Content

Chapter Chapter Name Page
No. No.
Introduction 1-4
1. Organization & Infrastructure 5-17
2. NRHM, Health & Population Policies 19-49
3. Funding For The Programme 51-61
4. Maternal Health Programme 63-69
5. Child Health Programme 71-74
6. National Programmes Under NRHM 75-112
7. Information, Education And Communication 113-118
8. Partnership With Non-Government Organisations 119-121
9. Family Planning 123-138
10. Training Programme 139-146
11. Other National Health Programmes 147-160
12. International Co-Operation For Health & Family Welfare 161-164
13. Medical Relief And Supplies 165-187
14. Quality Control in Food & Drugs Sector, Medical Stores 189-201
15. Medical Education, Training & Research 203-303
16. Facilities For Scheduled Castes And Scheduled Tribes 305-308
17. Use of Hindi In Official Work 309-310
18. Activities In North East Region 311-322
19. Gender Issues 323-331
Annexure Organisation Chart of Department of Health & Family Welfare, 333
Organization Chart of DGHS & Audit Observation.
Annual Report 2010-11 1
The Ministry of Health and Family Welfare oversees the
implementation of policies and programmes for health
care around the country, within the framework set by the
National Health Policy of 2002 and the priorities set in
successive Five Year Plans. While the responsibility for
the delivery of health care rests largely with the State
Governments, the Government of India plays a role in
setting policy and providing resources for the
implementation of National Programmes.
Despite substantial progress made on many fronts there
are still areas of concern. Maternal and Infant Mortality
are still unacceptably high in several areas, infectious
disease continues to remain a threat to public health. Non-
Communicable Diseases including cancers, cardio-
vascular disease, diabetes and mental illnesses affect
sizeable numbers of our population. India does not as
yet have an adequate number of all categories of health
professionals, whether of doctors, specialist doctors,
nurses, nurse practitioners, para-medics and health
workers.
The National Health Policy (NHP) was formulated in
2002 to provide prophylactic and curative health care
services towards building a healthy nation. The NHP-
2002 aims to achieve an acceptable standard of good
health amongst the general population of the country. This
is sought to be done by increasing access to the
decentralized public health system by establishing new
infrastructure in deficient areas, and by upgrading the
infrastructure in the existing areas and institutions. The
challenge has been to provide the country more equitable
access to health services across the social and
geographical expanse of the country. Thus, keeping in
line with this broad objective, several health programmes/
schemes have been launched from time to time. There
has been a steady increase in the aggregate public health
investment, in the country. The contribution of Central
Government towards public investment for provision of
health care services has also been enhanced over the
Introduction Introduction Introduction Introduction Introduction
years. Expenditure in Health Sector on Public Health is
about 1% of the GDP.
National Rural Health Mission (NRHM)
The country has a well structured multi-tiered public health
infrastructure, comprising District Hospitals, Community
Health Centres, Primary Health Centres and Sub-Centres
spread across rural and semi-urban areas and tertiary
medical care providing multi-Speciality hospitals and
medical colleges. Improvements in health indicators can
be attributed, in part to this network of health
infrastructure. However, the progress has been quite
uneven across the regions with large scale inter-State
variations. Despite the consistent effort in scaling up
infrastructure and manpower, the rural and remote areas
continue to be deficit in health facility and manpower.
Conscious and vigorous efforts continue to be made
during the current year to step up funding in the health
sector and to increase spending in the public domain, at
least to raise it to the level of 3 per cent of the GDP by
2012. The major thrust in the National Rural Health
Mission (NRHM) has been towards achieving qualitative
improvements in standards of public health and health
care in the rural areas through strengthening of institutions,
community participation, decentralization and creating a
workforce of health workers viz. ASHAs. While the
Mission was formally launched in 2005 and has taken a
while to effectively find a firm footing, early indications
reflect its positive impact. Reliable estimate based on
surveys show an appreciable decline in infant mortality
(50 per 1000 live births in 2009 as against 60 in 2003),
decline in total Fertility Rate (from 3.0 children per women
in 2003 to 2.6 in 2008) and improvement in the percentage
of safe deliveries etc. (from 48.0 in 2004 to 52.7 in
2007-08).
A new initiative under NRHM has been taken to identify
backward districts for ensuring differential financing.
Based on health indicators 264 backward districts across
Annual Report 2010-11 2
the country have been identified for providing focused
attention. Similarly, after many years the agenda of family
planning is back in mainstream health discourse and has
been repositioned for better maternal and child health
apart from population stabilization.
The Reproductive and Child Health (RCH) Programme
is a key element of National Rural Health
Mission(NRHM). The system strengthening being
undertaken under the Mission has lent support to the
Programme towards reducing MMR, IMR and TFR.
Janani Suraksha Yojana(JSY) has resulted in a steep rise
in demand for services in public health institutions with
the institutional deliveries registering a substantial
increase. The number of JSY beneficiaries has risen
from 7.3 lakhs in 2005-06 to about 1 crore in 2009-10.
Facility upgradation on a large scale has been undertaken
to strengthen health care services for mothers and the
neonates. Establishment of new born corners, new born
stabilization units and special care units for new born has
received a special thrust. In addition, capacity building
initiatives such as IMNCI, FIMNCI SBA, NSSK, EMOC
and LSAS have been upscaled. SBA trainings have
started showing positive results with percentage of skilled
attendants at birth registering an increase. Multi skilling
of doctors in EMOC and LSAS has led to
operationalization of First Referral Units providing C-
Section services. Referral Transport for pregnant women
has seen considerable progress across States and has
emerged as a key intervention to improve timely access
of pregnant women to public health facilities. Family
Planning has again come back to centre stage after several
decades. Wide political support for voluntary family
planning has given a new impetus to the Ministry‘s
initiatives.
A name-based tracking of mother and children has been
launched whereby pregnant women and children can be
tracked for their Ante-natal Care and immunisation along
with a feedback system for the ANM, ASHA etc to
ensure that all pregnant women receive their Ante-Natal
Care Check-ups (ANCs) and post-natal care (PNCs);
and further children receive their full immunisation. All
new pregnancies detected are being registered from 1st
April, 2010. The states are putting in place systems to
capture such information on a regular basis.
In pursuance of the commitment made by the Government
in the address of Hon’ble President of India to the Joint
Session of Parliament on 4
th
June 2009 an Annual Report
to the People on Health was published in September 2010
to generate a debate on the issues presented in the Report.
National Council of Human Resources in Health
(NCHRH)
The President in her address to the Joint Session of
Parliament on 26
th
June 2009, announced the
Government’s intention to set up a National Council of
Human Resources in Health (NCHRH) as an overarching
regulatory body for health sector to reform the current
regulatory framework and enhance supply of skilled
personnel. Consequently, a Task Force under the
Chairmanship of former Union Secretary (Health &
Family Welfare) was constituted to deliberate upon the
issue of setting up of the proposed National Council.
The National Commission, which will coordinate all
aspects of medical, dental, nursing, pharmacy &
paramedical education, will in itself consist of senior
professionals and experts of known integrity and social
commitment, selected/ nominated by the most stringent
standard.
Accordingly, the following three bodies have been
proposed to be formed under the ambit of NCHRH –
National Board for Health Education, National Evaluation,
Assessment & Accreditation Committee and National
Councils.
Non Communicable Disease:
The Ministry of MoHFW has launched two new
programmes namely (i) The National Programme for
Prevention and Control of Cancer, Diabetes, CVD and
Stroke(NPCDCS) and (ii) The National Programme for
Health Care of Elderly(NPHCE) to address the menace
of Non-Communicable Diseases(NCDs) such as cancer,
diabetes, cardiovascular diseases and stroke that are major
factors reducing potentially productive years of human
life and resulting in huge economic loss. Initially, these
two new programmes will be implemented in 100 districts
of 21 selected states of the country.
The country is experiencing a rapid health transition with
a rising burden of Non-Communicable Diseases which
are emerging as the leading cause of death in India
accounting for over 42% of all deaths with considerable
loss in potentially productive years of life. The
Government of India initiated National Programme for
Prevention and Control of Cancer, Diabetes,
Cardiovascular Diseases and Stroke. During the
Annual Report 2010-11 3
remaining part of the 11
th
Plan, 100 districts across 21
States will be supported under this programme. Main
activities would include health promotion, opportunistic
screening of 30+ population and management of common
NCDs. District Hospitals will be upgraded by setting up
NCD Clinic, District Cancer Facility and Cardiac care
Units. Besides, 65 Tertiary Cancer Centres will be set
up to provide comprehensive treatment to common
cancers across the country. A provision of Rs. 1230 crores
has been made for this programme during 2011-12.
In addition, with increasing life expectancy, there is a
growing geriatric population who require special health
care. National Programme for Health Care of the Elderly
has also been initiated this year in the same districts. The
programme will provide services to the elderly population
at various levels. Geriatric Clinic and 10 bedded Geriatric
wards will be set up in District Hospitals. In addition, 8
Regional Geriatric Centres will be set up in selected
medical colleges for tertiary care, training and research
activities. A provision of Rs 288 crores has been made
during 2010-12.
The Ministry of Health Family Welfare, Government of
India has launched National Programme for Prevention
and Control of Deafness (NPPCD) on the pilot phase
basis in the year 2006-07(January 2007) covering 25
districts which was extended to another 35 districts, 41
districts and 75 districts in the year 2008-09, 2009-10 and
2010-11 respectively, covering total of 176 districts of 16
States and 3 UTs.
The launch of the dedicated National Tobacco Control
Programme (NTCP) in the 11
th
Five Year Plan has been
the major milestone to facilitate the implementation of
the tobacco control laws to bring about greater awareness
about the harmful effects of Tobacco and to fulfil the
obligation(s) under the WHO-FCTC. The programme
at present is under implementation in 42 districts in 21
states in the country. The Global Adult Tobacco Survey
(GATS) Report was released by Hon’ble HFM on 19
th
October, 2010. An out lay of Rupees 30.00 Crore has
been earmarked for the NTCP in the current financial
year 2010-11, out of which an amount of Rs. 17.17 Crores
has been spent till date.
Central Government Health Scheme
The Central Government Health Scheme has been in
existence since 1954, when it started functioning in Delhi.
The Central Government Health Scheme has since come
a long way and presently Central Government Health
Scheme covers 25 cities. In order to make the CGHS
user friendly, its functioning has been streamlined and
revamped. Important actions in this direction have been
the computerisation of the functioning of the CGHS and
its dispensaries, delegation of enhanced financial powers
to CGHS functionaries and to Ministries / Departments,
issue of plastic cards to beneficiaries enabling them to
take treatment in any dispensary, introduction of direct
indenting of commonly prescribed medicines by CMOs
in charge of dispensaries, empanelment of private
hospitals and diagnostic centres to provide options, in
addition to the facilities available in Government hospitals,
polyclinics and laboratories, outsourcing of sanitary work
in dispensaries, outsourcing of dental services, opening
of stand-alone dialysis unit in Delhi, appointment of the
Bill Clearing Agency (BCA) of settlement of bills of
hospitals of pensioner beneficiaries treated in hospitals,
etc. These measures have resulted in increased
satisfaction level of CGHS beneficiaries.
Control of Infectious Disease
The upgradation of National Centre for Disease Control
(NCDC) is being taken up to enhance the capabilities of
the Central and State Governments in disease surveillance
outbreak investigation and rapid response to disease
outbreaks. The proposal has been approved by the
Cabinet. During the year 2010, about 1000 disease
outbreaks were reported and responded to under
Integrated Disease Surveillance Programme (IDSP).
Under Externally Aided Projects, scaling up of Long
Lasting Insecticidal Nets (LLINs), Rapid Diagnostic
Tests (RDTs) and Artemisnin Based Combination
Therapies (ACTs) in high malaria endemic states has
been taken up. Similarly, for Kala-Azar elimination, RDTs
and oral drugs are also being scaled up. In view of growing
threats of other vector-borne diseases like dengue and
chikungunya, institutional surveillance has been
strengthened and source reduction measures have been
taken. In spite of the widespread prevalence of dengue
infection in Delhi before and during Common-wealth
Games (CWG), members of foreign delegations and other
participants in the CWG were not affected by dengue
due to sustained source reduction measures at CWG sites.
The Revised National Tuberculosis Control Programme
(RNTCP) has moved beyond the case detection rate of
70% and cure rate of 85% in India and efforts are being
Annual Report 2010-11 4
made to further improve the rates. With a view to meeting
the challenge of Multi-Drug Resistant Tuberculosis
(MDR-TB), 43 Culture and Drug Sensitivity Laboratories
are being set up and MDR-TB care and management
services scaled up.
The Ministry of Health & Family Welfare is giving
financial assistance to the poor patients for treatment at
different hospitals in all over the country under the
following two schemes namely: (i) Rashtriya Arogya Nidhi
and (ii) Health Minister ’s Discretionary Grants.
“Rashtriya Arogya Nidhi is providing financial assistance
to patients, living below poverty line, who are suffering
from major life threatening diseases to receive medical
treatment in Government Hospitals. “Financial Assistance
up to a maximum of Rs.50,000/- is available to the poor
indigent patients from the Health Minster’s Discretionary
Grant to defray a part of the expenditure on
Hospitalization/treatment in Government Hospitals in
cases where free medical facilities are not available.
K. Chandramouli
Secretary (H&FW)
Ministry of Health & Family Welfare
March 14, 2011
New Delhi
Annual Report 2010-11 5
Chapter 1
1.1 INTRODUCTION
In view of the federal nature of the Constitution, areas of
operation have been divided between Union Government
and State Governments. Seventh Schedule of Constitution
describes three exhaustive lists of items, namely, Union
list, State list and Concurrent list. Though some items
like Public Health, Hospitals, Sanitation, etc. fall in the
State list, the items having wider ramification at the
national level like family welfare and population control,
medical education, prevention of food adulteration, quality
control in manufacture of drugs etc. have been included
in the Concurrent list.
The Union Ministry of Health & Family Welfare is
instrumental and responsible for implementation of various
programmes on a national scale in the areas of Health
and Family Welfare, prevention and control of major
communicable diseases and promotion of traditional and
indigenous systems of medicines. In addition, the Ministry
also assists States in preventing and controlling the spread
of seasonal disease outbreaks and epidemics through
technical assistance.
Expenditure is incurred by Ministry of Health & Family
Welfare either directly under Central Schemes or by way
of grants–in–aids to the autonomous/statutory bodies etc.
and NGOs. In addition to the 100% centrally sponsored
family welfare programme, the Ministry is implementing
several World Bank assisted programmes for control of
AIDS, Malaria, Leprosy, Tuberculosis and Blindness in
designated areas. Besides, State Health Systems
Development Projects with World Bank assistance are
under implementation in various states. The projects are
implemented by the respective State Governments and
Organization & Infrastructure Organization & Infrastructure Organization & Infrastructure Organization & Infrastructure Organization & Infrastructure
the Department of Health & Family Welfare only
facilitates the States in availing of external assistance.
All these schemes aim at fulfilling the national commitment
to improve access to Primary Health Care facilities
keeping in view the needs of rural areas and where the
incidence of disease is high.
The Ministry of Health & Family Welfare comprises the
following four departments, each of which is headed by
a Secretary to the Government of India:-
• Department of Health & Family Welfare
• Department of AYUSH
• Department of Health Research
• Department of AIDS Control
Organograms of the Department of Health & Family
Welfare are at Annexure at the end of the Annual Report.
Directorate General of Health Services (DGHS) is an
attached office of the Department of Health & Family
Welfare and has subordinate offices spread all over the
country. The DGHS renders technical advice on all
medical and public health matters and is involved in the
implementation of various health schemes.
1.2 MINISTER IN CHARGE
The Ministry of Health and Family Welfare is headed by
Union Minister of Health and Family Welfare, Shri Ghulam
Nabi Azad since 29
th
May 2009. He is assisted by the
Ministers of State for Health and Family Welfare – Shri
Dinesh Trivedi and Shri S Gandhiselvan.
Shri S. Gandhiselvan
Minister of State for Health and Family Welfare
Shri Dinesh Trivedi
Minister of State for Health and Family Welfare
Shri Ghulam Nabi Azad
Union Minister of Health and Family Welfare
Annual Report 2010-11 6
1.3 ADMINISTRATION
The Department has taken new initiatives and steps to
ensure that the Government policies and programmes are
implemented in a time-bound and efficient manner, as
part of Government’s commitment to provide better
healthcare facilities. It has enforced discipline and
accountability amongst its officers and staff.
Director (Administration) attends to service related
grievances of the staff in the Department of Health and
Family Welfare. Secretary (Health and Family Welfare)
also gives personal hearing to staff grievances.
Director (Welfare & PG) in the Department is functioning
as nodal officer for redressal of public grievances. Under
Secretary (Welfare and PG) assists him in the matter.
1.4 HEALTHY LIFESTYLE CENTRE (YOGA
& GYM)
A Healthy Lifestyle Centre (Yoga & Gym) duly funded
by WHO has been functioning in the Ministry since 28
th
November, 2005. Two well-trained (one male and one
female) Yoga instructors from Morarji Desai National
Institute of Yoga have been deployed to take yoga classes
for male and female employees of the Ministry.
1.5 CENTRAL HEALTH SERVICE
The Central Health Service was restructured in 1982 to
provide medical manpower to various participating units
like Directorate General of Health Services (DGHS),
Central Government Health Service (CGHS),
Government of National Capital Territory (GNCT) of
Delhi, Ministry of Labour, Department of Posts, Assam
Rifles, etc. Since inception a number of participating units
like ESIC, NDMC, MCD, Himachal Pradesh, Manipur,
Tripura, Goa, etc. have formed their own cadres. JIPMER,
Puducherry which has become an autonomous body
w.e.f. 14
th
July, 2008 has gone out of CHS cadre. The
latest in the list of institutions which has gone out of CHS
cadre is Govt. of NCT of Delhi. Consequent upon the
formation of Delhi Health Service 906 posts ( 14 SAG,
150-Non-Teaching, 742-GDMO ) belonging to Govt. of
NCT of Delhi have been decadred from CHS. At the
same time units like CGHS have also expanded. The
Central Health Service now consists of the following four
Sub-cadres and the present strength of each Sub-cadre
is as under:
(i) General Duty Medical
Officer sub-cadre - 2155
(ii) Teaching Specialists
sub-cadre - 850
(iii) Non-Teaching Specialists
sub-cadre - 772
(iv) Public Health Specialists
sub-cadre - 078
In addition to the above there are 19 posts in the Higher
Administrative Grade, which are common to all the four
sub cadres.
1.5.1. Recruitment:
(a) Recruitment of GDMOs: -Dossier of 450
candidates has been received from UPSC on the basis
of Combined Medical Service Examination-2009 including
16 physically handicapped candidates and they were
allocated to different Ministries/Departments as below:
i) Ministry of Railoways - 248 (including 8 PH)
ii) Ministry of Defence - 005 (including 1 PH)
iii) MCD - 026 (including 1 PH)
iv) NDMC - 019
v) Central Health Service - 152 (including 6 PH)
Government’s policy on reservation for SC, ST, OBC &
Physically Handicapped is being followed strictly in the
recruitment of Medical Officers of CHS.
“In order to avoid inordinate delays in issuing offers,
provisional offer of appointment are being issued to the
CMSE candidates pending verification of their character
and antecedents from the authorities concerned as per
decision of Committee of Secretaries.”
1.5.2. Promotions:
During the year, the following numbers of promotions
were effected/under process in various sub-cadres of the
Central Health Service:
Annual Report 2010-11 7
I. Review of CHS-Rules, 1996:
Recruitment Rules, 1996 for Central Health Service has
been revised in consultation with DOP&T and sent to
UPSC for approval.
II. Posting of doctors to Andaman & Nicobar
Islands:
Despite best efforts on the part of this Ministry, the
vacancies of Specialists (Non-Teaching) Sub-Cadre in
Sub- Sr. Designation of posts No.
cadre No.
G 1. Senior Medical Officers to (Grade Pay Rs. 6600/- in PB-3) to Chief Medical Officers. 01
D (Grade Pay Rs. 7600/- in PB-3)
M 2. Chief Medical Officer (Grade Pay Rs. 7600/- in PB-3) to Chief Medical Officer (NFSG)(Regular)
O (Grade Pay Rs. 8700/- in PB-4) 89
3. Chief Medical Officer (NFSG) (Grade Pay Rs. 8700/- in PB-4) to Senior Administrative Grade
(Grade Pay of Rs. 10000/- in PB-4) 586
T 1. Assistant Professor (Grade Pay Rs. 6600/- in PB-3) to Associate Professor (Grade Pay Rs. 7600/- in PB-3) 55
E
A
C 2. Associate Professors (Grade Pay Rs. 7600/- in PB-3) to the post of Professor (Grade pay 8700 in PB-4). 34
H
I
N 3. Professor (Grade Pay Rs. 8700/- in PB-4) Director-Professor(SAG) (Grade Pay Rs. 10000/- in PB-4) 160
G
N 1. Specialist Grade-II (Junior scale) (Grade Pay Rs. 6600/- in PB-3) to Specialist Grade –I 57
O (Grade Pay Rs. 7600/- in PB-3)
N 2 Specialist Grade-II (Senior scale) (Grade Pay Rs. 7600/- in PB-3) to Specialist Grade –I
T (Grade Pay Rs. 8700/- in PB-4) 17
E 3. Specialist Grade-I officers (Grade Pay Rs. 8700/- in PB-4) promoted to the post of SAG
A (Grade Pay Rs. 10000/- in PB-4) under DACP Scheme 219
C 4. A proposal for holding DPC for one post of HAG for 2008- 09 and 5 posts for 2009-10 and 2
H posts for 2010-11 is being sent to UPSC.
I 5. Proposal for holding DPC for 1 post of Special DGHS sent to UPSC
N
G
P 1 Specialists Gr. I officers (Grade Pay Rs. 8700/- in PB-4) to SAG (Grade Pay Rs. 10000/- in PB-4) 14
U
B
L
I
C
H
E
L
T
H
A & N Islands could not be filled. Accordingly, from
August 2008 onwards, General Duty Medical Officers
with requisite PG qualification as well as Specialists are
being deputed to the A & N Islands for a period of 90
days in Specialities of Paediatrics, Medicine, Radiology,
ENT, and Obstetrics & Gynaecology, Anaesthesia and
Ophthalmology. Requisition for all vacant Non-teaching
Specialist CHS posts in A&N Islands have been sent to
UPSC with a request to fill up these posts urgently.
Annual Report 2010-11 8
1.5.3. Other Service related matters
(i) RTI: The number of RTI cases received in
this Division is 548.
(ii) Court Cases: There were 79 Court cases
pending in various CAT/Courts in the beginning of
financial year 2010-11. But due to vigorous efforts
by the CHS Division, 14 cases have been disposed
off by the courts and only 65 cases are pending
in courts.
1.5.4. Constitution of a Committee for considering
the representations of CHS Officers for
Upgradation of below bench Mark Grading in the
ACRs:
Consequent to the instructions contained in Department
of Personnel and Training’s O.M. No. 21011/1/
2010-Estt.A dated 13.4.2010 , a Committee under the
Chairmanship of Shri Keshav Desiraju , Additional
Secretary has been constituted for considering the
representations of hundreds of CHS officers for
upgradation of the below bench mark grading in their
ACRs.
1.5.5. Non Medical Scientists 2010-11.
A proposal has been mooted to amend the ISP Rules,
1990 to incorporate provisions for inclusion of more posts
within its ambit. Participating Units/Institutes have been
asked to submit proposals in this regard.
A proposal for amendment of UPSC (Exemption from
Consultation) Regulations, 1958 under Ministry of Health
and Family Welfare with the view to do away with the
requirement of consultation with the UPSC in the matter
of in-situ promotions upto S.IV level has been sent to
Department of Personnel and Training.
Action has been taken to fill up Seven posts as S-V level
with UPSC. Pending ACRs and Bio-data are being
collected.
1.5.6. Dental Side - 2010-11
During the year six posts of Dental Surgeons under
Ministry of Health and Family Welfare have been filled
up on regular basis. For one post, administrative formalities
are being completed before offer of appointment to be
issued to recommended candidate by UPSC.
13 officers had been considered for promotion to SAG
level. 7 were promoted and 6 were not found fit, as
having below bench mark of ACRs, formalities for
upgradation of ACRs as per DOP&T’s guidelines are
being completed.
The process has also been initiated to amend the Dental
Posts Recruitments Rules, 1997 to bring them in
conformity with the changes that have since taken place.
1.6 E-Governance Initiatives of the Ministry of
Health & FW
Health Informatics Division of National Informatics
Centre provides MIS and Computerization support to
Ministry of Health & Family Welfare. More than 1300
PCs of the Ministry are connected to the Local Area
Network (LAN), which in turn, connected to NICNET
through RF Link and leased line circuits. Salient features
of the some of the projects handled by NIC are as follows:
1.6.1. Web Page
The updation of Website of the Ministry of Health &
Family Welfare http://mohfw.nic.in and various other
websites under the Ministry are done on a regular basis,
as and when the information is provided by the users.
Critical information such as notifications of the CGHS,
Tenders and Advertisements under the Ministry, sanction
details of the Principal Accounts Office &
Public Expenditure Management, etc are such areas
where regular updation takes place. In addition a no. of
websites under the MoHFW are being maintained by the
respective users on their own.
1.6.2. Network Maintenance and email, internet
usage
NIC provides new LAN connections; network based Anti-
virus solution in addition to maintaining existing network
users. At present over 1300 LAN nodes have been
provided in the Department of Health & Family Welfare,
Directorate General of Health Services and about 100
LAN nodes at IRCS Building at Dept of AYUSH. The
email and internet usage has grown significantly and
officials prefer email communication over other means.
The network maintenance and desktops require constant
updation from the operating system service providers and
hence the un-authorized access is controlled effectively.
1.6.3. Computerization of Mother and Child
Tracking System (MCTS)
It has been decided to have a name-based tracking
whereby pregnant women and children can be tracked
for their ANCs and immunisation along with a feedback
system for the ANM, ASHA etc to ensure that all pregnant
Annual Report 2010-11 9
women receive their Ante-Natal Care Check-ups (ANCs)
and post-natal care (PNCs); and further children receive
their full immunisation. All new pregnancies detected/
being registered from 1
st
December 2009 at the first point
of contact of the pregnant mother with the health facility/
health provider would be captured as also all Births
occurring from 1
st
December, 2009. The states are putting
in place systems to capture such information on a regular
basis. The National Informatics Centre is rolling out their
software application to other States based on the Gujarat
model of e-Mamta.
The master data entry of health facilities is almost
complete and now states will start entering the names of
the mothers and children in the online system. The system
will help in developing work plan for the ANMs and
ASHAs so as to deliver the health services to all the
mothers and children. An offline version of the MCTS
system has also been developed for facilities where the
internet connectivity is not there and this can be linked to
the online system on a periodic basis. The first cycle of
the system is expected to be completed by March 2011.
The URL is http://nrhm-mcts.nic.in .
1.6.4. Computerization of Central Govt. Health
Scheme (CGHS)
CGHS is high on the agenda of the Government with the
ultimate objective to provide effective, timely and hassle
free healthcare to the CGHS beneficiaries. The
computerized system is aimed at computerizing all
functions of the dispensary such as Registration, Doctors’
prescription, Pharmacy Counter, Stores, Laboratory &
Indent etc. The system has been successfully
implemented in all the 24 cities of CGHS including Delhi/
NCR covering 248 allopathic wellness Centres (WCs).
The introduction of plastic cards for every individual
CGHS beneficiary with the barcoded number has been
implemented successfully in Delhi/NCR. Now all the new
CGHS beneficiary has to have a plastic card in all CGHS
cities.
Bulk procurement of commonly indented medicines from
manufacturers / suppliers has been successfully
operational in Delhi/NCR and in 6 cities outside Delhi/
NCR.
The implementation of online MRC Claims module is under
implementation in Delhi/NCR. The AYUSH WCs are
being computerized in Delhi/NCR and are expected to
be completed by March 2011. The URL of the site is
http://cghs.nic.in.
The implementation of the CompDDO package for the
DDOs of CGHS in Delhi/NCR and 6 cities outside Delhi/
NCR is underway.
The telephone number for the CGHS HELPLINE 011-
66667777 is operational during office hours on all working
days and it provides information to the CGHS
beneficiaries.
1.6.5. Intra-Health Portal for the Ministry:
Intrahealth portal is a G2G and G2E application and caters
to the needs of employees and Divisions of MoHFW /
DteGHS. It has the following facilities:
1. Notice Board consisting of circulars/orders issued
by various Divisions of MoHFW and DteGHS.
2. Payslips for the employees under Department of
Health & FW, AYUSH, DGHS are available online
3. Office Procedure Automation (OPA) for tracking
of file movements
4. Bulletin Board for exchange of views and
comments.
5. Links to various Govt. web-sites.
6. Photo gallery relating to important events in Health
and FW sector.
The portal URL is http://intrahealth.nic.in.
1.6.6.Computerisation of Medical Stores
Organization (MSO) and General Medical
Stores Depots (GMSDs)
The MSO is a premier organization of the MoHFW, which
is involved in procurement and supply of medicines to
the Central Govt. hospitals across India, CGHS, Para-
military forces. MSO does it through its 7 GMSDs located
across India. Inventory management is therefore, very
vital for the MSO so that the medicines are supplied to
the indenters in time after proper quality check.
The web based Inventory management system for the
MSO & GMSD has been implemented on a full scale
now. All the stakeholders such as MSO, GMSDs,
indenters, suppliers; Labs etc are using the online system.
The suppliers have been providing the medicine supplies
with the barcodes (1D) at the tertiary level packaging
and secondary level packaging. http://
msotransparent.nic.in
Annual Report 2010-11 10
1.6.7. Usage of NIC CompDDO package by
various DDOs under the MoHFW
Composite DDO Package (CompDDO) has been in
regular usage by Cash(Health) Section, Cash(FW)
Section, MoHFW, and Cash Section, DteGHS, Nirman
Bhawan, New Delhi, with the technical support from
NIC. The same package has been in use by PPAO,
PAO(Sectt.), PAO(DteGHS), attached with MoHFW/
DteGHS, Airport Health Office,New Delhi, Rural Health
Training Centre(RHTC),Najafgarh,New Delhi, and
National Centre for Disease Control(NCDC).
Recently,the package has also been installed and made
operational at FSSAI,National Institute of
Biologicals,Central Pharmacopia Commission and
National Institute of Health and FW. The package
automates functions of Cash Sections as regards
preparation of pay bills, payments of employees’ salaries
through their bank accounts/ECS, GPF, income tax, etc.
The staff at all these organizations/sites has been trained
to operate the package, and issues that arise from time
to time are taken care of by NIC..
1.6.8. CPGRAMS and E-Service Book
Centralised Public Grievance and Redressal & Monitoring
System (CPGRAMS) is under implementation in the
Ministry and DteGHS. It provides for on-line monitoring,
processing and disposal of Public Grievances.
E-service Book project has provision for updation and
maintenance of service books of employees
electronically. The project is under implementation in the
Ministry and DteGHS.
1.6.9. Usage of PAO Package of NIC under
MoHFW
PAO-2000 is a software package developed by NIC,
and it monitors details of expenditure by MoHFW,
DteGHS and sub-ordinate organizations through on-line
transfer of data from various PAOs to PPAO, MoHFW,
Nirman Bhawan, New Delhi. The PPAO then transmits
the compiled data to CGA through the NETWORK for
on-line updation of database at their end. Provision is
also there for various reports and queries at different
levels. The package is in continued usage by PAOs and
PPAO attached with MoHFW / DteGHS and sub-
ordinate organizations.
All the 11 PAOs attached with MoHFW / DteGHS and
sub-ordinate Organizations have been using the package:
1.PAO(Secretariat) 2.PAO(DteGHS) 3. PAO(Safdarjung
Hospital). 4. PAO(Dr RML Hospital) 5. PAO(LHMC)
6. PAO(NCDC) 7. PAO(CGHS) 8. PAO(Mumbai)
9. PAO (Kolkata) 10. PAO(Puducherry)
11. PAO(Chennai).
1.6.10. OncoNET India Project:
This project envisages connecting of 27 Regional Cancer
Centres with associated Peripheral Cancer Centres to
provide early cancer diagnosis/detection, treatment and
follow up for cancer patients. The project has been
implemented successfully in 4 RCCs and 4 PCCs at
present and 3 more sites are under implementation.
1.6.11. Implementation of e-Hospital Solution at the
Sports Injury Centre, Safdarjang Hospital,
New Delhi:
The e-Hospital
@NIC
- consists of more than 14 core
modules that cover major functional areas of the Hospital
viz. Out Patient Department, In Patient Department,
Casualty, Ward Management, Operation Theatre
Management, Clinic Information, Path Laboratories,
Radiology, Blood Bank, MRD, Stores & Inventory control
Management, Accounts, Personnel Management have
been planned for implementation during this year.
Implementation support is being provided by NICSI from
Sep, 2010.
1.6.12. Online allotment and Display System of
Central Quota of UG/PG Medical/Dental
seats:
DGHS, Ministry of Health & Family Welfare allots 15%
of M.B.B.S/B.D.S and 50% M.D/M.S/M.D.S and Post-
graduate Diploma seats of recognised Medical Colleges
to the merit holders as provided by CBSE/AIIMS who
conduct competitive examinations on All India basis. The
Computerized Allotment and Display System software
of NIC fully complies with guidelines and orders given
by Hon’ble Supreme Court of India and various other
High Courts on various occasions over the period of last
15 years or so. Salient features of the Scheme are as
follows:
1.6.13. Under-Graduate Counselling
• More than 2250 MBBS and around 200 BDS seats
are available in 127 colleges across India.
• Allotment is done in two or more rounds as per
court orders.
Annual Report 2010-11 11
• SC, ST, OBC and PH reservations done through
roster system approved for this purpose.
• This system does VC based on-line allotment at
Delhi, Kolkata, Chennai and Mumbai, through
NICNET.
1.6.14. Post-Graduate Counselling
• More than 4250 MD/MS/Diploma in 106 disciplines
and 154 PG Dental seats in 28 Dental Colleges
across India.
• Allotment is done in two or more rounds as per court
orders.
• SC, ST, OBC and PH reservations done thro’ roster
system devised for this purpose.
• This system does VC based on-line allotment at
Delhi, Kolkata, Chennai and Mumbai through
NICNET.
1.6.15. Technical Support to AYUSH
• NIC AYUSH wing provides necessary IT support
including LAN, WAN, web security, anti-virus etc
to all the users of AYUSH at IRCS Building, New
Delhi.
1.6.16.Integrated Disease Surveillance Project
(IDSP)
NIC has completed establishment of IT centers at all 796
IDSP sites across the country and handed over the same
to the IDSP wing of NCDC. The URL of the site is http:/
/idsp.nic.in.
1.7 ACCOUNTING ORGANIZATION
As provided in Article 150 of the Constitution, the
Accounts of the Union Government, shall be kept in such
form as the President of India, may on the advice of
Comptroller & Auditor General of India prescribe. The
Controller General of Accounts (CGA) in the M/o Finance
shall be responsible to prepare and compile the Annual
Accounts of the Union Government to be laid in
Parliament. The CGA performs this function through the
Accounts Wing in each Civil Ministry. The Officials of
Indian Civil Accounts Organization are responsible for
maintenance of Accounts in Ministry of Health & Family
Welfare. They have dual responsibility of reporting to the
Chief Accounting Authority of the Ministry/Department
through the Financial Adviser for administrative and
accounting matters within the Ministry, as well as to the
Controller General of Accounts, on whose behalf they
function in this Ministry to carry out its designated functions
under the Allocation of Business Rules. The administration
of Accounts Officials in Ministry of Health & Family
Welfare is under the control of the office of the CGA.
The Secretary of each Ministry/Department is the Chief
Accounting Authority in Ministry of Health & Family
Welfare. This responsibility is to be discharged by him
through and with the help of the Chief Controller of
Accounts (CCA) and on the advice of the Financial
Advisor of the Ministry. The Secretary is responsible for
certification of Appropriation Accounts and is answerable
to Public Accounts Committee and Standing Parliamentary
Committee on any observations of the accounts.
Accounting Set Up In the Ministry:
The Ministry of H&FW has four Departments viz.
Department of Health & Family Welfare, Department of
Ayush (Ayurveda, Yoga, Unani, Sidha & Homeopathy),
Department of Health Research & Department of AIDS
Control (NACO). There is a common Accounting Wing
for all the Departments. The Accounting Wing is
functioning under the supervision of a Chief Controller of
Accounts supported by a Controller of Accounts (CA),
Dy. CA and eleven Pay & Accounts Officers (PAOs)
and Drawing & Disbursing Officers (DDOs) in the field.
The CCA is submitting internal audit observations and
matter related to financial discipline directly to the
Secretary in respect of each Department and its
subordinate organizations. The Annual Review Report of
the Internal Audit is also subject to scrutiny by the CGA
and Ministry of Finance. The CCA is also entrusted with
the responsibility of Budget Division & Official Language
Division of the Ministry.
In addition, there are fourteen encadred posts of the
Accounts Officers located at various places. There is a
common Internal Audit Wing for all the Departments,
which carry out the inspection of all the Cheque Drawing
and Non-Cheque Drawing Offices, Pr. Accounts Office
and all the PAOs. There are 5 Field Inspection Parties
located at Delhi, Chandigarh, Mumbai, Kolkata and
Bangaluru.
Accounting Functions in the Ministry:
The Accounting function of the Ministry comprises of
various kinds of daily payments and receipts, compiling
Annual Report 2010-11 12
of daily challans, vouchers, preparation of daily
Expenditures Control Register etc. Monthly expenditure
accounts, monthly receipts and monthly net cash flow
statements are being prepared for submission to Ministry
of Finance through the CGA’s office. The entire work of
payment and accounts has been computerized.
The Pr. Accounts Office prepares Annual Finance
Accounts, Annual Appropriation Accounts, Statement of
Central Transactions, Annual Receipts Budget, Actual
Receipts and Recovery Statement for each grant of the
Ministry. The head wise Appropriation Accounts are
submitted to the Parliament by the CGA along with the
C&AG’s report.
In addition, the Pr. Accounts Office issues orders of
placement of funds to other civil Ministries, issues advices
to Reserve Bank of India (RBI) for release of loans/
grants to State Governments and LOC to the accredited
Bank of the Ministry for placing funds with DDOs. Apart
from general accounting functions, the Accounts Wing
gives technical advices on various Budgetary, Financial
and Accounting matters.
The Accounting Wing also functions as a coordinating
agency on all accounts matters between Ministry and
the Office of the Controller General Accounts & the
Comptroller and Auditor General. Similarly it coordinates
on all budget matters between Ministry and the Budget
Division of the Ministry of Finance.
Internal Audit Wing
The Internal Audit Wing of the Department of Health
and Family is handling the internal audit work of all the
four Departments. There are more than 600 audit units
of the Department of Health and Family Welfare, 24 units
of Department of AYUSH and 25 units of Department
of Health Research. The Internal Audit plays a significant
role in assisting the Departments to achieve their aims
and objectives.
The role of Internal Audit is growing and shifting from
Compliance audit confined to examining the transaction
with reference to Government Rules and Regulations to
complex auditing techniques of examining the
performance and risk factors of an entity. In 2009-10,
97 audit paras have been raised which include
observations to the tune of Rs. 1368.47 crores. A total
No. of 851 paras have been settled during 2009-10.
1.8 IMPLEMENTATION OF RTI ACT, 2005
The Right to Information Act, 2005, enacted with a view
to promote transparency and accountability in the
functioning of the Government by securing to the citizens
the right to access the information under the control of
public authorities, have already come into effect w.e.f.
12.10.2005.
Under the Right to information Act, 2005, 32 Central
Public Information Officers( CPIOs) and 17 Appellate
Authorities( A/As) have been appointed in the Ministry
of Health & Family Welfare (Department of Health &
Family Welfare).
All CPIOs including autonomous organizations/PSUs have
placed all obligatory information pertaining to their
Division/programme, under Section 4(i) of the RTI Act,
2005 in the Website of Ministry. Now RTI Request/
Appeal Management System (RRAMS) is under
implementing stage. Under this system CPIOs and
Appellate Authorities (including autonomous
organizations) would create computer Based
management of RTI requests and appeal.
Applications under the Act for seeking information are
accepted at Facilitation Centre, near Gate No.5, Nirman
Bhavan & at Coordination-II ( CDN-II) Section, Room
No. 215A, ‘D’ Wing, Nirman Bhawan, New Delhi.
Applications are also accepted by post through Receipt
& Issue (R&I) Section. During 2009-2010, 1541
applications and 250 RTI Appeals were received under
RTI Act, 2005. Annual return for the year 2009-2010
has already been sent to CIC. During 2010-11, 2419
applications and 389 appeals till 31.12.10 have been
received.
1.9 VIGILANCE
Vigilance Wing of the Department of Health and Family
Welfare functions under the overall control of an officer
of the rank of Joint Secretary to the Government of
India who also works as part time Chief Vigilance Officer
(CVO) of the Ministry . The CVO is assisted by a
part –time Director(Vig.), an Under Secretary(Vig.) and
the supporting staff of Vigilance Section.
The Vigilance Division of the Ministry deals with vigilance
and disciplinary cases of the Department of Health and
Family Welfare and vigilance cases involving officers of
Dte.GHS and CGHS. The Vigilance wing monitors
vigilance enquiries, disciplinary proceedings in respect of
Doctors and non-medical/technical personnel borne on
the Central Health Service (CHS), P&T Dt.GHS
Annual Report 2010-11 13
dispensaries and other institutions like Medical Stores
Organizations, Port Health Organizations, Labour Welfare
Organization etc.
During 2010-11(till ending December,2010), one charge
sheet each for major penalty and minor penalty for alleged
irregularities were issued. Penalties were imposed in 7
cases and charges were dropped in 6 cases. Sanction for
prosecution was granted in one case and 2 appeal cases
were received/processed. One official was placed under
suspension. Suspension was revoked in 2 cases and
ongoing cases of suspension were reviewed by the
Committee. More than 115 complaints were received from
CVC, 45 miscellaneous complaints were forwarded by
CBI and 75 complaints were received from other sources.
29 references were sent to CVC, 6 to UPSC, 3 references
to DOP&T and 6 references were sent to Ministry of
Law & Justice for advice. Presently there are 2 court
cases being dealt with in the Division.
Central Vigilance Commission guidelines of use
Information Technology for vigilance administration are
being implemented vigorously and major initiatives have
been taken regarding use of technology in e-governance
for minimising the need of interfacing officials with
beneficiaries. The entire process of registration of patients,
maintenance of personal records, prescription,
investigation advices, distribution of medicines etc. have
been computerised in the CGHS to make the entire
process transparent. In Central Drugs Standard and
Control Organization, standard operating procedures and
e-submission has been introduced. The official web-site
has also been launched giving all details.
Vigilance Division, MOHFW – Organization and
Functions
The Vigilance Division of the Ministry functions under
the overall control of the Chief Vigilance Officer (CVO),
an officer of the rank of Joint Secretary to Government
of India, assisted by a Director, an Under Secretary and
a Vigilance Section with supporting staff. The CVO is
appointed by the Department with the concurrence of
Chief Vigilance Commission. The CVO is responsible
for keeping an eye on the integrity and conduct of public
servants of the Ministry and also for implementation of
anti corruption measures. He deals with all vigilance
cases and act as a link between the Ministry and agencies
like CBI, CVC, UPSC, DOP&T, etc. The CVOs of the
autonomous organizations and VO’s in attached/ sub-
ordinate offices under the Ministry are appointed in
consultation with CVO.
The main function of the Division is to implement the
preventive and punitive measures to combat the
corruption. Preventive measures adopted are –
Examination of Rules and procedure of the organization
to eliminate or minimize scope for corruption, identification
of sensitive issues, surprise inspections, surveillance on
officers and doubtful integrity, scrutiny of property returns
etc.
The Division follows rules, regulations and guidelines
issued from time to time in respect of vigilance cases of
different types and appropriate action is taken in
consultation with CVC, UPSC, and DOP&T etc.
wherever necessary.
1.10 ACTIVITIES OF THE COMPLAINT
COMMITTEE ON SEXUAL
HARASSMENT OF WOMEN
EMPLOYEES
In pursuance of the directions of Hon’ble supreme Court
in their judgement in the case of Vishakha and other vs.
State of Rajasthan and others, a Complaint Committee
has been constituted in the Department of Health & Family
Welfare to look into the complaints of sexual harassment
of women employees in the Department. The SHC is
chaired by Smt. Shalini Prasad, Joint Secretary and has
three members Smt. Aparna Sachin Sharma, Smt. Rekha
Chauhan and Sh. J. P. Pandey. No new case is received
for hearing during the period 2010-11.
1.11 PUBLIC GRIEVANCE CELL
Public Grievance Redressal Mechanism is functioning in
the Ministry of Health & Family Welfare as well as in
the attached offices of the Directorate of Health Services
and the other Subordinate offices of CGHS (both in Delhi
and other Regions), Central Government Hospitals and
PSUs falling under the Ministry for implementation of
the various guidelines issued from time to time by the
Government of India through the Department of
Administrative Reforms & Public Grievances.
Shri B. Nayak, Joint Secretary in the Department of
Health & Family Welfare has been designated as Nodal
Officer for Public Grievances relating to the Department.
Shri R. D. Indora,Under Secretary in the Department of
Health & Family Welfare is functioning as Public
Grievance Officer. Similarly other organizations under
the Ministry have also senior level officials functioning
as Public Grievances Officers.
Annual Report 2010-11 14
No. of Disposal Pendency
Grievances
received
2259 1006 1253
Pursuant to the instructions of the Govt. for creation of
Sevottam Compliant system to redress and monitor public
grievances under Results Framework Documents for
2010-11 and implementation of Centralised Public
Grievance Redress and Monitoring System (CPGRAMS)
in the Ministries/Departments, CPGRAMS has been
implemented in the Department, Attached Office, i.e.,
Directorate General of Health Services,(DteGHS),
Central Govt. Health Scheme, and extended to
Autonomous Bodies/PSUs. It is being extended to other
Subordinate Offices of Dte.GHS It is a web based portal
and a citizen can lodge grievance through this system
directly with the concerned Departments. A link of
CPGRAMS has also been provided on the website of
the Ministry, i.e., www.mohfw.nic.in.
The number of written Grievance petitions received/
disposed of and pending during 2009 & 2010 are as
follows:
The position in regard to grievance received through
CPGRAMS is as under (as on 24.01.2011):
1.12 INFORMATION & FACILITATION
CENTRE
To strengthen the Public Redressal Mechanism in the
Ministry of Health & Family Welfare, an Information &
Facilitation Centre is functioning adjacent to Gate No.5,
Nirman Bhawan. The Facilitation Center provides the
following information to public:
1. Circulars/ Booklets/ Pamphlets/ Posters/ NGO
Guidelines and forms for public use.
2. Information and Guidelines to avail of financial
assistance from Rashtriya Arogya Nidhi and Health
Minister’s Discretionary Grant.
3. Guidelines and instructions regarding issue of NOC
to Indian Doctors to pursue higher medical studies
abroad.
4. Information and guidelines relating to CGHS and
Queries relating to the work of the Ministry.
5. Receiving Petitions/Suggestions on Public
Grievances.
6. General queries regarding the work of the Ministry
received at the Information and Facilitation Centre
on telephone and personally were disposed of to
the satisfaction of all concerned.
1.13. NATIONAL URBAN HEALTH MISSION
(NUHM)
The launch of National Rural Health Mission (NRHM)
for providing accessible, affordable and accountable
quality health services to the poorest households in the
remotest rural regions has changed the health services’
delivery scenario remarkably in the rural areas of the
country, particularly in the high focus/backward States.
However, while there is somewhat a uniform public health
infrastructure in the rural areas, it is largely non-existent
in urban areas except in some large urban centres and
metropolitan cities that too mostly focused on reproductive
and child health services. Approximately three-quarters
of urban healthcare is accounted for by private health
facilities and therefore, result in substantial out of pocket
expenses.
The health indicators for the urban poor are as bad as
their rural counterparts and much worse than the urban
average. Poor environmental condition in the slums along
with high population density makes them vulnerable to
various communicable and vector borne diseases.
Although, the government has been active in initiating
improvements in the living conditions in slums,
unsatisfactory living conditions continue to prevail in most
of the slums. The poor health outcomes can partially be
traced to the inadequate services, like water supply and
sanitation, and housing facilities.
The unenviable health indicators of the urban poor along
with not so effective health care service delivery
mechanism clearly articulate the need to address the
Year Opening Grievance Grievance Pending
Balance petitions petitions
received disposed
during of during
the year the year
2009 102 165 117 150
2010 150 249 225 174
Annual Report 2010-11 15
growing challenges of urban health in a concerted way.
Ministry of Health & Family Welfare proposes to launch
National Urban Health Mission (NUHM) to address these
issues with a focus on the slum dwellers and other
disadvantaged sections. The proposed NUHM, presently
at consultation stage, aims to improve the health status
of the urban population by facilitating equitable access to
quality healthcare with active involvement of the Urban
Local Bodies (ULBs) in cities with population of one
lakh and above and State Capitals.
The NUHM would encourage the participation of the
community in planning and management of health care
services. It would promote community leadership in urban
settlements; ensure the participation by creation of
community based institutions under the local bodies. It
would proactively reach out to urban poor settlements by
way of regular outreach sessions and monthly health and
nutrition day. It would mandate special attention for
reaching out to other vulnerable sections like construction
workers, rag pickers, sex workers, brick kiln workers,
rickshaw pullers, etc. This could be done through the
public healthcare systems or through PPP or other
innovative models deemed suitable by the states.
Discussions with various stakeholders including the States
and Union Territories, Ministry of Urban Development,
Ministry of Housing and Urban Poverty Alleviation have
been undertaken, to finalise the contours of the Mission
and formulation of the framework of its implementation.
NHUM would also leverage the reform component of
JnNURM for promoting public health component among
Urban Local Bodies. With a view to improving
convergence and synergy among various stakeholders,
NUHM would envisage the active participation of these
stakeholders in Mission Steering Group, Coordination
Committees at the national, state and municipal levels.
NUHM would also utilize the infrastructure and skill-
sets of other programmes like JnNURM, SJSRY and
ICDS etc. to improve the urban health care service
delivery system.
1.14 RURAL HEALTH SERVICES
The health and family welfare programme in the country
is being implemented through primary health care system.
In rural areas, primary health care services are provided
through a network of 145894 Sub-centres, 23391 Primary
Health Centres and 4510 Community Health Centres as
Item Amount
Salary of ANM and LHVAs per State Govt. pay scale
Rent Rs. 3000
Medicine To be supplied under RCH Programme
Contingency Rs. 3200
Voluntary Worker Rs.1200/- as honorarium
on March 2009 based on the following norms of population
case load/work load and distance.
The population norms for SC/PHC/CHC is as follows :
Sub-Centre
Sub-centre is the first peripheral contact point between
Primary Health Care system and the community. It is
manned by one Female (ANM) and one Male Health
Worker and one LHV for six such Sub-Centres. Sub-
centres are assigned task relating to maternal and child
health, family welfare, nutrition, immunization, diarrhea
control and control of communicable diseases
programmes and provided with basic drugs for minor
ailments needed for taking care for essential health need
for women and children. The number of sub-centres
functioning in the country present as on March, 2009 is
annexed.
Govt. of India bears the salary of ANM and LHV besides
rent liability and contingency whereas, the salary of the
Male Health Worker is borne by the State Governments.
Expenditure per annum for the existing Sub-centres
Under NRHM, Sub-centres are being strengthened by
provision of untied funds of Rs.10,000/- per year which
is operated by the ANM and the Sarpanch, supply of
allopathic and indigenous medicines and provision of an
additional worker (male multipurpose worker or additional
ANM), Annual maintenance grant of Rs.10,000/- is also
made available to every Sub-centre to undertake and
supervise improvement and maintenance of the facility.
Centre Plain Area Population
NormsHilly/
Tribal area
Sub-Centre 5000 3000
Primary Health
Centre (PHC) 30,000 20,000
Community Health
Centre (CHC) 1,20,000 80,000
Annual Report 2010-11 16
Upgradation of existing Sub-centres, including building
for Sub-centres functioning in rented premises and setting
them up as per 2001 census has also been envisaged
under NRHM.
Primary Health Centre (PHC)
PHC is the first contact point between village community
and the Medical Officer. It is manned by a Medical
Officer and 14 other staff. It acts as a referral Unit for
6 Sub-Centres and has 4-6 beds for patients. It performs
curative, preventive, promotive and Family Welfare
services. There are 23391 PHCs functioning in the
country.
The PHCs are being strengthened under NRHM to
provide a package of essential public health programmes
and support for outreach services to ensure regular
supplies of essential drugs and equipment, round the clock
services in all PHCs across the country, upgrading single
doctor PHC to 2 doctors PHC by posting AYUSH
practitioners at PHC level, provision of 3 Staff Nurses in
a phased manner. The States/UTs have to incorporate
their proposals and requirement of funds in their Annual
Programme Implementation Plans under NRHM. Untied
Grant of Rs.25,000/- per PHC for local health action and
Annual Maintenance Grant of Rs.50,000/- per PHC
through PHC level Panchayat Committee/Rogi Kalyan
Samiti to undertake and supervise improvement and
maintenance of physical infrastructure have been provided.
Community Health Centre (CHC)
CHC is established and maintained by the State
Governments and as per standards it is supposed to be
manned by four Medical specialists i.e. Surgeon,
Physician, Gynecologist and Pediatrician supported by 21
paramedical and other staff. It has 30 in-door beds with
one OT, X-ray, and Labour Room and Laboratory facilities
and serves as a referral centre for 4 PHCs. It provides
facilities for emergency obstaetrics care and specialist
consultations. Indian Public Health standards lays down
that this CHC is to be manned by 6 Medical Specialists
including Anaesthetics and an eye surgeon (for 5 CHCs)
supported by 24 paramedical and other staff with inclusion
of two nurse midwives in the present system of seven
nurse midwives. At present 4510 CHCs are functioning
in the country.
For Upgradation of CHCs as per the Indian Pubic Health
Standards (IPHS). State/UTs have been requested to
carry out the facility survey of all CHCs so as to gauge
the exact requirement of funds in terms of upgrdation of
the facility as far as manpower, building, equipments etc.
Funds are being provided every year as requested by the
States in their annual Programme Implementation Plan
under NRHM.
Strengthening of the Sub-Divisional /Sub-District and
District Hospitals
Strengthening of sub-divisional /sub-district and district
hospitals is an approved activity under NRHM. The funds
are released to States/UTs Governments as per their
requirement reflected in their annual PIP. The same is
examined in this Ministry and funds are released the
recommendations of NPCC.
Indian Public Health Standards (IPHS)
Indian Public Health Standards (IPHS), which detail the
specifications of standards to which institutions of primary
health care would have to be raised to so that the citizen
is confident of getting public health services in the hospital
that can be measured to be of acceptable standards. Indian
Public Health Standards (IPHS for Sub-centres, PHCs,
CHCs, Sub-divisional/Sub-district Hospitals and District
Hospitals lay down Standards not only for personnel and
physical infrastructure, but also for delivery of services,
and management. A system of performance bench marks
will be introduced to concurrently assess the adherence
of public hospitals to IPHS, in a transparent manner.
Each Hospital would, as part of IPHS, be required to set
up a Rogi Kalyan Samitti (RKS)/Hospital Management
Committee), which will bring in community control into
the management of public hospitals. Guidelines for setting
up of Rogi Kalyan Samiti have been circulated to all
States/UTs. Based on the registration details of RKSs
set up by various States/UTs, funds @ Rs. one lakh per
PHC, CHC, Sub-divisional/Sub-district Hospitals and @
Rs.5.00 lakhs per District Hospital have been released
for RKSs to these States/UTs. The objective is to provide
sustainable quality care with accountability and peoples
participation alongwith total transparency.
Mobile Medical Units/Health Camps
With the objective to take health care to the door step of
the public in the rural areas, especially in under-served
areas, Mobile Medical Units (MMUs), have been
provided, one per district under NRHM. The States are
however, expected to address the diversity and ensure
the adoption of more suitable and sustainable model for
Annual Report 2010-11 17
the MMU to suit their local requirements. They are also
required to plan for long-term sustainability of the
intervention.
Two kinds of MMUs are envisaged, one with diagnostic
facility for the States other than North-East States,
Himachal Pradesh and J&K. In addition, for the North-
Eastern States, Himachal Pradesh and J&K, specialized
facilities and services such as X-ray, ECG and ultrasound
are proposed to be provided in MMUs due to their difficult
hilly terrain, non-approachability by public transport, long
distances to be covered etc.
The States are needed to involve District Health Society/
Rogi Kalyan Samiti/NGOs in deciding the appropriate
modality for operationalization of the MMUs. The
provision of staff will be considered only for the States
who will run the vehicles with support of NGOs/RKSs
and in case of States out-sourcing the vehicles. States
are needed to work out numbers of mobile dispensaries/
health camps as a means of mobilizing local communities
of health action and for creating demand
Tackling the problem of lack of manpower in Rural
Areas:
The Government is seized of the problem of lack of
skilled manpower in rural health infrastructure. A number
of new and innovative steps have been taken by various
State/UT Governments to bridge the gap between the
available and required manpower especially for ensuring
the availability of Doctors in rural areas. A Task Group
constituted under the National Rural Health Mission under
the chairmanship of Director General of Health Services
has recommended the following measures to ensure the
services of doctors in rural areas :
• Increase in the age of retirement of doctors to 65
years preferably with posting near hometown;
• Decentralization of recruitment at district level;
• Walk-in-interview and contractual appointment of
doctors;
• Enhancing the salary for posting in rural areas by
one-third;
• Increasing the admission capacity in medical
colleges for Anaesthesia;
• Reviving the Diploma Course in Anaesthesia;
• To start one year Certificate Course in Anaesthesia
for Medical Officers working in the system at
present to be given by National Board of
Examination.
• Recognition of five hundred bedded Hospitals to
provide the facility for conducting the above course;
• Hiring of private practitioners on case-to-case
basis.
The above recommendation were circulated to All the
State /UT Governments. State/UT Governments have
taken a number of initiatives to ensure presence of
doctors in rural areas such as :
• Compulsory rural/difficult area posting for admission
to post-graduate courses and as a pre-requisite for
promotion, foreign assignment or training abroad ;
Compulsory rotation of doctors on completion of
prescribed tenure as per classification of locations;
• Contractual appointment of doctors;
• Option to forgo non practicing allowance and
undertake practice without compromising on
assigned duties, as per the service rules; offering
incentive in form of allowance etc.
• Manning of PHCs by NGOs/ Non Government
Stakeholders;
• Involvement of Medical colleges.
Apart from doctors, steps have been taken to deploy
contractual manpower in all other cadres ie. ANM,
MPWs, Pharmacists etc. The funds are being released
to all States/UTs under NRHM as per their demand
reflected in their NRHM PIPs. There has been significant
improvement in manpower after engaging contractual staff
under NRHM.
Annual Report 2010-11 19
Chapter 2
2.1 NATIONAL RURAL HEALTH MISSION
(NRHM)
The National Rural Health Mission was launched by the
Hon’ble Prime Minister on 12
th
April 2005, to provide
accessible, affordable and accountable quality health
services to the poorest households in the remotest rural
regions. The detailed Framework for Implementation that
facilitated a large range of interventions under NRHM
was approved by the Union Cabinet in July 2006. Under
the NRHM, the difficult areas with unsatisfactory health
indicators were classified as special focus States to ensure
greatest attention where needed. The thrust of the Mission
is on establishing a fully functional, community owned,
decentralized health delivery system with inter sectoral
convergence at all levels, to ensure simultaneous action
on a wide range of determinants of health like water,
sanitation, education, nutrition, social and gender equality.
Institutional integration within the fragmented health
sector was expected to provide a focus on outcomes,
measured against Indian Public Health Standards for all
health facilities. From narrowly defined schemes, the
NRHM is shifting the focus to a functional health system
at all levels, from the village to the district.
The NRHM is about increasing public expenditure on
health care from the current 0.9% of the GDP to 2 to 3%
of the GDP. The corollaries of such a policy directive are
not only has increased Central Government budgetary
outlay for health, but States are also make a matching
increase – at least 10% of the budget annually including
a 15% contribution into the NRHM plan, and that the
center – state financing ratio shifts from the current 80:20
to at least a 60:40 ratio in this plan period. Another
important corollary is that the state health sector develops
the capacities to absorb such fund flows. There are
currently many constraints, especially in the High Focus
states to absorb these funds and the poorest performing
states which require the largest infusion of resources have
NRHM, Health & NRHM, Health & NRHM, Health & NRHM, Health & NRHM, Health &
Population Policies Population Policies Population Policies Population Policies Population Policies
some of the greatest problems to spend the funds already
with them. This is one of the main reasons why a process
of reforming and strengthening the state health systems
needs to go hand in hand with the increase of fund flows.
The NRHM is thus also about health sector reform. The
architectural correction envisaged under NRHM is
organized around five pillars, each of which is made up
of a number of overlapping core strategies.
a) Increasing Participation and Ownership by the
Community: This is sought to be achieved through
an increased role for PRIs, the ASHA programme,
the village health and sanitation committee,
increased public participation in hospital
development committees, district health societies
in the district and village health planning efforts and
by a special community monitoring initiative and
also through a greater space for NGO participation.
b) Improved Management Capacity: The core of
this is professionalising management by building up
management and public health skills in the existing
workforce, supplemented by inculcation of skilled
management personnel into the system.
c) Flexible Financing: The central strategy of this
pillar is the provision of untied funds to every village
health and sanitation committee, to the sub-center,
to the PHC, to the CHC including district hospital.
d) Innovations in human resources development
for the health sector: The central challenge of
the NRHM is to find definitive answers to the old
questions about ensuring adequate recruitment for
the public health system and adequate functionality
of those recruited. Contractual appointment route
to immediately fill gaps as well as ensure local
residency, incentives and innovation to find staff to
work in hitherto underserved areas and the use of
Annual Report 2010-11 20
multi-skilling and multi-tasking options are examples
of other innovations that seek to find new solutions
to old problems.
e) Setting of standards and norms with
monitoring: The prescription of the IPHS norms
marks one of the most important core strategies of
the mission. This has been followed up by a facility
survey to identify gaps and funding is directed to
close the gaps so identified.
The NRHM approach is summed up in the figures below:
Many path breaking initiatives operationalised
under the NRHM
2.1.1. More than 8.3 lakh Accredited Social Health
Activists (ASHAs) are connecting households to health
facilities. The presence of community volunteers on this
unprecedented scale has resulted in people’s growing
pressure on utilization of services from the public sector
health system. States across the country are reporting
significantly higher utilization of outpatient services,
diagnostic facilities, institutional deliveries and inpatient
care. Large scale demand side financing under the Janani
Suraksha Yojana (JSY) has brought poor households to
public sector health facilities on a scale never witnessed
before. Over 348.94 lakh women have been covered
under JSY so far since its introduction in 2005.
2.1.2. A second ANM in Sub Centres, 3 Nurses in
PHCs for 24X7 services along with diagnostic services,
co-location of AYUSH doctor at PHC and availability of
Specialist Doctors and Nurses on a much larger scale
has been attempted under the NRHM to take
accountability to the people. States are recruiting Nurses
and other Para Medic Staff on contract based on local
criteria. Even Doctors and Specialists are recruited at
the district level on contract and based on local criteria.
Various form of performance based incentives have been
attempted to make money follow the patient and to keep
the motivation of public health workers in remote areas
high. A lot more needs to be done in the sphere for
performance based incentives in remote and difficult
areas in order to ensure availability of skilled human
resources where needed.
2.1.3. Through formation of registered Societies (Rogi
Kalyan Samitis) at PHCs, CHCs and District Hospitals,
legal entities are created that have far greater flexibility
in discharge of their functions. NRHM has provided an
opportunity to provide cashless hospitalised services to
the poor through the Rogi Kalyan Samiti resources. It
has also provided an opportunity to charge a modest fee
from those who can afford to pay. The Rogi Kalyan
Samitis have adequate resources for local health action
and for ensuring a well maintained hospital. Wherever
Medical Officers, in-charge of PHCs and CHCs and their
RKSs, have taken interest, the face of government hospital
has been transformed with the untied funds available to
every institution under NRHM. NRHM is an opportunity
for States to display to the people that fully functional
quality health care is possible within the existing public
system.
2.1.4. The untied grants to sub-centres has given a new
confidence to our ANMs in the field who are far better
equipped now with Blood Pressure measuring equipment,
stethoscope, the weighing machine etc. They can actually
undertake a proper ante-natal care and other health care
services. Sub Centres are now functioning as sub-centres
Annual Report 2010-11 21
providing services of which, many of them were absent
on account of lack of regular resources. The constitution
of the Village Health and Sanitation Committees is taking
a little time in many States as the effort is to set up these
Committees within the umbrella of Panchayati Raj
Institutions. The intention of NRHM is inter-sector
convergence and the effort in all the States is to bring
Health, Sanitation, Nutrition, Water and Education
together on a common platform within the framework of
PRIs, at the village level. The untied funds to Village
Committees are a great boon for public health action as
was demonstrated in Kerala in Alleppey District where
large scale vector control measures could be taken up
with untied funds.
2.1.5. Human Resources is a key issue in the health
sector and, specially, resident health workers in remote
areas. Some excellent innovations have been attempted
in the States to train local women as ANM. West
Bengal’s efforts in this direction has been path breaking
where educated women from the 100 most difficult blocks
of West Bengal are being trained to become ANMs on
condition that they go back to the village for performing
duties. The efforts to provide opportunities for ASHAs
and Aanganwadi Workers to become ANMs has also
been emphasised as ultimately the quest for better health
care must realize that a locally resident person is the
best bet to secure a resident health worker. The problems
of absenteeism can be tackled through emphasis on the
local criteria in such recruitments.
2.1.6. Many un-served areas have been covered
through Mobile Medical Units. The efforts in Gujarat in
this direction have been commendable. Andhra Pradesh’s
EMRI system enables people to access well equipped
ambulances within no time anywhere in the State. Such
successful models are worthy of replication and NRHM’s
efforts have been to encourage emulation. Sincere
efforts to promote good practices have been made by
providing opportunities of all State level teams to visit
such regions that have done good work. There is a lot to
learn from each other and NRHM promotes the bonding
of States through regular inter-State visits to see good
practices.
2.1.7. While in some regions government health facilities
have geared up by utilizing flexible finances under NRHM
to cope with the increased workload, in many other
regions there is a long way to go before health facilities
fully gear themselves to meet the growing need of people’s
health care. Poor households have voted with their feet
by coming to the public system as never before. The
challenge of NRHM now is to provide quality health care
to the growing number of households whose faith in the
government system has been restored. NRHM cannot
afford to let down poor households who have come to
the public system with so much hope and aspiration. There
is a sense of urgency in improving the facilities for quality
health care.
2.1.8. The journey of NRHM has been crafted by the
responses of the States. It is for the States to decide on
what their priorities are. District and State Programme
Implementation Plans form the basis of approvals. Never
before has there been so much flexibility in a programme
to suit the diverse needs of States and regions. NRHM
has set a new standard of partnership with States where
it is the States that determine what is needed to resolve
the crisis of the public sector health system. Human
Resources, physical infrastructure, equipment, capacity
building, resources, skill up-gradation resources etc. are
available on an unprecedented scale. The philosophy of
NRHM is to move from distrust to trust. Within the
umbrella of Panchayati Raj Institutions, NRHM has tried
to formulate an accountability framework that makes
every health facility responsible to the people whose needs
it caters to. Starting from the Village Health and Sanitation
Committees, NRHM has crafted facility specific public
institutions within the framework of PRI to ensure that
Health Institutions have the flexibility to deliver in
partnership with the community.
2.1.9. From the village to the district level all
requirements of the health system can be met through
the NRHM and States have come up with innovative
plans to suit their needs. Realizing the need for improved
management of the Public Sector Health System, NRHM
has extended management support to States at all levels
and for all institutions. The thrust on Nursing Institutions,
Nurses and ANMs has been its foremost message to the
States considering the need for public sector facilities to
provide round the clock services.
2.1.10. Improved Financial Management:
In order to ensure that enhanced fund allocations to
States/UTs and other institutions under the NRHM are
fully coordinated, managed, and utilized, the Financial
Management Group for NRHM (FMG-NRHM) has been
set up to operationalize the following financial management
arrangements and funds flow processes for release,
monitoring and utilization of funds under NRHM as per
Annual Report 2010-11 22
recommendations of the Empowered Programme
Committee (EPC).
Organizational Set up
1. Joint Secretary (Policy) heads the NRHM Division,
under him Director, NRHM (Policy) looks after
the policy, infrastructure Development, Coordination
& Human Resource Development functions.
2. NRHM Finance Division under the Director
(NRHM-Finance) is functioning under the direct
control of Special Secretary & Mission Director
(NRHM) and coordinates the financial
management activities of all NRHM Programmes
such as RCH-II, NRHM Additionalities, Routine
Immunization and the National Disease Control
Programmes.
3. NRHM Finance Division is functional since 21.12.
2006 with ministerial staff i.e Director, Under
Secretary, Accounts Officer, Section Officer and
other financial management staff. The reorganized
FMG-NRHM isstaffed also by financial
management personnel on contract basis such as
Finance Controllers, Finance Analysts, Financial
Assistants. All sanction orders for release of funds
under all programmes and pools under NRHM are
processed through the FMG.
Objectives of FMG-NRHM
• Bring about integration in the financial management
of the National Health Programs subsumed under
the NRHM.
• Improve Financial Management Systems at the
Centre, State and District levels under the NRHM.
• Systematize the funds flow, monitoring utilization,
accounting and audit of all programmes under
NRHM.
Functions of FMG-NRHM
• Release of funds under RCH Flexible Pool and
Mission Flexible Pool and clearance of release
proposals of all other programmes under NRHM.
• Centrally transfer funds electronically to State
Health Societies for all programmes under NRHM
and maintain a centralized data base for all releases
and utilization under all components of NRHM viz.
(a) RCH, (b) Additionalities under NRHM, (c)
Routine Immunization and (d) National Disease
Control Programs.
• Monitoring and compilation of Financial Monitoring
Reports (FMRs) on quarterly basis.
• Claim refund of eligible expenditure from
Development Partners like World Bank, UNFPA,
DFID etc.
• Statutory Audit arrangements and submission of
Audit Reports to Development Partners.
• Provide Financial Management Formats, monitor
financial performance indicators and update state-
wise profiles.
• Capacity building of finance and accounts personnel
of States/UTs.
• Obtaining UCs for various programs under NRHM.
• Generating MIS reports on the basis of FMRs
received.
System for Funds Release
• Obtaining approval of National Programme
Coordination Committee (NPCC) and
communicating approved amounts to States/UTs.
• Release of funds is made on the basis of BEs/REs
approved by the Ministry of Finance, communicated
separately to States.
• As per GFRs, up to 75% of the approved BEs are
released to States on receipt of provisional UCs/
FMRs for the previous year.
• Balance 25% is released after receipt of
satisfactory audited accounts with final UCs.
Concurrence of IF is obtained in all cases.
Training/capacity building of Finance & Accounts
Personnel
• FMG-NRHM periodically conducts the training of
Finance and Accounts personnel of State/District
Health Societies.
• State-wise workshops with State Finance and
Accounts Managers were organized in August,
2010 to discuss various issues to prepare and update
the state-wise profiles on financial management.
• NRHM Finance Division is actively engaged in
preparing E-training Modules, Hand Books for
Annual Report 2010-11 23
State, District and Block level finance personnel
under NRHM.
• While e-transfers through the accredited bank of
the Ministry are taking place to all States, e-banking
has been introduced on a pilot basis in Karnataka
Stae which uses the Core Banking System (CBS)
for generation of MIS report to provide information
on funds movement, utilization and unspent balances
to the management. The Ministry is awaiting the
results of the pilot initiated in Karnataka to further
implement e-banking in other States/UTs.
• Detailed Operational Guidelines on Financial
Management are also being prepared for adoption
and implementation at State, District and Block and
Village levels under the NRHM to being about
efficiency, accuracy and accountability in financial
processes.
2.1.11. Under NRHM, electronic Transfer of Funds
(ETF) has been started from GoI to States and also States
to Districts. This has reduced the time lag in transfer of
funds from 1-2 months to a few hours. E-banking is
being operationalized for real time financial reporting and
monitoring. Financial Monitoring Reports are now being
received from all States. Detailed guidelines for
Delegation of Administrative & Financial Powers under
NRHM have been given to States. State Finance and
Accounts Managers and accounts personnel have been
recruited at State, district and block levels under NRHM.
A system for Concurrent Audit has been set up in the
SHSs and DHSs.
The National Rural Health Mission represents a major
departure from the past, in that central government health
financing is now directed to the development of state
health systems rather than being confined to a select
number of national health programmes. NRHM is
therefore, an effort at building a partnership with States
to ensure meaningful reforms with more resources.
Ultimately, success of NRHM will depend on ability of
the Mission interventions to galvanize State Governments
into action, pursuing innovations and flexibility in all
spheres of public health action. The progress on several
key indicators on NRHM has been noticed.
2.1.12. Progress under National Rural Health
Mission (NRHM)
ASHAs
Selection of 8,33243 ASHAs have been done in
the entire country, out of which 7,82807 up to 1
st
Module and 6,75693 up to 2nd Module 6,59037up
to 3
rd
Module, 641421 up to 4
th
Module and 3,19429
up to 5
th
Module.
5.70 lakhs ASHAs have been provided with drug
kit as well.
Infrastructure
1.46 lakhs Sub-centres in the country are provided
with untied funds of Rs. 10,000 each. 4,82219 Sub-
centres & VHSC have operational joint accounts
of ANMs and Pradhans for utilization of annual
untied funds. 50,728 Sub-centres are functional with
second ANM.
Out of 4510 Community Health Centres(CHCs),
2921 CHCs have been selected for upgradation to
IPHS and facility survey has been completed in
2864 CHCs (includes other also).
29904 Rogi Kalyan Samitis have been registered
at different level of facilities.
Manpower
9856 Doctors and Specialist, 53552 ANMs, 26734
Staff Nurses,18272 Paramedics have been
appointed on contract by States to fill in critical
gaps.
Management Support
1784 professionals (CA/MBA/MCA) have been
appointed in the State and 635 District level
Program Management Units (PMU) and 3529
Block level Program Management Units (BPMU)
have been established to support NRHM.
Mobile Medical Units
In 381 districts, the Mobile Medical Units has been
operationalised till September,2010.
Immunization
Intense monitoring of Polio Progress – Services of
ASHA useful.
JE vaccination completed in 11 districts in 4 states
– 93 lakh children immunized during 2006-07. JE
vaccination has been implemented in 26 districts
of 10 states in 2007. The 11 districts of 4 states
where JE vaccination was carried out in 2006 have
introduced JE vaccine in Routine Immunization to
vaccinate new cohort between 1-2 years of age
with booster dose of DPT.
Annual Report 2010-11 24
House tracking of polio cases and intense
monitoring.
Neonatal Tetanus declared eliminated from 7 states
in the country.
Full immunization coverage evaluated at 43.5% at
the national level.(NFHS-III)
Accelerated Immunization Programme taken up for
EAG and NE State.
Institutional Delivery
Janani Suraksha Yojana (JSY) is operationalised in
all the States, 7.38 lakh women are benefited in
the year 2005-06, 31.58 lakh in 2006-07, 73.28 lakh
in 2007-08, 90.36 lakh in 2008-2009, 100.78 in the
year 2009-2010.
Neo Natal Care
Integrated Management of Neonatal and Childhood
Illnesses (IMNCI) started in 323 districts and
3,13,783 health personnel trained in IMNCI.
Convergence
Over 35 lakhs in 2006-07, 49 lakhs in 2007-08, 58
lakhs in 2008-2009, 58 lakhs in year 2009-2010,
and 34 lakhs in 2010-11 so far. Monthly Health and
Nutrition Days being organized at the village in
various States.
The States have constituted 4,98378 Village Health
and Sanitation Committees. They are being
involved in dealing with disease outbreak.
Convergence with ICDS/Drinking Water/
Sanitation/NACO/PRIs ground work completed.
School health programmes have been initiated in
over 26 States.
Health Action Plans
State PIPs have been received from 35 States/UTs
during the Plans have been apprised and funds are
being released for the year 2010-11.
The first cut of Integrated District Health Action
Plans (IDHAP) has been finalized for 642 districts.
Mainstreaming of AYUSH
Mainstreaming of AYUSH has been taken up in
the State.14766 AYUSH facilities are available at
District and below district level health institutions.
AYUSH person are part of State Health Mission /
Society / RKS / ASHA training as members.
Trainings
Trainings in critical areas including Anesthesia,
Skilled Birth Attendance (SBA) taken up for MOs/
ANMs. Integrated Skill Development Training for
ANMs/ LMV/MOs, Training on Emergency
Obstetrics care and No Scalpel Vasectomy (NSV)
for MOs, Professional Development Programme
for CMOs is on full swing.
ANM Schools being upgraded in all States.
New nursing schools taken up.
Health Resource Centres
National Health Systems Resource Centre
(NHSRC) set up at the National level.
Regional Resource Centre set up for NE.
State Resource Centre being set up by States.
Monitoring and Evaluation
Independent evaluation of ASHAs / JSY by
UNFPA / UNICEF / GTZ in 8 States.
Immunization coverage evaluated by UNICEF.
Independent monitoring by identified institutions like
Institute of Public Auditors of India.
Phase I of community monitoring in 9 states namely
Rajasthan, Orissa, Maharashtra, Madhya Pradesh,
Tamil Nadu, Chhattisgarh, Jharkhand, Karnataka
and Assam has been completed.
Concurrent evaluation by several independent
agencies is in progress.
District wise Annual Health Survey for high focus
states are in pipeline. Cabinet approved.
Surveys
NFHS III and DLHS III completed.
Financial Management:-
Financial Management Group set up under NRHM
in the Ministry.
During the FY 2005-06, out of total allocation of
Annual Report 2010-11 25
Rs. 6,731.16 crore for the ministry, an amount of
Rs. 5,862.57 crore was released as part of NRHM.
Against Rs. 9065 crore for NRHM activities during
2006-07, Rs. 7,361.08 crore released.
During the FY 2007-08, out of total allocation of
Rs. 11,010 crore for the ministry, an amount of Rs.
10,189.03 crore was released as part of NRHM.
During the FY 2008-09, out of total allocation of
Rs. 12,050 crore for the ministry, an amount of
Rs. 11,229.47 crore was released as part of NRHM.
During the FY 2009-10, out of total allocation of
Rs. 14,050 crore for the ministry, an amount of
Rs. 11631.39 crore was released as part of NRHM.
For the FY 2010-11, the total allocation for NRHM
is Rs. 15,440 crore for the ministry, an amount of
Rs. 4300.13 crore is released so far.
2.1.13. Interventions under NRHM to Address the
Issues Relating to Left Wing Extremism
From the directions of the Union Home Minister, 33 High
Focus District have been identified by the Planning
Commission in order to address the critical gaps in these
districts in respect of the certain key parameters of the
concerned Ministries through Integrated Action Plan
(IAP) with the support of the respective State
Governments, District Administration, Elected
Representative and the respective State Holders. An
Interministrial Committee has been set up for providing
necessary recommendations and suggests possible
interventions for the purpose of addressing the focused
need of the affected blocks.
The necessary steps have been initiated in the Ministry
of Health and Family Welfare to fill up the corresponding
critical gaps in health infrastructure, human resources,
training, immunization, supply of drugs and equipments
etc. The necessary preventive steps have been formulated
to incentivize the difficult areas.
The following are some of the Measure taken under
NRHM:
• A Cadre of supportive and caring ASHA’s created
to stem alienation.
• Bridging infrastructure and human resource gaps.
• Appointment of Resident Health workers through
local criteria.
• Organizing of outreach camps.
• Incentivizing health workers and pooling of
resources.
• Cluster based development through Community
Health Workers.
• Creation of separate cadre of Rural Medical
Assistance to serve in the conflict prone areas, like
Chhattisgarh.
• Providing reservation of seats in Post Graduation
for Medical Studies as an incentive for serving in
rural areas.
• Performance based incentives for difficult areas,
hard areas, allowances etc. for encouraging doctors
and specialists to serve in these areas.
• Short term courses for Medical Officers posted in
CHCs for comprehensive obstretrics care,
anesthesis for emergency obstetrics and neo-natal
care.
• Providing health care service to inaccessible areas
through Mobile Medical Units.
• To increase awareness among women and local
communities about their health rights and their
public service entitlements.
2.1.14. Supportive Supervision of High Focus
Districts
In order to provide emphasis on evidence based planning,
using data triangulation methods in order to include some
non-negotiable elements and targeted health outcomes,
an attempt has been made to undertake Supportive
Supervision in 264 pre-identified backward districts for
high focus planning, based on the following criteria:-
• 140 backward districts based on ranking of 13
indicators from the DLHS III data prepared by the
Statistics Division of the Ministry. The indicators
inter alia include female literacy, households with
low standard of living, percentage of girls married
below 18 years, use of contraceptives, institutional
births, full Immunization, proximity to health
facilities, road connectivity etc, among others.
• Those districts with SC/ST population above 35%.
It is desirable that a certain percentage of allocation
is earmarked in the District Plans for these pockets
in the non SC/ST majority districts to minimize
Annual Report 2010-11 26
disparities. Some of the North Eastern States have
been excluded in this criterion, as they already have
a high percentage of tribal population and this
earmarking may not be essential.
• 33 highly left wing affected districts as prepared
by the Ministry of Home Affairs.
The Supportive Supervision intervention consistently
engages in refinement of the tools and techniques used
for reporting. It also serves as a channel for horizontal
communication of ideas and innovations to the state
through sharing of experiences between consultants.
For the purpose, the Ministry of Health & Family Welfare
has developed an action oriented monitoring plan in which
joint teams have been formed to visit the high focus
districts, in which the Consultants are visiting the states
in the identified districts and providing assistance to them
for improving the measurable health indicators with the
objective to bring desired improvements in health
indicators. The visits of consultants to the health facilities,
viz. Sub-centers, PHCs/CHCs and DH are relating to
monitoring of the progress, status and functioning of health
facilities in terms of infrastructure, human resources,
training etc. together with the quality of health care
service delivery by interaction with ASHAs, PRIs, Civil
Society Group etc.
Consultants interact at various levels such as village, block,
district, state and the center. Real time feedback is given
to the facility in charge. A detailed report so prepared is
shared with district and state authorities and submitted
at respective Programme Directors level for necessary
action.
2.1.15. Meeting of International Advisory panel on
NRHM
A meeting of the International Advisory Panel on NRHM
under the chairmanship of the Hon’ble Minister for
Health & Family Welfare held was on 7
th
August, 2009.
In this meeting several important issues relating to rural
health were discussed in detail.
The last meeting of the Forum held on 4
th
February, 2010
had recommended certain issues for implementation.
Among the various recommendations of IAP meeting held
on 7.9.2009 one recommendation was regarding
possibilities to explore the partnership with IAP in
developing model districts across the country, and adopt
the same practices in respect of districts of other States.
2.1.16. Meeting of Inter-Sectoral convergence
under NRHM with the other departments
of the Government of India.
A meeting of the Inter-Sectoral convergence under
NRHM was held on 7
th
September, 2010 with the
departments of HRD, Rural Development, Human and
Child Development, Panchayati Raj and the Department
of AYUSH. Among the various recommendations of the
meetings, one of the recommendations was for better
implementations of School Health Programme and Joint
Review of the Programme by the two Ministers. The other
important recommendations include, preparation of Health
Education Module for National Literacy Mission;
preparation of Integrated Training Module with inputs from
the Ministers of Health (including NACO & AYUSH),
Education, Women and Child Development (WCD), Water
and Sanitation; preparation of common IEC booklets with
inputs from (including NACO & AYUSH) and
preparation of training module for Emergency Medicine
for AYUSH doctors at public health facilities; Joint
Review of the programmes of Health and the Ministry of
Education.
2.2. HEALTH POLICY
The National Health Policy-2002 (NHP-2002) gives prime
importance to ensure a more equitable access to health
services across the social and geographical expanse of
the country. The policy outlines the need for improvement
in the health status of the people as one of the major
thrust areas in the social sector. It focuses on the need
for enhanced funding and organizational restructuring of
the public health initiatives at national level in order to
facilitate more equitable access to the health facilities.
An acceptable standard of good health amongst the
general population of the country is sought to be achieved
by increasing access to the decentralized public health
system by establishing new infrastructure in deficient
areas, and by upgrading the infrastructure in the existing
institutions. Emphasis has been given to increase the
aggregate public health investment through a substantially
increased contribution by the Central Government.
Priority would be given to preventive and curative
initiatives at the primary health level through increased
sectoral share of allocation.
2.3. NATIONAL COMMISSION ON
POPULATION
In pursuance of the objectives of the National Population
Policy 2000, the National Commission on Population was
Annual Report 2010-11 27
constituted in May 2000 to review, monitor and give
directions for the implementation of the National
Population Policy (NPP), 2000 with a view to meeting
the goals set out in the Policy, to promote inter-sectoral
co-ordination, involve the civil society in planning and
implementation, facilitate initiatives to improve
performance in the demographically weaker States in
the country and to explore the possibilities of international
cooperation in support of the goals set out in the National
Population Policy.
The first meeting of the Commission was held on
22.07.2000 and the then Prime Minister had announced
the formation of an Empowered Action Group within the
Ministry of Health and Family Welfare for paying focused
attention to States with deficient national socio-
demographic indices and establishment of National
Population Stabilization Fund [Jansankhya Sthirata Kosh]
to provide a window for canalizing monies from national
voluntary sources to specifically aid projects designed to
contribute to population stabilization.
The National Commission of Population has since been
reconstituted in April 2005 with 40 members under the
Chairmanship of the Prime Minster. Minister of Health
& FW and the Deputy Chairman of the Planning
Commission are Vice Chairmen of the Commission. The
present membership also includes the Chief Ministers of
the States of Uttar Pradesh, Madhya Pradesh, Rajasthan,
Bihar, Jharkhand, Kerala and Tamil Nadu.
The reconstituted National Commission on Population had
decided on the following.
• There should be Annual Health Survey of all
districts which could be published annually so that
health indicators at district level are periodically
published, monitored and compared against
benchmarks.
• Setting up of five groups of experts for studying
the population profile of the States of Bihar, Uttar
Pradesh, Rajasthan, Madhya Pradesh and Orissa
to identify weaknesses in the health delivery
systems and to suggest measures that would be
taken to improve the health and demographic status
of the States.
Annual Health Survey: The Ministry is in the process
of conducting an Annual Health Survey (AHS) to prepare
the District Health Profile of all Districts in pursuance to
the decisions of the National Commission on Population.
The Registrar General of India (RGI) has been designated
as the Nodal agency. The Mission Steering Group (MSG)
of NRHM, in its third meeting had approved the proposal
for AHS in 284 EAG districts including Assam. The
Survey is being conducted by RGI at an estimated annual
cost of Rs.110 crores. The current status of the Survey
is that the field units have been identified, the sample
units selected and the survey schedules/questionnaire
finalized in consultation with various stake holders. The
survey would be spread over 20252 sampling units in the
9 States and shall cover about 36 lakh households. It is
expected that the first set of results would be available in
early 2011.
Expert Groups: Five groups of experts were
constituted for studying the population profile of the States
of Bihar, Uttar Pradesh, Rajasthan, Madhya Pradesh and
Orissa. The draft reports of the expert groups was
examined in the Commission for correctness of the
demographic data and then sent to the concerned five
States for the following: -
o Commenting on the report of the expert group.
o Provide an update on what they are doing for
stabilization of population under NRHM.
o Prepare a presentation on their work on Population
Stabilization for the next meeting of the NCP.
The Commission has been providing policy support to the
population stabilization efforts under overall framework
of implementation of NRHM by the states. The
Commission has come out with a number of publications
in collaboration with Registrar General of India and
Institute of Economic Growth, which provides valuable
inputs on future demographic trends, challenges and
suggestive measures for achieving population stabilization
as envisaged in NPP 2000 and NRHM goals.
The second meeting of the Commission was held on 21
st
October 2010 under the Chairmanship of Prime Minister.
The Commission deliberated upon population stabilization
issue amongst other issues and after deliberation, the
Commission adopted the following resolution with broad
consensus recommending the key points for the
stakeholders as follows:
• According Priority
o Population Stabilization should be accorded high
priority.
Annual Report 2010-11 28
o Chief Ministers should provide leadership to the
promotion of small family norm.
o Social experts, social scientists and communication
experts should be involved.
o A safe motherhood campaign should be carried out
on the lines of pulse polio programme, with focus
on population issues.
• Programmatic Interventions
o IEC Campaign should be revitalized vigorously.
o Undertake strategy to meet the unmet need for
family planning services.
o Strengthen Public Health services and facilities like
clean toilets, water, electricity, etc.
o Strengthen Post Partum family planning services
at all centres where deliveries takes place.
o Focus to be on Delay of age at marriage, delay in
birth of first child and promotion of birth spacing
between children.
o Availability of medicines at all Public Health
Facilities.
o Involve AYUSH Doctors in family planning
programmes.
• Inter-Sectoral Co-ordination
o Ministries of HRD, WCD and Panchayati Raj
should be actively involved in population stabilization
programme.
o Utmost attention to be given for education,
particularly of girls.
o Education regarding family life including
reproductive and sexual health issues at a younger
age be given to adolescents to further
empowerment of women.
o Interventions to improve nutritional status,
particularly pregnant mothers to be strengthened.
o Institutions and Hospitals run by institutions like ESI,
Railways and Defence Services should be involved
in family planning services.
• Other Interventions
o Raising of legal age at marriage of girls to be
considered.
o Gender to be included in medical education.
o NGOs working among members of Muslim
Community may be actively involved in enhancing
awareness regarding small family norms.
o Emphasis on research to develop more innovative
contraceptives to expand available contraceptive
choices.
o Availability of funds for heath sector, as well as for
family planning should be increased.
2.4. JANSANKHYA STHIRATA KOSH
The National Population Stabilisation Fund was constituted
under the National Commission on Population in July 2000.
Subsequently it was transferred to the Department of
Health and Family Welfare in April 2002. It was renamed
and reconstituted as Jansankhya Sthirata Kosh (JSK)
under the Societies Registration Act (1860) in June 2003.
The General Body of JSK is chaired by the Minister for
Health and Family Welfare, while the Governing Board
is chaired by Secretary (H & FW). The Executive
Director is the Chief Executive Officer of the Kosh.
JSK has undertaken a number of initiatives for population
stabilization which in brief are as follows:
GIS Mapping: JSK has taken up the mapping of 485
districts and its sub divisions in the country through a unique
amalgamation of GIS maps and Census data. The maps
identify the basic health infrastructure available and
accessibility in terms of availability of roads. The density
of population in each district has now been added as
another layer, to provide an in - depth view of the health
services availability in relation to the density of population
in the area.
Call Centre: JSK runs a Call Centre (1800-11-6555) to
provide reliable and authentic information on issues
related to reproductive and child health. It specifically
cater to adolescents, newly married and about to be
married persons from the High Focus states of UP, Bihar,
MP, Rajasthan, Jharkhand and Chhattisgarh. Till 31
st
October 2010, the Call Centres have received
approximately 2,00,000 calls and more than 3,00,000
enquiries. The maximum numbers of queries being
received are on issues related to contraception, pregnancy,
sexual health and infertility. Strict quality checks are in
place to ensure high quality service. Extensive publicity
has been taken up to promote the Call Centre number.
Annual Report 2010-11 29
Prerna Strategy: This strategy identifies and recognizes
young married couples from backward districts who have
adopted Responsible Parenthood Criteria as role models
for other young couples in the district. JSK has instituted
Prerna Awards for couples who fulfil basic criteria, which
are girls marrying at the age of 19; having first child two
years after marriage; and keeping a gap of 3 years
between first and second child followed by sterilisation
of either parent. The couples are awarded with a
certificate and Kisan Vikas Patras at a widely publicized
and well attended function in the district. JSK has worked
in tandem with Union Ministries/ Departments, district
administration, civil society, the community, and corporate
houses and has identified 378 couples till 31
st
October
2010 to award them with the Prerna Award.
Santushti: The Santushti strategy provides private sector
gynaecologists and vasectomy surgeons an opportunity
to conduct sterilisation operations in Public Private
Partnership (PPP) mode under the scheme already
announced by Ministry of Health and Family Welfare in
September 2007. It offers accredited health facilities a
start up advance for 100 sterilization surgeries and an
additional Rs 500 per case to accredited nursing homes
for conducting 30 sterilization cases in camp mode in a
single day. Under this Scheme, 3331 sterilizations have
been performed during the period April 2010 to October
2010.
IUCD 380A: JSK has taken up the promotion of the
IUCD 380 A as a contraceptive device offering long term
highly effective, reversible protection against pregnancy.
Till dated about 400 senior Obstetricians and
Gynaecologists have been trained on NTT for IUCD 380A
insertion in different training sessions organized by JSK.
Presently JSK is pursuing training of more doctors, ANMs
in target States to increase utilization rates of this device.
Celebration of World Population Day 2010:
MoHFW, JSK and Govt. of NCT, Delhi jointly organized
a run for population stabilization on Raj Path, New Delhi
on the Population Day in which 3000 adolescents from
schools of Delhi participated.
The event was flagged up by the Union Minister for
Health & Family Welfare, Shri Ghulam Nabi Azad and
Chief Minister of Delhi, Smt. Shiela Dikshit in presence
of Union Minister of State for Health & Family Welfare
and important dignitaries of Govt. of NCT, Delhi. The
event was marked with participation of Kumari Saina
Nehwal, the World acclaimed Badminton star in the run.
Emphasizing the need of population stabilization Shri Azad
reiterated Government’s commitment to promote
population stabilization by making people aware about the
benefit of small families and on the need to educate girls.
He ruled out coercion completely in the efforts for
population stabilization. Speaking on the occasion, Smt
Sheila Dikshit stressed the need for empowerment of girls
and women to control population growth. The event was
widely covered in both print and electronic media. JSK
collaborated with NDTV to highlight Population
Stabilisation efforts of Union Government before a large
audience through some of its popular shows preceded
with week long promos and factoids on the issues.
Activities in states having high population growth:
In partnership with Kendriya Vidyalaya Sangathan and
DPS society, JSK organized debate, painting and
photography competition on Population Stabilisation
themes in schools managed by KVS and DPS Societies
in states of UP, Bihar, MP, Rajasthan, Jharkhand, Orissa,
Delhi and Chhattisgarh in which approximately 3.5 lakh
children participated.
A national level quiz and debate competition was organized
in Delhi on Population Stabilization for schools from the
6 states. Shri Dinesh Trivedi, the Minister of State for
Health and Family Welfare gave away the prizes to the
winning teams and participants.
In Bihar, competitions were organized in all higher
secondary schools in partnership with the State Education
Department thereby reaching out to almost 25 lakh
students.
At university/ higher level institutions, JSK organized
various competitive events on Population Stabilisation in
medical colleges of Bihar and Kalinga Institute of Medical
Sciences (KIMS) Orissa.
Annual Report 2010-11 30
Mid-Media Campaign
JSK in participation with the Song & Drama Division of
GOI organized 2000 shows in selected high fertility
districts on issues of Population Stabilisation.
Advertisement panels highlighting population issues were
printed and distributed in high fertility states for its display
in schools to make the adolescent aware about the
impending need of population stabilization.
