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TentativeProgrammeSchedule MeetingoftheStateHealthSecretariesandMissionDirectors,NRHM 78July2011 VigyanBhawan,NewDelhi

DayOne:RCHProgrammeReview 7thJuly2011,Thursday
9.009.30:Registration&Tea 9.3010.45:IntroductorySession AgendaItem Time 9.3010.10 Welcome&StatusReportbyJointSecretary(RCH) 10.1010.25 RemarksbySS&MD 10.2510.45 AddressbySecretary,Health&FamilyWelfare 10.4513.00:MaternalandChildHealth JananiShishuSurakhshaKarykram 10.4512.00 Presentation15minutes JointSecretary(RCH) Discussion60minutes 12.0013.00 StrengtheningNewbornCare:HomeBasedNewborn DeputyCommissioner,CH&I CareScheme Presentation10minutes Discussion45minutes Lunch13.0014.00 14.0015.30:FamilyPlanning,MotherandChildTrackingSystem 14.0014.40 PopulationStabilisation&Familyplanning:Scheme AssistantCommissioner,FamilyPlanning forInvolvingASHAsindistributionofcontraceptives Presentation15minutes Discussion25minutes MotherandChildTrackingSystem:Statusand Progress 14.4015.30 Mr.RajeshGera,SeniorTechnicalDirector,NIC Presentation20minutes Discussion30minutes TeaBreak15.3015.50 15.5018.00:PCPNDTAct,MenstrualHygieneScheme 15.5016.30 EBanking Director(NRHMFinance) 16.3017.15 ModifiedSchemeforPromotionofMenstrual Consultant,ARSH Hygiene Presentation15minutes Discussion25minutes

ImplementationofPC&PNDTAct Presentation15minutes Discussion25minutes

17.1518.00 Dr.ManoharAgnani.Mr.VikasKharage

DayTwo:ThrustAreasfor12thPlan,FutureStrategiesandChallenges 8thJuly2011,Friday
9.3011.30:CommunicableDiseases OverviewandProgress Discussion JointSecretary(PublicHealth) 11.3013.00:NonCommunicableDiseases OverviewandStatus Discussion JointSecretary(PMSSY) 13.0014.00:LunchBreak 14.0015.00:DrugsandRegulatoryIssues Presentation&Discussion 1. StrengtheningofDrugRegulatorySystems JointSecretary(DR) 2. AccessandAffordabilityofDrugs 15.0017.00:ThrustAreasfor12thPlan,ChallengesandFutureStrategies Presentation Director,NRHM Discussion 17.0017.15:SummingUpbySS&MD 17.1517.30:ConcludingRemarksbySecretaryHealth&FamilyWelfare HighTea

MeetingOverview
ThemeetingoftheStateHealthSecretariesandMissionDirectors(NRHM)is scheduledon78July2011undertheChairmanshipofSecretary(Health& FamilyWelfare). ThetwodaymeetingwillencompassdiscussiononprogressofReproductive andChildHealth,newinitiativesunderRCHII,DiseaseControlProgrammes andThrustAreasforthe12thPlan. BesidesStateHealthSecretariesandMissionDirectors,themeetingwillbe attendedbyDirector,HealthServices/DirectorGeneral,Healthservices(all states&UTs),OfficialsfromMOHFW,DevelopmentPartnersandTechnical Consultantsonrelevantthemeareas. Thepurposeofthemeetingisto: ReviewtheprogressmadeunderRCHII/NRHMin20102011 Reinforcekeyactionpointsandareasforfocussedattentionunder variousprogrammesandthemeareas Shareimplementationguidelinesfornewlylaunchedschemesunder RCHII/NRHM Jointlydiscussthrustareasandstrategiesforhealthin12thfiveyearplan ThevenueforthemeetingisVigyanBhawan(HallNumber4)locatednear IndiaGateonMaulanaAzadRoad,NewDelhi.

TableOfContents ProgrammeSchedule SectionOne:ReproductiveandChildHealthProgramme RCHProgramme:KeyComponentsandPresentStatus JananiShishuSurakhshaKarykram StrengtheningNewbornCare:HomeBasedNewbornCareScheme PopulationStabilisation&FamilyPlanning :Schemeforinvolving ASHAsindistributionofcontraceptives ModifiedSchemeforPromotionofMenstrualHygiene PreconceptionandPrenatalDiagnosticTechniquesAct Ebanking SectionTwo:CommunicableDiseases RevisedNationalTBControlProgramme NationalLeprosyEradicationProgramme NationalVectorBorneDiseaseControlProgramme IntegratedDiseaseSurveillanceProgramme(IDSP) SectionThree:NonCommunicableDiseases NationalProgrammeonPrevention&ControlofCancer,Diabetes, CVD&Stroke(NPCDCS) NationalProgrammeforControlofBlindness NationalProgrammeforPreventionandControlofDeafness NationalTobaccoControlProgramme NationalMentalHealthProgramme SectionFour:DrugsAndRegulatoryIssues SectionFive:ThrustAreasFor12thPlan,ChallengesAndFuture Strategies Annexure Annexure:PhysicalProgressunderRCHII Annexure:FinancialprogressunderRCHII
Annexure:PromotionofMenstrualHygieneScheme

PageNumber 3 718 1922 2326 2735 3640 4147 48 5052 5357 5862 6366 6870 7172 7375 7678 7981 8384 8693 94145

Annexure:NPCDCS Annexure:NationalProgrammeforControlofBlindness Annexure:MentalHealth Annexure:RevisedNationalTuberculosisControlprogramme

TentativeProgrammeSchedule MeetingoftheStateHealthSecretariesandMissionDirectors,NRHM 78July2011 VigyanBhawan,NewDelhi


DayOne:RCHProgrammeReview 7thJuly2011,Thursday
9.009.30:Registration&Tea 9.3010.45:IntroductorySession AgendaItem Time 9.3010.10 Welcome&StatusReportbyJointSecretary(RCH) 10.1010.25 RemarksbySS&MD 10.2510.45 AddressbySecretary,Health&FamilyWelfare 10.4513.00:MaternalandChildHealth JananiShishuSurakhshaKarykram 10.4512.00 Presentation15minutes JointSecretary(RCH) Discussion60minutes 12.0013.00 StrengtheningNewbornCare:HomeBased DeputyCommissioner,CH&I NewbornCareScheme Presentation10minutes Discussion45minutes Lunch13.0014.00 14.0015.30:FamilyPlanning,MotherandChildTrackingSystem 14.0014.40 PopulationStabilisation&Familyplanning:Scheme AssistantCommissioner,FamilyPlanning forInvolvingASHAsindistributionof contraceptives Presentation15minutes Discussion25minutes MotherandChildTrackingSystem:Statusand 14.4015.30 Progress Mr.RajeshGera,SeniorTechnicalDirector, Presentation20minutes NIC Discussion30minutes TeaBreak15.3015.50 15.5018.00:PCPNDTAct,MenstrualHygieneScheme EBanking ModifiedSchemeforPromotionofMenstrual Hygiene Presentation15minutes Discussion25minutes ImplementationofPC&PNDTAct Presentation15minutes
4 15.5016.30 Director(NRHMFinance) 16.3017.15 Consultant,ARSH 17.1518.00 Dr.ManoharAgnani.Mr.VikasKharage

Discussion25minutes

DayTwo:ThrustAreasfor12thPlan,FutureStrategiesandChallenges 8thJuly2011,Friday
9.3011.30:CommunicableDiseases OverviewandProgress Discussion JointSecretary(PublicHealth) 11.3013.00:NonCommunicableDiseases OverviewandStatus Discussion JointSecretary(PMSSY) 13.0014.00:LunchBreak 14.0015.00:DrugsandRegulatoryIssues Presentation&Discussion JointSecretary(DR) 1. StrengtheningofDrugRegulatorySystems 2. AccessandAffordabilityofDrugs 15.0017.00:ThrustAreasfor12thPlan,ChallengesandFutureStrategies Presentation Discussion Director,NRHM

17.0017.15:SummingUpbySS&MD 17.1517.30:ConcludingRemarksbySecretaryHealth&FamilyWelfare HighTea

SectionOne Reproductiveand ChildHealth Programme

Background ReproductiveandChildHealthProgramme,PhaseII(RCHII),isanintegralcomponentofthe NationalRuralHealthMission.Importantstepshavebeentakenwithinthemandateofthis programme to ensure universal and equitable access to quality maternal and child health servicesbasedontheprincipleofcontinuumofcare.RCHIIhasfocussedonreducingsocial and geographical disparities in access to and utilisation of reproductive and child health servicesinordertoacceleratetheachievementofitsgoals. The programme goals have been set in consonance with MDGs 4 and 5 and relate to maternal and infant mortality and total fertility rate. The major components of the RCH programme are Maternal Health, Child Health, Nutrition, Family Planning, Adolescent and ReproductiveHealth(ARSH)andPreconceptionPrenatalDiagnosticTechniquesAct.Abrief onkeyinterventionsundereachofthesecomponentsisdiscussedinthisnote. MillenniumDevelopmentandRCHIIGoals The Millennium Development Goals (MDGs) 4 and 5 relate to improving the health of motherandchildandIndiasnationalgoalsarealignedwiththem. MDG4:Reducechildmortality Target:Reducebytwothirdsthemortalityrateamongchildrenunderfive MDG5:Improvematernalhealth Target:Reducebythreequartersthematernalmortalityratio RCHGoalsandAchievements Infant Mortality Rate Maternal MortalityRatio Total Rate AsummaryofkeycomponentsunderRCHprogrammeandtheircurrentstatusis presentedbelow:

MDGTarget 28

NRHMGoals 30per1,000live births 100per1,00,000 livebirths 2.1

Achievement 50per1,000live births 254per1,00,000live births 2.6

Source SourceSRS 2009 SRS200406

Reduceby by2015

Fertility

SRS2009

I.

MaternalHealthInterventions KeyinterventionstoreduceMaternalMortalityare: 1.1DemandPromotion(JananiSurakshaYojana(JSY)

1.2ServiceguaranteesJananiShishuSurakshaKaryakram(JSSK) 1.3 Essential and Emergency Obstetric Care (Upgrading and operationalizing health facilities,Skillbasedtrainings,Multiskillingofdoctors) 1.4SafeAbortionServices(MTP) 1.5ManagementofRTIs&STIs(Colourcodeddrugkits,trainingofproviders) 1.6PublicPrivatePartnerships(forJSY,FamilyPlanning,MTP) 1.7Maternal&ChildHealth(MCH)CentresinHighFocusDistricts 1.8MotherandChildProtectionCard(MCP) 1.9NameBasedTrackingofPregnantWomenandChildren 1.10MaternalDeathReview PromotinginstitutionaldeliveryUnderJananiSurakshaYojana(JSY),cashincentivesare provided to mothers to promote institutional deliveries. In 201011, total numbers of JSY beneficiaries were 113.39 lakhs. The trend of JSY beneficiaries reported over the mission periodisshownbelow. NumberofBeneficiariesofJSY(inLakhs)
150.00 100.00 50.00 0.00 7.34 0506 30.74 0607 07 08 08 09 0910 1011 73.09 90.80

100.66 113.39

Janani Shishu Suraksha

NumberofBeneficiariesofJSY(inLakhs)

II. InfantmortalityrateinIndiahassteadilydeclinedfrom58perthousandlivebirthsin2004 to50perthousandlivebirthsin2009.Howeverthereisslowprogressinreducingneonatal mortalitywhichdeclinedfrom37in2004to34in2009.NMRhasdeclinedonlyby3points (37to35)ascomparedto8pointdeclineinIMR(58to50)intheperiod2005/2009.Deaths inthefirstweekoflifehaveshowntheleastprogress.Keyactionpointsunderchildhealth componentare:

Karyakram(JSSK):JSSKwaslaunchedon1stJune2011toprovidecompletelyfreeand cashless services to pregnant women (including normal deliveries and caesarean operations) and sick new born (up to 30 days after birth) in Government health institutionsinbothrural&urbanareas.Detailsoftheschemearepresentedlaterinthis document. MobileMedicalUnits&EmergencyResponseServices:Inordertoprovideservicesto the most remote and hard to reach areas, States have been supported for Mobile MedicalUnits.OversixyearsofNRHM,461outof642districtshavebeenequippedwith MMUs.Sofar1787vehiclesareoperationalasMMUsinthecountry.Further,toprovide Emergency referral transport, Call Centre based services have been operationalised in the11Statessofar. Skill development of health personnel For improving the skill of doctors and paramedics, various training programmes have been conducted during six years of NRHM. So far, 42,530 persons are trained in SBA, 4.57 lakh in IMNCI and 27,522 personnel trained in IUCD insertion. Further, 1,221 doctors have been trained for Life Saving Anaesthesia skills and 3892 doctors in Basic Emergency Obstetric care. Additionally,9,037doctorsaretrainedinMTP,9723doctorsintubectomy,2286doctors invasectomyand2406doctorsinFIMNCI. Referral systems are being strengthened through Public Private Partnership (PPP), voucherschemesandallocationoffundsforreferraltransport. SafeAbortionServicesarebeingmadeavailableatallFRUsandMCHLevel3facilities (District Hospitals and subdistrict level facilities). Private and NGO sectors are encouragedtoprovidequalityMTPservices.Serviceprovidersarebeingtrainedinsafe MTPtechniques.ThetotalnumberofMTPsconductedinbothpublicandprivatesector institutionsincreasedfrom6.42lakhsin200809to6.88lakhsin20092010. Strengthening outreach activities by organizing Village Health and Nutrition Days: In rural areas, VHND organised every month at Anganwadi centers has provision for maternal care including counselling of pregnant women, where ANMs, ASHAs, AWWs andotherfieldfunctionariesprovideMCHservices. ChildHeathInterventions

2.1UniversalprovisionforEssentialandHomeBasednewborncare EstablishmentofNBSUsatMCHlevelI TraininginEssentialNewBornCare(NSSK)andinHomeBasedNewBornCare (Modules6and7forASHAs,IMNCI) EstablishmentofSNCUsatDistrictHospitals/MCHlevelIIIandNBSUsatFRUs/MCH LevelIIfacilities FreeReferralTransportforsicknewbornsthroughJSSK EarlydetectionofchildrenwithmalnutritionthroughMCPcards,andin convergencewithMWCD FacilitybasedmanagementofchildrenwithSAMthroughNRCs EarlyInitiationofbreastfeedinginfirsthourofbirth;Exclusivebreastfeedingtill6 months;Complementaryfeedingofchildrenfrom6monthsonwards IFAsupplementationforchildren6monthsto6years VitaminSupplementationforchildren6monthsto5years ORSandZnsupplementation BehaviourChangeCommunicationthroughIEC Earlydetectionofrespiratoryinfections Administrationofantibiotics MicroplanningandChildTrackingSystem IncreasedCoveragebymeaslesvaccine,Seconddoseofmeasles

2.2FacilityBasedNewBornCare

2.3Managementofchildmalnutrition

2.4PromotionofInfantandYoungChildFeedingPractices

2.5Micronutrientsupplementation

2.6ManagementofDiarrhoealDiseases

2.7ManagementofAcuteRespiratoryInfections

2.8ImprovingImmunisationCoverage&EliminatingMeaslesrelatedDeaths

2.9IntegratedManagementofNeonatalandChildhoodIllnesses(IMNCI)andFacility BasedIMNCI Trainingoffrontlineworkers(ANMsandAWWs),SNsandphysicians Referralofsicknewborn(02mo.)andchildren(2mo5years)tohealthfacilities Screeningofschoolgoingchildren IFAsupplementation

2.10. SchoolHealthProgramme

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Essentialnewborncareistobeprovidedtoallnewbornsatallbirthingpoints.Navjat Shishu Suraksha Karyakram (NSSK) is a programme to train health personnel in basic newborn care and resuscitation which was taken up in September 2009. More than 37,600HealthcareprovidershavebeentrainedinNSSKsofar. HomeBasedNewbornCareScheme:Anewschemeisbeingintroducedtoincentivise ASHAsforprovidingHomeBasedNewborncareforbabiesupto42days.Homevisits willbemadebyASHAsonscheduleddaysandpaymentofRs.250willbemadewhen the specified conditions have been met. More details are provided later in this document. Capacity building of ASHAs on Home Based New Born Care will be done throughmodules6&7forASHAs.Thisschemewillfacilitateearlydetectionofdanger signsinneonatesandthereforepromptreferraltotheinstitutions. Newborn Care Facilities are being established from MCH level I to Level III facilities. LevelIprovidesEssentialNewborncaretoallchildrendeliveredinaninstitutionwhile levelII&IIIprovideemergencycareforsicknewborn.Presently263SickNewBornCare Units (SNCUs), 1120 New Born Stabilisation Units (NBSUs) and 6403 New Born Care Corners(NBCs)havebeenestablished(tillMarch2011). Management of children with severe acute malnutrition is being addressed through Nutritional Rehabilitation Centres. 1,346 NRCs have been established across the countrytillMarch2011. IntegratedManagementofNeonatal&ChildhoodIllnesses(IMNCI)whichincludesPre service and Inservice training of providers, improving health systems (e.g. facility up gradation,availabilityoflogistics,referralsystems),CommunityandFamilylevelcare,is being implemented in 408 districts across the country and 4, 57,463 health personnel havebeentrainedinIMNCItillMarch2011. SchoolHealthProgrammeaimsatscreeningschoolchildrenforcommonhealth problemsandmakingreferralstohealthfacilities.Inthefinancialyear201011,7,01, 65,698studentsin3,95,960schoolswerecoveredthroughtheprogramme.


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III. FamilyPlanningInterventions FamilyplanningisoneofthekeycomponentsunderRCHforpopulationstabilizationandfor improving health of mother and child. Provisional census data for 2011 shows that exponentialannualgrowthratehasdeclinedto1.6%butthedeclineisnotconsistentinall states. While 14 states/ UTs have already achieved the replacement level, 12 states have TFRbetween2.1and3and9states(Bihar,U.P.,Rajasthan,M.P.,Jharkhand,Chhattisgarh, Meghalaya,Nagaland,D&NHaveli)haveTFRmorethan3. Keyinterventionsunderthiscomponentare: 3.1 Strong Political Will and Advocacy at the highest level, especially in states with high fertilityrates 3.2 Availability of Fixed Day Static Services at all facilities round the year by ensuring availability of trained service provider and by gradually moving away from seasonal campapproach. 3.3 Revitalizing Postpartum Family Planning in order to capitalise on the opportunity providedbyincreasedinstitutionaldeliveries. 3.4 EmphasisonSpacingmethodslikeIUCD 3.5 Ensuring quality care in Family Planning services by establishing Quality Assurance Committeesatcentral,stateanddistrictlevelsandregularmonitoring 3.6 IncreasingmaleparticipationinfamilyplanningandpromotingNonscalpelvasectomy 3.7 Accreditationofprivateproviders 3.8 Strengthening community based distribution of contraceptives by involvement of ASHAsandFocussedIEC/BCCeffortsforenhancingdemandandcreatingawarenesson familyplanning 3.9 Improvingcontraceptivessupplymanagementtillperipheralfacilities 3.10 Strengtheningmonitoringandprovidingperformancelinkedincentives AnewschemeisbeinglaunchedwhereinASHAwillpromotetheuseofcontraceptivesat householdlevelandmakingitavailabletimelyby: Deliveringcontraceptivesathomesofbeneficiaries. CharginganominalamountofRs1forapackof3condoms,Re1foracycleofOCP andRs2foranECP,fromthebeneficiaries. Moredetailsareprovidedlaterinthisdocument.
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IV. Immunization Immunizationisoneofthekeyinterventionsforprotectionofchildrenfromsevenvaccine preventablediseasesnamelyDiphtheria,Pertussis,Tetanus,Polio,Measles,HepatitisBand severeformofchildhoodTuberculosis.Inaddition,vaccineforJapaneseEncephalitis(JE)is beingprovidedinselectedendemicdistrictsofthecountry. 4.1InterventionsinPolioeradication BivalentoralpoliovaccinewasintroducedforthefirsttimeinJanuary2010.This,aswellas focusonimprovingqualityofvaccination,hasledtoasignificantachievementtowardspolio eradication.Newpoliocaseshavecomedownfrom741in2009to42in2010.During2011, onlyonepoliocasehasbeenidentifiedtillMayascomparedto21casesduringthesame periodin2010. 4.2Immunizationactivities a. Government of India has introduced second dose of measles across the country. In addition,inStateshavinglessthan80%coverage,supplementaryimmunizationactivity hasbeentakenupinaphasedmanner. b. HepBvaccinewhichwasearlierintroducedin10Stateshasnowbeenexpandedtothe entirecountry. c. Pentavalent, a combination vaccine, which includes DPT + HepB + Hib has been introducedonpilotbasisin2States(KeralaandTamilNadu)covering14lakhchildren. d. As per Status on 11th April 2011, 101 out of 109 districts have completed the JE Vaccinationdrive(campaign)anditisnowintroducedinroutineimmunizationinthese districts. V. Programmereviewandmonitoring ReviewMissions :ToassesstheprogressmadebytheStatesinRCHprogramme,Joint Review Mission (JRM) is being conducted. The review is led by GoI with support and participation from state governments and Development Partners. So, far seven JRMs havebeenheld.TheseventhJRMwasheldduringtheperiodfromJulyAugust2010. Evaluation Surveys: M & E division organizes periodic surveys namely National Family HealthSurvey(NFHS),DistrictLevelHouseholdSurveys(DLHS),FacilitySurveys. Regional Evaluation Survey (RET): RETs monitor and evaluate the programme implementation.

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CommunityParticipation:Toensureinvolvementofthecommunitiesinoverseeingthe provisioning of health care and to redress the public grievances, 33149 Rogi Kalyan Samiti were constituted at health facilities and 4.83 lakh VHSCs constituted at village level,acrossthecountry. VI. OtherstrategiesunderRCHprogramme DifferentialPlanningandSupportiveSupervisionforHighFocusDistricts Toeffectivelyaddresstheproblemsofdifficult,inaccessible,backwardandunderserved areashavingpoorhealthindicators,Ministryhasidentified264highfocusdistrictsin21 States have been identified based on the health indicators, concentration of SC/ST populationforfocusedattention.Specificplanshavebeenpreparedforthesedistricts keepinginviewtheirspecialneeds.Facilitieshavealsobeenidentifiedinthesedistricts forbetterprovisioningofmotherandchildhealthservices.Besidesprovidingadditional resourcestothesedistricts,teamshavebeensetupbyMinistrytomonitorprogressin thesedistrictsonregularbasis. Maternal&ChildHealth(MCH)Centres MinistryisfacilitatingStatesinidentifyingthedeliverypoints/MCHcentresformaking provisionofbasicandemergencyobstetriccareduringpregnancy,childbirthandinpost natal period. Operationalization of these facilities is being made possible through rational deployment of existing manpower, training of doctors and specialists in these identifiedMCHcentres/deliverypointsandprovidingfundsforupgradationofphysical infrastructure. Trackingofmotherandchildren To ensure registration of all pregnant mothers and children and to monitor the ante natal and postnatal checkup of mothers and immunization of children by identifying dropoutcases,GovernmentofIndiahasintroducedMotherandChildTrackingSystem whichrecordscomplete dataof the motherswiththeiraddresses, telephone numbers etc.Ahelpdeskisintheprocessofbeingsetuptomonitortheprogressandfollowup ontheinterventions.Asthesystemevolves,itwouldalsoprovideaplatformforcreating awarenessonhealthrelatedissues. MaternalDeathReview Toanalyzethereasonsofmaternaldeathssothatappropriateinterventionsspecificto State/area could be taken, a system of maternal death review was introduced in 2010. DetailedguidelineswereissuedbyGovernmentofIndia.MostoftheStateshavealready

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initiated the process of maternal death review and have constituted District Review Committees. InfantDeathReview Infant Death Review has been introduced by many states on a pilot basis. Karnataka is one state that has developed the required structure and the mechanism to carry out Infant Death Review. This will provide an insight into causes of infant deaths in the country and help to develop specific plans in each district depending on predominant causesofdeath. AnnualHealthSurvey GovernmentofIndiahasapprovedtheAnnualHealthSurveytostudytheimpactofthe schemes under NRHM in reduction of Total Fertility Rate (TFR), Infant Mortality Rate (IMR)atthedistrict levelandtheMaternalMortalityRatio (MMR)attheregionallevel andtoprepareDistrictHealthProfileof284districtsintheEAGStates(Stateswithpoor RCH indicators) and Assam to assess progress of health indicators on an annual basis. Previously, there was no such survey which could capture the impact of the schemes underNRHMonanannualbasis.

VII.

FinancialProgress

ItisthemandateofNRHMtoincreasethepublicexpenditureinhealthsector.Intheyear 201011, Rs.14652.69 Crores was released to the States. This was 12% increase over the previous year. States have booked an expenditure of Rs. 11755.68 Crores till December 2010during201011.Since2005,therehasbeenasignificantimprovementintheutilization and absorption capacity of the states under NRHM. Over the period of six years, Rs 63268.43 Crores were released to the States under NRHM and Rs. 50175.69 Crores have beenspentbytheStates. DetailsofPhysicalandFinancialProgressmadeunderRCHIIin20102011maybeseenin tablesattachedinAnnexure.

