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MEETING STATE HEALTH MISSION
NRHM04-09-2009
NATIONAL RURAL HEALTH MISSION (2005-2012)
• NRHM launched by Hon’ble Prime Minister on 12/4/2005.
• 100% by GoI for 2005-06 and 2006-07 and 85:15 from 2007-08 to 2011-12.
• Aimed to ensure affordable, quality health care to the poorest house holds in
remotest areas.
• Special focus on 18 low performing States which have weak public health indicators
and weak infrastructure.
• Punjab is among the nine high performing States- Punjab, Haryana, Gujarat,
Maharashtra, Karnataka, Kerala, Tamil Nadu, Andhra Pradesh, West Bengal.
2
HISTORICAL PROSPECTIVE
• RCH-II (2005-2010) aimed at reducing IMR and MMR was already in progress.
• Programme for control of various diseases were already in progress for the last more than 15-20 years.
• Government felt the need to integrate all ongoing health programme into one programme and consolidate the work being done by other departments.
• NRHM encompasses – – RCH – II including immunization – All individual disease control programme– Flexi-pool as per requirement of the State– Convergence with other departments like AYUSH, Water
Supply and Sanitation, Nutrition, Woman and Child Development, Rural Development and Panchayats.
• Universalized access to quality health care especially to rural poor
with focus on women and children.
• Reduced Infant Mortality Rate and Maternal Mortality Rate.
• Ensuring population stabilization & gender equity.
• Prevention and control of communicable and non-communicable
diseases.
• Access to integrated comprehensive primary health care.
• Mainstream AYUSH- Integration of AYUSH with mainstream health
institutions .
• Emphasis on potable drinking water, hygiene, sanitation and
nutrition.
NRHM OBJECTIVES
4
NRHM STRATEGIES
• Decentralization of the process of health planning and management from Village to District level.
• Involvement of PRIs and Village Health & Sanitation Committees.
• Up-gradation of existing health institutions from Sub Centres to District Hospitals as per Indian Public Health Standards (IPHS).
• Flexible financing- untied funds for filling up the gaps in infrastructure and other related activities.
• Manpower requirement- recruitment of doctors, and paramedical staff in relation to Woman & Child Health.
• Improved management through capacity building- provision of computers, computer operators, establishment of State, District and Block Programme Management Units (PMUs).
• Integration of AYUSH with the mainstream health institutions including recruitment of Ayurvedic/Homeopathy doctors at PHC and CHC level.
• Intersectoral Convergence with Nutrition, water and sanitation programmes.
• Promotion of Public Private Partnership for achieving public health goals.
NRHM IN BRIEF
• Reduction in IMR and MMR through institutional deliveries - Recruitment of Gyne, Paed, Anaesth, Medical Officers (Female), Staff Nurse, ANM, ASHAs, Various Incentives, Upgradation of PHC, CHC for 24 hrs. delivery.
• Decentralization – Transfer of funds where needed. Untied funds and Maintenance Grant for SC, PHC, CHC; Funds for Rogi Kalyan Samiti, VHSC.
• Involvement of Community – State Health Society, District Health Society, Planning and Monitoring Committees at Block, District and State Level, Village Health and Sanitation Committees.
• Convergence – No separate funds but Department of Health expected to work in close coordination with other Departments like – Women and Child (ICDS), Water Supply and Sanitation, Education and Department of Rural Development. Besides AYUSH to be integrated with Allopathic Health Institutions.
Community Partnership
Village level planning
ASHA
Village Health & Nutrition Days
Village Health & Sanitation Committees
Increased involvement of PRIs
System strengthening
Infrastructure development
Monitoring through computerisation
Improved financial management & Human Resource
Public Private Partnership
Telemedicine
Mobile Medical Units
Intra & inter sectoral convergence
24-Hour- delivery services
Emergency Obstetric Services
Specialist Services – On call/contract
Immunization strengthening
IMNCI
Adolescent health
Family welfare services
KEY COMPONENTS OF NRHMImproved services
Accessibility, Approachability and Quality
BLOCKLEVEL
HOSPITAL
30-40 Villages
Strengthen Ambulance/transport ServicesIncrease availability of NursesProvide TelephonesEncourage fixed day clinics
AmbulanceTelephone
Obstetric/Surgical MedicalEmergencies 24 X 7
Round the Clock Services;
BLOCK LEVEL HEALTH OFFICE –--------------- Accountant
CLUSTER OF GPs – PHC LEVEL
3 Staff Nurses; 1 LHV for 4-5 SHCs;Ambulance/hired vehicle; Fixed Day MCH/Immunization
Clinics; Telephone; MO i/c; Ayush Doctor;Emergencies that can be handled by Nurses – 24 X 7;
Round the Clock Services; Drugs; TB / Malaria etc. tests
GRAM PANCHAYAT – SUB HEALTH CENTRE LEVEL
Skill up-gradation of educated RMPs / 2 ANMs, 1 male MPW FOR 5-6 Villages;Telephone Link; MCH/Immunization Days; Drugs; MCH Clinic
VILLAGE LEVEL – ASHA, AWW, VH & SC
ASHAs, AWWs in every village; Village Health & Nutrition DayDrug Kit, Referral chains
100,000 Population
100 Villages
5-6 Villages
Accredit private providers for public health goals
Health Manager
Store Keeper
NRHM – ILLUSTRATIVE STRUCTURE
NRHM FIVE COMPONENTS
(PART- A)
RCH AND RELATED ACTIVITIES
(RCH FLEXI POOL)
(PART- A)
RCH AND RELATED ACTIVITIES
(RCH FLEXI POOL)
(PART- B)
INITIATIVES UNDER NRHM OTHER THAN RCH
(MISSION FLEXI POOL)
(PART- B)
INITIATIVES UNDER NRHM OTHER THAN RCH
(MISSION FLEXI POOL)
(PART- C)
IMMUNIZATION STRENGTHENING
PROGRAMME
(PART- C)
IMMUNIZATION STRENGTHENING
PROGRAMME
(PART- D)
NATIONAL DISEASE CONTROL PROGRAMMES
(PART- D)
NATIONAL DISEASE CONTROL PROGRAMMES
(PART- E)
INTER SECTORAL CONVERGENCE
SCHEMES
(PART- E)
INTER SECTORAL CONVERGENCE
SCHEMES
INSTITUTIONAL ARRANGEMETS UNDER NRHM
STATE LEVEL
• State Health Mission chaired by Hon’ble Chief Minister.
• State Health Society chaired by Chief Secretary.
• Merger of all vertical societies into State Health Society.
• Signing of MoU with GoI.
• State Level Planning and Monitoring Committee headed by
Hon’ble Health Minister
INSTITUTIONAL ARRANGEMETS UNDER NRHM
DISTRICT LEVEL
• District Health Mission chaired by Chairman Zila Parishad.
• District Health Society chaired by Deputy Commissioner.
• District Planning and Monitoring Committee headed by Zila
Parishad Chairman.
• Rogi Kalyan Samities in District/Sub Divisional Hospitals.
• Merger of all vertical societies into District Health Society.
..contd.. INSTITUTIONAL ARRANGEMETS UNDER NRHM
BLOCK LEVEL
• Block Planning and Monitoring Committees at Block PHC.
• PHC Planning and Monitoring Committees at PHC level.
• Rogi Kalyan Samities for CHCs
VILLAGE LEVEL
• Village Health & Sanitation Committees in each village.
• Accredited Social Health Activist (ASHA) for every 1000
population.
SN CATEGORY INDIA PUNJAB BETTER STATES
1 Crude Birth Rate(SRS 2007)
23.1 17.6 Kerala (14.7), Himachal Pradesh (17.4), Tamil Nadu (15.8)
2Total Fertility Rate(SRS 2007)NFHS-III
2.72.7
2.02.0
Tamil Nadu (1.6), Kerala (1.7), AP (1.9), HP (1.9), W.B.(1.9)
3 Death Rate(SRS 2007)
7.4 7.0 J &K (5.8), W. Bengal (6.3), Haryana (6.6), Maharashtra (6.6), Kerala (6.8), Rajasthan (6.8)
4Sex Ratio at Birth (SRS 2007)
901 837
AP (915), Assam (939), Bihar (909), Chatisgarh (969), Himachal (931), Jharkhand (927), Karnataka (926), Kerala (958), Madhya Pradesh (913), Orissa (933), TN (944), W. Bengal (936)
5Sex Ratio (0 to 4 years)(SRS 2007)
914 838
AP (942), Assam (950, Bihar (940), Chatisgarh (954), Himachal (945), Jharkhand (926), Karnataka (925), Kerala (962), Madhya Pradesh (935), Orissa (952), TN (950), W. Bengal (964)
HEALTH INDICATORS
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HEALTH INDICATORS :
SN Category India Punjab Better States
6Maternal Mortality Ratio (SRS 2001-03)(SRS 2004-06)
301254
178192
Gujarat (172), Haryana (162), Kerala (110), Tamil Nadu (134), Maharashtra (149)
7.Infant Mortality Rate (SRS 2007) NFHS-III
5557
4342
Kerala (15), Tamil Nadu (31), Maharashtra (38), Himachal Pradesh (36)
MATERNAL HEALTH
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SN Category India Punjab Better States
8.
Ante Natal Care(3 or more visits)NFHS-III DLHS – III
50.775.3
72.565.1
Kerala (93.5), Tamil Nadu (96.5), Maharashtra (75.3)
9.Institutional deliveries NFHS – III DLHS – III
4147
5363.3
Andhra Pradesh (71.8), Goa (96.3), Karnataka (65.1), Kerala (99.4), Maharashtra (63.6), T. Nadu ( 94.1)
10.
Pregnant women who are anemic (%age) NFHS – III DLHS-III
57.9 41.6Goa (36.9), HP (37.0), Kerala (33.1), Manipur (36.4)
HEALTH INDICATORS :ANTE NATAL CHECK UP
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SN Category India Punjab Better States
11
Breast Feeding (%age)(i) Children under 3
years breast fed within one
hour of birth NFHS-IIIDLSH-III
23.440.2
10.344.6
Assam (65.7), Goa (61.5), Kerala (65.3), Meghalya (75), Mizoram (78.4), Orissa (63.7), Sikkam (64.7), Tamil Nadu (77.5)
12%age of children fully immunizedNFHS-III
DLSH-III44.054.1
60.079.9
Goa (93.4), Himachal Pardesh (82.3), Tamil Nadu (83.2)
HEALTH INDICATORS :CHILD HEALTH
TOP
Sr. No.
