cm review 26 08 08 by NiceTime

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									      PRESENTATION ON
NATIONAL RURAL HEALTH MISSION
           (NRHM)

              FOR
  HON’BLE CHIEF MINISTER

         26TH AUGUST 2008
NATIONAL RURAL HEALTH MISSION

 • NRHM launched by Hon’ble Prime Minister on 12/4/2005.

 • Aimed to ensure affordable, quality health care to the poorest
        house holds in remotest areas.

 • Special focus on 18 low performing States which have weak
        public health indicators and weak infrastructure.

 • Punjab is among the nine high performing States- Punjab,
        Haryana, Gujarat, Maharashtra, Karnataka, Kerala, Tamil
        Nadu, Andhra Pradesh, West Bengal.

 8/29/2008                                                     2
 NRHM OBJECTIVES
    • Universalized access to quality health care especially to rural poor
            with focus on women and children.
    • Reduced infant mortality rate and Maternal Mortality Rate.
    • Ensuring population stabilization & gender equity.
    • Prevention and control of communicable and non-communicable
            diseases.
    • Access to integrated comprehensive primary health care.
    • Mainstream AYUSH- Integration of AYUSH with mainstream
            health institutions .
    • Promotion of Healthy life style.
    • Emphasis on potable drinking water, hygiene, sanitation and
            nutrition.
8/29/2008                                                                    3
KEY COMPONENTS OF NRHM
System strengthening             Community Partnership                Improved services

Infrastructure development         Village level planning
                                                                      24-Hour- delivery
Monitoring through                                                    services
computerisation                    ASHA                               Emergency Obstetric
                                                                      Services
Improved financial                 Village Health &
management &                                                          Specialist Services – On
                                   Nutrition Days                     call/contract
Human Resource
Public Private Partnership         Village Health &                   Immunization
                                   Sanitation Committees              strengthening
Telemedicine
Mobile units for un reached                                           IMNCI
                                   Increased involvement of
                                   PRIs                               Adolescent health
Intra & inter sectoral
convergence                                                           Family welfare services



                         Accessibility, Approachability and Quality
NRHM STRATEGIES
•   Decentralization of the process of health planning and management from Village to
    District level.
•   Involvement of PRIs and Village Health & Sanitation Committees.
•   Up-gradation of existing health institutions from Sub Centres to District Hospitals as
    per Indian Public Health Standards (IPHS).
•   Flexible financing- untied funds for filling up the gaps in infrastructure and other
    related activities.
•   Manpower requirement- recruitment of doctors, and paramedical staff in relation to
    Woman & Child Health.
•   Improved management through capacity building- provision of computers, computer
    operators, establishment of State, District and Block Programme Management Units
    (PMUs).
•   Integration of AYUSH with the mainstream health institutions including recruitment
    of Ayurvedic/Homeopathy doctors at PHC and CHC level.
•   Intersectoral Convergence with Nutrition, water and sanitation programmes.
•   Promotion of Public Private Partnership for achieving public health goals.
NRHM – ILLUSTRATIVE STRUCTURE                                                       Health Manager
                          BLOCK LEVEL HEALTH OFFICE –---------------                   Accountant
                                                                                     Store Keeper

Accredit private                      100,000        BLOCK
providers for public               Population        LEVEL
health goals                      100 Villages
                                                    HOSPITAL                      Strengthen Ambulance/
                                                     Ambulance                    transport Services
                                                      Telephone                   Increase availability of Nurses
                                              Obstetric/Surgical Medical          Provide Telephones
                                                 Emergencies 24 X 7               Encourage fixed day clinics
                                              Round the Clock Services;
               30-40 Villages
                                       CLUSTER OF GPs – PHC LEVEL
                                          3 Staff Nurses; 1 LHV for 4-5 SHCs;
                                 Ambulance/hired vehicle; Fixed Day MCH/Immunization
                                      Clinics; Telephone; MO i/c; Ayush Doctor;
                                  Emergencies that can be handled by Nurses – 24 X 7;
                                 Round the Clock Services; Drugs; TB / Malaria etc. tests

5-6 Villages           GRAM PANCHAYAT – SUB HEALTH CENTRE LEVEL

                 Skill up-gradation of educated RMPs / 2 ANMs, 1 male MPW FOR 5-6 Villages;
                         Telephone Link; MCH/Immunization Days; Drugs; MCH Clinic

                                VILLAGE LEVEL – ASHA, AWW, VH & SC
                       ASHAs, AWWs in every village; Village Health & Nutrition Day
                                      Drug Kit, Referral chains
NRHM FIVE COMPONENTS

    (PART- A)                     (PART- B)                      (PART- C)
                                                                   (PART- C)
      (PART- A)                     (PART- B)

RCH AND RELATED
 RCH AND RELATED           INITIATIVES UNDER NRHM
                            INITIATIVES UNDER NRHM             IMMUNIZATION
                                                                IMMUNIZATION
   ACTIVITIES
    ACTIVITIES                 OTHER THAN RCH
                                OTHER THAN RCH                STRENGTHENING
                                                               STRENGTHENING
(RCH FLEXI POOL)
 (RCH FLEXI POOL)            (MISSION FLEXI POOL)
                              (MISSION FLEXI POOL)              PROGRAMME
                                                                 PROGRAMME




                  (PART- D)
                    (PART- D)                   (PART- E)
                                                  (PART- E)

         NATIONAL DISEASE
          NATIONAL DISEASE                 INTER SECTORAL
                                            INTER SECTORAL
       CONTROL PROGRAMMES
        CONTROL PROGRAMMES                  CONVERGENCE
                                             CONVERGENCE
                                              SCHEMES
                                               SCHEMES
INSTITUTIONAL ARRANGEMETS UNDER NRHM

STATE LEVEL
    • State Health Mission chaired by Hon’ble Chief Minister.