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VIII. OperationalIssuesidentifiedfromIntegratedFieldMonitoringVisit IntegratedFieldMonitoringTeams(IFMTs)havebeenconstituted,consistingofSenior TechnicalOfficersofMoHFW,ConsultantsfromRCHandNRHMDivision,NIHFW,NHSRCand representativesfromR.D.Office.Atotalof14teamshavebeenconstitutedandduringthe FirstQuarterof201112,24districtshavebeenvisited. Purposeoftheteamvisitsis: TomonitorthestatusofimplementationofRCHII/NRHMstrategiesinthedistrict To understand the strength, best practices, gaps in implementation, constraints, if any,andsupportthatcanberenderedbytheMoHFWtothestates Drugs,Consumables&Equipment Expired and shortly going to expire drugs found at many facilities, distribution of suchdrugswasalsoreported(e.g.APHCChapran,DistrictSaharsa,Bihar) LackofAnnualMaintenanceContractforequipmentsamajorissueinmostfacilities Training Limitedtrainingcapacityinsomeofthevisiteddistricts RTI/STI,IMNCI,IMEPtrainingnotrolledoutinChhattisgarh SBAtrainingneedscompletereorganizationinfewfacilities(e.g.DistrictSaharsa& Madhepura,Bihar) MaternalHealth QualityofANC&PNCservicesremainsinadequate Safeabortionservicesmostlynonfunctional(e.g.DistrictEast&WestGaroHills) JointMCHcardandSafeMotherhoodbookletnotbeingusedinmanyofthefacilities Maintenance of Partograph and case sheet lacking/inadequate in most facilities despiteANMsbeingSBAtrained(e.g.DistrictDhamtari,Chhattisgarh) MaternalDeathReviewnotinitiatedinmostofthevisiteddistricts ReferralServicesandTransport Inadequate,improperreferralsandpoorlinkages,exceptfordistrictsofGujarat At some places ambulance use charged (e.g. District Dhamtari and Rajnandgaon, Chhattisgarh@Rs.8perkm.) JananiSurakshaYojana Delayinpayment(8to15days)insomeofthevisiteddistricts Paymentsmadethroughcash disbursementduetolackofbankingfacilityatsome districts Problemswithissueofchequebooksbythebanksalsoobserved
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ChildHealth Newborncareserviceselementaryatmostofthehealthfacilities Babywarmerlyingunutilized,understandingofstaffisinadequateregardingusage ofequipments No record maintained on the number of Low Birth Weight babies delivered at facilities(e.g.DistrictDhamtari,Chhattisgarh) Nosysteminplacefortreatmentofseverelymalnourishedchildren(e.g.DistrictEast &WestGaroHills,Meghalaya) Immunization Lack of electricity back up provision for ILR and Deep Freezer observed in most facilities Lackofproperindentingsystemanissueforstockmaintenance Idealpracticeofbundlingofvaccinesnotobservedinmanyfacilities Nosystemofalternatevaccinedelivery(e.g.DistrictofDhamtari,Bihar;East&West GaroHills,Meghalaya;Kinnaur,HP) FamilyPlanning Familyplanningservicesqualityquestionable,notyetreceivingpriorityinmanyof thevisiteddistricts,postpartumfamilyplanningserviceanduseofspacingmethods weak(e.g.DistrictKinnaur,HP;East&WestGaroHills,Meghalaya) Stock outs observed for as much as six months at peripheral facilities (e.g. District Dhamtari&Rajnandgaon,Chhattisgarh) PC&PNDT ImplementationofPC&PNDTActinadequate Regularmeetingsnotconductedinmanyofthedistricts FormFunderPC&PNDTActnotmaintainedinmanyfacilities AdolescentHealth: No functional adolescent health services, except for signboards outside rooms in somefacilities FixedDayARSHservicesandcounsellorsplacedatsomeCivilHospital/s SchoolHealthProgramme: Weakschoolhealthprogrammeinalmostallthevisiteddistricts

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IX. Keyareasofconcern ProgrammeManagementStructureatStateandDistrictlevel DifferentialPlanningforBackwardareasandAllocationofResources RationalDeploymentofHumanResources FocusonImmunisationprogramme PrimaryRecordMaintenance FacilityBasedMonitoringofRCHProgramme

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JananiShishuSurakshaKaryakram

RATIONALE: About 67,000 women in India die every year due to pregnancy related complications and about9lakhsnewbornbabiesdiewithinfourweeksofbirthofwhichabout7lakhsi.e.75 per cent die within the first week. The first 28 days of infancy period are therefore very importantandcriticalinordertosavenewbornlives.Bothmaternalandinfantdeathscan be reduced by ensuring timely access to quality services, both essential & emergency, in public health facilities while assuring that they do not have to shoulder the burden of expenses. WiththelaunchoftheJananiSurakshaYojana(JSY),thenumberofinstitutionaldeliveries has increased significantly. However 25% pregnant women still hesitate to access health facilities.Thosewhohaveoptedforinstitutionaldeliveryarenotwillingtostayfor48hrs, which is a critical period for identification and management of complications in both the motherandtheneonate.Importantfactorsaffectingaccessinclude: Highoutofpocketexpenseson o UserchargesforOPD,admissions,diagnostictests,bloodetc. o Purchaseofmedicinesandotherconsumablesfromthemarket Nonavailabilityofdietinmostinstitutions Transportfortraveltothehealthfacilityandbackandbetweenfacilitiesincaseof referrals Outofpocket payments are, without doubt, a major barrier for pregnant women and childrensofarasaccesstoinstitutionalhealthcareisconcerned.Theimpoverishingeffectof healthcare payments on Indian households is well established. Outofpocket spending in governmentinstitutionsisboth commonandsubstantial,partlybecause ofaweaksupply chainmanagementofdrugsandotherlogisticsandpartlybecauseofmalpractices. Prescriptionsbydoctors,eveningovernmentsettings,canbeunnecessarilyexpensiveand may include not just medicines but consumables such as surgical gloves, syringes, IV (intravenous) sets, and cannulae, etc. Under these circumstances, the goals of NRHM for provisionofaffordable,equitableandaccessiblehealthservicesaredefeated.UnderNRHM, it is expected that each and every pregnant woman and infant gets timely access to the health care system for the required antenatal, intranatal, post natal care and immunizationservicesfreeofcost. Itisparadoxicalthatsomestateshavelevieduserchargesfordeliveriesatthetimewhen effortsarebeingmadenationallytoaddressfactorsimpedinginstitutionaldeliveriesandto give incentives to women to approach government institutions for childbirth through
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schemes such as the Janani Suraksha Yojana. Hence, notwithstanding substantial investmentstoimproveprovisioningformaternalandchildhealthcare,theburdenofout ofpocket expenses for pregnant women and children has persisted in the public health system across most states. The fact that entitlements were not explicitly articulated and werevagueleftmuchscopefordenialofservicesthatnationalprogrammes,includingthe NationalRuralHealthMissionanditsprecursors,haveconsistentlystrivedfor. THENEWINITIATIVE JananiShishuSurakshaKaryakram(JSSK)launchedfromMewatdistrictinHaryanaonJune 1,unmistakablysignalsahugeleapforwardinthequesttomake"healthforall"areality. It invokes a new approach to healthcare, placing, for the first time, utmost emphasis on entitlementsandeliminationofoutofpocketexpensesforbothpregnantwomenandsick neonates.Theinitiativeentitlesallpregnantwomendeliveringinpublichealthinstitutions toabsolutelyfreeandnoexpensedelivery,includingcaesareansection. Itstipulatesoutthatallexpensesrelatedtodeliveryinapublicinstitutionwouldbeborne entirely by the government and no user charges would be levied. Under this initiative, a pregnantwomanwouldbeentitledtofreetransportfromhometothegovernmenthealth facility, between facilities, in case she is referred on account of complications, and also dropbackhomeafterdelivery. Entitlements would include free drugs and consumables, free diagnostics, free blood whereverrequired,andfreedietforthedurationofawoman'sstayinthefacility,expected tobethreedaysincaseofanormaldeliveryandsevenincaseofacaesareansection. Similar entitlements have been put in place for all sick newborns accessing public health institutions for healthcare till 30 days after birth. They would also be entitled to free treatmentbesidesfreetransport,bothwaysandbetweenfacilitiesincaseofareferral. Theinitiativeisestimatedtobenefitmorethan1crorepregnantwomen&newbornsthat access public health institutions every year in both urban & rural areas, and also increase access to health care for the over 70 lakh women delivering at home. This initiative supplements the cash assistance given to a pregnant woman under JSY and is aimed at mitigating the burden of out of pocket expenses incurred by pregnant women and sick newborns. EntitlementsforPregnantWomen: FreeandzeroexpensefordeliveryandCaesareanSection FreeDrugsandConsumables FreeEssentialDiagnostics(Blood,UrinetestsandUltrasonographyetc) FreeDietduringstayinthehealthinstitutions(upto3daysfornormaldelivery&7 daysforcaesareansection)
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FreeProvisionofBlood FreeTransportfromHometoHealthInstitutions FreeTransportbetweenfacilitiesincaseofreferral DropBackfromInstitutionstohomeafter48hrsstay ExemptionfromallkindsofUserCharges EntitlementsforSickNewborntill30daysafterbirth: Freeandzeroexpensetreatment FreeDrugsandConsumables FreeDiagnostics FreeProvisionofBlood FreeTransportfromHometoHealthInstitutions FreeTransportbetweenfacilitiesincaseofreferral DropBackfromInstitutionstohome ExemptionfromallkindsofUserCharges Drugsandconsumables Drugs&consumablesincludingsupplementssuchasIronFolicAcidarerequiredtobegiven free of cost to the pregnant women during ANC, INC, PNC up to 6 weeks which includes managementofnormaldelivery,Csectionandanycomplicationsduringthepregnancyand childbirth. The same is also needed when a neonate is sick and needs urgent and priority treatment. Diagnostics Duringpregnancy,childbirthandinpostnatalperiod,investigationsareessentialfortimely diagnosis of complications and likely problems which the women can face during the process of child birth. Both essential and desirable investigations are required to be conductedfreeofcostforthepregnantwomenduringANC,INC,PNCupto6weekswhich includesinvestigationsrequiredpriortobothnormaldeliveryandCsection.Thesameare alsoneededwhenaneonateissickandneedsurgentandprioritytreatmentforconditions likeinfection,pneumonia,etc. Diet The first 48 hrs after delivery are vital for detecting any complications and its immediate management. Care of the mother and baby (including immunization) are essential immediatelyafterdeliveryandatleastupto48hrs.Duringthisperiod,motherisguidedfor initiatingbreastfeeding and advisedforextracalories,fluidsandadequaterestwhichare neededforthewellbeingofthebabyandherownself.Nonavailabilityofdietatthehealth facilities demotivates the motherswho have recently delivered from stayingat the health facilities and most of the mothers prefer returning home immediately after delivery. This

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hampers adequate care of the pregnant women and neonates, which is important for qualityPNCservices. Blood Blood transfusion may be required to tackle emergencies and complication of deliveries suchasmanagementofsevereanaemia,PPHandCsections,etc. Exemptionfromusercharges UserchargesareleviedbymanyStateGovernmentsforOPD,admissions,diagnostictests, blood etc. These add up to the out of pocket expenses. On occasion, there are situations where these pregnant women are misguided and become vulnerable for exploitation by privatediagnosticcentresforunnecessaryinvestigations. Referraltransport Itiswellproventhatasignificantnumberofmaternalandneonataldeathscouldbesaved byprovidingtimelyreferraltransportfacilitytothepregnantwomenfornormaldelivery,C section.Thisalsoneedstobeprovidedtoaneonateupto30days,whenthebabyissick and needs urgent and priority treatment particularly for conditions like infection, pneumonia,etc.Adropbackfacilityalleviatesthepressuretoleavethehealthfacilityearlier thandesirable&obviatesoutofpocketexpenses. The free referral transport entitlements for pregnant women and sick neonates up to 30 days&thereafterareasunder: 1. Transportfromhometothehealthfacility 2. Referraltothehigherfacilityincaseofneed 3. Dropbackfromthefacilitytohome Grievance Redressal: This is an important aspect of implementing this scheme and mechanism to address grievances should be in place. This includes display the names, addresses,emails,telephones,mobilesandfaxnumbersofgrievanceredressalauthorities at prominent places in health facility level, district level and state level, and disseminate them widely in the public domain, set up help desks and suggestion / complaint boxes at Governmenthealthfacilities,andmaintainingproperrecordsofactionstaken. DetailedGuidelinesonthisschememaybereferredtoforimplementationdetails.

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StrengtheningNewBornCare:HomeBasedNewbornCareScheme
InIndia26millionbabiesareborneveryyear,and940,000babiesdiebeforeonemonthof life. The neonatal period is only 28 days, and yet at 34/1000 lives births (SRS, 2009), neonatal mortality contributes about 68% of all infant deaths and 49% of all deaths in childrenyoungerthanage5years.Preventablemorbiditiessuchashypothermia,asphyxia, infections and respiratory distress continue to be the main causes of mortality in the neonatalperiod. ThereisagrowingrecognitionthatinordertobringIMR,substantialreductioninNeonatal Mortality Rate is needed. Rapidly increasing numbers of newborns are being delivered in hospitals after the launch of JSY scheme. The roll out of Home Based New Born Care and IMNCI also leads to increased contact of frontline health workers and newborns at their households, thus creating scope for improved detection and referral of sick newborns to healthfacilities. There are several interventions that have proven to be both feasible and costeffective in reducing newborn deaths. These include interventions such as skilled attendance at birth, access to emergency obstetric care, immediate and exclusive breastfeeding, drying and keepingthenewbornwarm,andifneeded,resuscitation,careoflowbirthweightinfants, andtreatmentofinfection.Therefore,improvingnewbornhealthisnotamatteroffinding newsolutionsbutscalinguptheprovensolutionsviaexistingmechanismsandworkforce.In other words, the real task is to spread awareness of sound newborn health practices or whatworkstothosewhoneedit,especiallymothers,otherprimarycaregivers,andhealth providers,andtointegrateessentialnewbornhealthcareintoexistingmaternalandinfant care. Most of the causes of deaths in the newborn period can be prevented or managed by households, communities and health facilities. Homebased care of all newborns and IntegratedManagementofNewbornandChildhoodIllnessesarethetwoprogrammesthat addresstheseproblems.Theyequipfrontlineworkers(ASHAs&ANMsandatplaceseven AWWs)withtherequiredskillstoassessthenewborn,promotehealthypractices,manage simpleproblemsandreferthosewithseriousillnesses.Provisionanddeliveryofservicesfor bothessentialnewborncareandcareofsicknewbornsintheexistinghealthfacilitiesatthe district and subdistrict level has been another approach towards achieving the same objective.

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WithinRCH,Newborncareisbeingseenasacontinuum withcomponentsofimmediate andEssentialCareofallNewborndeliveredathealthfacilitiestopreventcomplicationsat birth,HomeBasedNewbornCareforallbabiestopreventanddetectillnessesinpostnatal period with provision of extra care of low birth weight babies, and access to quality emergency care for the sick newborn at newborn care health facilities. The three componentsaretobeinterlinkedwithseamlessreferralandfollowupbetweenthem. EssentialNewbornCareandBasicResuscitation Essentialnewborncareincludescaretoallnewbornsmeansinterventionsforallnewborns to meet their physiological needs; prevention of infection, preservation of warmth, appropriate nutrition by early & frequent breastfeeding, initiation of breathing by resuscitation when needed. Essential newborn care assures survival of all those that are bornwellequippedtosurvive(term,newbornswithoutmalformations)andgivegoodstart forpreterm&smallbabies. The protocol of ENC is a series of time bound, chronologically ordered standard procedures that a baby receives at birth. At the heart of the protocol are time bound interventions:Handwashing,immediatedrying,skintoskincontactfollowedbyclamping of the code after 1 to 3 minutes, non separation of the body from mother and breast feedinginitiation.Simplesteps,yet,extremelyeffective: Cleanlinesstopreventinfectioninnewborns Immediatedryingpreventshypothermia,whichisextremelyimportanttosurvival. Delayedcodeclampinguntiltheumbilicalcodestopspulsatingdecreasesanaemia. Keeping mother and baby in uninterrupted skin to skin contact prevents hypothermia, increases colonization with protected family bacteria and improves breastfeedinginitiationandexclusivity. Breastfeedingwithinthefirsthouroflifepreventsinfections

Careduringtheimmediatepostnatalperiod&uptodischargefromthefacility Routinemonitoring Immunization Counselling Dischargeinstructions

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Inadditiontothebasicprotocols,Essentialnewborncareincludesadditionalprotocolsfor Basic Resuscitation. The basic resuscitation algorithm defines the steps necessary to ventilateanewbornbabythatisnotbreathingatbirth. In order to operationalize Essential Newborn Care and Basic Resuscitation services, an enablingenvironmentatthefacilitiesisneeded.Itisimportanttoprepareforeachdelivery, usingstandardprecaution,equipmentuse&maintenanceandorganizingcareinthelabor roomandpostnatalwards. HomeBasedNewbornCareScheme A major proportion of newborn deaths occur at home. Although, in the last 56 years, institutionaldeliverieshaverisentoabove70%,stillnewbornsremainathighriskofdying due to common ailments. Necessity for high quality home based newborn care while continuing to move towards institutional care and also catering to early diagnosis and ensuringpromptreferralofsicknewbornsisessentialinreducingNMR. Globalevidenceshowsthathomevisitsforneonatalcarebycommunityhealthworkersis associated with reduced neonatal mortality in resourcelimited settings with poorly accessiblefacilitybasedcare. The purpose of the Home Based New Born Care Scheme is to improve community new borncarepracticesandtoimproveealrydetectionofneonatalillnesses. HomeVisits:TheASHAisexpectedtovisitthenewbornaccordingtoascheduleofhome visits for the care of the newborn. The purpose of these visits is to ensure wamth, exclusive breastfeeding, promote hand washing, discourage unhealthy practices such as earlybathing,bottlefeeding,andpromptidentifcationofsepsisorotherillnesses.Therole of an ASHA during the visit for the newborn also combines crucial post partum care and support for the mother, including family planning counselling. These home visits are not solely focused on a vertical programme for newborn care but are holistic and comprehensive. Therecommendedscheduleisasfollows:Sixvisitsinthecaseofinstituionaldelivery(days 3,7,14,21,28and42),andsevenvisitsinthecaseofhomedelivery(days1,3,7,14,21,28, and42).Additionalvisitswillberequiredforbabiesthatarelowbirthweight,preterm,orill. PaymentandConditionality:TheASHAistobepaidRs.250forcondcutinghomevisitsfor the care of the newborn and post partum mother. The amount is paid based on the completedhomevisitform,validatedbythefacilitator. Thisispaidonthe45thdaysubjecttothefollowing
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Ensuring that birth weight is recorded in the Maternal and Child Protection (MCP)Card - Ensuringthatthenewbornisimmunizedwith:BCG,firstdoesofOPVandDPT - EnsuringBirthRegistration - Bothmotherandnewbornaresafeuntilthe42nddayofdelivery Extravisitsmadeforhomedeliveryorforthehighrisknewbornwillnotbepaid PaymentwouldbemadebythesamemechanismwhichthestatehaschosenformakingJSY payments. Using a crude birth rate of 26/1000, as an average estimate for the country, this would amounttoabout26birthsintheareathatanASHAwillcoverorapproximatelytwobirths permonth.ThusanASHAcouldearnRs500permonthonthistask. Capacity building of ASHAs: Ministry of Health has decided to scale up the Home Based Newborn Care (HBNC) to all states with priority focus in 264 high focus districts. ASHA module 6 and 7 that incorporates HBNC has been prepared and state level trainers have beentrainedfrommoststatesonthesemodulesandtrainingofdistricttrainersisongoing. ASHA support systems: To effectively implement these skills the ASHA requires competencybasedtraining,andaneffectivesupportstructureinthefieldtosuperviseand mentorherfunctioning.Othersupportmechanismsincludeacommunicationkitanddrugs andequipmenttoenablehertocounsel,manageorreferasrequired.StateASHAResource Centre, District and Block Mobilizers and ASHA facilitators are required to provide the management and monitoring support functions related to the training and rollout of the modules, to mentor and support the ASHA in the field and to enable performance monitoring. Mechanismformonitoringandevaluation TheASHAusestwochecklists:FirstVisittotheNewbornandHomevisitformtoremindher toaskthekeyquestionsandthestepsofexaminationandcounselingthemother.Thesecan alsoserveasthebasisforpayment. As part of skill building (Module 6), the ASHA is trained to complete a Home Visit Form, which also serves as a checklist of the ASHA on key signs and symptoms to look for, and actionstobetaken.Thisformcanbeusedtoassessthenumberandcontentofhervisits, andshouldbesignedbytheASHAfacilitator.ASHAwillbeentitledtogettheincentiveonly afternecessaryentriesintheMCPcardareverifiedbytheANM. DetailedguidelinesfortheSchemewillbesharedasaseparatedocument.

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POPULATIONSTABILISATION&FAMILYPLANNING
INTRODUCTION In 1952, India launched the worlds first national program emphasizing family planning to theextentnecessaryforreducingbirthrates"tostabilizethepopulationatalevelconsistent with the requirement of national economy". Since then, the family planning program has evolved and the program is currently being repositioned to not only achieve population stabilizationbutalsotopromotereproductivehealthandreducematernal,infant&child mortalityandmorbidity. The growth of Indias population since independence hovered around 2% per year for almostfourdecades.After1981,thetrendinthepopulationgrowthratewasreversed.The decline was slow during 198191 but accelerated during 19912000 (1.9%). Provisional census data for 2011 shows that exponential annual growth rate has further declined to 1.6%. Indias population as per 2011 census was 1.21 billion, second only to China in the world.Indiaaccountsfor2.4%oftheworld'ssurfaceareayetitsupportsmorethan17.5% oftheworld'spopulation. The TFR in India has declined from 6.0 in 1951 to 2.6 (SRS) in 2009 but the decline is not consistent in all the states. While 14 states/ UTs have already achieved the replacement level, 12 states have TFR between 2.1 and 3 and 9 states (Bihar, UP, Rajasthan, MP, Jharkhand,Chhattisgarh,Meghalaya,Nagaland,D&NHaveli)haveTFRmorethan3. TotalFertilityRateinDifferentStates(Source:SRS2009) TFR3.1&above 1 Bihar 3.9 3 UttarPradesh 3.8 2 Meghalaya 3.8 4 Nagaland 3.7(200506NFHSIII) 5 Dadra&NagarHaveli 3.5(1999 SRS) 6 Rajasthan 3.3 7 MadhyaPradesh 3.3 8 Jharkhand 3.2 TFR2.63.0 1 Chhattisgarh 3 2 ArunachalPradesh 3.0(200506NFHSIII) 3 Mizoram 2.9(200506NFHSIII)

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4 Lakshadweep 2.8(1999 SRS) 5 Manipur 2.8(200506NFHSIII) 6 Assam 2.6 7 Uttaranchal 2.6 TFR2.22.5 7 Gujarat 2.5 8 Haryana 2.5 1 Daman&Diu 2.5(1995 SRS) 2 Orissa 2.4 3 Jammu&Kashmir 2.3 4 Tripura 2.2(200506NFHSIII) TFR2.1&below 1 Chandigarh 2.1(2000 SRS) 2 Karnataka 2 3 Sikkim 2.0(200506NFHSIII) 4 Maharashtra 2 5 Delhi 2 6 HimachalPradesh 1.9 7 WestBengal 1.9 8 Andaman&Nicobar 1.9(1999 SRS) 9 Punjab 1.9 10 AndhraPradesh 1.8 11 Goa 1.8(200506NFHSIII) 12 Puducherry 1.8(1999 SRS) 13 TamilNadu 1.7 14 Kerala 1.7 AsperDLHS3(200708),54.1%oftheeligiblecouplesuseanyofthecontraceptivemethod comparedto.Outofthemodernmethods,34%acceptedfemalesterilizationandonly1% malesterilization.Amongspacingmethods,Pills,CondomsandIUCDwereacceptedby4%, 6% and 2% of the eligible couples respectively. Contraceptive Prevalence Rate has not increasedmuch.
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CurrentstatusofCPRandUnmetNeedinDifferentStates(SourceDLHSIII) Sl. CPR:Any CPR:Anymodern TotalUnmet NameoftheState/UT No. method(%) method(%) Need(%) INDIA 54 47.1 21.3 EAGSTATES 1. Bihar 32.4 28.4 37.2 2. Chhattisgarh 49.7 47.1 20.9 3. Jharkhand 34.9 30.8 34.7 4. MadhyaPradesh 56.2 53.1 19.3 5. Orissa 47 37.8 24 6. Rajasthan 57 54 17.9 7. UttarPradesh 38.4 26.7 33.7 8. Uttarakhand 60.1 57.7 20.8 OTHERSTATES 9. Delhi 66.1 55.5 13.9 10. Gujarat 61.6 54.3 16.5 11. Haryana 62 54.5 16 12. HimachalPradesh 70.2 68.1 14.9 13. Jammu&Kashmir 54.1 42.7 20.4 14. Meghalaya 22.9 16.8 32.7 KEYSTRATEGIESFORFAMILYPLANNINGUNDERRCHII 1. Strong political will and advocacy at the highest levels like Chief Ministers, parliamentarians, religious leaders and opinion leaders, for achieving population stabilizationwithaspecialfocusinthestateswithhighfertilityrates. 2. AvailabilityofFixedDayStaticServices atallfacilitiesroundtheyearbyensuring availabilityoftrainedserviceprovidersoastograduallymoveawayfromseasonal campapproach. 3. Revitalizing Postpartum Family Planning to address high unmet need for family planning during this period and utilizing the opportunity provided by increased institutionaldeliveries. 4. Equal emphasis on Spacing Methods Promoting IUCD as long term, safe and effectivemethod. 5. Ensuring Quality of Family Planning services by strengthening DQACs/SQAc and regularmonitoringofservices 6. Increasingmaleparticipation infamilyplanningincludingpromotionofNSV 7. AccreditationofPrivateproviders 8. Strengthening Community Based Distribution of Contraceptives by involvement
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9. 10. KEYISSUESINFAMILYPLANNING 1. 46%ofthepopulationin2011iscontributedby8EAGstatesoutofwhich6stateshave (UP, Bihar, MP, Rajasthan, Chhattisgarh and Jharkhand) Total Fertility Rate (TFR) more than3.0. 2. UnmetneedforbothspacingandlimitingmethodsofcontraceptionishighestinBihar (37.2),Jharkhand(34.7)andUttarPradesh(33.8)comparedtonational21.5(DLHSIII) 3. Contraceptiveprevalencerate(CPR)islowestinUP(26.7),Bihar(28.4).(Indiaaverageis 46.2.) 4. Lowfemaleliteracy,earlyageatmarriageandchildbearingarealsoprevalentinthese states adding to population momentum. About 49% of girls in rural areas are married even before they turn 18 and almost 5.6% of total births take place in girls below 18 yearsofage. 5. Insufficient availability of trained service providers at peripheral health facilities to provideregularqualityFP(especiallysterilization)servicesthroughouttheyear. 6. LackofmotivationofthestafftoprovideFamilyplanningservices. 7. Less focus on Post partum family planning services despite increase in institutional deliveries. 8. Continued dependenceonCampmodeforsterilizationservices,thattoointhewinter months. 9. Mostofthestatespredominantlycatertotheirdemandsoffemalesterilisationthrough thelaparoscopicmode,whichistechnically&logisticallydifficult;employingtheminilap modeoftubectomywouldresultinmoreserviceprovidersaswellasservices 10. Male participation in adopting Family planning remains low (less than 5% of total sterilizations). 11. Female sterilization continues to remain the predominant method of contraception despiteothereffectivemethodslikeIUCD,oralcontraceptivepillsbeingavailable.

of ASHAs and Focussed IEC/BCC efforts for enhancing demand and creating awarenessonfamilyplanning Improvingcontraceptivessupplymanagement tillperipheralfacilities Strengtheningmonitoringandprovidingperformancebasedincentives

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POPULATIONSTABILISATION Indias population as per 2011 census was 1.21 billion,second only to China in the world. Indiaaccountsfor2.4%oftheworld'ssurfaceareayetitsupportsmorethan17.5%ofthe world'spopulation. PopulationStabilizationhasalwaysbeenoneofthepriorityagendaandFamilyPlanningas oneofthekeyinterventionfortheGovernment.In1952,Indiawasthefirstcountryinthe worldtolaunchanationalprogramme,emphasizingfamilyplanningtotheextentnecessary for reducing birth rates "to stabilize the population at a level consistent with the requirementofnationaleconomy".TheprogramhascomealongwayandcurrentlyFamily PlanningProgramisbeingrepositionedtonotonlyachievepopulationstabilizationbutalso toreducematernalmortalityandinfantandchildmortality. TheNationalPopulationPolicy,2000(NPP2000)providesapolicyframeworkforadvancing goals and prioritizing strategies to meet the reproductive and child health needs of the people of India, and to achieve net replacement levels of fertility (i.e. TFR 2.1) by 2010. NationalSocioDemographicGoalsformulatedtoachievetheobjectivesofNPP,envisaged to Addresstheunmetneedsforbasicreproductiveandchildhealthservices,supplies and infrastructure and to promote vigorously the small family norm to achieve replacementlevelsofTFR. Achieve 80 percent institutional deliveries and 100 percent deliveries by trained persons Reduce infant mortality rate to below 30 per 1000 live births, maternal mortality ratiotobelow100per100,000livebirths,100%registrationofallbirths,deathsand pregnancies and achieve universal immunization of children against all vaccine preventablediseases. Promotedelayedmarriageforgirls,notearlierthanage18andpreferablyafter20 yearsofage. Achieve universal access to information/counselling, and services for fertility regulationandcontraceptionwithawidebasketofchoices. Bringaboutconvergenceinimplementationofrelatedsocialsectorprogramssothat familywelfarebecomesapeoplecentredprogramme Total Fertility Rate is still 2.6 at National level and scenario is diverse across states. Nine states are well above the replacement level fertility (TFR >3); twelve states/UTs are at thresholdofachievingthereplacementleveloffertility(TFR 2.13) while11stateand3 UTshavealreadyachievedthereplacementleveloffertilityi.e.<2.1.

