HMIS Annual 2019-20 Report

STATISTICS DIVISION
MINISTRY OF HEALTH & FAMILY WELFARE

GOVERNMENT OF INDIA
2019-20
(An Analytical Report)
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FOREWORD
Data is the main pillar of the planning process for any Public Policy. Quality data is
fundamental for good policy formulation, implementation, Monitoring and Evaluation. Health
Management lnformation System (HMIS) of Ministry of Health & Family Welfare is the
exclusive source of regular information for facility level health data nationwide. The collection
and analysis of HMIS data is used in monitoring the implementation of various health
programmes under National Health Mission and other national programmes.
Monitoring is the process of regular tracking of inputs and outputs. lt should provide
information on whether an intervention is on kack or within the budget. Analysis of data
enables us to assess whether and how our program has achieved its objectives. HMIS data
informs government about health status of country and eventually helps in evidence based
decisions making.
"HMIS Annual Report 2019-20" based on analysis of HMIS data, provides insight into
the NHM programme implementation. lt is an effort towards providing reliable and updated
information on health system that specifically includes data on services and infrastructure
and human resources. The data mentioned in this publication is based on the information
from April 2019 March 2020, provided by States and uTs. The publication provides
analytical insights on performance of different programme, service utilization, morbidity and
mortality.
The publication also provides comprehensive detail of statistics on health services

delivery. HMIS Annual Report 2019-20 may serve as a critical source of information to carry
out further comparative analyses and to take policy decisions based on informed data.
I am sure that this publication would provide valuable support to the users. This
document will serve as a base document on HMIS for policy makers for evidence based
decisions. Any suggestions/comments for improving the contents and layout of the
publication will be highly appreciated.
Place : New Delhi (Rajesh Bhushan)

Date : 30 September, 2021
Room No. '156, A-Wing, Nirman Bhawan, New Delhi-110 01'l

Tele : (O) 011-23061863, 23063221, Fax : 011-23061252, E-mail : secyhfw@nic.in
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Additional Secretary & Mission Director (NHM)
Acknowledgement
The Health Management Information System (HMIS)' a web based portal for M&E of National
Health Mission (NHM) and other national health programmes. This HMIS Annual Report 2019-20
has been prepared on the basis of the National Health Mission data reported through HMIS by around
2.08 lakh health facitities from all StatestuTs during April 2019 to March 2020'
fhe report covers a brief introduction on HMIS, New HMIS (HMIS 2.0) and its features' information
2019-20.
captured under HMIS and various reports available, reporting by heatth facilities during
data quality measures apptied on HIMS System are provided. Analysis of various programmes
performance of Matemal Health, Child Health. Famity Planning, Immunization, Adolescent Health'
provided in
Patient Services, Diagnostic Service - Lab & Radiotogy. Morbidity and Mortality are
detail. This is the first such an annual publication of HMIS is prepared'
HMIS data has been utilised in Programme Implementation Plan (PlPs) of States for effective
various
implementation, monitoring and evaluations of delivery of services to beneficiaries under
health schemes funded by Gol, grading of health facilities used for conditionality framework for
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incentive or dis-incentive under NHM, monitoring of aspirational districts. State health index,
ranking, pM Dashboard (Prayas), Data.Gov.in. Rural Health Statistics etc. The Monitoring
visits such
as cRtvt, supportive supervision visits also uses HMIS data. The analpical
reports generated through
HMIS also provides gap analysis and evidence based course correction'
I duly acknowledge the valuable contribution of whole HMIS team under overall guidance of Ms.
Anjati Rawat, Director (Stats), Shri Anindya Saha, DD (Stats) and all HMIS Consultants in bringing
out of this publication.
(Vikas Sheel)
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Tele : 01'l-2306 3693, Telefax : 011-2306 3687, E-mail : sheelv@ias.nic'in

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GOVERNMENT OF INDIA
SANDHYA KRISHNAMURTHY PREFACE MINISTRY OF HEALTH & FAMILY WELFARE
Director General (Stats) INDIAN RED CROSS SOCIETY BUILDING,
Telefax : 23736979, 23350003 NEW DELHI .11OOO1
e-mail : sandhya.k@nic.in
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Statistics Division (HMIS) has come up with first Annual HMIS publication, which
aims to provide State wise analysis of data as repofted, by States/ UTs during the year
2019-20 on HMIS portal.
Health Management Information System (HMIS) is a web based portal for

effectively monitoring the implementation of various programmes under National Health
Mission. The health facilities from across states/UTs are repofting their health care
service delivery and Infrastructure & HR information on monthly basis. Regular
monitoring of the health programmes implementation are undeftaken using data from
HMIS.
The current publication is divided into 12 Chapters. These chapters cover apart
from a brief introduction to HMIS, HMIS 2.0 and its features, programmes performance
on Maternal Health, Child Health, Family Planning, Immunization, Adolescent Health,
Patient Services, Diagnostic Service - Lab & Radiology, Morbidity and Moftality, Grading
of Health Facilities and First Referral Units.
Iwould like to convey my sincere gratitude and thanks to my colleagues from

States/UTs for timely uploading of data on HMIS poftal. This publication would cater to
the basic needs for effective planning, monitoring and evaluation of health care system
under the national health mission and other national health programmes. This report
would also serve as a valuable document in understanding the HMIS system and the
various key programmes data reported through it. This document will be of immense
use for various stakeholders working in health sector. Suggestions for further
improvement in future repoft are welcome.
(Sandh shnamufthy)
Place: New Delhi

Date: 30 September, 2021
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Contents
Contents
Chapter 1 Introduction to HMIS.........................................................................................1
Chapter 2 HMIS 2.0 and its Features .................................................................................9
Chapter 3 Maternal Health ...............................................................................................15
Chapter 4 Child Health .....................................................................................................39
Chapter 5 Adolescent Health ............................................................................................58
Chapter 6 Family Planning ...............................................................................................63
Chapter 7 Immunisation ...................................................................................................71
Chapter 8 Mortality and Morbidity ..................................................................................81
Chapter 9 Patient Services ................................................................................................91
Chapter 10 Diagnostic Service – Lab & Radiology ...........................................................99
Chapter 11 Grading of Health Facilities...........................................................................111
Chapter 12 First Referral Units ........................................................................................125
INTRODUCTION TO HMIS
Annexure 1.1 State/UT-wise number of Health Facilities with public and private
distribution as mapped in HMIS during 2019-20 ..........................................134
Annexure 1.2 State/UT-wise number of Health Facilities by type of facilities as
mapped in HMIS during 2019-20 ..................................................................135
MATERNAL HEALTH
Annexure 3.1 State/UT wise Annual Estimated Pregnancies...............................................136
Annexure 3.2 State/UT wise ANC Registration and PW received 4 ANC Checkups .........137
Annexure 3.3 State/UT wise No. of Deliveries by Type .....................................................138
Annexure 3.4 State UT wise No. of Home Deliveries .........................................................139
Annexure 3.5 State/UT wise Abortion (Spontaneous and Induced) ....................................140
Annexure 3.6 State/UT wise Post Natal Checkups ..............................................................141
CHILD HEALTH
Annexure 4.1 States/UTs wise, number of Live births, NBSU admission as reported
in HMIS during 2019-20................................................................................142
Annexure 4.2 States/UTs wise number of Live births, SNCU admission, SNCU
admission referred by ASHA and SNCU death as reported in HMIS
during 2019-20 ...............................................................................................143
Annexure 4.3 State/UT wise total number of Home delivery and Home delivery
followed by 7 HBNC Visits as reported in HMIS during 2019-20 ...............144
Annexure 4.4 State/UT-wise, Number of live births, number of newborns weighted
and newborns weighted less than 2.5 kg as reported in HMIS during
2019-20 ..........................................................................................................145
Annexure 4.5 State/UT-wise number of reported Live Births, Still Births and Total
birth (Live + Still) as reported in HMIS during 2019-20 ..............................146
Annexure 4.6 State/UT-wise number of reported Live Births – Male, Live Births-
Female, Sex Ratio at Birth as reported in HMIS during 2019-20 .................147
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Contents
Annexure 4.7 State/UT-wise number of number of children admitted in NRC and
discharged with target weight gain from the NRCs as reported in
HMIS during 2019-20....................................................................................148
Annexure 4.8 Number of children screened, identified and management under RBSK
by States/UT, India during 2019-20 ..............................................................149
ADOLESCENT HEALTH
Annexure 5.1 Percentage of services provided at AFHC for registered Adolescent by
States/UTs, India 2019-20 .............................................................................150
Annexure 5.2 Number of Adolescents provided IFA tablets under WIFS programme
by States/UTs, India 2019-20 ........................................................................151
FAMILY PLANNIG
Annexure 6.1 State/UT wise performance of Male & Female Sterilisation
F.Y. 2018-19 & 2019-20................................................................................152
Annexure 6.2 State/UT wise performance of IUCD & PPIUCD Insertions F.Y. 2018-
19 & 2019-20 .................................................................................................153
Annexure 6.3 State/UT wise ECP & Oral pills distribution during 2018-19 & 2019-
20 ...................................................................................................................154
Annexure 6.4 State/UT wise performance of Injectable Contraceptives during F.Y
2019-20 ..........................................................................................................155
Annexure 6.5 State wise achievement of contraceptive users during F.Y. 2019-20 ............156
IMMUNIZATION
Annexure 7.1 State/UT wise percentage of pregnant women received TT2+ TT
Booster against estimated pregnancies during 2019-20 ................................157
Annexure 7.2 State/UT wise Percentage of Children of 9-11 Months Fully
Immunized against Estimated Infants during 2019-20 ..................................158
Annexure 7.3 State/UT-wise percentage achievement of BCG coverage to estimated
need assessed during 2019-20........................................................................159
Annexure 7.4 State/UT wise coverage of measles/MR vaccination reported in HMIS
during 2019-20 ...............................................................................................160
Annexure 7.5 States/UTs wise Rotavirus 1st, 2nd & 3rd dose administered reported
in HMIS during 2019-20................................................................................161
Annexure 7.6 State/UT-wise distribution of AEFI Deaths, Abcess & other adverse
events reported in HMIS during 2019-20 ......................................................162
MORTALITY and MORBIDITY
Annexure 8.1 State/UT wise Distribution of Infant Deaths by Age and Cause ...................163
Annexure 8.2 State/UT wise Distribution of Maternal Deaths by Cause.............................164
Annexure 8.3 State/UT wise Distribution of Adolescent/ Adult Deaths by Cause ..............165
Annexure 8.4 State/UT wise Distribution of Deaths due to Vector Borne Diseases ...........166
PATIENT SERVICES
Annexure 9.1 State/UT wise Distribution of OPDs .............................................................167
Annexure 9.2 Inpatient Head Count at Midnight .................................................................168
DIAGNOSTIC SERVICE – LAB & RADIOLOGY
Annexure 10.1 State/UT wise Distribution of ANC Registration and Syphillis ....................169
Annexure 10.2 State/UT wise Distribution of OPD Attendance and Lab Test Done ............170
Annexure 10.3 State/UT wise Distribution of Haemoglobin Testing ....................................171
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Contents
Annexure 10.4 State/UT wise Distribution of Syphilis Testing .............................................172

GRADING OF HEALTH FACILITIES
Annexure 11.1 State/UT wise Grading of CHCs during 2019-20 ..........................................173
Annexure 11.2 State/UT-wise Grading of PHCs 2019-20 .....................................................174
Annexure 11.3 State/UT wise Grading of Rural PHCs 2019-20............................................175
Annexure 11.4 State/UT wise Grading of Urban PHCs 2019-20...........................................176
FIRST REFERRAL UNIT
Annexure 12.1 State/UTs wise Details of Total FRUs and Number
of FRUs Fulfilling the Conditionality Criteria 2019-20 ................................177
Annexure 12.2 State/UT wise Availability of Services and manpower at FRU CHCs..........178
Annexure 12.3 State/UT wise Availability of Services and
Manpower at FRU Blood Storage Facility at SDH .......................................179
Annexure 12.4 State/UT wise Availability of Services and
Manpower at FRU Blood Storage Facility at DH..........................................180
- iii -
Abbreviations
ABBREVIATIONS
ANC: Ante Natal Care
ANM: Auxiliary Nurse Midwife
ASHA: Accredited Social Health Activist
AYUSH: Ayurveda, Yoga & Naturopathy, Unani, Siddha and Homoeopathy
CBR: Crude Birth Rate
CHC: Community Health Centre
DEIC: District Early Intervention Centre
DH: District Hospital
DHQ: District Headquarters
FRU: First Referral Unit
G2G: Government-to-Government
GIS: Geographic Information System
HBNC: Home Based Newborn Care
HMIS: Health Management Information System
HR: Human Resources
IMR: Infant Mortality Rate
IPHS: Indian Public Health Standards
IUCD: Intrauterine Contraceptive Device
JSSK: Janani Shishu Suraksha Karyakram
MCH: Maternal and Child Health
MIS: Management Information System
MMU: Mobile Medical Unit
MO: Medical Officer
MOHFW: Ministry of Health & Family Welfare
MTP: Medical Termination of Pregnancy
NRC: Nutritional Rehabilitation Centre
NSV: Non Scalpel Vasectomy
NFHS: National Family Health Survey
NHM: National Health Mission
NRHM: National Rural Health Mission
OCPs: Oral Contraceptive Pills
PHC: Primary Health Centre
PIP: Programme Implementation Plan
PNC: Post Natal Care
PPIUCD: Postpartum Intrauterine Contraceptive Device
PRCs: Population Research Centre
RCH: Reproductive and Child Health
RBSK: Rashtriya Bal Swasthaya Karyakram
RKS: Rogi Kalyan Samiti
SC: Sub Centre
SBA: Skilled birth attendant
SAS: Statistical Analysis System
SBR: Still Birth Rate
SDH: Sub District/ Divisional Hospital
SNCUs: Sick Newborn Care Units
SRS: Sample Registration System
TFR: Total Fertility Rate
UTs: Union Territories
WIFS: Weekly Iron folic acid
Chapter 1 Introduction to HMIS
CHAPTER 1
Health Management Information System is an important building block for health system
strengthening. A Strong Monitoring and Evaluation system is a key to success of any project,
scheme or programme. A good Management Information System (MIS) has many roles to perform
like the decision support role, the performance monitoring role and the functional support role,
which in turn helps to improve performance and achieve results. In today`s world an agile and
efficient data driven decision support system is needed by every organization be it Government or
Private.
Ministry of Health & Family Welfare, Government of India has put in place the Health
Management Information System (HMIS) in 2008. Initially, HMIS started with uploading of district
level consolidated figures in to the system. Subsequently in 2010-11, the facility based reporting was
initiated. The facility wise service delivery data is reported on monthly basis and infrastructure
related data on annual basis on HMIS web portal (https://nrhm-mis.nic.in/).
HMIS is a web-based Monitoring Information System of Ministry of Health & Family Welfare
to monitor the National Health Mission and other National Health Programme and provide key
inputs for policy formulation and appropriate programme interventions. HMIS is specially designed
to assist health departments, at all levels, in managing and planning of health programmes.
Five type of health facilities viz. Sub Centres (SCs), Primary Health Centres (PHCs),
Community Health Centres (CHCs), Sub-District Hospitals (SDHs) and District Hospitals (DHs)
report on HMIS. Medical Colleges are mapped at SDH and DH level in respective States/UTs. As of
2019-20, there were around 705 districts and around 2.08 lakh health facilities mapped and reporting
on HMIS Portal.
1.1 Information Captured in HMIS

In HMIS primarily Service Delivery and Infrastructure & Human Resource data are captured.
Data for the service delivery for a specific month are entered in the subsequent month. Facilities are
supposed to enter the data by 5th of the subsequent month. Infrastructure data is entered on annual
basis, facility is supposed to enter this data at the beginning of the financial year (by 30 April of that
financial year) and update the information as and when required throughout the year. The details of
Service delivery and Infrastructure & Human Resource data captured on HMIS is as follows:
a. Service Delivery: Data on some of the important parameters such as Reproductive, Maternal
and Child-health, Immunization, Family-planning, Vector Borne Disease, Tuberculosis,
Morbidity and Mortality, OPD, IPD Services, Surgeries etc. are being captured on monthly
basis. HMIS is currently capturing data on around 300 items which cover most of the health
programmes/schemes run by Ministry of Health & Family Welfare. The entire HMIS format
is divided into 5 parts viz. Reproductive and Child Health, Health Facility Services,
Mortality, Monthly Inventory and Other Programmes. These major heads are then further
divided into specific modules like Ante Natal care, Child immunisation etc. that captures
data related to that particular area.
1
Introduction to HMIS Chapter 1
b. Infrastructure: Data on Manpower, Equipment, Cleanliness, Building, Availability of
Medical Services such as Surgery etc., Super Specialties services such as Cardiology etc.,
Diagnostics, Para Medical and Clinical Services etc. are collected on annual basis at facility
level.
1.2 Health Facilities Status

In all, there are around 2.08 lakh health facilities which include 8,885 private health facilities
which have reported on HMIS in 2019-20. Among these, most of the health facilities are Sub
Centres (161019). All India distribution of health facilities by type total and public-private
distribution is given below in Figure 1.1 and Table 1.1 respectively.
Figure 1.1: All India Distribution of Table 1.1: All India Distribution of
Health Facilities by type Public and Private Health Facilities
31296, 12923, 2430, 1% 1249, 1% Type of

Total Public Private
6% Facility
15%
SC 161019 160990 29
PHC 31296 30714 582
161019, CHC 12923 5786 7137

77%
SDH 2430 1501 929
DH 1249 1041 208
Total 208917 200032 8885

SC PHC CHC SDH DH
Note: Due to no time stamping of up-gradation/down-gradation of facilities, number of health

facilities may vary.
The State/UT-wise number of Health Facilities with public and private distribution and
State/UT-wise number of Health Facilities by type of facilities as mapped in HMIS during 2019-20
are provided at Annexure-1.1 and Annexure-1.2
1.3 Reporting in Infrastructure format by Health Facilities

Infrastructure and HR data is reported in HMIS by public health facilities only.
1.3.1 Overall Reporting by health facilities during 2019-20
Of around 2 lakh health facilities, around 99% have reported the Annual Infrastructure & HR
data. There are 23 States/UTs which have reported above National average of 99% and there are 13
States/UTs, which have reported below National level. The States/UTs wise details of Annual
Infrastructure and HR-Percentage of health facilities reported during 2019-20 is provided in
Figure 1.2.
2
Figure 1.2: Annual Infrastructure and HR: Overall Percentage reporting by
Public health facilities during 2019-20
Lakshadweep 42.9
Uttarakhand 81.4
Delhi 84.3
Goa 89.2
Jammu & Kashmir 92.7
Arunachal Pradesh 94.9
Kerala 95.2
Nagaland 97.4
Bihar 97.8
Himachal Pradesh 98.1
Tamil Nadu 98.7
A & N Islands 98.7
Dadra & Nagar Haveli 98.8
All India 98.9
Meghalaya 99.1
Puducherry 99.3
Chhattisgarh 99.3
Karnataka 99.3
Uttar Pradesh 99.3
Manipur 99.4
Rajasthan 99.5
West Bengal 99.6
Punjab 99.7
Assam 99.7
Mizoram 99.8
Tripura 99.8
Maharashtra 99.8
Jharkhand 99.9
Odisha 99.9
Gujarat 100.0
Telangana 100.0
Madhya Pradesh 100.0
Chandigarh 100.0
Sikkim 100.0
Haryana 100.0
Daman & Diu 100.0
Andhra Pradesh 100.0
0.0 20.0 40.0 60.0 80.0 100.0 120.0
1.3.2 Health Services - MIS Reporting for 2019-20

Health services data is reported by all facilities including private (8885). An overall reporting of
health service delivery data in HMIS was over 99 per cent at all India level. This include 99.5 per
cent at SC (161019) level, 99.4 per cent at PHC (31296) level, 95.2 per cent at CHC (12923) level,
91.1 per cent at SDH (2430) level and 95.3 per cent at DH (1249) level. The detail is provided at
Table 1.2.
3
Table 1.2: All India total (Public and Private) Health Facilities Reported Health Service
delivery data on HMIS during 2019-20
Type of Total Apr- May- Jun- Jul- Aug- Sep- Oct- Nov- Dec- Jan- Feb- Mar- Over
Facilities 2019 2019 2019 2019 2019 2019 2019 2019 2019 2020 2020 2020 all
SC 161019 99.6 99.5 99.5 99.4 99.4 99.4 99.4 99.5 99.5 99.5 99.5 99.5 99.5
PHC 31296 99.7 99.6 99.6 99.4 99.4 99.3 99.3 99.3 99.3 99.3 99.1 99.1 99.4
CHC 12923 95.2 95.2 95.3 96.0 95.9 95.7 95.5 95.1 95.2 94.9 94.9 93.8 95.2
SDH 2430 91.5 91.6 91.6 91.4 91.4 91.0 90.9 91.2 91.4 91.1 90.5 90.1 91.1
DH 1249 95.4 95.4 95.1 95.1 94.9 95.1 95.2 95.8 96.2 96.5 95.4 94.2 95.3
Total 208917 99.2 99.1 99.1 99.1 99.1 99.0 99.0 99.1 99.1 99.1 99.0 98.9 99.1
Note: Due to no time stamping of up-gradation/down-gradation of facilities, number of health

facilities may vary
1.4 Data Quality Measures in HMIS

HMIS data forms the backbone of Ministry of Health and Family Welfare. The goal of HMIS is
to generate quality data so as to enhance its usage for policy decisions in improving the health
service provision. Various data quality measures are applied in the HMIS to ensure data entered in
HMIS is of good quality.
1.4.1 Timeliness
Each facility is supposed to enter the data by 5th of the following month in case of monthly MIS
data and by 30th April of the reporting year in case of Annual Infrastructure data. This data is
subsequently verified and forwarded to next level in the upper hierarchy.
1.4.2 Accuracy: Accuracy is defined as the extent to which data are correct and reliable. In HMIS,
following checks are built-in to confirm the accuracy of data. These checks are as follows:
a. Compare Option
b. Inter-Data Validation Checks
c. Verify Option
a. Compare Option: This action is an inbuilt feature in HMIS to compare data with previous
month (in case of monthly data). Data fields are highlighted as per comparison status. This gives
instant view to a data entry personell for any issues related to data quality at the time of data
entry, so that necessary correction can be made. This ensures that the major data variation is
highlighted at the time of data uploading itself/at the first sight of inconsistency. Below is sample
Screenshot (Figure 1.3) of compare option available in HMIS for verifying the monthly data of a
District Hospital for the month of April 2019 with previous month.
4
Figure 1.3: Sample Compare Option for data quality checks in HMIS
b. Inter-Data Validation Checks: While saving data, as per prior inbuilt validation rules, error
highlighted in red colour for the erroneous data elements. This informs the person who is
entering data for data quality issues (if any) and accordingly corrections can be made. e.g.,
Number of pregnant women registered within 1st trimester (within 12 weeks) of pregnancy
cannot be greater than Total number of pregnant women registered for ANC during the reporting
month.
c. Verify Option: While uploading data, it is mandatory for the data to pass through the verify data
option before submitting and forwarding to next logical level (Sub-district/District/State).
Without this, submission and forwarding of data to next logical level is not possible. Below
sample screenshot (Figure 1.4) provides the validation summary of Data entry validation report
of a District Hospital for the month of April 2019.
Figure 1.4: Sample Data entry validation report of a District Hospital
1.4.3 Data Quality Report: Apart from inbuilt data quality validation rules and option for
correction at the time of data entry/ uploading, there are different standard reports which provide
information on probable data quality errors and outliers. Following are different standard reports for
identifying different data quality errors and outliers in the reported data on HMIS:
5
i. Data Entry Status Report
ii. Percentage Filled Report
iii. Validation Errors Report
iv. Probable Outliers & Validation Error Report
v. Reproductive and Child Health (RCH) performance Report
i. Data Entry Status Report: This report provides data entry status of the facility. This
means completeness of reporting of the facility. For example, Out of 10 active facilities in
the district, how many facilities have reported during the reporting month.
ii. Percentage Filled Report: This report provides completeness of data entry by the facility.
For example, there are 284 data elements in MIS format for PHC, out of that how many data
elements have been reported by the facility. One sample report is provided as screenshot
(Figure 1.5), Sample Percentage Filled Report of a PHC for the month of April 2019.
Figure 1.5: Sample Percentage Filled Report
iii. Validation Error Report: This report provides state wise/ district-wise and indicator-wise
validation errors. These validation reports are based on the inter data validation rules
implemented in the system. Based on this report corrective action can be taken against the
data violating validations. Below screenshot (Figure 1.6) provides sample validation error
summary report at a district.
Figure 1.6: Sample Validation Error Report
6
iv. Probable Outliers & Validation Error Report: This report provides outlier report
highlighting (Light Pink Background indicates only Outliers) the erroneous data field in a
particular month. Outlier is any data point more than 1.5 inter-quartile ranges (IQRs) below
the first quartile (Q1) or above the third quartile (Q3) of the reported data.
So, IQR = Q3 – Q1
Upper Bound = Q3 + (1.5*IQR)
Lower Bound= Q1- (1.5*IQR)
This report also shows the validation related data quality issues (Cell with pink background
indicates only Validation error exist) and whether both the validation and outlier error are
present in the particular data field (Yellow Background indicates both Validation Error and Outlier)
in a particular month. Below is screenshot of Sample Outlier & Validation Report.
Figure 1.7: Sample Outlier & Validation Report
v. RCH Performance Report:

The Reproductive and Child Health (RCH) report provides Performance of RCH data items
on Immunization, Maternal and Child Health and Family Planning against the estimated
target for the particular year. These reports are used to review the performance of service
utilization of RCH services at the facility. These reports can also be used to review data
quality issues such as completeness and consistency etc. while comparing data for two
periods. Below is screenshot (Figure 1.8) of sample RCH performance report.
Figure 1.8: Sample RCH Performance Report
7
1.5 Monitoring and Supervision Visits
Random checks of HMIS data in the registers at Facility Level is undertaken during field visits.
Supportive supervision visits undertaken by the Staff at various levels to verify HMIS data. During
Common Review Mission of National Health Mission, HMIS data is extensively used and verified.
Population Research Centre (PRCs) are also involved in the data verification exercise of the HMIS
data. State and District level HMIS nodal officers also visits health facilities and verify HMIS data
for providing supportive supervision to the field staff and for necessary data corrections if any.
1.6 Training and Orientation

HMIS Division of MoHFW has a structured training programme on various technical issues for
the personnel involved in data recording, reporting, aggregation, verification and feeding of data. In
the Annual PIP of State/UTs, certain amount of funds (as per a specific norm) are allocated for
holding trainings at State/ District/ Block level. Training is imparted on data definitions, various
indicators and new features/ aspects of HMIS portal.
As per State/UT PIP, at the State Level - two training cum review of three days per year is
supposed to be undertaken; at District Level -one training cum review of three days per quarter is
supposed to be undertaken and at Block Level - one training of one day per Month is supposed to be
undertaken. Funds for these activities are given by MoHFW under annual PIP in HMIS related
budget head (9.5.26.1).
1.7 National and Regional Review Meeting

The Ministry conducts Annual National level HMIS review meeting with an objective to discuss
the data quality issues with the State Level Data Manager and HMIS nodal officers and orient them
about new development in HMIS. Apart from this, 3-4 Regional review meetings for a group of
States/districts are conducted every year. The major focus of these review meetings is data quality.
In addition, State specific HMIS/M&E related best practices are also shared.
The main aim of all these activities is to ensure that data entered in HMIS portal are of good
quality.
8
Chapter 2 HMIS 2.0 and its Features
CHAPTER 2
HMIS 2.0 AND ITS FEATURES
The HMIS system which has been running since year 2008 has various strengths like well-
established data flow, usability, rationalized formats, user friendly interface and ease of data entry
system. However, it was facing certain drawbacks due to old technology (Hardware and Software),
lack of inter-operability, non-availability of web API and lack of decision support system. Therefore,
keeping in view the need to revamp the existing HMIS application and also this ministry’s view of
brining of all health information system at a single Platform; it was decided to get a new HMIS
portal.
HMIS 2.0 (http://hmis.nhp.gov.in) has been developed after series of discussion/deliberation
among the national HMIS Team and software developers of the WHO. The system requirements
study was conducted and various support documents like MIS monthly formats, Infrastructure
annual formats, Basic reports requirements and master details of health facilities details was shared
with the development team. Keeping in view the need to revamp the old HMIS (HMIS 1.0)
application and also ministry’s view of brining of all health information system at a single Platform;
it was decided to get a new HMIS (HMIS 2.0) portal on Integrated Health Information Platform
(IHIP).
The primary objective of IHIP is to enable the creation of standards compliant Electronic Health
Records (EHRs) of the citizens on all India basis along with the integration and interoperability of
the EHRs through a comprehensive Health Information Exchange (HIE) as part of this centralized
accessible platform. Integrated Health Information Platform (IHIP) of MoHFW has provision for
capturing data at facility and beneficiary level. The integration of HMIS online portal with IHIP
ensures full use of all applicable government standards, including standardized facility listing,
geographic and entity names, all geographic boundaries (up to the level of villages), population data
and other relevant information. The GIS based layers that are currently used in IHIP is fully
integrated with HMIS online portal. This will enable the policy makers for optimal information
exchange to support better health outcome, better decision support system, and thus eventually
facilitating improvement in health care at National level.
After first prototype of the new HMIS portal was developed, it was duly tested and the feedbacks
were shared with developers. Further, State level User Acceptance Test (UAT) were also conducted.
Requirements gathering workshops were conducted including Chandigarh (15-16 April 2019),
Karnataka (24 April 2019), Kerala (26 April 2019), Madhya Pradesh (02-03 May 2019), Uttar
Pradesh (23-24 May 2019) and Assam (06-07 June 2019).
Further various regional workshops were also conducted for User Acceptance Test (UAT) of
new HMIS (HMIS 2.0) included were: Chandigarh, Punjab on 18-19th July 2019 for Jammu &
Kashmir, Himachal Pradesh, Uttarakhand, Delhi, Haryana, Bihar; Thiruvananthapuram, Kerala on 1-
2nd August 2019 for Tamil Nadu, Puducherry, Jharkhand Maharashtra, Goa, Andhra Pradesh,
Lakshadweep; RRC NE (Guwahati) on 6-7 June, 2019 for Assam, Arunachal Pradesh, Manipur,
Meghalaya, Mizoram, Nagaland, Tripura, Sikkim and Delhi. Regional workshop were organized on
at Guwahati 6-7th August 2019 for Assam, Arunachal Pradesh, Manipur, Meghalaya, Mizoram,
Nagaland, Odisha, Sikkim, West Bengal and at Ahmedabad on 8-9th August 2019 for Madhya
Pradesh, Rajasthan, Dadra & Nagar Haveli, Daman & Diu, Chhattisgarh, Telangana. The glimpses
9
HMIS 2.0 and its Features Chapter 2
of various requirements gathering and User Acceptance Test Workshops and Regional workshop on
new HMIS held during 2019-20 is provided at Figure 2.1.
Figure 2.1: Glimpses of requirements gathering and User Acceptance Test and
Regional Workshops on new HMIS held during 2019-20
The new HMIS (HMIS 2.0) was pilot launched in five states in July 2019 by the then Secretary
(HFW) after extensive field testing. The new portal is interoperable and may enable data from the
various programmes to exchange relevant data elements by increasing efficiency and accuracy while
reducing or eliminating the need for multiple data entry. Home screen of new HMIS is given at
Figure 2.2.
Figure 2.2: Home screen of new HMIS
10
HMIS is accessible to all authorized users including the Facility/ Block/ District/ Stater users and
by those national health programs that are hosting their data. The certain features have been
incorporated which makes HMIS significantly advanced and following e-Gov standards. The Figure
2.3 showing the key features incorporated in HMIS.
Figure 2.3: Key features incorporated in HMIS
The key features of new HMIS (HMIS 2.0) portal are following:
i. Person Specific User Credentials (mapped to an Individual) for fixing responsibility to user
for entering complete and correct data in the system.
ii. National Identification Number (NIN) and Local Government Directory (LGD) have been
used for unique identification of health facilities at village/block.
iii. State specific administrative hierarchy as per LGD has been implemented and accordingly
States tagged their health facilities.
iv. Provision for real time data entry and real time monitoring of the system
v. Compatibility with multiple devices such as Mobile, Tab etc.
vi. API (Application Program Interface) developed to ensure direct linkage of HMIS online
portal with other programme/software application of the ministry to enable automated
extraction of aggregate data to HMIS software application at frequent intervals, and
wherever applicable, on real-time basis.
vii. Advanced data analytics such as SAS, GIS Integration with layer of village boundary is
developed.
viii. Interactive Dashboards has been developed
ix. Infrastructure data to be entered only once in the new system, later to be auto populated and
monthly basis updated.
x. Alerts system is developed which will provide alert to the programme managers at various
level for appropriate and timely action.
The new HMIS (HMIS 2.0) system is an excellent example of Re-engineering of Digital
Transformation under Government of India which will be able to reduce the work-load on the
11
frontline workers at facility level by integrating multiple health applications/software under single
platform.
System Architecture and Hardware and Database of HMIS 2.0:
HMIS 2.0 architecture is based on e Governance Data and Information Standards (UID, NIN,
ICD-10/11, LG Code etc.). It has ability to connect with My Health Record, E-Hospital Systems,
AB-PMJAY etc. It can also connect with public and private hospitals, laboratories to exchange
health data. 16 cloud servers have been procured from BSNL for HMIS 2.0. The Cloud servers are
distributed among States as per requirements for efficient data management.
DATA REPORTING & DATA ENTRY
HMIS captures data for:
Monthly Service Delivery- Every month all the health facilities enter data related to services
provided during the reporting month.
Monthly Infrastructure- the status of availability of Infrastructure and HR is entered every
month.
12
1. Daily – HMIS gives important opportunity to improve public health surveillance in India.
Daily data is captured at the facility level the most volatile information’s. Daily data entry
gives real time information which helps real-time analysis and rapid response, data analytics
and modelling support, and using technology to update health workers and the community.
HMIS 2.0 is playing very crucial role in capturing real time covid19 information. It captures
daily COVID data elements at all health facilities of India. Mobile app is also available for
entering this data.
2. Monthly-All facilities including health sub-Centre, PHC & CHC, will report monthly data in
format prescribed for their facility. There is a provision of tagging multiple facilities with
one login in HMIS 2.O. Monthly services, monthly infrastructure and HR data is captured
every month.
HMIS 2.O reports-
Three types of reports are available in HMIS 2.O
DASHBOARD:
HMIS dashboard is an information management tool that visually tracks, analyzes and displays
key performance indicators (KPI), metrics and key data points to monitor the performance of
programme, department or specific process.
The HMIS dynamic dashbord is giving following unique features:
 Dashboard chart filter/Click to filter features gives varous ways to dissect the data.
 Drillthroughs software feature gives more specific & detailed information of particular
element, variable/KPI without overcrowding the dashboard. Simple click on specific
indicator the drill through will enable to visualize the data in clear manner.
 Time interval Widget feature gives time scale on charts on dashboard with interactive drill
down function.
 Chart zoom feature provides multiple layes of knowledge allowing to upto district level
information with single click.
13
Gographical Information System (GIS) in a Health Management Information System (HMIS)

is a a powerful tool to manage health care delivery system more effective and far more efficient. It
includes database management, planning, risk service area mapping, location identification, etc.
Currently two reports are availabe on GIS:
1. Facility reporting Status.
2. Indicator performance.
We are entering in new era where country is witnessing rapid health transition, which not only
includes demographic, epidemiological transition but also socio cultural and technological transition
as well. This has immediate and long-term consequences for health policy and programme
development. The all new HMIS is sufficiently equipped and able to respond adequately to the
complex health transition.
14
Chapter 3 Maternal Health
CHAPTER 3
MATERNAL HEALTH
Maternal health is the health of a woman during pregnancy, childbirth, and the postpartum
period. It encompasses all health care dimensions in order to ensure a positive and fulfilling
experience and reduce maternal morbidity and mortality.
Improving maternal and child health has been one of the top health priorities of the Government
of India. In view of this, the Reproductive and Child Health (RCH) Phase I Programme was
launched throughout the country on 15th October, 1997. The second phase of RCH program i.e.
RCH – Phase II was launched on 1st April, 2005. The major strategies under the two phases of RCH
are-
 Essential Obstetric Care
o Institutional Delivery.
o Skilled attendance at delivery.
 Emergency Obstetric Care
o Operationalizing First Referral Units.
o Operationalizing PHCs and CHCs for round the clock delivery services.
 Strengthening Referral System
The main objective of the program was to bring about a change in mainly three critical health
indicators Reducing total fertility rate, Infant mortality rate and Maternal mortality rate with a view
to realize the outcomes envisioned in the Millennium Development Goals. In February 2013, the
Government of India held historic summit on the call to Action for child survival, where it launched
“A strategic Approach to Reproductive, Maternal, Newborn, child and Adolescent Health,
(RMNCH+A)” in India. Since then, RMNCH+A has become the heart of one of the Government of
India’s flagship public health programme i.e. the National Health Mission (NHM). The RMNCH +A
essentially addresses the major causes of mortality among women and children as well as the delays
in accessing and utilizing health care services. Further, various programs and schemes have been
added by Government of India to achieve reproductive health goals.
Maternal mortality-
Maternal death or maternal mortality is defined by the World Health Organization (WHO) as
"the death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of
the duration and site of the pregnancy, from any cause related to or aggravated by the pregnancy or
its management but not from accidental or incidental causes. Maternal mortality is a sensitive
indicator. It helps to understand the health care system of a country and also indicates the prevailing
Socio-economic Scenario.
Five states (Andhra Pradesh, Telangana, Tamil Nadu, Maharashtra, Kerala) of India already
achieved the SDG target of MMR below 70 by 2030.
Maternal Mortality Ratio (MMR): The maternal mortality ratio (MMR) is defined as the number
of maternal deaths during a given time period per 100,000 live births during the same time period.
15
Maternal Health Chapter 3
The maternal mortality ratio should not be confused with the maternal mortality rate (whose
denominator is the number of women of reproductive age), which reflects not only the risk of
maternal death per pregnancy or birth but also the level of fertility in the population.
Table 3.1: Maternal Mortality Ratio (MMR), Maternal Mortality Rate; India, 2016-18
(Source: SRS 2016-18)
India & Major States Maternal Maternal Mortality Rate
Mortality Ratio
INDIA 113 7.3
Assam 215 14.0
Bihar 149 15.1
Jharkhand 71 5.6
Madhya Pradesh 173 15.9
Chhattisgarh 159 12.1
Odisha 150 9.7
Rajasthan 164 14.5
Uttar Pradesh 197 17.8
Uttarakhand 99 6.4
EAG AND ASSAM SUBTOTAL 161 13.2
Andhra Pradesh 65 3.6
Telangana 63 3.6
Karnataka 92 4.9
Kerala 43 2.1
Tamil Nadu 60 3.2
SOUTH SUBTOTAL 67 3.6
Gujarat 75 5.1
Haryana 91 7.0
Maharashtra 46 2.6
Punjab 129 7.0
West Bengal 98 5.0
Other states 85 4.5
OTHER SUBTOTAL 83 4.7
Actions that helped India achieve the lower rates of mortality
Four key actions responsible for India’s remarkable achievement are:
First, India has made a concerted push to increase access to quality maternal health services.
Since 2005, coverage of essential maternal health services has doubled, while the proportion of
institutional deliveries in public facilities have tripled, from 70.6% in 2008-09 to 94.5% in 2019-20
as per the HMIS Key Indicator report for 2008-09 and 2019-20) (including private facilities,
institutional deliveries).
16
Second, state-subsidized demand-side financing like the Janani Shishu Suraksha Karyakram –
which allows free to and fro transport and no-expense delivery, including caesarian section for all
pregnant women delivering in public health institutions – has largely closed the urban-rural divide
traditionally seen in institutional births. Overall, 99% of rural births are safe delivery, as compared
to 93% of urban deliveries.
Figure 3.1: Percentage of JSSK beneficiaries to Total Institutional Deliveries
Percentage of JSSK Beneficiaries to Total

Institutional Deliveries
63 65
39
24 24
No. of PW provided - No. of PW provided - No. of PW provided - No. of PW provided - No. of Pw provided -
Free Medicines Free Diet Free Diagnostics Free Home to facility Free Drop Back home
transport
Third, India has put significant emphasis on mitigating the social determinants of maternal
health. Women in India are more literate than ever, with 65.46% (Source: Census 2011) now able to
read and write. They are also entering marriage at an older age, the mean age of marriage is also
increased to 19.2 (Source: census 2011). The Census data also show that 91% of all married women
were married by the age of 25 years. These factors alone have enabled Indian women to better
control their reproductive lives and make decisions that reflect their own interests and wants.
Finally, the government has put in substantive efforts to facilitate positive engagement between
public and private health care providers. Campaigns such as the Pradhan Mantri Surakshit Matritva
Abhiyan have been introduced with great impact, allowing women’s easy access to antenatal check-
ups, obstetric gynecologists and to track high-risk pregnancies – exactly what is needed to make
further gains and achieve the SDG targets.
3.1 Ante Natal Care (ANC)

Antenatal Care is the healthcare received by a woman during pregnancy. Antenatal care starts
with ‘history-taking’ and is followed by examination of the woman, which basically includes:
recording weight and height, blood test for anaemia, blood pressure measurement, regular abdominal
examination etc. as per the ANM guidelines. The woman is advised for a proper diet, regular
antenatal check-ups, and counselled for family planning. She is also provided with TT
immunization, IFA, Calcium and Albendazole tablets along with provision of proper treatment for
any complication during this period.
Ideally, the mother should attend ANC clinic once a month during the first 7 months; twice a
month, during the next month; and thereafter, once a week, if everything goes normal. A high
proportion of mothers in India are from lower socio-economic group, and many of them are working
women. Attendance at the antenatal clinic may mean loss of daily wages. Consequently, it is
difficult for them to attend the antenatal clinic so often. In these cases, a minimum of 4 visits
covering the entire period of pregnancy should be the target, as shown below:
17
Goals
FIRST VISIT SECOND VISIT THIRD VISIT FOURTH VISIT
8-12 WEEKS 24-26 WEEKS 32 WEEKS 36-38 WEEKS
 Pregnancy  Assess maternal  Assess maternal  Assess maternal and
confirmation & fetal and fetal well-  fetal well- being.
 Calculation of wellbeing. being.  Exclude PIH,
estimated date of  Exclude PIH  Exclude PIH, anaemia, multiple
pregnancy. and anaemia. anaemia, multiple pregnancy,
 Classify women for Give preventive pregnancies. malpresentation.
basic ANC measures.  Give preventive  Give preventive
or more specialized  Review and measures. measures.
care. modify birth  Review and  Review and modify
 Screen treat & give and emergency modify birth and birth and emergency
preventive plan. emergency plan. plan.
services.  Advice and  Advise and  Advise and counsel.
 Birth & emergency counsel. counsel.
preparedness.
 Counselling
Activities
History Assess significant Assess significant Assess significant Assess significant
symptoms. Take symptoms. Check symptoms. Check symptoms. Check
psychosocial, medicalrecord for previous record for previous record for previous
and obstetric history.
complications and complications and complications and
Confirm pregnancy treatments during treatments during the treatments during the
and calculate EDD. the pregnancy. pregnancy. pregnancy.
Classify all women. Re-classification if Re-classification if Re-classification if
needed needed. needed
Examination Complete general, and Anemia, BP, fetal Anemia, BP, fetal Anemia, BP, fetal
obstetrical growth & growth, multiple growth, multiple
examination, BP. movements. pregnancy. pregnancy,
malpresentation.
Screening Haemoglobin Syphilis Bacteriuria Bacteriuria Bacteriuria
and tests HIV Proteinuria
Blood/Rh group,
Bacteriuria.
Treatment Syphilis AntiretroviralAntihelminthic, Antiretroviral if Antiretroviral if
if eligible Treat antiretroviral if eligible, Treat eligible, External
eligible, Treat
bacteriuria if indicated bacteriuria if Cephalic version or
bacteriuria if indicated. referral, Treat
indicated. bacteriuria if indicated.
Preventive Tetanus toxoid Iron Tetanus toxoid, Iron and folate Iron and folate
measures and folate Iron and folate
Health Self-care, alcohol and Birth and Birth and emergency Birth and emergency
education, tobacco use, nutrition, emergency plan, plan, infant feeding, plan, infant feeding,
advice, and safe sex, rest, reinforcement of postpartum/postnatal postpartum/postnatal
counselling birth and previous advice care, pregnancy care, pregnancy
emergency plan spacing, spacing, reinforcement
reinforcement of of previous advice.
previous advice
Source: The four-visit ANC model outlined in WHO clinical guidelines.
18
HMIS is capturing a series of data elements related to these aspects of reproductive health
including Ante Natal care, Intra Natal care and Post Natal care.
To assess the extent of provision of services in any area, one of the benchmarks is to asses it
against the Estimated/Expected beneficiaries. At National level, the total expected pregnant women
for the year 2019-20 was 29926000. The same is arrived at by using the following formula:
Estimated number of Pregnant Women = ((Mid-Year Population * CBR) * Wastage in
NFHS4))
Based on the data reported on HMIS portal by State/UTs, ANC Registration at National level
was 29022447 during 2019-20, which is around 97% of the estimated ANC.
18 States have performed above the National Average of 97% for ANC Registration with
Puducherry reporting the highest ANC registration over estimated pregnancies. Whereas 18 States
have reported values less than the National Average of 97%. Figure 3.2 shows States/UTs
performing below All India Average for Percentage ANC Registered to Estimated Pregnancies
2019-20.
Figure 3.2: Percentage ANC Registered to Estimated Pregnancies 2019-20
Percentage of ANC Registration to Estimated

pregnancy
(States performing below All India Average)
408.7
187.5
177.7
153.1
150.7
126.4
123.6
115.8
112.9
109.2
104.7
104.4
100.2
116
99.7
99.5
98.8
97.9
96.5
95.9
94.9
92.2
90.2
89.3
88.8
88.3
87.2
86.9
86.6
86.2
85.4
84.7
79.8
97
85
78
Goa
Delhi
A & N Islands
Punjab
Karnataka
Tamil Nadu
Chhattisgarh
Kerala
West Bengal
Manipur
Uttarakhand
Nagaland
All India
Uttar Pradesh
Arunachal Pradesh
Jharkhand
Bihar
Telangana
Chandigarh
Puducherry
Odisha
Sikkim
Assam
Haryana
Gujarat
Mizoram
Daman & Diu
Rajasthan
Maharashtra
Tripura
Jammu & Kashmir

