GOVERNMENT OF JAMMU & KASHMIR NATIONAL RURAL HEALTH MISSION DISTRICT HEALTH ACTION PLAN Reasi December 2007 1 2 3 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 July 2007 with representation from various sectors concerned with NRHM. This group was responsible for management of the entire planning process in the district and also for provision of the technical support. The DPT is the standing body and will take charge of 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: 4 # Name Designation Department 1. R.C Puri Asstt. Commissioner Development RDD 2. Vinay Mohan Raina Chief Education Officer Education 3. Dina Nath DEPO Education 4. Dr. Jagdish Mehra Distt. Information Officer Information 5. N K Rohmetra Xen PHE Div. Udhampur PHE 6. Anil Kumar Kailu TO to Xen PHE PHE 7. S K Padha Xen M& RE Div. Udhampur M&RE 8. K K Sharma AEE PWD (R&B) PWD (R&B) 9. Dr. Bansi Lal Gupta Chief Medical Officer Health 10. Dr. K K Gupta Medical Suptd. DH Health 11. Dr. M H Malik Distt TB Officer Health 12. Dr. R K Sharma Distt. Immunisation Officer Health 13. Dr. Santosh Sharma Distt. Leprosy Officer Health 14. Dr. Arun Sharma Nodal Officer NRHM Udhampur Health 15. Dr. Chander Prakash Block Medical Officer Ramnagar Health 16. Dr. Jagdish Lal MO (ISM) Health 17. Shivali Bakshi DPM (NRHM) Health 18. Minerwa Raina DAM (NRHM) Health 19. Kuldeep Gupta SA (CMO office) Health The orientation of DPT, facilitated by EPOS Health India, was held on 14 July 2007. This enabled the DPT members to not only understand NRHM approach, key components and strategies of NRHM, but also manage the planning process and develop the District Action Plan. The DPT met a number of times and the individual members reviewed the situation of their respective sectors/areas and collectively developed the strategic vision for improving the health status of the district population. We the members of the DPT on behalf of the entire 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 97 Sub health centres, 35 PHCs, 5 CHCs and 1 DH in the District. Name of Chief Medical Officer Signature Date 5 CONTENTS PREFACE ....................................................................................................................................... 4 ABBREVIATIONS .......................................................................................................................... 7 PRIORITY MATRIX OF THE DISTRICT ....................................................................................... 11 EXECUTIVE SUMMARY .............................................................................................................. 17 1. SITUATION ANALYSIS............................................................................................................ 20 SOCIO ECONOMIC AND HEALTH INDICATORS....................................................................... 27 2. PLANNING PROCESS............................................................................................................. 39 3. PRIORITIES AS PER BACKGROUND AND PLANNING PROCESS ...................................... 44 4. GOALS ..................................................................................................................................... 46 5. TECHNICAL COMPONENTS................................................................................................... 48 PART A: Reproductive and Child Health (RCH) II ................................................................. 48 B- NRHM Initiatives..................................................................................................................... 75 PART C: Immunisation ............................................................................................................... 93 PART D: National Disease Control Programme........................................................................ 97 6: INTER SECTORAL CONVERGENCE.................................................................................... 112 7. COMMUNITY ACTION PLAN................................................................................................. 124 8.PUBLIC PRIVATE PARTNERSHIP......................................................................................... 126 9. GENDER AND EQUITY.......................................................................................................... 129 10. CAPACITY BUILDING.......................................................................................................... 132 11. HUMAN RESOURCE PLAN................................................................................................. 138 12. PROCUREMENT AND LOGISTICS ..................................................................................... 140 13. DEMAND GENERATION - IEC............................................................................................. 142 14. FINANCING OF HEALTH CARE.......................................................................................... 145 16. HMIS, MONITORING AND EVALUATION ........................................................................... 147 17. BIO-MEDICAL WASTE MANAGEMENT.............................................................................. 150 ANNEXURE: .............................................................................................................................. 167 6 ABBREVIATIONS ANC Ante natal Care ANM Auxiliary Nurse and Midwife ASHA Accredited Social Health Activist BPHC Block Primary Health Centre CBO Community Based Organizations CHC Community Health Centre CMO Chief Medical officer DoHFW Department of Health and Family Welfare DH District Hospital ENMR Early Neo-natal Mortality Rate EmOC Emergency Obstetric Care EAP Externally Aided Projects FRU First Referral Unit HMIS Health Management Information System HIV Human immuno-deficiency syndrome IPHS Indian Public Health Standards ISM Indian System of Medicine IMNCI Integrated Management Neo-natal of Child Illness JSY Janani Suraksha Yojana IMR Infant Mortality Rate NMR Neo-natal Mortality Rate MTP Medical Termination of Pregnancy MMR Maternal Mortality Rate MNGO Mother NGO MO Medical Officer MH Maternal Health NNMR Neo-natal Mortality Rate NGO Non-Government Organization NRHM National Rural Health Mission NAMP National Anti Malaria Programme NLEP National Leprosy Eradication Programme NKAP National Kala-Azar Programme NFP National Filaria Programme NIDDP National Iodine Deficiency Disorder Programme NBCP National Blindness Control Programme OPD Out Patient Department PNMR Primary Neo-natal Mortality Rate PHC Primary Health Centre RH Rural Hospital RCH II Reproductive and child Health Programme-II RI Routine