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District Monitoring Programme. Presentation on NRHM, Assam. Dated 20 th November, 2012. National Rural Health Mission, Assam Department of Health & Family Welfare Govt. of Assam. NRHM, A paradigm shift Promoting equity and excellence for ‘ Health for All’. The Mission: - PowerPoint PPT Presentation
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Presentation on NRHM, Assam
National Rural Health Mission, AssamDepartment of Health & Family Welfare
Govt. of Assam
Dated 20th November, 2012
District Monitoring Programme
NRHM, A paradigm shift Promoting equity and excellence for ‘ Health for All’
The Mission:
Providing affordable, accessible, equitable quality healthcare especially for those residing in rural areas, the poor, women and children
Focus Areas and priorities:
1. Improving the health status of pregnant women and children especially in rural areas
2. Stabilizing population by promoting family planning
3. Restructuring public health governance through community and PRI involvement, addressing resource shortages in terms of providing additional required manpower and increase public spending in healthcare
NRHM, A paradigm shift Promoting equity and excellence for ‘ Health for All’; cont.
Objective of the Mission: Reduction in Infant Mortality Rate (IMR) and Maternal
Mortality Ratio (MMR)
Universal access to public health services.
Prevention and control of communicable and non-communicable diseases, including locally endemic diseases
Access to integrated comprehensive primary healthcare
Population stabilization, gender and demographic balance.
Revitalize local health traditions and mainstream AYUSH
Promotion of healthy life styles
2001-03 2004-06 2007-08 2007-09(AHS 2010-11)
0
100
200
300
400
500
600
490 480
390 381
Trend of MMR in Assam
Year
MM
R pe
r 1,0
0,00
0 Li
ve B
irth
Trend of Maternal Mortality Ratio (MMR) in AssamTotal 99 point drop of MMR
during NRHM period which is the highest drop in the country
during NRHM period
1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 20110
10
20
30
40
50
60
70
80 76 76 76 75 7470
67 66 68 67 66 6461
5855
71 72 70 68 66
60 58 58 57 55 5350
4744
TREND OF INFANT MORTALITY RATE (IMR)
AssamIndia
Year
IMR
per 1
,000
Liv
e Bi
rth
Total 2 point drop 1997 to
2001 Total 7 point drop 2001 to 2006 Total 12 point
drop 2006 to 2011
Monitoring Checklist
Improve coverage, accessibility and quality of antenatal care (ANC)
Monitoring Required Monitor able Indicators Level of Monitoring Expected Level of
Achievement
Coverage of ANC Registration
% of ANC Registration against Expected number of pregnant women for the year 2012-13
District100% of expected pregnant women during the period
All Health Block100% of expected pregnant women during the period
Early Registration of pregnancy
% Pregnant Women Registered for ANC within 1st Trimester against Total ANC Registration in 2012-13
District100% of total pregnant women registered for ANC during 2012-13
All Health Block100% of total pregnant women registered for ANC during 2012-13
Improve coverage, accessibility and quality of antenatal care (ANC)
Monitoring Required Monitor able Indicators Level of
Monitoring Expected Level of Achievement
Coverage of 3 or more ANC
% of 3 ANC against Total ANC Registration
District100% of total pregnant women registered for ANC during 2012-13
All Health Block100% of total pregnant women registered for ANC during 2012-13
Coverage of TT% of pregnant women received TT2 or Booster against Total ANC Registration
District100% of total pregnant women registered for ANC during 2012-13
All Health Block100% of total pregnant women registered for ANC during 2012-13
Updation of MCP Card, MCH Register during service delivery
During visit of Health Facility
All Registers and MCP card to be updated at the time of Service Delivery
Mamoni – Cash assistance to pregnant women @Rs 1000/- in two installments during 2nd and 3rd ANC. To provide nutritional support
to pregnant women (under Assam Bikash Yojana)
Monitoring Required
Monitor able Indicators Level of Monitoring Expected Level of
Achievement
Spot payment at Sub Centre during 2nd & 3rd ANC
% of Pregnant Women received “Mamoni” cheque on Spot during 2nd & 3rd ANC during 2012-13
District100% of total pregnant women registered for ANC during 2012-13
All Health Block100% of total pregnant women registered for ANC during 2012-13
During visit of Health Facility
100% of total pregnant women registered for ANC during 2012-13
Record Maintenance
Whether Records of beneficiaries are maintained properly or not
During visit of Health Facility
Beneficiary payment records to be maintained properly
