GUJARAT

STATE REPORT
 Gujarat

Index

S. No. Content Page No.

1 Summary of Approvals 2–5

2 Demographic Profile 6–7

3 Progress of NRHM 8 – 11

4 Reproductive & Child Health 12 – 15

5 Immunization 16 – 16

6 Revised National Tuberculosis Control Programme (RNTCP) 17 – 19

7 National Vector Borne Disease Control Programme (NVBDCP) 20 – 21

8 National Leprosy Eradication Programme (NLEP) 22 – 22

9 Integrated Disease Surveillance Project (IDSP) 23 – 24

10 National Programme for Control of Blindness (NPCB) 25 – 25

11 National Iodine Deficiency Disorder Control Programme (NIDDCP) 26 – 26

12 RoP Approvals under Mission Flexible Pool 27 - 33

1 Gujarat
 GUJARAT

Summary of Approvals

Financial Management under NRHM (Rs. in crore)

% Release
% Expenditure
Years Allocation Release Expenditure against
against Release
Allocation
2005-06 306.82 346.28 177.63 112.86 51.30
2006-07 318.48 311.75 215.36 97.89 69.08
2007-08 380.58 417.89 378.26 109.80 90.52
2008-09 382.73 360.27 528.37 94.13 146.66
2009-10 391.37 0.00
Total 1779.98 1436.19 1299.61 80.69 90.49

S. No. Timeline Activities Achievement %

Selection 24065 76
1 ASHA
Training 898
2 VHSC 17751 96
3 24X7 PHCs 331 31
4 Mobile Medical Unit 25 96
5 Rogi Kalyan Samiti 1392 100

Budget Allocations (2005-09) ( Amount in Crores)

Allocation Releases Expenditure
RCH Flexipool
2005-06 60.06 33.83 7.42
2006-07 82.03 49.35 51.64
2007-08 64.10 67.01 48.16
2008-09 100.47 79.09 116.60
2009-10 102.50
Total (A) 409.16 229.28 223.82
NRHM Flexipool
2005-06 46.38 0.35
2006-07 68.89 93.63 25.37
2007-08 120.42 142.19 137.55
2008-09 87.52 101.58 260.74
2009-10 90.45
Total (B) 367.28 383.78 424.01
National Disease Control Programme
2005-06 26.92 25.94 26.01
2006-07 33.15 28.58 25.25
2007-08 41.91 24.93 25.44
2008-09 44.89 31.43 11.01
2009-10 47.00 3.32 0.00
Total (C) 193.85 114.20 87.71
Grand Total (A + B + C)

2 Gujarat
 Record of Proceedings (2005-2009) for Mission Flexible Pool

Approval for Infrastructure (Rs. in Crore)

S. No Health Facilities 2005-06 2006-07 2007-08 2008-09 2009-10

1 Sub C 7.27 8 3 1.8
2 PHC 15.12 5 5.77
3 CHC 15 39.4 5.1 2.5 8.6
4 DH 0.27 0 8
5 Equipment 2 0 0.13
6 Others 11.74 16.51 11.28 20.32
Total 22.27 51.14 47 21.78 44.62

Approval for Human Resources(Rs. in Crore)

S.
Personnel 2005-06 2006-07 2007-08 2008-09 2009-10
No
1 Doctors 4.47 0.00 2.78
2 Specialists 2.08 0.72 0.84
3 Staff Nurses 3.83 11.92 4.44
4 ANM 1.62 0.00 6.29
5 Others 11.33 14.01 17.47
Total 0.00 0.00 23.33 26.65 31.82

Approval of other activities (2005-2009) in Rs. Lakh

2005-06 2006-07 2007-08 2008-09 2009-10
S.No Initiative Remarks
Released Approved Approved Approved Approved
ASHAs
During 06-
07, for 549
ASHAs for
tribal
1 ASHA 54.95 9 1100 1297.58 Districts
Selection & Training
of Community Health
485.00
Workers (ASHAs &
2 Link Workers)
Performance related
1240.00
3 incentives to ASHA
TOTAL 54.95 494 1100 2537.58
Untied Funds, Annual Maintenance Grants and RKS Funds related matters
Rogi Kalyan Samiti at
30
4 Medical Colleges

3 Gujarat
 Rogi Kalyan Samiti-
115 115
5 DH
Rogi Kalyan Samiti-
273 277
6 CHC
Rogi Kalyan Samiti-
537 1073 1066
7 PHC
8 Untied Fund for CHC 137.00 136.50 1337.50
9 Untied Fund for PHC 267.5 269 268.25 266.5
Untied Fund for SC 727 727.4 727.4
In 09-10, for
18067
Revenue
Untied Fund for VHSC 988.00 1806.70 1798.20
Villages.
VHSCs in
10 17429
Annual Maintenance
200 267 273 277
11 Grant - CHC
Annual Maintenance
535 481 533
12 Grant -PHC 575.5
Annual Maintenance
658 727.4 727.4
13 Grant- SC
TOTAL 727 1002.5 3337 6005.75 7125
Infrastructure related matters
14 MMU 1073.75 482.00 553.68 343.40
Emergency & Referral
2050.00
15 Services
POL & Maintenance
support to Ambulances 197.00 224.40
16 @ CHCs
POL & Maintenance
support to Ambulances 122.00
17 @ FRUs

POL and maintenance

support to ambulances 80.4
at FRUs/DH
18
Emergency & Referral
3701.44
19 Services
TOTAL 1073.75 801.00 4559.92 2393.40

Status of Infrastructure 2005-2010

As per RHS 2008 New Construction Upgradation / Renovation

Number of Sub Centre 7274 235 170
Number of PHC 1073 58 124
Number of CHC 273 11 243
Number of DH 23 0 0
As per State Data
Sheet, NRHM

4 Gujarat
 Status of NRHM as on 15.05.2009

Selection 24065
1 ASHA
Training 898
2 VHSC 17751
3 Joint A/C @ Sub Centre and VHSC
17429
4 24X7 Facility
354
5 FRU 148
Doctors & Specialist 1419
AYUSH Doctors 773
6 Contractual Manpower
Staff Nurse 365
Paramedics 270
ANM 0
7 JSY Beneficiaries (in Lakhs) 5.62

National Disease Control Programme

NLEP
The state has already achieved the goal of elimination of leprosy. The state is advised to carry out
in depth situational analysis in districts/blocks reporting large number of new cases and take
suitable actions

IDSP
It is a Phase II state. The recruitment of required human resources needs to be fast tracked and
completed in a time bound manner.

NBCP
UCs for GIA released to State Blindness Control Society not being received timely. SOE for
Cash Grant are also not being received timely. Performance of School Eye Screening Programme
needs to be improved.

NVBDCP
The incidence of malaria as well as Pf cases are showing decline. Lymphatic Filariasis in the
state has been targeted for elimination by the year 2012. Capacity building for case management
and strengthening of health facilities need to be taken on priority basis for diagnosis and case
management. Kala-azar is not endemic in the state
RNTCP
Gujarat is one of the well performing States. Overall State level performance with annualized
total case detection rate is satisfactory.

