DISTRICT HEALTH ACTION PLAN District Sambadocuments.gov.in/JK/13474.pdf · DISTRICT HEALTH ACTION PLAN District Samba ... Dr. R.S Charak M.O DTC Health ... Dr. B.K Sharma BMO Dansal

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GOVERNMENT OF JAMMU AND KASHMIR

NNAATTIIOONNAALL RRUURRAALL HHEEAALLTTHH MMIISSSSIIOONN

DISTRICT HEALTH ACTION PLAN

District Samba

December 2007

SPECIMEN DRAFT

RESTRICTED USE

FOR EPOS STAFF UNDERCONTRACT

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PREFACE

The Hon’ble Prime Minister launched the NRHM on 12th April 2005 throughout the country with

the basic objective of providing accessible, affordable and accountable health care in rural

areas. Its primary focus is on making the public health system fully functional at all levels. While

detailing the functioning of the NRHM, the present planning process initiated in the State

provides the entire framework for making the Public Health System fully functional and

standardized upto the Indian Public Health Standards at all levels. In doing so, it emphasizes

the need for communitisation of the Public Health System, improved financing and management

of public health, human resource innovations, and a long-term financial commitment to enable

the state and districts to undertake programmes aimed at achieving the Mission goals.

National Rural Health Mission envisages the planning process to be participatory and

decentralized starting with the Village. It seeks to empower the community by placing the health

of the people in their own hands and determine the ways they would like to improve their health.

This is the only way to ensure that health plans are local specific and need based. The State

should facilitate the processes by providing enabling environment and required financial and

technical support. NRHM was launched in April 2005 and is being implemented by the

Department of Health and Medical Education, Government of Jammu & Kashmir.

In accordance with the National Rural Health Mission, Jammu & Kashmir. The district has

constituted the District Health Mission and significant progress has been made since it’s

beginning. As per the NRHM guidelines, it has merged multiple societies at the district level.

The District Action Plan was the most important aspect of the NRHM and to make District Plan

more meaningful and address local health problems, preparation of Block Health Plans was

considered essential. The decentralized planning process involved village consultations and

preparation of Village Health Plans by the Village Health Water and Sanitation committees;

followed by development of Block Action Plans through integration of Health Facility Surveys

and block specific needs. The Block Action Plans were then integrated to form District Action

Plan.

As result of this exercise, the district now has developed capacity for preparing the need based

health action plans following participatory processes. A District Planning Team (DPT) was set

up for this purpose in the month of July 2007 with representation from various sectors

concerned with NRHM. This group was responsible for management of the entire planning

process in the district and also for provision of the technical support. The DPT is the standing

body and will take charge of ensuring implementation of the plan. Thus the DPT not only owns

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

the objectives of the plan. The members of the DPT are:

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S.No. Name Designation Department

Charanjeet Singh Additional D.C D.C office

Dr. Shahid Mughal CMO Health

Romesh Chowdhery CEO Education

Dr Romesh Khajuria ZLO Health

Dr. Javed Akthar Dy. CMO Health

Dr. Ashok chayal BMO Sohanjna Health

Dr. R.S Charak M.O DTC Health

Dr. Jagdish lal BMO Akhnoor Health

Dr. Jaffar Ali Chib BMO Ramghar Health

Dr. Daljit Singh BMO Samba Health

Dr. Ram Dha BMO Bishnah Health

Dr. Rajinder Bhagat BMO Parmandal Health

Dr. Satpal Programme officer Social Welfare

Rachna Sharma Distt. Social welfare officer Social Welfare

Dr. Des Raj Mewis BMO Kot Bhalwal Health

Dr. DJ Raina R.S Pura Health

Dr. B.D Sharma BMO Pallanwala Health

Dr. T.R Sandal Astt. D Medical officer

R.K Raina Project Economist with ADDC Rural Development

Dr. B.K Sharma BMO Dansal Health

S.K Sabina Administrator Health

Payal Mengi DPM Jammu NRHM Health

Paramjeet Baus District Accounts Manager Jammu Health

Dr. Such Sharma Nodal Officer for DAP Health

Dr. Bal Nodal Officer Directorate of health Health

Dr. Tej Ram Nodal Officer NRHM Health

Prem Nath Ex. Eng., PHE DIV CITY-1 PHE

Ram Rattan CPO DC Office

The orientation of DCT, facilitated by EPOS Health India, was held on 7th July 2007. This

enabled the DCT members to not only understand NRHM approach, key components and

strategies of NRHM, but also manage the planning process and develop the District Action Plan.

The DCT met a number of times and the individual members reviewed the situation of their

respective sectors/areas and collectively developed the strategic vision for improving the health

status of the district population.

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A meeting of the District Planning Team was held on the 14th January 2008 in which the

strategies, activities proposed and the budgets were discussed and the District Action Plan was

finalized

We the members of the DPT on behalf of the entire Core Team reiterate and certify that this

District Action Plan has been prepared through participatory processes. It has been developed

by integrating the Block Action Plans prepared by integrating health facility surveys and village

health plans in each block of the District. This plan also incorporates the needs and plans from

82 Sub health centres, 15 PHCs, 2 CHCs in the District.

Name of Chief Medical Officer Signature Date

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CONTENTS

PREFACE ........................................................................................................................... 4 ABBREVIATIONS ............................................................................................................... 8 INTRODUCTION............................................................................................................... 10 PRIORITY MATRIX OF THE DISTRICT ........................................................................... 12 EXECUTIVE SUMMARY................................................................................................... 16 1. SITUATION ANALYSIS................................................................................................. 19 SOCIO-ECONOMIC AND HEALTH INDICATIORS OF THE DISTRICT........................... 26 2. PLANNING PROCESS ................................................................................................. 41 3. PRIORITIES AS PER BACKGROUND AND PLANNING PROCESS........................... 46 4. GOALS.......................................................................................................................... 48 5. TECHNICAL COMPONENTS ....................................................................................... 50

PART A: REPRODUCTIVE AND CHILD HEALTH (RCH) II .......................................... 50 PART B: NEW NRHM INITIATIVE................................................................................. 69 PART C: IMMUNIZATION ............................................................................................. 84 PART D: NATIONAL DISEASE CONTROL PROGRAM ............................................... 91

6: INTER- SECTORAL CONVERGENCE....................................................................... 105 7. COMMUNITY ACTION PLAN ..................................................................................... 113 8. PUBLIC PRIVATE PARTNERSHIP............................................................................. 115 9. GENDER AND EQUITY .............................................................................................. 117 10. CAPACITY BUILDING .............................................................................................. 119 11. HUMAN RESOURCE PLAN ..................................................................................... 123 12. PROCUREMENT AND LOGISTICS.......................................................................... 124 13. DEMAND GENERATION - IEC................................................................................. 126 15. HMIS, MONITORING AND EVALUATION................................................................ 129 16. BIO-MEDICAL WASTE MANAGEMENT................................................................... 131 Annexure......................................................................................................................... 149

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ABBREVIATIONS

ANC Ante Natal Care

ANM Auxiliary Nurse and Midwife

ASHA Accredited Social Health Activist

BPHC Block Primary Health Centre

CBO Community Based Organizations

CHC Community Health Centre

CMO Chief Medical officer

DoHFW Department of Health and Family Welfare

DH District Hospital

ENMR Early Neo-natal Mortality Rate

EmOC Emergency Obstetric Care

EAP Externally Aided Projects

FRU First Referral Unit

HMIS Health Management Information System

HIV Human Immuno-Deficiency Virus

IPHS Indian Public Health Standards

ISM Indian System of Medicine

IMNCI Integrated Management of Neo-natal & Child Illness

JSY Janani Suraksha Yojana

IMR Infant Mortality Rate

NMR Neo-natal Mortality Rate

MTP Medical Termination of Pregnancy

MMR Maternal Mortality Rate

MNGO Mother NGO

MO Medical Officer

MH Maternal Health

NNMR Neo-Natal Mortality Rate

NGO Non-Government Organization

NRHM National Rural Health Mission

NAMP National Anti Malaria Programme

NLEP National Leprosy Eradication Programme

NKAP National Kala-Azar Programme

NFP National Filaria Programme

NIDDP National Iodine Deficiency Disorder Programme

NBCP National Blindness Control Programme

OPD Out Patient Department

PNMR Primary Neo-natal Mortality Rate

PHC Primary Health Centre

RH Rural Hospital

RCH II Reproductive and child Health Programme-II

RI Routine Immunization

RNTCP Revised National Tuberculosis Control Programme

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SDH Sub-divisional Hospital

SHSDP II State Health System Development Project-II

SGH State General Hospitals

SRHM State Rural Health Mission

TFR Total Fertility Rate

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INTRODUCTION Jammu and Kashmir initially had 14 districts namely Kupwara, Baramulla, Srinagar, Budgam,

Pulwama, Anantnag, Leh (Ladakh), Kargil, Doda, Udhampur, Poonch, Rajouri, Jammu and

Kathua. But their number has now been increased to 22 by Government Order. The newly

added districts in Jammu Division are: Ramban, Kishtwar, Samba & Reasi and in Kashmir

Division are: Ganderbal, Shopian, Kulgam and Bandipora. These districts are in the process of

boundary demarcation. Total population of the State was 1,00,69,917 in 2001. The decadal

growth rate was 29.04 during 1991-2001. Overall density of population in the State was 90

persons per square Kilometre. Sex ratio was 900 females per thousand males.

Mission Statement

The Mission of the department of Health and Family Welfare is to work in active partnership with

the community to ensure health and well being of all its citizens.

Vision

The vision of the government of J & K is to achieve the goals and objectives envisaged in the

NPP-2000, NHP-2002, and the 10th Plan and those under NRHM. We envision path breaking

progress and development in healthcare delivery in all the districts in the state. We plan, making

available the necessary health care for improving the primary health care services, secondary

health care, specialised medical care through an integrated, focused and participatory

programme.

Based on earlier lessons learnt from implementation of various health programmes and

projects, the project incorporates certain changes such as adopting a uniform structure of the

program; strong supervision and monitoring with advanced analytical tools; and greater inter-

sectoral convergence at all levels.

The Road Map

The Road Map to achieve the aforesaid vision is that the State would strive for achieve various

indicator in a rising trend mode, that is, in the earlier years (say FY 2007 and FY 2008) the

objectives are to be achieved a bit slow initially but picking up in FY 2009 through to FY 2011.

There is a need to schedule extension and up gradation of services over five years period

keeping in view growth in population and absorptive capacity of the State in general and district

in particular.

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The support and resources made available through NRHM initiatives and through convergence

would be utilised for the purpose.

In order to propel and sustain the desired progress, there is an urgent need to construct,

upgrade and renovate health infrastructure and health facilities to make them fully functional.

Consequently, more investment is needed upfront on creation of the necessary infrastructure,

construction, civil works, renovation and maintenance. There is a need for increased investment

in this respect in earlier years (say FY 2007 and FY 2008) in this respect.

Also, a lot of activities cannot materialise due to the shortage of human resources in the state

health services. Thus, there is an urgent need to recruit professionals and support staff on a

priority basis. In the short term, this may be achieved by filling vacancies on contract basis.

However, to attract requisite staff, compensation needs to be based on reasonable calculations.

It needs to be attractive enough for persons to join and continue.

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PRIORITY MATRIX OF THE DISTRICT # Thematic Area Critical Issues of the District Specific Priorities

District Health Management:

Samba district has recently been bifurcated from Jammu that’s why district health society is not established yet. Functional integration of vertical societies like Blindness Control Society, TB Control Society, District Malaria Society etc. Monitoring and evaluation.

Constitution of District Health Society. Societies need functional integration and strengthening. Capacity building of the DHS members regarding the programme, their roles, various schemes and mechanisms for monitoring and regular reviews and also operational guidelines for running the District Health Society. Monitoring of health activities by health personnel only. Members from other departments and also from the elected representatives need to become members for better monitoring and implementation.

District & Block Programme Management

Need for providing more technical support to the CMO office for better implementation especially in light of the increased volume of work in NRHM. Strengthening the monitoring and reporting especially in the areas of Maternal and Child Health, Civil works, Behaviour change and accounting right from the level of the Subcentre.

Development of total clarity at the district and the block levels amongst all the officials and Consultants about NRHM activities Training of district officials and Block SMOs for programme management Streamlining Financial management and systems Strengthening the CMO office with DPMU with extra computers, telephone system and human resources. Capacity building of the DPMU personnel for monitoring Strengthening the Block Management Units by establishing BPMUs.

Reducing maternal and child deaths and Population stabilization

Lack of 24X7 facilities for safe deliveries in subcentres and PHCs. Lack of authentic data regarding the maternal and infant deaths in the district. Equipments are not working properly or not available as per the need in subcentres, PHCs & CHCs to provide quality services. Lack of facilities with for emergency obstetric care. Non-availability of Specialists for an aesthesia, obstetric care, paediatric etc. Lack of referral transport

Increase coverage of full ANC and Postpartum Care to pregnant women Increase in Institutional deliveries by operationalsing 24X7 PHCs Strengthen FRUs for Emergency Obstetric Care services along with minimum basic infrastructure, Blood Storage facilities, Facilities for Neonatal Care, drugs and equipments. Increase availability of safe abortion services at all block level CHCs/ PHCs. Increased coverage under JSY Strengthening the Village Health Day To increase awareness among mothers and communities about the importance of institutional deliveries Improved behaviour practices in the

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systems. Lack of Blood Storage facilities at FRUs Lack of Neonatal care facilities at FRUs

community Operationalization of all the sanctioned Anganwadis

Family Planning

Low level of FP acceptance due to lack of awareness or motivation and low male participation

Increased awareness for Emergency Contraception and 10 yr Copper T Decreasing the Unmet Need for Family Planning Ensure availability of all FP methods at block level facilities. Train more MOs for NSV and promote the same. Partner with private doctors for FP and RCH services Increasing Access to Emergency Contraception and spacing methods through Social marketing Building alliances with other departments, PRIs, Private sector providers and NGOs

Adolescent Health

Adolescents especially the boys are exposed to smoking, addictions, peer pressure and there is no one to counsel them. Teenage pregnancies also emerging as a problem and unsafe abortion & premarital sex trend are on rise.

Implement ASRH programme to increase the knowledge levels of Adolescents on RH and Life skills Implement of Kishori Shakti Yojana in coordination with ICDS and NGOs. Operationalise Adolescent Friendly Health services at the health facilities

Mobile Medical Units (MMUs)

Remote population is not covered due to lack of required staff, infrastructure. Communications system is poor.

Coverage of the tribal populations which are migratory in blocks. Provide one-MMU equipped with GPRS for services. Contract MOs and staff nurses for MMUs

Upgrading CHCs to IPHS

None of the CHCs are as per the IPHS standards.

Following CHCs needs to be upgraded as per IPHS Standards in the first year:- CHC Samba. CHC Ramgarh

Upgrading PHCs for 24 hr Services and IPHS standards

None of the PHCs are as per the IPHS standards. Out of 15 PHCs and Allopathic Dispensaries, 10 PHCs are housed in government buildings and 5 are still functioning from rented accommodation All of the PHCs/ADs are without staff quarters

Construction of 5 buildings PHC buildings as per IPHS standards. Names of PHCs are enclosed as Annexure-1 Construction of staff quarters in 15 govt. PHC (Names of PHCs given in Annexure – 1)

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Upgrading Sub Centres to IPHS standards

None of the Subcentres are as per he norms of IPHS Out of 82 subcentres, 54 subcentres are running in rented buildings and 28 subcentres are running from government owned buildings. There are no labour rooms in any of the Subcentres for Institutional deliveries There is no staff quarter in any of the subcentres of the district Samba. The numbers of Subcentres is also inadequate

Need to construct 54 Subcentre buildings (Names of SCs are enclosed as Annexure-2) Construction of staff quarters in all subcentres for ANM’s stay. (Names of subcentres given in Annexure - 2) Construction of Labour rooms at all Subcentres for promoting institutional deliveries

Immunisation Lack of awareness to mothers Alternate vaccine delivery Lack of Cold storage Efficient monitoring and supervision Gaps in difficult, flung areas & inaccessible areas Reporting and documentation Large number of cold chain equipment are not functional and need repair or need to be replaced

Strengthening the District Family Welfare Office Enhancing the coverage of Immunization Alternative Vaccine delivery mechanisms in place Effective Cold Chain Maintenance upto sub centre level Zero Polio cases and quality surveillance for Polio cases Close Monitoring and documentation of the progress Repair and replacement of cold chain equipment as per the need

Lack of coordination b/w ICDS and health department

Linkages to be developed between ICDS workers and health workers for timely diagnosis of malnourished children and their management (detailed activities under thematic heads)

Inter Sectoral Convergence

Lack of coordination b/w RDD and health department

Linkages to be developed between the Health Department and the Rural Development department Improving the health standard & general quality of life of rural community. Awareness on sanitation/ Hygiene & health education. Covering of school/ Anganwari in rural areas with sanitation facilities & promote Hygiene education & sanitary habits among students. Promote & encourage cost effective construction of household latrine & their proper use. Elimination of open defection to minimise the risk of contamination of water source & food.

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Lack of coordination b/w PHE and health department

Bleaching powder and chlorine tablets will be provided by PHE and distributed by field functionaries to households Joint communication strategy. Copy of water quality monitoring reports generated by IPH department will be shared with the Health Department at block, district and state levels Community based organisations formed under various programmes/sectors will be engaged by a team of frontline workers – health, ICDS and PHE departments.

Human Resource

Lack of manpower at all levels starting from sub centres to PHCs to CHCs in district Samba. Sub centre level The requirement of ANM as per IPHS norms of 2 ANMs per Sub centre. PHC level The PHC are adequate As per IPHS 2 MOs per PHC will be required whereas at resent there is only one MO per PHC CHC Level Likewise there are many vacancies of specialists and support manpower at CHCs

All staff to be in place as IPHS norms by 2012 Increased salaries for contractual doctors and Specialists Special allowances for Regular staff Increase in the number of training centres for LHV, ANM, Staff Nurses, Lab Technicians Rational placement of Specialists and trained staff Recruitment of staff on contract where vacancies Recruitment of staff for new facilities as per the infrastructure requirements Computers at all PHC and for each MO and Specialist at the CHC Allowing Specialists and MOs for developing special skills as per their needs by attending special courses anywhere in India.

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EXECUTIVE SUMMARY Samba district comprises of large unserved and underserved areas due to difficult hilly terrain in

some of the blocks. Hence there has been very little development including lack of health

facilities, poor transport network and communication. Although the number of PHCs is adequate

as per the population norms there is a need to increase their numbers of CHCs and Subcentres.

Not even one of the facilities is as per the IPHS standards.

The health status of district Samba is not very bad since the district ranks 123 out of 593

districts in the country in terms of RCH indicators. The data collection and analysis needs

strengthening. Regarding the HR status there are huge vacancies especially of some critical

posts like ANMs, MOs, Staff Nurses.

The District Action Plan was developed in a participatory manner with EPOS as a facilitator.

There was wide participation from all the related departments. A District Planning Team was

constituted who carried out the block consultations and the Subcentre level consultations.

Facility Survey was carried out for each facility. The consultations focussed on each of the

thematic areas with the present situation, the bottlenecks, strategies and how to achieve the

goals. The hot spots were identified from the village plans and the Block plans after

incorporating the Facility survey reports, were consolidated to form the district plan.

The District Action Plan comprises of the situational analysis, goals and objectives for each of

the defined indicators, strategies, activities, support required from the state, workplan and the

budget for each of the thematic areas. All the aspects of health have been incorporated

including the NRHM additionalities of ASHA, Untied funds, Mobile Medical Unit, Facilities as per

IPHS norms, the National Disease control programmes, and Intersectoral Coordination and

Community involvement. Capacity building and Human Resources have been dealt with in

details. The other Cross cutting issues of Gender, Logistics and Warehousing, HMIS, IEC and

Biomedical Waste management have been also incorporated

The priorities of the district include providing services for the unreached, accurate data

collection, strong district management, developing facilities as per IPHS norms and thereby

meeting the national goals of NRHM.

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NRHM BUDGET - AT- A GLANCE (in lakhs)

#. Components 08-09 09-10 10-11 11-12 Total

A RCH-II

1 DHS 1.62 2.03 2.25 2.46 8.36

2 DPMU 232.21 103.96 113.18 126.54 575.89

3 Maternal health 105.93 106.49 109.46 121.37 443.25

4 Child Health 48.55 13.80 14.98 16.78 94.13

5 Family Welfare 36.55 36.79 49.44 57.69 180.47

6 Adolescent Health 23.29 18.25 20.17 22.18 83.89

9 Gender & Equity 19.20 22.22 24.43 26.85 92.70 10 Capacity Building 94.70 74.89 76.90 29.73 276.22

11 HR 340.21 345.66 399.40 407.58 1492.85

12 IEC 47.25 36.67 39.24 43.15 166.31

13 HMIS 61.06 9.61 9.85 10.23 90.75

Total A 1010.59 770.37 859.30 864.54 3504.80 B NRHM

1 ASHA 62.82 26.42 26.60 26.80 142.64

2 SC Untied Fund & Maintenance 18.20 18.60 19.20 19.80 75.80

3 PHCUntied Fund & Maintenance 11.25 11.25 11.25 11.25 45.00

4 CHCUntied Fund & Maintenance 8.00 8.00 9.00 9.00 34.00

5 MMU 39.47 14.06 15.53 17.13 86.18

6 Upgradation of GH & CHC 899.42 34.05 174.99 45.40 1153.86

7 Upgradation of PHC 674.73 121.01 77.35 84.32 957.40

8 Upgradation of SC 254.05 189.94 263.05 203.05 910.09

9 VHWSC 17.30 17.30 17.30 17.30 69.20

10 Commuity Action Plan 25.49 28.04 30.84 33.92 118.29

11 PPP 2.75 3.03 3.34 3.74 17.36

12 Health Care Financing 31.42 26.67 26.67 26.67 111.41

13 Logistics 140.81 3.81 4.19 4.62 153.43

Total B 2185.70 502.17 679.30 502.99 3870.16

C Immunization 66.92 71.47 77.86 84.96 301.21

Total C 66.92 71.47 77.86 84.96 301.21 D NDCP

1 RNTCP 46.37 42.83 44.68 51.60 185.47

2 Leprosy 5.40 6.15 6.55 7.15 30.05

3 Malaria 194.66 188.48 206.79 227.20 817.13

4 Vector Borne 5.22 5.80 6.38 7.02 24.43

5 Blindness Control 27.32 30.05 33.06 36.37 126.80

6 IDSP 40.51 20.66 24.65 29.28 115.10

7 IDD 9.22 10.25 11.28 12.40 43.15

Total D 328.70 304.23 333.38 371.02 1337.33 E Others

1 InterSectoral 69.1 71.7 74.4 77.5 292.7

2 School Health 30.3 33.3 36.6 40.3 140.5

3 BioMedical Waste Management 18.3 20.5 22.5 24.7 86.0

Total E 117.8 125.4 133.6 142.5 519.2 Grand total 3709.66 1773.65 2083.40 1966.00 9532.71

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The above chart showing the status of the district in the country (Source- JSK, New Delhi-2007). Out of 593 districts ranked on selected RCH indictors, Samba district has got an overall rank of 123.

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1. SITUATION ANALYSIS Profile of Samba District Samba District is one of the 22 districts of the State of Jammu and Kashmir and recently been

carved out from parent Jammu district. In the North, Jammu and Udhampur districts bound the

district; district Kathua in the South. Samba is situated on the banks of river Tawi.

About one-fourth part of the district is hilly constituting Purmandal Block. Forest covers about a-

third of the area of the district. Consequently, Samba consists of difficult and inaccessible areas.

Distinguishing features

There are certain features in respect of J and K State in general, and Samba district in

particular, which have affected the availability and reliability of data. Some of the useful features

of the district are as under:

Parts of the districts are hilly. In certain CD Blocks most of the portion is inaccessible and hilly.

Further, forest covers good proportion of the area of the districts. Consequently, depending

upon topography, all the districts consist of difficult and inaccessible areas. While it is difficult for

the people to access services, on one hand, on the other, it is also difficult for health services to

extend, upgrade and improve services. It is difficult to organise outreach activities and maintain

regular supplies, especially in the context of essential medicines, vaccines, etc.

Due to the lack of amenities, it is very difficult to attract and retain human resources. There are

significant number of vacancies in respect of various professional (specialists, surgeons,

GDMOs), nursing, technical and support staff. This necessitates development of human

resources policies and strategies appropriate to the region. In this connection modes like PPP

and contracting may be used but after proper elaboration of the terms and conditions and

payment system

There seems to be different administrative units prevalent in respect of different agencies

(Census, Revenue Department, Medical and Health, etc.). The Medical and Health department

has Medical Blocks. There are Tehsils, Community Development Blocks, Medical Blocks,

Panchayats, Patwar Halqas, Gram Sabha and Villages. The units, which are conventional and

are adopted by Agencies like Census and Rural Development Department may be taken as

popular units than inventing or adopting different administrative units (for example Medical

Blocks). It is some time difficult to reconcile geographical areas covered by them, which renders

it impossible to compare data emanating from different units.

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Even at the lowest level, the concept of village is a bit misleading. Excepting some, most of the

villages do comprise a number of settlements with different names than the overall village;

commonly known as ‘Modas’. Usually it takes considerable time to travel from one settlement to

another, especially in hilly areas. This aspect is particularly important, inter alia, when we chose

Anganwadi Worker or ASHA or conduct immunisation sessions.

As motorable roads do not connect all settlements, travelling on foot and local modes of

transport becomes necessary. At some hilly and inaccessible places, mules are resorted to for

transportation of supplies as well as ill or incapacitated persons. Consequently while tackling

about the issues of accessibility (from the side of community) as well outreach and ensuring

timely supplies (on the part of Health Department and other agencies), these factors need to be

taken into account and provided for in the future plans.

Administrative The District Samba has 3 medical blocks 72 Gram Panchayats and 472 inhabited villages.

District headquarters is situated at Samba and comprised of Samba, Ramgarh and Purmandal

blocks. Total population of the district as per block data is 2,63,818 and density of population

presently is 649.6 persons per square Km.

Identifying information

Name of District Samba

Name of District Headquarters Samba

No. of Blocks in the District 3

No. of Gram Panchayats in the District 72

No. of Villages 472

1-500 212 501- 1500 221 1501-5000 28

Size of Villages

5000+ 11

Villages without motorable roads DNA

Villages without electricity Nil

No. of Towns 1

Municipal Corporation Municipality Notified Area Committee

Urban Local Bodies (ULB)

Others

Municipality 1

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Un-served / underserved / vulnerable areas, population in the District - There were 32.56% population belong to Scheduled Caste (SC) and 2.7% belonging to Tribal (ST) according to 2001 Census. * Here Jammu has been considered as the parent district. Development Indicators of the District S.No Indicators State District as per District data

1 Crude Birth Rate 18.7 SRS -05 31.47

2 Crude Death Rate 5.6 SRS -05 DNA 3 Infant Mortality Rate 49.0 SRS -05 50*

5 TFR 2.4 NFHS III 2.7

6 Couple Protection Rate 53 % NFHS III 61%

7 Decadal Growth Rate 29.93 31.1

8 Population Density 99/ sq. km 650

9 Sex Ratio (General) 900 Census 2001 868

10 Sex Ratio (0 – 6 years) 937 Census 2001 893

11 Sex Ratio at birth DNA DNA

12 Literacy rate (overall) 54.46 Census 2001 77.30

13 Literacy rate (male) 65. 75 Census 2001 84.4

14 Literacy rate (female) 41.82 Census 2001 68.5

T 77158 M 38599 15

Enrolment of students elementary education

F 38559 Source: Census, 2001; DLHS-RCH-II Survey, 2004

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Information on Services as per DLHS Survey Information related to certain aspects of services, in Samba district is given below. Family Planning Knowledge of any modern family planning method 96.8 Knowledge of any modern spacing family planning method 89.6

Knowledge of all modern family planning methods 35.1 Knowledge of any traditional method 26.2 Current use of any family planning method 73.2 Current use of any modern family planning method 69.7 Current use of any traditional family planning method 3.5 Current use - Female sterilization 11.5 Current use - Male sterilization 2.1* Current use - Male sterilization 5.4* Current use – PILLS 4.2 Current use – CONDOM 46.1 Unmet need

Unmet need for limiting-1 3.4 Unmet need for spacing-1 0.8*

Unmet need -total-1 4.2

Unmet need -total-1 3.4 Unmet need for spacing-2 4.8



RTI/STI Women aware of RTI/STI 11.1 Women aware of HIV/AIDS 72.4 Women had side effects due to use of female sterilization 3.8* Women had side effects due to use of IUD 13.9* Women had side effects due to use of Pills 6.8* Women who had any symptom of RTI/STI 25.7 Sought treatment abnormal vaginal discharge 46.7 Women who utilized government health facility for treatment of RTI/STI (vaginal discharge)

94.7*

Birth order 3+ 18.5

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Age of marriage Mean age at marriage for boys 27.4

Mean age at marriage for girls 22.7

Boys married below legal age at marriage 21 years 0.7

Girls married below legal age at marriage 18 years 0.0

Antenatal check up Any antenatal check up 88.8 3 or more antenatal check ups 82.9

Antenatal check up at home 0.0* Who had no TT injection during pregnancy 8.8*

Who had one TT injection during pregnancy 8.8* Who had two or more TT injection during pregnancy 69.9

Who consumed one IFA tablet regularly 54.3

Who consumed two or more IFA tablets regularly during pregnancy

23.3

Check-up during pregnancy

Who received 100 or more IFA tablets during pregnancy 61.2

Received adequate IFA tablets/syrup 64.6

Full ANC1 - (Atleast 3 visits for ANC + atleast one TT injection + 100 or more IFA tablets

44.8

Full ANC2 - (Atleast 3 visits for ANC + atleast one TT injection + 100 or more IFA tablets/syrup

46.2

Institutional delivery 72.7

Institutional delivery – government 61.9

Institutional delivery – private 10.8

Home delivery 26.0 Safe Delivery (Either institutional delivery or home delivery attendent by Doctor/Nurse/TBA)

90.4

Safe Delivery (Either institutional delivery or home delivery attendent by Doctor/Nurse)

75.8

Women who had pregnancy complications 48.8

Women who had delivery complications 49.7

24

Post delivery complications Women who had post delivery complications 44.9 Women who had Menstruation related problems 5.4

Sought treatment for Pregnancy complications 82.2

Sought treatment for Post delivery complications 81.7 Women visited by ANM/Health worker 5.3

Women who had said health worker spent enough time with them 73.2

Women who satisfied with service/advice given by health worker 97.7

Women who utilized government health facility for antenatal care 76.6

Women who utilized government health facility for treatment of pregnancy complications

81.7

Women who utilized government health facility for treatment of post delivery complications

81.8

Breastfeeding Breastfeeding within 2 hours (children age below 36 months) 52.8

Percentage whose mother squeezed out the first breast milk (children age below 36 months)

78.5

Exclusive breastfeeding atleast 4 months (children age 4-12 months)