    • State Health Society chaired by Chief Secretary.

    • Merger of all vertical societies into State Health Society.

    • Signing of MoU with GoI.
DISTRICT LEVEL
• District Health Mission chaired by Chairman Zila Parishad.

• District Health Society chaired by Deputy Commissioner.

• Rogi Kalyan Samities in District/Sub Divisional Hospitals.

• Merger of all vertical societies into District Health Society.
..contd.. INSTITUTIONAL ARRANGEMETS UNDER NRHM

BLOCK LEVEL
   • Block Health Committees at Block PHC.

   • PHC Management Committee at PHC level.

   • Rogi Kalyan Samities.
VILLAGE LEVEL
• Village Health & Sanitation Committees in each village.

• Accredited Social Health Activist (ASHA) for every 1000
  population.
HEALTH INDICATORS
                                       India   Punjab      Best State
Birth Rate                                              13.4    Manipur
                                       23.5     17.8
(SRS 2006)                                              14.9    Kerala
Death Rate                                              4.5     Manipur
                                        7.5      6.8
(SRS 2006)                                              4.7     Delhi
Life Expectancy at birth               62.15    68.25   73.5    Kerala
Sex Ratio                                               1001    Pondicherry
                                        933     876
(Census 2001)                                           1058    Kerala
IMR                                                      11     Manipur
                                        57       44
(SRS 2006)                                               15     Kerala
TFR (SRS 2005)                          2.9      2.1    1.7     Kerala

Maternal Mortality Ratio (SRS 2005)     301     178     110     Kerala

Ante Natal Care (at least 3 checkup)
                                       50.7     72.5    96.5    T.Nadu
(%)   (NFHS III)

Institution Delivery (%) (NFHS III)     41       53     100     Kerala
Contraceptive Use (%)                   56      63.3     73     HP
(NFHS III)

Vaccine coverage (%)                    44       60      81     T.Nadu
(NFHS III)
TARGETS FOR PUNJAB

                                                  Present
                           At the start of RCH               Target by
Indicators                   SRS 1998-1999
                                                   Status
                                                             2009-2010
                                                 2007-2008

Total Fertility Rate               2.5              2.1         1.8


Infant Mortality Rate              49               44         <30
(per 1000 live births)




Maternal Mortality Ratio          199              178         <100
(per 100000 live births)




                                 37.5%
Institutional Deliveries                           52.5        80%
                               (NFHS II)

ANC Check-up with 03             58.4%
                                                   72.5       100%
contacts                       (NFHS II)
HEALTH INSTITUTIONS

                                         PUBLIC   PRIVATE
            INSTITUTIONS
                                         SECTOR   SECTOR


MEDICAL COLLEGES                           3         5

DISTRICT HOPITALS                          20

SUB DIVSIONAL HOSPITALS                    42       983

COMMUNITY HEALTH CENTRES                  128
PRIMARY LEVEL HEALTH INSTITUTIONS
(PRIMARY HEALTH CENTRES/ CLINICS/         1823     3046
POLY-CLINICS/ DISPENSARIES)
SUB CENTRES AT VILLAGE LEVEL              2858      --

                               TOTAL =    4858     4034
    NRHM
   BUDGET
OVER THE YEARS
PROGRAMME IMPLEMENTATION PLAN

•   NRHM is a centrally sponsored scheme. For Year 2005-06 and 2006-
    07, GoI contribution was 100%, & from Year 2007-08, GoI
    contribution is 85% and state contribution is 15%.
•   Every year State Health allocation to increase at least 10% of the
    previous year.
•   Every year the State Govt. is required to prepare a Programme
    Implementation Plan (SPIP). It is discussed with Ministry of Health,
    GoI and then approved by it.
•   After approval of SPIP the funds are released by GoI and the Sate
    Govt.
•   Minor changes in PIP can be made and major changes are allowed
    only with the approval of GoI.
FINANCIAL REPORT FOR THE YEAR 2005-09
                                                                                                Rs. in lakhs
                               Approved Plan                       Releases
                                   State                                           Expendit % of Unspent
             Op                                           Funds    Funds   Total     ure   Utilizati Balance
  Year                          Share 15%
           Balance    GOI                       Total    released released Funds Incurred    on
                                from 2007-
                                                         by GOI by State Available
                                    08

    1        2         3            4            5          6         7       8 (2+6+7)     9         10       11 (8-9)


                                   Not
 2005-06   283.20    9820.78                   9820.78   8103.25     0.00     8386.45     5971.37    61%       2415.08
                                 Required


                                   Not
 2006-07 2415.08 16271.85                    16271.85 14194.06       0.00     16609.14 8326.24       46%       8282.90
                                 Required



 2007-08 8282.90 16196.72         2841.00    19037.72 11328.37      705.00    20316.27 16632.89      85%       3683.38


 2008-09
(Upto July 3683.38 20269.00       3000.00    23269.00    4423.06     0.00     8106.44     4405.60    54%       3700.84
   08)
FINANCIAL STATUS UPTO JULY 08 (FY 2008-09)

