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Day One: RCH Programme Review 7th July 2011,Thursday
9.00‐9.30: Registration & Tea 9.30‐10.45: Introductory Session Agenda Item Time 9.30‐10.10 Welcome & Status Report by Joint Secretary (RCH) 10.10‐10.25 Remarks by SS & MD 10.25‐10.45 Address by Secretary, Health & Family Welfare 10.45 ‐13.00 : Maternal and Child Health Janani Shishu Surakhsha Karykram 10.45 ‐12.00 Presentation 15 minutes Joint Secretary (RCH) Discussion 60 minutes 12.00 ‐ 13.00 Strengthening Newborn Care : Home Based Newborn Deputy Commissioner, CH&I Care Scheme Presentation 10 minutes Discussion 45 minutes Lunch 13.00 ‐14.00 14.00‐15.30 : Family Planning , Mother and Child Tracking System 14.00‐14.40 Population Stabilisation & Family planning: Scheme Assistant Commissioner, Family Planning for Involving ASHAs in distribution of contraceptives Presentation 15 minutes Discussion 25 minutes Mother and Child Tracking System: Status and Progress 14.40‐ 15.30 Mr. Rajesh Gera , Senior Technical Director, NIC Presentation 20 minutes Discussion 30 minutes Tea Break 15.30‐15.50 15.50‐18.00 :PC‐PNDT Act, Menstrual Hygiene Scheme 15.50‐16.30 E‐Banking Director (NRHM‐Finance) 16.30‐17.15 Modified Scheme for Promotion of Menstrual Consultant, ARSH Hygiene Presentation 15 minutes Discussion 25 minutes
Implementation of PC & PNDT Act Presentation 15 minutes Discussion 25 minutes
17.15‐18.00 Dr. Manohar Agnani. Mr. Vikas Kharage
Day Two: Thrust Areas for 12th Plan, Future Strategies and Challenges 8th July 2011, Friday
9.30‐11.30 : Communicable Diseases Overview and Progress Discussion Joint Secretary (Public Health) 11.30‐13.00: Non Communicable Diseases Overview and Status Discussion Joint Secretary (PMSSY) 13.00‐14.00: Lunch Break 14.00‐15.00: Drugs and Regulatory Issues Presentation & Discussion 1. Strengthening of Drug Regulatory Systems Joint Secretary (DR) 2. Access and Affordability of Drugs 15.00‐17.00: Thrust Areas for 12th Plan , Challenges and Future Strategies Presentation Director, NRHM Discussion 17.00‐17.15: Summing Up by SS & MD 17.15‐17.30: Concluding Remarks by Secretary Health & Family Welfare High Tea
The meeting of the State Health Secretaries and Mission Directors (NRHM) is scheduled on 7‐8 July 2011 under the Chairmanship of Secretary (Health & Family Welfare). The two day meeting will encompass discussion on progress of Reproductive and Child Health, new initiatives under RCH II, Disease Control Programmes and Thrust Areas for the 12th Plan. Besides State Health Secretaries and Mission Directors, the meeting will be attended by Director, Health Services/Director General, Health services (all states & UTs), Officials from MOHFW, Development Partners and Technical Consultants on relevant theme areas. The purpose of the meeting is to: • Review the progress made under RCH II/NRHM in 2010‐2011 • Reinforce key action points and areas for focussed attention under various programmes and theme areas • Share implementation guidelines for newly launched schemes under RCH II/NRHM • Jointly discuss thrust areas and strategies for health in 12th five year plan The venue for the meeting is Vigyan Bhawan (Hall Number 4) located near India Gate on Maulana Azad Road, New Delhi.
Table Of Contents Programme Schedule Section One: Reproductive and Child Health Programme RCH Programme: Key Components and Present Status Janani Shishu Surakhsha Karykram Strengthening Newborn Care : Home Based Newborn Care Scheme Population Stabilisation & Family Planning : Scheme for involving ASHAs in distribution of contraceptives Modified Scheme for Promotion of Menstrual Hygiene Preconception and Prenatal Diagnostic Techniques Act E‐banking Section Two: Communicable Diseases Revised National TB Control Programme National Leprosy Eradication Programme National Vector Borne Disease Control Programme Integrated Disease Surveillance Programme (IDSP) Section Three: Non Communicable Diseases National Programme on Prevention & Control of Cancer, Diabetes, CVD & Stroke (NPCDCS) National Programme for Control of Blindness National Programme for Prevention and Control of Deafness National Tobacco Control Programme National Mental Health Programme Section Four: Drugs And Regulatory Issues Section Five: Thrust Areas For 12th Plan , Challenges And Future Strategies Annexure Annexure : Physical Progress under RCH II Annexure: Financial progress under RCH II
Annexure: Promotion of Menstrual Hygiene Scheme
Page Number 3 7‐18 19‐22 23‐26 27‐35 36‐40 41‐47 48 50‐52 53‐57 58‐62 63‐66 68‐70 71‐72 73‐75 76‐78 79‐81 83‐84 86‐93 94‐145
Annexure: NPCDCS Annexure: National Programme for Control of Blindness Annexure: Mental Health Annexure: Revised National Tuberculosis Control programme
Tentative Programme Schedule Meeting of the State Health Secretaries and Mission Directors, NRHM 7‐8 July 2011 Vigyan Bhawan, New Delhi
Day One: RCH Programme Review 7th July 2011,Thursday
9.00‐9.30: Registration & Tea 9.30‐10.45: Introductory Session Agenda Item Time 9.30‐10.10 Welcome & Status Report by Joint Secretary (RCH) 10.10‐10.25 Remarks by SS & MD 10.25‐10.45 Address by Secretary, Health & Family Welfare 10.45 ‐13.00 : Maternal and Child Health Janani Shishu Surakhsha Karykram 10.45 ‐12.00 Presentation 15 minutes Joint Secretary (RCH) Discussion 60 minutes 12.00 ‐ 13.00 Strengthening Newborn Care : Home Based Deputy Commissioner, CH&I Newborn Care Scheme Presentation 10 minutes Discussion 45 minutes Lunch 13.00 ‐14.00 14.00‐15.30 : Family Planning , Mother and Child Tracking System 14.00‐14.40 Population Stabilisation & Family planning: Scheme Assistant Commissioner, Family Planning for Involving ASHAs in distribution of contraceptives Presentation 15 minutes Discussion 25 minutes Mother and Child Tracking System: Status and 14.40‐ 15.30 Progress Mr. Rajesh Gera , Senior Technical Director, Presentation 20 minutes NIC Discussion 30 minutes Tea Break 15.30‐15.50 15.50‐18.00 :PC‐PNDT Act, Menstrual Hygiene Scheme E‐Banking Modified Scheme for Promotion of Menstrual Hygiene Presentation 15 minutes Discussion 25 minutes Implementation of PC & PNDT Act Presentation 15 minutes
4 15.50‐16.30 Director (NRHM‐Finance) 16.30‐17.15 Consultant, ARSH 17.15‐18.00 Dr. Manohar Agnani. Mr. Vikas Kharage
Discussion 25 minutes
Day Two: Thrust Areas for 12th Plan, Future Strategies and Challenges 8th July 2011, Friday
9.30‐11.30 : Communicable Diseases Overview and Progress Discussion Joint Secretary (Public Health) 11.30‐13.00: Non Communicable Diseases Overview and Status Discussion Joint Secretary (PMSSY) 13.00‐14.00: Lunch Break 14.00‐15.00: Drugs and Regulatory Issues Presentation & Discussion Joint Secretary (DR) 1. Strengthening of Drug Regulatory Systems 2. Access and Affordability of Drugs 15.00‐17.00: Thrust Areas for 12th Plan , Challenges and Future Strategies Presentation Discussion Director, NRHM
17.00‐17.15: Summing Up by SS & MD 17.15‐17.30: Concluding Remarks by Secretary Health & Family Welfare High Tea
Section One Reproductive and Child Health Programme
Background Reproductive and Child Health Programme, Phase II (RCH II), is an integral component of the National Rural Health Mission. Important steps have been taken within the mandate of this programme to ensure universal and equitable access to quality maternal and child health services based on the principle of continuum of care. RCH II has focussed on reducing social and geographical disparities in access to and utilisation of reproductive and child health services in order to accelerate the achievement of its goals. The programme goals have been set in consonance with MDGs 4 and 5 and relate to maternal and infant mortality and total fertility rate. The major components of the RCH programme are Maternal Health, Child Health, Nutrition, Family Planning, Adolescent and Reproductive Health (ARSH) and Preconception Prenatal Diagnostic Techniques Act. A brief on key interventions under each of these components is discussed in this note. Millennium Development and RCH II Goals The Millennium Development Goals (MDGs) 4 and 5 relate to improving the health of mother and child and India’s national goals are aligned with them. MDG 4: Reduce child mortality ‐ Target: Reduce by two thirds the mortality rate among children under five MDG 5: Improve maternal health – Target: Reduce by three quarters the maternal mortality ratio RCH Goals and Achievements Infant Mortality Rate Maternal Mortality Ratio Total Rate A summary of key components under RCH programme and their current status is presented below:
MDG Target 28
NRHM Goals 30 per 1,000 live births 100 per 1,00,000 live births 2.1
Achievement 50 per 1,000 live births 254 per 1,00,000 live births 2.6
Source Source SRS ‐ 2009 SRS 2004‐06
Reduce by ¾ by 2015 ‐
Maternal Health Interventions Key interventions to reduce Maternal Mortality are: 1.1 Demand Promotion (Janani Suraksha Yojana (JSY)
1.2 Service guarantees – Janani Shishu Suraksha Karyakram( JSSK) 1.3 Essential and Emergency Obstetric Care (Upgrading and operationalizing health facilities , Skill‐ based trainings, Multi skilling of doctors) 1.4 Safe Abortion Services (MTP) 1.5 Management of RTIs & STIs (Colour coded drug kits,training of providers) 1.6 Public Private Partnerships (for JSY, Family Planning, MTP) 1.7 Maternal & Child Health (MCH) Centres in High Focus Districts 1.8 Mother and Child Protection Card (MCP) 1.9 Name Based Tracking of Pregnant Women and Children 1.10 Maternal Death Review Promoting institutional delivery – Under Janani Suraksha Yojana (JSY), cash incentives are provided to mothers to promote institutional deliveries. In 2010‐11, total numbers of JSY beneficiaries were 113.39 lakhs. The trend of JSY beneficiaries reported over the mission period is shown below. Number of Beneficiaries of JSY (in Lakhs)
150.00 100.00 50.00 0.00 7.34 05‐06 30.74 06‐07 07‐ 08 08‐ 09 09‐10 10‐11 73.09 90.80
• Janani Shishu Suraksha
Number of Beneficiaries of JSY (in Lakhs)
II. Infant mortality rate in India has steadily declined from 58 per thousand live births in 2004 to 50 per thousand live births in 2009. However there is slow progress in reducing neonatal mortality which declined from 37 in 2004 to 34 in 2009. NMR has declined only by 3 points (37 to 35) as compared to 8 point decline in IMR (58 to 50) in the period 2005/2009. Deaths in the first week of life have shown the least progress. Key action points under child health component are:
Karyakram (JSSK) : JSSK was launched on 1st June 2011 to provide completely free and cashless services to pregnant women (including normal deliveries and caesarean operations) and sick new born (up to 30 days after birth) in Government health institutions in both rural & urban areas. Details of the scheme are presented later in this document. Mobile Medical Units & Emergency Response Services: In order to provide services to the most remote and hard to reach areas, States have been supported for Mobile Medical Units. Over six years of NRHM, 461 out of 642 districts have been equipped with MMUs. So far 1787 vehicles are operational as MMUs in the country. Further, to provide Emergency referral transport, Call Centre based services have been operationalised in the 11 States so far. Skill development of health personnel – For improving the skill of doctors and paramedics, various training programmes have been conducted during six years of NRHM. So far, 42,530 persons are trained in SBA, 4.57 lakh in IMNCI and 27,522 personnel trained in IUCD insertion. Further, 1,221 doctors have been trained for Life Saving Anaesthesia skills and 3892 doctors in Basic Emergency Obstetric care. Additionally, 9,037 doctors are trained in MTP, 9723 doctors in tubectomy, 2286 doctors in vasectomy and 2406 doctors in F‐IMNCI. Referral systems are being strengthened through Public Private Partnership (PPP), voucher schemes and allocation of funds for referral transport. Safe Abortion Services are being made available at all FRUs and MCH Level 3 facilities (District Hospitals and sub‐district level facilities). Private and NGO sectors are encouraged to provide quality MTP services. Service providers are being trained in safe MTP techniques. The total number of MTPs conducted in both public and private sector institutions increased from 6.42 lakhs in 2008‐09 to 6.88 lakhs in 2009‐2010. Strengthening outreach activities by organizing Village Health and Nutrition Days: In rural areas, VHND organised every month at Anganwadi centers has provision for maternal care including counselling of pregnant women, where ANMs, ASHAs, AWWs and other field functionaries provide MCH services. Child Heath Interventions
2.1 Universal provision for Essential and Home Based new born care • • Establishment of NBSUs at MCH level I Training in Essential New Born Care (NSSK) and in Home Based New Born Care (Modules 6 and 7for ASHAs, IMNCI) Establishment of SNCUs at District Hospitals/MCH level III and NBSUs at FRUs/MCH Level II facilities Free Referral Transport for sick newborns through JSSK Early detection of children with malnutrition through MCP cards, and in convergence with MWCD Facility based management of children with SAM through NRCs Early Initiation of breastfeeding in first hour of birth ;Exclusive breastfeeding till 6 months ;Complementary feeding of children from 6 months onwards IFA supplementation for children 6 months to 6 years Vitamin Supplementation for children 6 months to 5 years ORS and Zn supplementation Behaviour Change Communication through IEC Early detection of respiratory infections Administration of antibiotics Microplanning and Child Tracking System Increased Coverage by measles vaccine , Second dose of measles
2.2 Facility Based New Born Care • • • • •
2.3 Management of child malnutrition
2.4 Promotion of Infant and Young Child Feeding Practices
2.5 Micronutrient supplementation • • • • • • • •
2.6 Management of Diarrhoeal Diseases
2.7 Management of Acute Respiratory Infections
2.8 Improving Immunisation Coverage & Eliminating Measles related Deaths
2.9 Integrated Management of Neonatal and Childhood Illnesses (IMNCI) and Facility Based IMNCI • • • • Training of frontline workers (ANMs and AWWs) , SNs and physicians Referral of sick newborn (0‐2 mo.) and children (2 mo‐ 5 years) to health facilities Screening of school going children IFA supplementation
2.10. School Health Programme
Essential newborn care is to be provided to all newborns at all birthing points. Navjat Shishu Suraksha Karyakram (NSSK) is a programme to train health personnel in basic newborn care and resuscitation which was taken up in September 2009. More than 37,600 Health care providers have been trained in NSSK so far. Home Based New born Care Scheme: A new scheme is being introduced to incentivise ASHAs for providing Home Based New born care for babies up to 42 days. Home visits will be made by ASHAs on scheduled days and payment of Rs. 250 will be made when the specified conditions have been met. More details are provided later in this document. Capacity building of ASHAs on Home Based New Born Care will be done through modules 6 & 7 for ASHAs. This scheme will facilitate early detection of danger signs in neonates and therefore prompt referral to the institutions. Newborn Care Facilities are being established from MCH level I to Level III facilities. Level I provides Essential Newborn care to all children delivered in an institution while level II & III provide emergency care for sick newborn. Presently 263 Sick New Born Care Units (SNCUs), 1120 New Born Stabilisation Units (NBSUs) and 6403 New Born Care Corners (NBCs) have been established (till March 2011). Management of children with severe acute malnutrition is being addressed through Nutritional Rehabilitation Centres. 1,346 NRCs have been established across the country till March 2011. Integrated Management of Neonatal & Childhood Illnesses (IMNCI) which includes Pre‐ service and In‐service training of providers, improving health systems (e.g. facility up‐ gradation, availability of logistics, referral systems), Community and Family level care, is being implemented in 408 districts across the country and 4, 57,463 health personnel have been trained in IMNCI till March 2011. School Health Programme aims at screening school children for common health problems and making referrals to health facilities. In the financial year 2010‐11, 7, 01, 65,698 students in 3, 95,960 schools were covered through the programme.
III. Family Planning Interventions Family planning is one of the key components under RCH for population stabilization and for improving health of mother and child. Provisional census data for 2011 shows that exponential annual growth rate has declined to 1.6% but the decline is not consistent in all states. While 14 states/ UTs have already achieved the replacement level, 12 states have TFR between 2.1 and 3 and 9 states (Bihar, U.P., Rajasthan, M.P., Jharkhand, Chhattisgarh, Meghalaya, Nagaland, D &N Haveli) have TFR more than 3. Key interventions under this component are: 3.1 Strong Political Will and Advocacy at the highest level, especially in states with high fertility rates 3.2 Availability of Fixed Day Static Services at all facilities round the year by ensuring availability of trained service provider and by gradually moving away from seasonal camp approach. 3.3 Revitalizing Postpartum Family Planning in order to capitalise on the opportunity provided by increased institutional deliveries. 3.4 Emphasis on Spacing methods like IUCD 3.5 Ensuring quality care in Family Planning services by establishing Quality Assurance Committees at central, state and district levels and regular monitoring 3.6 Increasing male participation in family planning and promoting Non scalpel vasectomy 3.7 Accreditation of private providers 3.8 Strengthening community based distribution of contraceptives by involvement of ASHAs and Focussed IEC/BCC efforts for enhancing demand and creating awareness on family planning 3.9 Improving contraceptives supply management till peripheral facilities 3.10 Strengthening monitoring and providing performance linked incentives A new scheme is being launched wherein ASHA will promote the use of contraceptives at household level and making it available timely by: Delivering contraceptives at homes of beneficiaries. Charging a nominal amount of Rs 1 for a pack of 3 condoms, Re 1 for a cycle of OCP and Rs 2 for an ECP, from the beneficiaries. More details are provided later in this document.
IV. Immunization Immunization is one of the key interventions for protection of children from seven vaccine preventable diseases namely Diphtheria, Pertussis, Tetanus, Polio, Measles, Hepatitis B and severe form of childhood Tuberculosis. In addition, vaccine for Japanese Encephalitis (JE) is being provided in selected endemic districts of the country. 4.1 Interventions in Polio eradication Bivalent oral polio vaccine was introduced for the first time in January 2010. This, as well as focus on improving quality of vaccination, has led to a significant achievement towards polio eradication. New polio cases have come down from 741 in 2009 to 42 in 2010. During 2011, only one polio case has been identified till May as compared to 21 cases during the same period in 2010. 4.2 Immunization activities a. Government of India has introduced second dose of measles across the country. In addition, in States having less than 80% coverage, supplementary immunization activity has been taken up in a phased manner. b. Hep‐B vaccine which was earlier introduced in 10 States has now been expanded to the entire country. c. Pentavalent, a combination vaccine, which includes DPT + Hep‐B + Hib has been introduced on pilot basis in 2 States (Kerala and Tamil Nadu) covering 14 lakh children. d. As per Status on 11th April 2011, 101 out of 109 districts have completed the JE Vaccination drive (campaign) and it is now introduced in routine immunization in these districts. V. Programme review and monitoring • Review Missions : To assess the progress made by the States in RCH programme, Joint Review Mission (JRM) is being conducted. The review is led by GoI with support and participation from state governments and Development Partners. So, far seven JRMs have been held. The seventh JRM was held during the period from July–August 2010. • Evaluation Surveys: M & E division organizes periodic surveys namely National Family Health Survey (NFHS), District Level Household Surveys (DLHS), Facility Surveys. • Regional Evaluation Survey (RET): RETs monitor and evaluate the programme implementation.
Community Participation: To ensure involvement of the communities in over‐seeing the provisioning of health care and to redress the public grievances, 33149 Rogi Kalyan Samiti were constituted at health facilities and 4.83 lakh VHSCs constituted at village level , across the country. VI. Other strategies under RCH programme • Differential Planning and Supportive Supervision for High Focus Districts To effectively address the problems of difficult, inaccessible, backward and under‐served areas having poor health indicators, Ministry has identified 264 high focus districts in 21 States have been identified based on the health indicators, concentration of SC/ST population for focused attention. Specific plans have been prepared for these districts keeping in view their special needs. Facilities have also been identified in these districts for better provisioning of mother and child health services. Besides providing additional resources to these districts, teams have been set‐up by Ministry to monitor progress in these districts on regular basis. • Maternal & Child Health (MCH) Centres Ministry is facilitating States in identifying the delivery points /MCH centres for making provision of basic and emergency obstetric care during pregnancy, child birth and in post natal period. Operationalization of these facilities is being made possible through rational deployment of existing manpower, training of doctors and specialists in these identified MCH centres/ delivery points and providing funds for upgradation of physical infrastructure. • Tracking of mother and children To ensure registration of all pregnant mothers and children and to monitor the ante‐ natal and post‐natal checkup of mothers and immunization of children by identifying drop‐out cases, Government of India has introduced Mother and Child Tracking System which records complete data of the mothers with their addresses, telephone numbers etc. A help desk is in the process of being set up to monitor the progress and follow up on the interventions. As the system evolves, it would also provide a platform for creating awareness on health related issues. • Maternal Death Review To analyze the reasons of maternal deaths so that appropriate interventions specific to State/area could be taken, a system of maternal death review was introduced in 2010. Detailed guidelines were issued by Government of India. Most of the States have already
initiated the process of maternal death review and have constituted District Review Committees. • Infant Death Review Infant Death Review has been introduced by many states on a pilot basis. Karnataka is one state that has developed the required structure and the mechanism to carry out Infant Death Review. This will provide an insight into causes of infant deaths in the country and help to develop specific plans in each district depending on predominant causes of death. • Annual Health Survey Government of India has approved the Annual Health Survey to study the impact of the schemes under NRHM in reduction of Total Fertility Rate (TFR), Infant Mortality Rate (IMR) at the district level and the Maternal Mortality Ratio (MMR) at the regional level and to prepare District Health Profile of 284 districts in the EAG States (States with poor RCH indicators) and Assam to assess progress of health indicators on an annual basis. Previously, there was no such survey which could capture the impact of the schemes under NRHM on an annual basis.
It is the mandate of NRHM to increase the public expenditure in health sector. In the year 2010‐11, Rs.14652.69 Crores was released to the States. This was 12% increase over the previous year. States have booked an expenditure of Rs. 11755.68 Crores till December 2010 during 2010‐11. Since 2005, there has been a significant improvement in the utilization and absorption capacity of the states under NRHM. Over the period of six years, Rs 63268.43 Crores were released to the States under NRHM and Rs. 50175.69 Crores have been spent by the States. Details of Physical and Financial Progress made under RCH II in2010‐2011 may be seen in tables attached in Annexure.
