National Rural Health Mission, Assam Progress

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					 Progress of NRHM, Assam



           (Dated 18th May 2010)




 National Rural Health Mission, Assam
Department of Health & Family Welfare
            Govt. of Assam
   STRUCTURE OF PRESENTATION
 Introduction to NRHM
Present Status
 Maternal Health
 Child Health
 Family Planning
 Other Activities
 Innovations
 New Initiatives
 HR Initiatives
 National Disease Control Programme
 Financial Status
                  NRHM, A PARADIGM SHIFT
    PROMOTING EQUITY AND EXCELLENCE FOR „ HEALTH FOR ALL‟


The Mission: Providing affordable, accessible, equitable quality healthcare
especially for those residing in rural areas, the poor, women and children
Focus Areas and priorities
1.Improving the health status of pregnant women and children especially in
rural areas
2.Stabilizing population by promoting family planning
3.Restructuring public health governance through community and PRI
involvement, addressing resource shortages in terms of providing additional
required manpower and increase public spending in healthcare
                 NRHM, A PARADIGM SHIFT
PROMOTING EQUITY AND EXCELLENCE FOR „ HEALTH FOR ALL‟; CONT.

Goals:
1.Reducing Infant Mortality Rate (IMR) and Maternal Mortality Ratio (MMR)
2.Population stabilization (reducing TFR)
3.Universal access to public health care services
4.Prevention and control of communicable and non communicable diseases
5.Revitalize local health traditions and mainstream AYUSH
Expected Outcomes from the Mission by 2012:
1.IMR reduced to 30/1000 live births
2.Maternal Mortality reduced to 100/100,000 live births
3.TFR reduced to 2.1
4.Reducing incidence and prevalence of diseases like Malaria, Filaria,
 Leprosy, TB etc.
Present Status


 Indicator                        Assam                         India



                       480                  333                  254
   MMR           (Source 2004-06,     (Source 2009, CES,   (Source 2004-06,
                      RGI)                RRC-NE)               RGI)




                        64                   46                   53
                 (Source SRS, RGI,    (Source 2009, CES,   (Source SRS, RGI,
   IMR
                   October 2009)          RRC-NE)            October 2009)




                        2.6                                       2.6
   TFR
                 (Source RGI, 2009)                        (Source RGI, 2009)
MATERNAL HEALTH
      MATERNAL HEALTH – ACTIVITIES
   Involvement of 28,798 trained ASHAs equipped with drug kit and pregnancy
    kit for maternal and child health care.

   Support to ASHAs by appointing 2664 ASHA facilitators.

   Organizing Village Health & Nutrition Day every month.

   Micro Birth Planning by the ANM for all the pregnant women

   “Mamoni” Nutritional Support of Rs. 1000/- to pregnant women – an
    initiative by Govt. of Assam.

   Cash assistance to mothers under JSY scheme.

   Encouraging mothers to stay in the Hospital up to 48 hours after delivery to
    prevent post partum hemorrhage by providing Baby Kit (Mamata Kit).

   Training of ANMs/Staff Nurse for SBA

   Training of Medical Officers on BeMOC, CeMOC and LSAS
       MATERNAL HEALTH – ACTIVITIES
   All the SCs have been provided with SC Kit – A and B.
   Upgradation of Sub Center for Delivery.
   Rural Health Practitioners have been posted in the Sub-centres and PHCs in
    difficult areas
   Compulsory one year Rural Posting for MBBS doctors to get admission in
    the PG courses. (808 MBBS doctors posted in rural areas)
   Construction of Labour Room/ Ward in PHC/SD/SHC and operationalizing
    343 PHCs as 24X7.
   Upgradation of SDCH/ CHC to 39 functional First Referral (FRU) Unit
    having specialist doctor with provision of C-section operation and Blood
    Storage facility.
   Strengthening of referral mechanism from village to Health Institutions
    through 108 Mrityunjoy Emergency Referral Transport and by providing
    ambulances to health institutions.
MATERNAL HEALTH - PROGRESS
   TREND OF INSTITUTIONAL DELIVERY IN ASSAM (HMIS REPORT)