Meghalaya
Lakshadweep
Himachal Pradesh
Andhra Pradesh
Madhya Pradesh
Out of these 18 states 11State/UTs have reported ANC Registration being below 90% of
Estimated Pregnancies.
3.2 1st Trimester Registration (1st ANC)

The first 12 weeks of pregnancy are considered as the first trimester. When a pregnant woman
registers herself with a health facility within first 12 weeks of her pregnancy for Ante Natal Care it is
considered as 1st Trimester Registration.
All pregnant women are recommended to go for their first antenatal check-up in the first
trimester to identify and manage any medical complication as well as to screen themselves for any
risk factors that may affect the progress and outcome of their pregnancy. The first visit is expected to
screen and treat anemia, syphilis and other risk factors and medical conditions that can be best dealt
during early pregnancy, and initiate prophylaxis, if required (e.g. for anemia and malaria) – is
recommended to be held by the end of fourth month.
19
As per data reported by State/UTs on HMIS Portal, among the total ANC registrations, around
72% of pregnant women registered within 1st Trimester of their pregnancy at National level. Figure
3.2 depicts Early Registration of Pregnant Women in Public, Private facilities and Rural, Urban
areas.
Fig 3.2: Percentage of Early Registration of Pregnant Women by Public & Private
and Rural & Urban during 2019-20
74
72
73
65
56
India Public Private Urban Rural
5 states like Nagaland, Meghalaya, Puducherry, Delhi, Arunachal Pradesh have reported less
than 50% 1st Trimester Registration out of total ANC registration as highligted below. Figure 3.3
depicts State/UT wise Percentage of 1st Trimester Registration within 4 Weeks Out of Total ANC
Registration
20
Fig 3.3: State/UT wise Percentage of 1st Trimester Registration within 4 Weeks Out of
Total ANC Registration
Dadra & Nagar Haveli 97

Tamil Nadu 93
Chhattisgarh 90
Assam 88
West Bengal 88
Himachal Pradesh 88
Odisha 87
Maharashtra 86
Gujarat 84
Daman & Diu 84
Lakshadweep 84
Kerala 83
Andhra Pradesh 81
Punjab 80
Karnataka 79
Sikkim 77
Haryana 76
Mizoram 75
Chandigarh 73
A & N Islands 72
All India 72
Telangana 71
Uttarakhand 71
Tripura 70
Rajasthan 70
Madhya Pradesh 70
Bihar 69
Jammu & Kashmir 67
Jharkhand 67
Manipur 59
Uttar Pradesh 58
Goa 58
Delhi 45
Arunachal Pradesh 37
Meghalaya 35
Puducherry 28
Nagaland 27
Based on the data reported on HMIS during 2019-20, it is observed that most of the low
performing State/UTs in terms of % 1st Trimester registration are the ones who have reported total
ANC Registration higher than the estimated pregnancies in the State/UT as shown in Figure 3.3.
21
3.3 Pregnant Women having Received 4 ANC Check-ups
There is a wide variation in percentage of pregnant women who received 4 ANC Checkups to
total ANC Registration with a few States reporting very high figures of more than 100% (Daman &
Diu & Chandigarh) and Meghalaya, Puducherry, Arunachal Pradesh, Nagaland reporting less than
50% pregnant women receiving 4 ANC checkups.
Table 3.2: State/UT wise Percentage of Pregnant Women Who Received 4 ANC Check-ups to
Total ANC Registrations in 2019-20
State/UT Percentage of Pregnant State/UT Percentage of Pregnant

Women Received 4 ANC Women Received 4 ANC
check-ups to Total ANC check-ups to Total ANC
Registrations Registrations
Daman & Diu 126 Jharkhand 78
Chandigarh 106 Himachal Pradesh 78
Kerala 99 Haryana 77
Andhra 99 Goa 77
Pradesh
Karnataka 97 Uttar Pradesh 76
Maharashtra 95 Uttarakhand 73
Chhattisgarh 94 Bihar 70
Lakshadweep 90 Tripura 69
Tamil Nadu 88 Sikkim 67
Gujarat 87 A & N Islands 67
Assam 85 Rajasthan 61
Telangana 84 Mizoram 57
Dadra & 82 Delhi 57

Nagar Haveli
Odisha 82 Manipur 55
West Bengal 82 Meghalaya 49
Punjab 82 Puducherry 44
All India 79 Arunachal Pradesh 36
Jammu & 79 Nagaland 23

Kashmir
22
3.4 (A) Maternal Immunization against Tetanus
All women giving birth and their newborn babies should be protected against tetanus. If the
mother is not immunized with the correct number of doses of tetanus toxoid vaccine, neither she nor
her newborn infant is protected against tetanus at the time of delivery.
Fig 3.4: All India Maternal Immunization against tetanus (%) Out of Total ANC Registration
3.4 (B) Maternal Anemia

It is one of the important factor associated with a number of maternal and foetal complications. It
decreases the women’s reserve to tolerate bleeding either during or after child birth and makes her
prone to infections. Anemia during pregnancy also has been associated with increased risk of intra
uterine growth restriction, premature delivery, low birth weight (LBW) and maternal and child
mortality.
Hemoglobin estimation is one of the essential component of ANC. In India 84 % of
pregnant women have been tested for Haemoglobin, four or more than four times during the
ANC period.
Fig 3.5: Maternal Anemia percentage to ANC Registration
• PW having Hb level<11
72% (tested cases0 (7.1 to 10.9)
• PW having Hb level<7
4% (tested cases)
3.4 (C) Maternal Hypertension

Hypertension is the most common medical disorder encountered during pregnancy. Hypertensive
disorders are one of the major causes of pregnancy-related maternal deaths. Hypertension in
pregnancy is defined as a blood pressure systolic of 140 mm Hg or greater or a diastolic of 90 mm Hg
or greater. Out of total registered pregnancy 2.1% of pregnant women detected hypertension during
their ANC visit
23
Fig 3.6: Maternal hypertension percentage to ANC Registration
(Source: HMIS, Data Item Wise report 19-20)
12 % eclampsia cases
managed during
delivery to
72% hypertension Hypertension detected
2% Hypertension cases managed at during pregnancy
detected during ANC institution to new
to total registered case detected during
ANC ANC
3.4 (D) Gestational Diabetes mellitus (GDM)

Gestational diabetes mellitus (GDM) is a special form of diabetes in women of child-bearing age
and is a common gestational endocrine disease. Due to its increasing prevalence, GDM results in
significant short- and long-term impairments in the individual’s health and their offspring’s health.
GDM is operationally defined as impaired glucose tolerance with onset or first recognition
during pregnancy. Its diagnosis is based on single-step procedure. In accordance to World Health
Organization recommendations, the guideline endorses 2-h 75-g OGTT, irrespective of last meal
timings with a cutoff value of ≥140 mg/dL using a plasma-standardized glucometer.
Fig 3.7: Gestational diabetes mellitus (GDM)- percentage to ANC Reg
3% 21.5%
16 % PW tested PW given
PW tested for positive for insulin out
OGTT to ANC GDM to total of total
registered tested for tested
OGTT positive
3.5 Deliveries
Childbirth, also known as labour or delivery, is the ending of pregnancy where one or more
babies leaves the uterus by passing through the vagina or by Caesarean section. The most common
way of childbirth is a vaginal delivery.
Availability of Skilled birth attendant (SBA) at delivery is an important factor in order to reduce
the maternal mortality. In addition to professional attention, it is important that a mother delivers her
baby(ies) in an appropriate setting, where avalability of life saving equipment and hygienic
conditions help reduce the risk of complications that may cause death or illness to mother and child.
Over the past decade, interest has grown in examining influences on care-seeking behavior and this
study investigates the determinants of place of delivery in rural India, with a particular focus on
assessing the relative importance of community access and economic status. The aim of the
government is to ensure 100% institutional deliveries or in case of emergencies atleast birth /
delivery is to be attended by SBA.
24
A home birth is a birth that takes place in a residence rather than in a hospital or a birthing
center. They may be attended by a midwife, or by someone with experience in managing home
births. Home birth was, until the advent of modern medicine, the de facto method of delivery.
SBA Skilled Birth Attendant, is a health professional who provides basic and emergency care
to women and their newborns during pregnancy, childbirth and the postpartum period. A birth
attendant, who may be a midwife/a physician/an obstetrician/a nurse, is trained to be present at
("attend") childbirth, whether the delivery takes place in a health care institution or at home.
Non SBA/Traditional Birth Attendant, also known as a traditional midwife, is a person who
provide basic pregnancy and birthing care and advice primarily based on experience and knowledge
acquired informally through the traditions and practices of the communities where they are
originated from. They usually have no modern health care training and are not typically subject to
professional regulation. As per the data reported on HMIS, maximum number of Home Deliveries
attended by Non-SBA trained was reported by Uttar Pradesh (493577) followed by Bihar (319701)
and
The seggregation of delivery by Place of delivery and attendant as per the data reported on
HMIS Portal by States/ UTs reveals that maximum deliveries are taking place at Institution (94%)
rest 6% deliveries taking place at Home out of which 5% deliveries are attended by Non Skilled
Birth Attendant and 1% deliveries are attended by Skilled Birth Attendant. Figure 3.8 depicts the
percentage share of categories of Delivery by Place and Attendant
Fig 3.8: Percentage Share of Categories of Delivery by Place
During/Attendant during 2019-20
Delivery- By Place of Delivery/ Attendant

Home Deliveries
Home Deliveries
attended by Skill Birth
attended by Non SBA
Attendant(SBA)
(Trained Birth
(Doctor/Nurse/ANM)
Attendant(TBA)
1%
/Relatives/etc.)
5%
Institutional Deliveries
conducted (Including
C-Sections)
94%
During 2019-20, Out of total 6% Home Deliveries, At National level 5% deliveries are attended
by Non Trained SBA and 1% by Skilled Birth Attendant.
12 States are reporting Non SBA Trained Home Deliveries above the National Average of 5%,
with Meghalaya reporting the highest i.e. 39%, followed by Bihar(12%) and Uttar Pradesh (10%),
rest of the states Mizoram, Uttrakhand, Nagaland, Manipur, Arunachal Pradesh, Tripura, assam,
Himcahla Pradesh and Jammu & Kashmir reporting less than 10% but above national average of
6%.
25
Fig 3.9: Percentage Home Deliveries by Non SBA during 2019-20
for states reporting above national average
% Home Deliveries by Non SBA

(States reporting above National average)
40
35
30
25
20 39
15
10
12 10 9 8
5 8 7 7 6 6 6 5 5
0
10 States have reported less than national average whereas, 14 States are reporting negligible
home deliveries by Non SBA
Fig 3.10: Percentage Home Deliveries by Non SBA during 2019-20
for states reporting below national average
% Home Deliveries by Non SBA

(States reporting below National average)
5
5
4
4
3
3 5
2 4 4 4
2 2
1 2 1 1
1 1 1 1
0
Type of Delivery
Normal/Vaginal delivery is the most common type of birth. Whenever necessary, assisted
delivery methods are needed. While labor can be a straightforward and uncomplicated process, it
requires the assistance of the medical staff. This assistance can vary from use of medicines to
emergency delivery procedures.
In HMIS, two types of deliveries are captured viz. Normal Delivery and C-section Delivery. At
National Level, based on the type of the delivery, 21% deliveries are reportedly being conducted
thorugh C-section, rest 79% are Normal Deliveries.
26
Figure 3.11: Percentage Share of Types of Delivery during 2019-20
Delivery- By Type
C -Section
deliveries
21%
Normal Deliveries
79%
Among the total c-section deliveries, both public and private are contributing almost equally, C-
section deliveries at private institutions being 53% whereas C-section deliveries at public institutions
is 47%.
Figure 3.12: Percentage Share of C-section Deliveries by (public & private) during 2019-20
C-section Deliveries - By type of Institution
Public
Private 47%
53%
However, for Vaginal Delivery 73% are happening in Public Institutions, 27% are happening in
Private institutions
27
Figure 3.13: Percentage Share of Normal Vaginal Deliveries by
(public & private) during 2019-20
Vaginal Delivery- By Type of Institution
Private
27%
Public
73%
A very high % of C-section to Institutional Deliveries has been reported by Tripura which is
around 97.94%, follwed by Jammu & Kashmir and west Bengal which have reported higher than
80% C-section rate. 30 states have reported more than 20% C-section rate at private facilities, only 6
have reported below 20%.
Table 3.3: State/UT wise Percentage of Private C-section deliveries
Private C-Section Rate
State/UT Total Institutional C-Section % C-section
Deliveries Deliveries Deliveries
Tripura 4570 4476 97.94
Jammu & Kashmir 16007 14310 89.40
West Bengal 248574 198373 79.80
Assam 90687 59727 65.86
Odisha 113182 68609 60.62
Goa 7717 4618 59.84
Delhi 52438 31152 59.41
Sikkim 1843 1038 56.32
Manipur 7316 4030 55.08
Dadra & Nagar Haveli 1066 583 54.69
Telangana 325090 174556 53.69
Tamil Nadu 430857 224752 52.16
Punjab 186745 93891 50.28
Puducherry 9910 4845 48.89
Himachal Pradesh 13996 6669 47.65
Chhattisgarh 112811 51277 45.45
28
Private C-Section Rate
State/UT Total Institutional C-Section % C-section
Madhya Pradesh 144927 63431 43.77
Meghalaya 12724 5484 43.10
Arunachal Pradesh 2652 1132 42.68
Karnataka 349054 145624 41.72
Kerala 314209 130903 41.66
Nagaland 3954 1559 39.43
Lakshadweep 869 342 39.36
Andhra Pradesh 427704 161475 37.75
Mizoram 3739 1282 34.29
All India 6484828 2216737 34.18
Daman & Diu 587 200 34.07
Chandigarh 28106 9489 33.76
A & N Islands 3537 1031 29.15
Haryana 204694 54798 26.77
Maharashtra 910695 240401 26.40
Gujarat 706553 146719 20.77
Rajasthan 324899 64184 19.76
Jharkhand 183567 35865 19.54
Uttar Pradesh 1008443 194155 19.25
Uttarakhand 45153 7985 17.68
Bihar 218465 18634 8.53
In regard to public facilities Maximum C-section Rate has been reported by Telangana i.e
43.66%, followed by Lakshadweep and Jammu & Kashmir which are reporting 40% C-section rate.
19 states have reported more than 20% C-section rate whereas rest 17 have reported below 20%
Table 3.4: State/UT wise Percentage of Public C-section deliveries
Public C-section Rate
State/ UT Total Institutional C-Section % C-section
Telangana 295575 129054 43.66
Jammu & Kashmir 166858 65147 39.04
Kerala 146174 56894 38.92
Tamil Nadu 511806 193210 37.75
Sikkim 5222 1900 36.38
Chandigarh 28106 9489 33.76
29
Public C-section Rate
State/ UT Total Institutional C-Section % C-section
Daman & Diu 3460 1126 32.54
Andhra Pradesh 304544 96714 31.76
Goa 10702 3351 31.31
A & N Islands 3537 1031 29.15
Punjab 186942 53010 28.36
Manipur 25935 7007 27.02
Puducherry 33265 8914 26.80
Karnataka 550949 144257 26.18
Delhi 222723 57127 25.65
West Bengal 999986 253199 25.32
Maharashtra 876508 185891 21.21
Tripura 44334 8670 19.56
Assam 463880 70844 15.27
Odisha 510738 76036 14.89
Mizoram 14753 2165 14.67
All India 13742236 1935598 14.09
Gujarat 439315 60576 13.79
Uttarakhand 90453 12209 13.50
Haryana 288509 38342 13.29
Nagaland 13158 1638 12.45
Rajasthan 1028018 102813 10.00
Meghalaya 41284 2969 7.19
Madhya Pradesh 1207305 83997 6.96
Chhattisgarh 364192 21632 5.94
Uttar Pradesh 2596990 114865 4.42
Jharkhand 520283 22822 4.39
Bihar 1653275 30282 1.83
If we compare c-section rate for Urban and Rural areas it is evident that a higher C-section rate is
reported in Urban Areas 35.30% as compared to 15.42% in Rural Areas
Whereas for C-sections at Public and private insitutions highre C-section rate is reported at
private facilities as compared to Public facilities.
30
Table 3.5: State/UT wise Percentage of C-section deliveries Rural & Urban, Public & Private
C-Section Rate
Total Institutional C-Section Deliveries % C-section Deliveries
Deliveries
Rural 15030284 2317612 15.42
Urban 5196780 1834723 35.30
Public 13742236 1935598 14.09
Private 6484828 2216737 34.18
3.6 Abortion/Medical Termination of Pregnancy

Abortion is the ending of a pregnancy by removal or expulsion of an embryo or fetus before it
can survive outside the uterus.
An abortion that occurs without intervention is known as a Miscarriage or a Spontaneous
Abortion.
When deliberate steps are taken to end a pregnancy, it is called an Induced Abortion or Medical
Termination of Pregnancy.
Based on the data reported on HMIS portal during 2019-20, the abortion rate i.e Number of
Spontaneous Abortion to Total ANC Registration is 2.05%.
Table 3.6: State/UT wise Percentage of C-section deliveries Rural & Urban, Public & Private
Total ANC 29022447
Abortion (spontaneous) 595593
% Abortion 2.05
MTP 715087
% MTP + Abortion 4.52
Whereas, total Spontaneous and induced abortion amount to 4.52% of Total ANC Regsitration.
27 states have reported above National Level, out of which 13 states have reported above 2% and
less than 3%.
Figure 3.14 : Percentage Abortion to Total ANC, States Reporting above National Level
% Abortion to Total ANC

(States reporting above National Level)
9.00
8.00
7.00
6.00
5.00
4.00 2.05
3.00
2.00
1.00
0.00
Dadra & Nagar…
Mizoram
Manipur
Karnataka
Kerala
Maharashtra
Chandigarh
All India
Daman & Diu
Tamil Nadu
Delhi
Madhya Pradesh
Assam
Goa
Jammu & Kashmir
Tripura
Odisha
Himachal Pradesh
Chhattisgarh
Sikkim
Meghalaya
Haryana
Lakshadweep
Rajasthan
A & N Islands
Jharkhand
West Bengal
Punjab
31
Figure 3.15: Percentage Abortion to Total ANC, States Reporting below National Level
% Abortion to Total ANC

(States reporting below National Level)
2.50 2.05
2.00
1.50
1.00
0.50 0.12
0.00
Figure 3.16: Percentage % Abortion and % MTP + Abortion to Total ANC,

States Reporting above National Level
% Abortion and % MTP + Abortion to Total ANC

20.00
(States reporting above National Level)
15.00
10.00
5.00
0.00
JAMMU &…
DADRA & NAGAR…
HIMACHAL…
DELHI
KERALA
ODISHA
MEGHALAYA
TRIPURA
DAMAN & DIU
GOA
MAHARASHTRA
PUNJAB
MIZORAM
HARYANA
LAKSHADWEEP
SIKKIM
RAJASTHAN
CHHATTISGARH
CHANDIGARH
A & N ISLANDS
JHARKHAND
MANIPUR
KARNATAKA
ALL INDIA
WEST BENGAL
ASSAM
TAMIL NADU
MADHYA PRADESH
% Abortion % MTP + Abortion
Abortion/MTP to Total ANC Registrations

In 2019-20, a total of 1310680 pregnancies were terminated at National level with Abortion or
MTP (at Public as well as Private Institutions) which accounts for 4.52% of total ANC Registrations
in 2019-20.
32
Figure 3.17 : %age Abortion (MTP + Abortion) to Total ANC
Bihar
Telangana
Uttar Pradesh
Andhra Pradesh
Puducherry
Jharkhand
Gujarat
Meghalaya
Uttarakhand
Sikkim
Jammu & Kashmir
Nagaland
Madhya Pradesh
Kerala
All India 4.52
Rajasthan
Tripura
Karnataka
Lakshadweep
Chhattisgarh
Mizoram
Delhi
Goa
A & N Islands
West Bengal
Chandigarh
Arunachal Pradesh
Odisha
Manipur
Haryana
Maharashtra
Himachal Pradesh
Daman & Diu
Punjab
Tamil Nadu
Dadra & Nagar Haveli
Assam
0.00 2.00 4.00 6.00 8.00 10.00 12.00 14.00 16.00 18.00 20.00
33
MTP After 12 Weeks of Pregnancy
By gestational age the MTPs may be classified as MTP conducted before 12 weeks of pregnancy
and MTP conducted after 12 weeks of pregnancy. 93% of MTPs have been reported to be conducted
with 12 weeks of pregnancy and only 7% of MTPs have been reported to be conducted after 12
weeks of pregnancy.
Figure 3.18: Breakup of MTP by Gestational Age
MTP- By Gestational Age

% MTP more
than 12 weeks
of pregnancy,
6.92
% MTP up to
12 weeks of
pregnancy,
93.08
Medical Termination of Pregnancy (MTP) after 12 weeks of pregnancy is considered to be

serious and complicated. It may also be linked to sex determination hence it is specially monitored.
In 2019-20, a total of 49450 MTP after 12 weeks of pregnancy were reported in HMIS portal by
States/UTs which is 93% of total MTPs.
At national level if we compare MTP more than 12 weeks with Total MTPs 7 % MTPs have
been conducted after 12 weeks of pregnancy.
Mizoram has reported highest figure which is 40% (MTP less than 12 weeks:121; MTP less than
12 weeks:79), followed by Telangana which has reported (30% MTP more than 12 weeks.
Figure 3.19: Percentage MTP more than 12 weeks of pregnancy depicting states reporting
above national average.
%age MTP more than 12 weeks of pregnancy

(States reporting above national average)
45.00 39.50
40.00
35.00 29.94
30.00
25.00
20.00
15.00
10.00 6.92
5.00
0.00
34
Figure 3.20 : Percentage MTP more than 12 weeks of pregnancy depicting states reporting
below national average.
%age MTP more than 12 weeks of pregnancy

(States reporting below national average)
8.00 6.92
7.00
6.00
5.00
4.00
3.00
2.00 0.98
1.00 0.23
0.00
Three UTs (Daman & Diu, Dadar & Nagar Haveli and Lakshadweep) have reported less than 1%
MTP More than 12 weeks
3.7 Post Natal Care (PNC)

The postnatal period can be defined as the first 6-8 weeks after birth. Postnatal care should be a
continuation of the care a woman has received through her pregnancy, labour and birth and takes
into account the woman’s individual needs and preferences. In HMIS, data for post natal check ups
given to the newly delivered mothers are categorised as first post partum checkup within first 48
hours and within 48 hours to 14 days.
At National level, 66% of Post Natal Mothers out of the Total Deliveries have been provided
with first Post Natal Checkup either within first 48 hours or within 48 hours to 14 days. 18 states
have reported above this national value of 66% and an equal number i.e. 18 states have reported
below this value.
Kerala and Himachal Pradesh are reporting cent percent 1st Post Natal checkup to all the
mothers, whereas Tamil Nadu is reporting the least.
5 states have reported 1st Post Natal checkup for mothers between 0-25%. 3 States have reported
between 26-50%, 15 states have reported between 51-75% and 14 states have reported above 76%.
Table 3.6: Categorization of %age 1st Post natal checkup to Total Deliveries
Number of
% States
0-25 5
26-50 3
51-75 15
76-100 14
35
Figure 3.20 : Percentage Women receieving 1st Post Partum Checkup to
Total Deliveries State/ UT wise
%age Women receiving 1st post partum checkup
Tamil Nadu 2.51

Rajasthan 10.88
Madhya Pradesh 14.89
Chandigarh 15.18
Mizoram 20.96
Puducherry 28.98
Telangana 33.42
Bihar 51.26
Manipur 51.91
Nagaland 52.31
Delhi 53.98
Daman & Diu 54.32
Jharkhand 57.61
Maharashtra 61.67
Uttarakhand 63.45
Haryana 64.77
All India 66.22
Chhattisgarh 68.09
Meghalaya 68.81
Tripura 72.60
Andhra Pradesh 76.29
Gujarat 78.97
Goa 81.90
Sikkim 83.65
Lakshadweep 84.94
A & N Islands 87.87
West Bengal 88.59
Punjab 89.74
Karnataka 95.21
Assam 97.16
Odisha 98.31
Uttar Pradesh 98.75
Kerala 100.00
0.00 20.00 40.00 60.00 80.00 100.00 120.00
36
If Post Partum are reviewed keeping in mind the time of checkups, Maximum checkups are
being provided between 48 hours and 14 days.
Figure 3.21 : Share of 1st Post Partum Checkup- By time
1st Post Partum Checkup

Within 48 hours
of home delivery
19%
Between 48
hours and 14
days
81%
Post Natal IFA Tablets and 360 Calcium tablets

At all India Level 60 % Mothers out of the Total Deliveries conducted were provided 180 IFA
tablets in the PNC Period and 56% mothers have been provided with 360 Calcium tablets in the
PNC period. A&N Islands is reporting the highest figure for both these indicators.
Table 3.7: %age Mothers provide full course of 180 IFA and 360 Calcium tablets
States/ UT Total Deliveries %age Mothers %age Mothers
provided full course provided 360
of 180 IFA tablets Calcium tablets
All India 21410780 after delivery
60.11 after delivery
55.07
A & N Islands 3602 122.52 117.18
Andhra Pradesh 734645 48.91 41.91
Arunachal Pradesh 20832 31.13 26.99
Assam 608156 102.49 98.33
Bihar 2207610 47.83 37.46
Chandigarh 28143 83.41 85.17
Chhattisgarh 485292 77.99 66.38
Dadra & Nagar Haveli 9577 66.32 65.54
Daman & Diu 4048 48.20 47.75
Delhi 286281 51.75 50.96
Goa 18434 97.09 96.60
Gujarat 1151437 82.24 80.57
Haryana 514301 42.49 42.81
Himachal Pradesh 88701 90.65 86.82
37
States/ UT Total Deliveries %age Mothers %age Mothers
provided full course provided 360
of 180 IFA tablets Calcium tablets
Jammu & Kashmir 193368 after delivery
88.63 after delivery
36.50
Jharkhand 733372 62.73 56.42
Karnataka 900933 79.23 76.20
Kerala 460850 45.27 35.99
Lakshadweep 870 71.61 67.93
Madhya Pradesh 1412758 73.41 71.27
Maharashtra 1798428 70.50 69.46
Manipur 39373 36.77 26.21
Meghalaya 90491 50.56 47.59
Mizoram 20728 16.20 15.28
Nagaland 20774 18.35 14.60
Odisha 641324 65.73 50.44
Puducherry 43178 26.76 23.34
Punjab 379150 48.84 41.43
Rajasthan 1376805 36.75 59.03
Sikkim 7111 66.60 76.68
Tamil Nadu 942869 40.55 38.32
Telangana 621253 45.45 47.18
Tripura 52158 17.69 17.26
Uttar Pradesh 4095081 53.50 46.37
Uttarakhand 152648 68.63 38.14
West Bengal 1266199 76.83 57.04
38
Chapter 4 Child Health
CHAPTER 4
CHILD HEALTH
The child health programme under the National Health Mission (NHM) comprehensively
integrates interventions that improve child survival and addresses factors contributing to infant and
under-five mortality. It is now well recognized that child survival cannot be addressed in isolation as
it is intricately linked to the health of the mother, which is further determined by her health and
development as an adolescent. Therefore, the concept of Continuum of Care, that emphasizes on
care during critical life stages in order to improve child survival, is being followed under the
national programme.
Continuum of Care is a multi-dimensional approach which ensures that critical services are
made available at home as Home Based Newborn Care (HBNC), through community outreach and
through health facilities at various levels (primary, first referral units, tertiary health care facilities),
interventions including Sick Newborn Care Units (SNCUs), Nutritional Rehabilitation Centre
(NRC), Rashtriya Bal Swasthya Karyakarm (RBSK) which improve child survival and addresses
factors contributing to infant and under-five mortality.
The Sustainable Development Goals (2016-2030) and New National Health Policy 2017 have
laid down the goals for Child Health. Table 4.1 presents the current situation of measurable indicator
of Child Health, Child Health Goals under National Health Policy (NHP) 2025 and Sustainable
Development Goals (SDG) 2030.
Table 4.1 Child Health Goals under NHP-2017 and SDG-2030
Current Status
Child Health Indicator NHP 2017 SDG 2030
(SRS 2018)
Neonatal Mortality rate 23 16 BY 2025 <12
Infant Mortality Rate 32 28 BY 2019 ----
Under 5 Mortality Rate 36 23 BY 2025 < 25
Source: Sample Registration System 2018
4.1 Trends of Child Health Indicators

4.1.1 Infant Mortality Rate:
Infant Mortality Rate (IMR) is defined as number of deaths of children in the age 0-1 years per
1000 live births. Around 24% decline in Infant Mortality Rate is observed in India during 2012 to
2018.
As per the Sample Registration System 2018, the IMR at all India level is 32 per 1000 live births
in 2018. The trend of Infant mortality at all India level is provided in Figure 4.1
39
Child Health Chapter 4
Fig 4.1: Trend of Infant Mortality Rate from 2012 to 2018 at All India Level
45 42
39
40 34
32
35
30
25
20
15
10
5
0
2012 2014 2016 2018
Source: Sample Registration System

4.1.2 Neo-natal Mortality Rate:
Neo-natal Mortality Rate (NMR) is defined as number of deaths of children during the period of
0-28 days per 1000 live births. NMR stands 23 per 1000 live births in India in 2018. Around 21%
decline in Neo-natal Mortality Rate has been observed in India during 2012 to 2018.
The trend of Neo-natal Mortality Rate at all India level is provided in Figure 4.2
Fig 4.2: Trend of Neo-natal Mortality Rate 2012 to 2018 at All India Level
35
29
30 26
24 23
25
20
15
10
5
0
2012 2014 2016 2018
Source: Sample Registration System

4.1.3 Under-five Mortality Rate
Under-five mortality is defined number of deaths of children in the age 0-5 years per 1000 live
births. As per the Sample Registration System 2018, the under five-mortality rate is 36 per 1000 live
births in 2018. Around 31% decline in Under-five mortality Rate observed in India during 2012 to
2018.
The trend of Under-five Mortality Rate at all India level is provided in Figure 4.3.
40
Fig 4.3: Trend of Under-five Mortality Rate 2012 to 2018 at All India Level
60
52
50 45
39
40 36
30
20
10
0
2012 2014 2016 2018
Health Management information System (HMIS) collects data on around 100 data elements
related to Child health. They are covered under various programs sub components like Pregnancy
Outcomes, Home Based New Born Care (HBNC), Sick Newborn Care Units (SNCUs), Rashtriya
Bal Swasthya Karyakarm (RBSK), Nutrition Rehabilitation Centre (NRC), Janani Shishu Suraksha
Karyakram (JSSK), Weekly Iron folic acid (WIFS) Junior, Childhood Diseases and Death.
The performance of various Child health interventions as reported in HMIS during 2019-20 is
given as follows:
4.2 Facility Based Newborn Care (FBNC)

Facility Based Newborn Care is one of the key components to improve the status of newborn
health.
The various components of FBNC are following:
i. Newborn Care Corners (NBCCs) are established at delivery points to provide essential
newborn care at birth soon after delivery. It is a dedicated space within the delivery room
where essential care as well as lifesaving care including resuscitation is provided to the
newborn.
ii. Newborn Stabilization Units (NBSUs) are located within or in close proximity to the
maternity ward where sick and low birth weight newborns are cared for short periods.
iii. Special Newborn Care Units (SNCUs) is a neonatal unit in the vicinity of the labor room to
provide special care (all care except assisted ventilation and major surgery) to the sick
newborns.
4.2.1 Newborn Stabilization Units (NBSUs):
Immediate care is given to the newborn in Peripheral Health Centre through Newborn Care
Corner (NBCC) and Newborn Stabilization Unit (NBSU) for all newborns. NBSUs expand the reach
of special newborn care within a district and beyond the district hospital. It is envisaged that, if
NBSU are properly linked to SNCU and then it reduces delay in initiation of appropriate care (due to
delay in reaching SNCU from a distant area) for sick newborns and improves outcomes in
stabilizing sick newborns. Further, referral to higher Centre prevent overloading of SNCUs at the
district hospital and reduces the cost of care.
41
As per HMIS data of 2019-20, at all India level around 3 per cent NBSU admission to total live
birth and around 4 per cent NBSU admission to total live birth in public health facilities were
observed. In total, Four State/UTs (Dadra & Nagar Haveli, A & N Islands, Daman & Diu and
Himachal Pradesh) have reported more than 10 percent NBSU admission out of total live birth.
Among the Public Health facilities, there are 7 States/UTs (Dadra & Nagar Haveli, A & N Islands,
Daman & Diu, Himachal Pradesh, Kerala, Andhra Pradesh and Telangana) have reported more than
10 per cent NBSU admission out of total live birth reported in the public health facilities. Percentage
of NBSU admission to total live births as reported in HMIS is given below Fig 4.4.
Fig 4.4 States/UTs -wise % NBSU admission out of total live birth reported in
HMIS during 2019-20
Jharkhand 0.5
1.1
Odisha 1.1
1.2
Uttar Pradesh 1.4
1.5
Madhya Pradesh 1.8
1.9
Manipur 1.9
2.1
2.9
Maharashtra 2.9
3.0
Mizoram 3.0
3.1
Punjab 3.3
3.3
Gujarat 3.6
3.7
Uttarakhand 4.2
4.2
Lakshadweep 4.9
5.1
Karnataka 5.4
5.5
Meghalaya 5.5
5.7
Telangana 5.8
5.9
Jammu & Kashmir 6.0
7.1
Chandigarh 8.6
13.0
Daman & Diu 19.4
33.4
0.0 5.0 10.0 15.0 20.0 25.0 30.0 35.0 40.0
The details of States/UTs wise number of Live births, NBSU admission as reported in HMIS
during 2019-20 is provided at Annexure-4.1
42
4.2.2 Special Newborn Care Unit (SNCU)
Special Newborn Care Units (SNCUs) have also been set up at both district level and tertiary
care hospitals. In this context, facility-based newborn care in Special Newborn Care Units (SNCUs)
at Medical Colleges and District Hospitals level institutions have been set up to improve the
newborn health within first week of their survival which is considered to be the most crucial period
of newborns’ life. SNCU is a neonatal unit in the vicinity of labor room which provides special care
(all care except assisted ventilation care and major surgery) for sick newborns.
i. Admissions at SNCUs – Newborns are admitted at the SNCU unit in the district hospital,
Sub-district hospital and Medical College for the special newborn care including prevention
of infection, hypothermia, refusal of breastfeeding, resuscitation, management of low birth
weight and referral services etc.
There were a total of 13,12,730 newborns admitted in the SNCU unit and a total live births
of 1,48,51,142 during 2019-20.
Of the total SNCU admissions, 12,69,294 were admitted at public health facilities which was
around 8.5% of total live births (1,48,51,142) reported at public health facilities.
Out of total 12.69 lakhs newborns admission in public health facilities, 4.85 lakhs were out-
born (who were born outside the hospitals) which is around 38.2% of total admissions and
rest were inborn (those who were born inside the hospital).
Total SNCU Admission to live births was 6.2 percent at all India level. The top 11
States/UTs with highest (>10%) percentage SNCU admission to total live births were A & N
Islands, Dadra & Nagar Haveli, Delhi, Daman & Diu, Jammu & Kashmir, Himachal
Pradesh, Tamil Nadu, Puducherry, Goa, West Bengal and Odisha. While bottom (<=5.5%)
eleven States/UTs with percentage SNCU admission to total live births Chandigarh,
Chhattisgarh, Maharashtra, Sikkim, Manipur, Gujarat, Uttarakhand, Uttar Pradesh,
Arunachal Pradesh, Bihar and Jharkhand.
One of the key components of the National Health Mission is to provide every village in the
country with a trained female community health worker– an ASHA (Accredited Social
Health Activist). An ASHA is a key pillar of NHM who works at the community level to
provide the outreach health care services and motivate the beneficiaries to avail the health
care services in the nearby facilities.
As per reported data in HMIS during 2019-20, overall 5.3 per cent of SNCU admissions
were referred by ASHA. There are 4 States (Odisha, Uttar Pradesh, Gujarat, Chhattisgarh
and Jharkhand) where more than 10 per cent SNCU admission were referred by ASHA. The
details of States where more than 1 per cent of SNCU admissions were referred by ASHA is
provided in Fig 4.5.
Fig 4.5: States/UTs with more than 1 % SNCU admission referred by ASHA reported in
HMIS during 2019-20
43
ii. Deaths at SNCUs –There were 90,979 deaths at SNCU reported in HMIS among the SNCU
admission at all India level which was around 6.9 percent to total SNCU admission
(13,12,730). 13 States/UTs have reported more than national average of 6.9 percent deaths
among SNCU admission. These States/UTs are Madhya Pradesh, Chhattisgarh, Bihar,
Assam, Rajasthan, West Bengal, Gujarat, Tripura, Odisha, Arunachal Pradesh, Meghalaya,
Puducherry and Andhra Pradesh.
Comparative percentage of total SNCU Admission to live births and percentage of deaths
(>5%) to SNCU admission during 2019-20 in States/UTs is provided in Figure 4.6.
Figure 4.6: Comparative percentage of total SNCU Admission to live births and percentage of
deaths (>5%) to SNCU admission during 2019-20 in States/UTs
The percentage deaths among SNCU admission has been categorized into five groups. There are
as follows: <2 %, 2-5%, >5-8%, >8-10% and >10%. Accordingly, it was observed that Madhya
Pradesh and Chhattisgarh are categorized under category 5 with more than 10% of SNCUs death.
The State/UTs falling under different category is provided table 4.2.
Table 4.2 Percentage of SNCU death to SNCU admission in States/UTs during 2019-20
Category % SNCU Death States/UTs
Category 1 <2% Haryana, Lakshadweep, Punjab, Kerala
Goa, Jammu & Kashmir, Jharkhand, Telangana, Manipur,

Category 2 2-5% Delhi, Himachal Pradesh, A & N Islands, Daman & Diu,
Sikkim, Chandigarh, Mizoram
Tripura, Odisha, Arunachal Pradesh, Meghalaya,

Puducherry, Andhra Pradesh, Nagaland, Maharashtra,
Category 3 >5-8%
Dadra & Nagar Haveli, Uttarakhand, Karnataka, Uttar
Pradesh, Tamil Nadu
Category 4 >8-10% Assam, Rajasthan, West Bengal, Gujarat
Category 5 >10% Bihar, Madhya Pradesh, Chhattisgarh
The details of States/UTs wise number of Live births, SNCU admission, SNCU admission
referred by ASHA, SNCU death as reported in HMIS during 2019-20 is provided at Annexure-4.2
44
4.3 Home Based Newborn Care (HBNC)
The strategy of home-based newborn care is to compliment the strategy of institutional delivery
as well as home delivery within 42 days of newborns life in order to reduce the post-partum and
neonatal morbidity and mortality. For that purpose, seven visits by an Accredited Social Health
Activist (ASHA) in case of a home delivery (on Day 1, 3, 7, 14, 21, 28, and 42) are necessary and in
case of an institutional delivery, where a mother returns after 48 hours from the institution, an
ASHA is supposed to complete six visits to the new born (on Day 3, 7, 14, 21, 28 and 42) for HBNC
within 42 days of birth. Under National Health Mission, Home-Based Care for Young Child
Programme (HBYC) was rolled out in 2018 as an extension of the Home Based New Born Care
programme (HBNC) which includes additional home visits by ASHAs in undertaking activities for
the additional visits for the child during the 3rd, 6th, 9th, 12th and 15th months of age to provide the
Home Based Care for the Young Child.
The key activities in HBNC are as follows:
 Care for every newborn through a series of home visits by an ASHA in the first six weeks of
life.
 Information and skills to the mother and family of every newborn to ensure better health
outcomes.
 An examination of every newborn for prematurity and low birth weight.
 Extra home visits for preterm and low birth weight babies by the ASHA or ANM, and
referred for appropriate care as defined in the protocols.
 Early identification of illness in the newborn and provision of appropriate care at home or
referral as defined in the protocols.
 Follow up for sick newborns after they are discharged from facilities.
 Counselling the mother on postpartum care, recognition of postpartum complications and
enabling referral
 Counselling the mother for adoption of an appropriate family planning method.
Out of 11.83 lakh home delivery at all India level, Home Deliveries followed by 7 HBNC Visits
was 80.1 percent by ASHA. There are six states which have reported more than national average.
These include Himachal Pradesh (83.1%), Gujarat (85.1%), Uttar Pradesh (87.6%), Karnataka
(95.7%), Uttarakhand (96.2%), Assam and Telangana 100 per cent. The percentage of Home
Deliveries which were followed by 7 HBNC Visits for all States/UTs is provided in figure 4.7.
45
Figure 4.7: States/UT wise Percentage of Home Deliveries followed by
7 HBNC Visits during 2019-20
Telangana 100.0
Assam 100.0
Uttarakhand 96.2
Karnataka 95.7
Uttar Pradesh 87.6
Gujarat 85.9
All India 80.1
Maharashtra 79.9
Madhya Pradesh 79.4
Tripura 78.8
Chhattisgarh 77.8
Chandigarh 75.7
Andhra Pradesh 73.5
Bihar 72.4
Delhi 71.7
Manipur 71.4
Odisha 70.7
Jharkhand 69.6
West Bengal 68.9
Punjab 67.3
Meghalaya 64.5
Haryana 60.5
A & N Islands 56.9
Kerala 55.5
Rajasthan 54.4
Nagaland 53.9
Sikkim 43.5
Puducherry 33.3
Mizoram 31.1
Tamil Nadu 14.6
Goa 13.3
Lakshadweep 0.0
Daman & Diu 0.0
0.0 10.0 20.0 30.0 40.0 50.0 60.0 70.0 80.0 90.0 100.0
States/UT wise total number of Home delivery and Home delivery followed by 7 HBNC Visits
as reported in HMIS during 2019-20 is provided at Annexure 4.3.
4.4 Low Birth Weight Infant (< 2.5 Kg)

