GOVERNMENT OF JAMMU & KASHMIR
NATIONAL RURAL HEALTH MISSION
DISTRICT HEALTH ACTION PLAN
LEH
December 2007
1 2 PREFACE
The Hon’ble Prime Minister launched the NRHM on 12 th April 2005 throughout the country with the basic objective of providing accessible, affordable and accountable health care in rural areas. Its primary focus is on making the public health system fully functional at all levels. While detailing the functioning of the NRHM, the present planning process initiated in the State provides the entire framework for making the Public Health System fully functional and standardized upto the Indian Public Health Standards at all levels. In doing so, it emphasizes the need for communitisation of the Public Health System, improved financing and management of public health, human resource innovations, and a long-term financial commitment to enable the state and districts to undertake programmes aimed at achieving the Mission goals.
National Rural Health Mission envisages the planning process to be participatory and decentralized starting with the Village. It seeks to empower the community by placing the health of the people in their own hands and determine the ways they would like to improve their health. This is the only way to ensure that health plans are local specific and need based. The State should facilitate the processes by providing enabling environment and required financial and technical support. NRHM was launched in April 2005 and is being implemented by the Department of Health and Medical Education, Government of Jammu & Kashmir.
In accordance with the National Rural Health Mission, Jammu & Kashmir. The district has constituted the District Health Mission and significant progress has been made since it’s beginning. As per the NRHM guidelines, it has merged multiple societies at the district level. The District Action Plan was the most important aspect of the NRHM and to make District Plan more meaningful and address local health problems, preparation of Block Health Plans was considered essential. The decentralized planning process involved village consultations and preparation of Village Health Plans by the Village Health Water and Sanitation committees; followed by development of Block Action Plans through integration of Health Facility Surveys and block specific needs. The Block Action Plans were then integrated to form District Action Plan.
As result of this exercise, the district now has developed capacity for preparing the need based health action plans following participatory processes. A District Planning Team (DPT) was set up for this purpose in the month of May 2007 with representation from various sectors
3 concerned with NRHM. This group was responsible for management of the entire planning process in the district and also for provision of the technical support. The DPT is the standing body and will take charge of ensuring implementation of the plan. Thus the DPT not only owns the plan but will also be responsible for monitoring the progress of implementation to achieve the objectives of the plan. The members of the DPT are:
# Name Designation Department 1. Dr M K Bhandari Dy Commissioner/CEO/ Chairmen District Administration Health Society / NRHM 2. Dr Dolma Tsering Convenor Health 3. Mr G.Q Giri Chief Planning Officer/ Member DC Office 4. Mr Tsering Morup Assistant Commissioner development / Rural Development Member 5. Mr Kaul Executive Engineer PHED / Member PHED 6. Sh T.K. Bhatt Chief Education Officer / Member Education 7. Dr P Tsering Dy CMO / Nodal Officer Health 8. Dr Yangchan Dolma DIO / Member Health 9. Dr Rinchen Dorjay Disst. TB Officer / Member Health 10. Dr P Wangchuk Chief Amchi / Member Health 11. Sh T Sangrup Nodal Officer / ICDS / Member ICDS 12. Sh T Paldan Disst. Social Welfare Officer / Member Social Welfare 13. Sh Tsering Phunchok Chief Amchi / Member ISM / Amchi 14. Sh Gurmeet Amchi Research Center / Member ISM / Amchi 15. Dr S T Phuntsog Director Mahabodhi Karuna Charitable MNGO Hospital / Member 16. Sh P Wangtak DPM / Member Health
The orientation of DPT, facilitated by EPOS Health India, was held on 29 June 2007. This enabled the DPT members to not only understand NRHM approach, key components and strategies of NRHM, but also manage the planning process and develop the District Action Plan. The DPT met a number of times and the individual members reviewed the situation of their respective sectors/areas and collectively developed the strategic vision for improving the health status of the district population.
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We the members of the DPT on behalf of the entire Core Group reiterate and certify that this District Action Plan has been prepared through participatory processes. It has been developed by integrating the Block Action Plans prepared by integrating health facility surveys and village health plans in each block of the District. This plan also incorporates the needs and plans from 121 Sub health centres, 17 PHCs, 2 CHCs & 1 DH in the District.
Name of Chief Medical Officer Signature Date
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CONTENTS
PREFACE ...... 3 Executive Summary ...... 8 Priority Matrix of District Leh ...... 10 1. SITUATION ANALYSIS ...... 16 Socio Economic and Health Indicators of the District ...... 21 2. PLANNING PROCESS ...... 40 3. PRIORITIES AS PER BACKGROUND AND PLANNING PROCESS ...... 44 4. GOALS ...... 49 5. TECHNICAL COMPONENTS ...... 50 PART A: Reproductive and Child Health (RCH) II...... 50 PART-B: NRHM Initiatives...... 78 PART C: Immunisation...... 97 PART D: National Disease Control Programme...... 102 6: Inter-Sectoral Convergence ...... 115 7. COMMUNITY ACTION PLAN ...... 121 9. GENDER AND EQUITY ...... 126 10. CAPACITY BUILDING ...... 129 11. HUMAN RESOURCE PLAN ...... 136 12. PROCUREMENT AND LOGISTICS ...... 139 13. DEMAND GENERATION - IEC ...... 141 14. FINANCING OF HEALTH CARE ...... 144 15. HMIS, MONITORING AND EVALUATION ...... 146 16. Adolescent Health ...... 149 16.Bio –Medical Waste Management ...... 152 Annexure ...... 153
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DISTRICT LEH
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Salt Distt. Hospital N OBR SDH / CHC 2 PHC/AD 21 Sub-Centre/MAC Kargil Ambulance KHALTS Indu I TA NGTS Roa LE CHIN Rived A Srinagar River Suru PANGONG TSO r 1 12 T I B E 5 N AYOM 28
2 KEYLA
7 Executive Summary Leh district comprises of large unserved and underserved areas due to difficult hilly terrain. Hence there has been very little development including lack of health facilities, poor transport network and communication. Although the number of CHCs, PHCs and SCs are adequate as per the population norms but there is a need to upgrade all health facilities as per IPHS norms. Not even one of the facilities is as per the IPHS standards. There is a huge population of scheduled tribes population in the district and needs to be addressed. Some most difficult and unreachable villages have been identified in different blocks of Leh for which special outreach sessions are required.
The District Action Plan was developed in a participatory manner with EPOS as a facilitator. There was wide participation from all the related departments. A District Planning Team was constituted who carried out the block consultations and the Subcentre level consultations. Facility Survey was carried out for each facility. The consultations focussed on each of the thematic areas with the present situation, the bottlenecks, strategies and how to achieve the goals. The hot spots were identified from the village plans and the Block plans after incorporating the Facility survey reports, were consolidated to form the district plan. These were approved by the District Health society and the District Action Plan was finalized after incorporation of the DHS suggestions.
The District Action Plan comprises of the situational analysis, goals and objectives for each of the defined indicators, strategies, activities, support required from the state, work-plan and the budget for each of the thematic areas. All the aspects of health have been incorporated including the NRHM additionalities of ASHA, Untied funds, Mobile Medical Unit, Facilities as per IPHS norms, the National Disease control programmes, and Intersectoral Coordination and Community involvement. Capacity building and Human Resources have been dealt with in details. The other Cross cutting issues of Gender, Logistics and Warehousing, HMIS, IEC and Biomedical Waste management have been also incorporated.
The priorities of the district include providing services for the unreached, accurate data collection, strong district management, developing facilities as per IPHS norms and thereby meeting the national goals of NRHM.
8 District Leh NRHM BUDGET - AT- A GLANCE (In Lakhs ) S. No Components 2007-08 2008-09 2009-10 2010-11 2011-12 Total A RCH-II 1 DHS 4.700 5.170 5.687 2.130 2.343 20.029 2 DPMU 296.240 83.354 91.807 101.022 111.107 683.530 3 Maternal health 119.887 132.641 160.055 164.721 182.652 759.956 4 Child Health 16.850 17.750 14.450 11.150 12.110 72.310 5 Family Welfare 66.023 107.515 109.101 141.566 192.090 616.293 6 Adolescent Health 31.180 28.638 33.524 35.110 39.492 167.944 7 Gender & Equity 30.530 27.983 30.779 33.733 37.070 160.095 8 Capacity Building 31.330 38.294 41.057 44.298 46.681 201.659 9 HR 1054.957 1040.557 1040.557 1040.557 1040.557 5217.185 10 IEC 110.142 120.889 132.710 145.713 160.017 669.471 11 HMIS & Monitoring 72.422 14.359 16.118 18.009 20.048 140.956 Total 1834.260 1617.149 1675.845 1738.010 1844.165 8709.429 B NRHM Additionalities 1 ASHA 57.970 34.700 30.860 30.980 31.210 185.720 SC Untied Fund & 24.200 24.200 24.200 24.200 24.200 121.000 2 Maintenance PHC Untied Fund & 12.750 12.750 12.750 12.750 12.750 63.750 3 Maintenance CHC Untied Fund & 8.000 8.000 8.000 8.000 8.000 40.000 4 Maintenance 5 MMU 38.877 13.098 14.407 15.848 17.433 99.663 Upgradation of DH & 3502.803 155.494 143.633 147.857 174.668 4124.455 6 CHC 7 Upgradation of PHC 541.874 147.082 77.080 78.179 79.891 924.106 8 Upgradation of SC 480.440 536.293 491.923 72.763 72.763 1654.184 9 VHWSC 19.550 19.550 19.550 19.550 19.550 97.750 10 Community Action Plan 15.708 17.279 19.007 20.907 22.998 95.899 11 PPP 20.000 27.700 28.975 29.330 30.828 136.833 12 Health Care Financing 24.380 19.630 19.630 19.630 19.630 102.900 13 Logistics 137.850 15.080 13.280 13.609 13.979 193.798 14 Biomedical Waste 12.774 14.051 15.461 17.005 18.706 77.996 Total 4897.176 1044.906 918.757 510.609 546.606 7918.054 C Immunization C Immunization 107.827 132.046 111.280 117.336 123.681 592.170 D NDCP 1 RNTCP 52.755 45.741 49.907 54.472 59.428 262.303 2 Leprosy 5.744 6.318 6.950 7.645 8.410 35.068 3 Blindness Control 38.430 11.278 12.409 13.651 15.015 90.782 4 IDSP 26.688 11.873 13.507 15.280 17.228 84.575 5 IDD 3.565 3.922 4.314 4.745 5.220 21.765 Total 127.182 79.132 87.086 95.793 105.300 494.493 E Others 1 Inter-Sectoral 62.998 64.8978 66.98758 69.286338 71.8149718 335.98469
Grand total 7029.443 2938.130 2859.957 2531.034 2691.567 18050.131
9 Priority Matrix of District Leh
S.No Thematic Area Critical Issues of the District Specific Priorities 1. District Health Functional integration of Societies need functional integration Management: vertical societies like and strengthening. Blindness Control Society, Capacity building of the DHS TB Control Society, District members regarding the programme, Malaria Society etc. their roles, various schemes and mechanisms for monitoring and regular reviews and also operational Monitoring and evaluation. guidelines for running the District Health Society. Monitoring of health activities by health personnel only. Members from other departments and also from the elected representatives need to become members for better monitoring and implementation. Strengthening the functioning of the DHS. 2. District & Block Need for providing more Development of total clarity at the Programme technical support to the CMO district and the block levels amongst Management office for better all the officials and Consultants implementation especially in about NRHM activities light of the increased volume Training of district officials and of work in NRHM. BMOs for programme management Strengthening the monitoring Streamlining Financial management and reporting especially in and systems the areas of Maternal and Strengthening the CMO office with Child Health, Civil works DPMU with extra computers, Behaviour change and telephone system and human accounting right from the resources. level of the Subcentre. Capacity building of the DPMU personnel for monitoring Strengthening the Block Management Units by establishing BPMUs. 3. Reducing Lack of 24X7 facilities for Increase coverage of full ANC and maternal and safe deliveries in subcentres Postpartum Care to pregnant
10 child deaths and PHCs. women and Population Lack of authentic data Increase in Institutional deliveries by stabilization regarding the maternal and operationalsing 24X7 PHCs infant deaths in the district. Strengthen FRUs for Emergency Equipments are not working Obstetric Care services along with properly or not available as minimum basic infrastructure, Blood per the need in subcentres, Storage facilities, Facilities for PHCs & CHCs to provide Neonatal Care, drugs and quality services. equipments. Lack of facilities with for Increase availability of safe abortion emergency obstetric care. services at all block level CHCs/ Non-availability of Specialists PHCs. for an aesthesia, obstetric Increased coverage under JSY care, paediatric etc. Strengthening the Village Health Lack of referral transport Day systems. To increase awareness among Lack of Blood Storage mothers and communities about the facilities at FRUs importance of institutional deliveries Lack of Neonatal care Improved behaviour practices in the facilities at FRUs community Operationalization of all the sanctioned Anganwadis 4. Adolescent Adolescents especially the Implement ASRH programme to Health boys are exposed to increase the knowledge levels of smoking, addictions, peer Adolescents on RH and Life skills pressure and there is no one Implement of Kishori Shakti Yojana to counsel them. Teenage in coordination with ICDS and pregnancies also emerging NGOs. as a problem and unsafe Operationalise Adolescent Friendly abortion & premarital sex Health services at the health trend are on rise. facilities
5. Mobile Medical Remote population is not Coverage of the tribal populations in Units (MMUs) covered due to lack of the blocks. required staff, infrastructure. Provide one-MMU equipped with Communications system is GPRS services. poor. Contract MOs and staff nurses for MMUs
11 6. Upgrading None of the CHCs are as per Following CHCs needs to be upgraded CHCs to IPHS the IPHS standards; however as per IPHS Standards in the first year:- the condition of CHC CHC Diskit Skurbuchan is deplorable and CHC Skurbuchan needs to be upgraded as per IPHS standard. 7. Upgrading None of the PHCs are as per Construction of staff quarters in 10 PHCs for 24 hr the IPHS standards. PHCs (Names of PHCs given in Services and 10 PHCs/ADs are without Annexure) IPHS standards staff quarters 8. Upgrading Sub None of the Subcentres are Need to construct 21 Subcentre Centres to as per IPHS norms. buildings ( Names of SCs are IPHS standards Out of 121 subcentres, 21 enclosed as Annexure) subcentres are running in Construction of staff quarters in all rented buildings and 97 subcentres for ANM’s stay. (Names subcentres are running from of subcentres given in Annexure) government owned buildings. Construction of Labour rooms at all There are no labour rooms in Subcentres for promoting any of the Subcentres for institutional deliveries Institutional deliveries. There is no staff quarter in any of the subcentres of the district Leh. 9. Immunisation Lack of awareness to Strengthening the District Family mothers Welfare Office Alternate vaccine delivery Enhancing the coverage of Lack of Cold storage Immunization Efficient monitoring and Alternative Vaccine delivery supervision mechanisms in place Gaps in difficult, flung areas Effective Cold Chain Maintenance & inaccessible areas upto sub centre level Reporting and Zero Polio cases and quality documentation surveillance for Polio cases Large number of cold chain Close Monitoring and equipment are not functional documentation of the progress and need repair or need to Repair and replacement of cold be replaced chain equipment as per the need
12 10. Inter Sectoral Lack of coordination b/w ICDS Linkages to be developed between Convergence and health department ICDS workers and health workers for timely diagnosis of malnourished children and their management (detailed activities under thematic heads) Lack of coordination b/w RDD Linkages to be developed between the and health department Health Department and the Rural Development department • Improving the health standard & general quality of life of rural community. • Awareness on sanitation/ Hygiene & health education. • Covering of school/ Anganwari in rural areas with sanitation facilities & promote Hygiene education & sanitary habits among students. • Promote & encourage cost effective construction of household latrine & their proper use. • Elimination of open defection to minimise the risk of contamination of water source & food.
13 Lack of coordination b/w PHE • Bleaching powder and chlorine and health department tablets will be provided by PHE and distributed by field functionaries to households • Joint communication strategy. • Copy of water quality monitoring reports generated by IPH department will be shared with the Health Department at block, district and state levels • Community based organisations formed under various programmes/sectors will be engaged by a team of frontline workers – health, ICDS and PHE departments.
Mainstreaming of AMCHI • Introduction and placement of Amchi Doctors instead of ISM Doctors at the Block Headquarters and PHCs. • Recognition of this traditional system of medicine by the State Government on similar lines as done by the Govt. of Himachal Pradesh by setting up Amchi Clinics in the District. 11. Human Lack of manpower at all levels • All staff to be in place as IPHS Resource starting from sub centres to norms by 2012 PHCs to CHCs to DH in district • Increased salaries for contractual Leh doctors and Specialists • Special allowances for Regular staff Sub centre level • Increase in the number of training • The requirement of ANM will centres for LHV, ANM, Staff Nurses, be around 242 in Lab Technicians Government as per IPHS • Rational placement of Specialists norms of 2 ANMs per Sub and trained staff centre. • PHC level Recruitment of staff on contract
14 • The PHC are adequate where vacancies • As per IPHS 2 MOs per PHC • Recruitment of staff for new facilities will be required whereas at as per the infrastructure resent there is only one MO requirements. per PHC • Computers at all PHC and for each • For IPHS norms 51 Staff MO and Specialist at the CHC. Nurses for PHC [3 per PHC] • Allowing Specialists and MOs for are required. At present developing special skills as per their there are just 20 SN needs by attending special courses • There are only 15 Lab anywhere in India. Technicians as against the • Proposal for Staff Nurse College required 17 today. and other Paramedical training CHC Level college. Similarly there is vacancies for specialist and other support staff at CHC level
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1. SITUATION ANALYSIS
Profile of the District Leh a part of the Jammu and Kashmir in north with an area of 45110 sq Km in the largest district in the country in term of area, but has the lowest population density across the country i.e. 3 person / Sq. Km as compared to 100/ Sq. Km of the state. The Total population of the Leh district is 1, 17,232 (Census 2001). The district borders Pakistan occupied Kashmir and China occupied Kashmir in north and North West respectively, Tibet in the east and Lahul Spiti of Himachal Pradesh in South.
It is at distance 434 Kms from Srinagar and 474 Kms from Manali. Leh district comprises of Leh town and 112 inhabited villages and one un-inhabited village
The leh district forms the northern tip of Indian compared with other parts of India. The district is the coldest and most elevated inhabitant between 30 to 36 north altitude and 75-80 east longitude. It is at distance of 434 Km from Srinagar and 470 Km from Manali, leh is the district headquarters at altitude of 11000 ft. It has six CD blocks namely, Leh, Khaltsi, Nyoma, Nubra, Tangtse and Kharu under the overall control of Deputy Commissioner/ CEO administratively. Politically the district is governed by Ladakh Autonomous Hill Development Council Leh having strength of 30 councillors which is being headed by the chairman / Chief Executive Councillor since 1995, working within a framework of the constitution of India of Jammu and Kashmir.
The health sector has an extremely important role to play in Ladakh. Being a high altitude region, Ladakh is home to a host of peculiar diseases that need to be studied especially in order to better understand them. Also, Ladakh’s locational disadvantage makes it imperative that all medical facilities be available within the region. Among the many suggestions put forth in this document to improve the health set-up in Ladakh, the more prominent ones include a general overhauling of the entire medical set-up, and the establishment of a special institution dedicated to studying high altitude ailments in the region.
16 Administrative Structure: Structure Details Sub Divisions ( 1) Leh Tehsils ( 2) Leh , Nubra Leh, Kharu, Khaltsi, Nubra, Panamic, Durbuk, Community Development Blocks ( 9 ) Saspol, Nyoma, Chuchot Health department Blocks (6) Leh, Kharu, Khaltsi, Nubra, Tangtsi, Nyoma Rehbar-e-Sehat Blocks Nil Municipal Committees (1) Leh No. of CHCs 2 No. of PHCs 7 No. of Sub-Centres 121
Panchayati Raj Institution: 3 Tier Setup Total Villages : 113 Village Level : Panchayat Block Level : Panchayat Samiti District Level : Zila Parishad
Identifying information of Leh District Name of District Leh Name of District Headquarters Leh No. of Blocks in the District 6 No. of Gram Panchayats in the District 68 No. of Villages 113 1-500 54 501-1500 43 Size of Villages 1501 – 3000 14 3001-5000 2 5000+ Nil Villages without motorable roads 31 Villages without electricity 15 No. of Towns 01 Municipal Corporation Municipality Urban Local Bodies (ULB) One Municipality in Leh Notified Area Committee Others
17 Un-served / underserved / vulnerable areas, population in the District: There are a large number of unserved and underserved areas in the district Leh as its population density is very low and people are living in scattered group of huts on hill tops.
In summer the population of Leh district almost gets doubled due to migrant labourers as especially from Nepal, Bihar and other parts of the country. They are bought by Army, GREF and local contractors and remain scattered through out the district. Due to this large migrant labour, health department faces many constraints and challenges especially tracing them for surveillance and other health related issues.
The list of most backward, far flung and unreachable villages in district Leh are as follows:
S.No Block Villages 1. Khaltsi Yulchung, Nerak, Lingshed, Photoksar 2. Nubra Thang, Largab, Waris fastan, Largyap Pachathang, Diggar, Khemi 3. Tangtse Phobrang, Chushul, Mann, Merak 4. Nyoma Samad Rokchan, Korzok, Kharnak, Anlay koyul
Development Indicators of the District S.No Indicators State District as per District data 1 Crude Birth Rate 18.7 SRS -05 11 .2 2 Crude Death Rate 5.6 SRS -05 3.43 3 Infant Mortality Rate 49.0 SRS -05 34 5 TFR 2.4 NFHS III 6 Couple Protection Rate 53 % NFHS III 61% 7 Decadal Growth Rate 29.93 8 Population Density 99/ sq. km 3/ Sq. km 9 Sex Ratio (General) 900 Census 2001 963 10 Sex Ratio (0 – 6 years) 937 Census 2001 992 11 Sex Ratio at birth DNA 925 12 Literacy rate (overall) 54.46 Census 2001 65.34 13 Literacy rate (male) 65. 75 Census 2001 75.6 14 Literacy rate (female) 41.82 Census 2001 52.7 Enrolment of students T 24504 15 elementary education M 11299 F 12205 Source: Census, 2001; DLHS-RCH-II Survey, 2004, CMO office. DLHS-RCH-II Survey, 2004
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Related to Pregnancy and Maternal Health Issue % Issue % Mean age at marriage for boys 27.6 Mean age at marriage for girls 28.1 Boys married below legal age at marriage 21 years 0.0 Girls married below legal age at marriage 18 yrs 0.0 Any antenatal check up 92.0 Antenatal check up at home 0.0* 3 or more antenatal check ups 89.6 Who had one TT injection during pregnancy 7.9* 9.7* 9.7* Who had two or more TT injection during pregnancy Who had no TT injection during pregnancy Who received 100 or more IFA tablets during Who consumed two or more IFA tablets regularly 75.9 pregnancy 24.0* during pregnancy Received adequate IFA tablets/syrup 58.7 Who consumed one IFA tablet regularly 7.9* Full ANC1 - (At least 3 visits for ANC + at least one Safe Delivery (Either institutional delivery or home 94.5 TT injection + 100 or more IFA tablets) 24.0* delivery attendant -Doctor/Nurse/TBA) Full ANC2 - (At least 3 visits for ANC + at least one Safe Delivery (Either institutional delivery or home 93.6 TT injection + 100 or more IFA tablets/syrup) 58.7 delivery attendant by Doctor/Nurse) Institutional delivery 89.6 Home delivery 7.7* Institutional delivery - government 89.6 Women who had pregnancy complications 40.1 Institutional delivery – private 0.0* Women who had delivery complications 81.9
Related to Family Planning Issue % Issue % Women aware of RTI/STI 46.5 Birth order 3+ 42.8* Women aware of HIV/AIDS 91.4 Unmet need for limiting-1 0.5* Knowledge of any modern family planning
method 99.3 Unmet need for spacing-1 0.4* Knowledge of any modern spacing family 97.6 planning method Unmet need -total-1 0.8* Knowledge of all modern family planning
methods 1.9* Unmet need -total-1 0.5* Knowledge of any traditional method 12.2 Unmet need for spacing-2 2.7* Current use of any family planning method 90.7 Unmet need -total-2 3.1* Current use of any modern family planning
method 90.5 Unmet need -total-2 8.0* Current use of any traditional family planning 0.2* 0.5* method Current use - Male sterilization
Current use - Female sterilization 14.4 Current use - PILLS 23.3 Current use - Male sterilization Current use - CONDOM 13.1 Women had side effects due to use of female 3.7* sterilization Women had side effects due to Pills 2.0* Women had side effects due to use of IUD 2.6* Sought treatment abnormal vaginal discharge 18.2* Women who utilized government health facility for treatment of RTI/STI (vaginal discharge) 85.1* Women who had any symptom of RTI/STI 19.6
19 Related to Child Health Issue % Issue % Breastfeeding within 2 hours (children age below 16.5 Percentage of children age 12-35 months 100.0 36 months) received BCG Percentage whose mother squeezed out the first 43.4 Percentage of children age 12-35 months 44.8 breast milk (children age below 36 months) received DPT 3 Exclusive breastfeeding at least 4 months 0.0 Percentage of children age 12-35 months 90.3 (children age 4-12 months) received Measles Percentage of children age 12-35 months received 100.0 Percentage of children age 12-35 months 12.6 Polio 0 received Full Immunization Percentage of children age 12-35 months received 31.9 Percentage of children age 12-35 months not 0.0 POLIO 3 received any vaccination Awareness of diarrhoea 89.0 Knowledge of ORS 80.0 Who had diarrhoea (two weeks prior to 14.4 100.0* survey) Given ORS to children during Diarrhoea
Sought treatment for Diarrhoea 91.4* Aware of danger signs of Pneumonia 5.5 Who had Pneumonia (two weeks prior to 5.0 100.0* survey) Sought treatment for Pneumonia
20 Socio Economic and Health Indicators of the District
Total for Name of Health Block Leh Kharu Khaltsi Nubra Tangtse Nyoma District Demographic indicators Total Population 47,241 7,281 16,911 17,261 4,747 8,878 1,02,319 Population of males 24,520 3,548 8,605 8,491 2,388 4,372 73,174 Population of females 22,701 3,733 8,306 8,491 2,388 4,506 50,125 Population of children less 854 130 391 517 91 155 2138 than a 1 year old Population of children in age 2,947 538 1,130 1,575 445 755 7,390 group between 1 and 6 years % Scheduled Castes 0.2 0.5 1.5 0.2 0.5 0.5 0.56 % Scheduled Tribes 82 88 79 83 84 83 83.16 Number of Inhabited Villages 112 Socio-economic indicators No. of <2 children benefiting 619 94 402 791 120 202 2,228 from the ICDS scheme No. of children aged 2 years and above benefiting from the 1106 279 623 901 327 344 3,589 ICDS scheme No. of BPL households 2,798 754 1340 1187 753 1427 8,259 No. of girls enrolled in primary 922 195 645 716 248 253 2977 schools last year No. of girls dropping out of DNA DNA DNA DNA DNA DNA 60 primary schools last year Number of overhead tanks or 04 03 04 08 03 07 29 hand pumps Number of functional hand 04 00 04 08 03 07 29 pumps in sub centres Number of wells currently being used for drinking water DNA DNA DNA DNA DNA DNA DNA purposes Number of households with 574 220 323 264 146 151 1678 access to toilets No. of private health 24 0 0 01 0 0 25 facilities/clinicians No. of women who have benefited through the JSY 403 70 40 52 27 73 665 Scheme till now 1
1 No. of pregnant women with the following mandatory characteristics: Belonging to BPL family
21 Total for Name of Health Block Leh Kharu Khaltsi Nubra Tangtse Nyoma District No. of girls who got married DNA DNA DNA DNA DNA DNA DNA last year No. of girls who got married last year and were <18 years DNA DNA DNA DNA DNA DNA DNA at the time of marriage Health Indicators No. of Tubectomies conducted in the last reporting 42 - - - - - 42 year No. of IUD insertions done in 1020 - 43 194 53 17 1327 the last reporting year No. of vasectomies done in 26 - - - - - 26 the last reporting year No. of pregnant women 2119 42 230 339 82 118 2930 No. of pregnant women registered for ANC during the 2119 42 230 339 82 118 2930 last reporting year No. of pregnant women who received both TT1 and TT2 1718 43 228 410 188 76 2663 during pregnancy in the last reporting year No. of institutional deliveries 1377 20 185 115 44 33 1774 in the last reporting year No. of women operation of MTPs in the last reporting 80 80 year No. of RTI/STI cases reported 4545 02 112 02 4661 in the last reporting year No. of children given measles 1068 120 159 278 87 77 1789 vaccine in the last reporting year No. of outpatients (monthly 5551 3601 5456 2039 2110 26293 average) No. of inpatients (monthly 605 16 05 79 03 04 772 average) Prevalent Diseases 1 Bronchiti Joint Acid Anemia Goitre Joint pain . s pain peptic Hyperten Joint 2 G.E. APD BP APD sion pain
Should be 19 years or older Up to two live births
22 Total for Name of Health Block Leh Kharu Khaltsi Nubra Tangtse Nyoma District
3 Arthritis Arthritis ARI ARI ARI URD Tuberculosis and Leprosy No. of patients currently undergoing DOTS therapy in 73 04 03 02 02 84 the block Number of new leprosy cases 02 02 reported in last reporting year NVBDCP No. of slides examined for malaria in last reporting year No. of notified malaria cases Nil Nil Nil Nil Nil Nil Nil (last reporting year) No. of new kala-azar cases in the block in the last reporting year NA No. of microfilaria cases reported NA in the last reporting year No. of JE cases reported in NA the last reporting year Blindness Control No. of cataract operations conducted in the block last 35 21 5 3 64 year School Health Programme No. of schools covered under 02 02 in the last reporting year
23 Health Institutions, Population Coverage Ratios and Health Functionaries in the District
Total for Name of Health Block Leh Kharu Khaltsi Nubra Tangtse Nyoma District
Health Institutions No. of Speciality Hospitals 01 01 No. Referral Hospitals 01 01 01 02 No. of CHC/BPHC No. of Blood Banks 01 01 No. of CHC 01 01 02 (IPHS Standards) No. of Blood Storage Units 01 01 No. of PHC in the Block 03 01 05 04 02 02 17 No. of MOs in Positions 02 01 02 02 02 01 10 No. of 24 hrs. PHC 01 01 No. of MTP Centres 01 01 No. of Sub Health Centres 26 11 28 23 12 21 121 No. of ANMs in Position 26 11 28 23 12 21 121 No. of AYUSH Dispensaries 01 01 (AMCHI) No. of Private Hospitals 01 01 No. of Beds in Govt. 180 10 70 100 20 10 390 Institutions No. of Beds in Pvt. 10 10 Institutions No. of Anganwadi Centres 70 24 35 61 13 21 223 No. of Govt. 01 01 01 01 04 Ultrasound Pvt. 03 03 Clinics Unregistered Population covered No. of Sub-centres covering more than the current norm Nil Nil Nil Nil Nil Nil Nil (3000) No. of Govt. 01 01 Obstetricians Pvt. No. of Govt. Gynaecologists Pvt. No. of Govt. 01 01 Paediatricians Pvt. 01 01 No. of Govt. 02 01 03 Surgeons Pvt. No. of Govt. 02 01 03 Anaesthetists Pvt. 01 01
24
Total for Name of Health Block Leh Kharu Khaltsi Nubra Tangtse Nyoma District
Health Institutions No. of Govt. 01 01 Orthopaedists Pvt. Govt. 01 01 No. of Dentists Pvt. No. of Eye Govt. 01 01 02 Surgeons Pvt. 01 01 No. of Gen. Govt. 02 02 Physicians Pvt. 01 01 No. of Govt. 02 02 Radiographers Pvt. No. of Public Health Nurses No. of Staff Nurses 44 01 04 11 02 01 63 No. of LHVs 02 01 01 04 No. of Pharmacists 52 11 29 26 14 24 156 No. of Lab. Technicians 10 01 04 05 02 01 23 No. X Ray Technicians 10 01 04 05 02 01 23 No of Ophthalmic Assts. 03 02 02 01 01 14 No. Dental 04 01 03 04 01 01 14 Mechanics/Hygienists No. of Male Health 24 Supervisors No. of ANMs 45 11 32 26 14 24 139 No. of Male Health Workers 136 No. of AW Workers 07 01 05 05 02 03 23 No. of UDCs 19 No. of LDCs 05 No. of Computer/Statistical 02 02 Assts. No. of Drivers 12 01 04 03 01 02 23 No. of ASHAs selected 44 19 63 59 20 33 238 No. of Trained Dais 11 04 17 08 14 54
25
Workforce Vacancy Position * Given below is the information about Workforce Vacancy Position in the District
Analysis of status of manpower sub-centre, PHC, CHC and FRU level Category Sanctioned In position Vacant MOs [Gen] 78 38 40 Specialists 18 14 04 No. of Public Health Nurses 05 00 05 Staff Nurses 64 63 01 Male Supervisor 23 23 00 Female Supervisor/LHV 04 04 00 ANMs 139 139 00 MHWs 23 23 00 Pharmacists 156 136 20 Lab Techs 23 23 00 No. X Ray Technicians / Radiographer 23 23 00 No of Ophthalmic Assts. 09 09 00 No. Dental Mechanics/Hygienists 14 14 00 No. of Upper Division Clerks 20 19 01 No. of Lower Division Clerks 22 17 05 No. of Computer/ Statistical Assts. 04 01 03 No. of Drivers 23 23 00 Any other category 345 305 40
26 Table:1 Percentage Availability of Infrastructure
District: Leh
Indicators SC (121) PHC (17) CHC (2) DH
1 Building (Govnt. + Donated) 86 100 100 100
2 Building (Rented) 14 0 0 0
3 Condition of Building (Good + Fair) 75 Na Na 100 Water Supply (Tap, borewell/ 4 32 59 100 100 handpump/tubewell, well) 4.1 Tap water supply NA 24 50 100 5 Electricity 39 41 100 100 5.1 In all parts of hospital NA 29 50 100 Electric supply (power generation NA NA NA 100 stablization) 6 Separate Toilet 16 35 50 100 6.1 Sep.Toilet with running water NA Na 50 100 7 Furniture 39 66 NA 100 8 Labor Room 4 65 100 100 8.1 Aseptic labor room NA Na 100 100 9 Avail. of Quater for staff 0 53 30 100 10 Number of beds available (Average) 6 30 100 11 Laboratory 76 100 100 12 Operation Theatare 6 50 100 13 Waste Disposal (Burnt+Dump) 65 50 100 14 Availability of incenator Na 0 0 15 Telephone 12 100 100 16 Computer 12 100 100 17 Generator/Invertor 24 100 100 18 Vehicle 65 67 100 19 Emergency Room / Casualty 50 100 Separate wards for males and females 20 50 100 (Yes/No) 21 No. of beds : Male 10 100 22 No. of beds : Female 3 100 23 Availability of ECG facilities 50 100 24 X-Ray facility 100 100
27 25 Ultrasound facility 50 100
26 Cardiac Monitor for OT 50 100
27 Blood Storage Unit available 0 100 28 Blood Bank Facility 100 29 Other Investigative Facility 100 30 Heating ventilatoin & air conditioning 100 31 Lift & vertical transport 100 32 Refrigeration 0 Na = Not Applicable Source: Health Facility Survey. August 2007
Table: 2 Identified Gaps of Manpower District- : Leh
Total Name of Blocks Leh
Staff Staff GAP Kharu Nubra Khaltsi Nyoma Tangtsi No.0f Req. No.of Exis. IPHS No. of Sub- Centres (121) Norm 26 11 23 28 21 12
ANM 2 26 11 23 28 20 12 242 122 120 N0. Of PHC's (17) 3 1 4 5 2 2 MO 2 3 1 6 6 2 2 34 20 14 Pharmacist 1 2 1 4 5 2 2 17 16 1 Nurse 3 6 1 3 6 2 2 51 20 31 Female Health Worker 1 2 1 4 7 3 3 17 20 -3 Health Educator 1 1 0 2 1 0 1 17 5 12
