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					DEPARTMENT OF HEALTH AND FAMILY WELFARE
                PUNJAB




        NRHM STATE ACTION PLAN
               2010- 2011




 NATIONAL RURAL HEALTH MISSION, PUNJAB
                                   Executive Summary

NRHM in the state intend to provide universal access to health care. Although Punjab
has better health indicators as compared to national level but still health care especially
primary health care needs focused attention.



The State PIP of NRHM for year 2010-11 for the state of Punjab seeks to build on the
efforts undertaken so far in the state, by consolidating and reinforcing on-going
strategies, making corrections and initiating new strategies where required, based on
lessons learnt The strategies for the year 2010-11, have been finalised with an aim to
attain the health outcomes proposed for the state, and specifically in few indicators
such as reducing maternal and infant deaths and increasing institutional deliveries

State is moving towards to improve the health indicators.

                                               Present
                                                                  Target by
                Indicators                     Status
                                                                  2010-
                                                                  2010-11

                                               2.0
                Total Fertility Rate                              1.8
                                               NFHS III

                Infant Mortality Rate
                                               41                 <35
                (per 1000 live births)

                Maternal    Mortality
                                               178
                Ratio
                                               192   (SRS         <172
                (per    100000   live
                                               2008)
                births)
                Institutional                  63.3
                                                                  80%
                Deliveries                     DLHS III

                ANC Check-up with 03           65.1
                                                                  100%
                contacts                       DLHS III



   To improve the health indicators state needs to focus on Primary Health Care.
   Service delivery especially Secondary Health care in the state is of good quality but
   Primary Health Care needs focused attention. Significant presence of Private Sector
   improves the accessibility on one hand but affordability needs to be addressed.
   DLHS III shows that 36.1% women are not attending Institutions for delivery



                                                                                         2
   because of cost too much. To further improve the health indicators state focused on
   improving Primary Health Care

   The State PIP is based on the DHAP prepared by the districts in consultation with
   different stake holders. Facility Survey was conducted to find out the gaps and
   initiatives has been designed accordingly. Need based planning has been done to
   improve the health delivery services.

   State PIP has been prepared in accordance with the guidelines issued by GOI. Part A
   RCH and related activities focus on the initiatives to improve the Maternal Child
   Health, Adolescent Health, Family Welfare programme,Sex ratio, strengthened
   Programme Management and HMIS and improvement in service delivery.

                                            IMR.
   A major issue for the state is increased IMR State has focused in the issue and
   augmented the efforts to improve the ANC check up, curbing the anemia among
   pregnant women and qualitatively improving Institutional Deliveries through
   operationalising CEmOC and 24x7 services. Institutional deliveries (Normal as well
   as Caesarian) in all the Govt. health institutions have been made free.

   Manpower is critical issue for reduction in IMR and MMR through institutional
   deliveries state has made efforts to recruitment specialists and Medical officers on
   regular and contract basis. Additional paramedical manpower has been provided
   under NRHM to strengthen the service delivery.

In the present plan state has focused on opeartinalising the EmOc services at all level.
State has planned to ensure, New Born Care Cornors in all delivery rooms of CEmOC and
24x7 PHCs.

State ranks 2nd amongst the major states in the country in achieving highest number of
Non Scalpel Vasectomy which is 13% of the total sterilizations.

During the year 2010-11 major thrust alongwith male participation will be on the
alternative methodology i.e. No Touch Technique of IUCD (CuT).

   For improving the sex ratio state has initiated policy of awards and punishment. To
   award who has contributed to improve the sex ratio and check on the culprits
   involved. 23Gram Panchayats who have shown improved sex ratio were awarded
   and regulation of PC PNDT was ensured through deterrent actions.31 Ultrasound
   Centers were suspended for violation of section 20 of the Act. Two court cases have
   been launched for violation of provision of the Act. Five convictions of the accused
                                                                                      3
   have been ordered by the Hon'ble Court. In the year 2010-11 state will award the
   outstanding panchayats , informers, decoy patients.



   The initiatives under NRHM described in Part B have been again informed by the
   need to strengthen systems to attain the outcomes Besides the activities to improve
   the quality of services by up-grading facilities, focus is placed more on strengthening
   community involvement to enhance accountability of the health system to deliver
   results This is also aimed to increase an ownership of the community and to ensure
   sustainability of the processes initiated under NRHM This year it is also proposed to
   establish a State Health System Resource Centre, (SHSRC); ASHA Resource Centre;
   and a centre for communication to coordinate and synergise all communication
   activities This should significantly help in strengthening the technical support for
   the implementation of the various activities and in attaining the outcomes



The National Disease Control Programme described in Part D of the document lays
more emphasis on addressing the problem of tuberculosis and NVBD emphasis is also
placed on strengthening the IDSP to ensure that the system responds to outbreaks

245 cases of dengue were reported in Punjab state during the year 2009 as compared to
4349 reported during the year 2008.21 deaths were reported due to Dengue during the
Year 2008 and only 1 death was reported in the year 2009 .There is marked decrease in
cases as well as deaths.No case of Japanese Encephalitis, Chickungunya and Kala Azar
were reported during the year 2009.

179 cases of and 31 deaths were reported from different hospitals due to H1N1
Influenza,till 29th December 2009.Facility for isolation wards, ventilators and sufficient
quantity of Tami Flue tablet is available in the state for all age group.3000 persons has
been given presumptive prophylactic treatment. State Govt. is also trying to establish
another testing lab at Govt. Medical College Amritsar in addition to one at PGI which is
already functional.

   One of the unique features of this year is the significant emphasis placed on inter-
   sectoral convergence Part E outlines the opportunities for convergence between the
   departments of Women and Child Development, Panchayati Rai, PHED, Education
   and also with SACS One of the key strategies proposed and on which the State is

                                                                                        4
placing significant emphasis is on strengthening the school health programme It is
proposed to have a complete health check up of all school going children in the state
to address their health needs and to ensure better health outcome of the future
generation

Decentralization – State has adopted the policy of decentralization through transfer
of funds where needed. Untied funds and Maintenance Grant for SC, PHC, CHC;
Funds for Rogi Kalyan Samiti, VHSC. Involvement of Community has been ensured
through State Health Mission, District Health Mission, Planning and Monitoring
Committees at Block, District and State Level, Village Health and Sanitation
Committees.

Convergence – No separate funds but Department of Health is working in close
coordination with other Departments like – Women and Child (ICDS), Water Supply
and Sanitation, Education and Department of Rural Development. Besides AYUSH to
be integrated with Allopathic Health Institutions.

For the year 2010-11 a total budget amounting to Rs. 388.67 Crore is proposed as:

              Component                 Amount Proposed           %age
                                         (Rs. in Crores)
    RCH and Related Components                 82.05             21.11%
    NRHM Additionalities                     172.54              44.39%
    Immunisation                                3.21              0.83%
    NDCP                                       20.35              5.23%
    Inter-Sectoral Convergence                 15.12              3.89%
    Centrally Sponsored Schemes                95.40             24.54%
                   Total                     388.67               100%




                                                                                    5
                          CONTENTS
                  LIST OF CONTENTS

Contents                                           Page
                                                    No.
Executive Summary
Preface                                             1
Situational Analysis                                7
NRHM in Punjab                                     15
Priorities Proposed                                35
Maternal Health                                    44
Child Health & IMNCI                               72
Family Welfare                                     86
Adolescent Health                                  96
Urban Health                                       105
Innovations PNDT & SEX Ratio                       108
PP/NGO Innovation/PPP                              117
Infrastructure & Human Resource                    124
Institutional Strengthening                        128
HMIS                                               130
Training                                           140
BCC                                                182
Procurement                                        193
Strengthening of Programme Management Unit         195
NRHM Part-B                                        200
ASHA                                               205
Village Health & Sanitation Committees             216
Untied Fund                                        221
Upgradation of Health Facilities                   223
Annual Maintenance Grant                           234
Rogi Kalyan Samitiis                               236
Mobile Medical Unit                                240
ERS                                                241
School Health Programme                            245
Complicated disease among the children &           247
Adolescent i.e. RHD/CHD/Thelesemia/Cancer
Community       Action    Programme    including   250
Community Monitoring
Dental Health                                      258
Provision of cell phones                           260
Strengthening of Programme Management              261
Immunization                                       264
NDCP                                               291
Inter Sectoral                                     355
Annexure RCH
Annexure Detail and Summary Budget




                                                          6
PREFACE
The NRHM launched by Hon’ble Prime Minister on April 12, 2005, is a significant
paradigm shift, which aims to ensure affordable, quality health care to the poorest
households in remotest areas. To enable this, the NRHM proposed “architectural
corrections” to make the public health system functional, accessible and importantly
accountable to enable an improved health status of people in the country.
Despite efforts of the Government some issues that continue to cause concern are:
       High IMR/MMR.
       These continue to be high in many rural areas and especially among poor. The
       chief cause for concern is that in the last few years there has been no real
       appreciable decline in IMR/MMR in the country.
       High out of pocket expenditure
       Studies indicate that high and prohibitive out of pocket expenditure is limiting
       access to health especially for the poor. Also, the high out of pocket expenditure
       is a major contributor for poverty and destitution in the country.
       Population Stabilisation
       The pace of population stabilization needs to be enhanced in many EAG states.
       Poorly functional Public Health System
       The public health system is perceived to be on the decline due to weak
       governance, manpower shortages and ineffective service delivery.
       Poor accountability
       Provision of health services by the public health system was not in sync with the
       needs of the people. One of the main reasons for this has been the poor
       involvement of the community and the PRI representatives.


NRHM seeks to address these issues through five main strategies:


   a) De-centralisation of the process of health planning and management: Some of the
       key elements of the strategy include formation of village health and sanitation
       Committees, involvement of the PRIs in the planning and monitoring process,
       formation of committees at different levels of health facilities, provision of untied
       grants to the health facilities to be managed in consultation with the community
       or their representatives, and engagement of ASHA to take the health services
       closer to the community.
                                                                                          1
b) Improved management through capacity building: This strategy proposes to
   equip the block and district officials with management skills and to also establish
   institutional arrangements in the form of resource centres to enable continuous
   skill building of personnel. Critical gaps identified in the form of managers and
   finance specialists is also sought to be addressed through this approach. The skill
   building of NGOs is also an important part of this process.
c) Flexible Financing: through the provision of untied grants to institutions to
   enable local level initiatives to address local needs. The norm based tied funds
   that were proposed earlier were not in sync with the efforts required to address
   diversity in the country. Efforts have also been initiated to ensure that there is
   greater risk pooling and that the poor are not forced to pay a higher out of pocket
   expenditure to access health care. The key aim is to ensure that the access to
   health care doesn’t lead to increased deprivation for the poor and marginal
   groups. Steps are afoot to involve NGOs in insurance schemes and to also engage
   the private sector to enable risk pooling. Also, the flexi funding is intended to
   facilitate innovation by the state governments to ensure that they initiate better
   reforms to improve the health outcomes in their respective states.
d) Innovation in human resource management is the other key strategy. Given the
   service levels of each facility, the HR requirements have been determined and
   provision is being made to enable their engagement. Emphasis is also on multi-
   skilling of staff to address the health needs in a horizontal perspective rather
   than a vertical one.
e) Outcome based approach: The emphasis of the NRHM is on outcome rather than
   on inputs. Rather than monitoring the inputs the NRHM proposes to monitor
   outcomes against standards. To enable this, NRHM has proposed standards in
   the form of IPHS. It also emphasizes on Facility Surveys which would form the
   basis for planning and monitoring to attain the outcomes.            Besides, the
   involvement of the community is expected to be a key element in monitoring the
   outcomes.
f) The other key elements include the efforts to facilitate inter-sector convergence
   to address the key health determinants and also to ensure synergy between the
   AYUSH and the allopathic system to enable an improved health status outcome in
   the country.


                                                                                    2
g) The NRHM thus signals a significant paradigm shift in the health policy process
   in the country. It is anticipated that the implementation of the NRHM during the
   period 2005-12 would lead to a substantial increase in the health outcome.




                                                                                 3
               GOAL OF NRHM


Improve the availability of and access to quality
   health care by people, especially for those
  residing in rural areas, the poor, women and
                     children.




                                                    4
1.       NRHM VISION & MISSION STATEMENTS

     •   The National Rural Health Mission (2005-12) seeks to provide effective
         healthcare to rural population throughout the country with special focus on 18
         states, which have weak public health indicators and/or weak infrastructure.

     •   The Mission is an articulation of the commitment of the Government to raise
         public spending on Health from 0.9% of GDP to 2-3% of GDP.

     •   It aims to undertake architectural correction of the health system to enable it to
         effectively handle increased allocations as promised under the National Common
         Minimum Program and promote policies that strengthen public health
         management and service delivery in the country.

     •   It has as its key components provision of a female health activist in each village; a
         village health plan prepared through a local team headed by the Health &
         Sanitation Committee of the Panchayat; strengthening of the rural hospitals for
         effective curative care, made measurable and accountable to the community
         through Indian Public Health Standards (IPHS), integration of vertical Health &
         Family Welfare Programs for optimal utilization of funds and infrastructure and
         strengthening delivery of primary healthcare.

     •   It seeks to revitalize local health traditions and mainstream AYUSH into the
         public health system.

     •   It aims at effective integration of health concerns with determinants of health
         like sanitation & hygiene, nutrition, and safe drinking water through a District
         Plan for Health.

     •   It seeks decentralization of programs for district level management of health
         programmes.

     •   It seeks to address the inter-State and inter-district disparities, especially among
         the 18 high focus States, including unmet needs for public health infrastructure.

     •   It shall define time-bound goals and report publicly on their progress.

     •   It seeks to improve access of rural people, especially poor women and children,
         to equitable, affordable, accountable and effective primary healthcare.




                                                                                             5
The Objectives of the Mission

   •   Reduction in infant and maternal mortality.

   •   Universal access to public services for food and nutrition, sanitation and hygiene
       and universal access to public health care services with emphasis on services
       addressing women’s and children’s health and universal immunization.

   •   Prevention and control of communicable and non-communicable diseases,
       including locally endemic diseases.

   •   Access to integrated comprehensive primary health care.

   •   Population stabilization, gender and demographic balance.

   •   Revitalize local health traditions & mainstream AYUSH.

   •   Promotion of healthy life styles.

To achieve these goals NRHM will:

   •   Facilitate increased access and utilization of quality health services by all.
   •   Forge a partnership between the Central, State and Local governments.
   •   Set up a platform for involving the Panchayati Raj institutions and community in
       the management of primary health programs and infrastructure.
   •   Provide an opportunity for promoting equity and social justice.
   •   Establish a mechanism to provide flexibility to the states and the community to
       promote local initiatives.
   •   Develop a framework for promoting inter-sectoral convergence for promotive
       and preventive health care.




                                                                                        6
            ANALYSIS
SITUATIONAL ANALYSIS

Demographic and Socio-Economic Features:
Punjab- the land of the five rivers (it was watered by the five rivers, namely, Sutlej, Beas,
Ravi, Chenab and Jhelum before partition in 1947) is spread over an area of 50,362 sq.
kms. The total population of Punjab is 24,358,999- Urban population is 33.92 percent
and rural is 66.08 percent (Census, 2001). The state accounts for 2.37 percent
population of the country. The population density is 484 persons per sq. km. Literacy
rate in the state for the 7+ age group is 69.65 percent – Male 75.23 percent and Female
63.36 percent. The life expectancy at birth is 68.4 for males and 71.4 for females- the
second highest in the entire country. While the life expectancy for the state as a whole
is high, reports indicate that there are inter-regional differences in life expectancy. This
emphasises the need for district specific planning to address the issues.
Table 1: Key Demographic Features of State

      SN           Characteristics         Year        Punjab               India

            Population                              24,358,999        1,026,443,540
      1.    Male                           2001     12,985,045         531,061,138
            Female                                  11,373,954         495,382,402
            Sex Ratio
                                                        876                 933
      2.    Sex     Ratio   (0-6     age
                                           2001         798                 927
            group)
            Literacy rate (%)                          69.65                64.82
      3.    Male                                       75.23                75.25
                                           2001
            Female                                     63.36                53.66



Despite its perceived prosperity, about 6.2 percent of the population live below the
poverty line. About 29 percent of the population of the State is Scheduled Castes. The
National average for SC population is 16.2 percent. There is no scheduled tribe
population in the State.

As mentioned above, about 29 percent of the state population belongs to Scheduled
Caste group and about 6.2 percent live below the poverty line. There is a need for
special attention to address these vulnerable groups, besides women and children who
form a significant part of the vulnerable groups in the state.

                                                                                           7
Punjab roughly forms a plain. But the shifting courses of the rivers and the various
processes of environmental changes over centuries have resulted in variations in relief,
drainage, soil and vegetation across the state. What is distinct however is the cultural
characteristic of each region. Culturally, Punjab could be divided into three regions:
Majha, Doaba and Malwa. Each region is distinct in terms of physical environment,
economic structure, social organization and cultural ethos.

Majha, also known as ‘Upper Bari Doab’, is surrounded by three rivers- Ravi in the west,
Beas in the east and Sutlej in the south. Majha constitutes for about 17 percent of the
area of the state. It consists of the districts of Amritsar and Gurdaspur and has a long
boundary with Pakistan. Majha however, is the most densely populated region of the
state. The density of population in this region is about 597 persons per sq.km as
opposed to a state average of 482. (Census, 2001). Amritsar in the region has the largest
population in the state (12.65 percent of the state population). About 40 percent of the
district population is urban and Amritsar is the second largest city in the state after
Ludhiana. Amritsar is an important place for the Sikh religion. Sikhs predominate but
there is also sizeable Christian population in the district- about 50 percent of the
Christian population of the state live in Amritsar.

The fertile lands irrigated extensively by canals and other sources coupled with the
hardworking people of Majha have made this region agriculturally prosperous. There is
a significant presence of industries too- sugar, cotton, woollen and textile industries are
found in this region.

Doaba is formed by the land between the rivers Beas and Sutlej. It includes districts of
Hoshiarpur, Nawanshahar, Kapurthala and Jalandhar. This region is separated from
Himachal Pradesh by the Shivalik hills. The area bordering the Shivaliks is also called
the Kandi area. Doaba is also densely populated and the density is about 539 persons
per sq.km (Census 2001). Jalandhar has the second highest population density in the
state after Ludhiana. The eastern parts of Hoshiarpur and Nawanshahar have low
population density as they form a part of the Kandi region. The Doabi dialect is distinct
and is believed to be influenced by Persian-Arabic. Doabis are believed to be
adventurous and there is said to be a significant presence of the Doabis all over the
world. Doab has well developed agriculture and tube wells are the predominate source
of supply. The region is rich in water resource. Jalandhar is famous for the sports good
                                                                                         8
industry in the entire country. Doaba has the highest road density among all regions in
the state.

The area south of Sutlej River is called Malwa. 11 districts of the state comprise the
Malwa region and thus, this is the one of the largest region of the region. Malwa is very
representative of the Punjabi folk traditions. The density of population in Malwa is less
compared to the other two regions- 436 persons (Census 2001). Ludhiana is the most
populated district of Malwa and accounts for about 12 percent of the state population.
The Sikh population predominates in the region and the highest percentage of Sikh
population is recorded in Faridkot. There are two coal based power plants at Rup Nagar
and Bathinda. Agriculture is the main occupation of Malwa region and there is an
intense use of the land. It has the largest network of canal irrigation in the state and
tube well irrigation also predominates.

The distinct cultural identity and the environmental aspects impact on the health status
and the provision of health in the state.

               Divisions:
Administrative Divisions:

Table 2 below provides details of the administrative divisions in the state. The state is
divided into 20 districts and these are further sub-divided into community development
blocks. There are 12, 278 villages and 139 towns in the state.

Table 2: Administrative Divisions in the state

                 Category                             No. of Units
                 Divisions                                   4
                 Districts                                  20
                 Sub divisions/Tehsils                      77
                 Community Development Blocks             141
                 Towns                                    139
                 Inhabited villages                    12,278
                 Municipal Corporations                      5
                 Municipal Councils                         96
                 Cantonment Boards                           3
                 Nagar Panchayats/NAC                       36
                        State:
Public Health System in State:

                                                                                        9
Table 3 provides details of the hierarchy of the public health facilities in the state by
districts. This is based on the Facility Survey that has been completed in the state.

Table 3: Public Health Facilities by Districts

  S. No      Name of District         SCs        SHC    PHC   RH   CHCs     SDH    DH
   1      Amritsar                   170         88     26    2      4       2      1

   2      Barnala                     75         35      8    3      4       0      1

   3      Bathinda                   136         60     17    3      9       2      2

   4      Faridkot                    62         20      8    0      4       1      1

   5      Fatehgarh Sahib             73         23     13    1      4       1      1

   6      Ferozepur                  231         79     31    3      8       3      1

   7      Gurdaspur                  290         113    38    2     15       2      1

   8      Hoshiarpur                 244         85     29    3     10       3      1

   9      Jalandhar                  198         95     26    3     10       2      1

   10     Kapurthala                  88         44     10    3      4       2      1

   11     Ludhiana                   258         109    27    5      9       4      1

   12     Mansa                      103         37     12    2      4       1      1

   13     Moga                       121         52     20    2      5       0      1

   14     Muktsar                    102         43     14    3      5       2      1

   15     Nawanshahar                 95         47     15    2      3       1      1

   16     Patiala                    191         61     29    0     11       3      1

   17     Ropar                       83         30     12    2      2       1      1

   18     Sangrur                    194         68     27    4      6       4      1

   19     SAS Nagar                   74         45     13    0      3       1      1

   20     Tarn Taran                 162         62     20    2      9       1      1

          TOTAL                      2950        1196   395   45    129     36     21


Besides the above facilities, there are 2 TB and Chest Diseases Hospitals and 13 TB
Clinics; 3 Mobile Eye Hospitals (Ferozepur, Jalandhar, and Sangrur), and Mobile Eye

                                                                                        10
Teams in 3 districts (Gurdaspur, Faridkot, Ludhiana). There are also 116 Urban Health
Centres, 7 ESI Hospitals and 71 ESI dispensaries.
Table 4 provides analysis about the access of the rural population to secondary health
facilities in the state. For the state as a whole, for every 98,000 persons in rural area
there is one secondary health facility.

Table 4: Coverage of Rural Population by Secondary Health Facilities

 SN     Name of District      Rural Popn.         No. of Secondary             Ratio of rural
                             Projected 2010      Health Facilities (DH,   population (in Lakhs) to
                               (in lakhs)             SDH,CHC)              Secondary facilities
  1    Amritsar                   12.47                   7                        1.78
  2    Barnala                     3.38                    5                       0.68
  3    Bathinda                    9.48                   13                       0.73
  4    Fatehgarh Sahib             4.08                    6                       0.68
  5    Faridkot                    4.41                    6                       0.74
  6    Ferozepur                  14.78                   12                       1.23
  7    Gurdaspur                  17.89                   18                       0.99
  8    Hoshiarpur                 13.56                   14                       0.97
  9    Jalandhar                  11.76                   13                       0.90
 10    Kapurthala                  5.79                    7                       0.83
 11    Ludhiana                   15.28                   14                       1.09
 12    Mansa                       6.23                    6                       1.04
 13    Moga                        8.17                    6                       1.36
 14    Muktsar                     6.60                    8                       0.83
 15    Nawanshahar                 5.78                    5                       1.16
 16    Patiala                    11.86                   15                       0.79
 17    Ropar                       5.56                    4                       1.39
 18    Sangrur                    10.01                   11                       0.91
 19    SAS Nagar                   5.27                    5                       1.05
 20    Tarn Taran                  9.38                   11                       0.85
       Total                      181.74                 186                       0.98


Barnala and Fatehgarh Sahib among all districts provide a better access. For every
68,000 rural populations, there is one secondary health facility. Amritsar, Moga and
Ropar are among the districts where the access to secondary health facilities needs to
be improved. In these districts for every 1.36-1.78        lakh population there is one
secondary facility. It is likely that in Amritsar the significant presence of private health



                                                                                          11
care facilities is being accessed by the community. Ferozepur is the other district where
the access needs to be improved.


Table 5: Ratio of ANMs to Rural Population in Districts

  S. No    Name of District
           Name                     No. of ANMs       Rural Popn.     Ratio of ANMs to
                                    Existing on                2010
                                                     Projected 2010   Rural Population
                                            2010
                                   January 2010        (in lakhs)
    1      Amritsar                     330               12.47             3779

    2      Barnala                     101                 3.38             3347

    3      Bathinda                    234                 9.48             4051

    4      Faridkot                     99                 4.08             4121

    5      Fatehgarh Sahib              83                 4.41             5313

    6      Ferozepur                   250                14.78             5912

    7      Gurdaspur                   400                17.89             4473

    8      Hoshiarpur                  284                13.56             4775

    9      Jalandhar                   343                11.76             3429

   10      Kapurthala                  147                 5.79             3939

   11      Ludhiana                    432                15.28             3537

   12      Mansa                       133                 6.23             4684

   13      Moga                        185                 8.17             4416

   14      SAS Nagar                   136                 6.6              4853

   15      Muktsar                     139                 5.78             4158

   16      Nawanshahar                 118                11.86            10051

   17      Patiala                     449                 5.56             1238

   18      Ropar                       140                10.01             7150

   19      Sangrur                     128                 5.27             4117

   20      Tarn Taran                  257                 9.38             3650

           Total                       4388               181.74            4142




                                                                                      12
Posts of ANMs were lying vacant in 513 Sub Centres for last many years which were
filled in the year 2008-09. In addition 954 sub-centres catering to a population of more
than 6000 have been provided with 2nd ANM.

Table 6: Ratio of Availability of OG Specialist to Rural Population across Districts

         S.N    Name of District        Rural Popn.         No of OGs in       Ratio of Rural
                                       Projected 2010       CHC +SDH          Population (per
                                         (in lakhs)                              lakh)/OG
                                                                                 specialist

           1 Amritsar                       12.47                 9                    1.39

           2 Barnala                        3.38                  3                    1.13

           3 Bathinda                       9.48                  5                    1.90

           4 Fatehgarh Sahib                4.08                  6                    0.68

           5 Faridkot                       4.41                  4                    1.10

           6 Ferozepur                      14.78                 6                    2.46

           7 Gurdaspur                      17.89                 6                    2.98

           8 Hoshiarpur                     13.56                 5                    2.71

           9 Jalandhar                      11.76                10                    1.18

         10 Kapurthala                      5.79                  4                    1.45

         11 Ludhiana                        15.28                16                    0.95

         12 Mansa                           6.23                  4                    1.56

         13 Moga                            8.17                 11                    0.74

         14 Muktsar                         6.60                  8                    0.83

         15 Nawanshahar                     5.78                  3                    1.93

         16 Patiala                         11.86                12                    0.99

         17 Ropar                           5.56                  3                    1.85

         18 Sangrur                         10.01                12                    0.83

         19 SAS Nagar                       5.27                  6                    0.88

         20 Tarn Taran                      9.38                  1                    9.38

               Total                       181.74                134                   1.36




                                                                                  13
               Services:
Private Health Services:

The private sector health services have seen a significant growth in the last few years in
the state. It is proposed to map the prevalence of the private sector health services in
the state. Steps will be initiated to partner with the private sector with a view to
improve the overall health outcome in the state. The mapping process would also
enable the Health Department to monitor the quality of care provided by the private
services.

               NGOs:
Involvement of NGOs:

There has been a significant involvement of the NGOs in health services in the state. The
MNGO scheme is an attempt to strengthen the role of NGOs in service delivery for
contributing towards reducing IMR, MMR and TFR. It envisages partnership between
the Government and the Non- Government organisations to improve the health status of
the community. In order to strengthen the partnership, the strategy would be to
organize seminars/workshops/study tools/meetings – sensitising and orientating
various stakeholders at different levels on the goals and objectives of RCH and the role
of NGOs in NRHM at large. To build the capacities of NGOs representatives under MNGO-
RCH scheme of the State, capacity building is proposed. 14 districts in the state have
been covered under the MNGO-RCH scheme, i.e. Ropar, Patiala, Ferozepur, Muktsar,
Nawanshahar, Fatehgarh Sahib, Amritsar, Jalandhar, Ludhiana, Hoshiarpur, Kapurthala,
Bathinda, Sangrur and Gurdaspur. Two SNGOs have also been selected in Amritsar and
Ludhiana.




                                                                              14
NATIONAL RURAL HEALTH MISSION IN PUNJAB
The MoU between the Government of Punjab and Government of India was signed on
December 15, 2005. This MoU between the two Governments is operational until March
2012. The MoU sets out the respective roles and commitment by both the Governments
in the implementation of the NRHM.


                   Institutional Framework




              Arrangements:
Institutional Arrangements
The Government of Punjab constituted the State Health Mission for NRHM under the
Chairpersonship of Hon’ble Chief Minister on October 26, 2005. Following this, the State
Health Society was incorporated through the issue of a notification on January 4, 2006.
The State Society was registered on February 26, 2007. The process of setting up
District Health Missions in line with the State Health Mission was also initiated and the
notification for the constitution of the District Health Missions was issued on August 17,
2005. All District Health Societies have been registered and established during the
period 2005-06.
                                                                              15
With the formation of the State and District Health Societies, all vertical programmes in
the state have been integrated into one composite program to ensure synergy.

Starting from the year 2005-10, substantial progress has been made in realising some of
the outputs of the NRHM in the state till date. Some of the key attainments include:

   ♦ State and District Health Missions and Societies have been constituted in the state.
   ♦ Rogi Kalyan Smities has been constituted for all DHs/SDHs/ CHCs. As per GOI
       guidelines registration of RKS is to be done. In case of Punjab, secondary level
       institutions are controlled by PHSC, an autonomous body under Department of
       Health & Family Welfare Punjab. As per PHSC by-laws no separate society can be
       registered for management of Hospitals. But to meet the mandate of
       decentralised planning RKS on the pattern of GOI norms has been notified at
       DH/SDH/CHC level. At PHC level Block/PHC Health Monitoring and Planning
       Committees has been assigned the role of RKS.
   ♦ The notification for the constitution of the Village Health and Sanitation
       Committees (VHSC) was issued on October 21, 2007. Later on these guidelines
       has been revised on December 22, 2008 to make these confirmation to Village
       Health Planning and Monitoring Committees
   ♦ State Programme Management Unit established.
   ♦ The District Action Plans (DAPs) for all the 20 districts are complete. These plans
       have been prepared by District Planning Teams duly constituted for the purpose.
       Capacity Building of these teams was done in collaboration with National Health
       System resource Centre. The Facility Survey of all health facilities in the state is
       complete. This Facility Survey would be one of the key tools for planning and
       monitoring the health programmes in the state.
   ♦ ASHAs have been engaged and 17300 ASHAs are in place now and trained in
       Module I.
   ♦ 13005 Village Health and Sanitation Committees (VHSC) have been constituted
       till now.
   ♦ State Health Systems Resource Centre (SHSRC) is in the process of being
       established. It is likely to be established by this year. SHSRC would provide the
       requisite technical support for the implementation of the NRHM in the state.




                                                                               16
The State is expecting to realise the following outcome

                                                                        Expected by
                 Indicators                     1998-
                                             On 1998-99       2009-
                                                           On 2009-10
                                                                         2010-
                                                                         2010-11

    Total Fertility Rate                        2.5           2.1           1.8

    Infant Mortality Rate
                                                49            41           <35
    (per 1000 live births)

    Maternal Mortality Ratio                                  192
                                                199                       < 173
    (per 100,000 live births)                              SRS 2008

                                               37.5 %       52.5 %

                                             (NFHS II)     (NFHS III)
    Institutional Deliveries                                               80 %
                                                              63.3

                                                           (DLHS III)

                                               58.4%         72.5%
    ANC check up with 3 contacts                                           90%
                                             (NFHS II)     (NFHS III)




The other outcomes that are proposed to be attained are:

   •   Prevention and control of communicable and non-communicable diseases in the
       state.
   •   Improving adolescent health through integrated Adolescent Reproductive and
       Sexual Health Services.
   •   Eliminating leprosy from the State.
   •   Improving and sustaining 85 percent cure rate and sustain planned case
       detection rate in TB.




                                                                           17
           PREPARATION                10-
                                    2010
PROCESS OF PREPARATION OF State PIP 2010-11 IN THE STATE OF PUNJAB

Planning Process
NRHM Punjab abiding the Mission of NRHM has initiated for decentralizing planning
process for formulating the PIP. Integrated DHAPs were prepared by the districts in
consultation with stakeholders.
The planning process of DHAP mainly focused on to improve the service delivery
especially in high focused districts i.e. Muktsar, Faridkot, Jalandhar and Nawanshahar.
State has highest SC population(29%), Although only 6% families are BPL in Punjab but
poverty in relative terms is significant especially among SC population.
Districts may have varied needs based on the socio-economic, demographic and
geographical needs. Punjab is a border state and international relations with
neighbouring country have direct bearing on states affairs especially boarder districts.
Prevalence of private sector is more concentrated in cities and major towns but less in
rural areas. Some districts of Malwa region have acute shortage of manpower. In nut
shell priorities of the district are different and terms of health services. Based on the
need assessment DHAPs have been prepared.
Decentralisation and Community Participation have been ensured through committees
at different level. The plan has decentralized the physical and financial components.
Even recruitment of paramedics and some district/block level staff has been
decentralized and recruitment is done at the district level. Planning is major component
of decentralization especially consultation with elected representatives and officials of
different departments for better convergence to improve health indicators and
determinants of health.


Steps for Planning.
Hon’ble Chief Minister Punjab in the State Health Mission meeting held on 4th
September 2009 directed the State to prepare integrated DHAPs.
On 16/09/2009, Principal Secretary Health and Family Welfare directed all the districts
to conduct facility survey and issued the guidelines for preparation of DHAP vide letter
no 10272-91 dated 08/10/2009.
Constitution
Constitution of Planning Teams
State Planning Teams was constituted to mentor the process of DHAP .District Planning
Teams consisting of DFPO, DPM, DMEO, officer from Disease Control Programme were
constituted. Mission Director NRHM directed to all the concerned and requested to
National Health Systems Resource Centre, New Delhi for the Capacity Building of
District Planning Teams.




                                                                                      18
Capacity Building of Planning Teams
State level Capacity Building workshop for District Planning Teams from 26th -31st
October, 3rd Nov-7th Nov 2009 was organized in collaboration with NHSRC New Delhi.
State is thankful to NHSRC for extending their support and giving their valuable time to
the State. In the Capacity Building Workshop resource envelop was given to districts on
1st day and issues related to planning for district and different technical components
were discussed.
District level Planning
District Planning teams hold the consultative meetings with Block level officials and
representatives to discuss the health issues and priorities needed for DHAP. Data of
facility survey was analysed for need assessment for manpower and infrastructure.
Chapter 2 of the plan was kept to discuss the gaps and initiatives needed for
infrastructure up gradation, chapter 3 on Governance issues especially functioning of
different committees and other governance issues and Chapter 4 to focus on technical
components.
Mission Director NRHM hold meeting with Planning teams form time to time to discuss
the progress and issues related to planning.
In the meantime GOI issued a circular declaring certain districts as high focused
districts. Four districts of the state: Muktsar, Faridkot, Jalandhar and Nawanshahar are
among the high focus district. Again meeting with these districts were held to discuss
the priority areas for plan.
Draft Planning
Draft Plans by all the districts were submitted by the 1st week of December and these
plans were reviewed by the Consultant PHP, NHSRC and officers of SPMU and
comments were given to revise the drafts. By the end of December draft of all the DHAP
were received and reviewed in the meetings of DPT chaired by Mission Director NRHM.
State Level Planning
At State level State Planning Teams under the Chairmanship of Mission Director
prepared the time plan and templates for DHAPs and reviewed the plans. During
discussions with districts state concerns were shared.
Considering the district specific issues and state concerns SPIP was prepared in line
with the GOI guidelines.




                                                                                     19
ACHIEVEMENTS UNDER NRHM

        In order to meet the shortage of medical and paramedical staff 312 Medical
     Officers, 50 Specialist Doctors, 21 Analysts, 11 Food Inspectors, 26 Clerks, have been
     recruited during the Year 2009.7 Medical Officers,41 Staff Nurses ,6 Lab
     Technicians, 4 Radiographers and 2 Operation Theatre Assistants were recruited to
     meet the staff requirements at Trauma Centers.

     Promotion:
     Promotion:

               A total no of 413 staff were promoted during the Year 2009 which
        includes 10 Superident,2 Personal Assistant,4 Senior Scale Stenographer, 2
        Junior Scale Stenographer, 10 Junior Statistical Assistant, 67 Assistant, 154 Multi
        Health Worker Supervisors, 12 Senior Medical Lab Technicians, 30 Medical Lab
        Technician Garde-1, 6 Assistant Malaria Officers, 27 Assistant Unit Officer, 6 Mass
        Media and Information Officers, 2 Deputy public Analyst and 1 Assistant
        Chemical Examiner,46 Staff Nurses,6 Public Health Nurse(teaching) and 28
        Nursing Sisters.

                    Contract:
     Recruitment on Contract:

                                              Filled up                   Filled
                                                                          Filled
                                                             Filled up             Total
                                  Total               05-
                                             during 05-                     up
SN           Category                                               08-
                                                            during 08-             Filled        Vacant
                                Sanctioned           07-
                                              06 to 07-                   during
                                                                 09                 Up
                                                  08                      09-
                                                                          09-10
1     SPMU                         61             32           16            8     53              8
2     DPMU                         200            71           72           30     161            39
3     BPMU                         354           228           118          52     320            34
4     FRU           Gynae          60             13           13            9     27             33
                    Paed.          60             14           11            6     26             34
                    Nurses         560           180           120         209     540            20
5     PHC 24X7      MO (F)         211            20           54           36     81             130
                    Nurses         633           174           129         241     549            84
6     MMU                          168             0           134          10     140             28
7     MPHW(F)                      230           230           116           -     230              -
      Urban
      Slums
8     2nd ANMs                     954                         933          -      933            21
      Sub
      Centres
                     Total =      3491          962           1716         601     3060           431


                                                                                            20
Programme Management Unit
      •   Under NRHM State Programme Management Unit established. 10 Manager
          level officers and 34 supporting officials recruited.

      •   District Programme Management Unit established. 20 District Programme
          Managers, 20 District Accounts Officers, 20 Monitoring & Evaluation Officers
          recruited. 17 Maintenance Engineer, 20 Statistical Assistant, 20 Accountant
          cum Cashier placed.

      •   At Block level – 102 Block Statistical Assistant and 102 Block Accountant cum
          Cashier at 117 blocks recruited.

      •   155 Computer Operators out of total 173 placed.

                Para
Specialists and Para Medicals

      •   To upgrade 115 CHCs as FRUs – 26 Obstetrician, 25 Pediatrician and 336
          Staff Nurses recruited.

      •   To upgrade 101 – 24x7 PHCs – 126 Female Medical Officers and 303 Staff
          Nurses recruited.

      •   For 20 Mobile Medical Units – 20 MO (Male) and 14 MO (F), 20 Staff Nurses,
          20 Radiographers, 20 Lab Technician, 20 Drivers and 20 Helpers recruited.

Recruitment of ANMs

      •   514 ANMs recruited in December 2008 to fill up all the vacant post of ANMs
          in the Sub-Centers (2858) under Central Government Scheme 2211.

      •   954 ANMs recruited in December 2008 as 2nd ANM for the Sub-Centers
          having population of 6000 or more.

      •   All these ANMs have been recruited district wise and there is no provision for
          their transfer. They can never be transferred outside the district.



MATERNAL HEALTH

      Institutional Deliveries

      Data of DLHS-III shows that 36.1% pregnant women are not going to health
      institutions for delivery because of cost factors. To promote institutional
      deliveries, the State Govt. has initiated the following steps:

      • Deliveries and delivery related services have been made free at all Govt.
          Hospitals from December 2008 by the State Govt.
      • Provision of referral transport, Rs. 200/- to PW for referral transport
                                                                                     21
• Incentive to ASHA for institutional deliveries
• VHND are observed regularly to promote health services till December 2009
    75408 VHNDS have been observed and approximately 11406 registrations,
    12953 ANCs, 11153 TT were given to PW and 29725 infants were immunized.
• The progress of institutional deliveries at strengthened institutions have
    raised significantly.

                                            Institutional
                            Institutional                                    %age
                                             Deliveries     Difference
Sr.        Institute/        Deliveries                                    Increase
                                                Upto         In No. of
No.         Category            Upto                                           2008
                                                                          over 2008-
                                             December -     Deliveries
                            December-
                            December-09                                       09
                                                 08
1                DH             19880          16849           3031         17.99
2                SDH            13024          10380           2644         25.47
3            CHCs
       a) CHCs                                                     6819     70.46
                                16497          9678
          (PHSC)
       b) CHCs                                                     411      68.61
                                1010            599
          (DHS)
                                                                   4439     93.35
4         24x7 PHCs             9194           4755

            RURAL                                                  207      60.17
5                                551            344
           HOSPITAL
          SATELLITE                                                133      30.79
6                                565            432
          HOSPITAL
                                  60721            43037       17684        41.09
        STATE TOTAL


112 CHCs have been designated as FRUs

• 50 CHCs in 2007-08, 10 in 2008-09 and 54 in 2009-10 upgraded to First
    Referral Units (FRUs). Blood storage units have been established in 25 CHCs
    and for rest is in progress out of 2008-09 & 2009-10 budget.
• So far 24 Gynecologist, 24 Pediatricians have been appointed under NRHM.
    Anesthetists on call in all the FRUs.
• 52 CHCs are without Gynaecologist and 81 CHCs are without Paediatrician.
• 5 Staff Nurses are being provided in each centre.
• Biometric based online attendance system for all upgraded centres has been
    installed.

                                                                              22
216 Primary Health Centres (PHCs) and Rural Hospitals has been strengthened as
24x7 Centres

•     75 PHCs upgraded to 24x7 PHCs in 2007-08, 26 PHCs in 2008-09 and 110
      PHCs/RH and 5 Satellite Hospitals in 2009-10 for providing 24 hours delivery
      services. Total upgraded 216.
•     Out of 216 PHCs identified for 24x7 services, Female Medical Officers have
      been posted in 102 PHCs on contractual/ regular basis. State Govt. has
      recruited Medical Officers through Punjab Public Service Commission. 3 Staff
      Nurses provided in each centre through NRHM.
24 x7 PHCs and FRUs
•     Special Sign-boards for these 101 and 60 institutions have been designed and
      work allotted for their installation at 161 sites and installation under process.
•     On line monitoring of performance of these institutions through PEC, work
      given.
•     Biometric based on-line attendance system. Tender already received.


    Janani Suraksha Yojna:

•     During year 2009 (upto Nov.09), 59024 JSY beneficiaries have been given
      incentives which is 138% more than the previous year.

          Year                 Number of Beneficiaries               Expenditure

                                                                    (Rs. In Lakhs)
                       For Home/ Non            For        Total
                        Institutional       Institution
                          Delivery          al Delivery

       2005-06
       2005-                 7489              4106       11595         70.99

       2006-
       2006-07               9466              6613       16079         88.69

       2007-
       2007-08               16453            12823       29256         170.90

       2008-09
       2008-                 40350            27561       67911         383.92

      2009-10
      2009-                  38482            26990       65472         414.49
           Dec.
      Upto Dec.




                                                                                     23
                    Jan     ojn
                           Yoj
          Surakshit Janepa Yojna
   •     Rs 2 crore provided in PIP 2008-09 for Private Health Institutions for Deliveries
         of BPL/SC families
   •     Scheme has been revised.
   •     The average fixed rate for delivery to be reimbursed to the API (Accredited
         Private Institution) has been revised to Rs. 2500/- from earlier rate of Rs. 1700/-
         on the basis of assessment in the field.
   •     400 deliveries conducted under Surakhit Janepa Yojna.



INNOVATION ON BREASFEEDING

Capacity building Training of Middle Level Trainers and Front Line Trainers on Infant and
Young Child Feeding Counselling (IYCF)

                An intervention has been carried out during FY 08-09 on pilot basis in
two districts, i.e. Gurdaspur and Ferozepur of Punjab to enhance optimal breastfeeding
rates.

                Training of Middle Level Trainers and Front line workers in Infant &
Young Child feeding counseling for district Ferozepur & Gurdaspur has been conducted
for the state of Punjab through National level NGO- BPNI (Breastfeeding Promotion
Network of India)

             • 29 Medical Officers & 77 Staff Nurses have been trained as Middle level
                trainers from the health sector, who could act as support system for any
                referral.
             • All these Middle Level Trainers have been further trained 3500 Frontline
                Workers (ANM & ASHA etc.) of the districts in counseling on
                breastfeeding and complementary feeding .
             • Breast feeding counseling has been integrated into existing instructions
                so as to bring down infant mortality.




                                                                                         24
FAMILY WELFARE PROGRAMME:

  •   State ranks 2nd amongst the major states in the country in achieving highest
      number of Non Scalpel Vasectomy which is 13% of the total sterilizations.
  •   58926 sterilizations were performed during the year (upto Nov.09) which is
      55.8 percent of the Expected level of achievement.
  •   During the year 2010-11 major thrust alongwith male participation will be on
      the alternative methodology i.e. No Touch Technique of IUCD (CuT).

  TFR for Punjab as per SRS data 2006 is 2.1 which is practically the maintenance
  level.

          Year         NSV         %age       Tubectomy       %age        NSV+
                                                                       Tubectomy

        2005-06       15482      14.43 %        91829       85.57 %      107311

        2006-07        5455       5.83 %        88143       94.17 %       93598

        2007-08       13110      12.61 %        90798       87.39 %      103908

        2008-09       12760       89.42%        84879       93.28%        97639

        2009-10        8435       58.09%        57560       63.14%        65995
        upto Dec.



IMPLEMENTATION OF PRE CONCEPTION & PNDT ACT:

  •   Sex Ratio in the age group 0-6 was 798 as per 2001 census. As per latest SRS data it
      has increased from 796 in 2002 to 821 (0-4 age group) in 2006.

  •   23 Panchayats of villages having sex ratio of 1000 or more were awarded
      cheques of Rs.1.5 lakh each at Amritsar on 8.11.2009.

  •   31 Ultrasound Centres were suspended for violation of section 20 of the Act.
  •   Two court cases have been launched for violation of provision of the Act.
  •   Five convictions of the accused have been ordered by the Hon'ble Court.




                                                                                       25
NGOs

    •   A sum of Rs 2.42 crore has been provided for NGOs under RCH in the PIP 08-09.
    •   Mother NGO scheme extended to 18+1 out of 20 districts of Punjab.13+1
        districts implementing        scheme in unserved and underserved areas of the
        districts and 5 Mother NGOs in preparatory phase of proposal development.
    •   Service NGO scheme extended to 4 districts: Ludhiana, Amritsar, Bathinda and
        Gurdaspur covering unserved /underserved slum areas and subcentres.
    •   External evaluation of MNGO-RCH Scheme conducted through external agency.
        Noticeable Improvement in RCH Indicators in the project areas.
    •   Few capable n credible Mother NGOs involved in training of ASHAs at block level
        .
    •   MNGOs/FNGOs acting as member secretary in planning                       and monitoring
        committees at district/block level. Act as facilitators for utilization of untied
        funds at SC/PHC and CHC level.
    •   Acting as facilitators for effective functioning of VHSCs and ASHAs in the field,
        especially in their project areas.

HMIS – MONITORING & EVALUATION –

With the introduction of HMIS/DHIS2, Punjab initiated the process of electronically entering the
 data and started facility wise online entry upto sub centre level since May 2009. The Phase I of
 the HMIS, (September 2008 to March 2009) focused on “establishing systems required for
 routine information processing, (including data entry, processing, reporting and transmission).”
 During this phase Punjab was successful in placing designated staff at the state and district levels
 capable of operating the applications for all the routine information processing activities
 including data entry, data validation, generation of routine and analysis reports, and the
 transmission of data and reports across different administrative levels.

Punjab has improved significantly in managing the database for each facility. Punjab now is in the
Phase II wherein main focus is on the use of information for action, including strengthening and
institutionalizing processes for the use of information for action.




                                                                                                  26
ACCREDITED               ACTIV     (AS
ACCREDITED SOCIAL HEALTH ACTIVISTS (ASHAS)
      •     One ASHA for 1000 population. Total number of ASHAs required to be
            selected is ·17756, out of which 17093 ASHAs have already been selected,
            remaining 359 ASHAs are under selection.
      •     ASHA Training for Module 1 completed.

INFRASTRUCTURE STRENGTHENING UNDER NRHM
Under NRHM Govt. of India has been providing funds for the Additions/Alterations and
Repair/Renovation of various Medical Institutions from time to time on the basis of
provisions made in the yearly state PIPs of NRHM. Accordingly, since the inception of
NRHM following civil works have been done in the State of Punjab.

      1)     District Hospitals

             All the district hospitals have been renovated under NRHM. Out of 20
             District Hospitals Civil Work in 16 district hospitals has been completed in
             the remaining District Hospitals where major works have been taken up,
             the work is likely to be completed by August & September of year 2010.

      II)    Sub-Divisional Hospitals (SDHs.)
             Sub-

             Major Civil Work has been taken up in 3 SDHs Patti, Pathankot & Batala
             which is likely to be completed by September, 2010.

             In addition to this 25 SDHs have been taken up for repairs during the year
             2009-10 @ Rs. 10.00 Lakh each.

      III) Community Health Centres (CHCs)

             Govt. of India provided Rs. 23.20 crore of its own for the repair &
             renovation of 116 CHCs @ Rs. 20.00 lakh each during the years 2005-06 &
             2006-07. All the CHCs have been repaired & renovated accept 5 CHCs
             where there was no work to be done. 10 more CHCs have been taken up for
             repairs. For 6 CHCs work orders have been issued. CHC Dhakoli (Mohali)
             has been taken up for major construction work and the work is likely to be
             completed by August, 2010.

             In addition to this by the year 2009-10 all the 114 CHCs under PHSC have
             been taken up for providing EmOC services.

                                                                                      27
     IV) Primary Health Centres (PHCs)

              Upto the year 2009-10 in all 211 PHCs/RHs and 5 Settelite Hospitals of
              Amritsar have been taken up strengthening to provide 24x7 hrs delivery
              services. Civil Works in 85 PHCs/RH have been completed and for the
              remaining institutes estimates are being prepared.

     V)       Sub-
              Sub-Centres (SCs)

                       Renovation:
              Repair & Renovation: Work for repair & renovation of 50 Sub-Centres have
              been started and for the remaining sub-centres which require renovation
              estimates are being prepared by PHSC-Mohali.

              New Construction :     180 New Sub-Centres are being constructed. The
              estimates are being prepared by PHSC.

DRUGS AND EQUIPMENT
     1) Drugs                                                        (Rs. In Lacs)
        -    PIP Provision:            2007-
                                       2007-07             2008-09
                                                           2008-          2009-
                                                                          2009-10
                PHC                     1662                 484            97
                CHC                         90               360           290
                SDH                          -                  -          108
                DH                           -                  -          200
          -     Procured for Rs. 17.68 crore from the CPSUs for PHCs and Sub-Centres
          -     For CHCs – funds being transferred to PHC for purchase of medicines.
                     Tenders received and under process.



     2) Equipment                                                    (Rs. In Lacs)
         -   PIP Provision:                                2008-09
                                                           2008-          2009-
                                                                          2009-10
                PHC                                        130.46           97
                CHC                                        621.32          200
                DH                                              -          100
          -     The requirement has been finalized by PHSC and tenders were floated
                     and received by PHSC
          -     Orders are being placed




                                                                                       28
 NTIED FU
UNTIED FUNDS AND ANNUAL MAINTENANCE GRANT

  •   Untied funds for SCs @ Rs. 10,000/-, PHCs @ Rs. 25,000/- and CHCs @ Rs.
      50,000/- provided.

  •   Annual maintenance grant to PHCs @ Rs. 50,000/- and CHCs @ Rs. 1,00,000/-
      provided.

  •   Rogi Kalyan Grant to DHs @ Rs. 5.00 lac, SDHs & CHCs @ Rs. 1.00 lac, provided.
MOBIL MEDICA UNIT (MMUs
MOBILE MEDICAL UNITS (MMUs)
  BI            NITS
  •   24 Mobile Medical Units (MMUs) purchased. The cost of one MMU is Rs. 36.00
      Lakh and it has the facility of ECG, X-ray and Laboratory.
  •   The staff provided is one Medical Officer (Female), one Medical Officer (Male),
      one Radiographer, one Laboratory Technician, one Staff Nurse, one Pharmacist,
      one Driver and one Helper.
  •   6 positions of Medical Officer (Female) vacant.
SCHOOL HEALTH
SCHOOL HEALTH
  •   Out of 26368 schools which were to be covered in 2009-10, a total 18225 schools
      covered till December 2009 by Government Doctors.
  •   2185194 students in Primary and Secondary level schools, examined till
      December 2009.

  •   Free treatment at Govt. hospitals to all school going Children.

  •   Albendazole Tablets (2 per Child) have been provided in all the schools.

  •   Scabies Lotion has also been provided in sufficient quantity.
  •   Under RHD control program so far 431 no of children were referred for
      treatment which includes 318 at PGI Chandigarh ,102 at DMC Ludhiana,8 at
      Silver Oak Hospital Mohali and 3 at IVY Hospital Mohali. So far 120 children have
      been treated and amount of Rs.1.55 Crore has been spent on the treatment and
      the remaining children will be cured by March 2010.
  •   Treatment of Children Suffering from Cancer has been started in May 2009 so far
      34 Children have been referred to PGI Chandigarh for treatment and Rs.10.00
      Lacs have been spent on their Treatment.




                                                                                       29
PART – C IMMUNIZATION:

  •   District level Household Survey (DLHS)-3 was undertaken in the year 2007-08
      and report has been released in the year 2009 by GOI. Punjab state has
      performed very well in the indicator of fully immunized children and achieved
      80% coverage.
  •   Punjab state is placed 3rd at the National level, first being Tamil Nadu at 83% and
      2nd being Himachal Pradesh at 82%.



     D-          DISEASE
PART D- NATIONAL DISEASE CONTROL PROGRAMME



REVISED
REVISED NATIONAL TB CONTROL PROGRAM

  •   Under this program , medicines are provided to patients free of cost in specific
      Patient wise Box.
  •   Initially in Punjab state only 20% of the regular LTs were allowed to be recruited
      under RNTCP but now the state has been allowed to recruit 50% of the regular
      LTs on Contractual basis.
  •   An intermediate reference laboratory for Culture Sensitivity test is going to be
      established at TB hospital, Patiala for the diagnosis and treatment MDR-TB cases.
  •   IMA Punjab, has initiated the Public Private partnership project between IMA,
      Punjab and RNTCP, Punjab to assist in achieving the goal to bring down the
      burden of TB in Punjab till it ceases to be a public health problem
  •   Various activities like Community Meetings, Awareness camps and Magic Shows
      are organized in all the districts across the state for creating awareness .
  •   Patient Provider Meetings are also organized to make patient compliance
      towards the treatment.
  •   Trainings of ASHA Workers are being done at district level.
  •   During this year upto Nov-09 , 36000 patients have been put on treatment and
      achieved 90 % cure rate.




                                                                                      30
NATIONAL
NATIONAL LEPROSY ERADICATION PROGRAM

  •   During the year 2008-09, 933 new leprosy cases have been detected and brought
      under       treatment   with   which   prevalence    rate   becomes     0.32/10000
      populations.(Elimination Goal One Case per 10,000 Population) Out of this, 180
      patients are Punjabi Cases, which is a matter of concern.
  •   614 new leprosy cases have been detected during the year 2009-10 (upto
      Nov.2009).
  •   There are 33 leper colonies in different parts of state in which 2192 inmates are
      residing.
  •   7 leprosy affected deformed persons have been operated for Reconstructive
      Surgery (RCS) for correction of deformity.

                                        ROGRAM
NATIONAL VECTOR BORNE DISEASE CONTROL P ROGRAM

  •   245 cases of dengue were reported in Punjab state during the year 2009 as
      compared to 4349 reported during the year 2008.21 deaths were reported due
      to Dengue during the Year 2008 and only 1 death was reported in the year 2009
      .There is marked decrease in cases as well as deaths.
  •   No case of Japanese Encephalitis, Chickungunya and Kala Azar were reported
      during the year 2009.
  •   179 cases of and 31 deaths were reported from different hospitals due to H1N1
      Influenza, till 29th December 2009
  •   Facility for isolation wards, ventilators and sufficient quantity of Tami Flue tablet
      is available in the state for all age group.3000 persons has been given
      presumptive prophylactic treatment. State Govt. is also trying to establish
      another testing lab at Govt. Medical College Amritsar in addition to one at PGI
      which is already functional.
MENTAL HEALTH PROGRAMME

  •   14 Medical officers and 138 Non-medical professionals at DMHP, Hoshiarpur and
      25 Medical officers, 151 Para medicals and 26 Non-medical professionals at
      DMHP, Sangrur have been trained in mental health during the year.
  •   209 Medical officers, 246 Para medicals, 256 Non Medical professionals and 26
      NGOs have been trained in Mental Health till date at both DMHPs.



                                                                                        31
  •   Two Drug Dependence Treatment Centers has been made functional at Civil
      Hospital, Ferozpur and Phagwara during the year. 10 Drug Dependence
      Treatment Centers have been functioning in the Civil Hospitals of the State.
  •   The building of Drug Dependence Treatment Center at Civil Hospital Talwandi
      Sabo at the cost of Rs.155.4 Lakh is almost complete. The Centre will be
      functional soon.
  •   A study on drug abuse in the four border districts of the State is being conducted
      by the Institute of Development and Communications ( IDC) at the cost of Rs.
      5.00 lacs. The Report is expected to be submitted soon.
  •   The Psychiatrists have been posted in all the districts of the state.
  •   Ten beds have been ear marked in the district hospitals for Drug Dependent
      persons for De-addiction.



         PROGRAMME
NATIONAL PROGRAMME FOR CONTROL OF BLINDNESS
  •   1,09,369 cataract operations and 1,02,332 IOL were performed in the year 2009-
      10 (Upto Dec. 09).
  •   3,95,772 School Children were Screened for refractive error , out of which
      27,779 children were found suffering with Refractive Error and 7,122 children
      were distributed free Spectacles.
  •   4 Yag Laser for Medical Colleges were purchased and supplied.
  •   Under IEC activity an advertisement has been given in Regional News paper for
      protection of eyes on the eve of festival and pamphlets have been published and
      distributed in district.
  •   GOI have granted sanction to upgrade Regional Institute of Ophthalmology at
      Medical College Amritsar.
  •   Eye Donation awareness camps with the help of Eye Banks (3 are Govt. and 2 are
      Private public) has been organized.



                CONTROL
NATIONAL CANCER CONTROL PROGRAM

  • Mammography unit for screening breast cancer has been installed at Civil
      Hospital Bathinda. It is working since February, 2009 and 158 patients have
      been screened till November, 2009.


                                                                                     32
   •   State Government in collaboration with Max Health Care is setting up Super
       Specialty Hospital for Cancer & Trauma Care in the premises of Civil Hospital
       Mohali and Super Specialty Cancer & Cardiac Hospital in the premises of Civil
       Hospital Bathinda. Construction work has been started and the hospitals are
       likely to be completed within 18 months.
   •   Cancer Detection Camps have been held in Bathinda, Mansa and Mukatsar
       districts in collaboration with Roko Cancer, Non Government Organization. 3506
       patients were examined, 893 patients were submitted to mammography and 31
       patients were found suspected.
   •   Proposal for setting up a Population Based Cancer Registry at Bathinda has been
       submitted to ICMR.
   •   The testing of heavy metals in drinking water like Arsenic, Cyanide, Chromium,
       Lead, and Mercury has been started in the State Public Health Laboratory. 89
       samples have been tested till November, 2009.
   •   Financial assistance under State Illness fund through Punjab Nirogi Society is
       provided to cancer patients along with other life threatening diseases belonging
       to below poverty line families up to the tune of Rs. 1.5 Lacs. 16 patients have
       been provided relief under the scheme till 8/12/2009 by Punjab Health Systems
       Corporation.
   •   School children suffering from cancer are provided free treatment by Punjab
       Government. 34 school children have been referred to PGI, Chandigarh.
   •   House to House Survey has been initiated by the department through field


Community Participation
State has constituted State/ District/ Block/ PHC Health Planning and Monitoring
Committees. As stated above RKS has been notified upto CHC level and at PHC these
committees will act as RKS alongwith planning and monitoring activities. State has
organised a orientation programme for approximately 12,000 PRI representatives in
collaboration with State Institute of Rural Development (SIRD), Nabha.




                                                                                    33
Major Issues affecting the implementation of NRHM/ RCH II in the State

The State has three distinct regions with relatively plain areas. The districts like
Amritsar, Tarn Taran, Ferozepur and Gurdaspur share International border with
Pakistan. Some of the critical issues adversely affecting the Health services are given
below:
      1. Non availability of Medical Officers (Female) and specialists in the fields of
         Gynaecology & Obstetrics, Paediatrics and Anaesthesia for 24 Hr PHCs Delivery
         Services and CHCs (EmOC) adversely affects the provision of 24 hr delivery
         services and Emergency obstetric care services respectively in these
         institutions.

      2. Lack of residential facilities adversely affects the availability of medical and
         para- medical staff in heath facilities for 24 hours delivery services. None of the
         sub centres have residential facilities for ANMs and PHCs lack residential
         facilities for MOs, SNs and other supporting staff.

      3. Vacancies of specialists (OG & Paediatricians) at CHCs and FRUs restrict the
         secondary level care to below desired level for EmOC and CNBC.

      4. Low level of implementation of planned activities due to above factors leading
         to under utilisation of approved budgets and other resources.




                                                                                         34
Due to the above hindering factors, the results of the programme are low. In order to
address the above issues, the following priority actions have been proposed in the plan:
           PROPOSED:
PRIORITIES PROPOSED:
                                    Reproductive & Child Health Programme
Maternal         •   To increase the early registration of ANC, specially in first trimester
Health
                     through VHNDs and initiative of ASHA and ANM
                 •   To increase full ANC registration by home visit and coverage through JSY.
                 •   to strengthen institutional deliveries and EmOC facilities by operationalising
                     115 CHCs for EmOC services and operationalising 236 PHCs, Rural Hospitals
                     and 5 Satellite Hospitals for providing 24x7 days delivery services by 2011
                 •   Recruitment of Gynaecologists and Female Medical Officers on
                     regular/contract basis
                 •   Contracting staff nurses (3 for PHCs and 5 for CHCs) for increasing
                     institutional deliveries and RTI services.
                 •   To facilitate referral transportation for institutional deliveries
                 •   Improve the post natal care services
                 •   Decrease the prevalence of RTIs/ STIs specially among women
                 •   To establish the institutional mechanism to carry out social audit to for
                     maternal and infant deaths.
                 •   To ensure reporting of every maternal and infant death with 24 hours with
                     occurrence to Civil Surgeon, Deputy Commissioner and Mission Director.
                 •   To train MOs for Basic Emergency Obstetric Care and Anaesthesia for
                     strengthening EmOC at PHCs and CHCs
Child Health     •   To strengthen Facility and Home Based New Born Care.
                 •   To Improve Neonatal and Child health through the Implementation of IMNCI.
                 •   Promote home based neo born care through health education and IEC.
                 •   Care of Sick Children and Severe Malnutrition.
Family           •   To sustain and further escalate the decrease in Total Fertility Rate
Planning
                     (TFR), to maintain at replacement level.
                 •   to bring down the unmet need for family planning through home visits
                     and IEC
                 •   To increase the CPR




                                                                                           35
Adolescent      •   To strengthen the adolescent health services through provision of
Health
                    Adolescent Friendly Health Services (AFHS) at DH/ SDH/ CHC/ PHC.
                •   To operationalize multi skill adolescent friendly health centres in DH/
                    SDH for counseling and treatment on adolescent problems.
                •   Increasing awareness among the adolescents about the service
                    availability.
                •   Training of ICTC Counselors and other stakeholders.
                •   Developing linkages for referral services and ASRH education
                •   Controlling anemia in adolescent girls & pregnant women-attention to
                    compliance to IFA
Urban RCH       •   To provide holistic RCH services to urban slum population.
Sex Ratio and   •   Advocacy for girl-child.
PC-PNDT
                •   Award money to Panchayats.
                •   Prize/ incentive to informers/ decoy patients
                •   To ensure efficient implementation of PC-PNDT Act.
HMIS            •   To strengthen MIS and Monitoring system for improving programme
                    efficiency and Effectiveness.
                •   To strengthen monitoring system through the establishment of a GIS
                    based MIS system.
                •   Central Registration System (CRS) for birth and death registration.
                •   To develop a performance grading system for Health facilities for
                    identifying and strengthening poor perform facilities and rewarding
                    best perform facilities as part of IPHS up gradation.
BCC             •   To bridge critical gaps between the health services and the targeted
                    beneficiaries with special emphasis upon bringing in positive Health
                    seeking behavior of community as well as behavior of service provider
                    through effective BCC tools varying from conventional IPC methods to
                    high profile multimedia strategies.
Programme       •   To strengthen the state’s capacity for implementing NRHM/ RCH II by
Management
                    establishing an SHSRC
                •   To strengthen State/District/ Block Programme Management Units
                    under NRHM for decentralised programme management.