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The states also differ widely in terms of health indicators, nutritional status and socio economic situation. Practice of Family planning is also low in the states where the other indicatorsarepoor.Therefore,addressingpopulationgrowthinthestateswithhighfertility requireacomprehensiveapproachtopopulationstabilizationbasedonsocialandeconomic developmentandimprovementsinthequalityoflifeofpeople. RENEWEDTHRUST Currently Govt of India follows Highfocus district approach (264 such districts have been selected)andsupportthesedistricts(&states)forbetterimplementationofFamilyPlanning programmes(&otherprogrammesaswell). GovtofIndiaiscommittedtoreducetheMaternalMortalityRatio(MMR)to100/100,000 livebirths,InfantMortalityRate(IMR)to30/1000livebirthsandtoachievethereplacement leveloffertility(TotalFertilityRate2.1)by2012.Thereisenoughevidencetoshowthat FamilyPlanningcanplayanintegralroletosavethelivesofmothersandchildrenandhelp in achieving the National Goals. It is estimated that If the current unmet need for family planninginIndiaisfulfilledbymakingavailable,affordablefamilyplanningservicesoverthe next5years,wecan STRATEGICOPTIONSFORPOPULATIONSTABILIZATION States with TFR >3.0 (U.P. Bihar, M.P., Rajasthan, Jharkhand, Chhattisgarh, and Meghalaya): These states will account for almost 50% of the increase in Indias Population in coming years.Inthesestates,theimmediateconcernistoaddresstheunmetneedandfocusupon socio economic development to reduce the wanted fertility (desire for more than two children).Atthesametimethemomentumforfuturepopulationgrowthistobechecked bydelayingageatmarriageandensuringadequatespacingbetweenbirths. StateswithTFRbetween2.1to<3(Uttarakhand,Gujarat,Haryana,J&K,Orissa): Theimmediateconcerninthesestatesistoassistthecouplestoachievetheirfertilitygoals bystrengtheningthefamilyplanningprogramme. ForStateswithTFR<2.1(DelhiandHimachalPradesh): Theimmediateconcerninthesestatesistocheckthepopulation momentumby delaying theageatmarriageandensuringadequatespacingbetweenbirths.
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KEYTHRUSTAREAS12THFIVEYEARPLAN:FAMILYPLANNING Addressing the unmet need in contraception through introduction of newer contraceptives. Strengtheningfamilyplanningservicedelivery,especiallyPostPartumSterilisationin highcaseloadfacilities. Enlisting private/NGO facilities to improve the provider base for family planning services. CommunitybaseddistributionofcontraceptivesthroughASHAs. Vigorous advocacy of family planning at all levels specially at the highest political level. Strategiestoachievethrustareas: Strengtheninghumanresourcestructures(forprogrammemanagement)atalllevels (national,stateanddistrict) Introduction of a dedicated counsellor for family planning at district hospitals and highcaseloadfacilities. MarketingofcontraceptivesathouseholdsthroughASHAsatnominalcharges Improvingcompensationpackage(bothforprovidersandacceptors)forsterilisation services Introducing Multi load IUD (375) as a short term spacing method to improve IUD acceptance Performance Linked Payment Plan to ASHAs for improving retention and usage of IUDs Enlistingmorenumberofprivateproviders/NGOsforprovisionofservices Ensuringvigorousadvocacy SCHEMEFORDELIVERYOFCONTRACEPTIVESBYASHAsATHOMES Scheme:ASHAwouldpromotetheuseofcontraceptivesatthehouseholdlevelandmaking itavailabletimely: ASHAswoulddelivercontraceptivesathomesofbeneficiaries. SheshallchargeanominalamountofRs1forapackof3condoms,Re1foracycle ofOCPandRs2foranECP,fromthebeneficiaries. Logistics&supplychain: Thecontraceptiveswouldbedispatchedtothepilotdistrictsdirectly.(CMOswould betheconsignee) Supplybelowdistrictwouldfollowexistingsupplychainofstate. TheASHAshallliftandreplenishherstockeverymonthfromtheBlockPHC. Thepackswouldbemarked GovernmentofIndiasupply,forhomedeliverybyASHA,
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Re1/forapackof3condoms/Re1/foracycleofOCPs/Re2/forapackofonetabletof ECP ThecurrentfreesupplyschemeshallbecontinuedonlyfromCHClevelupwardsi.e. CHC,subdistricthospitalanddistricthospital. TheschemewillbeoperationalatthePHCandSClevel. Coverage:Theschemeisproposedtobeimplementedin233districtsof17states: Sn. 1 2 3 4 5 6 7 8 9 State UttarPradesh Bihar MadhyaPradesh Rajasthan Jharkhand Chhattisgarh Orissa Uttarakhand Assam No.ofDist. 45 36 34 19 19 16 18 4 14 14 15 16 17 Tripura Manipur Meghalaya ArunachalPradesh TOTAL 2 4 5 3 233 Sn. 10 11 12 13 State Jammu&Kashmir HimachalPradesh Haryana Gujarat No.of Dist. 4 3 1 6

14districtshavebeenidentifiedforinitialsupplyofcontraceptivestostartwiththe programme,supplytoremainingdistrictswouldbeprovidedafterthisinitialsupply: QtyofContraceptiveUnderASHASchemetobeSuppliedbefore15thJuly2011 Sl. State District CondomNoof OCPNoofBoxes ECPillsNoofBoxes No. Boxes@2520pcs @600cycles @300packs 1 UP a)RaiBareli 358 45 69 b)Bareilly 470 c)Hardoi 430 2 Rajasthan Jaisalmer 49 11 13 3 Orissa Anugul 46 70 4 MP Barwani 86 5 Jharkhand Bokaro 70 6 Haryana Mewat 158 24 7 Gujarat Dangs 17 5 8 Chhattisgarh Bilaspur 93
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9 10 11

Bihar Jammu Assam

Gaya Doda a)Darrang b)Bongaigaon QuantityinM.pcs

124 35 23 19 1978 4.984mpcs

13 168 1.008L.Cycles

82 24600Packs

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SchemeforPromotionofMenstrualHygieneamongAdolescentGirls(1019years)in RuralIndia I.Background TheMinistryofHealthandFamilyWelfarehasapprovedanewschemeforthepromotion ofmenstrualhygieneamongadolescentgirlsintheagegroupof1019yearsinruralareas. This scheme is aimed at ensuring that adolescent girls (10 19 years) in rural areas have adequate knowledge and information about menstrual hygiene and the use of sanitary napkins. Evidencesuggeststhatlackofaccesstomenstrualhygiene(whichincludessanitarynapkins, toilets in schools, availability of water, privacy and safedisposal) could contribute to local infections including reproductive tract infections (RTI). Studies have shown that RTIs are closelyinterrelatedwithpoormenstrualhygieneandposegravethreatstowomenslives, livelihood,andeducation.ServicesforthepreventionandtreatmentofRTI/STIareintegral part of the Reproductive Child Health II Programme (RCH II). With specific reference to ensuring better menstrual health and hygienefor adolescent girls, Government of India is launchingthisschemeaspartoftheAdolescentReproductiveSexualHealth(ARSH)inRCH II. II.SchemeModalities Inthefirstphase,theschemewillcover25%ofthepopulationi.e.1.5croregirlsintheage groupof1019yearsin152districtsof20states.Thegirlswillbeprovidedwithapackof6 sanitarynapkinsundertheNationalRuralHealthMissionsbrandFreedays.Thesenapkins will be sold to the adolescents girls at Rs. 6 for a pack of 6 napkins in the village by the Accredited Social Health Activist (ASHA). This means a napkin will be available at an affordablerateofRs.1perpiece.Itisexpectedthatmakingsanitarynapkinsavailableatthe villagelevel,theusageofsanitarynapkinswillincrease.Currently,sanitarynapkinsarenot readily available in rural areas leaving young girls and women little choice besides using indigenous methods like cloth, straw, ash etc. Easy access and convenient pricing are the strategiesadoptedbytheMinistryforincreasingusageofsafeandhygienicpracticesduring menstruation.TheASHAwillgetanincentiveofRe.1onsaleofeachpack,besidesafree packofsanitarynapkinspermonth.ThecostoftheincentiveforASHAmustbemetoutof thesaleproceeds.TheASHAisalsorequiredtofacilitateamonthlymeetingwithadolescent girlsinthevillagetopromotemenstrualhygieneandshewillbegivenanincentiveofRs.50 foreachmonthlymeetingwithadolescentgirls.
36

III.CurrentStatus III.a.ASHATraining To ensure the smooth rollout of the scheme in the identified states, the Ministry with support from National Health Systems Resource Centre (NHSRC) developed operational guidelinesforthescheme.ThesehavebeenprintedinEnglishandHindianddisseminatedin the20stateswheretheschemeisbeingimplementedinthefirstphase.Trainingandinter personalcommunication(IPC)materialincludingtrainingandreadingmoduleforASHAand aflipbookonmenstrualhygienehasalsobeendevelopedandsharedwiththestatesand translated in vernacular languages to be used at the community level. The training of trainers (ToT) for master trainers from each of the 20 identified states was completed in August 2010. The training of ASHAs on menstrual hygiene in the states is expected to be completedbyJuly2011. III.b.StrengtheningWomensSelfHelpGroupsforProductionofSanitaryNapkins As part of this scheme, supply of sanitary napkins in 45 identified districts shall be from womensselfhelpgroups.TostreamlinetheSHGtrainingandproduction,NHSRChasbeen appointedasthenodalagencyforprovidingtechnicalsupport.2batchesofexposurecum trainingfor40nodalofficersfrom15statesfromtheDepartmentsofHealth,Womenand Child Development and Rural Development have been organised in Chennai in November 2010. III.cBranding TheMinistrywithsupportfromUNFPAhasdevelopedtheNRHMbrandofsanitarynapkins Freedays.ThisbrandnamewasfinalisedafterresearchwithadolescentgirlsinruralBihar. TVspotsarecurrentlyunderproduction.ThescriptsdraftedbyasubsidiaryofUSAIDhave beenapprovedandfinalspotswillbereadyforairingonTVandradioshortly. III.dSupplyofSanitaryNapkins M/s HLL Lifecare Limited, a PSU of this Ministry shall be supplying the packs of Freedays sanitarynapkinsatthedistrictlevelin107districtsaspertheconsigneedetailssharedby states.Inother45districts,packsofsanitarynapkinsaretobesourcedfromwomenSHGs. Procurement of sanitary napkins in 45 districts from Womens Self Help Groups has been fixedatRs.7.50perpackof6sanitarynapkins.Necessaryprovisionshavebeenmadebythe StatesintheirannualNRHMPIPsforthiscost.IncaseStatesintendtoprocurefromwomen SHGsatahigherratethanRs.7.50perpackof6napkins,additionalcostwouldbeborne outofthestatebudget. III.e.SellingPrice IthasbeendecidedthatapackofsanitarynapkinwillbesoldbyASHAatauniformselling price of Rs. 6/ per pack of 6 sanitary napkins for all adolescent girls covered under the scheme.
37

IV.RoleoftheStateintheImplementationoftheScheme To ensure the smooth rollout of the scheme for promotion of menstrual hygiene among adolescentgirlsinruralIndia,theresponsibilitiesofthestatesinclude: a. completionoftrainingforallASHAsinthe152districtsbyJuly2011 b. constitution of State Steering Committees and finalising the implementation modalities at the district, block and village level as suggested in the operational guidelines c. ensuringasystemoffundflow,maintenanceofrecords,stocksandaccounts. d. storageattheblocklevelanddistributionofstocktothesubcentreandfurtherto thevillage e. identification of key SHGs for undertaking the production and supply of sanitary napkinsforadolescentgirlstobecoveredunderthisscheme f. workingwithNHSRCtoensuretrainingofSHGmembersintheidentifiedproduction technologyforproductionofsanitarynapkins g. planningforeffectivedisposalofsanitarynapkins Annexure1
S.No 1 StatewiselistofFinalImplementationDistrictsforMenstrualHygieneScheme State Total Central SHG Tender SHG Supply Andhra 9 3 6 Adilabad,Nizamabad, Medak,Karimnagar, Pradesh Chittor Warangal,

Nalgonda, Mahboobnagar, Rangareddy


2 Assam 7 7 0 GoalPara,Dhubri,Barpeta, Kamrup,Marigaon, Nagaon,Sonitpur Saran,Bhojpur,Buxar, Vaishali Rohtas,Kaimur(Bhabua), Muzaffarpur,Darbhanga, Aurangabad,Gaya Bilaspur,Janjgir,Raipur, Mahasamund,Durg Surat,Kheda,Vadodara, Dahod,Anand, Bharuch, Narmada,Tapi

Bihar

10

4 5 6

Chattisgar h Gujarat Haryana

5 8 7

5 4 0

0 4 7

Mewat,Sonipat, Jind,Yamunanagar, Panchkula,Sirsa, Faridabad

38

7 8

Himachal Pradesh Jammu and Kashmir

5 7

4 7

1 0

9 10

Jharkhand Kerala

6 7

5 7

1 0

11

Karnataka

12

Madhya Pradesh Maharash tra Orissa

13

14

15 16

Punjab Rajasthan

5 7

5 7

0 0

Bilaspur,Mandi,Hamirpur, Una Baramullah(Erstwhile Bandipura),Rajouri, Udhampur,Kathua, Kupwara,Doda(Erstwhile Kishtwar/Ramban),Poonch Ranchi,Bokaro,Giridih, Hazaribagh,Dhanbad, Kasargod,Wayanad, Kannur,Mallapuram, Idukki,Kottayam,Palakkad Bidar,Gulbarga,Raichur, Mysore,Bagalkot, Belgaum Bhind,Morena,Sheopur, Datia,Shivpuri,Guna, Vidisha,Sagar Nandurbar,Dhule,Akola, Buldana,Satara,Latur, Amravati,Beed, Dhenkanal,Bhadrak, Kendrapara, Jagatsinghapur Moga,Firozpur,Muktsar, Bhatinda,Faridkot Jhunjhunu,Alwar,Sawai Madhopur,Bhilwara, Bundi,Chittaurgarh,Ajmer

Solan

Lohardagga

ChamarajNagar, Bijapur,Bellary Dewas

Osmanabad

Ganjam

17

Tamil Nadu

10

10

Namakkal,Karur, Madurai, Shivaganga, Dharmapuri, Krishnagiri, Kanyakumari, Tanjavur,Trichy, Nilgiris


Uttarkashi,Rudrapayag, TehriGarhwal,Haridwar, Garhwal Saharanpur, Muzaffarnagar,Bijnor, Moradabad,Unnao, 39

18

Uttarakha nd Uttar Pradesh

19

13

13

20

West Bengal

Sidharthnagar,Basti, Gorakhpur,Faizabad,Rae Bareli,Sultanpur, Maharajganj,Rampur

Malda, Murshidabad, Birbhum,Purilia, NorthParganas, Jalpaiguri, Coochbehar,Uttar Dinajpur,Paschim Medinipur

Total

152

107

45

SeeAnnexureonTechnicalSpecificationsofSanitaryNapkinsfortheSchemeforthe PromotionofMenstrualHygiene(asapprovedbythetechnicalcommitteeconstitutedby MoHFW)

40

PreconceptionandPrenatalDiagnosticTechniquesAct
Continuous decline in child sex ratio since 1961 Census is a matter of concern for the country (Table I). Beginning from 976 in 1961 Census, it declined to 927 in 2001. As per Census2011(provisional)theChildSexRatio(06years)hasdippedfurtherto914against 927 girls per thousand boys recorded in 2001 Census. Child sex ratio has declined in 22 States and 5 UTs and except for the states of Himachal Pradesh (906), Punjab (846), Chandigarh (867), Haryana (830), Mizoram (971), Tamil Nadu (946), Andaman & Nicobar Islands(966)showingmarginalimprovement,restofthe27states/UTshaveshowndecline. (TableII).StatesandUTswithchildsexratioof951andabovehasreducedfromeighteento nine in 2011. A declining trend in even North Eastern States (other than Mizoram) is also discernible. ThelistoffocusstatesforpurposesofthePC&PNDTAct,1994hasextendedfrom7to17 states (Punjab, Haryana, Chandigarh, Delhi, Gujarat, Himachal Pradesh, Rajasthan, Maharashtra, Orissa, Bihar, Uttar Pradesh, Madhya Pradesh, Uttaranchal, Jharkhand, Andhra Pradesh, Chhattisgarh, and J&K). In Haryana, Rewari (784), Jhajjar (774) and Mahendragarh (778) and Sonipat (790) indicate a Child Sex Ratio of below 800 in these districts.Similarly,Samba(787)andJammu(795)districtofJ&KshowaChildSexRatioof below800. Thisnegativetrendestablishesthefactthatthegirlchildismoreatriskthaneverbefore andtheeffortstilldatehavenotbeencompletelyeffective.Theissueofsurvivalofgirlchild is critical and needs systematic efforts to build a positive environment for the girl child through gender sensitive policies, provision and legislation to protect women against any genderbasedviolence. While changing the mind set and creating a favourable environment for girl child is the mandate of Ministry of Women and Child Development, Ministry of Health And Family Welfare is concerned with regulating and prohibiting the use of medical technology for selectiveeliminationofthegirlchild. Towards this end, the Prenatal Diagnostic Techniques (Regulation and Prevention of Misuse)ActwasenactedonSeptember20,1994andtheActwasfurtheramendedin2003. The main purpose of enacting the PC & PNDT (prohibition of Sex Selection) Act, 1994 has beento: i) Bantheuseofsexselectiontechniquesbeforeorafterconception ii) Prevent the misuse of prenatal diagnostic techniques for sex selective abortions iii) Regulatesuchtechniques
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ThePC&PNDTAct,1994prohibitssexselectionbeforeorafterconceptionandmisuseof prenatal diagnostic techniques for determination of the sex of the foetus as also advertisementsinrelationtosuchtechniquesfordetectionordeterminationofsex.TheAct specifies punishments for violation of its provisions. The Act is implemented through the followingagencies: CentralSupervisoryBoard(CSB) StateSupervisoryBoards(SSBs)andUnionTerritorySupervisoryBoards(UTSBs) AppropriateAuthorityforthewholeorapartoftheState/UnionTerritory StateAdvisoryCommittee(SAC)andUnionTerritoryAdvisoryCommittee(UTAC) Advisory Committees (AC) for designated areas (part of the State) attached to eachAppropriateAuthority. AppropriateAuthoritiesattheDistrictandSubDistrictlevels All places using preconception and sex selection techniques/procedures and any place having equipment capable of detecting thesex of the foetus and those related to genetic counsellingneedtoberegistered,i.e: AllGeneticCounsellingCentres GeneticLaboratories GeneticClinics UltrasonographyCentres MobileSonographyVans ImagingCentres Advancedversionsofultrasoundmachines InfertilityClinicsandIVFCentres The unit as a whole, including the place, equipments and persons using the machineshouldberegistered To qualify for registration, the applicant organization must fulfill the requirements of space, equipment, qualified employees and standards as specifiedinRule3oftheAct Any change of employee, place, equipment or address should be intimated to theAAwithin30daysofsuchchangeasperRule13. ThepunishmentsundertheActareasgivenbelow: Breachofanyprovisionbytheserviceprovider:3yearsimprisonmentand/orafine ofRs.10,000/;Foranysubsequentoffence:5yearsimprisonmentand/orfineofRs. 50,000/(Section23(1)) Medical Professionals: AA will inform the State Medical Council and recommend suspensionoftheoffendersregistrationifchargesareframedbythecourtandtill

42

the case is disposed off; removal of name from the register for 5 years on 1st convictionandpermanentlyincaseofsubsequentbreach(Section23(2)) Personsseekingtoknowthesexofthefoetus(Awomanwillbepresumedtohave been compelled by her husband and relatives): Imprisonment extending up to 3 yearsandafineofuptoRs.50,000/;Forsubsequentoffences:Imprisonmentupto5 yearsandorafineofRs.1,00,000/(Section23(3)) Personsconnectedwithadvertisementofsexselection/sexdeterminationservices: Imprisonment up to 3 years and/or a fine of Rs. 10,000/ with additional fine of continuingcontraventionattherateofRs.500/perday(Section22(3)) AdvertisementforthepurposeofSection22(3)includesanynotice,circular,label, wrapper or any other document including advertisement through internet or any othermediainelectronicorprintformandalsoincludesvisiblerepresentationmade bymeansofanyhoarding,wallpainting,signal,light,sound,smoke,gas,etc Contravention of provisions of the PC & PNDT Act, 1994 for which no specific punishmentisprovidedintheActarepunishablewithimprisonmentupto3months and/orfineofRs.1,000/withadditionalfineofcontinuingcontraventionattherate ofRs.500/perday(Section25) Suchcontraventionscanbepresumedtobethenonmaintenanceofrecords,non compliancewithstandardsprescribedforthemaintenanceofunits,etc TheoffencesundertheActarecognizable,nonbailableandnoncompoundable AsperthereportsreceivedfromtheStatesandUTs,41,182bodiesusingultrasound,image scannersetc.havebeenregisteredundertheAct.409ultrasoundmachineshavebeen sealedandseizedforviolationofthelawand876caseshavebeenfiledintheCourtsfor variousviolationsofthelaw.Atotalof55convictionshavebeensecuredbyPunjab(22), Haryana(23),Delhi(2),Chandigarh(1)andGujarat(4).TheconcernedStategovernments areregularlyrequestedtotakeeffectivemeasuresforspeedyprosecutionoftheongoing cases(Table3). While the regulatory framework has been in place for implementation by states, enforcement of the Preconception & Prenatal Diagnostic Techniques (Prohibition of Sex Selection)Act,1994hasbeenlackadaisicalinmoststates. Followingthepublicationof the 2011Censusfigures,MinistryofHealth& Family Welfare hasinitiatedthefollowingstepsforeffectiveimplementationofPC&PNDTAct: 1. CentralSupervisoryBoard(CSB)undertheActhasbeenreconstituted.The17thmeeting oftheCSBwasheldonthe4thJune,2011.Theboardreviewedprogressmadebythe States in respect of the implementation of the Act, suggested amendments in the Act andstrategiestomeetthechallenges.

43

2. 17 states with the most skewed child sex ratio have been identified for concerted attention.AmeetingofHealthSecretariesoftheseStateswasconvenedon20thApril 2011.TheeffortsontheirparttoimplementPC&PNDTActwerereviewedindepthand followingactionpointshighlighted: Constitute/reconstituteStatesupervisoryboardandconductregularmeetings Constitute/ reconstitute appropriate authorities and advisory committees at state/ districtandsubdistrictlevels Constitute State Inspection and Monitoring Committees (SIMC) for checking the activities of ultrasound facilities indulging in advertisement and/or determination/revealingofthesexofthefoetus. IdentifydistrictsandmapreasonsforskewedChildSexRatio. Conduct regular surveys, update registrations and renewals to avoid multiple registrationsandirregularitiesincludingoncallregistrationsandunrestraineduseof portablemachines. Analysis and scrutiny of Form F for effective monitoring and tracking of the Ultrasoundclinics TakeimmediateactionagainstanybreachoftheprovisionsoftheActandRules Make ultrasound manufacturers accountable and get regular details of the sale of machines. SubmitregularquarterlyprogressreporttotheCentralSupervisoryBoard. SensitizeandConducttrainingprogrammeforlawenforcers,medicalpractitioners, judiciaryetc.foreffectiveimplementationoftheAct. Enhance inhouse capacities for building strong cases against offenders that can successfullywithstandthelegalscrutiny DeviseinterstatecoordinationmechanismforregulatingactivitiesofUSGclinics acrossborders. 3. National Inspection Monitoring Committees have been reconstituted for regular state monitoringandsurpriseinspectionoftheclinicsontheground.Randominspectionsof ultrasoundfacilitieswereundertakeninthestatesofGujarat,UttarPradesh&Rajasthan inJanuaryFebruary,2011. 4. StateshavebeenaskedduringappraisaloftheannualProgrammeImplementationPlan (PIP) to take advantage of funding available under NRHM for strengthening
44

infrastructure and augmentation of human resources required for effective implementationofthePC&PNDTAct. 5. OperationalguidelinesforPNDTNGOGrantinAidSchemehavebeenrevisedtoensure targeteduseofresourcesforeffectiveimplementationoftheAct. 6. ChiefSecretariesinthestates/UTshavebeenaddressedtotakeeffectivemeasuresand regularlymonitorimplementationofthePNDTAct. 7. HFMhasaddressedtheChiefMinistersofallstates/UTadministration,exhortingthem toprovidepersonalleadershipincontainingthedecliningsexratiointhe06yearage group. 8. ItisproposedtocarryforwardregularappraisalofeffectiveimplementationoftheAct through zonal and state specific reviews. PC&PNDT will be high on the agenda in all futurereviewmeetinginReproductiveandChildHealthissues.

TableI:SexRatioofchildpopulationintheagegroup06:19612011
CensusYear 1961 1971 1981 1991 2001 2011 ChildSexRatio 976 964 962 945 927 914 Absolutechange 12 2 17 18 13

TableII:StatewiseChildSexRatioinIndia(AgeGroup06Years)(1991,
2001&2011) State India Haryana Punjab JammuandKashmir Delhi Chandigarh

2001 927 819 798 941 868 845


45

2011 914 830 846 859 866 867

AbsoluteChange 13 11 48 82 2 22

Rajasthan Maharashtra Gujarat Uttaranchal UttarPradesh HimachalPradesh Lakshadweep DamanandDiu MadhyaPradesh Goa DadraandNagarHaveli Bihar Orissa Manipur Karnataka AndhraPradesh ArunachalPradesh Jharkhand Sikkim Nagaland TamilNadu WestBengal Tripura Assam Kerala Chhatisgarh Pondicherry AndamanandNicobar Islands Meghalaya Mizoram

909 913 883 908 916 896 959 926 932 938 979 942 953 957 946 961 964 965 963 964 942 960 966 965 960 975 967 957 973 964

883 883 886 886 899 906 908 909 912 920 924 933 934 934 943 943 943 943 944 944 946 950 953 957 958 964 965 966 970 971

26 30 3 22 17 10 51 17 20 18 55 9 19 23 3 18 21 22 19 20 4 10 13 8 2 11 2 9 3 7

46

TableIII.STATUSOFIMPLEMENTATIONOFPNDTACTINSTATES(31.3.11) Sl.No State No.ofclinics registered 1317 1072 212 65 740 1789 1790 3398 84 577 409 1475 591 2912 3703 462 1042 4560 521 3051 345 42 34 24 17 132 54 10 9 57 13 11 23 36 1803 32380 No.of machines sealedas 26 133 0 1 168 48 76 82 0 13 1 52 68 12 37 5 1 72 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 6 801 No.ofcases filedin court/against doctors 112 54 7 2 82 61 161 139 0 3 9 70 17 19 54 5 10 77 0 13 0 0 0 0 0 0 0 0 0 0 0 0 0 0 7 902 No.of convictions

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 Total

Punjab Haryana H.P Chandigarh Gujarat Delhi Rajasthan Maharashtra J&K Jharkhand Uttaranchal MadhyaPradesh Orissa AndhraPradesh UttarPradesh Chhattisgarh Bihar TamilNadu Kerala Karnataka Assam Manipur Meghalaya Nagaland Sikkim Goa Tripura A&NIslands Lakshadweep Puducherry D&N.Haveli Daman&Diu Arunachal Pradesh Mizoram WestBengal

22 23 0 1 4 2 0 3 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 55

47

Ebanking(NRHMFinancialManagementInformationSystem)
TheMinistryhasbeenworkingwithvariouspublicsectorbanksthatareleadbanksintheir respective states to develop an ebanking MIS which would enable detailed reporting on fundmanagementandfundutilisationuptosubdistrictlevels.Theetransferoffundsto states using the services of the accredited bank of the Ministry is already in place since 2010.TheebankingMISbuildsupontheetransfersbeingeffectedtogenerateinformation and data on funds available and their manner of utilisation even at the lowest unit level whichisthevillage/SubCentreandVillageHealthandSanitationCommittees. TheMinistryhasworkedwithStateBankofIndiaandNRHM,Karnatakatosuccessfullypilot (inthetwodistrictsofBangaloreRuralandYadgirandworkunderwayintenmoredistricts), a webenabled MIS which contains information on all fund flows under the Mission including funds transferred through the Infrastructure Maintenance route. The ebanking system developed includes modules for sanction order tagging, budget allocation and planning, expenditure tracking wherein third party payments including ASHA payments, activity head wise expenditure tracking, drill down information; beneficiary and non beneficiaryexpenditurearereadilyavailableatSHSandDHSandsubdistrictlevels.Thee banking MIS can be used both in offline and online mode and with or without standard accountingsoftware.ReportsgeneratedincludeFinancialManagementReports,Statement of Fund Position, Aging of Advances, Querying options, Geographical Area/Budget head/Expenditure typewise and trending reports and there is a SHS and Government of Indialeveldashboardavailablewhichwouldenableviewsacrossalldistrictsandsubdistrict levelformations. SystemdevelopmentLifecycledocumentsandUserManualsandalistofFAQshavebeen developed by NRHMFinance for use across states. Helpdesks have been created fmgebanking.helpdesk@gmail.comand nrhmfmis.heldesk@gmail.comanddedicatedteamshave beenformedtoassistinebankingrolloutinstates. The ebanking (NFMIS) system is essentially a very powerful executive management financialtoolwhichwouldenablestatestomanagethefundsunderNRHMbetter.