2.5. FAMILY PLANNING INSURANCE
SCHEME
2.5.1. India is the first country that launched a National
Family Planning Programme in 1952, emphasizing fertility
regulation for reducing birth rates to the extent necessary
to stabilize the population at a level consistent with the
socio-economic development and environment protection.
Since then the demographic and health profiles of India
have steadily improved.
2.5.2. Government of India Scheme to
Compensate Acceptors of Sterilization for
Loss of Wages:
With a view to encourage people to adopt permanent
method of Family Planning, Government has been
implementing a Centrally Sponsored Scheme since 1981
to compensate the acceptors of sterilization for the loss
of wages for the day on which he/she attended the
medical facility for undergoing sterilization.
Apart from providing for cash compensation to the
acceptor of sterilization for loss of wages, transportation,
diet, drugs, dressing etc. out of the funds released to
States/UTs under this scheme, some States/UTs were
apportioning some amount for creating a miscellaneous
purpose fund. This fund was utilized for payment of ex-
gratia to the acceptor of sterilization or his/her nominee
in the unlikely event of his/her death or incapacitation or
for treatment of post operative complications attributable
to the procedure of sterilization, as under:-
i) Rs. 50,000/- per case of death.
ii) Rs. 30,000/- per case of incapacitation.
iii) Rs.20,000/- per case of cost of treatment of serious
post operation complication.
Any liability in excess of the above limit was to be borne
by the State/UT/NGO/ Voluntary Organization concerned
from their own resources.
The Hon’ble Supreme Court of India in its Order dated
1.3.2005 in Civil Writ Petition No. 209/2003 (Ramakant
Rai V/s Union of India) has, inter alia, directed the Union
of India and States/UTs for ensuring enforcement of
Union Government’s Guidelines for conducting sterilization
procedures and norms for bringing out uniformity with
regard of sterilization procedures by -
I. Creation of panel of Doctors/health facilities for
conducting sterilization procedures and laying down
of criteria for empanelment of doctors for
conducting sterilization procedures.
II. Laying down of checklist to be followed by every
doctor before carrying out sterilization procedure.
III. Laying down of uniform proforma for obtaining of
consent of person undergoing sterilization.
IV. Setting up of Quality Assurance Committee for
ensuring enforcement of pre and postoperative
guidelines regarding sterilization procedures.
V. Bringing into effect an Insurance Policy uniformly
in all States for acceptors of sterilizations etc.
The above directions have all been taken into consideration
and consolidated in the updated manuals on Standards
and Quality Assurance in Sterilization Services available
on the Ministry’s website (www.mohfw.nic.in). The
Family Planning Insurance Scheme is one of the initiatives
launched under direction from the Hon’ble Supreme Court
w.e.f 29
th
November, 2005.
Under the existing Government Scheme no compensation
was payable for failure of sterilization, and no indemnity
cover was provided to Doctors/Health Facilities providing
professional services for conducting sterilization
procedures etc. There was a great demand in the States
for indemnity insurance cover to Doctors/Health Facilities,
since many Govt Doctors are currently facing litigation
due to claims of clients for compensation due to failure
of sterilization. This has led to reluctance among the
Doctors/Health Facilities to conduct sterilization
operations.
2.5.3. First Year of Scheme : With a view to do away
with the complicated process of payment of ex-gratia to
the acceptors of Sterilisation for treatment of post
operative Complications, or Death attributable to the
procedure of sterilization, the Family Planning
Insurance Scheme (FPIS) was introduced w.e.f 29
th
Annual Report 2010-11 31
November, 2005 with Oriental Insurance Company,
to take care of the cases of Failure of Sterilization,
Medical Complications or Death resulting from
Sterilization, and also provide Indemnity Cover to the
Doctor / Health Facility performing Sterilization procedure,
as follows:-
Section I:
a) Death due to Sterilization in
hospital: Rs.1,00,000/-
b) Death due to Sterilization
within 30 days of discharge
from hospital Rs.30,000/-
c) Failure of sterilization
(including first instance of
conception after sterilization). Rs.20,000/-
d) Expenses for treatment of
medical complications due to
sterilization operation (within
60 days of operations Rs.20, 000/-*
Total liability of the Insurance Company shall not exceed
Rs. 9 crore in a year under each Section.
(*To be reimbursed on the basis of actual expenditure incurred,
not exceeding Rs.20, 000.)
Section II: All the doctors/health facilities including
doctors/health facilities of Central, State, Local-Self
Governments, other public sectors and all the accredited
doctors/health facilities of non-government and private
sectors rendering Family Planning Services conducting
such operations shall stand indemnified against the claims
arising out of failure of sterilization, death or medical
complication resulting therefrom upto a maximum amount
of Rs. 2 lakh per doctor/health facility per case, maximum
upto 4 cases per year. The cover would also include the
legal costs and actual modality of defending the
prosecuted doctor/health facility in Court, which would
be borne by the Insurance Company within certain limits.
2.5.4. Second Year of Scheme : This scheme was
renewed with Oriental Insurance Company w.e.f.
29-11-06 with modification in the limits and payment
procedure.
2.5.5. Third Year of Scheme : This scheme was
renewed with ICICI Lombard Insurance Company and
improved w.e.f. 01-01-08 with modification in the limits
and payment procedure based on 50 lakh sterilization
accepters. The revised packages are as follows:
Section Coverage Limits
I A Death due to Sterilization in
hospital or within 7 days from
the date of discharge from the
hospital. Rs. 2 lakh.
B Death due to Sterilization
within 8 -30 days from the
date of discharge from the
hospital. Rs. 50,000
C Failure of Sterilization Rs 30,000
D Cost of treatment upto 60 Actual not
days arising out of Complication exceeding
from the date of discharge. Rs 25,000/-.
II Indemnity Insurance per Upto Rs.2
Doctor/facility but not more Lakh per
than 4 cases in a year. claim
Total liability of the insurance Company shall not exceed
Rs. 9 crore in a year under each Section.
The revised package and guidelines are as follows:
Section Coverage Limits
I IA Death due to Sterilization
in hospital or within 7 days
from the date of discharge
from the hospital. Rs. 2 lakh.
IB Death due to Sterilization
within 8 - 30 days from the
date of discharge from the
hospital. Rs. 50,000/-.
IC Failure of Sterilisation Rs 25,000/-.
ID Cost of treatment upto 60 Actual not
days arising out of Complication exceeding
from the date of discharge. Rs 25,000/-.
II Indemnity Insurance per Upto
Doctor/facility but not more Rs. 2 Lakh
than 4 cases in a year. per claim
Total liability of the Insurance Company shall not exceed
Rs. 9 crore in a year under each Section.
Annual Report 2010-11 32
For the policy period of 1/1/2008 to 31/12/2008 an amount
of Rs. 31741700 was paid as premium. 3786 claims,
amounting to Rs. 13.63 crore was paid. Out of which Rs.
9.00 crore was paid by ICICI and Rs. 4.63 crore was
paid by the Ministry for claims in excess of Insures liability
of Rs. 9.00 crore upto Nov, 2010.
2.5.6. Fourth Year of Scheme : This scheme was
renewed with ICICI Lombard Insurance Company based
on 45 lakh sterilization accepter’s w.e.f. 01-01-09 with
modification in procedure as follows:
For the policy period of 1/1/2009 to 31/12/2009 an amount
of Rs. 49297951 was paid as premium. 3821 claims,
amounting to Rs. 14.40 crore was paid. Out of which
Rs. 9.00 crore was paid by ICICI and Rs. 5.40 crore
was paid by the Ministry for claims in excess of Insures
liability of Rs. 9.00 crore upto Nov, 2010.
2.5.7. Fifth Year of Scheme : This scheme was
renewed with ICICI Lombard Insurance Company w.e.f.
01-01-10 with all benefits available as mentioned under
Policy-2009 above based on 50 lakh sterilization accepters;
however, total Liability of the Insurance Company was
amended and shall not exceed Rs. 14.00 crore in total
inclusive of both under Section-I & II instead of Rs. 9.00
crore under each Section.
Section Coverage Limits
I A Death following Sterilization
in hospital or within 7 days from
the date of discharge from the
hospital. Rs. 2 lakh
B Death following Sterilization
within 8-30 days from the date
of discharge from the
hospital. Rs. 50,000
C Failure of Sterilization Rs. 30,000
D Cost of treatment upto Actual not
60 days arising out of exceeding
complication from the Rs 25,000/-
date of discharge.
II Indemnity Insurance per Upto Rs. 2
Doctor/facility but not more Lakh
than 4 cases in a year. per claim
Total liability of the insurance Company shall not exceed
Rs. 9 crore in a year under each Section.
For the policy period of 1/1/2010 to 31/12/2010 an amount
of Rs. 143390000 was paid as premium. 3132 claims,
amounting to Rs.10.73 crore was paid by the ICICI upto
Nov, 2010.
2.5.8. Sixth Year of Scheme : This Scheme is renewed
with ICICI Lombard Insurance Company w.e.f.
01.01.2011 based on 50 lakh sterilization accepters;
however, total Liability of the Insurance Company is
amended and shall not exceed Rs. 25.00 crore under
Section-I Rs. 1.00 crore under Section-II. A Premium
amounting Rs. 25,90,05,000 including service tax is paid
on 31/12/2010. The benefit under the policy is as follows:
2.6. COMPENSATION FOR ACCEPTORS OF
STERILIZATION
With a view to encourage people to adopt permanent
method of Family Planning, Government has been
implementing a Centrally Sponsored Scheme since 1981
to compensate the acceptors of sterilization for the loss
of wages for the day on which he/she attended the
medical facility for undergoing sterilization.
Section Coverage Limits
I A Death following Sterilization in
hospital (inclusive of death during
process of sterilization operation) or
within 7 days from the date of
discharge from the hospital. Rs. 2 lakh
B Death following Sterilization
within 8-30 days from the date of
discharge from the hospital Rs. 50,000
C Failure of Sterilization Rs. 30,000
D Cost of treatment upto 60 days Actual not
arising out of complication exceeding
following sterilization operation Rs. 25,000
(inclusive of complication during
process of sterilization operation)
from the date of discharge.
II Indemnity Insurance per Up-to Rs. 2
Doctor/facility but not more lakh per claim
than 4 cases in a year.
Note: The Liability of the insurance Company shall not exceed
Rs. 25.00 crore in a year under Section I and Rs. 1.00 crore under
Section II.
Annual Report 2010-11 33
Under the Scheme, compensation for loss of wages to
acceptors of sterilization was revised with effect from
31.1-.2006 and has been further improved with effect
from 7.9.07 .Revision in the compensation package to
boost to male participation in family planning i.e.
Vasectomy from existing Rs.800/- to Rs.1500/- and
Tubectomy from Rs.800/- to Rs.1000/- in public facilities
and to Rs.1500/- for both Vasectomy and Tubectomy in
accredited private health facilities to all categories in High
Focus States and BPL/ SC/ST in Non- High Focus States
with categorization of population as BPL, SC/ST and
Above Poverty Line (APL) and health facilities at public/
accredited private institutions has been approved. The
details of the revised scheme are as under:-
A. Public (Government) Facilities:
B. Accredited Private/NGO Facilities:
Category Type of operation Facility Motivator Total
*High focus 18 States Vasectomy(ALL) 1300 200 1500
Tubectomy(ALL) 1350 150 1500
**Non High focus Vasectomy (ALL) 1300 200 1500
17 States/UTs. Tubectomy (BPL + SC/ST) 1350 150 1500
Category Breakage of Acceptor Motivator Drugs and Surgeon Anaesthetist Staff OT / Refresh- Camp- Total
the dressings charges nurse technician ment manage
Compensation helper ment
package
*High Vasectomy 1100 200 50 100 - 15 15 10 10 1500
focus (ALL)
18 States Tubectomy
(ALL) 600 150 100 75 25 15 15 10 10 1000
**Non Vasectomy 1100 200 50 100 - 15 15 10 10 1500
High focus (ALL)
17 States/UTs Tubectomy
(BPL + SC/ST
only)) 600 150 100 75 25 15 15 10 10 1000
**Non Tubectomy 250 150 100 75 25 15 15 10 10 650
High (NON BPL +
focus NON SC/ST
17 States/ only) i.e. APL
UTs.
Annual Report 2010-11 34
*High Focus States- Bihar, Uttar Pradesh, Madhya
Pradesh, Rajasthan, Jharkhand, Chattisgarh, Uttrakhand,
Orissa, Jammu & Kashmir, Himachal Pradesh, Assam,
Arunachal Pradesh, Manipur, Mizoram, Meghalaya,
Nagaland, Tripura, Sikkim.
**Non-High Focus States- Karnataka, Kerala,Tamil
Nadu, Andhra Pradesh, Maharashtra, Goa, Gujarat,
Punjab, Haryana, West Bengal, Delhi, Chandigarh,
Puducherry, Andaman & Nicobar Islands, Lakshadweep
& Minicoy Islands, Dadra & Nagar Haveli, Daman &
Diu.
No apportioning of the above amount is admissible for
creating a miscellaneous purpose fund for payment of
compensation in case of deaths, complications and failures
as these are already covered under the National Family
Planning Insurance Scheme.
2.7. HEALTH INSURANCE SCHEME
A Task Force was established by the MOHFW to explore
new health financing mechanisms. The terms of reference
for this task force included review of existing mechanisms
to include health financing, human resource implications
to manage health financing and risk pooling schemes,
extent of subsidies required, ensuring equity and non-
discrimination, feasibility in various states, suggested
design of pilots and sites to launch community based health
insurance models, and required modifications of existing
structures to introduce health financing schemes.
This Ministry had advised the State/UT Governments to
prepare Health Insurance models as per their local
prepare Health Insurance models as per their local needs
to be run on pilot basis and certain guidelines were sent
to all States/UTs for preparation of pilot projects on Health
Insurance. Government of India will provide support to
State Governments under National Rural Health Mission.
The support from Government of India, for paying
premium for the Health Insurance Scheme for the BPL
families has been fixed as per Universal Health Insurance
Scheme of the Ministry of Finance, at Rs. 300/- for a
family of five.
The states which are implementing the Health Insurance
scheme for BPL population within the NRHM
framework, however, piloted and based on the local needs
are as under:
Din Dayal Antyoday Upchar Yojana - Madhya
Pradesh
The Government of Madhya Pradesh is providing free
treatment and investigation facility on hospitalization and
investigation facility on hospitalization without any
exclusion up to a limit of Rs. 20,000/- per family per annum
in all government health facilities to the under privileged
section of the society i.e. 57 lakh BPL families and 10
lakh other families under Din Dayal Antyoday Upchar
Yojana from 25
th
September 2004. The benefit is provided
for all disease and conditions including delivery, without
any exclusion. The Department of Public Health and
Family Welfare, Government of MP is the Implementing
Agency for the Scheme in the state. The average benefit
availed is under Rs. 1,000/- per family per annum.
Mukhya Mantri Raksha Kosh for BPL
Population ñ Rajasthan
Government of Rajasthan has launched the Mukhya
Mantri Jeevan Raksha Kosh with effect from January 1,
2009 and is being implemented to provide free in-patient
care and out-patient care to BPL families. BPL card
holder will get cash less health care facilities in Medical
Colleges, District hospitals and CHCs of the district for
inpatient care for any ailment and OPD care. Further, if
high end care facility not available in the state for such
ailment, they shall be sent out of the state to AIIMS, New
Delhi or PGI, Chandigarh for such treatment.
2.8. HEALTH MINISTERíS
DISCRETIONARY GRANT
Financial assistance up to maximum of Rs.50,000/- is
available to the poor indigent patients from the Health
Minister’s Discretionary Grant to defray a part of the
expenditure on Hospitalization/treatment in Government
Hospitals in cases where free medical facilities are not
Annual Report 2010-11 35
available. The assistance is provided for treatment of life
threatening diseases i.e. Heart, Cancer, Kidney, Brain-
tumor etc.. During the year 2009-10, financial assistance
totaling Rs.30.80 lakh was given to 167 patients. A
provision of Rs.100.00 lakh has been made during the
current financial year 2010-11. Till 3
rd
0January, 2011, a
sum of Rs.71.20 lakh has been released to 198 patients.
2.9. RASHTRIYA AROGYA NIDHI (RAN)
Rashtriya Arogya Nidhi was set up under Ministry of
Health & Family Welfare in 1997 to provide financial
assistance to patients, living below poverty line, who are
suffering from major life threatening diseases to receive
medical treatment in Government Hospitals. Under the
scheme of Rashtriya Arogya Nidhi, grants-in-aid is also
provided to State Governments for setting up State Illness
Assistance Funds. Such funds have been set up by the
Governments of Andhra Pradesh, Bihar, Chhattisgarh,
Goa, Gujarat, Himachal Pradesh, Jammu & Kashmir,
Karnataka, Kerala, Madhya Pradesh, Jharkhand,
Maharashtra, Mizoram, Rajasthan, Sikkim, Tamil Nadu,
Tripura, West Bengal, Uttarakhand, Haryana, Punjab,
Uttar Pradesh, NCT of Delhi and Puducherry. The
Grants-in-aid released to these Funds are at Table-A.
Other States/Union Territories have been requested to
set up such Fund, as soon as possible.
Applications for financial assistance up to Rs.1.5 lakh
are to be processed and sanctioned by the respective
State Illness Assistance Fund. Applications for assistance
beyond Rs.1.50 lakh and also of those where State Illness
Assistance Fund has not been set up are processed in
this Department for release from the Rashtriya Arogya
Nidhi.
In order to provide immediate financial assistance, to the
extent of Rs.1.00 lakh per case, to critically ill, poor
patients, who are living below poverty line (BPL) and
undergoing treatment, the Medical Superintendents of Dr.
RML Hospital, Safdarjung Hospital, Smt. Sucheta Kriplani
Hospital, All India Institute of Medical Sciences, New
Delhi, PGIMER, Chandigarh, JIPMER, Puducherry,
NIMHANS, Bangalore, CNCI, Kolkatta, Sanjay Gandhi
Post Graduate Institute of Medical Sciences, Lucknow,
RIMS, Imphal and NEIGRIHMS, Shillong have been
provided with a revolving fund of Rs.10-40 lakhs. The
revolving fund is replenished after its utilization. For cases
requiring financial assistance above the Rs.1.00 lakh per
case the applications are processed in the Department of
Health & Family Welfare through a Technical Committee
headed by Special Director General (ME), DGHS before
being considered for approval by a duly constituted
Managing Committee with Hon’ble Minister for Health
& Family Welfare as the Chairman. During the year 2009-
10, financial assistance totalling Rs.710.69 lakh was given
directly to 228 patients under Rashtriya Arogya Nidhi
(Central fund) and further, the revolving fund of amount
Rs.325.00 lakhs has been given to the above Hospitals/
Institutes. A provision of Rs.700.00 lakh has been made
during the current financial year 2010-11. Till 3
rd
January,
2011, a sum of Rs.599.63 lakh has been released to 200
patients, and further, revolving fund of amount Rs.130.00
lakh has been released to the above Hospitals/ Institutes.
2.10. HEALTH MINISTERíS CANCER
PATIENT FUND
“Health Minister’s Cancer Patient Fund” (HMCPF)
within the Rashtriya Arogya Nidhi (RAN) has also been
set up in 2009. In order to utilize the HMCPF, the
revolving fund as under RAN, has been established in
the various Regional Cancer Centre(s) (RCCs). Such step
would ensure and speed up financial assistance to needy
cancer patients and would help to fulfill the objective of
HMCPF. The financial assistance to the cancer patient
up to Rs.1.00 lakh would be processed by the concerned
Institute on whose disposal the revolving fund has been
placed. Individual cases which require assistance more
than Rs.1.00 lakh but not exceeding Rs.1.50 lakh is to be
sent to the concerned State Illness Assistance Fund of
the State/UT to which the applicant belongs or to this
Ministry in case no such scheme is in existence in the
respective State or the amount is more than Rs.1.50 lakh.
Initially, 27 Regional Cancer Centres (RCC) were
proposed at whose on proposal revolving fund of Rs.10.00
lakh was placed (List of RCCs is at Table B & C).
During the current financial year 2010-11 i.e. till 3rd
January, 2011, a sum of Rs.270.00 lakh have also been
released to 14 Regional Cancer Centres.
Annual Report 2010-11 36
TABLE-A
Year-wise Budget Estimate State/UT amount to
which grant was released (Rs. in crore)
Year Budget State/ UTs. Amount
Estimate (to which (Rs. in
(B.E) grant crore)
(Rs. in released)
crore)
1996-97 25.00 Karnataka 5.00
Madhya Pradesh 5.00
Tripura 2.00
NCT of Delhi 0.50
1997-98 25.00 Andhra Pradesh 5.00
Tamil Nadu 5.00
Himachal Pradesh 0.25
Jammu & Kashmir 0.25
NCT of Delhi 0.25
1998-99 25.00 Maharashtra 2.00
West Bengal 0.50
Kerala 1.00
Mizoram 0.50
Rajasthan 1.00
NCT of Delhi 0.50
1999-2000 25.00 Goa 0.15
Gujarat 1.00
Rajasthan 1.00
2000-01 6.50 Sikkim 0.25
Rajasthan 0.50
J & K 0.125
Bihar 1.25
Goa 0.15
2001-02 4.00 Chhattisgarh 0.50
Andhra Pradesh 2.50
2002-03 2.80 NCT of Delhi 0.40
Jharkhand 1.50
Rajasthan 1.00
2003-04 3.50 Uttaranchal 0.25
2003-04 3.50 Uttaranchal 0.25
Jharkhand 0.50
Jammu & Kashmir 0.24
Kerala 1.00
Rajasthan 1.01
NCT of Delhi 0.50
2004-05 3.20 Chhattisgarh 2.05
Karnataka 1.00
Goa 0.90
NCT of Delhi 0.25
Pondicherry 0.25
2005-06 3.00 Rajasthan 1.00
Mizoram 0.15
Tamil Nadu 1.05
Haryana 0.50
NCT of Delhi 0.30
2006-07 3.00 Andhra Pradesh 0.65
Jammu & Kashmir 0.125
Kerala 0.275
Tamil Nadu 0.95
Rajasthan 1.00
NCT of Delhi 0.25
2007-08 5.00 West Bengal 1.1025
Goa 0.30
Himachal Pradesh 0.27
Madhya Pradesh 0.8750
Rajasthan 1.00
Punjab 0.4525
NCT of Delhi 0.70
Puducherry 0.25
2008-09 5.00 Punjab 0.0475
Kerala 2.00
Uttar Pradesh 2.50
Goa 0.30
Sikkim 0.4750
2009-10 5.00 West Bengal 2.156
Chhattisgarh 1.8750
Haryana 0.25
2010-11 5.00 Tamil Nadu 2.50
Goa 0.25
West Bengal 1.25
Haryana 0.25
Annual Report 2010-11 37
TABLE-B
List of 27 Regional Cancer Centre and Financial
Assistance provided to them during the year 2009-2010
from Health Minister Cancer Patient Fund (HMCPF)
within Rashtriya Arogya Nidhi (RAN) Scheme are given
below.
List of 27 Regional Cancer Centre(s)
Sl. Name of Institute Rs. in
No lakh
1. Chittaranjan National Cancer Institute,
Kolkata, West Bengal 30.00
2 Kidwai Memorial Institute of
Oncology, Bangalore, Karnataka 10.00
3. Regional Cancer Institute (WIA),
Adyar, Chennai, Tamil Nadu 20.00
4 Acharya Harihar Regional Cancer
Centre for Cancer Research &
Treatment, Cuttack, Orissa. 10.00
5 Regional Cancer Control Society,
Shimla, Himachal Pradesh 10.00
6 Cancer Hospital & Research
Centre, Gwalior, Madhya Pradesh 10.00
7 Indian Rotary Cancer Institute,
(AIIMS), New Delhi 10.00
8 R.S.T. Hospital & Research Centre,
Nagpur, Maharashtra 10.00
9 Pt. J.N.M. Medical College,
Raipur, Chhattisgarh. 10.00
10 Post Graduate Institute of
Medical Education & Research,
Chandigarh 10.00
11 Sher-I Kashmir Institute of
Medical Sciences, Soura, Srinagar. 10.00
12 Regional Institute of Medical
Sciences, Manipur, Imphal 10.00
13 Govt. Medical College & Associated
Hospital, Bakshi Nagar,Jammu 10.00
14 Regional Cancer Centre,
Thiruvananthapuram, Kerala 10.00
15 Gujarat Cancer Research Institute,
Ahmedabad, Gujarat 10.00
16 MNJ Institute of Oncology,
Hyderabad, Andhra Pradesh 10.00
17 Puducherry Regional Cancer
Society, JIPMER, Puducherry 10.00
18 Dr. B.B. Cancer Institute,
Guwahati, Assam 10.00
19 Tata Memorial Hospital,
Mumbai, Maharashtra 10.00
20 Indira Gandhi Institute of
Medical Sciences, Patna, Bihar 10.00
21 Acharya Tulsi Regional
Cancer Trust & Research
Institute (RCC), Bikaner, Rajasthan. 10.00
22 Regional Cancer Centre,
Pt. B.D.Sharma Post Graduate
Institute of Medical Sciences,
Rotan, Haryana. 10.00
23 Regional Cancer Centre,
Pt. B.D.Sharma Post Graduate
Institute of Medical Sciences,
Rotan, Haryana. 10.00
24 Civil Hospital, Aizawl, Mizoram 10.00
25 Sanjay Gandhi Post Graduate Institute
of Medical Sciences,Lucknow 10.00
26 Kamala Nehru Memorial Hospital,
Allahabad, Uttar Pradesh 10.00
27 Govt. Arignar Anna Memorial
Cancer Hospital, Kancheepuram,
Tamil Nadu. 10.00
Total = Rs.280.00 lakh released in 2009-10
*Fund is yet to be released.
TABLE-C
List of Regional Cancer Centres and Financial Assistance
provided to them during the year 2010ó2011 from
(HMCPF within RAN) Scheme, are given below.
(in Rs. lakh)
1. Director, CNCI, Kolkata Rs .60.00
2. Chief, AIIMS, New Delhi Rs. 30.00
3. Director, RCC, Kerala Rs. 40.00
4. Med. Supdt., Rogi Kalyan Samiti, Shimla Rs. 20.00
5. Med. Supdt.,Civil Hos. Aizawl, Mizoram Rs. 20.00
6. Med. Supdt., Agartala, Tripura Rs.20.00
Annual Report 2010-11 38
2.11. PRE- CONCEPTION AND PRE-NATAL
DIAGNOSTIC TECHNIQUES
(PROHIBITION OF SEX SELECTION)
ACT, 1994.
Adverse Child Sex-Ratio in India
Sex ratio (number of females per thousand males) is one
of the most important indicators used for study of
population characteristics. The declining trend in sex ratio
has been a matter of concern for all in the country. Sex
ratio in India has declined over the century from 972 in
1901 to 927 in 1991. The sex ratio has since gone up to
933 in 2001.
In contrast the child sex ratio for the age group of 0-6
years in 2001census was 927 girls per thousand boys as
against 945 recorded in 1991 Census. The encouraging
trend in the sex ratio during 1991-2001 was marred by
the decline of 18 points in the sex ratio of children aged 6
years or below.
The Census 2001 figures further reveal that the child sex
ratio is comparatively lower in the affluent regions, i.e.,
Punjab (798), Haryana (819), Chandigarh (845), Delhi
(868), Gujarat (883), Himachal Pradesh (896) and
Rajasthan (909). (These are the seven focus States/
UTs for purposes of the PC&PNDT Act, 1994).
Some of the reasons commonly put forward to explain
the consistently low levels of sex ratio are son preference,
neglect of the girl child resulting in higher mortality at
younger age, female infanticide, female foeticide, higher
maternal mortality and male bias in enumeration of
population. Easy availability of the sex determination tests
and abortion services may also be proving to be catalyst
in the process, which may be further stimulated by pre-
conception sex selection facilities.
Sex determination techniques have been in use in India
since 1975 primarily for the determination of genetic
abnormalities. However, these techniques were widely
misused to determine the sex of the foetus and subsequent
abortions if the foetus was found to be female.
In order to check female foeticide, the Pre-natal
Diagnostic Techniques (Regulation and Prevention of
Misuse) Act, 1994, was brought into operation from 1
st
January, 1996. The Pre-natal Diagnostic Techniques
(Regulation and Prevention of Misuse) Act, 1994 has
since been amended to make it more comprehensive. The
amended Act and Rules came into force with effect from
14.2.2003 and the PNDT Act has been renamed as “Pre-
conception and Pre-Natal Diagnostic Techniques
(Prohibition of Sex Selection) Act, 1994” to make it more
comprehensive.
The technique of pre-conception sex selection has been
brought within the ambit of this Act so as to pre-empt the
use of such technologies which significantly contribute
to the declining sex ratio. Use of ultrasound machines
has also been brought within the purview of this Act more
explicitly so as to curb their misuse for detection and
disclosure of sex of the foetus lest it should lead to female
foeticide. The Central Supervisory Board (CSB)
constituted under the Chairmanship of Minister for Health
and Family Welfare has been further empowered for
monitoring the implementation of the Act. State level
Supervisory Boards on the line of the CSB constituted
at the Centre have been introduced for monitoring and
reviewing the implementation of the Act in States/UTs.
The State/UT level Appropriate Authority has been made
a multi member body for better implementation and
monitoring of the Act in the States. More stringent
punishments are prescribed under the Act so as to serve
as a deterrent for minimizing violations of the Act.
Appropriate Authorities are empowered with the powers
of Civil Court for search, seizure and sealing the machines,
equipments and records of the violators of law including
sealing of premises and commissioning of witnesses. It
has been made mandatory to maintain proper records in
respect of the use of ultrasound machines and other
equipments capable of detection of sex of foetus and also
in respect of tests and procedures that may lead to pre-
7. Med.Supdt., JIPMER, Puducherry Rs.10.00
8. Director & Dean, Chennai Rs.10.00
9. Hon. Director, Ahmedabad.(Gujarat.) Rs.10.00
10. Tata Memo.Centre, Mumbai Rs.10.00
11. Director, Bangaluru Rs.10.00
12. Med. Supdt. Kamala Nehru Memorial
Hospital, Allahabad. (Uttar Pradesh) Rs. 10.00
13 MS, PGIMER, Chandigarh Rs.10.00
14 Director, RCC Raipur, Chhattisgarh Rs.10.00
Total= Rs.270.00 lakh
(as on 03.01.11)
Annual Report 2010-11 39
conception selection of sex. The sale of ultrasound
machines has been regulated through laying down the
condition of sale only to the bodies registered under the
Act.
Punishment under the Act
Imprisonment up to 3 years and fine up to Rs. 10,000/-.
For any subsequent offences, imprisonment up to 5 years
and fine up to Rs. 50,000 / Rs.1,00,000.The name of the
registered medical practitioner is reported by the
Appropriate Authority to the State Medical Council
concerned for taking necessary action including
suspension of the registration if the charges are framed
by the court and till the case is disposed off.
Status and Report from States/UTs
As per the reports received from the States and UTs,
39854 bodies using ultrasound, image scanners etc. have
been registered under the Act. 462 ultrasound machines
have been sealed and seized for violation of the law. As
on 30.06.2010, there were 706 ongoing cases in the Courts
for various violations of the law. Though most of the
cases (223) are for non-registration of the centre/clinic,
216 cases relate to non-maintenance of records, 155 cases
relate to communication of sex of foetus, 36 cases relate
to advertisement about pre-natal/conception diagnostic
facilities and 76 cases relate to other violations of the
Act/Rules.
The concerned state governments are regularly requested
to take effective measures for speedy disposal of the
ongoing cases. Ministry of Health and Family Welfare
has taken a number of steps for the implementation of
the Act. The major steps taken are as follows:
Meetings of the Central Supervisory Board (CSB)
Meetings of the Central Supervisory Board (CSB) of PC
& PNDT Act are being held regularly (every six months)
under the Chairpersonship of Union Minister of Health
and Family Welfare. So far, 16 meetings have been held.
Sensitization through Members of Parliament
Funds were released to the Governments of Chandigarh,
Delhi, Gujarat, Haryana, Himachal Pradesh, Punjab and
Rajasthan at the rate of Rs.5.00 lakh per Hon’ble
Member of Parliament (both Lok Sabha and Rajya Sabha)
of these States/UTs, considered sensitive from the point
of view of Child Sex Ratio, for undertaking awareness
generation activities like organising exhibitions, seminars,
workshops, trainings / orientations programmes for PRIs,
public meetings, debates, essay competitions, nukkad
nataks, stage shows etc.
On 2.10.2007 on the occasion of the Birth Anniversary
of the Father of the Nation, Mahatma Gandhi, a signature
campaign was launched to generate awareness regarding
the evils of female foeticide. H.E. the President of India
appended her signature first on the scroll as the first citizen
of the country. Rallies were also organised on 4.10.2007
in every district of the NCT of Delhi to generate
awareness among the public.
The National Level Meeting on ‘Save the Girl Child’ held
on 28.4.2008 at Vigyan Bhawan, New Delhi, was
inaugurated by Dr. Manmohan Singh, Hon’ble Prime
Minister of India, in the presence of the Hon’ble Union
Minister of Health & F.W., Hon’ble Union Minister of
State (I/C) for Women & Child Development and Hon’ble
Minister of State for Health & F.W.. The large turn-out
of Ministers, Members of Parliament and senior Health
officers from the Central and State/UT Governments and
representatives of various organisations active in the area
of Child welfare at the day long fruitful deliberations of
the National Meet lent the necessary impetus to the ‘Save
the Girl Child’ mission. All the State/UT Governments
were requested to replicate such meeting in their
respective States/UTs. The message of the above
National Level Meet was disseminated through the
accredited print and electronic media.
Medical Audit
It is proposed to conduct Medical Audit of the ultrasound
clinics in the country in a phased manner to spread
awareness of the Act and required procedural formalities
so as to prevent violations of the Act. Scrutinizing ‘Form
F’ filled in respect of all pregnant women by the clinics
will also help in detecting violations, if any.
Changing Appropriate Authorities
In place of Chief Medical Officer / District Health Officer,
District Collectors / District Magistrates have been
nominated as District Appropriate Authorities to
strengthen the implementation of the Act at the ground
level. States of Maharashtra, Tripura, Gujarat, and
Chhattisgarh have informed that they have issued the
necessary notification in this regard.
Annual Report 2010-11 40
Proposed Amendments to PC & PNDT Act.
To make the implementation of the Act more effective
and stringent, it is proposed to amend certain provisions
of the Act, such as changing the Appropriate Authority
at the State level from Director (H&FW) to Secretary
(H&FW) to facilitate the reporting of District Appropriate
Authority (DAA) to State Appropriate Authority (SAA),
inclusion of an officer of or above the rank of Joint
Director of H&FW in the SAA, and vesting the power
the search and seize records to any Group B Gazetted
Officer.
Funding to the State through RCH - II
Funds have been provided to all States/UTs, as requested
by them, in their Programme Implementation Plan under
RCH – II for undertaking various activities for
implementation of the Act at the State level.
Inclusion of the issue under NRHM
Sensitization on sex ratio issue has been made a part of
curriculum for ANMs. For tracking delivery of a pregnant
woman, ASHAs are now provided a fixed remuneration
at the village level (Keeping a track of the ante-natal
check-ups and accompanying the pregnant mother to an
institution for delivery).
Constitution of National Inspection and Monitoring
Committee (NIMC)
A National Inspection and Monitoring Committee (NIMC)
has been constituted at the Centre to take stock of the
ground realities through field visits to the problem states.
During 2006-09, the Committee visited the States of Delhi,
Haryana, Maharashtra, UP, Rajasthan, Orissa, Karnataka,
Kerala, H.P. and Punjab. It is proposed to strengthen the
National Support and Monitoring Cell with induction of
appropriate consultants to oversee the implementation of
the Act.
Meeting with the manufacturers of ultrasound
machines
A meeting with all major manufacturers of the ultrasound
machines was held on 20.7.2007. It was learnt that L&T
and Wipro GE have developed an effective IEC message
on a sticker to put on all ultrasound machines. Wipro GE
has set up a PNDT Audit Cell. All the manufacturers
have since been sensitizing their engineers on this issue,
who in turn, brief the medical practitioners while installing
the machines.
Training of Judiciary
With a view to sensitize the judiciary, the National Judicial
Academy, Bhopal provided training to trainers from the
State Judicial Academies during 2005-06, who in turn
would provide training to the judiciary in the area under
their jurisdiction. The National Law School of India
University, Bangalore, was provided grants for Training
of lower judiciary and public prosecutors from State
Judicial Academies in a phased manner, beginning with
Karnataka during 2007-2008.
Annual Report on implementation of the PNDT Act
Implementation of the PNDT Act is being published in
Annual Report since 2005 which gives complete
information on the implementation of PC & PNDT Act.
Frequently Asked Questions (FAQs) booklet
The Ministry of Health and Family Welfare, in
collaboration with the United Nations Population Fund
(UNFPA), have developed a ‘Frequently Asked
Questions’ booklet about the PNDT Act which has proved
to be quite useful to the lay persons, medical community
and to the Appropriate Authorities in understanding the
provisions of the Act for better implementation.
Website on PNDT
In addition to the Union Health & F.W. Ministry’s Website,
(www.mohfw.nic.in), an independent website,
‘pndt.gov.in’ for PNDT Division was launched by the
Hon’ble Union Minister of Health & F.W. on 28.4.2008.
This website, in addition to containing all the relevant
information relating to PNDT Act, Rules, Regulations and
activities, enables online filing of data right from Clinics
(including submission of From-F’ online by the Clinics) in
the field to the District and State level and their retrieval
at the District, State and National levels. An exercise is
on to impart training to the user groups on the use of the
website in a phased manner beginning with the focused
states of Punjab, Haryana, Rajasthan, Gujarat, Himachal
Pradesh, Maharashtra and Delhi This training programme
will be conducted by the experts from National
Informatics Centre.
Toll Free Telephone:
Similarly, the Hon’ble Union Minister of Health & F.W.
launched a Toll Free Telephone (1800 110 500) on the
same day under the PNDT Division of the Ministry to
facilitate the public to lodge complaints anonymously
Annual Report 2010-11 41
against any violation of the provisions of the Act by any
authority or individual and to seek PNDT related general
information. (The service is presently suspended, pending
resolution of certain operational issues; mainly
unauthorized advertising by the outsourced service
provider).
Awareness Generation
The problem has its roots in social behaviour and
prejudices and along with the legislation various activities
have been undertaken to create awareness against the
practice of pre-natal determination of sex and female
foeticide through Radio, Television, and Print Media.
Workshops and seminars are also organized through
voluntary organizations at state/regional/district/block
levels to create awareness against this social evil.
Cooperation has also been sought from religious / spiritual
leaders, as well as medical fraternity to curb this practice.
The Government of India has launched ‘Save the Girl
Child Campaign’ with a view to lessen son preference by
highlighting achievements of young girls. Shri Kapil Dev,
former Captain of the Indian national Cricket Team, has
been nominated as the Brand Ambassador for the
campaign.
Advt. over the Internet regarding Gender Testing
Kits:
A new factor which is threatening to adversely impact
the PNDT efforts of the Government, i.e. the
advertisements placed on the websites regarding the
Gender Testing Kits. The Hon’ble High Court of Punjab
and Haryana Suo Motu took congnisance of the above
report and issued notices to the State Governments of
Haryana and Punjab and also to the Central Government.
Affidavit on behalf of UOI has been filed.
On 29.11.2007, the Customs Department was requested
by this Ministry to examine the possibility of intercepting
such Gender Determination Kits when imported into the
country under the Customs Act. They were also
requested to furnish details of such importers to facilitate
the Ministry to take appropriate action against them under
the PC & PNDT Act. This was followed up at the
Secretary level, vide the letter dated 5.1.2007.
In response to the above request of this Ministry, the
Customs Department informed that it has suitably alerted
its field formations to seize the Gender Testing Kits
imported from abroad. Subsequently, the Central Board
of Excise & Customs on 1.4.2008 made certain
suggestions for consideration of this Ministry for
interception of the Gender Testing Kits effectively. In
the light of CBEC’s letter dated 1.4.2008 cited above,
two rounds of Inter-Ministerial Meetings were held on
7.5.2008 and 16.5.2008 under the Chairmanship of Joint
Secretary (PK), where the representatives of the Customs
Department, DGFT, DGHS and DCG (I) were invited to
find a solution to the problem posed by the import of
Gender Testing/Sex-Determination Kits.
It was, inter alia, decided to amend the PC & PNDT
Act, 1994 and the Rules/Regulations framed thereunder
suitably to provide for establishment of a registration
mechanism in the matter of import of ‘Gender Testing
Kits’ and other similar medical kits. On the request of
the Customs authorities, DCG (I) and DDG (M) have
been requested to frame the required parameters for
identification of the ‘Gender Testing Kits’ from among
the similar kits imported into the Country.
Sting operation carried out of BBC in Delhi and
NOIDA:
The sting operation conducted recently by BBC at NOIDA
and New Delhi revealed that illegal sex determination
tests were carried out at Dr. Mangala Telang’ clinics on
an NRI couple from the U.K. This was reported in the
website of BBC News.The Appropriate Authorities of
Uttar Pradesh and NCT of Delhi were requested to inquire
into the matter and furnish their respective reports
thereon. In their respective reports, the State
Governments indicated that inspection of the facilities of
Dr. Mangala Telang at NOIDA and Delhi were carried
out, the Premises and sealed and her registration
suspended. In addition to the above, the Government of
U.P. has filed a court case against Dr. Mangala Telang
at NOIDA.
2.12 IMPROVEMENT IN THE QUALITY OF
HEALTHCARE
The improvement in the quality of healthcare over the
years is reflected in respect of some basic demographic
indicators (Table given below). The Crude Birth Rate
(CBR) has declined from 40.8 in 1951 to 29.5 in 1991
and further to 22.8 in 2008. Similarly there was a sharp
decline in Crude Death Rate (CDR) which has decreased
from 25.1 in 1951 to 9.8 in 1991 and further to 7.4 in
2008. Also, the Total Fertility Rate (average number of
Annual Report 2010-11 42
children likely to be born to a woman between 15-44 years
of age) has decreased from 6.0 in 1951 to 2.6 in the year
2008 as per the estimates from the Sample Registration
System (SRS) of Registrar General India (RGI), Ministry
of Home Affairs.
The Maternal Mortality Rate has also declined from 437
per one lakh live births in 1992 – 93 to 254 in 2004-06,
according to the SRS Report brought out by RGI. Infant
Mortality Rate, which was 110 in 1981, has declined to
53 per 1000 live births in 2008. Child Mortality Rate has
also decreased from 57.3 in 1972 to 15.2 in 2008.
Table 1
Achievements of Family WelfareProgramme
Family Planning Methods:
The total number of acceptors of different Family
Planning methods enrolled in the country during the year
2009-10 was 36.29 million. Table 2 below summarizes
Sl. Parameter 1951 1981 1991 Current level
No.
1 Crude Birth Rate
(Per 1000 Population) 40.8 33.9 29.5 22.8 (2008)
2 Crude Death Rate
(Per 1000 Population) 25.1 12.5 9.8 7.4 (2008)
3 Total Fertility Rate
(Per woman) 6.0 4.5 3.6 2.6 (2008)
4 Maternal Mortality Rate NA NA 437 (1992-93) 254(2004-06)
(Per 100,000 live births) NFHS S.R.S.
5 Infant Mortality Rate 146(1951-61) 110 80 53 (2008)
(Per 1000 live births)
6 Child (0-4 years) 57.3(1972) 41.2 26.5 15.2 (2008)
Mortality Rate per
1000 children
7 Couple protection 10.4(1971) 22.8 44.1 46.5 (2008)
Rate (%) $
Source: 1 Office of Registrar General, Ministry of Home Affairs, India.
$ (2) Deptt of Health & FW.
the position in regard to family planning achievements
during 2009-10 and 2010-11 (up to September 2010) at
All India Level.
Annual Report 2010-11 43
Table 2
Family Planning Acceptors by methods
(Figures in million)
Sl.No. Methods Achievement * Achievement *
ó ó ó ó ó ó ó ó ó ó ó ó ó ó
2009-2010 2010-11 2009-10
(April 2010- (April 2009-
Sep 2010) Sep.2009)
1. Sterilisation 5.02 1.60 1.72
2. IUD Insertions 5.79 2.46 2.87
3. Condom Users (Eq.) 17.36 6.49 8.71
i. Under Free Distribution 8.33 6.49 8.71
Scheme (Eq.)
ii. Under Commercial 9.03** NA NA
Distribution scheme(Eq.)
4. Oral Pill Users 8.11$ 3.55 4.69
i. Under Free distributionScheme (Eq.) 4.65 3.55 4.69
ii. Under Commercial Distribution 3.47** NA NA
Scheme(Eq.)
Total Acceptors 36.29 14.1 17.99
*: Provisional figures
Source: HMIS Portal
Eq -Equivalent
** Branded full cost commercial sales figures are not included. The data is still awaited from SSM Division of the Ministry.
$:- Total does not match due to round off.
Annual Report 2010-11 44
Table 3
Assessed Need of Immunisation vis-Ú-vis Achievement during
2009-10 under RCH Programme (All India)
Sl.No. Activity Assessed Achievement* % Change. % Achvt.of
Need for ó ó ó ó ó ó Assessed
2009-10 2009-10 2008-09 Need
1 2 3 4 5 6 7
A. Immunisation
i. Tetanus Immunisation for 29264 24717 24348 (+) 1.5 84.5
Expectant mothers
ii. DPT Immunisation 25187 25070 23345 (+) 7.4 99.5
For Children
iii. Polio 25187 24964 23916 (+) 4.4 99.1
iv. B.C.G. 25187 25809 26013 (-) 0.8 102.5
v. Measles 25187 24007 23443 (+)2.4 95.3
vi. DT Immunisation 24748 18171 14204 (+) 27.9 73.4
For Children
vii. T.T. (10 Years) 25706 16675 13523 (+) 23.3 64.9
viii. T.T. (16 Years) 25660 14636 11815 (+) 23.9 57.0
B. Prophylaxis against
nutritional anaemia
among women 29264 25568 22663 (+)12.8 87.4
C. Prophylaxis against Blindness
due to Vit. ‘A’ deficiency $
i. 1
st
dose (below 1 year +
above 1 year) 25187 24058 18292 (+) 31.5 95.5
ii. 5
th
dose 24364 20378 11480 (+) 77.5 83.6
iii 9
th
dose 24748 13504 9603 (+) 40.6 54.6
* Provisional figures received through HMIS Portal as on 22
nd
Oct., 2010.
(Figures in 000ís)
Immunization Performance for the year 2009-10 vis-à-vis 2008-09 is given in Table 3. Table-4 gives the comparative
performance during 2010-11 and 2009-10 for the period April-September of the respective years.
Annual Report 2010-11 45
Table 4
Assessed Need of Immunisation Vis-Ú-vis Achievement
During 2010-11 (April,10 to Sept, 10) under RCH Programme (All India)
Sl.No. Activity Assessed Achievement* % Change. % Achvt.of
Need for Assessed
2010-11 2010-11 2009-10 Need
(Apr.2010 to April 2009to
Sept.2010) Sept.2009)
1 2 3 4 5 6 7
A. Immunisation
i Tetanus Immunisation for 29678 10846 12212 (-) 11.2 36.5
Expectant mothers
ii DPT Immunisation 25540 10360 12184 (-) 15.0 40.6
For Children
iii. Polio 25540 10285 12210 (-) 15.8 40.3
iv. B.C.G. 25540 11260 12498 (-) 9.9 44.1
v. Measles 25540 10169 11740 (-) 13.4 39.8
vi. DT Immunisation 25092 4665 10484 (-)55.5 18.6
For Children
vii T.T. (10 years) 26065 6801 8427 (-)19.3 26.1
viii. T.T. (16 Years) 26013 6132 7296 (-) 16.0 23.6
B. Prophylaxis against
Nutritional Anaemia
among Total Women 29678 16629 11436 (+) 45.4 56.0
C. Prophylaxis against
blindness due to Vit.
‘A’ deficiency
i. 1
st
dose (below 1 year+ 25540 11155 12131 (-) 8.0 43.7
above 1 year)
ii. 5
th
dose 24706 9056 9643 (-) 6.1 36.7
iii 9
th
dose 25092 5991 6242 (-) 4.0 23.9
* Figures are provisional.
Source: HMIS Portal
(Figures in 000ís)
Annual Report 2010-11 46
2.13 HEALTH MANAGEMENT
INFORMATION SYSTEM
For capturing information on the service statistics from
the peripheral institutions, an exercise was undertaken
to rationalize the data capturing format by removing
redundant information, reducing the number of forms and
focused on facility based reporting. The revised forms
were finalized in September 2008 and disseminated to
the States. A web based Health MIS (HMIS) portal was
also launched in October, 2008 to facilitate data capturing
at District level. The HMIS portal has led to faster flow
of information from the district level and about 98% of
the districts reported monthly data for the fiscal year
2009-10. The Provisional Report for the performance of
the States for the year 2009-10 (up to March, 2010) as
reported by the States was brought and shared with the
stakeholders. Soft copy is also available on the HMIS
Portal in public domain. The HMIS portal is now being
rolled out to capture information at the facility level. Now
that data has started flowing regularly on the HMIS portal,
a workshop on improving the quality of data was
organized in May 2010. Core M&E teams have been
formed in the States to look at the consistency of the
HMIS data in finding the gap and providing solutions for
strengthening the Health MIS system in States.
2.13.1. Tracking of Mothers and Children
It has been decided to have a name-based tracking
whereby pregnant women and children can be tracked
for their ANCs and immunisation along with a feedback
system for the ANM, ASHA etc to ensure that all
pregnant women receive their Ante-Natal Care Check-
ups (ANCs) and post-natal care (PNCs); and further
children receive their full immunisation. All new
pregnancies detected/being registered from 1st April,
2010 at the first point of contact of the pregnant mother
would be captured as also all births occurring from 1st
December, 2009. The states are putting in place systems
to capture such information on a regular basis. Mother
and Child Tracking System require intense capacity
building at various levels primarily at the Block and Sub-
Centre levels. The National Informatics Centre (NIC)
has been requested to modify and adapt the Gujarat model
of e-Mamta software application to other States. This
application is being hosted on servers that are to be
procured for the purpose and customisation will be carried
out by NIC. The roll-out is being monitored centrally for
which dashboards are being prepared for the purpose
and it is proposed to integrate the application for a Help
Desk that is proposed to be put in place for the health
sector.
2.14 SURVEYS AND EVALUATION
ACTIVITIES
District level Household Surveys: The Ministry also
coordinated the activities of the District Level Household
Survey (DLHS)-3 during 2007-08 for assessing the impact
of the health programmes and generating various health
related indicators at the District and State level. All India,
State and District Fact Sheets for the results of the survey
have been released and hosted on the HMIS Portal for
use by the health officials and other stakeholders. The
detailed All India and State Reports have also been
released.
Concurrent evaluation of NRHM: In pursuant to a
decision taken by the Empowered Programme Committee
(EPC) of NRHM, Concurrent evaluation of NRHM has
been undertaken by the Ministry in 197 districts of all
States/UTs covering activities and programmes initiated
under the NRHM through the International Institute of
Population Science (IIPS), Mumbai. IIPS acted as the
nodal agency for conducting the Concurrent Evaluation
and outsourced the field work to independent agencies
having experience in conducting surveys / research
studies. The Fact sheet for 187 districts have been
disseminated in the Ministry in October 2010. National
and State reports are being finalised and expected to be
released by March, 2011.
Regional Evaluation Teams(RETs): There are 7
Regional Evaluation Teams (RETs) located in the Regional
Offices of the Ministry which undertake evaluation of
the NRHM activities including Reproductive and Child
Health Programme (RCH) on a sample basis by visiting
the selected districts and interviewing the beneficiaries.
These teams generally visit two adjoining districts in a
state every month and see the functioning of health
facilities and carry out sample check of the beneficiaries
to ascertain whether they have actually received the
services. Reports of the RETs are sent to the States for
taking corrective measures on issues highlighted in the
reports. During 2009-10, 114 districts were visited by the
RETs.
Annual Health Survey: The Annual Health Survey
(AHS) launched by the Ministry aims to prepare District
Health Profile of the 284 districts in the EAG States and
Annual Report 2010-11 47
Assam on an annual basis. The AHS is being conducting
through the Registrar General of India (RGI), Ministry
of Home Affairs. The AHS is a hybrid model where the
field work has been outsourced to external agencies and
supervision being done by the RGI staff. The Annual
Health Survey aims to provide feedback on the impact of
the schemes under NRHM in reduction of Total Fertility
Rate (TFR), Infant Mortality Rate (IMR) at the district
level and the Maternal Mortality Ratio (MMR) at the
regional level. These are important indicators of health
which are currently being estimated at the national/state
level through the Sample Registration System (SRS) by
Registrar General of India. The fieldwork of the Survey
is in progress and reports likely to be available in early
2011.
2.15 POPULATION RESEARCH CENTRES
(PRCs)
The Ministry has established 18 Population Research
Centres (PRCs) in various institutions in the country with
a view to carry out research on various topics pertaining
to population stabilization, demographic and other health
related programs. While 12 of these PRCs are located
in universities, the remaining six are located in institute of
national repute. The Ministry of Health & Family Welfare
provide 100% financial grant-in-aid to all PRCs as on a
year to year basis towards salaries of staff, books and
journals, TA/DA, data processing/stationary/contingency
etc., and other infrastructure requirement.
As a statutory requirement, under Rule 212 (2) of the
General Financial Rules 2005, the Annual Reports of 17
PRCs for 2009-10 which received Rs. 25 lakhs or above
as Recurring Grant during 2009-10, alongwith the audited
statement of accounts were laid on the table of both the
houses of parliament. The performance of PRC Sagar,
which received less than 25 lakhs as Recurring Grant
for 2009-10, was also found to be satisfactory.
During the year 2009-10, the studies completed by the
Population Research Centres (PRCs) on some of the
important topics of research including the studies assigned
by the Ministry are given below:
1) Male Involvement in Reproductive Health
:Evidence from NFHS-3 and DLHS-2
2) Rapid Appraisal of Critical components of National
Rural Health Mission (NRHM) in Karnataka
3) Reproductive Health Status of Adolescent Married
girls in Karnataka
4) Convergence of Demographic Indicators in
Karnataka :An Exploration
5) Orientation for Senior-level officials on use of
Demographic Data for Local Level Planning and
Monitoring of Development Programmes.
6) Study on Rapid Appraisal of National Rural Health
Mission(NRHM) Implementation in Sambalpur and
Kendrapara districts of Orissa
7) Monitoring of Coverage Evaluation Survey (CES)
2009
8) District Human Development Report –Hoshiarpur,
Punjab
9) Rapid appraisal of NRHM Ambala District –
Haryana
10) An Annotated Bibliography and Abstracts of
Research (2002-2007)
11) Rapid Appraisal of National Rural Health Mission
(NRHM) in the State of Punjab: Patiala district
12) A Study of Out-of-pocket Expenditure on Medial
Services and Drugs: An Exploratory
Analysis of U.P.,Rajasthan and Delhi.
13) Gender and forest conservation: The Impact of
women’s participation in community forest
governance, Ecological Economics,
14) Does women’s Proportional Strength affect their
Participation: Governing local forests in south Asia
15) ‘Exploring Gender Differences in functional
disabilities among the Old: Are Women at a
Disadvantageous Position
16) Changing Demographic Landscape of South Asia
and Emerging Issues of Employment, Ageing
and Old Age Security.
17) Challenges for the NRHM: Study of Recent
Demographic and Health Profile in NRHM States.
18) Shortages and surpluses: changing Female-male
Ratios in Younger and Older Ages: Policy
Implications in south Asia.
Annual Report 2010-11 48
19) Development, Demographic change and Migration:
A study of Two Hilly States of India.
20) Women, Empowerment and the State: Enhancing
Capabilities Through Employment –Generation
Schemes.
21) Sex Differentials in Child Health and Nutritional
Status in Punjab.
22) Education in MDGs: Is India Expected to Achieve
its Targeted Goal and How?
23) Rapid Assessment of NRHM in Uttar Pradesh
24) Rapid appraisal of National Rural Health Mission
(NRHM) implementation in Koppal district,
Karnataka.
25) Facility Assessment of Secondary Level Public
Hospitals in Tamil Nadu Phase – I
26) Facility Assessment of Medical college Hospitals
and Allied Hospitals in Tamil Nadu Phase – I
27) Rapid Appraisal of NRHM Implementation in
Bankura District of West Bengal
28) Rapid Appraisal of NRHM Implementation in Jorhat
District of Assam
29) Rapid Appraisal of NRHM Implementation in
Sonitpur District of Assam
30) Impact of Literacy in infant Mortality Rate in
Assam
31) A study on the Role of Assamese Radio
Programme ‘Sanjog’ in Promoting UEE with
Special reference to Alternative Schooling
32) Rapid Appraisal of National Rural Health Mission
Implementation on Udham Singh Nagar District
of Uttarakhand.
33) Maternal Mortality in districts of Uttar Pradesh:
An Illustration through indirect estimation
34) Utilisation of Maternal and Child health (MCH)
Care services in India with special reference to
EAG states.
35) Improving women’s Health in Bihar
36) A Critical Review of Community Participation in
Family Welfare Programmes.
37) Trends in contraceptive prevalence and fertility
across the different districts of Bihar
38) The Demographic Impact of the Partition of India
– With Special Reference to Eastern India
39) Can Beautiful be Backward? Tribes of India in a
Long Term Demographic Perspective
40) Employment differentials by Social Groups of India
41) Distributional Pattern of Social Groups in Higher
Education: An Analysis of Census Data for
Maharashtra, 1991-2001.
42) Disparities in Higher Education Between and Within
Social Groups: Analysis by Major States of India,
1999-2000.
43) Rapid Appraisal of National Rural Health Mission:
Gadchiroli District,Maharashtra .
44) Rapid Appraisal of NRHM Implementation in
Madhya Pradesh – district Anuppur
45) Rapid Appraisal of NRHM Implementation in
Madhya Pradesh: District Indore
46) Rapid Appraisal of National Rural Health Mission
in Rajouri District of Jammu and Kashmir.
47) Rapid Appraisal of National Rural Health Mission
in Baramulla District of Jammu and Kashmir.
48) Role of Men in Reproductive Health in Jammu &
Kashmir.
49) Disability Burden and the Need for Social Action:
The Role of the Family, Community and the NGOs.
50) National Rural Health Mission Initiatives and
Reproductive Child Health Phase-II: An Evaluation.
51) Organisation and Functioning of Health Services
in Himachal Pradesh.
52) Reducing Maternal and Child Mortality in Himachal
Pradesh
53) Unmet Reproductive Health Needs of the Couples
and the Role of the Male Partner in Meeting the
Needs.
54) National Rural Health Mission: An appraisal of its
rationale, structure and Prospects.
Annual Report 2010-11 49
55) Rapid Appraisal of National Rural Health Mission
Implementation in Kozhikode district, Kerala
2008-2009.
56) Infertility in India: A Comparative Study by State
57) Suicides in Kerala : What do Trends reveal!
58) A Profile of Adolescence and youth in India .
59) Morbidity among Men and women in India: State
wise analysis based on NFHS-III data.
60) Immunization coverage in EAG states and Assam:
A comparative study with Kerala based on
NFHS-III data.
61) The use of temporary contraception and
Discontinuation in Kerala .
62) Household headship and nutritional status of
women and children in Kerala
63) People living with HIV/AIDS in India, Inference
from NFHS-III.
64) Reproductive Health Status of Tribal Women in
Rajasthan.
65) Knowledge and Satisfaction of Patients about
NRHM Interventions at Dungarpur district
Hospital .
66) Impact Assessment of Institutional Delivery Care
Services in Tribal Areas of Rajasthan.
67) Rapid Appraisal of National Rural Health Mission
(NRHM) Implementation Banaskantha district,
Gujarat
68) Rapid Appraisal of National rural Heath Mission
(NRHM) implementation, Surat district, Gujarat.
69) District Level Household Survey (DLHS-3) in
Andaman and Nicobar Islands
70) Important RCH Indicators of DLHS-3 of Andaman
& Nicobar Islands.
Annual Report 2010-11 51
Chapter 3
The Ministry of Health & Family Welfare consists of
four departments viz. the Department of Health & Fam-
ily Welfare, Department of AYUSH, Department of
Health Research and Department of AIDS Control.
Achieving an acceptable standard of health for general
population has been the objective over the plan era in the
Health sector. In line with this objective, there has been
a steady increase in the allocations made for this sector
Funding For The Programme Funding For The Programme Funding For The Programme Funding For The Programme Funding For The Programme
since from the 1st Plan. The allocation for this sector
has been substantially enhanced from Rs. 36378.00 crores
in the 10th plan to Rs.1,36,147.00 crores in the 11th Plan.
The table below is captured the financial outlays and
expenditure for Health & Family Welfare for the 10th
Plan (2002-07) and Health, Family Welfare and Health
Research for the 11th Plan (2007-12).
Approved Outlay Expenditure
Plan Period Health F.W. $ Health Total Health F.W. Health Total
Research Research
10
th
Plan 10252.00 26126.00 X 36378.00 X
Outlay
Actual 10521.00 31064.00 X 41585.00 8694.15 26349.23 X 35048.87
Status
2002-03 1550.00 4930.00 X 6480.00 1359.82 3916.63 X 5276.45
2003-04 1550.00 4930.00 X 6480.00 1325.81 4409.27 X 5735.08
2004-05 2208.00 5780.00 X 7988.00 1772.36 4864.21 X 6636.57
2005-06 2908.00 6424.00 X 9332.00 2259.21 5672.53 X 7931.74
2006-07 2305.00 9000.00 X 11305.00 1982.44 7486.59 X 9469.03
11
th
Plan 41092.92 90558.00 4496.08 136147.00
(2007-12)
Outlay
2007-08 2985.00 10890.00 X 13875.00 2183.71 10380.25 X 12563.96
2008-09 3650.00 11930.00 420.00 16000.00 3008.82 11260.18 390.56 14659.56
2009-10 4450.00 13930.00 420.00 18800.00 3260.40 13304.51 399.90 16964.86
(Prov.) (Prov.) (Prov.)
2010-11 5560.00 15440.00 500.00 21500.00
(Rupees in Crores)
$ :- Figures shown as NRHM from 2006-07 onwards.
Prov.:- Provisional F.W. :- Family Welfare.
The scheme-wise break up of plan and non plan expenditure during 2009-10 and outlays 2010-11 for Health, NRHM and Health
Research is given at statement I and II.
Annual Report 2010-11 52
DEPARTMENT OF HEALTH AND FAMILY WELFARE HEALTH SECTOR
Scheme- wise Break- up of Actule Expenditure during 2009-10 and Outlay for 2010-11
(Rs.in crores)
Sl. Name of the schemes / 11th Plan Annual Plan 2009-10 Expenditure Outlay for 2010-11
No. Institutes Approved
Outlay Plan Non -Plan Total Plan Non- Plan Total
1 2 3 4 5 6 7 8 9
A. CENTRALLY SPONSORED
PROGRAMMES 23202.50 1202.38 25.09 1227.47 2734.75 22.05 2756.80
1 National AIDS Control
Programme and National
S.T.D. Control Programme 5728.00 938.06 0.00 938.06 1435.00 0.00 1435.00
2 Cancer 2871.92 69.65 25.09 94.74 225.00 22.05 247.05
(i) National Cancer Control
Programme 2400.00 28.25 11.59 39.84 180.00 9.05 189.05
(ii) Tobacco Control Programm 471.92 16.40 0.00 16.40 45.00 0.00 45.00
(iii) Rastriya Arogya Nidhi 0.00 25.00 13.50 38.50 0.00 13.00 13.00
3 National Mental Health Programme 1000.00 51.60 0.00 51.60 120.00 0.00 120.00
4 Assistance to State for
Capacity Building(Truma Care) 732.95 52.66 0.00 52.66 115.00 0.00 115.00
(i) Truma Care 0.00 52.66 113.00 0.00 113.00
(ii) Prevention of Burn Injury 0.00 0.00 2.00 0.00 2.00
5 Assistance to States for
Drug & PFA Control 260.00 0.00 0.00 0.00 0.00 0.00 0.00
New initiatives under CSS
(Others) 12609.63 90.41 0.00 90.41 839.75 0.00 839.75
6 Telemedicine (E- Health) 183.00 0.00 0.00 0.00 17.00 0.00 17.00
7 National Programme for
Prevention and Control of
Diabetes, Cardiovascular
Disease and Stroke 1660.50 3.44 0.00 3.44 100.00 0.00 100.00
8 National Programme for
Health for the Elderly 400.00 0.00 0.00 0.00 60.00 0.00 60.00
9 District Hospitals 1500.00 16.00 0.00 16.00 225.00 0.00 225.00
(i) Strengthening of MCH
wing/Hospitals and other
wing in District Hospitals 0.00 0.00 0.00 0.00 0.00 0.00 0.00
(ii) Upgradation of States
Govt. Medical Colleges(NE) 1500.00 16.00 0.00 16.00 225.00 0.00 225.00
10 Human Resource for Health 4000.00 17.22 0.00 17.22 351.00 0.00 351.00
(i) Upgradation/Strengthening
of Nursing Services 2900.00 17.22 0.00 17.22 250.00 0.00 250.00
(ii) Strengthening/Creation
of Paramedical Institutes 1000.00 0.00 0.00 0.00 100.00 0.00 100.00
(iii) Strengthening/
Upgradation of Pharmacy
Schools 100.00 0.00 0.00 0.00 1.00 0.00 1.00
Statement-I
Annual Report 2010-11 53
(Rs.in crores)
Sl. Name of the schemes / 11th Plan Annual Plan 2009-10 Expenditure Outlay for 2010-11
No. Institutes Approved
Outlay Plan Non -Plan Total Plan Non- Plan Total
1 2 3 4 5 6 7 8 9
11 Health Insurance
(National Urban Health
Mission) 4495.00 0.00 0.00 0.00 10.00 0.00 10.00
12 Pilot Projects 371.13 53.75 0.00 53.75 76.75 0.00 76.75
Sport Medicines/Sport Injiry 90.00 40.23 0.00 40.23 30.00 0.00 30.00
Deafness 100.00 7.36 0.00 7.36 11.50 0.00 11.50
Leptospirosis Control 4.48 0.52 0.00 0.52 0.85 0.00 0.85
Control of Human Rabies 8.65 0.67 0.00 0.67 1.60 0.00 1.60
Medical Rehabilitation 50.00 1.12 0.00 1.12 13.30 0.00 13.30
Ogran Transplant 25.00 0.30 0.00 0.30 11.00 0.00 11.00
Oral Health 25.00 0.00 0.00 0.00 3.50 0.00 3.50
Fluorosis 68.00 3.55 0.00 3.55 5.00 0.00 5.00
B. CENTRAL SECTOR SCHEMES 17890.42 2058.02 3055.77 5113.79 2825.25 2438.50 5263.75
1 Oversight Committee 1827.00 30.00 0.00 30.00 300.00 0.00 300.00
Strengthening of the Institutes
for Control of Communicable
Diseases 531.23 63.21 57.69 120.90 77.48 64.06 141.54
2 National Institute of
Communicable Diseases 60.00 16.88 20.49 37.37 18.05 22.48 40.53
National Tuberculosis Institute,
Bangalore 9.48 1.16 6.36 7.52 1.95 5.66 7.61
3 Others Research Institutes 461.75 45.17 30.84 76.01 57.48 35.92 93.40
i B.C.G. Vaccine Laboratory,
Guindy, Chennai 80.00 0.39 4.35 4.74 5.75 12.50 18.25
ii Pasteur Institute of India,
Coonoor 280.00 11.26 0.00 11.26 16.27 0.00 16.27
iii Lala Ram Sarup Institute of
T.B. and allied diseases,
Mehrauli, Delhi 78.75 30.37 14.41 44.78 30.00 11.00 41.00
iv Central Leprosy Training &
Research Institute
Chengalpattu (including
Integrated Vaccine complex &
Media Park) (Tamil Nadu) 10.00 0.48 7.07 7.55 2.73 6.65 9.38
Statement-I
Annual Report 2010-11 54
(Rs.in crores)
Sl. Name of the schemes / 11th Plan Annual Plan 2009-10 Expenditure Outlay for 2010-11
No. Institutes Approved
Outlay Plan Non -Plan Total Plan Non- Plan Total
1 2 3 4 5 6 7 8 9
v Regional Institute of Training,
Research & Treatment under
Leprosy Control Programme 13.00 2.67 5.01 7.68 2.73 5.77 8.50
(a) R.L.T.R.I., Aska (Orissa) 3.00 0.03 1.88 1.91 0.50 2.35 2.85
(b) R.L.T.R.I., Raipur (M.P.) 2.00 0.18 3.13 3.31 0.50 3.42 3.92
(c) R.L.T.R.I., Gauripur (W.B.) 8.00 2.46 0.00 2.46 1.73 0.00 1.73
4 Strengthening of Hospitals &
Dispensaries: 1162.34 202.68 1231.69 1434.37 241.75 1027.05 1268.80
i Central Government Health
Scheme (including Health
Insurance) 565.80 57.93 608.89 666.82 67.65 500.00 567.65
ii Medical Treatment of CGHS
Pensioners 0.00 0.00 449.74 449.74 1.00 377.87 378.87
iii Central Institute of
Psychiatry, Ranchi 100.00 20.73 27.28 48.01 27.25 24.18 51.43
iv All India Institute of Physical
Medicine & Rehabilitation,
Mumbai 56.00 4.11 7.91 12.02 5.00 8.00 13.00
v Dr. R.M.L. Hospital, New Delhi 351.00 103.07 127.39 230.46 118.00 107.00 225.00
vi Others 89.54 16.84 10.48 27.32 22.85 10.00 32.85
Institute for Human Behaviour
& Allied Sciences, Shahdara,
Delhi 8.00 0.00 0.00 0.00 1.00 0.00 1.00
Grant to New Delhi TB Centre 0.00 0.00 2.48 2.48 0.00 2.00 2.00
All India Institute of Speech
& Hearing, Mysore 81.54 16.84 8.00 24.84 21.85 8.00 29.85
5 Strengthening of Institutions
for Medical Education,
Training & Research: 2350.95 209.58 140.52 350.10 224.62 132.28 356.90
(a) Medical Education: 1749.67 166.19 75.52 241.71 171.40 59.15 230.55
i Indira Gandhi Institute of
Health & Medical Sciences for
NorthEast Region at Shilong* 1266.38 65.00 0.00 65.00 67.85 0.00 67.85
ii N.I.M.H.A.N.S., Bangalore 266.38 54.38 71.31 125.69 58.35 55.03 113.38
iii Kasturba Health Society, Wardha 106.91 28.60 0.00 28.60 27.00 0.00 27.00
Statement-I
Annual Report 2010-11 55
(Rs.in crores)
Sl. Name of the schemes / 11th Plan Annual Plan 2009-10 Expenditure Outlay for 2010-11
No. Institutes Approved
Outlay Plan Non -Plan Total Plan Non- Plan Total
1 2 3 4 5 6 7 8 9
iv National Medical Library,
New Delhi 100.00 18.21 4.21 22.42 17.70 4.12 21.82
v National Board of
Examinations, New Delhi 10.00 0.00 0.00 0.00 0.50 0.00 0.50
(b) Training: 288.65 18.56 6.32 24.88 22.38 6.77 29.15
i Upgradation/ Development
of Nursing Services 280.65 17.55 0.00 17.55 21.00 21.00
ii Nursing Colleges 8.00 1.01 6.32 7.33 1.38 6.77 8.15
(i) R.A.K. College of Nursing,
New Delhi 5.00 0.71 4.82 5.53 0.82 4.77 5.59
(ii) Lady Reading Health School 3.00 0.30 1.50 1.80 0.56 2.00 2.56
(c) Research: 10.00 3.12 11.60 14.72 5.00 16.44 21.44
(i) Indian Council of Medical
Research, New Delhi #
Membership for International
Organization 10.00 3.12 11.60 14.72 5.00 16.44 21.44
#- ICMR merged with department of Health Research from 2008-09
(d) Public Health 108.81 7.78 29.30 37.08 10.72 35.19 45.91
i Institute of Public Health (PHFI) 22.00 0.00 0.00 0.00 1.00 1.00
ii All India Institute of Hygiene
& Public Health, Calcutta
(AIIH&PH) and Serologist and
Chemical Examiner, Calcutta 86.81 7.78 29.30 37.08 9.72 35.19 44.91
a. AIIH&PH, Calcutta 85.81 7.59 25.88 33.47 9.22 30.98 40.20
b. Serologist & Chemical
Examiner, Calcutta 1.00 0.19 3.42 3.61 0.50 4.21 4.71
(e) Others 193.82 13.93 17.78 31.71 15.12 14.73 29.85
i Indian Nursing Council 10.00 0.15 0.12 0.27 0.25 0.12 0.37
ii V.P. Chest Institute, Delhi 158.00 12.00 17.00 29.00 12.00 13.00 25.00
iii National Academy of Medical
Sciences, New Delhi 7.72 0.78 0.37 1.15 0.87 0.42 1.29
iv Medical Council of India,
New Delhi 10.00 1.00 0.00 1.00 1.00 0.80 1.80
Statement-I
Annual Report 2010-11 56
(Rs.in crores)
Sl. Name of the schemes / 11th Plan Annual Plan 2009-10 Expenditure Outlay for 2010-11
No. Institutes Approved
Outlay Plan Non -Plan Total Plan Non- Plan Total
1 2 3 4 5 6 7 8 9
v Medical Grants Commission 8.10 0.00 0.00 0.00 1.00 0.00 1.00
vi Dental Council of India 0.00 0.00 0.19 0.19 0.00 0.19 0.19
viiPharmacy Council of India 0.00 0.00 0.10 0.10 0.00 0.20 0.20
6 System Strengthening including
Emergency Medical Relief/
Disaster Management 1106.58 273.36 137.66 411.02 198.71 148.32 347.03
i (a) Health Education,
Research & Accounts 32.33 0.56 2.42 2.98 3.28 3.55 6.83
Health Education Bureau,
New Delhi 11.65 0.12 2.42 2.54 1.00 2.20 3.20
Health Intelligence and Health
Accounts 20.68 0.44 0.00 0.44 2.28 1.35 3.63
a. Intelligence 10.68 0.44 0.00 0.44 1.68 1.35 3.03
b. Accounts 10.00 0.00 0.00 0.00 0.60 0.60
ii Strengthening of D.G.H.S./
Ministry: 25.00 2.84 77.12 79.96 4.23 78.80 83.03
a. Strengthening of Deptts
under the Ministry 15.00 2.24 39.76 42.00 2.60 42.05 44.65
b. Strengthening of DGHS 10.00 0.60 37.05 37.65 1.63 35.75 37.38
Other( Discretionary Grant) 0.00 0.31 0.31 0.00 1.00 1.00
iii Emergency Medical Relief 564.82 207.20 0.00 207.20 100.00 0.00 100.00
Health Sector Disaster
Preparedness and Management 447.25 2.03 0.00 2.03 38.40 0.00 38.40
Emergency Medical Relief
(including Avian Flu) 117.57 205.17 0.00 205.17 61.60 0.00 61.60
iv (d) Others 484.43 62.76 58.12 120.88 91.20 65.97 157.17
i Central Research Institute, Kasauli 292.92 6.51 22.57 29.08 30.00 28.12 58.12
ii National Institute of Biological,
NOIDA (U.P.) 62.65 11.00 0.00 11.00 17.25 0.00 17.25
iii Prevention of Food Adulteration
(including project of Feasibilities
Testing sheme of Vitamins and
Mineral ) 25.36
iv Food Safety & Standards
Authority of India 21.00 2.80 23.80 12.65 2.54 15.19
Statement-I
Annual Report 2010-11 57
(Rs.in crores)
Sl. Name of the schemes / 11th Plan Annual Plan 2009-10 Expenditure Outlay for 2010-11
No. Institutes Approved
Outlay Plan Non -Plan Total Plan Non- Plan Total
1 2 3 4 5 6 7 8 9
v Central Drug Standard &
Control Organization (CDSCO) 88.50 14.59 11.00 25.59 10.00 13.68 23.68
vi Indian Pharmacopeia Commission 8.82 3.56 12.38 20.00 2.75 22.75
vii National Pharmaccopoeia 0.00 0.00 0.00 0.35 0.35
viii Port Health Authority 15.00 0.84 18.19 19.03 0.95 18.88 19.83
i) Jawaharlal Nehru Port Sheva 8.20 0.55 0.00 0.55 0.60 0.00 0.60
ii) Setting up of offices at 8
newly created international
Airports 6.80 0.29 18.19 18.48 0.35 18.88 19.23
7 Pradhan Mantri Swasthya
Suraksha Yojana 3955.00 474.49 0.00 474.49 750.00 0.00 750.00
8 New Initiatives under CS 6957.32 804.70 1487.80 2291.64 1032.69 1066.26 2098.95
i Forward Linkages to NRHM
(New Initiatives in NE) 900.00 0.86 0.00 0.86 60.00 0.00 60.00
ii National Centre for Disease
Control 450.00 0.97 0.00 0.97 18.69 0.00 18.69
iii Advisory Board for Standards 22.00 0.00 0.00 0.00 2.00 0.00 2.00
iv Programme for Blood and
Blood Products 450.00 0.00 0.00 0.00 20.00 0.00 20.00
v Medical Store Organisation 0.00 0.00 39.11 39.11 0.00 40.00 40.00
vi Procurement of Meningitis
Vaccine for Inoculation of
Haj Pilgrims 0.00 0.00 3.76 3.76 0.00 6.00 6.00
9 Redevelopment of Hospitals /
Institutions 6035.32 802.87 1444.93 2247.80 992.00 1020.26 2012.26
i All India Institute of Medical
Sciences & its Allied
Departments, New Delhi 1461.00 250.51 636.00 886.51 400.00 400.00 800.00
ii P.G.I.M.E.R., Chandigarh 625.00 75.00 317.00 392.00 90.00 220.00 310.00
iii J.I.P.M.E.R., Pudicherry 564.00 115.00 160.00 275.00 132.00 120.00 252.00
iv Lady Harding Medical College &
Smt. S.K. Hospital, New Delhi 383.83 44.19 114.07 158.26 79.00 97.00 176.00
v Kalawati Saran Children Hospital,
New Delhi 74.88 20.29 25.57 45.86 24.00 23.26 47.26
Statement-I
Annual Report 2010-11 58
(Rs.in crores)
Sl. Name of the schemes / 11th Plan Annual Plan 2009-10 Expenditure Outlay for 2010-11
No. Institutes Approved
Outlay Plan Non -Plan Total Plan Non- Plan Total
1 2 3 4 5 6 7 8 9
vi RIMS, Imphal, Manipur 589.92 109.70 0.00 109.70 80.50 0.00 80.50
vii LGBRIMH, Tejpur, Assam 267.07 36.00 0.00 36.00 41.40 0.00 41.40
viii RIPANS, Aizwal, Mizoram 69.62 17.00 0.00 17.00 19.50 0.00 19.50
ix Safdarjung Hospital and
College, New Delhi 2000.00 135.18 192.29 327.47 125.60 160.00 285.60
10 Other Schemes (Award of
Prizes in Hindi, Treatment of
Ex-VIPs, Grants to Indiam
Red Cross Society & John’s
Ambulance 0.00 0.00 0.41 0.41 0.00 0.53 0.53
TOTAL(HEALTH) 41092.92 3260.40 3080.86 6341.26 5560.00 2460.55 8020.55
III Depart of Health Research 4296.08 399.90 184.07 583.97 500.00 160.00 660.00
Indian Council of Medical
Recearch (ICMR) 4296.08 399.90 184.07 583.97 500.00 160.00 660.00
GRAND TOTAL 45389.00 3660.30 3264.93 6925.23 6060.00 2620.55 8680.55
Statement-I
Annual Report 2010-11 59
DEPARTMENT OF HEALTH AND FAMILY WELFARE NRHM AND MEDICAL RESEARCH INSTITUTE
Scheme- wise Break- up of Actul Expenditure during 2009-10 and Outlay for 2010-11
(Rs.in crores)
Sl. Name of the schemes / 11th Plan Annual Plan 2009-10 Expenditure Outlay for 2010-11
No. Institutes Approved
Outlay Plan Non -Plan Total Plan Non- Plan Total
1 2 3 4 5 6 7 8 9
I CENTRALLY SPONSORED
SCHEMES 88451.22 13120.72 9.96 10231.41 15127.64 13.16 15140.80
A. Disease Control Programmes 6645.63 971.40 7.53 978.93 1132.32 6.95 1139.27
1 National Vector Borne
Disease Control Programme 3190.00 338.20 7.53 345.73 418.00 6.95 424.95
2 National T.B Control
Programme 1447.00 311.56 0.00 311.56 350.00 0.00 350.00
3 National Leprosy
Eradication Programme 268.70 34.83 0.00 34.83 45.32 0.00 45.32
4 Iodine Deficience Disorder
Control Programme (IDDCP) 155.40 21.20 0.00 21.20 45.00 0.00 45.00
5 National Programme for
Control of Blindness 1550.00 252.60 0.00 252.60 260.00 0.00 260.00
6 National Drug De-Addiction
Control Programme(NDDPC) 34.53 13.01 0.00 13.01 14.00 0.00 14.00
B. Free Distribution & Social
Marketing of Condoms for
NACO 2200.00 222.85 0.00 222.85 304.00 0.00 304.00
C. Family Welfare 79605.59 11926.47 2.43 9029.63 13691.32 6.21 13697.53
Infrastructure Maintenance 20448.70 3149.98 0.00 3149.98 3781.63 0.00 3781.63
i Direction & Administration 1955.28 281.31 0.00 281.31 375.00 0.00 375.00
(i) Maintenance of State &
Distt.FW Bureaus 1955.28 281.31 0.00 281.31 375.00 0.00 375.00
ii Rural Family Welfare Services
(Sub Centres) 16865.00 2649.24 0.00 2649.24 3108.06 0.00 3108.06
iii Urban Familiy Welfare Services 958.84 138.17 0.00 138.17 182.00 0.00 182.00
iv Grants to State Training
Institutions 669.58 81.26 0.00 81.26 116.57 0.00 116.57
(a) Basic Training for ANM/LHVs 520.48 59.40 0.00 59.40 85.18 0.00 85.18
(b) Maintenance &
Strengthening of HFWTCs 93.01 13.61 0.00 13.61 19.05 0.00 19.05
(c) Basic Training for MPWs
Worker (Male) 56.09 8.25 0.00 8.25 12.34 0.00 12.34
Statement-II
Annual Report 2010-11 60
(Rs.in crores)
Sl. Name of the schemes / 11th Plan Annual Plan 2009-10 Expenditure Outlay for 2010-11
No. Institutes Approved
Outlay Plan Non -Plan Total Plan Non- Plan Total
1 2 3 4 5 6 7 8 9
2 Free distribution of
Contraceptives 330.00 35.39 0.00 35.20 55.00 0.00 55.00
3 RCH Programme (Procurement
of Supplies & Materials) 1500.00 159.44 0.00 159.44 200.00 0.00 200.00
4 Routine Immunization
(Supply of vaccine etc) 2457.16 350.31 0.00 350.31 450.00 0.00 450.00
5 Pulse Polio Immunization 3994.18 1198.47 0.00 1198.47 1067.08 0.00 1067.08
(a) Procurement of Vaccines 1964.48 605.02 0.00 605.02 581.51 0.00 581.51
(b) Operating cost 2029.70 593.45 0.00 593.45 485.57 0.00 485.57
6 IEC (Inf., Edu. and Communication) 1001.50 155.13 2.43 157.56 204.94 6.21 211.15
7 Area Projects 463.51 17.87 0.00 17.87 31.67 0.00 31.67
(a) USAID assisted Projects 463.50 11.96 0.00 11.96 25.00 0.00 25.00
(b) EC assisted Projects 0.01 0.00 0.00 0.00 0.00 0.00 0.00
(c.) Projects through Vol.Orgns/
Sociaties/Autonomous 0.00 5.91 0.00 5.91 6.67 0.00 6.67
8 Flexible Pool for State PIPs 49410.54 6859.88 0.00 6859.88 7901.00 0.00 7901.00
(i) RCH Flexible Pool 16229.47 3479.11 0.00 3479.11 3850.00 0.00 3850.00
(ii) Mission Flexible Pool 33181.07 3380.77 0.00 3380.77 4051.00 0.00 4051.00
II CENTRAL SECTOR SCHEMES 2106.78 183.79 56.63 240.42 312.36 61.29 373.65
A. DISEASE CONTROL
PROGRAMME 300.45 40.02 0.00 40.02 35.00 0.00 35.00
1 Integrated Disease
Survillance Project 300.45 40.02 0.00 40.02 35.00 0.00 35.00
B. FAMILY WELFARE 1806.33 143.77 56.63 200.40 277.36 61.29 338.65
1 Social Marketing Area Project 50.00 0.00 0.00 0.00 0.50 0.00 0.50
2 Social Marketing of
Contraceptives 450.00 21.86 0.00 21.86 40.00 0.00 40.00
3 F.W Training and Res. Centre,
Mumbai 18.80 2.04 1.93 3.97 5.50 2.43 7.93
4 NIHFW, New Delhi 34.00 14.82 19.03 33.85 15.30 20.40 35.70
5 IIPS, Mumbai 24.00 3.00 11.30 14.30 20.00 9.90 29.90
6 RHTC, Najafgarh 23.65 0.00 7.61 7.61 0.02 9.35 9.37
7 Population Research Centres 53.50 9.73 0.00 9.73 14.20 0.00 14.20
8 CDRI, Lucknow 23.15 4.58 0.00 4.58 4.90 0.00 4.90
Statement-II
Annual Report 2010-11 61
(Rs.in crores)
Sl. Name of the schemes / 11th Plan Annual Plan 2009-10 Expenditure Outlay for 2010-11
No. Institutes Approved
Outlay Plan Non -Plan Total Plan Non-Plan Total
1 2 3 4 5 6 7 8 9
9 Travel of Exp./Conf/Meetings etc. 6.00 0.11 0.00 0.11 1.00 0.00 1.00
10 International Cooperation 8.95 2.62 0.00 2.62 3.50 0.00 3.50
11 NPSF/National Commission
on Population 30.00 0.59 0.00 0.59 4.00 0.00 4.00
12 NGOs (PPP) 100.00 1.74 0.00 1.74 2.65 0.00 2.65
13 FW Linked Health Insurance
Plan 40.00 18.33 0.00 18.33 15.00 0.00 15.00
14 RCH Training 51.62 4.58 0.00 4.58 7.00 0.00 7.00
15 Management Information
System (MIS) 750.00 34.49 0.00 34.49 100.00 0.00 100.00
16 Central Procurement Agency 5.00 5.00
17 Other Schemes 142.66 25.28 16.76 42.04 38.79 19.21 58.00
(a) Research & Study 30.00 0.58 0.00 0.58 2.20 0.00 2.20
(b) Role of Men in Planned
Parenthood 16.05 0.45 0.00 0.45 3.92 0.00 3.92
(c ) Training in Recanalisation 4.20 0.00 0.00 0.00 0.40 0.00 0.40
( d) Assistance to I.M.A. 1.00 0.35 0.00 0.35 0.50 0.00 0.50
(e) Testing Facilities for IUD
and Fallopian 4.50 1.10 0.00 1.10 1.20 0.00 1.20
(f) Expenditure at HQs (RCH) 30.00 5.19 0.00 5.19 6.22 0.00 6.22
(g) Regional Offices 24.00 14.86 5.87 20.73 20.00 8.75 28.75
(h) Information Technology 20.00 1.17 0.00 1.17 1.30 0.00 1.30
(i) FW Programme in Other
Ministries 7.00 0.27 0.00 0.27 1.20 0.00 1.20
(j) Gandhigram Institute 5.91 1.31 0.00 1.31 1.85 0.00 1.85
(k) Technical Wing (HQ) 0.00 10.89 10.89 10.46 10.46
Total (NRHM) 90558.00 13304.51 66.59 13371.10 15440.00 74.45 15514.45
III Depart of Health Research 200.00 0.00 0.00 0.00
ICMR & IRR 200.00 0.00 0.00 0.00
GRAND TOTAL 90758.00 13304.51 66.59 13371.10 15440.00 74.45 15514.45
Statement-II
Annual Report 2010-11 63
Chapter 4
4.1. INTRODUCTION
Promotion of maternal and child health has been one of
the most important objectives of the Family Welfare
Programme in India. Under the NRHM (2005-2012) and
the Reproductive and Child Health( RCH) Programme
Phase-II (2005-10) the Government of India is actively
pursuing the goals of reduction in Maternal Mortality by
focusing on the 4 major strategies of essential obstetric
and new born care for all, skilled attendance at every
birth, emergency obstetric care for those having
complications and referral services. The other major
interventions are provision of Safe Abortion Services and
services for RTIs and STIs. This policy recommends a
holistic strategy for bringing about total intersectoral
coordination at the grass root level and involving the
NGOs, Civil Societies, Panchayati Raj Institutions and
Women's Group in bringing down Maternal Mortality Ratio
and Infant Mortality Rate.
The National Rural Health Mission and the 11th Five Year
Plan have set the goal of reducing MMR to less than 100
per 100,000 live births by the year 2010. Accordingly,
schemes and programmes have been developed for
various interventions focused on reducing maternal deaths.
The Maternal Mortality Ratio in India is 254 per 100,000
live births (SRS, RGI: 2004-06 Maternal Mortality
Report).
4.2. MATERNAL MORTALITY RATIO (MMR)
MMR is defined as the number of maternal deaths per
100,000 live births due to causes related to pregnancy or
within 42 days of termination of pregnancy, regardless of
the site or duration of pregnancy.
MMR India: The national average of MMR is 254 per
100,000 live births ( SRS-2004-06), which in itself is very
high compared to the international scenario like Sweden
(5), USA (24), Brazil (58) and even in neighbouring
countries like Bangladesh (340), Pakistan (260), Sri Lanka
(39) and Thailand (48) (Source- 'Trends in Maternal
Mortality; 1990-2008 -Estimates developed by WHO,
UNICEF, UNFPA and the World Bank'). Some of the
States with high Maternal Mortality as per the RGI-SRS
report of 2004-06 are:
States MMR
Uttar Pradesh/Uttarakhand 440
Rajasthan 388
Madhya Pradesh/Chhattisgarh 335
Bihar/Jharkhand 312
Assam 480
Causes of Maternal Mortality: The major causes of
Maternal Mortality have been identified as haemorrhage
(both ante and post partum), toxemia (Hypertension during
pregnancy), anemia, obstructed labour, puerperal sepsis
(infections after delivery) and unsafe abortion as given
below:
Heamorrhage accounts for more than one- third of all
deaths followed by puerperal sepsis and abortion. Anaemia
which has been included in “other conditions” is a major
contributory factor. Most of these deaths are preventable
with good ante natal care, timely identification and referral
of pregnant women with complications of pregnancy and
timely provision of emergency obstetric care. Moreover
Maternal Health Programme Maternal Health Programme Maternal Health Programme Maternal Health Programme Maternal Health Programme
Annual Report 2010-11 64
social factors like Illiteracy, low socio-economic
conditions, poor access to health facilities are also
contributing factors leading to higher maternal mortality.
4.3. MATERNAL HEALTH INDICATORS
The estimates of maternal mortality at State/UTs levels
not being very robust, MMR can only be used as a rough
indicator of the maternal health situation in any given
country. Hence, other indicators of maternal health status
like antenatal checkup, institutional delivery and delivery
by trained personnel etc. are used for this purpose. These
reflect the status of the ongoing programme interventions
as well as give a reflection on the situation of Maternal
Health. All India figure for these indicators as per the
District Level Household Survey (DLHS II and III) are
tabled below:
DLHS II DLHS III
(2002-04) (%) (2007-08) (%)
Any Antenatal Checkup 73.6 75.2
Three or more Antenatal
check-up 50.4 49.8
Total Institutional Delivery 40.9 47.0
Safe Delivery 48 52.7
IFA tablets Consumed
for 100 days 20.5 46.6
PNC within 2 weeks of delivery N.A 49.7
From November, 2009 - January, 2010 a nationwide
survey called the Coverage Evaluation Survey (CES) was
conducted by the United Nations Children Emergency
Fund (UNICEF) & ORG- Centre for Social Research.
This study was monitored independently by the National
Institute of Health and Family Welfare (NIHFW) and
Population Resource Centre. According to the CES
report, the maternal health indicators are showing
significant improvement as given in table below:
4.4. SCHEMES FOR IMPROVING OBSTETRIC
CARE
4.4.1 Services:
Under the NRHM, several initiatives are under
implementation to achieve the goal of reduction in
Maternal Mortality. These interventions are as follows:
4.4.1.a.Essential Obstetric Care:
This includes quality ante-natal care including prevention
and treatment of anaemia, institutional/safe delivery
services and post natal care. To provide essential obstetric
care services Government of India is operationalizing the
PHCs for 24 X 7 services and also training the Staff
Nurses (SNs)/ Lady Health Visitors (LHVs)/ Auxiliary
Nurse Midwives (ANMs) in Skilled Attendance at Birth.
4.4.1.b. Quality Ante-natal care:
Quality ANC includes minimum of at least 4 ANCs
including early registration and 1st ANC in first trimester
along with physical and abdominal examinations, Hb
estimation and urine investigation, 2 doses of T.T
Immunization and consumption of Iron Folic Acid (IFA)
tablets for 100 days.
4.4.1.c.Prophylaxis and treatment of Nutritional
Anemia:
As per NFHS III (2005-06), 55.3% of women aged 15-
49 years are anaemic in the country. The problem is more
severe during pregnancy, with 58.7% of pregnant women
(15-49 years) being anemic and 63.2 % of lactating
women. Under the NRHM /RCH II Programme all
pregnant and lactating women are provided with one
tablet (containing 100 mg of elemental iron and 0.5 mg of
Folic Acid) daily for 100 days. Those who have severe
anaemia are provided with double dose of these tablets.
IFA in the form of tablets and liquid formulations are
currently being supplied by the Government of India in
RCH Kit A and are distributed through the Sub-Centres
and through outreach activities at Village Health and
Nutrition Days (VHNDs) to women and children. These
are also available at other health facilities like PHCs,
CHCs, District Hospitals throughout the country. Details
Major Indicators Achievement (%)
CES 2009-10
3+ ANC is reported 68.7%
Institutional delivery 73%
Skilled Birth Attendance
(Institutional+ Home) 76.2%
Annual Report 2010-11 65
regarding interventions for anemia are given below:
4.4.1.d Provision of 24 Hrs Delivery Services at
PHC:
Under RCH – II, all the CHCs and 50% of the PHCs
are being operationalized for providing round the clock
delivery services by placing at least 3 -5 Staff Nurses
and 1 Medical Officer in these facilities.
4.4.1.e.Post natal care for Mother and Newborn:
Ensuring post natal care within first 24 hours of delivery
and subsequent home visits on 3rd, 7th and 42nd day are
Pregnant and
lactating women
• 100 mg of
elemental iron
and 0.5 mg of
folic acid for at
least 100 days
for prevention
of Anaemia.
• Those who
have anaemia
are provided
with double
dose of these
tablets
• Health &
N u t r i t i o n
education to
p r o m o t e
d i e t a r y
diversification,
inclusion of
iron-folate rich
food and food
items that
promote iron
absorption.
6mths -5
years
20 mg elemental
iron and 100
mcg folic acid
per ml of liquid
formulation.
6-10
years
30 mg
elemental
iron and
250 mcg
folic acid
per child
per day
IFA supple-
mentation.