                                                                                     36
ASHA             •   To establish ASHA Resource Centre, as part of State Health Systems
                     Resource Centre to act as support mechanism to build the capacity and
                     monitor their performance.
                 •   Activity based incentive to ASHA.
                 •   Training and refresher training to ASHA.
                 •   Provision of Drug Kits to ASHA.
Infrastructure   •   To strengthen 115 CHCs and 296 PHCs for EmOC services with
Upgradation
                     infrastructure supports.
                                     National Programme
Revised          •   Training of DTOs, MOTCs, STSs, STLSs, MOPHI and DOTS Plus providers
National
Tuberculosis     •   Media Workshop & Sensitisation workshop for NGO Official.
Control          •   Organization of CME / sensitization workshops / publication & media
Programme
                 •   Training of all staff in medical colleges in RNTCP as per the NTF
                     recommendations and involving them in advocacy.
                 •   Conducting operational research/ Thesis.
                 •   Strengthening of mechanism for sputum collection & transportation.
National         •   Increase surveillance to find malaria cases among fever cases.
Vector Borne
Disease          •   Identification of villages/towns where significant increase in malaria
Control              incidence is observed.
Programme
                 •   Specific initiatives to involve the private practitioners for reporting of
                     malaria cases at district level
                 •   Concerned MO will carry out the rapid fever surveillance and will
                     provide treatment to all the suspected fever cases and radical treatment
                     to the confirmed malaria cases.
                 •   Training and re-orientation of existing laboratory technicians in the
                     public and private sectors to improve access to diagnosis and improve
                     quality.
National         •   To maintain a sufficient level of effort for New Case detection.
Leprosy
Eradication      •   Implementation of DPMR Activities.
Programme.       •   Implementation of Urban Leprosy Control Programme.
                 •   Services to be provided at 34 Leprosy colonies.
                 •   Capacity Building of GHC staff




                                                                                        37
National         •   Grant-in-aid to NGOs for cataract operations.
Programme
for Control of   •   Provision of spectacles etc. to school children.
Blindness.       •   Provision of Phaco and Yag laser machines.
                 •   Strong IEC campaign.
                 •   Manpower to strengthen the programme.
Iodine           •   Strengthen IDD Cell at State.
Deficiency
Disorder         •   State IML Lab.
Control          •   Promotion of consumption of Iodized salt
Programme
                 •   BCC Activities
Integrated       •   Training of Pharmacist, Nurse and Health Worker.
Disease
Surveillance     •   Sensitization of S/DSU.
Project (IDSP)   •   Strengthen the surveillance.
                 •   Provision of Contractual Staff.
Inter-Sectoral   •   To integrate AYUSH into public health system through CHCs and PHCs
Convergence
                     for meeting complete health needs of the community.
                 •   Convergence with Department of Social Security Women and Child
                     Development to strengthen Maternal and Child Health Programme.
                 •   BCC Campaign for sanitation in collaboration with DWSS.
                 •   Involvement of PRIs.
                 •   Orientation of members of VHSCs, Health Planning and Monitoring
                     Committees.
                 •   To initiate the Community Monitoring Mechanism
                 •   To operationalize hotline under NRHM




                                                                                 38
                                            2010-
                             BUDGET FOR PIP 2010-11

                   SAP SUMMARY BUDGET( RUPEES IN LAKHS)
S. Components        Sub Components                %age of Total    %age of
No.
No                                                     PIP         Component
 A                             Pool
                    RCH -Flexi Pool    Modified
                                        Budget
 1 Maternal Health  Maternal Health     210.00       0.58%           2.22%

                       Janani Surakshna       612.00   1.68%         6.48%
                       Yojna
2    Child Health &                           122.44   0.34%         1.30%
     IMNCI
3    Family Planning                         1128.55   3.10%        11.95%

4    ARSH                                     95.97    0.26%         1.02%

5    Urban RCH                                190.44   0.52%         2.02%

8    Innovations       PNDT Sex Ratio         95.04    0.26%         1.01%
     PNDT & SEX
     Ratio/PP/NGO      Innovations /          269.06   0.74%         2.85%
                       PPP/NGO
9 & Institutional      Infrastructure &      2632.00   7.23%        27.87%
10 Strenthening(HR     Human
    D/ Logistic/M&     Development
    E/HMIS, Quality    Logistic               17.09    0.05%         0.18%
    control)           Management
                       Quality Assurance      50.00    0.14%         0.53%
                       and Infection
                       Control Programme
                       HMIS Monitoring        430.97   1.18%         4.56%
                       and Evaluation
11   Training                                 813.73   2.23%         8.62%

12   Behaviour                                422.00   1.16%         4.47%
     Change
     Communications
13   Procurement                             1837.25   5.05%        19.46%

14   Programme                                516.35   1.42%         5.47%
     management
     Units SPMU,
     DPMUs and
     Operational
     Expenditure
                       Total A (RCH II)      9442.90   25.93%       100.00%


                                                                     39
S. Components          Sub Components                   %age of Total    %age of
No.
No                                                          PIP         Component
                                                                        Component
 B  NRHM Additionalities                     Modified
                                             Budget
                     ASHA                    1475.31       4.05%         9.73%
                     Untied Fund             1800.55       4.95%         11.88%
                     Upgrading District      2480.40       6.81%         16.36%
                     Hospitals
                     Upgrading of CHCs        788.88       2.17%          5.20%
                     to IPHS
                     Upgrading PHCs for      1827.50       5.02%         12.06%
                     24 hr Services,
                     IPHS
                     Provision for sitting     0.00        0.00%          0.00%
                     arrangement for
                     ANMs in the Non
                     Sub Centre Villages
                     Upgrading Sub           1416.23       3.89%          9.34%
                     Divisional
                     Hospitals/ FRUs
                     Other Activities i.e.    548.50       1.51%          3.62%
                     Computerization,
                     Ambulances
                     Annual                   638.60       1.75%          4.21%
                     Maintenance Grant
                     Rogi Kalyan Samiti       715.00       1.96%          4.72%
                     District Action Plan      0.00        0.00%          0.00%
                     Mobile Medical           480.00       1.32%          3.17%
                     Unit
                     Emergency                 0.00        0.00%          0.00%
                     Response Services
                     School Health           690.00        1.90%          4.55%
                     Additional Staff        1244.17       3.42%          8.21%
                     Community               380.00        1.04%          2.51%
                     Monitoring
                     Procurement              41.00        0.11%          0.27%
                     Dental Programme         63.32        0.17%          0.42%
                     Mobile Phone to          163.80       0.45%          1.08%
                     ANM
                     Management Costs         405.86       1.11%         2.68%
                     Total B                 15159.13        .63
                                                          41.63%        100.00%




                                                                          40
S. Components           Sub Components                  %age of Total    %age of
No.
No                                                          PIP         Component
 C  Immunization      RCH -Flexi Pool        Modified
                                             Budget
                       Immunization          1385.33       3.80%
                       including PPI
                       Total C               1385.33       3.80%          100%
                       (Immunization)
                       (Immunization)
D   National Disease Control Programme
                       RNTCP                  681.50       1.87%         37.44%
                       Leprosy                115.00       0.32%         6.32%
                       IDSP                   198.93       0.55%         10.93%
                       National Iodine        20.00        0.05%         1.10%
                       Deficiency Disorder
                       Control
                       Programme. -
                       NIDDCP
                       Malaria & Vector       114.38       0.31%          6.28%
                       Borne
                       Blindness Control     690.60        1.90%         37.94%
                       Total D               1820.41       5.00%          100%
E   Others
                       Covergence with        35.00        0.10%          2.22%
                       PRIs
                       Main Streaming of     1511.58       4.15%         95.70%
                       AYUSH
                       Special innovation     21.45        0.06%          1.36%
                       for Minorities
                       Convergence with       11.50        0.03%          0.73%
                       DWSS
                       Total E               1579.53       4.34%          100%
                                             29387.30
                      Total NRHM                          0.00%
                      Infrastructure and     7024.00      19.29%         100.00%
                      Maintenance
                      (Direction and
                      Administration
                      Head 2211)
                      Total CSS              7024.00      19.29%          100%
                      Total PIP Budget       36411.30     100.00%




                                                                          41
         PART-
         PART-A

RCH AND RELATED ACTIVITIES




                             42
Status of Health Indicators Punjab in comparison to India

SN                           CATEGORY                       INDIA   PUNJAB
      Crude Birth Rate
1                                                           22.8     17.3
      (SRS 2008)
      Total Fertility Rate
                                                             2.7     2.0
2     (SRS 2007)
                                                             2.7     2.0
      NFHS-III
      Death Rate
3                                                            7.4     7.2
      (SRS 2008)
      Sex Ratio at Birth
4                                                           901      837
      (SRS 2007)
      Sex Ratio (0 to 4 years)
5                                                           914      838
      (SRS 2007)
      Maternal Mortality Ratio (SRS 2001-03)                301      178
6
      (SRS 2008 data of 2004-06)                            254      192
      Infant Mortality Rate
                                                             57      42
7.    NFHS-III
                                                             53      41
      (SRS 2008
      Any Ante Natal Care
8.                                                          75.2     83.3
      DLHS – III
      Ante Natal Care
      (3 or more visits)                                    50.7     72.5
9.
      NFHS-III                                              75.3     65.1
      DLHS – III
      Full Ante Natal Checkup
10.                                                         18.8     14.3
      DLHS – III
      Institutional deliveries
                                                             41       53
11.   NFHS – III
                                                             47      63.3
      DLHS – III
      Pregnant women who are anemic (%age)
12.                                                         57.9     41.6
      NFHS – III
      Breast Feeding (%age)
       (i) Children under 3 years
                                                            23.4     10.3
13        breast fed within one hour of birth
                                                            40.2     44.6
      NFHS-III
      DLSH-III
      Exclusive breast-feeding (0-5 months)
                                                            46.8     32.4
14    DLHS-III
                                                            46.3     36.0
      NFHS-III
      %age of children fully immunized NFHS-III             44.0     60.0
15
            DLSH-III                                        54.1     79.9

                                                                             43
MATERNAL HEALTH

               Although %age of 3 Ante Natal Check-ups is 72.5 (NFHS-3), 65.1 (DLHS-
3) and of TT is 82.5% (DLHS-3) but consumption of IFA tablets is only 33.5% (DLHS-3)
26.1% (NFHS-3) and anemia among pregnant women is 41.6% (NFHS-3). These
indictors culminate to the full ANC only 14.3% (DLHS-3) i.e. pregnant women who have
at least three visits for ANC, one TT and 100 IFA tablets consumed. Institutional
deliveries have improved to 63.3% (DLHS-3) but data of SRS shows increase in MMR
which is a serious concern for the state.

             Institutional deliveries in the State are 63.33% and safe deliveries are
76.9%, but that means 23.1% deliveries are being conducted by unskilled attendants
which may be cause of Maternal and Infant Deaths.




                                   Source: DLHS 3

                                                                                  44
              District wise data shows that Institutional Deliveries in 7 districts are
below 60%. Institutional Deliveries in High Focused District Nawanshahar are below
55% and in Muktsar and Faridkot are below 60%. In the State PIP 2010-11 State focus
on these districts to improve institutional deliveries.

              State has to focus on early registration and ensures consumption of IFA
tablets by the pregnant women and strengthen the EmOC and referral services for
pregnant women.

•      Data shows that 62.9% women are registered for ANC check-up in the 1st trimester
       and in the rural areas its 60.4%




•      Mothers who have received any ANC have declined from 89.5% to 83.3%.




                                                                                    45
•   Mothers having 3 or more ANC have increased marginally from 63.5% to 65.1%.




•   The consumption of IFA tablets have increased from 22.7% to 33.5%, but full ANC
    check-up has declined from 18.4% to 14.3%.




                                  Source DLHS 3


                                                                                  46
               The initiative by the state under NRHM and state government are as:

Institutional Deliveries

               Data of DLHS-III shows that 36.1% pregnant women are not going to
health institutions for delivery because of cost factors. To promote institutional
deliveries, the State Govt. has initiated the following steps:

       •    Deliveries and delivery related services have been made free at all Govt.
            Hospitals from December 2008 by the State Govt.
       •    Provision of referral transport, Rs. 200/- to PW for referral transport
       •    Incentive to ASHA for institutional deliveries
       •    VHND are observed regularly to promote health services till December 2009
            75408 VHNDS have been observed and approximately 11406 registrations,
            12953 ANCs, 11153 TT were given to PW and 29725 infants were
            immunized.
       •    The progress of institutional deliveries at strengthened institutions have
            raised significantly.




                                                                                      47
                                 FRUs
112 CHCs have been designated as FRUs


      •   50 CHCs in 2007-08, 10 in 2008-09 and 54 in 2009-10 upgraded to First
          Referral Units (FRUs). Blood storage units have been established in 25 CHCs
          and for rest is in progress out of 2008-09 & 2009-10 budget.
      •   So far 24 Gynecologist, 24 Pediatricians have been appointed under NRHM.
          Anesthetists on call in all the FRUs.
      •   52 CHCs are without Gynaecologist and 81 CHCs are without Paediatrician.
      •   5 Staff Nurses are being provided in each centre.
      •   Biometric based online attendance system for all upgraded centres has been
          installed.




                                                                                  48
216 Primary Health Centres (PHCs) and Rural Hospitals has been strengthened as 24x7
Centres

      •   75 PHCs upgraded to 24x7 PHCs in 2007-08, 26 PHCs in 2008-09 and 110
          PHCs/RH and 5 Satellite Hospitals in 2009-10 for providing 24 hours
          delivery services. Total upgraded 216.
      •   Out of 216 PHCs identified for 24x7 services, Female Medical Officers have
          been posted in 102 PHCs on contractual/ regular basis. State Govt. has
          recruited Medical Officers through Punjab Public Service Commission. 3 Staff
          Nurses provided in each centre through NRHM.




Janani Suraksha Yojna




                                                                                   49
Although above efforts showed a positive trend especially for institutional deliveries
and JSY but non availability of Specialists and Female Medical Officers is of major
concern which hinders the functionality of institutions.

Constraints:

Non availability of Specialists




                                                                                   50
Objective: 1 To Increase early registration, especially in the first trimester

Issues/ Problems           • As per DLHS 3 62.9% women are registered for ANC check-up in the 1st
                              trimester and in the rural areas its 60.4%
                           • Most of the women are not availing themselves of these services as they are
                              not aware of the benefits and do not consider it necessary to get themselves
                              registered. Some intentionally avoid who are inclined towards having an
                              abortion in case the foetus is found to be female.
                           • Listing of all pregnant women through a system of registration is important
                              towards determining the exact need for the antenatal, natal and post-natal
                              services and thereby providing the requisite services effectively and
                              efficiently, and also checking and preventing female foeticide.

Strategies/ Services
Strategies/                Activities/ Inputs

Awareness       in   the • Organise Monthly Village Health and Nutrition Day (VHND) and use the
community            and      forum for early registration of pregnancy.
simultaneously       the • Increase the home visits of ANMs
public sector service • Orient ASHA and provide incentives to them for early ANC registration
delivery   to    ensure • Orient AWWs for early ANC registration of pregnant women.
prompt and        early • Propagate JSY among the BPL/ SC mothers for availing benefits by early
registrations in the 1st   registration by JSY.
trimester                • Provide RCH services through mobile health units in remote areas.
                           • Line listing of PW in the village by ANM.
                           • Increased involvement of several key institutions at the village level towards
                              increasing the number of registrations.
Support needed for • Early registration to be promoted through the coordination of Health Dept,
implementing                  ICDS and Panchayats
changes                    • Special incentives to be given to panchayat reporting 100% registrations for
                              pregnant women in 1st trimester.
                           • Community based organizations and religious institutions to be involved to
                              promote early registrations and care during pregnancy.
Benchmarks                 • Improved early registrations and institutional deliveries in the year 2010-
                              11

                           • Increased in registration of pregnancies in 1st trimester from 62.9% (DLHS


                                                                                                   51
3) to 80% in 2010-11




                       52
Objective: 2: To Increase ‘Full ANC’ registrations

Issues/ Problems            • Women with pregnancy are not aware of the possible complications arising
                               during pregnancy and thus do not seek ANC services/ medical help or get
                               delayed help

                            • It is reported that 46.8% pregnancies develop complications, while only
                               81.3% of those seek medical attention (DLHS 3)

                            • Although 65.1% received three or more ANC but only 14.3% women with
                               pregnancy received full ANC (3 ANC check-up, TT and 100 IFA tablets
                               consumed)

                            • Only 33.5% (DLHS 3) and 26.1% (NFHS 3) has consumed IFA tablets. This is
                               the major factor contributing the anaemia among pregnant women which is
                               41.6% as per NFHS-3.

                            • These factors contribute towards higher MMR and IMR and need to be
                               tackled

Strategies/ Services        Activities/ Inputs

Ensuring that all the • Increase the home visits of ANMs/ AWWs/ ASHAs with regular reporting
women               with       from them regarding the number and status of pregnancies in their area
pregnancy     undergo
                            • Orient ASHA and provide incentives to them for ensuring early registration of
full ANC availing of
                               pregnancies and full ANC and ensure that pregnant women consume IFA
all   the      facilities
                               tablet.
available in the full
                            • Orient AWWs to the importance and their role in motivating women to
ANC        basket      of
                               undergo early registration of pregnancies and full ANC
services
                            • Through increased coverage of JSY, ensure that the women with pregnancy
                               have early registration and undergo full ANC and institutional deliveries

                            • To ensure full ANC coverage, utilise the services of mobile medical units/
                               mobile health units to remote and inaccessible areas

                            • Map out the resources available at village level such as community based
                               organizations or women self help groups to enlist their support in ensuring
                               early registration of pregnancy and full ANC




                                                                                                     53
Support needed for • Active involvement of the Medical Officers at CHC/ PHC to counsel the
implementing           women on undergoing full ANC
changes
                    • Support of all the NGOs/ CBOs/ FBOs/ PPs/ Other Stakeholders in
                       motivating women with pregnancy and their family for full ANC registration

                    • Monitoring support from State/ District level health department
                       functionaries to ensure compliance from ANMs/ AWWs/ ASHAs etc

Benchmarks          • 90% ANC registration in 2010-11

                    • Women receiving 3 or more ANCs increased from 72.5% (NFHS-3) to
                       more than 90% by 2010-11

                    • Women receiving adequate IFA tablets increased from 33.5% (DLHS 3)
                       to more than 80% by 2010-11

                    • Possibility of developing complications during pregnancy reduced from
                       46.8% to below 20% by 2010-11

                    • Women having sought treatment for complications during pregnancy
                       increased from 81.3% to 95% by 2010-11




                                                                                          54
Objective: 3: To strengthen institutional deliveries and EmOC facilities

Issues/ Problems                         • Institutional deliveries have shown hike from 48.9% (DLHS 2) to
                                            63.3% (DLHS 3) and safe deliveries have increased from 64.2%
                                            to 77.1%.

                                         • During last three years state has operationalised 24x7 delivery
                                            services at PHCs and EmOC services at CHCs level leading to
                                            increase in institutional deliveries

                                         • Performance of high focused districts is below state average i.e.
                                            Jalandhar 60.4%, Nawanshahar 54.5%, Muktsar 55.9% and
                                            Faridkot 57.3%.

                                         • So State need to focused on service delivery in the focused
                                            districts and operationalise the 24x7 and EmOC services.

                                         • All first referral units and CHCs are expected to provide
                                            emergency obstetric care services

                                         • 24x7 PHCs are not fully functional mainly due to non availability
                                            of Female Medical Officer and referral transport

                                         • EmOC Facilities / FRUs are not fully functional mainly due to non
                                            availability of Specialists

                                         • Maternal Mortality Ratio at 192

Strategies/ Services                     Activities/ Inputs

1. Operationalising 236 PHCs, Rural • Contract Medical Officer Female and additional Staff Nurses (3 SN
   Hospitals and 5 Satellite Hospitals      for each PHC)
   for providing 24x7 days delivery
                                         • Female Medical Officers are posted in 102 PHCs for 24x7 services
   services by 2011
                                            and deliveries are being conducted in 197 PHCs.
• All PHCs and Rural Hospitals in
                                         • Provide need based supplies, support, equipments, service
   focused      districts   to     be
                                            guidelines & referral protocol/ cards, feedback cards, registers,
   strengthened to provide 24x7
                                            etc to PHCs
   delivery services.
                                         • Improve/ repair facilities like LR/ MW/ OT/ Toilet/ Water
• 24-hour delivery services, both
                                            supply, waiting area, fencing, etc
   normal and assisted

                                                                                                   55
• Essential new born care               • Formalise referral linkages with FRUs for EmOC.

• Referral for emergencies              • Provide referral transport through public private partnership-
                                           dovetail with Janani Suraksha Yojana
• Ante- natal care and routine
  immunization services for children
  and pregnant women (besides
  fixed day services)

• Post-natal care

• Early and safe abortion services
  (including MVA)

• Family planning

• services

• Prevention and management of
  RTIs/STIs

• Essential laboratory services

2. Operationalising 114 CHCs for • Improve facilities for EmOC
  EmOC services by 2011.                • Provide need based equipments, supplies and support

• Emergency Care of sick children.      • Equip the facilities for blood storage in 115 CHCs / FRUs. At 25 CHCs
                                           BSUs have been operationalised and rest will be operational by the end
• Full range of family planning
                                           of this year.
  services including Laparoscopic
  Services.                             • Hire contractual doctors/specialists and paramedic staff for making
                                           CHCs as FRUs
• Safe Abortion Services.
                                        • Training of 20 OBG or MO in EmOC.
• Treatment of STI/RTI.
                                        • Training Paediatricians or MO and Para Medicals in IMNCI/ENBC
• Essential Laboratory Services.           (detailed at 11.5.1, Trainings).

• Referral (transport) Services         • Anaesthetic or MO trained in LSAS.

• EmOC        including       surgical • Develop public private partnership for availability of safe blood
  interventions     like  Caesarean • Contract specialist through PPP, where specialists are not available
  Section     and    other medical
                                        • Maternal death audit by district health teams and review of maternal
  interventions.
                                           audit reports by district society meetings/ DC and state Executive
• Blood Storage facility                   committee/ MD NRHM.

                                                                                                       56
• New-Born Care                        • Provide ambulances to FRUs for referrals

• 24-hour      delivery     services • Support referral transport
  including normal and assisted
  deliveries

3. Increasing awareness among the • Support to NGOs for improving ANC care seeking during
  community regarding the need            pregnancy as part of MNGO activity
  and availability of delivery care/
                                       • Link up with AWWs and ASHAs and sensitization of AWWs on
  services particularly in reaching
                                          conducting ANC sessions
  SC/ BPL mothers
                                       • IEC on the importance of ANC and BCC for timely care seeking
                                          behaviour particularly for the BPL/ SC mothers

Support needed for implementing • Coordination with different agencies like PHSC, PSACS
changes
                                       • Active involvement of ICDS.

Benchmarks                             • Institutional deliveries increased to 80% by 2010-11

                                       • 50% PHCs to made 24x7 functional by 2010-11

                                       • FRUs fully functional 100% by 2010-11

                                       • 50% Maternal death audits conducted




                                                                                                57
Objective: 4 To facilitate referral transportation for institutional deliveries

Issues/ Challenges                  • Transport especially at night is a problem faced by almost all the
                                      districts’ women with pregnancy
                                    • Though willing, many women cannot access the facilities due to
                                      lack of availability of transport thus increasing the risk of
                                      complications during delivery due to lack of assistance from
                                      skilled personnel
Strategies/ Services                Activities/ Inputs
                                    • This scheme entails providing referral transport facilities to
                                      pregnant women requiring emergency obstetric care/ and for
                                      normal institutional delivery
                                    • This service shall be extended to transporting seriously ill
                                      infant/child
                                    • District Health Societies will decide the detailed modalities
                                      including rates to be paid for various areas of their respective
                                      districts, based on distances
                                    • Norms for rates per km would be defined by the District Health
1. To identify and enlist
                                      Societies
   private    agencies        for
                                    • To make this scheme successful, proper publicity through govt.
   ensuring availability of
                                      sector-staff and NGOs would be done
   vehicles for transporting
                                    • Active involvement of community and all stakeholders
   women with pregnancy to
                                    • For achieving the success of this scheme, it is proposed to prepare
   the   health    facility   for
                                      village-wise referral plan for EmOC
   institutional       delivery,
                                    • The final plan would be displayed at the sub-centre and a
   round-the-clock
                                      prominent place in the village in the form of wall painting
                                    • The PRIs will be involved in making the scheme operational
                                    • PRIs would identify and enlist the private vehicle agencies/
                                      ambulances as per DHSs norms
                                    • Funds to be kept with the FRU for referral cases. As soon as the
                                      referral patient comes, Medical officer will reimburse the
                                      necessary amount after proper verification. Funds will be provided
                                      to the BMO for reimbursement
                                    • This referral transport scheme would complement the JSY

                                                                                                    58
                           • Coordination with local transport agencies/ ambulance services, if
                              any
Support      needed    for • Active involvement and monitoring from PRIs
implementing changes       • Private    Public Partnerships       /Joint   ventures    with    private
                              practitioners
                           • Special incentives for MOs/ANMs attending to the referrals
                           • Safe deliveries with minimal loss of maternal and infant life
                           • Surveys such as DLHS to provide status on number of normal/
Benchmarks                    complicated pregnancies provided referral transport facilities with
                              output indicator being the number of lives saved and those lost
                              due to lack of access to institutional facility for delivery




                                                                                              59
Objective: 6 Improving Post Natal Care Services

                                   • In Punjab, 78.9% (DLHS 3), 55.3% (NFHS 3) women avail services
                                     after birth of the child
Issues/ Challenges                 • Percentage of women availing of these services varies substantially
                                     between regions and districts as well
                                   • The proportion of rural women availing post natal service is lower as
                                     compared to urban women

Strategies/ Services               Activities/ Inputs

                                   • Ensure regular home visits by the ANM to the house of the delivered
                                     mother, with records being maintained of these visits, minimum
1. Undertaking a two-
                                     three visits at regular intervals
  pronged strategy of a)
                                   • ANMs/ AWWs/ ASHAs educated on the components of post natal
  awareness generation
                                     care
  in     the     community
                                   • ANMs/ AWWs/ ASHAs to be oriented/ trained in the possible post
  towards       post       natal
                                     natal complications that can occur and how to identify these
  care          and          its
                                   • All the training modalities to be developed and standardised by
  importance           &     b)
                                     SIHFW
  strengthening             the
                                   • Adequate linkages of the field staff with necessary special care health
  public       health      care
                                     facilities
  delivery      system        to
                                   • Promote better PNC practices in the villages.
  cope     up     with      the
                                   • ANMs will coordinate with AWWs, develop her field movement plan
  increased           demand
                                     and provide services
  with quality services
                                   • Awareness campaign in the community apprising them of the post
                                     natal care facilities

Support        neededfor • Effective Private Public Partnerships
implementing changes     • Special incentives for MOs/ ANMs attending to emergencies
                                     successfully
                                   • Percentage of mothers receiving post natal care from a health
Benchmarks                           personnel to increased from 55.3% (NFHS 3) to above 80% by 2010-
                                     11




                                                                                                    60
Objective: 7 Decreasing the prevalence of RTIs in the population, especially among women

                          •       Only 60.6% (DLHS 3) women have any information about RTI/ STI.




Issues/
Challenges
                          • In Punjab more than half the women reported incidence of any
                              reproductive tract problem
                          • The proportion of women having such problems was much higher in rural
                              areas
                          • In general (67.3% (DLHS 3)) women do not seek any kind of treatment for
                              RTI/STI due to cultural issues, social stigma shyness and ignorance or lack
                              of awareness about facilities available
                          • Majority of those who seek treatment do not depend on government health
                              units for services
                          • Most seek these services from private practitioners where standardised
                              services are rarely provided
Strategies/
                          Activities/ Inputs
Services

1. Creating               • Identify trainers and training centres at district level to conduct training of
   awareness in the
                              medical officers, other support staff and ANMs/ AWWs/ ASHAs
   community         as
   well as the service    o District Programme Medical Officer will be trained as trainer for RTI/ STI
   providers about
                              services.
   the symptoms of
   RTI,             the   o Technical skills of medical officers, to effectively treat STI/RTI, will be
   treatment
                              updated and upgraded
   facilities available
   and preventive         o Training programmes for two days will be conducted to cover 600 medical
   measures to be

                                                                                                   61
  taken               officers including those posted at CHCs and PHCs.
                   o All ANMs and female supervisors will be trained for two days in RTI/STI
                      symptoms and counselling skills.
                   o Two-days training will be conducted for lab technicians (2 for each
                      district), at the SIHFW, to orient and train them in handling RTI/STI
                      diagnosis and for blood storage.
                   • Coordination linkages will be established both at the state and the district
                      level with Punjab State AIDS Control Society.
                   • NGOs/ CBOs/ FBOs/ PPs would be involved to propagate and provide
                      services for RTI/ STI
                   • Diagnostic facilities will be strengthened at all CHCs, by providing
                      equipment and supplies
                   • Counselling by ANM/ AWW/ ASHA

Support   needed • Private Practitioners to be provided with standardised treatment guidelines
for implementing   and IEC material

changes          • Coordination with VHSCs and using the forum of VHND (Village Health &
                      Nutrition Day)
                   • Active support of PRIs
                   • Reduced incidence and prevalence of RTI/ STI in the community, especially

Benchmarks            the women
                   • Increased percentage of women with RTI/ STI seeking treatment and
                      guidance from public/ private health care providers




                                                                                         62
Objective:
Objective: 8 Conducting Maternal Death Audits at the District Level

                             • Lack of any standardised system of validating the data of maternal
Issues/ Challenges             mortality
                             • Due to lack of data regarding the causes of maternal deaths, proper
                               interventions cannot be undertaken

Strategies/ Services         Activities/ Inputs

                             • Maternal death audits would be conducted in collaboration with
                               PGI.
                             • The medical officers, nurses, ANMs, AWWs, ASHAs etc would be
                               trained and involved in this process
1. Establishing a system
                             • DC to chair a monthly review of this initiative
  of ensuring that all the
                             • Information to be shared with the State soon as the DC has held the
  maternal deaths are
                               review of the maternal Death Audit
  audited      and     the
                             • Adequate documentation, recording and reporting systems would
  causes         properly
                               be established at district and block levels
  identified
                             • Necessary mechanisms for prompt feedback and corrective actions
                               shall be institutionalised
                             • Awareness campaign in the community regarding the importance of
                               prompt and actual reporting of maternal deaths
                             • Efficient HMIS networking
Support     needed     for • Suitable private research agencies
implementing changes         • Active involvement of all public sector health care delivery staff
                             • Active involvement of PRIs/ NGOs/ CBOs/ PPs
                             • Validated and exact data of maternal deaths available
Benchmarks                   • Voluntary reporting of maternal deaths from the community
                             • Regular reporting on maternal deaths from private sector




                                                                                     63
Objective: 9 Strengthening the implementation of Janani Suraksha Yojana

                             • Low registration of pregnancy in BPL/SC/ST mothers
                             • Lack of ante-natal checkups during pregnancy leading to poor follow
                               up
Issues/ Challenges
                             • Less percentage of institutional deliveries in this section of the
                               community
                             • Lack of awareness in this community towards the benefits of JSY and
                               the operational modalities

Strategies/ Services         Activities/ Inputs
                             • 100% registration of women with pregnancy from the BPL/ SC
                               families who are under JSY with proper documentation to be ensured
                               by the ANM/ MOs etc
                             • All the pre-natal, natal, post-natal and new born care services to be
                               provided as detailed under JSY guidelines
                             • Ensuring that all the logistics are in place and adequate at the state/
                               district/ block levels.
                             • HMIS would be strengthened to enable collect, collate and analyse
1. Ensuring    that    all     data on JSY.
  pregnant        women • Financial norms to be stringently followed:
  belonging to BPL/ SC o An incentive of Rs. 700/- and Rs. 600/- per institutional delivery in
  population           are     Rural and Urban Area respectively and Rs. 500/- for home delivery to
  registered under JSY         BPL/SC/ST pregnant mothers up to 2 living children provided the age
  and provided with all        of mother is 19 years or above
  the services/ facilities o Provision of Rs. 1500 per C-Section for hiring the services of
  entailed therein             specialists as per JSY guidelines
                             • Quarterly review meetings
                             • Budgetary support
                             o Estimated BPL/SC/ST births in the state = 1,80,000 among which
                               50% are of 2nd parity i.e. Target JSY Beneficiaries = 90,000 from which
                               100% are to be covered during the current year. Based on this it is
                               presumed that there will be 31500 Rural Beneficiaries and 10500
                               Urban     Beneficiaries   for   Institutional   Deliveries   and   48000
                               Beneficiaries for Home Deliveries.

                                                                                       64
                         • Mobility and quarterly meeting support
                         • Institutionalise PPPs to make the services under JSY accessible

Support   needed    for • From private practitioners and private health care providers
implementing changes    • Active involvement of PRIs, VHSCs
                         • Active involvement of the community and other stakeholders
                         • 100% women with pregnancy belonging to the BPL/ SC community

Benchmarks                  registered under JSY
                         • Private sector hospitals providing JSY services to the targeted
                            population




                                                                                65
STRATEGY FOR TRACKING OF PREGNANT WOMAN AND CHILD IMMUNIZATION CASES

            Conventionally, Public Health Systems have been recording and reporting
   aggregated data of the services provided across various health programmes. Though
   this is crucial in monitoring “reach” and “availability” of public health services, but it
   lacks tracing the patients being provided these services and quality of service. eg:
   the aggregate report will show that 300 pregnant registered for ANC and 120
   women given IFA tablets or 90 women given TT injection. In an aggregate system, it
   not possible to ascertain, if a particular pregnant woman registered for ANC, has
   also been given IFA and TT, as data only shows aggregate numbers. To understand
   the quality of services given to each pregnant woman registered for ANC,
   immunization cycle of each child, it is important that information of services
   provided to each beneficiary is maintained as an individual case.

Objectives of Name Based Information Tracking

   i.   Track (follow-up) a beneficiary (PW/child) through the entire service providing
        period.

   ii. Facilitate the service provider (health worker or doctor) in treatment follow-up;
        by recording all treatment related information at one place (makes it
        comprehensive for the service-provider).

   iii. Help the beneficiary in recording treatment history at one place, which could be
        used later in case of referral.

   iv. Improve the quality and fidelity of data.

        In strengthening this,

        •   State already has circulated the guidelines and formats provided by the Govt.
            of India to all districts till ANM level. State with the help of National Health
            Systems Resource Centre (NHSRC), will implement the Name Based
            Information Tracking System (NBITS) application for capturing and recording
            the individual based information, initially in one district and will fine tune it
            with the experience gained and then replicate in whole Punjab. NBITS is a
            generic tracking system which aims to provide information of different health
            services at the individual level, by monitoring all the health check-ups

                                                                                 66
              (encounters) that an individual undergoes in his/her treatment (health
              programme)
          •   ANM registers, MCH cards will be redesigned and printed in local language
              based on the formats designed and provided by GoI.
          •   State has proposed to provide one information assistant at each block
              covering rural areas and DH/SDH for covering urban area tracking process. It
              has also been proposed to provide one computer at each block and DH/SDH
              as a support to the existing structure.
          •   State has identified the Regional Computer Centre for providing on line
              trainings to DPMU/BPMU staff.
          •   State will provide mobile to each ANM through which it will also be possible
              to track the migrated PW/Child as every ANM providing services will be in
              contact with the migrated woman’s ANM.


                                        months)
Phase I (estimated to take place over 3 months): Establishing Routine Systems

The activities that constitute this phase include:

   i.         Enabling the transition to usage of new PW/Child Imm. tracking formats.
   ii.        Capacity building on new formats upto ANM level.
   iii.       Establishing the Block (or PHC) as the hub for NBITS information processing
              activities.
   iv.        Infrastructure needs established and arrangements for meeting it are
              completed.
   v.         Establishing the computer based NBITS application for name based data
              entry and reporting.
   vi.        Ensuring achievement in data coverage & timely reporting.
   vii.       Building mechanisms (technical and institutional) for ensuring data quality
              and institutionalizing these processes.
   viii.      Creating team of master trainers at state, district and block levels.
   ix.        Ensuring that all required support material including training material is
              easily available at each level.
   x.         Ensure formats and resource material are translated to the local language
              wherever the state so requires.



                                                                                      67
                                                                I):
Phase II (estimated to take place over 6 months following Phase I): Focusing on the use of
           information for action

The activities that constitute this phase include:

   i.     Integrating the tracking system with the facility reporting, and gradually
          ensuring that all facility data is aggregated and imported from the NBITS.
   ii.    Capacity building processes to focus on the use ‘information for action.’
          Different levels of action are envisaged for different levels. For example, for
          the ANM it is how to use the activity plan, for the district on tracking poor
          performing Sub centres, and for the state and national level to carry out
          higher level monitoring activities.
   iii.   Ensuring streaming of name-based data recording and reporting
   iv.    Stabilizing NBITS application for introduction of next level of application –
          mobile interface, alerts, activity reporting, village needs assessment.
   v.     Advanced training for master trainers and increasingly involving them in
          local capacity building processes.




BUDGET FOR PREGNANCY AND IMMUNIZATION TRACKING WILL BE TAKEN FROM
BUDGET HEAD COMMUNITY ACTION UNDER NRHM FLEXIPOOL PART-B
                                                  PART-




                                                                               68
    Camp-
RCH Camp-New Activity

               To increase the access and quality of RCH services in –under-served areas
where public health infrastructure is weak due to non-availability of Specialists/
Doctors, it is proposed to hold RCH Camps bi-monthly. In these camps ANC, PNC,
Immunization, Counseling for institutional deliveries, diagnosis of RTIs/ STIs and
management of other Gynaecological problems and counseling for newborn care,
treatment of childhood disease and referral system. Gynaecologists, Paediatricians,
Medical Offices, Staff Nurse and Lab Technician will provide services. For these detailed
plan will be prepared for organizing these camps and a budget Rs. 5000/- per camp is
proposed as:

       Publicity                    Rs. 1000/-

       Camp Arrangement             Rs. 1000/-

       Transport and POL            Rs. 1000/-

       Drugs and Medicine           Rs. 2000/- over and above the medicines available
                                    with MMU and concerned PHC

IEC:
IEC:           One time cost of preparation of flex, banner etc. will be met out from the
funds available for BCC. Miking, announcements through Gurudwaras, Mandir and other
system will be done. ASHA, AWW and ANM will convey the messages prior to camp.
               Community leaders, Members of VHSCs will be involved for advocating
the services available.
              Camps:
Management of Camps          State will identity the pocket/ areas of selected districts
where these camps are to be organized
               DFPO will be responsible for the RCH Camps. DFPO will identify and
select the places where these camps are to be organized and yearly calendar base on
fixed day, fixed place will be prepared.
               Civil Surgeon will identify the team of specialists and make a roaster for
deploying them for these camps.
               SMO in-charge of Block PHC will ensure all arrangements and publicity
well in advance.
               DFPO/ DPM will visit each camp and submit the supervisory report.
                             camps:
Utilization of MMU for these camps MMU will be utilized for these camps.



                                                                              69
                                            BUDGET MATERNAL HEALTH

                                    Physical                                               Modified
                                     Target                                               Budget for
                                               Rate                                         NPCC
                                                                             2010-
                                                          Amount (Rs. Lakhs) 2010-11                     Remarks
          Budget Head                          (Rs./                                     Amount (Rs.
                                    Unit of                                                     2010-
                                                                                         Lakhs) 2010-
                                               Unit)
                                    Measure                                                  11
                                                        Q1      Q2       Q3       Q4
          MATERNAL HEALTH
  1
          Operationalise
          facilities (details of
          infrastructure       &
          human resources,
 1.1      training, IEC/BCC,
          equipment, drugs
          and supplies in
          sections 9, 11, 12
          and 13)
 1.2      Referral Transport
          Referral Support to
          100000              all
          pregnant women                                                                                For 1 lakh
1.2.1                               100000      200    50.00   50.00   50.00     50.00     200.00
          for      institutional                                                                        PW
          delivery @ Rs.
          200/-
          Integrated Outreach
 1.3
          RCH Services
          RCH         Outreach                                                                          New
          Camps       in     un-               5000    2.50     2.50    2.50      2.50      10.00       Activity.
1.3.1                                 200
          served/under-                                                                                 Details
          served areas                                                                                  attached
          Monthly        Village
                                                                                                        To be met
          Health            and
                                                                                                        out of
1.3.2     Nutrition Days at         12278       100    0.00    0.00     0.00     0.00       0.00
                                                                                                        VHSC
          Anganwadi Centres
                                                                                                        funds
          for 12278 villages
          Janani      Suraksha
          Yojana/ JSY (details
 1.4
          of     IEC/BCC      in
          section 12)
1.4.1     Home Delivery             48000       500    60.00   60.00   60.00     60.00     240.00
          Institutional
1.4.2
          Delivery
          Rural                     31500       700    55.13   55.13   55.13     55.13     220.50
          Urban                     10500       600    15.75   15.75   15.75     15.75      63.00
          Home              and
                                                       130.8   130.8    130.8
          Institutional      for    90000                8       8        8
                                                                                130.88     523.50
          90000 deliveries
1.4.3     Other Activities JSY
          Monitor quality and
1.4.3.1   utilization         of                       0.125   0.125   0.125     0.125      0.50
          services.
1.4.3.2   JSY Cards (100000)        100000       4     0.00    4.00     0.00     0.00       4.00
                                                                                           70
                                   Physical                                               Modified
                                    Target                                               Budget for
                                              Rate                                         NPCC
                                                                            2010-
                                                         Amount (Rs. Lakhs) 2010-11                     Remarks
          Budget Head                         (Rs./                                     Amount (Rs.
                                   Unit of                                                     2010-
                                                                                        Lakhs) 2010-
                                              Unit)
                                   Measure                                                  11
                                                       Q1      Q2       Q3       Q4
          Incentive to ASHA
          for           early
          registration     of
          pregnancy,
1.4.3.3                            42000      200     21.00   21.00   21.00     21.00      84.00
          Institutional
          delivery @ Rs.
          200/- for 42000
          beneficiaries
 1.5      24 hours deliveries
          Strengthening     of
1.5.1                24-
          PHCs for 24-hours
          delivery services
          Female       Medical
          Officer for 236
          PHCs including RH                                                                            Booked
          and          Satellite                                                                       under
          Hospitals @       Rs.                                                                        Budget
          25000             PM                        116.1   135.0    135.0                           Head 9
1.5.1.1                             150       30000     0       0        0
                                                                               135.00     521.10
          +Incentive      after                                                                        Infrastruct
          minimum            10                                                                        ure &
          deliveries     @ Rs                                                                          Human
          500 per delivery +                                                                           Resource
          after 10 MTPs @ Rs
          200/ MTP
          Staff nurse for 236
          PHCs including RH
          and          Satellite
          Hospitals (3 SNs
                                                                                                       Booked
          per institution) Rs.
                                                                                                       under
          7500       P.M      +
                                                                                                       Budget
          Incentive       after
                                                      212.4   212.4    212.4                           Head 9
1.5.1.2   minimum              5    708       10000     0       0        0
                                                                               212.40     849.60
                                                                                                       Infrastruct
          deliveries
                                                                                                       ure &
          conducted @ Rs
                                                                                                       Human
          200     and     after
                                                                                                       Resource
          minimum              5
          deliveries assisted
          @ Rs . 100 per
          delivery
          Strehgthening       of
                       24-
          CHCs for 24-hour
1.5.2
          Emergency
          Obstetric Services




                                                                                          71
                                   Physical                                                 Modified
                                    Target                                                 Budget for
                                              Rate                                           NPCC
                                                         Amount (Rs. Lakhs) 2010-11
                                                         Amount             2010-                         Remarks
          Budget Head                         (Rs./                                       Amount (Rs.
                                   Unit of                                                       2010-
                                                                                          Lakhs) 2010-
                                              Unit)
                                   Measure                                                    11
                                                       Q1       Q2       Q3       Q4
          Obestetrician (60)for
          114 CHCs/SDH/DH                                                                                Booked
          Rs. 30000+Incentive                                                                            under
          after minimum 5 C-                                                                             Budget
          sections @ 1000 C-                                                                             Head 9
1.5.2.1                              40       35000   31.50    31.50    42.00    42.00      147.00
          section + after 15                                                                             Infrastruct
          Deliveries @ Rs. 500                                                                           ure &
          per          delivery                                                                          Human
          conducted + after 10                                                                           Resource
          MTPs @ Rs 200/ MTP
                                                                                                         Booked
          Paediatrician (60) for                                                                         under
          114 CHCs/ SDH/ DH                                                                              Budget
          Rs.     30000       +                                                                          Head 9
1.5.2.2                              40       35000   31.50    31.50    42.00    42.00      147.00
          Incentive Rs 200 per                                                                           Infrastruct
          Emergency        Case                                                                          ure &
          during off duty hours                                                                          Human
                                                                                                         Resource
                                                                                                         Booked
                                                                                                         under
          Anaesthetist for 114                                                                           Budget
          CHCs/SDH          @                                                                            Head 9
1.5.2.3                              114      10000   34.20    34.20    34.20    34.20      136.80
          1500/visit + Rs.                                                                               Infrastruct
          6/KM upto 50 KMs                                                                               ure &
                                                                                                         Human
                                                                                                         Resource
                                                                                                         Booked
                                                                                                         under
                                                                                                         Budget
          SNs for 114 CHCs, 5
                                                      171.0    171.0    171.0                            Head 9
1.5.2.5   SNs/CHC/SDH/DH             570      10000                              171.00     684.00
                                                        0        0        0                              Infrastruct
          Rs. 10,000/-
                                                                                                         ure &
                                                                                                         Human
                                                                                                         Resource
                                                                                                         Booked
                                                                                                         under
                                                                                                         Budget
          OT Assistant for 8
                                                                                                         Head 9
1.5.2.6   CHCs @ Rs. 10000/-          8       10000    2.40     2.40     2.40     2.40       9.60
                                                                                                         Infrastruct
          PM
                                                                                                         ure &
                                                                                                         Human
                                                                                                         Resource
                                                                                                         Budgetary
                                                                                                         provision
          Maternal Death Audit                                                                           proposed
                                                                                                         under
                                                                                                         innovation
                                                      52.50    52.50    52.50    52.50      210.00
   Total Maternal Health
                Total JSY                             152.00   156.00   152.00   152.00     612.00




                                                                                            72
     CHILD HEALTH

                   Indicator                            Status

1.    IMR (SRS 2008)                                      41

2.    Goal : Overall           • Reduce the neo-natal mortality from 28 (NFHS 3) to
                                 under 15 by 2012
                               • Reduce the post neonatal mortality from 13.7 (NFHS 3)
                                 to under 10 by 2011
                               • Reduce IMR from 41 (SRS 2008) to under 35 by 2011
                                 and 30 by 2012
                               • Increase the percentage of breast feeding within one
                                 hours of birth from 44.1% (DLHS-3) to 80% by 2012
                               • Increase the colostrums feeding from 89.9% (DLHS-3) to
                                 95% by 2011
                               • Increase in exclusive breast feeding from 32.4% (DLHS-
                                 3) to 80% by 2012
                               • Reduction in hypothermia and birth-asphyxia cases
                               • Reduction in underweight children under 3 years age
                                 from 27% (NFHS 3) to below 10% by 2012
3.    Goal : Annual            • Reduce the neo-natal mortality from 28 (NFHS 3) to
                                 under 20 by 2011
                               • Reduce the post neonatal mortality from 13.7 (NFHS 3)
                                 to under 10 by 2011
                               • Reduce IMR from 41 (SRS 2008) to under 35 by 2011
                               • Increase the percentage of breast feeding within one
                                 hours of birth from 44.1% (DLHS-3) to 60% by 2011
                               • Increase the colostrums feeding from 89.9% (DLHS-3) to
                                 95% by 2011
                               • Increase in exclusive breast feeding from 32.4% (DLHS-
                                 3) to 50% by 2011
                               • Reduction in hypothermia and birth-asphyxia cases
                               • Reduction in underweight children under 3 years age
                                 from 27% (NFHS 3) to below 10% by 2011

                                                                             73
4. Situational Analysis:     NRHM focused to reduce IMR especially neo natal mortality.
   Major cause of Neo Natal Mortality Hypothermia, ARI and Diarrhea. These can be
   addressed through strengthening the Facility Based Neo Natal Care, Home Based Neo
   Natal Care and immunization of children. In the State full immunization coverage has
   been 73% DLHS 1 & 2 and 80% DLHS 3.
Breast-feeding among the children under 3 years 89% and but within one hour is 44.1% so
state need to focus on breast-feeding practices and strengthening Facility/ Home Based
Neo Natal Care.

 Indicators                NFHS     NFHS   SRS       SRS        Comments
                           2        3      2007      2008

 Neo Natal Mortality

 Infant Mortality Rate                         43         41


 Indicators                NFHS 2    NFHS 3

 % of children with          80        80.1
 anaemia


 Indicators                         NFHS      NFHS   DLHS      DLHS 3   Comments
                                    2         3      2

 Children under 3 years 6.1                   10.3   12.2      44.6
 breastfed within one hour of
 birth

 Children age 0 – 5 months NA                 36.0   23.1      32.4
 exclusively breastfed

 Children age 6- 35 months                           NA        9.1
 receiving exclusively breastfed
 for at least 6 months

 Children age 6- 9 months NA                  50     NA        68.9
 receiving solid/semisolid and
 breast milk




                                                                            74
 Indicators                       NFHS   NFHS   DLHS   DLHS 3   Comments
                                  2      3      2

 Children with Diarrhoea in the                 26.2   52.1
 last 2 weeks who received ORS

 Children with Diarrhoea in the                 83.5   88.0
 last 2 weeks who were given
 treatment

 Children with ARI or fever in                  87.4   91.8
 the last 2 weeks who were
 given treatment



4.1 Progress till date
   training - no. of trainings
   conducted/           health
   persons      trained      /
   districts covered

• IMNCI

• Pre- Service IMNCI

• F-IMNCI

• Navjaat Shishu Suraiksha
  Katyakram (NSSK)

• Any other




                                                                    75
Objective: Facility Based New Born Care

                            • IMR of the State has improved from 43 to 41 (SRS 2008) but decline in
                              slow.
                            • Neonatal Mortality Rate in Punjab is quite less as compared at the
                              National level, still lot of efforts are required to bring down NMR
                              especially ENMR.
                            • Neonatal Infections due to improper sterilization of delivery
                              instruments and cleanliness of the place, inadequate personal hygiene
                              and cleanliness of the birth attendant, inadequate hygiene of the baby
Issues/ Challenges
                              and too many relatives/ visitors handling the newborn especially in
                              home conducted deliveries.
                            • Hypothermia due to delivery conducted in cold and humid
                              atmosphere, improper clothing of the newborn, bathing the newborn
                              with the notion of cleaning the baby and lack of 24 hours electricity
                              supply in peripheral institutions for keeping the environment warm
                            • Many neonates may die/ face problem due to asphyxia which can be
                              managed even at sub-centre, PHC level through the use of Manual
                              Mucus Sucker (disposable)

Strategies/ Services
Strategies/                 Activities/ Inputs

• Ensuring that through • To establish Sick Neo Natal Care Unit at Women and Children
  the      process     of     Hospital, Bathinda and Mata Kaushalya Hospital, Patiala
  institutional deliveries • 100 Bedded Women and Child Hospital, Bathinda caters to 6 Districts
  and those assisted by       for Neo Natal Emergencies. Monthly 150-170 Deliveries are being
  SBAs, proper care of        conducted and routine OPD of Paediatric cases is 200-250. Due to lack
  the newborn is taken        of SNNCU, premature and other severely sick neo natal are to be
  and all the services        referred to Ludhiana or GMCH/PGI Chandigarh. It is proposed to
  due to the newborn          strengthen the services by establishing SNNCU in the Hospital. It will
  are provided                require Infrastructure and Manpower interventions.
                            • Mata Kaushalya Hospital, Patiala is the specialised maternity hospital.
                              Monthly 250-300 deliveries are being conducted and routine OPD is
                              more than 300.
                            • To operationalise New Born care Centres with Baby warmers and UV


                                                                                   76
                            light unit at 114 CHCs.
                          • Baby warmer and UV light unit at 24x7 PHCs.
                          • Orientation of Medical and Paramedical Staff for FBNNC to enable
                            them to tackle serious new born babies.
                          • For complicated cases referral to higher institutions.
                          • Build and strengthen the institutional and the human resource
                            capacity of the concerned health facilities so as to manage Pre-term/
                            IUGR cases
                          • DDKs and Manual Mucus Suckers will be supplied for safe delivery
                            and neonatal care.
                          • Promotion of institutional deliveries
                          • Programme focused on Exclusive breastfeeding.
                          • Ensure that the newborn receive breast feeding especially the
                            colostrums and promotion of exclusive breast feeding for 6 months.
                          • Exclusive Breastfeeding and weaning.
                          • Important messages regarding care of new born are printed on
                            immunisation cards.
Support   needed       for • SIHFW
implementing changes      • Medical organisation like IMA,BPNI etc.

                          • Reduction in ENMR and NMR

Benchmarks                • Reduction in LBW babies
                          • Reduced neo natal mortality rate from 27 to 10 by 2010
                          • Reduction in hypothermia and birth-asphyxia cases




                                                                                     77
Objective: To Promote Home based Newborn care through appropriate health education and IEC to
mothers

                              • It is important to improve the management of new born at home
                                because more than 36.5% deliveries are being conducted at home and
                                only 13.9% home deliveries are assisted by SBA so there are chances
                                of neglect in care of new born.
                              • Proper newborn care not undertaken at home due to wrong notions
Issues/ Challenges
                                and beliefs
                              • Traditional methods followed in newborn care which may be
                                redundant or may not be hygienic and are prejudicial to the health of
                                the new born
                              • Inability to identify the signs of distress in the newborn due to lack of
                                knowledge
Strategies/ Services          Activities/ Inputs

                              • Ensure Home Visits by ANM, AWW, ASHA
                              • Enhanced social mobilization and awareness on care of the newborn
                                and to dispel myths like administration of pre-lacteal feeds to the new
                                born, bathing the new born, mishandling of the new born by the birth
1. Creating            and
                                attendants and at home
  sustaining the level of
                              • Important messages on home based neonatal care to be given wider
  awareness      in     the
                                publicity
  community              to
                              • Re-sensitization of birth attendants at the PHC/ mini PHC level by
  newborn              care
                                medical officers during monthly meetings to reinforce precautions
  modalities     through
                                against the newborn conditions like Birth Asphyxia.
  health care providers
                              • Management of respiratory tract infections, besides hypothermia,
  and             private
                                neonatal infections at the PHC level also
  stakeholders
                              • Using the network of NGOs/ CBOs/ FBOs/ PPs in propagating this
                                information
                              • IPC will continue by holding State/ District/ Block level sensitization
                                meetings




                                                                                       78
                              • Periodic ‘Well Baby’ clinics and healthy baby shows at all the

                                CHCs
                              • Counselling of mothers on breastfeeding either by doctors or

2. Improving    immunity        nurses for improving breast-feeding practices
  and     ensuring     Child • Focused     communication     campaign    to   address   myths
  Health          through       associated with colostrums
  exclusive                   • Counselling on breastfeeding will form part of the ANC and

  breastfeeding                 PNC services where ANMs and other service providers come
                                in contact with pregnant women at least three times
                              • Communication      campaign designed to address myths
                                associated with breastfeeding
                              • Promote best food practices of local food
                              • Develop special nutritional supplementation programme for
3. Reducing Malnutrition
                                severely anaemic
  among the children
                              • Nutrition messages on importance of proper nutrition and
                                care
                              • Monitoring and evaluation to be child health specific and
4. Monitoring     of    the     feature as such in the state HMIS
  programme                   • Monitoring will be done during monthly meetings of the Civil
                                Surgeons at the State HQ
Support     needed      for • ICDS, ASHA, AWWs, SHGs involvement
implementing changes          • Integrated IEC/ BCC strategy/ unit’s guidance and support

                              • Increase the percentage of breast feeding within one hours of
                                birth from 44.1% to 80% by 2010 (DLHS-3)
                              • Increase the colostrums feeding from 89.9% to 95% by 2010
                                (DLHS 3)
Benchmarks                    • Increase in exclusive breast feeding from 32.4% to 50% by
                                2010 (DLHS-3)
                              • Reduction in hypothermia and birth-asphyxia cases
                              • Reduction in underweight children under 3 years age from
                                27% (NFHS 3) to below 10% by 2010




                                                                                 79
Objective: To Improve Neonatal and Child health through the Implementation of IMNCI

                                  • Diarrhoea, Pneumonia, Measles, Malaria & Malnutrition
                                    account for more than 50% of deaths in children including
                                    neonatal deaths due to lack of IMNCI training of service
                                    providers
                                  • Diarrhoea due to Lack of knowledge about importance of
                                    breast- feeding, lack of hygiene and sanitation in the villages,
Issues/ Challenges
                                    consumption of unhygienic food and drinks and inadequate
                                    supply of ORS
                                  • Prevalence of Vaccine preventable diseases
                                  • Neglect of childhood illnesses due to multi parity, lack of
                                    knowledge and neglect of the female child
                                  • Malnutrition due to diluted milk given to infants, lack of
                                    balanced diet and myths about food
Strategies/ Services  Activities/ Inputs
1. Implementing IMNCI • The IMNCI technical guidelines and training modules have
  in     all    districts     -     been developed for the ANMs ASHAs and AWWs that cover
  Integrated Management             various aspects of neonatal care, basic health worker module,
  of      Neonatal          and     and home visit module for care of new born and young
  Childhood           Illnesses     infants
  (IMNCI)        as     Fever, • Access to mass media seems to be an important determinant
  ARIs     and        common        for the use of ORS
  childhood           ailments • Since this training provides a good platform for convergence
  will     be     addressed         of services between the two departments, the health
  through             effective     department proposes to involve the staff members of ICDS at
  homecare                  and     state, district and block levels in addition to those at village
  networking with the               level
  outreach systems. The • Appropriate IEC messages specific to childhood diseases to
  strategy        envisages         be propagated
  three components:

                                                                                    80
1. Improved           case • 70 TOT at Medical College.
  management               •   IMNCI training of faculty of ANM TC.
2. Health       systems • IMNCI training for 800 MOs (PHC/CHC) in a phased manner.
  strengthening and        •   IMNCI training of AWW/ ANMs.
3. Improved   household • Planning of the training itinerary and venue and arranging
  practices                    the logistics by SIHFW
                           •   For the rest of the service providers, the training will be
                               conducted as a component of IST of the respective groups
                           •   State-level master trainers will attend these training
                               programmes as resource persons
                           •   Doctors and ICDS functionaries who attended the block-level
                               training will be the lead trainers for training of ANMs and
                               AWWs
                           •   Joint monitoring plan at the block level and implementation
                               of IMNCI will be jointly monitored during monthly meetings
                               by health department and ICDS
                           •   Collect all available IEC messages and posters on childhood
                               diseases and distribute them in adequate quantity to all
                               health and ICDS facilities for their display at the facilities and
                               strategic locations in the area
                           •   Folk-media campaigns on childhood diseases, treatment and
                               management will be integrated with other similar campaigns
                           •   Besides these activities, social marketing of ORS will be taken
                               up to promote use of ORS for diarrhoea management
                           • Administrative will to establish the facilities for quality
                               IMNCI care
Support     needed     for • Active involvement of PRIs/ private health sector/ all public
implementing changes           health care delivery staff
                           • From ICDS
                           • Public and private specialized training centres


                                                                                 81
             • IMNCI established at specific institutions catering to the
               entire population of Punjab
             • Reduce the neo-natal mortality from 28 (NFHS 3) to under 20
Benchmarks     by 2011
             • Reduce the post neonatal mortality from 13.7 (NFHS 3) to
               under 10 by 2011
             • Reduce IMR from 41 (SRS 2008) to under 35 by 2011




                                                            82
Objective: Care of Sick Children and Severe Malnutrition

                             • 80.2% children age 6-35 months are anaemic (NFHS-3).
                             • Diarrhoea and ARI are the major cause for infant and
Issues/ Challenges               childhood morbidity and mortality. To reduce the deaths due
                                 to diarrhoea and ARI it is essential to make early diagnosis
                                 and early treatment.

Strategies/ Services         Activities/ Inputs


1. IMNCI                     •   Training of staff at grassroots level to ANM etc.

                             •   Early initiation of breast-feeding.
2. Mal Nutrition             •   Counselling of pregnant women for breast-feeding.
                             •   IFA tablet small to mal-nourished children
                             •   Management of ARI including mild Pneumonia will be done
3. Management           of       by ANM.
  illnesses                  •   Management of moderate Pneumonia at PHC.
                             •   Referral in case of severe Pneumonia.
                             •   Drugs, ORS and other supplies will be ensured at facility level.
                             •   Mothers will be educated regarding preparation and use of
4. Supplies
                                 ORS.
                             •   Supply of Albendazole
Support       needed   for •
implementing changes

Benchmarks                   •




                                                                                     83
                                      BUDGET FOR CHILD HEALTH

                              Physical                                           Modified
                               Target                                           Budget for
                                                                                   NPCC
                                          Rate                       2010-
                                                  Amount (Rs. Lakhs) 2010-11     Amount      Remarks
        Budget Head                       (Rs./
                                          (Rs./
                              Unit of                                               (Rs.
                                          Unit)
                              Measure                                             Lakhs)
                                                                                 2010-
                                                                                 2010-11
                                                  Q1      Q2     Q3     Q4
  2    CHILD HEALTH
 2.1   IMNCI
       Printing of Modules
       for IMNCI trainings
       (Doctors' 500,
2.1.1.
       Paramedic's 2300
       and Facilitator's
       guides 300)
       Setting up IMNCI
       cell at State HQ @
2.1.2                            1       420000   1.05   1.05    1.05   1.05         4.20
       Rs.    4.20     Lakh
       Annually
                                                                                             Booked
                                                                                             under
       Setting up of New
                                                                                             Budget
2.1.2. born care centres @
                                 2       25000    0.00   0.50    0.00   0.00         0.50    Head 13
  1    Rs. 25,000 CHC in 2
                                                                                             Procure
       CHCs
                                                                                             ment

        Facility based new
 2.2
        born care
                                                                                             Booked
                                                                                             under
        Baby Warmer and
                                                                                             Budget
        UV Light Unit @ Rs.                              333.2
2.2.1                           447      75000    0.00     5
                                                                 0.00   0.00        333.25   Head 13
        75000 for 2 CHCs &
                                                                                             Procure
        445 PHCs
                                                                                             ment

                                                                                             Booked
                                                                                             under
        Supply of 3.5 lakh
                                                                                             Budget
        Manual Mucus
2.2.2                         350000       7.5    0.00   26.25   0.00   0.00        26.25    Head 13
        Suckers @ Rs. 7.50
                                                                                             Procure
        each
                                                                                             ment



                                                                               84
                              Physical                                             Modified
                               Target                                             Budget for
                                                                                     NPCC
                                          Rate                        2010-
                                                   Amount (Rs. Lakhs) 2010-11      Amount      Remarks
        Budget Head                       (Rs./
                                          (Rs./
                              Unit of                                                 (Rs.
                                          Unit)
                              Measure                                               Lakhs)
                                                                                   2010-
                                                                                   2010-11
                                                   Q1      Q2     Q3      Q4
        Establishing SNNCU at Bathinda and Patiala
        Establishment Cost
        Civil Work/
        Renovation for                                                                         Booked
                                                                                               under
        SNCU in Women                   150000
                                 2                 0.00   30.00   0.00   0.00         30.00    Infrastruc
        and Children                       0                                                   ture and
        Hospital, Bathinda                                                                     HR
        and MKH Patiala
                                                                                               Booked
        Procurement of                                                                         under
        Equipment for                    250000                                                Budget
                                 2                0.00    50.00   0.00   0.00         50.00    Head 13
        SNCU Bathinda and                  0
        Patiala                                                                                Procurem
                                                                                               ent
        Recurring
        Consumables              2       350000   0.00    2.33    2.33   2.33          7.00
        Operational
        Expenditure
        including Manpower,      2       650000   0.00    4.33    4.33   4.33         13.00
        Salaries and other
        activities
        Sub Total for SNNCU                       0.00    86.67   6.67   6.67         100.00
2.5                        Chi
        Infant and Young Child Feeding
        Calcium Tablets 50
                                                                                               Mission
2.5.1   tabs per women         500000     3.60    0.00    18.00   0.00   0.00         18.00    Flexipool
        after delivery
2.5.2   Scheme on Breast feeding
        Training of Middle
        level trainers 2         12      182840   0.00    10.97 10.97    0.00         21.94
        batch for 6 districts
        Training of front
        line workers in 6       166      41990    0.00    23.09 23.09    23.51        69.70
        districts - 166 batch
        Supervision+Evalu
        ation @ 1.00 lack        6       100000   1.50    1.50    1.50   1.50          6.00
        per district
        Sub Total for Breast
                                 1                1.50    35.56 35.56    25.01        97.64
        Feeding

                                                                                 85
                               Physical                                           Modified
                                Target                                           Budget for
                                                                                    NPCC
                                          Rate                       2010-
                                                  Amount (Rs. Lakhs) 2010-11      Amount      Remarks
        Budget Head                       (Rs./
                                          (Rs./
                               Unit of                                               (Rs.
                                          Unit)
                               Measure                                             Lakhs)
                                                                                  2010-
                                                                                  2010-11
                                                  Q1      Q2     Q3      Q4
        Management for
        Diarrhoea, ARI &
2.7
        Micro Nutrient Mal
        Nutrition
        Supply of 10 lakh
        Zink Sulphate Tab      100000                                                         Mission
2.7.1                                      0.5    0.00   5.00    0.00   0.00          5.00    Flexipool
        for Management for       0
        Diarrhoea
                                                                                              under
                                                                                              Budget
        IFA Tablets to
2.7.2                                             0.00   20.00   0.00   0.00         20.00    Head 13
        children
                                                                                              Procure
                                                                                              ment
        Annual review
        meeting of State Co-
        ordination
2.8     Committee @ Rs.           2       30000   0.00   0.30    0.00   0.30          0.60
        30,000 each for two
        meeting every
        year.
         Total Child Health                       2.55   43.58 43.28    33.03        122.44




                                                                                86
FAMILY WELFARE

TFR for Punjab as per NFHS 3 data is 1.99 which is practically the maintenance level. Data
of DLHS 3 shows that use of modern methods of Family Planning has increased
significantly from 57.2% DLHS2 to 62.9% DLHS 3 and the increase is both in Rural and
Urban Areas.




             The rate of female and male sterilization is nearly static




                                                                            87
        State has to focus on the unmet need to bring it down from 7.3 NFHS-3 to 6.5 by
  2010-11.

         The year wise progress is shown in the table below:

               Year           NSV       %age       Tubectomy       %age         NSV+
                                                                              Tubectomy

            2005-06           15482    14.43 %        91829       85.57 %      107311

            2006-07           5455      5.83 %        88143       94.17 %       93598

            2007-08           13110    12.61 %        90798       87.39 %      103908

            2008-09           12760     6.72%         84879       93.28%        97639

            2009-10           8435     58.09%         57560       63.14%        65995
            upto Dec.