29.6

Immunization

Percentage of children age 12-35 months received Polio 0 94.0

Percentage of children age 12-35 months received BCG 92.1 Percentage of children age 12-35 months received DPT3 49.8 Percentage of children age 12-35 months received POLIO 3 55.1

Percentage of children age 12-35 months received Measles 78.1

Percentage of children age 12-35 months received Full Immunization

44.0

Percentage of children age 12-35 months not received any vaccination

2.2

Aware of diarrhoea 90.5 Knowledge of ORS 75.1

25

Child Care Who had diarrhoea (two weeks prior to survey) 3.1

Given ORS to children during Diarrhoea 70.5

Sought treatment for Diarrhoea 78.9

Aware of danger signs of Pneumonia 44.0

Who had Pneumonia (two weeks prior to survey) 14.3

Sought treatment for Pneumonia 95.1

26

SOCIO-ECONOMIC AND HEALTH INDICATIORS OF THE DISTRICT

Name of the block

Total for District

Name of Health Blocks Purmandal Ramgarh Samba

Demographic indicators

Total Population 95714 85734 82370 263818

Population of males 53174 45415 42370 140959

Population of females 42530 40319 39650 122499

Population of children less than a year old DNA DNA DNA DNA

Population of children in age group between 1 and 6 years

DNA DNA DNA DNA

% Scheduled Castes 39.23% 30.34% 28.12% 32.56%

% Scheduled Tribes 0.74% 4.18% 3.19% 2.70%

Number of Inhabited Villages NA NA NA NA

Socio-economic indicators

No. of <3 children benefiting from the ICDS scheme

2416 4499 2287 9202

No. of children aged 3 years and above benefiting from the ICDS scheme

1356 1977 1474 4807

No. of BPL households 2430 2842 4990 10262

No. of girls enrolled in primary schools last year 1436 2367 1415 5218

No. of girls dropping out of primary schools last year

14 24 14 52

Number of overhead tanks or hand pumps DNA DNA DNA DNA

Number of functional hand pumps in sub centres DNA DNA DNA DNA

Number of wells currently being used for drinking water purposes

DNA DNA DNA DNA

Number of households with access to toilets DNA DNA DNA DNA

27

No. of private health facilities/clinicians DNA DNA DNA DNA

No. of women who have benefited through the JSY Scheme till now[1]

111 117 112 340

No. of girls who got married last year DNA DNA DNA DNA

No. of girls who got married last year and were <18 years at the time of marriage

DNA DNA DNA DNA

Health Indicators

No. of Tubectomies conducted in the last reporting year

208 268 210 686

No. of IUD insertions done in the last reporting year

49 4 16 69

No. of vasectomies done in the last reporting year 0 398 128 526

No. of pregnant women DNA DNA DNA DNA

No. of pregnant women registered for ANC during the last reporting year

2030 3626 1736 7392

No. of pregnant women who received both TT1 and TT2 during pregnancy in the last reporting year

1550 4985 1387 7922

No. of institutional deliveries in the last reporting year

391 354 287 1032

No. of women operation of MTPs in the last reporting year

27 44 89 160

No. of RTI/STI cases reported in the last reporting year

0 0 5 5

No. of children given measles vaccine in the last reporting year

3874 1831 2155 7860

No. of outpatients (monthly average) 7054 10815 1000 18869

No. of inpatients (monthly average) 3 268 200 471

1

2 Prevalent Diseases

3

28

TUBERCULOSIS and LEPROSY

No. of patients currently undergoing DOTS therapy in the block

0 79 193 272

Number of new leprosy cases reported in last reporting year

109 109

NVBDCP

No. of slides examined for malaria in last reporting year

13521 11976 17181 42678

No. of notified malaria cases (last reporting year) 4 4 0 8

No. of new kala-azar cases in the block in the last reporting year

NIL NIL NIL NIL

No. of microfilaria cases reported in the last reporting year

NIL NIL NIL NIL

No. of JE cases reported in the last reporting year NIL NIL NIL NIL

Blindness Control

No. of cataract operations conducted in the block last year

0 108 13 121

School Health Programme

No. of schools covered under in the last reporting year

41 58 24 123

29

Health Institutions, Population Coverage Ratios and Health Functionaries in the District

Name of Health Blocks Purmandal Ramgarh Samba Total for District

Health Institutions

No. of Speciality Hospitals 0 0 0 0 No. Referral Hospitals 0 1 1 2 No. of CHC/BPHCs 1 1 1 3 No. of Blood Banks 0 0 0 0 No. of CHCs (IPHS Standards) 0 1 1 2 No. of Blood Storage Units 0 0 0 0 No. of PHCs included Ads in the Block 7 3 4 14 No. of MOs in Positions 21 30 22* 73 No. of 24 hrs. PHCs 0 0 1 1 No. of MTP Centres 0 1 1 2 No. of Sub Health Centres 28 23 25 76 No. of ANMs in Position 34 29 37 100 No. of AYUSH Dispensaries 9 3 3 15 No. of Private Hospitals 0 0 0 0 No. of Anganwari Centres 158 287 179 524

Govt. 0 1 6 7 No. of Ultrasound Clinics Pvt. 3 2 15 20 Unregistered 1 1 5 7 Population Coverage Population covered

No. of Sub-centres covering more than the current norm (5000)

4 1 2 7

Health Personnel and Support Staff No. of Obstetricians Govt. 0 2 7 9 No. of Gynaecologists Govt. 0 2 7 9 No. of Paediatricians Govt. 0 2 7 9 No. of Surgeons Govt. 0 2 7 9 No. of Orthopaedists Govt. 0 1 1 2 No. of Dentists Govt. 0 1 1 2

No. of Eye Surgeons Govt. 0 0 0 0

No. of Gen. Physicians Govt. 0 2 7 9

No. of Radiographers Govt. 0 0 0 0 No. of Public Health Nurses 0 0 0 0 No. of Staff Nurses 2 7 10 19 No. of LHVs 2 3 4 9 No. of Pharmacists 29 24 22 75 No. of Lab. Technicians 1 2 0 3 No. X Ray Technicians 2 2 3 7 No of Ophthalmic Assts. 0 1 1 2 No. Dental Mechanics/Hygienists (Assistant.)

1 2 2 5

30

Name of Health Blocks Purmandal Ramgarh Samba Total for District

Health Institutions

No. of Male Health Supervisors(CHO) 2 4 4 10

No. of ANMs 34 29 37 100 No. of Male Health Workers 0 0 4 4 No. of AW Workers 158 248 179 585 No. of UDCs 3 5 6 14 No. of LDCs 0 1 1 2

No. of Computer/Statistical Assts. 1 1 1 3

No. of Drivers 3 4 3 10 No. of ASHAs selected 117 89 100 306 No. of Trained Dais 20 30 20 70

31

Percentage Availability of Infrastructure in Samba District:

Table:1 Percentage Availability of Infrastructure

District: Samba

Indicators

SC (82)

PHC+ AD (15)

CHC (2)

DH

1 Building (Govnt. + Donated) 41 68 100 NA

2 Building (Rented) 51 30 0

3 Condition of Building (Good + Fair) 67 90 86

4

Water Supply (Tap, borewell/ handpump/tubewell, well)

35 65 86

4.1 Tap water supply 13 30 71

5 Electricity 51 90 100

5.1 In all parts of hospital 0 74 86

Elertic supply (power generation stablization)

0 0 0

6 Separate Toilet 6 10 57

6.1 Sep.Toilet with running water 0 23 71

7 Examination Table 61 88 100

8 Labor Room 0 3 100

8.1 Aseptic labor room 0 0 0

9

Avail. of Quater for staff

24

41

50 (Specialists,MO & Ambulance Driver)

10 Number of beds available (Average) 3 17

11 Laboratory 32 100

12 Operation Theatare 6 100

13 Waste Disposal (Burnt+Dump) 98 100

14 Availability of incenator 0 0

15 Telephone 8 71

16 Computer 1 43

17 Generator/Invertor 1 86

18 Vehicle 15 62

19 Emergency Room / Casualty

100

32

20 Separate wards for males and females (Yes/No)

71

21 No. of beds : Male 9

22 No. of beds : Female 9

23 Availability of ECG facilities 86

24 X-Ray facility 100

25 Ultrasound facility 71

26 Cardiac Monitor for OT 100

27 Blood Storage Unit available 0

28 Blood Bank Facility

29 Other Investigative Facility

30 Heating ventilatoin & air conditioning

31 Lift & vertical transport

32 Refrigeration

Source: Health Facility Survey August 2007

33

Identified Gaps of Manpower in Samba District

Name of Blocks Samba Ramgarh Purmandal

No

. of

Req

uire

d

Sta

ff

No

. of

Exis

ting

S

taff

To

tal

Iden

tified

G

ap

s

No. of Sub- Centres IPHS Norm 25 23 34 82

ANM 2 34 26 45 164 59 105

N0. Of PHC's IPHS Norm 4 3 8 15

MO* 2 0 -12 4 30 38 -8

Pharmacist 1 0 -1 -1 15 17 -2

Nurse 3 9 5 20 45 11 34

Female Health Worker 1 -3 1 0 15 17 -2

Health Educator 1 0 2 7 15 6 9

Health Assistant 2 7 6 7 30 10 20 (one male and one Female)

Clerks 2 6 6 6 30 12 18

LT 1 -3 -1 5 15 14 1

Class lV 4 6 3 20 60 31 29

No. of CHC's 1 NA A. CLINICAL MANPOWER

IPHS Norm 1 2

1 General Surgeon 1 0 0 2 2 0

2 Physician 1 0 0 2 2 0

3 Obstetrician / Gynaecologist 1 0 0 2 2 0

4 Paediatrics 1 0 0 2 2 0

5 Anaesthetist 1 1 1 2 0 2

6

Public Health Programme Manager 1 1 1 2 0 2

7 Eye Surgeon 1 1 1 2 0 2 B. SUPPORT MANPOWER

1 Nursing Staff 7+2

A Public Health Nurse 1 1 1 2 0 2

b ANM 1 0 0 2 2 0

c. Staff Nurse

d. Nurse/Midwife 7 0 3 14 11 3

6 Dresser 1 0 0 2 2 0

34

7 Pharmacist / compounder 1 -2 -1 2 5 -3

8 Lab. Technician 1 0 0 2 2 0

9 Radiographer 1 0 1 2 1 1

10 Ophthalmic Assistant 1 0 0 2 2 0

11 Ward boys / nursing orderly 2 -14 -1 4 19 -15

12 Sweepers 3 -4 -1 6 11 -5

13 Chowkidar 1 1 1 2 0 2

14 OPD Attendant 1 1 1 2 0 2

15 Statistical Assistant / Data entry operator 1 1 1 2 0 2

16 OT Attendant 1 1 1 2 0 2

17 Registration Clerk 1 1 1 2 0 2

18 Any other staff (specify)

Note: ( - ) Surplus staff

Source: Health Facility Survey August 2007 (*There are 14 MOs available at AH, Vijaypur)

35

Average Percentage Availability of Drugs

Name of Blocks

Samba Ramgarh Purmandal Average % of the District

SC’s IPHS Norm

25 23 34 82

1

Name of Drug Quantity ( Kit- A )

5 0 20 13.89 11.29

2

Name of Drug Quantity ( Kit- B )

9 22.22 33.33 40 31.85

3

Drugs required by ANMs and LHVs

6 33.33 50 18.18 33.83

4

Other Drugs and Vaccines

8 75 62.5 20 52.5

5

Medicines required for NDCP

7 42.86 42.86 57.14 47.62

6 Contraceptives required for F.Plang.

4 75 75 46.88 65.62

7

Proposed Drug List for A.Wadi Centres

12 8.33 8.33 61.9 26.18

Total 106

33.33 37.25 45.45

PHC's IPHS Norm

4 3 8 15

1 Essential & emergecy obstetrics care drugs 38 18.42 15.79 13.89 38.67

2 Antidots 4 50 25 40 38.33

3 Anticonvulsant / Antiepileptics 4 0 0 18.18 6.06

4 Antiinfective Medicines 5 40 60 20 40

5 Antifilarials 1 0 0 57.14 19.04

6 Antibacterials 16 0 12.5 46.88 19.71

7 Dermatological medicine 14 42.86 42.86 61.9 49.20

8 Antileprosy & Antitubercullar 2 0 0 45.45 15.15

9 Antifungal medicine 4 25 25 29.41 26.47

10 Antiprotozoal medicine 5 40 40 70 50

11 Blood Products and Plasma Substitutes 13 15.38 23.08 66.67 35.04

36

12 Antiseptics 6 50 50 72.73 57.57

13 Disinfectants 3 66.67 66.67 46.15 59.83

14 Diuretics 2 0 0 66.67 22.22

15 Gastrointestinal 22 40.91 45.45 15.25 33.87

16 Hormones, Endocrine & Contraceptives 10 20 20 20 20

17 Ophthalmological preparation 12 33.33 25 16.67 25

18 Psychotic Disorders 15 13.33 6.67 6.67 8.89

19 Solutions correcting water Electrolyte and Acid- Base disturbances

9 77.78 66.67 77.78 74.07

20 Vitamins & Minerals 3 66.67 66.67 66.67 66.67

21 Drugs under RCH 1 0 0 0 0

22 Product Strength formulation Units 31 0 0 0 0

23 RTI / STI Drugs 10 30 40 30 33.33

24 Drugs and Consumable for MVA 6 50 50 50 15

TOTAL 236 25 25.42 20.76 23.72

CHC's IPHS Norm 1 1 N.A

2

1 Essential drugs 70 71.4 75.71 49.03 Source: Health Facility Survey August 2007

37

Average Percentage Availability of Equipments

Name of Blocks Samba Ramgarh Purmandal Total Avg.

No. of SC's IPHS Norm

25 23 34 82

Equipment kit ( kit- C )

55 20.0 16.4 12.7

No. of PHC's IPHS Norm

4 3 8 15

Suggested equipments 36 16.7 13.89 13.89 14.83 Operational labour room 10 20.0 20 40 26.67 Pap Smear 11 36.4 27.27 18.18 27.28 Laboratory Reagents 10 30.0 20 20 23.33 Glassware and other equipment

7 57.1 42.86 57.14 52.37

Furniture 32 56.3 53.13 46.88 52.10 TOTAL 106 34.9 30.19 32.32 32.47

No. of CHC's 1 1 N.A 2

Standard Surgical Set-1 32 25 37.5 20.83

Standard Surgical Set - II 33 30.3 30.3 20.20

IUD Insertion Kit 19 47.37 36.84 28.07

Standard Surgical Set - III 17 52.94 52.94 35.29

Normal Delivery 12 66.67 66.67 44.45

Standard Surgical Set - IV 16 56.25 56.25 37.50

Standard Surgical Set - V 21 57.14 61.9 39.68

Standard Surgical Set - VI 11 45.45 45.45 30.30

Equip. for Anaesthesia 17 11.76 11.76 7.84

Equip.for Neo-natal Resuscitation

10 70 70

46.67

Materials Kit for Blood trans. 15 66.67 66.67 44.45

Equip. for OT 11 63.64 72.73 45.46

Equip. for Labour room 13 53.85 53.85 35.90

Equip. for Radiology 9 66.67 66.67 44.45

TOTAL 236 46.19 47.88 31.36

38

Workforce Vacancy Position * Given below is the information about Workforce Vacancy Position in the District Category Sanctioned In position Vacant

Doctor 236 231 11

Pharmacist 280 235 45

FMPHW 359 318 41

Jr. Staff Nurse 74 66 8

Lady health Visitor 31 31 0

X- Ray Asstt. 23 20 3

Dental Asstt. 26 25 1

Theatre Asstt. 6 3 3

Opth. Asstt. 9 8 1

Electrician 3 3 0

Sanitary Inspector 5 5 0

Lab. Tech. 7 4 3

Lab. Asstt. 43 36 7

CHO 35 26 9

Health Educator 34 12 22

Ext. Educator 8 3 5

Food Inspector 10 9 1

Jr. Health Inspector 26 21 5

Malaria Inspector 10 7 3

Basic Health Worker 101 69 32

MMPHW 19 16 3

Head Asstt. 1 1 0

Sr. Asstt. 50 46 4

Jr. Asstt. 38 20 18

Nursing Orderly 194 184 10

Safaiwala 212 198 14

*Analysis of status of manpower [NRHM provides support for man power at sub-centre, PHC, CHC and FRU level]:

39

Status of Health Centre Buildings in the District Sub-Centre (SC) Status:- Sub Centres Overall Status

(Number) Sub-Centres in own building 28 Sub-Centre in Panchayat Bldg / rented building 72

SC without Electricity connection 34 SC without Water Supply 70 SC without Toilets 78

Number of Institutions Requiring New Buildings # Category of Institution Numbers

1 PHCs 4

2 SCs 72

3 CHCs -

Source: CMO office Number of Buildings Requiring Repairs # Category of Institution Numbers

1 PHCs 11

2 SCs 28

3 CHCs 2

Source: Health Facility Survey

40

Non-Governmental Organization [NGOs]: The department of Health and Family Welfare in the 9th Five Year Plan introduced the Mother NGO

scheme under the RCH Programme with underline indent of the collaboration to address the gaps in

RCH services, building institutional capacity as well as advocacy and awareness generation amongst

the community. The scheme aims at involving NGOs in service delivery and addressing RCH needs in

un-served and underserved areas. Under this scheme department of Family Welfare has identified and

sanctioned grants to selected NGOs called mother NGOs in each district of the State, these MNGOs

in-turn issue grants to smaller NGOs called Field NGOs for promoting goals and objectives of RCH

Programme.

Under revised MNGO scheme a sum of Rs 15 lakh is given to each MNGO for each district to carry out

Need based RCH intervention in underserved or un-served areas with special focus in providing basic

health care services and IEC activities.

Some NGOs also implemented RCH related projects in the district on issues such as Gender, MCH,

Immunization, RTI/STI management and adolescent Health etc by funds received from external donor

agencies or funds under externally aided projects available with state government

The district Health and FW society monitor the activities periodically.

There is no service NGO under SNGO scheme that could be identified despite of government efforts

Other significant contribution of NGOs is in health sector (e.g. Rotary Club conducts eye camps)

The List of few NGOs operation in District Samba is following:

Catholic Social Service Society (CSSS)

Kasturba Gandhi Memorial Trust (KGMT)

Kristu Jyoti Social Welfare Society

SCOPE

INDCARE Trust

41

2. PLANNING PROCESS A decentralized participatory planning process has been followed in development of this District Action

Plan. This bottom-up planning process began with consultations with block stakeholder groups, Block

/core Group members and village communities in all villages of each Block of the District.

Block Action Plans were developed based on the inputs gathered through village action plans

prepared by Village Health Water Sanitation Committees. The health facilities in the block viz. SCs,

PHC and, CHC were surveyed using the templates developed by Government of India. The inputs

from these facility surveys were taken into account while developing the Block Action Plan.

The District Planning Core Team (DPT) provided technical oversight and strategic vision for the

process of development of District Action Plan.

The members of the DPT had also taken the responsibility of contributing to the selected thematic

areas such as RCH, Newer initiatives under NRHM, immunization etc. Assessment of overall situation

of the District and development of broad framework for planning was done through a series of

meetings of DPT.

This District Action Plan has been prepared through a long process of integration of Block Action Plans

including Health Facility Surveys. An initial meeting was held in which the current status of the District

Action Plan was presented and suggestions and feedback taken. The membership and roles and

responsibilities of DCT and the chapterization plans were discussed. Based on the inputs received

from the Blocks, a draft of each chapter was developed after discussions. These were further improved

upon through individual consultations with Teams and nodal officers. Specific dates and times were

fixed for this purpose. A date was also proposed for a meeting during which the individual chapters

would be discussed and approved before the final DAP was prepared for presentation to the District

Health Society for approval.

42

Details of Events followed during District Action Plan Preparation in Jammu/Samba District: S.No. Meetings Held Dates

Orientation of State Level officials and Formation of SPAT 20th April 2007

Orientation of District Level officials and Formation of DPT 7th July 2007

Training of Field facilitators 3rd August 2007

Hands on training to Field Facilitators 7th -15th August

Orientation of Block Level officials and Formation of BPT for Purmandal Medical Block

12th July 2007

Orientation of Block Level officials and Formation of BPT for Bishna Block

14th July 2007

Orientation of Block Level officials and Formation of BPT for Pallanwala Medical Block

18th July 2007

Orientation of Block Level officials and Formation of BPT for Samba Medical Block

19th July 2007

Orientation of Block Level officials and Formation of BPT for Dansal Medical Block

20h July 2007

Orientation of Block Level officials and Formation of BPT for Ramgarh Medical Block

21st July 2007

Orientation of Block Level officials and Formation of BPT for Sohanjana Medical Block

23rd July 2007

Orientation of Block Level officials and Formation of BPT for R.S Pura Medical Block

24rd July 2007

Orientation of Block Level officials and Formation of BPT for Kot Balwal Medical Block

25th July 2007

Orientation of Block Level officials and Formation of BPT for Akhnoor Medical Block

26th July 2007

DAP Preparation Meetings with DHS at CMO office 3rd Aug – 15th Sept

Finalization & Review of DAP 16th Sept – 15 Oct

Signing & Approval of Final DAP for Jammu/Samba by DHS 14th January 2008

N.B: Under signing authority of JAMMU.

43

HEALTH SERVICE INDICATORS FOR THE DISTRICT BASIC HEALTH SERVICES

No. <1 years No. completely immunised

% of fully immunized children

Maximum 1% Minimum 0%

1

IMMUNIZATION COVERAGE < 1 YEAR OF AGE

45617 35132 77%

Total no. of pregnant women

No of women who got full antenatal care as defined

% of women getting antenatal care as defined


2 ESSENTIAL ANTENATAL CARE

58938 25185 42.7%

Total no. of pregnant women

Total no of women who had institutional delivery

% of pregnant women who had institutional delivery.


3 INSTITUTIONAL DELIVERY

58938 12664 21.49%

Total no. of births in the year

No. of newborn weighed within three days

Percentage of newborn weighed within three days


4

WEIGHING OF NEWBORN WITH IN THREE DAYS 45617 87 0.19

BREASTFEEDING IN FIRST HOUR

Total no of births in the last year

No of newborns who were breastfed in the first hour

Percentage of newborns who were breastfed within an hour


5

45617 DNA

Approx no of blood slides sent in last 12months

Average time taken for reporting of blood slide

Maximum over 30 days Minimum 1 day

6 REPORTING OF BLOOD SLIDE

83426 1 Week

No of target couples for sterilisation services ( > 2 children)

Total no. of couples with at least one of them wanting FP operation:

No. who wanted to get FP operation done last year but could not

% of unmet demand for FP operation


9 ACCESS TO STERILISATION SERVICES

(M) 10 (F) 7000

(M) 85 (F) 4235

HEALTH RELATED SERVICES WATER and SANITATION 15 USE OF

DOMESTIC/ COMMUNITY TOILET

Total no. of families

Total no. of families where all members are using domestic/ community toilet

Percentage of families where all members are using domestic/ community toilet

Max imum : 50 % Minimum 0%

44

257212 DNA FOOD SECURITY RELATED

Total no. of children eligible for Anganwadi

Actual No. getting diet regularly

Percentage of Anganwadi beneficiaries

16 ANGANWADI

102020 44244 43.36 Total no. of students (primary and middle schools)

Total no. of students receiving cooked midday meals

Percentage of schools giving midday meals

17 MIDDAY MEAL

382421 63955 16.72% Total no. of BPL families eligible for lower cost grains

No. of families getting grains from PDS shop

Percentage of beneficiaries

18 PDS FUNCTIONING

DNA DNA DNA Total no. of BPL families eligible for free grains

No. of families getting free grains from PDS shop

Percentage of beneficiaries

19 ANTYODAYA YOJNA

DNA DNA DNA

Total no. of children in 6-14 age group

No. of children in age group not going to school

Percentage of school going children

20 SCHOOL ENROLMENT

382421 DNA DNA

HEALTH STATUS

Total no. of children below 3 with wt record.

no. of children with gr I or above malnutrition**

% of children malnourished

Max 200% Minimum 0%

21 CHILD MALNUTRITION

37423 13472 36.00%

Total no. of newborn who were weighed last year

Total no. of babies with LBW

Percentage of babies with LBW

Max 1% Min 10% 22

LOW BIRTH WEIGHT

81 81 DNA

Total no. of girls married last year

No. of girls married below 19 year of age

1% - % of married women below 19 year of age

Max 1% Min 0% 23

AGE OF MARRIAGE

DNA DNA DNA DNA Total number of births last year which were second or > child

No. of children born with more than 36 months difference

% of unspaced second or third children born

Max 1% Minimum 0%

24 SPACING

DNA DNA DNA DNA

25 INFANT DEATHS

Total number of births last year

Any deaths of any child below one year

% of infant deaths


45

53580 DNA DNA DNA Diarrhoeal outbreaks(More than three cases of a disease in same week )

jaundice outbreaks (as defined)

Sum of water borne disease outbreaks

Maximum 4 Minimum 0 26

OUTBREAK OF WATER BORNE DISEASE

DNA DNA DNA DNA N.B. Data of parent district Jammu has been considered as here.

46

3. PRIORITIES AS PER BACKGROUND AND PLANNING PROCESS National Rural Health Mission encompasses a wide range of health concerns including the

determinants of the good health. Though there is a significant increase in resource allocation for the

NRHM, there can never be adequate resources for all the health needs and all that needs to be done

for ensuring good health of all the people. It is therefore necessary to prioritize the areas where

appropriate emphasis needs to be given.

As per the situational analysis and need identified through the participatory planning process, Jammu

district requires additional inputs to achieve the goals of NRHM. Extra resources including personnel

and additional infrastructure and innovative schemes are required for reaching the essential health

services to the people. Following are the overall priorities of this District identified through the process;

Access to services:

Reaching the unreached population through out reach services and mobile health units

Ensuring availability of service providers like Specialists, Doctors and Staff Nurses and retaining the

staff in the difficult areas.

Increasing overall access to RCH services, especially FP services through public private partnerships

Quality of services:

Improving quality of services at all levels through the use of standard protocols and systems

Improving the condition of the facilities as per the IPHS norms including provision of quarters for the

personnel

Building capacity of functionaries at all levels for improving quality of services

Programme management:

Constitution of District Health Society and District Health Mission

Strengthening programme management and CMO office with good Infrastructure and additional

human resources through DPMUs.

Strengthening the HMIS through the development of GIS based MIS.

Building capacity of programme managers at the district and block levels for improving quality of

management.

Improving supervision and monitoring of services and resource utilisations for achieving intended

health results.

Community mobilisation:

Increasing the utilisation of public health services by the community

Involving PRI members and other community leaders for communitisation of health

Increasing male involvement in RCH services, especially FP.

47

Specific Priorities of the District:

Availability of Primary health care services: Providing services of ANC, Safe delivery, PNC,

Immunization, DOTS, Anaemia prevention, prevention of Malaria at the village level.

Programme Management: Efficient functioning of the District Health Society, a strengthened CMO’s

office with efficient district and Block programme managers and management units.

Demand Generation, IEC/BCC: Behaviour Change for utilization of services.

Human Resources: Filling of the vacancies as per the population based norms, increased mobility,

increased incentives for retaining the personnel in difficult areas, motivational issues, provision of

residential facilities, Availability of well-trained ASHAs.

Capacity Building: Focussed capacity building in Emergency Obstetric Care, Management,

Continuous skill building of all personnel as per needs expressed and also the new job responsibilities

under NRHM, opening a Staff Nurse Training College and Paramedical Staff training centre.

Maternal Health: Well managed system of deliveries by skilled birth attendants, promotion of

institutional deliveries (labour rooms in all sub centres with residential facilities for ANMs), Emergency

Obstetric Care services, JSY extended to all the pregnant women, Blood Storage Units in all CHCs.

All CHCs to be developed as FRUs, PHC to be developed as 24x7 facilities with good referral

mechanisms.

Neonatal and Child Health: Provision of Neonatal services at CHC, PHC, with trained personnel on

IMNCI and IMCI and addressing Anaemia and Malnutrition

Immunization: Total coverage for immunization of children, pregnant women and adolescents

Family Planning: Improving the coverage for Spacing methods, NSV and Tubectomy.

Adolescent Health: Adolescent Reproductive and Sexual health education through schools and also

awareness building on good health practices, responsible family life, marriage at right age.

National Disease Control Programmes: Prevention and treatment of Malaria, Tuberculosis, Anemia

and malnutrition

Infrastructure: Increase in the number of Subcentres, PHC, CHC and General hospitals catering to

the entire population and developing all the facilities as per IPHS norms.

Procurement and Logistics: Construction of a scientific Warehouse for Drugs

Monitoring and Evaluation: Data validation and computerized data availability upto PHC with district

linkages

Public-Private Partnership: Involvement of the private facilities for providing services and NGOs.

Intersectoral Convergence: Involving the related departments as members in the District Health

Society, Fixing Responsibilities of each sector for their accountability and Intersectoral Coordination

48

4. GOALS The District 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:

Goals INDICATOR Current 07-08 08-09 09-10 10-11 11-12

Reduction in Infant Mortality Rate (IMR) 50**

10 % Baseline

20 % Baseline

30 % Baseline

40 % Baseline

50 % Baseline

Reduce Neo-natal Mortality Rate (NMR) DNA

10 % Baseline

20 % Baseline

30 % Baseline

40 % Baseline

50 % Baseline

Reduction Maternal Mortality Ratio (MMR) per lakh births

DNA 10 % Baseline

20 % Baseline

30 % Baseline

40 % Baseline

50 % Baseline

Reduction in Birth Rate (Estimated from deliveries reported in MPR)

31.47 30 28 25 23 20

Reduction in Total Fertility Rate 2.7 2.6 2.5 2.4 2.3 2.1 Full ANC as defined

44.8%** 50% 60% 75% 90% 100 %

Increase 3 Ante-Natal Care 21.5%* 82.9%**

30% 50% 70% 90% 100 %

Increase Proportion of Women getting IFA tablets

DNA* 64.6**

70% 80% 90% 100% 100 %

Increase Proportion of Women getting 2 TT Injections

21.5%* 69.9%**

30% 50% 70% 90% 100 %

Increase Institutional Deliveries 21.5%* 72.7**

30% 50% 60% 70% 80 %

Increase Delivery by Skilled Birth Attendants 11.8%* 75.8**

30% 50% 60% 70% 90 %

Increase Contraceptive Prevalence Rate 69.7%** 70% 75% 80% 85% 90 %

Increase Complete Immunisation of Children (12-23 month of age)

65.6%* 44%**

50% 60% 75% 90% 100 %

Increase Proportion of Children Exclusively Breastfed 29.6%** 40% 60% 75% 90% 100 %

Reduce Prevalence of STI/RTI (have symptom)

25.7%**

25% 20% 15% 12% 10 %

Source: (*): CMO data (**): DLHS 2002-2004.