Item India Best Countries Neighboring countries
1. Infant Mortality Rate 56 Iceland (2)
Norway, Sweden
& Japan (3)
1. Sri Lanka (12)
2. China (23)
3. Bangladesh (54)
4. Nepal (56)
5. Pakistan (79)
2. Maternal Mortality Ratio 450 Ireland (1)
Sweden & Italy (3)
1. China (45)
2. Sri Lanka (58)
3. Pakistan (320)
4. Bangladesh (570)
5. Nepal (830)
3. Life Expectancy at Birth 63.7 Japan (82.3)
Hong Kong (81.9)
1. China (72.5)
2. Sri Lanka (71.6)
3. Pakistan (64.6)
4. Bangladesh (63.1)
5. Nepal (62.6)
Source Human Development Report 2007-08
Health Indicators – India and World
IndicatorsAt the start of RCH
SRS 1998-1999
Present Status
2008-2009
Target by 2009-2010
Total Fertility Rate 2.5 2.1 1.8
Infant Mortality Rate(per 1000 live births)
49 43 <30
Maternal Mortality Ratio(per 100000 live births)
199178
192<100
Institutional Deliveries37.5%
(NFHS II)52.5 80%
ANC Check-up with 03 contacts
58.4%
(NFHS II)72.5 100%
TARGETS FOR PUNJAB UNDER NRHM
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HEALTH INSTITUTIONS
INSTITUTIONSPUBLIC SECTOR
PRIVATE SECTOR
MEDICAL COLLEGES 3 5
DISTRICT HOPITALS 20
983SUB DIVSIONAL HOSPITALS (Total no. of Sub Divisions 78)
36
COMMUNITY HEALTH CENTRES 129(114 PHSC, 15 DHS)
BLOCK PHCs 118
- BLOCK PHCs AND SDH 5
- BLOCK PHCs AND CHCs 72
- ONLY (EXCLUSIVE) BLOCK PHCs 41TOP
HEALTH INSTITUTIONS
INSTITUTIONSPUBLIC SECTOR
PRIVATE SECTOR
TOTAL PHCs – EXCLUSIVE 394
- PHCs (MINI PHCs) – EXCLUSIVE 353
- PHCs BLOCK – EXCLUSIVE 41
TOTAL PHCs – EXCLUSIVE + AT CHC/SDH 394 + 77 = 471
SUBSIDIARY HEALTH CENTERS 1187
SUB-CENTRES AT VILLAGE LEVEL 2950
CLINICS /DISPENSARIES 3046
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FINANCIAL REPORT FOR THE YEAR 2005-10
Rs. in lakhs
Year
Ope-ning Bal-
ance
Approved Plan Releases Expendit
ure
Incurred
% of Utilizatio
n
Unspent Balance (Bank
Balance
SHS) GOI
State Share
15% from
2007-08 Total
Funds released
by GOI
Funds released
by State
Total Funds
Available
1 2 3 4 5 6 7 8 (2+6+7) 9 10 11 (8-9)
2005-06 283.2 9820.8Not
Required 9820.8 8103.3 0 8386.45 5971.37 61% 2415.08
2006-07 2415.1 16272Not
Required 16272 14194 0 16609.1 8326.24 46% 8282.9
2007-08 8282.9 16197 2841 19038 11516.2 0 20504.2 10469.28 53% 9329.89
2008-09 9329.89 17324 2600 19924 17821 2884 30034.98 17524.71 58% 12510.57
2009-10 (July 09)
12510.57 21805 3271 25245 5410 0 17920.57 4911.33 21.52 13009.24
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FINANCIAL REPORT FOR THE YEAR 2005-10
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Opening Balance 2009-10 - Rs. 12510.57 LakhsDistrict Health Societies - Rs. 5686.07 LakhsState Health Society - Rs. 6824.50 Lakhs
Closing Balance 2009-10 (July 2009) - Rs. 13009.24 LakhsDistrict Health Societies - Rs. 10673.15 LakhsState Health Society - Rs. 2336.09 Lakhs
Status of State Contribution2008-09
GOI share as per PIP - 173.23 croreState share - 26.00 croreTotal - 199.23 croreRelease by GOI - 178.03 croreMatching State share - 31.35 croreReleased by State - 21.79 croreBalance yet to be received - 9.56 crore
2009-10GOI share as per PIP - 218.05 CroreState share - 32.71 CroreUnspent Balance - 1.69 CroreTotal - 252.45 CroreRelease by GOI - 54.10 CroreMatching State share - 9.55 Croreyet to be received - 9.55 Crore
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FINANCIAL REPORT FOR THE YEAR 2005-10
ANNUAL PLAN 2009-10
Rs. In lakhs
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Part Component Approved Allocation
A RCH - Flexipool 6412
Maternal Health, Child Health, Family Planning, ARSH, Infrastructure, Training & BCC.
B NRHM- Additionalities 11276
Mandatory Funds- Untied Funds, Annual Maintenance Grant & Corpus Grant to RKS
Upgradation of Institutions- Civil Works, Drugs, Equipment, Mobile Medical Units, Emergency Response Services & Programme Management
C Immunization 280D National Disease Control Programme 1365
- RNTCP, NLEP, IDSP, NVBDCP, NIDDCP & NPCB E Inter sectoral Convergence 0 AYUSH, Convergence with PRIs, ICDS & PHED Family Welfare Direction & Administration -2211 5912
Total 25245
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Important Items of Expenditure – Rs. 252 Cr.
PARTICULARSAMOUNT (in
Crores)
Salaries under NRHM 100.86Mandatory Provisions for Untied Funds & Annual Maintenance Grant
28.12
Upgradation of health institutions 14.20National Disease Control Programmes 13.65Immunization 2.80Maternal Health 6.10Family Planning 11.17Training 6.54Behaviour Change Communication 3.67
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Important Items of Expenditure …contd.
PARTICULARSAMOUNT (in Crores)
Construction & Repair of SCs 8.65
Drugs for PHCs/CHCs/SDHs/DHs 7.18
Equipment for PHCs/CHCs/SDHs/DHs 3.97
Recurring Cost of MMUs 3.60
ASHA Training 4.49Emergency Response Services 25.61School Health Programme 2.00Total 252.45
ACHIEVEMENTS2008-09 & 2009-10
(July 09)
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RECRUITMENTS-SUMMARY
SN CategoryTotal
Sanctioned
Filled up during 2005-06
to2007-08
Filled up during 2008-
09
Filled up during 2009-10
Total Filled up Vacant
1 SPMU 48 32 16 2 41 7
2 DPMU 140 71 72 20 140 0
3 BPMU 394 228 118 53 394 0
4 FRU
Gynae 60 13 13 9 21 39
Paed. 60 14 11 6 24 36
Nurses 560 180 120 65 347 213
5PHC 24x7
MO (F) 196 20 54 36 86 110
Nurses 588 174 129 155 403 185
DHs Gynae 15 - - 10 10 5
6 MMU 168 0 134 17 154 14
7 MO - PHCs 95 59 - 43 52
8MPHW(F) – Urban Slums
230 330 116 230 0
9 ANMs – Sub Centres 1468 1338 1338 130
Total 4126 1062 2180 373 3231 791
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SNSub Components
Allocation Expenditure Allocation Expenditure
2008-092008-09 2009-10 (up to July 09)
1
Maternal Health ( Referral Transport, VHND etc.)
235.00 444.26 120.00 160.00
Janani Suraksha Yojna ( JSY, Incentive to ASHA)
186.00 417.18 490.00 150.35
2 ASHA 334.50 71.18 0 0
3 Child Health & IMNCI 86.15 7.37 25.30 0
4 Family Planning (Compensation)
920.60 835.82 1116.50 267.08
5 ARSH 27.07 15.75 38.23 6.78
6Urban RCH ( Salary of MPHW (F))
135.60 155.42 165.60 77.97
7
PNDT Sex Ratio (Awards to Panchayat, Decoy patients, Informers, sting operations)
64.84 26.91 62.80 2.29
Innovations / PPP/NGO 442.50 77.53 295.00 51.00
PART A- RCH FLEXI POOLRs. In lakhs
PART A- RCH FLEXI POOL(Contd..)
SN Sub Components Allocation Expenditure Allocation Expenditure2008-09 2009-10 ( up to July 09)
8
Infrastructure & Human Development (Specialist Doctors,, Female Medical Officers, SNs)
1558.50 664.12 2547.39 314.27
Logistic Management
323.34 170.23 61.76 53.93Quality Assurance and Infection Control Programme
HMIS Monitoring and Evaluation
9 Training 461.88 151.00 654.09 28.13
10Behaviour Change Communications
291.76 254.03 367.82 47.97
11 Procurement 122.50 437.71 53.55 34.64
13Programme management Units SPMU and DPMUs
347.26 278.13 414.22 97.78
12 Flexi pool 157.50 112.96
Total A (RCH II) 5695.00 4119.60 6412.26 1292.19
Rs. In lakhs
ACHIEVMENTS - PART AReproductive & Child Health Programme
Reproductive and Child Health Programme focus on reducing
MMR and IMR. Presently MMR of the State is 192 and IMR is
43. Target is to reduce MMR less than 100 and IMR to less than
30 by 2010.
This can be reduced only by improving ANC coverage and
promoting institutional deliveries.
State focuses on Up gradation of institutions and community
mobilisation.
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ACHIEVMENTS - PART AMATERNAL HEALTH
(1) Up-gradation of 196 PHCs to 24x7 PHCs
– 75 PHCs upgraded to 24x7 PHCs in 2007-08, 26 PHCs in 2008-09 and 95 PHCs in 2009-10 for providing 24 hours delivery services. Total upgraded 196.
– In each 24x7 PHC, 1 Medical Officer (Female) and 3 Staff Nurses on contract basis are being provided.
– Out of 196 Medical Officer (F), 86 posts have been filled up leaving 110 posts vacant.
– 403 Staff Nurses are in position (Target - 588).
– Generator set provided at 75 PHCs and for remaining 26 the process is on.
– Labour room etc. constructed.
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ACHIEVMENTS - PART AMATERNAL HEALTH (Contd..)
(2) Up-gradation of 114 CHCs to FRUs
– 50 CHCs in 2007-08, 10 in 2008-09 and 52 in 2009-10 upgraded to First Referral Units (FRUs). Facility for a complicated delivery including blood transfusion.
– 1 Gynecologist, 1 Pediatrician and 5 Staff Nurses to be appointed.
– So far 21 Gynecologist, 24 Pediatricians have been appointed. Anesthetists on call in all the FRUs.
– 347 Nurses are in position (Target – 560).
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ACHIEVMENTS - PART AMATERNAL HEALTH (Contd..)
(3)
• Signages for these 101 and 60 institutions developed. Order given.
• On line monitoring of performance of these institutions through PEC, work given.
• Biometric based on-line attendance system for these institutions.
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ACHIEVMENTS - PART AMATERNAL HEALTH (Contd..)
(4) Recruitment of ANMs :
– 486 ANMs recruited in December 2008 to fill up all the vacant post of ANMs in the Sub-Centers (2858) under Central Government Scheme 2211.
– 1161 ANMs recruited in December 2008 as 2nd ANM for the Sub-Centers having population of 6000 or more.
– All these ANMs have been recruited district wise and there is no provision for their transfer. They can never be transferred outside the district.
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ACHIEVMENTS - PART AMATERNAL HEALTH (Contd..)
(5) Village Health and Nutrition Day :
– PIP 2008-09 : Rs. 1.10 crore
– The amount has been released and a sum of Rs.7.71 lac has been utilized.
– Work started late in 2008-09 and would be systematized in 2009-10.
