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					                               RCH -II PROJECT
                            1. VISION STATEMENT

VISION STATEMENT :
        At the end of 2010, on completion of the implementation of the proposed
interventions under the Reproductive and Child Health Project – II in Andhra Pradesh
state, every rural and below-poverty-line pregnant woman will have the full
information and awareness about the advantages of obtaining comprehensive
antenatal care services, institutional delivery care services, postnatal and neonatal
care services, and will be utilizing these services either on her own initiative, or on the
advocacy and promotional efforts of the field healthcare workers. 100% of the
pregnant women in the state would register themselves for antenatal care services
either with the ANM in the rural areas, or with the urban family welfare centers in the
urban areas or with the private health care providers. At least 90% of the women in
the state will have three antenatal care check-ups, one of which will be with a medical
doctor. At least 90% of the women in the state will have childbirth in facilities that
have at least basic emergency obstetric care services. All the First Referral Unit
Hospitals in the state will have comprehensive emergency obstetric care services,
i.e., obstetricians and anesthetists, and blood transfusion facilities. Emergency health
transportation facilities will be in place in the rural parts of the state, to enable a
villager even in the remotest village to call for the emergency health transportation
vehicle and transport the pregnant woman ready for delivery, or a child in critical
health condition to the nearest First Referral Unit hospital with the confidence that the
person will receive assured medical attention.
      Every person in the state, in need of a reproductive or child healthcare service
would be able to obtain full information about the availability of such services and
proceed to such place to access the services with full confidence that they are of
good quality.
      The objectives, strategies, and proposed intervention activities under the
important program areas of the RCH-II project are described in the following
chapters.




                                                                                          1
    2. MATERNAL AND REPRODUCTIVE HEALTH STRATEGY

Objective :
       Reduction of the currently estimated MMR of about 350 - 400 per 100,000 live
births in the state to less than 100 per 100,000 live births by 2012, and
commensurate reduction in the maternal morbidity rate, particularly among the
women in rural areas of the state; and, reduction in the prevalence levels of RTI/STI
in the general population by 50% of the levels existing in 2005.
Strategies :
      The strategies that are being adopted for achievement of this strategy are:
      •        Universal registration of pregnancies and utilization of antenatal care
               services;
      •        Universal availability and utilization of supplemental nutrition services
               for all rural poor pregnant women;
      •        Radical improvements of availability, affordability and accessibility of
               basic and comprehensive emergency obstetric care services;
      •        Intensive promotion of institutional deliveries through health emergency
               transportation-linkage, motivation of rural poor women for institutional
               delivery through village level women health volunteers and through
               compensation for indirect costs to be incurred in accessing institutional
               delivery services, community-level motivation through rewards to village
               panchayats for high utilization of maternal healthcare services;
      •        Intensive promotion of postnatal care utilization in rural areas through
               training of Anganwadi workers and women health volunteers.
      •        In the remote and un-served and under-served areas, the services will
               be delivered through mobile delivery service units with trained nurses
               engaged by NGOs.
      •        In order to achieve a significant reduction in the Maternal and Infant
               Mortality Rates, Comprehensive Emergency Obstetric & Neonatal Care
               (CEMONC) Centres are being established in at least 5 to 6 identified
               FRUs in each district of the state with round-the-clock specialist
               services and blood transfusion facilities.
      •        In order to confidence to the pregnant lady who is in labour, it is
               proposed to permit one close relative (woman) to be with the delivering
               woman as ‘birth companion’ in the delivery room.




                                                                                       2
MATERNAL HEALTH INTERVENTIONS - VILLAGE LEVEL:

1.    Women Health Volunteers (ASHA) at Habitation Level :
      •   There are 21,943 Gram Panchayats and 67,561 habitations in the state of
          which 55,400 WHV were identified and selected during the year 2005-06
          by the Gram Panchyats health committees to act as Health Resource
          Persons of first resort in all manternal & child health services and to act as
          Link persons between the community and the service providers. Till date
          51900 WHVs were trained during the financial year 2006-07. Remaining
          11754 WHVs will be trained during the year 2007-08.
      •   Out of 8500 CHWs in 9 Tribal districts, 2054 CHWs were trained in 2006-
          07 and remaning 6446 CHWs and 1400 CHWs in Mahabubnagar district
          will be imparted similar training.
      •   It is also being proposed to take up WHVs training in Urban Areas for 6200
          WHV during 2007-08.
      •   It is proposed to train 19600 WHVs during the financial year 2007-08.
 a)   Training of the WHV candidates:
      This is an ongoing scheme, which had been approved in PIP 2005-06.
        The WHV candidates are being trained in all preventive healthcare aspects of
 pregnancy, antenatal care, Intranatal care, postnatal care, neonatal care, diarrhoea,
 acute respiratory infections, first-aid and treatment of minor ailments, in a four-week
 training program. This training conducted at Durgabai Mahila Sishu Vikasa
 Kendram.
        The overall organization, monitoring and coordination of the WHV training has
 been entrusted to M/s Academy for Nursing Studies, Hyderabad as a State Level
 Nodal Agency for guidance and supervision and district level training agency in 22
 districts.
 b)   Budget for Training WHVs:
       The budget for WHV training sessions will include cost of Training of Master
 Trainers, training of trainers, salaries of trainers and coordinators in each district
 level training institution, to and fro fares for the WHVs for attending the training,
 boarding and lodging cost at the training institution, cost of training material, wage
 compensation for the WHVs for the duration of the training, etc.
 c)   First-Aid Kits:
      On completion of the training, the WHVs are being provided with a first-aid kit
 and a health guide / manual, certificate and identity card.
 d)   Incentives for Women Health Volunteers:
        The WHVs will not be paid any fixed salary or honorarium. They are being
 paid incentive amounts mainly for carrying out specific activities related to the
 utilization of maternal and child healthcare services by families of underserved
 communities such as SC/STs and non SC/ST families below poverty line. The
 payment of incentive to the WHVs is as follows:



                                                                                       3
       •        Registration of early pregnancy in a SC/ST woman : Rs.25/-
       •        Completion of three antenatal checkups & ensuring TT immunization
                and IFA tablets given to the SC/ST pregnant woman: Rs.50/-
       •        Completion of one Antenatal Checkup with an MBBS Doctor: Rs.50/-
       •        SC/ST pregnant woman having institutional delivery in public or private
                hospital / PHC: Rs.150/-
       •        Postnatal Care and Newborn Care for a mother and a neonate in a
                SC/ST family: Rs.100/-
       •        Completing all doses of immunization in respect of a SC/ST child, for
                BCG, DPT, OPV, and Hepatitis-B before five months of age: Rs.50/-
       •        Completing Measles immunization and Vitamin-A administration for
                SC/ST child before one year of age: Rs.50/-
       •        Identification of Low-birth-weight baby less than 2000 grams of any
                community in the village and giving health and nutrition counseling to
                the parents and family members resulting in the child completing 3
                months of age in a healthy state: Rs.50/-
        For services to non SC/ST/BPL families, the WHVs are being paid incentives
as follows:
       •        Antenatal check-up with a medical doctor: Rs.25/-
       •        Institutional Delivery: Rs.100/-
       •        Post-natal and Neo-natal care: Rs.50/-
       •        Measles Immunization: Rs.25/-


The details of trainings position during the year 2007-08 is as follows:
 Sl.             Particulars                Target        Trained upto      Balance
 No.                                                        2006-07
1.     Women Health                          55400           49846            5554
       Volunteers
2.     CHWs (Tribal)                         8500            2054            6446
3.     CHW’s (Mahabubnagar)                  1400              0             1400
4.     Urban WHVs                            6200              0             6200
       Total                                 71500           51900           19600

1(a)   Estimated Training Cost for Women Health Volunteers (WHV) -2007-08:
       (i)     Total WHVs to be trained          :   11,754 (except CHWs - 7846)
       (ii)    Batch Size                        :   90 (with 6 sub-groups of 15 each; one
                                                     Trainer per sub-group)
       (iii)   No. of batches                    :   Approximately 131
       (iv)    Duration of institutional training:   3 weeks (institution) + 1 week
                                                     field training at PHC = 30 days
       (v)     Venue                             :   Women Development and Child Welfare
                                                     Department’s Durgabai Mahila Sishu


                                                                                       4
                                           Vikas Kendrams
       (vi)   Trainers                     Specially identified and trained trainers
                                              :
                                           from the Nodal Agency Academy for
                                           Nursing Studies
i      Approx. cost per batch of one month duration              (In Rupees)

       a) Wage compensation for WHV candidates
          Rs.50/- per day x 90 x 30 days                       :    1,35,000.00
       b) Traveling costs (Rs.100 per head x 90)               :       9,000.00
       c) ANM TA & DA                                          :      20,000.00
       d) Training module                                      :       5,400.00
       e) Medicine Kit                                         :      27,000.00
           Sub Total                                           :    1,96,400.00

ii.    Training institutions cost
       a) Diet for WHV                                         :    1,13,400.00
       b) Diet for Trainers                                    :      18,000.00
       c) Staff Salaries, Security, Electricity & Sanitation   :      30,000.00
       d) Overhead charges                                     :      24,530.00
           Sub Total                                           :    1,85,930.00
       Sub-Total ( i + ii ) – Cost per batch                   :     3,82,330.00
       OR                                                      :     3.82 lakhs

       Cost for 131 batches                                    :     498.89 lakhs

iii.   State level Nodal Agency cost
       a) Trainers (8 x 6 x 6000 x 22)                         :   63,36,000.00
       b) Supervisors (1 x 10000 x 6 x 22)                     :   13,20,000.00
       c) State level Coordinator (1 x 20000 x 6)              :    1,20,000.00
       d) Two Assistants (2 x 6000 x 6)                        :      72,000.00
       e) Three Regional Coordinators (3 x 20000 x 6)          :    3,60,000.00
       f) Telephone, Electricity & Computers (1 x 10000 x 6)   :      60,000.00
       g) Overhead charges 7%                                  :    5,79,000.00
       h) Misc. Training Expenditure (20 x 20200)              :    4,04,000.00
            Sub Total                                          :   92,51,000.00

Total training cost for WHVs (Rs.498.89 lakhs + Rs.92.51 lakhs): Rs.591.40 lakhs

1 (b) Supply of First Aid Kits to The Women Health Volunteers :

       First aid kits have supplied to the trained women volunteer after completion of 4
       weeks of training. Total no.of WHVs 61,600 (except CHWs) x Rs.150/- per
       replenishments x 2 times a year = Rs.184.80 lakhs

1 (c) Refresher Training for Women Health Volunteers :

       Refresher Training for the WHVs are being conducted to strengthen the skill
       and knowledge of the trained WHVs. This training is conducted for 3 days at
       district headquarters.




                                                                                      5
         Agency for Conducting the Refresher Trainings: Refresher training is being
         conducted by Academy of Nursing Studies, Hyderabad.

         PHC-Level Technical Guidance and Monitoring Meetings: It is further felt,
         that for the all round success of the WHV & CHW scheme in the long run, it is
         very necessary to regularly monitor their work and give them technical
         guidance at the field level by the training agency, in addition to the technical
         guidance that is given by the regular ANMs and the health supervisors. It is
         therefore proposed to enable the WHV-Trainers of the ANS to attend the PHC-
         level “Field-level Technical Guidance and Monitoring Meetings”, since they will
         be having close liaison with the WHVs.

         Costing for Refresher Trainings & PHC-Level Technical Guidance and
         Monitoring Meetings: For the above ‘Refresher Trainings’ and ‘Field-Level
         Technical Guidance and Monitoring Visits’, it is proposed that in each district,
         the Academy of Nursing studies will hire 8 trained ANM-qualified candidates to
         impart the refresher training at the DDMSV Kendrams for 15 working days in a
         month (2 ½ weeks) (there being approximately about 25 working days in a
         month); and attend and contribute in the PHC- level monthly technical guidance
         and monitoring visits over 7 working days, and the remaining 3 days being
         spent on report preparation, etc. The ANS will also recruit one Coordinator per
         district, to run and supervise the Refresher Trainings and PHC-level Monitoring
         meetings.
         The details of costing of the proposed refresher training, etc. for the WHVs and
         CHWs in the state are as follows:

i)       Cost of Refresher Training per District per month:

         100 WHVs per Batch; and Five batches per month; 500 WHVs to be given
         Refresher Training per month in each District:

a) Size per Batch: WHVs from two to three PHCs; i.e.               :    100
b) Five Batches in a month:                                        :    500 WHVs;
c) No of Refresher training days                                   :    3
d) Traveling expenses for 500 WHVs for
   coming for the Refresher training @ Rs.100: (500 x 100)         :    Rs.50,000
e) Compensation for wages lost for the
   days of training: (500 x 3 x50)                                 :    Rs.75,000
f) Diet cost for WHVs in Refresher training: (500 x 3 x 60)        :    Rs.90,000

      Total : Rs.215,000; or, Rs.2.15 lakhs per district per month;

      Total Cost for the WHVs’ TA, diet, and Wage compensation for two (six-
      monthly) rounds of WHV refresher trainings in the state : Rs.567.60 lakhs

ii)      AP Women’s Cooperative Finance Corporation’s Cost:

a) Staff Cost: Additional staff in Kitchen, Security,
   office, cleaning, maintenance, Electricity, water, etc.
   cost per month for the APWCFC per district                   : Rs.25,000/-


                                                                                       6
b) Cost for 22 districts for 12 months                     : Rs.66.00 lakhs;
c) Institutional Overheads: 7%                             : Rs.4.62 lakhs
   Total                                                   : Rs.70.62 lakhs
   (This is in addition to the Diet Cost of Rs.237.60 lakhs being provided to the
   APWCFCorpn)

iii)      Cost of Training Agency – Academy of Nursing Studies:

Monthly Expenditure per District
a) Salary of 8 trainers (6000 x 8)                                  :     Rs.48,000
b) Salary of one coordinator (10000 x 1)                            :     Rs.10,000
c) T.A./D.A. for PHC review meetings (8 x 150 x 7)                  :     Rs. 8,400
d) Communication, postage and incidentals                           :     Rs. 3,000
e) Diet charges for 9 staff @ Rs.60 for 30 days (60 x 9 x 30)       :     Rs.16,200

       Total per month/per district cost for the Training Agency :     Rs.85,600
       Total estimated Budget for Training Agency for District level Refresher
       Trainings: (85,600 x 22 x 12)                             : Rs.225.98 lakhs

iv)   Training Agency’s State Level Coordination Costs :
a) State level Coordinator: Rs.20000 pm                 :               Rs.20000 pm
b) 3 Regional Coordinators: Rs.12000 pm                 :               Rs.36000 pm
c) 3 Project Assistants: Rs.6000 pm                     :               Rs.18000 pm
d) 1 Accountant: Rs.12000 pm                            :               Rs.12000 pm
e) 1 Data Processing Assistant: Rs.6000 pm              :               Rs. 6000 pm
f) Postage, Stationery, etc.: Rs.10000                  :               Rs.10000 pm

       Total Training Agency State Level Coordination Costs     :       Rs.1.02lakhs pm;
                                                                :       Rs.12.24lakhs p.a.
       Training of Trainers Costs:                              :       Rs.21.00 lakhs
       Total of Training Agency Costs                           :       Rs.259.23 lakhs
       Institutional Overheads 7%                               :       Rs.18.15 lakhs

       TOTAL TRAINING AGENCY COSTS                              :       Rs.277.38 lakhs

v)        Cost of Monthly Review and Monitoring Meetings :

       During the visit to A.P. State, Smt.S.Jalaja, Additional Secretary to Govt. of
India & Mission Director (NRHM) has suggested to conduct monthly review meetings
at PHC level for monitoring the performance of WHVs.

                Cost: 40 x (25+25) = Rs.2,000 per PHC

          Total estimated budget (2000 * 12 * 1570):            Rs.376.80 lakhs

Grand Total Cost of Half-Yearly Refresher Trainings and Monthly PHC-Level
Technical Guidance and Monitoring Meetings for WHVs in the State:

•      Total Cost for the WHVs’ TA, diet, and Wage compensation for two (six-monthly)
       rounds of WHV refresher trainings in the state: Rs.567.6 lakhs


                                                                                          7
•   AP Women’s Cooperative Finance Corporation’s Cost: Rs.70.62 lakhs
•   Total Training Agency (Academy of Nursing Studies) Cost: Rs.277.38 lakhs
•   Cost of Monthly Review and Monitoring Meetings: Rs.376.80 lakhs

Total budget for Refresher training for WHVs is: 1292.40 lakhs


1(d)   Performance-Based Incentives to WHVs :
       The details of budget requirement for the payment of incentives to WHVs are
       as follows:
       i) Incentive to Women Health Volunteers (WHV) for Early Registration of
          Pregnancy in SC/ST Women (100% utilization):

          a) Total AN Mothers                                :    18,00,000
          b) Expected SC / ST AN mothers (22%)               :     3,96,000
          c) Incentive for AN registration                   :     Rs.25/- per case
              2007-08:            3,96,000 cases x Rs.25/-   :     Rs. 99.00 lakhs

       ii. Incentive to the WHV for SC/ST Pregnant Women 3 AN check-ups (90%
           utilisation) :

          a) Total AN Mothers                                :         18,00,000
          b) Expected SC / ST AN mothers                     :           3,96,000
             a. 90% Utilization                              :           3,56,400
             b. Incentive for 3 AN Check-ups                 :    Rs.50/- per case
                2007-08: 3,56,400 cases x Rs.50/-            :    Rs.178.20 lakhs

       iii. Incentive to WHVs for SC/ST Pregnant Women for undergoing
            Antenatal check-up with a Medical Officer (80% utilisation) :

          a) Expected SC / ST AN cases                       :           3,96,000
          b) Assuming 80% Utilization                        :           3,16,800
          c) Incentive for AN checkup with a MO              :    Rs.50/- per case
             2007-08:       3,16,800 cases x Rs.50/-         :    Rs.158.40 lakhs

       iv. Incentive to WHV for Institutional Delivery + accompanying to hospital
           – SC/ST (90% utilisation) :

          a)   Total AN Mothers                              :          18,00,000
          b)   Assuming 10% wastage, total deliveries        :          16,20,000
          c)   Expected deliveries (70%)                     :          16,20,000
          d)   Expected Rural SC/ST deliveries (22%)         :            3,56,400
          e)   Incentive for institutional delivery in       :   Rs.150/- per case
               SC/ST women 2007-08: 3,56,400 cases
               x Rs.150/-                                    :    Rs.534.60 lakhs

       v. Incentive to WHV for SC/ST post / neo-natal care (80% utilisation) :

          a) Expected deliveries in SC/ST women              :    3,96,000


                                                                                      8
          b) Incentive for Post/Neonatal Care                   :      Rs.100/- per case
             2007-08:       3,96,000 cases x Rs.100/-           :       Rs.396.00 lakhs

      vi. Incentive to WHV for identification and management of low birth-
           weight births in any community in the villages: (60% utilisation) :

          a) No. of newborns having low-birth weight                   : 2,45,000
          b) Incentive for each low-birth weight newborn case          : Rs.50/- case
             referral 2007-08: 1,47,000 cases x Rs.50/-                : Rs.73.50 lakhs

      vii. Incentive to WHV for full immunization (excluding measles) of SC/ST
           children (95% utilization) :

           a) Estimated number of SC/ST deliveries in the state        : 3,96,000
           b) 95% Utilization                                          : 3,76,200
           c) Incentive per case of full immunization of SC/ST         : Rs.50/-
              child 2007-08:               3,76,200 cases x Rs.50/-    : Rs.188.10 lakhs

      viii. Incentive to WHV for full immunization for Measles & administration
                  A'
            of Vit' for SC/ST children:

           The budget required for this item of incentive, similar to item (g), is:

           a) Estimated number of SC/ST deliveries in the state        : 3,96,000
           b) 70% Utilization                                          : 2,77,200
           c) Incentive per case of full immunization of               : Rs.50/-
              SC/ST child 2007-08          2,77,200 cases x Rs.50/-    : Rs.138.60 lakhs

