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Chapter-III

Health of the people of Tripura-A Prelude based on secondary data

3.1 Demography and Health Profile of Tripura: Tripura, one of the eight States in north-

eastern India, is one of the remotest in the region. It covers a total area of 10,491.69 square

kilometers, of which around 60 per cent is highland. It is bounded on the north, west, south

and south-east by Bangladesh whereas in the east it has a common boundary with Assam and

Mizoram. Total forest cover of the state is 7065 Sq.km out of which 3463 Sq.km is

categorized as dense forest and 3602 Sq.km as open forest (SFR, 2001). Before the merger of

Tripura into Indian Union on 15th Oct, 1949, the area of the state was much bigger which

included the present Tripura and the plains of Tripura (Tippera) (now a part of Bangladesh).

The plains of Tripura comprised of Chakla Roshanabad area of the then Bengal. Agriculture

is the mainstay of the economy; shifting cultivation is gradually being replaced by modern

farming methods. Important cash crops are tea, jute, cotton, and fruit. Wheat, rice, potatoes,

and sugarcane are also grown. The Government of India has recently taken a number of

initiatives to develop infrastructural facilities in Tripura and other North-eastern states.

The Government of Tripura traces the genesis of reforms to rapid socio-economic changes,

demographic and epidemiological transitions and the changing global scenario. Through the

reform measures, the government seeks to provide health services at the doorstep of the

people as well as to generate awareness amongst them. Reform Initiatives 1 include: (I)

Public Private Partnership.

For administrative purposes, the State is divided into four districts, 17 subdivisions, 40 rural

development blocks, 31 revenue circles, 183 tehsils, 874 revenue moujas, four zilla

parishads, 12 nagar panchayats, one municipal council, and one autonomous district council.

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Under the unicameral legislature system, it has 60 seats of legislative assembly. The state is

represented in the Lok Sabha and Rajya Sabha by two members and one member

respectively.

3.1.1 Demography

As per the 2001 Census, the total population of the State is 31, 99,203, the rural population

being 26, 53,453. Apart from the Bengali and Manipuri communities, the State has 19

different tribal communities. The State has the density of 305 persons per sq. km. As against

decadal growth rate of 21.54% at the national level, the population of the State has grown by

16.03% over the period 1991-2001. The sex ratio of Tripura at 948 females to 1000 males. It

is higher than the national average of933. Female literacy of the State rose to 65.41 % in

2001 from 49.65% in 1991. Tripura is a state, where a combined culture is scripted by tribal

and non-tribal communities. This State is named after Goddess Tripura Sundari (or

Tripureshwari). It is mainly a hilly territory with altitudes varying from 50 to 3080 ft above

sea level, though the major population of the state lives in the plains.

3.1.2. Health Profile of Tripura

The important demographic features of the state are presented in Table-3.1. The

corresponding national figures are cited side by side for comparison.

Table-3.1 reveals that so far as important indicators of Demography and health are concerned,

the small state of Tripura is better placed in comparison to India as a whole. The growth rate

of population, after witnessing explosive trend in immediate post-independence decades,

subsided in 2001 and recorded a much lower growth rate than that of India as a whole, the

decadal growth rate of population being only 16.03 percent in Tripura and 21.54 percent in

India in 2001. Crude Birth Rate is also lower than the all India figure (SRS 2008), so also the

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case with Crude Death Rate. The state has shown an achievement in case of restricting Infant

Mortality Rate to which is 53 per thousand in India according to SRS 2008. However, the

incidence of poverty is much higher in Tripura as 34.44 percent of state population lives

below poverty line. The corresponding figure for India is 26.10 percent.

Table-3.1

Demographic Profile of Tripura State

Sl. No. Item Tripura India 1 Total population (Census 2001) (in 3.20 1028.61 million)

2 Decadal Growth (Census 2001) (%) 16.03 21.54 3 Crude Birth Rate (SRS 2008) 15.4 22.8 4 Crude Death Rate (SRS 2008) 5.9 7.4 5 Total Fertility Rate (SRS 2007) NA 2.7 6 Infant Mortality Rate (SRS 2008) 34 53 7 Maternal Mortality Ratio (SRS 2004 – 2006) NA 254 8 Sex Ratio (Census 2001) 948 933

9 Population below Poverty line (%) 34.44 26.10

10 Schedule Caste population (in million) 0.56 166.64 11 Schedule Tribe population (in million) 0.99 84.33 12 Female Literacy Rate (Census 2001) % 64.9 53.7

(Source: RHS Bulletin, March 2008, Ministry of Health & F. W., GOI)

RHS Bulletin published by Ministry of Health & F.W.GOI of March 2008 shows the

health infrastructure of Tripura in terms of the availability of important health personnel and

health centres present in Tripura. The picture in shown in Table-3.2. The Table-2 also shows

the required number of health personnel and health centres in Tripura which is shown in the

said report and estimated on the basis of standard requirement criteria set by the government.