49

Infrastructure Scheduling (Based on Yearly Growth of population= 3.0% per annum)

Facility Existing Status

2008-09 2009-10 2010-11 2011-12

Projected Population* 263818 271733 279885 288281 296929

DH 0 1 1 1 1

CHC 2 3 3 4 4

PHC* 15 15 15 15 15

Subcentre 82 91 93 96 99

ASHA 306 306 306 306 306

* Block Population

50

5. TECHNICAL COMPONENTS PART A: REPRODUCTIVE AND CHILD HEALTH (RCH) II

A-1. Strengthening of District Health Management Situation Analysis

Since Samba district has recently carved out from District Jammu and as such there is no District Health Society constituted till date. CMO Samba has already initiated process of formation and constitution of DHS Samba with due consultation with District Development Commissioner. Contractual appointments of various categories of staff are yet to made.

Objectives Benchmarks

Formation and Registration of DHS Samba Empowered District Health Society to effectively plan, implement and monitor the progress of the health status and services in the district and achieve the goals of the District action Plan.

Strategies Constitution of DHS at the earliest. Functional Integration of all the vertical Societies Capacity building of the members of the District Health Mission and District Health Society regarding the programme, their role, various schemes and mechanisms for monitoring and regular reviews and also on GoI / GoJ&K guidelines for running the District. Health & FW Society Strengthening the functioning of the DHS Establishing Monitoring mechanisms

Activities Developing systems for proper management, governance and functioning through: Effective Planning – Annual, quarterly, monthly and as per needs Supervision mechanisms Convergence systems Procedures, Reporting systems, Regularity of meetings, Agenda of meetings, Maintaining minutes and its timely circulation Decentralisation, Delegation of decision-making power Rational decision making Orientation Workshop of the members of the District health Mission and society. Issue based orientation in the monthly Review and Planning meetings as per needs. Ensuring provision of Technical Assistance at the district, block levels and sector levels and their ongoing capacity building. Exposure visits of members of the District health Society to well functioning Panchayats in two states Improving the Review and planning meetings through a holistic review of all the programmes under NRHM and proper planning. Formation of a monitoring Committee from all departments. Development of a Checklist for the Monitoring Committee. Arrangements for travel of the Monitoring Committee Sharing of the findings of the committee during the Field visits in each Review Meeting with follow-up of the recommendations

51

Support required

Technical assistance needs to be imparted for orientation and integration of Society to achieve the given targets and objectives. Specific sessions may be arranged to clear doubts and difficulties. Relevant Government Orders and correspondences from Centre to State and from State to Districts need to be properly compiled and documented.

Timeline Activities

2008-09

2009-10

2010-11

2011-12

Developing systems Orientation Workshop of the members x x x x Issue based orientation x x x x Ensuring provision of Technical Assistance at the district, block levels and sector levels x x x x Exposure visits of DHS members x x x x Formation of a monitoring Committee from all departments. Development of a Checklist for the Monitoring Committee.

Budget Activity / Item 2008-09 2009-10 2010-11 2011-12 Total

Orientation Workshop 0.5 0.6 0.65 0.7 2.45

Issues based Workshops 0.5 0.7 0.8 0.9 2.90

Bi-monthly meetings @2000x6 0.12 0.132 0.145 0.160 0.56

Mobility for Monitoring 0.5 0.6 0.65 0.7 2.45

Total 1.62 2.032 2.245 2.460 8.36 Detailed Calculations

# Description Amount Rs. Exposure Visit 1 Airfare and travel expenses (Taxi, Bus etc;) 400000/- 2 Lodging, Boarding, Food 200000/- 3 Misc. 20000/- Total 6,20,000/- Mobility for Monitoring by the DHS members 1 Vehicle on Rent/ Mules trips @ Rs 1000 per visit x 5 days

visit per month x 12 months 60,000

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A- 2 District Programme Management Status In NRHM a large number of activities have been introduced with very definite

outcomes. The cornerstone for smooth and successful implementation of NRHM depends on the management capacity of District Programme officials. The officials in the districts looking after various programmes are overworked and there is immense pressure on the personnel. There is also lack of capacities for planning, implementing and monitoring. The decisions are too centralized and there is little delegation of powers. In order to strengthen the district PMU, three skilled personnel i.e. Programme Manager, Accounts Manager and Data Assistant will be provided to the district. These personnel would be providing basic support for programme implementation and monitoring at district level. The District Programme Manager will be responsible for all programmes and projects in district and the District Accounts Manager (DAM) is responsible for the finance and accounting function of District RCH Society including grants received from the state society and donors, disbursement of funds to the implementing agencies, preparation of submission of monthly/quarterly/annual SoE, ensuring adherence to laid down accounting standards, ensure timely submission of UCs, periodic internal audit and conduct of external audit and implementation of computerised FMS. The District Data Assistant (DDA) has to work in close consultation with district officials, facilitate working of District RCH Society, maintain records, create and maintain district resource database for the health sector, inventory management, procurement and logistics, planning and monitoring and evaluation, HMIS, data collection and reporting at district level. In Samba district, since there is no DHS, so all vacant posts of District Programme Manager and District Accounts Manager needs to be filled up along with Block Programme Management units.

Objectives Strengthen District Management Unit for effective programme implementation. Strategies Support to the CMO proper implementation of NRHM.

Capacity building of the personnel Development of total clarity at the district and the block levels amongst all the district officials and Consultants about all activities Provision of infrastructure for the personnel Training of district officials and MOs for management Use of management principles for implementation of District NRHM Streamlining Financial management Strengthening the CMO’s office Strengthening the Block Management Units Convergence of various sectors

Activities Support to the CMO for proper implementation of NRHM through involvement of more consultants for support to CMO for data analysis, trends, timely reports and preparation of documents for the day-to-day implementation of the district plans so that the CMO and the other district officers:

53

Finalizing the TOR and the selection process Advertisements for vacant positions of DPM, DAM, DDA and other consultants, one each for Maternal Health, Civil Works, Child health, Behaviour change. If properly qualified and experienced persons are not available then District Facilitators to be hired which may be retired persons. Selection of consultants Capacity building of the personnel Joint Orientation of the District officers and the consultants Induction training of the DPM and consultants Training on Management of NRHM for all the officials Review meetings of the District Management Unit to be used for orientation of the consultants. Development of total clarity in the Orientation workshops and review meetings at the district and the block levels amongst all the district officials and Consultants about the following set of activities: Disease Control Disease Surveillance Maternal and Child Health Accounts and Finance Management Human Resources and Training Procurement, Stores and Logistics Administration and Planning Access to Technical Support Monitoring and MIS Referral, Transport and Communication Systems Infrastructure Development and Maintenance Division Gender, IEC and Community Mobilization including the cultural background of the Masses Block Resource Group Block Level Health Mission Coordination with Community Organizations, PRIs Quality of Care systems Provision of infrastructure for officers, DPM, DAM, DDM and the consultants of the District Project Management Unit and also provision of office space with furniture and computer facilities, photocopy machine, printer, Mobile phones, digital camera, fax, etc. Use of Management principles for implementation of District NRHM Development of a detailed Operational manual for implementation of the NRHM activities in the first month of approval of the District Action Plan including the responsibilities, review mechanisms, monitoring, reporting and the time frame. This will be developed in participatory consultative workshops at the district level and block levels. Financial management training of the officials and the Accounts persons Provision of Rs. 500000 as untied funds at the district level under the jurisdiction of the CMO.

54

Compendium of Government orders for the DC, CMO, district officers, hospitals, CHC, PHC and the Subcentres need to be taken out every 6 months. Initially all the relevant documents and guidelines will be compiled for the last two years. Development of a District CMO office Construction of multi-storeyed district Swasthya Bhawan for housing the CMO and all the officials and their staff. There will be pooling of funds available for office expenses, personnel and better utilization of resources. This complex will also have a modern Conference Hall with speaker systems and facilities for LCD projector and a meeting hall along with a common Computer Cell. There will be a Control Room, Consultant Unit, Library, Waiting room, a record room, The Swasthya complex will be furnished and partitions will be made as per the modern offices to give each one of the staff a separate working area. Office Automation will be done through installation of PABX system, Computers systems with UPS, Printer and Scanner for each district office section, Laptop for CMO, District Family Welfare Officer, Fax machines, Photocopy machine, Broadband Internet connectivity, Digital Camera with date and time etc. Strengthening the Block Management Unit: The Block Management units need to be established and strengthened through the provision of: Block Programme Managers (BPM), Block Accounts Managers (BAM) and Block Data Assistants (BDA) for each block. These will be hired on contract. For the post of BPM and the BAM retired persons may also be considered. Office set-up will be given to these persons Accountants on contract for each PHC since under NRHM Subcentres have received Rs 10,000; also the village committees will get Rs 10,000 each, besides the funds for the PHC. Provision of Computer system, printer, Digital Camera, furniture etc. Convergence of various sectors at district level Provision of Convergence fund for workshops, meetings, joint outreach and monitoring with each CMO Monitoring the Physical and Financial progress by the officials as well as independent agencies. Yearly Auditing of accounts

Support from state

State should ensure delegation of powers and effective decentralization. State to provide support in training for the officials and consultants. State level review of the DPMU on a regular basis. Development of clear-cut guidelines for the roles of the DPMs, DAM and District Data Manager. Developing the capacities of the CMOs and other district officials to utilize the capacities of the DPM, DAM and DDA fully. Each of the state officers Incharge of each of the programmes should develop total clarity by attending the Orientation workshops and review meetings at the district and the block levels for all activities. If qualified persons for the posts of DPM, DAM are not available then State should allow the appointment of facilitators or Coordinators or retired qualified persons by the District Health Society.

55

Time Frame

Activity

2008-09

2009-10

2010-11

2011-12

DPM, DAM, DDA and Consultants x x x x Infrastructure, furniture, computer systems, fax, UPS, Printer, Digital Camera

x

Workshops for development of the operational Manual at district and Block levels

x x x x

Construction of District Swasthya Bhawan x Furnishing and Office Automation, Conference Hall with speakers, ACs

x

Compendium of Govt orders x x x x Joint Orientation of Officials and DPM, DAM, DDM

x x x x

Management training workshop of Officials Establishment of BPMU x Training of DPM and Consultants x x x x Review meetings x x x x Computer systems with printer and Digital Camera and furniture for DPMU, BPMUs, District, block personnel

x

Monitoring of the progress x x x x Budget

Activity/Item 2008-09

2009-10

2010-11

2011-12 Total

Honorarium DPM,DAM,DDA and Consultants

29.4 32.34 35.57 39.13 136.45

Hiring of vehicles at District level @ Rs 1000 x 15 days /mth 12 mths

1.8 1.98 2.18 2.40 8.35


1 1.10 1.21 1.33 4.64

Untied Fund 5 5.50 6.05 6.66 23.21 Construction Cost of Health Complex (11000sq.f @ 1000/sq.f)

110 0.00 0.00 0.00 110.00

Furnishing and Office Automation, Conference Hall with speakers, ACs

15 0.00 0.00 0.00 15.00

Maintenance of the Health Complex 0 1.00 1.50 2.00 4.50

Compendium of Govt orders 0. 50 0.60 0.65 0.70 1.95 Joint Orientation of Officials and DPM, DAM, DDM

0.25 0.30 0.00 0.35 0.90

Management training workshop of Officials 0.5 0.70 0.80 0.90 2.90

Personnel for BPMU 47.52 52.27 57.50 63.25 220.54 Training of DPM, BPMU and Consultants 0.5 1.00 0.00 1.50 3.00 Review meetings @ Rs 2000/ per month x 12 months

0.24 0.26 0.29 0.32 1.11

Office Expenses @ Rs 10,000/month x 12 months for district

1.2 1.32 1.45 1.60 5.57

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Computer systems (27) with printer and Digital Camera and furniture for DPMU, BPMUs and District and block & sectoral personnel 16.2

0.00 0.00 0.00 16.20

Annual Maintenance Contract for the equipment 0

1.62 1.62 1.62 4.86

Hiring of vehicles at block level @ Rs 1000 x 5 days /mth x 3 blocksx12 mths

1.8 1.98 2.18 2.40 8.35

Office expenses for Blocks @ Rs 5000 x 3 blocks x 12

1.8 1.98 2.18 2.40 8.35

Total 232.21 103.96 113.18 126.54 575.89 Detailed Calculations

Details Units Unit Cost Amount for 12 months

Personnel at District level

District Programme Manager 1 18000 216000

District Accounts Manager 1 15000 180000

District Data Assistant 1 12000 144000

Consultant for Maternal Health 1 40000 480000

Consultant for Child Health 1 40000 480000

Consultant for Civil Works 1 40000 480000

Consultant for HMIS 1 40000 480000

Consultant for Behaviour Change 1 40000 480000

SubTotal 2940000

Personnel at Block level

Block Programme manager 3 15000 540000

Block Accounts Manager 3 12000 432000

Block Data Assistant 3 10000 360000

Sectoral Manager 15 10000 1800000

Retired Accountants for each PHC @ Rs 5000 per month x 21 PHCs x 12 months

15 5000 900000

Subtotal 4032000

9 for BPMU Office Automation with Furniture, Computer system, Camera, Printer, etc

3 for DPMU

60,000 720000

Subtotal 720000

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A-2. MATERNAL HEALTH Situation Analysis

Maternal Health (old Jammu district)

Indicator No.

Maternal Deaths Nil

No. % ANC registration 32235 90

3 ANCs 24533 75.3

Institutional Deliveries + Private 11824 62

Deliveries by skilled birth attendants 7062 37.3

Total Deliveries 18886

Skilled Unskilled

No. % No. %

Home deliveries (Total No.) 7062 6981 36.

96 81 4.2

No. of pregnancy related complications referred to FRU level

235 12.4

Male participation in spacing: 1868 Source: MPR 2006-2007 Due to bifurcation of the district, there has been some problems in the available data. Consequently, Data from CMO as well as from other sources like DLHS has been used. As Samba district has been for created from parts of different districts including that of Jammu district, the availability of data was bit difficult. However, the data supplied by CMO office has been supplemented from other sources. The birth rate is reportedly is 31.47 for the undivided Jammu district. There is lack of data on IMR, MMR, Neo-natal mortality rate. Baseline information based on household data need to be generated through a specific study undertaken for the purpose. It may also generate other items of information. About 2.6% were High-risk pregnancies. Anaemia prevalence is high and acceptance of IFA is on the decline. Capacity building of TBAs is required through skill development. Delivery kits needs to be given to TBAs. TBA to be attached with the ANM. Some incentive should be given to TBAs as well. The recruitment of new ASHAS should be from the TBA taskforce. Maternal Mortality: There is no authentic data available regarding the maternal deaths in the district since there is a lot of under reporting due to lack of personnel and improper supervision. Age of marriage: Although the mean age of marriage for boys is 27.4 years but 0.7% of the boys get married below the legal age of marriage as per DLHS 2002-2004. Similarly for girls the mean age of marriage is 22.7 years. This is a good indication for RCH. Deliveries: Institutional deliveries in government and private hospitals are about 62%. The reasons for low ANC coverage are the shortage of staff, socio-cultural beliefs, large areas and lack of accessibility of services as well as inadequate outreach services. Anaemia: As per DLHS 2002 only 23.3 % of the pregnant women consume 2 tablets daily. 100 IFA tablets percent and among them 51.9 % had consumed it

58

A-2. MATERNAL HEALTH

daily. As per the CMO office acceptance of IFA is on the rise. The department of Ayurveda has come up with preparations rich in iron in both syrup and tablet form. Despite this consumption of IFA, anemia is widely prevalent Referrals: There is no inadequate data for referrals during complications. As per DLHS-2002, 44.9% women had complications during delivery. MTP: There were 1037 MTPs carried out last year which is 3.1% of the total pregnancies. Male participation: There 1868 male sterilisations in 2006-07. Janani Surakha Yojana: The JSY scheme has been launched in J and K and 1119 women have benefited last year and from April 06 to March 07. This low uptake has been due to poor awareness and also due to the fact that the data of BPL families needs to be updated. Village Health Day (VHD days) are being organized but there is little awareness amongst the community about the days when these are held and also regarding the services being provided. Also staff is inadequate to cover all the AWCs. RCH Camps: RCH camps are organized by the department to reach the community and provide services at the doorsteps. These camps provide specialist services with simple diagnostic tests. They also serve for screening of RTI and STDs.

Objectives

The overall objectives are to reduce MMR through improved maternal health care. Improved skilled care. Improved access to institutional delivery/ safe delivery. Improved EmoC and basic comprehensive EmoC services. Improve access to quality, women friendly and responsible RTI and STI services. To improve ANC registration during the first trimester from, 3 ANCs In order to reduce MMR and IMR

Benchmarks Decrease in the Maternal Mortality ratio to 50% of the baseline by 2012 100% ANC coverage by 2012 100% pregnant women administered two doses of TT by 2012 80% pregnant women to consume 100 IFA tablets by 2010 and 100% by 2012 90% Institutional deliveries by 2010 and 100% by 2012 75% deliveries to be carried out by trained /Skilled Birth Attendant by 2010, 100% by 2012 100% women to get improved Postnatal care by 2010 50 % increase the safe abortion services by 2010 Reduction in Anaemia to less than 20 per cent by 2012

Strategies and Activities

Early registrations of antenatal mothers and ensure quality of antenatal and postnatal care, regular field visits by health workers. (Registration, 2 doses of TT, 3 check-ups and 100 tablets of IFA plus additional IFA for women suffering from anaemia, 3 postnatal care visits). Supervision Setting up and upgradation of First Referral Units (FRUs) at block level. Outreach sessions to be organised with involvement of AWW. Increase accessibility of 24-hour delivery services (BEmoC) in all PHCs. Repairs and renovations of PHCs to be carried out. To deal with lack of specialized human resource short courses design to give general doctors the Obstetric or Anaesthetists skills necessary for basic and even comprehensive EmoC should be adopted. Comprehensive and basic emergency Obstetric care facilities are to be earmarked and furnished with suitable human resources and equipment on the basis of

59


population and access. Capacity building of ANM and TBAs for safe deliveries. Provide complete ANC with the help of other workers in the field (ASHA, AWW, TBAs etc.).

Support required

Technical Support, orientation and continuing education. Extension and upgradation of facilities and services. Adequate infrastructure need to be provided for each health institutions i.e. SCs, MACs, ADs, PHC level for conducting 24 hours Emergency Gynae and Obstetric Care. New Borne Baby Care unit is to be established at each PHCs, CHCs, and DH. There is a need to assess the manpower requirement and match it with health care infrastructure and the provision of emergency services. The difficulty of attracting doctors to remote area is widely recognized, but the lack of basic human resource management makes it difficult to rationalize the use of doctors in given area. Recruitment and retention of professional and support staff, especially Gynecologist, Pediatrician and Anesthetist in CHCs are a major hurdle in providing effective services. Panchayat of the village ensure 100 % Registration of births and ANC. IEC Activities

Timeline

Activities 2007-08

2008-09

2009-10

2010-11

2011-12

Identification of all pregnancies through house-to-house visits x x x x X Operationalizing the VHDs x x x x X Once a week ANC clinic All PHC and CHC Weekly ANCs All AWCs wherever possible Microplan for ANMs x x x x X Monthly Outreach sessions 35 difficult villages Delivery kits to be given to all TBAs 472 472 472 472 472 Incentive for TBA referral @Rs 100 per referral 2000 3000 4000 5000 6000 Provision of tracking bags for all the AWCs 585 585 585 585 585 Provision of Weighing machines to all Subcentres and AWCs 585

Regular meetings for progress and follow-up x x x x X

Establishing Blood storage units at all CHC 2 CHC 1 CHC

Increasing the Janani Suraksha coverage 5000 7500 10000 12500

Janani Suraksha Yojana Helpline x 1 Block

2 Blocks

3 Blocks

Provision of MTP kits and necessary equipment and consumables at all PHC x

15 PHC

15 PHC

15 PHC

15 PHC

Training of the MOs in MTP x x x x X RCH Camps x 12 12 12 12 Training of personnel for Safe motherhood and Emergency Obstetric Care x x x x x Training of the MOs in MTP x x x x X Training for skilled birth attendant x x x x X Training of RIS teachers x x x x X

60


Training to all TBAs x x x x X Training of ANM and AWWs for the use of Tracking bags x x x x


Consultancy support for developing Microplan for MCH & N days

1 1.1 1.21 1.33 4.64

Tracking Bags @ Rs 300/ bag x (585 AWCs+ 82 SCs)

2.00 2.20 2.42 2.66 9.29

Adult Weighing machines @ Rs 800 per machine x 585 AWCs & Maintenance

4.68 0 0 0 4.68

One day training workshop on Tracking bags at the district level and each sector

2 2.2 2.42 2.662 9.28

Janani Suraksha Yojna @1400 X 5000 inst. deliveries

70 77 84.7 93.170 324.87

Janani Suraksha Yojna @500 X 2500 Home deliveries of BPL families

12.5 12.5 12.5 12.5 50.00

Blood Storage @ Rs 3 lakhs per unit 3 3 0 0 6.00

Referral Cards @ Rs 2 per card x 20,000 0.4 0.44 0.484 0.532 1.86

MTP kits @ Rs 15000 Per kit (PHCs + CHCs)

2.55 2.55 0 2.55 7.65

Mobile phone instrument to ANMs @ Rs 2000

2 0 0 0 2.00

Mobile Phones recurring cost to ANMs @ Rs 2700

2.7 2.7 2.7 2.7 10.80

Mobile phone instrument to Supervisory Staff like CMO, Dy CMO, DIO, DTO & BMOs @ Rs 5000

0.5 0 0 0 0.50

Mobile Phones recurring cost to Supervisory Staff like CMO, Dy CMO, DIO, DTO & BMOs @ Rs 500/month

0.6 0.6 0.6 0.6 2.40

RCH Camps @ Rs 25000 per camp x 8 camps per year

2 2.2 2.42 2.662 9.28

Total 105.931 106.491 109.455 121.371 443.25

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A-3. NEWBORN and CHILD HEALTH (old Jammu district) Situation Analysis

Indicator No. Live Births 20195 Neonatal Deaths DNA Infant Deaths DNA Child Deaths DNA Still birth in the last year 9 Low birth weight newborns (less than 2.5 kg’s.) 77 BCG given 45617 Child Vaccination: completed (upto 1 yr of age) 35132 Severely malnourished children (Grade III and IV) 120 ARI cases in the last year 2742 Deaths in the last year due to pneumonia in children DNA Diarrhoea cases in the last year 3528 Deaths in last year due to Diarrhoea in children DNA Breastfeeding within 2 hours (children age below 36 months) 52.8* Percentage whose mother squeezed out the first breast milk (children age below 36 months)

78.5*

Exclusive breastfeeding at least 4 months (children age 4-12 months)

29.6*

*DLHS Data CHILD HEALTH The infant mortality rate is 50/1000 live births compared to all Indian average of 58 in the year 2005-20096 (NFHS3) infant and child mortality rates are higher in rural areas (53) compared to urban areas (39). Similarly child mortality is higher in rural (17) compared to urban areas (12) (NFHS2). Breast Feeding Practices: Breast Feeding, immediately after the child birth and continuing exclusive breast feeding for the first four to six months in one of the main components of child health recommendation. According to NFHS-3, only 31.9 % infants began breast - feeding within the first hour of their birth in J&K. It is reported that around 77 % of the mother squeeze out and throw the first milk (colostrums) , which deprives the baby of natural immunity against diseases that the highly beneficial colostrums provides. Only 42.3 % children are exclusively breast fed for 5 months as recommended. Besides, only 58.3 % children aged 6-9 months received recommendation for supplementary food addition. Immunization of children: The following table provides the immunisation status of children aged 12-23 months, as per NFHS3, in Jammu and Kashmir .As expected, sizeable differentials exist among urban and rural areas in immunisation coverage. The differential was highest in case of coverage by all the three doses of Polio and DPT. As per NFHS #, 15.2% of children, age 12-35 received a Vitamin A dose in 6 months preceding the survey. Morbidity in J and K respectively 77.6 %, 69.1 infants were ill due to acute respiratory infection (ARI) and diarrhoea.

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A-3. NEWBORN and CHILD HEALTH (old Jammu district) Objectives Benchmarks

Reduction in IMR from 50 to 30 by 2012 Reduction of neonatal mortality 40.3 to 25 by 2012 Increased proportion of women who are exclusively breastfed for 6 months to 100% by 2012. Increased in the Treatment of 100% cases of Pneumonia in children by 2009-2010 Increase in the utilization of services to 100% by 2009-2010 To reduce IMR to 30 in 5 years. To reduce the prevalence of anaemia. To ensure functioning of 24X 7 facility in all PHCs during plan period. To Vaccinate 95% children in five years. To Promote exclusive breast-feeding. To provide 5 doses of Vitamin A to all children under 3 years. Achieve agreed level of DPT-3 coverage Increase access to safe injection. Zero polio cases. Access to essential neo born care for each neonate at home. Improve coverage and quality of facility based care of neonates and children. Promote community based care Promote exclusive breastfeeding and appropriate complementary feeding. Reduction in Neonatal mortality. Increased use of ORS in diarrhoea to 100% by 2012


The following strategies may be adopted at district level: Early treatment-seeking behaviour in case of ill-health, especially ARI/Jaundice. Complete immunization. Availability of child care services, especially Child Specialist at the CHC . Encouraging exclusive breastfeeding. Promote knowledge and weaning practices. Reduction in anaemia in Children, especially in the age group 5 to 12 year. Activities Technical Health society members will communicate and address myth associated breastfeeding and to improve early and exclusive breastfeeding practice by communication campaign on importance of breastfeeding through reorientation of service providers at all level and to make the women realize the importance of breastfeeding. Orientation programs regarding breastfeeding practices to cover all health workers and supervisors on the importance of counselling the mothers about breastfeeding. Complete Immunization of children Special efforts will be made to identify the children not immunized at all. Community support will be sought and AWW/ASHA services will be utilized to mobilize such children. Information system will be strengthen to identify children dropping out and proper follow up mechanism will be established to cover them. PHCs not having ILRs will be supplied with them so that vaccine can be stored at the nearest possible centre location nearer to sub-centre. Generator and adequate financial provision for POL for genset will be supplied to PHCs. Cold chain system will be streamline at PHC level to ensure adequate supply of

63

A-3. NEWBORN and CHILD HEALTH (old Jammu district)

vaccines at all level. Strengthening of immunization of under covered and neglected areas will be done by planned outreach sessions for immunization four times in a month in each SC areas and special incentives for ANM / ASHA would be made available well in time. Integrated management of childhood illnesses would be managed in close collaboration with ICDS workers/RS teachers/ASHA Training neonatal nurses. Strengthening home based care through ANMs / AWWs / TBAs by personal visits for each neonate with in seven days of delivery with emphasis on first visit in 24 hours of the delivery at home or discharges from health facility. Developing guideline on essential neonate care at home importance and observation to be made during home visits, investigation related neonatal and child care.(State Level activity) Ensuring early neonatal care i.e. observing and examining the child for congenital abnormalities cleaning of eyes, respiration and weight after birth in PHCs, CHCs and FRUs. Developing BCC curriculum print and media with focus on importance of colostrums initiation of breastfeeding etc. ANM, AWW, TBA and Mahila Mandals would take up Oral Rehydration Therapy programme. Supply of medicines with ANMs, AWWs for treating childhood and neonates. Ensuring supply of ORS Packets and Cotrimaxazole with ANMs, AWWs and TBAs. Referral facility for all emergency cases identified by service providers i.e. ANM or Medical Officers. Strengthening the fixed Maternal and Child health days Organize Mother and Child protection sessions twice a week to cover each village and hamlet at least once a month Use of Tracking Bag Tracking of Left-outs and dropouts by ASHA, AWW and contacting them a day before the session Information of the dropouts to be given by ANM to AWW and ASHA to ensure their attendance Wide publicity regarding the MCHN days.

Support required

Procurement of computer for paediatric department, which would help maintain data, records in better way saving time and labour significantly. IEC activities

Timeline Activities

2007-08

2008-09

2009-10

2010-11

2011-12

Promoting (IMNCI) x x X x x IMNCI training x x X x x Assessment of FRUs with reference to IPHS for NB Care x x X Newborn corners – All CHC 1 CHC 1 CHC X x x Malnutrition Corners – DH and all CHC

DH , 1 CHC

DH , 1 CHC

64

A-3. NEWBORN and CHILD HEALTH (old Jammu district)

Study on the feeding practices for knowing what is given to the children x Education on early and exclusive breast feeding and Colostrum x x X x x Promotion of health seeking behaviour for sick children x x X x x Improving newborn care at the household level x x X x x Training on the home based Care IMNCI of ASHA/AWW/ANM/MOs x x X x x Training of MO in CEmOC, IMNCI x x X x x Training of LHV, AWW and ANM on IMCI including referral, Tracking Bags x x X x x Wide publicity regarding VHD days x x X x x

Budget Activity / Item 2008-09 2009-

10 2010-11

2011-12

Total

Study on the feeding practices 2 0 0 0 2.00

Innovative activities based on the study 0 2 2 2 6.00

Newborn Corner furnished with equipment @ Rs 1.40 lakh per CHC

2.8 0 0 0 2.80

Generator @ Rs. 50000 for PHC/CHC & Rs 1.5 lakhs for District Hospital

10.5 0 0 0.5 11.00

POL Generator @ Rs.140/PHC & CHC x 365 days and Rs 420 x 365 for District hospital

10.73 11.80 12.98 14.28 49.80

Examination table, chair, stool, table, other equipment @ Rs. 3000 x 585 AWCs

17.55 0 0 0 17.55

Infant Weighing Machines @ Rs. 800/AWCx 585

4.68 0 0 0 4.68

Foetoscope @ Rs. 50 x 585 AWCs 0.2925 0 0 0 0.29 Total 48.5535 13.804 14.985 16.783 94.13

65

A-4. FAMILY PLANNING

Situation Analysis

Indicators No. or Rate

Eligible Couple 150790* Female Sterilization operations during last year 2912* Vasectomies during the last year 1868* Knowledge of all modern family planning methods 35.1 DLHS

Data Knowledge of any traditional method 26.2 DLHS

Data Current use of any family planning method 73.2 DLHS

Data Current use of any modern family planning method 69.7 DLHS

Data Current use of any traditional family planning method 3.5 DLHS

Data

Current use - Female sterilization 11.5 DLHS

Data Current use - Male sterilization 2.1* DLHS

Data Current use - Male sterilization 5.4* DLHS

Data Current use - PILLS 4.2 DLHS

Data Current use - CONDOM 46.1 DLHS

Data *Old Jammu District

In old Jammu district there are many people, who are not adopting family planning methods, especially in rural areas. Only 2912 women had gone for Sterlization last year and vasectomies performed last year are 1868. As most of the population is living in rural areas and there livelihood is based on agriculture so, they think that sterilisation operation make weakness in them and they will not work in fields for longer time. There are some other reasons like:- Low level of knowledge and acceptance of Contraceptive use. Existing Unmet need for contraception. Low status of women in the society. Poor infrastructures for delivery of high quality Health and Family Welfare services related mainly to mothers and children. Population stabilization is not possible without addressing the health issues related to women and children. The status of women, gender equity, literacy, reduction of infant and maternal mortality, improved Health and Nutrition status of women and children are the key determinants of fertility behavior.