Village Health & Nutrition Day (VHND). One VHND organized in each village every month. To
provide Antenatal care, post natal care, routine immunization and counseling services to pregnant women,
infant, children and adolescentMonitoring Required Monitor able Indicators Level of Monitoring Expected Level of
Achievement
Status of VHND organized
% of VHND organized against Target
District100% of VHND targeted during 2012-13
All Health Block100% of VHND targeted during 2012-13
Involvement of ASHA, AWW, PRI members in VHND
During visit of Health Facility
ASHA, AWW & ANM should present in VHND, presence of PRI member is desirable
Operationalization of 24X7 PHC with New Born Care Corner (NBCC). To conduct round the clock normal delivery
Monitoring Required Monitor able Indicators Level of
MonitoringExpected Level of
Achievement
Functional status of Labour Room and Newborn Care Corner (NBCC)
Delivery trend compared to last year
District 1.1 X last years figure for same period
Health facility 1.1 X last years figure for same period
Whether Doctor and GNM stay at the Hospital Campus
% of Docotor & Nurses stay in the Hospital Campus
During visit of Health Facility
100% of all Doctors & Nurses in position
Whether Night Delivery conducted or not
No of Night Delivery conducted
During visit of Health Facility More than 0
functional Status of NBCC
No of Newborn treated in NBCC
During visit of Health Facility More than 0
Operationalization of FRU (First Referral Unit) - To facilitate round the clock C-section, assisted and normal delivery
with Blood Storage/ Blood Bank facility
Monitoring Required Monitor able Indicators
Level of Monitoring
Expected Level of Achievement
Facility to conduct Round the clock C-section delivery
C-Section delivery trend compared to last year
District 1.1 X last years figure for same period
During visit of Health Facility
1.1 X last years figure for same period
Whether both Gynecologist & Anesthetist in position
During visit of Health Facility
At least one Gynecologist and one Anesthetist should be in position
Functional Status of OT and Blood Storage/ Blood Bank
Functional Status of OT and Blood Storage/ Blood Bank
During visit of Health Facility
At least one Surgery per week
Average No of Blood transfusion done per month
During visit of Health Facility
Functional Blood Bank/ Blood Storage Unit - Availability of Blood Unit & transaction
Delivery at Sub Centre by Rural Health Practitioner (RHP). To facilitate normal delivery in the village level (Sub Centre)
Monitoring Required Monitor able Indicators Level of
MonitoringExpected Level of
Achievement
Functional status of the Sub Centre
Average No of Delivery conducted per month by the RHP at the Sub Centre
During visit of Health Facility
On an average Minimum 3 Delivery per month
Whether RHP resided in the Sub Centre village
Whether RHP resided in the Sub Centre village
During visit of Health Facility
To reside in the Sub Centre village
Janani Surkasha Yojana (JSY). Cash assistance to Mother (@Rs 1,400/- for women from Rural area and Rs. 1,000/- from
Urban area) & ASHA Incentive to promote Institutional Delivery
Monitoring Required Monitor able Indicators Level of Monitoring Expected Level of
Achievement
Status of JSY payment during discharge
% of Mother received JSY payment against total Delivery (excluding paying cabin and Pvt. Hospital Delivery)
District 100% of all elegible beneficairies
Health facility 100% of all elegible beneficairies
Status of JSY Incentive paid to ASHA
% of ASHA incentive under JSY paid
District20% to 40% against total amount paid to Mother under JSY
Health facility20% to 40% against total amount paid to Mother under JSY
Mamata Kit – Baby kit provided if Mother stay for 48 hrs after delivery To ensure 48 hrs stay of Mother & baby after
delivery to ensure post natal care (PNC)
Monitoring Required Monitor able Indicators
Level of Monitoring
Expected Level of Achievement
Status of providing Mamata kit
% of Mothers stay at Hospital at least for 48hrs after delivery
District 100% of all deliveries
Health facility
100% of all deliveries
% of Mothers received “Mamata kit” against Mothers stay for 48 hrs after delivery
District 100% of all deliveries
Health facility
100% of all deliveries
Supplementary Nutrition (Mother Horlicks). To provide supplementary Nutrition to Mother after Delivery
Monitoring Required Monitor able Indicators Level of
MonitoringExpected Level of
Achievement
Status of providing Mother Horlicks
% of Mothers received “Mother Horlicks” after delivery
District 100% of all deliveries
Health facility
100% of all deliveries
Implementation of Janani and Sishu Suraksha Karyakram (JSSK).