48

SectionThree Communicable Diseases

49

RevisedNationalTBControlProgramme
The Revised National TB Control Programme (RNTCP) is being implemented as a 100% Centrally Sponsored Scheme in the entire country. Under the programme, diagnosis and treatmentfacilitiesincludingthesupplyofantiTBdrugsareprovidedfreeofcosttoallTB patients. For quality diagnosis, designated microscopy centres have been established for everyonelakhpopulationintheplainareasandforevery50,000populationinthetribal, hilly and difficult areas. Sputum microscopy, instead of Xray, avoids over diagnosis and identifiesinfectiouscases.Morethan13000microscopycentreshavebeenestablishedin thecountry.DrugsareprovidedtotheTBpatientsinpatientwiseboxestoensurethatall drugsforfullcourseoftreatmentareearmarkedonthedayone,apatientisregisteredfor treatment under the programme. More than 4,00,000 Treatment centres (DOT centres) havebeenestablishedneartoresidenceofpatientstotheextentpossible.Allgovernment hospitals,CommunityHealthCentres(CHC),PrimaryHealthCentres(PHCs),Subcentresare DOT Centres, in addition to NGOs, Private Practitioners (involved under the RNTCP), CommunityVolunteers,Anganwadiworkers,WomenSelfHelpGroupsetc.alsofunctionas Community DOT Providers/DOT Centres. Drugs are provided under direct observation and thepatientsaremonitoredsothattheycompletetheirtreatment. The programme has launched DOTS Plus for the management of multidrug resistance tuberculosis(MDRTB)since2007.Tilldatetheseservicesareavailablein18States.RNTCP ispresentlyintheprocessofscalingupDOTSPlusservicesandaimstomaketheseservices availableinallStatesbyend2011whileachievingcompletegeographicalcoverageby2013. TBHIVcollaborativeactivitiesarebeingimplementedincollaborationwithNACPtoprovide TBtreatmentandcareandsupportforTBHIVpatients. To further extend the reach of programme and involve nonprogramme providers and community,RNTCPhasalreadyreviseditsguidelinesforinvolvementofNon Programme management is notable for decentralized financial control, management, and supervision to State and District health systems, supported by a small number of supervisorystaffs.RNTCPdiagnosticandtreatmentservicesarewhollyintegratedwithinthe generalhealthsystemandmedicalcolleges.NowRNTCPisanintegralpartoftheNational RuralHealthMission(NRHM).TheCentrallevelservesonlyfororganizinganddistributing financing for TB control activities within the NRHM, centralized drug procurement and distribution to States, development of comprehensive normative guidance, capacity building, and monitoring and evaluation of States and Districts programme management units.
50

TuberculosisDiseaseBurden&TrendinIndia IncidentNewSmearPositiveTBCases
Year Incidencerate(all NSPcasesperlakh population) 75 75 75 75 75 Estimatednoof NSPcases** 846000 846000 861000 873000 882750 TotalnoofNSP casesnotified underRNTCP 554,914 592,262 616,027 624,617 630,165 %of estimated NSPcases detected 66% 70% 72% 72% 72%

2006* 2007 2008 2009 2010

*DOTSexpansionwasdoneinphasedmannerwithcompletecoveragebyMarch2006.Thusthe
totalnumberofNSPcasesnotifiedunderRNTCPtill2006arelesser. **EstimatedbyWHObasedonARTI(AnnualRiskofTBInfection)surveyinIndia,conductedby NTI/CTDindifferentzonesofcountry

TrendsofNSPcasedetectionrateandsuccessrateinthecountry
100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0%
84% 85% 87% 86% 86% 86% 86% 87% 87% 87% 72% 70% 72% 72%

72% 69% 55% 59% 56% 66% 66%

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
Annualised New S+ve CDR

Success rate

Year 2006*

IncidentNewTB(NSP+NewSmearNeg+ExtraPulmonary)cases Incidencerate(allNEW Estimatednoof TotalnoofNEWTBcases TBcasesperlakh NEWTBcases notifiedunderRNTCP population)** 168 1895040 1,140,017
51

2007 2008 2009 2010

168 168 168 168

1895040 1928640 1955520 1977360

1,197,670 1,226,472 1,241,756 1,227,667

*DOTSexpansionwasdoneinphasedmannerwithcompletecoveragebyMarch2006.Thusthe totalnumberofcasesnotifiedunderRNTCPtill2006arelesser. **EstimatedbyWHObasedonARTIandassumptionofequalproportionofsmearpositiveand smearnegativecasesamongstnewcaseswhileextrapulmonarycasesoccurringattherateof 20%ofnewsmearpositivecases. PrevalentAllTBcases(NSP+NSN+NEP+Allretreatmentcases) Estimatednoofall Prevalencerate(allTB) TotalnoofTBcasesnotified TBcasesin casesperlakh underRNTCP population population) 333 3,759,060 1,400,340 316 3,568,992 1,474,605 300 3,438,834 1,517,363 283 3,290,628 1,533,309 266 3,129,055 1,522,147

Year 2006* 2007 2008 2009 2010

MajorChallengesofRNTCP: (1) Reachingtheunreachedisoneoftheimportantchallengesasitnecessitatesinnovative strategiesforensuringuniversalaccesstoTBdiagnosticandtreatmentfacilities. (2) Developingsputumcollection&transportmechanism. (3) DiagnosticfacilitiesforextrapulmonaryTBcasesarenotbeenwellestablished. (4) ReducingtreatmentdefaultofpatientsputontreatmenttopreventdrugResistantTB (5) MisuseofantiTBdrugs. (6) LinkingHIVinfectedTBpatientstoHIVcare. (7) PPMthoughbeneficial,remainsaverysmallproportionrelativetothelargenumbersof privatesectorproviders. (8) UrbanareasstillexperienceintenselevelsofTBtransmission. (9) Despitetheprogress,TBincidenceandmortalityarestillhigh,andanestimated280,000 peoplediedofTBin2009. Please see annexure for summary of the New / Innovative approaches of RNTCP in 12th FiveYearPlan
52

NATIONALLEPROSYERADICATIONPROGRAMME
ThrustAreasofXIIFiveYearPlanunderNLEP: AchieveeliminationofLeprosyatdistrictlevel(prevalenceoflessthan1 caseper10,000 population) StrengthenDisabilityPrevention&MedicalRehabilitationofLeprosyAffectedPersons

Background: The National Leprosy Control Programme was launched by the Govt. of India in 1955. MultiDrugTherapycameintowideusefrom1982andtheNationalLeprosyEradication Programmewasintroducedin1983.Sincethen,remarkableprogresshasbeenachieved in reducing the disease burden. India achieved the goal of elimination of leprosy as a publichealthproblem,definedaslessthan1caseper10,000population,attheNational level in the month of December 2005 as set by the National Health Policy, 2002. The National Leprosy Eradication Programme is 100% centrally sponsored scheme. MDT is suppliedfreeofcostbyWHO. Followingaretheprogrammecomponents (i) (ii) (iii) (iv) (v) EpidemiologicalSituation: 32 states/UTs have achieved leprosy elimination status. Only 3 States/UT viz. Bihar, Chhattisgarh and Dadra & Nagar Haveli are yet to achieve elimination. Further, out of 640districts,530(82.81%)havealsoachievedeliminationlevel(AnnexureI). AttheendofMarch2011,therewere83041leprosycasesonrecord(undertreatment). In201011,total1,26,800newleprosycasesweredetectedandputundertreatmentas compared to 1,33,717 leprosy cases detectedduring corresponding period of previous yeargivingAnnualNewCaseDetectionRate(ANCDR)of10.4per1,00,000population. Among the new cases detected in 201011, the proportions were MB cases (48.58%) female(36.20%),children(9.83%)andgradeIIdisability(3.10%). DecentralizedintegratedleprosyservicesthroughGeneralHealthCareSystem. TraininginleprosytoallGeneralHealthServicesfunctionaries. IntensifiedInformation,Education&Communication(IEC). RenewedemphasisonPreventionofDisabilityandMedicalRehabilitation& Monitoringandsupervision.

53

Outof1,45,082leprosycasesdischargedduringtheyear,1,32,105cases(91.06%)were releasedascuredaftercompletingtreatment. 2570reconstructivesurgerieswereconductedin201011forcorrectionofdisabilityin leprosyaffectedpersons(AnnexureII). Outof2,44,796globalleprosycasesreportedin2009,1,33,717caseswerereportedby India.ThusIndiacontributedabout54.6%ofnewcasesdetectedgloballyin2009,and thistrend islikelytocontinuefor some moreyears. ThedecliningtrendofPrevalence andAnnualNewCaseDetectionRateper10,000populationsince19911992isshownin the Graph below:
35 30 25 20 15 10 5 0
5.9

25.9 6.2 20.0 6.4


5.7

13.7 10.9

4.9 4.6 5.1 5.6

8.9 8.9 5.5 5.9 4.4 3.3

8.4 5.9 5.8 5.5 5.3 5.3

1.4 1.2 1.2 1.1 1.1 199119921993199419951996199719981999200020012002200320042005200620072008200920102011

0.720.74 0.720.71 2.3 0.84 3.7 4.2 3.2 0.69 2.4 1.0 1.3

ANCDR

PR

ActivitiesunderNLEP: Diagnosis and treatment of leprosy Services for diagnosis and treatment (Multi drug therapy) are provided by all primary health centres and govt. dispensaries throughout thecountryfreeofcost.Difficulttodiagnoseandcomplicatedcasesandcasesrequiring reconstructivesurgeryarereferredtodistricthospitalforfurthermanagement.ASHAs underNRHMarebeinginvolvedtobringoutleprosycasesfromvillagesfordiagnosisat PHCandfollowupcasesfortreatmentcompletion.ASHAsarebeingpaidincentivefor thisactivityfromtheprogrammebudget. Training Training of general health staff like medical officer, health workers, health supervisors, laboratory technicians and ASHAs are conducted every year to develop adequate skill in diagnosis and management of leprosy cases. As per the information receivedfromtheStates/UTs,healthfunctionariestrainedin200910. Urban leprosy control To address the complex problems in urban areas, the Urban Leprosycontrolactivitiesarebeingimplementedin422urbanareashavingpopulation
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sizeofmorethan1lakh.TheseactivitiesincludeMDTdeliveryservices&followupof patient for treatment completion, providing supportive medicines & dressing material andmonitoring&supervision. IEC Intensive IEC activities are conducted for awareness generation and particularly reductionofstigmaanddiscriminationagainstleprosyaffectedpersons.Theseactivities are carried through mass media, outdoor media, rural media and advocacy meetings. More focusisgiven on inter personnel communication. Intensive IEC Campaign with a theme Towards Leprosy Free India is being carried out towards further reduction of leprosyburdeninthecommunity,earlyreportingofcases&theirtreatmentcompletion, provision of quality leprosy services and reduction of stigma & discrimination against leprosy affected persons. Mass media campaign during the period October, 2010 and JanuaryFebruary2011,wascarriedoutthroughthePrasarBhartitospreadawareness aboutleprosyintheGeneralPublic. NGO services under SET scheme Presently, 39 NGOs are getting grants from Govt. of India under Survey, Education and Treatment (SET) scheme. The various activities undertaken by the NGOs are, IEC, Prevention of Impairments and Deformities, Case Detection and MDT Delivery. From financial year 2006 onwards, Grantinaid is being disbursedtoNGOthroughStateHealth(Leprosy)Societies. Disability Prevention and Medical Rehabilitation For prevention of disability among personswithinsensitivehands and feet, they are given dressing material, supportive medicines and microcellular rubber(MCR)footwear.Thepatientsarealsoempoweredwithselfcareprocedurefor takingcareofthemselves. More emphasis is being given on correction of disability in leprosy affected persons throughreconstructivesurgery(RCS).TostrengthenRCSservices,GOIhasrecognized85 institutionsforconductingRCSbasedontherecommendationsofthestategovernment. Outofthese,44areGovt.institutionsand41areNGOinstitutions(AnnexureIII). Supervision and Monitoring Programme is being monitored at different level through analysisofmonthlyprogressreports,throughfieldvisitsbythesupervisoryofficersand programme review meetings held at central, state and district level. For better epidemiological analysis of the disease situation, emphasis is given to assessment of NewCaseDetectionandTreatmentCompletionRateandproportionofgradeIIdisability amongnewcases.IndependentProgrammeEvaluationwascarriedoutduringtheyear 2010throughanindependentagency.


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Initiatives: DisabilityPreventionandMedicalRehabilitationAnamountofRs.5000/isprovidedas incentive to leprosy affected persons from BPL family for undergoing per major reconstructivesurgeryinidentifiedgovt./NGOinstitutionstocompensatelossofwages duringtheirstayinhospital.SupportisalsoprovidedtoGovernmentinstitutionsinthe formofRs.5000/perRCSconducted,forprocurementofsupply&materialandother ancillaryexpenditurerequiredforthesurgery. Involvement of ASHA A scheme to involve ASHAs was drawn up to bring out leprosy cases from their villages for diagnosis at PHC and follow up cases for treatment completion.Tofacilitatetheinvolvement ofASHA,theyarebeingpaidanincentiveas below (i)OnconfirmeddiagnosisofcasebroughtbythemRs.100/ (ii) On completion of full course of treatment of the case within specified time PB leprosycaseRs.200/andMBLeprosycaseRs.400/ 62528ASHAshavebeentrainedinleprosyandinvolvedinleprosywork(AnnexureIII). IncentiveisalsobeingpaidtoASHAsfordiagnosis&followupofthecases. Discriminatory laws relating to leprosy There are certain provisions under laws / acts which are discriminatory in nature against leprosy affected persons. The Ministry of Health & Family Welfare has taken up the matter with concerned Ministries/Departments/State Governments for their consideration and action on various such discriminatory acts/laws. These Acts and Laws are being modified or repealed,whichwillhelpthepersonsaffectedbyleprosyliveadignifiedlife.

Special Activity in High Endemic Distt. 209 Districts had reported ANCDR (Annual New Case Detection Rate) more than 10 per lakh population. Special activity for early detection and complete treatment, Capacity building and extensive IEC, Adequate availabilityofMDT,Strengtheningofdistt.nucleus,Regularmonitoring&supervisionand review, Regular follow up for neuritis and reaction, Self care practices, Supply of MCR footwear in adequate quantity and Improvement in RCS performance through camp approacharebeingplannedintheabovedistrictstoreducethediseaseburden. NationalSampleSurvey (i) The 131st report of the Committee on Petitions of Rajya Sabha, 2008, recommended thatthefinalsurvey,involvingPanchayatiRajInstitutions(PRI)maybeundertaken,so that the Government can have realistic figures of Leprosy Affected Persons (LAPs) to deviseanationalpolicy.Inreply,theMinistryofHealth&FamilyWelfareinformedthe Committee that a multi centric study to assess the burden of active leprosy cases,
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leprosy persons with grade I & II disability and the magnitude of stigma & discriminationprevalentinthesociety,willbecarriedout. (ii) ThehousetohousesurveywasstartedinStates/UTsasbelow,whichwasprecededby Training of the survey team members and IEC campaign in the concerned Block and Urbanareas. (iii) Six States/UTs viz. Arunachal Pradesh, Gujarat, Rajasthan, Manipur, Sikkim and D&N HavelistartedinMay2010andhavecompletedthesurvey. (iv) Twenty States/UTs viz. Andhra Pradesh, Assam, Chhattisgarh, Goa, Himachal Pradesh, Jharkhand, J&K, Karnataka, Madhya Pradesh, Kerala, Meghalaya, Mizoram, Nagaland, Orissa,Punjab,TamilNadu,Tripura,Uttarakhand,ChandigarhandDaman&Diustarted in June 2010. Survey completed in these States except by Kashmir Division of J&K. SurveyworkhasstartednewfromApril2011. (v) SixStates/UTsviz.UttarPradesh,WestBengal,Maharashtra,Haryana,A&NIslandsand PuducherrystartedinJuly2010.SurveycompletedbyalltheStates. (vi) DelhiandBiharhavestartedsurveyinAugust2010.Surveyhasbeencompletedinboth theStates. AlltheSurveyscheduleshavebeensenttotheidentifiedICMRCentresforcompilationof data,fromtheconcernedStates.Afteranalysisofthecollecteddatafrom34States/UTs, theNationalJALMAInstitutewillfinalisethereportoftheNationalSampleSurveybyendof July2011andsubmittotheGovernment. Budget:TheBudgetallocationunderNLEPfor200910was44.50croreandexpenditureof 35.11croreswasincurredduringtheyear.Budgetallocationfor201011was45.32crores. 37.35 crores expenditure has been incurred. Budget allocation for 201112 is Rs. 44.04 crores.

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NationalVectorBorneDiseaseControlProgramme
1. Malaria ObjectiveofXIIFiveYearPlan: PreparationforPreeliminationPhaseinstatesreportingAPI<1 Intensificationofmalariacontrolactivitiesinremainingareas ProposedactionforMalariaControlduringXIIFiveYearPlan Improvedsurveillanceandcasemanagement: SupportforonemaleMPWateachsubcentreaspernormsthroughNRHM StrengtheningofmalariamicroscopyatsectorlevelPHC ContinuedsupportforperformancebasedincentivetoASHAsformalariacase detectionandtreatment;expansioninalldistricts Involvementofprivatepractitionersandlaboratorypersonnels Strengtheningoftreatmentforseveremalariacasesatdistrictandsubdistrict hospitals Referralsupportserviceforseveremalariacases

IntegratedVectorManagement: Strengtheningofentomologicalsurveillance UniformsupportforspraywagesbyGoI IntensifiedsupervisionofIRSthroughM&E Acceleratedantilarvalmeasuresinurbanareas ScalingupofdistributionofLLINsinendemicdistricts SupportiveIntervention: Additionalhumanresource&training InvolvementofMedicalColleges&otherHealthInstitutions ComprehensivesupportforMonitoringandEvaluation SupportforMobility SupportforBehaviourChangeCommunication Effectiveandlocal/areaspecificneedbasedIECmethods Socialmobilizationforvulnerableandmarginalizedcommunity Effectiveenvironmentmanagement Strengtheningofoperationalresearch
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Optimizationoffundutilization: 2. Kalaazar::StateSpecificIssues Bihar: DedicatedStateProgrammeManager. DelayinAppointmentofVBSConsultantsandKTSunderWBProject(still9 postsofVBDConsultantsand43KTSvacant). NonPaymentofsalariestoVBDConsultantsinmanydistricts. Capacity building in the districts by filling keys posts of DMOs, Malaria Inspectors,MPHWs,andTechniciansetc. TofollowuniformStandardTreatmentguidelinesintheState. Paymentoflossofwagestothepatients@Rs50perday. NonpaymentofIncentivetoASHA/Healthworker@Rs.200/toreferacase andensurecompletetreatment. PoorqualityofIndoorresidualspraywithDDT50%. Lackofmonitoringandsupervision. Casesearchnotdoneduring2009&2010. 919sanctionedpostofMPHWshavenotbeenfilledupforkalaazarand otherVBDs. Jhakhand PoortreatmentCompliance. Nofollowupmechanism. IRSnotwellplanedandorganized. Lackofmonitoringandsupervision. Propertreatmentguidelines Casesearchactivitiesnotcarriedoutduring2010&2011. WestBengal: 60postsofKTSand5postsofVBDConsultantshavenotbeenfilledup. IRSactivitiesdelayedandnotdonewithproperplanning. Inadequatesupervisionandmonitoring.
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LinkageforinformingprogrammeregardingreleaseoffundsfromCentertoState NRHM ExpeditiousreleaseoffundsfromStateNRHMtodistricthealthsocieties Regularmonitoringofmonthly/QuarterlySOEs Efficientandlogisticsupplychainmanagement

Casesearchprogrammenotwellplanned. Propertreatmentguidelinestobefollowed. 3. LymphaticFilariasis 4. DengueandChikungunya DiscussionsonimplementationofMidTermPlan: CommitteeofSecretaries(CoS)inameetingheldon26.05.11undertheChairmanship ofCabinetSecretaryapprovedMidTermPlanforpreventionandcontrolofDengueand Chikungunya in the country. States need to focus on the issues as under for effective implementationofMidTermPlan. Functioningofdiagnosticfacilities ToaugmentdiagnosticfacilitiesforDengueandChikungunya,stateshaveidentified311 health facilities in 2011 (182 existing +129 new) across the country to function as diagnosticcentre. Thoughthenumberofdiagnosticcentreshasincreasedovertheyeartheirfunctioning hadbeenagreatconcernforNVBDCP.ExceptGoa,Punjab,TamilNadumonthlyreports arenotreceivedfromotherstates. VectorsurveillanceandManagement In absence of any drug or vaccine against Dengue and Chikungunya infection, vector control is the main stay to prevent transmission. Effective mosquito control primarily basedonsourcereductionisvirtuallynonexistentin mostoftheDengueChikungunya endemic states/towns. Due to vector bionomics, adult vector control is not feasible. Larval control needs constant and concurrent monitoring of the vector breeding. Emphasishasbeenplacedonultralowvolume(ULV)insecticidespacespraysforcontrol ofadultmosquitothoughitisrelativelynotveryeffectiveapproachforcontrollingAedes vector. An effective source reduction programme involving community volunteers for Urban andRuralareasneedstobeimplementedbyeachstate. Monitoringandevaluation EliminationofLymphaticfilariasisincountrybytheyear2015 ImprovedrugcompliancebyintensiveIEC/BCCactivityandsocialmobilization. IdentifyingLFendemicdistrictswithmicrofilariaratelessthan1%forMDAstoppage. Augmentingmorbiditymanagementtoincreaseprogrammevisibility.

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Most of states have no staff or resources to implement the strategies for Dengue/Chikungunya prevention and control during interepidemic period. The same needtobeputinplace. Entomological component is totally absent in most of the States/Municipalities and in somestates/townsveryweakorpoor.Outof72EntomologicalZones,only35zoneshave Entomologists in place. Similarly, out of 35 state entomologists only 10 are in position. Whereverpresenttheydonothavethefacilitieslikemobilitysupportorotherlogisticsto carry out entomological surveillance. Due to improper monitoring and evaluation programme implementation is adversely affected at State and district level for which earlywarningsignalsarenotcapturedontime. All the statesshould ensure strengthening ofentomological surveillance by fillingup all thevacantpostofStateEntomologist,ZonalEntomologist,InsectCollectorandmobility support. EnactmentofLegislation Dengueneedstobeaddedinthelist ofdiseasesthatrequiremandatory notificationin each state. It is envisaged to develop civic byelaws by each state to prevent mosquitogenic conditions in households/premises, building byelaws for health impact assessmentinalldevelopmentprojectsandbuildingconstructionactivitieshavinginbuilt provisions of mosquito breeding free premises covering all aspects of environmental sanitationinordertoeffectivelypreventbreedingofDengueandChikungunyavector. Thoughafewmunicipalitiesinthecountry,namelyMumbaiMunicipalCorporation,New Mumbai Municipal Corporation, Municipal Corporation Delhi, Chandigarh, Chennai, Goa have adopted legislation for the prevention of nuisance mosquitoes, they lack its implementationatthegroundlevel. SustainingSocialmobilization Asmosttransmissionoccursathome,therefore,ultimatesuccessoftheprogrammewill dependoncommunityparticipationandcooperation. Considerable efforts should be placed on community education through advocacy and social mobilization. Emphasis should be given on inter personal communication, group discussionetc. Intersectoralcoordination ThestrategyofDengueandChikungunyamainlyfocusesonintersectoralconvergencewith other National Health Programmes, nonhealth sector departments, civil society organizations.FollowingtheinstructionsofCoSalreadyMinistriesofUrbanDevelopment, RuralDevelopmentandPanchyatiRajhaveissuedinstructionstotheircounterpartsinthe
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states for implementation of guidelines to prevent mosquitogenic conditions and communitysensitization. Ministry of Urban Development vide letter No. A46020/130/2010Coord/PHE dated 5th January, 2011 issued the guidelines to Principal Secretaries incharge of UD/WS/SanitationofallStateGovernment. Ministry of Panchyati Raj vide its letter No. A44021/7/2011Estt. dated 23rd May, 2011issuedtheguidelinestoChiefSecretariesofallState. Ministry of Rural Development has also issued the guidelines (confirmed telephonically)copytobereceived.

Allthestatesshouldensureimplementationoftheseguidelineswillfocusedmonitoringand coordination with State Health Authorities under the supervision of Principal Secretaries/HealthSecretaries. 5. JapaneseEncephalitis(JE) JEVaccinationhasbeenintegratedwithUniversalImmunisationProgrammeofGOIwherein thenewcohortsareadministeredsingledoseofJEvaccinealongwithboosterdoseofDPT between 1824 months of age under Routine Immunisation. However implementation under Routine Immunisation is lacking in the states. States need to take up the issue on priority.SpecialattentionisrequiredinEasternUttarPradesh. Thefacilitiesatdistrictandsubdistricthospitalsneedstrengtheningforcasesmanagement ofencephalitiscases. Medical rehabilitation of the disabled cases following acute encephalitis syndrome (AES) needtobetakenupatmedicalcollegesanddistricthospitals,whereverpossiblebymaking linkageswithsocialwelfaredepartment.

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IntegratedDiseaseSurveillanceProgramme(IDSP)
Background IntegratedDiseaseSurveillanceProject(IDSP)waslaunchedwithWorldBankassistancein November2004todetectandrespondtoearlywarningsignalsofdiseaseoutbreaksandto initiatean effectiveresponseinatimelymanner.Theprojecthasbeen extendedfor two years up to March 2012 but the World Bank is funding Central Surveillance Unit (CSU) at NCDC&9identifiedstatesandtheremaining26states/UTsarebeingfundedfromdomestic budget. Objectives Tostrengthendiseasesurveillanceinthecountrybyestablishingadecentralizedstatebased surveillancesystemforepidemicpronediseases Todetecttheearlywarningsignalsandrespondtooutbreaksattheearliest,atalllevels ProjectComponents i. ii. Integration and decentralization of surveillance activities through establishment of surveillanceunitsatdistrict(DSU),state(SSU)andcentrallevel(CSU). Human Resource Development Training of State Surveillance Officers (SSOs), DistrictSurveillanceOfficers(DSOs),RapidResponseTeams(RRTs)andothermedical andparamedicalstaff. UseofInformationCommunicationTechnologyforcollection,collation,compilation, analysisanddisseminationofdata. Strengtheningofpublichealthlaboratories.

iii. iv.

Achievements i. SurveillanceunitshavebeenestablishedatallStateandDistrictHeadquarters(SSUs, DSUs).CentralSurveillanceUnit(CSU)isestablishedandintegratedin theNational CentreforDiseaseControl(FormerlyNationalInstituteofCommunicableDiseases), Delhi. Training of State/District Surveillance Teams (Training of Trainers) has been completedfor34States/UTsandpartiallycompletedforUttarPradesh. IT network has been established to connect all States/District HQ and premier institutes in the country for data entry, training, video conferencing and outbreak discussion.Sofar,ITequipmenthasbeenestablishedat776outof800sites.AMCof
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ii. iii.

iv.

IT equipment provided by NIC has been decentralized. Similarly, broadband connectivityhasalsobeendecentralized. A portal under IDSP has been established for data entry and analysis, to report outbreaks,andtodownloadreports,trainingmodulesandothermaterialrelatedto diseasesurveillance(www.idsp.nic.in).

v. Presently, 85% districts in the country report weekly, surveillance data through e mail and more than 67 % districts report through portal. The weekly data gives informationondiseasetrendsandseasonalityofdiseases.Wheneverthereisrising trend of illnesses in any area, it is investigated by the Rapid Response Team to diagnoseandcontroltheoutbreak.Dataanalysisandactionsarebeingundertaken byrespectiveState/DistrictSurveillanceUnits.

vi. Onanaverage,20outbreaksarereportedeveryweekbytheStatestoCSU.Atotal of553outbreakswerereportedandrespondedtobystatesin2008,799outbreaks in 2009 and 990 outbreaks in 2010. In 2011, 657 outbreaks have been reported in 2011till19June.Earlieronlyafewoutbreakswerereportedinthecountrybythe States/UTs.Thisisanimportantpublichealthachievement.Majorityofthereported outbreakswereofacutediarrhoealdiseases,foodpoisoning,measles,etc. vii. Media scanning and verification cell was established under IDSP in July 2008. It detects and shares media alerts with the concerned states/districts for verification and response. A total of 1441 media alerts were reported from July 2008 to May 2011. Majority of alerts in 2010 were related to diarrhoeal and vector borne diseases. viii. A24X7callcentrewasestablishedinFebruary2008toreceivediseasealertsacross the country on a Toll Free telephone number (1075). The information received is providedtotheStates/DistrictssurveillanceUnitsthroughemailandtelephonefor investigationandresponse.Thecallcentrewasextensivelyusedduring2009H1N1 influenzapandemicanddengueoutbreakinDelhiin2010.About2.33lakhcallshave been received from beginning till May 2011, out of which about 35000 calls were relatedtoInfluenzaAH1N1.

ix. 50identifieddistrictlaboratoriesarebeingstrengthenedinthecountryfordiagnosis of epidemic prone diseases. These labs are also being supported by a contractual microbiologisttomanagethelabandanannualgrantofRs2lakhperannumperlab

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for reagents and consumables. Till date 18 States i.e. 28 labs have completed the processofprocurement. x. In9WorldBankfundedStates,areferrallaboratorynetworkisbeingestablishedby utilizing the existing 65 functional labs in the medical colleges and various other major centres in the States and linking them with adjoining districts for providing diagnostic services for epidemic prone diseases during outbreaks. The network is functionalin7states(notinAndhraPradesh,WestBengal).Basedontheexperience gained,theplanwillbeimplementedintheremaining26States/UTs.

xi. 10 Labs have been strengthened and made functional under IDSP for Avian/H1N1 influenzasurveillance;fundsgivento2morelabstomakethemfunctional(Total12 labs).

xii. RecruitmentofcontractualmanpowerunderIDSPhasbeentotallydecentralizedin May2010sothattheStateHealthSocietiesrecruitthemattheearliest.About295 Epidemiologists, 51 Microbiologists and 22 Entomologists have joined in States/Districts till now. States have been requested to expedite filling up the remainingcontractualpositions.