From the figures, it is evident that there is shortfall of almost every categories of health

personal and health centres in Tripura except in the availability of number of Doctors, Health

Assistants and Nurse Midwives. In some specialized areas of Health, the absence of

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Specialists is glaring in the state for example, there is no Surgeons, Obstetricians and

Gynaecologists', Physicians, Paediatricians and Specialists in CHCs in the state as reported in

the Report.

The Report-2008 (reference as above) also shows the number of important Health Institutions

present in Tripura. The figures, category wise are presented in Table-3.3. There are two

Medical Colleges in Tripura which have started functioning only from 2006-07. The number

of Institutions in the area of alternative medicines is more or less satisfactory. There are 55

Ayurvedic Dispensaries and 93 Homeopathic Dispensaries available in the state.

Table- 3.2

Health Infrastructure of Tripura

Item Required In Position Shortfall Sub-centre 659 579 80

Primary Health Centre 104 76 28 Community Health Centre 26 11 15

Multipurpose Worker 655 638 17 (Female)/ ANM

Health Worker (Male)/ 579 436 143 MPW(M)

Health Assistants (Female)/ 76 62 14 LHV

Health Assistants(Male) 76 93 - Doctor at PHCs 76 255 -

Surgeons 11 - - Obstetricians & 11 - -

Physicians 11 - - Paediatricians 11 - -

Total specialists at CHCs 44 - - Radiographers 11 1 10

Pharmacist 87 76 11 Laboratory Technicians 87 67 20

Nurse Midwife 153 235 -

(Source: RHS Bulletin, March 2008, Ministry of Health & F. W., GOl)

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Table: 3.3

Important Health Institutions in Tripura

Medical College 2 District Hospitals 2 Referral Hospitals -

City Family Welfare Centre - Rural Dispensaries -

Ayurvedic Hospitals 1 Ayurvedic Dispensaries 55

Unani Hospitals - Unani Dispensaries -

Homeopathic Hospitals 1 Homeopathic Dispensary 93

(Source: RHS Bulletin, March 2008, Ministry of Health & F.W., GOl)

3.2 Demography and Health Profile of North Tripura

The North Tripura District comprises of 2,469.90 Sq.km of land and is divided into three

sub- divisions, namely, Dharmanagar, Kanchanpur and Kailashahar with eight Blocks

namely Kumarghat, Panisagar, Pecharthal, Kadamtala, Damcherra, Dasda, Gournagar and

Jampui Hill. Main tribes of the District are Tripuri, Koloi, Halam, Chakma. There are two

hill ranges, namely Jampui and Sakan and they run almost parallel to each other. "Berling

ship", the highest point of the state (939m.in height.), is located in the Jampui hill range.

Main rivers of the area are Deo, Manu, Longai and Juri. This district has 1204.59 Sq.km of

forested land. With relation to ownership and protection scenario, a total of 628.28 Sq.km is

under reserve forest category and 501.57 Sq.km is under private forest. Another 74.76 Sq.km

is proposed for the reserve forest. The area received 3014.5 mm and 2698.6 mm of rainfall

during year 2000 and 2001 respectively. Maximum and minimum temperature is 35°C and

27 °C, respectively in summer and 27°C and 7°C, respectively in winter.

The green North District is situated near to Sylhet District of Bangladesh in the North,

bounded in the East by Karimganj District of Assam, south by Mizoram and in the west by

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Dhalai District of Tripura. North District is one of the four districts in the State of Tripura.

The district headquarter is situated at Kailasahar with population of 590913 [Male - 302946

female- 287967, Census- 2001] residing in 79 ADC villages and 103 Gram Panchayats.

The Administrative district has 3 Sub-divisions, and 8 RD Blocks. Out of the 8 blocks, 4

blocks are in ADC area in North District. In North District there is one Zilla Parishad with 4

numbers of Panchayat Samities and 7 numbers of Block Advisory Committees.

Geographically it covers an area of 2820.63 sq. kms. The terrain is mostly hilly, with high

rainfall. The connectivity is poor both in terms of telecommunication as well as road access.

Map of the District preferably showing Blocks Head quarter, Sub divisional Head quarter,

inter-state and international Border.

Figure-3.1: Map of North Tripura District

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3.2.1. Demography:

The important demographic features of North Tripura District are shown in Table: 3.4. The

North Tripura District represents 26.88 percent geographical area of the state and its share of

state population is 18.47 percent. The density of population of the district is 304/sq. km.

