NRHM SPIP 2011-12 - Jharkhandjrhms.jharkhand.gov.in/PIP/PART B.pdf · Page 3 of 129 NRHM SPIP 2011-12 JHARKHAND the available Medical and Para medical professionals and the demand

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NRHM SPIP 2011-12 JHARKHAND

11. Human Resources & Programme Management Unit Human resource and adequate infrastructure are the most critical components of

development programmes. Health in particular is very much sensitive to the adequate

human resources and infrastructure as it directly linked with life of human beings.

After the independence the Government of India has provisioned for the human

resources and infrastructure for health along with other community development

programmes. Since than many policies have been framed and modifications have been

carried out in the frame work of health development. Human resource in health has

been the prime consideration in all such policy decisions.

Inception of National Rural Health Mission (NRHM) has opened new door in meeting

the challenges in human resources in health. Provisioning of adequate human resources

in clinical and management has been made in NRHM helped in filling the gaps in health

human resources.

Jharkhand in particular was also facing challenges in meeting the health needs of the

people due lack of adequate number of health resources and proper infrastructure.

Many health service delivery points were not having own buildings and were running in

rented buildings. Also there sufficient staffs were not recruited to man these health

institutions. Lack of sufficient accommodation has also resulted in the staff not residing

in the premises affecting the 24X7 availability of the health services. Most of the Health

Institutions were located below district level and most of them are in dilapidated

condition.

To address these, various

interventions were planned and are

being implemented under the NRHM.

The main interventions initiated were

the availability of untied funds,

infrastructure improvement and

deployment of human resources,

engagement of ASHAs and

involvement of village level health and

sanitation committees (VHC). The Mission seeks to operationalize functional health

Health facilities in Public Health, Jharkhand

District Hospital 21

Sub-Divisional Hospital 6

Referral Hospitals 32

CHC 194

PHC 330

HSC 3958

Medical Colleges 3

Nursing College 1

Nurses Training School (GNM) 3

ANMTC 10

Homeopathy College 1

Ayurveda College 1

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facilities in the public domain through revitalization of the existing infrastructure

through construction or renovation wherever required, deployment of skilled service

providers and availability of drugs and equipments. The institutions will be

strengthened and upgraded considering the recommendations provided as per Indian

Public Health Standards (IPHS).

The institutional mechanism from the state level to districts and downward has been

operationalised to monitor Programme performance, provide timely guidance, improve

decision making and taking mid-course corrections. In all 24 Districts of the state,

District Programme Management Units has been setup with the provision of mobility

and inputs to carry out office functions. The integration of new structure at district level

with existing departmental structure was facilitated. Efforts were made to clarify roles

and responsibilities in this evolving system.

The state has shown considerable growth in filling the Human Resource gaps in the

clinical services. The emphasis has been to get adequate number of doctors and

paramedics. Human resource for health is another major issue where the State health

system is struggling. Current staffing is as follows,

Status of Health Human Resource

Sl. Category Total Required

as per IPHS

Sanctioned (Regular)

Existing (Regular)

Existing (Contractual)

Existing Total

(Regular+ Contractual)

Shortfall (Required-

Existing)

1 Specialist 1453 174 84 0 84 1369

2 ANM 8906 4666 2978 4098 7076 1830

3 Staff Nurse 2408 304 216 362 578 1830

4 Male Health Worker

3958 1035 418 1636 2054 1904

5 Pharmacist 629 501 100 244 344 285

6 Lab Technician 629 446 85 332 417 212

7 Radiographer 257 54 30 96 126 131

8 Medical Officers 1237 1681 1376 457 1833

Table 11.1

The paucity of medical professionals especially the Specialists limits the public health

facilities in providing higher level of services. A mismatch exists in the State between

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the available Medical and Para medical professionals and the demand for their services.

More Specialists and Para medical professionals are required to fill up this gap.

Moreover despite number of trainings held, rationalization of manpower is yet to take

place. To overcome this, the State has initiated public private partnerships, out sourcing

health facilities and programmes to public/private sector and NGOs. There is also

dearth of well-trained public health professionals and managers to effectively steer the

public health programs. Manpower Management in the State would be undertaken vide

various initiatives like reorganizing & rationalizing the existing manpower, Web enabled

system to capture district level cadre information, cadre reforms of the Medical Officers

and other clinical Staffs, sanction for the post of Specialists Medical Officer, cadre rules

for paramedics and health educator, OT assistant, clerks, pharmacists, lab technicians,

X-ray technicians to be finalized in FY 2011-12. Timely promotion of various cadres of

staff like medical officers, specialists, administrative cadre as well as of paramedical

staffs and other workers to Supervisory category continued to be a problem and this

has been given sufficient attention. Though the state has reasonable number of MBBS

doctors, there is an acute shortage of specialist medical officers. The shortage of

specialists like obstetricians and Anesthetists are obstructing the state plans to

operationalise all district hospitals as First Referral Units. Recruitment of Medical

officers and paramedics- The process of recruitment is lengthy and takes about four to

six months. The number of applicants is quite limited because of dearth of doctors and

paramedics in the state.

It is felt that the state needs to restrict the turnover of doctors on contract. It is

proposed that a study may be undertaken to assess the situation and recommend

remedies, however it is assumed that hike in the salary of the specialists for serving in

rural areas will help to curb the turnover to same extent and an HR policy will be

finalized.

Progress so far

Strategies Progress Comments

Strengthening of existing ANM Training Centers

Complete All the existing 10 ANM Training Centers have been made functional. A study has been commissioned for developing the road map of improving the functioning of ANM TCs in the State. Up-gradation of ANM TCs including equipping the library and class rooms with books and other

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teaching aid has been done. Department has initiated the process of contractual engagement of faculties for ANM TCs, for meeting the shortage of faculties.

Operationalisation of new ANMTCs In Process Process of operationalisation of 10 more ANM Training centers has been initiated, that will be made functional in the current FY.. Department is already in negotiation with TELCO, Usha Martin group, Tata Memorial Hospital, Apollo Hospital, Seva Sadan and Gurunanak Hospital. Some more proposals for establishment of ANM TCs are expected in this year.

Capacity building of the ANMs In Process Skill building programmes for the in-service ANMs for better service delivery has been developed and is being imparted. Career progression plan for the ANMs is also being developed

Facilitation of the morale of the staffs

In Process The Department also proposes to develop conducive and supportive working environment. The officials including Health and Family Welfare Department who have done outstanding work will be recognized and awarded with an appreciation certificates. The department will review the service rules, recruitment policy and other cadre rules while bringing more clarity in the roles and responsibilities of contractual and regular staffs. The policy will be developed while using contingency funds allocated to state and district under human resources development.

Recruitment In process In the Left Wing Extremist districts of the State, recruitment of 500 ANMs and 500 MPWs is in process and is likely to be completed by End of January, 2011. Recruitment of 150 specialist doctors has been almost completed and would be placed in different facilities by the end of January 2011.

Table 11.2

Plan for 2011-12

11.1. Response to shortage of human resources

Though the state has reasonable number of MBBS doctors; there is an acute shortage

of specialized clinical manpower along with support staffs in the clinical and non-clinical

categories. There is a shortage of specialist Doctors like Obstetrics/Gynecologists,

Pediatricians and anesthetists in the state restrict the CHCs and FRUs to be function as

per norms. Many positions in the support categories are lying vacant in CHCs, PHCs and

other health facilities. In view of vast number of vacancies in the nursing and

paramedical categories, State has already initiated the process for recruitment of staffs

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against the existing vacancies. In view of staff shortages with respect to the IPHS norms,

process for sanctioning of posts for regular appointments has been initiated by the

Department. Sanction of posts and recruitment process against the sanctioned posts

are being defined and is likely to be completed in a phased manner. For addressing the

shortage of trained para-medical personnel, the state has already recruited nursing and

paramedical staffs on contract with support from NRHM.

11.1.1 Remuneration of clinical staffs 11.1.1.1 Remuneration to ANMs and MPWs recruited under NRHM 11.1.1.1.a. As per the IPHS norms there at least two ANMs should be provided in of the

each HSC. Despite of governments endeavor to fulfill the gap there is still shortfall of

1830 positions of ANMs in the state. Also, in view of shortage of nursing staffs, ANMs

are being placed at PHCs and CHCs for making the facilities 24X7 functional.

Apart from the regular ANMs, currently about 5000 ANMs are being supported by

NRHM. To retain the existing ANMs state is proposing to extend the funding support for

5000 ANMs to cater health services. Remuneration of Rs. 9,000/- per month for the

year 2011-12 has proposed in this regard.

Sl Name of the Post Total Nos. Existing

Unit Salary (Rs/Month)

Months Fund required for Salary (in lakh Rs.)

1 Salary of Contractual ANMs under NRHM

5000 9000 12 5400.00

Table 11.3 Budgeted under Sec. 9.1.1 under Infrastructure & HR of RCH

11.1.1.1.b. Remuneration to ANMs and MPWs for Left Wing Extremists Area. Against the planned recruitment of 500 ANMs and 500 MPWs in FY 2011-12, for the

Left Wing affected districts of the State; the process of recruitment is in process and will

be completed in the last quarter of the FY.

For this additional health work force, sum of Rs. 8000/- pm is being proposed for

coming year.

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Also ANMs posted at left wing districts will be trained in SBA and HBNC services on

priority basis.

Budget Requirement

Particulars Unit Unit Cost Total Cost (In Lacs)

Additional ANM for left wing (500 ANMs x 12 month )@ Rs 8000/ pm 6000 8000 480.00

Male Health worker in left wing Districts (500 MPWs x 12 month ) @ Rs 8000/- pm 6000 8000 480.00

Grand Total 960.00

Table 11.4 Budgeted under Sec. 9.1.2 & 9.1.6 under Infrastructure & HR of RCH

11.1.1.1.c. Incentive scheme for ANMs of Left Wing Extremists Area All the ANMs recruited in the Left Wing Extremists districts will be provide with

additional incentives for conducting deliveries.

ANM trained on SBA and providing continue health service from the HSC and

conducting deliveries will be provided with incentive of Rs 500/- per month.

Budget Requirement

Category of Recipients Units Unit Cost Total Cost (In Lacs)

Incentive to ANMs of Left Wing Extremists area (500 HSC x 2 ANM x 9 months) 9000 500 45.00


11.1.1.2. Remuneration of Staff Nurses

State the 500 staff nurses recruited in FY 2009-10 and deployed in different PHCs and

CHCs. Also there in FY 2010-11 state was planned to recruit 400 staff Nurses for the

LWE Districts. Recruitment for all these positions is in process and will be completed by

January, 2011.

Therefore, in order to retain the existing work force and remunerate the new recruits of

Staff nurses, state is proposing following sum of budget in the coming year.

Sl Name of the Post Total Nos. Existing

Unit Salary per month

Months Total fund required (in lakh Rs.)

1 Staff Nurses 500 13000 12 780.00

2 Staff Nurse for LWE area 400 12000 12 576.00

Grand Total 900 1356.00


11.1.1.3. Remuneration of Specialist and Lady Medical Officers at CHCs

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In the FY 2010-11, state had planned to recruit 150 Specialists Doctors (Gynaecologist,

Paediatrician, Physician, Surgeon and Anesthetist) who are supposed to be placed in 63

block level facilities that have been planned to be upgraded into FRUs in the same year.

Process for recruitment has already been completed and Specialist Doctors would be in

position by January, 2011. Their posting will be rationalized as per their specialization

and community health needs. These specialist doctors will be recruited on contract and

will be paid an honorarium of Rs. 40,000/- & 50,000/- per month as per the

specialization. In the coming FY State is proposing to provide remuneration to all the

150 specialist doctors.

Also there salary to the 25 Lady Medical officers posted at CHCs is being proposed in

the coming year. Salary for the specialists would be as follows:

Category Approved Salary (Rs P.M.) Number

MOs – MBBS 30,000/- 25

Specialists

Post graduate diploma

Post graduate degree

40,000/-

50,000/-

150

Table 11.7

Sl. # Name of the post Total Numbers existing/ Required

Unit Salary per month

No. of months

Total fund required (in lakh Rs.)

1 Existing Lady medical Officer on contract

25 35000 12 105.00

2 Number of Specialist Doctor to be recruited in FY 2010-11

150 65000 12 1170.00



11.1.1.4 Remuneration of para-medical staffs

State has recruited 400 Lab Technicians, 150 Radiologists and 200 Pharmacists as

planned in FY 2009-10. State proposes to retain all these para-medical staffs for the

coming FY 2011-12.

Sl #

Name of the post Number recruited

Unit salary per month (Rs)

Number of months

Total amount (in lakh Rs.)

1 Lab Technician 400 9500 12 456.00

2 Radiologist 150 11000 12 198.00

3 Pharmacist 200 9500 12 228.00



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11.1.2. Remuneration to Quality Assurance Cell For improving the functioning of the public health facilities and help in strengthening

the processes for the providing quality public health care services throughout the State,

provision for QA Cell was proposed in FY 09-10 with the following Staff positions:

1 State level consultant for Quality Assurance this position will be part of

SPMSU.

5 Consultants on regional level to monitor the functioning of facilities and up-

gradation of facilities for providing better health care services.

Currently 5 Regional Consultants – QA are in place and working for the five

administrative divisions in the State. Recruitment of State Consultant is yet to be done

as State is facing difficulty in getting the suitable candidate for the position.

Position Current Salary PM Proposed Salary PM in 2011-12

Consultant (Quality Assurance) - State level 30000 35000

Consultant (Quality Assurance) – Regional 25000 28000

Table 11.9

State is proposing to retain all these positions in the coming FY. To provide competitive

remuneration with respect to other agencies and retain the staff state has proposed for

marginal increase in the salary of the aforementioned staffs.

Along with it additional Rs. 5,000/- per month for each consultant Quality assurance is

provisioned for the mobility support and communication charges.

Budget Requirement for Remuneration to QA Cell

Particulars Units Unit Cost Total Cost (in Lacs) Consultant (Quality Assurance) - State level (1 x 12 months) 12 35000 4.20

Consultant (Quality Assurance) – Regional (5 x 12 months) 60 28000 16.80

Mobility Support and communication charges to the consultants for QA (6 x 12 months)

72 5000 3.60

Grand Total 24.60


11.1.3. Strengthening the Management of the District Hospitals

For better management of the hospital affairs state has initiated process of recruitment

of hospital managers for district and sub district level health facilities. Hospital

Managers have been supposed to look after routine maintenance and administration of

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the hospital as well as ensure cleanliness in the hospital campus and proper waste

disposal mechanism.

In the year 2009-10, positions of 30 Hospital Managers were approved.

State has already recruited 7 Hospital Managers and is in process of recruitment of 23

Hospital Managers. These positions will be in place by February, 2011.

In order to compete with the salary packages for the similar positions of other agencies

and to retain the Hospital Managers state proposes marginal hike in the salary in

coming year.

Position Current Salary PM Proposed Salary PM in 2011-12

Hospital Manager 22000 25000

Table 11.12

Along with it additional support for establishment of hospital management has also proposed in 18 facilities.

Sl #

Name of the post Numbers required

Approved unit Salary per month for FY

2010-11

Proposed Salary for FY

2011-12

Months

Total fund required (in

lakh Rs)

1 Hospital Manager 7 22000 25000 12 21.00

2 Hospital Manager 14 22000 22000 12 36.96

3 Support for establishment of

HMs 18 50000 50000 1 9.00

Total

66.96


11.1.4. Strengthening Cold Chain and Logistics Management

11.1.4.1. To strengthen the logistics management and maintenance of cold chain so as

to smooth and regular the supply of vaccine, drugs and other logistics from state level

to HSCs additional dedicated manpower are in place.

Staffing in Cold Chain and Logistics Management

Position Number

State Cold Chain Officer 1

Vaccine and Logistics Manager 1

Vaccine & Logistics Manager -Regional Level 1

Technical Assistant Cold Chain - State level 1

Technical Assistant Cold Chain - Regional Level 1

Refrigerator Mechanic 27

Total 32

Table 11.14

State is proposing to retain all above staff positions in the coming year.

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Sl. # Name of the position Number appointed

Salary per month (Rs.)

Number of months

Total Salary (in lakh Rs.)

1 State Cold Chain Officer 1 45,000 12 5.40

2 Vaccine and Logistics Manager 1 27,500 12 3.30

3 Vaccine & Logistics Manager (Regional)

1 25,000 12 3.00

4 Technical Assistant – cold chain (State level)

1 27,500 12 3.30

5

Technical Assistant – cold chain (Regional)

1 22,000 12 2.64

6 Refrigerator Mechanic 27 11,000 12 35.64

Grand total 32 53.28

Table 11.15 Budgeted under Sec. 9.1.16.1 -9.1.16.5 under Infrastructure & HR of RCH

11.1.4.2. It was planned in the FY 2010-11 to recruit additional manpower for logistics and vaccine management. Process for recruitment is in final stage and recruits will be in place by February, 2011.

Additional Manpower in Cold Chain and Logistics Management

Position Number

PROMIS Manager (State) 1 Store Keeper cum PROMIS Operator (District) 24

Store Keeper cum PROMIS Manager (State & Regional level) 9

Cold Chain Handlers 27

WIC/WIF Operator (State & Regional level) 3

Total

Table 11.16

State is proposing to retain to new recruited staffs in the coming year.

Sl. # Name of the position Number

proposed Salary per

month (Rs.) Number of

months Total Salary (in

lakh Rs.)

1 PROMIS Manager (State) 1 15000 12 1.80

2 Store Keeper cum PROMIS Manager

(State & Regional) 9 14000 12 15.12

3 WIC/WIF Operator (State & Regional

level) 3 10,000 12 3.60

4 Store Keeper cum PROMIS Operator

(District) 24 12000 12 34.56

5 Cold Chain Handlers 27 10,000 12 32.40

6 Outsourcing of Regional WIC /WIF cleaning - Deoghar, Ranchi, Giridih

3 4000 12 1.44

Total 64

88.92

Table 11.17 Budgeted under Sec. 9.1.16.7 -9.1.16.13 under Infrastructure & HR of RCH

11.1.5. Provisioning of Mobile phones expenses for service providers

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For strengthening the monitoring and reporting, it is proposed to provide mobile

phones to the ANMs, MOICs and District RCH Officers (other programme officers have

already provided with mobile phone under different programmes).

Therefore, State has proposed to provide mobile phones expenses to the ANMs and

MOICs of the high focus 92 CHCs and RCH officers of 24 districts.

Budgetary Requirement for Provisioning of Mobile phones expenses

Particulars Units Unit cost Total Cost

Mobile phone expenses to ANM 500 350 2100000

Mobile phone expenses to MOIC 100 500 600000

Mobile phone expenses to District RCH Officer 24 500 144000

Total 3000 2844000


11.2. Strengthening Programme Management Unit

To plan, coordinate and implement, i.e., for overall management of the health

programmes envisaged within NRHM, Programme Management Units has been

established at the State, Districts & Block levels.

11.2.1. Filing up positions of programme management staffs at all levels

11.2.1.1. At state level for efficient management of various functions following staff

positions have been provisioned at State Programme Management Unit.

Details for staffing at State Programme Management Unit are as follows,

Staff Positions at State Level

Sl. No.

Name of the Positions Salary as approved in PIP 10-11 (Rs/m)

Approved In positio

n

Vacant

1 Consultant – MIS 42,000 1 1 0

2 NGO Coordinator 42,000 1 0 1

3 Consultant - M & E 42,000 1 1 0

4 Consultant - HRD 42,000 1 1 0

5 Consultant-Training 42,000 1 1 0

6 Consultant – Media 28,000 1 1 0

7 Consultant – MCH 35,000 1 0 1

8 Consultant-Logistics & Procurement 35,000 1 0 1

9 State Consultant – QA 30,000 1 0 1

10 Regional Consultant-QA 25,000 5 4 1

11 Cold Chain officer 42,000 1 1 0

12 Vaccine & Logistics Manager 25,000 1 1 0

13 Technical Assistant- Cold Chain 25,000 1 1 0

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14 State Programme Manager 42,000 1 1 0

15 State Finance Manager 42,000 1 0 1

16 State Accounts Manager 30,000 1 0 1

17 State Data Officer 25,000 1 0 1

18 Demographer 26,500 1 1 0

19 Statistical Supervisor 20,000 1 1 0

20 Data Manager (State HQ) 22,000 2 2 0

21 System Analyst 24,000 1 1 0

22 Executive Documentation and Planning

28,000 1 0 1

23 Co-ordinator- ARSH & PCPNDT 28,000 1 0 1

24 Executive Assistant (Prog Mgmt) 18,000 1 0 1

25 Executive Assistant (Accounts) 18,000 1 0 1

26 Executive Assistant (Training) 18,000 1 0 1

27 Executive Assistant (NGO Coordinator)

18,000 1 0 1

28 Executive Assistant (HR) 18,000 1 0 1

29 Assistant (MD Cell) 18,000 1 0 1

31 State Project Coordinator - Sahiya 25,000 1 1 0

32 Admin & Finance Officer – Sahiya 18,000 1 1 0

33 Coordinator – FP 28,000 1 0 1

34 IEC Coordinator – FP (USAID support) 22,000 1 0 1

35 Demographer – FP (USAID support) 20,000 1 0 1

36 Accountant – FP (USAID support) 18,000 1 0 1

37 Data Entry Operator – FP (USAID) 12,000 1 0 1

38 Coordinator – AYUSH 28,000 1 0 1

39 Computer Operator – AYUSH 12,500 1 0 1

40 Computer Operators 12,500 50 44 6

Total 10,34,000 93 64 29

Table 11.19

Recruitment of the vacant positions at State level has been initiated and all the positions would be filled by January, 2011 with support from NHSRC.

State will continue the services of all the staff positions at SPMU in the coming year.

Sl. No. Name of the Positions Approved Proposed

salary (11-12) Months

Fund required

(Lakh Rs)

1 Consultant – MIS 1 45000 12 540000

2 Consultant - M & E 1 45000 12 540000

3 Consultant - HRD 1 45000 12 540000

4 Consultant-Training 1 45000 12 540000

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5 Consultant – Media 1 30800 12 369600

6 Consultant – MCH 1 35000 12 420000

7 NGO Coordinator 1 35000 12 420000

8 Consultant-Logistics &

Procurement 1 35000 12 420000

9 State Programme Manager 1 45000 12 540000

10 State Finance Manager 1 40000 12 480000

11 State Accounts Manager 1 33000 12 396000

12 State Data Officer 1 27500 12 330000

13 Demographer 1 30000 12 360000

14 Statistical Supervisor 1 22000 12 264000

15 Data Manager (State HQ) 2 25000 12 600000

16 System Analyst 1 26400 12 316800

17 Executive Documentation and

Planning 1 28000 12 336000

18 Co-ordinator- ARSH & PCPNDT 1 28000 12 336000

19 Executive Assistant (Prog Mgmt) 1 18000 12 216000

20 Executive Assistant (Accounts) 1 18000 12 216000

21 Executive Assistant (Training) 1 18000 12 216000

22 Executive Assistant (NGO

Coordinator) 1 18000 12 216000

23 Executive Assistant (HR) 1 18000 12 216000

24 Assistant (MD Cell) 1 18000 12 216000

25 Coordinator – FP 1 28000 12 336000

26 Computer Operators 50 14000 12 8400000

Budgeted under Sec. 11.1.1 -11.1.1 & 11.2.1 -11.2.5under Progm Management of RCH

11.2.1.2. District level

District Programme Management Unit has been established in all Districts of the State. Current status of District level PMUs are as follows:

Sl. No.

Name of Position Salary as approved in PIP 10-11 (Rs/m)

Approved In position

Vacant

1. District Programme Manager 30,000 24 21 3

2. District Accounts Manager 25,000 24 19 5

3. District Data Manager 22,000 24 20 4

Table 11.20

Process for filling up the vacancies at District level has been initiated and will be completed by January, 2011. All the staff positions at district level will be retained in the coming year.

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Sl.

No. Name of the Positions Approved

Proposed

salary (11-12) Months

Fund required

(Lakh Rs)

Remarks

1 District Programme

Manager 24 33000 12 9504000

Budgeted under Sec.

11.3.1 -11.3.3 under Progm Management

of RCH

2 District Accounts

Manager 24 27500 12 7920000

3 District Data Manager 24 25000 12 720000

Table 11.21

11.2.1.3. Block level For the proper management of health programmes at block level, block Programme

Management Unit have been established. All the positions at BPMU, 194 Block

Programme Managers (BPM) and 194 Block Accounts Manager (BAM) have been filled.

Present status of BAM and BPM are as follows,

Sl. No.

Name of Position Salary as approved in PIP 10-11 (Rs/m)

Approved In position

Vacant

1. Block Programme Manager 13,000 194 175 19

2. Block Accounts Manager 12,000 194 170 24

Total 25,000 388 345 43

Table 11.22

Recruitment process of vacant BPMU positions is going on and all such position will be filled by March, 2011. Services of the all BPMU staff positions will be continued in the coming year.

Sl.

No. Name of the Positions Approved

Proposed

salary (11-

12) Months

Fund

required

(Lakh Rs)

Remarks

1 Block Programme Manager 194 13000 12 30264000 Budgeted under Sec. 11.4.1 -11.4.2 under Progm Management

of RCH

2 Block Accounts Manager 194 13000 12 30264000

Total 388 605.28

Table 11.23

11.2.2. Improving HR management of PMU staffs at all levels

Most of the positions under Programme Management unit at all levels have been filled.

Process for filling up the vacant positions has already been initiated and will be

completed before March, 2011.