Low birth weight (LBW) is defined as a birth weight of infant being less than 2500 g at the time
of birth (up to and including 2499 g), as per the World Health Organization (WHO). The birth
weight of an infant is the first weight recorded after birth, ideally measured within the first hour after
birth, before significant postnatal weight loss occurs. Low birth weight has been considered a major
reason for infant’s death in India.
46
In India, 12.4 percent Infants were weighted as low birth infants against those infants weighted
at birth (2.03 crore) as reported in HMIS during 2019-20. The total live births reported during 2019-
20 was 2.1 crore at all India level. There is a huge variation among the States/UTs in percentage of
newborns having weight less than 2.5 kg over total number of newborns weighted at birth – ranging
from as low as 4.0% in Manipur to 35.2% in Dadra & Nagar Haveli in 2019-20. There are 15
States/UTs which have reported more than national average (12.4%). These States include Tamil
Nadu, Gujarat, Himachal Pradesh, Assam, Rajasthan, Madhya Pradesh, A & N Islands, Goa,
Puducherry, Odisha, Daman & Diu, West Bengal, Delhi, Chandigarh and Dadra & Nagar Haveli.
Figure 4.8 presents the percentage of LBW newborns over total live birth by States/UT during 2019-
20.
Figure 4.8-State/UT wise percentage of LBW Infants as reported during 2019-20
The details of number of live births, number of live births weighted and newborns weighted less
than 2.5 kg by States/UT, India during 2019-20 at Annexure 4.4.
4.5 Still Birth Rate

The still birth rate (SBR) is defined as the number of stillbirths per 1000 total births (live birth +
stillbirth). A baby born with no signs of life at or after 28 weeks of gestation is considered as
Stillbirth. Stillbirth is one of the most distressing complications of pregnancy and still occurs far too
frequently.
Although a number of antenatal and intrapartum interventions have shown some evidence of
impact on stillbirth incidence, much confusion surrounds ideal strategies for delivering these
interventions within health systems, particularly in tribal/high priority states where most of the
stillbirths occur.
47
The Government of India has developed an Indian Newborn Action Plan which includes effort to
'reduce stillbirths to <10 per 1000 births by 2030'. There are certain interventions to prevent stillbirth
which include Antenatal Testing of High-risk Women, Ultra-sonographic Assessments of Fetal
Growth and Partograph Assessment, Safe Childbirth Checklist (SCC).
Figure 4.9 presents the trend of Still Birth Rate (SBR) in India as reported in HMIS during 2013-14
to 2019-20. Decline trend of SBR is shown in India with around 20 percent decline in SBR from
2013-14 (15.5) to 2019-20 (12.3).
Figure 4.9- Trend of Still Birth Rate at all India level as reported during 2013-14 to 2019-20
18.0
15.5 15.0
16.0
14.1 13.9
13.2 12.9
14.0 12.3
12.0
10.0
8.0
6.0
4.0
2.0
0.0
2013-14 2014-15 2015-16 2016-17 2017-18 2018-19 2019-20
In 2019-20, at all India level, still birth rate is 12.3 percent. It is observed that there are 17 States
which have reported higher than national average. These States include Chandigarh, Meghalaya,
Odisha, Assam, Chhattisgarh, Dadra & Nagar Haveli, Jammu & Kashmir, Rajasthan, Delhi, A & N
Islands, Madhya Pradesh, Tripura, Sikkim, West Bengal, Nagaland, Haryana and Punjab. The detail
of States/UTs-wise percentage of Still Birth Rate as reported in 2019-20 is provided at Figure 4.10.
48
Figure 4.10- States/UTs-wise percentage of Still Birth Rate as reported in 2019-20
Kerala 3.7
Manipur 4.0
Telangana 5.3
Lakshadweep 5.8
Tamil Nadu 6.3
Mizoram 7.5
Maharashtra 8.1
Goa 8.6
Daman & Diu 8.8
Andhra Pradesh 9.6
Karnataka 9.8
Puducherry 9.9
Gujarat 10.6
Bihar 10.8
Uttar Pradesh 11.1
Uttarakhand 11.9
Jharkhand 12.2
All India 12.3
Punjab 12.9
Haryana 12.9
Nagaland 14.6
West Bengal 14.9
Sikkim 15.5
Tripura 16.3
Madhya Pradesh 16.5
A & N Islands 16.6
Delhi 17.3
Rajasthan 17.9
Chhattisgarh 19.6
Assam 20.7
Odisha 21.5
Meghalaya 21.8
Chandigarh 22.0
0.0 5.0 10.0 15.0 20.0 25.0
The Number of reported live births, still births and Total Live birth plus still birth, States/UTs,
during 2019-20 is provided at Annexure 4.5.
4.6 Sex Ratio at Birth
Sex ratio is the ratio of females to males in a population. The “sex ratio at birth” which is defined
as the number of girls born for every 1,000 boys born, is a more accurate and refined indicator of the
extent of prenatal sex selection. Ministry of Health & Family Welfare had passed an act in 1994 as
Pre-Conception and Pre-Natal Diagnostic Techniques (PCPNDT) Act, which emphasized to stop
49
female feticides and arrest the declining sex ratio in India. The act banned prenatal sex determination
to promote the gender equality.
Sex Ratio at Birth at all India level has increased by around 2 per cent from 918 (2013-14) to
935 (2019-20). Figure 4.11 presents the trend of Sex Ratio at Birth at National level reported in
HMIS during 2013-14 to 2019-20.
Figure 4.11 Trend of Sex Ratio at Birth at all India level reported in HMIS during 2013-14 to
2019-20
940
935 935
932
930
929
925 926
923
920 918
918
915
910
905
2013-14 2014-15 2015-16 2016-17 2017-18 2018-19 2019-20
There are 12 States/UTs which has reported less than national average of SBR (935). These
include Himachal Pradesh, Uttar Pradesh, Manipur, Haryana, Jharkhand, Dadra & Nagar Haveli,
Punjab, Gujarat, Bihar, Delhi, Nagaland and Daman & Diu. Figure 4.12 presents the States/UTs
wise sex ratio at birth as reported in HMIS during 2019-20.
50
Figure 4.12 Sex Ratio at Birth by States/UTs – as reported in HMIS during 2019-20
Daman & Diu 902

Nagaland 911
Delhi 915
Bihar 917
Gujarat 917
Punjab 919
Jharkhand 921
Haryana 922
Manipur 925
Uttar Pradesh 927
Himachal Pradesh 933
All India 935
Madhya Pradesh 936
Chandigarh 936
Puducherry 938
Karnataka 938
Odisha 940
Assam 942
Maharashtra 942
Tripura 943
Jammu & Kashmir 943
Andhra Pradesh 947
Meghalaya 948
Rajasthan 948
Uttarakhand 950
West Bengal 951
Telangana 951
Tamil Nadu 952
Sikkim 954
Kerala 958
Lakshadweep 961
Chhattisgarh 964
Goa 971
Mizoram 971
A & N Islands 985
860 880 900 920 940 960 980 1000
State/UT-wise number of reported Live Births – Male, Live Births-Female, Sex Ratio at Birth as
reported in HMIS during 2019-20 is provided at Annexure 4.6
51
4.7 Nutrition Rehabilitation Centre (NRC)
The Nutritional Rehabilitation Centres are facility based care units where severely acute
malnourished (SAM) children below five years are admitted with their mothers/ care givers for
treatment, stabilization and rehabilitation. The Mothers/ Care Giver stays with the children at the
NRCs and attend counseling sessions on how to take care of the SAM child after discharge from the
NRC. Special foods, nutritional supplements, medicines are administered according to the guidelines
of Ministry of Health and Family Welfare. 19.8 million children below age 6 in India are
undernourished (ICDS 2015).
Following are the objectives of NRC:
i. Improve access to basic preventive & curative services.
ii. Encourage sustainable behavior change.
iii. Support caring practices.
iv. Stimulate social mobilization by the community to demand better services
& Accountability.
There are two elements captured under HMIS. These include Number of children admitted in
NRC and Number of children discharged with target weight gain from the NRCs.
As mentioned in Figure 4.13, at national level Number of children admitted in NRC during
2019-20 was 197223 with 62 percent of Children discharged with target weight gain from the NRCs.
There are 15 States/UTs, which has shown more than national average. These States includes,
Karnataka, Uttar Pradesh, Rajasthan, Tamil Nadu, Jammu & Kashmir, Chhattisgarh, Kerala, Assam,
West Bengal, Bihar, Jharkhand, Odisha, Nagaland, Himachal Pradesh and Arunachal Pradesh.
52
Figure 4.13: Percentage of Children discharged with target weight gain from the NRCs,
States/UTs – as reported in HMIS during 2019-20

97.7
Nagaland 88.9
82.8
Jharkhand 79.0
75.4
West Bengal 75.4
74.9
Kerala 74.0
73.6
72.6
Rajasthan 65.4
64.2
Karnataka 62.1
62.0
Andhra Pradesh 60.6
59.7
Telangana 59.1
55.1
Maharashtra 53.0
53.0
Chandigarh 51.4
50.5
Mizoram 50.0
46.0
Meghalaya 42.0
36.7
Tripura 16.7
0.0 20.0 40.0 60.0 80.0 100.0 120.0
State/UT-wise number of children admitted in NRC and discharged with target weight gain from the
NRCs, as reported in HMIS during 2019-20 is provided at Annexure 4.7
4.8 Rashtriya Bal Swasthya Karyakarm (RBSK)

Rashtriya Bal Swasthya Karyakram (RBSK) was launched in February 2013 to cover all children
from birth to 18 years of age with aim to screen over 27 crore children from 0 to 18 years for 4Ds -
Defects at Birth, Diseases, Deficiencies and Development Delays including Disabilities. Children
diagnosed with illnesses are receiving follow up including surgical and medical intervention at
tertiary level free of cost under NHM. The launch of this programme assumes great significance as it
corresponds to the release of Reproductive, Maternal, Newborn, Child Health and Adolescent Health
strategy (RMNCHA+N).
According to March of Dimes (2006), out of every 100 babies born in this country annually, 6 to
7 have a birth defect. This would translate to around 17 lakhs birth defects annually in the country
and accounts for 9.6% of all the newborn deaths. Various nutritional deficiencies affecting the
preschool children range from 4 per cent to 70 per cent. Developmental delays are common in early
childhood affecting at least 10 percent of the children.
The ‘Child Health Screening and Early Intervention Services’ Programme under National Health
Mission (NRHM) was initiated by the Ministry of Health and Family Welfare in order to have early
53
detection and management of the 4Ds prevalent among children and these are Defects at Birth,
Diseases in Children, Deficiency Conditions and Developmental Delays including Disabilities.
Health screening of children was a known intervention under the School Health Programme.
It is important to note that the 0-6 years age group are specifically managed at District Early
Intervention Center (DEIC) level while for 6-18 years age group, management of conditions is done
through existing public health facilities. DEIC act as referral linkages for both the age groups.
Health conditions to be screened Child Health Screening and Early Intervention Services under
RBSK.
In Health Management information System (HMIS), around 12 data elements related to
Rashtriya Bal Swasthya Karyakram (RBSK) are being captured regarding screening for birth defect,
screening by RBSK mobile team at Aanganwadi centers and schools, identification and management
of Diseases, deficiencies and development delays.
i. Screening for Defect at Birth-
Child Health Screening and Early Intervention Services under NHM envisage covering 30
identified health conditions for early detection and free treatment & management. Based on
the high prevalence of diseases like hypothyroidism, sickle cell, anaemia and beta
thalassemia in certain geographical pockets of some States /UTs, and availability of testing
and specialized support facilities, States/UTs may incorporate them as part of this initiative.
At all India level, there were 2,12,33,538 live birth, of which 74,58,258 (35.1%) newborn
were screened for defects at birth (as per RBSK) during 2019-20.
Figure 4.14: Number of Newborns Screened for Defect at Birth against Reported in 2017-18
and 2019-20 (in Lakhs)
74.6
Number of newborn screened for
defects at birth (as per RBSK)
80.0
70.0
37.6
60.0
(lakh)
50.0
40.0
30.0
20.0
10.0
0.0
2017-18 2019-20
As shown in Figure 4.14, Number of Newborns Screened for Defect at Birth against Total Live
Birth in India has increased from 37.6 lakh (18%) in 2017-18 to 74.6 lakh in 2019-20 (35.1%).
Figure 4.15 presents the percentage of newborns screened for defect at birth against total live birth
as reported in HMIS during 2019-20. There are 16 States/UTs which has reported more than national
average. These States includes, Andhra Pradesh, Punjab, West Bengal, Uttar Pradesh, Mizoram,
Assam, Haryana, Tamil Nadu, Odisha, Gujarat, Tripura, Dadra & Nagar Haveli, Meghalaya, Daman
& Diu, Goa and Himachal Pradesh.
54
Figure 4.15: Percentage of Newborns Screened for Defect at Birth against Total Live Birth in
India as Reported during 2019-20 (in Lakhs)

Goa 99.9
Daman & Diu 79.2
Meghalaya 73.5
Tripura 64.1
Gujarat 63.9
Odisha 59.6
Tamil Nadu 54.9
Haryana 52.7
Assam 50.2
Mizoram 47.5
Uttar Pradesh 45.8
West Bengal 44.3
Punjab 43.4
Andhra Pradesh 37.8
All India 35.1
Jharkhand 33.0
Sikkim 22.6
Maharashtra 22.1
Telangana 20.5
Madhya Pradesh 20.1
Bihar 18.7
Uttarakhand 18.4
Chandigarh 15.0
Manipur 14.2
Kerala 13.6
Karnataka 13.1
Rajasthan 10.9
Nagaland 9.3
Delhi 5.5
Puducherry 4.4
Chhattisgarh 1.7
A & N Islands 0.9
Lakshadweep 0.0
0.0 20.0 40.0 60.0 80.0 100.0 120.0
ii. Screening at Anganwadi Centers and Schools

As per RBSK Guidelines, Children aged 6 Weeks to 6 years are screened at Anganwadi
Centres and children aged 6 years to 18 years are screened at Government and Government
aided school by dedicated Mobile Health Teams.
1866.17 lakh children were screened out of which 910.35 lakhs children aged 6 month to 6
years were screened at Anganwadi centres and 955.83 lakhs children aged 6 years to 18 years
were screened at Govt. and Govt. Aided schools in 2019-20 as reported in HMIS. The details
on comparative Statement on Children Screened at Anganwadi Centers and Govt. and Govt.
added Schools in India as reported during 2018-19 and 2019-20 is provided in Table 4.3.
55
Table 4.3 Children Screened at Anganwadi Centers and Govt. and Govt. added
Schools in India as reported during 2018-19 and 2019-20
2018-19 2019-20
a Childrens screened at Anganwadi centres (6 month 699.93 Lakh 910.35 lakh
to 6 years)
b Childrens screened at govt. and Govt. added schools 772.09 Lakh 955.83 lakh
(6 years to 18 years)
c Total children screened (6 month to 18 years) 1472.03 lakh 1866.17 lakh
iii. Identification of Diseases, Deficiencies and Development Delay
The ‘Child Health Screening and Early Intervention Services’ Programme under Rashtriya
Bal Swasthya Karyakram aims at early detection and management of the 4Ds prevalent in
children.
Table 4.4 presents the bifurcation of children identified under RBSK program. As mentioned
in table, Out of total 1866.17 lakhs children screened, 122.40 lakhs has been identified with
diseases, deficiency and development delay.
Table 4.4 Children Identified at Anganwadi Centers and Govt./Govt.
Aided Schools in India as reported during 2018-19 and 2019-20
2018-19 2019-20
Children Identified with Diseases 68.28 Lakh 122.40 lakhs
Children Identified with Deficiencies 28.14 Lakh 61.10 lakh
Children Identified with Development Delay 16.36 Lakh 20.46 lakh
Total Children identified with Diseases, Deficiencies 203.96 lakh
122.78 lakh
& Development Delays
iv. Management of 4Ds
Ministry of Health and Family Welfare (MoHFW) has signed MOUs with several Medical
Colleges and private hospitals in order to conduct medical and surgical procedures for
children in the age group of 0-18 years who suffering from various ailments for achieving the
desired objective of RBSK program.
Figure 4.16 presents total Children Screened, Identified and management of 4Ds component
under RBSK in India as reported in HMIS 2019-20. There are total, 1866.20 lakh children
identified with diseases (122.40 Lakh), deficiencies (61.10 lakh) and development delays
(20.46 lakh) and 10511 lakh children were managed either by medical intervention (1037
lakh) or surgical intervention (1.40 lakh).
56
Figure 4.16 – Total Children Screened, Identified and Management of 4Ds done under
RBSK during 2018-19 and 2019-20 (in Lakhs)
1866.2
2000.0 1472.0
1800.0
1600.0
Number (in lakh)
1400.0
1200.0
1000.0
800.0
600.0 112.8 204.0 105.1
51.0
400.0
200.0
0.0
Number of children (6 Number of children Number of Children
month to 6 years) identified with Disease, Managed by Intervention
screened by RBSK deficiencies and - Medical and Surgical
Developmental delay intervention
2018-19 2019-20
The top five States with management of 4Ds component in identification of birth defects disease,
deficiencies and developmental delay are Haryana -1380810(41%), Chandigarh - 11910 (40%),
Gujarat - 7170461 (38%), A & N Islands - 6481(30%) and West Bengal - 3183016 (20%). The
details of Number of children screened, identified and management under RBSK by States/UT, India
during 2019-20 is provided at Annexure 4.8.
57
Adolescent Health Chapter 5
CHAPTER 5
ADOLESCENT HEALTH
The term Adolescence is derived from the Latin term “adolescere” which means "to grow up". It
is a transitional stage of physical and mental human development that occurs between childhood and
adulthood. This transition involves biological (i.e. pubertal), social, and psychological changes.
WHO defines “adolescents” as individuals in the 10-19 years age group. Puberty has been heavily
associated with teenagers and the onset of adolescent development.
However, the start of puberty has had somewhat of an increase in preadolescence (particularly
females, as seen with early and precocious puberty); adolescence has had an occasional extension
beyond the teenage years (typically males). These changes have made it more difficult to rigidly
define the time frame in which adolescence occurs. With this in mind, encouraged by the
International Federation of Gynecology and Obstetrics (FIGO) ASRH workshop in April 2010, the
Adolescent Health Committee in consultation with team of experts from WHO has undertaken the
issue seriously by developing Adolescent Friendly Clinics in different localities in India.
5.1 Why Focus on Adolescents?
The number of adolescents (age 10-19) is increasing and comprises over one-fifth of the
population in our country (Census 2011). Adolescents are not homogenous populations. Their
situation varies by age, sex, marital status, class, region and the cultural context. A large number of
them are either out of school or get married early or may work in vulnerable situations or may likely
to be sexually active and hence, they are exposed to several health risks. These have serious social,
economic and public health implications for the nation. Their needs vary by their age, sex, stage of
development, life circumstances, socio-economic status, marital status, class, region and cultural
context. This calls for interventions that are flexible and responsive to their desperate needs. Some
of the public health challenges for adolescents are related to early pregnancy, with associated higher
risk of maternal and infant mortality, sexually transmitted infections (including HIV) and
reproductive tract infections, under-nutrition and anaemia, substance abuse, injuries etc.
Responding to these considerations, the Ministry of Health and Family Welfare, Government of
India has included Adolescent Reproductive and Sexual Health (ARSH) as a key technical
strategy under the National RCH II programme in 2006. This strategy focuses on reorganizing and
strengthening the existing public health system in order to meet the reproductive and sexual health
needs of adolescents. The primary focus is on meeting the national targets of reduction of Total
Fertility Rate (TFR), Maternal and Infant Mortality Rates (MMR and IMR), and the incidence of
STI and HIV
5.2 Rashtriya Kishor Swasthya Karyakaram (RKSK)
Ministry of Health and Family Welfare (MoHFW) launched RKSK program in 2014. About 25.3
crore adolescents in the age group of 10-19 years in India are in a transient phase of life requiring
nutrition, education, counselling and guidance to ensure their development into healthy adults.
RKSK highlights the need for strengthening Adolescent Friendly Health Clinics (AFHC) under its
facility-based approach, to provide clinical and counselling services on sexual & reproductive health
issues having an impact on maternal and child health outcomes and occurrence of non-
communicable disease. RKSK was launched with the following objectives:
58
Chapter 5 Adolescent Health
 To increase the awareness and access to information about adolescent health;
 Provision of counselling and health services;
 Provision of specific services such as sanitary napkins; iron and folic acid supplementation,
etc.
In Health Management information System (HMIS), there are total 16 data element on Adolescent
health which are linked to the health interventions including Adolescent Friendly Health Clinics
(AFHC), Menstrual Hygiene Programme (MHP) and Weekly Iron Folic Acid Supplementation
(WIFS).
5.2.1 Adolescent Friendly Health Clinics (AFHC)
Health care providers and health services have an important role to play in promoting healthy
development and preventing health problems amongst adolescents; specialized services dedicated to
adolescents can definitely help in detecting them early and in responding to them promptly and
effectively – if and when they do arise. However, adolescents often face constraints in seeking help
from the existing health services. The well-known barriers to access services are related to their
personal issues related to shyness; and embarrassment in disclosing their problems.
Besides this, outreach services by counsellors are carried out at schools, colleges, youth clubs and in
community at least twice a week to sensitize the adolescents, caregivers and influencers on various
adolescent health issues and apprise them of various available adolescent friendly health services.
 Services Provided at AFHCs
In India, 82.25 lakh adolescent (47.2 lakh girls and 34.9 lakh boys) have registered at Adolescent
Friendly Health Clinics as reported in HMIS during 2019-20. 67 % boys and 74% girls received
clinical services and 75 % boys and 85 % girls have received the counselling services out of total
registered boys and total registered girls respectively. Further, there is a huge variation found among
States/UTs for the clinical and couselling services provided at AFHC clinics. The Annexure 5.1
Percentage of services provided at AFHC for registered Adolescent by States/UTs, India 2019-20 at
Annexure-5.1.
Figure 5.1 presents the States/UTs wise percentage distribution of Counselling and Clinical services
provided to registered adolescents at AFHC clinics during 2019-20.
59
Figure 5.1: States/UTs wise percentage of Services provided at
Adolescent Friendly Health Clinics (AFHC) in 2019-20
(a) % of Registered Adolescent Received Counselling Services
120
96 97 97 98 100100
100 90 90 92
81 82 82 82 83 85 85 86 88
74 75 77 78 79
80 69 69 70 73
64 64 64
57 59 63
60 51 54
40 34
20
0
0
Kerala
Karnataka
Manipur
Maharashtra
Tamil Nadu
Mizoram
Gujarat
Goa
Puducherry
Madhya Pradesh
Assam
All India
Delhi
Andhra Pradesh
Odisha
Tripura
Daman & Diu
Chandigarh
Chhattisgarh
Sikkim
Haryana
A & N Islands
Jammu & Kashmir

Lakshadweep
Rajasthan
Telangana
Himachal Pradesh
Bihar
Nagaland
Meghalaya
Jharkhand
Uttarakhand
Punjab
West Bengal

Uttar Pradesh
Arunachal Pradesh
(b) % of Registered Adolescent Received Clinical Services
120
100 92 93 94 96
86 86 88 90
82 82 83
75 76 77 79 80 82
80 67 69 71 71 72 72
60 60 60 61 61 62 64 64
60 50
44
37 41
40 32
20
0
0
Kerala
Karnataka
Mizoram
Tamil Nadu
Puducherry
Manipur
Daman & Diu
Chandigarh
Jammu & Kashmir
Haryana
All India
Goa
Maharashtra
Gujarat
Madhya Pradesh
Tripura
Chhattisgarh
Sikkim
Lakshadweep
Assam
Telangana
Odisha
Andhra Pradesh
Himachal Pradesh
Meghalaya
Nagaland
Delhi
A & N Islands
Uttarakhand
Rajasthan
Bihar

Jharkhand
West Bengal
Uttar Pradesh
Punjab
Arunachal Pradesh
5.2.2 Menstrual Hygiene among adolescent Girls

In India, menstruation and menstrual practices are clouded by taboos and socio-cultural
restrictions for women as well as adolescent girls. Limited access to products for sanitary hygiene,
and lack of safe sanitary facilities could prove to be barriers to increased mobility and the likelihood
of resorting to unhygienic practices to manage menstruation. Traditionally in India, it appears that
there are some strategies are in use like use of old clothes as pads by recycling them, and use of ash
or straw, which offers no protection, and endangering menstrual hygiene with long term implications
for reproductive health.
60
Chapter 5 Adolescent Health
Anecdotal evidence suggests that the lack of access to menstrual hygiene (which includes
sanitary napkins, toilets in schools, availability of water, privacy and safe disposal) could constrain
school attendance and possibly contribute to local infections during this period. Therefore, creating
awareness and increasing access to the requisite sanitary infrastructure related to menstrual hygiene
is important. Accordingly Ministry of Health and Family Welfare, Government of India has
launched the Menstrual Hygiene Programme (MHP) in 2011 to target adolescent girls in the age
group of 10-19 years, residing in rural areas with the following objectives:
 To increase awareness among adolescent girls on menstrual hygiene, build self-esteem, and
empower girls for greater socialisation
 To increase access to and use of high quality sanitary napkins by adolescent girls in rural
areas.
 To ensure safe disposal of sanitary napkins in an environment friendly manner
The scheme adopts two key strategies:
 Demand generation through ASHA and other community mechanisms such as Women’s
Groups/Kishori Mandals. As per Reporting on HMIS during 2019-20, a total of 498.70 lakh
adolescent girls were provided with sanitary napkin packs and 150.30 lakh adolescent girls
attended monthly meeting.
 Supply side intervention through ensuring a supply of a product (sanitary napkin) which is
reasonably priced and of high quality. As per reporting on HMIS during 2019-20, a total of
296.06 lakh sanitary napkins were sold to adolescent girls while 37.84 lakh sanitary packs
were distributed free to Accredited Social Health Activist (ASHA).
5.2.3 Weekly Iron Folic Acid (WIFS) Coverage
Anaemia, a manifestation of under-nutrition and poor dietary intake of iron is a public health
problem, not only prevalent among pregnant women, infants and young children, but among
adolescents as well. Anaemia in India primarily occurs due to iron deficiency and is the most
widespread nutritional deficiency disorders in the country today.
The Ministry of Health and Family Welfare, Government of India launched the Weekly Iron
and Folic Acid Supplementation (WIFS) Programme in 2012 to reduce the prevalence and
severity of nutritional anaemia in adolescent population (10-19 years).
Salient features of WIFS:
 Objective of Weekly Iron Folic acid Supplementation (WIFS) –To reduce the prevalence
and severity of anaemia in adolescent population (10-19 years).
 Target group- Weekly Iron and Folic Acid supplementation programme is planned and
implemented for the following two target groups in both rural and urban areas:
 School going adolescent girls and boys in 6th to 12th class enrolled in government/
government aided/municipal schools.
 Out of school adolescent girls.
 Intervention
 Administration of supervised Weekly Iron-folic Acid Supplements of 100mg elemental
iron and 500mg Folic acid using a fixed day approach.
 Screening of target groups for moderate/severe anaemia and referring these cases to an
appropriate health facility.
61
 Biannual de-worming (Albendazole 400mg), six months apart, for control of helminthic
infestation.
 Information and counselling for improving dietary intake and for taking actions for
prevention of intestinal worm infestation.
 Convergence
 Convergence with key stakeholder ministries like the Ministry of Women and Child
Development and Ministry of Human Resource Development is an essential part of
implantation plan of the WIFS programme.
 Key convergent areas include: joint programme planning, capacity building of nodal
service providers including Medical Officers, Anganwadi Worker (AWW) Staff Nurses,
School teachers, monitoring and a comprehensive communication component.
Figure 5.2 presents the adolescent IFA tablet coverage under WIFS programme in India as
reported on HMIS during 2019-20. Among school going Adolescent (6th -12th Standard), there are
23.26 Cr. adolescent girls and 22.54 Cr. adolescent boys were provided with 4 IFA tablets in the
Government/Government aided and Municipal schools under WIFS programme.
In case of out of school adolescent girls (10-19 years), 6.4 Cr. were provided with 4 IFA tablets
at Anganwadi centres (AWCs) however there are huge variation found among states and UTs in
reporting of these figures. The details of Number of Adolescents provided IFA tablets under WIFS
programme by States/UTs, India 2019-20 is provided at Annexure 5.2.
Among school going adolescents, (6th -12th Standard), 4.08 Cr. adolescent girls and 4.05 Cr.
adolescent boys were provided with albendazole tablets. In case of out of school adolescent girls
(10-19 years), 1.09 Cr. were provided with albendazole tablets at Anganwadi centres (AWCs)
Figure 5.2: Coverage of adolescent IFA tablets (in crore) provided in India during 2019-20
25.0 23.3 22.5
20.0
15.0
10.0
6.4
5.0
0.0
Girls (6th -12th class) provided 4 IFA Boys (6th -12th class) provided 4 IFA out of school adolescent girls (10-19
tablets in schools tablets in schools years) provided 4 IFA tablets at
Anganwadi Centres
62
Chapter 6 Family Planning
CHAPTER 6
FAMILY PLANNING
6.1 Introduction
India is the first country in the world who launched a National Programme for Family Planning
in 1952. Over the decades, the programme has undergone transformation in terms of policy and
actual programme implementation – with a gradual shift from clinical approach to the reproductive
child health approach. Further, the National Population Policy (NPP) in 2000 brought a holistic and
a target free approach, which helped in the reduction of fertility to not only achieve population
stabilization goals but also promote reproductive health leading to favorable rates of maternal,
infant & child mortality and morbidity.
Access to high quality public awareness, affordable sexual and reproductive health services,
including a full range of contraceptive methods, is fundamental to realizing the rights and well-being
of women and girls, men and boys. Universal access to effective contraception ensures that all adults
and adolescents can avoid the adverse health and socioeconomic consequences of unintended
pregnancy and have a satisfying sexual life.
Goal 3.7 of SDG, by 2030, ensures universal access to sexual and reproductive health-care
services, including family planning, information and education, and the integration of reproductive
health into national strategies and programmes.
Over the years, the programme has expanded to reach every nook and corner of the country and
has penetrated the Primary Health Centres and Sub Centres in rural areas, Urban Family Welfare
Centres and Post-Partum Centres in the urban areas. There is also an extensive engagement of the
community health workers (ASHA) who distribute contraceptives and pregnancy testing kits to
desirous beneficiaries at their doorsteps. Technological advancements, improved quality and
coverage for healthcare have resulted in rapid fall in the Crude Birth Rate (CBR) and Total Fertility
Rate (TFR). Year wise Total Fertility Rate (TFR) & Crude Birth Rate (All India, Rural & Urban) for
India are given in Figure 6.1.
Figure 6.1: Year wise Total Fertility Rate (TFR) & Crude Birth Rate
(All India, Rural & Urban)
30 3.5
25 3
23.8 23.5 23.1 22.5
22.8 22.1 21.8 21.6 2.5
20 21.4 20.8 20.4 20.2 20
2
CBR
TFR
15
2.9 2.8 1.5
2.7 2.6 2.6 2.5
10 2.4 2.4 2.3 2.3 2.3 2.2 2.1 1
5 0.5
0 0
2005 2006 2007 2008 2009 2010 2011 2012 2013 2015 2016 2017 2018
TFR All India Rural India Urban India
Source: Sample Registration System (SRS 2018)
63
Family Planning Chapter 6
6.2 HMIS Performance on Family Planning, Sexual and Reproductive Health
HMIS captures a total of 20 data elements related to Family Planning services provided at
various health facility types. These include sterilisation (both male and female), Intrauterine
Contraceptive Device (IUCD) insertions, condom distribution, oral pill distribution, Emergency
contraceptive pills distribution, Injectable Contraceptive Vaccine, complications and deaths
following sterilisation.
6.3 Family planning Services
Family planning methods regulate the number and spacing of children in a family through use of
contraceptives or other methods of birth control. HMIS captures all types of contraceptive methods –
both permanent and spacing methods including modern contraceptives. The methods available
currently in India may be broadly divided into two categories;
A. Permanent or Limiting Methods include male sterilisation (Non scalpel vasectomy and
conventional vasectomy) and female sterilisation (Laproscopy & Min-lap sterilisation).
B. Spacing methods include IUD insertions, Oral pills (both daily and weekly), injectable
contraceptive and condom usage. The method of emergency contraceptive pill is to be used in
cases of emergency. These methods are the reversible methods of contraception and used by
couples who wish to have children in future.
6.4 Sterilization Services
 Male Sterilization (Non Scalpel Vasectomy (NSV)/Conventional Vasectomy): Through a
puncture or small incision in the scrotum, the provider locates each of the 2 tubes that carries
sperm to the penis (vas deferens) and cuts or blocks it by cutting and tying it closed or by
applying heat or electricity (cautery). The sterilisation procedure is performed by trained MBBS
doctors.
 Female Sterilisation: It permanently prevents women from becoming pregnant. There are two
different procedures to achieve this goal:
1. Laparoscopic sterilisation: Laparoscopy involves inserting a long thin tube with a lens in it
into the abdomen through a small incision. This laparoscope enables the doctor to see and
block or cut the fallopian tubes in the abdomen. A trained and certified MBBS doctor or
specialist can perform this operation. Post Abortion Sterilisation is also done within 7 days of
a complete abortion. It is usually done at CHC and higher level of facility.
2. Minilap Sterilisation: Mini-Lap sterilisation is a way of performing operation through a
small abdominal incision—about 2–3 inches. The fallopian tubes are brought to the incision
to be cut or blocked and can be performed by a trained MBBS doctor. It is usually done in
PHC and higher level of facility. Postpartum sterilisation is also done within 7 days of
deliveries.
All states have shown decline trend in sterilization from 2017-18 to 2019-20. Detailed state wise
and year wise data on sterilization is given at Annexure 6.1. State wise Sterilization per 10000
ECs is shown in the Figure 6.2.
64
Figure 6.2: State & UT wise Sterilization per 10,000 Eligible couple during 2019-20
250 234
224 225 223
201
200
171 166
156154
150
127121
109104 110
95 99
100 84 82 80 80 85
68
54 52 55 58
51 47 47 47 46
43 43
50 37
12 7
0
Manipur
Karnataka
Kerala
Mizoram
Maharashtra
Gujarat
Tamil Nadu
Tripura
Madhya Pradesh
Meghalaya
Goa
Puducherry
Chandigarh
Daman & Diu

Sikkim
Chhattisgarh
Jammu & Kashmir
Andhra Pradesh
Haryana
Delhi
Assam
Odisha
Nagaland
Himachal Pradesh
Bihar
Jharkhand
Uttarakhand
Telangana
Lakshadweep
A & N Islands
West Bengal
Rajasthan
Uttar Pradesh
Punjab

Arunachal Pradesh
I. High Focus-NE II. High Focus- Non NE III. Non High Focus Large IV. Non High Focus-
Small & UT
North-eastern (NE) states have low sterilisation rate i.e around 50 sterilisations per 10,000 ECs
as per data reported in HMIS by States/ UTs. Mizoram reported 84 sterilisations per 10,000 ECs and
Sikkim reported 7 sterilisations per 10,000 ECs, which is lowest rate in India. However, as per
NFHS 4, Sikkim has lowest TFR at 1.2 across all states of India. This may be due to low fertility
rate in adolescent women age 15-19 years (22), women age 20-24 years married before age 18 years
is less (15%), total unmet need is less (21.7%) as compared to other states (source: NFHS 4) and
also high women literacy rate.
Among high focused states#, Jammu & Kashmir (47 per 10,000 ECs) and Uttarakhand (51 per
10,000 ECs) are the three low performing states shown in figure 6.2.
Footnote: #High focused state: On account of the unacceptably high fertility and mortality
indicators, the eight Empowered Action Group (EAG) states (Bihar, Chhattisgarh, Jharkhand,
Madhya Pradesh, Odisha, Rajasthan, Uttarakhand & Uttar Pradesh), which account for about 48% of
India's population, are designated as “High Focus States” by the Government of India.
6.5 Postpartum Family Planning (FP) Services
In order to capitalize on the opportunity provided by increased institutional deliveries, the
Government of India is focusing on strengthening post-partum FP services.
As evident from the graph below (figure 6.3), there are States/ UTs like Lakshadweep (97%),
Sikkim (94%), Manipur (91%), Puducherry (81%), Kerala (76%), Tamil Nadu (75%), Chandigarh
(74%) & Goa (73%), which have reported more than 70% of total female sterilizations are post-
partum sterilization and among these, State Tamil Nadu (20%) and Kerala (12%), and two UTs,
Puducherry (14%) & Lakshadweep (9%) women underwent postpartum sterilization. There is a
huge potential for post-partum sterilization in High focus states where less than 1 to 2 percent of
women undergo post-partum sterilization.
65
Figure 6.3 Percentage of Post-partum Sterilisation to Total Female Sterilisation & against
Institutional Delivery during 2019-20
% Post Partum Sterlisations to Total Female Sterilisations
% Post Partum Sterlisations to Total Institutional Delivery
97
100 94 91
90 81
80 76 75 74 73
67
70
60 50 50 49 49 49
50 44 43
40
40
29 27
30 20 24 23 22 22
19 18 17
20 14
12 15 15 15 14 14
9 9
6
9 8 10 8 7 7
6 4 6 5 4 6 5
10 1 2 3 3 3 3 2 2 3 1 1 1 2 3 1 1 2 2 2 1
2 2 1
1
0
Karnataka
Manipur
Kerala
Mizoram
Maharashtra
Gujarat
Puducherry
Tamil Nadu
Chandigarh
Goa
Tripura
Daman & Diu
All India
Delhi
Andhra Pradesh
Jammu & Kashmir

Lakshadweep
Sikkim
Haryana
Chhattisgarh
Himachal Pradesh
Madhya Pradesh
Meghalaya
A & N Islands
Assam
Telangana
Odisha
Nagaland
Uttarakhand
Rajasthan
Jharkhand
West Bengal
Punjab
Bihar
Uttar Pradesh
Arunachal Pradesh
Copper containing IUCDs are a highly effective method for long-term birth spacing. New
approach of delivery -postpartum IUCD insertion (PPIUCD) by specially trained service
providers is to tap the opportunities offered by institutional deliveries.
As per reported data there is an increasing trend in percentage of PP IUCD insertions in public
health facilities in India. As evident from the figure 6.4, India has shown remarkable achievement of
18.2% of institutional deliveries underwent IUCD insertions within 7 days of their delivery in the
year 2019-20 which was only 5.1% in the year 2014-15.
Fig 6.4: Trend in % PP IUCD Insertions (public) to Total Institutional Deliveries (public)
20 18.2
% PP IUCD insertions to Inst. delivery
18 16.5
15
16
14 12.7
12
(public)
10 8.1
8
5.1
6
4
2
0
2014-15 2015-16 2016-17 2017-18 2018-19 2019-20
66
As per data reported on HMIS by states and UTs, some of the States have performed very good
in PPIUCD coverage viz. in figure 6.5. Tamil Nadu (49%), West Bengal (37%), Haryana (31%),
Delhi (26%), Rajasthan (26%), Odisha (22%), Punjab (20%), Assam (20%) and Madhya Pradesh
(19%), which are also above the national average of 18%. However, 18 states and UTs have reported
less than 10% PPIUCD insertions against total institutional deliveries in public health facilities.
There is an increasing trend in PPIUCD performance in most of the states over the years. A detailed
table on state wise and year wise performance on PPIUCD insertions is given in Annexure 6.2.
Figure 6.5: Percentage of Post-partum IUCD insertions to
Total Institutional Delivery during 2018-19 (Public Health Facilities)
50 49
45
40 37
35 31
30
26 26
25 22
20 20
19 18 18
20 17 17 16
14 14
15 12 11
10 9
10 8 7
5
4 3
5 2 2 2 2 2 2 1 1
1 1 0 0
0
Karnataka
Tamil Nadu
Manipur
Mizoram
Kerala
Daman & Diu

All India
Maharashtra
Madhya Pradesh
Gujarat
Jammu & Kashmir
Andhra Pradesh
Chandigarh
Puducherry
Sikkim
Haryana
Delhi
Odisha
Assam
Himachal Pradesh
Meghalaya
Goa
Tripura
Chhattisgarh
Nagaland
Rajasthan
Jharkhand
A & N Islands
Telangana
Lakshadweep
Bihar
Uttarakhand
West Bengal
Punjab
Arunachal Pradesh

Uttar Pradesh
6.6 Other Spacing methods

 Oral Contraceptive Pills (OCPs) are medications that prevent pregnancy. These are one of the
methods of birth control. Oral contraceptives are hormonal preparations that may contain
combinations of the hormones estrogen and progestin or progestin alone. Centchroman
“Chhaya” - The once in a week non-steroidal oral pill has also been recently introduced in the
current basket of choices. As per the data reported on HMIS by States and UTs, 20% of the total
contraceptive users are OCP users (figure 6.7).
 Emergency Contraceptive Pills (ECPs) are contraceptive pills to be consumed in cases of
emergency arising out of unplanned/unprotected intercourse and the pill should be consumed
within 72 hours of the sexual act and should never be considered a replacement for a regular
contraceptive.
The details State/ UT wise ECPs and Oral Pill distributions F.Y. 2018-19 and 2019-20 is
provided at Annexure 6.3.
 Condoms are the barrier methods of contraception which offer the dual protection of preventing
unwanted pregnancies as well as transmission of Reproductive Transmitted Infection/Sexually
67
Transmitted Infection (RTI/STI) including HIV. The brand “Nirodh” is available free of cost at
government health facilities and supplied at the doorstep by the ASHAs.
As per the data reported on HMIS by States and UTs, 25% of the total contraceptive users are
condom users (Figure 6.7). State wise performance of Condom users is given in below figure
6.6.
Figure 6.6: Condom Users per 10,000 of estimated no. of unsterilised couples during 2019-20
232
Focus- Small &
Lakshadweep
IV. Non High
349
362
UT
Daman & Diu 454

940
Puducherry 1,003
1,926
Kerala 68
III. Non High Focus Large
101
Telangana 177
200
Goa 201
275
Karnataka 337
406
Haryana 681
903
Andhra Pradesh 960
96
II. High Focus- Non NE
Uttar Pradesh 175

210
Uttarakhand 234
235
Jammu & Kashmir 254
266
Madhya Pradesh 385
577
Himachal Pradesh 585
33
I. High Focus-NE
Manipur 42
54
95
Assam 125
127
Sikkim 399
0 200 400 600 800 1000 1200 1400 1600 1800 2000
Formula for calculation of Condom users:

Condom users per 10,000 Unsterilised Couples= {(Number of condom pieces distributed/72)/
(Unsterlised Couples $)}*10,000
$
Unsterilised Couples= Eligible couple- (EC* %ge of Currently married women (15-49 age) using
sterilization as per NFHS 4)
 Injectable contraceptive under ‘Antara’ Programme, which has been recently introduced in
the current basket of choices of modern contraceptive methods. This is the commonest type of
injectable contraceptive given intra-muscularly in every three months. Data items on this
method have been introduced in the year 2017-18 in HMIS. HMIS captures number of
beneficiaries given 1st, 2nd, 3rd and 4th dose of injectable contraceptive. State wise
performance on 4 doses of injectable Contraceptives is given at Annexure-6.4.
6.7 Performance of various contraceptive users in India

As per data reported on HMIS by states and UTs, India has shown high percentage of IUCD
users (33%), Condom users (25%) and Female Sterilisation (19%) against all contraceptive users
and low percentage of Male Sterilisation (0.3%). In the year 2017-18, new modern contraceptive
68
methods like Centchroman (weekly pills) and Injectable contraceptives got into picture and since
then data on these methods are being captured in HMIS. The percentage distribution of all
contraceptive users in India is given in the Figure 6.7.
Figure 6.7: Percentage Distribution of Various Contraceptive Users in India during 2019-20
Injectable
Centchroman Contraceptive
(weekly pills) (MPA) users Male Sterilisation
distributed 3% 0.3% Female
2% Sterlisation
19%
Condom pieces
distributed
25%
Combined Oral IUCD insertiions

Pills distributed done
18% 33%
As per data reported on HMIS, Sterilisations are being conducted more in public sector (76%)
than private sector (24%) (Figure 6.8).
Figure 6.8: Percentage Sterilization
All India 2019-20 (Public vis-à-vis Private)
As per data reported by States & UTs, performance of
Private permanent methods of family planning services has
24% shown a decline trend whereas IUCD insertions shown an
increasing trend (fig.6.9). In the year 2018-19, a total of
35,42,434 sterilizations were conducted; while, a total of
Public 34,57,783 were conducted in the year 2019-20; whereas,
76% IUCD insertions increased from 56.57 Lakhs to 58.39
Lakhs from 2018-19 to 2019-20.
There is no such significant increase observed in number
of sterilisations and IUCD insertions in spite of declining
CBR and TFR. There is a need to sustain momentum to
reach the replacement level fertility. Considering the current efforts to focus on spacing, there is a
little shift in modern contraceptive users over conventional methods as shown in figure 6.9 and it is
69
expected that IUCD insertions and modern contraceptive performance would increase in near future.
A detailed table with all types of contraceptive users is given at Annexure 6.5.
Figure 6.9: Year wise Performance of Sterilization, IUCD Insertions & other modern
contraceptive users during F.Y. 2017-18 to F.Y. 2019-20 (in lakhs)
0.09
Injectable Contarceptive users 2.51
4.88
1.14
Centchroman (weekly pills) users 1.63
3.83
46.07
Condom Users 45.90
44.68
33.33
OCP users 31.43
32.59
59.91
IUCD Insertions done 56.57
58.39
36.15
Sterilisation Conducted 35.42
34.58
0.00 10.00 20.00 30.00 40.00 50.00 60.00 70.00
2017-18 2018-19 2019-20
6.7.1 Contraceptive users viz-a-viz MMR

