card 0.00 A.10.4 IMEP Training (Training/Capacity Building for MOs) 43 4.12 A.10.5 Child Health Training 0.00 A.10.5.1 IMNCI (Training M.O) 30 4.27 A.10.5.1.2 FIMNCI MO 18 1.88 A.10.5.1.3 Master Trainer MO 4.37 A.10.5.2 Facility Based Newborn Care 0.00 A.10.5.3 Home Based Newborn Care 0.00 A.10.5.4 Care of Sick Children and severe malnutrition 0.00 A.10.5.5 (IMNCI) (60 S/Nurse,45 ANM 18 1.14 A.10.5.6 SNCU Training (National Neonatology Forum) 0.00 A.10.5.7 Pre- Service IMNCI Training 0.00 A.10.6 Family Planning Training 0.00 A.10.6.1 Laparoscopic Sterilisation Training 16 3.11 A.10.6.2 Minilap Training 15 12.59 A.10.6.3 NSV Training 10 2.62 A.10.6.4 IUD Insertion Training (MO) 42 8.66 A.10.6.5 IUD Insertion Training (Staff Nurse) 100 11.28 IUD Insertion Training (ANM/LHV) A.10.6.6 Contraceptive Update/ISD Training 40 1.63 A.10.6.7 Other FP Training (pl. specify) 0.00 A.10.7 ARSH Training for NGOs & Staff 0.00 A.10.7.1 ARSH Training for 150 ANM &29 LHV & 27 concellors 206 13.81 A.10.8 Programme Management Training 0.00 A.10.8.1 SPMU Training 4.00 A.10.8.2 DPMU Training 6.00 A.10.9 Other training (pl. specify) in collaboration with PHFI 0.00 Management Tools to improve District Health services under A.10.9.1 NRHM 0.00 A.10.9.2 Health Communication and Advocacy 0.00 A.10.10 Training (Nursing) 0.00 A.10.10.1 Strengthening of Existing Training Institutions/Nursing School 0.00 A.10.10.2 New Training Institutions/School 0.00 A.10.11 Training (Other Health Personnel) 0.00 A.10.11.1 Promotional Trg of health workers females to ladyhealth visitor etc. 0.00 A.10.11.2 Training of AMNs, Staff nurses, AWW, AWS 0.00 A.10.11.3 NSSK M.O 80 7.29 A.10.11.3.1 NSSK Nurse 160 5.42 Other training and capacity building programmes worshop/Training A.10.11.3 IEC Staff 2 4.00
2 Routine Immunisation Training for ANM, Block Level Data Handlers Cold Chain 2.1 Handlers/refrigerator mechanics 4.89 2.2 Training of M.O.s /Other Staffs on R.I. 6.75 2.3 Training for Computer Assistants 0.20 Other National Disease Control Programme 3 NVBDCP 3.1 Training for MPWs 3.2 Training for ASHAs 20.90 3.3 Training for M.O.s 3.4 Training for para-medicals for MDA 3.5 Other Training & Capacity building 6.60 3.6 Training of Spray Workers 3.7 Dengue & Chikungunya Training on Clinical/integrated vector Management of 3.8 supervisors/staff/MPW/ASHA, capacity Building 3.8.1 Training/Workshop 2.50
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3.9 Training of JE activities Training specific toJ.E prevention and management 1.80
4 NLEP Training for Newly appointed medical and para medical 4.1 staffs 4.2 Training for existing medical and para medical staffs 4.3 Other Training & Capacity building programmes 4.00
5 NBCP 5.1 Training /Capacity Building for Health personnels 50000 11 5.50 5.2 Training of Teachers & Others 40000 11 4.40 5.3 Training of other personnel PMOA etc 1.00 6 RNTCP 6.1 Induction Training 29.90
7 IDSP 7.1 Training for M.O.s,Nurses, Data Managers and DEO 6.902 8 NIDDCP