WayForward Low Priority is given to public health/disease surveillance by many states. State Health Secretaries, MD (NRHM), DHS should monitor IDSP regularlyand frequently toimproveitsimplementation. DedicatedState/districtsurveillanceofficersarenotinpositioninmoststates.Either a dedicated officer should be responsible for surveillance activities, or it should be theprimarydutyofdesignatedofficer. Keyhumanresources(Epidemiologists,Entomologists,andMicrobiologists)needto be recruited to improve the programme. Recruitment of all contractual positions underIDSPhasbeenalreadydecentralized. There is a need to involve Medical Colleges in all activities of IDSP. Each Medical College may be given responsibility of 23 districts to improve disease surveillance andresponseactivity. Currentlyweeklydiseasesurveillancedataarecollectedinmoststatesfromprimary healthcareunitsandindoorwardsofsecondaryandtertiarycarefacilities.OPDdata areusuallynotcollectedfrommajorhospitals.CollectionofOPDdatafromallmajor hospitalsandmedicalcollegehospitalsisimportanttoimprovetheprogramme.

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All districts should report through portal for better data analysis. Some districts whichhavenotfilledupmasterdataintheportalneedtodoitquickly. Although increasing number of outbreaks are being reported and responded to by the states, not all states are reporting about outbreaks every week. It should be done,evenwhenthereisNilreport.Clinicalsamplesshouldbecollectedandsent tolabsduringalloutbreakstoimprovequalityofoutbreakinvestigation. 50identifieddistrictpublichealthlabsarebeingstrengthenedunderIDSP.Only28 labshavecompletedprocurementandonly14labsarefunctional.Allstatesshould completetheprocurementofequipmentandrecruitmentofmicrobiologisttomake theselabsfunctional.Somestatesarealsostrengtheningdistrictpublichealthlabs under NRHM. Once these labs also become functional, they should start reporting dataunderIDSP. Referrallabnetworkhasbecomefunctionalin7/9WorldBankfundedstates.Andhra Pradesh and West Bengal should also complete all activities to make referral lab networkfunctional.

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SectionTwo NonCommunicable Diseases

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NationalProgrammeonPrevention&ControlofCancer,Diabetes,CVD&Stroke (NPCDCS)
BurdenofNonCommunicableDiseases(NCDs)inIndia Indiaisexperiencingarapidhealthtransitionwith arisingburdenofNonCommunicable Diseases (NCDs). Overall, NCDs are emerging as the leading causes of death in India accounting for over 42% of all deaths (Registrar General of India). NCDs cause significant morbidity and mortality both in urban and rural population, with considerable loss in potentiallyproductiveyears(aged3564years)oflife. It is estimated that the overall prevalence of diabetes, hypertension, Ischemic Heart Diseases(IHD)andStrokeis62.47,159.46,37.00and1.54respectivelyper1000population ofIndia.Thereareanestimated25LakhcancercasesinIndia. CurrentStatusofProgramme Considering the rising burden of NCDs and common risk factors to major Chronic Non CommunicableDiseases,GovernmentofIndiainitiatedanintegratedNational Programme for Prevention and Control of Cancers, Diabetes, Cardiovascular Diseases and Stroke (NPCDCS). The focus of the programme is on health promotion and prevention, strengtheningofinfrastructureincludinghumanresources,earlydiagnosisandmanagement andintegrationwiththeprimaryhealthcaresystemthroughNCDcellsatdifferentlevelsfor optimaloperationalsynergies. Theprogrammeisbeingimplementedin100districtsspreadover21Statesduring201011 &201112.Thesedistrictshavebeenselectedkeepingintoaccounttheirbackwardness, inaccessibility&poorhealthindicators. ServicesofferedunderNPCDCS: (a) CardiovascularDiseases(CVD),Diabetes&Stroke: ACardiaccareunitateachofthe100districthospitals. NCD clinic at 100 district hospitals and 700 Community Health Centres (CHCs) for diagnosisandmanagementofCardiovascularDiseases(CVD),Diabetes&Stroke. Provisionforavailabilityoflifesavingdrugs,toeachdistricthospitalin100districts. OpportunisticScreeningfordiabetesandhighbloodpressuretoallpersonsabove30 yearsincludingpregnantwomenofallagegroupsat20,000SubCentres. Homebasedcareforbedriddencasesin100districts.
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Support for contractual manpower and equipments at the 100 district hospitals & 700CHCsformanagementofNCDsincludinghealthpromotionactivities. (b) Cancer: Common diagnostic services, basic surgery, chemotherapy and palliative care for cancer casesat100districthospitals. SupportforChemotherapydrugsateachdistricthospital DaycareChemotherapyfacilitiesat100districthospitals. FacilityforlaboratoryinvestigationsincludingMammographyat100districthospitals Homebasedpalliativecareforchronic,debilitatingandprogressivecancerpatientsat 100districts. Supportforcontractualmanpowerandequipmentformanagementof cancercases atthe100districthospitals. Strengtheningof65centreTertiaryCancerCentres(TCCs) Achievements OperationalGuidelinesdeveloped TrainingModulesdevelopedforHealthWorkersandMedicalOfficers. HumanResourceunderNationalNCDCellinplace HumanResourceunderStateandDistrictlevelinprocess SignedMOUReceivedfrom11States SettingupofStateandDistrictNCDcellsinprocess FundsforimplementationofNPCDCSin27districtsacross19stateswerereleasedin March 2011 for opportunistic screening, establishment of NCD clinic at CHCs and DistrictHospitals. Efforts are being taken to increase awareness for promotion of healthy lifestyle throughMassmedia. Funds for conducting training workshops were released to NIHFW and Indian NursingCounsel. PilotProjectonSchoolbasedDiabetesScreeningProgrammeinitiatedin6districts ProposalforsurveillanceofNCDriskfactorsisundersubmission
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Financialstatus201011(GoI:StateGovt.Share:80:20) Rs.inCrore Component 1. Diabetes, CVD & Stroke NorthEasternAreas 2.Cancer NorthEasternAreas ExpectationfromStateGovernments: SigningofMOUforprogramme Recruitmentofstaffundertheprogramme ImplementationofvariouscomponentsofNPCDCS Screeningofpersons,30yearsandaboveofageandpregnantwomenofallagesfor diabetesandhighbloodpressure. IdentificationofsitesforTertiaryCancerCentre(TCCs) SigningofMOUforTCCs Utilizationoffundsreleasedduringtheyear201011andsubmissionofSOE. Timelysubmissionofreports ActionpointsforGOI: Releaseof1stinstalmentto70districtsof21states OrganizationofreviewmeetingsofStatelevelofficers Annexureincludedinlastsection. B.E 90.00 F.E 35.30 Expenditure 35.29 Balance Nil

10.00 180.00 25.00

2.73 55.00 5.00

2.73 34.10 0.77

Nil 145.89 24.22

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NationalProgrammeforControlofBlindness
ExpectationsfromtheStates/UTsinthe12thPlan 1. Tofullyimplementandenhanceallearlieractivitieslikecataractoperation,schooleye screeningandeyedonationtoachievetheallocatedtargetsduringthe12thFiveYear Plan 2. Tocollectdataonprevalenceofdiseaseslike a. DiabeticRetinopathy b. GlaucomaManagement c. RetinopathyofPrematurity d. SquintandAmblyopia e. LaserTechniques f. CornealTransplantation g. VitreoretinalSurgery h. OthercausesofChildhoodblindnessetc. 3. Toreviewthecurrentstatusandtoundertakecapacitybuildingformanagementof abovementioneddiseasesasperparameterslistedbelow: CapacitybuildingineachdistricttodetectandtreatDiabeticRetinopathy TypeofHospital CapacitybuildingineachdistricttodetectandtreatGlaucoma TypeofHospital CapacitybuildingineachdistricttodetectandtreatRetinopathyofPrematurity TypeofHospital MedicalRetina Specialist Indirect Ophthalmoscopy /RedCamviewing Laserunittotreat ROP Shiotztonometry/ Applanationtono. fundusexamination Lasertreatment fieldcharting /surgicaltreatment MedicalRetina Specialist FundusFlouroscein Angiography LaserUnit

CapacitybuildingineachdistricttodetectandtreatSquintandAmblyopia SurgicalFacilityto SquintSpecialistto Refractionunit treatSquint measuretypeand + degreeofsquint Specsdispensing CapacitybuildingwillbeattheInstitutions/Hospitalsmentionedbelow: 1. RegionalInstitutesofOphthalmology TypeofHospital
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MedicalCollege DistrictHospital SubdistrictHospital NGOI NGOII NGOIII PrivateEyeHospital AnyOtherClinic Utilization of NGOs with mobile services for above diseases at district hospitals wherevernotavailable. 5. Implementationandmonitoringoftheprogrammeasperformatgivenbelow NPCBActivitiesreviewatDistrictLevel:SurgicalPerformanceData S/N HOSPITALS Year Catops KP Specs D.R. GS VR PaedS. Laser SES 1 RIO 2 MedicalCollege 3 4 5 6 7 8 9 10 11 12 Catops KP SpecsSES Paed.S.

2. 3. 4. 5. 6. 7. 8. 9. 4.

DistrictHospital SubDistrictHospital NGOHospital1 NGOHospital2 NGOHospital3 PrivateEyeHospital1 PrivateEyeHospital2 PrivateEyeHospital3 PrivatePractitioners ReligiousSocial OrganizationHospital

CataractOperation Keratoplasty SpectaclesprovidedunderSchoolEye Screening PaediatricSurgery

D.R. GS VR

DiabeticRetinopathy GlaucomaSurgery ViteroRetinalSurgery

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NationalProgrammeforPreventionandControlofdeafness
Hearinglossisthemostcommonsensorydeficitinhumanstoday.AsperWHOestimatesin India,thereareapproximately63millionpeople,whoaresufferingfromSignificantAuditory Impairment;thisplacestheestimatedprevalenceat6.3%inIndianpopulation.AsperNSSO survey, currently there are 291 persons per one lakh population who are suffering from severe to profound hearing loss (NSSO, 2001). Of these, a large percentage is children between the ages of 0 to 14 years. With such a large number of hearing impaired young Indians, it amounts to a severe loss of productivity, both physical and economic. An even larger percentage of our population suffers from milder degrees of hearing loss and unilateral(onesided)hearingloss. 1.OBJECTIVESOFTHEPROGRAMME 1. Topreventtheavoidablehearinglossonaccountofdiseaseorinjury. 2. Earlyidentification,diagnosisandtreatmentofearproblemsresponsibleforhearing lossanddeafness. 3. Tomedicallyrehabilitatepersonsofallagegroups,sufferingwithdeafness. 4. Tostrengthentheexistingintersectorallinkagesforcontinuityoftherehabilitation programme,forpersonswithdeafness. 5. To develop institutional capacity for ear care services by providing support for equipmentandmaterialandtrainingpersonnel. 2 ComponentsoftheProgramme: A. ManpowerTraining&Development B. CapacityBuilding C. ServiceProvisionIncludingRehabilitation D. AwarenessGenerationThroughIECActivities E. MonitoringAndEvaluation 3 ActivitywiseprogressofNPPCD I. Training. a. Pilotphasecommenced50%trainingsofthepresettargets(ieinthe25districts) which was undertook by RCI. In the expansion phase the responsibility of training was transferred to the states, for which funds were provided to the state health societies.

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b. ThestatesofUttarakhand,KarnatakaandGujaratinitiatedthetraininguptolevel4 (i.e. Medical Officers). Beyond level 4 only the state of Assam, Uttarakhand and AndhraPradeshorganizedsometraininginthedistricts. II. Screeningcamps a. States namely Tamil Nadu, Karnataka, Chandigarh, Sikkim, Uttarakhand and Andhra Pradesh have conducted screening camps under the Programme. Screeningcampshavenotbeenorganisedbyotherstates. III. ProcurementofEquipment a. States namely Sikkim, Uttarakhand, Karnataka, Tamilnadu, Assam have procured the equipments specified within the Programme but other states have not procurement due to problems in procedural formalities at state level. IV. Recruitmentonmanpower a. UndertheProgrammeAudiometricAssistant(AA)andInstructorforSpeech & Hearing Impaired (IHS) are to be recruited on contractual basis in the implementingdistricts.Howeveronly40AAsand4IHShavebeenrecruited sofar.Recruitmentislowduetononavailabilityoflocalcandidatesandless honorarium. V. HearingAids a. Under the programme 2459 hearing aids were distributed in the 22 pilot districtsoftheprogramme.ThestateofUttarPradeshandManipurcouldnot distributetheHearingaidsundertheprogramme. VI. Awarenesscampaign a. IECmaterialinformofposters/pamphletshasbeendistributedtothestates for further dissemination. Mass Media campaigns have been carried out in differentregionallanguages. b. National Institute of Health & Family Welfare, New Delhi (NIHFW) conducted the Impact assessment of the IEC campaign done for NPPCD in 4 states (Tamilnadu,Gujarat,AssamandUttarakhand)whereinitwasobservedthat awarenessgenerationwasnotsatisfactoryduetolowimpactofTVandradio media. Significant factors in this are the short duration of awareness campaignandlowfrequencyoftelecastingofthespotsontheTVandRadio.
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4. NPPCDOutlay&Expenditureduring11thFYP Financial Year 200708 200809 200910 201011 201112 Total Budget Estimate 542.00 1000.00 1000.00 1150.00 2000.00 5692.00 Revised Estimate 568.00 1000.00 1213.00 1151.00 3932.00 Rs.inlakhs Actual Expenditure 524.50 1000.00 773.00 1044.94 3343.36

AllocationofRs.20.00croreshavebeenmadefor201112.Rs0.80lakhofexpenditurehas beenincurredtilldate.Fundswouldbereleasedshortlybasedontheproposalssubmitted bythestates/UTs.(Detailsenclosed) 5.Expectationsfromstatein12thFiveYearplanwithrespecttoNationalProgrammefor PreventionandControlofDeafness(NPPCD) EnsuringavailabilityofENTsurgeonateachdistricthospitalwhowouldalsobedistrict nodalofficerforNPPCD. Putting contractual manpower viz. Audiometric Assistant and Instructor for Hearing Impairedinplaceatdistrictlevel. Strengtheningmonitoring&supervisionofprogrammeatstate&districtlevel. Developinglinkageswithmedicalcollegesforstrengtheningreferralservices. Greater awareness generation regarding prevention and management of hearing impairment. Greater involvement of AWW, ASHA and MPWs in the implementation of the programmeatcommunitylevel. Involvement of state training mechanisms in organizing the trainings under the programme. OrganizingscreeningcampsregularlythroughactiveinvolvementoflocalNGOs.

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NationalTobaccoControlProgramme
ExpenditureunderNTCP FinancialYear BudgetEstimate 200708 Rs.40.00Cr. 200809 200910 201011 Rs.30.00Cr. Rs.30.00Cr. Rs.45.00Cr. RevisedEstimate Rs.29.00Cr. Rs.39.00Cr. Rs.17.00Cr. Rs,30.00Cr Expenditure Rs.13.98Cr. Rs.33.86Cr. Rs.16.67Cr. Rs.29.32Cr. Rs.93.83cr.

Total Rs.145.00Cr. Rs.115.00 AnamountofRs.50Cr.hasbeenearmarkedfortheyear201112. Achievementsoftheprogramme Pilot phase of the NTCP launched in 200708 in 9 states covering 18 districts. The programme upscaled to cover 12 new states and 24 new districts. Currently NTCP is underimplementationin42districtscovering21states. ThetotalfinancialoutlayforNTCPapprovedintheXIPlanwasRs.182crore. Trainingmodulesdevelopedfordoctors,teachersandhealthworkers/ASHAontobacco control. Guidelines for Tobacco Free Educational Institutions developed and adopted by the CentralBoardofSecondaryEducation(CBSE).TheCBSEhascirculatedtheseguidelines toallCBSEaffiliatedschoolstoimplementthesame. GATSIndia2010 wascarriedoutinIndiaformonitoringadulttobaccouse(smoking& smokeless)andtrackingkeytobaccocontrolindicators. Tollfreehelplinetoreportviolations1800110456established. Nationalguidelinesontobaccodependencetreatmentdeveloped.

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VariousantitobaccoIECmaterialshasbeendevelopedanddisseminatedwidelythrough radio, TV for increasing public awareness on the risks of tobacco. A sustained media campaignhasbeeninitiatedafterdedicatedfundswereallocatedunderNTCP. Pilotprojectonalternativecroppingsystemtotobaccogrowinginitiatedwithsupportof CentralTobaccoResearchInstitute(CTRI)infiveagroecologicalzonesofthecountry. Interministerial Task Force set up at national level with representation from Stakeholders Ministries and representatives from larger States, Civil Society Organizations.Twomeetingshavebeenorganisedtilldate. SteeringCommitteeformedundertheChairmanshipofSecretary(Health)tolookinto specific instances of violation of Section 5 at national level. Similar Monitoring Committees formed at State/District level. [Prohibition of direct and indirect advertisementofcigaretteandothertobaccoproducts(section5)] Anetworkof18TobaccoCessationCentershasbeensetupacrossthecountry.Therole of TCC has now been expanded and now they have become ResourceCentre Tobacco Control (RCTC) and prove technical support for creation of TCC at subnational level. Thesecentresarealsousingcommunitybasedapproachestoenhanceawarenessabout theilleffectsoftobaccouseandprovidetobaccocessationfacilities. Processinitiatedforsettinguptobaccoproducttestinglabsfortestingofcontentsand emissions. Newstrongerpictorialhealthwarningshavebeennotifiedforimplementationfrom1st December,2011. IndiaisthekeyfacilitatorfordevelopmentofguidelinesundertheArticles1718ofthe WHOFCTC.

AchievementswithWHOBIPartnership Manpowerresourcesprovidedtoassistfocalpointsatnationallevel(NationalTobacco Control Cell) and at state level through the state level consultant at 12 State Tobacco ControlCells:(Delhi,TamilNadu,Assam,Gujarat,MadhyaPradeshWestBengal,Orissa, Bihar, Maharashtra, Tripura, Andhra Pradesh, Uttar Pradesh), Support for additional statesRajasthanandKarnataka. NationalandRegionalleveladvocacyworkshopsorganizedatDelhi,Chandigarh,Bhopal, Tamil Nadu, West Bengal, and Goa on tobacco control laws and related issues. These workshops sensitized over 2000 law enforcers / stakeholders from different departments (Agriculture, Customs, Labor, Education, Forest, Tribal, Health, Transport,
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Railways,Police,Judiciaryetc.)ontheneedandtheirroleinimplementationoftobacco controllawsandothermeasures. In 2011, state level advocacy workshops have been organized in the states of Jammu and Kashmir, Punjab, Rajasthan and Tripura More state level advocacy workshops plannedin2011inMaharashtra,Orissa,AndhraPradesh,UttarPradesh,Jharkhandand Haryana. 11 State level Advocacy Workshops at Kerala, Assam, Karnataka, Meghalaya, Sikkim, ArunachalPradesh,Nagaland,Bihar,UttarPradeshandHimachalPradeshorganizedto sensitizekeystatelevelstakeholdersontobaccocontrollawsandrelatedissues. National consultation on smokeless tobacco organized in April, 2011 to discuss preventionstrategiesandbuildcoalitiontocombattheusageofchewingtobaccoandits impactonhealth

ExpectationfromtheStateGovernment RecruitmentofStaff:StateslikeMadhyaPradesh,Delhi,andWestBengalwheretheNTCP waslaunchedin200708areyettorecruitstaffatthedistrictcells. ImplementationofthevariouscomponentsofNTCPUtilisationofthebudget:The componentsoftheprogrammeatdistrictlevelincludingcessationserviceshavenotbeen implementedinmostofthestates.Theutilisationofthebudgethasbeenunsatisfactoryin stateswhereeventhestaffhasbeenrecruited. COTPAmechanism:InordertoimplementthevariousprovisionsunderCOTPAastatelevel enforcementmechanismneedstobeputinplace,whichincludesopeningseparateheadof account, printing of challan books and constituting a raiding mechanism etc. Since COTPA implementationlieintheresponsibilityofhealthministryitshouldprintthechallanetc.All thestatesneedtonotifystate/distlevelmonitoringcommitteeforsection5 Trainingandawareness:sincetobaccoisariskfactorformanyNCDs,thespotsdeveloped byMoHFWshouldbecomeanintegralcomponentoftheIECcampaignunderNRHM. TimelysubmissionofactivityreportsandUCsisamatterofgreatconcernduetowhichthe fundshavenotbeenreleasedisasustainedmanner.
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NationalMentalHealthProgramme
At the time of independence, the existing mental health infrastructure and specialist manpowerwasverymeagre.Therewereonly10,000psychiatricbedsinIndiain1947fora population of over 300 million, with that of UK, with one tenth the population of India having over 1,50,000 psychiatric beds. The first two decades of Independent India were devoted to doubling the mental hospital beds followed by setting up of general hospital psychiatricbeds.Inthe1980stheGovernmentofIndiafeltthenecessityofevolvingaplan ofactionatmentalhealth.Subsequently,NationalMentalHealthProgrammewaslaunched inthecountryin1982withthefollowingobjectives: 1. Toensuretheavailability andaccessibilityof minimummentalhealthcare forallin the foreseeable future, particularly to the most vulnerable and underprivileged sectionsofthepopulation; 2. Toencouragetheapplicationofmentalhealthknowledgeingeneralhealthcareand insocialdevelopment;and 3. Topromotecommunityparticipationinthementalhealthservicedevelopmentand tostimulateeffortstowardsselfhelpinthecommunity. In11th FYP NMHP has four approvedschemesmentioned belowtoprovide mental health treatmentavailable atdistrictlevel,strengthening the infrastructureofpsychiatryatstate levelandproductionofmentalhealthprofessionals. 1. ManpowerDevelopmentSchemes In order to improve the training infrastructure in mental health, Government of India has approvedtheManpowerDevelopmentComponentsofNMHPfor11thFiveYearPlan.Ithas twoschemesgivenbelow. 1.1CentresofExcellence Under Manpower Development Component at least 11 Centres of Excellence in mental health were to be established in the 11th plan period by upgrading existing mental health institutions/medical colleges. A grant of upto 30 crore is available under the scheme. The supportincludescapitalwork(academicblock,library,hostel,lab,supportivedepartments, lecture theatres etc.), equipments and furnishing, support for faculty induction and retentionfortheplanperiod. AchievementandExpenditure:10CentresofExcellencehavebeenestablishedandoneis inprocess.AtotalofRs.87,64,00,000/hasbeenreleasedunderthescheme.AsumofRs.
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14,07,79,608/ has been spent till 8th April, 2011. The status & expenditure report is enclosedatannexure1. 1.2SettingUp/StrengtheningPGTrainingDepartmentsofMentalHealthSpecialities To provide an impetus for development of Manpower in Mental Health other training centers (Government Medical Colleges/ Government General Hospitals/ State run Mental Health Institutes) would also be supported for starting PG courses in Mental Health or increasingtheintakecapacityforPGtraininginMentalHealth.Supportwouldbeprovided forsettingup/strengthening30unitsofPsychiatry,30departmentsofClinicalPsychology, 30departmentsofPsychiatrySocialWorkand30departmentsofPsychiatricNursingwith thesupportofuptoRs.51lacstoRs.1croreperPGdepartment. Achievement and Expenditure: A total of 23 departments (7 Psychiatry, 5 Clinical Psychology, 5 Psychiatric Social Work, 6 Psychiatric Nursing) of different specialties of mental health have been supported and a total of Rs. 8,46,96,000/ has been released to under the scheme. Rs. 1,44,85,065/ has been spent (till 8th April 2011). The status & expenditurereportisenclosedatannexure2. 10 more departments (4 Clinical Psychology, 2 Psychiatric Social Work and 4 Psychiatric Nursing)havebeenrecommendedbytheStandingCommitteeonNMHP. 2. DistrictMentalHealthProgramme(DMHP) TheDMHPformsthementalhealthinterventionatdistrictlevel.StartingwiththeDMHPof Bellary in 1990s currently 123 districts are covered under this program. The central objectiveoftheprogrammeisearlydetectionandtreatmentofmentallyillpersonswithin thecommunitybyprovidingbasicsustainablementalhealthservicestothecommunityand toreducethestigmaattachedtowardsthementalillness. Achievement and Expenditure: DMHP is being run in 123 districts of the country. Out of 123, status of 116 is available. 73 districts of DMHP are having the services of a Psychiatrist/trainedmedicalofficer.OPDservicesarebeingprovidedat70districtsofDMHP atdistrictlevelatoutofthese70districts24districtsareconductingOPDsatPrimaryHealth Carelevel.InPatientDepartmentservicesareavailableat53districtswith10bedscapacity. ThoughthereisnobudgetprovisionofMentalHealthHelplineandMentalHealthServices in Schools/Colleges under DMHP, still 10 (8.62%) districts have the need based mental healthhelplineservicesand43outof116districtsarerunningneed/situationbasedmental healthservicesinschool/colleges.Reportedly66districtshavetrainedmedicalofficers,61 have trained paramedical staff and 48 districts to the members of Panchayati Raj Institutions,NGOS,schoolteachersandfamilymembersetc.outof116districts67DMHP districts are conducting IEC activities to generate awareness and reduce stigma related to mentalillness.
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A total of Rs. 53, 44,80,136/ has been released to the DMHP till date. The reported expenditureofDMHPsisRs.15,61,45,769/ 3. ModernizationOfStateRunMentalHospitals To modernize the existing staterun mental hospitals, a onetime grant with a ceiling of Rs.3.00 crores per hospital on the basis of benchmark of requirement and level of preparedness is available. The grant would cover activities such as construction/repair of existingbuildings,purchaseofequipment,provisionofinfrastructuresuchaswatertanks andtoiletfacilities,purchaseofcotsandequipments. AtotalofRs.68,38,69,000/hasbeenreleasedtomodernize29staterunmentalhospitals acrossthecountry. 4. UpgradationofPsychiatricWingsofMedicalColleges/GeneralHospitals AonetimegrantofRs.50lakhsforupgradationofPsychiatryDepartmentsofGovernment Medical Colleges which have not been funded earlier were to be supported. The grant covers;1.Constructionofnewward,2.Repairofexistingward,3.Procurementofitemslike cotsandtablesand4. EquipmentforpsychiatricusesuchasmodifiedECTs.AtotalofRs. 34,77,40,595/ has been released to 88 Psychiatric wings of medical colleges across the country. Latest expenditure of 201112 is attached for information at annexure 3. Expectations fromstategovernmentduringthe12thFYPareasgivenbelow. 1 Tofacilitateintheresourcemappingofmentalhealthservicesinthestate. 2 To facilitate the process of state commitment to be given under NMHP for various scheme. 3 TimelysubmissionofUtilizationCertificatesandStatementofExpenditure. 4 Facilitate the process of posts creation as required by the institutes under manpower developmentschemes. 5 DesignateaofficialasthestatenodalofficerexclusivelyfortheNMHP>

Pleaseseeannexureinthelastsection

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SectionFour Drugs&Regulatory Issues

