7TH CRM HIMACHAL PRADESH REPORT ON 7TH COMMON REVIEW MISSION HIMACHAL PRADESH Ministry of Health & Family Welfare, Government of India 9th – 15th November 2013 1 7TH CRM HIMACHAL PRADESH Table of Contents EXECUTIVE SUMMARY .......................................................................................................................... iv Key Observations............................................................................................................................... iv Key Recommendations ..................................................................................................................... ix INTRODUCTION ...................................................................................................................................... 1 A. Schedule of CRM visit .................................................................................................................... 1 B. State Profile .................................................................................................................................... 2 C. 5th and 7th CRM Observations ........................................................................................................ 4 D. NRHM Conditionalities and Incentives ......................................................................................... 6 E. Best Practices ................................................................................................................................ 12 TOR I – SERVICE DELIVERY.................................................................................................................... 14 A. Infrastructure and Adequacy of Facilities ................................................................................... 14 B. Utilization of facility based services ............................................................................................ 18 C. Quality of Care .............................................................................................................................. 20 D. Subcontracting ............................................................................................................................. 21 E. Ambulance & Referral Services .................................................................................................... 22 F. Mobile Medical Units (MMU) ...................................................................................................... 23 G. IEC/BCC ......................................................................................................................................... 23 Recommendations ........................................................................................................................... 25 TOR II – REPRODUCTIVE AND CHILD HEALTH ...................................................................................... 26 A. Planning ........................................................................................................................................ 26 B. Care of mother and child ............................................................................................................. 28 C. ARSH & School Health .................................................................................................................. 33 D. Community Level Care arrangements ......................................................................................... 36 E. Family Planning ............................................................................................................................ 37 F. Janani Suraksha Yojana (JSY) and Janani Shishu Suraksha Karyakram (JSSK) ............................ 37 G. Maternal and Infant death review .............................................................................................. 39 H. Immunization Services ................................................................................................................. 40 Recommendations ........................................................................................................................... 40 TOR III – DISEASE CONTROL PROGRAMMES ....................................................................................... 42 A. National Iodine Deficiency Disorders Control Program (NIDDCP) ............................................. 43 B. Integrated Disease Surveillance Program (IDSP) ........................................................................ 43 C. National Vector Borne Disease Control Program (NVBDCP) ...................................................... 44 D. Revised National Tuberculosis Control Programme (RNTCP) .................................................... 45 E. National Leprosy Elimination Programme (NLEP) ....................................................................... 47 i 7TH CRM HIMACHAL PRADESH F. National Programme for Control of Blindness (NPCB) ................................................................ 48 G. National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular diseases and Stroke (NPCDCS) ........................................................................................................................ 49 Recommendations ........................................................................................................................... 50 TOR IV – HUMAN RESOURCES AND TRAINING ................................................................................... 51 A. Generation of Human Resources ................................................................................................ 51 B. Availability .................................................................................................................................... 51 C. Deployment .................................................................................................................................. 55 D. Workforce management ............................................................................................................. 56 E. Training and capacity building ..................................................................................................... 59 Recommendations ........................................................................................................................... 59 TOR V – COMMUNITY PROCESSES AND CONVERGENCE .................................................................... 60 A.PRI.................................................................................................................................................. 60 B. VHSNC ........................................................................................................................................... 60 C. VHND ............................................................................................................................................ 61 D. ASHA ............................................................................................................................................. 62 E. Convergence ................................................................................................................................. 62 Recommendations ........................................................................................................................... 62 TOR VI – INFORMATION AND KNOWLEDGE ........................................................................................ 63 A. HMIS.......................................................................................................................................... 63 B. MCTS ......................................................................................................................................... 63 C. SHSRC & SIHFW ........................................................................................................................ 64 Recommendations ........................................................................................................................... 65 TOR VII – HEALTH CARE FINANCING .................................................................................................... 67 Major observations .......................................................................................................................... 67 Human Resources ............................................................................................................................. 70 Maintenance of Records /Books of Accounts /Reporting .............................................................. 70 Reporting / Monitoring / Utilization Trending ................................................................................ 70 Fund Flow ......................................................................................................................................... 71 Internal Control ................................................................................................................................ 71 Auditing ............................................................................................................................................ 72 Recommendations ........................................................................................................................... 72 TOR VIII – MEDICINE AND TECHNOLOGY ............................................................................................ 73 A. Drugs, equipment’s and diagnostics ..........................................................................................