      Total Cost of Incentives for WHVs (SC/ST): Rs.1766.40 lakhs

Incentives for Identified Critical Events Achieved in Non-SC/ST BPL Families:

         The budget requirement for the incentives for identified critical events of
utilization of healthcare services in BPL families of non-SC/ST groups are as follows:

      (i) Antenatal checkup with a medical doctor (80% Utilization):

           a)   Total AN Mothers                                       :18,00,000
           b)   AN Mothers (80%)                                       :14,40,000
           c)   Expected BPL non-SC/ST AN mothers                      :4,60,800
           d)   Incentive for AN check-up with a medical doctor        :Rs.25/- per case
                2007-08:      4,60,800 cases x Rs.25/-                 :Rs.115.20 lakhs

      (ii) Incentive for WHV for Institutional Delivery + Accompanying to
           Hospitals in non-SC/ST and BPL childbirth cases (80% utilization):
           a) Total Pregnancies                         :     18,00,000
           b) Assuming 10% wastage, total deliveries    :     16,20,000
           c) Expected deliveries                       :     16,20,000
           d) Expected non-SC/ST deliveries (80%)       :     12,93,000
           e) Below-Poverty-Line group (50%)            :      6,48,000


                                                                                           9
            f) Incentive for institutional delivery            :    Rs.100/- per case
               2007-08:              6,48,000 cases x Rs.100/- :     Rs.648.00 lakhs

        (iii) Incentive for Postnatal and Neonatal Care in BPL, Non-SC/ST
              pregnant women (70% Utilization):
              a) Expected deliveries in BPL, Non-SC/ST women  : 4,42,500
              b) Incentive for Post/Neonatal Care             :Rs.50/- per case
                 2007-08:            4,42,500 cases x Rs.50/- : Rs.221.25 lakhs

        (iv) Incentive for Measles Immunization and Vitamin A Administration for
             BPL, non-SC/ST children (70% utilization):

            a) Estimated BPL, non-SC/ST deliveries per year :        4,42,500
            b) 62% Utilization                              :        2,76,000
            c) Incentive per case of measles immunization &Vit.A:    Rs.25/-
               Second year: 2,76,000 cases x Rs.25/-        :        Rs.69.00 lakhs

Total Cost of Incentives for WHVs for service delivery to BPL non-SC/ST
families:  Rs.1053.45 lakhs
Total Budget for WHVs performance-based Incentives for 07-08: Rs.2819.85
lakhs;
The expected utilization of funds is 87% i.e. Rs.2458.00 lakhs

•   Total Training cost for WHVs                               :     Rs.591.40 lakhs
•   Total budget for supply of First Aid Kits to WHVs          :     Rs.184.80 lakhs
•   Total budget for Refresher training for WHVs               :     Rs.1292.40 lakhs
•   Total Budget for WHVs performance-based Incentives         :     Rs.2458.00 lakhs

Total for WHV programme                                        :     Rs.4526.60 lakhs

EXPECTED OUTPUTS:

    •   Availability of a trained female health resource-person for 24x365 days at the
        village level. Especially, in the areas of maternal, infant and child health for
        minor aliments and to advice the villagers regarding emergency health care
        services.
    •   Increased utilization of maternal healthcare services including Antenatal care
        services and intranatal care services, post-natal care services, immunization
        for children, institutional deliveries, etc.
    •   Reduced incidents of Infant Mortality, particularly of neonatal morality.
    •   Reduced Incidents of Maternal Mortality
    •   Increased percentage of fully immunized children




                                                                                        10
2.     Rural Emergency Health Transportation Services Scheme :

        Many studies in India and in other developing countries have conclusively
shown that lack of dependable transportation facilities in the rural areas acts as a
serious hindrance in the utilization of healthcare services by the rural poor, particularly
for services required by the pregnant and other women as well as infants and
children. Substantial improvement in utilization of institutional delivery services, and
reduction in maternal and infant mortality rates can be achieved through organization
of a rural ambulance service that is focused particularly on pregnant women who have
to be transported to hospitals for deliveries, and on infants and children who die in
large numbers due to completely avoidable and manageable conditions. Accordingly,
it is proposed to organize a “Rural Emergency HealthTransportation Scheme”
which will be called briefly as “Rural Ambulance Scheme” in all the districts of the
state (excepting the very well developed districts). The following are the salient
features of the proposed Rural Ambulance Scheme:

Salient Features of the Rural Ambulance Scheme:

Organization: As earlier described, it is being proposed to develop about 224
CEMONC centers in the entire state, at the rate of 4 to 6 such centers per district. The
geographical catchment area of every CEMONC center FRU will be divided into four
segments which will be primarily identified on the basis of the transportation and road
network availability in the area. Each segment will be served by one Rural Ambulance
vehicle, in which there will be standard emergency and resuscitation equipment, and
an ANM to give immediate possible medical help to the patient while s/he is being
transported to the hospital. Thus, it is proposed to organize 432 Rural Ambulance
Vehicles under this scheme.

Number of Ambulance Vehicles and Justification: The state has a mid-year
population of 791.0 lakhs in 2004-05, and an estimated 16.0 lakh births every year. Of
these, 12.62 lakh births (72.6) occur in rural areas. Assuming that about 20% of the
families that belong to higher socio-economic strata in the rural areas make adequate
arrangements on their own for the transportation of the pregnant women, each rural
ambulance vehicle would on an average need to assist in transportation of 2337
pregnant women to the hospitals for delivery, if 100% of the deliveries are institutional
and they use the vehicle. It is expected that some of the economically better-off
families would also use this facility on actual costs payment, and this would improve
the economics of the scheme. Besides the pregnant women, the scheme focuses on
transporting seriously ill infants and children from the villages to the nearest hospitals
and/or CEMONC centers.

Organization of the Scheme through NGOs: The Rural Ambulance Scheme will be
run through EMRI, a reputed NGO (M/s Satyam Foundation) that have strong and
dedicated presence in the respective districts / areas with Toll Free No.108. The
NGOs who will be entrusted with the running of the scheme will be selected by the
district RCH committee after a careful selection process with safeguards.

Vehicles for the Rural Ambulance Scheme: Vehicles for this scheme are proposed
to be purchased under the project, and given to the NGOs that will be selected to run
the scheme. An alternative to this approach is to hire the ambulance vehicles on a
monthly payment basis. However, it is felt that the total hire charges for a five-year


                                                                                        11
period would be more than the cost of the vehicle. Further, the sustainability of the
scheme at the end of the project would be more assured if the vehicle is in place, and
only maintenance and running costs are to be the operation of the project. Ambulance
vehicles are not usually available on hire from private operators. Further, if it is
envisaged that the selected would buy the vehicle and monthly hire charges would be
paid under the project, it is feared that all good NGOs may not have the financial
strength to buy an ambulance vehicle. If the amount is raised as a loan, the interest
cost would be an avoidable burden on the total costs that are to be recouped from the
users of the vehicle. For these reasons, it is proposed to buy the vehicles under the
project and entrust them to the selected NGOs for operation.

Safeguards for the safety of the vehicle: The ownership of the Rural Ambulance
vehicles will be with the District RCH Committee. It is proposed that the selected NGO
would be required to give a bank-guarantee for 75% of the cost of the vehicle, before
the vehicle is entrusted to it for operation. The vehicles would also be insured.

IEC for the Rural Ambulance Scheme: Before the scheme is grounded, an intensive
IEC campaign would be undertaken to make the people aware about the scheme. It is
proposed to have interaction sessions with the opinion leaders of the community at
district, sub-district (Mandal) level, and at village or Gram Panchayat level. For the
Mandal level interaction session, it is proposed to invite all the representatives of
people at the village level such as the Gram Sarpanches, leaders of the Mahila
Samakhyas (micro-credit groups), Mahila Swasthya Sanghs, DWCRA groups, Janani
Teams, Village Mothers’ Committees, Village Education Committees, Gram Vana
Samrakshana Samithis, Rytu Sanghams, and other voluntary bodies such as youth
clubs, etc. It is also proposed to use pamphlets, posters, mike-publicity, radio
messages, and TV messages to inform the public about the scheme, its advantages,
costs to be shared by the users, advance registration for the vehicle by pregnant
women, etc. Wide publicity would be given on a sustained basis about the telephone
number of the Rural Ambulance Service (NGO’s telephone number).

How the Rural Ambulance Scheme Works: NGOs that operate the rural ambulance
scheme vehicles would be required to position the ambulance at a central / focal point
that has the maximum advantage from the road communication point of view, and
from where, maximum number of villages in the segment can be reached. The NGO
would have an office there with a telephone. The NGO would have to make
arrangements for one person to be available on a 24 hour basis to receive emergency
calls from the villagers for the ambulance. It is also proposed to provide one cell
phone to each ambulance vehicle to improve the operational reach of the ambulance.
Where the ambulance is already transporting a patient to the hospital, if another
emergency call comes, the NGO office would be able to contact the driver and ask the
vehicle to go to the second village directly from the hospital, or enroute to the hospital,
depending on the relative medical urgencies of the two patients.

Telephone Facilities at Villages: It is envisaged under the scheme that villagers
would call the NGO’s office whenever a pregnant woman for delivery or with
complications in delivery, infant or child in acute health condition, or any other patient
in serious condition needs to be transported to the hospital. The Bharat Sanchar
Nigam Limited will be contacted at the state level as well as the district levels to find
out the availability of telephones at all villages. Most villages and habitations in the
plain areas of the state have telephone connectivity. However, in tribal and hilly areas,


                                                                                        12
all villages do not have telephone connections. Multi-pronged efforts are proposed to
enable the people of these villages access the rural ambulance services, through
establishing telephone lines, trying the mobile telephones, etc. However, it is felt that
in interior tribal areas, none of these may work, particularly since some tribal
habitations are in difficult-to-reach hill-top places. For such areas, it is proposed to
motivate the villagers to organize a motor-cycle messenger who would go to the
nearest telephone facility and call for the ambulance to reach the point nearest
possible to the village and the family of the patient would take the patient to that point
for onward transportation to the hospital.

Operational Costs of the Scheme and Participation by the Users: The Rural
Ambulance Scheme is primarily designed to be operated as a shared-costs scheme
by the user public. The initial cost of the rural ambulance vehicles is being provided
for under the project. It is also proposed to provide an operational subsidy to the
NGOs on a monthly basis to meet the salary costs of the drivers, ANMs who will travel
with the ambulance vehicle, telephone staff and part-salary costs of a project
manager; apart from the telephone rental and other costs, office rent, electricity, etc.
The operational subsidy will be paid partly (Rs.5000/- pm) as direct transfer, and the
remaining amount (about Rs.7,000)as subsidy per-case transported to the hospital.
Based on the total number of deliveries expected in one segment in the state on an
average, and other cases of infants/ children or other emergencies being transported,
it is estimated that each Rural Ambulance vehicle would transport about 5 to 6 cases
per day. Accordingly, about Rs. 50/- per case transported is proposed to be paid as
operational subsidy. It is envisaged that the actual costs of running of the ambulance
will be paid by the users. It is proposed to have three tier charges for use of the
ambulance services. The first category will be the above poverty-line families who
would pay a per-km charge for the use of the vehicle, adequate to meet the fuel and
other costs. The second category of users would be the below poverty-line non-
SC/ST who would pay Rs.100 in cash for transporting pregnant women to the hospital
for delivery; and another Rs.100 would be recovered from the “Sukheebhava” scheme
amount payable to them at the hospital. The third category would be the below-
poverty-line SC/ST users, for whom, for transporting pregnant women to hospitals, no
cash costs would be payable by them, and Rs.100 would be recovered from the
“Sukheebhava” scheme amount payable to them at the hospital, and a subsidy of
Rs.50 is proposed from the project per case of transporting SC/ST below poverty-line
pregnant women to the hospitals, to increase the utilization of institutional deliveries
among the SC/ST population. Similarly, it is proposed to provide for a subsidy of
Rs.50 per case of transportation in all cases of infant and child health emergency
cases of below poverty line families. In respect of all uses of the vehicles for
transporting patients other than pregnant women, irrespective of the poverty status,
the users would have to pay the per-km charges.

Registration of the Pregnant Women and Families with Infants / Children: It is
proposed to provide for advance registration of pregnant women and families with
infants for use of the rural ambulance vehicle. This would facilitate saving of time at
the time of actual event of transportation of the patient to the hospital, in obtaining
payment, and arranging for the same by the families. It is also proposed to give a
small rebate in charges to those who do advance registration.




                                                                                       13
Promotion of Village-level Group Responsibility for Payment for use of the
Rural Ambulance Scheme: In order to reduce the possibility of families pleading
poverty and insisting on using the ambulance services without payment, or of
promises of future payment, it is proposed to encourage the village level micro-credit
and self-help groups to organize rural ambulance users’ groups. The group would pay
for the use of the vehicle on behalf of the members and take the responsibility for the
collection of the charges in due course of time. It is also proposed to give a rebate in
charges who are members of such groups, to promote villagers to become members
of these groups.

a)    Implementation of the Rural Ambulance Scheme under other Current
      Projects: Under the Andhra Pradesh Eradication of Rural Poverty project
      (Health Component), in the tribal areas of nine districts if the state, the rural
      ambulance vehicles have already been proposed in 18 segments and
      implementation has already commenced in four segments. Similarly, under the
      European Commission Sector Investment Program, the scheme has been
      proposed to be implemented in four backward districts of the state, in a total of
      90 segments. The implementation of the rural ambulance scheme is being
      made under the same guidelines as described above.
Cost of the Intervention:

       i.    Total number of proposed CEMONC centers                        :     224
       ii.   Total number of Rural Ambulance Scheme segments                :     432

      EHTS: Operational Subsidy - III year:
      •    Rs.14,000 pm for 432 vehicles vehicles for 12 months: Rs.725.76

      Total budget for REHTS operational subsidy for 2007-08: Rs.725.76
      The expected utilization of funds is 79% i.e. Rs.574.56 lakhs

b.    Fuel Subsidy for transporting pregnant women to hospitals for delivery: It
      is proposed for utilization of institutional delivery services in the state by
      providing subsidy for transportation for pregnant women to hospitals for
      delivery @ Rs.200/- per case (expected cases 1,32,000 x 200) = Rs.264.00
      lakhs.
c.    Subsidy for transporting infants and children in acute health condition
      from rural areas to hospitals: It is proposed for utilization child care services
      in the state by providing subsidy for transportation for infants & children in
      acute health conditions from rural areas to hospitals @ Rs.100/- per case
      (expected cases 2,64,000 x 100) = Rs.264.00 lakhs. The expected
      utilization of funs is 50% i.e. Rs.132.00 lakhs.
 d.   It is proposed to cover Comprehensive Insurance to newly procured vehicles
      Rs.20.00 lakhs
       TOTAL REHTS Budget for 2007-08: Rs.990.56 lakhs




                                                                                     14
EXPECTED OUTPUTS
     •   Increased accessing of emergency healthcare services by the rural population,
         particularly in the areas of maternal health problems, neonatal and infant health
         problems;
     •   Reduced number of deaths of women in child birth through transporting the
         complicated cases to the hospitals in the right time;
     •   Increased accessing of hospital services for incidents of Neonatal and child
         hood illnesses;
     •   Increased health confidence in the rural population

3.       Continuation of First Referral Units with Comprehensive Emergency
         Obstetric Services :

       Comprehensive Emergency Obstetric & Neonatal Care (CEMONC) services
are being established at the rate of 4 to 6 per district in such a way that an emergency
case related to pregnancy/delivery and child birth need not travel more than 45 to 50
kms to reach a CEMONC center. In order to achieve this, 4 to 6 FRUs per district,
selected in a geographically well-dispersed manner, would be upgraded as CEMONC
centers with specialist and blood transfusion services available round-the-clock. It is
proposed that there will be four obstetricians, two pediatricians and one anesthetist in
each FRU CEMONC service. 108 such centers are being established in the State.
Additional paramedical staff, equipment, furniture and additional budget for drugs and
consumables to serve the increased utilization of services will be made available in
these centres. During 2006-07, an additional 40 CEMONC centers are proposed to be
added in the CHCs, to be operationalized as FRUs. During the year 2007-08 an
additional 65 new FRU CEMONC services are proposed to be added in the
CHCs/PHCs to be operationalized as FRUs.

a) Salaries to 370 Obstetrician Specialists:
     i) Specialist working in Larger towns
          (35 posts @ Rs.18000 pm x 12 months)         :    Rs.75.60 lakhs
     i) Specialist working in Smaller towns
          (159 posts @ Rs.22000 pm x 12 months)        :    Rs.419.76 lakhs
     ii) Specialist working in Remote & Interior areas
          (78 posts @ Rs.25000 pm x 12 months)         :    Rs.234.00 lakhs
     iii) Specialist working in Tribal areas
          (98 posts @ Rs.28000 pm x 12 months)         :    Rs.329.28 lakhs
     Total budget proposed for salaries of OBG Specialists for the year 2007-08 :
     Rs.1058.64 lakhs
     The expected utilization of funds is 62% i.e. Rs.660.00 lakhs
b) Salaries to 305 Staff Nurses @ Rs.5000/- pm x 12 months : Rs.183.00 lakhs
c) Incentives to 333 Regular Specialist Doctors in Plain Areas @ Rs.2000/- pm x 12
   months x 333 Specialists = Rs.79.73 lakhs
     The expected utilization of funds is 50% i.e. Rs.40.00 lakhs
d) Incentives to 152 Regular Specialist Doctors in Tribal Areas @ Rs.3000/- pm x 12
   months x 152 Specialists = Rs.54.25 lakhs
     The expected utilization of funds is 50% i.e. Rs.28.00 lakhs


                                                                                       15
e) Additional Drugs, Consumables & Laboratory Supplies – Rs.75/- x 4.00 lakh
   deliveries : Rs.300 lakhs
f) Equipment – Rs.1,00,000/- x 148 FRU CEMONC services : Rs.148.00 lakhs
Total budget proposed for existing 148 FRU CEMONC services : Rs.1492.98
lakhs


4.       24-Hours MCH Center PHCs – Continuation :
       To promote institutional deliveries at PHCs, the existing 800 units of 24-Hr
Mother and Child Health Centers are being continued to ensure the availability of
one basic emergency obstetric care facility per 100,000 rural population in the state
as per WHO norms. In addition, specialists’ services (Obstetrician and
Pediatricians) have been provided in all the 24-Hr MCH Center-PHCs once a week
to identify high-risk pregnancies and high-risk neonates and refer them to FRUs.
         a) No.of centres                                - 800
         b) Unit cost per annum                          - Rs.1,75,200/-
         c) Break up for Rs.1,75,200/- per annum

a)      Specialist Services (Gynaecologist) @ Rs.700 per visit x 2             Rs.16,800
        visits per month (700 x 2 x 12 months)
b)      Salaries for 2 Staff Nurses @ Rs.5000 for each (2 x 5000 x           Rs.1,20,000
        12 months)
c)      Night duty allowance @ Rs.1200/- per month (1200 x 12                  Rs.14,400
        months)
d)      Telephone and Miscellaneous expenditure (Rs.500/- x 12                  Rs.6,000
        months)
e)      Salary for 3 Contingency workers (Rs.500/- x 3 x 12 months)            Rs.18,000
        Total budget per centre                                              Rs.1,75,200

Total budget for 520 24-hrs MCH centres for 2007-08 : Rs.911.04 lakhs
50% utilization of budget for 280 24-hrs MCH centres for 2007-08 : Rs.245.28
lakhs
Total budget for 800 Round the Clock MCH Centres for 2007-08: Rs.1156.32
lakhs
EXPECTED OUTPUTS
(i)      Increased utilization of maternal and child healthcare services at these PHCs
         by the population in the surrounding villages
(ii)     Increased institutional delivery rates in the villages serviced by the 24-Hr PHCs
(iii)    Reduced Maternal Mortality incidents in these villages
(iv)     Reduced Neonatal mortality incidents in these villages


5.       Blood Transfusion Services for Emergency Obstetric Care Services
         (Blood Banks and Blood Storage Centres ):



                                                                                       16
       The state has at present 42 blood banks in the public sector, including those in
teaching hospitals, District Headquarters Hospitals and a few Area Hospitals and
CHCs. Of these, 6 blood banks are located in FRUs where CEMONC centers are
proposed to be established. It is proposed to strengthen the blood banks in the
districts so that small districts like Vizianagaram, Srikakulam, Nizamabad, etc. will
have one blood bank in the public sector, and larger districts will have two to three
blood banks. Comprehensive emergency obstetric care requires the availability of
blood transfusion services to enable conducting of caesarian surgeries. It is
proposed to set up additional 16 blood banks in selected Area Hospitals / CHCs in
large districts of the state, to ensure that large districts have about three blood banks
each that can service the blood storage centers in other AH and CHC CEMONC
centers.