VIII. Operational Issues identified from Integrated Field Monitoring Visit Integrated Field Monitoring Teams (IFMTs) have been constituted, consisting of Senior Technical Officers of MoHFW, Consultants from RCH and NRHM Division, NIHFW, NHSRC and representatives from R.D. Office. A total of 14 teams have been constituted and during the First Quarter of 2011‐12, 24 districts have been visited. Purpose of the team visits is: • To monitor the status of implementation of RCH II/NRHM strategies in the district • To understand the strength, best practices, gaps in implementation, constraints, if any, and support that can be rendered by the MoHFW to the states Drugs, Consumables & Equipment • Expired and ‘shortly going to expire’ drugs found at many facilities, distribution of such drugs was also reported (e.g. APHC Chapran, District Saharsa, Bihar) • Lack of Annual Maintenance Contract for equipments a major issue in most facilities Training • Limited training capacity in some of the visited districts • RTI/STI, IMNCI, IMEP training not rolled out in Chhattisgarh • SBA training needs complete re‐organization in few facilities (e.g. District Saharsa & Madhepura, Bihar) Maternal Health • Quality of ANC & PNC services remains inadequate • Safe abortion services mostly non‐functional (e.g. District East & West Garo Hills) • Joint MCH card and Safe Motherhood booklet not being used in many of the facilities • Maintenance of Partograph and case sheet lacking/inadequate in most facilities despite ANMs being SBA trained (e.g. District Dhamtari, Chhattisgarh) • Maternal Death Review not initiated in most of the visited districts Referral Services and Transport • Inadequate, improper referrals and poor linkages, except for districts of Gujarat • At some places ambulance use charged (e.g. District Dhamtari and Rajnandgaon, Chhattisgarh @ Rs. 8 per km.) Janani Suraksha Yojana • Delay in payment (8 to 15 days) in some of the visited districts • Payments made through cash disbursement due to lack of banking facility at some districts • Problems with issue of cheque books by the banks also observed
Child Health New born care services elementary at most of the health facilities Baby warmer lying unutilized, understanding of staff is inadequate regarding usage of equipments No record maintained on the number of Low Birth Weight babies delivered at facilities (e.g. District Dhamtari, Chhattisgarh) No system in place for treatment of severely malnourished children (e.g. District East & West Garo Hills, Meghalaya) Immunization • Lack of electricity back up provision for ILR and Deep Freezer observed in most facilities • Lack of proper indenting system an issue for stock maintenance • Ideal practice of bundling of vaccines not observed in many facilities • No system of alternate vaccine delivery (e.g. District of Dhamtari, Bihar; East & West Garo Hills, Meghalaya; Kinnaur, HP) Family Planning Family planning services quality questionable , not yet receiving priority in many of the visited districts, post partum family planning service and use of spacing methods weak (e.g. District Kinnaur, HP; East & West Garo Hills, Meghalaya) Stock outs observed for as much as six months at peripheral facilities (e.g. District Dhamtari & Rajnandgaon, Chhattisgarh) PC & PNDT • Implementation of PC & PNDT Act inadequate • Regular meetings not conducted in many of the districts • Form F under PC & PNDT Act not maintained in many facilities Adolescent Health: • No functional adolescent health services, except for signboards outside rooms in some facilities • Fixed Day ARSH services and counsellors placed at some Civil Hospital/s School Health Programme: • Weak school health programme in almost all the visited districts
IX. Key areas of concern • Programme Management Structure at State and District level • • • • • Differential Planning for Backward areas and Allocation of Resources Rational Deployment of Human Resources Focus on Immunisation programme Primary Record Maintenance Facility Based Monitoring of RCH Programme
Janani Shishu Suraksha Karyakram
RATIONALE: About 67,000 women in India die every year due to pregnancy related complications and about 9 lakhs newborn babies die within four weeks of birth of which about 7 lakhs i.e. 75 per cent die within the first week. The first 28 days of infancy period are therefore very important and critical in order to save newborn lives. Both maternal and infant deaths can be reduced by ensuring timely access to quality services, both essential & emergency, in public health facilities while assuring that they do not have to shoulder the burden of expenses. With the launch of the Janani Suraksha Yojana (JSY), the number of institutional deliveries has increased significantly. However 25% pregnant women still hesitate to access health facilities. Those who have opted for institutional delivery are not willing to stay for 48 hrs, which is a critical period for identification and management of complications in both the mother and the neonate. Important factors affecting access include: • High out of pocket expenses on – o User charges for OPD, admissions, diagnostic tests, blood etc. o Purchase of medicines and other consumables from the market • Non availability of diet in most institutions • Transport for travel to the health facility and back and between facilities in case of referrals Out‐of‐pocket payments are, without doubt, a major barrier for pregnant women and children so far as access to institutional healthcare is concerned. The impoverishing effect of healthcare payments on Indian households is well established. Out‐of‐pocket spending in government institutions is both common and substantial, partly because of a weak supply chain management of drugs and other logistics and partly because of malpractices. Prescriptions by doctors, even in government settings, can be unnecessarily expensive and may include not just medicines but consumables such as surgical gloves, syringes, IV (intravenous) sets, and cannulae, etc. Under these circumstances, the goals of NRHM for provision of affordable, equitable and accessible health services are defeated. Under NRHM, it is expected that each and every pregnant woman and infant gets timely access to the health care system for the required ante‐natal, intra‐natal, post natal care and immunization services free of cost. It is paradoxical that some states have levied user charges for deliveries at the time when efforts are being made nationally to address factors impeding institutional deliveries and to give incentives to women to approach government institutions for childbirth through
schemes such as the Janani Suraksha Yojana. Hence, notwithstanding substantial investments to improve provisioning for maternal and child healthcare, the burden of out‐ of‐pocket expenses for pregnant women and children has persisted in the public health system across most states. The fact that entitlements were not explicitly articulated and were vague left much scope for denial of services that national programmes, including the National Rural Health Mission and its precursors, have consistently strived for. THE NEW INITIATIVE Janani Shishu Suraksha Karyakram (JSSK) launched from Mewat district in Haryana on June 1, unmistakably signals a huge leap forward in the quest to make "health for all" a reality. It invokes a new approach to healthcare, placing, for the first time, utmost emphasis on entitlements and elimination of out‐of‐pocket expenses for both pregnant women and sick neonates. The initiative entitles all pregnant women delivering in public health institutions to absolutely free and no‐expense delivery, including caesarean section. It stipulates out that all expenses related to delivery in a public institution would be borne entirely by the government and no user charges would be levied. Under this initiative, a pregnant woman would be entitled to free transport from home to the government health facility, between facilities, in case she is referred on account of complications, and also drop‐back home after delivery. Entitlements would include free drugs and consumables, free diagnostics, free blood wherever required, and free diet for the duration of a woman's stay in the facility, expected to be three days in case of a normal delivery and seven in case of a caesarean section. Similar entitlements have been put in place for all sick newborns accessing public health institutions for healthcare till 30 days after birth. They would also be entitled to free treatment besides free transport, both ways and between facilities in case of a referral. The initiative is estimated to benefit more than 1 crore pregnant women & newborns that access public health institutions every year in both urban & rural areas, and also increase access to health care for the over 70 lakh women delivering at home. This initiative supplements the cash assistance given to a pregnant woman under JSY and is aimed at mitigating the burden of out of pocket expenses incurred by pregnant women and sick newborns. Entitlements for Pregnant Women: Free and zero expense for delivery and Caesarean Section Free Drugs and Consumables Free Essential Diagnostics (Blood, Urine tests and Ultra‐sonography etc) Free Diet during stay in the health institutions (up to 3 days for normal delivery & 7 days for caesarean section)
Free Provision of Blood Free Transport from Home to Health Institutions Free Transport between facilities in case of referral Drop Back from Institutions to home after 48 hrs stay Exemption from all kinds of User Charges Entitlements for Sick Newborn till 30 days after birth: Free and zero expense treatment Free Drugs and Consumables Free Diagnostics Free Provision of Blood Free Transport from Home to Health Institutions Free Transport between facilities in case of referral Drop Back from Institutions to home Exemption from all kinds of User Charges Drugs and consumables Drugs & consumables including supplements such as Iron Folic Acid are required to be given free of cost to the pregnant women during ANC, INC, PNC up to 6 weeks which includes management of normal delivery, C‐section and any complications during the pregnancy and childbirth. The same is also needed when a neonate is sick and needs urgent and priority treatment. Diagnostics During pregnancy, childbirth and in post natal period, investigations are essential for timely diagnosis of complications and likely problems which the women can face during the process of child birth. Both essential and desirable investigations are required to be conducted free of cost for the pregnant women during ANC, INC, PNC up to 6 weeks which includes investigations required prior to both normal delivery and C‐section. The same are also needed when a neonate is sick and needs urgent and priority treatment for conditions like infection, pneumonia, etc. Diet The first 48 hrs after delivery are vital for detecting any complications and its immediate management. Care of the mother and baby (including immunization) are essential immediately after delivery and at least up to 48 hrs. During this period, mother is guided for initiating breast feeding and advised for extra calories, fluids and adequate rest which are needed for the well being of the baby and her own self. Non availability of diet at the health facilities demotivates the mothers who have recently delivered from staying at the health facilities and most of the mothers prefer returning home immediately after delivery. This
hampers adequate care of the pregnant women and neonates, which is important for quality PNC services. Blood Blood transfusion may be required to tackle emergencies and complication of deliveries such as management of severe anaemia, PPH and C sections, etc. Exemption from user charges User charges are levied by many State Governments for OPD, admissions, diagnostic tests, blood etc. These add up to the out of pocket expenses. On occasion, there are situations where these pregnant women are misguided and become vulnerable for exploitation by private diagnostic centres for unnecessary investigations. Referral transport It is well proven that a significant number of maternal and neonatal deaths could be saved by providing timely referral transport facility to the pregnant women for normal delivery, C‐ section. This also needs to be provided to a neonate up to 30 days, when the baby is sick and needs urgent and priority treatment particularly for conditions like infection, pneumonia, etc. A drop back facility alleviates the pressure to leave the health facility earlier than desirable & obviates out of pocket expenses. The free referral transport entitlements for pregnant women and sick neonates up to 30 days & thereafter are as under: 1. Transport from home to the health facility 2. Referral to the higher facility in case of need 3. Drop back from the facility to home Grievance Redressal: This is an important aspect of implementing this scheme and mechanism to address grievances should be in place. This includes display the names, addresses, emails, telephones, mobiles and fax numbers of grievance redressal authorities at prominent places in health facility level, district level and state level, and disseminate them widely in the public domain, set up help desks and suggestion / complaint boxes at Government health facilities, and maintaining proper records of actions taken. Detailed Guidelines on this scheme may be referred to for implementation details.
Strengthening New Born Care: Home Based Newborn Care Scheme
In India 26 million babies are born every year, and 940,000 babies die before one month of life. The neonatal period is only 28 days, and yet at 34/1000 lives births (SRS, 2009), neonatal mortality contributes about 68% of all infant deaths and 49% of all deaths in children younger than age 5 years. Preventable morbidities such as hypothermia, asphyxia, infections and respiratory distress continue to be the main causes of mortality in the neonatal period. There is a growing recognition that in order to bring IMR, substantial reduction in Neonatal Mortality Rate is needed. Rapidly increasing numbers of newborns are being delivered in hospitals after the launch of JSY scheme. The roll out of Home Based New Born Care and IMNCI also leads to increased contact of frontline health workers and newborns at their households, thus creating scope for improved detection and referral of sick newborns to health facilities. There are several interventions that have proven to be both feasible and cost‐effective in reducing newborn deaths. These include interventions such as skilled attendance at birth, access to emergency obstetric care, immediate and exclusive breastfeeding, drying and keeping the newborn warm, and if needed, resuscitation, care of low birth weight infants, and treatment of infection. Therefore, improving newborn health is not a matter of finding new solutions but scaling up the proven solutions via existing mechanisms and workforce. In other words, the real task is to spread awareness of sound newborn health practices or “what works” to those who need it, especially mothers, other primary caregivers, and health providers, and to integrate essential newborn health care into existing maternal and infant care. Most of the causes of deaths in the newborn period can be prevented or managed by households, communities and health facilities. Home‐based care of all newborns and Integrated Management of Newborn and Childhood Illnesses are the two programmes that address these problems. They equip frontline workers (ASHAs & ANMs and at places even AWWs) with the required skills to assess the newborn, promote healthy practices, manage simple problems and refer those with serious illnesses. Provision and delivery of services for both essential newborn care and care of sick newborns in the existing health facilities at the district and sub‐district level has been another approach towards achieving the same objective.
Within RCH, Newborn care is being seen as a ‘continuum’ with components of immediate and Essential Care of all Newborn delivered at health facilities to prevent complications at birth, Home Based Newborn Care for all babies to prevent and detect illnesses in post natal period with provision of extra care of low birth weight babies, and access to quality emergency care for the sick newborn at newborn care health facilities. The three components are to be interlinked with seamless referral and follow up between them. Essential Newborn Care and Basic Resuscitation Essential newborn care includes care to all newborns means interventions for all newborns to meet their physiological needs; prevention of infection, preservation of warmth, appropriate nutrition by early & frequent breast‐feeding, initiation of breathing by resuscitation when needed. Essential newborn care assures survival of all those that are born well‐equipped to survive (term, newborns without malformations) and give good start for pre‐term & small babies. The protocol of ENC is a series of time bound, chronologically – ordered standard procedures that a baby receives at birth. At the heart of the protocol are time bound interventions: Hand‐washing, immediate drying, skin to skin contact followed by clamping of the code after 1 to 3 minutes, non separation of the body from mother and breast feeding initiation. Simple steps, yet, extremely effective: ♦ ♦ ♦ ♦ Cleanliness to prevent infection in newborns Immediate drying prevents hypothermia, which is extremely important to survival. Delayed code clamping until the umbilical code stops pulsating decreases anaemia. Keeping mother and baby in uninterrupted skin to skin contact prevents hypothermia, increases colonization with protected family bacteria and improves breast feeding initiation and exclusivity. ♦ Breast feeding within the first hour of life prevents infections
Care during the immediate postnatal period & up‐to discharge from the facility ♦ ♦ ♦ ♦ Routine monitoring Immunization Counselling Discharge instructions
In addition to the basic protocols, Essential newborn care includes additional protocols for Basic Resuscitation. The basic resuscitation algorithm defines the steps necessary to ventilate a newborn baby that is not breathing at birth. In order to operationalize Essential Newborn Care and Basic Resuscitation services, an enabling environment at the facilities is needed. It is important to prepare for each delivery, using standard precaution, equipment use & maintenance and organizing care in the labor room and postnatal wards. Home Based Newborn Care Scheme A major proportion of newborn deaths occur at home. Although, in the last 5‐6 years, institutional deliveries have risen to above 70%, still newborns remain at high risk of dying due to common ailments. Necessity for high quality home based newborn care while continuing to move towards institutional care and also catering to early diagnosis and ensuring prompt referral of sick newborns is essential in reducing NMR. Global evidence shows that home visits for neonatal care by community health workers is associated with reduced neonatal mortality in resource‐limited settings with poorly accessible facility‐based care. The purpose of the Home Based New Born Care Scheme is to improve community new born care practices and to improve ealry detection of neonatal illnesses. Home Visits : The ASHA is expected to visit the newborn according to a schedule of home visits for the care of the newborn. The purpose of these visits is to ensure wamth, exclusive breastfeeding, promote hand washing, discourage unhealthy practices such as early bathing, bottle feeding, and prompt identifcation of sepsis or other illnesses. The role of an ASHA during the visit for the newborn also combines crucial post partum care and support for the mother, including family planning counselling. These home visits are not solely focused on a vertical programme for newborn care but are holistic and comprehensive. The recommended schedule is as follows: Six visits in the case of instituional delivery (days 3, 7, 14, 21, 28 and 42), and seven visits in the case of home delivery (days 1, 3, 7, 14, 21, 28, and 42). Additional visits will be required for babies that are low birth weight, preterm, or ill. Payment and Conditionality: The ASHA is to be paid Rs. 250 for condcuting home visits for the care of the newborn and post partum mother. The amount is paid based on the completed home visit form, validated by the facilitator. This is paid on the 45th day subject to the following
Ensuring that birth weight is recorded in the Maternal and Child Protection (MCP) Card - Ensuring that the newborn is immunized with: BCG, first does of OPV and DPT - Ensuring Birth Registration - Both mother and newborn are safe until the 42nd day of delivery Extra visits made for home delivery or for the high risk newborn – will not be paid Payment would be made by the same mechanism which the state has chosen for making JSY payments. Using a crude birth rate of 26/1000, as an average estimate for the country, this would amount to about 26 births in the area that an ASHA will cover or approximately two births per month. Thus an ASHA could earn Rs 500 per month on this task. Capacity building of ASHAs: Ministry of Health has decided to scale up the Home Based Newborn Care (HBNC) to all states – with priority focus in 264 high focus districts. ASHA module 6 and 7 that incorporates HBNC has been prepared and state level trainers have been trained from most states on these modules and training of district trainers is ongoing. ASHA support systems: To effectively implement these skills the ASHA requires competency based training, and an effective support structure in the field to supervise and mentor her functioning. Other support mechanisms include a communication kit and drugs and equipment to enable her to counsel, manage or refer as required. State ASHA Resource Centre, District and Block Mobilizers and ASHA facilitators are required to provide the management and monitoring support functions related to the training and rollout of the modules, to mentor and support the ASHA in the field and to enable performance monitoring. Mechanism for monitoring and evaluation The ASHA uses two check lists: First Visit to the Newborn and Home visit form to remind her to ask the key questions and the steps of examination and counseling the mother. These can also serve as the basis for payment. As part of skill building (Module 6), the ASHA is trained to complete a Home Visit Form, which also serves as a checklist of the ASHA on key signs and symptoms to look for, and actions to be taken. This form can be used to assess the number and content of her visits, and should be signed by the ASHA facilitator. ASHA will be entitled to get the incentive only after necessary entries in the MCP card are verified by the ANM. Detailed guidelines for the Scheme will be shared as a separate document.
POPULATION STABILISATION & FAMILY PLANNING
INTRODUCTION In 1952, India launched the world’s first national program emphasizing family planning to the extent necessary for reducing birth rates "to stabilize the population at a level consistent with the requirement of national economy". Since then, the family planning program has evolved and the program is currently being repositioned to not only achieve population stabilization but also to promote reproductive health and reduce maternal, infant & child mortality and morbidity. The growth of India’s population since independence hovered around 2% per year for almost four decades. After 1981, the trend in the population growth rate was reversed. The decline was slow during 1981‐91 but accelerated during 1991‐2000 (1.9%). Provisional census data for 2011 shows that exponential annual growth rate has further declined to 1.6%. India’s population as per 2011 census was 1.21 billion, second only to China in the world. India accounts for 2.4% of the world's surface area yet it supports more than 17.5% of the world's population. The TFR in India has declined from 6.0 in 1951 to 2.6 (SRS) in 2009 but the decline is not consistent in all the states. While 14 states/ UTs have already achieved the replacement level, 12 states have TFR between 2.1 and 3 and 9 states (Bihar, UP, Rajasthan, MP, Jharkhand, Chhattisgarh, Meghalaya, Nagaland, D&N Haveli) have TFR more than 3. Total Fertility Rate in Different States (Source: SRS‐2009) TFR 3.1 & above 1 Bihar 3.9 3 Uttar Pradesh 3.8 2 Meghalaya 3.8 4 Nagaland 3.7 (2005‐06 NFHS III) 5 Dadra &Nagar Haveli 3.5 (1999‐ SRS) 6 Rajasthan 3.3 7 Madhya Pradesh 3.3 8 Jharkhand 3.2 TFR‐ 2.6 – 3.0 1 Chhattisgarh 3 2 Arunachal Pradesh 3.0 (2005‐06 NFHS III) 3 Mizoram 2.9 (2005‐06 NFHS III)
4 Lakshadweep 2.8 (1999‐ SRS) 5 Manipur 2.8 (2005‐06 NFHS III) 6 Assam 2.6 7 Uttaranchal 2.6 TFR – 2.2 – 2.5 7 Gujarat 2.5 8 Haryana 2.5 1 Daman & Diu 2.5 (1995‐ SRS) 2 Orissa 2.4 3 Jammu & Kashmir 2.3 4 Tripura 2.2 (2005‐06 NFHS III) TFR – 2.1 & below 1 Chandigarh 2.1 (2000‐ SRS) 2 Karnataka 2 3 Sikkim 2.0 (2005‐06 NFHS III) 4 Maharashtra 2 5 Delhi 2 6 Himachal Pradesh 1.9 7 West Bengal 1.9 8 Andaman & Nicobar 1.9 (1999 ‐ SRS) 9 Punjab 1.9 10 Andhra Pradesh 1.8 11 Goa 1.8 (2005‐06 NFHS III) 12 Puducherry 1.8 (1999‐ SRS) 13 Tamil Nadu 1.7 14 Kerala 1.7 As per DLHS–3 (2007‐08), 54.1% of the eligible couples use any of the contraceptive method compared to. Out of the modern methods, 34% accepted female sterilization and only 1% male sterilization. Among spacing methods, Pills, Condoms and IUCD were accepted by 4%, 6% and 2% of the eligible couples respectively. Contraceptive Prevalence Rate has not increased much.
Current status of CPR and Unmet Need in Different States (Source‐DLHS‐III) Sl. CPR: Any CPR: Any modern Total Unmet Name of the State/UT No. method (%) method (%) Need (%) INDIA 54 47.1 21.3 EAG STATES 1. Bihar 32.4 28.4 37.2 2. Chhattisgarh 49.7 47.1 20.9 3. Jharkhand 34.9 30.8 34.7 4. Madhya Pradesh 56.2 53.1 19.3 5. Orissa 47 37.8 24 6. Rajasthan 57 54 17.9 7. Uttar Pradesh 38.4 26.7 33.7 8. Uttarakhand 60.1 57.7 20.8 OTHER STATES 9. Delhi 66.1 55.5 13.9 10. Gujarat 61.6 54.3 16.5 11. Haryana 62 54.5 16 12. Himachal Pradesh 70.2 68.1 14.9 13. Jammu & Kashmir 54.1 42.7 20.4 14. Meghalaya 22.9 16.8 32.7 KEY STRATEGIES FOR FAMILY PLANNING UNDER RCH – II 1. Strong political will and advocacy at the highest levels like Chief Ministers, parliamentarians, religious leaders and opinion leaders, for achieving population stabilization with a special focus in the states with high fertility rates. 2. Availability of Fixed Day Static Services at all facilities round the year by ensuring availability of trained service provider so as to gradually move away from seasonal camp approach. 3. Revitalizing Postpartum Family Planning to address high unmet need for family planning during this period and utilizing the opportunity provided by increased institutional deliveries. 4. Equal emphasis on Spacing Methods – Promoting IUCD as long term, safe and effective method. 5. Ensuring Quality of Family Planning services by strengthening DQACs/SQAc and regular monitoring of services 6. Increasing male participation in family planning including promotion of NSV 7. Accreditation of Private providers 8. Strengthening Community Based Distribution of Contraceptives by involvement
9. 10. KEY ISSUES IN FAMILY PLANNING 1. 46% of the population in 2011 is contributed by 8 EAG states out of which 6 states have (UP, Bihar, MP, Rajasthan, Chhattisgarh and Jharkhand) Total Fertility Rate (TFR) more than 3.0. 2. Unmet need for both spacing and limiting methods of contraception is highest in Bihar (37.2), Jharkhand (34.7) and Uttar Pradesh (33.8 ) compared to national 21.5(DLHS III) 3. Contraceptive prevalence rate (CPR) is lowest in UP (26.7), Bihar (28.4). (India average is 46.2.) 4. Low female literacy, early age at marriage and child bearing are also prevalent in these states adding to population momentum. About 49% of girls in rural areas are married even before they turn 18 and almost 5.6% of total births take place in girls below 18 years of age. 5. Insufficient availability of trained service providers at peripheral health facilities to provide regular quality FP (especially sterilization) services throughout the year. 6. Lack of motivation of the staff to provide Family planning services. 7. Less focus on Post partum family planning services despite increase in institutional deliveries. 8. Continued dependence on Camp mode for sterilization services, that too in the winter months. 9. Most of the states pre‐dominantly cater to their demands of female sterilisation through the laparoscopic mode, which is technically & logistically difficult; employing the minilap mode of tubectomy would result in more service providers as well as services 10. Male participation in adopting Family planning remains low (less than 5% of total sterilizations). 11. Female sterilization continues to remain the predominant method of contraception despite other effective methods like IUCD, oral contraceptive pills being available.
of ASHAs and Focussed IEC/BCC efforts for enhancing demand and creating awareness on family planning Improving contraceptives supply management till peripheral facilities Strengthening monitoring and providing performance based incentives
POPULATION STABILISATION India’s population as per 2011 census was 1.21 billion, second only to China in the world. India accounts for 2.4% of the world's surface area yet it supports more than 17.5% of the world's population. Population Stabilization has always been one of the priority agenda and Family Planning as one of the key intervention for the Government. In 1952, India was the first country in the world to launch a national programme, emphasizing family planning to the extent necessary for reducing birth rates "to stabilize the population at a level consistent with the requirement of national economy". The program has come a long way and currently Family Planning Program is being repositioned to not only achieve population stabilization but also to reduce maternal mortality and infant and child mortality. The National Population Policy, 2000 (NPP 2000) provides a policy framework for advancing goals and prioritizing strategies to meet the reproductive and child health needs of the people of India, and to achieve net replacement levels of fertility (i.e. TFR 2.1) by 2010. National Socio‐Demographic Goals formulated to achieve the objectives of NPP, envisaged to – • Address the unmet needs for basic reproductive and child health services, supplies and infrastructure and to promote vigorously the small family norm to achieve replacement levels of TFR. • Achieve 80 percent institutional deliveries and 100 percent deliveries by trained persons • Reduce infant mortality rate to below 30 per 1000 live births, maternal mortality ratio to below 100 per 100,000 live births, 100% registration of all births, deaths and pregnancies and achieve universal immunization of children against all vaccine preventable diseases. • Promote delayed marriage for girls, not earlier than age 18 and preferably after 20 years of age. • Achieve universal access to information/counselling, and services for fertility regulation and contraception with a wide basket of choices. • Bring about convergence in implementation of related social sector programs so that family welfare becomes a people centred programme Total Fertility Rate is still 2.6 at National level and scenario is diverse across states. Nine states are well above the replacement level fertility (TFR >3); twelve states/UTs are at threshold of achieving the replacement level of fertility (TFR – 2.1‐3) while 11 state and 3 UTs have already achieved the replacement level of fertility i.e. <2.1.