                                                    Rs. in lakhs
     SN            Component             Releases   Expenditure

      1   RCH II                         1398.99         731.74

      2   NRHM Additionalities           1555.03         187.70

      3   Immunization & PP               164.05          20.72

      4   NDCP                            93.28           93.28

      5   Inter Sectoral Convergence       0.00           0.00

      6   CSS Family Welfare Head 2211   1194.25        1194.25

          TOTAL                          4405.60        2227.69
     STATE OBLIGATIONS UNDER NRHM

      State signed MoU with Govt. of India in December 2005 for implementation of NRHM

                                                                    DISTRICT       BLOCK LEVEL /
SN              INITIATIVES                      STATE LEVEL                                                 REMARKS
                                                                       LEVEL       VILLAGE LEVEL
                                                                          th
                                                     On 26th        On 17 August
1        Setting up of the Health Missions         October 2005          2005         Not applicable           Completed
                                                    constituted.      constituted.
                                                                                       Block Health
                                                                                   Committees notified
                                                                     Incorporated     on 11/12/2007
                                                  Incorporated on              th
                                                                       from 26        Village Health
2        Incorporation of Health Societies         26th February                                               Completed
                                                                    August 2005 to      Sanitation
                                                       2007
                                                                     January 2006      Committees
                                                                                      constituted on
                                                                                       21/10/2007.
     Integration of all vertical programmes of       Already           Already
3                                                                                      Already Integrated      Completed
      Health & Family Welfare Department.           Integrated        Integrated

      Merger of different societies with State       Done on                                                    Yet to be
4                                                                    Being Done          Not required
                 Health Society.                    21/12/2007                                                 completed
                                                                                        At Block Level
                                                                        Already        Community Health      Completed upto
      Constitution of Rogi Kalyan Samities in
5                                                  Not required     notified and are    Centres already     CHC but yet to be
        all Health Institutions upto PHCs
                                                                      operational       notified and are    done in 484 PHCs
                                                                                          operational.
…contd. STATE OBLIGATIONS UNDER NRHM
SN       INITIATIVES                  STATE LEVEL              DISTRICT LEVEL      BLOCK         REMARKS
                                                                                  LEVEL /
                                                                                  VILLAGE
                                                                                   LEVEL

6    Recruitment of staff for    Recruitment completed          Recruitment       Recruitment    Being
     Programme Management                                       completed         under          discussed
     Units.                                                                       process at     separately
                                                                                  block level.

7    State and District Health   2007-08:                       Facility Survey   Facility       District
                                                    th
     Plans                       PIP submitted on 10 July 07    completed.        survey upto    Action Plans
                                 PIP approved on 25/9/07        Integrated        Sub centre     completed in
                                 Outlay-Rs.16196 lacs           District Health   level          all 20
                                                                Action Plan       completed.     districts
                                 2008-09:                       ready for 20
                                                     th
                                 PIP submitted on 27 Feb 08     districts.
                                 Tentative approval of PIP
                                 received
                                 Outlay- Rs.23269 lacs
The Department has decided in principle to out source the setting up of State Health System
 Resource Centre (SHSRC), Price Water House Bangalore has been selected. Contract is
                                     being signed..
WORK DONE AND ACHIEVEMENTS

    Component             Amount/Scope            2007-08   2008-09      Remarks

                            Rs. 10,000           2858 SCs   2858 SCs   Funds Released
   Untied Funds             Rs. 25,000           484 PHCs   484 PHCs   Funds Released
                            Rs. 50,000           128 CHCs   128 CHCs   Funds Released
                           Rs. 20 Lacs            20 DHs      Nil      Funds Released
       IPHS
                            Rs. 2 Lacs           116 CHCs     Nil      Funds Released
     Annual                 Rs. 50,000           484 PHCs   100 PHCs   Funds Released
Maintenance Grant            Rs. 1 Lac              Nil     112 CHCs   Funds Released
                             Rs.5 Lac             20 DHs      Nil      One Time Grant
   Rogi Kalyan
                              1 Lac              36 SDHs      Nil      One Time Grant
     Samitis
                              1 Lac              110 CHCs     Nil      One Time Grant
 Mobile Phones for
                             134 Lacs                         4000       In Process
     ANMs
Application Solution for on line data transfer
                                                                         In Process
            from ANMs to State
..Contd. WORK DONE AND ACHIEVEMENTS

  Component      Amount/Scope      2007-08   2008-09          Remarks
                                                       Orders issued to 10
               One Gynaecologist     18        28
                                                       Doctors
                                                       Orders issued to 19
               One Paediatrics       12        31
                                                       Doctors
   EMOC        Empanelment of                          Empanelment under
                                     38        38
               One Anaesthetic                         Process
                                                       Appointment of 41 SNs
               5 Staff Nurses       209       250      in process at Distt.
                                                       Level
               Female Medical                          Orders issued to 34
                                     24        58
               Officer                                 Doctors
                                                       Appointment of 57 SNs
               3 Staff Nurses       168       225      in process at Distt.
  24 x7 PHCs                                           Level
                                                       Provided in 75 24x7
               Generator Set                   75
                                                       PHCs
                                                       Fund Spent through
               Rs. 6 Lac             49                PHSC for minor repairs
                                                       of 24x7 PHCs
  VILLAGE HEALTH & SANITATION COMMITTEE

• NRHM implementation planned within the frame work of PRIs at different
   levels.
• Village Health & Sanitation Committees formed in coordination with PRIs at
   each village level.