Family planning has undergone a paradigm shift and emerged as one of the interventions to
reduce maternal and infant mortalities and morbidities. It is well-established that the states with high
contraceptive prevalence rate have lower maternal and infant mortalities.
Figure 6.10: State wise Contraceptive users per 10,000 Eligible Couples &
MMR for selected states
1,200 250
1,000 215
197 200
800 173
164 159
150 149 150
600 129
113
91 98 92 99 100
400 75 71 65 63
60
200 46 43 50
0 0
Number of Contraceptive users per 10,000 eligible couple MMR 2016-18
MMR as per SRS MMR Bulletin 2016-18
70
Chapter 7 Immunisation
CHAPTER 7
IMMUNISATION
7.1 Introduction
Immunization is the process whereby a person is made immune or resistant to an infectious
disease, typically by the administration of a vaccine. Vaccines are substances that stimulate the
body’s own immune system to protect the person against subsequent infection or disease. India has
one of the largest immunisation programmes in the world targeting 2.6 crore newborns and 2.9 crore
pregnant women for vaccination each year.
Immunization programme was launched in 1978 as ‘Expanded Programme of Immunization’. It
was renamed as Universal Immunization Programme (UIP) in 1985 when its reach was expanded
beyond urban areas. In 1992, it became part of Child Survival and Safe Motherhood Programme and
in 1997, it was included under National Reproductive and Child Health Programme. Since the
launch of National Rural Health Mission in 2005, Universal Immunization Programme has become
part of it.
Under UIP, free of cost vaccines are being provided against 12 vaccine preventable diseases
(VPD) provided nationally and against 3 VPDs are provided sub nationally. These nine diseases at
all India level include: Diphtheria, Pertussis, Tetanus, Polio, Measles, Rubella, severe form of
Childhood Tuberculosis, Hepatitis B and Meningitis & Pneumonia caused by Haemophilus
Influenza type B and against 3 diseases, which include Rotavirus diarrhea, Pneumococcal
Pneumonia and Japanese Encephalitis at Sub-national level. Out of this, Rotavirus vaccine and
Pneumococcal Conjugate vaccine (PCV) are in process of expansion while JE vaccine is provided
only in endemic districts.
As a strategic endeavor, the Ministry of Health & Family Welfare (MoHFW), Government of India,
launched Mission Indradhanush (MI) in December 2014. The Mission focuses on interventions to
improve full immunization coverage for children in India from 65% in 2014 to at least 90% over the
next five years through special catch-up drives in hard to reach areas, vacant sub centres, areas with
outbreaks of vaccine preventable diseases, resistance pockets, etc. This was followed by Intensified
Mission Indradhanush (IMI) launched by PM in October 2017 which focused on urban settlements
and districts with slowest progress by close monitoring of ministries/ departments with defined roles.
IMI 2.0 was next step between December 2019-March 2020 carried out in states based on full
immunization coverage, burden of vaccinae preventable diseases and other factors.
There are around 50 data items related to Immunization services provided at various health
facilities and around 11 data items related to child hood diseases captured in Health Management
Information System (HMIS). These include various vaccines received by infants 0 to 11 months
which include BCG, DPT1, DPT2, DPT3, Pentavalent1, Pentavalent2, Pentavalent3, OPV1, OPV2,
OPV3, Hepatitis-B0 (Birth Dose), Hepatitis-B1, Hepatitis-B2, Hepatitis-B3, Inactivated Polio
Vaccine 1 (IPV 1), Inactivated Polio Vaccine 2 (IPV 2), Rotavirus 1, Rotavirus 2, Rotavirus 3;
various vaccines received by Children 9 - 11 months which include Measles & Rubella (MR) – 1st
Dose, Measles 1st dose, JE 1st dose. There are other vaccines related data items captured in HMIS
which includes vaccines given to Children of more than 12 months; Children of more than 23
months; Adverse Event Following Immunization (AEFI), Number of Immunization sessions and
71
Immunisation Chapter 7
Children received Vitamin A Doses between 9 months and 5 years. Childhood diseases (0-5 years of
age includes Pneumonia, Asthma, Sepsis, Diphtheria, Pertussis, Tetanus Neonatorum, Tuberculosis
(TB), Acute Flaccid Paralysis (AFP), Measles, Malaria and Diarrhea. Details of age-wise
vaccination schedule of Government of India are as follows:
Vaccination as per the National Immunization Schedule of 2019-20
Government of India
Age Vaccines given
Birth Bacillus Calmette Guerin (BCG), Oral Polio Vaccine (OPV)-0 dose, Hepatitis
B birth dose
6 Weeks OPV-1, Pentavalent-1, Rotavirus Vaccine (RVV)-1#, Fractional dose of
Inactivated Polio Vaccine (fIPV)-1, Pneumococcal Conjugate Vaccine (PCV)
-1*
10 Weeks OPV-2, Pentavalent-2, RVV-2#
14 Weeks OPV-3, Pentavalent-3, fIPV-2, RVV-3, PCV-2*
9-12 Months Measles & Rubella (MR)-1, JE-1**, PCV-Booster*
16-24 Months MR-2, JE-2**, Diphtheria, Pertussis & Tetanus (DPT)-Booster-1, OPV –
Booster
5-6 Years DPT-Booster-2
10 Years Tetanus & adult Diphtheria (Td)
16 Years Td
Pregnant Td-1, Td-2 or Td-Booster***
Mother
* PCV in selected states/districts in phases
** JE in endemic districts only
*** One dose if previously vaccinated within 3 years
#
RVV in some selected states
7.2 Immunization of Pregnant women/ mother against Tetanus:

Maternal and neonatal tetanus is an important preventable cause of neonatal and maternal
mortality. Both maternal and neonatal tetanus is one of the public health problem in poor, remote
and isolated communities with unhygienic obstetric and postnatal practices followed along with less
accessibility to health services. This can be easily preventable by maternal immunization with
tetanus toxoid (TT) containing vaccines, clean delivery and postnatal umbilical cord care.
If the mother is immunized with correct doses of tetanus toxoid vaccine, not only she but the
newborn is also protected against tetanus.
Since 1998, WHO has recommended that TT should be replaced by Td vaccine. This is
reiterated in the WHO tetanus vaccine position paper of 2017 and deliberations of Strategic
Advisory Group of Experts in 2002 and 2016. National Technical Advisory Group on Immunization
(NTAGI), Ministry of Health & Family Welfare has also recommended the replacement of TT
vaccine with Td vaccine in India’s immunization programme for all age groups, including pregnant
women.
72
Tetanus Toxoid (TT) vaccine has been replaced with Tetanus and adult diphtheria (Td) vaccine.
Tetanus and diphtheria can lead to hospitalizations or even cause death. There are increasing
numbers of cases of diphtheria amongst older age group. Td vaccine in place of TT will help to
decrease diphtheria outbreaks. The use of Td rather TT is recommended during pregnancy to protect
against maternal and neonatal tetanus & diphtheria during prenatal care.
Tetanus and adult diphtheria (Td) vaccine is a combination of tetanus and diphtheria with lower
concentration of diphtheria antigen (d) as recommended for older children and adults.
Td vaccine Schedule –
10 & 16 Years • Td Vaccine
• Td-1 : early in pregnancy

• Td-2 : 4 weeks after Td-1
For Pregnant women/
mother • Td-B: if pregnancy occur within 3 years of
last pregnancy and 2 Td doses were
received.
State/UT wise Percentage of pregnant women received TT2/Td2 + TT/Td booster against
estimated pregnancies during 2019-20 is given at figure 7.1 and details are provided at Annexure 7.1
The estimated number pregnancies in 2019-20 is measured as follows:
Estimated Live Births in 2019-20 + (Estimated Live Births in 2019-20 * Wastage as per NFHS
4/100)
The estimated number of live births in 2019-20 is measured as follows:
(𝑀𝑖𝑑 𝑌𝑒𝑎𝑟 𝑃𝑜𝑝𝑢𝑙𝑎𝑡𝑖𝑜𝑛 𝑎𝑠 𝑜𝑛 1𝑠𝑡 𝑜𝑐𝑡 2019 ∗ 𝐶𝐵𝑅 𝑎𝑠 𝑝𝑒𝑟 𝑆𝑅𝑆 2017)/1000
The Crude Birth Rate (CBR) is defined as the number of live births occurring among the
population of a given geographical area during a given year, per 1,000 mid-year total population of
the given geographical area during the same year.
Figure 7.1: State/UT wise percentage of pregnant women received TT2+ TT
Booster against estimated pregnancies during 2019-20
100 100100100 96 96 93 92 91
89 88 87 87 87 87 86 86
90 86 83 83
82 81 79
78 78
80 75 74 73 73 72
70 70
70 62 59
58 58
60 54 51
50
40
30
20
10
0
Jammu &…
Dadra & Nagar…
Arunachal…
Himachal…
Assam
Odisha
Puducherry
Uttar Pradesh
Maharashtra
Jharkhand
West Bengal
A & N Islands
Uttarakhand
Bihar
Sikkim
Delhi
Mizoram
Nagaland
Meghalaya
Andhra Pradesh
Gujarat
Haryana
Daman & Diu
Goa
Madhya Pradesh
Telangana
Chandigarh
Karnataka
Lakshadweep
Chhattisgarh
Tamil Nadu
Tripura
Kerala
Rajasthan
Manipur
All India
Punjab
73
7.3 Full Immunization
A child is said to be fully immunized if the child receives all due vaccine as per national
immunization schedule within 1st year of age of the child. Children aged between 9 and 11 months
are said to be fully immunized if they receive one dose of BCG; three doses of DPT/ Pentavalent;
Pneumococcal Conjugate Vaccine (PCV) (where applicable in some selected states); three doses of
Oral Polio Vaccines (OPV); two doses of Rotavirus (in some selected states) and one dose of
Measles/ MR vaccine between 9-11 months of their birth.
The full immunization coverage is measured as proportion of number of children provided all
due vaccines as per immunization schedule within 1st year of age against the estimated infants (0-1
year).
The estimated no. of infants of 0-1 year in 2019-20 is measured as follows:
𝐸𝑠𝑡𝑖𝑚𝑎𝑡𝑒𝑑 𝑙𝑖𝑣𝑒 𝑏𝑖𝑟𝑡ℎ 𝑖𝑛 2019_20 − (𝐸𝑠𝑡𝑖𝑚𝑎𝑡𝑒𝑑 𝑙𝑖𝑣𝑒 𝑏𝑖𝑟𝑡ℎ 𝑖𝑛 2019_20
∗ 𝐼𝑀𝑅 𝑎𝑠 𝑝𝑒𝑟 𝑆𝑅𝑆 2017/1000)
The Infant Mortality Rate (IMR) is defined as the number of deaths under one year of age
occurring among the live births in a given geographical area during a given year per 1,000 live births
occurring among the population of the given geographical area during the same year.
Figure 7.2: Year wise percentage of Children 9-11 Months Fully Immunized against Estimated
infant during 2017-18 to 2019-20- All India
92.8
86.7 87.9
90
80
70
60
50
40
30
20
10
0
2017-18 2018-19 2019-20
The All India average of percentage of children 9-11 months fully immunized against estimated
live births during 2019-20 is 92.8% and there is an increasing trend over last two years. State/UT
wise percentage of children 9-11 months fully immunized against estimated infants during 2019-20
is provided at Figure 7.3 and details are provided at Annexure 7.2.
74
Figure 7.3: State/UT wise Percentage of Children 9-11 Months Fully Immunized against
Estimated Infants during 2019-20

Meghalaya 100.0
Telangana 100.0
Mizoram 100.0
Maharashtra 98.9
Andhra Pradesh 98.9
Delhi 97.6
West Bengal 97.0
Jharkhand 96.5
Uttar Pradesh 96.0
Tripura 95.4
Chhattisgarh 94.7
Bihar 94.5
Karnataka 94.1
Uttarakhand 93.6
Haryana 93.5
Lakshadweep 93.3
All India 92.8
Goa 92.7
Kerala 92.4
Madhya Pradesh 91.0
Gujarat 91.0
Punjab 89.6
Assam 85.8
Odisha 85.6
Tamil Nadu 85.2
Manipur 83.6
Chandigarh 77.6
A & N Islands 76.7
Rajasthan 75.1
Daman & Diu 68.1
Puducherry 64.6
Sikkim 62.9
Nagaland 56.0
0 20 40 60 80 100 120
Note: States/UTs which have reported more than hundred percentage achievements have been
truncated to hundred percentages only assuming they have achieved the coverage of immunization.
This could be due to migration of cases.
75
Among the States, there are 17 states which have reported more than 92.8 per cent immunization
coverage i.e. above national average. And 11 states have more than 95 per cent full immunization
coverage which include Jammu & Kashmir, Meghalaya, Telangana, Mizoram, Maharashtra, Andhra
Pradesh, Delhi, West Bengal, Jharkhand, Uttar Pradesh & Tripura. There are few states like
Nagaland, Sikkim, Puducherry, Daman & Diu having below 70 per cent full immunization coverage.
7.4 Bacillus Calmette–Guérin (BCG)

Bacillus Calmette–Guérin (BCG) vaccine is a vaccine primarily used against tuberculosis (TB).
In countries where tuberculosis or leprosy is common, one dose is recommended for a healthy baby
as close as possible to the time of its birth. As per reported data in HMIS, achievements of BCG
vaccination coverage to the estimated need measured at all India level was 88%. Puducherry,
Chandigarh, Meghalaya, Mizoram & Telangana generally measured a higher BCG coverage
probably due to high case load of reported live birth and subsequent immunization. This happens
because in many cases, pregnant women from neighboring States come to deliver at high-level
medical facilities (e.g., JIPMER in Puducherry and PGI in Chandigarh) available in both the Union
Territories. The State/UT-wise percentage achievement of BCG to estimated need assessed during
2019-20 is provided at Figure 7.4.
Figure 7.4: State/UT-wise Percentage Achievement of BCG to
Estimated Need Assessed during 2019-20
100 10010010010010098 97 96 94 93 92 92 91 91 91 90 89 89 89 88
87 86 86 86 84 83
90 83 79
78 77 76 76 75 74
80 69
70 64 60
60
50
40
30
20
10
0
Mizoram
Kerala
Karnataka
Maharashtra
Manipur
Gujarat
Puducherry
Chandigarh
Tripura
All India
Tamil Nadu
Goa
Daman & Diu

Madhya Pradesh
Meghalaya
Jammu & Kashmir
Assam
Delhi
Andhra Pradesh
Nagaland
Haryana
Chhattisgarh
Lakshadweep
Himachal Pradesh
Telangana
Jharkhand
Odisha
Sikkim
Uttarakhand
Bihar
Rajasthan
A & N Islands
West Bengal
Uttar Pradesh
Punjab
Arunachal Pradesh
Note: States/UTs which have reported more than hundred percentage achievements have been
truncated to hundred percentages only assuming they have achieved the coverage of immunization.
This could be due to migration of cases.
State/UT-wise percentage achievement of BCG coverage to estimated need assessed during
2019-20 is provided at Annexure 7.3.
7.5 Measles & Rubella

Measles is a highly infectious disease causing illness and death due to complications in the form
of diarrhea, pneumonia or brain infection mostly among the children less than five years of age.
Rubella is a mild disease but when infection occurs in early pregnancy, it has the potential to cause
spontaneous abortions, fetal deaths, stillbirths and serious congenital defects in the child causing
lifelong disabilities. Measles Rubella vaccine is given for preventing both measles and rubella
76
disease in the child, as these diseases can be only prevented by vaccination. The first dose of
Measles-Rubella vaccine needs to be administered, according to the National Immunization
Schedule, after the completion of 9 months until 12 months of age while during 16-24 months the
second dose shall be given. HMIS captures children given Measles 1st dose and children given MR
1st dose (9-12 months), measles and MR 2nd dose (16-24 months). State/ UT wise coverage of
Measles/ MR vaccination is given in figure 7.5.
Figure 7.5: Percentage of infants given Measles/ MR vaccine during 2019-20
100 100 100 100 100 100 98 98 98 97
96 96 95 95 95 95 94 94 94 94
100 92 91 90
88 86 86 86 86
90 79 78
76 75 74
80 69 67
70 62 61
60
50
40
30
20
10
0
Goa
Bihar
Haryana
Telangana
Gujarat
Delhi

Rajasthan
Sikkim
Meghalaya
Tripura
Uttarakhand
Daman & Diu

Kerala
Uttar Pradesh
Madhya Pradesh
Lakshadweep
All India
Puducherry
West Bengal
Karnataka
Punjab
Manipur
Tamil Nadu
Odisha
Chandigarh
Nagaland
Jammu & Kashmir
Mizoram
Maharashtra
Jharkhand
Himachal Pradesh
Assam
A & N Islands
Andhra Pradesh
Chhattisgarh
Arunachal Pradesh
As per reported data in HMIS, 16 states reported more than 95 per cent coverage which is more than
the national average.
7.6 DPT
DPT (also DTP and DTwP) is a class of combination vaccines against three infectious diseases
in humans: Diphtheria, Pertussis (whooping cough), and Tetanus. The series of immunizations
known as DPT1, DPT2, DPT3 & DPT Boosters can prevent from Diphtheria, Pertussis and Tetanus
diseases.
7.7 Pentavalent Vaccine

Pentavalent vaccine is a vaccine that contains five antigens (Diphtheria + Pertussis + Tetanus +
Hepatitis B + Haemophilus + Influenzae Type B). This vaccine replaces Hepatitis B and DPT
primary vaccination schedule at 6, 10 and 14 weeks in the immunization programme except the birth
dose of Hep B and booster doses of DPT.
As per the data reported in HMIS for 2019-20, at all India level combined percentage of DPT3
and Penta3 achievement to the estimated need (2019-20) is around 92 per cent. There are 7
States/UTs which have reported 100% achievements (Mizoram, Jammu & Kashmir, Meghalaya,
Tripura, Telangana, Andhra Pradesh & Maharashtra) during 2019-20. The State/UT-wise percentage
DPT3 and Penta3 Achievement to estimated need (2019-20) is provided at Figure 7.6.
77
Figure 7.6: State wise percentage of children given DPT3+Penta3 against estimated infant
during 2019-20
Daman & Diu 65

Sikkim 67
Puducherry 68
Nagaland 71
Rajasthan 73
A & N Islands 74
Chandigarh 79
Odisha 84
Madhya Pradesh 85
Assam 86
Tamil Nadu 86
Punjab 87
Goa 87
Manipur 87
Gujarat 88
Himachal Pradesh 88
Chhattisgarh 89
All India 92
Haryana 92
Uttarakhand 92
Uttar Pradesh 94
Kerala 94
Delhi 94
Bihar 95
Jharkhand 95
Karnataka 96
Lakshadweep 96
West Bengal 98
Maharashtra 100
Andhra Pradesh 100
Telangana 100
Tripura 100
Meghalaya 100
Jammu & Kashmir 100
Mizoram 100
0 10 20 30 40 50 60 70 80 90 100
7.8 OPV-0 and Hepatitis-B Birth Dose

Oral Polio Vaccine (OPV-0) Birth dose is made from live-attenuated Polioviruses. The vaccine
is given by putting two drops into the child’s mouth. OPV-0 gives protection against the three types
of Polioviruses (types 1, 2 and 3) that cause Poliomyelitis (Polio) — a disease of the brain and spinal
cord.
78
Hepatitis is an inflammation of the liver, most commonly caused by a viral infection. There are
five main hepatitis viruses – referred to as type A, B, C, D and E. These five types are of the greatest
concern because of the burden of illness and death they cause and the potential for spread of
outbreaks and epidemics.
Hepatitis-B Birth Dose refers to the dose given to the children within 24 hours of their birth. A
child vaccinated with Hep-B after more than 24 hours of birth is not considered to have received the
birth dose. The birth dose of Hepatitis B vaccine is effective in preventing perinatal transmission of
Hepatitis B only if given within the first 24 hours.
As reported in HMIS in 2019-20, at all India level, the percentage of OPV-0 and Hepatitis-B
Birth Dose given against reported live birth are 87.3% and 72% respectively. 8 States/UTs who have
reported more than 95% coverage of OPV-0 includes Andhra Pradesh, Goa, Gujarat, Jammu &
Kashmir, Lakshadweep, Puducherry, Tamil Nadu and Telangana against reported live birth.
However, there are only 5 States/UTs (Lakshadweep, Tamil Nadu, Puducherry, Andhra Pradesh &
Sikkim) who have reported more than 90% coverage of Hep B0 against reported live birth. And 12
States (Haryana, Rajasthan, Nagaland, Manipur, Chhattisgarh, Uttarakhand, Mizoram, Maharashtra,
Assam, Jharkhand, Meghalaya and Uttar Pradesh) who have reported below national average i.e.
72% coverage of Hepatitis-B birth dose against reported live birth. The percentage coverage of
OPV-0 and Hep-B0 to reported live birth in 2019-20 is provided at Figure 7.7.
Figure 7.7: Percentage Coverage OPV 0 & Hep-B0 To Reported Live Birth in 2019-20
100100100 99 99 98 96 96
100 95 94 94 93 93 93 93 92
91 91 90 90 90 89 89 89 89 89 87
90 100 100 99 83
92
79 78 78 76
80 89 89 89
92
89 74
84 85 86 84 84 86 86 87 69 68
70 80 80 64 62
76 75 75 75 73
60 71 72 69 67
66 65 67
62 61 63
50 58
40 51 52
30
20
10
0
Karnataka
Kerala
Mizoram
Tamil Nadu
Puducherry
Manipur
Goa
Chandigarh
Maharashtra
Daman & Diu

Jammu & Kashmir
Gujarat
Sikkim
Chhattisgarh
Madhya Pradesh
All India
Tripura
Lakshadweep
Andhra Pradesh
Telangana
Himachal Pradesh
Delhi
Odisha
Nagaland
Assam
Haryana
Meghalaya
Bihar
A & N Islands
Uttarakhand
Uttar Pradesh
Jharkhand
West Bengal
Rajasthan
Punjab
Arunachal Pradesh
% Newborns given OPV0 at birth to Reported live birth % Newborns given Hep-B0(Birth Dose)at birth to Reported live birth
7.9 Rotavirus
Rotavirus is a highly contagious virus. It is the most common organism that causes diarrhea
among children which may lead to hospitalization and death. Rotavirus diarrhea has an incubation
period of 1-3 days. It presents usually with sudden onset of watery stools, often accompanied by
fever & vomiting and often accompanied with abdominal pain. The diarrhea and associated
symptoms may last for 3-7 days. The protective effect of Rotavirus vaccine lasts through the second
year of life. The dose and route for Rotavirus vaccine currently being supplied under UIP 5 drops
orally to be administered to all infants of 6, 10 and 14 weeks along with other vaccines in routine
immunization.
79
In India Rotavirus was introduced in February 2016. In HMIS, data-items related to Rotavirus
are being captured since 2017-18. The States/UTs wise Rotavirus 1st, 2nd & 3rd dose administered
reported in HMIS during 2019-20 is provided at Annexure 7.5.
7.10 AEFI Deaths

An Adverse Events Following Immunization is an adverse medical occurrence which follows
after immunization and which may not necessarily have a causal relationship with the usage of
vaccines. These events may include one or more unfavorable or unintended sign, symptoms or
laboratory findings which often raises concern among immunization program managers, policy
makers, family of beneficiary and the community. Adverse Events Following Immunization (AEFI)
can be common and minor (like fever, local pain and swelling), severe (like pain and swelling which
spreads beyond the nearest joint or high grade fever) and serious AEFIs (conditions requiring
hospitalization or leading to death or disability).
As per reported data in HMIS for 2019-20, 316 AEFI deaths were reported across India in 2019-
20. The major States having high burden of AEFI deaths include Bihar (52), West Bengal (36),
Assam (29), Uttar Pradesh (29), Karnataka (28) and Kerala (26), Tamil Nadu (17) and Maharashtra
(14), wheereas 11 States/ UTs have reported nil AEFI death. The State/UT-wise distribution of AEFI
deaths for those who have reported AEFI deaths in HMIS during 2019-20 is shown in Figure 7.8.
The details of AEFI cases is given in Annexure 7.6.
Figure 7.8: State/UT-wise Distribution of AEFI Deaths Reported in HMIS during 2019-20
Gujarat, Meghalaya,
Haryana, Punjab,
6 5 Bihar
Jharkhand, 8 5
10 Bihar,
West Bengal
Telangana, 52 Assam
11 Uttar Pradesh
Odisha,
11
Karnataka
Delhi,
West Bengal,
Kerala
11
36 Tamil Nadu
Maharashtra,
14
Maharashtra
Delhi
Tamil Nadu, Assam, Odisha
17 29
Telangana
Kerala,
26
Jharkhand
Karnataka,
28 Uttar Pradesh, Haryana
29
80
Chapter 8 Mortality and Morbidity
CHAPTER 8
MORTALITY AND MORBIDITY
Morbidity and Mortality describe the frequency & severity of specific illness/ conditions. There
is often a confusion between these two terms and are also studied in close conjunction with each
other. Morbidity refers to disease states, while mortality refers to death.
Morbidity and mortality are the two measures commonly used for epidemiological surveillance.
These two measures describe the progression and severity of a given population. They are useful
tools to learn about the risk factors of disease compare and contrast the health events between
different populations.
Mortality
Mortality refers to the state of being mortal.
HMIS captures data on Mortality age wise and cause wise. The data is captured under the
following heads:
1. Infants upto 24 hours of age
2. Infant Deaths up to 4 weeks
3. Infant Deaths 1 -12 months
4. Child Deaths 1-5 years
5. Adolescent / Adult death
6. Maternal Deaths
7. Deaths due Vector Borne Diseases
Infant Deaths
Death of a child before his or her first birthday is known as an Infant death. The rate of infant
deaths gives us key information about maternal and infant health, the infant mortality rate is an
important marker of the overall health of a society.
Based on HMIS data uploaded by States/ UT during 2019-20 it is seen that based on the age
group when the infant dies, it is seen that maximum deaths (54%) are occurring upto 1 month or 4
weeks of birth, followed by infant deaths (27%) 1-12 months and then infant deaths (19%) within 24
hours.
81
Mortality and Morbidity Chapter 8
Figure 8.1 showing Infant deaths by age group.
Infant Deaths by Age Group

Infant Deaths
within 24 hours
Infant 19%
Deaths 1 -12
months
27%
Infant Deaths up
to 4 weeks
54%
Infant Deaths upto 1 month (4 weeks)

As per 2019-20 HMIS data, Infant deaths occurring up to 4 weeks of age excluding the deaths
within 24 hours are being reported for two main cause i.e. sepsis and Asphyxia, rest all the deaths
are reported under other causes. Asphyxia (21%) is the major reason for Infant deaths in this age
group, followed by Sepsis being (16%).
Figure: 8.2 showing Infant deaths upto 4 weeks by age by cause.
Infant Deaths up to 4 weeks of

age- By Cause
Sepsis
16%
Other Asphyxia
causes 21%
63%
Infant Deaths (1 -12 months)

For deaths in infants aged between 1 month and 12 months, Other causes contribute 75%,
followed by Pneumonia(17%), fever related (5%), Diarrhoea (2%) and Measles (1%).
82
Figure: 8.3 showing Infant deaths 1-12 months by cause.
Number of Infant Deaths (1 -12 months)- By Cause
Diarrhoea Measles
2% 1%
Pneumonia
17% Fever related
5%
Other Causes
75%
Child Deaths
Deaths of children aged 1 year to 5 years is captured in HMIS under 4 causes and others causes
clubbed together. Various causes as captured in HMIS are:
 Pneumonia
 Diarrhoea
 Fever related
 Measles
 Others
Maximum Deaths in the age group 1 yr to 5 yrs children have been reported due to
Pneumonia (7%) followed by Fever (7%), diarrhoea (2%) and Measles (1%).
Figure: 8.4 showing Infant deaths 1-5 years of age by cause.
Child Deaths (1 -5 years)

of age- By Cause Diarrhoea
Pneumonia
2%
10%
Fever related
7%
Measles
1%
Others
80%
Maternal Deaths
A maternal death is the death of a woman while pregnant or within 42 days of termination of
pregnancy, irrespective of the duration and the site of the pregnancy, from any cause related to or
aggravated by the pregnancy or its management, but not from accidental or incidental causes.
83
Figure: 8.5 showing maternal deaths by cause.
Maternal Death - By Cause

High fever
3%
Abortion
Bleeding 1%
15% Obstructed/prolonge
d labour
2%
Other Causes Severe
(including causes hypertesnion/fits
not known) 10%
69%
Facility Based Maternal Deaths Review

Any maternal death which occurred in the hospital should be immediately investigated within
24hrs by the Medical officer who had treated the mother and was on duty at the time of occurrence
of death using the Facility Based Maternal Death Review (FBMDR). Based on data reported by
States during 2019-20 Facility Based Maternal Death Review has been done only for 28% of
maternal deaths. Every maternal death that occurs within a facility should systematically review and
reported in HMIS. This will improve the quality of safe motherhood programming to prevent future
maternal and neonatal morbidity and mortality.
Figure: 8.6 Showing Maternal Death Reviews Done Vs. Total Maternal Deaths
Maternal Death Reviews Done Vs. Total Maternal

Deaths
25000
20000
19283
15000
10000
5000
5554
0
Total Maternal Deaths Total Facility Based Maternal Death Reviews
(FBMDR) done
84
Adolescent/Adult Deaths
Adolescent/Adult Deaths other than Maternal Deaths are being captured in HMIS. For various
causes viz. Diarrhoeal diseases, Tuberculosis, Respiratory diseases, Including infections (other than
TB), Other Fever Related, HIV/AIDS, Heart disease/Hypertension related, Cancer, Neurological
disease including strokes, Accidents/Burn cases, Suicide, Animal bites and stings Apart from this
data is also captured for Known Acute Disease, Known Chronic Disease and Causes not known.
Figure: 8.7 showing adult/adolescent deaths by cause.
Respiratory
Adult/ Adolscent Deaths- By Cause diseases
including
Animal bites and Diarrhoeal infections
stings diseases Tuberculosis
3% (other than TB)
1% 1% 11%
Accidents/Burn
Suicide 6%
cases
11%
Other Fever
Related
4%
Neurologica
l disease HIV/AIDS
including 1%
strokes Heart
12% disease/Hypertensi
on related
40%
Cancer
10%
Deaths due to Vector Borne Diseases

Deaths due to Vector Borne Diseases is being captured for Malaria- Plasmodium Vivax,
Malaria- Plasmodium Falciparum, Kala Azar, Dengue, Acute Encephelitis Syndrome (AES)
and Japanese Encephalitis (JE). Based on 2019-20 data reported by States/ Uts on the HMIS portal
Approximately half of the deaths are being reported due to Malaria –Plasmodium Faciparum,
followed by Plasmodium Vivax (16%) and AES (15%) Rest JE and Dengue contribute to less than
10% of deaths, Kalaazar being the minimal.
85
Figure: 8.8 showing deaths due to vector borne diseases.
Deaths due to Vector Borne Diseases

Japanese
Encephalitis (JE)
9%
Malaria-
Plasmodium Vivax
Acute Encephelitis 16%
Syndrome (AES)
15%
Dengue
Kala Azar
8%
0%
Malaria-
Plasmodium
Falciparum
52%
Morbidity
Morbidity is any physical or psychological state considered to be outside the realm of normal
well-being. The term is often used to describe illness, impairment, or degradation of health.
Morbidity is often used in discussing chronic and age-related diseases, which can worsen over time
and impact your quality of life. In addition, the higher a person's morbidity, the shorter the expected
lifespan compared to healthy individuals. However, morbidity doesn't necessarily mean that your ill-
health is immediately life-threatening. Over time, if an illness progresses it may increase your risk of
mortality.
Child Morbidity
Morbidity and mortality from childhood illnesses is an important determinant to the health of the
population of a country. Malaria, respiratory tract infection and diarrheal diseases are the leading
causes of childhood morbidity and mortality.
In HMIS data is being captured for 12 childhood diseases treated in OPD (Pneumonia, Asthma,
Sepsis, Diphtheria, Pertussis, Tetanus Neonatorum, Tuberculosis, Acute Flaccid Paralysis(AFP),
Measles, Malaria, Severe Acute Malnutrition) and 2 Childhood Diseases treated in IPD (ARI and
Diarrhoea).
For the diseases treated in OPD, Diarrhoea remains to be the biggest cause. Among childhood
diseases other than Diarrhoea treated in OPD, Pneumonia occurrence is the most, followed by
Asthma and SAM. Percentage occurrence of rest all the diseases is less than 10%.
86
Figure: 8.9 showing percentage of childhood morbidity.
Severe Acute Childhood Diseases

Measles Malnutrition
1% (SAM)
Acute Flaccid 13%
Paralysis(AFP) Malaria Pneumonia
1% 9% 45%
Tuberculosis (TB)
2%
Tetanus Sepsis
Neonatorum 9%
0%
Pertussis
0%
Diphtheria
0%
Asthma 20%
Adult Morbidity
In HMIS morbidity data is captured for outpatients and inpatients.
Outpatients: For outpatients the data is being captured for Diabetes, Hypertension, Stroke
(Paralysis), Acute Heart Diseases, Mental illness, Epilepsy, Ophthalmic Related, Dental and
Oncology.
Figure: 8.10 showing percentage of Adult OPD by cause.
Outpatient- By Cause
Mental illness Epilepsy Oncology
Acute Heart Diseases
7% 1% 2%
3%
Stroke (Paralysis)
1% Diabetes
40%
Hypertension
46%
87
As far as disease occurrence is concerned, maximum OPD cases were related to Hypertension
(46%) and Diabetes (40%), rest all the disease are occurring less than 10%.
OPD Number of Patients
Dental 29045090
Ophthalmic Related 32586578
However, total OPD has shown an increasing trend over years

Figure: 8.11 showing trend of OPD attendance from 2015-16 to 2019-20.
OPD- Attendance (In Lakhs)
17215 17823
16035
14974
13362
33.38% Increase
2015-16 2016-17 2017-18 2018-19 2019-20
Same trend can be seen for OPD Allopathic as well as Ayush

Figure: 8.12 showing trend of Allopathic OPD attendance from 2015-16 to 2019-20.
OPD Allopathic (In Lakhs)
16073 16668
14929
14141
12592
2015-16 2016-17 2017-18 2018-19 2019-20
88
Figure: 8.13 showing trend of AYUSH OPD attendance from 2015-16 to 2019-20.
OPD Ayush (In Lakhs)
1107 1142 1155
832
770
2015-16 2016-17 2017-18 2018-19 2019-20
* A sudden increase is seen in year 2017-18, because of the change in data element.
Inpatients:
For patients admitted in hospital, data is being captured for Malaria, Dengue, Typhoid, Asthma,
Chronic Obstructive Pulmonary Disease (COPD), Respiratory infections, Tuberculosis, Pyrexia of
unknown origin (PUO), Diarrhea with dehydration, Hepatitis.
Maximum Admissions 32% are due to Diarrhoea & Pyrexia of unknown origin (PUO), followed
by Asthma which is 20% of total admissions. Rest all are less than 10%.
Overall if we see the trend, inpatient attendance is showing an increase in the total number of
inpatients
89
Figure: 8.14 showing trend of IPD attendance from 2015-16 to 2019-20.
Inpatient Attendance
90000000 83449677
78321205
80000000 75161065
71254630
70000000 62700320
60000000 33.09% Increase
50000000
40000000
30000000
20000000
10000000
0
2015-16 2016-17 2017-18 2018-19 2019-20
90
Chapter 9 Patient Services
CHAPTER 9
PATIENT SERVICES
Patient care refers to the prevention, treatment, and management of illness and the preservation
of physical and mental well-being through services offered by Hospital/health professional. Hospital
Services are the collective activities of all departments and all personnel of the hospital, which end-
up in satisfactory patient care.
IPHS is set of uniform standards envisaged to improve the quality of patient services in the
country. IPHS guidelines will act as the main driver for continuous improvement in quality and
serve as the bench mark for assessing the functional status of health facilities. As per IPHS 2012,
District Hospitals (DH) are expected to provide a set of Essential (Minimum Assured Services)
and Desirable services. Essential services include services include OPD, Indoor and Emergency
Services. Besides these, other services like Newborn Care, Psychiatric services, Physical Medicine
and Rehabilitation services, Accident and Trauma Services, Dialysis services, Anti-retroviral
therapy and Patient Safety and Infection control are desirable set of services. District Hospital
should be in a position not only to provide all basic specialty services but should aim to develop
super-specialty services gradually.
Sub-district (Sub-divisional) hospitals (SDH) are below the district and above the block level
(CHC) hospitals, they act as First Referral Units for the Tehsil/Taluk/block population in which
they are geographically located. Specialist services are provided through these Sub district hospitals
and they receive referred cases from neighboring CHCs, PHCs and SCs. They have an important
role to play as First Referral Units in providing emergency obstetrics care and neonatal care and help
in bringing down the Maternal Mortality and Infant Mortality.
Community Health Centres (CHCs) constitute the secondary level of health care and provide
referral as well as specialist health care to the rural population. All essential services as envisaged in
the CHC should be made available, which includes routine and emergency care in Surgery,
Medicine, Obstetrics and Gynaecology, Paediatrics, Dental and AYUSH in addition to all the
National Health Programmes.
Primary Health Centres (PHCs) are the cornerstone of rural health services- a first port of call
to a qualified doctor of the public sector in rural areas for the sick and those who directly report or
referred from Sub-Centres for curative, preventive and promotive health care. It acts as a referral
unit for Sub-Centres and refer out cases to Community Health Centres (CHC).
Health Management Information System (HMIS) captures 60 data elements related to the
patient services which includes Out Patient Department (OPD) by disease/ health condition,
Outpatient attendance- Allopathic and AYUSH, Inpatient, Inpatient by disease/ health condition,
Emergency admissions, Operations (excluding C-section) which include Operation major (General
and spinal anaesthesia), Operation minor (No or local anaesthesia), Laboratory Services etc.
9.1 Out Patient Services

Out Patient Department (OPD): An outpatient is one who receive medical attention at a hospital
without getting admitted to the facility; he/she does not spend a night in the hospital. Designated
place where these services are provided in a hospital is called out patient department. OPD services
91
Patient Services Chapter 9
are the essential service to be provided by health care facilities, on all days except on holidays. It
caters for all ambulatory patients who come to hospital for diagnosis, treatment, follow-up.
An OPD is the first point of contact with the hospital. It is a link in the chain of various
departments of healthcare facilities. It contributes to the reduction in morbidity and mortality by
early diagnosis and treatment. It is a good platform for health promotion and disease prevention as
target population is easily available.
9.1.1 HMIS captures data related to Out Patient Department (OPD) for Allopathic and AYUSH
at health facility level. The trend of OPDs in India shows that there is continuous increase in the
OPDs reported from 2015-16 to 2019-20. Total OPD reported during 2019-20 on HMIS has shown
an increase of 33% since 2015-16. National trend of OPD services for last five years is provided at
Figure 9.1.
Figure 9.1: Trend of OPD (in crore) from 2015-16 and 2019-20- All INDIA
200
178.2
180 172.1
160.4
160 149.7
140 133.6
120
100
80
60
40
20
0
2015-16 2016-17 2017-18 2018-19 2019-20
The States/UTs like Manipur, Odisha, and A & N Islands have reported maximum number of
increase in OPD data since FY 2017-18. While some States like Gujarat, Puducherry, & Sikkim
have shown a decline provided in Annexure-9.1.
9.1.2 Percentage of Out Patient Department data reported based on the place of living- Rural
& Urban
In HMIS both rural and urban area report data according to the location of the facility. Data
reported during FY 2019-20 shows that OPDs reported from rural area were 80% of out of the total
Out Patient data reported for urban and rural area. The detail provided at Figure 9.2.
92
Figure 9.2: OPDs Rural Vs Urban: All India and States/UTs (FY 2018-19)
100%
80%
60%
40%
20%
0%
Goa
Bihar
Gujarat
Haryana
Rajasthan
Sikkim
Telangana
Daman & Diu
Delhi
Meghalaya
Tripura
Uttarakhand
Kerala
Madhya Pradesh
Uttar Pradesh
All India
A & N Islands
Chandigarh
Karnataka
Lakshadweep
Maharashtra
Manipur
Nagaland
Odisha
Puducherry
Punjab
Tamil Nadu
West Bengal
Andhra Pradesh
Assam
Chhattisgarh
Himachal Pradesh
Jammu & Kashmir
Jharkhand
Mizoram
Arunachal Pradesh
Total OPD(Rural) Total OPD(Urban)
9.2 Inpatient Services

The Indoor Patient Department: The inpatient services are very important services of the
health care system. It commences when the patient is being registered and allotted bed in the ward
and deals with the treatment and services provided to patient there. Inpatient care refers to medical
treatment that is provided in a facility and requires at least one overnight stay. Most of the IPDs are
from OPD department, as per HMIS data the percentage of IPD to OPD in India reported during FY
2019-20 is 5%, States/UTs with the higher percentage than National average shown in Figure 9.3:
Figure 9.3: States/UTs wise percentage IPD to OPD (FY 2019-20)
10 9
9
8
7
6 5
5
4
3
2
1
0
Dadra & Nagar…
Karnataka
Mizoram
Maharashtra
Gujarat
Manipur
Tamil Nadu
Chandigarh
Kerala
Daman & Diu
Tripura
Puducherry
Madhya Pradesh
All India
Goa
Jammu & Kashmir
Haryana
Sikkim
Nagaland
Meghalaya
Chhattisgarh
Odisha
Himachal Pradesh
Andhra Pradesh
Assam
Telangana
Uttarakhand
Delhi
A & N Islands
Lakshadweep
Bihar
West Bengal
Jharkhand
Uttar Pradesh
Rajasthan
Punjab
Arunachal Pradesh
9.2.1 Inpatient Deaths to total Inpatients reported

Inpatient deaths refers to the death occurring during the hospital stay. As per data reported on
HMIS during FY 2019-20 the IPD deaths to total IPDs is 0.8% and States/UTs wise details are given
in Figure 9.4.
93
Figure 9.4: States/UTs wise Percentage IPD to total projected Population Vs
Percentage IPD Deaths to total IPDs- FY 2019-20
20
18
16
14
12 6
10
8
6
4
2
0
Mizoram
Karnataka
Kerala
Manipur
Tamil Nadu
Daman & Diu
All India
Gujarat
Maharashtra
Odisha
Chandigarh
Chhattisgarh
Jammu & Kashmir
Puducherry
Meghalaya
Sikkim
Tripura
Andhra Pradesh
Assam
Delhi
Goa
Himachal Pradesh
Madhya Pradesh
Haryana
Nagaland
A & N Islands
Telangana
Bihar
Jharkhand
Lakshadweep
Rajasthan
Uttarakhand
Punjab
Uttar Pradesh
West Bengal
Arunachal Pradesh
0.8
IPD per Population % Inpatient Deaths to Total IPD
States/UTs wise percentage IPD deaths to total IPDs for FY 2019-20 is given in Figure 9.5. UT of
Chandigarh reported more than 4 % of deaths.
Figure 9.5: States/UTs wise Percentage IPD deaths to total IPDs- FY 2019-20
4.5 4.3
4.0
3.5
3.0
2.5
2.0
1.5
1.0 0.8
0.5
0.0
Odisha
A & N Islands
Delhi
West Bengal
Nagaland
Sikkim
Assam
Jharkhand
Bihar
Jammu & Kashmir

Mizoram
Andhra Pradesh
Meghalaya
Puducherry
Maharashtra
Uttar Pradesh
Uttarakhand
Haryana
Daman & Diu
Madhya Pradesh
Gujarat
Lakshadweep
Telangana
Chhattisgarh
Goa
Kerala
Arunachal Pradesh
Manipur
Karnataka
Rajasthan
Tamil Nadu
Himachal Pradesh
Chandigarh
Tripura
All India
Punjab
9.2.2 Trend of In-Patient headcount