The states also differ widely in terms of health indicators, nutritional status and socio‐ economic situation. Practice of Family planning is also low in the states where the other indicators are poor. Therefore, addressing population growth in the states with high fertility require a comprehensive approach to population stabilization based on social and economic development and improvements in the quality of life of people. RENEWED THRUST Currently Govt of India follows High‐focus district approach (264 such districts have been selected) and support these districts (& states) for better implementation of Family Planning programmes (&other programmes as well). Govt of India is committed to reduce the Maternal Mortality Ratio (MMR) to 100/100,000 live births, Infant Mortality Rate (IMR) to 30/1000 live births and to achieve the replacement level of fertility (Total Fertility Rate ‐ 2.1) by 2012. There is enough evidence to show that Family Planning can play an integral role to save the lives of mothers and children and help in achieving the National Goals. It is estimated that If the current unmet need for family planning in India is fulfilled by making available, affordable family planning services over the next 5 years, we can STRATEGIC OPTIONS FOR POPULATION STABILIZATION States with TFR >3.0 (U.P. Bihar, M.P., Rajasthan, Jharkhand, Chhattisgarh, and Meghalaya): These states will account for almost 50% of the increase in India’s Population in coming years. In these states, the immediate concern is to address the unmet need and focus upon socio economic development to reduce the wanted fertility (desire for more than two children). At the same time the momentum for future population growth is to be checked by delaying age at marriage and ensuring adequate spacing between births. States with TFR between 2.1 to <3 (Uttarakhand, Gujarat, Haryana, J&K, Orissa): The immediate concern in these states is to assist the couples to achieve their fertility goals by strengthening the family planning programme. For States with TFR <2.1 (Delhi and Himachal Pradesh): The immediate concern in these states is to check the population momentum by delaying the age at marriage and ensuring adequate spacing between births.
KEY THRUST AREAS – 12TH FIVE YEAR PLAN: FAMILY PLANNING • Addressing the unmet need in contraception through introduction of newer contraceptives. • Strengthening family planning service delivery, especially Post‐Partum Sterilisation in high case load facilities. • Enlisting private/NGO facilities to improve the provider base for family planning services. • Community based distribution of contraceptives through ASHAs. • Vigorous advocacy of family planning at all levels specially at the highest political level. Strategies to achieve thrust areas: • Strengthening human resource structures (for programme management) at all levels (national, state and district) • Introduction of a dedicated counsellor for family planning at district hospitals and high case load facilities. • Marketing of contraceptives at households through ASHAs at nominal charges • Improving compensation package (both for providers and acceptors) for sterilisation services • Introducing Multi –load IUD (375) as a short term spacing method to improve IUD acceptance • Performance Linked Payment Plan to ASHAs for improving retention and usage of IUDs • Enlisting more number of private providers/ NGOs for provision of services • Ensuring vigorous advocacy SCHEME FOR DELIVERY OF CONTRACEPTIVES BY ASHAs AT HOMES Scheme: ASHA would promote the use of contraceptives at the household level and making it available timely: ASHAs would deliver contraceptives at homes of beneficiaries. She shall charge a nominal amount of Rs 1 for a pack of 3 condoms, Re 1 for a cycle of OCP and Rs 2 for an ECP, from the beneficiaries. Logistics & supply chain: The contraceptives would be dispatched to the pilot districts directly.(CMOs would be the consignee) Supply below district would follow existing supply chain of state. The ASHA shall lift and replenish her stock every month from the Block PHC. The packs would be marked “Government of India supply,” “for home delivery by ASHA,”
“Re 1/‐ for a pack of 3 condoms/ Re 1/‐ for a cycle of OCPs/ Re 2/‐ for a pack of one tablet of ECP” The current ‘free supply scheme’ shall be continued only from CHC level upwards i.e. CHC, sub district hospital and district hospital. The scheme will be operational at the PHC and SC level. Coverage: The scheme is proposed to be implemented in 233 districts of 17 states: Sn. 1 2 3 4 5 6 7 8 9 State Uttar Pradesh Bihar Madhya Pradesh Rajasthan Jharkhand Chhattisgarh Orissa Uttarakhand Assam No. of Dist. 45 36 34 19 19 16 18 4 14 14 15 16 17 Tripura Manipur Meghalaya Arunachal Pradesh TOTAL 2 4 5 3 233 Sn. 10 11 12 13 State Jammu & Kashmir Himachal Pradesh Haryana Gujarat No. of Dist. 4 3 1 6
14 districts have been identified for initial supply of contraceptives to start with the programme, supply to remaining districts would be provided after this initial supply: Qty of Contraceptive Under ASHA Scheme to be Supplied before 15th July 2011 Sl. State District Condom No of OCP No of Boxes EC Pills No of Boxes No. Boxes @2520 pcs @600 cycles @300 packs 1 UP a)Rai Bareli 358 45 69 b)Bareilly 470 ‐ ‐ c)Hardoi 430 ‐ ‐ 2 Rajasthan Jaisalmer 49 11 13 3 Orissa Anugul 46 70 ‐ 4 MP Barwani 86 ‐ ‐ 5 Jharkhand Bokaro 70 ‐ ‐ 6 Haryana Mewat 158 24 ‐ 7 Gujarat Dangs 17 5 ‐ 8 Chhattisgarh Bilaspur 93 ‐ ‐
9 10 11
Bihar Jammu Assam
Gaya Doda a)Darrang b)Bongaigaon Quantity in M.pcs
124 35 23 19 1978 4.984 mpcs
‐ 13 ‐ ‐ 168 1.008 L.Cycles
‐ ‐ ‐ ‐ 82 24600 Packs
Scheme for Promotion of Menstrual Hygiene among Adolescent Girls (10‐19 years) in Rural India I. Background The Ministry of Health and Family Welfare has approved a new scheme for the promotion of menstrual hygiene among adolescent girls in the age group of 10‐19 years in rural areas. This scheme is aimed at ensuring that adolescent girls (10‐ 19 years) in rural areas have adequate knowledge and information about menstrual hygiene and the use of sanitary napkins. Evidence suggests that lack of access to menstrual hygiene (which includes sanitary napkins, toilets in schools, availability of water, privacy and safe disposal) could contribute to local infections including reproductive tract infections (RTI). Studies have shown that RTIs are closely interrelated with poor menstrual hygiene and pose grave threats to women’s lives, livelihood, and education. Services for the prevention and treatment of RTI/STI are integral part of the Reproductive Child Health II Programme (RCH II). With specific reference to ensuring better menstrual health and hygiene for adolescent girls, Government of India is launching this scheme as part of the Adolescent Reproductive Sexual Health (ARSH) in RCH II. II. Scheme Modalities In the first phase, the scheme will cover 25% of the population i.e. 1.5 crore girls in the age group of 10‐19 years in 152 districts of 20 states. The girls will be provided with a pack of 6 sanitary napkins under the National Rural Health Mission’s brand ‘Freedays’. These napkins will be sold to the adolescents girls at Rs. 6 for a pack of 6 napkins in the village by the Accredited Social Health Activist (ASHA). This means a napkin will be available at an affordable rate of Rs. 1 per piece. It is expected that making sanitary napkins available at the village level, the usage of sanitary napkins will increase. Currently, sanitary napkins are not readily available in rural areas leaving young girls and women little choice besides using indigenous methods like cloth, straw, ash etc. Easy access and convenient pricing are the strategies adopted by the Ministry for increasing usage of safe and hygienic practices during menstruation. The ASHA will get an incentive of Re. 1 on sale of each pack, besides a free pack of sanitary napkins per month. The cost of the incentive for ASHA must be met out of the sale proceeds. The ASHA is also required to facilitate a monthly meeting with adolescent girls in the village to promote menstrual hygiene and she will be given an incentive of Rs. 50 for each monthly meeting with adolescent girls.
III. Current Status III.a. ASHA Training To ensure the smooth roll‐out of the scheme in the identified states, the Ministry with support from National Health Systems Resource Centre (NHSRC) developed operational guidelines for the scheme. These have been printed in English and Hindi and disseminated in the 20 states where the scheme is being implemented in the first phase. Training and inter‐ personal communication (IPC) material including training and reading module for ASHA and a flip‐book on menstrual hygiene has also been developed and shared with the states and translated in vernacular languages to be used at the community level. The training of trainers (ToT) for master trainers from each of the 20 identified states was completed in August 2010. The training of ASHAs on menstrual hygiene in the states is expected to be completed by July 2011. III.b. Strengthening Women’s Self Help Groups for Production of Sanitary Napkins As part of this scheme, supply of sanitary napkins in 45 identified districts shall be from women’s self help groups. To streamline the SHG training and production, NHSRC has been appointed as the nodal agency for providing technical support. 2 batches of exposure cum training for 40 nodal officers from 15 states from the Departments of Health, Women and Child Development and Rural Development have been organised in Chennai in November 2010. III.c Branding The Ministry with support from UNFPA has developed the NRHM brand of sanitary napkins ‘Freedays’. This brand name was finalised after research with adolescent girls in rural Bihar. TV spots are currently under production. The scripts drafted by a subsidiary of USAID have been approved and final spots will be ready for airing on TV and radio shortly. III.d Supply of Sanitary Napkins M/s HLL Lifecare Limited, a PSU of this Ministry shall be supplying the packs of Freedays sanitary napkins at the district level in 107 districts as per the consignee details shared by states. In other 45 districts, packs of sanitary napkins are to be sourced from women SHGs. Procurement of sanitary napkins in 45 districts from Women’s Self Help Groups has been fixed at Rs. 7.50 per pack of 6 sanitary napkins. Necessary provisions have been made by the States in their annual NRHM PIPs for this cost. In case States intend to procure from women SHGs at a higher rate than Rs. 7.50 per pack of 6 napkins, additional cost would be borne out of the state budget. III.e. Selling Price It has been decided that a pack of sanitary napkin will be sold by ASHA at a uniform selling price of Rs. 6/‐ per pack of 6 sanitary napkins for all adolescent girls covered under the scheme.
IV. Role of the State in the Implementation of the Scheme To ensure the smooth roll‐out of the scheme for promotion of menstrual hygiene among adolescent girls in rural India, the responsibilities of the states include: a. completion of training for all ASHAs in the 152 districts by July 2011 b. constitution of State Steering Committees and finalising the implementation modalities at the district, block and village level as suggested in the operational guidelines c. ensuring a system of fund flow, maintenance of records, stocks and accounts. d. storage at the block level and distribution of stock to the sub‐centre and further to the village e. identification of key SHGs for undertaking the production and supply of sanitary napkins for adolescent girls to be covered under this scheme f. working with NHSRC to ensure training of SHG members in the identified production technology for production of sanitary napkins g. planning for effective disposal of sanitary napkins Annexure ‐1
S.No 1 State wise list of Final Implementation Districts for Menstrual Hygiene Scheme State Total Central SHG Tender SHG Supply Andhra 9 3 6 Adilabad, Nizamabad, Medak, Karimnagar, Pradesh Chittor Warangal,
Nalgonda, Mahboobnagar, Rangareddy
2 Assam 7 7 0 Goal Para, Dhubri, Barpeta, Kamrup, Marigaon, Nagaon, Sonitpur Saran, Bhojpur, Buxar, Vaishali Rohtas, Kaimur (Bhabua), Muzaffarpur, Darbhanga, Aurangabad, Gaya Bilaspur, Janjgir, Raipur, Mahasamund, Durg Surat, Kheda, Vadodara, Dahod, Anand, Bharuch, Narmada, Tapi
4 5 6
Chattisgar h Gujarat Haryana
5 8 7
5 4 0
0 4 7
Mewat, Sonipat, Jind, Yamunanagar, Panchkula, Sirsa, Faridabad
Himachal Pradesh Jammu and Kashmir
Madhya Pradesh Maharash tra Orissa
Bilaspur, Mandi, Hamirpur, Una Baramullah (Erstwhile Bandipura), Rajouri, Udhampur, Kathua, Kupwara, Doda (Erstwhile Kishtwar/Ramban), Poonch Ranchi, Bokaro, Giridih, Hazaribagh, Dhanbad, Kasargod, Wayanad, Kannur, Mallapuram, Idukki, Kottayam, Palakkad Bidar, Gulbarga, Raichur, Mysore, Bagalkot, Belgaum Bhind, Morena, Sheopur, Datia, Shivpuri, Guna, Vidisha, Sagar Nandurbar, Dhule, Akola, Buldana, Satara, Latur, Amravati, Beed, Dhenkanal, Bhadrak, Kendrapara, Jagatsinghapur Moga, Firozpur, Muktsar, Bhatinda, Faridkot Jhunjhunu, Alwar, Sawai Madhopur, Bhilwara, Bundi, Chittaurgarh, Ajmer
Chamaraj Nagar, Bijapur, Bellary Dewas
Namakkal, Karur, Madurai, Shivaganga, Dharmapuri, Krishnagiri, Kanyakumari, Tanjavur, Trichy, Nilgiris
Uttarkashi, Rudrapayag, Tehri Garhwal, Haridwar, Garhwal Saharanpur, Muzaffarnagar, Bijnor, Moradabad, Unnao, 39
Uttarakha nd Uttar Pradesh
Sidharthnagar, Basti, Gorakhpur, Faizabad, Rae Bareli, Sultanpur, Maharajganj, Rampur
Malda, Murshidabad, Birbhum, Purilia, North Parganas, Jalpaiguri, Coochbehar, Uttar Dinajpur, Paschim Medinipur
See Annexure on Technical Specifications of Sanitary Napkins for the Scheme for the Promotion of Menstrual Hygiene (as approved by the technical committee constituted by MoHFW)
Preconception and Prenatal Diagnostic Techniques Act
Continuous decline in child sex ratio since 1961 Census is a matter of concern for the country (Table I). Beginning from 976 in 1961 Census, it declined to 927 in 2001. As per Census 2011 (provisional) the Child Sex Ratio (0‐6 years) has dipped further to 914 against 927 girls per thousand boys recorded in 2001 Census. Child sex ratio has declined in 22 States and 5 UTs and except for the states of Himachal Pradesh (906), Punjab (846), Chandigarh (867), Haryana (830), Mizoram (971), Tamil Nadu (946), Andaman & Nicobar Islands (966) showing marginal improvement, rest of the 27 states/ UTs have shown decline. (Table II). States and UTs with child sex ratio of 951 and above has reduced from eighteen to nine in 2011. A declining trend in even North Eastern States (other than Mizoram) is also discernible. The list of focus states for purposes of the PC&PNDT Act, 1994 has extended from 7 to 17 states (Punjab, Haryana, Chandigarh, Delhi, Gujarat, Himachal Pradesh, Rajasthan, Maharashtra, Orissa, Bihar, Uttar Pradesh, Madhya Pradesh, Uttaranchal, Jharkhand, Andhra Pradesh, Chhattisgarh, and J&K). In Haryana, Rewari (784), Jhajjar (774) and Mahendragarh (778) and Sonipat (790) indicate a Child Sex Ratio of below 800 in these districts. Similarly, Samba (787) and Jammu (795) district of J & K show a Child Sex Ratio of below 800. This negative trend establishes the fact that the girl child is more at risk than ever before and the efforts till date have not been completely effective. The issue of survival of girl child is critical and needs systematic efforts to build a positive environment for the girl child through gender sensitive policies, provision and legislation to protect women against any gender based violence. While changing the mind set and creating a favourable environment for girl child is the mandate of Ministry of Women and Child Development, Ministry of Health And Family Welfare is concerned with regulating and prohibiting the use of medical technology for selective elimination of the girl child. Towards this end, the Pre‐natal Diagnostic Techniques (Regulation and Prevention of Misuse) Act was enacted on September 20, 1994 and the Act was further amended in 2003. The main purpose of enacting the PC & PNDT (prohibition of Sex Selection) Act, 1994 has been to: i) Ban the use of sex selection techniques before or after conception ii) Prevent the misuse of pre‐natal diagnostic techniques for sex selective abortions iii) Regulate such techniques
The PC & PNDT Act, 1994 prohibits sex selection before or after conception and misuse of pre‐natal diagnostic techniques for determination of the sex of the foetus as also advertisements in relation to such techniques for detection or determination of sex. The Act specifies punishments for violation of its provisions. The Act is implemented through the following agencies: • Central Supervisory Board (CSB) • State Supervisory Boards (SSBs) and Union Territory Supervisory Boards (UTSBs) • Appropriate Authority for the whole or a part of the State/Union Territory • State Advisory Committee (SAC) and Union Territory Advisory Committee (UTAC) • Advisory Committees (AC) for designated areas (part of the State) attached to each Appropriate Authority. • Appropriate Authorities at the District and Sub‐District levels All places using pre‐conception and sex selection techniques/procedures and any place having equipment capable of detecting the sex of the foetus and those related to genetic counselling need to be registered, i.e: • All Genetic Counselling Centres • Genetic Laboratories • Genetic Clinics • Ultrasonography Centres • Mobile Sonography Vans • Imaging Centres • Advanced versions of ultrasound machines • Infertility Clinics and IVF Centres • The unit as a whole, including the place, equipments and persons using the machine should be registered • To qualify for registration, the applicant organization must fulfill the requirements of space, equipment, qualified employees and standards as specified in Rule 3 of the Act • Any change of employee, place, equipment or address should be intimated to the AA within 30 days of such change as per Rule 13. The punishments under the Act are as given below: • Breach of any provision by the service provider: 3 years imprisonment and/or a fine of Rs. 10,000/‐; For any subsequent offence: 5 years imprisonment and/or fine of Rs. 50,000/‐ (Section 23 (1)) • Medical Professionals: AA will inform the State Medical Council and recommend suspension of the offender’s registration if charges are framed by the court and till
the case is disposed off; removal of name from the register for 5 years on 1st conviction and permanently in case of subsequent breach (Section 23 (2)) • Persons seeking to know the sex of the foetus (A woman will be presumed to have been compelled by her husband and relatives): Imprisonment extending up to 3 years and a fine of up to Rs. 50,000/‐; For subsequent offences: Imprisonment upto 5 years and or a fine of Rs. 1,00,000/‐ (Section 23 (3)) • Persons connected with advertisement of sex selection/sex determination services: Imprisonment up to 3 years and/or a fine of Rs. 10,000/‐ with additional fine of continuing contravention at the rate of Rs. 500/‐ per day (Section 22 (3)) • Advertisement for the purpose of Section 22 (3) includes any notice, circular, label, wrapper or any other document including advertisement through internet or any other media in electronic or print form and also includes visible representation made by means of any hoarding, wall painting, signal, light, sound, smoke, gas, etc • Contravention of provisions of the PC & PNDT Act, 1994 for which no specific punishment is provided in the Act are punishable with imprisonment up to 3 months and/or fine of Rs. 1,000/‐ with additional fine of continuing contravention at the rate of Rs. 500/‐ per day (Section 25) • Such contraventions can be presumed to be the non‐maintenance of records, non‐ compliance with standards prescribed for the maintenance of units, etc • The offences under the Act are cognizable, non‐bailable and non‐compoundable As per the reports received from the States and UTs, 41,182 bodies using ultrasound, image scanners etc. have been registered under the Act. 409 ultrasound machines have been sealed and seized for violation of the law and 876 cases have been filed in the Courts for various violations of the law. A total of 55 convictions have been secured by Punjab (22), Haryana (23), Delhi (2), Chandigarh (1) and Gujarat(4). The concerned State governments are regularly requested to take effective measures for speedy prosecution of the ongoing cases (Table‐3). While the regulatory framework has been in place for implementation by states, enforcement of the Pre‐conception & Pre‐natal Diagnostic Techniques (Prohibition of Sex Selection) Act, 1994 has been lackadaisical in most states. Following the publication of the 2011 Census figures, Ministry of Health & Family Welfare has initiated the following steps for effective implementation of PC&PNDT Act: 1. Central Supervisory Board (CSB) under the Act has been reconstituted. The 17th meeting of the CSB was held on the 4th June, 2011. The board reviewed progress made by the States in respect of the implementation of the Act, suggested amendments in the Act and strategies to meet the challenges.
2. 17 states with the most skewed child sex ratio have been identified for concerted attention. A meeting of Health Secretaries of these States was convened on 20th April 2011. The efforts on their part to implement PC&PNDT Act were reviewed in depth and following action points highlighted : Constitute/ reconstitute State supervisory board and conduct regular meetings Constitute/ reconstitute appropriate authorities and advisory committees at state/ district and sub district levels Constitute State Inspection and Monitoring Committees (SIMC) for checking the activities of ultrasound facilities indulging in advertisement and/or determination/revealing of the sex of the foetus. Identify districts and map reasons for skewed Child Sex Ratio. Conduct regular surveys, update registrations and renewals to avoid multiple registrations and irregularities including on call registrations and unrestrained use of portable machines. Analysis and scrutiny of Form ‐F for effective monitoring and tracking of the Ultrasound clinics Take immediate action against any breach of the provisions of the Act and Rules Make ultrasound manufacturers accountable and get regular details of the sale of machines. Submit regular quarterly progress report to the Central Supervisory Board. Sensitize and Conduct training programme for law enforcers, medical practitioners, judiciary etc. for effective implementation of the Act. Enhance in‐house capacities for building strong cases against offenders that can successfully withstand the legal scrutiny Devise inter‐state coordination mechanism for regulating activities of USG clinics across borders. 3. National Inspection Monitoring Committees have been re‐constituted for regular state monitoring and surprise inspection of the clinics on the ground. Random inspections of ultrasound facilities were undertaken in the states of Gujarat,Uttar Pradesh & Rajasthan in January‐February, 2011. 4. States have been asked during appraisal of the annual Programme Implementation Plan (PIP) to take advantage of funding available under NRHM for strengthening
infrastructure and augmentation of human resources required for effective implementation of the PC&PNDT Act. 5. Operational guidelines for PNDT‐NGO Grant in Aid Scheme have been revised to ensure targeted use of resources for effective implementation of the Act. 6. Chief Secretaries in the states/ UTs have been addressed to take effective measures and regularly monitor implementation of the PNDT Act. 7. HFM has addressed the Chief Ministers of all states/ UT administration, exhorting them to provide personal leadership in containing the declining sex ratio in the 0‐6 year age group. 8. It is proposed to carry forward regular appraisal of effective implementation of the Act through zonal and state specific reviews. PC&PNDT will be high on the agenda in all future review meeting in Reproductive and Child Health issues.