                                                     11%       11.52%
                                                   increase   increase
                                  68%
                                increase




DLHS 3 (2007-08): 35.3%                    CES, 2009, RRC-NE: 66.3%
TREND OF JSY BENEFICIARIES IN ASSAM (HMIS REPORT)
MATERNAL HEALTH - PROGRESS
 VHND - ASSAM (HMIS REPORT)
     MATERNAL HEALTH – PROGRESS
  Antenatal Care Service (ANC) (Source HMIS Report)

            Activities                    2008-09    2009-10

Total number of pregnant women            7,35,358   7,47,982
Registered for ANC

Of which Number registered within first   2,30,650   2,80,392
trimester

Number of pregnant women received 3       3,70,702   4,14,735
ANC check ups

No of pregnant women received TT1         5,89,993   5,77,548

No of pregnant women received TT2         5,83,218   5,91,401
or Booster
                             Maternal Health Status
        Indicator                         Present Status             Status prior to
                                                                         NRHM
                             SRS Estimates, RGI      CES, RRC-NE   SRS Estimates, RGI
                                  2004-06                  2009         2001-03
Maternal Mortality Ratio            480                    333            490
(MMR) - per 1,00,000 Live
Birth
                                  DLHS-3             CES, RRC-NE        DLHS-2
                                  2007-08                  2009         2002-04
Institutional Delivery (%)
                                  35.3 %                   66.3%        23.2 %
Mothers who received
any antenatal check-up             74.8%                     -           59.8%
(%)
Mothers who had
antenatal check-up in              39.4%                     -           38.5%
first trimester (%)
Mothers who had three or           46.4%
more ANC (%)                                               68.3%         39.4%

Mothers who had at least
one tetanus toxoid                 69.3%                   88.9%         55.0%
injection (%)
  CHILD HEALTH




FOCUSING ON NEW BORNS
                        Child Health - Activities

   IMNCI Training of AWW & ANMs

   Strengthening Routine Immunization with special focus in
    Difficult areas.

   Special Vit. A and Deworming drive bi-annually.

   Establishment of Sick Newborn Care Unit in District Hospital.

   Establishment of Newborn Stabilization Unit in all the SDCH/
    CHC/ PHC

   Setting up of Nutritional Rehabilitation Center for malnourished
    children in 3 districts.
    ROUTINE IMMUNIZATION PERFORMANCE


Outcome % of Fully Immunized Children


 As per NFHS-II (1998-99)   : 17.0 %


 As per NFHS-III (05-06)    : 31.6 %


 As per DLHS-2(2002-04)     : 16.0 %


 As per DLHS-3(2007-08)     : 50.9 %

 As per CES, RRC-NE (2008) : 58.0 %


 As per CES, RRC-NE (2009) : 70.0 %
                             Child Health Status
        Indicator                        Present Status              Status prior to
                                                                         NRHM
                                                   CES, RRC-NE
                             SRS October 2009                        SRS April 2005
                                                          2009
Infant Mortality Rate               64
(IMR) per 1,000 live birth
                                                          46               67
                              DLHS-3 (2007-08)    CES, RRC-NE 2009   DLHS-2 (2002-04)

Children 12-23 months                                                    16.0%
fully immunized (%)               50.9%               70.0%

Children 12-23 months             83.8%
who have received BCG                                 94.5%              61.3%
vaccine (%)
Children 12-23 months                                                    36.3%
who have received 3 doses         60.4%               87.1%
of DPT vaccine (%).
Children 12-23 months
who have received 3 doses         64.9%               86.7%              27.6%
of polio vaccine (%)
Children 12-23 months             64.4%                                  33.7%
who have received measles                             81.7%
vaccine (%)
SNCU
FAMILY PLANNING
               Family Planning - Activities

   Fixed day sterilization in all the District Hospital.