     After having reviewed the intervention with the heads of the departments,
where these services are to be implemented in the hospitals, it has been decided to
establish 16 new Blood banks in addition to the existing Blood banks in the proposed
FRU CEMONC service Hospitals of the state. Similarly, it has been decided that the
balance number of hospitals identified as FRU CEMONC services i.e. 89 numbers to
be improved as Blood Storage centres, including those Area Hospitals which are
non-CEMONC locations and where there are currently no blood transfusion services.

      The Indian Red Cross Society, AP State Branch, Hyderabad has come up with
a proposal that they will take up the responsibility of establishing and maintenance of
the proposed Blood banks and Blood Storage centres. Since the Indian Red Cross
Society is doing pioneering work in Blood banks and Blood Storage services under
their control, and after having discussions with the State Secretary, IRCS,
Hyderabad, it has been proposed to entrust the establishment and maintenance of
the proposed 16 Blood banks and 89 Blood Storage centres to Indian Red Cross
Society, AP State Branch, Hyderabad through out-sourcing mode, appointing IRCS
as a nodal agency for this intervention. The full details of institution-wise recurring
and nor-recurring costs including the equipment, staff, etc. for each Blood Bank and
each Blood Storage Center are enclosed in Annexure A and B.

      In view of the excellent services rendered by Indian Red Cross Society
satisfactorily for maintaining Blood banks & Blood Storage centres, the proposal to
entrust the task of setting up and maintaining the proposed 16 Blood banks and 89
Blood Storage centre under RCH-II project to Indian Red Cross Society, AP Branch,
Hyderabad may please be approved. Adequate budget provision has been made
under the RCH-II project for the year 2006-07 and for subsequent years till 2010.

a) Blood Banks :

   i) Recurring Cost - Staff: New Blood Banks (16): It is proposed to place one
      Blood Bank Medical Officer and 11 more MOs for the existing ongoing Blood
      Banks; totaling 27 MOs (Rs.15,000 pm) and 2 Staff Nurses @Rs.5000/-per
      month; 4 Blood Bank technicians (Rs. 4,000 pm ) and 2 contractual service
      staff ( Rs.2000 per month) in each new Blood Bank.
      a) 27 Medical Officers x Rs.15000/- x 12 months       : Rs.48.60 lakhs
      b) Staff Nurse (16 x 2 posts x Rs.5000/- x 12 months) : Rs.19.20 lakhs
      c) Blood Bank Technician (16 x 4 posts x


                                                                                      17
           Rs.4000/- x 12 months)                              :      Rs.30.72 lakhs
        d) Contingent Staff (16 x 2 posts x Rs.2000/- x
           12 months)                                          :      Rs.7.68 lakhs

              Total budget                                :    Rs.106.20 lakhs

    ii) Blood Donation Camps: Proposed to collect 100 units per camp

        a) 2 camps per month per centre                        :      Rs.6000/-
           (Snacks, Misc. & IEC)
        b) Rs.6000/- x 75 camps x 26 weeks                     :      Rs.117.00 lakhs

        Total budget: Rs.117.00 lakhs

b) Blood Storage Centers :

       It is proposed to establish 105 new Blood Storage centres in addition to the
existing 89 Blood Storage centres sanction during 2006-07 to facilities to facilitate
conducting of caesarian sections. Blood will be transported from the blood banks in
each district to the blood storage centers.

Cost of the Intervention:

   i.   Non-Recurring cost – Equipment : It is estimated that the equipment cost
        (refrigerator, cold boxes for transportation, etc.) for each Blood Storage Center
        would be approximately Rs.4.50 lakhs. Accordingly, the total cost is: [105 x
        Rs.4.50 lakhs] = Rs.472.50 lakhs
   ii. Recurring Cost - Staff: Blood Storage Centers : It is proposed to place two
       Blood Bank technicians (Rs.4000 pm) and one Contingency worker (Rs.2000
       pm) in each Blood Storage Center. In addition to above the Regional Medical
       Officer of the centre who is looking after Blood storage centre is proposed to be
       given an include of Rs.1000/- per month. Accordingly, the total staff cost per
       blood storage center would be Rs.11,000 pm; Total cost for the year :
       [11,000*194*12] = Rs.256.08 lakhs
        Expected utilization 85% = Rs.217.66 lakhs
c). Transportation of Blood between and among Blood Banks and Blood
    Storage Centers: It is proposed to hire 68 vehicles @ Rs.14,000 pm; Total cost:
    [14,000x68x10) = Rs.95.20 lakhs.

d. Training to the Medical Officers & Staff for 105 Blood Storage Centers:

   a) Doctors Rs.2500/- x 105 centres : Rs.2.62 lakhs
   b) Training to Blood Bank Technicians (210 x Rs.1500/-) : Rs.3.15 lakhs
      Total training cost: Rs.5.77 lakhs

e) Overhead charges to Indian Red Cross Society (Nodal Agency) @ 7.5% =
   Rs.38.39 lakhs




                                                                                       18
         Total Cost of 16 new Blood Banks and 194 Blood Storage Centers:
         Rs.1052.72 lakh

EXPECTED OUTPUTS:
(i)   Strengthening of CHCs as FRUs
(ii)  Reduced number of deaths of women in child birth through facilitating
      Caesarian surgeries.
(iii) Increased availability of blood for any other emergencies in the smaller
      hospitals


6.        Free Bus Passes in State Transport Busses to Pregnant Women to
          Facilitate Travel to PHCs And Hospitals to have Antenatal Checkup by
          Medical Doctors :

       Every pregnant woman will have at least one antenatal checkup by PHC
medical officer for screening high-risk cases and advice them for institutional
delivery. It is expected that the scheme for free travel by the public transportation
for pregnant women from their village to the nearest PHC or FRU would help to
achieve this goal.

        A minimum of 3 visits has to be made by a women for health check up during
her pregnancy. Out of which the 1st visit will be at village by ANM. For the 2nd & 3rd
visits, the pregnant mother has to visit the nearest PHC / CHC / AH for health check
up. There are about 16,00,000 antenatal cases being registered. Taking into
economic status consideration, it is estimated that 8,00,000 AN mothers visit PHC /
CHC / AH. The department of Family Welfare has tied up with APSRTC for free
transportation of these 8,00,000 pregnant women for at least 3 visits. The programme
has been launched on 6.2.2006 by hon’ble Chief Minister of Andhra Pradesh and the
scheme is being continued for the financial year 2007-08 also. An amount of
Rs.150.00 lakhs is proposed to be provided for this scheme for 2007-08 from the
RCH-Flexi pool of Funds.

EXPECTED OUTPUTS
(i)  Increased Ante Natal Checkups with a medical doctor by rural BPL pregnant
     women
(ii) Increased accessing of hospitals for institutional deliveries


7.        Janani Suraksha Yojana in Rural Areas :

       Government of India has launched a new scheme named “Janani Suraksha
Yojana” in modification of the “National Maternity Benefit Scheme”. The salient
features of the new scheme are as follows:

     •    Cash benefit of Rs.500/- is to be made available to eligible Below-Poverty-Line
          pregnant women, irrespective of the place of delivery including home
          deliveries. The amount is to be paid “during the delivery”, whether the delivery
          is at home, or a private hospital, or a public hospital, or any other healthcare
          institution.


                                                                                       19
     •   Further, an amount of Rs.200/- will be paid to such eligible rural pregnant who
         have their deliveries in healthcare institutions.
     •   The benefit will be available to women who are aged 19 years and above only,
         belonging to households below poverty line, and only for their first and second
         deliveries.
     •   Registration of pregnant women for antenatal check-up and institutional
         delivery will be insisted upon.

       The scheme is being implemented in Andhra Pradesh also strictly as per the
guidelines of the Government of India. The budget requirement for this scheme in
Andhra Pradesh is estimated as follows:

Budget Requirement for the Janani Suraksha Yojana :

     •   Total number of births in the state per year:        :      16,00,000
     •   Of the above, number of births eligible
         for JSY benefit (Rural, of age 19 years and above,
         belonging to Below-Poverty line, and of first and
         second order)                                        :      7,03,000
     •   Percentage of utilization (70%)                      :      4,92,100
     •   Budget Required                                      :      Rs.3444.70 lakhs

Janani Suraksha Yojana In Urban Areas :

       The total number of childbirths in urban areas in the state in the current year is
estimated at 3.68 lakhs. Of these, about 1/3 are estimated to be eligible below poverty
line women, which comes to 1,21,000 cases, out of which the utilization of the
beneficiary comes to approximately 21% i.e. 25,883. Accordingly, @ Rs.600 per case,
the total budget required for JSY Urban is Rs.155.30 lakhs.

Total cost for JSY (Rural +Urban) for 2007-08 lakhs is = Rs.3600.00 lakhs

EXPECTED OUTPUTS
(i)   Increased institutional deliveries
(ii)  Reduced incidents of maternal mortality
(iii) Reduced incidents of infant mortality
(iv)  Higher acceptance of Small Family norm


8.       RCH Health Melas: MP Constituency-wise :

       Under Health Melas Medical Camps will be organized in the interior and
backward villages in 42 MP Constituencies in order to provide quality and better
health services to the poor and needy. It is proposed to provide a special services i.e.,
OBG, Paediatrician and General Physician these specialist doctors will be engaged
from private sector in the near by towns by paying an honorarium of Rs.1,000/- to
each specialist. One camp for one month 123 Camps in every MP constituency in
Andhra Pradesh State. The Total Health Camps are 5169. The proposed expenditure
towards for conducting each RCH Health Camps would be as follows:



                                                                                      20
Budget :
1   Honorarium to 3 Specialist @ Rs.1000/- each                          Rs.3000/-
2   POL / Transport charges                                              Rs.800/-
3   Shamiayanas and Chairs                                               Rs.1000/-
4   Drugs                                                                Rs.1000/-
5   Misc. expenses (local labour, drinking water, snacks for the         Rs.700/-
    doctors and staff, etc.)

Budget for 1 camp x 5169 camps :    Rs.336.00 lakhs
Total budget proposed under this scheme for the year 2007-08: 336.00 lakhs.

9.     RCH Health Melas : MLA Constituency-wise :

       Under Health Melas Medical Camps will be organized in the interior and
backward villages in 294 MLA Constituencies in order to provide quality and better
health services to the poor and needy. It is proposed to provide a special services i.e.,
OBG, Paediatrician and General Physician these specialist doctors will be engaged
from private sector in the near by towns by paying an honorarium of Rs.1,000/- to
each specialist. One camp per month in every MLA constituencies in Andhra Pradesh
State, the Total Health Camps are 3528. The proposed expenditure towards for
conducting each RCH Health Camps would be as follows:

Budget :
1   Honorarium to 3 Specialist @ Rs.1000/- each                          Rs.3000/-
2   POL / Transport charges                                              Rs.800/-
3   Shamiayanas and Chairs                                               Rs.1000/-
4   Drugs                                                                Rs.1000/-
5   Misc. expenses (local labour, drinking water, snacks for the         Rs.700/-
    doctors and staff, etc.)

Total budget per camp: Rs.6,500/-
Total budget proposed under this scheme for the year 2007-08: Rs.229.32 lakhs

10.    Notifications & Social Audit of Maternal Deaths :

       There is a gross under notification as against the expected No. of 5,246
maternal deaths, only 1189 Nos. of deaths are reported (21%). In order to improve
the recording of maternal deaths, it is proposed to provide cash incentive of Rs.100/-
per case each Aanganwadi worker / WHV by way of a telegram:

          (i) cost of telegram                         = Rs.20/-
               Rs. 20/- x 5246 = 1.05 lakhs x 12       = Rs.1.05 lakhs
          (ii) Incentive to AWW Rs.100/- x 5246 x 12   = 5.25 lakhs
               Grand total                             = 6.30 lakhs

a)    Social Audit and Verbal autopsy of Maternal deaths : In order to bring the
      awareness and desired changes in the manpower at different levels to prevent
      maternal deaths, Medical Colleges are being involved for this activity. Each
      Medical College will be allotted 2 districts in which 50% of all maternal death
      incidents will be audited by a team consisting of a specialist from Obstetric


                                                                                      21
     Department, SPM Department and Medical Department will visit the identified
     village and conduct a thorough enquiry and verbal autopsy on the maternal
     death in the presence of the relatives.

     On completion of investigations, the consult specialist team with the help of
     DM&HO will conduct a workshop for all the functionaries involved at various
     levels (ANM & AWW, MPHS(F), MO(PHC), and Staff involved at FRU level) who
     are involved in providing the medical care will be explained about the reasons
     leading to the death of the maternal case and they will be briefed above the
     steps that they have to take in order to present such deaths in the comments in
     future:

     i.      Costing (per case of maternal death audited) :

             (i) Transport cost                                   :   Rs. 1000/-
             (ii) Honorarium                                      :   Rs. 1500/-
                        Total                                     :   Rs.2500/-
             Rs.2500/- per case x 1312 cases per year            : Rs.32.80 lakhs

     ii.     Conducing quarterly workshops on the maternal death audit: Rs.2500/-
             per quarter per district = Rs.10,000/- x 22 =   : Rs.2.20 lakhs

          Total Budget for the year 2007-08                       : Rs.35.00 lakhs

b)   Maternal Outcome Analysis at FRU CEMONC services and other hospitals.
     This will be done through a reporting system from the hospitals to the Project
     office and anlaysis done. A team of consultants will be engaged on per-visit
     basis, and the consultants will visit all the CEMONC centers and other hospitals
     and assess the quality of maternal health care delivered to the patients. They will
     analyze the performance of the centers and identify problem areas for
     rectification, and report to the project office. A lump sum amount of Rs. 2.0 lakhs
     per year is proposed for the consultants’ visits, workshops with the providers,
     format printing, reporting, etc.

          Total budget 2007-08 is Rs.43.30 lakhs
          The expected utilization of funds is Rs.21.65 lakhs

Expected Outputs:
(i)   Increased awareness in the population of that village on maternal healthcare
      and the need for maximum utilization of maternal healthcare services,
      institutional delivery, etc
(ii)  Increase in utilization of maternal healthcare services in that village,
      subsequent to the audit
(iii) Reduced Maternal Mortality in that village




                                                                                     22
                                3. CHILD HEALTH
Objective :
       To reduce infant mortality rate from the current 59 per 1000 live births, to less
than 25 by 2010 and reduce Neonatal Mortality Rate from the current estimate of 43.7
per 1000 live births per year to less than 20; and to assure every parent that in the
event of sickness of neonate or infant, they can obtain emergency and essential
healthcare services and save the lives of their child.
Strategy :
        Ensuring that all the pregnant women below poverty-line get good antenatal
care, including those components that promote the health of the fetus, supplemental
nutrition ensuring proper intra-natal care through institutional deliveries that ensure
proper care of the newborn identifying low-birth weight children and monitoring their
growth, promotion of breast-feeding; promoting newborn care and neonatal care
through training of women health volunteers at village level and sensitization of the
community through habitation-level workshops; achieving 100% immunization of
children for all vaccine-preventable diseases; and promoting gender equity in parents’
upbringing of children, particularly among the poor rural population.
Activities / Interventions :
•    Training of women health volunteers at the village level to promote breast-
     feeding, sensitize women who have recently given birth regarding new-born care,
     motivating women to take the newborn for neonatal care check-up, inform women
     on the do’s and don’ts in caring for infants in matters such as putting babies ‘back
     to sleep’, not administering traditional medicines such as castor oil, keeping the
     baby warm always; frequent reiteration of these messages to the lactating mothers
     of the village through individual household visits and also in the sensitization
     meeting; Budget for this item has been shown in ‘Maternal Health Care’.
•    Training women health volunteers, and Anganwadi workers, in rendering home-
     based neonatal care. Budget has been shown in ‘Maternal Health Care’.
Neonatal and Paediatric services at PHCs and FRUs :
•    Provision of essential neonatal care at all PHCs and emergency neonatal care
     at FRU CEMONC services will be strengthened with required equipment, supplies,
     etc. Budget has been provided under the FRU CEMONC services item under
     maternal health care. Equipment kits will be received from Govt. of India
     under kind assistance.

1.      Neonatal Intensive Care Units: Neonatal Intensive Care Units (NICU) :

       Neonatal Intensive Care Units: Neonatal Intensive Care Units (NICU) will be
established in all 148 CEMONC centers (Community Health Centers), 23 district
hospitals, and 11 medical colleges hospitals in the state. For NICUs in 148 CEMONC
centers, one paediatrician, 4 staff nurses, 2 ANMs will be appointed on contractual
basis for the project period (up to 2010) and 4 staff nurses, 2 ANMs in NICUs of 11
teaching hospitals and 23 district hospitals on contract basis for the project period, as
regular paediatricians are available in medical college hospitals and district hospitals.




                                                                                      23
        The average cost for establishing Grade 3 NICU in teaching hospitals and
district hospitals will be Rs.10.0 lakhs per each unit and for 148 CEMONC centers it is
about Rs.5.00 lakhs per unit.

I.    Details of recurring expenditure for 11 Teaching Hospitals :

            Items             Amount Per      Amount Per       Total amount for 13
                                month           year           teaching hospitals
1. Recurring expenditure
   4 staff nurses on contract Rs.20,000/-    Rs.2,40,000/-             Rs.31,20,000.00
   basis (Rs.5000/- for
   each)
   2 ANMs on contract         Rs.6000/-      Rs.72,000/-                Rs.9,36,000.00
   basis (Rs.3000/- each)
                                             Total                   Rs.40,56,000.00

II.     Details of recurring expenditure for 23 District Hospitals :

            Items             Amount Per       Amount Per         Total amount for
                                month            year                23 district
                                                                     hospitals
1. Recurring expenditure
   2 Paediatricians on        Rs.36,000/-    Rs.4,32,000/-             Rs.99,36,000.00
   contract @ Rs.18000/-
   pm
   4 staff nurses on          Rs.20,000/-    Rs.2,40,000/-             Rs.55,20,000.00
   contract basis
   (Rs.5000/- for each)
   2 ANMs on contract         Rs.6000/-      Rs.72,000/-               Rs.16,56,000.00
   basis (Rs.3000/- each)
                                             Total                Rs. 1,71,12,000.00

III. Details of recurring expenditure for Area Hospitals :

            Items             Amount Per       Amount Per            Total amount
                                 month             year
1 Paediatrician in 16 AH      Rs.18,000/-    Rs.2,16,000/-             Rs.34,56,000.00
on contract @ Rs.18,000/-
pm
2 staff nurses on contract    Rs.10,000/-    Rs.1,20,000/-             Rs.19,20,000.00
basis (Rs.5000/- for each)
2 ANMs on contract basis      Rs.6,000/-     Rs.72,000/-               Rs.11,52,000.00
(Rs.3000/- each)
                                             Total                   Rs.65,28,000.00

IV. Details of recurring expenditure for 148 CEMONC centers :

            Items             Amount Per      Amount Per      Total amount for 148
                                month           year           CEMONC centers



                                                                                     24
              Items               Amount Per     Amount Per      Total amount for 148
                                    month          year           CEMONC centers
1. Recurring expenditure
   One paediatrician on           Rs.23,000/-   Rs.2,76,000/-        Rs.3,94,68,000.00
   contract
   2 staff nurses on              Rs.20,000/-   Rs.1,20,000/-        Rs.1,71,60,000.00
   contract basis
   (Rs.5000/- for each)
   2 ANMs on contract             Rs.6000/-     Rs.72,000/-          Rs.1,02,96,000.00
   basis (Rs.3000/- each)
                                           Total               Rs. 6,69,24,000.00
                                           Total – I             Rs.40,56,000.00
                                           Total – II          Rs. 1,71,12,000.00
                                           Total – III           Rs.65,28,000.00
                                           Total – IV          Rs. 6,69,24,000.00
                                           Grand Total         Rs.9,46,20,000.00
The total expenditure for recurring in respect of 11 teaching hospitals, 23 district
hospitals, and 148 CEMONC centers including Area Hospitals comes to
Rs.9,46,20,000/- per annum.