Note: FMR Codes of NDCP' has not been given Civil Work B NRHM Additionalities B.4 Hospital Strengthening B.4.1 Upgradation of CHCs, PHCs, Dist. Hospitals to IPHS) B4.1.1 District Hospitals (Mon & Dimapur) B4.1.2 CHCs Pungro B4.1.3 PHCs B4.1.4 Sub Centers B4.1.5 Others B 4.2 Strengthening of District, Sub-divisional Hospitals,CHCs, PHCs B.4.3 Sub Centre Rent and Contingencies B.4.4 Logistics management/ improvement(PROMIS) 0.00 B5 New Constructions/ Renovation and Setting up CHCs ( Chozuba in Phek & Dhansiripar, Dimapur District B5.1 Longkhim in Tuensang & SANIS in Wokha Dist) B5.2 PHCs B5.3 Sub Centers Sub Centers Quarters CHC Staff Quarters PHC Staff Quarters B5.4 Setting up Infrastructure wing for Civil works B5.5 Govt. Dispensaries/ others renovations Construction of BHO, Facility improvement, civil work,BemOC and 5000 B5.6 CemOC centers 00 11 55.00 Major civil works for operationalisation of FRUS/DH Deep B.5.7 Burial Pit Major civil works for operationalisation of 24 hour services 30000 B.5.8 at PHCs//Construction of Labour room 0 28 85.00 Civil Works for Operationalise Infection Management & 30000 B.5.9 Environment Plan at health facilities 0 3
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80000 B.5.10 Construction of H/T Storage facility 0 3 NPCC RoP Approval for 2009-10 & 10-11 to be released in 2011-12 under civil works CHCs - Construction of 3 new CHCs (Chiephobozou, Noklak & 175.5 Tobu) @ Rs. 117.00 L as per Nagaland SOR Construction of 11 CHC Staff quarters @ 21.00 L (Annexure 115.5 CW1) PHCs - 13 PHC for new Construction @ Rs. 65.68 L as per 426.92 Nagaland SOR (Annexure CW1) Construction of 22 PHC Staff quarters @ Rs. 21.0 L (Annexure 231 CW1) Sub Centers - 50 Sub Centres for new construction @ Rs. 12.33 L, 216.5 totalling to Rs. 616.50 L. (Annexure CW1) Construction of 3 Drug Warehouse (Longleng, Tuensang & Zunheboto) vide GoI letter No: M-11011/4/09-NRHM-III 433 dt 21st Dec 2009 B6 Minor Civil Works B6.1 Minor civil works for operationalisation of FRUs Minor civil works for operationalisation of 24 hour services B6.2 at PHCs E RNTCP a) Civil Works 23.51 F IDSP a) Civil Works G NPCB Vision Centre 50000 5 2.50 75000 Eye Ward & Eye OT 00 1 75.00 Note: FMR Codes of NDCP' has not been given Procurements-Drugs & Supplies B NRHM Additionalities B.16.2 Procurement of Drugs and supplies 213.2 B.16.2.1 Drugs & supplies for MH 8 B.16.2.2 Drugs & supplies for CH 4.90 B.16.2.3 Drugs & supplies for FP 11.00 B.16.2.4 Supplies for IMEP 0.00 B.16.2.5 General drugs & supplies for health facilities 0.00 C Routine Immunisation Other National Disease Control Programme D NVBDCP a) Procurement -Equipments 20.50 b Procurement -Drugs & Supplies c Dengue & Chikungunya d Sentinental Surveillance at Dimapur Infrastructure and other equipments 38.20 E NLEP Procurement of Supportive Drugs, Reagents, MCR a) Footware, Aids Appliances 6.00 F NBCP a) Procurement of Drugs & Supplies
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G RNTCP a) Note-Below
H IDSP
I NIDDCP