   Special monthly sterilization camp in CHC/ PHC

   IUCD insertion facility in all Govt. hospital and Sub
    Center

   No scalpel Vasectomy (NSV) camp cum training

   Training of Medical Officers and O&G Doctors on Mini
    Lap and Laparoscopic Sterilization

   Training of ANMs, Staff Nurse and Medical Officer on
    IUCD insertion.
Family Planning Performance– Male Sterilization
Family Planning Performance – Female Sterilization
Family Planning Performance – IUCD Insertion
Other Activities
Trend of OPD Patients in Assam
Trend of IPD Patients in Assam
 INITIATIVE TO REACH TO
UNSERVED, UNCOVERED AND
     RIVERINE AREA
     INITIATIVE TO REACH TO UNSERVED, UNCOVERED, RIVERRINE ISLAND
                     MOBILE MEDICAL UNIT
Activity                                2007-08   2008-09    2009-10

No of District MMU Functioning            10        23         27

No of Camps held                         183       1,606      4,226

No of Patient Treated                   40,304    2,59,150   6,71,911

No of ANC                                673       4,113     13,371

No of PNC                                177       1,792      3,558

No of X-Ray                              375       3,379      6,741

No of USG                                236       4,619      8,026

No of ECG                                162       2,604      3,875
No of Patient examined for Blood
                                        1,182     12,292     41,948
Test
No of Patient examined for Urine
                                         175       1,548      5,457
Test
No of Patient examined for Stool Test     0          0         265
Mobile Medical Unit
    INITIATIVE TO REACH TO UNSERVED, UNCOVERED, RIVERRINE AREAS

                            BOAT CLINIC
Activities                                     2008-09   2009-10

Total no of camps organized                     1,038     1,867

No of Patient treated under General Health     91,836    1,41,413
Checkup

No of Routine Immunization                      8,994    20,389

No of Antenatal Care (ANC) services provided    3,201     6,064

No of Postnatal Care (PNC) services provided    993       1,202

No of Vit. A administered                       1,463     7,170

Special Vaccination                             1,343     1,330

IPPI                                            4,281     1,684

No of Family Planning Services                  2,533    14,030
Services Rendered by Boat Clinic
            HEALTH SERVICES TO DAILY WAGE EARNERS

                             Evening OPD
    Operationalizing Evening OPD in 216 District Hospital/ Community Health
 center and Primary Health Center to provide OPD services for working class
 and daily wage earners.

             Evening OPD Services                         Evening OPD
                                                       (From 6th May 2008 to 31st March
                                                                    2010)




No of Patient Registered in Evening OPD                        23,99,052

No of Laboratory Investigation in Evening OPD                   2,32,953

No of Radiological Investigation in Evening
                                                                 36,356
OPD
HEALTH SERVICES FOR THE URBAN POOR / URBAN SLUMS


                        Urban Health Center

            State Summary                       Urban Health Center
   (Functioning in 48 Urban Centers)            (From February 2009
                                                   to March 2010)



No of Patient Treated                                 3,73,533



No of pregnant women received Antenatal Check          5,200
up

No of pregnant women received Postnatal Check          1,422
up
School Health Programme (For Primary School)



  School Health Programme started on 21st October 2009 in

 three districts of Assam on pilot basis.


  Total 1,96,350 students of 3101 nos of L.P. schools have

 been screened under this programme.


  Out of which 3,766 nos of students were referred to different

 health institutions for treatment.
 Yoga Programme for High School Students

 Under the Yoga Programme total 2,99,752 students from 502
schools have been enrolled. .
Total 32,233 yoga classes conducted out of the total target of
50,200.
          HEALTH SERVICES TO TEA GARDEN AREAS