Health Assistant 2 0 0 1 0 1 0 34 2 32 (one male and one Female)
Clerks 2 1 0 0 4 2 2 34 9 25 Lab. Technician 1 3 1 4 4 1 2 17 15 2 Driver __ 2 1 3 3 2 2 13 Class lV 4 5 2 11 12 5 3 68 38 30 No. of CHC's(2) 0 0 1 1 0 0 2 A. CLINICAL MANPOWER General Surgeon 1 1 0 2 1 1
28 Physician 1 0 0 2 0 2 Obstetrician / Gynaecologist 1 0 0 2 0 2 Paediatrics 1 0 0 2 0 2 Anaesthetist 1 0 0 2 0 2 Public Health Programme 1 0 0 2 0 2 Manager Eye Surgeon 1 1 0 2 1 1 B. SUPPORT MANPOWER Nursing Staff 7+2 Public Health Nurse 1 0 0 2 0 2 ANM 1 1 2 2 2 0 Staff Nurse 7 7 0 14 7 7 Nurse/Midwife Dresser 1 1 0 2 1 1 Pharmacist / compounder 1 1 1 2 2 0 Lab. Technician 1 1 2 2 3 -1 Radiographer 1 1 0 2 1 1 Ophthalmic Assistant 1 0 0 2 2 0 Ward boys / nursing orderly 2 2 1 4 3 1 Sweepers 3 3 2 6 5 1 Chowkidar 1 1 0 2 1 1 OPD Attendant 1 1 0 2 1 1 Statistical Assistant / Data 1 0 0 2 0 2 entry operator OT Attendant 1 0 0 2 0 2 Registration Clerk 1 0 0 2 0 2 Any other staff (specify) Note: ( - ) Surplus staff
29 Identified Gaps of Manpower in District Hospital (Leh) Doctors
IPHS Personnel Existing staff Identified Gaps Norm
Hospital Superintendent 1 1 0 Medical Specialist 3 2 1 Surgery Specialists 2 1 1 O&G specialist 4 0 4 Psychiatrist 1 0 1 Dermatologist / Venereologist 1 0 1 Paediatrician 2 0 2 Anesthetist (Regular / trained) 2 1 1 ENT Surgeon 1 1 0 Opthalmologist 1 2 -1 Orthopedician 1 0 1 Radiologist 1 1 0 Microbiologist 1 0 1 Casualty Doctors / General Duty Doctors 6 10 -4 Dental Surgeon 1 2 -1 Forensic Expert 1 0 1 Public Health Manager 1 1 0 1 AYUSH Physician 2 2 0 2 Pathologists 2 0 2 Total 34 21 13
Para-Medicals
Existing Identified Personnel IPHS Norm staff Gaps
Staff Nurse* 75 to 100 19 56 Hospital worker (OP/ward +OT+ blood bank) 20 7 13 Sanitary Worker 15 2 13
Ophthalmic Assistant / Refractionist 1 1 0 Social Worker / Counsellor 1 0 1 Cytotechnician 1 0 1 ECG Technician 1 2 -1 ECHO Technician 1 0 1 Audiometrician 0 0
30 Laboratory Technician ( Lab + Blood Bank) 12 6 6 Laboratory Attendant (Hospital Worker) 4 1 3 Dietician 1 0 1 PFT Technician - 0
Maternity assistant (ANM) 6 3 3 Radiographer 2 0 2 Dark Room Assistant 1 4 -3 Pharmacist 1 5 9 -4 Matron 1 0 1 Assistant Matron 2 1 1 Physiotherapist 1 1 0 Statistical Assistant 1 0 1 Medical Records Officer / Technician 1 0 1 Electrician 1 1 0 Plumber 1 1 0 Total 154 58 96
Administrative Staff
Existing Identified Personnel IPHS Norm staff gaps Manager (Administration) - . - Junior Administrative Officer 1 1 0 Office Superintendent 1 1 1 Assistant 2 2 3 Junior Assistant / Typist 2 2 1 Accountant 2 2 0 Record Clerk 1 1 0 Office Assistant 1 1 3 Computer Operator 1 1 0 Driver 2 2 3 Peon 2 2 0 Security Staff* 2 2 0 Total 17 17 11
31
Operation Theatre
Staff IPHS Norm Exist staff gaps Emergency / FW OT Staff Nurse 8 0 8 OT Assistant 4 5 -1 Sweeper 3 0 3 Total 15 5 14 Blood Bank / Blood Storage Staff IPHS Norm Identified Existing Staff Blood Bank Gaps Staff Nurse 3 0 3 MNA / FNA 1 0 1 Lab Technician 1 0 1
Safai Karamchari 1 1 0 Total 6 1 5
Table : 3 Percentage Availability of Equipments District : Leh
Leh Average Kharu Nubra Khaltsi Nyoma Name of Blocks Tangtsi % of District
IPHS Norm 26 11 23 28 21 12 No. of SCs (121) 121
56 41.0 40.4 46.8 33.1 43.3 41.4 41.0 Kit- C
No. of PHCs (17) 3 1 4 5 2 2 17
Suggested equipments 36 54.6 38.8 31.9 40.0 58.3 50.3 45.7
Operational labour room 10 86.6 90.0 52.5 48.0 60.0 96.2 72.2
Pap Smear 11 81.8 18.1 70.4 72.7 0.0 99.5 57.1
Laboratory Reagents 10 66.6 20.0 22.5 52.0 85.0 47.4 48.9
Glassware & other equipment 7 100.0 100.0 96.4 77.1 92.8 16.9 80.5
Furniture 25 41.3 60.0 28.0 59.2 78.0 39.7 51.0
32 Total 99 71.8 54.5 50.3 58.2 62.4 58.3 59.2
No. of CHCs (2) 1 1
Standard Surgical Set-1 FRU 32 56.2 51.5 53.9
Standard Surgical Set - II 33 33.3 42.4 37.9 IUD Insertion Kit 19 78.9 78.9 78.9
CHC Standard Surgical Set - III 17 47 23.5 35.3 Normal Delivery 12 91.6 45.8 68.7 Standard Surgical Set - IV 16 12.5 56.2 34.4 Standard Surgical Set - V 21 4.7 4.7 4.7 Standard Surgical Set - VI 11 9 4.5 6.8 Equipment for Anaesthesia 17 23.5 14.7 19.1 Equip. for Neo-natal 10 40 40.0 40.0 Resuscitation Materials Kit for Blood 15 0 3.3 1.7 tranfusion Equipment for Operation 11 81.8 68.1 75.0 theatre Equipment for Labour room 13 61.5 65.3 63.4 Equipment for Radiology 9 88.8 77.7 83.3 Total 236 44.9 41.2 43.1
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Table : 4 Percentage Availability of Medicines
District : Leh Average Name of Blocks Leh Kharu Nubra Khaltsi Nyoma Tangtsi % of the District IPHS No. of SCs (121) Norm 26 11 23 28 21 12 121
Kit- A 5 37.2 34.5 79.1 15.5 33.0 24.0 37.2 Kit- B 9 76.2 90.1 87.9 50.6 91.6 60.0 76.1 Drugs req. by ANMs and 6 45.9 48.5 60.1 53.7 35.8 31.5 45.9 LHVs Other Drugs & Vacci. 8 91.1 97.7 95.6 85.6 99.3 77.5 91.1 Med. Req. for NDCP 7 25.0 18.2 32.2 17.9 35.7 25.7 25.8 Contracep. Req. for F.Plang. 4 40.7 50.0 39.1 30.5 33.7 50.0 40.7 Drug List for AWC 12 41.7 36.3 56.8 40.4 60.0 15.0 41.7 Total 51 51.1 53.6 64.4 42.0 55.6 40.5 51.2 No. of PHCs (17) 3 1 4 5 2 2 Essential & emergecy 38 84.2 81.5 89.4 61.1 85.5 63.0 77.4 obstetrics care drugs Antidots 4 25.0 25.0 25.0 30.0 25.0 35.0 27.5 Anticonvulsant / 4 66.6 50.0 37.5 10.0 12.5 26.0 33.8 Antiepileptics Antiinfective Medicines 5 53.3 60.0 60.0 36.0 30.0 78.0 52.9 Antifilarials 1 0.0 0.0 50.0 0.0 0.0 56.0 17.6 Antibacterials 16 64.5 50.0 78.1 40.0 34.3 73.0 56.6 Dermatological medicine 14 45.2 35.7 66.1 20.0 67.8 20.0 42.4 Antileprosy & Antitubercullar 2 0.0 0.0 25.0 10.0 0.0 18.0 8.8 Antifungal medicine 4 0.0 0.0 0.0 15.0 10.0 0.0 2.5 Antiprotozoal medicine 5 46.6 60.0 45.0 32.0 40.0 44.0 44.7 Blood Products and 13 51.2 38.4 21.1 26.2 46.1 2.0 30.7 Plasma Substitutes Antiseptics 6 38.8 66.6 75.0 30.0 58.3 32.0 50.0 Disinfectants 3 33.3 0.0 66.6 26.7 33.3 86.0 41.1 Diuretics 2 100.0 100.0 75.0 50.0 50.0 65.0 73.5 Gastrointestinal 22 72.7 81.8 59.1 51.8 56.8 69.0 65.2 Hormones, Endocrine & 10 23.3 30.0 10.0 12.0 40.0 3.0 19.4 Contraceptives Ophthalmological 12 38.6 58.3 37.5 28.3 41.6 37.0 40.2 preparation Psychotic Disorders 15 40.0 53.3 18.3 32.0 13.3 37.0 32.5 Solutions correcting water 9 77.7 88.8 86.1 57.8 88.8 59.0 76.4 Electrolyte and Acid- Base Disturbances Vitamins & Minerals 3 88.8 100.0 100.0 53.3 50.0 78.0 78.4
34 Drugs under RCH 1 0.0 0.0 25.0 20.0 0.0 60.0 17.6 Product Strength 31 70.9 74.2 14.5 52.9 70.9 36.0 53.1 formulation Units RTI / STI Drugs 10 53.3 40.0 45.0 62.0 60.0 84.0 57.0 Drugs and Consumable 6 72.2 83.3 58.3 93.3 41.6 95.0 75.4 for MVA Total 236 47.8 49.0 49 35 39.8 48.2 44.8 No. of CHCs (2) Essential drugs 70 71.4 81.4 76.4
Immunization Status for 2006-2007 and 2007 ending October (CMO Office Data) Leh Nubra Nyoma Khaltsi Tangtsi 2007 2007 2007 2007 ending 2007 ending 2006- ending 2006- ending 2006-07 Oct 2006-07 ending Oct 2006-07 Oct 07 Oct 07 Oct BCG 1331 887 319 185 84 98 164 120 91 34 DPT&POLIO-I 1134 665 353 179 80 84 196 127 74 39 DPT&POLIO-II 1106 718 374 181 91 98 222 142 95 37 DPT&POLIO-III 1103 681 312 181 95 88 227 133 86 45 MEASLES 1188 659 278 174 77 78 159 123 87 38 DPT & POLIO 927 363 293 128 70 59 120 103 75 79 BOOSTER DT-I 219 248 139 84 81 68 28 89 8 - DT-II 564 207 104 34 36 37 64 91 60 53 TT 10YR I 160 141 64 60 63 51 216 93 64 - TT 10YR II 379 82 21 54 2 54 158 132 112 34 TT16 YRS I 91 45 38 30 32 4 160 38 8 - TT16 YRS II 68 44 15 22 16 12 82 61 84 5 TT PRG W-I 71 46 215 108 26 24 102 47 67 25 TT PRG W-II 51 40 96 66 30 22 64 39 63 18 BOOSTER 42 31 99 76 20 21 62 20 58 28
Comparative Statement of Immunization Status (ending October 2007 & 2008) Leh Nubra Nyoma Khaltsi Tangtsi Ending 2007 Ending 2007 Ending 2007 Ending 2007 Ending 2007 Oct ending Oct ending Oct ending Oct ending Oct ending 2006 Oct 2006 Oct 2006 Oct 2006 Oct 2006 Oct BCG 809 887 319 172 52 98 101 120 50 34 DPT & POLIO-I 677 665 353 176 49 84 123 127 40 39 DPT & POLIO-II 644 718 374 187 61 98 136 142 55 37 DPT & POLIO- 617 681 312 163 56 88 132 133 49 45 III MEASLES 718 659 278 174 49 78 87 123 46 38
DPT & POLIO 508 363 293 191 43 59 83 103 53 79 BOOSTER DT-I 153 248 139 74 59 68 104 89 3 -
35 DT-II 267 207 104 11 33 37 28 91 43 53 TT 10 YR I 119 141 64 31 51 51 117 93 2 - TT 10 YR II 178 82 21 1 26 54 113 132 52 34 TT16 YRS I 80 45 38 23 26 4 127 38 5 - TT16 YRS II 32 44 15 2 10 12 49 61 22 5 TT PRG W-I 34 46 215 142 16 24 71 47 39 25 TT PRG W-II 28 40 96 59 16 22 36 39 37 18 BOOSTER 22 31 99 55 15 21 36 20 25 28
Vaccination coverage of Leh District for Year 2006-07 S.No Age Group of Children Total Children Vaccinated % 1 0 - 9 months 1402 1177 84 2 9 month to 1year 908 898 99 3 1 – 2 Year 1637 1637 100 4 2 - 5 Year 4720 4720 100
Cold Chain Status (CMO Office)
Deep freezer Deep freezer Name of Block ILR Large ILR Small Refrigerator Stabilizer Day Carrier Large Small
Nyoma Block - 1 - 1 - 2 38 Tangtsi Block - 2 - 1 - 2 26 Nobra Block - 3 - 3 - 3 62 Khaltsi block - 3 - 1 - 2 45
Distt Store Leh 2 1 2 1 2 5 270 Total 2 10 2 7 2 14 441 Pit Status (CMO Office)
S.No Centre Pit Construction 1 District Immunization Centre 1 2 SDH Nubra 1 3 PHC Turtuk 1 4 PHC Diggar 1 5 PHC Chochut 1 6 PHC Nyoma 1 7 PHC Saspol 1 8 PHC Temisgam 1 9 PHC Tangtse 1 10 PHC Chuchul 1 11 PHC Panamik 1 12 PHC Bogdang 1 13 PHC Sakti 1 14 PHC Basgo 1 15 SDH Khaltsi 1 16 CHC Skurbuchan 1 17 PHC Thiksay 1
36
Requirement of cold Chain (CMO Office) Deep Deep Stabiliser Day S.No Centre ILR(S) ILR(L) Freezer(S) Freezer(L) AVS Carrier District Immunization 1 Centre 1 No 300 litres 5 10 2 SDH Nubra 1 No 300 litres 2 10 3 PHC Turtuk 1 - 2 1 4 PHC Diggar 1 - - - 2 1 5 PHC Chochut 1 - 1 - 2 1 6 PHC Nyoma - - - - 2 10 7 PHC Saspol - - 1 - 2 1 8 PHC Temisgam 1 - - - 2 1 9 PHC Tangtse 1 - - - 2 10 10 PHC Chuchul - - 1 - 2 1 11 PHC Panamik - - 1 - 2 1 12 PHC Bogdang 1 - 1 - 2 1 13 PHC Sakti 1 - 1 - 2 1 14 PHC Basgo - - 1 - 2 1 15 SDH Khaltsi - - 1 - 2 10 16 CHC Skurbuchan - - 1 - 2 1 17 PHC Thiksay 1 - 1 - 2 1
Disease Profile of District Leh
S.No. Particular Leh Khaltsi Tangtsi Nyoma Nobra SNM
1 Cataract Cases 35 5 - - 3 21 2 Diarrhoea Disease 460 372 64 72 1348 185 3 Typhoid ------4 Viral Hep ------5 STD ------6 Sputum test - 13 1 9 9 60 7 Spt +ve - - - - - 7 8 Measles - 29 2 - - - 9 Chicken Pox - - 3 - - -
37
Status of Health Centre Buildings in the District Sub-Centre (SC) Status: Sub Centres No. Overall Status Sub-Centres in own building 97 Needs minor repair work Sub-Centre in Panchayat Bldg / rented building 21 Building required with furniture. SC without Electricity connection 20 Funds for electricity connection required. SC without Water Supply 121 Drinking water collected from near by houses. SC without Toilets 31 No toilet available at SC level.
Primary Health Centres: Names of PHC Status Hanu Turtuk Diggar Bogdang Panamic Korzok Nyoma Temisgam Yokma 24 hour PHC yes yes yes yes yes yes yes yes Total beds 6 6 2 2 1 8 5 2 No. of OPD cases 30 23 20 25 15 30 36 14 No. of indoor ------cases Rogi Kalyan No No No No No No No No Samiti
Names of PHC Status Lingsh Khaltsi Sakti Chuchot Thuksey Bozgo Tangtsi Chuchul Saspol ed 24 hour PHC yes yes yes Yes yes yes yes yes yes Total beds 15 2 4 6 2 3 6 6 2 No. of OPD cases 30 15 20 35 30 20 20 15 20 No. of indoor ------cases Rogi Kalyan Yes No Yes Yes Yes No No No Yes Samiti
Number of Institutions Requiring New Buildings # Category of Institution Numbers 1 SC 21 2 PHC 06 3 CHC 01 Source: CMO office
38 Number of Buildings Requiring Additions/Expansion (staff quarters) # Category of Institution Numbers 1 SC 121 2 PHC 09 3 CHC 01
Number of Buildings Requiring Repairs # Category of Institution Numbers 1 SC 67 2 PHC 04 3 CHC 01
Status of Staff Quarters attached to CHC, PHC and SC in the District Building Staff Quarters Condition Available /Not available (G: Good, NMR: Needs Minor Repairs, MR: Needs Major Repairs, NAD: Needs Additions CHC Skurbuchen Available NMR SDH Diskit Available Good PHC Khalsi Available PHC Temisgum Not Available PHC Saspol Not Available PHC Bazgo Not Available PHC Chuchot Not Available PHC Thiksay Available NMR PHC Sakti Not Available PHC Nyoma Available NMR+ Addition PHC Chushol Available MR + Addition PHC Tangtsi Available NMR + Addition PHC Turtok Available MR PHC Bogdang Not Available PHC Panamic Not available PHC Digger Available
Non-Governmental Organization [NGOs] • Mother NGO : Mahabodhi Karuna Charitable Hospital • FNGO - LEHO, LNP, Skarchen, Rural Development and You, Women Alliance, NIRLAC, Save the Children Fund All the NGOs are working in the health sector; however there is no specific area of intervention.
39 2. PLANNING PROCESS
A decentralized participatory planning process has been followed in development of this District Action Plan. This bottom-up planning process began with consultations with block stakeholder groups, Block /core Group members and village communities in all villages of each Block of the District.
Block Action Plans were developed based on the inputs gathered through village action plans prepared by Village Health Water Sanitation Committees. The health facilities in the block viz. SC, PHC and, CHC were surveyed using the template developed by Government of India. The inputs from these facility surveys were taken into account while developing the Block Action Plan.
The District Planning Team (DPT) provided technical oversight and strategic vision for the process of development of District Action Plan. The members of the District Planning Team (DPT) had also taken the responsibility of contributing to the selected thematic areas such as RCH, Newer initiatives under NRHM, immunization etc. Assessment of overall situation of the District and development of broad framework for planning was done through a series of meetings of the District Planning Team (DPT).
This District Action Plan has been prepared through a long process of integration of Block Action Plans including Health Facility Surveys. An initial meeting was held in which the current status of the District Action Plan was presented and suggestions and feedback taken. The membership and roles and responsibilities of District Planning Team (DPT) and the chapterization plans were discussed. Based on the inputs received from the Blocks, a draft of each chapter was developed after discussions. These were further improved upon through individual consultations with groups and nodal officers. Specific dates and times were fixed for this purpose. A date was also proposed for a meeting during which the individual chapters would be discussed and approved before the final DAP was prepared for presentation to the District Health Society for approval.
40
HEALTH SERVICE INDICATORS FOR THE DISTRICT BASIC HEALTH SERVICES Goal Posts & S.No Indicator Criteria SCORE Immunization No. completely % of fully immunized Maximum 100% No. <3 years 1 Coverage immunised children Minimum 0% < 3 year of age 2172 1763 81% No of women Total no. of % of women getting who got full Maximum 100% Essential Antenatal pregnant antenatal care as 2 antenatal care as Minimum 0% Care women defined defined 109 87 80% Total no of Total no. of % of pregnant women women who had Maximum 100% pregnant who had institutional 3 Institutional Delivery institutional Minimum 0% women delivery. delivery 2930 1774 60% Total no. of No. of newborn Percentage of Weighing of Newborn Maximum 100% births in the weighed within newborn weighed 4 with in three days Minimum 5% year three days within three days
No of newborns Percentage of Total no of Breastfeeding in first who were newborns who were Maximum 100% births in the 5 hour breastfed in the breastfed within an Minimum 0% last year first hour hour 174 140 80% Approx no of Maximum over Reporting of Blood blood slides Average time taken for reporting of blood 30 days 6 Slide sent in last 3 slide Minimum 1 day months
No. who No of target Total no. of wanted to % of couples for couples with at get FP unmet Maximum 100% Access to Sterilisation sterilisation least one of operation demand 9 Minimum 0% Services services them wanting done last for FP ( > 2 children) FP operation: year but operation could not
HEALTH RELATED SERVICES
41 WATER & SANITATION 15 Use of Domestic/ Total no. of Total no. of Percentage of families Max imum : Community Toilet families families where where all members are 50 % all members are using domestic/ Minimum using domestic/ community toilet 0% community toilet
FOOD SECURITY RELATED Total no. of Actual No. children Percentage of Anganwadi Anganwadi getting diet 16 eligible for beneficiaries regularly Anganwadi 8565 5817 67% Total no. of Total no. of primary and schools giving Percentage of schools Midday Meal 17 middle cooked midday giving midday meals
schools meals 309 330 97.09 Total no. of BPL families No. of families Percentage of PDS Functioning eligible for getting grains 18 beneficiaries lower cost from PDS shop grains 8259 8259 Total no. of No. of families BPL families getting free Percentage of Antyodaya Yojna 19 eligible for grains from PDS beneficiaries
free grains shop 250 250 Total no. of No. of children in Percentage of school children in 6- age group not 20 School Enrolment going children 14 age group going to school 7557 150 985 HEALTH STATUS Total no. of no. of children children below with gr I or % of children Max 200% Child Malnutrition 21 3 with wt above malnourished Minimum 0%
record. malnutrition**
42 Total no. of newborn who Total no. of Percentage of babies with Max 100% Low Birth Weight 22 were weighed babies with LBW LBW Min 10%
last year
Total no. of No. of girls 100% - % of married Max 100% girls married married below women below 19 year of 23 Age of Marriage Min 0% last year 19 year of age age
Total number No. of children of births last born with more % of unspaced second or Max 100% year which 24 Spacing than 36 months third children born Minimum 0% were second difference or > child
Total number Any deaths of Maximum of births last any child below % of infant deaths 20% 25 Infant Deaths year one year Minimum 0% 2203 34 per 1000 Diarrhoeal outbreaks(Mo Jaundice Outbreak of Water re than three Sum of water borne Maximum 4 outbreaks (as 26 Borne Disease cases of a disease outbreaks Minimum 0 defined) disease in same week ) Nil Nil Nil Nil
43
3. PRIORITIES AS PER BACKGROUND AND PLANNING PROCESS
National Rural Health Mission encompasses a wide range of health concerns including the determinants of the good health. Though there is a significant increase in resource allocation for the NRHM, there can never be adequate resources for all the health needs and all that needs to be done for ensuring good health of all the people. It is therefore necessary to prioritize the areas where appropriate emphasis needs to be given.
Leh need to be given preferential treatment on all the aspects to achieve the goals of NRHM. Extra resources, innovative schemes, adequate personnel infrastructure is required for reaching the people. Based on the background and the planning process following are the overall priorities of this District:
1. Providing services for the Unreached population 2. Quality services at all levels 3. Availability of Programme Officers, Specialists, Doctors and Staff Nurses and retaining the staff 4. Improving the condition of the facilities as per the IPHS norms including provision of quarters for the personnel 5. Strengthening CMO office with good Infrastructure and technical assistance 6. Strengthening the HMIS especially availability of correct data and its use 7. Capacity building of functionaries at all levels 8. Improved monitoring for improved services 9. Improving the image of the health services within the community
SPECIFIC PRIORITIES OF THE DISTRICT
1. Availability of Primary health care services: Providing services of ANC, Safe delivery, PNC, Immunization, DOTS, Anaemia prevention, prevention of Malaria at the village level 2. Programme Management: Efficient functioning of the District Health Society, a strengthened CMO’s office with efficient district and Block programme managers and the district technical support. 3. Demand Generation, IEC/BCC: Behaviour Change for utilization of services, 4. Human Resources: Filling of the vacancies as per the population based norms, increased mobility, Increased emoluments for retaining the personnel, motivational issues, provision of quarters at all facilities, Availability of well trained ASHAs for each 1000 population 5. Capacity Building: Focussed capacity building in Emergency Obstetric Care, Management, Continuous skill building of all personnel as per needs expressed and also the new job
44 responsibilities under NRHM, opening a Staff Nurse Training College and Paramedical Staff training 6. Maternal Health: Well managed system of deliveries by Skilled birth attendants, promotion of institutional deliveries Emergency Obstetric Care services, JSY extended to all the pregnant women, Blood Storage Units at all CHC , All CHC to be developed as FRUs, PHC to be developed as 24x7 facilities with good referral mechanisms. 7. Neonatal and Child Health: Provision of Neonatal services at CHC, PHC, with trained personnel on IMNCI and IMCI and addressing Anaemia and Malnutrition 8. Immunization: Total coverage for immunization of children, pregnant women and adolescents 9. Family Planning: Improving the coverage for Spacing methods, NSV and Tubectomy. 10. Adolescent Health: Adolescent Reproductive and Sexual health education through schools and also awareness building on good health practices, responsible family life, marriage at right age. 11. National Disease Control Programmes: Prevention of Mosquito transmitted diseases especially Malaria 12. Infrastructure : Increase in the number of Subcentres, PHCs and CHCs to cater the entire population and developing all the facilities as per IPHS norms. 13. Procurement and Logistics: Construction of a scientific Warehouse for Drugs 14. Monitoring and Evaluation: Data validation and computerized data availability upto PHC with district linkages 15. Public-Private Partnership: Involvement of the private facilities for providing services and NGOs. 16. Intersectoral Convergence: Involving the related departments as members in the District Health Society, Fixing Responsibilities of each sector for their accountability and hence better Intersectoral Coordination
45
Suggestions/Comments given by DHS Leh:
During the plan, presentation numbers of suggestions specific to District Leh were given by District Health Society members for the improvement of the plan and its practical feasibility in the district. District Development commissioner Leh suggested some good suggestions in this regard.
Following suggestions were strongly recommended by District Development Commissioner Leh and other members of DHS:
1. Under District Programme Management, construction cost of District Health Complex as per IPHS is Rs. 600/- per sq.ft. Whereas the Agency has calculated the same at Rs. 1000 per sq.ft. for difficult districts. But keeping in view the distances and tough geographical terrain of District Leh, the per sq.ft. Cost, as worked out by engineering Wing comes to around Rs. 1400/- per sq.ft. According to District Superintending Engineer, the construction below this cost shall not be feasible. As such, District Health Society recommends incorporations of Rs. 1400/- per sq.ft as the rate for District Health Complex constructions.
2. Under various sectors in the plan, only two approved Community Health Centres have been considered for allocations. They are SDH Nobra and CHC Skurbuchan/Khaltse. But one major region i.e. Nyoma has been left out. Nyoma which is located at an altitude of more than 14000 ft. above mean sea level and where winter temperature deep down to –30ºC to –35ºC, has one major infrastructure coming up which is nearing completion. It is currently designated as PHC but has all the infrastructure of Sub District Hospital including Operation Theatres, state of Art Central Heating System, spacious Wards, OPDs etc. The same is likely to get commissioned within next few months. Since it caters to one big Sub Division, which is geographically, and climatically most compromised, it is strongly recommended that PHC Nyoma with infrastructure of SDH should be included for provision of all the facilities being made available to the other to CHC’s. This shall enable delivery of proper health care system to the distant and deprived population of Nyoma Sub Division. As such all the components of the remaining CHCs have been added in respect of PHC Nyoma also. District Health Society Leh strongly recommends the same.
3. Fund allocation for staff quarters at PHC Nyoma and CHC Khaltse should be provided @ Rs. 10.00 lac each.
46
4. For additional construction and other repairs in District Hospital Leh, in phase-I the Engineering Wing has estimated the cost at Rs. 35 crores in pursuance to the decision taken in the meeting held under the Chairmanship of Hon’ble Chief Minister. The figure has been conveyed to the District Health Society by District Superintending Engineer and the Society recommends incorporation of the same in the District Plan under the Head Up-gradation of CHC to IPHS.
5. In respect of recurring cost of District Hospital excluding manpower but including heating system, the District Health Society recommends escalation of the proposed figure of Rs. 50.00 lacs per year to Rs. 75.00 lacs per year. The figure has been worked out keeping in view the current expenditure under this Head and also keeping in view the increasing necessity of covering the CHCs and Sub District Hospital Nyoma under the Central Heating System. This amount shall partially meet up the requirements for Central Heating and shall work as complementing the budget, which is being provided by the District Plan under this Head.
6. Under upgrading Sub Centres, the construction cost of Staff Quarters for Sub Centres has been revised to Rs. 9.00 lacs per Quarter for two ANMs as per the estimate projected by Engineering Wing. District Health Society Leh recommends this cost for the work. 7. Under RNTCP, material and supplies, the projected cost has been reworked to Rs. 4.5 lacs per annum keeping in view specifically multi drug resistant cases, which are being detected with increasing frequency. The cost of medicines shall be met out from this head.
8. Under inter sectoral coordination, the District Health Society very strongly recommends the introduction of and placement of Amchi Doctors instead of ISM Doctors at the Block Headquarters and PHCs. This is based on the fact that this traditional system of medicine is very popular in the whole district. It finds due recognition not only in the trans Himalayan States but also in a number of neighbouring Countries like China, Bhutan, Nepal etc. The system is very efficacious, affordable and rational system of medicines. Further, there is partial recognition already by the State and Central Government in the form of an Amchi Research Centre under GOI functioning in the District. Rs. 300/- per month is being paid to 40 Amchis as stipend and Rs. 1500/- each for collection of herbs and preparing of medicines, by State Government. In addition, one Chief Amchi working under the administrative control of the CMO is also in place. Further, there is a full-fledged department catering to Amchi medicine in Central Institute
47 of Buddhist Studies at Leh. Rough estimate puts more than 60% patients seeking consultation from Amchies.
As such District Health Society recommends due recognition of this traditional system of medicine by the State Government on similar lines as done by the Govt. of Himachal Pradesh by setting up Amchi Clinics in various Districts. Rather them ISM Doctors who are not locally available within the district, Amchies should be placed in all the PHC’s and Block Headquarters and in addition parallel OPD in District Hospital can be run by Amchies (which to some extend is already running under Chief Amchi posted at SNM Hospital Leh).
9. Under the Head Immunization, another activity, which was missing has been proposed. It is construction of one under Five Clinic at District Hospital Leh at the cost of Rs. 23.5 lacs. This shall cater to better health care and monitoring in respect of under-5 children.
10. Under Immunization Head only, one specific Sub Head has been added. This is Solar Refrigerator for two Allopathic Dispensaries and two MAC’s @ Rs. 1.9 lacs per Unit. This is keeping in view non-availability of electricity in these four extremely distant and difficult stations. They get cut off during winters and Solar Energy remains the prime source of electricity in these Centres. Further Solar energy in Leh is a time tested and successful mode of provision of power and running of Refrigerators for Immunization purpose.
11. Under Head Upgrading CHC’s to IPHS, a new sub head i.e. provision of Laundry Machine @ Rs. 5.7 lacs each for CHC Khaltse/Skurbuchan and one of PHC Nyoma has been proposed.
48 4. GOALS
The District will strive to improve the availability of and access to quality health care by people, especially for those residing in rural areas, the poor, women and children and will achieve the following goals:
INDICATOR Current Goals 07-08 08-09 09-10 10-11 11-12 Reduction in Infant Mortality Rate (IMR) 34 10% 20% 30% 40% 50% Baseline Baseline Baseline Baseline Baseline Reduce Neo-natal Mortality Rate (NMR) 40%(est.) 10% 20% 30% 40% 50% Baseline Baseline Baseline Baseline Baseline Reduction Maternal Mortality Ratio (MMR) DNA 10% 20% 30% 40% 50% Baseline Baseline Baseline Baseline Baseline Reduction in Birth Rate( per)1000 31 25 20 20 20 15 Reduction in Total Fertility Rate 2.9* 2.8 2.7 2.5 2.3 2.1 Increased Full Ante-Natal Care as defined 70% 75% 80% 85% 90% 95% Increased Ante-Natal Care – 3 ANC 58.7** 60% 70% 80% 90% 100% checkups Increased Proportion of Women getting IFA DNA 50% 60% 70% 80% 90% tablets Increased Institutional Deliveries 74% 78% 80% 85% 90% 100% Increased Complete Immunisation of Children 90% 95% 98% 100% 100% 100% (12-23 month of age) Reduce Prevalence of STI/RTI 0.75% 0.50% 0.50% 0.25% 0.10% 0% Source: (*) CMO Office data (**) DLHS 2002-2004 data (DNA) means data not available
The data regarding IMR, CBR, TFR, TT, CPR, Complete Immunization does not appear to be accurate and needs to be revalidated through a baseline survey.
49
5. TECHNICAL COMPONENTS
PART A: Reproductive and Child Health (RCH) II A-1. Strengthening of District Health Management Situation The District Health Society Leh has been formed under the Chairmanship of the Deputy Analysis/ Commissioner. Meetings of the District Health Society are being held as and when Current required basis. The members are from health, AMCHI, Education, PHE, ICDS, Rural Status Development etc. There is a need to add one representative from each block.
The Societies under the vertical Health Programmes like Blindness Control Society, TB Control Society, District Malaria Society, and society for IDSP have not been integrated into single society at the district level yet. Thus societies need functional integration and strengthening.
Contractual appointments of various categories of staff have been made by the District Health Society but still there are vacancies for District Accounts officer and District Data Assistant. A district project management unit has been set up to provide technical support to the CMO for efficiency in carrying out the programmes. Recently the Block Management Units have been established for providing technical support to the blocks.
Monitoring of the activities of the health department is carried out by the DHS but it is comprised of members of the health department only. Members from other departments and also from the elected representatives need to become members for better monitoring and implementation. Objectives Empowered District Health Society to effectively plan, implement and monitor the progress of the health status and services in the district Leh and achieve the goals of the District action Plan. Strategies 1. Functional Integration of all the vertical Societies 2. Capacity building of the members of the District Health Mission and District Health Society regarding the programme, their role, various schemes and mechanisms for monitoring and regular reviews and also on GoI / GoJ&K guidelines for running the District. Health & FW Society 3. Strengthening the functioning of the DHS 4. Establishing Monitoring mechanisms Activities 1. Developing systems for proper management, governance and functioning through: • Effective Planning – Annual, quarterly, monthly and as per needs • Supervision mechanisms • Convergence systems • Procedures, • Reporting systems, • Regularity of meetings,
50 • Agenda of meetings, Maintaining minutes and its timely circulation • Decentralisation, • Delegation of decision-making power • Rational decision making 2. Orientation Workshop of the members of the District health Mission and society. 3. Issue based orientation in the monthly Review and Planning meetings as per needs. 4. Ensuring provision of Technical Assistance at the district and block levels and their ongoing capacity building. 5. Exposure visits of members of the District health Society to well functioning Panchayats in two states 6. Improving the Review and planning meetings through a holistic review of all the programmes under NRHM and proper planning. 7. Formation of a monitoring Committee from all departments. 8. Development of a Checklist for the Monitoring Committee. 9. Arrangements for travel of the Monitoring Committee 10. Sharing of the findings of the committee during the Field visits in each Review Meeting with follow-up of the recommendations. Support 1. State to provide support for building the capacity of the DHS through participation in required DHS meetings 2. A GO should be taken out that at the district level each department should monitor the meetings closely and ensure follow-up of the recommendations. 3. Instructions should be issued to the DHS that all approvals should be done in the DHS Governing board meetings and the CMO should implement them instead of sending each file to the DC for approval. Timeline 2007- 2008- 2009- 2010- 2011- 08 09 10 11 12 Developing systems x
Orientation Workshop of the members x x x x x
Issue based orientation x x x x x
Ensuring provision of Technical Assistance at the district, block levels and sector levels x x x x x
Exposure visits of DHS members x x x Formation of a monitoring Committee from all departments. x Development of a Checklist for the Monitoring Committee. x
51 Budget Activity / Item 2007-08 2008- 2009-10 2010- 2011-12 Total ( In Lakhs) 09 11 Orientation Workshop 0.5 0.55 0.605 0.666 0.732 3.053 Exposure visit 3.1 3.41 3.751 0.000 0.000 10.261 Issues based 0.5 0.55 0.605 0.666 0.732 3.053 Workshops Mobility for Monitoring 0.6 0.66 0.726 0.799 0.878 3.663 Total 4.7 5.17 5.687 2.130 2.343 20.029
Detailed Calculations # Description Amount Exposure Visit 1 Airfare and travel expenses (Taxi, Bus, etc;) 200000/- 2 Lodging, Boarding, Food 100000/- 3 Misc. 10000/- Total 3,10,000/- Mobility for Monitoring by the DHS members 1 Vehicle on Rent/ Mules trips @ Rs 1000 per visit x 5 days visit per 60,000 month x 12 months
52
A- 2 District Programme Management Existing In NRHM a large number of activities have been introduced with very definite outcomes. The Status cornerstone for smooth and successful implementation of NRHM depends on the management capacity of District Programme officials. The officials in the districts looking after various programmes are overworked and there is immense pressure on the personnel. There is also lack of capacities for planning, implementing and monitoring. The decisions are too centralized and there is little delegation of powers.
In order to strengthen the district PMU, three skilled personnel i.e. Programme Manager, Accounts Manager and Data Assistant have being provided in each district. These personnel are there for providing the basic support for programme implementation and monitoring at district level.
Recently interview were conducted for the post of DPMU but due to non-availability of eligible candidates only DPM, DAM and one Block level Accounts manager could be engaged. At present there is no office for DPMU staff at District/Block Head Quarters is established moreover at store and present data during meetings there is no computers and peripherals available with the DPMU, Leh which is one of the utmost need for HMIS in the district.