Details of PMU staffs are as follows,

Category Required In Position Gap

State Program Management Unit 93 64 29

District Program Management Unit 120 87 33

Block Programme Management Unit 388 345 43

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Grand Total 601 496 105

Table 24

11.2.2.1. Policy for Human Resource

More than 600 professionals are presently working at various levels as part of

programme management Unit in Jharkhand. For strengthening the PMUs at all levels

development of HR policy is required for better HR management, performance

management systems against set standards, leave regularizations, salary disbursal,

TA/DA etc. Therefore state has proposed to develop HR policy for its health staffs in FY

2011-12.

Particulars Unit Unit Cost Total Cost (in

Lacs)

Remarks

Development of HR Policy and Cost for recruitment process

1 25 25 Budgeted under Sec. 11.1.18 under Progm Management of RCH

Table 11.25

11.2.2.2. Introducing the performance management system

It is also proposed to introduce performance management system for enhancing the

performance of the PMU personnel. As part of appraisal system, pay band will be

introduced with annual increment system. As part of performance management

system, contractual services of SPMU, DPMU and Consultants will be renewed annually

based on performance. Initial contract for the PMU staffs will be done for 2 years and

will be further renewed as per the performance. The annual enhancement in

honorarium after completion of one year service will be done based on the

performance in the preceding year. The enhancements in honorarium will be maximum

up to 10 % or of the preceding year’s amount as approved in the HR policy, depending

upon performance.

11.2.2.3. Joint MDPs will be conducted for all DPMU, SPMU and consultants alongwith

Civil Surgeons, Additional Chief Medical Officers and Dist. RCH Officers to develop the

District level teams for better understanding and make the functioning smooth.

11.2.2.4 Leadership and Management Trainings for developing leadership and

management skills for state and district level teams will be arranged in this

year. Management training will also be conducted for the medical officers

working at the primary health centres and community health centres.

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11.2.2.5 It is also proposed to introduce performance management system for enhancing the performance of the PMU personnel. As part of appraisal system, pay band will be introduced with annual increment system. Proposed pay band for the existing PMU personnel would be as follows:

Sl # Category Salary Band (Rs per month) Remarks

1. State Level Consultants 35,000/- to 60,000/-

2. State Programme Manager 35,000/- to 60,000/-

3. State Finance Manager 28,000/- to 60,000/-

4. State Accounts manager 25,000/- to 50,000/-

5. State Data Officer 22,000/- to 40,000/-

6. Systems Analyst 20,000/- to 30,000/-

7. Computer Operators 10,000/- to 16,000/-

8. District Programme Manager 25,000/- to 40,000/-

9. District Accounts Manager 20,000/- to 32,000/-

10. District Data Officer 18,000/- to 30,000/-

11. District Program Co-ordinator 22,000/- to 35,000/-

12. Block Programme Manager 12,000/- to 22,000/-

13. Block Accounts Manager 10,000/- to 20,000/-

Table 11.26

11.3. Training Institutes

The major challenge faced by the Department of Health and Family Welfare is large

number of vacancies against the sanction positions in clinical services and

administrative support services. In view of it, State has already initiated the process for

the manpower planning for its future requirements of clinical and non clinical services.

Lack of Training Institutions in public health department at all levels in the State is a

major concern. It is major hindrance in the efforts for developing the capacities as well

as manpower for the future requirements. At present, there are very few training

Institutions working at District and State level. 10 ANM Training Centers are functional

at District level with annual output of 600 ANMs. All these training centers are situated

in the District Hospital premises. Along with this, 3 GNM Training Schools and only one

college of Nursing is working in the State. At regional level, State has only one training

center. Only three medical colleges are functional in the State with out-put capacity of

190 per annum. Only one Nursing school for GNM and B. Sc. Nursing courses is

functional. Training Institutions for the LHVs, Male Health Workers, Nursing and para-

medical staffs are yet to be made functional.

It is proposed that a hierarchy of training Institutions will be developed in the State.

These training institutions will work as the resource organizations for various training

Page 17 of 129


activities. Efforts have been initiated and study has been conducted with support from

UNICEF for development of road map for strengthening the existing ANM Training

Centers as resource organization at District Level. Development of training Institutes at

State and Divisional level will be taken up in FY 2011-12 with technical support from

NHSRC and development partners like PHFI, UNICEF etc. All the training activities will be

co-ordinate and monitored through the training institutions to be set up at regional

level.

Institute of Public Health (IPH) has been notified as apex body for training and

development in Public Health, which will also work as the training resource organization

for the Department. Institute of IPH is now equipped with better training facilities. A

Hostel has also been developed for IPH for strengthening the residential trainings.

Gap of availability of teaching faculties and experts in IPH has also been thought to be

taken up in FY 2011-12. Also, two of the existing training centers at Divisional level will

be developed as regional training centers in the State. Regional training centers will

work as the extension of IPH at Divisional level for imparting training of health

functionaries at various levels. State will further explore the opportunity for setting up

of 3 more regional training centers in the State for intensifying its in-service capacity

building efforts in the coming years. The study will be taken up in collaboration with

UNICEF and other development partners.

State Health resource Center (SHRC) has been made functional in this FY. Efforts are

being done for further strengthening of SHSRC as a resource organization for the Public

Health in the State.

11.3.5. Jharkhand Lok Swasthya Sewa Vistaar Yojana (JLSSVY) The Jharkhand Lok Swasthya Sewa Vistaar Yojana (JLSSVY) is a programme for

improving health services in difficult area through provision of incentives for health

service providers.

Management of Human Resources for Health (HRH) is widely acknowledged to be an

essential domain for addressing health care services. This is especially true for public

health interventions that aim to ensure health access for the economically poor and

socially excluded sections of society. This shortage can have an extremely adverse

Page 18 of 129


impact on the provision of health care services, more so in deprived and low income

regions that bear the highest burden of diseases. Developing a policy framework for

HRH thus assumes critical importance for a state that professes to be committed to

providing quality health care to the “last person of the last household of the last

village”.

Jharkhand’s public health system faces a variety of human resource challenges,

primarily associated with an overall lack of health professionals in key areas. Health

facilities areas are found to be severely under staffed especially in low income districts

at lower levels of the health system. This poses a major hurdle for efforts to scale up

health systems to reach out to remote and marginalized regions. The severity of the

problem is effectively demonstrated by the gaping divide between demand and supply.

When it comes to the service delivery issues, huge number of the Jharkhand health

facilities, including a larger amount of district hospitals in the state, has a long way to go

in order to reach the minimum levels of service provision.

When analysing the reasons, it is evident that there is a clearly severe HRH crisis

prevailing in the state, which is even challenging when it comes to difficult areas. Any

effort to address these challenges needs to adopt a holistic approach aiming for

comprehensive reforms in the health sector. Acknowledging the critical role of

workforce policy in health sector reforms, and the urgent need to identify the

unreached, the National Rural Health Mission (NRHM) launched a country wide

initiative to identify areas that are difficult to serve and need special solutions. It was

decided that these areas would qualify for intensive focus and additional financial

support through NRHM. Having completed the health facility classification, Jharkhand

Rural Health Mission (JRHM) now seeks to initiate the process for developing an

incentivisation policy to support and motivate health professionals working in the

state’s identified difficult areas. Through this policy State intends to concentrate its

efforts towards increasing HRH in rural areas and consequently bridging the gap

between HRH availability and the existing unmet needs of the community especially in

the area of Reproductive and Child Health.

Looking at these issues comprehensively, the Jharkhand Rural Health Mission Society

has decided to come up with “Jharkhand Lok Swasthya Seva Vistaar Yojna”, with a

designated plan for incentivising health service providers at various levels. Framework

of this scheme is based on a study of various state level initiatives in adopting and

Page 19 of 129


facilitating similar incentive mechanisms in rural health systems across India. Based on a

review of such initiatives, lessons and implications are drawn out to enable formulation

of an effective programme for improving Jharkhand’s rural health systems. This scheme

will be implemented based on the policy approval by the state, on the Jharkhand Lok

Swasthya Sewa Vistaar Neeti.

11.3.6. Goals and Objectives of “Jharkhand Lok Swasthya Seva Vistaar Yojna”

In the initial period of its implementation, the policy aims to support health services

focusing maternal and child health services in the targeted areas where the provision of

services are poor for various reasons, primarily the crisis related HRH shortage and HRH

motivation. Towards this end, the main objective of the policy is to motivate and retain

key health professionals and workforce posted in Jharkhand’s identified hard to reach

areas and to attract more workforce to those areas.

11.3.7. Expected Outcomes of the Scheme

Increased availability of desired set of human power at all levels, especially in highly

difficult areas

Improved Staff motivation and commitment

Improved performance of facilities against standards set

Better coverage of otherwise excluded people- scheduled populations, BPL category

populations and other vulnerable groups

11.3.8. Mapping and Notification of Health Facilities Covered under the Scheme

Health challenges in remote regions, areas with difficult terrain and with high

percentage of socially excluded communities, are more acute due to shortage of human

resources including doctors and paramedics. The health challenges in such areas call for

special focus and innovative solutions. Accordingly, it was decided that through NRHM

additional financial support (for human resources, infrastructure maintenance and

logistics supply chain management etc) would be made available to such areas. The task

of classifying the health facilities into difficult, most difficult, and inaccessible areas was

undertaken through the states governments. Besides, the existing norms like terrain,

left wing extremism, tribal concentrations followed by some states, other factors like

absence of proper road communication, electricity, telecommunication services, public

transport and climatic factors were also taken into consideration while preparing the

Page 20 of 129


area categorization. Based on the criteria, various health facilities were classified into

different Categories as given below, which will be notified in the specific formats as

finalised in the policy.

11.3.9. Health Facility Categorization:-

SN Level of Facility

Category

Total Difficult (A) Most Difficult (B)

Extreme Difficult/ Inaccessible (C)

1 Sub Centre 528 222 180 930

2 PHC 88 37 30 155

3 CHC/RH 64 20 36 120

4 District Hospital 6 5 8 19

686 284 254 1224

Table 11.27

11.3.10. Mapping of HRH under the Scheme

Mapping of HRH is essential for ensuring strategic planning and facilitating adherence

to the plans. The HRH mapping for Module-I is intended to asses RCH related HRH

requirement and availability in Jharkhand's Rural Health Care Systems. The assessment

will cover all facilities ranging from sub-centers to district hospitals (DHs). The mapping

exercise will entail mapping and coding of HRH, Listing of all key health professionals

into an HR database, and rationalisation of workforce based on coded/categorised

facilities. With focus on all the above components, the HRH mapping exercise will be

conducted regularly on an annual basis to ensure information updating. The output

from this exercise will serve as a ready reference in HRH planning as well as

management, which is is also expected to provide basis for rationalizing future planning

for HR placements, promotions and transfers in the state.

11.3.11. Incentive Plan- Jharkhand Lok Swasthya Sewa Vistaar Yojna

For incentivising the critical health services, the Jharkhand Jan Swasthya Vistaar Neeti

will run a scheme called “Jharkhand Lok Swasthya Sewa Vistaar Yojna”, adopting the

method of differential financing. Under this, each level of facility will be placed with a

annual lump sum grant for covering payment of incentives for all levels of staff in the

said facility. Basic unit of monthly incentive shall be decided and notified for each level

of staff, and multiples of this unit would be finalised for a specific level, based on the

category and performance grade of the facility. For each facility, gradation shall be done

based on the performance criteria set for that level of facility, which shall derive the

Page 21 of 129


actual percentage of the incentive bracket to be paid to each individual, over and above

their routine monthly salaries and emoluments. In order to become eligible for getting

the incentive, all staff members need to be working in the specific hospital/health

centre, ie, the incentives are not calculated just based on the place of posting, but

based on the place of actual working.

Basic Unit of Monthly incentives for different staff cadre in each level of facilities shall

be decided, with a higher amount of unit for contractual staff (shown as y in the tables

below) if compared to the regular staff (shown as x in the tables below), considering the

issues of job security, non- availability of other emoluments than salary etc. Similarly

the how much times ‘x’ or ‘y’ to be paid to a person shall be decided based on the

facility level of his/her work and the position of his or her work. These details shall be

worked out as part of the policy to be approved by the state. The initial value for X is

proposed to be INR 1000 and Y is proposed to be INR 1200; finalisation, hike or

amendment in these units may be done as approved and notified by the Society, if

deemed necessary. An illustrative example for the payment structure is given below.

Incentive Eligibility pattern for Different categories:-

Sl Level of staff

Mode of employment

Unit of incentive payment

Incentives for Category A Facilities

Incentives for Category B Facilities

Incentives for Category C Facilities

A1 Meeting minimum performance indicators

A2 Meeting Medium Performance indicators

A3 Meeting Best Performance indicators

B1 Meeting minimum performance indicators

B2 Meeting Medium Performance indicators

B3 Meeting Best Performance indicators

C1 Meeting minimum performance indicators

C2 Meeting Medium Performance indicators

C3 Meeting Best Performance indicators

Regular

nx

50% 75% 100% 100% 125% 150% 150% 175% 200% Contractual

Ny

Table 11.28

11.3.12. Mechanism for Payment of Incentives:

All these incentives shall be paid on a quarterly basis, as a cumulative package of 3

months incentive amounts. After the interim period, these incentives shall be paid

strictly after the performance reviews by the respective review teams constituted for

the purpose, which should be conducted within a month of the last day of the quarter.

A lump sum annual grant shall be placed with RKS/HMS of the facility (block facility

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HMS/RKS for the subcentres) for meeting the payments based on the quarterly

approvals.

An operational guideline for the scheme shall be prepared for the scheme wherein all

processes, criteria, incentive levels and amounts, framework for payment, grievance

redressal mechanisms etc shall be specified. This will be done immediately after the

finalisation of policy by the state.

11.3.13. Budget Implications

This is a pilot plan to improve field level health performance that is expected to

contribute to improved maternal & child health. Based on a number of criterions as

elaborated in the previous section, the health facility categorization was completed for

Jharkhand, as detailed below.

SN Facility

Level

Total Difficult (A) Most Difficult (B) Inaccessible (C)

1 Sub Centre 528 222 180 930

2 PHC 88 37 30 155

3 CHC 64 20 36 120

4 District Hospital 6 5 8 19

686 284 254 1224

Table 11.29

The budget estimate was calculated on the basis of the state health facility categorization as above, and based on the categorization a staff plan was drawn out as given below:

SN Staff Category Difficult (A) Most Difficult (B) Inaccessible (C) Total

1 MO (MBBS only-General Physician) 480 194 268 942

2 Specialist (Obs/Gyn, Ped, Anesth) 228 90 156 474

3 Specialist (Others) 152 60 104 316

3 Staff Nurse 538 264 392 1194

4 ANM 1296 541 494 2331

5 Lab. Tech 158 62 74 294

6 All other staff 392 154 200 746

Total 2694 1149 1414 5257

Table 11.30

With the above number of officials to be paid incentives at the specified rates, different levels of facility shall need and approximate grant as worked out below, based on the payment requirements at different levels. Projection of Lumpsum grant to be kept with the facilities: Facility/Position qty Av. Incentive

unit Average Number of units

Months Percentile of units

Total average Payment

Page 23 of 129


ANM 1 1100 5 12 150% 99000

MPW 1 1100 5 12 150% 99000

Total 198000

PHC

Doctors 2 1100 8.5 12 150% 336600

Nurse 2 1100 5 12 150% 198000

Lab Tech 1 1100 4 12 150% 79200

other staff 3 1100 3 12 150% 178200

Total 792000

CHC

Specialist 4 1100 9.5 12 150% 752400

Doctors 3 1100 7.5 12 150% 445500

Staff Nurses 5 1100 6 12 150% 594000

Gen Nurse 3 1100 4 12 150% 237600

Lab Tech 2 1100 3 12 150% 118800

Others 6 1100 2 12 150% 237600

Total 2385900

District Hospital

Specialists 7 1100 7.5 12 150% 1039500

Doctors 10 1100 5.5 12 150% 1089000

Staff Nurse 12 1100 4 12 150% 950400

Gen Nurse 3 1100 3 12 150% 178200

Lab Tech 3 1100 2 12 150% 118800

Other staff 10 1100 1 12 150% 198000

3573900

Table 11.31

When these are adjusted and averaged to different categories, we are reaching to a projection of annual lump sum grants per facility as detailed below: Sl Level of Facility Amount of Lump Sum Grants for the Category of Facility

Category A Category B Category C

1 District Hospital 34 lacs 37 lacs 40 lacs

2 CHC/referral hospital/Block PHCs

designated as FRU

21 lacs 24 lacs 27 lacs

3 CHCs/Block PHCs not designated as

FRUs

15 18 21

4 PHCs with 24 x 7 BEmOC functions 7.0 8.0 9.0

5 PHCs not designated as 24 x 7 5.0 6.0 7.0

6 Sub centres conducting Deliveries 1.75 2.0 2.25

7 Sub Centres not conducting

Deliveries

1.5 lacs 1.75 lacs 2.0

Table 11.32

Page 24 of 129


Based on the above calculations above, requirements into averages for each levels and

categories of facilities. The total budget needs based on this exercise comes to about

INR 58 crores. However, we see that the preparatory time to get the policies passed

and notified, basic mapping and classification/grading work all shall take time. Also, we

may limit the first year implementation to one or two levels and categories of facilities

only, to be scaled up in the consecutive years. With all this, we are looking forward for

an allocation of 10 crore rupees during 2011-12. We expect we can scale this up and

continue this scheme during coming years as well.

11.3.14. Projected Budget:

Facility Level

Category Total

Facilities Total

Incentives Difficult (A) Most Difficult (B) Inaccessible (C)

Number Unit cost

Tot. cost

Number Unit cost

Tot. cost

Number Unit cost

Tot. cost

Number Tot. cost

Sub Centre

528 1.6 844.8 222 1.9 421.8 180 2.15 387 930 1653.6

PHC 88 6 528 37 7 259 30 8 240 155 1027

CHC 64 18 1152 20 20 400 36 24 864 120 2416

District Hospital

6 34 204 5 37 185 8 40 320 19 709

686

2728.8 284

1265.8 254

1811 1224 5805.6

Budget Requirement for Initial year 1000.0

Table 11.33 Budgeted under Sec. 9.1.13.1 under Infrastructure & HR of RCH

Result based Financing for Improving the Performance of Government Run Healthcare

Institutions

1. Background

It is commonly acknowledged that the service providers for health care service

deliveries face several challenges in implementing various schemes and programmes at

different level. The poor infrastructure, bottlenecks in logistics and supply chain

management, uneven workload without robust planning and monitoring mechanism

etc work as major causes behind de-motivation of the employees leading to poor

performance and output of the systems as a whole. Performance based

financing/incentives especially for the frontline service providers have produced

positive result in different countries in getting desired output. Motivating the

Page 25 of 129


community members (pregnant mothers) without self-motivation on the part of ANM

or FLWs etc although has been expected but not been fruitful in reality. For improving

the certain health seeking indicators amongst the community members DoHFW,

Government of Jharkhand, wants to incentivize the performance of the personnel

working for healthcare service delivery.

2. The Proposed Scheme/Norms

In order to improve the indicators of maternal and child health the DoHFW, Jharkhand, wants to provide incentives to the health personnel might be given for the same-

- To increase the institutional Delivery

- To improve the basic infrastructure of the facilities as set by the state

Government

The proposed norms is for improving the performance of the District Hospitals and CHCs of two districts which will be selected for piloting the scheme in the districts having large number of reported home deliveries. The district hospitals which conduct around 150 deliveries per month and the CHCs which conduct around 75 deliveries per month will be selected to operationalise this scheme for piloting this idea. This scheme will be part of the hospital friendly health initiative undertaken by the state Government. 3. Financial incentives

The financial incentives per case will be distributed amongst the following personnel as per the percentage mentioned ANM- 35% Staff Nurse- 35% MO – 10% Administrative Staff- 10% Corpus Money- 10%

Indicators Incentive Means of Verification

Increase the Institutional Delivery over and above 20% of the present status

Rs 500/- per case to be given to Facilities

Monthly Report

Improve basic infrastructure of facilities in different phases as to be set by state Government

Rs 50,000/- to be given to the facilities for achieving next target. 20% of total Rs 50,000/- (approx) to be awarded to health personnel.

Physical inspection and UC report

Result Based Financing (Institutional Deliveries)

Level 1 Level 2 RBF (Result Based Financing)

Base line Desired level (per month) Incentives per month @ 500 per case

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No. of deliveries 10 % increase in ID per case over and above desired level 2

Physical Infrastructure

Base line (Minimum Basic Facility Survey )

Desired level Incentives Bi annualy @ 50000 per facility

Labour Room

Avaliable and operational in well condition

20 % of the total incentive (of Rs 50000) to the service providers

Toilet

Emergency Drugs

Equipments

Minor repair

Electricity

Running Water

Level 1 : Current Status

For Institutional Delivery – The current status of institutional delivery to be assessed as per the monthly report available from the district.

For Physical Infrastructure- The state level team will undertake field visits to assess the critical broad indicators as mentioned above.

Level 2: The benchmark which will ensure the fulfillment to get incentives.

Total Budget for RBF for promoting Institutional Delivery

Facility

Current Institutional Delivery (total)

benchmark (10%)

Desired (25%)

Incentives to be given on cases (%)

Unit Rate

Total Amount

Total Amount per year

District Hospital (2) 300 330 375 45 500 22500 270000

CHC (6) 450 495 562.5 67.5 500 33750 405000

Indicator 2 Current Status Benchmark

Unit Rate Total Amount

Incentive for Health staff (20% of total)

DH (2) and CHC (6)

Facility Survey

As per set standard 50000 400000 80000 400000

Total Budget 1075000

Budgeted under Sec. 9.1.13.2 under Infrastructure & HR of RCH

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12. Addressing Gaps in Infrastructure

Infrastructure and facilities for Healthcare, not on a purely commercial basis, which

satisfy a public need. To ensure one progress of any state, it is important to ensure that

its people are healthy and have round the clock easy access to adequate health

infrastructure.

In the state at least one CHC is required in each block as per the present population.

Apart from the new CHCs that need to be built according to the norms. It is needed to

upgrade the PHCs into CHCs and increase the bed strength to 30 at least in each of

them immediately. The total number of CHC will be 188.

The gaps in accommodation are huge. PHCs do not have the required number of

quarters for Doctors as well as nurses. Whatever the existing quarters are there, they

are in a very sorry state. There is acute shortage of quarters for Paramedics and other

staff at all the PHCs. In the campus residential accommodation for all staff is required

not just for few is very necessary if we really want to have our CHCs working for 24

hours a day and 7 days a week.

Most of the quarters for the Doctors, Nurses, paramedics and other staff needs to be

immediately renovated and quarters need to be constructed according to the minimum

manpower norms for CHCs.

As far as APHCs are concerned, 117 APHCs are functioning without any facilities with

damaged building. They are either functioning in the sub-centre building or Panchayat

Bhawan. Almost 117 APHCs are functioning in government buildings but building

condition is very poor. In this regards 185 APHCs are running in rented buildings and 28

APHCs have no buildings. All APHCs are devoided of electricity, lacking of water supply

because Hand pumps are not functioning properly. There are no residential facilities for

staff.

Apart from the new PHCs (all APHC will converted into PHC) that need to be built

immediately. We need to construct building for the 1005 PHCs or the existing building

need to be taken over and upgraded according to the PHC norms. All PHCs which do not

have facility for electricity should be immediately provided with the electricity. Existing

Page 28 of 129


PHCs, which do not have any kind of water supply need to be provided with a bore from

where they can have their own water supply round the clock. Staff quarters need to be

built for all the new 1005 PHCs. This will definitely help in the long run of a dream of

PHCs functioning for 24 hours a day and 7 days a week. Most of the PHCs do not have a

separate labour room or any kind of privacy during delivery. Until and unless all the

PHCs are equipped with the proper facilities and privacy, there will never be support

from the locals residing in the vicinity of the public facility for institutional delivery

whatever else we do for achieving 100% institutional delivery.

Out of 3958 existing Health Sub-Centre 1732 HSCs are running in Government building,

1953 HSCs are running in rented building and 273 HSCs are running in rent free building.

Almost all the Government buildings are in poor conditions and immediately renovation

/ new constructions are required. But 1732 HSCs are not in IPHS norms, so the

Government building will be also required new building. As per population norms and

geographical conditions 2858 new more sub-centers are required to provide better

health facility to the community. The total number of new buildings is required 4766

and others are renovated including rented buildings & rent free buildings i.e. (1732

existing building + 2858 new + 1953 rented + 273 rent free buildings). The total

requirement of HSC buildings are 6816.

The current Infrastructure Situation: Out of 212 blocks in Jharkhand are proposed to be converted to CHCs but are still

awaiting sanction from the Government. Currently 194 PHCs, 330 APHCs and 3958 HSCs

are functioning in the state. 22 State hospitals & 6 Sub – divisional hospitals are located

in the various states of Jharkhand state. So there is no need of CHC built there. The

state wise details are as follows:

States

Population covered PHCs

Existing (In No.)

APHCs Existing (In No.)

HSCs Existing (In No.)