            PPP WITH TEA GARDEN HOSPITALS

198 nos of Tea Garden hospitals were taken under PPP.
 Rs. 15 lakhs has been sanctioned for the selected tea garden
hospitals and the amount has been released to the respective District
Health Societies. Out of the total amount 1 (one) ambulance is also
provided to each Tea Garden Hospital.
 These are providing Maternal & Child Health Services.
Performance of Tea Garden Hospitals under PPP (Up to Feb 10)
    Total no of ANC registered  5092
    Total Deliveries conducted  2472
    Fully Immunized Children  3462
    IUCD inserted  39
    Medical camps organized  415
108 (MRITUNJOY) EMERGENCY RESPONSE SERVICE

Total 280 nos of Ambulances deployed for referral transport including obstetric
emergencies.
 Boat service will be also included in 108 service

  Sl              Emergency services                  Performance from 6th
                                                      Nov‟08 to 31st Mar‟ 10
   1     Total Calls                                        41,23,707
   2     Total Life Saved                                    15,511
   3     Pregnancy Related Emergency                        1,19,633
   4     Acute Abdomen                                       47,876
   5     Injury                                              38,178
   6     Cardiac Problem                                     13,504
   7     Respiratory Problem                                 11,145
   8     Poisoning/ Drug Overdose                              554
   9     Others                                              73,552
Mritunjoy 108 Service
                     Status of ASHA & VHSC
   Total no. of ASHAs in position =28,798.
   ASHA Drug kit distributed to all the ASHAs.
   Training module available in Assamese, Bengali.
   Training organized for all ASHAs.
   Incentive paid to ASHAs for Institutional Delivery, Full
    Immunization, Family Planning motivation, organizing VHND,
    detecting fever cases (Malaria), completion of DOTS treatment
    under RNTCP (TB).
   Radio set distributed to all the selected ASHAs.
   Radio Programme for ASHA’s started from 8th October 2007.
   4(four) Radio Stations Guwahati, Dibrugarh, Silchar and Tezpur
    broadcasting the Half an hour ASHA programme twice weekly.
   Bicycle is provided to each ASHA – an initiative by Govt. of
    Assam under Assam Vikash Yojana
   Total 2664 nos of ASHA facilitators appointed.

   Total 25,325 nos of VHSCs functioning with Joint Account of
    ASHA and PRI member.
               IEC/BCC ACTIVITIES

   Focal Group Discussion/ Interpersonal communication (IPC)
    with the community. Achievements
   ASHA Radio Programme with Health Messages.
   Health Messages through Mobile Theatres. No of audience
    during
   Print/ Radio/ TV Campaign/ Pamphlets/ Banners with Health
    Messages
   Street Play/ Dramas on various Health Issues. Achievements
   Installation of 1000 nos of IEC hoardings at public locations
    throughout all districts of the State.
   Community Screening of Films on Health
   Folk Media Presentation on Health Based themes
Ensuring Drugs Availability in all the Health Institutions



                Medicine Budget (Rs. In Crore)
     Year
                State Govt.          NRHM           Total

2005-06                  18.00              10.80           28.80

2006-07                  18.00              20.00           38.00

2007-08                  38.00              48.50           86.50

2008-09                  40.00              49.89           89.89

2009-10                  40.40              64.23       104.63
          Ensuring Referral Transport Facilities

• 350 ambulances procured under NRHM and placed in service in
Govt. Hospitals.
• 200 ambulances procured by Govt. of Assam and placed in
service in Govt. Hospitals.
• Additional 200 ambulances procured and placed in service in Tea
Garden Hospitals under PPP with Tea Garden Hospital..
•Under 108 Mritunjoy Emergency Response Service, 280 nos of
ambulances are deployed through out the State providing round the
clock services.
    Tolaram Bafna Hospital              School Building (GNM School, Morigaon)


             HEALTH INFRASTRUCTURE
                 DEVELOPMENT
                  UNDER NRHM




School Building (GNM School, Darrang)    RHBPC-Abhayapuri CHC,Bongaigaon
        Health Infrastructure Development (Under NRHM)
      Meeting the gap of the Health Facilities as per Population Norms