Table I : Sex Ratio of child population in the age group 0‐6: 1961‐2011
Census Year 1961 1971 1981 1991 2001 2011 Child Sex Ratio 976 964 962 945 927 914 Absolute change ‐12 ‐2 ‐17 ‐18 ‐13
Table II: State‐wise Child Sex Ratio in India (Age Group 0‐6 Years) (1991,
2001 & 2011) State India Haryana Punjab Jammu and Kashmir Delhi Chandigarh
2001 927 819 798 941 868 845
2011 914 830 846 859 866 867
Absolute Change ‐13 11 48 ‐82 ‐2 22
Rajasthan Maharashtra Gujarat Uttaranchal Uttar Pradesh Himachal Pradesh Lakshadweep Daman and Diu Madhya Pradesh Goa Dadra and Nagar Haveli Bihar Orissa Manipur Karnataka Andhra Pradesh Arunachal Pradesh Jharkhand Sikkim Nagaland Tamil Nadu West Bengal Tripura Assam Kerala Chhatisgarh Pondicherry Andaman and Nicobar Islands Meghalaya Mizoram
909 913 883 908 916 896 959 926 932 938 979 942 953 957 946 961 964 965 963 964 942 960 966 965 960 975 967 957 973 964
883 883 886 886 899 906 908 909 912 920 924 933 934 934 943 943 943 943 944 944 946 950 953 957 958 964 965 966 970 971
‐26 ‐30 3 ‐22 ‐17 10 ‐51 ‐17 ‐20 ‐18 ‐55 ‐9 ‐19 ‐23 ‐3 ‐18 ‐21 ‐22 ‐19 ‐20 4 ‐10 ‐13 ‐8 ‐2 ‐11 ‐2 9 ‐3 7
Table III. STATUS OF IMPLEMENTATION OF PNDT ACT IN STATES (31.3.11) Sl.No State No. of clinics registered 1317 1072 212 65 740 1789 1790 3398 84 577 409 1475 591 2912 3703 462 1042 4560 521 3051 345 42 34 24 17 132 54 10 9 57 13 11 23 36 1803 32380 No. of machines sealed as 26 133 0 1 168 48 76 82 0 13 1 52 68 12 37 5 1 72 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 6 801 No. of cases filed in court/against doctors 112 54 7 2 82 61 161 139 0 3 9 70 17 19 54 5 10 77 0 13 0 0 0 0 0 0 0 0 0 0 0 0 0 0 7 902 No. of convictions
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 Total
Punjab Haryana H.P Chandigarh Gujarat Delhi Rajasthan Maharashtra J & K Jharkhand Uttaranchal Madhya Pradesh Orissa Andhra Pradesh Uttar Pradesh Chhattisgarh Bihar Tamil Nadu Kerala Karnataka Assam Manipur Meghalaya Nagaland Sikkim Goa Tripura A & N Islands Lakshadweep Puducherry D & N.Haveli Daman & Diu Arunachal Pradesh Mizoram West Bengal
22 23 0 1 4 2 0 3 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 55
E‐banking (NRHM Financial Management Information System)
The Ministry has been working with various public sector banks that are lead banks in their respective states to develop an e‐banking MIS which would enable detailed reporting on fund management and fund utilisation up to sub district levels. The e‐transfer of funds to states using the services of the accredited bank of the Ministry is already in place since 2010. The e‐banking MIS builds upon the e‐transfers being effected to generate information and data on funds available and their manner of utilisation even at the lowest unit level which is the village/Sub Centre and Village Health and Sanitation Committees. The Ministry has worked with State Bank of India and NRHM, Karnataka to successfully pilot (in the two districts of Bangalore Rural and Yadgir and work underway in ten more districts), a web‐enabled MIS which contains information on all fund flows under the Mission including funds transferred through the Infrastructure Maintenance route. The e‐banking system developed includes modules for sanction order tagging, budget allocation and planning, expenditure tracking wherein third party payments including ASHA payments, activity head wise expenditure tracking, drill down information; beneficiary and non‐ beneficiary expenditure are readily available at SHS and DHS and sub district levels. The e‐ banking MIS can be used both in offline and online mode and with or without standard accounting software. Reports generated include Financial Management Reports, Statement of Fund Position, Aging of Advances, Querying options, Geographical Area/Budget head/Expenditure type‐wise and trending reports and there is a SHS and Government of India level dashboard available which would enable views across all districts and sub district level formations. System development Life cycle documents and User Manuals and a list of FAQs have been developed by NRHM‐Finance for use across states. Helpdesks have been created firstname.lastname@example.org and email@example.com and dedicated teams have been formed to assist in e‐banking roll out in states. The e‐banking (NFMIS) system is essentially a very powerful executive management financial tool which would enable states to manage the funds under NRHM better.
Section Three Communicable Diseases
Revised National TB Control Programme
The Revised National TB Control Programme (RNTCP) is being implemented as a 100% Centrally Sponsored Scheme in the entire country. Under the programme, diagnosis and treatment facilities including the supply of anti TB drugs are provided free of cost to all TB patients. For quality diagnosis, designated microscopy centres have been established for every one lakh population in the plain areas and for every 50,000 population in the tribal, hilly and difficult areas. Sputum microscopy, instead of X‐ray, avoids over diagnosis and identifies infectious cases. More than 13000 microscopy centres have been established in the country. Drugs are provided to the TB patients in ‘patient wise boxes’ to ensure that all drugs for full course of treatment are earmarked on the day one, a patient is registered for treatment under the programme. More than 4,00,000 Treatment centres (DOT centres) have been established near to residence of patients to the extent possible. All government hospitals, Community Health Centres (CHC), Primary Health Centres (PHCs), Sub‐centres are DOT Centres, in addition to NGOs, Private Practitioners (involved under the RNTCP), Community Volunteers, Anganwadi workers, Women Self Help Groups etc. also function as Community DOT Providers/DOT Centres. Drugs are provided under direct observation and the patients are monitored so that they complete their treatment. The programme has launched DOTS Plus for the management of multi‐drug resistance tuberculosis (MDR‐TB) since 2007. Till date these services are available in 18 States. RNTCP is presently in the process of scaling up DOTS Plus services and aims to make these services available in all States by end 2011 while achieving complete geographical coverage by 2013. TB‐HIV collaborative activities are being implemented in collaboration with NACP to provide TB treatment and care and support for TB‐HIV patients. To further extend the reach of programme and involve non‐programme providers and community, RNTCP has already revised its guidelines for involvement of Non Programme management is notable for decentralized financial control, management, and supervision to State and District health systems, supported by a small number of supervisory staffs. RNTCP diagnostic and treatment services are wholly integrated within the general health system and medical colleges. Now RNTCP is an integral part of the National Rural Health Mission (NRHM). The Central level serves only for organizing and distributing financing for TB control activities within the NRHM, centralized drug procurement and distribution to States, development of comprehensive normative guidance, capacity building, and monitoring and evaluation of States and Districts programme management units.
Tuberculosis Disease Burden & Trend in India Incident New Smear Positive TB Cases
Year Incidence rate (all NSP cases per lakh population) 75 75 75 75 75 Estimated no of NSP cases ** 846000 846000 861000 873000 882750 Total no of NSP cases notified under RNTCP 554,914 592,262 616,027 624,617 630,165 % of estimated NSP cases detected 66% 70% 72% 72% 72%
2006 * 2007 2008 2009 2010
* DOTS expansion was done in phased manner with complete coverage by March 2006. Thus the
total number of NSP cases notified under RNTCP till 2006 are lesser. ** Estimated by WHO based on ARTI (Annual Risk of TB Infection) survey in India, conducted by NTI / CTD in different zones of country
Trends of NSP case detection rate and success rate in the country
100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0%
84% 85% 87% 86% 86% 86% 86% 87% 87% 87% 72% 70% 72% 72%
72% 69% 55% 59% 56% 66% 66%
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
Annualised New S+ve CDR
Year 2006 *
Incident New TB (NSP + New Smear Neg + Extra Pulmonary) cases Incidence rate (all NEW Estimated no of Total no of NEW TB cases TB cases per lakh NEW TB cases notified under RNTCP population) ** 168 1895040 1,140,017
2007 2008 2009 2010
168 168 168 168
1895040 1928640 1955520 1977360
1,197,670 1,226,472 1,241,756 1,227,667
* DOTS expansion was done in phased manner with complete coverage by March 2006. Thus the total number of cases notified under RNTCP till 2006 are lesser. ** Estimated by WHO based on ARTI and assumption of equal proportion of smear positive and smear negative cases amongst new cases while extra‐pulmonary cases occurring at the rate of 20% of new smear positive cases. Prevalent All TB cases (NSP+NSN+NEP + All re‐treatment cases) Estimated no of all Prevalence rate (all TB) Total no of TB cases notified TB cases in cases per lakh under RNTCP population population) 333 3,759,060 1,400,340 316 3,568,992 1,474,605 300 3,438,834 1,517,363 283 3,290,628 1,533,309 266 3,129,055 1,522,147
Year 2006 * 2007 2008 2009 2010
Major Challenges of RNTCP: (1) Reaching the un‐reached is one of the important challenges as it necessitates innovative strategies for ensuring universal access to TB diagnostic and treatment facilities. (2) Developing sputum collection & transport mechanism. (3) Diagnostic facilities for extra‐pulmonary TB cases are not been well established. (4) Reducing treatment default of patients put on treatment to prevent drug Resistant TB (5) Misuse of anti‐TB drugs. (6) Linking HIV‐infected TB patients to HIV care. (7) PPM though beneficial, remains a very small proportion relative to the large numbers of private sector providers. (8) Urban areas still experience intense levels of TB transmission. (9) Despite the progress, TB incidence and mortality are still high, and an estimated 280,000 people died of TB in 2009. Please see annexure for summary of the New / Innovative approaches of RNTCP in 12th Five Year Plan
NATIONAL LEPROSY ERADICATION PROGRAMME
Thrust Areas of XII Five Year Plan under NLEP: • • Achieve elimination of Leprosy at district level(prevalence of less than 1 case per 10,000 population) Strengthen Disability Prevention & Medical Rehabilitation of Leprosy Affected Persons
Background: • The National Leprosy Control Programme was launched by the Govt. of India in 1955. Multi Drug Therapy came into wide use from 1982 and the National Leprosy Eradication Programme was introduced in 1983. Since then, remarkable progress has been achieved in reducing the disease burden. India achieved the goal of elimination of leprosy as a public health problem, defined as less than 1 case per 10,000 population, at the National level in the month of December 2005 as set by the National Health Policy, 2002. The National Leprosy Eradication Programme is 100% centrally sponsored scheme. MDT is supplied free of cost by WHO. Following are the programme components – (i) (ii) (iii) (iv) (v) Epidemiological Situation: • 32 states/UTs have achieved leprosy elimination status. Only 3 States/UT viz. Bihar, Chhattisgarh and Dadra & Nagar Haveli are yet to achieve elimination. Further, out of 640 districts, 530 (82.81%) have also achieved elimination level (Annexure‐I). At the end of March 2011, there were 83041 leprosy cases on record (under treatment). In 2010‐11, total 1,26,800 new leprosy cases were detected and put under treatment as compared to 1,33,717 leprosy cases detected during corresponding period of previous year giving Annual New Case Detection Rate (ANCDR) of 10.4 per 1,00,000 population. Among the new cases detected in 2010‐11, the proportions were‐ MB cases (48.58%) female (36.20%), children (9.83%) and grade II disability (3.10%). Decentralized integrated leprosy services through General Health Care System. Training in leprosy to all General Health Services functionaries. Intensified Information, Education & Communication (IEC). Renewed emphasis on Prevention of Disability and Medical Rehabilitation & Monitoring and supervision.
• • •
Out of 1,45,082 leprosy cases discharged during the year, 1,32,105 cases (91.06%) were released as cured after completing treatment. 2570 reconstructive surgeries were conducted in 2010‐11 for correction of disability in leprosy affected persons (Annexure‐II). Out of 2,44,796 global leprosy cases reported in 2009, 1,33,717 cases were reported by India. Thus India contributed about 54.6% of new cases detected globally in 2009, and this trend is likely to continue for some more years. The declining trend of Prevalence and Annual New Case Detection Rate per 10,000 population since 1991‐1992 is shown in the Graph below:
35 30 25 20 15 10 5 0
25.9 6.2 20.0 6.4
4.9 4.6 5.1 5.6
8.9 8.9 5.5 5.9 4.4 3.3
8.4 5.9 5.8 5.5 5.3 5.3
1.4 1.2 1.2 1.1 1.1 199119921993199419951996199719981999200020012002200320042005200620072008200920102011
0.720.74 0.720.71 2.3 0.84 3.7 4.2 3.2 0.69 2.4 1.0 1.3
Activities under NLEP: • Diagnosis and treatment of leprosy‐ Services for diagnosis and treatment (Multi drug therapy) are provided by all primary health centres and govt. dispensaries throughout the country free of cost. Difficult to diagnose and complicated cases and cases requiring reconstructive surgery are referred to district hospital for further management. ASHAs under NRHM are being involved to bring out leprosy cases from villages for diagnosis at PHC and follow up cases for treatment completion. ASHAs are being paid incentive for this activity from the programme budget. Training‐ Training of general health staff like medical officer, health workers, health supervisors, laboratory technicians and ASHAs are conducted every year to develop adequate skill in diagnosis and management of leprosy cases. As per the information received from the States/UTs, health functionaries trained in 2009‐10. Urban leprosy control‐ To address the complex problems in urban areas, the Urban Leprosy control activities are being implemented in 422 urban areas having population
size of more than 1 lakh. These activities include MDT delivery services & follow up of patient for treatment completion, providing supportive medicines & dressing material and monitoring & supervision. • IEC‐ Intensive IEC activities are conducted for awareness generation and particularly reduction of stigma and discrimination against leprosy affected persons. These activities are carried through mass media, outdoor media, rural media and advocacy meetings. More focus is given on inter personnel communication. Intensive IEC Campaign with a theme ‘Towards Leprosy Free India’ is being carried out towards further reduction of leprosy burden in the community, early reporting of cases & their treatment completion, provision of quality leprosy services and reduction of stigma & discrimination against leprosy affected persons. Mass media campaign during the period October, 2010 and January‐February 2011, was carried out through the Prasar Bharti to spread awareness about leprosy in the General Public. NGO services under SET scheme‐ Presently, 39 NGOs are getting grants from Govt. of India under Survey, Education and Treatment (SET) scheme. The various activities undertaken by the NGOs are, IEC, Prevention of Impairments and Deformities, Case Detection and MDT Delivery. From financial year 2006 onwards, Grant‐in‐aid is being disbursed to NGO through State Health (Leprosy) Societies. Disability Prevention and Medical Rehabilitation –For prevention of disability among persons with insensitive hands and feet, they are given dressing material, supportive medicines and micro‐cellular rubber (MCR) footwear. The patients are also empowered with self care procedure for taking care of themselves. • More emphasis is being given on correction of disability in leprosy affected persons through reconstructive surgery (RCS). To strengthen RCS services, GOI has recognized 85 institutions for conducting RCS based on the recommendations of the state government. Out of these, 44 are Govt. institutions and 41 are NGO institutions (Annexure‐III). Supervision and Monitoring –Programme is being monitored at different level through analysis of monthly progress reports, through field visits by the supervisory officers and programme review meetings held at central, state and district level. For better epidemiological analysis of the disease situation, emphasis is given to assessment of New Case Detection and Treatment Completion Rate and proportion of grade II disability among new cases. Independent Programme Evaluation was carried out during the year 2010 through an independent agency.
Initiatives: • Disability Prevention and Medical Rehabilitation‐ An amount of Rs. 5000/‐ is provided as incentive to leprosy affected persons from BPL family for undergoing per major reconstructive surgery in identified govt./NGO institutions to compensate loss of wages during their stay in hospital. Support is also provided to Government institutions in the form of Rs. 5000/‐ per RCS conducted, for procurement of supply & material and other ancillary expenditure required for the surgery. Involvement of ASHA– A scheme to involve ASHAs was drawn up to bring out leprosy cases from their villages for diagnosis at PHC and follow up cases for treatment completion. To facilitate the involvement of ASHA, they are being paid an incentive as below‐ (i) On confirmed diagnosis of case brought by them – Rs. 100/‐ (ii) On completion of full course of treatment of the case within specified time‐ PB leprosy case – Rs. 200/‐ and MB Leprosy case – Rs. 400/‐ • • 62528 ASHAs have been trained in leprosy and involved in leprosy work (Annexure‐III). Incentive is also being paid to ASHAs for diagnosis & follow up of the cases. Discriminatory laws relating to leprosy– There are certain provisions under laws / acts which are discriminatory in nature against leprosy affected persons. The Ministry of Health & Family Welfare has taken up the matter with concerned Ministries/Departments/State Governments for their consideration and action on various such discriminatory acts/laws. These Acts and Laws are being modified or repealed, which will help the persons affected by leprosy live a dignified life.
• Special Activity in High Endemic Distt.‐ 209 Districts had reported ANCDR (Annual New Case Detection Rate) more than 10 per lakh population. Special activity for early detection and complete treatment, Capacity building and extensive IEC, Adequate availability of MDT, Strengthening of distt. nucleus, Regular monitoring & supervision and review, Regular follow up for neuritis and reaction, Self care practices, Supply of MCR footwear in adequate quantity and Improvement in RCS performance through camp approach are being planned in the above districts to reduce the disease burden. National Sample Survey (i) The 131st report of the Committee on Petitions of Rajya Sabha, 2008, recommended that “the final survey, involving Panchayati Raj Institutions (PRI) may be undertaken, so that the Government can have realistic figures of Leprosy Affected Persons (LAPs) to devise a national policy. In reply, the Ministry of Health & Family Welfare informed the Committee that a multi – centric study to assess the burden of active leprosy cases,
leprosy persons with grade ‐ I & II disability and the magnitude of stigma & discrimination prevalent in the society, will be carried out. (ii) The house to house survey was started in States/UTs as below, which was preceded by Training of the survey team members and IEC campaign in the concerned Block and Urban areas. (iii) Six States/UTs viz. Arunachal Pradesh, Gujarat, Rajasthan, Manipur, Sikkim and D&N Haveli started in May 2010 and have completed the survey. (iv) Twenty States/UTs viz. Andhra Pradesh, Assam, Chhattisgarh, Goa, Himachal Pradesh, Jharkhand, J&K, Karnataka, Madhya Pradesh, Kerala, Meghalaya, Mizoram, Nagaland, Orissa, Punjab, Tamil Nadu, Tripura, Uttarakhand, Chandigarh and Daman & Diu started in June 2010. Survey completed in these States except by Kashmir Division of J&K. Survey work has started new from April 2011. (v) Six States/UTs viz. Uttar Pradesh, West Bengal, Maharashtra, Haryana, A&N Islands and Puducherry started in July 2010. Survey completed by all the States. (vi) Delhi and Bihar have started survey in August 2010. Survey has been completed in both the States. All the Survey schedules have been sent to the identified ICMR Centres for compilation of data, from the concerned States. After analysis of the collected data from 34 States / UTs, the National JALMA Institute will finalise the report of the National Sample Survey by end of July 2011 and submit to the Government. Budget: The Budget allocation under NLEP for 2009‐10 was 44.50 crore and expenditure of 35.11 crores was incurred during the year. Budget allocation for 2010‐11 was 45.32 crores. 37.35 crores expenditure has been incurred. Budget allocation for 2011‐12 is Rs. 44.04 crores.
National Vector Borne Disease Control Programme
1. Malaria Objective of XII Five Year Plan: Preparation for Pre elimination Phase in states reporting API<1 Intensification of malaria control activities in remaining areas Proposed action for Malaria Control during XII Five Year Plan • Improved surveillance and case management: • • • • • • • Support for one male MPW at each sub centre as per norms through NRHM Strengthening of malaria microscopy at sector level PHC Continued support for performance‐based incentive to ASHAs for malaria case detection and treatment; expansion in all districts Involvement of private practitioners and laboratory personnels Strengthening of treatment for severe malaria cases at district and sub district hospitals Referral support service for severe malaria cases
Integrated Vector Management: • • • • • Strengthening of entomological surveillance Uniform support for spray wages by GoI Intensified supervision of IRS through M&E Accelerated antilarval measures in urban areas Scaling‐up of distribution of LLINs in endemic districts Supportive Intervention: Additional human resource & training Involvement of Medical Colleges & other Health Institutions Comprehensive support for Monitoring and Evaluation Support for Mobility Support for Behaviour Change Communication Effective and local /area specific need based IEC methods Social mobilization for vulnerable and marginalized community Effective environment management Strengthening of operational research
• • • • • • • • •
• Optimization of fund utilization: • • • • 2. Kala‐azar:: State Specific Issues Bihar: • Dedicated State Programme Manager. • Delay in Appointment of VBS Consultants and KTS under WB Project (still 9 posts of VBD Consultants and 43 KTS vacant). • Non‐Payment of salaries to VBD Consultants in many districts. • Capacity building in the districts by filling keys posts of DMOs, Malaria Inspectors, MPHWs, and Technicians etc. • To follow uniform Standard Treatment guidelines in the State. • Payment of loss of wages to the patients @ Rs 50 per day. • Non‐payment of Incentive to ASHA/Health worker @ Rs.200/‐ to refer a case and ensure complete treatment. • Poor quality of Indoor residual spray with DDT 50%. • Lack of monitoring and supervision. • Case search not done during 2009 & 2010. • 919 sanctioned post of MPHWs have not been filled up for kala‐azar and other VBDs. Jhakhand • Poor treatment Compliance. • No follow up mechanism. • IRS not well planed and organized. • Lack of monitoring and supervision. • Proper treatment guidelines • Case search activities not carried out during 2010 & 2011. West Bengal: • 60 posts of KTS and 5 posts of VBD Consultants have not been filled up. • IRS activities delayed and not done with proper planning. • Inadequate supervision and monitoring.
Linkage for informing programme regarding release of funds from Center to State NRHM Expeditious release of funds from State NRHM to district health societies Regular monitoring of monthly/ Quarterly SOEs Efficient and logistic supply chain management
• Case search programme not well planned. • Proper treatment guidelines to be followed. 3. Lymphatic Filariasis • • • • 4. Dengue and Chikungunya Discussions on implementation of Mid Term Plan: Committee of Secretaries (CoS) in a meeting held on 26.05.11 under the Chairmanship of Cabinet Secretary approved Mid Term Plan for prevention and control of Dengue and Chikungunya in the country. States need to focus on the issues as under for effective implementation of Mid Term Plan. • Functioning of diagnostic facilities To augment diagnostic facilities for Dengue and Chikungunya, states have identified 311 health facilities in 2011 (182 existing +129 new) across the country to function as diagnostic centre. Though the number of diagnostic centres has increased over the year their functioning had been a great concern for NVBDCP. Except Goa, Punjab, Tamil Nadu monthly reports are not received from other states. • Vector surveillance and Management In absence of any drug or vaccine against Dengue and Chikungunya infection, vector control is the main stay to prevent transmission. Effective mosquito control primarily based on source reduction is virtually nonexistent in most of the Dengue‐Chikungunya endemic states/towns. Due to vector bionomics, adult vector control is not feasible. Larval control needs constant and concurrent monitoring of the vector breeding. Emphasis has been placed on ultra‐low volume (ULV) insecticide space sprays for control of adult mosquito though it is relatively not very effective approach for controlling Aedes vector. An effective source reduction programme involving community volunteers for Urban and Rural areas needs to be implemented by each state. • Monitoring and evaluation Elimination of Lymphatic filariasis in country by the year 2015 Improve drug compliance by intensive IEC/BCC activity and social mobilization. Identifying LF endemic districts with microfilaria rate less than 1% for MDA stoppage. Augmenting morbidity management to increase programme visibility.