Reduction in Total fertility Rate from 2.7 to 2.1 by 2012 Increase in Contraceptive Prevalence Rate to 80 % by 2012 Decrease in the Unmet need for modern Family Planning methods to 0% by 2012 Increase in the awareness levels of Emergency Contraception to 100% by 2010

66


Strategies

Family Planning services will emphasize on a multi pronged strategy. Developing client centre communication strategies. Strengthening community based distribution. Expanding the range of Providers and making contraceptives affordable accessible and available. Engaging the private sector to provide quality family planning services Assess the needs of the population, promote the mix of the methods offered for family planning and strengthen the provision of high quality family planning service. Promote the importance of male responsibility and enhanced the involvement of male as responsible sexual partners, husbands, and fathers. Improved use of NSV by promoting positive attitude amongst users. Strengthen the community distribution system for regular and timely supply of contraceptives. Focus on hard to reach population to communication strategies. 100% immunization to be assured to all the children of beneficiaries accepting contraceptive methods.

Activities In addition to the aforesaid strategies the following additional activities will have to be undertaken Massive IEC on war footing will be conducted and camps organized to achieve goals Increased awareness for Emergency Contraception and 10 yr Copper T Decreasing the Unmet Need for Family Planning Increasing access to terminal methods of Family Planning Increasing Access to Emergency Contraception and spacing methods through Social marketing Increasing the demand for services by conducting a communication campaign to target different segments of population with unmet demand for family planning and also promote NSV. Initiating “Integrated RCH camps” providing wide range of services including counselling, antenatal and post natal check ups, TT vaccination and IFA distribution, RTI/STI treatment, immunization of children, IUD insertions, distribution of oral pills, condoms and different types of sterilization services including NSV - through dedicated teams of specialist doctors and paramedical staff, deputed from district hospitals/ FRUs. Linking contraceptive marketing efforts, through social marketing efforts, with the AWW/ASHAS, and other community-based networks. Conducting IUD Insertion Training for ANMs Training MOs in providing Female and Male Sterilization Services to meet the significant unmet need for limiting methods of family planning in the state. Promote birth spacing through counselling and IEC campaign to newly married couples through ASHA. Involve AWWs for promoting family planning methods.

Support required

Involvement of NGOs especially Mother NGO and FNGOs in educating and creating awareness s Timely supply of contraceptives, equipments for lepro-ligation and NSV. Some stock of contraceptives pills and condoms should also be given to AWWs. Availability of a team of master trainers/ANM tutors and RFPTC trainers for follow up of trained MPHS and MPHWF after one month and six months of training and provide supportive feedback to the service providers A training cell will be created in the medical college for the training of the medical

67


officers in the area of various sterilization methods

Time line 2008-09 2009-10 2010-11 2011-12

Training of MOs for NSV 16 MOs 20 MOs 20 MOs 20 MOs

Training of MOs for Minilap 17 MOs

Training of Specialists for Laparoscopic Sterilization

2 CHC 1 CHC 1 CHC

Development of Static Centres at General hospitals and all CHC

2 CHC 1 CHC 1 CHC

Sterilization camps (Persons) 6000 7000 8000 10000

NSV Camps 700 800 1000 1200

Supply of Copper T – 380 4500 6000 9000 12000 Emergency Contraception 6000 8000 10000 12000

Laparoscopes 2 CHC Budget Activity / Item 2008-

09 2009-10

2010-11 2011-12 Total

NSV camps @ Rs. 50000 x 10 camps

5 5.5 6.71 7.38 24.59

Sterilization Camps @ 600 per case(Including medicine and compensation)

12 18 24 30 84.00

Copper T-380 @ Rs 45 / piece 1.35 1.485 1.634 1.797 6.27

EmergencyContraception@Rs10/2 tabs

0.2 0.8 1 1.2 3.20

Development of Static Centres @Rs 1 lakh

2 0 1 1 4.00

Laparoscopes for CHC @ Rs3.00 lakhs

6 0 3 3 12.00

IEC activities 10 11 12.1 13.31 46.41 Total 36.55 36.785 49.4435 57.687 180.47

68

Detailed Calculations

NSV Camp

Head Unit Unit Cost

2007-08 2008-09 2009-10 2010-11 2011-12 Total

District Workshop 1 4000 4000 4400 4840 5324 5856.4 24420.4

Block workshops 7 7500 52500 57750 63525 69877.5 76865.3 320518

TA/DA for NSV surgeons

7 2000 14000 15400 16940 18634 20497.4 85471.4

IEC activities 93250 102575 112832.5 124116 136527 569301

TA to Acceptor for Semen Analysis

600 50 150000 210000 25000 420000 480000 1285000

Payment to NSV Advocate/motivator, Drugs & Dressings

600 1162.5 290625

406875 581250 813750 930000 3022500

Total 604375 797000 804387.5 1451701 2256089 5913553

Head Unit Unit Cost

2007-08 2008-09 2009-10 2010-11 2011-12 Total

Medicines 1 500000 5 5.5 6.05 6.655 7.3205 30.5255

Per Case @ 738.50 Variable 738.5 44.31 55.3875 62.7725 73.85 88.62 324.94

IEC activities 1 100000 1 1.1 1.21 1.331 1.4641 6.1051

Other activities and Office Expenses

1 300000 3 3.3 3.63 3.993 4.3923

18.3153

Total 53.31 65.2875 73.6625 85.829 101.797 379.886

69

PART B: NEW NRHM INITIATIVE

B-1. ASHA – Accredited Social Health Activist Situation Analysis

At present every ASHA is being paid an incentive of Rs.150 per month for mobilizing the children for immunization. Besides these they are also entitled for Rs.600. for escorting a pregnant to near by Health Institution for delivery, Rs.250 is paid to ASHA as DOT provider if she will provide full dot medicine to a TB patient and rest of the activities mentioned below supposed to performed by the a trained ASHA is not being paid any incentives. ASHA is supposed to perform following activities: Registration of Births Complete immunization of children/tracing the left-overs Coordination with Anganwadi Worker and ANM Motivating women for safe deliveries and institutional deliveries Newborn care Counseling about spacing and help in getting sterilization services Adolescent health issues ASHA is the first step from grossroot level who make link with institutional delivery systems and the health care providers both formal and informal. 306 ASHAs have been selected in district Samba (unbifurcated) The selection is entrusted to PRIs at various level the clear and detailed communication is required urgently for completion of selection process. Keeping in view the past record of health and FW services preference will be given to the TBAs to be appointed as ASHA. Out of total Rs 10000/- per ASHA for their recruitment training on five prescribed manuals and medical kit. The medical kit to be provided in kind by the state government from flexi pool every year. To meet the cost of training it is recommended that the training to be carried out at block level and may be out sourced to external agency under PPP, so as to meet the benchmark of training of 750 ASHAs in time bound manner. The services of master trainers can be hired by external agency. The ToT is proposed to be organized and expenditure to be met by state government. In case the training part is to be out sourced to private agency the Master trainers of identified agency to be involved in ToT. The incentive of Rs 500 for various activities i.e. ANC registration, institutional delivery and PNC etc to be paid to ASHA in addition Rs 100 for Performing Immunization related actives. There fore the budget line per ASHA is calculated @ Rs 600 /Month in case she achieve the targets or on actual basis. The incentive part will pool in from various schemes as well as RCH flexi pool. Assuming that there will be requirement of re orientation of ASHAs about the changes and other developments / roles etc. under NRHM the reorientation is planned in 2010-11. This component may be out sourced. In year 2007-08 department of health will do the evaluation and monitoring. In subsequent year it is recommended to out source the monitoring and evaluation work to independent external agency. The contingencies are required assuming that during the plan period there may be need on appointment of additional ASHAs due to ongoing increase in population or

70

B-1. ASHA – Accredited Social Health Activist

induction and training of new ASHAs due to non-availability of old ASHAs to perform the role for natural and other reasons.

Objectives

To provide the link worker at grass root level to mobilizes the community so as to Address unmet needs for primary health care. Increase institutional deliveries. Enhance immunization coverage, nutrition education and ANC/ PNC coverage Improvement To generate demand for health services through ASHA (to act as communication resources, service provider, guide, mobiliser and an escort to village people to access health services. Counselling women on birth preparedness, immunization, contraceptive, RTI, STI. Mobilize the community and assist them in accessing the services, already available at aganwadi, sub-centre, PHC. To work with village health and sanitation committees under panchayats. Act as depot holder for ORS, IFA, chloroquine, delivery kits, oral pills, condoms etc. promote construction of toilets under TSC.


Training programme for ASHA’s: (unbifurcated Jammu) All the 1168 ASHAs have been trained for 1st module and 250 ASHAs trained for 2nd, 3rd and 4th module. Training of rest 767 ASHAs is proposed as per the details given: Module 2nd: 773 Module 3rd: 773, Module 4th: 773 AS per the norms every ASHA has to be provided with ASHA kit IEC Sets: Containing flash cards on health and its determinants. Since ASHA has to record the vital statistics of her area and other relevant information, so register and stationery items needs to be provided to ASHA. Presently no incentives is being paid to her for the other tasks besides escorting pregnant lady and mobilization for immunization, so it is proposed that Rs.30 per session for each tasks she carry out in the community and she shall be entitled for incentive of maximum of 3 session, during a month and it is also proposed that Rs.10 yearly honorarium should be given if she performed well.

Support required

Funds for the ASHA should be kept readily available with the DH so that ASHAs could be paid well in time. Funds for ASHA should be available at the SC or PHC under which she is presently working.

Time line 2008-09

2009-10

2010-11

2011-12

Selection of additional ASHAs x x x x

Total ASHAs 286 294 303 312 Training of new & untrained ASHAs x x x

Training of ASHAs for module 2,3,4 x x x x

Reorientation of the ASHAs x x x x

ASHA Performance Diaries x x x x

District ASHA Mentoring group x x x x

2007-08 the monitoring and evaluation will be done by department internally there after every year the M and E will be out sourced for each year to external agency till 2012. The ToT will be organized by State government

71

B-1. ASHA – Accredited Social Health Activist

Budget Activity / Item 2008-

09 2009-10

2010-11

2011- 12

Total

Training & kit @ Rs 10000 X No ASHAs 30.6 0 0 0 30.60 Module 2,3,4 Training @ 2000 6.12 0.16 0.16 0.16 6.60 Reorientation @ Rs 2000 X No ASHA 6.12 6.12 6.12 6.12 24.48

Intersectoral meeting at PHC level 1000 X 17 X 6 1.02 1.122 1.234 1.358 4.73 Compensation to ASHA @ Rs. 500 X 12 X No of ASHAs

18.36 18.36 18.36 18.36 73.44

Expenses for the District mentoring group – meetings, travel @ Rs 5000 per month x 12 months

0.6 0.66 0.73 0.80 2.78

Total 62.82 26.422 26.60 26.796 142.64

72

B-2. Provision of Untied Funds at Sub Centres Situation Analysis/

Untied funds were received only for 82 subcentres @10,000 and given to ANMs of respective blocks. This scheme is quite successful which fulfils the basics and emergency needs of the sub centre, as ANMs of their respective subcenters have funds for upgrading the subcenter. But only problem with the untied fund is that ANMs want some capacity building for investing these funds.

Objectives

To undertake minor construction and maintenance in the existing and newly recommended Subcentres so as to provide quality basic health care at grass root to community at large. To provide the flexibility in order to provide the better services. To increase institutional delivery. To improve health status of the village. To Improve Mother and child health.


The fund to be kept in a joint bank account of the ANM and the Sarpanch. Untied fund will be used for maintenance of the sub centre building including minor repair and purchase of essential equipments/ goods etc. Provision of safe water and sanitation facilities in sub centre.

Support required

Funds to be transferred on time to the Sub centers Payments for cleaning up sub Centre especially after child birth. Transport of emergencies to appropriate referral centres. Purchase of consumables such as bandages in Sub Centre

Timeline 2008-09

2009-10

2010-11

2011-12

Untied Fund of Rs 10000/subcentre 91 93 96 99

Annual Maintenance grant of Rs 10000/SC 91 93 96 99

Plan for maintenance to be developed and approved by Gram Panchayat

x x x x

Plan for use of untied funds x x x x

Gram Panchayat to identify mode of construction and repair

x x x x

Budget Activity / Item 2008

-09 2009-10

2010-11

2008- 12

Total

Untied Fund of Rs 0.10 Lakh X SCs 9.1 9.3 9.6 9.9 37.90

Annual Maintenance Grant of Rs 0.10 Lakh X SCs

9.1 9.3 9.6 9.9 37.90

Total 18.2 18.6 19.2 19.8 75.80

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B-3. Provision of Untied Funds at PHCs Situation Analysis

Untied fund is made for competing day-to-day needs of the PHCs like some drugs or some minor Upgradation. In district Jammu only the PHCs have received untied funds but ADSs have not received untied funds that are equivalent to PHC as per IPHS. And accounts of these PHCs have already opened. In district Samba out of PHCs, only PHCs have got untied fund+ annual maintenance fund @ 75000/- each

Objectives

To provide the flexibility in order to provide the better services. The objective of the untied fund is to mange the basic requirement of the PHC at the local level with community participation. To increase institutional delivery. To improve Mother and Child Care To improve health status of the village.


Untied funds will be used only for the common good and not for individual need except in the case of referral and transport in emergency situations Untied fund will be used for maintenance of the PHC building including minor repair and purchase of essential equipments/ goods etc. Provision of safe water and sanitation facilities in PHC. Activities suggested for the untied funds include minor modifications, cleanliness of premises, transport of emergencies, transport of samples, purchase of consumables, etc; This fund will not be used for salaries, vehicle purchase and recurring expenses of Gram Panchayat

Support required

Community Support.

Timeline Activity 2008-09

2009-10

2010-11

2011-12

Untied Fund of Rs 25000/PHC 15 PHC

15 PHC

15 PHC

15 PHC

Annual Maintenance grant of Rs 50000/PHC 15 PHC

15 PHC

15 PHC

15 PHC

Plan for maintenance to be developed and approved by the Rogi Kalyan Samitis

x x x x

Plan for use of untied funds x x x x Rogi Kalyan Samitis to identify mode of construction and repair

x x x x

Budget Activity/item 2008-

09 2009-10

2010-11

2011-11

Total

Untied Fund of Rs 0.25 Lakh X Per PHC including Allopathic Dispensaries.

3.75 3.75 3.75 3.75 15.0

Annual Maintenance grant of Rs 0.5 Lakh X Per PHC including Allopathic Dispensaries.

7.5 7.5 7.5 7.5 30.0

Total 11.25 11.25 11.25 11.25 45.0

74

B-4. Provision of Untied Funds at CHCs Situation Analysis

Under NRHM provision of untied grants and other grants namely maintenance grants, support money for Rogi Kalian Samiti (RKS) are being kept. Keeping such important provisions, the services of facilities e.g. maintenance, minor repair, electricity, water, any fund for consumables, telephone, hiring transport in emergencies, travel, IEC and cleanliness can be improved. No fund has been received under untied fund for 2 CHCs OF Samba District. Accounts had been opened but no funds transferred in those accounts.


To provide the flexibility in order to provide the better services. The objective of the untied fund is to mange the basic requirement of the CHC at the local level with community participation. To increase institutional delivery. To improve Mother and Child Care


Untied funds will be used only for the common good and not for individual need except in the case of referral and transport in emergency situations Untied fund will be used for maintenance of the CHC building including minor repair and purchase of essential equipments/ goods etc. Provision of safe water and sanitation facilities in CHC

Support required

Community Support.


2009-10

2010-11

2010-12

Untied Fund of Rs 50000/CHC 3 3 4 4

Annual Maintenance grant of Rs 100000/CHC 3 3 4 4

Plan for maintenance to be developed and approved by the Rogi Kalyan Samitis

x x x x

Plan for use of untied funds x x x x

Rogi Kalyan Samitis to identify mode of construction and repair

x x x x


-09 2009-10

2010-11

2011-12

Total

Untied Fund of Rs 0.5 Lakh X No of CHCs

1.5 1.5 2 2 7.00

Annual Maintenance grant of Rs 1.0 Lakh X No of CHCs

1.5 1.5 2 2 7.00

Seed Money for RKS for District hospital @ 5.0 lakhs

5 5 5 5 20.00

Total 8 8 9 9 34.00

75

B- 5. Mobile Medical Units Situation Analysis

Samba district have some villages that are located in hilly terrain and some are located at border areas, there are also some areas where health facilities are not in place, so Mobile Medical Unit is important for those areas. So, it will be much convenience and cost effective projects to ensure mobile medical units in the cut-off, remote, fur flung areas of the District. So, that a comprehensive Health Care services to the people living in the remote areas at their doorsteps. Such mobile Medical Units can be used during natural disaster also. It is proposed that one mobile Medical Unit ambulances/CHC may be provided to this District with surgical facilities with allied equipments like X-ray, laboratory, Ultra Sonography etc Medical mobile units are envisaged under NRHM. Apart from providing health care to the far flung areas and the areas where desirable quality services could not be provided due to lack of staff, there mobile units would be viable option.

Objectives

The Mobile Medical will cover at least three remote villages in a day and the community members will be informed about the timings and days of the vans visits in advance. The mobile medical van will be a travelling medical facility, which will cater to those who do not have access to basic health care. To provide a comprehensive Health Care Services to the people living in fur flung area. To ensure immediate response during epidemic and disaster.


Mapping of unserved and underserved areas in the District. Monthly plan of activities to be detailed out (the villages that will be covered, the services that will be rendered etc

Support required

Funds required for acquiring vehicle.

Timeline 2008-09

2009-10

2010-11

2011-12

Operationalizing the MMU x Orientation of the staff x x x x Wide Publicity x x x x Strengthening the MMU x x x x Addition of services x x x x


09 2009-10 2010-

11 2011-12 Total

Hiring staff 9.9 10.89 11.979 13.177 45.95

Orientation of the staff 0.1 0.2 0.25 0.3 0.85 Joint Workshop for finalizing modalities 0.1 0.2 0.25 0.3 0.85

Cost of Vehicle, equipment and accessories

26.85 0 0 0 26.85

Recurring Cost of Drivers, Drugs, supplies, Mobile phones, POL, Maintenance

2.518 2.770 3.047 3.351 74.50

Total 39.468 14.0598 15.526 17.128 86.18

76

Detailed Calculations

Budget for Vehicles, Equipment and Accessories S.No Head Unit Cost

Cost of Vehicle for staff to MMU 5,00,000 Cost of Vehicle for carrying A/V aids, equipment etc 18,00,000 Prefabricated tents and Furniture 1,50,000 Equipment 2,00,000 Mobile Phone (one for each Driver) 10,000 Computer system with Printer 30,000 Total 26,85,000

Budget of Personnel

S.No Head Unit Unit Cost Amount

Emoluments to MOs -1 12 months 15000 180000 Emoluments to Specialists –2 (Part time) 12 months 40000 480000 Lab Technician 12 months 5000 60000 Pharmacist 12 months 5000 60000 Nurse 12 months 7500 90000 Total 870000

Budget for Recurring Expenses

S.No Head Unit Unit Cost Amount Salary of Drivers –2 12 months 6660 159840 Drugs 30000 POL and Maintenance of Vehicles 40000 Maintenance of equipment 10000 Mobile Phone bill -2 12 months 500 12000 Total 251840

77

B – 6. Upgrading CHCs to IPHS Situation Analysis

Infrastructure All the CHCs are running in government buildings. Only total CHCs have water supply and 71% have tap water supply. From the facility survey it is revealed that 57% CHCs have facility of separate public utilities. 50% of CHCs have facility of staff quarters for Specialists, MO’s and Ambulance drivers. All the CHCs have labour room and operation theatre facility Manpower In both CHCs of the district Samba, there exists vacancies of General Surgeons, Physicians, Obstetrician / Gynaecologist, Paediatrics. And support manpower also. 2 more CHCs are required as there are 3 medical blocks and only 2 CHCs are there. All CHCs should have facilities of FRUs as per IPHS standards All the CHCs have sufficient staff quarters for there staff. 2 specialists for each speciality will be required. 7 MOs separate for casualty Conveyance allowance is required to be provided to Mos. VIP duty – separate 2 MOs or VIP at source Residences for every hospital employee Mobile phones and vehicles for doctors needed in emergency and living outside hospital One general OPD is a must per CHC. Separate wing for civil, electrical and public health Class IV as per number of beds Mechanical wing required Clerk/supervisor post required permanently Dispensary Purchase of land after site evaluation to determine accessibility

Objectives Main objective is to make available all the required manpower at CHCs to enable them to work effectively and address to the patients’ needs.


In the short term the manpower may be engaged on contract basis.

Support required

Man power and fund will be required for upgrading CHC .

Timeline Activity / Item 2008-09

2009-10

2010-11

2011-12

New CHC with quarters 1 0 1 1 Blood Storage Units 3 0 1 1 Repair /alterations/additions of CHC Repair/alterations/additions of Staff Quarters (CHCs)

2

Construction of Staff Quarters (CHC) Equipment (CHC) 3 3 4 4

78

Medicines, (CHC) 3 3 4 4 Furniture (CHC) 3 3 4 4 Generator (CHC) 3 3 4 4 Computer (CHC) 3 3 4 4 Maintenance (CHC) 3 3 4 4


09 2009-10

2010-11

2011-12

Total

Strengthening of Existing CHCs including Staff quarters (for IPHS) @ 30 X CHCs

60 0 0 0 60.00

Construction of 2 new CHCs (24 Lakhs for CHC building and 55.2 Lakhs for 4 MOs and 4 SN and 1 guard quarters) @ Rs. 79.2X CHCs

79.2

0

79.2

0 158.40 Construction of new staff Qtrs at existing CHCs(14.40 Lakhs for 2MOs and 12 Lakhs for 2SN )@26.4X 3 CHCs

79.2 26.4

105.60 Medicines @10.0 CHCs 30 30 40 40 140.00 Furniture @1.2 X No of CHCs 3.6 0 1.2 0 4.80 Equipment @ 22.19 X No of CHCs & FRUs 66.57 0 22.19 0 88.76 Hiring of vehicle for S/MOs @ 1000 x 7 days x12monthsX No of CHCs

2.52 2.52 3.36 3.36 11.76

Purchase of generator sets @ 0.6 lakh x No of CHCs

1.8 0 0.6 0 2.40

Recurring & Maintenance cost of generator sets Rs. 140 X 30 days X 12 months X 6 No of CHCs & FRUs

1.53 1.53 2.04 2.04 7.14

Strengthening of DH Samba 575 575.00 Total 899.42 34.05 174.99 45.4 1153.86

79

B – 7. Upgrading PHCs for 24 hr Services

Situation Analysis

District Samba is having 15 PHCs including Accidental Hospital Vijaypur. It has been decided to upgrade 50% of the PHCs to provide 24x7 hrs services. Main constraint is insufficient posting of doctors so to ensure 24 hours service delivery and it has to ensure that all the posts of doctors are filled.

Objectives

To upgrade 50 per cent of PHCs To promote institutional deliveries To provide health services to the poor people.


PHCs required sufficient manpower for round the clock duty. In first phase, above said two PHCs will upgraded as 24 hr service provider. At least one female doctor should be there in PHC for emergency delivery. Staff quarters should be there in the PHCs.

Support required

One female doctor will be provided in all the 24 hr PHCs.

Timeline Activity / Item

2008-09

2009-10

2010-11

2011-12

New buildings with quarters, equipment and furniture

5 0 0 0

Repair/ additions/ alterations of PHC @ 2 lakhs/PHC

10 0 0 0

Repair/ additions/ alterations of Staff Quarters @ 5 lakhs/PHC

15 0 0 0

Staff Quarters at PHC @28.80/PHC 15 Furniture 15 Electricity connections 15 Equipment 15 Water Connections 15 Generator 15 Computer System 15

Activity / Item 2008-09 2009-10

2010-11

2011-12 Total

Staff quarters for 10 PHCs where PHC buildings are available (28.8Lakhs for 2 MOs and 3 SNs quarters)

288 0 0 0 288.00

Strengthening PHCs for 24X7@ 10X 15 PHCs 100 50 0 0 150.00 Construction of building on 5 building-less PHCs with Staff Quarters (9 Lakhs for PHC building and 28.8Lakhs for 2 MOs and 3 SNs quarters) 189 0 0 0 189.00 Medicines @3.0 X PHCs 45 49.5 54.45 59.895 208.85 Furniture @0.45 XPHCs 6.75 0 0 0 6.75 Equipment @ 1.115 X PHCs 16.725 0 0 0 16.73

80

Vehicle will be hired for MOs @ 1000 x 7 days x 12MonthsX PHC

12.6 13.860 15.246 16.771 58.48

Purchase of generator sets @ 0.6 lakh x PHC

9 0 0 0 9.00

Recurring & Maintenance cost of generator sets Rs. 140 X 30 days X 12 months

7.65 7.65 7.65 7.65 30.60

Total 674.725 121.01 77.346 84.3156 957.40

81

B – 8. Upgrading Sub Centres Situation

Analysis Out of 82 Sub centres 54 sub centres are running in rented accommodation and 28 sub centers are running in Govt. or donated building. Only 12 SC have water supply and 4 have toilet facility. Sub Centres Overall Status

(Number) Sub-Centres in own building 28 Sub-Centre in Panchayat Bldg / rented building 54

SC without Electricity connection 34 SC without Water Supply 70 SC without Toilets 78

None of the subcentres have labour room and OT facility.

Objectives To upgrade the SCs, for providing routine good health care preventives and also promote health care services. To identify high risk cases at early stage. To conduct normal and safe delivery at the sub-centre


Subcentre is the first peripheral contact point between community and health care delivery system. Phase wise construction and major repair works to be undertaken in next three years. Minor repair of subcentres. Establishment of grievance boxes in all subcentres.

Support required

Subcentres should be equipped with all the preventive services which will be made available to the community. Upgradation of subcentres to the IPHS standard. Availability of necessary staff like 2 ANMs per subcenter and at least one ANM should be there in subcenter for 24 hours for emergency services. Residential facility for ANM.

Timeline 5 Years Budget Activity / Item 2008-09 2009-10 2010-11 2011-12 Total

New Building for Existing Sub Center with Equipment and Furniture 98.6 98.6 73.95 147.9 419.05 New Building for Additional Sub Center with Equipment and furniture 49.3 14.79 147.9 147.9 359.89 2 Staff Quarters 120 120 60 0 300.00 Equipment For SC 22.75 0.75 0.75 0.75 25.00 Furniture For SC 8 0.4 0.4 0.4 9.20 Drugs and Medicine For SC 18 18 18 18 72.00 Travel allownce@ 6000 XSC 36 36 36 36 144.00 Total 254.05 189.94 263.05 203.05 910.09

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B-9 Untied Funds and Incentive Fund for the Village Health and Water Sanitation Committees Situation Analysis/ Current Status

NRHM has placed a lot of stress on Community involvement and formation of Village Health & Water Sanitation Committees (VHWSC) in each village. These committees are responsible for the health of the village. In District Jammu these committees have been formed but need strengthening to improve their functioning. The selection of ASHA, her working, progress of the village is part of the responsibilities of the Gram Panchayat. In Samba district there are 433 villages with population less than 1500. There are 28 villages with population between 1500 and 5000. There are 11 villages with population more than 5000. Hence these amount to 123 units with population of 1500 persons or more.

Objectives Strengthening the Village Health & Water Sanitation Committees through financial support

Strategies Provision of annual Untied funds of Rs 10000 each year to the villages up to a population of 1500 Provision of Rs 5000 as permanent advance fund for Incentives for ASHA

Activities Provision of Annual Untied funds of Rs 10000 each year to the villages upto a population of 1500. Villages with more than 1500 population upto 3000 will get twice the funds. Villages with population more than 3000 will get three times the funds. Hence there will be 539 units of population 1500 or less to get the funds annually of Rs 10,000.00.This untied fund is to be used for household surveys, health camps, sanitation drives, revolving fund etc; Orientation of the MPHWF for the utilization of the untied funds and she in turn will orient the Village, Health & Water Sanitation committee. Provision of Rs 5000 as permanent advance fund for Incentives for ASHA based on performance norms. Monthly meetings of the VHWSC for reviewing the funds and activities. This is to be facilitated by the MPHWF Monthly review at the PHC level regarding the VHWSC functioning and utilization of funds.

Support required

State should ensure the orientation procedure for the VHWSC Funds to be transferred on time to the MPHWF PRIs to ensure proper usage and accounts

Timeline 2007-08

2008-09

2009-10

2010-11

2011-12

Untied Fund of Rs 10000/unit for Pop 1500/unit x 175 units

x x x x x

Orientation and reorientation of the VHWSC

x x x x x

Provision of Rs 5000 as permanent advance for incentives to ASHA

x x x x x

Monthly meetings of the VHWSC x x x x x Review of the VHWSC functioning at PHC level

x x x x x

83

Budget Activity / Item 2008- 09

2009- 10

2010- 11

2011- 12

Total

Untied Fund of Rs 10000/unit ( 1500population =1unit) x 123 units

12.3 12.3 12.3 12.3 49.20

Permanent Advance to VHWSC for ASHA incentive @ Rs5000/SC

5 5 5 5

20.00 Total 17.3 17.3 17.3 17.3 69.20

84

PART C: IMMUNIZATION

C-1. Strengthening Immunization Situation

Analysis As per the DLHS data, status of immunization of district Jammu (old Jammu) is given below: Percentage of children age 12-35 months received Polio 0 94.0

Percentage of children age 12-35 months received BCG 92.1 Percentage of children age 12-35 months received DPT3 49.8 Percentage of children age 12-35 months received POLIO 3 55.1

Percentage of children age 12-35 months received Measles 78.1

Percentage of children age 12-35 months received Full Immunization

44.0

Percentage of children age 12-35 months not received any vaccination

2.2

Aware of diarrhoea 90.5 Knowledge of ORS 75.1

. The reasons for children not being Immunized are related to the ignorance of the mothers on the importance of immunization, the place and time of Immunization sessions and fear of side effects. The community perceives that the Polio drops given repeatedly at the time of Pulse Polio campaign is equivalent to the complete immunization. The ANM have to take the vaccines from the PHC headquarters resulting in them not reaching the hamlets and also the difficult areas and also the Pulse Polio campaign. Supervision is not done properly at PHC level. Also there is large gap between reported and evaluated coverage.