Children
Interventions for Anemia under NRHM
Long Lasting Insecticide Nets (LLINs)/Insecticide Treated Bed
Nets (ITBNs) to households in endemic areas particularly to
pregnant women and children
important components for identification and management
of emergencies occurring during post natal period. The
ANMs, LHVs and staff nurses are being oriented and
trained for tackling emergencies identified during these
visits.
4.4.2 Skilled Attendance at Birth:
Government of India is commited to provide skilled
attendance at every birth both at community and institution
level. SNs/ANMs/LHVs are trained in Skilled Attendance
at Birth for a period of 3 weeks. For this curriculum and
technical guidelines have been revised and training is being
implemented accordingly in all the States and UTs.
4.4.3. Provision of Emergency Obstetric and
Neonatal Care at First Referral Units
(FRUs):
Provision of Emergency Obstetric and Neonatal Care at
FRUs is being done by operationalizing all FRUs in the
country. While operationalization the thrust is on the critical
components such as manpower, blood storage units and
referral linkages etc. Availability of trained manpower
(Skill Based Training for MBBS doctors) is linked with
operationalization of FRUs. The initiatives being
undertaken are:
4.4.3.a Training of MBBS Doctors in Life Saving
Anaesthetics Skills for Emergency Obstetric
Care:
Provision of adequate and timely Emergency Obstetric
Care (EmOC) has been recognized globally as the most
important intervention for saving lives of pregnant women
who may develop complications during pregnancy or
childbirth. The operationalization of FRUs, at sub- district
i.e. CHC level for providing EmOC to pregnant women
is a critical strategy of RCH-II, which needs focused
attention. It has not been possible to operationalize these
FRUs till now due to various factors most pertinent being
shortage of specialist manpower, i.e. Gynaecologist and
Anaesthetist, particularly at district and sub district level.
For effective and better management of Emergency
Obstetric needs at the grass root level, Government of
India has taken a policy decision and is implementing 18
weeks programme for training of MBBS doctors in life
saving anaesthetic skills for Emergency Obstetric care
at FRU. The training programme is being implemented in
nearly 100 medical colleges across all the major States
including NE Region.
Annual Report 2010-11 66
4.4.3.b Training in Obstetric Management Skills:
Government of India has introduced training of MBBS
doctors in Obstetric Management & Skills in collaboration
with Federation of Obstetric and Gynaecological Society
of India (FOGSI). A 16 weeks training programme in
obstetric management & skills including Caesarian
Section operation is being implemented at the level of
Medical Colleges and District Hospitals in nearly 25
medical colleges of the States.
4.4.3.c Referral Services at both Community and
Institutional level:
Establishing referral linkages between the community and
FRUs is an essential component for access of services
particularly during emergencies. Since emergencies
during the process of birth cannot be predicted, it is
essential to place effective referral linkages which can
be accessed by all pregnant women in case of emergency.
States have been given the flexibility to establish assured
referral systems.
4.4.4. Other Major Interventions are:
4.4.4.a.Safe Abortion Services/ Medical Termination
of Pregnancy (MTP):
Abortion is a significant medical and social problem in
India. An ICMR study (1989) documented that the rates
of safe (legal) and unsafe (Illegal) abortions were 6.1
and 13.5 per 1000 pregnancies, respectively. It is evident
that perhaps two-thirds of all abortions take place outside
the authorized health services by unauthorized, often
unskilled providers.
The Medical Termination of Pregnancy (MTP) Act was
passed by the Indian Parliament in 1971 and came into
force from April 1, 1972. The aim of this Act was to
reduce maternal mortality and morbidity due to unsafe
abortions. The MTP Act, 1971 lays down the conditions
under which a pregnancy can be terminated and the place
where such terminations can be performed. A recent
amendment to the Act (2003) includes decentralization
of power for approval of places, as MTP centers, from
the states to the district level with the aim of enlarging
the network of safe MTP service providers. The
amendment also provides for specific punitive measures
for performing MTPs by unqualified persons and in places
not approved by the government.
Whether spontaneous or induced, abortion has been a
matter of concern over many decades now, particularly
because of sepsis and other complications associated
with it. Eight percent of maternal deaths are attributed to
complicated abortions. This is a preventable tragedy. This
is also an indication of the unmet need for safe abortions.
The National Population Policy 2000 underlines the
provision of safe abortions as one of the important
operational strategies. Provision of MTP services at 24
X 7 PHCs, CHCs and FRUs are being strengthened by
training of medical manpower in techniques of MTP by
the States. The following are the strategies to promote
safe abortions:
• •• •• Community level:
Spread awareness regarding safe MTP in the
community and the availability of services
thereof.
Enhance access to confidential counseling for
safe MTP; train ANMs, AWWs and link workers/
ASHAs to provide such counseling.
Promote post-abortion care through ANMs, link
workers/ASHAs and AWWs while maintaining
confidentiality.
• •• •• Facility level:
Provide quality MVA (Manual Vacuum
Aspiration) facilities at all CHCs and at least 50%
of PHCs that are being strengthened for 24-hour
deliveries.
Provide comprehensive and high quality MTP
services at all FRUs.
Encourage private and NGO sectors to establish
quality MTP services.
Guidelines for Manual Vacuum Aspiration (MVA) upto 8
weeks of pregnancy for Medical Officers for performing
safe abortions at primary health care facilities have been
disseminated to the states for implementation.
Comprehensive safe abortion guidelines including medical
abortion and providing services for medical abortion
through the peripheral health care infrastructure have also
been disseminated.
4.4.4.b. RTI/STI Services
Reproductive Tract and Sexually Transmitted Infections
(RTI/STI) were not recognized as a public health problem
until recently. Research conducted in India to document
the magnitude of reproductive morbidity, has made the
Annual Report 2010-11 67
incidence of these infections more visible and brought
them into the reproductive health agenda. Several studies
conducted in India during the past decade suggest high
prevalence of reproductive morbidity among women. As
per DLHS-III (2007-2008), about one-fifth (18.3%) of
women reported some symptoms of RTI/ STI, however
there is no data regarding the percentage who sought
treatment. The spread of HIV infection and the role that
RTI/STI plays in the transmission of HIV have also
brought urgency to the problem. The identification and
management of reproductive tract infections is an
important objective of the RCH programme. The
following are the strategies under RCH II programme.
• The prevention, early detection and effective
management of common lower reproductive tract
infections have been included as a component of
essential care through the existing primary health care
infrastructure.
• Convergence with the National AIDS Control
Programme (NACP) is being sought for the provision
of these services, in terms of utilization of services
for case management, laboratory services, counseling
services, drugs, equipment’s, blood safety etc.
• Under RCH - II RTI/STI services are being
implemented at sub-district level i.e. in at least 50%
of the PHCs and all FRUs, including drugs, training,
disposable equipment, and provision for laboratory
technicians.
• National Guidelines for Management of RTIs/ STIs
have been developed in coordination with National
Institute for Research in Reproductive Health,
Mumbai (under ICMR) and have been disseminated
to States.
4.4.4.c.Setting up of Blood Storage Centers (BSC)
at FRUs:
Timely treatment of complications associated with
pregnancy is sometimes hampered due to non-availability
of Blood Transfusion services at FRUs. The Drugs and
Cosmetics Act has been amended to facilitate
establishment of Blood Storage Centers at such FRUs.
4.5. JANANI SURAKSHA YOJANA (JSY)
4.5.1. Janani Suraksha Yojana (JSY) is a safe
motherhood intervention under the National Rural Health
* In HPS Tribal area (Notified by Ministry of Tribal Affairs), the
ASHA package is Rs. 600 in Rural Area w.e.f. 15.6.2010. & in North
East States the ASHA package is Rs. 600 in Rural Area w.e.f. September,
2006.
Category Rural Area Urban Area
Motherís ASHA Motherís ASHA
package package
In LPS 1400 600 1000 200
In HPS 700 200* 600 200
State Eligibility
Category
LPS States In All births, delivered in a health centre
–Government or Accredited Private
Health Institutions.
HPS States In Up to 02 live births
Mission (NRHM) being implemented with the objective
of promoting institutional delivery among the poor
pregnant women. Launched on 12th April 2005, JSY is
being implemented in all States and UTs and integrates
JSY benefits with delivery and post-delivery care. The
scheme focuses on poor pregnant woman with special
dispensation for states having low institutional delivery
rate namely, the States of Uttar Pradesh, Uttrakhand,
Bihar, Jharkhand, Madhya Pradesh, Chattisgarh, Assam,
Orissa, Rajasthan and Jammu & Kashmir. While these
states have been classified as Low Performing States
(LPS), the remaining states have been named as High
Performing States (HPS). Besides the maternal care, the
scheme provides cash assistance to all eligible mothers
for delivery care.
ASHA, the Accredited Social Health Activist acts as an
effective link between the Government and the poor
pregnant women. Her role is to facilitate pregnant women
to avail services of maternal care and arrange referral
transport.
In Low performing States, all women including those from
SC and ST families, delivering in Government health
centres like Sub-centre, PHC/ CHC/FRU/general wards
of District and State Hospitals or accredited private
institutions are eligible to receive the cash assistance. In
High Performing States, BPL pregnant women, aged 19
years and above and the SC and ST pregnant women
are eligible to receive the cash assistance under the
Yojana.
The scale of Cash Assistance (in Rs.) for Institutional
Delivery is as under:-
Annual Report 2010-11 68
ASHA package of Rs. 600/- available in LPS, NE States
and in Tribal Districts of all States/UTs in the rural areas
includes the following three components:-
• Cash assistance, over and above the mother’s
package, for referral transport to go to the nearest
health centre for delivery. The state will determine
the amount of assistance (should not be less than
Rs.250/- per delivery) depending on the topography
and the infrastructure available in their state. It would,
however, be the duty of the ASHA and
the ANM to organize or facilitate in organizing referral
transport, in conjunction with Gram Pradhan, Gram
Sabha etc.
• Cash incentive to ASHA should not be less than
Rs.200/- per delivery in lieu of her work relating to
facilitating institutional delivery. Generally, ASHA
should get this money after her post-natal visit to the
beneficiary and that the child has been immunized
for BCG.
• Transactional cost (balance out of Rs. 600/-) is to be
paid to ASHA in lieu of her stay with the pregnant
woman in the health centre for delivery to meet her
cost of boarding and lodging etc. Therefore, this
payment should be made at the hospital/ heath
institution itself.
The Yojana subsidizes the cost of Caesarean Section or
for the management of obstetric complications, up to Rs.
1500/- per delivery to the Government Institutions, where
Government specialists are not in position.
LPS and HPS States, all such BPL pregnant women,
aged 19 years and above, preferring to deliver at home is
entitled to cash assistance of Rs.500/-per delivery, up to
two live births.
The progress on implementation of JSY during the last
five years is as reflected in the chart below:-
JSY Physical and Financial progress in past 5 years
4.5.2. Village Health and Nutrition Day
Village Health & Nutrition Day (VHNDs) is organized
at the Anganwadi Centre at least once every month to
provide ante natal/ post-partum care for pregnant women.
Promotion of institutional delivery, immunization, family
planning & nutrition are the other various services being
provided during VHNDs.
4.5.3. Other simultaneous steps being undertaken
are:
• Funds are provided to States to hire staff including
doctors and nurses, on a contractual basis wherever
necessary.
• SBA skills have been incorporated in the pre-service
curriculum of SNs/ANMs/LHVs.
• Bed strength of health facilities are being increased
to cope up with the demand of services.
• All Districts and selected high focus blocks have been
strengthened with persons with expertise in
managerial skills, data management and financial
management so that planning and implementation of
services can be ensured.
• States have identified difficult, most difficult and
inaccessible areas as per geographical location, tribal
population, underserved area, left wing affected areas
etc. or in terms of difficulty in finding human resource
for these areas and special incentives for specialists
and MOs for such areas have been proposed by the
States to overcome the shortage of medical officers
and specialists in these areas.
Category Rural Area Urban Area
Motherís ASHA Motherís ASHA
package package
In LPS &
HPS ** 500 Nil 500 Nil
** In LPS and HPS States, all BPL pregnant women, aged 19 years
and above, delivery at home are entitled to cash assistance of Rs.500/
-per delivery, up to two live births.
The scale of Cash Assistance (in Rs.) for Home Delivery
is as under:-
Annual Report 2010-11 69
• Flexibility funding to states and districts through untied
funds, AMGs and corpus funds.
4.5.4. Involvement of professional associations for
skill based training under PPP
• The services of private health facilities for providing
reproductive health services are being mobilized under
various demand side financing schemes through the
mode of Public Private Partnership (PPP). Many
states such as Gujarat (Chiranjeevi Yojana),
Jharkhand (Mukhya Mantri Janani Shishu Swasthya
Abhiyan), West Bengal (Ayushmati Scheme) are
being implemented under Public Private Partnership.
For better implementation of this, GOI guidelines have
been issued to the states. GOI Guidelines to the States
for engaging the services of private health facilities
for up-scaling SBA training for ANMs/ SNs/LHVs
have also been issued.
4.6. NEW INITIATIVES
4.6.1. Maternal Death Review(MDR):
It has been decided to review every maternal death both
at the health facilities and in the community through
formation of MDR Committees at district level and a
task force at State Level. The purpose of the review is
to find gaps in the service delivery which leads to
maternal deaths and take corrective action to improve
the quality of service provision. The process of Maternal
Death Review has been initiated by the states for which
guidelines and tools have been disseminated to the states
by the Ministry.
4.6.2 Maternal & Child Health (MCH) Centres:
The Government of India is facilitating the States in
identifying the delivery points /MCH centres (for basic
and emergency obstetric management) for quality care
during pregnancy, child birth and in post-natal period and
commensurate family planning services, operationalization
of these facilities along-with rational deployment of
existing manpower, training of doctors and specialists in
these identified MCH centres/ delivery points and
providing funds for strengthening and up gradation of
these centres.
4.6.3 Name Based Tracking of Pregnant Women:
Government of India has taken a policy decision to track
every pregnant woman by name for provision of timely
ANC, institutional delivery, and PNC along-with
immunization of the new- born.
4.6.4 Monitoring and Evaluation of Service
Delivery:
To monitor the performance and quality of the health
services being provided for maternal and child health under
the NRHM/RCH II program, several mechanisms like
performance statistics, surveys, community monitoring,
quality assurance, field visits etc have been placed to
strengthen the monitoring and evaluation of the key
indicators and strategies under these programs.
4.6.5. Health Management Information System
(HMIS):
A web-based system has been established by the M&E
Division of the Ministry for flow of information of both
physical and financial progress from District to State and
there in up to the national level. Comprehensive set of
formats for reporting by health facilities i.e. SCs/PHCs/
CHCs/DHs are available for monthly/quarterly and annual
reporting. Mode of e-governance is being used for quick
data sharing and evaluation of key indicators.
4.7. CHALLENGES/CONSTRAINTS:
4.7.1. Human resources for health: There is a huge
shortfall in the number of human resources
required and currently in position.
4.7.2. Governance issues:Tenure of key officers,
including Principal Secretaries, State NRHM
Mission Directors, Directorate officials at the
state levels, Chief District Medical Officers and
Block Medical Officers, is not assured. This
affects programme ownership and continuity of
interventions.
4.7.3. Decentralized Planning: Decentralized planning
capacities are inadequate, including capacity to
utilize locally available data for district planning.
Facility surveys have been carried out by most
states; however these have not been
systematically analyzed by the states to map out
the resources and gaps, and prepare facility-wise
micro plans for operationalization/strengthening.
4.7.4. Village Health and Sanitation
Committees:These need to be strengthened and
activated for improved outcomes.
4.7.5. Monitoring & Supervision:Supervisory
structures at the state and district level are weak.
At many places, there is no mechanism for
monitoring and supervision.
4.7.6. Public Private Partnership (PPP): PPP in
RCH services are not up to the expected levels
and needs to be scaled up.
Annual Report 2010-11 71
Chapter 5
5.1. INTRODUCTION
5.1.1 Under the National Rural Health Mission
(NRHM), Child Health Programme comprehensively
integrates interventions that improve child health and
addresses factors contributing to infant and under–five
mortality. The major components of child health
programme are: i) Establishment of New Born Care
facilities and Facility Based Integrated Management of
Neonatal and Childhood Illnesses (F-IMNCI), ii) Navjaat
Shishu Suraksha Karyakram iii) Integrated Management
of Neonatal and Childhood Illnesses (IMNCI) and Pre-
Service IMNCI iv) Home Based Care of Newborns v)
Universal Immunization vi) Early detection and
appropriate management of Acute Respiratory Infections,
Diarrhoea and other infections vii) Infant and young child
feeding including promotion of breast feeding viii)
Management of children with malnutrition ix) Vitamin A
supplementation and Iron and Folic Acid supplementation
x) School Health Programme
5.1.2 Child Health Goal under RCH II/NRHM:
Child HealthCurrent StatusRCH II/NRHM:
MDG
indicator SRS (2008) 2010-2012 2015
IMR (infant
mortality rate) 53 < 30 28
Neonatal mortality rate 36 < 20 < 20
Under 5 mortality rate 69 - < 39
The strategies for child health intervention focus on
improving skills of the health care workers, strengthening
the health care infrastructure and involvement of the
community through behavior change communication.
5.2. THE PROGRESS OF VARIOUS
COMPONENTS OF CHILD HEALTH
PROGRAMME ARE AS FOLLOWS
5.2.1 Integrated Management of Neonatal & Childhood
Illnesses (IMNCI) is being implemented in 323 districts
and 3.13 lakh personnel have been trained. F – IMNCI
launched to multi skill doctors and staff nurses with special
skills required to manage new born and child hood illnesses
at facilities. Moreover IMNCI has been introduced in
the curriculum of 79 Medical colleges and more than 4000
medical students have been trained on various aspects of
IMNCI.
5.2.2 A total of 192 Sick New Born Care Units
(SNCUs), 366 stabilization units and 1524 new born care
corners has been established.
5.2.3 Under the Navajat Shishu Suraksha
Karyakram (NSSK), 14490 health personnel have been
trained. This scheme launched to address issues of care
at birth and to reduce neonatal mortality.
5.2.4 Totally, 1898 Nutritional Rehabilitation
Centres (NRCs) have been set up across States for
treatment of acute malnutrition.
5.2.5 School Health Programme (SHP) has been
launched nationwide and is currently being implemented
in 33 States/UTs. Health check-up, treatment of minor
ailments, health education, micronutrient supplementation
and immunization services are being offered in close
conjunction with the ministry of HRD.
5.2.6 Vitamin A supplementation is being
implemented for all children of 9 months to 5 years of
age with the objective of decreasing the prevalence of
Vitamin A deficiency to levels below 0.5%. During 2009-
10 the coverage of 1st, 5th and 9th dose of vitamin A
was 80.8%, 71% and 45.9% respectively.
5.3 UNIVERSAL IMMUNIZATION
PROGRAMME
5.3.1 Immunization Programme is one of the key
interventions for protection of children from life
threatening conditions, which are preventable. Under the
Universal Immunization Programme, vaccination is carried
out to prevent seven vaccine preventable diseases i.e.
Diphtheria, Pertussis, Tetanus, Polio, Measles, severe
form of Childhood Tuberculosis and Hepatitis B. Since
Child Health Programme Child Health Programme Child Health Programme Child Health Programme Child Health Programme
Annual Report 2010-11 72
2006, 1 dose of SA-14-14-2 JE vaccine has been
introduced under routine immunization in the high burden
districts in phased manner.
5.3.2 The immunization coverage has seen an
improvement over the years. However, there is further
need for improvement especially in DPT3 & OPV3
coverage and reducing drop outs. Following table outlines
under the programme:
Source Coverage Evaluation Survey (CES) District Level Household Survey (DLHS)
Time Period 2006 2009 DLHS 2 (2002-04) DLHS 3 (2007-08)
Full Immunization 62.4 61.0 45.9 53.5
BCG 87.4 86.9 75.0 86.7
OPV3 67.5 70.4 57.3 65.6
DPT3 68.4 71.5 58.3 63.4
Measles 70.9 74.1 56.1 69.1
No Immunization - 7.6 19.8 4.6
(Figures in %)
5.3.3 To strengthen routine immunization, some newer
initiatives have been introduced as part of the State
Programme Implementation Plan (PIP). These initiatives
are provision of Auto Disable (AD) Syringe to ensure
injection safety, support for alternate vaccine delivery
from PHC to Sub-Centres and outreach sessions,
provision for deploying additional manpower to carryout
Immunization activities in urban slums and underserved
areas where services are deficient and support for
mobilization of children to immunization session sites by
Accredited Social Health Activist (ASHA), Women Self
Help Groups etc.
5.3.4 Expansion of Hepatitis B Vaccine: Hepatitis
B vaccination was introduced in UIP in the financial year
2002-03 as a pilot in 33 districts and 15 cities and was
further expanded to all the districts of 10 states namely
Andhra Pradesh, Himachal Pradesh, Jammu & Kashmir,
Karnataka, Kerala, Madhya Pradesh, Maharashtra,
Punjab, Tamil Nadu and West Bengal. Following the
recommendation of National Technical Advisory Group
on Immunization (NTAGI), it has been decided to provide
Hepatitis B vaccination all over the country.
5.3.5 Introduction of Measles Second
Opportunity: Measles immunization directly contributes
to the reduction of under-five child mortality and hence
to the achievement of Millennium Development Goal
number 4. In order to accelerate the reduction of measles
related morbidity and mortality, second opportunity for
measles vaccination is being implemented. The NTAGI
has recommended the introduction of another dose of
measles vaccine through measles Supplementary
Immunization Activity (SIA) for States where evaluated
coverage for measles vaccine is less than 80% while for
the remaining States where coverage is more than 80%,
NTAGI recommended a second dose through routine
immunization. The 14 states with measles coverage of
less than or equal to 80%, viz. Arunachal Pradesh,
Assam, Bihar, Chhattisgarh, Gujarat, Haryana, Jharkhand,
Madhya Pradesh, Manipur, Meghalaya, Nagaland,
Rajasthan, Tripura and Uttar Pradesh are being covered
through Supplementary Immunization Activity, in a phased
manner followed by introduction of second dose at 16-24
months in routine immunization.
5.3.6 Introduction of Japanese Encephalitis (JE)
Vaccine: JE vaccination was started in 2006 to cover
109 endemic districts in phased manner, using SA 14-14
-2 vaccine, imported from China. Single dose of JE
vaccine was given to all children between 1 to 15 years
of age through campaigns followed by one dose at 16-24
months under routine immunization to cover the newer
cohort. By the end of 2009-10, 90 districts have been
covered under the JE vaccination programme; and
remaining 19 districts are being covered in 2010-11. In
Annual Report 2010-11 73
addition, in 2010-11 re campaign has been planned in 9
districts; 7 in Uttar Pradesh and two in Assam, in view of
their low coverage as per the coverage evaluation survey
conducted in 2008. The JE vaccine is being integrated
into routine immunization in the districts where campaign
had already been conducted to immunize the new cohort
of children by vaccinating with single doses at 16 -24
months.
5.4 PULSE POLIO IMMUNIZATION(PPI)
In the pursuance of the World Health Assembly resolution
of 1988, the Pulse Polio Immunization (PPI) Programme
was started nation-wide from 1995 to eradicate polio in
India covering children in the age group 0-3 years. In
order to accelerate the pace of polio eradication, all
children under the age of 5 years were targeted since
1996-97. The annual strategy on polio eradication is
decided on the basis of recommendation of India Experts
Advisory Group (IEAG) which constituted of Indian
experts and international experts. The National Polio
Surveillance Project (NPSP) provides technical support
for high quality Acute Flaccid Paralysis (AFP) surveillance
& assists the government in micro planning, training &
monitoring of polio immunization campaign.
Since the PPI initiative in 1995, significant success has
been achieved in reducing the number of polio cases in
the country & total cases decline gradually. Of the 3 types
of polio causing viruses, type 2 (WPV-2) has already been
eradicated in 1999. The bivalent vaccine (bOPV) was
introduced in the country for the first time in 2010. In
2010, two National Immunization Days (NIDs) and six
sub-national Immunization Days (SNIDs) have been
conducted. The NID rounds covers approximately 170
million children and SNID rounds cover 40-80 million
children. In addition, large scale multi-district mop-ups
have been conducted in response to detection of the
WPVs. As a result of these interventions remarkable
progress has been made towards polio eradication with
only 41 polio cases detected (as on 24th December 2010)
compared to 650 cases detected during the same period
in 2009. Details are given in the table below. The most
significant progress is seen in the endemic states with no
type 1 case detected in UP since November 2009 and
one type 1 case detected in 2010 in Bihar with onset of
July 2010.
The major risks to eradication of type 1 polio are
transmission in West Bengal and Jharkhand areas and
re-introduction of type 1 polio from neighboring Nepal or
West Bengal through extensive migration and population
movements.
5.5 INFANT AND YOUNG CHILD FEEDING
(IYCF)
5.5.1 Promotion of infant and young child feeding
(IYCF) practices. The following are emphasized under
IYCF:
• Early initiation of breastfeeding within one hour of
delivery
• Exclusive breastfeeding of the first six months of
life
• Timely and adequate complementary feeding along
with continuation of breast feeding up to two years
of life
Comparison of indicators of child feeding
practices:
Table:
State-wise details of polio cases in 2010
(as on 24th December 2010)
S. State WPV-1 WPV-3 Total
No
1 Uttar Pradesh 0 10 10
2 Bihar 3 6 9
3 West Bengal 5 2 7
4 Jharkhand 3 5 8
5 Maharashtra 5 0 5
6 Haryana 0 1 1
7 Jammu & Kashmir 1 0 1
Total 17 24 41
NFHS I NFHS II NFHS III
(1992-93) (1998-99) (2005-06)
Indicators Rural Urban Total
Children under
3 years breastfeeding
within one hour of
birth (%) 9.5 16.0 21.5 28.9 23.4
Children aged
0-5 months
exclusively
breastfeeding (%) N.A N.A 40.7 31.1 38.4
Annual Report 2010-11 74
5.6 IRON AND FOLIC ACID
SUPPLEMENTATION
5.6.1 To manage the widespread prevalence of
anaemia in the country, Iron and Folic Acid
supplementation is provided for at least hundred days in
a year for all age groups, i.e infants above six months of
age up to adolescence and pregnant and lactating mothers
as well as IUD users.
5.6.2 Infant from the age of 6 months onwards up to
the age of five years shall receive iron supplements in
liquid formulation in doses of 20 mg elemental iron and
100 mcg folic acid (per day) for 100 days in a year.
Children 6-10 years of age shall receive iron in the dosage
of 30 mg elemental iron and 250 mcg folic acid for 100
days in a year and adolescents 11-18 years shall receive
supplements at the same dosage and durations as adults.
5.7 COLD CHAIN SYSTEM VACCINE
STORAGE AT PHC/CHC LEVEL
5.7.1 The cold chain system consists of a series of
transportation & storage facilities for vaccines from the
manufacturers to the beneficiaries at a recommended
temperature. Now this year nearly 15000 equipments
were procured and are being supplied to states for
upgradation of cold chain system in the country. More
than 87000 units consisting of the following equipments
are there in the states for storing the vaccines at various
levels.
I. Walk ñin Coolers and Walk-in - Freezers
Rooms: These are supplied at State/Regional
Level to maintain a vaccine stock required for 3
months in its catchment area. There are at present
161 walk in coolers and 36 walk in freezers installed
at various location of the states in the country.
II. Ice Lined Refrigerators (Large) and Deep
Freezers (Large) at the district Level: 8700
number ILRs (L) and Deep Freezers (L) have been
supplied. At the district stores Deep Freezers are
also used for storing Polio Vaccine at below (-) 15
Centigrade.
III. A Twin Set of ILR/Deep Freezers: These have
been supplied in pairs to all PHCs, where a stock
of one month’s requirement of vaccines is
maintained. 79000 such units have been supplied
to different health institutions.
IV. Skill based training to cold chain technicians was
provided to equip with repair management skills on
CFC free equipments. Cold chain stores renovation
has also been initiated in the States as per their
requirements.
Annual Report 2010-11 75
Chapter 6
6.1 INTRODUCTION
Several National Health Programmes such as the National
Vector Borne Diseases Control, Leprosy Eradication, TB
Control, Blindness Control and Iodine Deficiency Disorder
Control have now come under the umbrella of National
Rural Health Mission.
6.2. NATIONAL VECTOR BORNE DISEASES
CONTROL PROGRAMME (NVBDCP)
The National Vector Borne Disease Control Programme
is a comprehensive programme for prevention and control
of vector borne diseases namely Malaria, Filaria, Kala-
azar, Japanese Encephalitis (JE), Dengue and
Chikungunya which is covered under the overall umbrella
of NRHM. The States are responsible for implementation
of programme whereas the Directorate of NVBDCP,
Delhi provides technical assistance, policies and
assistance to the States in the form of cash & commodity,
as per approved pattern. Malaria, Filaria, Japanese
Encephalitis, Dengue and Chikungunya are transmitted
by mosquitoes whereas Kala-azar is transmitted by sand-
flies. The transmission of vector borne diseases in any
area is dependent on frequency of man-vector contact,
which is further influenced by various factors including
vector density, biting time, etc.
The general strategy for prevention and control of vector
borne diseases under NVBDCP is described below:
(i) Disease Management including early case
detection and complete treatment, strengthening of
referral services, epidemic preparedness and rapid
response.
(ii) Integrated Vector Management including
Indoor Residual Spraying (IRS) in selected high
risk areas, use of Insecticide Treated Bed Nets
(ITNs), Long Lasting Insecticidal Nets (LLINs),
use of larvivorous fish, anti larval measures in urban
areas including bio-larvicides and minor and
environmental engineering.
National Programmes National Programmes National Programmes National Programmes National Programmes
Under NRHM Under NRHM Under NRHM Under NRHM Under NRHM
(iii) Supportive Interventions including Behaviour
Change Communication (BCC), Public‘ Private
Partnership (PPP) & Inter-sectoral Convergence,
Human Resource Development through capacity
building, Operational Research including studies on
drug resistance and insecticide susceptibility and
Monitoring & Evaluation.
6.2.1. Malaria
a. Malaria is an acute parasitic illness caused by
Plasmodium falciparum or Plasmodium vivax in
India. Nine major species of anopheline mosquitoes
transmit malaria in India. The main clinical
presentation is with fever with chills; however,
nausea and headache can also occur. The diagnosis
is confirmed by microscopic examination of a blood
smear and Rapid Diagnostic Tests for Pf cases.
Majority of the patients recover from the acute
episode within a week. Malaria continues to pose
a major public health threat in different parts of the
country, particularly due to Plasmodium falciparum
as it is sometimes prone to complications and death,
if not treated early.
b. There are 9 species of Malaria vectors in India,
out of which the major vector mosquito for rural
malaria viz. Anopheles culicifacies, is distributed
all over the country and breeds in clean ground
water collections. Other important Anopheline
species namely An.minimus and An.fluviatilis
breed in running channels, streams with clean water.
Some of the vector species also breed in forest
areas, mangroves, lagoons, etc, even in those with
organic pollutants.
c. In urban areas, malaria is mainly transmitted by
Anopheles stephensi which breeds in man-made
water containers in domestic and peri-domestic
situations such as tanks, wells, cisterns, which are
more or less of permanent nature and hence can
Annual Report 2010-11 76
maintain density for malaria transmission throughout
the year. Increasing human activities, such as
urbanization, industrialization and construction
projects with consequent migration, deficient water
and solid waste management and indiscriminate
disposal of articles (tyres, containers, junk materials,
cups, etc.) create mosquitogenic conditions and thus
contribute to the spread of vector borne diseases.
The National Health Policy (2002) has set the goal of
reduction in mortality on account of malaria by 50% by
2010. Reduction of malaria morbidity and mortality is also
important to meet the overall objectives of reducing
poverty and is included in the Millennium Development
Goals (Goal 6 and target 8).
Epidemiological Situation:
The status of total cases, Pf cases, deaths and API from
1996 to 2010 (up to September) is given in the table and
the Graph as follows. The state-wise data on malaria
cases & deaths since 2007 is at Appendix- 1.
Pre-independence estimates of Malaria were about 75
million cases and 0.8 million deaths annually. The problem
was virtually eliminated in the mid sixties but resurgence
led to an annual incidence of 6.47 million cases in 1976.
Modified Plan of Operation was launched in 1977 and
annual malaria incidence started declining. The cases
were contained between 2 to 3 million cases annually till
2001 afterwards the cases have further started declining.
During 2009, the malaria incidence was around 1.56
million cases, 0.84 million Pf cases and 1144 deaths.
About 92% of malaria cases and 97% of deaths due to
malaria are reported from high disease burden states
namely, north eastern (NE) States, Chhattisgarh,
Jharkhand, Madhya Pradesh, Orissa, Andhra Pradesh,
Maharashtra, Gujarat and Rajasthan, West Bengal and
Karnataka. However, other States are also vulnerable
and have local and focal outbreaks. Resistance in
Plasmodium falciparum to Chloroquine is being detected
from more areas and Artesunate Combination Therapy
has been introduced in such areas as first line treatment.
For strengthening surveillance, Rapid Diagnostic Test
(RDT) for diagnosis of P.falciparum malaria has also
been introduced in high endemic areas. In these areas,
ASHAs have been trained in diagnosis and treatment of
malaria cases and are thus involved in early case detection
and treatment.
The Government of India provides technical assistance
and logistics support including anti malaria drugs, DDT,
larvicides, etc. under the National Vector Borne Disease
Control Programme. State Governments have to meet
other requirements of the programme and operational
costs and to ensure the implementation of programme.
North-eastern states are provided 100 per cent central
assistance for programme implementation that includes
operational cost.
Malaria Situation in the country during 1996-2010*
Year Cases (in million) Deaths API
Total Pf
1996 3.03 1.18 1010 3.48
1997 2.66 1.01 879 3.01
1998 2.22 1.03 664 2.44
1999 2.28 1.14 1048 2.41
2000 2.03 1.04 932 2.09
2001 2.09 1.01 1005 2.12
2002 1.84 0.90 973 1.82
2003 1.87 0.86 1006 1.82
2004 1.92 0.89 949 1.84
2005 1.82 0.81 963 1.68
2006 1.79 0.84 1707 1.66
2007 1.50 0.74 1311 1.39
2008 1.53 0.78 1055 1.36
2009 1.56 0.84 1144 1.36
2010* 1.04 0.53 547
* Data for 2010 up to September
Annual Report 2010-11 77
The major externally supported projects:
Additional support for combating malaria is provided
through external assistance in high malaria risk areas.
There are two such externally funded projects which are
currently being implemented for malaria control:
(i) Global Fund Supported Intensified Malaria Control
Project (IMCP)
(ii) World Bank Supported Project on Malaria Control
& Kala-azar Elimination.
The areas covered under these projects are as under:
TWO PROJECTS WITH EXTERNAL ASSISTANCE
The Global Fund supported Intensified Malaria
Control Project (IMCP)
This project is for a period of 5 years starting from July,
05 to June, 2010. The total financial outlay of this project
is Rs. 277.20 crores. The project is being implemented
in 106 districts in 10 States namely, 7 North-Eastern States
and in selected high risk areas of Orissa, Jharkhand and
West Bengal covering a population of about 100 million.
The goal of the project is to reduce malaria morbidity
and mortality in 100 million populations in 10 States by
30% in 5 years.
Additional Support provided in project area is listed
below:
Human resource such as Consultants and support
staff for project monitoring units.
Capacity building of Medical Officers/Lab.
Technicians/ Fever Treatment Depots/Volunteers
etc.
Commodities such as Synthetic Pyrethroid liquid
formulation insecticide for treatment of bednets,
Long-Lasting Insecticidal Nets (LLINs), Rapid
Diagnostic tests for quick diagnosis of Malaria,
alternate drugs (Artesunate Combination Therapy,
Inj. Arteether) for treating malaria cases resistant
to Chloroquine.
Planning & administration including mobility support,
monitoring, evaluation and operational research
(studies on drug resistance and entomological
aspects).
This project has ended in June 2010. This Intensified
Malaria Control Project–II (IMCP-II) will be
implemented for a period of five years (2010-2015).
Achievements of IMCP: (Project end): Under this
project in five years followings have been achieved:
(i) Provision of 5145475 ITNs (including 6,75,004
LLINs) to targeted population in project areas
(ii) 2,16,42,050 bed nets treated with insecticides in
project area during the project period
Annual Report 2010-11 78
(iii) Treatment with SP-ACT in 970450 uncomplicated
Pf cases
(iv) Treatment with artemisinin injections in 343930
severe malaria cases
(v) 4890 medical officers of public and private
healthcare sectors trained
(vi) 137 recruited and trained for the supervision in
project areas
(vii) 3261 LTs trained in malaria microscopy
(viii) 9601 service deliverers of local NGOs/CBOs
identified and trained
(ix) 2,13,997 community volunteers trained in malaria
control strategies
(x) 70860 awareness camps organized at village level
for treating bed-nets.
The impact in terms of epidemiological indicators for the
project areas based on the data received up to July 2009
are shown in the following table:
The enhanced inputs under the project ie, introduction of
RDT for early diagnosis and complete treatment with
ACT (SP + Artesunate) regimen and injection Artemisinine
derivatives along with use of ITN/LLINs as personal
protective measures have helped to achieve decline in
malaria incidence by 23.4%, with overall declining trend
in SPR, SfR with improvement in process indicator ABER
indicating improved surveillance.
The World Bank Supported Project on Malaria
Control & Kala-azar Elimination
This project has been approved for 5 years effective from
March 2009 to December 2013. The total financial outlay
for this project is Rs.1000 crore. This project is being
implemented in 93 malarious districts of eight (8) states
namely Andhra Pradesh, Chhattisgarh, Gujarat,
Jharkhand, Madhya Pradesh, Maharashtra, Orissa &
Karnataka and 46 Kala-azar districts in three states
namely Bihar, Jharkhand and West Bengal. The project
will be implemented in two phases. Phase one is covering
50 most malaria endemic districts in five States namely
Andhra Pradesh, Chhattisgarh, Madhya Pradesh, Orissa
and Jharkhand and 46 kala-azar districts in Bihar,
Jharkhand & West Bengal. From 3
rd
year, phase two shall
be implemented in remaining (43) malaria districts.
Additional support provided in this project are:
i) Provision of Human Resource like Consultants &
Support staff at National, State, District & Sub
District level for surveillance & monitoring.
ii) Promotion & use of long lasting Insecticide Nets
(LLINs) in high malaria endemic areas.
Table: Status of Epidemiological Indicators of malaria In IMCP (2002-09)
Indicator 2002 2003 2004 2005 2006 2007 2008 2009 % Change
from 2002
Population
(In,000s) Project 83838 89619 90807 93533 101887 103925 106004 105645 26.0
ABER Project 7.76 7.72 7.20 8.87 9.28 8.61 8.47 9.89 27.45
Annual Parasite
Incidence (API) 5.25 5.33 4.98 4.88 4.95 4.05 3.43 4.02 - 23.42
Project Slide Positivity
Rate (SPR) Project 6.77 6.90 6.79 5.51 5.33 4.70 4.05 4.07 -39.88
Slide falciparum
Rate (SfR) Project 3.41 3.33 3.32 2.55 2.79 2.52 2.41 2.63 -22.87
Malaria Mortality
Project 478 484 395 426 1124 ** 691 389 563 +17.78
** Due to epidemic situation in Assam
Annual Report 2010-11 79
Year Population Total P.f P.F %SPR SFR Deaths
cases
2008 113334073 113810 18963 13.42 1.66 0.22 102
2009 114699850 166065 31134 18.75 2.98 0.56 213
*2010115159555 111486 15332 13.75 2.81 0.39 118
*Provisional up to October, 2010
iii) Social mobilization and vulnerable community plan
to address the issues of marginalized sections.
iv) Strong BCC/IEC activities at Sub district level
through identified agencies.
v) The project also envisaged the safe guard policies
by undertaking Environmental Management Plan
(EMP) on safe disposal & environmental hazards.
vi) Capacity building of Medical Officers /Lab
Technicians/Fever Treatment Depots/Volunteers
etc.
vii) Supply of rapid kits for Malaria and drug Artesunate
combination therapy (ACT) for treatment of PF
cases.
6.2.2. Urban Malaria Scheme
The Urban Malaria Scheme (UMS) under NVBDCP is
being implemented in 131 towns in 19 States and Union
Territories protecting 115.1 million population.
Objectives:
The main objectives were reduction of the disease to a
tolerable level in which the human population in urban
areas can be protected from malaria transmission with
the available means.
The Urban Malaria Scheme aims at:
a). To prevent deaths due to malaria.
b). Reduction in transmission and morbidity.
Epidemiological Situation
About 10% of the total cases of malaria are reported
from urban areas. Maximum numbers of malaria
cases are reported from Ahmedabad, Chennai,
Kolkata, Mumbai, Vadodara, Vishakapatnam,
Vijayawada etc. The comparative epidemiological
profile of malaria during 2008-2010 in all urban towns
of the country is given below:
Control Strategy:
Under UMS, Malaria Control strategies are for: (i)
Parasite control & (ii) Vector control
(i) Parasite control: Treatment is done through
passive agencies viz. hospitals, dispensaries both
in private & public sectors. In mega cities malaria
clinics are established by each health sector/ malaria
control agencies viz. Municipal Corporations,
Railways, Defence services
(ii) Vector control comprises of source reduction,
use of larvicides, use of larvivorous fish, space
spray, minor engineering and Legislative measures.
The control of urban malaria depends primarily on the
implementation of urban bye-laws to prevent mosquito
breeding in domestic and peri-domestic areas or residential
blocks and government/commercial buildings, construction
sites. Use of larvivorous fish in the water bodies such as
natural water bodies, slow moving streams, lakes,
ornamental ponds/fountains etc. is also recommended.
Larvicides are used for water bodies, which are unsuitable
for use of larvivorous fish. Awareness campaigns are
also undertaken by Municipal Bodies/Urban area
authorities.The Bye-laws have been enacted and
implemented in Delhi, Mumbai, Chandigarh, Ahmedabad,
Bhavnagar, Surat, Rajkot, Bhopal, Agartala and Goa.
Central Cross Checking Organization (CCCO): The
Central Cross Checking Organization of the Directorate
of National Vector Borne Disease Control Programme
regularly cross check of anti-larval operations in
Municipal Corporation of Delhi (MCD), New Delhi
Municipal Council (NDMC), Northern Railways,
Cantonment Areas as well as Zoological Park, Indian
Institute of Technology Delhi, All India Radio, Jawahar
Lal Nehru University and Presidents Estate in NCT Delhi
and near by townships /localities of National Capital Region
namely Ghaziabad and Noida in Uttar Pradesh, Faridabad,
Gurgaon and Sonepat in Haryana to provide feedback
about the larval density/ breeding indices and remedial
measures to be undertaken by them. The monthly
Annual Report 2010-11 80
entomological indices of National capital territory of Delhi
for Aedes aegypti are as below from 2009 & 2010.
Followings are the vector control strategies for NCT
Delhi:
• Weekly recurrent application of larvicides like
temephos and mosquito larvicides oil in different
breeding habitats.
• Use of Larvivorous fish Gambusia affinis, and
Poecila reticulate (Guppy) in ornamental tanks,
ponds and other water collections.
• Filling up of unused well and water pools, desilting
and deweeding of the margins of the drains.
• Use of legislative measures and prosecution of
defaulters; for creating mosquitogenic conditions
in domestic places.
S.No. Month 2008 2009 2010*
HI CI BI HI CI BI HI CI BI
1. January 0.0 0.0 0.0 0.0 0.0 0.0 0.1 0.1 0.1
2. February 0.04 0.03 0.04 0.02 0.03 0.03 0.03 0.02 0.03
3. March 0.11 0.13 0.14 0.09 0.07 0.0 90.1 0.1 0.2
4. April 0.54 0.48 0.56 0.16 0.13 0.16 0.5 1.00.2 0.6
5. May 1.2 1.1 1.3 0.5 0.4 0.5 1.2 0.81.0 1.6
6. June 4.8 5.0 5.8 1.0 1.1 1.3 0.9 2.80.8 1.2
7. July 4.4 5.2 7.7 1.1 1.1 1.3 1.9 9.82.8 4.6
8. August 4.5 5.2 7.8 3.1 4.1 6.2 6.4 9.79.8 25.0
9. September 4.1 4.4 5.8 3.2 4.9 8.5 7.6 2.9.7 23.9
10. October 2.3 2.3 2.1 1.6 1.7 2.3 2.5 2.1 3.1
11. November 0.5 0.6 0.06 1.1 1.0 1.3
12. December 0.04 0.03 0.04 0.4 0.4 0.6
HI= HOUSE INDEX, CI= CONTAINER INDEX, BI= BRETEAU INDEX
*Provisional up to October 2010
Vector Control Strategy
Table showing breeding indices of Aedes aegypti in NCT Delhi 2008, 2009 and 2010
• Spray with pyrethrum in and around 50 house of a
positive malaria case.
• Use of fogging in case of very high density of vector
mosquitoes (Aedes aegypti and An. Stephensi).
6.2.3. El i mi nat i on of Lymphat i cFilariasis
6.2.3.a.Lymphatic Filariasis is transmitted mainly by
mosquito Culex quinquefasciatus which breeds in
polluted water in drains, cesspits etc., in areas with
inadequate drainage, sanitation.However, in some parts
of Kerala Mansonia annulifera / M.uniformis also
transmits the disease and the vector mosquitoes breed
in water pools with aquatic vegetation. The disease is
reported to be endemic in 250 districts in 20 States and
UTs. The population of about 600 million in these districts
Annual Report 2010-11 81
is at risk of lymphatic filariasis. This disease causes
personal trauma to the affected persons and is associated
with social stigma, even though it is not fatal.
6.2.3.b. The target year for Global elimination of this
disease is by the year 2020. Government of India is
signatory to the World Health Assembly Resolution in
1997 for Global Elimination of Lymphatic Filariasis. The
National Health Policy (2002) has envisaged elimination
of lymphatic fialriasis in India by 2015. The Elimination is
defined as “Lymphatic Filariasis ceases to be a public
health problem, when the number of microfilaria carriers
is less than 1% and the children born after initiation of
ELF are free from circulating antigenaemia (presence of
adult filaria worm in human body).
6.2.3.c.The strategy of lymphatic filariasis
elimination is through:
• Annual Mass Drug
Admi ni st r at i on
(MDA) of single
dose of antifilarial
tablets i.e. DEC +
Albendazole for 5
years or more to
the eligible
population (except
pregnant women,
children below 2
years of age and
seriously ill
persons) to
interrupt transmission of the disease.
• Home based management of lymphoedema cases
and up-scaling of hydrocele operations in identified
CHCs/ District Hospitals /Medical Colleges.
States/UTs): 20
Districts: 250
Pop.: 600 million
6.2.3.d. To achieve elimination of Lymphatic Filariasis,
the Government of India during 2004 launched annual
Mass Drug Administration (MDA) with annual single
recommended dose of DEC tablets in addition to scaling
up home based foot care and Hydrocele operation. The
co-administration of DEC+ Albendazole has been
upscaled to cover the population at risk. However, Mass
Drug Administration (MDA) - 2009 round was observed
in 18 States/UTs except Assam and Uttar
Pradesh with co-administration of DEC with
Albendazole. The coverage achieved in these states for
MDA is 88.6% against the targeted population. The MDA
coverage was 72.4% in 2004, 76% in 2005, 82% in 2006,
83% in 2007 and 86% in 2008. The state wise coverage
is indicated in Appendix-2.
The MDA 2010 round has started from 11
th
November,
2010.
6.2.3.e. The line listing of lymphoedema and Hydrocele
cases were initiated since 2004 by door to door survey
in these filaria endemic districts. The enlisted cases are
regularly being updated by state health authorities and
more cases
are being
r e c o r d e d .
T h i s
increase is
mainly due
t o
incomplete
s u r v e y s
during initial
years and
rel uct ance
on part of
Annual Report 2010-11 82
community to reveal their manifestations of lymphoedema
and Hydrocele. The updated figure till 2009 revealed that
7.62 lakhs lymphoedema and 3.93 lakhs Hydrocele cases
have been enlisted. The initiatives have also been taken
to demonstrate the simple washing of foot to maintain
hygiene for prevention of secondary bacterial and fungal
infection in chronic lymphoedema cases so that the
patients get relief from frequent acute attacks. The states
regularly update the list and intensify the hydrocele
operations in their respective states.
6.2.3.f. The microfilaria survey in all the implementation
units (districts) is being done through night blood survey
before MDA. The survey is done in 4 sentinel and 4
random sites collecting total 4000 slides (500 from each
site). There is definite evidence of microfilaria reduction
in the MDA districts. However, the coverage of
population with MDA should be above 80% persistently
for 5-6 year which would reduce microfilaria load in
community and thereby, interrupting the transmission.
6.2.4. Kala-Azar
6.2.4.a.Kala-azar is caused by a protozoan parasite
Leishmania donovani and spread by sandfly, which
breeds in shady, damp and warm places in cracks and
crevices in the soft soil, in masonry and rubble heaps,
etc. Proper sanitation and hygiene are critical to prevent
sand fly breeding. The National Health Policy (2002) of
GoI has set the goal for elimination of Kala-azar from
the country by 2010. In pursuance to achieve the
elimination goal, case detection and treatment compliance
has been strengthened and Rapid Diagnostic Test for
Kala-azar and oral drug miltefosine have been introduced.
World Bank is providing assistance in 46 districts in 3
states namely Bihar, Jharkhand and West Bengal.
Kala-azar is endemic in 52 districts (31 in Bihar, 4 in
Jharkhand, 11 in West Bengal and 6 in UP). The Kala-
azar Control Programme was launched in 1990-91. The
annual incidence of disease came down from 77,099
cases in 1992 to 33598 cases in 2008 and deaths from
1419 to 151 in 2008 respectively. In the year 2009, 24212
cases and 93 deaths were reported, whereas in 2010
upto October, 23375 cases and 78 deaths have been
reported - Appendix 3.
6.2.4.b. To realize the goal of elimination of Kala-azar,
the Govt. of India is providing 100% support to endemic
states since 2003-04.
6.2.4.c. Initiatives undertaken for Kala-azar elimination
are as follows:
• Active Case Search: The frequency of case
searches has been increased, from a single annual
case search to quarterly case searches. The active
case searches are carried out during a fortnight
designated as the ëKala-azar Fortnightí, during
which the peripheral health workers and volunteers
are engaged to make door-to-door search and refer
the cases conforming to case definition of kala-
azar and PKDL to the treatment centres for
definitive diagnosis and treatment.
• Institutional Surveillance through passive
case detection: Majority of the Kala-azar cases
are reported from PHC’s and district hospitals.
Annual Report 2010-11 83
Many private practitioner, NGO, FBO’s have also
been advised to report cases to the district health
authorities.
• Treatment: To ensure complete treatment
compliance a patient coding scheme has been put
in place in all the treatment cetnres.
• Vector Control: Two rounds of DDT spray are
undertaken in affected villages of the endemic
district, at a dosage of 1g/m
2
.
• A health education programme with personal
contacts as well as through mass media has been
initiated to create awareness of the disease
amongst the public, emphasizing the need for early
case detection, acceptance of a full course of
treatment and other control measures.
• Intensive training programme for all levels of health
staff has been undertaken including one inter-
country training and one inter-country training on
Standard Operation Procedures (SOP).
• Introduction of rapid diagnosis test for Kala-azar
and oral drug miltefosine in 10 pilot districts of 3
endemic states.
• An incentive for an amount of Rs.200/- is being
provided to the Health Workers/ASHAs for
referring a susceptive case of kala-azar and to
ensure complete treatment after confirmation.
• The kala-azar activist/ Accredited Social Health
Activist (ASHA) under the National Rural Health
Mission (NRHM) will be provided incentives to
involve them in the various activities for control of
kala-azar.
6.2.5. Japanese Encephalitis (JE)
6.2.5.a.Japanese Encephalitis is a zoonotic disease which
is transmitted by vector mosquito mainly belonging to
Culex vishnui group. The transmission cycle is maintained
in the nature by animal reservoirs of JE virus like pigs
and water birds. Man is the dead end host, i.e. JE is not
transmitted from one infected person to other. Outbreaks
are common in those areas where there is close interaction
between animals/birds and human beings. The vectors
of JE breed in large water bodies such as paddy fields.
The population at risk is about 300 million.
6.2.5.b. Case definition of AES: Clinically, a case of
AES is defined as a person of any age, at any time of the
year with the acute onset of fever and a change in mental
status (including symptoms such as confusion,
disorientation, coma or inability to talk), and/or new onset
of seizures (excluding/simple febrile seizures). Other
early clinical findings may include an increase in irritability,
somnolence or abnormal behaviour greater than that seem
with usual febrile illness.
A simple febrile seizure is defined as a seizure that occurs
in a child aged 6 months to less than six years old, whose
only findings is fever and a single generalized convulsion
lasting less than 15 minutes and who recovers
consciousness within 60 minutes of the seizure.
(Reference – Guidelines for surveillance of Acute
Encephalitis Syndrome with special reference to Japanese
Encephalitis, Dte. of NVBDCP, Dte. General of Health
Services, MOH&FW, November, 2006).
6.2.5.c. Epidemiological Situation: JE has been
reported from different parts of the country. The disease
is endemic in 14 states of which Assam, Bihar, Haryana,
and Uttar Pradesh have been reporting outbreaks. During
the year 2008, the reported AES figures indicated 3839
cases and 684 deaths. In the year 2009, 4482 cases and
774 deaths were reported. In 2010 (upto November, 2010)
4686 cases and 645 death were reported. State-wise JE
cases and deaths are given in Appendix - 4.
Annual Report 2010-11 84
6.2.5.d. There is no specific cure for this disease.
Symptomatic and early case management is very important
to minimize risk of death and complications. Govt. of India
launched JE vaccination programme as an integral
component of Universal Immunization Programme (UIP)
with single dose live attenuated JE (SA- 14-14-2) in 11
endemic districts of 4 States namely Uttar Pradesh,
Assam, West Bengal and Karnataka for children between
1 and 15 years of age and 88.39% coverage was
achieved. During 2007, 28 more districts were covered
with 84.28% coverage and during 2008 and 2009 children
between 1-15 years in 21 and 70 districts respectively
vaccinated bringing the total number vaccinated districts
to 90. During 2010 out of 19 districts, 5 districts in
Manipur, 2 districts in Assam and 1 district in uttarakhand
have been covered under vaccination campaign. In
addition 7 districts in Uttar Pradesh under special JE
vaccination campaign during 2010-11.
6.2.5.e.In addition, implementation of public health
measures such as, Health Education through different
media like radio, TV including cable network, miking, inter-
personal communication, etc for disseminating appropriate
messages in the community is crucial. The emphasis is
given on keeping pigs away from human dwellings or in
pigsties particularly during dusk to dawn which is the biting
time of vector mosquitoes. Sensitization of the community
regarding avoidance of man-mosquito contact by using
bet nets and fully covering the body are also advocated.
Since early reporting of cases is crucial to avoid any
complication and mortality, community is given full
information about the signs and symptoms as well as
availability of health services at health centres/hospitals.
Besides, the states are advised fogging with malathion
(technical) as an outbreak control measure in the affected
areas.
6.2.6. Dengue Fever/Dengue Haemorrhagic
Fever
6.2.6.a.Dengue Fever is an outbreak prone viral disease,
transmitted by Aedes aegypti mosquitoes. Aedes aegypti
mosquitoes prefer to breed in manmade containers, viz.,
cement tanks, overhead tanks, underground tanks, tyres,
desert coolers, pitchers, discarded containers, junk
materials etc, in which water stagnates for more than a
week. This is a day biting mosquito and prefers to rest in
hard to find dark areas inside the houses. The risk of
dengue has shown an increase in recent years due to
rapid urbanization, life style changes and deficient water
management including improper water storage practices
in urban, peri-urban and rural areas, leading to proliferation
of mosquito breeding sites. The disease has a seasonal
pattern i.e., the cases peak after monsoon and it is not
uniformly distributed throughout the year. Dengue is a
self limiting acute disease characterized by fever,
headache, muscle & joint pains, rash, nausea and vomiting.
Some infections results in Dengue Haemorrhagic Fever
(DHF) and in its severe form Dengue Shock Syndrome
(DSS) can threaten the patient’s life primarily through
increased vascular permeability and shock due to bleeding
from internal organs. Though during last 2 years numbers
of cases are increasing the deaths are declining. The case
fatality rate which was 3.3 % in 1996 had come down to
0.6 in 2009 and 0.4 till November 2010 because of better
Annual Report 2010-11 85
management of Dengue cases in the country following
National guidelines. The risk of Dengue has been
increased in recent year.
6.2.6.b. Epidemiological Situation: Dengue is
endemic in 29 States/UTs. After 1996, Outbreak with a
total number of 16517 cases and 545 deaths upsurge of
cases were recorded in 2003, 2005 and 2008. In 2009
total 15535 cases and 99 deaths have been reported.
During 2010, till November 25725 cases and 99 deaths
have been reported (Appendix-5). Maximum cases were
reported by Delhi (6221) followed by Punjab (4022),
Kerala (2501), Gujarat (2269) and Karnataka (2177).
6.2.6.c. There is no specific anti-viral drug or vaccine
against dengue infection. Mortality can only be minimized
by early diagnosis and prompt symptomatic management
of the cases. A strategic action plan has been developed
for prevention and control of Dengue and issued to the
endemic States for implementation. Guidelines for clinical
management of dengue fever/ dengue haemorrhagic fever
and dengue shock syndrome cases have been developed
and sent to the states for wider circulation. Advisories
have been sent to the endemic areas for effective vector
control through inter-sectoral collaboration and active
community involvement, regular monitoring of Dengue
cases as well as entomological parameters to forecast
likely outbreaks and to take timely remedial measures.
The States have been communicated to undertake
widespread campaigns for community awareness and
mobilization through different media like mass media,
miking, inter-personal communication, etc. The emphasis
is on elimination of mosquito breeding sources like
avoidance of water collection in and around houses,
removal of all discarded and disposed/junk materials,
keeping all water containers/storage facilities tightly
covered and cleaning the water coolers at least once a
week before re-filling. Since early reporting of cases is
crucial to avoid any complication and mortality, the
community is given full information about the signs and
symptoms as well as availability of health services at
health centres/ hospitals. Alerting the Hospitals for making
adequate arrangements for management of Dengue/
Dengue Haemorrhagic Fever cases have also been
advised.
The Directorate of National Vector Borne Disease Control
has provided detailed guidelines for the prevention and
control of dengue to the affected states. Intensive health
education activities through print, electronic and inter-
personnel media, outdoor publicity as well as an inter-
sectoral collaboration with civil society organization
(NGOs/CBOs/Self-Help Groups), PRIs and Municipal
bodies have been emphasized. Regular supervision and
monitoring is conducted. The Government of India in
consultation with States has identified 182 sentinel
surveillance hospitals with laboratory support for
augmentation of diagnostic facilities in the endemic states.
Further, for advanced diagnosis and backup support 13
Apex Referral Laboratories (Appendix-7) have been
identified and linked with sentinel surveillance hospitals.
To make these functional, test kits are provided through
National Institute of Virology, Pune free of cost.
Contingency grant is also provided to meet the operational
costs.
6.2.7. Chikungunya
Chikungunya is a debilitating non-fatal viral illness caused
by Chikungunya virus. The disease re-emerged in the
country after a gap of three decades. In India a major
epidemic of Chikungunya fever was reported during earlier
60s & 70s; 1963 Kolkata; 1965 (Pondicherry and Chennai
in Tamil Nadu, Rajahmundry, Vishakapatnam and
Kakinada in Andhra Pradesh; Sagar in Madhya Pradesh
and Nagpur in Maharashtra) and 1973, (Barsi in
Maharashtra). This disease is also transmitted by Aedes
mosquito. Both Ae. aegypti and Ae.albopictus can
transmit the disease. Humans are considered to be the
major source or reservoir of Chikungunya virus.
Therefore, the mosquitoes usually transmit the disease
by biting infected persons and then biting others. The
infected person cannot spread the infection directly to
other person (i.e. it is not contagious disease). Symptoms
of Chikungunya fever are most often clinically
indistinguishable from those observed in dengue fever.
Annual Report 2010-11 86
However, unlike dengue, hemmorrhagic manifestations
are rare and shock is not observed in Chikungunya virus
infection. It is characterized by fever with severe joint
pain (arthralgia) and rash. Chikungunya outbreaks
typically result in large number of cases but deaths are
rarely encountered. Joint pains sometimes persist for a
long time even after the disease is cured.
Deaths already occur in Chikungunya infection?(plz.
check it)
6.2.7.a.During 2006, total 1.39 million clinically suspected
Chikungunya cases reported in the country. Out of 35
States/UTs 16 were affected: Andhra Pradesh, Karnataka,
Maharashtra, Tamil Nadu, Madhya Pradesh, Gujarat, Kerala,
Andaman & Nicobar Islands, Delhi, Rajasthan, Puducherry,
Goa, Orissa, West Bengal, Lakshadweep and Uttar Pradesh.
There are no reported deaths directly related to Chikungunya.
In 2007, total 14 states were affected and reported 59535
suspected Chikungunya fever cases with nil death.
Subsequently in 2008, 95091 suspected Chikungunya fever
cases and nil deaths have been reported. In 2009 73288
Suspected Chikungunya fever cases and Nil death have been
reported. During 2010, 24364 Suspected Chikungunya fever
cases have been reported. Maximum cases were reported from
Karnataka (35.01%) followed by Maharashtra (24.26)
(Appendix-6).
6.2.7.b. As already mentioned, Aedes mosquitoes bite
during the day and breed in a wide variety of man-made
containers which are common around human dwellings.
These containers such as discarded tyres, flower pots,
old water drums, family water trough, water storage
vessels and plastic food containers collect rain water and
become the source of breeding of Aedes mosquitoes.
Ae.aegypti played the major role in transmitting the
disease in all the states except Kerala, where Ae.
albopictus played the major role. Ae. albopictus breeding
was detected in latex collecting cups of rubber plantations,
shoot-off leaves of areca palm, fruit shells, leaf axils,
tree holes etc.
There is neither any vaccine nor drugs available to cure
the Chikungunya infection. Supportive therapy that helps
to ease symptoms, such as administration of non-steroidal
anti-inflammatory drugs and getting plenty of rest are
found to be beneficial.
6.2.7.c.Government of India is continuously monitoring
the situation, sending guidelines and advisories for
prevention and control of Chikungunya fever to the states.
Since same vector is involved in the transmission of
Dengue and Chikungunya strategies for transmission, risk
reduction by vector control are also same. A
comprehensive Long Term Action Plan for prevention &
control of Chikungunya and Dengue/Dengue
Haemorrhagic Fever has been prepared and disseminated
for guidance to the states. Support in the form of logistics
and funds are provided to the states. The central teams
are deputed to the affected states for technical guidance
of the state health authorities. As most transmission
occurs at home, therefore, community participation and
co-operation is of paramount importance for successful
implementation of programme strategies for prevention
and control of Chikungunya. Therefore, considerable
efforts have been made through advocacy and social
mobilization for community education and awareness. For
effective community participation, people are informed
about Chikungunya and the fact that major epidemics can
be prevented by taking effective preventive measures by
community itself. For carrying out proactive surveillance
and enhancing diagnostic facilities for Chikungunya, the
182 Sentinel Surveillance hospitals involved in dengue
(Appendix-8) in the affected states also carries
Chikungunya tests. Both Dengue and Chikungunya
Diagnostic kits to these institutes are provided through
National Institute of Virology, Pune and cost is borne by
GOI. Further, rapid response by the concerned health
Annual Report 2010-11 87
authorities has been envisaged on report of any suspected
case from the Sentinel Surveillance Hospitals to prevent
further spread of the disease.
6.2.7.d. The overall strategies for prevention and
control are same as in Dengue such as symptomatic
management of cases, reduction of breeding sources,
personal protection and intensive IEC and capacity
building. Initiatives undertaken by Govt. of India for
prevention and control of Dengue/Chikungunya are as
follows:
1. Continuous monitoring of Chikungunya and Dengue
situation in states.
2. Circulation of guidelines and advisories for
prevention and control of diseases to affected
states.
3. Launch of intensive IEC and Behaviour Change
Communication activities through print, electronic
media, interpersonal communication, outdoor
publicity as well as inter sectoral collaboration with
civil society organizations (NGOs/CBOs/ Self Help
Groups), PRIs.
4. Provision of larvicides and adulticides to affected
states.
5. Identification and strengthening of Apex Referral
Laboratories and sentinel surveillance hospitals for
diagnosis and regular surveillance.
6. NIV, Pune has been entrusted for supply of test
kits to the identified institutions free of cost.
7. Contingency grant provided to the Apex Referral
Laboratories and sentinel surveillance hospitals to
meet the operational cost.
8. Training is imparted on various aspects of prevention
and control of Dengue and Chikungunya to
programme personnel, Medical Officers on Case
Management and laboratory personnel on case
diagnosis.
Annual Report 2010-11 88
STATEs/UTs. 2007 2008 2009 2010(till September)
updated on 28.08.10)
Cases Deaths Cases Deaths Cases Deaths Cases Death
Andhra Prd. 27803 2 26424 0 25152 3 25511 20
Arunachal Prd. 32072 36 29146 27 22066 15 12818 0
Assam 94853 152 83939 86 91413 63 52004 30
Bihar 1595 1 2541 0 3255 21 916 1
Chhattisgarh 147525 0 123495 4 129397 11 77553 10
Goa 9755 11 9822 21 5056 10 1753 1
Gujarat 71121 73 51161 43 45902 34 36603 6
Haryana 30895 0 35683 0 30168 0 7286 0
Himachal Prd. 104 0 146 0 192 0 139 0
J&K 240 1 217 1 346 0 504 0
Jharkhand 184878 31 214299 25 230683 28 128452 9
Karnataka 49355 18 47344 8 36859 0 31298 4
Kerala 1927 6 1804 4 2046 5 1756 4
Madhya Pradesh 90829 41 105312 53 87628 26 52828 0
Maharashtra 67850 182 67333 148 93818 227 102822 149
Manipur 1194 4 708 2 1069 1 770 4
Meghalaya 36337 237 39616 73 76759 192 34866 66
Mizoram 6081 75 7361 91 9399 119 12049 18
Nagaland 4976 26 5078 19 8489 35 3744 4
Orissa 371879 221 375430 239 380904 198 279519 161
Punjab 2017 0 2494 0 2955 0 2990 0
Rajasthan 55043 46 57482 54 32709 18 29007 26
Sikkim 48 0 38 0 42 1 32 0
Tamil Nadu 22389 1 21046 2 14988 1 11308 1
Tripura 18474 51 25894 51 24430 62 19941 4
Uttarakhand 953 0 1059 0 1264 0 1097 0
Uttar Pradesh 82538 0 93383 0 55437 0 36155 0
West Bengal 87754 96 89443 104 141211 74 67920 29
A&N Islands 3973 0 4688 0 5760 0 2089 0
Chandigarh 340 0 347 0 430 0 290 0
D & N Haveli 3780 0 3037 0 3408 0 4307 0
Daman & Diu 99 0 115 0 97 0 132 0
Delhi 182 0 253 0 169 0 191 0
Lakshadweep 0 0 0 0 8 0 6 0
Puducherry 68 0 72 0 65 0 97 0
All India Total 1508927 1311 1526210 1055 1563574 1144 1038753 547
Appendix-1
State-wise Malaria situation in the Country
Annual Report 2010-11 89
Appendix-2
Population Coverage (%) during Mass Drug Administration (MDA)
Sl. No. States/UTs 2004 2005 2006 2007 2008 2009
1 Andhra Pradesh 84.78 81.05 89.66 89.13 91.96 91.85
2 Assam 25.42 42.94 67.33 78.32 81.34 ND
3 Bihar 81.64 77.82 79.77 77.23 ND 85.17
(partial)
4 Chhattisgarh 84.17 82.80 ND 89.53 91.30 91.53
5 Goa 97.92 95.33 97.17 97.83 97.46 96.32
6 Gujarat 45.47 98.23 69.60 92.11 93.25 97.63
7 Jharkhand 42.25 74.16 72.75 79.03 84.64 84.32
8 Karnataka 85.22 89.31 90.20 89.67 90.53 89.30
9 Kerala 86.10 90.15 ND 92.19 93.67 77.81
10 Madhya Pradesh 73.74 79.29 88.01 88.48 90.14 87.59
11 Maharashtra 78.68 86.48 87.80 88.39 89.71 89.51
12 Orissa 90.11 90.60 87.40 88.47 85.43 89.81
13 Tamil Nadu 95.18 ND ND 77.22 87.61 94.1
14 Uttar Pradesh 66.40 71.03 75.97 79.87 81.67 ND
15 West Bengal 39.58 51.24 ND 76.63 77.79 86.93
16 A&N Islands 85.85 88.31 93.17 98.73 94.10 91.40
17 D & N Haveli 91.13 98.26 94.93 94.16 96.67 95.84
18 Daman & Diu 94.96 73.23 87.17 93.27 91.85 91.56
19 Lakshadweep 64.53 88.23 80.00 86.83 86.32 89.00
20 Puducherry 94.76 96.63 ND 96.30 97.01 96.02
Total 72.41 75.99 81.61 82.75 86.03 88.57
ND: - Not Done
YD: - Yet to do
RN: - Report not received
Annual Report 2010-11 90
Appendix-3
State-wise Kala-azar Cases & Deaths
Sl. No State 2007 2008 2009 2010
(upto Oct.
updated on
29.11.10)
† † C D C D C D C D
1 Bihar 37819 172 28489 142 20519 80 18738 69
2 W. Bengal 1817 9 1256 3 756 0 1146 4
3 UP 69 1 26 0 17 1 12 0
4 Jharkhand 4803 20 3690 5 2875 12 3426 4
5 Delhi* 19 0 34 0 12 0 33 0
6 Assam 0 0 98 0 26 0 12 0
7 Uttarakhand 2 0 0 0 2 0 0 0
8 Sikkim 0 0 4 1 5 0 3 0
9 Gujarat* 4 1 0 0 0 0 0 0
10 M.P 0 0 1 0 0 0 0 0
11. Himachal Prd. 0 0 0 0 0 0 5 1
INDIA 44533 203 33598 151 24212 93 23375 78
C: Cases D: Deaths
*Imported
Annual Report 2010-11 91
Appendix-4
STATE-WISE CASES AND DEATHS DUE TO SUSPECTED AES/JE
Sl. Affected 2007 2008 2009 2010
No. States/UTs (till 30.11.10)
C D C D C D C D
1 Andhra Pradesh 22 0 6 0 14 0 132 5
2 Assam 424 133 319 99 462 92 562 125
3 Bihar 336 164 203 45 325 95 50 7
4 Goa 70 0 39 0 66 3 58 0
5 Haryana 85 46 13 3 12 10 0 0
6 Karnataka 15 3 3 0 246 8 82 1
7 Kerala 2 0 2 0 3 0 19 5
8 Maharashtra 2 0 24 0 1 0 34 17
9 Manipur 65 0 4 0 6 0 116 14
10 Tamil Nadu 42 1 144 0 265 8 290 5
11 Uttarakhand 0 0 12 0 0 0 0 0
12 Uttar Pradesh 3024 645 3012 537 3073 556 3331 460
13 West Bengal 16 2 58 0 0 0 1 0
14 Nagaland 7 1 0 0 9 2 11 6
Grand Total 410 995 3839 684 4482 774 4686 645
C : Cases D : Deaths
Annual Report 2010-11 92
Sl. No. State 2007 2008 2009 2010*
Cases Deaths Cases Deaths Cases Deaths Cases Deaths
1 Andhra Pd. 587 2 313 2 1190 11 728 3
2 Assam 0 0 0 0 0 0 158 2
3 Bihar 0 0 1 0 1 0 287 0
4 Chhattisgarh 0 0 0 0 26 7 1 0
5 Goa 36 0 43 0 277 5 219 0
6 Gujarat 570 2 1065 2 2461 2 2269 0
7 Haryana 365 11 1137 9 125 1 1079 20
8 J & K 0 0 0 0 2 0 0 0
9 Jharkhand 0 0 0 0 0 0 11 0
10 Karnataka 230 0 339 3 1764 8 2177 6
11 Kerala 603 11 733 3 1425 6 2501 17
12 Madhya Pd. 51 2 3 0 1467 5 171 1
13 Meghalaya 0 0 0 0 0 0 1 0
14 Maharashtra 614 21 743 22 2255 20 1116 6
15 Manipur 51 1 0 0 0 0 5 0
16 Nagaland 0 0 0 0 25 0 0 0
17 Orissa 4 0 0 0 0 0 19 0
18 Punjab 28 0 4349 21 245 1 4022 13
19 Rajasthan 540 10 682 4 1389 18 1253 6
20 Sikkim 0 0 0 0 0 0 0 0
21 Tamil Nadu 707 2 530 3 1072 7 1662 8
22 Uttar Pradesh 132 2 51 2 168 2 941 8
23 Uttrakhand 0 0 20 0 0 0 21 0
24 West Bengal 95 4 1038 7 399 0 612 1
25 A&N Island 0 0 0 0 0 0 25 0
26 Chandigarh 99 0 167 0 25 0 163 0
27 Delhi 548 1 1312 2 1153 3 6221 8
28 D&N Haveli 0 0 0 0 0 0 25 0
29 Puducherry 274 0 35 0 66 0 38 0
TOTAL 5534 69 12561 80 15535 96 25725 99
Appendix-5
State-Wise Dengue Cases And Deaths
*provisional upto November
Annual Report 2010-11 93
2009 2010*
Sl.No Name of Total No. of No. of No. of Total No. of No. of
the State Suspected Samples confirmed deaths Suspected Samples confirmed No. of
Chikungunya tested cases Chikungunya tested cases deaths
fever cases fever cases
1 Andhra Pd. 591 297 117 0 107 107 41 0
2 Goa 1839 1525 685 0 1312 1312 595 0
3 Gujarat 1740 453 169 0 1353 586 248 0
4 Haryana 2 2 0 0 26 26 1 0
5 Karnataka 41230 7714 3164 0 8550 3460 1359 0
6 Kerala 13349 2761 711 0 1521 460 209 0
7 Madhya Pd. 30 30 5 0 31 31 14 0
8 Meghalaya 0 0 0 0 16 16 8 0
9 Maharashtra 1594 766 443 0 5913 1569 768 0
10 Orissa 2306 41 2 0 425 10 4 0
11 Rajasthan 256 256 106 0 365 365 110 0
12 Tamil Nadu 5063 2873 1053 0 4299 3478 736 0
13 Uttar Pradesh 0 0 0 0 1 1 1 0
14 West Bengal 5270 816 338 0 305 305 69 0
15 A&N Island 0 0 0 0 59 0 0
16 Delhi 18 18 18 0 70 70 70 0
17 Lakshadweep 0 0 0 0 0 0 0 0
18 Puducherry 0 0 0 0 11 11 3 0
Total 73288 17552 6811 0 24364 11807 4236 0
*provisional upto November
Appendix-6
Epidemiological Profile Of Chikungunya Fever In The Country
Annual Report 2010-11 94
Appendix - 7
APEX REFERRAL LABORATORIES
(i) All India Institute of Medical Sciences, New Delhi,
(ii) National Institute of Communicable Diseases, Delhi
(iii) National Institute of Virology, Pune,
(iv) National Institute of Mental Health and Neuro-Sceinces, Bangaluru,
(v) Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow,
(vi) Postgraduate Institute of Medical Sciences, Chandigarh,
(vii) ICMR Virus Unit (NICED), Kolkata,
(viii) Kings Institute of Preventive Medicines, Chennai,
(ix) Institute of Preventive Medicine, Hyderabad,
(x) B.J. Medical College, Ahmedabad,
(xi) Kerala State Institute of Virology and infectious diseases, Alleppey,
(xii) Defence Research Development and Establishment, Gwalior.
(xiii) Regional Medical Research Centre (ICMR), Dibrugarh, Assam.
Annual Report 2010-11 95
Name of the State Sentinel Hospitals/Institutes
Andhra Pradesh 1. MGM Hospital, Warangal,
2. Ruya Hospital,Tirupathi,
3. Govt.Hospital,Guntur,
4. Govt.Hospital,Vijayawada,
5. Govt. Hospital,Karimnagar,
6. Govt. Hospital,Nizamabad,
7. Govt.Hospital,Annanthpur.
8. VBRI,Hyderabad.
9. Medical College, Kurnool
10. Medical College,
Mahboobnagar
Goa 1. Hospicio Hospital, Margoa,
South Goa.
2. Goa Medical College, Goa
3. Asilo Hospital (North Goa),
Mapusa
Maharashtra 1. Govt. Medical Vollege,
Nagpur,
2. B.J. Medical College, Pune,
3. Govt. Medical College,
Aurangabad
4. District Hospital, Akola
5. District Hospital, Nashik
6. Govt. Medical College, Nanded
7. J.J.Hospital, Mumbai
8. District Hospital, Chandrapur
9. Govt. Medical College, Yavatmal
10. District Hospital, Beed
11. Govt. Medical College, Kolhapur
12. Govt. Medical College, Dhule
13. K.E.M. Hospital, Mumbai
Name of the State Sentinel Hospitals/Institutes
14. Sion Hospital, Mumbai
15. District Hospital, Thane
Gujarat 1. N.H.L. Municipal Med.
College, Ahmedabad.
2. Govt. Medical College, Vadodara,
3. Govt. Medical College,Surat,
4. Municipal Med. College,Surat,
5. M.P. Shah Med. College,
Jamnagar,
6. Govt. Med. College, Rajkot,
7. Govt. Medical College,
Bhavnagar.
8. General Hospital, Palanpur
9. General Hospital, Dahod
10. General Hospital, Bhuj
Madhya Pradesh 1. Gandhi Medical College, Bhopal,
2. G.R.Medical College,Gwalior
3. S.S. Medical College, Rewa,
4. N. S.C.B Medical college,
Jabalpur
5. M.G.M. Medical College, Indore
6. Khandwa district hospital
7. Betul district hospital
8. Sagar district hospital
9. Guna district hospital
10. Chhindwara district hospital
11.Satna district hospital
12. District Malaria Office, Bhopal
Haryana 1. B.K. Hospital, Faridabad.
2. General Hospital, Ambala
Appendix-8
List of the Sentinel Hospitals for Dengue and Chikungunya
Annual Report 2010-11 96
Name of the State Sentinel Hospitals/Institutes
3. State Bacteriological Laboratory,
Karnal
4. General Hospital, Gurgaon
5. General Hospital, Panchkula
6. Medical College, Agroha
Delhi 1. Swami Daya Nand Hospital,
Shahadra, Delhi
2. Raja Harish Chand Hospital,
Narela, Delhi
3. Hindu Rao Hospital , Delhi
4. Sanjay Gandhi Memorial
Hospital, Mangol Puri, Delhi
5. Baba Sahib Ambedkar Hospital,
Rohini, Delhi
6. Safdarjung Hospital, New Delhi
7. Malviya Nagar Hospital, Malviya
Nagar, Delhi
8. SVB Patel Hospital Patel Nagar
9. ABG Hospital, Moti Nagar, Delhi,
10.Ram Manohar Lohia Hospital,
New Delhi
11.Lok Nayak Hospital, Jawahar Lal
Nehru Marg, Delhi
12.Deen Dayal Upadhyay Hospital,
Hari Nagar, Delhi
13.GTB Hospital, Dilshad Garden,
Delhi
14.Chacha Nehru Children Hospital,
Geeta Colony, Delhi
15.Lal Bahadur Shastri Hospital,
Khichirpur, Delhi
16.Maharishi Balmiki Hospital,
Pooth Khurd, Delhi
17. Dr. Hedgewar Arogya
Sansthan, Karkardooma, Delhi
Name of the State Sentinel Hospitals/Institutes
18.Lady Hardinge Medical College
and its associated hospital
Sucheeta Kriplani Hospital
19.Army Hospital R & R Dhaula
Kaun
20.Central Hospital, Northern
Railway
21.Guru Govind Singh Govt.
Hospital, Raghuvir Nagar, Delhi
22.Babu Jagjivan Ram Memorial
Hospital, Jahangirpuri, Delhi
23.Bhagwan Mahavir Hospital,
Pitampura, Delhi
24.Jag Parvesh Chander Hospital,
(JPC) , Shastri Park Hospital
25.NC.Joshi Memorial Hospital,
Karolbagh, Delhi
26.Kasturba Hospital, Near Jama
Masjid, Delhi
27.Aruna Asaf Ali Hospital, Rajpur
Road, Delhi
28.NDMC Charak Palika Hospital,
Moti Bagh, New Delhi
29.Rao Tula Ram Memorial
Hospital,Jaffarpur, Delhi
30.G.B.Pant Hospital, Jawahar Lal
Nehru Marg, Delhi
31.Base Hospital Delhi Cant.,
32.Kalawati Saran Children
Hospital
33. ESI Hospital, Basai Darapur
Punjab 1. Civil Hospital, Ludhiana
2. Govt. Medical College, Amritsar
3. Govt. Medical Colelge, Patiala
4. Civil Hospital, Bathinda
5. Civil Hospital, Jalandhar
Annual Report 2010-11 97
Name of the State Sentinel Hospitals/Institutes
6. Civil Hospital, S.A.S.Nagar
(Mohali)
Rajasthan 1. SMS Hospital, Jaipur
2. J.K. Lone Hospital
3. Umaid Hospital,Jodhpur
4. SMDM, Jaipur
5. M.B. Hospital, Kota,
6. S.P. Medical College, Bikaner
7. RNT Medical College, Udaipur
8. JLN Medical College, Ajmer
9. General Hospital Bharatpur
Kerala 1. Govt. Medical College, Kozhikode
2. Medical College, Kottayam
3.Medical College,
Thiruvanthapuram
4.Public Health Lab,
Thiruvanthapuram
5. District Hospital, Kollam
6. THQHThodupuzha, Dist. Idukki
7. Regional Public Health
Laboratory, Ernakulam
8. District Hospital, Palakkad
9. District Hospital, Manjeri,
Malappuram
10. District Hospital, Mananthavady,
Dist. Wyanad
West Bengal 1. Burdwan Medical College
Hospital.
2. School of Tropical Medicine,
Kalkata
3. Medical College, Kolkata
4. Nil Ratan Sircar Medical College
& Hospital, Kolkata
5. SSKM Medical College &
Hospital, Kolkata
Name of the State Sentinel Hospitals/Institutes
6. R.G.Kar Medical College &
Hospital, Kolkata
7. National MCH, Kolkata
8. Midnapore Medical College &
Hospital, Midnapur
9. Bankura Sammilani Medical
College & Hospital, Bankura
10.North Bengal Medical College &
Hospital, Siliguri
Karnataka 1. Central Lab. (Hqrs), Bangaluru
2. Virus Diagnostic Lab, Shimoga
3. Vijay Nagar Institute of Medical
Science, Bellary
4. District Surveillance Unit, SNR
hospital, Kollar
5. District Surveillance Unit,
Belgaum
6. District Surveillance Unit,
Mangalore, D Kanada
7. Medical College, Hubli
8. District surveillance Unit
Chitradurga
9. District Surveillance Unit Hassan
10. District Surveillance Unit
Mysore11. D i s t r i c t
Surveillance Unit Bidar
12. District Surveillance Unit
Raichur
13. District Surveillance Unit Bijapur
14. District Surveillance Unit
Tumkur
15. NIV Field Station, Bangaluru
16. Indira Gandhi Institute of Child
Health (IGICH)
17.National Center for Disease
Control (NCDC)
Annual Report 2010-11 98
Name of the State Sentinel Hospitals/Institutes
Tamil Nadu 1. Kanniyakumari Medical College
2. Tirunelveli Medical College
3. Thoothukudi Medical College
4. Thanjavur Medical College
5. Mohan Kumaramangalam
Medical College, Salem
6. Coimbatore Medical College
7. K.A.P.Viswanathan Medical
College, Trichy
8. Theni Medical College
9. Chengalpattu Medical College
10. Madurai Medical College
11.Vellore Medical College
12. Madras Medical College
13.Institute of Vector Control and
Zoonoses, Hosur
Bihar 1.Patna Medical college & Hospital
Uttar Pradesh 1. Regional Lab. Swasthya
Bhawan, Lucknow.
2. District Hospital, Ghaziabad,
3. L.L.R.M., Medical College,
Meerut,
4. M.L.B. Medical College, Jhansi,
5. M.L.N.,Medical College,
Allahabad.
6. Institute of Medical Sciences,
B.H.U., Varanasi.
7. S.N., Medical College, Agra.
8. G.S.B.M., Medical College,
Kanpur.
Name of the State Sentinel Hospitals/Institutes
9. K.G.M.U., Lucknow.
10. Authority Hospital, Noida
Orissa 1. S.C.B. Medical College, Cuttak
2. VSS Medical College, Burla,
Sambalpur
3. MKCG, Medical College,
Berhampur, Ganjam
A&N Islands 1.GB Pant Hospital, Port Blair
Lakshadweep 1.Indira Gandhi Hospital, Kavaratti
Manipur 1. Regional Institute of Medical
Sciences, IMPHAL
Puducherry 1. JIPMER, Puduchery
2. General Hospital, Puduchery
Jammu & Kashmir 1.Govt. Medical College, Jammu
Chattishgarh 1. Pt. J.N.M Medical College,
Raipur,
2. Sardar Vallabh Bhai Patel District
Hospital, Bilaspur
Jharkhand 1.Rajendra Institute of Medical
Science (RIMS), Ranchi
2. MGM Medical College,
Jamsedpur
Assam 1. Gauhati Medical College,
Guwahati
2. Assam Medical College,
Dibrugarh
Uttarakhand 1. Doon Hospital, Dehradun
2. Susheela Tiwari Medical College,
Haldwani, Nainital
Total 182
Annual Report 2010-11 99
6.3. NATIONAL LEPROSY ERADICATION
PROGRAMME (NLEP)
The National Leprosy Control Programme was launched
by the Govt. of India in 1955. Multi Drug Therapy came
into wide use from 1982 and the National Leprosy
Eradication Programme was introduced in 1983. Since
then, remarkable progress has been achieved in reducing
the disease burden. India achieved the goal of elimination
of leprosy as a public health problem, defined as less than
1 case per 10,000 population, at the National 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 supplied free of cost by WHO.
Following are the programme components –
(i) Decentralized integrated Leprosy services through
General Health Care System.
(ii) Training in Leprosy to all General Health Services
functionaries.
(iii) Intensified Information, Education &
Communication (IEC).
(iv) Renewed emphasis on Prevention of Disability and
Medical Rehabilitation and
(v) Monitoring and supervision.
6.3.1. Epidemiological Situation
• 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 633 districts, 510
(80.57%) have also achieved elimination level.
• At the end of March 2010, there were 87,190
leprosy cases on record (under treatment).
• In 2009-10, total 1,33,717 new leprosy cases were
detected and put under treatment as compared to
1,34184 leprosy cases detected during
corresponding period of previous year giving Annual
New Case Detection Rate (ANCDR) of 10.93 per
1,00,000 population.
• Among the new cases detected in 2009-10, the
proportions were- MB cases (54.43%), female
(35.42%), children (9.97%) and grade II disability
(3.08%).
• Out of 1,47,642 leprosy cases discharged during
the year, 1,33,822 cases (90.6%) were released as
cured after completing treatment.
• 2856 reconstructive surgeries were conducted in
2009-10 for correction of disability in leprosy
affected persons.
The declining trend of Prevalence and Annual New Case
Detection Rate per 10,000 population since 1991-1992 is
shown in the diagram below:
6.3.1. Activities under NLEP:
6.3.2.a.Diagnosis and treatment of leprosy- Services
for diagnosis and treatment (Multi Drug Therapy) are
provided by all primary health centres and govt.
dispensaries throughout the country free of cost. Difficult
to diagnose and complicated cases and cases requiring
reconstructive surgery are referred to district hospital for
further management. ASHAs under NRHM are being
involved to bring out leprosy cases from villages for
diagnosis at PHC and follow up cases for treatment
completion. ASHAs are being paid incentive for this
activity from the programme budget.
6.3.2.b. 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. Training of State & District
Leprosy Officers organized at schieffline Institute of
Health Research & Leprosy Centre Vellore, Tamil Nadu
and RLTRI Raipur.
6.3.2.c.Urban Leprosy Control: To address the
complex problems in urban areas, the Urban Leprosy
Control activities are being implemented in 422 urban
areas having population size of more than 1 lakh. These
activities include MDT delivery services & follow up of
Annual Report 2010-11 100
patient for treatment completion, providing supportive
medicines & dressing material and monitoring &
supervision.
6.3.3. Involvement of NGOs
Non Governmental Organizations (NGOs) have been
involved in the programme for many decades and have
provided valuable contribution in reducing the burden of
leprosy. NGOs serve in remote, inaccessible, uncovered,
urban slums, industrial / labour population and other
marginalized population groups. IEC, Prevention of
impairments and disabilities, Case Detection & referral
and follow-up for treatment completion are some
important activities undertaken by NGOs. Under SET
scheme, Rs. 2.10 crores have been allocated to NGOs in
2010-11 and Grant-in-Aid to NGOs is routed through
State Leprosy Societies.
6.3.4. ILEP Agencies
The International Federation of Anti-leprosy Associations
(ILEP) is actively involved as partner in NLEP. In India,
ILEP is constituted by 10 Agencies viz. The Leprosy
Mission, Damien Foundation of India Trust, Netherland
Leprosy Relief, German Leprosy Relief Association,
Lepra India, ALES, AIFO, Fontilles – India, AERF - India
and American Leprosy Mission.
ILEP is providing support in the form of planning,
monitoring & supervision of the programme, capacity
building of GHC staff, IEC, providing re-constructive
surgery services and socio economic rehabilitation of
persons affected with leprosy. 36 NGOs conducting re-
constructive surgeries for disability correction in leprosy
affected persons are also supported by ILEP.
6.3.5 WHO Support
WHO support the programme in the form of providing
financial assistance for conducting annual review
meetings at national level and technical support through
State/Zonal NLEP Coordinators in the high endemic
states. WHO continues to provide requirement of anti-
leprosy MDT drugs to the country free of cost with
assistance from NOVARTIS.
6.3.6 Information, Education & Communication
(IEC)
Intensive IEC activities are conducted for awareness
generation and particularly reduction of stigma and
discrimination against leprosy affected persons. These
activities are carried through mass media, outdoor media,
rural media and advocacy meetings. More focus is given
on inter personnel communication. Intensive IEC
Campaign with a theme ‘Towards Leprosy Free India’ is
being carried out towards further reduction of leprosy
burden in the community, early reporting of cases & their
treatment completion, provision of quality leprosy services
and reduction of stigma & discrimination against leprosy
affected persons. Mass media campaign during the period
October, 2010 and January-February 2011, have been
planned through the Prasar Bharati to spread awareness
about leprosy in the General Public.
6.3.7 Disability Prevention and Medical
Rehabilitation
For prevention of disability among persons with insensitive
hands and feet, they are given dressing material,
supportive medicines and micro-cellular rubber (MCR)
footwear. The patients are also empowered with self care
procedure for taking care of themselves.
More emphasis is being given on correction of disability
in leprosy affected persons through reconstructive
surgery (RCS). To strengthen RCS services, GOI has
recognized 83 institutions for conducting RCS based on
the recommendations of the state government. Out of
these, 42 are Govt. institutions and 41 are NGO
institutions.
6.3.8 Supervision and Monitoring
Programme is being monitored at different level through
analysis of monthly progress reports, through field visits
by the supervisory officers and programme review
meetings held at central, state and district level. For better
epidemiological analysis of the disease situation, emphasis
is given to assessment of New Case Detection and
Treatment Completion Rate and proportion of grade II
disability among new cases. Independent Programme
evaluation is also been conducted through an independent
agency.
6.3.9 Initiatives:
6.3.9.a.An amount of Rs. 5000/- is provided as incentive
to leprosy affected persons from BPL family for
undergoing per major reconstructive surgery in identified
Govt./NGO institutions to compensate loss of wages
during their stay in hospital. Support is also provided to
Government institutions in the form of Rs. 5000/- per RCS
Annual Report 2010-11 101
conducted, for procurement of supply & material and other
ancillary expenditure required for the surgery.
6.3.9.b.Involvement of ASHAñ 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. To facilitate the involvement
of ASHA, they are being paid an incentive as below:
(i) On confirmed diagnosis of case brought by them –
Rs. 100/-
(ii) On completion of full course of treatment of the
case within specified time- PB leprosy case –
Rs. 200/- and MB Leprosy case – Rs. 400/-
4,22,638 ASHAs have been trained in leprosy and
involved in leprosy work 4572 ASHAs received
incentive for the above said activity during
2009-10.
6.3.9.c. 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, which will help the persons
affected by leprosy live a dignified life.
6.3.10 National Sample Survey
The 131
st
report of the Committee on Petitions of Rajya
Sabha, 2008, recommended that “the final survey,
involving Panchayati Raj Institutions (PRI) may be
undertaken, so that the Government can have realistic
figures of Leprosy Affected Persons (LAPs) to devise a
national policy. The Ministry of Health & Family Welfare
informed the Committee that a multi – centric study to
assess the burden of active leprosy cases, leprosy persons
with grade - I & II disability and the magnitude of stigma
& discrimination prevalent in the society, will be carried
out. The National JALAMA institute Agra (an ICMR
instt.) has been entrusted with the above task.
The house to house survey was started in States/UTs as
below, which was preceded by training of the survey team
member and IEC campaign in the concerned Block and
Urban areas.
(i) Six States/UTs viz. Arunachal Pradesh, Gujarat,
Rajasthan, Manipur, Sikkim and D&N Haveli
started in May 2010. Arunachal Pradesh, Sikkim
& D&N Haveli reported completion of the Survey.
(ii) Twenty States/UTs viz. Andhra Pradesh, Assam,
Chhattisgarh, Goa, Himachal Pradesh, Jharkhand,
J&K, Karnataka, Madhya Pradesh, Kerala,
Meghalaya, Mizoram, Nagaland, Orissa, Punjab,
Tamil Nadu, Tripura, Uttarakhand, Chandigarh and
Daman & Diu started in June 2010. Goa,
Chandigarh, Uttarakhand and Daman & Diu
reported completion of the Survey.
(iii) Six States/UTs viz. Uttar Pradesh, West Bengal,
Maharashtra, Haryana, A&N Islands and
Puducherry started in July 2010. Maharashtra,
A&N Islands and Puducherry reported completion
of the Survey.
(iv) Delhi and Bihar have started survey in August
2010.
The final report of National Sample Survey is expected
by July 2011.
6.3.11 Budget: Budget allocation under NLEP for for
2009-10 was 44.50 crores and expenditure of 35.12 crores
was incurred during the year. Budget allocation under
NLEP for 2010-11 is 45.32 crores. 26.85 crores
expenditure has been incurred till date.
6.4 REVISED NATIONAL TB CONTROL
PROGRAMME (RNTCP)
Tuberculosis is a major public health problem in India.
The burden of TB in India (Prevalence) as in the year
2000 was 8.5 million total cases of which 3.8 million were
bacillary pulmonary cases, 3.9 million abacillary cases
and 0.8 million extra-pulmonary cases.
India accounts for nearly one-fifth of the global incidence.
In 2009, out of the global annual incidence of 9.4 million
TB cases, 2 million were estimated to have occurred in
India. In the year 2009, India reported a total case
notification of 1.3 million (all forms of TB), of which 0.62
million were reported as sputum positive cases which are
infectious.
An infectious case if not treated on an average infects
10-15 persons in a year. Annual risk of becoming infected
with TB is 1.5% and once infected there is 10% life-time
Annual Report 2010-11 102
risk of developing TB disease. About one person dies
from TB in India every two minutes; ~ 760 people every
day and almost 2.8 lakh every year.