5 Gujarat
 Demographic, Socio-economic and Health profile

HEALTH INDICATORS OF GUJARAT

The Total Fertility Rate of the State is 2.6. The Infant Mortality Rate is 52 and
Maternal Mortality Ratio is 160 (SRS 2004 - 06) which are lower than the National average.
The Sex Ratio in the State is 920 (as compared to 933 for the country). Comparative figures
of major health and demographic indicators are as follows:

Table I: Demographic, Socio-economic and Health profile of Gujarat State as compared

to India figures

S. No. Item Gujarat India

1 Total population (Census 2001) (in million) 50.67 1028.61
2 Decadal Growth (Census 2001) (%) 22.66 21.54
3 Crude Birth Rate (SRS 2007) 23.0 23.1
4 Crude Death Rate (SRS 2007) 7.2 7.4
5 Total Fertility Rate (SRS 2007) 2.6 2.7
6 Infant Mortality Rate (SRS 2007) 52 55
7 Maternal Mortality Ratio (SRS 2004 - 2006) 160 254
8 Sex Ratio (Census 2001) 920 933
9 Population below Poverty line (%) 14.07 26.10
10 Schedule Caste population (in million) 3.59 166.64
11 Schedule Tribe population (in million) 7.48 84.33
12 Female Literacy Rate (Census 2001) (%) 57.8 53.7

Table II: Health Infrastructure of Gujarat

Particulars Required In position shortfall

Sub-centre 7263 7274 -
Primary Health Centre 1172 1073 99
Community Health Centre 293 273 20
Multipurpose worker (Female)/ANM at Sub 8347 7060 1287
Centres & PHCs
Health Worker (Male) MPW(M) at Sub Centres 7274 4456 2818
Health Assistant (Female)/LHV at PHCs 1073 267 806
Health Assistant (Male) at PHCs 1073 2421 -
Doctor at PHCs 1073 1019 54
Obstetricians & Gynaecologists at CHCs 273 6 267
Physicians at CHCs 273 0 273
Paediatricians at CHCs 273 6 267
Total specialists at CHCs 1092 81 1011
Radiographers 273 124 149
Pharmacist 1346 781 565
Laboratory Technicians 1346 897 449
Nurse/Midwife 2984 1585 1399
(Source: RHS Bulletin, March 2008, M/O Health & F.W., GOI)

6 Gujarat
The other Health Institution in the State are detailed as under:

Health Institution Number

Medical College 13
District Hospitals 23
Referral Hospitals 409
City Family Welfare Centre 106
Rural Dispensaries 8347
Ayurvedic Hospitals 47
Ayurvedic Dispensaries 1046
Unani Hospitals -
Unani Dispensaries -
Homeopathic Hospitals 16
Homeopathic Dispensary 216

7 Gujarat
 Note on Progress of NRHM in Gujarat
(June 2009)

National Rural Health Mission is aimed at ensuring effective and quality healthcare, especially to
the poor and vulnerable sections of the society. It is being implemented in the State with the aim of reducing
infant mortality rate & maternal mortality ratio, ensuring population stabilization, prevention & control of
communicable & non-communicable diseases. Significant progress has been made in terms of
implementation of various activities under NRHM. A number of new schemes have also been launched,
such as, the Saubhagyawati Surakshit Matretev Yojana, a scheme to promote institutional deliveries by
involving private sector providers. The overall objective of the State is to have the highest attainable
standards of services at the public health institutions coupled with the recent technical advances in terms of
well equipped facilities and adequate skilled manpower at every level. Brief information on progress vis-a-vi
issues have been highlighted which are as follows:

Institutional Framework of NRHM

Progress of institutional setup at state and district level is comparatively slow. Meeting of
State Health Mission are not regular and need some attention. The meetings of State Health Mission
was held twice and of District Health Mission held 62 times. The merger of societies is completed in
all the 25 districts. The progress at districts with regard to District Health Mission meetings is good.
About, 17751 VHSCs have been constituted & 17429 Joint Accounts have been operationalised at sub
centre level. Rogi Kalyan Samiti is operational at 23 DH, 273 CHCs & 1073 PHCs. All districts have
started developing their own IDHAP.

Infrastructure Improvements

A total of 331 PHC have been strengthened with three Staff Nurses each to make them
functional on 24x7 basis. Also, 278 CHC are functioning on 24X7 basis & facility survey completed
in 273(including others health institution also below district level). A total of 23 SDH, 23 DH, 102
CHC and others level are functioning as FRUs. All the 25 districts have functional Mobile Medical
Units (MMU)

Human Resources

A total of 24,065 ASHAs have been selected & 898 are trained upto 1st Module. ASHAs do
not have the drug kits. About, 7071 Sub-centers are functional with an ANM and the SCs are without
2nd ANM, whereas, 773 Contractual AYUSH Doctors have been appointed in the health institution.
As far as manpower augmentation is concerned, 865 Specialist, 554 Doctors, 271 SN recruited on
contractual basis.

Services

Institutional deliveries has improved from 8.11 lakhs (2006-07) to 9.20 lakhs (2007-08).
During the year 2008-09 institutional deliveries in the state were 8.43 lakhs. JSY beneficiaries have
increased from 1.21 lakhs (2006-07) to 1.86 lakhs (2007-08). The number of JSY beneficiaries was
2.13 lakh during the year 2008-09. Female sterilizations have increased from 2.68 lakh (2006-07) to
2.89 lakh (2007-08) and male sterlisation had increased from 1033 (2006-07) to 20646 (2007-08).
During 2008-09- 3, 13,577 female & 21,407 male sterilization have been reported. About 18 districts
are implementing IMNCI & 26,677 people are trained so far. A total of 10, 01,504 VHND held since
the launch of NRHM.

8 Gujarat
General

Overall improvement in health system since NRHM

Achievements Made

• There is overall increase in case loads in public health system.

• Effective Programme Implementation Unit for Infrastructure development that serves as national
benchmark in this area.
• Improved drug supply and distribution system
• Diagnostic Facilities in public health facilities improved
• Mamta Abhiyan and involvement of voluntary sector provides for better community involvement
• RKS at the level of hospitals and sub hospitals are well set
• The state has Chiranjeevi Scheme-an effective PPP model to increase institutional deliveries.
• There is effective disease control and disease surveillance programme.

Areas for Further improvements

• Contain the sharp decline in deliveries conducted by Public Institutions.

• Need to address acute shortage of human resources for public health system
• Proper utilization of untied and RKS funds need to be strengthened.
• The State need to gear up for the payments of JSY beneficiaries.
• Greater involvement of PRIs is required.
• HMIS system is relatively much better but data reports need to be acted upon.

Infrastructure
• Project Implementation Unit is the nodal agency for infrastructure and has done commendable
job in construction and repair. Now needed to delegate minor repairs to districts and
institutions

Human Resources
• Qualified medical officers for conducting deliveries in most of the institutions particularly in
district and sub district hospitals showed brisk activity and interest from doctors to patient
needs.
• Major shortages in most cadres, AYUSH doctors being posted to fill vacancies of medical
officers in PHCs.
• Lack of specialists; urgent need for nursing staff to provide actual 24X7 services. ANM
deputation reduces availability of ANMs where they are needed.
• Lab Technicians are available in most of the PHCs.