HSC Functioning in

Rented Building

HSC Functioning in

Rent free Building

Bokaro 1777662 8 16 116 53 27

Chatra 791434 6 8 93 23 5

Deoghar 1165390 8 5 181 118 0

Dumka 1106521 10 36 258 125 4

Jamtara 653081 4 15 132 77 0

Dhanbad 2397102 8 28 137 77 0

Page 29 of 129


E. Singhbhum 1982988 9 16 242 204 0

Garhwa 1035464 8 10 111 58 5

Giridih 1904430 12 15 180 20 0

Godda 1047939 7 9 188 111 10

Simdega 514325 7 7 155 88 1

Gumla 832447 11 13 242 138 8

Hazaribagh & Ramgarh

2277475 14 19 203 41 15

Koderma 499403 4 5 65 15 0

Lohardaga 364551 5 10 73 2 3

Pakur 701664 6 9 121 62 4

Palamu 2098359 10 21 172 132 10

Latehar 560898 7 10 99 12 0

Ranchi & Khunti 2785064 20 32 502 166 123

Sahibganj 927770 7 10 141 67 4

Saraikela 873613 8 12 194 153 10

W. Singhbhum 1233945 15 15 342 211 41

Jharkhand 26945829 194 330 3958 1953 270

Sanction of Facilities against Norms: There has been a creation of 6817 new sub centres and

1005 new PHCs and 188 CHCs in this period. This has brought up the creation of public health

facilities to what has been stated as required as per national norms. Currently, the state has

3958 sub centres and 330 PHCs which meets the current national norms. In the case of CHCs, we

have meeting almost one CHC per block- though it needs more CHCs to meet the national

norms. On the other hand, the requirement of district hospitals has been met except for 3

districts where the existing district hospitals have been upgraded as 100 – 300 bedded hospitals.

Additional Infrastructure to be Created / Sanctioned as required as per IPHS norms under NRHM

Sl. No. Districts

CHCs PHCs HSCs

No. of Building Required 0n IPHS Norms

Population covered

Existing (In No.)

Proposed

(In No.)

Required PHCs as per IPHS Norms (In No.)

Existing APHC

(In No.)

Additional

PHCs to be

created under NRHM

Proposed as per IPHS

Norms (In No.)

Existing (In No.)

Additional HSCs to

be created under NRHM

1 Bokaro 1777662 8 7 59 16 43 175 116 59 241

2 Chatra 791434 6 10 26 8 18 158 93 65 194

3 Deoghar 1165390 8 7 36 5 31 229 181 48 272

4 Dumka 1106521 10 9 46 36 10 303 258 45 358

5 Jamtara 653081 4 3 42 15 27 283 132 151 328

6 Dhanbad 2397102 8 7 80 28 52 479 137 342 566

7 E. Singhbhum 1982988 9 8 49 16 33 435 242 193 492

8 Garhwa 1035464 8 13 36 10 26 241 111 130 290

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9 Giridih 1904430 12 11 57 15 42 381 180 201 449

10 Godda 1047939 7 6 40 9 31 251 188 63 297

11 Simdega 514325 7 6 22 7 15 181 155 26 209

12 Gumla 832447 11 10 42 13 29 283 242 41 335

13 Hzr & Ramgarh 2277475 14 13 76 19 57 455 203 252 544

14 Koderma 499403 4 3 17 5 12 100 65 35 120

15 Lohardaga 364551 5 4 20 10 10 108 73 35 132

16 Pakur 701664 6 5 35 9 26 234 121 113 274

17 Palamu 2098359 10 11 28 21 7 321 172 149 360

18 Latehar 560898 7 6 21 10 11 188 99 89 215

19 Ranchi & Khunti 2785064 20 19 139 32 107 928 502 426 1086

20 Sahibganj 927770 7 8 40 10 30 299 141 158 347

21 Saraikela 873613 8 7 39 12 27 259 194 65 305

22 W. Singhbhum 1233945 15 15 55 15 40 417 342 75 487

Jharkhand 26945829 194 188 1005 321 684 6708 3958 2761 7901

CHC : The Existing PHCs will be upgraded into CHC.

PHC :

Existing 321 APHC will be upgraded into PHC. Besides this, 684

new PHCs will be in position. Thus the total Nos. are 1005

including existing & Proposed.

HSC :

Total 2761 HSCs are required in the Jharkhand State under NRHM

& Existing HSCs 3958 will be upgraded as per IPHS Norms. The

total nos. are 6791 including existing & proposed.

Creation of Buildings: There has been acceleration in creation of buildings also. Taking

funds from various sources – the table is given below:

Sl. No.

Institution NRHM State MSDP BRGF Welfare Department

1 CHC 18 126 15

2 PHC 5 81 43 10

3 HSC 73 319 1092 72 200

Associated Organizations:

1. Engineering Cell 2. Building Division 3. REO 4. Rural Development Special Division

Page 31 of 129


5. NREP 6. District Engineering Division 7. HSCL 8. NBCC 9. Housing Board

The details list of infrastructure are being const constructed under NRHM are given below:

353.59 159.00 0.00 194.59 353.59 0.00 59.13

353.59 150.00 50.00 153.59 353.59 0.00 200.00

353.59 50.00 50.00 253.59 353.59 0.00 50.00

318.00 150.00 0.00 168.00 318.00 0.00 63.00

318.00 50.00 100.00 168.00 318.00 0.00 97.58

318.00 50.00 0.00 268.00 318.00 0.00 50.00

353.59 50.00 87.61 215.98 353.59 0.00 76.15

353.59 50.00 50.00 253.59 353.59 0.00 50.00

353.59 50.00 50.00 253.59 353.59 0.00 300.00

367.81 50.00 0.00 317.81 367.81 0.00 50.00

376.53 50.00 50.00 276.53 376.53 0.00 17.39

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318.00 100.00 100.00 118.00 318.00 0.00 NREP-II 150.00

353.59 200.00 50.00 103.59 353.59 0.00 NREP-I 230.00

318.00 150.00 0.00 168.00 318.00 0.00 NREP-II FIR

318.00 200.00 50.00 68.00 318.00 0.00 HSCL 200.00

366.84 200.00 150.00 16.84 366.84 0.00 287.50

366.84 200.00 100.00 66.84 366.84 0.00 292.50

366.83 275.00 50.00 41.83 366.83 0.00 200.00

6227.98 2184.00 937.61 3106.37 6227.98 0.00 2373.25

149.41 64.75 84.66 0.00 149.41 0.00 33.92

129.49 50.00 79.49 0.00 129.49 0.00 79.00

129.49 50.00 79.49 0.00 129.49 0.00 79.00

Root Costing

Page 33 of 129


129.49 50.00 79.49 0.00 129.49 0.00 129.49

129.49 50.00 79.49 0.00 129.49 0.00 129.49

667.37 264.75 402.62 0.00 667.37 0.00 450.90

22.49 10.00 12.49 0.00 22.49 0.00 22.49

22.49 10.00 12.49 0.00 22.49 0.00 22.49

22.49 10.00 12.49 0.00 22.49 0.00 22.49

22.49 10.00 12.49 0.00 22.49 0.00 22.49

22.49 10.00 12.49 0.00 22.49 0.00 22.49

22.49 10.00 12.49 0.00 22.49 0.00 22.49

22.49 10.00 12.49 0.00 22.49 0.00 22.49

22.49 10.00 12.49 0.00 22.49 0.00 22.49

22.49 10.00 12.49 0.00 22.49 0.00 22.49

DC

22.49 10.00 12.49 0.00 22.49 0.00 22.49

22.49 10.00 12.49 0.00 22.49 0.00 22.49

22.49 10.00 12.49 0.00 22.49 0.00 22.49

22.49 10.00 12.49 0.00 22.49 0.00 22.49

22.49 10.00 12.49 0.00 22.49 0.00 3.23

22.49 10.00 12.49 0.00 22.49 0.00 0.00

22.49 10.00 12.49 0.00 22.49 0.00 0.00

22.49 10.00 12.49 0.00 22.49 0.00 17.59

Page 34 of 129


22.25 10.00 12.25 0.00 22.25 0.00 16.69

22.25 10.00 12.25 0.00 22.25 0.00 10.00

22.49 10.00 12.49 0.00 22.49 0.00 12.41

22.49 10.00 12.49 0.00 22.49 0.00 7.32

22.25 10.00 12.25 0.00 22.25 0.00 16.68

22.25 10.00 12.25 0.00 22.25 0.00 17.25

22.25 10.00 12.25 0.00 22.25 0.00 10.00

22.25 10.00 12.25 0.00 22.25 0.00 14.25

22.25 10.00 12.25 0.00 22.25 0.00 15.25

22.25 10.00 12.25 0.00 22.25 0.00 15.75

22.25 10.00 12.25 0.00 22.25 0.00 15.96

22.25 10.00 12.25 0.00 22.25 0.00 15.23

22.49 10.00 12.49 0.00 22.49 0.00 12.00

22.49 10.00 12.49 0.00 22.49 0.00 12.00

22.49 10.00 12.49 0.00 22.49 0.00 12.00

Page 35 of 129


22.49 10.00 12.49 0.00 22.49 0.00 12.00

739.77 330.00 409.77 0.00 739.77 0.00 527.98

22.49 15.00 0.00 7.49 22.49 0.00 NREP 3.00

22.49 15.00 0.00 7.49 22.49 0.00 NREP 3.00

21.16 15.00 0.00 6.16 21.16 0.00 15.00

22.49 15.00 0.00 7.49 22.49 0.00

22.49 15.00 0.00 7.49 22.49 0.00

22.49 15.00 0.00 7.49 22.49 0.00 NREP 15.00

22.49 15.00 0.00 7.49 22.49 0.00 NREP 15.00

22.23 15.00 0.00 7.23 22.23 0.00

22.23 15.00 0.00 7.23 22.23 0.00

15.00 15.00 0.00 0.00 15.00 0.00 3.17

22.49 15.00 0.00 7.49 22.49 0.00

22.49 15.00 0.00 7.49 22.49 0.00

22.49 15.00 0.00 7.49 22.49 0.00 9.36

22.49 15.00 0.00 7.49 22.49 0.00 7.32

22.49 15.00 0.00 7.49 22.49 0.00

22.49 15.00 0.00 7.49 22.49 0.00

22.49 15.00 0.00 7.49 22.49 0.00

22.49 15.00 0.00 7.49 22.49 0.00

22.49 15.00 0.00 7.49 22.49 0.00

22.49 15.00 0.00 7.49 22.49 0.00

22.49 15.00 0.00 7.49 22.49 0.00

Page 36 of 129


22.49 15.00 0.00 7.49 22.49 0.00

22.49 15.00 0.00 7.49 22.49 0.00

22.49 15.00 0.00 7.49 22.49 0.00

22.49 15.00 0.00 7.49 22.49 0.00

22.49 15.00 0.00 7.49 22.49 0.00

22.49 15.00 0.00 7.49 22.49 0.00

22.49 15.00 0.00 7.49 22.49 0.00

22.49 15.00 0.00 7.49 22.49 0.00

22.49 15.00 0.00 7.49 22.49 0.00

22.49 15.00 0.00 7.49 22.49 0.00 22.49

22.49 15.00 0.00 7.49 22.49 0.00 22.49

22.49 15.00 0.00 7.49 22.49 0.00 NREP 21.00

22.49 15.00 0.00 7.49 22.49 0.00 NREP 21.00

22.49 15.00 0.00 7.49 22.49 0.00 15.00

22.49 15.00 0.00 7.49 22.49 0.00 15.00

22.49 15.00 0.00 7.49 22.49 0.00 15.00

22.49 15.00 0.00 7.49 22.49 0.00 15.00

22.49 15.00 0.00 7.49 22.49 0.00 BDO 7.00

22.49 15.00 0.00 7.49 22.49 0.00 BDO

890.26 600.00 0.00 290.26 890.26 0.00 224.83

73 1630.03 930.00 409.77 290.26 1630.03 0.00 752.81

Infrastructure is the backbone of streamlining the health programme up to the

community level. Candidly the architectural improvement has been made in the various

dimension of infrastructural up gradation under the NRHM programme.

Page 37 of 129


Proposal of New Construction of CHC, PHC, HSC and 500 bedded Hospital at Dumka

It is essential to mention that 18 CHCs, 5 PHCs and 73 HSCs will be completed in the

financial year 2011-12 under NRHM programme. Keeping in view 15 CHC, 40 PHC, 250

HSC and 500 bedded Hospital have been proposed for construction in the FY 2011-12.

The total time of completion of HSC construction is 6 months, PHC and CHC is 18

Months. So we will propose the 50% of the total amount of PHC and CHC in the

financial year 2011 – 12 and next 50% for ongoing construction of PHC and CHC in FY

2012-13.

500 bedded Hospital at Hansdiha (Dumka)

Santhal Pargana region is backward, poor and in utter deprivation yet in modern era.

So much so this hilly terran area is not having any specialized medical facilities,

particularly the medical institutions despite of the fact that it had a very good history of

ancient education. Maharishi Arvind had established his holly ashram since long back.

Mahatama Gandhi mentioned about this place in his biography. Swami satyanand set

up his Yoga Ashram at Rekheya, which is also visited by large number of foreign tourists

every year. The Mandar Mountain of Samudra Manthan fame is nearly 40 kms away

and the famous Vikramshila University is hardly 100 kms away from Deoghar.

But in current time, needless to say the reduction on public health spending and the

growing inequalities in health and health care are taking its toll on the marginalized and

socially disadvantaged population of Santhal Pargana. Recently published report say’s

that “a child in the ‘Low standard of living’ economic group is almost four times more

likely to die in childhood than a child in the ‘High standard of living’ group. Child born in

the tribal belt is one and half times more likely to die before the fifth birthday than

children of other groups. Children below 3 years of age in scheduled tribes and

scheduled castes are twice as likely to be malnourished than children in other groups. A

tribal mother is over 12 times less likely to be delivered by a medically trined person. A

tribal woman is one and a half times more likely to suffer the consequences of chronic

malnutrition as compared to women from other social categories.

These figures speak for themselves and being to the fore unequal distribution of

resources and the effect of it on public health parameters. This unequal distribution of

resources is further complimented by inability access to healthcare due to various

access difficulties. Setting up the super specialty hospital at Hansdiha (Dumka) mainly

Page 38 of 129


because it’s geographically central location and ease of commuting for the paitents

from all across Doghar-Dumka and Godda. Secondly the above mentioned area is one of

the most backward areas where medical facilities and creation of health awareness are

really needed.

It is very much indispensable to mention that we need the new construction of CHC,

PHC, HSC and ongoing construction of HSC for better endurance and easy access the

health services to the community. Hence the estimated budget for new infrastructure

has been proposed. The Total Budget worth Rs. 14109.80 Lacs (One Hundred Forty One

Nine lakhs and Eighty Thousand only).

Components/ Activities Unit Unit Cost

(Rs.in Lakhs)

Physical Target

Financial Outlay (Rs.in Lakhs)

Remarks

2011-12 2011-12

New HSC construction HSC 22.49 250 5622.50 Budgeted under Sec. 6 under New Construction of NRHM Additionality

New PHC construction PHC 129.49 40 2589.80*

New CHC construction CHC 318.00 15 2385.00*

Ongoing construction of HSC HSC 7.50 335 2512.50

Construction of 500 Bedded Hospital in Dumka

per constr.

1000.00 1 1000.00

14109.80

* only 50% of the required fund has been demanded in FY 2011-12.

Page 39 of 129


13. Community Mobilization

Progress so far as per SPIP 10-11

Vision for Community Participation in 2011-12

Operational Objectives

Plan of action for the Financial Year 2011-12

Budget require for FY 11-12

The thrust of the National Rural Health Mission (NRHM) is to establish a fully functional,

community owned, decentralised health delivery system with inter-sectoral

convergence at all the levels, to ensure simultaneous action on a wide range of

determinants of health including social and gender equality. From narrowly defined

schemes, the NRHM has shifted the focus of health initiatives to a functional health

system at all levels, from village to the district with active Panchayati Raj Institutes (PRI)

and communities that are motivated and mobilised to access and demand services.

To ensure community participation and to make public health delivery system fully

functional and accountable to the community ‘Communitization’ has been identified as

a key working strategy under NRHM. It implies the capacity building of community in

identifying their own health needs, analyzing the causes of their problems, prioritize

and planning as per their needs and problems, rigorous monitoring & evaluation

ensuring that the accessibility, quality, behavioral and policy issues are as per defined

standards, reviewing the progress made through these interventions and Human

Resource Management and flexible financing.

Progress so far as per SPIP 10-11

Strategy as per PIP (10-11)

Status Comments

Sahiyya selection and capacity building

40,964 Sahiyyas (ASHAs) have been selected by the VHCs and Villagers through the Gram Sabha. Training on Module V i.e. Leadership Module completed for all Sahiyyas.

Today the Sahiyya is an empowered woman with an identity of her own.

VHC strengthening 30,012 Village Health Committees have been constituted Bank account has been opened for 26,636 VHCs and untied funds for these VHCs have also been transferred

The formation of VHCs and meetings of the same at the village level has provided the much needed platform to the community to raise its voices and issues.

VHC capacity building VHC member’s preliminary orientation on roles and

Page 40 of 129


Strategy as per PIP (10-11)

Status Comments

responsibilities carried out at block HQs across all 24 districts of the state. Orientation of VHCs and Sahiyyas on Operationalization of Village Health and Nutrition Day conducted in November and December, 2010.

Support team for community

participation under NRHM

VHC and Sahiyya Resource Centre (VSRC) team in place at the state level District Programme Coordinators (DPC) has been placed in 21 districts of the state to facilitate and promote community participation initiatives. 6 Regional coordinators placed in the six regions of the state to support the district teams and to liaison with officials as a part of the VSRC team State Training Team (STT) identified and trained (50/2 per district) Block Training Team (BTT) identified and trained (212X4= 848 i.e. 4 per district, primarily women)

VSRC team supports training, monitoring, and preparation of materials and planning of activities mandated under NRHM. Assessment of all STTs and BTTs on training capabilities has been conducted.

Materials/IEC/modules preparation

5th

module on leadership designed and prepared for Sahiyya VHC module on ROLES/RESPONSIBILITY and village health plan designed and prepared for VHC members. Sahiyya bulletin and appeal from the Mission Director prepared and sent for distribution. Sahiyya pass book and VHC register prototype prepared and sent to districts for printing. Disease and nutrition book (6A & B) prepared for review.

Specific Activities and innovations carried out

in ongoing financial year to strengthen

Community Action are:

1. 60 ,Sahiyya help desk training done and desk established in 16 districts and 22 CHCs

2. Pilot JAN-SAMVAD (public hearing) held at Angara Block of Ranchi District and tools developed for community based monitoring. All 20 District Programme Coordinators has been trained on CBM.48 BTTs form all 24 districts have been trained on CBM.

3. Sahiyya facilitation structure designed/Sahiyya Saathi identification under process.

4. Cluster meeting structure designed and field tested.

5. Sahiyya Sammelan process and materials finalized.

6. Sahiyya Sandesh Yatra concept designed for roll out.

7. Data base for Sahiyyas and VHC designed and Data entry in process

Table 13.1

Page 41 of 129


SOME FACTS AND FIGURES

Cluster formation for carrying out the VHC Trainings was done. The number of

Clusters formed was 2184.

Supportive supervision was provided to the statewide Sahiyya Training on Leadership.

The numbers of Sahiyyas trained during this training were 39,264.

The impact of all these activities has been encouraging and can be listed as follows.

1. Dialogue with Sahiyyas restarted and established at various levels.

2. Sahiyyas activated, motivated and capacitated through intensive cascade trainings

and interpersonal communication

3. Village health committee sensitized about their roles and responsibilities.

4. Village health committee bank accounts opened and untied fund transferred.

5. Transparent and rational use of untied funds initiated and expenditure report

sought.

6. Community mobilization on health issues initiated

7. The participation of community in health camps, sterilization and tubectomy camps

increased.

8. The immunization, institutional delivery and OPD patient’s numbers increased

reposing faith in the health system.

9. Training resource pool established under VSRC

10. Jharkhand specific modules and materials developed

11. The community /health system interaction and dialogue established and improved.

11.1. Vision for Community Participation in 2011-12:

The Vision of ‘Promoting Community Participation’ under NRHM upholds five

dimensions- social mobilization, Capacity building, Programme support system,

monitoring & evaluation and learning by doing (innovation) towards ensuring health

for all.

The dimensions are often reflected in particular operational designs that are based on

several common institutional arrangements, a multi-sectoral and cross functional

Page 42 of 129


framework and a dynamic people-centered relationship among the various

stakeholders.

While Capacity building efforts are not new in the broad spectrum of activities

undertaken in community participation initiatives in the state of Jharkhand this year the

strong emphasis will be given on an integrated enabling environment for sustaining the

ongoing efforts and building people-institutes at grassroots. For example, efforts for

Village Health Planning and capacity building of local government (Panchayati Raj

Institutes) are critical element of the overall enabling environment for community

empowerment.

13.2 Operational Objectives:

To ensure the presence of trained social health activities (Sahiyya) in all the

populations of the state based on the norms.

To have functional Village Health Committees with bank accounts in all the

villages of the state based on the norms for the same.

To sensitize and capacity build of the newly elected PRI members on the public

health issues.

To empower at least 75% of VHCs to prepare Village Health Plan.

To ensure least 80% of the VHCs are organizing Village Health and Nutrition Days

in their respective villages.

To complete the Sahiyya training on the Disease and Nutrition modules (12

days) and equipping them with new born care (HBNC) kit and counseling flip

charts (Salter weighing machines, thermometers, watches)

To strengthen the mentoring mechanism for Sahiyya, VHC and other

community initiatives at Panchayat, Block, District and State Level.

13.3 Plan of action for the Financial Year 2011-12

Strategies

Activities proposed for 2011-12

Introducing novel strategies for community mobilization (2011-12)

Expected Outcomes

Page 43 of 129


13.3.1. Strategies:

13.3.1.1 CAPACITY BUILDING:

To increase the effectiveness of roles with respect to implementation of NRHM at

community level, capacity building of Sahiyya, Sahiyya Sathi, Village Health Committees

and newly elected PRI members as well as newly formed VHCs and Sahiyyas for

Primitive Tribal Groups is a key strategy. Necessary orientation with respect to

programme management shall be provided to District Programme Coordinators and

Training Teams. Orientation and hand holding of VHCs for preparing village health plan

and proper utilization of untied funds has been carried out in the last year as a part of

this process.

TRAINING ROLL OUT STRATEGY

The trainings shall be imparted based on cascade approach having 3 levels State,

Regional and the actual training at block level. A two days capacity building package for

Block Training Team members mainly on Training Methodology, Team Building, and

Motivations will be designed and imparted. A state level Tot will be conducted and all

The VHC & SAHIYYA RESOURCE

CENTRE

(STATE LEVEL)

STATE TRAINING TEAM

(2 per district)

BLOCK TRAINING TEAM

(4 per block)

VHC SAHIYYA

Page 44 of 129


the BTTs (844) will be trained at district level. With the aim of establishing Sahiyya

mentoring team at the district level as well to facilitate the effective implementation of

the Sahiyya Programme, 21 District Programme Coordinators have been placed at the

district level. In order to enhance the capacity of DPCs on Result Based Management

and Rights Based Approach in community processes a four days residential training

programme will be designed and imparted to the DPCs. The participants will learn how

to strengthen the public health delivery system and essential competencies to think and

act systematically for managing the district level communitization processes.

13.3.1.2 Programme Support System:

A support structure for Sahiyyas (approximately one per 20 Sahiyyas) is proposed at

each block PHC area, wherein selections are to be based on active participation in

Sahiyya programme or other critical social processes. The process of selection of

members of this support structure called Sahiyya-Sathis has already been initiated. So

far, 974 (till the month of Dec, 2010) Sahiyya Sathis have been selected. Apart from

ensuring on the Job trainings, the Sahiyya Sathis will organize VHC meetings, Sahiyya

meetings, Village Health and Nutrition Days, Community Based Monitoring processes

etc.

National Health System Resource

Centre

District Program Coordinator

Admin and

Finance

Officer

Jharkhand State Health Resource

Centre

CINI-VSRC Support

Team

State Program

Coordinator

STT BTT Regional

Coordinator

Village Health

Committee

Sahiya Saathi

Sahiyya

Community Participation Cell

Village Health Committee-Sahiya Resource Centre (VSRC)

(CINI, ICCHN, NHSRC and Jh Rural Health Mission)

Page 45 of 129


The Sahiyya Sathis will be provided with specially designed ‘Activity Planner’ to

facilitate them for effective planning and implementation of their activities. Sub-center

level Sahiyya Days and convergence meetings will be institutionalized with the active

leadership from the Panchayat leaders and Sahiyya- Sathis will facilitate the meetings at

Sub Center level.

Periodical monitoring and reviews as well as report collection of Sahiyyas active role

shall be done through the Sahiyya Sathis, who is expected to work for about 15 days in

a month. Block level Sahiyya trainers called Sahiyya Prashikshikas (4 in number) shall be

brought in to ensure effective training and coordination of this team, after completing

their training loads calculated upto 10 days in a month. All these volunteers shall be

paid on a day-compensation against livelihood loss basis compensated volunteers. A

similar structure is suggested in the ASHA national guidelines as well.

Apart from this the district level and state level Sahiyya mentoring system will be

activated through regularizing the review meetings etc.

Streamlining incentives payment mechanisms for Sahiyyas and forging linkages

between Sahiyyas and other front line workers like ANMs, AWWs, para teachers &

Strengthening the District Level Sahiya Mentoring Team to guide the District

Programme Coordinators and Block Level Teams shall also constitute the Sahiyya

Support System. ‘Sahiyya Diaries’ and planning formats for better programme

implementation and smooth payment shall aide the above process.

13.3.1.3 CONVERGENCE

Convergence meetings (ICDS, PHED, SSA, HEALTH, PRI, and VHC) at Sub center level to

plan and review the activities of the month under the chairmanship of Panchayat

Leader.

13.3.1.4 Establishing a ‘Community Based Information System’ (CBIS) system

In line with HMIS to track and measure the real impact of the Sahiyya Programme based

on indicators set in HRHM.

Page 46 of 129


13.3.1.5 Institutionalizing the monthly review meetings

At different levels (Block, District and State) for establishing better coordination.

