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					     DISTRICT HEADQUARTER HOSPITAL


                 Established
Name of Facility Since           Bed Strength   No. of patients (1-1-05 to date)No. of operations(1-1-05)

                                                in-door   out-door              Major       Minor




* Cadre wise list to be attached as annexure.
                                            Table 1.1




          Staff Strength*                                 Phsical Facilities

SanctionedWorking           Vacant         Ambulance      Instruments           Equipments
                                     on Road   Off Road                 Functional Non-Functional
     TALUKA


                       Established
          Taluka
Name of Facility       Since       Bed Strength        no. of patients     No. of operations           Staff Stength*

                                                   in-door    out-door   Major     Minor       Santioned




* Cadre wise list of officers to be annexed as annexure.
                                    Table 1.2




Staff Stength*               Ambulance                   Phsical Facilities   Operational
                                             Instrumen                          (Y/N)
 Working         Vacant   On Road   Off Road ts            Equipments
             RHC                                                                                     Table 1.3


                                  Established Bed
                      Taluka      Since       Strength       no. of patients     No. of operations
  Name of Facility
                                                         in-door    out-door   Major     Minor




* Cadre wise list to be attached as an annexure.
Table 1.3




       Staff Strength*              Physical Facilities
                                                               Operational
Sanctioned Working Vacant   Ambulance Instruments Equipments     (Y/N)
            BHU


                               Established Bed
Name of Facility Taluka        Since       Strength            no. of patients            Phsical Facilities

                                                           in-door    out-door   Ambulance Instruments




* Cadre wise list of officers to be annexed as annexure.
                                    Table 1.4




hsical Facilities               Human Resources
                                                         Operation
               Equipments Sanctioned Working    Vacant   al (Y/N)
ADP Schemes 05-06                                                         Table 2.1
S.No Name     of Scheme      Capital               Revenue Total          Remarks.
     facility    Ongoing/New

(List Of Health Facilities to be enclosed for on going and new schemes separately).

Donor Assisted Schemes,                                       Table 2.2
S.No Name       of Capital              Revenue    Total      Remarks.
     Facility

Note: Donor Schemes being executed by DGs


Donor Assisted Schemes,                                       Table 2.3
S.No. Name      of Focus/Nature Budget             Targets/T Achieve
      Facility     of Scheme    Allocations        ime span ment


Note: Donor Schemes being executed by donor agencies.

Any other Schemes                                             Table 2.4
S.No Name          of Capital           Revenue    Total      Remarks.
     health Facility

Note: (List of Health Facilities to be enclosed)

Avoidance of Duplication                                                              Table 2.5
S.No Total No. Of Name           units Area   of                    Resources
       Health Units identified for intervention
       in the District intervention
                                                   SDSSP      DGs         Donor       Others
Strategies/Interventions/Activities (How we get there)?                       Table 3.1
            Priority        Strategy/    Objectives       Indicator/source    Risks/
S.no.       problem         Intervention                                      Assumption


Source: Planning toolkit for District Health Managers.




CBOs /NGOs working in Health.                                                 Table 3.2
S.No        Name of Registered               Scope of     Source of funding   Achievements
            CBO/NGO Y/N                      Activities
    GD/MCH


                   Established
Name of Facility
          Taluka   Since         Patient turn out(Average/month) for year 05            Physical Facilities

                                                                               Ambulance Instruments
                                    Table 1.5




ysical Facilities               Human Resources
                                                         Operation
              Equipments Sanctioned Working     Vacant   al (Y/N)
Name of District
SDSSP grant from PFC
SDSSP Allocation for Health Sector
Date MoU Signed
Date of District Council Resolution for ASP



                                                                                    School
 S.no.            Name of Scheme*                        Name of Facility           SEMIS
                                                                                    Code**




Grand     Total *****




* 1. School name (Construction of Shelterless school/ECE/ Upgradation/ Additional Rooms/Provision of L
   2. Furnishing of Administrative Offices.
   3.Anyother(mention).
** SEMIS code of School is mandatory for effective MIS, MIS will be shared with EDO (F&P) Office
*** Such as no. of class rooms to be built/ ECE specific procurement/ reason for hiring teachers / kind of




Signature
EDO (EDUCATION)
                         SDSSP Schemes Status for Health Sector (FY 2004-05)

                                                                           District Budget FY 04-05
                                                                                           District Total
                                                                           Salary
                                                                           Non-Salary
                                                                           Development


           Estimated Cost (as per PC-I)              Actual Cost                                        After Comple


                                                                   Total                    Equipm
           Revenue     Capital   Total Cost Revenue Capital                Building (Y/N)
                                                                   Cost                     ent




l Rooms/Provision of Lacking Facilities/Computer Labs/Technical Stream/SMC based hiring/SMC training).


DO (F&P) Office
 ing teachers / kind of Laboratory equipment being purchased / what is being procured for Administrative office
                                                                            Performa: SCR(H)-I
05)

t FY 04-05
  District Total                          District Health




              After Completion of scheme, facility has:

                            Other
           Instrum Medicine                               Patient turnout
                            consuma Staff (in numbers)
           ents    s                                      (average/month)
                            bles
                                                 Paramedi
                                    Medical               Indoor Outdoor
                                                 cal




ng/SMC training).



Administrative office
Performa: SCR(H)-I
Name of District


SDSSP grant from PFC


SDSSP Allocation for Health Sector


Date MoU Signed


Date of District Council Resolution for ASP




S.no.               Name of Scheme
Grand    Total

* Name of Health facility (All information required should be facility based
** Human Resource (Hiring of Staff include cadre of employee and name o
*** Expected Out come (No. of patients increased or decreased after inter
**** Capital includes expenditure on civil work & capital items
Signature
EDO (Health)
                                                      S




                                                   Immun



Name of Health Facility   Taluka   Vaccine (Rs.)
 required should be facility based).
de cadre of employee and name of facility where hiring has been made).
ncreased or decreased after intervention).
 & capital items
       SDSSP Schemes Analysis of Health Sector F




   Immunization                                  Human Resource**



               A
Cold Chain (Rs.) wareness (Rs.)   Hiring (Rs.)
made).
ysis of Health Sector FY 2005-06




Human Resource**                                 Strengthening of Healt



        Training (Rs.)   Capital****   Revenue
                 District Budget FY 05-06


                                  District Total


                 Salary


                 Non-Salary


                 Development




Strengthening of Health Units


                  PC-I Approval    Commencement of     Expected
 Total Cost           Date            Work Date      Completion Date
                          ABS-H-II




          District Health




 No. of Patient Current      Expected Increase



Indoor    Outdoor
          Outdoor         Indoor     Outdoor

				
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