Service Delivery

• Useful institution specific data being generated and regularly monitored; helps in focusing on
underperforming institutions
• Inter sectoral convergence for vector control in position through institutions

9 Gujarat
 An Analysis of Financial Monitoring Report for the FY 2008-09

A. RCH Flexible Pool

Component-wise expenditure & utilization under RCH

Rs. in Crores
% Utilization
Activities SPIP Expenditure
against PIP
Maternal Health 40.56 26.06 64.25%
Child Health 6.62 10.34 156.19%
Family Planning
Services 26.30 20.74 78.85%
ARSH 1.17 0.64 54.70%
Urban RCH 21.43 8.74 40.78%
Tribal RCH 0.67 0.77 114.92%
Vulnerable Groups 0.02 0.00 0.00%
Innovations/PPP/ NGO 13.03 5.31 40.75%
Infrastructure &
Human Resources 4.75 1.38 29.05%
Institutional
Strengthening 2.42 2.39 98.76%
Training 12.77 26.28 205.79%
BCC / IEC 2.85 4.06 142.49%
Procurement 1.62 6.03 372.22%
Programme
Management 6.19 4.45 71.89%
Total 140.40 117.19 83.46%

General Observations
1. Significantly, Rs.117.19 crores, i.e. 83% of the approved PIP of Rs.140.417 crores has been
utilized under RCH-II as compared to average national level expenditure of 71%.
2. There is 152% increase in expenditure as compared to 2007-08.
3. Since the launch of RCH-II, Rs. 221.88 crores, i.e. 97% has been utilized by the state against
the release of Rs. 229.28 crores during the period 2005-06 to 2008-09.
4. More than 64% and 79% expenditure during 08-09 under MH and Family Planning Services
respectively is also satisfactory as compared to the PIP approved.

Areas of Concern

1. There is only 29% utilisation under Infrastructure and Human Resources.

2. There is no synchronization between PIP Vs Utilisation as the expenditure reported under the
Training, BCC/IEC and Procurement heads is very high.
3. The expenditure booked under Urban RCH & Innovations /PPP/NGO is only 40% of the
approved PIP.
4. The procurement expenditure is not reimbursable by the World Bank. State is advised to book
all the expenditure according to the FMR format and guidelines issued by the Govt. of India.
5. RCH Flexible Pool part of the FMR was not sent in the prescribed format and expenditure is
not bifurcated accordingly.

10 Gujarat
B. Mission Flexible Pool:-
Component-wise utilization against approved PIP
Rs. In Crores
%Utilisation
Activities SPIP Expenditure
against PIP
ASHA 11.00 14.40 130.93%
Untied Funds 29.39 21.08 71.72%
Hospital Strengthening 1.00 5.58 558.00%
Annual Maintenance Grants 15.36 9.39 61.12%
New Constructions/ Renovation and Setting up 12.11 12.78 105.55%
Corpus Grants to HMS/RKS 14.91 17.08 114.58%
Panchayti Raj Initiative 0.00 5.64
Mainstreaming of AYUSH 16.77 9.63 57.42%
IEC-BCC NRHM 3.95 5.45 137.94%
Mobile Medical Units 5.53 1.45 26.15%
Referral Transport 3.05 0.15 4.84%
Additional Contractual Staff (Selection, Training,
12.60 2.63 20.87%
Remuneration)
PPP/NGOs 0.32 7.04 2264.82%
Training 0.77 1.31 168.50%
Incentive Schemes 10.00 13.39 133.94%
Planning, Implementation & Monitoring 7.00 6.78 96.81%
Procurement 3.55 9.41 265.28%
New Initiatives//Strategic Interventions 20.61 16.23 78.75%
Research, Studies & Analysis 2.09 0.00
State level health resources centre (SHSRC) 1.00 0.41 41.44%
Support Services 50.81 99.77 196.35%
NRHM Management Costs/ Contingencies 6.01 6.12 101.78%
Total 227.86 260.15 114.17%

General Observations
1. As compared to 2007-08, 145.42% increase has been noticed in expenditure during
2008-09.
2. Since the start of the programme, Rs.383.79 crores were released to the state, the
Utilization is Rs.392.70 crores (102.32%).
3. Rs 6.78 crores i.e. 96.81% of approved PIP has been incurred under Planning,
Implementation and Monitoring.
4. More than 50% expenditure of the total spending has been incurred under AYUSH
and New Initiatives/Strategic Interventions.

Areas of Concern
1. Against Rs.3.05 crores approved under Referral Transport during 08-09 only 4.84%
expenditure is reported.
2. Under Mobile Medical Units, Additional Contractual Staff, State level Health Resource
Centre expenditure varies from 20% to 41% of the approved PIP. Under training the
expenditure is 168.50% whereas additional contractual staff is only 20.87% of the approved
PIP.
3. Expenditure incurred under Hospital Strengthening, PPP/NGO and Procurement was not
planned. State is advised to earmark the funds appropriately.

11 Gujarat
 BRIEFING NOTE ON RCH II: GUJARAT

A. Background/ current status

1. RCH II Goals

Gujarat’s MMR at 160 (SRS 04-06) has improved from 172 in SRS 01-03. The IMR (SRS 2007) at 52
has reduced from 57 (SRS 2003). TFR at 2.6 (SRS 2007) is slightly lower than the national average of
2.7 (refer Annex 1).

2. RCH II Outcomes

Gujarat’s progress during the four year period between DLHS 2 (2002-04) to DLHS 3 (2007-08) is
mixed (refer Annex 1):
• Mothers having full ANCs decreased from 15.2% to 19.9%.
• Institutional deliveries marginally increased from 52.2% to 54.9%.
• Full immunisation in children 12-23 months only marginally increased from 54.0% to 54.9%.
• Children with diarrhoea receiving ORS has increased from 24.4% to 36.7%.
• Unmet need for family planning remained static (from 16.3% to 16.5%). Further, use of
modern contraceptives has marginally increased from 52.4% to 54.3%.

3. Expenditure

Audited expenditure has increased sharply from Rs. 7.42 crores in 05-06 to Rs. 51.64 crores in 06-07
and declined to Rs. 46.21 crores in 07-08; reported expenditure in 08-09 has increased sharply to Rs.
117.19 crores i.e. 84% of allocation (Rs. 140.41 crores). JSY accounted for 12% of the reported
expenditure in 08-09.