Objectives/ Milestones/ Benchmarks

Reduction in the IMR to 25 by 2012 100 % Complete Immunization of children (12-23 month of age) by 2012 100 % BCG vaccination of children (12-23 month of age) by 2012 % DPT 3 vaccination of children (12-23 month of age) by 2012 % Polio 3 vaccination of children (12-23 month of age) by 2012 % Measles vaccination of children (12-23 month of age) by 2012 % Vitamin A vaccination of children (12-23 month of age) by 2012

Strategies Strengthening the District Family Welfare Office Enhancing the coverage of Immunization Alternative Vaccine delivery Effective Cold Chain Maintenance Zero Polio cases and quality surveillance for Polio cases Close Monitoring of the progress

85

Activities Strengthening the District Family Welfare Office Support for the mobility District Family Welfare Officer (@ Rs.3000 per month (towards cost of POL) for supervision and monitoring of immunization services and VHD Days One computer assistant for the District Family Welfare Office will be provided for data compilation, analysis and reporting @ Rs 7000 per month. Training for effective Immunization Training for all the health personnel will be given including ANM, Health Supervisor, MPWs, Cold chain handlers and statistical assistants for managing and analyzing data at the district. Alternative vaccine delivery system (mobility support to PHC for vaccine delivery) For Alternative vaccine delivery, Rs. 50 to the ANM will be given per session. It is proposed to hold two sessions per week per Subcentre. Mobility support (hiring of vehicle) is for vaccine delivery from PHC to VHD days site where the immunization sessions are held for 8 days in a month. Immunization sessions to be carried out at each VHD day weekly For the difficult villages the monthly outreach sessions will be used for Immunization. The ANM, ASHA, AWW will inform the parents a day in advance. Incentive for Mobilization of children by Social Mobilizers Rs.100 per month will be given to Social Mobilizers for each village for mobilization of children to the immunization session site. This money will be provided to ASHA wherever possible but if there is no ASHA then it will be given to someone nominated from the village by the PRIs. This could be given to the Numberdars and Chowkidars. Incentive to for each child (12 – 23 months) completely immunized Rs 150 will be given for each child completely immunized including Vitamin A two doses – Mothers, ASHAs / SHG groups, Numberdars and Chowkidars. This will be verified by the AWW and ANM. Contingency fund for each block Rs. 100/ month per block will be given as contingency fund for communication. Disposal of AD Syringes For proper disposal of AD syringes after vaccination, hub cutters will be provided by Govt. of India to cut out the needles (hub) from the syringes. Plastic syringes will be separated out and will be treated as plastic waste. Regarding the disposal of needles, Pits will be formed at at every village as per CPCB guidelines. For construction of the pits at PHC, SC and villages a sum of Rs. 2000/ pit has been provisioned. Outbreak investigation Rapid Action Team for epidemics will be formed Dissemination of guidelines Training of Rapid Action Team for investigating outbreaks who will in turn orient the

86

ANM during Sector meetings Adverse effect following Immunization (AEFI) Surveillance: Standard Guidelines have been developed at national level and will be disseminated to the district officials and block levels in Review meetings. IEC & Social Mobilization Plans Rs 25 per session of Immunization fro IEC activities ( 96 villages once a month and In 290 villages 4 times a month) (Discussed in details in the Component on IEC) Cold Chain Repairs of the cold chain equipment (@ 750/- per PHC & CHC will be given each year For minor repairs, Rs. 10,000 will be given per year. Electricity & POL for Genset & preventive maintenance (Running Cost) of Walk in Coolers (WICs) & Walk in Refrigerators (WIF) () @ 15000/equipment per two months plus Rs. 1000 per machine for POL for Genset. Payment of electricity bills for continuous maintenance of cold chain for the PHC @ 300 per month PHC (vaccine distribution centres) has been budgeted under this head. POL & maintenance of vaccine delivery van @ Rs. 3000/month for maintenance and POL for Vaccine delivery van for regular supply of vaccine to the PHC. Effective Supervision and monitoring: For increasing the immunization supervision and monitoring are very important. The number of LHVs and Male Health Supervisors need to be adequate hence vacancies need to be filled up. Mobility support for MOs @ Rs 1000/session for hiring a vehicle/ mules HMIS The formats for Immunization should be properly filled for each child. The data should be shared in each review meeting for further planning.

Support required

State to ensure the following: Regular supply of vaccines and Autodestruct syringes Reporting and Monitoring formats Monitoring charts Cold Chain Modules and monitoring formats Temperature record books Polythene bags to keep vaccine vials inside vaccine carrier Polythene for the vaccines to avoid labels being damaged Training of Cold Chain handlers Training of Mid level managers


2009-10

2010-11

2011-12

Alternative Vaccine delivery x x x x

Children for Immunization Incentive 5000 7500 10000

12000

Mop up Round x x x x

87

Pit formation 472 472 472 472

MCH Cards 50000 50000 50000

50000

IEC activities x x x x

Tracking bags x x x x

Orientation in Tracking bags x x x x

Maintenance of Cold Chain x x x x

Provision of Generator

Budget Activity/item 2008-09 2009-

10 2010-11 2011-12 Total

Mobility support for alternative vaccine delivery Rs. 50 per session for 2 planned sessions per week at each Subcentre village for 12 months = Rs. 50x2 sessionsx4 weeks/mthx12 months x SCs

4.8 4.8 4.848 4.992 19.44

Vehicle for distribution of vaccines in remote areas @ Rs 1000 per PHC for 2 times per week x 4 weeks x 12 months x PHCs

14.4 15.840 17.424 19.166 66.83

Mobility Support Mop up campaign @ Rs 10000 per PHC ( Including travel, vaccine delivery, IEC) x 6 rounds/ year x PHCs

9 9.900 10.890 11.979 41.77

Mobilization of Children by Social Mobilizers @ Rs. 100/ session x4 sessions per month X 472 units x12 month

22.656 24.922 27.414 30.155 105.15

Contingency fund for each block @ Rs.1000/month x 3 blocks x 12 months

0.36 0.396 0.436 0.479 1.67

Pit Formation for disposal of AD Syringes and broken vials (@ Rs. 2000 per pit per Subcentre and PHC

2 0.1 0.1 0.1 2.30

Printing of Immunisation cards @1.50 per card x 30000 cards each year

0.45 0.495 0.545 0.599 2.09

Maintenance of Cold Chain Equipments (funds for minor &major repair) (@ Rs.750 per PHC/CHC for the first year then Rs. 500 per PHC/CHC) monthly and Rs 10,000 annual for major repairs

3.23 3.23 3.23 3.23 12.92

POL & maintenance for Vaccine delivery van at district level @ Rs.15000/month x 12 mths

1.8 1.980 2.178 2.396 8.35

Running Cost of WICs & WIF (Electricity & POL for Genset & preventive maintenance) Rs. 90000 for electricity @ 15000 equipment per two months plus Rs.8000 per annum @1000 for POL for

7.02 8.490 9.340 10.270 35.12

88

genset at DH

Mobility suppot to District Family Welfare Officer @ 3000/month

0.36 0.396 0.436 0.479 1.671

Computer Assistant for District Family Welfare Office @ 7000

0.84 0.924 1.016 1.118 3.898

Total 66.916 71.473 77.856 84.964 301.21

89

C-5. HMIS Data Monitoring and Support Situation Analysis

At present data from SC to PHC to Block level and block level to district level is collected on some formats and continuously new formats are coming for collecting data and it is very difficult for ANMs or other staff to maintain data in those formats. And it also not covers the whole information regarding nutrition, community health information. Accurate data for different indicators not available. Data varies from source to source.


To collect sufficient data related to Health and its determinant. To utilize the collected information for future planning To utilize the collected data for monitoring and evaluation purposes.


The Health Management and information system needs to be improved so that the requisite information can be collected and used for Health Management in the district for which the recently /advance information technology needs to be introduced. A fully functional two-way communication system leading to effective decision making needs to be developed. Specific HMIS software needs to designed which fulfill the basic information requirement of the district. In the first phase all the Block Headquarters needs to be linked with the District Programme Management Units through NIC Net centre and subsequently district PMUs with State Programme Management units for easy flow of information and data.

Support required

Policy level decision for development of computerised Districts of J and K State. Technical expertise

Timeline Activities 2007-08

2008-09

2009-10

2010-11

2011-12

Survey house-to-house by youth x Survey for practices, coverage, behaviour etc through independent agency

x

Software development x Data Entry of each household x x x x x Internet connectivity x x x x x Provision of computers for each CHC and PHC r

x x x x x

AMC for computers x x x x x GIS for the district, training and updation x x x x x Printing monitoring Charts x x x x x

90


09 2009-10

2010-11

2011-12

Total

Baseline survey 20 0 0 0 20

Software development 20 0 0 0 20 Internet connectivity @ Rs 900 /mth x No of facilities x12 mths

1.944 1.944 1.944 1.944 7.776

AMC for computers @ Rs 5000 /computer /year x No of computers

2.1 2.1 2.31 2.541 9.051

Consumables for computers @ Rs 1000/mth/facility x 12 mths

4.92 4.92 4.92 5.04 19.800

GIS for the district, training and updation 12 0.5 0.5 0.5 13.5 Printing monitoring Charts @ Rs. 5 per monitoring chart

0.1 0.15 0.175 0.2 0.625

Total 61.064 9.614 9.849 10.225 90.752

91

PART D: NATIONAL DISEASE CONTROL PROGRAM

D-1. RNTCP Situation Analysis

Indicators No. New Sputum Positive cases (ACDR) 455 Annual total cases 1565 Total new pulmonary TB cases 594 Proportion of new sputum positive out of total new pulmonary cases

45%

Cure rate 72.25% Smear Conversion Rate 77.5% Treatment success rate 75.5% Defaulter cases 300 Failure cases 1% Suspects per Lakh 165 % Smear + among suspects 13% Case Detection Rate (annual) 106 Death rate 4 to5%

*old Jammu district DMCs (designated microscopic centres) are examining the patients. Patients are taking treatment at DOT centres.

Objectives The goal of RNTCP is to decrease mortality and morbidity due to TB and cut Transmission of infection until TB ceases to a major public health problem. The objectives of RNTCP are: To achieve and maintain detection of at least 85 % of new sputum smear positive patients , and To achieve and maintain detection of at least 70 % of such cases in the population. The only effective means by which 85 % cure rate or more has been shown to be achievable on a programme basis is by application of the DOTS strategy


Involvement of the following: NGO : Kristu Jyoti Social Welfare Society. A DOT centre is already functioning. One Medical Officer has been trained recently with 5 days RNTCP Programme. One DOT provider is also trained. NGO Scheme 2 agreement signed under which one more Medical Officer and 9 paramedical officials planned to be trained. ESI : A DOT centre is planned to started very shortly. 1 Medical Officer and 2 DOT providers have already been trained. Railways: 1 DOT centre is functioning. A recently posted Medical Officer has been trained as earlier one was transferred. CRPF: One DOT centre is functioning. A clinical meet over RNTCP was organized for doctors of Group Centre Hospital Jammu. Army: A clinical meet over RNTCP was organized in which about 50 staff comprising of doctors and para-medicos participated. Negotiations are still on and shortly a DOT centre is planned to be started. Besides, more Peripheral Army Medical Units in Samba district are being identified

92

for RNTCP implementation. 2. IEC Awareness sessions in teaching institutions are being done so that students are imparted health education regarding RNTCP to enlighten the society. A few pockets in the rural areas of the district have been identified with likelihood of increased concentration of the population suffering from Tuberculosis. As active detection camps go against the programme, educative and awareness camps can be conceived and planned for such areas. Planning to project slogans through hoardings at prominent public places like bus stands, railway stations, commercial complexes, OPDs of various hospitals within the district and other prominent places of public gathering. As already stated above in the involvement of Forces, RNTCP clinical meets to be planned and such sessions to be used as awareness sessions. Every year World TB Day on March 24th, and Gandhi Jayanti on 2nd October are observed on behalf of District Tuberculosis Control Society, Jammu and District TB Association Jammu respectively. Such fora are used to project the RNTCP activities by speeches, rallies, banners to make the people aware regarding the programme. Health education by Medical Officers, STSs, STLSs and other technical staff throughout the RNTCP centres is already a common practice through which patients and their attendants are imparted to relevant knowledge.

Support required

Restoration of supervisory vehicle meant for supervisory visits by the DTO. Continuous and uninterrupted supply of drugs, laboratory regents, IEC material and other relevant material. Construction / Renovation of DTC Building and maintenance of RNTCP units in the field. Other administrative backup as and when required.

Timeline 2007-08

2008-09

2009-10

2010-11

2011-12

Improving the DTC building, MC Centres and TC centres x x Increasing the DOT providers through ASHAs x x x x x Training to RNTCP staff and ASHA x x x x x Awareness drives x x x x x

93


09 2009-10

2010-11

2011-12

Total

Civil Works

DTC building 1.5 lakhs MC 0.28/MC

TU 0.35/Tu except DTC

2.13 0 0 0 2.13

Material and supplies 1.2 1.45 1.6 1.76 6.01 Laboratory material 1 1.21 1.33 1.46 5.00

Strengthening of District TB Clinic 2 0 0 0 2.00 Awareness drive on World TB day 1 1.21 1.33 1.46 5.00

Salary of contractual staff 6.33 6.963 7.659 8.425 18.01 Training of Staff 22.424 24.666 27.133 29.846 104.07

IEC activities 1 1.21 1.33 1.46 5.00 Procurement of vehicle 6 0 0 0 6.00 Vehicle maintenance inc POL 1 1.21 1.33 1.46 5.00

Hiring of vehicle DTO

MO TC @ Rs 0.42lakh/yr

1.7 2.06 2.27 2.5 8.53

Equipment and maintenance Microscope @ Rs1000/yr/microscope

Computer@ Rs 5000/yr Photocopier/Fax Rs2500/ machine

0.085 0.103 0.113 0.124 0.43

Miscellaneous – TA/DA, Telephone, Meetings, Electricity repair etc

0.2 0.25 0.28 0.3 1.03

Orientation of PRIs 0.3 0.3 0.3 0.3 1.20

Re-orientation of PRIs and School Teachers 0 2.2 0 2.5 4.70

Total 46.369 42.832 44.675 51.596 185.47

94

D-2. LEPROSY Situation Analysis

Balance Cases at beginning of year

New cases detected in year

Cases Discharged in year

Balance Cases at end of year

Per 10,000 Population

PB MB PB MB RFT O.D PB MB PR NCDR

Proportion of Deformity Ratio among cases

855 146 3

231 Detected 109 Treated 257 Discharged 118 Balance PB 50 MB 89 Balance 139 T

Objectives To reduce prevalence of Leprosy from 1.8 per 10,000 to less than 1 per 10,000. Strategies and Activities

Main strategy will be: House to house detection Treatment Rigorous follow-up Wide publicity


2008-09

2009-10

2010-11

2011-12

House to house detection x x x x x Wide publicity x x x x x

Rigorous follow-up x x x x x Treatment x x x x x


-09 2009-10

2010-11

2011-12

Total

Routine Budget for Leprosy control programme 1.45 1.8 2 2.2 9.05 Monitoring & Supervision 1 1.2 1.3 1.5 6.10

Additional medicines 1 1 1 1 5.00 IEC Activities 1 1.2 1.3 1.5 6.10

POID Camps one per year @5000 XPHC 0.75 0.75 0.75 0.75 3.00 Celebration of world Anti Leprosy day@20000 0.2 0.2 0.2 0.2 0.80 Total 5.4 6.15 6.55 7.15 30.05

95

D-3. NATIONAL MALARIA CONTROL PROGRAMME Situation Analysis

Issues No.

Total Blood Slides Examined (BSE) 83426*

34 30

Total Positive Cases: Plasmodium Vivax (Positive): Plasmodium Falciparum (Pf): 4 Slide Positivity Rate (SPR) 0.04

Slide Positive plasmodium falciferum Rate (PFR) 0.005

Annual Blood Examination Rate (ABER) ----

Deaths NIL

* old Jammu district data (Source: CMO office) Shortage of staff: 5 vacant MPHW posts In J & K disease surveillance for Malaria was introduced under National Malaria Eradication Programme. Now the programme is part of National Vector Borne Disease Control programme. Under this District Malaria Working Committee has been constituted and representatives from various departments are there but there is very little help from these departments. The main bottlenecks are related to shortage of manpower especially for the remote areas. 15 PHCs have no laboratory facility. Also there is lack of skills for taking blood slides, record keeping and there is lack of motivation.

Objectives

Reduction in SPR, API, PFR death rate to 10% by 2012 To keep the number of cases due to malaria at low level by making the public aware of preventive measures collection of blood slides of all the fever cases and giving them treatment. To treat all the patients suffering from malaria promptly and efficiently so that spread of malaria is prevented, period of morbidity (illness) is reduced and mortality due to malaria is reduced to almost nil. This also includes hospital indoor treatment of the patients.

Strategies Provision of additional Manpower Training of personnel Strengthening of Malaria clinics Addressing Disease outbreak Health education Involvement of Private sector Innovative methods of Mosquito control Collection of blood slide both at health institutions and house to house of all the fever cases, which should be about 10 % of whole population every year.

Activities To give suppressive treatment to all the fever cases whose blood slides is taken and then radical treatment to be given within one week to all the positive cases, so that the plasmodia are killed.

96

Prompt and effective treatment shall be given to all the cases suffering from malaria, especially those who need hospital admission. To conduct spray of insect for killing the mosquitoes inside houses and other areas where needed especially in rural areas. I.E.C activity through press/ radio/ local cables fax / pamphlets / posters and booklets for educating people as regards preventive measures and getting blood tested for fever and taking treatment and Co-operate during insecticides spray as and when conducted.

Support required

Provision of Funds for POL/hiring of vehicle for overall supervision and monitoring from district head quarters. Amount required is Rs 30,000 / year. Total sanitation (Rural and Urban) in and around the houses in rural and urban areas is required so that the mosquitoes cannot hide in and around houses. Support is required from PHE Fishery and flood and irrigation departments for help in reduction of water stagnation and others measures which decrease mosquito breeding NGO’s should support the programme during anti malaria campaigns for educating, motivating and mobilising the people for measures to be taken from malaria.

Timeline Activity / Item 2007-08 2008-09 2009-10

2010-11

2011-12

Hiring Contractual Staff x x x x x Purchase of Jeep and Trucks x x x x x Fogging & Spraying x x x x x Hoardings 15 PHCs 3

CHC, 1 DH, CMO Off

Hatcheries for Gambusia Fish 1 CHC & 1 DH, CMO Off

15PHC 3CHC,,

IEC activities x x x x x

97


09 2009-10 2010-11 2008-12 Total

Salary Contractual staff 46.62 51.282 56.410 62.051 216.363

Travel expenses @ Rs 4000 per month x 12 months

0.72 0.87 0.95 1.05 3.59

Office expenses @ Rs 5000 per month x 12

0.6 0.73 0.8 0.88 3.01

Jeep and maintenance 6 0.66 0.73 0.8 8.19 Trucks – 3 and maintenance 24 2.64 2.9 3.19 32.73

One small Fogging machines for each PHC @ Rs 1.00 lakh and one at District HQ Pulse Fog Machines @ Rs.8.00 lakh per unit and maintenance

43 47.3 52.03 57.233 199.563

Training 23.44 25.784 28.362 31.199 108.785

Misc @ Rs 1Lakh per DH and Rs 20000 per CHC and Rs 10000 for PHC

4.71 5.181 5.699 6.269 21.859

Board hoarding: 8’x 12’ Initially at the CHCs and District hospitals @ Rs 25,000/-

1.75 1.75 1.75 2 7.25

Board hoarding: 5’x3’ initially at the PHCs@ Rs 10,000/-

3.5 3.5 3.5 3.5 14

POL @ Rs 48,000/- per vehicle jeep and truck for 12 months x 4

40.32 48.78 53.66 59.03 201.79

Total 194.66 188.477 206.792 227.202 817.131

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D-4. OTHER VECTOR BORNE DISEASES Situation Analysis

Other VBDs No. Kalazaar NIL Dengue 09 Lymphatic Filariasis NIL Japanese Encephalitis NIL

During the year 2006-07 there were 9 cases of Dengue in District Jammu. There were no suspected cases of Chikingunya. It is expected that intensive efforts should be made to prevent emergence of Chikingunya in District Jammu.

Objectives

No incidence of Dengue by 2012 Prevention of JE, Chikingunya and other new infections

Strategies Reduction of vector density Mosquito-man contact reduction Community awareness

Activities Reduction of vector density Identification of breeding sites Fogging and spraying Covering of any breeding sites Preparedness for new infections Increase in Manpower Training of personnel for identification of new infections Preparation of Laboratories in the district and State to diagnose the new diseases Preparedness of dealing with the epidemic outbreak Community awareness as part of the IEC for Malaria and IDSP Group meetings Pamphlets/ handbills Public announcements Kala Jathas One jeep for Entomologist (already covered in malaria budget) One truck for shifting manpower and drums /equipment (in malaria budget)

Support required

Support from State Laboratory and the NICD for diagnosing Dengue, Chikingunya, JE etc; Support from District Administration, PRIs, WCD, PHEd,

Time Frame Activity / Item

2007-08

2008-09

2009-10

2010 - 11

2011-12

Fogging and Spraying x x x x x Pamphlets x x x x x Kala Jathas for Malaria, Dengue and Chikingunya

x x x x x

99

Budget Activity / Item 2008-09

2009-10

2010-11

2008-12

Total

Unforseen expenses 0.5 0.61 0.67 0.74 2.52

Kala Jathas for Malaria, Dengue and Chikingunya @ Rs 1000 per village x 472

4.72 5.192 5.711 6.282 11.47

Total 5.22 5.802 6.381 7.022 24.43

100

D-5. BLINDNESS CONTROL PROGRAMME Situation

Analysis Indicators No. Total Cataract surgery performed 294* (old jammu) Cataract surgery with IOL -- School going children screened -- Children detected with refractive error -- Children provided with free corrective spectacles

--

Villages having no register -- Objectives To bring down no. of cases of blindness in the community by:

Firstly identify the cataract cases and then operate them. First screening and then correction of refractive errors (especially of school going children) by provision of spectacles. Increase awareness among people regarding measures to take healthy eyes and also take vitamin A in prevention of eye blindness.


IEC activity will be done through Charts, Pamphlets, Booklets, and Radio announcement for making the people aware of the preventive measures for eye problem and diseases. Screening of school going children will be done for detecting refractive errors and spectacles will be provided to those found with refractive errors. Vit A is being given to the children of upto 5 years of age starting from 9 months age then twice in a year upto 5 years for prevention of blindness due to Vit A deficiency Vit A is given here children at all the health institutions.

Support required

At least 2 teams of doctors and trained opth. Asstt are required to be provided from the hospital in Jammu by the Director Health Services Jammu. NGO’s are required to support during eye camps and for awareness generations among masses regarding prevention and treatment for blindness


09 2009-10

2010-11

2011-12

Total

Health Mela 2 2.2 2.42 2.662 9.28 IEC 1 1.1 1.21 1.331 4.64 Blind Register@100X 472 villages 0.472 0.519 0.571 0.628 2.19 Cataract Camps @ Rs 20000 per camp x 15 PHC

3 3.3 3.630 3.993 13.92

POL for Eye Camps @ Rs 3000/camp x15

0.45 0.495 0.545 0.599 2.09

Training of School teachers @ Rs 100/head x 200

0.2 0.22 0.242 0.266 0.93

Training of PRIs @ Rs 100/head x 200

0.2 0.22 0.242 0.266 0.93

Purchase, Maintenance and Repair of equipments

20 22 24.2 26.620 92.82

Total 27.322 30.054 33.060 36.366 126.8

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D-6. Integrated Disease Surveillance Programme Situation Analysis/

The programs with major surveillance components include: The National Anti-Malaria Control Program National Leprosy Elimination Program Revised National Tuberculosis Control Program Nutritional Surveillance National AIDS Control Program National Polio Surveillance Program as part of the Polio eradication initiative National Programme for Control of Blindness (Sentinel Surveillance) Surveillance activities of all these vertical programs of Malaria, Tuberculosis, Polio, HIV are functioning independently leading to duplication of Surveillance efforts. Surveillance has been ineffective due to: There are a number of parallel systems existing under various programs which are not integrated. The existing programs do not cover non-communicable diseases. Medical colleges and large tertiary hospitals in the private sector are not under the reporting system as well as for utilization of laboratory facilities. The laboratory infrastructure and maintenance is very poor Presently, surveillance is sometimes reduced to routine data gathering with sporadic response systems thereby leading to slow response to Epidemics, Information technology has not been used fully for information and to analyze and sort data so as to predict epidemics based on trends of the reported data. In response to these issues the Integrated Disease Surveillance Programme was launched in J & K to provide essential data to monitor progress of on going disease control programs and help in optimizing the allocation of resources. IDSP includes 15 diseases/ conditions (Malaria, Acute diarrhoeal disease-Cholera, Typhoid, Jaundice, Tuberculosis, Acute Respiratory Infection, Measles, Polio, Road Traffic Accidents, Plague, Yellow Fever, Meningoencephalitis /respiratory distress, etc., HIV, HCB, HCV) ) and 5 state specific diseases (Thyroid diseases, Cutaneous Leishmaniosis, Acid Peptic Diseases, Rheumatic Heart Diseases). Establishing of District Surveillance unit Upgradation of 1 PSU Labs Water testing labs are in place V-Sat is been installed but training is required Rapid response teams are being established at District levels. DSUs (District Surveillance Units) are being established in all districts One Computer, Printer and Scanner has been received

Objectives Improving the information available to the government health services and private health care providers on a set of high-priority diseases and risk factors, with a view to improving the on-the-ground responses to such diseases and risk factors. Establishing a decentralized state based system of surveillance for communicable and non-communicable diseases, so that timely and effective public health actions can be initiated in response to health challenges in the country at the state and national level. Improving the efficiency of the existing surveillance activities of disease control programs and facilitate sharing of relevant information with the health administration, community and other stakeholders so as to detect disease trends

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over time and evaluate control strategies. Strategies and Activities

Strengthening data quality, analysis and links to action; Improving the laboratories Training of all the stakeholders in disease surveillance and action Coordinating and decentralizing surveillance activities Intersectoral Coordination and involvement of communities and the private sector.

Strengthening of the District Surveillance Unit (DSU), established under the project, Training of the Unit Incharge for epidemiology – {DMO) Administrative Assistant Training of contract staff on disease surveillance and data analysis and use of IT Providing support for collection and transport of specimens to laboratory networks Provision of computers and accessories WEN connectivity to be operationalized Provision of software of GOI Setting up of Peripheral Surveillance Units at CHC Sensitizing the Community for Notifying the nearest health facility of a disease or health condition selected for community-based surveillance Supporting health workers during case or outbreak investigations Using feedback from health workers to take action, including health education and coordination of community participation. Meetings with the SHGs, school teachers, Numberdar and Chowkidars for sensitisation and prompt reporting of cases. Improvement in the Laboratories at the district and at CHC through provision of equipment and consumables

Support required

Provision of supplies on time.

Activity / Item 2007-08 2008- 2009

2009- 2010

2010- 2011

2011-12

Renovation of Labs with provision of equipment, furnishings, material

1 District Hosp, 2 CHC

PSU at 3 CHC

Training x x x x x Contractual staff Software for DSU & training of staff

x x x x x

WEN connectivity x x x x x Sensitization of Community x x x Meetings with SHGs x x x x x Meetings with teachers x x x x x Meetings with Numberdar and Chowkidars

x x x x x

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09 2009-10

2010-11

2011- 12

Total

Renovation of Labs at CHCs @ Rs 20,000 1 0 0 0.2 1.20

Renovation of Lab at District Hospital @ Rs 140,000 and maintenance

1.4 0.18 0.2 0.22 2.00

Equipment for Lab at PSU at CHCs @ Rs 40,000 2 0 0 0.4 2.40

Equipment for Lab at District @ Rs 850,000 8.5 0 0 0 8.50

Computer and Accessories at CHC @63000 3.15 0 0 0.63 3.78 Computer and Accessories at DSU@63000 0.63 0 0 0 0.63

Office Equipment for PSU at CHC @ Rs 20,000 per unit

1 0 0 0.2 1.20

Office Equipment for DSU @ Rs 20,000 0.2 0 0 0 0.20 Software for DSU@ Rs 335000 3.35 0 0 0 3.35

Furnishing of Lab at PSU at CHCs @ Rs 10,000 0.5 0 0 0.1 0.60

Furnishing of Lab at DSU @ Rs 60,000 0.6 0 0 0 0.60

Material and supplies at Lab at PSU at CHCs @ Rs 8,000

0.4 0.44 0.484 0.5324 1.86

Material and supplies at Lab at DSU @ Rs 75,000

0.75 0.91 1 1.1 3.76

Contract Staff at District level @ 200000/yr for 4 staff

2 2.92 3.71 4.58 13.21

IEC activities 1 1.21 1.33 1.46 5.00 Training and retraining 2.6 3.15 3.47 3.82 13.04

WEN connectivity 0.5 0.61 0.67 0.73 2.51 Operational costs at PSU for Surveillance @ Rs 15000/year x 5

0.75 0.9 1.31 1.59 4.55

Operational costs at DSU for Surveillance @ Rs 130000/year

1.3 0.57 1.73 1.9 5.50

Honorariun to Numberdars and Chowkidars for reporting @ Rs 100 pm x 275 Numberdars and 275 Chowkidars x12

8.88 9.768 10.745 11.819 21.59

Total 40.510 20.658 24.649 29.282 115.10

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D-7. Iodine Deficiency Disorders Situation Analysis

Iodine is one of the essential micronutrients. Minimum requirement is 150 microgram per day. The main source of Iodine is from soil and water. Deficiency result in a variety of disorders ranging from Abortion, stillbirths, Goitre, impaired mental function, retarded growth. In J&K the National Iodine Deficiency Programme is being implemented since 1986. There is a ban on the sale on non Iodized salt in J&K. In district Jammu exact data is not available of Iodine deficiency disorders but as per the medical departments assumption there might be possibility of one –two cases in each village

Objectives/ Prevention of Iodine Deficiency diseases Consumption of Iodized salt by 100% families


Supply/monitor quality of Iodized salt Monitoring is done through Food Inspectors who collect two samples of salt per month per district and send it to a laboratory. The Health workers have been supplied with Kits to test samples at least five per month. Review is done in the monthly meetings Monitoring through School health programme – Testing of samples and awareness Supply of Testing kits to AWCs, Schools, SHGs Assessment of the magnitude of the problem This will be done by the Central Survey team Laboratory Monitoring of Iodized salt and urine samples The samples are collected by MPHW and sent for analysis . Health Education: An IEC strategy is essential to promote the consumption of Iodized salt through AWWs, PRIs, NGOs, ASHA, SHGs etc; Demonstration of Iodized salt by school children through testing, Rallies, sensitisation of shopkeepers for keeping Iodized salt. Testing of salt at shops and homes

Support required

Regular Supply of Testing Kits Regular Supply of Iodized salt Regular supply of IEC material

Timeline 2008-2009 Widespread awareness regarding the consumption of Iodized salt Testing of Salt samples in each AWC by AWW, ANM, ASHA Awareness in schools and SHGs 2009-2010 Testing of Iodized salt in all the village shops Strict enforcement of iodised salt in shops

Activity / Item 2008-09 209-10 2010-11 2011-12 Total

Large Village meetings for awareness on IDD and consumption of Iodized salt

1 1.21 1.33 1.46 5.00

Programme in schools – Primary, Upper Primary, Secondary- Govt and Private by School health team @ 500

3.5 3.850 4.235 4.659 8.51

Awareness programme with the SHGs and shopkeepers @ Rs 500 per village x 472 villages

4.72 5.192 5.711 6.282 11.47

Total 9.22 10.252 11.276 12.401 43.15

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6: INTER- SECTORAL CONVERGENCE [The following matrix A note on Inter-sectoral Convergence 6.1 Partnership with AYUSH Department

AYUSH Department (old Jammu district) Situation Analysis

District Jammu is having Sixty Five Government Ayurvedic Dispensaries which are at Par with PHC’s (Allopathy). But Govt. Ayurvedic Defence (GADs) are situated mostly in far-flung rural areas of the Distt. Since the topography of the Distt is mostly hilly terrains so the most of the areas are yet to get safe water supply and other basic amenities for healthy life. The economic status of people in rural areas being low people cannot practise healthy habits like sanitary latrines and good mutative diet etc. Moreover lot of work needs to be done to educate people for healthy norms and preventive measures for various communicable diseases and other health hazards for coverage of 1% population catered by Govt. Ayurvedic Dispensaries, the existing set ups along with the recommended are given below:- 1. Existing Building Position Table - I Total No. of GAD’s

Sanctioned GAD’s

Internal Arrangement GAD’s (Non-sanctioned)

Govt. Buildings

Rented Buildings

Other s

65 52 13 17 45 3

2. Existing Staff Position (Sanctioned by Government) Table-II

AD

MO

D

istric

t O

fficer

MO

Sr. V

aid

Pharm

ac

ist

N.O

.