Monitoring Required Monitor able Indicators Level of Monitoring Expected Level of Achievement
Status of Free transportation from Home to Hospital, Hospital to Hospital and Hospital to Home (Adarani)
% of Pregnant Women/ Mothers received free transportation from Home to Hospital
District100% of pregnant women reported at Hospital
During visit of Health Facility
100% of pregnant women reported at Hospital
% of Pregnant Women/ Mothers received free transportation from Hospital to Hospital
District 100% of Referred cases
During visit of Health Facility
100% of Referred cases
% of Pregnant Women/ Mothers received free transportation from Hospital to Home (Adarani)
District 100% of Hospital Deliveries
During visit of Health Facility
100% of Hospital Deliveries
Status of free treatment to Pregnant Women and Children
% of Pregnant women, Mother and Children received free treatment
District100% of pregnant womenand children reported at Hospital
During visit of Health Facility
100% of pregnant womenand children reported at Hospital
Implementation of Janani and Sishu Suraksha Karyakram (JSSK).
Monitoring Required Monitor able Indicators Level of Monitoring Expected Level of Achievement
Status of availability of Drugs & Consumable for Normal Delivery and C-Section delivery
Availability of Drugs & Consumable for Normal Delivery and C-Section delivery
DistrictList of items available in CS Kit and Delivery kit enclosed
During visit of Health Facility
List of items available in CS Kit and Delivery kit enclosed
Reimbursement claim by Hospital under JSSK
Total amount of Reimbursement made to Hospital under JSSK
DistrictTotal expenditure incurred and claimed
During visit of Health Facility
Total expenditure incurred and claimed
Status of free diagnostics facility including Laboratory test, USG, etc
% of Pregnant Women/ Mother received free diagnostics facility
District100% of pregnant women reported at Hospital
During visit of Health Facility
100% of pregnant women reported at Hospital
Implementation of Janani and Sishu Suraksha Karyakram (JSSK).
Monitoring Required Monitor able Indicators Level of Monitoring Expected Level of
Achievement
Status of free test for Blood Transfusion
% of Pregnant Women/ Mother received free Blood Transfusion Facility against Total Pregnant Women/ Mother provided Blood Transfusion
District100% of pregnant women reporting blood transmission
During visit of Health Facility
100% of pregnant women reporting blood transmission
Status of availability of IEC material on JSSK
Hoarding on JSSK During visit of Health Facility
Should be installed at prominently visible location
Operationalisation of Newborn Stabilization Unit (NBSU)
Monitoring Required
Monitor able Indicators
Level of Monitoring
Expected Level of Achievement
To provide services to sick and low birth weight children
Functional status of NBSU
During visit of Health Facility
Should be made functional if construction completed i.e., admission made
Operationalization of Special Care Newborn Unit (SCNU)
Monitoring Required Monitor able Indicators Level of
MonitoringExpected Level of
Achievement
To provide special care to sick and low birth weight children to reduce Infant Mortality
Functional status of SCNU
District Hospital
Should be made functional if construction completed - No of admission and Survival rate > 90%
Routine Immunization Programme
Monitoring Required Monitor able Indicators Level of Monitoring
Expected Level of Achievement
To provide vaccine to children under National Routine Immunization Schedule to protect the children from different diseases
% of Fully Immunized Children
District 100% of childen
All Health Block 100% of childen
Health facility 100% of childen
BCG to Measles Drop Out Rate
District 0%
All Health Block 0%
Health facility 0%
Mother & Child Tracking System (MCTS)
Monitoring Required
Monitor able Indicators Level of Monitoring Expected Level of
Achievement
Status of implementation of MCTS
% of Pregnant Women Registered in MCTS against expected no of pregnant women registered ANC during the period
District 100% of all Pregnant Women Registered
All Health Block 100% of all Pregnant Women Registered
Status of implementation of MCTS
% of Children Registered in MCTS against expected no ofLive Birth during the period
District 100% of all Child Born
All Health Block 100% of all Child Born
Sterilization. Permanent method of limiting for population stabilization in order to reduce Total Fertility Rate (TFR)
Monitoring Required Monitor able Indicators Level of Monitoring
Expected Level of Achievement
Status of Male Sterilization
% of Male Sterilization conducted against Expected Level of Achievement
District 100%
Status of Female Sterilization
% of Female Sterilization conducted against Expected Level of Achievement
District 100%
Status of Sterilization Failure / Death case and insurance claim status
% of Compensation amount paid against Sterilization Failure / Death case and insurance claim
District 100%
Family Planning Method
Activity Monitoring Required Monitor able Indicators Level of Monitoring
Expected Level of Achievement
IUCD Insertion. Temporary Method of spacing
Status of IUCD Insertion
% of IUCD insertion conducted against Expected Level of Achievement
District 100%
OCP/ CondomStatus of Oral Contraceptive Pill (OCP) distribution
No of Oral Contraceptive Pill (OCP) distributed
During visit of Health Facility
More than 0
Temporary method of spacing / ECP
Status of Condom distribution
No of Condom distributed
During visit of Health Facility
More than 0
Status of Emergency Contraceptive Pill (ECP) distribution
No of Emergency Contraceptive Pill (ECP) distributed
During visit of Health Facility
More than 0
Involvement of ASHA Monitoring Required
Monitor able Indicators
Level of Monitoring
Expected Level of Achievement
Training Status of ASHA
% of ASHA completed 6th & 7th Module of Training
District 100% of ASHAs in position
Timely payment of incentives to ASHA
% of ASHA Incentive paid for Full Immunization @Rs. 250/-
District 100% of Fully Immunized Infant
All Health Block 100% of Fully Immunized Infant
% of ASHA Incentive paid for Full ANC @Rs. 100/-
District 100% of ANC Registered
All Health Block 100% of ANC Registered
Adolescent Clinic. Monitoring Required Monitor able Indicators Level of
MonitoringExpected Level of
AchievementFunctional status of Adolescent clinic
Functional status of Adolescent clinic
During visit of Health Facility
Records to be maintained properly
Untied, Maintenance and RKS fund to HospitalsFor smooth running of the hospitals, Untied, Maintenance
and RKS fund is provided to each health facility.