Scheduled Caste (SC) population and Tribal (ST) populations are 82902 and 150500

respectively. The total number of BPL families in the state is 77311 which are 17.11 percent

of the total BPL families of the state. The district's sex ratio is slightly better than the state

figure. The district is marginally less densely populated than the state Tripura as a whole. In

case of literacy rate also there is marginal difference between the state of Tripura and its

district North Tripura.

Table-3.4

Demographic Features of North Tripura District (2001)

Sl. No Indicators Tripura State North District 1. Area 10491.69 2820.63

2. Population 3199202 590913

3. Rural Population 2653453 528244

4. Urban Population 545750 62669 5. BPL (family) 451870 77311

6 Sex Ratio 950 952

7 Density of Population 304 281

8 Literacy Rate(Person) 73.66 73.10

Source: Office of the Chief Medical Officer, North Tripura, Kailashahar

3.2.2 Health Profile of North Tripura District

There were 5 Hospitals and 14 PHCs in the District during 1989-90.As many as 52985

patients were attended in the hospital and 228583 patients in PHCs during the year. The No.

of patients admitted in the hospital and PHCs during the year was 16691 and 16975

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respectively. The No. of dispensaries in the district was 128 and as many as 25265 patients

were attended in the dispensaries during the year. The number of village -guides in the

district was 508 during the year. There was no case of male sterilization in the district during

1989-90.The No. of female sterilization was 1791 during the same period. The No. of I.U.D

insertion cases was 609 during 1989-90. The Medical and Health statistics pertaining to the

year 1980-81 are presented in Table-5.

Table-3.5

Medical and Public Health Statistics of North Tripura 1980-81

Source: Office of the Chief Medical Officer, North Tripura, Kailashahar

Table: 3.5 shows the picture of Medical and Health statistics of the North Tripura District

where the total number of Hospitals are 4, number of Dispensaries are 33, number of

P.H.Cs are 13, Number of Hospital beds per lakh of population are 47 and number of PHC

beds per lakh of population are 26 only. The figures present a dismal picture of Health care

services available in Tripura during 1980-81. The Sub Division-wise data of Medical and

Health statistics pertaining to the year 1989- 90 are presented in Table-6.

The Table-3.6 presents the medical health and family welfare statistics of the district for the

period of 1989-1990.Number of Hospital were 5 in 1989 with just 255 beds and the number

SI. No Description Total No

1 No of Hospitals 4

2 No of Dispensaries 33

3 P.H.C 13

4 No of Hospital beds per lakh of population 47

5 No of PHC Beds per lakh of population 26

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of patients admitted in that year was 16,691.

Table-3.6

Medical Health Service and Family Welfare Statistics, 1989-90

SL.No Description Kailashahar Dharmanagar Kanchanpur NorthTripura

1 Hospitals 2 2 1 5 2 Beds in the 115 90 50 255 hospitals 3 Patients admitted 8898 4990 2803 16,691 in hospitals

4 Patients attended 22755 19175 11055 52,985 in hospitals 5 PHC 4 7 3 14

6 Beds in the PHCs 40 70 30 140

7 Patients admitted 7350 7200 2425 16,975 in PHCs 8 Total No of 85,225 1,00,232 43126 2,28,583 Patients 9 Dispensaries 46 54 28 128

10 Patients attended 7,903 10,390 6972 25,265 in Dispensaries

11 Village Health 157 249 102 508 Guide

12 Males sterilized Nil Nil Nil Nil

13 Females sterilized 679 688 424 1791

14 Total no. of I.U.D.

insertion 318 220 71 609

Source: Office of the Chief Medical Officer, North Tnpura, Kailashahar

The number of PHCs were 14 with only 140 beds and the total number of patients attended

by PHCs ,in that year, was 16,975.The total number of patients attended by the hospitals

were 2,28,583 altogether. Total number of dispensaries at that time was 128 and total of

25,265 patients attended the dispensaries in that year. The number of village Health Guides

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were 508. The number of sterilized females was only 1791 in the year in the district of North

Tripura.

The more recent picture of health services availed by the people of North Tripura is

presented in Table-3.7 and Table-3.8. The Table contains information about medical

statistics of North Tripura District pertaining to the year 2007-2008.

Table-3.7

Medical Statistics of North Tripura District, 2007-2008

SL. NO Description Kailashahar Dharmanagar Kanchanpur N Tripura 1 Total no. of 2 2 1 5 Hospital

2 Total No of P.H.C 4 7 7 18

3 Total No of Bed in 190 131 84 405 SL .No. 1&2

4 Total No of IPD 1,13,766 25,352 20,348 1,59,466 Patients in SL. No.l&2 5 Total No of OPD 16,448 11,967 4,481 32,896 Patients in SL. No 1&2

6 Total No of Sub 41 32 30 103 centre3 7 Total No of patients 16,710 13,932 14,001 44,643 in the Sub Centre

8 Total No of

Homeopathic 9 4 3 16

9 Total No of Ayurvedic

Hospital /Sub- centre 2 3 1 6

Source: Chief Medical Officer, North Tripura, Kailashahar

During the period of 1989-90 to 2007-08, the total number of Hospitals in the North Tripura

District has remained the same at 5 only. However, the number of PHCs has increased from

14 to 18.