Most of states have no staff or resources to implement the strategies for Dengue/Chikungunya prevention and control during inter‐epidemic period. The same need to be put in place. Entomological component is totally absent in most of the States/Municipalities and in some states/towns very weak or poor. Out of 72 Entomological Zones, only 35 zones have Entomologists in place. Similarly, out of 35 state entomologists only 10 are in position. Wherever present they do not have the facilities like mobility support or other logistics to carry out entomological surveillance. Due to improper monitoring and evaluation programme implementation is adversely affected at State and district level for which early warning signals are not captured on time. All the states should ensure strengthening of entomological surveillance by filling up all the vacant post of State Entomologist, Zonal Entomologist, Insect Collector and mobility support. • Enactment of Legislation Dengue needs to be added in the list of diseases that require mandatory notification in each state. It is envisaged to develop civic byelaws by each state to prevent mosquitogenic conditions in households/premises, building byelaws for health impact assessment in all development projects and building construction activities having inbuilt provisions of mosquito breeding free premises covering all aspects of environmental sanitation in order to effectively prevent breeding of Dengue and Chikungunya vector. Though a few municipalities in the country, namely Mumbai Municipal Corporation, New Mumbai Municipal Corporation, Municipal Corporation Delhi, Chandigarh, Chennai, Goa have adopted legislation for the prevention of “nuisance mosquitoes”, they lack its implementation at the ground level. • Sustaining Social mobilization As most transmission occurs at home, therefore, ultimate success of the programme will depend on community participation and co‐operation. Considerable efforts should be placed on community education through advocacy and social mobilization. Emphasis should be given on inter personal communication, group discussion etc. • Inter‐sectoral coordination The strategy of Dengue and Chikungunya mainly focuses on inter sectoral convergence with other National Health Programmes, non‐health sector departments, civil society organizations. Following the instructions of CoS already Ministries of Urban Development, Rural Development and Panchyati Raj have issued instructions to their counterparts in the
states for implementation of guidelines to prevent mosquitogenic conditions and community sensitization. • Ministry of Urban Development vide letter No. A‐46020/130/2010‐Coord/PHE dated 5th January, 2011 issued the guidelines to Principal Secretaries in‐charge of UD/WS/Sanitation of all State Government. Ministry of Panchyati Raj vide its letter No. A‐44021/7/2011‐Estt. dated 23rd May, 2011 issued the guidelines to Chief Secretaries of all State. Ministry of Rural Development has also issued the guidelines (confirmed telephonically) copy to be received.
All the states should ensure implementation of these guidelines will focused monitoring and co‐ordination with State Health Authorities under the supervision of Principal Secretaries/Health Secretaries. 5. Japanese Encephalitis (JE) JE Vaccination has been integrated with Universal Immunisation Programme of GOI wherein the new cohorts are administered single dose of JE vaccine along with booster dose of DPT between 18‐24 months of age under Routine Immunisation. However implementation under Routine Immunisation is lacking in the states. States need to take up the issue on priority. Special attention is required in Eastern Uttar Pradesh. The facilities at district and sub‐district hospitals need strengthening for cases management of encephalitis cases. Medical rehabilitation of the disabled cases following acute encephalitis syndrome (AES) need to be taken up at medical colleges and district hospitals, wherever possible by making linkages with social welfare department.
Integrated Disease Surveillance Programme (IDSP)
Background Integrated Disease Surveillance Project (IDSP) was launched with World Bank assistance in November 2004 to detect and respond to early warning signals of disease outbreaks and to initiate an effective response in a timely manner. The project has been extended for two years up to March 2012 but the World Bank is funding Central Surveillance Unit (CSU) at NCDC & 9 identified states and the remaining 26 states/UTs are being funded from domestic budget. Objectives To strengthen disease surveillance in the country by establishing a decentralized state based surveillance system for epidemic prone diseases To detect the early warning signals and respond to outbreaks at the earliest, at all levels Project Components i. ii. Integration and decentralization of surveillance activities through establishment of surveillance units at district (DSU), state (SSU) and central level (CSU). Human Resource Development – Training of State Surveillance Officers (SSOs), District Surveillance Officers (DSOs), Rapid Response Teams (RRTs) and other medical and paramedical staff. Use of Information Communication Technology for collection, collation, compilation, analysis and dissemination of data. Strengthening of public health laboratories.
Achievements i. Surveillance units have been established at all State and District Headquarters (SSUs, DSUs). Central Surveillance Unit (CSU) is established and integrated in the National Centre for Disease Control (Formerly National Institute of Communicable Diseases), Delhi. Training of State/District Surveillance Teams (Training of Trainers) has been completed for 34 States/UTs and partially completed for Uttar Pradesh. IT network has been established to connect all States/District HQ and premier institutes in the country for data entry, training, video conferencing and outbreak discussion. So far, IT equipment has been established at 776 out of 800 sites. AMC of
IT equipment provided by NIC has been decentralized. Similarly, broadband connectivity has also been decentralized. A portal under IDSP has been established for data entry and analysis, to report outbreaks, and to download reports, training modules and other material related to disease surveillance (www.idsp.nic.in).
v. Presently, 85% districts in the country report weekly, surveillance data through e‐ mail and more than 67 % districts report through portal. The weekly data gives information on disease trends and seasonality of diseases. Whenever there is rising trend of illnesses in any area, it is investigated by the Rapid Response Team to diagnose and control the outbreak. Data analysis and actions are being undertaken by respective State/District Surveillance Units.
vi. On an average, 20 outbreaks are reported every week by the States to CSU. A total of 553 outbreaks were reported and responded to by states in 2008, 799 outbreaks in 2009 and 990 outbreaks in 2010. In 2011, 657 outbreaks have been reported in 2011 till 19 June. Earlier only a few outbreaks were reported in the country by the States/UTs. This is an important public health achievement. Majority of the reported outbreaks were of acute diarrhoeal diseases, food poisoning, measles, etc. vii. Media scanning and verification cell was established under IDSP in July 2008. It detects and shares media alerts with the concerned states/districts for verification and response. A total of 1441 media alerts were reported from July 2008 to May 2011. Majority of alerts in 2010 were related to diarrhoeal and vector borne diseases. viii. A 24X7 call centre was established in February 2008 to receive disease alerts across the country on a Toll Free telephone number (1075). The information received is provided to the States/Districts surveillance Units through e‐mail and telephone for investigation and response. The call centre was extensively used during 2009 H1N1 influenza pandemic and dengue outbreak in Delhi in 2010. About 2.33 lakh calls have been received from beginning till May 2011, out of which about 35000 calls were related to Influenza A H1N1.
ix. 50 identified district laboratories are being strengthened in the country for diagnosis of epidemic prone diseases. These labs are also being supported by a contractual microbiologist to manage the lab and an annual grant of Rs 2 lakh per annum per lab
for reagents and consumables. Till date 18 States i.e. 28 labs have completed the process of procurement. x. In 9 World Bank funded States, a referral laboratory network is being established by utilizing the existing 65 functional labs in the medical colleges and various other major centres in the States and linking them with adjoining districts for providing diagnostic services for epidemic prone diseases during outbreaks. The network is functional in 7 states (not in Andhra Pradesh, West Bengal). Based on the experience gained, the plan will be implemented in the remaining 26 States/UTs.
xi. 10 Labs have been strengthened and made functional under IDSP for Avian/H1N1 influenza surveillance; funds given to 2 more labs to make them functional (Total 12 labs).
xii. Recruitment of contractual manpower under IDSP has been totally decentralized in May 2010 so that the State Health Societies recruit them at the earliest. About 295 Epidemiologists, 51 Microbiologists and 22 Entomologists have joined in States/Districts till now. States have been requested to expedite filling up the remaining contractual positions.
Way Forward • Low Priority is given to public health/disease surveillance by many states. State Health Secretaries, MD (NRHM), DHS should monitor IDSP regularly and frequently to improve its implementation. Dedicated State/district surveillance officers are not in position in most states. Either a dedicated officer should be responsible for surveillance activities, or it should be the primary duty of designated officer. Key human resources (Epidemiologists, Entomologists, and Microbiologists) need to be recruited to improve the programme. Recruitment of all contractual positions under IDSP has been already decentralized. There is a need to involve Medical Colleges in all activities of IDSP. Each Medical College may be given responsibility of 2‐3 districts to improve disease surveillance and response activity. Currently weekly disease surveillance data are collected in most states from primary health care units and indoor wards of secondary and tertiary care facilities. OPD data are usually not collected from major hospitals. Collection of OPD data from all major hospitals and medical college hospitals is important to improve the programme.
All districts should report through portal for better data analysis. Some districts which have not filled‐up master data in the portal need to do it quickly. Although increasing number of outbreaks are being reported and responded to by the states, not all states are reporting about outbreaks every week. It should be done, even when there is “Nil” report. Clinical samples should be collected and sent to labs during all outbreaks to improve quality of outbreak investigation. 50 identified district public health labs are being strengthened under IDSP. Only 28 labs have completed procurement and only 14 labs are functional. All states should complete the procurement of equipment and recruitment of microbiologist to make these labs functional. Some states are also strengthening district public health labs under NRHM. Once these labs also become functional, they should start reporting data under IDSP. Referral lab network has become functional in 7/9 World Bank funded states. Andhra Pradesh and West Bengal should also complete all activities to make referral lab network functional.
Section Two Non Communicable Diseases
National Programme on Prevention & Control of Cancer, Diabetes, CVD & Stroke (NPCDCS)
Burden of Non‐Communicable Diseases (NCDs) in India India is experiencing a rapid health transition with a rising burden of Non Communicable Diseases (NCDs). Overall, NCDs are emerging as the leading causes of death in India accounting for over 42% of all deaths (Registrar General of India). NCDs cause significant morbidity and mortality both in urban and rural population, with considerable loss in potentially productive years (aged 35–64 years) of life. It is estimated that the overall prevalence of diabetes, hypertension, Ischemic Heart Diseases (IHD) and Stroke is 62.47, 159.46, 37.00 and 1.54 respectively per 1000 population of India. There are an estimated 25 Lakh cancer cases in India. Current Status of Programme Considering the rising burden of NCDs and common risk factors to major Chronic Non – Communicable Diseases, Government of India initiated an integrated National Programme for Prevention and Control of Cancers, Diabetes, Cardiovascular Diseases and Stroke (NPCDCS). The focus of the programme is on health promotion and prevention, strengthening of infrastructure including human resources, early diagnosis and management and integration with the primary health care system through NCD cells at different levels for optimal operational synergies. The programme is being implemented in 100 districts spread over 21 States during 2010‐11 & 2011‐12. These districts have been selected keeping into account their backwardness, inaccessibility & poor health indicators. Services offered under NPCDCS: (a) Cardiovascular Diseases (CVD), Diabetes & Stroke: • A Cardiac care unit at each of the 100 district hospitals. • NCD clinic at 100 district hospitals and 700 Community Health Centres (CHCs) for diagnosis and management of Cardiovascular Diseases (CVD), Diabetes & Stroke. • Provision for availability of life saving drugs, to each district hospital in 100 districts. • Opportunistic Screening for diabetes and high blood pressure to all persons above 30 years including pregnant women of all age groups at 20,000 Sub Centres. • Home based care for bed ridden cases in 100 districts.
• Support for contractual manpower and equipments at the 100 district hospitals & 700 CHCs for management of NCDs including health promotion activities. (b) Cancer: • Common diagnostic services, basic surgery, chemotherapy and palliative care for cancer cases at 100 district hospitals. • Support for Chemotherapy drugs at each district hospital • Day care Chemotherapy facilities at 100 district hospitals. • Facility for laboratory investigations including Mammography at 100 district hospitals • Home based palliative care for chronic, debilitating and progressive cancer patients at 100 districts. • Support for contractual manpower and equipment for management of cancer cases at the 100 district hospitals. • Strengthening of 65 centre Tertiary Cancer Centres (TCCs) Achievements • Operational Guidelines developed • Training Modules developed for Health Workers and Medical Officers. • Human Resource under National NCD Cell in place • Human Resource under State and District level in process • Signed MOU Received from 11 States • Setting up of State and District NCD cells in process • Funds for implementation of NPCDCS in 27 districts across 19 states were released in March 2011 for opportunistic screening, establishment of ‘NCD clinic’ at CHCs and District Hospitals. • Efforts are being taken to increase awareness for promotion of healthy lifestyle through Mass media. • Funds for conducting training workshops were released to NIHFW and Indian Nursing Counsel. • Pilot Project on School based Diabetes Screening Programme initiated in 6 districts • Proposal for surveillance of NCD risk factors is under submission
Financial status 2010‐11 (GoI: State Govt. Share: 80: 20) Rs. in Crore Component 1. Diabetes, CVD & Stroke North Eastern Areas 2. Cancer North Eastern Areas Expectation from State Governments: Signing of MOU for programme Recruitment of staff under the programme Implementation of various components of NPCDCS Screening of persons, 30 years and above of age and pregnant women of all ages for diabetes and high blood pressure. • Identification of sites for Tertiary Cancer Centre (TCCs) • Signing of MOU for TCCs • Utilization of funds released during the year 2010‐11 and submission of SOE. • Timely submission of reports Action points for GOI: • Release of 1st instalment to 70 districts of 21 states • Organization of review meetings of State level officers Annexure included in last section. • • • • B.E 90.00 F.E 35.30 Expenditure 35.29 Balance Nil
10.00 180.00 25.00
2.73 55.00 5.00
2.73 34.10 0.77
Nil 145.89 24.22
National Programme for Control of Blindness
Expectations from the States/UTs in the 12th Plan 1. To fully implement and enhance all earlier activities like cataract operation, school eye screening and eye donation to achieve the allocated targets during the 12th Five Year Plan 2. To collect data on prevalence of diseases like a. Diabetic Retinopathy b. Glaucoma Management c. Retinopathy of Pre‐maturity d. Squint and Amblyopia e. Laser Techniques f. Corneal Transplantation g. Vitreoretinal Surgery h. Other causes of Childhood blindness etc. 3. To review the current status and to undertake capacity building for management of above mentioned diseases as per parameters listed below:‐ Capacity building in each district to detect and treat Diabetic Retinopathy Type of Hospital Capacity building in each district to detect and treat Glaucoma Type of Hospital Capacity building in each district to detect and treat Retinopathy of Prematurity Type of Hospital Medical Retina Specialist Indirect Ophthalmoscopy /Red‐Cam viewing Laser unit to treat ROP Shiotz tonometry / Applanation tono. fundus examination Laser treatment field charting /surgical treatment Medical Retina Specialist Fundus Flouroscein Angiography Laser Unit
Capacity building in each district to detect and treat Squint and Amblyopia Surgical Facility to Squint Specialist to Refraction unit treat Squint measure type and + degree of squint Specs dispensing Capacity building will be at the Institutions/Hospitals mentioned below:‐ 1. Regional Institutes of Ophthalmology Type of Hospital
Medical College District Hospital Sub district Hospital NGO I NGO II NGO III Private Eye Hospital Any Other Clinic Utilization of NGOs with mobile services for above diseases at district hospitals wherever not available. 5. Implementation and monitoring of the programme as per format given below NPCB Activities review at District Level: Surgical Performance Data S/N HOSPITALS Year Cat‐ops KP Specs D.R. GS VR Paed S. Laser SES 1 RIO 2 Medical College 3 4 5 6 7 8 9 10 11 12 Cat‐ops KP Specs SES Paed. S.
2. 3. 4. 5. 6. 7. 8. 9. 4.
District Hospital Sub District Hospital NGO Hospital‐1 NGO Hospital‐2 NGO Hospital‐3 Private Eye Hospital ‐1 Private Eye Hospital ‐2 Private Eye Hospital ‐3 Private Practitioners Religious Social Organization Hospital
Cataract Operation Keratoplasty Spectacles provided under School Eye Screening Paediatric Surgery
D.R. GS VR
Diabetic Retinopathy Glaucoma Surgery Vitero Retinal Surgery
National Programme for Prevention and Control of deafness
Hearing loss is the most common sensory deficit in humans today. As per WHO estimates in India, there are approximately 63 million people, who are suffering from Significant Auditory Impairment; this places the estimated prevalence at 6.3% in Indian population. As per NSSO survey, currently there are 291 persons per one lakh population who are suffering from severe to profound hearing loss (NSSO, 2001). Of these, a large percentage is children between the ages of 0 to 14 years. With such a large number of hearing impaired young Indians, it amounts to a severe loss of productivity, both physical and economic. An even larger percentage of our population suffers from milder degrees of hearing loss and unilateral (one sided) hearing loss. 1. OBJECTIVES OF THE PROGRAMME 1. To prevent the avoidable hearing loss on account of disease or injury. 2. Early identification, diagnosis and treatment of ear problems responsible for hearing loss and deafness. 3. To medically rehabilitate persons of all age groups, suffering with deafness. 4. To strengthen the existing inter‐sectoral linkages for continuity of the rehabilitation programme, for persons with deafness. 5. To develop institutional capacity for ear care services by providing support for equipment and material and training personnel. 2 Components of the Programme: A. Manpower Training & Development B. Capacity Building C. Service Provision Including Rehabilitation D. Awareness Generation Through IEC Activities E. Monitoring And Evaluation 3 Activity wise progress of NPPCD I. Training. a. Pilot phase commenced 50% trainings of the pre‐set targets (ie‐ in the 25 districts) which was undertook by RCI. In the expansion phase the responsibility of training was transferred to the states, for which funds were provided to the state health societies.
b. The states of Uttarakhand, Karnataka and Gujarat initiated the training up to level 4 (i.e. Medical Officers). Beyond level 4 only the state of Assam, Uttarakhand and Andhra Pradesh organized some training in the districts. II. Screening camps a. States namely Tamil Nadu, Karnataka, Chandigarh, Sikkim, Uttarakhand and Andhra Pradesh have conducted screening camps under the Programme. Screening camps have not been organised by other states. III. Procurement of Equipment a. States namely Sikkim, Uttarakhand, Karnataka, Tamilnadu, Assam have procured the equipments specified within the Programme but other states have not procurement due to problems in procedural formalities at state level. IV. Recruitment on manpower a. Under the Programme Audiometric Assistant (AA) and Instructor for Speech & Hearing Impaired (IHS) are to be recruited on contractual basis in the implementing districts. However only 40 AAs and 4 IHS have been recruited so far. Recruitment is low due to non availability of local candidates and less honorarium. V. Hearing Aids a. Under the programme 2459 hearing aids were distributed in the 22 pilot districts of the programme. The state of Uttar Pradesh and Manipur could not distribute the Hearing aids under the programme. VI. Awareness campaign a. IEC material in form of posters / pamphlets has been distributed to the states for further dissemination. Mass Media campaigns have been carried out in different regional languages. b. National Institute of Health & Family Welfare, New Delhi (NIHFW) conducted the “Impact assessment of the IEC campaign done for NPPCD” in 4 states (Tamilnadu, Gujarat, Assam and Uttarakhand) where in it was observed that awareness generation was not satisfactory due to low impact of TV and radio media. Significant factors in this are the short duration of awareness campaign and low frequency of telecasting of the spots on the TV and Radio.
4. NPPCD Outlay & Expenditure during 11th FYP Financial Year 2007‐08 2008‐09 2009‐10 2010‐11 2011‐12 Total Budget Estimate 542.00 1000.00 1000.00 1150.00 2000.00 5692.00 Revised Estimate 568.00 1000.00 1213.00 1151.00 ‐ 3932.00 Rs. in lakhs Actual Expenditure 524.50 1000.00 773.00 1044.94 ‐ 3343.36
Allocation of Rs. 20.00 crores have been made for 2011‐12. Rs 0.80 lakh of expenditure has been incurred till date. Funds would be released shortly based on the proposals submitted by the states/ UTs. (Details enclosed) 5. Expectations from state in 12th Five Year plan with respect to National Programme for Prevention and Control of Deafness (NPPCD) • Ensuring availability of ENT surgeon at each district hospital who would also be district nodal officer for NPPCD. • Putting contractual manpower viz. Audiometric Assistant and Instructor for Hearing Impaired in place at district level. • Strengthening monitoring & supervision of programme at state & district level. • Developing linkages with medical colleges for strengthening referral services. • Greater awareness generation regarding prevention and management of hearing impairment. • Greater involvement of AWW, ASHA and MPWs in the implementation of the programme at community level. • Involvement of state training mechanisms in organizing the trainings under the programme. • Organizing screening camps regularly through active involvement of local NGOs.
National Tobacco Control Programme
Expenditure under NTCP Financial Year Budget Estimate 2007‐08 Rs. 40.00 Cr. 2008‐09 2009‐10 2010‐11 Rs. 30.00 Cr. Rs. 30.00 Cr. Rs. 45.00 Cr. Revised Estimate Rs. 29.00 Cr. Rs. 39.00 Cr. Rs. 17.00 Cr. Rs, 30.00 Cr Expenditure Rs. 13.98 Cr. Rs. 33.86 Cr. Rs. 16.67 Cr. Rs. 29.32 Cr. Rs. 93.83 cr.
Total Rs. 145.00 Cr. Rs. 115.00 An amount of Rs. 50 Cr. has been earmarked for the year 2011‐12. Achievements of the programme • Pilot phase of the NTCP launched in 20070‐8 in 9 states covering 18 districts. The programme up‐scaled to cover 12 new states and 24 new districts. Currently NTCP is under implementation in 42 districts covering 21 states. • The total financial outlay for NTCP approved in the XI Plan was Rs. 182 crore. • Training modules developed for doctors, teachers and health workers/ ASHA on tobacco control. • Guidelines for Tobacco Free Educational Institutions developed and adopted by the Central Board of Secondary Education (CBSE). The CBSE has circulated these guidelines to all CBSE affiliated schools to implement the same. • GATS India 2010 was carried out in India for monitoring adult tobacco use (smoking & smokeless) and tracking key tobacco control indicators. • Toll free helpline to report violations 1800110456 established. • National guidelines on tobacco dependence treatment developed.
Various anti‐tobacco IEC materials has been developed and disseminated widely through radio, TV for increasing public awareness on the risks of tobacco. A sustained media campaign has been initiated after dedicated funds were allocated under NTCP. Pilot project on alternative cropping system to tobacco growing initiated with support of Central Tobacco Research Institute (CTRI) in five agro‐ecological zones of the country. Interministerial Task Force set up at national level with representation from Stakeholders Ministries and representatives from larger States, Civil Society Organizations. Two meetings have been organised till date. Steering Committee formed under the Chairmanship of Secretary (Health) to look into specific instances of violation of Section ‐5 at national level. Similar Monitoring Committees formed at State/District level. [Prohibition of direct and indirect advertisement of cigarette and other tobacco products (section 5)] A network of 18Tobacco Cessation Centers has been set up across the country. The role of TCC has now been expanded and now they have become Resource Centre Tobacco Control (RCTC) and prove technical support for creation of TCC at sub‐national level. These centres are also using community based approaches to enhance awareness about the ill effects of tobacco use and provide tobacco cessation facilities. Process initiated for setting up tobacco product testing labs for testing of contents and emissions. New stronger pictorial health warnings have been notified for implementation from 1st December, 2011. India is the key facilitator for development of guidelines under the Articles 17‐18 of the WHO‐FCTC.