13.3.1.6 Conducting research, advocacy and documentation of the best practices and

innovations

13.3.1.7 Social Mobilization Strategy:

Quarterly Sahiyya Sandesh Bulletin is being published as an organ of community action,

other than the routine IEC and media campaign by the state. District level Sahiyya

Sammelan shall be one of the key annual events where Sahiyyas, VHCs, officials from

block, district to the state level come at one platform. A state level sharing workshop

shall also be organized, to create an enabling environment for the community level

initiatives. A web-based information platform for community action under NRHM

Jharkhand also shall be developed and uploaded for public reference.

However the modification of the above strategies will be made based on the field level

inputs.

13.3.1.8 Monitoring and Evaluation Strategies:

The monitoring and evaluation strategy of Community processes of the state has been

in build with the programme support structure to establish an effective feedback and

review mechanism.

The strategies like the regular field visits by the Sahiyya Sathis, Monthly Sahiyya Days at

Sub-centre level, Monthly meetings of Sahiyya-Sathis at Block Level, Monthly Block

Coordinators meets at the district level, and quarterly DPC Review meets at the state

level shall also ensure concurrent review and feedback of the programme. This year an

internal review is in process under the guidance of the Jharkhand State Health Resource

Centre (JSHRC) to review all the activities related to communitization in the state and to

prepare a roadmap for the future.

13.4 Activities proposed for 2011-12

13.4.1 Human Resource:

Page 47 of 129


Strengthening the VSRC with three (3) thematic experts, in addition to the current staff

strength of one SPC, One Account & Administration officer and 24 DPCs.

SL. BUDGET HEAD UNIT MEASURE

Unit Cost Total Amount (in

Lakh Rs.)

Remarks

HUMAN RESOURCE COST

1 STATE PROGRAMME CO-ORDINATOR

Month 35000*12*1 4.2

Budgeted under Sec. 1.4 under

VSRC Human Resource

Cost of NRHM

Additionality

2 Coordinator- Training (New Recruit)

Month 30000*12*1 3.6

3 Content Editor consultant(New Recruit)

10 days in a Month

1000*120days 1.2

4 ADMINISTRATION & FINANCE OFFICER

MONTH 22000*12*1 2.64

5 DISTRICT PROGRAMME CO-ORDINATOR

MONTH 27000*12*24 77.76

6 LAPTOP for State VSRC team and 4 DPC (7 person)

SET 35000*7 10.5

7 Travel support for VSRC QRT 250000*4 10

8 Phone/ Internet/ Data Card for VSRC

QRT 75000*4 3

TOTAL 112.9

Table 13.2

13.4.2 Capacity Building: This will encompass-

Sahiyya training on the Disease and Nutrition modules (12 days) and equipping

them with newborn care kit and counseling flip charts (Salter weighing machines,

thermometers, watches)

Capacity Building Programme for Sahiyya Sathis on necessary skills to support the

Sahiyyas and to facilitate the sub center level meetings.

Capacity building of trainers’ team to sharpen their training skills.

Four Days residential training programme for DPCs on Results Based Programme

Management and Rights Based Community Action Programming.

As per recommendations from the Common Review Mission Team and other

development partners as well as experts it has been decided to bring all Sahiyyas to

the same level of knowledge and awareness. The Module VI and VII training shall

cover all the topics encompassed till Module IV and hence would also act as a

refresher for the 20,000 (approx.) Sahiyyas who had received training on the

same.

Page 48 of 129


Capacity building and induction training of Sahiyya Sathis(6 days) apart from training

on modules on Facilitation and Supervision skills.

Sensitization of District health societies and health personnel ,DPMU,BPMU on

Communitization

Hamlet wise Sahiyya selection and VHC formation in PTG areas

Capacity building of PTG Sahiyyas and VHCs and training pool creation for the same

Table 13.3

Capacity Building of PRIs: The NRHM Framework for Implementation clearly

articulates the role of PRIs in NRHM and hence the capacity building of newly

elected PRI members is essential. A consultation workshop on ‘Roles of PRIs in

SL. BUDGET HEAD Training Details No. Budget Details Amount Remarks

A TRAINING

A1 STATE TRAINING INCLUDING TRAINIING FOR DPC

16 days Training for Asha 6 & 7 module , VHC,Asha facilitator(Sahiyya sathi), PTGs Sahiyya and PRI functionaries

76 76DPC and STT*16days*Rs.800

9,72,800


ASHA Training of NRHM

Additionality

A2 REGIONAL TRAINING

16 days Training for Asha 6 & 7 module , VHC,Asha faciliitatoor(Sahiyya sathi), PTGs Sahiyya and PRI functionaries in trg sites and regions

850 850 BTT* 16 days*Rs.675

91,80,000

A3 SAHIYYA TRAINING

12 days Training for Asha 6 & 7 module

41000 41000*12days*300 14,76,00,000

A4 VHC TRAINING 2 days training on 100000 100000*2 days*Rs.65 1,30,00,000

A5 TRAINING OF PRI WITH VHC PRESIDENT

1 day 84000 84000*1day*Rs. 60 50,40,000

A6 TRAINING OF ASHA FACILITATOR(SAHIYYA SATHI)

2 day 2184 2184*2days*Rs.220 9,60,960

A7 PTG SAHIYYA SELECTION

For 100 hamlet 100 Hamlet

100*2000 2,00,000

A8 ,TRAINING,MATERIAL COST,

3 days 100 100*3days*Rs.300 90,000

A9 TRAVEL SUPPORT FOR PTG SAHIYYA

MONTH 100 100*12 month*500 6,00,000

TOTAL 17,76,43,760

Page 49 of 129


Public Health’ will be organized by UNICEF involving Tribal Welfare Department,

Social Welfare, Department of Panchayati Raj, Jharkhand State AIDS Control Society.

A vision document ‘The Role of PRIs in Public Health: Road map for Jharkhand’ will

be prepared with the support from UNICEF. Based on the vision document VSRC will

prepare the training module for the PRIs as well for the Health Functionaries and

the Training programme will be rolled out. Sensitization of PRIs on community

processes from Panchayat to district level shall be carried out.

13.4.3 Training Modules and IEC

Developing and printing of modules for Sahiyya and VHC trainings

Specific Training Modules for PTG Sahiyyas

Printing of Sahiyya bulletin and flip chart for Sahiyyas.

Printing of score cards and report formats for CBM.

Drug kits for Sahiya will be procured and distributed and refilling system will also

be established.

SL BUDGET HEAD DETAILS NO. BUDGET DETAILS AMOUNT

B COMMUNICATION AND TRAINING MODULE

B1 SAHIYYA SANDESH Monthly magazine

45000 45000*12month*Rs.8 48,00,000 Budgeted under Sec. 1.2 under

DEVELOPMENT of COMMUNICATION MODULE AND

TRAINING MODULE of

NRHM Additionality

B2 SAHIYYA MODULE Training module

42000 42000*3*Rs.45 37,80,000

3 VHC MODULE Training module

31000 31000*1*Rs.45 13,95,000

B4 PRI MODULE Training Module

85000 85000*Rs. 20 17,00,000

TOTAL 1,16,75,000

Table 13.4

13.4.4 Community based Monitoring: This will encompass-

Orientation of VHCs on Community based monitoring and social security schemes

(4days).

Community Based Monitoring (CBM) exercise in each village of Jharkhand through

score cards and Jan-Samvad.

State, district and PHC level sensitization, and implementation on CBM processes

Page 50 of 129


SL BUDGET HEAD DETAILS NO. BUDGET DETAILS AMOUNT Remarks

D Community Based Monitoring (CBM)

D1 State sensitization on CBM EVENTS 3 3*Rs.50000 1,50,000 Budgeted under

Sec. 17.1-17.3 under Community Based Monitoring (CBM) of NRHM

Additionality

D2 District sensitization and district sharing of findings of CBM

EVENTS 2 24 district*1 event*Rs.50000

12,00,000

D3 Training of the CBM teams and People’s dialogue(Jan Samvad) at PHC level For presentation and discussion on reports of the CBM teams

EVENT 1 48 blocks*Rs.20000 9,60,000

TOTAL 23,10,000

Table 13.5

13.4.5 Reviews and meetings:

Institutionalizing Cluster meeting/block meeting/district meetings and report flow

mechanism on trainings, meetings, untied fund utilization and specific problems will

form a part of the activities.

SL BUDGET HEAD DETAILS NO. BUDGET DETAILS

AMOUNT

E SAHIYYA MOBILISATION AND ADVOCACY SAHIYYA PROGRAMME

E1 SAHIYYA SAMMELAN AT DISTRICT LEVEL YEARLY

Events 24 24*Rs.60000 14,40,000

Budgeted under

Sec. 1.3 under

SAHIYYA MOBILISATION AND ADVOCAC

Y of NRHM

Additionality

E2 CLUSTER LEVEL MONTHLY MEETING OF THE SAHIYYA ,AWW,ANM AND VHC REPRESENTATIVE (2184 no. of cluster)

Events 12 12*2184cluster*Rs.100

26,20,800

E3 Supportive supervision by BLOCK TRAINERS for 6 days per month for supporting ASHA facilitators and block meetings and participating distt meetings

Nos. 848 848*Rs.300*72days

18,31,68,00

E4 Supportive supervision by STT for 6 days per month for Facilitating block meetings and distt meetings and participating in state level meetings

Nos. 50 50*Rs.500*72days

18,00,000

E5 Operational Cost to Sahiyya Help Desk for 98 help desk

Nos. 98 98*12sahiyya*48days*Rs.200

11,28,96,00

E6 Asha Facilitator(Sahiyya Sathi) Remuneration for 2184 sahiya sathi per month

Month 1500 2184*Rs.1500*12

3,93,12,000

TOTAL 7,47,79,200

Table 13.6

Page 51 of 129


13.4.6 Innovations:

Sahiyya Help Desk in all PHCs and CHCs will be established and effectively

functioning.

Organizing Sahiyya Sammelan in every six months at block and district level

Sahiyya feedback system for complaint redressal

Preparing Village Health Plan and Panchayat Swath Yojna at all the Panchayats

Establishing Sahiyya rest room in all district hospitals and CHCs

13.4.7 Documentation of best practices and conducting advocacy workshops for

sharing the best practices.

13.4.8 Designing communication strategy with special focus on bulletins and

periodicals as well as orientation of frontline workers on interpersonal

communication skills

13.5.1 Introducing novel strategies for community mobilization (2011-12)

SL BUDGET HEAD DETAILS

NO. BUDGET DETAILS

AMOUNT

F Innovative activities for Community programme

F1 Saas bahu Sammelan in every cluster (2184) (Quarterly)convergence with ICDS - Mother support group

Events 4 4*Rs.250*2184 cluster

21,84,000

Budgeted under

Sec. 17.4 under

Innovative

activities for

Community

programme of NRHM

Additionality

F2 Flag at Sahiyya House Nos. 40964 40964*Rs.50 20,48,200

F3 Exposure visit of VSRC members/DPC/STT/BTT/Sahiyya sathi/ Sahiyya

Event 1 Rs. 3,00,000 3,00,000

F4 Award (Bicycle) for sahiyya -24 at state, 72 at District and 424 at block

No. 520 520*Rs. 3000 15,60,000

F5 Award for Best Veer Birsa Unnat Village for 520 villages(VHC)

No. 520 520*Rs.3000 15,60,000

F6 Corpus fund for supporting Sahiyya against Accidents and Deaths (Sahiyya Sahayta Nidhi)

No. 41000 41000*Rs. 10 4,10,000

TOTAL 80,62,200

Table 13.7

Page 52 of 129


13.5.2 Convergence with ICDS and formation of mother support groups (Mata Samiti)

At every cluster in every quarter for discussing hygiene, nutrition, birth preparedness,

ANC/PNC and gender related issues: The Sahiyyas and Sahiyya Scathes along with

Aanganwadi workers shall play a key role in organizing and facilitating these Sammelan.

Need based issues or those that are vital to the overall health of women and children

shall be taken up at these events. Inter personal communication and other tools like

role plays shall be used to ensure effective dialogue and impact with the target group.

13.5.3 Corpus fund for Sahiyyas against accidents and disabilities:

One of the key tasks of the voluntary health workers is conducting referrals and

escorting patients for various health services which require a lot of movement in and

out of their respective villages which makes the task risky. Hence it is proposed to form

a corpus fund for all Sahiyyas across the state. This would be a mark of respect to this

cadre of voluntary health workers. Contributions to the fund would be on a 50-50

sharing basis wherein per Sahiyya contribution would be 1/- and the state would

contribute another 1/- for each Sahiyya, which would then amount to a total of about

80,000/- corpus fund for Sahiyyas.

13.5.4 Celebrating International women day (March 8):

This day may be used a platform to honor the work of key front line workers and

Sahiyyas and to showcase the community level innovations and achievements brought

about through Commoditization under NRHM.

13.5.5 Panchayat Swasthya Yojna:

The village Health Planning Process will be conducted at every villages to enable the

villagers to identify the key health issues and to plan for addressing the same under the

leadership of VHCs. The Village Health Plans will be consolidated at Panchayat level

under ‘PANCHAYAT SWASTHYA YOJNA’ and further it will be incorporated in BHAP. This

would be carried out by the key VHC members in close coordination with the PRI.

13.5.6 Setting up of VHC offices at villages at respective ICDS centers:

An office space for VHC at the ICDS centers shall ensure convergence of activities on

one hand and help the VHCs build better linkages with the system on the other.

13.5.7 Putting up flags at each Sahiyya’s house on 7th April to give prestige and fix

responsibilities

Page 53 of 129


13.5.8 Wall painting on each village depicting details about VHC, ambulance and other

important information

13.5.9 Community Based Information System (CBIS):

Based on key output and Impact indicators a MIS reporting structure will created line

with HMIS to track the progress and effect of communitization Process in this state.

13.5.10 Conducting Exposure Visits:

Interstate, district, block and village Exposure visits will be conducted for the VSRC

Team, DPCs, STTs, BTTs, Sahiyya Sathis, Sahiyyas and VHC members to get exposure

with the recent trend in communitization process as well as to share their experiences.

This will also enhance the skills of the participants as well as will as will act as stimulus

for motivation and promote cross learning.

13.5.11 Social Inclusion:

Primitive tribal group Sahiyyas in PTG hamlets will be selected and special training

modules, curriculum will be design and fix incentive packages for them will provide

towards achieving social inclusion. This strategy will be effective to reach out to the PTG

groups and to reach out to the mobile communities.

At the same time VHCs at hamlet level in PTG areas will be formed to focus on the

special health needs and issues of the PTGs and the PRIs of schedule areas will be

encouraged to take active leadership. Special incentives for them have been proposed

in the tribal health plan.

13.5.12 Community Based Birth Preparedness:

A community based birth preparedness programme will be designed and piloted in two

districts will the financial and technical support from UNICEF. This intervention will

helped to create and evidence based model at the state level for birth preparedness

involving Community, Sahiyya, VHCs, PRIs and service providers.

5.13 Cash or other incentives/awards shall be provided for Sahiyyas working in Hard to

reach area will be provided to facilitate their movement to each and every household.

13.5.13 Village Health Awards-

Any village that meets the below mentioned criteria shall be awarded as “Veer Birsa

Unnat Gram”. The village wise criteria of assessment for the same are : 80 percent

immunization, 100 percent institutional deliveries, proper utilization of untied funds

based on village health plans formulated by the VHC.

Page 54 of 129


11.6 Expected Outcomes:

Increase in institutional deliveries

Early identification and referral of danger signs in pregnancy

Increase in percentage of women receiving ANC/PNC services

Increase in the percentage of complete immunization amongst children

Timely information of epidemic outbreak.

Timely identification of malaria cases and treatment with Referrals

Reduction in diarrheal deaths through timely treatment and referrals

Accurate record of births and deaths

Tracking of pregnancy and mother and child

Decentralized planning reflecting people’s concerns, needs, problems and

priorities through capacity building of the community.

More sensitivity and transparency in health system functionaries.

Increase in numbers of mothers initiating colostrums feeding and

supplementary feeding.

Identification of TB patients and increase in number of patients completing

DOTs.

Increase in number of couples adopting family planning measures.

Transparent, rational and timely utilization of untied fund.

Home visits to all pregnant/lactating mothers by Sahiyya.

First aid, counseling and primary treatment of minor illnesses and availability of

identified drugs in the villages.

Sahiyya Incentives (AWARDS for Best Performing ASHAs) To ensure community participation and to make public health delivery system fully

functional and accountable to the community, ‘Communitization’ has been identified

as a key working strategy under NRHM. It implies the capacity building of community in

identifying their own health needs, analyzing the causes of their problems, prioritize

and planning as per their needs and problems, rigorous monitoring & evaluation

ensuring that the accessibility, quality, behavioral and policy issues are as per defined

Page 55 of 129


standards, reviewing the progress made. For this process, ASHA (Sahiyya)under NRHM

plays the vital role to link the community with the health care facilities.

Under NRHM in Jharkhand a total, 40,964 Sahiyyas (ASHAs) have been selected by the

VHCs and Villagers through the Gram Sabha. Training on Module V i.e. Leadership

Module completed for all Sahiyyas. For regular supportive supervision total 2184 cluster

has been formed with the support of Sahiyya , VHC members, PHC representatives and

VSRC team. Each cluster contents 15 to 20 villages according to geographical location,

socio-eco boundaries and power relations and accessibility to health facilities .In each

cluster one Sahiyya Sathi ,among the Sahiyyas has been nominated , who will be

responsible to periodic meetings at cluster level and other interventions under NRHM.

60, Sahiyya Help Desk in LWE districts and District hospital has been formed and

functional. Today the Sahiyya is an empowered woman with an entity of her own.

The impact of Sahiyyas activities has been encouraging and can be listed as follows.

12. Dialogue with Sahiyyas restarted and established at various levels.

13. Sahiyyas activated, motivated and capacitated through intensive cascade trainings and

interpersonal communication

14. Village health committee bank accounts opened and untied fund transferred with the

facilitation of Sahiyya.

15. Transparent and rational use of untied funds initiated and expenditure report sought.

16. Community mobilization on health issues initiated, Sahiyyas also involved in VHNDays at

village level.

17. The participation of community in health camps, sterilization and tubectomy camps

increased due to Sahiyyas initiatives.

18. The immunization, institutional delivery and OPD patient’s numbers increased reposing

faith in the health system due to Sahiyyas active involvement, support for the beneficiaries

and Sahiyya Help Desk.

The Sahiyyas has been provided performance based incentives for many activities under NRHM,

and for National Programme. For the PIP11-12, indifferent programmes following are the

incentives proposed for the programmes-

Sr.No Programme Amount in SPIP 11-12(Rs in

Lakh)

Page 56 of 129


1 ASHA payment under NRHM additionalities 496.69

2 Incentive to ASHA under JSY 1201.71

3 Incentive to ASHA under Family Planning Services 1057.5

4 Incentive to ASHA under IDP 10.86

5 Incentive to ASHA under Immunization 369

6 Incentive to ASHA under NLEP 10.5

7 Incentive to ASHA under NVBDCP 208.79

8 Incentive to ASHA under NBCP 2

9 Incentive to ASHA under RNTCP 13.75

Streamlining incentives payment mechanisms for Sahiyyas and forging linkages

between Sahiyyas and other front line workers like ANMs, AWWs, para teachers &

Strengthening the District Level Sahiya Mentoring Team to guide the District

Programme Coordinators and Block Level Teams shall also constitute the Sahiyya

Support System. ‘Sahiyya Diaries’ and planning formats for better programme

implementation and smooth payment shall aide the above process.

Apart from these all performance based incentives, the State has felt that

Sahiyyas are really contributing their efforts to reach the NRHM goals, and to

recognized their efforts, for best performance in family palnning week, total 48

Sahiyyas for all 24 districts has been facilitated by the state in programme year 10-

11.To recognize their efforts and to motivate them for the Healthy community life

practices, the state has proposed the BEST SAHIYYA AWARD of Rs-5000/-( Five

Thousand) for one thousand Sahiyyas in the state.With the criteria of 100 percent

immunization, 100 percent institutional deliveries, proper utilization of untied funds

based on village health plans formulated by the VHC with the facilitation of Sahiyya.

Sr.No Programme Amount in SPIP 11-12(Rs in Lakh)

1 BEST SAHIYYA AWARD for 5000 sahiyyas 50

Following expected outcome can be achieved through providing this award

An Increase in institutional deliveries

Early identification and referral of danger signs in pregnancy

Increase in percentage of women receiving ANC/PNC services

Page 57 of 129


Increase in the percentage of complete immunization amongst children

Timely identification of malaria cases and treatment with Referrals

Reduction in diarrheal deaths through timely treatment and referrals

Accurate record of births and deaths

Tracking of pregnancy and mother and child

Increase in numbers of mothers initiating colostrums feeding and supplementary

feeding.

Identification of TB patients and increase in number of patients completing DOTs.

Increase in number of couples adopting family planning measures.

Transparent, rational and timely utilization of untied fund.

Home visits to all pregnant/lactating mothers by Sahiyya.

First aid, counseling and primary treatment of minor illnesses and availability of

identified drugs in the villages.

The assessment of Sahiyyas performance will be carried out in an innovative way as well. The Sahiyyas have been provided the Sahiyya Passbook in which all their activity and incentives has been recorded and VHC will also appraise the Sahiyyas performance. A team comprising of elected representatives of Panchayats, representatives of development partners as well as experts from the concerned line department of government will visit each of the villages. The overall co-ordination will be provided by the district level administration. During the Annual Sahiyya Sammelan (Annual Meet) at District level the awards will be given to these best performing sahiyyas along with the certificates.

DURG KIT FOR SAHIYYA

SL BUDGET HEAD DETAILS NO. BUDGET DETAILS AMOUNT Remarks

C DURG KIT FOR SAHIYYA Budgeted under Sec. 22.6.2 under General Drug & Supply of NRHM Additionality

C1 SAHIYYA KIT REFILLING OF DRUG KIT

41000 41000*Rs.600 2,46,00,000

TOTAL 2,46,00,000

Page 58 of 129


13.7 Budget require for FY 11-12

STATE PROGRAMME IMPLEMENTATION PLAN 2011-12 (BUDGET SUMMARY)

Sl. No.

PIP Head VSRC Budget Head No. of Days Unit Amount (in Lakh Rs.)

B.1.1 ASHA TRAINING

State & RegionalToT 101.52

SAHIYYA TRAINING 12 41000 1476

VHC TRAINING 4 100000 130

SAHIYYA SATHEE TRAINING 3 2184 9.61

DEVELOPMENT OF COMMUNICATION MODULE AND TRAINING MODULE

Event Event 116.75

SAHIYYA MOBILISATION AND ADVOCACY SAHIYYA PROGRAMME

Event Event 747.79

Community participation of PTGs Event Event 8.90

B.1.2 ASHA Drug Kit PROCUREMENT OF SAHIYYA DRUG KIT

600 41000 246.00

B8 PRI SENSITIZATION

PRI SENSITIZATION Event Event 50.40

B15 CBM CBM Event Event 23.10

B.14.5 Other Innovation

Innovative activities for Community programme

Event Event 80.62

B.1.3. VSRC VSRC HR 112.90

GRAND TOTAL 3103.59

Page 59 of 129


14. Mobile Medical Unit (MMU)

State of Jharkhand is mainly a plateau and most of the land is covered by dense forest.

Jharkhand consists of 40% of the schedule population out of which 28% percent is

scheduled tribes and 12% is scheduled caste. Majority of the Tribal group still lives in

the forest land or in the remote areas with open land and forest near to them. Being a

plateau it has many hard to reach areas and inaccessible localities. Poor infrastructure

has added more burden to it. Lack of proper maintenance and management of the

Government healthcare facilities has depilated the situation of healthcare delivery

services. Moreover Health seeking behavior of the Tribal people of Jharkhand is

somewhat different from other habitant; these groups usually have no proper

accessibility to health facilities as communities reside in clusters in the far-flung areas.

Mainly the rural communities are ridden with poverty therefore; people usually do not

prioritize health or seek health. Far-flung areas in the state of Jharkhand are unaware

about health infrastructure and facilities provided by the department of health and

family welfare. Therefore, we can conclude that the overall health seeking behavior and

accessibility of the healthcare facilities of the state is very poor.

Rational:

State of Jharkhand is in process of creating a vast public health infrastructure of Sub-

centres, Public Health Centres (PHCs) and Community Health Centres (CHCs). There is

also a large cadre of health care providers (Auxiliary Nurse Midwives, Male Health

workers, Lady Health Visitors and Health Assistant Male). Yet, this vast infrastructure is

able to cater to only 20% of the population, while 80% of healthcare needs are still

being provided by the private sector (1). Rural India is suffering from a long-standing

healthcare problem. Studies have shown that only one trained healthcare provider

including a doctor with any degree is available per every 16 villages. Although, more

than 70% of its population lives in rural areas, but only 20% of the total hospital beds

are located in rural area. Most of the health problems that people suffer in the rural

community are preventable and easily treatable. In view of the above issues, the

Mobile health Units can ensure health care services to the last person of the last village.

This project is designed to cater to the health and unmet needs of rural communities of

Jharkhand with special focus on those residing in unserved, underserved and hard to

reach areas. The project aims to improve the availability of and access to quality health

Page 60 of 129


care services. Jharkhand Rural Health Mission society initiated the project with 24 MMU

(Mobile Medical Unit) in 2008-09, based on the success full experience the department

had scaled up to 66 MMU (24 + 42 MMUs), and this year it has proposed to provide 37

more MMUs to the NGOs in order to cater hard to reach, unserved , underserved area.

Progress so far - Mobile Medical Unit

Strategy 2010-11 Progress Comments

Operationalisation of new

MMUs

In Process 37 new MMUs have been

started. The process has

been decentralized to the

districts.