(6) Abolition of user fee for delivery related work in Govt. Hospitals (Rs. 300/900)
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ACHIEVMENTS - PART AMATERNAL HEALTH (Contd..)
(7) Promotion of Breast feeding : Rs. 25 lakh initiative through Breast Feeding Promotion Network of India (BPNI) in two districts – GDS and FZR for promotion of Breast Feeding. Project includes Training of Middle Level Trainers and the front line workers on breast feeding, complementary feeding and HIV counseling through Breast Feeding Promotion Network of India (BPNI). 16,000 (ASHAs & ANMs) to be trained as Front Line Workers.
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ACHIEVMENTS - PART A
ASHA
• One ASHA to cover 1000 population. No pay but incentives based on performance.
• Important incentives – Rs. 50/- to 200/- for delivery, Immunization, family planning, RNTCP, Blindness Control, Toilet Promotion, Registration of Births and Deaths, Intimation regarding death of mother and infant etc.
• 17279 ASHA selected in the State, 163 yet to be selected.• ASHA training for Module-1 completed• In the FY 08/09, Rs. 301 lakh was disbursed to ASHAs for
various incentives • In the FY 09/10 upto June 2009 – Rs.197.46 lakh. have been
spent for ASHA.• In the FY 09/10 upto June 2009 – Rs. 105.83 lakh was distributed
to ASHA for various incentives.
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ACHIEVMENTS - PART AASHA
• Provision of Rs. 4.49 crore for training of ASHAs in the PIP 2009-10.
In the FY 2008-09
• Training at the State level for district trainers of ASHA completed in July 2008.
• Training at the District level for Block level trainers completed in August, 2008.
• Master Trainers of ASHA include members of different departments like Education, Social Security, Women and Child Development, Rural Development.
• Mother NGOs are also trained as Master trainers of ASHA at State and District level.
• Training at the Block level for ASHAs has been conducted and 15203 ASHAs trained.
• ASHA Module has been translated in Regional Punjabi language.
• Training of ASHAs at Block level planned through credible and capable health NGOs in 4 districts.
• ASHA Drug Kit has been procured and distributed to ASHAs after the training of ASHAs at Block level.
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ACHIEVMENTS – PART AMATERNAL HEALTH (Contd…)
SNName of the Institution
Regular
NRHMNo
Gynae/FMO
Inst. Upgraded upto 2008-09
Inst. Upgraded upto 2009-10
1DH – Gynae
36 10 1
2SDH – Gynae
33 - - 6
3 CHC – Gynae 69 12 9 33
4 24 x 7 PHC – FMO 3 50 36 108
5 Non Sanctioned Posts 11
6Gynae administrative post
27
TOTAL
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(8) Posting Position of Gynecologists/ Female Medical Officer
ACHIEVMENTS - PART AMATERNAL HEALTH (Contd..)
(9) Institutional Deliveries in Govt. Institutions: 2008-09
SN Institute/ CategoryInstitutional
Deliveries 2008-09
Institutional Deliveries
2007-08
Difference In No. of
Deliveries
%age Increase over
2007-08
1 DH 22209 19991 2218 11.09
2 SDH 14270 13100 1170 8.93
3(a) CHCs(PHSC) 13535 8248 5287 64.1
(b) CHCs(DHS) 874 281 593 211.03
4 CHCs as FRUs 8928 4693 4235 90.24
5 24x7 PHCs 6752 1090 5662 519.45
6 STATE TOTAL 66451 44451 22000 49.49
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INSTITUTIONAL DELIVERIES IN GOVT. APRIL – JULY 09:
SN Institute/ CategoryInstitutional
Deliveries 2009-10Institutional
Deliveries 2008-09%age Increase over
2008-09
1 DH 7301 5996 21.76
2 SDH 4945 3756 31.6
Sub total (Urban) 12246 9752 25.57
3(a) CHCs(PHSC) 6229 3275 90.2
(b) CHCs(DHS) 383 225 70.22
4 CHCs as FRUs 3999 2213 80.70
5 PHCs 3358 1798 66.76
(a) 24x7 PHCs 3532 1638 115.63
6Satellite Hosp+RH+Others
213 169 36.03
Sub total (Rural) 17714 9318 90.10
7Medical Colleges+ ESI Hosp+ other allied Inst
1931 1731 11.55
8 STATE TOTAL 31891 20801 53.31
DELIVERIES – RURAL/URBAN
2007-08 2008-09 2009-10 (Upto July)
Rural Area Institutions 10065 23511 10371
% age increase 133.59
Urban Area Institutions 34420 43019 14177
% age increase 24.98
TOTAL 44485 66530 24548
% age increase 49.56 43.53
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TREND- MONTH WISE INSTITUTIONAL DELIVERIES IN GOVT. INSTITUTES (2007-08 , 2008-09 & 2009-10)
JANANI SURAKSHA YOJANA
Estimated Number of Cases :Estimated number of deliveries in a year in the State of Punjab =
5,00,000
Estimated number of deliveries of BPL/SC/ST @ 35% = 1,75,000
Estimated number of Beneficiaries upto 2 living Children @ 50% = 87,500
Financial Assistance : Home Delivery - Rs. 500
Institutional Delivery - Rs. 600/ 700 for Urban and Rural women
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ACHIEVMENTS - PART AJANANI SURAKSHA YOJANA (Contd..)
Year Number of Beneficiaries Expenditure(Rs. In Lakhs)
For Home/ Non
Institutional Delivery
For Institutional
Delivery
Total
2005-06 (Full) 7489 4106 11595 70.99
2006-07 (Full) 9466 6613 16079 88.69
2007-08 (Full) 16453 12823 29256 170.90
2008-09 40350 27561 67911 383.92
2009-10 Upto July 15109 8886 23995
Yearly Progress JSY :
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ACHIEVMENTS - PART APNDT & SEX RATIO
• Sex Ratio in the age group 0-6 was 798 as per 2001 census. As per latest SRS data it has increased from 796 in 2001 to 838 (0-4 age group) in 2006.
• A campaign has been launched to strictly enforce the provisions of PNDT Act-1994. There are 1356 Ultrasound Centres in the State.
• Action taken so far :– The licenses of 305 Centres were suspended or cancelled. 99 Court Cases/FIRs launched in the
State for violation of the act.
– 10 persons have been convicted for violation of PNDT Act and have been awarded fine/imprisonment varying from 3 months to 3 years.
– 11 Panchayats awarded Rs. 3 lac each during year 2006-07.
• Incentives in force:– Awards to Panchayats having > 1000 population.
– Awards to decoy patients (Rs. 10,000/-).
– Awards to Informers (Rs. 25,000/-)
– Awards for sting operations (Rs. 50,000/-)
• Fresh Sex Survey : Contract for survey of sex ratio for 25% population awarded in October 2008 to an agency, report expected by first week of March 2009.
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ACHIEVMENTS - PART APNDT & SEX RATIO (Contd..)
Other Schemes for female child :
• Balri Rakshak Yojna (Health Department)• Kanya Jagriti Jyoti Scheme (Woman and Child)• Mahila Jagriti YojnaMahila Jagriti Yojna and Swayamsidhaand Swayamsidha
• Kishori Shakti YojanaKishori Shakti Yojana (Woman and Child)
• Dhan Lakshmi (GoI)
• Nanhi Chhan
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ACHIEVMENTS - PART AINNOVATIONS – SURAKHIT JANEPA YOJANA (PPP)
• Rs. 2 crore provided in PIP 2008-09 for private health institutions for deliveries in BPL/ SC families.
• Rs. 4100 per delivery provided in the original guidelines.
• We have now vide letter dated 11/2/2009 revised the rates to Rs. 1700 per delivery and authorized the District Health Societies to empanel private health institutions.
• The scheme would be implemented till 30/10/2009.
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ACHIEVMENTS - PART ANGOs
• A sum of Rs. 2.42 crore has been provided for NGOs in the PIP of 2008-09. • MNGO/ FNGO scheme was launched in 6 districts – Ropar, SAS Nagar, Patiala,
Nawanshehar, Fatehgarh Sahib and Ferozepur during 2007-08 and their second installment of Rs. 15 lac per district has been released to 3 MNGOs in 6 districts.
• MNGO/ FNGO scheme has been extended to 8 more districts in the current year 2008-09. Applications were invited and 8 MNGOs have been selected. These MNGOs has been given grant-in-aid of Rs. 15.00 lakh per district.
• For the remaining 6 districts applications have been invited and field appraisals conducted at district level. The 5 MNGOs has been recommended by State NGO Committee for final approval of GOI.
• Service NGOs : The 2 Service NGOs for Ludhiana and Amritsar have been given Rs. 15 lac each. SNGOs for 2 districts Bathinda and Gurdaspur State NGO Committee has recommended for approval of GOI.
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2008-09 2009-10Planned Conducted Achievement Expenditure Planned Conducted Achievement Expenditure
20 Types
Employees (7574)
100%
(5540)
60-100%
(73.14%)
1.30 cr 20 Types
Employees
All Started 70-95% 22.8 lacs
Strengthening of Training Centres – State of the art equipments supplied to all Training Centres
Strengthening of Training Centres – 1.80 Crores earmarked for repair/ renovation and upgradation – Work being done by PHSC, Mohali
ACHIEVMENTS - PART ATRAINING
ACHIEVMENTS - PART AHMIS – MONITORING AND EVALUATION
• NHSRC – HMIS: Data from April 2008 onward is being uploaded on the HMIS portal as desired by GoI.
• Data Block wise from November 2008 uploaded at district level. SAs from Blocks come to the district headquarter to upload the data.
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ACHIEVMENTS - PART ACIVIL REGISTRATION SYSTEM
• Birth and death registration – As per the latest data the registration in the State is nearly 95%.
• There is a provision of Rs. 0.40 crore in the PIP 2008-09 and of Rs.0.79 Crore in the PIP 2009-10 for computerization of Civil Registration System (CRS).
• EoIs for digitization and computerization of CRS were invited in January 2009 and WIPRO is taking up two districts under e-governance project. State may allot the work of CRS to WIPRO for remaining districts on successful completion model of two districts.
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ACHIEVMENTS - PART ABCC
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UNDER THE BCC/IEC COMPONENT OF NRHM PUNJAB, THE FOLLOWING ACTIVITIES HAVE BEEN EXECUTED
Funds at a glance -2008-09
Total budget : Rs. 291.76 Lacs
Total expenditure till 31-3-2009 : Rs. 254. Lacs
Utilization of Funds 100%
Funds at a glance -2009-10
Total budget : Rs. 367.82 Lacs
Total expenditure till 30.07-2009 : Rs. 47.97 Lacs
TRANSLATION AND PRINTING
• NRHM material was translated and prepared.• Detailed guidelines were circulated to
– Sarpanches,
– ASHA,
– ANM,
– SMOs,
– Gynecologists and others involved.