Revised National TB Control Programme, an application
in India of the WHO-recommended Directly Observed
Treatment, Short Course (DOTS) strategy to control TB
with the objective of curing at least 85% of new sputum
positive TB patients and detecting at least 70% of such
patients, was launched in the country in March 1997 and
was implemented in a phased manner. By March 2006,
entire population (1114 million) of the country in all 632
districts had been covered under the Programme.
6.4.1. Achievements of RNTCP
HBC: High burden countries
Source: WHO Geneva; WHO Report 2010: Global Tuberculosis
Control; Surveillance, Planning and Financing.
• Since its inception, the programme has initiated nearly
1.24 million patients on treatment, thus saving more
than 2.2 million additional lives. In 2009 over 1.53
million TB patients have been initiated on treatment.
In 2010, 1.17 million patients have been registered
for treatment till 30
th
September.
• India has contributed to approximately 24% of the
total global new cases detection during the year 2009
as per the WHO Global Report 2010.
• Treatment success rates have tripled from 25% in
the pre-RNTCP era to 87% presently.
• TB death rates have been cut 7-fold from 29% in the
pre-RNTCP era to 4% presently.
Annual Report 2010-11 103
• The programme has consistently maintained the
treatment success rate >85% and new sputum
positive (NSP) case detection rate more than the
global target of 70%.
• All states are currently implementing the ‘Supervision
and Monitoring strategy’ – detailing guidelines, tools
and indicators for monitoring the performance from
the PHI level to the national level. The programme is
focusing on the reduction in the default rates amongst
all new and re-treatment cases and is undertaking
steps for the same.
• Quality assured Sputum Microcopy diagnostic
facilities are available through more than 12,700
laboratories across the country. To ensure quality,
external quality assurance of sputum microscopy is
being routinely conducted throughout the country. This
includes onsite evaluation, panel testing and blinded
crosschecking.
• To improve access to tribal and other marginalized
groups the programme has developed a Tribal action
plan which is being implemented with the provision
of additional TB Units and DMCs in tribal/difficult
areas, additional staff, compensation for
transportation of patient & attendant in tribal areas
and higher rate of salary to contractual staff etc.
The latest treatment outcome under RNTCP for the
patients’ registered in 2009 (Jan – Sept) is represented
as a pie chart
• Involvement of other sectors: Over 3000 NGOs,
30,000 Private practitioners, and 200 corporate
houses have been involved in the provision of RNTCP
services. Presently, 282 medical colleges (including
private colleges) have been involved in RNTCP and
are estimated to contribute nearly 10-15% of case
detection in the districts that have medical colleges.
Health facilities in government sectors outside Health
Ministry have been involved viz. ESI, Railways, Ports
and the Ministries of Mines, Steel, Coal, etc.
Collaboration for increased participation of all sectors
in RNTCP is being strengthened through constant
interaction with all stake holders, including
professional bodies like the Indian Medical
Association, and Faith Based Organisations such as
Catholic Bishops Conference of India.
• Drug Resistance Surveillance:
To estimate the prevalence of drug resistance
amongst new cases and re-treatment cases, state
wide community based surveys have been carried
out in the states of Gujarat and Maharashtra. These
surveys estimate the prevalence of Multi-drug
resistant TB (MDR-TB) to be ~3% in new cases
and 12-17% in retreatment cases. These surveys also
indicate that the prevalence of MDR-TB is not
increasing in the country. Two more surveys are
underway in the states of AP and western UP and
there is a plan to undertake a survey in Orissa in
near future.
Annual Report 2010-11 104
• DOTS Plus for management of Multidrug
Resistant TB (MDR-TB):
o The programme is in the process of establishing
a network of 43 accredited Culture and Drug
Susceptibility testing laboratories (DST) across
the country in a phased manner for diagnosis
and follows up of MDR TB patients.
o Currently, 14 Culture and DST Laboratories in
government sector are accredited under RNTCP
including-
4 National Reference Laboratories (NRLs) that
includes TRC Chennai, LRS Delhi, NTI Bangalore
and JALMA Agra,
10 State level Intermediate Reference Laboratories
(IRLs) at Gujarat, Maharashtra, Andhra Pradesh,
Kerala, Delhi, West Bengal, Tamil Nadu , Rajasthan,
Orissa and Jharkhand have been accredited; and
Another 11 IRLs are under the accreditation process.
The remaining IRLs will be accredited in 2011.
o To supplement and support the IRL network the
programme is also involving Mycobacteriology
laboratories of Government Medical Colleges as
well as laboratories in the NGO and Private
Sector. Till date, five such labs (CMC-Vellore;
BPRC-Hyderabad, Hinduja Hospital- Mumbai,
SMS-Jaipur and RMRCT-Jabalpur) have been
accredited and another 9 are under the
accreditation process.
o DOTS Plus services for management of MDR
TB have been rolled out in the 10 states of
Gujarat, Maharashtra, Andhra Pradesh, Haryana,
Delhi, Kerala, West Bengal, Tamil Nadu,
Rajasthan and Orissa. Services are available in
136 districts covering a population of 281 million.
Till 30
th
September 2010, ~15700 MDR suspects
were examined and a total of 2975 patients were
initiated on treatment in these states.
o The State of Jharkhand, Uttar Pradesh, Madhya
Pradesh, Uttarakhand, Karnataka and Himachal
Pradesh are in advanced stage of preparation
and will initiate identification of MDR suspects
shortly. DOTS Plus services in the remaining
states will be initiated in 2010-11.
• Advocacy, Communication and Social Mobilization
(ACSM):
o RNTCP has ACSM Strategicic framework that
clearly identifies:-
• Objectives (Communication needs)
• Target Groups (Communication players) i.e.(i)
Patients and Communities; (ii) Health care providers,
public and private; and (iii) Influencers and opinion
makers
• Media options to reach target groups (Communication
tools)
o ACSM strategy has been modified for including
and addressing newer thrust areas as MDR- TB,
TB HIV co-infection, and Infection control.
These areas has been identified as important
areas to be addressed by the media agency at
the national level .
o ACSM is integral part of planning at national, state
and district levels, and annual action plans.
• Format for development of ACSM Annual Action
Plan has been modified to included monitoring
indicators (outcome and output).
• Quarterly reporting of ACSM activities by the districts
and states
o Six national level ACSM capacity building
trainings workshops organized for State TB
Officers, State IEC Officers and Communication
Facilitators are currently going.
o Partnership developed with the other donor and
bilateral agencies to strengthen Center’s capacity
for ACSM
o Formative research for development of
communication material on MDR TB, TB HIV
and Infection control completed.
• Impact of the programme:
o TB mortality in the country has reduced from
over 42/lakh population in 1990 to 23/lakh
population in 2009 as per the WHO global report
2010.
o The prevalence of TB in the country has reduced
from 586/lakh population in 1990 to 249/lakh
population by the year 2009 as per the WHO
global TB report, 2010
Annual Report 2010-11 105
o Programme is currently undertaking repeat ARTI
survey (2007-09), disease prevalence surveys
(2007-09) to additionally monitor the progress
towards MDGs.
6.4.2. RNTCP Phase II
The RNTCP Phase II of the World Bank project has
been approved by the Government for the period Oct
2006 to Sep 2011 for a total outlay of Rs 1,156 crore
(USD 256.9 million) which includes credit from World
Bank of Rs 765 crore (USD 170 million) and commodity
assistance of anti-TB drugs from DFID through WHO
for Rs 287 crores (USD 63.7 million) with balance of RS
191 crore (USD 42.5 million) will be given by GoI. In
addition, 215.81 million US dollars is available for six years
(2009 – 2015) through GFATM RCC mechanism (Global
Fund for AIDS, Tuberculosis, Malaria – Rolling
Continuation Channel) for 27 districts of Uttar Pradesh,
and states of Bihar, Andhra Pradesh, Orrisa, Chattisgarh,
Jharkhand, Uttarakhand and Haryana. GFATM RCC will
also cater through CBCI (Catholic Bishop Conference
of India) in 19 states and in 11 states through IMA (Indian
Medical Association).
The second phase of the RNTCP is consolidating,
maintaining and further improving the achievements of
the first phase. Phase II of the RNTCP is a step towards
achieving the TB-related Millennium Development Goal
(MDG) targets. DOTS remain the core strategy. In
addition to the ongoing activities, the following new
activities have been envisaged in the second phase.
the scaling up of the State-level intermediate referral
laboratories (IRL) capacity for nation-wide
implementation of external quality assessment (EQA)
of sputum smear microscopy services and provision
of culture and drug sensitivity testing.
Implementation of DOTS-Plus for multi-drug
resistant TB cases will occur in a phased manner.
6.4.3. Major Initiatives
6.4.3.a.Public Private Mix in RNTCP: The RNTCP
employs the Public Private Mix (PPM) which is the
strategy to diagnose and treat TB patients reporting to all
sectors of health care under RNTCP through a mix of
different types of health care providers.
6.4.3.b. NGO/PPs: Currently, for enhancing the
involvement of NGOs and PPS under RNTCP, the
guidelines have been revised with enhanced financial
outlays. The programme has entered into a memorandum
of understanding with large NGOs/Professional
Associations like RK Mission, World Vision, Christian
Medical Association of India, Catholic Health Association
of India, Indian Medical Association etc. In addition, many
local NGOs support programme activities to improve
access of RNTCP in difficult and uncovered areas.
6.4.3.c.Medical colleges/TB Hospitals and others:
Medical colleges are being provided with manpower and
logistic support to facilitate their participation in the
programme. The involvement of medical colleges is
monitored by the Task Force mechanism at the State/
Zonal and National levels.
6.4.3.d.Other sectors: - All the 16 centrally owned ESI
hospitals, Zonal Railway Hospitals, Coal, Steel and Mines
health facilities, Port trust hospitals, CGHS hospitals and
200 corporate hospitals are involved in RNTCP services.
Four regional workshops were conducted by
Confederation of Indian Industry (CII) to sensitise and
promote about workplace interventions in RNTCP at
Chandigarh, Mysore, Ranchi and Pune .
6.4.3.e.Urban TB for slum dwellers†:- Recognizing
the problem and impact of TB on urban slum population
RNTCP intends to provide greater levels of access to its
services to the urban slum population. In addition, a special
PPM scheme for Urban Slum dwellers has been
introduced under the recently revised PPM schemes.
6.4.4 Other initiatives-
The IMA has formed a National Working Group for
RNTCP and has selected National and State coordinators.
National, State and Local workshops are being organized
by the IMA to sensitize the private practitioners. The PPM
project assisted by GFATM under RCC is being
implemented in 16 States - Andhra Pradesh, Chandigarh,
Haryana, Maharashtra, Punjab, Uttar Pradesh, Bihar,
Chhattisgarh, Gujarat, Jharkhand, Kerala, Orissa,
Rajasthan, Tamil Nadu, Uttaranchal, and West Bengal .
There has also been a professional coalition against TB
by IMA with IAP(Indian Academy of Paediatrics),NCCP
(National College of Chest Physicians),ICS (Indian Chest
Society),FPAI (Federation of Family Physicians
Association Of India ) as its members.
Annual Report 2010-11 106
The RNTCP has adopted the recently published
“International Standards for TB Care” (ISTC) document
to improve the standards of TB management across all
sectors of health care in India, and to recruit and involve
additional health care providers in RNTCP activities. As
the RNTCP conforms to all standards laid down in the
ISTC, the central government has urged all providers of
health care to adopt RNTCP to ensure adherence to the
internationally recognized standard of care for TB.
The Revised National TB Control Programme has signed
a MOU with the Catholic Bishops Conference of India,
for the involvement of Catholic Health Institutions under
RNTCP in 19 states - Andhra Pradesh, Assam, Bihar,
Chhattisgarh, Jharkhand, Karnataka, Madhya Pradesh,
Orissa, Rajasthan, Uttar Pradesh ,West Bengal , Kerala,
Tamil Nadu, Gujarat, Maharashtra, Goa, Meghalaya,
Manipur and Nagaland .The Catholic Healthcare network
is the largest in the NGO sector with more than 5,500
health care facilities.
Global Fund has also approved the Round 9 Grant for TB
to the three Principal Recipients, namely Central TB
Division , the Union and World Vision India (WVI) for a
period of 5 years (starting 1
st
April 2010) with the
following objectives:
1. Establish and enhance capacity for quality assured
rapid diagnosis of Drug Resistant-TB in 43 Culture
and DST laboratories in India by 2015;
2. Scale-up care and management of DR-TB in 35
States/Union Territories of India resulting in the
initiation of treatment of 55,350 additional cases of
Drug Resistant TB (DR-TB) by 2015;
3. Improve the reach, visibility and effectiveness of
RNTCP through civil society support in 374 districts
across 23 states by 2015; and
4. Engage communities and community-based care
providers in 374 districts across 23 states by 2015
to improve TB care and control, especially for
marginalized and vulnerable populations including
TB-HIV patients.
6.4.5 TB/HIV coordination: Globally, the HIV epidemic
is worsening the TB situation, by increasing the number
of tuberculosis cases and accelerating the spread of the
disease. HIV increases a person’s susceptibility to TB
infection and Tuberculosis increases morbidity and
mortality in HIV infected persons. HIV is the most potent
risk factor for progression of TB infection to disease.
Since 2001, Government has been implementing a joint
action plan in co-ordination with National AIDS Control
Programme (NACP), to counter the growing incidence
of the HIV-TB co-infection, initially in the six high HIV
prevalence States of Maharashtra, Tamil Nadu, Andhra
Pradesh, Karnataka, Manipur and Nagaland. Services
for HIV infected TB patients are provided through
linkages between the Integrated Counseling and Testing
Centre (ICTC) supported by the HIV/AIDS Programme
and Designated Microscopy Centres (DMCs) supported
by RNTCP, joint IEC activities and infection control
measures.
In 2007, the national action plan for TB/HIV was revised.
RNTCP & NACP have formulated a National
framework for joint TB/HIV Collaborative activities
which replaces the action plan. The document elaborates
the various activities that need to be undertaken at the
National, State & district level and provides the guidelines
for the same. Under the National framework there is
enhanced focus on the provision of HIV care including
ART, for all known HIV infected TB patients in order to
reduce mortality in this group of TB patients. With the
formulation of National framework, the TB/HIV
collaborative activities are being extended to the entire
country. The framework looks to establishing mechanisms
for coordination between the two programmes at all levels.
Technical working groups with the key staff of both the
programmes as members have been established at the
National and State level which are meeting on a periodic
basis. The framework was revised in 2008 and an
“Intensified HIV-TB Package” of services which give
opportunity to all TB patients to know their HIV status
and linking of all HIV+TB patients to HIV care and
support for ART and Cotrimoxozole prophylaxis therapy
(CPT), was rolled out to offer these additional services
in states with the higher burden of HIV-TB.
The 2009 revision of the National Framework establishes
uniform activities at ART centers and ICTCs nationwide
for intensified TB case finding and reporting, and set the
ground for better monitoring and evaluation jointly by the
two programmes. The HIV-TB performance indicators
and performance targets act as a guide to channelize the
HIV-TB interventions in the right direction at all the levels.
In addition to this, the revised reporting formats and
mechanisms have been incorporated in the National
Framework to develop a common understanding on the
monitoring system.
Annual Report 2010-11 107
In 2010, “Intensified TB-HIV package” of services has
been rolled out in 11 more states totalling to 29 States
&UTs in which this package of services has already been
rolled out with the vision to scale up Intensified TB-HIV
package in the entire country by 2012
ART- DOTS linkages are being established at all the ART
centres of the AIDS control programme to ensure optimal
access to TB diagnostic and treatment services to the
HIV positives at advanced stage of disease. A new TB/
HIV module for ART centre staff has been created and
ART staff have been trained in this module. In addition,
joint training modules on TB/HIV have been formulated
for various categories of staff of RNTCP and NACP
and the training activities are being scaled up. TOTs have
been conducted for State and District level trainers and
the training of field staff is on-going and is at various
stages in the different States. IEC materials regarding
TB are being made available at NACP facilities.
Selective IEC material on HIV is displayed at RNTCP
facilities.
6.4.6 MDR-TB: Another challenge to TB control in
India is the MDR-TB. The data available to date shows
that levels of MDR-TB remain relatively low, at around
3% amongst new patients and 12-17% in re-treatment
cases. However, these relatively low percentage figures
translate into large absolute number of MDR-TB cases,
which increase the magnitude and severity of TB epidemic
and pose a major threat to TB control. Guidelines for
management of MDR TB cases (DOTS Plus) have been
formulated and published. The Programme Division has
an ambitious plan to scale up services for management
of MDR-TB patients in the country and is in the process
of securing funding for the same. DOTS Plus services
for management of MDR TB have been rolled out in the
ten states presently i.e. in the states of Gujarat,
Maharashtra, Andhra Pradesh, Haryana, Delhi, Kerala,
West Bengal, Tamil Nadu, Rajasthan and Orissa. Till date
a total of over 2975 MDR-TB patients are on treatment
in these states.
Information, Education and communication (IEC) or
Advocacy, Communication and Social Mobilization
(ACSM) continue to be an important component of the
programme. In line with the stop TB strategy, replacement
of the terminology with ‘Advocacy, Communication, and
Social Mobilization’ (ACSM) is being promoted, as the
term ACSM has advantage over IEC as it clearly defines
the components and initiatives.
6.4.7 The IEC strategy in RNTCP envisages that:
1. IEC is a long term commitment where in IEC is a
process and not product oriented. Implementing IEC
activities is based on analysis of the needs, and
developing strategy to plan need based, locally
appropriate activities. Communication strategies for
TB control takes care of opportunities for
interactive communication, such as engaging cured
patients to convince and support others, group
meetings to discuss all aspects of TB control,
including the social aspects.
2. It focuses on decentralized planning, choice of
communication channels and monitoring to ensure
contextual relevance and wide reach of information.
The states and districts have to take active part in
this process while Centre continues to provide
leadership, develop core messages, mass media and
advocacy events.
3. IEC takes care to address social issues related to
TB such as stigma and gender, and special
communication initiatives to address the needs of
the special groups and ‘hard to reach populations’
RNTCP emphasizes on decentralized planning and
implementation of health communication initiatives.
States and districts develop need based annual
action plans and implement activities using local
popular media. To support the districts in planning
and implementing, Communication Facilitators have
been engaged who identify opportunities and
network through which communication activities
are undertaken to spread information about TB and
availability of free diagnosis and DOTS treatment.
Other important role of Communication Facilitators
is to integrate communication about TB within the
context of other health programmes and NRHM.
RNTCP encourages states to: i) systematic planning
and implementation of communication activities based on
the needs, knowledge of target groups, using the local
appropriate media; ii) to undertake IEC activity for
maintaining desired level of awareness, motivation, support
and services in patient friendly environment; and iii)
monitor IEC activities regularly like other components of
the programme.
RNTCP is also working to increase in state and district
level capacity to plan and execute IEC activities. For
this purpose, each state has undertaken an IEC audit to
take stock of its current capacity. This was done with a
standardized format and procedure.
Annual Report 2010-11 108
The objective is to assess the existing capacity in states
and districts for planning and implementing IEC activities.
In many case IEC planning and implementation is
individual driven depending upon the leadership role taken
by the programme manager or the designated person.
There is need to institutionalize these processes and IEC
capacity audit is a step in this direction to document that
exists at this point of time.
6.4.8 Web-based Resource Centre for IEC: A
web-based resource Centre for IEC is being used by the
States and Districts for reproduction of material. The
Resource Centre is available on the Programme’s
web site:www.tbcindia.org
6.4.9 Quality Control of diagnosis and drugs: A
protocol for External Quality Assurance (EQA) of sputum
microscopy of slides by different level of staff at the
Microscopy Centres (MCs), Districts, Intermediate
Reference Laboratories and National Reference
Laboratories have been operationalised. Similarly, an
independent agency had been contracted to test quality
of RNTCP drugs at various points.
6.4.10 Research activities: The RNTCP encourages
Operational Research (OR) and has provision for funding
such studies. Funds have also been made available to
States for inviting proposals and funding research activities
in their respective States. The OR priority research areas
as well as formats for the proposals are available on the
RNTCP websitewww.tbcindia.org. The aim of the
research is to improve DOT services to make them more
patient- friendly, ensure that treatment is directly observed
and increase detection of smear positive cases. A number
of studies have been done in this field. Some of these
have been and are being initiated/sponsored and funded
by the Central TB Division, some have been undertaken
by the States and National/Central institutes, and others
have been carried out by the teaching and training
institutes.
6.4.11 Physical Performance:
Comparative statement of achievements under RNTCP
during the last 8 years.
Indicators 2002 2003 2004 2005 2006 2007 2008 2009 2010
(Jan-Sep)
Population
coverage,
(millions) 530 775 947 1080 1114
1
1131 1148 1164
2
1176
Total number of
cases put on
DOTS 622873 906472 1187353 1293083 1397498 1475587 1517333 1533309 1173992
New smear
positive
patients put
on treatment 245051 358496 465331 506193 553660 592635 616016 624617 485018
Cure rate
(expected 85% 84% 86% 86% 84% 84% 84% 84% 85% 85%
No. of NGOs
involved (approx) 410 650 1011 1600 2263 2400 2524 2291 3000
1
Entire country covered under RNTCP in March 2006
2
Projected populations in 2009
Annual Report 2010-11 109
6.4.12 Financial Performance
6.5 NATIONAL PROGRAMME FOR
CONTROL OF BLINDNESS (NPCB)
National Programme for Control of Blindness (NPCB)
was launched in the year 1976 as a 100% centrally
sponsored scheme with the goal of reducing the
prevalence of blindness to 0.3% by 2020. Rapid Survey
on Avoidable Blindness conducted under NPCB during
2006-07 showed reduction in the prevalence of blindness
from 1.1% (2001-02) to 1% (2006-07).
Main causes of blindness are as follows: - Cataract
(62.6%) Refractive Error (19.70%) Corneal Blindness
(0.90%), Glaucoma (5.80%), Surgical Complication
(1.20%) Posterior Capsular Opacification (0.90%)
Posterior Segment Disorder (4.70%), Others (4.19%)
Estimated National Prevalence of Childhood Blindness /
Low Vision is 0.80 per thousand.
The Pattern of Assistance for National Programme for
Control of Blindness during the 11th Five Year Plan has
been approved by the Cabinet Committee on Economic
Affairs. The Pattern of Assistance for the 11th Five Year
Plan is effective from 16
th
October, 2008.
The allocation for the 11
th
Plan (2007-12) is Rs.1250.00
crore. The allocation for the current financial year (2010-
11) is Rs.260.00 crore.
6.5.1. Main objectives of the programme:
a) to reduce the backlog of blindness through
identification and treatment of blind;
b) to develop Comprehensive Eye Care facilities in
every district;
c) to develop human resources for providing Eye Care
Services;
Year Outlay as Actual
budgeted expenditure
(Rs. in Crores) (Rs. in Crores)
2006-07 202.17 220.97
2007-08 267.00 262.12
2008-09 275.00 279.90
2009-10 312.25 233.43
(till 30.09.2010)
d) to improve quality of service delivery;
e) to secure participation of Voluntary Organizations/
Private Practitioners in eye care;
f) to enhance community awareness on eye care.
6.5.2.Salient features/strategies adopted to achieve
the objectives:
• Provision of assistance to make eye care
programme comprehensive by covering diseases
other than cataract like diabetic retinopathy,
glaucoma, corneal transplantation, vitreo-retinal
surgery, treatment of childhood blindness etc.
• Reduction in the backlog of blind persons by active
screening of population above 50 years, organizing
screening eye camps and transporting operable
cases to fixed eye care facilities
• Coverage of underserved area for eye care services
through public-private partnership.
• Capacity building of health personnel for improving
their skill, enhancing their knowledge in delivery of
high quality eye services
• Community awareness/information education
communication (IEC) activities for creating
awareness on eye- care. Major events include eye
donation awareness fortnight (25
th
August to 8
th
September) and World Sight Day (2
nd
Thursday of
October) each year in addition to ongoing activities.
• Screening of children for identification and
treatment of refractive errors and provision of free
glasses to those affected and belonging to poor
socio-economic strata.
• Development of regional institute of ophthalmology
and medical colleges in a phase manner to be centre
of excellence in retina units/low vision units/
paediatric eye units.
6.5.3. New Initiatives introduced during 11
th
Plan
• Construction of dedicated Eye Wards & Eye OTs
in District Hospitals in North-Eastern States, Bihar,
Jharkhand, J&K, Himachal Pradesh, Uttarakhand
and few other States where dedicated Operation
Theaters are not available as per demand.
Annual Report 2010-11 110
• Appointment of Ophthalmic manpower
(Ophthalmic Surgeons, Ophthalmic Assistants
and Eye Donation Counsellors) in States on
contractual basis.
• Grant-in-aid to NGOs for management of other Eye
diseases other than Cataract like Diabetic
Retinopathy, Glaucoma Management, Laser
Techniques, Corneal Transplantation, Vitreoretinal
Surgery, Treatment of childhood blindness etc. The
assistance would be upto Rs. 750 per case for
Cataract/IOL Implantation Surgery and Rs.1000
per case of other major Eye diseases.
• Development of Mobile Ophthalmic Units in NE
States, Hilly States & difficult terrains for diagnosis
and medical management of eye diseases.
• Involvement of Private Practitioners in Sub District,
Blocks and Village level.
• Maintenance of Ophthalmic Equipments supplied
to Regional Institutes of Ophthalmology, Medical
Colleges, District/Sub-District Hospitals, PHC/
Vision Centres.
6.4.7 Major events during 2010-11:
• Annual review meeting of NPCB with State
Programme Officers was held on 8-9 April, 2010
as a part of review of the programme at the central
level.
• Meetings of Technical Committee to formulate
revised duties of Ophthalmic Assistants under
NPCB were held on 1.9.2010 and 8.11.2010.
Budget Allocation and expenditure:
(Rs. in crore)
Year Budget Expenditure
allocated
(BE/FE)
2006-07 111.87 111.53
2007-08 171.87 164.95
2008-09 250.00 249.49
2009-10 250.00 252.89
20010-11
(as on 30.11.2010) 260.00 125.00
Cataract Operations:
School Eye Screening Programme:
Collection of donated Eyes:
Year Target Cataract % surgery
operations with IOL
performed
2006-07 45,00,000 50,40,089 93
2007-08 50,00,000 54,04,406 94
2008-09 60,00,000 58,10,336 94
2009-10 60,00,000 59,06,016 95
2010-11(as on
30.11.2010) 60,00,000 23,11,000 95
Year No. of free spectacles provided to
school age group children with
refractive errors
Target Achievement
2006-07 70,000 4,56,634
2007-08 3,00,000 5,12,020
2008-09 3,00,000 10,21,082
2009-10 4,73,472 5,05,843
2010-11
(as on
30.11.2010) 3,00,000 85,000
Year Collection of donated eyes
Target Achievement
2006-07 45,000 30,007
2007-08 40,000 38,546
2008-09 50,000 41,780
2009-10 55,000 46,589
2010-11
(as on
30.11.2010) 60,000 14,481
Annual Report 2010-11 111
Training of Eye Surgeons:
6.6 National Iodine Deficiency disorders
Control Programme (NIDDCP)
6.6.1 Iodine an essential micronutrient required daily at
100-150 micrograms for normal human growth and
development. Deficiency of iodine can cause physical
and mental retardation, cretinism, abortions, stillbirth, deaf
mutism, squint & various types of goiter.
The sample surveys conducted in 325 districts covering
all the States/Union Territories have revealed that 263
districts are endemic as the prevalence of Iodine
Deficiency Disorders is more than 10%. It is also
estimated that in the country more than 71 million persons
are suffering from goiter and other Iodine Deficiency
Disorders.
The objectives of the programme is to (a) survey to assess
the magnitude of the Iodine Deficiency Disorders, (b)
supply of iodated salt in place of common salt, (c)
resurvey to asses iodine deficiency disorders and impact
of iodated salt after every 5 years, (d) health education
and publicity (Information, Education & Communication,
IEC), (e) laboratory monitoring of iodated salt and urinary
iodine excretion.
6.6.2. Initiatives and Progress
6.6.2.a.Salt Commissioner has issued licenses to 824 salt
manufacturers out of which 532 units have commenced
production. These units have an annual production
capacity of 120 lakh metric tonnes of Iodated salt.
6.6.2.b. Production of iodated salt of 45.90 lakh metric
tonnes was recorded during the period from April 2010
to August 2010 against 55.00 lakh metric tonnes target
for the year 2010-11.
Year Target No. of eye
surgeons
trained
2006-07 250 250
2007-08 400 300
2008-09 400 450
2009-10 400 400
2010-11(as on
30.11.2010) 400 300
6.6.2.c.The Ministry of Health & Family Welfare has
issued notification (with effect from 17
th
May, 2006 under
the Prevention of Food Adulteration (PFA) Act 1954)
banning the sale of non-iodized salt for direct human
consumption.
6.6.2.d. For effective implementation of National Iodine
Deficiency Disorders Control Programme 31 States/UTs
have established Iodine Deficiency Disorders Control
Cells in their State Health Directorate.
6.6.2.e. In order to monitor the quality of iodated salt
and urinary iodine excretion, 28 States/UTs have already
set up Iodine Deficiency Disorders monitoring laboratories
while the remaining States are in the process of
establishing the same.
6.6.2.f. During the year 2010-11, to ensure the quality
of iodated salt at consumption level, a total of 17426 salt
samples were analyzed out of which 16239 (93%) salt
samples were found confirming to the standard ( as per
the report - till October 2010).
6.6.2.g. Urine samples were collected and analyzed for
estimation of urinary iodine excretion for bio-availability
of iodine 6581, out of which 6173 samples were found
confirming to the standard (94%).
6.6.2.h. Global IDD Prevention day was observed
throughout the country on 21
st
October, 2010. On Global
IDD Prevention Day messages on benefits of
consumption of iodated salt in prevention and control of
IDD were published in National & Regional newspapers.
A two day national workshop on National Iodine
Deficiency Disorders Control Programme was also
organized at New Delhi
6.6.2.i. Visible goitre and cretinism has reduced
significantly in the country.
6.6.2.j. Information, Education & Communication
Activities
• In 16 States song and drama division through their
field units have been carrying out special interactive
programmes/ activities.
• The Directorate of Field Publicity through their 207
regional units in 29 States have carried out
extensive IEC campaigns in the country regarding
consumption of iodated salt for prevention and
control of IDDs. The activities include film shows,
group discussion and other special programmes.
Annual Report 2010-11 112
• IDD spots containing messages on consequences
of Iodine Deficiency Disorders and benefits of
consuming iodated salt are being telecast through
the National Network of Doordarshan daily. In
Kalyani Programme the IDD messages are
telecasted thrice a week in regional languages from
8 regional Kendras of Doordarshan.
• IDD spots containing messages on consequences
of iodine deficiency disorders and benefits of
consuming iodated salt are broadcast by the All
India Radio through its 40 regional channels, 133
primary channels and 22 FM channels from April
2010.
• State Governments have also been provided grants
for undertaking IEC activities at the local level in
their regional languages that includes celebration
of Global IDD Prevention Day in all districts.
Annual Report 2010-11 113
Chapter 7
7.1. INTRODUCTION
Public policy and communication strategies influence both
individual and collective change. The interface between
these two components provides the framework to position
behavior change. In other words, the balance between
communication and policy facilitates health seeking
behavior. Over the years the thrust of the Department
has been to place IEC as an intervention tool to generate
demand for the range of services under National Rural
Health Mission (NRHM) and various schemes under
public health being undertaken by the Government of India.
The Communication Strategy aims to facilitate awareness,
disseminate information regarding availability of and
access to quality health care within our Public Health
System. The key objective of the strategy is to encourage
a health seeking behavior that is doable in the context in
Information, Education And Information, Education And Information, Education And Information, Education And Information, Education And
Communication Communication Communication Communication Communication
which people live. The strategy views recipients of health
services as not merely users of services but key
participants in generating demand for services.
During the year, the communication strategy has focused
on sustaining behavior change on key health issues
through multimedia tools. This implies that it was not
enough to just give information and raise awareness about
a particular health issue. Awareness and information
dissemination should be used as tools to provide tools to
the community to press for changes to improve access to
health service provisions.
For making health care accessible to the general public
and to spread awareness on health issues, norms have
also been outlined for supporting IEC activities. The
framework incorporates a variety of activities involving
communities and also the media.
Panels inside
Delhi Metro
T r a i n s
hi ghl i ght i ng
health issues
as a part of the
IEC campaign.
Annual Report 2010-11 114
Major IEC initiatives undertaken during the year :
• Integration of various IEC activities
• MOU signed with NFDC to scale up
communication interventions in NE states.
• A series of press advertisements released in
national dailies across the country highlighting
achievements of the Ministry
• A magazine based programme, Kalyani-1 and 2
telecast in eight states and also all NE states.
• Awareness campaign on Delhi Metro trains
highlighting preventive and curative aspects of
various health issues.
• Capacity building workshops organized in states to
build capacities of state IEC personnels
• Health Pavilion at India International Trade Fair
wins gold medal for best display.
• Close monitoring of actual media utilization and
behavioral outcomes along with financial allocations
• Presented a tableau on ‘Healthy Living ‘ at the
Annual Republic Day Parade, 2011
• National Immunization Day (NID) held in Jan.-Feb.
2011.
The following tools were used during the year:
• Interpersonal Communication
• Community Channels
• Mass Media
• Folk and Traditional Media
• Outdoor Media
• Advocacy
• Events, Image management, PR and Publicity
The target audiences included:
* Citizens of India in various age groups
• Direct Healthcare Providers (ANM, ASHA,
AWW)
• Healthcare Managers/Administrative functionaries
• Health Communicators
• Grass-root functionaries
• Other Govt. Departments, e.g. Panchayati Raj,
WCD, Water & Sanitation
• NGOs, Civil society stake holders and Media
During the year, the following issues were being
highlighted through multi-media tools:
• Janani Suraksha Yojana
• ASHA
• Age At Marriage
• Routine Immunization
• PNDT and Girl Child
• Contraceptive choice and spacing
• Breast Feeding
• Use of Iodized Salt
• Care of New born
• Institutional delivery
• Maternal Care, Positioning of ASHA, Village and
Health Nutrition Day, JSY, IMNCI and also
awareness campaign on age at marriage, PNDT,
spacing and contraception.
• Adolescent health
• RCH and HIV/AIDS
• Communicable and non communicable diseases
platform for integration
A Budget allocation of Rs. 204.94 Crores was provided
for IEC activities for the year 2010-11.
Major achievements during 2010-11 were as under:
- Reinforcing the brand identity for NRHM.
- Innovations at State level for NRHM advocacy.
- Intra Communication strategies for implementation
at State level
- New content for multi-media tools.
- Integrated IEC management through Kalyani
Programme News Magazine format through Prasar
Bharati being telecast from EAG States and
Assam.
Annual Report 2010-11 115
- Special publications on
achievements under health
programmes
- Reinforced presence in Cable
and Satellite TV channels and
Private FM Radio.
- Special theme based issues for
NRHM Newsletter.
The IEC strategy of the Department
has undergone a strategic shift. The
communication challenge today is not
only demand generation, creating
awareness, but at the same time
initiating a comprehensive
understanding of behavior change
communication in the socio-cultural
framework of our Public Health
System. A number of initiatives were
taken to professionalize IEC activities and emphasis was
laid on intensive media planning and inter-personal
techniques for effective rollout of programmes and
messages.
7.2. ACTIVITIES THROUGH MEDIA UNITS OF
I & B MINISTRY
The Media Units of the Ministry of Information and
Broadcasting provide communication support to the FW
Programmes as per the requirements and guidelines of
the IEC Division of MOHFW. The focus is on mother
and child health issues, population growth, status of
women, small family norms, the Community Needs
Assessment Approach and also other issues related to
health programmes such as Ophthalmology, Cancer,
Tobacco etc.
7.3. DOORDARSHAN
i. Doordarshan telecast video spots at prime time on
NRHM, RCH issues through its National Network
as well Regional Kendras of Doordarshan, Prasar
Bharati.
ii. Doordarshan has also telecast programmes
including panel discussions, interviews etc. from
time to time related with NRHM.
iii. A half an hour Kalyani-I and II magazine based
programme was also telecast in 9 States including
North-Eastern-States twice a week. Kalyani also
repeated on DD Bharati. The proposal for telecast
of Kalyani-I and II from North-East are also in the
pipeline.
iv. The spots in regional languages of north-east region
were also dubbed for telecast for a special
campaign.Video Spots on emergency contraceptive
pill, NSV and CuT-380-A were also telecast.
7.4. DAVP
DAVP has produced video/ audio spots on NRHM for
telecast/broadcast. The programme proposed by DAVP
for broadcast through AIR was also approved by the
Ministry of Health & Family Welfare to propagate the
messages on maternal health, child health and family
planning and other critical issues of NRHM. The agency
was also engaged in putting up exhibition during IITF-
2010 at Pragati Maidan in the capital on November 14
this year which won the Gold Medal in its category.
7.5. NFDC
i. An MOU has been signed between Department
of Health & Family Welfare and NFDC, a public
sector company under the Ministry of Information
& Broadcasting for telecast of Audio/Video spots
through satellite channels as well as private FM
Channels in the North Eastern region. These
programmes were dubbed in regional languages
through NFDC for distribution in the states.
ii. The approved spots were also telecast through all
satellite channel as well as FM Channels in north-
eastern states.
Facade of the health pavilion with ‘Population Stabilisation’ theme. The pavilion won the
Gold Medal among Central Government pavilions for its thematic display.
Annual Report 2010-11 116
iii. NFDC is also conducting radio programmes based
on all issues of maternal health including Janani
Suraksha Yojana. They are also producing folk
music programme in local dialect in EAG States.
7.6. ALL INDIA RADIO
i. The spots approved were telecast through national
network at 7:59 AM before the National News at
8.00 AM and before the evening national news at
8.45 PM.
ii. AIR is broadcasting 15 minutes programme based
on NRHM through 189 primary channels, 42 Vivid
Bharati stations once a week on every Sunday at
7.00 PM. The programme are based on true
successful stories as well as questions and answers
through telephone as well as e-mail.
iii. A contract has also been signed with AIR, Mumbai
for broadcast of the spots on NRHM 3-4 times
daily in each popular programme ( film music, rural
programme, woman’s programme) and also before
and after regional news in 18 high focused stations.
iv. Department of Health & Family Welfare, Govt. of
India has also supported kendras like AIR, Patna
for telecast of the spots in their popular programme
like Munshi Prem Chand and special radio serial
titled “Cine Profile”.
v. AIR, Munbai also telecast spots on NRHM in the
North-Eastern States from the fund available under
RCH budget.
7.7. SONG AND DRAMA DIVISON
To educate the people about Family Welfare issues, Song
& Drama Division organized live entertainment
programmes like puppet shows, dance, dramas, folk
shows, during India International Trade Fair 2010.
7.8. PRESS INFORMATION BUREAU
It provided media coverage on important occasions,
events, activities, policies and programmes of the
Department. PIB arranged coverage of Family Welfare
Melas, World Population Day functions, Pulse Polio
Programme and other important events.
7.9. PRINT MEDIA/PRINT PUBLICITY
Press Advertisement:
The IEC Campaign through Press Advertisement enabled
the division to highlight key initiatives in both national and
regional media. A number of campaigns were launched
through the national and regional press. Especially
designed half page colour advertisement on the occasion
of and World Population Day was released in the
newspapers all over the country to generate mass
awareness toward stabilization of population. Colourful
advertisements highlighting various achievements on
National Rural Health Mission were also released to the
newspapers on the occasion of World Health Day,
Independence Day, Sadbhavana Divas, Children’s Day,
achievements of five years of NRHM, Immunization,
Dengue, Chickungunya etc.
The most intensive print media campaign was for the
national/sub-national rounds of Pulse Polio Programme
which was done systematically through a series of press
advertisements in major newspapers all over the country.
The IEC Division also released advertisements based on
focused theme such as Maternal & Child Health Care,
Health & Family Welfare Pavilion in IITF- 2010 etc. The
Division as part of an integrated IEC campaign covered
a range of issues on NRHM related themes which
provided a platform for information dissemination ,
awareness building and advocacy through the print media.
Printed Publicity Material:
In order to highlight the Ministry’s consistent efforts, a
series of documents were published. Each document
reflected critical areas of NRHM and related
programmes. These documents were distributed at major
advocacy meeting and programmes to all stake-holders
in States/UTs. The prominent documents published during
the year were:
i) Book on ‘Five years of NRHM’
ii) Book on ‘Comprehensive Abortion Care’
iii) Booklet on Achievement of one year of New
Government
iv) Bulletin of Rural Health Statistics in India
v) Book on Family Welfare Statistics in India
vi) Training Module for ASHA on NCD
vii) Operational Guidelines for promotion of Menstrual
Hygiene
viii) Training Module for ASHA on Menstrual Hygiene
ix) Reading Material for AHSA on Menstrual Hygiene
Annual Report 2010-11 117
x) Flip Book on Menstrual Hygiene
xi) Book on ‘Hospital Housekeeping Guidelines’
xii) Folders on Family Planning methods (multi-
languages)
a) “Hamara Ghar” an established house journal of
the Department of Health & FW is being published
for the last 39 year for promotion of Health and
Family Welfare programmes for grass root level
workers.
b) “Gagar Me Sagar” is a selected slogans booklet in
Hindi being brought out as supportive material for
Health and Family Welfare workers for publicity
of Health & FW programmes to grass root level.
NRHM Newsletter:
The NRHM Newsletter is now established as an important
publication for promotion of the programmes under
National Rural Health Mission. The NRHM Newsletter
is being published in Hindi, English, Assamese, Urdu,
Oriya, Punjabi, Marathi, Kannada, Tamil & Bengali for
NGOs and health functionaries working at the Sub-
Centre, PHC, CHC and District level. The Newsletter
publishes view points of all development partners, viz.
NGOs, donor agencies etc.
A special issue of
newsletter on
‘Population Stabilization’
was brought out during
the year. This issue
highlighted the
discussions in the lower
house of the Parliament
on ‘Population
Stabilization’. Other
important issue of
newsletter published in
the year was
‘Operational Plan for
Mother & Child
Tracking System’.
There has been
tremendous response to
the Newsletter,
especially from the
grass root health
w o r k e r s
from different regions. A number of health related issues,
in the form reader’s response have been discussed
through these Newsletter editions.
Annual Wall Calendar:
Special efforts were made to publish the Wall Calendar
2011 of the Ministry on integrated themes with poster
value. The Calendar has come out with innovative designs
highlighting initiatives taken on various health and family
welfare issues. Special efforts were also made through
visual publicity like this year’s Calendar for spreading
message on health issues as an integrated theme of the
Ministry. The Calendar was distributed to various health
set ups.
Outdoor Publicity Campaign:
An awareness campaign was launched in Delhi Metro
trains through panels inside train compartments
highlighting various issues like – New born care, Spacing
methods, Population Stabilization, Female feticide, Small
family, Right age of marriage, Emergency Contraception,
Hand washing, T.B., Anti Tobacco etc. The IEC Division
also conducted an outdoor publicity campaign by installing
hoarding, unipole on various health issues like – Dengue,
Chikungunya, Swine-flue, Maternal & Child Health,
Immunization etc.
The MOHFW tableau during the Republic Day Parade, 2011
Annual Report 2010-11 118
Mass Mailing Unit(Press)
The Mass Mailing Unit’s ( Direct Mail Communication)
main objective is to build up an effective mailing list of
opinion leaders from different parts of the country with
a view to utilize their services to bring awareness and
attitudinal change among common people.
At present, Mass Mailing Unit, Department of Health &
Family Welfare is disseminating the Ministry’s regular
journals, NRHM newsletter in English, Hindi and several
regional languages on a quarterly basis and wall calendars
on an Annual Basis. Apart from this regular dispatch, the
Mass mailing Unit has mailed various types of publicity
materials like posters, leaflets, pamphlets on Health and
Family Welfare programmes provided by various divisions
of the Ministry to the Health Functionaries at grass root
level all over the country.
7.10. IEC WORKSHOP
During the year, Capacity Building IEC Workshops were
organised for the District IEC Officers/District
Community Mobilizers in two phases in Uttar Pradesh
covering all the 80 districts. The purpose of the workshop
organised at Allahabad and Agra was to enhance the skills
of the officers. The workshops stressed on prioritizing
the health issues according to the need of the districts,
budgeting exercise, preparing IEC material and stressed
Inter-Personal Communication to spread Behaviour
Change messages to the general public etc.
7.11. WORLD POPULATION DAY
Like every year, the World Population Day was observed
on 11
th
July, 2010. On this occasion, a population run
was organized jointly by the Ministry and Jansankya
Sthirtha Kosh at New Delhi in which the Union Health
& Family Welfare Minister Ghulam Nabi Azad, Chief
Minister of Delhi,Smt Sheila Dikshit and Common Wealth
Games Gold Medalist Saina Nehwal participated along
with school children to create awareness about population
stabilization.
7.12. HEALTH PAVILION AT IITF-2010
The main theme of the Annual Health & Family Welfare
Pavilion at Pragati Maidan in the capital was “Population
Stabilization”. The Ministry has renewed and stepped
up its focus on this issue and used various forums to
highlight the importance of the theme. The Pavilion won
the Gold Medal for its display in its category.
Like every year, free health check-ups, i.e. Cancer
detection, Blood test, Eye Test, Height and weight
measurement, Family Planning counseling and services
for male with various family spacing methods, treatment
for communicable and non-communicable diseases were
arranged by the Deptt. of AYUSH through its Councils
of Ayurveda, Unani & Homeopathy and allopathic clinic
of CGHS.
Folk Dance/Nukkad Natak were organized by the Song
& Drama Division to spread health and social messages.
A small amphitheatre was also established to educate
people through showcasing documentary films. Painting
Competition was organized for the Children in two age
groups and first three entries were awarded with prizes
and certificate. NACO, JSK, HSCC, HLL, Rajiv Gandhi
Cancer Research Hospital, Heart Care Foundation &
VHAI etc also participated in the exhibition.
7.13. REPUBLIC DAY TABLEAU-2011
The Ministry of Health & Family Welfare presented a
tableau at the Republic Day Parade, 2011. The theme of
the Tableau was HEALTHY LIVING with emphasis
on preventive and curative health care including Yoga,
regular exercise and healthy food.
The tableau also highlighted the adverse effects of tobacco
use and substance abuse.
Annual Report 2010-11 119
Chapter 8
8.1 INTRODUCTION
The National Rural Health Mission (NRHM) seeks to
build greater ownership of the program among the
community through involvement of Non-Government
Organizations. Promotion of Public Private Partnership
for achieving public health goals is one of the strategies
initiated by the department in this regard. This partnership
will reinforce the strategy of involvement of NGOs
already spelt out in the National Population Policy 2000.
The Government of India is committed to voluntary and
informed choice in family planning, reproductive and child
health care services. Towards this end, the Government,
the corporate sector, voluntary and non-voluntary sector
are expected to work together in partnership. The
professional bodies like Indian Medical Association,
Federation of Obstetrician & Gynecologist are also
involved in the partnership to achieve the desired goal.
8.2 PARTNERSHIP WITH NON-
GOVERNMENT ORGANIZATIONS
The Government of India envisages collaboration with
NGOs through enhanced participation by the State
Government also. Under RCH-II, the ownership of the
program has been decentralized to the State Governments.
The planning process now starts from the district level.
The scheme has been included in the State PIP for NRHM
under RCH II.
NGOs in particular, have been assigned supplementary
or complementary role to that of the Government health
care delivery, thus aiding them in reaching the masses
meaningfully. They have a comparative advantage of
flexibility in procedures, rapport building with communities
and are at the cutting edge of program implementation.
NGOs will be involved in ASHA’s training, activities
relating to National Disease Control Programmes, PNDT
related activities and service delivery in addition to health
education and awareness programme.
Partnership With Non- Partnership With Non- Partnership With Non- Partnership With Non- Partnership With Non-
Government Organisations Government Organisations Government Organisations Government Organisations Government Organisations
8.3 NEW GUIDELINES
According to the guidelines of NGO Scheme, the States
have been given an important role in selection/approval
of the NGOs and overseeing implementation of the
projects undertaken by them. An inbuilt mechanism of
monitoring the working of the NGOs and various activities
undertaken under the project, in addition to the mid-term
appraisal, etc. by the designated evaluating agencies/
organizations has been built into the guidelines:
The key features are: -
• Decentralization of the schemes to the State and
District level.
• Integration with National Rural Health Mission.
• Training of ASHA
• Activities relating to various National Disease
Control Programme.
• Awareness relating activities concerning PNDT
Act.
• Shift from exclusive IEC and awareness generation
to Service Delivery.
• Delivery of RCH services by NGOs in un-served
and under served areas.
• Clearly defined eligibility criteria for Registration,
Experience, Assets and jurisdiction.
• Rationalization of the jurisdiction area serviced by
the NGO to provide in depth service and optimize
resources.
• Mainstreaming gender issues in all intervention
areas.
• Enhanced male participation and involvement in
delivery of all RCH services.
Annual Report 2010-11 120
• Emphasis on measurable qualitative and quantitative
performance indicators.
• Selection, approval, funding and monitoring of
Mother NGO/Service NGO projects by State and
District RCH Committees.
• Increased interface of NGOs with local
government bodies.
8.4 MOTHER NGO (MNGO) SCHEME
The underlying philosophy of the Mother NGO (MNGO)
Scheme is one of nurturing and capacity building through
partnership. In accordance with the National Population
Policy 2000, National Health Policy (NHP) 2002 and 10th
plan document that places emphasis on decentralization
of program management and RCH service delivery using
a gender sensitive approach, the NGO guidelines were
revised in accordance with the RCH II approach.
The objectives of the MNGO scheme, are to improve
RCH indicators in the under served and unserved areas,
with specific focus on Mother & Child Health, Family
Planning, Immunization, Institutional delivery, RTI/STI and
adolescent reproductive health care. It is expected that
the gender concerns and male involvement will be
addressed across all the interventions.
The un-served areas specifically include hilly, desert and
mountainous regions, SC/ST habitats, urban slums and in
areas where the government infrastructures are
functioning sub optimally. Under the revised mode, NGOs
are expected to facilitate RCH service delivery in addition
to addressing the awareness, education and advocacy
requirement.
The overall approach has shifted from a project to a
program mode (from one-year cycle to 3-5 year cycle).
Rationalization of NGO jurisdiction (reducing coverage
from 5-8 districts or more to 1-2 only), and each Mother
NGO to work with only 3-4 Field NGOs (FNGOs) from
each district, encouraging each Mother NGO to identify
the un-served and under served pockets within the districts
in consultation with District Health Officials, identification
of Field NGOs from the same pockets to serve populations
covering 1-2 sub centers in the provision of RCH service
delivery related to NRHM Family Planning, Immunization,
Mother & Child Health and access to institutional delivery.
RTI/STI, adolescent reproductive health care,
implementation of Janani Suraksha Yojana (JSY) are some
of the salient features. Currently, 310 existing Mother
NGOs are working in all the States of the Country.
8.5 SERVICE NGO (SNGO) SCHEME
The Service NGOs (SNGOS) are, those, who are
expected to provide clinical services and other specialized
aspects such as Dai training, MTP, male involvement,
covering 1,00,000 populations, contributing to achieving
the RCH objectives.
NGOs with an established institutional and infrastructure
for service delivery are encouraged to compliment the
public health care delivery system in achieving the goals
of RCH-II program. These SNGOs will cover an area
co-terminus to that of a CHC/block PHC with
approximately 1,00,000 population or around 100 villages.
Service NGOs are expected to provide a range of clinical
and non-clinical services directly to the community as an
integrated package of RCH-II services. Some of the
services expected to be provided by Service NGOs include
safe deliveries, neo natal care, treatment of diarrhoea
and ARI, abortion and IUD services, RTI/STI etc.
8.6 INSTITUTIONAL FRAMEWORK FOR
PROGRAM MANAGEMENT
The program management under the revised scheme is
decentralized to the State and district Authorities. The
State Government forms State RCH society, which has
the responsibility for the overall management of the
scheme. The State NGO Selection committee will be
responsible for MNGO selection, recommendation of
projects for GOI approval, fund disbursement, capacity
building, monitoring and evaluation. The District RCH
society is responsible for all the operational aspects of
the program management at the district level. The district
NGO committee holds the responsibility for
recommendation of MNGO composite proposals to State
RCH Society, facilitating the signing of MOU with the
MNGO and passes it on for fund release to state RCH
society. The State RCH society undertakes review
meetings and periodic monitoring in the field for assessing
Field NGO/Mother NGO performance.
Role of Government of India is related to provision of
policy guidelines, final approval of proposals, and technical
support for capacity building of NGOs and fund release
to State governments.
Annual Report 2010-11 121
8.7 STATE NGO COORDINATORS
(SNGOCs)
The SNGOCs are responsible for monitoring the
implementation, facilitating timely submission of NGO
reports to the state government, providing government
feed back to NGOs, communicating government policies
and programs and facilitating NGO dialogue with the
district health system. Presently there are 15 selected
Service NGOCs are in position.
8.8 INSTITUTIONAL FRAMEWORK FOR
NGO CAPACITY BUILDING
The Regional Resource Centres (RRCs) is the institutional
mechanism available to support this program. There are
11 RRCs covering the programme all over the country.
NGOs with expertise and experience in Reproductive
Child Health (RCH) and having national level stature are
identified as RRCs.
The RRCs are playing an important role to be a catalyst,
advocacy and net working with state governments,
strengthen managerial and technical competencies of the
Mother NGOs, support and oversee Field NGO training,
document and disseminate best practices, collect and
disseminate RCH policies, laws, and program from the
respective states where they work and for maintenance
of database on technical and human resources related to
RCH.
Annual Report 2010-11 123
Chapter 9
9.1 INTRODUCTION
In 1952, India launched the world’s first national
programme emphasizing family planning to the extent
necessary for reducing birth rates “to stabilize the
population at a level consistent with the requirement
of national economy”. Since then, the family planning
programme has evolved and the program is currently being
repositioned to not only achieve population stabilization
but also to promote reproductive health and reduce
maternal, infant & child mortality and morbidity.
The objectives, strategies and activities of the Family
Planning division are designed and operated towards
achieving the family welfare goals and objectives stated
in various policy documents (NPP: National Population
Policy 2000, NHP: National Health Policy 2002, and
NRHM: National Rural Health Mission) and to honour
the commitments of the Government of India (including
ICPD: International Conference on Population and
Development, MDG: Millennium Development Goals and
others) (see Table 1).
9.2. CURRENT SCENARIO OF
POPULATION AND FAMILY PLANNING
IN INDIA
9.2.1 Demographic Scenario:
India’s population as per 2001 census was 1.028 billion,
second only to China in the world. India which accounts
for 2.4% of the land area is already supporting around
Family Planning Family Planning Family Planning Family Planning Family Planning
17% of the world population. Even a cursory look at
following figure will give a broad idea of the demographic
scenario of India, where population of each state is
equivalent to one major country in the world. India has
been showing a slow but steady decline in population
growth. India’s annual population growth rate during
1991-2001 decade was 1.93%, a decrease of over 15%
from the previous decade. Similarly, Total Fertility Rate
(TFR) in the country has recorded a steady decline to
the current levels of 2.6 (SRS 2008), a 42% decline from
mid-1960s.
9.2.2. Family Planning Scenario:
Nationwide, the small family norm is widely accepted
(the wanted fertility rate for India as a whole is 1.9:
NFHS-3) and the general awareness of contraception is
Program/Policy X Five Year NPP NRHM MDG Current Status
Goals Plan(by 2007) (by 2010) (by 2012) (by 2015) (Reference Year)
Infant Mortality Rate 45 <30 30 27 53 (2008)
MaternalMortality Ratio 200 <100 100 100 254(2005)
Total Fertility Rate NA 2.1 2.1 NA 2.6(2008)
Table.1. Stated goals in recent National Population and Health Policies related to
Family Welfare and their current status
Annual Report 2010-11 124
almost universal (98% among women and 98.6% among
men: NFHS-3). Both NFHS and DLHS surveys showed
that contraceptive use is generally rising (see adjoining
figure). Contraceptive use among married women (aged
15-49 years) was 56.3% in NFHS-3 (an increase
of 8.1 percentage points from NFHS-2) while
corresponding increase between DLHS-2 & 3 is relatively
lesser (from 52.5% to 54.0%). The proximate
determinants of fertility like age at first marriage and age
at first childbirth (which are societal preferences) are
also showing good improvements at the national level and
adjoining figure indicates the current position of social
determinants of fertility in the country.
9.3 CURRENT FAMILY PLANNING
EFFORTS
The Family Planning (FP) Division is involved in the
development, implementation and monitoring of strategic
interventions for fulfilling the twin objectives of population
stabilization and promoting reproductive health within the
wider context of sustainable development. The
interventions, activities and performance in the area of
family planning over the year 2010-11 are as follows:
9.3.1. Contraceptive services under the National
Family Welfare Programme:
The public sector provides a wide range of contraceptive
services for limiting and spacing of births at various levels
of health system as described in Table 2:
Table 2: Family Planning Services in Public Health Sector
Family Planning Service Service Location Service Strategy*
Method Provider & Promotional Schemes
LIMITING METHODS
Minilap Trained & certified MBBS PHC & higher levels • FDS: Fixed Day
Doctors & Specialist • Static Approach
Doctors
Laparoscopic Sterilization Trained & certified Specialist CHC & • Camp Approach
Usually Doctors (OBG & higher levels • Revised Compensation Scheme
General Surgeons)
NSV: No Scalpel Trained & certified MBBS PHC & • National Family Planning
Vasectomy Doctors & Specialist higher levels • Insurance Scheme
Doctors
SPACING METHODS
IUD 380 A Trained & certified ANMs, Sub centre & • On demand
LHVs, SNs and Doctors higher levels • Camp Approach
• Revised Compensation Scheme
Oral Contraceptive Trained ASHAs, ANMs, Village level Sub centre • On demand
Pills (OCPs) LHVs, SNs and Doctors & higher levels • VHNDs: Village Health
Nutrition Days
Condoms Trained ASHAs, ANMs, Village level Sub centre • On demand
LHVs, SNs and Doctors & higher levels • VHNDs
EMERGENCY CONTRACEPTION
Emergency Contraceptive Trained ASHAs, ANMs, Village level Sub centre • On demand
Pills (ECPs) LHVs, SNs and Doctors & higher levels • VHNDs
Legends: ANM: Auxiliary Nurse Midwife; LHV: Lady Health Visitor; SN: Staff Nurse; ASHA: Accredited Social Health Activist
Note: * extensive IEC is key component of all the strategies of Family Planning Programme
Annual Report 2010-11 125
The salient features of the family planning services are
as follows:
• Counselling, access to and provision of good quality
services and follow-up care.
• ‘Fixed Day Static Services’ (FDS) approach in
sterilization services to increase access.
• Continuation of sterilization camps in the states with
high fertility till the time FDS is implemented
effectively.
• Revised compensation scheme for sterilization
acceptors.
• ‘National Family Planning Insurance Scheme’
(NFPIS) to cover service providers in both public
and accredited private facilities, where the clients
are insured in the eventualities of deaths,
complications and failures in sterilization and the
providers/ accredited institutions are indemnified
against litigations in those eventualities.
• ‘Quality Assurance Committees’ (QACs) have
been constituted at state and district levels.
• The division has repositioned IUD as short and long
term spacing method.
• Guidelines have been developed and disseminated
regarding use of Emergency Contraception Pills
(ECPs).
Achievements in 2010-11:
The performances of family planning services are showing
a marginal decline in all methods (refer Annex-1 for
details) for the year 2010-11 compared to the
corresponding period in 2009-10.
This decline could be because of incomplete data
uploaded by most states and it is assumed that once
complete data is entered an improved performance would
be reflected. However, anecdotal evidences suggest that
another reason for declining performance could be
attributed to better quality of data entered in HMIS web
portal.
9.3.2.Increasing male participation in Planned
Parenthood, including ëNo Scalpel Vasectomyí
(NSV):
• Increasing male participation in ‘Planned
Parenthood’ is one of the major strategic themes
of NPP-2000.
• Promotion of NSV acceptance is one of the most
important & visible component of increasing male
participation in RCH towards addressing the gender
equity issues.
• The No Scalpel Vasectomy (NSV), a modified male
sterilization technique, was introduced in 1997.
• Camp approach for male sterilization was adopted
initially to re-popularize male sterilization method.
Based on the experiential lessons from male
sterilization camps in certain states a strategy on
advocacy and community mobilization for
increasing NSV acceptance through camps was
introduced in 2005.
• Human resource development with a three pronged
strategy for training surgical faculty from Medical
colleges, district NSV trainers and service providers
is in place.
Achievements in 2010-11:
• The camp approach was continued in most states
across India (http://mohfw.nic.in/NRHM/FP/
Revised_Budget_ Guidelines_CSS.pdf)
• Training in NSV, was continued on a priority basis.
As on September 2010:
o As per the latest report (HMIS) there are 9239
facilities in the country with trained NSV
providers.
o Most districts in the country have district NSV
trainer/s.
o Surgical faculty training is being continued in
2010-11 across five regional training centres and
funds for the same are being disbursed.
Source: Report from HMIS web portal as on 25th November 2010
Annual Report 2010-11 126
• The annual ‘National NSV Review Workshop’ was
held in September 2009 to review states’
performance in NSV, and top three performing
states for the year 2008-09 (West Bengal, Punjab
& Maharashtra) were felicitated.
• NSV performance has continued its positive trend
and has shown an increase in 2009-10:
• Male sterilization as a percentage of total
sterilization had reached a low of 1.89% in 1999
and was hovering around 2.5% until 2006 without
much improvement. As a result of intensive efforts
to increase male participation, the proportion of
male sterilization rose to 4.3% in 2007-08 and 5.5%
in the year 2008-09 and it has further improved to
5.6% in 2009-10. Number of NSVs for the period
ending September 2010-11 is 4.7%.
• From above figure, it is evident that NSV as a
percentage of total sterilization is increasing across
the country and more and more states are moving
in the positive direction.
9.3.3. Promotion of IUDs as a short & long term
spacing method:
In 2006, GOI launched “Repositioning IUCD in National
Family Welfare Programme” ( http://mohfw.nic.in/
NRHM/FP/Repositioning_IUCD.pdf) with an objective
to improve the method mix in contraceptive services and
has adopted diverse strategies including advocacy of
IUCD at various levels; community mobilization for
IUCD; capacity building of public health system staff
starting from ANMs to provide quality IUCD services
and intensive IEC activities to dispel myths about IUCD.
ìAlternative Training Methodology in IUCDî using
anatomical, simulator pelvic models incorporating adult
learning principles and humanistic training technique was
started in September 2007 to train service providers in
provision of quality IUCD services. It was started in
twelve districts across twelve states of India on a pilot
basis and based on the success of the pilot phase and
lessons learned it was expanded to cover the entire
country in 2008-09.
Achievements in 2010-11:
• As on September 2010:
- GOI has trained state trainers from all the states
at the National level
Period† April ñ March* April-September^
Contraception 2008-09 2009-10 Annual 2010-11
(lakhs) (lakhs) Change (%) (lakhs)
Male Sterilizations 2.52 2.74 8.7 0.77
Male Sterilization as % of
Total Sterilization 5.2 5.5 4.7
Source: * MIS for NRHM as on November 2010
^ HMIS RCH Reports accessed on 25
th
November 2010
Table 3: Achievements in Male Sterilization, Nationwide
Source: 2006-2009: MIS for NRHM as on 30
th
April 2009
2009-10 & 2010-11: HMIS Standard RCH Reports
Annual Report 2010-11 127
- Anatomical simulator pelvic models have been
distributed to all the districts
- All the states have started district trainers’ and
service providers’ trainings.
- Approximately 35,000 service providers (MOs,
SNs, LHVs, & ANMs) have been trained till
date.
• Rapid assessment of the IUCD training is almost
complete (final report awaited).
• In order to increase basket of contraceptives in
spacing methods, decision to introduce Multi Load
Copper 375 has been taken and an operations
research study has been completed in 6 states.
The report/ recommendations of the study is
awaited. Requirement for Multi Load IUD to be
launched in the programme is being worked out.
9.3.4. Addressing the unmet need in contraception
through assured delivery of family planning
services:
9.3.4.a Fixed Day Static Services in Sterilisation at
facility level:
• Operationalization of FDS has following objectives
( h t t p : / / m o h f w. n i c . i n / N R H M/ F P /
Fixed_Day_Static_ Guidelines.pdf):
- To make a conscious shift from camp approach
to a regular routine services.
- To make health facilities self sufficient in
provision of sterilization services.
- To enable clients to avail sterilization services on
any given day at their designated health facility.
9.3.4.b. Camp approach for sterilization services is
continued in those states where operation of regular fixed
day static services in sterilization takes longer time
duration.
9.3.4.c. Training of service providers for full
operationalization of FDS is continued across all the states
for all sterilization services (NSV, minilap abdominal
tubectomy and laparoscopic tubectomy) and IUD
services.
9.3.4. d. Rational placement of trained providers at
the peripheral facilities for provision of regular family
planning services.
Achievements in 2010-11:
• FDS guidelines have been disseminated to all the
states.
• Most states have operationalized FDS in sterilization
at the district level and few states like Andhra
Pradesh and Tamil Nadu have opertaionalized FDS
up to the PHC level.
• Guidelines for “Standard Operating Procedures for
sterilization services in camps” were developed,
printed and disseminated to all the states.
• “Guidelines for Clinical Skill Building Trainings in
Male and Female Sterilization Services” was (http:/
/mohfw.nic.in/NRHM/FP/Scan_Clinical_Skill_
Building. pdf) developed and disseminated to all
states.
• Analysis of the data available from HMIS under
Source: Data accessed from HMIS on 25
th
November, 2010
and analyzed in-house
Table 4: FDS Guidelines for sterilization services
Health Facility Minimum frequency
of sterilization
services
District Hospital Weekly
Sub District Hospital Weekly
CHC / Block PHC Fortnightly
24  7 PHC / PHC Monthly
Note: Those facilities providing more frequent services
already must continue to do so
Annual Report 2010-11 128
NRHM for the period April-September 2010-11
reveals that around 60% of NSV, Minilap and even
laparoscopic sterilization (which requires specialist
training and expensive instruments) procedures and
approximately 42% of postpartum sterilizations are
being conducted at PHC and CHC level, indicating
that FDS approach in sterilization is taking root in
the country (See figure).
• Expert committee meetings have been convened
to standardize trainings in female and male
sterilization services.
9.3.5. Quality Assurance in Family Planning:
Quality assurance in family planning services is the
decisive factor in acceptance and continuation of
contraceptive methods and services.
The guidelines for ‘Quality Assurance and Standards’ in
place.
The Quality Assurance Committees (QACs) set up at
the State and District level, following the Supreme Court
directives. At the Central level, these activities are
monitored through reports and field visits.
Up-to-date guidelines on quality of services are now
available for
• Male and female sterilization services: (http://
mohfw.nic.in/NRHM/FP/Quality_Assurance.pdf)
• Sterilization services in camps (http://mohfw.nic.in/
NRHM/FP/SOP_Book.pdf)
• IUCD services(http://mohfw.nic.in/NRHM/FP/
medical_ officer.pdf &
• http://mohfw.nic.in/NRHM/FP/nursing.pdf)
• ECP administration (http://mohfw.nic.in/NRHM/
FP/ECP_Book_Final.pdf), the division has
developed reference manuals on:
• Minilap tubectomy
• Post partum family planning
• Immediate post partum insertion of IUCD
• Guidelines for training in female sterilisation
Achievements in 2010-11:
• Divisional workshops (5) on “Quality Assurance
in Family Planning” were held in the high focus
state of Uttar Pradesh.
• Another workshop was conducted in Bihar to orient
the newly appointed district nodal officers of family
planning.
• Almost all states have reported the constitution of
the “SQACs” and of ‘DQACs”.
9.3.6. Post-partum Family Planning (PPFP)
services:
• Institutional deliveries in India have increased
significantly since the launch of NRHM which gives
an opportunity to offer family planning counselling
and contraceptive services.
• PPFP services are not being offered uniformly at
all levels of health system across different states
of India resulting in missed opportunities.
Achievements in 2010-11:
• The division has undertaken advocacy for
strengthening PPFP services, at all levels; further,
it was ensured that PPFP is included in PIP for
2010-11 under NRHM.
• Training of Trainers for immediate PPIUCD have
been organised in medical colleges and district
hospitals of 18 states.
• PPS is showing increasing trends at the National
level. The proportion of PPS out of total female
sterilization has recorded an impressive 8.1
percentage points increase for the period April-
March 2009-10 (32.1%) compared to the period
April-March 2008-09 (24%). Further, this remains
static during the corresponding period of 2010-11
at 32.2%.
• Hand book on Post- partum family planning has
been developed.
9.3.7. Promotion of Emergency Contraceptive
Pills (ECPs):
ECPs are effective for preventing conception due to
unplanned/ unprotected sex. This helps to reduce
unwanted pregnancy and associated abortions, maternal
mortality and morbidity.
• ECPs have been included in National Family
Welfare Programme and efforts are being made
to utilize them at all levels of public health system.
Annual Report 2010-11 129
• ECP has been included in the ASHA kits to address
the issue of unwanted pregnancy at the community
level.
9.3.8. Assisted Reproductive Technologies (ART)
for infertility:
As per WHO data, the incidence of infertility in various
countries including India is around 10-15% which has
created demand for assisted reproduction. In order to
ensure quality in ART services and for regulating and
supervising the functioning of ART clinics, the National
Guidelines on ART has been developed by ICMR and
National Academy of Medical Sciences for GOI.
Achievements in 2010-11:
• The Draft bill on ART has been updated by
incorporating comments from various stakeholders
including the Law Commission and general public.
The draft Bill has been sent to the Law Ministry
for examination..
9.3.9. New contraceptive methods and
contraceptive services:
It has been documented worldwide that introduction of a
new contraceptive method increases the CPR by
approximately 3%. The division is taking proactive
approach to introduce new contraceptive methods and
services in family welfare programme.
Achievements in 2010-11:
• Post- Partum IUCD (PPIUCD) has been
introduced as a contraceptive technique in the
programme. Training of service providers and
trainers has been done in 18 states – 32
Gynaecologists and 30 (as state trainers) have
trained more than 100 Gynaecologists and nurses
at the district level who will be further train medical
officers from FRUs. 2000 anatomical pelvic models
with post-partum uterus procured with the support
of UNFPA and distributed to the states.
• Decision to introduce Multi Load Copper 375 has
been taken and operation research study for the
introduction of the same in National Family Welfare
Programme has been completed and the final report/
recommendation is awaited.
• Funds have been released to ICMR for Post
Marketing Surveillance study in Centchroman (a
non steroidal oral contraceptive developed
indigenously by CDRI, Lucknow).
• RISUG is an indigenously developed intra-vasal
male contraceptive. It is under Phase 3 clinical trial
which is funded by the ministry.
• A 3 year pre-introductory study on Net-EN,
Cyclofem and hormonal Implants is in progress.
ICMR is conducting the research study in HRRCs
and Medical Colleges prior to its introduction in
the National Programme.
9.3.10. Other promotional schemes:
9.3.10.a. Revised compensation scheme for acceptors
of sterilization:
GOI has been providing compensation to the acceptors
of sterilization for their loss of wages for availing the
services as per the revised rates since September 2007
and all the states are covered under this scheme. Funds
in the scheme have also been earmarked for the
compensation for sterilization in accredited private health
facilities and empanelled private healthcare providers.
The detailed scheme is available on the ministry’s website
at http://mohfw.nic.in/NRHM/FP/
Revised_compensation.pdf .
9.3.10.b.National Family Planning Insurance Scheme
(NFPIS):
GOI launched the NFPIS Scheme in November 2005 to
compensate for the acceptors of sterilization or his/her
nominee in the unlikely event of failure or complications
or his/ her death, following a sterilization operation. The
scheme also provides for indemnity insurance cover to
the medical officers and the health facilities for up to
four cases of litigations per year that the healthcare
provider or the facility may face as a consequence of
performing sterilization operations.
• The Insurance scheme has been renewed with the
ICICI Lombard Insurance company for the year
2009-10
• The manual for NFPIS is available on the ministry’s
website at http://mohfw.nic.in/NRHM/FP/
FP_Manual_ 2008-Final.pdf
9.3.10.c.Public Private Partnership (PPP):
• PPP in family planning services are intended to
utilize the reach of private sector in increasing the
access to family planning services. In order to
promote PPP in family planning services,
accredited private facilities and empanelled private
Annual Report 2010-11 130
healthcare providers are covered under revised
compensation scheme for sterilization and NFPIS.
• Accreditation and empanelment of private health
facilities /healthcare providers is decentralized to
districts.
• However, PPP in family planning has not been
adequately promoted. The division is addressing this
issue by increasing advocacy for PPP at all forums
including Indian Medical Association (IMA). Nearly
100 workshops have been conducted for private
practitioners through funding to IMA.
9.3.11. Some major activities during the year:
9.3.11.a.National consultation on Repositioning
Family Planning for Maternal & Child Health
in Addition to Population Stabilisation (May
05, 2010):
• The consultation was inaugurated by the Hon’ble
Minister of Health and the key note address was
delivered by Hon’ble Member of Parliament Shri
M S Swaminathan.
• Various experts from across the globe & from
various international organisations like UNFPA,
UNICEF, DFID, USAID, WHO, World Bank and
representatives from lead NGOs participated in the
consultation.
9.3.11.b.Celebration of World Population Day &
Week (July 11 – 17, 2010):
• World Population Day was celebrated for the first
time in all districts of the high focus states (304
districts) to generate awareness about population
issues.
• At the central level the Hon’ble Union Minister of
Health and Family Welfare Shri Ghulam Nabi Azad
flagged off a ‘Population Run’ from Vijay Chowk
to India Gate. The gathering was also addressed
by the Hon’ble Chief Minister of Delhi Smt. Sheila
Dixit.
• Similar functions were also held not only in all the
9 high focus states’ capital but also in all their
districts. In all the states two days’ district level
melas were also held where stalls were set up for
RCH services including counselling, IUD services,
other spacing methods and enlisting for clients for
sterilisation.
Key findings:
• During the population week over 90,000
sterilisations were performed; this was a result of
concerted IEC/BCC efforts and provision of quality
services.
• With meticulous micro planning the available service
providers could be judiciously distributed to make
more facilities functional and thereby provide
service to the clients nearer their place of
residence. Further, it was observed that those states
showed better performance where top bureaucratic
leadership was actively involved.
9.3.11.c.Debate on Population Stabilisation in
Parliament (August 04, 2010):
• The Hon’ble Minister of Health and Family Welfare,
Shri Ghulam Nabi Azad, piloted a debate in
Parliament – “That this house consider the issue
of Population Stabilisation in the country”
• It was a historic debate as the subject was debated
in Parliament after 33 long years. The debate lasted
almost 7 hours and more than 34 members spoke
in the debate. Cutting across party lines all members
appreciated the gravity of the subject and urged
the government to take all necessary steps to
contain the rising population.
9.3.11.d. Meeting of the National Commission on
Population (October 21, 2010) :
• The second meeting of the National Commission
on Population (NCP) chaired by Hon’ble Prime
Annual Report 2010-11 131
Minister, Shri Manmohan Singh was held on October
21, 2010.
• The meeting was attended by Chief Ministers of
high focus states, health ministers of the states and
members of the NCP.
9.4. KEY CHALLENGES & OPPORTU-
NITIES
9.4.1. Demographic challenges:
• It has been estimated that with current trends, the
population in India will increase from 1.029 billion
to 1.4 billion during the period 2001-2026, an
increase of 36% in twenty-five years at the rate of
1.2% annually.
• There are substantial differences in TFR in between
and within states and the national progress must
be seen in the context of these striking differences
e.g. Kerala, Tamil Nadu, Andhra Pradesh &
Karnataka with TFR at or below replacement levels
and states like Uttar Pradesh, Bihar, Madhya
Pradesh, Chhattisgarh, Uttarakhand, Rajasthan,
Jharkhand and Orissa, with an estimated combined
TFR of 4.2 in 2000. Table 5 gives the estimated
year by which some selected HFS will reach
replacement fertility if the current trends continue
and it will delay the attainment of replacement level
of fertility in India until 2021:
9.4.2. Programmatic and service delivery
challenges in family planning:
• Unavailability of regular sterilization services:
The access to sterilization services at sub-district
levels is restricted due to poor implementation of
FDS approach, especially so in high focus states
with high TFR and high unmet need due to:
- lack of trained service providers specially in
minilap & NSV at the CHCs and PHCs
- poor facility readiness
High seasonal variation in sterilisation services is evident
in high focus states (84% sterilization in last 6 months
and 42% in last three months) compared to a more uniform
performance throughout the year in non-EAG states (see
adjoining figure). This reflects the lack of regular service
provision rather than the ‘acceptors preference’, as
frequently claimed by many service providers.
• Heavy reliance on expensive, technically and
logistically high-demanding laparoscopic
sterilizations: As evidenced by adjoining figure,
the southern states (blue bars), except Karnataka,
Table 5 Projected Year to reach
Replacement-level Fertility
Sl. No. Name of the State Year
1 Uttar Pradesh 2027
2 Madhya Pradesh 2025
3 Chhattisgarh 2022
4 Uttarakhand 2022
5 Bihar 2021
6 Rajasthan 2021
7 Jharkhand 2018
INDIA 2021
Source: Report of the technical group on population projections
commissioned by the National Commission on Population, May 2006
Source: Data accessed as on November 25, 2010 from HMIS web
Source: Data accessed as on November 25, 2010 from HMIS
web portal
Annual Report 2010-11 132
show a high proportion of minilap sterilizations (75
to 89% out of total female sterilization). However,
in most of the high focus states (green bars), with
the exception of Bihar and Jharkhand, laparoscopic
female sterilization remains the predominant
procedure. Laparoscopic sterilization services can
be provided by trained gynaecologists/surgeons
only; the procedure requires expensive instruments
with high maintenance and sophisticated
infrastructure including basic OT. Hence, heavy
reliance on it would limit service provision in these
states where the availability of specialists and
facility readiness is still low. Promoting the simpler,
safer and easy-to-provide minilap would be a better
proposition for increasing the access to sterilization
services and reduce the unmet need in limiting
methods in high focus states.
• The huge potential for post-partum contraception
offered by the increasing number of institutional
deliveries has not been tapped adequately due to
lack of planning, lack of trained post-partum family
planning service providers and lack of infrastructure
in most of the high focus states. This is evident
from above figure which shows that in high focus
states like Uttar Pradesh, Bihar, Madhya Pradesh,
Rajasthan, Jharkhand, Chhattisgarh, Uttarakhand
and Orissa postpartum sterilization accounts for a
very lowly 3-19% of total female sterilization as
compared to 75-90% in non-high focus states like
Kerala and Tamil Nadu.
• Human resource development for minilap,
laparoscopic sterilization & NSV to operationalize
FDS in sterilization is picking up. However, the
quality of training, post-training follow-up and
support for adherence to standard service delivery
protocols are poor. More importantly, there is a lack
of rational human resource development plan in the
states where selection of trainees, post-training
placement and post-training infrastructure & logistic
support are not given adequate importance leading
to loss of trained service providers to the system
and wasted resources.
• Lack of regular contraceptive updates at state/
district level for all categories of service providers
is limiting the service providers’ knowledge level
and skills to provide quality contraceptive services
according to the latest service delivery protocols.
• Inadequate attention to spacing methods is
evident by consistently low use of spacing methods
across most states of India, despite high unmet need
in spacing. According to DLHS 3, all the spacing
methods together account for just around 25.5%
of the current contraceptive use compared to
74.5% by female & male sterilizations put together
as evidenced in adjoining pie chart.
• Inter-State variation in access to and use of
family planning services: The access to and use
of family planning services shows wide inter-state
variations. The performance of HFS in family
planning services, though improving, remains much
below expected levels and needs to be stepped up
considerably. Adjoining chart shows the gap
between the ELA (Expected Level of
Achievement) and actual performance in 2009-10
in sterilization services in select HFS and the gaps
range from of 3.44 lakhs in UP and 1.92 lakhs in
Bihar to 8 thousands in Chhattisgarh. The data on
Source: Data accessed as on November 25, 2010 from HMIS web
portal
Annual Report 2010-11 133
sterilizations per 10,000 unsterilized couples exposed
to higher birth order of 3 and 3+ further highlights
the poor performance of HFS. The sterilization rate
for 10,000 unsterilized couples exposed to high birth
order ranges from a lowly 35 in Uttar Pradesh, 56
in Bihar & 59 in J&K to a high of 1,399 in Tamil
Nadu and 3,493 in Andhra Pradesh as shown in
the figure.
• The demand from the states for contraceptives and
survey findings on contraceptive use are in variance.
To address this issue, the logistics of procurement
and supply of contraceptives has to be rationalized
to reflect the actual requirement and usage.
• Public Private Partnership (PPP) in family
planning has not been adequately promoted across
most states in India and there is a reluctance to
accredit private providers at state/district level
which is adversely affecting the widest possible
access of family planning services to clients.
Source: Data accessed as on November 25, 2010 from HMIS web
portal
• Community based family planning services
(including counselling, contraceptive distribution,
referral services) utilizing ASHAs, VHNDs and
VHSCs have not yet been opertaionalized
effectively.
9.5. FUTURE STRATEGIES
The ministry has set in motion new approaches to sustain
the momentum gained in the sphere of family planning
and population stabilization this year, some of which are
as follows:
• •• •• Advocacy for repositioning the Family Planning
Program at all levels, for achieving population
stabilization and reducing the maternal, infant and
child mortality and morbidity.
• •• •• Ensuring the Fixed Day Static Services round the
year.
• •• •• Rolling out the comprehensive training plan for
development of trained human resources in family
planning services which has been an area of
concern for a long time.
• •• •• Promoting male participation
• •• •• Increasing the thrust on Post-partum Family
Planning services.
• •• •• Organizing state Family Planning dissemination
workshops countrywide.
• •• •• State wide dissemination of IEC/BCC and
advocacy materials.
• •• •• Increasing the basket of choices in contraceptives
offering more options to the clients.
• •• •• Strengthening contraceptive logistics
(Decentralization of procurement): allowing state/
districts to procure NSV instruments / IUD kits/
Laparoscopes through the flexi pool
• •• •• Revised monitoring strategy is being put in place
with a clear road map for states to achieve dual
goals of population stabilisation and better
reproductive health:
a. Development of key performance indicators for
input, process and output
b. Categorisation of states based on TFR
c. Analysing states’ performance on the basis of
Annual Report 2010-11 134
information available through survey, HMIS,
review mission reports etc.
d. Conducting visit to states to corroborate the
findings of above analysis and analysing
underlying causes for poor performance which
would lead to the way forward.
e. Analysis of information with implication for
follow-up action.
9.6 CONTRACEPTIVES IN THE NATIONAL
FAMILY WELFARE PROGRAMME
The Department of Health and Family Welfare is
responsible for implementation of the National Family
Welfare Programme by interalia, encouraging the
utilization of contraceptives and distribution of the same
to the States/UTs through Free Supply Scheme and
Public-Private Partnership (PPP) under Social Marketing
Scheme. Under Free Supply Scheme, contraceptives,
namely, Condoms, Oral Contraceptive Pills, Intra Uterine
Contraceptive Device (IUCD), Emergency Contraceptive
Pills and Tubal Rings are procured and supplied free to
the States/UTs.
9.6.1. The channel for supply of these contraceptives
under Free Supply Scheme is Government network
comprising Sub-Centers, Primary Health Centres,
Community Health Centres and Govt. Hospitals, State
AIDS Control Societies throughout the country.
9.6.2. Procurement procedures: Orders are placed
on HLL Life Care Ltd. and IDPL (both PSUs) for
procurement of contraceptives being manufactured by
them as per Govt. instructions. For the remaining
quantities, tenders are solicited from the firms through
advertisement of Tender Enquiries for concluding Rate
Contracts. Rate Contracts are concluded with the
manufacturers and Supply Orders are placed upon them
as per their competitive rates and the capacity to
manufacture the items.
9.6.3. Quality Assurance: Manufacturers do in-house
testing of stores before offering them for inspection. At
the time of acceptance of stores, all the batches are tested
and thereafter, stores are supplied to the consignees.
9.6.4. The quantities given to the States under Free
Supply Scheme during the last two years and the current
year (upto November, 2010) along with the budget utilized
are given in the following tables:
Quantities supplied to States/UTs
9.7 SOCIAL MARKETING SCHEME
The National Family Welfare Programme initiated the
Social Marketing Programme of Condoms in 1968 and
that of Oral Pills in 1987. Under the Social Marketing
Programme, both Condoms and Oral Pills are made
available to the people at highly subsidized rates, through
diverse outlets. The extent of subsidy ranges from 70%
to 85% depending upon the procurement price in a given
year. Both these contraceptives are distributed through
Social Marketing Organizations (SMOs).
The SMOs are given Deluxe Nirodh condom at Rs.2.00
per packet of 5 pieces and this is sold @ Rs.3/- per packet
of 5 pieces to the consumer. One cycle of Oral Pills,
which is required for one month, is given to the SMOs @
Re.1.60/- and it is sold to the consumer @ Rs.3/- per
strip (cycle) under the brand name-”Mala –D”. Under
the Social Marketing programme, currently three
Contraceptives 2008-09 2009-10 2010-11
(up to
Nov.,10)
Condoms 170.30 98.79 60.54
Oral Pills 11.90 4.12 8.54
IUDs 6.48 6.13 14.28
Tubal Rings 1.50 1.07 1.97
ECP 0.44 3.60 1.72
Pregnancy Test Kits 24.47 24.47 8.4460
Budget Utilization
(Rs. in Crore)
Contraceptives 2008-09 2009-10 2010-11
(upto
Nov. 10)
Condoms(In million pieces)) 320.322 642.427 389.030
Oral Pills(In lakh cycles) 616.677 123.000 255.000
IUDs (In lakh pieces) 41.686 31.000 72.510
Tubal Rings (In lakh pairs) 16.32 13.744 15.470
ECP(in lakh packs) 6.59 45.000 21.540
Pregnancy Test Kits(in lakhs) 217.48 217.48 78.500
Annual Report 2010-11 135
Government brands and fourteen different SMOs brands
of condoms are sold in the market. Similarly for Oral
Pills, one Government brand and seven SMOs brands of
Pills are sold. Based on the recommendation of the
Working Group on Social Marketing of Contraceptives,
SMOs have the flexibility to fix the price of branded
condoms and OCPs within the range fixed by the
Government.
9.8. AREA SPECIFIC PROJECTS FOR
SOCIAL MARKETING
With a view to providing impetus to Social Marketing in
selected regions/districts, area specific projects are
initiated under the Social Marketing Programme. This
endeavour has been undertaken in the States of Madhya
Pradesh, Haryana, Andhra Pradesh, Bihar, Jharkhand and
Orissa. During the year 2010-11, till November, 2010 no
project under the scheme could be approved.
9.9. SALE OF CONDOMS (QUANTITY IN
MILLION PIECES)
Sl. Social Marketing 2008-09 2009-10 2010-11
No. Organisation (upto
Nov.,
2010)
1. HLL Lifecare Ltd,
Thiruvananthapuram 223.54 185.50 105.41
2. Population Services
International, Delhi 176.87 189.41 50.77
3. Parivar Seva Sanstha,
Delhi 61.19 34.32 11.95
4. DKT, India, Mumbai 114.36 105.62 25.50
5. World Pharma, Indore 11.60 3.60 0.00
6. Janani, Patna 25.19 29.23 8.95
7. Pashupati Chem. and
Pharmaceutical Ltd.,
Kolkata 10.57 4.96 0.00
8. Population Health
Services( India) 75.71 97.34 21.68
9. Sanskar Shiksha Samiti,
Bhopal … … …
Total 699.03 649.98 224.26
9.10. SALE OF ORAL CONTRACEPTIVE
PILLS (QUANTITY IN LAKH CYCLES)
Sl. Social Marketing 2008-09 2009-10 2009-10
No. Organisation (Up to
Nov. 2010)
1. HLL Lifecare Ltd,
Thiruvananthapuram 122.00 66.21 58.01
2. Population Services
International, Delhi 69.01 63.40 54.17
3. Parivar Seva Sanstha,
Delhi 30.66 25.00 7.86
4. World Pharma, Indore 15.86 4.00 0.00
5.. DKT, India, Mumbai 102.54 120.50 30.08
6. Eskag Pharma (Pvt.)
Ltd., Kolkata 62.51 75.68 0.00
7. Janani, Patna 21.43 22.90 7.58
8. Population Health
Services, Hyderabad 51.62 45.30 33.31
9 Sanskar Shiksha
Samiti, Bhopal 0.10 0.00 0.00
10 PCPL, Kolkata 19.40 10.05 0.00
Total 495.13 433.04 191.01
9.11. CENTCHROMAN (ORAL PILLS)
Since December 1995, a non-steroidal weekly Oral
Contraceptive Pill, Centchroman (Popularly known as
Saheli & Novex), to prevent pregnancy is also being
subsidized under the Social Marketing Programme. The
weekly Oral pill is the result of indigenous research of
CDRL, Lucknow. The pill is now available in the market
at Rs.2.00 per tablet. The Government of India provides
a subsidy of Rs.2.59 per tablet towards product and
promotional subsidy.
Annual Report 2010-11 136
9.12. PERFORMANCE OF SOCIAL
MARKETING PROGRAMME IN THE
SALE OF CONTRACEPTIVES
9.13. EMERGENCY CONTRACEPTIVE
PILLS[ECP]
Department of Health &Family Welfare introduced
‘Emergency Contraceptive Pills’ (E- pills) in the National
Family Welfare Programme during the year 2002-03.
This contraceptive is used within 72 hours of un-protected
sex. The following quantities of E-pills were procured
during the years 2008-09, 2009-10 & 2010-11 (upto
Nov.2010).
Quantity procured (in lakh packs)
Item 2008-09 2009-10 2010-11
(Nov.2010)
ECP 5.50 45.000 21.54 Contraceptives 2008-09 2009-10 2010-11
(Upto
Nov.,
2010)
Condoms(Million pieces) 699.03 649.98 224.26
Oral Pills (lakh cycles) 495.13 433.04 191.01
Centchroman (Saheli/
Novex) Weekly Oral Pills
(lakh tablets) 181.07 203.94 32.94
9.14. PREGNANCY TEST KITS
Orders have been placed on HLL Lifecare Ltd, (a PSU
under the Ministry), for procurement of 2,17,48,200
Pregnancy Test kits each during the year 2008-09, 2009-
10 and 2010-11 for free-of-cost supply for timely and
early detection of pregnancy. The kits are home-based
and easy to use.
9.15 COPPER-T
Under the National Family Welfare Programme, Cu-T-
200B was being supplied to the States/UTs. From 2003-
04, advanced version of Intra Uterine Contraceptive
Device i.e.IUCD-380-A has been introduced in the
Programme. This Cu.-T has longer life of placement in
the body and thus provides protection from pregnancy
for a period of about 10 years. Now the advanced version
of IUCDs i.e.IUCD-380A is being procured and supplied
to the States/UTs.
Annual Report 2010-11 137
State/UT/ Total Sterilization IUD Insertions during OCP Users during Condom Users during
Agency acceptors during April to September April to September April to September
April to September
2010-11 % Change 2010-11 % Change 2010-11 % Change 2010-11 % Change
from from from from
2009-10 2009-10 2009-10 2009-10
I. High Focus North-East
Arunachal Pradesh 528 46.7 1,277 4.8 1317 20 679 57
Assam 28,544 32.5 18,664 14.5 65,821 25 52,680 44
Manipur 640 79.8 2,490 -6.5 3,904 103 2442 -8
Meghalaya 1,033 6.3 1,777 62.6 5,446 9 3,756 3
Mizoram 1,359 -2.2 1,625 56.6 6,909 17 4,801 26
Nagaland 643 -10.4 781 -32 575 -5 706 93
Sikkim 71 . 1,017 52.7 4,406 -1 2383 -36
Tripura 1,540 -15.3 822 -47.1 4,245 -70 6,770 -8
II. High Focus Non North-East
Bihar 38,035 12.5 93,454 9.4 48,083 15 81,918 31
Chhattisgarh 28,077 5.3 50,659 1.4 98346 -16 159,055 -23
Himachal Pradesh1,821 -10.8 10,140 -13.8 23,282 -19 81,908 -21
Jammu & Kashmir3,287 -8.7 9,216 -14.4 16,338 24 25,921 7
Jharkhand 26,665 118.1 59,460 35.1 92560 7 134,974 -16
Madhya Pradesh112060 77.8 175876 -24.7 400672 -16 664511 -33
Orissa 29,300 62.4 58,283 -5.1 136736 -25 178,024 -30
Rajasthan 86,725 -1.4 258264 3.8 700969 -19 1,326,489 -18
Uttar Pradesh 53,377 -25.6 575094 -25.3 249664 -66 580,930 -41
Uttarakhand 3,939 -26.7 31,907 -39.1 20,181 -58 38,591 -44
III. Non-High Focus Large
Andhra Pradesh391607 -8.4 177431 -11.2 301685 -9 701091 -12
Goa 1954 -18.2 1088 0.6 3903 17 1598 10
Gujarat 87879 -13 256110 -9.8 255353 -12 660135 -35
Haryana 37210 -3.6 85784 -5.6 54337 -38 132796 -56
Karnataka 166709 -16.4 113211 -17.6 117126 -28 227275 -2
ANNEXURE 1:
Number and percentage of family planning users, by states: 2010-11
Annual Report 2010-11 138
State/UT/ Total Sterilization IUD Insertions during OCP Users during Condom Users during
Agency acceptors during April to September April to September April to September
April to September
2010-11 % Change 2010-11 % Change 2010-11 % Change 2010-11 % Change
from from from from
2009-10 2009-10 2009-10 2009-10
Kerala 52544 4 29418 -4.2 10071 -61 83478 -24
Maharashtra 163432 -24.9 153529 -14.8 190143 -32 308440 -29
Punjab 43044 12.6 105769 -22.9 78100 -22 388956 -3
Tamil Nadu 169890 -2.5 172911 10.1 107647 -3 169734 3
West Bengal 88523 -11.6 34269 -15.7 586412 -4 516323 -6
IV. Non-High Focus Small & UTs
A &N Islands 224 -43.1 80 -85.7 416 -76 203 -90
Chandigarh 1024 15.4 1,727 -11.6 699 -32 13,064 -9
Dadra & Nagar
Haveli 250 -51.7 71 14.5 183 -16 1162 39
Daman & Diu 55 . 39 . 118 . 457 .
Delhi 8,522 3.3 21,680 41.7 16,540 17 106,266 6
Lakshadweep 14 366.7 10 -50 3 . 76 -35
Puducherry 5,604 11.9 1,143 -21 2,280 -11 9,006 -12
V. Other Agencies
M/O Defence 1,279 -69.1 1,127 -59.2 1,128 -65 8,448 -69
M/O Railways 1,466 -14.2 1,123 -20.1 2,354 -30 17,584 -32
All India 1,638,874 -4.8 2,507,326 -12.8 3,607,952 -23.2 6,692,630 -23.2
Note: Collated from HMIS Periodic RCH Reports (accessed on 29
th
November 2010), Provisional Figures (Status as on: Oct 28, 2010)
Annual Report 2010-11 139
Chapter 10
10.1 INTRODUCTION
One of the key components of the “architectural
correction” envisaged under the NRHM is to strengthen
community participation in all health programmes.