                 The objectives and strategies are as:

Objective: 1 To sustain and further escalate the decrease in Total Fertility Rate (TFR), to
  maintain at replacement level
Issues/ Challenges             • TFR in rural areas is 2.1 (NFHS 3)
                               • Maintain Replacement Level
Strategies/ Services   Activities/ Inputs
1. Imparting knowledge • Make the ANMs, AWWs and ASHAs aware regarding various
  to   married    couples        methods of contraception available from the public sector and
  regarding             the      those available through the private sector
  availability of various • Medical Officers to play an active role of a counsellor to
  methods                of      married couples and to be trained accordingly
  contraception
2. Providing access to • Ensure availability of the contraceptive products at all the District
  various methods of             Hospitals (DHs), Sub-Division Hospitals (SDH), Community
  contraception         for      Health Centres (CHC), Primary Health Centres (PHC) and Sub
  population                     Centres (SC), by institutionalising effective logistic procurement
                                 and management processes
                               • Use the network of private practitioners (Allopathic and


                                                                                    88
                                Alternate Medicine branches) in the rural areas as depots for
                                these products
3. Promoting    ‘Limiting • Providing fixed day static services for family planning in the
  methods                of     health institutions.
  contraception’ among • Holding NSV/ Tubectomy camps in the districts.
  rural/ urban couples • ANMs, AWWs and ASHAs to identify such couples in the
  with two children             community and target them for awareness and adaptation of
                                limiting methods of contraception
                              • Laparoscopic Mini-Lap Sterilization Training
                              • NSV Training
                              • Medical officers to educate such couples on the benefits of
                                limiting methods of contraception
                              • Compensation to sterilization cases- compensation for
                                Tubectomy @ Rs 1000 for BPL and Rs 650 for General
                                population. Compensation @ Rs 1500/- to NSV accepter to
                                boost acceptance of NSV
                              • Holding NSV promotion and operation camps
                              • Regular BCC Campaign to advocate NSV.
4. Promoting        spacing • Availability of IUD in the health institutions specially DHs/
  method                        SDHs/ CHCs/ 24x7 PHCs.
                              • Promotion of IUD 380 through BCC and home visits by ASHA.
                              • Training of MO and Para Medicals for IUD insertions using
                                alternative methodology.
5. Creating         general 5. Use the monthly ‘VHND” to promote the methods of
  awareness     in      the     contraception
  community, especially 6. ANMs, AWWs and ASHAs to target the couples with two
  the rural areas               children and motivate them to adopt the limiting methods of
                                contraception
                              7. Use of electronic and print media to propagate the message of
                                ‘Use of Contraception’ for development and growth of the
                                community
                              8. Use the local folk media to propagate these messages
                              • Enlist the support of NGOs, CBOs and FBOs working in the


                                                                                89
                               field to undertake these awareness activities and implement
                               other interventions
                             • AWWs, ASHAs, Village Health & Sanitation Committees and
                               PRIs to extend total support
                             • NGOs, CBOs, FBOs and private health care providers to be
                               enlisted for support
                             • Involvement Professional organizations like IMA, FOGSI etc
Support   needed       for
                             • Training centres to be enlisted; Medical Colleges, Private
implementing changes
                               Institutions, ANMTCs etc
                             • Effective logistic procurement and management system by the
                               Health Department to ensure availability of contraceptive
                               products and scheduled organisation of sterilisation/ NSV
                               camps
                             • TFR in rural areas down to 2.0 by 2010 and eventually to 1.9
Benchmarks
                               by 2012




                                                                               90
Objective: 2 To bring down the Unmet need for Family Planning

                                 • Rural women are aware of the necessity for using
Issues/ Challenges                 contraceptive methods but do not have access to the facilities
                                 • Unmet need not being adequately identified by the public
                                   health delivery system
Strategies/ Services             Activities/ Inputs
1. Establishing           the • Develop and define a standard protocol for collecting, collating
  system of a structured           and analyzing the information of ‘unmet need’ from the
  inquiry protocol in the          married couples during their visits to the health facilities
  public      health     staff • Develop a training protocol and calendar for the health staff
  (from Medical Officers           (from Medical Officers to ASHAs) to implement the above
  to       ASHAs)          for     mentioned system
  collecting information • Create a database of the information collected through this
  from married couples             system for review and feedback
  regarding their unmet • To develop ‘Key Performance Indicators’ for assessing and
  needs                   monitoring the implementation of this strategy
2. Creating         awareness • Use of all the channels of communication (print, electronic and
  among       the     targeted     other local media)
  population   regarding • Develop and                implement     appropriate    BCC    and     IPC
  the necessity for them   interventions
  to   understand         and
  express their needs in
  regards       to      family
  planning services
                                 • Training centres in the public as well as the private sector
                                   (Medical Colleges, Private Institutions, ANMTCs etc)
Support       needed       for
                                 • Professional organisations like IMA, FOGSI etc
implementing changes
                                 • NGOs, CBOs, FBOs, private health care providers and SHGs to
                                   be enlisted for support



                                                                                     91
             • Active involvement of community and political leaders
             • Unmet need reduced from 11.9 (DLHS 3) to 5 by 2010-11
             • Unmet need further reduced to 2 by 2012
Benchmarks
             • At least 25% increase in demand for family planning services
               at each health facility every year till 2012




                                                                92
                                                               69.3%           2011
Objective: 3 To increase the Couple Protection Rate (CPR) from 69.3% to 70% by 2011

                                   • Crude Birth Rate is 19.2 in rural areas & 17.7 in the urban
                                      areas
                                   • Lesser involvement of males in the processes of family
Issues/ Challenges
                                      planning leading to lack of comprehensive couple
                                      protection initiatives
                                   • Lack of awareness in the community to availability of
                                      emergency contraceptive methods
Strategies/ Services               Activities/ Inputs
1. Creating           awareness • Develop suitable IEC material targeting the couples informing them
  towards      the       various      of various contraceptive methods available
  contraceptive         methods • To lay stress on the use of emergency contraceptive methods through
  available     for       couple      individual/ one-to-one interactions of the Medical Officers the
  protection                          married couples
                                   • Use of suitable media for disseminating the information
                                   • Mapping of NGOs, CBOs, FBOs and private health care providers to
                                      ensure uniform availability of this information to the population
2. Converting the high level of • Develop and implement adequate BCC and IPC protocol
  knowledge/ awareness in • All the medical staff (Medical Officers, ANMs etc) and
  the community to the      private partners to be trained in these BCC/ IPC
  availability of contraceptive       interventions
  methods (Table 2 above)
                                   • Uniform dissemination of the information within the
  into action to adopting
                                      urban and rural community to achieve the targets
  these measures
                                      mentioned in the objective above
3. Ensuring                 total • Counselling to be undertaken by Medical Officers and
  involvement of men in the           ANMs in the community motivating the men to actively
  couple              protection      accept the necessary contraceptive measures
  measures                         • To promote male sterilisation by undertaking intensive
                                      IEC/ BCC/ IPC interventions among men in the community
                                   • Cash and other attractive incentives to be provided to men


                                                                                          93
                                    undergoing sterilisation operation
                                  • To involve and train male nurses/ field level male health
                                    staff in motivating the men for active involvement in
                                    adopting contraceptive measures
4. Promoting            modern • Train the Medical Officers, ANMs, AWWs and ASHAs in the
  methods of contraception          protocols for disseminating the information on availability
                                    and benefits of modern methods of contraception
                                  • To remove misconceptions about the male sterilisation
                                    procedures within the community by undertaking IEC/
                                    BCC/ IPC interventions and involving reputed medical
                                    practitioners in such campaigns
                                  • To implement camps for male sterilisation operations,
                                    especially NSV, in remote/ rural areas
                                  • Provide attractive incentives for those adopting modern
                                    methods of contraception
                                  • Involvement of Professional organisations like IMA, FOGSI
                                    etc
                                  • The district and block level administrations to play a key
Support        needed       for     role
implementing changes              • Grassroots level organisations (NGOs, CBOs, FBOs etc) to
                                    help in mobilising the community
                                  • Medical Colleges, private teaching/ training institutes,
                                    ANMTCs to assist in the training protocols
                                  • Increase Couple Protection Rate from 63.3% to 70% by
Benchmarks                          2010
                                  • Further increase in CPR from 70% to 75% by 2012




                                                                                 94
                                               BUDGET FAMILY PLANNING

                                          Physical                                                     Modified
                                           Target                                                     Budget for
                                                     Rate                                                           Remark
                                                                                   2010-
                                                                Amount (Rs. Lakhs) 2010-11           NPCC Amount
            Budget Head                              (Rs./                                                            s
                                          Unit of                                                     (Rs. Lakhs)
                                                     Unit)                                             2010-
                                                                                                       2010-11
                                          Measure
                                                             Q1        Q2       Q3       Q4
  3       FAMILY PLANNING
          (Details     of     training,
          IEC/BCC,         equipment,
          drugs and supplies in
          sections 11, 12 and 13)
          Terminal/Limiting
 3.1
          Methods
          Dissemination of Manual
          on Sterilization standards
3.1.1
          and quality assurance of
          sterilization services
          Printing of Sterilization
3.1.1.1                                   125000      4      0.00     5.00     0.00     0.00             5.00
          Files 1.25 lakh
          Printing of Sterilization
3.1.1.2                                   100000      3      0.00     3.00     0.00     0.00             3.00
          Cards 1 lakh
          Printing of NSV Cards -
3.1.1.3                                   25000       3      0.00     0.75     0.00     0.00             0.75
          25000
          Printing of Operational
          Guidelines on Fixed Day
3.1.1.4                                    1000       50     0.00     0.50     0.00     0.00             0.50
          Static(FDS)approach for
          sterilization servies-1000
          Printing of Manual on
          Standard          Operating
3.1.1.5   Procedures                for    1000       50     0.00     0.50     0.00     0.00             0.50
          Sterilization Services in
          Camps-1000
          Printing of Manual on
3.1.1.6   Repositioning IUCD in FW         1000       50     0.00     0.50     0.00     0.00             0.50
          Programme-1000
          Printing of IUCD Reference
3.1.1.7                                    5000      100     0.00     5.00     0.00     0.00             5.00
          Manual for MOs
          Printing of IUCD Reference
3.1.1.8                                    6000      100     0.00     6.00     0.00     0.00             6.00
          Manual for Nursing Staff
          Printing of Guidelines for
          Administration             of
3.1.1.9   Emergency Contraceptive          6000       30     0.00     1.80     0.00     0.00             1.80
          Pills by Health Care
          Providers
3.1.1.1   Printing of Brochures on
                                          100000      5      0.00     5.00     0.00     0.00             5.00
   0      E-Pill & IUCD
          Organize              female
          sterilization camps in
3.1.2                                       240      15000   0.00     0.00    18.00     18.00           36.00
          districts.1 to 3 camps per
          district per month in the


                                                                                                95
                                         Physical                                                        Modified
                                          Target                                                        Budget for
                                                     Rate                                                             Remark
                                                                                     2010-
                                                                  Amount (Rs. Lakhs) 2010-11           NPCC Amount
            Budget Head                              (Rs./                                                              s
                                         Unit of                                                        (Rs. Lakhs)
                                                     Unit)                                               2010-
                                                                                                         2010-11
                                         Measure
                                                               Q1        Q2       Q3       Q4
         3rd and 4th quarter


         Organize NSV camps in
         districts 1 to 3 camps per
3.1.3                                      240      35000      0.00     0.00    42.00     42.00           84.00
         district per month in the
         3rd and 4th quarter
         For 30000 tubectomies @         Tubecto                                172.5
                                                    1000.00   172.50   172.50            172.50          690.00
         Rs. 1000/- for BPL and for        my                                     0
3.1.4
         60000 tubectomies @ Rs.         BPL @
         650/- each year                  35%
                                         Vasecto
         For 15000 NSV @ Rs.                         1500     56.25    56.25    56.25     56.25          225.00
                                           my
3.1.5    1500 per operation each
                                         BPL @
         year
                                          35%
3.2      Spacing Methods
         Prepare operational plan
         for provision of spacing
         methods across districts
3.2.1
         (including          training,
         BCC/IEC,       drugs     and
         supplies, etc.)
                                          Drug &
         Implementation of        IUD
3.2.2                                    Dressing     20
         services by districts.
                                         for IUD
         For 3,00,000 IUD
         insertions @ Rs. 20/- per       300000       20      15.00    15.00    15.00     15.00           60.00
         case .
         Monitor progress, quality
3.3                                                  8000      0.13     0.13     0.13     0.13             0.50
         and utilization of services
         Repair of Laproscopes &
3.4                                                            0.00     0.00     5.00     0.00             5.00
         AMC
        Total Family Planning                                 243.88   271.93   308.88   303.88          1128.55




                                                                                                  96
ADOLESCENT FRIENDLY HEALTH SERVICES (AFHS)

              Adolescent constitutes 25% of the population in the state. The major issues
associated wit the adolescents is inadequate knowledge and reluctant to seek help leads to
myths and misconceptions with this limited knowledge about their body defined
themselves vulnerable to HIV,STI, Drug Abuse, Sexual Abuse. Girls particularly are more
vulnerable due to socio cultural barriers.

              The awareness level of adolescent girls regarding family life education is
quite high. 82.8% girls in the age group 15-19 years were aware and of 87.8% perceived
that family life education is important. 69.6% of these were of the opinion that family life
education should be introduced in the age group of 12-17 years. It is worth mentioning that
54.2% unmarried girls aged 15-24 have ever received family life education out of these
87% received from school/ college, so under ARSH Programme school/ college will be
major interaction point with the adolescents. As per DLSH 3 22% girls in the age group of
15-24 experience menstruation relation problems during last three months of these 91.4%
complain of pain full period. 75.2% girls used cloth during menstruation which shows
unhygienic menstrual practices. State will focus on counseling adolescent girls regarding
menstruation hygiene and promotion of sanitary napkins through social marketing.

              In the state of Punjab ARSH was initiated in 2007-08 in 6 districts, in 2008-
09 7 more districts were covered and in remaining 7 districts programme is under
progress. The name focus of the programme was on establishing AFHS clinics. Clinics have
been established at 14 districts hospitals, 36 SDHs, 83 CHCs, 309 PHCs and clinics at
remaining DHs/ CHCs are being setup. Under this programme TOT for district level trainers
were conducted every year and by now 635 Medical Officers, 188 ANMs/ LHVs, 30 School
Teachers have been trained. It is expected that by March 2010 another 300 Medical
Officers, 350 paramedics and 150 teachers will be trained. For the advocacy of the ARSH
programme State Level/District Level/Block Level Workshops were organized. Youth
Clubs, Stakeholders were sensitized for ARSH issues. Involvement of Education Department
and integrating the programme with School Health Programme was done.



                                                                             97
                 Plan to utilize services of ICTC Counselors at DH/SDH level for providing
   Counseling Services to adolescents on fixed day fixed time basis in afternoon sessions so
   that working of ICTC centers is not affected.

                 During this year it is proposed that Social Marketing of Sanitary Napkins for
   School going adolescent girls will be initiated.

   The major problems faced by adolescent in the state are:

             •   Alcoholism /Drug addiction especially injectable drugs.
             •   Socio Cultural barriers especially relating to honour and shame.
             •   Lesser importance accorded to adolescent health issues, especially those
                 related to adolescent girls
             •   High prevalence of Anaemia especially among adolescent girls
   Keeping this in view, state propose to focus on DH, SDH for professional counseling and
   curative services



                                                 issues.
Objective: 1 To Mainstream the Adolescent Health issues.

                                   • Nearly 22.5 % of the state’s population is in the adolescents
                                      age group
Issues/ Challenges                 • Reluctant to seek help.
                                   • Adolescents are more vulnerable to RTI, STI, anaemia and
                                      other RH related problems
                                   • There is no organized system for addressing health
                                   Activities/ Inputs
Strategies/ Services
1. Providing AFHS at Institution • All districts have been covered under ARSH
  level                            • All DH, SDH, CHC functioning as AFHS.
                                   • Improve service environment in CHCs, FRUs and DHs.
                                   • Guidelines and workshop on ARSH.
                                   • Training of 600 Medical Officers, 1200 Para Medics and
                                      AWW on AFHS.


                                                                                98
                                     • To make the adolescent health care facilities accessible to
                                       handle the problems of unsafe adolescent pregnancies and
                                       management       of   reproductive tract   infections easily
                                       accessible to all.
                                     • Filling the skill gaps in health personnel for Adolescent
                                       Reproductive Sexual Health
                                     • (ARSH) and other adolescent health interventions
                                     • Treatment of menstrual disorder
                                     • Treatment of RTI/ STI
                                     • Establish referral mechanisms
                                     • Provide additional drugs and supplies
                                     • Develop monitoring mechanisms
                                     • Initiate services
                                     • Develop referral linkages with medical colleges
2. Increasing awareness among • To improve the health awareness in the adolescent on
  the   adolescents      and   the     personal     hygiene,    nutrition,   anemia,     sexual   and
  community      about    service      reproductive, RTI and STI, health services etc.
  availability                       • Advocacy to key stake holders to create conducive
                                       environment for providing services: print and electronic
                                       media, seminars, workshops, , etc
                                     • Increase awareness among adolescents on RH issues
                                     • Increase awareness in the community especially among
                                       parents
                                     • Mobilization and information dissemination to adolescent
                                       by ASHAs, Anganwari Workers.
                                     • Higher secondary school based adolescent health education
                                       initiatives by building a local cadre of trained students on
                                       life kill education. Awareness on contraceptives methods to
                                       enable well informed choices.
                                     • Organize adolescents health mela in districts

                                                                                   99
3. Reducing     anaemia   in • Screen for and manage anemia and malnutrition in
  adolescent girls                  adolescence
                                • Distribution of IFA tablets and de-worming tables in
                                    schools under school education program to manage
                                    anemia in defined adolescent age group.
                                • IFA to out of school adolescent girls.
                                • Conduct special IEC/BCC activities
                                • Provision of IFA Tablets
4. Menstrual Health             • In the State use of sanitary napkin among adolescent girls is
                                    low. Many families are less willing to discuss menstrual
                                    hygiene due to shyness/ taboos.
                                • Advocacy and social marketing of sanitary napkins in
                                    collaboration with NGOs, ICDS and other departments.
                                • Anganwadi workers, self-help groups to be oriented for
                                    promotion of sanitary napkins
                                • Counseling by female teachers.
                                • IEC/ BCC materials
Support       needed      for
                                • Coordination with ICDS, schools, etc
implementing changes
                                • Monitoring system- utilization of AHS services
                                • AHS provision in CHCs-100%
                                •   Incidence of anaemia in girls of 15-19 years.
                                •   Inter-Sectoral convergence with the ICDS and Education
Benchmarks                          department
                                •   Prevalence of RTIs/STIs among age group 15-19 years
                                •   No of maternal deaths among teenage mothers
                                • Proportion of HIV positives among 10-19 yrs age group




                                                                               100
Objective: 2 To make AFHS a tool to propagate Gender Equity
                                      • Lesser importance accorded to adolescent health
                                         issues, especially those related to adolescent girls
                                      • Gender bias still deep rooted in the community
Issues/ Challenges
                                         especially rural areas and BPL/ SC community
                                      • Lack of understanding to the correlation between
                                         adolescent health and maternal and child health and
                                         other broader health issues

Strategies/ Services                  Activities/ Inputs

1. Mainstreaming of AFSH issues       • Making adolescent health an important component of
                                         Village Health and Nutrition Day (VHND)
                                      • Community meetings to be held by ASHA/ ANM/
                                         Medical Officer
                                      • Gender issues to be highlighted in all such sessions,
                                         especially the fall-out of poor sex ratio.
                                      • Social marketing of sanitary napkins and other
                                         adolescent health friendly goods.
                                      • From Education Department
                                      • From Punjab State AIDS Control Society
                                      • Active support and involvement of PRIs, VHSCs and
Support needed for implementing
                                         other stakeholders in the community
changes
                                      • Effective partnerships with the private health care
                                         providers
                                      • Administrative will and political support
                                      • Acceptance in the community leaders regarding
                                         adolescent health and sexual health issues
Benchmarks                            • Acceptance from the community to make efforts to
                                         balance gender issues
                                      • Long term effect on sex ratio being balanced


                                                                                  101
Objective: 3 To operationalize Adolescent Friendly Health Centres in DH/ SDH
                                   • To provide extensive Adolescent Friendly Health Services in
                                      coordination with local clubs, teen groups, NYK.
Objectives
                                   • To support formation of NYKs affiliated youth clubs based teen
                                      clubs for out of school adolescent.
                                   • Convergence with School Health.
Strategies/ Services               Activities/ Inputs
Mainstreaming of AFSH issues       To Increase awareness of one’s own body (physical, psychological
                                      and reproductive health etc) and control over it – including
                                      fertility control and safe sexual practices.
                                   • To counsel for healthy life skill practices.
                                   • To counsel and treatment for RTIs/ STIs
                                   • Counselling on HIV AIDS
                                   • Referral services.
Opearationalise Youth Friendly • Training of ICTC counsellors.
Centre                             • Counselling services by trained counsellors at selected clinics.
                                   • Counselling to cope with sexual abuse.
                                   • Safe abortion services
                                   • Training of NSS voluntaries to act as peer counsellors.
Curative services                  • Special clinic for treatment for menstrual disorders, RTI/ STI
                                      and other adolescent issues will be made functional at DH/
                                      SDH level
To mobilize and provide easily Mother NGOs of the area will be involved in community outreach
accessible and friendly health programs to disseminate information to adolescents in groups
care services and counseling for through various methods including
adolescents.                       sports events and film shows in villages. Vocational training institutes
                                   and other adolescent hangouts will also be targeted for activities by
                                   NGOs to maximize the chances of having an interface with the school
                                   adolescents.

                                                                                     102
                             • From Education Department
Support      needed    for
                             • From Punjab State AIDS Control Society
implementing changes
                             • Coordination with Nehru Yuva Kendras/Youth Clubs
                             • Adolescent Attending the Clinics.
Benchmarks
                             • Outreach sessions organised.




                                                                        103
                       BUDGET FOR ADOLESCENT REPRODUCTIVE AND SEXUAL HEALTH

                                          Physical                                               Modified
                                           Target                                               Budget for
                                                     Rate                                         NPCC
                                                                                     2010-
                                                                  Amount (Rs. Lakhs) 2010-11                  Remarks
            Budget Head                              (Rs./                                       Amount
                                          Unit of                                               (Rs. Lakhs)
                                                     Unit)
                                          Measure                                                2010-
                                                                                                 2010-11
                                                                  Q1      Q2      Q3      Q4

  4       ADOLESCENT REPRODUCTIVE AND SEXUAL HEALTH / ARSH

          (Details of training, IEC/BCC in sections 11 and 12 )
          Adolescent          friendly
 4.1
          services
          Disseminate           ARSH
4.1.1
          guidelines.
          Implementation guide of
          RCH II. Adolescent
          reproductive sexual
4.1.1.1                                     600       75          0.00   0.45    0.00    0.00      0.45
          health strategy 600
          Copies @ Rs.. 75/- per
          copy.
          ARSH Facilitator guide
4.1.1.2                                     200      700          0.00   1.40    0.00    0.00      1.40
          200 @ Rs.700/- each
          Orientation programme
          for medical officer, ANMs,
          LHVs and others to
          provide adolescent                                             15.0
4.1.1.3                                    5000      300          0.00           0.00    0.00     15.00
          friendly reproductive and                                       0
          sexual services HAND
          OUTS 5000 Handouts @
          Rs.. 300 per copy.
          Programme CD's 300 CDs
4.1.1.5                                     300       40          0.00   0.12    0.00    0.00      0.12
          @ Rs.. 40/- per CD
          Prepare operational plan
          for ARSH services across
          districts        (including
4.1.2                                                             0.00   0.00    0.00    0.00      0.00
          training,         BCC/IEC,
          equipment, drugs and
          supplies, etc.).
          STATE /District/Block            Cost of
          LEVEL WORKSHOP                    one
                                          workshop
          Implement ARSH services
4.1.3
          in districts.
          Setting up of Adolescent
4.1.3.1
          Clinics at health facilities.
          To operationalise Multi
          Purpose Youth Friendly                                         14.2
                                            57       50000        0.00          14.25    0.00     28.50
          Centres in all Districts -                                      5
          21 DH and 36 SDH


                                                                                                104
                                      Physical                                           Modified
                                       Target                                           Budget for
                                                 Rate                                     NPCC
                                                                             2010-
                                                          Amount (Rs. Lakhs) 2010-11                     Remarks
         Budget Head                             (Rs./                                   Amount
                                      Unit of                                           (Rs. Lakhs)
                                                 Unit)
                                      Measure                                            2010-
                                                                                         2010-11
                                                          Q1      Q2      Q3      Q4
        Other strategies/activities
        (please specify – PPP/
4.2     Innovations/NGO to be
        mentioned under section
        8)
        Implementation           of
                                                                                                      Booked under
        Adolescent Programme                                     50.0
4.2.1                                                    0.00            0.00    0.00     50.00       Budget Head 8
        through MNGOs in 2                                        0
                                                                                                      NGO/PPP
        districts
        Sanitary Napkins to                                      50.0
4.2.2                                                    0.00            0.00    0.00     50.00
        adolescent girls                                          0
                                                                                                      Booked under
        IFA      Tablets       for
4.2.3                                                    30.00   0.00    0.00    0.00     30.00       Budget Head 13
        adolescent girls
                                                                                                      Procurement
        Operational Expenses             1       50000   0.13    0.13    0.13    0.13      0.50
                                                                 81.3
          Total ARSH                                     0.13            14.38   0.13     95.97
                                                                   5




                                                                                        105
URBAN RCH

•   At present more than 5% of the total population (280 lac) lives in the slum areas which
    are dominantly jhuggi-jhopri clusters situated all across the State, more so in the
    industrial areas.

•   These clusters are situated outside as well as inside the urban and peri-urban areas as
    also along the main roads of the State.

•   Dominantly, the migratory populations from across the country inhabit these clusters.

•   Some of these clusters also keep on shifting from place to place in search of livelihood.

•   Mapping of these has already been done district wise.

•   These slum areas are not covered under any urban health care centers and nor such an
    arrangement can be planned.

•   Poorest of the poor people inhabit these clusters and these people were deprived of
    basic health facilities e.g. immunization and MCH.

•   We have already deployed contractual MPHWs (F) for providing immunization and
    MCH services and these MPHWs are exclusively providing primary health care facilities
    to the slum dwellers.

•   These contractual ANMs are attached for logistic support and supervision etc. with the
    nearest health institution (SC/ PHC/ UHC/ CHC/ hospital).

•   Working of these ANMs is separately monitored and evaluated.

•   No vaccinators have been deployed on weekly basis in these slum areas under the
    immunization PIP.




                                                                               106
Problem     Identified   & • Urbanization is increasing at a fast rate in Punjab and so is the
Core Issues                    increase in urban slums, of which Ludhiana city is a classical
                               example.
                             • As per census of India 2001 (series 4), 4.74% of the state
                               population (2,42,89,296) i.e. 11.5 lac is living in urban slums
                               with majority of the population shifting from place to place. This
                               migratory population has increased further tremendously.
                             • Thousands of migratory labourers from the State of UP, Bihar,
                               Orissa etc. are migrating to and settling in newly created slums
                               around the cities and peri urban areas.
                             • These    agricultural   and    industrial    labourers      also   settle
                               temporarily in hutments near the under-construction buildings
                               or major projects for construction activities.
                             • The hutments shift around urban areas, but there is no provision
                               of MPHWs and Health supervisors in these areas to provide
                               Primary Health Care facilities, which the poorest deserve the
                               most.
Solutions         proposed • Mapping of the slum areas has already been done.
(Activity plan)              • To provide primary health care and to check spread of Vaccine
                               Preventable Diseases so as to lower the MMR & IMR and to control
                               other communicable diseases in the urban slums, appointment of
                               230 MPHWs (female) i.e. ANMs has already been made on
                               contractual basis. Vacancies if and when occur, are filled-in.
                             • These MPHWs are working under the supervision of existing
                               supervisory staff posted in the urban dispensaries & nearby PHCs
                               and Subsidiary Health Centres, under overall supervision of block
                               level PHC SMO, DIO and DFPO.
                             • Logistics are supplied from district pool and replenished by Govt. of
                               India in routine supplies.


                                                                                     107
Support needed for Financial support for payment of salary to 230 MPHWs @Rs.
implementing changes
                     7314/- each per month.

Benchmark(s) derived • Outreach of Primary Health Care to migrant populations begins.
from this component
                     • Immunization and Substantial decrease in IMR & MMR in the
                                  urban slums.
                               • 3. 100% of the migratory populations in the slum areas are
                                  covered under the immunization and MCH programme upto
                                  2010-11



                                     BUDGET FOR URBAN HEALTH

                                         Physical                                          Amount
                                          Target                                             (Rs.
                                                    Rate                       2010-
                                                            Amount (Rs. Lakhs) 2010-11     Lakhs)   Remarks
            Budget Head                             (Rs./
                                                    (Rs./                                   2010-
                                         Unit of                                            2010-
                                                    Unit)                                     11
                                         Measure
                                                            Q1     Q2      Q3      Q4
5     URBAN HEALTH
      Contractual Appointment of
      ANMs in the urban slums to
      cover migratory population 230
                                                            47.6   47.6            47.6
5.1   slum area clusters each with a       230      6900                  47.61            190.44
                                                               1      1               1
      population of appx. 10000
      identified. 230 health workers @
      Rs. 6900/- each Per Month)

                                                            47.6   47.6            47.6
         Total Urban Health                                               47.61            190.44
                                                               1      1               1




                                                                                     108
PRENATAL DIAGNOSTIC TECHNIQUE ACT & SEX RATIO

              Punjab, State of Martyrs has a scar of killing the daughters in the feotus. Sex
ratio at birth 837 (SRS 2007) and 0-4 year 838 (SRS 2007) is of serious concern. Despite
the efforts at different level progress is slow. Although trends of sex ratio shows that
Punjab has not un welcoming attitude towards girl child , when sex ratio was decreasing
the country, sex ratio of Punjab was improving. From 1971-81 there was marginal increase
in sex ratio in the country but in Punjab it was significant increase. 1981-91 sex ratio
deteriorated in the country but marginally increase in Punjab.




              But the major concern was steep decline in Child sex ratio in the year 1981-
91 and further more decline in 1991-2001.




                                                                              109
This was the era of sex selective abortion with the misuse of ultra sonography techniques.
              Rural Urban comparison shows that decline is more prominent in Urban
areas but rural is not untouched by this.




                                                                             110
              Girl-child, especially second girls-child is unwanted in family because the
socio cultural milieu has promoted the son preference because it relate to socio economic
matters. Son is considered as support of old age in the absence of concrete social security
policies. Curse like dowry atrocities against women has aggravated the sex-selection
practices. It’s not a medial phenomena, it’s a issue of social values preferences and overall
position of women in society. Besides effective implementation of PC-PNDT Act state needs
a strong campaign and commitment towards cause. In the previous year's state has
effectively worked on it.
              There are different schemes implemented by different departments Balri
Rakshak Yojna (Health Department), Kanya Jagriti Jyoti Scheme (Woman and Child),
Mahila Jagriti Yojna and Swayamsidha, Kishori Shakti Yojana (Woman and Child), Dhan
Lakshmi (GoI) and different social and religious organisatrions are playing important role
for the promotion of girl-child like Hukam Nama by Apex Religious Body and initiative like
Nanhi Chhan are being done.
              As a result of enforcement of PC and PNDT Act and multi furious awareness
generation activities undertaken in the state, SRS survey report pertaining to year 2007 has
shown improvement in child sex-ratio (0-4 years) from 796 in the year 2001 to 838 in the
year 2007. 105 court cases/ FIRs have been registered against violators of PC-PNDT Act
and in addition action has been taken in the form of suspension/ cancellation of
registration of centres. 15 centres have been convicted by the court. improving the sex-
ratio is the top agenda of the State Govt. Under NRHM various initiatives/ incentives have
been proposed for effective implementation of PC-PNDT Act and promotion of girl-child.




                                                                              111
Objective: Let her born

                           • Girl-child, especially second girls-child is unwanted in family
                               because the socio cultural milieu has promoted the son
                               preference because it relate to socio economic matters. Son is
                               considered as support of old age in the absence of concrete social
                               security policies.
Issues/ Challenges         • Curse like dowry atrocities against women has aggravated the
                               sex-selection practices.
                           • It’s not a medial phenomena, it’s a issue of social values
                               preferences and overall position of women in society.
                           • Besides effective implementation of PC-PNDT Act state needs a
                               strong campaign and commitment towards cause. In the
                               previous years state has effectively worked on it

Strategies/ Services      Activities/ Inputs
Campaign to save the girl • Involvement of community and stakeholders.
child                     • Awareness program with the help of NGOs.
                           • Publicity and information material developed in punjabi.

                           •   Public messages in the public places.
                           •   Involvement of print and electronic media to give wider publicity
                               to the issue like advertisement on TV relating to PNDT Act and
                               promotional Girl child schemes in the State.
Monitoring            and • Monitoring birth registration and Sex Ratio at birth by PRI
Evaluation                     institutions.
                           •   Monitoring of PNDT clinics by MNGOs that will share the
                               responsibility of inspection and monitoring of DAA.
                           •   Identification of unregistered machines in the district by
                               community workers.
                           •   Monitoring of Pregnancies, MTPs, live births and Birth
                               registrations by community workers.




                                                                               112
                           •   Regular review and monitoring meetings at the national level
                               and State level in steering group and state health mission
                               respectively for implementation of SGC scheme involving strict
                               implementation of PNDT Act by DAAs.
Networking and Alliance • Networking with NGOs working on the issue in the area
Building                • Interaction and dialogue with medical professionals.

                           •   Networking with women and child development department/ or
                               social welfare departments for the promotional schemes of Girl
                               child.
                           •   Networking with schools, colleges, professional colleges and
                               universities to promote the youth campaign
                           • State Health Mission
Support   needed       for • Voluntary and religious organisations
implementing changes       • Different departments especially Social Security Women & Child
                               Development and Education Department.
                           • Campaigns organised
Benchmarks                 • Appeals from community leaders
                           • Meetings of stakeholders




                                                                            113
                               implementation PC-
Objective: To ensure efficient implementation of PC-PNDT Act

Issues/ Challenges
                           •


Strategies/ Services       Activities/ Inputs

                           • Seminars/ workshops need to be conducted at state/ district/
                               sub-divisional   levels   for   repeated   sensitization   of   the
                               Appropriate Authorities, Medical Practitioners both public and
                               private, and community at large
                           • To enlist the support of professional bodies like IMA, FOGSI etc
Advocacy and BCC for
                               and other stakeholders like PRIs, religious organizations and
PC-PNDT
                               community groups.
                           • Involvement of mass media for dissemination of information
                           • Public messages
                           • Youth campaign against sex selection
                           • Use of folk media for propagation of act
Regulate ultrasound and • All the diagnostic/ USG centres in the district shall be registered
genetic centres                and regularly monitored by the Appropriate Authority
                           • Defaulters will be penalised and public notification regarding the
                               same shall be displayed
                           • Conducting sex determination test shall be propagated as a crime
                               and a shameful act
                           • Areas/ zones with poor sex ratios shall be targeted on a priority
                           • Funds for prize/ incentive for informers reporting violations of
                               the PNDT Act
                           • Funds for arranging decoy patients to nab violators of the PNDT
                               Act
Orienting the designated • Capacity building and orientation of stakeholders.
Authorities on the Act
and their envisaged roles • One-to-one interaction with the Deputy Commissioner and the


                                                                              114
                                Sub-Divisional Magistrate on the norms of the Act and their roles
                             • Get the necessary circulars/ notices issued from these officials
                                informing the services providers and the community about the
                                norms of the Act
Orienting the community • Intensive awareness campaign in the community informing
on the Act                      about the Act and the penalising actions envisaged therein for
                                defaulters
                             • To circulate brief handouts within the community informing
                                about the Act
                             • To use all the media channels for creating community awareness
                             • Enlist the support of political, community and religious leaders
Incentives     to   village/ • Award money to 50 villages that perform well the sex ratio scale
individuals                     @ Rs. 1.5 lakh per village
                             • Sting operation
                             • From the Judiciary, Police and other concerned departments
Support       needed    for • From all the NGOs/ CBOs/ FBOs/ PPs etc
implementing changes         • From the medical fraternity and their professional bodies like
                                IMA/ FOGSI
                             • Strict implementation of the Act

Benchmarks                   • Penalising the defaulters publicly
                             • Cooperation from all the stakeholders in propagating the Act
                                norms




                                                                               115
Objective: To Establish the Institutional framework for implementing the PNDT Act

                              • PNDT Act has been implemented and requires regular
Issues/ Challenges              monitoring and a strong regulatory framework
                              • Necessary staffing and logistics to be in place
                              • Legal guidance lacking

Strategies/ Services          Activities/ Inputs

Institutionalising     State • Strengthening PC-PNDT cell. The provision of and Statistical
and District level ‘PNDT        Assistant
Cells’                        • Operationalise State level PNDT Cell with members derived from
                                various govt. departments, Judiciary, NGOs/ CBOs/ FBOs
                              • Schedule regular structured review meetings of this cell
                              • Operationalise District Level PNDT cell with the district
                                administration, judiciary having important stake
                              • At the state level, Secretary Health to be the Member Secretary
                                while at the district level, the Civil Surgeon
                              • Regular meetings held to assess the implementation of the Act
                              • All the Government Departments, especially the Home Affairs
                                and the Judiciary
Support     needed      for
implementing changes          • From NGOs/ CBOs/ FBOs etc
                              • From the community
                              • From the private health care providers
                              • Proper documentation of all the activities/ meetings of these

Benchmarks                      cells
                              • Awareness among the community to the existence of the Act and
                                the Cell




                                                                                  116
                                                 Budget for PNDT

                                      Physical                                            Amount
                                       Target    Rate                         2010-
                                                           Amount (Rs. Lakhs) 2010-11    (Rs. Lakhs)   Remarks
           Budget Head                           (Rs./                                    2010-
                                                                                          2010-11
                                       Unit of   Unit)
                                      Measure             Q1       Q2     Q3      Q4
  8                         NGO
          INNOVATIONS/ PPP/ NGO
 8.1               Sex-
          PNDT & Sex-ratio
          PNDT Cell at the State
8.1.1
          HQ
          Lawyer @ Rs.25000 -
8.1.1.1                                  1       25000    0.75     0.75   0.75    0.75      3.00
          per month
          Statistical Asstt.@ Rs.
8.1.1.2                                  1       13000    0.39     0.39   0.39    0.39      1.56
          13000 p m
          Computer Asstt. @ Rs.
8.1.1.3                                  1       13000    0.39     0.39   0.39    0.39      1.56
          13000 pm
          Office expenses @ Rs.
8.1.1.4                                          6000     0.18     0.18   0.18    0.18      0.72
          6000 pm at State Level
          Orientation            of
          programme managers
8.1.2                                    2       150000   0.00     0.00   1.50    1.50      3.00
          and Service providers
          on PC & PNDT Act
          Mobility support for
          enforcement of PC &
8.1.3                                            200000   0.50     0.50   0.50    0.50      2.00
          PNDT Act at State HQ @
          Rs. 2 Lakh per year
          Award       money      to
          villages that perform
          well on the sex ratio
8.1.4                                   50       150000   0.00     0.00   0.00   75.00     75.00
          scale @ Rs. 1.5 Lakhs
          per village for 50
          villages in a year
          Budget       for    sting
          operation       @     Rs.
8.1.5                                   10       50000    2.50     0.00   2.50    0.00      5.00
          50,000/- each for 10
          operations
          Prize      money       to
          informers of violation
          of PNDT Act @ Rs.
8.1.6                                    8       20000    0.00     0.40   0.40    0.80      1.60
          20000 per informer for
          a maximum of 8
          informers in a year
          Payment       to   decoy
          patients @ Rs. 20000
8.1.7                                    8       20000    0.40     0.40   0.40    0.40      1.60
          for maximum of 8
          decoy patients in a year
                 Total PNDT                               5.11     3.01   7.01   79.91     95.04




                                                                                         117
Partnership with NGOs through Mother NGO Scheme:

       The concept of NRHM is to provide need based, client centered, demand driven, high
quality and integrated services to the communities. It aims to bring all RCH services within
the accessibility of the community as a whole and to expand the ownership of the
community in health programmes

To achieve the purpose of increasing access and coverage of a comprehensive package of
RCH services, the government, the corporate sector and the voluntary and non-government
sector are expected to work together in partnership.

The MNGO Scheme is one of the strategic themes envisaged in the National Population
Policy 2000 which involves the broad based consultation with all the stakeholders .


To ensure an effective decentralization, the MNGO Scheme is being implemented through the
                                 which:-
state government in a pattern in which:-

Each district to have one MNGO and each MNGO has 3-5 Field NGO. The shift has been
made from IEC, advocacy strategy to the facilitation of service delivery on RCH components
like:
        • Maternal and child health,
        • Family planning,
        • Adolescent reproductive health and
        • Prevention and management of reproductive tract infections in un-served and
          underserved areas identified by the district officials.
There would be one Service NGO at the district level to ensure service delivery in un-served
and underserved area identified in consultation with district authorities.

The NGOs are expected to play a pertinent role in the implementation of the RCH-
Programme hitherto considered to be the responsibility of the government alone.

At present, there are 15 Mother NGOs, which have been identified for 18+1(as a special
case) districts as the Mother NGOs. There are 50 NGOs identified as a Field NGO under the
Mother NGOs in (13+1) districts. 3 MNGOs have completed more than two years of
implementation. 7 MNGOs and two Service NGOs have started the implementation phase



                                                                             118
during 09-10. 5 Mother NGOs and 2 Service NGOs are in preparatory Phase of people
development.




                                                                    119
                       Mother NGO Scheme/ Service NGO Scheme
                    NGO involvement and PublicPrivate Partnership has been considered as
Rationale:    one of the major strategies of NRHM/RCH II.
                  NGOs can play a major role in facilitating service delivery in the unserved
              and underserved areas.
                   To achieve the purpose of increasing access and coverage of a
              comprehensive package of RCH services, the government, the corporate sector
              and the voluntary and non-government sector are expected to work together in
              partnership.
Objectives:   The MNGO with FNGO and SNGO scheme will be continued with the following
              objectives :
                To enhance the participation of NGOs in decision-making processes by
                involving them as full members in state, district, block and village level
                management Committees
                To facilitate a participatory process of establishing linkages between Health
                and Family Welfare department, NGOs and civil society.
                To strengthen issue- based advocacy initiatives on RCH issues.
                To develop partnership with NGOs to facilitate service delivery in unserved
                and underserved areas .
                To strengthen community participation in health and creating demand for
                RCH services.
Strategy:     Specific activities identified for NGO involvement:
                Provision of RCH services in unserved and underserved areas.
                Involvement of NGOs in, early detection of pregnancy, educating mother on
                birth preparedness and a newborn care and timely referral for institutional
                deliveries or delivery by skilled birth attendant.
                Participation in promotion of adolescent health focus on non-school going
                adolescents



                                                                       120
Women and community empowerment initiatives for improving RCH status
Demonstrative program addressing issues of Gender and gender based
Violence.
Promotion of NSVs.
Monitoring Public Health System,: SC PHC, CHC, State- as a measure of
Community Monitoring. As a facilitators for the utilization of untied funds at
Sub Centre, PHC level and CHC level.
To address issue of female foeticide and declining sex ratio
Involved in facilitation for effective functioning of VHSC, ASHAs in the field.
Capacity Building of VHSC functionaries and the ASHAs in their project areas
specifically.
Involvement of Mother NGO representatives as Trainers of ASHA at district
level. Few credible NGOs involved in training of ASHAs at block level in
previous years.




                                                        121
Surakhit Janepa Yojna

   •   Rs 2 crore provided in PIP 2008-09 for Private Health Institutions for Deliveries of
       BPL/SC families.
   •   Scheme has been revised
   •   The average fixed rate for delivery to be reimbursed to the API (Accredited Private
       Institution) has been revised to Rs. 2500/- from earlier rate of Rs. 1700/- on the basis of
       field assessment.


             No additional funds are asked under the scheme in year 10-11.The unspent
amount is being carried forward from the year 08-09.

                           Performance under Surakhit Janepa Yojana (From 08-Till Dec 09)
                           Performance                                    08-


                                            No. of              Number of Delivery
                                                                                                Total
                                         Accredited
             Sr.     Name of the                                                             Expenditure
                                           Private
             No.       District                                     Caesarian /      Total      (Rs.)
                                         Institution    Normal
                                            (API)                   Complicated      (Rs
                                                                                     (Rs.)

              1    Bathinda                   2            33            5            38       64600
              2    Faridkot                   1            0             1            1        1700
                   Fatehgarh
              3                               2             9            0            9        15300
                   Sahib
             5     Jalandhar                 6             20           2             22      37400
             6     Muktsar                   1            131           9            140      238000
             7     Nawanshahar               1             1            2             3        5100
             8     Patiala                   2             46           31            77      130900
             9     Ropar                     1             44           23            67      113900
             10    Sangrur                   2            101           1            102      173400
             11    Mohali                    3             21           19            40      68000
                   Total                     21           406           93           499      848300


              Earlier the package per delivery was devised as Rs 4100 per delivery (which
included honorarium to ASHA/link worker for ensuring 3 ANC+ delivery+ PNC for the
pregnant woman, etc). This package was examined by the state on the comments of ROP of
NPCC then. State then revised the scheme at the rate of Rs 1700 per delivery to Accredited


                                                                                  122
 Private Institutions as in Gujarat State. However the scheme did not receive any response
 from the Private sector. This year, after feedback of market trends for the delivery in
 Private health Institutions at district level, it has been decided to revise the package to Rs
 2500 per delivery.

                  This package has been arrived at as per calculations mentioned in Table-I.

         Calculation
 Table1: Calculation of Average Fixed Service Charges per delivery (normal,
 Caesarean or complicated) under Surakhit Janepa Yojna (SJY):

                                                         Delivery in a Private Nursing Home
Sr No                  Procedure                  Cases per
                                                                   Cost per              Total
                                                     100
                                                               procedure (Rs.)           (Rs)
                                                  Deliveries
 1. Normal Delivery                                   85             2000              1,70,000
    Complications:                                    8              3200               25,600
    Forceps/Vaccum./Breech                           (3)
 2.
    Septicemia                                       (2)
    Blood Transfusion                                (3)
 3. Caesarean                                         7              6400               44,800
    One Antenatal Check-Up in 3rd
 4. trimester and one Post Natal check-up            100            100
                                                                                         10,000
    after discharge from the API.                                 (50+50)
                                                                                      2,50,400
        Total for 100 deliveries
                                                                                   (Say 2,50,000)
        Average Fixed Service Charges per
        delivery                                                                         2,500
        (Normal, Caesarean or Complicated)
                  The guidelines for the accreditation of Private Health Institution are in
 synchronization with GOI guidelines for the accreditation of 24x7 PHC.

                  There is no different structure of payment for different modes of delivery
 under Surakhit Janepa Yojna. Accredited Private Institution will be paid Rs 2500 per
 delivery irrespective of the type of delivery.

                  The scheme is to ensure institutional delivery amongst BPL/SC/ST families.
 The focus of the scheme will be at sub district level, preferably in un-served /underserved
 areas where state is not yet able to ensure delivery services at PHC either for shortage of
 human resource or equipped infrastructure.

                                                                                   123
                                   BUDGET FOR NGO/ PPP/ INNOVATIONS
                                      Physical                                            Amount
                                       Target     Rate                                      (Rs.
                                                                             2010-
                                                          Amount (Rs. Lakhs) 2010-11                    Remarks
          Budget Head                             (Rs./                                    Lakhs)
                                      Unit of
                                                  Unit)                                   2010-
                                                                                          2010-11
                                      Measure
                                                          Q1      Q2       Q3     Q4
 8.2           Private
        Public Private Partnerships
 8.3    NGO Programme
8.3.1   MNGO RCH Scheme
        Preparatory phase to
        newly selected MNGOs
8.3.2                                    5       100000   0.00   0.00     5.00    0.00         5.00
        for             proposal
        Development
        External Evaluation of
8.3.3                                    9       50000    4.50   0.00     0.00    0.00         4.50
        Phase-II MNGOs
        2nd      installment of
        grant in aid for 12                      150000          135.0
8.3.4                                    9                0.00     0
                                                                          0.00    0.00     135.00
        months to 9 (Phase-II)                      0
        MNGOs
        Final installment of
        grant in aid for 12
8.3.5                                    3                0.00   13.40    0.00    0.00         13.40
        months to 3 (Phase-I)
        MNGOs
8.3.6   Service NGO Scheme                                                                     0.00
         Preparatory phase to
        newly selected SNGOs
8.3.7                                    2       100000   0.00   0.00     2.00    0.00         2.00
        for             proposal
        development
                                                                                                       Total fund
                                                                                                       require Rs.
                                                                                                       30 lakhs
                                                                                                       Rs. 15.00
        1st installment of grant
                                                 150000                                                Lakh
8.3.8   in aid for 15 months to          2                0.00   0.00     15.00   0.00         15.00
                                                    0                                                  carried
        new 2 SNGOs
                                                                                                       forward
                                                                                                       from 09-
                                                                                                       10 to 10-
                                                                                                       11
        External Evaluation of
8.3.9                                    2       50000    1.00   0.00     0.00    0.00         1.00
        SNGOs
        2nd installment of grant
8.3.1                                            150000
        in aid for 12 months to          2                0.00   30.00    0.00    0.00         30.00
  0                                                 0
        existing 2 SNGOs
8.3.1   Review meeting with
                                         4       50000    0.50   0.50     0.50    0.50         2.00
  1     NGO partners
                                                                          22.5
             Sub Total NGO                                6.00   178.90           0.50     207.90
                                                                           0
                                                          0.00   88.84    0.00    0.00         88.84
        Funds available from NGO


                                                                                         124
                                  Physical                                           Amount
                                   Target    Rate                                      (Rs.
                                                                        2010-
                                                     Amount (Rs. Lakhs) 2010-11                    Remarks
          Budget Head                        (Rs./                                    Lakhs)
                                  Unit of
                                             Unit)                                   2010-
                                                                                     2010-11
                                  Measure
                                                     Q1       Q2     Q3      Q4
        division directly

                          2010
        Funds required in 2010-                                      22.5
                                                     6.00    90.06          0.50          119.06
           11                                                           0

8.4     Other innovations

                                                                     25.0
8.4.1   Surakhit Janepa Yojna                        25.00   25.00          25.00         100.00
                                                                        0

        Implementation       of
        Adolescent   Programme                                                                     Booked
8.4.4                                                0.00    50.00   0.00   0.00          50.00
        through MNGOs in 2                                                                         from ARSH
        districts

                                                             165.0   47.5
                                                     31.00                  25.50         269.06
        Total NGO/ PPP                                           6      0




                                                                                    125
 INFRASTRUCTURE AND HUMAN RESOURCE

Objective: To Improve Public Health Infrastructure

Issues/ Challenges               • To make 115 CHCs as functional FRUs
                                 • To make 236 PHCs as functional for 24x7 delivery services
Strategies/ Services          Activities/ Inputs
Appoint contractual staff       To appoint specialists on regular and contract basis
                                 • State Govt. is appointing specialists on regular basis. But there is
                                   lack of Gynaecologists and Paediatricians.
                                 • 40 Gynaecologists and 40 Paediatricians are to be appointed on
                                   contract where ever vacancy exists.
                                 • Anaesthesia on call basis
                                 • To provide 5 staff nurses on contract at CHC level.
                                 • Provision of 236 Female Medical Officers.
                                 • Three staff nurses at PHCs.
                                 • Biometric Attendance System in all health institutions.
                                 • Training and Capacity Building.
Provision       of      other • Maternal Health Specialist, Family Welfare Specialists, Public
contractual staff                  Health Specialists for technical support.
                                 • System analyst, Hardware Supervisor.
Undertake      Repair       and • Maintenance of institutions
Renovation of Facilities         • Repair/ renovation of PHCs/ RH to be upgraded for 24x7
                                   services
                                 • Drugs and equipments to all the PHCs/ RH
                                 • Blood storage units at all CHCs
                                 Budgeted under Mission Flexipool
Support      needed         for • Punjab Health Systems Corporation
implementing changes

Benchmarks                       • Functional FRUs and 24x7 PHCs


                                                                                   126
Quality Assurance – Accreditation of Hospitals

              During the F/Y 2010-11, 5 big District Hospitals will be taken for
   accreditation of NABH. The 5 hospitals will be:




         SN                  Name of Hospital                       Sanction Bed

          1    Civil Hospital, Jalandhar                                400

          2    Civil Hospital, Mohali                                   150

          3    Civil Hospital, Bathinda                                 200

          4    Civil Hospital, Ludhiana                                 200

          5    Special Hospital, Mata Kaushalya, Patiala                200



          The department has already negotiated contract with Quality Council of India &
   the contract is likely to be signed within a week. Quality Council of India will charge Rs.
   7.00 Lakh per hospital for assisting the State Government for getting the accreditation
   from NABH.




                                                                               127
                                     INFRASTRUCTURE
                          BUDGET FOR INFRASTRUCTURE AND HUMAN RESOURCES

                                         Physical                                                       Modified
                                          Target                                                         Budget
                                                                                                        for NPCC
                                                    Rate (Rs./                          2010-
                                                                     Amount (Rs. Lakhs) 2010-11          Amount    Remarks
            Budget Head                                                                                    (Rs.
                                         Unit of      Unit)
                                         Measure                                                         Lakhs)
                                                                                                        2010-
                                                                                                        2010-11
                                                                  Q1       Q2       Q3        Q4

  9       INFRASTRUCTURE AND HUMAN RESOURCES
 9.1      Contractual Staff & Services
9.1.3     Staff Nurses
          Staff nurse for 236 PHCs
          including RH and Satellite
          Hospitals (3 SNs per
          institution) Rs. 7500 P.M                                                                                Booked
          + Incentive after                                                                                        from
9.1.3.1                                    708       10000       212.40   212.40   212.40   212.40      849.60
          minimum 5 deliveries                                                                                     Maternal
          conducted @ Rs 200 and                                                                                   Health
          after minimum 5
          deliveries assisted @ Rs .
          100 per delivery
                                                                                                                   Booked
          SNs for 114 CHCs, 5
                                                                                                                   from
9.1.3.2   SNs/CHC/SDH/DH Rs.               570       10000       171.00   171.00   171.00   171.00      684.00
                                                                                                                   Maternal
          10,000/-
                                                                                                                   Health
9.1.4     Doctors And Specialists
          Obstetrician (60) for 114
          CHCs/SDH/DH Rs.
          30000+Incentive after                                                                                    Booked
          minimum 5 C-sections @                                                                                   from
9.1.4.1                                    40        35000       31.50    31.50    42.00     42.00      147.00
          1000 C-section + after 15                                                                                Maternal
          Deliveries @ Rs. 500 per                                                                                 Health
          delivery conducted + after
          10 MTPs @ Rs 200/ MTP
          Paediatrician (60) for 114
                                                                                                                   Booked
          CHCs/SDH/DH Rs.
                                                                                                                   from
9.1.4.2   30000+Incentive Rs 200           40        35000       31.50    31.50    42.00     42.00      147.00
                                                                                                                   Maternal
          per Emergency Case
                                                                                                                   Health
          during off duty hours
                                                                                                                   Booked
          Anaesthetist for 114
                                                                                                                   from
9.1.4.3   CHCs/SDH @ 1500/visit +          114       10000       34.20    34.20    34.20     34.20      136.80
                                                                                                                   Maternal
          Rs. 6/KM upto 50 KMs
                                                                                                                   Health
          Female Medical Officer for
          236 PHCs including RH
                                                                                                                   Booked
          and Satellite Hospitals @
                                                                                                                   from
9.1.4.4   Rs. 25000 PM +Incentive          150       30000       116.10   135.00   135.00   135.00      521.10
                                                                                                                   Maternal
          after minimum 10
                                                                                                                   Health
          deliveries @ Rs 500 per
          delivery + after 10 MTPs


                                                                                                  128
                                       Physical                                                       Modified
                                        Target                                                         Budget
                                                                                                      for NPCC
                                                  Rate (Rs./                          2010-
                                                                   Amount (Rs. Lakhs) 2010-11          Amount    Remarks
             Budget Head                                                                                 (Rs.
                                       Unit of      Unit)
                                       Measure                                                         Lakhs)
                                                                                                      2010-
                                                                                                      2010-11
                                                                Q1       Q2       Q3        Q4
           @ Rs 200/ MTP




9.1.5      Other Contractual Staff
                                                                                                                 Booked
           OT Assistant for 8 CHCs @                                                                             from
9.1.5.1                                   8        10000        2.40     2.40     2.40     2.40         9.60
           Rs. 10000/- PM                                                                                        Maternal
                                                                                                                 Health
           Hardware Supervisor @
9.1.5.2                                   1        12500        0.38     0.38     0.38     0.38         1.50
           Rs. 12500
           System Analyst @ Rs.
9.1.5.3                                   2        20000        1.20     1.20     1.20     1.20         4.80
           20,000/-
           Maternal Health
9.1.5.4                                   1        35000        1.05     1.05     1.05     1.05         4.20
           Specialist@ Rs. 35000/-
           Family Welfare
9.1.5.5                                   1        35000        1.05     1.05     1.05     1.05         4.20
           Specialist@ Rs. 35000/-
           Hospital
           Administration/Public
9.1.5.6                                   1        35000        1.05     1.05     1.05     1.05         4.20
           Health Specialist @ Rs.
           35,000/-
            Minor Civil Work Blood
9.3.1      Storage Units 2 to be set     62        150000       0.00     3.00     0.00     0.00         3.00
           up @ Rs.1.5 lakh per unit
           Civil Work/ Renovation                                                                                Booked
           for SNCU in Women and                                                                                 from
9.3.2                                     2       1500000       0.00    30.00     0.00     0.00        30.00
           Children Hospital,                                                                                    Child
           Bathinda and MKH Patiala                                                                              Health
                  Activities
           Other Activities Vehicle
           Maintenance including
 9.5       POL expenses, 3.00 Lakh                             21.25    21.25    21.25     21.25       85.00
           per district , 25 Lakh at
           the state
          Total Infrastructure                                 625.08   676.98   664.98   664.98      2632.00
           QUALITY ASSURANCE
           Accreditation of District
           Hospitals for ISO/other                             12.50    12.50    12.50     12.50       50.00
           certification




                                                                                                129
INSTITUTIONAL STRENGTHENING

Logistics Management

Objective: 1 To establish a robust and comprehensive logistic management system as an excellent
support system to implement RCH programme
                          • Lack of efficient inventory management system
                          • Lack of computerization and effective communication network i.e.
Issues/ Challenges          telephone and fax facility as well as internet connectivity for
                            keeping abreast of logistic management
                          • Irregular distribution of supplies
                          • Maintenance of warehouse facilities
Strategies/ Services         Activities/ Inputs
1. Institutionalising an • Streamline the procurement and disbursement procedures to
   efficient        logistic   facilitate uninterrupted availability of logistics for smooth
   procurement          and    implementation of RCH initiatives
   disbursement system
                             • Development of inventory management software
                          • To develop logistic management manual, purchase of stationary
                            and the preparation of reporting, recording and analyzing
                            templates
                          • Operational computerization up to district level
                          • Appointment of ware house-keeper on contract basis
                          • Availability of High-Tech communication facilities i.e. Telephone
                            with STD Facility, Fax Machine and internet connection
                          • To provide funds for mobility
                          • Developing appropriate software for efficient logistic management
Support   needed
          needed     for • Administrative will to streamline the processes and avoid red-
implementing changes       tapism
                          • Availability of skilled staff to perform the activities efficiently
                          • Monitoring/ reporting templates and manuals developed
                          • Computerized data at all levels with easy access to concerned
                            programme managers
Benchmarks
                          • Inventory management software developed
                          • Coordination among all the concerned to ensure streamlining of
                            the processes and avoiding of delay


                                                                               130
                                      • Pilferages and expiry below 5%

                                  BUDGET FOR INSTITUTIONAL STRENGTHENING

                                       Physical                                           Amount
                                        Target                                              (Rs.
                                                  Rate                        2010-
                                                           Amount (Rs. Lakhs) 2010-11     Lakhs)      Remarks
           Budget Head                            (Rs./                                    2010-
                                                                                           2010-
                                       Unit of    Unit)
                                       Measure                                               11
                                                           Q1      Q2      Q3      Q4
                      STRENGTHENING
        INSTITUTIONAL STRENGTHENING
 10
        Human             Resource
10.1
        Development
10.2.   Logistics   management/
 1      improvement
        Mobility    Support     @
10.2.
        Rs.3000 Per Month at State                3000    0.09    0.09    0.09    0.09         0.36
 1
        Level.
        Mobility Support @ Rs.
10.2.
        2000 Per Month Per                        2000    1.20    1.20    1.20    1.20         4.80
 2
        District
10.2.   Mobility Support at @ Rs.
                                                  800     2.83    2.83    2.83    2.83     11.33
 3      800 per Month Per Block
10.2.
        Ware housekeeper                  1       3000    0.15    0.15    0.15    0.15         0.60
 4
            Total Institutional
                                                          4.27    4.27    4.27    4.27     17.09
                                                                                           17.09
             Strengthening




                                                                                         131
MONITORING & EVALUATION

HEALTH MANAGEMENT INFORMATION SYSTEMS (HMIS)

Issues/Challenges:    Earlier data was collected and compiled in the manual form by the
clerical staff of the department. No technical inputs on the quality of the data were
provided. To computerize the whole HMIS data was a big challenge for the State. With the
introduction of HMIS/DHIS2, Punjab initiated the process of electronically entering the
data and started facility wise online entry upto sub centre level since May 2009. The Phase
I of the HMIS, (September 2008 to March 2009) focused on “establishing systems required
for routine information processing, (including data entry, processing, reporting and
transmission).” During this phase Punjab was successful in placing designated staff at the
state and district levels capable of operating the applications for all the routine information
processing activities including data entry, data validation, generation of routine and
analysis reports, and the transmission of data and reports across different administrative
levels.

Punjab has improved significantly in managing the database for each facility. Punjab now is
in the Phase II wherein main focus is on the use of information for action, including
strengthening and institutionalizing processes for the use of information for action.

A key aim is to shift the focus from looking at computerization and HMIS as an end in itself
but as a means to improve action to support health systems strengthening and
improvement. So, the focus will be very much on information (and not only the tools used
to generate this), and how this can be applied in various priority areas of planning and
monitoring at various levels of the health administration - from block level planners to
district administrators, and state level program managers and policy makers. Thus the
quality of data would again be the major challenge for the State.

State has also initiated the pregnant woman and child immunization tracking process, for
which sensitization till ANM level will be one of the priority area for the State




                                                                                    132
Objective: To strengthen MIS and Monitoring system for improving programme efficiency and
Effectiveness
Strategies/ Services    Activities/ Inputs
1. Strengthening of M & Monitoring will focus on:
  E & HMIS               1. Implementation of planned activities and reporting
                         • Whether planned activities are carried out at Community level/GP, Sub
                            centre level, PHC level, FRU level, District level and state level in time
                            bound manner
                         • Whether regular information captured on prescribed formats and
                            reports are being produced at various level (including reports to be sent
                            to GoI) or not.
                         • whether these reports are being utilized to strengthen the programme
                            and plan for the next year
                         2. Financial Supervision :
                         • Whether money is being spent in relation to budget allocated and time
                            to time Govt. orders
                         • Whether the timely utilization certificates and other reporting done in
                            time
                         3. HR Management :
                         • Whether the training and capacity building of health personnel is taking
                            place regularly based on TNA
                         • Whether the HR placement is taking place as per planned milestones
                         • Supplies and Equipments: Selection and Procurement of essential
                            material/equipments
                         • The monitoring and evaluation officers, computer personnel           placed
                            and budgeted in State, district and block programme management units
                            will look after the overall task of M&E and HMIS at various level
                         Evaluation would focus on:
                         • Process evaluation : To assess the implementation of planned activities



                                                                                 133
   with in due time line
• Outcome Evaluation : To assess the degree of attainment of
   predetermined objectives and targets of the programme
                   :
• Impact Evaluation: To assess the overall effect of the programme on
   relevant Health and socio- economic development indicators. This
   would be based on base line conducted in the beginning of Programme.
• Establishing external evaluation mechanism for midterm, annual
   evaluation and impact assessment through experienced and trained
   private agencies/NGOs.
Specific activities:
• Development of customised and simplified formats to measure the
   indicators.
• Provide service delivery registers, family welfare survey registers,
   immunisation registers etc.
• Monthly quarterly and yearly reporting from Sub- centre to state level
• Monthly quarterly and yearly review meetings at state district and Block
   level involving all the programme heads and concerned officials from
   concerned departments other than health. Specific task assignment to
   various officials to avoid the overlapping of activities and rationale use
   of resources
• Timely dissemination of meeting minutes to all concerned Sectors and
   programme in charges.
• Clear dissemination of any new guidelines from state to various levels.
• Continuous analysis of all the data / information collected
• Installation of Computerized HMIS Hardware and upgraded software till
   PHC level.
• Regular Computerization and analysis of data
• Ensuring regular reporting on structured formats through internet or using
   official web sites
• Capacity building of all the Personnel responsible for Electronic data base


                                                        134
                               generation and analysis at all the levels
                             • Establishing the video conferencing facilities in all 20 districts and state
                               head quarters for cost effective and        prompt communication (The
                               provision of networking is to requested from National Information
                               Centre (NIC)
2. Tracking of pregnant • Outsourcing of data entry for computerisation of name based tracking of
  women      and    child      pregnant women and immunization
  immunisation

3. Strengthening of Civil To strengthen the Civil Registration System following activities will be
  Registration     system      carried out :
  (CRS)
                             • Establish a CRS unit by providing CR Assistants

                             • Procurement and installation of 30 computer systems 2 each in bigger
                               districts, 1 each in smaller districts and two States for computerization
                               of RBD data and reporting

                             • Recruitment of 30 civil registration assistants for monitoring, coding
                               and data entry.

                             • Provision of incentive to link workers for reporting unregistered events
                               of births and deaths. For reporting unregistered births and death the
                               incentive will be provided

                             • IEC activities will be carried out through Print/ wall painting and other
                               audio visual means as specified in budget line.

                             • Supportive supervision at all levels
Support    needed      for
                             • Mobility support
implementing changes
                             • Financial allocation

Benchmarks                   • Fully computerised MIS is in Place




                                                                                      135
Objective: Strengthening Monitoring & Evaluation (M&E) Cell

                           • District Level M&E Cells are laying significant role in monitoring and
Issues/ Challenges           evaluation of all activities under RCH. M&E cell is fully functional in
                             all the districts. Infrastructure support has already been provided.
                             Accuracies of data and validation to be improved.
Strategies/ Services   Activities/ Inputs
1. Operationalzing new • Printing of new formats
   formats under NRHM.
                       • Review of existing registers
                           • Training to district/ block level trainers
2. Strengthening     block • Provision of one computer
   HMIS unit
                           • Data card for block Statistical Assistants
                           • Provision of internet connections and consumables for blocks
                           • Time to time trainings for data improvement/data quality

                           • Review meetings with district M&EOs and Block SAs to discuss the
                             monthly and quarterly progress
                         • Extra manpower at district/block level
Support   needed     for
implementing changes     • Additional computer at block level

                           • All the data collected, collated and analyzed electronically
Benchmarks                 • Immediate feedback and corrective action protocol established
                           • Least discrepancy in the data available




                                                                                  136
Objective: Operational Research
                           Operational Research is proposed to be conducted for
                           • In order to identify the incidence and prevalence of specific health
                               problems and factors related to it
                           • To find out the actual status of service delivery through community
                               survey etc.
                           • To understand and know various health issues and health services it is
Issues/ Challenges             very important to have an independent feedback from the community.
                               A part from various health services such as Maternal and Child Health,
                               Immunization, NRHM also has a very important component of BCC/
                               IEC activities. When it comes to Health Education we need to adopt
                               multipronged strategies such as Audio-Video clippings, posters, wall
                               paintings, advertisement, pamphlets. But it is well established that the
                               most effective way to disseminate health education is Inter Personal
                               Communication (IPC).
Strategies/ Services       Activities/ Inputs
                           Activities/
3. Community Survey        • For this purpose department proposes to engage School/ College going
                               girls of class 11th and 12th from the same village and train them to
                               disseminate health education and collect the feedbacks and
                               information in a form of questionnaire for mother and child health
                               services. This will serve the dual purpose i.e. not only these girls from
                               the same village would be in a better position to relate with the
                               women folk of the same village but at the same time they would also
                               get educated in this process.
                           • Since this work is of technical nature, PGI Chandigarh would be
                               requested for their support in Community Monitoring.
Support    needed      for • Education Department
implementing changes       • PGI
Benchmarks                 •



                                                                                    137
                                                       Flexipool.
Budget for operational research is proposed under NRHM Flexipool.




                                                                    138
                              BUDGET FOR MONITORING & EVALUATION / HMIS

                                            Physical                                                Amount
                                             Target    Rate                                           (Rs.
                                                                                   2010-
                                                                Amount (Rs. Lakhs) 2010-11                    Remarks
              Budget Head                              (Rs./                                         Lakhs)
                                            Unit of    Unit)                                        2010-
                                                                                                    2010-11
                                            Measure             Q1      Q2      Q3      Q4
 10.3      MONITORING & EVALUATION

           Operationalising the new
           MIES formats/PW and Child
10.3.1
           Immunization       tracking
           formats
           Printing of New Format
           under NRHM (Monthly,
10.3.1.1   Quarterly and Annual for                            0.00    10.00   0.00    10.00         20.00
                                                                                                     20.00
           Subcenters, SHCs, PHC, CHC
           and Hospitals)
           Printing of New Format for
10.3.1.2   PW and Child Immunization                           10.00   0.00    10.00   0.00          20.00
           tracking
           New Register for each ANM
           on    PW      and     Child
10.3.1.3                                                       7.20    0.00    0.00    0.00          7.20
           Immunization      Tracking
           (Rs120x6000 ANMs/LHVs)

10.3.2     Training

           2 day (thrice a year) training
           to District Monitoring and
           Evaluation     officers    (20
           Participants) (Rs.10,000 for
10.3.2.1                                                       0.40    0.40    0.40    0.00          1.20
           booking of lab + 300 per
           participant per day)x 2
           Days+(Rs.1000*4 resource
           personsx2 days)
           2 day (thrice a year) Distt.
           Level training to Block
           Statistical        Assistant
           (Division     wise)      [30
           Participants per day x Rs.
10.3.2.2   300      per   day    x    2                        1.84    1.84    1.84    0.00          5.52
           Day]+[Rs.10000 for booking
           of      labx2    day]x     4
           divisions+[Rs.1000*4
           resource personx 2 daysx4
           divisions]
           1 day training to ANM
           ((5094
10.3.2.3   ANMs)x(Rs.100+Rs.150+Rs                             11.28   11.28   0.00    0.00          22.56
           .75)+255      batchxRs.1200
           (batch of 20 ANMs+300 to

                                                                                              139
                                           Physical                                                 Amount
                                            Target    Rate                                            (Rs.
                                                                                   2010-
                                                                Amount (Rs. Lakhs) 2010-11                    Remarks
              Budget Head                             (Rs./                                          Lakhs)
                                           Unit of    Unit)                                         2010-
                                                                                                    2010-11
                                           Measure             Q1       Q2      Q3      Q4
           facultyx4)    +15%       Inst
           charges




10.3.3     Review Meetings                                               .
           1 Day Review Meeting with
           District level M&E officers,
           SAs and Block levels
10.3.3.1   Statistical Assistants (20                          0.32    0.32    0.32    0.32          1.26
           DMEOs+20DSAs+118
           BSAs=158
           ParticipatsxRs.200 per day)
10.3.4     Other M & E activities
           HMIS               Divisional
10.3.4.1   Coordinators for 4 divisions                        2.59    2.59    2.59    2.59          10.35
           and one at State HQ
           One Information Assistant at
           each DH/SDH/ Block for PW
10.3.4.1                                                      31.50    31.50   31.50   31.50        126.00
           and Child immunization
           tracking
           One Information Assistants
10.3.4.2   at Districts having 10 or                           0.36    0.36    0.36    0.36          1.44
           more (2 districts)
           1 computer System for each
10.3.4.2   DH/ SDH/ Block (118                                105.00   0.00    0.00    0.00         105.00
           blocks) @ Rs.60,000 each
           1 Data Card for each
           DH/SDH       Data       Assts
           (21+36), Block SA (118
10.3.4.3                                                       4.10    4.10    4.10    4.10          16.38
           Block SAs) and for 20 M&E
           officers at District level
           (@700 each month)
           Outsourcing of data entry for
           computerization of Name
           based tracking of pregnant
           women        and        child
           immunization     at    block,
10.3.4.4                                                      12.39    12.39   12.39   12.39         49.56
           district and State level +
           other reports ( Monthly 700
           forms*118 blocksxRs.5)x9
           months from 1/4/2009 to
           31/12/2009




                                                                                              140
                                           Physical                                                 Amount
                                            Target    Rate                                            (Rs.
                                                                                   2010-
                                                                Amount (Rs. Lakhs) 2010-11                     Remarks
              Budget Head                             (Rs./                                          Lakhs)
                                           Unit of    Unit)                                         2010-
                                                                                                    2010-11
                                           Measure             Q1       Q2      Q3      Q4
                                                                                                              (will be met
           Development       of    State
                                                                                                              out       of
10.3.4.5   Specific Application through                                                                       operational
           outsourcing                                                                                        cost)
           Internet connection and
           Consumable (Paper, CD,
10.3.4.5
           Floppy, Printer Cartridge
           etc.)
10.3.4.6   Rs. 25000/- per Block                               7.38    7.38    7.38    7.38          29.50

10.3.4.7   Rs. 30000/- District H.Q.                           1.50    1.50    1.50    1.50          6.00

10.3.4.8   State HQ                                            1.75    1.75    1.75    1.75          7.00
           POL for state head quarter
10.3.4.9   monitoring & Evaluation                             0.50    0.50    0.50    0.50          2.00
           team
              TOTAL HMIS                                      198.09   85.89   74.61   72.37        430.97




                                                                                              141
                                                                            09-
                  BUDGET FOR CIVIL REGISTRATION SYSTEM TO BE MET OUT OF PIP 09-10
                                                    2010-
                                       FOR THE YEAR 2010-11


                                         Physical                                               Amount (Rs.
                                          Target    Rate                          2010-
                                                               Amount (Rs. Lakhs) 2010-11         Lakhs)      Remarks
           Budget Head                              (Rs./                                        2010-
                                          Unit of                                                2010-11
                                                    Unit)
                                         Measure             Q1       Q2       Q3       Q4
10.33
10.33   Digitilization     of    CRS
(A3)    records
        Strengthening of CRS                                7.44   7.44      7.44      7.44     29.76
        System        with       Civil
        Registration        Assistant
        (Total 31) @ Rs.8000/-
        pm to each CRA. Two for
        big districts, one for small
        district and one for state
        HQ
        TA/DA to          CRA for                           0.37   0.37      0.37      0.37     1.50
        inspection of registration
        units of births & deaths @
        Rs.200/- per visit
        IEC activities ( Wall                               0.00   0.00      15.00              15.00
        Painting of size 3' x 2' @
        Rs.100/-        per      wall
        painting)
                                                            7.81    7.81     22.81     7.81     46.26
               Total




                                                                                              142
TRAINING

TRAINING NEED ASSESSMENT

           NRHM was introduced in the country in April 2005 with the major objective
  of improving the health status of the mother and child. Since then there is
  continuous effort to improve the quality of services at the grassroot level. In order to
  achieve the objectives of NRHM and provide quality services to the community,
  need was felt for sensitization and training of health care providers at all levels.