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PART B- NRHM ADDITIONALITIES
Rs. In lakhs
SN Sub Components 2008-09 2009-10
B NRHM Additionalties Allocation Expenditure AllocationExpenditure
upto July 2009
aVillage Health & Sanitation Committees
1230.00 1824.44 1273.80 197.16
b ASHA - proposed under RCH II 0 449.00 213.55
c SC Untied Fund & Maintenance 286.20 301.94 285.80 4.29
dPHC Untied Fund & Maintenance
121.00 108.78 99.00 4.02
eCHC Untied Fund & Maintenance
64.00 54.01 63.00 31.58
f Annual Maintenance Grant 162.00 199.25 454.00 22.61
g Mobile Medical/ Health Units 397.40 859.75 360.00 65.25
h Upgradation of CHC 1091.80 625.53 811.40 793.41
I Upgradation of PHC 821.43 850.00 658.62 33.92
j Upgradation of SC 725.38 145.79 1551.88 275.84
SN Sub Components 2008-09 2009-10
B NRHM Additionalties Allocation Expenditure AllocationExpenditure (Upto
July 2009)
k Upgradation of SHC 600.00 96.00 0.00 21.45
l Upgradation on SDH/ FRUs 100.00 0.00 488.00 0.00
m Upgradation of DH 370.00 143.88 689.50 52.71
n School Health 500.00 174.53 200.00 77.36
o Strengthening of Programme Management 476.56 150.79 254.88 57.36
p Strenthning of Logistics Management 50.00 0.00 0.00 0.00
q Rogi Kalyan Samitiis 12.33 0.00 648.15 0.00
r Emergency Response Services 937.50 0.00 2561.00 0.00
s Mobile Phones for ANMs 134.00 0.00 24.70 0.00
t District Action Plan 0.00 42.08 0.00 0.00
Major Civil Works for FRUs 200.00 0.00
Other Activities 226.47 0.00
u SHC under Rural Development Board 0.00 638.60 0.00 0.00
v Health Mela 0.00 2.86 0.00 3.31
w Panchayati Raj Initiative 10.60
Total B 8079.60 6218.23 11299.20 1864.42
Rs. in lacs
PART B- NRHM ADDITIONALITIES (Contd..)
ACHIEVMENTS - PART B
VILLAGE HEALTH AND SANITATION COMMITTEES (VHSC)
• 12592 VHSCs constituted upto 30/6/09. Almost Complete.
• Untied Grant of Rs. 10,000 each for 2007-08, 2008-09 and 2009-10 released and deposited in the bank account.
• So far, a sum of Rs. 19.16 crore has been spent out Rs. 38 Crore.
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ACHIEVMENTS - PART BMOBILE MEDICAL UNIT (MMUs)
• 24 MMUs deployed in districts. 4 districts Faridkot, Bathinda, Mansa and Barnala have one additional MMU.
• Cost of each MMU Rs. 36.00 lacs. Full Bus chassis used for MMUs. Has the facility of ECG, X-Ray and Lab.
• 1 MO(F), 1 MO(M), 1 Radiographer, 1 Lab Technician, 1 Staff Nurse, 1 Pharmacist (Regular) and 1 Driver and 1 Helper provided.
• 13 MO(F) and 21 MO(M) recruited.
• Instruction issued for free treatment and medicine (Rs. 7500 per month) issued.
• The works of MMUs is monitored through GPS Tracking System.
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ACHIEVMENTS - PART BUNTIED FUNDS AND MAINTENACNE GRANT
Component Amount/Scope 2007-08 2008-09 2009-10 Remarks
Untied Funds
Rs. 10,000 2858 SCs 2858 SCs 2947 SCs Funds Released
Rs. 25,000 484 PHCs 484 PHCs 396 PHCs Funds Released
Rs. 50,000 Nil 128 CHCs 126 CHCs Funds Released
Annual Maintenance
Grant
Rs. 50,000 484 PHCs 100 PHCs 396 PHCs Funds Released
Rs. 1 Lac Nil 112 CHCs 112 CHCs Funds Released
Rogi Kalyan Samitis
Rs.5 Lac 20 DHs Nil 20 DHs Funds Released
1 Lac 36 SDHs Nil 36 SDHs Funds Released
1 Lac 110 CHCs Nil 114 CHCs Funds Released
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ACHIEVMENTS - PART BUPGRADATION OF HEALTH INSTITUTIONS
(1) Sub-Centres : Rs. 7.25 crore PIP 2008-09 and Rs.15.51 Crore PIP 2009-10.
– 954 Second ANMs for the Sub-Centres having more than 6000
population. Pay of these second ANMs is booked here.
Sub-Centres New Construction Renovation
FY 08/09 50 77
FY 09/10 60 150
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ACHIEVMENTS - PART BUPGRADATION OF HEALTH INSTITUTIONS (Contd..)
(2) Up-gradation of CHCs : 128 CHCs at a cost of Rs. 20 lakh per CHC during 2005-06 to 2008-09. Work almost completed.
(3) Upgradation of SDH: Proposed 25 SDHs @ Rs. 10 lakh per SDH during 2009-10.
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ACHIEVMENTS - PART BUPGRADATION OF HEALTH INSTITUTIONS (Contd…)
(4) Upgradation of other Institutions: -
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Category Amount required
Provided in 2008-09
Provided in 2009-10
New PHC -Adampur and Ghuda 2.70 Cr. 2.70 Cr.
New CHC – Zirakpur 3.00 Cr. 1.00 Cr. 2.00 Cr.
New RH – Morinda 2.00 Cr. 2.00 Cr.
Upgradation of SDH - Batala, Patti and Pathankot.
7.15 Cr. 1.00 + 5.50 Cr.
DH- Mohali, Patiala, Gurdaspur, Ludhiana and Bathinda
17.00 Cr. 3.70 Cr. 1.40 + 5.00 Cr. (ACA, FTGH)
DH- Faridkot and Sangrur 2.00 Cr. 2.00 Cr.
ACHIEVMENTS - PART BDRUGS AND EQUIPMENTS
(1) Drugs (Rs. in lacs)
– PIP provision : 2007-08 2008-09 2009-10
PHC 1662 484 97
CHC 90 360 290
SDH - - 108
DH - - 200
– Procured for Rs. 17.68 crore from the CPSUs for PHCs and Sub-Centres.
– For CHCs – funds being transferred to PHSC for purchase of medicines. Tenders received and under process.
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ACHIEVMENTS - PART BDRUGS AND EQUIPMENTS (Contd..)
(2) Equipments (Rs. in lacs)
– PIP provision : 2008-09 2009-10
PHC 130.46 97
CHC 621.32 200
DH - 100
– The requirement has been finalized by PHSC and
tenders were floated and received by PHSC.
– Orders are being placed.
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ACHIEVMENTS - PART BSCHOOL HEALTH
• Out of 22706 schools which were to be covered in 2008-09, 20001 schools (89%) have been covered by Government Doctors.
• 32,64,926 of students are in Primary and Secondary level schools, 2697739 examined in 2008-09 and 266064 examined till 30/6/09
• School Health Cards have been got printed by Education Department (upto class 8th ) and NRHM for Secondary/ Senior Secondary Schools.
• IFA and Albendazole Tablets, Scabies Lotion distributed to School Children.
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ACHIEVMENTS - PART BSCHOOL HEALTH (Contd..)
Free Treatment for CHD and Cancer • Decision taken on 4/11/2008 for free treatment of students (up-to
+2 level) studying in Govt. & Govt. aided schools suffering from
Congenital Heart Disease (CHD) and Rheumatic Heart Disease
(RHD) in PGI Chandigarh. Their treatment would cost about Rs.
50,000 to 1,25,000. So far 72 students have been treated at PGI.
• 7 Students suffering from Cancer referred to PGI for treatment.
• Referral treatment of students in Govt. Hospitals made free w.e.f.
July 2009.
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ACHIEVMENTS - PART BEMERGENCY MEDICAL RESPONSE SYSTEM
PIP Provision – Rs. 9.37 crore in 2008-09 • Tenders invited and work awarded to EMRI Hyderabad on 30/12/2008 for
90 ambulances and the control facility.
• The matter was kept on hold due to SATYAM Episode.
• Rs. 25.61 Crore in 2009-10. GOI has now allowed
Capital Cost from NRHM
Recurring Cost - GOI State
1st year 60%40%
2nd year 40%60% 3rd year 20%80% 4th year 0%100%
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ERS contd
Punjab
Phase No of Ambulance Capital Cost Recurring Cost
Phase I 90 990 Lakh 1782 Lakh
Phase II 150 1650 Lakh 2970 Lakh
Total 240 2640 Lakh 4752 Lakh
ACHIEVMENTS - PART BMOBILE PHONES FOR ANMs
• PIP Provision - Rs. 1.34 crore in 2008-09 and Rs. 0.23 crore in 2009-10.
• Bids have been received and the work is being allotted.
• NSHRC has designed mobile based application for monitoring the performance of ANMs. It would be operationalized.
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Activity Monthly Target Achievement Gain/ Loss %
2007-08 2008-09 2009-10 2007-08 2008-09 Upto 30/06/09
Fully immunized
39358 38751 38625 379983 362312 97884 -3
BCG 39358 38751 38625 423539 386171 97884 -14.6
DPT 39358 38751 38625 410939 330907 115789 16.6
OPV-3 39358 38751 38625 440939 346783 115954 12.9
Measles 39358 38751 38625 379983 362312 106768 2.3
Hep. B 39358 38751 38625 36383 271634 108223 38.2
TT-2 (PW) 45335 44588 44450 388211 364220 114375 3.2
ACHIEVMENTS - PART C
IMMUNIZATION
TOP
• Expenditure in 2008-09 was Rs. 4.23 Cr. against the allocation of Rs. 12.34 Cr. Allocation during 2009-10 is Rs. 10.09 Cr.
• As per NFHS-III (2006), the immunization coverage was 60% whereas as per DLHS-III (2008), it was 80%.
ACHIEVMENTS - PART CIMMUNIZATION Contd..
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SN Sub ComponentsAllocation Expenditure Allocation Expenditure
Up to July 09
2008-09 2009-10
a RNTCP (T.B.) 522.16 439.04 616.30 77.83
b Leprosy 0.76 105.17 130.30 9.44
c IDSP 79.91 95.91 142.45 0
d
National Iodine Deficiency Disorder Control Programme. - NIDDCP
20.00 0.00 20.00 0
e Malaria & Vector Borne 212.36* 32.25 107.35 3.06
f Blindness Control 637.50 81.46 350.00 10.87
Total D 1366.40 101.20
PART D- NATIONAL DISEASE CONTROL PROGRAMME
Rs. In lakhs
TOP* Includes in-kind grant of Rs. 148.00 lakh.
ACHIEVMENTS - PART DRNTCP (Contd..)
Year wise RNTCP Performance of Punjab
Year Suspects examined per
Lac per quarter
(150/lac/qtr)
Total TB cases put on DOTs
Annualized total case detection
rate(180-257)
Annualized new smear positive case detection
rate 67- 95(70%)
3 month conversion
rate of NSP
patients (>90%)
Cure rate of NSP
patients (>85%)
Success rate of NSP
patients(85%)
2005 140 30764 118 46 (48%) 81% 81% 84%
2006 149 34538 133 52 (55%) 87% 84% 86%
2007(National)
2007(Punjab)
143
146
1475587
35875
130
136
52(55%)
53 (56%)
89%
88%
84%
83%
86%
85%
2008 154 38456 143 58 (61%) 84% 80% 83%
2009 165 69 90% 85% 73%
National Leprosy Eradication Program
Punjab is a low endemic state.