Total budget required for this scheme is Rs.1020.54 lakhs
The expected utilization of funds is 40% which is Rs.378.48 lakhs
Total budget required for this scheme for 2007-08: Rs.378.48 lakhs

EXPECTED OUTPUTS:

 (i)      Increased availability of emergency neonatal and infant healthcare services in
          the rural areas in the state;
 (ii)     Increased utilization of emergency and essential infant and neonatal
          healthcare services by the people in the region surrounding the Neonatal
          Intensive Care Unit.
 (iii)    Better health outcomes for infants and neonates brought to the NICUs
 (iv)     Reduced infant mortality rate and neonatal mortality rate in that region, and in
          the entire state

2.       New Born Care Kits :

       It is an existing scheme approved in 2005-06. 1.2 lakhs New Born Care Kits
are being distributed to low birth weight babies during 2006-07. The newborn care kit
contains the following:

         1.   Baby mattress – 2
         2.   Baby jackets – 4
         3.   Baby caps -3
         4.   Gloves – 3
         5.   Baby diapers – 12
         6.   Baby blankets - 8

         The newborn care kits help in:



                                                                                       25
       a) Prevention of possible exposure of the baby to cold weather, resulting in
          hypothermia.
       b) Prevention of infection to the baby from the environment.
       c) Keeping the baby in hygienic condition.

       The kits are manufactured by Innovative Linen Co. Pvt. Ltd., Indore. The cost
       of the kit is Rs.232.40 and it is proposed to meet this expenditure under RCH-II
       project budget.

       It is also proposed to distribute these kits for the babies of mothers belonging to
       Below Poverty Line and who are born with Low Birth Weight (less than 2500
       gms) and / or small for dates (pre-term babies).

       •   16.0 lakh deliveries are reported in the state annually.
       •   Approximately 25% of the total deliveries of 16.0 lakhs i.e., 4.0 lakhs babies
           belong to SC/ST families.
       •   Out of 12 lakhs balance of deliveries 55% i.e., 6.60 lakhs belong to BPL
           (SC/ST and others).

       In view of the advantages of the newborn care kits listed above, it is proposed
to provide newborn care kits to Low-Birth weight babies. Of these, it is proposed to
provide the New Born Care Kits to only the Low-Birth Weight babies, who are
estimated at 33% in SC/STs (i.e. 1.33 lakhs) and 20 % in the BPL families (i.e. 1.32
lakhs). Thus, the New Born Care Kits are proposed to be distributed to a total of 2.65
lakhs low birth weight babies in the state. The financial implication @ Rs.232.40/- per
each kit for 2.65 lakhs babies initially to reduce the IMR.

       Total cost for Newborn care kits is Rs.615.86 lakhs
       The expected utilization of funds is 45% which is Rs. 277.14 lakhs
       Total budget required for this scheme for 2007-08: Rs.277.14 lakhs

EXPECTED OUTPUTS:

(i)    Reduced Infant Mortality Rate and Neonatal Mortality Rate;
(ii)   Increased acceptance of the small family norm in the medium and long run




                                                                                       26
                     4. FAMILY PLANNING STRATEGY
Objective :

       The objective of the RCH-II project under family planning services is to improve
the couple protection rate under all methods of contraception, including spacing,
abstinence, temporary methods such as Oral Pills, IUDs, condoms, Female condoms,
emergency contraception pills, etc., and permanent methods such as vasectomy
including “no-scalpel vasectomy”, tubectomy, double-puncture laparoscopy, etc. in the
state from the present levels of 65% to 90% by 2010; and reduce the prevalence
levels of RTIs and STIs in the state by 50% by 2010. The overall objective of the
project is to ensure that all individuals in the reproductive age-group in the state are
able to get complete information about the various methods of family planning, and
are able to access the services of their choice with the least cost to themselves and
with minimum time delays, and the needy couples get information and services on the
problem of infertility. The Government of Andhra Pradesh is fully committed to
providing a “cafeteria-approach” in making family planning services available to all the
couples and other individuals intending to utilize such services, without focusing or
stressing on any particular method. The project also seeks to ensure that all
individuals in the reproductive age-group also have access to information and
services in the area of reproductive and sexual tract infections.
Strategy :
      To reduce unmet needs for spacing and permanent methods for the needy
couples
Activities / Interventions
1.     Wage compensation for Family Planning (Sterilizaiton) acceptors :

        Under the Family Planning services, provision of permanent methods of
contraception, i.e. sterilization services with the highest quality of care will be a high-
priority action-area. Currently, the performance of the state under sterilization
surgeries is the highest in the country over the past decade. For the past five years,
each year, about 8.0 lakh sterilizations are being performed in the state. One
unfortunate aspect of this performance however, is that about 96.5% of these
surgeries are tubectomies, while only about 3.5% are vasectomies. Hence,
interventions have been proposed to drastically improve the participation of men in
family planning sterilizatoions.

       Budget for Compensation for Loss of Wages for Sterilizations: Under the
current Government of India policy, each acceptor of the permanent method of
contraception, i.e. sterilization surgery is entitled for cash compensation towards
wages lost during the days of surgery and the recuperative period. This amount is
currently fixed at Rs.800/- for below-poverty-line acceptors of sterilizations, inclusive
of drugs and consumables required for the surgery and Rs.300/- for APL families.
Keeping in view the possible increase in the number of acceptors of sterilization, it is
proposed to provide a budget of Rs.4800.00 lakhs for compensation for wages lost
for sterilization surgeries. This amount will enable payment of compensation for
approximately 6.00 lakh cases (75% of the annual ELA for which Compensation
amount is tobe paid). Provision will be made for the II and subsequent years under the
RCH-II project also, at this scale.


                                                                                        27
Total Family Planning acceptors (Approximately FP operations)         - 8 lakhs nos.

Govt. & Authorized private centres                                    - 6.00 lakhs

Budget required        - 6.00 lakh operations x Rs.800                -Rs.4800.00 lakhs

Total budget for Compensation for FP Cases for 07-08: Rs.4800.00 lakhs
The expected utilization of funds is 66% which is Rs.3200.00 lakhs
Total budget required for this scheme for 2007-08: Rs.3200.00 lakhs


2.        Family Planning training :

          a. NSV Training : NSV training programme is one of the components of
             Family Welfare Programme. The main objective of this programme is to
             train MBBS doctors and help men, adopt male sterilization and thus create
             demand generation to promote more male participation in Family Welfare
             Programme to the peripheral level.
          b. DPL Training : DPL training programme is one of the components of
             Family Welfare programme. The main objective of this programme is to
             train OBG Specialist / MS Specialist which is most useful method for camp
             approach.
          c. Mini-Lap Training : Mini-Lap training programme is one of the components
             of Family Welfare programme. The main objective of this programme is to
             train MBBS doctors working in Family Planning Service Centres to render
             their services to the Family Planning programme.

          Total Budget required for 2006-07 – Rs.60.00 lakhs

3.        Implementation of Camp-Approach for “No-Scalpel Vasectomy” method :

        To promote male participation in permanent methods of sterilization, it is
proposed to conduct special camps under the “No-Scalpel Vasectomy” method of
sterilization surgery. It is proposed to provide an amount of Rs.60.00 lakhs for this
purpose, per year. Accordingly, the budget requirement for this item is as follows:

i.     District level workshops                                   …    Rs.4000/-
ii.    Block level workshops for 10 blocks                        …    Rs.30,000/-
iii.   TA/DA for NSV Surgeons for 1 District camp                 …    Rs.10,000/-
iv.    Consolidated IEC activity                                  …    Rs.93,250/-
v.     TA for Semen Analysis to the acceptor @ Rs.50/- per case   …    Rs.30,000/-

       Sub-total                                                  … Rs.1,67,250/-


1) Funds required for NSV camp in 23 Districts                    … Rs.38,46,750/-
2) Purchase of NSV Kits (5000 x Rs.200/- per kit)                 … Rs.10,00,000/-
3) Advertisement, preparation of TV spots, Radio


                                                                                       28
   jingles and other media messages                                             … Rs.10,00,000/-
4) State level workshop & review meetings                                       … Rs.1,53,250/-
   Grand total                                                                  … Rs.60,00,000/-

Total Budget for Camp Approach for “No-Scalpel Vasectomy” for 2007-08:
Rs.60.00 lakhs

EXPECTED OUTPUTS
(i)   Improved facilitation for all couples in the state who are desirous of utilizing
      any Family Welfare services
(ii)  Improved acceptance of Family planning services
(iii) Increased Couple protection rate
(iv)  Reduced population growth rate


4.        State / District Quality Assurance Workshops; Inspection; Biomedical
          Waste management training for all staff :

       State Quality Assurance committee / District Quality Assurance committee /
Quality Circles

       As per the guidelines laid down by the Hon’ble Supreme Court of India, Quality
Assurance Committees (QACs) are formed at State and District Levels to ensure that
the standards for Female and Male Sterilization as laid down by the Govt. of India to
look into the issue of pre-operative measures, operational facilities and post-operative
measures, accreditation of the facilities, inspection and enquiry into the family
planning deaths, failures and complications.

       The Govt. of India directed to organize State & District level workshops for
orientation of the health care functionaries towards standard guidelines prescribed for
family planning sterilizations and standard quality assurance manuals.

     1.   State review meetings                                         …            Rs.5.00 lakhs
     2.   District review meetings (Rs.50,000 per district)             …            Rs.11.50 lakhs
     3.   Workshops                                                     …            Rs.3.00 lakhs
     4.   Printing of Manuals                                           …            Rs.1.00 lakhs
     5.   Contingency                                                   …            Rs.1.00 lakhs
     6.   Miscellaneous                                                 …            Rs.1.00 lakhs
     7.   IEC                                                           …            Rs.2.50 lakhs
                                                            Contraceptive Usage
                Budget proposed          70
                                                        62.9
          Rs.25.00 lakhs
                                         60

5.    Family Planning and                50
Contraceptive spacing                            37.3
                                         40
methods Usage in AP
                                         30
Andhra Pradesh has the lowest
                                         20
usage of spacing methods in                                                                 10.2
                                         10                                    3.0
                                                                       1.0                         1.3
                                          0
                                                   Female         Male sterilization         Spacing      29
                                              Sterilization (%)           (%)

                                                     INDIA NFHS- 3 (2005-06)     A.P. NFHS- 3 (2005-06)
India. The current use of any modern family planning method in AP is 67%. Out of
this, 65.9% is sterilization (62.9% is female sterilization and 3% is male sterilization)
and 1.3% is contraceptive spacing method usage. The use in rural Andhra Pradesh is
negligible. When compared to the national average, which is 5.3% for condoms and
3.1% for OCPs. The table given below clearly shows that the contraceptive usage in
Andhra Pradesh is skewed towards female sterilization.


Unmet need for spacing
The total unmet need for family planning is 5% and the unmet need for spacing is
3.2%.

The trend among women in Andhra Pradesh has been that they get married at the
age of 16 and have their first child by the age of 17 and then immediately the second
child and go for sterilization by the age of 23. This is a clear indicator that spacing
after marriage and after the first child is not a felt need. Due to cultural and traditional
reasons women get married as early as 16 years and have their first child even before
they attain the age of 18 years even without realizing that their body is not ready for
conception due to various biological and other reasons like lack of proper nutrition and
care. Secondly, the concept of planning a family is entirely missing. The trend is to
 Sl.       Family Planning                    India                    Andhra Pradesh
 No.                                   NFHS- 3         NFHS- 2       NFHS- 3       NFHS- 2
                                      (2005-06)       (1998-99)     (2005-06)     (1998-99)
                                   Overall   Rural     Overall    Overall Rural    Overall
Current use
1       Any Method (%)                56.3       53        48.2      67.7    67.7       59.6
2       Any modern method (%)         48.5     45.3        42.8      67.0    67.0       58.9
3       Female sterilization (%)      37.3     37.1        34.1      62.9    63.6       52.7
4       Male sterilization (%)         1.0      1.0         1.9       3.0     2.9        4.3
5       IUD (%0                        1.8      1.1         1.6       0.5     0.2        0.6
6       Pill (%)                       3.1      2.8         2.1       0.3     0.1        0.5
7       Condom (%)                     5.3      3.3         3.1       0.5     0.1        0.7
 Unmet need for family planning
8       Total unmet need (%)          13.2     14.6        15.8       5.0     4.4        7.7
9       For spacing (%)                6.3      7.1         8.3       3.2     3.0        5.2
10      For limiting (%)               6.8      7.5         7.5       1.8     1.4        2.5
have the second child immediately after the first child even with out realizing that it
might lead to morbidity and in some cases mortality. As per NFHS – 2, lack of spacing
has clearly shown high IMR.

Andhra Pradesh has the lowest usage of contraceptive spacing methods in India.
Over a period of time the emphasis of modern contraceptive methods has been
skewed towards female sterilization. Low usage of spacing method is definitely one of
the reasons for high Infant Mortality and maternal mortality in Andhra Pradesh. The
need and importance of spacing methods needs to be transmitted and reinforced for a
real change in the programme. The low usage can be attributed to various reasons
like –

       •   Lack of knowledge on the importance and need for spacing methods and its
           overall effect on the maternal and infant deaths.
       •   Lack of knowledge on contraceptive spacing methods


                                                                                         30
       •   Lack of accessibility and availability of spacing methods
       •   Myths and misconception on spacing methods

The state would focus on increasing the usage of temporary contraceptive spacing
methods by increasing the user base. A holistic approach would be adopted for
increasing the usage of temporary contraceptives and to address the relevant issues
and deliver relevant messages.

The increase in usage would be through a
   • Holistic communication strategy,
   • Networking and developing linkages with community led networks and
   • Strengthening the channel partners through capacity building.

Strategy
The state proposes to promote trainings and communication activities on family
planning with respect to temporary contraceptive spacing methods in the state. The
focus would be on promoting usage of condoms, oral contraceptive pills and Intra
Uterine Devices. The approach would be that of social marketing, through a mix of
capacity building and communication in order to increase knowledge and awareness.
This would then be adequately supported with product provisioning.

Capacity Building Details

It is important to train the health workers at the rural and village level in order to have
an impact on the MMR and IMR. It is proposed that the following four types of rural
level health workers be trained.

Sl.         Partner to be Trained           Numbers       Per Person      Total Cost
No.                                                        Training
                                                             Cost
1      ANMs                                   10,000          150          15,00,000
2      Women Health Volunteers                20,000          100          20,00,000
3      Rural Health Service Providers         10,000          100          10,00,000
4      ICDS Workers                           10,000          100          10,00,000

Communication Activities Details
In order to support and add to the impact of the trainings provided through the
different health workers in the villages, it is important to have communication support.
Communication support is proposed as under.

SNo.   Communication                                                     Budget
1      Eligible couples motivation campaigns                              20,00,000
2      Counseling and incentivisation of motivators                       20,00,000
3      IEC Materials and local media activities                           25,00,000

Overall Budget for Family Planning and Contraceptive Spacing

SNo. Budget Item                                                       Amount (Rs.)
1    Capacity Building                                                    55,00,000


                                                                                        31
2      Communication Activities                                      65,00,000
3      Personnel                                                     30,00,000
       TOTAL                                                       1,50,00,000

Total budget proposed for this scheme is Rs.150.00 lakhs


Expected Outputs
   i. 50,000 health workers trained on contraceptive promotion
  ii. 10,000 villages covered though the training programme
 iii. Contraceptives made available in the 10,000 villages in AP




                                                                                 32
                  5. ADOLESCENT HEALTH SERVICES

Objective :

       The average Age-at-marriage and the average Age at first-child birth in the
State is the lowest in the country. This is contributing to high maternal mortality and
high infant mortality. The State considers adolescent health is one of the top priority
items in the Family Welfare Programme.

Strategy :

        About 22% of the population in the community comprises adolescents and
considered healthy since mortality rates in this age group are low. But there are huge
public health issues related to this age group like adolescent marriages, adolescent
pregnancies. This adolescents contributes high MMR, IMR, prevalence of HIV
infection, RTI/STI infections and suffer sever to moderate anemia, etc. and contributes
adverse impact on reproductive health and national productivity.

Activities / Interventions :

1.     Training school treachers (male & female) to act as counselors for
       Adolescent Girls & Boys separately at High Schools is being taken up in
       convergence with APSACS :
       • Iron supplements for clinically anemic adolescent girls through ANMs and
          AWWs. Iron & Folic Acid tablets will be supplied by the ANMs from Drug Kit
          – A (kind assistance)
       • Campaigns in schools Separate campaigns will be conducted for boys
          and girls.

       The activity has been done under HIV / AIDS Project

2.      Training of Service Providers

        Under NRHM, RCH-II, two districts in Andhra Pradesh, Kurnool and Prakasam
are identified on pilot basis to implement the strategy of improving the health needs
and health seeking behavior of adolescents. It is proposed to establish adolescent
clinics on fixed days at the PHC, CHC and District hospitals.

       It is proposed to improve facilities and keep separate timings, privacy and
making availability of all necessary drugs. It is also proposed to provide training to all
service providers. Budget required for the above facilities is estimated Rs.87.28 lakhs
including training for the service provers

Service package for Kurnool district  …   Rs.54.48 lakhs
Budget for training component         …   Rs.2.85 lakhs
Service package for Prakasam district …   Rs.27.95 lakhs
Budget for training component         …   Rs.2.00 lakhs
Total budget proposed under this scheme is Rs.87.28 lakhs



                                                                                       33
EXPECTED OUTPUTS
(i)   Increased knowledge, awareness in adolescent population about personal
      hygiene, social hygiene, sexual and reproductive hygiene, family health
      education, importance of clean drinking water, nutrition, preventive measures
      against infectious diseases, etc.
(ii)  Better healthcare practices and utilization of healthcare services by these
      adolescents when they grow up and enter marital lives
(iii) Better knowledge and practices in respect of age at marriage among the
      adolescents, which would translate into a higher age at marriage for the rural
      and urban poor adolescents in course of time.




                                                                                 34
                              6. URBAN HEALTH
      Under Urban RCH for implementation of Urban Health Programme in 44 cities
and towns with population 1-10 lakhs for a period of five years i.e.2005-06 to
2009-2010, were selected by Govt. of India.

      The GoAP has approved the year wise coverage of the towns as follows.

ANDHRA REGION
Year-1        Year-2               Year-3            Year-4           Year-5
Visakhapatnam Guntur               Tenali            Vizianagaram     Tadepalligudem
Vijayawada    Nellore              Gajuwaka          Ongole           Gudiwada
Rajahmundry   Kakinada             Eluru             Bhimavaram
                                   Machlipatnam      Srikakulam

RAYALASEEMA REGION
Year-1     Year-2                  Year-3            Year-4            Year-5
Kurnool    Proddatur               Hindupur          Adoni             Dharmavaram
Cuddapah   Anantapur               Chittoor          Guntakal          Nandyal
Tirupathi

TELENGANA REGION
Year-1      Year-2                  Year-3            Year-4           Year-5
Warangal    Qutubullapur            Rajendranagar     Alwal            Nizamabad
L.B.Nagar   Malkajigiri             Kukatpally        Ramagundam       Karimnagar
Mahbubnagar Rajendranagar           Uppalkalan        Nalgonda
            Alwal                   Adilabad          Khammam

       The GOAP in GO.Ms.No.1097 HM&FW( D1) department dated 19-10-2005
has approved the budget required for the 1st year towns. The urban projects for the
first year for the 9 cities were approved by Govt. of India in the D.O.No.M
15012/21/2004- RCH(DC) part B dated 3.3.2006 and the projects implementations
have started in all the cities. The details of implementation of Urban Health Project in
9 new towns during the year 2006-07 are given in Annexure. The Project
Implementation Plans (PIPs) for the second year 9 cities / towns are herewith
enclosed. The budget requirement under Urban RCH project for the year 2006-07 is
Rs.1100.52 lakhs including the second year cost for the Year-I towns and for the
second year 9 new cities and towns for which PIPs are herewith submitted. The
detailed break up of the budget is enclosed in the Annexure.