There is a need for providing more support to the CMO office for better implementation especially in light of the increased volume of work in NRHM, monitoring and reporting especially in the areas of Maternal and Child Health, Civil works, Behaviour change and accounting right from the level of the Sub centre. Objectives Strengthened District Programme Management Unit Strategies 1. Support to the CMO for proper implementation of NRHM. 2. Capacity building of the personnel 3. Development of total clarity at the district and the block levels amongst all the district officials and Consultants about all activities 4. Provision of infrastructure for the personnel 5. Training of district officials and MOs for management 6. Use of management principles for implementation of District NRHM 7. Streamlining Financial management 8. Strengthening the CMO office 9. Strengthening the Block Management Units 10. Convergence of various sectors Activities 1. Support to the CMO for proper implementation of NRHM through involvement of more consultants for support in data analysis, trends, timely reports and preparation of documents for the day-to-day implementation of the district plans so that the CMO and the other district officers: • Finalizing the TOR and the selection process • Advertisements for consultants, one each for Maternal Health, Civil Works, Child health, Behaviour change. If properly qualified and experienced persons are not
53 available then District Facilitators to be hired which may be retired persons. • Selection of the consultants for Maternal Health, Child Health, Civil Works, IEC.
2. Capacity building of the personnel • Joint Orientation of the District officers and the consultants • Induction training of the DPM and consultants • Training on Management of NRHM for all the officials • Review meetings of the District Management Unit to be used for orientation of the consultants.
3. Development of total clarity in the Orientation workshops and review meetings at the district and the block levels amongst all the district officials and Consultants about the following set of activities: • Disease Control • Disease Surveillance • Maternal & Child Health • Accounts and Finance Management • Human Resources & Training • Procurement, Stores & Logistics • Administration & Planning • Access to Technical Support • Monitoring & MIS • Referral, Transport and Communication Systems • Infrastructure Development and Maintenance Division • Gender, IEC & Community Mobilization including the cultural background of the Masses. • Block Resource Group • Block Level Health Mission • Coordination with Community Organizations, PRIs • Quality of Care systems
4. Provision of infrastructure for officers , DPM, DAM, DDM and the consultants of the District Project Management Unit and Provision of office space with furniture and computer facilities, photocopy machine, printer, Mobile phones, digital camera, fax etc.
5. Use of Management principles for implementation of District NRHM • Development of a detailed Operational manual for implementation of the NRHM activities in the first month of approval of the District Action Plan including the responsibilities, review mechanisms, monitoring, reporting and the time frame. This will be developed in participatory consultative workshops at the district level and block levels. • Financial management training of the officials and the Accounts persons
54 • Provision of Rs. 500,000 as untied funds at the district level under the jurisdiction of the CMO. • Compendium of Government orders for the DC, CMO, district officers, hospital, CHCs, PHCs and the Subcentres need to be taken out every 6 months. Initially all the relevant documents and guidelines will be compiled for the last two years.
6. Development of a District CMO office • Construction of Health Complex near the district hospital wherever space is available for housing the CMO and all the officials and their staff. There will be pooling of funds available for office expenses, personnel and better utilization of resources. • This complex will also have a modern Conference Hall with speaker systems and facilities for LCD projector and a meeting hall along with a common Computer Cell. There will be a Control Room, Consultant Unit, Library, Waiting room, a record room. • The Health Complex will be furnished and partitions will be made as per the modern offices to give each one of the staff a separate working area. • Office Automation will be done through installation of PABX system, Computers systems with UPS, Printer and Scanner for each district office section, Laptop for CMO, District Family Welfare Officer, Fax machines, Photocopy machine, Broadband Internet connectivity, Digital Camera with date and time etc.
7. Strengthening the Block Management Unit : The Block Management units need to be established and strengthened through the provision of : • Block Programme Managers (BPM), Block Accounts Managers (BAM) and Block Data Assistants (BDA) for each block. These will be hired on contract. For the post of BPM and the BAM retired persons may also be considered. • Office setup will be given to these persons • Accountants on contract for each PHC since under NRHM Subcentres have received Rs 10,000 also the village committees will get Rs 10,000 each, besides the funds for the PHC. • Provision of Computer system, printer, Digital Camera with date and time, furniture.
8. Convergence of various sectors at district level • Provision of Convergence fund for workshops, meetings, joint outreach and monitoring with each CMO. 9. Monitoring the Physical and Financial progress by the officials as well as independent agencies. 10. Yearly Auditing of accounts Support 1. State should ensure delegation of powers and effective decentralization. from state 2. State to provide support in training for the officials and consultants. 3. State level review of the DPMU on a regular basis. 4. Development of clear-cut guidelines for the roles of the DPMs, DAM and District Data Manager.
55 5. Developing the capacities of the CMOs and other district officials to utilize the capacities of the DPM, DAM and DDA fully. 6. Each of the state officers Incharge of each of the programmes should develop total clarity by attending the Orientation workshops and review meetings at the district and the block levels for all activities. 7. If qualified persons for the posts of DPM, DAM are not available then State should allow the appointment of facilitators or Coordinators or retired qualified persons by the District Health Society. Time Frame 2007- 200 2009- 2010-11 2011-12 Activity 08 8-09 10 DPM,DAM,DDA and Consultants x x x x x Infrastructure, furniture, computer systems, fax, x x UPS, Printer, Digital Camera Workshops for development of the operational x x x x x Manual at district and Block levels Construction of Health Complex x x Furnishing and Office Automation, Conference x Hall with speakers, ACs Compendium of Govt orders x x x x x Joint Orientation of Officials and DPM, DAM, x x x x x DDM Management training workshop of Officials x Establishment of BPMU x x Training of DPM and Consultants x x x x x Review meetings x x x x x Computer systems with printer and Digital x x Camera & furniture for DPMU, BPMUs, District, block personnel Monitoring of the progress x x x x x
Budget Activity / Item 2007- 2008- 2009- 2010- 2011- Total In Lakhs) 08 09 10 11 12 Honorarium DPM,DAM,DDA 29.4 32.34 35.574 39.131 43.045 179.490 and Consultants Travel Costs for DPMU @ Rs 1.2 1.32 1.452 1.597 1.757 7.326 10,000/ per month x 12 mths Infrastructure costs, furniture, 5 0.5 0.550 0.605 0.666 7.321 fax, UPS, Printer, Digital Camera Workshops for development of 1 1.1 1.210 1.331 1.464 6.105 the operational Manual at district and Block levels Untied Fund 5 5 5 5 25.000 5 Construction Cost of District 154 0 0.000 0.000 0.000 154.000 Health Complex @ Rs 1400 /sq.ft x 11000sq ft
56 Furnishing and Office 50 0 0.000 0.000 0.000 50.000 Automation, Conference Hall with speakers, ACs, Audio Video conferencing equipments Maintenance of the District 0 0.5 1.000 1.500 2.000 5.000 Health Complex Compendium of Govt orders 0. 50 0.55 0.610 0.670 0.730 2.560 Joint Orientation of Officials 0.25 0.275 0.303 0.333 0.366 1.526 and DPM, DAM, DDM Management training workshop 0.5 0.55 0.605 0.666 0.732 3.053 of Officials Personnel for BPMU 26.64 29.304 32.234 35.458 39.004 162.640 Training of DPM and 0.5 0.75 1.000 1.250 1.500 5.000 Consultants Review meetings @ Rs 1000/ 0.12 0.132 0.145 0.160 0.180 0.737 per month x 12 months Office Expenses @ Rs 1.2 1.32 1.450 1.600 1.800 7.370 10,000/month x 12 months for district Computer systems (21) with 12.6 0 0.000 0.000 0.000 12.600 printer and Digital Camera and furniture for DPMU, BPMUs and District and block personnel @60,000/unit Annual Maintenance Contract 0.63 0.693 0.7623 0.839 0.922 3.846 for the equipment Travel costs for BPMU @ Rs 3.6 3.96 4.356 4.7916 5.27076 21.978 5000 per month per block Monitoring of the progress by 1 1.1 1.200 1.300 1.400 6.000 independent agencies Office expenses for Blocks @ 3.6 3.96 4.356 4.7916 5.27076 21.978 Rs 5000 x 6 blocks Total 296.24 83.354 91.807 101.02 111.107 683.530 2
57 Detailed calculation for Personnel at DPMU for one year S.No Details Units Unit Cost Amount for 12 months 1 Personnel at District level 2 District Programme manager 1 18000 216000 3 District Accounts Manager 1 15000 180000 4 District Data Assistant 1 12000 144000 5 Consultant for Maternal Health 1 40000 480000 6 Consultant for Child Health 1 40000 480000 7 Consultant for Civil Works 1 40000 480000 8 Consultant for HMIS 1 40000 480000 9 Consultant for Behaviour Change 1 40000 480000 Sub Total 2940000 Personnel at Block level 1 Block Programme manager 6 15000 1080000 2 Block Accounts Manager 6 12000 864000 3 Block Data Assistant 6 10000 720000 Sub Total 2664000
Hiring of vehicles at block level @ Rs 1000 x 6 20000 1440000 20days /mth x6blocksx12 mths Office Automation with Furniture, Computer 6 for BPMU 60,000 480000 system, Camera, Printer, etc 1 for DPM 1 for DAM
58
A-2. MATERNAL HEALTH Existing Indicator Status No of Pregnancies 2930 Maternal Deaths(April-06 to March. DNA 07 ) ANC registration 2930 100% Full ANC coverage as defined 2663 90.8% Institutional Deliveries 1774 60.5% Total Deliveries Home deliveries Skilled Unskilled No. No.
No. of pregnancy related DNA complications referred to FRU level MTP 80
Maternal Mortality: There is no authentic data available regarding the Maternal deaths in the district since there is a lot of under reporting due to lack of personnel and improper supervision.
Age of marriage: Although the mean age of marriage for boys is 23.2 years but 23 % of the boys get married below the legal age of marriage as per DLHS 2002-2004. Similarly for girls the mean age of marriage is 21 years. This is a good indication for RCH.
ANC: Out of the estimated pregnancies 100 % pregnancies had been registered of which 85 % were administered TT2 from April 06 to Jan 07. As per DLHS 2002, full ANC is 58.7%, only, and 19.7% women had pregnancy complications. The reasons for low ANC coverage are the shortage of staff, socio-cultural beliefs, large areas and populations unreached and the unmotivated staff.
Anaemia: There is no data available regarding the consumption of IFA. As per DLHS 2002 only 45.8 % of the pregnant women received 100 IFA tablets percent and among them 51.9 % had consumed it daily. As per the CMO office acceptance of IFA is on the rise. The department of Ayurveda has come up with preparations rich in iron in both syrup and tablet form. Despite this consumption of IFA, anaemia is widely prevalent.
TT: 85 % of the pregnant women had received TT2. As per DLHS 2002, 34.5 % of the pregnant women had received two doses of TT. This hence carries a grave risk for the pregnant women. Immunization needs to be strengthened with thrice a week sessions.
Referrals: There is no inadequate data for referrals during complications. As per DLHS-2002,
59 23% women had complications during delivery.
MTP: There were 80 MTPs carried out last year.
Malnutrition: There is no data available but malnutrition is prevalent 5199 mothers received Supplementary nutrition out of a total 21876 mothers registered at the AWCs (MPR Oct 06 ICDS).
Male participation : There is no data available for the level of male participation and also on what issues does male participation occur
Janani Suraksha Yojna : The JSY scheme has been launched in J & K and 665 women have benefited last year and from April 06 to March 07. This low uptake has been due to poor awareness and also due to the fact that the data of BPL families needs to be updated. Most cases were reported from Kandi. The CHC Nowshera and Darhal have reported very few beneficiaries of JSY.
Services: The Community does not have enough confidence in the government facilities since the personnel are not always available and also adequate infrastructure, equipment and drugs. The private facilities also are not available.
Training : Regular training programmes on TBA, EmOC and MTP need to be arranged for the personnel. Also the TBAs need to be trained and equipped
Village Health Day (VHD days) are being organized but there is little awareness amongst the community about the days when these are held and also regarding the services being provided. Also staff is inadequate to cover all the AW Cs. The daughter-in-laws are now making presence in these meetings. Earlier only the mother in laws would show up but now these daughter-in-laws are taking initiative.
RCH Camps: RCH camps are organized by the department to reach the community and provide services at the doorsteps. These camps provide specialist services with simple diagnostic tests. They also serve for screening of RTI and STDs. Objectives 1. Decrease in the Maternal Mortality ratio to 50% of the baseline by 2012 / 2. 100% ANC coverage by 2012 Milestone 3. 100% pregnant women administered two doses of TT by 2012 s/ 4. 80% pregnant women to consume 100 IFA tablets by 2010 and 100% by 2012 Benchmar 5. 60% Institutional deliveries by 2010 and 90% by 2012 ks 6. 75% deliveries to be carried out by trained /Skilled Birth Attendant by 2010, 100% by 2012 7. 100% women to get improved Postnatal care by 2010 8. 50 % increase the safe abortion services by 2010 9. Reduction in Anaemia to less than 20 per cent by 2012
60 Strategies 1. Provision of quality Antenatal and Postpartum Care to all pregnant women 2. Increase in Institutional deliveries 3. Provision of Quality services in the health facilities and availability of Emergency Obstetric Care services 4. Availability of safe abortion services at all CHC and PHC 5. Increased coverage under JSY 6. Strengthening the Village Health Day 7. To increase awareness among mothers and communities about the importance of institutional deliveries 8. Improved behaviour practices in the community 9. Increase accessibility to services 10. Operationalization of all the sanctioned Anganwadis Activities 1. Identification of all pregnancies through house-to-house visits by AWWs, ASHAs and TBAs 2. Operationalizing the Village Health Day • Once a week ANC clinic at all PHC and CHC • Weekly ANCs at all AWCs wherever possible • Development of a microplan for the ANMs in a participatory manner with the ICDS at the level of PHC to cover all the AWCs. In the beginning it is expected that there should be 100% coverage at the population covered by the AWCMO and later each hamlet need to develop its microplan. • Wide publicity regarding the VHD day by AWWs and ASHAs and their services • A day before the VHD day the AWW and the ASHA should visit the homes of the pregnant women needing services and motivate them to attend the VHD day • If the pregnant women do not attend the VHD day then they should be brought from their homes to the AWC • Registration of all pregnancies • Each pregnant woman to have at least 3 ANCs, 2 TT injections and 100 IFA tablets • Nutrition and Health Education session with the mothers at each of the mother’s meetings 3. Improving accessibility to care • Monthly Outreach sessions at each of the 96 difficult area villages • Pooling of resources at the PHC for conducting sessions for all services • Team to consist of MO PHC, LS, LHV, ANM, AWW, ASHA, Rehbar-e-Sehat teachers • Wide publicity for these outreach sessions by the ANMs/ AWWs/ ASHAs 4. Postnatal Care • The AWW along with ANM will use IMNCI protocols and visit neonates and mothers at least thrice in first week after delivery and in total 5 times within one month of delivery. They will use modified IMNCI charts to identify problems, counsel and refer if necessary. There is a need to train the AWWs intensively since initially till the posts are filled the ANM cannot do joint visits 5. Active involvement of TBAs:
61 • Training to all TBAs focussing on their involvement in VHD days, motivating clients for registration, ANC, institutional deliveries, safe deliveries, postnatal care, care of the newborn & infant, prevention and cure of anaemia and family planning , on the 5 cleans, danger signs and timely referral • Delivery kits to be given to all TBAs • TBA to be attached with the ANM • Incentive of Rs 100 per delivery should be given to TBAs for promoting safe and institutional delivery through Skilled Birth Attendant • The recruitment of new ASHAs should be from the TBA taskforce. 6. Reduction of Anaemia • Wider distribution of IFA tablets and overseeing their consumption • ASHAs to be developed as depot holders for IFA tablets • ASHA to ensure that all pregnant women take 100 IFA tablets Promotion of kitchen gardens to promote intake of iron rich vegetables. Attractive packaging and Ayurvedic preparations of Iron and Folic Acid as an alternative to persons not consuming IFA tablets for increasing acceptance • Availability of IFA tablets 7. Operationalization of the non functional AWCs in a phased manner 8. Tracking bags • Provision of tracking bags for all the Pregnant mothers • Training of ANM and AWWs for the use of Tracking bags 9. Provision of Weighing machines to all Subcentres and AWCs 10. Training of personnel for Safe motherhood and Emergency Obstetric Care (Details in Component on Capacity building) 11. Training for skilled birth attendant 12. Developing the CHC and PHC for quality services and IPHS standards (Details in Component Upgradation of CHC& PHC and IPHS Standards) 13. Increase accessibility of 24-hour delivery services (BEmoC) in 13 PHC. Repairs and renovations of PHC to be carried out. 14. Availability of Blood at the CHC • Establishing Blood storage units at all CHC • Certification of the Blood Storage centres 15. Improving the services at the Subcentres (Details in Component on Upgradation of Subcentres and IPHS) 16. Behaviour Change Communication (BCC) efforts for awareness and good practices in the community (Details in Component on IEC) 17. Increasing the Janani Suraksha coverage • Wide publicity of the scheme (Details in Component on BCC) • List of BPL pregnant women to be part of each month’s report • Advance Funds for JSY should be available with the ANMs • Timely payments to the beneficiary should be ensured • Starting of Janani Suraksha Yojana Helpline in each block through Rogi Kalyan
62 Samitis 18. Provision of Mobile Phones to all the ANMs, PHC MOs and CHC personnel • Provision of Mobile phone instrument to all ANMs and other supervisory staff including BMOs and CMO. • Display of the Mobile numbers at all Subcentres, AWCs, Panchayat Ghar, PHC and CHC. • Plan of Rs. 225 per month of BSNL, which includes facility for 50 free calls 19. Provision of Safe Abortion: • Provision of MTP kits and necessary equipment and consumables at all PHC • Training of the MOs in MTP • Wide publicity regarding the MTP services and the dangers of unsafe abortions • Encourage private and NGO sectors to establish quality MTP services. • Promote use of medical abortion in public and private institutions: disseminate guidelines for use of RU-486 with Mesoprestol. 20. Development of a proper referral system with referral cards 21. Improvement of supervision and monitoring of ANM tour programme, Fixed VHD days, outreach sessions, payment of JSY, EmOC services, referral • Fixed VHD days and Tour plan of ANM to be available at the PHC with the MOs • Checklist for monitoring to be developed • Visits by MOs and report prepared on basis of checklist filled • Findings of the visits by MOs to be shared by MO in meetings 22. Use of the Village Chowkidar and Numberdar as Social Mobilizers for getting data on Maternal deaths, abortions, Pregnancies 23. Involvement of Rehbar-e-Sehat teachers for IEC, reporting and community mobilization • Training of RIS teachers • Regular meetings for progress and follow-up • Increase of emoluments to Rs 500 per mot for motivation of families, giving some safe drugs, promotion of good health practices and disease control 24. RCH Camps: These will be organized monthly to provide specialist services especially for RTI/STD cases. 25. Build public-private partnership in this area. Support 1. Issue of joint letters from Health & WCD department for joint working and ensuring its required implementation 2. The Social Welfare department should ensure operationalization of no functional Anganwadis 3. Ensuring availability of personnel especially specialists and Public Health Nurses for the 24 hour PHC, CHC and two ANM at the subcentres 4. Ensuring availability of formats and funds with the ANM for JSY and timely payments 5. Certification of PHC as MTP centres 6. Ensuring smooth flow of Blood from the Blood Bank at District Hospital to the Blood Storage units 7. The State should closely monitor the progress of all the activities
63 8. JSY should be extended to all the pregnant women irrespective of BPL and APL Timeline 2007-08 2008-09 2009-10 2010- 2011- 11 12 Identification of all pregnancies through house-to-house visits x x x x x Operationalizing the VHDs x x x x x Once a week ANC clinic at All PHC and CHC Weekly ANCs All AWCs wherever possible Microplan for ANMs x x x x x Monthly Outreach sessions 25 difficult villages Delivery kits to be given to all TBAs 113 113 113 113 113 Incentive for TBA referral @Rs 100 per 2000 3000 4000 5000 6000 referral Incentive to RIS teachers @ Rs 500/mth x x x x X Provision of tracking bags for all the AWCs & SC 396 396 396 396 396 Provision of Weighing machines to all Subcentres and AWCs 396 396 396 396 396 Regular meetings for progress and follow- up x x x x X Establishing Blood storage units at all CHC 1CHC 1 CHC Increasing the Janani Suraksha coverage 5000 6000 7000 8000 9000 1 1 Janani Suraksha Yojana Helpline 1 Block 1 Blocks 2 Blocks Blocks Blocks 121ANMs 34 PHC MO, 6 CHC 6 BMO, 1 CMO, 1 Provision of Mobile Phones D. CMO Provision of MTP kits and necessary 17 equipment and consumables at all PHC 17 PHC 17 PHC 17 PHC 17 PHC PHC Training of the MOs in MTP x x x x X RCH Camps 12 12 12 12 12 Training of personnel for Safe motherhood and Emergency Obstetric Care x x x x X Training of the MOs in MTP x x x x X Training for skilled birth attendant x x x x X Training of RIS teachers x x x x X Training to all TBAs x x x x X Training of ANM and AWWs for the use of Tracking bags x x x x
64 Budget Activity / Item 2007-08 2008-09 2009-10 2010-11 2011-12 Total Consultancy support for developing 1 1.1 1.210 1.331 1.464 6.105 Microplan for Village health Day Tracking Bags @ Rs 300/ bag x 300 0.82 0.902 0.9922 1.09142 1.20056 5.006 AWCs 2 Adult Weighing machines @ Rs 800 2.4 2.2 2.2 2.2 2.2 11.200 per machine x 300 AWCs & Maintenance(10% cost of machine) Monthly special outreach session in 2.5 2.75 3.025 3.3275 3.66025 15.263 25 difficult villages@10000/session Blood Storage @ Rs 3 lakhs per unit (2 3 3 3 0 0.000 9.000 CHC+PHC Nyoma)_ Referral Cards @ Rs 2 per card x 0.4 0.44 0.484 0.532 0.586 2.442 20,000 MTP kits @ Rs 15000 Per kit 2.55 2.805 3.0855 3.39405 3.73345 15.568 5 One day training workshop on 1 1.1 1.210 1.320 1.450 6.080 Tracking bags at the district level and each sector JSY beneficiaries @ Rs 1400/person 70 84 98 112 126 490.000 JSY Helpline through RKS 9.99 9.99 19.980 9.99 9.99 59.940 Mobile phone instrument to ANM and 4.25 0 0.000 0.000 0.000 4.250 other supervisory staff like Mos, BMOs, CMO & Dy. CMO @ Rs 3000 Mobile Phones recurring cost to ANMs 3.267 3.267 3.267 3.267 3.267 16.335 @ Rs 2700/annum Mobile Phones recurring cost to other 2.94 2.94 2.94 2.94 2.94 14.700 supervisory staff like Mos, BMOs, CMO & Dy. CMO@ Rs 6000/annum Delivery kits to TBA's@3000and 3.39 3.729 4.1019 4.51209 4.96329 20.696 refilling @ 1000 9 Incentives to TBA @ 100 per delivery 2 3 4 5 6 20.000 by skilled birth attendent Incentives to Rehbar-e-Sehat 6.78 7.458 8.2038 9.02418 9.92659 41.393 @500X12months X113 8 RCH Camps @ Rs 30000 per camp x 3.6 3.96 4.356 4.792 5.271 21.978 12 Total 119.887 132.641 160.055 164.721 182.652 759.956
65
Detailed Calculations JSY Helpline through Rogi Kalyan Samitis
S.No Details of one block helpline Amount (Lakhs) 1. Personnel @ Rs 4500 x 4 x 12 months 2.16 2. Travel of personnel Rs 2500 per person/mth x 12 mths 3.6 3. Mobile Phones @ Rs 2000/ mth x 90 sets 1.8 4. Rec cost of mobile @ Rs 225 x 12 x 90 persons 2.43 Total 9.99
66 A-3. NEWBORN & CHILD HEALTH Situation Indicator No. Analysis Estimated births (90% of pregnancies) 2637 Live Births (Based on BCG target) 1989 Infant Deaths( as per CMO data) DNA Still birth in the last year DNA Low birth weight newborns (less than 2.5 kgs.) 330 Child Vaccination: completed ( 12-23 months age ) 1789 Severely malnourished children ( Grade III & IV ) As per ICDS DNA
Anaemia in children : There is no data available `with the CMO or the ICDS regarding the levels of anaemia in children. Children are given IFA tablets for iron supplements under the national programme.
Malnutrition: Under nutrition is a cause of serious concern amongst the children of the 0-6 years age group. In the ICDS programme Supplementary nutrition is provided to children below 6 yrs. The coverage of ICDS is only 17 %. Nutrition is being provided at the AWC and 33.3 % of the children at the AWCs are malnourished and there are no severely malnourished as per the data from the MPR of ICDS programme. The data for the severely malnourished appears unrealistic. The reasons for malnutrition are related to repeated diarrhoeal episodes, feeding practices of not giving colostrums, late weaning, poor sanitation and worm infestation.
Breast feeding: There is no data regarding exclusive breast feeding. As per DLHS 30.4 % children were breastfed exclusively for the stipulated period of 4 months . There is lack of knowledge regarding the significance of Colostrum and the socio-cultural factors associated with it since 94.7 % of mothers squeezed out the first breast milk as per DLHS.
Childhood illnesses Diarrhoea : Undernutrition is associated with diarrhea, which further leads to malnutrition. There is no data on diarrhoea but according to the district MOs it is common. According to the DLHS 2002 43 % of the women were aware of what was to be done when a child got diarrhea and 32 % were aware about Oral Rehydration Solution (ORS) and 35.9% give ORS to children and a negligible percentage gave more fluids to drink. Also only 30.5% sought treatment for Diarrhoea. This shows that there is a need for more knowledge regarding the use of ORS and increased intake of fluids and the type of food to be given.
Pneumonia : There is no data on childhood Pneumonia but as per the district official there is a need to create awareness regarding the danger signs of Pneumonia. As per DLHS 2002, 42.8% persons were aware of danger signs of Pneumonia and all persons sought treatment for Pneumonia.
Newborn and Neonatal Care: There is very little data available for the newborns and the neonates. The District data shows that a negligible percentage of newborns and neonates died which is
67 A-3. NEWBORN & CHILD HEALTH doubtful. Reporting regarding these deaths is not done properly. The various health facilities also are poorly equipped to handle newborn care and morbidity. The TBAs and the personnel doing home deliveries are unaware regarding the neonatal care especially warmth, prevention of infection and feeding of Colostrum.
Training: IMCI and IMNCI training is essential for the MOs, Staff Nurses, ANMs. Training on the home based care package is required for the ANMs/AWWs/ASHAs/TBAs. However some portion is being covered under SBA trainings.
Data: There is no data available for childhood diseases, Prenatal mortality, Low birth weight at birth, deaths due to various causes.
Services: There are no Paediatricians as against the required 4 in the whole district. The infrastructure for providing services for Childhood morbidity and Neonatal care is not there even at the District hospital. Objective 1. Reduction in IMR to 50% from baseline by 2012 s 2. Reduction in Neonatal mortality to 50% from baseline by 2012 Benchma 3. Increased proportion of women who exclusively breastfeed for 6 months to 100% by 2010-2012 rks 4. Increased in Complete Immunization to 100% by 2010-2012 5. Increased use of ORS in diarrhoea to 100% by 2009-2010 6. Increase in the Treatment of 100% cases of Pneumonia in children by 2010-2012 7. Increase in the utilization of services to 100% by 2012 Strategies 1. Improving feeding practices for the infants and children including breast feeding & 2. Promotion of health seeking behaviour for sick children Activities 3. Community based management of Childhood illnesses 4. Improving newborn care at the household level and availability of Newborn services in all CHC & hospitals 5. Improving the care for Malnourished children 6. Enhancing the coverage of Immunization 7. Zero Polio cases and quality surveillance for Polio cases Support 1. Promote early and exclusive breastfeeding up to 6 months of age and complementary required feeding thereafter 2. Promoting Integrated management of neonatal and childhood illnesses (IMNCI) • IMNCI training will be carried out for the health workers • Assess the FRUs with reference to IPHS developed by GOI and identify the gaps • Provide necessary instruments and equipment needed to ensure CEmOC • Training of MO in CEmOC, newborn care and lifesaving saving anaesthesia skills as per the models developed per GOI. Also resuscitation skills. • Blood storage facilities will be operationalised in all 7 CHC/ PHC/ FRUs to be proposed (only district hospital working as FRU) • Referral transport facility will be provided to all health facilities for bringing the patients to
68 A-3. NEWBORN & CHILD HEALTH FRUs. • Training neonatal nurses (one month at medical college) • Strengthening the neonatal services and emergency Child care services in District hospital and at all CHC. This will be done in phases • In all of these units, newborn corners would be established and staff trained in management of sick newborns and immediate management of newborns. For all the equipment for establishing newborn corners, a five year maintenance contract would be drawn with the suppliers. The suppliers would also be responsible for installing the equipment and training the local staff in basic operations. • The equipment required for establishing a newborn corner would include Newborn Resuscitation trolley, Ambubag (including newborn sizes), Laryngoscopes, Phototherapy units, Room warmers, Inverters for power back-up, Centralized oxygen and Pedal suctions 3. Improving feeding practices for the infants and children including breast feeding • Study on the feeding practices for knowing what is given to the children • Education of the families for provision of proper food and weaning • Educate the mothers on early and exclusive breast feeding and also giving Colostrum • Introduction of semi-solids and solids at 6 months age with frequent feeding • Administration of Micronutrients – Vitamin A as part of Routine immunization, IFA and Vitamin A to the children who are anaemic and malnourished 4. Promotion of health seeking behaviour for sick children and Community based management of Childhood illnesses • Training of LHV, AWW and ANM on IMCI including referral • BCC activities by ASHA, AWW and ANM regarding the use of ORS and increased intake of fluids and the type of food to be given • Availability of ORS through ORS depots with ASHA • Identification of the nearest referral centre and also Transport arrangements for emergencies with the PRIs and community leaders with display of the referral centre and relevant telephone numbers in a prominent place in the village 5. Improving newborn care at the household level • Adaptation of the home based care package of services and scheduling of visits of all neonates by ASHA/AWW/ANM on the 1st, 2nd, 7th, 14th and 28th day of birth. • In case of suspicion of sickness the ASHA /AWW must inform the ANM and the ANM must visit the Neonate • Referral of the Neonate in case of any symptoms of infection, fever and hypothermia, dehydration, diarrhoea etc; • Training on IMNCI of ASHA/AWW/ANM/MOs on the home based Care package • Supply of medicine kit and diagnosis and treatment protocols (chart booklets) for implementation of the IMNCI strategy • Training of staff in Newborn Care, IMNCI and IMCI (MOs, Nurses) including the management of sick children and severely malnourished children. • Availability of Paediatricians in all the CHC
69 A-3. NEWBORN & CHILD HEALTH • Ensuring adequate drugs for management of Childhood illnesses. 6. Strengthening the fixed Village Health Days (Also discussed in the component on Maternal Health) • Use of Tracking Bag for Tracking of Left-outs and dropouts by ASHA, AWW and contacting them a day before the session • Information of the dropouts to be given by ANM to AWW and ASHA to ensure their attendance • Wide publicity regarding the VHD days 7. Developing Malnutrition Centres for the care and treatment of malnourished children at all CHC 8. Strengthening Immunization (Discussed in Component C) Timeline 2007-08 2008-09 2009-10 2010-11 2011-12 Promoting (IMNCI) x x X x x
IMNCI training x x X x x Assessment of FRUs with reference to IPHS for NB Care x x X Newborn corners – All CHC 1 CHC 1 CHC x x x Malnutrition Corners – DH and all CHC DH , DH , DH DH 1 CHC 1 CHC DH Study on the feeding practices for knowing what is given to the children x Education on early and exclusive breast feeding and Colostrum x x X x x Promotion of health seeking behaviour for sick children x x X x x Improving newborn care at the household level x x X x x Training on the home based Care IMNCI of ASHA/AWW/ANM/MOs x x X x x Training of MO in CEmOC, IMNCI x x X x x Training of LHV, AWW and ANM on IMCI including referral, Tracking Bags x x X x x Wide publicity regarding VHD days x x X x x
70 A-3. NEWBORN & CHILD HEALTH Budget Activity / Item 2007- 2008-09 2009- 2010- 2011- Total 2006-07 08 10 11 12 Study on the feeding and Care 2 0 0.000 0.000 0.000 2.000 practices for the infants and children Innovative activities based on the 0 2 2.000 2.000 2.000 8.000 study Newborn Corner furnished with 3 6 3.000 0.000 0.000 12.000 equipment @ Rs 3 lakh per facility (+PHC Nyoma) Examination table, chair, stool, table, 9 9 9 9 9.96 45.960 other equipment @ Rs. 3000 x No of AWCs Infant Weighing Machines @ Rs. 2.4 0 0 0 0 2.400 800/AWCx No of AWCs Foetoscope @ Rs.50 x No AWCs 0.15 0.15 0.15 0.15 0.15 0.750 Malnutrition Corners @ Rs 30,000 0.3 0.6 0.3 0.000 0.000 1.200 per CHC and District Hospital (1DH & 2 CHCs + 1 PHC Nyoma ( will be upgraded to CHC) Total 16.85 17.75 14.450 11.150 12.110 72.310
71
A-4. FAMILY PLANNING Situation Indicators No. Analysis Eligible Couple (Estimated) 19000 Couple Protection Rate 61% Female Sterilization operations during last year 42 Vasectomies during the last year 26
Under family welfare programme the Health and family welfare department Leh has achieved the highest target compared to other district of the State and above the national level. The couple protection rate is 61% which is higher than national figure and growth rate is much below the national level, hence the population explosion is not a primary issue to keep on priority in Leh district,. As per modern conception population is also taken as resource of a nation subject to create better option for the use of human resource. However as part of national programme, to stabilize the population and sustain the couple protection rate at 61% is the priority of the district.
Copper T-380 has been recently introduced but there is very little awareness regarding its availability. There is a need to promote this 10 yr Copper-T. Some socio-cultural groups have low acceptance for Family Planning. Promotion efforts for Vasectomy have been very infrequent and only 26 men have undergone Vasectomy.
Objectives 1. To sustain the couple protection rate. 2. To decrease the unmet need in family planning to 10 % by 2010 3. Increase in Contraceptive Prevalence Rate to 80 % by 2012 4. Increase in the awareness levels of Emergency Contraception to 100% by 2010 Strategies 1. Increased awareness for Emergency Contraception and 10 yr Copper T 2. Decreasing the Unmet Need for Family Planning 3. Availability of all methods at all places 4. Increasing access to terminal methods of Family Planning 5. Promotion of NSV 6. Expanding the range of Providers 7. Increasing Access to Emergency Contraception and spacing methods through Social marketing. 8. Building alliances with other departments, PRIs, Private sector providers and NGOs
72 A-4. FAMILY PLANNING Activities 1. Counselling of couples for Family Planning • Establishment of Family Planning Counselling Unit at SC/PHC/CHC level for improvement of quality services of Planning • Training of MOs and Specialists counselling. • Training of Health Supervisors, Health workers, ASHAs, AMCHI doctors, AWW in FP- counselling • Counselling of newly married couples on importance of birth spacing 2. Improving t he quality of services of Public Sector providers for Terminal methods • Specialists from District hospitals and CHC will be trained in Laparoscopic Tubal Ligation. • At CHC, one medical officer will be trained in NSV • Each CHC will be a static center for the provision of sterilization services on regular basis. The Static centers will be developed as pleasant places, clean, good ambience with TV, music, good waiting space and clean beds and toilets. • About 4 -7 PHC come under the catchments area of CHC and the camps will be organized on fixed days in each of the PHC. • Equipments and supplies will be provided at CHC for conducting sterilization services. • A systemic effort will be made to assess the needs of all facilities, including staff in position and their training needs, the availability of electricity and water, Operation theatre facilities for District hospitals/CHC/PHC, Inventory of equipment, consumables and waste disposal facilities and the condition, location and ownership of the building. • At least three functional Laparoscopes will be made available per team, as will the equipment and training necessary to provide IUD and emergency contraception services. The existing non-functional Laparoscopes need to be replaced. For effective coverage 4 teams are required with minimum three Laparoscopes for each team. • Vacant positions will be filled in on a contractual basis. • Provision of Sterilization services every day in the hospital and at CHC. 3. NSV • Formation of District implementation team consisting of DC, CMO, District MEIO, District NSV trainer • One day Workshop with elected representatives, Media, NGOs, departments for sensitisation and implementation strategy, fixing pre-camp, camp and post-camp responsibilities • Development of a Micro plan in one day Block level workshops • NSV camp every quarter in all hospitals initially and then CHC • IEC for NSV • Trained personnel • Follow-up after NSV camp on fixed days after a week and after 3 months for Semen analysis. 4. Access to non-clinical contraceptives increased in all the villages • AWWs and ASHAs as Depot holders • Training in Spacing methods, Emergency Contraceptives and interpersonal
73 A-4. FAMILY PLANNING communication for dissemination of information related to the contraceptives in an effective manner. • Supply of Emergency Contraceptives to all facilities • IEC campaign on importance of birth spacing • Improving the availability of spacing methods in villages through all possible deport holder. 5. Access for the quality IUD insertion improved at all the subcentres. • All the ANMs at 121 subcentres will be given a practical hands on training on insertion of IUD • Diagnosis and treatment of RTI/STI as per syndromic approach. The various screening protocols related to the IUD insertion enabling her to screen the cases before the IUD insertion. This will result in longer retention of IUDs. • Counselling of the cases • Repair of subcentres so that the IUD services can be provided and ensuring privacy and confidentiality. • IUD 380 will be used due to its long retention period and can be used as an alternative for sterilization.