Achievements with WHO‐BI Partnership • Manpower resources provided to assist focal points at national level (National Tobacco Control Cell) and at state level through the state level consultant at 12 State Tobacco Control Cells: (Delhi, Tamil Nadu, Assam, Gujarat, Madhya Pradesh West Bengal, Orissa, Bihar, Maharashtra, Tripura, Andhra Pradesh, Uttar Pradesh), Support for additional states ‐ Rajasthan and Karnataka . • National and Regional level advocacy workshops organized at Delhi, Chandigarh, Bhopal, Tamil Nadu, West Bengal, and Goa on tobacco control laws and related issues. These workshops sensitized over 2000 law enforcers / stakeholders from different departments (Agriculture, Customs, Labor, Education, Forest, Tribal, Health, Transport,
Railways, Police, Judiciary etc.) on the need and their role in implementation of tobacco control laws and other measures. In 2011, state level advocacy workshops have been organized in the states of Jammu and Kashmir, Punjab, Rajasthan and Tripura More state level advocacy workshops planned in 2011 in Maharashtra, Orissa, Andhra Pradesh, Uttar Pradesh, Jharkhand and Haryana. 11 State level Advocacy Workshops at Kerala, Assam, Karnataka, Meghalaya, Sikkim, Arunachal Pradesh, Nagaland, Bihar, Uttar Pradesh and Himachal Pradesh organized to sensitize key state level stakeholders on tobacco control laws and related issues. National consultation on smokeless tobacco organized in April, 2011 to discuss prevention strategies and build coalition to combat the usage of chewing tobacco and its impact on health
Expectation from the State Government Recruitment of Staff: States like Madhya Pradesh, Delhi, and West Bengal where the NTCP was launched in 2007‐08 are yet to recruit staff at the district cells. Implementation of the various components of NTCP Utilisation of the budget: The components of the programme at district level including cessation services have not been implemented in most of the states. The utilisation of the budget has been unsatisfactory in states where even the staff has been recruited. COTPA mechanism: In order to implement the various provisions under COTPA a state level enforcement mechanism needs to be put in place, which includes opening separate head of account, printing of challan books and constituting a raiding mechanism etc. Since COTPA implementation lie in the responsibility of health ministry it should print the challan etc. All the states need to notify state /dist level monitoring committee for section ‐5 Training and awareness: since tobacco is a risk factor for many NCD’s, the spots developed by MoHFW should become an integral component of the IEC campaign under NRHM. Timely submission of activity reports and UC’s is a matter of great concern due to which the funds have not been released is a sustained manner.
National Mental Health Programme
At the time of independence, the existing mental health infrastructure and specialist manpower was very meagre. There were only 10,000 psychiatric beds in India in 1947 for a population of over 300 million, with that of UK, with one tenth the population of India having over 1,50,000 psychiatric beds. The first two decades of Independent India were devoted to doubling the mental hospital beds followed by setting up of general hospital psychiatric beds. In the 1980’s the Government of India felt the necessity of evolving a plan of action at mental health. Subsequently, National Mental Health Programme was launched in the country in 1982 with the following objectives: 1. To ensure the availability and accessibility of minimum mental healthcare for all in the foreseeable future, particularly to the most vulnerable and underprivileged sections of the population; 2. To encourage the application of mental health knowledge in general healthcare and in social development; and 3. To promote community participation in the mental health service development and to stimulate efforts towards self‐help in the community. In 11th FYP NMHP has four approved schemes mentioned below to provide mental health treatment available at district level, strengthening the infrastructure of psychiatry at state level and production of mental health professionals. 1. Manpower Development Schemes In order to improve the training infrastructure in mental health, Government of India has approved the Manpower Development Components of NMHP for 11th Five Year Plan. It has two schemes given below. 1.1 Centres of Excellence Under Manpower Development Component at least 11 Centres of Excellence in mental health were to be established in the 11th plan period by upgrading existing mental health institutions/medical colleges. A grant of upto 30 crore is available under the scheme. The support includes capital work (academic block, library, hostel, lab, supportive departments, lecture theatres etc.), equipments and furnishing, support for faculty induction and retention for the plan period. Achievement and Expenditure: 10 Centres of Excellence have been established and one is in process. A total of Rs. 87,64,00,000/‐ has been released under the scheme. A sum of Rs.
14,07,79,608/‐ has been spent till 8th April, 2011. The status & expenditure report is enclosed at annexure – 1. 1.2 Setting Up/ Strengthening PG Training Departments of Mental Health Specialities To provide an impetus for development of Manpower in Mental Health other training centers (Government Medical Colleges/ Government General Hospitals/ State run Mental Health Institutes) would also be supported for starting PG courses in Mental Health or increasing the intake capacity for PG training in Mental Health. Support would be provided for setting up/strengthening 30 units of Psychiatry, 30 departments of Clinical Psychology, 30 departments of Psychiatry Social Work and 30 departments of Psychiatric Nursing with the support of upto Rs. 51 lacs to Rs. 1 crore per PG department. Achievement and Expenditure: A total of 23 departments (7 Psychiatry, 5 Clinical Psychology, 5 Psychiatric Social Work, 6 Psychiatric Nursing) of different specialties of mental health have been supported and a total of Rs. 8,46,96,000/‐ has been released to under the scheme. Rs. 1,44,85,065/‐ has been spent (till 8th April 2011). The status & expenditure report is enclosed at annexure – 2. 10 more departments (4 Clinical Psychology, 2 Psychiatric Social Work and 4 Psychiatric Nursing) have been recommended by the Standing Committee on NMHP. 2. District Mental Health Programme (DMHP) The DMHP forms the mental health intervention at district level. Starting with the DMHP of Bellary in 1990’s currently 123 districts are covered under this program. The central objective of the programme is early detection and treatment of mentally ill persons within the community by providing basic sustainable mental health services to the community and to reduce the stigma attached towards the mental illness. Achievement and Expenditure: DMHP is being run in 123 districts of the country. Out of 123, status of 116 is available. 73 districts of DMHP are having the services of a Psychiatrist/trained medical officer. OPD services are being provided at 70 districts of DMHP at district level at out of these 70 districts 24 districts are conducting OPDs at Primary Health Care level. In Patient Department services are available at 53 districts with 10 beds capacity. Though there is no budget provision of Mental Health Helpline and Mental Health Services in Schools/Colleges under DMHP, still 10 (8.62%) districts have the need based mental health helpline services and 43 out of 116 districts are running need/situation based mental health services in school/colleges. Reportedly 66 districts have trained medical officers, 61 have trained para‐medical staff and 48 districts to the members of Panchayati Raj Institutions, NGOS, school teachers and family members etc. out of 116 districts 67 DMHP districts are conducting IEC activities to generate awareness and reduce stigma related to mental illness.
A total of Rs. 53, 44,80,136/‐ has been released to the DMHP till date. The reported expenditure of DMHPs is Rs. 15, 61,45,769/‐ 3. Modernization Of State Run Mental Hospitals To modernize the existing state‐run mental hospitals, a one‐time grant with a ceiling of Rs.3.00 crores per hospital on the basis of benchmark of requirement and level of preparedness is available. The grant would cover activities such as construction/repair of existing buildings, purchase of equipment, provision of infrastructure such as water‐ tanks and toilet facilities, purchase of cots and equipments. A total of Rs. 68, 38,69,000/‐ has been released to modernize 29 state run mental hospitals across the country. 4. Upgradation of Psychiatric Wings of Medical Colleges/General Hospitals A one‐time grant of Rs.50 lakhs for upgradation of Psychiatry Departments of Government Medical Colleges which have not been funded earlier were to be supported. The grant covers; 1. Construction of new ward, 2. Repair of existing ward, 3. Procurement of items like cots and tables and 4. Equipment for psychiatric use such as modified ECTs. A total of Rs. 34,77,40,595/‐ has been released to 88 Psychiatric wings of medical colleges across the country. Latest expenditure of 2011‐12 is attached for information at annexure – 3. Expectations from state government during the 12th FYP are as given below. 1 To facilitate in the resource mapping of mental health services in the state. 2 To facilitate the process of state commitment to be given under NMHP for various scheme. 3 Timely submission of Utilization Certificates and Statement of Expenditure. 4 Facilitate the process of posts creation as required by the institutes under manpower development schemes. 5 Designate a official as the state nodal officer exclusively for the NMHP>
Please see annexure in the last section
Section Four Drugs & Regulatory Issues
Drugs and Regulatory Issues
1. The last two decades have witnessed an exponential growth in the pharmaceutical industry in the country. The total value of production of drugs and pharmaceuticals in the country is estimated to be over rupees one lakh crores. The industry has consistently been recording a growth rate of 14‐15%. India is the third largest producer of pharmaceuticals in the world in terms of volume and 12th largest in terms of value. Indian pharmaceutical products are exported to almost all the countries of the world. The total exports from India for the year 2009‐10 were rupees forty two thousand crores (approx). Indian pharmaceutical products, world‐wide are known to be affordable, safe and efficacious. Indian generic drugs have helped in bringing down the cost of treatment of various diseases world‐wide which includes HIV/AIDS. 2. With the growth of the industry it is important that regulatory machinery should ensure that the drugs available in the country are not only of good quality but also safe and efficacious. Regulation of the pharma sector necessitates technical capabilities and is also depends upon the equipments used for testing. 3. The Central Government has taken several steps to strengthen the Central Drugs Standards Controls Organisation (CDSCO) in terms of man power and equipments. The CDSCO has been strengthened by induction of additional man power from the level of Assistant Drug Controller to Drug Inspectors. Additional man power has also been provided for handling technical and administrative issues. Several steps have been taken to strengthen the Central Drug Testing Laboratories (CDTLs) by induction of man power, capacity building of existing man power and sophisticated equipments for testing of drug samples. New zones and sub‐zones have been created for better administration. 4. Dr. R.A. Mashelkar Committee set up in the year 2003, recommended amendments in the Drugs & Cosmetics Act to address the problem of spurious and sub‐standard drugs and also recommended creation of new structure for better drug regulation in the country. The Committee recommended that there is a need for one Drug Inspector for every 50 manufacturing units and one for every 200 sale units. Going by the rough estimates of such units, there would be requirement of 3200 Drug Inspectors in the country whereas the available number is only 900. There is thus, a strong need to recruit more Drug Inspectors in the country. 5. At present, there are six Drug Testing Laboratories in the country. It is proposed to add another 8 testing labs in the coming 12th Five Year Plan. It is also proposed to create 12 mini‐labs at the Port Offices (Air and Sea ports). 6. For effective regulation of the drugs and pharmaceutical products, it is important to have adequate testing capabilities. For the last few years, the number samples tested
across the country, varies between 38000‐40000 samples. There is need to increase the number of samples tested substantially. States would therefore be required not only to recruit man power but also to set up new drug testing labs and to upgrade the existing ones. It is also important that once the drug samples fail quality and safety standards, prosecutions are launched and culprits are booked quickly. There is need to set up Special Courts to try prosecution cases under the Drugs & Cosmetics Act 1940. Around 220 States have already designated Special Courts for such trails while then others are in the process of notifying such Courts. 7. MOHFW has also taken several steps to increase the access and affordability of drugs in the country. As per WHO estimates, India has the highest out‐of‐pocket expenditure. Large part of out‐of‐pocket expenditure is on the purchase of drugs. The rise in the incidences of out‐of‐pocket expenditure on drugs is one of the key challenges to provide universal health coverage and makes large section of the poor, most vulnerable to high cost of drugs. Several steps need to be taken to address this issue. The Department Of Pharmaceutical under the Ministry of Chemicals & Fertilisers, has initiated Jan Aushidhi Stores (JAS) Scheme for selling generic drugs to the common man. At present there are 102 JAS across the country. There is an urgent need to scale‐up JAS and have at least one such store in each district preferably located in the District hospital. It is also important that doctors in the public health system prescribe generic medicines which are as safe and effective as its branded counter‐part and also substantially cheaper. 8. There is also great merit in making bulk purchase of drugs through a specialised agency. This is not only ensures better quality but also reduces the prices. States may like to examine the Tamil Nadu Medical Services Corporation model set up by the Govt. of Tamil Nadu for the purchase of drugs for public health programmes. 9. While promoting the generic drugs, it is important that a rational Fixed Dose Combination (FDC) are weeded out from the market. This not only enhances the price of the drug but also leads to several other health consequences including drug resistance. While granting licenses for manufacture of FDCs, State Drug Regulators must be very careful regarding efficacy of such drugs. 10. The states were requested to prepare action plans for opening of Jan Aushidhi Stores and promotion of generic drugs to the Ministry. This was to be sent by May 2011. Till date, no state has submitted its action plan. States may expeditiously prepare their plans and submit the same to the Ministry
Section Five Thrust Areas for th 12 Five Year Plan
Thrust Areas for 12th Five Year Plan
The National Rural Health Mission (NRHM) was launched by the Prime Minister on 12th April 2005 with special focus on 18 states, which have weak public health indicators and/or weak infrastructure. The NRHM seeks to provide effective, accessible and affordable healthcare to rural population. The High Focus 18 States are Arunachal Pradesh, Assam, Bihar, Chhattisgarh,Himachal Pradesh, Jharkhand, Jammu & Kashmir, Manipur, Mizoram, Meghalaya, Madhya Pradesh, Nagaland, Orissa, Rajasthan, Sikkim,Tripura, Uttaranchal and Uttar Pradesh. The Mission is an articulation of the commitment of the Government to raise public spending on Health from 0.9% of GDP to 2‐3% of GDP. Goals of NRHM: • • • • • • • Reduction in Infant Mortality Rate (IMR) to below 100/100,000 live births and Maternal Mortality Ratio (MMR) to below 30/1000 live births. Universal access to public health services such as Women’s health, child health, water, sanitation & hygiene, immunization, and Nutrition. Prevention and control of communicable and non‐communicable diseases, including locally endemic diseases Access to integrated comprehensive primary healthcare Population stabilization, gender and demographic balance by bring down TFR to 2.1 by 2012 Revitalize local health traditions and mainstream AYUSH Promotion of healthy life styles
Achievements so far: • IMR reduced from 58 in 2006 to 50 in 2009 • TFR reduced from 2.9 to 2.6 • 1.48 Lakhs human resources including 7432 doctors, 7063 specialists, 11575 AYUSH doctors, 60268 ANMs, 33667 staff nurses, 21740 paramedical staff and 4616 AYUSH paramedics have been added to strengthen the health care delivery system. • 8.49 lakh ASHAs and link workers have been selected out of which 8.06 lakh has been engaged & 6.90 lakh have been provided with drug kit . • 17388 new constructions and 22139 renovation projects for various health facilities were sanctioned. • 9107 PHCs have been functional on 24x7 basis & 2891 health facilities were made operational as first referral unit (FRU). • 33149 Rogi Kalyan Samiti constituted • 4.83 lakh VHSCs Constituted
12th Five Year Plan – an opportunity to consolidate Gains Although a lot of progress has been made under NRHM in the last six years, the goals set are yet to be achieved. The 12th Five Year Plan provides opportunity to work further for achievement of NRHM and MDG goals and improve the service quality further. Working group on NRHM for 12th FYP has been Constituted under the chairmanship of Secretary HFW. First meeting of working group was held on 10th June 2011 wherein the progress of NRHM and strategies for next FYP were discussed in detail. Representatives of some states are part of the working group while some other States have also given suggestions on the TOR for working group and thrust areas for 12th Plan. The draft Report of working group to be submitted by 31st July 2011 and final report by 31st August, 2011. Challenges for the 12th Plan Period: • Achieving the goals of IMR MMR TFR • Increasing health expenditure as % of GDP • Shortage of human resources • Rational deployment of available HR • Infrastructure gaps • Quality of care • Assured referrals • Community ownership and accountability • Intersectoral convergence • NGO and private partnership • Out of pocket expense • Monitoring and evaluation systems Proposed Thrust Areas for 12th Plan Under: A. Health Systems: 1. Human Resource • Clearly defined Human Resources Policy. • Facilitating availability of HR as per norms in heath facilities especially in difficult and hard to reach areas. • Addressing the issues of short fall and skill up gradation of Human Resources • In place of 2 ANMs in all sub centers, only 10 % SCs (conducting deliveries) to be provided 2nd ANM on contractual basis. • One male multipurpose worker in each sub centre
2. Health Infrastructure • Creation of new infrastructure to ensure 100% public health facilities in government buildings. • Renovation of existing buildings. • Priority to health facilities in High Focus Districts • Revitalization and repositioning of sub‐centres 3. Addition of Public Health Facilities: • Increasing the number of sub centres and PHCs as per 2011 population census 4. Others: • Up scaling of the community monitoring initiative piloted in 9 States to the entire country to ensure greater community participation and social accountability. • One Mobile Medical Unit per district is proposed to be provided especially in under‐ served rural areas Strategies to meet the Human Resource gap & Infrastructure requirement in the country: • A male multipurpose worker will be provided in each sub‐centre to handle communicable and non communicable diseases • The salaries of ANM/ LHV will continue to be borne by the GoI through the Treasury Route. Salary of MPWs will also flow through the same route. • IPHS 2010 are taken as the standards to determine HR requirement at all levels • Gaps in infrastructure are analyzed taking into consideration the population according to Census 2011 • Population Norms remain unchanged • For SCs the increase is higher in view of the expansion of staff at SC level (including BRHC). • Facility Assessment and Supportive Supervision B. Reproductive and Child Health: 1. Expanding Service Guarantees in Public Health Facilities • Continuum of free care during ante‐natal, intranatal and post‐natal period including management of complications, for every pregnant woman and free delivery including C‐section. • Ensuring for every pregnant woman free supplementation, drugs including consumables, free diagnostics, free diet during hospital stay, free blood and free referral transport( to and fro) with no out of pocket expenses.