During 2008-09, new leprosy cases detected and brought under
treatment were 933.
Out of 933, the 180 patients are Punjabi cases.
Total No. of Cases detected during the year 2007-08 were 964.
Out of 964, the 196 patients are Punjabi cases.
Prevalence Rate comes to 0.32 per 10000 population.
State achieved the goal elimination set by Govt. of India i.e. less than 1
case/10000.
Prevalence of Blindness in the State is 9.5 per 1000 Population as compared to
11.2 of all India .
Estimated No. of cases (incidence) of blindness per year in Punjab= 49072
Estimated No. of cases (incidence) of blindness per year in India = 2132048.
The cataract surgical coverage is 105% in the year 2007-08 and 94.8% in the year
2008-09.
To encourage eye donations ,camps are organized from 25 August to 08-
September .
NATIONAL PROGRAMME FOR CONTROL OF BLINDNESS
NATIONAL PROGRAMME FOR CONTROL OF BLINDNESS Contd..
Cataract Operations
ACHIEVEMENTS
Year Cataract Operation IOL Implantation
Target Performance % Cataract
Target Performance % IOL
2007-08 1,60,000 1,67,256 105.0 1,60,000 1,52,353 95
2008-09 1,80,000 1,70,572 94.8 1,62,000 1,60,878 99.3
2009-10(Upto July)
60,000 (Prop)
38,360 63.0 54,000 35,175 65.1
NATIONAL PROGRAMME FOR CONTROL OF BLINDNESS Contd..
School Eye Screening Programme, Eye Donation and Teacher Trained:- ACHIEVEMENTS Contd..
Particulars Target for the year 2008-09
Performance Target for the year 2009-10
Performance
2008-09 % Age 2008-09
2009-10 % Age 2009-10
School Children Screened by DBCS
2,38,095 4,69,055 197.0 116667 152170 130.00
School Children Detected with Refractive errors
16,667 35,876 215.3 7000 8810 136.00
No. of Free Spectacles given to Children
5,000 5924 118.5 2100 2427
Eye Donation 600 247 41.2 267 89
Teacher Trained 4,000 2580 65 1333 2805 210.00
1. Infrastructure Development
• Launched in the State in Phase-3 on 12th June, 2007.
• State Surveillance Officer, District Surveillance Officers in all districts nominated.
• State Surveillance Unit and District Surveillance Units established.
• IT networking through broadband, EDUSAT system at SSU , 3 Govt. Medical Colleges and all districts.
• MoU signed with five Private Medical Colleges and private practitioners in the districts.
2. Lab. Upgradation
• Up gradation of State Public Health Lab. at CH Mohali, District Labs in all the Civil Hosp. and provision of heavy metal testing in drinking water under Water Quality component, supplied equipment and reagents.( Approx 24 lacs)
• 20 CHCs (1 in each Distt.) selected for up gradation. ( Approx 4 lacs)
ACHIEVMENTS - PART D INTEGRATED DISEASE SURVEILLANCE PROJECT (IDSP)
TOP
In Punjab, Dengue and Malaria are of main public concern. Although three random cases of Japanese Encephalitis have been reported in the State in 2008. No case of Chikungunya, Kala Azar and Filaria have been reported in the State.
In the year 2009-10 only 4 cases of PF Malaria has been detected.
ACHIEVMENTS - PART D NATIONAL VECTOR BORNE DISEASE CONTROL PROGRAMME.)
TOP
Year Disease Confirmed cases Death
April 2008 to March 2009
Upto June 2009
Dengue 4349
Nil
21
Nil
April 2008 to March 2009
Upto June 2009
Malaria 2494
637
Nil
• Six Apheresis machines have been procured.
• 7 districts of the Punjab State have Blood Cell Separator units.
• 10 Blood Cell Separator Units procured.
• Apart from above, effective steps shall be undertaken to further strengthen the surveillance to lower the number of Malaria cases. A strict watch shall be kept on Japanese Encephalitis during the year 2009-2010.
ACHIEVMENTS - PART D NATIONAL VECTOR BORNE DISEASE CONTROL PROGRAMME (Contd..)
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SN Sub ComponentsAllocation Expenditure Allocation
Expenditure (upto July 09)
2008-09 2009-100020002009-10
a
Convergence with AYUSH (Pay of AMOs)
424.80 77.90 715.00 155.17
bCo ordination & Orientation with PRIs
75.15 40.00 0
cSpecial innovation for Minorities
33.45 0.00 0 0
Total E 533.40 117.90 0 155.17
PART E- INTERSECTORAL CONVERGENCE
Rs. In lakhs
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PART-II OF NRHM (CSS-2211)
• The salary of ANMs deputated in 2950 Sub-Centres is paid by GoI under 100% GoI
Scheme.
• A sum of Rs. 59.32 Cr. was utilized against the allocation of Rs. 59.34 Cr. in 2008-09.
• Allocation in 2009-10 is Rs. 59.12 Cr.
PART ECONVERGENCE WITH AYUSH
• Against 121 AMOs, 108 MOs have been appointed in November 2008.
• Against 112 HMOs, 94 HMOs have been appointed in January 2009.
• In 2009-10 in 121 Dispensers are to be appointed.
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PART ECOORDINATION WITH PRIs (Rural Development Department)
• In the FY 08/09 Rs. 40 lac for coordination and orientation with PRIs.
• Guidelines being got printed in Punjabi and circulated to all Gram Panchayats.
• State Institute of Rural Development has organised training and orientation of Gram Panchayats. Approximately 15,000 representatives of VHSCs, Block/PHCs Monitoring and Planning Committee given training for NRHM.
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• Joint BCC campaigns by health and PHED department on sanitation and toilet
use.
• ASHA, AWW and ANM oriented to communicate with the community on
sanitation and toilet use. Incentive of Rs. 50/- per toilet given to ASHA.
• Improve sanitation and toilet facilities in all schools and promote use of toilet
and clean water in all schools through a joint campaign.
• Coordination meeting between WSS and health department through the District
and State Health Missions. The head of the WSS in both district and state
headquarters to be invited to participate in the meetings of the NRHM.
PART ECONVERGENCE – WATER SUPPLY AND SANITATION
PART EDRINKING WATER SUPPLY
• Out of 11623 villages, a total of 5724 habitations (2241 NC and 3483 PC) are yet to be covered. These will be covered by 2012.
• For Rural Areas, there are various schemes – Accelerated Rural Water Supply Scheme (Rs. 120 crore), NABARD (Rs. 120 crore), World Bank (Rs. 150 crore), Rajiv Gandhi National Drinking Water Mission (Rs. 28 crore), RO Process (Rs. 19.61 crore) for clean drinking water.
• Out of 327 villages RO system commissioned in 107 villages, and will be commissioned in 140 villages as soon as electricity connection is installed and remaining in process
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PART ESANITATION
• Sewerage works will be executed in urban areas under JNNURM and JBIC Projects.
• Rs. 100 Cr. provided for rural toilets during 2009-10.
• Under Total Sanitation Programme of GoI, a sum of Rs. 70 has been
sanctioned for providing toilets in schools, Aanganwadi Centers,
Community toilets and individual toilets.
• Under World Bank Project, there is a provision for laying underground
sewer in 100 villages and cleaning of village ponds in 1000 villages.
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PART ESANITATION
Nirmal Gram Puruskar
Under TSC Nirmal Gram Puruskar is awarded by the GOI to the Villages where people are not going for toilet in open places.
• 22 Villages awarded with Nirmal Gram Puruskar in 2008-09.
• Target to cover 251 more villages in 2009-10.
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PART ECONVERGENCE WITH EDUCATION DEPARTMENT
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• School Health programme to provide health check up to all school going children.
• Special campaign for treatment of Rheumatic Heart Disease and Congenital Heart Disease among School going children.
• Orient secondary school teachers on the Adolescent issues and availability of health services in the public health facilities.
• Undertake a joint campaign with the Education Department on the ill-effects of habit forming practices.
• Encourage Education Department to promote co-production of health by students through practices such as Yoga and physical exercises.
• Use the opportunity of NSS camps in colleges to involve youth on health issues. Orientation of youth done during the camps and they could be encouraged to undertake campaign on behalf of the health department.
• IEC campaign through school children i.e. awareness generation rallies, poster competitions, wall painting by children.
PART ESCHOOL – WATER & TOILETS
• A campaign was launched to provide toilets and drinking water to all schools during 2008-09.
• As of now 195 schools are without toilets and 18 schools without drinking water. These would be covered in three months.
• The number of toilets are inadequate as per the student strength in some of the schools. A total of 5089 schools do not have adequate number of toilets. These would be covered in the current year.
• Funds to the extent Rs. 20000.00 per school for Girls toilet and Rs 20000.00 for Boys toilets provided from Total Sanitation Campaign (TSC)
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• Observe VHND strengthen fixed health and nutrition day at village level. ASHA to mobilize women and children for the fixed health and nutrition day.
• AWW to be a part of the Village Health and Sanitation Committees and inform the VHSC about the activities of the ICDS.
• AWW to facilitate referral of women to appropriate health facilities for institutional deliveries, RTI/STI, MTP, violence and any other gynaecological and other morbidity
• AWW and ASHA to counsel the adolescent girls on the provision of adolescent health in various health facilities. AWW and ASHA to be informed of the provision.
• A joint strategy meeting on BCC is done at the state and district level to evolve common communication strategy between the two departments and ensure convergence.
• AWW along with ASHA to participate in routine immunization and in special campaigns like pulse polio and mobile community.
ACHIEVMENTS - PART E Convergence with DWCD
ACHIEVMENTS - PART E NUTRITION
• Under ICDS Programme (50:50) the State Government will be spending Rs. 100 crore in 2009-10.
• Under Kishori Shakti YoMarcha (Nutrition for
adolescent girls) will spent Rs. 5.00 crore through Woman
and Child Development.57921 beneficiaries
• Under these ICDS programmes a total of 13.86 lakh
children and mothers were provided nutrition.
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SYSTEMATIC CHANGES 2008-09
(1) District wise recruitment of ANMs and Nurses – There was a practice in the state to depute these employees at the places
other than the places from which they were drawing their pay. This practice has been completely stopped and now these employees have been recruited in the NRHM district wise.
There is no provision what so ever for transfer of these employees from one district to the other district.
The deputation of existing employees have been cancelled and the ANMs have been sent to their proper places of posting.
(2) Increase in the pay of Gynecologists and Medical Officer (F) recruited under NRHM – The existing pay of these employees under NRHM was increased by Rs. 5000/- to as under in 2008-09:Gynecologists : Rs. 30000+IncentivesPediatricians : Rs. 30000+IncentivesMO (F) : Rs. 25000+Incentives
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(3) Special Incentive for Remote Areas - A special incentive of Rs. 5000/10000/- and Rs. 10000/15000/- provided in the annual plan of 2009-10 for MO(F) and Gyne. working in remote and extreme remote PHC and CHCs. These are being identified.