B. Key achievements

1. Maternal Health, including JSY

• Number of JSY beneficiaries in the state increased from 1.21 lakhs in 06-07 to 1.86 lakhs in
07-08. A total of 2.13 lakh beneficiaries have availed of the services in 08-09.
• State has operationalised 148 FRUs (against the target of 141) and 331 PHCs as 24x7 (against
the target of 536).
• Training on Life Saving Anaesthesia Skills (LSAS): 4 medical colleges have been identified,
29 master trainers and 80 MBBS doctors have been trained in LSAS against a target of 141.
• Training in comprehensive Emergency Obstetric Care (EmOC): Surat medical college has
been strengthened as a training site, and 50 MBBS doctors have been trained in EmOC
against at target of 141.
• Skilled Birth Attendant training (SBA): 25 districts have been identified, and 586 SNs/ ANMs
have been trained as SBA, against a target of 7162.
• Chiranjeevi Yojana: An innovative health financing scheme covered through public private
partnership- ‘Chirnajeevi Yojana’ for emergency obstetric care and emergency transport
services, primarily for the benefit of the poorer section. The state has accredited 846 private
institutions under the scheme.
• To enhance the referral transport state has initiated EMRI services in 2007. Further state is
scaling up the Mobile Health Comprehensive Units for inaccessible areas.
• Mamta Abhiyan: ' Mamta Divas'(Village Health and Nutrition Days) are being regularly
organised. Link workers and NGOs assist the ANMs in the identification of pregnant women
and NGOs undertake reorientation training of AWWs. Mobility support is provided to the
ANMs and Rs. 100 is provided for organising each Divas. The services of retired ANMs are
sought wherever they are available.

12 Gujarat
2. Child Health
• 18 districts are implementing IMNCI and state plans to cover all the 25 districts in the current
year. Pre-service IMNCI has been started in 12 medical colleges. Gujarat is first state to
introduce Facility based care for new born and children and Integrated Management and
Childhood Illness (F-IMNCI) as an integrated package to take care of referrals and to enhance
capacity of all health personnel at facilities as well as at community level to address sick new
born and sick child.
• State has started Bal-Sakha scheme; a PPP model for providing Essential and emergency new
born care.
• Considering high prevalence of malnutrition, the state has established State Nutrition cell.
Child Development and Nutrition Centres (CDNC) have been initiated in the state and 11
CDNC centres are reported to be functional.

3. Other initiatives
• Considering lack of specialists in the system, state has made provision for on-call specialists
as per requirement at the facility level.
• An incentive system has been devised for service providers to increase the performance at
public sector facilities. Minimum performance levels have been decided for each facility and
incentive is given to the entire team of providers for achievements beyond the levels.

C. Key issues

1. Maternal Health, including JSY

• Effect of Chiranjeevi Yojana is not visible on indicators (institutional delivery has increased
marginally from 52.2% to 54.9% between DLH-2 and DLHS-3). Further, it is observed that,
Chiranjeevi Yojana is undermining utilisation of public sector facilities.
• In spite of comprehensive Mamta Diwas in place, full ANC has declined between DLHS 2
and DLHS 3.

2. Child Health
• Reduction in IMR is slow; 1.25 points per year between SRS 2003 and SRS 2007.
• Neonatal mortality rate (NMR – infant deaths within 4 weeks of life per 1000 live births) at
37 (SRS 2007) accounts for 71% of the IMR, while early NMR (infant deaths within one
week of life per 1000 live births) at 29 (SRS 2007) accounts for 78% of the NMR. Inadequate
steps to ensure two-day stay at the facility after delivery is a concern highlighted in previous
reviews; this is clearly a missed opportunity to address early neonatal mortality. Additionally,
facility based newborn care is not easily available in the state (as reported in the Mid Term
Review of RCH II during September-December 2008).

13 Gujarat
 ANNEX 1

A. Progress on Key Indicators

1. RCH II Goals

GUJARAT INDIA
RCH GOAL
S. No. Current RCH II/ NRHM
INDICATOR Trend (year & source)
status (2012) goal
Maternal Mortality Ratio 172 160 254
1. <100
(MMR) (SRS 01-03) (SRS 04-06) (SRS 04-06)
Infant Mortality Rate 57 52 55
2. <30
(IMR) (SRS 2003) (SRS 2007) (SRS 2007)
2.8 2.6 2.7
3. Total Fertility Rate (TFR) 2.1
(SRS 2003) (SRS 2007) (SRS 2007)

2. RCH II Outcomes

GUJARAT INDIA*
S.
RCH OUTCOME INDICATOR DLHS–2 DLHS–3 DLHS–2 DLHS–3
No.
(2002–04) (2007–08) (2002–04) (2007–08)
Mothers who received 3 or more antenatal care
1. 57.3 56.8 50.4 51.0
checkups (%)
2. Mothers who had full antenatal check-up (%) 25.2 19.9 16.5 19.1
3. Institutional deliveries (%) 52.2 56.5 40.9 47.0
Children 12-23 months age fully immunised
4. 54.0 54.9 45.9 54.1
(%)
Children age 6-35 months exclusively breastfed
5. 11.1 28.8 22.7 24.9
for at least 6 months (%)
Children with diarrhoea in the last 2 weeks who
6. 24.4 36.7 30.3 33.7
received ORS (%)
7. Use of any modern contraceptive method (%) 52.4 54.3 45.2 47.3
Total unmet need for family planning - both
8. 16.3 16.5 21.4 21.5
spacing methods and terminal methods (%)
* - Provisional results for DLHS-3

B. Trends in Financial Expenditure

(Rs. crores)
FY 2005-06 FY 2006-07 FY 2007-08 FY 2008-09
Release 33.83 49.35 67.00 79.09
Audited Expenditure 7.42 51.64 46.21 117.19*
* - Audit for 2008-09 not yet carried out; reported expenditure provided.
- Allocation for 2008-09: Rs. 140.41 crores.

C. Progress on Key Strategies

1. Demand side interventions

S. Indicators Achievement (no. of beneficiaries)

No. 2005–06 2006–07 2007–08 2008–09
1. Janani Suraksha Yojana 1,21,153 1,85,956 2,13,000
2. Total Sterilisation 2,80,334 2,67,549 3,10,064 na
3. IUD Insertions 4,66,230 4,64,484 4,94,529 na
(Source: M&E Division reports, and JSY reports from the states)

14 Gujarat
2. Technical interventions

S. Achievement upto March 2009

Indicators
No. Number %
1. No. of First Referral Units (FRUs) operationalised 104.9 (against the
148
target of 141 FRUs)
2. No. of PHCs operationalised to provide 24-hour 61.8 (against the
331
services target of 536 PHCs)
3. No. of private institutions accredited under JSY
846 NA
(Chiranjeevi Yojana)
4. No. of districts implementing Integrated Management 18 72 (out of 25
of Neonatal & Childhood Illness (IMNCI) districts)
5. No. of people trained in IMNCI 26,677 NA
6. No. of Village Health & Nutrition Days (VHNDs) held 10,01,504 NA
(Source: NRHM MIS report, April 2009)

15 Gujarat
 Immunization

Gujarat

Evaluated Immunization Coverage

Survey NFHS
NFHS 2 NFHS 3 DLHS 2 DLHS3
1 CES CES
(1998- (2005- (2002- (2007-
(1992- (2005) (2006)
Indicator 99) 06) 04) 08)
93)
FI 50.0 53.0 45.2 63.1 71.9 54.0 52.5
BCG 77.1 84.7 86.4 89.8 91.2 85.4 87.9
Measles 55.9 63.6 65.7 82.5 79.7 65.2 75.5
DPT 3 63.8 64.1 61.4 74.1 78.2 66.1 61.2

Progress

As per the various evaluated surveys Full Immunization Coverage is 52.8% and the coverage of
BCG and Measles shows an improving trend.
The State has so far trained 51.6% (4372/8474) Health workers in last 2 years.
District Level AEFI committees have been constituted in 20 out of 32 districts.
All the districts have been regularly uploading data on RIMS.
The State is piloting the use of Smart cards for tracking of beneficiaries.