2. Making Maternal and Child health care more comprehensive • National Framework for the prevention & control of moderate and severe anaemia among children, adolescents, pregnant and lactating mothers • Focus on prevention & control of diseases in children , e.g., Thalessemia, Haemophilia, Rheumatic heart disease & congenital Heart diseases and syphlis • Scaling up of HIV Testing & Counselling during Ante‐Natal Care in the country ‐ up to 24X7 PHC level in convergence with NACP‐4 • Prevention & control of Malaria in Pregnant Women in identified endemic areas • Strengthening and scaling up of school health program • Developing a robust mechanism of facility based counseling for children, adolescents and women 3. Thrust on new born care • Provision of services for sick newborn through establishment of SNCUs in every district of the country • Establishing newborn care corners at every delivery point • Improving home based postnatal and newborn through ASHA incentives • Development of Joint field operational plans in convergence with ICDS for result oriented management of malnutrition including establishment of NRCs for management of Severe acute malnutrition • Strengthening of RCH program monitoring units both at state and district level 4. Other thrust areas • Strengthening the quality of trainings of ANMs/Nurses/Medical Officers with special focus on enhancement of skills to provide quality maternal, newborn and child care • Dedicated 100 bedded Maternal and Child Wing in each District hospital to provide quality antenatal, intranatal, postnatal and child care to cope with increasing case loads of pregnant women, newborns and children, and with a focus on post partum family planning services • Birth Waiting Homes in close proximity to road heads accessible to referral transport, in remote and tribal areas with poor road connectivity • Up scaling the implementation and monitoring of Maternal Death Review and roll out of Infant Death Review • Scaling up of safe abortion services at health facilities in public and private sector. • Strengthening national framework on adolescent health, currently a weak pillar of RCH • Addressing the challenge of skewed sex ratio • Expansion & Strengthening of cold chain system through identification of more cold chain points near the community
Modernising existing Alternate vaccine delivery mechanism through branded mobile immunization services for outreach work Expanding/Maximizing the use of available vaccines for various preventable diseases through evidence based approach
C. Family Planning: Thrust Areas • Addressing the unmet need for contraception through introduction of newer contraceptives • Community based distribution of contraceptives through ASHAs • Strengthening family planning service delivery, especially post partum services in high case load facilities • Enlisting private/NGO facilities to improve the provider base for family planning services • Vigorous advocacy of family planning at all levels especially at the highest political level Proposed Strategies • Strengthening HR structures (for programme management) from national to the district level • Marketing of contraceptives up to the door step through ASHA • Improving compensation scheme (both for providers and acceptors) • Roll out of Multi –load IUD (375) as short term spacing method • Performance Linked Payment Plan to ASHAs for improving acceptance of IUDs • Ensuring vigorous advocacy • Enlisting more number of private providers/ NGOs for provision of services. Marketing of contraceptives up to the door step through ASHA • Supplies of contraceptives generally do not reach on time to actual users and unmet need for spacing is very high • Generally people do not go to government facility to get contraceptives because of lack of privacy & confidentiality • Contraceptives are distributed free of cost and hence not much value is attached to it ASHAs could deliver contraceptives at door steps and allowed to charge a nominal amount for contraceptives (Re 1/‐ for a pack of 3 condoms and OCPs and Re 2/‐ for ECPs). Scheme is expected to be launched on July 11, 2011 Ensuring vigorous advocacy • Political level:
Engaging with Parliamentarians and MLAs Community level: Increasing PRI and VHSC Involvement Enhanced understanding of population related issues Role of male in family planning decisions Involving youth for population stabilization: Integrating life skills based learning about concerns such as marriage, reproductive health and contraception, into skill based schemes /programmes Reaching out to youth networks like NSS, NYKs, NCC Focusing on networks that connect with out of school youths Quarterly review of district collectors to sensitize them. Discussion on population stabilization and family planning needs During the assembly sessions Ensuring involvement of MPS and MLAs during the “World Population Day” celebration Available advocacy tool kits to be distributed again to districts
• • •
• Incentives proposed for Population Stabilization • States achieving TFR of 2.1 or below will be provided incentive fund to State Health Mission/Society. • It will be untied fund to undertake health related activities. • Rs 5 (Rs 2000 cr) Adolescent Health: Promotion of Menstrual Hygiene Among Adolescent Girls in Rural India. The plan is to Scale‐up to all 643 Districts during the XII Plan to reach out to adolescent girls (10‐19 years) in rural India with the NRHM brand of sanitary napkins ‘Free days’. However, initially the plan will take off in 152 districts. Central supply of Free days sanitary napkins will be provided to 543 districts and rest 100 districts to be supplied by women Self Help Groups. D. Disease Control Programs: Malaria: a. Thrust areas Intensification of Malaria Prevention and Control. Currently the reported cases approx. 1.5 million annually (52% Pf) which is to bring down morbidity & mortality by 50% in 2016. b. Strategies
Up‐scaling use of Rapid Diagnostic Tests (RDTs). Quality microscopy in health facilities of rural & urban areas Up scaling of Artimisinin based Combination Therapy (ACT) for Pf and Chloroquine & Primaquine for Pv malaria • Up‐scaling & replenishment of Long Lasting Insecticidal Nets (LLINs) • 100% support for spray of insecticides and larvicides • Additional technical and managerial manpower. Kala Azar a. Thrust areas Achieve Elimination of Kala‐azar by 2015 • Kala‐azar cases 28,939 in 2010 with 45% reduction in Mortality in 2010 from 2006 • 320 blocks out of 514 achieved elimination (less than 1 case per 10,000 population at block level b. Strategies • Strengthen case search for hot spots • Up‐scaling of RDT & Oral drug for early detection and complete treatment • Mechanism for Directly Observed Treatment • Training & IEC/BCC • Monitoring & Supervision • Quality spray and coverage ‐ > 80 % coverage Filaria a. Thrust Areas: Achieve Elimination of Filaria by 2015 • Microfilaria prevalence reduced to < 1% in 150 out of 250 Districts • Elimination to be achieved in all 250 districts by 2015 b. Strategies • Administration of DEC & Albendazole to population at risk • Honorarium for Drug distribution to ASHAs & Supervisors • Specific Training • Intensification of IEC/BCC for Drug Compliance • Management of Lymphoedema / Elephantasis cases • Up‐scaling Hydrocele Operations • Elimination verification through Immuno‐chromatographic test (ICT) Dengue & chikungunya a. Thrust Areas • Dengue cases – 28,292 in 2010 against 12,317 in 2006. • CFR reduced to 0.4% against 1.39% in 2006 • • •
• b. • • • •
Chikungunya cases from 13.90 lakhs in 2006 to 0.48 lakhs in 2010 Strategies Strengthen & upscale Diagnostic services Strengthen & upscale Case management to further reduce case fatality rate Strengthen & upscale entomological surveillance for source reduction Strengthen Human Resource Development, Inter‐sectoral convergence & Monitoring
Japanese Encephalitis a. Thrust areas • Strengthen by Prevention and Control Measures. • JE/AES cases 5149 in 2010 as compared to 6727 in 2005 & Mortality reduced by 59%. ( CFR in 2010 – 13%) b. Strategies • Strengthening of disease and vector surveillance • Enhancing capacity building • Thrust on case management at district and sub‐district hospitals • Intensification of BCC/IEC at field level • Medical Rehabilitation of disabled cases following AES/JE • Covering new cohorts under Routine Immunization with > 80% coverage NVBDCP‐ Entomological Surveillance & HRD • Strengthen entomological surveillance of vectors and their susceptibility to various insecticides Urban VBD Control Programme to be revamped Entomological units across country to be strengthened • Strengthen Human Resources Development and Monitoring & Evaluation for prevention and control of vector‐borne diseases Human Resources at National, State, District & sub‐district level to be ensured with full support viz., salary, travel, training, etc One trained MPW (male) at every sub‐centre
INSTITUTIONAL DELIVERIES ACROSS STATES (2010‐11) S. No. A. Non‐NE High Focus States 1 2 3 4 5 6 7 8 9 10 B. NE States 11 12 13 14 15 16 17 18 C. Non‐High Focus States 19 20 21 22 23 24 25 26 27 28 D. Union Territories State Estimated Reported % no. of Institutional Achievement Deliveries Deliveries 1,231,840 335,462 65,372 133,525 328,110 1,332,607 521,447 1,213,054 2,491,339 79,498 7,732,254 10,617 398,707 25,554 31,564 18,151 11,269 6,648 40,040 542,550 1,437,365 20,107 1,098,150 399,472 717,648 376,934 1,248,947 273,236 1,033,125 971,786 7,576,770 44.5% 54.1% 56.2% 61.6% 41.0% 67.1% 61.2% 66.2% 43.5% 40.8% 51.2% 40.7% 55.5% 68.1% 49.6% 103.1% 29.3% 60.3% 75.2% 56.2% 93.0% 85.2% 83.9% 69.6% 62.2% 74.4% 63.3% 58.3% 94.2% 63.4% 74.4%
Bihar 2,769,972 Chhattisgarh 619,987 Himachal Pradesh 116,392 Jammu & Kashmir 216,857 Jharkhand 801,101 Madhya Pradesh 1,986,976 Odisha 852,663 Rajasthan 1,833,307 Uttar Pradesh 5,721,259 Uttarakhand 194,735 Sub Total 15,113,249 Arunachal Pradesh 26,059 Assam 717,747 Manipur 37,545 Meghalaya 63,660 Mizoram 17,600 Nagaland 38,494 Sikkim 11,023 Tripura 53,265 Sub Total 965,392 Andhra Pradesh 1,544,996 Goa 23,612 Gujarat 1,309,055 Haryana 573,629 Karnataka 1,153,815 Kerala 506,665 Maharashtra 1,971,939 Punjab 468,452 Tamilnadu 1,096,550 West Bengal 1,533,518 Sub Total 10,182,230
29 30 31 32 33 34 35
Andaman & Nicobar 7,971 Chandigarh 22,451 Dadra & Nagar Haveli 9,396 Daman & Diu 5,088 Delhi 329,981 Lakshadweep 1,140 Puducherry 22,589 Sub Total 398,615 Grand Total 26,659,486
2,921 20,031 3,381 2,617 170,505 174 43,058 242,687 16,094,261
36.6% 89.2% 36.0% 51.4% 51.7% 15.3% 190.6% 60.9% 60.4%
STERILISATION STATUS ACROSS STATES (2010‐11) S. No. State ELA for sterilisation (ROP) 650,000 198,000 33,000 24,000 175,000 580,000 160,000 485,700 748,100 48,000 3,101,800 3,205 119,484 3,000 7,628 3,510 2,615 300 9,875 149,617 700,000 3,691 285,396 120,000 541,477 158,303 574,750 105,000 405,000 410,593 3,304,210 1,700 1,266
Reported % of ELA sterilisations (ROP)
A. Non‐NE High Focus States 1 2 3 4 5 6 7 8 9 10 B. NE States 11 12 13 14 15 16 17 18 C. Non‐High Focus States 19 20 21 22 23 24 25 26 27 28 D. Union Territories 29 30
Bihar Chhattisgarh Himachal Pradesh Jammu & Kashmir Jharkhand Madhya Pradesh Odisha Rajasthan Uttar Pradesh Uttarakhand Sub Total Arunachal Pradesh Assam Manipur Meghalaya Mizoram Nagaland Sikkim Tripura Sub Total Andhra Pradesh Goa Gujarat Haryana Karnataka Kerala Maharashtra Punjab Tamilnadu West Bengal Sub Total Andaman & Nicobar Chandigarh
411,431 150,031 23,638 18,027 120,624 661,350 108,171 338,574 414,673 24,856 2,271,375 1,657 74,526 1,468 2,030 2,373 1,621 239 4,043 87,957 557,434 3,776 325,748 80,184 329,503 83,891 407,846 81,524 327,440 274,878 2,472,224 711 2,012
63.3% 75.8% 71.6% 75.1% 68.9% 114.0% 67.6% 69.7% 55.4% 51.8% 73.2% 51.7% 62.4% 48.9% 26.6% 67.6% 62.0% 79.7% 40.9% 58.8% 79.6% 102.3% 114.1% 66.8% 60.9% 53.0% 71.0% 77.6% 80.8% 66.9% 74.8% 41.8% 158.9%
31 32 33 34 35
S. No. A. Non‐NE High Focus States 1 2 3 4 5 6 7 8 9 10 B. NE States 11 12 13 14 15 16 17 18 C. Non‐High Focus States 19 20
Dadra & Nagar 1,350 1,045 77.4% Haveli Daman & Diu 470 391 83.2% Delhi 33,290 18,672 56.1% Lakshadweep 130 32 24.6% Puducherry 8,130 11,218 138.0% Sub Total 46,336 34,081 73.6% Grand Total 6,601,963 4,865,637 73.7% STATUS OF EMOC TRAINING: 2010‐11 Achievemen State Target % Achievement t Bihar 180 27 15% Chhattisgarh 78 7 9% Himachal 32 5 16% Pradesh Jammu & 16 4 25% Kashmir Jharkhand 24 2 8% Madhya 32 26 81% Pradesh Orissa 25 1 4% Rajasthan 40 19 48% Uttar Pradesh 25 251 1004% Uttarakhand 24 5 21% Sub Total 476 347 73% Arunachal 2 4 200% Pradesh Assam 48 9 19% Manipur 2 0 0% Meghalaya 24 4 17% Mizoram 2 0% Nagaland 5 1 20% Sikkim 2 0 0% Tripura 4 0 0% Sub Total 89 18 20% Andhra Pradesh Goa
21 22 23 24 25 26 27 28 D. Union Territories 29 30 31 32 33 34 35
Gujarat Haryana Karnataka Kerala Maharashtra Punjab Tamilnadu West Bengal Sub Total Andaman & Nicobar Chandigarh Dadra & Nagar Haveli Daman & Diu Delhi Lakshadweep * Puducherry Sub Total Grand Total
16 32 36 152 48 25 17 24 390 2 18 2 2 0 4 0 28 983
29 16 108 27 234 1 41 3 459 0 0 0 0 824
181% 50% 300% 18% 488% 4% 241% 13% 118% 0% 0% 0% 0% #DIV/0! 0% #DIV/0! 0% 84%
S. No. A. Non‐NE High Focus States 1 2 3 4 5 6 7 8 9 10
STATUS OF LSAS TRAINING: 2010‐11 Achieveme State Target nt Bihar 155 37 Chhattisgarh 52 29 Himachal 16 11 Pradesh Jammu & 8 7 Kashmir Jharkhand 32 54 Madhya 16 34 Pradesh Orissa 36 14 Rajasthan 72 49 Uttar Pradesh 20 1728 Uttarakhand 16 11 Sub Total 423 1974
% Achievement 24% 56% 69% 88% 169% 213% 39% 68% 8640% 69% 467%
B. NE States 11 12 13 14 15 16 17 18 C. Non‐High Focus States 19 20 21 22 23 24 25 26 27 28 D. Union Territories 29 30 31 32 33 34 35
Arunachal Pradesh Assam Manipur Meghalaya Mizoram Nagaland Sikkim Tripura Sub Total Andhra Pradesh Goa Gujarat Haryana Karnataka Kerala Maharashtra Punjab Tamilnadu West Bengal Sub Total Andaman & Nicobar Chandigarh Dadra & Nagar Haveli Daman & Diu Delhi Lakshadweep Puducherry Sub Total Grand Total
4 20 2 6 4 5 4 5 50 24 0 32 12 28 0 96 87 96 25 400 2 2 1 0 0 3 0 8 881
5 16 3 5 5 7 0 41 0 0 8 32 130 0 74 17 40 4 305 0 0 0 0 2320
125% 80% 150% 83% 0% 100% 175% 0% 82% 0% #DIV/0! 25% 267% 464% #DIV/0! 77% 20% 42% 16% 76% 0% 0% 0% #DIV/0! #DIV/0! 0% #DIV/0! 0% 263%
STATUS OF MTP TRAINING: 2010‐11 S. No. A. Non‐NE High Focus States 1 2 3 4 5 6 7 8 9 10 B. NE States 11 12 13 14 15 16 17 18 C. Non‐High Focus States 19 20 21 22 23 24 25 26 27 28 D. Union Territories 29 30 State Bihar Chhattisgarh Himachal Pradesh Jammu & Kashmir Jharkhand Madhya Pradesh Orissa * Rajasthan Uttar Pradesh Uttarakhand Sub Total Arunachal Pradesh Assam Manipur Meghalaya Mizoram Nagaland Sikkim Tripura * Sub Total Andhra Pradesh Goa Gujarat Haryana Karnataka Kerala Maharashtra Punjab Tamilnadu West Bengal Sub Total Andaman & Nicobar Chandigarh
220 171 20 24 36 150 120 120 150 40 1051 10 250 20 18 20 30 0 15 1414 0 0 200 138 32 33 270 40 70 654 1437 10 12
50 29 0 8 113 154 25 28 324 19 750 15 34 8 9 16 12 0 94 0 0 36 42 256 11 198 43 130 0 716 0
23% 17% 0% 33% 314% 103% 21% 23% 216% 48% 71% 150% 14% 40% 50% 0% 53% #DIV/0! 0% 7% #DIV/0! #DIV/0! 18% 30% 800% 33% 73% 108% 186% 0% 50% 0% 0%
31 32 33 34 35
Dadra & Nagar Haveli * Daman & Diu Delhi Lakshadweep Puducherry Sub Total Grand Total
4 0 6 12 0 44 3946
7 0 7 1567
0% #DIV/0! 117% 0% #DIV/0! 16% 40%
STATUS OF SBA TRAINING (SNs, ANMs, LHVs): 2010‐11 S. No. A. Non‐NE High Focus States 1 2 3 4 5 6 7 8 9 10 B. NE States 11 12 13 14 15 16 17 18 State Bihar Chhattisgarh Himachal Pradesh Jammu & Kashmir Jharkhand Madhya Pradesh Orissa Rajasthan Uttar Pradesh Uttarakhand Sub Total Arunachal Pradesh Assam Manipur Meghalaya Mizoram Nagaland Sikkim Tripura Sub Total
% Achievement 8% 147% 42% 98% 111% 97% 116% 527% 176% 14% 75% 102% 54% 121% 309% 0% 72% 117% 88% 72%
Target * Achievement 15927 554 150 88 864 1200 495 1500 3000 588 24366 60 1632 104 96 92 60 84 148 2276 1339 817 63 86 963 1164 576 7899 5272 82 18261 61 878 126 297 43 98 130 1633
C. Non‐High Focus States 19 20 21 22 23 24 25 26 27 28 D. Union Territories 29 30 31 32 33 34 35
Andhra Pradesh # Goa
1000 Not provided Gujarat 1140 Haryana 1460 Karnataka 1000 Kerala 0 Maharashtra 776 Punjab 720 Tamilnadu 2627 West Bengal 1440 Sub Total 10163 Andaman & Nicobar 100 Chandigarh 20 Dadra & Nagar 64 Haveli Daman & Diu 22 Delhi 45 Lakshadweep 12 Puducherry 16 Sub Total 279 Grand Total 37084 STATUS OF IMNCI TRAINING: 2010‐11
468 45 1271 1054 8097 0 1282 764 1061 958 15000 0 6 0 6 34900
47% #VALUE! 111% 72% 810% #DIV/0! 165% 106% 40% 67% 148% 0% 0% 0% 0% 13% 0% 0% 2% 94%
S. No. A. Non‐NE High Focus States 1 2 3 4 5 6
Bihar Chhattisgarh Himachal Pradesh Jammu & Kashmir Jharkhand Madhya Pradesh
9564 2160 432 96 5712 3840
6757 11 0 0 990 1432
71% 1% 0% 0% 17% 37%
7 8 9 10 B. NE States 11 12 13 14 15 16 17 18 C. Non‐High Focus States 19 20 21 22 23 24
Orissa Rajasthan Uttar Pradesh Uttarakhand Sub Total Arunachal Pradesh Assam Manipur Meghalaya Mizoram Nagaland Sikkim Tripura Sub Total
7200 8250 38500 936 76690
330 5932 8187 252 23891
5% 72% 21% 27% 31%
104 10032 150 369 300 614 168 38 11775
2 2224 369 2
2% 22% 246% 1% 0%
68 90 24 2779
11% 54% 63% 24%
Andhra Pradesh Goa Gujarat Haryana Karnataka Kerala
864 2 3480 8500 6000 5640
241 0 2430 1650 2648 272
28% 0% 70% 19% 44% 5%
25 26 27 28 D. Union Territories 29 30 31 32 33 34 35
Maharashtra Punjab Tamilnadu West Bengal Sub Total
12452 2056 16900 12480 68374
10169 332 2825 1883 22450
82% 16% 17% 15% 33%
Andaman & Nicobar Chandigarh Dadra & Nagar Haveli Daman & Diu Delhi Lakshadweep Puducherry Sub Total Grand Total
52 75 296 50 192 4 32 701 157540 14 49134 14 0 0
0% 0% 0% 0% 7% 0% 0% 2% 31%
NOTE: * ‐ No target in the ROP; provided by the State
STATUS OF NSV TRAINING: 2010‐11 S. No. A. Non‐NE High Focus States 1 2 3 4 5 6 7 8 9 10 B. NE States 11 12 13 14 15 16 17 18 C. Non‐High Focus States 19 20 21 22 23 24 25 26 27 28 State Bihar Chhattisgarh Himachal Pradesh Jammu & Kashmir * Jharkhand Madhya Pradesh Orissa Rajasthan Uttar Pradesh Uttarakhand Sub Total Arunachal Pradesh Assam * Manipur Meghalaya Mizoram Nagaland * Sikkim Tripura Sub Total Andhra Pradesh Goa * Gujarat Haryana Karnataka Kerala Maharashtra Punjab Tamilnadu * West Bengal
152 40 56 44 30 100 313 100 242 48 1125 3 100 23 29 0 24 0 12 191 25 2 76 212 300 24 32 25 60 175
12 31 7 1 61 37 1 2098 195 23 2466 0 46 16 16 3 4 5 90 54 0 21 33 143 7 89 6 25 142
8% 78% 13% 2% 203% 37% 0% 2098% 81% 48% 219% 0% 46% 70% 55% #DIV/0! 13% #DIV/0! 42% 47% 216% 0% 28% 16% 48% 29% 278% 24% 42% 81%
D. Union Territories 29 30 31 32 33 34 35 S. No.
Sub Total 931 520 Andaman & 5 Nicobar * Chandigarh 0 0 Dadra & Nagar 0 Haveli Daman & Diu 2 Delhi 30 2 Lakshadweep 4 0 Puducherry * 4 Sub Total 45 2 Grand Total 2292 3078 STATUS OF MINILAP STERILISATION TRAINING: 2010‐11 State Bihar Chhattisgarh Himachal Pradesh Target 152 50 Not provided Jammu & Kashmir 0 Jharkhand 24 Madhya Pradesh 50 Orissa 240 Rajasthan 100 Uttar Pradesh 208 Uttarakhand 22 Sub Total 846 Arunachal Pradesh 25 Assam 240 Manipur 15 Meghalaya 3 Mizoram 20 Nagaland * 24 Sikkim 0 Tripura 15 Sub Total 342
56% 0% #DIV/0! #DIV/0! 0% 7% 0% 0% 4% 134%
A. Non‐NE High Focus States 1 2 3 4 5 6 7 8 9 10 B. NE States 11 12 13 14 15 16 17 18 C. Non‐High Focus
80 3 0 0 25 7 42 0 335 10 502 5 10 0 8 4 0 0 27
53% 6% #VALUE! #DIV/0! 104% 14% 18% 0% 161% 45% 59% 20% 4% 0% 267% 0% 17% #DIV/0! 0% 8%
States 19 20 21 22 23 24 25 26 27 28 D. Union Territories 29 30 31 32 33 34 35 Andhra Pradesh Goa Gujarat Haryana Karnataka Kerala Maharashtra Punjab Tamilnadu West Bengal Sub Total Andaman & Nicobar * Chandigarh Dadra & Nagar Haveli Daman & Diu Delhi Lakshadweep Puducherry Sub Total Grand Total 660 0 93 306 60 33 320 40 500 330 2342 5 1 4 0 0 4 0 14 3544 83 0 34 56 152 5 228 22 8 162 750 0 0 0 0 1279 % Achievement #DIV/0! 38% 0% 3% 17% 92% 50% 26% 114% 138% 83% 13% #DIV/0! 37% 18% 253% 15% 71% 55% 2% 49% 32% 0% 0% 0% #DIV/0! #DIV/0! 0% #DIV/0! 0% 36%
STATUS OF LAPAROSCOPIC STERILISATION TRAINING: 2010‐11 S. No. A. Non‐NE High Focus States 1 2 3 4 5 6 7 8 9 10 B. NE States
State Bihar Chhattisgarh Himachal Pradesh Jammu & Kashmir Jharkhand Madhya Pradesh Orissa Rajasthan Uttar Pradesh Uttarakhand Sub Total
0 40 18 30 12 50 20 100 334 8 612
15 15 0 1 2 46 10 26 382 11 508
11 12 13 14 15 16 17 18 C. Non‐High Focus States 19 20 21 22 23 24 25 26 27 28 D. Union Territories 29 30 31 32 33 34 35
Arunachal Pradesh * Assam Manipur Meghalaya Mizoram Nagaland * Sikkim Tripura Sub Total Andhra Pradesh Goa
3 150 0 0 1 24 2 12 192 120 2
0 16 0 0 4 1 0 21 2 0
0% 11% #DIV/0! #DIV/0! 0% 17% 50% 0% 11% 2% 0%
Gujarat Haryana Karnataka Kerala Maharashtra Punjab Tamilnadu West Bengal Sub Total Andaman & Nicobar Chandigarh Dadra & Nagar Haveli Daman & Diu Delhi Lakshadweep Puducherry Sub Total Grand Total
82 18 30 36 27 24 100 27 466 2 1 0 2 9 4 0 18 1288
920 13 488 8 21 25 38 4 1519 0 2 0 2 2050
1122% 72% 1627% 22% 78% 104% 38% 15% 326% 0% 0% #DIV/0! 0% 22% 0% #DIV/0! 11% 159%
STATUS OF IUD INSERTION TRAINING: 2010‐11