SYSTEMATIC CHANGES 2008-09 Contd…
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(4) Medical Officers under NRHM in PHCs – Large number of PHCs were without any medical doctor and this problem was more acute in the southern of the state. The state government accordingly in the month of December gave an advertisement for filling up 97 posts of MOs in PHCs which were without any doctor in the 10 southern districts. We have been able to fill up 59 posts for these PHCs.
(5) Rationalization of postings and transfers –There was an acute shortage of doctors in PHCs and CHCs. Part of this shortage was on account of irrational deployment of the doctors specially the specialists who were deputed in excess of the resistance at CHCs/PHCs/DH/SDH. The Department in July 2008 carried out a comprehensive exercise to remove the excess staff to vacant places. As on date only 40 CHCs are without Gynecologists.
SYSTEMATIC CHANGES 2008-09 Contd…
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(6) Recruitment on regular basis –
(a) Medical Officers – The State Government has appointed 100 MOs through PPSC.
- The Government has approved recruitment of another 212 MOs through PPSC.
(b) Specialists – 2 rounds of recruitment were carried out to appoint 165 MO (specialists) i.e. MD/MS in the department. 53 specialists doctors have already been issued appointment letters in March 2009. Remaining posts are being filled up.
SYSTEMATIC CHANGES 2008-09 Contd…
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(c ) Regular recruitments - The State Government has also decided that recruitment of doctors would be carried out every year to fill up the vacancies arising from retirement, selection in medical colleges and resignations.
(7) Tele-medicine- Government Medical Colleges and all the 20 District Hospitals have been linked to PGIMER to receive specialized services through tele-medicine. Necessary equipment and connectivity have been provided.
SYSTEMATIC CHANGES 2008-09 Contd…
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(8) Super-Specialty Cancer Hospitals- The incidence of Cancer in Punjab has increased in recent years. The State Government got a study conducted from the Department of Community Medicine, PGI, Chandigarh and they reported that the increased incidence was due to increased use of pesticides especially in the cotton growing districts.
The State Government decided to set up two Super-Specialty Cancer Hospitals in Public- Private- Partnership –
-Super-Specialty Cancer and Cardiac Hospital, Bathinda-Super-Specialty Cancer and Trauma Hospital, Mohali
Land has been earmarked in the existing hospitals for the private parties. Bids have been invited and work has been allotted to Max Healthcare Institute Limited against upfront fee of Rs. 1.58 crore of Bathinda and Rs. 4.73 crore for Mohali and 5% revenue share at both the places. The party would commission the hospitals within 2 years i.e. by 31/3/2011.
SYSTEMATIC CHANGES 2008-09 Contd…
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(9) New Hospitals-
(i) Satellite Hospital- State Government secured an Additional Central Assistance of Rs. 10 crore for construction of 4 satellite hospitals in slum basties of Bathinda. The amount was received in February, 2009 and the work has been started.
(ii) Mother and Child Hospital at Fatehgarh Sahib- The State Government secured Rs. 5 crore from the Government of India as Additional Central Assistance for completing the Mother and Child Hospital at Fatehgarh Sahib. These two hospitals are now being given to PIDB for PP project.
SYSTEMATIC CHANGES 2008-09 Contd…
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UNDER MATERNAL HEALTH PROGRAMME
INSTITUTIONAL DELIVERIES – 51 % IN THE STATE, STATE AT NO. 10 IN THE COUNTRY. NO. OF DELIVERIES IN GOVERNMENT HOSPITALS IN 2008-09 (March) IS 53530 AGAINST 37916 IN 2007-08, AN INCREASE OF 15614 (41.81 %). STILL GOVERNMENT HOSPITLAS ACCOUNT FOR ONLY 13 % OF TOTAL BIRTHS IN THE STATE. PLAN TO INCREASE THIS NUMBER.
UNDER NRHM• REFERRAL TRANSPORT @ RS. 200/- FOR BPL/SC/ST . A TOTAL Rs. 90 LAKH
PROPOSED• DURING 09/10 96 MORE PHCs TO BE STRENGTHENED AS 24 x 7 CENTRES. 101 PHCs
ALREADY TAKEN UPTO 2008-09• DURING 09/10 52 MORE CHCs TO BE STRENGTHENED AS FRUs. 60 CHCs ALREADY
TAKEN UPTO 2008-09• PREGNANCY TRACKING AND WORK DONE BY ANMs – WILL PROPOSE A NEW
SCHEME FOR RS. 70 LACS + 140 x 12000 = 87 LACS.• PILOT PROJECT – WILL PROPOSE FOR ON LINE REGISTRATION OF PREGNANCIES.
NEW ACTIVITIES 2009-10
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STATE GOVERNMENT INITIATIVES – • NEW PLAN SCHEME – ASSISTANCE FOR INSTITUTIONAL DELIVERIES TO
BPL/ SC FAMILIES (RS. 10 CRORE) – RS. 1500 PER BIRTH UPTO TWO CHILDREN.
• MONITORING OF WORKS DONE BY GYNAECOLOGISTS – MONTHLY MONITORING AND ISSUANCE OF LETTERS.- REGULAR GYNE : 11, 7, 10 ABOVE AVERAGE, AVERAGE, BELOW AVERAGE- NRHM GYNE : 6, 3, 5 30, 20, < 20- SMC : 47, 25, 85 15, 10, <10 PER MONTH
UNDER CHILD HEALTH PROGRAMME PROMOTION OF EXCLUSIVE BREAST FEEDING THROUGH TRAINING, IEC AND
FOCUSED GROUP DISCUSSIONS. RS. 50.00 LAKH PRPOSED DURING THE FY 09/10
–UNDER ARSH PROGRAMME - –SEVEN MORE DISTRICTS TO BE COVERED IN THE YEAR 09/10 (BARNALA, HOSHIARPUR, MANSA, MOGA, NAWANSHAHAR, ROPAR AND TARN TARAN).
NEW ACTIVITIES 2009-10
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• Multi purpose youth friendly centers in 4 districts – Rs. 2 lakh per district proposed.
• Provision of sanitary napkins through social marketing to adolescent girls
TO ENFORCE PC PNDT
• Award money for sting operation @ rs. 50,000/- per operation
UNDER PPP MODEL
• To outsource 20 PHCs for 24x7 services @ rs. 70,000/- per PHC.TRAINING• 5 more districts added for sba• IMNCI training of LHVs, ANMs, AWWs, school teachers to continue and
completed during this year• IUD insertion training using alternative methodology – 4 selected districts -
initially
NEW ACTIVITIES 2009-10 (Contd..)
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• MEDICAL OFFICER FOR 50 PHCs WITHOUT DOCTORS @ Rs. 25,000 PER MONTH PER MEDICAL OFFICER
• INCENTIVES TO DOCTORS WORKING IN
EXTREMELY REMOTE AREAS
• ENGAGEMENT OF 5 HOSPITAL ADMINISTRATOR
• ONE GYNAECOLOGIST FOR 15 DHs
NEW INITIATIVES -ADDITIONALITIES
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Thank You
PIP 2009-10
Rs. 120.00 LAKH HAS BEEN APPROVED FOR THE FY 09/10 FOR ACTIVITIES UNDER MATERNAL HEALTH
• Early registration of pregnancies and ensuring institutional delivery
• REFERRAL TRANSPORT @ RS. 200/- FOR BPL/SC/ST FAMILIES
• 24 HR DELIVERY SERVICES IN IDENTIFIED PHCs
– During 09/10 96 more PHCs to be strengthened 101 PHCs already taken upto 2008-09
– 20 PHCs to be outsourced for providing 24X7 services
– Human resource and infrastructure strengthening
Contd…
107
MATERNAL HEALTH
MATERNAL HEALTH
24 HR CEmONC SERVICES IN SELECTED CHCs
• During 09/10 52 more CHCs to be strengthened 60 CHCs
already taken upto 2008-09
• Provision of Obstetrician, Paediatrician and 5 S/Ns
• New born care corners in the identified CHCs.
• Blood storage units in the identified CHCs.
Contd…108
JANANI SURAKSHA YOJNA
RS. 490.00 LAKH HAS BEEN APPROVED FOR THE FY 09/10
• Implementation to be as per GOI guidelines • Payments to be through bearer cheques• Incentive of Rs. 200.00 to ASHA
ACCREDITED SOCIAL HEALTH ACTIVIST (ASHA)
RS. 462.70 LAKH HAS BEEN PROPOSED DURING THE FY 09/10
• Total 17285 ASHAs selected . • Trainings and supply of drug kits.• ASHA resource centre as a part of the state resource centre
to be established funds to be utilized from the PIP 08/09 approvals.
MATERNAL HEALTH
109
Rs. 25.30 LAKH HAVE BEEN APPROVED FOR THE FY 09/10
– New programme of integrated management of neonatal and childhood illnesses (IMNCI) in 4 districts (Amritsar, Tarn Taran, Ludhiana and Patiala)- already launched
– Strengthening IMNCI cell at state & 4 districts by providing data recording & analysis support and training facilities.
– IMNCI training for 22 tots, 360 MOs, 76 SNs, 335 LHVs and 967 ANMs, 780 AWW (identified districts) & DIOs of all 20 districts
– Strengthening of immunisation services (details under immunization)
CHILD HEALTH
110
– 25 new born care centres established, 35 are in process at CHC level, total 112 centres are to be established upto 09/10.
– Distribution with training of manual mucus suckers to SBAs
– Promotion of exclusive breast feeding through training, IEC and focused group discussions
– Promotion of deliveries by SBAs by providing trainings and sensitization through IEC activities
CHILD HEALTH
111
Rs. 25.00 LAKH APPROVED FOR THE FY 09/10• State-wide behaviour change effort to promote breastfeeding by
involving all grassroot workers (ANMs/ AWWs/ ASHAs). • At PHC level Medical Officer, staff nurse to be sensitized.• ANMs/Male Health Workers to counsel mothers for breast-
feeding. • Booklets to mothers on exclusive breast-feeding.• Train ASHAs, TBAs, AWWs, ANMs, LHVs, Male Workers to
improve their counselling skills for breast-feeding
• Adequately qualified ASHAs to be trained as breast-feeding counsellor at CHC level
• Supplementary diet in kind to BPL/ SC/ ST mothers for promoting breast-feeding.
BREAST FEEDING SCHEME
112
Rs. 1116.50 LAKH APPROVED FOR THE FY 09/10
– Dissemination of revised manuals on sterilization standards and quality
assurance of sterilization services
– Organizing female sterilization & IUD insertion camps in districts -one
camp per month per block-
– Organizing NSV camps – 40 camps per month in the state
– Printing of sterilization files, printing of cards, insurance manuals and
purchase of computers- continues process
– Compensation package for sterilization / IUD as per GOI guidelines
FAMILY PLANNING
113
Rs. 38.23 LAKH APPROVED FOR THE FY 09/10
– 13 districts covered upto 08/09.
– Seven more districts to be covered in the year 09/10 (Barnala, Hoshiarpur, Mansa, Moga, Nawanshahar, Ropar and Tarn Taran).