           Trainings of health care providers including, Medical Officers, Staff Nurses,
  Health Assistants (Male and Female), Multipurpose Health Workers (Male and
  Female), Laboratory Technicians and other staff, were started in the State at
  Medical Colleges, SIHFW, HFWTC and at District Training Centres.

           The infrastructure at the training centres had not been upgraded since
  many years so need was also felt for the upgradation of infrastructure. Along with
  this need was also felt for the upgradation of training centres for basic training of
  Multipurpose Health Workers (Male and Female).

           Keeping these factors in view, plan was prepared for the upgradation of
  training centres and training of staff in a phased manner. The present plan is a
  further step in the same direction.

           With the implementation of the plan outlined below, it is expected that:

  1. There would be improvement in the training infrastructure with the result that
     there would be improvement in the quality of trainings.
  2. There would be sufficient capacity building of the staff at various levels to provide
     quality services to the community, especially at the village level.
  3. This would ultimately lead to improvement in the health services and hence
     health indicators.




                                                                             143
Cost of Implementing Changes

11.1        Strengthening of Training Institutions SIHFW Mohali, HFWTC Amritsar, MPHW (M)
               Training Centres Nabha and Kharar, District Training Centres, ANM Training
               Centres

11.1.1      1. SIHFW Mohali

            To carry out Repairs/ Renovations – Upgradation of lecture halls

            @ Rs. 2 lacs* 1st quarter, Rs. 3 lacs*2nd quarter, Rs. 5 lacs* 3rd and 4th quarter

                                                                            = Rs. 15,00,000/- per annum



            2. HFWTC Amritsar

            To carry out Repairs/ Renovations

            @ Rs. 1 lacs*1st quarter, Rs. 1.5 lacs*2nd quarter, Rs. 2.5 lacs*3rd and 4th quarter

                                                                            = Rs. 15,00,000/- per annum



            3. MPHW (M) Training Centres Kharar and Nabha

            To carry out Repairs and Renovations

            @ Rs. 1 lacs*1st quarter, 2 lacs*2nd quarter and 1 lacs*3rd and 4th quarter per institute

                                                         = Rs. 5,00,000*2 = Rs. 10,00,000/- per annum



            4. ANM Training Centres at Hoshiarpur, Gurdaspur, Sangrur, Nangal, Moga,
               Bathinda

            To carry out Repairs and Renovations

            @ Rs. 1 lacs*1st quarter, Rs. 2 lacs*2nd quarter, Rs. 1 lacs*3rd quarter and Rs. 1 Lacs*4th
              quarter = Rs. 5,00,000/- per institution

                                                                            = Rs. 30,00,000/- per annum

            TOTAL for Repair and Renovations                                = Rs. 70,00,000/-




                                                                                   144
11.1.2     Provide Equipment and Training Aids to the Training Institutions (SIHFW Mohali,
              HFWTC Amritsar



           Non Medical Equipments

              1. Provide Smart classrooms = Rs. 10,00,000/-
              2. Upgradation of Auditorium/ Hostel = Rs. 10,00,000/-


           TOTAL for Equipment and Training Aids                               = Rs. 20,00,000/-

11.1.3     Contractual Staff under CTI, SIHFW, Mohali – One Consultant (Management) and
              Consultant (Medical – Gynaecologist) in position. Others to be recruited. Salary of
              consultants needs revision.

11.2       Development of Training Packages

11.2.1     Subscription of Journals of Public Health, WHO Publications and others for the SIHFW,
           Mohali

           Purchase of latest books for SIHFW, Mohali

                                                                                       = Rs. 2,00,000/-

11.2.2     Development/ Translation and Duplication of Training Materials @ Rs. 0.50 lacs*4 quarter
           at SIHFW, Mohali

                                                                          = Rs. 2,00,000/- per annum

11.3       Other Activities

11.3.1     Strengthening of Nursing Training College, Jalandhar

           Provide Training Aids, Computers, Printers, LCD Projectors, Digital Visual Presenters etc. to
           Nursing Training College, Jalandhar                       30,00,000/-
                                                               = Rs. 30,00,000/- per annum

11.3.2     Trainings other than reflected in this format

11.3.2.1   BCC Skill Building Training for MOs at SIHFW, Mohali and HFWTC, Amritsar



           Training Load                                                    = 600

           Total Batches                                                    = 20

           No. of Trainees per Batch                                        = 30



                                                                                145
           Duration                                                      = 5 days

           Honorarium                      2*300*5+2*500*5               = Rs. 8,000/-

           (No. of Trainers*Honorarium*Duration) – {A}

           Contingency                     300*30*5                      = Rs. 45,000/-

           (Amount per participant*No. of Participants* Duration – {B}

           TA (as per State Government Rules – approx) 1000*30           = Rs. 30,000/-

           DA (No. of Trainees*DA*Duration) – {C}        30*300*5        = Rs. 45,000/-

           Cost of Batch                                                 = Rs. 1,28,000/-

           TOTAL COST                      1,28,000*20                   = Rs. 25,60,000/-

11.3.2.2   BCC Skill Building Training for District MEIOs, ANMs, LHVs, MPHW (M), HA (M),
             BEE, Dy. MEIO, at SIHFW, Mohali and HFWTC, Amritsar

           Training Load                                                 = 600

           Total Batches                                                 = 20

           No. of Trainees per Batch                                     = 30

           Duration                                                      = 5 days

           Honorarium                  2*300*5+2*500*5                   = Rs. 8,000/-

           (No. of Trainers*Honorarium*Duration) – {A}

           Contingency                  300*30*5                         = Rs. 45,000/-

           (Amount per participant*No. of Participants* Duration – {B}

           TA (as per State Government Rules – approx)      500*30       = Rs. 15,000/-

           DA (No. of Trainees*DA*Duration) – {C}     30*200*5           = Rs. 30,000/-

           Cost of Batch                                                 = Rs. 98,000/-

           TOTAL COST                                       98,000*20    = Rs. 19,60,000/-

11.3.2.3   Computer Training for Medical Officers at SIHFW, Mohali

           Training Load                                                 = 144

           Total Batches                                                 = 12



                                                                            146
           No. of Trainees per Batch                                       = 12

           Duration of Training                                           = 5 days

           Honorarium                      4*300*5                        = Rs. 6,000/-

           (No. of Trainers*Honorarium*Duration) – {A}

           Contingency                     300*12*5                        = 18,000/-

           (Amount per participant*No. of Participants*Duration) – {B}

           TA (as per State Government Rules – approx) 1000*12             = Rs. 12,000/-

           DA (No. of Trainees*DA*Duration) – {C}     12*300*5            = Rs. 18,000/-

           Cost of Batch                                                  = Rs. 54,000/-

           TOTAL COST                                 54,000*12           = Rs. 6,48,000/-

11.3.2.3   Computer Training for Statistical Assistants, Clerks, Senior Assistants, Jr.
             Pharmacists at SIHFW, Mohali

           Training Load                                                 = 144

           Total Batches                                                 = 12

           No. of Trainees per Batch                                     = 12

           Duration of Training                                          = 11 days

           Honorarium                         4*300*11                   = Rs. 13,200/-

           (No. of Trainers*Honorarium*Duration) – {A}

           Contingency                        300*12*11                  = 39,600/-

           (Amount per participant*No. of Participants*Duration) – {B}

           TA (as per State Government Rules – approx) 500*12            = Rs. 6,000/-

           DA (No. of Trainees*DA*Duration) – {C}     12*200*11          = Rs. 26,400/-

           Cost of Batch                                                 = Rs. 85,200/-



           TOTAL COST                                 85,200*12          = Rs. 10,22,400/-




                                                                                147
11.3.2.4   Orientation Training of Rural Medical Officers in NRHM at SIHFW, Mohali



           Training Load                                                 = 300

           Total Batches                                                 = 10

           No. of Trainees per Batch                                     = 30

           Duration of Training                                          = 5 days

           Honorarium                  2*300*5 + 2*500*5                 = Rs. 8,000/-

           (No. of Trainers*Honorarium*Duration) – {A}

           Contingency                 300*30*5                          = 45,000/-

           (Amount per participant*No. of Participants*Duration) – {B}

           TA (as per State Government Rules – approx) 1000*30           = Rs. 30,000/-

           DA (No. of Trainees*DA*Duration) – {C}    20*300*5            = Rs. 30,000/-

           Cost of Batch                                                 = Rs. 1,13,000/-



           TOTAL COST                                1,13,000*10         = Rs. 11,30,000/-

11.3.2.5   Orientation Training of Rural Medical Officers in NRHM at HFWTC, Amritsar



           Training Load                                                 = 300

           Total Batches                                                 = 10

           No. of Trainees per Batch                                     = 30

           Duration of Training                                          = 5 days

           Honorarium                   2*300*5 + 2*500*5                = Rs. 8,000/-

           (No. of Trainers*Honorarium*Duration) – {A}

           Contingency                   300*30*5                        = 45,000/-

           (Amount per participant*No. of Participants*Duration) – {B}

           TA (as per State Government Rules – approx) 1000*30           = Rs. 30,000/-



                                                                                 148
           DA (No. of Trainees*DA*Duration) – {C}     20*300*5            = Rs. 30,000/-

           Cost of Batch                                                  = Rs. 1,13,000/-



           TOTAL COST                                 1,13,000*10         = Rs. 11,30,000/-

11.3.2.6   Orientation Training of Contractual ANMs in NRHM at SIHFW, Mohali



           Training Load                                                 = 300

           Total Batches                                                 = 10

           No. of Trainees per Batch                                     = 30

           Duration of Training                                          = 5 days

           Honorarium                  2*300*5 + 2*500*5                 = Rs. 8,000/-

           (No. of Trainers*Honorarium*Duration) – {A}

           Contingency                     300*30*5                      = Rs. 45,000/-

           (Amount per participant*No. of Participants*Duration) – {B}

           TA (as per State Government Rules)     500*30                 = Rs. 15,000/-

           DA (No. of Trainees*DA*Duration) – {C} 30*200*5               = Rs. 30,000/-

           Cost of Batch                                                 = Rs. 98,000/-



           TOTAL COST                                 98,000*10          = Rs. 9,80,000/-

11.3.2.7   Orientation Training of Contractual ANMs in NRHM at HFWTC, Amritsar



           Training Load                                                 = 300

           Total Batches                                                 = 10

           No. of Trainees per Batch                                     = 30

           Duration of Training                                          = 5 days

           Honorarium                   2*300*5 + 2*500*5                = Rs. 8,000/-



                                                                                 149
               (No. of Trainers*Honorarium*Duration) – {A}

               Contingency                  300*30*5                         = 45,000/-

               (Amount per participant*No. of Participants*Duration) – {B}

               TA (as per State Government Rules)      500*30                = Rs. 15,000/-

               DA (No. of Trainees*DA*Duration) – {C} 30*200*5               = Rs. 30,000/-

               Cost of Batch                                                 = Rs. 98,000/-



               TOTAL COST                                98,000*10           = Rs. 9,80,000/-

11.3.2.8       PDC Training for District Level Officers at SIHFW, Mohali



               4 Batches of 10 weeks duration each, 20 trainees per batch @ Rs. 15,50,000/- Budget
                  provided directly by NIHFW, New Delhi.



11.2.3.11      Meetings to be organised with DRME & Principals of Medical Colleges for
                 Conducting Trainings at Medical Colleges – Four meetings to be organised at
                 quarterly intervals



               TOTAL Cost                                        Rs. 50,000/-

11.2.3.12      Strengthening of District Training Centres

11.2.3.12(a)   Provision of the District Training Centres at 2 districts where separate Training
                  Centres are not available

               Cost per District                                = Rs. 8,00,000/-



               TOTAL COST                     8,00,000*2        = Rs. 16,00,000/-




                                                                                     150
11.2.3.12(b)   Repair and Renovation of District Training Centres

               Cost per District                                 = Rs. 1,00,000/-



               TOTAL COST                        1,00,000*15       = Rs. 15,00,000/-

11.2.3.12(d)   Strengthening of State Training Cell



               Recurrrent cost of running State Training Cell

               Salary of 2 Computer Assistants    16,000*12                         = Rs. 1,92,000/-

               @ Rs. 8,000/- per head per month

               Recurrent Cost at State Training Cell incl. Toner cartridges etc.    = Rs. 20,000/-

               (with printers, UPS and Scanner for the State Training Unit)

               Communication expenses (Telephone and Internet) 2000*12              = Rs. 24,000/-

               @ Rs. 2,000/- per month



               TOTAL COST                                                           = Rs. 2,36,000/-

11.3           Maternal Health Trainings

11.3 (a)       Setting up of Skilled Birth Attendant Training Centres at 5 new districts @ Rs.
                  15,000/- per district



               TOTAL COST                    15,000*5                       = Rs. 75,000/-

11.3.1         Training of Trainers for Skilled Birth Attendants at SIHFW, Mohali for 5 New
                  Districts (Barnala, Fatehgarh Sahib, Mansa, Moga, Muktsar)



               Training Load                                               = 25

               Total Batches                                               =1

               No. of Trainees                                             = 25


                                                                                      151
             Duration of Training                                         = 2 days

             Honorarium                - 2*300*2 + 2*500*2                = Rs. 3,200/-

             (No. of Trainers*Honorarium*Duration) {A}

             Contingency                                      300*25*2    = Rs. 15,000/-

             (Amount per participant*No. of Participants* Duration) {B}

             TA (as per State Govt. Rules – approx) – 1000*25             = Rs. 25,000/-

             DA (No. of Trainees*DA*Duration) – {C} 25*300*2              = Rs. 15,000/-

             Support Staff                 150*2*2                        = Rs. 600

             (Amount per head*No. of persons*Duration)

             Cost of Batch                                                = Rs. 58,800/-

             TOTAL COST                                                   = Rs. 58,800/-

11.3.1 (a)   Training of Medical officers as Skilled Birth Attendants in 5 new districts (Barnala,
                Fatehgarh Sahib, Mansa, Moga, Muktsar) at district level

             Training Load                                                       = 100

             Total Batches                                                       =5

             No. of Trainees per Batch     (1 per district)                      = 20

             Duration of Training                                               = 10 days

             Honorarium             2*300*10+2*500*10                           = Rs. 16,000/-

             (No. of Trainers*Honorarium*Duration) {A}

             Contingency                 200*20*10                              = Rs. 40,000/-

             (Amount per participant*No. of Participants*Duration) {B}

             TA (as per State Government Rules) 500*20                          = Rs. 10,000/-

             DA (No. of Trainees*DA*Duration)    {C}     20*300*10              = Rs. 60,000/-

             Institutional Overheads @ {A+B+C}*15%                              = Rs. 16,500/-

             Cost of Batch                                                      = Rs. 1,42,500/-

             TOTAL COST                         1,42,500*5                     = Rs. 7,12,500/-



                                                                                  152
11.3.2 (b)   Training of LHVs/ ANMs as Skilled Birth Attendants in all districts



             Training Load                                          = 360

             Total Batches                                          = 120 (@ 6 batches per district)

             No. of Trainees per Batch                              =3

             Duration of Training                                   = 21 days (extendable to 30 days)

             Honorarium                  4*300*21                   = Rs. 25,200/-

             (No. of Trainers*Honorarium*Duration) – {A}

             Contingency                 200*3*21                   = 12,600/-

             (Amount per participant*No. of Participants*Duration) – {B}

             TA (as per State Government Rules – approx) – 100*3 = Rs. 300/-

             DA (No. of Trainees*DA*Duration) – {C}    3*200*21     = Rs. 12,600/-

             Institutional Overheads @ 15% of A+B+C                 = Rs. 7,560/-

             Cost of Batch                                          = Rs. 58,260/-



             TOTAL COST                                58,260*120 = Rs. 69,91,200/-

11.3.1 (f)   Training of Staff Nurses as Skilled Birth Attendants in all districts



             Training Load                                                 = 360

             Total Batches                                                         = 120 (@ 6 batches per
                district)

             No. of Trainees per Batch                                     =3

             Duration of Training                                      = 21days

             Honorarium                    4*300*21                    = Rs. 25,200/-

             (No. of Trainers*Honorarium*Duration) – {A}

             Contingency                  200*3*21                     = Rs. 12,600/-



                                                                                    153
(Amount per participant*No. of Participants*Duration) – {B}

TA (as per State Government Rules – approx) – 100*3          = Rs. 300/-

DA (No. of Trainees*DA*Duration) – {C}        - 3*200*21     = Rs. 12,600/-

Institutional Overheads @ 15% of A+B+C                        = Rs. 7,560/-

Cost of Batch                                               = Rs. 58,260/-



TOTAL COST                                58,260*120          = Rs. 69,91,200/-

EmOC Training (At Medical Colleges)



Training Load                                               = 25

Total Batches                                                 =5

No. of Trainees per Batch                                     =5

Duration of Training                                        = 16 weeks

Honorarium              2*500*16 weeks (6 days a week)      = Rs.96000

(No of trainers*Honorarium*duration {A}

Contingency             200*5*16weeks (6 days a week)       = Rs.96000

(Amount per participant*No. of Participants*duration) {B}

Training Material         1000*5                            = Rs.5000

TA (as per state Govt. Rule approx.) 1000*5                 = Rs.5000

DA                  300*5*16 weeks (7 days a week)          = Rs. 168000

(No. of Trainees*DA*Duration) {C}

Administrative Expenses @ 15% of A+B+C                      = Rs. 54000

Cost of the batch                                             = Rs. 424000



Total Cost                     424000*5                     = Rs. 2120000/-




                                                                      154
11.3.3.1       Setting up of Life Saving Anaesthesia Skills Training Centres at identified Medical
                  Colleges – To be completed, funds already provided



11.3.3.2       TOT for Anaesthesia Skills Training of District Anaesthetists at Medical Colleges



               Training Load                                           = 20

               Total Batches                                           =1

               No. of Trainees per Batch                               = 20

               Duration                                                = 1 day

               Honorarium                         4*500*1              = Rs. 2,000/-

               (No. of Trainers*Honorarium*Duration)

               Contingency                      300*20*1               = Rs. 6,000/-

               (Amount per participant*No. of Participants*Duration)

               TA (as per State Govt. Rules)         20*1000           = Rs. 20,000/-

               DA (No. of Trainees*DA*Duration)     20*300*1           = Rs. 6,000/-

               Support Staff                   100*2*1                 = Rs. 200/-

               Cost of Batch                                           = Rs. 34,200/-



               TOTAL COST                                              = Rs. 34,200/-

11.3.3.3 (a)   Training of M.B., B.S. Medical Officers in Life Saving Anaesthesia Skills at 6
                  identified Medical Colleges

               Training Load                                           = 48

               Total Batches                                           = 12

               No. of Trainees per Batch                               =4

               Duration                                                = 12 weeks

               Honorarium      2*500*12 weeks (6 days per week)        = Rs. 72,000/-

               (No. of Trainers*Honorarium*Duration) {A}


                                                                                     155
               Contingency 200*4*12 weeks (6 days per week) {B} = Rs. 57,600/-

               (Amount per participant*No. of participants*Duration)

               Training Materials @ Rs. 1000/- per participant          = Rs. 4,000/-

               TA (as per State Govt. Rules)     4*1000                 = Rs. 4,000/-

               DA      4*300*12 weeks (7days per week) {C}              = Rs. 1,00,800/-

               (No. of Trainees*DA*Duration)

               Administrative Expenses     @ 10% of A+B+C               = Rs. 23,040/-

               Cost of Batch                                            = Rs. 2,61,440/-

               TOTAL COST                  2,61,440*12                  = Rs. 31,37,280/-

11.3.3.3 (b)   Training of M.B., B.S. Medical Officers in Life Saving Anaesthesia Skills at District
                  Hospitals

               Training Load                                            = 48

               Total Batches                                            = 12

               No. of Trainees per Batch                                =4

               Duration                                                 = 6 weeks

               Honorarium      4*300*6 weeks (7 days per week)          = Rs. 50,400/-

               (No. of Trainers*Honorarium*Duration) {A}

               Contingency 200*4*6 weeks (7 days per week) {B} = Rs. 33,600/-

               (Amount per participant*No. of participants*Duration)

               TA (as per State Govt. Rules)     4*1000                 = Rs. 4,000/-

               DA      4*300*6 weeks (7days per week) {C}              = Rs. 50,400/-

               (No. of Trainees*DA*Duration)

               Administrative Expenses     @ 10% of A+B+C               = Rs. 13,440/-

               Cost of Batch                                            = Rs. 1,19,280/-



               TOTAL COST             1,51,840*12                       = Rs. 18,22,080/-



                                                                                     156
11.3.4.2   Training of Medical Officers in MTP using MVA (3 MOs per Batch) at Districts



           Training Load                                               = 60

           Total Batches                                               = 20

           No of Trainees per Batch                                    =3

           Duration                                                    = 12 days

           Honorarium            1*300*12 days                         = Rs. 3,600/-

           (No of trainers*Honorarium*Duration) {A}

           Contingency                            200*3*12 days        = Rs. 7,200/-

           (Amount per participant*No. of participants*Duration) {B}

           TA (as per state Govt. Rule approx.)      750*3             = Rs. 2,250/-

           DA (C)                                 3*300*14             = Rs. 12,600/-

           (No of trainees x DA x duration)        {C}

           Institutional Over Head @ 15% of A+B+C                      = Rs. 3510/-

           Cost of the batch                                           =Rs. 29,160/-



           TOTAL COST                 29,160*20                        = Rs. 5,83,200/-

11.3.5.1   Training of Medical Officers in RTI/ STI at SIHFW, Mohali and HFWTC, Amritsar



           Training Load                                               = 600

           Total Batches                                                = 60

           No of Trainees per batch                                    = 10

           Duration                                                    = 2 Days

           Honorarium                   2*300*2 +2*500*2               = Rs. 3,200/-

           (No of trainers*Honorarium*Duration)

           Contingency                  300*10*2                       = Rs. 6,000/-



                                                                                157
           (Amount per participant*No of participants*Duration)

           TA (as per state Govt. Rule)        1000*10                 = Rs. 10,000/-

           DA (No. of Trainees*DA*Duration)          10*300*2          = Rs. 6,000/-

           Administrative Expenses @ 2*100*2                          = Rs. 400/-

           Cost of the batch                                          = Rs.25,600/-



           TOTAL COST              25,600*60                           = Rs. 15,36,000/-

11.3.5.2   Training of Lab Technicians, Staff Nurses, LHV/ ANM in RTI/ STI at SIHFW, Mohali
              and HFWTC, Amritsar



           Training Load                                              = 600

           Total Batches                                               = 60

           No of Trainees per Batch                                    = 10

           Duration                                                    = 2 Days

           Honorarium                     2*300*2 +2*500*2            = Rs. 3,200/-

           (No of trainers*Honorarium*Duration) {A}

           Contingency                    300*10*2                    = Rs. 6,000/-

           (Amount per participant*No of participants*Duration) {B}

           TA (as per state Govt. Rule)         500*10                = Rs. 5,000/-

           DA (No. of Trainees*DA*Duration) {C} 10*200*2              = Rs. 4,000/-

           Administrative Expenses @Rs. 2*100*2                       = Rs. 400/-

           Cost of the Batch                                          = Rs.18,600/-



           TOTAL COST                 18,600*60                       = Rs. 11,16,000/-




                                                                               158
11.4.1.1   IMEP Training of Medical officers at SIHFW Mohali and HFWTC Amritsar



           Training Load                                                = 600

           Total Batches                                                = 60

           No of trainees in the Batch                                  = 10

           Duration                                                     = 2 Days

           Honorarium      2*300*2 +2*500*2                             = Rs. 3,200/-

           (No. of Trainers*Honorarium*Duration) {A}

           Contingency                   300*10*2                       = Rs. 6,000/-

           (Amount per Participants*No. of Participants*Duration) {B}

           TA (as per state Govt. Rule approx.)     Rs.1000*10          = Rs. 10,000/-

           DA                    10*300*2                               = Rs. 6,000/-

           (No of trainees*DA*Duration) {C}

           Administrative Expenses @ 2*100*2                            = Rs. 400/-

           Cost of the Batch                                            = Rs. 25,600/-



           TOTAL COST                    25,600*60                      = Rs. 15,36,000/-

11.4.1.2   IMEP Training of Pharmacists, Lab Technicians, LHVs, ANMs, Staff Nurses, HA (M),
              MPHW (M) at SIHFW Mohali and HFWTC Amritsar



           Training Load                                                = 600

           Total Batches                                                = 60

           No of trainees in the Batch                                  = 10

           Duration                                                     = 2 Days

           Honorarium      2*300*2 +2*500*2                             = Rs. 3,200/-

           (No. of Trainers*Honorarium*Duration)



                                                                               159
               Contingency                    300*10*2                      = Rs. 6,000/-

               (Amount per Participants*No. of Participants*Duration)

               TA (as per state Govt. Rule approx.)      Rs. 500*10        = Rs. 5,000/-

               DA                     10*200*2                             = Rs. 4,000/-

               (No of trainees*DA*Duration)

               Administrative Expenses 2*100*2                              = Rs. 400/-

               Cost of the Batch                                           = Rs. 18,600/-



               TOTAL COST                  18600*60                        = Rs. 11,16000/-

11.5.1.1 (a)   IMNCI training of Medical College teachers



               Training Load                                              = 10

               Total Batches                                            As per GoI

               No. of Trainees per Batch                                As per GoI

               Duration of Training                                       = 10 Days

               Per diem to 10 participants       10*1000*10               = Rs. 1,00,000/-

               (@ Rs.1000/- per day)

               Estimated TA to 10 participants (as per State Govt. Rules) = Rs. 1,00,000/-

               TOTAL COST                                                 = Rs. 2,00,000/-

11.5.1.1 (b)   IMNCI Training of faculty of ANM Training Centres and Staff Nurse Training
                  Colleges



               Training Load                                             = 40

               No. of Trainees per Batch                                 = 20

               Total Batches                                             =2

               Duration of Training                                      = 10 Days


                                                                                 160
               Per Diem to Participants          20*250*10                       = Rs. 50,000/-

               (No. of Trainees*Per diem*Duration)

               Estimated TA to 10 participants                                   = Rs. 5,000/-

               (At State Govt. Rates)

               Honorarium to Resource Persons           4*500*10                 = Rs. 20,000/-

               (No. of Resource Persons*Honorarium*Duration)

               Refreshments           20+4+2*200*10                               = Rs. 52,000/-

               (No. of Participants+No. of Resource Persons+Officials*Amount*Duration)

               Contingency         @ Rs. 5,000/- per batch                        = Rs. 3,000/-

               Secretarial Assistance            2*125*10                         = Rs. 2,500/-

               (No. of officials*Per Diem*Duration)

               Cost of the Batch                                                  = Rs. 1,12,500/-



               TOTAL COST                          1,32,500*2                     = Rs. 2,65,000/-

11.5.1.1 (d)   F - IMNCI Training of District Trainers at Medical College



               Training Load                                           = 80

               No. of Trainees per Batch                                = 16

               Total Batches                                          =5

               Duration of Training                                         = 11 Days

               Per Diem to Trainees (excluding accommodation)20*300*11 = Rs. 66,000/-

               (No. of Trainees*Per Diem*Duration)

               Estimated TA to participants (At State Govt. Rates) 16*750        = Rs. 12,000/-

               Honorarium to Resource Persons       4*500*11                   = Rs. 22,000/-



                                                                                         161
(No. of Resource Persons*Honorarium*Duration)

Refreshments        16+4+2*200*11                            = Rs. 48,400/-

(No. of Participants+No. of Resource Persons+Officials*Amount*Duration)

Contingency            @ Rs. 15,000/- per Batch              = Rs. 15,000/-

Secretarial Assistance       2*125*11                        = Rs. 2,750/-

(No. of Officials*Per Diem*Duration)

Cost of Batch                                           = Rs. 1,66,150/-



TOTAL COST                1,66,150*5                          8,30,750/-
                                                        = Rs. 8,30,750/-

                                              College
NSSK Training of District Trainers at Medical College



Training Load                                           = 80

No. of Trainees per Batch                                = 40

Total Batches                                           =2

Duration of Training                                      = 2 Days

Per Diem to Trainees (excluding accommodation)40*300*2 = Rs. 24,000/-

(No. of Trainees*Per Diem*Duration)

Estimated TA to participants (At State Govt. Rates) 40*750       = Rs. 30,000/-

Honorarium to Resource Persons         4*500*2               = Rs. 4,000/-

(No. of Resource Persons*Honorarium*Duration)

Refreshments        40+4+2*200*2                           = Rs. 18,400/-

(No. of Participants+No. of Resource Persons+Officials*Amount*Duration)

Contingency            @ Rs. 20,000/- per Batch            = Rs. 20,000/-




                                                                           162
           Secretarial Assistance        2*125*2                     = Rs. 500/-

           (No. of Officials*Per Diem*Duration)

           Cost of Batch                                         = Rs. 96,900/-

           TOTAL COST               96,900*2                                  0/-
                                                                       1,93,800/
                                                                 = Rs. 1,93,800/-

11.5.1.2   NSSK Training of Medical Officers at District Level



           Training Load                                         = 800

           No. of Trainees per Batch                              = 40

           No. of Batches per district                             =1

           Total Batches                                         = 20

           Duration of Training                                   = 2 Days

           Per Diem to Trainees           40*300*2                  = Rs. 24,000/-

           (No. of Trainees*Per Diem*Duration) {A}

           Estimated TA to participants (At State Govt. Rates)           = Rs. 30,000/-

           Honorarium to Resource Persons          4*300*2              = Rs. 2,400/-

           (No. of Resource Persons*Honorarium*Duration) {B}

           Contingency/ Refreshments           40+4+2*200*2              = Rs. 18,400/-

           (No. of Participants+No. of Resource Persons+Officials*Amount*Duration) {C}

           Institutional Expenses        15% of A+B+C                = Rs. 6,720/-

           (No. of Officials*Per Diem*Duration)

           Cost of Batch                                         = Rs. 81,520/-

           TOTAL COST               81,520*20                          16,30,400/-
                                                                 = Rs. 16,30,400/-

11.5.1.3   NSSK Training of Staff Nurses at District Level




                                                                                        163
               Training Load                                         = 800

               No. of Trainees per Batch                              = 40

               Total Batches                                         = 20

               Duration of Training                                   = 2 Days

               Per Diem to Trainees        40*200*2                    = Rs. 16,000/-

               (No. of Trainees*Per Diem*Duration) {A}

               Estimated TA to participants (At State Govt. Rates)           = Rs. 6,000/-

               Honorarium to Resource Persons      4*300*2                  = Rs. 2,400/-

               (No. of Resource Persons*Honorarium*Duration) {B}

               Contingency/ Refreshments          40+4+2*200*2               = Rs. 18,400/-

               (No. of Participants+No. of Resource Persons+Officials*Amount*Duration) {C}

               Institutional Expenses 15% of A+B+C                      = Rs. 5,520/-

               Cost of Batch                                     = Rs. 48,320/-

               TOTAL COST             48,320*20                        9,66,400/-
                                                                 = Rs. 9,66,400/-

11.5.1.4 (a)   IMNCI Training of LHVs and ICDS Supervisors at Sub-Divisional Level



               Training Load                                                      = 500

               No. of Trainees per Batch                                          = 20

               Total Batches                                                      = 25

               Duration of Training                                               = 8 Days

               Per Diem to Trainees           20*200*8                           = Rs. 32,000/-

               (No. of Trainees*Per Diem*Duration)

               Estimated TA to participants (At State Govt. Rates)                = Rs. 3,000/-

               Honorarium to Resource Persons         3*300*8                     = Rs. 7,200/-



                                                                                             164
               (No. of Resource Persons*Honorarium*Duration)

               Contingency/ Refreshments             20+3+2*200*8                 = Rs. 40,000/-

               (No. of Participants+No. of Resource Persons+Officials*Amount*Duration)

               Cost of Batch                                                     = Rs. 82,200/-

               TOTAL COST                    82,200*25                            = Rs. 20,55,000/-

11.5.1.4 (b)                             Sub-
               IMNCI Training of ANMs at Sub-Divisional Level



               Training Load                                         = 720

               No. of Trainees per Batch                               = 24

               Total Batches                                         = 30

               Duration of Training                                    = 8 Days

               Per Diem to Trainees        24*200*8                     = Rs. 38,400/-

               (No. of Trainees*Per Diem*Duration)

               Estimated TA to participants (At State Govt. Rates)           = Rs. 5,000/-

               Honorarium to Resource Persons      4*300*8                  = Rs. 9,600/-

               (No. of Resource Persons*Honorarium*Duration)

               Contingency/ Refreshments         24+4+2*200*8                = Rs. 48,000/-

               (No. of Participants+No. of Resource Persons+Officials*Amount*Duration)

               Cost of Batch                                         = Rs. 1,01,000/-

               TOTAL COST              1,01,000*30                          30,30,000/-
                                                                      = Rs. 30,30,000/-

11.5.1.5       IMNCI Training of AWWs at Sub-Divisional Level



               Training Load                                                     = 800

               No. of Trainees per Batch                                         = 20



                                                                                            165
               Total Batches                                                     = 40

               Duration of Training                                              = 8 Days

               Per Diem to Trainees             20*200*8                         = Rs. 32,000/-

               (No. of Trainees*Per Diem*Duration)

               Estimated TA to participants (At State Govt. Rates)               = Rs. 3,000/-

               Honorarium to Resource Persons           3*300*8                  = Rs. 7,200/-

               (No. of Resource Persons*Honorarium*Duration)

               Contingency/ Refreshments              20+3+2*200*8               = Rs. 40,000/-

               (No. of Participants+No. of Resource Persons+Officials*Amount*Duration)

               Cost of Batch                                                     = Rs. 82,200/-

               TOTAL COST                      82,200*40                         = 32,88,000/-

11.6.1.1 (a)                                                             Districts
               F-IMNCI training of Medical Officers at District Level (4 Districts selected earlier)



               Training Load                                         = 64

               No. of Trainees per Batch                              = 16

               Total Batches                                        =4

               Duration of Training                                   = 5 Days

               Per Diem to Trainees      16*5*300                        = Rs. 24,000/-

               (No. of Trainees*Duration*Per diem) {A}

               Estimated TA to Trainees (At State Govt. Rates)            = Rs. 12,000/-

               Honorarium to Resource Persons 4*300*5                    = Rs. 6,000/-

               (No. of Resource Persons*Honorarium*Duration) {B}

               Contingency/ Refreshments            4+16+2*200*5            = Rs. 22,000/-




                                                                                          166
               (No. of Resource Persons+Participants+Officials*Amount*Duration) {C}

               Institutional Expenses 15% of A+B+C                       = Rs. 7,800/-

               Cost of Batch                                        = Rs. 71,800/-

               TOTAL COST               71,800*4                        2,87,200/-
                                                                  = Rs. 2,87,200/-

11.6.1.1 (b)   F-IMNCI training of Staff Nurses at District Level (4 districts selected earlier)

               Training Load                                         = 160

               No. of Trainees per Batch                                = 16

               Total Batches                                        = 10

               Duration of Training                                     = 5 Days

               Per Diem to Trainees      16*5*250 {A}                    = Rs. 20,000/-

               (No. of Trainees*Duration*Per diem)

               Estimated TA to Trainees (At State Govt. Rates)             = Rs. 7,000/-

               Honorarium to Resource Persons 4*300*5 {B}                  = Rs. 6,000/-

               (No. of Resource Persons*Honorarium*Duration)

               Contingency/ Refreshments            4+16+2*200*5           = Rs. 22,000/-

               (No. of Resource Persons+Participants+Officials*Amount*Duration) {C}

               Institutional Expenses 15% of A+B+C                       = Rs. 7,200

               Cost of Batch                                        = Rs. 62,200/-

               TOTAL COST               62,200*10                         6,22,000/-
                                                                    = Rs. 6,22,000/-

11.6.1.1 (a)   F-IMNCI training of Medical Officers at District Level



               Training Load                                         = 250




                                                                                           167
               No. of Trainees per Batch                              = 16

               Total Batches                                        = 16

               Duration of Training                                   = 11 Days

               Per Diem to Trainees     16*11*300                       = Rs. 52,800/-

               (No. of Trainees*Duration*Per diem) {A}

               Estimated TA to Trainees (At State Govt. Rates)             = Rs. 12,000/-

               Honorarium to Resource Persons 4*300*11                     = Rs. 13,200/-

               (No. of Resource Persons*Honorarium*Duration) {B}

               Contingency/ Refreshments            4+16+2*200*11            = Rs. 48,400/-

               (No. of Resource Persons+Participants+Officials*Amount*Duration) {C}

               Institutional Expenses 15% of A+B+C                      = Rs. 17,160/-

               Cost of Batch                                        = Rs. 1,43,560/-




               TOTAL COST              1,43,560*16                        22,96,960/-
                                                                    = Rs. 22,96,960/-

11.6.1.1 (b)   F-IMNCI training of Staff Nurses at District Level



               Training Load                                        = 250

               No. of Trainees per Batch                              = 16

               Total Batches                                        = 16

               Duration of Training                                   = 11 Days

               Per Diem to Trainees     16*11*250 {A}                   = Rs. 44,000/-

               (No. of Trainees*Duration*Per diem)

               Estimated TA to Trainees (At State Govt. Rates)             = Rs. 7,000/-



                                                                                           168
           Honorarium to Resource Persons 4*300*11 {B}           = Rs. 13,200/-

           (No. of Resource Persons*Honorarium*Duration)

           Contingency/ Refreshments        4+16+2*200*11         = Rs. 48,400/-

           (No. of Resource Persons+Participants+Officials*Amount*Duration) {C}

           Institutional Expenses 15% of A+B+C                 = Rs. 15,840

           Cost of Batch                                   = Rs. 1,28,440/-



           TOTAL COST             1,28,440*16                     20,55,040/-
                                                            = Rs. 20,55,040/-

11.6.1.2   Laparoscopic Sterilisation Training for Surgeons/ Gynaecologists+Staff Nurse+OT
              Technicians at Districts



           Training Load                                              = 60

           No. of Trainees per Batch                                  =3

           Total Batches                                              = 20

           Duration of Training                                       = 12 Days

           Per Diem to Trainees          1*300*14+2*200*14            = Rs. 9,800/-

           (No. of Trainees*Per Diem*Duration) {A}

           Honorarium to Trainers        1*300*12                     = Rs. 3,600/-

           (No. of Trainers*Per Diem*Duration) {B}

           TA to Trainees (As per Govt. Rules)                        = Rs. 1,200/-

           Contingency                 3*200*12                       = Rs. 7,200/-

           (No. of Trainees*Amount per Head*Duration) {C}

           Institutional Overheads @ 15% of A+B+C                    = Rs. 3,090/-




                                                                                169
           Cost of Batch                                          = Rs. 24,890/-



           TOTAL COST                    24,890*20                = Rs. 4,97,800/-




11.6.2.2   Minilap Sterilisation Training for Medical Officer+Staff Nurse+OT Technicians at
              Districts



           Training Load                                           = 60

           No. of Trainees per Batch                               =3

           Total Batches                                           = 20

           Duration of Training                                   = 12 Days

           Per Diem to Trainees          1*300*14+2*200*14        = Rs. 9,800/-

           (No. of Trainees*Per Diem*Duration) {A}

           Honorarium to Trainers        1*300*12                 = Rs. 3,600/-

           (No. of Trainers*Honorarium*Duration) {B}

           TA to Trainees (As per Govt. Rules)                     = Rs. 1,200/-

           Contingency                 3*200*12                   = Rs. 7,200/-

           (No. of Trainees*Amount per Head*Duration) {C}

           Institutional Overheads @ 15% of A+B+C                 = Rs. 3,090/-

           Cost of Batch                                          = Rs. 24,890/-



           TOTAL COST                    24,890*20                = Rs. 4,97,800/-

11.6.2.3   NSV Training for Medical Officers/ Doctors at District Level

           Training Load                                          = 25



                                                                           170
           No. of Trainees per Batch                                   =5

           Total Batches                                               =5

           Duration of Training                                        = 5 days

           Per Diem to Trainees     300*5*5                            = Rs. 7,500/-

           (Per Diem*No. of Trainees*Days)

           Honorarium to Trainers         300*5*1                      = Rs. 1,500/-

           (Honorarium*Days*No. of Trainers)

           TA to Trainees (As per Govt. Rules) 750*5                   = Rs. 3,750/-

           IEC Activities                                              = Rs. 25,000/-

           Contingency                 5*200*5                         = Rs. 5,000/-

           Cost of Batch                                               = Rs. 53,000/-

           TOTAL COST                      53,000*5                    = Rs. 2,65,000/-

11.6.4.1   Training of Medical Officers in IUD Insertion using Alternate Methodology

           Training Load                                               = 160

           No. of Trainees per Batch                                   = 10

           Total Batches                                               = 16 (1 per district)

           Duration of Training                                        = 6 Days

           Honorarium to Trainers        2*300*6+2*500*6               = Rs. 9,600/-
           (No. of Trainers*Honorarium*Duration) {A}

           TA to Trainees (As per Govt. Rules)      750*10         = Rs. 7,500/-

           Per Diem to Trainees               10*300*6                 = Rs. 18,000/-
           (No. of Trainees*Per Diem*Duration) {B}

           Contingency                   200*10*6                      = Rs. 12,000/-
           (Amount per Participant*No. of Participants*Duration) {C}




                                                                                  171
           Institutional Overheads @15% of A+B+C                       = Rs. 5,940/-

           Cost of Batch                                               = Rs. 53,040/-

           TOTAL COST                   53040*20                       = Rs. 10,60,800/-




11.6.4.4   Training of LHV/ ANMs in IUD Insertion using Alternate Methodology



           Training Load                                               = 800

           No. of Trainees per Batch                                   = 10

           Total Batches                                               = 80 (4 per district)

           Duration of Training                                        = 6 Days

           Honorarium to Trainers      2*300*6+2*500*6                 = Rs. 9,600/-

           (No. of Trainers*Honorarium*Duration) {A}

           TA to Trainees (As per Govt. Rules)     250*10              = Rs. 2,500/-

           Per Diem to Trainees           10*200*6                     = Rs. 12,000/-

           (No. of Trainees*Per Diem*Duration) {B}

           Contingency                 200*10*6                        = Rs. 12,000/-

           (Amount per Participant*No. of Participants*Duration) {C}

           Institutional Overheads @15% of A+B+C                       = Rs. 5,040/-

           Cost of Batch                                               = Rs. 41,140/-



           TOTAL COST                   41,140*80                      = Rs. 32,91,200/-

11.7.3     ARSH Training of Medical Officers at District Level




                                                                                  172
         Training Load                                      = 600

         No. of Trainees per Batch                          = 30

         Total Batches                                      = 20

         Duration                                          = 2 Days

         Honorarium to Trainers         2*300*2+2*500*2     = Rs. 3,200/-

         (No. of Trainers*Honorarium*Duration) {A}

         TA to Trainees (as per Govt Rules)    750*30     = Rs. 22,500/-

         Per Diem to Trainees         30*300*2 {B}         = Rs. 18,000/-

         (No. of Trainees*Per Diem*Duration)

         Contingency              30*200*2                = Rs. 12,000/-

         (No. of Trainees*Amount*Duration) {C}

         Institutional Overheads 15% of A+B+C             = Rs. 4,980/-

         Cost of Batch                                    = Rs. 60,680/-



         TOTAL COST                      60,680*20        = Rs. 12,13,600/-

11.7.4   ARSH Training of LHVs, ANMs, HA (M), MPHW (M), AWWs at District Level



         Training Load                                      = 1200

         No. of Trainees per Batch                          = 30

         Total Batches                                      = 40

         Duration                                          = 3 Days

         Honorarium to Trainers         2*300*2+2*500*2     = Rs. 3,200/-



                                                                      173
             (No. of Trainers*Honorarium*Duration) {A}

             TA to Trainees (as per Govt Rules)    250*30         = Rs. 7,500/-

             Per Diem to Trainees         30*200*2 {B}            = Rs. 12,000/-

             (No. of Trainees*Per Diem*Duration)

             Contingency              30*200*2                    = Rs. 12,000/-

             (No. of Trainees*Amount*Duration) {C}

             Institutional Overheads 15% of A+B+C                 = Rs. 4,080/-

             Cost of Batch                                        = Rs. 38,780/-



             TOTAL COST                      38,780*40            = Rs. 15,51,200/-

11.7.6 (c)   ARSH Training of School Teachers at District Level



             Training Load                                         = 1200

             No. of Trainees per Batch                             = 30

             Total Batches                                         = 40

             Duration                                              = 2 Days

             Honorarium to Trainers         2*300*2+2*500*2        = Rs. 3,200/-

             (No. of Trainers*Honorarium*Duration) {A}

             TA to Trainees (as per Govt Rules)    250*30         = Rs. 7,500/-

             Per Diem to Trainees         30*200*2 {B}            = Rs. 12,000/-

             (No. of Trainees*Per Diem*Duration)

             Contingency              30*200*2                    = Rs. 12,000/-

             (No. of Trainees*Amount*Duration) {C}




                                                                              174
Institutional Overheads 15% of A+B+C              = Rs. 4,080/-

Cost of Batch                                     = Rs. 38,780/-

TOTAL COST                     38,780*40          = Rs. 15,51,200/-




Training of ANMs in Laboratory Methods, Statistical and Clinical Skills at Block
   Level



Training Load                                    = 1000

No. of Trainees per Batch                        =5

Total Batches                                    = 200

Duration                                          = 5 Days

Honorarium to Trainers       2*200*5      {A}     = Rs. 2,000/-

(No. of Trainers*Honorarium*Duration)

TA to Trainees (As per Govt. Rules)     100*5     = Rs. 500/-

Per Diem to Trainees        5*200*5      {B}      = Rs. 5,000/-

(No. of Trainees*Per Diem*Duration)

Contingency                 5*100*5       {C}     = Rs. 2,500/-

Institutional Overheads @15% of A+B+C             = Rs. 1,425/-

Cost of Batch                                     = Rs. 11,425/-



TOTAL COST                  11,425*200            = Rs. 22,85,000/-

TOTAL COST                                        = Rs. /- 8,31,19,060




                                                             175
                                             BUDGET FOR TRAINING

                                       Physical                                                       Modified
                                        Target                                                         Budget
                                                     Rate                            2010-
                                                                  Amount (Rs. Lakhs) 2010-11          Amount       Remarks
          Budget Head                                (Rs./                                           (Rs. Lakhs)
                                       Unit of
                                                     Unit)                                            2010-
                                                                                                      2010-11
                                       Measure
                                                                 Q1       Q2     Q3       Q4
11        TRAINING
          TRAINING
11.1      Strengthening of Training Institutions (SIHFW, ANMTCs, etc.)
 11.1.1   Carry    out     repairs/                  150000       2.00    3.00    5.00     5.00           15.00
          renovations     of    the                       0
          training     institutions
          (SIHFW)
          Carry    out     repairs/                  150000       2.00    3.00    5.00     5.00           15.00
          renovations     of    the                       0
          training     institutions
          (HFWTC)
          Carry    out     repairs/                  500000       2.00    4.00    2.00     2.00           10.00
          renovations     of    the
          training     institutions
          (MPHW-M         Training
          Centres     Kharar      &
          Nabha)
          Carry    out     repairs/                  500000       6.00   12.00    6.00     6.00           30.00
          renovations     of    the
          training     institutions
          (ANM Training Centres
          Hoshiarpur, Gurdaspur,
          Sangrur, Nangal)
11.1.2    Provide equipment and                      200000       0.00   10.00   10.00     0.00           20.00
          training aids to the                            0
          training     institutions
          (SIHFW, Mohali and
          HFWTC, Amritsar)
11.1.3    Contractual          staff
          recruited and in position
          at SIHFW Mohali

11.1.4    Other activities      (pl.
          specify)
11.2      Development of training packages
          Subscription of Journals                   200000     1.00     1.00    0.00    0.00           2.00
          of Public Health, WHO
                         etc.
          Publications etc. for
          SIHFW, Mohali
11.2.1    Development/                               200000       0.50    0.50    0.50     0.50            2.00
          translation        and
          duplication of training
          materials at SIHFW
          Mohali
11.2.2

                                                                                               176
                                               Physical                                                   Modified
                                                Target                                                     Budget
                                                            Rate                         2010-
                                                                      Amount (Rs. Lakhs) 2010-11          Amount        Remarks
            Budget Head                                     (Rs./                                        (Rs. Lakhs)
                                              Unit of
                                                            Unit)                                         2010-
                                                                                                          2010-11
                                              Measure
                                                                     Q1      Q2     Q3        Q4
11.2.3      Other activities (pl. specify)
11.2.3.1    Strengthening of SIHFW
            Provide Training Aids,                      300000       30.00   0.00    0.00      0.00           30.00
            Computers, Printers,                               0
            LCD Projectors, Digital
            Visualisers etc. to
            Nursing College,
            Jalandhar
11.2.3.5    Trainings to be conducted other than reflected in this format
11.2.3.6    BCC     Skill     Building 1 Batch of       128000        7.68   5.12    7.68      5.12           25.60    20
            Training for MO at 30 MOs                                                                                  Batch*30
            SIHFW,      Mohali       &                                                                                 MO
            HFWTC, Amritsar
11.2.3.7    BCC     Skill     Building 1 Batch of        98,000       4.90   4.90    4.90      4.90           19.60    20
            Training for District 30 Trainees                                                                          Batch*30
            MEIO, Dy MEIO, BEE, HS                                                                                     Trainees
            (M), LHV, ANM, HW (M)                                                                                      per batch
            HS (M) at SIHFW,
            Mohali
11.2.3.8(   Computer Training for 1 Batch of 8           54000        1.62   1.62    1.62      1.62            6.48    12 Batch*
a)          Medical Officers           trainees                                                                        8 per
                                                                                                                       batch
11.2.3.8(   Computer Training for            1 Batch of 8   85200    2.56    2.56    2.56      2.56           10.22    12 Batch*8
b)          Statistical   Assistants,        trainees                                                                  per Batch
            Clerks etc. at SIHFW,
            Mohali
11.2.3.9    Orientation Training of          1 Batch of     113000   5.65    5.65    5.65      5.65           22.60    20
a,b         Rural Medical Officers in        20 Trainees                                                               Batch*20
            NRHM at SIHFW Mohali                                                                                       per batch
            & HFWTC Amritsar
11.2.3.9c   Orientation Training of          1 Batch of     98000    4.90    4.90    4.90      4.90           19.60    20
,d          Contractual ANMs in              20 Trainees                                                               Batch*20
            NRHM at SIHFW Mohali                                                                                       per batch
            & HFWTC Amritsar
11.2.3.1    PDC Training for Distt.          1 Batch of     155000   0.00    0.00    0.00      0.00                    4 Batches
0           Level Officers at SIHFW,         20 trainees         0
            Mohali
11.2.3.1    Meeting to be organized                                  0.13    0.13    0.13      0.13            0.50
1           with DRME for Training of
            MBBS Students on Basic
            Obst. Skills at State level
11.2.3.1    Strengthening of DTCs
2
11.2.3.1    Provide District Training                       800000   0.00    8.00    8.00      0.00           16.00
2a          Centres at 2 districts
11.2.3.1    Carry    out     repairs/                       100000   3.00    4.00    5.00      3.00           15.00
2b          renovations     of     the

                                                                                                   177
                                          Physical                                                   Modified
                                           Target                                                     Budget
                                                       Rate                         2010-
                                                                 Amount (Rs. Lakhs) 2010-11          Amount        Remarks
           Budget Head                                 (Rs./                                        (Rs. Lakhs)
                                         Unit of
                                                       Unit)                                         2010-
                                                                                                     2010-11
                                         Measure
                                                                Q1       Q2     Q3       Q4
           training      institutions
           (DTCs)
11.2.3.1   Strengthening of State       Provide 2      59000     0.59    0.59    0.59     0.59            2.36
2c         Training Cell                Computer
                                        Assistants
                                        and
                                        Computers
                                        etc.
11.3       Maternal Health Training
11.3.1     Skilled Attendance at
           Birth / SBA
11.3 a     Setting up of Skilled                       15000     0.75    0.00    0.00     0.00            0.75
           Birth          Attendance
           Training Centres at 5
           New districts
11.3.1     TOT for SBA for 5 new        1 Batch of     58800     0.59    0.00    0.00     0.00            0.59
           districts    at    SIHFW,    25 trainees
           Mohali
11.3.1 a   Training of Medical          1 Batch of     142500                                             0.00
           Officers in SBA in 5 new     20 trainees
           districts
11.3.1b    Training of LHV/ ANM         1 Batch of 3   58260    17.48   17.48   17.48   17.48            69.91    120
           in SBA at districts          trainees                                                                  batches*3
                                                                                                                  Trainees
                                                                                                                  per batch in
                                                                                                                  20 districts
11.3.1.2   Training of Staff Nurses     1 Batch of 3   58260     8.74   20.39   20.39   20.39            69.91    30 Batch*3
           in SBA at districts          trainees                                                                  trainees per
                                                                                                                  Batch in 5
                                                                                                                  districts
                                                                                                                  identified
                                                                                                                  during
                                                                                                                  2006-07
11.3.2.3   EmOC      Training     at
           medical colleges
11.3.3     Setting up of EmOC
           Training Centres
11.3.3.1   TOT for EmOC
11.3.3.2   Training of Medical          1 Batch of     424000    0.00    8.48   12.72     0.00           21.20
           Officers in EmOC             Two
                                        Trainees
11.3.3.3   Life saving Anaesthesia
           skills training




                                                                                              178
                                           Physical                                                   Modified
                                            Target                                                     Budget
                                                        Rate                         2010-
                                                                  Amount (Rs. Lakhs) 2010-11          Amount        Remarks
           Budget Head                                  (Rs./                                        (Rs. Lakhs)
                                          Unit of
                                                        Unit)                                         2010-
                                                                                                      2010-11
                                          Measure
                                                                 Q1     Q2      Q3        Q4
11.3.3.3   Setting up of Life saving     Rs. 625000              0.00   0.00    0.00       0.00                    Out of
                                                                                                                   31,25,000/-
(b)        Anaesthesia         skills    per
                                                                                                                   Rs.
           Training Centres at           CetnresX 5                                                                11,40,000/-
           medical colleges              Med.                                                                      already
                                         College                                                                   received from
                                                                                                                   GOI during
                                                                                                                   the year
                                                                                                                   2006-07.
11.3.4     TOT for Anaesthesia           1 Batch of     34200    0.34   0.00     0.00      0.00            0.34
           skills training at medical    20 trainees
           colleges
11.3.4.1   Training of Medical           1 Batch of 4   261440   7.84   7.84     7.84      7.84           31.37
           Officers in life saving       trainees
           Anaesthesia skills (12
           weeks       at     medical
           colleges)
11.3.4.2   Training of Medical           1 Batch of 4   151840   4.56   4.56     4.56      4.56           18.22
           Officers in life saving       trainees
           Anaesthesia skills (6
           weeks        at    district
           hospitals)
11.3.4.3   MTP training at districts
11.3.5     TOT on MTP using MVA
11.3.5.1   Training of Medical           1 Batch of 3   29160    1.46   1.46     1.46      1.46            5.83    20 Batches
           Officers in MTP using         MOs                                                                       (1 batch
           MVA                                                                                                     per distt.)
11.3.5.2   Training of MOs in MTP
           using other methods (pl.
           specify)
11.3.5.3   RTI / STI Training
11.3.7     Training of laboratory        1 Batch of     18600    2.79   2.79     2.79      2.79           11.16    20 batches
           technicians,SN,               10 trainees                                                               (one batch
           ANM/LHV in RTI/STI at                                                                                   per dist.
           SIHFW and HFWTC
11.4       Training of Medical           1 Batch of     25600    3.84   3.84     3.84      3.84           15.36    20 Batches
           Officers in RTI/STI at        10 trainees                                                               (1 per
           SIHFW and HFWTC                                                                                         distt)
11.4.1.1   Orientation of Dai /
           TBAs on safe delivery
11.4.1.2   Other maternal health
a          training (please specify)
11.4.3     IMEP Training
                Training
11.5       IMEP    training   for        1 Batch of     25,600   3.84   3.84     3.84      3.84           15.36
           medical   officers  at        10 trainees
           SIHFW, Mohali and
           HFWTC, Amritsar



                                                                                               179
                                          Physical                                                     Modified
                                           Target                                                       Budget
                                                         Rate                         2010-
                                                                   Amount (Rs. Lakhs) 2010-11          Amount       Remarks
           Budget Head                                   (Rs./                                        (Rs. Lakhs)
                                          Unit of
                                                         Unit)                                         2010-
                                                                                                       2010-11
                                          Measure
                                                                  Q1     Q2      Q3        Q4
11.5.1 a   IMEP training for LHV/       1 Batch of       18,600   2.79   2.79    2.79       2.79           11.16
           SN/ HA (M)/ ANM/             10 Trainees
           MPHW (M) at SIHFW
           and HFWTC
11.5.1 b   Child Health Training
11.5.1.1   IMNCI Training (pre-         10 Medical       200000   1.00   1.00     0.00      0.00            2.00
           service and in-service)      College
                                        Teachers to
                                        be trained at
                                        New Delhi
11.5.1.2   IMNCI Training (pre-         40 ANMTC         132500   1.33   1.33     0.00      0.00            2.65
           service and in-service)      and SN
                                        Training
                                        College
                                        Faculty to be
                                        trained at
                                        Medical
                                        Colleges
11.5.1.4   TOT on F - IMNCI (pre-       Training of      166150   3.32   4.98     0.00      0.00            8.31
           service and in-service)      80 District
                                        trainers at
                                        State Medical
                                        Colleges in 5
                                        batches

11.5.1.4   NSSK     Training      for   Training of      96900    0.97   0.97     0.00      0.00            1.94
           District Trainers       at   80 District
           Medical College              Trainers at
                                        Medical
                                        College in 2
                                        batches of 40
                                        each
           NSSK      Training     for   Training of      81520    4.08   4.08     4.08      4.08           16.30
           Medical     Officers    at   800 Medical
           District Level               Officers in 20
                                        batches of 40
                                        each
11.5.1.5   NSSK Training for staff      NSSK             48320    2.42   2.42     2.42      2.42            9.66
           nurses                       Training of
                                        800 Staff
                                        Nurses at
                                        District
                                        Hospital in
                                        20 batches of
                                        40 each




                                                                                                180
                                         Physical                                                    Modified
                                          Target                                                      Budget
                                                       Rate                         2010-
                                                                 Amount (Rs. Lakhs) 2010-11          Amount        Remarks
           Budget Head                                 (Rs./                                        (Rs. Lakhs)
                                        Unit of
                                                       Unit)                                         2010-
                                                                                                     2010-11
                                        Measure
                                                                Q1      Q2      Q3       Q4
11.5.2     IMNCI Training for LHVs     Training of     101000   0.00    5.05   10.10      5.05           20.20
           and ICDS Supervisors        480 LHVs
                                       and ICDS
                                       Supervisors
                                       in 20
                                       batches of
                                       24 each
11.4.2.1   IMNCI Training of ANMs      Training of     101000   0.00   10.10   10.10    10.10            30.30
                                       960 ANMs
                                       at sub
                                       divisional
                                       hospitals in
                                       40 batches
                                       of 24 each
11.4.2.2   IMNCI Training for          Training of     100000   0.00   10.00   10.00    10.00            30.00
           Anganwadi Workers           720 AWWs
                                       in 30
                                       batches of
                                       24 each
11.4.2.3   Facility Based Newborn
           Care / FBNC
11.5.3     TOT on FBNC
11.5.3.1   F-IMNCI Training       of   Training of     71800    0.00    1.44    1.44      0.00            2.87    4 Districts
           Medical     Officers   at   64 Medical                                                                 selectd
           District Level              Officers in 4                                                              earlier
                                       batches of
                                       16 each
11.5.3.2   Training on F-IMNCI for     Training of     62200    0.00    1.87    1.87      2.49            6.22    4 Districts
           SNs                         160 Staff                                                                  selectd
                                       Nurses in                                                                  earlier
                                       10 batches
                                       of 16 each
                                       at District
                                       Level
           F-IMNCI Training       of   Training of     143560   0.00    7.18    7.18      8.61           22.97
           Medical     Officers   at   250 Medical
           District Level              Officers at
                                       District
                                       Level in 16
                                       batches of
                                       16 each




                                                                                              181
                                          Physical                                                   Modified
                                           Target                                                     Budget
                                                       Rate                         2010-
                                                                 Amount (Rs. Lakhs) 2010-11          Amount        Remarks
           Budget Head                                 (Rs./                                        (Rs. Lakhs)
                                         Unit of
                                                       Unit)                                         2010-
                                                                                                     2010-11
                                         Measure
                                                                Q1     Q2      Q3        Q4
           F-IMNCI Training of SNs      Training of    128440   0.00   6.42    6.42       7.71           20.55
                                        250 Staff
                                        Nurses at
                                        District
                                        Level in 16
                                        batches of
                                        16 each
11.5.4     Home Based Newborn
           Care / HBNC
11.5.4.1   TOT on HBNC
11.5.4.2   Training on HBNC for
           ASHA
11.5.5     Care of sick children and
           severe malnutrition at
           FRUs
11.6       TOT on Care of sick
           children and severe
           malnutrition
11.6.1     Training on Care of sick
           children and severe
           malnutrition for Medical
           Officers
11.6.1.1   Other     child    health
           training (please specify)
11.6.1.2   Family Planning Training
11.6.2     Laparoscopic
           Sterilisation Training at
           districts
11.6.2.1   TOT on laparoscopic
           sterilisation
11.6.2.2   Laparoscopic                 1 Batch of I   24890    1.24   1.24     1.24      1.24            4.98    20 Batch
           sterilisation training for   MO + 1                                                                    (1 per
           medical officers             Staff Nurse                                                               distt.)
                                        + 1 OT
                                        Tech.
11.6.3     Minilap Training
11.6.3.1   TOT on Minilap
11.6.3.2   Minilap training      for    1 Batch of I   24890    1.24   1.24     1.24      1.24            4.98    20 Batch
           medical officers             MO + 1                                                                    (1 per
                                        Staff Nurse                                                               distt.)
                                        + 1 OT
                                        Tech.
11.6.4     Non-Scalpel Vasectomy
           (NSV) Training
11.6.4.1   TOT on NSV

                                                                                              182
                                          Physical                                                  Modified
                                           Target                                                    Budget
                                                       Rate                        2010-
                                                                Amount (Rs. Lakhs) 2010-11          Amount        Remarks
           Budget Head                                 (Rs./                                       (Rs. Lakhs)
                                          Unit of
                                                       Unit)                                        2010-
                                                                                                    2010-11
                                          Measure
                                                               Q1     Q2      Q3        Q4
11.6.4.2   NSV                                         53000   0.00   2.65    0.00       0.00            2.65    5 Batches
                                                                                                                 of 5
                                                                                                                 doctors
                                                                                                                 each
11.6.4.3   IUD Insertion
11.6.4.4   TOT       for    Alternate
           Methodology in IUD
           insertion
11.6.5     Training of Medical           1 Batch of    53040   2.65   2.65     2.65      2.65           10.61    1 Batch
           officers in IUD insertion     10 Trainees                                                             per
                                                                                                                 selected
                                                                                                                 district
           Training of staff nurses
           in IUD insertion
11.6.6     Training of ANMs/ LHVs        1 Batch of    41140   8.23   8.23     8.23      8.23           32.91    20
           in IUD insertion at           10 trainees                                                             Batch*10
           districts                                                                                             trainees/
                                                                                                                 Batch
11.7       Contraceptive     update      1 Batch of
           Training for ANM/LHV          30 trainees
           at districts
11.7.1     Contraceptive                 1 Batch of
           update/ISD      Training,     30 trainees
           HW (M) at districts
11.7.2     Other family planning
           training (please specify)
11.7.3     Adolescent Reproductive
           and Sexual Health/ARSH
           Training
11.7.3     TOT for ARSH training
(a)        at SIHFW Mohali for
           remaining 7 districts
11.7.4     Orientation training of
           state     and      district
           programme managers
11.7.4(b   ARSH      training      for   1 Batch of    60680   3.03   3.03     3.03      3.03           12.14    20 Batches
)          medical     officers     at   30 trainees
           districts
11.7.4
(c)
11.7.5     ARSH      training for        1 Batch of    38780   3.88   3.88     3.88      3.88           15.51    4 Batches
           ANMs/LHVs/ AWWs at            30 trainees                                                             per district
           districts
11.7.6
11.7.6
(b)


                                                                                             183
                                         Physical                                                           Modified
                                          Target                                                             Budget
                                                        Rate                            2010-
                                                                     Amount (Rs. Lakhs) 2010-11             Amount        Remarks
          Budget Head                                   (Rs./                                              (Rs. Lakhs)
                                        Unit of
                                                        Unit)                                               2010-
                                                                                                            2010-11
                                        Measure
                                                                   Q1        Q2       Q3        Q4
11.7.6
(c)
          ARSH       Training   for   1 Batch of        38780       3.88     3.88     3.88       3.88           15.51    1 Batch/
          School      Teachers   at   30 trainees                                                                        district
          districts
          Training      of    ANMs    1 Batch of 5      11425       5.71     5.71     5.71       5.71           22.85
          recruited under NRHM        Trainees
          in      Lab      Methods,
          Statistical and Clinical
          Skills at Block
11.8
11.8.1
11.8.2
11.8.3    Programme
          Management Training
          Other    training   (pl.
          specify)
          Funds Available Rs.
                                                                  -36.23                                     -36.23
          36.23 lakh
               Total Training                                              233.7
                                                                 136.28      7
                                                                                    230.69    192.27         793.02




     Note:
        1.    Base-line refers to current status. For example in the case of 9.1.1: Contractual staff: ANMs, baseline refers to
              staff already recruited and on the rolls. Target for the quarter refers to additional ANMs to be recruited in the
              quarter. Rate ref
         2.   In cases where a rate and quantity is not possible, a lump sum amount could be provided. But this should be in
              exceptional cases. As far as possible, every effort should be made to provide rates and quantities as a basis for
              arriving at costs.
         3.   The above formats should be prepared separately for each quarter.
         4.   The physical targets for the quarter must match the figures in the format for current status and targets (Annex
              3b).