Issues

The Full Immunization coverage of State has shown a declining trend especially in rural areas
while the dropout from BCG to DPT 3 is showing an increasing trend which is a matter of grave
concern.
The State needs to strengthen AEFI surveillance and injection safety mechanisms.
The fund utilization under Immunization is low for the year 2008-09.

Comments

The State needs to further improve service delivery and other infrastructure as Rubella vaccine is
going to be introduced shortly in form of MR vaccine for children of 16-24 months.

16 Gujarat
 Brief on National TB Control Programme in State of Gujarat

1. Infrastructure

Total Population - 572 lakh

No. of Districts - 30
No. of Tuberculosis Units (TUs) - 134
No. of Designated Microscopy Centres (DMCs) - 712 - 667

2. Status of Implementation

• All the 29 districts are implementing RNTCP.

3. State level Performance (Based on quarterly report for 1st quarter 2009)

• Gujarat is one of the well performing State. Overall State level performance with
annualized total case detection rate of 140/lakh, new sputum positive (NSP) case
detection rate of 61/lakh (76%), sputum conversion rate of 92% and cure rate of 86% in
new sputum smear positive patients is satisfactory. However, NSP patients are 76% of all
new pulmonary TB patients which is more than acceptable range and shows that the State
is perhaps not able to capture all NSN patients or the quality of sputum microscopy is not
good..
• 180 TB suspects/lakh pop are examined in 1st quarter which is good.
• DOTS Plus for the treatment of MDR (Multi Drug Resistance) cases has been started
from August, 2007.

Annualized New Smear-Positive Case Detection Rate

and Treatment Success Rate in DOTS Areas, Gujarat, 2000-2009*

100%

90%

80%

70%

60%

50%

40%

30%

20%

10%

0%
Qtr1-00
Qtr2-00
Qtr3-00
Qtr4-00
Qtr1-01
Qtr2-01
Qtr3-01
Qtr4-01
Qtr1-02
Qtr2-02
Qtr3-02
Qtr4-02
Qtr1-03
Qtr2-03
Qtr3-03
Qtr4-03
Qtr1-04
Qtr2-04
Qtr3-04
Qtr4-04
Qtr1-05
Qtr2-05
Qtr3-05
Qtr4-05
Qtr1-06
Qtr2-06
Qtr3-06
Qtr4-06
Qtr1-07
Qtr2-07
Qtr3-07
Qtr4-07
Qtr1-08
Qtr2-08
Qtr3-08
Qtr4-08
Qtr01-09

Annualised New S+ve CDR Success rate

•Population projected from 2001 census
•Estimated no. of NSP cases - 80/100,000 population per year (based on recent ARTI report)

17 Gujarat
4. District-wise Performance (Based on quarterly report for 1st quarter of 2009)

• All districts have examined more than 140 TB suspects/lakh pop in 1st quarter 2009.
• However, total case detection rate is low in 22 (73%) districts but NSPCD rate is good in
28 (93%) districts. Total case detection rate is low because of NSN patients which are
only 34% of all new pulmonary TB patients. 24 (80%) districts have NSP cases more than
70%.

Annulised New smear Sputum

Suspects Cure rate of
total case positive case conversion
examined New
Districts detection detection rate in new
per lakh cases(Against
rate(against rate(Against cases(Against
population 85%)
151/lakh) 56/lakh) 90%)
Ahmadabad 193 122 56 70% 88% 85%
AMC 195 192 61 76% 91% 84%
Amreli 184 105 57 71% 92% 85%
Anand 166 141 60 75% 93% 86%
Banas Kantha 153 149 56 70% 92% 85%
Bharuch 173 124 66 83% 93% 89%
Bhavnagar 155 126 58 72% 92% 87%
Chhota Udepur 146 125 62 78% 94% 88%
Dahod 244 173 72 90% 95% 88%
Gandhinagar 170 126 56 71% 92% 88%
Jamnagar 175 117 52 65% 91% 87%
Junagadh 168 113 56 70% 90% 85%
Kachchh 167 111 51 63% 88% 84%
Kheda 167 118 62 77% 91% 87%
Mahesana 204 120 61 76% 93% 89%
Narmada 205 125 67 84% NA NA
Navsari 178 139 66 82% 94% 87%
Panch Mahals 176 166 83 104% 96% 90%
Patan 194 133 57 71% 90% 86%
Pobandar 160 141 57 72% 95% 92%
Rajkot 196 115 57 72% 91% 86%
Sabar Kantha 167 161 60 75% 91% 86%
Surat 206 136 68 85% 94% 88%
Surat Municipal
184 184 66 82% 89% 87%
Corp
Surendranagar 172 123 56 70% 91% 82%
The Dangs 202 116 61 76% 90% 86%
Vadodara 171 137 64 80% 93% 86%
Vadodara Corp 194 151 61 76% 90% 86%
Valsad 165 110 56 70% 92% 88%
Vyara(Surat) 144 155 79 99% 95% 83%
Total 180 140 61 76% 92% 86%

18 Gujarat
5. Funds Status as on 31st March 2009 (Rs. In lakh)

C/F Release Expenditure Balance

73.23 1127.00 1187.00 13.23

6. Drugs

Drugs released as per the requirement in the quarterly reports.

7. Issues

• Human Resource – Status of staffing & training is satisfactory except that posts of 4
STSs, 7 STLSs and 27 LTs are vacant.

• Performance
o Overall total case detection rate of 144/lakh is low. 22 (73%) districts have reported
low TCD rate where as NSPCD rate of 61/lakh (76%) is good and all districts except
Jamnagar and Kachchh have reported NSPCD rate of more than 70%. NSP patients
are 76% of all new pulmonary patients which is more than acceptable range and in 24
(80%) districts NSP patients are >70% of all new pulmonary TB patients. There may
be two reasons:
– Quality of microscopy is perhaps not good or/and
– State is not able to capture all the NSN patients.
o The quality of sputum smear microscopy needs strengthened monitoring with respect
to working condition of microscopes, collection of good quality sputum samples,
quality of reagents, proper staining and microscopy.
o Overall cure rate of 86% in NSP patients is good and all districts except Kachchh and
Surendranagar have cure rate of 85% but cure rate among the retreatment cases is
only 63% because of high default rate (18%) and death rate (9%). Retreatment
sputum positive patients need to be given same attention as to NSP patients.