In RNTCP, commodity grant for anti TB Drugs has been approved from Central Level procurements and specific Laboratory Equipments Procurements-Equipment NRHM Note: Additionalities Procurements - Equipments B NRHM Additionalities 111.7 B16.1.1 Procurement of equipment: MH 2 B16.1.2 Procurement of equipment: CH 66.15 B16.1.3 Procurement of equipment: FP 59.78 B16.1.4 Procurement of equipment: IMEP 0.00 B16.1.5 Procurement of Others Dental Equipments for CHC 0.00 B16.1.6 Procurement ofXRay equipments & installation for CHC 0.00 C Routine Immunisation Procurement -Equipments (e.g.ADS, Bags, Buckets ) 0 Other National Disease Control Programme 0 D NVBDCP a) Procurement -Kits (e.g. Elisa Kit, Chikengunia Kits ) b) Procurement of insecticides 3.00 E NLEP Procurement of Equipments (Equipments related to RCS). a) Printing forms 2.00 b) Other Procurements
F NBCP Procurement of Equipments-Opthalmic Microscopes, Flash a) Auto claves etc. 40.00 G RNTCP a) Procurement of Equipments 18.50 b) Procurement of Two wheelers
H IDSP Procurement -Equipments for strengtheninig of Surveillance a) Unit b) Other Procurement c Power Back-up for EDUSAT 0 0 0.00 75000 d Priority Laboratory Equipments (2 Dist.) 0 2 15.00 e Computer for priority Lab. 50000 2 1.00 10000 f Outbreak Investigation Kit 0 1 1.00 g Entomological Kit 80000 1 0.80 I NIDDCP Procurement of Kits (Salt Testing Kits)
IEC/BCC Works B NRHM Additionlities B10 IEC-BCC NRHM B.10 Strengthening of BCC/IEC Bureaus(state and district levels) 2.00 B.10.1 Development of State BCC/IEC strategy
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B.10.2 Implementation of BCC/IEC strategy B.10.2.1 BCC/IEC activities for MH 55.73 B.10.2.2 BCC/IEC activities for CH 60.33 B.10.2.3 BCC/IEC activities for FP 47.56 B.10.2.4 BCC/IEC activities for ARSH 27.14 174.2 B.10.2.5 Other activities (please specify) Details as per Text 1 5000 B.10.4 Health Mela 00 11 55.00 B.10.5 Creating awareness on declining sex ratio issue B.10.6 Other activities Integrated IEC of NDCP 34.96 Other NDCPs C Routine Immunisation IEC-BCC Activities D NVBDCP IEC-BCC Activities 57.70 IEC-BCC Activities for Malaria 12.95 IEC-BCC Activities for Dengue & Chikungunya 4.00 Sensitization, IEC materials& Publuicity IEC-BCC Activities for J.E 2.00 E NLEP IEC-BCC Activities 8.00
F NBCP IEC-BCC Activities 10.00 a) Cataract Operations b) Eye Donation Camps c) Other Activities
G RNTCP 13.57 IEC/Publicity 6
H IDSP IEC-BCC Activites
I NIDDCP IEC (Press Advertisement,Health Education ,Global IDD Prevention Day) 9.20 Untied Funds B NRHM Additionalities B.2 Untied Funds B2.1 Untied Fund for CHCs 50000 21 10.50 B2.2 Untied Fund for PHCs 25000 124 31.00 B2.3 Untied Fund for Sub Centers 10000 398 39.80 132.4 B2.4 Untied fund for VHSC 10000 1324 0 B.3 Annual Maintenance Grants 10000 B4.1 CHCs 0 21 21.00 B4.2 PHCs 50000 124 62.00 B4.3 Sub Centres 10000 398 39.80 B8 Panchayti Raj Initiative Constitution and Orientation of Community leader & of B8.1 VHSC,SHC,PHC,CHC etc 2232 400 8.93 Orientation Workshops, Trainings and capacity buildingof PRI at B8.2 State/Dist. Health Societies, CHC,PHC 3972 400 15.89