                                                                                                     184
BEHAVIOR CHANGE COMMUNICATION (BCC)
                BCC for health is the process of understanding people situation and
influences, developing messages that respond to the concerns with these situations and
using communication processes and media to persuade people to increase their knowledge
and change the behavior and practices relating to health and developing health-seeking
behavior.

                It is empowering the individuals, communities to take health related
decisions and motivating the community to play proactive role in enhancing health status.

        BCC helps in understanding the dynamics of health issues in terms of:

            •   Cause of health issues its preventive measures

            •   Health related behavior

            •   Based on socio cultural values develop IEC/ BCC material and activities to
                facilitate the masses to adopt desirable health practices for healthy living

            •   Apart from carrying out awareness activities support of stakeholders is
                important for sustainability of health messages

                BCC strategies for the state are planned with the objective To bridge critical
gaps between the health services and the targeted beneficiaries with special emphasis
upon bringing in positive Health seeking behavior of community as well as behavior of
service provider through effective BCC tools varying from conventional IPC methods to
high profile multimedia strategies.

                For successful implementation of programme stakeholder analysis is
important. Besides Department of Health and Family Welfare, Department of Social
Security Women and Child Development, Department of Water and Sanitation and
Department of Rural Development and Panchayats will be involved. Health workers will be
oriented and trained, NGOs and local community based organizations and community at
large




                                                                                  185
                 The focus of the plan is on strengthening the IEC/ BCC Cell and use media
mix to propagate the health issues especially Maternal and Child Health Programme,
Adolescent issues and curbing the menace of skewed sex-ratio.

Strategy                 Activity
Strengthening IEC/ BCC • Programme Coordinator BCC placed under SPMU
Cell
                               • Provision of BCC Facilitator at State and District level

                               • Provision of Art and Exhibition expert at State level

                               • Technical support for printing

                               • To provide TV and DVD sets at Block level for audio visual shows
                                 during camps, festivals and other community programmes.

                               • Sehat Rath –Two state of art multi-media van equipped with
                                 multi-media gadgets for awareness of health issues.

Strengthening IEC, BCC • Strengthen of IEC infrastructure and optimum utilization of it.
and       advocacy        to
                               • In house training/sensitization of IEC personnel on interpersonal,
undertake
                                 modern techniques of mass communication, street plays, folk
comprehensive activities
                                 dances, theatre etc.
at the state level.
                               • Develop IEC/BCC plan at district level.
Support                   of
                               • Identify areas for NGOs and involve them in RCH- II interventions.
communication experts,
professionals,                 • Identify pilot initiatives on priority communication activities and
institutions and NGOs to         initiate area specific pilot IEC & BCC programs using innovative
bring invocations and            ways like development and display of portable hoardings in health
use       of          modern     institutions carrying key messages for dissemination of NRHM
communication                    goals and interventions.
techniques.
                               • Implementation and Monitoring of IEC/BCC plan.

Advocacy       on      health Maternal Health
issues                         • Advocacy workshop for state/ district/ block level on Maternal



                                                                                   186
  Health issues
• Focused group discussions on Maternal Health, Institutional
  deliveries
• To propagate need for ANC check-up, consumption of IFA tablets,
  danger signs, institutional deliveries through inter-personal
  communication by ANM, ASHA during home visits and VHNDs

• Use of Mass Media, Communication Channels for promotion of
  ANCs, Institutional Deliveries, JSY etc



Child Health

• Immunization, ARI, Diarrhoea, HBNC are important interventions
  to reduce the morbidity and mortality of neo natal and infants

• Advocacy workshop for state/ district/ block level on Child Health
  issues

• Focused group discussions on Child Health, exclusive breast-
  feeding and management of neo-natal/ infants illnesses.

• IPC through home visits by ANM, ASHA

• Counseling of mothers, mother-in-laws during ANC and PNC for
  early and exclusive breast-feeding and weaning practices

• Counseling on Management of sick neo-natal

• Use of audio visual media messages

Family Planning

• Popularizing spacing methods like 10 years IUD and NSV

• To reduce gender bias towards girl-child.

• Use of audio visual media messages



                                                  187
                          ARSH

                          • Advocacy workshop for state/ district/ block level on ARSH

                          • Counseling sessions for adolescents during school visit by para-
                            medics and MOs

                          • Ensure functioning of ARSH clinics by generating demand for
                            services among adolescents

                          • Information on physical development and changes, personal care
                            and ways of seeking help on STI/ RTI, HIV

                          • Developing and telecasting TV and radio spots for adolescents

                          Sex Ratio

                          • Punjab is focusing on girl-child. To reduce the gender bias against
                            female child a campaign in the form of sensitizing stakeholders
                            and advocating the sex-ratio issues

                          • Information to track number of boys and girls attending
                            anganwadi etc.

                          • Sensitization through media on menace of female-foeticide

                          • Awareness and award to panchayat performing well-on sex-ratio

                          • Incentives/ awards to informers/ decoy patients

                          • List of all Appropriate Authorities can be publish in print media to
                            reach the urban and rural communities

                          • Girl-child competitions

Audio/ Visual Publicity   • Use TV Channels, Cable Network for advocating the health issues

                          • Radio spot jingles

Innovations               • Portable fiber canopies at State/ District levels having NRHM logo
                            for publicity during camps, festivals etc. This activity has been


                                                                             188
                           designed to leave an everlasting impact on the mind of the
                           community participating in camps festivals, health melas etc.
                           regarding National Rural Health Mission. These canopies will act
                           as make-shift camp office of NRHM staff wherein essential
                           materials of publicity, records etc. can be stored during outdoor
                           events. On the other hand this canopy will made of attractive fiber
                           material and color scheme with NRHM logo inscribed on it.

                        • Two Sehat Rath on pilot basis. These multimedia vans/ buses will
                           be equipped with State of the art equipments and gadgets like
                           huge size LCDs on either side, good quality public address system,
                           exhibition panel, projection system, computer, other multimedia
                           kits etc. for dissemination of key health care issues.

Other Activities        • Inter Personal Communication workshops at State , Regional and
                           District level to discuss the issues under NRHM

                        • Road shows

                        • Independence Day and Republic Day celebrations

                        • Campaign during big fairs of the state especially Hola Mohalla at
                           Sri Anandpur Sahib and Sabha of Fatehgarh Sahib

                        • Fixing of flex-boards, hoarding

                        • It is proposed to decentralized some IEC/ BCC activities to the
                           district level to undertake local need based activities focusing on
                           BCC through local Folk Media, IPC etc.

Support    needed   for Availability of budget for IEC/BCC.
implementing changes

Benchmarks              • Advocacy workshops organized

                        • Focused group discussions conducted




                                                                             189
                           • TV/ Radio Spots telecasted/ broadcasted

                           • Coverage of BCC Vans

                           • Special campaigns organized during festivals

                           campaign
Special focus area for IEC campaign

          o To improve complete ANC check-up
          o Exclusive breast-feeding and pre lacteal administration
          o Holding VHND
          o Improve institutional deliveries
          o Skewed sex-ratio


              To address these issues Inter Personal Communication, Mass Media in the
form TV, Radio, advertising and publicity will be done.




                                                                            190
                      BUDGET FOR BEHAVIOUR CHANGE COMMUNICATION (BCC/IEC)

                                           Physical                                                  Modified
                                            Target                                                  Budget for
                                                                                                       NPCC
                                                      Rate                          2010-
                                                                 Amount (Rs. Lakhs) 2010-11          Amount      Remarks
          Budget Head                                 (Rs./
                                           Unit of                                                     (Rs.
                                                      Unit)
                                           Measure                                                    Lakhs)
                                                                                                     2010-
                                                                                                     2010-11
                                                               Q1      Q2       Q3       Q4
  12     Behaviour Change Communication (BCC/IEC)
 12.1    Strengthening of BCC/IEC Wing (State and District Levels)
12.1.1   Salary to Art & Exhibition
         expert one at State Level       1         14000       0.42   0.42     0.42     0.42          1.68
         @ 14000/- per month
12.1.2   Salary to Contractual one
         BCC facilitator at state
                                         1         15000       0.45   0.45     0.45     0.45          1.80
         level @ 15000/- per
         month
12.1.3   Technical support for
         printing @ 12000/- per          1         12000       0.36   0.36     0.36     0.36          1.44
         month
12.1.4   Salary to Contractual 20
         BCC facilitator at each
         district level @ 13000/-       20         13000       7.80   7.80     7.80     7.80          31.20
         per month 13000x20 =
         260000/- per month
12.1.5   TV & DVD Sets for all (118
         blocks) - For awareness
         amongst community on
                                        118        10000       0.00   0.00     11.80    0.00          11.80
         the issues of MH. CH, JSY,
         PNDT etc. @ 10000/- per
         unit/block
12.1.6   Portable fibre canopies for
         20 Districts & 1 at S.H.Q -
         For awareness canopies to
         each districts having
                                        21        125000       0.00   26.25    0.00     0.00          26.25
         NRHMs Logo for publicity
         during camps and fares /
         public events @ 125000/-
         per unit
12.1.7   2 Multimedia Buses on
         Swaraj Mazada / force on
         pilot basis for 4 regions of
         Punjab - State of the art
         multimedia bus equipped         2                                                                       As per
         with multimedia gadgets                                                                                 comments
         for awareness of health                                                                                 of NPCC
         issues @ 1000000/- per                                                                                  shifted to
         bus                                                                                                     Part-B
12.1.8   Digital camera having still
         and video modes for each
         district & S.H.Q - For coverage
                                             21       14400   3.02    0.00     0.00     0.00          3.02
         of events, monitoring of


                                                                                              191
                                         Physical                                                   Modified
                                          Target                                                   Budget for
                                                                                                      NPCC
                                                     Rate
                                                                                   2010-
                                                                Amount (Rs. Lakhs) 2010-11          Amount      Remarks
            Budget Head                              (Rs./
                                         Unit of                                                      (Rs.
                                                     Unit)                                           Lakhs)
                                         Measure
                                                                                                    2010-
                                                                                                    2010-11
                                                              Q1      Q2       Q3       Q4
           health programmes @
           15000/- per unit
                     Sub Total                               12.05   35.28    20.83     9.03         77.19
  12.3     Implementation of BCC/ IEC Strategies
 12.3.1    BCC/ IEC Activities for Maternal Health
12.3.1.1   Advocacy workshop for
           Maternal Health at Block          118     2500    2.95    0.00     0.00     0.00          2.95
           Level
12.3.1.2   District Level Advocacy
           Workshop for Maternal             20      20000   4.00    0.00     0.00     0.00          4.00
           Health
12.3.1.3   State Level Advocacy
           Workshop for Maternal              1      75000   0.00    0.75     0.00     0.00          0.75
           Health and Child Health
                     Sub Total                               6.95    0.75     0.00      0.00         7.70
 12.3.2                                  Health
           BCC/ IEC Activities for Child Health
12.3.2.1   Advocacy workshop for
           Child Health at Block             118     2500    0.00    2.95     0.00     0.00          2.95
           Level
12.3.2.2   District Level Advocacy
           Workshop for Child                20      20000   0.00    4.00     0.00     0.00          4.00
           Health
12.3.2.3   FGD on Maternal & Child          2950     500     0.00    7.38     0.00     7.38          14.75
           Health @ 250/- per S.C
                     Sub Total                               0.00    14.33     0.00     7.38         21.70
12.3.3     BCC/ IEC Activities for Family Planning
12.3.3.1   District Level Workshop
                                             20      20000   0.00    2.00     2.00     0.00          4.00
           on FP Programmes
12.3.3.2   Block Level Workshop on
                                            118      5000    0.00    2.95     2.95     0.00          5.90
           FP Programmes
                     Sub Total                               0.00    4.95     4.95      0.00         9.90
 12.3.4    BCC/ IEC Activities for ARSH
12.3.4.1   District Level Advocacy           20      20000   0.00    0.00     0.00     4.00          4.00
           Workshop for ARSH
12.3.4.2   State Level Advocacy
                                              1      75000   0.00    0.00     0.75     0.00          0.75
           Workshop for ARSH
12.3.4.3   Advocacy workshop for Intra
           Personal Communication at       118       2500    0.00    0.00     2.95     0.00          2.95
           Block Level
                    Sub Total                                0.00     0.00     3.70     4.00          7.70
  12.4            Activities
           Other Activities
 12.4.1    Intra Personal Communication
12.4.1.1   Two District Level
                                            40       20000   0.00    8.00     0.00     0.00          8.00
           Workshop on NRHM


                                                                                             192
                                        Physical                                                   Modified
                                         Target                                                   Budget for
                                                                                                     NPCC
                                                   Rate
                                                                                  2010-
                                                               Amount (Rs. Lakhs) 2010-11          Amount      Remarks
            Budget Head                            (Rs./
                                        Unit of                                                      (Rs.
                                                   Unit)                                            Lakhs)
                                        Measure
                                                                                                   2010-
                                                                                                   2010-11
                                                             Q1      Q2       Q3       Q4
12.4.1.2   Two State Level
                                            2      75000    0.00    1.50     0.00     0.00          1.50
           Workshops on NRHM
12.4.1.3   State Level Advocacy
           Workshop for Intra
                                            1      75000    0.00    0.75     0.00     0.00          0.75
           Personal Communication
           and BCC
12.4.1.4   Four Regional Advocacy
           Workshops Intra Personal
                                            4      75000    0.75    0.75     0.75     0.75          3.00
           Communication / NRHM
           @ 100000 per workshop
                    Sub Total                               0.75    11.00
                                                                    11.00    0.75      0.75         13.25
12.4.2     Save the Girl Child under
           PNDT Act - Girl Child          2400     2500     0.00    0.00     0.00     60.00         60.00
           Competition
12.4.3     Folk Media (From parties
           of song & drama division
           at DAVP rates) Twice a
                                           118     10000    0.00    5.90     0.00     5.90          11.80
           year - Maternal Health,
                                 VHSC,
           Child Health, NRHM, VHSC,
           FW, ARSH, PNDT
12.4.4     Road Shows of NRHM on
           26 January & 15 August
12.4.4.1   Independence day &
           Republic day @ 10000/-          20      20000    0.00    2.00     0.00     2.00          4.00
           per day
12.4.4.2   State level fares at
           Anandpur Sahib in Dist.
                                            2      25000    0.00    0.00     0.25     0.25          0.50
           Ropar & Fatehgarh Sahib
           @ 25000/- per fare
 12.4.5    World Population Day (11 July 2010)
12.4.5.1   Block @ 2000/- per block        118     2000     0.00    2.36     0.00     0.00          2.36
12.4.5.2   District @ 5000/- per
                                           20      5000     0.00    1.00     0.00     0.00          1.00
           district
12.4.5.3   State @ 10000/-                  1      100000   0.00    1.00     0.00     0.00          1.00
 12.4.6    Exhibition (Various Health
           programmes under
                                                   5000
           NRHM) - Rs. 5000 per            138              1.98    1.98     1.98     1.98          7.90
                                                   10000
           Block and Rs. 10000 per
           District
 12.4.7    Audio -Visual
 12.7.1    TV Spots
12.7.1.1   Production through
           leading National level          3       500000   15.00   0.00     0.00     0.00          15.00
           professional firms, topics
           to be covered are MH, JSY,

                                                                                            193
                                          Physical                                                   Modified
                                           Target                                                   Budget for
                                                                                                       NPCC
                                                      Rate
                                                                                    2010-
                                                                 Amount (Rs. Lakhs) 2010-11          Amount      Remarks
             Budget Head                              (Rs./
                                          Unit of                                                      (Rs.
                                                      Unit)                                           Lakhs)
                                          Measure
                                                                                                     2010-
                                                                                                     2010-11
                                                               Q1      Q2       Q3       Q4
            CH, ARSH, PNDT & NRHM
            @500000/- per spot


12.7.1.2    Production of documentaries
            on health issues
                                                     1000000   0.00   0.00     10.00    0.00          10.00
12.7.1.3    Telecasting through
            leading National level
            professional firms, topics
                                            4        1000000   0.00   10.00    15.00    15.00         40.00
            to be covered are MH, JSY,
            CH, ARSH, PNDT & NRHM
            @ 1000000/- per quarter
 12.7.2     Radio Spot Jingle - Topics
            to be covered are MH, JSY,
                                            4        750000    7.50   7.50     7.50     7.50          30.00
            CH, ARSH, PNDT & NRHM
            @ 750000/- per quarter
 12.4.8     Printing Material
12.4.8.1    Poster to be printed for
            following topics MH, JSY,
                                            4        300000    3.00   3.00     3.00     3.00          12.00
            CH, ARSH, PNDT & NRHM
            @ 300000/- per quarter
12.4.8.2    One lac Comic Books for
            children on health issues    100000        5       5.00   0.00     0.00     0.00          5.00
            @ 5/- per copy
12.4.8.3    Publishing of materials/
            leaflets/ handouts on                              0.00   2.00     2.00     0.00          4.00
            health programmes
 12.4.9     Newspapers
            Advertisement - For all
                                            4        750000    7.50   7.50     7.50     7.50          30.00
            health programmes @
            750000/-
            750000/- per quarter
12.4.10     Outdoor Publicity (Scroll) -
            Messages on key health
                                            4        250000    2.50   2.50     2.50     2.50          10.00
                         250000/-
            issues @ 250000/- per
            quarter
 12.4.11    Permanent Hoardings & Flex
12.4.11.1   For awareness amongst
            community on the issues
                                            4        250000    2.50   2.50     2.50     2.50          10.00
            of MH. CH, JSY, PNDT etc.
            @ 250000/- per quarter
12.4.11.2   Display of 50 Hoardings on
            DAVP rentals at public
            places - For awareness
                                            4        250000    2.50   2.50     2.50     2.50          10.00
            amongst community on
            the issues of MH. CH, JSY,
            PNDT etc. @ 250000/- per

                                                                                              194
                                Physical                                                   Modified
                                 Target                                                   Budget for
                                                                                             NPCC
                                           Rate
                                                                          2010-
                                                       Amount (Rs. Lakhs) 2010-11          Amount      Remarks
 Budget Head                               (Rs./
                                Unit of                                                      (Rs.
                                           Unit)                                            Lakhs)
                                Measure
                                                                                           2010-
                                                                                           2010-11
                                                     Q1      Q2       Q3       Q4
quarter




         Sub Total                                  47.48   51.74    54.73   110.63        264.56
Flexi Pool (Unmet activities)
For meeting the issues
and objectives that remain
unmet due to
circumstantial reasons &           4       500000   5.00    5.00     5.00     5.00          20.00
making emergency
purchases @ 500000/-
per quarter
                                                    5.00     5.00     5.00     5.00         20.00
          Sub Total
                                                    72.23   123.04   89.96    136.78       422.00
          Total BCC




                                                                                    195
     PROCUREMENT

Objective: To Streamlining the procurement processes

                            • For procurement of various items (drugs and equipments) it is
Issues/ Challenges            proposed to strengthen the Procurement Cell at state level.
                              Procurement will be undertaken as per GOI guidelines and
                              procurement policy.

Strategies/ Services        Activities/ Inputs

Strengthening          of • Contractual Appointment of Manager Procurement, Procurement
Procurement Cell at State     Assistant and Ware House Keeper
HQ

Procurement Policy          • Mode of Procurement

                            • Preparation of Tender Document

                            • Advertisement Procedures

                            • Issue of tender Documents

                            • Opening of tenders

                            • Evaluation Processes

                            • Award of Contract

                            • Inspection and Testing

Procurement of Items        • Details of Items to be procured is placed in respective components.


Support    needed      for • Supply and Purchase Cell of Directorate
implementing changes        • Punjab Health Systems Corporation


Benchmarks                  • Supply Chain Maintained




                                                                                 196
                                             BUDGET FOR PROCUREMENT

                                     Physical                                                   Amount
                                      Target     Rate                                             (Rs.
                                                                                   2010-
                                                                Amount (Rs. Lakhs) 2010-11                 Remarks
           Budget Head                           (Rs./                                           Lakhs)
                                     Unit of     Unit)                                          2010-
                                                                                                2010-11
                                     Measure               Q1         Q2        Q3       Q4
  13       PROCUREMENT
           Procurement        of
 13.1
           Equipment
           Procurement        of
13.1.2
           Equipment for CH
           Setting up of New
                                                                                                          Booked
           born care centres @
13.1.2.1                                2        25000    0.00       0.50      0.00     0.00     0.50     from Child
           Rs. 25,000 CHC in 2
                                                                                                          Health
           CHCs
           Baby Warmer and UV
                                                                                                          Booked
           Light Unit @ Rs.
13.1.2.2                               447       75000    0.00      335.25     0.00     0.00    335.25    from Child
           75000 for 2 CHCs &
                                                                                                          Health
           445 PHCs
           Supply of 3.5 lakh
                                                                                                          Booked
           Manual        Mucus
13.1.2.3                             350000       7.5     0.00       26.25     0.00     0.00     26.25    from Child
           Suckers @ Rs. 7.50
                                                                                                          Health
           each
           Procurement        of                                                                          Booked
13.1.2.4   Equipment for SNCU           2       2500000   0.00       50.00     0.00     0.00     50.00    from Child
           Bathinda and Patiala                                                                           Health
 13.2      Drugs & Supplies
                                                                                                          Booked
           IFA     Tablets     to
13.2.2                                                    0.00       20.00     0.00     0.00     20.00    from Child
           children
                                                                                                          Health
           IFA     Tablets     for                                                                        Booked
13.2.2                                                    30.00      0.00      0.00     0.00     30.00
           adolscent girls                                                                                from ARSH
           Drugs @ Rs. 12 lakh
                                       21       1200000   0.00       0.00     252.00    0.00    252.00
           for 21 DH per annum
           Drugs @ Rs. 3 lakh
           for 129 CHC per             129      300000    0.00       0.00     387.00    0.00    387.00
           annum
           Drugs @ Rs. 1.25
           lakh per PHC per
           annum for 445, 24x7
                                       445      125000    0.00       0.00     556.25    0.00    556.25
           PHCs including Rural
           Hospitals          and
           Satellite Hospitals
           Drugs @ Rs.5 lakh for
                                       36       500000    0.00       0.00     180.00    0.00    180.00
           36 SDH per annum
                                                          30.00     432.00   1375.25    0.00    1837.25




                                                                                               197
STRENGTHENING OF PROGRAMME MANAGEMENT UNIT

Strengthening of State/District Programme Management Units

                         • Under NRHM emphasis on strengthening the Human Resource for
                            Management of Health Programmes at State level State Health
                            Mission is apex body for policy directions and review the
                            implementation. Governing body SHS is responsible for approving
                            annual plan including budget, review progress. Executive
                            committee reviews the operational issues for programme
Issues/ Challenges
                            implementation. At district level District Health Mission and District
                            Health Society are responsible for execution of programme.

                         • Secretary Health-cum-Mission Director, NRHM act as a CEO of the
                            State Health Society and State Programme Management Unit is
                            established to assist the State Health Society in day to day
                            functioning.

Strategies/ Services                 Inputs
                         Activities/ Inputs

                          • SHSRC will consist of:

                            Consultant - Public Health Planning
                            Consultant - Quality Assurance/ Quality Improvement
                            Consultant - Community Participation
                            Consultant - IEC/BCC
                            Consultant - Monitoring and Evaluation
                            Consultant - Health Human Resource Development
                            Documentation Officer
Strengthening PMUs at • State Programme Management Unit consisting of SPM, Manager
State/ District level.      (Finance & Accounts, Monitoring & Evaluation, HRD) and
                            Specialists (Maternal Health, Family Welfare, Public Health),
                            Programme Coordinator (NGOs, ARSH & Gender and BCC),
                            Consultant (M&E, Administration) has been established.



                                                                                       198
                          • District Programme Management Unit Consists of DPM, DAO,
                            DMEO, District Accountant-cum Cashier, District               Statistical
                            Assistant.

                          • Other Consultants/ other contractual staff if required may be
                            appointed Mission Director, NRHM and cost will be met out of office
                            expenditure of 6%.

                          • In the year 2009-10, salaries of S/D/BPMU were enhanced to
                            approximately 15%. But as pay package of other national
                            programme like IDSP, NACO and other organisations have raised
                            significantly. The revision has also been made in the salaries of all
                            categories of staff of Govt. of India and State Govt. based on this, the
                            salary structure of S/D/BPMU has been revised as per annexure.
                            There will be annual enhancement of honorarium @ 6% for
                            proceeding years after completion of one year.

                          • HRD policy has been framed and under consideration of Govt.

Support   needed       for • NHSRC
implementing changes      • Guidelines by GOI on HR.

                          • Position of consultant and supporting staff filled at all level.
Benchmarks
                          • Retain the professionals in the system.




                                                                                          199
                                BUDGET FOR PROGRAMME MANAGEMENT

                                Physical                                                        Modified
                                 Target                                                        Budget for
                                           Rate                                                  NPCC
                                                                              2010-
                                                           Amount (Rs. Lakhs) 2010-11                          Remarks
                                                                                                               Remarks
         Budget Head            Unit of    (Rs./                                                Amount
                                Measur     Unit)                                               (Rs. Lakhs)
                                  e                                                             2010-
                                                                                                2010-11
                                                    Q1         Q2         Q3            Q4
14.1     PROGRAMME MANAGEMENT
         Strengthening of State society/State Programme Management Support Unit (details of
14.1
         training under section 11)
                                                                                                               On
         State   Programme
14.1.1                             1                                                                           Deputati
         Manager
                                                                                                               on
         Director Finance (
                                                                                                               Deputati
14.1.2   deputation/contract)      1       50000    1.50      1.50       1.50           1.50      6.00
                                                                                                               on
         @ Rs. 50,000/- pm
         Procurement
14.1.6   Manager @ Rs              1       30000    0.90      0.90       0.90           0.90      3.60
         30000/-
         Manager Human
         Resource
14.1.7                             1       35000    1.05      1.05       1.05           1.05      4.20
         Development @ Rs.
         35000/-
         Manager Finance &
14.1.8   Accounts @ Rs.            1       40000    1.20      1.20       1.20           1.20      4.80
         40000/-
         Manager (Monitoring
14.1.9   & Evaluation) @           1       35000    1.05      1.05       1.05           1.05      4.20
         Rs.35000/-
         State NGO
14.1.1
         Coordinator @ Rs.         1       35000    1.05      1.05       1.05           1.05      4.20
  0
         35000/-
         Programme
14.1.1
         Coordinator – ARSH &      1       35000    1.05      1.05       1.05           1.05      4.20
  1
         Gender @ Rs.35000/-
         Programme
14.1.1
         Coordinator – BCC @       1       35000    1.05      1.05       1.05           1.05      4.20
  2
         Rs. 35000/-
         Consultant
14.1.1   Monitoring &
                                   1       28000    0.84      0.84       0.84           0.84      3.36
  3      Evaluation @
         Rs.28000/-
14.1.1   Consultant Admn @
                                   1       28000    0.84      0.84       0.84           0.84      3.36
  4      Rs. 28,000/-
         Assistant Manager
14.1.1
         (Finance)@ Rs                              0.75      0.75       0.75           0.75      3.00
  5
         25000/-
         Accounts Officer-
14.1.1
         Compilation &             3       20000    1.80      1.80       1.80           1.80      7.20
  6
         Audits@20000/-
14.1.1   Accountant / Cashier      3       13000    1.17      1.17       1.17           1.17      4.68


                                                                                                         200
                                   Physical                                                        Modified
                                    Target                                                        Budget for
                                              Rate                                                  NPCC
                                                                                 2010-
                                                              Amount (Rs. Lakhs) 2010-11                          Remarks
                                                                                                                  Remarks
         Budget Head               Unit of    (Rs./                                                Amount
                                   Measur     Unit)                                               (Rs. Lakhs)
                                     e                                                             2010-
                                                                                                   2010-11
                                                       Q1         Q2         Q3            Q4
  7      @ Rs. 13000 x 3
         Procurement
14.1.1
         Assistant 1 @ Rs             1       13000   0.39       0.39       0.39           0.39      1.56
  8
         13,000/-
         Statistical Assistant 2
14.1.1
         @ Rs. 13000/- and            3       13000   1.25       1.25       1.25           1.25      4.99
  9
         one @ Rs. 15600/-
14.1.2   Computer Assistant 2
                                 2            15750   0.95       0.95       0.95           0.95      3.74
  0      @ Rs. 15750/-
14.1.2   Office Assistant @ Rs.
                                 1            13800   0.41       0.41       0.41           0.41      1.66
  1      13800/-
14.1.2   Office Assistant @ Rs.
                                 7            10000   2.10       2.10       2.10           2.10      8.40
  2      10000 x 7
14.1.2
           Clerk @ Rs. 6000                   6000    0.18       0.18       0.18           0.18      0.72
  3
14.1.2
           Driver @ Rs.7000 x 2  2            7000    0.42       0.42       0.42           0.42      1.68
  4
14.1.2
           Peon @ Rs. 5000x3     6            5000    0.90       0.90       0.90           0.90      3.60
  5
Sub Total State Programme Management
                                                      20.85      20.85      20.85      20.85        83.35
Unit
Unit - Salaries
           District Programme
 14.2.
           Management Unit
           District Programme
14.2.1 Manager@ Rs. 28000        20           28000   16.80      16.80      16.80      16.80        67.20
           x 20 districts
           District Account
14.2.3 Officer @ Rs. 19000 x     20           19000   11.40      11.40      11.40      11.40        45.60
           20 districts
           Monitoring &
           Evaluation Officer @
14.2.4                           20           19000   11.40      11.40      11.40      11.40        45.60
           Rs. 19000 x 20
           districts
           District Accountant /
14.2.6 Cashier @ Rs. 12000       20           12000   7.20       7.20       7.20           7.20     28.80
           x 20 districts
           District Statistical
           Assistant @ Rs. 12000
14.2.7                           20           12000   7.20       7.20       7.20           7.20     28.80
           x 20 districts

Sub   Total   District         Programme
                                                      54.00      54.00      54.00      54.00        216.00
Management Unit - Salaries
       Block Programme
       Management Unit
14.2.1 Block Statistical Asstt.
                                    118
  0    @ Rs. 11000 x 118


                                                                                                            201
                                    Physical                                                         Modified
                                     Target                                                         Budget for
                                               Rate                                                   NPCC
                                                                                  2010-
                                                               Amount (Rs. Lakhs) 2010-11                           Remarks
                                                                                                                    Remarks
         Budget Head                Unit of    (Rs./                                                 Amount
                                    Measur     Unit)                                                (Rs. Lakhs)
                                      e                                                              2010-
                                                                                                     2010-11
                                                        Q1         Q2         Q3             Q4
         Blocks

         Block Accountant
14.2.1
         Cum Cashier @ Rs.            118
  1
         11000 x 118 Blocks
         Sub Total BPMU                                0.00       0.00       0.00           0.00       0.00
         Other Activities
 14.4    (Operational
         Expenditure)
         Expenditure)
         TA / DA for SPMU,
         SCOVA, State
         Functionaries for
14.1.2
         attending meetings/           1       60000   3.75       3.75       3.75           3.75      15.00
  4
         seminars/workshops
         /study tour under
         NRHM
         Infrastructure Support
14.1.2
         and office operational                        37.50      37.50      37.50      37.50         150.00
  5
         cost at State
         Rent,       Electricity,
                                                       12.00      12.00      12.00          12.00     48.00
         Water and Telephone
         Charges
                                                       5.00       5.00       5.00           5.00      20.00
         Audit Fee
           Operational Cost Rs.                         6.00        6.00        6.00         6.00         24.00
           2.00 Lakh per month
           Infrastructure,
                                                        7.50        7.50        7.50         7.50         30.00
           Furniture,      Office
           Equipment etc.
           Infrastructure
           Support and
           Operational                       15000
14.2.9                              1                  20.00       20.00       20.00        20.00         80.00
           Expenditure to DPMU                 0
           @ Rs.4 Lakhs per
           district 20
Rumenarations proposed are only suggestive it may increase or decrease depending upon the exceptional
qualifications/experience/performance of the individuals or as per any decisions taken by the State Health Society .

Any position if required may be sanctioned and appointed by MD- NRHM and the cost will be met out of Management cost i.e.
within 6%.management cost
                  Total-
             Sub Total-Other
          Activities (Operational
           Expenditure) i.e. TA/                       54.25    54.25     54.25         54.25        217.00
            DA, Infrastructure
           Support to S/DPMU/
           Audit Fees and Misc.


                                                                                                              202
                    Physical                                                        Modified
                     Target                                                        Budget for
                               Rate                                                  NPCC
                                                                    2010-
                                                 Amount (Rs. Lakhs) 2010-11                      Remarks
                                                                                                 Remarks
Budget Head         Unit of    (Rs./                                                Amount
                    Measur     Unit)                                               (Rs. Lakhs)
                      e                                                             2010-
                                                                                    2010-11
                                        Q1           Q2         Q3            Q4
    Expenditure




  Total Programme                      129.10
                                       129.10      129.10     129.10      129.10     516.35
  Management Unit
                                       1742.32     2518.58    3254.51    1906.82    9442.90
GRAND TOTAL RCH




                                                                                           203
      Part-
      Part-B:

NRHM Additionalities




                       204
PART B: NRHM INITIATIVES

Background

The NRHM Additionalities, specified under Part B of the State PIP, are not only intended to
strengthen the health system in the State as a whole but also to ensure quality. It provides
scope for innovations by the State to address State specific needs to strengthen health
system and to improve the quality.

In State PIP 2010-11, the Government has proposed the following set of activities under the
NRHM Additionalities:

      •       Strengthening of selected ASHAs in all the Districts
      •       Provision of Untied Funds to SCs, PHCs and CHCs to address local needs
      •       Upgrading CHCs to IPHS, PHCs for 24 hour service and Sub-Centres
      •       Support for the alternate health system managed by the Panchayats
      •       Up-gradation of the SDH and DH in the State
      •       Setting up of Emergency Response Service (ERS) in the State
      •       Providing Mobile Phone to every ANM
      •       Strengthening SCs by providing additional ANMs & maintaining standards


In approving the proposals for the proceeding years, the GoI said that since Punjab wasn’t a
high-focus State, the cost of ASHA is charged to the RCH flexible pool. During the current
year 2010-11, State has proposed ASHA Training, ASHA Kits, Performance Related
Incentives and Support Mechanism for ASHA from NRHM Additionalities; rest is from RCH
Flexi pool.

                          2009-
Progress of Activities in 2009-10

Though the GoI launched NRHM on April 12, 2005, the activities in Punjab gained
momentum in the last year.




                                                                              205
Some of the key attainments are:

      •    Constitution of the State and District Health Missions.
      •    Preparation of the need-based decentralised planning at village level. Punjab is
           one of the few States in the country to have 100 percent Gram Panchayat wise
           NRHM implementation plans. The plans at the GP, Block and District level are
           all complete and this is informing the process of preparing the State plans.
      •    Formation of Village Health & Sanitation Committees (VHSC). The notification
           for the constitution of the VHSC was issued on October 21, 2007.
      •    Selection of Accredited Social Health Activists (ASHA). Against the proposed
           number of 17756 ASHAs, 17229 ASHAs were selected by September, 2009.
      •    All health facilities in the State entitled to Untied Funds (Sub-Centre
           (Rs.10,000), PHC (Rs.25,000), CHC (Rs.50,000)) were provided Untied Funds to
           meet local needs.
      •    Construction and Maintenance Grant provided to all health facilities that were
           entitled to it (Sub-Centre in Government Building Rs. 10,000, 24x7 PHC Rs.
           50,000 and CHC Rs 1.00 lakh). The facilities are improving for the provision of
           services.
      •    Rogi Kalyan Samities established in health facilities up to CHC level. Block &
           PHC Planning & Monitoring Committees at Block & PHC level would act as RKS.
      •    District Planning and Monitoring Committee, Block Planning and Monitoring
           Committee for Health Blocks and PHC Planning and Monitoring Committee
           constituted.
      •    The process of Up-grading health facilities was initiated. 49 PHCs and 112 CHCs
           were taken up for Up-gradation in the year 2007-08. Up-gradation of the SDH
           and DH is taken up this year. 4 SDHs and 5 DHs where major up-gradation was
           required have been taken up this year and the work is in progress.
      •    Up-gradation and repair of Sub-Centres taken up.




                                                                              206
      •    The Operationalization of the 24X7 days PHCs for improving Institutional
           deliveries has already been initiated.
      •    Mainstreaming AYUSH into health services up to CHC and PHC levels. One
           AYUSH doctor for CHCs and one AYUSH doctor for PHCs @ Rs. 20,000 per
           month provided in the PIP and out of this 121 Ayurveda doctors and 112
           Homeopathy doctors were appointed in the PHCs and CHCs respectively in last
           year and in this year recruitment is under process for recruitment of 88 number
           of Ayurvedic Doctors & 192 number of Dispensers.
      •    GIS based / Computerized Health Management Information System.
      •    Programme Management Units at the State, District and Block levels has been
           established.
      •    The process of establishing a State Health Systems Resource Centre (SHSRC)
           has been initiated and expected to be complete by January 2010.
      •    24 Mobile Medical Units have been procured to cover difficult out-reach areas.
      •    The process has been initiated for providing Mobile Phone Connections to each
           ANM and expected to be completed by January 2010.
      •    The process of strengthening Civil Registration System has been initiated.
      •    Drugs, equipments and furniture procured for CHCs and PHCs.
      •    Under the School Health Programme, free treatment of school going children
           suffering from CHD and RHD taken up with PGI. Till September 2009, 97
           children were treated for RHD/CHD.
      •    Emergency Response Service: MoU signed with EMRI for providing Emergency
           Response Services in the State but that was put on hold due to Satyam case, now
           again the process has been started for the operationalization of ERS in Punjab.

                                          2010-
Brief overview of strategies proposed for 2010-11

NRHM Additionalities provide us the flexibility of using funds, the main focus will again be
to strengthen the existing infrastructure; reaching the under-served & un-served areas by
operationalizing ERS & strengthening MMUs; involving Community participation through
capacity building of Community Health Planning & Monitoring Committees at various

                                                                             207
levels; reinforcing the monitoring by providing Mobile Phone to each ANM & taking worker
wise feedbacks through Web-based Application on mobile & ensuring timely fund flow of
Untied Funds, AMG & Corpus Grant to various Institutions/Committees.

The strategies proposed are:

      •    Strengthening of Village Health and Sanitation Committees
      •    Skill building of ASHA to bring the health system closer to the community
      •    Strengthening of the Rogi Kalyan Samities (RKS)
      •    Strengthening & capacity building of District Planning and Monitoring
           Committee, Block Planning and Monitoring Committee for Health Blocks and
           PHC Planning and Monitoring Committee
      •    Provision of Untied Funds to health facilities
      •    Up-gradation of health facilities to improve health care provision
      •    Establishment of the State Health Resource Centre to provide technical support
           for the implementation of NRHM
      •    Operationalization of ERS in the State
      •    Provision of Mobile Phone to each ANM
      •    Provision of Ambulance up to CHC level
      •    Provision of one Gynaecologist at each District hospital
      •    Provision of 2nd ANM for strengthening of SCs
      •    Computerisation of selected CHCs/ SDH/ DH in phased manner including
           software migration and hardware cost
      •    Implementation of Tele Medicine Project




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                     ACCREDIATED SOCIAL HEALTH ACTIVISTS (ASHA)

To complement the work of ANM, Accredited Social Health Activist (ASHA) is selected
through a selection process to fill the gaps in the health care delivery system. She is a
volunteer who acts as a bridge between the community and the available health care
system. She is working towards catalyzing behavioral change in rural areas of the State.
ASHA is contributing towards enhancing quality of life with focus on health, nutrition,
sanitation, drinking water etc.

Roles and Responsibilities of ASHA

The ASHA is appointed to take steps to create awareness and provide information to the
community on determinants of health such as nutrition, basic sanitation & hygiene
practices, healthy living condition for working conditions, information on existing health
services and timely utilization of health & family welfare services.

She will counsel women on birth preparedness, importance of safe delivery, breast feeding
and complementary feeding, immunization, contraception and prevention of common
infections including RTI/STI and care of young child.

ASHA will mobilize the community and facilitate them in accessing health and its related
services available at the Anganwadi / Sub-Centers / Primary Health Centers.

She will assist the Village Health & Sanitation Committee of the Gram Panchayat to develop
a comprehensive village health plan.

She will escort / accompany pregnant women & children requiring treatment / admission
to the nearest pre-identified health facility i.e. PHC/CHC/FRU.

ASHA will provide primary medical care for minor ailments such as diarrhea, fever, and
first aid for minor injuries work as provider of DOTS under RNTCP.

She will also act as depot holder for essential provisions which will be made available to
every habitation.




                                                                              209
She will inform about the births and deaths in her village and any unusual health
problems/disease outbreaks in the community to the Sub-Center/Primary Health Centre.

Besides, she will also promote construction of household toilets under Total Sanitation
Campaign.

I      Capacity Building of ASHA

Training of ASHA in Vth Module of GoI has been kept in the F/Y 2010-11 besides the
refresher training for continuous skill building.

II     Performance based incentives to ASHA
                                                  pool-
Additional incentives to ASHA under Mission flexi pool-NRHM Additionalities for the year
2010-
2010-11:

1.                                                          tablets
       Incentive to promote complete ANC, intake of 100 IFA tablets and institutional
delivery
The institutional delivery though has improved with the collective effort of strengthening
of heath system by means of human resource and the infrastructure up-gradation on one
hand and the involvement of community participation in the NRHM in the form of ASHA,
NGOs and the PRIs as the facilitators in achieving the set goals of millennium; however
there is lot more which need to be done to achieve the set goal of millennium.

As per NFHS-3 (2005-06), the institutional delivery is 51.5% which has improved to 63.3%
as per the report of DLHS (2007-08). With the advent of NRHM, this institutional delivery
has shown remarkable improvement. There has been a sharp increase of 43.53% in the
Government institutional deliveries (2009-10) in comparison to last year (2008-09).
However in order to achieve the set goal of millennium of 80 % institutional deliveries by
2012, there is a need to promote the institutional deliveries of all pregnant women besides
the JSY beneficiaries.

As per NFHS-3, the prevalence of anemia among pregnant women is higher. The prevalence
of moderate to severe anemia is greater among pregnant women. It has been seen that as
per DLHS-3(2007-2008), mothers who consumed IFA for 90 days or more when they


                                                                                 210
were pregnant with their last child (%) is 33.5% which has improved from 2005-2006
report as per NFHS-3 which was 26.1%. However, lot more emphasis is needed to improve
complete ANC. Facilitation by ASHA is one of the feature to ensure improved complete ANC.

There is a need of participation of ASHA to motivate the pregnant women and ensure her
complete ANC, with intake of 100 Iron Folic Acid tablets and finally institutional delivery.

ASHA may be given Rs. 200 to ensure complete ANC (3 ANC + 100 IFA Tablets) and
institutional delivery at Govt. /Accredited Pvt. Institution under JSY in their population for
all categories of women.

2.      Birth and Death Registration
Currently, the registration of birth is not up to the satisfactory level and registration of
deaths especially the infant and maternal deaths is under–reported. This hampers the
generation of vital statistics for the State and also defeats the purpose of prompt planning
and corrective measures to address issues like IMR and declining Juvenile sex ratio.

As per NFHS-3, for the birth registration of children under five years it has been seen that
of the total 76.3% registered, 52.3% had birth certificate and 24.0% did not had birth
certificate.

Moreover reduction of maternal and infant mortality is the crucial and main objective
under RCH-II Programme. It is necessary to identify the underlined causes of maternal
death and infant death and to take preventive measures through investigation of each and
every cause of maternal and infant death by the District level and State level Authorities. In
order to identify and investigate each and every maternal death, it is essential to screen
every female death of 15 to 49 years age group to avoid missing of maternal death from
being investigated.

ASHA, the first hand health resource person available at the door step of the community
may be paid Rs 100 per case for reporting of maternal or infant death to the ANM and the
Block Nodal Officer within 10 days.




                                                                                211
She may be given Rs 100 every quarter for ensuring 100 percent birth registration and
issuing of birth certificate in her area.

3.     Regular Conduct of meeting of Village Health and Sanitation Committee
ASHA can facilitate the VHSC in the conduct of its meeting, the preparation of village action
plan on the basis of community need assessment, maintenance of village health register at
the Panchayat level. Here, in order to have effective functioning of VHSC, ASHA may be
given Rs 200 to facilitate conduct of regular VHSC meeting once in every quarter. She may
prioritize issues & problems through participatory discussion with villagers. Expenditure
will be met from VHSC funds.

4.     Rashtriya Swasthya Bima Yojna (State Scheme)
A scheme to provide health insurance cover up to Rs. 30000/- to around 4.44 lakh BPL
families all over the Punjab. So far, 1.07 lakh smart cards have been issued. In order to
make the scheme more effective in its implementation that it reaches the masses,
facilitation to refer patient to Govt./Pvt./Institution for Hospitalization under RSBY (BPL
Families) may be done by the ASHA. She may be paid Rs 10/- per case referred.

III    Strengthening Support System for the Operationalization of ASHA in effective mode.

As per the guidelines of GoI for State having ASHAs less than 20000, there is a need of
Project Manager and Statistical Assistant at State Level and Community Mobilizer and one
Data Assistant in each District as a support mechanism to strengthen the capacities viz a viz
performance of ASHAs, their better linkages with health department, and readdressal of
grief mechanism, streamlining of timely payment, their monitoring, drug kit replenishment
etc.

IV                 I-
       Uniform and I-Card for ASHA

Uniform / I-card creates an identity for the service providers/community level workers
working in the field. It facilitates their better recognition with both community and the
Health Department. This has an overall impact on their motivation and their recognition
amongst various stakeholders and reflects visibility of the programme. This will enhance



                                                                               212
ASHAs self esteem as a health facilitator in the field while people will be benefitted through
better identification of Community Worker-ASHA.

It is expected that uniform and I-card will create better identity and further motivate the
ASHAs for their better performance in the field. A provision has been kept for the uniform
in the form of Apron and the I-Card for the ASHAs.



                      ACCREDITED SOCIAL HEALTH ACTIVISTS (ASHA)

 Rationale      17229 ASHAs have been selected till date and have been trained in 1st
                Module. Total nearly 17360 ASHAs are to be selected. Their 2nd, 3rd and
                4th module training is being taken during 2009-10. The Vth module
                training of ASHA along with refresher training of ASHAs is to be
                undertaken in 2010-11.

                In the State, already trained ASHAs are currently doing their job and they
                have facilitated institutional deliveries, assisted JSY beneficiaries,
                motivating men and women for sterilization and immunization of
                children. They are also motivating people for household toilets in the
                villages.

                 There is a need to establish and institutionalize the supportive
                supervision forums for ASHA activity at various levels.

 Objectives     ♦ Create awareness on health and its social determinants.
                ♦ Mobilize the community towards local health planning, generating
                   demand among the community.
                ♦ Increase utilization and accountability of the existing health services.
                ♦ Provide a minimum package of curative care as appropriate and
                   feasible for that level.
                ♦ Undertaking timely referrals.
                ♦ Mechanism for the supportive supervision of ASHA.
                ♦ To ascertain the activities undertaken by the ASHA in the field.

                                                                               213
           ♦ Build regular Interface with the health system.
           ♦ Regular capacity building of ASHA for addressing health issues.
           ♦ Addressing issues like grievance redressal, streamline payment, drug
             replenishment.
           ♦ Better recognition from community and health Institution.
Strategy   ♦ All the ASHAs to be trained in the modules developed by GoI.
           ♦ Vth Module to be taken up during the year besides regular refresher
             training of ASHA.
           ♦ Appointment of Project Manager (ASHA) at State level and Community
             Mobilizer at District level to oversee the effective functioning of ASHA
             Scheme in the State.
           ♦ Review of ASHA activity to be planned at various levels. Monthly
             meeting to be planned at PHC level under the supervision of LHV.
           ♦ ASHA Mentoring Group to be set up.
           ♦ Procurement of 2860 ASHA drug kits and replenishment of 14500
             ASHA drug kits.
           ♦ Performance based incentives to ASHA. Ensuring timely payment of
             incentives to ASHA on the basis of her performance.
           ♦ Provision of uniform/I-Card for ASHAs.




                                                                       214
                                 ACCREDIATED SOCIAL HEALTH ACTIVISTS (ASHA)

                                    B NRHM Additionalities
 SN                                                                                                   Remarks
                      Activity                Q1        Q2       Q3       Q4      Rs in Lakhs
 B       ASHA
B1.1     Selection and Training of ASHA

         Training   and     Refresher
B1.1.1   Training of ASHA (17360             104.16   104.16    104.16   104.16     416.64
         ASHAs @ Rs 2400/- per ASHA)

         DA to ASHA for Monthly
B1.1.2   Meeting at PHC level (17360         52.08     52.08    52.08    52.08      208.32
         ASHAs @ Rs 1200/- per ASHA)

B1.1.3   ASHA Uniform and ID card            52.08      0.00     0.00     0.00      52.08

B1.2     Drug Kit

         Replenishment of ASHA Drug
B1.2.1   Kit for 14500 ASHAs @ Rs            65.25      0.00     0.00     0.00      65.25
         450/- per ASHA

         New Drug Kit for 2860 ASHAs
B1.2.2                                       17.16      0.00     0.00     0.00      17.16
         @ Rs 600/- per ASHA

         Performance               Related                                                        Revised as per
B1.3                                         155.00   155.00    155.00   155.00     620.00
                                                                                    620.00
         Incentives to ASHAs                                                                     comments. Details
                                                                                                 attached
B1.4     Support Mechanism for ASHA          23.97     23.97    23.97    23.97      95.86

                    Total Budget             469.70    335.21   335.21   335.21    1475.31




                                                                                                215
                                   SUB-
                                   SUB-DETAIL OF THE ACTIVITIES

  SN                     Activity Item                   Unit of     Baseline     Rate      Amount(Rs   in
                                                         Measure                (Rs./uni    Lakh)
                                                                                   t)
6        ASHA
6.1      Capacity Building of ASHA

6.1.1.   Training ,and refresher trainings of ASHA     per ASHA      17360      2400        416.64


6.1.2.   DA to ASHA for monthly meeting at PHC per ASHA              17360      1200        208.32
         during the year

6.1.3.   ASHA Uniform and I-card                       Per ASHA      17360      300         52.08
6.2      Drug Kit                                                                           0
6.2.1    Replenishment of ASHA Drug Kit                per ASHA      14500      450         65.25

6.2.2    New Drug Kit                                  per ASHA      2860       600         17.16


  SN                     Activity Item                   Unit of     Baseline     Rate      Amount(Rs   in
                                                         Measure                (Rs./uni    Lakh)
                                                                                   t)
6.3      Performance related incentives to ASHAs       As per performance

6.3.1.   Early registration of Pregnant women in first per case         100     200.00 To address MMR
         trimester                                                                     which           has
                                                                                       increased to 192
                                                                                       as per latest SRS

6.3.2    Motivation for complete ANC and ensuring per case              100     106.00 To address MMR
         Institutional Deliveries at Govt. /Accredited                                 and increase in
         Pvt. Institution in their population for all                                  institutional
         categories of women.                                                          deliveries which
                                                                                       though        has
                                                                                       improved to 63%
                                                                                       (as per DLHS-3)
                                                                                       but need to be
                                                                                       addressed to meet
                                                                                       millennium goals
                                                                                       of 80% by 2012




                                                                                      216
  SN                      Activity Item                  Unit of   Baseline     Rate    Amount(Rs        in
                                                         Measure              (Rs./uni Lakh)
                                                                                 t)
6.3.3.   To ensure that pregnant women consume 100 per case           50       53.00 As per DLHS-
         IFA tablets                                                                   3(2007-2008),
                                                                                       mothers         who
                                                                                       consumed IFA for
                                                                                       90 days or more
                                                                                       when they were
                                                                                       pregnant        with
                                                                                       their last child (%)
                                                                                       is 33.5%

6.3.4.   To ensure three post natal visits             per case       50       53.00    To early detection
                                                                                        of danger signs in
                                                                                        the mother and the
                                                                                        baby,            and
                                                                                        subsequent
                                                                                        referral. As nearly
                                                                                        two-thirds of the
                                                                                        early       neonatal
                                                                                        deaths       (deaths
                                                                                        within first week
                                                                                        of    life)    occur
                                                                                        within the first 48
                                                                                        hours, a huge
                                                                                        opportunity       to
                                                                                        reduce NMR is
                                                                                        lost.

6.3.5.   To counsel for breastfeeding with in one hour per case       25       62.50    As per DLHS-
         of birth and exclusive breastfeeding                                           3(2007-2008),
                                                                                        early and exclusive
                                                                                        breastfeeding     is
                                                                                        one of the grey
                                                                                        area that needs to
                                                                                        be addressed to
                                                                                        reduce         IMR,
                                                                                        especially neonatal
                                                                                        mortality .

6.3.6.   Birth & Death Registration




                                                                                  217
  SN                      Activity Item                  Unit of   Baseline     Rate     Amount(Rs        in
                                                         Measure              (Rs./uni   Lakh)
                                                                                 t)
         Reporting of death of mother or infant within per case      100        20.00    It is necessary to
         10 days                                                                         identify         the
                                                                                         underlined causes
                                                                                         of maternal death
                                                                                         and infant death
                                                                                         and      to    take
                                                                                         preventive
                                                                                         measures through
                                                                                         investigating each
                                                                                         and every cause of
                                                                                         maternal        and
                                                                                         infant death .As a
                                                                                         first    step     to
                                                                                         ensure reporting
                                                                                         of maternal/infant
                                                                                         death     incentive
                                                                                         has been devised
                                                                                         for ASHA.

         100% birth registration and issue of birth per ASHA       100 x 4     700.00     As per NFHS-3,
         certificate in their area.                                                      for     the    birth
                                                                                         registration      of
                                                                                         children      under
                                                                                         five years it has
                                                                                         been seen that of
                                                                                         the total 76.3%
                                                                                         registered, 52.3%
                                                                                         had            birth
                                                                                         certificate     and
                                                                                         24.0%       did not
                                                                                         had            birth
                                                                                         certificate. Effort
                                                                                         is made to ensure
                                                                                         100%           birth
                                                                                         registration

6.3.7.   Facilitate to conduct regular

         VHSC meeting once in 3 months                 per ASHA    100 x 4     70.50     To be met from
                                                                                         VHSC Funds



                                                                                  218
  SN                      Activity Item                    Unit of       Baseline     Rate     Amount(Rs       in
                                                           Measure                  (Rs./uni   Lakh)
                                                                                       t)
6.3.8.   To complete village health register            per ASHA         Rs 500       87.50    To be met from
                                                                                               VHSC funds

6.3.9.   Refer patient to Govt./ Pvt. / Institution for per        BPL    Rs 10      50.00     In order to make
         hospitalization under RSBY (BPL Families)      families                               the scheme more
                                                                                               effective in its
                                                                                               implementation
                                                                                               that it reaches the
                                                                                               masses providing
                                                                                               health insurance
                                                                                               cover upto Rs
                                                                                               30000/- to BPL
                                                                                               families

                                Total Funds for Performance based ASHA Incentive     615.00




                                                                                        219
                       Village Health and Sanitation Committees (VHSC)
Objective: To make the VHSCs fully functional

Issues/ Problems              ♦ VHSCs have been constituted in the State and representatives of
                                  VHSCs were oriented on NRHM in collaboration with State
                                  Institute of Rural Development, Nabha
                              ♦ Integration and their role at the grassroots level are very crucial
                                  for health delivery system.
Strategies                    Activities

Strengthening      capacity ♦ The notification for the constitution of the Village Health and
of VHSCs to enable them           Sanitation Committees (VHSC) was issued on October 21, 2007.
to    discharge       their       Later on these guidelines has been revised on December 22,
responsibilities leading          2008 to make these confirmation to Village Health Planning and
to   a    better    health        Monitoring Committees
outcome                       ♦ 13005 Village Health and Sanitation Committees (VHSC) have
                                  been constituted till now. State NRHM Mission will prepare a
                                  guideline on the role of the VHSC in local language and
                                  disseminate to all VHSC. However, the VHSC are expected to do
                                  the following activities in their villages:
                              ♦ Provide funds to @ Rs 10,000 per VHSC to undertake various
                                  activities like the IEC, household survey, preparation of health
                                  register, organization of meetings at the village level
Benchmarks                    ♦

Support                       Support from the PRIs and the community




                                                                                   220
These committees have already been constituted vide notification dated 21/10/2007. This
committee will have both Planning/ Monitoring and Financial functions. Its Composition,
Activity and Powers are described in the following paragraph

1.      Constitution

 1.     Sarpanch/Member Gram Panchayat                                 Chairperson

 2.     Representative from Women Self Help Group                       Member

 3.     Representative from PRIs (SC/ST)                                Member

 4.     Representative from Weaker Sections of the Society              Member

 5.     Representative from Ex-Serviceman                               Member

 6.     Retired Teacher / PTA Secretary                                 Member

 7.     Representative from any NGO                                     Member

 8.     ANM (AWW/ASHA in non-Sub-Center Village)                        Convener

 9.     MPHW                                                            Member

 10. Anganwari Worker                                                   Member

 11. ASHA                                                               Member

             These committees will be constituted by District Health Society in a
democratic and transparent manner. Efforts are to be made to enroll dynamic people as
members. In this regard, decision of District Health Society will be final.

Note:

(i)     There shall be one VHSC for every inhabited Revenue Village.

(ii)    The selection of members of the VHSC shall be made by District Health Society by
        involving the District Health authorities, Rural Development & Panchayat
        Department and Block level Health Committees. The members shall be selected in
        an open Gram Sabha Meeting, which will be held after giving atleast 15 days notice
        regarding time and place of meeting shall be given. Thorough consensus will be
        generally encouraged but nomination by any authority shall not be permissible.



                                                                               221
(iii)   Committees may be constituted in such a way that women get atleast 50%
        representation.
(iv)    Every hamlet within the area of the VHSC shall be given due presentation on the
        VHSC to ensure that the needs of the weaker section especially Scheduled Castes,
        Scheduled Tribes, Other Backward Classes are fully reflected in the activities of the
        committee.
(v)     Representative to women’s Self Help Groups etc on the VHSC shall be encouraged to
        enable the Committee to undertake women’s health activities more effectively.
(vi)    For deciding important matters, quorum shall be of 1/3rd members, in the event of a
        tie, the Chairman of the Committee shall have the right to casting vote.
(vii)   If there is any vacancy, it shall be filled up promptly as per procedure in (ii) above.

2.      Activities

(1)     Awareness: Create Public Awareness about the essentials of health programmes,
        with focus on People’s knowledge of entitlements to enable their involvement in the
        monitoring.
(2)     Preparing Village Health Plan
(3)     Analyze key issues and problems related to village level health and nutrition
        activities, give feedback on these to relevant functionaries and officials. Present an
        annual health report of the village in the Gram Sabha.
(4)     Participatory Rapid Assessment
(5)     Village Health Register: Maintenance of a village health register and health
        information board/calendar:  :
(6)     Supervisions of work of ANMs/ MPHWs:
(7)     Get a bi-monthly health delivery report from health service providers during their
        visit to the village. Discuss the report submitted by ANM and MPW and take
        appropriate action.
(8)     Take into consideration of the problems of the community and the health and
        nutrition care providers and suggest mechanisms to solve it.
(9)     Audit of Deaths: Discuss every maternal death or neonatal death that occurs in
        their village, analyze it and suggest necessary action to prevent such deaths. Get
        these deaths registered in the Panchayat.
(10)    The Block Level Panchayat Samiti will review the functioning and progress of
        activities undertaken by the VHSC.
(11)    Managing the village health fund.



                                                                                222
3.    Powers of the Committee

(1)     The Chairperson will sign the attendance registers of the AWWs, Mid-Day meal
        Sanchalaks, MPWs, and ANMs.
(2)     MPWs and ANMs will submit a bi-monthly village report to the committee along
        with the plan for next two months. Format and contents of the bi-monthly reports
        would be decided by village health committee.
(3)     Member Secretary will maintain a register where complete details of activities
        undertaken, expenditure incurred etc. will be maintained for public scrutiny. Thus
        shall be periodically reviewed by the Chairperson.
(4)     The committee will receive funds of Rs.10,000 per year. This fund may be used as
        per the discretion of the VHSC
                Fund
Village Health Fund -Every such committee duly constituted would be entitled to an annual
untied grant of Rs. 10,000/-.

(1)   The untied grant is a resource for community action at the local level and shall only be used
      for community activities that involve and benefit more than one household.
(2)   The untied grant shall be preferentially used for areas concerning Public Health, Nutrition,
      Education & Sanitation, and Environmental Protection.
(3)   Some of the common activities for which funds are already put into use are village level
      cleanliness drive, sanitation drive, school health activities, ICDS/Anganwadi level
(4)   Health awareness activities or improvements of amenities in anganwadi, the conduct of
      household surveys, source reduction measures for vector control, the building of transport
      communication links that could be used to summon/ access emergency ambulance services,
      publication of IEC material or notices, etc.
Exceptions to the guidelines that the fund shall be used only for activities that benefit a
group and not a single household are:

(1)   When it is used as a revolving fund from which households could draw in times of need to
      be returned in installments thereafter.
(2)   In extraordinary case of a destitute women or very poor or marginalized household or
      individual, where the Village Health & Sanitation Committee discusses and decides to make
      an exception .Every village is free to contribute additional grant towards the Village Health
      & Sanitation Committee.




                                                                                   223
(3)    In village where the community contributes financial resources to the Village Health &
       Sanitation Committee untied grant of Rs. 10,000/-, additional incentive and financial
       assistance to the village could be explored.
(4)    The intention of this untied grant is to enable local action and to ensure that Public Health
       activities at the village level receive priority attention.
                      Account-
Maintenance of Bank Account- The Village Health & Sanitation Committee fund shall be
credited to a bank account, which will be operated with the joint signature of Convener of
the VHSC alongwith the Chairman of Village Health & Sanitation Committee. The account
maintenance of this joint account shall be the responsibility of the Village Health &
Sanitation Committee especially the Convener of the Committee. She shall maintain a
register of funds received and expenditure incurred. The register shall be available for
public scrutiny and shall be inspected from time to time by the ANM/MPW/Gram
Panchayat or any other authority as notified.

4.     Meeting of Committee -

The VHSC shall meet at least once in a month and Convener shall keep a note of
proceedings of all the meetings in a separate register.

If any stage, VHSC is found to be acting not up to the mark, a report shall be sought by the
District Health Society which by acting through Member Secretary of VHSC and looking into
the facts, may dissolve VHSC and order re-selection within three months. In extreme cases,
when VHSC does not exist, the Member Secretary of VHSC shall perform the duties &
functions of the VHSC.




                                                                                    224
                  PROVISION OF UNTIED FUNDS TO HEALTH INSTITUTIONS


Objective:
Objective: To enable local action by health facilities to improve quality of service.

Issues / Problems              Provision of Tied Funds doesn’t allow health institutions to
                           meet local needs. Tied Funds inhibit innovation to improve
                           quality of health. Hence, Untied Funds to be provided to enable
                           local initiatives.
Strategies                 Activities

Providing flexi-fund to ♦ Provide flexi-funds @ Rs 10,000 to 2950 SCs & 13298 VHSCs,
the health institutions       Rs. 25,000 to 445 PHCs and Rs 50,000 to 129 CHCs per annum
and              involve      to innovate local actions to increase access and quality of care.
community              in ♦ Strengthen PRI role in the management of the funds at SC and
management of funds           PHC level.
to               increase ♦ Training of key staff of SC, PHC and CHC in record maintenance
accountability                and account keeping to ensure accountability.
Benchmarks                     All VHSCs, SCs, PHCs and CHCs provided Untied Funds and
                              they initiate local action in consultation with the community to
                              address local needs.
Support                    ♦ Timely availability of Untied Funds to enable health
                              functionaries to initiate local action.
                           ♦ Support from PRIs and members of the RKS to enable an early
                              and transparent decision making.




                                                                                  225
                                 BUDGET FOR UNTIED FUNDS

                          B NRHM Additionalities
SN                                                                                Remarks
                                                                  Rs in
               Activity              Q1       Q2    Q3     Q4
                                                                  Lakhs
                                                                  Lakhs
B2     Untied Funds
       Untied Funds for 129
B2.1   CHCs @ Rs. 50,000 per        64.50    0.00   0.00   0.00    64.50
       annum
       Untied Funds to 445
       PHCs including Rural
B2.2   Hospitals and Satellite      111.25   0.00   0.00   0.00   111.25
       Hospitals @ Rs. 25,000
       per annum
       Untied Funds to 2950
B2.3   SCs @ Rs. 10,000 per         295.00   0.00   0.00   0.00   295.00
       annum
       Provision of Untied
       Funds to 13298 VHSCs
B2.4                               1329.80   0.00   0.00   0.00   1329.80
       @ Rs. 10,000 per VHSC
       per annum
             Total Budget          1800.55   0.00   0.00   0.00   1800.55




                                                                            226
                           UP-GRADATION
                           UP-GRADATION OF DISTRICT HOSPITALS

Objective: To upgrade District Headquarter Hospitals (DHH) to provide specialist care.

Issues/ Problems               The State has a requirement for 3 new District hospitals, in view
                           of 3 new Districts. In these three Districts, given the anticipated
                           additional influx of population, it was proposed to convert existing
                           SDH into 100 bedded hospitals. Work has been started in 5 District
                           hospitals (District hospital Gurdaspur, MKH Patiala, District hospital
                           Mohali, District hospital Ludhiana, District hospital Bathinda).
Strategies            Activities
Upgrade DH to provide ♦ Major repair and renovation of 5 DHs. (District Hospital Mohali,
specialist care              Mata Kaushalaya Hospital Patiala, District Hospital Ludhiana,
                             District Hospital Bathinda and District Hospital Gurdaspur). Work
                             has been started. Partial provision has been made in current year.
                           ♦ One Gynaecologist for all the 21 DHs.
                           ♦ Drugs will be provided to all the DHs.
                           ♦ Equipped with adequate equipment and furniture.
Operationalization    of In the State out of 60% institutional deliveries 13-15 % are taking
Modern Maternity and place in government institutes. State has strengthen CHCs and PHCs
Children    Wards    and for CEmOC and 24x7 services but these have not been fully functional
Units in all the District due to lack of manpower especially Gynaecologists and Female Medical
Hospitals                  Officers. State has good road and transport infrastructure so each
                           and every area is accessible. Manpower availability at DH is
                           sufficient. Keeping this in view to improve the service delivery for
                           Maternal and Child Health Services state propose to operationalise
                           modern maternity and children wards and units in all the District
                           Hospitals. Under this Civil work to improve/ repair facilities like LR/
                           MW/ OT/ Toilet, need based supplies, support, equipments, etc will be
                           provided.New born care corners will be strengthened.

Benchmarks                 ♦ Completion of major repair and renovation of 5 DHs.


                                                                                  227
                                  ♦ Completion of up-gradation of 2 DHs.
Support                           ♦ Timely availability of funds.
                                  ♦ Availability of agency to undertake construction.