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Table-3.8

Statistics of Health and Family Welfare, 2007-2008

1 Total No of Sterilization 159 56 73 2 Male 2 2 0

3 Female 157 54 73

4 Total No of IUD 68 194 128 5 Total No of Doctors 42 29 21 including Homeo & Allopathic 6 Total No of Nurses 50 39 30

7 Total No of - 2 - Midwives/Dhais

8 Other paramedical 4 2 3 workers

Source: Chief Medical Officer, North Tripura, Kailashahar,

The number of beds in hospitals and PHCs has increased marginally from 395 to

405. The total number of patients attended by different types of health institutions has also

increased marginally from 228583 to 237005. This indicates that the prevalence of diseases

has remained more or less at the same level over a period of 18 years.

The overall picture that emerges from Table-3.6, 3.7 and Table-3.8 portrays the extent of

health care facilities available in North Tripura District in a poor light. There is severe

deficiency in health care services available to the people of that district. The number of

people found to be falling ill is also, by no means, a meagre number as is evident from the

number of people reported for treatment in different categories of health institutions. This

establishes the need for a detailed investigative research on the health status of the people of

North Tripura District.

The point is further substantiated by Table- 3.9 which shows the status of Man Power

available to Heath Services Department in the district in the year 2007-08.

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Table-3.9

Man Power in Health Services in Position

Category In position

MOs [Gen] 46

Ayurved 13

Homeopathy 5

Dentist 3

Specialists 27

ANMs 118

MPWs 48

Pharmacists 11

Staff Nurses 112

Lab Techs 13

Male Supervisor 21

Female Supervisor 3

BEE-4 Any other category SW-2

Source: DAP: DHFWS, N .Tnpura, Kailashahar 2007-08

The number of Medical Officers available in position is 46 (General)only. In addition to

that, the district has 13 Ayurvedic, 5 qualified Homeopath, 3 dentists, 27 specialist

doctors, 11 Pharmacists and 112 stuff Nurses. There is an ANM training institute for

training of female MPWs and has a capacity of 25 students per year. At present the

registration of the training institute stands cancelled. The cancellation was due to lack of

infrastructure. With the completion of the works for providing infrastructural facilities to

the institution, it is expected that the registration of the institute shall be allowed soon. It

is proposed to increase the strength of the institute to 50 in this financial year.

The important training programmes conducted in the district for developing health care

services in the district in the year 2007-08 are as under.

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52 district level trainers for ASHA have been trained. Training of one batch of

ASHA had also been taken up in the month of April, 2007.

In the North District, under training component, Integrated Skill Training had been

taken up during the month of March 2007 for 5 batches of MOs, 6 batches of MPWs

(M/F) and 8 batches of Nurses.

Training on IDSP has been imparted to the MOs, MPW (F), and MPW (M). The

supervisors were not trained and it is contemplated that the training of supervisors

will be taken up shortly.

165 dhais trained in the last year.

The priority training areas identified are as under:

Priority training areas:

IMNCI

SBA

Anaesthesia

Gynaecologist

Paediatrician

Dai

Capsule training for A WW along with ANM, PHC wise in small batches.

Capacity building of Village Health & Sanitation Committee, SDCG

The additional infrastructural facilities available in the district are:

There are two blood banks in the district located at Kailasahar and Dharmanagar.

There is only one CHC at Kumarghat.

There are 4 Ultra Sound Clinics registered in the district out of which three are

government controlled and one is private (Mahanam Seva Sadan, Dharmanagar

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The state government has taken a number of initiatives for strengthening the health care

services in the district. The objective is to spread the health care services to the fur flung

areas of the district. One of such initiatives is to establish more health sub-centres in

different parts of the districts. The sub-division- wise details of these are submitted below in

Table-3.10.