Sl.                Name of work                            Numbers
                                                         Target – 5
1     Construction of new District Hospital             Completed – 1
                                                          and functional
                                                          Target – 4
      Upgradation of District Hospital as per
2
      IPHS
                                                 Completed – 2 and functional
                                                        Target – 103
3     Up gradation of CHC to IPHS
                                                 Completed – 100 and functional
                                                         Target – 100
4     Construction of new PHC
                                                   Completed -7 and will be
                                                     functional from May 2010
                                                        Target – 122
5     Construction of Ward
                                                  Completed – 19 and utilized
                                                        Target -1500
6     Construction of new Sub-Centers
                                                Completed – 236 and functional
        Health Infrastructure Development (Under NRHM)
           To meet the gap of Medical & Paramedical personnel



Sl.                Name of work                           Numbers

                                                      Target – 3
                                             Functional – 1 (Jorhat Medical
1     Construction of Medical College
                                                    College Hospital)


                                                         Target – 2
      Construction of new      BSc Nursing
2
      School
                                                 (Work under progress)


                                                         Target – 8
      Construction of new GNM School and
3
      Hostel Building                                 Completed – 4
                                               and will be functional from May 2010
     Health Infrastructure Development (Under NRHM)

      Ensuring Manpower Availability in Rural Health Facilities



Sl         Name of the Schemes/ works          Total nos. of scheme




1
      Rural Health Block Pooling                 Target – 76
      Complex                             Completed – 40 and occupied




                                                Target – 153
2     Doctors & Nurses Quarter
                                         Completed – 85 and occupied
INTERVENTION IN 5 HIGH FOCUS DISTRICTS

NC Hills, Karbi Anglong, Karimganj, Dhubri &
                  Dhemaji
     Intervention in 5 High Focus Districts

 Skill Up gradation of 300 ANMs

 Operationalization of 50 nos. of SCs in Dhubri & Karimganj for

  delivery

 IMNCI training of ANM and Anganwadi Workers

 ASHA training on Nutrition (6th Module)

 Training of GNM / FP coordinator – Dhubri

 Partnering with NGO for social marketing of contraceptives in

  Dhubri & Karimganj
Innovations
                         Mamoni Scheme




        ASHA Radio Prg

Majoni Scheme                 MOBILE PHONE TO ANM
              Innovation- MAMONI SCHEME
                   Under Assam Vikash Yojana

   All pregnant women are eligible for availing the scheme.
    During the First Registration, the Pregnant Women is given Mamoni, a
    book on antenatal, natal and postnatal care.
    During her 2nd ANC, the pregnant women is given an account payee
    cheque of Rs. 500/- as a nutritional support.
   During here 3rd ANC she is given Rs. 500/-

Physical Achievement                      Performance From March 2009 to
                                                  February 2010

1st installment of Rs. 500/- per                     85,233
pregnant women

1st installment of Rs. 500/- per                     29,061
pregnant women

Total                                               1,14,294
                    Innovation - MAJONI
              SPECIAL ASSISTANCE TO GIRL CHILD
                          Under Assam Vikash Yojana

   “Majoni” – Social assistance to all the girl child born in
    the family up to second order is given a fixed deposit of
    Rs. 5,000/- for 18 years – an initiative by Govt. of Assam
   The families conforming to the Govt. policy of 2 children
    is only be eligible for the scheme.

    Physical Achievement                Performance From February
                                          2009 to February 2010
    No of application form submitted                  50,180
    for Majoni benefit
    No of Fixed deposit issued to                     33,841
    beneficiaries
                          Innovation
   “Compulsory one year Rural Posting for MBBS doctors to get
    admission in the PG courses. (808 MBBS doctors posted in rural
    areas)
   Rural Health Practitioners have been posted in the Sub-centres
    and PHCs in difficult areas
   Introduction of 104 Health Information Help Line (Planned)
   Healthcare center in riverine island. Services provided in these
    institutions will be equivalent to Sub Center.
HR Initiatives
Initiative/ Innovation to meet the manpower requirement