Total budget for 2007-08 : Rs.876.21 lakhs

EXPECTED OUTPUTS
(i)   Better healthcare services to the urban poor
(ii)  Better accessing of maternal healthcare and child healthcare services by the
      urban poor
(iii) Reduced Infant Mortality Rate among the urban poor
(iv)  Reduced Maternal Mortality Ratio among the urban poor



                                                                                     35
                                                                       ANNEXURE
RCH.II - Urban Health Programme - Probable expenditure for continuation in 18 towns and implementation in 10 new towns having
                                   above one lakh population Implementation Year 2007-08
Sl.             Town                No. of    UHC    Total    No. of   FRU     Total FRUs                      Other Costs                            Total Cost
No.                                 UHCs      Cost   UHCs     FRUs     Cost       Cost      B.L.S   BCC/ IEC      Contingencies      Total of other
                                                      cost                                                     including Audit Fee       costs
      For Continuation of UHP in 19 Towns
1     Vijayawada                       5      4.79   23.95      1      19.00     19.00                                0.40               0.40           43.35
2     Visakhapatnam                    4      4.79   19.16      2      19.00     38.00                                0.50               0.50           57.66
3     Rajahmundry                      2      4.79   9.58       1      19.00     19.00                                0.25               0.25           28.83
4     Kurnool                          3      4.79   14.37      1      19.00     19.00                                0.30               0.30           33.67
5     Kadapa                           3      4.79   14.37      1      19.00     19.00                                0.30               0.30           33.67
6     Tirupathi                        1      4.79   4.79       1      19.00     19.00                                0.20               0.20           23.99
7     Warangal                         3      4.79   14.37      1      19.00     19.00                                0.30               0.30           33.67
8     L.B.Nagar                        3      4.79   14.37      0      19.00      0.00                                0.15               0.15           14.52
9     Mahbubnagar                      1      4.79   4.79       0      19.00      0.00                                0.05               0.05            4.84
10    Guntur                           3      4.79   14.37      1      19.00     19.00                                0.30               0.30           33.67
11    Nellore                          1      4.79   4.79       1      19.00     19.00                                0.20               0.20           23.99
12    Kakinada                         3      4.79   14.37      1      19.00     19.00                                0.30               0.30           33.67
13    Proddatur                        1      4.79   4.79       0                                                     0.05               0.05            4.84
14    Anantapur                        1      4.79   4.79       0                                                     0.05               0.05            4.84
15    Qutubullapur                     3      4.79   14.37      0                                                     0.15               0.15           14.52
16    Malkajigiri                      3      4.79   14.37      0                                                     0.15               0.15           14.52
17    Rajendranagar                    3      4.79   14.37      0                                                     0.15               0.15           14.52
18    Alwal                            3      4.79   14.37      0                                                     0.15               0.15           14.52
19    Srikakulam                       1      4.79   4.79       0                                                     0.05               0.05            4.84
20    Continuation of old UHCs in      17     4.79   81.43      1                                                     0.85               0.85           82.28
      Vijayawada
      Sub-total                        64            306.56    12               209.00      0.00      0.00            4.85               4.85          520.41
      For implementation of UHP in 10 new towns
1     Tenali                           2      6.79   13.58                                           5.30             0.10               5.40           18.98
2     Gajuwaka                         4      6.79   27.16                                           9.15             0.20               9.35           36.51
3     Eluru                            2      6.79   13.58                                           6.71             0.10               6.81           20.39
4     Machilipatnam                    2      6.79   13.58                                           6.48             0.10               6.58           20.16
5     Hindupur                         2      6.79   13.58                                           4.42             0.10               4.52           18.10
6     Chittoor                         2      6.79   13.58                                           5.41             0.10               5.51           19.09
7     Kapra                            3      6.79   20.37                                           5.63             0.15               5.78           26.15
8     Kukatpally                       6      6.79   40.74                                           10.27            0.30              10.57           51.31
9     Uppalkalan                       1      6.79   6.79                                            4.18             0.05               4.23           11.02
10    Adilabad                         1      6.79   6.79                                            3.83             0.05               3.88           10.67




                                                                                                                                                                   36
Sl.               Town          No. of   UHC      Total    No. of   FRU    Total FRUs                      Other Costs                            Total Cost
No.                             UHCs     Cost     UHCs     FRUs     Cost      Cost      B.L.S   BCC/ IEC      Contingencies      Total of other
                                                   cost                                                    including Audit Fee      costs
11    Amudalavalasa               1       6.79    6.79                                  1.00                       0.05              1.05           7.84
12    Palasa Kasibugga            1       6.79    6.79                                  1.00                       0.05              1.05           7.84
13    Saluru                      1       6.79    6.79                                  1.00                       0.05              1.05           7.84
14    Kovuru                      1       6.79    6.79                                  1.00                       0.05              1.05           7.84
15    Jaggaiahpeta                1       6.79    6.79                                  1.00                       0.05              1.05           7.84
16    Pedana                      1       6.79    6.79                                  1.00                       0.05              1.05           7.84
17    Jammalamadugu               1       6.79    6.79                                  1.00                       0.05              1.05           7.84
18    Punganur                    1       6.79    6.79                                  1.00                       0.05              1.05           7.84
19    Korutla                     1       6.79    6.79                                  1.00                       0.05              1.05           7.84
20    Mancherial                  1       6.79    6.79                                  1.00                       0.05              1.05           7.84
21    Medak                       1       6.79    6.79                                  1.00                       0.05              1.05           7.84
22    Bhongir                     1       6.79    6.79                                  1.00                       0.05              1.05           7.84
23    Gaddiannaram                1       6.79    6.79                                  1.00                       0.05              1.05           7.84
      for conducting baseline
      survey for 10 towns (12
      UHCs)                                                                             21.50                                        21.50          21.50
      Sub-total                   38     156.17   258.02     0       0         0        34.50    61.38            1.90               97.78         355.80
      Grand Total                102     156.17   564.58    12       0        209       34.50    61.38            6.75              102.63         876.21




                                                                                                                                                               37
                                7. TRIBAL HEALTH
Objective :

      The objective under tribal health under the RCH-II project is to achieve a
quantum improvement in the healthcare services’ availability, particularly in the
maternal and child health aspects to the population in the tribal areas.

Strategy :

       Enabling tribal population living in remote interior tribal areas to access health
services through strengthening the existing facilities and creating new innovative
types of health services delivery mechanisms.

1.      Tribal Shandy-level weekly RCH Health Camps :

       There are 193 PHCs in the tribal areas in the state. A package of RCH
services have been introduced in the tribal areas including Shandy level RCH
medical camps once every week at every shandy.

(i)     Total No. of shandy level health camps in 9 tribal districts per week: 500; per
        year: 26,000 Tribal Shandy Clinics;
(ii)    Mobility for PHCs: It is estimated that about 50% of the tribal PHCs have
        vehicles, and would need only additional POL for attending to the shandy level
        camps. 97 tribal PHCs in the state have government vehicles. Therefore:-
        -   Additional POL for 97 PHC vehicles @ Rs.400 per week; for 52 weeks:
            Rs.20.17 lakhs
        -   Hiring of Vehicles for 96 tribal PHCs to enable the medical officer to
            conduct the shandy clinic on every working day: Rs.14,000 per month for
            96 PHCs * 12 months: 161.28 lakhs
(iii)   Additional Drugs for Tribal Shandy Clinics @ Rs.250 per clinic (balance from
        the PHC drug budget): Rs.65.00 lakhs

        For Tribal Shandy-level RCH Medical Camps: Rs.246.45 lakhs

        The expected utilization of funds for Tribal Shandy-level RCH Medical
        Camps is 55%: Rs.135.55 lakhs

2.      Special monthly Obstetric & Gynaecological & Child Health Camps at
        selected places in the tribal areas :

       It is proposed to take special gynaec and child health camps for rendering
better health care services in the tribal areas once in a month.

        1. Location                       …      CHCs
        2. No.of ITDA areas               …      10 Districts
        3. Total locations 10 x 5         …      50
        4. No.of camps 50 x 12            …      600




                                                                                      38
       5. Expenditure
             a) Honorarium for Gynaecologists @ Rs.2000/- per day
             b) Paediatrician @ Rs.2000/- per day
             c) Vehicle will be provided by the department
             d) Additional drugs @ Rs.4000/- per day
             e) Miscellaneous arrangements @ Rs.2000/- per day
       Cost per camp @ Rs.10000/- per camp.

       Budget required: 600 camps x Rs.10,000/- = Rs.60.00 lakhs

4.     Construction of Birth Waiting Rooms :

       Construction of birth-waiting rooms, each of a size 15’x 8’ with a provision for a
small kitchenette to enable women from distant and interior habitations to reach the
delivery care institution a couple of days before the expected date of delivery so as to
avoid the complications while in the village, or on the way from the village to the
hospital:

       The birth-waiting rooms component will be taken up in one or two pilot districts
in the most backward and tribal areas of the state. The Rural Emergency Health
Transportation System (EHTS) will also be available in these areas at a 100% level,
to help poor women from rural interior households reach the hospital in advance to
the expected date of delivery, and utilize the institutional delivery care services. It is
proposed to take up this intervention in 9 ITDA districts @ 2 per district at a cost of
Rs.8.0 lakhs per unit. This intervention will be completed in the first year of the
project. Total Cost: Rs.80.00 lakhs

       Total budget required for this scheme is Rs.80.00 lakhs




                                                                                       39
                      8. PROCUREMENT (GENERAL)

1.     Govt. of India under RCH-II project, have released budget for Rs.1758.00
lakhs towards procurement of different types of drug kits to be supplied to the Sub-
centre ANMs, PHCs, FRUs & RTI/ STI kits. As per the Govt. of India guidelines, the
procurement of kits is to be made by the State Govt. under RCH-II budget.
Accordingly, the following kits are being supplied to the different institutions as per
Govt. of India guidelines for successful implementation interventions

a.    Kit - A : Kit A are to be supplied to 12,522 Sub-centres @ 2 kits each per year
      per Sub-centre
b.    Kit – B : Kit B are to be supplied to 12,522 Sub-centres @ 2 kits each per year
      per Sub-centre
c.    PHC Medicine Kit : PHC Kits are to be supplied to 1570 PHCs @ 1 each
d.    CHC Medicine Kit : CHC Kits are to be supplied to 167 CHCs and 56 Area
      Hospitals
e.    FRU Medicine Kit : FRU Kits are to be supplied to 22 District Hospitals and 11
      Teaching Hospitals
f.    RTI/STI Medicine Kit : RTI/STI Kits are to be supplied to 167 CHCs and 56
      Area Hospitals @ 1 each

      Total budget proposed for procurement of different types of Drug Kits
      for 2007-08 is Rs.1758.00 lakhs


2.    Disposable Delivery kits are to be supplied to all Govt. Institutions where
      deliveries are conducted @ 1 per each delivery

      i.      Approximate deliveries at Govt. Institutions   … 8,00,000 per annum
      ii.     No.of DD Kits required                         … 8,00,000
      iii.    Rate per Kit                                   … Rs.19/-
      iv.     Total cost                                     … 8,00,000 x Rs.19/-
      v.      Total budget required for procurement of DD Kits - Rs.152.00 lakhs

      Total budget proposed for procurement of DD Kits for 2007-08 is
      Rs.152.00 lakhs


3.    Neonatal Intensive Care Units - Procurement of Drugs & Consumables:

Sl.           Item                Amount per month        Amount per         Total
No.                                                          year           amount
a   11 Teaching Hospitals         10000/- per each          1,20,000/-     15,60,000/-
                                  hospital
b     23 District Hospitals       4000/- per each             48,000/-     11,04,000/-
                                  hospital



                                                                                    40
Sl.          Item              Amount per month       Amount per      Total
No.                                                     year         amount
c   Area Hospitals             2500/- per each           30,000/-    4,80,000/-
                               hospital
d    148 CEMONC centers        2500/- per each           30,000/-   42,90,000/-
                               hospital
     Total                                                          74,34,000/-

     Budger proposed under this scheme is Rs.74.34 lakhs


4.   Better quality Iron Tablets for Tribal Women :

     a) Tribal population                    …    40.00 lakhs
     b) Approximate pregnancies              …    1.00 lakh
     c) Cost of Iron Tablets @ 1/- each x 90 …    Rs.90/-

     Total budget required : Rs.90/- x 1.00 lakh cases = Rs.90.00 lakhs

     Budget required under RCH-II, 55% cost = Rs.50.00 lakhs
     State Govt. contribution 45% = Rs.40.00 lakhs


5.   Strengthening MIS wing at PHC & District levels: To strengthening the
     PHC / District Accounting and MIS wings and also providing Computers to
     newly constructed PHCs and CEMONC centres for getting speedy information
     on financial and physical performance               …      Rs.100.00 lakhs




                                                                             41
                9. INSTITUTIONAL STRENGTHENING

1.   Strengthening the decentralized planning process :
     The Decentralised planning process, which was initiated by establishing
     Health and Family Welfare Society at State level and District level RCH
     Committees are further strengthened by setting up RCH Societies at district
     level and also strengthening the State PMUs & District PMUs and following
     bottom to top approach by providing flexibility in their area of activity.
2.   Prioritizing the RCH interventions based on local needs :
     Identifying the priority districts based on RCH outcomes as revealed by
     Reproductive Health Survey (RHS) and planning the interventions as per the
     priorities identified.
3.   Involvement of the PRIs for provision of service delivery as per GOI
     policy :
     The Janani teams, which are formed at the Gram Panchayat level, will be
     further strengthened by providing training to the team members for creating
     demand for the services and monitoring their proper utilization. At the Gram
     Panchayat level, Gram Panchayat Health Committees are being constituted to
     do the selection of the WHV candidates for the village, and also regularly
     supervise the work of the WHVs, Anganwadi Workers, and the ANMs.
4.   Improving quality of service delivery and increase the availability of
     services :
        Standards will be set to ensure the quality of services at various levels
        (sub-centre, PHC, CHCs, PP Units, Urban Health Centres, etc.), for each
        element of health service that is rendered in these institutions.
        To increase the access to the services to all the beneficiaries particularly,
        the vulnerable groups and to the difficult to reach areas
        Involvement of Public Private Partnership (PPP) in provision of RCH
        services
        To enhance the capacity of service providers through proper trainings at all
        levels
5.   Optimizing the utilization of existing health facilities / scope of 800 PHCs
     have relocation based on load & utilization :
     The existing health care facilities like Rural Health Sub-centres and PHCs
     have been reorganized after taking into consideration the distance, travel, time
     availability of private health facilities and referral transport arrangements. 800
     PHCs have been upgraded as 24-hours Mother and Child Health Centers so
     as to provide 24-hours delivery care services.
     To improve the accessing and utilization of healthcare services by pregnant
     women and children in FRUs, it is proposed to initiate an emergency health
     transport system that will be entrusted to NGOs for management.. The NGO
     will be provideded with a rural ambulance vehicle, and will also be provided an
     operational subsidy for meeting part of the operation and maintenance costs. It
     is proposed that under this scheme, the users would pay the recurring costs
     (e.g. diesel charges) towards the transportation, based on distance.


                                                                                    42
      Improve management structures at all levels :
      To strengthen the management structures at State, District and Sub Divisional
      levels by creating/redeploying staff.
6.    Effectively monitor outcomes :
         Monitoring and evaluation systems based on transparent data collection
         and analysis focusing on identifying the barriers to equitable RCH
         outcomes would be designed and disseminated.
         Computerized MIES has been developed. It will be utilized for monitoring
         and evaluation of the RCH outcomes. It may also be utilized for analysis of
         household survey data for BPL, SC, ST and minorities and Gender issues
         that may be relevant under RCH.
7.    Improved Financial Management System at State and District levels to
      help efficient use of resources to achieve RCH outcomes :
      The Financial Management System would be further strengthened at State
      and District levels by creating a post of Asst. Accounts Officer in each district
      to look after accounts exclusively, and at the state headquarters to assist the
      Accounts Officer and attend to RCH accounts exclusively.
8.    Strengthening Information, Education and Communication Area at the
      State, District levels :
      The State IEC wing would be further strengthened with Audio Visual
      equipment and other logistics. At the sub-district level, IEC Cells will be
      established by positioning Deputy DEMO (District Extension and Media
      Officer) to assist the Deputy District Medical & Health Officer in implementing
      and monitoring various health programmes from the health communication
      perspective.
Detailed cost for institutional strengthening (project management) of RCH-II:
1.    State Head Quarters: It is proposed to strength State IEC & Demography &
      Accounts wing with supporting staff under RCH-II Project.
                                                                     (Rs. in lakhs)
                                                                      Cost      per
                                                                      Annum
 1     NGO Coordinator for monitoring Mother NGO scheme                       3.60
       Rs.30,000/- pm x 12
 2     RCH Consultants (5) (Finance, IEC, Administration, Technical,         12.00
       MIS) @ Rs.20,000/- per month x 12 months (Rs.15,000/- +
       Rs.5,000/- TA & DA) x 5 consultants
 3     Accounts Clerk on Contract – (One) Rs.8000/- pm for                    1.92
       maintenance of SCOVA Society – Rs.8000/- x 12
 4     Comupter Assts. on Contract – (3) Rs.8000/- x pm for                   2.88
       maintenance of SCOVA Society – Rs.8000/- x 12
 5     Computer Supervisors @ Rs.15000/- consolidated x 2 x 12                3.60
       months
 6     Computer Programmers / Project Asst. @Rs.10000/-                       4.80
       consolidated x 4 x 12 months
 7     Librarian @Rs.8000/- consolidated PM x 12 months                       0.96


                                                                                    43
                                                                         Cost   per
                                                                         Annum
 8   Contract Office Assistants (Jr.Asst) @ Rs.5200/- consolidated            13.73
     pm x 12 months x 22 nos.
 9   Contract Drivers @ Rs.4500/- consolidated pm x 12 months x 4               2.16
     nos.
 10  Contract Office Subordinate & Special Messenger (@                         3.46
     Rs.4200/- salary & allowance Rs.600/- = Rs.4800/-) @
     Rs.4800/- pm x 12 months x 6 nos.
 11  Maintenance of Computers (AMC)                                             2.00
 12  Materials & Consumables for Computers                                      1.00
 13  RCH Review meetings, Misc. contingences expenditure                        2.00
     Sub Total (I)                                                             54.11
Amount required for 1 year = Rs.54.11 lakhs

2.     District level:
       (a)    To strength the District level IEC / BCC wing and Accounting wing and
              also MIS wing.
                                                                          (Rs. In lakhs)
                                                                         Cost     per
                                                                         Annum
        District Level
 1     Data Entry Operator consolidated – (1) Rs.8000/- x 23 x 12              19.32
 2     Maintenance of Computers, Staionary, Material & Repairs for             69.35
       District & PHC Level
 3     RCH Review meetings,           miscellaneous & contingences             11.50
       expenditure
 4   Training Programme (BCA & FHIMS)                                        130.20
     Sub Total (II)                                                          230.37
Amount required for 1 year = Rs.454.62 lakhs

(b)    Software support at District level
                                                                    (Rupees in lakhs)
 Sl.   Activity                                                         Cost     per
 No.                                                                    Annum
 1     Software Engineer for 22 districts @Rs.23,600/- p.m.                    62.30
 2     Hardware Engineer for 22 districts @Rs.16,850/- p.m.                    44.48
       Total Cost for 1 year                                                 106.78




                                                                                   44
(c) District Programme Management Unit (Rupees in lakhs)
 Sl.                           Activity                               Cost per
 No.                                                                   annum
1     Assistant Accounts Officer @ 1 per district @ Rs.15000/- x 12        41.40
      months x 23
2     Additional District Program Managers in the Cadre of Civil          224.64
      Surgeon / Dy. Civil Surgeons @ Rs.18000/- pm x 12 months x
      104
3     Hiring of vehicles for ADPMs @ Rs.14000/- pm x 12 months x          174.72
      104
4     TA / DA to the Officers in ADPMs & AAOs @ Rs.3000/- pm x             45.72
      12 months x 127
      Total cost for 1 year                                               486.48

Total budget for Project Management units at State & District levels for 2007-
08: Rs.877.54 lakhs

The expected utilization of funds is 60% which is Rs.526.64 lakhs as
recruitment of the Additional District Program Managers and other State
Consultants is under process and it will take to another 3 to 4 months to
complete task.