Jr. A

sstt.

Sw

eeper

Full T

ime

Chow

kid

ar

F.M

.P.W

Driv

er

1 52 02 65 16 1 Nil Nil Nil Nil

All the buildings whether government or rented in which GAD’s are functioning are very poor in condition and totally insufficient to provide services to the pubic. As there is no planned structure they mostly comprise of two rooms or three. Without any facility of residential quarters for Medical officers. It is very difficult to do even dispensing services what to talk of very useful Ayurvedic procedures for public health to treat the ailments with the application of Panchkarma and Khshar Sutra. We cannot think of conducting institutional deliveries due to lack of accommodation and other required equipments and paramedical staff. There is no provision for immunization of mother and children. As there is no cold chain system staff and accommodation for the same. As reflected in table II the staff position in GAD’s is very miserable. As against the sixty five institutions the sanctioned post of Medical Officer’s whereas only 52 and the Paramedical Staff also lacking too much and Class IV employees are only sixteen against the sixty five institutions and there is no full time sweeper, chowkidars, FMPHW and driver employed for GAD’s. Office of the District Officer (ADMO) who is controlling offices of Jammu District for AYUSH is also without government accommodation and is being run in rented

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building with insufficient staff and other facilities. There is no provision in Jammu District to update the knowledge and skill of in-service MO, ISM for which a conference hall is to be made in the district office along with the staff for providing the trainings / orientation courses.

Objectives

To keep the 1% population covered for GAD’s, Health problem, by education of health norms. By making them aware of importance of various national programmes implementing the same in their daily life, which covers the immunization of pregnant mothers and children, importance of institutional deliveries and by educating them for the importance of nutrition for mother and children and making them aware of family planning by advocating various means of contraceptives measures. Moreover implementation of all national and state health schemes for the masses. Also to make the public aware of the most useful procedures of Ayurveda in the form of Panchkarma and Khshar Sutra which treat most of the incurable and recurring health problems. To educate the masses for the importance of AYUSH Deptt. for the sake of safe medical care and to promote the herbal medicines for day to day ailments for which the toxic modern medicines can thus be avoided which have been proved to create serious side effects.


The strategy of AYUSH Deptt. ISM is the betterment of existing health status of the public and safe management of health disorders by ISM and by implementing all health schemes from the National and State Governments in full swing by integrating fully with other health institutions like Allopathy System, Public Health Engineering, ICDS, Malaria, Leprosy, IDD, Tuberculosis, IDSP, HIV/AIDS, Waterborne disease, Maternal Care, Child Care, Adolescent Health and School Health. Nutrition guidelines to masses in general and to mother and children in particulars and by advocating for safe drinking water and sanitation. Rogi Kalyan samities in ISM Dispensaries / Hospitals be framed along with allocation of funds of the pattern the funds are being allocated for PHC/CHC and health center (Allopathic).

Support required

65 Government Ayurvedic Dispensaries buildings are required to be constructed besides providing man power, electric / water facility, laboratory facility, machinery equipment for all 65 dispensaries. Along with ambulance for each GAD.

Timeline Activity / Item 2007-08 2008-

2009 09- 10

10- 11

2011-12

Renovation of Labs with provision of equipment, furnishings, material

1 District Hosp, 2 CHC

PSU at 5 CHC

Training x x x x x Contractual staff Software for DSU & training of staff x x x x x WEN connectivity x x x x x Sensitization of Community x x x Meetings with SHGs x x x x x Meetings with teachers x x x x x

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Meetings with Numberdar and Chowkidars

x x x x x

Budget – Intersectoral Convergence

Activity / Item 2008-09

2009-10

2010-11

2011-12

Total

Meetings of the Block Committees @ Rs 1000 /meeting x 3 blocks x 12 months

0.36 0.396 0.436 0.479 1.67

Meetings of the Village groups @ Rs 50 per village x 472 villages x 12

2.832 3.115 3.427 3.769 13.14

Joint CNA training @ Rs 200 per person ( 550 AWW, 200 ANMs, 306 ASHAs, 15 MOs, 3 CDPOs) x 1074

2.148 2.363 2.599 2.859 9.97

Joint monitoring at the sector level Hiring of vehicle @ Rs 1000/ day x 5 days/month x 15 sectors x 12 months

9 9.9 10.890 11.979 41.77

Joint monitoring at the block level Hiring of vehicle @ Rs 1000/ day x 5 days/month x 3 blocks x 12 months

1.8 1.98 2.178 2.396 8.35

Yearly joint Planning Workshops at the Block level for development of the Action Plans @ Rs 1.00 lakhs per block x 3 blocks

3 3.3 3.63 3.993 13.92

Yearly joint Planning Workshops at the District level for development of the Action Plans @ Rs 1.00 lakh

1 1.1 1.21 1.331 4.64

Yearly joint Workshops to consolidate the plans from the village to the Gram Panchayats to the Sectors and then Blocks at the Block level for Annual Action Plans @ Rs 1.00 lakhs per block x 4 blocks

4 4.4 4.84 5.324 18.56

Yearly joint Workshops to consolidate the findings at the block levels at the District level for development of the Action Plans @ Rs 1.00 lakh

1 1.1 1.21 1.331 4.64

Training of PRIs,VHWS committee members under Chiranjeevi Scheme @22 lakhs

22 22 22 22.000 88.000

Regular monthly meetings under Chiranjeevi Scheme @12 lakhs

12 12 12 12.000 48.000

Development of Education material and hands on trainingunder Chiranjeevi Scheme @ 10 lakhs

10 10 10 10.000 40.000

Total 69.14 71.65 74.419 77.461 292.675

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Issues / Areas Areas of cooperation Areas of convergent action

Curative ; Patient care, Surveillance referral

In order to provide Medicare facilities to the masses there is a vast potential for cooperation with health department so as to implement all the national programmes like National Malaria eradication Programme, T.B. control programme (DOTS), HIV / Aids awareness programme, implementation of institutional deliveries. The cooperation is also needed from the department of social welfare, (ICDS) Anganwari centres located in the areas where the ISM dispensaries are functioning by the way that the staff of these centres (Anganwari workers) can bring the unvaccinated children to the nearest ISM institutions so that their complete vaccination should be done.

The ISM doctors are providing the health Medicare facilities by the way of providing Ayurvedic / Unani medicine but as the dispensaries of AYUSH are located in the Isolation / far flung areas where there is no existence of any health facility (Allopathic) in the form of primary health centres / community health centres or even allopathic dispensaries. Here people come across emergencies which are supposed to be attended by Ayurvedic / Unani doctors or staff. Therefore there is dire need of emergency drugs , life saving drugs , bandaging material , antiseptic lotions , antibiotics which are not supplied in ISM dispensaries. Due to non-availability of these drugs in some cases precious lives are lost and wrath of people falls on the staff of ISM institutions. Therefore life saving drugs, antiseptic lotions and dressing materials need to be supplied to avoid suffering of the ailing masses.

Preventive; Immunization, Prophylaxis services Promotive, IEC

Health department’s cooperation is needed in providing ILR, Deep freezers to the ISM dispensaries, as these are lacking cold chain facility.

As the facility of cold chain in the form of ILR’s and deep freezers is provided to ISM institutions. Routine vaccination as well as out reach vaccination camps should organise easily in remotest and far flung areas. For IEC funds should be kept at the disposal of the Asstt. Distt. Medical officer so as it should be used for awareness Programmes.

Specific issues in Implementation of national programmes Maternal care

Health Department to assist ISM institutions and to provide kits of iron Folic acid tablets directly to the dispensaries through the Asstt. Distt. Medical officer. All ASHA’s operational in the areas of ISM institutions should be given training on providing emergency health care services.

As Kits of Iron folic acid tablets be provided to ISM institutions. ISM Doctors can treat Pregnant women as well as cases of iron deficiency anaemia in better way. In present situation only Ayurvedic /Unani medicines which contain iron are given to pregnant women for deficiencies of Iron.

Child care Health department should cooperate with Assistant Distt. Medical officer Jammu and kits

As it contains iron, septran (paed) and antihelminthics tabs be provided ISM dispensaries better care of children

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containing Iron small and folic acid, septran (paed) and antihelminthics tabs should be supplied to ADMO office and then it is supplied to all the ISM institutions. As far as social welfare department is concerned Anganwari workers can bring unvaccinated children to the dispensaries.

suffering from iron deficiency anaemia, worm infestation and other diseases. As Anganwari workers / helpers bring the children to the ISM Dispensaries on a fixed date of immunization through this goal of 1 % immunization could be achieved.

Adolescent health Health department and education department organised camp far the awareness of adolescent health age group. Ayurvedic / Unani doctors should be invited to give awareness lectures and these camps should be organised at ISM institution also. Education department can cooperate with ISM institutions in a particular areas and through chief education officers or Zonal education officers, it should be made mandatory that medical officer of that area should visit schools and give awareness lectures to the adolescent children on different issues.

Some funds should be kept at the disposal of the concerned ADMO for procuring IEC materials like banners / posters etc. for organising awareness camps. With this people living in remotest and far flung areas particularly adolescent age groups children can be benefited from this awareness campaign as most of the ISM institutions are in remotest and far flung areas.

School Health Education department’s help is needed for the health check up of children as done as a routine matter few years back.

When approached by the concerned chief education officer/ Zonal education officers, the ISM Doctors are willing to provide these services for general health check up of children of different schools.

Leprosy Cooperation from health department is needed to train ISM doctors/ Paramedical staff. All ISM doctors, paramedical staffs should be given training to address sensitive health issues like Leprosy.

After diagnosis of a case of leprosy the anti-leprotic drugs should be made available directly to ISM institution so that patients can avail the medicines from the nearest dispensary

IDD Health department cooperation is needed

Only IEC activities are done on our own to aware the masses about the iodine deficiency diseases.

Tuberculosis Health department should cooperate with ISM

Anti tuberculosis drugs Dots therapy should be provided directly to ISM

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department and all ISM doctors /paramedical staff should be trained through regular training / workshop from to time laboratory facility with laboratory technician should be provided

dispensaries so that patient of Tuberculosis can avail the facility from the nearest dispensary as in some far flung areas. There is no existence of allopathic institutions and only ISM institutions are catering the health needs of the areas

HIV/AIDS Cooperation from health department is needed for training of ISM Doctors / Paramedical staff for AIDS. Regular workshops training Programmes should be organised so that knowledge of the staff is updated about the disease.

Funds for AIDS awareness camps should be kept at the disposal of Asstt. Distt. Medical officer at Distt. Level so that IEC material like Banners , pamphlets etc should be disturbed to the masses so that exact cases of the disease its sign and symptoms are known to the people or IEC material from health (allopathic ) department should be supplied to the ADMO’s

Water borne diseases

PHE department and health departments’ cooperation is needed. As water born disease are due to the infected water chlorine tablets should be supplied.

If the cases of the particular disease on particular area rises. In order to check it chlorine tablets and other drugs should be supplied to the ISM institutions so that Medical officers / officials can treat the cases. IEC materials for water born diseases should be kept at the disposal of ADMO .So that according to need it should be distributed about the masses and awareness camps about the staff drinking water should be organised as in rural areas major source of drinking water is well, springs, and the water is often polluted in rainy season.

RTI/ STI Health department to provide medicines, antibiotics as to check RTI / STI. One laboratory technician with laboratories should be given to dispensaries

As antibiotics are provided to ISM institutions, Medical officers of these institutions can treat the patients of RTI /STI in a better way and by providing laboratory facilities in these institutions which are situated in remotest areas , the diagnosis of diseases is made in initial stage that helps in treatment of the patient.

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6.2 ICDS projects Issues / Areas Areas of cooperation Areas of convergent action

Coordination with allied departments

Linkages to be developed between ICDS workers and health workers for timely diagnosis of malnourished children and their management. Health Department

AWW share information/records of pregnant mothers and newborns with ANMs AWW help in tracking beneficiaries and bring them for immunization They keep community informed of next session’s date of health checkup camp and immunization. AWW should reports disease outbreaks in the village to ANM. IEC to be developed and disseminated to the community regarding food and nutrition. For proper management of malnourished cases, medicines will be supplied along with the PHC and CHC drug kits annually.

6.3 Rural Development Department

Situation Analysis

Sanitation is away of life. It is the quality of living, which is expressed in clean home and clean community. It can be created by : Avoiding of pollution of land Contamination of water. Disposal of human excreta. Home sanitation and hygiene. Disposal of solid and liquid waste.

Objectives Improving the health standard and general quality of life of rural community. Awareness on sanitation/ Hygiene and health education. Covering of school / Anganwari in rural areas with sanitation facilities and promote Hygiene education and sanitary habits among students. Promote and encourage cost effective construction of household latrine and their proper use. Elimination of open defection to minimise the risk of contamination of water source and food.


Demand driven approach with increased emphasises on awareness Subsidy for individual household units replaced by incentive the poorest of poor household. Rural school sanitation is major component for wider acceptance of children who can encourage their parents for sanitation environment. Construction of toilets is also required in urban areas as slum population is living in urban areas and they use to do open defecation.

Support required

To aware the A.P.L families for construction of toilet by there own. Anganwari toilet in private house with a cost of Rs Five thousand for each Anganwari Toilet facility in health sub centre.

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Services of doctor and paramedical staff for awareness for sanitation condition and environment. Activity / Item

2006-07

2007-08

2008-09

2009-10

2010-11

2011-12

Total Budget

Budget will be provided by the department

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7. COMMUNITY ACTION PLAN

Community Health Action Situation Analysis

1294* Village Health and Sanitation Committees have already been constituted in the 10 medical blocks by the concerned Block Medical Officers in consultation with District Rural Health Society. Each committee comprises of Concerned ANM, AWW and Village Representatives (Nambardar etc) Training of these committee members has not been taken up. Because of prevailing circumstances PRIs could not be involved. The said committees have facilitated the process of selection of ASHAs and are actively involved in utilization in untied funds ear marked for subcentres. The members have not been trained so far through the core trainers at district level although the block trainers have received training. Meetings are not held regularly under the current scenario. The village health registers have not been prepared by the concerned ANMs though concerned medical officers are conducting village health days. *old Jammu district

Objectives

Complete and intense community involvement in planning and management of Health Facilities. Completely involved and enthusiastic community Community Ownership.


Formation of Village Health and Sanitation committees in villages where they have not been framed yet. Training of Village Health Committees. Actively Involving Community groups in health sector by educating them on the benefits of effectively running health facilities. Organising Public meetings, hearings in PHCs. Organising Health camps at every village/.sub centres by concerned Regular meetings of VHS committees at least twice a month. Preparation of Village Health action plan / Block action plan/ District Health action plan Block level committee shall supervise and review the implementation of village and block health plans and provision of transport facility for such activity. District health mission shall oversee the implementation of NRHM activities in addition to health sector provision of transport facilities for such activities.

Support required

Govt orders for inter-sectoral coordination with clear roles and responsibilities and If the various sectors do not attend the meetings then the decisions will be taken and will be binding for all the sectors. Strict follow-up at the State level for ensuring coordination.

Timeline Activity / Item

2007-08

2008-09

2009-10

2010-11

2011-12

Formation of Block Committees x Orientation of Committee members at all levels

x

Joint Community action x x x x x Joint Annual Action Plan x x x x x Sector Alignment x x

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Reorientation of the Committees and Societies

x x x x x

Strengthening the Gram Panchayat meetings and Gram Sabhas

x x x x x


09 2009-10

2010-11

2008-12

Total

Training of the VHWSC @ Rs 200 per person x 15 persons/village x 472 villages

14.16 15.576 17.134

18.847 34.42

Meetings of the VHWSC @ Rs 100 per village x 472 villages x 12 months

5.664 6.230 6.853 7.539 13.77

Meetings of Women SHGs @ Rs 100 per year x 472 villages

5.664 6.230 6.853 7.539 13.77

Total 25.488 28.037 30.84 33.925 118.29

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8. PUBLIC PRIVATE PARTNERSHIP

Public Private Partnerships Situation Analysis

At present, no any Public Private Partnership activity is going on in the District. No MNGO and SNGO identified yet for RCH in district Samba. No initiatives taken under Public Private Partnership. Some Rotary clubs are working in the far-flung areas of the district.

Objectives To explore various options feasible for Pubic Pvt. Partnership to achieve the goals of NRHM in the distt. To develop detailed operational frame work for all feasible options available To initiate innovated pilot interventions on priority issues to be addressed under PPP. To develop the capacity of privet partners (eg. NGOs, Rotary Clubs, PVT. Health care providers)


To conduct Feasibility study for various PPP options in the district. To develop detailed operational framework and schemes for various feasible options in the district. To identify technical support agency for studies on above activities. To initiate one pilot innovative intervention based on the priority in each block of district under PPP To prepared resource directory of all active NGOs involved in health and development issues in the district. To prepared a list of all private health care providers including Practioners of alternative system of medicine in the district. To conduct training need assessment (TNA) for all the identify private partners. To orient all identified private partners on NRHM and various national health programmes. To develop detailed framework or monitoring and evaluation of various PPP interventions

Support required

Approval from Go J and K to allow PPP and to give enabling environment and support. To get TOR and other mechanisms worked out. Availability of funds


2008-09

2009-10

2010-11

2011-12

Feasibility study Operational Frame work x Operationalization of PPP x x x x x Innovative interventions x x x x x Advertisement for hiring technical support agency for assisting for achievement of objective of PPP mentioned above

Establishing technical support agency Preparation of directories of resource agencies and privet partners

x

TNA for private partners x

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Capacity building NGOs, CBOs, ToT 2 batches x 25per batch on national health programme

x x x x x

Training of pvt. Health care providers 2 batches x 25per batch on national health programme

x x x x x

Capacity building of PRIs, VHWSC, SHGs and other field functionaries

x x x x x

Area specific training modules Monitoring and evaluation of PPP initiative x x x x x

Budget Activity / Item 2008-09

2009-10

2010-11

2011-12

Total

5 Workshops for involvement of the Private sectors (one each with NGOs/Trusts/Private institutions; Media; Ex-servicemen association, transportation ,HR agencies) @ 50000 per workshop

1.5 0.5 0 0 2.50

Sharing Workshops with Private players 0 0.61 0.67 0.74 2.57

Admin and overhead Charges for hiring the agencies

2 2.2 2.42 2.662 12.29

TOTAL 2.75 3.03 3.34 3.74 17.36

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9. GENDER AND EQUITY

Gender and Equity Situation Analysis

Foeticide and infanticide of female children is still occurring in some areas of the district. The dowry system and other traditional beliefs are perpetuating discrimination against girl children Domestic abuse is rife in homes where the men drink. In such a situation there is a lack of options for the abused wife and children – there needs to be more support in this situation. Usually men do not go for sterilization and asked their wives for sterilization.

Objectives

To improve the decline in sex ratio in 0-6 years of age group. To reduce the domestic violence. To empower women in all age groups for gender equity. To enhances male participations in ensuring the gender balance and equity in the community. To develop capacities of various stakeholders in Govt. and privet sectors on gender issues and various laws and acts related to establishing gender balance in the society. To establish strong mechanism for monitoring of sex ratio and implementations of various acts to ensure gender balance and equity in the society.


Monitoring of USG/Private clinics under PNDT Act shall be strengthened. 2/3rd Seats of Village Health and Sanitation committee shall be reserved for Women members. Village based Women Institutions shall be empowered and involved in all village welfare Planning and decision. Dowry/Violence against women cases shall be brought into the notice of administration through Women related organizations. Girl Child Education shall be strengthened more.

Support required

Funds Govt. directives to other deptt. for collaboration


2008-09

2009-10

2010-11

2011-12

Research study for the increase in sex ratio for 0-6 years

Preparation of GIS maps as planning tool to monitor and control decline sex ratio

x

Up gradation of GIS x x x x x IEC campaign through print audio visual and folk media

x x x x x

Capacity building x x x x x Orientation of public and Pvt health care providers including NGOs on various laws related to health specially PC-PNDT & MTP act

x x x x x

Reorientation x x x x x Development/procurement training modules

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Monitoring x x x x x Periodic advisory committee meeting and field monitoring @ Rs.5000 x 4(this includes meeting, travel and other contingencies)

x x x x x

Panchayat level vigilance committees to check decline in sex ratio and violence against women

x x x x x

Training of all MOs, ANMs on gender issues

x x x x x


09 2009-10

2010-11

2011- 12

Total

Orientation and sensitisation programmes 10 12.1 13.3 14.6 50.00 Media workshops 2 2.200 2.420 2.662 9.28 Monitoring and supervision 2 2.200 2.420 2.662 9.28 IEC campaigns 5 5.500 6.050 6.655 23.21 Health Card for Girl Child @ Rs 2 /card x 10,000 cards

0.2 0.220 0.242 0.266 0.9282

TOTAL 19.2 22.22 24.432 26.845 92.70

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10. CAPACITY BUILDING

Capacity Building Situation Analysis

In district Samba, training programmes for ANMs, Staff Nurse and LHV were organised for building their capacities and to give orientation about implementation of various national health programmes and NRHM under RCH II. Integrated skill enhancement training was also imparted to Medical Officers of the District Jammu. Capacity Building training of ASHA was also conducted for different modules as the details given below: Module 1 -306 ASHAs Module 2 - 250 ASHAs Module 3 - 250 ASHAs Module 4 -250 ASHAs

Objectives To devolved the capacity of various health functionaries to achieve the goals of NRHM. To develop the capacity of ANMs for conducting deliveries in the SCs. To produce technical staff for the department. To organise special/ advance courses for Doctors and para-medical staff. Training of service providers. To orient various stake holders including NGOs and Pvt. Health care providers to conduct various activities for behaviour change among the community To upgrade existing training centres with training aids, equipments etc.


Reorientation training for ASHA, ANMs, LHV,CHO,AWW and other staff members Skill enhancement trainings for Medical Officers Training of MO / AYUSH Doctors / Specialists.

Support required

Funds Technical Support


(Numbers) 2008 –2009 (Numbers)

2009-2010 (Numbers)

2010-2011 (Numbers)

2011-2012 (Numbers)

TBA training 472 472 472 472 472 MVA MTP training to all PHC MOs

20 MOs

Training on Blood transfusion for MOs and Lab Technicians for CEmOC centres with Blood storage facilities for 3 days

1MO 1LT

6 MO 6 LT

Training in Obstetric management & skills for 24x7 PHC for 16 weeks

2 MOs 2 Staff Nurses

Staff of 10 PHC

Staff of 10 PHC

Staff of 10 PHC

Staff of 8 PHC

Training in Skilled Birth attendants for 15 days:

16 64 64 64 64

120

IMNCI training to ANM/LHV, SN, ASHA for 8 days

10 ANM 4 SN 25 ASHA 4 LHV





IMNCI training to MOs 6 MOs 20 MOs 25 MOs 25MOs 25 MOs

Training in Life saving/Anaesthesia for EmOC at CHC for MOs (State Budget )

2 MOs 4 MOs 4 MOs 6 MOs

Integrated skill training of all SN

10SNs 20 SNs 30 SNs 30 SNs 40 SNs

Integrated skill training for ANMs

10 ANM

25 ANMs

25 ANMs 25 ANMs 25 ANMs

Integrated skill training for MOs

5 MOs 5 MOs 5 MOs 5 MOs 5 MOs

Training of MOs, SN in Mgt of Newborns & sick children at Medical College Jammu

2 MOs 2 SN

2 MOs 2 SN

2 MOs 2 SN

2 MOs 2 SN

2 MOs 2 SN

Training in BCC for MOs, LHV, ANM

13 MOs 4 LHV 25 ANM

13MOs 4 LHV 25 ANM

13 MOs 4 LHV 25 ANM

13 MOs 4 LHV 25 ANM

13 MOs 4 LHV 25 ANM

Training of Ayush personnel on issues of RCH and reporting

15 Ayush 15 Ayush 15 Ayush 15 Ayush 15 Ayush

Training on NSV for MOs at NSV camps


Training on Minilap 4 MOs 4 MOs 4 MOs 4 MOs 4 MOs Training for Laparoscopic Sterilization for Surgeons, Gynaecologists, SN, OT attendants for 12 days

2 Specialists 2 SN 2 OT attendants

2 Sp 2 SN 2 OT attendants

2 Sps 2 SN 2 OT attendants



Orientation on contraceptive devices for MOs - Govt as well as private facilities


Training on Medico-legal aspects to MOs

30 MOs & Specialities

30 30 30 30

Continuing Medical Education sessions for doctors each month during the monthly meetings on current topics

10 CME sessions

10 CME sessions

10 CME sessions

10 CME sessions

10 CME sessions

Orientation on PCPNDT Act for Dy. CMO, CMOs, doctors both Govt and private, members of District Appropriate authority NGOs in a workshop

x x x x x

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General & Financial rules (G & FR) for Officials, MOs, clerical staff for 3 days

50 Distt officials and MOs 50 clerks



Financial management training for Accounts Officers, Accountants for 2 days

25 persons 50 persons 50 persons 50 persons 50 persons

Computer training to all the MOs, Clerical staff, accounts personnel

100 50

CNAA for MOs, LHV, ANM & MPW, AWW

30 MOs 22 LHV 146 ANM 559 AWWs

30 MOs 18 LHV 178 ANM 41 AWWs

100 AWWs 100 AWWs 100 AWWs

Total sanitation orientation and reorientation of VHWSC x 1 day

472 villages

472 villages

472 villages

472 villages

472 villages

Training of NGOs in BCC 30 persons

30 persons

30 persons

40 persons

40 persons

Staff Nurse Training College As per the State approval ANMTC As per the State budget Professional Development course for District Programme Managers, Senior district officials, MOs for 10 weeks

As per the State budget

Training of ASHAs Discussed in the respective chapters Budget

Activity 2008–09

2009-10

2010-11

2011-12

Total

TBA training @ Rs 10100 x 275 27.775 12.1 13.3 14.6 67.78

MVA MTP training to all PHC MOs for 15 days @ Rs 500 x 15 days x 42 MOs

1.575 1.733 1.906 2.096 7.31

Training on Blood transfusion for MOs and Lab Technicians for CEmOC centres with Blood storage facilities for 3 days,MOs @ Rs 500/day/person x 3 days and LabTechnicians@Rs 200/person x 3 days

0.345 0.069 0 0 0.41

Training in Obstetric management & skills for 24x7 PHCs for 16 weeksMOs: Rs 500/day x 112 days x 4MO,StaffNurses:Rs200/dayx112daysx 4 SN

3.136 0 0 0 3.14

Training in skilled Birth attendants for 15 days: One batch of 4 persons: Rs. 7500 as hon. to participants, Rs 13500 hon. to training team, 15% institutional charges

2

2.200 2.420 2.662

9.28

IMNCI training to ANM/LHV, SN, ASHA for 8 days,Rs 300 as hon. to participant x 8 days

2.592 2.736 2.784 2.496 10.61

IMNCI training to MOs @ Rs 5390 /participant 0.8624 0.8624 0.8624 0 2.59

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Integrated skill training for MOs @ Rs 3683 0.5888 0.5888 0.5888 0 1.77 Training of MOs, SN in Mgt of Newborns & sick children at Medical College Jammu @ Rs 7500/MO, Rs 4500 ( Rs 300 x 15 days)/SN

1.44 0.48 0 0 1.92

Training in BCC for MOs, LHVs, ANMs 1.28 0 0 0 1.28

MOs: Rs 500/MO x 5 days LHVs & ANMs: Rs 300/person x 5 days

Training of Ayush personnel on issues of RCH and reporting for 3 days

0.153 0.153 0.153 0 0.46

Rs 300/person x 3 days Training on NSV for MOs at NSV camps 40.8 45.6 45.6 0 132.00 Rs 500/MO /camp x 12 camps,

Rs 3000 per camp for trainer x 12 camps Training on Minilap @ Rs 500 per day for 15 days and during camps

0.6 1.8 1.2 1.2 4.80

Training for Laproscopic Sterilization for Surgeons, Gynaecologists, SN, OT attendants for 12 days

0.6 0.6 0.6 0.6 2.40

SMO: Rs 500/SMO x 12 days SN: Rs 300/SN x 12 days OT Attendant: Rs 200 x 12 days

Orientation on contraceptive devices for MOs - Rs 500 /MO x 1 day

0.42 0.462 0.508 0.559 1.95

Training on Medico-legal aspects to Mos @ Rs 500/MO x 1 day

0.445 0.47 0.92

Orientation on PCPNDT Act for DCs, CSs, doctors both Govt and private, members of District Appropriate authority NGOs in a workshop

1 1.2 1.32 1.45 4.97


1.8 0 1.8 0 3.60

Rs 500/official and MOs x 3 days Rs 200 /clerical staff x 3 days Financial management training for Accounts Officers, Accountants for 2 days

0.172 0.172 0.172 0.52

Rs 200/Accounts persons x 2 days Computer training to all the MOs, Clerical staff, accounts personnel @ Rs 200 per person x 15 days

3.72 3.72

CNAA for MOs, LHVs, ANMs, AWW 2.3 2.38 2.4 2.43 9.51 @ Rs 200/person x 1 day each year

Total sanitation orientation and reorientation of VHWSCs x 1 day @ Rs 200/person/day

0.74 0.74 0.74 0.74 2.96

Training of NGOs in BCC @ Rs 300 per person x 6 days

0.36 0.54 0.72 0.72 2.34

Total 94.704 74.886 76.902 29.725 276.22

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11. HUMAN RESOURCE PLAN

Human Resource Plan Situation Analysis

As per results of health facility survey (on patterns of IPHS), gaps both in respect of facility and human resources were identified at Sub centre, PHC, CHC and District Hospital levels.