Table-3.10

Status of New Health Sub- Centres Propose

Sub-Division Name of Institution Name of Proposed Sub-

Centre

Kai

lash

ahar

Sub

-Div

ision

1. RGM Hospital 1. Kawlikura

2. Nuncherra

2. Kumarghat RH

1. East Kanchanbari (ADC)

2. Dodhpur

3. Ujan Dodhpur

4 South Unokoti (ADC)

5. East Beathcherra (ADC)

6. Nagar Panchayet (Urban)

3. Fatikroy PHC 1. Saidacherra

4. Kanchanbari PHC 1. Masawli West

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2. Saidarpar

3. Juricherra

5. Irani PHC

1. Yeajakharra

2. Herracherra

3. Khawerbil

6. Kanika Memo. PHC

1. N C Para (ADC)

2. Mailowng (ADC)

3. Bilashpur

4. Chandipur

Dha

rman

agar

Sub

-Div

ision

7. Dharmanagar SD Hosp.

1. Chandrapur

2. East Hurua

3. Kameswar

8. Brajendranagar PHC

1. Piaracherra

2. Sarala

3. Pratyekroy

9. Kadamtala PHC

1. Govindapur

2. Kalagangerpar

3. Central kurti

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4. Balicherra (ADC)

10. Uptakhali PHC 1. South Padmabil

11. Tilthai PHC 1. East Tilthai

12. Panisagar PHC 1. Agnipara

2. Bilthai

13. Jalebasa PHC 1. Ramcherra

14. Bungnung PHC

1. Dewanpasa

2. Madhuban (ADC)

3. Baithangbari (ADC)

Kan

chan

pur

15. Kanchanpur SD Hosp.

1. Chandipur

2. Makumcherra

3. Jamaraipara

16. Damcherra PHC 1. Titarampara (ADC)

17. Peachartal PHC

1. Baghaicherra (ADC)

2. East Andharcherra

3. Nalkata

4. Andharcherra

Sub-Division Name of Institution Name of Proposed Sub-

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Centre

Kan

chan

pur

18. Anandabazar PHC

1. Srirampur

2. Prabhurampur

3. Kakchang

19. Jampui PHC 1. Konpui (ADC)

2. Chimluang (ADC)

20. Dasda PHC 1. Manuchailengta (ADC)

2. Satnala West (ADC)

21. Machmarra PHC Nil

22. Khedacherra PHC 1. Dugangapara

Source: Office of the Chief medical officer, North Tripura, Kailashahar, 2006-7

Table-3.11

Year wise & Sub-Divisional wise plan for proposed SC

SD Kailashahar Dharmanagar Kanchanpur Total

Year

2007 -2008 3 4 3 10

2008 - 2009 7 7 7 21

2009 -2010 5 4 2 11

Total 19 18 16 53

Source: Office of the Chief Medical officer, North

Tripura, Kailashahar, 2006-7

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Some salient features are-

In North Tripura district 3 Primary Health Centres proposed at Bhadrapalli

(under Kailashahar SD, Gournagar Block) , Laljuri (under kanchanpur SD)

and Sanichherra (Dharmanagar SD, Kadamtala Block). All 3 are in this

financial year.

Panisagar PHC proposed to be upgraded to CHC.

Kumarghat CHC & Kanchanpur SDH to be upgraded as FRU.

Khedacherra PHC to be upgraded to 24 X 7 PHC.

The numbers of sub-centres having 1 ANM, 2 ANM and without any ANM in the

North District of Tripura as in the year 2007-08, are shown in Table-3.12.

Table-3.12

Sub Centres with ANM

Institution Total No. of SC l ANM 2ANM No ANM

1. RGM Hosp. 5 4 1

2. Kumarghat R. Hosp. 6 5 1

3. Fatikroy PHC 4 2 1 1

4. Kanchanbari PHC 5 4 1

5. Irani PHC 8 7 1

6. Kanika Memo. PHC 13 10 2 1

7. Dharmanagar SD 5 4 1

8. Brajendranagar PHC 2 1 1

9. Sanicharra PHC 2 1 1

10. Kadamtala PHC 5 4 1

11. Uptakhali PHC 3 3

12. Tilthai PHC 5 4 1

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13. Panisagar PHC 2 1 1

14. Jalebasha PHC 3 1 2

15. Bungnung PHC 5 4 1

16. Kanchanpur SD 4 2 2

17. Damcherra 2 1 1

18. Peachartal 2 1 1

19. Anandabazar 4 1 3

20. Jampui PHC 7 6 1

21. Dasda PHC 5 4 1

22. Machmarra 4 3 1

23. Khedacharra 2 2

Total 103 74 7 22

Source: NRHM DAP North Tripura, 2007-8

The Table- 12 shows that there are 22 health sub-centres which have no ANM and 74 sub-

centres functioning with just one ANM. Additional 53 ANM atleast are also required for

proposed 53 sub-centres.

The number of MPW (M) is also insufficient in sub-centres of North Tripura district. The

requirement is shown in Table-3.13.