Total budget required for this scheme for 2007-08: Rs.526.64 lakhs

EXPECTED OUTPUTS
(i)   Strengthening of supervisory structure for program implementation and
      monitoring as well as functioning of PHCs, and implementation of all the
      national health sector programs such as Family Planning, TB control, Malaria
      Control, Leprosy Control, Blindness control, etc.
(ii)  Better communication of guidelines, and more frequent on-ground review of
      program implementation
(iii) Better compliance with reporting, accounting and auditing requirements




                                                                              45
                           10. TRAINING STRATEGY

Background :

       Enhancing the skills of service providers is critical to achieve goals of the
project. For delivery of quality care, trainings have to be provided to enhance the
knowledge & skills and motivation in different managerial methods.

Objectives :

     •   To equip the service providers with skills for delivery of programme
         interventions at different levels.
     •   To enable the trained personnel for practice of these skills leading to improved
         performance aiming to achieve the desired goals.

Strategy :

     •   To plan and implement interventions to improve the clinical, managerial and
         communication skills of the personnel in the health systems.
     •   To provide conductive environment for effective application of the skills
         resulting in improved quality of service delivery at various service delivery
         points.
     •   To address the training needs for skill upgradation amongst private providers.

1.       It is proposed to strengthen the training centres at District and Regional
         level with infrastructure support and also taking up different skilled
         training programmes to the Medical & Paramedical personnel.

         Total budget required for this scheme for 2007-08: Rs.100.00 lakhs

2.       Training of Medical Officers in Emergency Obstetric Care Services :

       Medical Officers with MBBS qualification working in PHCs / CHCs will be given
in sixteen weeks training programme in Emergency Obstetric Care Services to
enable to attend and identify emergency obstetric cases and also to perform
caesarian sections in emergencies in phased manner.

a)       DA (Rs.200/- x 120 participants x 112 days)                 … Rs.26,88,000/-
b)       TA (will be paid in actuals) (Rs.1000 x 120 participants)   … Rs.1,20,000/-
c)       Lunch & Tea (Rs.100/- x 120 partc. x 112 days)              … Rs.13,44,000/-
d)       Course fee & Stationary (Rs.1000/- x 120 Partc.)            … Rs.1,20,000/-
e)       Chief Coordination honorarium (Rs.1000/- x 60 batches)      …    Rs.60,000/-
f)       Unit Chief honorarium (Rs.1000 x 52 units)                  …    Rs.52,000/-
g)       Guest Faculty & Miscellaneous (200 x 112 days x 11)         … Rs.2,46,400/-

Total budget proposed under this scheme for the year 2007-08: Rs.46.30 lakhs




                                                                                        46
3.        Training in Essential and Emergency Neonatal Care to PHC Medical
          Officers:
     All PHC medical officers are being trained in essential neonatal care and
management of sick neonates, since normally only general doctors are posted in
PHCs; similarly, one medical officer of Civil Assistant Surgeon cadre and sub-district
Government hospitals are also being trained, since these facilities do not have
earmarked pediatric specialist on their rolls.
i)     Medical Officers (1570 PHCs & 167 CHCs)          …      1737
ii)    Duration of training                             …      3 days
iii)   Training Institutions                            …      11 Teaching Hospitals
iv)    Batch size                                       …      5 doctors
v)     No.of batches per month (5 batches x 11)         …      55 batches
vi)    Total batches                                    …      347 batches

a) DA (Rs.200/- x 1737 participatns x 3 days)           …      Rs.10,42,200/-
b) TA (actuals) (Rs.1000 x 1737 participants)           …      Rs.17,37,000/-
c) Lunch & Tea (Rs.100/- x 1737 x 3 days)               …      Rs.5,21,100/-
d) Contingencies, Materials, etc.
   (Rs.100/- x 3 days x 347 batches)                    …      Rs.1,04,100/-
e) Honorarium to Guest Faculty
   (Rs.300/- x 3 days x 347 batches)                    …      Rs.3,12,300/-

Total budget proposed under this scheme for the year 2007-08: Rs.37.17 lakhs


4.        Anesthesiology Training to MBBS Doctors:

       MBBS Doctors working in FRUs (all CEMONCs & other FRUs) at the rate of
three per FRU will be given in four-month course training in anesthesiology to enable
them give anesthesia for caesarian sections; also training will be given to
obstetricians and other doctors who are interested in ultra-sound diagnostic
equipment; and training in pediatrics to non-specialist doctors.

         i.    Total number of FRUs                 …      223
        ii.    Cost per candidate                   …      Rs.30,000/-
       iii.    Duration of training program         …      4 months
       iv.     Training Centre                      …      11 Govt. Teaching Hospitals
               (Initially, 1 medical college in each region i.e. Osmania Medical College,
               Kurnool Medical College & Andhra Medical College)
       v.      Nodal Officer                        …      Professor of Anaesthesiology
                                                           of respective medical college)

1st Phase:
       i.      3 Medical Colleges x 6 candidates x 3 batches …        54 candidates
       ii.     Total amount for 1st phase                    …        Rs.16,20,000/-
2nd Phase:
       iii.    8 Medical Colleges x 4 candidates x 2 batches …        64 candidates
       iv.     Total amount for 2nd phase                    …        Rs.19,20,000/-

Total amount proposed for Anesthesiology training for MOs is Rs.35.40 lakhs



                                                                                       47
5.    Integrated Management of Neonatal & Childhood Illnesses (IMNCI)
      Training for Doctors & Staff Nurses:

       IMNCI is an approach to a comprehensive and structured management of
diarrhea, ARI, malaria, young infant illnesses and feeding problems developed by
WHO / UNICEF. The generic IMNCI guidelines and training modules have recently
been adapted for the country. The Indian version, termed as Integrated Management
of Neonatal and Childhood Illness is specially oriented to newborn care in order to
address the high priority given to neonatal health in the country. A module for the
basic health workers (ANMs, AWWs) has also been developed which, incorporates
home visits to the neonates.

a) Doctors training:
   1. Medical Officer                         …      1000 numbers
   2. Per batch                               …      6 candidates
   3. Total number of batches                 …      166
   4. Training Institutions                   …      Medical Colleges
   5. Duration of Training                    …      8 days
   6. TA                                      …      Rs.200/-
   7. DA                                      …      Rs.200/- per day for 8 days
   8. TA & DA for 1000 Doctors x Rs.1800/- …         18.00 lakhs
   9. Honorarium to Guest Faculty
       (Rs.500/- x 8 days x 166 batches)      …      Rs.6,64,000/-
   10. Training Expenditure (materials, consumables, etc.)
       Rs.500/- per batch x 166 batches       …      Rs.83,000/-
   11. Study materials & Miscellaneous expenditure
       per batch @ Rs.5000/- x 166 batches …         Rs.8,30,000/-

      Sub-Total for Medical Officers training – Rs.33.77 lakhs

b) Training of Staff Nurses
   1. Staff Nurses                            …      2000
   2. Training Institutional                  …      23 District Hospitals
   3. Batch Size                              …      10 candidates
   4. Total no.of batches                     …      200 batches
   5. Duration of training                    …      8 days
   6. TA                                      …      Rs.200/- actuals
   7. DA                                      …      Rs.125/- per day for 8 days
   8. TA & DA for 2000 SNs x Rs.1200/-        …      24.00 lakhs
   9. Honorarium to Guest Faculty
       (Rs.300/- x 8 days x 200 batches)      …      Rs.4,80,000/-
   10. Training Expenditure (materials, consumables, etc.)
       Rs.250/- per batch x 200 batches       …      Rs.50,000/-
   11. Study materials & Miscellaneous expenditure
       per batch @ Rs.2500/- x 200 batches …         Rs.5,00,000/-

      Sub-Total for Staff Nurses training – Rs.34.30 lakhs

Total Budget for IMNCI Training: Rs.68.07 lakhs




                                                                                   48
6.     Training Calendar for the ensuing year

Sl.           Title            Jun   Jul   Aug Sep   Oct   Nov Dec   Jan   Feb   Mar
No.
1   Training of Medical
    Officers in Emergency
    Obstetric Care
    Services
2   Training in Essential
    and Emergency
    Neonatal Care to PHC
    Medical Officers
3   Anesthesiology
    Training to MBBS
    Doctors
4   Integrated
    Management of
    Neonatal & Childhood
    Illnesses (IMNCI)
    Training for Doctors &
    Staff Nurses
5   Implementation of
    PC&PNDT
6   Induction Training
    Program for PHC MOs
7   Specialized
    Management Training
8   Orientation training for
    SBAs, LHVs, SNs &
    ANMs
9   Orientation training for                    Date to be decided
    MOs of UHCs
10 Training course on                           Date to be decided
    Health Statistics and
    Demography for
    Demographers & SO
11 IEC / BCC Training                           Date to be decided
12 Temporary                                    Date to be decided
    contraceptive spacing
    methods
13 Sensitization workshop                       Date to be decided
    to HDS members
14 Sensitization workshop                       Date to be decided
    to VHSC members

EXPECTED OUTPUTS
(i)   Improved delivery of essential and emergency neonatal care services to the
      infants brought to that hospital
(ii)  Better patient outcomes at that hospital
(iii) Improved delivery of essential and emergency neonatal care services to the
      infants in the rural areas of the state
(iv)  Reducing of Infant and neonatal mortality in the rural areas of the state
(v)   Improved acceptance of the small family norm by the rural poor families




                                                                                  49
        11. BEHAVIOUR CHANGE COMMUNICATION (BCC)

1.    Concept

       Behaviour Change Communication (BCC) is not simply providing information
but it also provides the people the required knowledge, skills, encouragement and
support they need to practice the aquired knowledge.

        Behaviour Change Communication uses multiple channels to transmit &
reinforce messages that address well defined target audiences, gives people the
skills & tools required to prevent illnesses and creates a supportive environment that
helps people adopt and maintain good health seeking behaviours.

2.    Current Status:

        The department of Family Welfare is taking up IEC through mass media like
the radio, television, print-media; conventional media; hoardings; wall paintings & wall
posters; flute boards; etc. The field staff like the ANM and supervisors also take up
IEC through inter-personal communication during the immunization and antenatal
clinics and during the outreach sessions and field visits.

3.    Objective:

       The overall objective in behavioural change communication in Health and
Family Welfare programmes is to become knowledgeable about the services that are
available for maternal and child health including family planning activities and to
motivate the people to access the services provided under these programmes.

4.    Strategy:

      The BCC strategy would have the following stages:
      • Building awareness
      • Imparting knowledge
      • Imparting skills
      • Motivating and encouraging trial
      • Ensuring that the outcome of the trial is successful and hence the
         behaviour change sustainable.

       Under RCH-II, emphasis is given on issues relating to maternal health and
child health. In these areas action is being taken to reach the most vulnerable target
groups in the rural areas and remote & inaccessible areas. Accordingly, the strategy
for communication will be through (1) wall writings; (2) wall paintings; (3) folk art
performance; (4) village level community sensitization sessions; (5) Radio; (6) local
cable network; (7) exhibitions and essay writing / elocution competitions on
adolescent health and reproductive health and personal hygiene; and (8) film shows.




                                                                                     50
5.    Present setup:

State level: There is an IEC wing at state level in the Commissionerate of Family
Welfare under the overall supervision of Commissioner of Family Welfare with the
following officers:
       • Dy. Director (MEM)
       • Health Education officer
       • Projectionist
       • Artist
       • Supporting Staff

District Level: District IEC wing is functioning under the administrative supervision of
DM&HO with the following officers:
       • District Extension & Media Officer (1)
       • Dy. District Extension & Media Officer (2)
       • Projectionist (1)
       • Artist (1)
       • Supporting Staff

6.    Areas of focus:

      The important subject areas for BCC are:
      • Girl Child Projection and effective implementation of PNDT Act.
      • Nutrition for pre-adolescent girls and adolescent girls
      • Equal rights to girls
      • Adolescent education including personal hygiene and reproductive health
      • Age at marriage for girls
      • Antenatal care
      • Care of the pregnant women
      • Institutional delivery
      • Post natal care
      • Neonatal care
      • Care low-birth weight babies
      • Feeding practices
      • Breast feeding
      • ORT & ARI
      • Promoting small family norm through temporary & permanent methods
      • Male participation

7.    Evaluation:

       The BCC strategy will be evaluated periodically by independent agencies to
assess the impact at various stages of implementation. Depending on the feedback
received, necessary rectification measures will be adopted to improve the
programme implementation.




                                                                                     51
8.        Costing For Behavior Change Communication :

             IEC / BCC activities proposed under NRHM for the year 2007-08

                                                                                   (Rs.in lakhs)
Sl.                   Name of the Activities                   Allocation    Proposed Target for
No.                                                            of Budget           2007-08
                                                               by GOI for    Physical Financial
                                                                2007-08
I         IEC budget proposed under NRHM / RCH-II                   100.00
          PIP
II        IEC budget proposed under Govt. of India                  58.00
          Activities proposed for implementation
          during 2007-08
1         Workshops for IEC Officer for development of                              2       0.50
          IEC Material
2         Local specific BCC in Rural / Urban Areas
     a)   Wall Paintings / Wall writings (23x100xRs.500                         2300       11.50
          per painting )
     b)   Folk Programme / Dramas / Kalajathars (23 x                           2300       27.60
          100 x Rs.1200 per programme)
     c)   c) Hoardings / Boards (23x5xRs.2000 each                               115        2.30
          boards )
3         IEC / BCC outdoor publicity
     a)   Metal Boards / Flute Boards (23x2500xRs. 80)                         69000       46.00
     b)   Organization exhibition 23 districts @                                  24        2.80
          Rs.10,000/- per districts + State level
          @Rs.50,000/-
     c)   Display laminated boards in the Health                                1800        9.00
          Institutions @Rs.500/- each
4         BCC through Mass Media Channels
     a)   Production and Telecast of TV spots through                             12       35.00
          Doordarshan / Other Channels / Cable Net
          Work on NRHM & RCH-II interventions
     b)   Production of Radio jingles and broad casting                           15       35.00
          through All India Radio and other FM channels
          on NRHM/RCH-II interventions
5         World Population Day including Tableaux
     a)   World Population Day Celebrations (23                                   24        5.00
          Districts + State level)
     b)   Tableaux (15th August and 26th January) (23                             24        6.60
          Districts + State level) (State level 2.00 lakhs
          & District Rs.20,000/- per district)
6         Audio Visual Aids for Inter Personal                                    23       11.50
          Communications (IPC) and preparation of
          material (Print Media) like Pamphlets, Flip
          Books, Flip Charts, Broachers etc.., (23
          Districts) @Rs.50000/- each district
7         Press Advertisements on different NRHM /                                  5      20.00
          RCH-II interventions through News papers
                                                   Sub total                              212.80
8         IEC Equipment (Procurement of LCD                                       23       28.75
          Projectors + DVD Players and other
          accessories ) at one per district (23 Districts x
          Rs.1.25 lakh) for screening of the films /


                                                                                             52
Sl.               Name of the Activities                Allocation   Proposed Target for
No.                                                     of Budget          2007-08
                                                        by GOI for   Physical Financial
                                                         2007-08
     message / spots in the villages
9    NRHM / RCH - II Campaigns
  a) Campaign on breast feeding and ORT week                               23      11.50
     @Rs.50000/- each districts
10   Printing of NRHM / RCH-II intervention                          2 Crore       20.00
     advertisement on Lapakshi Nandi Note books
     through AP State Trading Corporation,
     Hyderabad (Rs.0.10 each x 2 crores books)
11   Other IEC activities including miscellaneous                    24 Units       2.80
     activities for maintenance of AV equipment (23
     districts @ Rs.10,000 each + state @
     Rs.50,000/-)
                                            Sub total                              63.05
     Grand total                                                                  275.85

Total budget for Behavior Change Communication for 2007-08: Rs.275.85
lakhs, however, as per the allocation, the activities will be taken up by limiting
the budget for Rs.100.00 lakhs


Expected Outputs
(i)   Increased awareness in the community for utilization of benefits on Janani
      Suraksha Yojana scheme, Free Buss Passes for pregnant women for
      improving maternal care through effective IEC activities.
(ii)  To sanitize rural population to utilize maternal health care services in that
      village for Institutional delivery service, Emergency Health Transportation
      scheme, availability of Blood Banks & Blood Storage facilities.
(iii) Create awareness in the tribal population for utilizing the services on Mobile
      Medical Units, Tribal Health Camps, Birth waiting homes, Mosquito nets.
(iv)  Increased knowledge, awareness for adolescent health through counseling
      the teachers, adolescent boys and adolescent girls.
(v)   Increased knowledge, awareness in rural population against family health
      education, importance of clean drinking water, environmental sanction,
      through the involvement of village health & sanitation committees.
(vi)  Increased knowledge, awareness in the community for organization health
      awareness campaign on ORT/ARI Neonatal care, Age at marriage.
(vii) Increase knowledge, awareness in the community for utilizing the services of
      neonatal care by providing new born care kits, routine immunization.




                                                                                     53
                12. UNTIED FUNDS AT DISTRICT LEVEL

      Untied funds of Rs.230.00 lakhs is envisaged at District level to address the
unmet need reflected in the District Health Plans.

        Funds required for the State of Andhra Pradesh :

        1.    No.of DM&HOs in the State 23
        2.    Untied funds per districts        Rs.10.00 lakhs

        3.    Total funds for the State         Rs.230.00 lakhs

      Untied funds will be used only for the common good not for individual needs,
except in the case of referral and transport in emergency situations.

Total budget for Untied Schemes at District level for 07-08: Rs.230.00 lakhs


EXPECTED OUTPUTS


(i)     Increased utilization of maternal healthcare services including Antenatal care
        services and intranatal care not only from public sector but also through
        NGOs.
(ii)    Increased institutional delivery rates among SC/ST families
(iii)   Reduced Maternal Mortality incidents in these communities since the current
        IMR and MMR in these communities is substantially higher than the rest of the
        population.