                          BUDGET FOR UP GRADATION OF DISTRICT HOSPITALS

                                      B NRHM Additionalities
  SN                                                                                                  Remarks
                       Activity                 Q1         Q2        Q3       Q4      Rs in Lakhs
  B3       Infrastructure Related Matter
B3.1.1     Upgrading District Hospitals
           Major Repair & Renovation of
B3.1.1.1   the DHs - Activity in progress      250.00    250.00     250.00   250.00    1000.00
           from 08-09
                                                                                                    Rs. 252 lakh
           Drugs @ Rs. 12 lakh for 21 DH
B3.1.1.2                                        0.00      0.00       0.00     0.00                  shifted to RCH
           per annum
                                                                                                    flexipool
           Equipment/Furniture for 21 DH
B3.1.1.3                                        0.00      0.00      105.00    0.00      105.00
           @ Rs 5 lakh
           Diaylsis Units at 14 DHs
           14 Machine Units comparising 2
B3.1.1.4   machines and RO Plant @ Rs.          0.00     224.00      0.00     0.00      224.00
           16.00 Lakh

           Construction of new area for
           Diaylsis Machine at Ropar,
B3.1.1.5   Mansa, Ludhiana, Ferozepur,          0.00     48.00       0.00     0.00      48.00
           Tarn Taran and Nawanshahar @
           Rs. 8.00 Lakh each
           Augmentation of         Maternity
B3.1.1.6                                        0.00    1000.00      0.00     0.00     1000.00
           Wards in DHs

           Dental Chair for all DHs @ Rs.
B3.1.1.7                                       103.40                                   103.40
           5.17 lakh
B3.1.1.8   RVG for 20 DHs @ Rs. 3.60 lakh       0.00                                                Not approved
           Total Budget                        353.40   1522.00     355.00   250.00    2480.40




                                                                                          228
                               UP-
                               UP-GRADATION OF CHCs TO IPHS

Objective: To upgrade CHCs to IPHS

Issues/ Problems        There are 129 CHCs in the State. This is to ensure that all CHCs provide
                        specialist care to the clients. There is a shortage of specialist doctors
                        like Gynaecologist, Paediatricians & Anaesthetists.
Strategies              Activities

Upgrading    CHCs   to ♦ Construction of new building at CHC Lambi & CHC Apra as the
standards prescribed       existing building is in very bad condition. At the time of World Bank
by NRHM                    Project, CHC Lambi was not taken up for up gradation.
                        ♦ Equip all the CHCs to ensure that quality and adequate equipment
                           and furniture are available.
                        ♦ Requisite human resources to be engaged.
                        ♦ Drugs for all the CHCs.
Benchmarks              ♦ Construction of new building for 2 CHCs.
                        ♦ All CHCs equipped to IPHS.
                        ♦ Contingency and support made available to enable CHCs to provide
                           quality service.
Support                 • Timely availability of funds.
                        • Availability of an agency to undertake construction.




                                                                                 229
                      BUDGET FOR UP GRADATION OF CHCs TO IPHS

                              B NRHM Additionalities
  SN                                                                                Remarks
                                                                     Rs in
                   Activity              Q1     Q2     Q3     Q4
                                                                     Lakhs
         Upgrading of CHCs to
B3.1.2
         IPHS
         Construction of New
B3.1.2.1 building of CHC Lambi         450.00 0.00     0.00   0.00   450.00
         & Apra
                                                                                Rs. 387
           Drugs @ Rs. 3 lakh for                                               lakh shifted
B3.1.2.2                                0.00    0.00   0.00   0.00    0.00
           129 CHC per annum                                                    to RCH
                                                                                flexipool
         Equipment and
B3.1.2.3 Furniture @ Rs 1 lakh          0.00    0.00 129.00   0.00   129.00
         for 129 CHCs
         Dental Chair for 44
B3.1.2.4                               209.88                        209.88
         CHCs @ Rs. 4.77 lakh
                Total Budget           659.88   0.00 129.00   0.00   788.88




                                                                              230
                           UP-
                           UP-GRADATION OF PHCs FOR 24 HRS. SERVICES

Objective: To upgrade PHCs to provide 24 x 7 services

Issues/            PHCs are a crucial link in the chain of health facilities. Many PHCs are proposed to
Problems           be 24 x 7 facilities to provide round the clock service. This is to ensure that these
                   institutions facilitate institutional deliveries and provide emergency care. The
                   upgradation is proposed based on IPHS norms.
Strategies     Activities
Upgrading PHCs ♦ As mentioned for the SCs, the construction of the new buildings requires a higher
to    standards       rate than the one prescribed in NRHM. From the perspective of feasibility and to
prescribed    by      ensure that quality construction is undertaken, the norm for construction is fixed at
NRHM                  Rs 1000 per Sq. ft.
                   ♦ Up-gradation of 97 PHCs is required; out of which 47 were taken up in 2009-10 & 50
                      PHCs are proposed to be taken in the current year 2010-11.
                   ♦ There are 445 PHCs & Rural hospitals in the State, out of which 180 have already
                      been taken up. 265 PHCs are yet to be taken up for up-gradation. Most of these PHCs
                      are in dilapidated condition, so more funds are required for the up-gradation of
                      these PHCs. State has proposed to take up all the 39 PHCs / RHs in high focused
                      districts for up-gradation in the F/Y 2010-11.
                   ♦ Construction of one new PHC at Bhaini Sahib has also been proposed.
                   ♦ Construction of new building of PHC Purkhali has been proposed.
                   ♦ Equipment & furniture will be provided to remaining 39 PHCs / RHs.
                   ♦ Equipment & furniture has already been provided to 180 PHCs in the preceding
                      years.
                   ♦ Drugs will be provided to all the PHCs including Rural hospitals & Satellite hospitals.
                   ♦ One Medical Officer for 50 PHCs, where there is no doctor.
                   ♦ Incentive to Doctors working in the extremely remote area.
Benchmarks         ♦ Up-gradation of 50 PHCs which are slightly in better condition.
                   ♦ Up-gradation of 39 PHCs & Rural hospitals which are in dilapidated condition.
Support
                   • Timely availability of financial support


                                                                                        231
             • Availability of agency to undertake construction
                         UP-
              BUDGET FOR UP-GRADATION OF PHCs FOR 24 HRS. SERVICES

                            B NRHM Additionalities
  SN                                                                             Remarks
                                                                       Rs in
                 Activity           Q1      Q2        Q3          Q4
                                                                       Lakhs
           Upgrading
           Upgrading PHCs for 24
B3.1.3
           hr Services, IPHS
           Construction of one
B3.1.3.1   new PHC at Bhani         0.00  61.00   0.00   0.00   61.00
           Sahib
           Construction of New
B3.1.3.2   building of PHC          0.00  61.00   0.00   0.00   61.00
           Purkhali
           Upgradation of 97
           PHCs for 24x7
           delivery services 47
B3.1.3.3   taken in 2009-10 and 187.50 187.50 187.50 187.50 750.00
           50 PHC @ Rs. 15.00
           lakh per PHC for the
           year 2010-11
           Upgradation of
           remaining all the 39
           PHCs/RHs in 4 high
B3.1.3.4   focused districts for   224.25 224.25 224.25 224.25 897.00
           24x7 delivery services
           @ Rs.23.00 lakh per
           PHC/RH/SH
           Equipment and
           Furniture for 39 PHCs
           including Rural
B3.1.3.5                            0.00   0.00  58.50   0.00   58.50
           Hospitals and Satellite
           Hospitals @ Rs.
           1,50,000 per PHC
           Drugs @ Rs. 1.25 lakh
           per PHC per annum                                                    Rs. 556.25
           for 445, 24x7 PHCs                                                   lakh shifted
B3.1.3.6                            0.00   0.00   0.00   0.00
           including Rural                                                      to      RCH
           Hospitals and Satellite                                              flexipool
           Hospitals
                Total Budget       411.75 533.75 470.25 411.75 1827.50




                                                                          232
   UP-
   UP-GRADATION OF SUB CENTERS

                 Each facility is defined by the set of services it provides. The key objective of
   the IPHS under NRHM is to ensure optimum quality health care in an environment that is
   sensitive and responsive to the needs of the client. Standards have been prescribed to
   enable this. The Facility Survey is the basis for enabling the graduation of the facilities to
   the prescribed standards. The Facility Survey has been undertaken and based on it, the up-
   gradation is proposed for the year 2008-09 to 2011-12.

Objective: To upgrade SCs to IPHS

Issues/ Problems           SCs are the first interface point for public health system. Standards
                        have been prescribed to ensure that the SCs provide quality service. Based
                        on the Facility Survey, the up-gradation of SCs is proposed for ensuring
                        quality service.
Strategies              Activities

Upgrading     health ♦ As per annual plan of 2008-09 & 2009-10, 180 new SCs are being taken
facilities         to      up for construction in place of such SCs, which are in dilapidated
standards                  condition & are not fit for repair during the year 2009-10, work may
prescribed         by      continue till 2010-11. This construction will be facilitated under
NRHM                       Mission Flexi pool.
                        ♦ 353 new SCs based on population/facility and IPHS norms. The
                           construction of these facilities would be taken up in 2011-12.
                        ♦ About 823 SCs need substantial restoration out of that 227 have been
                           taken up for repair & renovation in the F/Y 2008-09 & 2009-10. Work
                           in progress in 50 SCs & work may continue in remaining 177 SCs during
                           2010-11.
                        ♦ One additional ANM in all the 457 SCs for high focus Districts. Total
                           1411 2nd ANMs are proposed, out of which 954 2nd ANMs appointed in
                           2008-09 & 457 more 2nd ANMs are proposed to be appointed in this
                           year.


                                                                                   233
                    ♦ Conveyance Allowance to ANM @ Rs. 200/- PM to 1411 2nd ANMs.
                    ♦ Provision for sitting arrangement for ANMs in the Non Sub Centre
                      Villages
Benchmarks          • Provision made for appointment of 457 new ANMs as 2nd ANMs.

Support             • Timely availability of financial support.
                    • Availability of agency to undertake construction & repair.

                                 UP-
                      BUDGET FOR UP-GRADATION OF SUB CENTERS


                             B NRHM Additionalities
    SN                                                                               Remarks
                                                                       Rs in
                Activity             Q1       Q2      Q3          Q4
                                                                       Lakhs
        Salary @ Rs. 6900/-                                        Salary
        for      ANM.      One                                     Revised
  B14.2 additional ANM in the                                      from     Rs.
                               292.08 292.08 292.08 292.08 1168.31
        1411 SCs including all                                     6900 to Rs.
        SCs of high focus                                          7100 per
        Districts                                                  month
        Incentive to Doctors
  B14.5 working      in    the
                                0.00   0.00   0.00   0.00
                                                                   Not
                                                            0.00
        extremely       remote                                     approved
        areas
                                                                   As      per
                                                                   Comments
        Travelling allowance
  B14.5 to 1411 ANMs @ Rs. 8.47                                    of    NPCC
                                       8.47   8.47   8.47   33.86
                                                                   not
        200.00 P.M
                                                                   permissibe
                                                                   so deleted
        One Gynaecologist @
  B14.6 Rs. 35,000/- PM for 10 10.50 10.50 10.50 10.50
                                                            42.00
        DH
              Total Budget         311.04 311.04 311.04 311.04 1244.17
          Provision for sitting                                                     As per
                                                                                   Comments
          arrangement for ANMs
                                                                                   of NPCC not
          in the Non Sub Centre                                                    permissible
                                                                                   permissible
          Villages                                                                 so deleted




                                                                               234
                                  UP GRADATION OF SDHs / FRUs

Objective: To upgrade SDH to provide specialist care

Issues/ Problems               There are 36 SDHs in the State. The State has no Sub Divisional
                          hospital in Moonak, Lehragaga, Tappa & Bolath sub-divisions in Districts
                          Sangrur, Barnala and Kapurthala Districts. Sub-Divisional hospital, Abohar
                          is in very bad condition, needs a new building.

Strategies                Activities

Upgrade      SDH      to ♦ Major repair and renovation of 4 Sub-divisional hospitals in progress,
provide                      partial budget is proposed in the current year.
                          ♦ Construction of new building for Sub-divisional hospital, Abohar.
                          ♦ Up gradation of SDH Khanna.
                          ♦ All the Sub-divisional hospitals will be equipped with adequate,
                             equipment and furniture.
                          ♦ All the Sub-divisional hospitals will provided with adequate drugs.
Benchmarks                ♦ Completion of repair & renovation in 4 SDHs.
                          ♦ Construction of new building for Sub-divisional hospital, Abohar.
Support                   ♦ Availability of timely funds.
                          ♦ Availability of agency to undertake construction.




                                                                                 235
                                  UP-
                       BUDGET FOR UP-GRADATION OF SDH/FRUs

                           B NRHM Additionalities
 SN                                                                          Remarks
                                                                  Rs in
                Activity           Q1       Q2      Q3     Q4
                                                                  Lakhs
         Upgrading Sub
B3.2     Divisional Hospitals/
         FRUs
         Major      Repair     &
B3.2.1   Renovation of the 4 150.00 150.00 150.00 150.00          600.00
         SDHs
         Construction of SDH
B3.2.2                           131.25 131.25 131.25 131.25      525.00
         Abohar
         Upgradation of Sub
B3.2.3   Divisional     Hospital 0.00    0.00  47.21   0.00       47.21
         Khanna
         Upgradation of Sub
B3.2.4   Divisional     Hospital 0.00    0.00  12.00   0.00       12.00
         Jagraon
         Equipment           and
B3.2.5   Furniture @ Rs 3 lakh 108.00 0.00      0.00   0.00       108.00
         for 36 SDH
                                                                             Rs.    108
                                                                             lakh
         Drugs @ Rs.5 lakh for
B3.2.6                             0.00    0.00     0.00   0.00              shifted to
         36 SDH per annum
                                                                             RCH
                                                                             flexipool
         Dental Chair for 26
B3.2.7                        124.02                      124.02
         SDHs @ Rs. 4.77 lakh
              Total
              Total Budget    513.27 281.25 340.46 281.25 1416.23




                                                                       236
                               B NRHM Additionalities
  SN                                                                                     Remarks
                                                                          Rs in
                    Activity              Q1      Q2      Q3      Q4
                                                                          Lakhs
B3.1.5   Other Activities
         Computerization        of
         Selected
         CHCs/SDHs/DHs          in
B3.1.5.1 Phased            manner         0.00   200.00 0.00      0.00    200.00
         including        software
         migration      cost     &
         Hardware cost.

           Referral Ambulances
           for     FRUs      (41
                                          0.00    0.00    0.00 348.50     348.50
B3.1.5.2   Ambulances @ Rs. 8.50
           Lacs)

B3.1.5.3   2 Multimedia Buses on          0.00   0.00     0.00 0.00       0.00       Not
           Swaraj Mazada / force on                                                  approved
           pilot basis for 4 regions of
           Punjab - State of the art
           multimedia bus equipped
           with multimedia gadgets for
           awareness of health issues
           @ 1000000/- per bus
                                          0.00   200.00   0.00   348.50   548.50
                 Total Budget




                                                                                   237
                       PROVISION OF ANNUAL MAINTENANCE GRANT
Objective To provide Annual Maintenance Grant to health facilities to enable repair and
maintenance for provision of quality service.

Issues/Problems                Most health facilities suffer repair for want of regular
                          Maintenance Grant. This has an impact on quality of service and
                          subsequently on retaining client base. NRHM has made an annual
                          provision to enable the health facilities to be repaired on a
                          regular basis to ensure quality

Strategies                Activities

Providing         Annual ♦ Annual Grant of Rs 10,000 to 2871 Sub-Centres in Government
Maintenance Grant to        & Panchayat Building
enable regular repair ♦ Annual Grant of Rs 50,000 to 445 PHCs made to ensure regular
of health facilities        repair
                          ♦ Annual Grant of Rs.1,00,000 to 129 CHCs
Benchmarks                ♦ All health facilities regularly repaired and providing quality
                            service
Support                   ♦ Timely availability of funds.
                          ♦ Flexibility for local health facilities to undertake repairs using
                            local artisans




                                                                               238
                      BUDGET FOR ANNUAL MAINTENANCE GRANT

                          B NRHM Additionalities
SN                                                                              Remarks
                                                                 Rs in
               Activity              Q1      Q2    Q3     Q4
                                                                 Lakhs
       Annual Maintenance
B4
       Grant
       Annual Maintenance
B4.1   Grant to 129 CHCs @ Rs.     129.00   0.00   0.00   0.00   129.00
       100,000 per CHC
       Annual Maintenance
       Grant to 445 PHCs
B4.2   including Rural Hospitals   222.50   0.00   0.00   0.00   222.50
       and Satellite Hospitals @
       Rs. 50,000 Per annum
       Annual Maintenance
B4.3   Grant to 2871 SCs @ Rs.     287.10   0.00   0.00   0.00   287.10
       10,000 Per SC
              Total Budget         638.60   0.00   0.00   0.00   638.60




                                                                          239
                                     ROGI KALYAN SAMITIES

Objective To Strengthen Rogi Kalyan Samities to enable local management of health facilities
and ensure sustainability in the long run.
Issues/ Problems           ♦ At present Rogi Kalyan Samities are registered up to DH level. But
                              notified up to CHC level and Block Health Monitoring & Planning
                              committee & PHC Health Monitoring & Planning committee would
                              act as RKS, consist of PRI members, NGOs, local elected
                              representatives and officials from Government Sector, who are
                              responsible for proper functioning and management of hospitals.
                              RKS is tasked with the responsibility of generating and managing
                              the use of funds placed with it, to ensure quality and effective
                              provision of health services. The RKS is expected to:
                           1. Ensure compliance to standards and treatment protocols
                              prescribed by the Government.
                           2. Ensure accountability of the public health providers to the
                              community.
                           3. Introduce transparency with regard to management of funds.
                           4. Upgrade and modernize the health services provided by the
                              facility.
                           5. Supervise the implementation of National Health Programmes at
                              the facility.
                           6. Organize outreach services / health camps at facilities under the
                              jurisdiction of the health facility
                           7. Display a Citizens’ Charter in the Health facility.
                           8. Generate resources locally through donations, user fees and other
                              sources.
                           9. Undertake construction and expansion in the hospital building.
                           10. Ensure optimal use of hospital land as per govt. Guidelines.
                           11. Ensure skill building of the health personnel in the facility.
                           12. Ensure subsidized food, medicines and drinking water and


                                                                                    240
                               cleanliness to the patients and their attendants.
                            13. Contracting need based local personnel as per the budget.
                            14. Provide support and incentives to contracted Staff nurses, ASHA
                               and others, falling under CHC and PHC areas.
                            15. Ensure proper use, timely maintenance and repair of hospital
                               building equipment and machinery.
                            16. Recommend user fees systems, if required/ as appropriate.
                            However, RKS members need to be trained and their capacity built
                            to discharge their responsibilities. They may also need the services
                            of a public health manager / management specialist to implement
                            the activities.
Strategies                  Activities

♦      Building capacity ♦ A guideline on the role of the RKS has been prepared and shared by
of the RKS to strengthen       the health department.
the          management ♦ Training RKS members on planning, hospital management,
structure in a health          procurement and other skills has been taken up by State Institute of
facility for provision of      Rural Development Nabha.
quality health care and ♦ RKS to prepare a citizen’s charter and display prominently in each
ensuring a sustainable         health facility.
system of management ♦ PHC Health Monitoring and Planning Committees have been
in the long run.               constituted and these committees will also act as RKS.
Benchmarks                  ♦ To strengthen RKS.
                            ♦ All RKS hold annual meetings to present income and expenditure
                               for the year as a measure of transparency
Support                     ♦ Timely availability of funds




                                                                                    241
                            BUDGET FOR ROGI KALYAN SAMITIES

                           B NRHM Additionalities
SN                                                                               Remarks
                                                                  Rs in
                Activity              Q1      Q2     Q3     Q4
                                                                  Lakhs
B6     Rogi Kalyan Samiti
       RKS Grant to 21 DH @
B6.1                                105.00   0.00   0.00   0.00   105.00
       Rs. 5.00 lakh
       RKS Grant to 129 CHCs
B6.2                                129.00   0.00   0.00   0.00   129.00
       @ Rs. 1.00 lakh
       RKS Grant to 445 PHCs
       including Rural Hospitals
B6.3                                445.00   0.00   0.00   0.00   445.00
       and Satellite Hospitals @
       Rs. 1.00 lakh
       RKS Grant to 36 SDHs @
B6.4                                 36.00   0.00   0.00   0.00   36.00
       Rs 1 lakh
              Total Budget          715.00   0.00   0.00   0.00   715.00


                             BUDGET FOR DISTRICT ACTION PLAN

                           B NRHM Additionalities
SN                                                                               Remarks
                                                                  Rs in
                Activity              Q1     Q2     Q3     Q4
                                                                  Lakhs
B7              Action
       District Action Plans         0.00    0.00   0.00   0.00    0.00




                                                                           242
                                 MOBILE MEDICAL UNITS (MMU)

Objective To strengthen Mobile Medical Units.

Issues/ Problems                  Mobile Medical Units (MMU) was envisaged to ensure access to
                                 remote and difficult locations in the State, by taking quality
                                 health care to the people thus ensuring equity in access. MMU is
                                 also expected to be the visible face of the NRHM Mission.

Strategies                       Activities

Strengthen MMUs to provide ♦ Provide recurring cost for the functioning of the MMUs.
outreach services
Benchmarks                       ♦    All MMUs functional and reaching health services to remote
                                     locations.
Support                          ♦ Timely availability of funds & consumables.




                          BUDGET FOR MOBILE MEDICAL UNITS (MMUS)

                               B NRHM Additionalities
    SN                                                                                   Remarks
                                                                           Rs in
                    Activity             Q1       Q2      Q3       Q4
                                                                           Lakhs
   B11  Mobile Medical Unit
        Recurring cost @ Rs.
        20.00 lakhs per MMU
  B11.1                               120.00 120.00 120.00 120.00         480.00
        per annum for 24
        MMUs
             Total Budget             120.00 120.00 120.00 120.00         480.00




                                                                                   243
                                EMERGENCY RESPONSE SERVICES IN PUNJAB

The ERS would provide the emergency ambulance services equipped with medical facilities
and Emergency Medical Technician. Under the programme, a total 224 vehicles are to be
deployed in phased manner. Each vehicle will cater to approximately 1-1.25 Lakh
population with the radius of 20-25 Km. Out of these 56 vehicles (25%) will be Advanced
Life Saving Ambulances (ALSA) and rest 168 will be Basic Life Saving Ambulances (BLSA).
A toll free no ‘108’will be provided to access the services from landline phone as well as
cellular phones.

Emergency Response Centre equipped with IT infrastructure will be established. At ERC
Communication, Officer will answer a call and collect the specific information. Dispatch
officer assigns the vehicle and inform the police, medical fire as per need. Emergency
Response Centre Physician guide the ambulance staff as per feedback, condition of the
patient, and the patient will be taken to nearest centre as per the required treatment and
available facilities.

For the programme purposes State has been classified in 6 category towns and rural areas.
CLASS I       CLASS II             CLASS III                      CLASS IV                          CLASS V         CLASS VI
Abohar        Barnala      Ahmedgarh Mukerian      Adampur       Dhanaula      Majitha      Akalgarh    Jandiala    Bharoli
Amritsar      Faridkot     Bhagha     Nakodar      Ajnala        Dharamkot     Makhu        Alawalpur   Khamanon    Bhisiana
Batala        Fazilka      Budhlada Nangal         Amloh         Dhariwal      Moonak       Badhni      Kot         Daulatpur
Bathinda      Firozpur     Dasua      Nawanshahr   Amritsar      Dirba         Mullanpur    Bariwala    Lohian      Sansarpur
Hoshiarpur    Firozpur     Dhuri      Patran       Anandpur      Doraha        Nehon        Begowal     Maloud      Sham
Jalandhar     Gobindgarh   Dinanagar Patti         Balachaur     Fatehgarh     Nurmahal     Bhabat      Mullanpur   Shekhpura
Khanna        Gurdaspur    Giddarbaha Phillaur     Banga         Garhshankar   Rahon        Bhankharpur Payal
Ludhiana      Jagraon      Jaitu      Qadian       Banur         Goniana       Raja         Budha       Ramdas
Malerkotla    Kapurthala   Jalalabad Raikot        Bareta        Goraya        Raman        Cheema      Rurki
Moga          Kot          Jalandhar Rampura       Bassi         Guru          Rayya        Chohal      Sangat
Pathankot     Malout       Jandiala   Rupnagar     Bhadaur       Hussainpur    Sahnewal     Dera        Sri
Patiala       Mansa        Karoran    Samana       Bhawanigarh   Jugial        Samrala      Dhilwan
Phagwara      Muktsar      Kartarpur Sirhind       Bhikhi        Kalanaur      Sanaur       Gardhiwala
S.A.S.Nagar   Nabha        Kharar     Sujanpur     Bhikhiwind    Khanauri      Sardulgarh   Ghagga
              Rajpura      Kurali     Talwara      Bhogpur       Khemkaran     Shahkot      Ghanaur
              Sangrur      Longowal Urmar          Bhucho        Lehragaga     Sultanpur    Hajipur
              Sunam        Maur       Zira         Bhulath       Machhiwara    Talwandi     Handiaya
              Tarn-Taran   Morinda    Zirakpur     Dera          Mahilpur      Tapa         Hariana

Total Towns: 157

Total Population: 89 (2001 census)

Classification of Towns against population:

Class I - >1, 00,000; Class II -50,000-99,999; Class III - 20,000-49,999;

                                                                                                             244
Class IV - 10,000-19,999; Class V - 5,000-9,999; Class VI - <5,000)

Coverage plan will be: in the 1st phase i.e. year 2009-10 all the towns including the sub
urban areas and neighboring villages will be covered and the 2nd phase other rural areas
will be covered.

In the FY 2009-10, 72 LSAs will be deployed (44 LSA for class 1 towns and 30 LSA for class
II-VI) and in FY 2010-11,150 LSA will be deployed to cover other rural population.


             Capital                             Operational
                                                                           Total
Period       Expenditure                         Expenditure (95%)
             74 Ambulances
                                                 Salaries        2.16
             20 ALS @ Rs 17.53      3.16
                                                 Ambulance
             54 BLS @ Rs 11.53       6.22
Oct 09 –                                         Running Costs 0.56
             IT Infrastructure
 Mar 10                                          Direct Operations
             4.00      Temp ERC setup
                                                 Cost           2.56       20.97
             2.00
                                                  Total           5.28
                Total              15.69
             150 Ambulances
             36 ALS @ Rs. 17.53 lakhs
                                                 Salaries       10.96
             6.31
                                                 Ambulance
             114 BLS @ Rs. 11.53 Lakhs
Apr 10 –                                         Running Costs 5.38
             13.14
 Mar 11                                          Direct Operations
             Permanent ERC set up                                          48.36
                                                 Cost          6.41
             6.16
                                                  Total          22.75
             Total
             25.61
                                                 Recurring Cost 28.03
Total        Capital Cost Rs 41.31 Crore
                                                 Crore
                                                 Salaries       16.00
                                                 Ambulance
Apr 11 –     Equipment etc                       Running Costs 11.54
Mar 12       0.16                                Direct                    33.16
                                                 Operations Cost 5.45
                                                  Total        33.00
                                                 Salaries       18.10
                                                 Ambulance
Apr 12 –     Equipment etc                       Running Costs 5.43
Mar 13       1.72                                Direct                    41.18
                                                 Operations Cost 5.93
                                                  Total        39.46
TOTAL        43.19                               100.51                    143.70


                                                                             245
A total expenditure of Rs 143.70 Crore will be incurred.
The entire physical infrastructure, moveable and immovable assets and software from the
funds of GoP shall be property of GoP.

The above expenditure is 95% of the total cost which will be borne by the State. 5% of the
operational expenses would be met by the agency.

During the current F/Y, 1st phase will be taken up. Capital cost of 90 Ambulances (Phase 1)
& IT Infrastructure cost to be met out from the funds provided for ERS in the last year.
Recurring cost of 90 Ambulances (1.65 x 12 x 90 x 60%) under NRHM to be met out from
the funds provided for ERS in last year.




                                                                             246
                   BUDGET FOR EMERGENCY RESPONSE SERVICES

                           B NRHM Additionalities
 SN                                                                               Remarks
                                                                    Rs in
              Activity              Q1       Q2      Q3      Q4
                                                                    Lakhs
      Emergency Response
B12
      Services
      Capital cost of 90
      Ambulances (Phase 1)
      & IT Infrastructure cost
B12.1                          1491.80      0.00    0.00    0.00    1491.80
      to be met out from the
      funds provided for ERS
      in the last year.
      Recurring cost of 90
      Ambulances
      (1.20X6X90X60%)
B12.2 under NRHM to be met 97.20            97.20   97.20   97.20   388.80
      out from the funds
      provided for ERS in
      last year

            Total Budget           0.00     0.00    0.00    0.00     0.00




                                                                            247
                                    SCHOOL HEALTH PROGRAMME

Objective Enable inter-generational change by addressing school going children.

Issues/Problems                 ♦ To enable an inter-generational change, there is a need to address
                                  youth. Also there is a need to orient the youth on ill-effects of the
                                  habit-forming practices such as smoking, drinking and substance
                                  abuse. ASRH issues also need to be addressed for which Education
                                  dept. has to be involved actively.
Strategies                      Activities

♦         Addressing youth ♦ Orient all secondary school teachers on the ASRH and availability
and school going children         of health services in the public health facilities.
to improve the overall ♦ Undertake a joint campaign with the Education Department on
health outcomes in the            the ill-effects of habit forming practices.
State    by     enabling   an ♦ Encourage Education Department to promote co-production of
inter-generational                health by students through practices such as Yoga and Physical
change.       Also,   improve     exercises.
health        outcomes     to ♦ Use the opportunity of NSS camps in colleges to involve youth on
enable        adoption     of     health issues. Orientation of youth done during the camps and
healthy lifestyle.                they could be encouraged to undertake campaign on behalf of the
                                  health department.
                                ♦ Identify youth ambassadors to campaign in schools and colleges
                                  on key health issues and prevention of habit forming practices.
                                ♦ Provide health check up to all school going children.
                                ♦ Provide Iron Folic Acid, Albendazole Tablet & Scabies Lotion to
                                  school going children.
                                ♦ Provide emergency kits in all schools.

                                ♦ Recruitment of contractual staff under school health programme.

                                ♦ Operational cost, IEC material, health cards, referral cards etc. for
                                  Districts.



                                                                                        248
Benchmarks                      ♦ All school going children provided health check up.
                                ♦ Improved health among youth and school going children.
                                ♦ Provide emergency kits in all schools.

                                ♦ Recruitment of contractual staff under school health programme.

Support                         • Effective         coordination     between   health    and     education
                                    departments.


                             BUDGET FOR SCHOOL HEALTH PROGRAMME

                                    B NRHM Additionalities
    SN                                                                                             Remarks
                                                                                        Rs in
                         Activity                     Q1      Q2       Q3       Q4
                                                                                        Lakhs
   B13     School Health Programme
           Providing Iron Folic Acid to 30 Lakh
   B13.1   students. (For control of Anaemia         60.00   0.00     60.00    0.00     120.00
           100 tablets per child)

           Providing Albendazole Tablets 2 to
   B13.2                                             25.00   0.00     25.00    0.00     50.00
           per child (For Deworming)
           Providing Scadies lotion for skin
   B13.3                                             15.00   0.00     15.00    0.00     30.00
           diseases
           Providing emergency kits in all
   B13.4                                             60.00   0.00      0.00    0.00     60.00
           schools (20,000X300)

           Incentives to RMO / MO, ANMs etc.
   B13.5   for examining and screening of all        12.50   12.50    12.50    12.50    50.00
           children during the year.

           Recruiting contractual staff as per
   B13.6   Govt. of India's guidelines along with    12.50   12.50    12.50    12.50    50.00
           operational expenses from them

           POL,    stationary     and    other
   B13.7   operational expenes at State Head         5.00    5.00      5.00    5.00     20.00
           Quarter and District Head Quarters

           IEC material, Health cards, referral
   B13.8                                             2.50    2.50      2.50    2.50     10.00
           cards etc.
           Complicated Disease among the
           children and adolescents i.e
   B13.9                                             75.00   75.00    75.00    75.00    300.00
           RHD,CHD, Thelesemia, Cancer, Cleft
           palate & Juvenile diabetics

                                                                                         249
Total Budget   255.00   95.00   195.00   95.00   690.00




                                                  250
                COMPLICATED DISEASE AMONG THE CHILDREN & ADOLOSCENT i.e.
                             RHD/CHD/THELESEMIA/CANCER

Objective To provide free treatment to the children & adolescents suffering from RHD / CHD /
THELESEMIA / CANCER.

Issues/Problems              ♦ Children & Adolescent in the age group of 0-19 years are
                                  approximately 22% of the total population in Punjab means
                                  around 59 lakh children & adolescent out of the total population
                                  of 2.7 Crore.


                              SN Disease            Estimated No of Cases Cost of Treatment
                                                    per Year                 per Child
                              1      RHD/CHD        250-300                   1.00 – 1.50 lakh
                              2      Thalassemia    700-800                   0.50 – 2.00 lakh
                              3      Haemophilia    100                       0.50 lakh
                              4      Cancer         150-200                   1.00 – 1.50 lakh

                             In addition to this, there are also children who are also suffering
                             from Cleft Palate occurrence variables & Juvenile diabetics etc
                             incidence variable.
Strategies                   Activities

♦ Free       treatment   for Substantial number of children in the age group of 0-19 years is
  children suffering from suffering from complicated diseases, the treatment of which is
  RHD/CHD,                   expensive and longer. If timely treatment is given to these children,
  Thalassemia,               their precious life can be saved & they can live a normal life. Cancer
  Haemophilia,      Cancer, is a major menace in the Malwa region of the State. We are proposing
  Cleft palate occurrence free treatment though PGIMER of all the children in the age group of
  variables & Juvenile 0-19 years suffering from RHD/CHD, Thalassemia, Haemophilia,
  diabetics etc incidence Cancer, Cleft Palate occurrence variables & Juvenile diabetics etc
  variable.                  incidence variable.



                                                                                 251
Benchmarks   ♦ Provide free treatment to the children in the age group of 0-19
               years who are suffering from complicate disease.
Support      • Effective coordination between health department and Post
               Graduate Institute of Medical Education & Research Chandigarh
               (PGIMER).




                                                                  252
                         BUDGET FOR OTHER CONTRACTUAL STAFF


                          B NRHM Additionalities
 SN                                                                         Remarks
                                                              Rs in
              Activity            Q1       Q2      Q3   Q4
                                                              Lakhs
       Additional Contractual
B14
       staff
                                                                    Salary
      Salary @ Rs. 6900/- for
                                                                    Revised
      ANM. One additional
                                                                    from Rs.
B14.2 ANM in the 1411 SCs 292.08 292.08 292.08 292.08 1168.31
                                                                    6900     to
      including all SCs of high
                                                                    Rs. 7100
      focus Districts
                                                                    per month
      Incentive to Doctors
      working        in     the                                     Not
B14.5                            0.00   0.00   0.00   0.00   0.00
      extremely         remote                                      approved
      areas
                                                                    As      per
                                                                    Comments
      Travelling allowance to
                                                                    of    NPCC
B14.5 1411 ANMs @ Rs. 8.47              8.47   8.47   8.47   33.86
                                                                    not
      200.00 P.M
                                                                    permissibe
                                                                    so deleted
      One Gynaecologist @
B14.6 Rs. 35,000/- PM for 10 10.50 10.50 10.50 10.50         42.00
      DH
            Total Budget        311.04 311.04 311.04 311.04 1244.17




                                                                      253
                                       OTHER ACTIVATES

                               COMMUNITY ACTION PROGRAMME
Major mandate of NRHM is to provide equitable, affordable health services to the masses
especially rural poor, women and children. Community monitoring forms the crucial part
because community is a major stakeholders and community participate in the systems as
beneficiary of programmes. Under NRHM the role community has been more vibrant as a
participant in the programme activities, implementation especially selection of ASHA, VHSC.

There is need to involve community for monitoring the programmes by engaging in collecting
analyzing respective health related information. It will also put out the distrust between provider
and community as the implementation and monitoring is at same level and make the system
more accountable.

In the State, Health Planning and Monitoring Committees have been constituted at all levels.

Community Monitoring Initiative
Objectives                       •   Provide regular and systematic information about community
                                     needs, which would guide related planning.
                                 •   Provide feedback according to the locally developed yardsticks
                                     for monitoring as well as key indicators. This would essentially
                                     cover the status of entitlements, functioning of various levels of
                                     the Public health system and service providers, identifying gaps,
                                     deficiencies and levels of community satisfaction, which can
                                     facilitate corrective action in a framework of accountability.
                                 •   Enable the community and community-based organisations to
                                     become equal partners in the planning process. It would
                                     increase the community sense of involvement and articipation
                                     to improve responsive functioning of the public health system.
                                     The community should emerge as active subjects rather than
                                     passive objects in the context of the public health system.·
                                 •   Validating the data collected by the ANM, Anganwadi worker



                                                                                   254
                                     and other functionaries of the public health system.
Strategies                  Activities
Opeartionalise        the      • State Preparatory meetings and workshops in consultation with
Community      Monitoring            AGCA / NHSRC.
in the State                    •    State mentoring team, formation, finalization of State appropriate
                                     frameworks.
                                •    Designating State Nodal NGO.
                                •    Printing of material provided by AGCA.
                                •    State Training of trainers – one state level workshop for Facilitators.
                                     Training of Community Monitoring teams at different level.
                                •    Formation of District Mentoring Team.
                                •    Designating District Nodal NGO.
                                •    District workshop – one in each district.
                                •    Formation and Training of Block Community and Facilitation Team.
                                •    Block level training for four members of a Block Community
                                     Monitoring team, including at least two civil society members.
                                •    Orientation of members of Community Monitoring Committees at all
                                     level.
                                •    PHC and block level Public Hearings.
                                •    District level media workshops.
                                •    Block providers orientation
Indicators                      •    No of Health Planning and Monitoring Committees functional
                                •    No of Meeting of these committees
                                •    No of committees conducting social audit.
                                •    Utilization of VHSC funds.
Support                     •       Advisory Group on Community Action (AGCA)
                            •       National Health Systems Resource Centre.


Amount Rs. 80.00 Lakhs has been proposed. Detailed budget will be made in consultation with
AGCA and NHSRC.


                                                                                    255
Implementation

Community Monitoring process is being implemented through specially constituted Task Group
of the Advisory Group on Community Action.

    •   The State Mentoring Group would be framed involving representatives of the State
        Health department and state level Health sector voluntary networks. This team would
        have definite responsibilities to develop community monitoring in the state.
    •   One of the State level NGOs with membership in the State mentoring team would be
        selected to work as the state nodal NGO. This state nodal NGO would work under the
        direction of the State mentoring team.
    •   A State level workshop will be organised by the State mentoring team and State Health
        Mission involving all stakeholders (State Mission Officials, District Health Officials and
        PRI representatives from selected districts, NGO networks and civil society organizations
        from these districts) along with NRHM GOI representatives. The activities of the first
        phase will be shared and the process would be finalized. Detailed timetable for Districts
        level meetings, formation and orientation of committees could be worked out in this state
        level workshop.
    •   State level Training of Trainers for the facilitating teams from all pilot districts would
        need to be conducted primarily by voluntary sector facilitators, since Government
        officials may not have adequate experience in community monitoring activities. However
        State Health Department officials would be present and would be involved in these
        workshops, enabling them to actively participate in further such trainings.
    •   District and block level facilitating organizations will be selected and trained
    •   4 members Block level training team will be trained. These will be responsible for further
        orientation process.
As the committees at different level already have been constituted, the community will monitor
demand/ need coverage, access, quality, effectiveness behavior and presence of health care
facilities at service point, possible denial of care and negligence.

Information will be organized village/ PHC/ Block/ District wise.



                                                                                      256
Objective: Operational Research




                                  257
                     Operational Research is proposed to be conducted
                     • In order to identify the incidence and prevalence of specific health problems
                        and factors related to it
                     • To find out the actual status of service delivery through community survey etc.
                     • It has been observed that there is a strong need to create further awareness in
                        the community regarding important issues like Maternal and Child Health. At
                        the same time enhanced community participation in health care activities is
                        envisaged bringing-in desired “health seeking behaviour of community” in
                        regard to health schemes / services provided under National Rural Health
                        Mission. Awareness is the key to effective service delivery. In absence of
                        adequate awareness primary health objectives such as universal
                        immunisation, institutional deliveries, low IMR & MMR cannot be achieved.
                        Due to less awareness among the community, the gap between the service
                        delivery
                        delivery and beneficiaries is widening. In order to bridge this critical gap
Issues/ Challenges      effective awareness generation exercise is required to be undertaken. A
                        situational analysis is required to be initiated for assessing the community’s
                        awareness level, with the objective to provide them with appropriate useful
                        information and dissemination of awareness regarding key maternal health
                        and child health issues like Early Registration of Pregnancy, Institutional
                        delivery, Ante-natal, Intra-natal, Post-natal care, Immunization, Mother &
                        Child health, promotion of breast feeding, Family planning, Janani Suraksha
                        Yojna (JSY) etc.
                     • To understand and know various health issues and health services it is very
                        important to have an independent feedback from the community. A part from
                        various health services such as Maternal and Child Health, Immunization,
                        NRHM also has a very important component of BCC/ IEC activities. When it
                        comes to Health Education we need to adopt multipronged strategies such as
                        Audio-Video clippings, posters, wall paintings, advertisement, pamphlets. But
                        it is well established that the most effective way to disseminate health
                        education is Inter Personal Communication (IPC).


                                                                                 258
Strategies/ Services       Activities/ Inputs
4. Community Survey        • For this purpose department proposes to engage School/ College going
                             girls of class 11th and 12th from the same village and train them to
                             disseminate health education and collect the feedbacks and
                             information in a form of questionnaire for mother and child health
                             services. This will serve the dual purpose i.e. not only these girls from
                             the same village would be in a better position to relate with the
                             women folk of the same village but at the same time they would also
                             get educated in this process.
                           • A direct, independent feedback from the community regarding their
                             knowledge about various health services, extent of this services being
                             availed by the community, the reasons for deficiencies.
                           • Since this work is of technical nature, PGI Chandigarh would be
                             requested for their support in Community Monitoring.
Support    needed      for • Education Department
implementing changes       • PGI

Benchmarks




                                                                                  259
                        IMPLEMENTATION OF COMMUNITY HOTLINE


Community HOT LINE under NRHM, Punjab - a key component to have the community based
monitoring under NRHM.

       feticide                      Silence.
Female feticide is the Conspiracy of Silence People in the family as well as in the
neighborhood know that the lady is pressurized for female foeticide or female foeticide was
performed in number of cases. People including mother prefer to keep silence. To break
                                                                 silence-
this bitter fact of female feticide and to end the conspiracy of silence- a veil of secrecy,
Department proposes to have an innovative scheme COMMUNITY HOTLINE by which we
would come to know about the cases where female feticide is being done or has already
been done. Under this scheme, anyone can give information about female foeticide through
free call number. Since the information is confidential, the telephone number of the
informer or identity would not be captured. Even informer’s voice will be digitized and
recorded. There would not be any human interaction with the informer. The moment, the
voice is recorded, the operator then would send the message through SMS to all
concerned:-

       1) Civil Surgeons

       2) SMOs

       3) ANMs (are being provided with the mobile connection under some different
          activities.

In case where the lady is under pressure of female foeticide, Health Workers would simply
visit her house under the pretext of health check up and enquire about ANC checkups and
also say that he or she would again visit after two months. In case where the lady has
undergone female foeticide, Civil Surgeon would conduct detailed enquiry or where in
emergency cases, lady is being taken to the Nursing Homes or some other places for female
foeticide, places would be raided by the Civil Surgeon.

It would also gather information/feedbacks under various programmes. Progress of various
                                                         programmes
health programmes will be monitored, as through this hotline (toll free number) people


                                                                             260
would easily be able to provide information like whether Immunization sessions held;
whether TB medicine/other medicines or services at the facility level are being provided;
whether ANM is disseminating the desired services at the ground level; whether
community is being supplied by the health services it deserves etc.

It would be a COMMUNITY HOTLINE to be used by the community for the benefit of the
community. It will serve as a key component to have the community based monitoring
under NRHM.

As the pilot phase, the system will only register information for female feticide and then
further will be extended to register feedbacks on different programmes, analyzing and
taking decisions thereafter.




                                                                            261
                   PLANNING IMPLEMENTATION & MONITORING

                              Community Action Programme

                           B NRHM Additionalities
 SN                                                                            Remarks
                                                                      Rs in
                Activity               Q1      Q2      Q3      Q4
                                                                      Lakhs
      Community Action
B18
      Programme
      Community Based Survey
B18.1                                 0.00    150.00 150.00    0.00   300.00
      and community hotline
B18.2 Community Monitoring            0.00    40.00 40.00      0.00   80.00
             Total Budget             0.00    190.00 190.00    0.00   380.00


                              BUDGET
                              BUDGET FOR PROCUREMENT

                           B NRHM Additionalities
 SN                                                                            Remarks
                                                                      Rs in
                Activity                Q1      Q2    Q3      Q4
                                                                      Lakhs
B19   Procurement
      Procurement of Calcium
B19.1                                 18.00    0.00   0.00    0.00    18.00
      tablets
      Procurement of Zinc
B19.1                                 23.00    0.00   0.00    0.00    23.00
      sulphate tablets
              Total Budget            41.00    0.00   0.00    0.00    41.00




                                                                         262
                               DENTAL HEALTH PROGRAMME

Mobile Vans were provided under the Intensive Dental Health Care Programme during the
year 1992-93 under a scheme sponsored by Government of India. These vans are meant to
visit far flung areas of the States & schools for providing dental treatment at door step.
These vans were fully equipped with dental chairs & units & providing dental treatment
like extraction, filings, scaling & other treatments.

In total, 14 vans were provided but by the passage of time, 5 vans have become un-
operational & these are beyond repair. Only 9 vans are still operational, require minor
repairs & running cost along with the regular supply of dental material.

These vans are very important & useful in providing dental treatment under School Health
Programme, during their school visits. Under NRHM, we are proposing minor repairs,
running cost & supply of dental material.




                        BUDGET FOR DENTAL HEALTH PROGRAMME


                           B NRHM Additionalities
  SN                                                                                Remarks
                                                                      Rs in
                   Activity              Q1      Q2     Q3     Q4
                                                                      Lakhs
          Dental Health
 B22
          Programme
          Operationalaiztion of
B22.1
          Mobile Dental Vans
B22.1.1   Major repair of vehicles      0.00    0.00    0.00   0.00    0.00
          Operational expenditure
B22.1.2   like POL (4,000 PM per        1.08    1.08    1.08   1.08    4.32
          vehicle)
          Dental material
B22.1.3                                 2.70    2.70    2.70   2.70   10.80
          (10000X12X9)
          Maintenance of
B22.1.4   equipments for Dental         0.45    0.45    0.45   0.45    1.80
          Vans (20000X9)
          Maintenance of Vans (
B22.1.5                                 0.45    0.45    0.45   0.45    1.80
          20000X9)


                                                                              263
                Total Budget           4.68 4.68 4.68         4.68     18.72
                                     DENTAL FORTNIGHT

Dental Fortnight is being organized every year in the month of November to create
awareness regarding dental diseases & to give curative treatment free of cost to all the
patients. Special feature of this Fortnight is that the poor & needy patients are given free
full set of Artificial Dentures. The actual cost of Dentures in the market is Rs. 3,000 to Rs.
5,000, which is quite difficult for the poor & needy patients to afford. Under NRHM, we are
proposing such type of Fortnights to be organized twice a year at each DHs / SDHs / CHCs.




                             BUDGET FOR DENTAL FORTNIGHT


                                  B NRHM Additionalities
  SN                                                                                         Remarks
                                                                                     Rs in
                          Activity                    Q1      Q2      Q3       Q4
                                                                                     Lakhs
 B22.2    Dental Fortnight
B22.2.1   District Hospitals (20000X21X2)       2.00 2.00 2.00 2.00 8.00
B22.2.2   Sub Divisional Hospitals (15000X36X2) 2.70 2.70 2.70 2.70 10.80
B22.2.3   CHCs (10000X129X2)                    6.45 6.45 6.45 6.45 25.80
                        Total Budget            11.15 11.15 11.15 11.15 44.60




                                                                               264
                                  PROVISION OF CELL PHONE

Mobile Phone to ANMs & other officers for Capturing Sub-Center level Data online through
an application run on mobile.



                        BUDGET FOR PROVISION OF CELL PHONE

                             B NRHM Additionalities
  SN                                                                               Remarks
                                                                    Rs in
                  Activity             Q1      Q2     Q3     Q4
                                                                    Lakhs
B27.7   Provision of Cell Phone
        Capital Cost of 457
B27.7.1 Mobile Handsets for           13.71   0.00    0.00   0.00   13.71
        newly recruited ANMs
        Reimbursement of
        monthly cell phone bill
B27.7.2 to ANM/LHV/ Block SA          36.34 36.34 36.34 36.34       145.37
        and Accountant @
        Rs.222/- PM
        Reimbursement of
        monthly cell phone bill
B27.7.3                                1.18   1.18    1.18   1.18    4.72
        to BSMOs @ Rs.333/-
        PM
               Total Budget           51.23 37.52 37.52 37.52       163.80




                                                                             265
                           STRENGTHENING PROGRAMME MANAGEMENT

Objective: To Enable Effective Operationalization of Block PMUs
                              ♦ To make BPMU fully functional.
Issues/ Challenges
                              ♦ Establish comprehensive monitoring system.
                              ♦ Strengthen BPMU by filling the vacant positions at the earliest.
Strategies/ Services          Activities/ Inputs
Strengthening          PMUs ♦ Most of the positions at BPMU level are filled but vacancies arise
through recruitment and          due to resignation are to be filled immediately.
effective     operational ♦ Develop and implement an effective monitoring system for all the
strategy                         PMU staff.
                              ♦ Establish regular reporting system and documentation of the
                                 same.
                              ♦ Regular monthly review meetings at the State and District levels.
                              ♦ At Block Level, Block Accountant and Block Statistical Assistant
                                 to be responsible for activities at Block Level.




                                                                                    266
            BUDGET FOR STRENGTHENING OF PROGRAMME MANAGEMENT

                            B NRHM Additionalities
  SN                                                                            Remarks
                                                                                Remarks
                                                                     Rs in
               Activity            Q1       Q2        Q3      Q4
                                                                     Lakhs
        Strengthening of
 B27    Programme
        Management
        Support for Block
        Programme
        Management Unit.
B27.1.1                           32.57    32.57     32.57   32.57   130.27
        Salary for Block
        Statistical Asstt. @
        Rs.9200 x 118 Blocks
        Support for Block
        Programme
        Management Unit:
B27.1.2 Salary for Block          32.57    32.57     32.57   32.57   130.27
        Accountant Cum
        Cashier @ Rs. 9200 x
        118 Blocks
        173 Computer
        operator for
        strengthening of
B27.1.3                           36.33    36.33     36.33   36.33   145.32
        District Society and
        BPMU. Salary @ Rs.
        7000


                                  101.47 101.47 101.47 101.47        405.86
             Total Budget




                                                                          267
                                OPERATIONAL EXPENDITURE


Salaries, reimbursement of monthly telephone bills, various health camps, administrative
activities, publicity, IEC/BCC, innovative activities, operational research activities &
miscellaneous expenditure will be met out of operational expenditure (6% of
additionalities).



                           BUDGET FOR OPERATIONAL EXPENDITURE

                               B NRHM Additionalities
 SN                                                                                  Remarks
                                                                           Rs in
                    Activity           Q1        Q2      Q3        Q4
                                                                           Lakhs
       Operational Expenditure
           meeting
       for meeting out salaries,
       reimbursement of monthly
       telephone bills, various                                                     Approve
       health camps,                                                                   d in
       administrative activities,                                                   different
       publicity, IEC/BCC,                                                          compone
       innovative activities,                                                          nts
       operational research
       activities & miscellaneous
       expenditure.




                                                                          268
   PART-
   PART-C


IMMUNIZATION




               269
                                         PUNJAB STATE



 PROJECT IMPLEMENTATION PLAN FOR STRENGTHENING OF IMMUNIZATION SERVICES YEAR
                                    2010-
                                    2010-11



               (Objective is to attain 100% immunization coverage for all antigens)




                                             Program
Situation analysis of the State Immunization Program



(The States/UTs should provide a brief write-up covering all the following issues)



   1. Current scenario of implementation of immunization program


       a. Implementation status (Manpower/ Cold Chain/ Vaccine & Logistics / Trainings)
       b. District wise coverage levels of all antigens for 2008-09, 2009-10 till Dec’09
          (including Hepatitis B & JE wherever applicable).
       c. Reporting and incidence of VPDs for 2009-10 till Dec’09.
       d. Trend of IMR of the State/UT for last 5 years.
       e. Reporting and Response to Outbreaks and AEFIs for, 2009-10 till Dec 09.


   2. Supervision and Monitoring (Status of Routine Immunization cell, Review meeting and
   data analysis and action taken at all levels etc)


   3. Status of RIMS implementation for monitoring (details of districts uploading data
   regularly, issues with other districts and proposed support required)


   4. Co-ordination with Partners (ICDS, Public Private Partnerships, Other agencies)


   5. Strategies for further improving Routine Immunization


       a.   To improve the accessibility of routine immunization services (reflected by BCG and
            DPT-1 coverage); identify the districts with poor access and reasons thereof.
                                                                                           270
       b. To reduce dropouts (reflected by DPT3 coverage); reasons for dropout and specify
          steps taken for this.
       c. To create community demand for routine immunization;(write specific steps taken)
       d. Any other innovation started for strengthenming of routine immunization in the
          state.


   6. Additional support required to improve Routine Immunization; for any state specific need
   please provide a separate write-up on objective, strategy, expected output and budgetary
   basis for the activities.


   7. Component-wise receipt & expenditure of funds received from 2005 onwards (format
   attached).


   8. Infrastructural and manpower requirements that are essential for implementation of UIP
   but not admissible under Part C (Immunization) may be provisioned under the NRHM/RCH
   heads. (eg; Refrigerator mechanics, renovation of stores etc.). This should include district
   level need for godown for vaccines/logistics.


   9. IEC plan for strengtheninig UIP; however the budget for IEC is to be provisioned under
   RCH.


   10. ILRs, DF, Voltage stabilizers


      a. All CFC equipments supplied till 1992 has been replaced with Non CFC equipment. The
         expansion plan should include replacement of remaining CFC equipments supplied
         during the period of 93-98
      b. Plan for replacement of all condemned or non service able equipment which is beyond
         repair.
      c. Expansion: - Need based depending on the setting up of New PHC/ cold chain points
      d. Cold boxes, Vaccine carriers - replacement plan for expansion or replacement of
         condemn equipment.
      e. Insulated/Non Insulated vaccine van: Plan for supply of insulated vaccine vans against
         condemned vehicles and expansion plan for supply of vaccine van for newly created
         district.


11. Status of implementation of Procurement Management Information System (ProMIS)




                                            -271-
 Situational Analysis (As per observations of GOI)



1.   Regarding dropout from BCG to DPT-3 by about 9.3%, about 2% dropout is natural due to
     prevailing NNMR; however for ensuring almost nil dropout, micro-planning for all the rural
     areas of the State is already in place and information is available even on the website of the
     Punjab NRHM. Now revised formulae with latest birth rate and IMR have been circulated in the
     districts for updating the micro-plans accordingly. Tracking bags are being introduced in less
     than a month's time in the State so as to facilitate tracking of each and every PW and child after
     delivery in all the sessions by ANM/ AWW.
2.   Regarding inter-district variation as per the DLHS-3 report, we have filled vacant posts of
     ANMs and rather additional ANMs have been deployed under NRHM in sub-centers with
     excess population which will help to promote immunization and MCH services in the districts
     which have shown decline in coverage since there was shortage of ANMs in the Malwa belt of
     the state earlier. These districts have already been sensitized to the issue and coverage is
     expected to improve with enhanced supervision and monitoring as well.
3.   Regarding disparity between the reported and evaluated coverage data, the disparity has come
     down significantly in the last 3 - 4 years.
4.   Regarding coverage not commensurate with fiscal progress, more emphasis has been laid on
     utilization of services of ASHA and AWWs in mobilization of children as well as utilizing the
     opportunity of VHNDs.
5.   Regarding completion of trainings, the training of Medical Officers is expected to be completed
     in the current financial year itself. Training of Health workers has been delayed due to non
     availability of training modules in local Punjabi language, which is now expected to be
     completed in 3 – 4 months time.
6.   Decrease in number of sessions in the rural areas has been an outcome of study of the village
     wise computerized micro-plan and now sessions are held every month for population of at
     least 1000 and sessions have been planned on alternate months also where the population is
     less than 1000 so as to curb unnecessary wastage of manpower and vaccines. This is also going
     to help save funds on sub component mobilization of children and AVD.
7.   The supervision and monitoring is done on a specific Performa and is by and large supportive;
     however necessary administrative/ disciplinary action is taken wherever required.
                                                   -272-
8.   Regarding posting of M & E Officers (immunization) and Refrigerator Mechanics in
     6 districts (without Refrigerator Mechanic) we will hire them on contractual basis under
     NRHM Component B.




                                             -273-
                                           PUNJAB STATE

A.    Basic information of Punjab related to Immunization

                                                                              Target
        S.No                          Beneficiaries
                                                                   2008-
                                                                   2008-09   2009-
                                                                             2009-10    2010-11
                                                                                        2010-

         1        Pregnant women                                   535061     534000    533000*

         2        0 to 1 yr infants                                465017     463500    464000*

         3        1-2 yr                                           472322     465017    440000

         4        2-5 yr                                          1416966 1416966 1400000

         5        5 yr                                             618102     598100    605000

         6        10 yr                                            618102     769500    778000

         7        16 yr                                            564354     614100    621000

                                               IMR
     * As per GOI intimation with BR of 17.6 & IMR 43 whereas as per SRS (2009 data) BR is 17.3 &
     IMR is 41



        S.No               Routine Immunization Sessions           2008-09
                                                                   2008-     2009-
                                                                             2009-10    2010-11
                                                                                        2010-

         1        Session planned in Urban Areas                    20880     20880      20880

         2        Session planned in Rural Areas                   137184     137184    120360

         3        Total Sessions planned                           158064     158064    141240

         4        Total Sessions Held                              150141        -

         5        No. of session with hired vaccinators*
                                                       *             Nil        Nil

                                                                  Under slum area project, full
         6        No. of hired vaccinators*
                                          *                       time ANMs have         been
                                                                  appointed.




                                                                                            274
              IMR

S.No   Year         IMR of the State/UT

 1     2004                 45

 2     2005                 44

 3     2006                 44

 4     2007                 43

 5     2008                 41




                                          275
B.        Existing Support to the States

                                        Stock                    Requirement
     Sl                              (functional)
                     Item                                                                    Remarks
     No                               as on 31st       2009-10
                                                       2009-      2010-
                                                                  2010-11       2010-
                                                                                2010-12
                                        Dec'09
1         Cold Chain Equipments -
a)        WIC                               5                                              Replacement
                                                                                           of       CFC
b)        WIF                          1 (CFC)                                             equipment
c)        ILR                              1334                                            required.

d)        DF                               1155
e)        Cold Boxes                       1329
f)        Vaccine Carrier                  33172
                                                                    2000
g)        Ice Pack                         35000
                                                                   10000
h)         Vaccine Van                      17
                                                                 3
          Vaccine stock and requirement (including 25% wastage and 25%
2
          buffer) in lacs.
a)        TT                                                        40.98
b)        BCG                                                       12.50
c)        OPV                                                       30.46
d)        DPT*                                                      40.52
e)        Measles                                                   7.71
f)        Hep B                                                     22.0
g)        JE (Routine)                                                -
3         Syringes including wastage of 10% and 25 % buffer
a)        0.1 ml
                                                                     6.6
b)        0.5 ml
                                                                    86.0
          Reconstitution                                             3.5
c)                                                                             As per vials of BCG & MSL
          Syringes
                                                                               to be opened
4         Hub Cutters
                                                                  1200 No.

          *Note: DPT is to be given instead of DT at 5 yrs once the current stock of DT
          Vaccine is exhausted



                                                    -276-
C.       Additional Support required by the State


                                                                                             Expenditure & Achievement

                                       2005-
                                       2005-06         2006-07
                                                       2006-           2007-
                                                                       2007-08                          2008-09
                                                                                                        2008-               2009-10 (till Oct'09)
                                                                                                                            2009-                                  2010-
                                                                                                                                                                   2010-11

      Service                                                                                                                                                                         Remar
                       Norms*




                                                                                                              Achievement




                                                                                                                                              Achievement
                                         Expenditure




                                                         Expenditure




                                                                         Expenditure




                                                                                          Expenditure




                                                                                                                              Expenditure
     Delivery: -                                                                                                                                                                        ks
                                                                                                                                                               Funds
                                                                                                                                                                           Target
                                                                                                                                                            requirement
                                                                                                                                                            requirement



                      @Rs.50,000       1689412         2641998         2892101                               No of                           No of                         No of
      Mobility
                    per District for     out of          out of          out of                             sessions                        sessions                      sessions
     support for                                                                                                            250833
                     district level     702000          702000          702000                              Supervis                        Supervis                      Supervis
     supervision                                                                                                             (prov.,
                     officers (this    approved        approved        approved                                ed                              ed                            ed
                                                                                                                            incompl                          10,00,000
                     includes POL
                                                                                                                               ete
                          and
                                                                                                                             report)
                    maintenance)                                                                             22092                                                        24544
   Supervisory         per year
  visits by state                                                                        872320
                    By state level      21961           94712           78636                                 No of                           No of                         No of
   and district
                    officers    @        out of          out of          out of                             districts                       districts                     districts
  level officers
                    Rs.100,000          144000          144000          144000                               visited                         visited         1,00,000      visited
 for monitoring
                    /year              approved        approved        approved                              for RI                          for RI                        for RI
        and                                                                                                                  30000
                                                                                                            review                          review                        review
 supervision of                                                                                                              (prov.)
         RI
                                                                                                                  14                                 8       11,00,000       20
                    Total

      Cold Chain    @ Rs 500 per       332470          305009          306102                               % Funds          83528          % Funds         2,42,000 &    % Funds
                                                                                         219242
     maintenance    PHC/CHC per         out of          out of          out of                               used            (prov.,         used            2,00,000      used


                                                                                       -277-
                  year District        442000     442000     442000                          incompl               --------------
                  Rs 10,000 per       approved   approved   approved               46.5         ete                  4,42,000
                      year                                                                    report)

                   Hiring an ANM                                                   No of                 No of                       No of
                   @Rs.300/sessi                                                  sessions              sessions                    sessions
                     on for four                                                    with                  with                        with
                   sessions/mont                                                   hired                 hired                       hired
                      h/slum of       434410     693153      37600                vaccinat              vaccinat                    vaccinat
                                                                                                                    Funds not
                       10000                                                        ors                   ors                         ors
                                                                                                                   required as
Focus on slum     population and
                                                                                                                    ANMs are
& underserved       Rs.200/- per
                                                                                                                    appointed
areas in urban        month as
                                                                                                                      under
    areas:          contingency
                                                                                                                    Slum Area
                   per slum of i.e.                                                                                                 Minimu
                  total expense of                                                                                    Project
                                                                                                                                      m
                   Rs. 1400/- per                                                                                                   10,320
                     month per
                   slum of 10000
                     population.

                       @ Rs           1603525    2331764    2436321                No. of                No. of                      No. of    Planne
                   150/session          out of     out of     out of              sessions              sessions                    sessions   d
                      (for all        3429600    3429600    3429600                 with                  with                        with     session
                   states/UT.s)       approved   approved   approved               ASHA                  ASHA                        ASHA      s
Mobilization of                                                                                                                                120360
   children                                                                                  3260453                                           .    No.
                                                                        4414747                                    14443200
through ASHA/                                                                                 (prov.)                                          that
  mobilizers                                                                                                                                   may be
                                                                                                                                    120360     actuall
                                                                                                                                               y held
                                                                                                                                               (80%)
                                                                                                                                               96288




                                                                       -278-
                    Geographically
                     hard to reach
                       areas (eg.
                   Session site>30                                                 No of                 No of                  No of
                       kms from                                                   sessions              sessions               sessions
                   vaccine delivery                                                 with                  with                   with
                      point, river                                                  AVD                   AVD                    AVD
                   crossing etc.) @
                    Rs 100 per RI
                        session
  Alternative
   Vaccine                            1575588    2257617    2531090                                                                       Planne
   Delivery:                            out of     out of     out of                                                                      d
                                      3429600    3429600    3429600                                                                       session
                                      approved   approved   approved                                                                      s
                   For RI session                                                                                                         109740
                   in other areas                                                            1478798                                      .    No.
                                                                        4507110   65.7%                            4389600     109740
                    @ Rs.50 per                                                               (prov.)                                     that
                      session.                                                                                                            may be
                                                                                                                                          actuall
                                                                                                                                          y held
                                                                                                                                          (80%)
                                                                                                                                          87792



  Support for                          51871     82580     CA from
                     State @Rs
   Computer                             out of   out    of other                             49000 @
Assistant for RI      12,000-                              sources                                         1       1,44,000
                                       96000     96000                                       7000 PM
reporting (with     15,000 p.m.
                                      approved   approved                982982
    annual
 increment of
10% w.e.f. from
                   Districts @ Rs                                                  No of                 No of                  No of
   2010-11)                                                                                                        24,00,000
                   8000- 10,000                                                    C.A. in   643358      C.A. in                C.A. in
                        p.m           376498     995807     1302653               position              position               position
                                       out of     out of     out of

                                                                       -279-
                                  1428000    1428000    1680000
                                  approved   approved   approved                                      17                    20
                                                                                                              25,44,000
                     Total

 Printing and
dissemination
      of
immunization      @ Rs 5 per                                                             Under
                                  1950000    1950000    1950000     1950000                                   25,00,000
  cards, tally    beneficiary                                                            process
    sheets,
 monitoring
  forms, etc.