Table-3.13

Status of MPW (M) in SCs

Institution Total No. of SC No. of MPW Requirement

1. RGM Hosp. 5 1 4

2. Kumarghat R. Hosp. 6 3 3

3. Fatikroy PHC 4 1 3

4. Kanchanbari PHC 5 1 4

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5. Irani PHC 8 1 7

6. Kanika Memo. PHC 13 3 10

7. Dharmanagar SD Hosp. 5 1 4

8. Brajendranagar PHC 2 2 0

9. Sanicharra PHC 2 1 1

10. Kadamtala PHC 5 3 2

11. Uptakhali PHC 3 2 1

12. Tilthai PHC 5 2 3

13. Panisagar PHC 2 1 1

14. Jalebasha PHC 3 2 1

15. Bungnung PHC 5 2 3

16. Kanchanpur SD Hosp. 4 2 2

17. Damcherra PHC 2 1 1

18. Peachartal PHC 2 1 1

19. Anandabazar PHC 4 2 2

20. Jampui PHC 7 1 6

21. Dasda PHC 5 2 3

22. Machmarra PHC 4 3 1

23. Khedacharra PHC 2 2 0

Total 103 40 63

Source: NRHM DAP, North Tripura, 2007-8

Therefore 63 MPW (M) need to be appointed for the old SCs. Additional 53 MPW (M)

are also to be appointed in 53 proposed SCs. The additional Place-wise staff requirement

in DH, SDH, CHC and PHCs are shown in Table- 3.14.

Table-3.14

Status & Requirement of Staff in Institutions (DH, SDH, CHC & PHC):

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MO + MO (AYUSH) Staff Nurse + ANM LT Institution

In Pos Req In Pos Req In Pos Req

1. RGMHosp. 20 +4 NA 22 +2 NA 2

2. Kumarghat R. Hosp. 4+2 NA 6+1 NA 1

3. Fatikroy PHC 3+0 0+2 2+2 3 0 1

4. Kanchanbari PHC 2+0 1+2 1+2 3 1

5. Irani PHC 2+2 NA 1+0 2 0 1

6. Kanika Memo. PHC 1+2 2+0 0 3 0 1

7. Dharmanagar SD 6+4 NA 15 + 5 NA 3

8. Brajendranagar PHC 1+0 2+2 0+2 3 0 1

9. Sanicharra PHC 0+0 3+2 1 + 0 3 0 1

10. Kadamtala PHC 3+0 0+2 4+0 2 1

11. Uptakhali PHC 2+1 1 + 1 3 + 1 1 0 1

12. Tilthai PHC 2+0 1+2 1+0 3 0 1

13. Panisagar PHC 3+0 1+2 3 + 1 2 1

14. Jalebasha PHC 1+0 2+2 2+0 2 0 1

15. Bungnung PHC 1+0 2+2 0 3 0 1

16. Kanchanpur SD 8+1 NA 3 + 1 NA 2

17. Damcherra PHC 2+0 1+2 0 3 0 1

18. Peachartal PHC 2+0 1+2 2+1 2 1

19. Anandabazar PHC 2+0 1+2 0+3 3 0 1

20. Jampui PHC 1 + 0 2+2 0+2 3 0 1

21. Dasda PHC 2+0 1+2 2+0 2 0 1

22. Machmarra PHC 2+0 1+2 2+0 1 0 1

23. Khedacharra PHC 1+2 2+0 0 3 0 1

Total 72 + 18 =

90 24 + 31 70 + 23 47 12 15

Source: Office of the Chief Medical officer, 2006-7

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3.3 Morbidity Profile of the district as in 2007

The prevalence of vaccine preventable disease in North District is in the minimum. Along

with the state, North District did not have a single case of polio militias since 1997. The

AFP rate of North Tripura District is above one which indicates that the surveillance of

polio militias in the North District is good. There has been no outbreak of Measles in the

district during the year. Cases of neo-natal Tetanus, adult Tetanus, diphtheria, and

whooping cough cases are very few in the district.

Table-3.15

Vaccine preventable disease (2006-07):

SI. No Diseases Cases Death

1. Polio Nil Nil

2. Measles 160 Nil

3. Whooping cough 4 Nil

4. Tetanus Nil Nil

5. Diphtheria Nil Nil

6. Childhood tuberculosis 6 Nil

Source: NRHM DAP North Tripura

Table-3.16

Status of Malaria (2006-07)

Annual Blood %of

Blood sample Sample Treatment PF API SPR Death Examination collected tested Given reported

Rate cases

8.02% 49779 49779 49779 4.9 4.55% 15.68% 4

Source: NRHM DAP

Malarial death and diarrhoeal outbreak is under control. With the de-warming campaign, the

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nutritional status has improved slightly. The disease-wise additional information are

submitted in Table- 3.15, Table-3.16 and Table-3.17.

At present 35 Squads of DDT spraying are in position (6 members in each Squadj. It is

proposed that the no. of Squads for DDT spray to be increased to 45 Squads.