   Initiated 3 yrs Diploma course of “Rural Health
    Practitioners”. The first batch of 92 RHP posted at the PHCs.
   Compulsory one year Rural Posting for MBBS doctors to get
    admission in the PG courses. (808 MBBS doctors posted in rural
    areas)
   Setting up of 3 new Medical Colleges, 8 GNM school and 2 BSc
    Nursing School , the Construction work is going on
   Multi Skilling Training Programme for in- service Medical
    Officers –
          18 weeks training on Aneasthesia
          12 weeks training on Radiology & Ultra sonography
          16 weeks training on EmOC
          12 weeks training on Paediatric & Neonatal Management
      MANPOWER STATUS OF MEDICAL AND PARAMEDICAL STAFFs

                            In position                                       In position
   Staff Cadre                                           Staff Cadre             Contract
                  Regular     Contractual   Total                       Regular           Total
                                                                                   ual
Gynecologist       170            22        192     Medical Officer
                                                    (Including 1 year    1431     1128    2559
Pediatrician        73            19         92     rural posting)
Physician           73             8         81     AYUSH MO              385      259     644
Anesthetics         71             11        82
                                                    Dental Surgeon        47       39      86
Ophthalmologist     97             2         99
                                                    Pharmacist           1110      179    1289
Surgeon             96             6        102
                                                    Radiographer          91       27      118
ENT                 64             1         65
                                                    LT                    707      492    1199
Orthopedics         8              1         9      Rural Health
                                                                           0       92      92
Pathologist         29             2         31     Practitioner
                                                    Staff Nurse          1321     2295    3616
Radiologist         13             1         14
                                                                                          1025
Dermatologist       9              0         9      ANM                  5333     4921
                                                                                           4
Psychiatrist        13             0         13     MPW                  1000       0     1000
National Disease Control
      Programme
Situation of Malaria
         Situation of Japanese Encephalitis

            Age distribution of AES cases

  Year            <15 yrs.               >15 yrs.        % of cases
                                                          in adult



           Case          Death    Case          Death



2008       125               19   194               81   60.31%



2009       231               25   412               84   64.07%
National Programme for Control of Blindness
        Achievement in Cataract Surgery
   National Programme for Control of Blindness
           Achievement in School Eye Screening



 Year     School Children Screened     R.E.        Glass
                                     Detected    Provided

           Target    Achievement

2006-07   7,58,833     2,36,995       9,867       1,764

2007-08   3,00,000     1,85,097       5,004       2,123

2008-09   3,00,000     2,97,101      13,206       3,727


2009-10   3,00,000     3,53,662      15,724       5,089
Financial Status
                              Financial Status (NRHM)



                              Fund
                Opening                   Fund                      Closing     % of
     Year                  Approved in              Fund Utilized
                Balance                  Received                   Balance    Utilized
                               PIP




2005-06               -      12691.00     9275.96          837.04    8438.92      9.02%



2006-07          8438.92     42269.00    21847.61       12797.26    17489.27     42.25%



2007-08         17489.27     60215.00    57111.40       44229.56    30371.11     59.29%



2008-09         30371.11     73172.76    57772.15       58408.59    29734.67     66.27%



2009-10
                29734.67     89352.18    70015.61       63912.93    27073.73     64.07%
(Provisional)
                  State Govt. Budget
          Health & Family Welfare Department
                    BE/RE Budget                  % of Increase
Year                   (Rs. In Crore)
                  BE                    RE
2004-05             652.75               649.69

2005-06             621.52               769.15      18.39%

2006-07             960.12              1008.02      31.06%

2007-08            1183.05              1194.28      18.48%

2008-09            1379.88              1385.46      16.01%

2009-10            1604.95                           15.84%
CONTRIBUTION OF STATE SHARE to NRHM

  Sl       Year       Fund received
                       (Rs. In lakh)
  1       2006-07                      Nil
  2       2007-08                 6000.00
  3       2008-09                 8000.00
  4       2009-10                 9000.00

       Total                     23000.00
Thank You

				
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