District Health Action Plan 2012 – 13 District Health Society, Nalanda Foreword National Rural Health Mission (NRHM) was introduced to undertake architectural corrections in the public Health System of India. District Health Action Plan (DHAP) is an integral aspect of National Rural Health Mission. District Health Action Plan are critical for achieving decentralization, intersectoral convergence, capacity building of health system and most importantly facilitating people’s participation in the health system’s programmes. District Health Action Planning provides opportunity and space to creatively design and utilize various NRHM initiatives such as flexi –financing, Rogi Kalyan Samiti(RKS), Village Health and Sanitation Committee (VHSC) to achieve our goals in the socio-cultural context of Nalanda. The National Rural Health Mission (NRHM) is a comprehensive health programme launched by Government of India to bring about architectural corrections in the health care delivery systems of India. The NRHM seeks to address existing gaps in the national public health system by introducing innovation, community orientation and decentralization. The mission aims to provide quality health care services to all sections of society, especially for those residing in rural areas, women and children, by increasing the resources available for the public health system, optimizing and synergizing human resources, reducing regional imbalances in the health infrastructure, decentralisation and district level management of the health programmes and community participation as well as ownership of the health initiatives. The mission in its approach links various determinants such as nutrition, water and sanitation to improve health outcomes of rural India. The NRHM regards district level health planning as a significant step towards achieving a decentralised, pro-poor and efficient public health system. District level health planning and management facilitate improvement of health systems by 1) Addressing the local needs and specificities 2) Enabling decentralisation and public participation and 3) Facilitating interdepartmental convergence at the district level. Rather than funds being allocated to the States for implementation of the programmes developed at the central government level, NRHM advises states to prepare their perspective and annual plans based on the district health plans developed by each district. The concept of DHAP recognises the wide variety and diversity of health needs and interventions across the districts. Thus it internalises structural and social diversities such as degree of urbanisation, endemic diseases, cropping patterns, seasonal migration trends, and the presence of private health sector in the planning and management of public health systems. One area requiring major reforms is the coordinate departments and vertical programmes affecting determinants of health. DHAP seeks to achieve pooling of financial and human resources allotted through various central and state programmes by bringing in a convergent and comprehensive action plan at the district level. It is our pleasure to present the Nalanda District Health Action Plan for the financial year 2012-13. The District Health Action Plan (including the Block Health Action Plan) seeks to set goals and objective for the District Health system and delineate implementing processes in the present context of gaps and opportunities for the Nalanda district health team. (DPMU –DPM-P.P.Chakhaiyar, DAM-Nirbhay Kumar & M & E Officer Kumar Manoj, DPC- Abhishek Azad, District Epidemiologist Dr.Manoranjan Kumar District Health Society, Nalanda) for putting his sheer handwork with dedication to complete the Action Plan on time. participated in the planning process. The plan is a result of collective knowledge and insights of each of the District Health System Functionary. We are sure that the plan will set a definite direction and give us an impetus to embark on our mission. Sd- Sanjay Kumar Agarwal (IAS) District Magistrate cum Chairman District Health Society, Nalanda. Acknowledgements The commitment to bridge the gaps in the public health care delivery system, has led to the formulation of District Health Action Plan. The Intersectoral Coordination of department departments that are directly or indirectly related to determinants of health, hygiene and Water sanitation, will lead to betterment of health care delivery, and to make this collaboration possible actions are to be outlined in the District Health Action Plan. Thus this assignment is a shared effort between the departments of Health and Family Welfare, ICDS, PRI, PHED, Education to draw up a concerted plan of action. The preparation of a District Action Plan for Nalanda district of Bihar entailed a series of Consultative Meetings with stakeholders at various levels, collection of secondary data from various departments, analysis of the data and presentation of the existing