6. Awareness on the various methods of contraception for making informed choices Discussed in the Component on IEC 7. Increasing the gender awareness of providers and increasing male involvement • Empowering women • Increasing male involvement in family planning through use of condoms for safe sex • BCC activities to focus on men for Vasectomy. • Gender sensitization training will be provided for all health providers in the CHC/PHC and integrated into all other training activities. ( Component on Gender) • Service delivery sites for male methods by training health providers in NSV and conventional vasectomy will be expanded so that each CHC and Block PHC in the district has at least a provider trained in NSV. \ 8. Improving and integrating contraceptives/RCH services in PHC and Sub-centres • Skill-based clinical training for spacing methods including IUD insertion and removal, LAM, SDM and EC of Health Supervisors and Auxiliary Nurse Midwives (ANM). • Training in infection prevention and follow up for different family planning methods. • MIS training to the health workers to enable them to collect and use the data accurately. • Health supervisors training for facilitative supervision and MIS. • Follow up of trained Health Supervisors and ANMs after one month and six months of training and provide supportive feedback to the service providers. 9. Strengthening linkages with ICDS programme of women and child development department and ISM (Ayurveda) • A detailed action plan will be produced in co-ordination with the ICDS department for involvement of the AWWs and their role in increasing access to contraceptive services.
74 A-4. FAMILY PLANNING • Department of health officials and ICDS officers will be orientated to the plan. • AWWs and their supervisors will receive technical training and training in communication skills and record keeping by Medical Officer of the PHC and LHV. • Staff of AMCHI department will be trained in communication and non-clinical methods to promote and increase the availability of FP methods. 10. Role of ASHAs: • Training for provide counselling and services for non-clinical FP methods such as pills, condoms and others. • Act as depot holders for the supplies of pills and condoms by the ANM for free distribution • Procurement of pills and condoms from social marketing agencies and provide these contraceptives at the subsidized rate • Provide referral services for methods available at medical facilities • Assist in community mobilization and sensitisation. 11. Proper Supervision and Monitoring and reporting • Each Health Supervisor to be trained for supportive supervision and monitoring • Developing Microplans for each personnel with their participation to ensure maximum coverage. • Ensuring proper filling of formats ad meaningful review and planning meetings • Follow-up as per the action plans. 12. Study on Aryan (Brogpa) Tribe : A study on Aryan Tribe for research purpose keeping in view the population stagnation of the tribe.
Support 1. Ensuring Timely payments to ASHA, other stakeholders required 2. Availability of a team of master trainers/ANM tutors and State trainers for follow up of trained Supervisor and ANM after one month and six months of training and provide supportive feedback to the service providers 3. A training cell will be created in the medical college for the training of the medical officers in the area of various sterilization methods 4. Availability of equipment, supplies and personnel Timeline 2007- 2008- 2009- 2010- 2011- 08 09 10 11 12 Training of MOs for NSV 4 MOs 12 MOs 12 MOs 16 MOs Training of MOs for Minilap 4 MOs 4 MOs Training of Specialists for Laparoscopic DH 2 CHC Sterilization Development of Static Centres at General DH, 2 CHC hospitals and all CHC Sterilization camps (Persons) 5000 6000 7000 8000 10000 NSV Camps 600 700 800 900 1000 Supply of Copper T – 380 2000 3000 4000 5000 7000
75 A-4. FAMILY PLANNING Emergency Contraception 2000 4000 5000 8000 10000 Laparoscopes 2 DH, CHC Research on Aryan Tribe X
Budget Activity / Item 2007-08 2008- 2009- 2010- 2011- Total 09 10 11 12 NSV camps @ Rs. 359750 8.6475 69.269 9.9973 11.361 13.952 25.313 8 Sterilization Camps @ 19.50 45.925 65.2875 84.740 122.75 160.87 479.58 /cases 4 7 35 Development Static Centres 1 2 1.000 0.000 0.000 @Rs 1 lakh 4.0000 Copper T-380 @ Rs 45 / piece 1.35 2.03 2.700 4.060 5.400 15.540 0 EmergencyContraception@Rs1 0.1 0.2 0.3 0.8 0.5 0/2 tabs 1.9000 Laparoscopes 3per CHC&DH 9 18 0 0.000 36.000 @ Rs3.00 lakhs/laparoscopes 9.00 0 Research Study 0 10 0.000 0.000 0.000 10.000 0 Total 66.0225 107.51 109.10 141.56 192.09 616.29 48 1 6 0 33 Detailed Calculations Calculations per Case of NSV S.No Head Unit Cost 1. Payment to NSV acceptor 1000 2. Mobilization/Transport cost 50 3. Payment to Service Provider 50 4. Payment to IEC advocate/Motivator 25 5. Payment to Assistant/OT Nurse etc; 10 6. Drugs and Dressing 27.5 Total 1162.5
Requirements for organizing one camp (600 cases) S.No Head Unit Unit 2007- 2008- Cost 08 09 2009-10 2010-11 2011-12 Total 1. District Workshop 1 4000 4000 4400 4840 5324 10164 28728 2. Block workshops 4 7500 30000 33000 36300 39930 76230 215460 3. TA/DA for NSV surgeons 5 2000 10000 11000 12100 13310 25410 71820 4. IEC activities 93250 102575 112832.5 124116 236948 669722 5. TA to Acceptor for Semen 600 50 30000 35000 40000 50000 90000 245000 Analysis 6. Payment to NSV 1162.5 Advocate/motivator, Drugs & 600 697500 813750 930000 1162500 2092500 5696250 0 Dressings Total 864750 999725 1136073 1395180 2531252 6926980
76 Budget for IEC activities for NSV camp S.No Head Unit Unit Cost Amount 1. Hand Bills 100000 0.15 15000 2. NSV booklets 10000 2 20000 3. Banners 250 54 13500 4. Posters 11000 2.50 27500 5. DA for Driver & 2 persons 45 Mondays 50 2250 6. Electronic Media Publicity for 15 days 5000 7. Wall writing & publicity 1000 8. Other Innovative activities 9000 9. Total 93250
Budget for sterilization per case S.No Head Unit Cost (Rs) 1. Payment to acceptor 500 2. Mobilization/Transport cost 50 3. Payment to Service Provider 50 4. Payment to IEC advocate/Motivator 35 5. Payment to Assistant/OT Nurse etc; 10 6. Drugs and Dressing 93.5 Total 738.5
Budget for sterilization camps benefiting 5000 cases 2009- S.No Head Unit Unit Cost 2007-08 2008-09 2010-11 2011-12 Total 10 1. Medicines 500000 5 5.5 6.05 6.655 7.3205 30.5255 2. Per Case @ 5000 738.5 36.925 55.3875 73.85 110.775 147.7 424.638 738.50 3. IEC activities 100000 1 1.1 1.21 1.331 1.4641 6.1051 4. Other activities and Office 300000 3 3.3 3.63 3.993 4.3923 18.3153 Expenses Total 45.925 65.2875 84.74 122.754 160.877 479.583
77 PART-B: NRHM Initiatives B-1. ASHA – Accredited Social Health Activist Situation The Subcentre caters to a population of approximately 3000 spread over an average of 5 -7 Analysis villages in hilly areas. Hence keeping in view the difficulties faced by the ANM to provide health and family welfare services in all the villages and also carry out effective community contact, under NRHM a village level community based functionary has been brought in all villages and will be trained for meeting the health-related demands of people and will create awareness on health and its social determinants and mobilize the community towards local health planning and increased utilization and accountability of the existing health services indicators in the villages.
During the past two years 238 ASHA were selected and 214 have been trained in Module I. At present every ASHA is being paid an incentive of Rs.150 per month for mobilizing the children for immunization. Besides these they are also entitled for Rs.600. for escorting a pregnant to near by Health Institution for delivery and rest of the activities supposed to performed by the a trained ASHA is not being paid any incentives
Leh district with a thin and a scattered population and also negligible growth rate ASHA hardly gets a pregnant lady in one month even in some case she only gets 2-3 cases per annum. In comparison to this ASHA’ engaged in other parts of the country earned a much better incentives due the high density of population.
This result in de- motivation of ASHA and lead to quit the job quite often, which result in frequent change of ASHA. This also effects the impartment of a comprehensive training programme to ASHA’s. In coming future this will also lead to huge loss of funds which has already spent on the ASHA’s training. Further the incentive is so less that they loss their interest to work as ASHA’s, besides this the community also with the misconception that this ASHA’s shall be regularized as health worker on permanent basis.
All the villages should have an ASHA by 2008. Objectives 1. Availability of a Community Resource, service provider, guide, mobilizer and escort of community 2. Provision of a health volunteer in the community at 1000 population for healthcare 3. To address the unmet needs Strategies 1. Selection of a woman from the community 2. Capacity building of this worker 3. Constant mentoring, monitoring and supportive supervision by district Mentoring group
78 Activities 1. Strengthening of the existing ASHAs through support by the ANM. . and their involvement in all activities. 2. Reorientation of existing ASHAs 3. Selection of new ASHAs to have one ASHA in all the villages 4. Training of these ASHAs and those selected ASHAs who have not received any training. 5. Training for Module 2,3,4 6. Provision of a kit to ASHAs with AMCHI medicine in place of Ayush medicine. 7. Formation of a District ASHA Mentoring group to support efforts of ASHA and problem solving 8. Review and Planning at the Monthly sector meetings 9. Periodic review of the work of ASHAs through Concurrent Evaluation by an independent agency 10. ASHA Performance Diaries is to be printed 11. Special incentives @ Rs 500 per ASHA for the hilly and difficult terrain. Support • Timely Payments to ASHA required • Advance of Rs. 5000 always with ASHA for prompt payments to the women Timeline 2007- 2008-09 2009-10 2010-11 2011- 08 12 Selection of additional ASHAs x x x x x Total ASHAs 238 238 238 238 238 Training of new & untrained ASHAs 160 30 30 10 Training of ASHAs for module 2,3,4 238 238 238 238 238 Reorientation of the ASHAs 238 238 238 238 238 ASHA Performance Diaries 250 300 350 400 450 District ASHA Mentoring group x x x x x
Budget Activity / Item 2007-08 2008- 2009- 2010- 2011- Total 09 10 11 12 Training & kit @ Rs 10000/ New 26.18 2.8 3.000 3.000 3.100 38.08 ASHA+ Kit @ 1000/ Trained ASHA Training of ASHA in Module 4.76 4.76 0.6 0.6 0.6 11.32 II,III,IV @ 2000/ASHA Reorientation @ Rs 1000/ 2.38 2.38 2.380 2.380 2.380 11.9 ASHA Expenses for the District 0.6 0.66 0.730 0.800 0.880 3.67 mentoring group – meetings, travel @ Rs 5000 per month x 12 months ASHA Performance Diary @ 0.25 0.3 0.350 0.400 0.450 1.75 100/ASHA Compensation to ASHA 23.8 23.8 23.8 23.8 23.8 119 @1000/ASHA Total 57.97 34.7 30.860 30.980 31.210 185.72
79 B-2. Untied Funds and an Annual Maintenance grant for Sub Centres Situation Till NRHM was launched there was no provision for any fund for the subcentres for Analysis/ maintenance, electricity, water, any fund for consumables and cleanliness of the subcentre. Current Status Rs 2000 was given as contingency funds, which were totally inadequate to meet any demands. Due to this the Subcentres were in a pathetic condition and the ANM worked alone for deliveries sometimes helped by the family members. A number of equipment needed some repair due to which they were lying unutilized. The Gram Panchayat members were never involved in any activities of the Subcentre.
Untied fund for 58 sub centre @ Rs 10000/- (58 sub centre x 10000 = Rs.5,80,000) have been paid to ANMs for opening joint accounts with sarpanchs in 2006-07 in their respective sub centre village for carrying out various health activities, the remaining 63 sub centers needs to be included under untied funds scheme. Objectives Strengthening of the Subcentre through financial support for immediate needs and maintenance Strategies 1. Provision of Untied funds of Rs 10000 each year to the Subcentres at the disposal of the ANM for local needs 2. Provision of Rs 10000 for construction and annual maintenance Activities 1. Besides the usual recurring cost support to the sub-centres, each Subcentre would be given an untied support of Rs. 10,000 per annum. The fund would be kept in a joint account to be operated by the ANM and the local Sarpanch/ Numberdars. 2. Rs 10000 will be given as annual maintenance grant to each Subcentre. This will be under the mandate of the VHWSC for undertaking construction and maintenance. This will bring in greater community control and the sub-centres would be brought fully under the Panchayati Raj framework. 3. Activities suggested for the untied funds include minor modifications, cleanliness of premises, transport of emergencies, transport of samples, purchase of consumables, etc; 4. This fund will not be used for salaries, vehicle purchase and recurring expenses of Gram Panchayat 5. Monthly and quarterly expenditure statement will be submitted along with UC Support 1. Funds to be transferred on time to the ANM required 2. Sarpanch to ensure proper usage and accounts Timeline 2007-08 2008-09 2009- 2010- 2011-12 10 11 Untied Fund of Rs 10000/subcentre 121 121 121 121 121 Annual Maintenance grant of Rs 121 121 121 121 121 10000/SC Plan for maintenance to be developed x x x x x and approved by Gram Panchayat Plan for use of untied funds x x x x x
80 Gram Panchayat to identify mode of x x x x x construction and repair
Budget Activity / Item 2007-08 2008-09 2009-10 2010-11 2008- 12 Total Untied Fund of Rs 12.1 12.1 12.1 12.1 12.1 60.5 10000/subcentre Annual Maintenance grant 12.1 12.1 12.1 12.1 12.1 60.5 of Rs 10000/SC Total 24.2 24.2 24.200 24.200 24.200 121
81 B-3. Provision of Untied Funds an Annual Maintenance grant at PHC Situation Till NRHM was launched there was no provision for any fund for the subcentres for maintenance, Analysis/ electricity, water, any fund for consumables, telephone, hiring transport in emergencies and Current cleanliness PHC. Due to this the PHC were in a bad shape. They were unable to provide Status services as per the needs of the patients. A number of equipment needed some repair due to which they were lying unutilized.
At present District Leh has received untied/annual maintenance funds to the tune of Rs.75, 000/ per PHC for 13 PHCs Rest 4 PHCs including Allopathic dispensaries needs to be incorporated in this scheme. Objectives Strengthening of the PHC through financial support
Strategies 1. Provision of Untied funds of Rs 25000 each year to the PHC at the disposal of the Rogi Kalyan Samities 2. Provision of an Annual Maintenance grant of Rs 50,000 to the PHC
Activities 1. These funds will be routed through the Rogi Kalyan Samitis who will approve the yearly activities and the related budgets and also undertake and supervise improvement and maintenance of physical infrastructure. 2. An untied fund of Rs 25000 will be provided each year for activities as per the local needs including minor modifications, cleanliness of premises, transport of emergencies, transport of samples, purchase of consumables, etc; 3. This fund will not be used for salaries, vehicle purchase and recurring expenses of Gram Panchayat or any other facility. 4. An Annual Maintenance grant of Rs 50,000 will be given to the PHC for water, toilets,, maintenance of building. 5. Monthly and quarterly expenditure statement will be submitted along with UC
Support 1. Timely release of funds required 2. Meetings of the Rogi Kalyan Samitis to be regularly held
Timeline Activity 2007-08 2008-09 2009-10 2010-11 2011- 12 Untied Fund of Rs 25000/PHC 17 17 PHC 17 PHC 17 PHC 17 PHC PHC Annual Maintenance grant of Rs 17 17 PHC 17 PHC 17 PHC 17 50000/PHC PHC PHC Plan for maintenance to be developed x x x x x and approved by the Rogi Kalyan Samitis Plan for use of untied funds x x x x x
82 Rogi Kalyan Samitis to identify mode of x x x x x construction and repair
Budget Activity 2007-08 2008- 2009-10 2010-11 2011-11 Total 09 Untied Fund of Rs 4.25 4.25 4.25 4.25 4.25 21.25 25000/PHC Annual Maintenance grant of 8.5 8.5 8.5 8.5 8.5 42.5 Rs 50000/PHC x 17 PHC Total 12.75 12.75 12.750 12.750 12.750 63.75
83 B-4. Provision of Untied Funds an Annual Maintenance grant at CHC &DH Situation Till NRHM was launched there was no provision for any fund for the CHCs and District Analysis/ Hospital for maintenance, electricity, water, any fund for consumables, telephone, hiring Current transport in emergencies, travel and cleanliness of CHC. Status Although the Rogi Kalyan Samitis were formed still more funds were required on a regular basis. Due to this the CHC were in a bad shape. They were unable to provide services as per the needs of the patients. A number of equipment needed some repair due to which they were lying unutilized.
Objectives • Strengthening of the CHC through financial support • Strengthening of the DH through financial support
Strategies 1. Provision of Untied funds of Rs 50000 each year to the CHC at the disposal of the Rogi Kalyan Samites 2. Provision of an Annual Maintenance grant of Rs 100,000 to the CHC 3. Provision of an Annual Maintenance grant of Rs 500,000 to the DH
Activities 1. These funds will be routed through the Rogi Kalyan Samitis who will approve the yearly activities and the related budgets and also undertake and supervise improvement and maintenance of physical infrastructure. 2. An untied fund of Rs 50000 will be provided each year for activities as per the local needs including minor modifications, cleanliness of premises, transport of emergencies, transport of samples, purchase of consumables, etc; 3. This fund will not be used for salaries, vehicle purchase and recurring expenses of Panchayat or any other facility. 4. An Annual Maintenance grant of Rs 100,000 will be given to the CHC for water, toilets, maintenance of building. 5. An Annual Maintenance grant of Rs 500,000 will be given to the DH for maintenance. 6. Monthly and quarterly expenditure statement will be submitted along with UC
Support Timely release of funds required Meetings of the Rogi Kalyan Samitis to be regularly held
84 Timeline Activity 2007- 2008- 2009- 2010- 2011-12 08 09 10 11 Untied Fund of Rs 50000/CHC 2 2 2 2 2 Annual Maintenance grant of Rs 2 2 2 2 2 100000/CHC Plan for maintenance to be x x x x x developed and approved by the Rogi Kalyan Samitis Plan for use of untied funds x x x x x Rogi Kalyan Samitis to identify x x x x x mode of construction and repair
Budget Activity / Item 2007- 2008- 2009- 2010- 2011- Total 08 09 10 11 12 Untied Fund of Rs 50000/CHC 1 1 1 1 1 5 Annual Maintenance grant of Rs 2 2 2 2 2 10 100000/CHC Annual Maintenance grant of Rs 5 5 5 5 5 25 500000/ DH Total 8 8 8 8 8 40
85
B- 5. Mobile Medical Units Situation The District is scattered at a geographical area of 45,000 Sq km with a population density of 2 Analysis/ to 3 person per square km. with such a topographic condition it is not feasible to establish Current Health Centre at every nook and corner of the District. So, it will be much convenience and Status cost effective projects to ensure mobile medical units in the cut-off, remote, fur flung areas of the District. So, that a comprehensive Health Care services to the people living in the remote areas at their door steps. Such mobile Medical Units can be used during natural disaster also.
Objectives/ Meeting the unmet health needs of the people residing in difficult and underserved areas, through provision of healthcare at their doorstep Strategies Operationalizing a Medical Mobile Unit (MMU) Activities Joint meeting of the District Health Society and the Rogi Kalyan Samiti (RKS) to decide the appropriate modality for Operationalization of the MMU. Formation of a Monitoring Committee. The RKS will operate the MMU for long-term sustainability of the intervention. Staff will be hired on contract by the RKS – MO, male and Female Nurse, Lab Technician, Pharmacists, Members of Ayush, private providers, IMA members, NGOs, two drivers, Specialist from District Hospital and Medical Colleges, etc; Need Analysis to be carried out for determining the areas of MMU. Development of a monthly roster for operationalizing MMU Services will be given from 9 am to 4 pm from Monday to Friday. Saturday is for the maintenance of the vehicle. Services to be provided: a. ANC, PNC, Immunization b. Diagnostic – Haemoglobin, Urine, Blood Sugar, Blood slide for Malaria, etc; c. Treatment of minor ailments d. Referral of cases needing Specialist care e. Provision of Emergency services f. Dissemination of information through the use of TV/DVD player g. Holding meetings of Village water and Sanitation Committees h. Maintenance of Records 2. Wide publicity before the arrival of the MMU 3. Communication support for the personnel 4. Periodic Review. Support Govt Order from the State for exemption of the Regular Staff from providing services in the required MMU Timeline 2007-08 2008-09 2009-10 2010-11 2011- 12 Operationalizing the MMU 1 Orientation of the staff x x x x x Wide Publicity x x x x x
86 Strengthening the MMU x x x x Addition of services x x x x
Budget Activity / Item 2007- 2008- 2009-10 2010-11 2011- Total 08 09 12 Cost of Vehicle, 26.85 0 0 0 0 26.85 equipment and accessories Hiring staff 8.7 9.57 10.527 11.5797 12.737 53.114 6 Recurring Cost of Drivers, 2.5184 2.77 3.047 3.351 3.687 15.373 Drugs, supplies, Mobile phones, POL, Maintenance Mobile phones to each 0.2 0.12 staff @ Rs 2000/set Recurring cost of mobile 0.189 0.208 0.229 0.252 0.277 1.154 @ Rs 2700/person/yr Orientation of the staff 0.25 0.275 0.3025 0.33275 0.3660 1.52627 25 5 Joint Workshop for 0.25 0.275 0.3025 0.33275 0.3660 1.52627 finalizing modalities 25 5 Total 38.877 13.097 14.407 15.848 17.433 99.663
Detailed Calculations
Budget for Vehicles, Equipment and Accessories S.No Head Unit Cost 1. Cost of Vehicle for staff to MMU 5,00,000 2. Cost of Vehicle for carrying A/V aids, equipment etc 18,00,000 3. Prefabricated tents & Furniture 1,50,000 4. Equipment 2,00,000 5. Mobile Phone (one for each Driver) 10,000 6. Computer system with Printer 30,000 Total 26,85,000
Budget of Personnel S.No Head Unit Unit Cost Amount 1. Emoluments to MOs -1 12 months 15000 180000 2. Emoluments to Specialists –2 (Part time) 12 months 40000 480000 3. Lab Technician 12 months 5000 60000 4. Pharmacist 12 months 5000 60000 5. Nurse 12 months 7500 90000 Total 870000
87
Budget for Recurring Expenses
S.No Head Unit Unit Cost Amount 1. Salary of Drivers –2 12 months 6660 159840 2. Drugs 30000 3. POL & Maintenance of Vehicles 40000 4. Maintenance of equipment 10000 5. Mobile Phone bill -2 12 months 500 12000 Total 251840
88
B – 6. Upgrading CHC & DH to IPHS Situation • DH is the main referral unit for district Leh. Due to lack of funds construction of the DH Analysis/ is affected, it needs to be completed on priority basis. Current • CHC Skurbuchan and Diskit are housed in govt building however the condition of Status CHCs needs to be upgraded as per IPHS standard. • CHC Diskit does not have residential facilities for the staff and CHC Skurbuchan staff quarters needs major repair work. Also lack of manpower and equipment problem exists. Objectives To upgrade all the CHC as per IPHS standards Strategies 1. Availability of all personnel as per IPHS 2. Proper building 3. Adequate Laboratory, Blood Storage Unit, Equipment and Drugs Activities All CHCs to be equipped having facilities of FRUs as per IPHS standards:
• Hiring of additional staff as per IPHS with 7 Specialists and MOs, in each of the facilities, 10 staff nurses,! PHN, 1 Computer clerk, 1 Dresser, 1 Pharmacist, 1 Lab Technician, 1 BEE, 1 Radiographer, 1UDC, 1Accountant, 1Clerk, 1Epidemiologist and ancillary staff like Aya, Chowkidar, Dhobi, Sweepers, Peon and filling of Vacancies • Building to be built for CHC with staff quarters • Building to be up gradated of DH as per IPHS. Support State to sanction posts as per IPHS required Allowing Contractual Personnel at Market Rates Timeline Activity / Item 2007- 2008- 2009-10 2010- 2011-12 08 09 11 Repair /alterations/additions of CHC 2 Repair /alterations/additions of Staff 1CHC Quarters Construction of Staff Quarters 1 CHC Equipment 2 Medicines, x x x x x Furniture 2 Generator 2 Computer 2 Maintenance x x x x x Addition & Repairing of DH X
Budget Activity / Item 2007- 2008- 2009- 2010- 2011 Total 08 09 10 11 -12 CHC Building Repair, Alteration and Edition @ 15 Lakh 30 0 0.000 0.000 0.000 30 Repairing of Staff Qtrs @ 10 10 10 0.000 0.000 0.000 20
89 Lakh/CHC*2 Construction of Staff Qtrs at CHC Diskit @ 55.20 Lakh ( Qtrs of Mos@ 28.8+ SN @ 24+ 10.00 Chowkidar @ 2.4) 55.2 0 0.000 0.000 0 65.2 Furniture @1.2 X No of CHCs 3.6 0 0.000 0.000 0.000 3.6 Equipment @ 11 X No of CHCs 212.46 33 36.3 39.930 43.923 59.31 83 Recuring cost of CHC excluding 131.97 Man Power 26 26 26 26 26 4 Purchase of generator sets @ 3 lakh x No of CHCs 9 0.00 0.00 0.00 0.60 9.6 Recurring & Maintenance cost of generator sets Rs. 140 X 30 days X 12 months X No.of CHCs 1.008 1.11 1.22 1.34 1.98 6.658 Computer ,printer, fax @1 lakh X No.of CHCs 3 3 AMC of computer @ 3000 X 5.5545 No.of CHCs 0.9 0.99 1.09 1.20 1.38 9 Laundry machines for 2 CHCs @5.7 lakhs/unit 5.7 5.70 0.00 0.00 0.00 11.4 Additional construction cost and other repairing work in DH @ 3250.0 32.5 crores 3250 0.00 0.00 0.00 0.00 00 Recurring cost of DH excluding manpower including heating 375.00 system 75 75 75 75 75 0 Total 3502.8 155.4 143.63 147.85 174.6 4124.4 028 94 3 7 68 55
90
B – 7. Upgrading PHC for 24 hr Services Situation There are 17 Primary Health Centres in the District out of these seven PHCs namely Khaltse, Analysis/ Temisgam, Nyoma, Tangtse, Chuchul, Turtuk and Panamik are providing round the clock Current services. The district is determined to strengthen the remaining facilities particularly for providing Status obstetric care services in a phased manner.
Need of staff quarters and repair renovations are badly needed to strengthen and upgrade the PHCs. As 12 PHCs have staff quarters but needs repair and 5 PHCs still needed staff quarters . Objectives To establish all the PHC for 24 hour delivery and IPHS Strategies 1. Availability of all personnel as per IPHS 2. Proper building with staff quarters in all PHC 3. Adequate Laboratory, Equipment and Drugs 4. Additional PHC
Activities 1. Hiring of additional staff as per IPHS with 2 MOs( maybe Ayush), in each of the facilities, 3 staff nurses, 1 PHN, 1 Lab Technician, Part time Pharmacist, 1UDC, 1 Accountant, and Class IV and filling of Vacancies 2. Building with adequate quarters in all the PHC 3. Upgrading the Laboratory for tests necessary for 24 hour PHC 4. Furniture, Drugs and Equipment as per IPHS norms
Support State to sanction posts as per IPHS required Allowing Contractual Personnel at Market Rates
Time Activity / Item 2007-08 2008-09 2009-10 2010-11 2011-12 Frame Repair/ additions/ alterations of PHC 5 5 Repair/ additions/ alterations of Staff 7 5 Quarters Staff Quarters at PHC 5 Furniture 10 Equipment 10 Computer System 17
Budget Activity / Item 2007- 2008- 2009- 2010- 2011- Total 08 09 10 11 12 PHC Building Repair, Alteration and Edition @ 5Lakh 25 25 0.000 0.000 0.000 50 Construction of Staff Qtrs for PHCs having own building 144 0 0.000 0.000 0.000 144 Repairing of Staff Qtrs @ 5Lakh/PHC 35 25 0.000 0.000 0.000 60 Furniture @1 X No of PHCs 10 0 0.000 0.000 0.000 10 Equipment @ 11 X No of PHCs 187 0 0.000 0.000 0.000 187
91 Recuring cost of PHCs excluding 66.096 66.096 66.096 66.09 66.096 330.4 Man Power 6 8 Purchase of generator sets @ 3 lakh 30 21 0.000 0.000 0.000 x No of PHCs 51 Recurring & Maintenance cost of generator sets Rs. 140 X 30 days X 52.81 12 months X No of PHCs 8.568 9.42 10.37 11.40 13.05 2 Computer with scanner, printer, UPS 0.000 ,Fax@60000 /PHC 10.2 0.00 0.00 0.00 10.2 AMC of computer @ 3000 X No of PHC 0.51 0.56 0.62 0.68 0.75 3.114 Provision of heating systems @ 1.5 25.50 lakhs per PHC 25.5 0.00 0.00 0.00 0.00 0 Total 541.87 147.081 78.17 924.1 4 8 77.080 9 79.891 06
92 B – 8. Upgrading Sub Centres Situation • Out of 121 Subcentres, 104 Subcentres are functioning in Govt. buildings. There is no Analysis water source or water pump in majority of the sub-centres. There is no electricity source or any provision in most sub-centres.
• There is irregular supply of Kit A & B. The supply of Kit A & B is not in proportion of population. The Staff, Drugs, Equipment, Cold Chain, Accommodation for smooth functioning of Sub-Centres is insufficient. None of the Subcentres are according to IPHS norms
. • 17 Sub centers are running in rented/ private buildings and 15 Sub centers needs major repair work. Only 23 subcenters have one staff Qtrs for ANM and these Qtrs also needs some repair work. Rest subcenter don’t have any residential facilities. All the subcenters needs up gradation as per IPHS.
Objectives 1. Upgrading of Subcentres as per IPHS standards 2. Quarters for the ANMs
Strategies 1. 17 sub centres must be constructed in the project period and 15 Sub-Centres are to be & Activities required additions alteration as per IPHS Standard. 2. Electricity, Water facilities in every Sub-Centre. 3. Sufficient drugs, machinery equipments, cold chain unit for each sub-centre, etc.
Support Smooth flow of Funds. Required Time line Activity / Item 2007- 2008- 2009- 2010- 2011- 08 09 10 11 12 Total Subcentres 160 180 200 220 220 New buildings with quarters, 10 7 equipment and Furniture for existing centres -17 Two staff Quarters - 21 40 40 Repair/Addition/Alteration of SC 15 -15 One Staff Quarters -23 23
Budget Details Activity / Item 2007-08 2008- 2009-10 2010- 2011- Total 09 11 12
93 New buildings with quarters, equipment and Furniture for existing subcentres @14.79 Lakhs 147.900 103.53 59.160 0.000 0.000 310.590 Non recurring cost of subcentres including equipment& furniture 40.777 0.000 0 0.000 0.000 40.777 Repair, Addition and Alteration of Subcenter @2 lakh 30 0 0.000 0.000 0.000 30 Staff Quarters @ Rs 9 lakhs per Quarter for 2 ANMs 189 360 360.000 0.000 0.000 909 Recurring costs of Subcentres 72.763 72.763 72.763 72.763 72.763 Including Heating Systems 363.817 Total 536.29 1654.18 480.440 3 491.92 72.763 72.763 4
94
B-9 Untied Funds and Incentive Fund for the V H WS C Situation NRHM has placed a lot of stress on Community involvement and formation of Village Health & Analysis/ Water Sanitation Committees (VHWSC) in each village. These committees are responsible for Current the health of the village. In District Leh these committees have been formed but need Status strengthening to improve their functioning. The selection of ASHA, her working, progress of the village is part of the responsibilities of the Gram Panchayat.
In Leh there are 97 villages with population less than 1500. There are 14 villages with population between 1500 and 3000. There are 2 villages with population more than 3000. Hence these amount to 131 units of 1500 population.
Objectives Strengthening the Village Health & Water Sanitation Committees through financial support
Strategies 1. Provision of annual Untied funds of Rs 10000 each year to the villages upto a population of 1500 2. Provision of Rs 5000 as permanent advance fund for Incentives for ASHA
Activities 1. Provision of Annual Untied funds of Rs 10000 each year to the villages upto a population of 1500. Villages with more than 1500 population upto 3000 will get twice the funds. Villages with population more than 3000 will get three times the funds. Hence there will be 131 units of population 1500 or less to get the funds annually of Rs 10,000.00.This untied fund is to be used for household surveys, health camps, sanitation drives, revolving fund etc ; 2. Orientation of the MPHWF for the utilization of the untied funds and she in turn will orient the Village, Health & Water Sanitation committee.
3. Provision of Rs 5000 as permanent advance fund for Incentives for ASHA based on performance norms.
4. Monthly meetings of the VHWSC for reviewing the funds and activities. This is to be facilitated by the MPHWF
5. Monthly review at the PHC level regarding the VHWSC functioning and utilization of funds.
Support 1. State should ensure the orientation procedure for the VHWSC required 2. Funds to be transferred on time to the MPHWF 3. PRIs to ensure proper usage and accounts
95 Timeline 2007- 2008- 2009- 2010- 201 08 09 10 11 1-12 Untied Fund of Rs 10000/unit for Pop x x x x x 1500/unit x 539 units Orientation and reorientation of the VHWSC x x x x x Provision of Rs 5000 as permanent advance x x x x x for incentives to ASHA Monthly meetings of the VHWSC x x x x x Review of the VHWSC functioning at PHC x x x x x level
Budget Activity / Item 2007- 2008- 2009- 2010- 2011 Total 08 09 10 11 - 12 Untied Fund of Rs 10000/unit 13.5 13.5 13.5 13.5 13.5 67.5 1500/unit x 135units Permanent Advance to VHWSC for 6.05 6.05 6.05 6.05 6.05 30.25 ASHA incentive @ Rs5000/SC Total 19.55 19.55 19.550 19.550 19.55 97.75 0
96 PART C: Immunisation C-1. Strengthening Immunization Situation Status of Immunization Analysis As per the District data for 2006-2007, 96% children had received DPT, 96% Polio vaccination, 90% BGC had been given to the children and Measles to 103 %. Vitamin A second dose had been administrated to 125% and IFA tablets to 83 % of the children. Complete Immunization is present in 86.5 % children in the age group 24-35 months.
As per DLHS 2002, 88.4 % children were immunized against BCG, 21.5% against all the three doses of DPT 3, 31 % against all the three drops of polio and 79.1 % against Measles. Overall, only 8.8 % of the children were fully immunized. The availability of health facilities in villages definitely affected and increased the immunization of children.
The reasons for children not being Immunized are related to the ignorance of the mothers on the importance of immunization, the place and time of Immunization sessions and fear of side effects. The community perceives that the Polio drops given repeatedly at the time of Pulse Polio campaign is equivalent to the complete immunization.
The ANM have to take the vaccines from the PHC headquarters resulting in them not reaching the hamlets and also the difficult areas and also the Pulse Polio campaign. Supervision is not done properly at PHC level.