                 -11319 VHSCs already constituted
• The committee consists of ideally        11 member under the chair of
  Sarpanch/Panchayat Member and ANM or AWW as Member Secretary with
  50% representation of women and due representation from weaker sections.
• Committee provided with annual grant of Rs 10,000/- to be used as untied grant
  to meet village level public health activities. Funds already released to VHSCs
  (Total – Rs. 11.31 Cr. In 2007-08)
• Constituted in December 07–January 08. Headed by Panch / Sarpanch.
ACCREDITED SOCIAL HEALTH ACTIVISIT (ASHA)


             13201 ASHAs selected in the State
•   ASHA - a female health activist in the community to create awareness on
    health and mobilize the community for utilization of the existing health
    services.
•   One ASHA to cover 1000 population.
•   ASHA to be a woman resident of the village-Married/Widow/Divorced
    preferably in the age group of 25 to 45 years with the formal education up to
    eighth class.
•    Selection of ASHA to be made by the District Health Society under the
    supervision of Deputy Commissioner, and Civil Surgeon to be as District
    Nodal Officer.
•   SMO at block level to be the Block Nodal Officer.
•   Performance based incentive money of Rs. 3.96 crore has already been
    released to District Health Societies for ASHAs for the year 2008-09 & Rs.
    1.3 crore in 2007-08.
TRAINING OF ASHAs
•   Training of ASHAs in Module 1 is scheduled to be conducted during the current
    financial year.
•   Starting with Training of Trainers.
     – State Level – Training of Master Trainers – 3 days’ duration. Trainees
       include :
         • District Programme Co-ordinator
         • District Medical Officer Incharge ASHA Programme.
         • Representative from ICDS (Social Security and Welfare of Women
            and Child Development).
         • Representative from Education Department.
         • Representative from PRIs under Department of Rural Development
            and Panchayats.
         • Representative from MNGO.
     – conducted in 4 batches of 30 each with 6 participants per district, from
       7th July-12 July, 08, 14th July-19th July 08, covering all 20 districts.
    TRAINING OF ASHAs ….. contd

•   District Level Trainings – 3 days’ duration; 2 batches per district.
     – At the District level – Training of 5 participants per block
       including
         • Medical Officer
         • Supervisor from ICDS Department
         • LHV/ Senior ANM
         • Member from FNGO/ CBO (Community Based
           Organisation)
         • Member from PRIs
     – Conducted in all the districts involving Master trainers, trained at
       State level.
TRAINING OF ASHAs ….. contd

• Training of ASHAs – At block level – To be conducted by
  Block level Trainers with assistance from State and District
  level resource persons.

• Duration of Training – 6 days.

• To involve NGOs for the training of ASHAs at Block level in
  district Barnala, Bathinda, Fatehgarh Sahib, Mohali,
  Gurdaspur and Sangrur.
• Advertisement involving expression of interest from NGO has
  been given on 17th August, 2008.
 RECRUITMENT -
 STATE PROGRAMME MANAGEMENT UNIT
                                 Sanctioned                     Consolidated
SN      Name of the Post                      Filled   Vacant                          Remarks
                                    Post                         Salary PM
1    Director Finance                1          1        0                     On Deputation
     State Programme
2                                    1          1        0                     From State Govt.
     Manager
     Maternal Health                                                           Services have been
3                                    1          0        1         40,000
     Specialist                                                                terminated
4    Family Welfare Specialist       1          1        0         40,000

5    Procurement Manager             1          0        1         25,000      Candidate resigned

6    Manager (HRD)                   1          1        0         20,000
7    Manager (F&A)                   1          1        0         25,000

8    Manager (M&E)                   1          1        0         20,000

9    State NGO Coordinator           1          1        0         30,000

     Programme Coordinator
10                                   1          1        0         20,000
     (ARSH & Gender)
…contd…

                              Sanctioned                     Consolidated
SN       Name of the Post                  Filled   Vacant                         Remarks
                                 Post                         Salary PM
     Programme Coordinator
11                                1          1        0         20,000
     (BCC)
12   Consultant (Admn)            1          0        1         20,000      Candidate resigned

13   Consultant (M&E)             1          1        0         20,000
                                                                            Selection has been
                                                                            done for the vacant
14   System Analyst               1          0        1         15,000      position candidate is
                                                                            yet to join

                                                                            Selection has been
15   Accounts Officer             1          0        1         15,000      done for the vacant
                                                                            position
16   Statistical Assistant        4          4        0         10,000

17   Hardware Supervisor          1          1        0         10,000
     Accountant/ Accounts                                                   Action is being
18                                1          0        1         10,000
     Clerk                                                                  initiated
19   Accountant-cum-Cashier       2          2        0         10,000
     …contd…

                              Sanctioned                     Consolidated
SN       Name of the Post                  Filled   Vacant                             Remarks
                                 Post                         Salary PM

                                                                            Selection has been done for
20    Computer Assistant          4          3        1         8,000       the vacant position candidate
                                                                            is yet to join

21    Office Assistant            9          5        4         7,000       Action is being initiated

                                                                            Selection has been done for
22    Computer Assistant          4          3        1         8,000       the vacant position candidate
                                                                            is yet to join

                                                                            Selection has been done for
23    Graphic Designer            1          0        1         10,000
                                                                            the vacant position

                                                                            Candidates have been adjusted
24    Procurement Assistant       2          2        0         8,000
                                                                            at State HQ from the districts