• Coordination with NRHM: NRHM has supported RNTCP in getting. IRL equipments,
civil works and sputum collection and transportation in non-tribal areas. Review meetings
of the TB Sub Committees are held at the district and state level and RNTCP is reviewed
in the Executive Committee and Governing Body meetings at all levels. There are no
issues in Gujarat pertaining to RNTCP integration under NRHM.

• TB-HIV Collaboration – State is expected to report TB-HIV data after implementing

intensified package from July 2009.

• IRL
o IRL is accredited since March 08. Culture & DST for first line anti TB drugs is
performed for all districts.
o IRL also monitors EQA activities in the district and conducts OSE visits.
o Another Culture & DST Laboratory is being established at Govt. Medical College
Jamnagar.

• DOTS Plus
o Currently BJ Medical College Ahmedabad is the DOTS Plus Site and around 180
MDR TB patients have been placed in Cat-IV treatment.
o State Plans State-wise coverage by next year.

19 Gujarat
 Fact Sheet on NVBDCP-Gujarat

Background Information
• The State has 25 districts with a population of 50.67 Million. There are 273 CHCs, 1073 PHCs,
4840 Sub-centres, and 18539 villages. There are 7071 Multipurpose Worker (Female)/ANM,
3347 Health Worker (Male), 267 Health Assistant (Female)/LHV, 2421 Health Assistant (male)
and 899 Laboratory Technicians. In addition, the state has 8777 Fever Treatment Depots (FTDs)
and 1381 Malaria Clinics.

MALARIA

Epidemiological Situation
Total slide Total Malaria Total Pf
Year Deaths
examined cases cases
2006 11139833 89835 17932 45
2007 9504240 71121 18407 73
2008 9078952 50884 11668 36
2009(Upto Mar.) 1916495 4210 885 1

• The incidence of malaria as well as Pf cases are showing decline during 2007 & 2008 as well
as during 2009 (upto March.).
• Chloroquine resistance in P. falciparum has been reported in 6 PHCs of 5 districts where
second line treatment is being implemented.

Elimination of Lymphatic Filariasis

• The goal of Elimination of Lymphatic Filariasis in the country is set to be achieved by 2015. In
pursuance to achieve this, Government of India during 2004 initiated Mass Drug Administration
(MDA) with annual single dose of DEC tablets to all the population living at the risk of Filariasis
excluding pregnant women, children below 2 years of age and seriously ill persons. The
population coverage of MDA in the state was 45.47% in 2004, 98.23% in 2005, 69.60% in 2006,
92.11 % in 2007 and 93.25% in 2008.
• Line listing of Lymphoedema and Hydrocele cases was also initiated in 2004 for morbidity
management and as per updated report (2007), there are 2051 Lymphoedema and 508 Hydrocele
cases.

Kala-azar is not endemic in the state. However, 2 cases in 2006 and 4 cases in 2007 were reported as
imported.

Dengue/DHF: Total of 1065 Dengue cases and 2 deaths were reported during the year 2008. In the
year 2009 till 27th May, 334 dengue cases and no death have been reported. Epidemiological data for
last three years are as under:

Year Cases Deaths

2006 545 5
2007 570 2
2008 1065 2
2009(Prov. Upto 334 0
27th May)

20 Gujarat
Chikungunya: Total of 303 suspected Chikungunya fever cases were reported during 2008. Out of
the total 163 samples tested 53 was confirmed serologically for Chikungunya. In the year 2009 till
27th May, 228 suspected Chikungunya fever cases have been reported.

For proactive surveillance 7 Sentinel Surveillance Hospitals with laboratory support have been
identified in 2007. In addition 3 more Sentinel Surveillance Hospitals has been identified in 2008. all
these 10 Sentinel Surveillance Hospitals were linked with B.J. Medical College, Ahmedabad, which
has been identified as Apex Referral Laboratory. NIV Pune has been entrusted the supply of IgM
ELISA test kits.

Japanese Encephalitis is not reported from the State of Gujarat.

Central assistance
(Rs. In lakhs)
Year Allocation Release/Expenditure
Cash Kind Total Cash Kind Total
2004-05 0.00 345.09 345.09 310.62 397.71 708.33
2005-06 333.82 1410.97 1744.79 420.20 320.33 740.53
2006-07 469.19 882.36 1351.55 716.70 343.10 1059.80
2007-08 683.38 1019.46 1702.84 341.69 66.61 408.30
2008-09 813.94 510.45 1324.39 385.82 97.47 483.29
2009-10(B.E.) 554.00 387.17 941.17

Issues:
Filaria:

• The line listing of lymphoedema and hydrocele cases needs to be mapped for each district
indicating the village-wise list in order to provide morbidity management.

21 Gujarat
 STATUS OF NATIONAL LEPROSY ERADICATION PROGRAMME IN GUJARAT

• Epidemiological scenario-
The state has already achieved the goal of elimination of leprosy (i.e. prevalence rate of less
than 1 case /10000 population). There were 4412 leprosy cases on record as on March 2009.

• New case detection and treatment completion-

During 2008-09, a total of 7581 new leprosy cases were detected as compared to 7228 new
cases detected during the corresponding period of previous year. Out of 7921 cases
discharged during the year, 7750 cases (97.8%) were released as cured after completing
treatment.

• Reconstructive Surgery for leprosy affected persons-

There are 4 Govt. institutions providing reconstructive surgery services to leprosy affected
persons with disability in the state. In the year 2008-09, about 265 reconstructive surgeries
were performed in these institutions.

• NLEP action plan for the year 2009-10 amounting to 180 lakhs has been approved for the
state.

Issues -

1. Large numbers of new leprosy cases are being detected in the state every year which suggest
active transmission of the disease in the community. The state is advised to carry out indepth
situational analysis in districts/blocks reporting large number of new cases and take suitable
actions like –
(i) Ensuring completion of treatment in each of the new cases detected.
(ii) Enhance awareness of the community to improve self reporting of suspected
cases to health facility and
(iii) Carrying out family contact survey against all multibacillary and child cases.

2. The state has listed around 800 grade II disability cases since last 5 years. RCS services are
being provided by 4 institutions. However only 2 institutes viz. SSG Govt. Hospital,
Vadodara and Govt. Civil Hospital, Ahemedabad have been recently recognized by GOI for
providing RCS services. The states should send proposals of remaining 2 centres to GOI for
recognition and utilize the services of these institutions effectively for conducting RCS so that
the backlog of leprosy cases with disability could be reduced.

3. There are 17 leprosy colonies in the state. The state should ensure provision of proper health
care facilities like ulcer care, provision of supportive drugs and dressing materials to the
persons affected with leprosy residing in these colonies.

22 Gujarat
 State - Gujarat

Integrated Disease Surveillance Project (IDSP) –Fact sheet as on 17 June 2009

The state of Gujarat has an area of 196,024 sq. km. and a population of 50.67 million. There are 25
districts, 170 blocks and 18539 villages. The State has population density of 258 per sq. km. (as
against the national average of 312). The decadal growth rate of the state is 22.66% (against 21.54%
for the country) and the population of the state continues to grow at a much faster rate than the
national rate. (source:www.mohfw.nic.in/nrhm.htm)

Gujarat is a Phase-II state under IDSP and has been inducted into the programme during 2005-06.The
state PIP was received and MoU was signed with GoI on 25.8.05. Dr.A.S.Sanghavi, has been
designated as the State Surveillance Officer from Directorate Health Services, Govt of Gujarat.