Table-3.17

Diarrhoea Status (2006-07)

Cases reported Treatment given Death reported

10935 10935 4

Source: NRHM DAP

Family Welfare Activities:

3.4 Current Status:

According to the guideline of Honourable Supreme Court, RCH camps are being

implemented by the H&FW Society with the help of All Tripura Govt. Doctor's Association

(ATGDA) this year and the performance of LL has dramatically increased along with other

activities of FW services. But in spite of our sincere efforts the no. of NSV cases are again

very poor. We organized one Mega Camp on NSV for 5 days at Panisagar but unfortunately

the no. of cases was only 2.

The following table shows the target and achievement of the family welfare activities (2006-

07):

The health care delivery system is in a lean state both in terms of skilled manpower supply as

well as physical infrastructure.

Although the physical infrastructure can be created through monetary support, necessary

institutional systems are required to provide long term sustainability of all health initiatives

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keeping in view the achievement of Millennium Development Goals. Tripura lacks only in

terms of MMR, TFR & Sex Ratio.

Table-3.18

Target and Achievements of Family Welfare Activities

SI No Activities Target Achievement

1. MTP done 1870 2046

2. Ligation operation 920 996

3. NSV operation 50 4

4. Oral pill distributed NT 58475

5. Condom distributed NT 140515

Source: NRHM DAP, 2007-8

To reduce MMR to less than 100, we need to have a vision whereby percentage of

institutional deliveries needs to be improved at the institutes where all emergency

obstetric care services are available.

Also, the District Hospitals, Sub divisional Hospitals & CHCs need to become

institutions for comprehensive health services including other medical, surgical health

care services as well.

Seven blocks do not have a health care institution at the Block HQ, these needs to be

established.

All existing District Hospitals need to become centres for comprehensive health care

along with availability of super-specialist services like nephrology, cardiology

gastroenterology etc

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To start with it is proposed that the shortage of skilled manpower (specialists) be met

through training of existing State Medical Officers in specialist skill training at

RIMS, Imphal, Agartala Govt. Medical College & at Tripura Medical College,

Agartala. Other institutions to provide such residential skill based training need to be

identified.

The existing medical colleges in the state can also start-up the super-specialty courses

in near future.

Other supportive institutions like

Nursing College

ANM training Schools

Dental College

Training Institutions (preferably run by professional agencies)

Therefore, there is an overall need to scale up the capacity of institutions to sustain

the expansion of health care delivery. This shall determine the long term direction

of our efforts.

3.5 Flagship Program of Government of India and Context of Tripura

Health is one of the important parameters for Social and human resource development

in both urban and rural parts of our country. Human development and well being of

individual is the primary objective held by our country in the form of implementing

monitor able plans and policies. In this age of Information Technology where our

present world has shifted to a global village, the process of advancing developmental

priorities has doubly reinforced. The rural parts of the country have been facing socio-

economic problems mainly characterized by poverty, gender inequity and low

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participation in developmental initiatives. This is in spite of the implementation of

various programmes related to poverty alleviation intervening in the areas of

livelihood opportunities, access to education and of course access to health care

services & facilities.

Health is one of the vital elements that determine human development and progress.

Health care delivery system is confronting various challenges today posed by rapid

developments worldwide, the need for cost-containment and focus on effectiveness

and efficiency of the delivery mechanism. Different strategies are formulated for

providing better health care services in India. Under the constitution, Health is a State

subject. But in the present context, Central Government's initiatives to assist the State

Government is commendable in the areas of control of major communicable and non-

communicable diseases, broad policy formulation and awareness activities for

prevention of diseases. Several National Health Programmes are being implemented

as centrally sponsored schemes aimed mainly at reduction of mortality and morbidity

causes by major diseases.

The major Health schemes include the National programmes for Eradication of

Malaria, Blindness, Leprosy, Tuberculosis, AIDS, and Cancer Control etc. National

Rural Health Mission was launched in April 2005 throughout the country for better

improvement in the health care delivery system, particularly for the underprivileged

and the marginalized population.

Tripura is a small State in the periphery of North Eastern region of India. All National

Health Programmes are being implemented in the state for better improvement in

quality and nature of health care services. Different strategies have been taken for

prevention of diseases like Malaria, Tuberculosis, Leprosy and other diseases in the

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State. The prevention of health care activities largely depends on awareness creation

to enable people to go for health seeking behaviour. The prevention and control of

different diseases cannot be done without acting at the community level through mass

media tools besides the steps taken in Hospitals and Health Centres. The mass media

strategies have been formulated for prevention and control of diseases in urban and

rural areas as the part of IEC/BCC activities. Health & Family Welfare Department

is publishing "One Year's Achievement" in order to provide glimpse on various

activities carried out by the Department at fingertips. This booklet will inevitably act

as a source of providing information to different stakeholders on health issues,

activities and achievements of implementing different National Health Programmes

during April, 2006 to March 2007.