                   Support for                                                 No of                No of                  No of
                     Quarterly                                                meetings             meetings               meetings
                    State level                                                held                 held                   held
                      Review
                   Meetings of
                      district
  Review                                                                                  Under     3 to be
                  officers @ Rs    34317      71157      54326       57588                                    2,00,000
  Meetings                                                                       2       process     held
                 1250/particip
                  ant/day for 3
                      persons
                 (CMO/DIO/Dis
                   t Cold Chain
                      Officer)




                                                                   -280-
   Quarterly
   Review &
    feedback
  meeting for
 exclusive for
 RI at district
level with one
                                                16789
  Block MO.s,
                                                (prov.,   20x4x20x
  ICDS CDPO
                   Nil   Nil   Nil       Nil   incompl      100=       1600
   and other
                                                  ete     1,60,000
stakeholders@
                                                report)
 Rs 100/- per
participant for
    meeting
   expenses
     (lunch,
organizational
   expenses)

  Two yearly                                                 2x118x
     review                                                   2500
   meetings                                                (50ASHA)
exclusive for RI                                               +
 at Block level                                207927      2x118x80
@Rs 50/-pp as                                   (prov.,   (50ASHA &
honorarium for     Nil   Nil   Nil       Nil   incompl    30others)x
ASHAs (travel)                                    ete         25=
 and Rs 25 per                                  report)   5,90,000+
 person at the                                              4,72,000
disposal of MO-                                                =
I/C for meeting
                                                           10,62,000
expenses(refre
   shments,


                                     -281-
                   stationery and
                   misc. expenses)
                                                                                                   12,62,000
                       Total
                     (Meetings)

                                                                      No of               No of                 No of
   Trainings                                                         persons             persons               persons
                                                                     trained             trained               trained

 District level
  orientation
 training for 2                                                                                                   To
   days ANM                                                                                                    complet
                                                                                Under
(4500), MHPW       As per revised    1448282   Nil   Nil       Nil                                 12,00,000     e left
                                                                               process
(Male) (1800),       norms for                                                                                 over Trg
   LHV(650),         trainings                                                                                  during
BEEs & others       under RCH                                                                                     the
  (500) @ Rs.                                                                                                  previous
    500 each                                                                                                    years
 (consolidated)



    Three day
   training of     As per revised
                                                                      No of               No of                 No of
Medical Officers     norms for                                                  Under
                                       Nil     Nil   Nil       Nil   persons             persons       -       persons
   on RI using       trainings                                                 process
                                                                     trained             trained               trained
   revised MO       under RCH
training module




                                                           -282-
     One day
    refresher
   training of
   District RI     As per revised
   Computer          norms for                                         Under
                                    -   -   -       Nil
  Assistants on      trainings                                        process
RIMS/HMIS and       under RCH
 Immunization
 formats under
     NRHM



 One day Cold
Chain handlers
   training for
block level cold
chain handlers     As per revised
                                                             No of               No of         No of
  by State and       norms for                                         Under
                                    -   -   -           -   persons             persons   -   persons
  District Cold      trainings                                        process
                                                            trained             trained       trained
 Chain Officers     under RCH
 and DIO for a
batch of 15-20
  trainees and
 three trainers




                                                -283-
    One day
  Training of
block level data                                                                                     -
  handlers by
    DIO and
 District Cold     As per revised
                                                                   No of               No of                   No of
chain Officer to     norms for                                               Under
                                      Nil   Nil   Nil       Nil   persons             persons                 persons
train about the      trainings                                              process
                                                                  trained             trained                 trained
   reporting        under RCH
   formats of
Immunization
  and NRHM                                                                                       12,00,000
  Total (Trg)



Micro-
Micro-planning

                    @ Rs 100/-
                   per subcentre                                                                 For
                    (meeting at       Nil   Nil   Nil                                            revision
To devlop sub-                                                                          % of                    % of
                    block level,                                                                 2,95,000
center and PHC                                                                        SC/PHC/                 SC/PHC/
                     logistic)
  microplans                                                                          CHC/Dis                 CHC/Dis
 using bottom                                                                           tricts                  tricts
                         For                                                                     For
  up planning                                                                           have                    have
                    consolidation                                                                revision
      with                                                                            updated                 updated
                   of microplan at                                                               1,18,000 &
participation of                                                                      micropla                micropla
                   PHC/CHC level      Nil   Nil   Nil                                            40,000
  ANM, ASHA,                                                                           ns this                 ns this
     AWW            @ Rs 1000/-                                                          year                    year
                     block & at
                   district level @
                   Rs 2000/- per

                                                        -284-
                       district
                                                                                                        4,53,000
                         Total
                    (Micro-
                    (Micro-planning)

POL for vaccine                                                           % Funds             % Funds               % Funds
 delivery from                                                             used                used                  used
State to District   Rs100,000/         State:   State:   State:
                                                                                                        20,00,000
   and from         district/year      21961    55092    90476
   district to
  PHC/CHCs

                      @ 400/ -
                      month/
                      district          Nil      Nil      Nil                                             96,000
 Consumables
 for computer
   including
 provision for                                                                                            9,600
internet access      @ Rs. 800/-
   for RIMS         PM at State HQ      Nil      Nil      Nil
                         Total
                                                                                                         1,05,600


                                                                          % funds             % Funds               % Funds
Injection Safety
                                                                           used                used                  used

  Red/Black             @ Rs
                                                                                     Under               2,82,480
Plastic bags etc    2/bags/session      Nil      Nil      Nil
                                                                                    Process
                    @ Rs 500 per
Bleach/Hypochl
                    PHC/CHC per                                                                           59,000
 orite solution
                       year




                                                                  -285-
                     @ Rs 400 per                                                                                            47,200
                     PHC/CHC per
  Twin bucket
                         Year

                         Total                                                                                              3,88,680




                                                                                       % funds                 % Funds
                                                                                        used                    used
                                                                                                    75849
                                     14714700     244775       436702      275755
                                                                                                    (prov.)

    Any State
  Specific
  Specific Need                                                                          60.2
       with
   justification                                                                   peri-
                                     1. Hiring of Vaccinators for uncovered urban/ peri-urban areas
(Please provide a    10 % of total
 separate write-
            write-                   Mobile teams were constituted previously for enhanced coverage in the uncovered
                      amount of
 up on objective,                    urban and peri-urban colonies. Bigger cities of Ludhiana and Amritsar had two          2136x300
                     approved PIP
     strategy,                       mobile teams every Saturday, Jalandhar, Patiala & Bathinda city had one team every     =6,40,800
 expected output                     Saturday and rest of the district/ sub-divisional cities had one team visit once a
  and outcomes,                      month and these teams were provided POL @Rs.400/-PM/team. Now instead of
   basis for cost                    mobility support, we will hire contractual vaccinators @Rs.300 each per session
  estimates etc.)
                                     and keeping in view the increased population in bigger cities, we will provide 12                  Additiona
                                     hired vaccinator sessions per month for Ludhiana city, 8 hired vaccinator sessions,                    l
                                     each, PM for Amritsar, Patiala, Bathinda, Ferozepur & Jalandhar cities and 2 hired                     requi
                                     vaccinator sessions PM for remaining 14 district headquarter cities & 50 sub-                          rem
                                                                                                                                            ent
                                     divisional level towns, totaling 105 contractual vaccinators PM i.e. 2136 additional
                                                                                        There
                                     hired vaccinator sessions for the year 2010-11. There is no duplicity of ANMs in
                                     these uncovered areas and these areas are also not covered under the slum area
                                     project.




                                                                         -286-
                                                                                     5000x125
                                                                                     =6,25,000
2. Procurement of tracking bags for ensuring 100% coverage

We will provide tracking bags to all the ANMs individually for keeping record
(tracking) of each and every PW & child, as per place of session. The state
specific tracking bag will have 13 pockets for tracking each & every beneficiary
i.e. PW & children upto the age of 2 years for MCH and immunization services.
We will procure 13000 tracking bags at estimated cost of Rs. 125 each.



3. AEFI Surveillance/ meetings/ Case management                                      10,000x20
                                                                                     = 2,00,000
As per suggestion from GOI, we will provide funds to all the districts for holding
quarterly meetings of the District AEFI Committees or as per necessity and for
surveillance as well as case management @ Rs. 10,000/- per district.

                                                                                     14,65,800
Total of state specific plan




                                   -287-
District –wise Coverage reports (in numbers)

                                                                        OPV - 1st Dose       OPV - 3rd Dose    DPT - 1st Dose     DPT - 3rd Dose
                 Yearly Target    Yearly Target    BCG Coverage
                                                                          Coverage             Coverage          Coverage          Coverage ( in
                   (2008-09)
                   (2008-          (2009-10)
                                   (2009-          ( in Numbers)                                                                    Numbers)
                                                                            ( in Numbers)    ( in Numbers)     ( in Numbers)
S.   Name
     Name of
No   District                                                                                        2009-
                                                                                                     2009-             2009-
                                                                                                                       2009-
                                                            2009-
                                                            2009-10*              2009-10*
                                                                                  2009-                                                2009-
                                                                                                                                       2009-10*
                        Pregnant         Pregnant                                     2008-
                                                                                      2008-           10*      2008-
                                                                                                               2008-    10*      2008-
                                                                                                                                 2008-
                Infants
                Infants          Infants          2008-
                                                  2008-09    (Upto  2008-
                                                                    2008-09 (Upto Sep
                         Women           Women                                         09             (Upto     09      (Upto     09 (Upto Sep
                                                            Sep 09)            09)                                                       09)
                                                                                                     Sep 09)           Sep 09)

1 Amritsar      41852 48155 42179 48539           45036`    21314      44783       21102 42941 20811 37299 21076 41758 20782

2 Barnala       9765    11236    9734   11201     9726       4417       9038        4509     8788    4602      13463   4509      8828     4602

3 Bathinda      22786 26218 22712 26137           24458     11915      23964       11735 22762 11794 32138 11735 22762 11797

4 Faridkot      10695 12306 10661 12268           11238      5270      10561        5330     9784    5096      15246   5330      9626     5096

5 F. Sahib      10230 11771 10197 11735           9515       4823       9067        4554     8166    4637      30812   4554      8166     4637

6 Ferozepur 33481 38524 33372 38405               32379     15587      30342       17128 26115 16184 21528 17087 23599 16206

7 Gurdaspur 39991 46015 39861 45872               35342     16427      34652       16103 33524 15957 22125 16053 33519 15936

8 Hoshiarpur 26971 31034 26883 30937              24356     12246      23702       11806 21739 12801 22275 11520 16607 12961

9 Jalandhar     37201 42805 37080 42672           37032     16331      36636       16958 38012 17817 22869 16904 33692 17810

10 Kapurthala 13951 16052 13905 16002             14000      7147      14981        7443     14143   7158      13055   7443      14143    7158

11 Ludhiana     59522 68488 59792 68809           60946     29320      56986       28118 54972 29908 41937 27997 55781 29666

12 Mansa        13020 14982 12978 14935           12003      5061      11139        5956     9186    5862      12043   5975      9552     5878


                                                                    -288-
                                                                        OPV - 1st Dose       OPV - 3rd Dose    DPT - 1st Dose     DPT - 3rd Dose
                 Yearly Target    Yearly Target    BCG Coverage
                                                                          Coverage             Coverage          Coverage          Coverage ( in
                   (2008-
                   (2008-09)       (2009-10)
                                   (2009-          ( in Numbers)                                                                    Numbers)
                                                                            ( in Numbers)    ( in Numbers)     ( in Numbers)
S.   Name
     Name of
No   District                                                                                        2009-
                                                                                                     2009-             2009-
                                                                                                                       2009-
                                                            2009-10*
                                                            2009-                 2009-
                                                                                  2009-10*                                             2009-
                                                                                                                                       2009-10*
                        Pregnant         Pregnant                                    2008-
                                                                                     2008-            10*      2008-
                                                                                                               2008-    10*      2008-
                                                                                                                                 2008-
                Infants
                Infants          Infants          2008-
                                                  2008-09           2008-
                                                             (Upto 2008-09 (Upto Sep 09
                         Women           Women                                                        (Upto     09      (Upto     09 (Upto Sep
                                                            Sep 09)           09)                                                        09)
                                                                                                     Sep 09)           Sep 09)

13 Moga         16741 19262 16223 18669           18041      8066      14783        8145     11824   8243      17776   8145      11730    8243

14 Mohali       13485 15517 13442 15469           12592      6179      12253        6418     11331   6316      14582   6418      11331    6316

15 Muktsar      14881 17122 14832 17069           14783      6919      14561        6718     12645   6401      11237   6718      11642    6405

16 SBS Nagar 10695 12306 10197 11735              11703      4765       9310        4474     9203    4420      15269   4474      9203     4420

17 Patiala      31621 36384 31518 36271           36780     15554      32798       15901 29638 15969 18464 15901 28084 15969

18 Ropar        12090 13912 12051 13868           11539      6559      11779        5828     11766   5772      11782   5828      12697    5772

19 Sangrur      27901 32104 27810 32004           27532     13206      22834       12876 22281 13436 17543 12876 21506 13436

   Tarn
20 Taran        18136 20867 18077 20803           22404      9849      20111       10677 20379 11215 15145 10595 19913 11224

                46501        46350                                    41919        40658        40412
     TOTAL
                  7   535061   0   533400 471405 220955 444280 221779   9   224399   8   221138   9   224314




                                                                    -289-
                                                  Hep B - 3rd Dose
                                                                                     TT2+Booster
      Name of Hep B - Birth Dose Hep B - 1st Dose    Coverage          Measles
                                                                       Measles                           A-
                                                                                                     Vit A- 1st Dose
S. No                                                                                  Coverage
      District    Coverage          Coverage        (Wherever          Coverage                         Coverage
                                                     applicable)

                                            2009-
                                            2009-         2009-
                                                          2009-      2008-
                                                                     2008-   2009-
                                                                             2009-   2008-
                                                                                     2008-   2009-
                                                                                             2009-   2008-
                                                                                                     2008-   2009-
                                                                                                             2009-
                 2008- 2009-      2008-
                 2008-09 2009-10* 2008-09         2008-
                                                  2008-09
                                             10*           10*        09      10*     09      10*     09      10*

 1 Amritsar         -       -     40873     19715   33314   20109 38508 19349 42457          21068 28853 14927

 2 Barnala          -       -     9191      4509    8689    4600     8949    4580    10594   4465    5893     3656

 3 Bathinda         -       -     22039     11288   18265   11119 22906 11567 23902          11986 14208      8380

 4 Faridkot         -       -     8706      5322    6831    5089     9389    5016    10120   5314    5606     2736

 5 F. Sahib         -       -     5802      3892    5071    4021     9002    4825    9581    4584    5441     3907

 6 Ferozepur        -       -     28820     15378   19375   13755 25806 15644 31040          15690 13388 11805

 7 Gurdaspur        -       -     25247     14718   22053   14288 34507 16407 34614          17325 27134      8217

 8 Hoshiarpur       -       -     29609     11621   22948   12629 23103 14103 26374          13183 15940      5159

 9 Jalandhar        -       -     30949     16308   22843   17169 34604 17315 37369          18128 18067      8674

 10 Kapurthala      -       -     13815     7443    11804   7158     12937   7413    13184   6979    5951     2679

 11 Ludhiana        -       -     54891     25706   44762   25189 59895 27479 49820          27643 21399 10755

 12 Mansa           -       -     7282      3244    5787    3039     10043   5867    10527   5719    6092     3848



                                                        -290-
                                                  Hep B - 3rd Dose
                                                                                     TT2+Booster
      Name of Hep B - Birth Dose Hep B - 1st Dose    Coverage          Measles
                                                                       Measles                           A-
                                                                                                     Vit A- 1st Dose
S. No                                                                                  Coverage
      District    Coverage          Coverage        (Wherever          Coverage                         Coverage
                                                    applicable)

                                           2009-
                                           2009-         2009-
                                                         2009-       2008-
                                                                     2008-   2009-
                                                                             2009-   2008-
                                                                                     2008-   2009-
                                                                                             2009-   2008-
                                                                                                     2008-   2009-
                                                                                                             2009-
                2008- 2009-      2008-
                2008-09 2009-10* 2008-09         2008-
                                                 2008-09
                                            10*           10*         09      10*     09      10*     09      10*

 13 Moga           -       -      14279    7955    11412    7916     12949   6721    20438   10969 11437      7027

 14 Mohali         -       -      11999    6339    10884    6306     11902   6468    12419   6630    10412    3577

 15 Muktsar        -       -      12519    6504    8941     6165     12717   6555    14300   6718    9695     3055

 16 SBS Nagar      -       -      8207     3964    6896     3777     9486    5282    9887    4823    7962     3293

 17 Patiala        -       -      31913    15901   27316   15969 31873 16278 32495           16040 41927 15350

 18 Ropar          -       -      11781    5828    12348    5772     11823   6433    11637   6385    7494     3526

 19 Sangrur        -       -      20051    12003   18262   12693 23339 13633 28619           14296 17237 10439

    Tarn
 20 Taran          -       -      19540    10694   18119   11174 18831 10427 21068           12091   9715     8481

    TOTAL          -       -     407513 208332 335920 207937 421759 221362 450445 230036 283851 139490




                                                        -291-
                                   2009-
     District –wise VPD reports in 2009-10 (in numbers) Upto Sep. 09 (as per statistics branch record)

                                           Whooping           Neonatal
        Name of                                                                                                                       HB
                         Diptheria          Cough             Tetanus            Tetanus(Other)      Measles           Polio
S.        the
No      Districts     Cases    Deaths    Cases   Deaths    Cases   Deaths Cases         Deaths    Cases   Deaths   Cases   Deaths Cases Deaths

1      Amritsar

2      Barnala

3      Bathinda

4      Faridkot

5      F. Sahib

6      Ferozepur

7      Gurdaspur

8      Hoshiarpur

9      Jalandhar

10     Kapurthala

11     Ludhiana

12     Mansa

13     Moga

14     Mohali



                                                                         -292-
                                    Whooping          Neonatal
      Name of                                                                                                                     HB
                    Diptheria        Cough            Tetanus            Tetanus(Other)      Measles            Polio
S.      the
No    Districts   Cases   Deaths   Cases   Deaths   Cases   Deaths Cases        Deaths    Cases   Deaths   Cases   Deaths Cases Deaths

15   Muktsar

16   SBS Nagar

17   Patiala

18   Ropar

19   Sangrur

20   Tarn Taran

     TOTAL         0        0       2        0       0        0            3      0        34       0       3           0   346        2




                                                                 -293-
Routine Immunization Monitoring System Status

       Name                  Compute                   RIMS uploaded for analysis and programme monitoring                    Remarks
 S.     of         RIMS      r Asst in
 No   District   Installed   position    Apr'09   May'09    Jun'09      Jul'09   Aug'09   Sep'09   Oct'09   Nov'09   Dec'09




      STATE
      /UT**

* Write Yes/No for the month the district has uploaded RIMS data of district

** Write Yes/No for the month the State/UT has uploaded State/UT level data




                                                                               2008-     2009-
Comments: Training was supposed to be imparted by the NPSP during the year 2008-09/ 2009-10 to the Computer Assistants for
uploading data on RIMS but the same was not imparted and moreover HMIS now has been introduced which is used.




                                                                -294-
                   IMMUNIZATION PROGRAM (Component C)
                                     2010-
                           PLAN YEAR 2010-11

             CONSOLIDATE ITEM WISE BUDGET ESTIMATES
SN                          Activity                      Budget Outlay
                                                           (in Lakhs)

1
     Mobility Support for Supervision                              11.00
2
     Cold Chain Maintenance                                         4.42
3    Mobilization of children through ASHA/
     mobilizers                                                  180.54
4
     Alternate Vaccine Delivery                                    54.87
5
     Support for Computer Assistants                               25.44
6
     Printing & Dissemination of Cards etc.                        25.00
7
     Review Meetings                                               25.84
8
     Trainings                                                     22.25
9
     Micro-planning                                                 4.53
10
     POL for vaccine delivery                                      20.00
11
     Computer consumables                                           1.00
12
     Injection Safety                                               3.88
13
     Hiring of Vaccinator for uncovered urban area                  6.40
                                    Total Budget Outlay           385.17
     Pulse Polio                                                  1000.16
                       Grand Total                              1385.33




                                          -295-
             PART-
             PART-D


National Disease Control Programme




                                     296
                   Annual Plan for Programme Performance & Budget for the year
                                  1st April 2010 to 31st March 2011
(These population statistics may be obtained from Census data /State Statistical Dept/ District
plans) No. of districts without DTC: __Nil____
                                             State: Punjab

Objectives:

1.    To achieve and maintain a cure rate of at least 85% among newly detected infectious
(new sputum smear positive) cases, and
2.    To achieve and maintain detection of at least 70% of such cases in the population


                                                      STCS.
This action plan and budget have been approved by the STCS



Signature of the STO__________                    _______

Name_______________          __________________



Section-
Section-A – General Information about the State



  1 State Population (in lakh) please give projected population for next year 27175000
    (2010)

  2 Number of districts in the State                                        20

  3 Urban population (In Lacs)                                              97.43 Lacs

  4 Tribal population                                                       Nill

  5 Hilly population                                                        108814

  6 Any other known groups of special population for specific interventions Nil

     (e.g. nomadic, migrant, industrial workers, urban slums, etc.)




                                                                                            297
No. of districts that submitted annual action plans, which have been consolidated in this state
plan: __20___
Organization of services in the state:
 S.    Name of the District       Projected   Please indicate number   Please indicate no. of DMCs of
No.                              Population     of TUs of each type       each type in the district
                                 (in Lakhs)     Govt         NGO        Public     NGO       Private
                                                                       Sector*               Sector^
1.    AMRITSAR                 2164494            4           -         19        1         -
2.    BARNALA                  602338             1           -         6          -        -
3.    BATHINDA                 1309806            3           -         11        1         1
4.    FARIDKOT                 612598             1           -         6          -        -
5.    FATEHGARH SAHIB          598500             1           -         6          -        -
6.    FEROZEPUR                1934659            4           -         20         -        -
7.    GURDASPUR                2325122            5           -         22         -        -
8.    HOSHIRPUR                1638921            3           -         16         -        -
9     JALANDHAR                2166135            4           -         21        1         1
10    KAPURTHALA               834169             2           -         10         -        -
11    LUDHIANA                 3360187            7           -         34        7         7
12    MANSA                    763583             2           -         7          -        -
13    MOGA                     982783             2           -         10         -        -
14    MOHALI                   735173             2           -         6          -        -
15    MUKATSAR                 861241             2           -         9          -        -
16    NAWANSHAHR               650489             2           -         7         1         -
17    PATIALA                  2039226            4           -         18         -        -
18    ROPAR                    737608             2           -         8          -        -
19    SANGRUR                  1613647            3           -         16         -        -
20    TARN TARAN               1244321            3           -         16         -        -
      TOTAL                    27175000          57           -        268        11        9
*Public Sector includes Medical Colleges, Govt. health department, other Govt. department and
PSUs i.e. as defined in PMR report

^ Similarly, Private Sector includes Private Medical College, Private Practitioners, Private
Clinics/Nursing Homes and Corporate sector




                                                                                               298
RNTCP performance indicators:

Important: Please give the performance for the last 4 quarters i.e. Oct 08___ to September 09_____
 Name of the District       Total   Annualised No of new       Annualised      Cure rate for Plan for the next year Proportion of TB       No. of   No. of MDR
 (also indicate if it is number of   total case    smear       New smear           cases                            patients tested for MDR TB       TB cases
notified hilly or tribal patients detection rate positive     positive case     detected in                                HIV            suspects diagnosed &
        district           put on    (per lakh   cases put    detection rate     the last 4                                              identified   put on
                         treatment*    pop.)         on         (per lakh      correspondi                                                  and     treatment
                                                treatment *       pop)         ng quarters                                              subjects to
                                                                                                                                         C/DST of
                                                                                                                                          sputum
                                                                                              Annualized Cure
                                                                                               NSP case      rate
                                                                                               detection
                                                                                                 rate
AMRITSAR                3777          176         1337             62             82%           80         90    1757/3777=46% Nil               Nil
BARNALA                  685          115          256             57             79%           75         85      130/685=19% Nil               Nil
BATHINDA                2151          166          898             70             93%           80         95      156/2151=7% Nil               Nil
FARIDKOT                1119          186          389             65             87%           75         90     563/1119=50% Nil               Nil
FG SAHIB                 817          138          355             60             75%           75         90      205/817=25% Nil               Nil
FEROZEPUR               2112          110          915             48             81%           70         90      130/2112=6% Nil               Nil
GURDASPUR               2666          116         1242             54             88%           70         95     302/2666=11% Nil               Nil
HOSHIRPUR               2179          134          934             58             86%           70         90      133/2179=6% Nil               Nil
JALANDHAR               3099          144         1327             62             82%           70         90      252/3099=8% Nil               Nil
KAPURTHALA               965          118          444             53             91%           70         95      138/965=14% Nil               Nil
LUDHIANA                5323          162         1937             58             86%           70         90     900/5323=17% Nil               Nil
MANSA                   1054          140          514             69             89%           80         95     185/5323=18% Nil               Nil
MOGA                    1089          112          599             62             91%           80         95     351/1054=32% Nil               Nil
MOHALI                  1325          174          491             68             79%           80         85     465/1325=35% Nil               Nil
MUKATSAR                1259          148          538             65             88%           80         95     187/1259=15% Nil               Nil
NAWANSHAHR               926          143          474             73             93%           80         95       95/926=10% Nil               Nil
PATIALA                 3004          168         1022             57             74%           70         80     621/3004=21% Nil               Nil
ROPAR                    964          132          483             66             91%           80         95      558/964=58% Nil               Nil
SANGRUR                 2197          138          837             53             82%           70         95     364/2197=17% Nil               Nil
TARN TARAN              1517          123          646             53             86%           70         90     341/1517=22% Nil               Nil
Total                                                                                           80         90    7833/38228=20 Nil               Nil
                       38228        142.15        15638          60.65            85%                            %

                                                                                                                                                           299
*   Patients   put   on   treatment   under   DOTS   regimens   only   are   to   be   included.




                                                                                            300
S.No.             Priority areas          Activity planned under each priority area


 1      Medical Colleges both Govt. and 1 a) Training and sensitization of faculty
        Private
                                        1 b) Regular STF and core committee meeting
                                          1 c) Sensitization of residents and interns
                                          through regular CMES
 2      PPs and NGOs            and   IMA 2 a) Involvement of more PPs and IMA members
        involvements
                                          2 b) PPM-IMA partnership and giving project to
                                          IMA members
                                          2 c) Intensive supervision of involved PPs

 3      Intensify IEC activities          3 a) More emphasis on Community meetings
                                          3 b) More emphasis on Patient-provider
                                          meetings
                                          3 c) School activities

 4      Training/Re-trainings         and 4 a) Update training of all Medical Officers
        update training
                                          4 b) Re-training of MOs,STLSs,STSs, LTs and
                                          other staff
                                          4 c) Training of ASHA workers and RHOs
 5      Intensive Supervision             5 a) By State Officers/ Officials
                                          5 b) By STDC Staff
                                          5 c) By DTOs and MO-TCs

 6.     Intensified TB-HIV Collaborative 4 a) Establishment of State TB-HIV Coordination
        activities                       Committee
                                          4 b) Establishment of District TB-HIV
                                          Coordination Committee to ensure smooth
                                          implementation of TB-HIV activities.
                                          4 c) Training for Mo & Paramedical Staff




                                                                                         301
Priority Districts for Supervision and Monitoring by State during the next year
     S No                District                      Reason for inclusion in priority list


1.            Barnala                        Low case detection Rate and Cure Rate
2.            Fatehgarh Sahib                Low case detection Rate and Cure Rate
3.            Ferozepur                      Low conversion Rate, Cure Rate and Total Case
                                             Detection Rate.
4.            Gurdaspur                      Low Detection rate, NSP Case Detection and Cure
                                             rate
5.            Moga                           Low Total Case Detection Rate and              NSP Case
                                             Detection
6.            Patiala                        Cure Rate is low
7.            Sangrur                        Total Case Detection, and NSP Case Detection is low.
8             Tarn Taran                     Total Case Detection, and NSP Case Detection is low.
9




                                                   and
     Section C – Consolidated Plan for Performance and Expenditure under each head, including
            estimates submitted by all districts, and the requirements at the State Level




                                                                                                 302
1.     Civil Works

     Activity No.        No.           No.          Pl provide        Estimated      Quarter in
              required   already       planned      justification     Expenditure    which    the
              as per     upgraded/     to     be    if          an    on       the   planned
              the        present in    upgraded     increase is       activity       activity
              norms      the state     during       planned in                       expected to
              in the                   next         excess      of                   be
              state                    financial    norms (use                       completed
                                       year         separate
                                                    sheet        if
                                                    required)
                 (a)         (b)          (c)             (d)             (e)            (f)
     STDC/        1           1           Nil              -               -              -
     IRL
     SDS          -            -                           -               -              -
     DTCs        20           20           -               -            90,000           For
                                                                                     maintenance
     TUs         57           57           -               -            74,100           For
                                                                                     maintenance
     DMCs        268         268           -               -           2,68,000          For
                                                                                     maintenance
     Amount actually       spent    on    the      last   quarter      4,32,100
     Total
     Rs 1,33,809


           10,00,000/-                                                       (01-10-      31-03-
        Rs 10,00,000/- is likely to be incurred during the next two quarters (01-10-09 to 31-03-10)
in Civil works.




                                                                                                    303
  2.        Laboratory Materials

Activity                 Amount         Amount         Procurement      Estimated      Justification/
                         permissible    actually       planned          Expenditure    Remarks for (d)
                         as per the     spent in the   during     the   for the next
                         norms in the   last       4   current          financial year
                         state          quarters       financial year   for      which
                                                       (in Rupees)      plan is being
                                                                        submitted
                                                                        (Rs.)
                             (a)           (b)              (c)               (d)              (e)
Purchase      of   Lab    42,00,000     23,46,403        45,00,000         42,00,000     As per norms
Materials           by                                                                    given in the
Districts                                                                                   financial
                                                                                          guidelines.
Lab materials for             -              -               -                Nil               -
EQA activity at STDC
(eg.              Lab
consumables        for
trainings,
preparation of Panel
slides etc)
Lab materials &               -              -               -               Nil              -
consumables        for
Culture/DST activity
at IRL and other
Accredited Culture &
DST labs in Govt.
sector      including
Medical Colleges
Total                         -              -               -            42,00,000           -




  Note:- 43,00,000/-                    incurred                              (01-10-      31-03-
  Note:- Rs 43,00,000/- is likely to be incurred during the next two quarters (01-10-09 to 31-03-10)
  in Laboratory Materials




                                                                                                  304
3.      Honorarium

     Activity        Amount        Amount     Expenditure     Estimated            Justification/
                     permissible   actually   (in       Rs)   Expenditure    for   Remarks for
                     as per the    spent in   planned for     the next financial   (d)
                     norms in      the last   current         year for which
                     the state     4          financial       plan    is   being
                                   quarters   year            submitted
                                                              (Rs.)
                         (a)          (b)        (c)                  (d)               (e)
     Honorarium     250        per 4,94,205 9,00,000               37,50,000       Due        to
     for        DOT patient                                                        increase   in
     providers                                                                     no.        of
     (both tribal                                                                  patients
     and        non
     tribal
     districts)
     Honorarium     -              -          -               -                    -
     for        DOT
     providers of
     Cat         IV
     patients


                          No. presently involved in Additional enrolment proposed for the
                          RNTCP                        next fin. year

Community volunteers      1298                         900
 in all the districts*
* These community volunteers are other than salaried employees of Central/State government
and are involved in provision of DOT e.g. Anganwadi workers, trained dais, village health guides,
ASHA, other volunteers, etc.

Note:-    5,00,000/-                                                       (01-10-      31-03-
Note:- Rs 5,00,000/- is likely to be incurred during the next two quarters (01-10-09 to 31-03-10)
in Honorarium.




                                                                                                    305
   Annual Action Plan Format Advocacy, Communication and Social Mobilization (ACSM) for RNTCP Consolidated 20 Districts & State

   1)     Information on previous year’s Annual Action Plan
   a)     Budget proposed in last Annual Action Plan: 30 lacs (including Districts & State level)
   b)     Amount released by the state: 1.20 lacs
   c)     Amount Spent : 1.83 lacs ( including Districts & State level)
   2)     Permissible budget as per norm : 30lacs
   3)     Budget for next financial year for the district as per action plan detailed below:
Program         WHY         For                     WHAT                            When
Challenges                  WHOM
                                                                                                    By WHOM        Monitoring        and Budget
to      be
                                                                                                                   Evaluation
tackled by     ACSM                            ACSM Activities                   Time Frame
ACSM          Objective Target
during the                  Audience
Year
20010-
20010-11

Based on      Desired                   Activities   Media/          Q1     Q2     Q3     Q4        Key            Outputs;     Outcomes   Total
existing      behavior or                                                                           implement                   :          expendi
                                                     Material                                       er      and
TB            action                                                                                                                       ture for
                                                     Required                                       RNTCP
indicators    (make                                                                                                Evidence                the
                                                                                                    officer
and           SMART:                                                                                responsibl     that the Evidence activity
analysis of   specific,                                                                             e        for   activities that      it during
communic      measurable                                                                            supervisio     have been has been the
ation         ,                                                                                     n              done       effective    financia
challenges    achievable,                                                                                                                  l year
              realistic &
(Maximum
              time bound
3
              objectives)
Challenges
)


                                                                                                                                           306
                                 detection
Challenge 1. Increase Total Case detection Rate & Improve Cure Rate

Advocacy Activities

Increase     Gaining        District      1.One to    Publications                           1.State    & 1.           1.               Nil
Total Case   Administrat    Magistrat     one                                                District     Minutes      Increase
                                                      PPT
detection    ive support    e/ District   meeting                        5    5    5    5    Program      of           referral of
Rate         from           Health        district    -Audio    Visual                       Officer      Meeting      chest
             District       Society       authoriti   Adds -Posters-                                                   symptom
             authorities                  es          booklets/brochu                                                  atic
             for increase   Health
                                                      re                                     2. MOTC      2.Photogr
             referral       and other
                                                                                                          aphs
             from OPD       departme                  -poster in local
                                                                                                                       2.Progra
                            nt                        language
                                                      -                                      3.   Support              mme Data
                            administr
                            ators                                                            from    WHO 3.
                                          2.Sensiti                                          Consultant   Reports
                                          zation
                                                                                                          4. Review
                                          meeting                        5    5    5    5                                            Nil
                                                                                                          meeting
                                           ( with                                                         by     the
                                          Civil                                                           authoritie
                                          Surgeons                                                        s
                                          & other
                                          health
                            Private       staff
                            Health        from
                                          State                                                                                      64000/-
                            care
                                          level)                                                                                     (@
                            providers                                    20   20   20   20
                                                      Fact sheets                                                                    800/-)
                            (to     be
                            organized


                                                                                                                                  307
at     TU 3.             -success stories
level on Briefing
rotational
basis)



Districits
having
more than
4      TUs
may club
eith other
TU)


                                                -   -          200000/-
                                            -           20
                                                               (@
             4. World
                                                               10000)
             TB Day
             (District
             level)

             5. State                                   1      250000/-
             level
             World
             TB Day
             function




                                                             308
Communication Activities

Increase      To      inform    1General       Use      of     Booklet,      Flip   57   57   57          57            District   1.Develope     1.Increase
Total Case    communities       Public         regional /      Book,     Posters,                                       Program    d        IPC   of referral
detection     and        care                  local cable     Stickers,                                                Officer    Material                       1026000/
Rate          providers                        channels        Banners,                                                            and                                -
              about the DOT                                    Pamphlet,                                                MOTC       evidence of
                                2. Religious                                                                                                       2.Analysis     (@4500)
              services for                                     Patient                                                             pre testing
                                bodies                                                                                  CF                           of data
              early                                            information                                                         of material
                                               Participate
              detection                                        booklet                                                  STS
                                               in the health                                                                       2.      Flip
                                               mela                                                                                books for
                                3.     Care                                                                             STLS
                                provider                                                                                           STS and CFs

                                                                                                                                   3.     Wall
                                                                                                                                   writings

              Awareness         General        Wall            Matter for wall           -    520         520           DTO,       1.Visible
              Generation in     Public,        painting on     painting                                                            wall
              general public    schools,       TB                                             (@22 /sq    (@22 /sq      MO-TC,     paintings at                   342000/-
                                                                                              feet        feet          MO, IEC    Sub center
                                                                                              approx.,R   approx., Rs   Officer    level
                                                                                              s    300    300
                                                                                              approx.)    approx.)

                                               Flex Sheets                                    1150
                                               (supplied by
                                               state)                                         (@22 /sq                                                            303600/-
                                                                                              feet                                                                 approx.
                                                                                              approx.2
                                                                                              64/-)




                                                                                                                                                                309
Social Mobilization activities
Increase        1.Generate       Community   Community      Flip Chart and                               MO-TC, IEC       Minutes of        Increase
Total Case      Awareness in                 Meeting        Posters, Talks                               Officer,         Meetings          Self
                                 General                                                                                                                   342000/-
detection       general public                                                                           Communicat                         reporting in
                                 Public,     School                                                                       Display      of
Rate                                                                          171   171   171     171    ion                                chest          (@ 500/-
                                 Patients,   Activity                                                                     Posters
                                                                                                         Facilitator,                       symptomati         )
                                 DOTs
                2. Encourage                 Miking                                                      STS              Flip Chart        c
                                 Providers
                early     self
                                             Magic Show
                reporting
                3. Community                 PP Meeting
                Groups. PRI                                                   171   171   171     171                                                      205200/-

                                 School                                                                                                                    (@300/)
                                 Children    Drawing &      Pamphlets   IEC                              DTO,             Documenta         Increase
                                             Quiz           Material                                     Communicat       tion       of     Self
                                                                                                                                                           547200/-
                                             Competition                                                 ion              Activities/       reporting in
                                             s                                                           Facilitator,     Photograph        chest          (@
                                                                                                         STS,       IEC   s                 symptomati     1200/-)
                                                                                                         Officer, NGO                       c
                                                                                                         Partners
                                                                              114   114   114     114                                                      225000/-
                                                                                                                                                           approx.

                                             Radio Advt
                                             thrugh State
                                             level


                                                                                                TOTAL BUDGET                                               35,05,000



    Note:- 28,00,000/-                                                          (01-10-      31-03-
    Note:- Rs 28,00,000/- is likely to be incurred during the next two quarters (01-10-09 to 31-03-10) in IEC Activities..




                                                                                                                                                       310
5.     Equipment Maintenance:

Item                                         No.        Amount        Amount            Estimated           Justification/ Remarks
                                             actually   actually      Proposed for      Expenditure for the for (d)
                                             present    spent in the Maintenance        next financial year
                                             in the     last        4 during            for which plan is
                                             state      quarters      current           being submitted
                                                                      financial yr.     (Rs.)
                                                (a)           (b)          (c)                   (d)                    (e)
Computer                                        25         1,78,577     12,00,000             7,50,000       As per norms given in
(maintenance includes AMC, software and                                                                       Financial Guidelines
hardware upgrades, Printer Cartridges and
Internet expenses)
Binocular Microscopes (RNTCP)                   310            -               -              4,65,000                     -
STDC/ IRL Equipment                              -             -               -                 Nil                       -
Any Other (pl. specify)                          -             -               -              100000                       -
Replacement of lenses (Eye Piece and
objectives)
                                   TOTAL                   1,78,577                           13,15000


Note:- 10,00,000/-                                                          (01-10-      31-03-
Note:- Rs 10,00,000/- is likely to be incurred during the next two quarters (01-10-09 to 31-03-10) in Equipment Maintenance.




                                                                                                                               311
5.     Training:

Activity                             No. in No.       No. planned to be     Expenditure      Estimated         Justification/
                                     the    already   trained in RNTCP      (in        Rs)   Expenditure for remarks
                                     state  trained   during each quarter   planned for      the          next
                                            in        of next FY (c)        current          financial year
                                            RNTCP                           financial year   (Rs.)
                                       (a)      (b)   Q1 Q2 Q3 Q4                (d)                (e)               (f)
Training of DTOs (at National level)   20       20     2   2   2   2                               50,000              -
Training of MO-TCs                     57       57     5   5   5   5                               10,000              -
Training of MOs (Govt + Non-Govt)     2400     2000   100 100 100 100                            17,60,000             -
Training of LTs of DMCs- Govt + Non    483     433    25 25 25 25                                3,57,500              -
Govt
Training of MPWs                      4416     4016   100 100 100 100                            1,43,000             -
Training of MPHS, pharmacists, 2400            2000   100 100 100 100                            1,43,000             -
nursing staff, BEO etc
Training of Community Volunteers      2722            100 100 100 100                            40,000               -
Training of Pvt Practitioners                                                                                         -
Other trainings #                                                            20,00,000                                -

Re- training of MOs                  1155     900     70   70   70    45                         1,20,000             -
Re- Training of LTs of DMCs          492       -      25   25   25    25                          60,000              --
Re- Training of MPWs                 1687             25   25   25    25                          30,000              -
Re- Training of MPHS, pharmacists,   404              20   20   20    20                          24,000              -
nursing staff, BEO
Re- Training of CVs                  404              50   50   50    50                         60,000               -
Re-training of Pvt Practitioners     160                                                                              -




                                                                                                                           312
Activity                                No. in No.           No. planned to be        Expenditure      Estimated         Justification/
                                        the    already       trained in RNTCP         (in        Rs)   Expenditure for remarks
                                        state  trained       during each quarter      planned for      the          next
                                               in            of next FY (c)           current          financial year
                                               RNTCP                                  financial year   (Rs.)
                                                             Q1 Q2 Q3 Q4                                                         -
TB/HIV Training of MO-TCs and MOs        1155                125 125 125 125                               2,00,000              -
TB/HIV Training of STLS, LTs ,           4000       2000     500 500 500 500                               6,50,000              -
MPWs,     MPHS,     Nursing   Staff,
Community Volunteers etc
TB/HIV Training of STS                     40                 10    10    10     10                         13,000              -
Training of MOs and Para medicals in                                                                                            -
DOTS Plus for management of MDR
TB
                                                                                                                                -
Provision for Update Training at
Various Levels #

Review Meetings at State Level                                                                         1,00,000

Any Other Training Activity                                                                                                     -
Amount spent in the last 4 Quarter,
Rs. 907992/-

Note:-    15,00,000/-                                     next              (01-10-      31-03-
Note:- Rs 15,00,000/- is likely to be incurred during the next two quarters (01-10-09 to 31-03-10) in Training .



# Please specify                                                       37,60,500/-
                                                             TOTAL Rs. 37,60,500/-




                                                                                                                                     313
 7.       Vehicle Maintenance:

Type        of Number      Number Amount                Expenditure      Estimated       Justification/
Vehicle        permissible actually spent     on        (in       Rs)    Expenditure     remarks
               as per the present POL        and        planned for      for the next
               norms in             Maintenance         current          financial year
               the state            in       the        financial        for which plan
                                    previous 4          year             is        being
                                    quarters                             submitted
                                                                         (Rs.)
                     (a)           (b)         (c)             (d)             (e)             (f)
Four                 21            17                                       27,00,000           -
Wheelers                                                 30,00,000
Two                  57            57    19,05,265                         14,25,000            -
Wheelers
                                                             TOTAL       41,25,000     -
 Note:- Rs 20,00,000/- is likely to be incurred during the next two quarters (01-10-09 to 31-03-10)
 Note:-    20,00,000/-                                                       (01-10-      31-03-
 in Vehicle Maintenance.

 8.       Vehicle Hiring*:

Hiring of Number             Number      Amount      Expenditure      Estimated           Justification/
Four      permissible        actually    spent in    (in       Rs)    Expenditure     for remarks
Wheeler   as per the         requiring   the         planned for      the next financial
          norms in           hired       prev. 4     current          year for which
          the state          vehicles    qtrs        financial        plan   is   being
                                                     year             submitted (Rs.)
              (a)            (b)         (c)         (d)              (e)                 (f)
For STC/                                                                     Nil
STDC
For DTO              -             -           -           -                  -                  -
For MO-             57             -           -           -              33,51,600           7 Days
TC                                                                                         Tour/Month
                                                                                           by MOTC, Rs
                                                                                            700/Day
TOTAL                                                           Nil          33,51,600
1,50,000
                    * Vehicle Hiring permissible only where RNTCP vehicles have not been provided

 Note:- Rs 1,00,000/- is likely to be incurred during the next two quarters (01-10-09 to 31-03-10)
 Note:-    1,00,000/-                                                       (01-10-      31-03-
 in Vehicle Hiring.

  * 5 two wheelers are required for few districts which are unserviceable condition –Appx Amount
          Rs.-
 required Rs.- 3 Lacs.




                                                                                                    314
9.      NGO/ PP Support:

                                     01-10-
NGO/ PP Support: (New schemes w.e.f. 01-10-2008)

 Activity                      No.    of   Additional   Amount     Expenditure     Estimated          Justification/
                               currently   enrolment    spent in   (in       Rs)   Expenditure for    remarks
                               involved    planned      the        planned for     the         next
                               in          for   this   previous   current         financial year
                               RNTCP       year         4          financial       for which plan
                                                        quarters   year            is         being
                                                                                   submitted
                                                                                   (Rs.)
                                 (a)          (b)         (c)          (d)                (e)              (f)
 ACSM       Scheme:      TB
 advocacy,
                                  26           -         42,500                            200000           -
 communication,         and
 social mobilization
 SC     Scheme: Sputum
                                  20           -                                           100000           -
 Collection Centre/s
 Transport         Scheme:
 Sputum Pick-Up and               5            -                                            25,000          -
 Transport Service
 DMC Scheme: Designated
 Microscopy            Cum
                                  19           -         50,000                            200000           -
 Treatment Centre (A &
 B)
 LT                Scheme:
 Strengthening      RNTCP          -           -           -                                      -         -
 diagnostic services
                                                                    10,00,000
 Culture and DST Scheme:
 Providing          Quality
 Assured Culture and               -           -           -                                      -         -
 Drug         Susceptibility
 Testing Services
 Adherence         scheme:
 Promoting       treatment       251           -           -                               100000           -
 adherence
 Slum Scheme: Improving
 TB control in Urban              11           -           -                               400000           -
 Slums
 Tuberculosis Unit Model           -           -           -                                      -         -
 TB-HIV            Scheme:
 Delivering         TB-HIV                                                                                  -
                                   -           -           -                                      -
 interventions to high HIV
 Risk groups (HRGs)
 TOTAL                                                                  92,500        10,25,000
 10,00,000
Note:-    8,00,000/-                                                       (01-10-      31-03-
Note:- Rs 8,00,000/- is likely to be incurred during the next two quarters (01-10-09 to 31-03-10)
   NGO/
in NGO/ PP Support.




                                                                                                                  315
10.      Miscellaneous:

      Activity*     Amount      Amount     Expenditur    Estimated      Justification/
      e.g. TA/DA,   permissi    spent in   e (in Rs)     Expenditure    remarks
      Stationary,   ble    as   the        planned for   for the next
      etc           per the     previous   current       financial year
                    norms in    4          financial     (Rs.)
                    the state   quarters   year
                       (a)         (b)          (c)          (d)                   (e)
      All            500000     21,59,77     40,00,000     5000000        Touring activities
      permissible       0           2                                       proposed to be
      activities                                                         increased. TA/DA of
                                                                            STO and of all
                                                                           contractual staff
                                                                          postage, telephone
                                                                           bills, stationery,
                                                                         expenses on review
                                                                          meetings etc to be
                                                                          paid on this head.
                                               TOTAL 5000000
                    * Please mention the main activities proposed to be met out through this head



Note:-    30,00,000/-                                                       (01-10-      31-03-
Note:- Rs 30,00,000/- is likely to be incurred during the next two quarters (01-10-09 to 31-03-10)
in Miscellaneous.




                                                                                                316
11.    Contractual Services:

Category of Staff No.            No.        No.          Amoun      Expendi     Estimated Justificati
                  permissibl     actuall    planned      t spent    ture (in    Expendit on/
                  e as per       y          to      be   in the     Rs)         ure     for remarks
                  the norms      presen     additional   previou    planned     the next
                  in the state   t     in   ly hired     s     4    for         financial
                                 the        during       quarter    current     year
                                 state      this year    s          fin. year   (Rs.)
                       (a)         (b)          (c)                    (d)          (e)
TB/HIV Coord.           1           0            -                                324000
Urban          TB       2           2            -                                576000
Coord.
MO-STCS                 1           1           -                                324000
State                   1           1           -                                270000
Accountant                                                                                     50%
State IEC Officer      1           1            -                               270000      increase
Pharmacist             1           1            -                               153000        due to
Secretarial Asst       1           1            -                               126000       revised
State DEO              1           1            -        3,02,98,   3,30,00,    126000      pay scale
MO-DTC                 3           2            -          574        000       864000        & 5%
STS                    57          57           -                               7695000    increment
                                                                                           increment
STLS                   57          57           -                               7695000          .
TBHV                   71          71           -                               7668000
DEO                    20          20           -                               2160000
Accountant-part        20          20           -                               720000
time
Contractual LT        127         127           -                               1485900
                                                                                   0
Driver                  1           1           -                                81000
Any         other                               -                                               -
contractual post       20
approved under                                                                   600000
RNTCP                   1           1
a.                                                                               480000
Communication
Facilitators
b.
Microbiologist

TOTAL                                                                       4,49,91,0
3,02,98,574 3,30,00,000                                                            00
Note:-    1,80,00,000/-                                                       (01-10-      31-03-
Note:- Rs 1,80,00,000/- is likely to be incurred during the next two quarters (01-10-09 to 31-03-
10)                  in                                     Contractual                  Services.




                                                                                                    317
    12.     Printing:

Activity                  Amount        Amount     Expenditure     Estimated Expenditure Justificatio
                          permissibl    spent in   (in       Rs)   for the next financial n/ remarks
                          e as per      the        planned for     year for which plan is
                          the norms     previous   current         being submitted
                          in      the   4          financial       (Rs.)
                          state         quarters   year
                              (a)          (b)          (c)                (d)                   (e)
Printing-State level:*     4200000       105188      40,00,000           4200000               As per
                                                                                               norms
                                                                                              given in
                                                                                              Financial
                                                                                             Guidelines
Printing-        Distt.        -           -             -                    -                   -
Level:*


                                                      * Please specify items to be printed in this column



    Note:- Rs 40,00,000/- is likely to be incurred during the next two quarters (01-10-09 to 31-03-10)
    Note:-    40,00,000/-                                                       (01-10-      31-03-
    in Printing.



    13.     Research and Studies (excluding OR in Medical Colleges):



    Any Operational Research projects planned (Yes/No) Yes (2 OR Projects)

    Estimated Total Budget _____10,00,000_______________________




                                                                                                     318
14.    Medical Colleges

Activity                             Amount         Estimated              Justification/
                                     permissible as Expenditure for the remarks
                                     per norms      next         financial
                                                    year(Rs.)
                                           (a)               (b)                   (c)
Contractual Staff:
       MO-Medical College (Total         16,000x8             2304000
approved in state __8_ )
       STLS in Medical Colleges                                                 50% increase due
(Total no in state __Nil_ )                                      Nil             to revised pay
       LT for Medical College                                                      scale & 5%
(Total no in state __8_ )                6500x8               936000               increment
       TBHV for Medical College
(Total no in state__8_)                                       864000
                                         6,000x8
Research and Studies:                                                                   -
       Thesis of PG Students       20000x8                    160000
       Operations Research*        50000x4                    200000
Travel Expenses for attending            -                    250000                    -
STF/ZTF/NTF meetings
IEC: Meetings and CME planned            -                    170000                    -
Equipment Maintenance at Nodal           -                       -                      -
Centres
Amount spent in the last 4 Quarter       -                        -                     -
(Rs. 21,39,562/-)
                                       Total                 48,84,000


Note:-    20,00,000/-                          during                       (01-10-      31-03-
Note:- Rs 20,00,000/- is likely to be incurred during the next two quarters (01-10-09 to 31-03-10)
in Medical Colleges.




                                                                                              319
15.     Procurement of Vehicles:

      Equipment       No.           No. planned Estimated Expenditure Justification/
                      actually      for              for the next financial remarks
                      present in    procurement year for which plan is
                      the state     this     year being submitted (Rs.)
                                    (only       if
                                    permissible
                                    as        per
                                    norms)
                      (a)           (b)                        (c)              (d)
      4-wheeler **    17            -                           Nil             -
      2-wheeler       57            -                           Nil             -
                                         ** Only if authorized in writing by the Central TB Division

Note:-    80,000/-                 incurred                              (01-10-      31-03-
Note:- Rs 80,000/- is likely to be incurred during the next two quarters (01-10-09 to 31-03-10)
Procurement of Vehicles

16.     Procurement of Equipment:

      Equipment          No. actually No.           Estimated           Justification/
                         present in planned         Expenditure for the remarks
                         the state    for this      next financial year
                                      year          for which plan is
                                      (only as      being    submitted
                                      per           (Rs.)
                                      norms)
                         (a)          (b)           (c)                    (d)
      Office Equipment 21
      (Computer,
      modem, scanner,
      printer, UPS etc.)
                         Nil          1                    40,000          State Headquarter
      Laptop
      Any         Other Nil           1                                    State Headquarter
      (digital camera)                                     10,000
      Amount actually                 Total                50,000
      spent in last 4
      Quarter 83,232


Note:- Rs 1,75,000/- is likely to be incurred during the next two quarters (01-10-09 to 31-03-10)
Note:-    1,75,000/-                                                       (01-10-      31-03-
Procurement                                       of                                  Equipment.




                                                                                                320
Section D: Summary of proposed budget for the state –
 SN    Revised
       Revised National Tuberculosis Control            (Rs. In Lakh)
       Programme (RNTCP)
       Activity / Item                                    2010-11
                                                          2010-
   1   Civil works                                          5.40
   2   Laboratory materials                                 31.20
   3   Honorarium                                           15.00
   4   IEC/ Publicity                                       17.50
   5   Equipment maintenance                                8.40
   6   Training                                             18.90
   7   Vehicle maintenance                                  30.90
   8   Vehicle hiring                                       14.40
   9   NGO/PP support                                       24.30
  10   Miscellaneous                                        27.30
  11   Contractual services                                425.10
  12   Printing                                             21.00
  13   Research and studies                                 5.00
  14   Medical Colleges                                     36.60
  15   Procurement –vehicles                                0.50
  16   Procurement – equipment                              0.00
                           TOTAL
                           TOTAL                           681.50




•                                NRHM-
       Additionality Funds from NRHM-Details of the activities with justification for which
Additionally Funds are proposed to be sought.


             No of TUs = 57

             Electronic Ticker Machine required = 57

                                                 10,000/-
             Approx cost of one Ticker Machine = 10,000/-

             Total Amount required                 57*10,000=5,70,000/-
                                                 = 57*10,000=5,70,000/-




                                                                                        321
NATIONAL LEPROSY ERADICATION PROGRAMME




                                         322
                              PROGRAMME-
 NATIONAL LEPROSY ERADICATION PROGRAMME-PUNJAB
                                       2010-
                               PIP for 2010-11

   1.               analysis-
          Situation analysis-

   Punjab is a low endemic state in terms of prevalence of leprosy. There were a total of 868
                           31-03-
cases on record as on 31-03-2009 with which prevalence rate becomes 0.32/10000
                                2008-
populations. During the year 2008-09, 933 new leprosy cases have been detected and
brought under treatment. Out of this, 180 patients are Punjabi Cases, which is a matter of
concern. As much as, State is already under elimination goal of Govt. of India i.e. less than 1
case/10000 population. National PR is 0.72/10000 whereas of Punjab is 0.32/10000 as on
31-03-2009
31-03-2009.
                                  2010-
Objective, Strategies & Work Plan 2010-11
Objective:
   1)      To continue the efforts to achieve elimination of leprosy through existing MDT
   services.

2) To maintain the gains achieved so far & to continue the efforts to achieve     elimination
at Block level & village level.

3) To reduce the leprosy burden

   4)    To make quality leprosy services available through integrated general health care
   system as well as other private and Public health facilities.

5) To provide DPMR services
    Strategies
1) Strengthening and Integration of Service Delivery
2) Disability care and prevention
3) Information, Education & Communication.
4) Training
5) Institutional Development

   2.                       SHS-
          Performance under SHS-NLEP

             Indicators               2006-
                                      2006-        2007-
                                                   2007-       2008-
                                                               2008-       2009-10
                                                                           2009-
                                       07           08          09         (till Jan.
                                                                            2010)
    No. of new cases detected          958          964
                                                    964         933           691
    (ANCDR)
                                      (3.61)      (3.57)       (3.33)          -
      No. of cases on record at        849         897          923          845
                 year end (PR)        (0.32)      (0.33)       (0.32)       (0.30)
    No. of Grade II disability          28          40           34           37
    among new cases (%)                2.9%       4.15%        3.64%        5.35%
    Treatment      Completion         89.59       85.96           -            -
    Rate

                                                                                           323
    Re-constructive Surgery         -            -           -             7
    conducted
   (Cumulative number to be mentioned and rate / percentage to be given in brackets)

                                   GENERAL HEALTH SET UP

MEDICAL FACILITIES IN PUNJAB

                        Regions:
(i) Geographical Zone / Regions:

1. Divisions                            04
2. Districts                            20
3. Sub-Divisions                76
4. Blocks                       141
5. No. of Cities/Towns          157
6. No. of Villages              12673
7. State Population                     28015424 as on 31.03.2009
8. Literacy Rate                69.95
9. District Leprosy Societies   20
                                Rural          Urban         Total
10. No. of Hospitals                    73             146           219
  CHCs                          72             56            128
  PHCs                          443            41            484
  SHCs/Dispensaries             1207           242           1449
11.Sub-Centres                  2858           -             2858

   3.     Infrastructure
   State Leprosy Cell    : Contractual Staff

   A)                                Pb-
           HQ : State Health Society Pb-NLEP.
              1. Chairman: PSHFW                 5. Surveillance Medical Officer (SMO)
           2. Vice-Chairman: MD-NRHM                  6. Budget & Finance Officer, (BFO)
          3. Mem. Secretary: DHS                     7. State Data Entry Operator (SDEO)
            4. Member: SPO-NLEP                        8. Administrative Assistant (AA)
        District HQ            Contractual
                             : Contractual Staff

                          B) Distt : District Health Societies NLEP.
           1. Chairman: Deputy Commissioner           4. Non-Medical Supervisor (NMS)
                    2. Vice Chairman: Civil Surgeon             5. Driver
                                     3. Mem. Secretary: DLO

   4.                plan-
           Training plan-
         2 days Orientation training of MOs 2 batches of 20 Trainee in each district.
           2 days Orientation training of Health Workers 2 batches of 20 Trainee in        each
           district.
         5 days training of Distt Lab. Technician-1 Batch of 20 Trainees



                                                                                            324
                          11,75,000/-              calculated
         Total Amount Rs. 11,75,000/- (Note: Rates calculated as per NRHM new financial
         norms)


   5.          plan-
           IEC plan-
         IPC & folk media -Magic Show (480), School Debates (240)
         Rural & outdoor media -Wall Painting (2150), Hoardings (100), Bus Pannels
                                  (500), PRI Meetings (20), Mehalan Mandal (240) &
                                  Community meetings (240)
         Mass media- (A.I.R Advertisement)
         Health melas- (Orientation Camps (120) , Rallies (40)
         Celebration- (Anti-Leprosy Day Activities)

                            31,72,500/-
           Total Amount Rs. 31,72,500/-

   6.          plan-
         DPMR plan-
       Procurement of MCR footwears (120 Per Distt.) , Aids & Appliances
       Name of recognized institutes conducting RCS –(Through NGOs)
    Expected Number of patients to be undergoing RCS-20
       Coordination with other departments for rehabilitation of leprosy affected persons
             Amount     10,50,000/-
       Total Amount Rs. 10,50,000/-

   7.                        Control-
             Urban Leprosy Control-
         List of Identified urban localities- 13 in (11) Districts.
         As per Guidelines Plan for urban leprosy control. Activities to be under taken:
        i) Identification of Health facilities.
        ii) Identification of willing stake holders
        iii) Involvement of local body government of the Municipal Corporation and District
        Administration as the pivotal agency for implementation of MDT service delivery
        through their health institutions
        iv) Identify and delegate responsibility to one nodal point.
        v) Organization of sensitization meetings.
        vi) Form an urban leprosy control committee.
        vii)Preparation of memorandum of understanding (MOU to be signed by all partners).
        viii)       Develop a system of record keeping and reporting by each centres.
        ix) Develop a system of MDT drug supply.

                        8,00,000/-
       Total Amount Rs. 8,00,000/-
           Colonies-
8. Leprosy Colonies-
        Number of leprosy colonies- 34 appox.
        Number of persons living in colonies- 2192
        Number of persons with grade II disability-Exact Nos. not available
        Number of cases with ulcers- 533
        Services to be provided during the year- Free health checkup, medicines, dressing
        materials, MCR footwear and Civic amenities like electricity, water, sanitation etc
   9.                Supplies-             plan-
          Material & Supplies- Procurement plan-



                                                                                       325
           After getting approval of the budget the Supportive Medicines, Lab Reagents and
   Printing of Registers/Forms the procurement will be undertaken by the Purchase Section
   of State HQ DHS Office, Punjab.

                           10,40,000/-
          Total amount Rs. 10,40,000/-

   10.       Services-
        NGO Services-
   Names of NGOs providing leprosy services under SET scheme- (NIL)
                                                               NIL)

   11.                  ASHA-
          Incentive for ASHA-
   Number of ASHA trained & involved in NLEP. Number of new PB & MB cases likely to be
detected during the year by ASHA based on the trend of new case detection.

   MDT Management-                                     Rs. 100000/-
   Sensitization of 2000 ASHA Worker                   Rs. 100000/-

                           2,00,000/-
          Total Amount Rs. 2,00,000/-


   12.                                  plan-
             NLEP monitoring and Review plan-
         State level 4 meetings -     Rs. 100000/-
         District level               -       Nil

                           1,00,000/-
          Total Amount Rs. 1,00,000/-

   13.                                hiring-
           POL/Vehicle operation and hiring-
   State level- 2 vehicles             Rs. 1,70,000/-
   District level 10 Nos.      Rs. 7,50,000/-

             Note:   This is subject to approval of 6 more post of drivers.

                           9,20,000/-
          Total Amount Rs. 9,20,000/-

   14.                           Consumable-
          Office expenditure and Consumable-
      State level              Rs. 96000/-
   District level              Rs. 640000/-

   Note:     This is as per norms of Central Leprosy Division (CLD), New Delhi.

                           7,36,000/-
          Total Amount Rs. 7,36,000/-



   15.           Assistance-
            Cash Assistance-
   It is required for purchase of new vehicles.
                       5,00,000/-
   Total Amount Rs. -5,00,000/-



                                                                                      326
Format for submitting budget proposal

 SN     National Leprosy Eradication Prorgamme              (Rs. In Lakh)

        Activity / Item                                       2010-
                                                              2010-11
  1     Contractual Services
 1.1    State-                                                 32.00
 1.2    District -
  2     Services through ASHA/USHA
 2.1    Sensitization of ASHA, Incentive to ASHA                2.00
  3     Office expenses & Consumables                           7.50
  4     Capacity building (Training)
 4.1    4 days training of newly appointed MO (rural &         15.00
        urban)
 4.2    3 days training of newly appointed health
        worker & health supervisor
 4.3    2 days refresher training of MO
 4.5    5 days training of newly appointed Lab.
        Technician
  5     Behavioral Change Communication (IEC)

 5.1    Mass media, Outdoor media, Rural media and             20.00
        Advocacy
  6     POL/Vehicle operation & hiring
 6.1    2 vehicles at state level & 1 vehicle at district       3.00
        level
  7     DPMR
 7.1    MCR footwear, Aids and appliances, Welfare             10.50
        allowance to BPL patients for RCS, Support to
        govt. institutions for RCS
  8     Material & Supplies
 8.1    Supportive drugs, lab. reagents & equipments           10.50
        and printing forms
  9     Urban Leprosy Control
 9.1    Township, Medium cities-I, Medium cities-II &           8.00
        Mega cities
  10    NGO - SET Scheme                                        0.00
  11    Supervision, Monitoring & Review
 11.1   Review meetings and travel expenses                     2.50
  12    Cash Assistance                                         4.00


                                                                            327
TOTAL   115.00




                 328
                     2010-
                 PIP 2010-2011

NATIONAL VECTOR BORNE DISEASE CONTROL PROGRAMME

                (NVBDCP) PUNJAB




                                                  329
NVBDCP: National Vector Borne Disease Control Programme is an umbrella
programme for prevention & control of 6 vector borne diseases, namely:

1)     Malaria          2) Dengue   3) Chikungunya          4) Lymphatic Filariasis
5)     Japanese Encephalitis        6) Kala Azar

The National Vector Borne Disease Control Programme (NVBDCP) is an integral part
of the India’s National Rural Health Mission (NRHM).
The National Health Policy (NHP) of 2002 has set goals:
     1. Achieving reduction of mortality due to Malaria, Dengue and JE by 50% by
       the year 2010 along with efficient morbidity control;
     2. Eliminating Kala-azar by the year 2010,
     3. Elimination of Lymphatic Filariasis by 2015.
The NVBDCP envisages a well informed and self-sustained, healthy India free from
vector borne diseases with equitable access to quality health care and the
Programme activities are in tandem with the NHP and NRHM goals as well as the
Millennium Development Goal of halting and reversing the incidence of malaria and
other vector borne diseases by the year 2015 towards reduction of poverty.
Burden             and          distribution           of             Malaria            in
Punjab:

                                                                                2811
     3000
                                                            2494
     2500

                 1898               1917
     2000


     1500


     1000


      500


          0
                    2006               2007                    2008             2009 (Till Oct)




                                                                                       330
Although, the state of Punjab has reported an upsurge of the cases of Malaria over
the years, no death due to Malaria has been reported in the state. The increase in the
number of Malaria cases can be attributed to:

    1. Increased surveillance to find malaria cases among fever cases.
    2. Changed Drug Policy for Malaria (where in Presumptive treatment to all fever
       cases has been stopped leading to more presentation of the hidden infection).
    3. Increased projects/construction sites throughout the state of Punjab leading
       to increased vector breeding and increased man-mosquito contact.
Burden and distribution of Dengue in Punjab:


                                                         4394
      4500
      4000
      3500
      3000
      2500
      2000        1166
      1500
      1000                                                                  204
                                      28      0                   21
       500                6                                                         1
         0
                   2006                2007                2008          2009(Till Nov)

                                              Cases   Deaths


Dengue has shown cyclical epidemics in Punjab as well as in India and is considered
a very important emerging infectious disease. Cases of Dengue have shown a marked
decrease as compared to last year (2008) but owing to its cyclical nature and its
potential to cause morbidity and mortality, preparations have to made before hand
to deal with any eventuality.

Chikungunya:        No case of Chikungunya has been reported in Punjab till date.
The vector of Chikungunya is same as that of Dengue and owing to the history of
outbreaks of Dengue in Punjab, the vector control measures for Dengue helps in
control of Chikungunya as well.

Japanese Encephalitis:     3 cases of JE were reported in Punjab in 2008. No case of
JE has been reported in 2009 till date. IEC activities regarding Vector Borne Diseases
and measures undertaken for control of vector of Malaria helps in control of JE as
well as the breeding habits of the vector of JE resembles those of the vector of
Malaria.


                                                                                    331
     Lymphatic Filariasis and Kala Azar: No case of Lymphatic Filariasis and Kala Azar has
     been reported from Punjab till date. The IEC activities regarding these diseases and
     the control measures for Lymphatic Filariasis and Kala Azar have to be undertaken
     throughout Punjab.