Objectives To equip health system with adequate manpower specially as per IPHS to meet the NRHM goals


To recruit and train Specialist, MOs, staff nurses, ANMs and other personnel based on gap analysis. Engagement of additional staff as per IPHS on contractual basis. Capacity building of all the staff by training. Monitoring / Supervision of the staff. Involvement of PRI/VHSC for supportive supervision. Give incentives to those who give good performance in their duties. To provide additional allowances to the staff working in the far flung areas. To provide basic facilities for residential staff including accommodation, bedding, sanitary facilities, lighting facilities, recreation facility like TV etc

Support required

Availability of Funds Policy decision

Timeline 2 years Budget Activity / Item 2008-09 2009-10 2010-11 2011-12 Total

Subcentre ANM 173.101 181.279 189.457 197.635 741.472

PHC MO 72.496 72.496 72.496 72.496 289.984 Staff Nurse 92.22 92.22 92.22 92.22 368.88

Health worker (F) 7.685 7.685 7.685 7.685 30.74 Health Educator 32.277 32.277 32.277 32.277 129.108

Health Assistant 0 0 0 0 0 Clerk 49.896 49.896 49.896 49.896 199.584

Pharmacist 6.12 6.12 6.12 6.12 24.48 Lab.Tech 16.632 16.632 16.632 16.632 66.528 Class IV 37.44 37.44 37.44 37.44 149.76

CHC Specialist(4) 59.04 59.04 59.04 59.04 236.16

PHN 6.848 6.848 6.848 6.848 27.392 SN 29.203 29.203 29.203 29.203 116.812 Dresser 3.45 3.45 3.45 3.45 13.8

lab.Tech 1.188 1.188 1.188 1.188 4.752 Radiographer 1.188 1.188 1.188 1.188 4.752

Opthalmic Assistant 2.376 2.376 2.376 2.376 9.504 Class IV 10.08 10.08 10.08 10.08 40.32

Statistical Assistant 5.94 5.94 5.94 5.94 23.76 Registration cleark 5.94 5.94 5.94 5.94 23.76 Total 613.12 621.298 629.476 637.654 2501.548

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12. PROCUREMENT AND LOGISTICS

Procurement and Logistics Situation Analysis

Majority of equipments, drugs and supplies are made available on requisition from State Govt and GoI. Currently there is no warehouse facility for storage of medicines, contraceptive and cold chain storage of vaccines in the district head quarter for distributing medicines to the blocks. One warehouse is needed at district head quarter of Jammu including the facility of cold chain. For management of the ware house and record maintenance following staff is required: Inventory Manager/ Pharmacist – One Assistant Pharmacist- One Data entry /store keeper-one Packers Watchman.

Objectives

The aim of the procurement process is to ensure that necessary supplies of right quality are obtained at reasonable cost through fair and transparent system. The DH will make procurement and FW on the basis of need projected by District but for the proper storage of the medicines there is dire need to construct a store for medicines and other equipments. Logistic system helps to provide medicines, contraceptives, vaccines and other consumables to service providers in adequate quantity at right time and place, which would also help in reducing wastages. To establish a mechanism of monitoring and reporting of ware house To induct required staff for the management of ware house


Blocks would prepare need-based list of medicines and equipments well in time and that it may be projected for procurement as per IPHS. For proper storage construction of stores will be taken up. For cold chain maintenance ILR and Deep Freezer will be provided at all CHCs/PHCs. Genset and POL will be provided at all CHCs and PHCs. Stores will be constructed in the district wherever required. List of medicines and equipments will be communicated to higher authorities well in advance as per IPHS. For cold chain maintenance, proper electricity will be ensured. Storekeeper will be trained in maintaining logistics properly. For procurement of necessary articles and equipments, proper procedure lay down by the GoI is followed to ensure transparency and quality. State level study for improvement of procurement and logistic is required to be conducted along with detailed operational framework by department of health and family welfare at state level.

Support required

Funds for the construction of stores and for procuring genset at PHC/CHC level.


2008-09

2009-10

2010-11

2011-12

Construction of Warehouse x Software x

125

Computer system with UPS, Printer, Scanner,

x

Equipment & Hardware x Pharmacist @ Rs 9000/mth x Assistant Pharmacist @ Rs 5000/mth x Packers -2 @ Rs 4000/mthx2 x Security Staff @ Rs 6000/month x Training of personnel x Consultancy to agency to Operationalise Warehouse

x x

Total Budget Activity / Item 2008-

09 2009-10

2010-11

2011-12

Total

Construction of Warehouse 100 0 0 0 100

Software 0.25 0 0 0 0.25

Computer system with UPS, Printer, Scanner, 0.6 0 0 0 0.6

Equipment & Hardware 34.5 0 0 0 34.5

Pharmacist @ Rs 9000/mth 1.08 1.19 1.31 1.44 5.02

Assistant Pharmacist @ Rs 5000/mth 0.6 0.66 0.726 0.799 2.785

Packers -2 @ Rs 4000/mthx2 0.96 1.056 1.162 1.278 4.456

Security Staff @ Rs 6000/mth 0.72 0.792 0.871 0.968 3.351

Training of personnel 0.1 0.11 0.121 0.133 0.464

Consultancy to agency for Operationalization of the Warehouse

2 0 0 0 2

Total 140.81 3.808 4.19 4.618 153.426

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13. DEMAND GENERATION - IEC

Demand Generation – IEC Situation Analysis

IEC is an important component for delivering quality health care services; it has been observed that people either have no knowledge of basic health related information or having misconception of it. So its basic aim is to provide right and scientific information to the community. To change their attitude and behaviour to adopt a healthy life style. The behavioural change is a two way process it applies both to the service provider and the clients. Still our societies have certain myths and misconceptions regarding health and diseases, these will be change through the IEC activities. The following can also be taken as a need of launching an IEC campaign in the district: Occurrence of infant and maternal mortality. Outbreak of vaccine preventable diseases and other communicable diseases. Promote institutional deliveries and breastfeeding. Promote spacing methods. Information about family planning and use of contraceptive pills etc.

Objectives To provide scientific and need base information to General Public. To initiate BCC activities for adaptation of Healthy life style. To facilitate to eliminate communicable/non-communicable diseases.

Strategies IEC/BCC orientation for Doctors/Para Medical Staff. Some orientation programmes should be organised at community level to give knowledge about adolescent age etc. School Health Education Programme. Introduction of Folk Media. Drama/Film Shows. Quiz/Lecture /debate/painting competition. Rally /Prabat Pharies/Sanitation drives/Health Marathons.

Activities Awareness on Fixed VHD days JSY Services available Designing of BCC messages on exclusive breast feeding and complimentary feeding, ANC, Delivery, PNC, FP, Care of the Newborn, Gender, male involvement in the local language Consistent and appropriate messages on electronic media – TV, radio Use of the Folk media, Advertisements, hoardings on highways and at prominent sites Training of ASHA/AWW/ANM on Interpersonal communication and Counselling on various issues related to maternal and Child health Display of the referral centres and relevant telephone numbers in a prominent place in the village Promoting inter-personal communication by health and nutrition functionaries during the Fixed health & Nutrition days Orientation and training of all frontline government functionaries and elected

127

representatives Integration of these messages within the school curriculum Kit for the newly married and during first pregnancy to be given at the time of marriage and during pregnancy Mothers meeting to be held in each village every month to address the above mentioned issues and for community action Kishore Kishori groups to be formed in each village and issues relevant to be addressed in the meetings every month Meetings of adult males to be held in each village to discuss issues related to males in each village every month and for community action. Village Contact Drives with the whole staff remaining at the village and providing services, drugs, one to one counselling and talks with the Village Health & Water Sanitation Committee and the Mother’s groups. The whole district administration will get geared up for 33 days quarterly to carry out this massive drive in which registration of birth, death, Immunization of each child, ANC of each pregnant woman, growth monitoring of each child, disinfection of wells, spraying of houses and fogging, treatment of the stagnant water sites, detection of TB and Leprosy, treatment of all ailments, eye conditions through massive publicity. This will be carried out in each village through Rath Yatra. Monthly Swasthya Darpan describing all the forthcoming activities and also what happened in the month along with achievements Bal Nutrition Melas 4 times at each Sub centre Wall writings Pamphlets for various issues packed in an envelope

Support required

Inter-sectoral co-ordination is needed from Electronic, Printed Media, ICDS, Education, Rural Development, PRIs and NGOs

Timeline Activities 2007-08

2008-09

2009-10

2010-11

2011-12

Developing and finalizing the messages x x x x x Advertisements x x x x x TV spots x x x x x Radio Jingles x x x x x Folk Media shows x x x x x Hoardings on highways and prominent places

x x x x x

Display boards x x x x x Pamphlets x x x x x Developing Nirdeshika for holding VHD days

x x

Monthly Swasthya Darpan x x x x x Orientation & training of all frontline govt functionaries and elected representatives

x

VCD in each village quarterly x x x x x Bal Nutrition Melas x x x x x Adolescent meetings x x x x x Opinion leaders workshops x x x x x Wall writings x x x x x

128

Budget Activities 2008-

09 2009-10

2010-11

2011-12

Total

Finalizing the messages 1 1.1 1.21 1.331 4.64

Advertisements 5 5.5 6.05 6.655 23.21 TV spots 1 1.1 1.21 1.331 4.64

Radio Jingles 1 1.1 1.21 1.331 4.64 Folk Media shows @ Rs 1000/vill 4.72 5.192 5.711 6.282 21.91 Hoardings @ Rs 10000/hoarding 10 11 12.1 13.31 46.41

Display boards @ Rs 2000/board 1.8 1.98 2.178 2.396 8.35 Pamphlets @ Rs 10/pamphlets 1 1.1 1.21 1.331 4.64

Nirdeshika for Fixed Health Nutrition days @ Rs 20/ Nirdeshika

0.8 1 0 0 1.80

[email protected] /copy/mth 0.8 1.2 1.4 1.6 5.00 Orientation of frontline government functionaries & elected rep

0.8 0.88 0.968 1.065

@ Rs 200 x 400 persons x1 day

3.71

VCD @ Rs 15000 per SC and maintenance 15 0.75 0.75 0.75 17.25 MSS meetings @ Rs 100/vill x 472 0.472 0.519 0.571 0.628 2.19 Bal Nutrition Melas @ Rs 300 x 4 times x No of SCs

1.2 1.320 1.452 1.597 5.57

Opinion leaders workshops @ Rs 300 /person x 100

0.3 0.330 0.363 0.399 1.39

Wall writings @ Rs 500 x 472 villages 2.36 2.596 2.856 3.141 10.95 Total 47.252 36.667 39.239 43.148 166.31

129

15. HMIS, MONITORING AND EVALUATION

HMIS Current Status

HMIS is a monitoring tool for the performance that provides information to support planning, decision-making and executive control for managers in the Health & FW department. In this sector Data collection is ongoing for more than 60-90 different conditions. The basis of HMIS is the data collected by the ANM who is over burdened with a substantial amount of her time being spent on surveillance related activities. Each year a CNAA exercise is carried out but the set procedures under the CNAA are generally not followed in development of annual action plans and in their utilization in planning the activities of health workers. The action plans are prepared more as a normative exercise rather than as a management tool for estimation of service needs and monitoring the programme outputs. There is no horizontal integration of surveillance activities of existing disease control programmes. Absence of clear case definitions and poor supervision or crosschecking of the data collected hampers the quality of reporting. Non-Communicable diseases are not included in surveillance even though the burden due to them is high. Absence of formats for reporting diseases also affects quality of the data collect. The data from the ANMs is sent upto the district level with no analysis done at any of the higher levels. There is no system of feedback to the lower levels in the health system. The transmission of data is affected by poor communication facilities available. Data is not collected from private practitioners, private laboratories and private hospitals both in rural and urban setting. Data collected during emergencies and epidemics is of better quality The response system at the District level is activated only in times of outbreaks. There is lack of coordination between departments. Discrepancy between the data of the Health department and the ICDS. There is large gap between reported and evaluated coverage. The District administrative system not able to make use of the health data

Objective Integration of several parallel running programme software HMIS is used for decision making on regular basis Inclusion of RCH indicators monitoring Linkage to decision making at Central level Refresher training Make it more useful for State level officials

Strategy Research on various issues related to RCH to get a correct baseline Improvement in the CNAA Computerized HMIS

Activity Base line Survey on RCH parameters and indicators. The Baseline survey will be

130

conducted by and external agency. Joint CNAA by the ANM, AWW, ASHA along with the PRIs so that there is one data validated by the PRIs Printing of Reporting & Monitoring Formats Data entry of each Household, Eligible couples, Adolescents Computerization of all the formats and software for the various programmes and finances Computer training for data entry Internet connectivity upto all PHCs for online transfer of data. The ANMs will get the data entered each month after the household and Eligible Couple entries have been made GIS for the district covering all the parameters AMC for all computers

State Support

Provision of software for data entry

Time line Activities 2007-08

2008-09

2009-10

2010-11

2011-12

Base line survey by external agency x Software development x Internet connectivity x x x x x Consumables for computers x x x x x GIS for the district, training and updation x x x x x Printing monitoring Charts 2000 2500 3000 3500 4000

Budget



Software development 20 0 0 0 20

Internet connectivity @ Rs 900 /mth x No of facilities x12 mths

1.944 1.944 1.944 1.944 7.776


2.1 2.1 2.31 2.541 9.051


4.92 4.92 4.92 5.04 19.800

GIS for the district, training and updation 12 0.5 0.5 0.5 13.5

Printing monitoring Charts @ Rs. 5 per monitoring chart

0.1 0.15 0.175 0.2 0.625

Total 61.064 9.614 9.849 10.225 90.752

131

16. BIO-MEDICAL WASTE MANAGEMENT

Bio-Medical Waste Management

Situation Analysis / Current Status

As per the Bio-Medical Waste Rules, 1998, indiscriminate disposal of hospital waste was to be stopped with handling of Waste without any adverse effects on the health and environment. In response to this the Government has taken steps to ensure the proper disposal of Biomedical waste from all Nursing homes, hospitals, Pathological labs and Blood Banks. The District Health Officer is the Nodal Person in each district for ensuring the proper disposal of Biomedical Waste. For effective disposal of Biomedical waste in the district; Trainings to the personnel for sensitizing them, Pits. Segregation of Waste is taking place though Separate Colour Bins/containers it has to be done more systematically. Proper Supervision is lacking. The treatment (incineration) of waste is being by handled by a company selected at the State level that is also managing additional 3-4 districts. Since there is a monopoly of these companies they charge very high rates.

Objectives Stopping the indiscriminate disposal of hospital Waste from all the facilities by 2008 Ensuring proper handling and disposal of Biomedical Waste in each Facility

Strategies Capacity Building of personnel Proper equipment for the disposal and disposal as per guidelines Strict monitoring and Supervision

Activities Review of the efforts made for the Biomedical Waste Interventions Development of Microplan Plan for each facility in District & Block workshops Capacity Building of personnel. Biomedical Waste management to be part of each training in RCH and IDSP Proper equipment for the disposal Installation of the Separate Colour Bins/containers and Plastic Bags for the bins Segregation of Waste as per guidelines Partnering with Private providers for waste disposal Proper Supervision and Monitoring Formation of a Supervisory Committee in each facility by the MOs and the Supervisors

Timeline Activity

2007-08

2008- 09

2009-10

2010-11

2011-12

Orientation and Reorientation for the personnel for Biomedical Waste Management at District and Block levels

x x x x x

Consumables x x x x x

Payment for the incinerators x x x x x

132


Orientation and reorientation for Biomedical Waste Management at District and Block levels 1.5 1.820 2.000 2.200 7.52 Consumables 1 1.210 1.330 1.440 4.98 Payment for incinerators@ Rs. 8 per bed 12 mths 15.84

17.424 19.166 21.083 73.513

Total 18.34 20.454 22.496 24.723 86.013

133

Summary of Budget proposals for the Years 2007-08 to 2011-12 (Rs. Lakh)

District Samba Detailed NRHM Budget in Lakhs

Strengthening of District Health Management # Activity / Item 2008-09 2009-10 2010-11 2011-12 Total

Orientation Workshop 0.5 0.6 0.65 0.7 2.45

Issues based Workshops 0.5 0.7 0.8 0.9 2.90

Bi-monthly meetings @2000x6 0.12 0.132 0.145 0.160 0.56

Mobility for Monitoring 0.5 0.6 0.65 0.7 2.45

Total 1.62 2.032 2.245 2.460 8.36 District Programme Management Activity/Item 2008-09 2009-10 2010-11 2011-12 Total

Honorarium DPM,DAM,DDA and Consultants

29.4 32.34 35.57 39.13 136.45

Hiring of vehicles at District level @ Rs 1000 x 15 days /mth 12 mths

1.8 1.98 2.18 2.40 8.35


1 1.10 1.21 1.33 4.64

Untied Fund 5 5.50 6.05 6.66 23.21

Construction Cost of Health Complex (11000sq.f @ 1000/sq.f)

110 0.00 0.00 0.00 110.00

Furnishing and Office Automation, Conference Hall with speakers, ACs

15 0.00 0.00 0.00 15.00

Maintenance of the Health Complex

0 1.00 1.50 2.00 4.50

Compendium of Govt orders 0. 50 0.60 0.65 0.70 1.95 Joint Orientation of Officials and

DPM, DAM, DDM 0.25 0.30 0.00 0.35 0.90

Management training workshop of Officials

0.5 0.70 0.80 0.90 2.90

Personnel for BPMU 47.52 52.27 57.50 63.25 220.54

Training of DPM, BPMU and Consultants

0.5 1.00 0.00 1.50 3.00

Review meetings @ Rs 2000/ per month x 12 months

0.24 0.26 0.29 0.32 1.11

Office Expenses @ Rs 10,000/month x 12 months for district

1.2 1.32 1.45 1.60 5.57

Computer systems (27) with printer and Digital Camera and furniture for DPMU, BPMUs and District and block & sectoral personnel 16.2

0.00 0.00 0.00 16.20

Annual Maintenance Contract for the equipment 0

1.62 1.62 1.62 4.86

Hiring of vehicles at block level @ Rs 1000 x 5 days /mth x 3

1.8 1.98 2.18 2.40 8.35

134

blocksx12 mths

Office expenses for Blocks @ Rs 5000 x 3 blocks x 12

1.8 1.98 2.18 2.40 8.35

Total 232.21 103.96 113.18 126.54 575.89 Maternal Health Activity / Item 2008-09 2009-10 2010-11 2011-12 Total

Consultancy support for developing Microplan for MCH & N days

1 1.1 1.21 1.33 4.64

Tracking Bags @ Rs 300/ bag x (585 AWCs+ 82 SCs)

2.00 2.20 2.42 2.66 9.29

Adult Weighing machines @ Rs 800 per machine x 585 AWCs & Maintenance

4.68 0 0 0 4.68

One day training workshop on Tracking bags at the district level and each sector

2 2.2 2.42 2.662 9.28

Janani Suraksha Yojna @1400 X 5000 inst. deliveries

70 77 84.7 93.170 324.87

Janani Suraksha Yojna @500 X 2500 Home deliveries of BPL families

12.5 12.5 12.5 12.5 50.00

Blood Storage @ Rs 3 lakhs per unit

3 3 0 0 6.00

Referral Cards @ Rs 2 per card x 20,000

0.4 0.44 0.484 0.532 1.86

MTP kits @ Rs 15000 Per kit (PHCs + CHCs)

2.55 2.55 0 2.55 7.65

Mobile phone instrument to ANMs @ Rs 2000

2 0 0 0 2.00

Mobile Phones recurring cost to ANMs @ Rs 2700

2.7 2.7 2.7 2.7 10.80

Mobile phone instrument to Supervisory Staff like CMO, Dy CMO, DIO, DTO & BMOs @ Rs 5000

0.5 0 0 0 0.50

Mobile Phones recurring cost to Supervisory Staff like CMO, Dy CMO, DIO, DTO & BMOs @ Rs 500/month

0.6 0.6 0.6 0.6 2.40

RCH Camps @ Rs 25000 per camp x 8 camps per year

2 2.2 2.42 2.662 9.28

Total 105.931 106.491 109.455 121.371 443.25 Newborn and Child Health Activity / Item 2008-09 2009-10 2010-11 2011-12 Total

Study on the feeding practices 2 0 0 0 2.00

Innovative activities based on the study

0 2 2 2 6.00

Newborn Corner furnished with equipment @ Rs 1.40 lakh per

2.8 0 0 0 2.80

135

CHC

Generator @ Rs. 50000 for PHC/CHC & Rs 1.5 lakhs for District Hospital

10.5 0 0 0.5 11.00

POL Generator @ Rs.140/PHC & CHC x 365 days and Rs 420 x 365 for District hospital

10.73 11.80 12.98 14.28 49.80

Examination table, chair, stool, table, other equipment @ Rs. 3000 x 585 AWCs

17.55 0 0 0 17.55

Infant Weighing Machines@Rs. 800/AWCx 585

4.68 0 0 0 4.68

Foetoscope @ Rs. 50 x 585 AWCs 0.2925 0 0 0 0.29

Total 48.5535 13.804 14.985 16.783 94.13

Family Welfare Activity / Item 2008-09 2009-10 2010-11 2011-12 Total

NSV camps @ Rs. 50000 x 10 camps

5 5.5 6.71 7.38 24.59

Sterilization Camps @ 600 per case(Including medicine and compensation)

12 18 24 30 84.00

Copper T-380 @ Rs 45 / piece 1.35 1.485 1.634 1.797 6.27

EmergencyContraception@Rs10/2 tabs

0.2 0.8 1 1.2 3.20

Development of Static Centres@Rs 1 lakh

2 0 1 1 4.00

Laparoscopes for CHC @ Rs3.00 lakhs

6 0 3 3 12.00

IEC activities 10 11 12.1 13.31 46.41

Total 36.55 36.785 49.4435 57.68685 180.47 Adolescent Health

Activity 2008-09 2009-10 2010-11 2011-12 Total

Research on adolescent health 5 0 0 0 5.00

Awareness generation @ Rs 2000 per village x 472 villages

9.44 10.384 11.422 12.565 43.81

Training a district pool of Master trainers

0.5 0.550 0.605 0.666 2.32

Orientation & Reorientation Health and ICDS personnel

1 1.100 1.210 1.331 4.64

Setting up of Adolescent Friendly Health Corners at CHC and PHC level (renovation, furnishing and Misc. expenses) @ Rs 10000/-

1.7 0 0.1 0.1 1.90

Health camps for Adolescents once per quarter x 4 x Rs 100000 per camp

4 4.400 4.840 5.324 18.56

Monitoring and supervision 1 1.100 1.210 1.331 4.64

Workshop of All the Partners @ 50000 (Once in a year)

0.5 0.550 0.605 0.666 2.32

136

Training of Peer Educators @ Rs 100 per person x 3 days x 2 batches and retraining

0.15 0.165 0.182 0.200

0.70 Total 23.29 18.249 20.174 22.181 83.89

ASHA Activity / Item 2008-09 2009-10 2010-11 2011- 12 Total

Training & kit @ Rs 10000 X No ASHAs

30.6 0 0 0 30.60

Module 2,3,4 Training @ 2000 6.12 0.16 0.16 0.16 6.60

Reorientation @ Rs 2000 X No ASHA

6.12 6.12 6.12 6.12 24.48

Intersectoral meeting at PHC level 1000 X 17 X 6

1.02 1.122 1.234 1.358 4.73

Compensation to ASHA @ Rs. 500 X 12 X No of ASHAs

18.36 18.36 18.36 18.36 73.44

Expenses for the District mentoring group – meetings, travel @ Rs 5000 per month x 12 months

0.6 0.66 0.73 0.80 2.78

Total 62.82 26.422 26.600 26.796 142.64 Untied Funds and an Annual Maintenance grant for Sub Centres

Activity / Item 2008-09 2009-10 2010-11 2008- 12 Total

Untied Fund of Rs 0.10 Lakh X SCs

9.1 9.3 9.6 9.9 37.90

Annual Maintenance Grant of Rs 0.10 Lakh X SCs

9.1 9.3 9.6 9.9 37.90

Total 18.2 18.6 19.2 19.8 75.80 Untied Funds and an Annual Maintenance grant for PHCs

Activity/item 2008-09 2009-10 2010-11 2011-11 Total

Untied Fund of Rs 0.25 Lakh X Per PHC including Alopathic Dispencieries.

3.75 3.75 3.75 3.75 15.00

Annual Maintenance grant of Rs 0.5 Lakh X Per PHC including Alopathic Dispencieries.

7.5 7.5 7.5 7.5 30.00

Total 11.25 11.25 11.25 11.25 45.00 Untied Funds and an Annual Maintenance grant for CHCs


Untied Fund of Rs 0.5 Lakh X No of CHCs

1.5 1.5 2 2 7.00

Annual Maintenance grant of Rs 1.0 Lakh X No of CHCs

1.5 1.5 2 2 7.00

Seed Money for RKS for District hospital @ 5.0 lakhs

5 5 5 5 20.00

Total 8 8 9 9 34.00 Mobile Medical Unit Activity / Item 2008-09 2009-10 2010-11 2011-12 Total

Hiring staff 9.9 10.89 11.979 13.177 45.95

Orientation of the staff 0.1 0.2 0.25 0.3 0.85

Joint Workshop for finalizing 0.1 0.2 0.25 0.3 0.85

137

modalities

Cost of Vehicle, equipment and accessories

26.85 0 0 0 26.85

Recurring Cost of Drivers, Drugs, supplies, Mobile phones, POL, Maintenance

2.518 2.770 3.047 3.351 74.50

Total 39.468 14.0598 15.526 17.128 86.18 Upgrading of CHCs to IPHS


Strengthening of Existing CHCs including Staff quarters (for IPHS) @ 30 X CHCs

60 0 0 0

60.00

Construction of 2 new CHCs (24 Lakhs for CHC building and 55.2 Lakhs for 4 MOs and 4 SN and 1 guard quarters) @ Rs. 79.2X CHCs

79.2

0

79.2

0 158.40

Construction of new staff Qtrs at existing CHCs(14.40 Lakhs for 2MOs and 12 Lakhs for 2SN )@26.4X 3 CHCs

79.2 26.4

105.60

Medicines @10.0 CHCs 30 30 40 40 140.00 Furniture @1.2 X No of CHCs 3.6 0 1.2 0 4.80

Equipment @ 22.19 X No of CHCs & FRUs

66.57 0 22.19 0 88.76

Hiring of vehicle for S/MOs @ 1000 x 7 days x12monthsX No of CHCs

2.52 2.52 3.36 3.36 11.76

Purchase of generator sets @ 0.6 lakh x No of CHCs

1.8 0 0.6 0 2.40

Recurring & Maintenance cost of generator sets Rs. 140 X 30 days X 12 months X 6 No of CHCs & FRUs

1.53 1.53 2.04 2.04 7.14

Strengthening of DH Samba 575 575.00

Total 899.42 34.05 174.99 45.4 1153.86 Upgrading PHCs for 24 hr Services, IPHS Activity / Item 2008-09 2009-10 2010-11 2011-12 Total

Staff quarters for 10 PHCs where PHC buildings are available (28.8Lakhs for 2 MOs and 3 SNs quarters)

288 0 0 0 288.00

Strengthening PHCs for 24X7@ 10X 15 PHCs 100 50 0 0 150.00

Construction of building on 5 building-less PHCs with Staff Qurters (9 Lakhs for PHC building and 28.8Lakhs for 2 MOs and 3 SNs quarters) 189 0 0 0 189.00

Medicines @3.0 X PHCs 45 49.5 54.45 59.895 208.85 Furniture @0.45 XPHCs 6.75 0 0 0 6.75

138

Equipment @ 1.115 X PHCs 16.725 0 0 0 16.73

Vehicle will be hired for MOs @ 1000 x 7 days x 12MonthsX PHC

12.6 13.860 15.246 16.771 58.48

Purchase of generator sets @ 0.6 lakh x PHC

9 0 0 0 9.00

Recurring & Maintenance cost of generator sets Rs. 140 X 30 days X 12 months

7.65 7.65 7.65 7.65

30.60 Total 674.725 121.01 77.346 84.3156 957.40 Upgrading Sub Centres and additional Subcentres Activity / Item 2008-09 2009-10 2010-11 2011-12 Total

New Building for Existing Sub Center with Equipment and Furniture 98.6 98.6 73.95 147.9 419.05

New Building for Additional Sub Center with Equipment and furniture 49.3 14.79 147.9 147.9 359.89

2 Staff Quarters 120 120 60 0 300.00

Equipment For SC 22.75 0.75 0.75 0.75 25.00 Furniture For SC 8 0.4 0.4 0.4 9.20

Drugs and Medicine For SC 18 18 18 18 72.00 Travel allownce@ 6000 XSC 36 36 36 36 144.00

Total 254.05 189.94 263.05 203.05 910.09 Untied Funds and Incentive Fund for the Village Health and Water Sanitation Committees Activity / Item 2008- 09 2009- 10 2010- 11 2011- 12 Total

Untied Fund of Rs 10000/unit ( 1500population =1unit) x 123 units

12.3 12.3 12.3 12.3 49.20

Permanent Advance to VHWSC for ASHA incentive @ Rs5000/SC

5 5 5 5

20.00

Total 17.3 17.3 17.3 17.3 69.20 Immunisation Activity/item 2008-09 2009-10 2010-11 2011-12 Total

Mobility support for alternative vaccine delivery Rs. 50 per session for 2 planned sessions per week at each Subcentre village for 12 months = Rs. 50x2 sessionsx4 weeks/mthx12 monthsx SCs

4.8 4.8 4.848 4.992 19.44

Vehicle for distribution of vaccines in remote areas @ Rs 1000 per PHC for 2 times per week x 4 weeks x 12 months x PHCs

14.4 15.840 17.424 19.166 66.83

Mobility Support Mop up campaign @ Rs 10000 per PHC ( Including travel, vaccine delivery, IEC) x 6 rounds/ year x PHCs

9 9.900 10.890 11.979 41.77

Mobilization of Children by Social Mobilizers @ Rs. 100/ session x4 sessions per month X 472 units

22.656 24.922 27.414 30.155 105.15

139

x12 month

Contingency fund for each block @ Rs.1000/month x 3 blocks x 12 months

0.36 0.396 0.436 0.479 1.67

Pit Formation for disposal of AD Syringes and broken vials (@ Rs. 2000 per pit per Subcentre and PHC

2 0.1 0.1 0.1 2.30

Printing of Immunisation cards @1.50 per card x 30000 cards each year

0.45 0.495 0.545 0.599 2.09

Maintenance of Cold Chain Equipments (funds for minor &major repair) (@ Rs.750 per PHC/CHC for the first year then Rs. 500 per PHC/CHC) monthly andRs 10,000 annual for major repairs

3.23 3.23 3.23 3.23 12.92

POL & maintenance for Vaccine delivery van at district level @ Rs.15000/month x 12 mths