Meeting the unmet health

needs of rural people

In process 989938 persons has been

observed and got

treatment,

X-ray examination of 21048

persons and Pathological

examination of 194942

persons have been done,

11131 ECGs and 1837

ultrasound were done

through the MMUs

between April to December

2010.

Since inception MMUs has catered to 2956638 patients, out of which total X-ray

conducted is 73843, Total Pathological Test conducted is 499723, Total ECG conducted

is 28459, Total Ultrasound conducted is14649, and number of total cases referred

is 143250 in 25629 total working days of the MMUs. This is a very significant number

and with the inception of 37 new MMUs this figure will increase drastically. This will

also improve the reach to the far flung rural areas. This year onward state has decided

to decentralize the process of MMU operationalization to the District Health Society.

Page 61 of 129


State will monitor and provide necessary support for the proper functioning and

operation of the MMUs.

Cumulative Status of MMU- April 2010 to December 2010

Page 62 of 129


Sl.

No.

District

Name Name of Organization

Date of

MMU

Initiation

Total no.

of patient

observed

Cumulat

ive

report

on X-ray

Cumulati

ve report

on Patho.

Test

Cumulativ

e report

on no. of

ECG

conducted

Cumulativ

e report

on no. of

Ultarsoun

d

conducted

Cumulativ

e report

on Cases

reffered

1 Bokaro

Human Rural

Foundation 12/8/2009 24403 0 4034 479 229 1150

Human Rural

Foundation 12/8/2009 24859 0 3415 1530 351 2669

Vikas Bharti (OLD) 23/04/08 24054 867 7119 122 0 1745

2 Chatra

Marksman Welfare

Society 3/8/2009 9921 0 254 9 13 119

Vikas Bharti (OLD) 13/03/08 22897 129 4187 0 0 767

3 Deoghar

NEEDS 27-08-09 0 0 0 0 0 0

Human Rural

Foundation 2/9/2009 8209 0 816 0 0 195

Vikas Bharti (OLD) 23/04/08 21104 435 4871 170 0 2340

4 Dhanbad

Sri Lal Jee

Prashikshan Kendra 4/8/2009 8708 301 1661 275 64 211

T.S.R.D.S 12/1/2010 7049 0 0 0 0 6

Human Rural

Foundation 14-08-09 19827 0 2181 859 184 2168

Vikas Bharti (OLD) 21/04/08 18332 1118 4901 156 48 1101

5 Dumka Citizen foundation 24-08-09 12515 235 2788 0 0 1014

Vikas Bharti (OLD) 15/02/08 19867 471 5216 345 0 1449

6 East

Singhbhum

Pragati 26-8-09 0 0 0 0 0 0

Aadarsh Seva

Sansthan 3/11/2009 0 0 0 0 0 0

T.S.R.D.S 1/8/2009 5181 0 0 0 0 38

Vikas Bharti (OLD) 26/03/08 21979 553 5356 857 43 973

7 Garhwa Vikash Bharti 2/8/2009 18426 412 2663 118 0 785

Vikas Bharti (OLD) 5/2/2008 20401 615 3364 262 0 782

8 Giridih

Vikash Kendra 5/8/2009 14944 0 535 311 249 641

Human Rural

Foundation 17-08-09 27559 3 1265 376 113 1994

Vikas Bharti (OLD) 18/04/08 24096 655 3347 268 44 2069

9 Godda Citizen foundation 7/8/2009 12092 376 4032 113 0 390

Vikas Bharti (OLD) 25/03/08 24283 208 4235 100 0 1027

10 Gumla St. Michal H. Centre 1/8/2009 10624 36 2830 1 0 411

St. Lievens H. Centre 1/8/2009 8635 469 1549 22 0 1544

Page 63 of 129


Vikas Bharti (OLD) 24/02/08 22523 440 6344 206 0 1069

11 Hazaribagh

T.S.R.D.S 0 0 0 0 0 0

Marksman Welfare

Society 2/8/2009 20670 0 293 105 109 320

Vikas Bharti (OLD) 23/04/08 0 0 0 0 0 0

12 Jamtara

Dynamic Tarang 1/8/2009 10328 338 3524 226 0 407

Citizen foundation 7/8/2009 11767 405 3564 178 0 763

Vikas Bharti (OLD) 22/4/08 21830 436 8602 200 0 757

13 Khunti

Sankalp Joyti 7/8/2009 16764 0 1759 0 0 739

Sankalp Kisan Vikas

Kendra 26-8-09 7898 631 1146 105 0 197

Vikas Bharti (OLD) 1/5/2008 23860 356 5570 194 53 1672

14 Koderma Pragati 26-8-09 0 0 0 0 0 0

Vikas Bharti (OLD) 21/4/08 29689 1161 6422 241 36 2004

15 Latehar Vikash Bharti 5/8/2009 16675 393 3085 75 0 631

Vikas Bharti (OLD) 23/4/08 20109 42 3585 165 0 504

16 Lohardaga

ICERT 1/8/2009 12566 295 4687 0 0 289

Madhur Muskan 28-12-09 6473 17 415 31 0 215

Vikas Bharti (OLD) 1/5/2008 21693 321 8031 275 0 971

17 Pakur Citizen foundation 15-8-09 16219 390 3626 0 0 180

Vikas Bharti (OLD) 6/4/2008 22845 1178 5300 140 0 1305

18 Palamu

Vivek For Vikas 3/8/2009 25114 1024 2706 505 193 536

Vikash Bharti 7/8/2009 20731 485 3222 0 0 754

Vikas Bharti (OLD) 28/2/08 24149 448 5240 99 0 417

19 Ramgarh

Sankalp Kisan Vikas

Kendra 4/9/2009 7264 234 583 17 0 198

Vikas Bharti (OLD) 6/5/2008 23962 1159 5424 158 0 1097

20 Ranchi

Madhur Muskan 2/1/2010 2412 64 366 2 20 96

RINCHI 14-8-09 7771 346 2044 19 49 122

SID 12.08.09 11524 0 1040 0 0 388

Vikas Bharti (OLD) 20/4/2008 24426 744 4611 135 8 1386

21 Sahebganj

Dynamic Tarang 1/8/2009 13911 1202 4142 126 0 1047

Vikash Bharti 2/8/2009 15607 251 4760 47 0 511

Vikas Bharti (OLD) 5/4/2008 17928 278 6072 127 0 497

22 Saraikela

ICERT 1/8/2009 12431 156 1160 25 0 154

T.S.R.D.S 3/8/2009 4473 0 0 0 0 14

Vikas Bharti (OLD) 3/4/2008 23630 402 3407 293 31 819

23 Simdega Citizen foundation 20-08-09 12362 153 1892 79 0 606

Vikas Bharti (OLD) 28/2/2008 21090 392 6544 622 0 1182

24 West T.S.R.D.S 0 0 0 0 0 0

Page 64 of 129


Broad Objective:

To cater to the health and unmet needs of rural communities of Jharkhand with special

focus on those residing in unserved, underserved and hard to reach areas

Specific Objectives:

a. To provide all the primary health services in underserved villages/regions in

selected blocks of the districts through Mobile Medical Units where health

facilities such as PHCs, CHCs or private health care facilities are absent or

limited.

b. To improve uptake of curative and preventive health services such as

immunisation, antenatal and post natal care, and general OPD services, in the

identified villages/regions, with the aim of reducing the incidence of common

illnesses and lowering maternal mortality and infant mortality.

c. To converge and facilitate with the ANM, AWW, SAHIYYA and village health

committee for betterment of the Health services.

d. To provide all the diagnostic facilities in the rural area

Services

MMU will be operational six days a week and will conduct all the duties as

mentioned below

a. All OPD services

b. Blood and urine, X-ray, ECG, Malaria test.– ensuring that there is no

contravention of the PCPNDT Act,

c. General physician consultation, obstetric and gynecological consultation,

ANC checkups,

d. Family planning services including IUCD insertion and RTI/STI diagnosis and

treatment

e. Immunization of children including Vitamin A supplementation with measles

Singhbhum RINCHI 14-9-09 6648 120 1250 0 0 68

Vikas Bharti (OLD) 16/12/200

7 22631 304 3907 363 0 1530

Jharkhand Total 989938 21048 194942 11131 1837 49033

Page 65 of 129


f. Treatment of minor ailments and minor injuries including supply of drugs to

patients.

g. Prophylaxis and treatment of Anaemia with IFA Tablets.

h. IEC and counselling.

i. Provide appropriate referral services to malnourish children, delivery cases,

TB cases, leprosy cases.

j. Will cooperate in all the Service related to various public health

programmes.

Activity plan, approved by the Concerned Deputy Commissioner / Civil Surgeon

of the area of operation with a copy being sent to District Health Society and

JRHMS, should be strictly followed.

The van will be operated on a predetermined route plan on regular basis every

month. The tour /camp plan detail need to be submitted to the DC/CS and Block

Medical Officers at least 15 days in advance.

MMU to have minimum number for staff as given below, there has been slight

change in the number of staff from the earlier agreement to ensure that the

medical staff is always available in the MMU.

S.No. Staff Number

1. Doctor – MBBS (Male) 1

2. Lady Doctor – MBBS 1

3. ANM or Staff Nurse 1

4. Lab technician 1

5. X Ray Technician 1

6. Driver 1

7 Helper 1

All minor maintenance and repair work for the vehicle or equipment should be

undertaken by the operator on the weekly off days.

Operational guideline and Inspection for the MMU

1. The mobile medical unit would be operational in consultation and direct

supervision of the Deputy Commissioner and Civil Surgeon of the concerned

district.

Page 66 of 129


2. DRHS shall have right to inspect, ask for the report and review the MMU

performance and Operator has to extend necessary support.

3. Operator / NGO shall adhere to the advices / opinion given by the Deputy

Commissioner /Civil Surgeon of the district concerned for extending health

services to targeted beneficiary for which it is intended for.

4. Route planning for the placement of mobile health units will be done after the

mapping and demarcation of the outreach areas.

5. Cluster of 5-6 surrounding villages will be formed and camps will be organized at

cluster level to cover maximum number of patients.

6. Frequency of the visit will be finalized based on area mapping. It would also

prioritize the need of the community.

Monitoring and Evaluation

a. There will be a district level monitoring and Evaluation committee for the proper

operationalization of Mobile Medical Unit headed by Deputy Commissioner / Civil

Surgeon of the respective districts and Medical Officer In charge (MOIC) of the

respective block in which area the MMU would operate.

b. Monthly review meeting will be held at district level to ensure proper utilization and

review of the services provided by MMU.

c. Committee will develop monitoring plan which would be used for Monitoring and

Evaluation of the MMU.

d. Operator / NGO will submit a progress report once in every month in the prescribed

Performa / format provided by the DRHS.

Plan for 2011-12

Strategies and Activities

14.1. The state had been using mobile medical services to increase the reach of

medical and health services to inaccessible areas and disadvantaged population

groups. Currently state has 66 operational mobile medical units run by NGOs in

different districts. This year 2010 another 37 mobile medical unit will be made

operational. These new mobile medical unit will be provide mobile medical

Page 67 of 129


services specially in tribal areas on Hat-Bazaar days / RCH and PTG camp days

apart from the regular six days a week services. Since the state has procured

sufficient no. of MMUs, now it will focus on their proper utilization and quality

service delivery. This year state will mainly focus on their monitoring; evaluation

and their performance, therefore each district to nominate nodal officer who

will ensure their proper utilization and service delivery on daily basis. State,

regional and district Quality Assurance team will asses the performance on

monthly basis on the basis of the following Performance parameters which help

in gauging performance of MMUs like,

a) Frequency of Visit

b) Following of Schedule

c) Advance Intimation of Schedule

d) Duration of Stay and Timing of MMU

e) Doctors accompanying

f) Availability of Medicine / essential drugs

g) Cured of illness in last visit

h) People satisfaction about skill and behaviour

i) Location of MMU

j) Average distance travelled to MMU

k) Average time taken per patient

l) Availability of diagnostics

m) Follow up of Patients.

n) Family planning services and medicines

GPS tracking system will be placed in the MMUs so that they can be easily traced and

services can be optimized.

Community mobilization will be done through the active involvement of Sahiyya and

Village Health Committees already functional in the state of Jharkhand.

Page 68 of 129


Budget Requirement

Particulars Unit Cost Total Cost for 103

MMU (In Lakhs)

rEMARKS

Monthly Running cost

300000/- per MMU

3708.00

Budgeted under

Sec. 12.1-12.2

under Mobile

Clinic of NRHM

Additionality

Wear and Tear of the Tyres and spare

parts

Management and Maintenance of the

Equipment

Insurance for the MMUs whose free

insurance is getting over

GPRS for 103 MMUs 15000 / - 15.45

14.1.1 Mobile Medical Units/Emergency Referral Transport: State specific requirement

of MMUs needs to be assessed realistically. Performance parameters which help in

gauging performance of MMUs like,

a) Frequency of Visit

b) Following of Schedule

c) Advance Intimation of Schedule

d) Duration of Stay and Timing of MMU e) Doctors accompanying f) Availability of

Medicine g) Cured of illness in last visit h) People satisfaction about skill and behaviour

i) Location of MMU j) Average distance travelled to MMU k) average time taken per

patient l) Availability of diagnostics

m) Follow up of Patients etc need to be reflected in the MMU plan.

Page 69 of 129


MAMTA WAHAN

Jharkhand is a state which is still struggling with its quality referral

network to save both the mother and child. As we are all aware that most

of the maternal deaths occur due to three delays. These delays are from

community to facility, from primary level facility to secondary level facility

and from secondary level facility to tertiary level facility. If we analyze the

data of MAPEDIR of the state we found that the women who died almost

80% of them did not have the access to any formal means of

transportation.

It has also been observed that nearly 60% of deaths in hospital happen in

the first hour of admission. 60% who die in an emergency could have been

saved had quality care been available to them earlier. With a view to

providing emergency transportation & promote care to victims of

accident, risk pregnancy cases and other medical emergency like cardiac,

cancer, asthma, snake bite, case of burn have been managed by

Emergency Medical Services.

Bottlenecks

Long distances from 24 x 7 delivery centers’/facility with poor connectivity

_ Lack of referral transport to connect Rural community to Health centers

Page 70 of 129


Objective

To establish a quality referral/ emergency service system across the

state in a Private Public Partnership mode.

To reduce at least 25% maternal mortality and morbidity rates in an

emergency.

Strategy

24x 7 Free Emergency Transports along with Call Center

24x 7 Call center will be established at district level for coordinated contact at all

levels. Already piloted in Khunti district of Jharkhand

The Call Centers will be located in all 24 districts headquarter

The system will function on a three tire system which will help to establish a

connect rural community with Health centers.

The three tier system will be

Mapped vehicle will be used to bring women from facility to the

center

Ambulances will be used from Primary facility to secondary or

tertiary care

After the heal from facility to back to community free of cost

Fleet of 167 government owned ambulances owned by government and given to

different NGOs

State Government has promised to procure 110 ambulances to be given to the

Health department.

Ambulances of other agencies like Rotary, Faith Based organizations at various

locations

Mapping of other vehicles that can be utilized for this purpose

Emergency transport of pregnant women & sick children will be the main focus.

In districts of Ranchi & Dhanbad it will also be utilized during any type of

Emergencies

Page 71 of 129


_All vehicles will be equipped with Mobile phones for coordination.

The tracking of the vehicle will be done through call center level

Sahiya will be accompanying the pregnant women or the sick child to the

institution.

Operational Cost

The operational Cost will be borne from the NRHM fund parked in the district for this

purpose. Mechanism of detailed operational cost will be developed and will be shared at

all levels.

The total requirement will be as follows:

Sl.

No

Activity Unit Unit Cost Total

Months

Total Amount

(in Lakh)

Remarks

01 Operational Cost

includes servicing

277 30000.00 10 831 Budgeted under

Sec. 12.3 under

Mobile Clinic of

NRHM

Additionality

02 Mobile Operational

Cost

277 300.00 10 8.31

Total 839.31

The operational Cost of the Call Center has already been budgeted in the Maternal

Health Part.

Partnership

The Mamta Wahan will function in public private partnership mode.

MIS & Reporting

The data will be captured at the call center level. Follow up mechanism will also be

developed for the mother and child. The Call Center is also having the MIS in place and

currently used in Khunti.

The report generated will be shared at all levels.

Page 72 of 129


15. Mainstreaming of AYUSH

The Indian Systems of Medicine and Homoeopathy (ISM&H) were given an independent

identity in the Ministry of Health and Family Welfare in 1995 by creating a separate

Department of Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homoeopathy

(AYUSH) in November 2003. The department is entrusted with the responsibility of

developing and propagating officially recognized systems, namely, Ayurveda, Yoga,

Naturopathy Siddha, Unani, and Homoeopathy. This was done in explicit realization of

contributions these ancient and holistic systems can make towards the health care of

the people. These systems have marked superiority in addressing chronic conditions

and offer a package of promotive and preventive interventions.

The AYUSH systems of medicine and its practices are well accepted by the community,

particularly, in rural areas. The medicines are easily available and prepared from locally

available resources, economical and comparatively safe. With this background, it will be

more useful for the mainstreaming/integration of AYUSH systems in National Health

Care Delivery System under “National Rural Health Mission (NRHM)”.

Jharkhand in particular, is habitated with rich flora and fauna. The people particularly

the rural people making use of the herbal medicines extracted from the herbal plants

found in the forests. Therefore integration of AYUSH with modern system of medicine is

supposed to improve the health condition of the people of Jharkhand.

All the AYUSH activities in the state are being coordinated by a well established AYUSH

department under department of Health and Family Welfare, Jharkhand. Department is

headed by a Director with 2 Dy. Directors respectively for Ayurveda and Unani unit of

AYUSH. There is need of 1 deputy director of homeopathic. 22 districts AYUSH Medical

Officers (DAMO) has been appointed in the entire 24 district for streamlining the AYUSH

Page 73 of 129


services at the facilities at district level still need 2 more DAMO. Jharkhand state AYUSH

medical council has been formed but need staff along with registrar.

Sl District Name Regular

Sanctioned In position Extra in-charge

Vacant

1 Director AYUSH 1 1 0 0

2 Add. Director AYUSH 1 1 0

3 Deputy director (Ayurvedic) 1 1 0

4 Deputy director (Homoeopathic) 1 1 0

5 Deputy director (Unani) 1 1 0

6 registrar, JS AYUSH Medical council 1 1 0

7 District AYUSH medical officer 22 22 0 0

Table 15.1

AYUSH Existing Human Resource

For better co-ordination of the various activities, doctors and Para medics have been

posted at the various health facilities. Figure indicates there is huge shortage of medical

officer in all Heads of AYUSH only 149 in position against the 454 sanctioned posts. It’s

an urgent need to fill all this post as earlier to boost the AYUSH health services.

Table 15.2

Heads of AYUSH Regular

Sanctioned In position Vacant

Ayurvedic 274 91 183

Homoeopathic 119 47 72

Unani 61 11 50

Total 454 149 305

District Name

Ayurvedic Unani Homeopathic

Sanctioned In position

Vacant Sanctioned In position

Vacant Sanctioned In position

Vacant

2 3 4 2 3 4 2 3 4

Ranchi 16 14 2 4 3 1 3 2 1

Gumla 7 4 3 2 0 2 4 3 1

Lohardaga 3 2 1 2 1 1 3 3 0

Simdega 11 4 7 3 0 3 6 1 5

Hazaribagh 1 1 0 1 1 0 1 1

Koderma 11 2 9 3 0 3 6 6

Chatra 11 3 8 3 0 3 6 6

Page 74 of 129


Giridih 3 3 0 1 0 1 2 2

Dhanbad 2 2 0 2 1 1 2 2 0

Bokaro 11 0 11 3 0 3 6 3 3

Dumka 9 6 3 2 0 2 4 3 1

Jamtada 11 1 10 3 0 3 7 2 5

Godda 4 2 2 2 1 1 1 1 0

Pakur 11 3 8 3 0 3 6 2 4

Deoghar 2 2 0 2 0 2 1 1 0

Sahebganj 6 4 2 3 0 3 4 4 0

Palamu 3 2 1 1 0 1 1 1

Gadwa 11 1 10 3 0 3 6 1 5

latehar 11 4 7 3 0 3 6 4 2

East. Singhbhum

11 6 5 3 2 1 6 3 3

West Singhbhum

16 11 5 2 1 1 7 4 3

Sarikela 14 9 5 3 0 3 6 4 2

Additional PHC

88 5 83 0 1 1 22 4 18

Ayush medical Board

1 1 1 1 1 1

Total 185 86 99 54 10 44 94 43 51

Table 15.2

Third grade Staff pattern also indicates that there is wide gap in position. It would be

urgent priorities to fill the gaps.

Sl Designation Class – 3

Sanctioned In position Vacant

1 Stenographer Cum Typist 22 11 11

2 Clerk cum Storekeeper 119 9 110

3 Ayurvedic compounder 145 61 84

4 Unani compounder 54 26 28

5 Homoepathic compounder 94 44 50

Table 15.3

AYUSH Existing Infrastructure Status:

Overall 24 districts have 267 dispensaries along with 22 joint dispensaries to provide

health care services.

Sl Districts No. of Dispensaries No. of Joint Dispensary

1 Bokaro 17 1

2 Chatra 19 1

3 Deoghar 2 1

Page 75 of 129


4 Dhanbad 3 1

5 Dumka 14 1

6 East Singhbhum 17 1

7 Garhwa 22 1

8 Giridih 3 1

9 Godda 4 1

10 Gumla 10 1

11 Hazaribag 0 1

12 Jamtara 17 1

13 Khunti (included with Ranchi) 0 0

14 Koderma 17 1

15 Latehar 17 1

16 Lohardaga 5 1

17 Pakur 14 1

18 Palamu 2 1

19 Ramgarh (included with Hazaribagh)

0 0

20 Ranchi 20 1

21 Sahibganj 10 1

22 Saraikela 19 1

23 Simdega 13 1

24 West Singhbhum 22 1

Jharkhand Total 267 22

Table 15.4

Progress so far

Strategies in 2010-11 Progress Comments

Establishment of AYUSH Clinics under Centrally Sponsored Scheme

In process Recruitment of doctors and paramedics for AYUSH clinics in 97 PHCs and 48 CHC is in process.

Recruitment In process Recruitment of computer operator has been done. Recruitment of AYUSH Coordinator and Store keeper is in process which is likely to be completed by the 2

nd

week of Feb 2011

IEC In Process Allocation for IEC has been disbursed to districts. Activities are being taken up by the districts

Capacity Building In Process Training of AYUSH doctors on Primary Health Care and NDCP is in process. Trainings of ANMs on AYUSH and Compounders on medicine preparation have not been initiated due to un availability of staffs.

Table 15.5

Plan for Year 2011-12

Broad Objective

Page 76 of 129


Mainstreaming of AYUSH in the health care service delivery system to

strengthen the existing public health system.

To draw up schemes for,

Promotion of all the systems under AYUSH

Promotion, cultivation and regeneration of medicinal plants used in

these systems.

Standardization of AYUSH Education & continuing Medical Education (CME);

research & development; IEC & international collaboration.

Strategy and Activities

15. 1. Strengthening of AYUSH

Integration of AYUSH in to the regular health service delivery system has been

visualized in NRHM. Though the state has taken up several initiatives in order to put up

AYUSH in the main way along with other systems of medicine the slow pace of in

implementation of activities came up as major bottleneck in realizing the objectives of

AYUSH.

To accelerate the implementation of programme strengthening of the institutions

under AYUSH is therefore one of the major concern of the state.

In year 2011-12 state is proposing to take up activities for strengthening of the AYUSH

as follows,

15.1.1. Establishment of AYUSH clinics in PHC and CHCs

State is proposing to establish AYUSH clinics in the 97 PHCs and 48 CHCs in the coming

year under the Centrally Sponsored Scheme. Establishment will cover the cost of human

resources for AYUSH, medicines and equipments.

Facilities Establishment of AYUSH Clinics proposed in 2010-11

Establishment of AYUSH Clinics proposed in 2011-12

Total Establishment of AYUSH Clinics by

2012

PHC 97 153 200

CHC 48 52 100

Total 145 205 300

Table 15.6

Page 77 of 129


Budget Requirement for Establishment of AYUSH clinics in PHC and CHCs

Particulars Units Unit Cost To be supported by Department of AYUSH.

Establishment of AYUSH Clinics in PHCs 153 1000000

Establishment of AYUSH Clinics in CHCs 52 2200000

Total

Table 15.7

15.1.2. Strengthening of the Management System of AYUSH State level / District level

Although there the AYUSH Directorate functioning, need for management and technical

capacities has been sought in making the AYUSH properly functional.

In the FY 2010-11, it was proposed to create necessary managerial post in the State and

District level for effective implementation and supervision of different activities under

AYUSH. This is process and likely to be completed by 2nd week of February 2011.

In the coming FY, salary for the all those posts has proposed.

Budget Requirement Strengthening of the Management System of AYUSH


Remarks

Salary to Technical Coordinator / Consultant AYUSH ( 1 x 12 Months) (Pay band 28000-35000)

12 28000 3.36 Budgeted under Sec. 11.1.17.1-11.1.17.2

under Staff for Ayush of Progm Mngmt of

RCH Salary to Computer Operator ( 1 x 12 Months)

12 12500 1.50

Total 4.48

Table 15.7

15.1.3. Strengthening of the Jharkhand State AYUSH Medical Council

Jharkhand State AYUSH Medical Council is the apex institution that deals with various

affairs of AYUSH initiatives in the state. The council has recently constituted and started

functioning. Its major activities include registration of AYUSH doctors in the state and

conducting examination and registration of AYUSH-Compounders (Dip. in Ayurvedic

Pharmacy, Dip. in Homeopathy Pharmacy, and Dip. in Unani Pharmacy).