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DrugsandRegulatoryIssues
1. The last two decades have witnessed an exponential growth in the pharmaceutical industryinthecountry.Thetotalvalueofproductionofdrugsandpharmaceuticalsinthe countryisestimatedtobeoverrupeesonelakhcrores.Theindustryhasconsistentlybeen recordingagrowthrateof1415%.Indiaisthethirdlargestproducerofpharmaceuticalsin the world in terms of volume and 12th largest in terms of value. Indian pharmaceutical productsareexportedtoalmostallthecountriesoftheworld.ThetotalexportsfromIndia for the year 200910 were rupees forty two thousand crores (approx). Indian pharmaceutical products, worldwide are known to be affordable, safe and efficacious. Indiangenericdrugshavehelpedinbringingdownthecostoftreatmentofvariousdiseases worldwidewhichincludesHIV/AIDS. 2. With the growth of the industry it is important that regulatory machinery should ensurethatthedrugsavailableinthecountryarenotonlyofgoodqualitybutalsosafeand efficacious.Regulationofthepharmasectornecessitatestechnicalcapabilitiesandisalso dependsupontheequipmentsusedfortesting. 3. The Central Government has taken several steps to strengthen the Central Drugs Standards Controls Organisation (CDSCO) in terms of man power and equipments. The CDSCO has been strengthened by induction of additional man power from the level of AssistantDrugControllertoDrugInspectors.Additionalmanpowerhasalsobeenprovided for handling technical and administrative issues. Several steps have been taken to strengthen the Central Drug Testing Laboratories (CDTLs) by induction of man power, capacity building of existing man power and sophisticated equipments for testing of drug samples.Newzonesandsubzoneshavebeencreatedforbetteradministration. 4. Dr.R.A.MashelkarCommitteesetupintheyear2003,recommendedamendments in the Drugs & Cosmetics Act to address the problem of spurious and substandard drugs andalsorecommendedcreationofnewstructureforbetterdrugregulationinthecountry. The Committee recommended that there is a need for one Drug Inspector for every 50 manufacturing units and one for every 200 sale units. Going by the rough estimates of suchunits,therewouldberequirementof3200DrugInspectorsinthecountrywhereasthe availablenumberisonly900.Thereisthus,astrongneedtorecruitmoreDrugInspectorsin thecountry. 5. Atpresent,therearesixDrugTestingLaboratoriesinthecountry.Itisproposedto addanother8testinglabsinthecoming12thFiveYearPlan.Itisalsoproposedtocreate12 minilabsatthePortOffices(AirandSeaports). 6. Foreffectiveregulationofthedrugsandpharmaceuticalproducts,itisimportantto have adequate testing capabilities. For the last few years, the number samples tested
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across the country, varies between 3800040000 samples. There is need to increase the number of samples tested substantially. States would therefore be required not only to recruitmanpowerbutalsotosetupnewdrugtestinglabsandtoupgradetheexistingones. It is also important that once the drug samples fail quality and safety standards, prosecutionsarelaunchedandculpritsarebookedquickly.ThereisneedtosetupSpecial CourtstotryprosecutioncasesundertheDrugs&CosmeticsAct1940.Around220States havealreadydesignatedSpecialCourtsforsuchtrailswhilethenothersareintheprocessof notifyingsuchCourts. 7. MOHFWhasalsotakenseveralstepstoincreasetheaccessandaffordabilityofdrugs in the country. As per WHO estimates, India has the highest outofpocket expenditure. Large part of outofpocket expenditure is on the purchase of drugs. The rise in the incidences of outofpocket expenditure on drugs is one of the key challenges to provide universalhealthcoverageandmakeslargesectionofthepoor,mostvulnerabletohighcost of drugs. Several steps need to be taken to address this issue. The Department Of Pharmaceutical under the Ministry of Chemicals & Fertilisers, has initiated Jan Aushidhi Stores(JAS)Schemeforsellinggenericdrugstothecommonman.Atpresentthereare102 JASacrossthecountry.ThereisanurgentneedtoscaleupJASandhaveatleastonesuch store in each district preferably located in the District hospital. It is also important that doctors in the public health system prescribe generic medicines which are as safe and effectiveasitsbrandedcounterpartandalsosubstantiallycheaper. 8. There is also great merit in making bulk purchase of drugs through a specialised agency.Thisisnotonlyensuresbetterqualitybutalsoreducestheprices.Statesmayliketo examinetheTamilNaduMedicalServicesCorporationmodelsetupbytheGovt.ofTamil Naduforthepurchaseofdrugsforpublichealthprogrammes. 9. While promoting the generic drugs, it is important that a rational Fixed Dose Combination(FDC)areweededoutfromthemarket.Thisnotonlyenhancesthepriceof the drug but also leads to several other health consequences including drug resistance. WhilegrantinglicensesformanufactureofFDCs,StateDrugRegulatorsmustbeverycareful regardingefficacyofsuchdrugs. 10. The states were requested to prepare action plans for opening of Jan Aushidhi Stores andpromotionofgenericdrugstotheMinistry.ThiswastobesentbyMay2011.Tilldate, no state has submitted its action plan. States may expeditiously prepare their plans and submitthesametotheMinistry

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SectionFive ThrustAreasfor th 12 FiveYearPlan

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ThrustAreasfor12thFiveYearPlan
TheNationalRuralHealthMission(NRHM)waslaunchedbythePrimeMinisteron12thApril 2005withspecialfocuson18states,whichhaveweakpublichealthindicatorsand/orweak infrastructure.TheNRHMseekstoprovideeffective,accessibleandaffordablehealthcareto rural population. The High Focus 18 States are Arunachal Pradesh, Assam, Bihar, Chhattisgarh,Himachal Pradesh, Jharkhand, Jammu & Kashmir, Manipur, Mizoram, Meghalaya,MadhyaPradesh,Nagaland,Orissa,Rajasthan,Sikkim,Tripura,Uttaranchaland Uttar Pradesh. The Mission is an articulation of the commitment of the Government to raisepublicspendingonHealthfrom0.9%ofGDPto23%ofGDP. GoalsofNRHM: Reduction in Infant Mortality Rate (IMR) to below 100/100,000 live births and MaternalMortalityRatio(MMR)tobelow30/1000livebirths. Universal access to public health services such as Womens health, child health, water,sanitation&hygiene,immunization,andNutrition. Preventionandcontrolofcommunicableandnoncommunicablediseases,including locallyendemicdiseases Accesstointegratedcomprehensiveprimaryhealthcare Populationstabilization,genderanddemographicbalancebybringdownTFRto2.1 by2012 RevitalizelocalhealthtraditionsandmainstreamAYUSH Promotionofhealthylifestyles

Achievementssofar: IMRreducedfrom58in2006to50in2009 TFRreducedfrom2.9to2.6 1.48Lakhshumanresourcesincluding7432doctors,7063specialists,11575AYUSH doctors,60268ANMs,33667staffnurses,21740paramedicalstaffand4616AYUSH paramedicshavebeenaddedtostrengthenthehealthcaredeliverysystem. 8.49 lakh ASHAs and link workers have been selected out of which 8.06 lakh has beenengaged&6.90lakhhavebeenprovidedwithdrugkit. 17388newconstructionsand22139renovationprojectsforvarioushealthfacilities weresanctioned. 9107 PHCs have been functional on 24x7 basis & 2891 health facilities were made operationalasfirstreferralunit(FRU). 33149RogiKalyanSamiticonstituted 4.83lakhVHSCsConstituted
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12thFiveYearPlananopportunitytoconsolidateGains AlthoughalotofprogresshasbeenmadeunderNRHMinthelastsixyears,thegoalsset are yet to be achieved. The 12th Five Year Plan provides opportunity to work further for achievement of NRHM and MDG goals and improve the service quality further. Working group on NRHM for 12th FYP has been Constituted under the chairmanship of Secretary HFW.Firstmeetingofworkinggroupwasheldon10thJune2011whereintheprogressof NRHMandstrategiesfornextFYPwerediscussedindetail.Representativesofsomestates arepartoftheworkinggroupwhilesomeotherStateshavealsogivensuggestionsonthe TORforworkinggroupandthrustareasfor12thPlan.ThedraftReportofworkinggroupto besubmittedby31stJuly2011andfinalreportby31stAugust,2011. Challengesforthe12thPlanPeriod: Achievingthegoalsof IMR MMR TFR Increasinghealthexpenditureas%ofGDP Shortageofhumanresources RationaldeploymentofavailableHR Infrastructuregaps Qualityofcare Assuredreferrals Communityownershipandaccountability Intersectoralconvergence NGOandprivatepartnership Outofpocketexpense Monitoringandevaluationsystems ProposedThrustAreasfor12thPlanUnder: A.HealthSystems: 1.HumanResource ClearlydefinedHumanResourcesPolicy. FacilitatingavailabilityofHRaspernormsinheathfacilitiesespeciallyindifficultand hardtoreachareas. AddressingtheissuesofshortfallandskillupgradationofHumanResources In place of 2 ANMs in all sub centers, only 10 % SCs (conducting deliveries) to be provided2ndANMoncontractualbasis. Onemalemultipurposeworkerineachsubcentre
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2.HealthInfrastructure Creationofnewinfrastructuretoensure100%publichealthfacilitiesingovernment buildings. Renovationofexistingbuildings. PrioritytohealthfacilitiesinHighFocusDistricts Revitalizationandrepositioningofsubcentres 3.AdditionofPublicHealthFacilities: IncreasingthenumberofsubcentresandPHCsasper2011populationcensus 4.Others: Up scaling of the community monitoring initiative piloted in 9 States to the entire countrytoensuregreatercommunityparticipationandsocialaccountability. OneMobileMedicalUnitperdistrictisproposedtobeprovidedespeciallyinunder servedruralareas Strategies to meet the Human Resource gap & Infrastructure requirement in the country: A male multipurpose worker will be provided in each subcentre to handle communicableandnoncommunicablediseases ThesalariesofANM/LHVwillcontinuetobebornebytheGoIthroughtheTreasury Route.SalaryofMPWswillalsoflowthroughthesameroute. IPHS2010aretakenasthestandardstodetermineHRrequirementatalllevels Gaps in infrastructure are analyzed taking into consideration the population accordingtoCensus2011 PopulationNormsremainunchanged ForSCstheincreaseishigherinviewoftheexpansionofstaffatSClevel(including BRHC). FacilityAssessmentandSupportiveSupervision B.ReproductiveandChildHealth: 1.ExpandingServiceGuaranteesinPublicHealthFacilities Continuumoffreecareduringantenatal,intranatalandpostnatalperiodincluding management of complications, for every pregnant woman and free delivery includingCsection. Ensuring for every pregnant woman free supplementation, drugs including consumables,freediagnostics,freedietduringhospitalstay,freebloodandfree referraltransport(toandfro)withnooutofpocketexpenses.
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2.MakingMaternalandChildhealthcaremorecomprehensive NationalFrameworkfortheprevention&controlofmoderateandsevereanaemia amongchildren,adolescents,pregnantandlactatingmothers Focus on prevention & control of diseases in children , e.g., Thalessemia, Haemophilia,Rheumaticheartdisease&congenitalHeartdiseasesandsyphlis ScalingupofHIVTesting&CounsellingduringAnteNatalCareinthecountryupto 24X7PHClevelinconvergencewithNACP4 Prevention&controlofMalariainPregnantWomeninidentifiedendemicareas Strengtheningandscalingupofschoolhealthprogram Developing a robust mechanism of facility based counseling for children, adolescentsandwomen 3.Thrustonnewborncare Provision of services for sick newborn through establishment of SNCUs in every districtofthecountry Establishingnewborncarecornersateverydeliverypoint ImprovinghomebasedpostnatalandnewbornthroughASHAincentives Development of Joint field operational plans in convergence with ICDS for result oriented management of malnutrition including establishment of NRCs for managementofSevereacutemalnutrition StrengtheningofRCHprogrammonitoringunitsbothatstateanddistrictlevel 4.Otherthrustareas StrengtheningthequalityoftrainingsofANMs/Nurses/MedicalOfficerswithspecial focusonenhancementofskillstoprovidequalitymaternal,newbornandchildcare Dedicated100beddedMaternalandChildWingineachDistricthospitaltoprovide quality antenatal, intranatal, postnatal and child care to cope with increasing case loadsofpregnantwomen,newbornsandchildren,andwithafocusonpostpartum familyplanningservices Birth Waiting Homes in close proximity to road heads accessible to referral transport,inremoteandtribalareaswithpoorroadconnectivity UpscalingtheimplementationandmonitoringofMaternalDeathReviewandroll outofInfantDeathReview Scalingupofsafeabortionservicesathealthfacilitiesinpublicandprivatesector. Strengthening national framework on adolescent health, currently a weak pillar of RCH Addressingthechallengeofskewedsexratio Expansion&Strengtheningofcoldchainsystemthroughidentificationofmorecold chainpointsnearthecommunity

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ModernisingexistingAlternatevaccinedeliverymechanismthroughbrandedmobile immunizationservicesforoutreachwork Expanding/Maximizingtheuseofavailablevaccinesforvariouspreventablediseases throughevidencebasedapproach

C.FamilyPlanning: ThrustAreas Addressing the unmet need for contraception through introduction of newer contraceptives CommunitybaseddistributionofcontraceptivesthroughASHAs Strengthening family planning service delivery, especially post partum services in highcaseloadfacilities Enlisting private/NGO facilities to improve the provider base for family planning services Vigorous advocacy of family planning at all levels especially at the highest political level ProposedStrategies Strengthening HR structures (for programme management) from national to the districtlevel MarketingofcontraceptivesuptothedoorstepthroughASHA Improvingcompensationscheme(bothforprovidersandacceptors) RolloutofMultiloadIUD(375)asshorttermspacingmethod PerformanceLinkedPaymentPlantoASHAsforimprovingacceptanceofIUDs Ensuringvigorousadvocacy Enlistingmorenumberofprivateproviders/NGOsforprovisionofservices. MarketingofcontraceptivesuptothedoorstepthroughASHA Suppliesofcontraceptivesgenerallydonotreachontimetoactualusersandunmet needforspacingisveryhigh Generallypeopledonotgotogovernmentfacilitytogetcontraceptivesbecauseof lackofprivacy&confidentiality Contraceptivesaredistributedfreeofcostandhencenotmuchvalueisattachedto it ASHAs could deliver contraceptives at door steps and allowed to charge a nominalamountforcontraceptives(Re1/forapackof3condomsandOCPs andRe2/forECPs). SchemeisexpectedtobelaunchedonJuly11,2011 Ensuringvigorousadvocacy Politicallevel:
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EngagingwithParliamentariansandMLAs Communitylevel: IncreasingPRIandVHSCInvolvement Enhancedunderstandingofpopulationrelatedissues Roleofmaleinfamilyplanningdecisions Involvingyouthforpopulationstabilization: Integrating life skills based learning about concerns such as marriage, reproductive health and contraception, into skill based schemes /programmes ReachingouttoyouthnetworkslikeNSS,NYKs,NCC Focusingonnetworksthatconnectwithoutofschoolyouths Quarterlyreviewofdistrictcollectorstosensitizethem. Discussion on population stabilization and family planning needs During the assemblysessions Ensuring involvement of MPS and MLAs during the World Population Day celebration Availableadvocacytoolkitstobedistributedagaintodistricts

IncentivesproposedforPopulationStabilization StatesachievingTFRof2.1orbelowwillbeprovidedincentivefundtoStateHealth Mission/Society. Itwillbeuntiedfundtoundertakehealthrelatedactivities. Rs5(Rs2000cr) AdolescentHealth: PromotionofMenstrualHygieneAmongAdolescentGirlsinRuralIndia. TheplanistoScaleuptoall643DistrictsduringtheXIIPlantoreachouttoadolescentgirls (1019years)inruralIndiawiththeNRHMbrandofsanitarynapkinsFreedays.However, initiallytheplanwilltakeoffin152districts. CentralsupplyofFreedayssanitarynapkinswillbeprovidedto543districtsandrest100 districtstobesuppliedbywomenSelfHelpGroups. D.DiseaseControlPrograms: Malaria: a. Thrustareas IntensificationofMalariaPreventionandControl. Currentlythereportedcasesapprox.1.5millionannually(52%Pf)whichistobringdown morbidity&mortalityby50%in2016. b. Strategies
91

UpscalinguseofRapidDiagnosticTests(RDTs). Qualitymicroscopyinhealthfacilitiesofrural&urbanareas UpscalingofArtimisininbasedCombinationTherapy(ACT)forPfandChloroquine& PrimaquineforPvmalaria Upscaling&replenishmentofLongLastingInsecticidalNets(LLINs) 100%supportforsprayofinsecticidesandlarvicides Additionaltechnicalandmanagerialmanpower. KalaAzar a. Thrustareas AchieveEliminationofKalaazarby2015 Kalaazarcases28,939in2010with45%reductioninMortalityin2010from2006 320blocksoutof514achievedelimination(lessthan1caseper10,000populationat blocklevel b. Strategies Strengthencasesearchforhotspots UpscalingofRDT&Oraldrugforearlydetectionandcompletetreatment MechanismforDirectlyObservedTreatment Training&IEC/BCC Monitoring&Supervision Qualitysprayandcoverage>80%coverage Filaria a. ThrustAreas: AchieveEliminationofFilariaby2015 Microfilariaprevalencereducedto<1%in150outof250Districts Eliminationtobeachievedinall250districtsby2015 b. Strategies AdministrationofDEC&Albendazoletopopulationatrisk HonorariumforDrugdistributiontoASHAs&Supervisors SpecificTraining IntensificationofIEC/BCCforDrugCompliance ManagementofLymphoedema/Elephantasiscases UpscalingHydroceleOperations EliminationverificationthroughImmunochromatographictest(ICT) Dengue&chikungunya a. ThrustAreas Denguecases28,292in2010against12,317in2006. CFRreducedto0.4%against1.39%in2006
92

b.

Chikungunyacasesfrom13.90lakhsin2006to0.48lakhsin2010 Strategies Strengthen&upscaleDiagnosticservices Strengthen&upscaleCasemanagementtofurtherreducecasefatalityrate Strengthen&upscaleentomologicalsurveillanceforsourcereduction StrengthenHumanResourceDevelopment,Intersectoralconvergence&Monitoring

JapaneseEncephalitis a. Thrustareas StrengthenbyPreventionandControlMeasures. JE/AEScases5149in2010ascomparedto6727in2005&Mortalityreduced by59%.(CFRin201013%) b. Strategies Strengtheningofdiseaseandvectorsurveillance Enhancingcapacitybuilding Thrustoncasemanagementatdistrictandsubdistricthospitals IntensificationofBCC/IECatfieldlevel MedicalRehabilitationofdisabledcasesfollowingAES/JE CoveringnewcohortsunderRoutineImmunizationwith>80%coverage NVBDCPEntomologicalSurveillance&HRD Strengthen entomological surveillance of vectors and their susceptibility to various insecticides UrbanVBDControlProgrammetoberevamped Entomologicalunitsacrosscountrytobestrengthened Strengthen Human Resources Development and Monitoring & Evaluation for preventionandcontrolofvectorbornediseases Human Resources at National, State, District & subdistrict level to be ensuredwithfullsupportviz.,salary,travel,training,etc OnetrainedMPW(male)ateverysubcentre

93

Annexure

94

INSTITUTIONALDELIVERIESACROSSSTATES(201011) S.No. A.NonNEHighFocusStates 1 2 3 4 5 6 7 8 9 10 B.NEStates 11 12 13 14 15 16 17 18 C.NonHighFocusStates 19 20 21 22 23 24 25 26 27 28 D.UnionTerritories State Estimated Reported % no.of Institutional Achievement Deliveries Deliveries 1,231,840 335,462 65,372 133,525 328,110 1,332,607 521,447 1,213,054 2,491,339 79,498 7,732,254 10,617 398,707 25,554 31,564 18,151 11,269 6,648 40,040 542,550 1,437,365 20,107 1,098,150 399,472 717,648 376,934 1,248,947 273,236 1,033,125 971,786 7,576,770 44.5% 54.1% 56.2% 61.6% 41.0% 67.1% 61.2% 66.2% 43.5% 40.8% 51.2% 40.7% 55.5% 68.1% 49.6% 103.1% 29.3% 60.3% 75.2% 56.2% 93.0% 85.2% 83.9% 69.6% 62.2% 74.4% 63.3% 58.3% 94.2% 63.4% 74.4%

Bihar 2,769,972 Chhattisgarh 619,987 HimachalPradesh 116,392 Jammu&Kashmir 216,857 Jharkhand 801,101 MadhyaPradesh 1,986,976 Odisha 852,663 Rajasthan 1,833,307 UttarPradesh 5,721,259 Uttarakhand 194,735 SubTotal 15,113,249 ArunachalPradesh 26,059 Assam 717,747 Manipur 37,545 Meghalaya 63,660 Mizoram 17,600 Nagaland 38,494 Sikkim 11,023 Tripura 53,265 SubTotal 965,392 AndhraPradesh 1,544,996 Goa 23,612 Gujarat 1,309,055 Haryana 573,629 Karnataka 1,153,815 Kerala 506,665 Maharashtra 1,971,939 Punjab 468,452 Tamilnadu 1,096,550 WestBengal 1,533,518 SubTotal 10,182,230
95

29 30 31 32 33 34 35

Andaman&Nicobar 7,971 Chandigarh 22,451 Dadra&NagarHaveli 9,396 Daman&Diu 5,088 Delhi 329,981 Lakshadweep 1,140 Puducherry 22,589 SubTotal 398,615 GrandTotal 26,659,486

2,921 20,031 3,381 2,617 170,505 174 43,058 242,687 16,094,261

36.6% 89.2% 36.0% 51.4% 51.7% 15.3% 190.6% 60.9% 60.4%

96

STERILISATIONSTATUSACROSSSTATES(201011) S.No. State ELAfor sterilisation (ROP) 650,000 198,000 33,000 24,000 175,000 580,000 160,000 485,700 748,100 48,000 3,101,800 3,205 119,484 3,000 7,628 3,510 2,615 300 9,875 149,617 700,000 3,691 285,396 120,000 541,477 158,303 574,750 105,000 405,000 410,593 3,304,210 1,700 1,266

Reported %ofELA sterilisations (ROP)

A.NonNEHighFocus States 1 2 3 4 5 6 7 8 9 10 B.NEStates 11 12 13 14 15 16 17 18 C.NonHighFocusStates 19 20 21 22 23 24 25 26 27 28 D.UnionTerritories 29 30

Bihar Chhattisgarh HimachalPradesh Jammu&Kashmir Jharkhand MadhyaPradesh Odisha Rajasthan UttarPradesh Uttarakhand SubTotal ArunachalPradesh Assam Manipur Meghalaya Mizoram Nagaland Sikkim Tripura SubTotal AndhraPradesh Goa Gujarat Haryana Karnataka Kerala Maharashtra Punjab Tamilnadu WestBengal SubTotal Andaman&Nicobar Chandigarh
97

411,431 150,031 23,638 18,027 120,624 661,350 108,171 338,574 414,673 24,856 2,271,375 1,657 74,526 1,468 2,030 2,373 1,621 239 4,043 87,957 557,434 3,776 325,748 80,184 329,503 83,891 407,846 81,524 327,440 274,878 2,472,224 711 2,012

63.3% 75.8% 71.6% 75.1% 68.9% 114.0% 67.6% 69.7% 55.4% 51.8% 73.2% 51.7% 62.4% 48.9% 26.6% 67.6% 62.0% 79.7% 40.9% 58.8% 79.6% 102.3% 114.1% 66.8% 60.9% 53.0% 71.0% 77.6% 80.8% 66.9% 74.8% 41.8% 158.9%

31 32 33 34 35

S.No. A.NonNEHighFocus States 1 2 3 4 5 6 7 8 9 10 B.NEStates 11 12 13 14 15 16 17 18 C.NonHighFocus States 19 20

Dadra&Nagar 1,350 1,045 77.4% Haveli Daman&Diu 470 391 83.2% Delhi 33,290 18,672 56.1% Lakshadweep 130 32 24.6% Puducherry 8,130 11,218 138.0% SubTotal 46,336 34,081 73.6% GrandTotal 6,601,963 4,865,637 73.7% STATUSOFEMOCTRAINING:201011 Achievemen State Target %Achievement t Bihar 180 27 15% Chhattisgarh 78 7 9% Himachal 32 5 16% Pradesh Jammu& 16 4 25% Kashmir Jharkhand 24 2 8% Madhya 32 26 81% Pradesh Orissa 25 1 4% Rajasthan 40 19 48% UttarPradesh 25 251 1004% Uttarakhand 24 5 21% SubTotal 476 347 73% Arunachal 2 4 200% Pradesh Assam 48 9 19% Manipur 2 0 0% Meghalaya 24 4 17% Mizoram 2 0% Nagaland 5 1 20% Sikkim 2 0 0% Tripura 4 0 0% SubTotal 89 18 20% AndhraPradesh Goa
98

40 0

0 0

0% #DIV/0!

21 22 23 24 25 26 27 28 D.UnionTerritories 29 30 31 32 33 34 35

Gujarat Haryana Karnataka Kerala Maharashtra Punjab Tamilnadu WestBengal SubTotal Andaman& Nicobar Chandigarh Dadra&Nagar Haveli Daman&Diu Delhi Lakshadweep* Puducherry SubTotal GrandTotal

16 32 36 152 48 25 17 24 390 2 18 2 2 0 4 0 28 983

29 16 108 27 234 1 41 3 459 0 0 0 0 824

181% 50% 300% 18% 488% 4% 241% 13% 118% 0% 0% 0% 0% #DIV/0! 0% #DIV/0! 0% 84%

S.No. A.NonNEHighFocus States 1 2 3 4 5 6 7 8 9 10

STATUSOFLSASTRAINING:201011 Achieveme State Target nt Bihar 155 37 Chhattisgarh 52 29 Himachal 16 11 Pradesh Jammu& 8 7 Kashmir Jharkhand 32 54 Madhya 16 34 Pradesh Orissa 36 14 Rajasthan 72 49 UttarPradesh 20 1728 Uttarakhand 16 11 SubTotal 423 1974
99

% Achievement 24% 56% 69% 88% 169% 213% 39% 68% 8640% 69% 467%

B.NEStates 11 12 13 14 15 16 17 18 C.NonHighFocus States 19 20 21 22 23 24 25 26 27 28 D.UnionTerritories 29 30 31 32 33 34 35

Arunachal Pradesh Assam Manipur Meghalaya Mizoram Nagaland Sikkim Tripura SubTotal AndhraPradesh Goa Gujarat Haryana Karnataka Kerala Maharashtra Punjab Tamilnadu WestBengal SubTotal Andaman& Nicobar Chandigarh Dadra&Nagar Haveli Daman&Diu Delhi Lakshadweep Puducherry SubTotal GrandTotal

4 20 2 6 4 5 4 5 50 24 0 32 12 28 0 96 87 96 25 400 2 2 1 0 0 3 0 8 881

5 16 3 5 5 7 0 41 0 0 8 32 130 0 74 17 40 4 305 0 0 0 0 2320

125% 80% 150% 83% 0% 100% 175% 0% 82% 0% #DIV/0! 25% 267% 464% #DIV/0! 77% 20% 42% 16% 76% 0% 0% 0% #DIV/0! #DIV/0! 0% #DIV/0! 0% 263%

100

STATUSOFMTPTRAINING:201011 S.No. A.NonNEHighFocus States 1 2 3 4 5 6 7 8 9 10 B.NEStates 11 12 13 14 15 16 17 18 C.NonHighFocusStates 19 20 21 22 23 24 25 26 27 28 D.UnionTerritories 29 30 State Bihar Chhattisgarh HimachalPradesh Jammu&Kashmir Jharkhand MadhyaPradesh Orissa* Rajasthan UttarPradesh Uttarakhand SubTotal ArunachalPradesh Assam Manipur Meghalaya Mizoram Nagaland Sikkim Tripura* SubTotal AndhraPradesh Goa Gujarat Haryana Karnataka Kerala Maharashtra Punjab Tamilnadu WestBengal SubTotal Andaman& Nicobar Chandigarh
101

Target

Achievement

% Achievement

220 171 20 24 36 150 120 120 150 40 1051 10 250 20 18 20 30 0 15 1414 0 0 200 138 32 33 270 40 70 654 1437 10 12

50 29 0 8 113 154 25 28 324 19 750 15 34 8 9 16 12 0 94 0 0 36 42 256 11 198 43 130 0 716 0

23% 17% 0% 33% 314% 103% 21% 23% 216% 48% 71% 150% 14% 40% 50% 0% 53% #DIV/0! 0% 7% #DIV/0! #DIV/0! 18% 30% 800% 33% 73% 108% 186% 0% 50% 0% 0%

31 32 33 34 35

Dadra&Nagar Haveli* Daman&Diu Delhi Lakshadweep Puducherry SubTotal GrandTotal

4 0 6 12 0 44 3946

7 0 7 1567

0% #DIV/0! 117% 0% #DIV/0! 16% 40%

STATUSOFSBATRAINING(SNs,ANMs,LHVs):201011 S.No. A.NonNEHighFocus States 1 2 3 4 5 6 7 8 9 10 B.NEStates 11 12 13 14 15 16 17 18 State Bihar Chhattisgarh HimachalPradesh Jammu&Kashmir Jharkhand MadhyaPradesh Orissa Rajasthan UttarPradesh Uttarakhand SubTotal ArunachalPradesh Assam Manipur Meghalaya Mizoram Nagaland Sikkim Tripura SubTotal
102

% Achievement 8% 147% 42% 98% 111% 97% 116% 527% 176% 14% 75% 102% 54% 121% 309% 0% 72% 117% 88% 72%

Target* Achievement 15927 554 150 88 864 1200 495 1500 3000 588 24366 60 1632 104 96 92 60 84 148 2276 1339 817 63 86 963 1164 576 7899 5272 82 18261 61 878 126 297 43 98 130 1633

C.NonHighFocusStates 19 20 21 22 23 24 25 26 27 28 D.UnionTerritories 29 30 31 32 33 34 35

AndhraPradesh# Goa

1000 Not provided Gujarat 1140 Haryana 1460 Karnataka 1000 Kerala 0 Maharashtra 776 Punjab 720 Tamilnadu 2627 WestBengal 1440 SubTotal 10163 Andaman&Nicobar 100 Chandigarh 20 Dadra&Nagar 64 Haveli Daman&Diu 22 Delhi 45 Lakshadweep 12 Puducherry 16 SubTotal 279 GrandTotal 37084 STATUSOFIMNCITRAINING:201011

468 45 1271 1054 8097 0 1282 764 1061 958 15000 0 6 0 6 34900

47% #VALUE! 111% 72% 810% #DIV/0! 165% 106% 40% 67% 148% 0% 0% 0% 0% 13% 0% 0% 2% 94%

S.No. A.NonNEHigh FocusStates 1 2 3 4 5 6

State

Target

Achievement

%Achievement

Bihar Chhattisgarh HimachalPradesh Jammu&Kashmir Jharkhand MadhyaPradesh

9564 2160 432 96 5712 3840

6757 11 0 0 990 1432

71% 1% 0% 0% 17% 37%

103

7 8 9 10 B.NEStates 11 12 13 14 15 16 17 18 C.NonHigh FocusStates 19 20 21 22 23 24

Orissa Rajasthan UttarPradesh Uttarakhand SubTotal ArunachalPradesh Assam Manipur Meghalaya Mizoram Nagaland Sikkim Tripura SubTotal

7200 8250 38500 936 76690

330 5932 8187 252 23891

5% 72% 21% 27% 31%

104 10032 150 369 300 614 168 38 11775

2 2224 369 2

2% 22% 246% 1% 0%

68 90 24 2779

11% 54% 63% 24%

AndhraPradesh Goa Gujarat Haryana Karnataka Kerala

864 2 3480 8500 6000 5640

241 0 2430 1650 2648 272

28% 0% 70% 19% 44% 5%

104

25 26 27 28 D.Union Territories 29 30 31 32 33 34 35

Maharashtra Punjab Tamilnadu WestBengal SubTotal

12452 2056 16900 12480 68374

10169 332 2825 1883 22450

82% 16% 17% 15% 33%

Andaman&Nicobar Chandigarh Dadra&NagarHaveli Daman&Diu Delhi Lakshadweep Puducherry SubTotal GrandTotal

52 75 296 50 192 4 32 701 157540 14 49134 14 0 0

0% 0% 0% 0% 7% 0% 0% 2% 31%

NOTE:* NotargetintheROP;providedbytheState

105

STATUSOFNSVTRAINING:201011 S.No. A.NonNEHighFocus States 1 2 3 4 5 6 7 8 9 10 B.NEStates 11 12 13 14 15 16 17 18 C.NonHighFocus States 19 20 21 22 23 24 25 26 27 28 State Bihar Chhattisgarh Himachal Pradesh Jammu& Kashmir* Jharkhand Madhya Pradesh Orissa Rajasthan UttarPradesh Uttarakhand SubTotal Arunachal Pradesh Assam* Manipur Meghalaya Mizoram Nagaland* Sikkim Tripura SubTotal AndhraPradesh Goa* Gujarat Haryana Karnataka Kerala Maharashtra Punjab Tamilnadu* WestBengal
106

Target

Achievement

% Achievement

152 40 56 44 30 100 313 100 242 48 1125 3 100 23 29 0 24 0 12 191 25 2 76 212 300 24 32 25 60 175

12 31 7 1 61 37 1 2098 195 23 2466 0 46 16 16 3 4 5 90 54 0 21 33 143 7 89 6 25 142

8% 78% 13% 2% 203% 37% 0% 2098% 81% 48% 219% 0% 46% 70% 55% #DIV/0! 13% #DIV/0! 42% 47% 216% 0% 28% 16% 48% 29% 278% 24% 42% 81%

D.UnionTerritories 29 30 31 32 33 34 35 S.No.