In patient headcounts are the total numbers of in-patients admitted in the facilities and present at
midnight. Mid-night count is conducted on daily basis which is cumulated at month end and reported
in HMIS. In India, the total Inpatient Head Count at midnight reported from last three years shows
an increase in each year and the total percentage change since FY 2017-18 is 14%. The detail of
trend of In-patient head count reported at mid-night during last three years is given at Figure 9.6.
94
Figure 9.6: Trend of In-Patient Head Count reported at mid-night during
last 3 years at All India
12.9 Cr
12.2 Cr
11.4 Cr
2017-18 2018-19 2019-20

The States/UTs like Manipur, Dadar & Nagar Haveli and Jharkhand have reported maximum
increase in In-Patient headcount data since FY 2017-18. While some States like Puducherry,
Himachal Pradesh & Chandigarh have shown a decline provided in Annexure-9.2.
9.3 Emergency Department

Emergency Department (ED) or casualty in the hospital offers comprehensive emergency care
24 hours a day on all the days in a clean safe environment, especially for those who are suffering
from sudden acute illness or who are the victims of severe trauma. It caters to all ages who require
emergency care. An emergency is sudden illness or injury requiring immediate physician’s attention
to prevent the danger of disability and death.
There are 7 data items which are captured in HMIS related to Emergency admissions. These
include Trauma (accident, injury, poisoning etc), Burn, Obstetrics complications, Snake Bite, Acute
Cardiac Emergencies, CVA (Cardiovascular Disease) and Number of deaths occurring at Emergency
Department.
9.3.1 Trauma Cases
Trauma refers to physical injuries of sudden onset and severity, which require immediate
medical attention. Trauma Cases out of total registrations in Emergency Department reported by
States/UTs during FY 2019-20 are shown in Figure 9.7. The State of Rajasthan has reported highest
percentage for Trauma i.e. 47 per cent. Whereas the All India average is 8%.
95
Figure 9.7: Percentage Emergency - Trauma (accident, injury, poisoning etc.) to
Total Registrations FY 2019-20
50 47%
45
40
35
30 22%
25 20%
20
15
8%
10
5
0
Karnataka
Mizoram
Kerala
Tamil Nadu
Manipur
Gujarat
Daman & Diu
Maharashtra
Puducherry
Chhattisgarh
All India
Madhya Pradesh
Sikkim
Jammu & Kashmir

Odisha
Goa
Tripura
Chandigarh
Himachal Pradesh
Meghalaya
Telangana
Assam
Andhra Pradesh
Nagaland
A & N Islands
Delhi
Lakshadweep
Haryana
Rajasthan
Jharkhand
Uttarakhand
Bihar
West Bengal
Uttar Pradesh
Punjab
Arunachal Pradesh
When data reported on deaths in emergency department compared with total registrations in
emergency department during FY 2019-20, it shows that UT Chandigarh has reported highest
number of deaths. The Figure 9.8 shows percentage deaths out of total emergency registration for
States reported more than 1%.
Figure 9.8: Percentage Deaths out of total registration In Emergency Department
(FY 2019-20)
1.4 1.3
1.2 1.1 1.1
1.0
1.0
0.8
0.6
0.4
0.2
0.0
Chandigarh Gujarat Chhattisgarh Rajasthan
9.4. Surgeries
Surgery is the branch of medicine that deals with the physical manipulation of bodily structure to
diagnose, prevent or cure diseases. Due to increase in traumatic injuries, cancers, and many other
diseases, surgical interventions on public health systems is also growing. Also at many instances,
surgeries are the only intervention that alleviates disabilities and reduce the risk of deaths from
various ailments.
Generally the patients are referred to District Hospitals or FRUs for surgical treatment related to
trauma, obstetric, abdominal, orthopedic emergencies etc. Therefore, surgical department should
have surgical specialists available in these facilities for providing quality of surgical and acute care
to patients. If there is, unavailability of apparatus, drugs, and various other essential supplies, it
limits the good quality of surgical care. This leads to mortalities resulting from trauma, obstetric
96
complications and non-traumatic surgical disorders as well as disability resulting from injury.
District hospitals & FRUs should be able to manage all common surgical and obstetric procedures.
Data reported on HMIS for FY 2019-20 shows that an average of 362 Major Surgeries per lakh
population are being conducted in India. However, State/UT wise data shows that many States/UTs
including Rajasthan, Odisha, Madhya reported less than national average while Chandigarh has
reported 4864 Major operations per lakh population which is the highest in the country. Figure 9.9.
shows State wise Major Surgeries per lakh population (FY 2019-20).
Figure 9.9: Major Operations per Lakh Population (FY 2019-20)
6000
4864
5000
4000
3000
2000
1000 362
0
Mizoram
Tamil Nadu
Kerala
Karnataka
Manipur
Daman & Diu
Chandigarh
Puducherry
Jammu & Kashmir
Tripura
All India
Maharashtra
Gujarat
Delhi
Himachal Pradesh
Goa
Assam
Madhya Pradesh
Nagaland
Meghalaya
Rajasthan
Andhra Pradesh
Lakshadweep
Odisha
Haryana
Chhattisgarh
Sikkim
A & N Islands
Telangana
Jharkhand
Bihar
Uttarakhand
West Bengal
Punjab
Uttar Pradesh
Arunachal Pradesh
9.5 Blood Bank

Blood Bank and transfusion services are the essential services to be provided by district hospitals
as per IPHS 2012. Blood bank should be in close proximity to pathology department and at an
accessible distance to operation theatre, intensive care units and emergency and accident department.
In addition, it should follow all existing guidelines and fulfil all requirements as per the various acts
pertaining to setting up of the Blood Bank. The blood bank is lifesaving during emergencies.
Complications during pregnancy and childbirth, severe anemia in childhood, trauma etc. requires
urgent blood transfusion.
Demand-supply gap for blood units persists in India and facilities are largely dependent on
replacement donors due to poor blood collections from camps. Blood Units issued on Replacement
is a condition when the blood is provided to patient only after patient’s relative/ friend donated
blood.
The percentage of blood units issued on replacement to total blood units issued during FY 2019-
20 is greater than 50% in Manipur, Meghalaya, Arunachal Pradesh, Jharkhand, Kashmir and
Bihar as per data reported on HMIS. All India average is 19% for the Blood Units Issued on
replacement to total blood units issued.
In addition, it is observed that Tamil Nadu and Lakshadweep have reported nil blood units issued
on replacement to total blood units issued in the FY 2019-20. The detail Percentage of Blood Units
Issued on replacement to total blood units issued during FY 2019-20 provided at Figure 9.11.
97
0
10
20
30
40
50
60
70
80
Manipur 90 81 80
Meghalaya
Patient Services
72
Jharkhand
Jammu & Kashmir
53 52
Bihar
Assam
48 45
Chhattisgarh
Rajasthan
43 41
Madhya Pradesh
Goa
37 35
Tripura
30
Odisha
Delhi
26 22
Nagaland
Puducherry
Kerala
98
21 21 19
All India
Telangana
Uttar Pradesh
(FY 2019-20)
Andhra Pradesh
17 16 16 13
West Bengal
Daman & Diu
Uttarakhand
Karnataka
13 11 10 10 9
Himachal Pradesh
Mizoram
Chandigarh
8 8 5
Haryana
Sikkim
Gujarat
Punjab
A & N Islands
4 4 3 1 1
Maharashtra
Figure 9.11: Percentage Blood Units Issued on replacement to total blood units issued
Tamil Nadu
0 0
Lakshadweep
Chapter 9
Chapter 10 Diagnostic Service – Lab & Radiology
CHAPTER 10
DIAGNOSTIC SERVICE – LAB & RADIOLOGY
Diagnosis is the first step to disease management, as without accurate identification there is no
possibility for accurate treatment. It is a medical procedure that involves testing a sample of blood,
urine, or other substance from the body. Diagnostic services facilitate the provision of timely, cost
effective & high quality diagnostic care in a safe & secure environment. It includes Clinical services
of Pathology, Laboratory, medicine, radiology & nuclear medicine. Diagnostics are an integral part
of the health care system and provide information needed by service providers to make informed
decisions about care provision related to prevention, screening, detection, treatment and
management.
Limited availability and access to quality laboratory and radiology services are among the major
challenges contributing to delayed or inappropriate responses to disease control and patient
management. Currently HMIS captures data related to diagnostics services related of various
procedures. The same may be classified in to tests for Pregnant women and others
10.1 Laboratory Tests for Pregnant Women

Haemoglobin testing during Pregnancy
Hb estimation is one of the important component of ANC. Anaemia in pregnancy is associated
with PPH, neural tube defects, low birth weight, premature births, still births & Maternal Deaths.
Mild anemia is common during pregnancy, whereas, severe anemia may result from from low iron
or vitamin levels or from other reasons. If such cases are detected well in time, interventions to
improve the haemoglobin levels may be initiated well in time.
Based on the data reported by States/ UTs on HMIS during 2019-20, it is seen that around 75%
of pregnant women were tested and found anaemic. Out of this 95% pregnant women have mild
anaemia, whereas 5% have severe anaemia.
Figure: 10.1 Showing Pregnant Women Tested For Anaemia
Pregnant women tested for anaemia
PW having Hb
level<7 (tested cases)
PW having Hb
5%
level<11 (tested cases)
10.9)
(7.1 to
95%
99
Diagnostic Service – Lab & Radiology Chapter 10
Figure: 10.2 Showing Severity of Anaemia In Pregnancy Among Women Reported In HMIS.
Testing of Haemoglobin in Pregnancy

35000000
29022447 75%
30000000
25000000 21930330
20848129
20000000
15000000
10000000
5000000
1082201
0
Total pregnant women PW having Hb level<11 PW having Hb level<7 Total Tested and found
registered for ANC (tested cases)(7.1 to 10.9) (tested cases) Anaemic
Blood Sugar Testing during pregnancy

Pregnant, women who have never had diabetes before but develop high blood glucose levels in
pregnancy may be diagnosed as having gestational diabetes, according to the American Diabetes
Association. In such cases the blood glucose level (blood sugar) of the mother stays high
(hyperglycemia) because she is unable to make and use all the insulin needed to support the
demands of the pregnancy.
The OGTT (Oral Glucose Tolerance Test) is gold standard for diagnosis of Gestational Diabetes
Milletus (GDM) is done between 24 and 28 weeks of pregnancy. If a pregnant woman had a history
of gestational diabetes before, an OGTT is done at the time of registration and then another OGTT at
24 to 28 weeks if the first test is normal.
Based on the data reported on HMIS during 2019-20, 4642479 pregnant women out of the total
registered pregnant women i.e. 29022447 which is 16% were tested for Blood sugar using OGTT.
Figure: 10.3 Showing Maternal Diabetes During Pregnancy.
PW Tested for Blood Sugar using OGTT
30000000
20000000
29022447
10000000
4642479
142852
0
Number of pregnant PW tested for blood Number of PW tested
women registered for sugar using OGTT positive for GDM
ANC
100
At all India level out of those who were tested 3% were found to be positive for gestational
diabetes. Assam has reported the highest rate (31.8%) of PW found positive for Gestational diabetes
whereas Daman & Diu has reported lowest rate (0.08%).
Figure: 10.4 Prevalence of Gestational Diabetes By States.
Out of those tested, PW found positive for Gestational Diabetes-

States reporting above India level
35.00 31.78
30.00
25.00
20.00 17.57 16.03
15.00 11.98
9.32
10.00 6.28 5.16 5.06 4.77 4.17 4.13 3.72 3.56 3.08
5.00
0.00
Out of those tested, PW found positive
Figure: 10.5 Prevalence of Gestational Diabetes by States in Ascending Order.
Out of those tested, PW found positive for Gestational Diabetes-

States reporting below India level
3.50
3.00
2.50
2.00
1.50
1.00
0.50
0.00
Out of those tested, PW found positive
Syphillis Testing during pregnancy

Syphilis is caused by the spirochete Treponema pallidum subspecies pallidum, which is of
particular concern during pregnancy because of the risk of trans-placental infection to the foetus.
Stillbirths and early childhood mortality due to syphilis are continually being reported each year.
World Health Organization (WHO) estimated that up to 1.5 million cases of syphilis in pregnancy
occurs each year. Timely diagnosis and proper management of the infection in the pregnant woman
are important in order to prevent adverse outcome. Syphilis in pregnancy remains an important
medical condition due to its consequences. Timely diagnosis and treatment of the disease is
therefore very important.
101
As per the data reported by States/UTs only 0.13% Pregnant women were found to be sero
positive for syphilis (Annexure 10.1).
Figure-10.6 Sero-prevalence of pregnant women for syphilis
ANC Registration and PW found sero positive

35000000
29022447
30000000
25000000
20000000
15000000
10000000
5000000
39117
0
Total pregnant women registered for ANC Pregnant women tested found sero positive for
Syphilis
Total Lab tests Vs. Total OPD

Diagnostic services are an important component of the package of services required for the patients
who are visiting the health facility for OPD services and for the inpatients.
Total Number of lab tests conducted has shown increasing trends over years.
Figure-10.7 Showing Trend of Annual Increase of Laboratory Investigation All India.
Total Lab Tests (In Lakhs)
9031
10000 7719
5859
8000
6000
4000
2000
0
2017-18 2018-19 2019-20
a. Lab Tests & OPD

At National level, around 178 crore Out Patients (Allopathic and Ayush) were attended, whereas
around 90 crore lab tests were conducted i.e 51% of Out Patients were provided with diagnostic
services during 2019-20 (Annexure: 10.2).
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18 States have reported higher than the national average of 50.67% and rest have reported less than
national average. Chandigarh, Mizoram and Punjab are reporting 100% Lab tests as compared to
outpatients.
Figure-10.8 Showing Percentage of Laboratory Investigations to the
Total OPD by States Reporting Above National Average.
% Lab Test to Total OPD

States Reporting above Nationl Average
120.00
100.00
80.00
60.00 50.67
40.00
20.00
0.00
Among the states which have reported less than national average, Bihar has reported the least i.e.
11.42% followed by Arunachal Pradesh which is 19.12%, rest all have reported above 20% lab tests
when compared to Outpatients.
Figure-10.9 Showing Percentage of Laboratory Investigations to the Total OPD by
States Reporting below National Average.
% Lab Test to Total OPD

States Reporting below Nationl Average
60.00
50.00
40.00
30.00
20.00
10.00
0.00
a. Lab Tests & OPD + IPD

On the other hand, if Lab tests are compared with total patient-load of the facility i.e. both out-
patient and in-patient, a similar trend is seen with 48% of the patients (both out-patient and in-
patient), having received lab services during 2019-20.
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Figure-10.10 Showing patient load vs laboratory investigations.
Patient Load Vs. Lab Tests (in Lakhs)

18000 16668
16000
14000
12000
10000 9031
8000
6000
4000
2000 1155 834
0
Allopathic- Outpatient Ayush - Outpatient Inpatients Number of Lab Tests
attendance attendance done
10.2 Lab Tests – By Type

Apart from total number of lab tests, HMIS is capturing individual lab tests data for:
1. Haemoglobin
2. HIV
3. Syphillis
4. Widal
5. Malaria
6. Kala Azar
7. Japanese Encephalitis.
Figure-10.11 Showing Percentage of Laboratory Investigations By Type.
Kala
Azar Lab Tests - By Type JE
0% 0%
Mal`aria
36%
Haemoglobin
40%
Widal
5% Syphillis
5% HIV 14%
Maximum number of tests have been conducted for haemoglobin (40%) followed by Malaria
(36%), then HIV (14%), Widal and Syphillis being 5% only and Kala Azar and JE are less than 1%.
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Haemoglobin Testing
A haemoglobin test measures the levels of haemoglobin in the blood. Haemoglobin is a protein
in the red blood cells that carries oxygen from lungs to the rest of the body. If the haemoglobin
levels are abnormal, it may be a sign of disorder in the body.
12.58 crore haemoglobin tests have been conducted across the country in 2019-20, out of which
37 lakhs i.e. 2.97% cases have been found to be anaemic with hb < 7 mg. 13 states have reported
higher than national average, with Chandigarh being the highest at 6.59%, followed by Telangana at
6.26%.
Figure-10.12 Showing Percentage of Anaemic With Hb 7 Mg/Dl.
By State Reporting Above National Average.
% Haemoglobin 7 mg
(States reporting above National Average)
7.00
6.00
5.00
4.00 2.97
3.00
2.00
1.00
0.00
Rest of the States have reported less than the national average of 2.97%, Kerala and Lakshadweep
reporting less than 1% hb < 7mg (Annexure 10.3).
Figure-10.13 Showing Percentage Of Anaemic With Hb < 7 Mg/Dl.
By State Reporting Below National Average.
% Haemoglobin < 7 mg
(States reporting below National Average)
3.50 2.97
3.00
2.50
2.00
1.50
1.00
0.50
0.00
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HIV Testing
HIV testing, is essential for slowing the spread of HIV infection. It is the only way to know if the
virus is present in the body.
HIV antibody tests finds out for antibodies to HIV in the blood or oral fluid. In general, antibody
tests that use blood from a vein can detect HIV sooner after infection than tests done with blood
from a finger prick or with oral fluid.
At National Level, out of the total HIV tests, maximum were done for Pregnant women,
followed by males and Non ANC Women.
Figure-10.14 Showing Percentage OF HIV Test by Gender.
HIV - Number Tested (by Category)
Male 27%
Pregnant women
49%
Female Non ANC

24%
At National level, 0.85% males have tested positive for HIV, while 0.65% non ANC females
have tested positive for HIV. In case of pregnant women 0.32% have tested positive for HIV
HIV - Number Tested HIV - Number Positive
Male 12039371 102883
Female Non ANC 10797843 70343
Pregnant women 22399303 71358
Although the testing for Pregnant women is the maximum it is seen that positivity rate is the least for
pregnant women i.e. 0.32%. Maximum positivity rate for HIV is seen in Males.
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Figure-10.14 Showing Percentage of Tested Positive For HIV By Gender.
% Tested Positive for HIV
0.85
1.00
0.65
0.80
0.60 0.32
0.40
0.20
0.00
Male Female Non ANC Pregnant women
Syphillis
Syphilis is a sexually transmitted disease (STD). Blood tests can reveal if the body is making the
antibodies to fight the infection. Syphilis tests can help diagnose syphilis in the early stages of
infection, when the disease is easiest to treat. Rapid Plasma Reagin (RPR), a syphilis blood test, that
looks for antibodies to the syphilis bacteria. Venereal Disease Research Laboratory (VDRL) test is
also blood test for Syphilis.
HMIS is capturing data for Male and female tested for syphilis and found to be positive.
At All India level 5.22% Males are found sero positive for Syphillis and 1.48% Non ANC
Female are found to be sero positive for syphilis (Annexure 10.4)
Widal Tests
Widal is a presumptive serological test for enteric fever or undulant fever whereby bacteria
causing typhoid and protozoa causing malaria fever are mixed with a serum containing specific
antibodies obtained from an infected individual.
During 2019-20 at National Level, 14227658 Widal tests were done, out of this 2035455 were
found to be positive, the rate of positivity is 14.31 at National Level. Bihar has reported the highest
positive Widal cases i.e. 30.77%. and Sikkim has reported the lowest i.e 0.49%.
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Figure-10.15 Showing Percentage Of Tested Positive For Widal By States/
UT Reporting Above National Average.
% Widal Positive
(States reporting Above National Average)
40.00
30.00
20.00 14.31
10.00
0.00
Figure-10.16 Showing Percentage of Tested Positive For Widal By States/

UT Reporting below National Average.
% Widal Positive
(States reporting below National Average)
14.31
15.00
10.00
5.00
0.00
Malaria Testing
Malaria is a disease caused by a parasite. The parasite is transmitted to humans through the bites
of infected mosquitoes. People who have malaria usually feel very sick, with a high fever and
shaking chills.
Malaria parasites can be identified by examining under the microscope a drop of the patient's
blood, spread out as a “blood smear” on a microscope slide. Prior to examination, the specimen is
stained (most often with the Giemsa stain) to give the parasites a distinctive appearance.
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Rapid diagnostic test. Also called RDT or antigen testing, is a quick option when blood draws
and smears aren't available. Blood taken from a prick on your finger is put on a test strip that
changes colour to show whether you have malaria or not.
Data for both these tests are captured in HMIS.
Microscopy Test for Malaria
It is seen that for microscopy, at all India level while 99% tested negative for malaria test, out of
those who tested positive 27 % were plasmodium vivax positive and 73% were plasmodium
falciparum positive.
Figure-10.17 Showing Percentage of Malaria positivity by species.
Malaria Test- Microscopy

Plasmodium
Falciparum test
positive, 27%
Plasmodium Vivax test

positive, 73%
Total Blood Smears Examined for Malaria 90638182
Malaria (Microscopy Tests) - Plasmodium 224061

Vivax test positive
Malaria (Microscopy Tests) - Plasmodium 81370

Falciparum test positive
Rapid Diagnostic Test (RDT) for Malaria

While for RDT tests 98% cases tested negative, out of those who tested positive 45 % cases were
plasmodium vivax positive while 55% tested positive for plasmodium falciparum.
RDT conducted for Malaria 22878498
Malaria (RDT) - Plasmodium Vivax test 129075

positive
Malaria (RDT) - Plamodium Falciparum 158038

test positive
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Figure-10.18 Showing Percentage of Malaria positivity by species using
Rapid Diagnostic Tests.
Malaria Test- RDT
Plasmodium
Plamodium Vivax test
Falciparum test positive 45%
positive 55%
Radiology
Radiology is a branch of medicine that uses imaging technology to diagnose and treat disease.
Radiology may be divided into two different areas, diagnostic radiology and interventional
radiology. In HMIS data is being captured Diagnostic Radiology only. This includes Both X-Ray
and Ultrasonography
5.92 crore Radiology tests were conducted across the country during 2019-20 which comprised
of 4.38 crore X rays and 1.54 crore ultrasound examinations.
Figure-10.19 Showing percentage wise distribution of types of Radiological Examination.
Diagnostic Radiology
Ultrasonography
(USG)
26%
X-ray
74%
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Chapter 11 Grading of Health Facilities
CHAPTER 11
The healthcare infrastructure in India consists of Primary, Secondary, and tertiary health care. At
the primary level of health care, it includes sub-centers (SCs), Primary health centers (PHCs) and
community health centers (CHCs). The Sub-district hospitals and District Hospitals come under the
category of Secondary Health care and the tertiary level of health care comprises of the Medical
Colleges.
Despite sharing the same purpose of healing and offering health services for patients, these
health facilities at a different level of healthcare vary significantly in terms of patient type and
services provided. Considering this fact, a set of standards known as Indian Public Health Standards
(IPHS) is defined for each type of health care facility (SC, PHC, CHC, SDH, and DH) to organize
and maintain quality of care as per the requirement.
Different facilities at a similar level of care may have a difference in the quality of care
depending upon the availability and quality of resources. To assess this and monitor the quality of
care provided by CHCs and PHCs of States/UTs, NHM started grading of Community Health Center
(CHC) in 2014-15 and grading of PHCs in 2018-19 based on the data reported on Health
Management Information System (HMIS) which is a web-based portal to facilitate the flow of data
related to physical and financial performance from theHealth Facility to the District level to the State
HQ and the Centre i.e. the MoHFW. The portal provides periodic reports on the status of the health
sector which is fed in by health facilities; hence it plays a key role in monitoring the performance of
health care services by health facilities.
Broadly, as per IPHS, a Primary Health Centre (PHC) covers a population of 20,000 in hilly,
tribal, or difficult areas and 30,000 populations in plain areas staffed by one medical officer (MO)
and other Paramedical staffs. PHC’s provide integrated curative and preventive healthcare to rural
people and promote family welfare services and schemes. It acts as a referral unit for 6 Sub-Centers
and refers cases to Community Health Centers (CHCs-30 bedded hospital) and higher order public
hospitals at sub-district and district hospitals care services.
Community health centers (CHC) are designed to provide referral health care for cases from the
Primary Health Centers level and for cases in need of specialist care approaching the center directly.
A CHC is manned by four medical officers specialized in surgery, General medicine, Obstetrics and
Gynaecology and pediatrician with 21 paramedical officers and other staff. A CHC should have at
least 30 beds, x-ray machine, Operation Theater, delivery room and labs.4 PHCs are included under
each CHC thus catering to approximately 80,000 populations in tribal/hilly/desert areas and 1,20,000
populations for plain areas. CHC is a 30-bedded hospital providing specialist care in Medicine,
Obstetrics and Gynecology, Surgery, Pediatrics, Dental and AYUSH.
Objective of PHC/CHC Grading:
PHC and CHC serves as important link in the primary healthcare ecosystem. It was important to
monitor their quality of care, so NHM institutionalized process of grading of CHC and PHCs.
The main objective of grading was to monitor the health care services rendered by CHCs and
PHCs by continuous assessment of resources, quality of services and providing feedback during
resource allocation. The grading of facilities also invoked a sense of motivation between different
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Grading of Health Facilities Chapter 11
facilities to perform better as it resulted into incentives and disincentives as per facilities’
performance. Grading also provided an insight to NHM for resource allocation to facilities by
depicting the area of service to be improved and an estimation of expenditure to improve care
services for coming financial year.
11.1 Grading of Community Health Center’s

The grading exercise is based on the Infrastructure and MIS data reported by the CHCs on HMIS
Portal.
CHCs are graded based on 6 aspects/categories/ groups,
1. Human Resource availability,
2. Infrastructure availability,
3. Drug & Supplies availability,
4. Service Availability,
5. Client Orientation,
6. Service Utilization.
To start with, CHCs meeting norms on two mandatory categories, viz., Human Resource
availability and Infrastructure availability are only considered for grading, they also get Grade 1 for
it. Those not meeting the norms on two mandatory categories are excluded from the grading exercise
and are labeled as ‘Not Eligible’ (NE).
The CHCs selected for grading are then assigned grades from 1 to 5 using 6 categories, the
details of which are briefed below.
11.1.1 Criteria for Grading of CHCs
For each category there is a defined criterion for the award of grades to the concerned CHC as
given below:
Mandatory Criteria
a) Human Resource Availability
Doctors including specialists >=2
Nurse and ANM >=6
Lab. Technician >=1
b) Infrastructure Availability
Separate public utilities for males and females Yes
Operation Theatre available Yes
Stand-by facility/alternate power resource (generator) Yes
available
Note:
 If a CHC satisfies both the criteria (Human Resources and Infrastructure), CHC is eligible
for Grading & also gets Grade 1.
 CHC is not eligible for Grading and falls under “Not Eligible” (NE) criteria:
1. If a CHC fails to satisfy any of the criteria (Human Resources and Infrastructure).
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2. If a CHC fails to satisfy both of the criteria (Human Resources, Infrastructure) & has
any non-zero value for Human Resources, Infrastructure, Drugs and supplies, Service
availability and Client Orientation.
 If a CHC fails to satisfy both of the criteria (Human Resources, Infrastructure) & also do not
have Drugs and supplies, Service availability and Client Orientation then Grading is not
applicable for CHC & status of CHC will be “NA” (Not Applicable) i.e. for all the items/
parameters considered for grading has either not reported or reported ‘0’.
A. Award of Grades
a. Infrastructure Annual Data
i. Drug & Supply (Grade 1)
Whether two-month supply of essential drugs available? Yes
Whether two-month supply of essential vaccines available? Yes
Whether two-month supply of essential contraceptives Yes
available?
 If a CHC satisfies all the three criteria with “Yes”, CHC gets Grade 1
ii. Service Availability (Grade 1)
24 - hour delivery services including normal and assisted Yes
deliveries
Emergency care of sick children Yes
Essential Laboratory Services (Specify the type of lab tests Yes
conducted)
iii. Client Orientation (Grade 1)
Is there a publicly displayed mechanism, whereby a complaint/grievance can be Yes
registered?
Citizen's charter Yes
Constitution of Rogi Kalyan Samiti (Yes/No) (give a list of office order notifying the Yes
members)
b. Monthly Service Utilization (Grade 1)
Data Element Minimum value/month
Deliveries conducted at the facility (Including C-Sections) 30
Number of new IUCD Insertions at facility 3
BCG 80% of deliveries conducted
In-Patient (IPD) 100
OPD attendance (All) 750
For CHCs falling under “Hilly districts” & “NE States” a relaxation of 30% is provided. Based
on which the “Minimum value/month” is considered as:
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Data Element Minimum value/month
Deliveries conducted at the facility (Including C-Sections) 21
Number of new IUCD Insertions at facility 2
BCG 80% of deliveries conducted
In-Patient (IPD) 70
OPD attendance (All) 525
 If a facility satisfies any 4 or all 5 Service Utilization criteria, it would get Grade 1. Figure
11.1.1 depicts the logic for CHC Grading
Figure 11.1.1: Logic for CHC Grading
11.1.2 Key Findings

There has been a significant improvement in performance of CHCs over the years (2014-15 to
2019-20) wherein percentage of facilities “3 and higher grades” has increased from 15% to 52%
and percentage of “less than 3 grades” also decreased from 7% to 2%.
The said improvement in CHCs having grades of 3 or higher is primarily due to the fact that
majority of the facilities which were not eligible for grading during 2014-15, have exhibited
improvement in performance / upgradation of infrastructure and have become eligible for grading.
The data of such CHCs has declined from 67% to 52% during the same period and percentage of
facilities which were not reporting their data declined from 10% to 2%. (Figure 11.1.2 depicts Trend
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in Percentage of CHC Grading over the Years During 2014-15 to 2019-20). The details of State/UT-
wise details of CHC Grading are attached at Annexure 11.1.
Figure 11.1.2: Trend in Percentage of CHC Grading Over the Years: 2014-15 to 2019-20
Comparative Analysis of CHCs Grading During 2014-15 to 2019-20 across India

Looking at the data of individual grades, it can be seen from Figure 11.1.3 that major
improvement was observed in facilities with higher grades. During 2014-15, only 1% of the facilities
were placed in highest grade (Grade 5) while during 2019-20 this figure improved to 28%.
Similarly, during 2014-15, facilities with grade 4 have increased from 7% to 18%. (Figure 11.1.3
depicts Comparative Analysis of CHCs Grading during 2014-15 to 2019-20 across India)
Figure 11.1.3: Comparative Analysis of CHCs Grading during 2014-15 to 2019-20 across India
2014-15 2019-20
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Percentage of 3 and Higher Grades in FY 2019-20 among Bigger States, Smaller States and
Union Territories
Among 20 bigger States, the performance of 10 States is muchbetter than all-India performance.
The top 4 performing states are;Tamil Nadu (89%), Assam (84%), Andhra Pradesh (77%) &
Karnataka (77%) where more than 80% facilitiesfall under grade “3 and higher grade”. On the other
hand, facilities from Kerala (2%), Uttarakhand (10%), Bihar (19%), Telangana (25%) and Uttar
Pradesh (34%) have poor performing states have percentage (less than 40%) in “3 and higher grade”.
(Figure 11.1.4 depicts Percentage of 3 and Higher Grades in FY 2019-20 among Bigger States)
Figure 11.1.4: Percentage of 3 and Higher Grades in FY 2019-20 among Bigger States
Among 9 smaller States, Goa tops the list with 67% of the facilities having “3 and higher grade”.
Manipur’s performance is 35% which is less than all-India performance while remaining states are
lagging far behind in their performances and need to step up to improve health care in their States.
(Figure 11.1.5 depicts Percentage of 3 and Higher Grades in FY 2019-20 among Smaller States)
Figure 11.1.5: Percentage of 3 and Higher Grades in FY 2019-20 among Smaller States
Among Union Territories (UTs), Chandigarh and Dadra & Nagar Haveli have only 2 facilities in
total and both have secured grading of 3 and higher followed by Puducherry and Andaman &
Nicobar Islands with 75% facilities and Daman & Diu with 50% in “3 and higher grade”. Only
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Lakshadweep has 33% facilities falling under these categories. (Figure 11.1.6 depicts Percentage of
3 and higher grades in FY 2019-20 among Union Territories)
Figure 11.1.6: Percentage of 3 and higher grades in FY 2019-20 among Union Territories
Comparison of Grading of CHCs located in Hilly and non-Hilly areas during 2019-20
Figure 11.1.7 shows that topographical features of the country have its impact on the quality of
health care services being provided. Among non-hilly areas, where around 42% of the facilities are
not eligible, the figure for hilly areas is 63%. Similarly, percentage of facilities from non-hilly areas
(55%) are more than hilly areas (33%) in “3 and higher grade”. (Figure 11.1.7 depicts Comparison
of Grading of CHCs located in Hilly and non-Hilly areas during 2019-20).
Figure 11.1.7: Comparison of Grading of CHCs located in Hilly and non-Hilly
areas during 2019-20
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Facilities not reported data on selected Infrastructure and Service Delivery indicators
As per grading criteria, health facilities which have not reported selected Infrastructure and
Service Delivery data elements are considered in category NA (Not Applicable). For FY 2019-20,
2% (86) facilities have not reported infrastructure data at national level in which highly contributed
State/UTs are Lakshadweep (33%), Uttarakhand (26%) and Bihar (14%).
Facilities not fulfilling mandatory criteria for grading
Based on following mandatory item/parameters considered for grading, most of the facilities
2471 (44%) are “not eligible” for grading. (Table 11.1.1 depicts Number of facilities not fulfilling
mandatory criteria for grading)
Table 11.1.8: Number of facilities not fulfilling mandatory criteria for grading
Human Resource Availability
Mandatory criteria Number of facilities not fulfilling
the mandatory criteria
Doctors including specialists >=2 651
Nurse and ANM >=6 1323
Lab. Technician >=1 561
Infrastructure Availability
Separate public utilities for males and Yes 2194
females
Operation Theatre available Yes 1719
Standby facility (generator) available Yes 1994
States with majority of facilities “Not eligible” for grading were Arunachal Pradesh (90%),
Himachal Pradesh (96%), Kerala (91%), Mizoram (89%), Tripura (86%) and Sikkim (100%).
Based on Infrastructure data uploaded on portal for FY 2019-20, there are 48% facilities which
are not eligible due to “Non availability of Manpower” while 34% facilities are not eligible due to
“Non availability of Infrastructure”. 18% facilities are not eligible because of lack of both manpower
and infrastructure. (Figure 11.1.8 depicts Reasons for Non-eligibility of facility)
Figure 11.1.9: Reasons for Non-eligibility of facility
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11.2 Grading of Primary Health Center’s
The grading exercise is based on the Infrastructure and MIS data reported by the PHCs on HMIS
Portal
PHCs are graded based on 5 aspects/categories,
1. Human Resource availability,
2. Infrastructure & Service Availability
3. Essential Laboratory Services
4. Drug & Supplies availability,
5. Service Utilization/ Performance Indicators.
In short, PHCs meeting norms on mandatory category i.e., Human Resource availability are only
considered for grading and those not meeting the norms on mandatory category (Human Resource
availability) are excluded from the grading exercise and are labeled as ‘Not Eligible’ (NE).
The PHCs selected for grading are then assigned grades from 0 to 5 using all 5 categories, the
details of which are briefed below.
11.2.1 Criteria for Grading of PHCs:
For each category there is a defined criterion for the award of grades to the concerned PHC as given
below:
A. Mandatory Criteria (eligibility criteria)
a. Human Resource availability
i. For rural –
1. Medical Officer >=1
2. Nurse-Midwife (Staff Nurse) >=2
ii. For Urban
1. Medical Officer >=1
2. Nurse-Midwife (Staff Nurse) >=1
 Once PHC satisfies the mandatory criteria only then it is eligible for grading.
B. Infrastructure & Service Availability (Rural and Urban)
Data Element Expected data
Referral Services Yes
Standby facility (Generator) available in working condition Yes
Separate Public utilities for Males & Females Yes
OPD rooms/cubicles Yes
 PHC satisfying 3 out of 4 criteria will get Grade 1
C. Essential Laboratory Services (Rural and Urban)
Routine urine, stool and blood tests Yes
Blood grouping Yes
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Bleeding time, clotting time Yes
Diagnosis of RTI/STDs with wet mounting, grams stain, etc. Yes
Sputum testing for TB Yes
Blood smear examination for malaria parasite Yes
Rapid tests for pregnancy Yes
RPR test for Syphilis / YAWS surveillance Yes
Rapid tests for HIV Yes
 PHC satisfying 6 out of 9 criteria will get Grade 1
D. Drug & Supplies availability (Rural and Urban)
Whether one month supply of essential drugs available? Yes
Whether one month supply of essential vaccines available? Yes
Whether one month supply of essential contraceptives available? Yes
 PHC satisfying all 3 criteria will get Grade 1
E. Service Utilization/ Performance Indicators
Rural Urban
Number of Interval IUCD Insertions +
Number of Postpartum + Number of Post TT2 + TT Booster
Abortion IUCD insertions
Measles+ MR 1st Dose Measles+ MR 1st Dose
IPD Number of new IUCD insertions at facility
OPD attendance (All) Total lab test done
OPD attendance (All)
Criteria for assigning points for service utilization/Performance Indicators for Rural PHCs
In case the facility lies in a Non-Hilly district, then following values would be considered:
Number of Points assigned
new IUCD Measles / MR OPD attendance on fulfilling
IPD
insertions at 1st Dose (All) condition for
facility any indicator
1 to 3 1-3 1 to 25 1-500 1 point
4 to 7 4-6 26 to 50 501-1000 2 points
Range 7 to 9 7-9 51 to 100 1001-1500 3 points
10 and onwards 10 and above 101 and 1501 and
4 points
onwards onwards
Total (1 to 4) (1 to 4) (1 to 4) (1 to 4) (4 to 16)
120
In case the facility lies in a Hilly district, then following values with 30% relaxation would be
considered:
Points assigned
Number of new
Measles + MR OPD attendance on fulfilling
IUCD insertions IPD
1st Dose (All) condition for
at facility
any indicator
1-2 1-2 1-13 1-350 1 point
3-5 3-4 14-35 351-700 2 points
Range
6-7 5-6 36-70 701-1050 3 points
8 onwards 7 and above 71 onwards 1051 onwards 4 points
Total (1 to 4) (1 to 4) (1 to 4) (1 to 4) (4 to 16)
Criteria for assigning points for service utilization/Performance Indicators for Urban PHCs
In case the facility lies in a Non-Hilly district, then following values would be considered:
Points
Number of
OPD assigned on
TT2 + TT new IUCD Measles / Total lab test
attendance fulfilling
Booster insertions at MR 1st Dose done
(All) condition for
facility
any indicator
1-3 1-2 1-3 1-50 1-150 1 point
4-7 3-6 4-6 51-100 151-300 2 points
Range 8-10 7-10 7-9 101-150 301-425 3 points
11 and above 10 and above 426 and above
11 and above 151 and above 4 points
Total (1 to 4) (1 to 4) (1 to 4) (1 to 4) (1 to 4) (5 to 20)
In case the facility lies in a Hilly district, then following values would be considered:
Points
Number of
Measles + OPD assigned on
TT2 + TT new IUCD Total lab test
MR 1st attendance fulfilling
Booster insertions at done
Dose (All) condition for
facility
any indicator
1-2 0-1 1-2 1-35 1-105 1 point
3-5 2-4 3-4 36-70 106-210 2 points
Range
6-7 5-7 5-6 71-105 211-300 3 points
8 and above 8 and above 7 and above 106 and above 301 and above 4 points
Total (1 to 4) (1 to 4) (1 to 4) (1 to 4) (1 to 4) (5 to 20)
11.2.2 Key Findings
Status of PHC Grading across India
As per HMIS data during 2019-20 on PHC grading, it has been observed that 60% of the PHCs are
“Not eligible” for grading. Among graded PHCs majority (17%) are in grade 3, while grade 0, 1, 2,
4 and 5 are 1%, 3%, 7%, 9%, and 3% respectively. (Figure 11.2.1 depicts Status of PHC Grading
across India). (State-wise detailed status is shown at Annexure 11.2)
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Figure 11.2.1: Status of PHC Grading across India 2019-20
Grade 4 and 5 witnessed an increase from 6% to 9% and 2% to 3% respectively during 2019-20

compared to 2018-19 while other grades showed no improvement. (Figure 11.2.2 depicts the
comparative Status of PHC Grading across India)
Figure 11.2.2: Comparative Analysis of PHCs Grading during 2018-19 to 2019-20
Status of PHC grading by Urban/ Rural

In Rural/Urban comparison, 66% of rural PHCs are “Not eligible” for grading while in urban area
30% PHC fall in this category. In rural area only 25% PHCs are in 3 and higher grade, while in
urban area value for this category is 49%. (Figure 11.2.3 depicts Comparison of PHC grading as per
Rural /Urban classification). The details of State/UT-wise Grading of Rural PHCs 2019-20are
provided at Annexure 11.3 and State/UT-wise Grading of Urban PHCs for 2019-20 for Annexure
11.4.
122
Figure 11.2.3: Comparison of PHC grading as per Rural/Urban classification.
Status of PHCs Grading by Hilly and Non- hilly area

Percentage of PHCs in 3 and higher grade is less in hilly area (22 % rural, 33 % Urban) than non-
hilly areas (25 % rural, 50 % Urban) for both rural and urban categories. Percentage of PHCs less
than 3 grades is low in rural hilly (11%) when compared urban hilly areas (45%). There is no major
difference in percentage of “Not eligible” PHCs in rural area for hilly and non-hilly category.
(Figure 11.2.4 depicts PHC Grading as per Hilly &Non-Hilly Area)
Figure 11.2.4: PHC grading as per territory (Hilly and Non hilly)
State wise distribution of PHC grading status

SevenStates/UTs (Mizoram 82%, Dadra & Nagar Haveli 78%, Tamil Nadu 77%, Daman & Diu
75%, Goa 72%, Tripura 71% & Puducherry 70%) were found to have more than 50% PHC which
have grade 3 and higher. For the same seven States/UTs, majority of the facilities from rural area
received the grade 3 and more as compared to urban facilities except Tamil Nadu, Daman & Diu and
Puducherry. 15 States had more than 75% PHC categorized as “not eligible” for grading. (Table
11.2.1 depicts State wise distribution of PHC status)
123
Table 11.2.5: State wise distribution of PHC status
State/UT’s Out of Total PHCs percentage of grading Out of Out of
Rural Total Urban
Total
Grade <3 Grade >=3 Not Eligible Grade >=3 Grade >=3
Mizoram 14% 82% 5% 88% 38%
Dadra & Nagar Haveli 22% 78% 0% 100% 0%
Tamil Nadu 12% 77% 11% 76% 79%
Daman & Diu 25% 75% 0% 67% 100%
Goa 21% 72% 7% 80% 25%
Tripura 18% 71% 12% 74% 0%
Puducherry 23% 70% 8% 68% 73%
Haryana 11% 51% 38% 44% 80%
Rajasthan 14% 49% 37% 50% 45%
Andhra Pradesh 0% 47% 52% 49% 41%
Sikkim 44% 44% 12% 46% 0%
A & N Islands 52% 41% 7% 50% 0%
Assam 11% 40% 49% 39% 68%
Karnataka 6% 39% 55% 33% 77%
Telangana 23% 38% 38% 32% 55%
Delhi 46% 35% 19% 50% 35%
Meghalaya 51% 34% 15% 40% 4%
Gujarat 4% 31% 65% 22% 71%
Jammu & Kashmir 9% 30% 61% 29% 60%
Bihar 4% 26% 70% 26% 25%
Lakshadweep 25% 25% 50% 25%
Manipur 52% 21% 28% 21% 0%
Chhattisgarh 8% 16% 75% 12% 78%
Maharashtra 9% 15% 76% 5% 39%
Uttar Pradesh 7% 15% 79% 8% 49%
Punjab 23% 15% 62% 7% 48%
Madhya Pradesh 0% 15% 85% 12% 38%
Kerala 18% 13% 68% 11% 34%
West Bengal 30% 12% 58% 5% 27%
Ladakh 0% 9% 91% 9%
Uttarakhand 5% 7% 88% 1% 55%
Nagaland 30% 7% 64% 4% 57%
Odisha 5% 7% 89% 2% 69%
Arunachal Pradesh 47% 6% 47% 7% 0%
Jharkhand 13% 6% 81% 4% 17%
Chandigarh 8% 5% 87% 0% 6%
Himachal Pradesh 1% 0% 98% 0% 0%
124
Chapter 12 First Referral Units
CHAPTER 12
FIRST REFERRAL UNITS
12.1 Background
Health services are designed to meet the community's health needs by leveraging available
knowledge and resources. In 1977, Govt. of India launched a rural health system, based on the
principle of placing people's health in the hands of people. It is a three-tier health care delivery
system in rural areas, namely Primary, Secondary and Tertiary, based on the 1975 Shrivastava
Committee recommendation. Secondary level of health care includes predominantly community
Health Centers (CHCs), the First Referral Units (FRUs) and sub district and District Hospital. As
envisaged by the NRHM health delivery system in rural areas, needs to be upgraded from its current
level to a standard set called the Indian Public Health Standard, which was released in early 2007, to
provide optimal specialized care to the community to achieve and maintain of acceptable quality
care. The Indian Public Health standard (IPHS) are the benchmark for the quality expected from
various component of public health care organization and may be used for assessing performance of
health care delivery system.
Women in the reproductive age group (15-44 years) form a substantial proportion (22.2%) of
population of India and their health is exposed to varying degrees of disability related to pregnancy
and delivery. Poor health status of women and children in terms of high mortality and morbidity has
been a major concern and priority for the health planners/administrators in India.
If some of the complications of pregnancy such as anemia, hemorrhage, obstructed labour and
sepsis are detected early and managed appropriately, maternal morbidity and mortality can be
reduced substantially. All PHCs are not in a situation to provide complete obstetric care to the
clients due to limited facilities and expertise available. Hence, some of the health facilities have been
identified by the Government of India as First Referral Units (FRUs).
125
First Referral Units Chapter 12
Figure 12.1: Referral systems in India
Medical College
(MC)
District Hospital (DH)/ Sub