In the coming FY 11-12 state is proposing for quarterly review of activities of council.

Page 78 of 129


Budget Requirement for Strengthening of the Jharkhand State AYUSH Medical Council


Remarks

Quarterly Meeting / Sensitization Program (One day event)

2 35000 0.70 Budgeted under Sec. 10.1.1 under Ayush of NRHM

Addlt

Table 15.8

15.1.4. Strengthening of the Jharkhand State Medicinal Plant Board (JSMPB).

JSMPB is a registered society under the Society Registration Act, 1960 under the

Department of Health and Family Welfare, Govt. of Jharkhand.

JSMPB follow and work in field of Central Sector Schemes as per the guidelines of

National Medicinal Plant Board (NMPB).

In the current year as per the direction of 6th Standing Financing Committee (SFC),

Project Proposal for National Campaign for Amla and Sahjan has been sent for approval

from NMPB.

Also proposal from NGOs has been invited under the Central Sector Schemes of NMPB.

Recommendation from State Level Screening and Evaluation Committee (SLSEC) is

under screening.

At present the Board is functioning with only one Officer on Special Duty (OSD). Thus,

there is urgent need of supporting man power for making the Board fully functional.

Therefore in the coming year state is proposing for recruitment of manpower to

strengthen the JSMPB.

Budget Requirement

Particulars Unit Unit Cost Total Cost (In lacs)

Remarks

Account officer (1 x 9 months) 1 20000 1.80 Budgeted under Sec. 11.1.17.4-

11.1.17.5 under Staff for Ayush of Progm Mngmt of

RCH

Computer operator (1 x 9 months) 1 8000 0.72

Total 3.375

Table 15.9

Page 79 of 129


15.2. Provide AYUSH services under one roof with NRHM

The AYUSH health facility has to work under one roof and separate space would be

allocated exclusively for it in the same building of DH/CHC/PHC.

In case of not availability of separate space in the DHs /CHC/PHC civil works should be

undertaken from the funds provided to AYUSH Department for this purpose.

In this regard to mainstream AYUSH along with other systems of medicine state is

proposing following activities.

15.2.1. Mapping and Setting up of AYUSH health facilities

Mapping / Facility survey of the AYUSH facilities will be undertaken in the coming year.

The Jharkhand State Health Resource Centre (JHSRC) will undertake the facility survey

of AYUSH facilities in coordination with AYUSH department.

15.2.2 Develop Infrastructure for AYUSH

After the facility survey requirement of the infrastructure for AYUSH will be demanded

and proposal for the same will be sent to Department of AYUSH, GoI for approval.

15.2.3. Filling up the different HR positions under AYUSH

To support the activities under AYUSH there is need to fulfill the positions of adequate

staffs in the dispensaries and joint dispensaries.

In the FY 2010-11 establishment of State Level Warehouse of AYUSH (Ayurveda, Unani

and Homeopath) with three Store keepers was proposed. The recruitment of these

positions is in process which is likely to be completed by the end of February 2011.

In the FY 2011-12, salary for the store keepers has proposed.

Budget Requirement

Particulars Unit Unit Cost Total Cost (In lacs) Remarks

Recruitment of Storekeeper on contract (3 x 10 months)

3 12000 per month

4.32 Budgeted under Sec. 11.1.17.3 under

Staff for Ayush of Progm Mngmt of

RCH

Table 15.10

Page 80 of 129


15.2.4. Provisioning of storage of equipments will be made

15.2.5. Availability of AYUSH Drugs at all levels

Drugs for AYUSH will be made available at all levels by the Dept. of AYUSH, GoI.

15.3. Integration of AYUSH with Community processes

15.3.1. Drug kit that will be provided to Sahiyya will contain two AYUSH preparation

Purnavadi Mandur - Iron supplement Pudin Hara. Other drugs which are used in the

treatment of common diseases, control of communicable diseases as well as drugs

promoting the maternal and child health as well as improving quality of life could be

included subsequently.

The availability of drug will be supported by Dept. of AYUSH, GoI.

15.3.2. Training module for ASHA will be updated with information of AYUSH.

15.3.3. Sahiyya Sandesh Each issue of the sahiyya sandesh magazine will cover one

component of AYUSH.

15.4. Promotion of AYUSH

15.4.1. The state is proposing to organize AYUSH Mela at the district level. AYUSH

Doctors shall be involved in IEC, health promotion and also supervisory activities. Also

under RCH Camps AYUSH doctors shall be involved. AYUSH Mela will be organizing in all

22 AYUSH Operational districts.

Budget Requirement for AYUSH Mela

Particulars Unit Unit cost Total Cost Remarks

Organizing AYUSH Health Mela (1 x 24 districts)

22 50000 1100000 Budgeted under Sec. 10.2 under Ayush of NRHM Addlt

Table 15.11

15.4.2. IEC for AYUSH

Using the mass media Radio / TV, leaflets/handbills / posters, wall writing, folk plays will

be taken up for promoting AYUSH. This will be done in integration with IEC of other

health programmes.

Page 81 of 129


The budget of IEC for AYUSH is been integrated with the allocation of other health

programmes in the IEC section.

Budget Requirement for IEC

Particulars Unit Unit cost Total Cost Remarks

Budget for IEC 24 20000 480000 Budgeted under Sec. 10.3 under Ayush of NRHM Addlt

Table 15.12

15.5. Capacity building in AYUSH

15.5.1. Training of AYUSH doctors in Primary Health Care and NDCP – To update

AYUSH doctors on Primary Health Care and National Disease Control Programmes

(NDCPs), it has been proposed to provide them refresher training on Primary Health

Care and National Disease Control Programmes (NDCPs). Each State ToT covered 40

participants for one day in 2 batches.

Particulars Unit cost Unit Total Cost Remarks

State ToT (In 2 batch) on Primary Health Care and NDCP (Refresher Training)


Table 15.13

15.5.2. Training of ANMs and Anganwadi workers on AYUSH system of medicine

As an innovative strategy, the department of AYUSH needs to train the Anganwadi

workers working for Mother and Child Health and the ANMs, who are the grass root

level health care providers in Allopathic units. The Anganwadi workers can enhance the

child nutrition and Maternal Health by the AYUSH herbs. These ANM’s and Anganwadi

workers can propagate the AYUSH based preventive principles and herbal remedies for

common public.

Initially 500 ANM’s from the 100 tribal blocks will be trained on AYUSH based heath

principles for maternal and child health. The training will be conducted at the block

level with two days training by AYUSH dept.

Page 82 of 129


Budgetary Requirement for Training of ANM

Particulars Unit Unit Cost

Total Cost Remarks

District level one day training of ANMs on AYUSH based heath principles for maternal and child health (100 tribal block) (500 ANMs x Rs 500)

500 1000 500000 Budgeted under Sec. 10.5 under Ayush of NRHM

Addlt

Table 15.14

15.5.3. Refresher Training of paramedical staffs

For preparation, storage and dispensing of AYUSH medicine - The major supporting

staffs of the Ayurveda dispensaries are compounders. A large cadre of

101compounders working in AYUSH in the state. The compounder handles record and

medicines. Medicine preparation and dispensing to the patient is the primary work of

compounders. The compounders are not trained for preparation of simple Ayurvedic

herbal combinations. To enhance the performance of compounder and for the patient

to receive correct herbal combination for the ailments the compounder’s essential

needs to be trained. Right medicine to be dispensed is very essential for proper cure of

diseases and by training of compounders, the right method of dispensing of medicine

can be inculcated in the compounders Ayurvedic medicines need to be stored with

caution and basic understanding of the herbal combination. This basic understanding of

preservation of Ayurvedic herbs need to be incorporated in the compounder. Due lack

of skills among the compounders on preservation and preparation of herbs, wastage of

large quantity of Ayurvedic medicines is occuring.

Therefore, training of AYUSH compounders for better methods of medicine storage has

pllaned in the coming year. 101 compounders will be trained in 4 batches (each batch 4

days) at Government Ayurveda College on Medicine preparation, storage and

dispensing.

Budgetary Requirement

Particulars Units Unit Cost Total cost Remarks

Training of Compounders for medicine preparation, storage and dispensing

2 130000 260000 Budgeted under Sec. 10.6 under Ayush of

NRHM Addlt

Table 15.15

Page 83 of 129


15.5.4. Herbal Treatment and Research Hub

To broaden space of AYUSH services and to promote research and development on

AYUSH system of medicines with special focus on local system of medicine it has been

proposed to establish herbal treatment hub in the five districts namely West

Singbhum, Deoghar, Hazaribagh, Gumla, Palamu one each in 5 divisions of state.

Apart from treatment of ailments, these hubs are intended to promote medicine

system being used by the people since the ages. Also these hubs will undertake

research on the system of medicine to explore the potential of the system in curing

ailments. This hub will also undertake activities to conserve cultivate, regenerate the

herbs.

A detailed action plan will be developed by the State AYUSH department to start the

hubs. It has been proposed to avail the proposed districts with Rs. 500000 each for the

establishment of the hub in the first phase.

Budget Requirement for Herbal Treatment and Research Hub

Particulars Unit Unit Cost Total Cost Remarks

Establishment of Herbal Treatment Hub


Table 15.16

15.6. PPP for AYUSH

To mainstream AYUSH in health Sector Jharkhand Rural Health Mission Society has

partnered with Kerala Ayurveda Treatment center with objective,

To create awareness about the Strengths of Ayurveda treatment and revive the

Indian System of Medicine

To integrate Ayurveda system with the health care delivery system as well as a

national program.

To upgrade the skill and develop a team of experts (therapists, doctors etc) who

will mainstream the activities under AYUSH

The success of the programme will help us to replicate the same in all the districts of

Jharkhand.

Page 84 of 129


The strategies adopted under the PPP as follows,

1. Strengthening the existing Ayurveda system Jharkhand

2. BCC / IEC campaign

3. Training / capacity building packages for doctors, paramedical staffs and therapists

4. Convergence and coordination with other government department and agencies

working in the same field

The operational area for the pilot program was selected in Ranchi division in all the five

districts namely Ranchi, Khunti, Gumla, Lohardaga and Simdega. In this partnership, an

ambulance has been provided for outreach services of Ayurvdeda services at the

community level. This ambulance has to provide five days services in each district based

on the micro plan develop by the Civil Surgeon.

To mainstream OPDs services two room has been provided in each district hospitals for

promotion of ayurveda treatment & therapy. Also KATC has to provide medicines to

cure the diseases.

Budget Requirement


Ayurveda Treatment center 5 500000 2500000 Budgeted under Sec. 10.8 under Ayush of NRHM Addlt

Table 15.17

Page 85 of 129


16. Hospital Management society

Rogi Kalyan Samiti (Patient Welfare Committee) / Hospital Management Society is a

simple yet effective management structure. This committee, which would be a

registered society, acts as a group of trustees for the hospitals to manage the affairs of

the hospital. It consists of officials from Government sector and members from NGOs,

local elected representatives and who are responsible for proper functioning and

management of the hospital / PHC. Each HMS has one Governing Board for policy

decisions and one Executive Committee for execution of the functioning of HMS. HMS

can accept funds from NRHM and other sources including the donations from private

parties. Each district hospital would get a grant of Rs 5 lakhs, each CHC (existing PHC)/

PHC (existing APHC)/ Sub Divisional Hospital (SDH)/ Referral Hospital/ Urban Family

Welfare Centre would get a grant of Rs 1 lakh each from NRHM flexi-pool. The RKS/

HMS is free to prescribe, generate and use the funds placed with it, as per its best

judgment for smooth functioning and maintaining the quality of services.

16.1 Objectives the RKS (Hospital Management Society)

Ensure compliance to minimal standard for facility and hospital care and

protocols of treatment as issued by the Government.

Ensure accountability of the public health providers to the community.

Introduce transparency with regard to management of funds.

Upgrade and modernize the health services provided by the hospital and any

associated outreach services.

Supervise the implementation of National Health Programmes at the Hospital

and other institutions that may be placed under its administrative jurisdiction.

Organize outreach services/ health camps at facilities under the jurisdiction of

the hospital

Display a Citizens’ Charter in the Health facility.

Generate resources locally through donations, user fees and other means

Establish affiliations with private institutions to upgrade services

Undertake construction and expansion in the hospital building

Page 86 of 129


Ensure optimal use of hospital land as per govt. guidelines

Improve participation of the society in the running of the hospitals

Ensure proper training for doctors and staff

Ensure subsidized food, medicines and drinking water and cleanliness to the

patients and their attendants.

Ensure proper use, timely maintenance and repair of hospital building

equipment and machinery.

16.2 Functions of the RKS (HMS)

To achieve the above objective, the Society shall direct its resources for undertaking

the following activities / initiatives:

Identifying the problems faced by the patients in CHC / PHC.

Acquiring equipment, furniture, ambulance (through purchase, donation, rental,

or any other means, including loans, from banks) for the hospital

Expanding the hospital building, in consultation with and subject to any

Guidelines that may be laid down by the State Government.

Making arrangements for the maintenance of hospital building (including

residential buildings), vehicles and equipment available with the hospital.

Improving boarding/ lodging arrangements for the patients and their attendants

Entering into partnership arrangement with the private sector (including

individuals) for the improvement of support services such as cleaning services,

laundry services, diagnostic facilities and ambulatory services.

Developing/ leasing out vacant land in the premises of the hospital for

commercial purposes with a view to improve financial position of the Society.

Encouraging community participation in the maintenance and upkeep of the

hospitals

Promoting measures for resources conservation through adoption of wards by

institutions and adopting sustainable and environmental friendly measures for

the day-to-day management of the hospitals e.g. scientific hospitals waste

disposal system, solar refrigeration systems, water harvesting and water re-

charging systems.

Page 87 of 129


16.3 Progress till date

All the health facilities such as CHCs/PHCs/DHs have been informed to form

Hospital Management Societies and register them. Accordingly, current status of

formation of HMS is given in table below:

Status of HMS formed

Sl. No. Name of the District No. of HMS Formed No. of Registered HMS

1 Bokaro 29 1

2 Chatra 17 1

3 Deoghar 14 14

4 Dhanbad 43 38

5 Dumka 44 1

6 East Singhbhum 28 0

7 Garhwa 20 20

8 Giridih 28 1

9 Godda 17 5

10 Gumla 24 24

11 Hazaribagh 25 1

12 Jamtara 13 1

13 Khunti 12 1

14 Koderma 13 1

15 Latehar 15 15

16 Lohardaga 16 1

17 Pakur 16 2

18 Palamu 33 1

19 Ramgarh 11 0

20 Ranchi 38 6

21 Sahebgaunj 20 19

22 Saraikela 20 1

23 Simdega 15 2

24 West Singhbhum 35 1

Jharkhand 546 157

Table 16.1

16.4 Utilization of Hospital Management Society (RKS) funds

Almost all the RKS have started utilizing their funds for welfare of patients.

Department has issued guidelines to utilise the funds to all RKS. Pattern of utilisation of

funds by RKS up to November 2010 is mentioned below:

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16.5 Plan of action – 2011-12

State Health Society will concentrate on optimizing the functioning of HMS

during current year. Guidelines to all HMS for utilization of funds and delegation of

powers have already been published. HMS training/workshop will be organized. This

will be completed at earliest and RKS will be supported for better role in planning and

management of hospitals during year 2011-12.

16.6 Budget requirement for HMS is given in table below:

Budget requirement for the year 2011-12

Rs. In Lakhs

Sl.no. Type of Facility No. of Facility

Total budget required

Unit rate Budget required

Remarks

1 District Hospital 21 5.0 105 Budgeted under Sec. 7 under RKS of NRHM

Addlt 2 Sub Divisional Hospitals/

Ref. Hospital/ CHCs/ PHCs/ 530 1.0 530

Total 546 635

Table No. 16.2

Table above indicates that budget requirement for RKS/HMS is Rs. 630 Lakhs.

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Page 89 of 129


17. Untied Fund & Annual Maintenance Grant

17.1 Objective

To increase functional, administrative and financial resources and autonomy to

the field units.

To develop the physical infrastructure and centre specific activities for PHCs.

17.2. Strategy

Provide Untied Funds to Village Health Committees @ Rs. 10,000 each

Provide Untied Funds to Health Sub centres @ Rs. 10,000 each

Provide Untied Funds to Primary Health Centers @ Rs. 25,000 each

Provide Untied Funds to Community Health Centers @ Rs. 50,000 each

Provide Annual Maintenance Grant to Health Sub centres @ Rs. 10,000 each

Provide Annual Maintenance Grant to Primary Health Centers @ Rs. 50,000 each

Provide Annual Maintenance Grant to Community Health Centers @ Rs.

1,00,000 each

17.3 Activities

17.3.1. Village Health Committee

Any village level public health activity like cleanliness drive, sanitation drive,

school health activities, ICDS, Anganwadi level activities, household surveys etc.

Health care need of the poor household.

Community activities that involve and benefit more than one household.

Nutrition, Education & Sanitation, Environmental Protection, Public Health

Measures shall be key areas.

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17.3.2. HSC :

Minor modifications to sub centre- curtains to ensure privacy, repair of taps,

installation of bulbs, other minor repairs

Ad hoc payments for cleaning up sub centre, especially after childbirth.

Transport of emergencies to appropriate referral centers

Transport of samples during epidemics.

Purchase of consumables such as bandages in sub centre

Purchase of bleaching powder and disinfectants for use in common areas of the

village.

Labour and supplies for environmental sanitation, such as clearing or larvicidal

measures for stagnant water.

Payment/reward to ASHA for certain identified activities

17.3.3 PHC, CHC

Minor modifications to the Center- curtains to ensure privacy, repair of taps,

installation of bulbs, other minor repairs, which can be done at the local level

Patient examination table, delivery table, DP apparatus, hemoglobin meter,

copper-T insertion kit, instruments tray, baby tray, weighing scales for mothers

and for newborn babies, plastic/rubber sheets, dressing scissors, stethoscopes,

buckets, attendance stool, mackintosh sheet

Provision of running water supply

Provision of electricity

Ad hoc payments for cleaning up the Center, especially after childbirth.

Transport of emergencies to appropriate referral centers

Transport of samples during epidemics.

Purchase of consumables such as bandages in the Center

Purchase of bleaching powder and disinfectants for use in common areas

Labour and supplies for environmental sanitation, such as clearing or Larvicidal

measures for stagnant water.

Payment/reward to Sahiyya for certain identified activities

Repair/operationalsing soak pits

Page 91 of 129


17.3.4 Untied Fund & AMG released (April-Nov. 10’)

Rs. In Lakhs

Table 17.1

Budget Required for Untied Fund & AMG

Rs. In Lakhs

Table 17.1

Sl. Type of Facility Fund Released

% Expenditure (April-Nov 2010)

1 Untied Fund for CHC 97.0 64%

2 Untied Fund for PHC 29.25 63%

3 Untied Fund for SC 395.8 51%

4 Untied Fund for VHSC 2000 36%

5 Annual Maintenance Grant –CHC

194.0 58%

6 Annual Maintenance Grant –PHC

58.5 51%

7 Annual Maintenance Grant –SC 59%

Sl. Type of Facility Facility Unit Cost Budget Required

Remarks

1 Untied Fund for CHC 50000 194 97.00 Budgeted under Sec. 2

under Untied Fund

of NRHM Addlt

2 Untied Fund for PHC 25000 330 82.50

3 Untied Fund for SC 10000 3958 395.80

4 Untied Fund for VHSC 10000 32615 3261.50

5 Annual Maintenance Grant –SDH

100000 6 6 Budgeted

under Sec. 3 under

Untied Fund of NRHM

Addlt

6 Annual Maintenance Grant –CHC

100000 194 194

7 Annual Maintenance Grant –PHC

50000 120 60

8 Annual Maintenance Grant –SC 10000 1809 180.90

Page 92 of 129


18. CONVERGENCE

NRHM has laid emphasis on the aspect of convergence which is a cross cutting theme.

There are a heap of factors like nutrition, literacy – education, water and sanitation,

means of transportation and communication besides availability of health care which

results in the psycho-social well being of a person. Hence it is imperative to identify

and intertwine all these health determinants in a logical manner to impact positively in

the well being of a person and overall good health status of families.

The need of convergence is widely recognized in all areas to get optimum results in set

timeframe for the targeted audience and more so in the sector of health because the

determinants of health are varied and are spread over areas like drinking water and

sanitation, nutrition, education, livelihood, environment and social justice which cannot

be ignored if Health for all is intended.

For the achievement of said goal, convergence is needed at all the level of policy

making, planning, and framing of programmes till down to implementation and review

of the same. Coordination has to be made effective with other sectoral departments

like panchayati raj system, village health and sanitation committee, AWW, ANMs, ICDS,

Sahiyyas (ASHA) from the village level BDOs, MOs and other block officials from the

block level so on. At the district level, the District Commissioner, DPMU, DHS, CDPOs

(ICDS), DEOs and public health engineering works, social welfare, civil supplies dept,

PWD, Electricity Board. All these in one way or the other contribute and are inter

dependent and complement each other.

Different sectors have their own programs, strategies and human resources to cater to

the need of the mother and child. Convergence, in this sense becomes an important

strategy where different departments can come together, share their resources and

work towards a common goal. The functional issues have to be sorted out between

these departments. In Jharkhand, efforts have been made by government and non

Page 93 of 129


government sector on better coordination among intra department and inter

department especially in health programming.

The departments that are having close synergy with RCH are

Women Development and Child Welfare

Rural Development

Urban Development

Tribal Welfare

Panchayati Raj Institution.

Human Resource ( Education) Department.

Labour Department

Jharkhand State AIDS control society

The different methods to establish the convergence in letter and spirit will largely be in

the form of

Joint meetings at all levels for policy framing and designing implementation

strategies with activity timeline

Multi sectoral Capacity Building programmes

Assigning responsibilities for different convergence avenues

Common reporting mechanisms

Joint monitoring and review

It is also equally important to be kept in mind that at no time the duplication in the

form of activities and expenditure does happen which will be the loss of public money

and energy.

Objectives

To prepare bilateral convergence plans with various departments and facilitate

its implementation.

Department Topics for convergence

ICDS (Social Welfare) VHND- A common day for service

Malnutrition – Referral and Treatment

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Joint IEC plan

Human Resource Department School Health Programme

Drinking Water and Sanitation Linkage of the Sahiyya and VHC program for Total Sanitation

Campaign

Tribal Welfare Running of MESO Hospitals and other health programs under the

Tribal welfare scheme

Panchayat Raj Department The function of the VHC and the use of untied funds.

Joint action on Public Health at village level.

Urban Development USHA and Urban Health Outposts

Labour Department Effective Rolling out of RSBY scheme

Jharkhand State AIDS Control

Society

RTI/STI

HIV screening at ANC and referral to PPTCT

Establishment of Blood banks/ storage

Table 18.1

18.1 Strategies for convergence:

Developing joint plan of action for convergence activities and periodic joint

review of the same: The convergence meetings represented by nodal persons

from all relevant departments shall provide the required platform to develop a

joint plan of action based on issues identified and shared by the Sub-Group. The

Plan of Action shall be subject to periodic joint reviews and reports.

Supportive supervision: The nodal persons shall provide supportive supervision

to all convergence activities and also provide written feedback/input from time

to time.

Mapping of different stakeholders working on health and nutrition.

Utmost efforts will be to develop a close coordination among all the above mentioned

departments to carry out an overall programme implementation in the state.

18.2 Activities

1. Setting up of a Mission Convergence Unit at State NRHM

Under the leadership of the MD-NRHM, SPM and the Directorate-Health

Services the convergence plans are made

2. Joint Action Plans developed with six departments in a closed workshop mode.

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3. Bimonthly review at the level of Directors or Program Managers of the

programme.

18.2.1 Major activities:

Convergence with ICDS department/ Strengthening the Village Health and

Nutrition (VHND)

A synergy between the health and social welfare department is crucial for the overall

development of health. This amalgamation of the two departments can be seen in the

observation of the Village health and Nutrition day (VHND). VHND are organized once

a month at each Anganwadi center. During these days the ANMs, AWWs who hosts this

activity provides health care services especially maternal and child health services like

ANC, immunization, distribution of nutrition supplements to the community. ANM

provides immunization for children and also responsible for health nutrition education

and for management of common childhood illness. The Aanganwadi Worker [AWW]

provides them with food supplements and is also responsible for health and nutrition

education and for management of common illnesses. The Sahiyyas facilitates in

mobilizing the community (pregnant women, children, ANC/PNC cases, family planning

cases, LBW babies) and bringing them to avail the services of the VHND. At the end of

the day a common achievement report is also prepared. To strengthen this activity

monthly report will be prepared and to be shared with both the departments for

necessary actions. ANM will be responsible for preparing the report with the help of

AWW.

The State has proposed to strengthen the Village Health Committee and Mother’s

support group under the ICDS in all the villages to monitor and support in the maternal

and child health activities especially the supplementary food given regularly at the

Anganwadi and during the VHND.

Malnutrition Treatment Centers (MTCs) are established in most of the District

Hospitals of the state. Severely malnourished children are referred to the center by

AWWs. The Sahiyya facilitates in identifying the SAM children. The children are treated

for 15 days, nutritional counseling given to the mothers, they are discharged and their

follow up tracking is done at the Anganwadi centres by the AWW and Sahiyya. The

Page 96 of 129


State proposes to increase the number of MTCs to address the needs of the

community.

Convergence with Education department :

Literacy is one of the critical social determinants of health status and the utilization of

health services. The education department can play a significant role in ameliorating

the barrier to avail health services. Presently both the departments – health and

education converge at the primary level health check up of school going children.