Also there is large gap between reported and evaluated coverage. Objective Reduction in the IMR to 25 by 2012 s/ 1. 100 % Complete Immunization of children (12-23 month of age) by 2012 Milestone 2. 100 % BCG vaccination of children (12-23 month of age) by 2012 s/ 3. % DPT 3 vaccination of children (12-23 month of age) by 2012 Benchmar 4. % Polio 3 vaccination of children (12-23 month of age) by 2012 ks 5. % Measles vaccination of children (12-23 month of age) by 2012 6. % Vitamin A vaccination of children (12-23 month of age) by 2012 Strategies 1. Strengthening the District Family Welfare Office 2. Enhancing the coverage of Immunization 3. Alternative Vaccine delivery 4. Effective Cold Chain Maintenance 5. Zero Polio cases and quality surveillance for Polio cases 6. Close Monitoring of the progress Activities 1. Strengthening the District Family Welfare Office • Support for the mobility District Family Welfare Officer (@ Rs.3000 per month (towards cost of POL) for supervision and monitoring of immunization services and VHD Days. • One computer assistant for the District Family Welfare Office will be provided for data compilation, analysis and reporting @ Rs 4500 per month. 2. Training for effective Immunization Training for all the health personnel will be given including ANM, Health Supervisor, MPWs,
97 Cold chain handlers and statistical assistants for managing and analyzing data at the district. 3. Alternative vaccine delivery system (mobility support to PHC for vaccine delivery) • For Alternative vaccine delivery, Rs. 50 to the ANM will be given per session. It is proposed to hold two sessions per week per Subcentre. • Mobility support (hiring of vehicle) is for vaccine delivery from PHC to VHD days site where the immunization sessions are held for 8 days in a month. 4. Immunization sessions to be carried out at each VHD day weekly
5. For the 25 most difficult and unreachable villages the monthly outreach sessions will be used for Immunization. The ANM, ASHA, AWW will inform the parents a day in advance. 6. Incentive for Mobilization of children by Social Mobilizers Rs.100 per month will be given to Social Mobilizers for each village for mobilization of children to the immunization session site. This money will be provided to ASHA wherever possible but if there is no ASHA then it will be given to someone nominated from the village by the PRIs. This could be given to the Numberdars and Chowkidars. 7. Incentive to for each child (12 – 23 months) completely immunized Rs 150 will be given for each child completely immunized including Vitamin A two doses – Mothers, ASHAs / SHG groups, Numberdars and Chowkidars. This will be verified by the AWW and ANM. 8. Contingency fund for each block Rs. 100/ month per block will be given as contingency fund for communication. 9. Disposal of AD Syringes For proper disposal of AD syringes after vaccination, hub cutters will be provided by Govt. of India to cut out the needles (hub) from the syringes. Plastic syringes will be separated out and will be treated as plastic waste. Regarding the disposal of needles, Pits will be formed at at every village as per CPCB guidelines. For construction of the pits at PHC, SC and villages a sum of Rs. 2000/ pit has been provisioned. 10. Outbreak investigation • Rapid Action Team for epidemics will be formed • Dissemination of guidelines • Training of Rapid Action Team for investigating outbreaks who will in turn orient the ANM during Sector meetings 11. Adverse effect following Immunization (AEFI) Surveillance: Standard Guidelines have been developed at national level and will be disseminated to the district officials and block levels in Review meetings. 12. IEC & Social Mobilization Plans Rs 25 per session of Immunization fro IEC activities ( 96 villages once a month and In 290 villages 4 times a month) (Discussed in details in the Component on IEC) 13. Cold Chain • Repairs of the cold chain equipment (@ 750/- per PHC & CHC will be given each year • For minor repairs, Rs. 10,000 will be given per year.
98 • Electricity & POL for Genset & preventive maintenance (Running Cost) of Walk in Coolers (WICs) & Walk in Refrigerators (WIF) () @ 15000/equipment per two months plus Rs. 1000 per machine for POL for Genset. • Payment of electricity bills for continuous maintenance of cold chain for the PHC @ 300 per month PHC (vaccine distribution centres) has been budgeted under this head. • POL & maintenance of vaccine delivery van @ Rs. 3000/month for maintenance and POL for Vaccine delivery van for regular supply of vaccine to the PHC. 14. Effective Supervision and monitoring: For increasing the immunization supervision and monitoring are very important. • The number of LHVs and Male Health Supervisors need to be adequate hence vacancies need to be filled up. • Mobility support for MOs @ Rs 1000/session for hiring a vehicle/ mules 15. HMIS The formats for Immunization should be properly filled for each child. The data should be shared in each review meeting for further planning. Support State to ensure the following: required • Regular supply of vaccines and Autodestruct syringes • Reporting and Monitoring formats • Monitoring charts • Cold Chain Modules and monitoring formats • Temperature record books • Polythene bags to keep vaccine vials inside vaccine carrier • Polythene for the vaccines to avoid labels being damaged • Training of Cold Chain handlers • Training of Mid level managers Timeline Activity 2007-08 2008-09 2009-10 2010-11 2011- 12 Alternative Vaccine delivery x x x x x Children for Immunization 5000 7500 10000 12000 14000 Incentive Mop up Round x x x x x Pit formation 386 386 386 386 386 MCH Cards 50000 50000 50000 50000 50000 IEC activities x x x x x Tracking bags x x x x x Orientation in Tracking bags x x x x x Maintenance of Cold Chain x x x x x Provision of Generator x
Budget Activity 2007- 2008- 2009- 2010- 2011- Total 08 09 10 11 12
99 Mobility support for alternative 5.808 5.808 5.808 5.808 5.808 29.04 vaccine delivery Rs. 50 per session for 2 planned sessions per week at each Subcentre village for 12 months = Rs. 50x2 sessionsx4 weeks/mthx12 months x SCs Vehicle for distribution of vaccines in 13.056 13.05 13.05 13.056 13.05 65.280 remote areas @ Rs 800 per PHC for 6 6 6 2 times per week x 4 weeks x 12 months x PHCs Mobility Support Mop up 10.2 10.2 10.2 10.2 10.2 51 campaign @ Rs 10000 per PHC ( Including travel, vaccine delivery, IEC) x 6 rounds/ year x PHCs Mobilization of Children by Social 10.848 10.84 10.84 10.848 10.84 54.24 Mobilizers @ Rs. 100/ session x2 8 8 8 sessions per week x 4 weeks/mth X 113 village x12 mths Incentives to mothers @Rs 150 7.5 11.25 15.00 18.000 21.00 72.75 per child for full immunization 0 0 Contingency fund for each block 0.72 0.72 0.72 0.72 0.72 3.6 @ Rs.1000/month x 6 blocks x 12 months Pit Formation for disposal of AD 22.6 22.6 22.6 22.6 22.6 113 Syringes and broken vials (@ Rs. 2000 per pit per village Printing of Immunisation cards 0.75 0.825 0.908 0.999 1.099 4.581 @1.50 per card x 50000 cards each year Special IEC session @25/session 3.555 3.911 4.302 4.732 5.205 21.704 X15072 Session Maintenance of Cold Chain 2.21 1.64 1.640 1.640 1.640 8.77 Equipments (funds for major repair) (@ Rs.750 per PHC/CHC for the first year then Rs. 500 per PHC/CHC per month) and 50,000 for minor repairs Provision of Generator at DH: Rs 5 0 0.000 0.000 0.000 5 5lakhs Recurring & Maintenance cost of 10.08 11.08 12.19 13.416 14.75 61.539 generator sets Rs. 140 X 30 days X 8 7 8 12 months X No of PHCs & CHCs POL & maintenance for Vaccine 1.8 1.98 2.180 2.400 2.640 11 delivery van at district level @ Rs.15000/month x 12 mths Running Cost of WICs & WIF 7.02 7.72 8.490 9.340 10.27 42.84 (Electricity & POL for Genset & 0 preventive maintenance) Rs. 90000 for electricity @ 15000 equipment per two months plus Rs.8000 per annum @1000 for POL for genset at DH Mobility support to District Family 0.36 0.396 0.436 0.479 0.527 2.198 Welfare Officer@ 3000/month
100 Computer Assistant for District 0.84 0.924 1.016 1.118 1.230 5.128 Family Welfare Office @ 7000 Mobility support for Monitoring 0.68 0.68 0.68 0.68 0.68 3.400 Immunization sessions for MO's PHC @1000/session Construction of under 5 clinic 0 23.5 0 0 0 23.500 Mobility support (pony charges) to 1 1.1 1.2 1.3 1.4 6.000 unreachable villages + accessories like shoes, tents, blankets etc @1 lakh/yr Solar refrigerator for 2 AD and 2 3.8 3.8 0 0 0 7.600 MAC @1.9 lakhs/unit 107.82 132.0 111.2 117.33 123.6 592.170 Total 7 46 80 6 81
10 1 PART D: National Disease Control Programme
D-1. RNTCP Situation Indicators No. Rate Analysis New Sputum positive Cases (ACDR) 2006 48 62.82% Annual Total Cases 157 70% Total New Pulmonary TB Cases 26 34% Proportion of New Sputum Positive out of total New 74 96% Pulmonary Cases Cure Rate 42 72% Smear Conversion rate 39 66% Treatment Success rate 73% Defaulter Cases 2 4% Failure Cases 5 10% To fight Tuberculosis the revised National Tuberculosis Control Programme based on the DOTS regime was launched in 1993.
TB control programme is running satisfactorily in the district as success rate of is 73% and cure rate is 72%. However, defaulter rate is 4 % while 5 failure cases were registered last year. A total of 157 No. of patients currently undergoing DOTS therapy in the district.
The program needs more efforts in terms of infrastructure, surveillance and training of the staff. Objectives 1. Reduction in the cases of Tuberculosis by 25% 2. 100 % detection of Cases 3. 85 % Cure rate in New Cases 4. Detection of 70% new smear positive cases once cure rate of 85% is achieved 5. Reduction in the defaulter rate to less than 3% Strategies 1. Improvement in the infrastructure 2. Improvement in the quality of the intervention 3. Increasing the outreach of the programme 4. Increasing the awareness regarding Tuberculosis Activities 1. Improvement in the infrastructure • Improved DTC building with a computer room • Improved MC centres and TC centre 2. Improvement in the quality of testing of sputum • Training to the RNTCP staff in the district • Equipment maintenance – Microscope, Computer and Others • Adequate supply of drugs 3. Increasing the outreach of the programme by Increasing the DOTS providers through involvement of ASHAs who will be paid Rs. 500 per year for providing services. She will be oriented regarding DOTS. Also the AWH should be involved in reporting suspicious cases. Training will be given to ASHA for identifying the suspects.
102 4. Incentive scheme (prizes of 1000, 2000, 3000) to various people (sweeper, DOT provider, Rehbar-e-sehat, LTs etc.) 5. The patient will be given an incentive of Rs 250 on completion of the treatment. 6. Increasing the awareness regarding the various issues of Tuberculosis through involvement of Rehbar-e-Sehat teachers and NGOs. Special drive for detection of cases on World TB day through the involvement for all departments 7. DOTS regime to be strictly monitored through the VHWSC, Rehbar-e-Sehat teachers, the PRIs and the PHC MO 8. Address verification system to be developed 9. Electronic information sharing to be initiated 10. Strengthen prevention 11. Vehicle hiring provision for STS, STLS for outreach because due to the tough geographical condition two wheelers can not used in winter period. Support • Persons carrying the sputum to DMC required • Every health centre should be a collecting centre • Private DOT provider may be paid as a Govt allowed payment to 25% payment • Supervisory Vehicles is being required for monitoring purpose. • POL/Maintenance of vehicle is being required. • Telephones and computers Persons carrying the sputum to DMC Timeline 2007 2008 2009 2010- 2011- -08 -09 -10 11 12 Improving the DTC building, MC Centres and TC centres x x Increasing the DOT providers through ASHAs x x x x x Training to RNTCP staff and ASHA x x x x x Awareness drives x x x x x Mask Provision
103 Budget Activity / Item 2007-08 2008- 2009- 2010- 2011-12 Total 09 10 11 Civil Works DTC building 5 lakhs 5 0 0.000 0.000 0.000 5 MC 0.28/MC 4.76 0 0.000 0.000 0.000 4.76 TU 0.35/Tu except DTC 1.05 0 0.000 0.000 0.000 1.05 Material and supplies @ 4.5 4.5 4.5 4.5 4.5 4.5 22.5 LAKHS/ANNUM (avg 3 patients) Laboratory material 1 1.1 1.210 1.330 1.460 6.1 Training 18.97 20.867 22.954 25.249 27.774 115.814 Awareness drive on World TB day 1 1.1 1.210 1.330 1.460 6.1 IEC activities 1 1.1 1.210 1.330 1.460 6.1 Vehecle hiring for STS/STLS in winter @ 1 1 1.1 1.210 1.330 1.460 6.1 lakh Salaries of contractual staff 11.19 12.31 13.540 14.890 16.330 68.26 Vehicle maintenance inc POL 1 1.1 1.210 1.330 1.460 6.1 2 wheeler 4 wheeler Hiring of vehicle 1.7 1.87 2.060 2.270 2.500 10.4 DTO MO TC @ Rs 0.42lakh/yr Equipment and maintenance 0.085 0.094 0.103 0.113 0.124 0.519 Microscope @ Rs1000/yr/microscope Computer@ Rs 5000/yr Photocopier/Fax Rs2500/ machine Miscellaneous – TA/DA, Telephone, 0.5 0.6 0.700 0.800 0.900 3.5 Meetings, Electricity repair etc (0.5 LAKHS)
Total 52.755 45.741 49.907 54.472 59.428 262.303
Detailed Calculations
Training in RNTCP
Personnel Unit Cost Units 2007-08 DTO State MOTC 23320 3 69960 MO 15580 40 623200 STS 6726 2 13452 STLS 16720 2 33440 LT 5972 19 113468 MPW 2875 121 347875 ANM 2875 242 695750 1897145
104
Personnel RNTCP Personnel Unit Cost Units Months Amount TB health visitor 6750 6 12 486000 STS 7000 2 12 168000 STLS 7000 2 12 168000 LT 6500 2 12 156000 Data Entry Operator 6000 1 12 72000 Accountant 1250 1 12 15000 Driver 4500 1 12 54000 Total 1119000
105 D-2. LEPROSY Situation Leprosy remained one of the major Health Programme in the District in the past. At present there Analysis are two cases of leprosy under treatment and both of them are non local. No new cases has been detected in local population IEC activities are being launched in the District to create awareness among masses so that people can come voluntarily at the Health Centre with sign and symptoms of the diseases for further treatment.
To make sure that there is no leprosy case in the district it needs house to house visit for detection of suspicious cases and intensive IEC for awareness. Objectives Eradication of Leprosy by 2012 Strategies 1. Detection of New cases & 2. House to house visit for detection of any cases Activities 3. IEC for awareness regarding the symptoms and effects of Leprosy 4. Prompt treatment to all cases Timeframe 2007-08 2008- 2009- 2010- 2011-12 09 10 11 House to house detection x x x x x Wide publicity x x x x x Rigorous follow-up x x x x x Treatment x x x x x
Budget Activity / Item 2007- 2008- 2009- 2010- 2011- Total 08 09 10 11 12 Treatment -1 (240x 393.01) 0.943 1.038 1.141 1.255 1.381 5.758 Treatment -2 (240x 1167.53) 2.801 3.081 3.389 3.728 4.101 17.099 IEC for information on the disease to 2 2.200 2.420 2.662 2.928 12.210 be spread all over the rural outposts 2 through posters and instructional booklets. Total 5.744 6.318 6.950 7.645 8.410 35.068
106 D-5. BLINDNESS CONTROL PROGRAMME Situation Indicators No. Analysis Total Cataract surgery performed 64 Cataract surgery with IOL 31 School going children screened 415 Children detected with refractive error DNA Children provided with free corrective spectacles DNA Villages having no register DNA
Eye Care is being provided through the DH & SDH Nubra but there is one Ophthalmologist in each facility and district has nine Ophthalmic Assistant. The current prevalence rate is 1.5% hence the district have estimated 1700 blind persons actual number may be different.
The private sector too is inactive in the district. In 2006-07 a total of 64 operations of cataract were carried out. There is a need to urgently tackle the cataract cases for the district Leh to get blind person to base hospital and operation to be performed in the theatre, Camp would be organized in exceptional cases. There is no Eye Bank or Eye donation centre in District Leh. The nearest Eye Bank is at Jammu Medical College. Objectives 1. Reduction in the Prevalence Rate of blindness to 0.5 % by 2012 2. Decrease in the Prevalence Rate of Childhood blindness to 0.6 % per 1000 children by 2010 3. Usage of IOL in 100 % of Cataract operations Strategies 1. Provision of high quality Eye Care 2. Expansion of coverage 3. Reduce the backlog of blindness 4. Development of institutional capacity for eye care services Activities 1. Determining the prevalence of Cataract through a study by an external agency. • One time house-to-house survey for study of prevalence of vision defects and Cataract of entire population leading to referrals and appropriate case management including cataract surgeries 2. Training of Paramedical staff and Teachers, NGOs, Patwaris and AWW for screening of school children and IEC activities. 3. AMC for all equipment will be done. 4. Equipment: Purchase of latest equipment for regular surgeries 5. Construction of Eye Unit in Hospitals and later CHC 6. Supply of basic Eye medicines like eye drops, eye ointments and consumables for Primary Eye Care in PHC/CHC. 7. All PHC and CHC to be developed for vision screening and basic eye care Eye Care centre Vision Centre Screening Eye Surgeon Primary Eye Care Identify Blind Treatment of eye conditions Vision Test Maintain Blind Register and follow-up Training Screening Eye Camps Motivator
107 Supervision Referral for surgery Referral 8. Blind Register to be filled up by the AWW, together with PRIs 9. Health Mela at each CHC 10. Eye Camps with the involvement of Private sector and NGOs from other districts if no agency is available in Leh. 11. School Eye Screening sessions • IEC activities Support Procurement of latest equipment for hospitals by GOI required Timely Repair of equipment Timeline Activity / Item 2007- 2008-09 2009-10 2010-11 2011-12 2008 H-H Survey for Vision defects x Health Mela DH CHC CHC CHC CHC IEC activities x x x x x School Eye Screening 100 100 100 100 100 Blind Register x x x x x Observance of Eye Donations x x x x x Cataract Camps 5 PHC 5 PHC 5PHC 5 PHC 5 PHC Development of PHC and CHC as 5 PHC 10 PHC 2 PHC Vision Centres 2 CHC Development for CHC for Eye Unit 1 1 Training of School teachers 100 50 50 50 50 50 Training of PRIs 100 100 100 100 100 Repair and purchase of equipment x x x x x and maintenance
108 Budget Activity / Item 2007- 08 2008-09 2009-10 2010- 2011-12 Total 11 Health Mela @50000 / CHC 0.5 0.55 0.605 0.666 0.732 3.053 IEC @1lakh 1 1.1 1.210 1.331 1.464 6.105 School Eye Screening @1000 X 384 3.84 4.224 4.646 5.111 5.622 23.444 school Blind Register 0.13 0.143 0.157 0.173 0.190 0.794 Observance of Eye Donations 0.15 0.17 0.190 0.210 0.230 0.95 Cataract Camps @ Rs 40000 per camp x 2 2.2 2.420 2.662 2.928 12.210 5 PHC POL for Eye Camps @ Rs 6000/camp x 6 0.36 0.396 0.436 0.479 0.527 2.198 House to house survey for vision defects 10 0 0.000 0.000 0.000 10 @ 10 lakhs Training of School teachers @ Rs 0.15 0.165 0.182 0.200 0.220 0.916 300/head x 50 Training of PRIs @ Rs 300/head x 100 0.3 0.33 0.363 0.399 0.439 1.832 Repair and purchase of equipment and 20 2 2.200 2.420 2.662 29.282 maintenance Total 38.43 11.278 12.409 13.651 15.015 90.782
109
D-6. Integrated Disease Surveillance Programme
Situation The programs with major surveillance components include: Analysis/ • The National Anti-Malaria Control Program • National Leprosy Elimination Program • Revised National Tuberculosis Control Program • Nutritional Surveillance • National AIDS Control Program • National Polio Surveillance Program as part of the Polio eradication initiative • National Programme for Control of Blindness (Sentinel Surveillance)
Surveillance activities of all these vertical programs of Malaria, Tuberculosis, Polio, HIV are functioning independently leading to duplication of Surveillance efforts. Surveillance has been ineffective due to There are a number of parallel systems existing under various programs which are not integrated. The existing programs do not cover non-communicable diseases. Medical colleges and large tertiary hospitals in the private sector are not under the reporting system as well as for utilization of laboratory facilities. The laboratory infrastructure and maintenance is very poor Presently, surveillance is sometimes reduced to routine data gathering with sporadic response systems thereby leading to slow response to Epidemics, Information technology has not been used fully for information and to analyze and sort data so as to predict epidemics based on trends of the reported data.
In response to these issues the Integrated Disease Surveillance Programme was launched in J & K to provide essential data to monitor progress of on going disease control programs and help in optimizing the allocation of resources.
IDSP includes 15 diseases/ conditions (Malaria, Acute diarrhoeal disease-Cholera, Typhoid, Jaundice, Tuberculosis, Acute Respiratory Infection, Measles, Polio, Road Traffic Accidents, Plague, Yellow Fever, Meningoencephalitis /respiratory distress, etc., HIV, HCB, HCV) ) and 5 state specific diseases (Thyroid diseases, Cutaneous Leishmaniosis, Acid Peptic Diseases, Rheumatic Heart Diseases). Establishing of District Surveillance unit Upgradation of 2 PSU Labs Water testing labs are in place V-Sat is been installed but training is required Rapid response teams are being established at District levels. DSUs (District Surveillance Units) are being established in all districts Objectives 1. Improving the information available to the government health services and private health care
110 providers on a set of high-priority diseases and risk factors, with a view to improving the on- the-ground responses to such diseases and risk factors. 2. Establishing a decentralized state based system of surveillance for communicable and non- communicable diseases, so that timely and effective public health actions can be initiated in response to health challenges in the country at the state and national level. 3. Improving the efficiency of the existing surveillance activities of disease control programs and facilitate sharing of relevant information with the health administration, community and other stakeholders so as to detect disease trends over time and evaluate control strategies. Strategies 1. Strengthening data quality, analysis and links to action; 2. Improving the laboratories 3. Training of all the stakeholders in disease surveillance and action 4. Coordinating and decentralizing surveillance activities 5. Intersectoral Coordination and involvement of communities and the private sector Activities 1. Strengthening of the District Surveillance Unit (DSU), established under the project, • Training of the Unit Incharge for epidemiology – {DMO) • Administrative Assistant • Training of contract staff on disease surveillance and data analysis and use of IT • Providing support for collection and transport of specimens to laboratory networks • Provision of computers and accessories • Provision of software of GOI 2. Setting up of Peripheral Surveillance Units at CHC 3. Sensitizing the Community for • Notifying the nearest health facility of a disease or health condition selected for community- based surveillance • Supporting health workers during case or outbreak investigations • Using feedback from health workers to take action, including health education and coordination of community participation. • Meetings with the SHGs, school teachers, Numberdar and Chowkidars for sensitisation and prompt reporting of cases 4. Improvement in the Laboratories at the district and at CHC through provision of equipment and consumables Support Provision of supplies on time required Time Frame Activity / Item 2007-08 2008- 2009- 2010- 2011- 2009 2010 2011 12 Renovation of Labs with provision of 1 District Hosp, equipment, furnishings, material PSU at 2 CHC Training x x x x x Contractual staff x Software for DSU & training of staff x x x x x WEN connectivity x x x x x Sensitization of Community x x x Meetings with SHGs x x x x x
111 Meetings with teachers x x x x x Meetings with Numberdar and Chowkidars x x x x x Budget Activity / Item 07-08 08-09 09-10 10-11 11- 12 Total Renovation of Labs at CHCs a@ Rs 20,000 0.4 0 0.000 0.000 0.000 0.4 Renovation of Lab at District Hospital @ Rs 1.4 0.14 0.180 0.200 0.220 2.14 140,000 and maintenance Equipment for Lab at PSU at CHC and @ Rs 0.8 0 0.000 0.000 0.000 0.8 40,000 Equipment for Lab at District @ Rs 850,000 8.5 0 0.000 0.000 0.000 8.5 Computer and Accessories at CHC @50000 1 0 0.000 0.000 0.000 1 Office for PSU at Maintenance CHC @ Rs 0.2 0.2 0.200 0.200 0.200 1 10,000 per unit Office Maintenance for DSU @ Rs 10,000 0.1 0.1 0.100 0.100 0.100 0.5 Software for DSU@ Rs 335000 3.35 0 0.000 0.000 0.000 3.35 Furnishing of Lab at PSU at CHCs and @ Rs 0.2 0 0.000 0.000 0.000 0.2 10,000 Furnishing of Lab at DSU @ Rs 60,000 0.6 0 0.000 0.000 0.000 0.6 Material and supplies at Lab at PSU at CHCs @ 0.16 0.16 0.16 0.16 0.16 0.8 Rs 8,000 Material and supplies at Lab at DSU @ Rs 75,000 0.75 0.83 0.910 1.000 1.100 4.59 Contract Staff at District level @ 200000/yr for 4 2 2.2 2.920 3.710 4.580 15.41 staff yr wise IEC activities 1 1.1 1.210 1.330 1.460 6.1 Training and retraining 1.916 2.430 2.673 2.940 3.234 13.192 Operational costs at PSU for Surveillance @ Rs 0.3 0.3 0.3 0.3 0.3 1.5 15000/year x 2 Operational costs at DSU for Surveillance @ Rs 1.3 1.430 1.573 1.730 1.903 7.937 130000/year Honorarium to Numberdars and Chowkidars for 2.71 2.983 3.282 3.61 3.971 16.557 reporting @ Rs 100pm x 113 Numberdars and 113 Chowkidars x12 Total 26.688 11.8728 13.507 15.280 17.228 84.575
112 D-7. Iodine Deficiency Disorders Situation Iodine is one of the essential micronutrients. Minimum requirement is 150 microgram per day. Analysis The main source of Iodine is from soil and water. Iodine is taken from food grown in iodine rich soil. At present there is a depletion of Iodine in the soil due to which there is a deficiency of Iodine.
Deficiency result in a variety of disorders ranging from Abortion, stillbirths, Goitre, impaired mental function, retarded growth. In J & K the National Iodine Deficiency Programme is being implemented. People in J & K consume rock Salt and crystal salt Objectives/ 1. Prevention of Iodine Deficiency diseases 2. Consumption of Iodized salt by 100% families Strategies 1. Supply/monitor quality of Iodized salt 2. Assessment of the magnitude of the problem 3. Laboratory Monitoring of Iodized salt and urine samples 4. Health Education Activities 1. Supply/monitor quality of Iodized salt • Monitoring is done through Food Inspectors who collect two samples of salt per month per district and send it to a laboratory. • The Health workers have been supplied with Kits to test samples at least five per month. • Review is done in the monthly meetings • Monitoring through School health programme – Testing of samples and awareness • Supply of Testing kits to AW Cs, Schools, SHGs 2. Assessment of the magnitude of the problem This will be done by the Central Survey team 3. Laboratory Monitoring of Iodized salt and urine samples 4. Health Education: An IEC strategy is essential to promote the consumption of Iodized salt through AWWs, PRIs, NGOs, ASHA, SHGs etc; Demonstration of Iodized salt by school children through testing, Rallies, sensitisation of shopkeepers for keeping Iodized salt. 5. Testing of salt at shops and homes Support 1. Regular Supply of Testing Kits required 2. Regular Supply of Iodized salt 3. Regular supply of IEC material Timeline Activity / Item 07-08 08-09 09-10 10-11 08- 2012 Large Village meetings for awareness on x x x x X IDD and consumption of Iodized salt Programme in schools – 100 Primary, x x x x X Upper Primary, Secondary- Govt and Private by School health team Awareness programme with the SHGs and 113 113 113 113 113 shopkeepers villages villages villages villages villag es
113 Budget Activity / Item 2007- 2008- 2009- 2010- 2008- Total 08 09 10 11 2012 Large Village meetings for 1 1.100 1.210 1.331 1.464 6.105 awareness on IDD and consumption of Iodized salt Programme in schools – 100 2 2.200 2.420 2.662 2.928 12.210 Primary, Upper Primary, Secondary- Govt and Private by School health team Awareness programme with the 0.565 0.622 0.684 0.752 0.827 3.449 SHGs and shopkeepers @ Rs 500 per village x 386 villages Total 3.565 3.922 4.314 4.745 5.220 21.765
114 6: Inter-Sectoral Convergence
6.1 Partnership with AMCHI department Issues / Areas Areas of cooperation Areas of convergent action Curative ; Traditional treatment • For outreach and coverage Patient care, Surveillance, referral Notification of diseases of areas not covered by outbreak MOs. • Joint training in Surveillance • Joint meetings. Preventive; Immunization, Traditional treatment to Joint planning for BCC Promotive & Prophylaxis services increase the immunity IEC for prevention Specific issues in Implementation of Participation in Pulse • District AMCHI Officer to sit national programmes Like- Polio, in the same CMO office • Maternal & Child care Family Welfare, school premises. • Adolescent health health, Malaria, Skin • Joint Review and joint • School Health diseases planning • Leprosy Participation in all national • Joint participation and • IDD programmes monitoring • Tuberculosis • Participation in Fixed Village • IDSP Health days • HIV / AIDS • Provision of medicine kits • DOTS providers • Diseases Surveillance
6.2 ICDS projects Issues / Areas Areas of Areas of convergent action cooperation There are 223 AWCs in • Fixed VHD days • Training for counselling clients, the district but there is • Joint CNAA • Provision of spacing methods including oral pills, scarcity of Infant • Common data condoms, LAM and SDM and community weighing machine, • Common sectors mobilization. examination table. Also • Collecting • Convergence of services at the grassroots would there are not enough children and ensure increasing the access to and demand for medicines with the pregnant women services AWW. • Provision of Examination table and Infant At the fixed VHD day the weighing machine to all AWCs AWWs work closely with • Joint sector meetings, block and district meetings
115 the MPHWF • DDCs; DOTS providers • Diseases Surveillance
6.3 Rural Development Department Issues / Areas Areas of cooperation Areas of convergent action Formation of a Core group at Joint action for electricity and 1. In the district, around 7% people the gram Panchayat level for water, Latrines in Health facilities joint action also. are having sanitary latrines facilities
School Sanitation and IEC are Roads to be developed to the important components of Total health facilities. Sanitation Campaign. The performance is relatively poor on Maintenance of buildings sanitation through joint reviews and plans. 2. Roads, Maintenance of buildings, Electricity and water supply is the domain of the rural development. DOTS providers Diseases Surveillance
6.4 Public Health department Issues / Areas Areas of cooperation Areas of convergent action Provision of safe drinking water. As Safe Water supply to all Provision of GLRs, tanks majority of the population of district households and all health Periodic Chlorination Leh is dependent on traditional facilities Health facilities source of water. Ensuring the proper drainage Proper drains to be built of stagnant water Covering all open drains and puddles of water. Notification of diseases in
villages Diseases Surveillance
6.5 PRIs Issues / Areas Areas of cooperation Areas of convergent action The PRIs have been envisaged to Motivating the community Joint plans play a very important role in NRHM Availability of personnel and Joint review and monitoring At the village level they are part of services Mobilization of the community the VHWSC. Participation in the VHD days for action and fund raising At the Gram Panchayat level they Giving importance to issues of are part of the Gram Panchayat health in the Gram Panchayat health committee. Similarly at the meetings Block and the District they are part
116 of the Block and District health mission. At the Subcentre the Sarpanch/ Numbardar is the joint signatory to the bank account for the operation of the Untied funds of Rs 10000. In the Gram Panchayat meetings held twice each month the PRIs review the activities of the health department along with the ICDS
6.6 Education Department Issues / Areas Areas of cooperation Areas of convergent action 1. For regular check up of school children Co-operation with 1. Strengthening of school there should be a provision for a doctor health department health programme. (physician specialist) & expert team which PHED, RDD, ICDS 2. Promotion of yoga in the will assist the doctor. department. school. 2. Mid day meal in school is being 3. Launching of Adolescent successfully carried. Cooks are engaged at Health programme Rs 500/mth. 4. Regular school health 3. The message of balanced diet is not being programmes successfully carried out. 4. School health education programme is not taking place regularly. 5. There is no Adolescent Health programme in the district.
6.7 Social Welfare Department Issues / Areas Areas of cooperation Areas of convergent action 1. For financial assistance for treatment Financial support for the 1. Financial Support whose treatment is not possible in J& K patient through Social 2. Regular health checkups. state. welfare department. 3. Disability checkup camps 2. Regular health checkups of inmates of Bal Cooperation with Social and distribution of artificial Ashrams and Nari Niketan. welfare department, limbs. 3. Treatments and artificial limbs to physically District Disability challenged people. Rehabilitation Centre and Health Department
117 Inter Sectoral Convergence Situation Health is a social responsibility and is not the domain of the health department only. Analysis/ Unfortunately the total responsibility has fallen on the health department. The various Current departments have been involved in the Pulse Polio campaign which has led to the massive Status mobilization and success of the campaign. The District Health Society has been formed consisting of members of various departments. Block health societies will be formed and also at the sector, and village level. At the Gram Panchayat level under the Sarpanch Gram Panchayat committees have been formed consisting of various sectors. The Village health and Water Sanitation Committees also consist of various sectors and the community.
In reality these committees need to be strengthened since they are not functional. All the various sectors are working separately although for the same cause. Hence there is a lot of duplication and wastage of resources.
Although orders have been issued for convergence but other sectors do not participate readily. Joint working of the ICDS and health is happening on the Fixed Maternal Child Health and Nutrition day. This needs to be strengthened and streamlined. The community is not aware regarding this day. The forum of the fixed health day each week has a lot of potential and has not been used properly. Objectives 1. Providing Primary and basic quality health care services at the village level 2. Providing quality RCH services 3. Optimal utilization of RCH services by community especially women 4. Empowering women to facilitate them to seek and demand quality RCH services. Strategies 1. Strengthening the various Committees and Societies 2. Strengthening the VHD days 3. Joint action for various issues Activities 1. Joint workshops for Planning and Review at all levels • Orientation programmes • Monthly meetings 2. Strengthening the VHD days • Wide participation of all the sectors in preparation of the community and in the actual activities, in health education • Each Wednesday during Immunization sessions joint orientations by all sectors and problem solving for each of the sectors 3. Joint Action for Sanitation, provision of safe water, provision of services and personnel at facilities 4. Joint review at the Gram Panchayat meetings 5. Joint efforts for education of the girls, improving the sex ratio, raising age of marriage, improving the nutritional status, identifying the correct BPL families, income generation.
118 6. Joint CNAA to determine the needs and thereby developing the plans jointly 7. Realignment of the Health and the ICDS sectors for common data and common work boundaries. 8. ASHA to participate in all the meetings of the ICDS held between the 20 th and 22 nd of each month. 9. At the CHC level monthly meetings are organized. This should be jointly organized with the ICDS 10. At the monthly meetings of the CMO, the officers of all the departments should come 11. Annual action Plans to be developed jointly through meetings at the village, Gram Panchayat, Sector and culminating in Block workshops and District workshops 12. Chiranjeevi Scheme to involve PRIs for promoting safe deliveries for rural BPL women through PPP initiative by involving the private sector 13. Upgrading Ayush at all levels from PHC to DH. 14. Involvement of the RDD for construction of toilets in all health facilities and public places Support Govt orders for intersectoral coordination with clear roles and responsibilities and If the required various sectors do not attend the meetings then the decisions will be taken and will be binding for all the sectors. Strict follow-up at the State level for ensuring coordination. Timeline Activity / Item 2007- 2008- 2009- 2010- 2011-12 08 09 10 11 Meetings of the Block Committees x x x x x Meetings of the Village groups x x x x x Joint monitoring at the sector level x x x x x Hiring of vehicle x x x x x Joint monitoring at the block level x x x x x Yearly joint Planning Workshops at the Block x x x x x level for development of the Action Plans Yearly joint Planning Workshops at the District x x x x x level for development of the Action Plans Yearly joint Workshops to consolidate the x x x x x plans from the village to the Gram Panchayats to the Sectors and then Blocks at the Block level for Annual Action Plans
Budget Activity / Item 2007- 2008- 2009- 2010- 2011- Total 08 09 10 11 12 Meetings of the Block Committees @ Rs 0.72 0.792 0.871 0.958 1.054 4.396 1000 /meeting x 6blocks x 12 months Meetings of the Village groups @ Rs 50 per 0.678 0.746 0.820 0.902 0.993 4.139 village x 113villages x 12 Joint monitoring at Block/ Sector level 0.000 Hiring of vehicle @ RS 1000/ day x 5 3.6 3.96 4.356 4.792 5.271 21.978 days/month x 6 blocks x 12 months
119 Yearly joint Planning Workshops at the 6 6.6 7.26 7.986 8.785 36.631 Block level for development of the Action Plans @ Rs 1.00 lakhs per block x 6 blocks Yearly joint Planning Workshops at the 1 1.1 1.21 1.331 1.464 6.105 District level for development of the Action Plans @ Rs 1.00 lakh Yearly joint Workshops to consolidate the 6 6.6 7.26 7.986 8.785 36.631 plans from the village to the Gram Panchayats to the Sectors and then Blocks at the Block level for Annual Action Plans @ Rs 1.00 lakhs per block x 6blocks Yearly joint Workshops to consolidate the 1 1.1 1.21 1.331 1.464 6.105 findings at the block levels at the District level for development of the Action Plans @ Rs 1.00 lakh Training of PRIs, VHWS committee 22 22 22 22 22.000 110.000 members under Chiranjeevi Scheme @22 lakhs Regular monthly meetings under 12 12 12 12 12.000 60.000 Chiranjeevi Scheme @12 lakhs Development of Education material and 10 10 10 10 10.000 50.000 hands on training under Chiranjeevi Scheme @ 10 lakhs Total 62.998 64.898 66.988 69.286 71.815 335.985
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7. COMMUNITY ACTION PLAN
Community Health Action Situation Health is a social responsibility and is not the domain of the health department only. Analysis Unfortunately the total responsibility has fallen on the health department. The various departments have been involved in the Pulse Polio campaign which has led to the massive mobilization and success of the campaign.
The District Health Society has been formed consisting of members of various departments. Block health societies will be formed and also at the sector, and village level. At the Gram Panchayat level under the Sarpanch Gram Panchayat committees have been formed consisting of various sectors. The Village health and Water Sanitation Committees also consist of various sectors and the community.
In reality these committees need to be strengthened since they are not functional. All the various sectors are working separately although for the same cause. Hence there is a lot of duplication and wastage of resources.