Monitoring Required Monitor able Indicators Level of
MonitoringExpected Level of
Achievement
Utilization status of Untied, Maintenance & RKS Fund
Utilization status of Untied, Maintenance & RKS Fund During visit of
Health Facility
Should be properly and fully utilized and maintaining of documents
Type Untied Fund Maintenance Fund RKS Fund
DH - - Rs. 5,00,000SDCH Rs. 50,000 Rs. 1,00,000 Rs. 1,00,000CHC Rs. 50,000 Rs. 1,00,000 Rs. 1,00,000PHC Rs. 25,000 Rs. 50,000 Rs. 1,00,000SC Rs. 10,000 Rs. 10,000 -VHSNC Rs. 10,000 - -
Construction of New Health Facility. - To meet up the gap of Health Facility as per populations norms
Monitoring Required Monitor able Indicators Level of Monitoring
Expected Level of Achievement
Status of construction of District Hospital
% of Civil Works & Electrical Work Completed and being utilized
District 100%
Status of Construction of new Model Hospital (CHC)
% of Civil Works & Electrical Work Completed and being utilized
District 100%
Status of Construction of New PHC
% of Civil Works & Electrical Work Completed and being utilized
District 100%
Status of Construction of Riverine PHC
% of Civil Works & Electrical Work Completed and being utilized
District 100%
Construction of New Health Facility. - To meet up the gap of Health Facility as per populations norms
Monitoring Required Monitor able Indicators Level of Monitoring
Expected Level of Achievement
Status of Construction of Sub Centre
% of Civil Works & Electrical Work Completed and being utilized
District 100%
Status of Construction of Labour Room
% of Civil Works & Electrical Work Completed and being utilized
District 100%
Status of Construction of Ward
% of Civil Works & Electrical Work Completed and being utilized
District 100%
Status of up gradation of CHC to IPHS standard
% of Civil Works & Electrical Work Completed and being utilized
District 100%
Status of Construction of NBSU
% of Civil Works & Electrical Work Completed and being utilized
District 100%
Construction of Doctors’ and Nurses’ quarter. To ensure residential facility of Doctor, Nurse and paramedical staff in
order to operationalize 24X7 facilityMonitoring Required Monitor able Indicators Level of
MonitoringExpected Level of Achievement
Status of construction of Rural Health Block Pooling Complex (RHBPC)
% of Civil Works & Electrical Work Completed and being utilized
District 100%
Status of construction of Doctors’ and Nurses Quarter
% of Civil Works & Electrical Work Completed and being utilized
District 100%
Status of Construction of Boundary Wall
% of Civil Works Completed District 100%
Status of Construction of ASHA Waiting Shed
% of Civil Works & Electrical Work Completed and being utilized
District 100%
Health Manpower position. To ensure services to the rural people
Monitoring Required
Monitor able Indicators
Level of Monitoring
Expected Level of Achievement
Status of availability of critical manpower in the health facilities
Status of availability of critical manpower in the health facilities
District 100%
Mobile Medical Unit (MMU) - Hospital on wheel. To provide health care services to remote areas
Monitoring Required
Monitor able Indicators
Level of Monitoring
Expected Level of Achievement
Status of utilization of District level and Sub Divisional MMU
Average no of camps organized by MMU every month
District 25 camps per month
Rational use of MMU so that needy people are served first
Average patients treated per camp by MMU
District Around 100 patient per camp
Status of Sub Divisional level MMU
After how many days, the same camp (locality) visited by the MMU Unit
District Every month
Boat Clinic - Hospital on boat.To provide health care services to riverine and char areas
Monitoring Required
Monitor able Indicators
Level of Monitoring
Expected Level of Achievement
Status of utilization of Boat Clinic
Average no of camps organized by Boat Clinic per month
District 25 camps per month
Average patients treated per camp by Boat Clinic
District Around 80 patient per camp
After how many days, the same camp (locality) visited by the Boat Clinic Unit
District Every month
Sanjeevani – Village Health Outreach Programme. To provide health care service at the door step of the rural people
Monitoring Required Monitor able Indicators Level of Monitoring
Expected Level of Achievement