                                                                                   54
                          13. EQUITY AND GENDER

        Special attention is proposed under RCH-II project to allocate interventions in
areas that are disadvantaged and under-served. Rural and interior areas are being
specially focused upon, in respect to most of the IEC programmes and sensitization
efforts. Special project components have been proposed in the tribal and hilly areas
where people experience severe problems in accessing health services due to lack of
roads and communication facilities.
1.     High Priority and Low Priority Areas :
       Some parts of the state are relatively better developed in economic terms,
which reflects in the health and demographic indicators of these areas. Important
among these developed areas are the irrigated parts of district in coastal Andhra
Pradesh, mainly East Godavari, West Godavari, Krishna, Guntur, Prakasam, and
Khammam districts. Out of the total 314 mandals in these districts, 160 mandals
have assured irrigation facilities as a result of which the population (including
landless agricultural labourers and other service population) have a substantially
higher per capita income than the population in the rest of the state. In demographic
terms, these districts have much better or more positive indicators in respect of IMR,
MMR, Life Expectancy, etc. than the rest of the state. However, within these districts,
only those areas that have assured irrigation facilities enjoy the higher incomes and
better health indicators, and the health and demographic indicators in respect of the
other parts of these districts are similar to the other districts in the state. Accordingly,
in planning the interventions under RCH-II project, the scale and intensity of some of
the components has been kept at a considerably lower level in these areas.
2.     Pro-Poor Strategies :
        All the project interventions proposed under the RCH-II are specifically aimed
at enabling the rural poor to improve their access and utilization of reproductive and
child health services. Examples in this regard are the Rural Emergency Health
Transportation Scheme, specific program objectives to be achieved in very poor and
underserved community groups such as SC/STs, etc. Incentives payable to the
Women Health Volunteers in villages being linked to specific services rendered to, or
utilized by the SC/ST groups in the village who are invariably the poorest.
3.     Gender :
       Women need the maximum focus in the reproductive and child health
programme initiatives. Accordingly, under RCH-II in AP maximum emphasis has
been given to strengthen the information on health and health care services available
to women, through a programme for extensive sensitization workshops to be
periodically conducted in all the 67,505 habitations of the state. Further, specific
components have been proposed to address the special problems faced by women
in accessing health services, such as, providing free transportation in public buses to
pregnant women for seeking antenatal check-up services from PHC doctors,
provision for emergency health transportation scheme, focused more towards
transporting pregnant women to hospitals for delivery, Chaduvulatalli scheme, etc.
4.     Gathering Disaggregated Data :
       To ensure equity and gender sensitiveness in implementation of RCH-2, as
well as measure the achievement of objectives in this regard, the data collection on



                                                                                         55
all key indicators is being done in a disaggregated method, to monitor the receipt of
services by
       -    males & females separately; and
       -    SC / ST / BC / OC separately
5.     Addressing the Needs of the Female Health Service Providers :
      Special needs of female staff are being addressed. To assure them functional
comfort and security in discharging their functions. Proposals in this regard include:
       i.   Intervention to identify sub-centers located in tribal, hilly and interior areas
            and difficult terrains; provide the MPHA(F)’s with a special allowance to
            engage a female helper to carry the vaccine carrier.
       ii. Tribal area allowance for MPHA(F)’s is being considered by the state
            government.
             Staff will be given gender-sensitized by conducting
             - Training
             - Monitoring meetings
       iii. The primary stakeholders (community leaders, etc.) will be given gender-
            sensitization through
            - IEC sessions
            - Habitation level workshops
6.     Policy for Encouraging Staff to Work in Less-Developed Districts/Areas:
Additional Allowances :
        The state government has issued orders in 2001 granting a special rural
allowance of Rs. 1000 per month to doctors working in rural PHCs and CHCs, and
Rs. 2000 for those working in tribal areas. For the women doctors working in rural
areas the allowance is Rs. 1500 per month, and for those women doctors working in
tribal areas, the allowance is Rs. 2500 per month.
Earmarked % of Seats in PG Courses :
       Doctors working in rural areas for at least three years are eligible to be
considered for admission into the Post-Graduate medical courses under the special
in-service quota.




                                                                                         56
                 14. LOW / NO COST INTERVENTIONS

      The following low-cost / no cost interventions will be implemented in the state
as a part of the RCH-II project:

•   In the state’s doctors cadre at entry level (called Civil Assistant Surgeon), it is
    proposed to earmark a specific percentage of positions for specialists in the
    areas of obstetrics and gynecology, pediatrics, and anesthesiology. Similarly, in
    each FRU’s civil assistant surgeon level posts, it is proposed to specifically notify
    a given number of posts for the above three specialty areas, to ensure
    availability of emergency maternal and child healthcare services in the FRUs.

•   Redeployment of specialists, particularly in the areas of Gynecology and
    Obstetrics, Pediatrics, and Anesthesiology, who are working in PHCs will be
    considered to CHCs and FRUs to improve the assured availability of services in
    these centers on a 24-hour basis. The Govt. in principle to agreed for
    rationalization of specialist posts for achieving the objective of providing 24-
    hours maternal and paediatric services.

•   Training of general duty doctors (who may have only MBBS qualification, or may
    be specialists in other areas) in all FRUs in elementary aspects of neonatal and
    pediatric care, to ensure that when emergency cases in infants or children come
    to the hospitals, the doctors on duty are able to attend to them confidently and
    render possible help.

•   Redeploying the staff like Lab Technicians, X-Ray Technicians, Drivers, etc.,
    wherever they are required from places where they are presently posted without
    work, etc. will be considered.

•   Redeploying of vehicles, equipment and supplies, from places where they are
    not being used or needed, to places where they are needed, to ensure their
    timely use and benefit to the needy. This would also ensure that time-limited
    supplies such as drugs are used without wastage.

•   Under the IEC programme, a newsletter exclusively for the MPHA(F)s in the
    state on important program-priorities, guidelines, etc. is proposed. This would
    help in having a direct communication with the field workers and sending them
    information on RCH program activities, and improve their performance.

•   In urban areas, it is proposed to designate the Medical Officer of the PP Unit as
    the nodal officer responsible for the supervision and monitoring of the functioning
    of all Urban Family Welfare Centers and Urban Health Centres (UHCs) in that
    town and ensure effective and quality service delivery in these centers.




                                                                                      57
                      15. FINANCIAL MANAGEMENT

1.    Current Situation :
       Similar to all other departments of the government, in the Health and Family
Welfare department in Andhra Pradesh, all matters relating to finance and accounts
are guided by the Andhra Pradesh Treasury Code of the Finance Department. The
treasury code is a document that originated during the pre-Independence days, and
has undergone considerable changes from time to time. The treasury code is
primarily based on the premise that all financial transactions of the government
departments take place through the treasury, and under the budgetary control.
However, in the past decade, the advent of many special projects in the Health &
Family Welfare department as well as other development departments, that needed
timely flow of funds without being hampered by the constraints of the budgetary
process, saw the evolution of an alternative mechanism of funds management under
these projects. This mechanism involved keeping the funds in separate bank
accounts, exclusively for each project, to facilitate easy flow of funds and obtaining a
clear picture about the funds position under the project at any given point of time.
This method has become more and more common with all special projects taken up
with Government of India financial assistance, or under the externally financed
projects. However, one drawback in this mechanism has been that, till now there
have not been any effort to develop a code of guidelines for scientific management of
finance and accounts in projects where funds are maintained in separate bank
accounts.
2.    Progress in the Development of a Project Finance and Accounts Manual:
       To achieve systematization and develop a scientific approach to finance and
accounts management under the RCH-II project, a comprehensive manual on
finance and accounts has been developed, and train all field level officers on the
same. The manual will built upon the computer software module on ‘Finance and
Accounts Management System’ that has been developed under the “Family Health
Information System” by the Computer Maintenance Corporation of India for the
Family Welfare Department in Andhra Pradesh.
3.    Training to the Project Implementation Staff on the Finance and
      Accounts Manual :
        It is proposed that all the finance and accounts staff in the RCH-II project at
the state, district and sub-district levels will be trained in 2006-07 for implementing
the manual, all its systems and forms, and in using the same. Periodical refresher
training sessions will also be held at the state and regional levels to all the finance
and accounts staff to clarify their doubts and questions if any. The task of conducting
the initial trainings will also be entrusted to the same consultant-group that is given
the task of developing the manual.




                                                                                     58
4.     Comprehensive One-Week Financial Management training to District /
       Divisional / PHC level officers and accountants for better management of
       financial account :

       a) District level : DM&HOs, Addl.DM&HO, DIOs, Dy.DM&HO, AO, Supdts., &
          2 Accountants @ 9 x 23 = 217 nos.
       b) PHC level : MOs & Sr.Assistant @ 2 x 1490 = 2980
       c) Total : 3197 or 3200

       3200 nos. x 5 days x Rs.300 per day = Rs.48.0 lakhs lakhs per annum – for
       2007-08

       Total budget for Financial Management for 07-08: Rs.48.00 lakhs

5.     Periodical Refresher Training Programmes in Financial Management :

       Periodical Refresher Training Programmes in Financial Management are
proposed once in every alternate year to refresh all the staff engaged in finance and
accounts with better skills in financial and accounts management.The refresher
training will be held for two days a year, for all the staff involved. The activity will be
taken up in the 3rd year.

6.     Funds Management :
        Funds for the project are being received at the state level and is being
distributed to the districts according to their achievement of certain pre-established
bench marks, which will be verified through periodical inspections and evaluations. In
the present pattern, funds for different project currently are in implementation are
being disbursed to the districts on a quarterly basis. It is proposed that under RCH-II
project also disbursement of funds will be made on a quarterly basis under different
components to the districts, subject to their achieving the benchmarks. The funds
under the project will be drawn / obtained at the state headquarters level and
deposited in an exclusive bank account to be opened for the project. At the districts
also, bank accounts would be opened for the District RCH Societies, and funds
released to the districts deposited and spent through these bank accounts.
        In the matter of obtaining utilization certificates and audit reports from the
district-level officers, considerable difficulties are being faced at present. It is hoped
that the development of a comprehensive finance and accounts manual, and training
on the same would enable the district and sub-district level officers to become more
confident in finance matters, and do the required paper work in this regard in a timely
manner.
EXPECTED OUTPUTS
(i)    To develop a code of guidelines for scientific management of finance and
       accounts.
(ii)   To develop a system in such way to obtain utsalisation certificates, statement
       of expenditure and audit reports from district level and sub-district level offices
       to state level with more confident with less paper work.




                                                                                        59
              16. IMPLEMENTATION OF PC&PNDT ACT
        For effective implementation of the PC&PNDT Act in the State, the following
activities are proposed per annum.

Sl   Details of Activities                                              Budget
No                                                                      proposal
                                                                        In lakhs Rs
1    Training Programmes to the District Appropriate Authorities,                8.00
     Divisional Appropriate Authorities and supporting staff /Officers/
     Legal Experts for implementation of the act on a continues
     basis
2    Conducting workshops to the doctors, nursing home personnel                 7.00
     and public representatives towards awareness of the
     programme implementation
3    Implementation of the IEC activities and awareness campaigns                6.00
     through Radio jingles, Kala-jathas and printing of pamphalets,
     etc.
4    State Level / District Level Audit teams                                   20.00
5    State Level Meetings of State Supervisory Board, State Level                2.00
     Inspection Monitoring Committee, State Level Advisory
     Committees
6    Incentives per Women Health Volunteers, Angan Wadi Workers                  2.00
     for identification of Female Foeticide and other public
7    Incentive and administrative cost for Decoy Customers                       1.00
     Incentive
8    State Level Administrative Cost                                             1.00
9    TA/DA claims for State Supervisory Board, State Inspection                  2.00
     monitoring Committee, State Advisory Committee, State PNDT
     Cell Members for continuous monitoring and inspection
10   Preparation of ID Cards for State Supervisory Board, State and              1.00
     District Level Appropriate Authorities and Staff, State Level
     Inspection & Monitoring Committee, State Level Advisory
     Committees Members
     Total (Excluding Ngo Net Work)                                             50.00

      Total budget for Implementation of the PC&PNDT act for 2007-08:
      Rs.50.00 lakhs




                                                                                   60
                    17. MONITORING & EVALUATION
1.    Evaluation of the Programmes by Independent Agencies :

       District level service coverage level for various service indicators is not
available in the NFHS. NFHS is giving only the state level service indicators status.
Hence it is planned to have the Baseline, Mid-line & End-line surveys under RCH-II to
have district level status of various service indicators. Already the Baseline Survey
was conducted under RCH-II by involving 11 Research & Study Organization and got
the district wise coverage level for various Service Indicators. It is proposed to have
midline survey with same methodology and sample size of baseline survey for the
interventions that are already functioning / in practice.

      1.   Maternal Care Performance Indicators
      2.   Child Care Performance Indicators
      3.   Family Welfare Performance Indicators
      4.   Schemes Performance Indicators

      It is proposed to have only baseline survey for the newly started interventions
under RCH-II as shown below:

      1. No.of AN cases paid transport subsidy
      2. No.of pregnant women used the birth waiting homes
      3. No.of pregnant women and infants provided with emergency health
         transport
      4. No.of women health volunteers trained, positioned & incentives paid
      5. No.of sensitization workshops conducted
      6. No.of adolescent boys health campaigns conducted
      7. Functioning of FRU CEMONC services
      8. Functioning of IPHS hospitals
      9. Functioning of Blood Banks and Blood storage facilities in FRU CEMONC
         services

a)    Management Information System

      The Monthly Return under National Rural Health Mission, the Quarterly Return
under National Rural Health Mission and the Annual Return under National Rural
Health Mission communicated by the MoHFW, G.O.I are being implemented from
Sub Centres level onwards.

      Software is also being developed for the Monthly Return under National Rural
Health Mission through C.M.C Ltd., Hyderabad to generate the reports from the
name based service data available at the PHCs level.

b)    Evaluation Surveys & Studies

      RCH-II Baseline Survey was conducted by involving 11 Research & Study
Organizations. IIH&FW, Hyderabad worked as Nodal Agency for the Survey.

      Maternal care, Child care & F.W service indicators and IMR at the District level
are covered in the survey. Community wise, Rural / Urban wise and Economic status


                                                                                    61
wise service coverage levels for important service para meters were covered in the
survey.

c)    Plan of Action for Monitoring & Evaluation

     i) House Hold Surveys: House hold Surveys is being conducted every year at
         village level by the field staff covering House to House and recording
         changes in the population composition & update the Eligible Couple
         registers.

     ii) Service Registers: The MPHA(F) field Service Registers contains the
         following parts
         • Antenatal cases Register
         • High risk ANC Register
         • Births & PNCs Register & Record of Maternal Deaths
         • Child Immunization Register & Record of Infant Deaths
         • Child Immunization Register (DT-5Yrs & TT-10Yrs & 16Yrs)
         • E.C Register
         • FWP – Sterilization Register
         • FWP – IUD Acceptors Register
         • FWP – OP Users Register
         • FWP – Nirodh (condom) users Register
         • Communicable Diseases Register
         • Deaths Recording Register.

       80,000 Service Registers are printed and distributed to the Field Staff @ 1
Service Register per 1000 population during 2006-07 which will be sufficient for the
next 3 years for recording the services given to the beneficiaries. Services given to
the beneficiaries are being recorded community wise to know the community wise
service coverage levels.

d)     Regular Reporting: Monthly performance reports are being collected at all
levels and the performance is being reviewed at all levels.

e)     District Level Data: The District Level Data on important service indicators
under Child care, Maternal Care, Family Welfare Services and selected vital events is
available.

f)      Use of Information Technology: PHC Computerization Project is taken up
during 2002-03. 1387 PHCs are provided with computers. Each DM&HO office is
provided with 5 computers. Basic Computer awareness training was conducted to all
the field staff and Medical Officers. Family Welfare and Health information
Management Systems (FHIMS) Application Software Training was given to 2
identified persons in each PHC who are being called as System Administers at PHCs
level.

g)     Annual Maintenance Contract for Hardware & Software: Annual
Maintenance Contract was given to CMC Ltd., for maintaining of the Software at
State, District & PHC levels. Hardware maintenance was also given to CMC Ltd.,
Hyderabad after expiry of the warranty period for the Hardware.



                                                                                  62
h)     Details of PHC Computerisation: 1387 PHCs are supplied with Computers,
Printers, UPS and maintenance budget for consumables. 22 DM&HO offices are
provided with 5 computers each under PHC Computerization project.

        •   Hardware Supply & Maintenance: Annual Maintenance Contract is given to
            CMC Ltd., Hyderabad for maintenance of Hardware & Software.

Description: At PHC level the field staff enter their service data weekly ones. The
field staff gets monthly schedules on every 1st for delivery of services to the pregnant
women and infants. The monthly schedule contains the names of the Pregnant
Women & Infants who are due for services during the particular month. Different
types of service reports are being generated from the service data at the PHC level.

i)     Budget of Rs.1.00 crore for Monitoring & Evaluation Activity: District level
service coverage level for various service indicators are not available in the NFHS.
NFHS is giving only the state level service indicators status. Hence it is planned to
have the Baseline, Mid-line & End-line surveys under RCH-II to have district level
status of various service indicators. Already the Baseline Survey was conducted
under RCH-II by involving 11 Research & Study Organization and got the district wise
coverage level for various Service Indicators. It is planed to have mid-line survey
during 2007-08 and the budget of Rs.1.00 crore is needed for the Mid-line survey.

Research activities: It is proposed to have research activities particularly on
Maternal & Child Health and the modality for research work is under process in
collaboration with Indian Institute of Health & Family Welfare, Hyderabad.

Details of budget requirement

•       Cost of survey and research activities particularly on Maternal & Child Health in
        23 districts @ Rs.4 lakhs per district: 23 x 4 lakhs         = Rs.92.00 lakhs
•       Service charge for the Nodal agency for coordination
        of Research and study organizations, conduct the
        investigation, trainings, supervision of surveys in the      = Rs.5.00 lakhs
        field, analysis of the data, preparation of findings etc..
•       Cost of printing of schedules for the survey                 = Rs.1.00 lakh
•       Miscellaneous (contingency)                                  = Rs.2.00 lakhs
                           Total                                     = Rs.100.00 lakhs
Total budget for Evaluation & Monitoring for 07-08: Rs.100.00 lakhs
EXPECTED OUTPUTS
(i)         Effective monitoring of all interventions for providing quality services in
            maternal care, child care
(ii)        Identify the problem areas in implementation and take corrective action
(iii)       Identify areas (districts or parts of districts) in the state where the program
            implementation has not been upto the expected level, and intensify the
            programs in those districts, etc.




                                                                                        63
                      18. MOTHER N.G.O. SCHEME
      Mother NGO scheme in Andhra Pradesh has currently taken on board 6
MNGOs for 11 districts. The RRC (HLFPPT) has completed trainings to the MNGOs
and the proposals have been submitted to the state. The following activites would be
taken up by the state during the year 2007-08.

   1. Recruitment of a State NGO Coordinator for the MNGOs scheme
   2. Review and approvals of the proposals and plans submitted by the MNGOs
      and release of grants for undertaking the activities.
   3. Identification and recruitment of MNGOs in the remaining 12 districts.
   4. Identification and recruitment of Service NGOs in the un-served and under-
      served areas of the state
   5. Capacity Building of the MNGOs, FNGOs and SNGOs by RRC.

      The MNGOs and FNGOs would provide RCH services in the un-served and
under-served areas of the state. The key service delivery areas would be maternal
and child health, family planning, adolescent reproductive health, prevention and
management of RTI.

       The state will coordinate with RRC for technical support for NGO capacity
enhancement, documentation of best practices, induction and in-service training and
other technical requirements.

      The Service NGOs would provide a range of clinical services directly to the
community like safe deliveries, neo- natal care, treatment of diarrhea, abortion and
IUD services.

Budget

Sl.   Particulars                                                Amount (Rs.)
No.
1     MNGO and FNGO Budget in 23 districts                           3,45,00,000
2     SNGOs Budget in 10 districts                                   1,50,00,000
      TOTAL                                                          4,95,00,000




                                                                                   64
                  18. PUBLIC-PRIVATE PARTNERSHIP
        Participation of private sector has been recognized as having a critical role in
ensuring that health services, particularly, maternal and child health services reach
the underserved and needy population in rural and difficult-to-reach areas. The
strategy of public-private partnership is under implementation in the state, in the
areas of obtaining the services of specialist doctors for the Round-the-Clock Mother
and Child Health Centers, and in the operationalization of the Urban Health Centers
under the AP Urban Slum Healthcare Project (IPP-VIII). Under the ‘Sukheebhava’
scheme, in cases of institutional deliveries occurring in private hospitals, incentive
payment is being made to the pregnant women who undergo such deliveries. Under
the ‘Aarogya Raksha’ scheme, limited hospitalization health insurance coverage is
being provided to the below-poverty-line couples who undergo permanent methods
of sterilization with two or less living children. The insurance coverage is being
provided for a period of five years (so as to take care of the childhood illnesses in the
children), for the children and the partner who undergoes the sterilization surgery.
The in-patient hospitalization services under this scheme are being provided in more
than 420 reputed private hospitals (that have enrolled themselves under the scheme)
to give more confidence to the beneficiary about the quality of care of the services.
Family Planning (temporary and spacing methods, as well as sterilization method)
services are also being provided in private hospitals as per the preference of the
clients, and the compensation is being paid to the acceptors. In case of temporary
methods and sterilization and immunization services, the IUD and vaccine supplies
are being given by the department, and services provided by the private sector.