scenario at a District-level workshop. The District level Workshop was organized to identify district specific strategies based on which the District Action Plan has been prepared by the District & Block Program Management Unit. We would also like to acknowledge the much needed cooperation extended by the District Magistrate cum Chairman, and Deputy Development Commissioner cum Vice Chairman of the District Health Society, Nalanda without who's his support the conduct of the district level was not possible. We are very thankful to All the Program officers and Medical officers of the district for their assistance and full support from the inception of the project. The involvement of the all the Medical officers played a pivotal role throughout the exercise enabling a smooth conduct of consultations at block and district levels. The present acknowledgement would be incomplete without mentioning the participation of representatives and officials from department of Integrated Child Development Services (ICDS), Panchayati Raj Institutions(PRIs), Education ,Water and Sanitation, who actively participated in consultations with great enthusiasm. Without their inputs it would not have been possible to formulate the strategic health action plan for the district. The formulation of this plan being a participatory process, with inputs from the bottom up, the participation of community members at village level proved very helpful. These consultations at grassroots level supplemented the deliberations at block and district levels, adding value to the planning process. Finally, we would like to appreciate the efforts and supports of all those including PHRN Bihar, Team who were associated with the team for accomplishment of this task and brought the effort to fruition. Dr.Shailendra Narayan Civil Surgeon -cum- Member Secretary District Health Society, Nalanda. INDEX Chapter Content Page No. Executive Summary 1 Process of Plan Preparation 7 1.1 Background and Current Status 10 1.2 Demographic and Socio-Economic Features 14 1.3 Institutional Setup and Organizational Development 19 1.4 Program Finance 23 2 Situational Analysis 2.1 Maternal Health 23 2.2 Child Health 26 2.2.1 Nutrition Rehabilitation Centres (NRCs) 28 2.3 Family Planning 34 2.4 Adolescent Health 36 2.5 Health Infrastructure and Facilities 40 2.6 Human Resource Development including Training 42 2.7.1 Management of Childhood Diarrhea 42 2.7.2 Urban Slums 42 3 Progresses since RCH II Implementation 3.1 Major achievement during 2005-06 to Nov.2011 43 3.2 Major obstacle of Programme Management 44 4 RCH II Programme Objectives and Strategies 4.1 Vision Statement 48 5 Technical Objectives, Strategies and Activities 5.1 Maternal Health 53 5.2 Child Health 63 5.3 Family Planning 68 5.4 Adolescent Reproductive and Sexual Health 74 5.5 Urban Health 77 5.6 Vulnerable Groups (Health Camps in Maha Dalit Tola) 79 5.7 PNDT Act 85 79 5.8 Muskaan Ek Abhiyan 81 5.9 Infrastructure and Human Resource 81 5.10 Institutional Strengthening 81 5.11 Training 81 5.12 Nutrition Rehabilitation Centres (NRCs) 82 5.13 Programme Management 82 6. Role of District & Blocks 85 7. Synergie with NRHM Additionalities 86 10.PROGRAMME / NRHM MANAGEMENT 87 A.10.2.1 District Programme Management Unit 87 A.10.2.2.b Provision for HR Consultant 88 A.10.3. Block Programme Management Unit 89 A.10.4.9. Additional Manpower for FRU 90 A10.5.1.a Appointment of CA at DHS Level for Audit 90 Part B – NRHM Additionalities B.1. ASHA 91 1.1 At the District Level 92 1.2 At the Block Level 92 1.3 At the Village Level 92 1.4 ASHA Training 94 1.5 ASHA Drug Kit and it‟s repleniPshment 94 1.6 Emergency Services of ASHA 94 1.7 Motivations for ASHA 95 1.8 Capacity Building/Academic Support Programme 95 1.9 ASHA Divas 96 B.2. Untied Fund for Health Sub Centre, APHC and PHC 99 B.2.4 Village Health and Sanitation Committee 100 B.3 Annual Maintenance Grant 100 B.4. Infrastructure Development (civil work) B.4.1.2 Upgradation of community health centre (CHC) 101 B.5.2 Construction of PHC 101 B.5.2.1 Renovation and construction of boundry wall of APHC 101 B.5.A Construction of APHC 101 B.5.2.A.1 Renovation of APHC 102 B.5.2.B Construction of Residential Quarters for Doctors in PHC/APHC 102 ablishment of Health Sub Centre (HSC) 73 B.5.2.B.1 Construction of Resi. Quarters for Staff Nurses in PHC/APHC 103 B.5.3 Construction of Health Sub Centre (HSC) building 103 B.5.3.1 Renovation of Health Sub Centre (HSC) building 105 B.5.3.2 CONSTRUCTION OF District Health Society OFFICE 105 B.5.3.3 CONSTRUCTION OF District Program Management Unit Residential Quarters 106 5.2.c Strengthening of Cold Chain 107 B.5.10.2 Upgradation of Infrastructure of ANM Training Schools 108 B.6. Seed Money for Rogi Kalyan Samitis 109 B.7 Decentralize Planning 111 B.8. Panchayati Raj Institution 112 B.9. Mainstreaming AYUSH under NRHM 113 B.10.a IEC/BCC 114 B.10.b Behavior Change Communication 115 B.10.2 Convergence/Coordination 116 B.11.