Status of implementation of Sanjeevani – Village Health Outreach Programme
Average no of camps organized by Sanjevani VAN
District 48 camps per month per van
Average patients treated by each Sanjeevani VAN
District
No of Diabetics, Hypertension, et cases detected
District Every month
Mritunjoy – 108 Emergency Management Services. To provide emergency services at the golden hour
Monitoring Required Monitor able Indicators
Level of Monitoring
Expected Level of Achievement
Status of utilization of Mritunjoy 108 service
Average no of patients transported per month
District Around 90 patients per month
Availability of 108 services
No of PW transported District
State average, 40% of the total transported patients are pregnant women
Status of transportation of Pregnant women and sick children
No of Sick Infant transported District
NCD Screening Programme. To screen adult population (more than 30 years of age) to detect
and timely referral for non communicable diseases like Hypertension, Diabetics etc
(Implemented in Barpeta, Dibrugarh, Jorhat, Kamrup Metro, Kamrup Rural, Lakhimpur, Morigaon, Nagaon, Nalbari, Sivasagar, Sonitpur & Tinsukia)
Monitoring Required Monitor able Indicators Level of
Monitoring Expected Level of Achievement
Status of implementation of NCD screening programme by MPW (Male) by house to house visit
% of MPW(M) trained for NCD Screening Programme District 100%
% of trained MPW(M) screening for Hypertension and Diabetics cases on regular basis
District 100%
No of persons screened District
No of persons detected as Hypertension case District
State average - Around 10% of screened persons deteceted as suspected hypertensive case
No of persons detected as Diabetics case. District
State average - Around 3.5% of screened persons deteceted as suspected Diabetics case
“Majoni” – Social assistance to all the girl child born in the family up to second order is given a fixed deposit of Rs. 5,000/- for 18 years – an initiative by Govt. of Assam. To
promote girl child
Monitoring Required Monitor able Indicators Level of
MonitoringExpected Level of
Achievement
Status of issue of Fix Deposit
% of Fix Deposit issued against no of application form received
District 100%
“Morom” - The Morom scheme provides financial support to indoor patients of Government Health Institutions
Indoor patients admitted to a Hospital will receive Rs. 75/- per day for Medical College, Rs. 50/- per day for District
Hospital and Rs. 30/- per day for SDCH/ CHC/ PHC.For supplementary nutrition and compensation for wage loss during hospitalisation and post hospital expenses
Monitoring Required
Monitor able Indicators
Level of Monitoring
Expected Level of Achievement
Status of Morom payment
% of Indoor patient stayed at Midnight received "Morom" fund excluding Delivery cases
During visit of Health Facility
100%
Other Activities Monitoring Required Monitor able Indicators Level of Monitoring Expected Level of
Achievement
For quality health services
Overall cleanliness and Hygiene Issue
During visit of Health Facility
Should be clean and hygenic
Functional Status of Laboratory
During visit of Health Facility Should be functional
Availability of Diet facility During visit of Health Facility Should be functional
Status of Indoor Ward During visit of Health Facility
Should be functional, clean and hygenic
Status of Patient Waiting Area with Drinking Water facility, Toilet, etc
During visit of Health Facility Should be available
Implementation of Bio Medical Waste Management System
During visit of Health Facility Should be available
Availability Free Medicine and proper record keeping of stock
During visit of Health Facility Should be available
Emergency service facility During visit of Health Facility Should be available
Availability Fire fighting measures
During visit of Health Facility Should be available
PPP with Tea Garden Hospital. To provide healthcare services to Tea Garden areas
Monitoring Required
Monitor able Indicators
Level of Monitoring
Expected Level of Achievement
Functional Status of PPP Tea Garden Hospital
Whether all services provided to pregnant women and children
During visit of Health Facility
Should be available
Availability of Doctor and other health personnel
During visit of Health Facility
Should be available
THANK YOU
NRHM, ASSAM
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