       Under the RCH-II, in addition to continuing the above public-private
partnership initiatives, it is proposed to utilize the facilities and services of private
maternal and child healthcare service providers in such rural and difficult areas where
no Government healthcare facility is available nearby, to obtain emergency referral
services. It is also proposed to train all the private allopathic medical practitioners
who are not specialists, in managing complicated delivery cases, rendering
emergency and essential neonatal care, so that they are able to render better quality
services to the public who access them.

The following are the PPP interventions proposed under RCH-II.

   s
UHC' under Urban Health Strategy (through NGOs)

•   Operationalization of rural Ambulances under Emergency Health Transportation
    Scheme
•   Delivery care for SC/ST pregnant (through NGOs) women in selected backward
    districts through private hospitals.
•   Young Infant Health Assurance Scheme through private hospitals, pediatricians,
    general practitioners.
•   FP sterilization services through private hospitals. Details are in respective
    sections.
Total budget for Public Private Partnership for 06-07: Rs.10.00 lakhs




                                                                                      65
                          19. QUALITY ASSURANCE

       Special initiatives are being proposed under RCH-II project to ensure that the
services delivered under various components of the project are of the highest
standards and quality. Extensive training programmes for the staff, close and
periodical monitoring of the programme implementation at various stages, together
with process evaluation to be conducted by external agencies for some of the
important components are expected to ensure the quality of services rendered under
the project.
       Providing quality services is considered to be most important.                 The
Government is taking all steps for improving the quality services at all the institutions
and by the field level staff. To improve the quality of services at the field level by the
ANMs, additional drug kits called Kit-C & Kit-D (only in A.P) are provided by the State
Government from the state budget. Similarly, for improving the services at the PHCs
for the reproductive age groups, RTI / STI drug kits are supplied to all the PHCs from
the EC funds. The supply of these kits will be continued in RCH-II also.
1.     Developing an Accreditation System for Health Care Institutions in the
       Public and Private Sectors :
       It is proposed to carefully and comprehensively study the issue of developing
an accreditation system for healthcare institutions both in the public and private
sector in the state. An enactment has already been passed by the state legislature to
provide for compulsory registration of all private healthcare establishments. The rules
to bring the enactment into force are under formulation at the government level.
        It is also proposed to bring in a uniform accreditation system for healthcare
institutions both in the public and private sectors in the state. At present, the state
government is very actively considering the introduction of a Health Insurance
Scheme to assist the poor in rural and urban areas to meet catastrophic healthcare
expenditures, since such expenditures have been identified as the second most
important reason for the phenomenon of farmers in the rural areas committing
suicides. As a part of the preparatory steps for implementing the proposed health
insurance scheme for the poor, it is felt that development of a “Accreditation
System for Healthcare Institutions” in the state (both Government and Private
hospitals) will be very useful in identifying and networking quality healthcare
institutions for provision of services to the people enrolled under the health insurance
scheme.
       State and District level committee of specialists will been constituted and the
committee will be responsible for accreditation of the hospitals. The rules and
regulations of the accreditation are also been workedout.
       Further, it is also proposed to utilize the proposed “Accreditation System for
Healthcare Institutions in the State” to streamline the existing system of
reimbursement of healthcare expenditure for employees in the government sector in
the state. Currently, private hospitals are recognized for being eligible as healthcare
service-rendering institutions for government employees in the state, in an adhoc
manner. Introduction of the “Accreditation System for Healthcare Institutions” will also
help in the process of enrolling private hospitals for providing healthcare services to
government employees on a reimbursement basis.




                                                                                       66
2.   Focus on Assuring Quality of Care in Services in the Training Programs :
     i) Preparation of Modules :
     It is proposed to give an overarching importance to improving quality of care
     aspects in the training programs for all levels of medical and paramedical
     personnel in the state under maternal health, child health, neonatal care,
     family welfare services, immunization, Information Education and
     Communication activities, and other areas of services. Special training
     modules for training in all these areas are being prepared under other projects.
     These modules will be widely disseminated and efforts made to improve the
     quality of service delivery to the public.
     ii) Forming Quality Circles :
     It is proposed to form quality circles in all the PHCs in the state in the area of
     rendering of maternal and child health, and family welfare services. Quality
     circles will also be formed in the urban slum health care projects that are being
     implemented through the NGOs, and in the Rural Ambulance Scheme, also
     being implemented through the NGOs. For formation and popularizing the
     quality circles, special IEC, and preparation of literature will be taken up, and
     motivation meetings held, the budget for which will be met under the IEC of
     respective interventions or balances of Flexible pool amount.
     iii) Time Frame for Efforts for Quality Improvement:
     It is proposed to take up quality of care improvement programs in the initial
     stages of the implementation of the RCH-II project, so that the benefits of such
     quality of care improvement will be available across the sector and help
     delivery of better services to the people both in the private and public sector
     healthcare institutions.




                                                                                    67
              20. CONVERGENCE AND COORDINATION

1.    State and District Level Convergence Workshops :
        A State level workshop was conducted for effective coordination and
convergence in program designing and implementation in programs aimed at
improving the health and quality of life of women and children, with the related
department like the Women Development and Child Welfare, Rural Development
(Velugu) and NGOs like CARE. The Secretaries of these departments and the heads
of the departments have attended the workshop. All the District officers of these
departments have participated in the workshop and have been requested to develop
a plan for effective coordination between the departments and convergence of
services for women, pregnant women, and children at the district level. The District
Collectors have been requested to conduct similar convergence workshops at the
district level also with all the social sector departments, particularly the Women
Development and Child Welfare, the AP Elimination of Rural Poverty Project
(Velugu), Rural Development department, etc.
2.    Convergence Efforts under RCH-II :
        Many of the RCH-II project components have been designed with the clear
understanding that they will be implemented in close convergence and coordination
with other departments and agencies within the State Government and outside that
are working in the same area. Important examples of such components include: (i)
identification, training, setting up, and monitoring of performance of Women Health
Volunteers in the 67,505 habitations of the state with the support and participation of
the ICDS project and the AP Eradication of Rural Poverty project (APERP), i.e.
Velugu Project; (ii) implementation of the supplemental nutrition component through
the Women Development and Child Welfare department; (iii) Behavioural Change
Communication programmes in coordination with the other major wings of the health
department under the State Government and the AP Eradication of Rural Poverty
project, etc..
3.    Convergence with Other Externally Funded Projects in the State :
        Under the Andhra Pradesh Eradication of Rural Poverty Project, (Velugu
project) a separate health component intervention is being implemented in the
program districts in close convergence with the Health and Family Welfare
department and the Women Development and Child Welfare departments. In the
ICDS projects, nutrition for pregnant and lactating women and children is being
provided, besides addressing the health needs of the adolescent girls. Adolescent
girls are being sensitized and health awareness created on family health issues, age
at marriage, nutrition, prevention of anemia, etc., through attachment to the
Anganwadi workers in the villages.
       Under the RCH-II, all these departments are involved in developing District
Action Plan and their implementation.




                                                                                    68
4.    Convergence with National and International NGOs working in the State
      in Health Area :
       Active convergence is being achieved with the international NGO CARE India,
which is providing support for improving the nutrition of pregnant women and children
in nine districts of the state. Similarly, another NGO ‘Naandi’, working with the
support of Non-Resident Indians settled in the USA, is implementing an intervention
for reduction of Neo-natal Mortality in the backward district of Mahabubnagar in the
state, under the European Commission Sector Investment Project of the Family
Welfare department.
5.    Convergence & Staff, Activities, and Budget of Externally Funded
      Projects :
        It is not proposed to merge the activities, staff and budget of other externally
funded projects with the RCH-II, since under those projects, specific MOUs have
been entered into with the project sanctioning and monitoring teams for achievement
of specific outcomes/benchmarks, etc. Further, release of funds under these projects
is closely linked to achievement of such benchmarks. However, it is proposed to take
into account the relevant program components under these projects in designing and
finalizing the RCH-II project.
       Further, close convergence with other externally funded projects with in the
Family Welfare department, such as the APERP Health Component will be easily
achieved through the Commissioner of Family Welfare being the Project Director for
both the APERP Health Component and the RCH-II Project. As described earlier,
convergence with other projects that are located in other departments of the
government, such as the APERP (Velugu Project) which is under the Rural
Development department, ICDS Project which is under the Women Development and
Child Welfare department, will be achieved through sharing of project proposals at
the design stage among these departments, having frequent meetings between the
state level to the field level functionaries, etc. on all common program areas and
interventions.
6.    Institutional Arrangements for Convergence at the District Level :
       Convergence in program implementation at the district level has by and large
been already achieved in Andhra Pradesh. The District Collector is the chairperson of
the district level committees that are entrusted with the project implementation,
monitoring and review, for projects implemented by most social and developmental
departments at the district level. Further, in these committees, officers of other
related departments are most often co-opted as members as per the existing
instructions of the government. This helps in achieving the required convergence in
program implementation at the district level.
7.    Convergence in Program Designing and Implementation between
      Different Wings of the Health Department :
       In the Health department in Andhra Pradesh, the following are the main wings
that render services to the public: (i) Director of Health, who coordinates the
functioning of all PHCs, and some FRUs in the state, besides being the cadre
controlling authority for all the medical and paramedical personnel in the state; (ii)
Commissioner of Family Welfare, who coordinates the functioning of all Rural and
Urban Health Sub-Centers in the state, supervises the implementation of all the
centrally sponsored schemes under the family welfare program and the RCH project,
besides other externally funded projects in these areas; (iii) Commissioner of APVVP,


                                                                                     69
which is a semi-autonomous agency that coordinates the functioning of most of the
First Referral Unit Hospitals in the state (with more than 230 FRUs under its
management); (iv) Director of Medical Education, who coordinates the functioning of
medical colleges and teaching hospitals in the state; and (v) Commissioner, AYUSH
(Ayurveda, Unani, Siddha, and Homeopathy) who coordinates the functioning of the
hospitals under Alternative Indian systems of medicine.
       Convergence between these wings in program implementation is currently
being achieved through frequent meetings and interaction depending upon the
program needs. Under the RCH-II, since there is overwhelming focus on improving
emergency obstetric service delivery to pregnant women through institutional
deliveries, as well as neonatal care and infant/child emergency health care, it is
considered very necessary to have more formal coordination arrangements in place,
particularly between the wings that control the functioning of the FRUs in the districts,
and the Family Welfare department. At present, there is a state level FRU committee
with representation from concerned heads of wings of the health department.
However, this committee generally addresses the issues relating to the referral cases
in the FRUs. In order to achieve better coordination with all wings in the health
department on the RCH issues, it is proposed to request the Government to
constitute a ‘State Level Coordination Committee for Strengthening of RCH Services
and their Improved Accessing and Utilization by the Urban and Rural Poor’, with the
Project Director RCH as the convener, and heads of other important wings in the
health department as members. Multi-wing issues that have an impact on RCH
services will be taken up in this committee.




                                                                                      70
                         21. RCH FLEXIBLE POOL QUARTER-WISE – WORK PLAN FOR THE YEAR 2007-08

       The following is the Quarter-wise work-plan for the year 2007-08 under the RCH-II Project for Andhra Pradesh. This takes
into account the various interventions which have been commenced and need to be continued, interventions that are partly
commenced, and lastly those that need to be initialized during the year 2007-08.
                                                                                                                 (Rs. in lakhs)
   Sl.                                 Intervention                                 1st        2nd        3rd        4th       Total
  No.                                                                              Quarter    Quarter    Quarter    Quarter
I.       Maternal Health
1        Women Health Volunteers
a)       Total Training cost for Village level WHVs                                  295.70     295.70                           591.40
b)       Total budget for supply of First Aid Kits to WHVs                            92.40      92.40                           184.80
c)       Total budget for Refresher training for WHVs                                323.10     323.10     323.10     323.10    1292.40
d)       Total Budget for WHVs performance-based Incentives                          614.50     614.50     614.50     614.50    2458.00
         Sub-total                                                                  1325.70    1325.70     937.60     937.60    4526.60
1        Rural Emergency Health Transport Scheme
a)       REHTS operational subsidy                                                   143.64     143.64     143.64     143.64     574.56
b)       Fuel Subsidy for transporting pregnant women to hospitals for delivery       66.00      66.00      66.00      66.00     264.00
c)       Subsidy for transporting infants and children in acute health condition      33.00      33.00      33.00      33.00     132.00
         from rural areas to hospitals
d)       Comprehensive Insurnance to newly procured vehicles                           5.00       5.00       5.00       5.00      20.00
         Sub-total                                                                   247.64     247.64     247.64     247.64     990.56
3        Continuation of FRUs strengthened as CEMONC Services                        373.25     373.25     373.25     373.23    1492.98
4        24-hours MCH centre PHCs:                                                   289.08     289.08     289.08     289.08    1156.32
5        Blood Bank & Blood Storage Centres                                          263.18     263.18     263.18     263.18    1052.72
6        Free Bus Passes                                                             150.00                                      150.00
7        Janani Suraksha Yojana - (Rural + Urban)                                    900.00     900.00     900.00     900.00    3600.00
8        RCH Health Melas: MP Constituency-wise                                       84.00      84.00      84.00      84.00     336.00
9        RCH Health Melas: MLA Constituency wise                                      57.33      57.33      57.33      57.33     229.32
10       Notification and Social Audit of Maternal Deaths                              5.42       5.41       5.41       5.41      21.65
         Total budget for Maternal Heatlh                                           3695.60    3545.59    3157.49    3157.47   13556.15
II.      Child Health
1        Neonatal Intensive Care Units                                                94.62      94.62      94.62      94.62     378.48
2        Newborn Care Kits                                                                      138.57     138.57                277.14
         Total budget for Child Health                                                94.62     233.19     233.19      94.62     655.62
III.     Family Welfare Strategy

                                                                                                                                       71
  Sl.                               Intervention                                1st        2nd        3rd        4th       Total
 No.                                                                           Quarter    Quarter    Quarter    Quarter
1       Wage compensation for Family Planning (Sterilization) acceptors          800.00     800.00     800.00     800.00   3200.00
2       Family Planning Trainings                                                 15.00      15.00      15.00      15.00     60.00
3       Implementation of Camp-Approach for "No-Scalpel Vasectomy" Method         15.00      15.00      15.00      15.00     60.00
4       State / District Quality Assurance Workshops; Inspection; Biomedical       6.25       6.25       6.25       6.25     25.00
        Waste management training for all staff
5       Family Planning and Contraceptive spacing methods Usage in AP             37.50      37.50      37.50      37.50    150.00
        Total budget for Family Welfare                                          873.75     873.75     873.75     873.75   3495.00
IV.     Adolescent Health Strategy                                                21.82      21.82      21.82      21.82     87.28
V.      Urban Health Strategy                                                    219.06     219.05     219.05     219.05    876.21
VI.     Tribal Health Strategy
1       Tribal Shandy-level Weekly RCH Health Camps                               33.88      33.89      33.89      33.89    135.55
2       Better-quality Iron Tablets for Tribal pregnant Women                     12.50      12.50      12.50      12.50     50.00
3       Special monthly OBG/Gyn. & Child Health Camps at selected places in       15.00      15.00      15.00      15.00     60.00
        the tribal areas
4       Construction of Birth Waiting Rooms                                       20.00      20.00      20.00      20.00     80.00
        Total budget for Tribal Health                                            81.39      81.39      81.39      81.38    325.55
VII.    Procurement
1       Procurement of different types of Drug Kits                              439.50     439.50     439.50     439.50   1758.00
2       Disposable Delivery kits                                                  38.00      38.00      38.00      38.00    152.00
3       Neonatal Intensive Care Units - Procurement of Drugs & Consumables        18.59      18.59      18.59      18.57     74.34
4       Better quality Iron Tablets for Tribal Women                              10.00      10.00      10.00      10.00     40.00
5       Strengthening MIS wing at PHC & District levels                           25.00      25.00      25.00      25.00    100.00
        Total budget for Procurement                                             531.09     531.09     531.09     531.07   2124.34
VIII.   Institutional Strengthening
        Project Management Units at State & District levels                      131.66     131.66     131.66     131.66    526.64
IX.     Training Strategy
1       Strengthen the training centres at District and Regional level with       25.00      25.00      25.00      25.00    100.00
        infrastructure support
2       Training of Medical Officers in Emergency Obstetric Care Services         11.58      11.58      11.58      11.56     46.30
3       Training in Essential and Emergency Neonatal Care to PHC MO                9.30       9.29       9.29       9.29     37.17
4       Anesthesiology Training to MBBS Doctors                                    8.85       8.85       8.85       8.85     35.40
5       Integrated Management of Neonatal & Childhood Illnesses (IMNCI)           17.02      17.02      17.02      17.01     68.07
        Training for Doctors & Staff Nurses
        Total budget for Trining Strategy                                         71.75      71.74      71.74      71.71    286.94
X.      Behavior Change Communication Strategy                                    25.00      25.00      25.00      25.00    100.00
XI.     Untied Funds at District Level                                            57.50      57.50      57.50      57.50    230.00

                                                                                                                                   72
 Sl.                                Intervention    1st        2nd        3rd        4th       Total
 No.                                               Quarter    Quarter    Quarter    Quarter
XII.     Equity & Gender
XIII.    Low / No Cost Interventions
XIV.     Financial Management                         12.00      12.00      12.00      12.00      48.00
XV.      Implementation of PC & PNDT Act              12.50      12.50      12.50      12.50      50.00
XVI.     Monitoring & Evaluation                                 33.34      33.33      33.33     100.00
XVII.    Mother NGO scheme                           123.75     123.75     123.75     123.75     495.00
XVIII.   Public-Private Partnership                    2.50       2.50       2.50       2.50      10.00
         GRAND TOTAL                                5953.98    5975.87    5587.76    5449.12   22966.73




                                                                                                       73
1.     Preparation of District Plans :

Preparation of District plans will also be completed in a systematic manner by
31.5.2007. Detailed guidelines for preparing the district plans have already been issued
to the District Medical and Health Officers. Regional workshops have been organized
with the DMHOs and instructions have been given to draft the District PIPs and finalize
them according to the overall structure indicated by the Government of India.

2.     Entering into MOUs with the Districts :

       After the District Plans are prepared and approved by the Government of India,
the Health Department at the state level will enter into MOUs with the Districts to
provide for implementation of the RCH-II PIP and achieve the objectives under the PIP
at the district level. This will be completed by 30.4.2007.

3.     Specialized Management Training :

        Individual officers and staff involved in the respective functional areas will be
made part of periodical capacity-building training programs which will be specially
organized under the project. These capacity-building training programs will be
organized through reputed national level training and research organizations such as
the Indian Institutes of Management, National Institute for Health and Family Welfare,
Indian Institute of Health and Family Welfare, Administrative Staff College of India,
International Institute of Population Sciences, etc. Some of the state and district level
officers who undergo these trainings and show a suitable aptitude will be identified as
‘Trainers’, and will be associated with trainings conducted at the district level for the field
functionaries.

4.     Time Frame :

        All the objectives set under the RCH-II project at the state level, and for individual
districts under the district plans will be will be achieved according to the year-wise goals
set under individual health indicators such as Infant Mortality Rate, Maternal Mortality
Ratio, Neo-Natal Mortality Rate, Institutional Delivery Rate, and all these four measures
in the underserved SC/ST Population, compared to the general population.




                                                                                            74

				
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