25    Drivers                     2          0        2         5,000       Action is being initiated

                                                                            Action is being initiated
26    Class-IV                    3          2        1         3,000

            Total                45         30        15
 RECRUITMENT -
 DISTRICT PROGRAMME MANAGEMENT UNITS
                                 Sanctioned                     Consolidated
SN       Name of the Post                     Filled   Vacant                            Remarks
                                    Post                         Salary PM
     District Programme
1                                   20          8        12        20,000      Selection has been Done.
     Manager
2    District Accounts Officer      20         15        5         15,000      Selection has been Done.
     District Monitoring &
3                                   20         11        9         15,000      Selection has been Done.
     Evaluation Officer
                                                                               No further recruitment to
4    Procurement Officer            20          4        16        15,000
                                                                               be made

5    Maintenance Engineer           20         17        3         12,000      Selection has been Done.

6    Statistical Assistant          20         17        3         8,000       Selection has been Done.
                                                                               No further recruitment to be
                                                                               made. Procurement Assistant
                                                                               have been adjusted as
7    Procurement Assistant          20          0        20        8,000       Statistical Assistant or
                                                                               accountant as per their
                                                                               qualification

8    Accountant-cum-Cashier         20         13        7         8,000       Selection has been Done.

9    BCC Facilitator                20         11        9         8,000       Selection has been Done.

     Total                          180        96        84
RECRUITMENT -
BLOCK PROGRAMME MANAGEMENT UNITS

                            Sanctioned                     Consolidated
SN      Name of the Post                 Filled   Vacant                        Remarks
                               Post                         Salary PM

                                                                          *Recruitment under
     Block Statistical                                                    process at district
 1   Assistant                 118        93       25*        8,000       level from July 2008
                                                                          and reports being
                                                                          received
                                                                          *Recruitment under
     Block Accountant cum                                                 process at district
 2   Cashier                   118        102      16*        8,000       level from July 2008
                                                                          and reports being
                                                                          received
                                                                          *Recruitment under
                                                                          process at district
3.   Computer Operator         173        97       76*        5,000       level from July 2008
                                                                          and reports being
                                                                          received

     Total                     409        292      117
RECRUITMENT -
EmOCs
                                                              Consolidated
SN   Name of the Post   Sanctioned Post   Filled   Vacant                               Remarks
                                                               Salary PM
                                                            Rs. 20000/- +
                                                            Rs. 3000/- HRA+      *Appointment letter to
                                                            Rs. 1000/ EmOC +
1    Obstetricians            50           18       32*     Rs. 500/- per
                                                                                 10 Obst. Issued on
                                                            delivery conducted   13.08.2008
                                                            + Rs. 200/ MTP
                                                            Rs. 20000/- +
                                                            Rs. 200/- per        *Appointment letter to
                                                            Emergency Case
2    Paediatricians           50           12        38     during off duty
                                                                                 19 Paed issued on
                                                            hours + Rs. 3000/-   13.08.2008
                                                            HRA
                                                            Rs. 1500/- on call
                                                                                 *Empanelment for 12
3    Anaesthesia              50           38        12     per case + TA Rs.
                                                            6/KM upto 50 KM      CHCs under process
                                                            Rs. 8500/- + Rs.     *Recruitment under
                                                            1500/- (if
4    Staff Nurses            250           209       41     accommodation is
                                                                                 process from July 2008
                                                            not provided)        at district level
                                                            Rs. 4000/- + 300/-
                                                            evey Major OT
5    OT Assistant             50           10        40     Case + Rs. 1500/-
                                                                                 Not required to recruit
                                                            HRA
 RECRUITMENT -
 PHCs 24x7
                              Sanctioned                     Consolidated
SN      Name of the Post                   Filled   Vacant                                 Remarks
                                 Post                         Salary PM
                                                             Rs. 15000 PM +
                                                             Rs. 500 per          *Appointment letter to 34
1    Female Medical Officer      75         24       51*     Delivery+ Rs.        FMOs       issued      on
                                                             200/ MTP + Rs.       14.08.2008
                                                             3000/- HRA
                                                             Rs. 5000/- + Rs.
                                                             500/- per delivery
                                                             conducted + Rs.      *Recruitment under
                                                             100/- per delivery   process at district level
2    Staff Nurses                225        168      57*     assisted and Rs.     from July 2008 and reports
                                                             1500/- HRA (if       being received
                                                             accommodation
                                                             is not provided)
     RECRUITMENT -
     Mobile Medical Unit (MMU)
                               Sanctioned                     Consolidated
SN       Name of the Post                   Filled   Vacant                             Remarks
                                  Post                         Salary PM
1     Medical Officer (Male)      20         20        0         22,000      Appointed in August 2008
      Medical Officer
2                                 20         20        0         22,000      Appointed in August 2008
      (Female)
                                                                             *Recruitment under process at
3     Nurses                      20          0       20*        8,000       district level from July 2008
                                                                             and reports being received
                                                                             *Recruitment under process at
4     Radiographer                20          0       20*        8,000       district level from July 2008
                                                                             and reports being received
                                                                             *Recruitment under process at
5     Lab Technician              20          0       20*        8,000       district level from July 2008
                                                                             and reports being received
                                                                             *Placement agency is to be
6     Driver                      20          0       20*        7,000
                                                                             hired
                                                                             *Placement agency is to be
7     Helper                      20          0       20*        4,000
                                                                             hired
RECRUITMENT -
ANM for Urban Slum Area & Sub-Centres