Community participation is not to be limited to the
community acting only as beneficiaries, but rather playing
an active role in the design, implementation and monitoring
of health programmes.
The major schemes through which community processes
are strengthened are:
a. ASHA programme;
b. Village Health and Sanitation Committee (VHSC);
c. Un-tied fund provided to the sub-center and VHSC;
d. Rogi Kalyan Samitis (RKS) (or Hospital
management committees) as a vehicle for public
participation in facility management and the
provision of un-tied funds for this purpose;
e. District health societies and the district health
planning process;
f. Community monitoring programme and
g. Involvement of NGOs/private sector in the mother
NGO programme and public- private partnerships.
10.2 ASHA UNDER NRHM
The National Rural Health Mission initiated in 2005, rolled
out the ASHA programme in a ‘Mission Mode’, scaling
up simultaneously in several states.
Of the community based programmes, NRHM’s most
well known and talked about face, is undoubtedly the
ASHA programme. Going by national and international
Training Programme Training Programme Training Programme Training Programme Training Programme
experience, community health worker programmes have
the potential to make a significant, if not massive, positive
contribution to community health and awareness and to
impact favourably on major MDG indicators like child
survival. There is a need, therefore, to strengthen the
ASHA programme and other communitisation initiatives
so that much greater outcomes are realized.
All reports and evaluations show that the ASHA
programme appears to be making a positive impact.
However most assessments also show that there are
significant gaps in the implementation of each of these
programmes in the states and some process of active
support to address these gaps is essential.
10.3 SELECTION OF ASHAS
The general norm for selection is ‘one ASHA per 1000
population’. In tribal, hilly and desert areas the norm may
be relaxed to one ASHA per habitation.
ASHAs are necessarily a woman resident in the village,
preferably married and in the age group of 25 to 45 yrs.
ASHA should have effective communication skills,
leadership qualities and be able to reach out to the
community. She should be a literate woman with formal
education up to Eighth Class, which can be relaxed if
suitable women with this qualification are not available.
Selection of ASHAs are done by the community, and
actively facilitated to ensure that weaker sections
participate in the selection. Selection has to be endorsed
by the gram panchayat.
10.4 PROGRESS MADE IN SELECTION OF
ASHAS
Of the targeted 8,99,986 ASHAs in the country; 8,42,654
(93.6%) ASHAs have been selected. Progress made in
selection and training of ASHAs (as on December 2010)
is given in table-1.
Annual Report 2010-11 140
Table-1: State wise status of ASHA selection and training of ASHAs up to Dec. 2010
Name of Selection ASHA Percentage ASHA Training
states Target of selected of selection
ASHA †
Module Module Module Module Module Module
I II III IV V VI
EAG Bihar 87,135 78,973 90.63 69402 52859 52859 52859 TOT
Done
States Chhattisgarh 60092 60092 100.00 60092 60092 60092 60092 60092
Jharkhand 40964 40964 100.00 40115 39482 39214 35675 40964 TOT
Done
MP 52117 50113 96.15 48159 44938 44518 42426 808 TOT
Done
Orissa 41,102 40932 99.59 40765 40763 40763 40763 39657 TOT
Done
Rajasthan 48372 43787 90.52 40310 33811 32652 35499 TOT TOT
Done Done
UP 136268 136182 99.94 135130 128434 128434 128434 TOT
Done
Uttarakhand 11086 11086 100.00 11086 11086 11086 11086 8978 8750
NE
Arunachal 3862 3629 93.97 3426 3305 3324 2906 2497 756
States
Assam 29693 28798 96.99 26225 26225 26225 26225 23271
Manipur 3878 3878 100.00 3878 3878 3878 3878 3878 TOT
Done
Meghalaya 6258 6258 100.00 6175 6175 6175 6175 3427
Mizoram 987 987 100.00 987 987 987 987 987 TOT
Done
Nagaland 1700 1700 100.00 1700 1700 1700 1700 1700 TOT
Done
Sikkim 666 666 100.00 666 666 666 666 666 TOT
Done
Tripura 7367 7367 100.00 7367 7367 7367 7367 7362 TOT
Done
Non-
EAG Andhra Pradesh 70700 70700 100.00 70700 70700 70700 70700 70700 TOT
Done
Delhi 5400 3200 59.26 2680 2138 2075 1276 0
Annual Report 2010-11 141
Gujarat 31438 29675 94.39 28809 28052 26373 24201 13589 TOT
Done
Haryana 14000 13098 93.56 12825 12169 12169 12169 5097
Himachal
Pradesh 18248 16888 92.55 16888 0 0 0 0
J & K 9764 9500 97.30 9500 9000 9000 9000 5711 TOT
Done
Karnataka 39195 32939 84.04 32939 32939 32939 32939 32939 TOT
Done
Kerala 32854 31868 97.00 30719 29223 25534 20544 697
Maharashtra 60457 58954 97.51 56854 46580 8464 8038 7029 TOT
Done
Punjab 17360 17014 98.01 15481 14026 14026 14026 0
Tamil Nadu 6850 2650 38.69 2650 2650 0 0 0
West Bengal 61008 39736 65.13 29552 25465 21666 19663 17195 TOT
Done
UTs
Andman &
Nicobar 407 407 100.00 407 407 184 49 49
Chandigarh 423 423 100.00 - - - 0
Dadra and Nagar
Haveli 250 107 42.80 85 85 85 85 85
Lakshadweep 85 83 97.65 83 83 0 0
Daman & Diu NA
Goa NA
Pondichery NA
Total † 8,99,986 8,42,654 93.60 8,05,655 7,35,285 6,83,155 6,69,428 3,47,378 9,506
Name of Selection ASHA Percentage ASHA Training
states Target of selected of selection
ASHA †
Module Module Module Module Module Module
I II III IV V VI
As one can see from the above Table-1, high focus states
has selected over 90% of proposed number of ASHAs.
The lower figure in MP is as a result of a recent
modification to one ASHA per Anganwadi centre (AWC)
instead of previous one ASHA per thousand populations.
In the north east the figures are even better with the
entire process being complete and with much better
densities as appropriate to the low population density.
Chhattisgarh has a widely dispersed population and had
therefore, opted for one Mitanin per habitation- a total of
54,000 habitations. This gives a ratio of one per just 300
population. GOI agreed to finance the programme using
Annual Report 2010-11 142
29347 as the number of ASHAs – as this was the number
of anganwadis in place.
In other states and union territories till the beginning of
2009, ASHAs were sanctioned only for tribal areas, which
were less than 10% of the blocks. Since January 2009,
the programme has been expanded to the whole nation.
Some states have availed of this and others have not. It
is worth noting that Tamilnadu and Himachal Pradesh
which had not opted for this scheme so far have done so
this year –leaving only Goa and a couple of Union
territories without the ASHA programme.
10.5 TRAINING OF ASHAS
Capacity building of ASHA is critical in enhancing her
effectiveness. It has been envisaged that training will help
to equip her with necessary knowledge and skills resulting
in achievement of scheme’s objectives. Training of ASHA
is thus a continuous process. ASHAs are trained by block
trainers who mostly are women- who are chosen at block
level are trained by a district training team who in turn
are trained by the state training team.
Considering the range of functions and tasks to be
performed, induction training is imparted over in 23 days
spread over a period of 18 months. After the induction
training, periodic refresher training is planned for about
12 to 24 days per year. In many states, existing NGOs,
especially those working on community health issues at
the district / block level, have been entrusted with the
responsibility for identifying trainers and conducting of
TOTs. Progress in Training varies across the states. Most
states have completed an average 16 to 19 days of
training, and few states are working on the sixth round of
training.
10.6 ASHA SUPPORT STRUCTURE
The success of ASHA scheme depends upon how well
the scheme is implemented and monitored. It is also
depends crucially on the motivational level of various
functionaries and the quality of all the processes involved
in implementing the scheme. It is therefore, necessary
that well defined and yet flexible and participatory
institutional structures are put into place at all levels from
state to village.
(1) The District Health Society under the chairmanship
of the District Magistrate/President Zila Parishad
oversees the selection process. The Society had
designated a District Nodal Officer and a Block
Nodal Officer. The job of the Nodal Officers at
the District and Block are to facilitate the selection
process by involving the Gram Sabha and Gram
Panchayat, holding of training for ASHA and for
trainers as per the guidelines of the scheme.
(2) At the village level- women’s committees (like
self help groups or women’s health committees),
Village Health & Sanitation Committee of the Gram
Panchayat, peripheral health workers especially
ANMs and Anganwadi workers, and the trainers
of ASHA and in-service periodic training are major
source of support to ASHA.
(3) District ASHA training team/resource centre. There
are full time staff hire to play this role.
(4) Block coordinators and sub-block facilitators: For
every 15-20 ASHAs one facilitator is deployed and
to coordinate 10 such facilitators a block coordinator
is deployed.
District mobilisers are in place in Orissa, Uttarakhand,
UP and Jharkhand and almost there in Rajasthan and
Madhya Pradesh. Rest of the states are yet to start, Sub-
district facilitators are in place in Uttarakhand and Orissa
only.
State ASHA Resource Centers or equivalent institution
has been established in Uttarakhand, Jharkhand, Orissa
Assam, Jharkhand and Rajasthan. Chhattisgarh has the
SHRC playing this role. Other states have to start this up
and there is a long way to go to make it effective.
10.7 ASHA MENTORING GROUP
The Government of India has set up an ASHA Mentoring
Group comprising of leading NGOs and well known
experts on community health.
There are 17 members in National ASHA Mentoring
Group representing renowned NGOs across the country.
Each member of National Mentoring Group has designated
for particular states where they are making visit and
providing guidance and advice on matter related to
selection, training, payment of incentives etc. National
Health Systems Resource Centre is secretariat for
National ASHA mentoring group. Similar mentoring groups
at the State level has been to provide guidance and advise
on matter relating to selection, training and support for
ASHA
Annual Report 2010-11 143
State ASHA mentoring group is functional in Uttarakhand,
Chhattisgarh, Orissa, Madhya Pradesh, Uttar Pradesh,
Jharkhand, Rajasthan, Kerala, Assam, Arunachal Pradesh,
Manipur, Mizoram, Meghalaya, Nagaland, Sikkim, and
Tripura. The administration has to recognize the need for
bureaucracy to be guided by the best of civil society in
theory and practice of community health worker
programmes.
10.8 PERFORMANCE BASED INCENTIVES
Responsibilities of ASHAs that currently are incentivized
includes; promoting institutional delivery, promoting
immunization, DOT provider, Malaria slide collection.
Most states have an integrated list of incentive package
for ASHAs with information on various activities of
ASHAs with amount of incentive attached to it. In most
States, the bulk of ASHAs’ incentive are from JSY and
immunisation. It has been suggested to the States to
expand the activities and attached incentive to it. The
mode of payment by cheque has been operationalise in
most of the states. The major reason for success in
streamlining ASHA incentive payment in some states
are ; payment by cheque, a designated point person at
district, block and sector level reviews to handle issues
relating to ASHA incentive payment, and tight monitoring,
and certification of those PHCs having no backlog of
incentive payment to ASHAs.
10.9 ASHA DIARY & VILLAGE HEALTH
REGISTER
Two simple tools essential for strengthening the ASHA
programme, which all states are putting in place are the
ASHA diary and the other is the village health register.
The ASHA diary is a simple record of all the works she
does, as and when she does it. It is a useful tool for
supportive supervision of her work, a data source for
village health planning and an important tool for
performance.
The Village Health Register (VHR) is an important tool
for ensuring access and completion of service delivery,
and a major source of information for village level health
planning. The Village Health Register provides household
and family level data. The VHR is a vehicle for tracking
eligible couples, children below 3 (for immunization) and
pregnant women to ensure that they receive the services
they need. It can also record incidents of serious illness
in each family.
10.10 ASHA DRUG KITS
In almost all states, drug kits have been distributed to
ASHAs. Across the country, 6, 11,821 ASHAs have
received drug kit till Dec. 2010. States are now moving
on mechanisms of drug kit replenishment. Govt. of India
has recently issued a guideline for regular refilling drug
kits and maintaining stock card.
10.11 VILLAGE HEALTH & NUTRITION DAY
Monthly Health and Nutrition day is expected to be
organized in every village (Anganwadi centers) with the
help of AWW/ANM. ASHA along with AWW mobilizes
women, children and vulnerable population for the monthly
health day activities like immunization, careful assessment
of nutritional status of pregnant/lactating women, newborn
& children, ANC/PNC and other health check-ups of
women and children, taking weight of babies and pregnant
women etc. and all range of other health activities. A
total of 23619245 monthly village health and nutrition days
has been organized till September 2010 across the country.
10.12 ASHA INNOVATIONS
There is a wide variety of state specific innovations in
this programme. To name a few; ASHA gruha (rest house
in Orissa), Mitanin help desk (in Chhattisgarh), ASHA
Diwas (monthly review meeting- in UP), ASHA radio
programme (in Assam, Chhattisgarh, Manipur and
Tripura), bicycles for ASHA, Swasth Chetan Yatra (in
Rajasthan) and so on.
10.13 COMMUNITY MONITORING
PROGRAMME
Community-based Monitoring of health services is a key
strategy of National Rural Health Mission (NRHM) to
ensure that the services reaches to those for whom they
are meant for, especially for those residing in rural areas,
the poor, women and children. Community Monitoring is
also seen as an important aspect of promoting community
led action in the field of health. The provision for
Monitoring and Planning Committees has been made at
Primary Health Centre (PHC), Block, District and State
levels. Community monitoring is to review the progress
to ensure that the work is moving towards the decided
purpose. Community monitoring helps in identifying and
meeting the challenges in the field. The process of
Community Monitoring is taking place across nine states
(Assam, Jharkhand, Chhattisgarh, Madhya Pradesh,
Rajasthan, Maharashtra, Tamil Nadu, Karnataka and
Orissa).
Annual Report 2010-11 144
10.14 CENTRALLY SPONSORED SCHEME OF
ìBASIC TRAINING OF ANM/LHVî
ANMs/LHVs play a vital role in MCH and Family
Welfare Service in the rural areas. It is therefore, essential
that the proper training to be given to them so that quality
services be provided to the rural population.
For this purpose 319 ANM/Multipurpose Health Worker
(Female) schools with an admission capacity of
approximately 13,000 & 34 promotional training schools
for LHV/ Health Assistant (Female) with an admission
capacity of 2600 are imparting pre-service training to
prepare required number of ANMs and LHVs to man
the Sub centres, Primary Health Centres, Community
Health Centres, Rural Family Welfare Centres and Health
posts in the country. The duration of training programme
of ANM is one and half years and minimum admission
requirement for this course is 10
th
pass. Senior ANM
with five years of experience is given six months
promotional training to become LHV/ Health Assistant
(Female). Health Assistant(Female) provides supportive
supervision and technical guidance to the ANMs in sub-
centres. Curricula of these training courses are provided
by the Indian Nursing Council.
The staffing pattern of the school for, which financial
assistance is provided by the Department of Family
Welfare, varies according to the annual admission capacity
of the school. The financial pattern of assistance has
been revised w.e.f. 7.2.2001. Other approved costs
besides salary to staff are stipend to trainees, contingency
and rent.
Funds under the scheme are released by Family Welfare
Budget Section on the basis of audited accounts submitted
by States and unspent balance with states. Under the
scheme during 2010-11 under BE Rs.8517.95 lakhs were
available.
Item Norm (in Rupees)
1. Salary & allowances
of staff As per State Government
2. Stipend for trainees 500/- per month/trainee
3. Contingency 10,000/- per annum /school
4. Rent* 60,000/- per annum/school
* Rent payable in respect of such schools, which are func-
tioning in rented buildings
10.15 CENTRALLY SPONSORED SCHEME OF
ì BASIC TRAINING FOR MULTI
PURPOSE HEALTH WORKER (MALE)î
The Basic Training of Multi Purpose Health Worker
(Male) scheme was approved during 6
th
Five-Year Plan
and taken up since 1984, as a 100% Centrally Sponsored
Scheme. This training is provided through forty nine basic
training schools of Multipurpose Health Workers (Male).
The training is of one-year duration and on successful
completion of the training, the Male Health Worker is
posted at the sub-centre along with an ANM/Health
Worker (Female).
The financial pattern of assistance for this scheme has
been revised since 7.2.2001. Under the scheme the salary
of the staff, rent for school and hostel, stipend for
trainees, educational aids and training material,
transportation and contingency are supported.The financial
norms are as follows:
Funds under the scheme are released by Family Welfare
Budget Section on the basis of audited accounts submitted
by States and unspent balance with states. Under the
scheme during 2010-11 under BE Rs.1233.97 lakhs were
available.
10.16 MAINTENANCE OF HEALTH AND
FAMILY WELFARE TRAINING CENTRE
49 Health and Family Welfare Training centres were
established in the country in order to improve the quality
and efficiency of the Family Planning Programmes and
to bring the changes in the attitude of the personnel
Item Norm
Rent (for basic schools) Rs. 10,000 / month
Rent for hostel (for basic schools) Rs. 250 / month
per candidate
Stipend Rs. 300 / month /
candidate
Educational Aids and Training
Material Rs. 15,000
per annum
Transportation (for hiring bus) Rs. 30,000
per annum
Contingency Rs. 50,000
per annum
Annual Report 2010-11 145
engaged in the delivery of health services through in
service training programmes. These training centres are
supported under Centrally Sponsored Scheme of
“Maintenance of Health and Family Welfare Training
Centre”.
These training centres are now conducting various in-
service training programmes of Department of Family
Welfare. Apart from in-service education some of the
selected centres are also responsible for conducting the
basic training of Male Health Worker’s course of one
year.
Apart from the salary of the staff of the training centres,
other assistance under the scheme includes contingency
for purchase of educational material, rent for training
centres and payment to guest faculty. The financial
pattern of assistance for this scheme has been revised
since 7.2.2001. The details of the financial norms are as
follows:
Item Norms
Contingency Rs. 15,000 per annum
Rent* Rs. 40,000 per annum
Payment to Guest Faculty Rs. 50,000 per annum
*Rent payable in respect of such centres that are functioning
from rented buildings.
Funds under the scheme are released by Family Welfare
Budget Section on the basis of audited accounts submitted
by States and unspent balance with states. Under the
scheme during 2010-11 under BE Rs.1905.00 lakhs were
available.
10.17 TRAINING ACHIEVEMENT
Details regarding the total number of persons trained
since beginning of the programme under each of the above
training activities reported up to 31 December 2010 are
given in the consolidated table below:-
Type of Training Cumulative Progressup to
31/12/2010
Integrated Service Delivery National Level 280
under NRHM State Level 393
PDC National & State 1366
PMU National Level 305
State Level 2606
Workshop 324
SBA National Level 121
State Level 6528
District Level 40182
BEmOC State and District Level 351
Contraceptive Update National Level 133
State Level 13506
IUD – 380 A Training National Level 164
State & Dist. Level 23789
NSV Dist. Level 2220
Laparoscopic sterilization State Level 4259
Minilap District Level 9617
MTP State and District Level 8886
Annual Report 2010-11 146
IMNCI State & District Level 191249
F-IMNCI State Level 648
District Level 2418
NSSK State Level 519
District Level 21217
SNCU District Level 168
RTI\STI State & District Level 4372
Anesthesia State Level 1140
District Level 193
EmOC State & District Level 2584
Blood Storage 785
Immunization State Level 774
District Level 22648
ARSH District Level 6351
Specialized Clinical Skill Training National Level 91
State and District Level 64643
Other Disease Control Programme
NVBDCP MOs 10089
Lab. Techns. 1779
Other Paramedical Staff 40653
RNTCP MOs 42454
Lab. Techns. 7471
Other Paramedical Staff 123887
NLEP MOs 6227
Other Paramedical Staff 3106
NCBP MO 1479
Pharma & GNM 150
Teacher 1062
IDSP MOs 20126
Lab. Techns. 5302
Other Paramedical Staff 2272
Routine Immunization MOs 887
Others paramedical staff 41921
Other Trainings State and District Level 10711
Type of Training Cumulative Progressup to
31/12/2010
Annual Report 2010-11 147
Chapter 11
Several National Health Programmes are now under the
umbrella of NRHM. Details of other National Health
Programmes are in this chapter.
11.1. NATIONAL PROGRAMME FOR
CONTROL OF CANCER, DIABETES,
CVD AND STROKE (NPCDCS)
11.1.1 India is experiencing a rapid health transition
with a rising burden of Non Communicable Diseases
(NCDs). According to a WHO report (2002),
cardiovascular diseases (CVDs) will be the largest cause
of death and disability in India by 2020. 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 potentially productive years (aged 35–64 years) of life.
It is estimated that the overall prevalence of diabetes,
hypertension, Ischemic Heart Diseases (IHD) and Stroke
is 62.47, 159.46, 37.00 and 1.54 respectively per 1000
population of India. There are an estimated 25 Lakh cancer
cases in India at any point of time. The leading sites of
cancer are oral cavity, lungs, oesophagus and stomach
among men and cervix, breast and oral cavity amongst
women. Non-communicable diseases – especially
cardiovascular diseases, cancers, chronic respiratory
diseases and diabetes caused 60% of all deaths globally
in 2005. Total deaths from NCDs are projected to increase
by a further 17% over the next 10 years. These diseases
are largely preventable by modifying the four common
risk factors: tobacco use, unhealthy diet, physical inactivity
and harmful use of alcohol.
To address Non-communicable diseases, Ministry has
formulated a National Programme for Prevention and
Control of Cancers, Diabetes, Cardiovascular Diseases
and Stroke (NPCDCS) after integrating the National
Cancer Control Programme (NCCP) with National
Other National Health Other National Health Other National Health Other National Health Other National Health
Programmes Programmes Programmes Programmes Programmes
Programme for Prevention and Control of Diabetes,
Cardiovascular Diseases and Stroke (NPDCS).
Government of India has approved the programme at an
estimated outlay of Rs. 1230.90 crore for the remaining
period of the 11
th
Five Year Plan. The programme focuses
on health promotion, capacity building including human
resource development, early diagnosis and management
of these diseases and integration with the primary health
care system.
The major objectives of the NPCDCS are briefly listed
below:
• Prevent and control common NCDs through
behaviour and life style changes,
• Provide early diagnosis and management of
common NCDs,
• Build capacity at various levels of health care for
prevention, diagnosis and treatment of common
NCDs.
• Train human resource within the public health setup
viz doctors, paramedics and nursing staff to cope
with the increasing burden of NCDs, and
• Establish and develop capacity for palliative &
rehabilitative care.
11.1.2 Strategies:
The programme will be implemented in 20,000 Sub-Centres
and 700 Community Health Centres (CHCs) in 100
Districts across 21 States/UTs and the strategies are as
under:
(i) Promotion of healthy lifestyle through massive
health education and mass media efforts at country
level regarding increased intake of healthy foods,
increased physical activity through sports, exercise,
etc., avoidance of tobacco and alcohol and stress
Annual Report 2010-11 148
management through awareness generation using
community education and interpersonal
communication methods and social mobilization
through NGOs.
(ii) Opportunistic screening of persons above the
age of 30 years at the point of primary contact
with any health care facility, be it the village,
community health centre, district hospital, tertiary
care hospital etc. Such screening involves simple
clinical examination comprising of relevant questions
and easily conducted physical measurements (such
as history of tobacco consumption and
measurement of blood pressure etc.) to identify
those individuals who are at a high risk of developing
cancer, diabetes and CVD, warranting further
investigation/ action. Screening at the community
level will be done by the frontline health workers -
ANM and Male Health Worker in sub-centres
located for every 5000 population.
(iii) ëNCD clinicí will be established at the Community
Health Centre (CHC) located at block headquarter
for every 1, 00,000 population for comprehensive
examination of patients to rule out common NCDs.
Screening, diagnosis and management (including
diet counselling, lifestyle management) and home
based care and referral will be the key services
provided at this level of care.
(iv) At all selected 100 District hospitals a ëNCD
clinicí will be established for prevention and
management of cancer, diabetes, hypertension and
acute cardiovascular diseases including emergency
care. District level health facilities will be
strengthened for early diagnosis, prompt treatment,
chemotherapy (including day care facilities),
palliative care and rehabilitative measures including
the required level of blood banking and laboratory
support. District hospitals will also be strengthened
for early detection of cervix cancer, breast cancer
and other common cancers.
(v) Development of trained manpower with
required skills and competencies by providing
customised short term training in diabetology, cancer
management, cardiovascular diseases, etc. to
existing doctors, in the departments of medicine
surgery and gynaecology and training in cytology
to the pathologist. Non availability of these
subspecialties in district level hospitals and below
is a severe constraint for scaling up these services
to rural areas.
(vi) Strengthening of Tertiary level health facilities:
65 Government Medical Colleges/ Government
Hospitals will be strengthened as Tertiary Cancer
Centres (TCC) to provide comprehensive cancer
care services, training and research. 20 TCCs in
2010-11 and 45 TCCs in 2011-12 will be
strengthened. These centres will have a high
degree of specialization and comprehensive
provision of all of the facets of cancer care
necessary in modern cancer management. These
will also be centres of Human Resource
Development in the field of Cancer e.g. Capacity
building for initiating/strengthening of courses in
Medical/ Surgical/ Radiation/ Gynaecology
Oncology etc.
(vii) Monitoring & Evaluation: Monitoring and
supervision of the programme will be carried out
at different levels through NCD cell through reports
from the state, regular visits to the field and periodic
review meetings. A NCD cell will be established
at the National, State and District levels. This cell
will be responsible for overall planning, coordination,
implementation and monitoring of the programme.
During the 11
th
Five Year Plan, the NPCDCS will be
implemented in 100 Districts. 30 districts will be taken
up in 2010-11 and 70 will be added in 2011-12. List of
the 21 States along with the list of 30 districts selected
for the year 2010-11 is given below:-
S. States Districts CHCs Sub
No. Centres
1 Andhra Pradesh Nellore 6 481
Vijayanagaram 7 470
2 Assam Dibrugarh 6 240
Jorhat 4 142
3 Bihar Vaishali 2 336
Rohtas 1 186
4 Chhattisgarh Bilaspur 10 379
5 Gujarat Gandhi Nagar 6 171
Surendranagar 11 200
6 Haryana Ambala 3 102
Annual Report 2010-11 149
11.1.3. New Initiatives:
(i) Urban Health Check-up Scheme for Diabetes
and High Blood Pressure:
14
th
November every year, is being observed as World
Diabetes Day as an official United Nations Day since
2007. The day marks the birthday of Frederick Banting
who discovered insulin in 1922. An Urban Health
Check-up Scheme for Diabetes and High Blood
Pressure in Urban Slums was launched on 14
th
November,
2010 at Baba Ramdev Park, New Delhi. In the first phase,
the scheme will be initiated in seven metros, viz. Delhi,
Bangaluru, Hyderabad, Kolkata, Mumbai, Chennai and
Ahmedabad.
The scheme has the following objectives:
1. To screen urban slum population for diabetes and
high blood pressure
2. To create database for prevalence of diabetes and
high blood pressure in urban slums
3. To sensitize the urban slum population about healthy
lifestyle.
The Blood sugar and Blood pressure will be checked for
all > 30 years and all pregnant women of all age.
7 Himachal
Pradesh Chamba 7 170
8 Jammu &
Kashmir Leh (Ladakh) 3 24
Udhampur 2 97
9 Jhankhand Bokaro 8 116
10 Karnataka Shimoga 11 307
Kolar 6 201
11 Kerala Pathanathitta 13 230
12 Madhya Pradesh Ratlam 5 158
13 Maharashtra Washim 7 153
Wardha 6 181
14 Sikkim East Sikkim 0 48
15 Orissa Naupada 4 95
16 Punjab Bhatinda 9 136
17 Rajasthan Bhilwara 16 415
Jaisalmer 6 136
18 Uttrakhand Nainital 4 136
19 Tamil Nadu Theni 6 162
20 Uttar Pradesh Rae Bareli 11 377
Sultanpur 14 403
21 West Bengal Darjeeling 11 230
TOTAL 30 Districts 205 6482
Annual Report 2010-11 150
11.1.4. Ongoing Activities:
(i) Membership of IARC: International Agency for
Research on Cancer is a specialized agency of
WHO to coordinate International Cooperation in
Cancer Research. India has become a member of
IARC at the 48
th
Session of the governing Council
of IARC held in May 2006 at Lyon, France, which
shall provide a fillip to cancer research in the
country. IARC has extended technical and financial
support for several cancer research and preventive
projects in India.
(ii) National Cancer Awareness Day: The birth
anniversary of Nobel Laureate Madam Curie, 7
th
November is being observed as National Cancer
Awareness Day since 2001, to create more
awareness about cancer. Like the previous years,
this year too awareness generation activities were
carried through from 6
th
November to 13
th
November 2010 through All India Radio (AIR),
Doordarshan, News Papers, Delhi Metro Rails and
DTC Bus Shelters.
(iii) ‘Kalyani’ is a health programme telecast in 9 capital
Doordarshan stations and 12 sub regional stations
by Prasar Bharti targeting especially those living in
the most populous States. It is an interactive
programme which provides an interface to the
people with experts on various health and social
issues including that of cancer.
(iv) Awareness generation for cancer, diabetes and
healthy life style was also done during the Common
Wealth Games 2010 through live broadcast in AIR.
Budget Allocation: The budget allocation during 2010-
11 for NPCDCS is Rs. 326.76 crore.
11.2. NATIONAL MENTAL HEALTH
PROGRAMME
11.2.1 Burden of mental health disorders:
Prevalence of mental disorders as per World Health
Report (2001) is around 10% and it is predicted that
burden of disorders is likely to increase by 15% by 2020.
According to various community based surveys,
prevalence of mental disorders in India is 6-7% for
common mental disorders and 1-2% for severe mental
disorders. With such a magnitude of mental disorders it
becomes necessary to promote mental health services
for the well being of general population, in addition to
provide treatment for mental illnesses. Treatment gap
for severe mental disorders is approximately 50% and in
case of Common Mental Disorders it is over 90%.
National Mental Health Programme(NMHP) was started
in 1982 with the objectives to ensure availability and
accessibility of minimum mental health care for all, to
encourage mental health knowledge and skills and to
promote community participation in mental health service
development and to stimulate self-help in the community.
Gradually the approach of mental health care services
has shifted from hospital based care (institutional) to
community based mental health care, as majority of
mental disorders do not require hospitalization and can
be managed at community level.
NMHP evaluation undertaken in 2008 identified following
constraints for the effective implementation of NMHP -
• Lack of an inbuilt and dedicated monitoring and
implementing mechanism for programme.
• Shortage of skilled manpower in Mental Health
i.e. Psychiatrists, Clinical Psychologists, Psychiatric
Social Workers & Psychiatric Nurses. This is a
major constraint in meeting the mental health needs
and providing optimal mental health services at the
community level. Due to shortage of manpower in
mental health, the implementation of DMHP
suffered adversely in previous years.
• Lack of awareness /stigma about Mental Illness.
• Lack of facilities for treatment of mentally ill.
• Lack of coordination between implementing
departments of DMHP i.e. Medical Education and
Health in the states.
• Lack of Community involvement.
Taking into account these constraints, consultations were
held with relevant stakeholders and components of
NMHP were revised for XI five year plan.
11.2.2 District Mental Health Programme-
During IX five year plan, District Mental Health
Programme was initiated (1996) based on Bellary Model
developed by NIMHANS, Bangaluru. During the plan
period, 27 districts were covered under DMHP. At present
DMHP is covering 123 districts in 30 states and UTs. In
addition to early identification and treatment of mentally
Annual Report 2010-11 151
ill, District Mental Health Programme has now
incorporated promotive and preventive activities for
positive mental health which includes:
- School Mental Health Services: Life skills
education in schools, counselling services
- College Counselling services: Through trained
teachers /councillors
- Work Place Stress Management: Formal &
Informal sectors, including farmers, women etc.
- Suicide Prevention Services- Counselling
Center at District level, sensitization workshops,
IEC, Help lines etc.
11.2.3 Manpower Development Schemes :
A. Establishment of Centre of Excellence in Mental
Health- Centre of excellence in the field of mental
health are being established by upgrading and
strengthening identified existing mental health
hospitals/ institutes for addressing acute manpower
gap and provision of state of the art mental health
care facilities in the long run. Eleven such Centre
of excellence are envisaged for total budgetary
support of up to Rs 338 crore (Rs 30 crore per
center ) for undertaking capital work, equipment,
library, faculty induction and retention for the plan
period. As of now 9 Mental Health institutes have
been funded for developing as centers of excellence
in Mental Health.
B. Establishment/up-gradation of Post Graduate
Training Departments -To provide an impetus to
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 or increasing the intake
capacity for PG training in Mental Health. Support
would be provided for setting up/strengthening 30
units of Psychiatry, 30 Departments of Clinical
Psychology, 30 Departments of PSW and 30
Departments of Psychiatric Nursing. Total budget
allocated for this scheme is Rs 70 crores during
plan period with a limit of Rs 51 lacs to Rs 1 crore
per PG Department. As of now, 23 PG departments
have been taken up during the XI plan period.
11.2.4 Spill Over of X plan schemes-
A. Modernization of State-run Mental Hospitals – A
one time grant of up to Rs 3 crore per mental
hospital is available under the scheme to old
custodial pattern mental hospital for their
modernization. A total of 29 mental hospitals/
institutes have been supported under this scheme.
B. Upgradation of Psychiatric wings in the government
medical colleges/general hospitals. Some of the
deserving areas where there is no well established
government medical colleges, government general
hospitals/district hospitals could be funded for
establishment of psychiatry wing. A one time grant
of Rs. 50 lacs per college is available for up-
gradation of facilities and equipments. Preference
would be given to colleges and hospitals planning
to start or increase seats of PG courses in
psychiatry. A total of 88 psychiatry wings have
availed grant under this scheme.
11.2.5 Research and Training-
There is a gap in research in the field of mental health in
the country. Funds will be provided to institutes and
organizations for carrying basic, applied and operational
research in mental health field. In order to address
shortage of skilled mental health manpower a short term
skill based training will be provided to the DMHP teams
at identified institutes. Standard Treatment Guidelines,
Training Modules, CME, Distance Learning courses in
mental Health, surveys etc will also be supported. Total
allocation is Rs. 6.5 crore for the plan period.
11.2.6 Information, Education & Communication-
It has been observed that there is low awareness regarding
mental illness and availability of treatment. There is also
lot of stigma attached to mental illness leading to poor
utilization of available Mental Health resources in the
country. The awareness regarding provisions under
Mental Health Act, 1987 is also very low among the public
and implementing authorities. These issues are addressed
through IEC activities at the District level by the District
Mental Health Programme. In addition to the district level
activities, National Mental Health Programme Division
conducts nationwide mass media campaign through audio-
video and print media. Awareness activities are also
conducted during World Mental Health Day, 10
th
October,
2010.
Annual Report 2010-11 152
11.2.7 Support for Central and State Mental Health
Authorities
As per Mental Health Act,1987, there is provision for
constitution of Central Mental Health Authority (CMHA)
at Central level and State Mental Health
Authority(SMHA) at state level. These statutory bodies
are entrusted with the task of development, regulation
and coordination of mental health services in a state/UT
and are also responsible for the implementation of Mental
Heath Act,1987 in their respective states and union
territories. States are required to have functional SMHAs
to operationalize the mental health program activities.
However in most of the states, there is no financial
support for these bodies and as such they function in an
ad-hoc manner and are unable to do justice to their
statutory role of implementation of Mental Health
Act,1987 and development of Mental Health services.
Support under NMHP has been approved for SMHAs
during the 11
th
Plan period. Total allocation is Rs. 5 crores.
11.2.8 Monitoring & Evaluation
In order to strengthen the monitoring and improve
implementation of existing NMHP schemes in states
support has been approved under the program during XI
plan period. Total allocation is Rs. 8.0 crore for the plan
period.
11.2.9 Mainstreaming NMHP into NRHM
Efforts are being made to mainstream the components
of NMHP under the overall umbrella of National Rural
Health Mission so that the States are able to plan
requirements concerning mental health services as part
of their respective PIPs.
11.2.10 Expenditure statement under National
Mental Health Programme
Rs 1000 crore has been approved as XI plan outlay for
the National Mental Health Program. Year wise financial
Print Media Campaign on World Mental Health Day 10
th
October,2010..
Annual Report 2010-11 153
allocation for the NMHP and expenditure incurred is as
given in the table below –
11.3. TOBACCO CONTROL LEGISLATION
11.3.1 Tobacco is the foremost preventable cause of
death and disease in the world today. Globally approx.
5.4 million people die each year as result of diseases
resulting from tobacco consumption. More than 80% of
these deaths occur in the developing countries. Tobacco
is a risk factor for 6 of the 8 leading causes of death.
Nearly 8-9 lakhs people die every year in India due to
diseases related to tobacco use. Nearly 30% of cancers
in India are related to tobacco use. The majority of the
cardio vascular diseases and lung disorders are directly
attributable to tobacco consumption.
India is the second largest consumer (after China) of
tobacco products in the world. As per Global Adult
Tobacco Survey, India (GATS), 2009-10, 47.8% men and
20.3% women consume tobacco in some form or the
other. The Global Youth Tobacco Survey (GYTS), 2009
also indicates that 14.6% children in the age group of 13-
15 years are consuming tobacco in some form.
In order to protect the
youth and masses from
the adverse harm effects
of tobacco usage, second
hand smoke (SHS) and
discourage the
consumption of tobacco,
the Govt. of India enacted
the comprehensive
tobacco control laws namely “Cigarettes and other
Tobacco Products (Prohibition of Advertisement and
Regulation of Trade and Commerce, Production, Supply
and Distribution) Act, 2003”. The Act is applicable to all
tobacco products and extends to whole of India. The
specific provisions of the Anti Tobacco Law include:
1. Ban on smoking in public places. (Section -4)
2. Ban on direct/indirect advertisement of tobacco
products. (Section -5)
3. Ban on sale of tobacco products to children below
18 year. (Section – 6a)
4. Ban on sale of tobacco products within 100 yards
of the educational institution. (Section – 6b)
5. Mandatory depiction of Specified health warnings
on tobacco products. (Section - 7).
6. Testing of tobacco products for tar and nicotine.
The rules related to prohibition of smoking in public places
came into force from the 2
nd
October, 2008. As per the
rules, it is mandatory to display smoke free signages at
all public places and labeling and
packaging rules mandating the
depiction of specified health
warnings on all tobacco product
packs came into force from the 31
st
May, 2009.
11.3.2. WHO-Framework Convention on Tobacco
Control
The WHO Framework Convention on Tobacco Control
(WHO FCTC) is the first global health treaty negotiated
under the auspices of the World Health Organization. India
ratified the FCTC on 5 February 2004 and is now a party
to the Convention and has to implement all provisions of
this international treaty. It enlists key strategies for
reduction in demand and reduction in supply of tobacco.
Some of the demand reduction strategies include price
and tax measures & non price measures (statutory
warnings, comprehensive ban on advertisement,
promotion and sponsorship, tobacco product regulation
etc). The supply reduction strategies include combating
illicit trade, providing alternative livelihood to tobacco
farmers and workers & regulating sale to / by minors.
11.3.3. National Tobacco Control Programme
(NTCP)
Launch of the dedicated National Tobacco Control
Programme in the 11
th
Five Year Plan has been the major
milestone to facilitate the implementation of the tobacco
control laws to bring about greater awareness about the
harmful effects of Tobacco and to fulfill the obligation(s)
under the WHO-FCTC. NTCP was launched in 2007-
08 in 18 Districts covering 9 States. In the 2008-09 it has
been upscaled to 24 New Districts covering 12 States.
The programme at present is under implementation in 42
districts in 21 states in the country. The main components
of NTCP are:-
Financial Year Allocation Expenditure
(Rs. In crore ) (Rs. In crore)
2007-08 38 14 .57
2008-09 70 23.45
2009-10 55 52.27
2010-11 120 (including 58.80 (Till date
Rs. 53 crore GIA including
ad Rs. 17 crore for Rs. 52.63
NE) crore for GIA)
Annual Report 2010-11 154
a. National level
i. Public awareness/mass media campaigns for
awareness building & for behavioral change. Ministry
of Health has launched comprehensive mass media
campaign (both print and electronic) in 2010-11. A
series of public notices on tobacco control laws were
issued in leading National & regional dailies all over
the country. A half page coloured advertisement was
also issued in the leading National & regional dailies
all over the country on World No Tobacco day, 31
st
May, 2010.
ii. Establishment of tobacco product testing laboratories,
to build regulatory capacity, as required under
COTPA, 2003.
iii. Mainstreaming the program components as a part of
the health delivery mechanism under the NRHM
framework.
iv. Mainstream Research & Training – on alternate
crops and livelihoods with other nodal Ministries.
v. Monitoring and Evaluation including surveillance e.g.
Adult Tobacco Survey.
b. State level
i. Dedicated State Tobacco Control Cells for effective
implementation of the national programme and
monitoring of anti tobacco initiatives.
c. District level
i. Training of health and social workers, NGOs, school
teachers etc.
ii. Local IEC activities.
iii. School Programme
iv. Provision of tobacco cessation facilities
v. Monitoring of tobacco control laws.
11.3.4. Other initiatives in collaboration with WHO/
BGI
I. Advocacy Workshops
• Ministry of Health & Family Welfare had organized
one National Workshop and five Regional Advocacy
Workshops for Western, Central, Southern, Eastern
& North-eastern and Northern region of the country
to sensitize various stakeholders on tobacco control
laws and related issues in India in the collaboration
with WHO. The purpose of these workshops was to
build awareness about tobacco control issues
including the existing legislations and to improve
enforcement capacity of the provisions of the India
Tobacco Control Act, 2003. Through these workshops
nearly 800 key personnel in the Government(s) and
civil society groups were sensitized on the anti-tobacco
laws and its related enforcement strategies.
• Subsequent to the successful national and regional
level workshops, 11 State Advocacy Workshops were
held and nearly 1200 key personnel in the
Government(s) and civil society groups were
sensitized on the anti-tobacco laws and its related
enforcement strategies. Extensive list of
recommendations were generated for preparation of
national and state-wise enforcement action plans for
effective implementation of tobacco control laws at
district level.
• Through these workshops, the key stakeholder
ministries / departments such as Police, Education,
Custom & Excise, Information and Broadcasting,
Tourism, Transport, Labour, Agriculture, etc were
sensitized on their role in tobacco control. In addition,
Annual Report 2010-11 155
various advocacy materials were developed and
disseminated through these workshops.
• A workshop for developing media strategy for the
north-east region was organized at Guwahati, Assam
and participants were from all the seven north-east
states.
II. Global Adult Tobacco Survey (GATS):
The Global Adult Tobacco
Survey (GATS) is the
global standard for
systematically monitoring
adult tobacco use
(smoking and smokeless)
and tracking key tobacco
control indicators. Global
Adult Tobacco Survey-
India was carried out in all
29 states of the country
and 2 Union Territories of
Chandigarh and Puducherry, covering about 99 percent
of the total population of India. The major objectives of
the survey were to obtain estimates of prevalence of
tobacco use (smoking and smokeless tobacco); exposure
to second-hand smoke; cessation; the economics of
tobacco; exposure to media messages on tobacco use;
and knowledge, attitudes and perceptions towards tobacco
use.
The Global Adult Tobacco Survey, India (GATS), Report
was released on 19
th
October 2010. The key highlights
of the survey are:
• Current tobacco use in any form: 34.6% of adults;
47.9% of males and 20.3% of females
• Current tobacco smokers: 14.0% of adults; 24.3%
of males and 2.9% of females
• Current cigarette smokers : 5.7% of adults; 10.3%
of males and 0.8% of females
• Current bidi smokers: 9.2% of adults; 16.0% of males
and 1.9% of females
• Current users of smokeless tobacco: 25.9% of adults;
32.9% of males and 18.4% of females
• Average age at initiation of tobacco use was 17.8
with 25.8% of females starting tobacco use before
the age of 15
• Among minors (age 15-17), 9.6% consumed tobacco
in some form and most of them were able to
purchase tobacco products
• Five in ten current smokers (46.6%) and users of
smokeless tobacco (45.2%) planned to quit or at least
thought of quitting
• Among smokers and users of smokeless tobacco who
visited a health care provider, 46.3% of smokers and
26.7% of users of smokeless tobacco were advised
to quit by a health care provider
• About five in ten adults (52.3%) were exposed to
second-hand smoke at home and 29.0% at public
places (mainly in public transport and restaurants)
• About two in three adults (64.5%) noticed
advertisement or promotion of tobacco products.
• Three in five current tobacco users (61.1%) noticed
the heath warning on tobacco packages and one in
three current tobacco users (31.5%) thought of
quitting tobacco because of the warning label on
tobacco products package. GATS India Report is
available on the website at www.mohfw.nic.in
III. Intervention related to alternative crops/
alternative vocations.
• A pilot project for alternatives to tobacco/bidi crops
in collaboration with Central Tobacco Research
Institute, Andhra Pradesh (Ministry of Agriculture)
was launched in 6 agro-climatic zones of the country.
This project costing Approx Rs. 3.28 crores will be
completed in three years.
• The Ministry of labour also undertook a pilot project
to provide alternative vocations to bidi rollers in the
regions where bidi is produced viz Karnataka,
Madhya Pradesh, Maharashtra, West Bengal and
Rajasthan.
• Ministry of Rural Development has taken up the
matter of rehabilitation of bidi rollers in 10 States
where bidi roller are concentrated. The State
Government were advised to work out special
projects for developing alternative livelihood options
for bidi rollers under Swarnjayanti Gram Swarozgar
Yojana (SGSY) and other similar schemes of the
Ministry.
Annual Report 2010-11 156
11.4 NUTRITION
11.4.1 Introduction and Initiatives
The Nutrition Cell in the Directorate General of Health
Services provides technical advice in all matters related
to policy making, programme implementation, monitoring
& evaluation, training content for different levels of
Medical and Para Medical workers. It also provides
technical inputs on standards and labels for foods,
fortification of foods, nutrition related proposals, project
evaluation, review of research project etc.
11.4.2. Initiatives and Progress
11.4.2.a. The cell has been making efforts in creating
awareness regarding prevention of micro-nutrient
deficiency disorders, diet related chronic disorders and
promotion of healthy life style. This has been done by
disseminating posters and pamphlets on the above
mentioned issues. In addition to this video films and radio
programme have been developed on National Iodine
Deficiency Disorders Control Programme (NIDDCP),
diet related Non Communicable Diseases (NCD) and
promotion of healthy life style including micro-nutrient
deficiency. The cell has also developed, published and
disseminated a handbook on “Current Nutritional Therapy
Guidelines, in Clinical Practices” for Physicians, Dieticians
and Nurses.
11.4.2.b. National & Regional levels workshops and
meetings were conducted on core issues related to nutrition
(i.e micro-nutrient, hospital diets, fluorosis, diet related
chronic disorders & promotion of healthy life style, fast/
junk food etc).
11.4.2.c. At national level the nutrition cell coordinates,
monitors all administrative and technical issues related
to implementation of the new health initiative namely
“National Programme for Prevention & Control of
Fluorosis (NPPCF)” which was launched in the year
2008-09. The programme was launched to address
fluoride related health problems in the country.
11.4.2.d. In 17 States/UTs Nutrition Division have been
established to provide updates on development in the field
of nutrition, micro-nutrient deficiencies, diet related
chronic non-communicable diseases, ill effects of junk/
fast foods etc.
11.5. STRENGTHENING OF EMERGENCY
FACILITIES OF STATE HOSPITALS
LOCATED ON NATIONAL HIGHWAYS
Expansion in road network, motorization and urbanization
in the country has been accompanied by a rise in road
accidents leading to Road Traffic Injuries (RTIs) and
fatalities as major public health concern. Today road
traffic injuries are one of the leading causes of deaths,
disabilities and hospitalization with severe socio-economic
costs across the world.
In view of the above, the Ministry of Health & FW has
been implementing a project for upgradation &
strengthening of Emergency Trauma Care Facility in State
Government Hospitals located on National Highways
under the scheme “Assistance for Capacity Building” with
a view to provide immediate treatment to the victims of
road traffic injury. Financial assistance was provided up
to a maximum of Rs.1.5 crores per hospital or actual
requirement of the hospital whichever was less, during
the 9
th
& 10
th
five year plan periods. During the 9
th
Five
year plan, 18 Hospitals/ Medical Institutions in 13 States/
UTs received grant @ Rs. 1.5 crores each for
strengthening of emergency facilities of State hospitals
of cities located on National Highways. During the 10
th
Plan Rs. 110 crores have been allocated. 85 Hospitals/
Institutions in 30 States received the grants during 10
th
Plan. In total about 139.00 crores has been released to
103 institutes during 9
th
& 10
th
Plan.
The scheme was subsequently evaluated by the Ministry
and certain deficiencies were observed like shortage of
required manpower, inadequate funding for civil work etc.
In the light of the facts, a revised new scheme at a total
outlay of Rs.732.75 crores has been approved for
developing a network of 140 trauma care centres along
the Golden Quadrilateral covering 5,846 Kms connecting
Delhi-Kolkata-Chennai-Mumbai-Delhi, North-South &
East-West corridors covering 7,716 Kms connecting
Kashmir to Kanyakumari and Silchar to Porbandhar
respectively of the National Highways during the 11
th
five
year plan period.
The scheme provides for 3-category of trauma care
centres viz. L-III, L-II and L-I. The level-III trauma
centre is designed to stabilize the patients and to manage
the trauma victim and to refer the trauma victim to level-
II and Level-I centers as per the requirement for further
management. The level-II would provide definite care to
severe trauma victim while the L-I would provide the
highest level of definite and comprehensive care patients
with complex injuries.
So far 113 trauma care centers have been provided
financial assistance in 15 states which are at various stages
of progress.
Annual Report 2010-11 157
The financial assistance amounting to Rs. 4.8 crores, 9.65
crores and 16 crores are provided to level-III, level-II
and level-I respectively, to strengthen the manpower,
building, equipments, communication network and legal
services and data entry operator of existing State Govt.
Hospitals.
One advances life support ambulance is augmented by
Ministry of Surface Transport at each of the trauma care
centers, while NHAI is providing one basic life support
ambulance at every 50 kms of the highways.
The total outlay and the year wise budget allocation viz-
a-viz the expenditure incurred on the scheme is as under:
Total outlay for the scheme during the 11
th
five year
plan - Rs. 732.75 crores.
Subsequently and after evaluation of the project, National
Highways (other than Golden Quadrilateral, North-
South and East-West corridor) with substantial number
of accidents and considering the following parameter
another 160 Trauma care centres could also be added
to the existing network of trauma care centres during
the 12
th
five year plan:
Connecting two capital cities
Connecting major cities other than capital cities
Connecting ports to major cities
Connecting industrial townships with capital cities.
11.6. NATIONAL PROGRAMME FOR
PREVENTION AND CONTROL OF
DEAFNESS
Hearing loss is the most common sensory deficit in
humans today. As per WHO estimates in India, there are
approximately 63 million people, who are suffering from
Significant Auditory Impairment; this places the estimated
prevalence at 6.3% in Indian population. As per NSSO
survey, currently there are 291 persons per one lakh
population who are suffering from severe to profound
hearing loss (NSSO, 2002). 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 (one sided) hearing loss.
11.6.1. Objectives of the Programme
1. To prevent the avoidable hearing loss on account
of disease or injury.
2. Early identification, diagnosis and treatment of ear
problems responsible for hearing loss and deafness.
3. To medically rehabilitate persons of all age groups,
suffering with deafness.
4. To strengthen the existing inter-sectoral linkages
for continuity of the rehabilitation programme, for
persons with deafness.
5. To develop institutional capacity for ear care
services by providing support for equipment and
material and training personnel.
11.6.2. Components of the Programme:
• Manpower Training & Development
• Capacity Building
• Service Provision including Rehabilitation
• Awareness Generation through IEC Activities
• Monitoring and Evaluation
11.6.3. Programme Execution & Expansion
The programme has been launched in 25 districts of 10
states and 1 union territory in Jan, 2007 on the pilot phase
till March 2008. The programme was extended to another
35 districts in the year 2008-09, 41 districts in the year
2009-10 and 75 districts in the year 2010-11 making it a
total of 176 districts of 15 States and 4 Union Territories.
It is proposed to expand the programme to 203 districts
by the end of eleventh five year plan. The programme
Year Funds allocated Allocated Funds released
(Rs. in crores) for NE States (Rs. in crores)
(Rs. in crores)
2007-08 Rs. 42 Rs. 5 Rs. 37
2008-09 Rs. 120 Rs. 14 Rs. 110.34
(including
Rs. 10 crores
for NE States)
2009-10 Rs. 120 but at
FE Stage
reduced to
Rs. 55 Rs. 14 Rs. 55
2010-11 Rs.113 Rs. 15 Rs. 75.63
Annual Report 2010-11 158
has got into fourth year of implementation in the year
2010-11.
11.6.4. Training activities under NPPCD
In the current year 2010-11 the funds amounting for
conducting training has been released to the states to carry
out the trainings prescribed under the programme.
11.6.5. Capacity building of PHCs/CHCs/Distt.
Hospitals
i) Manpower capacity building: Launched one year
DHLS(Diploma in Hearing Language and Speech)
programme to address the issue of shortage of
audiometric manpower at 11 centres in the country
i.e. JIPMER Puducherry, AIIPMR Mumbai,
RIMS Imphal, RML, N. Delhi, IGMC Shimla,
JLNMC Ajmer, KGMC Lucknow, GMC
Jabalpur, SRBMC Cuttack, RIMS Ranchi along
with the nodal centre AIISH Mysore with the total
intake capacity of 220 students annually. The
programme was officially launched on 25
th
August
2007.
ii) Infrastructure capacity building of District
Hospitals/CHCs/PHCs: – Funds for 75 new
districts have been released for procurement of
ENT/Audiology equipments and construction of
sound proof room for audiology at the district
hospitals (Rs. 9.50 lakh per district) and CHC/PHC
Kit (Rs. 10000 per kit).
The States/U.Ts are in the process of procurement of
above stated equipments for their respective district
hospitals, CHC and PHC.
11.6.6. IEC and awareness campaign:
IEC material in the form of 6 different posters in English,
Hindi and regional languages have been printed and
distributed to various health centers, hospitals. 6 video
spots and 3 audio spots were prepared and telecast/
broadcast through national TV and satellite to facilitate
wider outreach of the programme.
11.6.7. Distribution of Hearing aids
Funds for distribution of hearing aids were given to 25
districts in which approximately 2484 Hearing aids (BTE)
have been given to the hearing impaired children who
belong to families having monthly income of less than Rs
6500/- per month.
11.6.8. Under the 11
th
Five Year Plan, it is proposed to
upscale the NPPCD to 203 districts all over the country.
The EFC of Rs.94.77 crore for NPPCD has already been
approved in the year 2008.
11.7. NATIONAL PROGRAMME FOR
PREVENTION & CONTROL OF
FLUOROSIS
Fluorosis, a public health problem is caused over a long
period by excess intake of fluorosis through drinking water/
food products/industrial pollutants. Besides inducing
ageing it also results in major health disorders like dental
fluorosis, skeletal fluorosis and non-skeletal fluorosis.
11.7.1. Initiatives and Progress
In the 11th Five Year Plan with a goal to prevent & control
fluorosis in the country “National Programme for
Prevention and Control of Fluorosis” have been launched.
The programme was with a financial allocation of Rs.
68.00 crore for implementation in 100 districts of the
country.
The objectives of the programme is to (a) collect, assess
and use the baseline survey data of fluorosis from
Department of Drinking Water & Supply, (b)
comprehensive management of fluorosis in the selected
areas and (c) capacity building for prevention, diagnosis
and management of fluorosis cases.
The strategies under the porogramme are (a) imparting
training to health personnel for preventive health promotion,
(b) early diagnosis and prompt intervention (c) capacity
building of district and medical college hospital for
reconstructive surgery and rehabilitation (d) establishment
of diagnostic facilities in the district hospitals, (e) health
education for prevention and control of Fluorosis cases.
As per the plan, the programme will be implemented in
phased manner in the 100 fluoride affected districts of
the country. Presently the programme is being
implemented in 20 Districts of 16 States and in the
financial year 2010-11 another 40 districts of the country
have been selected.
11.8. NATIONAL PROGRAMME FOR
HEALTH CARE OF ELDERLY (NPHCE)
According to 2001 census, there were 76.62 million
Indians above the age of sixty years. The projections for
Annual Report 2010-11 159
next five censuses till the year 2051 are: 96.30 million
(2011), 133.32 million (2021), 178.59 (2031), 236.01
million (2041) and 300.96 million (2051). Along with rising
numbers, the expectancy of life at birth is also consistently
increasing indicating that a large number of people are
likely to live longer than before. On the medical front an
epidemiological transition is underway whereby as a result
of longer survival of man, more and more chronic
degenerative diseases will have to be handled. This will
also be accompanied by medical, psychological, social and
economic problems for the burgeoning population of older
persons. At present elderly persons are sharing health
care with general public which is causing severe problem
to the elderly people.
Considering the growing number of elderly population
accompanied by changes in society & economy and its
impact on the morbidity pattern, Government of India
declared National Policy on Older Persons (NPOP) in
1999 and enacted “The Maintenance & Welfare of Parents
& Senior Citizen’s Act, 2007".
Keeping in view the recommendations made in the
“National Policy on Older Persons” as well as the State’s
obligation under the “Maintenance & Welfare of Parents
& Senior Citizens Act 2007”, the Ministry of Health &
Family Welfare has formulated a “National Programme
for the Health Care of Elderly” (NPHCE) during the 11th
Plan period to address various health related problems of
elderly people. The Planning Commission had allocated
Rs.400 crore for the 11th Plan period for this Programme.
Broad guidelines on the National Programme were
decided by the “Working group on communicable and non
communicable diseases” for 11th Five Year Plan set up
in September, 2006. Based on these guidelines, National
Programme for Health Care of Elderly (NPHCE) was
formulated and the EFC was approved in May 2010 for
an amount of Rs. 288 crore for the remaining period of
11th five year plan, out of which Rs. 48 crore will be
shared by the state Government towards 20% contribution
of the total expenditure. The programme will cover 100
identified districts covering 21 states
Main objective of the programme is to provide preventive,
curative and rehabilitative services to the elderly persons
at various level of health care delivery system of the
country. Other objectives are, to strengthen referral
system, to develop specialized man power and to promote
research in the field of diseases related to old age.
Major components of the NPHCE programme are,
establishment of 30 bedded department of Geriatric in 8
identified Regional Medical Institutes in different regions
of the country, providing dedicated health care facilities
Sl. States Districts CHCs PHC Sub
No. Centres
1 Andhra Nellore 6 65 481
Pradesh Vijayanagaram 7 59 470
2 Assam Dibrugarh 6 26 240
Jorhat 4 39 142
3 Bihar Vaishali 2 53 336
Rohtas 1 36 186
4 Chhattisgarh Bilaspur 10 74 379
5 Gujarat Gandhi Nagar 6 24 171
Surendranagar 11 31 200
6 Haryana Ambala 3 17 102
7 Himachal
Pradesh Chamba 7 42 170
8 Jammu & Leh (Ladakh) 3 13 24
Kashmir Udhampur 2 21 97
9 Jhankhand Bokaro 8 16 116
10 Karnataka Shimoga 11 88 307
Kolar 6 60 201
11 Kerala Pathanathitta 13 37 230
12 Madhya
Pradesh Ratlam 5 25 158
13 Maharashtra Washim 7 25 153
Wardha 6 27 181
14 Sikkim East Sikkim 0 8 48
15 Orissa Naupada 4 17 95
16 Punjab Bhatinda 9 17 136
17 Rajasthan Bhilwara 16 63 415
Jaisalmer 6 14 136
18 Uttrakhand Nainital 4 18 136
19 Tamil Nadu Theni 6 23 162
20 Uttar Rae Bareli 11 71 377
Pradesh Sultanpur 14 77 403
21 West Bengal Darjeeling 11 21 230
in District hospitals, CHCs, PHCs and sub centres in the
100 identified districts, covering 21 States of the country.
The 8 Regional Medical Institutions and 100 districts have
been identified. 30 districts will be taken up in 2010-11
and 70 will be added in 2011-12.
List of the 21 States along with the list of 30 districts and
the number of CHC/PHC/Sub Centres to be covered
under these districts for the year 2010-11 is given below:-
Annual Report 2010-11 160
Operational guidelines have been developed for the
implementation of the programme. Monitoring of the
programme will be done by the common NCD Cells,
being established at various levels under the National
programme for Cancer, Diabetes, Cardiovascular
Diseases and Stroke.
Annual Report 2010-11 161
Chapter 12
12.1. INTRODUCTION
Various International Organisations and United Nations
Agencies continued to provide significant technical and
material assistance for many Health and Family Welfare
programmes in the country. The status of international
assistance from various agencies is discussed in this
chapter.
12.2 WORLD HEALTH ORGANIZATION
(WHO)
World Health Organisation (WHO) is one of the main
UN agencies collaborating in the Health Sector with the
Ministry of Health & Family Welfare, Government of
India. WHO provides technical support in the major areas
of Health & Family Welfare programmes and health care
facilities in the country.
Activities under WHO are funded through two sources:
- The Country Budget which comes out of contributions
made by member countries and Extra Budgetary
Resources which comes from (a) donations from various
sources for general or specific aspects of health; and (b)
funds routed through the WHO to countries by other
member countries or institute agencies. India is the largest
beneficiary of the country budget within the SEA Region.
The budget is operated on a biennium basis, calendar year
wise.
12.2.1. Nodal Functions of WHO:
World Health Assembly: The World Health Assembly
(WHA) is the most important annual event of the World
Health Organisation. The WHA is held once every year
and deliberates various draft resolutions that are put up
for its approval by the Executive Board of WHO. It is
the highest policy making body of World Health
Organisation where all member countries are represented
by high-level delegations (led by Hon’ble Health
Ministers).
International Co-Operation For International Co-Operation For International Co-Operation For International Co-Operation For International Co-Operation For
Health & Family Welfare Health & Family Welfare Health & Family Welfare Health & Family Welfare Health & Family Welfare
The 63
rd
WHA was held in May, 2010 at Geneva and a
high level delegation comprising of technical officials of
this Ministry under the leadership of Shri Ghulam Nabi
Azad, Hon’ble Minister of Health & Family Welfare
attended. The 63
rd
WHA has, inter-alia, discussed the
following agenda items and the resolutions were adopted
on some of the agenda items –
• Pandemic influenza preparedness: sharing of
influenza viruses and access to vaccines and other
benefits.
• Implementation of the International Health
Regulations (2005)
• Public health, innovation and intellectual property:
global strategy and plan of action
• Monitoring of the achievement of the health related
Millennium Development Goals
• International recruitment of health personnel: draft
global code of practice
• Infant and young child nutrition: quadrennial
progress report.
• Birth defects
• Food safety
• Prevention and control of non-communicable
disease: implementation of the global strategy
• Viral hepatitis
• Tuberculosis Control
• Leishmaniasis control
• Chagas disease: control and elimination
• Global eradication of measles
Annual Report 2010-11 162
• Smallpox eradication: destruction of variola virus
stocks
• Availability, safety and quality of blood products
• Strategic Approach to International Chemicals
Management
• WHO’s role & responsibilities in health research
• Counterfeit medical products
• Human organ and tissue transplantation
• Strengthening the capacity of governments to
constructively engage the private sector in providing
essential health-care services
• Treatment and Prevention of Pneumonia
• Progress Report on Poliomyelitis, human African
trypanosomiasis, Reproductive health, Health of
migrants, Climate Change and health etc.
Meeting of Ministers of Health and Regional Committee
of WHO South East Asia Regional Countries: The
Health Ministers’ Meeting (HMM) and the Regional
Committee (RC) Meeting of WHO SEAR countries are
held annually. HMM provides a forum for Health
Ministers to discuss important health issues in the region
as well as for forging bilateral arrangements and the
Regional Committee is a forum to review progress made
on health issues and to lay down the roadmap for future
action. The 28
th
HMM and the 63
rd
Session of RC held
in Bangkok, Thailand during 7-10 September, 2010 and a
high level delegation of this Ministry under the leadership
of Hon’ble Minister of Health & Family Welfare attended.
During the 28
th
HMM the following agenda items have
come up for discussion viz.
i) Review of Kathmandu Declaration on Protecting
Health Facilities from Disasters/follow up actions
on the decisions and recommendations of the
twenty-seventh meeting of Ministers of Health,
ii) Urbanization and Health,
iii) Decentralization of health lower case care
services.
12.2.2. GOI contribution to WHO:
As a member country of WHO, India makes regular
contribution to WHO for each biennium. A WHO biennium
commence in January of the first year of the biennium
and ends in December of the second year of the biennium.
For the biennium 2010-11, the total Assessed Contribution
(AC) and Voluntary Contribution (VC) to the working
capital of WHO, to be paid by Government of India was
US $ 45,69,900 and US $ 1,20,000 respectively. The first
installment of the contribution AC & VC for the year
2010 amounting to US $ 20,89,890 and US $ 60,000
respectively, have already been paid in 2009. The second
installment of US $ 24,80,010 and US $ 60,000 have also
been paid on 21.12.2010.
12.2.3. GOI/WHO collaborative Activities:
WHO funding is available for taking services of the
experts on contractual basis on specific terms and
references; training within and outside the country;
holding of workshops, seminars and meetings for raising
awareness or exchange of information and medical
supplies of equipment, viz: (i) Technical Services
Agreement; (ii) Fellowship; (iii) Agreement for
Performance of Work; (iv) DFC; and (v) Supplies and
Equipment etc.
Since the biennium 2010-11, 11 Strategic Objectives have
been introduced under which the GOI/WHO collaborative
activities are being implemented. Monitoring the activities
for timely and effective utilization of funds and their proper
accounting is one of the main tasks. The areas of work
financed by WHO, inter alia cover HIV/AIDS,
communicable and non communicable diseases, mental
health, drug abuse, environment, food safety, maternal
and child health besides health policy, health financing &
social protection as well as emergency preparedness &
response. For the biennium 2010-11, under the Country
Budget an amount of US $ 7,852,000 was allocated for
carrying out various GOI/WHO collaborative activities.
All the programme are being implemented efficiently with
close monitoring and approx. 30% funds have been utilized
till 30
th
November, 2010.
12.3. SPECIAL ACHIEVEMENT
During the last World Health Assembly held in May 2010,
India have presented successful intervention on the
agenda “Counterfeit Medical Products” which was
almost accepted by WHO and a resolution was adopted
accordingly. The brief of India’s achievements in this
regard is as under:
“On the opening day of the World Health Assembly
(WHA) Hon’ble Minister of Health & FW raised the
issue counterfeit medicines in his statement. He urged
countries to steer clear from the commercially motivated
Annual Report 2010-11 163
debates over the ‘counterfeit’ issue which have hampered
public health by preventing access to good quality and
low cost generic drugs. The resolution submitted by India
on behalf of South East Asia Region (SEAR) on
‘Measures to ensure access to safe, efficacious, quality
and affordable medical products’ contextualized the
problem in the public health arena and sought World Health
Organization’s (WHO’s) support in strengthening the
national drug regulatory authorities to ensure the
availability of quality, safe and efficacious medical
products. It requested the Director General (DG) to
replace WHO’s involvement in IMPACT and the
programme on ‘counterfeit medical products’ with an
effective member driven programme to address the issues
of quality, safety and efficacy. The resolution also
requested the WHO not get involved with Intellectual
Property (IP) enforcement and other measures that could
potentially undermine availability of quality, safe,
efficacious and affordable medical products and
production of generic medical products. As a result WHA
has adopted a resolution establishing a time limited and
result oriented working group on substandard/ spurious/
falsely-labelled/falsified/counterfeit medical products
comprised of and open to all Member States. The Working
Group will examine, from a public health prospective,
excluding trade and intellectual property considerations.”
12.4. AIRPORT HEALTH ORGANISATIONS/
PORT HEALTH ORGANISATIONS
Airport and Port Health organizations (APHO/PHOs)
are subordinate offices of Directorate General of Health
Services. At present, there are 9 PHOs and 5 APHOs
established at all major international Airports and Ports
of the country. There is also one border quarantine centre
at Attari border, Amritsar. In addition to these, the health
offices at Bangalore and Hyderabad Airports have also
been established and started functioning in full swing and
action has been taken to set up the health offices at
Ahmadabad, Lucknow and Trivendrum Airports. The
Budget Division of the Ministry has been requested to
provide sufficient budget so that contractual staff could
be recruited at these 3 APHOs during the financial year
2010-2011. These are statutory organizations and are
discharging their regulatory functions as delineated under
Indian Aircraft (Public Health) Rules 1954 and Port
Health Rules 1955 respectively.
Apart from this, India is also signatory to International
Health Regulations (IHR), 2005 framed by WHO and
therefore, it is obligatory on our part to implement these
regulations. Accordingly, both Indian Air craft Public
Health Rules as well as the Indian Port Health Rules
have been framed in agreement with these International
Health Regulations.
Main objective of the APHO/PHSs is to prevent spread
of infectious disease of epidemic proportion from one
country to another with minimum interference to the
international traffic. Some of the important functions of
this organization are - Health Screening of International
passengers, Quarantine, Clearance of dead bodies,
Supervision of airport sanitation, clearance for imported
food items, vaccination to international passengers, vector
control etc.
Apart from this, issuance of deratting exemption certificate
is another major responsibility at international ports.
WHO has notified a list of yellow fever endemic countries
under IHR and any person coming to India from these
notified endemic countries is required to possess valid
yellow fever vaccination certificate, failing which such
passengers are quarantined for a maximum period of six
days. In the light of changing global health scenario,
existing IHRs have been revised by WHO and these new
IHRs have come to effect from June, 2007.
12.5. CUSTOM DUTY EXEMPTION CER-
TIFICATE
During 2010-2011 (i.e. upto November, 2010) this
Ministry has issued one time Custom Duty Exemption
Certificates in favour of Additional Director Medical Store
Depot, CGHS, New Delhi.
12.6. FOREIGN TRAVEL BY SENIOR
OFFICERS
For the year 2010-2011, a provision of Rs.200.00 lakhs
has been made against Foreign Travel Expenses under
Non-Plan. Out of this, the expenditure till November,
2010 is Rs. 105,09,493 (approx.)
12.7. VISIT ON FELLOWSHIP/CONFERENCE
ABROAD
During the period under report (Upto November, 2010),
116 medical personnel were permitted to participate in
International conference/symposia etc. abroad. This
includes 20 medical personnel from CHS cadre who have
been granted financial assistance subject to a maximum
of Rs.1.00 lakh- each to attend International Conference
Annual Report 2010-11 164
abroad under the scheme which provides financial
assistance to attend seminars/conferences abroad in order
to acquaint themselves with the latest developments in
the field of medicine and surgery in other countries and
to exchange views with their counterparts.
12.8. AGREEMENTS/MOUS
In the year 2010-2011, this Ministry has signed the
following Agreements/MoUs:-
I. An MOU on Cooperation in the field of Health
between the Ministry of Health and Family Welfare
of the Republic of India and the Ministry of Social
Protection of the Republic of Colombia was signed
on 19
th
January, 2010.
II. An MOU between the Government of the Republic
of India and the Government of the Republic of
the Croatia on Cooperation in the field of the Health
and Medicine was signed on 9
th
June, 2010.
III. An MOU between the Government of India and
the Government of Malawi in the field of Health
and Medicine was signed on 3
rd
November, 2010.
IV. An MOU between the Government of the Republic
of India and the Government of the Republic of
Rwanda in the field of Health and Medicine was
signed on 12
th
November, 2010 at New Delhi.
V. An MOU on the Establishment and Operation of
Global Disease Detection- India Center between
National Centre for Disease Control, Delhi
(Ministry of Health and Family Welfare,
Government of India) and Centres for Disease
Control and Prevention, Atlanta (The Department
of Health and Human Services of the United States
of America) has been concluded on 6
th
November,
2010.
12.9. MEETINGS/CONFERENCES UNDER
THE AEGIS OF INTERNATIONAL
COOPERATION
(i) An Indo-Swedish Health Week was organized in
New Delhi and Hyderabad to commemorate the
completion of one year of the Memorandum of
Understanding on Health between India and
Sweden and to explore and enhance the potential
for strengthened collaboration between various
stake holders in the public and private health care
sector in India and Sweden.
(ii) The Joint Working Group (JWG) set-up under the
Memorandum of Understanding MOU on
cooperation in the field of Health Care and Public
Health between the Government of India and
Sweden held its third joint meeting in New Delhi
on 8
th
February, 2010, in which issues of mutual
interest in health sector were discussed.
(iii) An Indian delegation led by Hon’ble HFM visited
Bangladesh from 13-16
th
February, 2010 to attend
the meeting of the Executive Committee of Partners
in Population and Development (PPD)
(iv) The Joint Working Group (JWG) constituted under
the Agreement on bilateral cooperation in the field
of Health and Medicine between India and Fiji held
its first Joint meeting in New Delhi.
Ministerial/Official bilateral meeting between India and
Turkey, Nigeria, Australia, Pakistan, China, U.K., Iraq,
Sweden, Armenia were held with a view to improving
the bilateral relations in the Health Sector during the year
2010-2011 (upto November, 2010.)
12.10. PERMISSION FOR INTERNATIONAL
CONFERENCES
In the year 2010-2011 (upto November, 2010),
permissions were granted to 70 Organizations/
Instsitutions for holding health related international
Conferences in India.
Annual Report 2010-11 165
Chapter 13
Medical Relief And Supplies Medical Relief And Supplies Medical Relief And Supplies Medical Relief And Supplies Medical Relief And Supplies
13.1 CENTRAL GOVERNMENT HEALTH
SCHEME (CGHS)
Central Government Health Scheme has been in
existence since 1954, when it started functioning in Delhi.
Central Government Health Scheme has since come a
long way and presently Central Government Health
Scheme covers 25 cities. In order to make the CGHS
user friendly, its functioning has been streamlined and
revamped. Important actions in this direction have been
the computerisation of the functioning of the CGHS and
its dispensaries, delegation of enhanced financial powers
to CGHS functionaries and to Ministries / Departments,
issue of plastic cards to beneficiaries enabling them to
take treatment in any dispensary, introduction of direct
indenting of commonly prescribed medicines by CMOs
in charge of dispensaries, empanelment of private
hospitals and diagnostic centres to provide options, in
addition to the facilities available in Government hospitals,
polyclinics and laboratories, outsourcing of sanitary work
in dispensaries, outsourcing of dental services, opening
of stand-alone dialysis unit in Delhi, appointment of the
Bill Clearing Agency (BCA) of settlement of bills of
hospitals of pensioner beneficiaries treated in hospitals,
etc. These measures have resulted in increased
satisfaction level of CGHS beneficiaries.
The Central Government Health Scheme (CGHS) is a
scheme for providing health care to serving Central
Government employees and their dependant family
members. Over the years, the scheme has been extended
to cover central government pensioners, their dependant
family members and certain other categories like Members
of Parliament and ex Members of Parliament, freedom
fighters etc. Employees of some select autonomous bodies
as also PIB accredited journalists have also been
extended CGHS facilities on cost-to-cost basis in Delhi.
13.1.1. Membership Profile
As on 31
st
March 2009, CGHS had 9.34 lakh members
with coverage of over 31.81 lakh beneficiaries. The
break-up of the current membership profile is given in
the table below:
Membership profile (31.3.2009)
Category Card Holders Beneficiaries
Serving 627004 2518805
Pensioners 290880 634167
Freedom Fighters 13068 18293
MPs 609 2437
Ex-MPs 1010 2593
Journalists 128 220
Others 1452 3235
General Public 674 1969
Total 9,34,825 31,81,719
COVERAGE
CGHS was started initially in Delhi. Today it covers 25
cities as indicated below:
Ahmedabad Allahabad Bangaluru Bhubaneshwar Bhopal Chennai Chandigarh
Delhi Dehradun Guwahati Hyderabad Jaipur Jabalpur Kanpur
Kolkata Lucknow Meerut Mumbai Nagpur Patna Pune
Ranchi Shillong Jammu Thiruvananthapuram
Annual Report 2010-11 166
There is no CGHS coverage in the States of Himacjhal
Pradesh, Chattisgarh, Punjab, Haryana, Tripura, Manipur,
Mizoram, Nagaland, Sikkim, Goa and Union Territory of
Puducherry.
13.1.2. CGHS Infrastructure
The beneficiaries are being provided health service
through a huge network of:
A) Dispensaries (247 Allopathic, 82 AYUSH),
B) Yoga Centres (4),
C) Polyclinics (19),
D) Laboratories (65)+ 1(Hind lab)
E) Dental Units (21)
F) Gynae– maternity Hospital (1)
G) Dialysis Centre (Sadiq Nagar, New Delhi).
In addition, beneficiaries are offered medical facilities in
private hospitals and diagnostic centres empanelled by
the CGHS by following an open tender system.
CGHS was finding it difficult to fill up the vacancies of
medical officers as the majority of the doctors
recommended by the Union Public Service Commission
did not assume charge in the CGHS for various reasons.
To overcome the problem of unfilled vacancies, it has
been decided to appoint, on contract basis, doctors who
had retired from Government service. As a result of this
decision, 79 retired doctors have been appointed on a
contract basis in the CGHS.
13.1.3. Facilities provided under CGHS
Facilities of outpatient care in all systems and emergency
services in allopathic system, supply of necessary drugs,
laboratory and radiological investigations, domiciliary visits
to the seriously ill patients, specialists consultation both
at the dispensary and hospital level, family welfare
services, treatment in specialised hospitals, both
Government and CGHS empanelled private hospitals etc.
are being provided to the beneficiaries through
dispensaries, polyclinics and Government / CGHS
empanelled private hospitals / diagnostic centers. There
are special facilities for the convenience of pensioners
and senior citizens. CGHS Pensioner beneficiaries can
obtain a CGHS pensioner card with life-time validity, by
paying an amount equivalent to ten years’ subscription.
The pensioners living in areas not covered by the CGHS
have the option to get their CGHS pensioner cards from
the nearest CGHS covered city. Credit facilities are also
available to the pensioners for treatment taken in private
hospitals /diagnostic centers empanelled under CGHS by
obtaining a permission / referral letter from CGHS. In
such cases, the hospitals are directed to send the bill for
the treatment to the CGHS and not to charge from the
pensioners. Pensioner beneficiaries are being allowed
to get medicines for chronic ailments up to three months
at a stretch.
Two Geriatric Clinics have been established and are
functioning at CGHS Timarpur and Janakpuri in Delhi.
13.1.4. Computerisation of CGHS
The computerisation of CGHS and its’ dispensaries which
was initiated in 2005 has been completed in all cities.
Computerisation of CGHS Wing in Dr. Ram Manohar
Lohia Hospital in Delhi has also been completed.
13.1.5. Issue of Plastic Cards
All the new cards in Delhi and other cities are made only
in the form of Plastic Cards to each beneficiary with a
distinct beneficiary identification number. Each card will
have a bar code. In Delhi so far 8.5 lakh cards have
been printed and distributed to CGHS beneficiaries.The
benefit of having a plastic card is that the beneficiaries,
while on tour to any CGHS city, can go to the wellness
centre in that city and obtain treatment in case of need.
13.1.6. Subscription to CGHS
Serving Government servants residing in areas covered
by the CGHS are compulsorily covered by the CGHS.
In order to avail the CGHS facility, they have to contribute
on a monthly basis at the rates brought into force from
1
st
June, 2009, which are as below:
S. No. Grade pay drawn by the officer Contribution(Rupees per month)
1 Upto Rs. 1,650/- per month 50/-
2 Rs. 1,800/-; Rs. 1,900/-; Rs.2,000/-; Rs.2,400/-; and Rs.2,800/- per month 125/-
3 Rs. 4,200/- per month 225/-
4 Rs. 4,600/-; Rs.4,800/-; Rs.5,400/-; and Rs. 6,600/- per month 325/-
5 Rs. 7,600/- and above per month 500/-
Annual Report 2010-11 167
Central Government pensioners can avail CGHS facilities
by depositing the applicable subscription rates. Pensioners
have the option of either subscribing on an annual basis
or pay a lump sum equivalent to 10 years’ contribution
and avail CGHS facilities for life time alongwith dependent
family members.
13.1.7. Definition of Family
A. Family for purposes of availing CGHS facilities has
been defined as under:
(i) Husband / wife
(ii) Parents and stepmother
(iii) Female employee has a choice to include her
parents or her parents-in-law and option exercised
can be changed once during the service period
(iv) Children (including legally adopted children) subject
to the conditions that:
(a) Son – till he starts earning or attains the age of 25
years, whichever is earlier. A son, if married, even
if he is dependent on his parents and is below 25
years’ of age will not be part of the family for CGHS
purposes
Son, even if he is more than 25 years of age, but is
suffering from permanent disability [as defined in (i)
Disabilities defined in Section 2(i) of “The Persons with
Disabilities (Equal Opportunities, Protection of Rights
and Full Participation) Act, 1995 (No: 1 of 1996)”,
and in Clause (j) of Section 2 of National Trust for
Welfare of Persons with Autism, Cerebral Palsy,
Mental Retardation and Multiple Disabilities Act,
1999 (No: 44 of 1999)] and is fully dependent on his
parents will be entitled to CGHS facility.
The matter regarding ineligibility of sons above the age
of 25 years has been challenged in Delhi High Court and
final orders of the Court are awaited.
(b) Daughter – Till she starts earning or gets married,
whichever is earlier, irrespective of age-limit.
Widowed dependent daughters, divorced /
separated daughters if dependent on her parents
will be entitled to CGHS facility irrespective of age-
limit.
(v) Sisters including unmarried / divorced / abandoned
or separated from husband / widowed sisters, if
dependent on the Government servant will be
entitled to CGHS facilities irrespective of age-limit.
(vi) Minor brothers
13.1.8. Dependency Criteria
Members of the family (other than one spouse) whose
income from all sources is less than Rs.3,500/- plus an
amount equivalent to the DA announced by the
Government from time to time will be treated as dependent
on the Government servant and hence are entitled to avail
CGHS facilities.
13.1.9. Empanelment of private hospitals and
diagnostic centres
As CGHS does not have adequate facilities to offer
medical treatment to its beneficiaries in Government
hospitals, it empanels private hospitals and diagnostic
centers in all CGHS covered cities. For this purpose
tenders were floated in 2009 calling for private hospitals
and diagnostic centers interested in being empanelled
under CGHS to offer their rates for various procedures /
tests, etc. Based on the rates quoted by the private
hospitals and diagnostic centers, the lowest rates in respect
of each procedure / test were offered to the private
hospitals and diagnostic centers and those private hospitals
and diagnostic centers which accepted the rates have
been empanelled under CGHS in Delhi and most of other
cities. It is expected that with the completion of the tender
process and introduction of continuous empanelment
scheme, almost all the cities will have private hospitals/
diagnostic centres in the CGHS panel.
Private hospitals and diagnostic centers which were
empanelled under CGHS have signed MOAs with the
CGHS. Any violation of the provisions of the MOA meant
that fines would be levied on these private hospitals and
diagnostic centers and bank guarantee could also be
utilised.
13.1.10.Procedure for referral to empanelled
hospitals & diagnostic centres
The CGHS beneficiary first visits the dispensary (now
renamed as Wellness Centre) for treatment of an ailment.
The CMO in the wellness centre will refer to the patient
to a specialist in a Government hospital for suggesting
the procedure / tests, etc., to be undergone by the patient.
If the CGHS beneficiary is a pensioner, then the wellness
centre will issue a referral letter to the private hospital
and diagnostic centre where the beneficiary wants to be
treated. The private hospitals and diagnostic centres will
provide credit facility to the beneficiary and raise their
bill on the CGHS.
Annual Report 2010-11 168
If, however, the CGHS card holder is a serving Central
Government servant, then he / she will have to obtain
permission from his / her Ministry / Department.
13.1.11.Change in procedure for payment of
hospitals / diagnostic centres’ bills:
Private hospitals and diagnostic centres have to provide
credit facility to pensioner CGHS beneficiaries referred
to them by the CGHS. Due to paucity of funds and
procedural bottlenecks, settlement of the bills of private
hospitals and diagnostic centers got delayed with the result
that many private hospitals and diagnostic centers refused
to extend credit facility without receiving payment towards
the bills already submitted. To overcome the problem, a
Third Party Administrator (TPA) (the Bill Clearing
Agency – UTI – TSL) has been engaged for processing
of bills and release of payments electronically. CGHS
will then carry out medical audit of the bills passed for
payment by the TPA.
13.1.12. Supply of medicines to beneficiaries
Medicines for CGHS are procured by HSCC / Medical
Stores Depot and Medical Stores Organisation, on the
basis of the indents made by different wellness centres,
and supplied to the wellness centres. The medicines
prescribed by the treating doctor, if available in the store
of the wellness centre, are supplied to the beneficiary.
If, however, the prescribed medicine is not available by
the brand name but in another brand name or there is
another medicine with the same active ingredients, then
the same is supplied to the beneficiary.
13.1.13. Local indenting of medicines
Each wellness centre holds certain quantity of branded
and generic drugs, which are distributed to the
beneficiaries on the basis of prescriptions of specialists.
If any drug is not available in stock, then the wellness
centre places an indent on the locally authorised chemist
for the wellness centre for the supply of the drugs.
As it is not possible for the wellness centers to keep in
stock all the drugs that are prescribed by the specialists
and if drugs with the same active ingredients are also not
available, then the wellness centre is authorised to place
an indent on the local authorised chemist for the supply
of the drug prescribed by the specialist.
Authorized local chemists for wellness centres are
appointed on the basis of tenders floated by the CGHS
for such appointment. The selection of the chemist is
done on the basis of the highest rebate offered by the
chemist on the printed MRP. Before the chemist is
appointed, his premises are inspected to ensure that he
has the capacity to handle the volume of indents that will
be placed by the wellness centre on the chemist.
13.1.14. Treatment for Cancer
As there is no private hospital empanelled (both old and
new) under CGHS for treatment of cancer patients, ad-
hoc arrangements for treatment of cancer patients have
been made in view of the hardships faced by CGHS
beneficiaries undergoing treatment for cancer. Patients
can be referred to any hospital offering treatment to CGHS
beneficiaries suffering from cancer.
In addition, orders have been issued for treating the
following Regional Cancer Centres as empanelled under
CGHS / CS (MA) Rules.
13.1.15.Regional Cancer Centres deemed to be
empanelled under CGHS:-
1. Kamla Nehru Memorial Hospital, Allahabad, Uttar
Pradesh;
2. Chittaranjan National Cancer Institute, Kolkata,
West Bengal;
3. Kidwai Memorial Institute of Oncology, Bangaluru,
Karnataka;
4. Regional Cancer Institute (WIA), Adyar, Chennai,
Tamil Nadu;
5. Regional Cancer Centre, Thiruvananthapuram;
6. Gujarat Cancer Research Institute, Ahmedabad,
Gujarat;
7. MNJ Institute of Oncology, Hyderabad, Andhra
Pradesh;
8. Dr. B.B. Cancer Institute, Guwahati, Assam;
9. Indian Rotary Cancer Institute (AIIMS) , New
Delhi;
10. RST Hospital & Research Centre, Nagpur,
Maharashtra;
11. Tata Memorial Hospital, Mumbai, Maharashtra; and
12. Indira Gandhi Institute of Medical Sciences, Patna,
Bihar.
Annual Report 2010-11 169
13.1.16. Regional Cancer Centres deemed to be
empanelled under CS(MA) Rules, 1944
1. Acharya Harihar Regional Cancer Centre for
Cancer Research & Treatment, Cuttack, Orissa;
2. Puducherry Regional Cancer Society, JIPMER,
Puducherry;
3. Regional Cancer Control Society, Shimla, Himachal
Pradesh;
4. Cancer Hospital and Research Centre, Gwalior,
Madhya Pradesh;
5. Pt. JNM Medical College, Raipur, Chhatisgarh;
6. Acharya Tulsi Regional Centre Trust and Research
Institute (RCC), Bikaner, Rajasthan; and
7. Regional Cancer Centre, Pt. B. D. Sharma Post
Graduate Institute of Medical Sciences, Rohtak,
Haryana.
13.1.17. Other facilities
CGHS beneficiaries in Kolkata can avail treatment /
facilities in the Afternoon Pay Clinics run by the
Government of West Bengal, with a provision for
reimbursement of the consultation fee. The OPD
consultation fee charged by the Pay Clinics will be
reimbursed at the rate of Rs. 100/- (Rupees one hundred
only) for the first visit and Rs. 60/- (Rupees Sixty only)
for subsequent visits. The reimbursement of the
expenditure will be made by the concerned Department /
Ministry in case of serving employees and by CGHS in
case of pensioner beneficiaries.
Beneficiaries under CGHS possessing a valid CGHS card
can avail treatment / investigation facilities at Nizam’s
Institute of Medical Sciences, Hyderabad, for which prior
referral / permission / approval will not be necessary from
the concerned Department / CGHS Dispensary. Similarly,
beneficiaries under Central Services (Medical
Attendance) Rules, 1944 can also avail treatment /
investigation facilities at Nizam’s Institute of Medical
Sciences, Hyderabad without prior referral / permission
/ approval.
13.1.18. Grievance Redressal Mechanism
13.1.18.a. Local Advisory Committees
Instructions have already been issued to all CGHS cities
that meetings of Local Advisory Committees should be
held on Second Saturday of every month in each
dispensary. The meetings are held under the
chairmanship of CMOs in charge of the dispensaries, in
which Area Welfare Officers and representatives of
pensioners’ associations are members to discuss local
problems faced by the beneficiaries and dispensaries and
to resolve such issues.
All wellness centers have been directed to keep a
complaints / suggestions Box and also to maintain a
complaints / suggestions register. The complaints Box
will be opened at the time of the meeting of the Local
Advisory Committee.
CGHS Help Lines (No. 011-66667777 & 155224), are in
operation between 9.30 A.M. to 5.30 P.M. There is also
a e-mail help line – cghs @ nic.in where readily available
information is provided E-mails are addressed. Otherwise,
beneficiaries are directed to contact the concerned nodal
officers to get the desired information.
13.1.18.b. Holding of Caims Adalats under CGHS
Complaints were received in the CGHS and in the
Ministry that old cases of reimbursement of medical
expenses incurred by pensioners had been pending for
settlement for a long time. It was decided that Claims
Adalats be held in each CGHS city under the chairmanship
the Additional / Joint Directors of the respective city. For
holding of the Adalats, advertisements were released in
local leading newspapers requesting aggrieved pensioners
to apply to the respective Additional Directors by
furnishing the details of their long pending claims. A good
number of long pending cases could be settled in Delhi
and in outside CGHS cities through this mechanism.
Instructions have been issued for holding such Adalats in
2011 also.
13.1.18.c. Expenditure:
Over the years, expenditure under CGHS has been
showing an increasing trend. The details of actual
expenditure since 2005 – 06 are as under:-
S. No. Year PORB Head Other heads Total Expenditure
1. 2006-07 349.47 397.86 747.39
2. 2007-08 438.45 470.69 909.14
3. 2008-09 498.00 547.91 1045.91
4. 2009-10 617.00 532.00 1149.00
5. 2010-11 600.00 Proposed (RE) 568.65 811.07 (Till 22-12-10)
6 2011-12 Proposed (BE) 604.00 680.81 1,284.81
( Rs. In crores)
Annual Report 2010-11 170
13.1.19.Status in respect of North East:
The CGHS is in operation in two cities in the North Eastern
States viz. Guwahati and Shillong since 1996 and June
2002 respectively. One Ayurvedic and one Homeopathy
dispensary in Guwahati have since started functioning.
There were 12,008 card holders with 45,427 beneficiaries
in Guwahati and 1,857 card holders with 6,544
beneficiaries in Shillong as on 31-3-09.
13.1.19.a. Recent initiatives taken
1) Strengthening of administrative set up of
CGHS: To further improve the functioning of
CGHS, a senior position at the level of Additional
Secretary & Director General (CGHS), to be filled
up under the Central Staffing Scheme has been
newly created. The full administrative control of
the entire CGHS staff has been vested with
Additional Secretary & Director General (CGHS).
2) Simplification of procedures under referral
System and Reimbursement :
a. Submission of Medical claims has been simplified
by doing away with the requirement of verification
of bills by the treating doctor and Essentiality
Certificate.
b. Specific guidelines have been issued for examining
requests for full reimbursement of claims. The
power for relaxation of rules is vested with the
Ministry of Health & Family Welfare, except in
case of Hon’ble Members of Parliament and Sitting
Judges and Former Judges of Hon’ble Supreme
Court of India.
3) Reimbursement from two-sources: Instructions
were issued in February 2009 regarding
reimbursement under CGHS and Health Insurance
Scheme. As per the revised guidelines beneficiaries
have the option to submit the original bills under
the Health Insurance Scheme and claim the balance
amount from CGHS / Department subject to the
condition that the reimbursement (balance amount)
from CGHS/ Department shall be as per CGHS
rates and regulations.
4) Bulk Procurement of Commonly Indented
Medicines from Manufacturers/ Suppliers:
Based on the Data generated by Computers a list
of 272 medicines commonly indented through
Authorised Local Chemists (ALCs) was prepared.
Based on the success of a pilot project which was started
in 10 WCs in Delhi to procure these commonly indented
medicines directly from manufacturers / suppliers on a
monthly basis, the same has been replicated in 16 cities
namely Ahmedabad,, Allahabad, Bengaluru, Bhubaneswar,
Chennai, Guwahati, Hyderabad, Jabalpur, Jaipur, Kolkata,
Lucknow, Mumbai, Nagpur, Patna, Pune, and Ranchi..The
advantage being that medicines are readily available for
issue to beneficiaries instead of indenting through ALC.
Manufacturers / suppliers offer a better discount on rates
as compared to ALCs.
5) Health Check-Up of Beneficiaries above 40
years in Delhi
A pilot project is being implemented in 2 Wellness Centres,
namely Sector 8 and Sector 12 in Ramakrishna Puram,
for the Health Check-up of all beneficiaries above the
age of 40 years in Delhi.
30 beneficiaries per day would be registered in advance
– online and would undergo a list of identified
investigations. Beneficiaries would have a clinical check
up on the date of appointment along with investigation
report. The health check-up is proposed to identify risk
factors including Life –style related diseases for
prevention / early identification for further follow-up and
treatment, if required. So far, 1200 beneficiaries have
availed of this facility.
6) Outsourcing of Dental Services: Dental
services in eight dispensaries in Delhi have so far
been outsourced though Public Private Partnership
(PPP). These are at Moti Bagh, Ramakrishna
Puram Sector 12, Kidwai Nagar, Sadiq Nagar,
Srinivas Puri, Kalkaji I, Pushp Vihar Sector IV and
Faridabad.
7) Delegation of Financial Powers to settle
reimbursement claims in CGHS: Powers for
settlement of reimbursement claims by pensioner
beneficiaries by CGHS were last delegated in 1999.
This resulted in delay in settlement of claims by
CGHS. Instructions have been issued on 24
th
January, 2011, delegating enhanced financial powers
to AS & DG (CGHS), Director CGHS and all
Additional Directors / Joint Directors of CGHS.
This is expected to ensure speedy settlement of
reimbursement claims of all hospitals and individual
beneficiaries.
Annual Report 2010-11 171
8) Increasing the level of Imprest Money at
dispensary level: Imprest money available with
the Chief Medical Officer in charge of dispensaries
were very low resulting in CMOs not being able to
attend to minor items of work. In order that minor
items of work do not get delayed, the quantum of
Imprest Money available with CMO in charge of
each dispensary has been increased to Rs. 20,000/
- (Rupees Twenty thousand only) per annum.