SubTotal 931 520 Andaman& 5 Nicobar* Chandigarh 0 0 Dadra&Nagar 0 Haveli Daman&Diu 2 Delhi 30 2 Lakshadweep 4 0 Puducherry* 4 SubTotal 45 2 GrandTotal 2292 3078 STATUSOFMINILAPSTERILISATIONTRAINING:201011 State Bihar Chhattisgarh HimachalPradesh Target 152 50 Not provided Jammu&Kashmir 0 Jharkhand 24 MadhyaPradesh 50 Orissa 240 Rajasthan 100 UttarPradesh 208 Uttarakhand 22 SubTotal 846 ArunachalPradesh 25 Assam 240 Manipur 15 Meghalaya 3 Mizoram 20 Nagaland* 24 Sikkim 0 Tripura 15 SubTotal 342
107

56% 0% #DIV/0! #DIV/0! 0% 7% 0% 0% 4% 134%

Achievement

% Achievement

A.NonNEHighFocus States 1 2 3 4 5 6 7 8 9 10 B.NEStates 11 12 13 14 15 16 17 18 C.NonHighFocus

80 3 0 0 25 7 42 0 335 10 502 5 10 0 8 4 0 0 27

53% 6% #VALUE! #DIV/0! 104% 14% 18% 0% 161% 45% 59% 20% 4% 0% 267% 0% 17% #DIV/0! 0% 8%

States 19 20 21 22 23 24 25 26 27 28 D.UnionTerritories 29 30 31 32 33 34 35 AndhraPradesh Goa Gujarat Haryana Karnataka Kerala Maharashtra Punjab Tamilnadu WestBengal SubTotal Andaman& Nicobar* Chandigarh Dadra&Nagar Haveli Daman&Diu Delhi Lakshadweep Puducherry SubTotal GrandTotal 660 0 93 306 60 33 320 40 500 330 2342 5 1 4 0 0 4 0 14 3544 83 0 34 56 152 5 228 22 8 162 750 0 0 0 0 1279 % Achievement #DIV/0! 38% 0% 3% 17% 92% 50% 26% 114% 138% 83% 13% #DIV/0! 37% 18% 253% 15% 71% 55% 2% 49% 32% 0% 0% 0% #DIV/0! #DIV/0! 0% #DIV/0! 0% 36%

STATUSOFLAPAROSCOPICSTERILISATIONTRAINING:201011 S.No. A.NonNEHighFocus States 1 2 3 4 5 6 7 8 9 10 B.NEStates

State Bihar Chhattisgarh HimachalPradesh Jammu&Kashmir Jharkhand MadhyaPradesh Orissa Rajasthan UttarPradesh Uttarakhand SubTotal
108

Target

Achievement

0 40 18 30 12 50 20 100 334 8 612

15 15 0 1 2 46 10 26 382 11 508

11 12 13 14 15 16 17 18 C.NonHighFocus States 19 20 21 22 23 24 25 26 27 28 D.UnionTerritories 29 30 31 32 33 34 35

ArunachalPradesh * Assam Manipur Meghalaya Mizoram Nagaland* Sikkim Tripura SubTotal AndhraPradesh Goa

3 150 0 0 1 24 2 12 192 120 2

0 16 0 0 4 1 0 21 2 0

0% 11% #DIV/0! #DIV/0! 0% 17% 50% 0% 11% 2% 0%

Gujarat Haryana Karnataka Kerala Maharashtra Punjab Tamilnadu WestBengal SubTotal Andaman& Nicobar Chandigarh Dadra&Nagar Haveli Daman&Diu Delhi Lakshadweep Puducherry SubTotal GrandTotal

82 18 30 36 27 24 100 27 466 2 1 0 2 9 4 0 18 1288

920 13 488 8 21 25 38 4 1519 0 2 0 2 2050

1122% 72% 1627% 22% 78% 104% 38% 15% 326% 0% 0% #DIV/0! 0% 22% 0% #DIV/0! 11% 159%

109

STATUSOFIUDINSERTIONTRAINING:201011
S.No. A.NonNEHighFocusStates 1 2 3 4 5 6 7 8 9 10 B.NEStates 11 12 13 14 15 16 17 18 C.NonHighFocusStates 19 20 21 22 23 24 25 26 27 28 D.UnionTerritories 29 30 31 32 33 34 35 State Bihar Chhattisgarh HimachalPradesh Jammu&Kashmir Jharkhand MadhyaPradesh Orissa Rajasthan UttarPradesh Uttarakhand SubTotal ArunachalPradesh Assam Manipur Meghalaya Mizoram Nagaland Sikkim Tripura SubTotal AndhraPradesh Goa Gujarat Haryana Karnataka Kerala Maharashtra Punjab Tamilnadu WestBengal SubTotal Andaman&Nicobar Chandigarh Dadra&NagarHaveli Daman&Diu Delhi Lakshadweep Puducherry SubTotal GrandTotal Target* 1440 2538 500 220 480 2500 360 2236 3870 1872 16016 115 2400 350 518 73 339 0 200 3995 0 0 1875 2130 5400 3090 2380 800 6000 3000 24675 95 50 0 0 60 0 40 245 44931 Achievement 1171 1816 46 105 604 1897 48 16220 9305 453 31665 57 1378 167 602 148 85 150 2587 105 0 1712 1674 5954 286 2313 646 3035 2643 18368 32 22 0 54 52674 %Achievement 81% 72% 9% 48% 126% 76% 13% 725% 240% 24% 198% 50% 57% 48% 116% 0% 44% #DIV/0! 75% 65% #DIV/0! #DIV/0! 91% 79% 110% 9% 97% 81% 51% 88% 74% 0% 64% #DIV/0! #DIV/0! 37% #DIV/0! 0% 22% 117%

110

STATUSOF24x7FACILITIESACROSSSTATES
S.No. A.NonNEHighFocusStates 1 2 3 4 5 6 7 8 9 10 B.NEStates 11 12 13 14 15 16 17 18 C.NonHighFocusStates 19 20 21 22 23 24 25 26 27 28 D.UnionTerritories 29 30 31 32 33 34 35 State Bihar* Chhattisgarh HimachalPradesh Jammu&Kashmir Jharkhand MadhyaPradesh Orissa Rajasthan UttarPradesh Uttarakhand SubTotal ArunachalPradesh Assam Manipur Meghalaya Mizoram Nagaland Sikkim Tripura SubTotal AndhraPradesh Goa* Gujarat Haryana Karnataka Kerala Maharashtra Punjab Tamilnadu WestBengal SubTotal Andaman&Nicobar Chandigarh Dadra&NagarHaveli Daman&Diu Delhi Lakshadweep Puducherry SubTotal GrandTotal Target (till201011) 558 348 95 160 285 500 340 1418 850 120 4674 30 445 38 26 41 33 24 62 699 1200 19 331 337 1200 178 908 236 1539 225 6173 19 6 6 1 35 9 25 101 11647 Achievement 96 2 95 15 43 41 157 644 485 86 1664 15 284 17 34 0 26 24 58 458 761 13 137 301 1076 0 52 99 1316 36 3791 0 0 5 2 0 0 25 32 5945

%Achievement 17% 1% 100% 9% 15% 8% 46% 45% 57% 72% 36% 50% 64% 45% 131% 0% 79% 100% 94% 66% 63% 68% 41% 89% 90% 0% 6% 42% 86% 16% 61% 0% 0% 83% 200% 0% 0% 100% 32% 51%

111

MMUNISATIONSTATUSACROSSSTATES(201011) S.No. State Estimatedno. oflivebirths Reportedlive births BCGcoverage % Achievemen t(estimated births) % Achievemen t(reported livebirths) Estimated no.ofUIP beneficiari es DPT3 coverag e % Achievement Measles coverage %Achievement Infantsfully immunised % Achieve ment

A.NonNEHighFocusStates 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 Bihar Chhattisgarh Himachal Pradesh Jammu& Kashmir Jharkhand Madhya Pradesh Odisha Rajasthan Uttar Pradesh Uttarakhand SubTotal Arunachal Pradesh Assam Manipur Meghalaya Mizoram Nagaland Sikkim Tripura SubTotal 2,769,972 619,987 116,392 216,857 801,101 1,986,976 852,663 1,833,307 5,721,259 194,735 15,113,249 26,059 717,747 37,545 63,660 17,600 38,494 11,023 53,265 965,392 1,236,691 579,130 102,226 142,465 550,107 1,564,079 630,398 1,366,398 4,221,798 126,780 10,520,072 11,091 494,250 33,760 70,184 22,107 16,393 8,072 47,879 703,736 2,248,082 583,528 128,046 220,218 711,883 1,610,270 737,600 1,369,169 5,156,987 181,822 12,947,605 19,585 627,871 52,026 79,822 22,803 20,295 8,899 55,186 886,487 81.2% 94.1% 110.0% 101.5% 88.9% 81.0% 86.5% 74.7% 90.1% 93.4% 85.7% 75.2% 87.5% 138.6% 125.4% 129.6% 52.7% 80.7% 103.6% 91.8% 181.8% 100.8% 125.3% 154.6% 129.4% 103.0% 117.0% 100.2% 122.2% 143.4% 123.1% 176.6% 127.0% 154.1% 113.7% 103.1% 123.8% 110.2% 115.3% 126.0% 2,625,933 586,508 111,155 207,099 765,852 1,853,849 797,240 1,725,142 5,360,820 186,750 14,220,348 25,225 673,964 36,944 59,904 16,966 37,493 10,648 51,614 912,758 1,929,131 572,676 121,582 218,638 643,355 1,632,108 692,434 1,541,946 4,770,010 178,085 12,299,965 15,192 574,076 45,154 67,272 22,821 18,826 8,921 49,943 802,205 73.5% 97.6% 109.4% 105.6% 84.0% 88.0% 86.9% 89.4% 89.0% 95.4% 86.5% 60.2% 85.2% 122.2% 112.3% 134.5% 50.2% 83.8% 96.8% 87.9% 1,919,461 558,589 116,789 213,619 721,359 1,619,633 663,216 1,489,689 4,540,003 167,817 12,010,175 15,352 558,352 42,035 63,191 21,817 17,716 8,814 48,301 775,578 73.1% 95.2% 105.1% 103.1% 94.2% 87.4% 83.2% 86.4% 84.7% 89.9% 84.5% 60.9% 82.8% 113.8% 105.5% 128.6% 47.3% 82.8% 93.6% 85.0% 2,593,589 556,647 116,568 235,175 547,037 1,552,228 651,913 1,370,213 4,524,447 168,338 12,316,155 13,159 544,842 39,719 57,891 21,267 15,410 8,730 39,572 740,590 98.8% 94.9% 104.9% 113.6% 71.4% 83.7% 81.8% 79.4% 84.4% 90.1% 86.6% 52.2% 80.8% 107.5% 96.6% 125.3% 41.1% 82.0% 76.7% 81.1%

B.NEStates

C.NonHighFocusStates

112

19 20 21 22 23 24 25 26 27 28

Andhra Pradesh Goa Gujarat Haryana Karnataka Kerala Maharashtr a Punjab Tamilnadu West Bengal SubTotal

1,544,996 23,612 1,309,055 573,629 1,153,815 506,665 1,971,939 468,452 1,096,550 1,533,518 10,182,230

1,511,673 20,085 1,181,961 507,876 843,042 378,829 1,531,851 391,332 1,073,630 1,462,731 8,903,010

1,486,717 23,965 1,239,731 585,243 1,115,862 385,295 1,620,440 468,442 1,053,582 1,654,042 9,633,319

96.2% 101.5% 94.7% 102.0% 96.7% 76.0% 82.2% 100.0% 96.1% 107.9% 94.6%

98.3% 119.3% 104.9% 115.2% 132.4% 101.7% 105.8% 119.7% 98.1% 113.1% 108.2%

1,469,291 23,352 1,246,220 544,374 1,106,509 500,585 1,910,809 450,651 1,065,847 1,482,912 9,800,548

1,476,573 23,008 1,192,082 542,941 1,098,221 380,065 1,596,866 439,541 1,063,421 1,468,044 9,280,762

100.5% 98.5% 95.7% 99.7% 99.3% 75.9% 83.6% 97.5% 99.8% 99.0% 94.7%

1,456,038 22,169 1,153,782 542,894 1,038,278 365,085 1,523,556 420,244 1,041,200 1,423,533 8,986,779

99.1% 94.9% 92.6% 99.7% 93.8% 72.9% 79.7% 93.3% 97.7% 96.0% 91.7%

1,465,68 8 22,169 1,135,47 1 532,424 1,162,77 2 351,070 1,420,63 3 416,196 1,034,05 6 1,351,56 0 8,892,03 9 2,752 14,332 6,545

99.8% 94.9% 91.1% 97.8% 105.1% 70.1% 74.3% 92.4% 97.0% 91.1% 90.7%

D.UnionTerritories 29 30 31 Andaman& Nicobar Chandigarh Dadra& Nagar Haveli Daman& Diu Delhi Lakshadwe ep Puducherry SubTotal GrandTotal 7,971 22,451 9,396 2,976 22,263 8,877 3,093 23,852 7,670 38.8% 106.2% 81.6% 103.9% 107.1% 86.4% 7,755 21,890 9,048 2,452 15,541 7,095 31.6% 71.0% 78.4% 2,694 16,109 6,700 34.7% 73.6% 74.0% 35.5% 65.5% 72.3%

32 33 34 35

5,088 329,981 1,140 22,589 398,615 26,659,486

1,524 184,238 480 42,276 262,634 20,389,452

2,715 252,733 583 37,760 328,406 23,795,817

53.4% 76.6% 51.1% 167.2% 82.4% 89.3%

178.1% 137.2% 121.5% 89.3% 125.0% 116.7%

4,966 319,092 1,112 22,092 385,954 25,319,608

2,799 210,503 678 16,152 255,220 22,638,152

56.4% 66.0% 61.0% 73.1% 66.1% 89.4%

3,068 197,040 751 15,165 241,527 22,014,059

61.8% 61.8% 67.6% 68.6% 62.6% 86.9%

3,056 213,080 789 15,137 255,691 22,204,4 75

61.5% 66.8% 71.0% 68.5% 66.2% 87.7%

113


SchemeWiseExpenditureforRCHFlexipoolforFY201011(Upto31032011) Rs.InLakhs Tribal RCH A.6 A.HighFocusStates 1 2 3 4 5 6 7 8 9 10 B.NEStates Bihar Chhatisgarh Himachal J&K Jharkhand MP Orissa Rajasthan UP Uttarakhand SubTotal 0.00 0.00 28.50 0.00 32.57 11.85 46.87 34.89 0.00 0.00 154.68 0.00 0.00 52.34 0.00 15.05 61.21 15.45 0.00 0.00 0.00 144.05 9.91 1.45 87.57 35.34 22.02 122.82 344.45 148.76 277.08 199.19 1248.59 4548.37 362.25 26.98 387.45 1271.94 2632.80 1779.91 1776.89 6770.21 460.76 20017.56 11 12 13 14 15 16 17 18 Arunachal Pradesh Assam Manipur Meghalya Mizoram Nagaland Sikkim Tripura SubTotal 0.00 0.00 7.26 0.00 0.00 0.00 5.70 0.00 12.96 0.00 57.56 4.24 0.00 0.00 0.00 0.00 0.00 61.80 606.27 3214.71 17.86 3.59 52.49 1.00 15.78 12.76 3924.46 249.25 1676.93 469.43 74.35 373.96 251.40 95.81 201.30 3392.43 71.38 118.10 2.16 12.08 42.74 116.60 7.13 0.00 370.19 148.80 1272.39 142.57 125.57 120.44 63.09 39.26 80.26 1992.38 70.91 0.00 95.05 179.69 9.78 242.58 12.13 256.11 866.25 14.72 8045.74 135.18 3.57 332.16 365.87 30.47 369.17 9296.88 270.91 326.18 147.31 190.10 105.40 366.30 83.00 169.57 1658.77 1690.29 24137.54 1344.81 1028.53 1246.59 1717.46 404.06 1663.78 33233.05 216.59 0.00 121.46 44.06 15.45 458.43 204.48 516.77 546.29 81.85 2205.38 1286.16 143.06 135.17 152.66 838.44 1175.72 848.08 887.66 1639.07 110.86 7216.88 488.52 63.73 98.73 83.00 139.99 939.78 311.82 506.74 1384.83 170.95 4188.09 5114.44 1082.52 318.52 343.42 156.04 0.00 332.25 1322.57 22.66 3.83 8696.25 1301.77 728.23 120.70 200.77 814.78 1469.24 802.35 753.89 1567.57 187.72 7947.02 42594.97 8994.39 2043.38 3791.17 10914.33 37589.23 19104.84 28690.33 65509.42 3791.06 223023.1 2 Vulnerable Groups A.7 Innovation /PPP/NGO A.8 Infrastructure HumanResource A.9 Institutional Strengthening A.10 Training A.11 BCC/ICC A.12 Procurement A.13 Programme Management A.14 TotalRCH Flexi pool A

S.No.

State

114

C.NonHighFocusStates 19 20 21 22 23 24 25 26 27 28 Andhra Goa Gujarat Haryana Karnatak Kerala Maharashtra Punjab Tamilnadu WestBengal 0.00 0.00 81.72 0.00 56.70 71.53 109.08 0.00 0.00 206.96 525.99 0.00 0.00 628.72 0.00 80.60 0.00 60.24 0.00 0.00 183.97 953.53 2.70 6.52 1928.57 71.57 37.79 29.09 349.74 289.03 2.49 175.38 2892.88 1824.57 70.86 776.09 1368.63 5010.25 3916.48 1904.29 1616.80 5526.49 1294.73 23309.19 29 30 31 32 33 34 35 Andaman& Nicobar Chandigarh Dadra&Nagar Haveli Daman Delhi Lakshadweep Puducherry SubTotal GrandTotal 0.00 0.00 0.49 0.00 0.00 0.00 0.00 0.49 694.12 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 1159.38 0.00 3.03 0.40 1.93 12.19 2.16 24.40 44.11 8110.04 0.00 96.13 96.46 0.00 1544.61 0.00 55.70 1792.90 48512.08 0.00 0.00 3.63 2.01 13.58 0.00 23.75 42.97 4407.33 13.91 3.51 1.69 0.57 30.78 4.03 16.28 70.77 15117.30 16.14 12.89 8.30 10.62 43.03 3.20 28.36 122.54 8403.03 1.51 31.23 11.49 0.00 247.74 1.37 6.12 299.46 25682.24 0.42 13.31 15.00 13.87 33.51 29.08 19.56 124.75 13894.10 47.06 173.97 155.50 32.27 2246.24 60.11 388.94 3104.09 368518.8 8 6.31 1.29 255.87 12.37 301.03 71.04 97.02 271.92 466.03 305.91 1788.79 56.12 11.30 611.18 396.52 1554.36 370.16 1311.67 473.08 701.53 351.36 5837.28 283.50 24.56 756.67 122.21 482.87 376.07 686.85 347.45 102.16 43.81 3226.15 0.00 27.42 1181.67 1743.49 11.98 479.62 0.00 1023.20 2919.58 2.70 7389.66 431.56 38.13 658.61 437.70 526.28 444.75 756.89 588.16 1.49 280.00 4163.57 6278.88 234.25 17010.61 6295.09 16359.44 7837.49 18969.20 6808.10 15269.77 14095.78 109158.6 1

SubTotal D.SmallStates/UTs

Note:ExpenditurearebasedonFMRsreceivedfromstatesason28.06.2011

115

SchemeWiseExpenditureforRCHFlexipoolforFY201011(Upto31032011) Rs.InLakhs TotalMH JSY Maternal Health Other ChildHealth Family Planning Compensation Sterilization OtherFP ARSH UrbanRCH

S.No.

State

A.1 A.1.4 A.1 A.2 A.3 A.4 A.5 A.HighFocusStates 1 Bihar 24265.80 23969.03 296.77 715.45 4609.53 4516.64 92.89 5.26 33.17 2 Chhatisgarh 4937.56 4900.34 37.22 254.96 1398.69 1382.46 16.23 5.65 16.29 3 Himachal 520.66 130.54 390.12 237.92 287.22 267.21 20.01 7.61 0.00 4 J&K 2118.56 2018.28 100.28 45.67 195.74 193.40 2.34 29.74 154.76 5 Jharkhand 5649.65 5224.68 424.97 295.43 1622.40 1605.43 16.97 32.53 8.04 6 MP 21661.58 20085.45 1576.13 2364.28 6544.24 6408.83 135.41 81.05 66.23 7 Orissa 12045.72 10672.61 1373.11 775.47 1466.99 1441.83 25.16 4.60 126.40 8 Rajasthan 18162.07 18013.44 148.63 275.97 3877.90 3696.97 180.93 12.00 414.22 9 UP 46568.30 45049.01 1519.29 973.25 4427.11 4114.71 312.39 261.25 1071.81 10 Uttarakhand 1541.77 1404.00 137.77 266.21 347.02 347.02 0.00 179.87 241.03 SubTotal 137471.67 131467.38 6004.29 6204.61 24776.84 23974.51 802.33 619.56 2131.95 B.NEStates Arunachal 11 Pradesh 166.44 133.14 33.30 21.20 20.92 18.52 2.40 5.22 44.27 12 Assam 7374.86 6852.70 522.16 35.20 1648.18 1473.47 174.71 10.74 356.95 13 Manipur 238.75 171.49 67.26 32.38 22.18 19.35 2.83 0.13 30.31 14 Meghalya 164.55 117.94 46.61 18.16 38.11 29.53 8.58 17.85 200.91 15 Mizoram 151.48 129.59 21.89 6.03 27.69 26.39 1.30 6.58 17.84 16 Nagaland 258.75 257.96 0.79 0.08 33.89 33.89 0.00 17.90 0.00 17 Sikkim 71.72 41.48 30.24 18.94 6.61 4.72 1.89 0.90 16.62 18 Tripura 428.60 244.41 184.19 36.95 72.24 69.14 3.10 36.82 0.00 SubTotal 8855.15 7948.71 906.44 168.94 1869.82 1675.00 194.81 96.14 666.90 C.NonHighFocusStates 19 20 21 Andhra Goa Gujarat 1075.35 20.37 3737.18 985.91 9.14 1995.42 89.44 11.23 1741.76 0.00 21.31 1595.30 2465.78 11.58 1622.95 2465.78 11.58 1582.82 0.00 0.00 40.14 0.66 0.36 152.19 132.33 0.55 3023.89

116

22 Haryana 23 Karnatak 24 Kerala 25 Maharashtra 26 Punjab 27 Tamilnadu 28 WestBengal SubTotal D.SmallStates/UTs Andaman& 29 Nicobar 30 Chandigarh Dadra&Nagar 31 Haveli 32 Daman 33 Delhi 34 Lakshyadweep 35 Puducherry SubTotal GrandTotal

895.46 4667.56 1090.86 3421.10 1041.36 2921.94 8139.09 27010.27

672.04 4663.12 920.20 3084.76 674.65 2670.73 5663.64 21339.61

223.42 4.44 170.66 336.34 366.71 251.21 2475.45 5670.66

136.89 282.69 349.03 4887.22 104.62 0.00 857.17 8234.23

495.63 3012.11 350.35 3856.01 846.65 2626.40 2240.81 17528.27

483.94 2933.21 347.83 3664.01 817.41 2461.78 2185.20 16953.56

11.69 78.90 2.52 192.00 29.24 164.62 55.61 574.72

8.85 52.00 17.04 113.80 7.56 0.00 13.89 366.35

605.77 283.22 271.47 1415.29 198.27 1.66 0.00 5932.45

6.32 2.62

6.05 2.35

0.27 0.27

3.49 0.89

5.27 9.79 11.47 1.34 146.49 1.49 62.38 238.23 44413.16

5.27 9.51

0.00 0.28

0.00 0.57

0.00 0.00 0.00 0.00 22.41 0.00 4.80 27.21 8758.51

6.57 6.22 1.33 0.00 136.39 119.59 14.83 7.02 69.95 30.73 238.01 171.96 173575.10 160927.6

0.35 0.00 1.33 0.60 16.80 9.69 7.81 2.54 39.22 11.18 66.05 28.39 12647.44 14636.17

11.47 0.00 0.00 1.33 0.01 0.00 136.62 9.87 5.82 1.49 0.00 1.41 60.88 1.50 66.46 226.57 11.66 74.26 42829.64 1583.52 1156.31

Note:ExpenditurearebasedonFMRsreceivedfromstatesason28.06.2011

117

Annexure:PromotionofMenstrualHygieneScheme TechnicalSpecificationsofSanitaryNapkinsfortheSchemeforthePromotionofMenstrual Hygiene(asapprovedbythetechnicalcommitteeconstitutedbyMoHFW) A. Preamble: SanitaryNapkinconsistsofanoutercoveringprovidedwithsufficientnumberofchannelsfor leakprotectionandanabsorbentfillermaterialwithanadhesivebackstrip. B. Description: 1. Covering The covering of the absorbent filler shall be made of good quality perforated film sleeve which has sufficient porosity to permit the assembled napkin to meet the absorbency requirements. This shall be made of a product that is non allergenic. The sanitary napkins shall have a nonabsorbent barrier on one side which shall have an identifyingmarkindicatingclearlythesideofthebarrier. 2. AbsorbentFillerThefillermaterial,shallconsistofcellulosepulp(eitherbasedonwoodor paper.)Thisshallbefreefromlumps,oilspots,dirtorforeignmaterialetc. 3. Back Strip A back strip for sticking the sanitary napkin onto the underwear should be thereusinggoodqualityadhesivematerial. 4. AbsorbencyThesanitarynapkinshouldbeabletoabsorbnotlessthan50mlofnormal saline(I.P.) 5. SizeThesizeofabsorbentsectionoftheSanitaryNapkinshallbeasfollows: PadLengthWidth Thickness 210+_1060to75notmorethan10 (allfiguresinmm.) Thethicknessshallbemeasuredbystacking10completepadsandmeasuringthestackheight. Theaveragethicknessforthe10padsshallbeusedasthepadthickness. 6. Weight Theweightofonefullsanitarynapkinshallnotbemorethan10grams.\ C. MANUFACTURE,WORKMANSHIP,ANDFINISH: Theabsorbentfillershallbearrangedandneatlycuttotherequiredsizeofthepadand form a uniform thickness throughout without any wrinkles or distortion. It shall be placed in the covering in such a way that it does not cause lump formation with the effectofsuddenpressure.
118