                             Sanctione                     Consolidated
 SN     Name of the Post                 Filled   Vacant                           Remarks
                              d Post                        Salary PM

                                                                          *Recruitment under process
      MPHW (Female) for                                                   at district level from July
 1                             230        114      *116       6,000
      urban slums                                                         2008 and reports being
                                                                          received

      ANM for vacant sub-                                                 Advertisement given on
 2                             514         0       514        6,000
      centres (2211)                                                      23.08.2008


      2nd ANM for 954 sub-                                                Advertisement given on
 3                             954         0       954        6,000
      centres                                                             23.08.2008
   FAMILY PLANNING
Compensation package for
                                                    Sterilisation achievements
Vasectomy                  Rs.1500 per case
                                                           (2007-08)                2008-09
Tubectomy (BPL)            Rs.1000 per case                                       (upto July, 08)
Tubectomy (APL)            Rs.650 per case    Annual expected          102224
                                              level of
IUD Insertion              Rs.20 per case
                                              achievement
                                              Total Sterilization       103908        29813
                                              achieved                 (101.6%)
                                              NSV                       13110         2090
   Repair of laparoscopes done
                                              Tubectomy                 90798         27723
   Revised manuals on sterilization           Organizing female sterilization & IUD Insertion
                                              camps in Districts -one camp per month per block-
   standards and quality assurance of
   sterilization services disseminated
 SEX RATIO
                                     1. Regulatory
           Integrated
Integrated Approach Approach
                                     2. Advocacy
                                     3. Raising status of women
                                Stringent Enforcement of PNDT Act

            OUTCOME OF ENFORCEMENT
              OF THE PC & PNDT ACT
      900
                                                    821 (0-4 yrs)
      850
                                                   as per SRS in 2006
      800                                           Enforcement of the PNDT Act
             875
      750                                          765 ? As per trend
                                          798
      700

      650
            1991         1995            2001             2006               2011


8/29/2008                                                                           36
 INSTITUTIONAL DELIVERIES




           1992-93         1997-98           2005-06




INSTITUTIONAL DELIVERIES             Year 2007-08      Year 2008-09 (Upto July 08)
       STATE
    PROGRAMME
IMPLEMENTATION PLAN
       2008-09
 PIP 2008-2009
  COMPONENTS                DESCRIPTION                    OUTLAY
                                                         (Rs. In crores)

     PART A      RCH                                         56.95

     PART B      NRHM ADDITIONALITIES                        92.39

     PART C      IMMUNIZATION                                 2.61

                 NATIONAL DISEASE ONTROL
     PART D                                                  16.07
                 PROGRAMME

     PART E      INTERSECTORAL CONVERGENCE                    5.33

     TOTAL       NRHM                                        173.35


                 CENTRALLY SPONSORED SCHEMES
                 (Already under Implementation but now       59.34
                 merged with NRHM)

GRAND TOTAL                                                  232.69
 PIP 2008-2009


• GoI contribution Rs. 180 Cr., GoP contribution
  Rs. 30 Cr.
• Previous funds available – GoI- Rs. 29.38 Cr.;
  GoP – Rs. 7.05 Cr. = TOTAL – Rs. 36.43Cr.
• TOTAL FUNDS AVAILABLE FOR 2008-09
  Rs. 210 Cr. + Rs. 36 Cr.= Rs. 246 Cr.
PART A- RCH FLEXI POOL
                                                              Rs. In lakhs
                                                Allocation             Releases/ Expenditure
SN   Sub Components                                          2008-092008-09
     Maternal Health                           235.00                         37.49
 1
     Janani Suraksha Yojna                     186.00                         93.00
 2   ASHA                                      334.50                        396.03
 3   Child Health & IMNCI                       86.15                          .60
 4   Family Planning                           920.60                        266.78
 5   ARSH                                       27.07                         10.02
 6   Urban RCH                                 135.60                         32.90
     PNDT Sex Ratio                             64.84                           0
 7
     Innovations / PPP/NGO                     442.50                           0
     Infrastructure & Human Development        1558.50                       236.93
     Logistic Management
 8   Quality Assurance and Infection Control
                                               323.34                         40.08
     Programme
     HMIS Monitoring and Evaluation
 9   Training                                  461.88                        285.49
10   Behaviour Change Communications           291.76                         40.75
11   Procurement                               122.50                        125.91
     Programme management Units SPMU and
13                                             347.26                        260.25
     DPMUs
12   Flexi pool                                157.50                          1.20
     Total A (RCH II)                          5695.00                       1827.43
..contd.. PART A
•   Digitization of Civil Registration Systems (CRS). RFP under preparation.
    Under e-Governance Project of the State on pilot basis CRS is being
    implemented in dsitrict Kapurthala & Nawanshahar. Work has been alloted to
    WIPRO.
•   Sex Ratio Survey. The work has been alloted to AMS,
    Luckhnow. The work will be complete within three months.
•   City Specific GIS mapping for Urban Health Mission for three
    cities i.e. Amritsar, Jalandhar and Ludhiana was assigned to
    Punjab Engineering College, Chandigarh. Mapping of Ludhiana
    and Amritsar is complete and of Jalandhar will be complete
    within a week.
•   To ensure dissemination of information relating to NRHM to
    field level functionaries and to ensure immediate reporting, steps
    have been taken to finalize website of the NRHM. The work will
    be complete by the end of this month.
PART B- NRHM
ADDITIONALITIES                                               Rs. In lakhs
                                               Allocation     Releases/ Expenditure
 SN   Sub Components                                         2008-09
 B    NRHM Additionalties
 a    Village Health & Sanitation Committees       1230.00               0.00
 b    ASHA - proposed under RCH II
 c    SC Untied Fund & Maintenance                  286.20              285.80
 d    PHC Untied Fund & Maintenance                 121.00              121.00
 e    CHC Untied Fund & Maintenance                 64.00                64.00
 f    Annual Maintenance Grant                      162.00              655.80
 g    Mobile Medical/ Health Units                  397.40               0.00
 h    Upgradation of CHC                           1091.80               0.00
 I    Upgradation of PHC                            821.43               0.00
 j    Upgradation of SC                             725.38               0.00
 k    Upgradation of SHC                            600.00               0.00
 l    Upgradation on SDH/ FRUs                      100.00               0.00
 m    Upgradation of DH                             370.00               0.00
 n    School Health                                 500.00               0.00
 o    Strengthening of Programme Management         476.56               0.00
 p    Strenthning of Logistics Management           50.00                0.00
 q    Rogi Kalyan Samitiis                          12.33                0.00
 r    Emergency Response Services                  2097.00               0.00
 s    Mobile Phones for ANMs                       133.99                0.00
      Total B                                      9239.09             1126.60
..contd.. PART B