The component wise action points are as under:

1. Manpower

• Contractual staff at State surveillance unit and District surveillance units are designated.
• The offer letters to the recommended candidates for the positions of state /district epidemiologists
(16),microbiologists(2) & State Entomologist(1) has been issued by State NRHM. Only 1 State
Entomologist and 5 District Epidemiologists have joined till 15.6.09.

2. IT & EDUSAT

• There is two Data entry operators positions vacant in Dang and Jamnagar districts.
• IT equipments damaged in Junagarh district due to fire. Similarly, IT equipments destroyed in
Surat district due to flood. There is short shippment of IT equipments in Vadodara district.
• In Infectious disease hospital at Ahmedabad, IT set up is yet to be installed.

3. Training

• The training of the following completed : Master Trainers (94), FETP(23),Medical Officers
(1722),Health workers(11188),District lab technicians( 51) and Peripheral lab technicians(864) .

4. Laboratory Strengthening

• Two Priority district laboratories at District Hospital Lab ,Mehsana and District hospital
Lab,Sabarkantha has been identified for strengthening under IDSP. The state was sanctioned in
February 2009 to procure required equipments for these labs.
• A network of 4-5 state reference laboratories (i.e Medical colleges/ICMR institutions) need to be
identified for strengthening for which one time contingency grant of Rs 2 lakhs per lab and Rs 3
lakhs for tests conducted on pro rata basis can be paid from IDSP fund on annual basis.

5. Data Reporting

• Data reporting in IDSP portal is regular from all the 25 districts. Reporting is to be initiated on
new S, P, L forms .

23 Gujarat
 6. Outbreak

• There is regular reporting of outbreaks. Total no of outbreaks reported for 2008-2009 was 24.

7. Finance:

Year Release (in lakhs) Expenditure (in lakhs)

2006-07 0 144.24
2007-08 7.71 137.98
2008-09 33.66 94.85
Balance – 54.89 lakhs

• Audit report & utilization certificate for 2007-08 has been received at CSU.
• Financial Monitoring Report (FMR) for quarterly ending March 2009, has been received at CSU.

24 Gujarat
 NATIONAL PROGRAMME FOR CONTROL OF BLINDNESS

STATUS NOTE ON GUJARAT

Magnitude:
Prevalence of blindness (2003-04) 1.89 %
Estimated blind persons 3.98 lakhs

Infrastructure developed

Upgraded Medical Colleges 1

Upgraded District Hospitals 6
District Blindness Control Societies 17
Mobile Eye Care Units 4
Eye Banks 1
Upgraded PHC’s 80

Cataract Performance

YEAR TARGET ACHIEVEMENT

2007-2008 100000 128634
2008-2009 700000 745143

School Eye Screening

YEAR TEACHER TRAINED SCREENED DETECTED PROVIDED

IN SCREENING FOR WITH FREE
REFRACTIVE REFRACTIVE GLASSES
ERRORS ERRORS
2007-2008 2900 654512 25162 8298
2008-2009 845 453043 6959 1141

GIA is released to Distt. Blindness Control Societies/State Blindness Control Society

(Rs in lakhs)
YEAR EXPENDITURE BALANCE
RELEASED
2007-2008 611.25 411.47 199.78
2008-2009 1206.65 1421.06 -214.41

Issues

Ucs for GIA released to State Blindness Control Society are not being received timely.
SOE for Cash Grant are also not being received timely.
Performance Report of School Eye Screening Programme are not being received regularly.

25 Gujarat
 NIDDCP

Gujarat

Activity Amount Amount Remarks

proposed Approved
1 Establishment 5.80 6.00
of IDD Control
Cell The State Government may carry
2 Establishment 2.92 3.50 out the activities as per the fund
of IDD allocation of GOI.
Monitoring Lab
3 Health 5.00 12.00
Education and
Publicity
4 IDD surveys 3.75 2.50
Total 17.47 24.00

26 Gujarat
 Mapping of Record of Proceedings of the NPCC of NRHM for
2005-06 to 2009-10
The mapping charts the NRHM Mission Flexipool approvals contained in the RoP in
following broad thematic chapters

1. ASHA (including selection, training, drug kits, mentoring, specific performance

incentives and anything else associated with ASHA)
2. Infrastructure related matters (including construction, strengthening, renovation, new
construction etc), equipments, transport (ambulances, EMRI, associated expenses) and
others)
3. Human Resource related matters (including HR salary, contractual payments,
incentives, etc)
4. Programme Management related matters (including PMUs, SHS/DHS, SHSRC,
IDHAP, M&E, Mobility support to SHS etc)
5. Untied funds, AMG & RKS related mattes
6. Training & Capacity Building related matters (including trainings, workshops, training
institutions including their upgradation or new construction, courses, etc)
7. Innovations (including Procurement of medicines, School Health, Health Mela,
Insurance, Accreditations, Monthly VHND etc)

NATIONAL RURAL HEALTH MISSION

Gujarat
Total MFP
6889 16664.1 22785.58 27754.89
Approvals
RoP Approvals for Various Years in Rs. Lakh
2005-06 2006-07 2007-08 2008-09 2009-10
S.No Initiative Remarks
Released Approved Approved Approved Approved
ASHAs
1 ASHA 54.95 9 1100 1297.58
Selection & Training
of Community Health
485.00
Workers (ASHAs &
2 Link Workers)
Performance related
1240.00
3 incentives to ASHA
TOTAL 54.95 494 1100 2537.58
Infrastructure related matters
4 Infrastructure 85
Construction/
1500 3940 .
5 Upgradation of CHC 1030 350.04 722.5
6 Renovation of CHC 200
7 Construction of PHC 1512 500 250
8 Renovation of PHC 324
Construction of Sub-
800 300 160
9 Centre

27 Gujarat
10 Renovation of SC 13.75 20
Setting up Disability
11 Rehabilitation Centres 50 15.98
Construction of new
12 BHO Office 800 48 120
Renovation of BHO
13 office 45
Construction of
Maternity room in the 60
14 area of SCs
Upgradation-District
15 Hospital 800
16 Upgradation-PHC 150
Improving Physical
Infrastructure &
37.00 37.00
maintenance of
17 Training Schools
Renovation/
maintenance of
physical infrastructure 13.00
at Government
18 Dispensaries
Facility Improvement-
Civil Works @
19 BEmOC 124 19.5
Facility Improvement-
Civil Works @
20 CEmOC 70
Improving Physical
Infrastructure of 27.00
21 District Hospital
22 Telephone @ CHCs 58.00
23 Telephone @ PHC 38.00
24 Telephone @ SC 104.00
25 MMU 1073.75 482.00 553.68 343.40
Emergency & Referral
2050.00
26 Services
POL & Maintenance
support to Ambulances 197.00 224.40
27 @ CHCs
POL & Maintenance
support to Ambulances 122.00
28 @ FRUs
POL and maintenance
support to ambulances 80.4
29 at FRUs/DH
Emergency & Referral
3701.44
30 Services