Thecoveringfabricshallcoverthefillercompletely. Thesanitarynapkinsshallhaveaverysoftfeelandwhenwornshallnotchafeorgiveany uncomfortablefeeling.Itshallbefreefromallsortsofforeignmatterandshouldbe odorless. Thematerialusedinthefabricationisnonallergenic. Thesanitarynapkinwillbefreefromacidsandalkali. Theadhesiveusedinthenapkinshouldnotleaveanymarkandstain. D. Storage: Themanufacturershallensurethattherawmaterialsaswellasthefinishedgoodsare storedinacleanplaceprotectedfromdust,moisture,rodentsandpests. E.ShelfLife: Theproductshallhaveaminimumshelflifeofthreeyears.Atleast5/6thoftheshelflife shouldbeavailableonreceiptofshipmentatConsigneelevel. F. PackagingandLabelling: (i) PrimaryPackage: Each Primary Package shall contain 6 Sanitary Napkins in a Polyethylene bag of good qualitymaterialwithaminimummicronthicknessthatensuresthatthepackdoesnot tearinroutinehandling(subjecttoapprovalofsamplebyStateNodalOfficer)whichwill confirmtosizeoftheproductandsealedproperly.Thedesigningandprintingofthebag shallbedoneatthecostofthemanufacturerasperprintingmatterincludinglogo(in fourcolours)providedbyMoHFW.Theprintingworkshallbeinweatherproofinkand shall withstand immersion in water and remain intact. The primary package shall also include the name of the manufacturer, manufacturing license number, address of manufacturer, length and dimensions, lot /batch number, date of manufacturing and expiryandnumberofsanitarynapkinsineachpackage.Thedesigningoftheprimary packageshallbesubjecttotheapprovalofMoHFW. (ii) SecondaryPackage: Thesanitarynapkinscontainedinprimarypackageshouldbepackedinboxesforeasy handling,transportanddistribution.OneBoxshallcontain160primarypackagesof(6) Sanitary Napkins each. It shall be fabricated from Millboard / grey board / cardboard withaminimumofburstingstrengthof910Kg/cm2.Thedesigningandprintingofthe
119

label on the secondary package shall be done at the cost of the manufacturer as per printingmatterincludinglogoprovidedbyMoHFW. (iii)

BarCoding: Barcodeshallbeusedtotrackdowntheproduct.Itshallbeprintedonthelabelofthe secondarypackage 1) Productidentification(GTIN14)usingapplicationidentifier(01) 2) ExpiryDateinYYMMDDformat&usingapplicationidentifier(17) 3) Masterbatchnumberusingapplicationidentifier(10) CompletedetailsonGS1standardsalongwithtechnicalguidelinescanbedownloadedfrom www.gs1india.orgorwww.gs1.org G. Qualityassurance (i) Compliance: Themanufacturershallguaranteethattheproducts: (a)complywithallprovisionsofthespecifications (b)meetthelaiddownstandardsforsafety,efficacyandquality; (c)arefitforthepurposesmadeknowntotheSeller (d)arefreefromdefectsinworkmanshipandinmaterials (ii) PreDispatchInspection/Testing: MoHFW or authorised representative may inspect the product at the manufacturers factory and / or warehouse. Samples shall be drawn on random basis from each lot / batchoffered.ItshallbesenttothelaboratoryidentifiedbyMoHFW.Thegoodsshallbe acceptedsubjecttotheapprovalofthesamplesforthelaiddowntechnicalparameters inthespecificationsincludingpackageintegritytest. SanitaryNapkinsmaybeprocured/despatchedandsoldonlyafterclearancefromthe TestingLaboratoryandpriorintimationtothemanufacturer. H. Recalls: The products must be recalled by the manufacturer at the manufacturers cost if rejected by MoHFW or authorized representative because of problems with product qualityoradversereactionsoftheproducttotheuser.Thesupplierwillbeobligedto replacetheproductinquestionatitsowncostwithafreshbatchofacceptablequality,
120

orwithdrawandgiveafullrefund.Thesuppliershallhavetopaypenaltyasprescribed byMoHFW. I. Markings (i) All packages and invoices must bear the name of the product, expiry date and appropriatestorageconditions. (ii) SecondaryPackage: Thefollowinginformationshallbestenciledorlabeledontheexteriorshippingcartons onallfoursidesinboldletters atleastArialfontsize14withwaterproofindelibleinkinaclearlylegible mannerwhichisacceptabletoMoHFW: Genericnameoftheproduct Lotorbatchnumber Dateofmanufacture(monthandyear) Expirationdate(monthandyear) BarCode Manufacturersnameandregisteredaddress Consignees address and emergency phone number including mobile number Contactnumber Numberofboxescontainedinthecarton Grossweightofeachcarton(inkg) Instructionsforstorageandhandling

121

Annexure:RevisedNationalTuberculosisControlProgramme SummaryoftheNew/InnovativeapproachesofRNTCPin12thFiveYearPlan Sr No Key Programme Area 11thFive YearPlan Objective 12thFiveYearPlan Objective Universal (90%)access tocareforall typesof estimatedTB cases 90%amongst New&85% amongstre treatmentTB cases registered underRNTCP New/Innovativeapproaches Evidencebasedre alignmentofTBUnit (presentlyat1per5lakh pop)toBlocklevel Useoftelecommunication indemandgeneration, servicedelivery&patients tracking Designing&implementing innovativeACSMtools,NGO PPMapproachesand evaluatingtheirimpact Intensified case finding activities in high risk groups like smokers, diabetics, Malnourished, HIV, urban slums & difficult to reach areasetc Useofnewerrapid diagnostictools Conductingprescription auditsinprivateandpublic sectorsincludingmedical colleges Exploringlegislativeoptions forregulating&promoting rationaluseofAntiTBdrugs anddiagnostics Casebasedelectronic notificationsystemsfordata qualityimprovement Notificationofcases

Keystrategies Community 70%of empowermentfor estimated Case earlyselfreporting NewSmear detection fordiagnosisand PositiveTB treatment cases Mobilizing communitybased organizations 85%ofall Intensifying Treatment NewSmear appropriate success positiveTB involvementof cases formaland informalprivate healthcare providers Ensuringquality diagnosis,DOTS& defaultprevention Strengthening Reductionin thecrossborder defaultrate referral&feedback Further ofnewTB systembetween Preventionof reducingthe casestoless districts/states drugresistant defaultinTB than5%and withafocuson TB patientson retreatment migratory treatment TBcasesto populationin lessthan10% urbanareas

122

Sr No

Key Programme Area

11thFive YearPlan Objective

12thFiveYearPlan Objective Keystrategies New/Innovativeapproaches diagnosedandtreatedinthe privatesector Developingdiagnostic algorithmsforExtra pulmonaryTBinconsultation withprofessionalbodies Establishingreferral linkagesbetweenprimary, secondaryandtertiary hospitals

TBHIV

OfferofHIV Counselling andtesting Strengthen forallTB collaboration patientsand andcross linkingHIV referralin14 infectedTB states patientsto HIVcareand support;

Introduce diagnostic and Management treatment ofDrug servicesfor resistantTB MDRTBin phased manner

Prioritydeploymentof Earlydiagnosis newerrapiddiagnosticsin andimproved HIVcaresettings managementof NationwideprovisionofTB HIVinfectedTB preventivetherapyamong patients HIVinfectedindividualsafter Strengtheningof pilot TBHIVintensified Exploringthepossibilityof package alternativeregimensinHIV implementation positiveTBpatients Decentralizationofsecond Initial 43Cultureand linedrugsusceptibility Drug screeningof testingtoidentifiedState susceptibility allre referencelaboratories,for testing(C&DST) treatment routineapplicationin smear laboratoriestobe diagnosedMDRTBcases positivetill establishedby 2015andall 2013 ProcurementofantiTB Smear drugsforthemanagement Another30 positiveTB ofpatientswithMDRTB C&DST patientsby andalsoadditionalsecond laboratoriestobe year2017for lineantiTBdrugresistance establishedin drug (e.g.XDRTB) governmentand resistantTB othersectors Developingevidencebased andprovision throughpublic treatmentguidelinesforTB oftreatment Private casesresistanttodrugs
123

Sr No

Key Programme Area

11thFive YearPlan Objective

12thFiveYearPlan Objective servicesfor MDRTB patients Keystrategies partnershipsby 2015 Establishmentof 120DOTSPlus sites(1per10 million population indoorfacilityfor MDRTB) New/Innovativeapproaches otherthanRifampicin Establishingdrugresistance surveillanceinthecountry Involvingsecondaryand tertiarylevelhospitalsin managementofDrug resistantTB

Addressingat riskand vulnerable population

HRD& capacity building

Capacity buildingof state& district programme managers

Developingguidelinesfor addressingTBcareinspecial settingslike,prisons,mines, alcoholics,beggars, Developingand homeless,migrantlabourers implementation etc ofTribalAction Developinggendersensitive Plan approachestofacilitate LinkingTB accessandutilizationofTB patientswith controlservicesbyboth existingsocial menandwomen welfareschemes Intersectoralcoordination Strengtheningthe forincreasingaccessand contacttracing qualityofTBcare policy InitiatingTBsurveillancein implementation healthcareworkers Promotingimplementation ofAirborneInfectioncontrol guidelines Continuationof Increasedhumanresources existing commensuratetore contractual alignmentofTUstoblock manpower level Needbased Performanceappraisal continued systemforcontractualstaff
124

Sr No

Key Programme Area

11thFive YearPlan Objective

12thFiveYearPlan Objective Keystrategies training New/Innovativeapproaches Development&capacity BuildingofnationalTB InstituteslikeNTI,N.D.T.B. center,LRSunderRNTCP Operationalresearch o Improvementinquality andproficiencyof services. o Diagnostic&treatment delaysbothonpartof patientsandproviders o TBriskperceptions,health seekingbehaviour,KAPof patientsandproviders andreasonsofoptingof RNTCP. Improvementin surveillance,bothby strengtheningroutine surveillanceaswellas planninglargeinventory studies. Epidemiologicalstudiesfor incidence,prevalenceand mortalitymeasurement. CoordinatingwithNRHM divisionfordevelopmentof longtermpolicyon sustainablehuman resourcesinstatesfor RNTCP CoordinatingwithNRHM divisionforclearlydefining therolesand responsibilitiesof

Research& independent Evaluation

National levelsurveys tostudythe impactof the programme

Thirdparty evaluation

Health system strengthening

125

Sr No

Key Programme Area

11thFive YearPlan Objective

12thFiveYearPlan Objective New/Innovativeapproaches directorateofhealth servicesandmission directoratesinthestate; whileempoweringtheSTOs &DTOsinfinancialand programmaticmanagement andreportingwithinthe frameworkofNRHM Individualpatient monitoringfacilitatedby electronicupdatingof Continuetodo patienttreatmentcard themonitoringof Developingmonitoring performanceof indicatorsinviewof allstatesat changesandupdatesto nationallevel coverallareas Regularcentral& Barcodingusagefor statelevel trackingofpatientwise internal boxes evaluationsof Regularmeasurementsof programmesin thequalityofthe thedistricts programmethrough indicatorslikedelaysin diagnosisandtreatment Keystrategies

10

Monitoring and Evaluationof the Programme

Identifying poor performing unitswith intensified monitoring

126

Annexure(NPCDCS) Listof21Statesand100DistrictsselectedforNPCDCS

1.

States AndhraPradesh

2.

Assam

1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19.

Districts(100) Srikakulam VijayaNagaram Chittor Cuddapah Nellore Krishna Karnool Prakasham Lakhimpur Sibsagar Jorhat Dibrugarh Kamrup Vaishali Mauzaffarpur Rohtas PaschimChamparan PoorvaChamparan Keimur(bhabua) JashpurNagar Raipur Bilaspur GandhiNagar SurendraNagar Rajkot JamNagar Porbandhar Junagarh Mewat Yamnagar Kurukshetra Ambala Chamba Lahul&Sapiti Kinnaur
127

3.

Bihar

4.

Chhattisgarh

5.

Gujarat

6.

Haryana

20. 21. 22. 23. 24. 25. 26. 27. 28. 29. 30. 31. 32. 33. 34. 35.

7.

HimachalPradesh

8.

Jammu&Kashmir

36. 37. 38. 39. 40.

Kupawara Doda(Erstwhile)Kishtwar/Ramban) Kargil Leh(Ladak) Udhampur(Erstwhile) Ranchi Dhanbad Bokaro Kolar Udupi Shimoga Tumkur Chikmagulur Khozikode(Calicut) Pathanathitta Allppuza Idukki Thrishur Hoshangabad Chindwara Jhabua Ratlam Dhar Gadchirela Bhandara Chanderpur Washim Wardha Amaravati EastSikkim SouthSikkim Naupada Balangir
128

9.

Jharkhand

41. 42. 43.

10. Karnataka

44. 45. 46. 47. 48.

11. Kerala

49. 50. 51. 52. 53.

12. MadhyaPradesh

54. 55. 56. 57. 58.

13. Maharashtra

59. 60. 61. 62. 63. 64.

14. Sikkim 15. Orissa

65. 66. 67. 68.

69. 70. 71. 16. Punjab 72. 73. 74. 17. Rajasthan 75. 76. 77. 78. 79. 80. 81. 18. Uttrakhand 19. TamilNadu 82. 83. 84. 85. 86. 87. 88. 20. UttarPradesh 89. 90. 91. 92. 93. 94. 95. 96. 97. 21. WestBengal 98. 99. 100.

Nabrangpur Koraput Malkangiri Bhatinda Mansa Hoshiarpur Bilwara Jodhpur GangaNagar Bikaner Jaisalmer Barmer Nagaur Nainithal Almora Coimbatore Theni Virundhanagar Toothukudi Trinelveli RaeBareli Sultanpur Jhansi LakhimpurKheri Farookhabad Firozabad Eatawah Lalitpur Jalaun Darjeeling Jalpaiguri DakshinDinajpur

129

entofReleaseofGrantInAidsforNPCDCSfortheFinancialYr.201011endedason31.3.11 CVD District Cancer Care Facility Non Recurrin g 400,000 400000 400,000 200000 400000 200000 200000 400000 0 Cancer State&DistrictNCD Cell Recurrin g Non Recurrin g 750000 750000 750000 500000 750000 500000 500000 750000 0

States

Recurring Non Recurring

SUB TOTAL

Recurring

SUB TOTAL 5020400 5020400 5020400 2750700 5020400 2750700 2750700 5020400 0

TOTAL NPCDCS

Andhra Pradesh Assam Bihar Chattisgarh Gujrat Haryana Himachal Pradesh Jammu Kashmir Jharkhand

8437400 13,408,00 21,845,400 0 6,600,400 13288000 19,888,400 3488200 13008000 16,496,200 5,753,600 6844000 12,597,600

3228400 3228400 3228400 1614200 3228400 1614200 1614200 3228400 0

642000 642000 642000 436500 642000 436500 436500 642000 0

26,86

24,90

21,51

15,34

9815800 13568000 23,383,800 1832800 4204600 6524000 8,356,800

28,40

11,10

6724000 10,928,600

13,67

4088600 13,088,00 17,176,600 0 0.00 0 0

22,19

130

Karnatakka Kerala Madhya Pradesh Maharastra Sikkim Orissa Punjab Rajasthan

9925400.0 13568000 23,493,400 0 7016200.0 6964000 13,980,200 0 3273800.0 6644000 9,917,800 0 7943800.0 13408000 21,351,800 0 882800.00 6444000 7,326,800 2762800.0 0 5098600 6604000 9,366,800

3228400 1614200

400,000 200000

642000 436500

750000 500000

5020400 2750700

28,51

16,73

1614200 3228400 1614200 1614200 1614200

200000 400000 200000 200000 200000

437500 642000 436500 436500 436500

500000 750000 500000 500000 500000

2751700 5020400 2750700 2750700 2750700

12,66

26,37

10,07

12,11

6804000 11,902,600

14,65

Uttarakhand Tamilnadu UttarPradesh WestBengal Total

12262800 25,930,800 13,668,00 0 2795600 6604000 9,399,600 3737600 0 6095000 6684000 10,421,600 0 0

3228400 1614200 1614200 0 1614200

400000 200000 200000 0 200000

642,000 436500 436500 0 437500

750000 500000 500000 0 500000 1150000 0

5020400 2750700 2750700 0 2751700 7042290 0

30,95

12,15

13,17

6884000 12,979,000

15,73

106,015,8 180,728,0 286,743,80 00 00 0

43583400 5400000

9939500

357,16

131

SubHeadas inthe Demandfor Grant

NATIONALPROGRAMMEFORCONTROLOFBLINDNESS201011 DemandNo.&Title46Deptt.ofHealth Dated:31.03.2011((Rs.Inlakh) B.E. F.E.201011 Exp.Incurred Approvedby 201011 Finance

TotalExp.

Grantinaidto VOsandother Instts. ExpenditureInUTs without Legislature Trachoma&BC Cell(GC)New Salaries MedicalTreatment DomesticTravel Expenses OfficeExpenditure OtherAdmn. Expenses Professional Services TotalCentralCell (GC) H.E.Adv.& Publicity

22270.00

16656.43

16656.43

16656.43

1306

0.00

0.00

1307

130701 130706 130711 130713 130720 130728 130826

15.00 1.00 4.00 0.00 100.00 10.00 130.00 1000.00

12.00 0.00 0.00 0.00 29.09 0.00 41.09 1470.00

5.11 28.69 28.69 1459.84

5.11 0.00 0.00 0.00 28.69

33.80 1459.84

132

2552

Total2210 NorthEastern States LumSumProvision GRANDTOTAL %ofExpenditure

23400.00 2600.00 26000.00

18167.52 2091.03 20258.55

1488.53 2091.00 20235.96

1493.64 2091.00 20241.07 99.91

133

TotalBudgetaryallocationofGrantsinaidunderNPCBfortheyear201112:Rs.24850.00Crores,toNorthEasternStates:2 rores;Dated:23.06.2011;(Rs.InLacs) Nameof TotalBudget Fundsreleased Fundsreleased MC Funds State Allocation forCatops(in fornewschemes /RIO releas instalments) (install.) edfor procur 1st 2nd 3rd 1st 2nd 3rd ement 2500.00 1300.00 468.68 139.82 1715.40 885.60 244.00 466.80 593.30 1131.86 523.40 2438.98 1735.10 804.92 729.80 1176.00 2355.00 3200.00 407.79 1042.68 270.14 1039.38 1633.55 85.22 1182.79 516.79 101.8 171.54 671.78 1452.44 1109.83 319.42 597.5 875.57 272.66 116.06
134

ndhraPd. ihar hhattisgarh oa ujarat aryana imachalPd. ammu&Kashmir harkhand arnataka erala MadhyaPd. Maharashtra Orissa unjab ajasthan amilNadu ttarPradesh ttranchal WestBengal runachalPd. ssam

142.00 15.00 30.00 101.00 230.89 185.00 145.00 168.00 191.50 2.00 112.00 5.00

Manipur Meghalaya Mizoram agaland ikkim ripura ndman&Nicobar handigarh adar&Nag.Haveli aman&Diu elhi akshdweep ondicherry

224.87 239.90 555.05 189.39 181.27 200.00 99.77 78.70 128.86 64.49 450.57 31.30 137.18 27750.00

173.47 413.98 9694.40

1327.39

135

e:MentalHealth CentreWiseProgressReportoftheCentreofExcellenceinMentalHealthason08:04:2011 CapitalWork SupporttoFaculty andapprovalfor PGCourses Library Equipment Outcome (increase inPG Seats) 2MD Psychiatr yseats increased

f tre

Updateprogress withrespectto increaseinPG Seats Facultyappointed gra PreConstruction: 4 Completed Psychiatry:Prof.1, Associate Professor1, AssistantProfessor MDPsychiatry: d) 1 2seats permitted Clinical CapitalWork: Psychologist: Stoppedduetonon Senior2,Junior3 availabilityoffunds.The secondandthird PSW:Assistant instalmentshavenot ProfessorSelected beentransferredin butdidnotjoin.As institutesaccountby yetPSW04 StateHealthMission Psychiatric Nursing:Assistant
136

291Booksprocured 35Booksordered forsupply.Timeline annexed.

Noprogress

Professor Allthevacantpost arefilledandnew postcreatedinnew itembudget Permissionof stategovtand affiliationof universityforall the4Specialities obtained, Creationof facultypost donefor Psychiatryand Psychiatric Nursing. Approvalof regulatory bodiesobtained onlyfor psychiatric Nursingand10 studentsof Psychiatric nursinggot admission Financialapproval Permissionof forcreationofnew stategovt postsobtained. obtainedforall Stepsfor the4
137

for PreConstruction: Preliminarydesigns stage/obtaining bad approvaloflocalbodies. Detaildesignstagewith DPRTendering&award ofworkisunder process. CapitalWork: Notyetstarted

Orderplacedfor booksasspecified byMCI/INC/RCIwill becompletedby March2011.

Listof equipments were submittedto Central MedicalSupply Organization (CMSO),atthe marchend tenderingwill completed

Psychiatri cNursing 10seats increased

of

& ien

PreConstruction: Preliminarydesign completed.Detail designcompleted.

Noprogress

Noprogress

No progress

S, de,

ty h ,

Decidedtoawardthe workcontracttoaGovt. agencyHLLLtd. CapitalWork:Landhas beenallottedinthe medicalcollegecampus. Constructionworkwill startaftertheState ElectionbyApril31st, 2011. PreConstruction:Done, Howeverdepartment infrastructureis sufficienttostartthe courseimmediately. Drawingswere preparedanddiscussed somerevisionwere proposedandreturn backchiefarchitectto reviseaccordinglyand areawaited. CapitalWork:Notyet started

recruitmentwillbe specialities, completedbyMay, Affiliationof 2011 university obtainedonly forpsychiatry. Approvalof regulatory bodies(MCI, RCIannursing council)isstill pending Thepostswillbe advertisedshortly Permissionof stategovtisnot requiredforany speciality. Affiliationof university obtainedforCl Psychology,PSW &Psychiatric Nursing ListofBookshas beenfinalized. Processtoprocure willbestarted soon. Procurementis underprocess

MD psychiatr y12 seatscan be increased withthe existing faculty

138

of PreConstruction: Preliminarydesign stage/obtaining bad approvaloflocalbodies. CapitalWork: Notyetstarted

of ry,

Preliminarydesigns: stage/obtaining approvaloflocal authoritiesdone. Capitalwork:has started Preconstruction:work done DPRbeingprepared. Willtakeanother3 months Capitalworknotyet

8vacantpostsof AssistantProfessor ofPsychiatryare filledbydirect recruitment recently.Necessary proposalsare submittedtoState Govt.forfillingup ofpostscreated underCentreof ExcellenceScheme. AdvertisementFor FacultyPostBeing Planned(13 TeachersAreIn Different CategoriesAre WorkingOn ContractualBasis) Creationofone unitoffaculty done.One psychiatrist appointed.Process initiatedfor approvalofsecond

Appliedforstate govtapproval forstartingPG courses, Appliedfor obtaining university affiliation, Noprogress withrespectto

Alistofthebooks tobeprocured finalizedNecessary correspondence wasmade requestingthe Dept.ofSocial Work,andNursing Councilforthelist ofbooksrequired.

Willbecarried No outabreastof progress the construction work.

StateGovt Permission, Approvalof regulatory bodiesand affiliationwith theuniversities isunderprocess Underprocess

Listofbooksbeing preparedand tenderingisdone. Shortlythesupplier willsupplythe books.

Thereisno placetokeep the equipment.

No progress

Listsbeingtaken andPostof Librarian/Asst. Librarianand librarianapplied, requestedfor Technicalapproval

Procurement No ofequipments progress yettobe initiated.

139

started

unitasperthe scheme. Applicationfor initiatingcourses appliedfor.

Preliminarydesign stage/obtaining approvaloflocalbodies. 2Detaildesignstage withDPR 3.Tendering&awardof workdone Remodelling/renovation ofexisting/new Academicblocksfor psychiatry,Clinical Psychologysocialwork

TheState Governmenthas recentlycreated facultypositionsin thespecialtiesof psychiatry,clinical psychology,social workand psychiatricnursing. Approvaltakenfor fillingupthe vacancies& Creationofnew

ForMD Psychiatrythe processof obtainingstate govtpermission, approvalof regulatory bodiesand creationof Facultypostis through.
140

Ordersforbooks Underprocess worth15lacs alreadyplacedto theapprovedbook supplycontractorof Govt.Medical CollegeSrinagar .OrdersforJournals underprocess.

1MD Seat. Increased .

andpsychiatricNursing initiated Theprocessof arrangingadditional landofabout40kanals adjuststotheinstitute bythestate governmentforthe institutehasalsobeen takenoverduringthe monthofOctober, 2010. Theworksundertaken bytheStateEngineering Departmentwillalsoget completedduringthe currentfinancialyear. (Before31stMarch 2011.) men Preconstruction: Plotidentified,Drawing al approvedsentforcost arh estimateandtendering.

posts.

2MDSeats alreadythere. Increasein2 moreMDSeats. Otherallied disciplinescan bestarted subjecttothe approvalofRCI, Nursingcouncil.

Proposalfor creationofposts senttoUT administration. Fillinguplateron.

Stategovt approval obtained. University affiliation

Booksidentified. Procurement processbeing initiated.

Procurement ofequipments beingplanned. Tobe completedin8

Psychiatr yseats likelyto increased in2011

141

Capitalwork:Notyet Notime started commitment. Howeversincethereisa sparebuildingwith indoorcapacityof80 beds,thecentreof excellencecouldbe startedtheretillthe newbuildinggets constructed.The renovationofthis buildinghasalready startedandlikelytobe finishedbytheendof thisyearConstruction ofnewbuildinglikelyto startin34monthsand completein2.5years elhi Fundsreleasedrecently Fundsnotreleased.

obtained.MCI nursingcouncil inspectionis awaited.RCI Inspectionis over.Report waited.

months

12.Cl. Psycholo gyand PSW courseis likely from current year.

stra

142

StatusandExpenditureSchemeBofManpowerDevelopmentRs.InLakhs of Headsfunded Funds received work 40.60 facility hostel), & Expenditure Incurred 40 Balance remaining .60 StatusofworkundertakeninBrief

e dical Capital (Academic and an furnishing equipments

Support for Faculty andtechnicalstaff Capital work (Academic facility and hostel), furnishing & equipments Support for Faculty andtechnicalstaff Capital work (Academic facility and hostel), furnishing & equipments Support for Faculty andtechnicalstaff Capital work

18

18

, lhi

24.36

8,05,715

16,30,285

Re Ex Constructionhasreacheduptoplinthlevel. Approx. date for completion is by October 2011. Administrative and financial approval taken andequipmentshavebeeninstalled. Approval taken for fulfilling the vacancy & creationofnewposts. Postsadvertised Matterisinprogressatgovernmentlevel. The rooms have been constructed and furnitureindented

10.80

10.80

Approval has been obtained for advertising fourposts. Advertisementnotdoneyet

123.34

92,86,684

Notavailable

ty, w

50.32 32.78 Grant not Noprogressduenonreceiptoffunds


143

(Academic facility and hostel), furnishing & equipments Support for Faculty andtechnicalstaff Capital work (Academic facility and hostel), furnishing & equipments Support for Faculty andtechnicalstaff

received

7.92 Nofund allocated

173

3,90,666

1,69,75,334

AllthepostsunderNMHP werenewlycreated. All the sanctioned posts under NMHP were advertised. 2 Psychiatric Social Workers and 3 Clinical Psychologists wererecruited. The remaining posts couldnotbefilledupdue to lack of qualified candidates.

144

ExpenditureonNationalMentalHealthProgramme S.No. 1 2 3 Year 200708 200809 200910 General NE General NE General NE General 4 201011 NE TOTAL 8cr(RE201011) 264cr Allocation 28cr(RE200708) 10cr(RE200708) 58cr(RE200809) 12cr(RE200809) 50cr(RE200910) 5cr(RE200910) 93cr(RE201011) Expenditure 14.5736cr 0 23.2622cr 0 49.3710cr 2.6194cr 64.9081cr (ason 14.02.2011) 0cr (ason 14.02.2011) 154.7343cr

145

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