Health is the indicator of the socio economic status of the state. The health profile of

Tripura indicates the infant and maternal mortality ratio and the crude death and birth

rates. The government has developed the health infrastructure of Tripura to ensure

that the primary health facilities are available to all the people of the state.

The main objective of the Health and Family Welfare Department of the State

government is to render curative, preventive and promotive health care services to the

people. Apart from making adequate health care services available at the doorstep of

the people, the department plays a key role in educating them about prevailing health

problems and methods of preventing and controlling them. The main activities of the

department centre on treatment, control and eradication of communicable, non-

communicable and endemic diseases through the implementation of various schemes.

The State government also extends assistance to patients living below the poverty line

from its State Illness Assistance Fund and organizes health camps in interior areas

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For the benefit of the poor, particularly those in the BPL category, the Social Welfare

and Social Education Department of the State government has implemented a number

of schemes. During 2008-09, 1, 36,592 beneficiaries received old-age pension; and

5,455 people were extended the pension for the visually challenged and otherwise

handicapped. At present, 56 Integrated Child Development Services (lCDS) projects

are in operation in the State

The government has established 539 sub centers in the hilly and undulating regions of

the state of Tripura. There are 73 primary health centers in the state. The government

has the scope of expanding the number to 104. Only 10 community health centers

have been established by the government of Tripura when the scopes of 26 such

centers are present in the state. The community health centers are referral units that

treat patients referred by the primary health centers. The community centers are

equipped with more diagnostic and therapeutic facilities and specialized physicians.

The specialist health physicians, assisted by the health male and female workers

attend the patients in these health care centers. These centers have 268 nurses and

midwives to assist the doctors. The government has also placed laboratory

technicians to run the para clinical centers that conduct s examinations.

The Health indices reflected the success of health scenario of the state in respect of

All India figure as mentioned below: SRS (Sample Registration Survey by

Government of India) Birth rate 23.8 16.0 SRS 2005 Death rate 7.6 5.7 -do-Growth

rate 16.3 10.3 -do Infant Mortality Rate 58.0 31 -do- Couple Protection Rate 56.03

65.08 NFHS-3 Total Fertility Rate 2.68 2.22 -do- Maternal Mortality Rate 4.37 4

State Population policy published at August 2001 Sex ratio 933:1000 950:1000

Census 2001

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Medical College 2 (Public Sector - AGMC & G. B. Pant Hospital, Private Sector -

Tripura Medical College & BRAM Teaching Hospital) State Hospital Allopathic 2

(IGM Hospital, Cancer Hospital) Homeopathic 1 Ayurvedic 1 District Hospital 2 viz.

T. S. Hospital, Udaipur & R. G. M. Hospital, Kailashahar Sub-Divisional Hospital

11 CHC 10 PHC 76 Homeopathic Dispensary 79 Ayurvedic Dispensary 41 Sub-

Center 579 Mahila Swasthya Sangha 1,297 Blood Bank 06 Blood Storage Centre 07

Blood Component Separation Unit 01 A study of the demography of the state reveals

that the health facilities provided by the government have improved reducing the

number of infant and maternal mortality. The developed infrastructure has also

reduced the premature deaths in the region.

NRHM was launched in April 2005. Department of Health, Government of Tripura is

implementing the NRHM in right earnest. The decentralized planning process

involved development of GP and village Action Plans based on village level data and

community consultations. This was followed by health facility assessment, collection

of village level data at Health Sub-Centre, PHC/CHC and Sub-divisional level. The

planning workshops at sub- divisional level were organized and facilitated to develop

Sub-divisional Action Plans. These were integrated through district level planning

workshops for development of District Action Plans. The Facility Assessment Data

was also used as inputs for the District Action Plans. .This created environment

conducive for decentralized planning by the district.

We now have the capacity for preparing the need based plans following participatory

processes. A District Core Group (DCG) was set up for this purpose on 7th March

2007. This group was responsible for management of the entire planning process in the

district and also for provision of technical support. Thus the DCG not only owns the

plans but will also be responsible for monitoring the progress of implementation to

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achieve the objectives of the plan.

Goal

The National Rural Health Mission will strive to improve the availability of and

access to quality health care by people, especially for those residing in rural areas, the

poor, women and children and will achieve the following goals:

Reduction in Infant Mortality Rate (IMR) and Maternal Mortality Ratio (MMR)

Universal access to public health services such as Women's health, child health,

water,

sanitation & hygiene, immunization, and Nutrition.

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