     Programme Implementation Planning (Financial)

SN
                National Vector Born Disease Control Programme             Rs in Lakhs
                                                                                               Remarks
                   Activity                Q1      Q2      Q3      Q4         Total

     MALARIA
      Supplies, Consumables & Medicines

     Glass Slides - Qty 3301400
     Lancets - Qty 3301400
     Tab Chloroquine - Qty 9500000
     Tab Primaquine 2.5 mg - Qty 100000
     Tab Primaquine 7.5 mg - Qty 100000
                    Total                 0.00    0.00     0.00   0.00        0.00
           Indoor Residual Spray
     DDT 50% - Qty 18 MT                                                                  Supplied in kind
                                                                                          by GOI
     Malathion 25% - Qty 175 MT
                    Total                 0.00    0.00     0.00   0.00        0.00
     Anti Larval Measures in Urban &
     Peri-
     Peri-Urban Areas
     Temephos - Qty 2500 Litres
     Pyrethrum Extract 2% - Qty 6000
     Litres
     Bti (WP) - 16 MT
     Kerosene Oil - 114000 Litres
                    Total                 0.00    0.00     0.00   0.00        0.00
     NAMMIS                                                                  20.00
     IEC                                                                     15.00
     Trainings (SMOs, Mos &
                                                                              5.00
     Paramedics)
                    Total                   0       0       0       0         40.00
               Total MALARIA              0.00    0.00    0.00
                                                          0.00    0.00       40.00
     DENGUE & CHIKUNGUNYA
     Sentinel Surveillance - 6 SSHs @
                                                                              3.00
     50,000/-
                   Hospitals
     Mac ELISA Kits 6 SSHS @ 5                                                            In Kimd by GOI
     Monitoring & Evaluation - State &                                       10.00

                                                                                         332
District
Epidemic Preparedness - State &
                                                                               10.00
District
Fogging Machines - State & District                                            3.05
IEC, Trainings & Workshop - State &
                                                                               12.00
District
       Total Dengue & Chikungunya           0.00    0.00   0.00    0.00        38.05
             Decentralised
    Cash for Decentralised Commodities                                         36.33

    TOTAL VECTOR BORNE DISEASES             0.00    0.00   0.00    0.00      114.38

    Commodity to be supplied by GOI                                           24.03
      TOTAL BUDGET REQUIRED                 0.00    0.00   0.00    0.00      138.41




NVBDCP Punjab

    SN      Activity proposed             Amount                     Remarks
                                                                     Remarks
                                         Proposed



1         IRS in Rural Areas              Actual     Funds to be utilized from VHSC funds as
                                                     per the guidelines of Directorate of
                                                     NVBDCP, New Delhi for conducting IRS
                                                     (Indoor Residual Spray) with DDT &
                                                     Malathion as per the guidelines of in
                                                     District Amritsar, Tarn Taran, Ferozepur,
                                                     Faridkot, Mansa, Muktsar & Sangrur




                                                                                       333
                                    Annexure 3

                                 ASHA Incentives



         Activity                  Incentive rate                     Remarks

Preparation of Blood Slide        Rs 5/ per slide           For preparation of Blood
                                                            slide   of    fever   case
                                                            suspected to be a case of
                                                            malaria and transporting it
                                                            to PHC Laboratory



1.    Population covered by ASHA                    =       500     (MPHW M &
                                                            ASHA     will   cover   1000
                                                            population)
2.    Target of Blood Slide Collection         = 50(10% of Population in one
                                                            year)
3.    Yearly payment to ASHA for                    =       250 (50X5)slide collection
4.     No. of ASHA                        =         17756
5.    Total Amount                        =         4400000 (17756X250)




                                                                                     334
                                                                                ANNEXURE 4

    Staff Requirement for Indoor Residual Spray with DDT and Malathion in rural areas as per GOI guidelines and budget required from concerned VHSC of villages as per GOI
                                                                                  guidelines



                       Indoor Residual Spray (IRS) with DDT 50%



     District            Block                     Subcentre         Villages    Population     Days required              Rate               Total Budget       DDT Required

                                                                                                 by a squad of         (928 for 5+1)           for 2 rounds          (MT)

                                                                                                     5+1            (from VHSC funds)

I   Tarn Taran          Sarhali          1          Sarhali-I          0.5          5816              29                  26986                   53972

                        Sarhali          2         Sarhali-II          0.5          5376              27                  24945                   49889

                        Sarhali          3         Gandiwind            4           6969              35                  32336                   64672

                        Sarhali          4           Khara              2           4397              22                  20402                   40804

                        Sarhali          5          Warrian             3           4147              21                  19242                   38484

                        Sarhali          6        Dader Sahib           3           6163              31                  28596                   57193

                       Fatehabad         7          Dhunda              3           6853              34                  31798                   63596

                       Mianwind          1      Goindwal Sahib          6          10190              51                  47282                   94563




                                                                                                                                                                    335
                Total District        8                       22         49911          250             231587            463174         7.49



II   Amritsar            Threawal     1      Threawal          5         6903            35              32030            64060

                                      2    Bhangali Kalan      7         5325            27              24708            49416

                         Manawala     3       Jaanian          3         7762            39              36016            72031

                                      4    Jandiala Guru       1         14274           71              66231            132463

                Total District        4                       16         34264          171             158985            317970         5.14

        Total with DDT 50%            12                      38        84175           421             390572           781144         12.63




                 Indoor Residual Spray (IRS) with MALATHION 25%

                                                                                                                                       Malathion
     District              Block             Subcentre      Villages   Population   Days required         Rate          Total Budget   Required

                                                                                    by a squad of     (928 for 5+1)     for 3 rounds     (MT)

                                                                                        5+1         (from VHSC funds)

I    Faridkot            Jhandsahib   1      Bhagthalla        5         5105            26              23687            71062




                                                                                                                                        336
                     Bajja Khana   2    Bajja Khana    1    6339    32    29413    88239

                                   3    Jhakhar Wala   2    5882    29    27292    81877

                                   4    Chand Bhaan    1    4460    22    20694    62083

                                   5     Bishnandi     3    6540    33    30346    91037

                                   6    Rorhi Kapura   2    6340    32    29418    88253

                                   7      Gurusar      1    3894    19    18068    54204

                                   8      Sarawan      1    5095    25    23641    70922

                                   9       Jaitton     1    35340   177   163978   491933

                                   10      Sivian      1    4750    24    22040    66120

             Total District        10                  18   83745   419   388577   1165730   75.37

                                                                     0

II   Ferozepur         Mamdot      1    Hamad Chakk    13   8679    43    40271    120812

                                   2       Attari      10   8411    42    39027    117081

                                   3       Rakhri      10   8473    42    39315    117944

                                   4     Phularwan     8    6616    33    30698    92095

                     Khuhi Khera   5     Kabul Shah    2    9079    45    42127    126380

                                   6    Ajjam Wala     2    7134    36    33102    99305

                                   7     Katehrha      2    5975    30    27724    83172




                                                                                             337
                 Total District         7                     47    54367   272   252263   756789   48.93




III   Sangrur             Kourhian      1      Kourhian       2     6650    33    30856    92568

                 Total District         1                     2     6650    33    30856    92568     5.99




IV    Mukatsar        Chakk Sherawala   1   Chakk Sherawala   2     5966    30    27682    83047

                             Doda       2       Doda I        0.5   5484    27    25446    76337

                                        3       Doda II       0.5   5687    28    26388    79163

                                        4      Gilje Wala     2     4595    23    21321    63962

                 Total District         4                     5     21732   109   100836   302509   19.56




V      Mansa                Khiala      1   Thuthuian Wali    2     6893    34    31984    95951

                                        2    Bhaini Bagha     1     5830    29    27051    81154

                                        3       Bhupal        1     4001    20    18565    55694

                                        4    Khiala Lalaan    1     5804    29    26931    80792




                                                                                                    338
                           5    Khiala Malak Pur   3     4302            22               19961    59884

                           6      Attla Kalaan     2     5122            26               23766    71298

       Total District      6                       10   31952           160              148257   444772    28.76




Total with MALATHION 25%   28          0           82   198446          992             920789    2762368   178.60



                                                                Total Budget Required for IRS     3543512




                                                                                                            339
PIP UNDER INTEGRATED DISEASE SURVEILLANCE PROJECT FOR THE STATE OF
                     PUNJAB         2010-
                     PUNJAB (PERIOD 2010-11)

                                                                2010-
                                                                2010-
                                                                 2011
  Activity     Sub-
               Sub- Activity   Tasks                           (Amount                  Remarks
                                                                 in Rs.
                                                                 Lacs)
Surveillance   1. Training      1.1    Training of Hospital             2 Batches per district. One Batch of
Preparedness                           Doctors                          10 trainees. Total Trainees per
                                                                        District 20. Per head Training Cost
                                                                        Rs. 1100/-. Unit Cost per
                                                                   3.08 participant: Training Material Rs.
                                                                        100/-: Travel Rs. 350/-, Food: 250
                                                                        (10 X 650) + Other expenses Rs.
                                                                        2500/- : Trainer Charges Rs. 2000/-
                                                                        = Total Rs. 11000/- per batch.
                                1.2    Training of Hospital             2 Batch per district. One Batch of
                                       Pharmasist/ Nurses               20 trainees. Total Trainees per
                                                                        District 40. Per head Training Cost=
                                                                        Rs. 750/-. Unit Cost per Participant:
                                                                   4.20 Training Material Rs. 50/-: Travel
                                                                        Rs. 100/-; Food: 150/- (20 X 300)+
                                                                        Other expenses Rs. 5000/-; Trainer
                                                                        Charges Rs. 4000/- = Total Rs.
                                                                        15,000/- per batch.
                                1.3    Training of Medical              Total 2 batches. One Batch of 20
                                       College Doctors                  trainees. Per Head Training Cost =
                                                                        Rs. 2150/-. Unit Cost per participant
                                                                        : Training Material Rs. 150/-; Travel
                                                                   0.72
                                                                        Rs. 1000/-; Food 250/- + Other
                                                                        Expenses Rs. 5000/-. Trainer
                                                                        Charges: Rs. 10000/-. Total Rs.
                                                                        43,000/- per batch.
                                1.4    Training of Medical                Total 3 batches. One Batch of 20
                                       College Pharmasist/                trainees. Per Head Training cost = Rs.
                                       Nurses/ Medical                    850/-. Unit Cost per participant:
                                       Record Technician           0.21   Training Material Rs. 50/-; Travel Rs.
                                                                          200/-; Food Rs. 200/- + Other Expenses
                                                                          Rs. 5,000/-. Trainer Charges: Rs.
                                                                          4,000/- = Rs. 17,000/- per batch.
                                1.5    Data Entry and                     Total 7 batches. One Batch of 20
                                       analysis training for              Trainees. Per Head Training Cost = Rs.
                                       Block Health Team                  1,000/-. Unit Cost per participant:
                                                                          Training Material Rs. 50/-; Travel Rs.
                                                                 2.10     300/-; Food: Rs. 200/- + Other
                                                                          Expenses Rs. 5,000/-. Trainer Charges
                                                                          Rs. 4,000/-= Total Rs. 20,000/- per
                                                                          batch.
                                1.6    DM & DEO Training                  Total 2 batches. Total 21 X 2= 42. Unit
                                                                          Cost per participant: Training Material
                                                                          Rs. 50/-; Travel Rs. 200/-; Food: Rs.
                                                                 0.72     150/- + Other Expenses Rs. 5,000/-.
                                                                          Trainer Charges : Rs. 4,000/-= Total
                                                                          Rs. 17,000/- per batch.
                                       SUB TOTAL (A)              11.03

                                                                                              340
Salary of staff     2. Staff
                    Salary       2.1    Epidemiologists                      Originally appointed 18. Joined 10.
                                                                             Presently Working 8. Salary
                                                                             Claimed for 21 at average rates.
                                                                             Avg. Rs. 30,000 per month as per
                                                                52.92
                                                                             draft sanction letter. (As per norms
                                                                             established     by     GOI)     New
                                                                             Recruitment already under process.
                                 2.2    Microbiologists                      Rs. 20,000 per month for 2. (As per
                                                                             norms established by GOI). New
                                                                 4.80
                                                                             Recruitment already under process.
                                 2.3    Entomologists                        Rs. 20,000 per month for 1. (As per
                                                                             norms established by GOI). New
                                                                 2.40
                                                                             Recruitment under process.
                                 2.4    Finance and
                                        Procurement                          Rs. 14,000 per month. One post at
                                        Consultant               1.68        State. (As prescribed by GOI)

                                 2.5    State Nodal Officer -
                                        cum-Consultant                       Rs. 28,000 per month. One post at
                                        Training                 3.36        State. (As prescribed by GOI)

                                 2.6    Data Managers                        Rs. 13,500/- per month for 1 at State
                                                                34.08        and 20 at Districts.
                                 2.7    Data Entry Operators                 Rs. 8,500/- per month for 1 at State
                                                                             and 20 at Districts and 3 at Medical
                                                                24.48
                                                                             Colleges. Total 24.
                                 2.8    Administrative                       Present Salary Rs. 7,000/- per
                                        Assistants                           month. 21 posts including 1 at SSU.
                                                                         -
                                                                             (Abolished/ Not Continued by GOI
                                                                             from 01.04.2010 onwards).
                                 2.9    Accountants                          Present Salary Rs. 9,500/- per
                                                                             month. 20 posts at Districts.
                                                                         -
                                                                             (Abolished/ Not Continued by GOI
                                                                             from 01.04.2010 onwards).
                                 2.10   Helper                               Present Salary Rs. 4,500 per month.
                                                                             One post at State. (Abolished/ Not
                                                                         -
                                                                             Continued by GOI from 01.04.2010
                                                                             onwards).
                                        Mobility Support                     (Rs. 1,000/- per visit X 10 visits)/
                                                                             per month per district. Total 20
                                                                24.00
                                                                             districts.
                                        Office Expenses @                    Rs. 2000 at districts and Rs. 5000 at
                                        Rs. 2000 per month       5.40        SSU
                                        SUB TOTAL (B)
                                                                153.12
 Community            3.         3.1    Community                            Rs. 1,20,000/- per State. (Awareness
    based         Community             sensitization                        Campaigns).
 surveillance     Surveillance   3.2    Review meetings
                                                                             Rs. 1,400/- per month in States
                                        (monthly) at PHC                 -
                                                                             where CBS is planned.
                                        level
                                 3.3    Contingency                          Rs. 2,000/- per month in States
                                                                         -   where CBS is planned.
                                 3.4    Evaluation                           Rs. 25,000/- per State per year.
                                        SUB TOTAL (C)                    -
                                                                                                341
  Outbreak           4.         4.1    ASHA incentives for                 Estimated to get 10 informations per
investigation   Operational            Outbreak                            month from volunteers. A total of
and response/   Investigation                                              120 such information in a year per
                                                                 2.40
 Operational        and                                                    district. Each informant to be given
  Expenses        response                                                 an incentive of Rs. 100/-.
                                4.2    Medical college/                    At an average cost of Rs. 5,000/-
                                       institute participation             per outbreak X 2 outbreaks per year.
                                       in outbreak                         In the current year only 1
                                                                 1.00
                                       investigation                       investigation     per   district   is
                                                                           expected. (Total 20 districts).
                                4.5    State IDSP Weekly
                                       Alert Bulletin                      Rs. 30,000/- per SSU per year.
                                                                 0.30
                                4.6    Annual IDSP report
                                                                           Rs. 20,000/- per SSU per year.
                                                                 0.20
                                4.7    Printing of Reporting               Rs. 10,000/- per district and
                                       Forms                     2.30      Medical College per year.
                                4.8    Broadband Expenses                  Rs. 1,000/- per district + SSU +
                                                                 2.88      Medical Colleges per month.
                                4.9    Meeting State
                                       Epidemiologists and                 Rs. 50,000/- per State.
                                       Microbiologists           0.50

                                4.10   Telephone and other                 Rs. 1,000/- per district/ per month
                                       expenses                            and Rs. 3,000/- per month for SSU.
                                       SUB TOTAL (D)
                                                                 9.58
Lab Support        5. Lab       5.1    Consumables and kits
                  Support              for lab                             Rs. 2,00,000/- per lab (1 lab.)
                                                                 4.00
                                5.2    Collection and
                                       Transportation of                   Rs. 6,000/- per district per year.
                                       samples                   1.20

                                5.3    Referral Lab                        Rs. 5,00,000/- per referral lab per
                                       Network                   20.00     year.
                                5.4    Preparedness related                Procurement and Operational Cost
                                       to Swine Flu                        (Including Transportation and IEC
                                                                           related Advertisements) relating to
                                                                           Influenza A H1N1 Swine Flu.
                                       SUB TOTAL (E)
                                                                 25.20
         TOTAL                         INR                        198.93




                                                                                               342
               NATIONAL PROGRAMME FOR CONTROL OF BLINDNESS

                                           (NPCB)
                                           (NPCB)


1.      Situational Analysis

        National Programme for Control of Blindness (NPCB) was launched in
the State of Punjab in 1976 with 100% central assistance. The infrastructure
was developed in the State in a phased manner and has been covered under
Non-Plan Scheme. The Cataract Surgery coverage was 110% in the year 2005-
06 and 107% in the year 2006-07 and 105% in 2007-08, 94.8% in the year
2008-09 and 79.0% in the year 2009-10 till 30.11.09. Since, 80% of blindness
is due to cataract, major focus at national level is on reducing Cataract
prevalence by bringing down the level of blindness from 1.3% to 0.3% by
2020.

1.      A part from the major thrust on Cataract Surgeries by doing about 95%
        of cataract surgery with IOL

2.      To provide latest equipments for Eye surgeries like Phaco Machines
        and A-scan

3.      To use Non invasive technology like Yag laser to correct post operation
        PCO.

4.      Other     components        of    the      programme    are    being   effectively
        implemented in the               State.

        I.      School Eye Screening Programme is carried out in the State by
                Ophthalmic Officers and Medical Officers of PHC's.
        II.     Free Distribution of the spectacles through District Health
                Societies.
        III.    Training of Teachers & Para-Medical Staff.
        IV.     Emphasis       is   given         on   Intraocular    Lenses   &   Phaco
                Emmulsification -- Stitch less Eye Surgery.


                                                                                      343
2.      Health Infrastructure For Eye Care Facilities

State Blindness Control Society                              Formed in April 02
                                                             merged with State Health
                                                             Society in Dec. 07

Regional Institute of ophthalmology                          Purposal    to     declare
                                                             Medical College Amristasr
                                                             has been sent to GOI

Medical Colleges                                             Patiala, Fardikot

District Hospitals                                                       20

District Blindness Control Society                           20 merged with District
                                                             Health Society in 2007

Eye Banks Registered under Human Organ Transplant Act        5 Eye Bank Registered ( 3
                                                              in Govt Sector and two
                                                                     private)

Sub District Hospitals                                                   39

CHCs.                                                             129 sanctioned

                                                                   116 Functional

PHCs                                                                    484




        The State has carried out an assessment of over-served, average and
under-served areas and area-specific actions have been undertaken to reduce
blindness uniformly throughout the State. Following are the findings:-

Over-Served Areas:                      Amritsar, Barnala, Faridkot, Jalandhar, Ludhiana,
                                        Ropar & Mohali and Tarantarn

Average Served Areas:                   Mansa, Kapurthala, Hosiarpur, Bathinda, Patiala,
                                        Nawashahar and Gurdaspur

Under Served Areas:                     Fatehgarh Sahib, Ferozepur Mukatsar Sangrur and
                                        Moga



                                                                                    344
            of
Performance of Cataract & IOL Surgeries

     No.          Year         No. of Cataract            IOL         %Cataract      % IOL
                                Operations

     1          2002-03           122861                 55678            77              46

     2          2003-04           133376                 75722            83              63

     3          2004-05           159783                 117480          100              92

     4          2005-06           176697                 144727          110          113

     5          2006-07           171077                 146187          107              91

     6          2007-08           167256                 152353          105              95

     7          2008-09           170572                 160878          94.8         99.3

     8.       2009-10 till         94812                 88380            79          81.8
               Nov. 2009




3.        Performance of School Eye Screening Activity




     No.            Year           Children Examined         No. of Spectacles Provided

     1            2002-03               1243295                       23175

     2            2003-04                526869                        5327

     3            2004-05                584840                        4552

     4            2005-06                379322                        4249

     5            2006-07                610077                        7222

     6            2007-08                521940                        9664

     7            2008-09                469055                        5924

     8          2009-10 till             352404                        6708
                  Nov. 09




                                                                                           345
4.       Performance of Eye Donation Activity

     No.           Year               Target    Eye Donated

     1           2002-03               500         319

     2           2003-04               500         203

     3           2004-05               500         113

     4           2005-06               500         138

     5           2006-07               500          73

     6           2007-08               600         122

     7          2008 -09               600         247

     8         2009-10 till            800         228
                 Nov. 09




                                                              346
Objectives:
1) To improve the quantity and quality of eye surgery in Public Health Care system in the
   state by using Phaco Emulsification technique at all 39 selected sites in state by 2010.
2) To achieve the target from 95% to 100% by use of intra-ocular.
3) 100% coverage for School going & non school going children under School Eye Screening
   programme & to distribute free spectacles to all needy children.
4) Giving 100% coverage to un-served and underserved areas and Rural Areas in all 20
   districts during plan period.
5) Ensuring the Promotion of Eye Donation to meet the demand.
6) To ensure quality Eye aspect under NPCB.
7) To cure other diseases like Glaucoma, Diabetic Retinopathy, Laser Tech.,            Corneal
   transplantation, Childhood blindness, Squint surgery etc.


                                      • Very low turn up of vulnerable population under
                                        programme due to lack of supplies, consumable
                                        and facilities in public sector (estimated 20:80
                                        ratio of patients turn up between Public and Pvt.
                                        Sector) due to lack of technologies, consumable
                                        and HR required.
                                      • Reduction in the backlog of blind persons by active
                                        screening of population above 50 years.
                                      • Greater involvement of NGOs, Private partner to
                                        meet the goals which is significantly low.
                                      • Capacity building needs for especially newly
                                        inducted officials.
     Issues/ Challenges               • Make eye care comprehensive, besides cataract
                                        surgery other Intra Ocular Surgical operations for
                                        treatment of Glaucoma, Diabetic Retinopathy,
                                        squint surgery and Laser Technique etc. may also
                                        be provided free of cost to the poor patients
                                        through government as well as qualified non
                                        government organisation.
                                      • Inclusion of Eye Surgeons/Specialists in the
                                        District Human Organ Transplant Committee to
                                        improve decision making and facilitation in eye
                                        transplant (Cornea Transplant).
                                      • To Promote Eye Donation 5 Eye Banks are already
                                        working . 20 Eye Donation Centre One at District
                                        Level is to be established
Strategies/
Strategies/ Services                  Activities/ Inputs
Upgradation of Infrastructure and • Purchase and installation of Phaco machines at 39
procurement of equipments at        identified in faced manner. 18 Phaco machine have
                                    been provided rest of 21 will be provided in faced
State and District levels
                                    manner in 2009-10, 2010-11 & 2011-12.
                                                                                              347
                                 • Yag-Laser machines in at 20 sites in 2008-09 and
                                   15 in 2009-10,2010-11 & 2011-12.
                                 • Up-gradation on new Vision centres in all 20
                                   districts.
                                 • Up gradation of Mobile units
Ensuring regular supply of • Supply of recurring equipments and material to
consumable in Vision centres and   Vision centres & all mobile units.
                                 • Last due payment to Private partners. (NGOs)
Mobile units
                                • Public sector IEC events through various Means
IEC in State                      mentioned in budget line.
                                • Pvt. Sector partners will evolve the innovative
                                  strategies.
                                • The need based training to be provided by GOI.
Capacity building               • The state specific training are mentioned in
                                  capacity building Matrix for MOs, ON,, O/As and
                                  MPHWs in training plan.
Support needed for implementing • Effective Private Public Partnerships with eye
changes                           hospitals.
                                • Coordination with NGOs.
                                • Active involvement of the field support network of
                                  ANMs/ AWWs/ ASHAs
Benchmarks Derived from the • Increased number of High risk surgeries.
Components                      • Achievement of coverage of all school children
                                  with in school education and out side the school in
                                  plan period under programme.




                                                                                  348
Sr.                 Particulars             PIP for   What is to be done
No.                                         2010-
                                            2010-11                               Approved
                                                                                   By GOI
1     Grant-in-Aid to NGOs for free         425.00    Annual Target of Catops
      Cataract (Annual target for free                is 1,80,000 out of it
      catops 1,80,000 & for IOL                       40,000 operations are                   Approved
      1,62,000 for which the                          performed by NGOs @                     under the
      achievement of the State is 107%                750/- per case i.e. Rs.                 head GIA
      in the year 2007-08 & 94.8% in                  3,00,00,000. Rest of the                   for
      the year 2008-09                                amount Rs. 1,25,00,000                   Catops
                                                      is spent to procure                        and
                                                      consumable IOL, Visco                    various
                                                      elastic, sutures & drugs                  other
                                                      for Ophthalmic Surgery.                 schemes
2     GIA for School Eye Screening.         50.00      In 2010-11 distribution
      Provision for supply of                         of spects to the poor and               Approved
      spectacles,medicines and other                  needy in the rural and                  under the
      supplied for school eye care                    semi urban areas. The                   head GIA
      programme.                                      estimate number of                         for
                                                      children with refractive                 Catops
                                                      error is 35,000 out of it                  and
                                                      25,000 spectacles are                    various
                                                      distributed @ Rs.200/-                    other
                                                      per spectacle.                          schemes
       Year          Refractive Error
                                                                                   625.00
      Spectacles           No. of
      student

      distributed            not provided
                                                                                              Approved
      spectacles (due to                                                                      under the
                                                                                              head GIA
      paucity of funds)                                                                          for
      2008-09          35,876                                                                  Catops
      5,924                29,952                                                                and
      2009-10          18,712                                                                  various
      5,919               12,793                                                                other
      (upto 10/09)                                                                            schemes
3          Distt. Hospitals                 261.00    Phaco machines are                      Approved
       1) Purchasing of 2 Phaco                       already distributed to 18               under the
           Machines @ 12 lacs                         districts in the year                   head GIA
           = 24.00                                    2008-09 and for                            for
           for Civil Hospital Mukatsar                remaining 2 districts,                   Catops
           & Hoshiarpur                               Phaco machines will be                     and
                                                      purchased soon.                          various
                                                                                                other
                                                                                              schemes




                                                                                        349
2)   5 Yag Laser for 5 District      After IOL surgery there
     hospital @ 12 lacs              is opacification of
     = 60.00                         postirior capsule in
                                     which the vision of the
                                     patient is agaub
                                     decreased markly due to
                                     advancement of
                                     technique & availability
                                     of better equipment in             Approved
                                     the form of Yag laser              under the
                                     which is non-invasive              head GIA
                                     technique . This Yag                  for
                                     laser use to restore the            Catops
                                     vision and 5 Yag Laser                and
                                     are proposed in the year            various
                                     2010-11 for 100 bedded               other
                                     hospital.                          schemes
3)   Maintenance of ophthalmic       As per Demand received             Approved
     equipments 16 lacs     =        from DBCS for                      under the
     16.00                           maintenance of                     head GIA
                                     ophthalmic equipments                 for
                                     so that the funds will be           Catops
                                     utilized.                             and
                                                                         various
                                                                          other
                                                                        schemes
4)   Applanation Tonometer           As per attached                    Approved
     for district hospitals i.e.     Annexure at III (B) in the         under the
      (10x60,000)                    11th plan of GOI                   head GIA
     = 6.00                          guidelines as item No 11.             for
                                     It give good results for            Catops
                                     diagnose Glaucoma                     and
                                     (ekbk w'shnK)                       various
                                                                          other
                                                                        schemes
5)   Auto refractometer for           As per attached
     each districts hospitals i.e.   Annexure III (B) item
     (20x3.50)                       No. 5. It is a basic
     = 70.00                         equipment to diagnose
                                     difficult cases of
                                     Astigmastism &
                                     Keratocomos & also save
                                     time to give better
                                     facilities for eye testing
                                     of poor, rural and lower
                                     middle class families
                                     who are visiting the
                                     Govt. institutions/Sub
                                     district hospital.



                                                                  350
    6)   Fluroscein Angiography              This is a new initiative
         (10,00,000x2)                       for the year 2010-11 in
         = 20.00                             the beginning it is two
                                             major districts hospitals            Approved
                                             to diagnose the various              under the
                                             ailments of retina and               head GIA
                                             other macular disorders                 for
                                             to compete with other                 Catops
                                             Semi Govt. and other                    and
                                             private institutes this is a          various
                                             must for 100 bedded                    other
                                             Hospitals.                           schemes
    7)   Flash Autoclave for each            As per guidelines of GOI
         districts hospitals i.e             as shown in Annexure
         (20x2.50)=50.00                     III(B) item No. 6 it is to           Approved
                                             be supplied to all the               under the
                                             districts Hospitals and              head GIA
                                             for 20 districts Hospitals.             for
                                             This is required to give              Catops
                                             better auto claving & to                and
                                             minimize complication                 various
                                             due to Faulty Auto                     other
                                             claving.                             schemes
    8)   Non contact Keratometer             It is a new initiative
         for 10 districts i.e.               although not mentioned
         (10x1.50)         = 15.00           in Annexure III(B) but to
                                             give better & Latest
                                             facilities to our poor &
                                             lower Middle facilities
                                             and also to Govt.
                                             employees and this is
                                             proposed to be supply to
                                             10 Major district                      Not
                                             Hospitals                            approved
         These equipments are as
         per Annexure III -B except
         at Sr. No. 6 & 8
4   Recurring GIA to Eye Banks        6.00   There are 5 Eye Banks
                                             out of it 3 are Govt.
                                             sector and 2 Private Eye
                                             Banks named Shri Guru
                                             Harkrishan Charitable
                                             eye hospital, Sohana                 Approved
                                             (Mohali), Punarjot Eye               under the
                                             Bank Ludhiana. To                    head GIA
                                             promote eye Donation                    for
                                             activities & cornea                   Catops
                                             transplantation after                   and
                                             death. This activity is to            various
                                             be promoted as per                     other
                                             guidelines of GOI. There             schemes

                                                                            351
                                                 is a provision of Rs.
                                                 1500/- per pair of eyes
                                                 to the Eye Bank in the
                                                 State which is given in
                                                 the form of Honorarium
                                                 to Eye Bank staff,
                                                 Transportation/Travel
                                                 Cost/POL and
                                                 contingencies.
                                                 preservation material &
                                                 Media & publication.
                                                 These funds are required
                                                 to achieve the target of
                                                 Eye Collection set by
                                                 GOI.
5   Recurring GIA to Eye Donation        5.00    There is a proposal to
    Centres                                      open 1 EDC in each 20
                                                 districts There is a
                                                 provision of Rs. 1000/-
                                                 per pair of eyes to the
                                                 Eye Bank in the State             Approved
                                                 which is given in the             under the
                                                 form of Honorarium to             head GIA
                                                 Eye Bank staff,                      for
                                                 Transportation/Travel              Catops
                                                 Cost/POL and                         and
                                                 contingencies.                     various
                                                 preservation material &             other
                                                 Media & publication.              schemes
6   Training of PMOAs and MPHWs          5.00    For training of eye
    Training of eye surgeons in                  surgeon in ECCE, IOL
    identified institutes in following           implantation, small
    areas:                                       incision cataract surgey,
    ECCE/IOL implantation Surgery,               Phaco emulsification              Approved
    small incision Cataract Surgery              upto Rs. 70,000 per               under the
    Phaco-emulsification, low vision             trainee is permissible as         head GIA
    services, Glaucoma, Pediatric                per GOI guidelines.                  for
    Ophthalmology, Indirect                      Training of PMOAs done             Catops
    Ophthalmology & Laser                        at Chittarkoot (MP) for              and
    Techniques, Vitreoretinal                    which the required fees            various
    Surgery, Eye Banking & Corneal               is paid by the training             other
    Transplantation Surgery etc.)                institute                         schemes
7   IEC activities                       15.00   Out of it Rs. 50,000 will         Approved
    World Sight Days and Fortnight               be transferred to 20              under the
    at 20 districts @ 50,000 and 100             districts and Rs.                 head GIA
    eye donation awareness camps                 15,000/- for Eye                     for
    in remote and border areas at                Donation awareness                 Catops
    PHCs and CHCs level                          camps at remote                      and
                                                 PHCs/CHCs and interior             various
                                                 areas and rest of the               other
                                                 amount at state head              schemes

                                                                             352
                                                quarter for IEC
                                                acitivities.



8    SBCS Remuneration other            14.00                                         Approved
     activities & Contingency                   - Furniture                           under the
                                                - Stationery                          head GIA
                                                - Honorarium of Staff                    for
                                                - Maintenance work                     Catops
                                                - Other contingency etc.                 and
                                                                                       various
                                                                                        other
                                                                                      schemes
9    Financial assistance for other     5.00    It is proposed as per GOI
     Eye diseases                               guidelines through NGOs
                                                and other institution for
                                                Other Eye diseases @
                                                1000 tentatively for 500              Approved
                                                cases.                                under the
                                                - Glucoma                             head GIA
                                                - Diabetic Retinopathy                   for
                                                - Laser Tech.                          Catops
                                                - Corneal                                and
                                                transplantation                        various
                                                - Childhood blindness                   other
                                                - Squint surgery etc.                 schemes
10   Regional Institute of              60.00   As per list of equipments
     Ophthalmology (RIO) as per                 ( Sr. No. 1 to 66) copy
     Annexure III                               attached as Annexure A
                                                with guidelines of GOI.
                                                Equipments will be
                                                purchased and supplied
                                                to RIO i.e. Amritsar
11   Grant for Medical Colleges         60.00   As per Annexure III (I)
                                                Equipments will be
                                                purchased and supplied
                                                to concerned Medical
                                                colleges (Faridkot &
                                                Patiala @ 30.00 lakh
                                                each)                       30.00     Approved
12   Establishing & Strengthening and   15.00   As per Annexure III (E)
     supply to New Vision Centres               in the year 2010-11
                                                there is a proposal to
                                                open 30 new vision
                                                centres @ 50,000/- at
                                                Mini PHC, PHC,CHC in
                                                remote and interior and
                                                in cities in which there
                                                are large number of
                                                industrial workers .        15.00     Approved

                                                                                353
13   For recruitment of Ophthalmic     9.60     For recruitment of 10
     Assistant 10 @ 8,000                       Ophthalmic Assistants at
                                                consolidated pay Rs.
                                                8000/- per month at 10
                                                New Vision Centres as
                                                per qualfication from
                                                GOI i.e.
                                                Should have passed
                                                Senior Secondary Part- II
                                                examination in Science
                                                with Biology as one of
                                                the subject & diploma of
                                                Ophthalmic Assistant
                                                recognized by respective
                                                university.                   9.60         Approved
14   For recruitment of Eye Donation   6.00     For recruitment of Eye
     Counsellor 5 @ 10,000                      Donation Counsellor for
                                                5 Eye Banks as per
                                                qualfication from GOI i.e.
                                                Graduate degree in
                                                sociology/social
                                                work/arts/science
                                                recognized by respective
                                                university.                   6.00         Approved
15   Non-recurring Grant-In-Aid to     5.00      For establishing 5 new
     Eye Donation Centre                        Eye donation Centres
                                                during the year 2010-11
                                                in the State @ Rs. 1.00
                                                lakh each.                    5.00         Approved
              TOTAL                    941.60
                                                                             690.60




                                                                                     354
                          BLINDNESS
      BUDGET FOR NATIONAL BLINDNESS CONTROL PROGRAMME (NBCP)

               National Blindness Control Programme (NBCP)
SN
                            Activity                         Rs in Lakhs
                        Activity / Item                        2010-11
      Grant-in-Aid to NGOs for free Cataract (Annual
      for free catops 1,80,000 & for IOL 1,62,000 for
1
      which the achievement of the State is 107% in the
      year 2007-08 & 94.8% in the year 2008-09
      GIA for School Eye Screening. Provision for
2     supply of spectacles, medicines and other supplied
      for school eye care programme

3     District Hospitals

      Purchase of 2 Phaco Machones @ Rs. 12.00 lakh
3.1
      for Civil Hospital Muktsar & Hoshiarpur
      5 Yag Laser for 5 District Hospital @ Rs. 12.00
3.2
      Lakh
      Maintenance of ophthalmic equipments @ Rs.
3.3
      16.00 lakh
      Applantation Tonometer for district hospital i.e.
3.4
      (10x60,000)
      Auto refractometer for each districts hospitals i.e.
3.5
      20x3.50)

3.6   Fluroscein Angiography (10,00,000x2)

      Flash Autoclave for each districts hospitals i.e.
3.7
      (20x2.50)

3.8   Non contact tonometer for 5 disticts i.e. (5x3.00)

      District Hospitals Total                                 625.00

      Recurring GIA to Eye Banks (three are 4 eye
4     banks in the State) which has got collection of
      more than 100 eye balls

5     Recurring GIA to Eye Donation Centres


6     Training of PMOAs and MPHWs


      IEC activities
      World Sight Days and Fortnight at 20 districts @
7
      50,000 and 100 eye donotation awareness camps in
      remote and border areas at PHCs and CHCs level
      SBCS Remuneration other activities &
8
      Contingency


                                                                           355
9    Financial assistance for other Eye disease @ Rs.
     1000/cases tentatively for 500 cases
     Regional Institute, Amritsar of Ophthalmology
10
     (RIO)
     Grant for Medical Colleges (there are 2 Medical
     Colleges in the State). Grant-in-Aid for Govt.
11                                                      30.00
     Medical College Faridkot & Medical College
     Patiala @ Rs. 30.00 Lakh each

     Establishing & Strengthening and supply to New
     Vision Centres at CHCs and Sub-District Hospital
12                                                      15.00
     at 30 centres @ 50,000 in the border and remote
     areas of the State.

     Non-recurring Grant-in-Aid to Eye Donation
13   Centre @ Rs. 1.00 Lakh for 10 eye donotation        9.60
     centres

     For recruitment of Ophthalmic Assistant 10 @ Rs.
14                                                       6.00
     8,000 per month

     For recruitment of Eye Donation Counseloor 5 @
15                                                       5.00
     Rs. 10,000 per month

                           Total                        690.60




                                                                 356
IODINE DEFICIENCY DISORDERS CONTROL PROGRAMME (IDDCP)

Situation Analysis

Iodine is essential micronutrient with an average daily requirement of 100-150
micrograms for normal human growth and development. Iodine Deficiency
Disorders (IDD) refers to all of the ill effects of iodine deficiency in a population that
can be prevented by ensuring that the population has an adequate intake of iodine.
Inadequate or poor intake of iodine can result in physical and mental retardation. It
affects people of all ages, both sexes and of different socio economic background.
The effect of IDD is most critical during pregnancy and childhood. For iodine
deficiency in pregnant mother can result in abortions, still birth and the birth of
mentally retarded babies. Other adverse effects include deaf- mutism, dwarfism,
squint, cretinism and even milder neuro motor defects.

Iodine deficiency, through its effects on the developing brain, has condemned
millions of people to a life of few prospects and continued underdevelopment. On a
worldwide basis, iodine deficiency is the single most important preventable cause of
brain damage. IDD are among the easiest and cheapest of all disorders to prevent. A
small, constant amount of iodine to the salt every day is all that is needed.

WHO, UNICEF, and ICCIDD recommend that the daily intake of iodine should be as
follows:

       90 µg for preschool children (0 to 59 months);
       120 µg for schoolchildren (6 to 12 years);
       150 µg for adults (above 12 years); and
       200 µg for pregnant and lactating women
Sources of Iodine:

The primary sources of dietary iodine are saltwater fish, seaweed, and trace
amounts in grains, bread, milk, eggs, and meat. Fruits contain little iodine, as do
vegetables with the exception of spinach. Iodine deficiency disorder primarily
occurs in mountainous regions such as the Himalayas where iodine has been washed
away by glaciations and flooding.



                                                                                      357
Punjab Status:

                                                         10-
Objectives: To reduce goitre prevalence in the age group 10-14 to less than 5 per cent
and to bring down to zero the number of cretins born by year 2000 A. D.
1.     To strengthen the monitoring system from production to consumption level to
ensure that 100 per cent population get only iodised salt

Issues/ Challenges            • No state IDD cell
                              • Less focus on control measure

Strategies/ Services          Activities/ Inputs

                              • Setting up of a Iodine Deficiency Disorder (IDD) cell
                                 in the state:
                                 A State IDD officer to be designated in-charge of the
Establishing Iodine
                                 implementation of NIDDCP in the state
Monitoring Laboratory
                                 The State IDD cell to comprise of:
(IML) in the state.
                                 A Medical Officer- trained in IDD as per GoI norms
                                 A Data Assistant
                                 A clerical staff
                                 A Peon

Setting up state lab for IDD State IML to be set up in the Government Medical
control and monitoring           College

                              • Public sector IEC events through various Means
                                 mentioned in budget line
IEC in state
                              • Pvt. Sector partners will evolve the innovative
                                 strategies.
                              • The Government shall ensure regular and adequate
Enabling environment from
                                 supply of Iodised Salt to the entire population
Govt.
                                 through the Public Distribution System (PDS)
                              • Effective Private Public Partnerships
Support        needed    for • Coordination with NGOs
implementing changes          • Active involvement of the field support network of
                                 ANMs/ AWWs/ ASHAs

Benchmarks                    • Elimination of ID Disorders




                                                                                  358
 BUDGET FOR NATIONAL IODINE DEFICIENCY DISORDERS CONTROL PROGRAMME - NIDDCP




SN     National IODINE Deficiency Disorders Control   (Rs. In Lakh)
                  Programme - NIDDCP
                     Activity / Item                    2010-
                                                        2010-11
 1
1.1   Establishment of IDD Control Cell                   6.00
1.2   Establishment of IDD Monitoring Lab                 3.50
                        Total Salary                      9.50
 2
2.1   Salt Testing Kits supply by GOI                     8.00
2.2   IDD Survey                                          2.50


                  Total Monitoring & IEC                 10.50

                           Total                         20.00




                                                                          359
         PART-
         PART-E
Inter Sectoral Convergence




                             360
CONVERGENCE
CONVERGENCE WITH DIFFERENT DEPARTMENTS

Convergence with other departments comes under Part-E, only Budget from Part-B.

I.     CONVERGENCE WITH AYUSH

The healthcare scenario both in India and across the world is changing. Evidence indicates that
about 40 percent of the population seeks medical support from complementary health care.
Consequently, a shift towards pluralistic health care regime is occurring. It is also becoming
increasingly evident that no single system of healthcare has capacity to solve all health needs of
society. India’s Indigenous Knowledge Systems is believed to have the potential to contribute
significantly to medical pluralism. Hence, the efforts made to mainstream AYUSH in public
health system under NRHM. The significant fallout of this process would be the revitalization of
the Indian system of medicine in the country

         Objective: To mainstream AYUSH and shift public health system towards pluralistic
         health care regime to enable a better health outcome.

         Issues                      Though popular and economical, AYUSH systems have
                                     been functioning in relative isolation from the
                                     mainstream public health system. In Punjab there are
                                     507 Ayurvedic / Unani dispensaries besides, there are 5
                                     ten bedded hospitals and 17 Ayurvdic Swasthya
                                     Kendras. A Government run Ayurvedic Pharmacy also
                                     exists at Patiala. There is a need to mainstream the
                                     AYUSH to improve the health outcome.

         Strategies                  Activities
         ♦ Integrating        and    • ASHA to be trained to propagate AYUSH in the
            mainstream AYUSH to        community.
            enable    intra-health   • AYUSH medications to be supplied to PHC and CHC in
            system convergence         the state.
            to improve health
                                     • One AYUSH doctor to be appointed in PHC and Two (one
            outcomes.
                                       Ayurveda and one Homeopathic) in CHCs
                                     • Cross referral between AYUSH and Allopathic system to
                                       be encouraged in the health facilities based on need.


                                                                                              361
             • All AYUSH doctors to be trained in national health
               programmes.
             • AYUSH doctors to dispense medicines under the National
               Health Programs.
             • AYUSH doctors to be jointly made responsible for
               monitoring the implementation of the National Health
               Programmes.
             • All AYUSH personnel to participate in the monthly
               meetings at PHC and CHC. Their work plan and
               attainments to be reflected in the reports of the PHC and
               CHC.
             • AYUSH doctors would be made a part of the RKS and
               they would participate in its meetings.
             • As part of the school health programme where feasible
               the AYUSH doctors would organize yoga camps.
             The BCC strategy for the state will incorporate AYUSH as
             one of the significant component for improving the
             health status of the community.

Indicators   • Collocation of AYUSH Practitioners
             • AYUSH doctors engaged as per plan and AYUSH is
                mainstreamed in the health system reflected in the
                off-take of services
Support      • Support to the AYUSH MO’s from the allopathic
                system to ensure convergence




                                                                       362
                                   BUDGET FOR AYUSH

SN                                                                               Remarks
                                                                        Rs in
                Activity             Q1      Q2        Q3      Q4
                                                                        Lakhs
B9     Integration of AYUSH

       Contractual appointment
B9.1
       of one AYUSH MO in 236      152.22   152.22   152.22   152.22   608.88
       PHCs @ Rs. 21500 per MO
       Contractual appointment
B9.2   of one Dispenser in 236
                                   56.64    56.64     56.64   56.64    226.56
       PHCs (Ayurveda) @ Rs.
       8,000 per Dispenser
       Contractual appointment
       of one        AYUSH MO
B9.3   (Homeopathy) in 115         74.18    123.20   123.20   123.20   492.78
       CHCs, 36 SDH and 2 MO at
       DH @ Rs. 21500 per MO
       Contractual appointment
B9.4   of one Dispenser in 115
                                   27.60    45.84     45.84   45.84    183.36
       CHCs, 36 SDH and 2 at DH
       @ Rs. 8,000 per Dispenser
              Total Budget         310.64   377.90   377.90   377.90   1511.58




                                                                                 363
II.  CONVERGENCE WITH DEPARTMENT OF SOCIAL SECURITY WOMEN AND CHILD
DEVELOPMENT
DEVELOPMENT

         There is significant convergence with the efforts of the Department of Women
and Child and the Department of Health and Family Welfare, in nutrition, health and
women’s empowerment. There have been many initiatives at different levels to enable
this convergence. Fixed health and nutrition days and community based monitoring
systems are some of the processes that have been jointly undertaken between the two
departments. Since programmes of both the departments have overlapping goals,
convergence is essential. For NRHM to realize its goals, convergence with the DWCD is a
key element.

Objective: Convergence between Department of              Social Security Women and Child
Development and National Rural Health Mission , Punjab for improving the health outcome
of community

Issues                    There is a gap between service delivery and beneficiary outcome
                          because of lack of coordination of different stake holders at grass
                          root level. VHND a key to Village Health Programme is lacking
                          due to this. The supplementary nutrition, health checkup are a
                          regular. There is a strong need of convergence to ensure the
                          services at grass root level.

Strategies                                         Activities
Strengthening     the • AWW along with ASHA and other health personnel to counsel
linkage between ANM/    pregnant women on institutional deliveries and facilitate referral.
AWW/ASHA          for   Details of JSY to be made available to all Angawandi centres in the
service delivery        state.

                          • AWW along with ASHA to participate in routine immunization and
                            in special campaigns like pulse polio and mobilse community.

                          • Joint Training of ANM/AWW/ASHA for upgradation in skill for
                            nutrition and health education.

Strengthening            • Ensure ANC Check-up to all PWs by mobilizing and registering the
Maternal          Health   PWs at AWC.
Services
                          • Counsel and encourage for best practices during pregnancy and
                            promote for institutional deliveries.



                                                                                      364
                          • Ensure referral and feed back for complicated cases

                          • AWW to facilitate referral of women to appropriate health
                            facilities for institutional deliveries, RTI/STI, MTP, violence and
                            any other gynaecological and other morbidity.

Strengthening     the • AWC as base of immunization and AWW to make arrangement
MAMTA Divas and         for holding session and tracking of PWs and Children. ANM to
Routine Immunization    ensure logistics and organize sessions as per plan regularly.

                          • Mechanism to ensure full immunization to beneficiaries under
                            ICDS

                          • ASHA alongwith AWW to act as a Social Mobilizer for generating
                            health seeking behaviour among masses.

                          • Track the children who have missed the immunization.

Management     of   Mal • Identification of Mal nourished children by ANM and AWC
Nutrition
                          • Supplementary nutrition

                          • Referral to Grade-III and IV.
Strengthening services • AWW and ASHA to counsel the adolescent girls on the provision of
to           Adolescent  adolescent health in various health facilities. AWW and ASHA to be
especially Girls         informed of the provision.

                          • Supplementary nutrition for Adolescent Girls

                          • Advocating personal hygene practices.

Social Mobilization and • AWW to be a part of the Village Health and Sanitation Committees and
Institutional             inform the VHSC about the activities of the ICDS.
Mechanism
                          • AWW along with ASHA to facilitate discussion on health issues in SHG
                            meetings.

                          • AWW to discuss in the SHG meetings and the meetings of the VHSC on
                            issues such as PNDT.

                          • A joint strategy meeting on BCC is done at the state and district level to
                            evolve common communication strategy between the two departments
                            and ensure convergence.

                          • AWW to act as depot holders for Vitamin-A, IFA and
                            Contraceptives.

Indicators                • Number of ANCs registered

                          • Full Immunization coverage


                                                                                              365
          • MAMTA Divas organized

          • Identification of anaemic women and malnourished children

Support   • Department of Social Security Women and Child Development

          • State/District Health Mission




                                                                    366
III.                                                  SANITATION
                CONVERGENCE WITH DEPARTMENT WATER AND SANITATION


       One of the determinants of good health is safe drinking water and sanitation. There is a
       need to improve the health and hygiene by improving access to quality water supply
       and sanitation. Convergence between health department and Department of Water and
       Sanitation is an essential requirement to impact on one of the key health determinants

       Objective: To improve the Key Health Determinant – Safe Drinking Water and Sanitation

       Issues                   For better quality of life and health; Safe Drinking Water,
                                Sanitation and Public Hygiene plays important role. Health
                                means free from disease, water and unhygienic living
                                conditions pose major threat to healthy life. Although Public
                                Hygene water supply has improved significantly since
                                initiation of total sanitation campaign in the state however
                                there is still need to improve health and hygiene by improving
                                access to water supply and sanitation.

                                Although safe drinking water and sanitation is under the
                                domain of department of Water Supply and Sanitation but
                                these determinants have major impact on health so the stake
                                of health department is equally important. Under NRHM there
                                is strong need for convergence for National Rural Water
                                Supply programme, TSC and Water Quality Monitoring
                                programme. So there is need of convergence between both
                                departments.

       Strategies               Activities
       Institutional            • Convergence through State/District Health Mission and
       Strengthening              Societies. Secretary DWSS, Xen, Incharge of TSC are
                                  members of missions/societies at different levels.

                                • Convergence at Village level through Village Health &
                                  Sanitation Committees.

                                • Provision of untied grants Rs. 10,000/- for VHSC under
                                  NRHM which is being utilised for undertaking health and
                                  hygiene education activities at village level.


                                                                                           367
Joint Strategies                • Joint training for ASHA, ANM and TSC Functionaries on
                                  Health & Sanitation

                                • Joint BCC campaigns by health and DWSS department on
                                  sanitation and toilet use.

                                • ASHA, AWW and ANM oriented to communicate with the
                                  community on sanitation and toilet use.

                                • Suitable incentive to ASHA from TSC funds for promoting
                                  sanitation activities.

                                • Improve sanitation and toilet facilities in all schools and
                                  promote use of toilet and clean water in all schools through a
                                  joint campaign.

                                • Use of rubber stamp messages on Health & Hygiene by Doctors
Indicators
Indicators                      • IEC/BCC Campaign

                                • Sanitary Toilets

                                • Nirmal Gram Puruskar

Support                         • Department of Water and Sanitation

                                • State/District Health Mission



                          BUDGET FOR CONVERGENCE WITH DWSS

   SN                                                                                         Remarks
                                                                                    Rs in
                     Activity              Q1         Q2          Q3       Q4
                                                                                    Lakhs
             IEC/                 BCC
 B10.3       Convergence          With
             DWSS

        IEC/BCC Campaign
B10.3.1 for   Health and                   2.5        2.5         2.5      2.5       10
        Hygiene

        State           Level
B10.3.2 Workshop          on               0.00      1.50         0.00    0.00      1.50
        Sanitation and Health

                   Total Budget
                                           2.50       4.00        2.50    2.50      11.50




                                                                                            368
IV                                                 CONTROL
        CONVERGENCE BETWEEN NRHM AND NATIONAL AIDS CONTROL PROGRAMME
NRHM envisage strengthening the Health delivery system and ensuring services to
masses especially women and children. National AIDS Control Programme is being
implemented with strong technical competencies for prevention and care for HIV/AIDS.
Although NACP has not been merged into NRHM but there are many areas of
convergence or significant overlapping with interventions in RCH programme since
target groups are same.

                                                                         collaboration
Objective: To strengthen the RTI/STI and Adolescent Health Programmes in collaboration with
State AIDS Control Society
Issues                    Public Sector interventions from district to peripheral level for
                          RTI/STI to be implemented through DHFW, in line with the RCH II
                          design document. RTI/STI prevention, management of the client,
                          partner notification, treatment, and follow-up are the key
                          components of an RTI/STI programme. Comprehensive RT/STI
                          treatment will be provided at CHC and 24 hour PHC (clinical and
                          etiologic) and first line drugs at the PHCs.

                          RTI/STI control among High Risk Groups through NGOs with
                          funding support for RTI/STI diagnosis and treatment, to continue
                          through NACO and SACS, but reporting also to HFW.

Strategies                Activities
RTI/STI Services          Comprehensive RTI/STI treatment will be provided at CHCs and
                          24×7 PHCs. ASHAs to act as communication agent at village level
                          and Obstetricians at FRUs, Medical Officers at PHC level and ANMs
                          at Sub Centre Level to function as service providers for RTI/STI

Integrated Counselling • ICTCs are equipped with trained counsellors and may be
                         developed as youth information centres to increase the access of
and Testing Centres
                         young people especially adolescents for counselling, referral
(ICTCs)    and   RSH     services for RCH issues.
Services

PPTCT        and   MCH • At community level ASHA/ANM to be able for risk assessment
                         and identification of expectant mothers for HIV. Follow up for
services
                         ANC/PNC, institutional deliveries to positive women. Linkage
                         with IMNCI component, to address the issue related to feeling,


                                                                                      369
                   nutrition, and infection may be developed

ARSH Programme   • ARSH programme is being implemented in the State. This
                   programme may be coordinated with the school education
                   programme of PSACS. There is provision in SPIP for developing
                   multi skilling youth Friendly centres.

                 • Youth information centres may be developed at DH/SDH/CHC
                   level where trained counsellors in ICTCs are available. While
                   organising ARSH training, ICTC counsellors may be oriented on
                   adolescents RSH issues and services of counsellor may be utilised
                   for counselling adolescents in the adolescent clinic established
                   /being established.

BCC Strategies   Joint BCC strategies may be designed on common issues


Trainings        • Coordinate training programme on RSH, RTI/STI and other
                   issues RCH II trainings to include HIV/AIDS inputs.

                           trainings
                 • RTI/STI trainings for MO, LT/ANM are proposed in SPIP 2009-10,
                   which may be organised in coordination with Punjab State AIDS
                   Control Society. PSACS may be requested to appoint an officer to
                   coordinate with NRHM training division.

                 • IMNCI training While importing IMNCI training under RCH,
                   HIV/AIDS issues to be incorporated.

                 • ASHA training During ASHA training, ASHA may be trained/
                   oriented on HIV/AIDS, RTI/STI issues with inputs/resource
                   person effective from SACS. So that she can be agent for
                   prevention of RTI/STI/HIV/AIDS.

MIS              • Data sharing on RTI/STI, HIV related components may be
                   initiated.

Indicators       • RTI/STI clinics

                 • RTI/STI Trainings

                 • RTI/STI Treatments

                 • AFHS Clinics

Support          • Punjab State AIDS Control Society




                                                                           370
CONVERGENCE WITH PRIs
To enhance local accountability and improve the functioning of health facilities
convergence with PRIs is important.

Objective: To strengthen convergence with PRIs to enhance local accountability and
improve the functioning of health facilities.

Issues/ Problems          Communitisation of health services thereby building local
                          ownership     is   a   prerequisite   for   sustaining   health
                          programmes and outcomes in the long- run. PRIs have a key
                          role in NRHM. In villages, they are part of the village health
                          and sanitation committees. They are also represented at the
                          Block and District Health Missions. The Sarpanch is the joint
                          signatory of the bank account for the operation of the Untied
                          Funds. They are also represented in the Rogi Kalyan Samities.
                          In the Gram Panchayat meetings held twice every month the
                          PRIs review activities of both health department and ICDS.
                          While the PRIs have a significant role to play there is a need
                          to orient them on their responsibilities and their role in the
                          realization of the goal of NRHM.

Strategies                Activities

♦ Strengthening          • An orientation meeting for all PRI representatives on
  convergence       with   NRHM and their role.
  PRIs
                          • Strengthen capacity of PRIs to facilitate village level
                            planning and implementation o in collaboration with
                            Panchayat dept.

                          • Organise advocacy meetings with PRIs on key issues, such
                            as maternal health, JSY, PNDT and gender based violence.

♦ Indicators              • District Health Mission Meetings

                          • Workshops

                          • Trainings
Support                   • Support from both PRIs and health department to
                            strengthen convergence



                                                                                     371
              BUDGET FOR CONVERGENCE WITH PRIs

                                                                               Lakhs
                                                                     Budget in Lakhs
SN                                 B NRHM Additionalities                       Remarks
                                                                     Rs in
                 Activity                Q1      Q2     Q3    Q4
                                                                     Lakhs
B8     Panchayati Raj Initiative

       Preparation of guideline
       on role of PRIs/ RKS
       members printed and
       disseminated in local
B8.1   language to all PRI              0.00   15.00   0.00   0.00   15.00
       members and other key
       stakeholders in NRHM. 3
       lakh copies @ Rs. 5 per
       copy

       Organise         advocacy
       meetings with PRIs/ RKS
       members on key issues
       such as maternal health,
       JSY, PNDT and GBV.
       SHSRC and Centre for
       Communication to jointly
       provide     support      in
B8.2                                    5.00    5.00   5.00   5.00   20.00
       preparing        advocacy
       materials. Advocacy to be
       organised in each district
       by the District Health
       Mission. A provision of Rs
       1 lakhs per district made,
       detailed budget to be
       prepared by each district

               Total Budget                     20.0
                                        5.00           5.00   5.00   35.00
                                                   0




                                                                                372
V.       CONVERGENCE WITH EDUCATION DEPARTMENT

Objective: To strengthen the School Health Programme
Issues                    There is strong need of convergence between NRHM and
                          Education Department to focuses on addressing school going
                          children and youth to improve the overall health outcomes in the
                          state by enabling an inter-generational change. Also, improve
                          health outcomes to enable adoption of healthy lifestyle
                          To enable an inter-generational change, there is a need to address
                          youth. Also there is a need to orient the youth on ill-effects of the
                          habit-forming practices such as smoking, drinking and substance
                          abuse. Adolescent Health issues also need to be addressed for
                          which Education department has to be involved actively.
Strategies                Activities
School            Health • School Health programme to provide health check up to all
Programme           and      school going children.
Treatment of Children • Special campaign for treatment of Rheumatic Heart Disease and
for RHD and CHD              Congenital Heart Disease among School going children.
                          • Orient secondary school teachers on the Adolescent issues and
                             availability of health services in the public health facilities.
                          • Undertake a joint campaign with the Education Department on
                             the ill-effects of habit forming practices.
                          • Encourage Education Department to promote co-production of
                             health by students through practices such as Yoga and physical
                             exercises.
                          • Use the opportunity of NSS camps in colleges to involve youth
                             on health issues. Orientation of youth done during the camps
                             and they could be encouraged to undertake campaign on behalf
                             of the health department.
                          • IEC    campaign     through     school   children    i.e.   awareness
                             generation rallies, poster competitions, wall painting by
                             children.




                                                                                         373
Indicators   • Schools visited for School Health Checkup
             • Children referred for different diseases
Support      • Department of School Education
             • State/District Health Mission




                                                           374
                          B NRHM Additionalities
  SN                                                                  Rs in   Remarks
                    Activity              Q1     Q2     Q3     Q4
                                                                      Lakhs
B10.1     Special Innovative Programme for Minorities
          Camps to be held 10 in every
          month @ Rs. 10000 per camp
          for providing Family Welfare
          services and dissemination of
B10.1.1   information on RCH               3.00  3.00   3.00   3.00   12.00
          components and also counselling
          on various issues like FP,
          Adolescent health and early
          registrations of pregnancies
          Peer Educator 20 @ Rs. 1000/-
B10.1.2                                    0.60  0.60   0.60   0.60   2.40
          p.m
          Audience specific
          communication material in
          Urdu, Punjabi pertaining to
          themes like age at marriage,
B10.1.3   immunization, sterilization, CC  1.50  1.50   1.50   1.50   6.00
          use, IUD, OCP, Male
          involvement, Child Health
          Issues (Pamphlets, Hoardings,
          wall paintings)
          Meetings/Workshops with
B10.1.4                                    0.26  0.26   0.26   0.26   1.05
          Stakeholders and opinion leaders
                     Total Budget          5.36  5.36   5.36   5.36   21.45




                                                                               375
ANNEXURE




           376
                                                                                   Annexure I (3a)

            FORMAT FOR SELF APPRAISAL CRITERIA (STATE)
                                 CRITERIA                                        REMARKS
                                                                                 (Yes (Y) or No (N)
                                                                                 If Yes, specify page
                                                                                 no. of state PIP)
                               A. OVERALL
1   Has the state PIP been reviewed in detail by a single person to              Yes
ensure internal consistency? If yes, by whom? (Mandatory)                        Dr. C.L. Bhatia, State
                                                                                 Programme Manager,
                                                                                 NRHM/ RCH
2   Has a chartered accountant reviewed the budget in detail?                    Yes
(Mandatory)
    B. RCH II PROGRAMME MANAGEMENT ARRANGEMENTS                                  Yes
Has    the state     PIP spelt out the programme               management
arrangements already in place and additional steps to be taken?
These include:
 (Mandatory)
1   Firming up the background and tenure (at least 3 years) of person            Yes
having overall responsibility for RCH II at state and district levels;           All   efforts    will   be
delegation of powers                                                             made
2   Steps to ensure that RCH II is high priority for the District                Yes
Collector                                                                        Regular
                                                                                 communication           by
                                                                                 Mission Director with
                                                                                 Deputy
                                                                                 Commissioners DHS
                                                                                 meetings            under
                                                                                 Chairmanship of DC
3   Extent to which programme management support structure at                    Yes
state and district / sub-district levels is consistent with expertise required   To     the      maximum
for programme strategies; job descriptions including person specifications,      possible
delegation of powers and basis for assessment of performance; strategy and       Annexure -II
time bound plan for sourcing of staff vacancies, if any
4   Steps to establish financial management systems including funds              Yes
flow mechanisms to districts; accounting manuals, training, audit                Annexure –II)
5   Steps to ensure performance review of district program managers              Proposed


                                                                                                  377
                                CRITERIA                                    REMARKS
                                                                            (Yes (Y) or No (N)
                                                                            If Yes, specify page
                                                                            no. of state PIP)
6   Capacity building of programme management staff at state and            Yes
district levels
7   Steps to ensure/establish quality assurance committees in the           Yes
districts
8   Step to ensure systems for holistic, monitoring (outcomes,              Yes
activities, costs) against the state PIP including variance analysis




C. INSTITUTIONAL STRATEGIES
Has the state PIP spelt out the steps undertaken for the following and
additional steps required?
    (Mandatory)
1   Have DHAPs been prepared for all districts? If not, for how many?       Prepared      by         all
Has the approach to incorporating DHAPs in the state PIP been spelt         Districts               and
out?                                                                        submitted
2   Review of HRD practices in order to motivate staff and increase         Yes
effectiveness e. g. appropriate criteria for placement of staff
(especially CMOs), rationalization of work load of ANMs, performance
appraisal based on e. g. improvement in MMR/ IMR/TFR related
process indicators, package of incentives for postings in less
developed districts, transfer and posting policies, improved
supervision
3   Strengthening of HMIS with emphasis on improved decision                Yes           Reporting
making/ initiation of corrective action based on timely availability of     System is on-line and
reliable and relevant information at appropriate levels e. g.               HMIS fully functional
community, SHC, block, district and state; system for monitoring of
utilization of health facilities in terms of volume and quality. Steps to
ensure implementation of new MIES format.
4   Improved logistics/ management of drugs & medical supplies in                       Yes
order to ensure continuous availability of essential supplies at various
health facilities including SHC and the community
5   Development of revised criteria (e. g. travel time, cost, potential                 Yes
patient load, referral arrangements, etc) for location of facilities



                                                                                              378
                                CRITERIA                                       REMARKS
                                                                               (Yes (Y) or No (N)
                                                                               If Yes, specify page
                                                                               no. of state PIP)
    (Desirable criteria)
6   Provision for MoU with districts                                                   Yes
7   Strategy for piloting public-private partnerships and social                       Yes
franchising and subsequent scale up
8   Functional review of State Health and Family Welfare Department                    Yes
including respective roles of state, district, block and community level
(including PRI) institutional structures; delegation of powers;
organisational emphasis to key functions such as quality, HRD and
training
9   Optimizing the utilization of existing health facilities/ scope of                 Yes
relocation based on load/ utilization, distance/ travel time and cost
especially for the poor/women and taking into account availability of
private/ NGO run facilities, referral transport arrangements




10 Training Strategy (Mandatory)                                                Yes (Page No.138)
The training strategy should strengthen existing training schools to
function as District Health Resource Centers. Training should be
channelised through these institutions. The strategy should also
indicate target groups (e. g. medical officers, ANMs, AWWs, link
workers, community health team, etc), estimate training load and
provide broad details of training programmes including objective,
broad course content, duration of training, and mechanisms for
assessment      of   quality/   impact.    Strengthening     the    training
management function including the institutional arrangement at state/
district levels, especially seniority of head of training function is
particularly important.
11 BCC strategy (Mandatory)                                                     Yes (Page No 178)
Development of a service oriented BCC strategy should be based on
an assessment of the current status of knowledge, attitudes, beliefs
and practices regarding issues concerned with MMR, IMR, TFR and
ARSH; and factors likely to influence necessary change in behaviour.
Creation of awareness of key aspects such as breast feeding and




                                                                                             379
                              CRITERIA                                      REMARKS
                                                                            (Yes (Y) or No (N)
                                                                            If Yes, specify page
                                                                            no. of state PIP)
PNDT act is particularly important. Based on evidence, the strategy
should aim to determine appropriate combination of messages and
media and a mechanism for assessing impact at appropriate stages.
The institutional arrangement including role of state and district and
strengthening capacities for BCC is again important.
12 Convergence/ coordination arrangements (Mandatory)                               Yes
Have steps taken to ensure convergence within state DHFW (e.g.               Detailed strategies
how to leverage NRHM Additionalities for RCH) and with other key             designed (Page No
departments such as DWCD and PRI? Have all externally funded                        350)
programs/projects having a bearing on RCH been reflected in the
State PIP and convergence (organisation structures; staff; resources)
arrangements spelt out?
13 Pro poor strategy (Mandatory)                                                    Yes
Does the SPIP demonstrate how pro poor and gender strategies are
mainstreamed into RCH II? The recommendations of the equity and
gender studies and contained as supporting documents in the
National PIP are of relevance. Some steps that could be taken are e.
g. a arrangements for collection and reporting of disaggregated data;
gender needs of female health service providers e. g. addressing the
needs of ANMs, LHVs, and doctors; policy for encouraging staff to
work in less developed districts; strategy developed for creating
gender and equity consciousness amongst various stakeholders
especially programme staff and community.
14 Infection Management and Environmental Plan / IMEP                        Yes Facility Survey
(Mandatory)                                                                  completed gaps will
Does the SPIP have a clear plan for dissemination of IMEP                        be covered
guidelines and operational sing IMEP in health facilities in a phased
manner?
15 Sustainability (Mandatory)                                                       Yes
In the case of facilities and resources created from state funds, the
strategy to ensuring sustainability is another criterion for appraisal of
state PIPs. Sustainability could be addressed through e. g.
introduction of user charges with cross-subsidy for BPL families,




                                                                                           380
                                CRITERIA                                    REMARKS
                                                                            (Yes (Y) or No (N)
                                                                            If Yes, specify page
                                                                            no. of state PIP)
higher allocations in the state budget and taking steps to place family
welfare in the community’s agenda.
D. TECHNICAL STRATEGIES (Mandatory)                                                 Yes
(Has the state spelt out steps taken / or constraints faced so far in
RCH II and identified corrective actions for the following?).
1   Separate goals and strategies for MMR, IMR, TFR and ARSH
based on evidence and in consonance with the results of the
situational analysis. The SPIP should specify, for example:
2   MMR: steps to ensure availability of anesthetists and                           Yes
gynecologists, at FRUs; 24 hour delivery services at 50% PHCs with              Substantially
skilled providers to provide BEmOC services; coverage of                         addressed
inaccessible villages by ANMs; emergency transportation between
village, BEmOC centers and FRUs. If states plan to pursue PPP or
demand side financing options these should also be shown as
strategies.
3   IMR: steps to ensure acceleration of immunization activities,                   Yes
essential new born care, promotion of breast feeding and timely
initiation of complementary feeding, micronutrient supplementation
collaborating arrangements with ICDS for immunization and IMNCI
services and ensuring IMNCI service package is delivered
4   TFR: steps to increase the availability of quality sterilization                Yes
services by training more providers or increasing the range of
sterilization methods by emphasizing NSV, minilap and traditional
tubectomy in addition to laparoscopy and ensuring service availability
on fixed days at specified no of CHCs and PHCs. For increasing the
use of spacing methods, approaches to be pursued to increase
availability of methods at the community levels through community
based distributors, social marketing or private sector
5   Quality strategy                                                                Yes
Has the PIP spelt out the strategy and activities for assuring quality of
service delivery at public facilities? This would include steps for
implementation of GOI guidelines, an accreditation system and
necessary institutional arrangements. The institutional arrangement




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                                CRITERIA                                  REMARKS
                                                                          (Yes (Y) or No (N)
                                                                          If Yes, specify page
                                                                          no. of state PIP)
for implementing the accreditation system is particularly important.
6   Strategy and activities for quality assurance of private sector        Yes (Nursing home
facilities/ service providers similar to the above (Desirable).           registration Act ready
                                                                                 for enactment)
E. WORK PLAN (Mandatory)                                                  Yes (Annexure1 (3d)-
1   Is the work plan consistent with stated components/ objectives,              Part A RCH)
strategies and activities? and whether the proposed phasing of
activities would lead to targeted increase in delivery/ utilization of
services? The Work Plan should separately address each component
of the PIP showing objectives, strategies, activities and should be in
quarters for 07-08 with physical targets against activities.
F. COSTS/ BUDGET (Mandatory)                                              Yes (Annexure1 (3e)-
Key criteria are:                                                         Part A RCH)
1   Does the budget follow the prescribed formats?                        Yes (Annexure 1 (3a
                                                                                     to 3e)
2   Are districts allocated a certain amount / % of total allocation as               Yes
genuinely untied i.e. districts can propose district schemes? If yes,
how much?
3   Absorptive capacity: If very ambitious utilization of funds is        Yes
envisaged compared to performance in 05-06/ 06-07, then what are          SPMU,               DPMU,
the steps proposed to be taken to bring this about?                       BPMU       strengthened
                                                                          with        professional
                                                                          especially                for
                                                                          Finance, Accounting,
                                                                          Procurement, M & E
                                                                          etc.




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