Although orders have been issued for convergence but other sectors do not participate readily. Joint working of the ICDS and health is happening on the Fixed Village Health day. This needs to be strengthened and streamlined. The community is not aware regarding this day. The forum of the fixed Village health day each week has a lot of potential and has not been used properly . Objectives 1. Providing Primary and basic quality health care services at the village level 2. Providing quality RCH services 3. Optimal utilization of RCH services by community especially women 4. Empowering women to facilitate them to seek and demand quality RCH services. Strategies 1. Strengthening the various Committees and Societies 2. Strengthening the VHD days 3. Joint action for various issues
Activities 1. Joint workshops for Planning and Review at all levels • Orientation programmes • Monthly meetings 2. Strengthening the VHD days • Wide participation of all the sectors in preparation of the community and in the actual activities, in health education • Each Wednesday during Immunization sessions joint orientations by all sectors and problem solving for each of the sectors 3. Joint Action for Sanitation, provision of safe water, provision of services and personnel
121 at facilities 4. Joint review at the Gram Panchayat meetings 5. Joint efforts for education of the girls, improving the sex ratio, raising age of marriage, improving the nutritional status, identifying the correct BPL families, income generation. 6. Joint CNAA to determine the needs and thereby developing the plans jointly 7. Realignment of the Health and the ICDS sectors for common data and common work boundaries. 8. ASHA to participate in all the meetings of the ICDS held between the 20 th and 22 nd of each month. 9. At the CHC level monthly meetings are organized. This should be jointly organized with the ICDS 10. At the monthly meetings of the CMO the officers of all the departments should come 11. Annual action Plans to be developed jointly through meetings at the village, Gram Panchayat, Sector and culminating in Block workshops and District workshops Support Govt orders for inter-sectoral coordination with clear roles and responsibilities and If the required various sectors do not attend the meetings then the decisions will be taken and will be binding for all the sectors. Strict follow-up at the State level for ensuring coordination. Timeline Activity / Item 2007- 2008 2009- 2010 2011-12 08 -09 10 -11 Formation of Block Committees x Orientation of Committee members at all x levels Joint Community action x x x x x Joint Annual Action Plan x x x x x Sector Alignment x x Reorientation of the Committees and x x x x x Societies Strengthening the Gram Panchayat x x x x x meetings and Gram Sabhas
Budget Activity / Item 2007- 2008- 2009-10 2010- 2008- Total 08 09 11 12 Training of the VHWSC @ Rs 200 per 3.39 3.729 4.102 4.512 4.963 20.696 person x 15 persons/village x113 villages Meetings of the VHWSC @ Rs 50 per 0.678 0.7458 0.820 0.902 0.993 4.139 village x 113 villages x 12 months Meetings of Women SHG @ Rs 1000 per 11.3 12.43 13.673 15.040 16.544 68.988 year x113 villages
Honorarium for MOs for promoting 0.34 0.374 0.411 0.453 0.498 2.076 Community health Action @ Rs 1000 pm and travel charges Rs 1000 pm Total 15.708 17.279 19.007 20.907 22.998 95.899
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8. Public Private Partnerships
Public Private Partnerships Situation • The Public Private Partnership (PPP) depicts that the joint efforts of both the players Analysis/ i.e. Public sector and Private sector i.e. NGOs, Private Practitioners, Trusts, Trade Current Status and Industry Organizations, Corporate Social Responsibility Initiatives to be made to provide quality and affordable health care services to the community.
• Under NRHM this component has been given due emphasis however the PPP policy has not yet endorsed in the state.
• At present, no any Public Private Partnership activity is going on in the District. No MNGO and FNGO have been selected.
• There is a dire need to take this initiative in the district on priority basis as the topographic condition of the district needs collaborative efforts to take care the health problem of the district. Objectives 1. Increasing the coverage of the health services and also increasing the accessibility for health services 2. Widening the scope of the services to be provided to the clients Strategies Incentives and training to encourage private providers to provide sterilization services Activities Involve private players including NGOs/Trusts by providing a conducive environment for accessing quality and affordable health care services to the community:
Partnership for Services for Training: Lot of capacity building activities are envisaged under NRHM, but departments neither have that much of expertise nor sufficient time to carry out the capacity building activities properly. Therefore, all such training programme will be outsourced to a capable agency selected by the DHS. Partnership for Services for IEC: For implementing and managing IEC activities (mela, shows, campaign, rally, Village Contact Drives etc) including designing and printing of IEC material, a technical and Technical Support Agency will be hired. Partnership for Services for Transportation: One agency will be hired for getting services of vehicles with drivers for field monitoring by the officers at District and below level, for transportation of drugs, equipment, linen and others up to the Sub Centre level. Drivers for department’s vehicles and ambulances will also be hired from such agency. Annual contract will be done for this purpose.
This kind of partnership will much effective for the unreached and far flung areas where there no motorable roads available. Alternate transport like Mules/ Potters can be hired from the private sector. Partnership for Services for conducting Studies, survey and evaluations: For
123 understanding the trends of diseases, impact of programs being implemented, assessing the health scenario, a technical support agency will be hired for conducting surveys, evaluation, Data analysis, HMIS etc. Partnership for School Health Programme: For covering all the primary schools both government and private and strengthening School Health Programme private organisations especially local NGOs will be involved.
The following activities will be carried out: • To conduct Feasibility study for various PPP options in the district. • To develop detailed operational framework and schemes for various feasible options in the district. • To identify technical support agency for studies on above activities • To initiate one pilot innovative intervention based on the priority in each block of district. under PPP • To prepared resource directory of all active NGOs involved in health and development issues in the district. • To prepared a list of all private health care providers including Practitioners of alternative system of medicine in the district. • To conduct training need assessment (TNA) for all the identify private partners • To orient all identified privet partners on NRHM and various national health programmes • To develop detailed framework or monitoring and evaluation of various PPP interventions • To conduct exit polls at General and Civil hospitals CHC, PHC from OPD ,IPD patients to improve the condition of the health facilities • Workshops for involvement of the Private sectors (one each with NGOs/Trusts/Private institutions; Media; Ex-servicemen association, transportation ,HR agencies) • Sharing Workshops with Private players Support Support required form the State to allow PPP; to develop a conducive environment by required formulating a workable PPP Policy.
124 Timeline Activity / Item 2007-08 2008- 2009- 2010- 2011-12 09 10 11 Feasibility study Operational Frame work x Operationalization of PPP x x x x x Innovative interventions x x x x x Advertisement for hiring technical support agency for assisting for achievement of objective of PPP mentioned above Establishing technical support agency Preparation of directories of resource x agencies and privet partners TNA for private partners x Capacity building x x x x x NGOs, CBOs, ToT 2 batches x 25per batch on national health programme Training of pvt. Health care providers 2 x x x x x batches x 25per batch on national health programme Capacity building of PRIs, VHWSC, SHGs x x x x x and other field functionaries Area specific training modules Monitoring and evaluation of PPP initiative x x x x x
Budget Activity / Item 2007 2008- 2009- 2010- 2011- Total -08 09 10 11 12 Feasibility study on PPP issues 10 0 0.00 0.000 0.000 10 0 Innovative activities based on the study 0 20 20.0 20.00 20.00 80 00 0 0 Capacity Building of NGOs 0.5 0 0.50 0.000 0.500 1.5 0 Establishing Tech. Support Agency 2 2.2 2.42 2.662 2.928 12.2 0 10 Capacity Building of 0.5 0.55 0.60 0.666 0.732 3.05 PRIs,SHGs,VHWSCs 5 3 Area specific Modules 0.5 0 0.00 0.000 0.000 0.5 0 Exit poles 2 2.2 2.42 2.662 2.928 12.2 0 10 5 Workshops for involvement of the 2.5 0 0 0 0 2.5 Private sectors (one each with NGOs/Trusts/Private institutions; Media; Ex-servicemen association, transportation ,HR agencies) @ 25000 per workshop Sharing Workshops with Private players 0 0.55 0.61 0.67 0.74 2.57 Admin and overhead Charges for hiring 2 2.2 2.42 2.67 3 12.2 the agencies 9 TOTAL 20 27.7 28.9 29.33 30.82 136. 75 0 8 833
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9. GENDER AND EQUITY
Gender and Equity Situation • Gender discrimination is a common phenomenon. It has a direct bearing on the health status Analysis of women and children. Some of the parameters are the Sex Ratio, Age at marriage, enrolment of girls in schools, Male sterilization.
• There is no specific data on Gender Based Violence but women take it as part of marriage and hence undermine the facts. Male involvement in Family Welfare is minimal since there are very few Vasectomies as against Tubectomies. The indicators for morbidity and mortality also show differential values for boys and girls.
• The socio-cultural setup of Leh district shows no discrimination between male and female. The census 2001 shows a sex ratio of 822. The figure is self explanatory that the situation is under control but it does not mean that it will be remain same in future. There is strong possibilities of gender based discrimination among women will increase in near future. Objectives 1. To maintain the sex ratio between 0-6 years. 2. To reduce the domestic violence 3. To empower women in all age groups for gender equity 4. To enhances male participations in ensuring the gender balance and equity in the community 5. To develop capacities of various stake holder in Govt. and privet sectors on gender issues and various laws and acts related to establishing gender balance in the society 6. To ensure implementations of PC-PNDT and MTP act in the district with close monitoring. 7. To establish strong mechanism for monitoring of sex ratio and implementations of various acts to ensure gender balance and equity in the society Strategies 1. Addressing Adverse Sex ratio 2. Increasing male involvement in family planning 3. Increasing male involvement in family planning 4. Gender sensitization Activities 1. Addressing Adverse Sex ratio • Workshops with private providers, IMA members, Religious leaders, Caste leaders, PRIs, MLAs • Early registration of pregnancies through TBAs, ASHAs, AWWs, Numberdar and Chowkidar . • Rallies in all schools and colleges and generating discussions in schools and colleges through debates • Regular advertisements in the newspapers • Regular meetings of the Appropriate Authorities • Registration of all Ultrasonography machines • Review of the monthly format to be filled by the Ultrasonography machines providers 2. Increasing male involvement in family planning • Use of condoms for safer sex
126 • Vasectomy and NSV are safer and easier to perform in primary health centres than Tubectomy. • BCC activities to focus on men for Vasectomy. Service delivery sites for male methods by trained health providers in NSV and conventional vasectomy will be expanded so that each CHC and Block PHC in the district has at least a provider trained in NSV. • Demand for male contraceptive methods, men’s reproductive health services through designing and implementing male-focused BCC activities. 3. Gender sensitization training will be provided for all health providers in the CHC/PHC and integrated into all other training activities so that they will have greater awareness of factors that influence women’s decision making and thereby help them respond better to the needs of women and support her in exercising her choice. 4. Health card would be provided to all girl children upto the age of 18 years. 5. Improving the Literacy status and promotion of education upto 10 th standard. 6. Treatment of anaemia in girls and also improving their nutritional status through Supplementary food at the AWCs 7. Reporting of Gender Based Violence cases by all the departments 8. Affidavit in court should be given regarding the dowry given to prevent false cases. 9. Preparation of GIS maps as planning tool to monitor and control decline sex ratio 10. IEC activities to raise the awareness regarding gender discrimination 11. Development of training modules Support Strict enforcement of the PCPNDT Act required Timeline Activity / Item 2006- 2007- 2008- 2009- 2010- 2011- 07 08 09 10 11 12 Preparation of GIS maps as planning tool to x monitor and control decline sex ratio Up gradation of GIS x x x x x IEC campaign through print audio visual and folk x x x x x x media Capacity building x x x x x x Orientation of public and Pvt health care x x x x x x providers including NGOs on various laws related to health specially PC-PNDT & MTP act Reorientation x x x x x x Development/procurement training modules x Monitoring x x x x x x Periodic advisory committee meeting and field x x x x x x monitoring @ Rs.10000 x 4(this includes meeting, travel and other contingencies) Panchayat level vigilance committees to check x x x x x x decline in sex ratio and violence against women Training of all MOs, ANMs on gender issues x x x x x x
127 Budget Activity / Item 2007 2008- 2009- 2010- 2011- Total -08 09 10 11 12 Preparation of GIS maps for monitoring 5 1 1.000 1.000 1.000 9 IEC Campaign @2000 X113 villages 1.13 1.243 1.367 1.504 1.654 6.899 Periodic Advisory committee meetings @ 0.4 0.44 0.484 0.532 0.586 2.442 10000 Development of Trg. Modules 1 0 0.000 0.000 0.000 1 Traning of MO's & ANMs 2 2.2 2.420 2.662 2.928 12.21 0 Panchayat level vigilance committees 0.8 0.88 0.968 1.065 1.171 4.884 @1000X80 Workshops with private providers, IMA 10 11 12.10 13.31 14.64 61.05 members, Religious leaders, Caste leaders, 0 0 0 PRIs, MLAs in every block and Gram Panchayat and with SHGs Rallies in all schools and colleges and 5 5.5 6.100 6.700 7.400 30.7 generating discussions in schools and colleges through debates Regular advertisements in the newspapers 5 5.5 6.100 6.700 7.400 30.7 Health Card for Girl Child @ Rs 2 /card x 0.2 0.22 0.240 0.260 0.290 1.21 10,000 cards Total 30.5 27.98 30.77 33.73 37.07 160.0 3 3 9 3 0 95
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10. CAPACITY BUILDING
Capacity Building Situation Training is an essential part of human development. Although the personnel have the basic skills Analysis necessary for carrying out their duties there is a need to upgrade the skills as well as to keep pace with the new developments under NRHM. There is a skill gap for managing safe deliveries, Abortions, Newborn Care, managing Childhood illnesses, Obstetric and Paediatric emergencies, morbidity and epidemics. There is no system for continuing education of the personnel.
The management skills are also lacking resulting in poor management of programmes including financial management. Most of the personnel are unable to use computers and internet.
One AMT school is functioning at SNM hospital Leh, which produces 70% of the total para- medical staff required for the department. Besides this one male and female MPW training school is also sanctioned for the district which is non functional since 10 years.
The trainings are carried out by the RIHFW along with the Regional training centres and the district training centres. There is a shortage of staff.
The monitoring of the trainings needs to be done for the quality of trainings. Also monitoring of the work output of the personnel for which they have received the trainings should also be done.
Objectives 1. Fully skilled personnel at all levels in the Health sector, ICDS, PRIs, NGOs and private sector for provision of services Strategies 1. Development of training plan and methodology for all the personnel on various issues of RCH to reduce the Maternal and Neonatal mortality, meeting the unmet needs, building Gender perspective, good programme management and managing various components of NRHM 2. Ensuring the quality of trainings Activities 1. Capacity building for the reduction in Maternal and Neonatal mortality • TBA training for 15 days in the concept of clean deliveries, danger signs, early referral, Newborn care and family planning, communication, • MTP training on MVA to all PHC MOs for 15 days. • Training in Obstetric management & skills for operationalization of 24x7 PHC for 16 weeks • Training in skilled Birth attendants (ANM, LHV, SN) for 15 days • IMNCI training to ANM/LHV, SN, MO, CDPO for 8 days in the area covering the 24 x 7 PHC • Training on Blood transfusion for MOs and Lab Technicians for CEmOC centres with Blood storage facilities for 3 days • Training in Life saving/Anaesthesia for EmOC at FRUs for MOs for 18 weeks • Integrated skill training of all SN • Integrated skill training for FMPW
129 • Training in management of newborns and sick children of the MOs & SN • Training in BCC for MOs, MPHS, MPHWF • Training of AMCHI personnel on issues of RCH and reporting for 3 days 2. Capacity building to meet the unmet needs • Training on NSV for MOs for 5 days • Training for Laparoscopic Sterilization for Surgeons, Gynaecologists, SN, OT attendants for 12 days • Skill upgradation of FMPW & MPHS for 5 days • Orientation on contraceptive devices for MOs of Govt facilities as well as private facilities 3. Training on Medico-legal aspects 4. Continuing Medical Education sessions for doctors each month during the monthly meetings on current topics. An expert from a reputed institution will be invited on the current topics and Certificates will be given. 5. Capacity building for Gender equality • Orientation on Gender equality & PCPNDT Act for doctors both Govt and private, members of District Appropriate authority NGOs 6. Capacity building for good programme management • Professional Development course for District Programme Managers, Senior district officials, MOs for 10 weeks • Management Development course for MOs for 5 days • General and Financial rules (G & FR) for the district officials, MOs, clerical staff for 3 days • Financial management training for Accounts Officers, Accountants for 3 days • Computer training to all the MOs, Clerical staff, accounts personnel • CNAA for MOs, MPHS, MPHWF, AWW 7. Capacity building for managing the other components of NRHM RNTCP • Reorientation Training of DOT providers for 1 day • Orientation of MOs on revised Paediatric & PWBs under Paediatric management for 1 day Convergence for Sanitation and hygiene under NRHM • One day orientations of VHWSC for total sanitation Disease Control Programme – Blindness Control, IDSP, IDDM • MPW • LT training PRIs • Training on NRHM and their roles of the members of the Zila Parishad, Panchayat Samitis, Gram Panchayat members, VHWSC for 1 day NGOs • Training in BCC
130 • Training of Field NGOs Private Sector Training on Family Planning issues, PCPNDT Act, Reporting 8. Ensuring the quality of trainings • A district quality training team will be formed to ensure the organization of trainings as per schedule, arrangements and monitoring the quality of all the trainings on the basis of checklists to be developed by the state. • They will ensure the availability of trainers and the staff at the District Training Centre. • The team will also monitor the work output of the trained personnel and give recommendations regarding improvements in the training and the future requirements. • For ensuring the availability of trainers a District Resource team and Block Resource teams will be formed for various issues. • A list of Resource persons will be developed from the State for specialized issues. 9. Start the FMPW Training centre: The sanctioned FMPW training centre should be started with updated facilities so that the desired position can be trained and fulfilled. 10. There is a need of Hostel and Mess/ Kitchen and dining hall facilities of the training centre. Currently there is no hostel facility. Support • RIHFW to develop the training calendar and organize the trainings as per schedule required • Medical colleges to be prepared for providing trainings on EmOC, MTP, Neonatal Care • Monitoring by the State the quality of trainings and the work output through the development of a format and checklist • Placement of the personnel trained in various specialized issues at the right facilities • Ensuring staff at the District training centre Time Line Activity 2007-08 2008 – 2009-2010 2010-2011 2011-2012 (Numbers) 2009 (Numbers) (Numbers) (Numbers) (Numbers) TBA training 113 113 113 113 113 MVA MTP training to all PHC 17 17 MOs Training on Blood transfusion for 1MO 1MO MOs and Lab Technicians for 1LT 1LT CEmOC centres with Blood storage facilities for 3 days Training in Obstetric management 4 MOs 6 MOs 8 MOs 8 MOs 8 MOs & skills for 24x7 PHC for 16 4 Staff 6 Staff 8 Staff 8 Staff 8 Staff weeks Nurses Nurses Nurses Nurses Nurses
Training in Skilled Birth 20 42 60 60 60 attendants for 15 days: IMNCI training to ANM/LHV, SN, 10 ANM 25 ANM 25 ANM 25 ANM 25 ANM ASHA for 8 days 4 SN 4 SN 4 SN 4 SN 4 SN 25 ASHA 50 ASHA 50 ASHA 50 ASHA 50 ASHA 4 LHV 4 LHV 4 LHV 4 LHV 4 LHV IMNCI training to MOs 8 MOs 10 MOs 10 MOs 10MOs 12 MOs
131 Training in Life 4 MOs 4 MOs saving/Anaesthesia for EmOC at CHC for MOs (State Budget ) Integrated skill training of all SN 20SNs 30 SNs 30SNs 30 SNs 30 SNs Integrated skill training for ANMs 24 ANM 50 ANMs 50 ANMs 60 ANMs 60 ANMs
Integrated skill training for MOs 6 MOs 7 MOs 7 MOs 7 MOs 7 MOs Training of MOs, SN in Mgt of 4 MOs 4 MOs 4 MOs 4 MOs 4 MOs Newborns & sick children at 4 SN 4 SN 4 SN 4 SN 4 SN Medical College Jammu Training in BCC for MOs, LHV, 6 MOs 7 MOs 7 MOs 7 MOs 7 MOs ANM 3 LHV 4 LHV 4 LHV 2 LHV 2 LHV 24 ANM 50 ANM 50 ANM 60 ANM 60 ANM Training of AMCHI personnel on 17 AMCHI 17 AMCHI 17 AMCHI 17 AMCHI 17 AMCHI issues of RCH and reporting Training on NSV for MOs at DH 2 MOs 5 MOs 4 MOs 3 MOs 3 MOs for 7 Days Training on Minilap at DH for 15 4 MOs 4 MOs 4 MOs 4 MOs 4 MOs days Training for Laparoscopic 2 2 Sp 2 Sps 2 Sps 2 Sps Sterilization for Surgeons, Specialists 2 SN 2 SN 2 SN 2 SN Gynaecologists, SN, OT 2 SN 2 OT 2 OT 2 OT 2 OT attendants for 12 days 2 OT attendants attendants attendants attendants attendants Orientation on contraceptive 17 MOs 17 MOs 17 MOs 17 MOs 17 MOs devices for MOs - Govt as well as private facilities Training on Medico-legal aspects 68 MOs & 68 MOs & 68 MOs & 68 MOs & 68 MOs & to MOs Specialities Specialitie Specialitie Specialitie Specialities s s s Continuing Medical Education 10 CME 10 CME 10 CME 10 CME 10 CME sessions for doctors each month sessions sessions sessions sessions sessions during the monthly meetings on current topics Orientation on PCPNDT Act for X x x X x Dy. CMO, CMOs, doctors both Govt and private, members of District Appropriate authority NGOs in a workshop General & Financial rules (G & 30 Distt 30 Distt 30 Distt FR) for Officials, MOs, clerical officials and officials officials staff for 3 days MOs and MOs and MOs 30 clerks 30 clerks 30 clerks Financial management training for 25 persons 40 40 40 40 persons Accounts Officers, Accountants persons persons persons for 2 days
132 Computer training to all the MOs, 80 35 Clerical staff, accounts personnel CNAA for MOs, LHV, ANM & 34 MOs 34 MOs 34 MOs 34 MOs 34 MOs MPW, AWW 17 LHV 17 LHV 17 LHV 17 LHV 17 LHV 242 ANM 242 ANM 242 ANM 242 ANM 242 ANM 223 AWWs 223 223 223 223 AWWs AWWs AWWs AWWs Total sanitation orientation and 113 113 113 113 113 villages reorientation of VHWSC x 1 day villages villages villages villages Training of NGOs in BCC 30 30 40 40 30 persons persons persons persons persons Staff Nurse Training College As per the State approval ANMTC As per the State budget Professional Development course for District Programme Managers, As per the State budget Senior district officials, MOs for 10 weeks Training of ASHAs Discussed in the respective chapters
Budget Activity 2007-08 2008– 2009- 2010-11 2011- Total 09 10 12 TBA training @ Rs 10100 /TBA 11.413 12.5543 13.810 15.191 16.71 69.678 0 MVA MTP training to all PHC MOs 1.275 1.275 0 0 0 2.550 for 15 days @ Rs 500 x 15 days x MOs Training on Blood transfusion for MOs and Lab Technicians for CEmOC centres with Blood storage facilities for 3 days MOs @ Rs 500/day/person x 3 0.015 0.015 0.000 0.000 0.000 0.030 days LabTechnicians@Rs 200/person x 0.006 0.006 0.000 0.000 0.000 0.012 3 days Training in Obstetric management & skills for 24x7 PHCs for 16 weeks MOs: Rs 500/day x 112 days x 2.24 3.36 4.48 4.48 4.48 19.040 4MOs StaffNurses:Rs200/dayx112daysx 0.896 1.344 1.792 1.792 1.792 7.616 4 SNs Training in skilled Birth attendants 0.000 for 15 days: One batch of 4 persons: Rs. 7500 1.25 2.75 3.75 3.75 3.75 15.250 as hon. to participants, Rs 13500 hon. to training team, 15% institutional charges, = Rs 25000/batch - 17 batches IMNCI training to ANM/LHV, SN, ASHA for 8 days Rs 300 as hon. to participant x 8 1.032 2.1912 2.410 2.651 2.916 11.201 days
133 IMNCI training to MOs @ Rs 5390 0.4312 0.593 0.6468 0.711 0.783 3.165 /participant Integrated skill training of all SN @ 0.816 1.3464 1.4688 1.5912 1.713 6.936 Rs 4080/person 6 Integrated skill training for ANMs 0.49152 1.1264 1.2288 1.59744 1.720 6.164 @ Rs 2048/person 32 Integrated skill training for MOs @ 0.22098 0.28359 0.312 0.343 0.377 1.537 Rs 3683 1 Training of MOs, SN in Mgt of 0.48 0.528 0.581 0.639 0.703 2.930 Newborns & sick children at Medical College Jammu @ Rs 7500/MO, Rs 4500 ( Rs 300 x 15 days)/SN Training in BCC for MOs, LHVs, 0.555 0.985 0.985 1.105 1.105 4.735 ANMs MOs: Rs 500/MO x 5 days
LHVs & ANMs: Rs 300/person x 5 days Training of AMCHI personnel on 0.36 0.396 0.436 0.479 0.527 2.198 issues of RCH and reporting for 3 days Rs 300/person x 3 days
Training on NSV for MOs at 0.14 0.35 0.280 0.210 0.210 1.190 DH@7000/MO Training on Minilap @ Rs 500 per 0.3 0.33 0.363 0.3993 0.439 1.832 day for 15 days 23 Training for Laproscopic 0.24 0.264 1.162 1.278 1.406 4.349 Sterilization for Surgeons, Gynaecologists, SN, OT attendants for 12 days Specialist: Rs 500/Specialist x 12 days SN: Rs 300/SN x 12 days
OT Attendant: Rs 200 x 12 days
Orientation on contraceptive 0.2 0.22 0.242 0.266 0.293 1.221 devices for MOs - Govt as well as private facilities Rs 500 /MO x 1 day
Training on Medico-legal aspects 0.34 0.374 0.411 0.453 0.498 2.076 to MOs @ Rs 500/MO x 1 day
Continuing Medical Education 2.5 2.75 3.025 3.328 3.660 15.263 sessions for doctors each month during the monthly meetings on current topics @ Rs 25000 per CME Orientation on PCPNDT Act for 0.5 0.55 0.605 0.666 0.732 3.053 DCs, CMOs, doctors both Govt and private, members of District Appropriate authority NGOs in a workshop
134 General & Financial rules (G & FR) 0.63 0.693 0.000 0.762 0.000 2.085 for Officials, MOs, clerical staff for 3 days Rs 500/official and MOs x 3 days Rs 200 /clerical staff x 3 days
Financial management training for 0.1 0.176 0.194 0.213 0.234 0.917 Accounts Officers, Accountants for 2 days Rs 200/Accounts persons x 2 days
Computer training to all the MOs, 2.4 1.155 0.000 0.000 0.000 3.555 Clerical staff, accounts personnel @ Rs 200 per person x 15 days CNAA for MOs, LHVs, ANMs, 1.032 1.1352 1.2487 1.37359 1.510 6.300 AWW 2 2 9512 @ Rs 200/person x 1 day each year Total sanitation orientation and 0.226 0.2486 0.273 0.301 0.331 1.380 reorientation of VHWSCs x 1 day @ Rs 200/person/day Training to AWWs @ 700/AWW for 0.7 0.7 0.7 0.000 0.000 2.100 3 days Training of NGOs in BCC @ Rs 0.54 0.594 0.653 0.719 0.791 3.297 300 per person x 6 days Total 31.3297 38.2935 41.057 44.298 46.68 201.659 91 1
135
11. HUMAN RESOURCE PLAN
Human Resource Plan Situation The Human Resources in district Leh is not as per IPHS norms. There is no motivation for the Analysis doctors to work and promotions are hard to happen. No doctors and Specialists want to work in the rural areas.
Subcentre level • The requirement of ANM will be around 242 as per IPHS norms of 2 ANMs per Subcentre, addition to this 121 Male multipurpose worker also required as one per subcentre. Total Identified gaps of ANM is 102 in district Leh.
PHC level • The PHCs are adequate as per the population norms. • As per IPHS 2 MOs per PHC will be required whereas at present there is only one MO per PHC hence total 19 MOs required for PHCs. • For IPHS norms 51 Staff Nurses for PHC [3 per PHC] are required. At present there are just 20 SN • There are only 15 Lab Technicians as against the required 17 today. • At present there are 16 Pharmacists in the PHC as against 17.
CHC Level • There are only 2 specialists in position in CHC as against 14 sanctioned posts. In the CHC there should be at least 7 specialists, 3 MOs, 10 Staff Nurses, I PHN, 1 Computer clerk, 1 Dresser, 1Pharmacist, 1 Lab technician, 1 BEE, 1 radiographer, 1 UDC, 1 Accountant, 1 LDC, 1 Epidemiologist, and Ancillary staff on contract. Objectives 1. All staff to be in place as IPHS norms Benchmarks 2. Increased salaries for contractual doctors and Specialists at least equivalent to the regular staff. 3. Increase in the number of training centres for LHV, ANM, Staff Nurses, Lab Technicians Strategies & 1. Rational placement of Specialists and trained staff Activities 2. Recruitment of staff on contract where vacancies 3. Recruitment of staff for new facilities as per the infrastructure requirements 4. Computers at all PHC and for each MO and Specialist at the CHC 5. Allowing Specialists and MOs for developing special skills as per their needs by attending special courses anywhere in India. Support 1. The State must approve and give sanctions for the necessary personnel for each required facility before actually starting the facilities. 2. Contractual staff should be allowed recruitment as and when required. Permission
136 from State should not be taken each time. Timeline Activity / Curre 2007 200 2009 201 201 200 200 2009- 2010- 2011- Item nt -08 8-09 -10 0- 1- 7- 8- 10 11 12 Statu 11 12 08 09 s Total requirements(IPHS Norms) Additional requirement - Contractual Subcentre 121 121 121 121 121 121 0 0 0 0 0 ANM 138 242 242 242 242 242 104 104 104 104 104 MPW(M) 0 12 121 121 121 121 121 121 121 1 121 121 PHC 17 17 17 17 17 17 0 0 0 0 0 MO 14 34 34 34 34 34 20 20 20 20 20 Staff 21 51 51 51 51 51 30 30 30 30 30 Nurse Health 16 17 17 17 17 17 1 1 1 1 1 worker (F) Health 3 17 17 17 17 17 14 14 14 14 14 Educator Health 6 34 34 34 34 34 28 28 28 28 28 Assistant Clerk 7 17 17 17 17 17 10 10 10 10 10 Pharmacis 16 17 17 17 17 17 1 1 1 1 1 t Lab.Tech 14 17 17 17 17 17 3 3 3 3 3 Class IV 37 68 68 68 68 68 31 31 31 31 31 accountant 0 17 17 17 17 17 17 17 17 17 17 (part time) Driver 13 13 13 13 13 13 13 13 13 13 13 CHC 2 2 2 2 2 2 0 0 0 0 0 Specialist( 14 14 14 14 14 11 11 11 11 11 7) 3 MO 8 8 8 8 8 8 8 8 8 8 General Duty (3) 0 PHN 1 2 2 2 2 2 1 1 1 1 1 ANM 3 2 2 2 2 2 -1 -1 -1 -1 -1 SN 8 14 14 14 14 14 6 6 6 6 6 Dresser 1 2 2 2 2 2 1 1 1 1 1 Pharmacis 2 0 0 0 0 0 t 2 2 2 2 2 lab. Tech 3 2 2 2 2 2 -1 -1 -1 -1 -1 Radiograp 1 1 1 1 1 1 her 2 2 2 2 2 Opthalmic 1 1 1 1 1 1 Assistant 2 2 2 2 2 Class IV 11 20 20 20 20 20 9 9 9 9 9 Statistical 1 1 1 1 1 1 Assistant 2 2 2 2 2 Registratio 1 1 1 1 1 1 n clerk 2 2 2 2 2 Accountan 0 2 2 2 2 2 t 2 2 2 2 2 Epidemiol 0 2 2 2 2 2 ogist 2 2 2 2 2
137 BEE 0 2 2 2 2 2 2 2 2 2 2 Budget Activity / Item 2007-08 2008- 2009-10 2010-11 2011-12 Total 09 Subcentre ANM 329.846 329.84 329.846 329.846 329.846 1649.23 6 MPW(M) 143.748 143.74 143.748 143.748 143.748 718.74 8 PHC MO 107.168 107.16 107.168 107.168 107.168 535.84 8 Staff Nurse 78.387 78.387 78.387 78.387 78.387 391.935 Health worker (F) 26.129 26.129 26.129 26.129 26.129 130.645 Health Educator 26.129 26.129 26.129 26.129 26.129 130.645 Health Assistant 58.174 58.174 58.174 58.174 58.174 290.87 Clerk 20.196 20.196 20.196 20.196 20.196 100.98 Pharmacist 26.01 26.01 26.01 26.01 26.01 130.05 Lab.Tech 20.196 20.196 20.196 20.196 20.196 100.98 Class IV 48.96 48.96 48.96 48.96 48.96 244.8 accountant(part time) 10.2 10.2 10.2 10.2 10.2 51 Driver 12.48 12.48 12.48 12.48 12.48 62.4 CHC 0 0 0 0 0 Specialist(7) 51.66 51.66 51.66 51.66 51.66 258.3 MO General Duty (3) 25.216 25.216 25.216 25.216 25.216 126.08 PHN 3.424 3.424 3.424 3.424 3.424 17.12 ANM 2.376 2.376 2.376 2.376 2.376 11.88 SN 21.518 21.518 21.518 21.518 21.518 107.59 Dresser 1.38 1.38 1.38 1.38 1.38 6.9 Pharmacist 3.06 3.06 3.06 3.06 3.06 15.3 lab. Tech 2.376 2.376 2.376 2.376 2.376 11.88 Radiographer 2.376 2.376 2.376 2.376 2.376 11.88 Opthalmic Assistant 2.376 2.376 2.376 2.376 2.376 11.88 Class IV 14.4 0 0 0 0 14.4 Statistical Assistant 2.376 2.376 2.376 2.376 2.376 11.88 Registration clerk 2.376 2.376 2.376 2.376 2.376 11.88 Accountant 3.86 3.86 3.86 3.86 3.86 19.3 Epidemiologist 5.5 5.5 5.5 5.5 5.5 27.5 BEE 3.06 3.06 3.06 3.06 3.06 15.3 1054.957 1040.5 1040.55 1040.55 1040.557 5217.185 Total 57 7 7
138
12. PROCUREMENT AND LOGISTICS
Procurement and Logistics Situation • All the supplies to the peripheral Health Institutions is estimate on the basis of last year Analysis/ procurement/ consumption and requisition made by BMOs. Supply to the health institution Current is based on population and its requirement. Status • A committee of doctors is constituted to monitor the district needs. In district Leh there is no proper Warehouse. There is one room in which drugs are stored but it is not a scientific Warehouse. Most of the drugs are supplied by the State but some drugs are locally procured.
• Inventory Management is not very scientific and the records are not computerized. There is no system of wastage control, replacements, transfer of stocks from one centre to the other. Record Keeping is done manually. There is one storekeeper and one packer in the District hospital. The store also supplies Linen for the field activities; there is no facility to wash the linen. Objectives Development of a Scientific Warehouse system by 2008 Strategies 1. Developing a Warehouse 2. Capacity building of the personnel for stores and also record keeping 3. Computerization of all the stocks Activities 1. Construction of a scientific Warehouse 2. Procurement of software and computer hardware for the Warehouse from TNMSC 3. Proper Equipment and hardware 4. Availability of Pharmacist, Assistant Pharmacist, Packers 5. Training of personnel 6. Appointment of an agency for Operationalization of the Scientific Warehouse Support State to develop a scientific and transparent Procurement, Logistics and Warehousing system required with quality control Timeline Activity / Item 2007-08 2008- 2009-10 2010- 2011- 2006-07 09 11 12 Construction of Warehouse x Software x Computer system with UPS, Printer, x Scanner, Equipment & Hardware x Pharmacist @ Rs 9000/mth x Assistant Pharmacist @ Rs 5000/mth x Packers -1 @ Rs 4000/mthx2 x Security Staff @ Rs 6000/mth x Training of personnel x
139 Consultancy to agency for x x Operationalization of the Warehouse Procurement of Washing machine X Budget Activity / Item 2007- 2008- 2009- 2010- 2011- Total 08 09 10 11 12 Construction of Warehouse and 100 10 10.00 10.000 10.000 140 maintenance 0 Software 0.25 0 0.000 0.000 0.000 0.25 Computer system with UPS, Printer, 0.6 0 0.000 0.000 0.000 0.6 Scanner, Equipment & Hardware 34.5 0 0.000 0.000 0.000 34.5 Pharmacist @ Rs 9000/mth 0 1.08 1.190 1.310 1.440 5.02 Assistant Pharmacist @ Rs 0 0.6 0.660 0.726 0.799 2.785 5000/mth Packers -2 @ Rs 4000/mthx2 0 0.48 0.528 0.581 0.639 2.228 Security Staff @ Rs 6000/mth 0 0.72 0.792 0.871 0.968 3.351 Training of personnel 0 0.1 0.110 0.121 0.133 0.464 One washing machine 20 Kg @ Rs 0.5 0 0.000 0.000 0.000 0.5 50000 Consultancy to agency for 2 2.1 0.000 0.000 0.000 4.1 Operationalization of the Warehouse Total 137.85 15.08 13.28 13.609 13.979 193.7 0 98
140
13. DEMAND GENERATION - IEC
IEC – Information, Education and Communication Existing With a low educational status and limited knowledge of services, general public in the rural area Status especially in remote areas are not aware of the certain services or facilities available with the department.