1.8 1.980 2.178 2.396 8.35

Running Cost of WICs & WIF (Electricity & POL for Genset & preventive maintenance) Rs. 90000 for electricity @ 15000 equipment per two months plus Rs.8000 per annum @1000 for POL for genset at DH

7.02 8.490 9.340 10.270 35.12

Mobility suppot to District Family Welfare Officer @ 3000/month

0.36 0.396 0.436 0.479 1.671

Computer Assistant for District Family Welfare Office @ 7000

0.84 0.924 1.016 1.118 3.898

Total 66.916 71.473 77.856 84.964 301.21

RNTCP Activity / Item 2008-09 2009-10 2010-11 2011-12 Total

Civil Works

DTC building 1.5 lakhs

MC 0.28/MC

TU 0.35/Tu except DTC

2.13 0 0 0 2.13

Material and supplies 1.2 1.45 1.6 1.76 6.01

Laboratory material 1 1.21 1.33 1.46 5.00

Strengthning of District TB Clinic 2 0 0 0 2.00

Awareness drive on World TB day 1 1.21 1.33 1.46 5.00

Salary of contractual staff 6.33 6.963 7.659 8.425 18.01

Training of Staff 22.424 24.666 27.133 29.846 104.07

IEC activities 1 1.21 1.33 1.46 5.00

Procurement of vehicle 6 0 0 0 6.00

140

Vehicle maintenance inc POL 1 1.21 1.33 1.46 5.00

Hiring of vehicle

DTO

MO TC @ Rs 0.42lakh/yr

1.7 2.06 2.27 2.5 8.53

Equipment and maintenance

Microscope @ Rs1000/yr/microscope

Computer@ Rs 5000/yr

Photocopier/Fax Rs2500/ machine

0.085 0.103 0.113 0.124 0.43

Miscellaneous – TA/DA, Telephone, Meetings, Electricity repair etc

0.2 0.25 0.28 0.3 1.03

Orientation of PRIs 0.3 0.3 0.3 0.3 1.20

Re-orientation of PRIs and School Teachers

0 2.2 0 2.5 4.70

Total 46.369 42.832 44.675 51.596 185.47 Leprosy


Routine Budget for Leprosy control programme

1.45 1.8 2 2.2 9.05

Monitoring & Supervision 1 1.2 1.3 1.5 6.10

Additional medicines 1 1 1 1 5.00

IEC Activities 1 1.2 1.3 1.5 6.10

POID Camps one per year @5000 XPHC

0.75 0.75 0.75 0.75 3.00

Celebration of world Anti Leprosy day@20000

0.2 0.2 0.2 0.2 0.80

Total 5.4 6.15 6.55 7.15 30.05

National Malaria Control Programme Activity / Item 2008-09 2009-10 2010-11 2008-12 Total

Salary Contractual staff 46.62 51.282 56.410 62.051 216.363

Travel expenses @ Rs 4000 per month x 12 months

0.72 0.87 0.95 1.05 3.59

Office expenses @ Rs 5000 per month x 12

0.6 0.73 0.8 0.88 3.01

Jeep and maintenance 6 0.66 0.73 0.8 8.19

Trucks – 3 and maintenance 24 2.64 2.9 3.19 32.73

One small Fogging machines for each PHC @ Rs 1.00 lakh and one at District HQ Pulse Fog Machines @ Rs.8.00 lakh per unit and maintenance

43 47.3 52.03 57.233 199.563

Training 23.44 25.784 28.362 31.199 108.785

Misc @ Rs 1Lakh per DH and Rs 20000 per CHC and Rs 10000 for PHC

4.71 5.181 5.699 6.269 21.859

Board hoarding: 8’x 12’ Initially at the CHCs and District hospitals @ Rs 25,000/-

1.75 1.75 1.75 2 7.25

141

Board hoarding: 5’x3’ initially at the PHCs@ Rs 10,000/-

3.5 3.5 3.5 3.5 14

POL @ Rs 48,000/- per vehicle jeep and truck for 12 months x 4

40.32 48.78 53.66 59.03 201.79

Total 194.66 188.477 206.792 227.202 817.131 Other Vector Borne Diseases


Unforseen expenses 0.5 0.61 0.67 0.74 2.52

Kala Jathas for Malaria, Dengue and Chikingunya @ Rs 1000 per village x 472

4.72 5.192 5.711 6.282 11.47

Total 5.22 5.802 6.381 7.022 24.43 Blindness Control Programme


Health Mela 2 2.2 2.42 2.662 9.28

IEC 1 1.1 1.21 1.331 4.64

Blind Register@100X 472 villages 0.472 0.519 0.571 0.628 2.19

Cataract Camps @ Rs 20000 per camp x 15 PHC

3 3.3 3.630 3.993 13.92

POL for Eye Camps @ Rs 3000/camp x15

0.45 0.495 0.545 0.599 2.09

Training of School teachers @ Rs 100/head x 200

0.2 0.22 0.242 0.266 0.93

Training of PRIs @ Rs 100/head x 200

0.2 0.22 0.242 0.266 0.93

Purchase, Maintenance and Repair of equipments

20 22 24.2 26.620 92.82

Total 27.322 30.054 33.060 36.366 126.80 Integrated Diseases Control Programme

Activity / Item 2008-09 2009-10 2010-11 2011- 12 Total

Renovation of Labs at CHCs @ Rs 20,000

1 0 0 0.2 1.20

Renovation of Lab at District Hospital @ Rs 140,000 and maintenance

1.4 0.18 0.2 0.22 2.00

Equipment for Lab at PSU at CHCs @ Rs 40,000

2 0 0 0.4 2.40

Equipment for Lab at District @ Rs 850,000

8.5 0 0 0 8.50

Computer and Accessories at CHC @63000

3.15 0 0 0.63 3.78

Computer and Accessories at DSU@63000

0.63 0 0 0 0.63

Office Equipment for PSU at CHC @ Rs 20,000 per unit

1 0 0 0.2 1.20

Office Equipment for DSU @ Rs 20,000

0.2 0 0 0 0.20

Software for DSU@ Rs 335000 3.35 0 0 0 3.35

142

Furnishing of Lab at PSU at CHCs @ Rs 10,000

0.5 0 0 0.1 0.60

Furnishing of Lab at DSU @ Rs 60,000

0.6 0 0 0 0.60

Material and supplies at Lab at PSU at CHCs @ Rs 8,000

0.4 0.44 0.484 0.5324 1.86

Material and supplies at Lab at DSU @ Rs 75,000

0.75 0.91 1 1.1 3.76

Contract Staff at District level @ 200000/yr for 4 staff

2 2.92 3.71 4.58 13.21

IEC activities 1 1.21 1.33 1.46 5.00

Training and retraining 2.6 3.15 3.47 3.82 13.04

WEN connectivity 0.5 0.61 0.67 0.73 2.51

Operational costs at PSU for Surveillance @ Rs 15000/year x 5

0.75 0.9 1.31 1.59 4.55

Operational costs at DSU for Surveillance @ Rs 130000/year

1.3 0.57 1.73 1.9 5.50

Honorariun to Numberdars and Chowkidars for reporting @ Rs 100 pm x 275 Numberdars and 275 Chowkidars x12

8.88 9.768 10.745 11.819 21.59

Total 40.510 20.658 24.649 29.282 115.10 Iodine Deficiency Disorders


Large Village meetings for awareness on IDD and consumption of Iodized salt

1 1.21 1.33 1.46 5.00

Programme in schools – Primary, Upper Primary, Secondary- Govt and Private by School health team @ 500

3.5 3.850 4.235 4.659 8.51

Awareness programme with the SHGs and shopkeepers @ Rs 500 per village x 472 villages

4.72 5.192 5.711 6.282 11.47

Total 9.22 10.252 11.276 12.401 43.15 Intersectoral Coordination


Meetings of the Block Committees @ Rs 1000 /meeting x 3 blocks x 12 months

0.36 0.396 0.436 0.479 1.67

Meetings of the Village groups @ Rs 50 per village x 472 villages x 12

2.832 3.115 3.427 3.769 13.14

Joint CNA training @ Rs 200 per person ( 550 AWW, 200 ANMs, 306 ASHAs, 15 MOs, 3 CDPOs) x 1074

2.148 2.363 2.599 2.859 9.97

Joint monitoring at the sector level

143

Hiring of vehicle @ Rs 1000/ day x 5 days/month x 15 sectors x 12 months

9 9.9 10.890 11.979 41.77

Joint monitoring at the block level

Hiring of vehicle @ Rs 1000/ day x 5 days/month x 3 blocks x 12 months

1.8 1.98 2.178 2.396 8.35

Yearly joint Planning Workshops at the Block level for development of the Action Plans @ Rs 1.00 lakhs per block x 3 blocks

3 3.3 3.63 3.993 13.92

Yearly joint Planning Workshops at the District level for development of the Action Plans @ Rs 1.00 lakh

1 1.1 1.21 1.331 4.64

Yearly joint Workshops to consolidate the plans from the village to the Gram Panchayats to the Sectors and then Blocks at the Block level for Annual Action Plans @ Rs 1.00 lakhs per block x 4 blocks

4 4.4 4.84 5.324 18.56

Yearly joint Workshops to consolidate the findings at the block levels at the District level for development of the Action Plans @ Rs 1.00 lakh

1 1.1 1.21 1.331 4.64

Training of PRIs,VHWS committee members under Chiranjeevi Scheme @22 lakhs

22 22 22 22.000 88.000

Regular monthly meetings under Chiranjeevi Scheme @12 lakhs

12 12 12 12.000 48.000

Development of Education material and hands on trainingunder Chiranjeevi Scheme @ 10 lakhs

10 10 10 10.000 40.000

Total 69.14 71.65 74.419 77.461 292.675

Community Health action Activity / Item 2008-09 2009-10 2010-11 2008-12 Total

Training of the VHWSC @ Rs 200 per person x 15 persons/village x 472 villages

14.16 15.576 17.134 18.847 34.42

Meetings of the VHWSC @ Rs 100 per village x 472 villages x 12 months

5.664 6.230 6.853 7.539 13.77

Meetings of Women SHGs @ Rs 100 per year x 472 villages

5.664 6.230 6.853 7.539 13.77

Total 25.488 28.037 30.840 33.925 118.29

Public Private Partnership Activity / Item 2008-09 2009-10 2010-11 2011-12 Total

144

5 Workshops for involvement of the Private sectors (one each with NGOs/Trusts/Private institutions;Media; Ex-servicemen association, transportation ,HR agencies) @ 50000 per workshop

1.5 0.5 0 0 2.50

Sharing Workshops with Private players

0 0.61 0.67 0.74 2.57

Admin and overhead Charges for hiring the agencies

2 2.2 2.42 2.662 12.29

TOTAL 2.75 3.03 3.34 3.74 17.36 Gender and Equity Activity / Item 2008-09 2009-10 2010-11 2011- 12 Total

Orientation and sensitisation programmes 10 12.1 13.3 14.6 50.00

Media workshops 2 2.200 2.420 2.662 9.28 Monitoring and supervision 2 2.200 2.420 2.662 9.28

IEC campaigns 5 5.500 6.050 6.655 23.21

Health Card for Girl Child @ Rs 2 /card x 10,000 cards

0.2 0.220 0.242 0.266 0.9282

TOTAL 19.2 22.22 24.432 26.845 92.70 Capacity Building

Activity 2008–09 2009-10 2010-11 2011-12 Total

TBA training @ Rs 10100 x 275 27.775 12.1 13.3 14.6 67.78

MVA MTP training to all PHC MOs for 15 days @ Rs 500 x 15 days x 42 MOs

1.575 1.733 1.906 2.096 7.31

Training on Blood transfusion for MOs and Lab Technicians for CEmOC centres with Blood storage facilities for 3 days,MOs @ Rs 500/day/person x 3 days and LabTechnicians@Rs 200/person x 3 days

0.345 0.069 0 0 0.41

Training in Obstetric management & skills for 24x7 PHCs for 16 weeksMOs: Rs 500/day x 112 days x 4MO,StaffNurses:Rs200/dayx112daysx 4 SN

3.136 0 0 0 3.14

Training in skilled Birth attendants for 15 days: One batch of 4 persons: Rs. 7500 as hon. to participants, Rs 13500 hon. to training team, 15% institutional charges

2

2.200 2.420 2.662

9.28

IMNCI training to ANM/LHV, SN, ASHA for 8 days,Rs 300 as hon. to participant x 8 days

2.592 2.736 2.784 2.496 10.61

IMNCI training to MOs @ Rs 5390 0.8624 0.8624 0.8624 0 2.59

145

/participant

Integrated skill training for MOs @ Rs 3683

0.5888 0.5888 0.5888 0 1.77

Training of MOs, SN in Mgt of Newborns & sick children at Medical College Jammu @ Rs 7500/MO, Rs 4500 ( Rs 300 x 15 days)/SN

1.44 0.48 0 0 1.92

Training in BCC for MOs, LHVs, ANMs

1.28 0 0 0 1.28

MOs: Rs 500/MO x 5 days

LHVs & ANMs: Rs 300/person x 5 days

Training of Ayush personnel on issues of RCH and reporting for 3 days

0.153 0.153 0.153 0 0.46

Rs 300/person x 3 days

Training on NSV for MOs at NSV camps

40.8 45.6 45.6 0 132.00

Rs 500/MO /camp x 12 camps,

Rs 3000 per camp for trainer x 12 camps

Training on Minilap @ Rs 500 per day for 15 days and during camps

0.6 1.8 1.2 1.2 4.80

Training for Laproscopic Sterilization for Surgeons, Gynaecologists, SN, OT attendants for 12 days

0.6 0.6 0.6 0.6 2.40

SMO: Rs 500/SMO x 12 days

SN: Rs 300/SN x 12 days

OT Attendant: Rs 200 x 12 days

Orientation on contraceptive devices for MOs - Rs 500 /MO x 1 day

0.42 0.462 0.508 0.559 1.95

Training on Medico-legal aspects to Mos @ Rs 500/MO x 1 day

0.445 0.47 0.92

Orientation on PCPNDT Act for DCs, CSs, doctors both Govt and private, members of District Appropriate authority NGOs in a workshop

1 1.2 1.32 1.45 4.97


1.8 0 1.8 0 3.60

Rs 500/official and MOs x 3 days

Rs 200 /clerical staff x 3 days

Financial management training for Accounts Officers, Accountants for 2 days

0.172 0.172 0.172 0.52

Rs 200/Accounts persons x 2 days

146

Computer training to all the MOs, Clerical staff, accounts personnel @ Rs 200 per person x 15 days

3.72 3.72

CNAA for MOs, LHVs, ANMs, AWW

2.3 2.38 2.4 2.43 9.51

@ Rs 200/person x 1 day each year

Total sanitation orientation and reorientation of VHWSCs x 1 day @ Rs 200/person/day

0.74 0.74 0.74 0.74 2.96

Training of NGOs in BCC @ Rs 300 per person x 6 days

0.36 0.54 0.72 0.72 2.34

Total 94.704 74.886 76.902 29.725 276.22 Human Resources


Subcentre ANM 167.649 173.101 181.279 189.457 711.486

PHC

MO -25.216 -25.216 -25.216 -25.216 -100.864

Staff Nurse 52.258 52.258 52.258 52.258 209.032

Health worker (F) -3.074 -3.074 -3.074 -3.074 -12.296

Health Educator 13.833 13.833 13.833 13.833 55.332

Health Assistant 34.22 34.22 34.22 34.22 136.88

Clerk 21.384 21.384 21.384 21.384 85.536

Pharmacist -3.06 -3.06 -3.06 -3.06 -12.24

Lab.Tech 1.188 1.188 1.188 1.188 4.752

Class IV 20.88 20.88 20.88 20.88 83.52

CHC

Specialist(4) 14.76 14.76 29.52 29.52 88.56

Eye Surgeon 11.07 11.07 14.76 14.76 51.66

Anaesthetist 11.07 11.07 14.76 14.76 51.66

PHN 5.136 5.136 6.848 6.848 23.968

SN 15.37 15.37 26.129 26.129 82.998

Dresser 0.69 0.69 1.38 1.38 4.14

lab.Tech 1.188 1.188 2.376 2.376 7.128

Radiographer 2.376 2.376 3.564 3.564 11.88

Opthalmic Assistant 1.188 1.188 2.376 2.376 7.128

Class IV -8.64 -8.64 -4.32 -4.32 -25.92

Statistical Assistant 2.376 2.376 3.564 3.564 11.88

Registration cleark 3.564 3.564 4.752 4.752 16.632

Total 340.21 345.662 399.401 407.579 1492.852

Procurement and Logistics


Construction of Warehouse 100 0 0 0 100

Software 0.25 0 0 0 0.25

Computer system with UPS, Printer, Scanner,

0.6 0 0 0 0.6

Equipment & Hardware 34.5 0 0 0 34.5

147

Pharmacist @ Rs 9000/mth 1.08 1.19 1.31 1.44 5.02

Assistant Pharmacist @ Rs 5000/mth

0.6 0.66 0.726 0.799 2.785

Packers -2 @ Rs 4000/mthx2 0.96 1.056 1.162 1.278 4.456

Security Staff @ Rs 6000/mth 0.72 0.792 0.871 0.968 3.351

Training of personnel 0.1 0.11 0.121 0.133 0.464

Consultancy to agency for Operationalization of the Warehouse

2 0 0 0 2

Total 140.81 3.808 4.19 4.618 153.426 IEC

Activities 2008-09 2009-10 2010-11 2011-12 Total

Finalizing the messages 1 1.1 1.21 1.331 4.64

Advertisements 5 5.5 6.05 6.655 23.21

TV spots 1 1.1 1.21 1.331 4.64

Radio Jingles 1 1.1 1.21 1.331 4.64

Folk Media shows @ Rs 1000/vill 4.72 5.192 5.711 6.282 21.91

Hoardings @ Rs 10000/hoarding 10 11 12.1 13.31 46.41

Display boards @ Rs 2000/board 1.8 1.98 2.178 2.396 8.35

Pamphlets @ Rs 10/pamphlets 1 1.1 1.21 1.331 4.64

Nirdeshika for Fixed Health Nutrition days @ Rs 20/ Nirdeshika

0.8 1 0 0 1.80

[email protected] /copy/mth

0.8 1.2 1.4 1.6 5.00

Orientation of frontline government functionaries & elected rep

0.8 0.88 0.968 1.065

@ Rs 200 x 400 persons x1 day

3.71

VCD @ Rs 15000 per SC and maintenance

15 0.75 0.75 0.75 17.25

MSS meetings @ Rs 100/vill x 472 0.472 0.519 0.571 0.628 2.19

Bal Nutrition Melas @ Rs 300 x 4 times x No of SCs

1.2 1.320 1.452 1.597 5.57

Opinion leaders workshops @ Rs 300 /person x 100

0.3 0.330 0.363 0.399 1.39

Wall writings @ Rs 500 x 472 villages

2.36 2.596 2.856 3.141 10.95

Total 47.252 36.667 39.239 43.148 166.31

Financing of Health Care Activity 2008-09 2009-10 2010-11 2011-12 Total

Provision of Seed money @ Rs 1 lakh per CHC and PHC @ Rs 1.00 lakhs

26 26 26 26 104.00

Training of the Incharges and second in command @ Rs 800 per person x 1 day

0.416 0.416 0.416 0.416 1.66

Development of Software for RKS with training of personnel on the use

5 0.25 0.25 0.25 5.75

Total 31.416 26.666 26.666 26.666 111.41

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HMIS: Data Monitoring and Support Activity / Item 2008-09 2009-10 2010-11 2011-12 Total


Software development 20 0 0 0 20

Internet connectivity @ Rs 900 /mth x No of facilities x12 mths

1.944 1.944 1.944 1.944 7.776


2.1 2.1 2.31 2.541 9.051


4.92 4.92 4.92 5.04 19.800

GIS for the district, training and updation

12 0.5 0.5 0.5 13.5

Printing monitoring Charts @ Rs. 5 per monitoring chart

0.1 0.15 0.175 0.2 0.625

Total 61.064 9.614 9.849 10.225 90.752

School Health Program Activity / Item 2008-09 2009-10 2010-11 2011-12 Total

Health Check up camps @2000/school

28.68 31.548 34.703 38.173 133.10

IEC campaigns 1 1.1 1.21 1.331 4.64

Monitoring and supervision (10% increase per year) 0.6

0.66 0.726 0.799 2.78

TOTAL 30.280 33.308 36.639 40.303 140.53

BioMedical Waste management Activity / Item 2008-09 2009-10 2010-11 2011-12 Total

Orientation and reorientation for Biomedical Waste Management at District and Block levels 1.5 1.820 2.000 2.200 7.52

Consumables 1 1.210 1.330 1.440 4.98

Payment for incinerators@ Rs. 8 per bed 12 mths 15.84

17.424 19.166 21.083 73.513

Total 18.34 20.454 22.496 24.723 86.013

Grand Total 3709.66 1773.65 2083.40 1966.00 9532.71

149

Annexure Annexure 1 PHC buildings need to be constructed and Staff quarter position in the district: -

S.NO. Ramgarh Buildings Need to Constructed For PHC

Staff Quarters Needs to be Constructed For PHC

1 Gurha Salathian(available onl;y for M.O)

2 Nandpur(available only for M.O)

3 AH on xpress highway(available only for M.O)

Samba

1 Daghore

2 Nud

3 Sumb

4 Bainglar (available only for M.O&Pharmacist)

Purmandal

1 Bhore Purmandal (available only for M.O)

2 Tarore Bhore

3 AD Gangyal Rahya

4 Chowadhi Tarore

5 Chattha Gangyal

6 Chowadhi

7 Chattha

8 Barikhad

150

Annexure 2 Subcentre buildings and Staff Quarters need to be constructed: -

Block Samba SC Needs to be cunstructed SC staff quarters Needs to be cunsreucted

1 Devaka Balode

2 Rayour Paaper

3 Lian Bagoon Devaka

4 Khabbal Rayour

5 Mandi Sangwali Lian Bagoon

6 Pangdour Khabbal

7 Chila Dinga Goran

8 Rai Pur Panthi

9 Nai Kali Maithlian Kalan

10 Kullian Mandi Sangwali

11 Sujwan Hunder

12 Supwal Pangdour

13 Sarna Diani

14 Chila Dinga

15 Rai Pur

16 Nai Kali

17 Kullian

18 Rakh Amb Talli

19 Sujwan

20 Samba

21 Sarna

Ramgarh

1 Sangwal Sangwal

2 Sajad Pur Sajad Pur

3 Ghar Mandi Ghar Mandi

4 Kamala Kamala

5 Chak Salarian Chak Salarian

6 Gudwal Gudwal

7 Chattaka Chak Chattaka Chak

8 Kaka Dabuj Kaka Dabuj

9 Gho Barhamana Gho Barhamana

10 Koul Pur

11 Kamore

12 Nathwal

13 Pakhari

Purmandal

1 Pargalta Pargalta

2 Deon Deon

3 Talab Turutto Talab Turutto

4 Chatha Chatha

5 Sandhi Sandhi

151

6 Kotli Chaka Kotli Chaka

7 Birpur Birpur

8 Tarore Tarore

9 Patti Patti

10 Dharp Dharp

11 Sanik Colony Sanik Colony

12 Majeen Majeen

13 Bassi Kallin Bassi Kallin

14 Khara Madana Khara Madana

15 Lower Chowadi Lower Chowadi

16 Sujwan Sujwan

17 Sidhra Sidhra

18 Channi Rama Channi Rama

19 Sangar Sangar

20 Kana Chak Kana Chak

21 Utter Vani Utter Vani

22 Bathindi Bathindi

23 Raipur Raipur

24 Prithipur Prithipur

25 Katwalta Katwalta

26 Smail Pur Smail Pur

27 Gorkha Basti Gorkha Basti

28 Digiana Digiana

29 Mandal Mandal

30 Upper Gadi Garh Upper Gadi Garh

31 Gujjar Colony

152

Assessment of District Health Action Plan (DHAP)

Appraisal Criteria to be used by State/ District Planning & Appraisal Team

District Sambha Sl. No.

Criteria Remarks Yes/ No

A. OVERALL

1 Has the DHAP been reviewed in detail by the District authorities to ensure internal consistency? If yes, by whom? This means that Situation analysis, goals, strategies, activities, work plan budget are in line with the proposed interventions and are evidence based.

Yes

2 Has Account Person from the Department reviewed the budget in detail?

Yes

3 Executive summary /At a Glance has been enclosed in the beginning of the document.

Yes,

4 Has plan developed in all inclusive and participatory process by involving representatives of health, water and sanitation, ISM, ICDS, Rural Development, NGOs and community members?

Yes

5 Funds requirement matches with the absorption capacity and has judicious increase over the years (The planning should be based on past experiences in implementing interventions and realistic time frame/ workplan )

Yes

6 The Plan caters needs of vulnerable groups (SC/ST, BPL, Women and Children, others) (Activities proposed to cover SC/ST population for Immunization coverage, JSY scheme etc.)

Yes

7 Inter-department coordination and convergence mechanism is clearly mentioned for multi-sectoral inputs/elements. (Planned joint sector ,block and dist level meetings with ICDS, education and local self Govt. etc and joint circulars for implementing intervention)

Yes,

8 The findings of the facility survey/ assessment has been integrated in the Plan

Yes,

9 Plan has been approved by appropriate district authority District (District Health Society)

Yes, attached after the cover page

11 Training Plan The training strategy to strengthen existing HR. The training plan has indicated target groups (e.g. MO, ANM, ASHAs, AWW etc), training load and broad details e.g. duration, quality assurance for training, etc

Yes,

12 BCC /IEC strategy A service oriented BCC strategy based on assessment of the current status of issues with MMR, IMR, TFR, awareness of PNDT, etc. has been narrated in the plan

Yes

13 Work Plan Is the work plan consistent with stated

Yes,

153

Sl. No.


components/objectives, strategies and activities? And whether the proposed phasing of activities would lead to increase in delivery/utilization of services? COSTS/BUDGET Key criteria are:

Does the budget follow the prescribed formats? Yes

The justification column has break-up of total amount

14

1. Absorptive capacity: If very ambitious utilization of funds is envisaged compared to performance of 05-06/06-07, then key steps have been proposed to achieve plan expenditure?

Yes

B RCH-II PROGRAM

PROGRAM MANAGEMENT ARRAGEMENTS 1 Steps to establish financial management system including

fund flow mechanisms to blocks and downward level and accounting system including timely reporting expenditure

Yes, Page 55-60

2 Steps to establish quality assurance committees/system in the district.

Yes

3 Step to ensure systems for holistic monitoring (Outputs, activities, costs) against DHAP .( Dist level review meeting and DHS meetings)

Yes

4 Strengthening of HMIS with emphasis on timely availability of reliable and relevant information at appropriate level e.g. community, SC, PHC, Block and district, analysis and feedback system, steps to ensure implementation of revised HMIS system.

Yes,

5 Provision of logistics management of drugs and medical supplies in order to ensure continuous availability of essential supplies at S/C, PHC and CHC level.

Yes,

TECHNICAL STRATEGIES A. Reproductive & Child Health

Maternal Health 1 A. Interventions for 100% ANC coverage, B. 24x7 for EmOC services at selected institutions C. Skill birth attendance during labour (ANM) D. Provision for availability of safe blood in

FRUs/CEmOCs, E. Intervention for anesthesia training for MOs, F. Provision of Safe abortion services and, G. Management of RTI/STI Cases H. Provision for Janani Suraksha Yojana

Yes,

2 Child Health

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Sl. No.


A. Organizing MCHN days for complete immunization

coverage, B. Interventions for IMNCI services (Optional) C. Provision for new born care at institutions and, D. Promotion of breast feeding E. School Health Programme

Yes,

Family Planning 3 A. Interventions to provide regular FP services in every

block facilities, B. Increase number of service providers for vasectomy,

NSV, Tubectomy, and Laproligation , C. Intervention to improve quality of camps, D. Quality IUD insertion services, E. Increased availability of OP, Condoms through

community workers, ASHA, AWW, NGOs

Yes,

ARSH 4 A. Intervention for training of MOs, paramedic for ARSH

services ( optional) B. Provision of AFHS services at selected institutions

(optional)

Yes

5 Gender Mainstreaming Activities planned for awareness generation of gender,

PCPNDT Act and strengthening implementation of PCPNDT Act.

Yes,

Urban RCH 7 Interventions for provision of MH/CH/FP services in urban slums and urban areas.

NA

Tribal Health 8 Interventions to cover tribal population for FP/MH/CH. NA

B NRHM ADDITIONALITIES Whether provision made for-

1 ASHA Training in the district Yes

2 PRI Trainings (Block/Village health & Sanitation Committees)

Yes

3 Untied Funds at SC & Untied funds to RKS at PHC/CHC/District Hospitals

Yes

4 Civil Works as per IPHS (CHC/PHC/SC) Hospital Building- Staff Quarters

Yes

5 Strengthening Field Monitoring and Supervision (Enhance the provision of POL, Maintenance and of vehicle)

Yes

6 Need assessment done for-Procurements as per IPHS CHC/PHC/SC)

Yes

7 Appropriate provision made for-Programme Management Units at Divisional, District and Block levels-Adequate

Yes,

155

Sl. No.


salary and OE provisions ( District PMU is a part of RCH II and Block level PMUs are part of NRHM)

8 Adequate provision made for-Additional Manpower Specialists at CHCs ANMs at SCs Divisional/Block Programme Managers

Yes

9 Provision made for-Drug Kits at different institutions Yes 10 Plan for management of Mobile Medical Units at districts Yes

11 No of Ambulances available and required Yes District specific innovative activities to address local needs

have been incorporated Yes, addressed in all the technical chapters

12 Public private partnerships ( optional) Yes,

12 Provision of hiring of vehicle for BMOs (as per requirements)

Yes

C IMMUNIZATION PROGRAM Whether provision made for-

1 Social mobilization Yes 2 Alternative vaccine delivery Yes

3 Cold Chain Maintenance Yes 4 PoL & Maintenance requirement for vehicles Yes, D National Disease Control Programme

1 Water Borne Diseases Clear strategy prepared for combating Water Borne Diseases like Malaria, dengue etc

Yes

2 TB

Whether Separate section on TB with operational details and budget prepared

Yes,

3 Leprosy Separate section on Leprosy with detailed operational

guidelines and budget

Yes,

4 Blindness 1 Separate section on Blindness Control with detailed targets

and budget Yes,

2 Monitoring mechanism for NGO E CONVERGENCE/ INTER-DEPARTMENTAL

COORDINATION Whether interventions in the following areas have been planned

Yes,

1 ISM Integration Activities Yes

2 Department of Social Welfare (ICDS) Yes

3 PHED Yes

Documents

DISTRICT HEALTH ACTION PLAN District Sambadocuments.gov.in/JK/13474.pdf · DISTRICT HEALTH ACTION PLAN District Samba ... Dr. R.S Charak M.O DTC Health ... Dr. B.K Sharma BMO Dansal