Instructions have been issued to declare Chief
Medical Officers in charge of dispensaries as
Heads of Office under provisions of the Delegation
of Financial Power Rules.
9) Engagement of Bill Clearing Agency (BCA):
The major grouse of private hospitals and diagnostic
centres empanelled under CGHS was that
settlement of bills sent to CGHS in respect of
treatment given to pensioner CGHS beneficiaries
took unduly long time, which was one of the reasons
why hospitals and diagnostic centres were showing
their unwillingness to provide credit facility to
CGHS beneficiaries. In order to overcome this
difficulty, CGHS has appointed UTI – TSL as the
Bill Clearing Agency, by signing a MOA with it.
Under the procedure, hospitals and diagnostic
centres are required to submit their bills
electronically to UTI – TSL after discharge of the
patient, followed by forwarding of bill physically.
UTI – TSL is required to pay to the hospitals the
applicable amount as per package rates for the
treatment within ten days of receipt of the bill
physically. To enable UTI – TSL to make
payments to hospital, an advance of Rs. 70.00
crores has been forwarded to it by the CGHS. After
UTI-TSL makes payments to the hospitals, it will
submit the bills to CGHS periodically for recouping
the money paid to hospitals.
13.2 SAFDARJANG HOSPITAL &VMMC
13.2.1. Introduction of the Hospital
Safdarjang Hospital was founded during the Second
World War in 1942 as a base hospital for the allied forces.
It was taken over by the Government of India, Ministry
of Health in 1954. Until the inception of All India Institute
of Medical Science in 1956, Safdarjang Hospital was the
only tertiary care hospital in South Delhi. Based on the
needs and developments in medical care the hospital has
been regularly upgrading its facilities from diagnostic and
therapeutic angles in all the specialties. The hospital when
started in 1942 had only 204 beds, which has now
increased to 1531 beds. The hospital provides medical
care to millions of citizens not only of Delhi but also the
neighboring states free of cost. Safdarjung Hospital is a
Central Government Hospital under the Ministry of Health
& Family Welfare and is receives its budget from the
Ministry. Safadarjung Hospital has a Medical College
associated with it named Vardhman Mahavir Medical
College.
13.2.2. Vardhman Mahavir Medical College was
established at Safdarjung Hospital in November 2001 and
on 20
th
November 2007, the Vardhman Mahavir Medical
College building was dedicated to the nation. The first
batch of MBBS students joined the college in February
2002.
The college has recognition from the Medical Council of
India. The college is affiliated to Guru Govind Singh I P
University, Delhi. From 2008 onwards the post graduate
courses are also affiliated to GGSIP University which
were with Delhi University.
NEW OPD BUILDING AT SAFDARJANG
HOSPITAL
Vardhman Mahavir Medical College
Annual Report 2010-11 172
13.2.3. The Services Available:
The hospital provides services in various Specialties and
Super Specialties covering almost all the major disciplines
like Neurology, Urology, CTVS, Nephrology, Respiratory
Medicine, Burns & Plastics, Pediatric Surgery,
Gastroenterology, Cardiology, Arthroscopy and Sports
Injury clinic, Diabetic Clinic, Thyroid Clinic. Further, it
has two Whole Body CT Scanner, MRI, Colour Doppler,
Digital X-ray, Cardiac Cath. Lab. A Homoeopathic OPD
and Ayurvedic OPD are also running within this hospital
premises.
13.2.4. OPD Services
OPD Services are running in New OPD Building of
V.M.M.C & Safdarjang Hospital. Patients coming to
OPD of Safdarjang Hospital find a congenial and helpful
atmosphere. Various Public Friendly Facilities exist in the
OPD registration area of the New OPD Building like the
‘May I help You’ Counter, Computerized Registration
Counters, which are separately marked for Ladies,
Gents , Senior Citizens and Physically Challenged.
The hospital has an ever increasing attendance of
23,21,526 in the year 2010 i.e. @ 7790 per working day
of patients in the OPD. To cater to this load and for
convenience of the patients a new OPD Block was
commissioned in August, 1992. All Departments run their
OPD in the new OPD block. There are several disciplines
for which the OPD services are provided daily. The OPD
complex has a spacious registration hall with 18
registration windows. The OPD registration services
have been computerized and the new system is functional
since mid February 2005. The first floor of the OPD
complex caters to the Department of General Medicine
and allied Super-specialties; the second floor caters to
the Department of General Surgery and allied super-
specialties; the third floor is occupied by Pediatrics and
Homeopathy; the fourth floor houses the ENT & Eye
OPD’s and the fifth floor is occupied by the Department
of Skin & STD. The out – patient attendance for the
last 5 years are as under :-
YEAR OPD ATTENDANCE
2006 21,17,201
2007 21,19,980
2008 22,18,294
2009 23,13,585
2010 23,21,526
13.2.5. Sports Injury Centre (SIC) : The Government
of India has established the Sports Injury Centre (SIC)
at Safdarjang Hospital, New Delhi at an approved cost
of Rs. 70.72 crores with an objective of providing
Comprehensive Surgical, Rehabilitative and Diagnostic
services under one roof for specialized treatment of Sports
and related Joint disorders. The benefits would not be
limited only to the sports persons but will also be extended
to other patients sustaining similar and related joint injuries.
The Centre has become functional from 26.9.2010 after
its inauguration by the Hon’ble Prime Minister. The Centre
also aims to develop the specialty of sports medicine in
due course.
Annual Report 2010-11 173
Besides the OPD and emergency services, the Centre
has an in-patient capacity of 35 beds in single bed, two
bed, 4 bed wards and is expected to take care of about
2500 cases pertaining to Arthroscopic & specialized joint
surgical procedures every year. The SIC building
comprising of seven floors apart from the basement has
been equipped with state of the art Operation Theatres
and Physiotherapy Centre with all latest facilities adhering
to the global standards. The Centre, as part of providing
diagnostic services under one roof is housing all modern
diagnostic facilities such as MRI and CT scan, Ultrasound,
Bone Densitometer, Colour Doppler, etc. and laboratory
services which have been wet-leased under PPP mode
on revenue sharing basis. The centre will have its own
facilities of CSSD and laundry which are being
outsourced.
13.2.6. In-Patient Services
The hospital has total bed strength of 1531 including
bassinets. There are in addition observation beds for
Medical (Ward A) and Surgical (Ward B) patients in the
first and second floor of the main causality building. There
are 10 beds in the causality for observation. As a policy
the hospital does not refuse admission if indicated to any
patient in the causality. As a major shift in policy decision,
the casualty is now run by post graduate doctors. Senior
Residents from the disciplines of Medicine, Surgery,
Paediatrics, Orthopaedics and Neuro-Surgery are
available round the clock in the causality to provide
emergency care.
The administrative requirements of the causality are taken
care of by a chief medical officer and a specialist (nodal
officer) who are also posted in the causality from various
Departments by rotation. There is a 24 hour laboratory
facility besides round the clock ECG, Ultrasound, X-ray
& CT Scan services. The Departments of Obst. &
Gynaecology and the burns have separate, independent
causalities.
13.2.7. Casualty Services
CMO I/c Casualty- Dr. Veer Bhushan, was nominated
as the Nodal Officer for CWG 2010 for SJH. He
successfully coordinated & managed two venues at
Sirifort Stadium & also provided medical facility at JLN
Stadium, SJH was supplementary response hospital for
many stadium. One Defibrillator for casualty procured
for Patient care. Surveillance Cameras were installed to
strengthen the Security System. Safdarjang Hosptial
successfully managed the Epidemics of Swine Flu and
Dengue. Waste management training has been made
compulsory for casualty. The guidelines for referral of
poor patient to other hospital have been strengthened.
Large display board in Hindi regarding Poor Patient
referral to Pvt. Hospital were put at several prominent
places.
Several New Super Speciality Departments
(Endocrinology, Medical Oncology, Nephrology, Nuclear
Medicine and Haematology) are also being run in this
hospital.
The hospital also provides the services for cardiac
catheterisation, lithotripsy, sleep studies, endoscopies,
arthroscopies, video EEG, spiral CT, MRI, colour Doppler,
mammography and BAC T ALERT microbiology rapid
diagnostic system.
Total No. of In-Patients admitted and operations
conducted in this hospital for the last 5 years are as
under :-
ADMISSION:-
OPERATIONS
Years Admissions Major Minor Total
2006 1,15,441 21,385 57,827 79,212
2007 1,18,923 19,638 61,847 81,485
2008 1,29,271 21,604 69,640 91,244
2009 1,28,175 23,354 69,091 92,445
2010 1,25,192 23,096 70,544 93,650
Annual Report 2010-11 174
OPERATIONS:-
The total number of deliveries conducted in the
Department of Obst. & Gynae during the year 2010
was 25439.
The details of Lab Examination and X-ray examinations
since 2006 are given below:
The Significant Achievements during the year 2010
1. The transport Deptt. VMMC & Safdarjang Hospital
intent to purchase 16 new vehicles. out of which
presently 9 (Nine) Ambulances including (2
Advance Life Support & 4 Basic Life Support)
and 3 normal ambulances have been procured and
put on service.
2. Two Ultrasound machines, Multi load CR system,
Digital OPG X-ray Machine, Bone Mineral Density
Measurement Equipment & HD 11 XE High
Definition U/S system (Color Doppler Machine)
have been installed in the Deptt. of Radiology.
3. The construction of residential hostel for MBBS
Student, VMMC was started in 18.01.2008 and the
same has completed on May 2010, 254 MBBS
students have been accommodated since August
2010.
4. The hospital has successfully completed
Community Based Rehabilitation, Pilot Project
sponsored by WHO at District Gurgoan in selected
rural area. A rural rehabilitation programme is being
run in the selected areas of Gurgaon district by the
Deptt. of Physical Medicine and Rehabilitation.
Regular rehabilitation services are being given at
the door steps at selected rural communities.
5. Hematology OPD in the H Block extension has
been started.
6. Blood Bank and Transfusion Medicine has 25005
donations and 14,241 components (from Jan’09 to
Nov.09) and it has issued 31,988 units of blood and
components to hospital.
7. A Museum has been built up in VMMC Pathology.
Fluid cytology on cytospin has been introduced and
2006 2007 2008 2009 2010 Daily
Average 2010
Lab. examination 3392554 3431028 3354439 3698191 4239160 11614
X-Ray examination 214802 225793 230530 248211 256432 703
Annual Report 2010-11 175
DNB course has been started in the Pathology
Department.
8. Three new tests 1) VMA 2) Anti HBs 3)
Parathyroid Hormone have been introduced in the
Lab. Medicine Deptt. of Clinical Pathology.
9. A total no. of 156 CCTV cameras have been
installed on approved locations and are functional.
10. A special counter for senior citizens, physically
handicapped patients and hospital staff was opened
in Central Dispensary to avoid inconvenience to
these patients. Additional counter for Clinic patients
was opened with in the existing strength of
Pharmacists in order to minimize waiting time of
the patients.
11. M.Sc. Perfusion Training Course has been started
w.e.f. 01.08.2009.
12. A total of 6399 poor patients were given free
sanction for various tests.
13. A “Dual Head Gamma Camera with integrated
Multislice CT”, Turnkey works has already been
installed and is functional in the Deptt. of Nuclear
Medicine .
14. Blood Gas & Electrolyte Analyzer Model ABL800
Basic Radiometer-Copenhagen: was installed in the
Deptt. of Respiratory Medicine in January 2009.
A Tyco-sleep lab was established in the Deptt in
February 2009.
15. A new pharmacokinetic lab has been established
in the Deptt. of Pharmacology. Animal house facility
too has been created in the Department.
16. The Casualty Deptt. has been equipped with
Tracked overhead IV system.
17. The Deptt. of Burns, Plastic and Maxillofacial
Surgery has been equipped with Scrub station in
Plastic & Burn O.T., Transport ventilator in Burn
I.C.U. & Deep Freezer in Burn O.T. to store skin
graft for longer period and Six Vital monitor have
also been procured in the Deptt. for managing
seriously ill patients.
18. Mother & Child care 100 bedded satellite hospital
in Gurgaon Sec. 10 has been taken over by
Safdarjang Hospital.
19. A 360 bedded new Super specialty building
proposal has been sent to Min. of Health & Family
Welfare Site earmarked.
13.2.8. Transport Services
Safdarjang Hospital has 21 Ambulances which are
available for emergency services round the clock. Out of
21 ambulances six ambulances were purchased during
C.W.G. 2010, of which 4 are Basic Life support ambulance
and 2 Advance Life Support ambulance. Three other
newly acquired ambulances will be used as patient
transport ambulances for needy patients.
Besides this 8 other vehicles are available which include
2 Buses, 1 STD Van, 1 Truck and 4 Staff cars.
13.2.9. Right To Information Cell (RTI)
An R.T.I. Cell is also functioning on the guidelines of
Ministry of Law & Justice, as per the RTI Act 2005, in
the Gazette of India on 15
th
June 2005.
13.2.10. Hindi Section:
It is constant endeavor of Hospital to regularly monitor
and see the progressive use and implementation of the
Official Language in the functioning of hospital. Due to
the constant efforts, the use of official language has
reached to approximately 60%.
13.2.11. Web Site
VMMC & Safdarjang Hospital had launched its web site
(www.vmmc-sjh.nic.in) which was inaugurated on
17.09.2002 by the then Union Health Minister. The
website is a user friendly and reveals all the necessary
information about hospital and its activities.
13.2.12. Training And Teaching
Teaching of Post-graduate Degree & Diploma to the
students enrolled through GGSIP University are
conducted in the Departments of Medicine, Surgery,
Orthopaedics, Obst. & Gynae, Paediatrics, Anaesthesia,
Radio-Diagnosis, Radiotherapy, Opthalmology, ENT,
Dermatology, PMR, Physiology, Anatomy, Community
Medicine, Microbiology, Biochemistry, Pathology,
Pharmacology. In the year 2010, 10 students have been
enrolled for M.Ch. Plastic surgery course & 1 student
for M.Ch. CTVS course. Out of 173 seats sanctioned
for PG Degree courses, 130 students have joined for the
session 2010-11 & PG Diploma courses are abolished
from the 2010-11 session.
Annual Report 2010-11 176
The regular courses are also being run for Nurses Training,
Medical Lab. Technology (MLT) apprenticeship; Diploma
in Lab Technology; Pre-hospital trauma technician course
and courses in pharmacy. Medical Record Technician
(MRT) and Medical Record Officer training,
Physiotherapy training, O.T. Assistants training and Short
term laboratory training programs for all MLT are being
conducted regularly.
The proposal for starting MDS course in prosthodontis
was approved by Ministry of H.& F.W and extra space
for that purpose has been allotted to Dental Department.
The branch of Prosthodontics deals with replacement of
teeth and associated structures. With starting of this
course this hospital will be able to provide facilities of
crowns, bridges and dentures to common OPD patients
in large scale. The post graduate course will start in near
future.
13.2.13. Research Activities
Besides the regular clinical work various research
activities are undertaken on a regular basis in the different
Departments of the hospital. A number of those have
been published in national and international medical
journals. A few journals have been also published from
Safdarjang Hospital. The research activities are often in
coordination with ICMR, DST& WHO.
o ICMR Research Project “Multi Centric National
Task Force Project on Epidemiology of
Musculoskeletal conditions in India” is being
followed in Rehabilitation Section.
o WHO Project “Community Based Rehabilitation-
Pilot Project- Gurgaon” has been completed by
Rehabilitation Deptt.
o Comparative efficacy of Novamin vs Potassium
Nitrate in treatment of Dentinal Hyper-sensitivity.
o Comparative efficacy of Tacrolimus vs
Triamcinalone in treatment of Lichen Planus.
o Effect of gum disease in pregnant patients on
incidence of preterm low birth weight babies.
13.2.14. Construction Activities
Two additional theatres for general surgery have been
started on 1
st
floor OT.
One theatre has been added for Cancer surgery and
Urology services. The microsurgery operational theatre
is under up-gradation .
13.2.15. Budget Allocation
(Rs. In crores)
Safdarjang Hospital & VMMC
Funds Budget Allocated
(2006-2007) (2007-2008) (2008-2009) (2009-2010) (2010-2011)
Plan 48.00 70.00 70.00 84.00 132.53
Non – Plan 74.40 79.90 95.70 157.00 160.00
Total 122.40 149.90 165.70 241.00 292.53
VMMC (Revenue) (Rs. in crores)
Budget allocated Expenditure incurred
2004-05 5.00 4.66
2005-06 BE 28.76 FE 32.25 32.24
2006-07 (plan) 4.00 FE 4.20 4.03
2007-08 (Plan) 1.00 FE 2.50 2.49
2007-08 (Non-Plan) 0.01 -
2008-09 Nil Nil
2009-2010 Nil Nil
2010-2011 2.00 2.00 (till mid Dec-2010)
Annual Report 2010-11 177
Plan Revenue (SJH)
(Rs. in crores)
Year Allocation (Year wise) Expenditure
2006-07 48.00 47.66
2007-08 30.00 FE 37.22 37.08
2008-09 30.00 63.12
2009-2010 44.00 101.68
2010-2011 77.00 63.03
Non – Plan Revenue (SJH)
(Rs. in crores)
Year Allocation Expenditure
(Year wise)
2006-2007
(non plan) 74.40 FE 81.41 81.33
2007-2008 79.89 F.E 95.79 95.65
2008-2009 95.70 141.81
2009-2010 157.00 189.89
2010-2011 160.00 146.18
(till mid Dec-2010)
VMMC(4210) Construction (Rs. in crores)
BE Expenditure
incurred
2006-07 26.00 25.32
2007-08 20.00 FE 15.00 15.00
2008-09 20.00 19.99
2009-10 15.00 04.73
2010-11 05.00 04.30 (till mid
Dec 2010)
4210 (SJH)
BE Expenditure incurred
2007-08 19.00 16.06
2008-09 20.00 37.08
2009-10 20.00 29.62
2010-11 43.53 22.20 (till mid Dec-2010)
13.2.16. Library
The library in SJH has all the basic essential tools including
Photostat, computers (in computer lab) and Internet
facilities. Book bank facilities are given to poor students.
It has electronic security system of books and journals
for safety purpose. The library has latest and international
books and journals. A total number of 360 books were
purchased during the last year.
13.2.17. Telephone Exchange
The Telephone Department is located in a double storey
building near Gate No.1 next to Dental Surgery
Department. Ground floor of the building has an Operator
room with console of Exchange and Administrative office.
On the first floor is the EPABX Electronic Exchange
with other Machinery and Equipments. It interconnects
the various Deptts. of SJ Hospitals and also to the medical
college through telephonic services. One hundred lines
for V.M.M.C are operational for the benefit of many
Departments of VMMC. One Mini Intercom Exchange
with capacity of 100 lines also has been made operational
in casualty recently so as to avoid any interruption in
Emergency Services due to power failure or any other
circumstance.
13.3.18. Staff Strength as at the end of November
2010
S. No. Name of the Group No. of In
Post Position
Sanctioned
1. Group A Gazetted 382 314
2. Group A Non Gazetted 95 94
3. Group B Gazetted 56 28
4. Group B Non Gazetted 1362 1199
5. Group C 961 807
6. Group D 1234 1076
7. Resident Doctors/
PG/DNB/Intern 1279 1096
Total 5369 4614
4216(SJH)
BE Expenditure incurred
2009-10 5.00 0.78
2010-11 5.00 0.10 (till mid Dec 2010)
Annual Report 2010-11 178
13.3 DR. RAM MANOHAR LOHIA HOSPITAL
13.3.1. Background
The Hospital, originally known as Willingdon Hospital and
Nursing Home, renamed as Dr. Ram Manohar Lohia
Hospital, was established by the British Government in
the year 1933. The hospital has thus surpassed over 75
years of its existence and also emerged as a Centre of
Excellence in the Health Care under the Government
Sector Hospitals. Its Nursing Home was established
during the year 1933-35 out of donations from His
Excellency Marchioner of Willingdon. Later, its
administrative control was transferred to the New Delhi
Municipal Committee, now Council (NDMC). In the year
1954, this hospital was taken over by the Central
Government. In the recent past, the Old Building portion
of the hospital has been declared as a Heritage Building.
Starting with 54 beds in 1954, the hospital has been
expanded to meet the ever-increasing demand on its
services and now is a 1055 bedded hospital, spread over
an area of 37 acres of land. The hospital caters to the
needs of C.G.H.S. beneficiaries and Hon’ble MPs, Ex-
MPs, Ministers, Judges and other V.V.I.P. dignitaries
besides other general patients. The mandate of the hospital
is to provide utmost patient care and the hospital authorities
are making all out efforts to fulfill the mandate for which
it has been set-up. The hospital is providing
comprehensive patient care including specialized treatment
to C.G.H.S. beneficiaries and General Public. Nursing
Home facilities are available for entitled CGHS
beneficiaries. The Nursing Home, including Maternity
Nursing Home , is having 75 beds for the CGHS and
other beneficiaries
The hospital is one of the most prestigious Government
Hospitals not only because of its central location, near
the Parliament House and in close proximity to North
and South Block where most of the V.V.I.Ps stay but
also because of availability of expertise and super
specialties. The Government of India has chosen this
Hospital for NABH accreditation, an international
hallmark for health care service provider, through the
Quality Council of India (QCI). The accreditation
application has already been made to QCI for undertaking
inspection to get the accreditation and to become the first
NABH accredited Central Government Hospital.
The hospital annually provides health care services to
approximately 16 lacs outdoor patients and admits around
50000 indoor patients. About 1.99 lacs patients are
attended in the Emergency and Casualty Department
annually. The hospital has round-the-clock emergency
services and does not refuse any patient requiring
emergency treatment irrespective of the fact that beds
are available or not. All the services in the hospital are
free of cost except Nursing Home treatment and some
nominal charges for specialized tests.
13.3.2. The Services Available
The hospital provides services in the following Specialties
and Super Specialties covering almost all the major
disciplines:
Clinical Services
• Accident & Emergency Services
• Anaesthesia Services
• Dermatology
• Eye
• ENT
• Family Welfare
• General Medicine
• General Surgery
• Gynaecology & Obstetrics
• Orthopedics
• Paediatrics
• Psychiatry
• Physiotherapy
• Dental
Super Speciality Departments / Units
• Neuro-Surgery
• Burns & Plastic Surgery
• Cardiology
• Cardio Thoracic & Vascular Surgery
• Gastroenterology
• Neurology
• Paediatrics Surgery
Annual Report 2010-11 179
• Urology
• Nephrology
• Endocrinology
Departmental Special Clinics
• Diabetic Clinic
• Asthma Clinic
• Pre Anaesthetic Clinic
• ART Clinic
• ARC Clinic
Paediatrics & Neonatology Specialty Clinics
• Neonatology & Well Baby Clinic
• Follow – up clinic
• Neurology Clinic
• Nephrology Clinic
• Rheumatology Clinic
• Asthma Clinic
• Thalassemia clinic
• Nutrition Clinic
Gynaecology & Obstetrics
• Antenatal Clinic
• Infertility Clinic
Skin
• Leprosy Clinic
• Leukoderma
Eye
• I.O.L
• Glaucoma
• Retina
Psychiatry
• Child Guidance Clinic
• Drug De-addiction Clinic
• Marriage counselling
• Psycho-Sexual Clinic
• Geriatric Psychiatry Clinic
Yoga Centre for cardiac and other patients Unani
OPD (Daily)
Ayurveda clinic has been started and
Homeopathy clinic has been planned
Blood Bank Services
Dental
• Dental Fracture
DIAGNOSTIC SERVICES
• Hematology
• Pathology
• Microbiology
• Histopathology & Cytology
• Biochemistry
• Radiology including CT Scan, digital X-ray, Color
Doppler, Ultrasound & MR
SUPPORT SERVICES
• State of the art Library
• C.S.S.D
• Laundry
• Pharmacy
• Bank
• Post Office
• ISD, STD, PCO Booth
• Mortuary including Hearse Van
• Hospital Waste Management Facilities
• Departmental Canteen
• Ambulance Services
13.3.3. Emergency & Trauma Care Services
This hospital has well- established Emergency services
including round- the-clock services in Medicine, Surgery,
Orthopedic and Paediatrics while other specialties are
also available on call basis. All services like laboratory,
Annual Report 2010-11 180
X-Ray, CT-Scan, Ultra-sound, Blood Bank and
Ambulances are available round the clock. A well
established Coronary Care Unit (CCU) and an Intensive
Care Unit (ICU) exist in the hospital for serious Cardiac
and Non-Cardiac patients. The Coronary Care Unit of
the hospital has been completely renovated recently with
new equipments and infrastructure. The hospital has a
well laid down disaster action plan & disaster beds, which
are made operational in case of mass casualties and
disasters.
A Disaster Management Unit is also functioning in the
Casualty Department to attend the serious patients with
the desired care.
An H1N1 Screening centre has been started since June,
2009 to screen the patients round–the-clock which is
supported with Information Cell & Call Centre to inform
& follow up the treating patients. A separate H1N1
Isolation Ward & a 5- bedded ICU has also been set up
in the Hospital on the need basis for treatment of H1N1
patients.
The Hospital has comprehensive trauma care facility with
74 beds at the Trauma Care Centre in readiness to
shoulder the added responsibility of providing
comprehensive & timely emergency medical care to
victims of trauma in the event of any accidents occurring
in Delhi especially in Lutyen’s Delhi.
13.3.4. Sanitation & Enviournmental Concern in
Hospital Campus
The hospital has given high importance to the sanitation
and beautification of entire campus to create a nature
friendly ambience. Under a Special Drive, remodeling
of Plants, landscaping of Central Park Lawns, relaying
of grass, creation of Artificial Water Falls with colorful
lights & fountains and a beautiful Herbal Garden in the
Nursing Home Block have been under taken to give a
refreshing look to the visitors and the patients alike.
Special Sanitation Drives are undertaken at regular
intervals to ensure proper cleanliness and hygienic
atmosphere in the hospital. The Hospital has been
adjudged by the FICCI as the best Hospital under the
enviourrnental concern category in 2010.
13.4.5. Resident Hostels for Doctors & Nurses:
The hospital has provided accommodation to Resident
Doctors as well as Nurses/Nursing students to improve
the Health Care Services by ensuring their availability on
duty in the campus at the time of requirement. There
are 143 rooms in the Doctors Hostel and 100 rooms in
the Nurses Hostel.
13.4.6. Benefits/Activity for person with disability:
The Hospital has facilitated for setting up ramps and wheel
chair service through porters for the person with disability.
13.4.7. Recent Achievements of the Hospital
The following are the latest additions of the patient care
facilities in the hospital;
1. Sanction of General Maternity Ward and Neo-
natal Ward in the Hospital: The Hospital has
received the approval for sitting up of a General
Maternity and Neo-natal Ward at a total cost of
Rs. 2.45 Crores for which 79 posts have been
provided to support the General Maternity and Neo-
natal Services. Till now, the Maternity services were
confined to entitled CGHS beneficiary in the
Maternity Nursing Home having 25 beds with the
approval of General Maternity Ward. It is expected
that with the start of extended Maternity Services
in the year 2010, the quality Maternity services
would be available to all CGHS beneficiaries.
2. College of Nursing: The Hospital’s School of
Nursing set up in 1963 with 25 students capacity
per year has been upgraded into College of Nursing
with intake capacity of 50 students per year. Two
batches of B. Sc (Nursing) have since been
admitted. The estimated cost of the project is
Rs.3.00 crores. The Construction work of the new
campus of college has been completed by HSCC
and the teaching classes have been started in the
New Campus in the year 2010.
3. Dharamshala: A Dharamshala for attendants of
patients has been planned to be constructed on one
acre of land allotted to hospital near the Birla Mandir
to help the attendants/relatives of the outpatients
coming from different parts of the country. The
designs /clearances have been approved & Govt.’s
approval on the estimates of Rs. 6.14 crores has
been received. The detailed estimates and drawings
have been got approved from NDMC. The
construction activity is planned to be started by
CPWD during the current Financial Year itself.
4. Computerization: The computerization of
centralized OPD Registration was started from
2005 to facilitate the outdoor patients to get their
Annual Report 2010-11 181
registration done from any of the 20 Counters in
the OPD Block. There are separate Registration
Counters opened for Senior Citizens, physically
handicapped persons and the staff. The
computerization of Administration & Accounts and
cash handling work has also been started for easy
retrieval of information/record. Only recently, NIC
has undertaken the comprehensive E-Hospital
Project with approved cost of 3.50 crores to cover
all the activities under its umbrella. OPD registration
& repeat visits, IPD registration & ward allotment,
casualty registration, transfer and discharges under
E-Hospital software had been implemented. E-
Hospital implementation covering all aspects of
patient care, Labs, Human Resources of the
Hospital, Inventory control System for the Hospital
and IT induction . The online monitoring of lab tests
has since been made operational.
5. Construction of New Casualty Building: In
order to provide state of the art Emergency Medical
Care, a new Casualty Building is under construction
with a provision of 280 beds. The estimated cost
of the project is about Rs. 26 crores. Moreover, 16
VIP Rooms in the Nursing Home are also under
complete renovation, out of which 6 Rooms have
since been renovated for patients care.
6. Medical Care Arrangements during the
Commonwealth Games-2010: The Hospital
was designated as Nodal Hospital for Medical Care
Arrangements for SPM Swimming Center and
Boxing Center at Talkatora Stadium and National
Stadium. Moreover, the Hospital had created
necessary infrastructure in the Nursing Home for
delegates, Sports person and their families for
Medical Care during the Commonwealth Games-
2010.
7. Improvements in the Super Specialty
Services: The hospital has focused attention
towards the patient care and improved services.
Many new and sophisticated types of equipments
have been procured in the hospital to update the
hospital services. In order to strengthen the super
specialty services to the patients, the Hospital has
planned to construct a new Multi-story Super
Specialty Block on the land available at G- point,
adjacent to Trauma Center which has been recently
handed over to the Hospital by the Land and
Development Office. This will considerably
improve the patient care services and also reduce
the waiting time for the patients. Several new
disciplines are also planned to be aided in proposed
new Super Specialty Block.
8. Citizen Charter & Public Grievance
Redressal: The Hospital has adopted a Citizen
Charter since 1998 and as per the directives of
Hon’ble High Court of Delhi, Public Grievance
Redressal Machinery has also been set up to inform
the patients about the facilities available and also
for redressal of their grievances, if any. There are
19 Complaint & Grievance Boxes placed at
various strategic locations which are opened
periodically and put up before a High Powered
Committee headed by a Consultant & HOD &
reviewed by a Designated Addl MS and also by
the Medical Superintendent. The complainants are
given an opportunity to speak in person to the CMO
in charge and a written reply of the outcome of the
complaint is also sent to the complainant. The
Hospital is revising the Citizen Charter under the
scheme “Sarvotam”.
9. Advance Trauma Life Support (ATLS)
Training: The Hospital started an intensive ATLS
Training Programme for the Senior Doctors to train
them on latest advancement in the Trauma life
support systems. Ten batches, each with 16
trainees have since been conducted in the Hospital
training centre equipped with latest equipments
required for ATLS. In India this course is
conducted only at Lok Nayak Jai Prakash Narayan,
Apex Trauma Centre of AIIMS and at Trauma
Care Centre of Dr. Ram Manohar Lohia Hospital.
10. Distance Education Learning Programme: The
Hospital has started e-diploma course DHLS
(Diploma in Hearing and Learning Speech) in
association with All India Institute of Speech and
Hearing (AIISH) Mysore in which 20 students are
trained each year. Till now, the Hospital has
conducted three courses.
The Hospital has also started a PG Diploma in
Hospital Administration (PGDHA) in collaboration
with IGNOU on distance learning basis. This is
one year diploma course in which 30 students are
admitted. This is third course in a row.
Annual Report 2010-11 182
11. A New Modular Operation Theaters Complex. The
Hospital has proposed for setting up of a New
modular OT complex comprising new State of the
Art 20 modular Operation Theaters in X-ray Block
Building with an estimated cost of
Rs. 36.00 crore. On execution, the OT complex
will provide relief to the patients in getting operation
done and reducing the waiting time.
Financial Allocations: -The financial allocations
made to the hospital during the last five financial
years are given below:
13.4 INDIAN RED CROSS SOCIETY
The Indian Red Cross is the largest independent
humanitarian organization in India. It has always been at
the forefront to alleviate suffering at the time of any man
made or natural disaster. It is a huge family of 12 million
volunteers and members and staff exceeding 3500. It
reaches out to the community through 700 branches spread
through out the country. Its attempt to reduce vulnerability
and empower the community for disaster mitigation is
highly commended. The last Managing Body meeting was
held on14th June 2010 under the chairmanship of
Shri Ghulam Nabi Azad.
Final Estimate Expenditure
( Figures in
lakhs)
2006-2007
Plan 5673.50 5672.95
Non Plan 5801.05 5794.82
2007-2008
Plan 7071.12 7078.33
Non Plan 6381.00 6360.73
2008-2009
Plan 8364.01 8400.26
Non Plan 9315.00 9313.47
2009-2010
Plan 9430.00 7441.88
Non Plan 12738.00 11990.56
2010-2011
Plan 13397.00 9037.00
Non Plan 12347.00 9516.00
(up to Jan,2011)
13.4.1. Disaster Management:
During the reporting period, a flash flood instigated by
cloud burst occurred at Leh (Jammu & Kashmir) in the
intervening night of 5
th
and 6
th
August 2010. About 400
families were badly affected due to the flash flood and
subsequent massive landsliding made the situation worse.
The Secretary General accompanied the Hon’ble
Chairman IRCS, (Union Health Minister) Shri Ghulam
Nabi Azad to assess the needs and formulate a response
strategy for the affected . Indian Red Cross was the only
organization that deployed water purification unit for
providing clean drinking water to the affected population.
Along with the drinking water, IRCS provided shelter
,relief material and non-food items . Entire relief consisted
of 2 Nomad Water purification units, 123 pairs of gum
boots, 1000 woollen blankets, 1000 kitchen sets, and 300
family tents. The total estimated cost for the non food
items released was Rs 76, 74 600.
Relief activities were undertaken also in Andhra Pradesh,
Haryana , Punjab , Uttar Pradesh and Tripura which
Annual Report 2010-11 183
were affected by storm , rainfall, and flooding. From The
IRCS National Headquarters, the Hon’ble Chairman,
IRCS,(Union Health Minister) Shri Ghulam Nabi Azad
flagged off relief supplies for Bihar cyclone on 23-4-2010.
WatSan units deployed served 60,000 people with safe
drinking water during AP floods. Total Relief sent across
to the states during the adverse times amounted to
Rs 7 crores.
13.4.2. DRR & Livelihood Disaster Risk Reduction
(DRR)
The purpose of the programme, “Community centered
Disaster Risk Reduction” in India is based on the
approaches founded in the Indian Red Cross Society
strategic development plan. This plan of the National
Society addresses practical DM strategic measures to
minimize vulnerability and risk of affected communities.
For IRCS this means working with vulnerable
communities, identifying their capacities, plan for actions
that reduce specific risks and “build safer communities”.
IRCS seeks to implement its DM strategic measures by
addressing locally based risks, vulnerabilities, community’s
coping capabilities, and required institutional capacities
to manage disaster events. IRCS being efficient in
disaster response and rehabilitation activities has also
implemented successfully community based disaster
preparedness programmes.
IRCS is implementing Disaster Risk Reduction (DRR)
program in 3 states - Maharashtra, AP and Orissa
supported by Hong Kong & Canadian RC. DRR
program implementation guidelines have been developed.
13.4.3. Livelihood Projects
The project supported by Spanish Red Cross has been
completed in the states of Andhra Pradesh and Tamil
Nadu to benefit fisher folk community, at a total cost of
Rs.4.72 crores for 11,000 beneficiaries.
13.4.4. Health: During the reporting period, the Society
continued its HIV/AIDS activities under which Youth Peer
Education, Stigma & Discrimination and care for children
of HIV positive parents were covered. The Red Cross
India HIV Consortium has 11 members with German and
Hungarian Red Cross as new members and Italian Red
Cross also joining the HIV activities.Tuberculosis Project
India is a Pilot Project to take care of 200 CAT II patients
who are defaulters or likely to default .The Project has
been implemented in the states of Punjab, Uttar Pradesh
and Karnataka. TB Project has been successful and
through Programme Integration TB as an opportunistic
infection has been addressed. H2P Programme supported
by USAID is implemented in 9 districts of the state of
Punjab, AP and Maharashtra with the total budget
amounting to INR 1.62 crores. Community preparedness
for influenzas programme supported by WHO is being
implemented in 9 target states i.e., West Bengal, Tripura,
Orissa, Uttarakhand, J&K, Chhattisgarh, Gujarat, Dadra
& Nagar Haveli and Andhra Pradesh. Total Budget INR
20.00 lakhs. The health maternity and child welfare
services continued throughout the services under the Red
Cross banner at its 440 centres.
Indian Red Cross blood banks contribute 10% of the
total blood requirement in the country. The IRCS NHQ
Blood Bank collects 85% blood from voluntary donors
against the national average of 62%.The(NHQ) Blood
Bank is fully equipped with infrastructure to provide blood
services and training facilities of the highest standards,
as per national guidelines. IRCS,NHQ Blood Bank is the
first Red Cross Blood Bank in the non governmental set
up in the country to be designated as Model Blood Bank
by NACO.The upgraded Model Blood Bank was
inaugurated by Hon’ble Minister of Health& Family
Welfare ,(Chairman of IRCS )Shri Ghulam Nabi Azad
on 14
th
June 2010. During the period 2009-10 the blood
bank collected were 26486 units of blood and 293 blood
donation camps held.
13.4.5. Family News Service (FNS)
FNS is provided to the anguished families and its
members separated due to conflicts, disasters, migration
and other socio-economic situations. During the last
financial year 560 Red Cross Messages were exchanged,
and 21 tracing cases were successfully solved.
13.4.6. Post Graduate Diploma Course in Disaster
Preparedness and Rehabilitation
This course has been initiated by the Indian Red Cross
Society to develop knowledge on disaster preparedness,
rehabilitation, and sustainable development including
framework and skills for addressing anticipated hazards,
disaster and complex emergencies with an emphasis on
either post development or majority world context. Four
batches have successfully completed the course and
process for enrollment for the 5th batch has started.
Annual Report 2010-11 184
Following facilities have been added and upgraded:
• Ham Radio
• GIS lab
• Emergency operation centers
• Facilities for computer training.
13.4.7. Health Promotion through Ayurveda & Yoga
IRCS in collaboration with Department of Ayush, Ministry
of Health and Family Welfare, has started 50 hours
certificate course (3 month part-time programme).
Due to drug resistance in the post antibiotic era this course
shall initiate people to discover alternate ways of
medication, recovery and better health. The first batch
was started on 2-2-2010 with 50 students. Most of the
course participants reported enhanced level of energy,
cure from ailments and overall better health. Due to
overwhelming response and excellent feedback more
batches are being started on regular basis.
13.5 ST. John Ambulance India
The National Council of St John approved the upgraded
version of the First Aid Manual for use by the St John
Ambulance (India) as well as the Indian Red Cross, which
would be available from January 2011.The National
Council also approved the establishment of fourteen St
John Centers in Tamil Nadu besides one centre each in
Jharkhand, S.E.C.R Railway Chattisgarh ,Bilaspur. During
the period April 2010 to November 2010, National
Headquarters computerized, printed and issued 3,93,187
proficiency certificates to the eligible candidates who have
qualified for First Aid, Home Nursing, Hygiene and
Sanitation, Mother Craft and Child Care.
13.6 EMERGENCY MEDICAL RELIEF
Health Sector Disaster Management:
Emergency Medical Relief Division (EMR) of Directorate
General of Health Services, Ministry of Health & Family
Welfare, Govt. of India is mandated for prevention,
preparedness, mitigation and response on health sector
disaster management activities and coordinates health
activities in terms of manpower and material logistics
support to the states.
13.6.1. Preparedness and Response for Disasters
13.6.1.a. Preparedness for disasters:
The Emergency Support Function Plan was circulated to
all concerned and it contains the emergency support
functions assigned to the MOHFW which includes details
of nodal officers for coordination, crisis management &
quick response at Hqrs. and field level, resource inventory
etc. This plan also contains instructions regarding
deployment of resources in the event of disasters. Advance
Trauma Life Support training were institutionalized in two
Central Government Hospitals. About 200 doctors from
Delhi & Central Government Hospitals were trained in
Advance Trauma Life Support.
13.6.1.b. Response
Ministry of Health and Family Welfare was represented
in the central assessment teams of the Ministry of Home
Affairs that visited Leh (flash floods), Uttarakhand (flood)
and Uttar Pradesh (flood) for Rapid Health Assessments.
Relief were recommended in terms of norms under
Calamity Relief Fund /National Calamity Contingency
Fund. Public Health Expert teams were deputed to
investigate disease outbreaks in the States of Gujarat, Uttar
Pradesh, Orissa, Bihar and Kerala during the current year.
The concerned State Governments were advised on
prevention and containment measures.
13.6.2. Public Health Emergencies
13.6.2.a. Pandemic Influenza –Preparedness and
Response.
Influenza like Illness caused by Influenza A [H1N1], a
re-assorted influenza virus, was reported from Mexico
on 18
th
March, 2009 and rapidly spread to affect 214
countries. World Health Organization raised the pandemic
alert level to 6, declaring pandemic of influenza H1N1 of
moderate severity.
The preparedness measures undertaken for avian influenza
came handy. The existing measures were scaled up and
additional measures put in place to limit the entry / spread
of disease into India and to mitigate the impact of the
evolving pandemic.
13.6.2.b. Action Taken by Govt. of India
Government of India took a series of action to prevent/
limit the spread of Pandemic Influenza A H1N1 and to
mitigate its impact. Surveillance to detect clusters of
influenza like illness is being done through Integrated
Disease Surveillance Project. Laboratory network has
been strengthened, from the then existing two laboratories
to forty five laboratories (26 in Govt. Sector and 19 in
Annual Report 2010-11 185
Private Sector) for testing the clinical samples.
Government of India procured 40 million capsules of which
about 28 million have been given to the States/UTs which
is also used for preventive chemoprophylaxis.
Government of India supported State Government/UTs
by strengthening of logistics (medicine, PPE, diagnostic
kits, etc.). Retail sale of Oseltamivir was allowed under
Schedule X of Drugs & Cosmetic Act. Number of retail
outlets have been increased to improve access to anti-
virals. Three Indian manufacturers of Vaccine are being
supported to manufacture H1N1 vaccine. 1.5 million
doses of vaccine have been imported to vaccinate health
care workers. Training of State/District level rapid
response teams are supported by Ministry of Health and
Family Welfare. Indian Medical Association has been also
provided funds to train private practitioners. All States
were requested to gear up the State machinery, open large
number of screening centres and strengthen isolation
facilities including critical care facilities at district level.
A task force in the I&B Ministry is implementing the
media plan. Travel advisory, do’s and don’ts and other
pertinent information has been widely published to create
awareness among public. Senior Officials and Public
health teams were deployed to monitor the situation from
time to time. Necessary guidelines were issued to the
States from time to time. All informations were made
available on dedicated website www.mohfw-h1n1.nic.in.
13.6.3. Medical Care Arrangements on Special
Occasions
Medical care arrangements were organised by the
Dte.G.H.S. for Republic Day and Independence Day
celebrations and important International Conferences etc.
Medical care arrangements were also made during the
State Visits of Heads of States. EMR Division has been
the focal point in monitoring the medical care arrangements
for the Commonwealth Games 2010. Regular meetings
were held and progress reviewed. It also supported the
Delhi Government in providing medical care at 7
competition and 3 training venues. Ministry of Health &
FW supported the State of Uttarakhand in terms of
manpower, drugs, equipments to the Maha Kumbh held
between January to April 2010.
13.7 E- HEALTH (TELEMEDICINE)
E-Health/Telemedicine can expand the reach, range and
quality of Primary Health care services available in Public
Health system. The efforts would seamlessly synergize
with the overall health sector rejuvenation being
undertaken under NRHM. In most hard to reach areas
of the country, the telemedicine technology has the
potential to transform the quality and range of services
initiated through health sector reforms under National
Rural Health Mission. Many other agencies are also
undertaking e-Health initiatives like Department of
Information Technology, Indian Space Research
Organization, Sanjay Gandhi Post Graduate Institute,
Lucknow, All India Institute of Medical Sciences, New
Delhi, Post Graduate IInstitue of Medical Education and
Research, Chandigarh.
As part of the e-Health initiative in the Ministry of Health
& Family Welfare, Government of India, has initiated a
scheme for establishing National Medical College
Network for Rs.60 crores. The National Medical College
Network will be used for the educational needs of medical
students, teachers & healthcare professionals. The
Telemedicine Centre at SGPGI, Lucknow would be the
National Resource Centre and network hub. The National
Resource Centre and the Regional Resource Centres
identified under National Medical College Network would
be strengthened/upgraded and linked through a network
to various medical colleges and medical institutes to
undertake a capacity building exercise and bridge the
knowledge and resource gap.
Tele-Ophthalmology
Tele-ophthalmology is a new approach for ensuring
connectivity and data transfer. With the objective to
provide health care services in the rural areas and to
nullify the shortage of ophthalmologist in the country,
National Program Control of Blindness launched Tele-
ophthalmology project in India. It is important in the view
of the fact that most of the health facilities are centered
on big cities and towns and significant no. of patients
from rural/tribal areas can be managed with some advice
and guidance from specialists and super specialist in the
cities and towns. This technology is helpful in elimination
of preventable blindness from the rural, tribal and un-
served area in the country.
OncoNET India Project
Under this project 2 Regional Cancer Centers (RCCs)
and two associated Peripheral Cancer Centers (PCCs)
have been connected. These are:
1. PGIMER, Chandigarh (RCC) with Civil Hospital,
Bhatinda
Annual Report 2010-11 186
2. KMIO, Bangaluru (RCC) with District Hospital,
Mandya
These four centers are using this facility for early
diagnosis and treatment of patients and further referring
of patients to the respective RCC.
At present, the following are in the process of being
connected with the network and these are:
1. JIPMER Puducherry (RCC) with Government
Hospital, Yanam (PCC)
2. Govt. Arignar Anna Memorial Cancer Hospital,
Kancheepuram (RCC) with Govt. Hospital
Arakkonam (PCC)
3. SKIMS, Srinagar (RCC) with District Hospital,
Poonch (PCC).
13.8. CLINICAL ESTABLISHMENTS ACT, 2010
The Clinical Establishments (Registration & Regulation)
Bill, 2010 which aims at providing registration and
regulation of clinical establishments in the country with a
view to prescribing the minimum standards of facilities
and services for them, has been passed by both Houses
of Parliament. This Act has been notified in the Gazette
of India on the 19
th
August, 2010. The Act will initially
take effect in four states viz., Arunachal Pradesh,
Himachal Pradesh, Mizoram, Sikim, and all union
territories. Subsequently, the Act may be adopted in other
States also. The Ministry is now in the process of
formulating Rules under the Act. This is a progressive,
pro-public and user friendly legislation which will enable
a national data base for all clinical establishments including
the Government hospitals in the country.
13.9 INDIAN ORGAN DONATION DAY
The 6
th
World and 1
st
Indian Organ Donation Day and
Organ Donation Congress 2010 was organized on 27-28
November 2010 at New Delhi. Scientific meeting of
‘Organ Donation Congress 2010’ was held at Vigyan
Bhawan and inaugurated by Shri Ghulam Nabi Azad
Hon’ble Union Minister of Health & Family Welfare. Shri
Dinesh Trivedi, Hon’ble Union Minister of State Health
& Family Welfare was the guest of honour on the
occasion.
About 500 delegates and invited guests participated in
the scientific event. Experts in the field of organ transplant
from various organizations like World Health Organization
(Geneva), Fair Transplant (Geneva), The Transplantation
Society (USA), German Organ Procurement
Organisation (Germany), National Transplant
Organization (Spain), Red Cross Society (Thailand),
International Society of Nephrology (Australia) and
various other international societies from China, South
Africa etc. participated in these two day events. Various
national associations related to organ transplantation like
Indian Society of Organ Transplantation, Indian Society
of Nephrology, Indian Society of Urology,
Gastroenterology Society of India, Cardiothoracic Society
etc were co-partners of the event. Private sector and
NGOs also extended their support and participated. Nine
deceased organ donors were also honoured by
Shri Ghulam Nabi Azad, Hon’ble Union Minister of Health
& Family Welfare with silver plated plaques at Vigyan
Bhawan.
A painting competition and slogan competition on the
theme of ‘organ donation’ was also held at Delhi
University before the main event was held. A rally and
painting competition was also organised at India Gate on
27
th
November 2010. About 2500 children and others
participated in the rally and painting competition. Mrs.
Sheela Dixit, Hon’ble Chief Minister of Delhi was chief
guest at India Gate function. Shri Ghulam Nabi Azad,
Hon’ble Union Minister of Health & Family Welfare
presided over the function. The evening function was
attended by about 5000 people including eminent invited
experts, faculty, international and national delegates of
the conference and general public. The winners of various
activities and distinguished international delegates were
also honoured in the evening function. This event has
taken the agenda of deceased organ donation to the
Shri Ghulam Nabi Azad, Hon’ble Union Minister of Health &
Family Welfare honoring a relative of deceased organ donor
on the occasion of inauguration of ‘Organ Donation Congress
2010.
Annual Report 2010-11 187
forefront and increased awareness in the general public
which is likely to change the attitude in increasing the
organ availability.
Action plan for implementation of THOA amendments
to initiate National Organ Transplant Program, was
approved in November 2010. An amount of Rs. 25 crores
for 2010-11 & 2011-12 has been allocated for 11
th
plan
for this purpose which will be utilized for Tissue bank,
Model Organ procurement & distribution organization
(MOPDO), transplant coordinators training and IEC/
media purpose for mass awareness.
A view of painting competition on the occasion of Organ Donation Day on 27
th
November 2010.
Annual Report 2010-11 189
Chapter 14
14.1 FOOD SAFETY AND STANDARDS
AUTHORITY OF INDIA
The Food Safety and Standards Authority of India (FSSAI)
has been established under the Food Safety and Standards
Act, 2006 as a statutory body for laying down science
based standards for articles of food and regulating
manufacturing, processing, distribution, sale and import
of food so as to ensure safe and wholesome food for
human consumption.
Highlights of the Food Safety and Standards Act, 2006
aims to establish a single reference point for all matters
relating to Food Safety and Standards, by moving from
multi-level, multi-departmental control to a single line of
command. Various Acts and Orders that have hitherto
handled food related issues in various Ministries and
Departments have been integrated in the Food Safety
and Standards Act, 2006. Thus, the Central Acts like
Prevention of Food Adulteration Act, 1954, Fruits Products
Order, 1955, Meat Food Products Order, 1973, Vegetable
Oil Products (Control) Order, 1947, Edible Oil Packaging
(Regulation) Order, 1998, Solvent Extracted Oil, De-oiled
Meal and Edible Flour (Control) Order, 1967, Milk and
Milk Products Order, 1992 etc will be repealed after
commencement of the FSS Act, 2006.
Notification
Ministry of Health and Family Welfare, Government of
India is the administrative ministry for FSSAI which is
the agency for implementation of the new law. The
Authority was notified on 5
th
September, 2008 with 22
members. The head office of the Authority is at Delhi.
The Authority has started its operations with Chairperson
and Chief Executive Officer who are in the rank of
Secretary and Additional Secretary to Government of
India respectively, and the staff who were implementing
the various food related orders.
Quality Control in Food & Quality Control in Food & Quality Control in Food & Quality Control in Food & Quality Control in Food &
Drugs Sector, Medical Stores Drugs Sector, Medical Stores Drugs Sector, Medical Stores Drugs Sector, Medical Stores Drugs Sector, Medical Stores
Shri P.I. Suvrathan, former Secretary to Ministry of Food
Processing Industries, is the Chairperson of FSSAI. Shri
V. N. Gaur in the rank of Additional Secretary to
Government of India, is the Chief Executive Officer of
the Authority.
FSSAI has been mandated by the FSS Act, 2006 for
performing the following functions:
Framing of Regulations to lay down the Standards
and guidelines in relation to articles of food and
specifying appropriate systems of enforcing various
Standards thus notified.
Laying down mechanisms and guidelines for
accreditation of certification bodies engaged in
certification of food safety management systems
for food business.
Laying down procedure and guidelines for
accreditation of laboratories and notification of the
accredited laboratories.
To provide scientific advice and technical support
to the Central Government and State Governments
in matter s of framing the policy and rules in areas
which have a direct or indirect bearing on food
safety and nutrition.
Collect and collate data regarding food
consumption, incidence and prevalence of food
hazards, contaminants in food, identification of
emerging risks, food surveillance, introduction of
rapid alert system etc.
Creating an information network across the country
so that the public, consumers, Panchayats etc
receive rapid, reliable and objective information
about food safety and issues of concern.
Annual Report 2010-11 190
Provide training programmes for persons who are
involved or intend to get involved in food businesses.
Contribute to the development of international
technical standards for food , sanitary and phyto-
sanitary standards.
Promote general awareness about food safety and
food standards.
Composition of FSSAI
The FSSAI consist of a Chairperson, Member Secretary
and 22 members which includes representative of Food
industry (Small Scale & Large), Food technologists, States
& UTs, Farmer’s orgn etc.
Steps Taken By FSSAI till December, 2010
1. Six meetings of the Authority have been held so
far in which various rules and regulations have been
approved.
2. The Central Advisory Committee (CAC), as per
Section 11 of the Food Safety and Standards Act,
2006, was constituted and notified on 5
th
October,
2009. The CAC comprises of 44 members and
the Chief Executive Officer of FSSAI is the ex-
officio Chairperson. Two meetings of Central
Advisory Committee have been held so far.
3. Food Authority has constituted a Scientific
Committee and eight Scientific Panels for providing
scientific opinion to the Food Authority on various
issues consisting of independent scientific experts:
a) Panel for food additives, flavourings, processing aids
and materials in contact with food.
b) Panels for pesticides and antibiotic residues.
c) Panel for genetically modified organisms and foods.
d) Panels for functional foods, nutraceuticals, dietetic
products and other similar products.
e) Panel for biological hazards.
f) Panel for contaminants in the food chain
g) Panel for labelling and claims/Advertisements.
h) Panel for method of sampling and analysis.
• Two meetings of the Scientific Committee have
been held so far.
• The second meeting of the scientific panel for
functional foods, nutraceuticals, and dietetic
products, genetically modified organisms and foods
were held on 29
th
March, 2010 and 5
th
April, 2010
respectively.
• The third meeting of the scientific panel for
genetically modified organisms and foods was held
on 20
th
December, 2010.
4. Consultation meetings on the draft Rules and
Regulations under Food Safety and Standards Act,
2006 including process for Registration and
Licensing were held region wise across India during
2009 with State Government/UTs Food Safety
Commissioners, stakeholders. A notification on the
draft Food Safety and Standards Regulations
(including Draft Regulations for Licensing
Registration) had been published in part III Section
4 of Extraordinary Gazette of India dated the 21
st
October, 2010 for the information of all persons
like to be affected thereby inviting objections and
suggestions within thirty days. It has also been
notified by the Ministry of Commerce and Industry
to WTO as per the requirements of SPS and TBT
agreements.
5. An Integrated IT-enabled food import information
system is required to be established to facilitate
FSSAI to regulate safety of food imports into the
country an efficient, transparent and hassle free
manner. For this purpose, the project of
ëStructuring and Implementation of Integrated
IT-enabled Imported Food Safety Systemí by
Food Safety and Standards Authority of India
(FSSAI) was assigned to the National Institute of
Smart Government (NISG). National Visioning
workshop and Regional workshop to discuss on the
preparation of a Blue Print for Structuring and
Implementation of integrated IT enabled Imported
Food Safety System under FSSAI were held during
2010.
Based on the reports submitted by NISG and in active
consultation with all stake holders, the imported food
clearance process is being taken over by FSSAI in a
phased manner to ensure that safe food is imported into
the country. FSSAI has since taken over the function of
PHO in the ports of Kolkata, Haldia, Chennai, Mumbai,
Jawahar Lal Nehru Port Trust in Aug-Sep, 2010.
Annual Report 2010-11 191
6. The Food Authority is now the National Codex
Contact Point (NCCP) for maintaining contact with
the Codex Alimentarius Commission, exchanging
information, responding to queries, participating in
meetings etc.
The Food Authority has approved the guidelines for
participation in codex meetings and preparation of
response to Codex matters and also guidelines for the
Codex Contact Point, the National Codex Committee and
National Shadow Committees. The Food Authority has
also established the various Shadow Committees for
reviewing the agenda of the Codex Alimentarius
Commission and its subsidiary committees and finalizing
India’s comments on the various agenda items before
they are sent for approval of the government.
During the year 2009-10, Food Authority had participated
in the 26
th
Session of Codex Committee on General
Principles (CCGP) held in April, 2010 in Paris, 34
th
Session of Codex Alimentarius Commission (CAC) held
in July, 2010 in Geneva, 17
th
Session of Coordinating
Committee for Asia (CCASIA) held in November, 2010
in Indonesia.
7. FSSAI constituted the following Expert Groups to
handle specific assignments for a specific duration:
• Amaze Brain Food
• Energy Drinks
• Fats and Oils
• Food for special purpose and nutritional uses.
8. Meeting with State Food Commissioners and other
stakeholders have been organised for obtaining
feedback on transition to FSSA.
9. Workshops have also been conducted across India
inviting suggestions on transition from PFA to FSSA.
10. Advisories have been issued on hazards from
Melamine contamination in Chinese milk products,
Salmonella contamination in Peanut Butter,
antibiotics in honey.
11. The following studies which were initiated by
FSSAI are in various stages of operation as
enumerated below:
• To review the present status of safety and quantity
of food as well as sanitary and hygiene conditions
of the food made available to children in school
premises and to develop guidelines/manual for
improvement in quality of food served in schools.
In this regard FSSAI have received a proposal from
IIM Bangaluru which is being evaluated. The
expected outcome of the study would be
development of guidelines for safety of food
available to children in schools.
• Diet Study titled, “Assessment of consumption of
processed and non-processed foods in India” by
NIN.
• Laboratory Gap Study by QCI is under process.
QCI has submitted interim report containing
assessment of 35 laboratories, which has been duly
approved by the Authority.
12. Draft framework for interim arrangements of GM
processed food was earlier approved by FSSAI
but now it would be regulated under Biotechnology
Regulatory Authority of India (BRAI) Bill, 2010
moved by Department of Biotechnology.
13. Training programmes have been held for Food
Safety Commissioners, Food Safety Officers and
Designated Officers during June- September, 2010
with a view to prepare them for transition from
PFA to FSSA regime.
14. An International Conference on Best Practices in
Food Safety Implementation was organised in Delhi
in November, 2010 in collaboration with TERI and
MSU.
15. Following drafts for Consultation have been
prepared:
• Draft on Regulation of Trans Fatty Acids, TFAs, in
Partially Hydrogenated Vegetable Oils, PHVOs.
• Draft Regulation on Foods for Special Nutritional
or Dietary Uses
16. Guidelines on the following have been prepared:
• Scheme of Research and Development for Food
Quality and Safety.
• Guidelines and Application Forms Meat Food
Product Order- MFPO
• Setting up of unit under Fruit Products Order.
Annual Report 2010-11 192
17. The following are being finalised keeping in view
recommendations of stakeholders:
• The draft of Code of Self Regulation in Food
Advertisement
• The draft document for Food Safety in Eating
Establishments.
18. New structure of the Authority has been approved.
19. Portal of FSSAI is in place. Public notices and
various drafts for public consultation are posted on
web through this portal.
20. Modernisation of the existing offices has been
undertaken by hiring new offices, providing
computers and internet, installing various software
packages for office automation like com- ddo
package, file tracking system, e- office etc.
21. A Pilot project called “Safe Food, tasty Food” a
first of its kind for upgrading the safety and quality
of food served in eating establishments across the
country has been prepared and circulated to all the
State Govts. /UTs for guidance.
What to expect in the near future
• Implementation of FSS Act and repeal of the PFA
Act & other Orders, relating to Fruits & Vegetables,
Edible Oil, and Meat & Milk.
• Draft paper on surveillance of food & food borne
disease.
• A framework for Food Safety Management System
comprising of :
Competency framework for food safety
professionals to ensure that they retain the skill and
competence requirements needed.
Framework for Certification bodies / Registration
bodies
Procedure for recognizing equivalence of food
safety system with national standards.
Guidance document for implementation of GMP/
GHP.
• Training policy for FSSAI
• Laboratory upgradation policy
• Consumer food safety scheme/ competitive grant
for R&D projects
• Scheme for Centre of Excellence and Food Safety
Centres
• Strategy for revision of standards
• Communication strategy as a part of the risk
analysis and awareness generation
• Pilot project on traceability and recall
• Manuals and guidelines for implementing the rules
and regulations
• Finalization of voluntary code on advertising
• Regulation on labelling & claim and advertising
• Accreditation mechanism and procedure for the
food testing laboratories
• A system for accreditation of food safety audit
personnel and organisations.
• Fixation of limit on Trans Fatty Acids
• Implementation of IT enabled import monitoring
system related to food safety in major entry points
of imported food in the country
• Regulation of GM Foods, Alcoholic drinks, Olive
oil and Energy drinks.
• Continuation of capacity building programmes for
food safety personnel all over the country.
14.2 CENTRAL DRUGS STANDARD CONTROL
ORGANIZATION(CDSCO)
Public Health is one of the major objectives of the
Government of India and to achieve this it is important
that drugs available to the public are safe, potent and
efficacious. Regulatory control over the quality of drugs
in the country is exercised through the Drugs and
Cosmetics Act, 1940 and Rules made there under. The
manufacture and sale of drugs is looked after by the State
Governments while imports, permissions for marketing
of New Drugs in the country, Clinical Trials on New
Drugs are the responsibility of the Central Government.
At the Central level these functions are performed by
the Central Drugs Standard Control Organization
(CDSCO) headed by the Drugs Controller General
(India).
Annual Report 2010-11 193
A. CDSCO Organization
The Central Drugs Standard Control Organization
(CDSCO) has its head quarters at Food and Drug
Bhawan, Kotla Road, Near ITO, New Delhi-110002.
CDSCO has under its control Zonal/Sub-zonal offices,
Port offices and Drugs Testing Laboratories to perform
various regulatory functions in respect of quality control
of drugs.
CDSCO has six zonal offices situated at Mumbai,
Ghaziabad, Kolkata, Chennai and Ahmadabad and three
sub-zonal offices at Bangaluru, Chandigarh and Jammu.
These offices are involved in the GMP audits and
inspection of manufacturing units of large volume
parental, sera and vaccine, recombinant DNA (r-DNA)
derived drugs, blood banks and blood product
manufacturing units. Zonal offices also coordinate with
the State Drugs Control Organizations situated under the
respective zone or subzone in matters of quality control
of drugs in the country.
Regulatory control over the quality of drugs, cosmetics
and medical devices imported into the country is exercised
by the Port offices situated at Sea ports/Airports in Delhi,
Mumbai, Nhava Sheva, Chennai, Kolkata, Cochin and
Ahmadabad.
There are Six laboratories functioning under CDSCO.
Four Central Drug Testing Laboratories are situated at
Kolkata, Mumbai, Chennai and Kasauli and two regional
Drug Testing Laboratories are situated at Guwahati and
Chandigarh. These laboratories are engaged in testing
of samples of drugs in the country.
Functions of CDSCO
1. Approval of new drugs including vaccines to be
introduced in the country.
2. Grant of permission to conduct clinical trials in the
country.
3. Registration and grant of import licenses for drugs,
cosmetics and notified medical devices.
4. Regulation of quality of drugs, cosmetics and
notified medical devices imported into the country.
5. Meetings of the statutory committees like Drugs
Technical Advisory Board and Drugs Consultative
Committees.
6. Laying down regulatory measures and recommend
amendments to the Drugs and Cosmetics Act and
Rules made there under.
7. Prescribing regulatory procedures for regulating
quality of drugs, cosmetics, diagnostic reagents and
medical devices.
8. Approval of Licence as Central License Approving
Authority for manufacture of large volume
parenterals, sera and vaccines, biotechnology
products, medical devices and operation of blood
banks and manufacture of blood products.
9. Coordinating the activities of the States and advising
them on matters relating to uniform administration
of the Act and Rules in the country.
B. Drug Industry
Indian pharmaceutical industry is one of the most vibrant
sectors of Indian industry and has maintained a growth
of 11-12%. It is 3rd largest in the world by volume. The
total size of the Indian Pharmaceutical Industry is about
Rupees 1,00,000 crore out of which exports account for
Rupees 42,000 crore and the rest is the size of the
domestic market. It is 8% of global Production and 2%
of world Pharma market. A large number of bulk drug
units from India are exporting drugs to the US and Europe.
India has the highest number of USFDA approved plants
outside USA. There are 169 USFDA approved
manufacturing facilities in India. Indian pharma companies
are filing highest Abbreviated New Drugs Approval
(ANDA) applications in the USA. Further, there are 153
manufacturing facilities in the country which have been
certified by European Directorate of Quality Medicine
(EDQM) for export of drugs to the European Union.
Such excellent growth in the Pharma sector has resulted
in high expectations from the office of Drugs Controller
General (India). There is significant increase in the
workload of CDSCO in the last few years as shown in
the graph given below:-
Annual Report 2010-11 194
The number of applications received and processed in
CDSCO has increased from around 10,000 in 2005 to
23,000 by 2010.
C. Strengthening of CDSCO
In view of this scenario, the Ministry of Health and Family
Welfare has taken initiatives to strengthen the manpower
at CDSCO to cope up with the increased workload. The
Government of India sanctioned 216 new posts in the
CDSCO to strengthen the headquarters as well as zonal
and port offices of CDSCO. The present strength of
CDSCO is 124 and by filling of the vacant posts the
strength would rise to 327. The posts are being filled
through UPSC. 63 New Drug Inspectors have already
joined while the remaining vacant posts are at various
stages of recruitment process through UPSC. The
Government is also providing additional manpower to
CDSCO through the appointment of contractual staff to
assists the Department in handling the workload.
New Sub-zonal offices have been created at Bangalore,
Jammu and Chandigarh for better coordination with the
State Drugs Regulatory Authorities in these regions.
D. Regulatory Activities at the Headquarters
1. Quality Control over import of drugs and
cosmetics
The CDSCO regulates the quality of drugs and cosmetics
imported in to the country through the system of
registration and licensing as provided under the Drugs
and Cosmetic Rules, 1945. This includes registration of
overseas manufacturing sites and of drugs, both bulk
drugs and finished formulations. Import licences are then
granted to the Indian importers for import of the drugs
from these manufacturers. The quality of imported drugs
is, however, further regulated at the port offices when
the drugs are actually imported.
During the year 2010-11, the office of DCG(I) has granted
391 registration certificates of the manufacturers of the
drugs who intended to export their drugs to India and
have granted 2509 licences for import of drugs into the
country.
The Office of DCG(I) also grants no objection certificates
for dual use items (drugs) which may not be imported for
use as a drug and extension of shelf life on the basis of
stability studies conducted by the manufacturer for the
purpose of export. The office of DCG(I) granted 241
‘No Objection Certificates’ for dual use items and shelf
life extension for export purposes in the year 2010.
Drugs and Cosmetics Rules have been amended to
incorporate a system of registration of cosmetics imported
into the country and the registration will become
mandatory for import of cosmetics from April 2011.
2. Quality Control Over Notified Medical
Devices
Medical Devices notified by the Government of India
under the Drugs and Cosmetics Act, 1940 are regulated
by CDSCO under the provisions of the Drugs and
Cosmetics Rules. The quality control over these devices
is regulated through the system of registration and import
licences as applicable for drugs.
During the year 2010 the office of DCG(I) has granted
301 registration certificates of the manufacturers of the
Medical Devices who intended to export their products
to India and has granted 680 licences for import of
Medical Devices into the country. Apart from this, in 150
cases permissions for import of Medical Devices for test
and analysis have also been granted.
The manufacture of the notified devices is approved by
the DCG(I) as Central Licence Approving Authority.
During the year 2010, 37 manufacturing licences were
approved by DCG(I).
The Office of DCG(I) also processes the applications
for grant of permissions for clinical trials in the country.
The office of DCG(I) has processed 40 such applications
for grant of permissions for clinical trials on Medical
Devices and granted permission for clinical trials in three
cases.
3. Grant of permission for introduction of new
drugs in the country
New Drugs are permitted to be marketed in the country
in accordance with the permission granted by the Drugs
Controller General (India) after ensuring that these are
safe and efficacious and comply with the requirements
of Schedule Y of the Drugs and Cosmetics Rules. The
applicants are required to provide technical data in respect
of safety and efficacy before these could be permitted to
be marketed in the country. The definition of the new
drug also includes Fixed Dose Combinations which are
required to be marketed for the first time in the country.
Annual Report 2010-11 195
During the year 2010-11, the office of DCG(I) granted
1057 permissions for manufacture or import of new drugs.
Apart from this, 180 permissions for additional indications
/ additional strength in already approved drugs were also
granted.
In case of vaccines each manufacturing process is
required to be approved as a new drug and is evaluated
for safety and efficacy before permission for marketing
is granted.
During the year 2010-11, permission for manufacture of
vaccine as New Drugs was granted in 17 cases.
4. Clinical trials
Clinical research is gaining momentum in the country as
there is an increased level of acceptance of Indian
research in the developed countries. The availability of
highly developed infrastructure of clinical research has
made India a destination for global clinical research. Multi
centric trials are conducted by pharma companies
simultaneously in different parts in the world to assess
the safety and efficacy of the drug in different ethnic
groups and these are termed as Global Clinical Trials.
The office of DCG(I) is receiving a large number of
applications for grant of permissions for conducting global
clinical trials in India. During the year 2010, the office of
DCG(I) has granted permissions for 239 Global clinical
trials.
Clinical Trials are also permitted to be conducted in the
country to examine the safety and efficacy of the drugs
proposed to be marketed in the country. The protocols of
such trials are examined by the office of DCG(I) before
these permission are granted. 272 permissions for
conducting such clinical trials in the country were granted
in 2010. In case of vaccines, permissions for clinical trials
were granted in 26 cases.
The Office of DCG(I) also grants permissions for
conducting bioequivalence studies in chemically equivalent
drug formulations to study whether they produce identical
therapeutic response in patients. Permissions for 443 such
studies were granted to conduct of bioequivalence studies
in 2010.
Various initiatives have been taken for further streamlining
the regulatory control over the conduct of clinical trials.
a. Registration of clinical trials has been made
mandatory with the Centralized Clinical Trial
Registry of ICMR with effect from 15th June 2009.
b. Guidelines for conducting Clinical Trials inspections
have been posted on the website of CDSCO (i.e.
cdsco.nic.in).
c. Dugs and Cosmetics Rules are being amended to
make mandatory the registration of Clinical
Research Organizations.
d. The Drugs and Cosmetics Act is proposed to be
amended to include a separate Chapter on Clinical
Trials.
5. National Pharmacovigilance Programme
A Pharmacovigilance Programme of India (PVPI) has
been launched on 14.07.2010 to capture Adverse Drug
Reactions data in Indian population in a systematic way.
The programme will be coordinated by the Department
of Pharmacology, All India Institute of Medical Sciences,
New Delhi which will act as the National Coordinating
Centre (NCC). The Centre will operate under the
supervision of a Steering Committee, under the
chairmanship of Director, AIIMS, New Delhi with
DCG(I) as one of the members of the Committee.
The objectives of the programme are as under:
To monitor Adverse Drug Reactions (ADRs) in
Indian population
To create awareness amongst health care
professionals about the importance of ADR
reporting in India
To monitor benefit-risk profile of medicines
Generate independent, evidence based
recommendations on the safety of medicines
Support the CDSCO for formulating safety related
regulatory decisions for medicines
Communicate findings with all key stakeholders
Create a national centre of excellence at par with
global drug safety monitoring standards
In the first phase of the programme, ten medical colleges
spread across the country will collect the data of Adverse
Drug Reactions (ADRs) in Indian population, and
subsequently it will be expanded to other medical colleges
also. These medical colleges will act as peripheral Adverse
Drug Reaction Monitoring and Reporting (ADR) Centres.
Annual Report 2010-11 196
These ADR Centres will be responsible for collecting the
ADR reports, performing the follow up with the
complainant to check completeness of the ADR reports
as per Standard Operating Procedures (SOP’s) prescribed
for the purpose. The Data so collected will be forwarded
to the National Coordinating Centre (NCC) at AIIMS,
New Delhi.
The Medical Colleges involved in the programme will be
provided Technical, Administrative & financial support
by CDSCO. This support will have the following
components:
1) Providing contractual Manpower in the form of one
Technical Associate (TA) to each of the ADR
Centre.
2) Administrative & financial support in the form of
Computers, Printers, Photocopiers, internet services
etc.
6. Drugs Technical Advisory Board
Drugs Technical Advisory Board is a statutory body under
the Drugs and Cosmetics Act, 1940 to advise the Central
Government on technical matters arising out of the
administration of the said Act and Rules made thereunder
and to recommend amendments to the Drugs and
Cosmetic Rules.
7. Drugs Consultative Committee
The Drugs Consultative Committee is another statutory
committee consisting of Central and State Drug
Controllers to advise the Government on matters relating
to uniform implementation of the Drugs and Cosmetics
Act and Rules made thereunder throughout the country.
The 41
st
meeting of the DCC was held on 28
th
October,
2010.
8. Banning of Drugs
The Drugs and Cosmetics Act, 1940 provides powers to
Central Government to prohibit manufacture etc., of any
drug or cosmetic in public interest. Drugs about which
reports are received that these are likely to involve risk
to human beings or animals in the present context of the
knowledge are examined for their safety and rationality
through the expert committees and DTAB. Manufacture
and sale of the drug if considered necessary is prohibited
by Central Government in public interest through a gazette
notification. During the year 2010 the Drug Rosiglitazone,
an anti-diabetic drug, was prohibited for manufacture and
sale in the country vide Gazette Notification GSR 910(E)
dated 12.11.2010.
9. Training Programmes
Training Programmes for updating the skills of the
personnel working in CDSCO were held during the period
in various fields. Workshops were held on clinical trial
inspections, Medical Devices, training of New Drug
Inspectors, Regulatory affairs and Pharmacovigilance.
10. Transparency in the functioning
The approvals granted by the CDSCO are regularly posted
on the website www.cdsco.nic.in for the purpose of
transparency and accountability. The licences and
approvals granted are put on display daily on two LCDs
for the information of the general public at FDA Bhavan,
Kotla Road, New Delhi. File tracking system has been
introduced in the CDSCO headquarters. The approval
letters in respect of Clinical trials and registrations of
imports have also been started to be posted on the
website.
E. Port Offices
The regulatory control over the quality of imported drugs
and cosmetics is exercised at the port of entries at Sea
ports/Airports situated at Delhi, Mumbai, Nhava Sheva,
Chennai, Kolkata, Cochin and Ahmadabad. The quality
is checked through random sampling of drugs from
consignments, for test and analysis.
Initiatives have been taken for creation of pharmaceutical
zones at Delhi and other air ports for providing dedicated
areas for storage of drugs and sampling of drugs meant
for import or export to ensure that the quality of drugs
does not deteriorate at the ports because of inappropriate
storage.
F. Zonal Offices
Six Zonal offices located at Ghaziabad, Mumbai, Kolkata
Chennai, Ahmadabad, Hyderabad and three sub zonal
offices at Chandigarh, Jammu and Bangaluru, co-ordinate
with State Drug Control Authorities under their jurisdiction
for uniform standards of inspection and enforcement. The
zonal offices are involved in the GMP audits and inspection
of manufacturing units of large volume parental, sera and
vaccine, recombinant DNA (r-DNA) derived drugs and
blood banks and blood product manufacturing units and
coordination with the State Drugs Control Organizations
situated under the respective zone or subzone.
Annual Report 2010-11 197
G. Central Drugs Testing Laboratories
There are six Central Drug Testing Laboratories engaged
in the testing of drugs and cosmetics in the country.
1. Central Drug Laboratory, Kolkata
2. Central Drug Testing Laboratory, Mumbai
3. Central Drug Testing Laboratory, Chennai
4. Central Drug Laboratory, Kasauli
5. Regional Drug Testing Laboratory, Guwahati
6. Regional Drug Testing Laboratory, Chandigarh.
The Central Drug Laboratory, Kolkata is the National
statutory laboratory for quality control of Drugs and
Cosmetics in the country. It is an appellate laboratory in
matters of dispute regarding testing of drugs. The
laboratory is NABL accredited laboratory for chemical
and biological sections. The Central Drug Testing
Laboratory, Mumbai is a statutory laboratory involved in
testing of samples of drugs from the ports, new drugs
and oral contraceptive pills. It is an appellate laboratory
for copper T – intrauterine contraceptive device and tubal
rings. The Central Drug Testing Laboratory, Chennai is
an appellate laboratory for condoms and is testing, as
Government analyst, samples of cosmetics and drugs.
The laboratory has been granted NABL accreditation for
both chemical and mechanical sections. Central Drug
Laboratory, Kasauli is Government testing laboratory for
sera and vaccines. Regional Drug Testing Laboratory,
Guwahati is testing samples of drugs received especially
from States in the East Zone. The laboratory is NABL
accredited laboratory for both chemical and biological
testing. The Regional Drug Testing Laboraotry,
Chandigarh which has been recently established is
involved in testing of survey samples.
H. New Regulatory Initiatives
1. Overseas Inspections
Overseas inspections of drug manufacturing sites would
be initiated from the year 2011. The inspections would
be carried out in the first place in certain units located in
Italy and China.
2. Strengthening of Drugs Testing Laboratories
The testing capacities of the Central Drugs Testing
Laboratories are being strengthened by increasing the
manpower as well as equipments available for testing at
these laboratories. An amount of Rs. 6.39 Crore for
procurements of essentials laboratory equipments through
HSCC has been sanctioned and 50% of this amount i.e.
Rs. 3.195 crore has already been released to HSCC for
procurement of equipments. Further requirements of
equipments for various laboratories for upgrading their
testing facilities are also under consideration of the
Government.
For the purpose of strengthening of manpower in the
Central Drug Testing Laboratories, a proposal for the
creation of 397 additional posts is under consideration in
the Ministry of Finance, Department of Expenditure.
For strengthening of State Drug Testing facilities
assistance was provided to establish or upgrade testing
laboratories in the State to enhance testing facility in the
State laboratories under capacity building project through
World Bank. States have been further requested to
strengthen infrastructure in the State laboratories so as
to increase the testing facilities in the country.
3. Common Technical Documents for New Drug
It is proposed to introduce Common Technical Documents
for submission of technical information for new chemicals
entities by the applicants. Draft guidelines have been
placed on the website of CDSCO. Common Technical
Documents for submission of information for biological
products was earlier introduced in October, 2008.
4. Guidance Documents
Guidance documents for applications for approval of Fixed
Dose Combinations have been put on website for the
benefit of the applicants in providing necessary technical
data along with the applications. A system of preliminary
scrutiny at the time of the receipt of the applications has
also been introduced to expedite the processing of
applications.
14.3 INDIAN PHARMACOPOEIA
COMMISSION DRUG AND ALCOHOL
DE-ADDICTION PROGRAMME
In order to full-fill its main objectives, the commission
has to focus on its priority works with limited resources
being the formative years. By accepting these challenges,
during the period, the one of the important work to be
accomplished was updating of the Indian Pharmacopoeia,
the book of standards for drugs by ways of bringing out
the 6
th
edition. This work was completed within the
stipulated time schedule. The book was released by
Annual Report 2010-11 198
Shri Ghulam Nabi Azad, Union Health & Family Welfare
Minister. The book comprises three volumes. The salient
features are 287 new monographs are included, 1/3
rd
of
the existing monographs of IP 2007 have been updated,
harmonized the monographs on vaccines and sera, special
emphasis on herbal drugs monographs, added monographs
of commonly used exciepents are included, the
Appendices and general chapters are updated, special
emphasis on Liposomal drugs, 8 new and upgraded existing
monographs related to Veterinary products have been
added. It is getting overwhelming response from the
stakeholders for it’s scientific content and presentation.
The other mandate of IPC is publication of the National
Formulary of India. The process has made substantial
progress as the compendium is under printing and could
be published during 2010. As the compendium had been
last published in 1979, a lot of data had to be collected for
compilation of the new publication and the task was
accomplished with concerted efforts.
In the matter of infrastructure development also the
Commission has made substantial progress. The existing
buildings are redesigned and renovated to accommodate
the new task of ‘Reference Substances’ production and
supply to the Regulatory Bodies and Industry including
private drugs testing laboratories. The Commission has
made available reference substances in respect of 51
active pharmaceutical ingredients during 2010 and more
are to be added in the coming times.
Scientists have been recruited in place of those who left
the organization and in the posts created to take up the
task of Reference Substances manufacture.
14. 4 DRUG AND ALCOHOL DE-ADDICTION
PROGRAMME
Drug addiction in India has of late emerged as a matter
of great concern both concerned both due to the social
and economic burden caused by substance use and due
to its establishment linkage with HIV/AIDS. The onus
of responding to the problems associated with drug use
lies on the central and state governments. The constitution
of India under Article 47, enjoins that the state shall
endeavor to bring about prohibition of the consumption,
except for medical purposes, of intoxication drinks and
of drug, which are injurious to health. The activities to
reduce the drug use related problems in the country could
broadly be divided into two arms supply reduction and
demand reduction. The supply reduction activities which
aim at reducing the availability of illicit drugs within the
country come under the purview of the Ministry of Home
Affairs with at the Department of Revenue as the nodal
agency and are executed by various enforcement
agencies. The demand reduction activities focus upon
awareness building, treatment and rehabilitation of drug
using patients. These activities are run by agencies under
the Ministry of Health and Family Welfare, and the
Ministry of Social Justice and Empowerment.
The role of Ministry of Health & Family Welfare in the
area of Drug De-addiction is demand reduction by way
of providing treatment services. The Drug De-addiction
Programme in the Ministry of Health & Family Welfare
was started in the year 1987-88 which was later modified
in 1992-93. The programme was initiated as a scheme
with funding from the central government and
implementation through the states. Under the scheme, a
one time grant in aid of Rs. 8.00 lakhs was given to states
for construction of each Drug De-addiction Centre and
a recurring grant of Rs. 2.00 lakhs was given to Drug
De-addiction Centres established in North Eastern
Regions to meet the expenses on medications and other
requirements. At present 122 such Centres have been
established across the country including centres in Central
Government hospitals and institutions of which 43 Centres
have been established in the North Eastern Region. Under
this programme, a national nodal centre, the “National
Drug Dependence Treatment Centre”, has been
established under the All India Institute of Medical
Sciences (AIIMS), New Delhi which is located in
Ghaziabad while two centres i.e. NIMHANS, Bangaluru
and PGI, Chandigarh have also been upgraded by this
Ministry. The purpose of these centres would not only to
provide de-addiction and rehabilitation services to the
patients but also to conduct research and provide training
to medical doctors in the area of drug de-addiction.
Annual Report 2010-11 199
14. 5 NATIONAL DRUG DEPENDENCE
CENTRE, AIIMS
National Drug Dependence Treatment Centre, AIIMS
which was established during the year 1987-88 and
functioning at Deen Dayal Upadhyay Hospital, Hari
Nagar has now shifted in its own building constructed at
CGO complex, Kamla Nehru Nagar, Ghaziabad started
indoor facilities. Community Clinic of this centre at
Trilokpuri has been functioning from August, 2003 and a
mobile clinic in an urban slum area of Delhi w.e.f. March,
2007. Apart from rendering patient-care services, the
centre, engaged in a number of research projects has an
well equipped laboratory for both clinic and pre- clinical
research and CME activities.
Education:
Undergraduate and Post graduate medical and nursing
students undergo formal training. This includes attendance
to Journal discussions, seminars, case conferences and
staff presentations held every week apart from clinical
training.
14. 6 DE-ADDICTION CENTRE, NATIONAL
INSTITUTE OF MENTAL HEALTH AND
NEURO SCIENCES (NIMHANS),
BANGALURU
Activities at the De-addiction Centre
The De-addiction Centre has entered into its 20
th
year of
functioning. In addition to expanded inpatient facilities,
the centre has been actively providing in-house post-
graduate training in substance use management for
postgraduates in psychiatry, psychology, psychiatric social
work and psychiatric nursing. Short-term training has
been provided for deputed medical officers and social
work trainees from several parts of the country. This
includes WHO fellows from the Asian region and DMHP
trainees. As the regional centre for South India, the DAC
has carried out training programmes in substance abuse
management for de-addiction centres in South India in
addition to functioning as the nodal centre for monitoring
the functioning of these centres. The centre has a thrust
on community interventions primarily workplace
interventions.
Patient care: The Centre has seen 1514 new patients
and 4132 patients have come for follow up during the
period from April 2010 to October 2010.
Training: The centre has conducted the following training
programmes:
1. One day workshop for medical officers on 26
th
September 2010 at Bidar
2. Two day workshop for medical officers and lay
counselors at South Central Railways,
Secunderabad on 24
th
and 25
th
September 2010.
3. One month orientation program on Substance
Use Disorders in the month of November 2010.
4. Conducted Workshop on tobacco cessation for
dentists from Indian Dental Association conducted
by “National Resource Centre for Tobacco
Control”, Department of Psychiatry, NIMHANS,
Bangaluru at Deaddiction Centre, NIMHANS,
during the months of April, August and September
2010.
Toxicology tests:
The toxicology lab has conducted more than 3000 tests
for Urine by HPTLC, Urine kits both single and poly kits
during the above period.
One month Orientation programme on Substance Use
Disorders.
Annual Report 2010-11 200
Release of Information Booklet, ‘Addiction-What to know &
How to get Help’
14. 7 DE-ADDICTION CENTRE, PGI,
CHANDIGARH
The Drug De-addiction and Treatment Center was actively
involved in various extramural activities during this period.
This was aimed at making the general population and,
special and high risk groups aware of various types of
addictive substances, their harmful effects, myths
involved, and various treatments options and accessibility.
A. Following were the activities and achievements of
the center during the period.
1. International Day against Drug Abuse and Illicit
Trafficking was celebrated by the Youth Affairs
Organization in their 3
rd
State Level function in the
Red Cross Bhawan, Sector-16 Chandigarh. Doctor
from the Drug Deaddiction Center gave a talk on
medical, psychological, social aspects of drug and
alcohol abuse.
2. The Faculty of the Center participated in the
Doordarshan program on the problem of addiction,
its prevention and treatment.
3. Doctors of the center held two interactive
programmes with NSS Volunteers of Chandigarh
region.
4. Doctors from the Center participated in three
Chandigarh Administration sponsored lectures and
interactive sessions with the students of Government
and Private Colleges Chandigarh.
5. The Center also organized 3 interactive programmes
with school children and women on various aspects
of drug abuse in the Villages of Tehsil Kharar of
Distt. Mohali of Punjab.
6. A Centre doctor addressed Punjab Armed Police
(PAP) on the various aspects of drug and alcohol
related problems.
7. Center organized three drug deaddiction awareness
and treatment camps in the villages of Tehsil Kharar
of Distt. Mohali of Punjab.
B. The center commissioned 500 SQMT expansion for
Outpatient services. This expansion included
spacious Waiting Halls for patients and their
relatives, larger Record Room cum Registration
room. 8 rooms for Consultant, Senior Residents,
Junior Residents and Medical Social Workers, and
toilets for OPD visitors and staff members. The
facility became operational from 21
st
October
2010.
C. The Outpatient facility has incorporated a ramp for
the disabled patients.
D. The center has started well equipped 2-bed isolation
facility from the existing beds of inpatient for
acutely ill intoxicated patients from 6
th
December
2010.
14. 8 REGIONAL DE-ADDICTION CENTRE
(UNDER DEPARTMENT OF
PSYCHIATRY), JAWAHARLAL
INSTITUTE OF POSTGRADUATE
MEDICAL EDUCATION AND
RESEARCH(JIPMER) , PUDUCHERRY
Background
Department of Psychiatry came into existence at JIPMER
from 1962. The clinical services provided by the
department in the area of substance use disorder was
upgraded and designated as a Regional De-addiction
Centre in 1991 by Ministry of Health and Family Welfare,
Government of India.
This centre has inpatient facilities for the management
of substance abuse disorders. Drug De-addiction Clinic
is conducted on every Saturday (forenoon) which offers
comprehensive psychosocial assessment and
management of substance abuse disorders. The services
for Tobacco cessation facility are also available in this
clinic.
This centre is mainly involved in :
1. Providing clinical care of patients through the
hospital, community based out-reach care. Services
offered have been daily OPD, in-patient care.
Annual Report 2010-11 201
2. Health education-talks on radio and talks in school
on substance use disorders delivered by our faculty
3. Manpower development-training of several
categories of staff
4. Overall quantification of health damage as all
specialities of medicine are available at JIPMER
5. Documentation and creation of data base to facilitate
research in this area.
The services and facilities at the Centre include the
following:
Clinical Service: (out patients department, In-
patient, brief intervention, community care in urban
and rural areas through community health camps)
Teaching/ training: (Junior Residents, General
Duty Medical Officers from various states, Nursing
staff and Anganwadi workers)
Laboratory Service: (Biochemical,
haematological tests and screening for HIV/AIDS
as a part of assessment of health).
Information and Library: (for substance abuse
related health education various pamphlets, videos
are available in local languages).
Education:
A) Under Graduate-During their posting in the
department of Psychiatry, they are posted for a day
in the de-addiction clinic.
B) Post Graduate-Residents doing MD (Psychiatry)
are posted for 6 months during their entire course
duration.
C) Post graduate teaching
Seminar- Weekly
Journal discussion- Once in two weeks
Case Conference- Once in two weeks
Continuing Medical Education
Our faculty attends regularly conferences,
workshops, seminars, symposium, training courses
related to this field
Training by Trainers programme
Lectures delivered by faculty for workers in
transport services, state of Puducherry and to
nursing students from different medical colleges
International Conferences
Effectiveness of Yoga in reduction of stress in
primary caregivers of patients with alcohol
dependence.
Patient Care (Statistics 2010-11)
General Information
1. Total No. of beds : 07
2. OPD Attendance : 1715
3. Admission : 118
4. Discharges : 100
OPD & Specialty New Old Total
Clinics Attendance Cases Cases
General OPD:
(Follow –up-cases) 315 1400 1715
Admitted
patients 118 - 118
Total: 433 1400 1833
Annual Report 2010-11 203
Chapter 15
15.1 INTRODUCTION
The Centre has set up regulatory bodies for monitoring
the standard of medical education, promoting training the
research activities. This is being done with a view to
sustain the production of medical and para-medical
manpower to meet the requirements of health care delivery
system at the Primary, Secondary and Tertiary levels in
the country. This chapter discusses the status of these
activities conducted by the various bodies and institutions.
15.2 MEDICAL COUNCIL OF INDIA
The Medical Council of India was established as a
statutory body under the provisions of the Indian Medical
Medical Education, Training Medical Education, Training Medical Education, Training Medical Education, Training Medical Education, Training
& Research & Research & Research & Research & Research
Council Act, 1933, which was later, replaced by the Indian
Medical Council Act, 1956 (102 of 1956). The main
functions of the Council are (1) Maintenance of uniform
standard of Medical Education at undergraduate and
postgraduate level; (2) Maintenance of Indian Medical
Register; (3) Reciprocity with foreign countries in the
matter of mutual recognition of medical qualifications;
(4) Provisional/permanent registration of doctors with
recognized medical qualifications, registration of additional
qualifications, and issue of good standing certificate for
doctors going abroad (5) Continuing Medical Education,
etc.
Inspections:
A) Undergraduate:
1) Inspections for establishment of new medical colleges = 25
2) Inspections for renewal of permission = 50
3) Compliance Verifications Inspections +Esst. + 11(2)
+ Surprise Inspections (Esst.(10+25+3+1) = 39
4) Inspections for Approval of the colleges = 02
5) Inspections for Increase of seats = 03
6) Inspections for renewal of permission for increase of seats = 14
7) Compliance verification inspections for renewal of
Increase of seats+ increase+ 11(2) Surprise (14+ 0+0) = 14
8) Inspections for approval of the colleges for increase of seats = 01
9) Pre-PG inspection = 01
10) Compliance Verification Inspection for Pre-PG = 00
11) As per Court Order = 00
12) Periodical Inspection + Compliance verification (7+20) = 27
Total 176
Annual Report 2010-11 204
B) Postgraduate:
(i) 279 inspections for approval of starting various
postgraduate medical courses at Medical Colleges
were carried out subsequent to request received
u/s 10A of the IMC Act, 1956 through Central
Government, Ministry of Health &family Welfare.
(ii) 288 inspections for recognition (including
compliance verification) of postgraduate medical
qualification u/s 11(2) of the IMC Act, 1956 were
carried out.
(iii) 223 inspections for increase of seat in various
course u/s 10A of the IMC Act, 1956 were carried
out.
Registration:
Various types of Registration Certificate issued from
1.04.2010 to 30-11-2010 by this Council during the year
under review are as under:
(i) Permanent Registration Certificate - 1387
(II) Provisional Registration Certificate - 1222
(III) Additional Qualification Certificate - 0332
(IV) Good Standing Certificate - 0804
(V) Eligibility Certificate - 1054
Continuing Medical Education: During the year 2010-
2011, the Council has planned to hold 200-250 CME
programmes. Till November, 2010, 200 CME programmes
have been approved are likely held at various medical
institutions in the country.
Accounts & Establishment: The following outlay has
been approved by the Central Government as Grant-in-
aid (Plan & Non-Plan) for the year 2010-2011:
Out lay approved (Rs.)
Plan (including CME) 100 Lakhs
Non –Plan Nil
A sum of Rs. 67,19,66,154/- has been received by the
Council till December, 2010 from other resources. A sum
of Rs. 50,00,000/- was received so far under plan Grants-
in- aid (plan) till December 2010 from the Central
Government.
Policy regarding Establishment of Medical College:
As on date November, 2010 there are 314 medical
colleges in the country out of which 237 medical colleges
have been recognized under Section 11(2) of the IMC
Act, 1956 by Medical Council of India. The remaining
77 colleges have been permitted under section 10A of
the IMC Act, 1956 for starting MBBS course.
The provisions of IMC (Amendment) Act, 1993 whereby
Section 10A was introduced and came into deemed effect
from 27
th
August, 1992 (initially promulgated as an
ordinance). As per the amended Act prior permission of
the Central Government is mandatory for opening of a
new medical college, increase in admission capacity and
starting of new or higher course of studies. The eligibility
and qualifying criteria for opening of a new medical college
is laid down in Establishment of Medical College
Regulations, 1999. The minimum requirement for 50/100/
150/200/250 students admission are contained in the
minimum standard requirements for the medical college
Regulations, 1999.
As per the newly inserted Section 3B (b) (ii) in Indian
Medical Council (Amendment) Act, 2010, the Board of
Governors shall grant independently permission for
establishment of new medical colleges or opening a new
or higher course of study or training or increase in
admission capacity in any course of study or training
referred to in Section 10A without prior permission of
Central Government including exercise of power to finally
approve or disapprove the same.
At present, there are 314 medical colleges in the country
out of which 238 medical colleges have been recognized
under Section 11(2) of Indian Medical Council Act, 1956
by Medical Council of India. The remaining 76 medical
colleges have been permitted under Section 10(A) of
Indian Medical Council Act, 1956 for starting MBBS
course. Out of these 314 Medical colleges, 149 medical
colleges with annual admission capacity of 17382 students
are in Government Sector and 165 medical colleges with
annual admission capacity of 19645 students are in Private
Sector. The admission capacity both in Government and
Private medical colleges is about 37027 students per year.