Usually school health is limited to areas of health care provided to school children

through institution of the school.

The School health programme is implemented in the state in collaboration with the

Department of education. Under the existing school health programme all primary

schools are visited by PHC doctors on a monthly basis for check-up relating to refractive

error correction, hearing, oral hygiene, basic medicine for some common problems like

deworming, iron supplements and skin diseases. Drug Kits are also supplied to each

primary level school. There is clearly a need for more intensive interaction between the

schools and the health authorities. Existing services of Mobile Medical Unit (MMU) will

also be extending to different educational institutions in rural as well as urban areas.

1. A bi- annual health checks with follow up and remedial action on illnesses

identified with the help of govt school teachers/para teachers

2. At least one annual dental check up with follow up and remedial action on

illnesses identified.

3. At least one annual eye check up including for refractive errors with follow up

and remedial action and where needed giving the spectacles.

4. Provision of micronutrients to students and services of referrals are provided to

the students of primary schools.

In the coming year state is proposing to organize health camps for the inmates of the

Kasturba Gandhi & Eklavya Residential Schools in convergence with the Welfare

department. Health check up of all the students of these schools will be ensured that

will cover regular health check up, hemoglobin, malaria, Kala Azar (for the Kala Azar

endemic districts). In addition to that IFA and chloroquin tablet will also be distributed.

Page 97 of 129


Mid Day Meal Scheme is under implementation by the education department with the

objective to retention of children in the schools and to compensate their nutritional

requirement.

In the coming year Department of Health proposed to have convergence with

education department in district where iodized salt will be provided to the school

children with meal. Supply of iodized salt to the schools will be ensured by the District

Health Societies (DHS) in their respective districts. Compliance of this will be essentially

reported to the state by the DHS.

Convergence with Department of drinking water and sanitation:

With the panchayati raj institutions coming up in the state, the Village health and

sanitation committees will be formed. Thus far the Village Health committees were

formed with the Sahiyyas, ANMs and AWWs being a part of it.

Under the Total Sanitation Campaign (TSC), installation of toilets has been initiated in

some villages. This year the state proposes for the construction of toilets and

installation of tube wells for safe drinking water in the HSCs which is in the

government land. The Village Health Committee and Sahiyya can coordinate with the

Water and Sanitation department to identify BPL and non BPL families for the

promotion of toilets for better sanitation.

Convergence with the Department of tribal welfare:

The department is providing medicines and other essentials supplies to the MESO

hospitals along with the Mobile Medical Unit to address the health needs of the tribal

population in the most vulnerable and hard to reach area. At present 9 such hospitals

are being supported by Department of Health which is being run by 4 NGOs under

Public private Partnership mode.

WHO are operationalising MESO hospitals.

Convergence with the Department of Labour:

The health department can converge with the labour department to provide the RSBY

scheme to all the PTG families uniformly. Presently the labour department is providing

the Health Insurance facility to BPL families under the RSBY scheme.

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Convergence meeting at different level department of social welfare and

Health:

Both the social welfare and health departments are providing nutrition, health and

IEC/BCC services, it is proposed that these departments will meet regularly at different

level for monitoring and reviewing of the programmes. Both the departments could

host the convergence meeting. In districts, convergence meeting will be arranged on a

monthly basis under the chairmanship of Deputy Commissioner of the district. In each

PHC level as well meetings will be arranged involving block level functionaries of both

the departments. At the state level the meetings could be arranged on a quarterly

basis.

Convergence Committee at different levels – block, district and state:

The Jharkhand Rural health Mission Society has been working for all inter-sectoral and

intra- sectoral convergence. The sub group within this society has been functioning

under the chairmanship of Secretary Health. These subgroups share regular updates to

the state programme coordination committee for developing future strategy. The

subgroups also focus on the inter-sectoral convergence issues. It comprises of members

from various departments of health and representative of development partners,

NGOs. A calendar of convergence meeting has been prepared on the basis that there

will be a meeting on mutually agreed date. At the district level, the convergence

meeting is called under the chairman ship of the DS with the presence of CS, DEO, DPO,

Zilla Parishad and so on.

Convergence with JSACS The state proposes to converge with JSACS for

one day orientation programmes on the basics of HIV/AIDS to MOs, ANMs, AWWs, Sahiyyas

RTI/STI screening

HIV screening at ANC and referral to PPTCT

Establishment of Blood banks/ storage.

Mapping of different Stakeholders working on health and nutrition:

The health department has maintained a data base of NGOs working on health and

nutrition, which would help in reaching out to the underserved areas to ensure better

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service delivery. Care has been taken to avoid duplicacy of work done by the different

stakeholders.

Table 18.2

Particulars Unit Unit cost Total cost Remarks

State Level Quarterly meeting/workshops/events 2 50,000.00 1,00,000/-

Budgeted under Sec. 29

under Convergenc of NRHM

Addlt

Meetings/events at district level/ Mapping of

different Stakeholders working on health and

nutrition for index preparation

2X24 35,000.00 16,80,000/-

Mapping of different Stake Holders 1 unit 1,00,000.00 1,00,000/-

Printing cost of directory 3000 150 4,50,000

Intersectoral Capacity Building (Orientation/

Training)

Dist & Block Level

24 50000 12,00,000

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Quality Assurance

National Rural Health Mission (NRHM) is in its 6th year. Since the inception of NRHM in

2005, Department of Health and Family Welfare, Government of India has taken up

several initiatives for improving the health care service delivery system in coordination

with state counterparts.

State of Jharkhand has also witnessed subsequent changes and developments in the

health sector after the advent of NRHM. Several initiatives have been taken up in order

to meet the health needs of the people of Jharkhand.

Providing quality health care services to its people is one of the major objectives that

the state intended to achieve. In view of this state has also provisioned that quality of

healthcare service must be ensured to every individual. To have done it is important to

assess and evaluate the programs and service delivery points on set standards. To meet

this objective State of Jharkhand provisioned for Quality Assurance Cell in the year

2009-10, consisting of one Consultant Quality Assurance at state level, five Regional

Consultant Quality Assurance and 30 Hospital managers. These professionals would be

responsible for the improvement of the Healthcare systems. Currently, five regional

quality consultants (RQC) and 7 hospital managers (HM) are in position. State and

regional quality assurance cell has been created in-order to ensure the quality outcome

of the NRHM/RCH and FP services along with strengthening the healthcare delivery

centers / facilities.

Progress so far

Strategies Progress Comments

Establishing Quality Assurance Cell at District Level

Completed District quality assurance cell is formed and functioning as per the government of India guideline to ensure quality of services for the family Planning services.

Operationalisation of State and Regional QA cell

Completed After the recruitment of the five regional quality assurance consultants, State and Regional quality assurance cell has been initiated. This cell will look after quality outcome of all the programs run under NRHM, RCH and other national programs apart from the Family Planning. QA cell will ensure quality and monitor all MCH activities which should also include monitoring of the training and facility.

Page 101 of 129


Appointment of State QA consultant yet to be done.

Notification of Nodal Officer for districts, Flying squad and formation of Maternal Death Audit Review Committee

Completed Two Nodal officers nominated by the Mission Director NRHM consisting of one member form Directorate and one NRHM consultant. These Nodal Officers were responsible for two districts and were to ensure that healthcare services are delivered as per the standard guidelines and funds are properly utilized. Flying squad were also nominated, whose task is to conduct sudden check of the healthcare services and systems. Maternal Death Audit review committee was formed inorder to review and inspect the Maternal death.

Plan for 2011-12

Broad Objective

Broader objective in quality assurance is associated with the concern that quality of

healthcare services will be ensured to every individual.

Specific Objectives

To ensure quality of services and monitor all MCH activities including monitoring of the training

To follow Standard treatment protocol in service delivery for all national programmes and locally common diseases will be made available at all healthcare delivery points / centers. (Standard Treatment/Operating protocol is the "Heart" of quality and cost of care. All the efforts that are being made to improved "hardware i.e. infrastructure" and "software i.e. human resources" are necessary but NOT sufficient. )

To maintaining ISO/BIS/IPHS/NABH accreditation

To perform clinical audits, quality improvement, mortality and morbidity reviews

To carry out supportive supervision visit to ensure the infrastructure status, manpower status

To conduct regular Continuing Medical Education (CME) programmes for health care professionals

To observe and ensure infection control protocols

To follow international/National external quality controls

To ensure ethical staff work practices

To perform regular audits of clinical standards by external organizations

To maintain State/National/International Hospital Accreditation Standards

Strategy and Activities

Quality Assurance cell has been formed at the state, regional and district level. The cell

will be managed by the State Quality Assurance Manager at the state level, Regional

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Quality Assurance Manager at the regional level and Hospital / Health Manager at the

District level.

It is proposed that in the year 2011-2012 Quality Assurance cell will widen its scope and

will work towards the systematic improvement of the Healthcare facilities. State and

regional level consultant along with the Regional Directors and Hospital managers will

regularly visit the facilities and conduct supportive supervision. State and regional

consultant are expected to visit Healthcare facility on regular basis to check the quality

outcome of the program and the services delivered at the facility. For their travel,

amount of Rs. 10000/- per month is proposed in the current financial year and amount

of Rs. 10000/- per month as the running cost of the regional quality assurance cell at

the regional and state level. There is a need of computer operator at the regional level

to compile the data and reports for the regional consultant; this will enhance the

output and task of the regional and state quality consultant.

The core areas of work for the Quality assurance cell for this financial year will be as

follows:-

1. System Strengthening 1.1. Strengthening of Hospital Management Society / RKS State will undertake strengthening of HMS/RKS in coordination with State Health

Resource Centre – Jharkhand. Every District Hospital and CHC has Rogi Kalyan Samiti /

Hospital Management Society to look after the functioning of the District Hospitals and

CHC and the services provided by the Healthcare staffs. Though these societies have

been formed and are functional, there has been little or no change in terms of the

quality services and proper utilization of the funds. Many HMS/RKS seldom meet or

they meet only to fulfill the meeting agenda. Therefore it is necessary to strengthen

theses societies and enable them to carry forward the task specified to RKS/HMS and

for the betterment of the patients.

In the financial year 2011-2012 state will concentrate on strengthening of these

societies and make them capable to carrying forward the RKS and HMS tasks. Special

team consisting of state officials, SPM unit and SHRC members will look after the

functioning of the HMS/RKS as external members. They will strengthen these societies

in order to improve and optimize the performance of District Hospitals. This team will

also ensure that proper planning and implementation process is being followed by the

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HMS/RKS and will optimize the utilization of healthcare facilities and health care

services

HMS-Strengthening Team (HMS-ST) will facilitate and strengthen the HMS/RKS at the

district level.

Member of the District and State Health Missions under RKS-ST

1. Mission Director – NRHM

2. State Health Director

3. Deputy Commissioners

4. Civil Surgeons

5. Deputy Superintendents

6. SHRC members

7. SPMU

8. DPMUs

9. Quality Consultant / Hospital Managers

10. BPMUs

Activities to be Under taken by HMS-Strengthening Team (HMS-ST)

1. Prepare Operational Guidelines for HMS

2. Planning for Hospital Development- : The vital component of HMS-ST a. Creation of Planning Team b. Mandatory Processes for Planning c. Conduct Gap analysis processes d. Making a long-term plan for achieving IPHS: e. Medium term plan for achieving hospital accreditation standards (ISO/NBHS) f. Develop Annual Facility Development Matrix to g. Annual Work Plan for Facility Development

h. Facilitating in getting the annual plans approved and displayed

3. Facilitating the Implementation of the Plan- collective action by HMS and hospital staff

4. Ensure regular HMS meetings, motivation building, responsibility fixations, appreciative inquiry and review processes

5. Annual External Evaluation and Accreditation Processes a. Evaluation of all the Healthcare programs

1. Evaluation of Stake Holder 2. Desk Review of HMS functionality 3. Evaluation of RSBY coverage and management 4. Evaluation of fund utilisation 5. Evaluation of Quality of care

b. Comparison with internal assessment and Peoples Charter

6. Annual Accreditation and Award Processes

7. Governance and Policy/Decision Making Processes for HMS under HMS-ST

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8. Community Accountability in HMS under HKS-ST

9. HMS-ST: roles, responsibilities, duties and powers for various HMS bodies and officials

10. Technical Assistance and Capacity Building inputs for HMS under HMS-ST

2. Certification of the Hospitals / Healthcare facilities 2.1. ISO Certification District Hospital, Deoghar has got ISO certification year 2008-09. Process for ISO

certification of District Hospital of Hazaribagh, West Singhbhum (Chaibasa) and Giridih

has been initiated in 2009-10. In order to complete the certification process and to

maintain these certificates certain amount is required for the training, purchase of

certain equipments and for the minor repair and management.

Budget Requirement

Particulars Units Unit Cost

Total Cost Remarks

Management and Maintenance of ISO certification

50000 5 2500000.00

Budgeted under Sec. 18.1 under Quality

Improvement of Hospitals of NRHM Addlt

2.2. Family Friendly Health Certification State is endeavoring to provide homely and friendly feeling to the patients and their

relatives during their visit to government hospitals. In the year 2010-11 amount of Rs.

140.60 Lakhs was sanctioned for the Family Friendly Health Initiative (FFHI).

Despite of State’s efforts things in all the District Hospitals have not improved. Facilities

for the patients and relatives are still in dull condition. Also the fund under HMS is

found not sufficient for management hospital affairs.

Therefore, in the coming year state has decided to provide financial support to all the

21 district hospitals in order to accelerate undergoing FFHI process. Rs. 3 Lakhs per

dstrict Hospitals (total 63 Lakhs) has propsed in this regard. Amount of Rs. 70 Lakhs was

diverted for completion of construction work.

Under FFHI process District Hospitals will have to take up activities as follows,

1. White washing of the Facility

2. Purchase of chairs / benches

3. Purchase of the safe drinking water equipment

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4. Minor repairing of the Toilets and Labour Room

For the year 2011-12 the FFHI certification process will be undertaken at a large scale and 25 facilities will be certified. Initially 17 District Hospitals and 7 best performing CHC will be certified and the rest facilities will be certified gradually.

Activities Under the FFHI Cerification

Broad categories Specific Criterion Verifiable Indicator

Creating environment for Service delivery

1. Running water in Labour room/OT/OPD/Toilets @ 24hrs

(i) Presence of Overhead tank

(ii) Running water supply

(iii) Elbow taps present in OT and labour room.

2. Hot water supply to Labour room / OT / wards

(i) Heating system for water

3. Protected drinking water (i) Purification system (Reverse osmosis)

4. Uninterrupted electric supply

(i) Emergency Light, Generator (High capacity-50-80 KvA)

(ii) Inverter (800 MA) in OT, Labor room and blood bank.

5. Service guarantees (i) Display of services available, timings and doctors availability

6. Seating arrangement available

(i) Seating facility for OP/IP patients

(ii) Seating facility for attendance.

(iii) Fans, lights, TV available in OPD and wards

7. Queue management system

(i) Numbering system in place

(ii) Electronic display of token

8. No junks inside hospital / premises

(i) Junk not occupying the wards and premises

9. Toilet clean, no leaking pipes, no blocked toilets

(i) Clean floor and functional door/latches

(ii) Monitoring sheets which have specified timings to clean with initials of person who cleans the toilets, with time mentioned.

(iii) Tap with running water present, no leaking taps.

(iv) No blocks in toilet.

(v) Washbasins are not stained.

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10. Clean and hygienic environment

(i) Floors cleaned with disinfectant.

(ii) Building whitewashed

(iii) No littering

(iv) Rainbow linen maintained / Clean linen

(v) Windows not broken

(vi) Wards have mosquito screens

(vii) Labour room cots not rusted

(viii) Mattress not worn out, cloth not torn, cotton / coir not coming out.

(ix) For labour room, labour boards not rusted, not broken, and no blood stains present.

(x) Fumigation machine (for OT) present and working

(xi) OT windows closed, anteroom present

(xii) electric switch board not broken/electric wires not exposed

(xiii) electric bulbs in wards, pathways and toilets

(xiv) Functional Phone/internet connection

C. IEC and Patients care

1. Provider talks courteously (i) Feedback system (as per format)

2. Patient Grievance redressal system present

(i) Grievance box with a lock whose key is with medical officer in charge.

(ii) Complaint book with action taken to the complaint, with date mentioned.

1. IEC Display (i) Display of OT maintenance protocol

(ii) Display of immunization chart

(iii) Display of Immediate & EBF message

(iv) Other informational messages

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2. Barrier free environment for disabled

(i) Hand rails (on way to toilet etc)

(ii) Ramps (on way to wards/OT/labour room etc)

3. Signage and directions present

(i) Signage’s / directions present

D. Equipments 1. OT equipments present (i) As per requirements

2. CSSD Equipment (ii) semi auto hydraulic auto autoclave machine / Washing machine

3. Housekeeping equipment s and Biomedical waste management systems

(iii) Purchase of Bins

(iv) Purchase of Trolly

(v) Construction of the common disposal Pit

E. Professional Standards and Technical Competence

1. Protocol for infection control, Universal safety precautions and Surgical safety guidelines (WHO)

(i) Protocols displayed (Safe child birth checklist and Active management of labor etc.)

(ii) Staff practices protocols (e.g. hand washing)

(iii) Printed check list in the case sheet

(iv) Printed partograph, recordings in the case sheet

(v) Soap available in OT

2. Bio-medical waste Management (BWM) followed

(i) Deep burial pit for anatomical waste is disposed

(ii) Needle cutter

(iii) no mix of infectious or non-infectious waste

(iv) Colour coded waste bins in each wards and departments

(v) Colour coding instructions displayed.

Client Provider Interaction

Access to Health Services

F. Service delivery & Continuity of care

1. 24 hour doctor availability and various register to be maintained

(i) Duty roster, causality register, Stock register, Lab register, Supply movement register, Delivery register Pediatric ward register, Immunization register

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G. FFHI Certification

(i) Certification process and consultation meeting for 25 facility

H. Workshop and Meeting

(i) Orientation and dissemination meetings.

I. Trainings (i) Training of the staffs

Budget Requirement for FFHI Certification

Particulars Units Unit Cost Total Cost Remarks

Gap Analysis - Assessment of the facility

25 20000 500000.00


Quality Improvement of

Hospitals of NRHM Addlt

Creating service environment 25 200000 5000000.00

Client Provider interaction 25 30000 750000.00

Access to health services 25 50000 1250000.00

Equipments and Supplies 25 500000 12500000.00

Setting Professional Standards and technical Competence

25 60000 1500000.00

Service Delivery and Continuity of care

25 50000 1250000.00

FFHI Certification 25 1000000 1000000.00

Workshop/meeting/Dissemination 500000 12500000.00

Total 36250000.00

2.3. National Accreditation Board of Health and Hospitals (NABH) accreditation and certification Among District Hospitals in the five administrative divisions of the state three best district hospitals will be identified taking account of the condition of the infrastructure, systems and standards, manpower and quality of services being delivered at the facility. Since these facilities would have also undergone FFHI certification process, minimum effort will be required and cost of up gradation will also be less. The district hospitals of following districts will be selected, 1. Gumla

2. Lathehar

3. Simdega

Budget Requirement

Particulars Unit Unit Cost Total

NABH Standards for hospital accreditation

Guide book to NABH Standards for hospital 3 3000 9000 Budgeted under Sec. 18.5 under

Quality Improveme

nt of Hospitals of NRHM Addlt

Application fee (60000/-) and NABH Accreditation charges for Pre-assessment, Assessment and Surveillance (175000/-)

3 235000 705000

Orientation Workshop and Meeting state (200000/- ) and regional level (100000/-)

1 300000 300000

Up gradation of the facility 3 500000 1500000

Purchase of additional equipments 3 200000 600000

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Total 3114000

3. Standard Based Management and Recognition In accordance with the revised draft IPHS guidelines 2010 for hospitals, special

emphasis has been given for preparation of the standard operating procedures /

manual are to be prepared for each department and the activities. QA Cell will develop

this Standard Operating Processes Manual and will implement it in every Healthcare

facility so that quality of services will be measurable. SOPs will be developed in

consultation with the state of art healthcare setups like Armed Force Medical College,

Wockhardt Hospitals, Fortis Group of Hospital, TMH, Aravind Eye Hospital, AIIMs and

Ministry of Health and Family Welfare, GOI.

Budget Requirement

Particular Unit Unit Cost Total Remarks

Preparation of SOPs Manual (Workshop, Work group meeting, Field visits)

1 500000 500000 Budgeted under Sec. 18.3.1 & 18.3.2 under Quality Improvement of Hospitals of NRHM Addlt

Printing of the standards for all the Health care facilities

1 1000000 1000000

Total 1500000

4. Computerization of the District Hospitals Under NRHM most of the district hospitals have been either upgraded or newly constructed. All most all the district hospitals are either 100 bedded or more, with approximately hundred manpower working day and night to handle the patients, relatives and equipments. To manage such a huge infrastructure and manpower, proper management system and latest technology is required. NRHM Jharkhand has recruited 7 Hospital Managers in 2010 and in process for recruitment of rest 23 Hospital Managers. State is intended to upgrade hospital management system with latest technology for quality services to the patients. For the year 2011-12 State has planned for segmentation and computerization of the major and larger department in each district hospital–

1. Reception

2. Ward Management

3. Stores (LIFO/FIFO)

4. Laboratory (Lab)

5. OT / Labour Room

6. Housekeeping

i. Linen

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ii. Waste management / Cleanliness

iii. CSSD

7. Diet / Kitchen

8. Medical record Department

9. EPABX

10. Pharmacy

Each of these departments to be handled by the departmental In-charge and are to be

computerized so that delay in response can be minimized and data management is

improved at the facility level. The computer placed in this department will be

connected to LAN and software like Hospital Management Information System (HMIS)

software. Hospital Management Information System (HMIS) software will be consist of

different modules like Billing Module, IPD Module, OPD Module, Lab Module, Medical

Record Keeping, HR and Account Module and Housekeeping Module. These modules

will be installed once the Hospital manager are placed and as per the requirement of

the District Hospital and manpower available. Module can be purchased from the

reputed institute like Wipro, TCS or for the local companies.

Budget Requirement for Segmentation and Computerization

Particulars Unit Unit Cost Total Cost Reamrks

Computer with UPS (5 nos x 21) 210 60000/- 12600000 Budgeted under Sec. 18.3.3 under Quality Improvement of Hospitals of NRHM Addlt

Duplex Printer (5 nos x 21) 210 10000/- 2100000

Scanner (5 nos x 21) 210 5000/- 1050000

Total 7875000

5. Mentoring, Guidance and Training of Hospital Managers, Deputy Superintendent

(District Hospitals), MOIC and Quality Consultant

It has been thought that deployment of Hospital Managers will improve the various

administrative and management functions of the district hospital. In very short time

period they have been contributed very well in management of hospital affairs. Hospital

Managers in coordination with the DS – Deputy Superintendent and RQC are helped in,

1. Proper waste disposal. 2. Cleanliness of the hospital premises. 3. Preparation of the duty roster and ensuring that the services providers are

following it. 4. Queue management, file keeping and proper record keeping. 5. Proper maintenance and utilization of the equipment and 6. Calibration of the equipment

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Which were un recognized and un noticed due to absence officiating authority for

hospital management functions

In the coming year state is proposing to provide proper motivation, guidance, support

and training of these Hospital manager and Quality Assurance consultant.

6. Monitoring and Evaluation of the Healthcare Facilities and Services

6.1 Supportive Supervision and Medical Monitoring By Internal Facilitator - utilizing

Supportive Supervision Tool and Medical Monitoring Tool

Apart from regular visit done by the Quality Assurance team, Supportive Supervision

visits will be done on regular basis. Supportive Supervision will provide critical support

to health care service providers. Facilitative Supervision is based on widely accepted

quality management principles and emphasizes mentoring, joint problem solving and

two way communication. Evidence demonstrates that continuous implementation of

facilitative and supportive supervision generates sustainable performance and

improvement in quality of services provided. It is proposed to develop a pool of

facilitative supervisors from among the supervisory cadre at the district levels and

orient them on the facilitative approach to supervision. Supervisors will cross check the

HIMS reports and program implementation status of the districts at the block level.

6.2. Medical Monitoring for Quality Improvement Medical Monitoring is crucial for maintenance and improvement of services provided at

a health facility. Medical monitoring (using COPE/CME) will be done at District

Hospitals, Community Health Centers for the purpose of quality improvement using

standardized checklist. The following processes will be followed in Medical Monitoring,

Objective and ongoing assessment for readiness and process of service delivery

Identification of gaps

Providing constructive feedback and solutions

Development of action plan with the involvement of facility staff.

The state will utilize the services of trained Facilitative Supervisors for Medical

Monitoring.

A budgetary provision of Rs. 25000 is being proposed per district for logistical support

for Medical Monitoring visits.

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Budget Requirement for Medical Monitoring


Logistical support for Medical Monitoring

visits

24 25000 600000.00

Budgeted under Sec. 18.4.1 under Quality Improvement of Hospitals of NRHM Addlt

6.3. Monitoring and evaluation of the Healthcare facilities By External Agencies / Interns from reputed institute like

i. TISS – Tata Institute of Social Sciences

ii. IHMR – Institute of Healthcare Management and Research

iii. AIIMS – All India Institute of Medical Sciences

Students from the reputed institute will be invited for one month internship program.

These interns will be stationed in a particular District for a month and will monitor and

evaluate the quality of services, programs and systems of the District Hospital, CHC and

PHC. At the end of the program they will submit the report; on the basis of this report

many important management decisions can be taken forward.