District Hospital (SDH)
Community Health Centre (CHC)

30 bed hospital/ referral unit for 4 PHC
with specilised services
Primary Health Centre (PHC)

A 4-6 bed referral unit for 6 subcentres manned with
MO I/C Medical ofiicer Incharge & 14 subordinate
Paramedical staff.
Sub Centre (SC)

First point of contact for community in India's Primary Healthcare
ecosystem, manned with one female health worker/Auxillary Nurse
midwife and one male health worker
12.2 National focus on maternal mortality reduction

In India during the sixties and seventies, maternal health services under MCH (maternal and
child health) focused on ante-natal care and high-risk approach. It was thought that good ANC along
with high-risk approach will help in reducing maternal mortality. As traditional birth attendants
(TBAs) were conducting many deliveries, it was thought that MMR will decline by training them.
However, after several years of implementing these approaches, it was realized in mid-eighties that
maternal mortality was still very high in India.
The strategy of establishing fully functional 24/7 First Referral Units (FRUs) for Emergency
Obstetric Care has been expressed in India’s national MCH program and health policy documents
from the time of Child Survival and Safe Motherhood (CSSM)programme (1992 to 1997). It was
further re-emphasized under RCH programme (1997- 2004)
126
Figure: 12.2 Critical determinants of a First Referral Unit
Surgical New
interventi born
on care
services
Blood
Storage
facility
24X7
FRU
12.2.1 Recommended service package
An existing facility (district hospital, sub-divisional hospital, community health centre etc.) can
be declared a fully operational First Referral Unit (FRU) only if it is equipped to provide round-the-
clock services for Emergency Obstetric and New-born Care, in addition to all emergencies that any
hospital is required to provide:
The minimum services to be provided by fully functional FRUs are: -
 24 hour delivery services including normal and assisted deliveries.
 Emergency obstetric care including surgical interventions like caesarian sections and other
medical interventions.
 New born care.
 Emergency care of sick children.
 Full range of Family Planning Services including laparoscopic services.
 Safe abortion services.
 Treatment of STI/RTI.
 Blood storage facility.
 Essential laboratory services.
 Referral (transport) services.
12.2.2 Infrastructure of First referral unit
To be able to perform the full range of FRU functions, a health facility must have the following
physical infrastructure:
 Minimum bed strength of 20-30. However, in difficult areas like North-East States and the
EAG States, there may be a relaxation of 10-12 beds
 A fully functional operation theatre equipped for undertaking anesthetic and emergency
surgical procedures including Caesarean Sections and Laporotomies.
127
 A fully operational Labour Room.
 An area earmarked and equipped for New-born Care in the Labour Room and in the ward.
 A functional laboratory with facilities for all essential investigations.
 Blood storage facility as per the guidelines issued by Government. of India (GoI).
 24-hour water supply.
 Arrangements for waste disposal.
 Regular electricity supply with back-up arrangements to ensure uninterrupted supply to the
operation theatre and labour room, cold chain and blood storage facility.
 Telephone connection.
 Ambulance (owned or arranged through local hiring).
12.2.3 Human resources at First referral Unit:
First referral unit provide specialized medical care in the form of facilities of surgeons,
obstetricians & gynecologists, physicians and pediatricians. The current FRU guideline suggest
following basic human resource availability at each designated FRU:
 A minimum of 4 medical officers (who are either qualified or especially trained to work as
surgeon, obstetrician, physician and pediatrician) are required. Adequate number of nursing
staff for Operation Theatre, Labour Room and In-patient wards
 Multi-skilling training of paramedical workers are required for handling critical areas of
Obstetric Care, New-born Care and Blood Storage and Laboratory Services.
12.2.4: Referral transport Services at First referral Unit:
Appropriate referral transport from the periphery to the functioning First Referral Units,
providing emergency services and from FRUs to district/tertiary level institutions is required.
12.3 Key Findings

There has been a significant improvement in performance of FRUs over the years (2017-18 to
2019-20) wherein percentage of facilities which are fulfilling the FRU conditionality of conducting c
section (as per criteria) for DH, SDH and CHC has increased from 80%, 65% and 22% to 86%, 70%
and 28%.
Figure-12.3: FRU status over the Years: 2017-18 to 2019-20
1650 1659
1599
784 809 825

661 680 672
531 558 548 580 574
508 460
427
357
DH SDH CHC DH SDH CHC DH SDH CHC

2017-18 2018-19 2019-20
Number of FRU FRU conducting C-sect as per conditionality
128
12.4 FRU status in India
A total of 3,156 First Referral Units (FRU) were identified during the FY2019-20 in HMIS, of
which 672 (21%) were situated at the District Hospital level, 825 (26%) at the Sub-Divisional
Hospital level and 1659 (53%) at the Community Health Center level. Figure 12.4 depicts FRU
mapped in HMIS.
Figure-12.4: FRUs Mapped in HMIS during 2019-20
Series1, DH,
672, 21%
Series1, CHC,
1659, 53%
Series1, SDH,
825, 26%
12.5 District Hospital

District Hospital is a secondary level referral unit responsible for a district of a defined
geographical area, containing a defined population. Its objective is to provide comprehensive
secondary health care services to the people in the district at an acceptable level of quality. Every
district is expected to have a district hospital. As the population of a district is variable, the bed
strength also varies from 75 to 500 beds depending on the size, terrain and population of the district.
12.5.1 Conditionality’s framework for DH FRU:
The framework of conditionality has been developed keeping in mind the most critical criteria of
the FRU in India which the States must strive to achieve. In long run these conditionality’s will help
in monitoring and facilitating speedy improvement
12.5.2 District Hospital
FRU conditionality framework for district hospital –

Number of FRU DH conducting C- section on average 10 C- Section/month and avg. 7
CS/month in case of NE and UT's.
There are 705 districts in India, and a total of 1249 facilities are mapped in HMIS as district
hospital or equivalent to DH reporting on HMIS. Out of these, States has mapped 672 DH facilities
as FRU and only 580 (86%) have fulfilled the conditionality criteria in 2019-20. The State/UT-wise
number of FRU functional and number of FRUs fulfilling the conditionality criteria is provided at
Annexure 12.1.
129
12.5.3 Status of States fulfilling conditionality of FRU- DH
The FRU –DH of the states of- Andhra Pradesh, Andaman & Nicobar, Chandigarh, Dadra &
Nagar Haveli, Daman & Diu, Goa, Karnataka, Kerala, Lakshadweep, Odisha, Puducherry, Tamil
Nadu, Telangana, Tripura and West Bengal were 100% eligible for conditionality.
 The States of Arunanchal Pradesh, Nagaland and Uttarakhand have even less than equal to
50% of the FRU’s which were eligible for conditionality with their respective percentages as
27%, 36% and 50%. Figure-12.5 depicts percentage of states fulfilling conditionality of
FRU- DH.
Figure: 12.5 Percentage of States Fulfilling Conditionality of FRU- DH during 2019-20
3%
6%
19%
72%
Less than 40 % 41 % - 60 % 61 % - 80 % 81 % - 100 %
12.6. Sub-district (Sub-divisional) hospitals

Sub-district (Sub-divisional) hospitals are below the district and above the block level (CHC)
hospitals and act as First Referral Units for the Tehsil/Taluka/block population within which they are
geographically situated. They have significant role to carry out First Referral Units in providing
emergency obstetrics care and neonatal care and help in bringing down the Maternal Mortality and
Infant Mortality. They form a vital link between SC, PHC and CHC on one end and District
Hospitals on another end. They also save the travel time for the cases require emergency care and
reduces the workload of the district hospital. A subdivision hospital caters to about 5-6 lakh people.
12.6.1 Conditionality’s framework for sub district (Sub- divisional) hospital based on HMIS:
FRU conditionality for sub-district (Sub-divisional) hospital –
Number of FRU SDH conducting C-sect on avg. 5 CS/month (60 for the year) and average. 3
CS/month in case of North- East and Union Territories
There are only 825 FRU SDH indentified by states are reporting in HMIS out of which 410 are
rural and 415 are urban. Annexure 12.1 depicts state/UTs wise number of SDH FRU and number of
SDH FRU fulfilling HMIS conditionality in rural and urban area both. The percentage of
performance of rural FRU- SDH (250) fulfilling the conditionality is 61% (out of 410 total rural
FRU-SDH) which is lower than the Urban FRU SDH (324) 78% (out of 415 total urban FRU-SDH).
Figure 12.6 depicts percentage of states fulfilling conditionality of FRU- SDH for rural and urban
respectively.
130
Figure: 12.6 Percentage of states fulfilling conditionality of FRU-SDH during 2019-20
Rural Urban
23% 27% 17%

23% 27%
11%
9% 9%
61% 11%
41%
41%
Less than 40 % 41 % - 60 % 61 % - 80 % 81 % - 100 % Less than 40 % 41 % - 60 % 61 % - 80 % 81 % - 100 %

Less than 40 % 41 % - 60 % 61 % - 80 % 81 % - 100 %
12.7 The Community health Center

The Community Health Centers (CHCs) which constitute the secondary level of health care were
designed to provide referral as well as specialist health care to the rural population. These centers are
however fulfilling the tasks entrusted to them only to a limited extent. 4 PHCs are included under
each CHC thus catering to approximately 80000 populations in tribal/hilly/desert areas and 120000
populations for plain areas. CHC is a 30-bedded hospital providing specialist care in Medicine,
Obstetrics and Gynecology, Surgery, Pediatrics, Dental and AYUSH. There are 12923 CHCs
functional in the country out of which 7343 rural CHCs and 5580 urban CHCs are mapped in HMIS
as on 31st March 2020.
12.7.1 Conditionality framework for Community Health Centers (CHCs) based on HMIS.
Conditionality for Community health Center–

Number of FRU CHCs conducting C-sect on average 5 CS/month and average 3 CS/month in case
of North east and UT's
Total 1659 CHC were designated as CHC- FRU but only 460 (28%) were fulfilling
conditionality of 5 cesarean section per month on average and 3 CS per month in case of North-
eastern states and Union Territory 's. 1435 identified FRU CHC were rural and only 322 (22.4%)
were fulfilling the conditionality. Only 224 were Urban CHC-FRU and 138 were fulfilling the
conditionality.
CHC- FRU (Rural)
 The 100 % CHC-FRU of States of Arunachal Pradesh, Himachal Pradesh and Tripura were
fulfilling conditionality.
131
 No CHC-FRU (rural) of the States of Bihar, Daman & Diu and Puducherry were fulfilling
the conditionality.
 Efforts should be made to improve the status of Haryana (10%), Madhya Pradesh (10%),
Rajasthan (10%), Chhattisgarh (13%), Tamil Nadu (13%), Andhra Pradesh (17%), Jharkhand
(19%) and Nagaland(20%). The above-mentioned states are those where only less than 20 %
of CHC- FRU was eligible for conditionality. Figure 12.7 depicts percentage of states
fulfilling conditionality of FRU- CHC during 2019-20.
CHC- FRU (Urban)
 Assam, Chandigarh and Jammu Kashmir were the state where 100% CHC- FRU were
functional and eligible for conditionality.
 No CHC-FRU (Urban) of states of Haryana and Uttarakhand is fulfilling the conditionality.
 Less than 50 % of FRU- CHC of Rajasthan and Bihar were fulfilling conditionality. Figure
12.7 Showing Percentage of states fulfilling conditionality of FRU- CHC during 2019-20.
Figure : 12.7 Percentage of states fulfilling conditionality of FRU- CHC during 2019-20
4%
Rural 16% Urban
4%
16%12% 18% 23%
12% 68%
24%
68% 35%
Less than 40 % 41 % - 60 % 61 % -Less80than%40 % 81

41 %%- 60
- 100
% %
Less than 40 % 41 % - 60 % 61 % - 80 % 81 % - 100 %
61 % - 80 % of services
12.8 Availability 81 % - and
100 %
manpower of First referral unit
Blood storage facility and blood bank is one the mandatory criteria of FRU as major causes of
maternal mortality are ante partum haemorrhage, post-partum haemorrhage, anaemia, Obstructed
labour, hypertensive disorders, post-partum sepsis and unsafe abortions. Haemorrhage during
pregnancy is generally not predictable. First Referral Units are provided with 12 types of equipment
kits, which were considered necessary for carrying out laparotomies, caesarian sections, other
necessary surgical interventions and newborn care. However, most of the identified FRUs could not
become fully operational due to a variety of reasons, including lack of blood transfusion facilities.
Efforts are being taken to improve the situation.
12.8.1 Availability of services and manpower at FRU-CHC
According to HMIS, the status of blood bank and blood storage in FRU- CHC, out of 1659 FRU-
CHC only 775 (46.7%) have blood storage facility available and only 747 (45%) have blood storage
132
unit is available. 90% facilities providing the referral transport services and 95% have laboratory and
OT available.
Percentage of Obstetrician/Gynaecologist is 67.6%, Anaesthetist 46% and Paediatrician 46.6 at
FRU CHCs. Only 1596 (96%) of labour room available at FRU CHC.
State/UT-wise availability of services and manpower at Community Health Center- First
Referral Unit is provided at Annexure 12.2.
12.8.2 Availability of services and manpower at FRU-SDH
According to HMIS, the status of blood bank and blood storage in FRU- SDH, the 608 (73.6%)
of FRU SDH having provision of blood transfusion & storage, and out of total FRU only 41 % are
fully equipped blood bank according to drug and cosmetic act.
Laboratory services are 624 (76%) and 650 (78%) fully equipped OT are available at FRU SDH.
The State/UT-wise availability of services and manpower at SDH- First Referral Unit is
provided at Annexure 12.3
12.8.3 Availability of services and manpower at FRU-DH
According to HMIS, the status of blood bank and blood storage in FRU- DH, out of 672 FRU-
DH only 466 (70%) FRU-DHs are fully equipped blood bank as per drug& cosmetic Act. Fully
equipped laboratory is 593 (88%) whereas fully equipped OT are 601 (89%) and fully equipped
delivery suit located near OT are 531 (79%).
The State/UT-wise availability of services and manpower at DH- First Referral Unit is provided
at Annexure 12.4
133
Annexure 1.1
Annexure-1.1
State/UT-wise number of Health Facilities with public and private distribution as
mapped in HMIS during 2019-20
State / UTs Total Public Private
All India 208917 200032 8885
Andhra Pradesh 9240 9214 26
Arunachal Pradesh 569 565 4
Assam 6768 6224 544
Bihar 12551 12475 76
Chhattisgarh 6614 6519 95
Goa 307 288 19
Gujarat 13945 11524 2421
Haryana 3404 3382 22
Himachal Pradesh 2965 2950 15
Jammu & Kashmir 3662 3621 41
Jharkhand 4627 4473 154
Karnataka 12657 12457 200
Kerala 7416 7142 274
Madhya Pradesh 13921 13849 72
Maharashtra 13990 13930 60
Manipur 583 558 25
Meghalaya 679 666 13
Mizoram 472 455 17
Nagaland 625 608 17
Odisha 8558 8524 34
Punjab 4056 3903 153
Rajasthan 17002 16726 276
Sikkim 193 192 1
Tamil Nadu 11384 11352 32
Telangana 5697 5666 31
Tripura 1165 1157 8
Uttar Pradesh 28687 25242 3445
Uttarakhand 2280 2272 8
West Bengal 12425 12329 96
Delhi 1979 1280 699
Chandigarh 55 55 0
Puducherry 137 133 4
Daman & Diu 36 34 2
Dadra & Nagar Haveli 85 84 1
A & N Islands 158 158 0
Lakshadweep 25 25 0
134
Annexure 1.2
Annexure-1.2
State/UT-wise number of Health Facilities by type of facilities as mapped in
HMIS during 2019-20
State / UTs Public Health Facilities Private
SC PHC CHC SDH DH Health
Facilities
ALL INDIA 160990 30714 5786 1501 1041 8885
Andhra Pradesh 7458 1504 198 28 26 26
Arunachal Pradesh 363 124 60 18 4
Assam 4933 1046 198 14 33 544
Bihar 10305 2027 64 35 44 76
Chhattisgarh 5487 820 168 11 33 95
Goa 218 59 6 2 3 19
Gujarat 9255 1794 389 46 40 2421
Haryana 2664 526 142 22 28 22
Himachal Pradesh 2174 583 95 82 16 15
Jammu & Kashmir 2794 711 87 29 41
Jharkhand 3922 336 176 16 23 154
Karnataka 9440 2534 208 230 45 200
Kerala 5837 937 230 83 55 274
Madhya Pradesh 11800 1467 336 195 51 72
Maharashtra 10649 2676 432 100 73 60
Manipur 438 93 17 1 9 25
Meghalaya 482 143 28 13 13
Mizoram 368 65 9 4 9 17
Nagaland 439 137 21 11 17
Odisha 6690 1379 385 33 37 34
Punjab 3153 526 150 45 29 153
Rajasthan 13530 2477 614 78 27 276
Sikkim 160 25 2 1 4 1
Tamil Nadu 8713 1898 400 309 32 32
Telangana 4700 821 83 45 17 31
Tripura 1001 113 22 12 9 8
Uttar Pradesh 20780 3536 736 190 3445
Uttarakhand 1881 283 69 19 20 8
West Bengal 10388 1396 419 71 55 96
Delhi 652 546 25 10 47 699
Chandigarh 0 48 2 1 4 0
Puducherry 80 40 4 5 4 4
Daman & Diu 26 4 2 2 2
Dadra & Nagar Haveli 71 9 2 1 1 1
A & N Islands 124 27 4 3 0
Lakshadweep 15 4 3 2 1 0
135
Annexure 3.1
Maternal Health
Annexure 3.1: State/UT wise No. of Annual Estimated Pregnancies
Estimated Number of Total number of % ANC Registered
Annual Pregnancies pregnant women to Estimated
# Registered for ANC Pregnancies
2019-20 2018-19 2019-20 2018-19 2019-20 2018-19
All India 29913500 29584120 29022447 28787946 97.02 97.31
A & N Islands 5500 5400 4784 4972 86.98 92.07
Andhra Pradesh 919900 913530 803046 858326 87.30 93.96
Arunachal Pradesh 30300 30010 30162 32159 99.54 107.16
Assam 805700 797450 685229 701133 85.05 87.92
Bihar 3242100 3209480 3394623 3271782 104.70 101.94
Chandigarh 23700 22710 35734 42358 150.78 186.52
Chhattisgarh 701100 693500 646957 632015 92.28 91.13
Dadra & Nagar Haveli 11500 11130 8070 8394 70.17 75.42
Daman & Diu 7700 7350 6527 6555 84.77 89.18
Delhi 384600 373980 721322 931041 187.55 248.95
Goa 24100 23520 27969 26896 116.05 114.35
Gujarat 1436800 1422390 1296148 1349576 90.21 94.88
Haryana 644300 635940 572676 591130 88.88 92.95
Himachal Pradesh 127800 126900 110701 112583 86.62 88.72
Jammu & Kashmir 234200 232160 358624 395092 153.13 170.18
Jharkhand 912600 902270 953011 940941 104.43 104.29
Karnataka 1212400 1203120 1151533 1140111 94.98 94.76
Kerala 546700 544110 527626 504654 96.51 92.75
Lakshadweep 1100 1140 1274 1266 115.82 111.05
Madhya Pradesh 2173300 2145450 1919655 1875916 88.33 87.44
Maharashtra 2138200 2114480 2051346 2100266 95.94 99.33
Manipur 55500 54930 55346 57301 99.72 104.32
Meghalaya 78200 77430 138997 141030 177.75 182.14
Mizoram 19100 18950 23614 22750 123.63 120.05
Nagaland 31200 30950 39462 37553 126.48 121.33
Odisha 924500 917870 721502 738453 78.04 80.45
Puducherry 24200 23290 98914 98869 408.74 424.51
Punjab 490800 486900 438357 456150 89.31 93.68
Rajasthan 2031500 2006660 1736201 1825723 85.46 90.98
Sikkim 11700 11590 9343 9420 79.85 81.28
Tamil Nadu 1210500 1205640 1043510 1054940 86.20 87.50
Telangana 694700 689930 759098 758446 109.27 109.93
Tripura 59400 58810 67065 72307 112.90 122.95
Uttar Pradesh 6827400 6729430 6745784 6117234 98.80 90.90
Uttarakhand 216700 214310 217191 230252 100.23 107.44
West Bengal 1654500 1641410 1621046 1640352 97.98 99.94
136
Annexure 3.2
Annexure 3.2
State/ UT wise No. of ANC Registration and PW received 4 ANC Checkups
State/ UT Total number of pregnant Number of pregnant women
women Registered for ANC received 4 or more ANC check
ups
2019-20 2018-19 2019-20 2018-19
All India 29022447 28787946 23055973 21092687
A & N Islands 4784 4972 3214 4134
Andhra Pradesh 803046 858326 792669 843616
Arunachal Pradesh 30162 32159 10846 8811
Assam 685229 701133 584592 572055
Bihar 3394623 3271782 2370252 2176753
Chandigarh 35734 42358 37746 38473
Chhattisgarh 646957 632015 606623 566381
Dadra & Nagar Haveli 8070 8394 6655 6923
Daman & Diu 6527 6555 8215 6266
Delhi 721322 931041 407582 407668
Goa 27969 26896 21484 18154
Gujarat 1296148 1349576 1121390 1146788
Haryana 572676 591130 440795 436810
Himachal Pradesh 110701 112583 86052 88538
Jammu & Kashmir 358624 395092 284406 288808
Jharkhand 953011 940941 747405 750214
Karnataka 1151533 1140111 1119384 1123482
Kerala 527626 504654 523084 507289
Lakshadweep 1274 1266 1146 1166
Madhya Pradesh 1919655 1875916 1518862 1399890
Maharashtra 2051346 2100266 1943469 1870511
Manipur 55346 57301 30525 29030
Meghalaya 138997 141030 68065 52306
Mizoram 23614 22750 13490 11015
Nagaland 39462 37553 9048 8155
Odisha 721502 738453 589978 597738
Puducherry 98914 98869 43507 67567
Punjab 438357 456150 358020 358729
Rajasthan 1736201 1825723 1054332 908992
Sikkim 9343 9420 6294 6278
Tamil Nadu 1043510 1054940 919385 957987
Telangana 759098 758446 640697 804940
Tripura 67065 72307 46588 40717
Uttar Pradesh 6745784 6117234 5158335 3491050
Uttarakhand 217191 230252 157722 125467
West Bengal 1621046 1640352 1324116 1369986
137
Annexure 3.3
Annexure 3.3
State/ UT wise No. of Deliveries by Types
States/ UTs Number of Home Deliveries Conducted at Deliveries Conducted Institutional deliveries Total reported
deliveries Public Institutions at Private Institutions (Public Insts.+Pvt. deliveries
Insts.)
2019-20 2018-19 2019-20 2018-19 2019-20 2018-19 2019-20 2018-19 2019-20 2018-19
All India 1,183,716 1,391,194 13,742,236 13,665,067 6,484,828 6,061,967 20,227,064 19,727,034 21,410,780 21,118,228
A & N Islands 65 86 3,537 3,754 3,537 3,754 3,602 3,840
Andhra Pradesh 2,397 4,605 304,544 322,027 427,704 420,611 732,248 742,638 734,645 747,243
Arunachal 2,114 1,888 16,066 14,438 2,652 2,546 18,718 16,984 20,832 18,872
Pradesh
Assam 53,589 60,007 463,880 446,108 90,687 86,858 554,567 532,966 608,156 592,973
Bihar 335,870 391,138 1,653,275 1,612,421 218,465 84,431 1,871,740 1,696,852 2,207,610 2,087,990
Chandigarh 37 63 28,106 28,958 28,106 28,958 28,143 29,021
Chhattisgarh 8,289 15,261 364,192 360,446 112,811 114,996 477,003 475,442 485,292 490,703
Dadra & Nagar 36 42 8,475 8,063 1,066 972 9,541 9,035 9,577 9,077
Haveli
Daman & Diu 1 3 3,460 3,376 587 478 4,047 3,854 4,048 3,857
Delhi 11,120 12,232 222,723 220,550 52,438 50,935 275,161 271,485 286,281 283,717
Goa 15 34 10,702 10,563 7,717 7,358 18,419 17,921 18,434 17,955
Gujarat 5,569 6,721 439,315 422,055 706,553 710,332 1,145,868 1,132,387 1,151,437 1,139,108
Haryana 21,098 25,756 288,509 286,922 204,694 188,143 493,203 475,065 514,301 500,821
Himachal Pradesh 6,658 8,383 68,047 67,491 13,996 11,518 82,043 79,009 88,701 87,392
Jammu & 10,503 10,396 166,858 172,065 16,007 16,923 182,865 188,988 193,368 199,384
Kashmir
Jharkhand 29,522 34,020 520,283 512,774 183,567 191,189 703,850 703,963 733,372 737,983
Karnataka 930 1,268 550,949 564,549 349,054 345,978 900,003 910,527 900,933 911,795
Kerala 467 720 146,174 143,847 314,209 339,989 460,383 483,836 460,850 484,556
Lakshadweep 1 0 869 845 869 845 870 845
Madhya Pradesh 60,526 68,512 1,207,305 1,172,770 144,927 134,349 1,352,232 1,307,119 1,412,758 1,375,631
Maharashtra 11,225 12,680 876,508 890,351 910,695 823,513 1,787,203 1,713,864 1,798,428 1,726,544
Manipur 6,122 6,735 25,935 25,343 7,316 5,950 33,251 31,293 39,373 38,028
Meghalaya 36,483 35,617 41,284 37,522 12,724 11,233 54,008 48,755 90,491 84,372
Mizoram 2,236 2,247 14,753 13,762 3,739 3,431 18,492 17,193 20,728 19,440
Nagaland 3,662 3,537 13,158 12,366 3,954 3,807 17,112 16,173 20,774 19,710
Odisha 17,404 25,055 510,738 530,094 113,182 100,671 623,920 630,765 641,324 655,820
Puducherry 3 7 33,265 33,431 9,910 10,539 43,175 43,970 43,178 43,977
Punjab 5,463 8,705 186,942 187,024 186,745 177,153 373,687 364,177 379,150 372,882
Rajasthan 23,888 32,973 1,028,018 1,035,980 324,899 315,319 1,352,917 1,351,299 1,376,805 1,384,272
Sikkim 46 65 5,222 4,636 1,843 2,406 7,065 7,042 7,111 7,107
Tamil Nadu 206 105 511,806 512,604 430,857 426,838 942,663 939,442 942,869 939,547
Telangana 588 829 295,575 326,350 325,090 283,012 620,665 609,362 621,253 610,191
Tripura 3,254 3,336 44,334 44,586 4,570 2,421 48,904 47,007 52,158 50,343
Uttar Pradesh 489,648 570,912 2,596,990 2,519,939 1,008,443 881,411 3,605,433 3,401,350 4,095,081 3,972,262
Uttarakhand 17,042 18,668 90,453 87,968 45,153 41,205 135,606 129,173 152,648 147,841
West Bengal 17,639 28,588 999,986 1,029,089 248,574 265,452 1,248,560 1,294,541 1,266,199 1,323,129
139
Annexure 3.4
Annexure 3.4
State UT wise No. of Home Deliveries
States/UTs Number of Home Number of home Number of home
deliveries deliveries attended by deliveries attended by
SBA trained Non SBA trained
(Doctor/Nurse/ANM) (trained TB/Dai)
2019-20 2018-19 2019-20 2018-19 2019-20 2018-19
All India 1,183,716 1,391,194 216,320 247,196 967,396 1,143,998
A & N Islands 65 86 9 30 56 56
Andhra Pradesh 2,397 4,605 1,552 2,884 845 1,721
Arunachal Pradesh 2,114 1,888 758 788 1,356 1,100
Assam 53,589 60,007 16,737 17,316 36,852 42,691
Bihar 335,870 391,138 64,167 71,437 271,703 319,701
Chandigarh 37 63 3 2 34 61
Chhattisgarh 8,289 15,261 3,396 7,301 4,893 7,960
Daman & Diu 1 3 0 1 1 2
Delhi 11,120 12,232 74 204 11,046 12,028
Goa 15 34 5 6 10 28
Gujarat 5,569 6,721 3,925 3,877 1,644 2,844
Haryana 21,098 25,756 1,026 2,245 20,072 23,511
Himachal Pradesh 6,658 8,383 1,317 1,130 5,341 7,253
Jammu & Kashmir 10,503 10,396 730 694 9,773 9,702
Jharkhand 29,522 34,020 11,905 12,077 17,617 21,943
Karnataka 930 1,268 381 483 549 785
Kerala 467 720 114 166 353 554
Madhya Pradesh 60,526 68,512 7,012 7,115 53,514 61,397
Maharashtra 11,225 12,680 4,145 5,050 7,080 7,630
Manipur 6,122 6,735 3,500 4,266 2,622 2,469
Meghalaya 36,483 35,617 1,364 1,290 35,119 34,327
Mizoram 2,236 2,247 436 566 1,800 1,681
Nagaland 3,662 3,537 2,005 2,070 1,657 1,467
Odisha 17,404 25,055 7,834 8,258 9,570 16,797
Punjab 5,463 8,705 2,285 3,834 3,178 4,871
Rajasthan 23,888 32,973 8,500 10,867 15,388 22,106
Sikkim 46 65 25 29 21 36
Tamil Nadu 206 105 71 56 135 49
Telangana 588 829 314 585 274 244
Tripura 3,254 3,336 13 16 3,241 3,320
Uttar Pradesh 489,648 570,912 68,383 77,335 421,265 493,577
Uttarakhand 17,042 18,668 4,249 4,806 12,793 13,862
West Bengal 17,639 28,588 80 403 17,559 28,185
138
Annexure 3.5
Annexure 3.5
State/UT wise No. of Abortion (Spontaneous and Induced)
States/UT Total ANC Abortion MTP up to 12 MTP more
(spontaneous) weeks of than 12 weeks
pregnancy of pregnancy
A & N Islands 4784 143 201 7
All India 29022447 595593 665637 49450
Andhra Pradesh 803046 7677 1988 839
Assam 685229 25778 95687 1780
Bihar 3394623 4230 10047 814
Chandigarh 35734 1156 1315 402
Chhattisgarh 646957 24277 11057 987
Daman & Diu 6527 340 303 3
Delhi 721322 22219 17656 1878
Goa 27969 760 935 149
Gujarat 1296148 26073 10911 1522
Haryana 572676 15223 38504 1070
Jammu & Kashmir 358624 9036 5453 261
Jharkhand 953011 19768 7932 449
Karnataka 1151533 29304 26944 6393
Kerala 527626 12502 9158 1710
Lakshadweep 1274 60 10 0
Madhya Pradesh 1919655 47360 34370 2093
Maharashtra 2051346 53288 133996 9917
Manipur 55346 1586 3081 260
Meghalaya 138997 4274 294 27
Mizoram 23614 1161 121 79
Nagaland 39462 401 1153 109
Odisha 721502 47717 14925 674
Puducherry 98914 1013 1067 246
Punjab 438357 18360 25371 741
Rajasthan 1736201 65270 24371 984
Sikkim 9343 291 56 2
Tamil Nadu 1043510 33586 88234 7078
Telangana 759098 4171 1439 615
Tripura 67065 1424 2047 59
Uttar Pradesh 6745784 30863 37162 3069
Uttarakhand 217191 3863 3918 190
West Bengal 1621046 74884 49507 4397
140
Annexure 3.6
Annexure 3.6
State/UT wise No. of Post Natal Checkups
State/ UT Women received 1st Women received 1st
post partum check-up post partum check up
Total reported deliveries
within 48 hours of home between 48 hours and 14
delivery days
2019-20 2018-19 2019-20 2018-19 2019-20 2018-19
All India 21,410,780 21,118,228 2,743,742 2,670,389 11,433,465 10,918,726
A & N Islands 3,602 3,840 393 675 2,772 3,379
Andhra Pradesh 734,645 747,243 2,512 9,956 557,917 595,971
Arunachal Pradesh 20,832 18,872 2,277 2,970 4,306 4,024
Assam 608,156 592,973 60,682 87,395 530,184 457,219
Bihar 2,207,610 2,087,990 293,813 338,054 837,879 794,386
Chandigarh 28,143 29,021 33 62 4,239 4,421
Chhattisgarh 485,292 490,703 31,392 48,368 299,046 326,068
Dadra & Nagar Haveli 9,577 9,077 45 41 5,680 5,415
Daman & Diu 4,048 3,857 0 441 2,199 1,792
Delhi 286,281 283,717 11,560 43,371 142,984 149,479
Goa 18,434 17,955 12 12 15,085 14,035
Gujarat 1,151,437 1,139,108 5,316 15,324 903,949 893,386
Haryana 514,301 500,821 19,823 61,004 313,293 304,490
Himachal Pradesh 88,701 87,392 7,665 11,681 86,393 86,109
Jammu & Kashmir 193,368 199,384 12,913 28,955 126,915 148,677
Jharkhand 733,372 737,983 53,356 131,546 369,160 354,142
Karnataka 900,933 911,795 42,005 58,216 815,740 810,342
Kerala 460,850 484,556 2,892 8,468 523,990 607,428
Lakshadweep 870 845 112 97 627 579
Madhya Pradesh 1,412,758 1,375,631 53,759 55,909 156,574 176,873
Maharashtra 1,798,428 1,726,544 9,418 10,117 1,099,585 1,046,501
Manipur 39,373 38,028 3,376 3,669 17,063 18,340
Meghalaya 90,491 84,372 22,891 22,384 39,377 36,562
Mizoram 20,728 19,440 1,134 1,337 3,211 10,723
Nagaland 20,774 19,710 2,589 2,958 8,277 8,976
Odisha 641,324 655,820 15,788 22,184 614,708 605,220
Puducherry 43,178 43,977 17 1,790 12,496 30,857
Punjab 379,150 372,882 4,481 8,189 335,753 333,044
Rajasthan 1,376,805 1,384,272 22,999 42,958 126,831 155,781
Sikkim 7,111 7,107 119 111 5,829 6,572
Tamil Nadu 942,869 939,547 7,432 11 16,265 8
Telangana 621,253 610,191 23,078 58,926 184,544 290,576
Tripura 52,158 50,343 3,448 4,124 34,417 32,747
Uttar Pradesh 4,095,081 3,972,262 1,926,575 1,390,498 2,117,413 1,417,380
Uttarakhand 152,648 147,841 28,378 40,465 68,474 64,292
West Bengal 1,266,199 1,323,129 71,459 158,123 1,050,290 1,122,932
141
Annexure 4.1
CHILD HEALTH
Annexure-4.1
States/UTs wise, number of Live births, NBSU
admission as reported in HMIS during 2019-20
State Total Live birth Number of Admission in New Born
Stabilisation Unit (NBSU)
All India 21233538 628584
A & N Islands 3618 1208
Andhra Pradesh 736774 40306
Arunachal Pradesh 20668 472
Assam 600797 8985
Bihar 2114235 39224
Chandigarh 27957 2407
Chhattisgarh 479404 15984
Dadra & Nagar Haveli 9539 3386
Daman & Diu 4059 787
Delhi 283719 16095
Goa 18491 385
Gujarat 1148115 40888
Haryana 511004 18967
Himachal Pradesh 88410 11505
Jammu & Kashmir 191384 11456
Jharkhand 731400 3984
Karnataka 898459 48148
Kerala 464530 32897
Lakshadweep 851 42
Madhya Pradesh 1403115 25519
Maharashtra 1796217 52094
Manipur 39462 763
Meghalaya 89449 4930
Mizoram 20577 610
Nagaland 20582 1051
Odisha 632591 7103
Puducherry 43023 483
Punjab 377525 12552
Rajasthan 1362923 56863
Sikkim 7188 83
Tamil Nadu 942471 29480
Telangana 633667 36593
Tripura 51339 3032
Uttar Pradesh 4071547 57866
Uttarakhand 152300 6351
West Bengal 1256148 36085
142
Annexure 4.2
Annexure-4.2
States/UTs wise number of Live births, SNCU admission, SNCU admission
referred by ASHA and SNCU death as reported in HMIS during 2019-20
State Total live Total SNCU SNCU admission Number of deaths
birth Admission referred by ASHA occurring at
SNCU
All India 21233538 1312730 69210 90979
A & N Islands 3618 1403 2 47
Andhra Pradesh 736774 54093 2047 3821
Assam 600797 58053 2982 5207
Bihar 2114235 41299 3038 4256
Chandigarh 27957 1551 0 37
Chhattisgarh 479404 26261 2894 2782
Daman & Diu 4059 789 0 22
Delhi 283719 57977 44 2114
Goa 18491 1994 0 91
Gujarat 1148115 49244 5781 4142
Haryana 511004 32149 2083 623
Jammu & Kashmir 191384 30782 430 1367
Jharkhand 731400 10527 1105 462
Karnataka 898459 77831 4043 4715
Kerala 464530 39229 108 350
Lakshadweep 851 52 0 1
Madhya Pradesh 1403115 104650 6810 12822
Maharashtra 1796217 94714 2244 6053
Manipur 39462 1788 0 66
Meghalaya 89449 5340 0 404
Mizoram 20577 1644 1 38
Nagaland 20582 1246 0 85
Odisha 632591 68043 14764 5188
Puducherry 43023 4812 0 345
Punjab 377525 21296 442 318
Rajasthan 1362923 103175 1145 9185
Sikkim 7188 328 2 8
Tamil Nadu 942471 107131 981 5432
Telangana 633667 37497 636 1480
Tripura 51339 4624 238 362
Uttar Pradesh 4071547 117479 15000 6387
Uttarakhand 152300 5027 51 314
West Bengal 1256148 135398 2323 11799
143
Annexure 4.3
Annexure 4.3
State/UT wise total number of Home delivery and Home delivery followed by 7
HBNC Visits as reported in HMIS during 2019-20
State Total Home Number of newborns received 7 Home Based
delivery Newborn Care (HBNC) visits in case of Home
delivery
All India 1183716 948725
A & N Islands 65 37
Assam 53589 58808
Bihar 335870 243226
Chandigarh 37 28
Daman & Diu 1 0
Delhi 11120 7972
Goa 15 2
Gujarat 5569 4785
Haryana 21098 12773
Jharkhand 29522 20555
Karnataka 930 890
Kerala 467 259
Lakshadweep 1 0
Manipur 6122 4371
Meghalaya 36483 23535
Mizoram 2236 695
Nagaland 3662 1974
Odisha 17404 12313
Puducherry 3 1
Punjab 5463 3678
Rajasthan 23888 13001
Sikkim 46 20
Tamil Nadu 206 30
Telangana 588 689
Tripura 3254 2563
Uttarakhand 17042 16389
144
Annexure 4.4
Annexure 4.4
State/UT-wise, Number of live births, number of newborns weighted and
newborns weighted less than 2.5 kg as reported in HMIS during 2019-20
State Total live Number of newborns Number of newborns having
birth weighed at birth weight less than 2.5 kg
All India 21233538 20312792 2518668