During the academic year 2010-11, 08 new medical
colleges in private sector and 06 medical colleges in
government sector with admission capacity of 1650
students were granted permission. Out of these, 03
medical colleges were granted permission by the Central
Government and rest 11 medical colleges were granted
permission by the newly constituted Board of Governors,
Medical council of India in view of the Indian Medical
Council (Amendment) Act, 2010. The Central
Annual Report 2010-11 205
Government/Board of Governors has also granted
permission for increase in seats of 175 students in existing
medical colleges during the academic year 2010-11. The
Post Graduate intake capacity of these colleges is about
18625 students annually.
The Central Government has a Centrally Sponsored
Scheme for Strengthening and Up-gradation of State
Government Medical Colleges for starting/increasing post
graduate seats in existing disciplines with priority given
to the disciplines like Anatomy, Forensic Medicine, Obst.
& Gynaecology, Paediatrics, Anaesthesiology, General
Medicine, General Surgery, Microbiology, Paediatrics,
Anaesthesiology, General Medicine, General Surgery,
Microbiology, Physiology, Pharmacology, Community
Medicine, Geriatric, Transfusion Medicine and Bio-
Chemistry. Under this scheme, an amount of Rs. 1350
crores has been earmarked for this purpose. With the
implementation of the scheme, approximately 4000 more
PG seats would be available.
Till December 2010, 44 State Government Medical
Colleges from Bihar, Chandigarh, Himachal Pradesh,
Jharkhand, Kerala, Madhya Pradesh, Orissa, Punjab,
Rajasthan, Uttarakhand, Uttar Pradesh and West Bengal
including 03 medical colleges from Assam have been
covered under this scheme.
15.3 DENTAL COUNCIL OF INDIA (DCI)
The Dental Council of India is a statutory body constituted
by an Act of Parliament viz. Dentists Act, 1948 (XVI of
1948) with the main objective of regulating the Dental
Education, Dental Profession, Dental ethics in the country
and recommend to the Govt. of India to accord permission
to start a Dental College, start higher course & to increase
of seats. For this purpose the Council periodically carries
out inspection to ascertain the adequacy of courses and
facilities available for the teaching of Dentistry.
The Council had received 348 applications in prescribed
form/scheme from the Central Govt. for (i) establishment
of new Dental colleges (ii) starting of MDS Courses
(iii) increase of seats in BDS/MDS Courses, and (iv)
starting of P.G. Diploma Course, for evaluation &
recommendations in accordance with the provisions of
the Section 10A of the Dentists Act, 1948. During the
said period, the Central Govt. on the recommendations
of the Council had permitted for 01 new Dental College
and increase of admission capacity in BDS course in 01
Dental College, starting of MDS Courses in 114
specialities at 43 Dental Colleges, increase of seats in
MDS Courses in 40 specialities in 14 Dental Colleges
and starting of PG Diploma Course in 01 speciality at 01
Dental College.
The Central Govt. on the recommendations of the Council
had allowed / renewed its permission for 2
nd
/3
rd
/4
th
/5
th
/
6
th
year BDS course in 83 Dental Colleges and renewed
its permission for increase of seats for 2
nd
/3
rd
/4
th
/5
th
/6
th
year BDS Course at 27 Dental Colleges, renewed its
permission in MDS Course for 2
nd
/3
rd
/4
th
year at 83 Dental
Colleges in 323 specialities and with increased intake
capacity at 17 Dental Colleges in 56 specialities and also
renewed its permission in PG DiplomaCourse for 2
nd
/3
rd
year at 03 Dental Colleges in 13 specialities. 1012
Inspections of the various Dental Colleges in the country
had been carried out by the Council’s Inspectors/Visitors
during this period. The Council had granted its permission
to start Dental Mechanic Courses at 07 Dental Colleges
& Dental Hygienist Course at 03 Dental Colleges. The
applications for starting of MDS courses / increase of
MDS seats / renewal of MDS course for 2011-12 will be
finalised in February/March, 2011 after considering the
recommendations of DCI.
The Govt. of India on the recommendation of the Council
had issued 87 notifications of recognition of BDS/MDS
qualifications awarded by the 34 Indian Universities &
02 Foreign Universities under Section 10(2) & 10(4) of
the Dentists Act, 1948. The Council had recognized the
Dental Mechanic Course at 05 Dental Colleges and Dental
Hygienist Course at 04 Dental Colleges. A sum of
Rs.19.00 Lakhs has been provided as grant-in-aid to the
Council during the year 2010-2011.
15.4 PHARMACY COUNCIL OF INDIA
The Pharmacy Council of India (PCI) is a body constituted
under section 3 of the Pharmacy Act, 1948 to regulate
the profession and practice of Pharmacy. The objectives
of the Council is to be prescribe minimum standards of
education required for qualification as a pharmacist,
uniform implementation of educational standards,
approval of course of study and examination for
pharmacists, withdrawal of approval, approval of
qualifications granted outside India and maintenance of
Central Register of pharmacists.
The Council arranged 775 inspections of diploma and
degree institutions and held a number of meetings of the
Executive Committee and central council during the last
one year as a result of which approval of 80 Diploma &
Degree institutions was extended u/s 12 of the Pharmacy
Annual Report 2010-11 206
Act; 32 new Diploma & Degree institutions were granted
approval u/s 12 of the Pharmacy Act; 16 new Pharm. D.
institutions were granted approval for the conduct of
course and 5 new Pharm. D. (Post Baccalaureate)
institutions were granted approval for the conduct of
course.
At present 561 institutions with 33635 admissions for
Diploma in Pharmacy and 383 institutions with 22,715
admissions for degree in Pharmacy has been approval
by the Pharmacy Council of India.
Continuing Education Programmes (CEP) play an
important role in the growth of the knowledge bank of
the pharmacist. The PCI from its own resources is giving
a financial assistance of Rs. 10,000/- per course subject
to ceiling of 12 courses to the State Pharmacy Councils
for the conduct of CEP for pharmacists. PCI further
decided to give a financial assistance of Rs. 10,000/- to
one pharmacy institution per state once in a year for
conduct of orientation programme for pharmacy teachers.
The Council has taken up the matter with the State Govts./
State Pharmacy Councils for setting up of Drug
Information Centres for dissemination of knowledge. The
Council is constantly pursuing with the State Governments
for appointment of inspectors to ensure implementation
of section 42 of the Pharmacy Act, 1948.
A new initiative for strengthening/upgradation of
Pharmacy institutions and continuing education
programme for pharmacy teachers and practicing
pharmacists has been approved by Govt. for Rs. 85.00
crores during the 11th Five year plan.
15.5 DEVELOPMENT OF PARAMEDICAL
SERVICES
A Centrally Sponsored Scheme for establishment of one
National Institute of Paramedical Sciences (NIPS) at
Delhi and eight Regional Institutes of Paramedical
Sciences (RIPS) as well as developing the existing
RIPANS, Aizawal as the 9th RIPS and manpower
development to support State Government Medical
Colleges through one time grant has been initiated by
M/o H&FW during the 11th Plan period at the cost of
Rs. 1156.43 crores to be shared in the ratio 85:15 between
Centre and the State Governments.
The Scheme aims to augment the supply of skilled
paramedical manpower and promote paramedical training
through standardization of such education/courses across
the country. This Capacity Building scheme will also lead
to:-
• Reduction in regional imbalances in availability of
Paramedics
• Introduction of courses in New/Cutting Edge
Disciplines
• Augmentation of Capacity for Planning, Monitoring,
Evaluation etc.
• Provision of quality assured services through
in-service training, action research, onsite support
etc.
15.6 INDIAN NURSING COUNCIL (INC)
The Indian Nursing Council is an autonomous body under
the Government of India, Ministry of Health and Family
Welfare. Indian Nursing Council Act, 1947 enacted by,
giving statutory powers to maintain uniform standards and
regulation of nursing education all over the Country.
Indian Nursing Council prime responsibility is to set the
norms and standards for education, training, research and
practice with in the ambit of the relevant legislative
framework. First Inspection is conducted to start any
nursing program prescribed by Indian Nursing Council.
Periodic inspections are conducted as per the requirement
of the institution for new programmes as well as
enhancement of seats.
A sum of Rupees 3,67,32,530.00 has been received from
the training institution as inspection/affiliation fees upto
30
th
November 2010.
Institutions recognized by Indian Nursing Council
Number of Nursing Institutions recognized upto 30
th
November 2010 is as follows:
Number of Registered Nurses
11,28,116 Nurses, 5,76,810 ANM’S and 52,490 Health
Visitors have been registered with various State Nursing
Council upto 31
st
December 2009.
Programme Total
ANM 944
GNM 2287
B.Sc. (Nursing) 1502
P.B.BSc. (Nursing) 462
M.Sc. (Nursing) 432
Post Basic Diploma Programme 173
Annual Report 2010-11 207
New Initiatives
i) National consortium for Ph.D. in Nursing : National
Consortium for Ph.D. in Nursing has been
constituted by Indian Nursing Council to promote
research activities, in various fields on Nursing in
collaboration with Rajiv Gandhi University of Health
Science, supported by WHO. Total 153 students
have been enrolled under National consortium of
Ph.D. in Nursing.
ii) Indian Nursing Council has initiated pro active
measures to relax certain norms with regard to
student patient ratio, student teacher ratio,
experience, having constructed building instead of
five acre land, allowing sharing of physical and
clinical facility to run different programmes.
iii) Relaxing of Govt. order for opening of Additional
Programme in institutions which are running already
INC recognized programme.
iv) Syllabus for different speciality nursing programme
one year post basic has been developed for Training
of Nurses in various speciality courses.
v) 14 Speciality courses have been developed.
vi) Nurse Practitioner programme: The council has
developed Nurse Practitioner programme and under
implementation in various states.
vii) Recipient of Global Funding (GFATM) for training
of 90,000 Nurses in HIV/AIDS and capacity
building of 55 nursing educational institutions in
India.
The website of Council is www.indiannursingcouncil.co.in
& www.indiannursingcouncil.org is being updated
regularly.
15.7 DEVELOPMENT OF NURSING
SERVICES
In order to improve the quality of Nursing Services, the
following activities are being implemented under the
scheme of Development of Nursing Services: -
(i) Training of Nurses.
(ii) Strengthening of existing Schools/Colleges of
Nursing.
(iii) Upgradation of Schools of Nursing attached to
Medical Colleges into Colleges of Nursing
(iv) Establishment of College of Nursing at JIPMER,
Puducherry.
(v) Upgradation of Schools of Nursing into Colleges
of Nursing attached to Dr. R.M.L. Hospital, S.J.
Hospital and Lady Hardinge Medical College, New
Delhi.
(vi) National Florence Nightingale Award for Nursing
Personnel.
Training of Nurses:
The pattern of assistance for conducting Continuing
Nursing Education Programme on the following areas
in order to update the knowledge and skills of the
Nursing personnel has been revised from Rs. 75,000 /- to
1,65300/-
A sum of Rs. 1.00 crore has been allocated for the year
2010-11 for conducting 60 courses to train 1800 Nursing
personnel.
Strengthening of Schools / Colleges of Nursing: In
order to improve the quality of training imparted at the
existing Schools and Colleges of Nursing, a sum of
Rs.25.00 lakhs as revised pattern of assistance has been
approved towards procurement of A.V Aids, improvement
of library, additions and alterations of School/College/
Hostel building.
A sum of Rs. 50.00 lakhs have been released during the
year 2010-11 for strengthening two institution during the
year 2010-11.
Upgradation of Schools of Nursing attached to
Medical Colleges into Colleges of Nursing:
A revised one time assistance of Rs. 6.00 crores has
been approved for upgrading a School of Nursing into
College of Nursing in order to increase the availability of
graduate nurses. The funds are released to the Institute
subject to the condition that State Government/Institution
Category of Nursing Area of continuing
Personnel Education
Staff Nurses - Different clinical specialty
Nurse Administrators - Management Technique
Nursing Educators - Educational Technology
Duration of training - 7 days
No. of Participants - 30 per training
programme
Annual Report 2010-11 208
will bear the recurring expenditure. The financial
assistance is meant for civil works including addition and
alteration of school and hostel building and for furniture,
audio- visual aids.
20 institutions in the states of Rajasthan (5), Jharkhand
(3) Gujarat (2). Tamil Nadu (2), West Bengal (2)
Himachal Pradesh (1), Manipur (1) , Mizoram (1),& Uttar
Pradesh (3) have been released grant-in aid during the
year 2010-11.
Establishment of College of Nursing at JIPMER,
Puducherry and Upgradation of Schools of Nursing
into Colleges of Nursing attached to Dr. R.M.L.
Hospital, S.J. Hospital and Lady Hardinge Medical
College, New Delhi:
College of Nursing at JIPMER, Puducherry has been
established during 2006-07 and the School of Nursing at
Lady Hardinge Medical College, New Delhi has been
upgraded into College of Nursing during 2007-08. The
School of Nursing at Dr. RML Hospital and Safdarjung
Hospital has bee upgraded during the year of 2008-09.
National Florence Nightingale Award for Nursing
Personnel:
National Awards for Nurses are given as a mark of highest
recognition for the meritorious services of the nurses and
nursing profession in the country. From 2007 onwards
this award has been revived with the consent of Hon,le
President of India and named as National Florence
Nightingale Award”. 27 nursing personnel had been
honored with this prestigious award. Each award carries
a Certificate of Merit and Cash Award of Rs. 50,000/- .
A sum of Rs. 80.00 lakhs has been earmarked during the
year 2010-11.
New scheme of strengthening/upgradation of
nursing services under human resource:
I. Opening of ANM /GNM Schools:
A sum of Rs. 250.00 crore have been allocated for the
year 2010–11 for implementing the new scheme. CCEA
has approved this Ministry’s proposal for opening of 132
ANM Schools and 137 GNM Schools in those districts
of the states where there are no such schools. 154 districts
in 23 High Focus States have been identified having no
ANM and GNM schools. A Sum of Rs. 123.00 crore
has been approved so far for release under the new
Sl.No Name of the State No. of No. of
Districts Districts for
for opening opening
ANM GNM
Schools Schools
I. Arunachal Pradesh 3 2
II. Bihar 9 5
III. Haryana - 1
IV. J&K 6 5
V. Manipur - 6
VI. Puducherry 2 -
VII. Orissa 2 1
VIII. Rajasthan 1 1
IX. Sikkim 2 -
X. Uttarakhand 5 4
Total 30 25
scheme of opening of ANM /GNM Schools to the states
as per details given below :-
II. Faculty Development Scheme:
In order to meet the shortage of qualified Post Graduate
teachers in nursing to improve the quality of nursing
education in the high focused States, a faculty
Development programme has been approved and 22
nominations have been received from 7 States for
undergoing training in M.Sc (Nursing) at the identified
Institutions wiz. SNDT College of Nursing, Mumbai,
PGIMER, Chandigarh and Govt. College of Nursing,
SSKM Hospital, Kolkata.
15.8. RAJKUMARI AMRIT KAUR COLLEGE
OF NURSING
The Rajkumari Amrit Kaur College of Nursing, New Delhi,
a subordinate organization of the Ministry of Health and
Family Welfare was established in 1946 with the object
of developing and demonstrating model programmes in
Nursing Education. The College works in close
association with health centres, hospitals, medical centres
and allied agencies for teaching undergraduates, post-
graduates and also for continuing education of nursing
personnel. The college provides advisory and consultative
services on nursing education matters to the States, Union
Territories and some developing countries.
Annual Report 2010-11 209
The admissions & graduations to B.Sc. (Hons) Nursing,
Master of Nursing and M.Phil in Nursing are made on
the basis of merit in the selection test as laid down by the
Academic Council of the University of Delhi.
Total admissions made in July, 2010 = 92
B.Sc. (H) Nursing 1
st
year = 68
Master of Nursing 1
st
Semester = 24
No. of foreign students admitted
during 2010-11:
B.Sc. (H) Nursing = 02
Master of Nursing = Nil
No. of participants in Short term courses: = 60
Community Services: During B.Sc. (Hons.) Nursing
programme the major emphasis was to develop primary
health care competencies in the family and community
setting by utilizing local resources and achieve community
participation. Students actively participated in the national
health programmes.
Continuing Education: During the period under review,
continuing education courses were conducted for nursing
personnel. One national level short-term course on
“Quality Assurance in Nursing” was conducted during
the year 2010-11.
Rural Field Teaching Centre, Chhawla: The Rural
Field Teaching Centre was established in 1950 for the
purpose of providing objective oriented Rural Community
Health Nursing experience to the students. It covers 7
villages with approximately population of 17000 and is
situated 35 Kms. away from the College. The Centre
provides an integrated comprehensive health and family
welfare services to the community in MCH services,
family planning, immunization, nutrition and health
education programme.
The Centre also has DOTS and Microscopic Centre for
screening and treatment of T.B . Patients. Chief Medical
Officer of the R.A.K. College of Nursing is the In-charge
of the R.F.T.C. and DOTS Centre. In addition, the Centre
provides mobile Van clinic services to seven villages with
special emphasis on Primary, secondary and tertiary level.
R.F.T.C. is a team movement point for Pulse Polio
Programme.
15.9. ALL INDIA ENTRANCE EXAMINATION
FOR ADMISSION TO MBBS/BDS
COURSES, 2010 CONDUCTED BY CBSE
The All India Pre-Medical/Pre-Dental Entrance
Examination was conducted in two stages (Preliminary
& Final) by Central Board of Secondary Education
(CBSE) on 3.4.2010 and 16.5.2010 for 15% All India
Quota seats in Medical/Dental courses all over the
country. Total 1,46,230 candidates appeared for
Preliminary Examination. On the basis of the result of
Preliminary Entrance Examination, 14,218 candidates had
been declared qualified for final stage examination. The
final result was declared on 23.5.2010 and 2434
candidates were placed in the merit list and 2238 in
waiting list. Allotment was made upto rank UR- 3467 in
120 Government Medical and 27 Dental Colleges on 2012
MBBS and 238 BDS courses seats respectively.
Allotment of Colleges and courses to the successful
candidates were made as per their rank by Video
Conferencing at three centers AIIH&PH, Kolkata,
AIIPMR, Mumbai, NIS, Chennai and CHEB Building,
New Delhi in two rounds. The whole admission process
for 15% All India Quota of MBBS/BDS seats was
successfully completed by 11.8.2010.
15.10. ALL INDIA ENTRANCE EXAMINATION
FOR ADMISSION TO 50% POST-
GRADUATE SEATS-2010 CONDUCTED
BY A.I.I.M.S. NEW DELHI.
In compliance with directions of the Hon’ble Supreme
Court of India, the All India Institute of Medical Sciences,
New Delhi conducted the All India Entrance Examination
for admission to 50% All India Quota PG Medical/Dental
courses on all India basis.
The Entrance Examination was held at 126 Centers in 15
capital cities in the country on 10.1.2010. A total 62,161
candidates were registered and 56,826 candidates
appeared in the examination for admission to MD/MS/
Diploma and MDS courses. The result was declared on
15.2.2010 for enabling the allotment of seats for the merit/
wait list candidates in 102 Medical and 24 Dental Colleges
all over India. There were 3850 recognized/approved seats
in MD/MS/Diploma Courses and 155 approved seats in
MDS course under the 50% All India PG Quota for 2010.
The allotments were made to the successful candidates
by personal appearance from 23.2.2010 to 17.3.2010 (1
st
round) & 22.4.2010 to 12.5.2010 (2
nd
round for merit
Annual Report 2010-11 210
and wait listed candidates for unallotted seats) and
2.6.2010 to 12.6.2010 (Extended 2
nd
round). The whole
admission process to All India Quota PG/Diploma seats
was successfully completed by 12.6.2010.
15.11 ALLOCATION OF MEDICAL/DENTAL
SEATS FROM CENTRAL POOL
MBBS and BDS Seats:
A Central Pool of MBBS and BDS is maintained by the
Ministry of Health and Family Welfare by seeking
voluntary contribution from the various States having
medical colleges and certain other Medical Education
Institutions. In the academic session 2010-11, 261 MBBS
and 28 BDS seats were contributed by the States and
medical institutions. These seats were allocated to the
beneficiaries of the Central Pool, viz., States/Union
Territories, which do not have medical/dental colleges of
their own, Ministry of Defence (for the wards of Defence
Personnel), Ministry of Home Affairs (for the children
of para-military personnel and Civilian Terrorist Victims),
Cabinet Secretariat, Ministry of External Affairs (for
meeting diplomatic/ bilateral commitments and for the
children of Indian staff serving in Indian Mission abroad),
Ministry of Human Resource Development (for Tibetan
Refugees) and Indian Council for Child Welfare (for
National Bravery Award winning children).
MDS Seats:
There are 4 MDS seats in the Central Pool contributed
by Government of Uttar Pradesh, which are allotted to
the in-service doctors sponsored by the States/Union
Territories without MDS teaching facility on a rotational
basis. For the academic session 2010-11, in-service
doctors sponsored by the States of Uttranchal, Tripura,
Nagaland and Manipur were nominated against these
seats.
Post Graduate Medical Seats for Foreign Students:
There are 5 P.G. medical seats in the Institute of Medical
Sciences, Banaras Hindu University, Varanasi, reserved
for foreign students in a calendar year. The foreign
students against these seats are nominated by the Ministry
of Health & Family Welfare on the advice of Ministry of
External Affairs. During the year 2010, these seats were
allocated to the candidates from Nepal (1 seat), Maldives
(1 seat) and Mauritius (3 seats).
15.12 NATIONAL BOARD OF
EXAMINATIONS
The National Board of Examinations established in 1975,
functioned as a wing of the National Academy of Medical
Sciences upto 1982 Government of India, after a review,
took a policy decision to make it an independent
autonomous body with effect from March 1, 1982 under
the Ministry of Health and Family Welfare.
The Diplomate qualifications awarded by the National
Board of Examinations have been equated with
postgraduate degree and post-doctoral level qualifications
of universities by the Government of India Ministry of
Health and Family Welfare. Considering the fact that
India has the expertise in various sub-specialty areas with
centers having high tech equipment and trained manpower
performing exceptional quality work and also keeping in
mind the need to increase manpower that can render
highest degree of professional work,the National Board
is also conducting Fellowship programme in 16 sub-
specialties.
The 16
th
Convocation of National Board of Examination
was held on 5
th
April 2010 at Vigyan Bhawan, Maulana
Azad Road, New Delhi to confer the Prestigious
“Diplomate of National Board” Degrees to the successful
candidates during the session from Dec, 2008 to June
2009. On that occasion Dr. Montek Singh Ahluwalia,
Deputy Chairman, Planning Commission, would be the
Guest of Honour. Prof. K Srinath Reddy, President of
National Board of Examination presided the Ceremony.
In the convocation, 1500 candidates were awarded
“Diplomate of National Board” Degrees from December
2008 to June 2009 sessions. Approximately 700
candidates in 46 specialties were awarded the degrees in
person and 800 candidates were awarded their degrees
inabsentia. Dr. Montek Singh Ahluwalia awarded Gold
Medals to the candidates for their outstanding
performance in various broad and super specialities.
Interactive teleconferencing sessions for DNB candidates
using facilities of IGNOU are being done every Thursday
from 2.30 PM to 7.30 PM at IGNOU. Interactive radio
counseling sessions for DNB candidates using facilities
of IGNOU are being done every Thursday from 5.00
PM to 6.00 PM at IGNOU.
Annual Report 2010-11 211
The NBE conducted 33 CME programmes for DNB
candidates and 5 CMEs for consultants during the year
under report.
15.13. NATIONAL ACADEMY OF MEDICAL
SCIENCES (INDIA)
The National Academy of Medical Sciences (India)
established in 1961 is a unique institution which fosters
and utilises academic excellence as its resource to meet
the medical and social goals. Over the years, the
Academy has recognized the outstanding achievements
of Indian scientists in the field of medicine and allied
sciences and conferred Fellowship and Memberships.
Fellows and Members are chosen through a peer review
process consisting of screening by the Advisory Panel of
Experts and the Credentials Committee, election through
voting by the Council and by all the Fellows.
As on 31
st
October, 2010, the Academy has on its roll, 6
Honorary Fellows, 830 Fellows and 4950 Members
(including 1625 MAMS and 3325 MNAMS).
The 50
th
Annual Meeting of the Academy was held at
the Govt. Medical College, Patiala on 29
th
, 30
th
and 31
st
October, 2010. The Governor of Punjab, Shri Shivraj Patil
was the Chief Guest. Professor J.S. Bajaj, Emeritus
President and Chairman- Academic Committee, NAMS
was the Guest of Honour.
Seventy Five candidates were given Scrolls of Fellowship
and Membership of the Academy at the ceremonial
occasion of the Annual Convocation of the Academy held
at Govt. Medical College, Patiala.
The Annual General Body Meeting was held on 30
th
October, 2010. Ten Orations and Six Awards were
awarded to eminent Bio-medical Scientists of the Country
for the year 2010-2011.
The Academy has been recognized by the Government
of India as Nodal Agency for Continuing Medical
Education for medical and allied health professionals.
Since 1982, CME programmes are an important activity
of the NAMS to keep medical professionals abreast with
newer/current medical problems of the country and to
update their knowledge for better delivery of medical
education, patient care and health care at large.
In this financial year, financial assistance has been
provided to various Medical Institutions to conduct
seminars/workshops/CMEs on topics of interest and
relevance to India.
Emeritus Professors of NAMS: In order to strengthen
the intramural CME Programmes, the Academy has
appointed 43 eminent Fellows of the Academy for
Emeritus Professorship. The Emeritus Professors have
been assigned the responsibilities viz. (i) to identify one
or more medical colleges where intramural CMEs of
NAMS can be organized and where lectures can be given
by designated emeritus Professors who will also
strengthen the Postgraduate Medical Education through
clinical rounds, case discussion or laboratory exercises,
(ii) to suggest topics/subjects related to their expertise
for intramural CME and would assist in organizing and
conducting these with NAMS support, (iii) to undertake
travel to any part of the country at least once a year and
visit one or two medical institutions to deliver lectures,
seminars and also contribute towards academic activities
and training of Postgraduates. The Directory of the
Emeritus Professors is being updated during the Golden
Jubilee Year of the Academy.
Intramural CME Programmes: The CME Programme
Committee identifies, from time to time, topics of national
and academic relevance for funding as intramural CME
Programmes. The Academy provides TA/DA and
honorarium to Fellows who attend the CME programmes
as Observers. During the year 2010-2011, an intramural
CME programme-NAMS-PGI National Symposium on
“Acute Coronary Syndromes” is being held at the
Postgraduate Inst itute of Medical Education and
Research, Chandigarh.
NAMS has made a major effort to improve the outreach
of CME programme by establishing tele-linkages between
medical colleges so that more medical colleges can
participate and benefit from CME programmes. The
NAMS-PGI Centre for Tele-education in the Health
Sciences at Chandigarh was established in November
2005. The centre is connected to the medical colleges in
Punjab, Haryana and Himachal Pradesh and also to some
district hospitals in Punjab and Himachal Pradesh.
Encouraged by these successful outcomes, NAMS
proposes to intensify such tele-education activities by
developing the NAMS JSB Centre for Multi-professional
Education and Research at Delhi as the major in-house
facility for tele-education.
The Annals of National Academy of Medical Sciences
(India), which is published quarterly, is the flagship
publication of the NAMS and serves as an important tool
for dissemination of recent advances to fellows and
Annual Report 2010-11 212
members of the Academy. The NAMS web site http://
nams-india.in serves as the window to the global medical
community and provides information on the major events
at NAMS.
A highlight of this year’s Annual Conference at Patiala
has been the Continuing Medical Education Programme
on “Modern Multi-Disciplinary Care for Breast Cancer”
and the Scientific Symposium on “High Altitude
Medicine”.
The CME programme of NAMS (India) also covers
Human Resource Development by sending Junior
Scientists to Centres of Excellence for providing training
in advanced methods and techniques. Twenty two
Scientists/Teachers have been selected for advanced
training at specialized centres during 2010-2011.
During 2010-2011, the budget provision is 87.00 lakhs
and 42.00 lakhs under Plan and Non-Plan respectively.
15.14. ALL INDIA INSTITUTE OF MEDICAL
SCIENCES (AIIMS)
All India Institute of Medical Sciences (AIIMS) was
established in 1956 by an Act of Parliament as an
institution of national importance.
The institute has been entrusted to develop patterns of
teaching in undergraduate and postgraduate medical
education in all its branches so as to demonstrate a high
standard of medical education to all medical colleges and
other allied institutions in India, to bring together at one
place educational facilities of the highest order for the
training of personnel in all important branches of health
activity, and to attain self sufficiency in postgraduate
medical education.
For pursuing academic programmes, the AIIMS has been
kept outside the purview of the Medical Council of India.
The Institute awards its own degrees. The AIIMS
continues to be a leader in the field of medical education,
research and patient-care in keeping with the mandate
of the Parliament.
The Institute is fully funded by the Government of India.
However, for research activities, grants are also received
from various sources including national and international
agencies. While the major part of the hospital services
are highly subsidized for the patients coming to the AIIMS
hospital, certain categories of patients are charged for
treatment/services rendered to them.
15.14.1.Medical Education
Undergraduate Medical Education
This year the Institute has admitted 77 students to its
MBBS course. 26 students to B.Sc Nursing (post-
certificate) course, 62 students to B.Sc (Hons) in Nursing
Course, 15 students to B.Sc. (Hons.) in Ophthalmic
Techniques and 09 students to B.Sc (Hons.) in Medical
Technology in Radiography.
The MBBS course is spread over 5 ½ years, dividing the
period to 1 year for pre-clinical, 1 ½ year for para-clinical,
2 year for clinical and 1 year rotating internship. Para-
medical courses like B.Sc (Hons) in Nursing, Ophthalmic
Techniques, Medical Technology in Radiography
continued to be popular and attracted students from other
countries also. The curricula of these courses are under
constant scrutiny by the faculty of the Institute for
purposes of improvement.
This year AIIMS has admitted OBC seats in
undergraduate courses as indicated against each: 19 seats
in MBBS, 03 seats in B.Sc (H) Ophthalmic Techniques,
02 seats in B.Sc (H) Radiotherapy, 10 seats in B.Sc (H)
Nursing, 06 seats in B.Sc (PC) Nursing.
Post-Graduate Medical Education
A total of 448 students, including 24 state-sponsored and
12 foreign nationals were admitted to the above-
mentioned courses during the year under review. The
total number of postgraduate and doctoral students on 31
March 2010 was 1134.
A total of 294 postgraduate students MS/MS/MDS/DM/
MCh/PhD/MSc/M.Biotech passed out during the year
2009–2010.
The Institute provide full time post-graduate and post-
doctoral courses in 57 disciplines. In the year under
review, many post-graduate students qualified for various
degrees and qualified for various superspeciality degrees.
The guiding principle in post-graduate training is to train
them as teachers, researchers and above all as competent
doctors to manage and treat the patients independently.
Continuing Medical Education
The institute organized a number of workshops, symposia,
conferences and training programme in collaboration with
various national and international agencies during the year.
Professionals from various institutions all over the country
Annual Report 2010-11 213
participated in these seminars and workshops and
benefited with update knowledge. Guest and Public
lectures were organized by visiting experts and faculty
of AIIMS.
Training for long term/short term, WHO-in-Country
Fellowship and Elective Training to the Foreign
Nationals Students:
The institute is also providing short/long term training,
WHO-in-Country Fellowship and Elective training to the
Foreign Nationals students.
Training for Scheduled Castes (SC) and the
Scheduled Tribes (ST) Candidates:
The SC and ST candidates are given due consideration
and weightage in accordance with the Govt. of India
guidelines in all selections. During this year 36 SC/ST
candidates were selected for various undergraduate
courses. 11 SC and 6 ST candidates were selected to
the MBBS course, 2 SC and 1 ST candidates were
admitted to B.Sc (Hons) Ophthalmic Technique, 2 SC
and 3 ST candidates admitted to B.Sc Nursing (Post-
certificate) course and 7 SC, 4 ST candidates have been
selected for B.Sc (Hons) Nursing course.
15.14.2. International Role
The Institute continued to provide consultancy services
in several neighbouring countries under bilateral
agreements or under the aegies or international agencies.
During 2009-2010 the institute trained many
WHO-Sponsored candidates to fulfill its international
obligations.
15.14.3. Research
As per the mandate given to the All India Institute of
Medical Sciences, research forms an important
component. AIIMS has been at the forefront of
conducting high quality research, both in the fields of basic
and applied sciences. During the year under review, the
faculty of the AIIMS drew extramural grants for various
research projects from national and international agencies.
15.14.4. Patient-Care Services
The hospital has maintained its tradition of services and
quality of patient care, in spite of ever increasing number
of patients that come to this hospital from all over the
country as well as from abroad. A total of 14,40,254
patients attended the general outpatient department and
specialty clinics of the main hospital and other centres of
AIIMS. A total of 88,486 patients were admitted during
the year in the various clinical units of the Main Hospital
and other centers at AIIMS. A total of 82,474 of surgical
procedures performed during the year in different surgical
disciplines at AIIMS from 01.04.2009 to 31.03.2010
15.14.5. Cardio-Thoracic Centre
The Cardiothoracic Centre at AIIMS continued to be in
the forefront in maintaining the tradition of patient care,
teaching and research encompassing a wide range of
surgical, interventional imaging and laboratory procedures,
stem cell therapy and organ retrieval and banking in
addition to medical therapy for a wide range of ailments
related to disease of the cardiovascular system.
New facilities were added to strengthen patient care
including two new surgical operating rooms, one of which
is a hybrid operating room which combines surgery and
interventional therapy; A 10-bedded neonatal intensive
care unit to take care of extremely small babies & a new
CT6 ward. A new outpatient clinic (Aortic Clinic) has
been started on Wednesday and Thursday morning to
cater to patients suffering from diseases of the aorta under
one roof. The faculty of the cardiothoracic center was
actively involved in delivering lectures at national and
international meetings and projecting AIIMS as a leader
in this field. In addition several conferences were
organized by the various departments of the center and
many observers and specialists were imparted training.
Important areas of continuing research include stem cell
research, applications of advanced cardiovascular CT and
MRI genetic polymorphism studies in coronary artery
disease patients, nuclear cardiology studies related to stem
cell labeling cardiac dyschrony evaluation, assessment of
myocardial viability and various projects funded by ICMR.
In addition to this, community health and stress
management programs are being actively promoted.
The stem cells facility at AIIMS has initiated clinical
research in degenerative disorders like heart muscle cells
regeneration, ocular surface reconstruction, peripheral
vascular disease, stroke, myocardial infarction, dilated
cardiomyopathy, non union of fracture, extrahepatic biliary
atresia & spina bifida. The Organ Retrieval & Banking
Organization (ORBO) has been instrumental in procuring
organs and tissues for transplantation & in spreading the
knowledge of importance of donating organs.
Annual Report 2010-11 214
15.14.6. Dr. Rajendra Prasad Centre For
Ophthalmic Sciences
Dr. Rajendra Prasad Centre for Ophthalmic Sciences for
now more than 43 years is the oldest Centre at the AIIMS
functioning on the tenets and guidelines issued from the
MHFW and the GB/ IB, on which norms all the subsequent
superspeciality Centres here at AIIMS have been
developed. The Centre carries about 25% of the total
AIIMS patient care load. Dr. R.P. Centre is the first major
continuously reaccredited WHO Collaborating Centre for
Prevention of Blindness (PBL) in the South East Asian
SEARO region since 1973. The Centre continues to be
the initial member of INTERSUN (WHO’s International
Sun Monitoring Project) – efforts are under way to set
up the UV monitoring units with Project ISUVRA (Indian
Solar Ultra-Violet Radiation Assessment). The Chief of
the Centre is the Director of this WHO Collaborating
Centre for PBL, & also continues to be the Honorary
Advisor Ophthalmology to the Ministry of Health &
Family Welfare, Govt. of India, the RPC remaining the
Apex Centre under the NPCB, GOI.
The Faculty of this premier Eye Centre have been
honoured by several international and national awards and
published numerous scientific works in international and
national peer reviewed journals and, even residents and
research associates have presented their research works
in various international conferences, authored books and
delivered lectures besides attending scientific meetings
and providing specialized training and filing patents. Many
such research projects in various fundamental aspects
are ongoing at the Eye Centre.
Efforts are under way to secure an upgraded and
integrated 4-year programme for Bachelor of Optometry
and Visual Sciences at RPC along with a 1-year
internship, and also Fellowships for both this Course as
well as in the specialities of Clinical Ophthalmology, etc.
Over 110 junior and senior residents at any one time,
constitutes the world’s largest ophthalmology residency
training programme.
Dr. R.P. Centre has 15 clinical and paraclinical
departments with numerous state-of-the- art Investigative
and Clinical Service labs. During this period, 113712
patients in OPD and 91165 in our Speciality Clinics were
attended to [total 224375], 17512 indoor patients admitted,
13564 operations performed, and more than 200,000
laboratory and other investigations were carried out. The
Centre also provides round-the-clock Eye Casualty
services, with 19498 more patients registered in Eye
Casualty alone during this period. Our workload continues
to escalate. The Centre is providing eye care services to
urban slum populations, including eye OPDs, provision of
subsidized spectacles, free surgeries and investigations.
Cataract surgery is being provided totally free of cost to
patients identified and brought in from the rural areas.
At the Centre several specialized procedures in
ophthalmoplasty, corneal and refractive areas are being
carried out, along with newer vitreoretinal and macular
procedures including intravitreal drugs especially for
ARMD and DR, and newer investigations and techniques
in glaucoma, squint, and neuro-ophthalmic disorders being
undertaken with gratifying results.
For further upgradation of patient care services, newer
facilities have been initiated in Ocular Biochemistry,
Ocular Microbiology, Ocular Pathology, and Ocular
Pharmacology. A DNA chip for diagnosis of eye infections
has been developed and commercially launched by the
Industrial partner of the recently concluded CSIR
(NMTLI) multicentric project. Newly established Stem
cell/ Tissue and Cell culture facility, PCR and Molecular
Biology laboratories are fully functional. The advanced
bioanalytical system with LC-MS/MS has completed
installation at RPC.
Community Ophthalmology services and projects continue
to form a major part of the activities of RPC along with
NPCB (National Programme for Control of Blindness)
and WHO. Inculcating awareness of disease among the
public has been given a suitable fillip with the recent ADR
monitoring, Glaucoma Awareness, and Drug Monitoring
programmes. Dr. R.P. Centre has extended its exemplary
and unique Eye Centre services spread far afield, and
continuing as in the North Eastern state of Meghalaya,
with several speciality eye camps under the NRHM, and
also closer to home as in the state of Uttarakhand.
The Centre organized several conferences/ workshops/
symposia during this period including live surgeries in
Ophthalmic superspecialities. The XXV
th
National Eye
Donation Fortnight was held from 25 Aug – 08
th
Sep 2010
where Awareness Drive for Eye Donation was launched
and charts and pamphlets distributed. Dr. R.P. Centre is
in constant collaboration with ORBIS International and
major INGOs especially with regard to childhood
blindness activities, and the National Forum of Vision 2020:
The Right to Sight-India. The Chief RPC continues as
the active Vice President of Vision 2020: India.
Annual Report 2010-11 215
• CCTV in the OTs has been improved to long
distance transmissions in the city – Telemedicine
is being augmented for better patient care, teaching
and research.
• A newer Digital TV system with direct transmission
has been initiated at RPC Private Wards etc. for
the first time at AIIMS.
The Centre has taken significant steps in improving the
quality of services delivered to all patients (including
Daycare services), despite several constraints. All our
Investigative and Clinical Service Labs are being
constantly upgraded as far as practicable.
Various expansion plans for RPC are also under way,
especially under the XI Five Year Plan. This is a nodal
referral Centre for Tribunals, Commissions, all Courts,
Consumer forum, etc. not to mention innumerable legal
notices and RTI, which have all increased our multifarious
workload tremendously.
15.14.7. Dr. BRA Institute Rotary Cancer Hospital
Expansion project of Dr. BRA Institute Rotary Cancer
Hospital has been completed, and the floor are functional.
15.14.8. National Drug Dependence Treatment
Centre
Besides the Professor and Chief, currently the Centre
has 3 Professors, 2 Associate Professors and 1 Assistant
Professor.
During this period (2009-10), a total of 34570 (new and
old) patients in the OPD, 20401 (old & new) in the
Trilokpuri Community clinic, 8692 in Sundar Nagari mobile
clinic, 72 patients in the Adolescent Drug Abuse clinic,
and 791 patients in the Tobacco Use Cessation clinic and
251 patients in the Dual Diagnosis clinic were seen. A
total of 957 patients were admitted in the ward.
During this period, the following laboratory investigations
were carried out: Drugs of abuse screened (20733),
various biochemical tests to assess health damage
(19739), haematology (5109), and HIV screening (340).
Last 2 years (2008-09) activities supported by the Ministry
and WHO-I supported were:
Workshop: Revisiting the Current Situation and
Planning Ahead
Workshop: Curriculum Development on Agonist
Maintenance
Two Training Programmes on Agonist Maintenance
Development of Minimum Standards of Care
Managing of Alcohol and Drug Dependence in
Primary Care Settings
Assessment of substance use among out of school
children
Peer based Intervention in out of school children
District based monitoring system
Training by Trainers (TBT) Programme
Drug Abuse Monitoring System-data on new
treatment seekers in Govt. De-addiction Centres
Collaboration with NACO and UNODC on starting
OST and evaluation of Centres providing OST and
their accreditation.
Control of alcohol abuse and development of Policy,
carried out with support from WHO-SEARO,
WHO-HQ, Indo-Swedish collaboration and of
course India’s /Ministry’s contribution towards
development of Global Strategy to Reduce Harmful
Use of Alcohol (WHO-HQ activity).
The current (2010-11) ongoing projects being supported
by WHO-I are:
• Convergence of services with special emphasis
on management of substance among adolescents
• Addressing alcohol use in diverse settings including
E-health
• •• •• Developing a network of De-addiction
services between the government, NGO and
private sectors.
The Chief of the Centre was nominated by the WHO as
member of the International Narcotics Control Board
(INCB), 2010-2015 and also appointed as Head and
Member of the Expert Group to finalise National Policy
on Prevention of Alcoholism and Substance Abuse and
Rehabilitation, Ministry of Social Justice &
Empowerment, Govt. of India, January 2010.
In this period seven research projects on ‘Substance Use
Disorder” are ongoing which is being funded by national
and International agencies. Besides these, five funded
research projects have been completed. The faculty
published twelve research articles in indexed national and
Annual Report 2010-11 216
international journals and seven chapters in books\manuals
Reports\Proceedings\Manuals\monographs.
Some faculty also received national as well as international
awards in recognition. The faculty of the centre acted as
a resource person in national and international meetings
as well as in various training programmes held in Delhi
as well as in various states of the country.
The faculty of the department of Psychiatry and the centre
jointly carry out post-graduate teaching that includes
journal discussion, seminar, and case conference and
research/academic presentations once every week.
15.14.9. Department Of Neurology
The new imitates four the department of neurology is
use of stem cells in Parkinson’s disease, subacute stroke
and chronic ischeamic cerebral damage. Pilot project in
this area has been completed or going on a multi centre
study is on going in patient with subacute stroke.
15.14.10. Centre for Community Medicine
The Centre for Community Medicine carries out teaching
training and research activities keeping in view the
mandate of AIIMS. There are 20 post graduates and 2
PhD students. Currently, 11 research projects are
underway through intra mural and extramural funding,
and 26 papers were published.
Rural Programme: The Comprehensive Rural Health
Services Project, Ballabgarh Haryana which is the rural
programme of the Centre provides secondary and primary
level care through a 50 bedded hospital and 2 PHCs.
About 138,894 patients are seen in various outpatient
clinics in CRHSP Ballabgarh annually.
Urban Health Programme: The UHP is located at
Dakshinpuri Extension [Dr. Ambedkar Nagar] in South
Delhi and apart from providing health care to the
inhabitants, acts as a training & teaching centre for
MBBS, MD, Nursing and other students. A mobile health
clinic provides primary care daily, and about 23,712
patients are seen annually.
The telephone helpline on HIV/AIDS, Sex related issues
and contraception (“Shubhchintak”) and Internet based
helpline “E-shubhchintak” continued to be operated with
usual popularity, attracting a good number of calls and
mails daily.
Contribution to various National programmes:
• National Iodine Deficiency Disorders Control
Programme;
• National Rural Health Mission;
• National AIDS Control Organization (NACO) for
HIV sentinel surveillance Uttar Pradesh,
Uttarakhand, Bihar, Jharkhand, and Delhi;
• National Programme for Prevention and Control
of Cancer, Diabetes, Cardiovascular Diseases and
Stroke;
• National Urban Health Mission and
• Revision of the Indian Public Health Standards
(IPHS).
New Initiatives:
• Started an innovative program “Pre-Marriage
Orientation & Counseling for Happy Married Life”.
Seven courses have been conducted so far with
great success.
• Started a series of regular, monthly lecture
discussions on health topics for general public
“HELPs” (Health Education Lecture-discussions
for Public) at AIIMS for important public health
problems like Diabetes, Swine Flu etc.
• Setting up of delivery huts in the Primary Health
Centres as recommended under the National Rural
Health Mission where about 350 deliveries were
conducted last year.
15.14.11. Department Of Nephrology
Department of nephrology is providing integrated best
care for nephrology patients in a government set-up in
the country. Department has done 80 renal transplants
during this period including cadaver transplants. Increasing
chronic ambulatory peritoneal dialysis and hemodialysis
facilities are being provided at cheapest cost. Department
is providing bed side facility of hemodialysis to large
number of departments within the institute inspite of
limitation of staff. Nationally and internationally recognized
work is being done on tuberculosis and hepatitis patients
with kidney disease. Department is the only centre
contributing to world largest transplant registry;
Collaborative Transplant Study, Germany. Department
faculty is awarded grant by the World Health
Organization, International Society of Nephrology and
Japanese Society of Dialysis Therapy. Faculty is regularly
Annual Report 2010-11 217
invited for Guest Lectures at various meetings.
Department has ten publication during this period. Dr.
SK Agarwal, professor and head has been appointed
chairman of nephrology specialty by MCI and National
Board of Nephrology. Dr SK Agarwal is organizing
secretary of 6
th
World Organ Donation Day being
observed at Vigyan Bhawan under Ministry of Health
and Family Welfare on 27
th
Nov 2010. Dr Agarwal is
also coordinator for a multicentric study to find out
prevalence of CKD being funded by ICMR. Faculty had
regularly conducted patient education program in print
and electronic media particularly in U.P. Sahara Samay
on series of education program on chronic kidney disease
for lay public. Department also had visiting faculty from
USA and Australia during this period.
15.14.12. Department Of Urology
The Department of Urology is equipped with the state-
of-art devices and provides a wide range of services,
specializing in minimally access techniques, microsurgery,
robotics and oncology. It organized a Mock Examination
for post graduate trainees (M Ch and DNB) in Urology
for the Urological Society of India in March 2010. 80
PG students of urology attended this three day program
and over 15 faculty members from all over the country
conducted exams in the standard pattern. A live operative
demonstration was also given on common urological
procedures. The department of Urology, AIIMS jointly
organized an “International Uro-oncology Workshop”
with Rajiv Gandhi Cancer Institute & Research Centre
and RML Hospital PGIMER, New Delhi on October 1-
3, 2010. During this Workshop a wide variety of surgical
procedures (open, laparoscopic and robotic) were
demonstrated by International and national faculty. The
faculty of the department delivered numerous lectures
and live operative demonstrations at various meetings
nationally and abroad. It continues to conduct research
in basic and clinical aspects of Urology in collaboration
with various departments in the Institute with both
intramural and extramural funding. The department
published over 40 articles in peer reviewed journals over
the last one year and the faculty received a number of
awards and honors. Over 7500 surgical procedures
including 130 robotic surgeries were performed during
the last year.
Major achievement and success of the department has
been ‘computerisation of discharge summaries and other
related data’.The Department of Urology has taken new
initiatives in the field of Advanced Robotic Surgery and
has done a pioneering work in establishing Pre Peritoneal
approach for doing Radical Prostatectomy with the robot
for the first time in the country besides other advanced
procedures.
15.14.13. Department of Orthopaedics
“The Department of Orthopaedics at AIIMS continues
to be the best in the country and occupies an eminent
position in the field of Orthopaedics in the country. Newer
and highly complex surgeries in the field of trauma, tumor,
hand, spine, joint replacement, arthroscopic surgery and
paediatric orthopaedics are done on a regular basis. The
Department has facility for comprehensive physiotherapy
and rehabilitation of the patients. We also have facility
for Bone banking including cadaver bone banking. A
number of research projects funded by ICMR, DST, DBT
and CSIR are being carried out in the Department. The
Department continues to publish articles in indexed
journals of repute. The faculty members have actively
contributed in many CMEs at national and international
levels. The Department has also served the country at
various health camps at far-flung remote areas. The
department continues to enjoy the trust and faith of millions
of countrymen and is the best testimony to its character”.
15.14.14. Department of Forensic Medicine &
Toxicology
Routine Work:- The Department of Forensic Medicine
& Toxicology continued to provide medicolegal services
to the South Zone and South East Zone of Delhi along
with round the clock coverage to the casualty.
Department also provided consultation in complicated
medicolegal cases to the CBI, NHRC, Crime Branch,
Delhi Police and other investigating agencies.
Forensic Pathology:- Total 1775 postmortems were
performed during this period including at trauma centre.
Department also participated in exhumation as ordered
by competent authorities and guided the investigating
agencies to arrive at logical conclusion.
Casualty Services: About 500 calls were attended from
casualty pertaining to cases of various natures.
Department is also looking after medicolegal records of
casualty.
Clinical Forensic Medicine:- Clinical Forensic
Medicine services were provided by the Department in
cases of injury, age estimation, paternity dispute etc. 20
such cases were dealt during this period.
Annual Report 2010-11 218
Expert Opinion: Department gave expert opinion in
various cases referred by Honorable Courts, CBI and
other investigating agencies.
Court Summons: 380 summons were received by the
Department to appear as an expert from various courts
of law in Delhi and other states.
DNA-Finger Printing: Department is running DNA-
Fingerprinting Laboratory where training is provided to
short term trainees referred from all over India. This
laboratory of the Department performs tests for
medicolegal cases referred by Delhi Police, SDM of
neighboring States, CBI and Honourable Courts of India.
Toxicology Laboratory: The Department provides only
hospital services for toxicology analysis or cases referred
by courts. Tests were done for various poisons and heavy
metals in this laboratory.
CME:- Departmental faculty and officers participated
in various CME programmes. Lectures were delivered
to the officers of CBI, Forensic Scientist, Judicial officers
and medical officers. CME Programmes organized by
the Department include Workshop on Crime Scene
Investigation, DNA-Finger printing and International
conference- INPALMS-2010 in collaboration with
PGIMER, Chandigarh and Amity University, Noida (UP)
Research Publications: 08 research papers have been
published in various scientific journals during this period.
15.14.15. Department Of Biochemistry
• The Department has innovative teaching programs
involving problem based learning and case oriented
small group discussions for MBBS students.
• The Department has provided short-term research
training to many post-graduate students.
• Provided research exposure to undergraduate
students, leading to some of them being successful
in obtaining KVPY fellowship of DST.
• Research grants/ funding amounting to Rs.3.57
crores obtained from DBT, DST, CSIR, DRDO,
ICMR and Indo-US, Indo-Canadian collaborations.
• There are forty ongoing research projects with
departmental faculty.
• Forty seven publications in indexed National and
International Journals.
• Patient care laboratory of the department is
providing clinical service for a number of tumor
markers, free of cost.
• Have applied for two patents.
• Prof. N. Singh conferred fellowship of National
Academy of Medical Sciences.
15.14.16. Department Of Cardiac Radiology
During this year, the Department of cardiac radiology
continued to be at the forefront of providing advanced
cardiovascular imaging and vascular interventional
services to the the Cardiothoracic center as well as other
allied Departments within the AIIMS. These include
cardiovascular CT and MRI, vascular Doppler and
fluoroscopic procedures as well as percutaneous
techniques for vascular recanalization, reconstruction and
occlusion of diseased vessels for all organ systems.
Among educational activities, the Department organized
the Annual Registry meet cum CME of Indian Society
of Vascular and Interventional Radiology on 17-18
th
April,
2010. The Departmental faculty was also involved in
delivering lectures, presenting papers and participating
in workshops dealing with this subspecialty.at various
national and international forums. Besides, the faculty
members are also reviewers for many reputed cardiology/
radiology journals. On the research front, the department
completed participation in 8 research projects, and
initiated/contributed to starting 4 others, dealing with
various diagnostic and interventional aspects of
cardiovascular diseases. At the forefront are projects
dealing with stem cell research and applications of
advanced cardiovascular CT and MRI. There were 6
research papers and one book chapter that were published
with the involvement of this Department.
15.14.17. Department Of Cardiology
In the current year, the Department of Cardiology has
catered to over 1,00,000 outpatients. Over 20,000 patients
had undergone echocardiography, and over 4000 cardiac
catheterizations were performed. Overall around 1000
patients had undergone interventional procedures
including coronary angioplasty, balloon valvuloplasty and
device implantations.
Department of cardiology has been renovating its existing
facilities to cope with its ever increasing demands. The
Echo, Holter, and TMT have been renovated and started
functioning with added capacity. A new state-of the art
Annual Report 2010-11 219
Department is actively involved in many intramural and
extramural research projects. Newer projects including
stem cell research in dilated cardiomyopathy and ischemic
heart disease are underway. Efforts have been made to
refocus the educational activities of the Department to
address the changing needs of current cardiology practice.
The Department has organized a successful CME and
‘Professor Philip Poole Wilson Heart Failure Research
Symposium’ in collaboration with Imperial College /Royal
Brompton Hospital London.
The Faculty of our department has authored 60 papers in
indexed medical journals and some prestigious books.
They have participated and contributed in various national
and International conferences/committees.
15.14.18. Department Of Physiology
The Department provided about 400 hours of teaching to
the first year MBBS students and about 60 hours of
teaching to students of B.Sc. Nursing and allied courses,
besides conducting M.Sc. (Physiology) and MD
(Physiology) courses and guiding Ph.D. students.
15.14.19. Department Of Biostatistics
The Department was actively involved in teaching
“Biostatistics and Essentials of Research Methods” for
the undergraduate, paramedical and postgraduate courses,
viz. MBBS, BSc (Hons) in Medical Technology in
Radiology, M. Biotech, B.Sc. & M.Sc. Nursing and MD
Community Medicine. The Department organised a series
of fourteen evening classes on “Essentials of Biostatistical
Methods and Research Methodology” for the new
residents, Ph.D. students and other researchers in the
Institute. On request, for statistical methods in specific
areas of medical research, Departmental faculty members
delivered series of lectures for the residents, Ph.D.
students and faculty members in several departments in
the Institute. Also, departmental faculty and scientists
delivered invited talks outside the institute throughout the
country. On request, the faculty and scientists also
participated in departmental scientific presentations in
most of the departments in the Institute. Besides guiding
Ph.D. students in the department, faculty members
contributed to the academic activities of other departments
in the Institute as Co-Guides and DC Members of Ph.D.
students. Both faculty members and Scientists contributed
to the academic activities of most of the departments as
co-guides for MD/MS, DM, MCH students.
15.14.20. Department Of Gastroenterology And
Human Nutrition
Established a New Molecular Biology Laboratory In
The Department With State Of Art Facility.
Continuing Medical Education
1. The department organized an “International
Workshop on Micronutrients and Child Health” held
on October 20-23, 2009 at AIIMS, New Delhi.
2. The department organized a “National Consensus
Workshop on Management of SAM Children through
Medical Nutrition Therapy on November 26-27,
2009.
3. The department organized Current perspective in
Liver Diseases (Oct 14-15, 2010)
Lectures delivered in CMEs, national and international
conferences: All faculty members of the department
delivered 42 lectures at the international and national
meetings.
15.14.21. Department Of Pathology
During the period of 01.04.2010 to 30.11.2010 the Faculty
of the Department has published 64 publications in
reputed national and international journals.
Laboratory Services:
Surgical Pathology Laboratory:
No. of specimens processed 28,588
Cytopathology Laboratory:
No. of specimens processed 15,449
Immunohistochemistry Laboratory:
No. of cases processed 4,357
15.14.22. Department Of Cardiac-Anaesthesia
Faculty & Residents of the Department of
Cardiac-Anaesthesia are involved in providing
Anaesthesia care in 7 operation theater, 5 catheterization
labs, CT angiography and MRI Cardiac-Anaesthesia
Department is also involved in resuscitation & ventilatory
care in CTVS-ICU-A & B, ICCU, all the general wards
and C.N.Tower.
9-DM-Candidates including two sponsored LT.Col. from
Army and 8 other post MD-Senior resident doctor are
undergoing superspeciality training in Cardiac-Thoracic-
Annual Report 2010-11 220
Anaesthesia. Dr.Mulidharan from Shree Chitra Institute
of Medical Sciences, Triventhapuram & 3
M.D.Candidates from Lady Hardinge Medical College
were imparted short term training in the specialty of
Cardiac-Anaesthesia.
Researh: - The Departmental faculty is involved in 5
extramural 3 AIIMS funded research projects as chief
investigator/co-investigators.The Departmental faculty is
involved in 06 non-funded (Departmental) research
projects as chief investigator/co-investigators.
Scientific Presentation
Faculty of the Department delivered twenty-nine lectures
in different national & International forums and Resident
doctors & DM students presented- Six papers in national
conferences, topics:-
Thalasamia & heart surgery, Chest trauma, aortic injury
management, PDA ligation in 900gm child.
Percardectomy management in 3mths old child. Post stent
inschaenic TAPVC stent blocked.
New Initiatives Taken & Community Progamme
1). Department is running stress management clinic
for cardiac and neuro patient in CT5 meditation
room.
2). Research initialed on sonoclot and pharmacological
preconditioning youth.
3). Nine Community health programme, stress
management and health awareness for children are
conducted as part of the project My India, healthy
India at GT Karnal Road, Industrial Area. Invited
by Nepal, govt. for participation in “Healthy Nepal”
a mega project.
4). Quit tobacco awareness programme for Rural area
of Panipat.
5). Mind body intervention for heart patients and their
attendants.
15.14.23. Department of Physical Medicine and
Rehabilitation
The Department of Physical Medicine and Rehabilation
was actively involved in providing medical cover for
Commonwealth Games 2010 held at Delhi
Dr. U Singh, Professor and Head was Nodal Officer
Incharge from AIIMS. AIIMS provided medical cover
for the athletes, the teams and the VIPs at the medical
centre located at the Jawaharlal Nehru Stadium and
Thyagraj Stadium.
Dr. Sanjay Wadhwa, Additional Professor, Department
of Physical Medicine and Rehabilitation received the
following awards during this period.
1. Distinguished Services Award by the Geriatric
Society of India, New Delhi
Dr. S.L. Yadav, Associate Professor of the
Department was deputed as acting Venue Medical
Officer for JLN Stadium
Dr. Gita Handa, Associate Professor of the Department
was awarded Standford India Biodesign fellowship
(Pioneering initiative by Department of Biotechnology,
Govt. of India in collaboration with IIT Delhi and AIIMS
to promote Medtech Innovation) and worked as visiting
Associate Professor at Standford University for 6 months
from January to June 2010.
15.14.24. Department of Dermatology And
Venereology
Department Achievements
1. National CME Dermatology AIIMS, 2010 was
organized on April 10-11, 2010.
2. Renovation of D-1 ward was undertaken.
3. Procurement of laswers (Pulsed dye laser, Diode
Laser, Q-Switched Nd-YAG laser) was done.
Laser OT was set up providing free laser services
to the patients.
Faculty Achievements
Dr. M. Ramam elected as President, Indian Association
of Dermatologists, Venereologists and Leprologists, Delhi
State Branch, 2010.
Dr. Sujay Khandpur award as ICMR International
Fellowship for Biomedical Scientists 2010-2011.
15.14.25. Department of Paediatrics
1. A life saving drug for newborn babies, namely,
pulmonary surfactant derived from goat lungs
developed by the Department of Paediatrics has
been licensed for clinical use.
2. The Department continues to provide technical
support on child health in areas of IMNCI, ASHA
Annual Report 2010-11 221
training, Neonatal resuscitation, Pediatric HIV and
tuberculosis.
3. Department developed package for training of
neonatal nurses working at district and sub-district
hospitals.
4. The Department conducted telemedicine training
with medical colleges at newborn health. It also
established sub-speciality training knowledge
exchange using telemedicine with the Department
of Pediatrics at PGIMER, Chandigarh.
15.15JAWAHARLAL INSTITUTE OF POST
GRADUATE MEDICAL EDUCATION AND
RESEARCH (JIPMER)
Jawaharlal Institute of Post Graduate Medical Education
and Research (JIPMER), was declared an Institution of
National Importantance on 14.7.2008 through an Act of
Parliament. The primary functions of this Institute are
patient care, teaching, training and research. During
the year under review, the Institute has made all round
progress in all its activities.
JIPMER Hospital has total bed strength of 1591. The
daily average number of outpatients treated in the year
2009-2010 was 4,760 .Under the Rashtriya Arogaya Nidhi
(RAN) 22 patients were benefited and Rs. 10,59,277/-
was utilized during the year. Rs.10 Lakhs was allotted
under special Rastriya Arogya Nidhi for the treatment of
cancer patients. 09 patients were benefited by this scheme
and one patient is under treatment. In the year 2009-
2010, a total of 14, 04,389 outpatients were treated in
JIPMER Hospital. In the year 2009-2010, a total of 64,331
admission were made in the Hospital .A total of 19,48,543
investigation were carried out in the year 2009-2010. Total
number of deliveries conducted was 16,363. Total
numbers of operations perfomed were 35,195. The total
attendances in Emergency Medical Service (Main
Casualty) were 1,17,517 and the total attendance in OG
(Obstetrics & Gynaecology) Casualty was 18,267.
JIPMER caters to people from the states of Puducherry,
Tamil Nadu, Andhra Pradesh, Karnataka and Kerala and
other States.
New Services Started:
• An Acute Stroke and Neuro Intensive Care Unit
has been set up in the Nerurology department
.Neuro Surgery department has started doing
Stereo tatic biopsy for deep seated brain lesions.
• World Bank supported ‘Regional Influenza
Laboratory ‘for the surveillance of human, avian
and swine Influenza has been set up in Microbiology
department.
• Orthopaedics Department has started doing Total
Knee Replacement.
• Clinical Immunology has been made an independent
division and diagnostic and therapeutic services are
being offered by this division.
• Yoga therapy OPD has been started and
generalized yoga therapy consultation is provided
for diabetes mellitus, hypertension, respiratory
disorders, and for other chronic ailment thereby
providing holistic health care.
• Crisis Intervention Clinic has been started in the
Psychiatry Department to cater to the needs of
cases of attempted suicide.
Academic Activities:
The admission to first year MBBS course in JIPMER is
through All India Entrance Examination. A total of 22,674
applications were received and 17,389 candidates
appeared in the Entrance Examination for the first year
MBBS Course, 2009-2010 session. Out of the 11,966
candidates who qualified in the Entrance Examination,
82 candidates were admitted based on their category merit
rank. Eighteen candidates were nominated for the
Academic Session 2009-2010 by the Government of India.
College of Nursing was started by JIPMER during the
year 2006 with an annual intake of 75 students.
Admissions were made to the B.Sc (Nursing) course
based on an Entrance Examination for 2009-10 session.
Post graduate courses (M.D /M.S ) are conducted in 21
disciplines. A total of 88 seats are available for the 21
postgraduate courses. Thirty-four new PG seats will be
added from the academic session 2011-12. At present,
Super Specialty Programmes (D.M./M.Ch) are
conducted in 7 disciplines. A total of 10 seats are available
in these 7 Super Specialty Programmes.
PhD programmes are conducted in 8 disciplines and a
total of 18 seats are available for these 8 PhD
programmes. JIPMER has been conducting M.Sc
(Medical Biochemistry) course for the last 32 years. For
the academic year 2009-2010, nine students were
admitted on the basis of the entrance examination to this
3 years course.
Annual Report 2010-11 222
New Courses:
The Central Government has accorded its approval to
the starting of the following courses from the academic
year 2010-11: B.Sc (Dialysis Technology), B.Sc (Perfusion
Technology), B.Sc (Medical Radiation Technology). B.Sc
(Operation Theatre Technology) and M.Sc (Medical Lab
Technology-Microbiology). Besides, several new courses
such as D.M.in Clinical Pharmacology, Clinical
Immunology, Neurology, Neonatology,MD Radiotherapy
and post doctoral fellowship in Diabectology have been
started.
First Convocation:
Besides awarding its own degrees, the Institute is now
empowered to start various new courses and develop its
own curriculum.The first Convocation of JIPMER as an
Institute of National Importance was held under the
Chancellorship of Prof. N.K. Ganguly, the president of
the Institute on 22
nd
March 2010 in which Shri. Ghulam
Nabi Azad, Hon’ble Union Minister of Health and Family
Welfare was the Chief Guest and Shri V. Narayanasamy,
Hon’ble Union Minister of State for Planning,
Parliamentary Affairs and Culture was the Guest of
Honour. A total of 154 degrees were awarded to the
MBBS, PG (MD/MS), B.Sc. (MLT) and Super Specialty
students who had successfully completed the course.
Faculty Recruitment:
The Institute on becoming an autonomous body conducted
the interviews and selected about 100 Assistant
Professors in various disciplines and almost all of them
have joined.
Projects:
Department of Radiotherapy got the status of Regional
Cancer Centre in the year 2002.A new building has been
constructed with bed strength of 82 .Medical Oncology,
Radiation Oncology and Cancer Registry, Day Care
Centre have been commissioned along with the Super
specialty Block & Trauma Care Centre. A 360 bedded
Super Specialty Block housing all the super specialty
departments under one roof has been constructed at a
cost of Rs.93.04 crores. A Trauma Care Centre has been
constructed over the existing Emergency Medical
Services Department at a cost of Rs.13 crores. This
centre has state-of –the –art equipments such as Multi
Slice CT Scanners, high profile Operating Tables, Micro-
Vascular Instruments etc. and 2 high tech Ambulances.
Medical Oncology, Surgical Oncology, Medical
Gastroenterology, Surgical Gastroenterology, Nephrology,
Neuro Surgery and Endocrinology Departments have
started functioning in the new super specialty block.
Efforts are being made to start post doctoral training
programmes in all these Departments.
Action has also been initiated for second phase of
development which includes construction of a 400 bedded
Women and Children hospital, a Teaching Block, Hostel
Complex and upgradation of all the departments.
The total budget provision as per BE 2010-11 is Rs.252
crores (Plan – Rs.132.00 crore & Non-Plan – Rs.120.00
crore).
15.16. POST GRADUATE INSTITUTE OF
MEDICAL EDUCATION AND
RESEARCH (PGIMER), CHANDIGARH
The postgraduate Institute of Medical Education and
Research, Chandigarh was declared as an Institute of
“National Importance” and became an Autonomous Body
by an Act of Parliament (Act 51 of 1966), on 1
st
April,
1967. The Institute in fully funded by the Government of
India. The main objectives of the Institute are:-
o To develop pattern of teaching of undergraduate
and postgraduate medical education in all its
branches so as to demonstrate a high standard of
medical education;
o To bring together as far as may be in one place
educational facilities of the highest order for training
of personnel in important branches of health
activity; and
o The attain self-sufficiency in postgraduate medical
education to meet the country’s need for specialists
and medical teachers.
Academic Activities
Postgraduate Institute of Medical Education & Research,
Chandigarh has been empowered to grant medical, dental
and nursing degrees, diplomas and other academic
distinctions and titles under the PGIMER, Chandigarh Act,
1966 (No.51 of 1966 and thereafter amended from time
to time). For attaining self-sufficiency of postgraduate
medical education and to meet the country’s needs to
have highly qualified and skilled medical teachers in
medical sciences and to undertake basic community based
research, the Institute has been striving hard and achieving
Annual Report 2010-11 223
the desired goals in this direction too. The Institute
conducts various Postgraduate courses viz. MD/MS,
DM/M.Ch, Ph.D. and other paramedical courses viz.
B.Sc. MLT and M.Sc. etc. The number of candidates
passing various courses is increasing day by day with the
increase of new centres at the Institute. A total of 116
candidates passed the MD/MS examinations in 2010 –
97 in the June batch and 59 in the December batch,
Similarly, 20 candidates passed their DM/M.Ch.
examination in May 2010 whereas 29 candidates passed
DM/M.Ch. examination in December 2010 session. A
total number of 2994 candidates have passed their MD/
MS course and 1291 candidates have passed DM/M.Ch.
Course upto 31.12.2010 and 30.06.2010 respectively.
Apart from above, 56 candidates passed various other
examinations viz. MHA, MPH (Part I & II), M.Sc. (Part
I & II) and M.Sc. Nursing Part I examinations in May
2010 session whereas there were 65 candidates who
passed out in December 2010 session. Similarly, in the
examination held in August, 2010 for various paramedical
courses like B.Sc. MLT, B.Ph., B.Sc.MT (OT) and B.Sc.
Nursing etc., there were 261 candidates passing out above
courses.
Candidates for MD/MS courses come from all parts of
the country and also from abroad. At present the number
of such candidates is 549 as on 31.07.2010. Similarly, for
DM/M.Ch. Courses, there were 194 candidates on roll
as on 31.07.2010. Besides, there were 144 candidates on
rolls of the Institute as on 31.07.2010 pursuing Ph.D.
courses. Lists showing above position are attached for
showing no. of candidates from different States pursuing
different courses at PGI, Chandigarh.
Since 2007, PGI has introduced three new courses in the
super-specialties viz. D.M. (Paediatric Critical Care and
Paediatric Haematology Oncology) in the Department
of Paediatrics and D.M. in Neuro-Radiology in the
Department of Radiodiagnosis. Besides, Postgraduate
course of M.Sc. (Anatomy) has also been started.
There are also other courses which are proposed in the
near futute:-
a) D.M. in Haemato-Pathology in Haematology
Department.
b) D.M. in Cardiac-Anaesthesia in Anaesthesia
Department.
c) D.M. in Clinical Haematology in Internal Medicine
Department.
d) D.M. in Paediatric Neurology in Paediatrics
Department.
e) M.Sc. in Respiratory course in Pulmonary Medicine
Department.
f) M.D.S. in Oral & Maxillofacial Surgery in Oral
Health Sciences.
g) A.P.G. Diploma in Public Health Management
(PGDPHM) in the School of Public Health.
Hosptial Services
The Nehru Hospital attached to the Postgraduate Institute
of Medical Education & Research, Chandigarh provides
tertiary care in all the medical and surgical specialties to
the patients, who came not only from the adjoining States
but also from far off States like West Bengal and Bihar.
The total bed strength of the PGI has increased to 1612
beds. The number of patients who attended the
Outpatients Departments and those admitted during the
last three years is as under:-
2007-08 2008-09 2009-10
OPD Attendance 13,19,973 14,13,796 15,46,639/-
Admissions 56,078 58,496 62,330/-
Emergency and critical patients were attended to round
the clock. A total number of 50,943 patients were attended
in the emergency and 30,845 were admitted. In the
emergency operation theatres, a total of 10,766 operations
were performed including 9,535 major operations (which
includes Labour Room operations) and 1,231 minor
operations. During the financial year 2009-10,
2,09,24,201/- was spent for subscription of 530 Journals
Rs.23,23,1809 lacs was spent for online Medical Database
and, Rs. 86543/- has been spent for the purchase of books.
A new Central Animal House facility and clean room for
Stem Cell Research have been established in the Institute
during the year, 178 Research Schemes were completed
and 324 Research Schemes funded by ICMR, DST.U.T.,
New Delhi, international agencies etc. were under
progress. There were 569 publications in indexed and
non indexed national and international journals, 10 visiting
Professors, from all over the World, visited the Institute.
293 students were conferred various doctoral/post
doctoral degrees. 29 faculties members were conferred
various awards/honours during the year.
Annual Report 2010-11 224
15.17 LADY HARDINGE MEDICAL COLLEGE
& SMT. S. K. HOSPITAL NEW DELHI
The Lady Hardinge Medical College (LHMC), New Delhi
was established in the year 1916 with a modest beginning
of just 14-16 students. Over the years, the Institute has
matured as a pioneering Institute for Medical Education
and now it has the existing strength of 150 admissions
per year for MBBS girl students. The 95
th
Academic
Year (2009-10) of the College began with 724
undergraduates and 128 interns on the rolls. The College,
which is affiliated to the University of Delhi since the
year 1949, has continued to admit students from all over
India, as well as from foreign countries. A separate out
patient block was started in 1958 to cater the needs of
ever increasing population of Delhi.
The hospital statistics for the period 2008-09 is as under:-
The necessary follow up action is going on to implement
the comprehensive re-development plan of LHMC&
Associated Hospitals approved by Cabinet Committee of
Economic Affair at the total cost of Rs. 387.31 crore.
A modern intensive Coronary unit has been established.
Rheumatology Clinic and Adult Thalassemia Clinic have
been started under the Deptt. of Medicine. H1N1
Infuenza screening OPD and in-patient ward have also
been established under the Deptt. of Medicine. Voluntary
Counseling Test Centre (VCTC) and Prevention of parent
to child transfer (PTCT) for HIV patients under the
supervision of National Aids Control Organization
(NACO) are part of the Department of Microbiology.
HIV DNA PCR Lab under National Pediatric HIV
initiative to diagnose HIV infection in newborns up to 18
months has also started functioning in the Deptt. of
Bed Strength 1247
OPD Attendance 541240
Indoor Admissions 31145
Sterilization 1295
Bed Occupancy 65.7%
Surgeries
performed:-
Minor 6891
Major 8077
Total 14968
Microbiology. Surveillance facilities for meningococcal
and Dengue fever are also in place in view of frequent
occurrences of these diseases. Facilities for Advanced
Laparoscorpic Surgery using High Definition Camera and
24 hours Ambulatory Esophageal PH Monitoring for
diagnostic and research purpose are also available in the
Deptt. Of Surgery a number of “Rainwater harvesting
wells” have been constructed and Solar panels installed.
Separation of Eye Operation Theatre and ENT Operation
Theater is under process and is likely to be completed
during the current financial year.
A number of research projects have been going on in
many Departments of the institution. The total numbers
of papers published during the year are 131.
The total budget provision as per BE 2010-11 is Rs.176
crores (Plan – Rs.79.00 crore & Non-Plan – Rs.97.00
crore).
15.18 KALAWATI SARAN CHILDRENíS
HOSPITAL, NEW DELHI
Kalawati Saran Children’s Hospital (KSCH) is a premier
referral Children’s Hospital of national importance. The
Hospital started functioning in the year 1965 for imparting
medical care service exclusively for Paediatrics patients
upto 18 years of age. At present it has 370 beds. Under
the (JICA) scheme for the improvement of KSCH, the
bed strength of this Hospital is being increased to 500.
Kalawati Saran Children’s Hospital is one of the busiest
children hospitals in the country and caters to a daily OPD
attendance of 800-1000 children, and 80-100 new
admissions per day from Delhi and neighbouring states.
The hospital is a Sentinel Centre for Poliomyelitis, Tetanus
and Measles. It has the unique distinction of having a
separate Pediatric Emergency with direct inflow of
patients. It also houses the Diarrhoea Training and
Treatment Unit, the first such unit in the country, which
has also been recognized by WHO and Govt. of India as
a training centre for diarrhoeal diseases. The hospital has
also served as a training centre for ARI, UIP and other
National Health Programmes.
The Institution is a super speciality hospital in real sense
with its fully developed subspecialities like Neurology,
Nephrology, Gastroenterology & Nutrition, Hematology,
Pulmonology and Endocrinology.
Indo-Japan Friendship Block of Kalawati Saran Children’s
Hospital has been constructed with an expenditure of
over Rs.54 crores for the building and the latest equipment
Annual Report 2010-11 225
for various sections of the Hospital which has been helpful
in easing the problem of inadequate space and
technological upgrading of the Institution.
Kalawati Saran Children’s Hospital was designated as
“Nodal Centre for Pre-service IMNCI (Integral
Management of Neonatal and Childhood Illness)
implementation in NIPI States”. The Hospital organized
National Training of Trainers Course of IMNCI with
support of Govt. of India/ WHO/UNICEF.
Infant and Young Child Feeding (IYCF) Counseling
Centre was started in Kalawati Saran Children’s Hospital
to strengthen IYCF practices. Autism evaluation cell was
started in the Hospital. Hemophilia follow-up clinic
facilities are provided on first Wednesday (afternoon) of
every month in the Department of Physical Medicine &
Rehabilitation Department. Once a month After
Completion of Therapy (ACT) clinic for follow-up of
children treated for lymphoma and leukemia was started
in the first Monday of every month. Kalawati Saran
Children’s Hospital organized a sensitization workshop
on “Infant and Young Child Feeding” in collaboration with
Govt. of NCT Delhi from 24
th
to 26
th
March 2009.
An advanced centre of pediatrics care has been set up at
the Hospital. This Centre is poised to be one of the premier
center of Paediatrics care in the country. The Hospital
statics for 2009-10 are as under :-
Total No. of sanctioned beds 370 (340 + 30
at Nursery
Smt SK Hospital)
Total OPD attendance 3,09,398
No. of admissions 27,951
Bed occupancy rate 110.6%
Minor operations 1427
Major operations 2519
Casualty attendance 62,339
Neonatal & Nursery Care 7,200
No. of patients admitted in ICU 1228
Patients attended in PMR Deptt. 80,115
Gross Death Rate 9.0
Centre for adolescent Health was established in March
2009 with the objectives of providing special services to
adolescents , to teach and train medical and nursing
students, and to conduct research relevant to the needs
of adolescents of India.
Kalawati Saran Children’s Hospital has developed the
training modules on Facility Based Care-Integrated
Management of Neonatal and Childhood Illness (IMNCI).
Kalawati Saran Children’s Hospital also developed training
modules on Facility Based Care of Severe Acute
Malnutrition.
Clinical Epidemiology Unit was established in Lady
Hardinge Medical College in November 2009 with the
objectives of felicitating research activities, and for
teaching and training of undergraduates, postgraduates
and faculty in clinical epidemiology.
The total budget provision as per BE 2010-11 is Rs 47.26
crore (Non-Plan-Rs 3.26 crore & Plan- Rs 24 crore.
15.19 MAHATMA GANDHI INSTITUTE OF
MEDICAL SCIENCES/KASTURBA
HEALTH SOCIETY, SEVAGRAM,
WARDHA
The Mahatma Gandhi Institute of Medical Sciences
(MGIMS), Sevagram is India’s first rural medical college.
Nestled in the karmabhoomi of Mahatma Gandhi, in
Sevagram, this Institute was founded by Dr Sushila Nayar.
Started in the Gandhi Centenary Year 1969, it was
designed to be an experimental model institute where
medical education will be reoriented to meet the needs
of the rural areas. In the spirit of its founder, the mission
of MGIMS today continues to be committed to the pursuit
of professional excellence by evolving an integrated
pattern of medical education and seeks to provide
accessible and affordable health care primarily to
underprivileged rural communities. It has completed 41
successful years in the service of this mission and is now
one among the best rated medical colleges in the country.
The expenditure of MGIMS is shared by the Govt of
India, Govt of Maharashtra and the Kasturba Health
Society in the proportion of 50:25:25 as per the agreed
pattern. This Government of India released the grant-in-
aid of Rs.27.21 crores during the year 2009-10.
The students at MGIMS are drawn from all parts of the
country and come from all kinds of social backgrounds.
Every effort is made to acquaint the medical student to
the real rural India. The approach to medical education
Annual Report 2010-11 226
with spotlight on rural community oriented education
makes the doctors coming out of the Institute be sensitive
to the felt needs of the underprivileged. The entrance
examination to the MBBS course includes a separate
qualifying paper on Gandhian Thought. The students and
staff of the Institute adhere to a unique code of conduct,
where they are expected to wear khadi, participate in
shramdan, attend all-religion prayer and abstain from non-
vegetarian food, alcohol and tobacco.
The Institute offers degrees and diplomas in 19
postgraduate disciplines of which 18 are MCI recognized
and 19
th
in Skin and VD has just started this year. Seven
of its Departments are recognized for PhD. It has a well
equipped fully computerized digital library which is a
recognized resource library for HELLIS network in
Western India.Since 1991, the Institute follows a unique
Rural Service Scheme through its graduates. The students
are posted in these NGOs and regularly monitored. Two
years rural service is mandatory eligibility criteria for
admission to post-graduation and this is achieved through
96 non-governmental organizations who have joined hands
with the institute to fulfill this dream.
At present 95 extramural research projects are on going.
Each year, the large numbers of national and international
peer reviewed publications from this Institute provide
evidence of excellence in research. Based on its recent
research the Department of Forensic Medicine had
submitted a 258 pages report to Union Ministry of Health
and Law highlighting the lacunae in examination reports
of victims of sexual assault resulting in the lack of
documentary evidence to implicate the assaultees. Based
on this report the Centre and State Governments have
come up with various guidelines for medical officers to
ensure proper forensic examination of victims of sexual
assault.
The Department Community Medicine has adopted many
villages over 60 in number, where they have constituted
number of Women‘s Self Help Groups in order to promote
women to play pro-active role in health care delivery in
their villages. A total of 149 Groups have been created
and more than 98% of these groups are linked with banks
and have updated account books.
Hospital Services
Kasturba Hospital of the Institute has the distinction of
being the only hospital in the country which was started
by the Father of the Nation himself. The patient load
comes to us not only from Vidarbha in Maharashtra, but
also from adjoining parts of Andhra Pradesh, Madhya
Pradesh and Chhatisgarh. It acts as a tertiary care
hospital with all the modern health care amenities but
provides health services at affordable cost and with
compassion. It has a unique insurance scheme in which
20345 families were insured this year.
In 2009-10, 528184 patients attended the hospital as
outpatients and 40256 patients were admitted for various
ailments. The Hospital has state-of-the-art intensive care
units in Medicine, Surgery, Obstetrics and Gynecology
and Paediatrics which provide excellent critical care. A
well equipped hemodialysis unit is available for patients
of renal failure. The Sri Satya Sai Accident and
Emergency Unit provides succour to patients of trauma.
With the grant from Govt. of India for Emergency and
Accident Ward the Institute has a fully equipped high
tech Trauma Ambulance alongwith wireless system. The
Institute has the only Blood Component Unit in the district
which provides components not only to patients in
Kasturba hospital, but also to private hospitals in the
district. Facilities for MRI, CT scan and Mammography
are available. The Alcohol and Drug De-addiction centre
seeks to rehabilitate patients who are addicted to drugs
and alcohol. The Hospital has also been providing Geriatric
services to address to the needs of older people. Its
Radiation Oncology Department has received a grant-
in-aid of Rs. 2 crore from the Govt of India to develop
the Oncology wing under the National Cancer Control
Programme and the Department is fully equipped with
state of the art radiotherapy equipments including Linear
Accelerator, HDR Brachytherapy Machine, 3D
treatment Planning system and Simulator. The Pathology,
Microbiology and Biochemistry laboratories have in-
house facilities and automation to conduct a battery of
diagnostic tests. All Departments of the hospital are
connected by an advanced Hospital Information System.
The Govt. of India has sanctioned grant-in-aid for
infrastructural facility to accommodate additional 192
indoor patients to Kasturba Health Society at MGIMS,
Sewagram. The building is under construction.
The Department of Obstetrics and Gynaecology offers
expert obstetric care to the unwed, the divorced, and the
widowed women with advanced pregnancy and ensures
that they deliver safely in the hospital. Till date 289 women
have been helped under this project. This year eight
unwed mothers have availed themselves of this
assistance. The project also supports babies born out of
such pregnancies and keeps them in “Aakanksha” till they
Annual Report 2010-11 227
can be legally adopted. This year legal adoption of 10
babies has been facilitated.
The total budget provision as per BE 2010-11 is Rs 27.00
crore.
15.20 NATIONAL CENTRE FOR DISEASE
CONTROL (NCDC)
The Institute in under administrative control of the
Director General of Health Services, Ministry of Health
and Family Welfare, Govt. of India. The Director, an
officer of the Public Health subcadry of Central Health
Services, is the administrative and technical head of the
institute. The Institute has its headquarters in Delhi and
had 8 branches located at Alwar (Rajasthan), Bengaluru
(Karnataka), Kozhikode (Kerala), Coonoor (TamilNadu),
Jagdalpur (Chattisgarh), Patna (Bihar), Rajahmundry
(Andhra Pradesh) and Varanasi (Uttar Pradesh).
There are several technical Divisions at the headquarters
of the institute i.e. Centre for Epidemiology and Parasitic
Diseases (Dept. of Epidemiology, Dept. Parasitic
Disease), Division of Microbiology, Division of Zoonosis,
Centre for HIV/ AIDS and related diseases, Centre for
Medical Entomology and Vector Management, Division
of Malariology and Coordination, Division of Biochemistry
and Biotechnology.
In each division there are several sections and
laboratories dealing with different communicable diseases.
The divisions have well equipped laboratories with modern
equipments, capable of undertaking tests using latest
technology. The activities of each division are supervised
by an officer in –charge, supported by medical and non-
medical scientists, research officers and other technical
and paramedical staffs. The branches are also well
equipped and staffed to carry out field studies, training
activities and research.
15.20.1. Integrated Disease Surveillance Project
Background:
Integrated Disease Surveillance Project (IDSP) was
launched by Hon’ble Union Minister of Health & Family
Welfare in November 2004 for a period upto March 2010.
The Project has been extended for two years up to March
2012 by Government of India.
A Central Surveillance Unit (CSU) at Delhi, State
Surveillance Units (SSU) at all State/UT head quarters
and District Surveillance Units (DSU) at all Districts in
the country have been established.
Objectives:
• To strengthen the disease surveillance in the country
by establishing a decentralized State based
surveillance system for epidemic prone diseases
to detect the early warning signals, so that timely
and effective public health actions can be initiated
in response to health challenges in the country at
the Districts, State and National level.
Project Components:
• Integration and decentralization of surveillance
activities through establishment of surveillance units
at Centre, State and District level.
• Human Resource Development – Training of State
Surveillance Officers, District Surveillance
Officers, Rapid Response Team and other Medical
and Paramedical staff on principles of disease
surveillance.
• Use of Information Communication Technology for
collection, collation, compilation, analysis and
dissemination of data.
• Strengthening of public health laboratories.
Data Management:
Under IDSP data is collected on epidemic prone diseases
on weekly basis (Monday–Sunday). The information is
collected on three specified reporting formats, namely
“S” (suspected cases), “P” (presumptive cases) and “L”
(laboratory confirmed cases) filled by Health Workers,
Clinicians and Laboratory staff respectively. The weekly
data gives information on the disease trends and
seasonality of diseases.
Whenever there is a rising trend of illnesses in any area,
it is investigated by the Rapid Response Teams (RRT) to
diagnose and control the outbreak. Data analysis and
actions are being undertaken by respective State/District
Surveillance Units. Emphasis is now being laid on
reporting of surveillance data from Major Hospitals and
also from Infectious Disease Hospitals. Overall 85%
Districts are reporting weekly disease surveillance data
under IDSP.
Outbreak Surveillance and Response:
CSU, IDSP receives disease outbreak reports from the
States/UTs on weekly basis. Even NIL weekly reporting
is mandated and compilation of disease outbreaks/alerts
Annual Report 2010-11 228
is done on weekly basis. On an average 10-20 outbreaks
are reported to CSU weekly. A total of 553 outbreaks
were reported in 2008 and 799 outbreaks in 2009. In 2010,
871 outbreaks have been reported from January to
October 2010. Majority of the reported outbreaks were
of Acute Diarrhoeal diseases, Food poisoning, Measles
and Chickenpox.
Contribution of IDSP in Influenza A H1N1
Outbreak Monitoring Cell on 24x7 basis has been
established at National Centre for Disease Control
(NCDC) for monitoring the situation. Community, Private
Practitioners, Nursing homes and Hospitals have been
requested to report to IDSP Call Centre on 1075 (Toll
free number) in case of any occurrence of clusters of
Influenza like illness in the community. 12 Laboratories
are strengthened out of which 10 laboratories are
functional and 2 are in process of strengthening under
IDSP for testing clinical samples of Influenza A H1N1 in
different regions of the country. 11 strains have been
sequenced at NCDC Laboratory. State and District RRTs
have been alerted to investigate and manage suspected
outbreaks.
Media Scanning and Verification Cell:
Media scanning is an important component of surveillance
to detect the early warning signals. Media scanning and
verification cell daily receives an average of 4-5 media
alerts of unusual health events which are detected and
verified. A total of 1298 health alerts have been detected
since its establishment in July 2008. In 2010, 388 media
alerts were reported from January to October 2010;
majority of them were Acute Diarrhoeal diseases, Food
poisoning and Malaria.
Information & Communication Technology Network
(ICT):
ICT plays an integral and most powerful role in
implementing IDSP across the country. One of the
important components of the project is data management,
analysis and rapid communication in case of outbreaks.
Data Centre:
National Informatics Centre (NIC) has installed Data
Centre Equipment at 776 out of 800 sites. The objective
of Data Centre is online data entry for speedy data
transmission.
Training Centre (NIC):
Training Centre Equipments have been installed at 378
out of 400 sites. State to District communication is possible
by NICs E-Learning Portal (http://e-learning.nic.in/lms),
which has facility in managing live virtual classrooms for
training (State/Area specific discussion on disease
surveillance activities), e-learning, interactive electronic
discussion (Chat rooms, Boards, Mailing Lists) and
reviewing and monitoring project related activities.
Training Centre (ISRO):
Indian Space Research Organization (ISRO) has installed
training centre at 367 out of 400 sites (EDUSAT/VSAT).
Call Centre:
A 24X7 call centre has been established to receive disease
alerts from anywhere across the country on a toll free
number 1075 for verification and initiating appropriate
public health actions. The call centre has a response
mechanism by informing respective health officials at
concerned Districts for early response. A total of 51496
calls were received from January - October 2010, out of
which 3663 calls were related to Influenza A H1N1.
IDSP Portal:
The IDSP portal is a one stop portal (www.idsp.nic.in)
which has facilities for data entry, view reports, outbreak
reporting, data analysis, training modules and resources
related to disease surveillance. Overall 55% of Districts
reported in the portal from January to October 2010.
Training:
The training in IDSP is three-tiered:
Master Trainers State and District Surveillance
Officers and RRT members are trained at identified
9 National level institutes.
The Medical Officers and District Lab Technicians
are trained by Master Trainers at State level.
Health Workers & Lab Technician/Assistants at
peripheral institutions are trained by District
officers/Medical Officers at District level.
Training of State/District Surveillance Teams has been
completed for 27 States/UTS and partially completed in
4 States.
Annual Report 2010-11 229
The main focus of training for State level participants is
on basics of disease surveillance, concepts of
epidemiology and data management, whereas the District
training focuses on correct procedures of data collection,
compilation and reporting and outbreak response. A need
based special two-week Disease Surveillance and Field
Epidemiology Training Programme (FETP) have been
initiated for the District Surveillance officers. A total of
288 District Surveillance Officers have been trained for
2- week FETP in which 44 District Surveillance Officers
were trained from January to October 2010.
State Health Societies were requested in May 2010 to
recruit technical manpower under IDSP. 246
Epidemiologist, 34 Microbiologists and 16 Entomologists
have joined in States and Districts till October 2010. States
has been requested to expedite the filling up the remaining
contractual positions at the State/Districts levels.
Induction training to 191 Epidemiologists, 15
Microbiologists and 7 Entomologists has been completed.
Infectious Disease Hospital Surveillance Network:
7 Infectious Disease Hospitals, one each in Delhi,
Mumbai, Chennai, Kolkata, Bangaluru, Ahmedabad and
Hyderabad have been given funds for strengthening
epidemic-prone disease surveillance under IDSP.
EDUSAT network has been installed at these Hospitals.
Infectious Disease Hospitals of Mumbai, Chennai, Delhi,
Ahmedabad and Kolkata have started reporting weekly
disease surveillance data.
Strengthening of Laboratories:
50 priority District laboratories are being strengthened in
the country for diagnosis of epidemic prone diseases. The
guidelines and procurement of certain deficient lab
equipment were communicated to the States in February
2009. Till date 18 States i.e. 26 labs have completed the
process of procurement. These labs are also being
supported by a trained manpower to mange the lab and
an annual grant of Rs 2 lakhs per annum per lab for
reagents and consumables. 13 laboratories are functional
at present.
In 9 States, a referral lab network is being established by
utilizing the existing functional labs in the medical colleges
and various other major centers in the States and linking
them with adjoining Districts for providing diagnostic
services for epidemic prone diseases during outbreaks.
The plan for all 9 States has been finalized through State
level meetings and the network is functional in 3 States
namely Gujarat, Punjab and Rajasthan. The network plan
is in process of implementation in the remaining 6 States.
Entomological Surveillance on Vector Borne
Diseases:
Vector borne diseases like Malaria, Japanese Encephalitis,
Dengue, Kala-azar etc. are of major public health
concern. Every year outbreaks/ epidemics occur in
different parts of the country leading to high morbidity
and mortality. Entomologists have joined in 16 out of 35
States/UTs. Entomological surveillance and monitoring
of vector borne diseases are being carried out by the
Entomologists.
Tribal and Social Plan:
Gujarat, Maharashtra and Karnataka are piloting
community surveillance as part of the Tribal Action Plan.
West Bengal is planning to prepare a community
surveillance strategy involving Panchayat representatives
and community volunteers.
Gujarat has started planning the tribal action plan (TAP)
(community surveillance among tribal communities) in two
Taluks of the Nizar block of the Tapi district, where over
90 percent are tribal and live in remote locations. The
Gujarat TAP pilot will involve participation of community
volunteers, health workers, and NGOs. The Tapi DSU is
collecting baseline data on health service, access, disease
incidence and outbreak reporting patterns so as to be able
to prioritize outreach and monitor outcomes.
Karnataka and Maharashtra have started working on their
TAP pilots in two select blocks each involving community
health workers and volunteers. Maharashtra is piloting
community surveillance as part of the TAP in Taloda and
Akkalkowa blocks of Nadurbar district; and Karnataka
in Gundulpet and Kollegal blocks of Chamrajnagar district.
Prevention and Control of Avian/H1N1 Influenza:
A networking model has been developed with 12
laboratories, out of which 10 labs are functional. The
Animal Component of Avian Influenza is being looked
after by Ministry of Agriculture (Dept. of Animal
Husbandry).
Annual Report 2010-11 230
Finance:
Budget and Expenditure for IDSP is as under:
Achievements of Integrated Disease Surveillance
Project (IDSP)
A Central Surveillance Unit (CSU) at Delhi, State
Surveillance Units (SSU) at all State/UT head quarters
and District Surveillance Units (DSU) at all Districts in
the country have been established.
• Central Surveillance Unit, IDSP presently receives
weekly disease surveillance data from 527 districts
(85%) in the country.
• A total of 335 (55%) districts are accessing one
stop portal for data transmission, trend analysis and
resources like guidelines, advisories for health
personnel related to disease surveillance, etc.
• On an average, 10-20 outbreaks are reported to
CSU weekly by States. In 2010, 871 outbreaks have
been reported from January to October 2010.
Majority of the reported outbreaks were of Acute
Diarrhoeal diseases, Food poisoning, Measles and
Chickenpox.
• Media scanning and verification cell detects an
average of 4-5 media alerts of unusual health events
daily. In 2010, 388 media alerts were reported from
January to October 2010; majority of them were
Acute Diarrhoeal diseases, Food poisoning and
Malaria.