Budget Requirement for M & E by External Agencies / Interns from reputed institute

Particulars Units Unit Cost Total Cost Remarks

Evaluation by Interns (Internship) – TISS, IHMR, AIIMS (30 interns per year)

1 600000 600000.00

Budgeted under Sec. 18.4.2 & 18.4.3 under Quality Improvement of Hospitals of NRHM Addlt

Quality Assurance Cell workshop and meetings (Monitoring Visit of DQAC Member)

72 5000 1440000.00

Total 2040000.00

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Innovation

1. Public Private Partnership

To cater the State health need, the government of Jharkhand is facing the challenges’ of

instability of government as well as the qualified health manpower, insufficient

infrastructure at all facility level. In spite of these challenges government and various

organizations are committed to work for the betterment and upliftment of the people

and the community. NRHM has brought significant changes towards the Healthcare

services but still lot need to be done before the last person receives quality healthcare

services. In order to move a step closer towards the delivery of the quality of care

NRHM has come up with various flexible and innovative projects. Public private

partnership is one of the components. Public private partnership or PPP in the context

of the Health sector is an instrument for improving the health of the population. PPP is

to be seen in the context of viewing the whole medical sector as a national asset with

health promotion as goal of the health providers, private or public.

The term PPP comprises of Public means government or organization functioning under

state budgets, Private stands for profit/non-profit/voluntary sector and the

collaborative effort and reciprocal relationship between two parties with clear terms

and conditions to achieve the said objectives following certain mechanisms is the

Partnership.

PPP however does not mean privatization of the health sector. Partnership is not meant

to be a substitute for lesser provisioning of government resources nor an abdication of

Government responsibilities but as a tool for augmenting the public health system.

1.1.Broad Objective of PPP :

Involvement of the private agency in development and improvement of the Healthcare

services through partnership

1.2.Specific Objectives:

1. Strengthening of the Government Healthcare facility and services by

involvement of the private stake holders.

2. Creation of the Model and better Healthcare management system, which can

set an example to others and can be replicated.

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3. Improvement of the Healthcare services by involving Development partners

Under PPP, last year government of Jharkhand has proposed for outsourcing the PHC

(APHC) to the private agencies (NGOs, corporate) under the public private partnership.

Progress of the Public Private Partnership

Partnership with the agency is in progress and 10 PHC will be handed over to the

agencies by February 2011.

Following are the list of PHC to be handed over to the selected agencies

Region District Name of the Block /CHC

PHC

Santal Pargana 1 Godda Maherma Singari

2 Sahebganj Rajmahal Teenpahar

South Chottanagpur 3 Ranchi Rathu Mc Luiskiganj

4 Simdega Jaldega Basjoor

North Chottanagpur 5 Hazaribagh Badkagoan Badam

6 Giridihi Bagodar Atka

Palamu 7 Lathehar Manika Palahiya

8 Garhwa Ranka Chinia

Kolhan 9 West Singhbum Noamundi Barajamda

10 SarikelaKarshwan Gamria Hudu

1.3.Modalities of Implementation of the PPP is given as follows

As per an inventory made jointly by the Society and the agency, the condition of the

building / equipment handed over is also recorded. The agency will provide all the

Health/Medical / Family welfare services. The agency has to engage its own

Medical/Paramedical / Other staff for providing these services. The agency will ensure

that these personnel are always available at the pre decided timings. The personnel

should reside locally. In case of leave of any personnel the agency will provide an

alternative so that the PHC does not become non functional due to lack of required

personnel at any point of time. The existing staff at PHCs will be suitably redeployed by

the Society / Department to other PHCs/ PHCs.

Services that the agency / partner is required to provide

24*7 Emergency services OPD services for six days a week, as per the timings specified by the state

government 6 bed inpatient facility

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Make availability of essential medicines Minor operation theatre facility 24*7 Labour, and essential obstetric facility Availability 24*7 referral services Immunization services

Any change in the above pattern would be effected with the prior approval of the state

government

Minimum staff that has to be deployed under the PPP is as listed below

Sl. No. Category of staff No of Post

1 Medical officer -1 Male, 1 female(preferably) 2

2 Pharmacist 1

3 Staff nurse 2

4 ANM 2

5 Lab tech 1

6 Security 3

7 Group D - Ward boy cum Helper 1

8 Group D - Sweeper cum cleaner 1

9 Store keeper cum Accountant 1

Laboratory test facilities that the agency has to perform at the PHC level

Hb%, TLC, DLC, ESR Blood grouping and Rh typing MP (Malaria Parasite) test , widal test Routine stool Routine urine Pregnancy test Sputum for AFB Blood sugar VDRL

The agency will provide all the services free of cost. Standard of hygiene and health safety

The agency will maintain and run the PHC in a hygienic manner conforming to the

normal norms of health safety. The hospital waste is being disposed of in conformity

with the recognized and acceptable norms as specified by biomedical waste

management norms. The agency will assist the government for controlling any epidemic

or medical emergency in the area.

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Purchase of Drugs and Consumables

Agency will receive all the allotted fund, drugs and consumable from the state and

central as per the existing norms of the government. The agency is allocated funds by

the society (JRHMS) for procurement of drugs / consumables. All procurement of drugs

/ consumables can be purchased as per government norms.

Audit and Accounting

Separate books of accounts are to be maintained for PHC. Accounts are to be audited

by a chartered Accountant. SOE & UC is to be submitted on time. State government can

ask for a special audit of PHC accounts after giving 30 days notice.

Records and Reporting

The agency will maintain records and send reports in time as normally expected from

any PHC in the government system. The agency will preserve the records carefully and

hand over the same to the state government at the time of exiting from the project.

The agency will also maintain a record of proceedings of the meeting of the PHC

Planning and monitoring committee. Society may authorize officers to conduct

inspections at the PHC. The agency will also maintain a visitor’s book where authorized

government functionaries can record their views / suggestions after conducting an

inspection. Agency will submit Annual Progress report and also publish it after the

approval of the Society at the end of the year.

Review and Monitoring Structure

PHC planning and monitoring committee would be constituted at the PHC level

comprising the representative of the Agency, MOIC, Medical Officer, BPM and members

from Hospital Management society of the area.

Monthly Budget operationalisation of the PHC in the current financial year is

A

Monthly Budget for Running One PHC In PPP Mode

Particular

1 HR unit/Rate No. of Person

Total Per month

1.1 Medical Officer (Male) 30000 1 30000

1.2 Medical Officer (Female) 30000 1 30000

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1.3 Pharmacist 8500 1 8500

1.4 Lab Tec. 8500 1 8500

1.5 Staff Nurse 12000 2 24000

1.6 ANM 8000 2 16000

1.7 Store keeper cum Accountant 6000 1 6000

1.8 Group D (Ward boy cum Helper) 4000 1 4000

1.9 Group D (Sweeper cum Cleaner) 4000 1 4000

1.10 Security 4000 3 12000

1.11 Sub Total 115000 14 143000

2 Medicine 10000

3 Admin (Phone+ Fax+ Printing + internet) 3000

4 House keeping 2000

5 Sub Total 158000

6 Overhead (20%) (includes POL of generator, electricity, water, diet for the patients, minor maintenance of building )

31600

7 Total Monthly Operational Cost 189600

8 Total Operational Cost Per Year 2275200

9 Establishment Cost 100000

10 Purchase of 5KV Generator 250000

11 Total Yearly Budget 2625200

Total yearly cost for operational of one PHC under PPP is Rs 2625200 (Twenty Six lakhs

Twenty five thousand Two hundred only) for one PHC under the PPP in the current

financial year.

National Programmes

All national programmes of health and family welfare in the area assigned to the agency

are to be implemented by the agency in coordination with the existing field staff

specifically appointed by the government for such programmes.

Any drugs/vaccine/equipment made available by the central government / state Govt.

under any national programme for use at PHC will also be given to the agency.

Evaluation

External evaluation after every 6 month and Concurrent evaluation after every 6 month

Asset Creation

Any assets created at the PHC from the funds of this project or funds collected from the

community / other donor will be the property of the state government and will be

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handed back to the government as such after project duration is over. Assets register

must be present at the facility.

Assets created by agency from its own funds will also remain as the property of the Government.

Strategy

Once the PHC are outsourced or handed over to the Private agencies, society will

monitor the performance on regular basis and will ensure that these facilities are

performing better than the other government facilities so that they set an example to

the other facilities. On the basis of better services provide by these agencies, Society

can demand such efficient services from the government staff also.

For the financial year 2011-12 government will continue with the PPP mode for the

current 10 outsourced PHC and will hand over another 10 PHC to the private agencies

with the similar condition or with some modifications.

1.4.Budget requirement Activity Unit cost Physical Target Total Remarks

Total Operational Cost for Running existing PHC through PPP

2625200 20 525.04 Lakh Rs.

Budgeted under Sec. 15.1 under Public Private Partnership of NRHM Addlt

2. An approach to reduce the genetic load of Haemoglobinopathies (sickle cell

anemia & Thallasemia) in a district of Jharkahnd

INTRODUCTION:

Inherited hemoglobinopathies are major health problem in Mediterranean region,

Middle East, Indian sub continent, Far East and tropical Africa. Beta – thallesemia is

commonest single gene disorder in India.

Estimated carrier population could be 44 million with an addition of 13000 children

each year having major Hemoglobin disorder [Assuming a population of 100 million and

birth rate of 28 ].

Among the Indian Sub continent one of the most under assessed region is Chotanagpur

plateau comprising of Jharkhand, Chattisgarh and parts of Orissa. Jharkhand state has

got a major share of Hemoglobinopathy that is; Beta thallesemia and sickle cell

anaemia.

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2.1.OBJECTIVE –

1. Assessment & estimation of disease load of Sickle cell anemia and Thallasemia in

tribal and nontribal population.

2. Establishment of screening and diagnostic centre at Rajendra Institute of medical

Sciences, Ranchi, Jharkhand.

3. Establishment of day care centre for regular management of diagnosed patients of

sickle cell anemia and Thallasemia [heoglobinopathy]

2.2.BACKGROUND OF PROBLEM:

The state of Jharkhand is land locked territory bound by Districts of Rohtas,

Aurangabad, Gaya , Nawada, Jamui, Banka, Bhagalpur, and Katihar of Bihar in North ,

The districts of Malda, Murshidbad, Birbhum, Bardhwan , Purulia, and Medinipur of

West Bengal on the east , The districts of Mayurbhanj , Kenduhargarh , and Sundergarh

of Orissa , on the south , the districts of Raigarh , Surguja of Chhattisgarh and district of

Mirzapur of UP.on the west .

Estimated carrier state of Jharkhand region is approximately 0.15 million and about

1200 children are expected to join the pool of existing Hemoglobinopathies [assuming a

population of 30 million and birth rate of 28].

If adjoining regions of Orissa, Bengal, and Chhattisgarh are also added, these figures will

increase. This heavy genetic load causes physical, psychological trauma, mental

harassment, and numerous blood transfusions, with high cost of treatment without a

final hope of cure. In spite of all the problems, real genetic load remains unappreciated

at the level of community in Jharkhand.Though the tribal communities constitute a

major part of India, unfortunately they are highly vulnerable to many hereditary

disorders causing high degree of morbidity and mortality.

Various Study and Literature review shows that thalassemia and other

haemoglobinopathies are highly prevalent (0.028-18%) among the tribal communities.

Some types of deleterious mutation are restricted to some particular tribes. As for

example, tribes of Maharastra and Gujrat have shown prevalence of 619bp deletion

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mutations in 49.2% and 45.5% carriers, respectively. HbS (codon 6A→T) mutant allele is

widespread among many Indian tribes.

Since last 20 years the high frequencies of these mutant alleles is maintained by the

tribal populations probably due to consanguinity and endogamous mating for a long

period of time, along with ignorance, lack of awareness and conveyance, low-income

status and high cost of treatment make them vulnerable.

An interesting aspect of sufferers of the sickle cell anemia is, though having short life

span; it is believed that carriers (sickle cell trait) are relatively resistant to malaria. Since

the gene is incompletely recessive, carriers have a few sickle red blood cells at all times,

not enough to cause symptoms, but enough to give resistance to malaria. Because of

this, heterozygotes have a higher fitness than either of the homozygotes. This is known

as heterozygote advantage.

The malaria parasite has a complex life cycle and spends part of it in red blood cells. In a

carrier, the presence of the malaria parasite causes the red blood cell to rupture,

making the plasmodium unable to reproduce. Further, the polymerization of Hb affects

the ability of the parasite to digest Hb in the first place. Therefore, in areas where

malaria is a problem, people's chances of survival actually increase if they carry sickle

cell anemia.

Hemoglobinopathies are autosomal recessive condition and involve the globins moiety

of Hb molecule in thallesemia . The hereditary effect causes severe hemolytic anemia.

Beta globins gene on chromosome 11 has 22 mutations identified in Beta thalllesemia

in Indian patients. Most of the mutations are point mutation .Detection of mutation is

done by southern blot, ARMS – PCR, Reverse dot blot.

It has also been seen that major hemoglobinopathies are prevalent in tribal population

of Chhotanagpur plateau.

Following causes could be attributed.

Causes in increase of Homozygosity of Hemoglobinopathy gene in community -----

1. Marital consanguinity [Marriage among blood relatives]

2. Heterozygotes produce more children to compensate loss of Homozygos

children.

3. Terminal proximity.

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4. Endogamy.

5. The situation is further compounded by caste class hierarchy, geographical

barrier, climatic variation and echo diversity.

6. Natural selection and adaptation of globins gene to fight the menace of Malaria

*It is well known fact that malaria parasite can’t survive in hemoglobinopathic

patients]

Cost factor of disease:

Patient with beta thallesemia develop disabling disease in infancy or childhood. Most

children are severely anemic having Hepatosplenomegaly and skeletal abnormalities.

Sickle cell disease also poses frequent complications. Beta thalesemic are usually

inadequately transfused without prevention of iron overload. Death invariably awaits

them before adolescence. Cost of ideal treatment is tremendous and rises with each

additional child. All these facts demonstrate that prevention is only strategy and

plausible option for India.

The State propose a strategy to identify, estimate and assess the disease load of

hemoglobinopathy in 1 district of Jharkhand. This may gradually extend to whole of the

state.

2.4.Budget for the Strategy implementation –

Sl. Particulars Amount Remarks

1 Non – recurring ---[Instruments etc].- 13.80 lakh Budgeted under Sec.

16.3 under Public

Private Partnership

of NRHM Addlt

2 Recurring --- [ articles ] – 5.50 lakh

3 Establishment cost – 5.85 lakh

4 Cost of awareness program – 3.64 lakh

Total – 28.79 lakh

Annexure -1

Approximate list of Instruments (with price)

Non – recurring

Electrophoresis— 60 thousand

Binocular microscope – optima – 70,000

Osmometer – 1.5 lakh

Multipara monitor – 6 lakh

Patient intensive care bed – 1 lakh (4)

Auto infusion pump- 2 lakh – (4)

Mobile light on stands – 1 lakh

Oxygen cylinders – with mask – 0.50lakh (2)

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Suction machine – 0.50 lakh (2)

Total = INR 13.80 lakh

Recurring –

Lab articles- tubes, chemical, microtips etc.— 0. 50 lakh

Publicity materials- 1 lakh

Paper advertisements- 0.50 lakh

TA to staff & doctors – 1.50 lakh

DA to staff & doctors- 1.50lakh

Contingency 0.50 lakh

Total – INR 5.50 lakh

Annexure –2 List of article for establishment

2 Computer- 100,000

FaX, 15000

printer 20000

Furniture- 1lakh

Air conditioning – 1 lakh

LCD projector with screen – 1.5 lakh

Furnishing of space provided- 1 lakh

Total – 5.35 lakh

Annexure -3 Budget for awareness program of 1 district for the year 2011— 3.64 lakh

District – one

Population—10 lakh

Average no. of PHC – 10

Participants – Doctors – 50 Non medical persons --- 50 local panchayat officials =- 50 Paramedical staff – 50 AWD – 50 Teachers and professors – 50 Workers from Industry- 50 College students -50 Journalists + women’s and citizen’s organization – 50 Total - - - 350

No. of training – 7

Participants per training – 50

Duration of program – 1 working day [ 6 hours]

No. of trainers – 4

Budget for Doctor’s awareness and training program No. of program - one

Resource person – 2 from outside state TA [out side state ] @ 10,000 x2 = 20000

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2 from state TA [inside state] @ 5000 x2 = 10000

DA @ 1000 each x4 = 4000

DA for participants @ 200 x50 = 10000

Stationary – 5000

Contingency 3000

Working refreshments – 200x 50 = 10000

Total INR 57000

Budget for nonmedical person’s training program No. of program = 7

Resource person – 4 from state TA [inside state] @ 5000 x4 =20000

DA @ INR 1000 each x4 = 4000

DA for participants @ 200 x50 = 10000

Stationary 5000

Contingency- 3000

Working refreshments – 200x 50 = 10000

Total 52000

Grand total for 7 programs = 52000 x 7 = INR 364000

3. OCCUPATIONAL HEALTH HAZARDS CONTROL PROGRAMME in Jharkhand –

A Pilot in two districts

Occupational Health is one of the components of the National Health Policy 1983. It is

included in National Health Policy 2002. Ministry of Health & Family Welfare, Govt. of

India has launched a scheme entitled “National Programme for Control & Treatment of

Occupational Diseases” in 1998-99. The National Institute of Occupational Health,

Ahmedabad (ICMR) has been identified as the nodal agency for the same. Planning

Commission had identified occupational health as one of the priority areas and set up a

working group to prepare the Xth Five Year Plan on Occupational Safety and Health

comprising NIOH, DGFALI & DGMSf and secretaries of different state governments.

National Institute of Occupational Safety & Health (NIOSH) has developed a priority list

of 10 leading work-related illnesses and injuries. Three criteria were used to develop

the list: a) The frequency of occurrence of the illness or injury, b) Its severity in

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individual cases, and c) Its potential for prevention. Occupational lung disease is first on

the list. Silicosis, coal worker pneumoconiosis, asbestosis, sederosis, beriliosis,

stroniosis and byssinosis are still prevalent in many parts of the world as well as in

mining areas of Jharkhand, Assam, Orissa, Chhattisgarh, Andhra, Karnataka, Goa,

Tamilnadu etc in India. The prevalence of Occupational Asthma varies from 10% to

nearly all of the workers in certain high-risk occupations. NIOSH considers occupational

cancer to be the second leading work-related disease, followed by cardio-vascular

diseases; disorder of reproduction, neurotoxicity, noise induced hearing loss,

dermatological conditions, and psychological disorders. Silicosis and different other

forms of dust diseases also known its generic name pneumoconiosis is one of lethal and

incurable lung disease.

WHO has estimated that in India a population of 10, million ( 1 crore) is exposed to

silicosis and a report O K International, US working with stone query operators in India

reveals that silicosis kills 30,000 people a year in India.

In Jharkhand there is 15 thousand dust generating mines & units that includes

nearly 10000 stone crushers, 40-45 ramming mass units (quartz powder mill), 192 iron

ore crushers and 77 segments of (production & construction) areas are in operation

without dust control measures are identified as potentially crystalline silica exposed

areas. A conservative estimate is 25-30 lakhs people have been suffering from silicosis

in Jharkhand as history of mining and its processing in Jharkhand is of more than 200

years.

The said units do not take preventive measure to check silica dust pollution and there is

not a single designated centre for lung diseases in government hospital in Jharkhand.

The prevalence in ramming mass unit is 100% and average year of death is 33.5 to 35

years and in granite/basalt stone crusher prevalence ratio is 55% and average year of

death is 45- 50 years. Mostly the silicosis victims belong to tribal and other weaker

sections of the society who are engaged as daily wage earner in unorganised sector or

industrial belt of urban areas. More detail study is needed for effective intervention.

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A comprehensive plan and its implementation for prevention and control of health

hazards that may start with undertaking a pilot project for implementation as

pneumoconiosis identification & elimination programme in East Singhbhum &

Seraikella- Kharswan as decided in the meeting of 6th January 2011 under the newly

formed Occupational Health Hazards Control Cell of JRHM. Notably Delhi and some

other state governments are implementing similar project along with local NGO.

3.1.Strategy

Setting up of an Occupational Health Hazards Control Cell at the state level. This

body would work in close collaboration with the health and labour department

with the following objectives’

o Prepare a white paper on Occupational Health in Jharkhand.

o Prepare a working policy and a five year plan for Jharkhand that would

comprehensively cover the major Occupational diseases in Jharkhand.

o Initiate and supervise a pilot program for the prevention, treatment and

rehabilitation for Occupational Lung Diseases at Jharkhand.

Setting up of Occupational Disease Diagnosis Centre (ODDC) at Jamshedpur for

the early diagnosis and treatment of those who suffer from Occupational Lung

diseases catering to two districts of Jharkhand.

3.2.Outputs and Activities

1. Constituting the Occupational Health Hazards Control Cell under the State

Health Systems Resource Cell

a. Appointment of a nodal officer at the level of director for the cell.

b. A workshop conducted for Occupational Health Hazard that will lead to a

white paper on occupational health at Jharkhand.

c. Drafting a working policy and five year roadmap for Jharkhand

2. Setting up an Occupational Disease Diagnosis Centre (ODDC) at Jamshedpur

under a PPP mode with Occupational Safety and Health Association of

Jharkhand.

a. MoU with OHASJ

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b. Setting up of ODDC at Sonari PHC, East Singhbhum.

c. Preparation of inventory of the silica dust / iron ore / coal dust polluting

sites of unorganised, mining and industrial sites at East Singhbhum and

Saraikela-Kharsawan.

d. Trained Sahiyyas will identify the dust affected workers and community

and refer them to the ODDC.

e. Medical Screening conducted at the clinic for those referred through a

panel of trained doctors under the ILO classification

f. Referral to the respective CHC of all patients with Occupational Lung

Disease in the two districts

g. Orientation and training of Medical officers in the two districts on the

treatment and rehabilitation of patients suffering from Occupational

Lung diseases and related respiratory diseases.

3.3.Budget No Activity Budget

required Remarks

1 Workshop for Occupational Health Hazard 100,000 Budgeted under

Sec. 16.4 under

Public Private

Partnership of

NRHM Addlt

2 Setting up of ODDC 1,00,000

3 Preparation of inventory 2,00,000

4 Sensitization and Capacity building 1,00,000

Total 5,00,000

4.Innovations in Tribal areas:

In the state of Jharkhand and Orissa, Ekjut NGO has conducted a trial, using community

based women’s groups and in the past 2 years has shown proven results like 45 percent

reduction in newborn mortality and reduced maternal deaths in the study areas (study

population was 2,30,000 and included two districts of Jharkhand). The results have now

been replicated in newer areas and disaggregated results show that the poorest and

the marginalized had the maximum reduction in newborn deaths.

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Based on this and other evidences of community empowerment and reduction of

maternal and child health indicators, the state proposes to build that capacity of

Sahiyyas/Sahiyya Sathees to enable them to make home visits and facilitate monthly

women’s group meetings which will work towards ensuring the community capacities

to ensure improved newborn and child survival .

4.1.Proposed Plan (Empowering Women) in Santhal Pargana

The Department of Health will take up twelve blocks-two each from 6 districts ( Dumka,

Deogarh, Pakur, Jamtara, Godda and Sahebganj) of Santhal Pargana region for this

scale-up initiative during 2011-12.

150 women’s groups in each block will be facilitated to go through a monthly

Participatory Learning and Action (PLA) meeting cycle. Sahiyas will work with the

existing women’s groups in their respective villages or form new groups if there are

none. These groups will open up to non members during these monthly facilitation

meetings.

Capacity of Sahiyas Sathees/Sahiya to conduct these meetings will be built by the Block

Training Teams who in turn will be trained by the State Training Teams on participatory

methods. Ekjut has agreed to share all training modules tested and piloted by them and

share their training methods.

The process will be documented during this pilot and further improve the delivery of

this intervention in the second year of the programme .Lessons leant will be

incorporated for wider replication in subsequent years. Community empowerment

takes time and that community mobilization has to be a sustained community capacity

building effort. The PLA process will continue during the second year(2012-13) also and

expect that at the end of two years there will be significant improvement in hygienic

practices related to deliveries , percentage of women exclusively breast feeding their

babies, protecting them from hypothermia , early emergency referrals etc. We also

expect that there will be reduced newborn and maternal deaths and increased decision

making power among women.

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4.2.Proposed Plan of Action

4.3Budget

S.no DESCRIPTION UNITS RATE YEARLY COST Remarks

1

Participatory learning and action Cycle Manual In hindi preparation cost ( One time)Two manuals will

be prepared for two years (10 meetings per manual)

2,00,000

Budgeted

under Sec.

16.5 under

Public

Private

Partnership

of NRHM

2 Manual printings for 2400

Sahiyas+ 100 Trainers and others ( one time)

2500 Rupees 200 500000

3

Preparation of Picture cards sets( 10 cards per set ) for 2400

SAHIYAS+100 set for Trainers and backup.

2500

Rupees 150/

Picture card set

375000

5

Compensation to SAHIYAS for attending training programmes at block level 2400 SAHIYA x 6 days

training x Rupees 100 each

2400 Rupees 100

per day 1440000

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Travel Allowance to 2400 SAHIYAS for attending training

programmes at block level 2 times in a year

2400 Rupees 50

per visit 240000

Addlt

6 Administrative cost-(15% to the

total cost such as Travelling, communications, and other fees)

413250

7 Process Evaluation

6,00,000

Total

37,68,250

Documents

NRHM SPIP 2011-12 - Jharkhandjrhms.jharkhand.gov.in/PIP/PART B.pdf · Page 3 of 129 NRHM SPIP 2011-12 JHARKHAND the available Medical and Para medical professionals and the demand