Extension of New Institutions
•   40 New Sub Centre's is to be constructed at a cost of Rs. 2.5 crore.
•   One new CHC to be constructed at Zirakpur at a cost of Rs. 2.5 crore
•   Up-gradation of Institutions
•   77 Sub Centres to be renovated at a cost of Rs. 1.00 Lakh each
•   10 PHCs to be repaired / renovated at cost of rs. 60.00 Lakh.
•   PHC at Adampur and Rural Hospital Morinda to be completely renovated.
•   Following Sub Divisional Hospitals to be upgraded with an outlay of Rs.6.00
    Crore
     – Batala (50 to 80 beds) ...             Rs. 1.5 crore
     – Patti (50 to 80 beds) ...              Rs. 1.5 crore
     – Nabha (100 to 130 beds) ………            Rs. 1.5 crore
     – Pathankot (100 to 130 beds) ……         Rs. 1.5 crore
..contd.. PART B
•   Following District Hospitals to be upgraded
     – Mohali (70 to 120 beds) …                         Rs. 3.00 Crore
     – Mata Kaushalya Hospital Patiala …                 Rs.2.00 Crore
       (154 to 250 beds)
     – Gurdaspur (100 to 150 beds) …                     Rs.2.50 Crore
     – Ludhiana (addition of 30 beds burnh Unit)…        Rs. 1.00 Crore
     – Bathinda (Renovation) ...                         Rs.0.50 Crore
• Equipment and furniture worth Rs.6.50 Crore to be provided in CHCs as per IPHS
  Norms
• Equipment and furniture worth Rs.1.83 Crore to be provided in the PHCs as per
  IPHS norms
• Drugs and consumables as per following details to be given:
    - CHCs …       Rs. 3.60 Crore
    - PHCs …       Rs.4.84 Crore
    - SHCs …       Rs.6.00 Crore
PART C- IMMUNIZATION
                                                     Rs. In lakhs

                                      Allocation       Releases/
                                                      Expenditure
SN   Sub Components                                2008-09
a    Alternative vaccine Delivery      103.34
b    Mobilization of Children by
                                       68.59
     AWW/TBA/ASHA
c    Strengthening of Monitoring
                                        9.18
     and Supervision
d    Computer Assistant to DIO,
     Provision for Additional
                                       79.58
     Support, Slums and underserved
     area
     Total C                           260.69            164.05
PART D-
NATIONAL DISEASE CONTROL PROGRAMME

                                                      Rs. In lakhs

                                     Allocation       Releases/
                                                     Expenditure
SN   Sub Components                               2008-09
a    RNTCP                            522.15            83.14
b    Leprosy                          135.15             7.59
c    IDSP                             79.91              0.00
d    National Iodine Deficiency
     Disorder Control Programme. -    20.00              0.00
     NIDDCP
e    Malaria & Vector Borne           212.36             0.97
f    Blindness Control                637.50             1.58
     Total D                         1607.07            93.28
PART E-
INTERSECTORAL CONVERGENCE
                                                     Rs. In lakhs

                                      Allocation    Releases/
                                                   Expenditure
SN     Sub Components                         2008-09
 a     Convergence with AYUSH          424.80       0.00
 b     Co ordination & Orientation
                                       75.15          0.00
       with PRIs
 c     Special innovation for
                                       33.45          0.00
       Minorities
       Total E                         533.40         0.00
Part
 II    CSS Family Welfare Head 2211   5934.00       1194.25

  • Appointment of one Ayurveda MO & one Homeopathy MO
    in 121 PHCs & 112 CHCs respectively, Appointments are
    under process
    SCHOOL HEALTH

•   32,64,926 of students are in Primary and Secondary level

    School                                  No. of Students
    Primary                     7,09,747         6,29,510      13,39,257

    Middle-Secondary           10,39,509         8,86,160      19,25,679


    Total                      17,49,256        15,15,670      32,64,926


•   School Health Campaign initiated.
•   Requirement of Drugs :-
     – IFA Tablets-
          Pediatric with2 0 mg elementary iron           7 Crore Tabs
          Adult with60 mg elementary iron 60mg           3 Crore Tabs
     – Deworming Tablets                                 32.64 lakh Tabs
    has been placed with Procurement Branch
•   Report from PGI regarding Congenital Heart Disease (CHD) and Rheumatic Heart
    Disease (RHD) among children received and proposal is being finalized
DRINKING WATER SUPPLY

There are numerous schemes for providing clean drinking water in rural and
urban areas :

•Under JNNURM, UIDSSMT and BSUP high priority has been given to
providing drinking water supply. The total allocation for current year is Rs.
350 crore.