– Adolescent Friendly health services through 1057 special clinics (PHCs, CHCs, civil hospitals and selected sub centres) to be provided i.e. management and treatment of anemia, menstrual disorders, tt immunization, nutrition counselling, management & treatment of RTIs/STIs and reducing the incidence of HIV/AIDs
– Printing of ARSH IEC material for dissemination to health care providers & stakeholders
– Printing of guidelines, handouts, facilitator guides for MOs ANMs, LHVs
– Under IEC activities advocacy workshop at state 7 districts & all blocks in the selected districts
– Multi purpose youth friendly centers.
– Provision of sanitary napkins through social marketing to adolescent girls
ARSH
114
Rs.165.60 LAKH APPROVED FOR THE FY 09/10
– Contractual appointment of 230 MPHWs in slum areas of the state to continue
URBAN RCH
115
Rs. 62.80 LAKH APPROVED FOR THE FY 09/10 :
– Orientation programme for programme managers and service providers on PC PNDT
– Organization of seminars, workshops of prominent personalities on the declining sex ratio
– Manpower & operational support for PNDT cell at the state HQ by induction of a lawyer, social scientist,
– Annual analysis of sex – ratio in the state on the basis of institutional deliveries and civil registration data.
– Monitoring of sex ratio at birth through ASHA.
– Award money for sting operation @ Rs. 50,000/- per operation
– Award money for informers @ Rs. 20,000/- & provision for decoy patients- @ Rs. 10,000/- .
– Award to panchayats – Rs. 1.5 lac, 2 best performing panchayats in each district.
PNDT & SEX RATIO
116
Rs. 295.00 LAKH APPROVED FOR THE FY 09/10
•MNGO & NGO (SNGO)
– Preparatory phase to newly selected MNGOs for proposal development.
– 1st instalment of grant in aid for 12 months to 5 MNGOs
– Service NGO scheme
– Preparatory phase to newly selected SNGOs for proposal development (04 SNGOs)
– 1st instalment of grant in aid for 18 months to existing SNGOs
– Promotional activity for seminar/ workshop/ review meeting/ study tours as per need assessment
– To outsource 20 PHCs for 24x7 services @ Rs. 70,000/- per PHC.
INNOVATIONS / PPP / NGO
117
LOGISTICSRs. 13.20 LAKH APPROVED FOR THE FY 09/10
– Development of inventory management system and software development is in process
– POL for transportation of supplies from state up to sub centre level
– Strengthening of warehouse facilities.
INSTITUTIONAL STRENGTHENING
118
Rs. 74.76 lakh APPROVED FOR the FY 09/10
• Strengthening of HMIS system at state level by providing computers & peripherals
• 173 Computer Operators on contract recruited- 2 Programmers 2 Hardware Supervisors, 1 System Analyst on contract to be recruited – 1 Hardware Supervisor already recruited
• Operationalization of new MIES formats
• Internet connectivity upto block level
• Need assessment study on strengthening HMIS.
• Mid term and endline evaluation study through external agencies.
• Establishing CRS, preservation and digitalization of CRS reports
• Printing of new formats, compilation sheets and publication and dissemination of state level reports on various health indicators.
• Training and monitoring by the M & E team.
HMIS
– Quality assurance committees at State, District and Block Level
– Patient Satisfaction Survey is being conducted through private agency
– Training for management of waste
– Training of staff for segregation & treatment of medical waste
QUALITY ASSURANCE
120
• Strengthening & Upgradation of Training Institutes – As per GOI Guidelines
– SIHFW, Mohali; HFWTC, Amritsar
– MPHW (M) Training Centres – Kharar, Nabha
– ANM Training Centres – Hoshiarpur, Nangal, Sangrur, Gurdaspur, Moga, Bathinda
• Strengthening of District Training Centres
• SIHFW/ HFWTC– BCC Skill Building Training for Medical Officers
– BCC Skill Building Training for Paramedicals
– Integrated NRHM Training for Rural Medical Officers
– TOT for IUCD Insertion using Alternative Methodology
– Computer Training for MOs
– Computer Training for Clerical staff
– TOT for RTI/ stI
– TOT for ARSH
– Integrated NRHM Training of ANMs (Contractual under NRHM)
TRAININGS
121
• Districts – Apart from most of the trainings conducted during 2008-09 New Trainings added– 5 more districts added for SBA
– IMNCI Training of LHVs, ANMs, AWWs, School Teachers to continue and completed during this year
– IUD Insertion Training using Alternative Methodology – 4 selected districts - initially
TRAININGS
122
Rs. 367.82 LAKH APPROVED FOR THE FY 09/10– Strategies for Intra Communication designed
– Printing of booklets for adolescents on ARSH issues.
– Implementation of BCC strategy as per GOI guidelines
– Focus group discussions, wall paintings, hoardings, folders, posters, radio/TV coverage,
newspapers adds & folk media for components of maternal health, child health, family
planning, JSY, ARSH, water and sanitation, gender and sex ratio
– Advocacy workshop at state, district & block level on issues of early registration of
pregnancy, ANC and institutional delivery
– Flip book for neonatal care and NSV etc.
– Strengthening of BCC/IEC bureau (state & district level)
– School based activities on sanitation purchase of exhibition stand and digital camera.
– Educational material for life style diseases
BEHAVIOUR CHANGE COMMUNICATION
123
PART-B NRHM ADDITIONALTIES
124
SN ACTIVITY BUDGET APPROVED
(Rs. In Lakhs)
1 VILLAGE HEALTH & SANITATION COMMITTEES 1273.80
2 ASHA 449.00
3 SC UNTIED FUND 285.80
4 PHC UNTIED FUND 99.00
5 CHC UNTIED FUND 63.00
6 ANNUAL MAINTENANCE GRANT(1443 SC, 396 PHC & 112 CHCs
454.00
7 MOBILE MEDICAL/ HEALTH UNITS 360.00
8 UP-GRADATION OF CHC 811.40
9 UP-GRADATION OF PHC 658.62
10 UP-GRADATION OF SC 1551.00
(RS IN LAKHS)
NRHM-ADDITIONALITIES
Contd…125
SN ACTIVITY BUDGET APPROVED(Rs. In Lakhs)
11 UP-GRADATION OF SHC 0.00
12 UP-GRADATION ON SDH/ FRUS 488.00
13 UP-GRADATION OF DH 689.50
14 SCHOOL HEALTH 200.00
15 ROGI KALYAN SAMITIES 648.15
16 STRENGTHENING OF PROG. MANAGEMENT
371.31
17 ADDITIONAL ACTIVITIES(EMRI,CELL PHONE, ZINC SULPHATE)
2617.04
18 CRS 78.70
19 MAJOR CIVIL WORKS 200.00
TOTAL B 11298.32
(RS IN LAKHS)
NRHM-ADDITIONALITIES
126
NRHM Additionalities
Mandatory Provisions
Untied Funds and Annual Maintenance Grant Funds to 12673 VHSCs @ Rs. 10,000.00 – ProvidedUntied Funds
Sub Centre 2858 @ Rs. 10,000.00 – ProvidedPHCs 396 @ Rs. 25,000.00 – ProvidedCHCs 126 @ Rs. 50,000.00 – Provided
Annual Maintenance GrantSub Centre 1443 @ Rs. 10,000.00 – ProvidedPHCs 396 @ Rs. 50,000.00 – ProvidedCHCs 112 @ Rs. 1,00,000.00 – Provided
127
NRHM Additionalities
Rogi Kalyan SamitiRs. 5.00 lakh per district hospital – ProvidedRs. 1.00 lakh per sub-divisional hospital/ CHC– Provided
ASHA
Funds @ Rs. 200/- per ASHA per month claimed in NRHM Part-B and Rs. 2300/- per ASHA claimed for training in Part-A.
128
NRHM Additionalities
Mobile Medical Unit
Approval was sought for deploying 4 additional MMUs in the State out of the funds already available in the PIP 08/09, in the southern districts of the State where health facilities are lacking due non availability of manpower. In these 4 districts two MMUs have already been provided. In 4 districts where presently no MMUs in place, MMUs needs to be provided.
Medical Officers in Mini PHCs – demand for additional 100 MOs not justified, State should bear this expenditure
Additional posts deleted. 59 Medical Officers in Mini PHCs in place so salary may kindly be allowed for only one year 2009-10.
129
• Medical Officer for 60 PHCs without doctors @ Rs. 25,000 per month per Medical Officer
• Incentives to doctors working in extremely remote areas
• Engagement of 5 Hospital Administrator
• One Gynaecologist for 15 DH
NEW INITIATIVES -ADDITIONALITIES
130
Part-C
VILLAGE HEALTH & SANITATION COMMITTEES
•Funds to 12673 VHSCs @ Rs. 10,000.00 – Provided
UNTIED FUNDS
• Sub Centre 2858 @ Rs. 10,000.00 – Provided
• PHCs 396 @ Rs. 25,000.00 – Provided
• CHCs 126 @ Rs. 50,000.00 – Provided
ANNUAL MAINTENANCE GRANT
• Sub Centre 1443 @ Rs. 10,000.00 – Provided
• PHCs 396 @ Rs. 50,000.00 – Provided
• CHCs 112 @ Rs. 1,00,000.00 – Provided
UNTIED FUNDS
131
– Recurrent cost for 24 MMUs @ Rs. 15 lakh P.A. Rs. 360.00 lac proposed for FY 09/10
– Recurrent cost for salaries, medicines etc for 24 MMUs
MOBILE MEDICAL UNITS (MMUs)
132
UPGRADATION OF CHCs TO IPHS
Rs. 811.40 LAKH APPROVED FOR THE FY 09/10
– Construction of 6 new CHCs @ Rs.200 lakh. Work to be initiated in 09/10 4 CHCs on priority and continue to 10/11. Rs. 300 lakh proposed
– Drugs @ Rs. 2.3 lakh per CHC per annum - Rs. 289.80 lakh proposed.
– Equipment/furniture for CHCs based on facility survey Rs. 221.60 lakh proposed
UPGRADATION OF SDH/FRUs
Rs. 488.00 LAKH APPROVED FOR THE FY 09/10
– Major repair and renovation of 4 SDHs Rs. 130 lakh Approved
– Repair renovation and alteration of existing 25 SDH @ Rs. 10.00 lakh.
– Drugs @ Rs. 3.00 lakh for 36 SDH
UPGRADATION OF INSTITUTIONS
133
UPGRADATION OF PHCs FOR 24 HRS SERVICESRS. 658.62 LAKH APPROVED FOR THE FY 09/10
– Upgradation of 97 PHCs for 24x7 services Rs. 200 lakh
– Equipment & furniture for 97 PHCs
– Drugs @ Rs. 1.00 lakh per 24X7 PHC P.A.
– Medical Officer for 60 PHCs without doctors @ Rs. 25,000 per month per Medical Officer
– Incentives to doctors working in extremely remote areas
UPGRADATION OF SUB CENTRESRS. 1551.88 LAKH APPROVED FOR THE FY 09/10
– Construction of 353 existing SCs located in rented buildings in phases out of which 100 to be taken up in 09/10. Rs. 640.00 Lacs
– 823 existing SCs need restoration, out of which 150 will be taken up in 09/10 @ Rs. 1.5 lakh per SC
– Salary of 2nd ANM in 954 SCs.