A & N Islands 3618 3553 574
Andhra Pradesh 736774 727691 35471
Assam 600797 591026 83603
Bihar 2114235 1982083 203453
Chandigarh 27957 27852 6673
Chhattisgarh 479404 476287 54297
Daman & Diu 4059 4041 822
Delhi 283719 274996 59981
Goa 18491 18480 3214
Gujarat 1148115 1113404 143543
Haryana 511004 507101 60020
Jammu & Kashmir 191384 188832 10451
Jharkhand 731400 712080 49974
Karnataka 898459 866847 93449
Kerala 464530 455978 51471
Lakshadweep 851 872 84
Madhya Pradesh 1403115 1356289 211528
Maharashtra 1796217 1762571 213241
Manipur 39462 39168 1566
Meghalaya 89449 85982 6815
Mizoram 20577 19821 1009
Nagaland 20582 20215 896
Odisha 632591 630401 117894
Puducherry 43023 34778 6070
Punjab 377525 371836 28698
Rajasthan 1362923 1302895 188673
Sikkim 7188 6797 621
Tamil Nadu 942471 942326 120464
Telangana 633667 528801 41286
Tripura 51339 50529 6012
Uttar Pradesh 4071547 3772401 435122
Uttarakhand 152300 146679 11013
West Bengal 1256148 1172610 254284
145
Annexure 4.5
Annexure 4.5
State/UT-wise number of reported Live Births, Still Births and Total birth (Live
+ Still) as reported in HMIS during 2019-20
State Live Births Still Birth Total birth (Live + Still)
All India 21233538 263342 21496880
A & N Islands 3618 61 3679
Andhra Pradesh 736774 7148 743922
Assam 600797 12692 613489
Bihar 2114235 23110 2137345
Chandigarh 27957 628 28585
Chhattisgarh 479404 9602 489006
Daman & Diu 4059 36 4095
Delhi 283719 5002 288721
Goa 18491 161 18652
Gujarat 1148115 12256 1160371
Haryana 511004 6692 517696
Jammu & Kashmir 191384 3530 194914
Jharkhand 731400 9025 740425
Karnataka 898459 8883 907342
Kerala 464530 1712 466242
Madhya Pradesh 1403115 23475 1426590
Maharashtra 1796217 14614 1810831
Manipur 39462 159 39621
Meghalaya 89449 1995 91444
Mizoram 20577 156 20733
Nagaland 20582 306 20888
Odisha 632591 13906 646497
Puducherry 43023 428 43451
Punjab 377525 4919 382444
Rajasthan 1362923 24775 1387698
Sikkim 7188 113 7301
Tamil Nadu 942471 5946 948417
Telangana 633667 3403 637070
Tripura 51339 850 52189
Uttar Pradesh 4071547 45556 4117103
Uttarakhand 152300 1835 154135
West Bengal 1256148 18940 1275088
146
Annexure 4.6
Annexure 4.6
State/UT-wise number of reported Live Births – Male, Live Births-Female, Sex
Ratio at Birth as reported in HMIS during 2019-20
State Live Birth - Male Live Birth - Sex Ratio of
Female Birth
All India 10972266 10261272 935
A & N Islands 1823 1795 985
Andhra Pradesh 378496 358278 947
Assam 309449 291348 942
Bihar 1103022 1011213 917
Chandigarh 14441 13516 936
Chhattisgarh 244057 235347 964
Daman & Diu 2134 1925 902
Delhi 148140 135579 915
Goa 9382 9109 971
Gujarat 598966 549149 917
Haryana 265869 245135 922
Jammu & Kashmir 98484 92900 943
Jharkhand 380748 350652 921
Karnataka 463663 434796 938
Kerala 237287 227243 958
Madhya Pradesh 724808 678307 936
Maharashtra 924996 871221 942
Manipur 20497 18965 925
Meghalaya 45929 43520 948
Mizoram 10438 10139 971
Nagaland 10769 9813 911
Odisha 326056 306535 940
Puducherry 22203 20820 938
Punjab 196700 180825 919
Rajasthan 699717 663206 948
Sikkim 3679 3509 954
Tamil Nadu 482901 459570 952
Telangana 324779 308888 951
Tripura 26423 24916 943
Uttar Pradesh 2112601 1958946 927
Uttarakhand 78102 74198 950
West Bengal 643906 612242 951
147
Annexure 4.7
Annexure 4.7
State/UT-wise number of number of children admitted in NRC and discharged
with target weight gain from the NRCs as reported in HMIS during 2019-20
State Number of children Number of children discharged
admitted in NRC with target weight gain from the
NRCs
All India 197223 122372
A & N Islands 0 3
Assam 1946 1458
Bihar 9152 6903
Chandigarh 142 73
Daman & Diu 1 0
Delhi 1110 561
Goa 0 0
Gujarat 10209 5621
Haryana 2357 1407
Jharkhand 7985 6309
Karnataka 10637 6608
Kerala 131 97
Lakshadweep 0 0
Manipur 0 0
Meghalaya 433 182
Mizoram 2 1
Nagaland 36 32
Odisha 11302 9354
Puducherry 0 0
Punjab 0 0
Rajasthan 5417 3544
Sikkim 782 287
Tamil Nadu 2943 2137
Telangana 2940 1739
Tripura 42 7
Uttarakhand 176 81
148
Annexure 4.8
Annexure 4.8
Number of children screened, identified and management under RBSK by
States/UT, India during 2019-20
State Number of Number of children Number of Children
children (6 years identified with Disease, Managed by Intervention -
to 18 years) deficiencies and Medical and Surgical
screened by Developmental delay intervention
RBSK
A & N Islands 21966 6481 1003
All India 186617786 20397501 10511195
Andhra Pradesh 5658114 111422 55227
Assam 6240912 188997 154920
Bihar 6208935 257028 101070
Chandigarh 29917 11910 319
Chhattisgarh 4865172 622331 320588
Daman & Diu 42575 3050 555
Delhi 0 0 0
Goa 471333 10746 4983
Gujarat 18652419 7170461 3742565
Haryana 3347880 1380810 710040
Jammu & Kashmir 1689318 155656 44919
Jharkhand 2835013 302253 89616
Karnataka 8988015 502863 163398
Kerala 1942660 219786 163092
Lakshadweep 0 0 0
Madhya Pradesh 6638274 693484 591167
Maharashtra 38111636 1639757 1057744
Manipur 115506 21778 8843
Meghalaya 1031691 58430 29854
Mizoram 201890 10203 7741
Nagaland 202309 21957 3055
Odisha 9819017 804495 504712
Puducherry 178949 200 0
Punjab 3324990 184555 68189
Rajasthan 3695992 240264 141220
Sikkim 24903 2800 730
Tamil Nadu 12033789 716801 401531
Telangana 6023605 347409 144353
Tripura 669774 59596 35073
Uttar Pradesh 23671568 1255378 703505
Uttarakhand 1297966 107196 7723
West Bengal 16267882 3183016 1245370
149
Annexure 5.1
ADOLESCENT HEALTH
Annexure 5.1
Percentage of services provided at AFHC for registered Adolescent by
States/UTs, India 2019-20
Sn. States/UTs Total Out of total adolescent Out of total adolescent
Adolescent registered, % of registered, % of
Registered Adolescent received Adolescent received
Clinical services Counselling services
1 All India 8225908 71 78
2 A & N Islands 4716 32 82
3 Andhra Pradesh 182020 71 82
4 Arunachal Pradesh 9657 72 69
5 Assam 45130 67 70
6 Bihar 87237 72 63
7 Chandigarh 7500 92 100
8 Chhattisgarh 358511 64 64
9 Dadra & Nagar 8043 82 100
Haveli
10 Daman & Diu 6165 61 97
11 Delhi 213238 96 54
12 Goa 47284 77 51
13 Gujarat 368530 83 82
14 Haryana 249305 60 81
15 Himachal Pradesh 30433 82 86
16 Jammu & Kashmir 65747 44 85
17 Jharkhand 150308 76 88
18 Karnataka 559944 79 73
19 Kerala 75455 37 34
20 Lakshadweep 0 NA NA
21 Madhya Pradesh 236155 60 64
22 Maharashtra 945998 86 90
23 Manipur 22795 94 85
24 Meghalaya 42658 82 92
25 Mizoram 24296 93 75
26 Nagaland 13401 86 79
27 Odisha 82759 75 90
28 Puducherry 42203 41 64
29 Punjab 47441 88 77
30 Rajasthan 800977 60 57
31 Sikkim 21151 80 69
32 Tamil Nadu 639763 90 59
33 Telangana 91777 69 74
34 Tripura 20258 62 97
35 Uttar Pradesh 1326131 64 83
36 Uttarakhand 82126 50 98
37 West Bengal 1316796 61 96
150
Annexure 5.2
Annexure 5.2
Number of Adolescents provided IFA tablets under WIFS programme by
States/UTs, India 2019-20
Sn. States/UTs Girls (6th -12th Boys (6th -12th Number of out of school
class) provided 4 class) provided 4 adolescent girls (10-19
IFA tablets in IFA tablets in years) provided 4 IFA
schools schools tablets at Anganwadi
Centres
1 All India 232696667 225463653 64039552
2 A & N Islands 193097 370499 7790
3 Andhra Pradesh 14142509 14756138 2749428
5 Assam 7238126 6948011 1505211
6 Bihar 27011962 26511773 12414372
7 Chandigarh 39808 48349 172
8 Chhattisgarh 7383317 6964896 930259
9 Dadra & Nagar Haveli 139286 143136 0
10 Daman & Diu 75727 79120 0
11 Delhi 598992 501446 6383
12 Goa 740250 765661 688
13 Gujarat 17376593 18095713 5931067
14 Haryana 5610053 5319071 126634
15 Himachal Pradesh 2144112 2189957 16976
16 Jammu & Kashmir 63127 46482 11972
17 Jharkhand 5545396 4600986 4532077
18 Karnataka 12383906 12484696 1087619
19 Kerala 819 281858 1710
20 Lakshadweep NA NA NA
21 Madhya Pradesh 19437468 19853405 4386863
22 Maharashtra 27565566 28867105 1898170
23 Manipur 100344 89637 20366
24 Meghalaya 636200 544828 41958
25 Mizoram 278700 271733 51292
26 Nagaland 44129 39893 7580
27 Odisha 5958641 5981954 3431049
28 Puducherry 427282 335004 15430
29 Punjab 2976196 3052062 122353
30 Rajasthan 2443495 2282818 2598487
31 Sikkim 220630 215320 5
32 Tamil Nadu 24713259 22054506 9187794
33 Telangana 6355844 5711714 1687414
34 Tripura 95110 99598 3728
35 Uttar Pradesh 23630551 21089769 10394198
36 Uttarakhand 1846238 1722464 278538
37 West Bengal 15205243 13081564 590386
151
Annexure 6.1
FAMILY PLANNIG
Annexure 6.1
State/ UT wise performance of Male & Female Sterilisation
F.Y. 2018-19 & 2019-20
Sl. States/ UTs Total Sterilisation Total Sterlisation Total Sterlisation % Total % Total
No. Conducted (Tubectomies and (Tubectomies and Sterilisation Sterilisation
Vasectomies) Vasectomies) (Tubectomies and (Tubectomies and
conducted at Private conducted at Public Vasectomies) Vasectomies)
institutions institutions conducted at conducted at
Private Public institutions
institutions to to Total
Total Sterlisation Sterlisation
2019-20 2018-19 2019-20 2018-19 2019-20 2018-19 2019-20 2018-19 2019-20 2018-19
All India 34,57,783 35,42,434 8,34,646 8,36,895 26,23,137 27,05,539 24.1 23.6 75.9 76.4
1 A & N Islands 429 745 429 745 0.0 0 100.0 100
2 Andhra Pradesh 1,68,622 2,06,099 56,347 69,104 1,12,275 1,36,995 33.4 33.5 66.6 66.5
3 Arunachal Pradesh 1,110 854 133 131 977 723 12.0 15.3 88.0 84.7
4 Assam 34,915 35,792 2,771 2,749 32,144 33,043 7.9 7.7 92.1 92.3
5 Bihar 4,09,137 4,19,410 95,547 1,13,020 3,13,590 3,06,390 23.4 26.9 76.6 73.1
6 Chandigarh 2,344 2,337 2,344 2,337 0.0 0 100.0 100
7 Chhattisgarh 66,766 66,703 13,280 14,721 53,486 51,982 19.9 22.1 80.1 77.9
8 Dadra & Nagar 943 1,139 99 105 844 1,034 10.5 9.2 89.5 90.8
Haveli
9 Daman & Diu 266 316 46 46 220 270 17.3 14.6 82.7 85.4
10 Delhi 18,392 17,531 4,012 4,037 14,380 13,494 21.8 23 78.2 77
11 Goa 2,216 2,369 519 437 1,697 1,932 23.4 18.4 76.6 81.6
12 Gujarat 3,05,912 3,22,665 1,52,826 1,47,083 1,53,086 1,75,582 50.0 45.6 50.0 54.4
13 Haryana 59,569 60,746 10,819 11,118 48,750 49,628 18.2 18.3 81.8 81.7
14 Himachal Pradesh 11,756 11,937 199 224 11,557 11,713 1.7 1.9 98.3 98.1
15 Jammu & 9,871 10,989 620 547 9,251 10,442 6.3 5 93.7 95
Kashmir
16 Jharkhand 80,502 96,330 17,763 30,119 62,739 66,211 22.1 31.3 77.9 68.7
17 Karnataka 2,95,726 2,80,766 97,824 75,595 1,97,902 2,05,171 33.1 26.9 66.9 73.1
18 Kerala 71,022 75,428 33,431 37,041 37,591 38,387 47.1 49.1 52.9 50.9
19 Lakshadweep 77 51 77 51 0.0 0 100.0 100
20 Madhya Pradesh 3,45,251 3,30,105 21,213 12,610 3,24,038 3,17,495 6.1 3.8 93.9 96.2
21 Maharashtra 3,71,742 3,99,634 78,685 80,547 2,93,057 3,19,087 21.2 20.2 78.8 79.8
22 Manipur 583 1,052 136 111 447 941 23.3 10.6 76.7 89.4
23 Meghalaya 2,624 2,377 733 618 1,891 1,759 27.9 26 72.1 74
24 Mizoram 1,564 1,530 94 134 1,470 1,396 6.0 8.8 94.0 91.2
25 Nagaland 1,352 1,210 210 196 1,142 1,014 15.5 16.2 84.5 83.8
26 Odisha 79,652 82,228 5,258 5,687 74,394 76,541 6.6 6.9 93.4 93.1
27 Puducherry 7,597 7,167 1,667 1,763 5,930 5,404 21.9 24.6 78.1 75.4
28 Punjab 30,749 32,963 6,789 6,982 23,960 25,981 22.1 21.2 77.9 78.8
29 Rajasthan 2,53,455 2,60,077 52,688 51,683 2,00,767 2,08,394 20.8 19.9 79.2 80.1
30 Sikkim 77 63 77 63 0.0 0 100.0 100
31 Tamil Nadu 2,58,079 2,58,858 86,874 88,184 1,71,205 1,70,674 33.7 34.1 66.3 65.9
32 Telangana 79,317 78,292 18,752 15,950 60,565 62,342 23.6 20.4 76.4 79.6
33 Tripura 3,001 2,529 662 354 2,339 2,175 22.1 14 77.9 86
34 Uttar Pradesh 3,09,207 2,84,703 45,271 41,305 2,63,936 2,43,398 14.6 14.5 85.4 85.5
35 Uttarakhand 10,301 12,817 46 770 10,255 12,047 0.4 6 99.6 94
36 West Bengal 1,63,657 1,74,622 29,332 23,924 1,34,325 1,50,698 17.9 13.7 82.1 86.3
152
Annexure 6.2
Annexure 6.2
State/ UT wise performance of IUCD & PPIUCD Insertions F.Y. 2018-19 &
2019-20
Sl. States/ UTs Total Institutional Total IUCD Total PP IUCD % PP IUCD % PP IUCD
No deliveries insertions done Insertions done Insertions to Insertions to
Total Total IUCD
Institutional Insertions
Delivery
2019-20 2018-19 2019-20 2018-19 2019-20 2018-19 2019- 2018- 2019- 2018-
20 19 20 19
All India 2,02,27,064 1,97,27,034 58,38,789 56,56,904 25,45,373 22,90,562 13 12 44 40
1 A & N Islands 3,537 3,754 701 695 410 400 12 11 58 58
2 Andhra 7,32,248 7,42,638 101068 85,598 12,848 10,787 2 1 13 13
Pradesh
3 Arunachal 18,718 16,984 2900 2,701 662 575 4 3 23 21
Pradesh
4 Assam 5,54,567 5,32,966 172717 1,35,760 92,929 56,377 17 11 54 42
5 Bihar 18,71,740 16,96,852 382077 4,22,324 1,84,229 1,80,533 10 11 48 43
6 Chandigarh 28,106 28,958 5120 5,855 2,841 3,064 10 11 55 52
7 Chhattisgarh 4,77,003 4,75,442 157605 1,35,751 64,876 54,646 14 11 41 40
8 Dadra & 9,541 9,035 353 533 63 161 1 2 18 30
Nagar Haveli
9 Daman & Diu 4,047 3,854 250 486 47 246 1 6 19 51
10 Delhi 2,75,161 2,71,485 94572 75,403 57,634 40,904 21 15 61 54
11 Goa 18,419 17,921 883 1,021 113 121 1 1 13 12
12 Gujarat 11,45,868 11,32,387 604185 5,96,744 77,157 62,318 7 6 13 10
13 Haryana 4,93,203 4,75,065 208942 2,07,308 90,304 86,217 18 18 43 42
14 Himachal 82,043 79,009 13569 15,569 3,619 3,625 4 5 27 23
Pradesh
15 Jammu & 1,82,865 1,88,988 17805 19,097 3,823 5,298 2 3 21 28
Kashmir
16 Jharkhand 7,03,850 7,03,963 151706 1,49,227 82,335 72,160 12 10 54 48
17 Karnataka 9,00,003 9,10,527 233965 2,09,353 1,02,368 77,421 11 9 44 37
18 Kerala 4,60,383 4,83,836 36583 41,103 3,317 3,601 1 1 9 9
19 Lakshadweep 869 845 7 3 0 1 0 0 0 33
20 Madhya 13,52,232 13,07,119 415025 4,20,329 2,26,392 2,25,367 17 17 55 54
Pradesh
21 Maharashtra 17,87,203 17,13,864 396668 4,18,422 1,27,122 1,20,671 7 7 32 29
22 Manipur 33,251 31,293 4115 4,337 697 978 2 3 17 23
23 Meghalaya 54,008 48,755 3281 3,215 669 528 1 1 20 16
24 Mizoram 18,492 17,193 1964 1,654 339 155 2 1 17 9
25 Nagaland 17,112 16,173 4220 4,016 193 209 1 1 5 5
26 Odisha 6,23,920 6,30,765 176885 1,64,345 1,11,306 90,559 18 14 63 55
27 Puducherry 43,175 43,970 3478 2,513 2,657 1,478 6 3 76 59
28 Punjab 3,73,687 3,64,177 122470 1,43,546 38,080 41,950 10 12 31 29
29 Rajasthan 13,52,917 13,51,299 511226 4,87,684 2,62,737 2,38,549 19 18 51 49
30 Sikkim 7,065 7,042 664 768 352 348 5 5 53 45
31 Tamil Nadu 9,42,663 9,39,442 334333 3,40,581 2,50,155 2,01,261 27 21 75 59
32 Telangana 6,20,665 6,09,362 50566 44,825 7,035 8,974 1 1 14 20
33 Tripura 48,904 47,007 836 951 236 288 0 1 28 30
34 Uttar Pradesh 36,05,433 34,01,350 1018550 8,45,876 3,57,227 3,08,157 10 9 35 36
35 Uttarakhand 1,35,606 1,29,173 39288 52,096 8,372 10,703 6 8 21 21
36 West Bengal 12,48,560 12,94,541 570212 6,17,215 3,72,229 3,81,932 30 30 65 62
153
Annexure 6.3
Annexure 6.3
State/ UT wise ECP & Oral pills distribution during 2018-19 & 2019-20
Emergency Contraceptive Combined Oral Pills Centchroman (weekly
Sl.
Indicators Pills Distributed distributed pills) distributed
No.
2019-20 2018-19 2019-20 2018-19 2019-20 2018-19
All India 27,06,560 19,74,531 4,23,71,629 4,08,56,742 34,50,716 14,67,953
1 A & N Islands 413 484 15,409 15,156 187 18,480
2 Andhra Pradesh 22,598 24,650 23,22,215 23,97,275 1,29,244 50,372
Arunachal
3 9,476 5,266
Pradesh 31,375 21,284 5,441 1,749
4 Assam 51,448 29,911 20,61,281 17,26,294 83,434 37,613
5 Bihar 3,07,490 2,26,340 11,26,502 10,16,511 4,44,715 1,87,884
6 Chandigarh 1,075 692 21,332 24,749 956 231
7 Chhattisgarh 18,088 11,881 8,67,846 7,51,548 83,283 32,742
Dadra & Nagar
8 142 131
Haveli 24,045 12,908 4,848 84
9 Daman & Diu 634 321 9,133 9,698 499 392
10 Delhi 30,611 28,782 1,62,564 1,73,691 62,597 28,209
11 Goa 227 203 16,920 14,910 2,326 1,628
12 Gujarat 43,196 38,477 23,94,395 24,91,713 1,30,160 1,15,205
13 Haryana 35,524 57,142 8,86,295 8,86,408 69,247 50,676
Himachal
14 18,515 17,223
Pradesh 2,82,195 3,22,306 10,358 4,918
Jammu &
15 54,497 49,471
Kashmir 4,58,562 4,29,393 28,128 13,144
16 Jharkhand 2,02,902 94,781 16,20,637 10,02,479 2,29,052 68,715
17 Karnataka 20,388 19,171 18,62,030 18,69,777 1,42,115 67,489
18 Kerala 7,762 9,947 54,579 43,366 7,526 4,540
19 Lakshadweep 229 232 1,589 2,100 239 116
Madhya
20 80,390 59,790
Pradesh 45,22,535 40,60,055 2,48,101 91,901
21 Maharashtra 37,549 20,758 30,17,971 31,83,029 1,48,855 69,472
22 Manipur 8,104 6,958 47,336 56,791 3,845 758
23 Meghalaya 1,573 1,273 96,493 92,133 2,423 1,397
24 Mizoram 1,694 1,858 84,677 74,374 331 2,068
25 Nagaland 3,355 2,902 18,421 17,010 831 431
26 Odisha 55,924 55,953 17,03,242 17,97,059 48,944 12,699
27 Puducherry 3,490 5,117 16,442 18,817 7,438 2,169
28 Punjab 54,822 41,158 11,06,437 11,37,369 48,516 22,497
29 Rajasthan 1,24,631 94,026 37,29,245 37,57,888 1,32,701 55,158
30 Sikkim 138 144 77,502 82,060 1,957 2,094
31 Tamil Nadu 24,639 30,844 3,85,346 4,55,118 1,30,534 74,588
32 Telangana 29,021 30,596 7,15,882 6,08,162 45,948 69,243
33 Tripura 3,983 5,084 1,19,103 1,25,639 1,122 1,241
34 Uttar Pradesh 13,69,679 9,34,484 46,44,343 36,87,426 6,93,530 2,63,438
35 Uttarakhand 22,013 36,433 2,85,135 3,45,077 25,754 9,318
36 West Bengal 60,340 32,048 75,82,615 81,47,169 4,75,531 1,05,294
154
Annexure 6.4
Annexure 6.4
State/ UT wise performance of Injectable Contraceptives during F.Y 2019-20
Number of
Number of Number of Number of
beneficiaries
beneficiaries beneficiaries beneficiaries
given 4th or more
Sl. given 1st dose of given 2nd dose of given 3rd dose of
Indicators than 4 doses of
No. Injectable Injectable Injectable
Injectable
(Antara (Antara (Antara
(Antara
Program) Program) Program)
Program)
All India 10,00,294 4,69,364 2,54,627 2,29,578
1 A & N Islands 1,575 199 143 248
2 Andhra Pradesh 685 455 94 2,413
3 Arunachal Pradesh 371 236 109 137
4 Assam 50,177 21,530 10,159 7,579
5 Bihar 1,70,343 93,551 54,043 33,619
6 Chandigarh 2,149 985 497 380
7 Chhattisgarh 12,037 5,012 2,119 2,454
8 Dadra & Nagar Haveli 687 503 374 439
9 Daman & Diu 225 92 54 15
10 Delhi 18,893 7,042 3,720 4,537
11 Goa 451 252 141 135
12 Gujarat 29,459 16,387 4,902 5,426
13 Haryana 27,510 12,364 5,666 4,535
14 Himachal Pradesh 2,641 1,151 700 925
15 Jammu & Kashmir 15,799 7,498 4,319 3,572
16 Jharkhand 37,112 16,612 9,164 7,679
17 Karnataka 30,488 14,204 8,060 8,934
18 Kerala 2,396 843 494 399
19 Lakshadweep 1 2 0 3
20 Madhya Pradesh 56,857 27,987 16,732 23,071
21 Maharashtra 29,368 10,691 4,647 2,831
22 Manipur 219 56 25 12
23 Meghalaya 5,432 2,896 1,585 2,078
24 Mizoram 205 90 114 67
25 Nagaland 153 87 76 360
26 Odisha 28,665 11,231 4,922 3,671
27 Puducherry 1,184 806 589 443
28 Punjab 6,534 2,561 1,339 1,118
29 Rajasthan 99,661 55,294 35,202 30,824
30 Sikkim 481 264 150 314
31 Tamil Nadu 32,920 10,458 4,699 3,677
32 Telangana 5,108 1,342 317 2,726
33 Tripura 1,191 368 126 116
34 Uttar Pradesh 2,04,059 71,544 34,585 32,194
35 Uttarakhand 1,724 566 317 567
36 West Bengal 1,23,534 74,205 44,444 42,080
155
Annexure 6.5
Annexure 6.5
State wise achievement of contraceptive users during F.Y. 2019-20
a b c d e f g h i
Injectable
Total
Contracepti Number of
Estimated number of
Centchrom ve (MPA) - Contracepti
no of Number of Number of IUCD Combined Condom Contracepti
Sl. an (weekly Antara ve users per
State/ UT Eligible Vasectomies Tubectomie insertiions Oral Pills pieces ve users
No. pills) Program 10,000
Couples Conducted s Conducted done distributed distributed h=a+b+c+(d
distributed (1st to 4th eligible
(2019-20) /13)+(e/72)+
or more couple
(f/9)+(g/4)
doses)
All India 25,27,06,600 54,817 34,02,966 58,38,789 4,23,71,629 32,17,31,260 34,50,716 19,53,863 1,78,96,296 708
A&N
1
Islands 91,500 0 429 701 15,409 1,44,252 187 2,165 4,881 533
Andhra
2
Pradesh 1,08,34,400 1,299 1,67,323 101068 23,22,215 2,32,85,453 1,29,244 3,647 7,87,003 726
Arunachal
3
Pradesh 2,58,200 2 1,108 2900 31,375 88,452 5,441 853 8,470 328
4 Assam 64,32,400 2,262 32,653 172717 20,61,281 52,15,075 83,434 89,445 4,70,255 731
5 Bihar 2,03,44,900 3,784 4,05,353 382077 11,26,502 1,11,46,117 4,44,715 3,51,556 11,69,977 575
6 Chandigarh 2,76,900 46 2,298 5120 21,332 14,64,271 956 4,011 30,551 1,103
7 Chhattisgarh 52,74,000 6,775 59,991 157605 8,67,846 47,43,792 83,283 21,622 3,71,674 705
Dadra &
8 Nagar
Haveli 85,900 5 938 353 24,045 8,13,913 4,848 2,003 15,489 1,803
Daman &
9
Diu 56,300 2 264 250 9,133 1,36,888 499 386 3,272 581
10 Delhi 40,25,500 740 17,652 94572 1,62,564 53,87,988 62,597 34,192 2,15,805 536
11 Goa 3,26,800 5 2,211 883 16,920 3,95,900 2,326 979 10,402 318
12 Gujarat 1,30,91,000 1,476 3,04,436 604185 23,94,395 2,53,60,190 1,30,160 56,174 14,75,012 1,127
13 Haryana 54,49,700 2,361 57,208 208942 8,86,295 1,63,75,095 69,247 50,075 5,84,332 1,072
Himachal
14
Pradesh 14,30,400 825 10,931 13569 2,82,195 38,05,636 10,358 5,417 1,02,394 716
Jammu &
15
Kashmir 21,20,100 334 9,537 17805 4,58,562 29,17,806 28,128 31,188 1,14,397 540
16 Jharkhand 66,55,300 1,352 79,150 151706 16,20,637 87,57,180 2,29,052 70,567 5,21,592 784
17 Karnataka 1,31,47,900 787 2,94,939 233965 18,62,030 1,63,84,989 1,42,115 61,686 9,31,705 709
18 Kerala 71,80,700 658 70,364 36583 54,579 18,96,821 7,526 4,132 1,40,017 195
Lakshadwee
19
p 13,200 0 77 7 1,589 29,631 239 6 646 489
Madhya
20
Pradesh 1,54,18,700 4,491 3,40,760 415025 45,22,535 2,45,18,597 2,48,101 1,24,647 15,07,428 978
21 Maharashtra 2,41,82,100 8,943 3,62,799 396668 30,17,971 1,70,59,963 1,48,855 47,537 12,65,929 523
22 Manipur 4,98,700 16 567 4115 47,336 1,46,158 3,845 312 10,874 218
23 Meghalaya 5,01,800 4 2,620 3281 96,493 3,20,655 2,423 11,991 21,048 419
24 Mizoram 1,85,700 0 1,564 1964 84,677 1,39,830 331 476 12,139 654
25 Nagaland 3,13,000 3 1,349 4220 18,421 1,10,844 831 676 8,790 281
26 Odisha 84,14,000 1,459 78,193 176885 17,03,242 91,18,007 48,944 48,489 5,31,755 632
27 Puducherry 3,40,200 10 7,587 3478 16,442 10,46,301 7,438 3,022 28,454 836
28 Punjab 55,98,500 1,368 29,381 122470 11,06,437 2,25,39,919 48,516 11,552 5,59,663 1,000
29 Rajasthan 1,47,89,800 2,617 2,50,838 511226 37,29,245 3,63,39,800 1,32,701 2,20,981 16,26,255 1,100
30 Sikkim 1,17,800 0 77 664 77,502 2,67,474 1,957 1,209 10,937 928
31 Tamil Nadu 1,55,01,300 956 2,57,123 334333 3,85,346 57,07,744 1,30,534 51,754 7,28,771 470
32 Telangana 76,49,600 3,422 75,895 50566 7,15,882 43,13,339 45,948 9,493 2,52,337 330
33 Tripura 8,13,900 40 2,961 836 1,19,103 1,66,349 1,122 1,801 15,884 195
Uttar
34
Pradesh 3,88,29,100 5,700 3,03,507 1018550 46,44,343 4,05,27,698 6,93,530 3,42,382 24,10,553 621
35 Uttarakhand 20,21,500 244 10,057 39288 2,85,135 24,47,699 25,754 3,174 1,09,173 540
36 West Bengal 2,04,35,800 2,831 1,60,826 570212 75,82,615 2,86,11,434 4,75,531 2,84,263 18,38,431 900
156
Annexure 7.1
IMMUNIZATION
Annexure-7.1
State/UT wise percentage of pregnant women received TT2+ TT Booster against
estimated pregnancies during 2019-20
Total %ge PW % Pregnant
Estimated TT Booster
number of TT2 given given (TT2 + women
Number of given to
Sl. pregnant to Pregnant Booster) received TT2+
State Annual Pregnant
No. women women against TT Booster to
Pregnancies women
Registered (numbers) estimated Total ANC
# (numbers)
for ANC pregnancies Registration
1 A & N Islands 5,500 4,784 3,054 796 70 80
2 All India 2,99,13,500 2,90,22,447 1,85,88,385 61,45,359 83 85
3 Andhra Pradesh 9,19,900 8,03,046 7,31,886 71,701 87 100
4 Arunachal Pradesh 30,300 30,162 14,362 3,331 58 59
5 Assam 8,05,700 6,85,229 5,75,220 55,253 78 92
6 Bihar 32,42,100 33,94,623 16,05,380 11,83,992 86 82
7 Chandigarh 23,700 35,734 20,353 4,612 105 70
8 Chhattisgarh 7,01,100 6,46,957 4,91,569 1,28,498 88 96
Dadra & Nagar
9 Haveli 11,500 8,070 5,685 2,392 70 100
10 Daman & Diu 7,700 6,527 4,762 989 75 88
11 Delhi 3,84,600 7,21,322 1,85,663 37,120 58 31
12 Goa 24,100 27,969 10,994 2,051 54 47
13 Gujarat 14,36,800 12,96,148 9,07,471 3,22,116 86 95
14 Haryana 6,44,300 5,72,676 3,76,173 1,59,111 83 93
15 Himachal Pradesh 1,27,800 1,10,701 65,976 26,554 72 84
Jammu &
16 Kashmir 2,34,200 3,58,624 1,73,749 51,909 96 63
17 Jharkhand 9,12,600 9,53,011 6,41,529 1,69,964 89 85
18 Karnataka 12,12,400 11,51,533 8,42,678 3,23,811 96 101
19 Kerala 5,46,700 5,27,626 3,88,187 16,528 74 77
20 Lakshadweep 1,100 1,274 868 150 93 80
21 Madhya Pradesh 21,73,300 19,19,655 12,84,008 4,32,974 79 89
22 Maharashtra 21,38,200 20,51,346 13,03,138 6,45,162 91 95
23 Manipur 55,500 55,346 26,558 6,341 59 59
24 Meghalaya 78,200 1,38,997 45,400 26,448 92 52
25 Mizoram 19,100 23,614 14,003 6,883 109 88
26 Nagaland 31,200 39,462 11,921 4,063 51 41
27 Odisha 9,24,500 7,21,502 6,04,355 66,000 73 93
28 Puducherry 24,200 98,914 15,975 3,571 81 20
29 Punjab 4,90,800 4,38,357 3,69,138 32,090 82 92
30 Rajasthan 20,31,500 17,36,201 9,09,267 5,66,544 73 85
31 Sikkim 11,700 9,343 6,550 732 62 78
32 Tamil Nadu 12,10,500 10,43,510 8,75,917 1,74,390 87 101
33 Telangana 6,94,700 7,59,098 6,29,843 80,398 102 94
34 Tripura 59,400 67,065 47,016 4,389 87 77
35 Uttar Pradesh 68,27,400 67,45,784 39,49,630 13,62,988 78 79
36 Uttarakhand 2,16,700 2,17,191 1,52,967 33,515 86 86
37 West Bengal 16,54,500 16,21,046 12,97,140 1,37,993 87 89
157
Annexure 7.2
Annexure -7.2
State/UT wise Percentage of Children of 9-11 Months Fully Immunized against
Estimated Infants during 2019-20
Estimated Number of fully
%ge of Children
Sl. Number of Estimated infants immunized
Indicators fully immunized
No. Annual Live (0-1 years) children (9-11
(9-11 months)
Births ## months)
All India 2,71,92,790 26297590 2,44,12,021 93
1 A & N Islands 5,230 5160 3,956 77
2 Andhra Pradesh 8,59,730 832220 8,22,839 99
3 Arunachal Pradesh 27,790 26620 19,410 73
4 Assam 7,29,820 697710 5,98,636 86
5 Bihar 30,35,680 2929430 27,68,372 95
6 Chandigarh 20,620 20330 15,773 78
7 Chhattisgarh 6,44,350 619860 5,86,951 95
8 Dadra & Nagar Haveli 10,930 10790 8,132 75
9 Daman & Diu 6,990 6870 4,680 68
10 Delhi 3,25,640 320430 3,12,742 98
11 Goa 22,130 21930 20,330 93
12 Gujarat 13,30,400 1290490 11,73,928 91
13 Haryana 5,89,490 571810 5,34,414 93
14 Himachal Pradesh 1,16,400 113840 99,971 88
15 Jammu & Kashmir 2,11,760 206890 2,26,903 110
16 Jharkhand 8,35,750 811510 7,83,410 97
17 Karnataka 11,49,150 1120420 10,54,456 94
18 Kerala 4,98,840 493850 4,56,525 92
19 Lakshadweep 1,080 1060 989 93
20 Madhya Pradesh 20,38,760 1942940 17,67,769 91
21 Maharashtra 19,59,870 1922630 19,02,253 99
22 Manipur 45,760 45210 37,816 84
23 Meghalaya 74,250 71350 74,872 105
24 Mizoram 18,060 17790 17,870 100
25 Nagaland 29,310 29100 16,286 56
26 Odisha 8,22,530 788810 6,75,322 86
27 Puducherry 22,620 22370 14,456 65
28 Punjab 4,48,220 438810 3,93,111 90
29 Rajasthan 18,60,380 1789690 13,43,164 75
30 Sikkim 10,960 10830 6,807 63
31 Tamil Nadu 11,23,990 1106010 9,41,886 85
32 Telangana 6,44,470 625780 6,29,948 101
33 Tripura 52,420 50900 48,546 95
34 Uttar Pradesh 59,31,700 5688500 54,60,112 96
35 Uttarakhand 1,94,500 188280 1,76,282 94
36 West Bengal 14,93,210 1457370 14,13,104 97
158
Annexure 7.3
Annexure -7.3
State/UT-wise percentage achievement of BCG coverage to estimated need
assessed during 2019-20
Estimated %ge of infants
Number of
Sl. Number of Reported Live given BCG
Indicators Infants given
No. Annual Live Birth against estimated
BCG
Births ## live birth
All India 2,71,92,790 2,12,33,538 2,39,33,592 88
1 A & N Islands 5,230 3,618 3,348 64
2 Andhra Pradesh 8,59,730 7,36,774 7,37,277 86
3 Arunachal Pradesh 27,790 20,668 21,185 76
4 Assam 7,29,820 6,00,797 6,66,512 91
5 Bihar 30,35,680 21,14,235 27,42,146 90
6 Chandigarh 20,620 27,957 26,237 127
7 Chhattisgarh 6,44,350 4,79,404 5,56,103 86
8 Dadra & Nagar Haveli 10,930 9,539 9,398 86
9 Daman & Diu 6,990 4,059 5,189 74
10 Delhi 3,25,640 2,83,719 2,90,204 89
11 Goa 22,130 18,491 18,334 83
12 Gujarat 13,30,400 11,48,115 12,37,164 93
13 Haryana 5,89,490 5,11,004 5,42,744 92
14 Himachal Pradesh 1,16,400 88,410 90,909 78
15 Jammu & Kashmir 2,11,760 1,91,384 2,05,700 97
16 Jharkhand 8,35,750 7,31,400 7,88,235 94
17 Karnataka 11,49,150 8,98,459 10,20,798 89
18 Kerala 4,98,840 4,64,530 4,56,084 91
19 Lakshadweep 1,080 851 856 79
20 Madhya Pradesh 20,38,760 14,03,115 14,02,695 69
21 Maharashtra 19,59,870 17,96,217 19,21,037 98
22 Manipur 45,760 39,462 38,560 84
23 Meghalaya 74,250 89,449 90,495 122
24 Mizoram 18,060 20,577 20,503 114
25 Nagaland 29,310 20,582 22,701 77
26 Odisha 8,22,530 6,32,591 6,23,113 76
27 Puducherry 22,620 43,023 42,668 189
28 Punjab 4,48,220 3,77,525 3,89,716 87
29 Rajasthan 18,60,380 13,62,923 13,90,146 75
30 Sikkim 10,960 7,188 6,605 60
31 Tamil Nadu 11,23,990 9,42,471 9,37,391 83
32 Telangana 6,44,470 6,33,667 6,70,136 104
33 Tripura 52,420 51,339 50,390 96
34 Uttar Pradesh 59,31,700 40,71,547 54,05,864 91
35 Uttarakhand 1,94,500 1,52,300 1,79,177 92
36 West Bengal 14,93,210 12,56,148 13,23,972 89
159
Annexure 7.4
Annexure – 7.4
State/ UT wise coverage of measles/ MR vaccination reported in HMIS during
2019-20
%ge of infant
Estimated no. of Number of Number of given Measles/
Sl. No. State/UT Infants (2019- Infants given Infants given MR to
20) Measles MR estimated
infant
All India 2,62,97,590 9,85,498 2,37,09,859 94
1 A & N Islands 5,160 214 3,866 79
2 Andhra Pradesh 8,32,220 18,714 8,27,563 102
3 Arunachal Pradesh 26,620 82 19,556 74
4 Assam 6,97,710 190 5,98,430 86
5 Bihar 29,29,430 9,776 27,78,081 95
6 Chandigarh 20,330 0 15,810 78
7 Chhattisgarh 6,19,860 1,649 5,88,011 95
8 Dadra & Nagar Haveli 10,790 0 8,147 76
9 Daman & Diu 6,870 0 4,734 69
10 Delhi 3,20,430 5,436 3,09,272 98
11 Goa 21,930 0 20,620 94
12 Gujarat 12,90,490 21,960 11,59,183 92
13 Haryana 5,71,810 0 5,41,086 95
14 Himachal Pradesh 1,13,840 0 99,976 88
15 Jammu & Kashmir 2,06,890 486 2,29,280 111
16 Jharkhand 8,11,510 10,443 7,86,344 98
17 Karnataka 11,20,420 19,816 10,55,813 96
18 Kerala 4,93,850 6,488 4,58,167 94
19 Lakshadweep 1,060 10 995 95
20 Madhya Pradesh 19,42,940 50,090 17,25,211 91
21 Maharashtra 19,22,630 499 19,14,414 100
22 Manipur 45,210 3 38,818 86
23 Meghalaya 71,350 7,686 68,147 106
24 Mizoram 17,790 2 17,938 101
25 Nagaland 29,100 6 17,833 61
26 Odisha 7,88,810 0 6,75,604 86
27 Puducherry 22,370 86 14,863 67
28 Punjab 4,38,810 96 3,94,661 90
29 Rajasthan 17,89,690 4,91,526 8,59,477 75
30 Sikkim 10,830 277 6,444 62
31 Tamil Nadu 11,06,010 3,198 9,44,599 86
32 Telangana 6,25,780 8,354 6,33,265 103
33 Tripura 50,900 179 48,919 96
34 Uttar Pradesh 56,88,500 3,21,466 52,53,936 98
35 Uttarakhand 1,88,280 201 1,77,094 94
36 West Bengal 14,57,370 6,565 14,13,702 97
160
Annexure 7.5
Annexure – 7.5
States/UTs wise Rotavirus 1st, 2nd & 3rd dose administered reported in HMIS
during 2019-20
No. of infants given No. of infants No. of infants No. of infants
Sl.
State/UT Measles Rubella received Rotavirus received Rotavirus received Rotavirus
No
vaccine 1st dose Vaccine 1st dose Vaccine 2nd dose Vaccine 3nd dose
All India 2,37,09,859 1,93,32,648 1,77,97,743 1,69,14,746
1 A & N Islands 3,866 2,286 1,939 1,629
2 Andhra Pradesh 8,27,563 7,69,407 7,62,983 7,89,971
3 Arunachal Pradesh 19,556 16,712 13,051 11,063
4 Assam 5,98,430 5,95,833 5,88,366 5,81,429
5 Bihar 27,78,081 20,27,021 16,81,892 13,69,825
6 Chandigarh 15,810 11,585 8,927 7,810
7 Chhattisgarh 5,88,011 3,54,246 3,09,581 2,77,363
8 Dadra & Nagar Haveli 8,147 4,918 4,370 3,852
9 Daman & Diu 4,734 3,563 3,008 2,819
10 Delhi 3,09,272 2,00,446 1,53,907 1,22,344
11 Goa 20,620 12,715 11,290 9,879
12 Gujarat 11,59,183 8,04,004 6,94,303 6,12,924
13 Haryana 5,41,086 4,99,612 4,87,299 4,73,542
14 Himachal Pradesh 99,976 1,01,326 1,00,980 1,00,392
15 Jammu & Kashmir 2,29,280 1,17,706 96,787 82,732
16 Jharkhand 7,86,344 7,67,899 7,48,620 7,40,519
17 Karnataka 10,55,813 5,47,020 4,37,701 3,74,522
18 Kerala 4,58,167 1,34,565 92,987 61,849
19 Lakshadweep 995 341 252 186
20 Madhya Pradesh 17,25,211 16,05,185 15,70,959 15,69,539
21 Maharashtra 19,14,414 11,88,481 10,06,186 9,01,378
22 Manipur 38,818 31,892 25,090 20,878
23 Meghalaya 68,147 40,627 27,211 19,662
24 Mizoram 17,938 13,804 11,660 9,650
25 Nagaland 17,833 13,247 10,315 8,708
26 Odisha 6,75,604 6,40,974 6,35,877 6,34,230
27 Puducherry 14,863 8,760 7,612 6,592
28 Punjab 3,94,661 2,41,631 1,96,772 1,60,678
29 Rajasthan 8,59,477 13,06,160 12,67,920 12,51,720
30 Sikkim 6,444 5,192 4,545 3,897
31 Tamil Nadu 9,44,599 8,95,066 8,93,745 8,97,675
32 Telangana 6,33,265 3,01,285 2,54,189 2,26,301
33 Tripura 48,919 54,151 52,161 50,767
34 Uttar Pradesh 52,53,936 50,48,976 48,61,931 49,16,826
35 Uttarakhand 1,77,094 1,13,011 95,971 80,930
36 West Bengal 14,13,702 8,53,001 6,77,356 5,30,665
161
Annexure 7.6
Annexure – 7.6
State/UT-wise distribution of AEFI Deaths, Abscess & other adverse events
reported in HMIS during 2019-20
Adverse Events Adverse Events Adverse Events
Sl.
State/UT Following Immunisation Following Immunisation Following Immunisation
No.
(Abscess) (Deaths) (Others)
All India 23,741 316 4,39,800
1 A & N Islands 14 4 183
2 Andhra Pradesh 204 2 811
4 Assam 522 29 17,070
5 Bihar 2,980 52 16,791
6 Chandigarh 4 0 51
7 Chhattisgarh 360 0 6,845
8 Dadra & Nagar Haveli 2 0 7,168
9 Daman & Diu 4 0 95
10 Delhi 75 11 241
11 Goa 13 1 65
12 Gujarat 1,851 6 13,284
13 Haryana 864 8 7,270
14 Himachal Pradesh 81 0 4,970
15 Jammu & Kashmir 246 1 5,778
16 Jharkhand 1,460 10 11,224
17 Karnataka 1,131 28 8,914
18 Kerala 364 26 3,207
19 Lakshadweep 0 0 49
20 Madhya Pradesh 1,207 3 23,407
21 Maharashtra 92 14 1,540
22 Manipur 5 0 308
23 Meghalaya 108 5 1,945
24 Mizoram 30 1 502
25 Nagaland 0 0 2
26 Odisha 2,385 11 1,52,029
27 Puducherry 172 0 2,886
28 Punjab 102 5 4,894
29 Rajasthan 376 0 6,119
30 Sikkim 42 0 454
31 Tamil Nadu 109 17 332
32 Telangana 783 11 2,947
33 Tripura 122 1 525
34 Uttar Pradesh 3,657 29 20,022
35 Uttarakhand 525 4 32,925
36 West Bengal 3,844 36 83,993
162
Annexure 8.1
Annexure – 8.1
State/UT wise Distribution of Infant Deaths By Age and Cause
Infant Infant Infant Infant Total Infant Infant Infant Infant Infant Total Total
deaths Death Deaths Death Infant Deaths Deaths Deaths Deaths Deaths Infant Infant
within s up up to 4 s up Deaths (1 -12 (1 -12 (1 -12 (1 -12 (1 -12 Deaths Deaths
24 hrs to 4 weeks to 4 upto 4 months) months) months months months (1 -12
(1 to weeks due to weeks weeks due to due to ) due ) due ) due months
State/UT 23 due to Asphyxi due to (excludi Pneumon Diarrhoe to to to )
Hrs) of Sepsis a Other ng ia a Fever Measle Others
birth causes deaths related s
within
24
hours)
All India 46665 21406 27506 83417 132329 11280 1445 3431 279 48640 52350 231344
A & N Islands 12 5 9 18 32 2 0 3 1 17 21 65
Andhra Pradesh 1452 1150 1825 2653 5628 406 16 109 23 1691 1823 8903
Arunachal Pradesh 38 6 10 7 23 8 1 1 0 14 15 76
Assam 1916 1049 2423 3665 7137 735 35 353 10 2232 2595 11648
Bihar 2001 441 1026 3258 4725 339 49 182 20 1597 1799 8525
Chandigarh 288 101 73 405 579 11 2 2 2 613 617 1484
Chhattisgarh 1047 470 851 3016 4337 563 34 86 6 1865 1957 7341
Dadra & Nagar Haveli 22 8 26 139 173 5 0 0 0 43 43 238
Daman & Diu 10 2 3 13 18 4 1 0 0 3 3 31
Delhi 769 846 509 1152 2507 384 41 92 8 848 948 4224
Goa 17 18 10 56 84 7 0 3 0 20 23 124
Gujarat 2926 1871 2361 6923 11155 764 256 200 11 3282 3493 17574
Haryana 2866 607 505 4158 5270 536 122 267 36 3323 3626 11762
Himachal Pradesh 293 81 83 493 657 56 10 42 0 305 347 1297
Jammu & Kashmir 2616 627 217 716 1560 125 4 19 8 286 313 4489
Jharkhand 1234 217 313 2030 2560 190 104 126 11 925 1062 4856
Karnataka 1456 1114 1434 3301 5849 443 46 77 15 2325 2417 9722
Kerala 241 109 161 598 868 84 11 5 9 444 458 1567
Lakshadweep 2 0 1 1 2 0 0 0 0 1 1 5
Madhya Pradesh 6493 2215 2773 12972 17960 1409 134 459 44 6553 7056 31509
Maharashtra 3088 1779 1942 5967 9688 670 68 187 0 2929 3116 15892
Manipur 27 4 24 36 64 6 3 1 0 14 15 106
Meghalaya 404 177 154 550 881 348 46 161 2 682 845 2130
Mizoram 42 34 36 86 156 64 4 15 0 88 103 301
Nagaland 38 20 28 24 72 20 1 0 1 42 43 153
Odisha 2208 1219 1935 3861 7015 1001 20 83 0 2650 2733 11956
Puducherry 40 76 47 135 258 16 1 2 0 41 43 341
Punjab 429 114 98 959 1171 127 32 67 13 636 716 2316
Rajasthan 4444 2723 2162 11992 16877 974 165 363 12 6297 6672 27993
Sikkim 9 3 2 8 13 10 8 2 0 49 51 73
Tamil Nadu 1337 935 1387 3104 5426 248 28 29 17 2514 2560 9323
Telangana 311 103 200 1102 1405 150 19 46 7 756 809 2525
Tripura 190 57 87 233 377 52 4 8 0 351 359 926
Uttar Pradesh 3277 717 1565 3502 5784 336 159 281 14 1558 1853 10914
Uttarakhand 278 44 40 477 561 43 11 33 4 302 339 1178
West Bengal 4844 2464 3186 5807 11457 1144 10 127 5 3344 3476 19777
163
Annexure 8 .2
Annexure – 8.2
State/UT wise Distribution of Maternal Deaths by Cause
Maternal Maternal Maternal Maternal Maternal Maternal Deaths Total Facility
Deaths due Deaths due Deaths due to Deaths due to Deaths due to due to Other Based Maternal
State/UT to Bleeding to High Abortion Obstructed/pro Severe hyper- Causes Death Reviews
fever longed labour tension/fits (including causes (FBMDR) done
not known)
All India 2864 524 246 444 1863 13342 5554
A & N Islands 0 0 0 0 0 5 0
Andhra Pradesh 65 17 4 3 74 229 169
Arunachal Pradesh 3 0 1 1 0 8 2
Assam 109 22 21 29 129 699 405
Bihar 193 22 13 41 73 701 244
Chandigarh 0 0 0 0 0 31 1
Chhattisgarh 74 8 3 31 67 459 157
Dadra & Nagar
Haveli 2 0 0 0 0 4 0
Daman & Diu 0 0 0 0 0 0 0
Delhi 47 32 6 0 54 345 170
Goa 0 0 0 0 0 7 2
Gujarat 134 36 22 10 75 653 345
Haryana 73 12 14 10 52 443 20
Himachal Pradesh 9 0 0 1 2 43 10
Jammu & Kashmir 5 0 0 10 10 65 394
Jharkhand 147 19 18 27 44 531 156
Karnataka 106 17 8 3 109 481 195
Kerala 2 0 1 1 5 113 4
Lakshadweep 0 0 0 0 0 1 0
Madhya Pradesh 233 45 34 44 265 1483 492
Maharashtra 136 24 12 19 102 1043 749
Manipur 6 1 0 0 1 27 21
Meghalaya 37 1 3 13 10 110 6
Mizoram 2 2 0 1 0 8 3
Nagaland 7 0 1 2 5 7 3
Odisha 53 2 4 14 48 510 123
Puducherry 0 0 0 0 2 9 6
Punjab 34 12 3 1 31 295 167
Rajasthan 231 32 26 32 150 862 185
Sikkim 1 0 0 0 1 13 1
Tamil Nadu 58 9 3 7 60 362 60
Telangana 25 6 2 2 53 339 14
Tripura 6 0 3 1 2 35 4
Uttar Pradesh 928 197 31 122 318 2558 919
Uttarakhand 21 4 0 2 19 129 6
West Bengal 117 4 13 17 102 734 521
164
Annexure 8.3
Annexure – 8.3
State/UT wise Distribution of Adolescent/ Adult Deaths By Cause
Due to Due to Due to Due to Due to Due to Due Due to Due to Due Due Due to Due to Due to
Diarrhoe Tuber- Respirato Other HIV/ Heart to Neurolo Acciden to to Known Known Causes
al culosis ry Fever AIDS disease Cance gical ts/Burn Suicid Anim Acute Chronic not
diseases diseases Relate / r disease cases e al Disease Disease known
State/UT
including d Hypert includin bites
infections ension g and
(other related strokes stings
than TB)
All India 5130 24088 84722 29713 7802 312136 77356 99221 85948 52138 9137 100741 285322 1119182
A & N Islands 5 21 31 16 21 392 70 19 60 68 0 73 188 498
Andhra Pradesh 199 2195 4264 741 1319 20795 3320 6988 4228 3024 358 5826 19496 165629
Arunachal Pradesh 4 17 61 20 2 67 59 46 37 4 3 27 103 156
Assam 148 559 1945 1154 72 5435 2474 1921 1914 1235 194 2575 5362 21347
Bihar 59 34 188 195 11 192 89 64 341 38 49 109 266 3282
Chandigarh 2 215 342 147 47 2776 339 186 420 71 16 46 475 288
Chhattisgarh 73 539 966 1079 82 3616 1060 1203 3244 2533 579 4407 14840 24956
Dadra & Nagar Haveli 0 15 117 9 0 154 21 119 146 64 2 86 195 503
Daman & Diu 0 16 1 2 0 89 30 45 25 18 1 39 80 207
Delhi 169 248 2491 331 262 3698 1846 1292 799 878 13 3122 3844 3003
Goa 1 18 151 1 2 618 68 90 53 40 3 51 313 642
Gujarat 180 1567 6549 541 297 9046 2966 1181 3187 2141 416 1577 13803 39016
Haryana 216 1478 2904 969 225 11580 5039 1062 3569 1868 249 1521 3673 76709
Himachal Pradesh 23 274 600 161 22 2522 1358 342 935 410 66 752 3035 15874
Jammu & Kashmir 0 24 205 40 4 674 252 113 117 25 5 108 440 1931
Jharkhand 42 170 309 568 17 408 147 133 763 199 164 411 516 5266
Karnataka 202 1628 9415 1158 1402 27818 8729 13838 6203 5723 694 11402 22199 125194
Kerala 20 110 1758 43 13 3851 2561 1144 349 440 31 1541 2992 4015
Lakshadweep 0 0 13 0 0 93 23 23 4 0 0 8 36 97
Madhya Pradesh 238 1948 4545 1217 242 10158 4539 3709 9148 4631 1481 9695 18231 59432
Maharashtra 283 2792 16013 2420 1491 51369 9787 15784 9199 6301 947 17320 44583 94756
Manipur 4 9 54 20 27 353 222 104 117 72 3 143 772 1370
Meghalaya 76 234 387 573 21 820 1020 673 372 176 27 570 1965 4449
Mizoram 10 59 249 141 146 413 763 182 211 87 9 466 1211 498
Nagaland 14 55 112 25 78 231 127 98 48 1 19 158 376 48
Odisha 210 1016 1936 1809 111 12635 3670 5530 2177 1227 543 5616 20962 122766
Puducherry 5 38 127 96 4 500 168 99 346 70 6 285 340 428
Punjab 255 1269 1884 3376 342 41670 5649 1522 3871 1503 264 2462 8800 56563
Rajasthan 1420 2677 4591 8525 163 8847 3336 1894 6113 2033 636 4484 10558 30451
Sikkim 1 22 104 36 0 244 132 61 78 111 4 81 380 248
Tamil Nadu 141 1370 4340 737 432 44457 6119 6286 13610 7300 515 6655 29256 60869
Telangana 149 766 1006 536 505 4825 1584 1622 2974 3118 282 1658 5557 58732
Tripura 7 41 521 54 2 1126 302 504 188 238 3 397 850 7535
Uttar Pradesh 662 868 2921 1737 94 2538 688 966 2490 587 358 1269 2054 15657
Uttarakhand 58 120 396 342 30 715 300 178 343 163 22 204 508 3408
West Bengal 254 1676 13226 894 316 37411 8499 30200 8269 5741 1175 15597 47063 113359
165
Annexure 8 .4
Annexure – 8.4
State/UT wise Distribution of Deaths due to Vector Borne Diseases
Due to Due to Due to Due to Due to Acute Due to
Malaria- Malaria- Kala Dengue Encephelitis Japanese
State/UT
Plasmodium Plasmodium Azar Syndrome Encephalitis
Vivax Falciparum (AES) (JE)
All India 692 2305 4 362 634 407
A & N Islands 0 0 0 0 1 0
Andhra Pradesh 76 145 0 3 18 10
Arunachal Pradesh 0 25 0 0 2 1
Assam 10 11 0 3 136 72
Bihar 52 83 0 10 4 6
Chandigarh 1 2 0 29 124 0
Chhattisgarh 59 40 0 0 1 0
Dadra & Nagar 0 0 0 4 1 0
Haveli
Daman & Diu 0 0 0 0 0 1
Delhi 9 2 0 54 1 0
Goa 0 2 0 0 0 0
Gujarat 11 46 0 39 21 83
Haryana 27 45 1 6 1 4
Jammu & Kashmir 2 0 0 0 0 52
Jharkhand 2 20 0 0 0 0
Karnataka 97 89 0 31 20 21
Kerala 3 6 1 10 6 7
Madhya Pradesh 59 92 0 4 11 0
Maharashtra 17 45 0 89 84 9
Manipur 1 0 0 0 0 6
Meghalaya 1 14 0 2 12 2
Mizoram 1 20 0 0 0 0
Nagaland 0 0 0 3 0 2
Odisha 0 8 0 2 10 0
Punjab 4 0 0 3 0 0
Rajasthan 146 35 1 30 68 118
Sikkim 0 0 0 0 0 0
Tamil Nadu 7 2 0 4 27 1
Telangana 5 482 0 6 10 0
Tripura 1 0 0 0 0 0
Uttar Pradesh 59 1063 0 3 6 9
Uttarakhand 0 0 0 5 0 0
West Bengal 42 28 1 22 70 3
166
Annexure 9.1
PATIENT SERVICES
Annexure 9.1
State/UT wise Distribution of OPDs
% change from
States/UTs FY 2017-18 FY 2018-19 FY 2019-20
FY 2017-18
All India 1603537081 1721488782 1782252366 11
A & N Islands 1867028 1895013 2476877 33
Andhra Pradesh 72508744 79115597 79266139 9
Assam 33879656 35948263 37236133 10
Bihar 75827096 76518123 76709298 1
Chandigarh 6880234 7351326 7135246 4
Chhattisgarh 20902413 21438729 25835138 24
Daman & Diu 864245 887447 936880 8
Delhi 70978783 76814952 78257618 10
Goa 2079737 2166129 2533808 22
Gujarat 70827809 51721047 62679703 -12
Haryana 29702978 33743005 35275227 19
Jammu & Kashmir 27661972 27521967 29302310 6
Jharkhand 14922309 15044432 16308679 9
Karnataka 94387501 104382297 114128758 21
Kerala 120630739 166667728 137340469 14
Lakshadweep 463499 522205 543075 17
Madhya Pradesh 52199478 57482267 65911119 26
Maharashtra 96818391 98900286 110721506 14
Manipur 1407786 1380144 1997298 42
Meghalaya 4355069 4211384 4378258 1
Mizoram 1375363 1520622 1624582 18
Nagaland 1103357 1212324 1266182 15
Odisha 51700675 62732140 72652805 41
Puducherry 9388778 9330353 8239553 -12
Punjab 26389010 25639701 24051866 -9
Rajasthan 114334243 126354838 141549009 24
Sikkim 1139592 1038809 926227 -19
Tamil Nadu 261133204 275650732 273488026 5
Telangana 38679482 45129750 51108774 32
Tripura 4442299 4766223 4705207 6
Uttar Pradesh 142361846 142040873 151349374 6
Uttarakhand 8538449 8105605 8533673 0
West Bengal 126783432 136909971 134616706 6
167
Annexure 9.2
Annexure 9.2
State/UT wise Distribution of Inpatient Head Count at Midnight
% Change from
States/UTs FY 2017-18 FY 2018-19 FY 2019-20
FY 2017-18
All India 114333866 121532619 129964421 14
A & N Islands 138352 152442 152027 10
Assam 1306221 1431986 1677306 28
Bihar 3361755 3585396 3719818 11
Chandigarh 1232029 519264 1212108 -2
Chhattisgarh 982024 1188305 1280703 30
Daman & Diu 45834 57500 57908 26
Delhi 6045758 6310683 6533102 8
Goa 175220 168888 176451 1
Gujarat 1885711 2041344 2177604 15
Haryana 1223777 1380530 1620407 32
Himachal Pradesh 1308543 1258986 1216445 -7
Jammu & Kashmir 624916 766116 861500 38
Jharkhand 689733 771464 955715 39
Karnataka 8948148 9773988 10821262 21
Kerala 9586685 9286715 9635643 1
Lakshadweep 12451 13775 14866 19
Madhya Pradesh 5779424 7486700 7699449 33
Maharashtra 7966723 8919136 8530444 7
Manipur 93024 150162 256915 176
Meghalaya 919725 910596 1000806 9
Mizoram 321091 307972 371761 16
Nagaland 148253 149529 157079 6
Odisha 3625416 4112063 4886981 35
Puducherry 1141318 1042019 849788 -26
Punjab 1773425 1828715 2038459 15
Rajasthan 6265068 6377642 7305276 17
Sikkim 95246 100221 106688 12
Tamil Nadu 17351252 18191977 19455891 12
Telangana 2237959 2198409 2663333 19
Tripura 908323 936072 1173871 29
Uttar Pradesh 4184025 3742601 5116854 22
Uttarakhand 339940 383851 403652 19
West Bengal 16827901 17829751 17628426 5
168
Annexure 10.1
PATIENT SERVICES
Annexure: 10.1
State/UT wise Distribution of ANC Registration and Syphillis
Pregnant Out of above, PW tested
PW tested
women number found PW tested found sero
State/UT using POC test
registered for sero positive for Syphilis positive for
for Syphilis
ANC for syphilis Syphilis
All India 29022447 1026971 6133 10244216 39117
A & N Islands 4784 606 5 4735 11
Andhra Pradesh 803046 6849 159 420706 667
Arunachal Pradesh 30162 83 7 14613 273
Assam 685229 5133 249 296146 630
Bihar 3394623 991 61 313302 948
Chandigarh 35734 31012 20
Chhattisgarh 646957 2772 68 239458 628
Dadra & Nagar Haveli 8070 0 0 12641 1
Daman & Diu 6527 0 0 3200 0
Delhi 721322 8 0 209324 456
Goa 27969 127 0 23239 10
Gujarat 1296148 3778 64 423372 6950
Haryana 572676 5750 28 368134 541
Himachal Pradesh 110701 587 3 70737 67
Jammu & Kashmir 358624 144 4 83911 1908
Jharkhand 953011 129483 383 255919 368
Karnataka 1151533 4801 116 894949 2791
Kerala 527626 38 13 178042 3922
Lakshadweep 1274 0 0 1452 10
Madhya Pradesh 1919655 15989 488 771137 1266
Maharashtra 2051346 9382 85 793874 350
Manipur 55346 22 0 17072 16
Meghalaya 138997 160 5 62347 1279
Mizoram 23614 421 12 12654 21
Nagaland 39462 831 8 16918 83
Odisha 721502 57316 80 416149 286
Puducherry 98914 444 17 23750 76
Punjab 438357 708 0 302396 220
Rajasthan 1736201 53412 431 819955 2066
Sikkim 9343 127 0 5028 17
Tamil Nadu 1043510 22 0 283975 1260
Telangana 759098 1847 349 232843 3861
Tripura 67065 0 0 43396 99
Uttar Pradesh 6745784 552986 3050 2097227 7759
Uttarakhand 217191 3683 56 77133 29
West Bengal 1621046 168471 392 423470 228
169
Annexure 10.2
Annexure 10.2
State/UT wise Distribution of OPD Attendance and Lab Test Done
Allopathic- Outpatient Ayush - Outpatient Number of Lab Tests
State/UT
attendance attendance done
All India 1666777926 115474440 903125299
A & N Islands 2348015 128862 2130773
Andhra Pradesh 76695602 2570537 42840794
Assam 34287489 2948644 16776536
Bihar 66300825 10408473 8757016
Chandigarh 6908048 227198 19427065
Chhattisgarh 24574718 1260420 9533373
Daman & Diu 834038 102842 300126
Delhi 74485274 3772344 71455754
Goa 2386682 147126 2344620
Gujarat 59814451 2865252 53110481
Haryana 33028470 2246757 20223953
Jammu & Kashmir 27667213 1635097 16523635
Jharkhand 15779651 529028 7129825
Karnataka 108868991 5259767 51512867
Kerala 137123326 217143 60958949
Lakshadweep 450288 92787 282959
Madhya Pradesh 62179866 3731253 28117364
Maharashtra 104951740 5769766 54539359
Manipur 1884603 112695 1025909
Meghalaya 4072477 305781 2924847
Mizoram 1582275 42307 1736284
Nagaland 1234928 31254 908821
Odisha 66023054 6629751 22501983
Puducherry 7446398 793155 5206741
Punjab 21727864 2324002 24833536
Rajasthan 137586029 3962980 59470468
Sikkim 908777 17450 450512
Tamil Nadu 242469193 31018833 154160425
Telangana 49145935 1962839 15807390
Tripura 4406298 298909 2020428
Uttar Pradesh 131357817 19991557 90433958
Uttarakhand 7659969 873704 3545329
West Bengal 131698516 2918190 44511259
170
Annexure 10.3
Annexure 10.3
State/UT wise Distribution of Haemoglobin Testing
Out of the total Hb tests
Number of Hb tests
State/UT done, Number having Hb Percentage of Hb < 7 mg
conducted
< 7 mg
All India 125806100 3734941 2.97
A & N Islands 145541 4796 3.30
Andhra Pradesh 4666668 186968 4.01
Assam 2713002 54712 2.02
Bihar 2846746 79966 2.81
Chandigarh 964109 63497 6.59
Chhattisgarh 4014652 104820 2.61
Daman & Diu 91237 1353 1.48
Delhi 7261458 190798 2.63
Goa 198540 3266 1.65
Gujarat 8741700 226801 2.59
Haryana 3227176 125509 3.89
Jammu & Kashmir 1578659 60194 3.81
Jharkhand 1627115 36350 2.23
Karnataka 7947943 244965 3.08
Kerala 7480348 59529 0.80
Madhya Pradesh 8108877 261555 3.23
Maharashtra 9980430 331983 3.33
Manipur 89284 1286 1.44
Meghalaya 418789 10869 2.60
Mizoram 160809 2949 1.83
Nagaland 134010 3826 2.86
Odisha 5191600 143121 2.76
Puducherry 373141 9519 2.55
Punjab 2848509 72840 2.56
Rajasthan 7302346 235194 3.22
Sikkim 77009 794 1.03
Tamil Nadu 12451288 348578 2.80
Telangana 2859265 179126 6.26
Tripura 234964 10939 4.66
Uttar Pradesh 13268401 487081 3.67
Uttarakhand 556083 15734 2.83
West Bengal 7072787 157922 2.23
171
Annexure 10.4
Annexure 10.4
State/UT wise Distribution of Syphilis Testing
Male STI/RTI attendees Female (Non ANC) STI/RTI attendees
Found
sero % sero Found sero % sero
Tested for Tested for
State/UT Positive positive for Positive for positive for
syphilis syphilis
for syphillis syphilis syphillis
syphilis
All India 2207255 115296 5.22 2317147 34267 1.48
A & N Islands 1779 87 4.89 798 5 0.63
Andhra Pradesh 84754 2133 2.52 98638 1378 1.40
Arunachal Pradesh 3595 452 12.57 6099 291 4.77
Assam 43687 787 1.80 29189 354 1.21
Bihar 90020 13818 15.35 75279 411 0.55
Chandigarh 12546 218 1.74 11143 104 0.93
Chhattisgarh 49001 542 1.11 61758 189 0.31
Dadra & Nagar Haveli 383 25 6.53 686 37 5.39
Daman & Diu 130 19 14.62 346 10 2.89
Delhi 22545 794 3.52 47690 1090 2.29
Goa 687 17 2.47 1574 3 0.19
Gujarat 116520 36588 31.40 61494 841 1.37
Haryana 49024 2838 5.79 87156 649 0.74
Himachal Pradesh 27732 338 1.22 21358 627 2.94
Jammu & Kashmir 9360 13 0.14 6509 94 1.44
Jharkhand 31809 403 1.27 27206 55 0.20
Karnataka 132339 4508 3.41 157336 2633 1.67
Kerala 64467 1131 1.75 84959 682 0.80
Lakshadweep 609 3 0.49 255 0 0.00
Madhya Pradesh 169031 4495 2.66 162412 1191 0.73
Maharashtra 293717 8865 3.02 251772 981 0.39
Manipur 1013 15 1.48 2452 14 0.57
Meghalaya 8128 441 5.43 14208 605 4.26
Mizoram 3871 56 1.45 3968 34 0.86
Nagaland 5948 124 2.08 5429 96 1.77
Odisha 67810 2158 3.18 67085 4199 6.26
Puducherry 11504 39 0.34 9568 55 0.57
Punjab 64608 3561 5.51 75114 205 0.27
Rajasthan 167782 2094 1.25 269168 2488 0.92
Sikkim 1588 9 0.57 788 3 0.38
Tamil Nadu 248026 2881 1.16 215206 2944 1.37
Telangana 55877 9555 17.10 52289 1541 2.95
Tripura 16422 80 0.49 15759 29 0.18
Uttar Pradesh 301145 14417 4.79 297299 9483 3.19
Uttarakhand 7712 129 1.67 13127 338 2.57
West Bengal 42086 1663 3.95 82030 608 0.74
172
Annexure 11.1
Annexure 11.1
State/UT wise Grading of CHCs during 2019-20
Not Not Total
State/UT Grade 1 Grade 2 Grade 3 Grade 4 Grade 5
Applicable Eligible CHCs
A & N Islands 0 0 1 1 1 0 1 4
Andhra Pradesh 0 0 0 93 60 0 45 198
Arunachal Pradesh 0 2 3 1 0 0 54 60
Assam 0 4 20 70 76 6 22 198
Bihar 0 1 2 3 7 9 42 64
Chandigarh 0 0 0 0 2 0 0 2
Chhattisgarh 0 1 5 26 65 2 69 168
Dadra & Nagar Haveli 0 0 0 2 0 0 0 2
Daman & Diu 0 1 0 1 0 0 0 2
Goa 0 1 1 3 0 0 1 6
Gujarat 1 10 29 81 62 14 179 376
Haryana 0 0 1 27 38 0 65 131
Himachal Pradesh 0 0 2 0 0 2 91 95
Jammu & Kashmir 0 1 4 13 24 0 38 80
Jharkhand 0 9 31 42 30 0 64 176
Karnataka 0 7 32 68 60 1 40 208
Kerala 1 4 3 2 0 11 209 230
Ladakh 0 0 0 0 0 4 3 7
Lakshadweep 0 0 1 0 0 1 1 3
Madhya Pradesh 0 0 0 9 155 0 166 330
Maharashtra 3 12 33 102 151 4 127 432
Manipur 0 2 3 2 1 0 9 17
Meghalaya 0 1 0 4 2 0 21 28
Mizoram 0 0 0 1 0 0 8 9
Nagaland 0 1 5 1 0 0 14 21
Odisha 1 0 0 32 159 0 192 384
Puducherry 0 0 2 1 0 0 1 4
Punjab 1 12 32 33 13 1 56 148
Rajasthan 0 1 16 77 274 4 242 614
Sikkim 0 0 0 0 0 0 2 2
Tamil Nadu 0 1 2 152 203 0 42 400
Telangana 3 2 9 10 2 1 56 83
Tripura 0 1 0 2 0 0 19 22
Uttar Pradesh 1 16 49 93 88 7 426 680
Uttarakhand 0 0 3 2 2 18 44 69
West Bengal 0 4 32 64 115 1 123 339
173
Annexure 11.2
Annexure 11.2
State/UT-wise Grading of PHCs 2019-20
State/UTs Grade 0 Grade 1 Grade 2 Grade 3 Grade 4 Grade 5 Not Eligible Total PHC
A & N Islands 1 3 10 9 2 0 2 27
Andhra Pradesh 0 0 5 467 192 3 729 1396
Assam 15 29 61 257 107 38 493 1000
Bihar 1 5 16 26 67 47 372 534
Chandigarh 0 0 3 1 0 1 33 38
Chhattisgarh 3 14 52 90 30 11 616 816
Dadra & Nagar
Haveli 0 2 0 7 0 0 0 9
Daman & Diu 0 0 1 2 1 0 0 4
Delhi 17 91 136 114 56 19 103 536
Goa 0 3 3 11 10 0 2 29
Gujarat 2 11 60 301 156 89 1171 1790
Haryana 1 2 49 133 78 38 184 485
Jammu & Kashmir 1 7 26 67 39 9 232 381
Jharkhand 10 17 16 13 6 0 272 334
Karnataka 5 18 131 553 356 82 1390 2535
Kerala 18 65 87 92 33 1 640 936
Ladakh 0 0 0 3 0 0 29 32
Madhya Pradesh 0 0 3 99 69 27 1143 1341
Maharashtra 21 66 143 207 139 41 1975 2592
Manipur 2 10 33 14 4 0 24 87
Meghalaya 7 20 46 37 12 0 21 143
Mizoram 2 2 5 53 0 0 3 65
Nagaland 8 16 17 8 1 0 87 137
Odisha 1 13 53 40 36 14 1220 1377
Puducherry 0 2 7 18 8 2 3 40
Punjab 6 30 84 48 23 6 327 524
Rajasthan 28 89 230 759 362 104 905 2477
Sikkim 0 0 11 8 3 0 3 25
Tamil Nadu 11 54 165 874 444 129 207 1884
Telangana 9 40 142 222 80 12 316 821
Tripura 0 6 14 60 19 1 13 113
Uttar Pradesh 10 84 131 182 239 86 2683 3415
Uttarakhand 0 2 11 11 7 0 238 269
West Bengal 44 158 207 106 60 1 787 1363
174
Annexure 11.3
Annexure 11.3
State/UT wise Grading of Rural PHCs 2019-20
State/UTs Grade 0 Grade 1 Grade 2 Grade 3 Grade 4 Grade 5 Not Total
Eligible Rural
PHC
A & N Islands 0 1 9 9 2 0 1 22
Andhra Pradesh 0 0 0 448 108 1 585 1142
Assam 15 24 59 241 91 32 482 944
Bihar 0 3 12 24 60 43 341 483
Chandigarh 0 0 0 0 0 0 3 3
Chhattisgarh 3 14 45 73 14 1 611 761
Daman & Diu 0 0 1 1 1 0 0 3
Delhi 0 0 0 1 1 0 2 4
Goa 0 1 2 11 9 0 2 25
Gujarat 2 9 47 261 59 2 1094 1474
Haryana 1 2 49 126 43 0 164 385
Jammu & Kashmir 0 7 26 66 36 7 229 371
Jharkhand 5 8 6 7 3 0 253 282
Karnataka 5 14 96 468 215 33 1345 2176
Kerala 10 48 60 74 22 1 635 850
Ladakh 0 0 0 3 0 0 29 32
Madhya Pradesh 0 0 0 78 48 15 1057 1198
Maharashtra 1 1 7 35 40 12 1733 1829
Manipur 1 9 33 14 4 0 24 85
Meghalaya 2 15 40 36 12 0 14 119
Mizoram 0 1 4 50 0 0 2 57
Nagaland 8 15 15 5 0 0 87 130
Odisha 1 12 37 18 8 0 1208 1284
Puducherry 0 1 5 14 3 0 2 25
Punjab 0 20 66 26 3 0 310 425
Rajasthan 17 57 185 701 271 83 786 2100
Sikkim 0 0 10 8 3 0 3 24
Tamil Nadu 11 44 129 790 288 3 157 1422
Telangana 5 21 103 166 25 1 280 601
Tripura 0 6 14 60 19 1 8 108
Uttar Pradesh 9 61 70 94 85 38 2466 2823
Uttarakhand 0 2 10 2 0 0 226 240
West Bengal 41 140 160 36 8 1 527 913
175
Annexure 11.4
Annexure 11.4
State/UT wise Grading of Urban PHCs 2019-20
State/UTs Total
Not
Grade 0 Grade 1 Grade 2 Grade 3 Grade 4 Grade 5 Urban
Eligible
PHC
A & N Islands 1 2 1 0 0 0 1 5
Andhra Pradesh 0 0 5 19 84 2 144 254
Assam 0 5 2 16 16 6 11 56
Bihar 1 2 4 2 7 4 31 51
Chandigarh 0 0 3 1 0 1 30 35
Chhattisgarh 0 0 7 17 16 10 5 55
Daman & Diu 0 0 0 1 0 0 0 1
Delhi 17 91 136 113 55 19 101 532
Goa 0 2 1 0 1 0 0 4
Gujarat 0 2 13 40 97 87 77 316
Haryana 0 0 0 7 35 38 20 100
Jammu & Kashmir 1 0 0 1 3 2 3 10
Jharkhand 5 9 10 6 3 0 19 52
Karnataka 0 4 35 85 141 49 45 359
Kerala 8 17 27 18 11 0 5 86
Madhya Pradesh 0 0 3 21 21 12 86 143
Maharashtra 20 65 136 172 99 29 242 763
Manipur 1 1 0 0 0 0 0 2
Meghalaya 5 5 6 1 0 0 7 24
Mizoram 2 1 1 3 0 0 1 8
Nagaland 0 1 2 3 1 0 0 7
Odisha 0 1 16 22 28 14 12 93
Puducherry 0 1 2 4 5 2 1 15
Punjab 6 10 18 22 20 6 17 99
Rajasthan 11 32 45 58 91 21 119 377
Sikkim 0 0 1 0 0 0 0 1
Tamil Nadu 0 10 36 84 156 126 50 462
Telangana 4 19 39 56 55 11 36 220
Tripura 0 0 0 0 0 0 5 5
Uttar Pradesh 1 23 61 88 154 48 217 592
Uttarakhand 0 0 1 9 7 0 12 29
West Bengal 3 18 47 70 52 0 260 450
176
Annexure 12.1
FIRST REFERRAL UNIT
Annexure- 12.1
State/UTs wise Details of Total FRUs and Number
of FRUs Fulfilling the Conditionality Criteria 2019-20
DH SDH CHC
Total Number of Total Number of Tota Number of Total Number of Total Number of
number FRU DH Number FRU SDH l FRU SDH Number FRU Number FRU
of FRU conducting C- of FRU conducting C- Num conducting of FRU CHCs of FRU CHCs
DH sect on avg. SDH sect on avg. 5 ber C-sect on CHC conducting CHC conducting
10 CS/month CS/month of avg. 5 C-sect on C-sect on
States/UTs (avg. 7 (avg. 3 CS in FRU CS/month avg. 5 avg. 5
CS/month in case of NE SDH (avg. 3 CS CS/month CS/month
case of NE and UT's) in case of (avg. 3 CS (avg. 3 CS
and UT's) NE and in case of in case of
UT's) NE and NE and
UT's) UT's)
Rural Rural Urban Rural Urban
All India 672 580 410 250 415 324 1435 322 224 138
A & N Islands 1 1 0 0 0 0
Andhra Pradesh 14 14 3 1 25 24 141 24 57 33
Arunachal Pradesh 11 3 0 0 1 1
Assam 25 24 11 10 0 0 30 25 2 2
Bihar 36 29 22 5 10 4 54 0 8 1
Chandigarh 2 2 0 0 1 1 0 0 2 2
Chhattisgarh 23 14 2 1 1 0 31 4 0 0
Daman & Diu 2 2 0 0 2 0
Delhi 22 20 0 0 4 4 0 0 0 0
Goa 2 2 0 0 0 0
Gujarat 21 19 17 9 17 9 39 17 11 8
Haryana 22 20 15 8 0 0 10 1 2 0
Jammu & Kashmir 23 22 0 0 0 0 75 26 2 2
Jharkhand 23 17 12 2 0 0 36 7 2 1
Karnataka 15 15 124 95 12 11 19 10 3 2
Kerala 37 37 22 12 21 18 0 0 0 0
Madhya Pradesh 51 45 8 1 43 19 40 4 5 3
Maharashtra 38 36 41 35 48 41 39 28 68 53
Manipur 4 3 0 0 0 0
Meghalaya 8 5 0 0 0 0
Mizoram 8 5 0 0 0 0
Nagaland 11 4 0 0 5 1
Odisha 32 32 28 13 0 0 30 8 4 2
Puducherry 4 4 0 0 2 2 2 0 0 0
Punjab 22 21 22 14 17 17 114 25 6 3
Rajasthan 27 25 6 3 12 8 94 9 15 6
Sikkim 3 2 0 0 0 0
Tamil Nadu 32 32 45 18 107 79 367 46 0 0
Telangana 6 6 18 15 27 25 58 22 24 12
Tripura 7 7 2 1 3 1 1 1 0 0
Uttar Pradesh 94 73 0 0 0 0 196 46 12 8
Uttarakhand 10 5 4 2 7 6 2 1 1 0
West Bengal 22 22 1 1 58 55 48 15 0 0
*Medical colleges not included
177
Annexure 12.2
Annexure 12.2
State/UT wise Availability of Services and manpower at FRU CHCs
Blood Referral Blood
Laborat Operation Labour
FRU storage transport Storage Obstetrician /
States/UTs ory Theatre room Paediatrics Anaesthetist
CHCs facility service Unit Gynaecologist
available available available
available available available
India 1659 775 1502 1584 747 1581 1596 1122 774 761
A & N Islands 0 - - - - - - - - -
Andhra Pradesh 198 95 177 192 90 198 195 190 149 133
Arunachal
1 1 1 1 1 1 1 1 1 1
Pradesh
Assam 32 32 32 32 31 32 32 56 20 26
Bihar 62 19 52 51 16 49 50 24 15 17
Chandigarh 2 1 2 2 1 2 2 6 3 1
Chhattisgarh 31 21 30 30 23 29 31 11 8 6
Dadra & Nagar
0 - - - - - - - - -
Haveli
Daman & Diu 2 0 2 2 0 2 2 0 0 0
Delhi 0 - - - - - - - - -
Goa 0 - - - - - - - - -
Gujarat 50 40 49 45 37 45 44 27 12 14
Haryana 12 3 12 12 3 12 12 7 4 2
Himachal
1 1 1 1 1 1 1 1 0 0
Pradesh
Jammu &
77 29 76 72 26 63 73 55 42 48
Kashmir
Jharkhand 38 16 37 36 14 36 34 28 10 14
Karnataka 22 15 22 21 15 22 21 18 12 11
Kerala 0 - - - - - - - - -
Lakshadweep 0 - - - - - - - - -
Madhya Pradesh 45 34 45 45 37 45 45 17 9 5
Maharashtra 107 56 103 106 49 106 106 242 177 167
Manipur 0 - - - - - - - - -
Meghalaya 0 - - - - - - - - -
Mizoram 0 - - - - - - - - -
Nagaland 5 1 5 5 1 5 5 1 1 0
Odisha 34 25 34 34 27 34 34 25 11 5
Puducherry 2 0 2 2 0 2 1 0 0 0
Punjab 120 17 100 117 15 117 117 44 31 6
Rajasthan 109 63 104 104 73 100 105 75 80 61
Sikkim 0 - - - - - - - - -
Tamil Nadu 367 215 334 359 215 359 362 46 16 59
Telangana 82 17 39 70 12 70 75 79 59 56
Tripura 1 1 1 1 1 1 1 1 1 1
Uttar Pradesh 208 40 192 196 24 202 197 125 94 107
Uttarakhand 3 2 2 2 2 2 2 1 1 2
West Bengal 48 31 48 46 33 46 48 42 18 19
178
Annexure 12.3
Annexure 12.3
State/UT wise Availability of Services and
Manpower at FRU Blood Storage Facility at SDH
Fully
Blood Fully Fully Fully equipped
O&G
FRU Transfusio equipped equippe equipped Delivery Paediatricia Anesthetis
States/UTs speciali
SDHs n and laborator d Blood Operatio Suit Unit n t
st
Storage y Bank n Theatre located
near OT
India 825 608 624 344 650 591 1225 976 875
A & N Islands 0 - - - - - - - -
Andhra Pradesh 28 27 28 19 27 27 54 37 30
Arunachal Pradesh 0 - - - - - - - -
Assam 11 10 8 3 11 9 20 9 12
Bihar 32 17 15 9 18 11 17 16 12
Chandigarh 1 1 1 0 1 1 4 3 1
Chhattisgarh 3 1 3 0 3 3 0 0 1
Dadra & Nagar
1 1 1 1 1 1 1 0 0
Haveli
Daman & Diu 0 - - - - - - - -
Delhi 4 2 4 0 4 3 9 10 11
Goa 0 - - - - - - - -
Gujarat 34 30 23 9 29 25 25 19 19
Haryana 15 11 12 5 12 11 14 12 19
Himachal Pradesh 5 4 4 2 4 4 5 7 5
Jammu & Kashmir 0 - - - - - - - -
Jharkhand 12 5 9 2 8 6 4 4 3
Karnataka 136 122 106 66 118 106 138 108 103
Kerala 43 26 35 8 24 23 79 76 44
Lakshadweep 1 1 0 0 1 1 1 1 2
Madhya Pradesh 51 29 46 28 45 42 19 27 15
Maharashtra 89 72 81 36 80 73 108 96 114
Manipur 0 - - - - - - - -
Meghalaya 0 - - - - - - - -
Mizoram 0 - - - - - - - -
Nagaland 0 - - - - - - - -
Odisha 28 24 26 18 26 21 49 29 11
Puducherry 2 1 1 1 1 1 21 14 23
Punjab 39 30 37 22 35 30 43 36 33
Rajasthan 18 15 16 14 15 14 22 25 12
Sikkim 0 - - - - - - - -
Tamil Nadu 152 99 103 44 118 102 263 210 174
Telangana 45 22 17 18 28 24 101 85 83
Tripura 5 4 4 3 1 3 3 3 3
Uttar Pradesh 0 - - - - - - - -
Uttarakhand 11 5 5 2 4 5 8 8 7
West Bengal 59 49 39 34 36 45 217 141 138
179
Annexure 12.4
Annexure 12.4
State/UT wise Availability of Services and
Manpower at FRU Blood Storage Facility at DH
Fully
equipped
Fully
Blood
Blood Fully Fully equipped
Bank (As Anesthetist
FRU Transfusio equipped equipped Delivery O&G Paediatricia
States/UTs per Drug (Regular /
DHs n and laborator Operatio Suit Unit specialist n
and trained)
Storage y n Theatre located
Cosmetic
near OT
Act
1945)
India 672 533 593 466 601 531 2023 1637 1486
A & N Islands 1 1 1 1 1 1 2 0 2
Andhra Pradesh 14 14 14 13 13 13 78 43 46
Arunachal Pradesh 11 7 6 5 5 8 10 8 5
Assam 25 22 23 19 22 19 93 62 44
Bihar 36 30 27 25 30 25 51 45 36
Chandigarh 2 1 2 1 2 2 17 8 8
Chhattisgarh 23 23 19 20 22 18 23 28 16
Dadra & Nagar
1 1 1 1 1 1 4 5 4
Haveli
Daman & Diu 2 2 2 2 2 0 5 2 4
Delhi 22 17 21 10 20 17 70 59 103
Goa 2 2 2 2 2 2 6 6 8
Gujarat 21 18 19 11 19 16 35 39 82
Haryana 22 20 23 20 23 19 74 48 59
Himachal Pradesh 12 9 11 11 11 11 15 17 23
Jammu & Kashmir 23 19 18 17 20 15 35 25 37
Jharkhand 23 21 18 18 17 16 36 36 25
Karnataka 15 11 13 10 13 11 37 26 23
Kerala 37 23 35 21 34 23 156 110 72
Lakshadweep 1 1 1 0 1 0 2 1 3
Madhya Pradesh 51 50 53 48 49 48 97 141 81
Maharashtra 38 31 37 28 38 35 158 144 114
Manipur 4 3 3 2 4 4 7 6 8
Meghalaya 8 2 4 1 5 5 17 10 12
Mizoram 8 8 6 7 7 5 12 11 15
Nagaland 11 5 7 4 8 6 13 10 11
Odisha 32 31 32 30 32 29 135 92 66
Puducherry 4 3 4 2 4 3 12 5 6
Punjab 22 21 21 18 20 17 63 55 60
Rajasthan 27 26 27 27 27 24 86 80 68
Sikkim 3 3 3 3 3 1 9 6 4
Tamil Nadu 32 24 29 28 32 32 189 171 150
Telangana 6 7 7 7 7 7 47 39 47
Tripura 7 7 6 7 4 5 19 13 12
Uttar Pradesh 94 45 76 22 77 72 284 184 135
Uttarakhand 10 4 2 4 5 4 5 6 6
West Bengal 22 21 20 21 21 17 121 96 91
180
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STATISTICS DIVISION