TOTAL 1500 5013.75 5464 5953.71 5220.38

28 Gujarat
 Human Resources related matters

31 Specialists 208 72 84
Selection , training &
remuneration of
447.10
AYUSH MO @
32 PHC/CHC
Mainstreaming of
AYUSH- AYUSH 180 1474.14
33 Doctors at PHC 1677.35
34 Staff Nurse 383 1192.13 443.82
35 Lab Technician 66.00
Accountant cum Data
36 Entry Operator at CHC 149.58
Appointing
Accountant cum Data
Entry Operator at PHC
37 Level 258 400 575.64
Honorarium to
Assistant Hospital 33.00
38 Administrators
Support for
strenthening
Midwifery Services 300.00
under Medical
39 Services
Support for Additional
40 ANMs 162 629.1
Other Incentives
Schemes-paramedical
41 staff 342.9
Incentives to
Paramedics of State
1000
Govt. for PHC/CHC &
42 DH
Incentive for Staff
0.84 136.56
43 Nurses
TOTAL 180 1857.1 4342.32 3835.74
Programme Management related matters
44 SHSRC 100 100 100 100
45 Preparation of DHAP 250
Management Costs/
Contingencies for
46 SPMU 329.8 73 201.47 38.48
Management Costs/
Contingencies for
47 RPMU 90.24

29 Gujarat
 Management Costs/
Contingencies for
48 AHA 240.24
M&E cost & Support
for Central Server 716.00 600.00
49 Room
Monitoring and
Evaluation Costs-
support for setting up
Block PMU for
strengthening block
level monitoring and
50 evaluation 824.22
Support monitoring
100 100 15.38
51 system at State Level
Support for monitoring
system-supportive
supervision in
Gandhinagar Region at
52 state level- Rs 1 crore 50
Support for
Community
Monitoring System at
53 District level 50
Preparation of State
2.00
54 Public Report
Preparation of District
13 9
55 Public report
Support for
contigencies/operation
13.00
al support to Govt
56 Dispensaries
TA/DA to Accountant
57 at CHCs level 12.47
TA/DA to Accountant
58 at PHCs level 47.97
TOTAL 250 429.8 1017.00 1010.47 1469.00
Untied Funds, Annual Maintainence Grants and RKS fundsrelated matters
Rogi Kalyan Samiti at
30
59 Medical Colleges
Rogi Kalyan Samiti-
115 115
60 DH
Rogi Kalyan Samiti-
273 277
61 CHC
Rogi Kalyan Samiti-
537 1073 1066
62 PHC
63 Untied Fund for CHC 137.00 136.50 1337.50
64 Untied Fund for PHC 267.5 269 268.25 266.5
65 Untied Fund for SC 727 727.4 727.4
Untied Fund for
988.00 1806.70 1798.20
66 VHSC
67 Annual Maintenance 200 267 273 277

30 Gujarat
 Grant - CHC
Annual Maintenance
535 481 533
68 Grant -PHC 575.5
Annual Maintenance
658 727.4 727.4
69 Grant- SC
TOTAL 727 1002.5 3337 6005.75 7125
Training & Capacity Building related matters

Strenthening of
25.00 25.00 25.00
Nursing Schools
70
Support to State for
Capacity building
71 needs at all levels 11.75 50
Visioning Workshop
13.00
72 @ District Level
Training meeting of
3.00 2.85
73 Staff Nurses
Constitution and
Orientation of
VH&SCs ( Training
Materials, Training
Costs, Village
74 Planning etc. ) 205
Constitution &
orientation of all
PRIs/Community
29.00
Leaders on
Village,SC,PHC, CHC
75 Committees; NGO
TOTAL 70.00 36.75 282.85
Innovations related matters
76 Health Melas 208
Support for
77 Chiranjeevi Yojana 11.57 2500
Support for IEC
activities @ State 200.00 200.00 300.00
78 Level
Support for IEC
activities @ District 563.00 195.34 237.00
79 Level
Resources for survey,
camps/hoardings @ 5.00
80 State Level
Grant in Aid to NGOs
81 at State level 700 500
Grant-in-Aid to NGOs
158.00 31.08
82 @ District Level
Procurement and
distribution of quality
1255.00 355.00 508.24
equipments and drugs
83 in the health system
84 Drug supply for 1600

31 Gujarat
 CHC/FRU
Procurement of drugs
and supplies District
85 level 153.01
Strengthening CMSO
to procure quality
drugs and equipments
and develop logistic
86 arrangment 140.18
87 Research Studies 10 200 15.63
Strengthening
management of life
264.00
style Diseases in
88 Teaching Hospitals
Strengthening Eye
Banks for eye donation 200.00
89 activities
Fluorosis Control
197.00 256.69
90 Activity
Support for PNDT
activities @ State 300.00
91 Level
Support for
implementing GPS
200.00
Monitoring Systems in
92 selected Districts
Epidemic Branch at
200.00 55.20 48.00
93 State Level
Support for
150.00 63.00
94 strenthening NPCB
Support to
95 Strengthening RNTCP 32 13 18
Disaster Management
Cell/ Disaster
41.54
Planning for gandhi
96 nagar District
Additional support for
institutional delivery 2.16
97 in Maliya taluka
Access of diagnostic
0.79
98 services under RNTCP
Pol support for
3.7
99 cataract surgery
100 Risk Pooling 9.78
Support to IDSP for
15.4
101 Gandhi Nagar
Support for innovative
actions-District/Blocl 71.29
102 Level
103 Support to DTT 52.5
104 RCH center 25
Support to Mobile
105 Monitoring Cell at 21.04

32 Gujarat
 State Level

Computerization
HMIS and e-
106 governance, e-health 10
Support for Nirogi Bal
107 Varsh 200
108 Support for Bal Sakha 1068
Support to CRS
Division of State
Government under
109 NRHM Additioanlity. 18 18.04
110 Support for NPPCD 107.4 52.71
Support for NCD
111 programme 83.96
Support to Nutrition
Cell (state & district
112 level) 1403.75
Strengtheining
Medical Services
113 department 6.31
IDSP budget training
and operations 5.6
114 expenses
Sickle cell Anaemia
740.85
115 Project under NRHM
Support for
strengthening of
126
Midwifery Services (6
116 medical Colleges)
Support to Mental
123.58
117 Health Project
Support for
677.13
118 NABH/NABL
119 urban health 362.35
Support for Disability
issue into PH System 12.45
120 of Gujarat
Nirogi balak
Campaign Extension
of Meena campaign to
497.68
all the Primary School
for Education
121 Department
Support for Disability
Rehab centres for
147.5
Social Justice &
122 Empower deptt.
TOTAL 1600 208 4434 4421.58 7283.87

33 Gujarat