•Under Municipal Development Fund a sum of Rs. 1 crore is to be spent in
various towns.

•For Rural Areas, there are various schemes – Accelerated Rural Water Supply
Scheme (Rs. 110 crore), NABARD (Rs. 70 crore), World Bank (Rs. 132
crore), Rajiv Gandhi National Drinking Water Mission (Rs. 10 crore), RO
Process (Rs. 25 crore) for clean drinking water.

• Under SSA, funds can be provided for drinking water in elementary schools
in the State.
SANITATION
• Sewerage works will be executed in urban areas under
  JNNURM and JBIC Projects.
• For Rural Areas there is a State Government schemes for
  providing individual toilets (Rs. 5 crore).
• Under Total Sanitation Programme of GoI we have Rs. 77
  crore project for providing toilets in schools, Aanganwadi
  Centers, Community toilets and individual toilets.
• Under World Bank Project, there is a provision for laying
  underground sewer in 1000 villages and cleaning of village
  ponds.
• For cleaning of village ponds we have a State Scheme (Rs. 5
  crore). NREGA funds can also be used for this purpose in all
  the districts without any limit.
SCHOOLS – WATER & TOILETS

• Schools not having Water & Toilet facilities have been
  identified by a survey.
• 480 Schools are without drinking water facilities Water &
  Sanitation Department would provide these facilities from
  their regular schemes like ARWSP.
• 4447 schools are without Toilet facilities Water & Sanitation
  Department has been asked to prepare estimates.
• Funds to the extent Rs. 40000.00 per school will be provided
  from Total Sanitation Campaign (TSC) & above Rs.
  40000.00 from 12th Finance Commission of Rural
  Development Department.
 NUTRITION

• Under ICDS Programme (50:50) the State
  Government will be spending Rs. 55 crore in 2008-09.
• Under Kishori Shakti Yojana (Nutrition for adolescent
  girls) will spent Rs. 2.50 crore through Woman and Child
  Development.

• Under these 2 programmes a total of 13.52 lakh children
  and mothers were provided nutrition.
VILLAGE HEALTH COMMITTES

• The Village Health & Sanitation Committees has
  been constituted in all the villages. These committees
  are headed by Sarpanch/ Panches.
• The new Panches and Sarpanches have been
  inducted in the already constituted VHSCs and the
  Health Department would thereafter coordinate these
  3 programmes – Water Supply, Sanitation and
  Nutrition at block level.
• The Agriculture Department would also be involved.
COORDINATION WITH OTHER DEPARTMENTS



 • We are holding regular meetings with WSS, Rural
   Development, Woman and Child Development
   Departments.

 • We are going to constitute Coordination Committees
   with these departments for greater synergy.
   OTHER
INITIATIVES
NATIONAL URBAN HEALTH MISSION
•   GoI proposes to launch NUHM from 2008-09 to 2011-12 (4 years). Current year allocation is
    likely to be Rs. 1012 crore and Punjab would get about Rs. 25 crore.
•   The target population would be urban poor living in slum areas, homeless poor and construction
    workers.
•    3 towns - Amritsar, Jalandhar and Ludhiana will be taken up from 2008-09 and the remaining 10
    towns – Patiala, Abohar, Batala, Bathinda, Moga, Malerkotla, Khanna, Pathankot, Hoshiarpur
    and Mohali from 2009-10.
•    The programmes aims at upgradation of Primary Urban Health Centers in terms of infrastructure
    and man power. Urban Social Health Activist (USHA) will be provided for every 1000
    population.
•    Private hospitals would be empanelled in case there are no government institutions in the slum
    areas.
•    There would be a separate Health Insurance Scheme for Urban Slum Poor's and they would be
    free to seek treatment from Government and Private referral hospitals.
•   State has already initiated the process for GIS mapping of the urban slums (notified & non
    notified) and health facilities (Private & public) in three cities, work has been allotted to Punjab
    Engineering College Chandigarh. The work will be completed in the first week of September 08.
EMERGENCY RESPONSE SERVICE IN THE STATE

•   224 Ambulances equipped with medical facilities and medical technicians to be
    deployed.

          • 56 ambulances will have advance life saving equipment (cardiac care,
            highway trauma care, EmOC)
          • 168 ambulances will have basic life saving equipment (EmOC, highway
            trauma etc.).
•   Patient to be shifted to nearest centre through the ambulance positioned with
    trained medical technician and expert driver.

•   Capital cost of the ambulances will be Rs.29 crore and for establishing IT
    infrastructure and Emergency Response Centre the capital cost will be Rs. 12
    crore. Total initial cost will be Rs. 41 crore. Recurring cost will be Rs. 25 cr. per
    annum
•   Emergency Call Centre with a common three digit toll free number.
•   For hiring services, the companies have been short-listed, RFP has been finalized
    and being issued to short-listed companies.
THANK YOU

								
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