• IT network has been established for data entry,
training, video conferencing and outbreak
discussions. Data centre has been established in
776 out of 800 sites, and training centre has been
established in 745 out of 800 sites with video
conference facility.
• A 24X7 call center has been established to receive
disease alerts from across the country on a Toll
free number 1075. A total of 51496 calls were
received from January - October 2010 out of which
3663 calls were related to Influenza A H1N1.
Sl. No. Year Budget Estimates Expenditure % of expenditure
(Rs. in crores) (Rs. in crores) w.r.t. BE
1 2009-10 48.50 39.95 82.37
2 2010-11(upto October 2010) 35.00 27.24 77.82
• Outbreak Monitoring Cell on 24x7 basis has been
established at National Centre for Disease Control
(NCDC) for monitoring the situation. Community,
Private Practitioners, Nursing homes and Hospitals
have been requested to report to IDSP Call Centre
on 1075 (Toll free number) in case of any
occurrence of clusters of Influenza like illness in
the community. 12 Laboratories are strengthened
out of which 10 laboratories are functional and 2
are in process of strengthening under IDSP for
testing clinical samples of Influenza A H1N1 in
different regions of the country. 11 strains have
been sequenced at NCDC Laboratory. State and
District RRTs have been alerted to investigate and
manage suspected outbreaks.
• Training of State/District Surveillance Teams has
been completed for 27 States/UTS and partially
completed in 4 States.
• A total of 288 District Surveillance Officers have
been trained in special 2- week FETP of which 44
District Surveillance Officers were trained from
January to October 2010.
• State Health Societies were requested in May 2010
to recruit technical manpower under IDSP. 246
Epidemiologist, 34 Microbiologists and 16
Entomologists have joined in States and Districts
till October 2010. States has been requested to
expedite the filling up the remaining contractual
positions at the State/Districts levels. Induction
training to 191 Epidemiologists, 15 Microbiologists
and 7 Entomologists has been completed.
• Procurements of deficient equipments completed
in 9 more Sates (16 labs); making it a total of 18
States (26 labs). Expenditure guidelines for the
annual grant of Rs. 2 Lakhs per District priority
lab communicated to the States. Hand holding of
the States via video conferencing and on site lab
Annual Report 2010-11 231
visits for making the District lab functional. 13
laboratories are functional at present.
• Referral lab network plans were finalized through
State level meetings with the stakeholders for
remaining 3 States namely Maharashtra, Andhra
Pradesh and Rajasthan. Implementation guidelines,
prototype MoU for the referral lab network and
expenditure guidelines for the grant for the referral
labs under the network communicated to the States.
Specimen collection and transport guidelines for use
at the district level during outbreaks communicated
to the States for further communication to the
Districts.
• Entomology unit has been established with the
objective of updating the entomological surveillance
of vector borne diseases in the country.
Integrated Disease Surveillance Project - North
Eastern States:-
Background:
Integrated Disease Surveillance Project (IDSP) is a
decentralized State based programme to strengthen
surveillance system for epidemic prone diseases for early
detection and control of outbreaks. As on date, all States
and Union Territories including North Eastern States are
implementing IDSP. The component wise details of status
/ achievements in North East states are as under:
IT Networking:
In N.E States, IDSP has established linkages with all
States/Districts HQ & all Govt. Medical colleges on a
Satellite Broadband hybrid network. The State wise details
are as under:
Sl. No. State Data Broadband Video Conference
Centre Connectivity Facility
1. Arunachal Pradesh 14/14 11/14 13/14
2 Assam 27/27 27/27 26/27
3. Manipur 11/11 4/11 11/11
4. Meghalaya 9/9 7/9 9/9
5. Mizoram 10/10 4/10 10/10
6. Nagaland 12/12 9/12 12/12
7. Sikkim 6/6 6/6 4/6
8. Tripura 6/6 5/6 4/6
Total 95/95 73/95 89/95
Manpower status:
Since July 2010, manpower recruitment has been
decentralized and State wise break up of technical
manpower is as under.
Sl. No. States Epidemiologists Microbiologists Entomologist
in position in position in position
i) Arunachal Pradesh 15/17 1/2 1/1
ii) Assam 4/24 2/2 0/1
iii) Manipur 7/10 1/2 0/1
iv) Meghalya 0/8 2/2 1/1
v) Mizoram 0/9 1/3 0/1
vi) Nagaland 0/12 0/3 0/1
vii) Sikkim 1/4 1/2 0/1
viii) Tripura 0/5 0/2 0/1
Total 27 / 90 8/18 1/8
Annual Report 2010-11 232
Training Status:
Training of Trainers (ToT) of State and District Rapid
Response teams (RRT) has been completed for eight
North Eastern States. State wise details are as under:
Data Management Status:
IDSP presently receives weekly disease surveillance
reports from about 96% of the Districts of NE region (80
out of 83 districts). Data analysis and action are being
taken by respective Districts.
Strengthening of Laboratories:
In North East States, strengthening of 10 identified district
laboratories for diagnosis of epidemic prone diseases is
in progress. These labs are being supported under IDSP
for procurement of certain deficient equipments and
posting of a trained Microbiologist to manage the lab. In
addition these labs have been allocated Rs 2 Lakhs per
annum per lab for reagents and consumables. Guidelines
related to procurements, manpower recruitment and
expenditure guidelines for Rs 2 Lakhs per annum have
already been communicated to the States.
Outbreaks detected:
The major component of the project is to detect and
respond to outbreaks in the early rising phase. In 2010,
Sl. No. States Master Medical Health District Peripheral
Trainers Officers Workers Laboratory Laboratory
Trained Technicians Technicians
in ToT
i) Arunachal Pradesh 61 Trainings to be initiated
ii) Assam 85 1792 1032
iii) Manipur 41 300 0 0 0
iv) Meghalya 38 123 515 17 102
v) Mizoram 43 106 767 34 8
vi) Nagaland 20 158 683 159 35
vii) Sikkim 29 43 380 33 5
viii) Tripura 20 131 658 14 36
Total 337 2653 4035 257 186
the State has detected a total of 57 outbreaks till October
2010 which is as follows:
Finance:
The Grants-in-aid released and expenditure incurred in
Sl.No. States No. of Outbreaks
in 2010(up to
October)
i) Arunachal Pradesh 5
ii) Assam 44
iii) Manipur 2
iv) Meghalaya 2
v) Mizoram 0
vi) Nagaland 2
vii) Sikkim 1
viii) Tripura 1
Total 57
Annual Report 2010-11 233
last 5 years i.e starting from the year 2003-04 of the
project till 24 November 2010 is as under:
15.20.2. Division of Parasitic Diseases
The Department is a nodal agency for planning,
implementation, monitoring and evaluation of Yaws
Eradication Programme (YEP) and Guinea Worm
Eradication Programme (GWEP) in the country. It
undertakes surveys, manpower development and
research. On request, it also provides teaching materials
like filarial slides to various colleges in the country and
contributes to training of post graduate, undergraduate
and nursing medical students who visit NCDC. The
department also provides advice to states and districts in
the control of parasitic diseases.
A. Yaws Eradication Programme (YEP) in India
Yaws Eradication Programme (YEP) was launched as a
centrally sponsored scheme in 1996-97 in Koraput district
of Orissa, which was subsequently expanded to cover all
the 51 Yaws endemic districts in ten states (Andhra
Pradesh, Orissa, Maharashtra, Madhya Pradesh,
Chhattisgarh, Tamil Nadu, Uttar Pradesh, Jharkhand,
Assam and Gujarat). The programme aimed to reach
the un-reached tribal areas of the country.
National Centre for Disease Control has been identified
as the nodal agency for the planning, monitoring and
evaluation of the Programme. The Programme is
implemented by the State Health Directorates through
Sl. States Amount Amount
No. released expenditure
(In Lakhs) (In Lakhs)
i) Arunachal
Pradesh 282.08 244.44
ii) Assam 295.39 288.99
iii) Manipur 94.20 22.28
iv) Meghalaya 162.63 120.72
v) Mizoram 358.49 375.91
vi) Nagaland 365.31 321.71
vii) Sikkim 96.20 67.8
viii) Tripura 113.39 86.2
Total 1767.69 1528.05
the existing health care system. The number of reported
cases has come down from 3751 to nil during the period
from 1996 to 2004 and subsequently no case has been
reported from any of the states till October, 2010.
The programme envisages achieving its objective through
adoption of following strategies:
• Case finding: active case search, passve
surveillance, rumour reporting;
• Treatment of cases and contacts;
• Manpower development;
• IEC activities and
• Multisectoral approach.
Around 10000 sera samples collected from 1-5 years
children till October, 2010 tested negative for Yaws by
RPR/TPHA test. Funds in the form of “Grant-in-aid”
are being provided to the states for operational cost to
undertake activities under YEP.
B. Guinea Worm Eradication Programme
(GWEP) in India
In 1983-84, National Centre for Disease Control was
made the nodal agency by the Minsitry of Health & Family
Welfare, Govt. of India for planning, co-ordination,
guidance and evaluation of Guinea Worm Eradication
Programme (GWEP). At the beginning of the Programme
i.e. in 1984, about 40,000 GW cases were reported in
12,840 guinea worm endemic villages 89 districts of seven
endemic states, viz. Andhra Pradesh, Gujarat, Karnataka,
Madhya Pradesh, Maharashtra and Rajasthan. The State
of Tamil Nadu remained free from GW disease since
1982.
The last guinea worm case in India was reported in July
1996 in Jodhpur district of Rajasthan. World Health
Organization certified India as guinea worm disease free
country in February 2000. However, routine surveillance
continues till the disease is eradicated from the globe.
C. Lymphatic Filariasis: Manpower Development
The Department is imparting training course on lymphatic
filariasis at its three Regional Filaria Training and Reseach
Centres (RFT&RC) functioning at Kozhikode in Kerala,
Rajahmundry in Andhra Pradesh and Varanasi in Uttar
Pradesh.
Training courses for Medical Officers/Biologist/
Programme Officers for 5 days on lymphatic Filariasis
organized during the reported period at NCDC branches
Annual Report 2010-11 234
Varanasi from 23-27 August, 25-29 September, Kozhikode
19-23 July, 4-8 October and Rajahmundry 6-10 September
2010.
Training course on filariology for Fialria Inspectors/
Technicians for 10 days organized during the reported
period at NCDC branch Varanasi 12-23 April, 13-14
Sepember, Kozhikode 2-13 August and Rajahmundry 15-
26 November 2010.
15.20.3. Microbiology Division
Coxsackie B Virus: To find out the association between
myocarditis and Coxsackie B virus, paired serum samples
from 36 cases from different hospitals were received and
tested. All the samples were found negative to Coxsackie
B group (B1-B6) virus infection.
Measles: Sixty-two (62) clinically suspected cases of
SSPE were reported to the laboratory. Twenty-four (24)
of these cases were confirmed by laboratory tests
showing of high titre anti measles antibodies in serum
and CSF samples. No such case, so far, is reported
following measles vaccination. Twenty-four (24) serum
samples from suspected measles cases were received.
Thirteen (13) were positive for anti measles IgM
antibodies.
Viral Hepatitis
A total of 1216 serum samples were received and tested
for various markers of viral hepatitis. 28 cases showed
evidence of hepatitis A, 32 of hepatitis E and 148 of
acute and chronic hepatitis B.
Congenital Viruses: These viral infections result in
abortions and congenital malformation in infants. A total
of 495 samples from women having bad obstetric history
and congenitally malformed babies and viral encephalitic
cases were tested for antibodies against Rubella,
Cytomegalo virus & Herpes simplex virus infections. 229
serum and 203 CSF were tested for HSV encephalitis.
Viral Encephalitis: 26 cases from viral encephalitis from
Delhi hospitals were received and tested for anti-measles
anti HSV, anti Rubella, Vericella, mumps, EBV IgM and
EV-71 antibodies.
ILI Surveillance
A total of 879 ILI Surveillance samples have been
processed by Multiplex PCR from May, 2008 to till date
out of which 31 are positive for Influenza A, 10 positive
for influenza B, 8 for Influenza A H1N1 and 5 for para
Influenza.
Viral Conjunctivitis: Twenty-five (25) eye swab were
tested for enteroviruses. Four were found positive for
Coxsackie A24 and EV-71 viruses.
National Polio Surveillance:
AFP Surveillance: The Virology laboratory of NCDC
has been accredited as WHO National Polio Lab to assist
NPSP on lab based surveillance of Acute Flaccid
Paralysis. In this regard, 3000 stool specimens, 1500
cases were received and tested. 150 isolates found
positive for polio virus were sent to ERC, Mumbai for
further typing and intratyping characterization.
Supplementary Environmental Surveillance:
As per Govt. of India, Ministry of Health & FW, NCDC
has been selected to carry out supplementary surveillance
by collecting sewage samples on weekly basis from 7
sites selected by NPSP to see the presence of any wild
poliovirus in the sewage. In this regard, 118 sewage
samples have been collected and tested at NCDC and
ERC, Mumbai in parallel. 18 samples were found to be
positive for wild polio virus (P1-5. P3-7 and P1+P3 – 46)
indicating that the wild virus is still circulating in the
community.
Tuberculosis:
A total of 731 clinical samples (mainly serum samples
and a few other samples like CSF pleural, other fluids,
obtained from suspected cases of tuberculosis were tested
for the presence of anti A60 mycobacterial antibodies by
ELISA test. 287 samples were found to be positive. In
addition, 150 clinical samples obtained from suspected
cases of tuberculosis were subjected to mycobacterial
culture 6 mycobacterial isolates were subjected to drug
sensitivity test using BACTEC as well as Conventional
method.
Bacteriology
148 samples (including CSF, blood and slides) obtained
from suspected cases of pyogenic meningitis were
subjected to culture examination and rapid latex
agglutination test for antigen detection. 365 clinical
samples from suspected diphtheria cases in Delhi were
processed for diphtheria cases in Delhi were processed
for diphtheria culture. 347 urine samples were subjected
to culture examination. Blood culture was carried out in
98 samples from cases of enteric fever. 89 pus, throat
swabs and other samples were subjected to culture
examination. 15 samples were processed for Legionella
culture and IFA test.
Annual Report 2010-11 235
Diarrheoal Diseases Laboratory
A total No. of 642 rectal swab/stool samples from
gastroenteritis cases in and around Delhi from Infectious
Diseases Hospital, and Aruna Asaf Ali Hospital, Delhi
processed for the presence of enteropathogens Vibrio
cholerae 01 and non-agglutinating cholera, Shigella and
Salmonella sp. Out of 642 samples, 187 positive for
V.cholerae 01, 3 NAG, 8 Shigella, 31 Salmonella, 6, E.coli
pure culture, 1 Clostridium difficile and 3 Rota virus.
Twenty-nine (29) referral diagnostic samples were
received, out of which 2 VCO1, 2 Shigella, 4 Clostridium
difficile were diagnosed.
A total No. of 31 samples received from various parts of
India, as pert of outbreak investigation, 9 positive for
VCO1, 5 EFC 1 Rota virus. 100 isolates processed for
Antimicrobial sensitivity.
Following new diagnostic services are added during the
reporting year.
i. Diagnosis of viral diarrheoa: Rotavirus and
Norovirus detection by ELISA test.
ii. Diagnosis of antibiotic associated diarrheoa:
Clostridium difficile toxin detection by ELISA test.
iii. Molecular diagnosis of Traveller’s diarrheoa:
Enterotoxigenic E.coli (ETEC); Enteropathogenic
E. coli (EPEC) and Enteroaggresive E.coli (EAEC)
detection by multiplex PCR.
Environmental Laboratory:
A total of 351 (Three hundred and fifty-one) drinking
water samples belonging to different drinking water
sources (collected during outbreak investigations of water
borne diseases, samples from air-line caterers serving
VVIP flights, referred samples from schools, hospitals,
domestic sources etc.) were tested for bacteriological
standards by the MPN Coliform method. 233 (66.38%)
of these were found satisfactory, while the remaining 118
(33.6%) were unsatisfactory. Other than this, 123
sewage water samples were collected and processed for
polio virus surveillance in Delhi. Concentrated samples
were sent to ERC, Mumbai for polio virus isolation. 2500
H2S strip bottles prepared were supplied for polio
surveillance in other outbreaks.
Media Room
Approximately 4000 plates of routine plate media (Blood
agar, MacConkey agar, Chocolate agar, MH agar etc.)
were supplied in this period. 2000 plates of specialized/
selective media (e.g. XLD, SSA, TCBS, etc) were
supplied. Around 5000 tubes, 550 vials and 300 flasks of
liquid media (e.g. Peptone water, Selenite broth,
McConkey broth etc.) were supplied. 600 vials of
transport media eg (Cary-Blair medium were supplied
by Media room. 1000 nutrient agar stabs were supplied
as preservative media. 5000 tubes of biochemical test
media (e.g. PPA, TSI Agar, Simmon’s citrate, RCUT
media etc.) were supplied.
Mycology Laboratory
It provides Diagnostic mycology services to the referred
cases from Delhi Hospitals. The important mycotic
infections that were diagnosed: Cryptococcusis- 6,
Aspergillusis - 9 Candida albicans – 2, Candida sp.p-1,
Alternaria spp.-1, Nocardia spp-1. This involved
processing of 105 clinical specimens such as CSF, sputum,
blood, serum, skin scrapings and tissue biopsies.
In addition assisted in disease outbreaks and carried out
teaching and training activities.
15.20.4. Centre for Medical Entomology and Vector
Management
Centre for Medical Entomology and Vector Management
is reorganized to develop it as a National Centre par
excellence for undertaking research, providing technical
support and to develop trained manpower in the field of
vector-borne diseases and their control. The centre
provides technical guidance, support and advice to various
states and organizations on outbreak investigations and
entomological surveillance of vector-borne diseases and
their control. Major achievements are highlighted below:
Major achievements
1. Based on the detection of Dengue virus antibodies
in vector mosquitoes early warning signals were
issued to Municipal Health Officer, MCD, Delhi,
Chief Medical Officers of district Sonipat &
Panipat (Haryana) for possible outbreak of
Dengue.
2. Officers and staff members of CME&VM
monitored dengue surveillance activities in Central
Zone, Shahadra Zone & South Zone of Delhi during
current Dengue/Chikungunya epidemic.
3. Laboratory evaluation of two Transfluthrin based
mosquito repellent liquid (RDE/LV/A-165) and
1.6% Transfluthrin (RDE/LV/A-166) vaporizer was
Annual Report 2010-11 236
carried out in Peet Grady chamber against Culex
quinquefasciatus mosquitoes and house flies
(Musca domestica).
4. Field evaluation of six insecticide compounds in
respect of its residual efficacy under field condition
is being carried out in Bastar district, Chhattisgarh
state.
Ongoing Research Projects
1. Studies on the presence of Dengue/JE Virus in
vector mosquitoes.
2. Japanese Encephalitis /Dengue virus detection in
mosquitoes of some endemic areas.
3. Entomological surveillance of vector of Yellow
Fever, dengue and chickungunya mosquitoes in and
around international airports and sea ports and
vector control measures thereof.
4. Studies on rodent-flea association at major Sea
Ports of India.
5. Studies on the role of certain anophelines in the
transmission of malaria in Arunachal Pradesh and
other parts of the country.
6. Entomological surveillance of vectors of Scrub
typhus in selected urban, peri-urban and rural set
up of Delhi, NCR and other parts of the country.
Research abstracts submitted & accepted for
presentation:
• Title “Malaria in rural foot hill of Aravali hill mountain
range, India” submitted to DRDO for conference
on “International Symposium on Recent Advances
in Ecology & Management of Vector Born
Disease” at Gwalior (M.P.), w.e.f. 1
st
to 3
rd
December 2010.
• Title “Prevalence of different species of Aedes
mosquitoes in urban localities of National Capital
Territory of Delhi, India and detection of Dengue
virus.” submitted to DRDO for conference on
“International Symposium on Recent Advances in
Ecology & Management of Vector Born Disease”
at Gwalior (M.P.), w.e.f. 1
st
to 3
rd
December 2010.
• Title “Effectiveness of Diflubezuron (IGR)
formulations against four vector species of
mosquitoes.” submitted to DRDO for conference
on “International Symposium on Recent Advances
in Ecology & Management of Vector Born
Disease” at Gwalior (M.P.), w.e.f. 1
st
to 3
rd
December 2010.
15.20.5. Division of Malariology & Coordination
A. The division has a malaria clinic to check/cross
check blood smears of clinically diagnosed cases
for the presence of malarial parasites, referred by
various hospitals of Delhi and surrounding districts
of Uttar Pradesh and Haryana state. During the
year 2010 upto 31
st
October,10 a total of 1227
blood smears were examined, of which 91 were
found to be positive. 72 for P vivax and 19 for P
falciparum. Clinic also checks the slides brought
from field by various divisions during Research &
survey. A total of 11 blood smears were examined
and all were found negative.
B. A total of 582 students from different institutes were
given short term training as follows:
S.No Month Institutions No. of
participants
1 18-1-10 to MD Microbiology students of Delhi University of MAMC, LHMC,
20-1-10 UCMS & VPCI 6
2 4-2-10 to
5-2-10 5 senior veterinary Army officers of RVC Centre and College Meerut
under the aegis of Indian Vet. Research Institute, Izatnagar, Bareilly 5
3 05-2-10 B.Sc Nursing Students of St. Ann’s group of Institutions, Mulki, Mangalore 37
4 8-2-10 to
12-2-10 Post Graduate students from Department of Community Medicine of MAMC,
LHMC, UCMS New Delhi 5
Annual Report 2010-11 237
S.No Month Institutions No. of
participants
5 15-2- 10 Trainees of ‘diploma in health promotion Education” & PG Diploma in community
Health care (PG- DCHC) from Health & Family Welfare Training and Research
centre, Mumbai 30
6 17-2-2010 Medical officers of Himachal Pradesh under going “Professional Development
Course in Management public health & Health sector reforms for the mid level
Medical Officers” at State Health and Family Welfare Training Centre,
Pari Mahal, Shimla 17
7 18-2-2010 B.Sc III yr life science students of Sri Aurobindo College(University of Delhi),
Malviya Nagar, New Delhi 9
8 23-2-2010 Newly appointed CGHS and CHS officers undergoing induction training
course at NIHFW, Munirka 22
9 11-3-2010 BHMS students of Dr. Padiar Memorial Hoemopathic Medical college,
Ernakulum, Kerala 38
10 22& 23-3-10 DNB Students 3
11 27-4-10 2
nd
year MBBS students of Army college of medical sciences, Delhi cantt. 19
12 11-5-10 2
nd
year MBBS students of Army college of medical sciences, Delhi cantt 9
13 13-5-10 4
th
year B.Sc Nursing students of Vidyarathana college of Nursing, Udupi 34
14 25-5-10 2
nd
year MBBS students of Army college of medical sciences, Delhi cantt 14
15 28-5-10 Visit of 4
th
year B.Sc Nursing students of VidyarathanaNitte Usha Institute of
Nursing Sciences, Deralakatte, Karnataka 102
16 8-6-10 2
nd
year MBBS students of Army college of medical sciences, Delhi cantt 14
17 15-6-10 MD (CHA) & DHA Final Year students from National Institute of Health &
Family Welfare, Munirka 12
18 23-6-10 Senior Medical officers of BSF Academy, Tekanpur, Gwalior 11
19 13-7-10 Visit of 2
nd
year M.Sc Nursing students of K. Pandyarajah Ballal Nursing
Institute , Ullal, Karnataka 27
20 19-8-10 Visit of Class XIIth students of lady Irwin Senior Secondary school Shrimant
Madhav Rao Scindia Marg, New Delhi 34
21 13-9-10 Medical officers of Department of community medicine, AFMC, Pune 10
22 23—9-10 Visit of M.Sc Nursing students of Bombay Hospital College of Nursing, Bombay 32
23 5

-10-106-
10-10 7-10-10 Visit of Final year BHMS students of Nehru Homeopathic Medical College and
Hospital, Defence Colony, New Delhi 92
582
Annual Report 2010-11 238
15.20.6. Centre for AIDS & Related Diseases
Introduction
The Division of AIDS was established at National Centre
for Disease Control (NCDC) in the year 1995. Prior to
this it had existed as AIDS Reference Laboratory in
Division of Microbiology (since 1985), one of the first
reference centers in India, which initiated surveillance of
HIV-infection in the country. In December 2004, it was
upgraded as Centre for AIDS & Related Diseases.
The Centre has the following laboratories/units
i. National Reference Laboratory
ii. HIV Serology Laboratory
iii. Quality Control Laboratory
iv. Immunology Laboratory
v. STI and Opportunistic Infections Laboratory
vi. Molecular Virology Laboratory
vii. Integrated Counselling and Testing Centre (ICTC)
viii. HIV Test Kits Distribution Unit
ix. Central Blood Collection Unit
Brief overview of the activities of the Centre
• Serological testing and confirmation of HIV infection
for referred samples.
• Counselling and HIV testing for direct walk-in
clients
• Panel preparation and delivery of EQAS to SRLs
of 4 linked states i.e. Delhi, Haryana, Rajasthan
and J&K.
• Quality Control of HIV testing performed by linked
state reference laboratories (SRLs) and linked
sentinel surveillance centres in four states viz. Delhi,
Haryana, Rajasthan and J&K
• Preparation and characterization of panel for kit
evaluation (HIV, HBV & HCV)
• HIV, HBV and HCV test kits evaluation.
• Testing of blood products referred by DCGI for
various infectious markers (HIV, HBV and HCV)
• CD4 cell estimation for samples referred from linked
ART and PPTCT centers
• Diagnosis of common opportunistic infections i.e.
Cryptosporidium spp. Microsporidium spp. and
P. jeroveci in stool and sputum respectively.
• Serological diagnosis of syphilis
• Participation in EQAS for CD4 cell estimation
conducted by National AIDS Research Institute
(NARI), Pune in collaboration with QASI, Canada.
• Participation in EQAS for HIV serology conducted
by the National AIDS Research Institute, Pune.
• Participation in EQAS for VDRL/RPR testing
conducted by Regional STD Teaching, Training &
Research Center, VM Medical college &
Safdarjung Hospital, New Delhi.
• Manpower development for
1. Laboratory investigations for HIV/AIDS
2. Development of Quality management System in
HIV testing laboratories
• Centralized sample collection for different Divisions
of NCDC.
• HIV test kits storage facility to DSACS.
Activities performed in various laboratories/units
of the Centre
A. Participation in International and National
EQAS
• This Center regularly participates in an EQAS for
HIV serology conducted by National AIDS
Research Institute, Pune. The Centre has
consistently given 100% concordant results as
part of the proficiency testing programme.
• Centre regularly participates in EQAS for CD4 cell
estimation conducted by National AIDS Research
Annual Report 2010-11 239
Institute, Pune in collaboration with QASI, Canada.
The Centre has consistently performed
satisfactorily during the period.
• This centre regularly participates in External Quality
Assessment Scheme (EQAS) for VDRL/ RPR test
conducted by Regional STD Teaching, Training &
Research Centre, VMM College & Safdarjung
Hospital. The centre has consistently given 100%
concordant results for qualitative RPR.
B. National Reference Laboratory
• A total of 52 blood products referred from Drugs
Controller General of India (DCGI), Govt. of India
have been tested for various infectious markers
i.e. HIV, HBV and HCV (a total of 624 tests were
performed during the testing of these blood
products).
• A total of 05 HIV kits were evaluated at NRL (a
total of 2500 tests were performed during the
evaluation of these kits).
• A total of 272 samples have been tested for HIV
as part of Quality Control of HIV testing performed
by liked SRLs (a total of 408 tests performed) .
• EQAS programme was conducted twice in this
year for all the 13 SRLs and their associated ICTCs
o A panel comprising of 08 members for each of the
SRLs and a bulk panel comprising of 04 members
for ICTCs was sent after getting them validated
from NARI, Pune.
o Report of testing conducted on panel by SRLs was
compiled and feedback was given to the respective
SRLs.
C. Serology / Quality Control Laboratory
• A total of 609 serum samples were tested for
diagnosis and conformation of HIV infection.
• A total of 2186 samples were tested during last
round of HIV Sentinel surveillance as part of
Quality Control of HIV testing performed linked
sentinel surveillance centers in four states viz.
Delhi, Haryana, Rajasthan and J&K.
• A total of 6325 Dried Blood Spot (DBS) specimens
received from Twenty eight high risk group (HRG)
sentinel sites spread across four states namely
Jammu & Kashmir, Haryana, Rajasthan & Delhi
were tested for anti-HIV antibodies.
D. Immunology Laboratory
• CD4/CD3 cell estimation was performed on 1148
samples referred from anti retroviral treatment
(ART) centre, Deen Dayal Upadhyay Hospital,
New Delhi and 08 PPTCT centers of Delhi.
E. Molecular Virology Laboratory
• HIV viral load assay by quantitative RT-PCR
performed on 200 samples as part of collaborative
research project entitled “Comparative study on
HIV/AIDS with anti-retroviral and add on
Homoeopathy drugs” with Central Council for
Research in Homoeopathy, Department of AYUSH,
MoH&FW, GoI.
F. Opportunistic Infections/STI Laboratory
• A total of 359 sera samples from suspected cases
of Syphilis were tested by RPR card test and TPHA
test (A total of 779 tests performed).
Annual Report 2010-11 240
• A total of 10 samples were tested for various
opportunistic infections.
G. Integrated Counselling & Testing Centre
(ICTC)
• A total of 293 direct walk-in-clients were provided
pre test counseling while 260 subjects were given
post test counselling.
H. Central Blood Collection Unit
• This unit acts as a central sample collection facility
for the institute. During the period a total of 2262
samples were collected and distributed to the
respective laboratories for testing.
I. Kits Distribution Unit
• A total of 8843 HIV, HBV and HCV kits were
received and distributed by DSACS to various
Centers of Delhi.
J. On going Research Projects
1. Collaborative research project “Comparative study
on HIV/AIDS with anti retroviral and add on
Homoeopathy drugs” with CCRH, New Delhi.
K. Training Activities
1. Organized two days workshop on “External Quality
Assessment Scheme (EQAS) for HIV testing” for
Officers of the linked State Reference Laboratories
from 16th - 17th March 2010.
2. Organized two days workshop on “External Quality
Assessment Scheme (EQAS) for HIV testing” for
Laboratory Technicians of the linked State
Reference Laboratories from 18th - 19th March
2010.
3. Practical demonstration of “ HIV – Testing
Methodologies” to 25 participants from South East
Asia Region during the 3 months FETP Programme
on 20th August, 2010, at NRL (CA&RD) of
NCDC, Delhi.
15.20.7. Epidemiology Division:-
A. Activities of the Division
• Organization and coordination of training courses
in Epidemiology to develop trained health
manpower. Development of teaching materials such
as Modules, Manuals etc. on disease surveillance
and outbreak investigation of epidemic prone
communicable diseases.
• Investigation of outbreak of diseases of known /
unknown etiology and recommend measures for
its prevention and control to the States / UTs of the
country. Provision of technical support to State
government for investigation and control of disease
outbreaks.
• Provision of administrative and technical
supervision to three branches of the Institute viz.,
Alwar (Rajasthan), Jagdalpur (Chhattisgarh) and
Conoor (Tamil Nadu).
• Provision of technical support to various National
Health Programmes in the form of developing
guidelines for control, manpower development,
evaluation of different components / indicators.
• Assisting the Director for publication of monthly
Bulletin “CD Alert”.
• Carry out field research on different aspects of
communicable diseases.
B. Outbreaks Investigated/ Rapid Health
Assessment.
During the period, officers from the division of
Epidemiology carried out investigations of outbreaks in
the country and suggested containment measures to the
Annual Report 2010-11 241
authorities. Some of the outbreak investigations are as
follows:
• Avian Influenza in Murshidabad district of West
Bengal.
• Reported wild polio virus cases in Ghaziabad district
of Uttar Pradesh on 9th Feb. 2010
• Reported cases of blindness among infants and
children in village Shivpur of Gauri bazaar, Deoria
district of Uttar Pradesh from 12 – 14 May 2010.
• Dengue outbreak in the districts of Idukki,
Kottayam, Pathanamthitta and Thiruvuanan
thapuram in Kerela state from 20 – 24 July 2010 .
• Malaria in Mumbai (Maharashtra) from 29 – 30
July, 2010.
• After cloud burst leading to flash floods causing
damage to human life and provided Disease control
facilities in Leh from 7- 15 August and from 13- 28
August.
• Reported cases of wild poliovirus in Motihari (East
Champaran) District of Bihar from 13-17 October
2010.
• Reported cases of wild poliovirus in Beed district
of Maharashtra from 12-25 October 2010.
C. Manpower Development
National Centre for Disease Control (NCDC), Delhi is a
WHO Collaborating Center for Epidemiology and training.
The division of Epidemiology conducts regular training
programmes and numerous other short-term training
activities every year. The course curricula of these training
programmes are designed and tailor-made to develop the
necessary need-based skills for the health professionals.
The participants to these courses come from different
States/ Union Territories of India. In addition, trainees
from some of the neighbouring countries like Bangladesh,
Bhutan, Sri Lanka, Myanmar and Nepal also participate
in some of the training programmes.
D. The Training Courses Organized
• 15th Regional Field Epidemiology Training
Programme (FETP) from 2nd August 2010 to 29
th
October 2010. A total of 25 participants from 10
countries participated in this training.
• Four week Regional Training Programme on
Prevention and Control of Communicable Diseases
from 9th November 2010 to 6th December 2010.
A total of seven participants from Maldives, Bhutan
and Nepal attended the said training.
E. Training/ Meetings & Workshops Attended
• Meeting on Public Health Bill 2009 in the Ministry
of Law and Justice at New Delhi on 22.1.10.
• Meeting on South-East Asia Regional conference
on Epidemiology organized by WHO and IAE at
Hotel Taj, New Delhi from 8 – 10 March 2010.
• Ethical Committee meeting at NCDC on
25.05.2010 to look for the ethical issues of the long
projects of MPH Scholars.
• Meeting for revision of Indian Public Health
Standards held at NCDC on 5 – 6 May 2010.
• Expert Group Meeting on Firming of Sentinel
Surveillance for Vaccine Preventable Diseases
under the chairmanship of Dr. L.M. Nath at
N.C.D.C., Delhi on 28
th
June, 2010.
• Sixth World Organ Donation Day on 27 – 28
November 2010 at Vigyan Bhawan, New Delhi
15.20.8. Zoonosis Division
The objectives of the division is to provide technical
support for outbreak investigations, conduct operational
research and trained manpower development in the field
of zoonotic diseases and their control in the country.
Diagnostic support is provided to State Governments for
laboratory diagnosis of zoonotic infections of public health
importance.
The Division has Reference Laboratory for Plague. It
has also been recognized by the World Health
Organisation as WHO Collaborative Centre for Rabies.
Currently the work is being carried out on following
Zoonotic diseases: Plague, Rabies, Kala-azar, Arboviral
infections (Dengue, JE & Chikungunya), Toxoplasmosis,
Brucellosis, Leptospirosis, Rickettsiosis, Hydatidosis,
Neurocysticercosis and Anthrax.
The Central Animal Facility for breeding & maintenance
of different species of laboratory animals is being
supervised by the Division.
Annual Report 2010-11 242
Major Role and Activities of Division during 2010 are as follows:
A. Referral diagnostic services for the years
2010 (01.01.2010 ñ
30.11.2010)
Rabies
(a) Post-mortem diagnosis in animal brain samples by Negri body, FAT, BT 15
(b) Diagnosis in hydrophobia cases by 16
(c) Assessment of antibodies by ELISA test
(i) Human 617
(ii) Animal 28
Kala-azar
(a) Parasitological diagnosis by smear examination and culture 96
(b) Serological diagnosis by IFA test 228
Toxoplasma
Serological and diagnosis by IFA test 390
Brucellosis
Serological diagnosis by tube agglutination test 76
Rickettsiosis
Serological diagnosis by Weil Felix test 156
Hydatidosis
Serological diagnosis by ELISA 32
Arboviral diseases
Serological diagnosis by IgM ELISA test for Japanese Encephalitis.
(i) Human sera samples 29
(ii) Human CSF 72
IgM ELISA test for Dengue 742
IgM ELISA test for Chikungunya 292
Plague
Serological diagnosis by PHA and PHI in rodent Sera 1204
Culture for isolation of Y.pestis from rodent organs 846
Neurocysticercosis
Serological diagnosis by ELISA 187
Annual Report 2010-11 243
2010 (01.01.2010 ñ
30.11.2010)
Leptospirosis
Serological diagnosis by ELISA 292
Anthrax Nil
Viral isolation
Chikungunya 60
Dengue 280
JE Nil
Rabies 4
Lymes Disease Nil
Hanta virus Nil
B Training courses/Expert group meetings
• Joint Orientation Workshop on Zoonotic infections
for medial and veterinary professionals from 17
th
to 21
st
May, 2010
• Training Course on laboratory diagnosis of Dengue
& Chikungunya for doctors & paramedicals of
sentinel hospitals of Delhi from 8
th
to 11
th
June 2010.
• Training of core trainers in appropriate animal bite
management including intra-dermal inoculation of
cell culture anti-rabies vaccine, August, 2010.
C (1). Research projects undertaken
• To study the epidemiological profile of Kala-azar
patients in Delhi
• Serological studies in Toxoplasmosis in different
Delhi Hospitals.
• Comparative analysis of various serological tests
in diagnosis of Toxoplasmosis.
• Surveillance of Plague in different parts of the
country.
• Specificity of Passive haemagglutination Test for
Y.pestis.
• Use of ELISA in serological diagnosis of
Neurocysticercosis.
• Molecular characterisation of strains of
Leishmania.
• Sero-epidemiology of Brucellosis in high risk
population in Delhi
• Standardization of appropriate diagnostic methods
for sero-diagnosis and sero-epidemiology of human
and animal leptospirosis
• Surveillance of arboviral infections in man and
animals
• Isolation of rabies virus in-vitro (Neuroblastoma 2A
cell lines).
• Study of prevalence of Rabies in peridomestic and
wild rodents.
• Standardization of Rapid Fluorescent Focus
Inhibition Test (RFFIT) for rabies antibody titer.
• Isolation of Chikungunya virus in mouse
neuroblastoma cell lines.
• Serological studies in clinically suspected cases of
hydatid disease
• Sero-epidemiological studies for rickettsial diseases
(scrub typhus & Indian tick typhus) in patient with
pyrexia of unknown origin.
C (2) Pilot Projects on Prevention and Control of
Human Rabies and Control of Leptospirosis.
Annual Report 2010-11 244
The Zoonosis division is presently undertaking two
projects as “New initiative” under 11
th
five year plan
namely:-
o Pilot Project on Prevention and Control of Human
Rabies
o Pilot Project on Control of Leptospirosis.
Pilot project on Prevention and Control of Human
Rabies
To prevent human deaths due to rabies a pilot project has
been initiated as a ‘New Initiative’ in the 11
th
Five Year
Plan since March 2008, to be completed by March 2010.
NICD is the nodal agency to coordinate various activities
under the project. It is being carried out in five cities viz:
Ahemdabad, Bangaluru, Delhi, Pune & Madurai. The
focus of the pilot project is on training of health
professionals about rabies and animal bite management,
ensuring timely and adequate post-exposure treatment to
all animal bite victims, creating awareness in the
community regarding rabies, animal bites and its
prevention, strengthening laboratory diagnostic
capabilities, facilitating introduction of intradermal route
of vaccination and sensitizing veterinarians. A total amount
of Rs. 3.26 crore has been allocated for the project. An
amount of Rs. 1.81 crore was released during 2008-2009
to pilot project cities to carry out various activities.
Pilot Project on Control of Leptospirosis
To prevent morbidity and mortality due to Leptospirosis
in human a pilot project has been initiated as a ‘New
Initiative’ in the 11
th
Five Year Plan for two years (March
2008 to March 2010). NCDC is the nodal agency and
the three states under the project are Gujarat, Kerala
and Tamil Nadu. The focus of the project is on early
diagnosis and treatment of Leptospirosis cases,
Strengthening of Laboratory and patient management
facilities, trained manpower, awareness in the community
and inter-sectoral co-ordination. A total amount of Rs.
2.05 crore has been allocated for the project. An amount
of Rs 99 Lakhs was released during the year 2008-09.
Rs 95.50 lakhs was allocated to pilot project states to
carry out various activities. Utilization Certificate and
Statement of expenditure of Tamil Nadu (Rs 30.00 Lakhs)
and Gujarat (Rs 35.50 lakhs) has been obtained. In the
current financial year 2009-10, a sum of Rs. 80.00 Lakhs
has been allocated.
15.20.9.Division of Biochemistry & Biotechnology:-
The division is actively involved in disease diagnosis during
various epidemics and outbreak, operational research,
manpower development, advisory role and other
multifarious activities towards prevention and control of
a cascade of epidemic-prone diseases of larger public
health importance.
The division provides laboratory support to epidemiological
studies, surveys and outbreaks and also participates in
teaching, training, conference, workshops, seminar,
symposia and other academic related activities organized
by the Institute from time to time. The division conducts
applied research activities leading to Ph.D degree from
GGSIP University, Delhi. It also imparts project training
to M.Sc/B.Tech students from different Universities and
Institutes.
The division has two laboratory wings:
A. Biotechnology/ Molecular Biology Wing
i) Biotechnology & Molecular Biology Laboratory
ii) Molecular Diagnostics & Gene Cloning
Laboratory
• •• •• Molecular Diagnosis & Molecular Epidemiology of
over 25 epidemic-prone diseases viz. Polio,
Dengue, Hepatitis, HIV, SARS, Avian
influenza,Swine flu, Anthrax, MDR TB, Malaria,
Kala-azar etc of greater public health importance.
PCR/RT-PCR & DNA Fingerprinting/Gene
Sequencing for ultimate diagnosis of pathogens.
Tracking the source of infection of emerging/re-
emerging diseases.
Molecular differentiation of strains, detection of
virulent/drug resistant forms.
Genotyping and Sub-typing of strains.
Maintenance of “Gene Bank” of important disease
pathogens.
Molecular typing of drug resistant M. tuberculosis,
S.aureaus and K.pneumoniae.
B. Biochemistry & Environmental Biochemistry
Wing
Annual Report 2010-11 245
i) Clinical Biochemistry & Toxicology Laboratory
ii) National Reference Lab for Iodine Deficiency
Disorders
Referral services/support to outbreak investigations.
Analysis of iodine in salt and urine samples in Iodine
deficiency disorders (IDD) analysis.
Thyroid function test (FT3, FT4 & TSH) in referred
serum samples.
Chemical analysis of water for fluoride toxicity,
Imparts training under NIDDCP for manpower
development.
Significant achievements:
Department of Biotechnology, NCDC has been
recognized as Regional Reference Laboratory of
NACO for DBS-based HIV-DNA PCR for early
infant diagnosis (EID). MOU between NACO and
NCDC signed by Director, NCDC on 27.11.2010.
Four Ph.D students of the division have been
awarded Ph.D. Degree from GGSIP University,
Delhi.
Research Projects:
• Genomic characterization of circulating strains of
Influenza A Virus including H5N1/H1N1.
• Molecular characterization of Dengue virus isolates
in the Cpre-M, M and Env/NS1 gene of region of
the virus isolates from DF outbreaks.
• Genotyping of HBV Strains from Gujarat HBV
outbreak and typing of HCV from Delhi isolates.
• Molecular typing of HIV-1 subtype-C and drug
resistance gene in Indian strains.
• Molecular characterization of M.tuberculosis in
endometrium obtained from infertile women
undergoing infertility management.
• Studies on drug resistance gene(s) in Salmonella
species.
• 7. Characterization of DNA repair enzymes in
MDR and XDR M. tuberculosis and their role in
drug resistance.
• Molecular studies of Chikungunya virus isolates in
different parts of the country.
• Monitoring of thyroid hormones in sera from
suspected cases and iodine levels in urine and salt
samples under NIDDCP.
Outbreak Investigations
Pandemic Influenza A (H1N1) : In view of the major
pandemic Influenza A (H1N1) virus outbreak in the
country, clinical samples of more than 34285 suspected
cases of swine flu were tested at NCDC, Delhi using
CDC recommended protocol for Real Time RT-PCR,
alongwith PCR and gene sequencing. Till date, over 7966
confirmed cases of Influenza A (H1N1) were reported
by NCDC alone. Further regular lab-testing is going on
to detect new cases of pandemic Influenza A (H1N1).
15.20.10. Proposed upgradation of NICD to NCDC
NICD, a premier public health institute in the country
tasked to meet the challenges of emerging and re-
emerging diseases. The upgradation was considered
essential as no major upgradation had taken place since
long. The institute got its independent appraisal done as
advised by the Planning Commission in July, 2007. The
Department of Management Studies, IIT Delhi carried
out evaluation during November 2007 and submitted its
report in May 2008. M/s. HSCC was appointed as
Consultant for preparing Detailed Project Report (DPR).
They submitted the DPR. Based on the above inputs and
also detailed consultations at different levels, including
with technical officers, a draft Memo for Expenditure
Finance Committee (EFC) was prepared and circulated
in December 2009. EFC Memo was finalized after
incorporating response from the concerned Ministries/
Departments. The estimated cost includes capital cost
for civil and services works, furniture, equipment and
additional manpower.
EFC has since recommended the project at a total cost
estimates of Rs.382.41 crore. A draft note for Cabinet
Committee on Economic Affairs (CCEA) was prepared
and sent to MOH&FW for further necessary action. In
addition, it has since been decided to engage National
Building Construction Corporation (NBCC) as an agency
for construction works. Further action to execute an MoU
with them is being taken. Simultaneously approvals from
local authorities on the site plan and master plan are also
being taken.
Annual Report 2010-11 246
15.21 LADY READING HEALTH SCHOOL
(LRHS), DELHI
Lady Reading Health School, Delhi is established in
1918 ,is imparting the following courses:-
I. Diploma in Nursing Education and Administration
(Elective in Community Health Nursing).
II. Certificate Course for Health Workers (Female)
under Multipurpose Workers Scheme.
III. Auxiliary Nurse-cum-Midwife Course under
(10+2) Vocational Scheme.
Ram Chand Lohia Infant Welfare Centre, under Lady
Reading Health School provides field practice area for
Urban Health experience for the students and gives
integrated M.C.H. Family Welfare Services to over
39,000 populations.
Staff and students actively participated in ‘Pulse Polio
Programme’, Reproductive Child Health Programme and
Perfect Health Mela etc. during the year.
15.22 PASTEUR INSTITUTE OF INDIA (PII)
COONOOR
The Institute registered as Society under the Societies
Registration Act, 1960, started functioning as Pasteur
Institute of Southern India, on 6
th
April 1907 and the
Institute took a new birth as the Pasteur Institute of India
and started functioning as an autonomous body under the
Ministry of Health and Family Welfare, Government of
India, New Delhi from the 10
th
of February, 1977.
Activities undertaken during 2010-11 were:-
Institute has a Rabies Diagnostic Lab and treatment
center to cater the need of the general public.
Clinical Laboratory service
Present Activities
Production of DPT vaccine and TCAR vaccine
keeping in view of Supply Order received from the
Ministry.
Training Programmes to Post-Graduate and
Graduate students.
Academic programmes like Ph. D. (Microbiology
– Part time & Full time) affiliated to Bharathiar
University, Coimbatore and M.D (Microbiology)
affiliated to Tamilnadu Dr. M. G. R Medical
University, Chennai.
Breeding of Mice and Guinea pigs for Experimental
purpose like Quality Control of DPT and TCAR
vaccine and stability study of such vaccines.
Quality Control Division
The Quality Control Division comprises the following
divisions.
1. Quality Control Department
2. Rabies Diagnostic Laboratory
3. Sterility Media Section
The following processes were carried out in Quality
Control Division.
a) Quality Control Tests on Bacterial Vaccines ( DPT
group of vaccines) and Tissue Culture Anti Rabies
Vaccines
b) Sterility media preparation
c) Rabies Diagnostic Tests
a. Quality Control Tests
IPQC tests for 9 batches BPDT, 7 batches of BPTT and
13 batches of B.P. pool samples were carried out in QCD.
Aluminium Phosphate Gel samples (63 Nos) were tested
for Aluminium Phosphate content and the Sterility test
was conducted for 40 samples. Estimated Thiomersal
content for 3 samples and 1 batch of 5 ml tubular glass
vials tested for measurement and hydrolytic resistance
(Raw Material Testing). Growth Promotion Test was
carried out for 1 batch of FTM. Analysed 40 water
samples and performed Lf test for 20 samples. The
Standard Microbial ATCC Strains and SP2/O Ag 14
Mouse Myeloma cell line have been received and stored.
b. Sterility Media Preparation Division
During this period the Sterility Media section was engaged
in the preparation of sterility media to rule out the microbial
contamination on various samples and also for the
checking of microbes in the classified sterile area in
vaccine production. The following table shows the figures
of various bacteriological media prepared and utilized.
Annual Report 2010-11 247
Nutrient Agar 42 Litres Prepared in Petri dishes and used for various testings
Sabourauds Agar 32 Litres Prepared in Petri dishes and used for various testings
Alternate Thioglycollate broth fluid medium 795 Litres Used in the sterility testings as per I.P.
Soyabean Casein Digest broth 840 Litres Used in the sterility testings as per I.P.
Fluid Thioglycollate Broth 85 Litres To use in the sterility test as per I.P.
Nutrient Broth 15 Litres Used in various tests
c. Rabies Diagnostic Lab
48 sera samples both from Human, Domestic animals
were subjected to Rapid Fluorescent Focus Inhibition Test
(RFFIT) for the detection and quantification of Rabies
Neutralizing Antibodies using Murine Neuroblastoma-2A
cells and 96 well flat bottom Micro titre plates. This
includes the samples received from our Dispensary from
the Patients reporting for consultation and to assess the
post vaccination sero conversion for the protection against
rabies infection.
Laboratory Animal Division
Number of animal weaned: Mice : 14091 Nos
Guinea pig : 468 Nos
Number of animal supplied to internal users:
Mice : 3386 Nos
Guinea Pig : 159 Nos
Number of Animals Supplied to neighbouring Institute:
Mice : 2350 Nos
Guinea pig : 25 Nos.
Details of grant-in-aid received from the Ministry
of Health and Family Welfare, and the expenditure
incurred, etc., during 2010-11:
The Ministry of Health and Family Welfare, New Delhi,
out of the annual budget of Rs.20.00 Crores has released
a total sum of Rs.5.00 Crores to this Institute during the
financial year 2010-11 vide the Sanction Order
No.V.11011/12/2010/V-I dated 02.08.2010-
As against the Grant-in-Aid amount of ‘9.91 Crores (i.e.,
5.00 crores + 4.91 crores unutilized Grant-in-Aid available
as on 01.04.2010), this Institute has already spent a sum
of Rs.7.46 crores during the financial year 2010-11 under
Plan scheme upto October, 2010. While releasing the
Grant-in-Aid, the Ministry has, vide above letter informed
that the normal expenditure of the Plan scheme including
the administrative expenses of grantee institutions may
be met from the above amount.
Academic activities:
The Industrial visit of Graduate and Post Graduate
students of different college/universities were
discontinued due to the revival of vaccine production. Two
students underwent training for 15 days during May 2010.
The Institute has a well stocked library with 4183 books
and 12414 bound volumes, 4 International journals, 13
Indian Journals and WHO publication (Global
subscription). The Library is connected with 31 E-books
(Print form) and rest of the E-Books are stored in the
CD. The Library is connected with internet to utilize the
E-journal service to the maximum. Journal Club activities
are revived and decided to have two scientific presentation
per month.
Quality Assurance
“Quality Assurance” is a wide – ranging concept covering
all matters that individually or collectively influence the
quality of a product. It is the totality of the arrangements
made with the object of enduring that pharmaceutical
products are of the quality required for their intended use.
Quality Assurance therefore incorporated GMP and other
factors, including those outside the scope of this guide
such as product design and development.
The following activities were carried out in Quality
Assurance Section.
Regular monitoring of cold storage of bacterial seed
copies (DTP group of vaccine) and issued to
concerned section for vaccine production purpose
based on their request.
Annual Report 2010-11 248
Issuing of approved and Authorized copies of BPR
to the concerned section (DTP production,
formulation & Sterility Media Section) based on
their request and reviewed the same when their
submitted to quality Assurance Section.
Organogram and Responsibilities prepared for all
the sections of this organization based on source
data from the respective section and issued back
the approved copies.
SOP revision work carried out for the following
sections : Tetanus Section, Diphtheria Section,
pertussis Section, gel and mixing section, DTP
Containerization and filling section, labeling and
packing Section, sterility media Section, Quality
control section, Administration section, Account
Section, purchase and Stores section, Library,
Dispensary, laboratory Animal division, Quality
Assurance Section and TCARV section.
Preparation of site master file completed.
Viable and non viable particle count as part of
environmental monitoring carried at Gel and Mixing
Section, DTP Filling Section, TC ARV Section,
Quality Control Section, Sterility Media and report
generated and issued to concern section.
Verification of In-house training records and
documentation of the reports from all the sections
is being carried out periodically.
Revocation of suspension of licence:
The Drugs Controller General (India), Central Licence
approving Authority, Drugs Control Division, DGHS, New
Delhi has vide Office Memorandum No.X-11026/1/06-D
dated 15.01.2008 informed that the Drug Licence has
been suspended till such time all the deficiencies pointed
out by the Inspection team of NRA Assessment are
rectified. Accordingly, the production of all vaccines
stopped since January 2008 in this Institute. However,
Central Government vide order numbers V.12011/1/2009-
VI/DFQC dated 12.02.2010 and F.No.X.11035/2/2010-
DFQC dated 26.02.2010 revoked the suspension to the
above licence.
DPT production:
To comply with the Ministry’s order the production activity
initiated and different components like Diphtheria Toxoid,
Pertussis component and Tetanus Toxoid are at different
stages of preparation. The tentative schedule of supply
is as follows:
January, 2011 50.00 LDs
February, 2011 50.00 LDs
March, 2011 50.00 LDs
April, 2011 50.00 LDs
May, 2011 60.00 LDs
June, 2011 60.00 LDs
TOTAL 320.00 LDs
15.23 ALL INDIA INSTITUTE OF PHYSICAL
MEDICINE AND REHABILITATION
(AIIPMR), MUMBAI
15.23.1 About the Institute
The All India Institute of Physical Medicine and
Rehabilitation, Mumbai, established in the year 1955 is
an apex Institute in the field of Rehabilitation Medicine
under DGHS.
Objectives
To provide need based Medical Rehabilitation Services
including provision of Prosthetic & Orthotic appliances
for persons with neuro-musculo-skeletal (locomotor)
disorders.
• To provide training at Under Graduate and Post
Graduate level to all categories of Rehabilitation
professionals.
• To conduct research in the field of Physical
Medicine and Rehabilitation (P.M.R.).
• To provide and promote community based
programmes of Disability Prevention &
Rehabilitation for the rural disabled.
15.23.2. The Institute has initiated several steps for
commencing new service lines to meet the challenges
arising from increasing incidence of disability due to non
communicable disorders. Rehabilitation team meets
periodically and confer on rehabilitation management in
the following special clinics for the PWD.
CP Clinics – 295, Prosthetic & Orthotic Clinics –
208, Case Conference –103, Disability Certificate
Evaluation –1585.
Annual Report 2010-11 249
Types of disability managing in the Institute.
Birth anomalies affecting musculo-skeletal system,Post
Polio Residual Paralysis, Cerebral Palsy, Stroke, Amputee,
Spinal Cord Injury , Neuropathies, Myopathies,
Occupational Disability.
15.23.3.a Community Based Rehabilitation Projects
(CBR): Following project is now completed by this
Institute and report is submitted to WHO – A Pilot Project
on CBR, in Mumbai urban slum of S-Ward, Bhandup,
sponsored by WHO (Country office, India) in-
collaboration with Municipal Corporation of Greater
Mumbai.
15.23.4.b “Mobile Domiciliary Rehabilitation Project” in
collaboration with Rotary Club of Mumbai- Worli in H
ward of Municipal Corporation of Greater Mumbai. This
project is ongoing project for last Five years, which
represents exemplary collaboration between Government
of India, NGO and MCGM i.e. local self Government.
Highlights: -
• Persons with disability belonging to below poverty
line living in the urban slums are targets for
intervention under this project. Population living in
Santacruz belongs to H (East) ward, Mumbai are
being covered by outreach services. Those who
require referral services to the Institute are
provided transport facilities which are modified to
ease the boarding and the alighting of the individual
by customized hoist attachable to the entrance.
• Schools children in the locality are periodically
screened and provided counseling and intervention
services.
• During this period 161 PWD’s have been screened
in the urban slums.
15.23.4.c Intervention-wise distribution ñ (Under
the Project)
Therapeutic intervention Exs Therapy - 128
Electrotherapy - 26
Referrals visit to AIIPMR for
reconstructive surgeries - 13
No of Aids & Appliances delivered - 7
15.23.4.d Post-graduate students were conducted
following projects in the Department of
P & O.
• Gait Evaluation of a Swing Phase Assist Orhtotic
Knee Joint in Patients with Poliomyelitis.
• Performance study of anatomic versus
Quadrilateral socket design
• Design and evaluation of multi purpose walker for
Elderly people
• A comparative study between supracondylar socket
and Anatomical Contoured Socket for Trans-Radial
Amputee.
15.23.5. Academic Activities
• The institute had received permission to start MD
(Physical Medicine & Rehabilitation) course from
the academic year 2010-11 from Ministry of Health
& Family Welfare, Government of Maharashtra,
Maharashtra University of Health Sciences,
Nashik.
Sr. No. Name of Courses Intake Capacity
1 MD (Physical Medicine &
Rehabilitation) 2
• Under graduate and post graduate counselling
centre - Institute is recognized as one of the center
for UG & PG counseling for admission to MBBS,
MD, Dental Courses through Video Conference
Mode. Counselling was held during the month of
February and March.
• Diploma in Hearing Languages and Speech
Programme is ongoing training programme on
video conference mode. 14 students enrolled for
the Academic year 2009-10. All the passed out
students have obtained jobs at various organizations.
15.23.6. Implementation of Right to Information
Act. (RTI)
Institute is responding to information sought by the
applicants. Nominated Central Public Information Officer
(CPIO) duly assisted by the committee members provides
such information.
Annual Report 2010-11 250
15.24 All India Institute of Speech and Hearing
(AIISH), Mysore
The All India institute of Speech and Hearing is a pioneer
institute in the country imparting professional training,
clinical services, conduct of research and education of
the public on various communication disorders.
15.24.1.Academic Issues
AIISH has been conducting courses in the area of
communication disorders from its inception. The institute
which started offering one PG course in 1965 is now
offering 14 courses. The student strength has increased
from 15 in 1965 to 583 as on today. The admission to all
the courses is made on All India basis duly following
reservation policies of Government of India.
Besides one certificate course, AIISH conducts 14
Academic courses, which include, three Diploma, UG /
PG programs of B.Sc (Speech and Hearing), B.S.Ed
(Hearing Impairment), M.Sc (Audiology), M.Sc (Speech-
Language Pathology), and M.S.Ed (Hearing Impairment).
It has Ph.D and Post-doctoral fellowship programs both
in Audiology and Speech Language Pathology.
In addition to the existing two post graduate diploma
programs Viz., PG Diploma in Clinical Linguistics for
Speech Language Pathologist and Forensic Speech
Sciences and Technology, a new Post-graduate Diploma
Program in Neuro-Audiology has been introduced at this
institute from this academic year 2010-11. On 1
st
Oct.
2010, this program was launched by Sri V G Talwar, Vice
Chancellor, University of Mysore and Dr. Mewasingh,
Professor and Dean, Dept. of Psychology, University of
Mysore was the guest of honour on this occasion.
DHLS Program:
This Diploma program introduced through quasi distance
mode in the year 2007-08 has been continued. At present,
the institute has 11 study centers spread over 11 different
states covering all the zones in the country, as follows,
with AIISH, Mysore as nodal center ;
Jawaharlal Institute of Post-graduate Medical Education
and Research (JIPMER), Puducherry, Regional Institute
of Medical Sciences (RIMS), Imphal, Manipal, Dr. Ram
Manohar Lohia Hospital, New Delhi, All India Institute
of Physical Medicine and Rehabilitation (AIIPMR), Haji
Ali, Mumbai, Indira Gandhi Medical College, Himachal
Pradesh University, Shimla, Himachal Pradesh, Shri
Chathrapathi Sahuji Maharaj Medical College, Lucknow
University Chowk, Lucknow, Uttar Pradesh, Jawahar
Lal Nehru Medical College, Ajmer, Rajasthan, Srirama
Chandra Bhanj Medical College, Cuttack, Orissa,
Dr. Rajendra Institute of Medical Sciences, Baritayu,
Ranchi, Jharkand, Netaji Subhash Chandra Bose Medical
College, Jabalpur, Madhya Pradesh, Jawaharlal Nehru
Medical College and Hospital, Mayaganj, Bhagalpur,
Bihar.
An annual meet of the All India DHLS Coordinators was
held on 1
st
and 2
nd
July, 2010 at the institute. The
coordinators of the 12 DHLS centers from all over India
participated in the meeting along with their counterparts
from AIISH.
Courses conducted and admission details:
The admission details for different courses conducted at
the institute for the academic year 2010-11 are as follows:
Sl Name of the course Nos.
No.
1 Diploma in Hearing Aid and Earmold
Technology 04
2 Diploma in Hearing, Language and
Speech (DHLS) at AIISH, Mysore 06
3 DHLS at other 11 study centres
(through quasi distance mode) 182
4 DTYHI (Diploma in Training Young
Hearing Impaired) 08
5 BASLP (Bachelors in Audiology &
Speech Language Pathology)
I Year - 61
II Year - 62
III Year - 44
Internship - 36 203
6 B.S.Ed (Hearing Impairment) 03
7 M.S.Ed (Hearing Impairment) 03
8 M.Sc (Speech-Language Pathology)
I Year 36
II Year 35 71
9 M.Sc (Audiology)
I Year 36
II Year 35 71
10 Ph.D 15
11 Post-doctoral fellowship 01
12 P.G. Diploma in Forensic Speech
Sciences & Technology (PGDFSST) 04
13 P.G. Diploma in Clinical Linguistic for
Speech Language Pathologists
(PGDCLSLP) 03
14 P.G Diploma in Neuro
Audiology(PGDNA) 08
Total 583
Annual Report 2010-11 251
Short-term Training Program
Short term training programs were conducted on the
following topics:
a. Assessment of Communication Disorders on
20.4.2010
b. Identification of language problems in school
children on 6.5.2010, 10.6.2010 and 16.7.2010
c. Speech and language disorders on 9.6.2010
Workshops/ Semi nars/ Symposi a/ Ori entati on
Programs
Ten workshops/orientation programs were conducted in
these seven months on the following topics:
a. A program on Communication Disorders: Early
Identification and Prevention held on 18.5.2010 and
19.5.2010 to Social workers and Health workers.
b. A program on practical observation of pre-school
training for children with communication disorders
was held on 4.6.2010 to 30.6.2010 to 14 trainees
of C4D2 batch.
c. Orientation regarding activities of speech language
sciences and its activities to nurses on 14.6.10
d. An orientation program on Speech, Hearing and
Language Disorders and Training on Survey for
Early Identification and Prevention Communication
Disorders held on 2.9.2010 to AHSA Workers of
Gumballi and Volunteers of Home Makers from
Hullahalli and Akkihebbal.
e. A workshop on ‘Fine tuning of digital hearing
aids – Individuals with hearing impairment’ was
conducted on 2.9.2010.
f. Workshop on “Preparing young children with
Autism to learn language” on 10.9.2010
g. Orientation program on Professional Voice Care –
causes and management of voice disorders to
students BGS Apollo Hospital on 14.9.2010.
h. A program on ‘Staff enrichment on application
MATLAB’ held on 15.9.2010.
i. An orientation program on use of Hearing Aid
analyzers and tester by Special Educator.
Library and Information Center
A total of 210 books were procured during the year
making the total number of books to 17045. Besides this,
69 Journals are being subscribed, out of which 13 are e-
journals.
15.24.2.Research:
Five research projects with extra mural funding (WHO,
DST, CIIL, SBMT and Society of Bio Medical
Technology) and 6 projects from AIISH Research Fund
are in progress. Additionally, 36 research projects were
approved under AIISH Research Fund during the report
period.
A collaborative project on ‘Design and Development of
Speech Enhancer with Vellore Institute of Technology
sponsored by Society for Biomedical Technology,
Bangalore is being carried out at the institute.
Publications / Releases:
29
th
Volume (No.1 2010) of Journal of All India Institute
of Speech and Hearing (JAIISH) was released on 9th
August 2010 on the 45
th
Anniversary Day of the institute.
Proceedings of the International Symposium on
“Bilingual Aphasia”, Seminar on “Cochlear Dead
Regions” and “Auditory Dys-Synchrony” were released
during the period under report. A book on “Train Your
Child Level I” was also released for Care-givers of
children with hearing impairment during the period
15.24.3. Clinical Services:
The institute continued to provide clinical services for
clients with communication disorders through the
Departments of Audiology and Clinical Services with its
specialized clinical units and Department of Prevention
of Communication disorders. A total of 11,912 new clients
and 19,176 repeat clients registered during the period from
1.4.2010 to 31.10.2010.
Annual Report 2010-11 252
Details of clinical services provided at AIISH, Mysore Total
Hearing Evaluation 6408
Hearing Aid Trial 4994
Ear Mould Impression 1902
Clients provided with Speech, Language Therapy 4227
Clinical Psychology 3174
ENT cases evaluated at AIISH and KR Hospital 26201
Major and Minor operations conducted 183
Physiotherapy 489
Occupational Therapy 516
Special Clinics
Augmentative and Alternative Communication Unit:
Evaluation 11
Therapy 108
Autism Spectrum Disorders Unit:
Evaluation 103
Therapy 178
Craniofacial Unit 45
Listening Training Unit 877
Professional Voice Care centre 01
Tele-diagnosis and Tele-Rehabilitation to DHLS study centers
No. of Clients provided Tele-diagnosis and Tele-intervention 16
Clients attended Educational Guidance 126
Preschool Training Center
Total No. of groups 42
Total No. of languages 04
Total No. of children 1224
Hearing Aid dispensing:
Under ADIP Scheme of Ministry of Social Justice and Empowerment, 3055
Govt. of India
Issued at Camps 257
Issued under AIISH Hearing aid dispensing
scheme 596
Hearing Aid Repaired 612
Annual Report 2010-11 253
Outreach Services
I. Hearing Screening: Hearing Screening at the
Hospitals at Mysore, wherein new born and infant hearing
screening was carried out on 7577 babies during the period
from 1.4.2010 to 31.10.2010. The babies were referred
for confirmation of hearing loss, if any, to AIISH. The
babies with confirmed hearing loss were taken for
management intervention.
II. Outreach Service Centers: All India Institute
of Speech and Hearing has established Outreach Service
centers at Akkihebbal, Hullahalli and Gumballi, wherein
a speech and hearing unit has been established at the
Public Health Centers. Between 1
st
April 2010 and
31.10.2010, 161 cases were seen at Akkihebbal, 274 at
Hullahalli and 192 at Gumballi villages.
III. Camps
Five camps were conducted in Karnataka and Kerala
where 1242 were examined, 112 hearing aids were issued
and 164 certificates were provided.
IV. AIISH-SSA Project
A collaborative project with Govt. of Karnataka under
Sarva Shikshana Abhiyaan was continued and around
95 teachers underwent training in the detection of
academic difficulties of school children in the report period.
Two New Special units were launched namely:
1. Fluency Unit.
On 9
th
August 2010, Prof. V N Rajashekaran Pillai, Vice-
Chancellor, Indira Gandhi National Open University
(IGNOU), New Delhi, inaugurated the Fluency Unit.
Fluency unit cater to the academic, clinical and research
and public education needs. Clients with stuttering,
neurogenic stuttering, cluttering, and fast rate of speech
are offered clinical services. Approximately 40 to 50
persons with stuttering avail the therapeutic services and
250 number of therapy sessions are provided in a month
in this unit.
2. ëVertigo Clinicí
Vertigo Clinic was inaugurated in the Department of ENT
at the institute on 22.10.2010.
This clinic was launched to benefit the patients with
peripheral and central vertigo problems. The
Multidisciplinary team comprises of ENT surgeons,
Neurologists, Audiologists and Nurses. The facilities
available in the Vertigo Clinic are Microscopic
examination of the ear, Electro Nystagmography, Vestibulo
Spinal tests, neurological evaluation, Audiological tests
for Cochlear and Retrocochlear Pathology.
15.24.4. Public Education
(i) Public Lecture Series: The monthly lecture
series was continued and seven lectures on
various topics related to communication disorders
were conducted on the following topics during
the period.
a. Public lecture on identification of hearing
problems in school going children on 24.4.2010.
b. Physiotherapeutic Aspects in Communication
disorders on 29.5.2010.
c. Inclusive Education for Children with hearing
impairment on 26.6.2010.
d. Early Identification and Intervention of Hearing
Impairment on 31.7.2010.
e. Stuttering in Children on 28.8.2010.
f. Hearing Aids – Care and Maintenance on
25.9.2010.
g. Augmentative and Alternative Communication on
30.10.2010.
Inaugurations:
‘Bodhi’, the New Mens Hostel was and this new hostel
situated at Panchavati Campus of the institute
accommodates 94 number of students.
‘Ashoka’, the newly constructed International Guest
House with 15 number of guest faculty suites recently
started with a total living area of 63 sq. mtrs. and parking
space with a lounge.
Financial Achievements: Funds from the Ministry
(` in crores)
Grants for the Grants received Internal
year 2010-11 April-October Revenue
2010
Plan 21.85 9.70
Non-Plan 8.00 5.64 1.67
Annual Report 2010-11 254
15.25. CENTRAL INSTITUTE OF
PSYCHIATRY, KANKE, RANCHI
The Central Institute of Psychiatry, Ranchi covers a
sprawling area of about 210 acres and has the bed
capacity of 643. All beds in this hospital are paying. Some
beds are reserved for the patients sponsored by the
Central Government, Railways, Coal India and some for
the state Governments. There are 17 Wards, Nine wards
for the Male and six for the Female patients, one Family
Unit and one Emergency Ward. Each ward is at some
distance from other wards. Each ward has well laid out
roads and lawns around it. Male and Female sections are
separated by a high wall. All the wards are named after
eminent psychiatrists. It may be worth noting that unlike
other mental hospitals, CIP, Ranchi has never been a
custodial care facility. It has always been an open hospital
and the patients are never confined to rooms. They are
free to roam within the hospital.
Apart from drug therapy various psychotherapies,
behavior therapy, group therapy and family therapy are
routinely employed. A milieu therapy approach exists
where patients participate in running the ward and help
in looking after other patients. Regular physical exercise,
outdoor and indoor games and Yoga are available for the
patients. A very well stacked library having books in
English, Hindi, Urdu and Bengali as well as a number of
newspapers and magazines is freely accessible to the
patients.
Main objectives of CIP have been Patient care,
Manpower development and Research for which the
institute has the facilities of:
15.25.1. Adult Inpatient Services: The Inpatient
Psychiatry Unit provides services for acutely ill psychiatric
patients, including those requiring extensive care for
concurrent medical disorders. The entire gambit of mental
health expertise is available for the care of in-patients.
15.25.2. Patient OPD- Attendance, Admission and
Discharge: During the period from January -October
2010 the total number of OPD cases was 55334 (20478
New and 34856 Old) [including Psychiatric Cases
(Adult & Child), Staff OPD, Clinical Psychiatry,
Extension Clinics, Skin Clinics & School Mental
Health Programme, Epilepsy Camps]. New Cases
(Psychiatry) were 9730 (6647 Male, 3083 Female); old
cases were 32900 (23669 Male, 9231 Female); 3864
(3045 Male, 805 Female) patients were admitted, 3822
(3015 Male, 807 Female) discharged and only Three (03)
deaths occurred during the period. The average bed
occupancy rate was 87%.
15.25.3. Special Clinics: Special clinics include chronic
Schizophrenia Clinic, Skin & Sex Clinic, Neurology Clinic,
Sleep Clinic, Epilepsy Clinic, Staff OPD, Headache Clinic,
De-addiction Clinic, Child Guidance Clinic; Mood Clinic,
OCD Clinic etc. are also run here. Attendance of patients
in Special Clinics during the period from January -October
2010 was 16413 which is given below:
15.25.4. Centre for Addiction Psychiatry: This is a
new and modern De-addiction Center with capacity of
30 patient beds for the treatment of the person suffering
from problems of alcohol & drugs addiction. It is also the
nodal Center for the eastern India for the manpower
training and research in the field of alcohol and drugs
abuse. During the period from January -October 2010,
531 patients suffering from the problem of Alcohol and
Drug addiction were seen in the OPD in De-addiction
Clinic, 539 patients were admitted, 526 discharged.
15.25.5. Centre for Child & Adolescent Psychiatry:
Child psychiatry has been an important discipline at CIP,
Ranchi. A child guidance clinic was started in 1950 and
an independent 50-bed child psychiatry unit in 1975. This
unit also imparts training to resident doctors and
postgraduate students in the field of child and adolescent
Clinics No. of Patients
Epilepsy clinic 2435
Emergency service 2268
Sleep clinic 58
Skin clinic 2102
Headache clinic 169
Staff OPD 7534
Mood clinic 601
De-addiction 531
Chr. Schiz. Clinic 456
Ocd clinic 212
Neurology 40
Sex clinic 7
Total 16413
Annual Report 2010-11 255
mental health. It caters the needs of grossly psychotic
children, children with development disorders and mental
retardation. The parents are required to stay with their
children for the duration of the treatment. During the
period from January -October 2010, 5150 (New-1286,
Follow-up-3864) patients attended OPD for treatment.
15.25.6. Department of Clinical Psychology
The Clinical Psychology Department at the Central
Institute of Psychiatry was established in 1948 and is the
oldest independent Department of Clinical Psychology in
India. Over a period of years the Department has gained
excellence in the field of teaching, training, research and
clinical services.
15.25.7. Teaching and Training
Initially, the Department was involved in the patient care
only; however, later in the year 1962 a teaching course in
Clinical Psychology was also started. The course was
known as Diploma in Medical and Social Psychology (now
known as M.Phil in Medical and Social Psychology). In
1972 Ph.D. in Clinical Psychology was started. Presently,
there are 18 seats in M.Phil. (M&SP) and 04 seats are in
Ph.D. (Clinical Psychology). Our faculty includes 2
assistant professor, 2 assistant psychologists and 1 lab
assistant.
15.25.8. Clinical Services
The Department provides non-pharmacological
management for the patients of wide ranging psychiatric
problems with the help of psychotherapy, counseling,
group meetings, psycho-education, psycho-diagnostic
testing, intelligence testing and so forth. Apart from the
patients coming to the hospital, the Department is also
involved in providing services at various extension clinics
as well as schools. There is a separate out-patient unit of
the Department. The out-patient unit either gets referral
from the general OPD of the hospital or people can
directly come and seek help for their psychological
problems. The psychosocial OPD, as it is called, caters
to the needs of those patients who suffer from minor
psychological problems and who can be below exclusively
by psychological methods viz counseling, behaviour
therapy or biofeedback or relaxation therapy.
15.25.9. Psychology Labaratory
The clinical psychology lab was established for the first
time in India in 1949. It has various psychological tests,
rating scales, instruments and apparatus which aid in the
management of the patients. The lab has these tests
designed for use with both children as well as adult
population. There are in total 13 equipments and
apparatuses, 43 tests for the assessment of cognitive
functions, 19 tests for the assessment of personality which
includes projective and objective tests and there are 44
various scales. These tests are for use with both child-
hood as well as adult population. There are also 66 new
tests which the lab has acquired which assess various
domains of personality and cognition.
Departmental Activities
Apart from management of the patients, the Department
holds weekly academic exercises in the form of
departmental seminars and psychotherapy meetings.
Further, regular classes are taken for M.Phil and
Ph.D. students as well as for the students of other
disciplines such as Psychiatry, Psychiatric Social Work
and Nursing.
Research Activities
Research is an integral part of the Department. Faculty
members and the students of the Department are involved
in research activities on a regular basis. Major focus of
the current research is psychological assessment,
cognitive neurosciences and psychotherapy. Research
papers have been published in various international and
national journals. The Department is growing every year
and is contributing significantly to the field of mental health.
15.25.10. Department of Psychiatric Social Work
The Department of psychiatric social work came into
existence in the decade of 1950s although the family
psychiatry can be dated back to 1922 when patients were
admitted in specially made cottages with their family
members for multi-dimensional treatment. Training of the
students and professionals who were aspiring to be trained
“psychiatric social worker started in the year 1970. Since
then various achievements have been attained by this
Department. Training of psychiatric social work started
as the “Diploma in Psychiatric Social Work (DPSW)”
firstly and in the year 1985 it was upgraded to M.Phil.
Presently, 12 seats are available for M. Phil trainees.
15.25.11. Outreach Program: Extension Clinics include
General Psychiatry Clinic at West Bokaro, Hazaribagh
and CCL Gandhi Nagar Clinic, Ranchi and Epilepsy Clinic
at Deepshikha, Ranchi. These Units are conducting these
programmes regularly. We also arrange regular Camps
for awareness program, workshop with teachers, parents
Annual Report 2010-11 256
etc. School mental health programme also runs in two
schools details of which have been shared in the table
below:
15.25.12.Centre for Cognitive Neurosciences
The Centre for Cognitive Neurosciences had its humble
beginning as Electro-encephalography (EEG) Department
in 1948 with 6 channels and then 8 channels EEG
equipment. The Department was rechristened as
Psychophysiology and Neurophysiology Labs in 1995 and
recently as the Centre for Cognitive Neurosciences; each
new name representing the phenomenal growth that this
department has witnessed. Presently the centre has two
sections; a clinical section and a research section. The
clinical section contains a 21 channels paper EEG, 32
channels QEEG and 40 channels video EEG. The research
section includes Dense array EEG acquisition systems
(64, 128 and 192 channels), ERP acquisition units (40
channels), a polysomnography unit (40 channels) and a
repetitive Transcranial Magnetic Stimulation (rTMS) unit.
The centre has acquired advanced signal processing
softwares like ASA, BESA, Neuroscan, Curry, Matlab
and Mathematica.
The Centre runs a weekly Epilepsy Clinic in the Outpatient
Department of the institute (Thursdays) and at
Deepshikha, Ranchi (Wednesdays).
25.15.13 Department of Pathology and
Biochemistry
Department of Pathology and Biochemistry performs
number of pathological test in clinical pathology,
microbiology, bacteriology and biochemistry, serology and
immunology. The Department has innumerable
Total No. of Patients
Clinics No of Patients
West Bokaro 328
CCL Gandhi Nagar 74
Hazaribagh Clinic 731
Deepshikha Epilepsy Clinic 173
Deepshika, ICD & H 212
Epilepsy Camp Baripada, Orissa 84
Total 1602
pathological specimens of rare cerebral disease. This
Department is also engaged in high level of research.
15.25.14. Emergency Services: A 24 hours
emergency service is available in the OPD of the institute
with bed strength of 16 patients (8 for male and 8 for
female patients).
15.25.15. 24 Hours Services of Telephonic
Helpline & E-Mail Helpline: During January –
October 2010, 761 helpline calls and 124 e-mails were
attended.
15.25.16. Training Programme: In the training
program, Case conference, Seminar, journal clubs were
regularly held every week. Seminar-27 (1284
participants), Case Conference-29 (1283 participants),
Journal Club-20 (626 participants) Visiting Nursing
Students from other centers (402 participants).
15.25.17. Medical Library
In accordance with the objectives of the institute to
become a “Centre of Excellence Medical Library is to
provide the information services and access to
bibliographic and full text digital and printed resources in
the field of Mental Health and Allied Sciences to the
scholarly and informational needs to the institute
community. It also support the educational and research
programme of the institute by providing physical and
intellectual access to information, consistent with the
present and anticipated educational and research
programmes of the institute.
Library provide a wide range of current , accurate and
authoritative information from a vast selection of print
and electronic resources using State of the art technology
at it’s newly constructed three storied building. The library
collection focused primarily on Psychiatry, Psychology,
Neurosciences, Psychiatric Social Work and Psychiatric
Nursing. The collection of the library which includes
Books, Journals, Weekly Magazines, Newspapers, VHS,
VCDs, Reports, Dissertation, Thesis, WHO publication,
Microfilms, Atlas and electronic databases is regarded
one of the richest collection of its kind in the country. It
has some rarest collection of reference materials dating
back from pre independent (1910) and onwards. It has
collection of nearly 55,000 books, bound volumes of
journals and WHO publication. Nearly 2000 books from
different world wide publishers have been added every
year to make the library collection richer. The library
currently subscribes 318 print journals and has access of
Annual Report 2010-11 257
almost more than 2000 e-journals by using different
platform such as Science Direct, Wiley’s Online Library,
OvidSP, Cambridge Online, Sage Online, Springer link
etc. Library is also a member of the ERMED – India
consortia which is run by National Medical Library, New
Delhi. ERMED provides full text access of almost 1800
journals on its platform. It is no exaggeration to state that
the CIP Library is the largest and finest of its kind in the
country.
The library has been using the KOHA an Integrated
Library Management Software package for library
housekeeping operations. All the holdings of the library
have been indexed and users can search the database by
using KOHA OPAC online from any computer in the
institute’s LAN and from anywhere of the world by using
Web OPAC as usual. All the holdings of the library are
equipped with RFID Tags which help the users in Self
Issue and renewal of the library holdings by using Bio-
Metric system based Self Issue KIOSK and also help in
finding any books on the self by using Handheld Reader.
RFID tags also helps in library’s self management and
security of the library holdings.
Apart from the above library offers Reference Services,
Photocopying, User Guiding Services, Display of New
Arrivals, Document Delivery Service, Current Awareness
Service etc. Library is well connected with institute’s LAN
and has 10 Mbps Leased Line connectivity.
Library is equipped with Wi-Fi to provide Internet access
to it’s users on their own Laptops. Anyone can contact
the library for any type of information needed in their
academic/research work by using the e-mail address
ciplibrary@hotmail.com.
15.25.18. Homoeopathy Interventional Research
Project in CIP
On 17 September 2007 CIP launched two Homoeopathic
interventional Research Projects entitled “To Assess the
Feasibility of Add on Homeopathic Therapeutic
Intervention in Schizophrenia: an Open Trial” and “To
Assess the Feasibility of Add on Homeopathic
Therapeutic Intervention in Depression: an Open
Trial”. These projects are funded by Central Council for
Research in Homoeopathy, Ministry of Health and Family
Welfare New Delhi. The launch of this project widened
the horizon in the mental health intervention. This project
gave an impetus to the general belief toward alternative
therapy and thus opened new avenues for the treatment
of mental health problems.
The joint venture of homeopathy and modern approach
to mental health generated new knowledge that is useful
for the field of mental health.
15.25.19. The 36th Annual Conference of Indian
Psychiatric Society, Eastern Zone Branch
(CEZIPS 2010) & World Mental Health
Day
The 36th Annual Conference of Indian Psychiatric Society,
Eastern Zonal Branch (CEZIPS 2010) was held at Central
Institute of Psychiatry (CIP) on 8th and 9th October, 2010
which was jointly organized by Central Institute of
Psychiatry and Indian Psychiatric Society, Jharkhand
State Branch. The theme of the conference was “Child
and Adolescent Mental Health”. Over 350 delegates and
accompanying persons were registered who attended the
conference.
15.25.20. Major Achievement
• Centre for Cognitive Neurosciences Block, Central
Store Building, 16 nos. of Type IV and 8 nos. of
Type V residential quarters are at the verge of
completion and will be handed over to CIP shortly.
• Construction of new boundary wall in place of old
damaged boundary wall is in progress.
• 50 candidates out of total 79 seats were admitted
for the various courses conducted by CIP, Ranchi
in the session starting from 1st May, 2010
• Digtal X-ray, Haematology Analyzer, Bio Chemistry
auto analyzer, Coils for Magnetic Stimulator
Machine, Radio Frequency identification system
for Books & Journals for Medical Library,
Digitization of Medical Records, EEG Records,
Office Records, Fiber-Optic networking of the
Campus and heavy duty switches for Campus
Server have been added to the Institute.
• Installation of 380 KVA DG set, 400 KVA
transformer & underground electric cabling and
development of lawns in the hospital.
• Chapatti making machine, Flour kneading machine,
Steam cooking system, 150 ltrs. cooker, Three
burner and Two burner Gas Chulha, Potato Piller
and Veg. cutting machine have been added to the
kitchen.
Annual Report 2010-11 258
15.25.21. Clinical & Research
Marked increase in the number of cases attending OPD,
inpatient admission and sharp decline in mortality rates,
expansion of community outreach programme, increase
in the number of research paper publication, publication
of research journal- Indian Journal of Social Psychiatry
(Official Journal of Indian Association of Social
Psychiatry), increase in the number of students admitted
to various courses, conversion of microfilms into digital
formats.
15.5.22. Budgetary Provision
FINANCIAL YEAR PLAN NON-PLAN
BUDGET REVISED FINAL EXPENDITURE BUDGET REVISED FINAL EXPENDITURE
ESTIMATE ESTIMATE ESTIMATE ESTIMATE ESTIMATE ESTIMATE
2009-10
Revenue 100000 72300 74092 73858 262000 266600 273700 272537
Capital 50000 144100 139600 135800 — — — —
Total 150000 216400 216392 209658 262000 266600 273700 272537
2010-11 (Up to Oct. 10)
Revenue 120000 — — 53767 241800 — — 153351
Capital 152500 — — 103500 — — — —
Total 272500 — — 157267 241800 — — 153351
(Rs. in thousand)
15.25.23. Workshop on the Amendments to the
Mental Health Act.
A workshop was held in the Central Institute of Psychiatry
on 17th July, 2010 to discuss the proposed amendments
to the Mental Health Act, 1987.This workshop was a
part of several regional workshops organized by the
Ministry of Health and Family Welfare across the country
to gather opinion regarding the proposed amendments to
the Act. The Central Institute of Psychiatry was the venue
for eastern India.
Annual Report 2010-11 259
15.26. CENTRAL RESEARCH INSTITUTE
(CRI) KASAULI
Central Research Institute was established on 3
rd
May,
1905 as Pasteur Institute for North India. It is a
subordinate office of Directorate general of Health
Services, under the Ministry of Health & F.W. Govt. of
India. The Institute has a huge complex which divided in
seven sub-sections i.e. Establishment, Academic, Auxiliary
Facilities, Production Division, Quality Control Division,
Animal House and Research & Surveillance Division. It
has a network of large number of laboratories engaged
in manufacturing vaccines/sera and research activities.
Central Research Institute is engaged in production of (i)
Bacterial and Viral Vaccines & Sera on large scale. (ii)
Production & Supply of diagnostic reagents. (iii) Research
and Development in the field of immunology and
vaccinology. (iv) Teaching and training in vaccinology and
Microbiology. (v) Quality Control of immunologicals.
Staff Strength:
There are 725 sanctioned posts in CRI-Kasauli. The
number of sanction posts of group A,B, C and D are
50,32,213 and 430 respectively. The total staff in –
Position is 577. The staff in-position of group A,B,Cand
D is 16,24,186 and 351 respectively. Total Vacant posts
are 148. The Vacant position of group A,B,Cand D are
34,8,27and 79 respectively.
Budget Provisions 2010-11
(Rs. in Lakh)
Budget Provisions Plan Non Plan Total
BE 2010-11 1200.00 2812.00 4012.00
Expenditure
Oct, 2010 234.00 1313.00 1547.00
RE 2010-11 3232.00 2589.00 5821.00
BE 2011-12 4568.00 3312.00 7880.00
Manufacturing Demand and Supply of Vaccine and
anti-sera :
Since its inception the institute has developed into a
premier institute in research and production of a number
immunobiologicals. The order suspending the production
license was revoked by the Govt. of India in February,
2010. Production has been restarted and work on
upgrading all the facilities to meet cGMP standards is
underway. The quantity of vaccines and anti-sera supplied
during the last three years is given in the table No. 1.
Sl . Vaccines and Anti Sera Installed 2008-2009 2009-2010 2010-2011 Balance Stock
No. Capacity Demand Supply Demand Supply Demand Supply as on (31.10.2010)
1 DPT(Doses) 312 260 206.23 00 00 53.50 53.50 16.84
2 DT(Doses) 144 140 37.49 00 00 0.006 00 00
3 TT(Doses) 264 400 116.08 300.00 0.33 1.94 3.98 0.0018
4 Typhoid (AKD) (Doses) 20 20 1.96 1.42 00 00 00 00
5 J.E. (doses) Not Definite 4.00 00 00 00 0.0011 00 2.91
6 Yellow Fever (Doses) 0.40 1.32 0.84 1.07 1.06 0.75 0.75 0.89
Quantity in lakh of ml
7 ARS 2.00 0.38 0.38 0.1 00 1.52 0.22 0.0125
8 ASVS 3.00 0.04 0.04 0.0006 00 1.20 1.20 0.53
9 DATS(Lakh Vials) 0.10 00 00 0.01 00 0.03734 0.00054 0.00013
10 NHS As per Demand 00 00 0.279 0.253 0.035 0.035 0.05
11 Diag. AG. 2.50 0.243 0.243 0.714 0.714 0.443 0.443 0.07
Table No.1 Details of vaccine supplied during the period:-
(Quantity in lakh of doses)
Annual Report 2010-11 260
Other activities of the institute:
In addition to manufacturing of the vaccine and sera the
Institute is engaged in a large number of the activities
such as :
• Quality Assurance and Quality control
• National Salmonella and Escherichia Coli Center.
• National influenza surveillance center
• Rabies research center
• National Polio laboratory for surveillance
• Experimental animal House
• Medical treatment Centre & Diagnostic section
• Academic & Research Activities
For developing DPT group of vaccine manufacturing
facility at CRI, Kasauli, Ministry has engaged M/s HLL
Life care Limited, a Public Sector Enterprises under the
Ministry as Project management Consultant and to utilize
the services of M/s NNE Pharmaplan as their Detailed
Engineering Consultant for revival of CRI Kasauli.
Conceptual layout plan of the project has been approved
by WHO and DCG (I) and further activities are also
being undertaken. The project is likely to be completed
by May-June, 2011.
15.27. VALLABHBHAI PATEL CHEST
INSTITUTE (VPCI), UNIVERSITY OF
DELHI, DELHI
Brief Background
The Vallabhbhai Patel Chest Institute (VPCI) is a unique
post graduate medical institution devoted to the study of
chest diseases. It is a University of Delhi maintained
institution under ordinance XX (ii). The Institute is
administered by a Governing Body constituted by
Executive Council of the University and is funded entirely
by Grants-in-Aid from the Ministry of Health and Family
Welfare, Government of India. The Institute fulfills the
national need for providing relief to large number of
patients in the community suffering from chest diseases.
It has eminently discharged its role and has earned a
unique place in the field of Chest Medicine.
Main Objectives
The main objectives of VPCI are to conduct research on
basic and clinical aspects of Chest Medicine, to train post
graduates (D.T.C.D., M.D., Ph.D.) in Pulmonary
Medicine and allied subjects, to develop new diagnostic
technology and disseminate scientific knowledge related
to Chest Medicine to other institutions in the country and
to provide specialized clinical and investigative services
to patients.
Patient Management Services
The Viswanathan Chest Hospital (VCH), is the hospital
wing of the Institute which provides the patient
management services with the following facilities;
Outpatient Department, Inpatient Facility with 60 beds,
24 hours Respiratory Emergency, 8 bedded Respiratory
Intensive Care Unit (with facilities of 7 ventilators), Sleep
Laboratory, Tobacco Cessation Clinic, National Yoga
Therapy Centre, Cardio-pulmonary Rehabilitation Clinic,
Picture Archiving and Communication Systems (PACS),
Medical Records Section, Oxygen Plant.
During the year 2009-10 the VCH enrolled 10426 new
patients, 54386 old patients. A total number of 3956
patients were admitted as Indoor cases. A total number
of 19531 were provided 24 hours Respiratory Emergency
Services and 429 patients were provided ventilator
(invasive and non-invasive) treatment in ICU. A number
of specialized investigations done were as follows;
Pulmonary function tests: 20444, Arterial blood gases:
2046, Bronchoscopy: 261, Bronchoalveolar lavage: 28,
CT scans: 2462, Ultrasound examinations: 569, X-rays:
20834, Electrocardiograms: 5919, Polysomnograms: 67,
HIV testing: 218, Serum IgE tests: 622, Skin tests: 758,
Clinical biochemistry: 26742.
During the year under review, the Institute has played a
vital role in conducting investigations for the pandemic
influenza H1N1 virus as per the directive of the
Government of India.
Research Activities
The Institute continued its thirst for research in Respiratory
Diseases and allied sciences. These research projects
were sponsored by different agencies of Government of
India, World Health Organization, etc. The notable
contributions during the period on research include:
Development of novel therapeutics based upon natural
products from Indian Medicinal plants, Pulmonary function
in normal children in Delhi region: development of
reference standards for spirometry, Heart rate variability
in chronic obstructive pulmonary disease: associations
with systemic inflammation and clinical implications,
Annual Report 2010-11 261
Systemic mycoses in HIV positive patients: a study of
species spectrum of etiologic agents, antifungal
susceptibility pattern and epidemiologic aspects,
Functional characterisation of lspA gene of
Mycobacterium tuberculosis: cloning, expression and
its role during pathogenesis, Prospects for the
development of anti-tubercular drugs based on
transacetylase function of glutamine synthase, Studies
on the possible mechanisms involved in the effects of
UNIM-352, a polyherbal, anti-asthmatic unani preparation
in experimental animals, Brain nitric oxide and high
altitude stress, To study the prevalence of obstructive
sleep apnoea amongst middle aged chronic obstructive
airway disease (COPD and asthma) patients by a home
based sleep study and atopy, and Multi-site
epidemiological and virological monitoring of human
influenza virus surveillance network in India –Phase II.
Post Graduate Teaching and Training
A total of 9 MD students for academic year 2008-11 and
10 DTCD students for academic year 2008-10 were
enrolled. In addition, 48 students were given training
under the MD and DTCD programmes. Sixteen research
scholars pursued their PhD programmes. As a part of
imparting updated knowledge regarding various
developments in respiratory diseases, the Institute had
conducted 9
th
CME course on, “Pneumonia” on 13
th
,
February 2010 and the 35
th
Workshop on “Respiratory
Allergy: Diagnosis and Management”, Delhi on
March 8
th
-12
th
March 2010. Training in Behavioural
Counselling – Tobacco Cessation on 22
nd
July 2010.
An important milestone during this year is the approval
to start DM course in Pulmonary and Critical Care
Medicine with an intake of two students every year by
the University of Delhi.
Conferences/ Workshops during the year
“National Symposium on Sleep Apnea: An Update”, held
on 5
th
- 6
th
April 2010 on the occasion of the 61
st
Foundation Day Celebrations of the VPCI, Delhi.
The 12
th
“Prof. R. Viswanathan-VPCI Oration” was
delivered by Prof. M.K. Bhan, Secretary, Government
of India, Department of Biotechnology, New Delhi, on
6
th
April 2010.
The 6
th
“Prof. A.S. Paintal Memorial Oration” was
delivered by Prof. Chulani Tissa Kappagoda, Professor
of Medicine, University of California, Davis, U.S.A., on
24
th
September 2010.
Publication
The Institute has been publishing a quarterly periodical,
The Indian Journal of Chest Diseases and Allied Sciences
and continues its effort to disseminate the recent advances
in Chest Diseases an