MINISTRY OF HEALTH & FAMILY WELFARE

The publication also provides comprehensive detail of statistics on health services

Place : New Delhi (Rajesh Bhushan)

Room No. '156, A-Wing, Nirman Bhawan, New Delhi-110 01'l

fl r ) ENQ{ \,ti qfrqR 6,@Iur {Trdq

Cr{' qr{.d - ENEI qFKI

Tele : 01'l-2306 3693, Telefax : 011-2306 3687, E-mail : sheelv@ias.nic'in

Health Management Information System (HMIS) is a web based portal for

Iwould like to convey my sincere gratitude and thanks to my colleagues from

Place: New Delhi

Annexure 10.4 State/UT wise Distribution of Syphilis Testing .............................................172

1.1 Information Captured in HMIS

1.2 Health Facilities Status

31296, 12923, 2430, 1% 1249, 1% Type of

PHC 31296 30714 582

161019, CHC 12923 5786 7137

DH 1249 1041 208

Total 208917 200032 8885

Note: Due to no time stamping of up-gradation/down-gradation of facilities, number of health

1.3 Reporting in Infrastructure format by Health Facilities

1.3.2 Health Services - MIS Reporting for 2019-20

Note: Due to no time stamping of up-gradation/down-gradation of facilities, number of health

1.4 Data Quality Measures in HMIS

v. RCH Performance Report:

1.6 Training and Orientation

1.7 National and Regional Review Meeting

Gographical Information System (GIS) in a Health Management Information System (HMIS)

Percentage of JSSK Beneficiaries to Total

3.1 Ante Natal Care (ANC)

Percentage of ANC Registration to Estimated

Jammu & Kashmir

3.2 1st Trimester Registration (1st ANC)

India Public Private Urban Rural

Dadra & Nagar Haveli 97

State/UT Percentage of Pregnant State/UT Percentage of Pregnant

Daman & Diu 126 Jharkhand 78

Chandigarh 106 Himachal Pradesh 78

Karnataka 97 Uttar Pradesh 76

Tamil Nadu 88 Sikkim 67

Gujarat 87 A & N Islands 67

Dadra & 82 Delhi 57

West Bengal 82 Meghalaya 49

All India 79 Arunachal Pradesh 36

Jammu & 79 Nagaland 23

3.4 (B) Maternal Anemia

3.4 (C) Maternal Hypertension

3.4 (D) Gestational Diabetes mellitus (GDM)

Delivery- By Place of Delivery/ Attendant

% Home Deliveries by Non SBA

% Home Deliveries by Non SBA

C-section Deliveries - By type of Institution

Vaginal Delivery- By Type of Institution

3.6 Abortion/Medical Termination of Pregnancy

% Abortion to Total ANC

Jammu & Kashmir

% Abortion to Total ANC

Figure 3.16: Percentage % Abortion and % MTP + Abortion to Total ANC,

% Abortion and % MTP + Abortion to Total ANC

% Abortion % MTP + Abortion

Abortion/MTP to Total ANC Registrations

MTP- By Gestational Age

Medical Termination of Pregnancy (MTP) after 12 weeks of pregnancy is considered to be

%age MTP more than 12 weeks of pregnancy