There is lack of awareness and good practices amongst the community due to which they neither avail the services nor take any positive action. There is lack of awareness regarding the services, schemes including the Fixed Village Health days.
The following issues need special focus: • Importance of 3 visits for ANC, advantages of institutional delivery, Post natal care, availability of skilled birth attendants, balanced diet during pregnancy, anaemia, misgivings about IFA. • Importance of complete immunization, disadvantages of drop outs, nutritional requirements of infants and children, malnutrition, exclusive breastfeeding • Problems of adolescents, drugs addiction, malnutrition, problems of sexuality, tendency to take risks in sexual matters • DOTS programme for TB, location of microscopy centres, cardinal symptoms of TB, • High risk behaviour in the community in relation to heart diseases and lung diseases, and HIV/AIDS, STDs • Ill effects of drugs addiction affecting adolescents, • High prevalence of RTIs, including STDs, • JSY, Fixed Health days , availability of services
The personnel have had no training on Interpersonal communication. Objectiv Widespread awareness regarding the good health practices e Knowledge on the schemes, Availability of services Strategy 1. Information Dissemination through various media, 2. Interpersonal Communication 3. Promoting Behaviour change Activity 1. Awareness on • Fixed VHD days • JSY • Services available 2. Designing of BCC messages on exclusive breast feeding and complimentary feeding, ANC, Delivery, PNC, FP, Care of the Newborn, Gender, male involvement in the local language 3. Consistent and appropriate messages on electronic media – TV, radio 4. Use of the Folk media, Advertisements, hoardings at prominent sites 5. Training of ASHA/AWW/ANM on Interpersonal communication and Counselling on various issues related to maternal and Child health
141 6. Display of the referral centres and relevant information in a prominent place in the village 7. Promoting inter-personal communication by health and nutrition functionaries during the Fixed health & Nutrition days 8. Orientation and training of all frontline government functionaries and elected representatives 9. Integration of these messages within the school curriculum 10. Kit for the newly married and during first pregnancy to be given at the time of marriage and during pregnancy 11. Mothers meeting to be held in each village every month to address the above mentioned issues and for community action 12. Kishore Kishori groups to be formed in each village and issues relevant to be addressed in the meetings every month 13. Meetings of adult males to be held in each village to discuss issues related to males in each village every month and for community action. 14. Village Contact Drives with the whole staff remaining at the village and providing services, drugs, one to one counselling and talks with the Village Health & Water Sanitation Committee and the Mother’s groups. 15. Monthly Swasthya Darpan describing all the forthcoming activities and also what happened in the month along with achievements 16. Bal Nutrition Melas 4 times at each Subcentre 17. Wall writings 18. Pamphlets for various issues packed in an envelope State State to give guidelines for the good practices and also training module on BCC Support Timeline Activities 2007- 2008-09 2009-10 2010-11 2011-12 08 Finalizing the messages x x x x x Advertisements x x x x x TV spots x x x x x Radio Jingles x x x x x Folk Media shows x x x x x Hoardings on prominent places x x x x x Display boards x x x x x Pamphlets x x x x x Developing Nirdeshika for holding VHD x x days Monthly Swasthya Darpan x x x x x Orientation & training of all frontline govt x functionaries and elected representatives VCD in each village quarterly x x x x x Bal Nutrition Melas x x x x x Adolescent meetings x x x x x Opinion leaders workshops x x x x x
142 Wall writings x x x x x Budget Activities 2007- 2008- 2009-10 2010-11 2011-12 Total 08 09 Hiring of an agency for carrying out the 40 44 48.400 53.240 58.564 intensive IEC and behaviour change 244.2 activities 0 Finalizing the messages in the local 1 1.1 1.210 1.331 1.464 language 6.11 Advertisements 5 5.5 6.050 6.655 7.321 30.53 TV spots 1 1.1 1.210 1.331 1.464 6.11 Radio Jingles in local language 1 1.1 1.210 1.331 1.464 6.11 Folk Media shows @ Rs 1000/vill 0.113 0.1243 0.137 0.150 0.165 0.69 Hoardings @ Rs 10000/hoarding 10 11 12.100 13.310 14.641 61.05 1 Display boards @ Rs 2000/board 2 2.2 2.420 2.662 2.928 12.21 Pamphlets @ Rs 10/pamphlets x 100000 10 11 12.100 13.310 14.641 61.05 Nirdeshika for Fixed Health Nutrition 1.6 1.76 1.936 2.130 2.343 days @ Rs 20/ Nirdeshika x 8000 9.77 Swasthya Darpan @Rs.10 /copy/mth x 0.8 0.88 0.968 1.065 1.171 8000 4.88 Orientation of elected rep and PRIs@ Rs 2 2.2 2.420 2.662 2.928 200 x 1000persons x1 day 12.21 Village campaign @ Rs 31.188 lakhs per 31.188 34.306 37.737 41.511 45.662 Campaign 8 190.4 1 Bal Nutrition Melas @ Rs 300 x 4 times x 2.676 2.676 2.676 2.676 2.676 13.38 AWCs Kishori Shakti meetings @ Rs 100 per 0.113 0.1243 0.137 0.150 0.165 group x 113 villages 0.69 Community and religious leaders 1.2 1.32 1.452 1.597 1.757 workshops @ Rs 300 /person x 100 x 4 7.33 times Wall writings @ Rs 400 x 113 villages 0.452 0.4972 0.547 0.602 0.662 2.76 Total 110.14 120.88 132.71 145.71 160.01 669.4
143
14. FINANCING OF HEALTH CARE
Financing Health Care Situation For sustainability and needs based care, health financing is the key. Analysis/ Current In District Leh Rogi Kalyan Samitis (RKS) have been formed in each of the hospitals, CHC and Status PHC. These are hospital autonomous societies which are allowed to take user fees for services provided at the facilities. Formation of these RKS has resulted in great satisfaction amongst the patients and also the staff since now funds is available with the facilities to care for the people.
No trainings have been given for the skill building of the Incharges of these facilities. There is no standardized reporting format and information regarding these RKS is not there. Objectives Availability of sufficient funds for meeting the needs of the patients Strategies 1. Generation of funds from User charges 2. Donations from individuals 3. Efficient management of the RKS 4. Provision of Seed money to each RKS Activities 1. Generation of funds from User charges: User charges are taken for Registration, IPD, Laboratory investigations from persons who can afford to pay. 2. Donations from individuals: Donations are to be generated from individuals. For the betterment of hospitals, equipment, additions to the buildings, etc 3. Efficient management of the RKS: Training will have to be given for efficient management and utilization of the funds for activities that generate fund 4. s. Computerization of data and all the parameters need to be carried out preferably through customized software. Trainings can be organized with the help of RIHFW Jammu who have developed modules and conducted trainings for the management of these Societies. 5. Provision of Seed money to each RKS at CHC and PHC of Rs 100000 each year for repair, purchase of new equipment, additions, alterations, etc’; 6. Development of customized software and training of staff for the use of this software 7. Regular filling of formats Support 1. Timely meetings of Rogi Kalyan Samitis required 2. RIHFW Jammu to agree for providing trainings on the management of the RKS Timeline Activity 2007- 2008- 2009- 2010- 2011- 08 09 10 11 12 Provision of Seed money @ Rs 1 lakh per CHC x x x x x and PHC Training of the Incharges and second in x x x x x command Development of Software for RKS with training of x x x x x personnel on the use
144 Budget Activity 2007- 2008- 2009- 2010- 2011- Total 08 09 10 11 12 Provision of Seed money @ Rs 1 lakh 19 19 19.000 19.000 19.00 95 per CHC and PHC @ Rs 1.00 lakhs 0 Training of the Incharges and second in 0.38 0.38 0.38 0.38 0.38 1.9 command @ Rs 1000 per person x 1 day Development of Software for RKS with 5 0.25 0.250 0.250 0.250 6 training of personnel on the use Total 24.38 19.63 19.630 19.630 19.63 102.9 0 00
145 15. HMIS, MONITORING AND EVALUATION
HMIS Status HMIS is a monitoring tool for the performance that provides information to support planning, decision-making and executive control for managers in the Health & FW department.
The basis of HMIS is the data collected by the ANM who is over burdened with a substantial amount of her time being spent on surveillance related activities. Presently the data is collected on some printed format on monthly basis it does not cover the information on nutrition community participation and community Health Information. All the information is collected through post which takes days to reach from one place to another and during winter when the passes are closed it takes months to communicate. Each year a CNAA exercise is carried out but the set procedures under the CNAA are generally not followed in development of annual action plans and in their utilization in planning the activities of health workers. The action plans are prepared more as a normative exercise rather than as a management tool for estimation of service needs and monitoring the programme outputs.
There is no horizontal integration of surveillance activities of existing disease control programmes. Absence of clear case definitions and poor supervision or crosschecking of the data collected hampers the quality of reporting. Non-Communicable diseases are not included in surveillance even though the burden due to them is high. Absence of formats for reporting diseases also affects quality of the data collect.
There is lack of coordination between departments. Discrepancy between the data of the Health department and the ICDS. There is large gap between reported and evaluated coverage. The District administrative system not able to make use of the health data.
Specific HMIS software needs to designed which fulfill the basic information requirement of the district. In the first phase all the Block Headquarters needs to be linked with the District Health Quarter through NIC Net centre, Leh for better communication, All CHCs and PHCs should be computerised for better data collection and reporting. a cable from SDM office may extend to the block PHC since tele-conferencing facility is available to the SDM office it needs to be extended to the Block PHC, the system can also be utilized for tele-conferecing purpose thus benefiting hundreds of patients getting consultation of specialist at their door step.
A V sets needs to be installed at the district Health headquarters for better and prompt communication services. District Leh introduced Health Card scheme, where every individual is provided with a Health Card with the basic health information of individual and whenever the individual seek health services he/ she brings the card and the consulting doctor put the prescription in the card. In the HMIS system this thing should be incorporated so that all the information must be computerized and during referral the doctor can find out all the detail on his / her computer. Objectiv 1. Integration of several parallel running programme software
146 e 2. HMIS is used for decision making on regular basis 3. Inclusion of RCH indicators monitoring 4. Linkage to decision making at Central level 5. Refresher training 6. Make it more useful for State level officials Strategy 1. Research on various issues related to RCH to get a correct baseline 2. Improvement in the CNAA 3. Computerized HMIS Activity 1. Survey for Data on • Newborn deaths, births, maternal deaths, Infant deaths, Level of malnutrition in Pregnant women, Adolescents and children at birth, one year, two years and six years • Newborn Care and practices at home for the newborn and neonate • Male participation in Maternal and Child health • Actual poor people who need free treatment • Coverage of hamlets • Access to services • Health Care practices and behaviour patterns • Number of Eligible couples, data on all the RCH parameters and indicators 2. Computerization of All the Health Card with the identification number and put the data into the data bank for further update and use. 3. Joint CNAA by the ANM, AWW, ASHA along with the PRIs so that there is one data validated by the PRIs 4. Printing of Reporting & Monitoring Formats 5. Data entry of each Household, Eligible couples, Adolescents 6. Computerization of all the formats and software for the various programmes and finances 7. Computer training for data entry 8. Internet connectivity upto all PHC for online transfer of data. The MPHWF will get the data entered each month after the health card entries have been made 9. GIS for the district covering all the parameters 10. Computers at all CHC and PHC including AMC for all computers State Provision of software for data entry Support Time line Activities 2007-08 2008 2009 2010 2011- -09 -10 -11 12 Survey for practices, coverage, behaviour etc x through independent agency Software development x Data Entry of each household x x Internet connectivity x x Provision of computers for each CHC and PHC x AMC for computers x x x x x
147 GIS for the district, training and updation x x x x x Printing monitoring Charts x x x x x
Budget Activities 2007- 2008- 2009-10 2010- 2011- Total 08 09 11 12 Survey for practices, coverage, 15 0 0.000 0.000 0.000 15 behaviour etc through independent agency 20 0 0.000 0.000 0.000 20 Software development Data Entry of each households health 1.8 0.4 0.800 1.200 1.600 5.8 card @ Rs 2 per card x 90000 cards (approax.) Internet connectivity @ Rs 900 /mth x 2.052 2.257 2.483 2.731 3.004 12.52 No of facilities x12 mths 8 provision of computers for each CHC 11.4 0 0 0 0 11.4 and PHC @ Rs 60,000/computer system with UPS and printer AMC for computers @ Rs 5000 0.95 1.045 1.1495 1.264 1.391 5.800 /computer /year x 19 computers Consumables for computers @ Rs 9.12 10.032 11.035 12.139 13.353 55.67 4000/mth/facility x 12 mths 9 GIS for the district, training and 12 0.5 0.500 0.500 0.500 14 updation Printing monitoring Charts @ Rs. 5 0.1 0.125 0.150 0.175 0.200 0.75 per monitoring chart Total 72.422 14.359 16.118 18.009 20.048 140.9 56
148 16. Adolescent Health
Adolescent Health Current The adolescents are very vulnerable since the awareness levels for various issues of RCH are Status low. Adolescence have unmet needs regarding nutrition, reproductive health, mental health and require appropriate counselling. No efforts have been made for any counselling of the adolescents. There is hence a great lacuna in the knowledge of the Adolescents.
Adolescents especially the boys are exposed to smoking, addictions, peer pressure and there is no one to counsel them. Teenage pregnancies also emerging as a problem ad Unsafe abortion & premarital sex trend is on rise.
The Kishori Shakti Yojana for Adolescent girls in AWCs is not functional. In this scheme they are given IFA tablets, Deworming, Supplementary Nutrition and also given vocational training. Adolescents need to be brought under the ambit of this programme so that the levels of anaemia are reduced due to IFA and Deworming.
The School Health programme and The school AIDS education programme and school sanitation programme are covering the entire state. Some degree of anaemia and severe anaemia is reported but the data needs to be validated. Data regarding the perceptions and practices of girls and boys is lacking especially in the context of rural setting. Objectives 1. Increase the knowledge levels of Adolescents on RH and Life skills 2. Enhance the access of RH services to all the Adolescents 3. Improvement in the levels of Anaemia to 50% by 2012 Strategy 1. Implementation of Kishori Shakti Yojna 2. Awareness amongst all the adolescents regarding Reproductive health and Life skills 3. Provision of Adolescent Friendly Health package at the health facilities 4. Provision of Adolescent Health Counselling services Activity 1. Research study involving quantitative and qualitative aspects on the perceptions and practices of girls and boys in the context of rural setting and also the age of marriage and consummation. 2. Operationalization of Kishori Shakti Yojna • Adolescent Mentoring group consisting of Master Trainers for carrying out trainings, mentoring, monitoring the process of formation of Kishore- Kishori groups • Set up Kishore-Kishori Groups in all villages and family life education and IEC on high risk behaviour 3. School based programmes. • Regular screening of Adolescent for anaemia in the school and Family Life Education session. • Specialists for school adolescence health 4. The Adolescent Health package will consist of the following activities:
149 • Formation of a Subcommittee as part of District Partnership for Adolescent Health (DPAH) consisting of representatives of: Health department, Education department, Social Welfare department, ICDS, NGOs, PRIs, National Service Volunteers, other youth organizations, local chapters of Indian Academy of Paediatricians & FOGSI and other stakeholder groups. • Workshop to develop an understanding regarding the Adolescent health and to finalize the operational Plan • Provision of Adolescent friendly health services at PHC, CHC, FRUs and district hospitals in a phased manner. Training of the MOs, ANMs on the needs of this group, vulnerabilities and how to make the services Adolescent friendly. • Adolescent Health Clinics will be conducted at least once every week by the MO to provide Clinical services, Nutrition advice, Detection and treatment of anaemia, easy and confidential access to medical termination of pregnancy, Antenatal care and advice regarding child birth, RTIs /STIs detection and treatment, HIV detection and counselling, • In the difficult villages the clinics will be part of the monthly Outreach session • Carrying out the services at the fixed VHD days • Provision of IFA tablets to all Adolescents, deworming every 6 months, Vitamin A administration and Inj. TT • Awareness building amongst the PRIs, Women’s groups, ASHA, AWWs
5. Developing a cadre of Peer Educators • Selection of Peer Educators, two for each village in a phased manner, and their training for three days. • Selection of Counsellors for Peer Educator workshops and carrying out counselling clinics. These will be selected one per PHC. There will be equal number of Male and female counsellors and will alternate between two PHC – one week the male counsellor is in one PHC and the female counsellor in the other and they switch PHC in the next week so that both the boys and girls benefit. The counsellor will be • Providing ongoing training to the Peer Educators, • Facilitating group meetings • Organizing Counselling session once per week at the PHC. Organization of counselling sessions at PHC with wide publicity regarding the days of the sessions • Collecting data and information regarding the problems of Adolescents 6. Close monitoring of the under 18 marriages, pregnancies, prevalence of RTI/STDs. 7. Three-day health camps for Adolescent boys and girls at block level for De addiction, Mental health and problems of adolescents quarterly • Involvement of NGOs for awareness generation, Appointment of Counsellors, Peer Educators State Approval by State for Life skill education and Life skill education to be initiated in all schools Support
150 Timeline Activities 2007- 2008-09 2009- 2010- 2011-12 08 10 11 Research x Awareness generation x x x Formation of Adolescent Mentoring Group x Workshop of all the partners x x x Training a district pool of Master trainers x Selection of Peer Educators 1 block 3 Blocks 2 Block Counsellor through NGOs All PHC Training of Peer Educators 100 100 100 Retraining of Peer Educators 0 100 200 300 300 Orientation of the Health personnel x x x Counselling Clinics All All PHC All All PHC All PHC PHC PHC Three day health camps for Adolescents x x x Budget Activity 2007-08 2008- 2009- 2010-11 2011-12 Total 09 10 Research 5 0 0.000 0.000 0.000 5.000
Awareness generation @ Rs 2000 2.26 2.486 2.7346 3.00806 3.30886 13.798 per village x 113 villages 6 Workshop of all the partners 0.5 0.55 0.605 0.6655 0.73205 3.053 Training of Adolescent Mentoring 1 1 1.000 1.000 1.000 5.000 Group and other expanses@1 Lakh Counsellors@ Rs 8000 per month 16.32 17.95 19.747 21.7219 23.8941 99.635 x PHCs x12 mths 2 2 2 12 Training of Peer Educators @ Rs 0.15 0.15 0.150 0.000 0.450 50 per person x 3 days xNo of Peer Educators ReTraining of Peer Educators @ 0 0.15 0.300 0.450 0.450 1.350 Rs 50 per person x 3 days x peer Educators Orientation & Reorientation Health 0.25 0.28 0.310 0.340 0.370 1.550 personnel Counselling sessions @ Rs 1 2 3.000 3.000 3.000 12.000 1000/yr/peer Educator Counselling Clinics renovation, 1.7 1.87 2.057 2.2627 2.48897 10.379 furnishing and Misc expenses @ Rs 10000.00 Health camps for Adolescents 2 2.2 2.42 2.662 2.9282 12.210 once per quarter x 4 x Rs 50000 per camp Joint Evaluation by an agency & 1 0 1.200 0.000 1.320 3.520 Govt Total 31.18 28.63 33.524 35.110 39.492 167.94 8 4
151 16. Bio –Medical Waste Management
Bio-Medical Waste Management Situation As per the Bio-Medical Waste Rules, 1998, indiscriminate disposal of hospital waste was to be Analysis stopped with handling of Waste without any adverse effects on the health and environment. In / Current response to this the Government has taken steps to ensure the proper disposal of Biomedical waste Status from all Nursing homes, hospitals, Pathological labs and Blood Banks.
The District Health Officer is the Nodal Person in each district for ensuring the proper disposal of Biomedical Waste.
For effective disposal of Biomedical waste in the district; Trainings to the personnel for sensitizing them, Pits. Segregation of Waste is taking place though Separate Colour Bins/containers it has to be done more systematically. Proper Supervision is lacking.
The treatment (incineration) of waste is suppose to handled by a company selected at the State level but till date the company has not been selected. There is a monopoly of these companies so their charges are very high. Objectiv 1. Stopping the indiscriminate disposal of hospital Waste from all the facilities by 2008 es 2. Ensuring proper handling and disposal of Biomedical Waste in each Facility Strategie 1. Capacity Building of personnel s 2. Proper equipment for the disposal and disposal as per guidelines 3. Strict monitoring and Supervision Activitie 1. Review of the efforts made for the Biomedical Waste Interventions s 2. Development of Microplan Plan for each facility in District & Block workshops 3. Capacity Building of personnel. Biomedical Waste management to be part of each training in RCH and IDSP 4. Proper equipment for the disposal Installation of the Separate Colour Bins/containers and Plastic Bags for the bins 5. Segregation of Waste as per guidelines 6. Partnering with Private providers for waste disposal 7. Proper Supervision and Monitoring Formation of a Supervisory Committee in each facility by the MOs and the Supervisors Timeline 2008 2009 2010- 201 Activity 2007-08 - 09 -10 11 1-12 Orientation and Reorientation for the personnel for Biomedical Waste Management at District and Block x x x x x levels Consumables x x x x x Payment for the incinerators x x x x x Budget 2007- 2008- 2009- 2010- 2011- Activity Total 08 09 10 11 12 Orientation and reorientation for Biomedical Waste Management at District and Block levels 1.5 1.65 1.820 2.000 2.200 9.17 Consumables 2 2.2 2.42 2.662 2.928 12.210 Payment for incinerators@ Rs. 8 per bed 12 10.201 11.22 12.34 13.57 mths 9.274 1 3 7 56.616 Total 12.774 14.051 15.46 17.00 18.70 77.996
152
Annexure Detailed NRHM Budget District Leh (in lakhs)
Strengthening of District Health Management S.No Activity / Item 2007-08 2008-09 2009-10 2010-11 2011-12 Total Orientation Workshop 0.5 0.55 0.605 0.666 0.732 3.053 Exposure visit 3.1 3.41 3.751 0.000 0.000 10.261 Issues based Workshops 0.5 0.55 0.605 0.666 0.732 3.053 Mobility for Monitoring 0.6 0.66 0.726 0.799 0.878 3.663 Total 4.7 5.17 5.687 2.130 2.343 20.029 District Programme Management Activity / Item 2007-08 2008-09 2009-10 2010-11 2011-12 Total Honorarium 29.4 32.34 35.574 39.131 43.045 179.490 DPM,DAM,DDA and Consultants Travel Costs for DPMU @ 1.2 1.32 1.452 1.597 1.757 7.326 Rs 10,000/ per month x 12 mths Infrastructure costs, 5 0.5 0.550 0.605 0.666 7.321 furniture, fax, UPS, Printer, Digital Camera Workshops for 1 1.1 1.210 1.331 1.464 6.105 development of the operational Manual at district and Block levels Untied Fund 5 5 5 5 25.000 5 Construction Cost of 154 0 0.000 0.000 0.000 154.000 District Health Complex @ Rs 1400 /sq.ft x 11000sq ft Furnishing and Office 50 0 0.000 0.000 0.000 50.000 Automation, Conference Hall with speakers, ACs, Audio Video conferencing equipments Maintenance of the District 0 0.5 1.000 1.500 2.000 5.000 Health Complex Compendium of Govt 0. 50 0.55 0.610 0.670 0.730 2.560 orders Joint Orientation of Officials 0.25 0.275 0.303 0.333 0.366 1.526 and DPM, DAM, DDM Management training 0.5 0.55 0.605 0.666 0.732 3.053 workshop of Officials Personnel for BPMU 26.64 29.304 32.234 35.458 39.004 162.640 Training of DPM and 0.5 0.75 1.000 1.250 1.500 5.000 Consultants Review meetings @ Rs 0.12 0.132 0.145 0.160 0.180 0.737 1000/ per month x 12 months
153 Office Expenses @ Rs 1.2 1.32 1.450 1.600 1.800 7.370 10,000/month x 12 months for district Computer systems (21) 12.6 0 0.000 0.000 0.000 12.600 with printer and Digital Camera and furniture for DPMU, BPMUs and District and block personnel @60,000/unit Annual Maintenance 0.63 0.693 0.7623 0.839 0.922 3.846 Contract for the equipment Travel costs for BPMU @ 3.6 3.96 4.356 4.7916 5.27076 21.978 Rs 5000 per month per block Monitoring of the progress 1 1.1 1.200 1.300 1.400 6.000 by independent agencies Office expenses for Blocks 3.6 3.96 4.356 4.7916 5.27076 21.978 @ Rs 5000 x 6 blocks Total 296.24 83.354 91.807 101.022 111.107 683.530 Maternal Health Activity / Item 2007-08 2008-09 2009-10 2010-11 2011-12 Total Consultancy support for 1 1.1 1.210 1.331 1.464 6.105 developing Microplan for Village health Day Tracking Bags @ Rs 300/ 0.82 0.902 0.9922 1.09142 1.200562 5.006 bag x 300 AWCs Adult Weighing machines 2.4 2.2 2.2 2.2 2.2 11.200 @ Rs 800 per machine x 300 AWCs & Maintenance(10% cost of machine) Monthly special outreach 2.5 2.75 3.025 3.3275 3.66025 15.263 session in 25 difficult villages@10000/session Blood Storage @ Rs 3 3 3 3 0 0.000 9.000 lakhs per unit (2 CHC+PHC Nyoma)_ Referral Cards @ Rs 2 per 0.4 0.44 0.484 0.532 0.586 2.442 card x 20,000 MTP kits @ Rs 15000 Per 2.55 2.805 3.0855 3.39405 3.733455 15.568 kit One day training workshop 1 1.1 1.210 1.320 1.450 6.080 on Tracking bags at the district level and each sector JSY beneficiaries @ Rs 70 84 98 112 126 490.000 1400/person JSY Helpline through RKS 9.99 9.99 19.980 9.99 9.99 59.940 Mobile phone instrument to 4.25 0 0.000 0.000 0.000 4.250 ANM and other supervisory staff like Mos, BMOs, CMO & Dy. CMO @ Rs 3000 Mobile Phones recurring 3.267 3.267 3.267 3.267 3.267 16.335 cost to ANMs @ Rs
154 2700/annum Mobile Phones recurring 2.94 2.94 2.94 2.94 2.94 14.700 cost to other supervisory staff like Mos, BMOs, CMO & Dy. CMO@ Rs 6000/annum Delivery kits to 3.39 3.729 4.1019 4.51209 4.963299 20.696 TBA's@3000and refilling @ 1000 Incentives to TBA @ 100 2 3 4 5 6 20.000 per delivery by skilled birth attendant Incentives to Rehbar-e- 6.78 7.458 8.2038 9.02418 9.926598 41.393 Sehat @500X12months X113 RCH Camps @ Rs 30000 3.6 3.96 4.356 4.792 5.271 21.978 per camp x 12 Total 119.887 132.641 160.055 164.721 182.652 759.956 Newborn and Child Health Activity / Item 2007-08 2008-09 2009-10 2010-11 2011-12 Total 2006-07 Study on the feeding and 2 0 0.000 0.000 0.000 2.000 Care practices for the infants and children Innovative activities based 0 2 2.000 2.000 2.000 8.000 on the study Newborn Corner furnished 3 6 3.000 0.000 0.000 12.000 with equipment @ Rs 3 lakh per facility (+PHC Nyoma) Examination table, chair, 9 9 9 9 9.96 45.960 stool, table, other equipment @ Rs. 3000 x No of AWCs Infant Weighing Machines 2.4 0 0 0 0 2.400 @ Rs. 800/AWCx No of AWCs Foetoscope @ Rs.50 x No 0.15 0.15 0.15 0.15 0.15 0.750 AWCs Malnutrition Corners @ Rs 0.3 0.6 0.3 0.000 0.000 1.200 30,000 per CHC and District Hospital (1DH & 2 CHCs + 1 PHC Nyoma ( will be upgraded to CHC) Total 16.85 17.75 14.450 11.150 12.110 72.310 Family Welfare Activity / Item 2007-08 2008-09 2009-10 2010-11 2011-12 Total NSV camps @ Rs. 359750 8.6475 9.9973 11.361 13.952 25.313 69.2698 Sterilization Camps @ 45.925 65.2875 84.740 122.754 160.877 479.583 19.50 /cases 5 Development Static 1 2 1.000 0.000 0.000 Centres@Rs 1 lakh 4.0000 Copper T-380 @ Rs 45 / 1.35 2.03 2.700 4.060 5.400 15.5400
155 piece EmergencyContraception 0.1 0.2 0.3 0.8 0.5 @Rs10/2 tabs 1.9000 Laparoscopes 3per 9 18 0 0.000 CHC&DH @ Rs3.00 9.00 lakhs/laparoscopes 36.0000 Research Study 0 10 0.000 0.000 0.000 10.0000 Total 66.0225 107.5148 109.101 141.566 192.090 616.293 3 Adolescent Health Activity 2007-08 2008-09 2009-10 2010-11 2011-12 Total Research 5 0 0.000 0.000 0.000 5.000 Awareness generation @ 2.26 2.486 2.7346 3.00806 3.308866 13.798 Rs 2000 per village x 113 villages Workshop of all the 0.5 0.55 0.605 0.6655 0.73205 3.053 partners Training of Adolescent 1 1 1.000 1.000 1.000 5.000 Mentoring Group and other expanses@1 Lakh Counsellors@ Rs 8000 per 16.32 17.952 19.7472 21.72192 23.894112 99.635 month x PHCs x12 mths Training of Peer Educators 0.15 0.15 0.150 0.000 0.450 @ Rs 50 per person x 3 days xNo of Peer Educators ReTraining of Peer 0 0.15 0.300 0.450 0.450 1.350 Educators @ Rs 50 per person x 3 days x peer Educators Orientation & Reorientation 0.25 0.28 0.310 0.340 0.370 1.550 Health personnel Counselling sessions @ Rs 1 2 3.000 3.000 3.000 12.000 1000/yr/peer Educator Counselling Clinics 1.7 1.87 2.057 2.2627 2.48897 10.379 renovation, furnishing and Misc expenses @ Rs 10000.00 Health camps for 2 2.2 2.42 2.662 2.9282 12.210 Adolescents once per quarter x 4 x Rs 50000 per camp Joint Evaluation by an 1 0 1.200 0.000 1.320 3.520 agency & Govt Total 31.18 28.638 33.524 35.110 39.492 167.944 ASHA Activity / Item 2007-08 2008-09 2009-10 2010-11 2011- 12 Total Training & kit @ Rs 10000/ 26.18 2.8 3.000 3.000 3.100 38.08 New ASHA+ Kit @ 1000/ Trained ASHA Training of ASHA in 4.76 4.76 0.6 0.6 0.6 11.32 Module II,III,IV @ 2000/ASHA Reorientation @ Rs 1000/ 2.38 2.38 2.380 2.380 2.380 11.9
156 ASHA Expenses for the District 0.6 0.66 0.730 0.800 0.880 3.67 mentoring group – meetings, travel @ Rs 5000 per month x 12 months ASHA Performace Diary @ 0.25 0.3 0.350 0.400 0.450 1.75 100/ASHA Compensation to ASHA 23.8 23.8 23.8 23.8 23.8 119 @1000/ASHA Total 57.97 34.7 30.860 30.980 31.210 185.72 Untied Funds and an Annual Maintenance grant for Sub Centres Activity / Item 2007-08 2008-09 2009-10 2010-11 2008- 12 Total Untied Fund of Rs 12.1 12.1 12.1 12.1 12.1 60.5 10000/subcentre Annual Maintenance grant 12.1 12.1 12.1 12.1 12.1 60.5 of Rs 10000/SC Total 24.2 24.2 24.200 24.200 24.200 121 Untied Funds and an Annual Maintenance grant for PHCs Activity 2007-08 2008-09 2009-10 2010-11 2011-11 Total Untied Fund of Rs 4.25 4.25 4.25 4.25 4.25 21.25 25000/PHC Annual Maintenance grant 8.5 8.5 8.5 8.5 8.5 42.5 of Rs 50000/PHC Total 12.75 12.75 12.750 12.750 12.750 63.75 Untied Funds and an Annual Maintenance grant for CHCs Activity / Item 2007-08 2008-09 2009-10 2010-11 2011-12 Total Untied Fund of Rs 1 1 1 1 1 5 50000/CHC Annual Maintenance grant 2 2 2 2 2 10 of Rs 100000/CHC Annual Maintenance grant 5 5 5 5 5 25 of Rs 500000/ DH Total 8 8 8.000 8.000 8.000 40 Mobile Medical Unit Activity / Item 2007-08 2008-09 2009-10 2010-11 2011-12 Total Cost of Vehicle, equipment and accessories 26.85 0 0.000 0.000 0.000 26.85 Hiring staff 8.7 9.57 10.527 11.580 12.738 53.114 Recurring Cost of Drivers, Drugs, supplies, Mobile phones, POL, Maintenance 2.518 2.770 3.047 3.351 3.687 15.373 Orientation of the staff 0.25 0.275 0.3025 0.333 0.366 1.526 Joint Workshop for finalizing modalities 0.25 0.275 0.3025 0.333 0.366 1.526 Mobile phone for MMU staff @ 2000X6 phone 0.12 0 0.000 0.000 0.000 0.120 Reccuring cost of mobile phone @2700 X6 phone 0.189 0.208 0.229 0.252 0.277 1.154 Total 38.877 13.0977 14.407 15.848 17.433 99.663 Upgrading CHCs to IPHS Activity / Item 2007-08 2008-09 2009-10 2010-11 2011-12 Total