UPGRADATION OF INSTITUTIONS
134
UPGRADATION OF DISTRICT HOSPITALSRs. 689.50 LAKH APPROVED FOR THE FY 09/10
– Drugs @ Rs. 10 lakh per DH PA
– Equipment/furniture based on Facility Survey Rs. 100 lakh proposed
– Upgradation of District Hospitals Sangrur, Faridkot Rs. 200 lakh proposed
– Engagement of 5 Hospital Administrator
– One Gynaecologist for 15 DH
ROGI KALYAN SAMITIS
Grant in Aid to Rogi Kalyan Samities at
PHC/CHC/SDH @ Rs. 1.00 Lakh
DH Level @ Rs.5.00 Lakh
UPGRADATION OF INSTITUTIONS
135
• Provision for screening of all the School Children for which Rs. 200 lakh have been Approved.
• Special focus on RHD and CHD treatment at PGI
SCHOOL HEALTH
136
• Funds Approved Rs. 2617.04 lakh• Capital cost of 90 Ambulances and infrastructure for
ERS (proposed in additional over planning activities)• Cell phone to State Officers/Civil Surgeons, DPMs,
Block SMOs, LHVs and ANMs• Procurement of Calcium & Zinc Sulphate tab.
OTHER ACTIVITIES
137
PART-C IMMUNIZATION
138
S.N. ACTIVITYBUDGET APPROVED
(Rs. In Lakhs)
1 Mobility Support for Supervision 10.83
2 Cold Chain Maintenance 4.72
3 Mobilization of Children Through ASHA/ Mobilizers 130.00
4Alternative Vaccine Delivery: For RI Session in Other Areas
34.30
5 Support For Computer Asst. For RI Reporting 12.72
6 Printing & Dissemination of Cards Etc. 27.50
7 Review Meetings 15.15
8 Trainings 14.91
9 Microplanning 4.43
10POL For Vaccine Delivery From State To District & From District To PHC/CHCs
20.00
11 Consumable for Computer E.G. Internet etc. 0.08
12 Injection Safety 1.05
13Enhansed Immunisation coverage in Urban & Peri Urban colonies
4.58
TOTAL 280.27
PART C- IMMUNIZATION: BUDGET
139
• BUDGED APPROVED FOR Rs. 280.27 LAKH FOR THE YEAR 09/10
• Alternate Vaccine Delivery, Mobilization of Children, Slums and under served areas, strengthening and monitoring, computerization as per GOI guidelines.
• State specific strategies
• Social mobilization to increase awareness to serve uncovered and leftover children
• Enhanced immunization coverage and urban and peri urban colonies
• Waste disposal plan at PHCs level
• Totally micro-plan based at the sub-centre level
• Pulse-polio drive strategy used in uncovered urban areas
• Monitoring and supervision at state, district and PHC level
• Identification & coverage of slums areas
• State wide immunization in partially covered/ uncovered areas on Saturdays
• Training /orientation of DIO/DFPO and other functionaries
IMMUNIZATION
140
PART-D NATIONAL DISEASE
CONTROL PROGRAMME
141
SN ACTIVITY BUDGET APPROVED(Rs. In Lakhs)
1 National Vector Borne Disease Control Programme (NVBDCP)
135.00
2 Integrated Disease Surveillance Programme (IDSP) 142.42
3 National TB Control Programme (RNTCP) - Approved 616.30
4 National Leprosy Eradication Programme (NLEP ) - approved
131.00
5 National Blindness Control Programme (NBCP) 350.00
6 National Iodine Deficiency Disorder Control Programme (NIDDCP) - Approved
20.00
TOTAL 1394.72
PART D- NDCP : BUDGET
142
S. NO ACTIVITY BUDGET APPROVED
(Rs. In Lakhs)
1 Incentive to ASHA 0.00
2 Supplies, Consumables and Medicines 2.00
3 Indoor Residual Spray (IRS) 0.00
4 Anti Larval Measure in Urban And Peri-urban Areas 40.00
5 Entomological Monitoring0.00
6 IEC 20.00
7 Training 10.00
8 MIS (NAMMIS) 5.00
MALARIA TOTAL 77.00
Dengue and Chikungunya 58.00
Japanese Encephalitis IEC 0.00
GRAND TOTAL 135.00
PART D- NVBDCP : BUDGET
143
PART D- IDSP : BUDGET
144
S.N. ActivityAmount
approved
1Incremental staff/ personnel
+ Operational cost132.95
2. Training cost 0
3. IEC 5.00
4. Lab. equipment etc. 4.50
Total 142.42
PART D- RNTCP and NLEP :
Formal approval received for an outlay of Rs. 616.30 for RNTCP from the Concerned Division and budget revised accordingly in the PIP
Formal approval received for an outlay of Rs. 131.00 for NLEP from the Concerned Division and budget revised accordingly in the PIP
145
PART D- NBCP : BUDGET
146
Sr. No
Particulars Approved Amt
1
Grant-in Aid to NGOs for free Catract Operations (Annual target for free catops 1,80,000 & for IOL 1,62,000 for which the achievement of the State is 107% in the year 2007- 08 & 88% upto Jan. 2008-09
198.40
2GIA for School Eye Screening. Provision for supply of spectacles, medicines and other supplied for school eye care programme.
3
Grant for Medical Colleges (there are 3 Medical Colleges in the State. Grtant-in-Aid for Govt. Medical College Faridkot & Medical College Patiala @ 20.00 lakh each
40.00
4
Distt. Hospitals
1) 2 Phaco Machines @ 12,00,0002) 5 Yag Laser @ 10,00,0003) Maintenance of ophthalmic equipments 16,00,000
5Establishing & Strengthening and supply to New Vision Centres at CHCs and Sub-Distt. Hospitals at 25 centres @ 50,000 in the border and remote areas of the State.
5.00
PART D- NBCP : BUDGET
147
Sr. No Particulars Approved Amt
6Recurring GIA to Eye Banks (there are 4 eye banks in the State). Which has got collection of more than 100 eye balls
7Non-recurring GIA to Eye Donation Centre @ Rs. 1 lakh for 10 eye donation centres
1.00
8 Recurring GIA to Eye Donation Centres
9 Training for PMOAs and MPHWs
10IEC activities World Sight days and Fortnight at 20 districts @ 50,000 and 100 eye donation awareness camps in remote and border areas at PHCs and CHCs level @ 15,000 for each camp.
PART D- NBCP : BUDGET
Sr. No Particulars Approved Amt
11 SBCS Remuneration other activities & Contingency
12
Financial assistance for other diseases Glucoma, Diabetic Retinopathy, Laser Tech., corneal transplantation, childhood blindness, squint surgery etc.
13 Maintenance of Tele Ophthalic Van and the staff
14 Ophthalmic Surgeon 30.00
15 Ophthalmic Assistant 9.60
16 Eye Donation Consellor 6.00
17 GIA for strengthening of RIO 60.00
Total 350.00
Activity / Item 2009-10(Rs. In Lakhs)
Salary
Salary for Punjab State IDD Cell 6.00
Salaries for lab technician, Lab astts. And other staff of IDD monitoring laboratories
3.50
Monitoring and IEC
Cost for IDD surveys/ monitoring 2.50
IEC Activities for the programme 8.00
Total 20.00
PART D- IDDCP : BUDGET
149
PART-E INTER SECTORAL CONVERGENCE
150
AYUSH –
– To meet the health needs and harness the potential of indigenous health knowledge convergence with AYUSH
– Contractual appointment of one AYUSH doctor and dispensor (in phased manner)
– Contractual appointment of one AYUSH doctors (Homeopathy) and dispensor (in phased manner)
PART E- INTERSECTORAL CONVERGENCE -
151
• Outreach camps to be held 20 in every month @ Rs 10000 per camp for providing family welfare services and dissemination of information on RCH components and also counselling on various issues like FP, adolescent health and early registrations of pregnancies
• Audience specific communication material in Urdu, Punjabi pertaining to themes like age at marriage, immunization, sterilization, CC use, IUD, OCP, male involvement, child health issues (pamphlets, hoardings, wall paintings)
• Meetings/workshops with stakeholders and opinion leaders
• Peer educator
SPECIAL PROGRAMME FOR MINORITIES- CARRY OVER ACTIVITIES
152
Special Innovative Programme for Minorities Activity / Item 2009-10Camps to be held 20 in every month @ Rs. 10000 per camp for providing Family Welfare services and dissemination of information on RCH components and also counselling on various issues like FP, Adolescent health and early registrations of pregnancies (Rs 3000/- for arrangements, mobility, and referral , Rs 6000/- for Drugs and supplies, Rs 1000/- for miscellaneous )
24.00
Peer Educator 20 @ Rs. 1000/-p.m 2.40Audience specific communication material in Urdu, Punjabi pertaining to themes like age at marriage, immunization, sterilization, CC use, IUD, OCP, Male involvement, Child Health Issues (Pamphlets, Hoardings, wall paintings)
6.00
Meetings/Workshops with Stakeholders and opinion leaders 1.05Total 33.45
SPECIAL PROGRAMME FOR MINORITIES
153
Activity / ItemBUDGET
PROPOSED(Rs. In Lakhs)
BUDGET MODIFIED
(Rs. In Lakhs)
Preparation of guideline on role of PRIs printed and disseminated in local language to all PRI members and other key stakeholders in NRHM. 3 lakh copies @ Rs. 5 per copy
15.00 15.00
Preparation of module to orient PRIs on their role in NRHM 0.15 0.15
Discussion with Panchayati Raj Department on orientation of PRI representatives
40.00 0.00
Organise advocacy meetings with PRIs on key issues such as maternal health, JSY, PNDT and GBV. SHSRC and Centre for Communication to jointly provide support in preparing advocacy materials. Advocacy to be organised in each district by the District Health Mission. A provision of Rs 1 lakhs per district made, detailed budget to be prepared by each district
20.00 20.00
Total Budget 75.15 35.15
CONVERGENCE WITH PRIs
POSITION WITH REGARD TO CONCURRENT AUDIT AND HMIS
Concurrent Audit – The work for 2008-09 was allotted to M/s. N. C. Mittal & Association, New Delhi vide this office letter dated 28.01.2009 for Rs. 5.40 lacs after inviting bids through newspapers.
For 2009-10 we are again inviting bids through newspapers and work has been allotted to M/s A Agarwal & Associates of Chandigarh.
HMIS – Monitoring and Evaluation• NHRC – HMIS : Data from April 2008 to October 2008 uploaded on the HMIS portal.• Data Block wise from November 2008 uploaded at district level. SAs from Blocks
come to the district headquarter to upload the data.• Other initiatives of the State Mission –
Website : Website of Punjab NRHM www.pbnrhm.org launched in June 2008. Service particulars : Service particulars of doctors with complete bio-data prepared and uploaded.
GIS – Administrative maps upto village level have been digitized by Punjab Remote Sensing Agency, Ludhiana. The work of health functionaries would be monitored through this GIS enabled system.
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