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B8.3 Others ASHAs B NRHM Additionalities B1 ASHA 10000 2584 184.9 B1.1 Selection & Training of ASHA 9 B1.2 Procurement of ASHA Drug Kit 20.67 B1.3 Incentive to ASHAs under JSY B1.4 Incentive under Family Planning Services B1.5 Incentive under Child Health B1.6 Other Incentives to ASHAs B1.7 Awards to ASHA's/Link workers 1.56 B1.8 ASHA resource center 51.20 C Routine Immunisation a) Special ASHA Incentive under Immunisation b) Social Mobilization by ASHA / Link Workers ASHA Incentive on PPI Day (may be considered with the c) cost of PPI)
D NVBDCP a) Incentive to ASHAs 50.00 E NLEP a) Services through ASHAs 0.50 b) Honorium to ASHAs, Sensitization through ASHAs F NBCP a) ASHA Incentive 1.575
G RNTCP ASHA Incentive for DOTs H NIDDCP Incentive to ASHA 6.60
RKS/HMS 1.1 RCH
1.2 NRHM Additionalities (i) Corpus Grants to HMS/RKS 50000 B6.1 District Hospitals 0 11 55.00 10000 B6.2 CHCs 0 21 21.00 10000 124.0 B6.3 PHCs 0 124 0 50000 B6.4 Other- For 2 TB Hospitals & 1 Mental Hospital 0 3 15.00 JSY 1.1 RCH Maternal Health Janani Suraksha Yojana / JSY A.1.4.1 Home Deliveries 500 13000 65.00 A.1.4.2 Institutional Deliveries 1300 15000 195.00 A.1.5 24 Hours Deliveries 0.00 A1.6 Payment to Link Workers/AWW/AWS (other than ASHA) 0.00 A1.7 PPP 700 480 3.36 A1.8 JSY Related activities 42.23 Incentive for Sterilization 1 RCH
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A.3 FAMILY PLANNING A.3.1 Terminal/Limiting Methods 0.00 Dissemination of manuals on sterilisation standards &quality 10000 A.3.1.1 assurance of sterilisation services 0 1 1.00 A.3.1.2 Female Sterilisation camps (Budgeted under MH camp) 75000 0 0.00 A.3.1.3 NSV camps 0.00 10000 A.3.1.4 Accreditation of private providers for sterilisation services 0 0 0.00 A3.1.5 Female Sterilization Compensation 1000 2500 25.00 A.3.1.6 Compensation for NSV male 1500 30 0.45 A.3.2 Spacing Methods 0.00 A.3.2.1 IUD services at health facilities 20 2500 0.50 A.3.2.2 IUD Compensation (Camp) A.3.2.3 Accreditation of private providers for IUD insertion services 25000 0 0.00 A.3.2.4 Social Marketing of contraceptives 0.00 A.3.2.5 Contraceptive Update seminars 75000 0 0.00 A.3.2.6 Compensation for ASHA 10 2500 0.25 Performance based rewards to institutions & providers 3.70 A.3.3 POL for Family Planning 30000 22 6.60 A.3.3.1 Review Meeting, Orintation Workshop (As per B 5) 2.00 A.3.4 Repairs of Laparoscopes 75000 0 0.00 Referral Transport 1.1 RCH Referral Transport a) Maternal Health 45.00 b) Child Health 22.5
1.2 NRHM Additionalities Referral Transport 7000 133.0 a) Ambulance/ EMRI 00 19 0 b) Operating Cost (POL) 16.68 1.3 Routine Immunisation 1.4 NVBDCP Referral Services 1.5 NLEP 1.6 NBCP
1.7 RNTCP 1.8 IDSP 1.9 NIDDCP
Other RCH Activities 1 RCH 1.1 Maternal Health Operationalise facilities(only dissemination, monitoring, and A.1.1 quality) A.1.1.1 Operationalise FRUs 4 0.00 A.1.1.2 Operationalise 24x7 PHCs 33 A.1.1.3 MTP services at health facilities 0.00 A.1.1.4 RTI/STI services at health facilities 0.00 A.1.1.5 Operationalise Sub-centres A.1.1.6 Printing of ANM Dairy 0 0 0.00 A.1.1.7 Printing &Dessimination of Partogram & Apgar Score Card 0 0 0.00 A.1.1.8 Rolling out of MCP Card 8.64 A.1.3 Integrated outreach RCH services A.1.3.1 RCH Camps 50000 44 22.00 A.1.3.2 Population Week/ Sterilization Camp 50000 11 5.50 A.1.3.3 Monthly Village Health and Nutrition Days 1.00