157 CHC Building Repair, Altration and Edition @ 15 Lakh 30 0 0.000 0.000 0.000 30 Repairing of Staff Qtrs @ 10 Lakh/CHC*2 10 10 0.000 0.000 0.000 20 Construction of Staff Qtrs at CHC Diskit @ 55.20 Lakh ( Qtrs of Mos@ 28.8+ SN @ 24+ Chawkidar @ 2.4) 55.2 0 0.000 0.000 10.000 65.2 Furniture @1.2 X No of CHCs 3.6 0 0.000 0.000 0.000 3.6 Equipment @ 11 X No of 212.468 CHCs 33 36.3 39.930 43.923 59.315 3 Reccuring cost of CHC excluding Man Power 26 26 26 26 26 131.974 Purchase of generator sets @ 3 lakh x No of CHCs 9 0.00 0.00 0.00 0.60 9.6 Recurring & Maintenance cost of generator sets Rs. 140 X 30 days X 12 months X No.of CHCs 1.008 1.11 1.22 1.34 1.98 6.658 Computer ,printer,fax @1 lakh X No.of CHCs 3 3 AMC of computer @ 3000 X No.of CHCs 0.9 0.99 1.09 1.20 1.38 5.55459 Laundry machines for 2 CHCs @5.7 lakhs/unit 5.7 5.70 0.00 0.00 0.00 11.4 Additional construction cost and other repairing work in 3250.00 DH @ 32.5 crores 3250 0.00 0.00 0.00 0.00 0 Recurring cost of DH excluding manpower including heating system 75 75 75 75 75 375.000 Total 4124.45 3502.8028 155.494 143.633 147.857 174.668 5 Upgrading PHCs for 24 hr Services, IPHS Activity / Item 2007-08 2008-09 2009-10 2010-11 2011-12 Total PHC Building Repair, Altration and Edition @ 5Lakh 25 25 0.000 0.000 0.000 50 Construction of Staff Qtrs for PHCs having own building 144 0 0.000 0.000 0.000 144 Repairing of Staff Qtrs @ 5Lakh/PHC 35 25 0.000 0.000 0.000 60 Furniture @1 X No of 10 0 0.000 0.000 0.000 PHCs 10 Equipment @ 11 X No of 187 0 0.000 0.000 0.000 PHCs 187 Recuring cost of PHCs 66.096 66.096 66.096 66.096 66.096 excluding Man Power 330.48 Purchase of generator sets 30 21 0.000 0.000 0.000 @ 3 lakh x No of PHCs 51
158 Recurring & Maintenance cost of generator sets Rs. 140 X 30 days X 12 months X No of PHCs 8.568 9.42 10.37 11.40 13.05 52.812 Computer with 0.000 scanner,printer,UPS ,Fax@60000 /PHC 10.2 0.00 0.00 0.00 10.2 AMC of computer @ 3000 X No of PHC 0.51 0.56 0.62 0.68 0.75 3.114 Provision of heating systems @ 1.5 lakhs per PHC 25.5 0.00 0.00 0.00 0.00 25.500 Total 541.874 147.0818 77.080 78.179 79.891 924.106 Upgrading Sub Centres Activity / Item 2007-08 2008-09 2009-10 2010-11 2011-12 Total New buildings with quarters, equipment and Furniture for existing subcentres @14.79 Lakhs 147.900 103.53 59.160 0.000 0.000 310.590 Non recurring cost of subcentres including equipment& furniture 40.777 0.000 0 0.000 0.000 40.777 Repair,Addition and Alteration of Subcenter @2 lakh 30 0 0.000 0.000 0.000 30 Staff Quarters @ Rs 9 lakhs per Quarter for 2 ANMs 189 360 360.000 0.000 0.000 909 Recurring costs of 72.763 72.763 72.763 72.763 72.763 Subcentres Including Heating Systems 363.817 Total 1654.18 480.440 536.293 491.92 72.763 72.763 4 Untied Funds and Incentive Fund for the Village Health and Water Sanitation Committees Activity / Item 2007-08 2008- 09 2009- 10 2010- 11 2011- 12 Total Untied Fund of Rs 13.5 13.5 13.5 13.5 13.5 67.5 10000/unit 1500/unit x 135units Permanent Advance to 6.05 6.05 6.05 6.05 6.05 30.25 VHWSC for ASHA incentive @ Rs5000/SC Total 19.55 19.55 19.550 19.550 19.550 97.75 Immunisation Activity 2007-08 2008-09 2009-10 2010-11 2011-12 Total Mobility support for 5.808 5.808 5.808 5.808 5.808 29.04 alternative vaccine delivery Rs. 50 per session for 2 planned sessions per week at each Subcentre village for 12 months = Rs. 50x2 sessionsx4 weeks/mthx12 monthsx SCs
159 Vehicle for distribution of 13.056 13.056 13.056 13.056 13.056 65.280 vaccines in remote areas @ Rs 800 per PHC for 2 times per week x 4 weeks x 12 months x PHCs Mobility Support Mop up 10.2 10.2 10.2 10.2 10.2 51 campaign @ Rs 10000 per PHC ( Including travel, vaccine delivery, IEC) x 6 rounds/ year x PHCs Mobilization of Children 10.848 10.848 10.848 10.848 10.848 54.24 by Social Mobilizers @ Rs. 100/ session x2 sessions per week x 4 weeks/mth X 113 village x12 mths Incentives to mothers 7.5 11.25 15.000 18.000 21.000 72.75 @Rs 150 per child for full immunization Contingency fund for 0.72 0.72 0.72 0.72 0.72 3.6 each block @ Rs.1000/month x 6 blocks x 12 months Pit Formation for disposal 22.6 22.6 22.6 22.6 22.6 113 of AD Syringes and broken vials (@ Rs. 2000 per pit per village Printing of Immunisation 0.75 0.825 0.908 0.999 1.099 4.581 cards @1.50 per card x 50000 cards each year Special IEC session 3.555 3.911 4.302 4.732 5.205 21.704 @25/session X15072 Session Maintenance of Cold Chain 2.21 1.64 1.640 1.640 1.640 8.77 Equipments (funds for major repair) (@ Rs.750 per PHC/CHC for the first year then Rs. 500 per PHC/CHC per month) and 50,000 for minor repairs Provision of Generator at 5 0 0.000 0.000 0.000 5 DH: Rs 5lakhs Recurring & Maintenance 10.08 11.088 12.197 13.416 14.758 61.539 cost of generator sets Rs. 140 X 30 days X 12 months X No of PHCs & CHCs POL & maintenance for 1.8 1.98 2.180 2.400 2.640 11 Vaccine delivery van at district level @ Rs.15000/month x 12 mths 7.02 7.72 8.490 9.340 10.270 42.84
Running Cost of WICs & WIF (Electricity & POL for Genset & preventive 160 maintenance) Rs. 90000 for electricity @ 15000 equipment per two months plus Rs.8000 per annum @1000 for POL for genset at DH
Mobility suppot to District 0.36 0.396 0.436 0.479 0.527 2.198 Family Welfare Officer@ 3000/month Computer Assistant for 0.84 0.924 1.016 1.118 1.230 5.128 District Family Welfare Office @ 7000 Mobility support for 0.68 0.68 0.68 0.68 0.68 3.400 Monitoring Immunization sessions for MO's PHC @1000/session Construction of under 5 0 23.5 0 0 0 23.500 clinic Mobility support (pony 1 1.1 1.2 1.3 1.4 6.000 charges) to unreachable villages + accessories like shoes, tents, blankets etc @1 lakh/yr Solar refrigerator for 2 AD 3.8 3.8 0 0 0 7.600 and 2 MAC @1.9 lakhs/unit Total 107.827 132.046 111.280 117.336 123.681 592.170 RNTCP Activity / Item 2007-08 2008-09 2009-10 2010-11 2011-12 Total Civil Works DTC building 5 lakhs 5 0 0.000 0.000 0.000 5 MC 0.28/MC 4.76 0 0.000 0.000 0.000 4.76 TU 0.35/Tu 1.05 0 0.000 0.000 0.000 1.05 except DTC Material and supplies @ 4.5 4.5 4.5 4.5 4.5 22.5 4.5 LAKHS/ANNUM (avg 3 patients) Laboratory material 1 1.1 1.210 1.330 1.460 6.1 Training 18.97 20.867 22.954 25.249 27.774 115.814 Awareness drive on World 1 1.1 1.210 1.330 1.460 6.1 TB day IEC activities 1 1.1 1.210 1.330 1.460 6.1 Vehecle hiring for 1 1.1 1.210 1.330 1.460 6.1 STS/STLS in winter @ 1 lakh Salaries of contractual staff 11.19 12.31 13.540 14.890 16.330 68.26 Vehicle maintenance inc 1 1.1 1.210 1.330 1.460 6.1 POL 2 wheeler 4 wheeler Hiring of vehicle 1.7 1.87 2.060 2.270 2.500 10.4 DTO MO TC @ Rs 0.42lakh/yr Equipment and 0.085 0.094 0.103 0.113 0.124 0.519 maintenance
161 Microscope @ Rs1000/yr/microscope Computer@ Rs 5000/yr Photocopier/Fax Rs2500/ machine Miscellaneous – TA/DA, 0.5 0.6 0.700 0.800 0.900 3.5 Telephone, Meetings, Electricity repair etc (0.5 LAKHS) Total 52.755 45.741 49.907 54.472 59.428 262.303 Leprosy Activity / Item 2007-08 2008-09 2009-10 2010-11 2011-12 Total
Treatment -1 (240x 0.943 1.038 1.141 1.255 1.381 5.758 393.01) Treatment -2 (240x 2.801 3.081 3.389 3.728 4.101 17.099 1167.53) IEC for information on the 2 2.200 2.420 2.662 2.928 12.2102 disease to be spread all over the rural outposts through posters and instructional booklets. Total 5.744 6.318 6.950 7.645 8.410 35.068 Blindness Control Programme Activity / Item 2007- 2008-09 2009-10 2010-11 2011-12 Total 2008 Health Mela @50000 / 0.5 0.55 0.605 0.666 0.732 3.053 CHC IEC @1lakh 1 1.1 1.210 1.331 1.464 6.105 School Eye Screening 3.84 4.224 4.646 5.111 5.622 23.444 @1000 X 384 school Blind Register 0.13 0.143 0.157 0.173 0.190 0.794 Observance of Eye 0.15 0.17 0.190 0.210 0.230 0.95 Donations Cataract Camps @ Rs 2 2.2 2.420 2.662 2.928 12.210 40000 per camp x 5 PHC POL for Eye Camps @ Rs 0.36 0.396 0.436 0.479 0.527 2.198 6000/camp x 6 House to house survey for 10 0 0.000 0.000 0.000 10 vision defects @ 10 lakhs Training of School teachers 0.15 0.165 0.182 0.200 0.220 0.916 @ Rs 300/head x 50 Training of PRIs @ Rs 0.3 0.33 0.363 0.399 0.439 1.832 300/head x 100 Repair and purchase of 20 2 2.200 2.420 2.662 29.282 equipment and maintenance Total 38.43 11.278 12.409 13.651 15.015 90.782 Integrated Diseases Control Programme Activity / Item 2007-08 2008-09 2009-10 2010-11 2011- 12 Total Renovation of Labs at 0.4 0 0.000 0.000 0.000 0.4 CHCs a@ Rs 20,000
162 Renovation of Lab at 1.4 0.14 0.180 0.200 0.220 2.14 District Hospital @ Rs 140,000 and maintenance Equipment for Lab at PSU 0.8 0 0.000 0.000 0.000 0.8 at CHC and @ Rs 40,000 Equipment for Lab at 8.5 0 0.000 0.000 0.000 8.5 District @ Rs 850,000 Computer and Accessories 1 0 0.000 0.000 0.000 1 at CHC @50000 Office for PSU at 0.2 0.2 0.200 0.200 0.200 1 Maintenance CHC @ Rs 10,000 per unit Office Maintenance for 0.1 0.1 0.100 0.100 0.100 0.5 DSU @ Rs 10,000 Software for DSU@ Rs 3.35 0 0.000 0.000 0.000 3.35 335000 Furnishing of Lab at PSU at 0.2 0 0.000 0.000 0.000 0.2 CHCs and @ Rs 10,000 Furnishing of Lab at DSU 0.6 0 0.000 0.000 0.000 0.6 @ Rs 60,000 Material and supplies at 0.16 0.16 0.16 0.16 0.16 0.8 Lab at PSU at CHCs @ Rs 8,000 Material and supplies at 0.75 0.83 0.910 1.000 1.100 4.59 Lab at DSU @ Rs 75,000 Contract Staff at District 2 2.2 2.920 3.710 4.580 15.41 level @ 200000/yr for 4 staff yr wise IEC activities 1 1.1 1.210 1.330 1.460 6.1 Training and retraining 1.916 2.430 2.673 2.940 3.234 13.192 Operational costs at PSU 0.3 0.3 0.3 0.3 0.3 1.5 for Surveillance @ Rs 15000/year x 2 Operational costs at DSU 1.3 1.430 1.573 1.730 1.903 7.937 for Surveillance @ Rs 130000/year Honorarium to Numberdars 2.712 2.983 3.282 3.610 3.971 16.557 and Chowkidars for reporting @ Rs 100pm x 113 Numberdars and 113 Chowkidars x12 Total 26.688 11.8728 13.507 15.280 17.228 84.575 IDD Activity / Item 2007-08 2008-09 2009-10 2010-11 2008- Total 2012 Large Village meetings for 1 1.100 1.210 1.331 1.464 6.105 awareness on IDD and consumption of Iodized salt Programme in schools – 2 2.200 2.420 2.662 2.928 12.210 384 Primary, Upper Primary, Secondary- Govt and Private by School health team
163 Awareness programme 0.565 0.622 0.684 0.752 0.827 3.449 with the SHGs and shopkeepers @ Rs 500 per village x 113 villages Total 3.565 3.922 4.314 4.745 5.220 21.765 Intersectoral Coordination Activity / Item 2007-08 2008-09 2009-10 2010-11 2011-12 Total Meetings of the Block 0.72 0.792 0.871 0.958 1.054 4.396 Committees @ Rs 1000 /meeting x 6 blocks x 12 months Meetings of the Village 0.678 0.746 0.820 0.902 0.993 4.139 groups @ Rs 50 per village x 113villages x 12 Joint monitoring at Block/ 0.000 Sector level Hiring of vehicle @ RS 3.6 3.96 4.356 4.792 5.271 21.978 1000/ day x 5 days/month x 6 blocks x 12 months Yearly joint Planning 6 6.6 7.26 7.986 8.785 36.631 Workshops at the Block level for development of the Action Plans @ Rs 1.00 lakhs per block x 6 blocks Yearly joint Planning 1 1.1 1.21 1.331 1.464 6.105 Workshops at the District level for development of the Action Plans @ Rs 1.00 lakh Yearly joint Workshops to 6 6.6 7.26 7.986 8.785 36.631 consolidate the plans from the village to the Gram Panchayats to the Sectors and then Blocks at the Block level for Annual Action Plans @ Rs 1.00 lakhs per block x 6blocks Yearly joint Workshops to 1 1.1 1.21 1.331 1.464 6.105 consolidate the findings at the block levels at the District level for development of the Action Plans @ Rs 1.00 lakh Training of PRIs,VHWS 22 22 22 22 22.000 110.000 committee members under Chiranjeevi Scheme @22 lakhs Regular monthly meetings 12 12 12 12 12.000 60.000 under Chiranjeevi Scheme @12 lakhs Development of Education 10 10 10 10 10.000 50.000 material and hands on trainingunder Chiranjeevi Scheme @ 10 lakhs
164 Total 62.998 64.898 66.988 69.286 71.815 335.985 Community Health action Activity / Item 2007-08 2008-09 2009-10 2010-11 2008-12 Total
Training of the VHWSC @ 3.39 3.729 4.102 4.512 4.963 20.696 Rs 200 per person x 15 persons/village x113 villages Meetings of the VHWSC @ 0.678 0.7458 0.820 0.902 0.993 4.139 Rs 50 per village x 113 villages x 12 months Meetings of Women SHG 11.3 12.43 13.673 15.040 16.544 68.988 @ Rs 1000 per year x113 villages Honorarium for MOs for 0.34 0.374 0.411 0.453 0.498 2.076 promoting Community health Action @ Rs 1000 pm and travel charges Rs 1000 pm Total 15.708 17.279 19.007 20.907 22.998 95.899 Public Private Partnership Activity / Item 2007-08 2008-09 2009-10 2010-11 2011-12 Total
Fesiability study on PPP 10 0 0.000 0.000 0.000 10 issues Innovative activities based 0 20 20.000 20.000 20.000 80 on the study Capacity Building of NGOs 0.5 0 0.500 0.000 0.500 1.5 Establishing Tech. Support 2 2.2 2.420 2.662 2.928 12.210 Agency Capacity Building of 0.5 0.55 0.605 0.666 0.732 3.053 PRIs,SHGs,VHWSCs Area specific Modules 0.5 0 0.000 0.000 0.000 0.5 Exit poles 2 2.2 2.420 2.662 2.928 12.210 5 Workshops for 2.5 0 0 0 0 2.5 involvement of the Private sectors (one each with NGOs/Trusts/Private institutions;Media; Ex- servicemen association, transportation ,HR agencies) @ 25000 per workshop Sharing Workshops with 0 0.55 0.61 0.67 0.74 2.57 Private players Admin and overhead 2 2.2 2.42 2.67 3 12.29 Charges for hiring the agencies TOTAL 20 27.7 28.975 29.330 30.828 136.833 Gender and Equity Activity / Item 2007-08 2008-09 2009-10 2010-11 2011- 12 Total Preparation of GIS maps 5 1 1.000 1.000 1.000 9 for monitoring
165 IEC Campaign @2000 1.13 1.243 1.367 1.504 1.654 6.899 X113 villages Periodic Advisory 0.4 0.44 0.484 0.532 0.586 2.442 committee meetings @ 10000 Development of Trg. 1 0 0.000 0.000 0.000 1 Modules Traning of MO's &,ANMs 2 2.2 2.420 2.662 2.928 12.210 Panchayat level vigilence 0.93 1.023 1.125 1.238 1.362 5.678 committees @1000X 93 Workshops with private 10 11 12.100 13.310 14.640 61.05 providers, IMA members, Religious leaders, Caste leaders, PRIs, MLAs in every block and Gram Panchayat and with SHGs Rallies in all schools and 5 5.5 6.100 6.700 7.400 30.7 colleges and generating discussions in schools and colleges through debates Regular advertisements in 5 5.5 6.100 6.700 7.400 30.7 the newspapers Health Card for Girl Child 0.2 0.22 0.240 0.260 0.290 1.21 @ Rs 2 /card x 10,000 cards Total 30.66 28.126 30.937 33.906 37.260 160.889 Capacity Building Activity 2007-08 2008–09 2009-10 2010-11 2011-12 Total TBA training @ Rs 10100 11.413 12.5543 13.810 15.191 16.710 69.678 /TBA MVA MTP training to all 1.275 1.275 0 0 0 2.550 PHC MOs for 15 days @ Rs 500 x 15 days x MOs Training on Blood transfusion for MOs and Lab Technicians for CEmOC centres with Blood storage facilities for 3 days MOs @ Rs 500/day/person 0.015 0.015 0.000 0.000 0.000 0.030 x 3 days LabTechnicians@Rs 0.006 0.006 0.000 0.000 0.000 0.012 200/person x 3 days Training in Obstetric management & skills for 24x7 PHCs for 16 weeks MOs: Rs 500/day x 112 2.24 3.36 4.48 4.48 4.48 19.040 days x 4MOs StaffNurses:Rs200/dayx11 0.896 1.344 1.792 1.792 1.792 7.616 2daysx 4 SNs Training in skilled Birth 0.000 attendants for 15 days: One batch of 4 persons: 1.25 2.75 3.75 3.75 3.75 15.250 Rs. 7500 as hon. to participants, Rs 13500 hon.
166 to training team, 15% institutional charges, = Rs 25000/batch - 17 batches IMNCI training to ANM/LHV, SN, ASHA for 8 days Rs 300 as hon. to 1.032 2.1912 2.410 2.651 2.916 11.201 participant x 8 days IMNCI training to MOs @ 0.4312 0.593 0.6468 0.711 0.783 3.165 Rs 5390 /participant Integrated skill training of 0.816 1.3464 1.4688 1.5912 1.7136 6.936 all SN @ Rs 4080/person Integrated skill training for 0.49152 1.1264 1.2288 1.59744 1.72032 6.164 ANMs @ Rs 2048/person Integrated skill training for 0.22098 0.283591 0.312 0.343 0.377 1.537 MOs @ Rs 3683 Training of MOs, SN in Mgt 0.48 0.528 0.581 0.639 0.703 2.930 of Newborns & sick children at Medical College Jammu @ Rs 7500/MO, Rs 4500 ( Rs 300 x 15 days)/SN Training in BCC for MOs, 0.555 0.985 0.985 1.105 1.105 4.735 LHVs, ANMs MOs: Rs 500/MO x 5 days LHVs & ANMs: Rs 300/person x 5 days Training of AMCHI 0.36 0.396 0.436 0.479 0.527 2.198 personnel on issues of RCH and reporting for 3 days Rs 300/person x 3 days Training on NSV for MOs at 0.14 0.35 0.280 0.210 0.210 1.190 DH@7000/MO Training on Minilap @ Rs 0.3 0.33 0.363 0.3993 0.43923 1.832 500 per day for 15 days Training for Laproscopic 0.24 0.264 1.162 1.278 1.406 4.349 Sterilization for Surgeons, Gynaecologists, SN, OT attendants for 12 days Specialist: Rs 500/Specialist x 12 days SN: Rs 300/SN x 12 days OT Attendant: Rs 200 x 12 days Orientation on 0.2 0.22 0.242 0.266 0.293 1.221 contraceptive devices for MOs - Govt as well as private facilities Rs 500 /MO x 1 day Training on Medico-legal 0.34 0.374 0.411 0.453 0.498 2.076 aspects to MOs @ Rs 500/MO x 1 day
167 Continuing Medical 2.5 2.75 3.025 3.328 3.660 15.263 Education sessions for doctors each month during the monthly meetings on current topics @ Rs 25000 per CME Orientation on PCPNDT 0.5 0.55 0.605 0.666 0.732 3.053 Act for DCs, CSs, doctors both Govt and private, members of District Appropriate authority NGOs in a workshop General & Financial rules 0.63 0.693 0.000 0.762 0.000 2.085 (G & FR) for Officials, MOs, clerical staff for 3 days Rs 500/official and MOs x 3 days Rs 200 /clerical staff x 3 days Financial management 0.1 0.176 0.194 0.213 0.234 0.917 training for Accounts Officers, Accountants for 2 days Rs 200/Accounts persons x 2 days Computer training to all the 2.4 1.155 0.000 0.000 0.000 3.555 MOs, Clerical staff, accounts personnel @ Rs 200 per person x 15 days CNAA for MOs, LHVs, 1.032 1.1352 1.24872 1.373592 1.5109512 6.300 ANMs, AWW @ Rs 200/person x 1 day each year Total sanitation orientation 0.226 0.2486 0.273 0.301 0.331 1.380 and reorientation of VHWSCs x 1 day @ Rs 200/person/day Training to AWWs @ 0.7 0.7 0.7 0.000 0.000 2.100 700/AWW for 3 days Training of NGOs in BCC 0.54 0.594 0.653 0.719 0.791 3.297 @ Rs 300 per person x 6 days Total 31.3297 38.293591 41.057 44.298 46.681 201.659 Human Resources Activity / Item 2007-08 2008-09 2009-10 2010-11 2011-12 Total Subcentre ANM 329.846 329.846 329.846 329.846 329.846 1649.23 MPW(M) 143.748 143.748 143.748 143.748 143.748 718.74 PHC MO 107.168 107.168 107.168 107.168 107.168 535.84 Staff Nurse 78.387 78.387 78.387 78.387 78.387 391.935 Health worker (F) 26.129 26.129 26.129 26.129 26.129 130.645 Health Educator 26.129 26.129 26.129 26.129 26.129 130.645
168 Health Assistant 58.174 58.174 58.174 58.174 58.174 290.87 Cleark 20.196 20.196 20.196 20.196 20.196 100.98 Pharmasist 26.01 26.01 26.01 26.01 26.01 130.05 Lab.Tech 20.196 20.196 20.196 20.196 20.196 100.98 Class IV 48.96 48.96 48.96 48.96 48.96 244.8 accountant(part time) 10.2 10.2 10.2 10.2 10.2 51 Driver 12.48 12.48 12.48 12.48 12.48 62.4 CHC 0 0 0 0 0 Specialist(7) 51.66 51.66 51.66 51.66 51.66 258.3 MO General Duty (3) 25.216 25.216 25.216 25.216 25.216 126.08 PHN 3.424 3.424 3.424 3.424 3.424 17.12 ANM 2.376 2.376 2.376 2.376 2.376 11.88 SN 21.518 21.518 21.518 21.518 21.518 107.59 Dresser 1.38 1.38 1.38 1.38 1.38 6.9 Pharmasist 3.06 3.06 3.06 3.06 3.06 15.3 lab.Tech 2.376 2.376 2.376 2.376 2.376 11.88 Radiographer 2.376 2.376 2.376 2.376 2.376 11.88 Opthalmic Assistant 2.376 2.376 2.376 2.376 2.376 11.88 Class IV 14.4 0 0 0 0 14.4 Statistical Assistant 2.376 2.376 2.376 2.376 2.376 11.88 Registration cleark 2.376 2.376 2.376 2.376 2.376 11.88 Accountant 3.86 3.86 3.86 3.86 3.86 19.3 Epidemiologist 5.5 5.5 5.5 5.5 5.5 27.5 BEE 3.06 3.06 3.06 3.06 3.06 15.3 Total 1054.957 1040.557 1040.557 1040.557 1040.557 5217.185 Procurement and Logistics Activity / Item 2007-08 2008-09 2009-10 2010-11 2011-12 Total Construction of Warehouse 100 10 10.000 10.000 10.000 140 and maintenance Software 0.25 0 0.000 0.000 0.000 0.25 Computer system with 0.6 0 0.000 0.000 0.000 0.6 UPS, Printer, Scanner, Equipment & Hardware 34.5 0 0.000 0.000 0.000 34.5 Pharmacist @ Rs 9000/mth 0 1.08 1.190 1.310 1.440 5.02 Assistant Pharmacist @ Rs 0 0.6 0.660 0.726 0.799 2.785 5000/mth Packers -2 @ Rs 0 0.48 0.528 0.581 0.639 2.228 4000/mthx2 Security Staff @ Rs 0 0.72 0.792 0.871 0.968 3.351 6000/mth Training of personnel 0 0.1 0.110 0.121 0.133 0.464 One washing machine 20 0.5 0 0.000 0.000 0.000 0.5 Kg @ Rs 50000 Consultancy to agency for 2 2.1 0.000 0.000 0.000 4.1 Operationalization of the Warehouse Total 137.85 15.08 13.280 13.609 13.979 193.798 IEC Activities 2007-08 2008-09 2009-10 2010-11 2011-12 Total
169 Hiring of an agency for 40 44 48.400 53.240 58.564 carrying out the intensive 244.20 IEC and behaviour change activities Finalizing the messages in 1 1.1 1.210 1.331 1.464 the local language 6.11 Advertisements 5 5.5 6.050 6.655 7.321 30.53 TV spots 1 1.1 1.210 1.331 1.464 6.11 Radio Jingles in local 1 1.1 1.210 1.331 1.464 language 6.11 Folk Media shows @ Rs 0.113 0.1243 0.137 0.150 0.165 1000/village 0.69 Hoardings @ Rs 10 11 12.100 13.310 14.641 61.051 10000/hoarding Display boards @ Rs 2 2.2 2.420 2.662 2.928 2000/board 12.21 Pamphlets @ Rs 10 11 12.100 13.310 14.641 10/pamphlets x 100000 61.05 Nirdeshika for Fixed Health 1.6 1.76 1.936 2.130 2.343 Nutrition days @ Rs 20/ 9.77 Nirdeshika x 8000 Swasthya Darpan @Rs.10 0.8 0.88 0.968 1.065 1.171 /copy/mth x 8000 4.88 Orientation of elected rep 2 2.2 2.420 2.662 2.928 and PRIs@ Rs 200 x 12.21 1000persons x1 day Village campaign @ Rs 31.188 34.3068 37.737 41.511 45.662 31.188 lakhs per Campaign 190.41 Bal Nutrition Melas @ Rs 2.676 2.676 2.676 2.676 2.676 13.38 300 x 4 times x AWCs Kishori Shakti meetings @ 0.113 0.1243 0.137 0.150 0.165 Rs 100 per group x 113 0.69 villages Community and religious 1.2 1.32 1.452 1.597 1.757 leaders workshops @ Rs 7.33 300 /person x 100 x 4 times Wall writings @ Rs 400 x 0.452 0.4972 0.547 0.602 0.662 113 villages 2.76 Total 110.142 120.8886 132.710 145.713 160.017 669.47 Financing of Health Care Activity 2007- 08 2008-09 2009-10 2010-11 2011-12 Total Provision of Seed money 19 19 19.000 19.000 19.000 95 @ Rs 1 lakh per CHC and PHC @ Rs 1.00 lakhs Training of the Incharges 0.38 0.38 0.38 0.38 0.38 1.9 and second in command @ Rs 1000 per person x 1 day Development of Software 5 0.25 0.250 0.250 0.250 6 for RKS with training of personnel on the use
170 Total 24.38 19.63 19.630 19.630 19.630 102.900 HMIS Activities 2007-08 2008-09 2009-10 2010-11 2011-12 Total Survey for practices, 15 0 0.000 0.000 0.000 15 coverage, behaviour etc through independent agency Software development 20 0 0.000 0.000 0.000 20 Data Entry of each 1.8 0.4 0.800 1.200 1.600 5.8 households health card @ Rs 2 per card x 90000 cards (aprox.) Internet connectivity @ Rs 2.052 2.257 2.483 2.731 3.004 12.528 900 /mth x No of facilities x12 mths Provision of computers for 11.4 0 0 0 0 11.4 each CHC and PHC @ Rs 60,000/computer system with UPS and printer AMC for computers @ Rs 0.95 1.045 1.1495 1.264 1.391 5.800 5000 /computer /year x 19 computers Consumables for 9.12 10.032 11.035 12.139 13.353 55.679 computers @ Rs 4000/mth/facility x 12 mths GIS for the district, training 12 0.5 0.500 0.500 0.500 14 and updation Printing monitoring Charts 0.1 0.125 0.150 0.175 0.200 0.75 @ Rs. 5 per monitoring chart Total 72.422 14.359 16.118 18.009 20.048 140.956 Bio Medical Waste management Activity 2007-08 2008- 09 2009-10 2010-11 2011-12 Total Orientation and reorientation for Biomedical Waste Management at District and Block levels 1.5 1.65 1.820 2.000 2.200 9.17 Consumables 2 2.2 2.42 2.662 2.9282 12.2102 Payment for incinerators@ 10.20096 11.221 12.343 13.577 Rs. 8 per bed 12 mths 9.2736 56.616 Total 12.774 14.051 15.461 17.005 18.706 77.996
18050.1 Grand total 7029.443 2938.130 2859.957 2531.034 2691.567 31
171 Annexure
Status of Staff Quarter Buildings in CHC/PHC S.No Name of CHC/PHC Staff Quarters Available /Not available 1 CHC Skurbuchen Available 2 SDH/CHC Diskit Available 1 PHC Khalsi Available 2 PHC Termsgam Not Available 3 PHC Saspol Not Available 4 PHC Bazgo Not Available 5 PHC Chuchot Not Available 6 PHC Thiksay Available 7 PHC Sakti Not Available 8 PHC Nyoma Available 9 PHC Chushol Available 10 PHC Tangtsi Available 11 PHC Turtok Available 12 PHC Bogdang Not Available 13 PHC Panamile Not available 14 PHC Digger Available 15 PHC Korzok Not Available 16 PHC Hanu Yokma Khaltsi Not Available 17 Lingsted Not Available
Status of Subcentre Buildings and Staff Quarter Buildings Staff Quarters Needs to be S.NO. Block SC Buildings Constructed For SC 1 Khaltsi Ulleytokpa Skindyang 2 Dha Urbis 3 Dipling Kanji 4 Hemisshu Khachan 5 Domkhare Gongma 6 Takmachik 7 Mangue 8 Ulleytokpa 9 Lamayuru 10 Domkhartdoo 11 Yangthang
172 12 Domkhar Burma 13 Achinathang 14 Saspochey 15 Wanla 16 Hanugongma 17 Fanjila 18 Beema 19 Nerak 20 Dha 21 Lehdho 22 Alchi 23 Yulchung 24 Tia 25 Dipling 26 Nurla 1 Nubra Hunderi Largyab 2 Hunderdoc Tsati 3 Tongsted 4 Hunderi 5 Kubed 6 Hunderdoc 7 Khemi 8 Partapur 9 Chemshen 10 Lakjung 11 Charasa 12 Waris 13 Tirith 14 Tyakshi 15 Hunder 16 Tigar Sumoor 17 Pachayhang 18 Tangyar 19 Khardong 20 Terchey 21 Udmaru 1 Kharu Hemis Tagar 2 Changa Gia 3 Igoo 4 Kharu 5 Phuktsey 6 Shang 7 Hemis 8 Changa 9 Shara 10 Chemday 1 Leh Palam Palam 2 Stok Phey 3 Sabu Nang
173 4 Horzey Stok 5 Phyang Taru 6 Matho Sabu 7 Ranbirpur Horzey 8 Markha Phyang 9 Umlla Stakmo 10 Chiling 11 Likeryoqma 12 Sumda 13 Ranbirpur 14 Chogamsar 15 Markha 16 Kuzey 17 Nimo 18 Stakna 19 Spituk 20 Rumbak 21 Umlla 22 Chuchot Gongma 23 Shey 24 Ney 1 Nyoma Puga Skidmang 2 Samadrokchan Nee 3 Teri 4 Nider 5 Kuangyam 6 Samadrokchan 7 Koyul 8 Kumdok 9 Anlaypongog 10 Mudh 11 Tsaga 1 Tangtsi Chillam Durbuk 2 Kargyam Shayok 3 Iching Phobrang 4 Shachukul 5 Mann 6 Kherapulu 7 Langbarma 8 Merak 9 Tharuk 10 Chillam 11 Kargyam 12 Iching
174 Assessment of District Health Action Plan (DHAP) Appraisal Criteria to be used by State/ District Planning & Appraisal Team
District Leh Sl. Criteria Remarks No. Yes/ No
A. OVERALL 1 Has the DHAP been reviewed in detail by the District Yes, authorities to ensure internal consistency? If yes, by whom? This means that Situation analysis, goals, strategies, activities, work plan budget are in line with the proposed interventions and are evidence based. 2 Has Account Person from the Department reviewed the Yes budget in detail? 3 Executive summary /At a Glance has been enclosed in the Yes, beginning of the document. 4 Has plan developed in all inclusive and participatory Yes process by involving representatives of health, water and sanitation, ISM, ICDS, Rural Development, NGOs and community members? 5 Funds requirement matches with the absorption capacity Yes and has judicious increase over the years (The planning should be based on past experiences in implementing interventions and realistic time frame/ workplan ) 6 The Plan caters needs of vulnerable groups (SC/ST, BPL, Yes Women and Children, others) (Activities proposed to cover SC/ST population for Immunization coverage, JSY scheme etc.) 7 Inter-department coordination and convergence Yes, mechanism is clearly mentioned for multi-sectoral inputs/elements. (Planned joint sector ,block and dist level meetings with ICDS, education and local self Govt. etc and joint circulars for implementing intervention) 8 The findings of the facility survey/ assessment has been Yes, integrated in the Plan 9 Plan has been approved by appropriate district authority Yes, attached after the cover District (District Health Society) page 11 Training Plan Yes, The training strategy to strengthen existing HR. The training plan has indicated target groups (e.g. MO, ANM, ASHAs, AWW etc), training load and broad details e.g. duration, quality assurance for training, etc 12 BCC /IEC strategy Yes A service oriented BCC strategy based on assessment of the current status of issues with MMR, IMR, TFR, awareness of PNDT, etc. has been narrated in the plan 13 Work Plan Yes, Is the work plan consistent with stated
175 Sl. Criteria Remarks No. Yes/ No
components/objectives, strategies and activities? And whether the proposed phasing of activities would lead to increase in delivery/utilization of services? 14 COSTS/BUDGET Key criteria are: Does the budget follow the prescribed formats? Yes The justification column has break-up of total amount 1. Absorptive capacity: If very ambitious utilization of Yes funds is envisaged compared to performance of 05- 06/06-07, then key steps have been proposed to achieve plan expenditure? B RCH-II PROGRAM PROGRAM MANAGEMENT ARRAGEMENTS 1 Steps to establish financial management system including Yes, fund flow mechanisms to blocks and downward level and accounting system including timely reporting expenditure 2 Steps to establish quality assurance committees/system in Yes the district. 3 Step to ensure systems for holistic monitoring (Outputs, Yes activities, costs) against DHAP .( Dist level review meeting and DHS meetings) 4 Strengthening of HMIS with emphasis on timely availability Yes, of reliable and relevant information at appropriate level e.g. community, SC, PHC, Block and district, analysis and feedback system, steps to ensure implementation of revised HMIS system. 5 Provision of logistics management of drugs and medical Yes, supplies in order to ensure continuous availability of essential supplies at S/C, PHC and CHC level. TECHNICAL STRATEGIES A. Reproductive & Child Health 1 Maternal Health A. Interventions for 100% ANC coverage, Yes, B. 24x7 for EmOC services at selected institutions C. Skill birth attendance during labour (ANM) D. Provision for availability of safe blood in FRUs/CEmOCs, E. Intervention for anesthesia training for MOs, F. Provision of Safe abortion services and, G. Management of RTI/STI Cases H. Provision for Janani Suraksha Yojana 2 Child Health
176 Sl. Criteria Remarks No. Yes/ No
A. Organizing MCHN days for complete Yes, immunization coverage, B. Interventions for IMNCI services (Optional) C. Provision for new born care at institutions and, D. Promotion of breast feeding E. School Health Programme 3 Family Planning A. Interventions to provide regular FP services in Yes, every block facilities, B. Increase number of service providers for vasectomy, NSV, Tubectomy, and Laproligation , C. Intervention to improve quality of camps, D. Quality IUD insertion services, E. Increased availability of OP, Condoms through community workers, ASHA, AWW, NGOs 4 ARSH A. Intervention for training of MOs, paramedic for ARSH Yes services ( optional) B. Provision of AFHS services at selected institutions (optional)
5 Gender Mainstreaming Activities planned for awareness generation of gender, Yes, PCPNDT Act and strengthening implementation of PCPNDT Act. 7 Urban RCH Interventions for provision of MH/CH/FP services in urban NA slums and urban areas. 8 Tribal Health Interventions to cover tribal population for FP/MH/CH. NA B NRHM ADDITIONALITIES Whether provision made for- 1 ASHA Training in the district Yes, 2 PRI Trainings (Block/Village health & Sanitation Yes, Committees) 3 Untied Funds at SC & Yes, Untied funds to RKS at PHC/CHC/District Hospitals 4 Civil Works as per IPHS (CHC/PHC/SC) Yes, Hospital Building- Staff Quarters 5 Strengthening Field Monitoring and Supervision (Enhance Yes the provision of POL, Maintenance and of vehicle) 6 Need assessment done for-Procurements as per IPHS Yes CHC/PHC/SC) 7 Appropriate provision made for-Programme Management Yes, Units at Divisional, District and Block levels-Adequate
177 Sl. Criteria Remarks No. Yes/ No
salary and OE provisions ( District PMU is a part of RCH II and Block level PMUs are part of NRHM) 8 Adequate provision made for-Additional Manpower Yes Specialists at CHCs ANMs at SCs Divisional/Block Programme Managers 9 Provision made for-Drug Kits at different institutions Yes 10 Plan for management of Mobile Medical Units at districts Yes 11 No of Ambulances available and required Yes District specific innovative activities to address local needs Yes, addressed in all the have been incorporated technical chapters 12 Public private partnerships ( optional) Yes, 12 Provision of hiring of vehicle for BMOs (as per Yes requirements) C IMMUNIZATION PROGRAM Whether provision made for- 1 Social mobilization Yes, 2 Alternative vaccine delivery Yes, 3 Cold Chain Maintenance Yes, 4 PoL & Maintenance requirement for vehicles Yes, D National Disease Control Programme 1 Water Borne Diseases Yes Clear strategy prepared for combating Water Borne Diseases like Malaria, dengue etc 2 TB Whether Separate section on TB with operational details Yes, and budget prepared 3 Leprosy Separate section on Leprosy with detailed operational Yes, guidelines and budget
4 Blindness 1 Separate section on Blindness Control with detailed targets Yes, and budget 2 Monitoring mechanism for NGO E CONVERGENCE/ INTER-DEPARTMENTAL Yes, COORDINATION Whether interventions in the following areas have been planned 1 ISM Integration Activities Yes 2 Department of Social Welfare (ICDS) Yes 3 PHED Yes
178