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1.1.4 CHILD HEALTH A.2.1 IMNCI 0.00 A.2.2 Facility Based Newborn Care/FBNC 0.00 A.2.3 Home Based Newborn Care/HBNC 0.00 A.2.4 School Health Programme 0.00 A.2.5 Infant and Young Child Feeding/IYCF 0.00 A.2.6 Care of Sick Children and Severe Malnutrition 0.00 A.2.7 Management of Diarrohea, ARI and MicronutrientMalnutrition 18.86 1.1.5 URBAN RCH a) Establishment of New Urban Centres b) Urban RCH Services ADOLESCENT REPRODUCTIVE AND SEXUAL 1.1.6 HEALTH / ARSH a) Adolescent services at health facilities. b) Other strategies/activities 6.00 Vulnerable Groups A RCH A.6 TRIBAL RCH a) Organise Tribal Camps b) Other Tribal Activities A.7 VULNERABLE GROUPS
Other Mission Flexible Pool Activities B NRHM Additionalities Other MFP activities B7 District Health Action Plans (Including Block, Village) 60.00 B9 Mainstreaming of AYUSH Activities other than HR 18.52 B9.1 Training and IEC/BCC 0 2060 226.6 B10 Mobile Medical Units (Including recurring expenditures) 000 11 0 B13 School Health Programme 16.12 B15 Planning, Implementation and Monitoring Community Monitoring (Visioning workshops at state, Dist, Block B15.1 level) B15.1.1 State level 6.81 B15.1.2 District Level 32.52 B15.1.3 Block Level 60.24
B15.2 Quality Assurance B 15 .2.1 Development of Standard Treatrment Guideline 1.00 B 15 .2.2 Publication & distribution of QA literature 24.00 B 15 .2.3 Workshop of health staff on QA 4.28 B15.3 Monitoring and Evaluation B15.3.1 Monitoring & Evaluation / HMIS Workshops 69.29 B15.3.2 Computerization HMIS and e-governance, e-health 56.52 B15.3.3 Other M & E (MCTS) 74.24 128.6 B15.3.3.1 Mobility Support (99.57+28.69) 2 B15.3.3.2 Forms & Registers 35.79 B15.3.3.3 M & E Studies 45.76 B18 Regional Drug Warehouses 0.00 B.19 New Initiatives/ Strategic Interventions (As per State health policy)/ Innovation/ Projects(Telemedicine,Hepatitis, Mental Health, Nutition Programme for Pregnant Women, Neonatal) NRHM Health Helpline) as per need (Block/ District Action Plans) 50.15
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B19.2 Notional Sub Centres B19.3 Medical Equipment Maintenance Unit 74.16 B.20 Health Insurance Scheme 0.00 B.21 Research, Studies, Analysis (ASHA Intervention & JSY) 9.00 B23 Support Services B23.1 Strengthening NPCB (Opthalmic Assistants) 0 0 0.00 25000 B23.2 Strengthening of IDSP (power backup for Edusat) 0 12 30.00 B23.3 Strengthening of UIP (R/Mechanic) 0 0 0.00 Strengthening of NSACS (Blood Component, Blood Bank Dimapur) 0 0 0.00 B23.4 Strengthening of Oral Health 61.84 B23.5 Strengthening of NTCP 45.64 B23.6 Strengthening of NMHP 52.82 122.6 B23.7 Strengthening of NPPCD 4 B.24 Other Expenditures (Power Backup, Convergence etc) 0 INNOVATIONS/ PPP/ NGO B NRHM Additionalities B14 PPP/ NGOs B14.1 Non governmental providers of health care RMPs/TBAs B14.2 PNDT and Sex Ratio Public Private Partnerships (Continuing support to 3 Mission 5000 B14.3 Hospitals in Wokha Mokokchung & Zunheboto) 00 3 15.00 325.3 B14.4 NGO Programme/ Grant in Aid to NGO 11 4 Othet innovations Partnership with Medecins Sans Frontiers 7980 B14.5 (MSF) for Mon District Hospital 000 1 79.80 Other innovations(Continuing support for Weaving a Dream- 8109 B14.6 Peoples Initiative) 000 1 81.09 2800 B14.7 State PPP cell 00 1 2.80 4903 B14.8 Partnership with Police Department 000 1 49.03 C Routine Immunization Operational Cost (Printing of Cards, Review meeting, 116.1 POL, IW & computer consumables) 68 1.4 NVBDCP
D NLEP NGO Services 2.00 a) NGOs b) Pvt. Sector
E NBCP Cataract Performance a) NGOs 1.00 b) Pvt. Sector
F RNTCP NGO/PPP Support 28.98
G IDSP
H NIDDCP
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Operational Cost Other NDCPs E NVBDCP Mobility Support/, Transportation of DDT/Rent &taxes 43.40 Lab Consumables/ Materials/Diagnostic Kits and commodities Quality Assurance Review Meetings (Quarterly State/District) Field Visits Formats and Reports Communication facility to Staffs Repair of Laparoscopes Incidental Charges Monitoring & evaluation (TA/DA,ASHA incentives/entomological Studies,Travel expenses, State/ 192.9 District and support for report) 2 Planning & Administration 78.39 Activities for Dengue & Chikungunya (a) Epidemic Preparedness 8.50 (b) Integrated Vector Management © Monitoring & Evaluation 2.00 (d) Contingency grant for 1 Lab Strengthening Surveillance 5.00 (e) Contingency for emergency hospitalization in case of outbreak for SSH Maintenance of vehicles 6.00 Activities for J.E Consumables Support,Equipment maintenance F NLEP Mobility Support 10.00 Lab Consumables Review Meetings 2.5 Field Visits Office Expenditures, Formats and Reports 6.00 DPMR 5.00 Urban Leprosy Control 1.00 Cash Assistance 3.50 G NBCP Mobility Support 2.64 Lab Consumables 2.64 Review Meetings Field Visits 2.20 Formats and Reports 1.10 Cateract Operation 750 1750 13.13 Eye Disease 1000 100 1.00 SES Spectacles 200 1500 3.00 Equipement maitenance 5.00 Management of State Health Society NPCB 7.00 H RNTCP Mobility Support/ Vehicle Maintenance & hiring 53.66 Lab Consumables 25.00 Review Meetings Field Visits Formats and Reports 12.00 Others/ Miscellaneous 33.00 Equipement maitenance 10.61 I IDSP
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Mobility Support (SSU/DSU) 6.50 Lab Consumables 2.00 Review Meetings 3.90 Field Visits/ Collection &Transportation of Samples 1.50 Office Expenses 15.70 Formats and Reports 3.00 Broad Band expenses 6.00 20000 Outbreak investigation(consumables) 0 2 4.00 I NIDDCP Mobility Support 1.2 1.20 Lab Consumables/Lab Disposals 1.036 1.20 Review Meetings/ Advocacy and Workshop 15.30 Field Visits Formats and Reports IDD Survey 2.00 Strenghthening State IDD set up 1.00
Financial Aid /Grant to Institutions For all NDCP's---- i) Financial Aid /Grant to Medical Collages ii) Financial Aid /Grant to Referral Institutions iii) Financial Aid /Grant to Sentinel Sites iv) Financial Aid /Grant to Medical Hopitals Financial Aid /Grant to OthersNDCPs- NTCP,Oral Health, NPPCD & Mental Health
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