S. No. A. Non‐NE High Focus States 1 2 3 4 5 6 7 8 9 10 B. NE States 11 12 13 14 15 16 17 18 C. Non‐High Focus States 19 20 21 22 23 24 25 26 27 28 D. Union Territories 29 30 31 32 33 34 35 State Bihar Chhattisgarh Himachal Pradesh Jammu & Kashmir Jharkhand Madhya Pradesh Orissa Rajasthan Uttar Pradesh Uttarakhand Sub Total Arunachal Pradesh Assam Manipur Meghalaya Mizoram Nagaland Sikkim Tripura Sub Total Andhra Pradesh Goa Gujarat Haryana Karnataka Kerala Maharashtra Punjab Tamilnadu West Bengal Sub Total Andaman & Nicobar Chandigarh Dadra & Nagar Haveli Daman & Diu Delhi Lakshadweep Puducherry Sub Total Grand Total Target * 1440 2538 500 220 480 2500 360 2236 3870 1872 16016 115 2400 350 518 73 339 0 200 3995 0 0 1875 2130 5400 3090 2380 800 6000 3000 24675 95 50 0 0 60 0 40 245 44931 Achievement 1171 1816 46 105 604 1897 48 16220 9305 453 31665 57 1378 167 602 148 85 150 2587 105 0 1712 1674 5954 286 2313 646 3035 2643 18368 32 22 0 54 52674 % Achievement 81% 72% 9% 48% 126% 76% 13% 725% 240% 24% 198% 50% 57% 48% 116% 0% 44% #DIV/0! 75% 65% #DIV/0! #DIV/0! 91% 79% 110% 9% 97% 81% 51% 88% 74% 0% 64% #DIV/0! #DIV/0! 37% #DIV/0! 0% 22% 117%
STATUS OF 24x7 FACILITIES ACROSS STATES
S. No. A. Non‐NE High Focus States 1 2 3 4 5 6 7 8 9 10 B. NE States 11 12 13 14 15 16 17 18 C. Non‐High Focus States 19 20 21 22 23 24 25 26 27 28 D. Union Territories 29 30 31 32 33 34 35 State Bihar * Chhattisgarh Himachal Pradesh Jammu & Kashmir Jharkhand Madhya Pradesh Orissa Rajasthan Uttar Pradesh Uttarakhand Sub Total Arunachal Pradesh Assam Manipur Meghalaya Mizoram Nagaland Sikkim Tripura Sub Total Andhra Pradesh Goa * Gujarat Haryana Karnataka Kerala Maharashtra Punjab Tamilnadu West Bengal Sub Total Andaman & Nicobar Chandigarh Dadra & Nagar Haveli Daman & Diu Delhi Lakshadweep Puducherry Sub Total Grand Total Target (till 2010‐11) 558 348 95 160 285 500 340 1418 850 120 4674 30 445 38 26 41 33 24 62 699 1200 19 331 337 1200 178 908 236 1539 225 6173 19 6 6 1 35 9 25 101 11647 Achievement 96 2 95 15 43 41 157 644 485 86 1664 15 284 17 34 0 26 24 58 458 761 13 137 301 1076 0 52 99 1316 36 3791 0 0 5 2 0 0 25 32 5945
% Achievement 17% 1% 100% 9% 15% 8% 46% 45% 57% 72% 36% 50% 64% 45% 131% 0% 79% 100% 94% 66% 63% 68% 41% 89% 90% 0% 6% 42% 86% 16% 61% 0% 0% 83% 200% 0% 0% 100% 32% 51%
MMUNISATION STATUS ACROSS STATES (2010‐11) S. No. State Estimated no. of live births Reported live births BCG coverage % Achievemen t (estimated births) % Achievemen t (reported live births) Estimated no. of UIP beneficiari es DPT3 coverag e % Achievement Measles coverage % Achievement Infants fully immunised % Achieve ment
A. Non‐NE High Focus States 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 Bihar Chhattisgarh Himachal Pradesh Jammu & Kashmir Jharkhand Madhya Pradesh Odisha Rajasthan Uttar Pradesh Uttarakhand Sub Total Arunachal Pradesh Assam Manipur Meghalaya Mizoram Nagaland Sikkim Tripura Sub Total 2,769,972 619,987 116,392 216,857 801,101 1,986,976 852,663 1,833,307 5,721,259 194,735 15,113,249 26,059 717,747 37,545 63,660 17,600 38,494 11,023 53,265 965,392 1,236,691 579,130 102,226 142,465 550,107 1,564,079 630,398 1,366,398 4,221,798 126,780 10,520,072 11,091 494,250 33,760 70,184 22,107 16,393 8,072 47,879 703,736 2,248,082 583,528 128,046 220,218 711,883 1,610,270 737,600 1,369,169 5,156,987 181,822 12,947,605 19,585 627,871 52,026 79,822 22,803 20,295 8,899 55,186 886,487 81.2% 94.1% 110.0% 101.5% 88.9% 81.0% 86.5% 74.7% 90.1% 93.4% 85.7% 75.2% 87.5% 138.6% 125.4% 129.6% 52.7% 80.7% 103.6% 91.8% 181.8% 100.8% 125.3% 154.6% 129.4% 103.0% 117.0% 100.2% 122.2% 143.4% 123.1% 176.6% 127.0% 154.1% 113.7% 103.1% 123.8% 110.2% 115.3% 126.0% 2,625,933 586,508 111,155 207,099 765,852 1,853,849 797,240 1,725,142 5,360,820 186,750 14,220,348 25,225 673,964 36,944 59,904 16,966 37,493 10,648 51,614 912,758 1,929,131 572,676 121,582 218,638 643,355 1,632,108 692,434 1,541,946 4,770,010 178,085 12,299,965 15,192 574,076 45,154 67,272 22,821 18,826 8,921 49,943 802,205 73.5% 97.6% 109.4% 105.6% 84.0% 88.0% 86.9% 89.4% 89.0% 95.4% 86.5% 60.2% 85.2% 122.2% 112.3% 134.5% 50.2% 83.8% 96.8% 87.9% 1,919,461 558,589 116,789 213,619 721,359 1,619,633 663,216 1,489,689 4,540,003 167,817 12,010,175 15,352 558,352 42,035 63,191 21,817 17,716 8,814 48,301 775,578 73.1% 95.2% 105.1% 103.1% 94.2% 87.4% 83.2% 86.4% 84.7% 89.9% 84.5% 60.9% 82.8% 113.8% 105.5% 128.6% 47.3% 82.8% 93.6% 85.0% 2,593,589 556,647 116,568 235,175 547,037 1,552,228 651,913 1,370,213 4,524,447 168,338 12,316,155 13,159 544,842 39,719 57,891 21,267 15,410 8,730 39,572 740,590 98.8% 94.9% 104.9% 113.6% 71.4% 83.7% 81.8% 79.4% 84.4% 90.1% 86.6% 52.2% 80.8% 107.5% 96.6% 125.3% 41.1% 82.0% 76.7% 81.1%
B. NE States
C. Non‐High Focus States
19 20 21 22 23 24 25 26 27 28
Andhra Pradesh Goa Gujarat Haryana Karnataka Kerala Maharashtr a Punjab Tamilnadu West Bengal Sub Total
1,544,996 23,612 1,309,055 573,629 1,153,815 506,665 1,971,939 468,452 1,096,550 1,533,518 10,182,230
1,511,673 20,085 1,181,961 507,876 843,042 378,829 1,531,851 391,332 1,073,630 1,462,731 8,903,010
1,486,717 23,965 1,239,731 585,243 1,115,862 385,295 1,620,440 468,442 1,053,582 1,654,042 9,633,319
96.2% 101.5% 94.7% 102.0% 96.7% 76.0% 82.2% 100.0% 96.1% 107.9% 94.6%
98.3% 119.3% 104.9% 115.2% 132.4% 101.7% 105.8% 119.7% 98.1% 113.1% 108.2%
1,469,291 23,352 1,246,220 544,374 1,106,509 500,585 1,910,809 450,651 1,065,847 1,482,912 9,800,548
1,476,573 23,008 1,192,082 542,941 1,098,221 380,065 1,596,866 439,541 1,063,421 1,468,044 9,280,762
100.5% 98.5% 95.7% 99.7% 99.3% 75.9% 83.6% 97.5% 99.8% 99.0% 94.7%
1,456,038 22,169 1,153,782 542,894 1,038,278 365,085 1,523,556 420,244 1,041,200 1,423,533 8,986,779
99.1% 94.9% 92.6% 99.7% 93.8% 72.9% 79.7% 93.3% 97.7% 96.0% 91.7%
1,465,68 8 22,169 1,135,47 1 532,424 1,162,77 2 351,070 1,420,63 3 416,196 1,034,05 6 1,351,56 0 8,892,03 9 2,752 14,332 6,545
99.8% 94.9% 91.1% 97.8% 105.1% 70.1% 74.3% 92.4% 97.0% 91.1% 90.7%
D. Union Territories 29 30 31 Andaman & Nicobar Chandigarh Dadra & Nagar Haveli Daman & Diu Delhi Lakshadwe ep Puducherry Sub Total Grand Total 7,971 22,451 9,396 2,976 22,263 8,877 3,093 23,852 7,670 38.8% 106.2% 81.6% 103.9% 107.1% 86.4% 7,755 21,890 9,048 2,452 15,541 7,095 31.6% 71.0% 78.4% 2,694 16,109 6,700 34.7% 73.6% 74.0% 35.5% 65.5% 72.3%
32 33 34 35
5,088 329,981 1,140 22,589 398,615 26,659,486
1,524 184,238 480 42,276 262,634 20,389,452
2,715 252,733 583 37,760 328,406 23,795,817
53.4% 76.6% 51.1% 167.2% 82.4% 89.3%
178.1% 137.2% 121.5% 89.3% 125.0% 116.7%
4,966 319,092 1,112 22,092 385,954 25,319,608
2,799 210,503 678 16,152 255,220 22,638,152
56.4% 66.0% 61.0% 73.1% 66.1% 89.4%
3,068 197,040 751 15,165 241,527 22,014,059
61.8% 61.8% 67.6% 68.6% 62.6% 86.9%
3,056 213,080 789 15,137 255,691 22,204,4 75
61.5% 66.8% 71.0% 68.5% 66.2% 87.7%
Scheme Wise Expenditure for RCH Flexipool for FY 2010‐11 (Upto 31‐03‐2011) Rs. In Lakhs Tribal RCH A.6 A. High Focus States 1 2 3 4 5 6 7 8 9 10 B. NE States Bihar Chhatisgarh Himachal J & K Jharkhand MP Orissa Rajasthan UP Uttarakhand Sub Total 0.00 0.00 28.50 0.00 32.57 11.85 46.87 34.89 0.00 0.00 154.68 0.00 0.00 52.34 0.00 15.05 61.21 15.45 0.00 0.00 0.00 144.05 9.91 1.45 87.57 35.34 22.02 122.82 344.45 148.76 277.08 199.19 1248.59 4548.37 362.25 26.98 387.45 1271.94 2632.80 1779.91 1776.89 6770.21 460.76 20017.56 11 12 13 14 15 16 17 18 Arunachal Pradesh Assam Manipur Meghalya Mizoram Nagaland Sikkim Tripura Sub Total 0.00 0.00 7.26 0.00 0.00 0.00 5.70 0.00 12.96 0.00 57.56 4.24 0.00 0.00 0.00 0.00 0.00 61.80 606.27 3214.71 17.86 3.59 52.49 1.00 15.78 12.76 3924.46 249.25 1676.93 469.43 74.35 373.96 251.40 95.81 201.30 3392.43 71.38 118.10 2.16 12.08 42.74 116.60 7.13 0.00 370.19 148.80 1272.39 142.57 125.57 120.44 63.09 39.26 80.26 1992.38 70.91 0.00 95.05 179.69 9.78 242.58 12.13 256.11 866.25 14.72 8045.74 135.18 3.57 332.16 365.87 30.47 369.17 9296.88 270.91 326.18 147.31 190.10 105.40 366.30 83.00 169.57 1658.77 1690.29 24137.54 1344.81 1028.53 1246.59 1717.46 404.06 1663.78 33233.05 216.59 0.00 121.46 44.06 15.45 458.43 204.48 516.77 546.29 81.85 2205.38 1286.16 143.06 135.17 152.66 838.44 1175.72 848.08 887.66 1639.07 110.86 7216.88 488.52 63.73 98.73 83.00 139.99 939.78 311.82 506.74 1384.83 170.95 4188.09 5114.44 1082.52 318.52 343.42 156.04 0.00 332.25 1322.57 22.66 3.83 8696.25 1301.77 728.23 120.70 200.77 814.78 1469.24 802.35 753.89 1567.57 187.72 7947.02 42594.97 8994.39 2043.38 3791.17 10914.33 37589.23 19104.84 28690.33 65509.42 3791.06 223023.1 2 Vulnerable Groups A.7 Innovation /PPP/NGO A.8 Infrastructure Human Resource A.9 Institutional Strengthening A.10 Training A.11 BCC/ICC A.12 Procurement A.13 Programme Management A.14 Total RCH Flexi pool A
C. Non‐High Focus States 19 20 21 22 23 24 25 26 27 28 Andhra Goa Gujarat Haryana Karnatak Kerala Maharashtra Punjab Tamilnadu West Bengal 0.00 0.00 81.72 0.00 56.70 71.53 109.08 0.00 0.00 206.96 525.99 0.00 0.00 628.72 0.00 80.60 0.00 60.24 0.00 0.00 183.97 953.53 2.70 6.52 1928.57 71.57 37.79 29.09 349.74 289.03 2.49 175.38 2892.88 1824.57 70.86 776.09 1368.63 5010.25 3916.48 1904.29 1616.80 5526.49 1294.73 23309.19 29 30 31 32 33 34 35 Andaman & Nicobar Chandigarh Dadra & Nagar Haveli Daman Delhi Lakshadweep Puducherry Sub Total Grand Total 0.00 0.00 0.49 0.00 0.00 0.00 0.00 0.49 694.12 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 1159.38 0.00 3.03 0.40 1.93 12.19 2.16 24.40 44.11 8110.04 0.00 96.13 96.46 0.00 1544.61 0.00 55.70 1792.90 48512.08 0.00 0.00 3.63 2.01 13.58 0.00 23.75 42.97 4407.33 13.91 3.51 1.69 0.57 30.78 4.03 16.28 70.77 15117.30 16.14 12.89 8.30 10.62 43.03 3.20 28.36 122.54 8403.03 1.51 31.23 11.49 0.00 247.74 1.37 6.12 299.46 25682.24 0.42 13.31 15.00 13.87 33.51 29.08 19.56 124.75 13894.10 47.06 173.97 155.50 32.27 2246.24 60.11 388.94 3104.09 368518.8 8 6.31 1.29 255.87 12.37 301.03 71.04 97.02 271.92 466.03 305.91 1788.79 56.12 11.30 611.18 396.52 1554.36 370.16 1311.67 473.08 701.53 351.36 5837.28 283.50 24.56 756.67 122.21 482.87 376.07 686.85 347.45 102.16 43.81 3226.15 0.00 27.42 1181.67 1743.49 11.98 479.62 0.00 1023.20 2919.58 2.70 7389.66 431.56 38.13 658.61 437.70 526.28 444.75 756.89 588.16 1.49 280.00 4163.57 6278.88 234.25 17010.61 6295.09 16359.44 7837.49 18969.20 6808.10 15269.77 14095.78 109158.6 1
Sub Total D. Small States/UTs
Note:‐ Expenditure are based on FMRs received from states as on 28.06.2011
Scheme Wise Expenditure for RCH Flexipool for FY 2010‐11 (Upto 31‐03‐2011) Rs. In Lakhs Total MH JSY Maternal Health Other Child Health Family Planning Compensation Sterilization Other FP ARSH Urban RCH
A.1 A.1.4 A.1 A.2 A.3 A.4 A.5 A. High Focus States 1 Bihar 24265.80 23969.03 296.77 715.45 4609.53 4516.64 92.89 5.26 33.17 2 Chhatisgarh 4937.56 4900.34 37.22 254.96 1398.69 1382.46 16.23 5.65 16.29 3 Himachal 520.66 130.54 390.12 237.92 287.22 267.21 20.01 7.61 0.00 4 J & K 2118.56 2018.28 100.28 45.67 195.74 193.40 2.34 29.74 154.76 5 Jharkhand 5649.65 5224.68 424.97 295.43 1622.40 1605.43 16.97 32.53 8.04 6 MP 21661.58 20085.45 1576.13 2364.28 6544.24 6408.83 135.41 81.05 66.23 7 Orissa 12045.72 10672.61 1373.11 775.47 1466.99 1441.83 25.16 4.60 126.40 8 Rajasthan 18162.07 18013.44 148.63 275.97 3877.90 3696.97 180.93 12.00 414.22 9 UP 46568.30 45049.01 1519.29 973.25 4427.11 4114.71 312.39 261.25 1071.81 10 Uttarakhand 1541.77 1404.00 137.77 266.21 347.02 347.02 0.00 179.87 241.03 Sub Total 137471.67 131467.38 6004.29 6204.61 24776.84 23974.51 802.33 619.56 2131.95 B. NE States Arunachal 11 Pradesh 166.44 133.14 33.30 21.20 20.92 18.52 2.40 5.22 44.27 12 Assam 7374.86 6852.70 522.16 35.20 1648.18 1473.47 174.71 10.74 356.95 13 Manipur 238.75 171.49 67.26 32.38 22.18 19.35 2.83 0.13 30.31 14 Meghalya 164.55 117.94 46.61 18.16 38.11 29.53 8.58 17.85 200.91 15 Mizoram 151.48 129.59 21.89 6.03 27.69 26.39 1.30 6.58 17.84 16 Nagaland 258.75 257.96 0.79 0.08 33.89 33.89 0.00 17.90 0.00 17 Sikkim 71.72 41.48 30.24 18.94 6.61 4.72 1.89 0.90 16.62 18 Tripura 428.60 244.41 184.19 36.95 72.24 69.14 3.10 36.82 0.00 Sub Total 8855.15 7948.71 906.44 168.94 1869.82 1675.00 194.81 96.14 666.90 C. Non‐High Focus States 19 20 21 Andhra Goa Gujarat 1075.35 20.37 3737.18 985.91 9.14 1995.42 89.44 11.23 1741.76 0.00 21.31 1595.30 2465.78 11.58 1622.95 2465.78 11.58 1582.82 0.00 0.00 40.14 0.66 0.36 152.19 132.33 0.55 3023.89
22 Haryana 23 Karnatak 24 Kerala 25 Maharashtra 26 Punjab 27 Tamilnadu 28 West Bengal Sub Total D. Small States/UTs Andaman & 29 Nicobar 30 Chandigarh Dadra & Nagar 31 Haveli 32 Daman 33 Delhi 34 Lakshyadweep 35 Puducherry Sub Total Grand Total
895.46 4667.56 1090.86 3421.10 1041.36 2921.94 8139.09 27010.27
672.04 4663.12 920.20 3084.76 674.65 2670.73 5663.64 21339.61
223.42 4.44 170.66 336.34 366.71 251.21 2475.45 5670.66
136.89 282.69 349.03 4887.22 104.62 0.00 857.17 8234.23
495.63 3012.11 350.35 3856.01 846.65 2626.40 2240.81 17528.27
483.94 2933.21 347.83 3664.01 817.41 2461.78 2185.20 16953.56
11.69 78.90 2.52 192.00 29.24 164.62 55.61 574.72
8.85 52.00 17.04 113.80 7.56 0.00 13.89 366.35
605.77 283.22 271.47 1415.29 198.27 1.66 0.00 5932.45
5.27 9.79 11.47 1.34 146.49 1.49 62.38 238.23 44413.16
0.00 0.00 0.00 0.00 22.41 0.00 4.80 27.21 8758.51
6.57 6.22 1.33 0.00 136.39 119.59 14.83 7.02 69.95 30.73 238.01 171.96 173575.10 160927.6
0.35 0.00 1.33 0.60 16.80 9.69 7.81 2.54 39.22 11.18 66.05 28.39 12647.44 14636.17
11.47 0.00 0.00 1.33 0.01 0.00 136.62 9.87 5.82 1.49 0.00 1.41 60.88 1.50 66.46 226.57 11.66 74.26 42829.64 1583.52 1156.31
Note:‐ Expenditure are based on FMRs received from states as on 28.06.2011
Annexure: Promotion of Menstrual Hygiene Scheme Technical Specifications of Sanitary Napkins for the Scheme for the Promotion of Menstrual Hygiene (as approved by the technical committee constituted by MoHFW) A. Preamble: Sanitary Napkin consists of an outer covering provided with sufficient number of channels for leak protection and an absorbent filler material with an adhesive back strip. B. Description: 1. Covering – The covering of the absorbent filler shall be made of good quality perforated film sleeve which has sufficient porosity to permit the assembled napkin to meet the absorbency requirements. This shall be made of a product that is non allergenic. The sanitary napkins shall have a non‐absorbent barrier on one side which shall have an identifying mark indicating clearly the side of the barrier. 2. Absorbent Filler ‐ The filler material, shall consist of cellulose pulp (either based on wood or paper.) This shall be free from lumps, oil spots, dirt or foreign material etc. 3. Back Strip – A back strip for sticking the sanitary napkin onto the underwear should be there using good quality adhesive material. 4. Absorbency – The sanitary napkin should be able to absorb not less than 50 ml of normal saline (I.P.) 5. Size – The size of absorbent section of the Sanitary Napkin shall be as follows: Pad Length Width Thickness 210+_ 10 60 to 75 not more than 10 ( all figures in mm.) The thickness shall be measured by stacking 10 complete pads and measuring the stack height. The average thickness for the 10 pads shall be used as the pad thickness. 6. Weight ‐‐ The weight of one full sanitary napkin shall not be more than 10 grams.\ C. MANUFACTURE, WORKMANSHIP, AND FINISH: The absorbent filler shall be arranged and neatly cut to the required size of the pad and form a uniform thickness throughout without any wrinkles or distortion. It shall be placed in the covering in such a way that it does not cause lump formation with the effect of sudden pressure.
The covering fabric shall cover the filler completely. The sanitary napkins shall have a very soft feel and when worn shall not chafe or give any uncomfortable feeling. It shall be free from all sorts of foreign matter and should be odorless. The material used in the fabrication is non allergenic. The sanitary napkin will be free from acids and alkali. The adhesive used in the napkin should not leave any mark and stain. D. Storage: The manufacturer shall ensure that the raw materials as well as the finished goods are stored in a clean place protected from dust, moisture, rodents and pests. E. Shelf‐Life: The product shall have a minimum shelf life of three years. At least 5/6th of the shelf life should be available on receipt of shipment at Consignee level. F. Packaging and Labelling: (i) Primary Package : Each Primary Package shall contain 6 Sanitary Napkins in a Polyethylene bag of good quality material with a minimum micron thickness that ensures that the pack does not tear in routine handling (subject to approval of sample by State Nodal Officer) which will confirm to size of the product and sealed properly. The designing and printing of the bag shall be done at the cost of the manufacturer as per printing matter including logo (in four colours) provided by MoHFW. The printing work shall be in weatherproof ink and shall withstand immersion in water and remain intact. The primary package shall also include the name of the manufacturer, manufacturing license number, address of manufacturer, length and dimensions, lot /batch number, date of manufacturing and expiry and number of sanitary napkins in each package. The designing of the primary package shall be subject to the approval of MoHFW. (ii) Secondary Package: The sanitary napkins contained in primary package should be packed in boxes for easy handling, transport and distribution. One Box shall contain 160 primary packages of (6) Sanitary Napkins each. It shall be fabricated from Millboard / grey board / cardboard with a minimum of bursting strength of 9‐10 Kg/cm2. The designing and printing of the
label on the secondary package shall be done at the cost of the manufacturer as per printing matter including logo provided by MoHFW. (iii)
Bar Coding: Bar code shall be used to track down the product. It shall be printed on the label of the secondary package 1) Product identification(GTIN 14) using application identifier (01) 2) Expiry Date in YYMMDD format & using application identifier (17) 3) Master batch number using application identifier (10) Complete details on GS1 standards along with technical guidelines can be downloaded from www.gs 1india.org or www.gs1.org G. Quality assurance (i) Compliance: The manufacturer shall guarantee that the products: (a) comply with all provisions of the specifications (b) meet the laid down standards for safety, efficacy and quality; (c) are fit for the purposes made known to the Seller (d) are free from defects in workmanship and in materials (ii) Pre‐Dispatch Inspection/Testing : MoHFW or authorised representative may inspect the product at the manufacturer’s factory and / or warehouse. Samples shall be drawn on random basis from each lot / batch offered. It shall be sent to the laboratory identified by MoHFW. The goods shall be accepted subject to the approval of the samples for the laid down technical parameters in the specifications including package integrity test. Sanitary Napkins may be procured / despatched and sold only after clearance from the Testing Laboratory and prior intimation to the manufacturer. H. Recalls: The products must be recalled by the manufacturer at the manufacturer’s cost if rejected by MoHFW or authorized representative because of problems with product quality or adverse reactions of the product to the user. The supplier will be obliged to replace the product in question at its own cost with a fresh batch of acceptable quality,
or withdraw and give a full refund. The supplier shall have to pay penalty as prescribed by MoHFW. I. Markings (i) All packages and invoices must bear the name of the product, expiry date and appropriate storage conditions. (ii) Secondary Package : The following information shall be stenciled or labeled on the exterior shipping cartons on all four sides in bold letters • at least Arial font size 14 with waterproof indelible ink in a clearly legible manner which is acceptable to MoHFW: • Generic name of the product • Lot or batch number • Date of manufacture (month and year) • Expiration date (month and year) • Bar Code • Manufacturer’s name and registered address • Consignee’s address and emergency phone number including mobile number • Contact number • Number of boxes contained in the carton • Gross weight of each carton (in kg) • Instructions for storage and handling
Annexure: Revised National Tuberculosis Control Programme Summary of the New / Innovative approaches of RNTCP in 12th Five Year Plan Sr No Key Programme Area 11th Five Year Plan Objective 12th Five Year Plan Objective Universal (90%) access to care for all types of estimated TB cases 90% amongst New & 85% amongst re‐ treatment TB cases registered under RNTCP New / Innovative approaches • Evidence‐based re‐ alignment of TB Unit (presently at 1 per 5 lakh pop) to Block level • Use of telecommunication in demand generation, service delivery & patients tracking • Designing & implementing innovative ACSM tools, NGO‐ PPM approaches and evaluating their impact • Intensified case finding activities in high risk groups like –smokers, diabetics, Malnourished, HIV, urban slums & difficult to reach areas etc • Use of newer rapid diagnostic tools • Conducting prescription audits in private and public sectors including medical colleges • Exploring legislative options for regulating & promoting rational use of Anti‐TB drugs and diagnostics • Case‐based electronic notification systems for data quality improvement • Notification of cases
Key strategies • Community 70% of empowerment for estimated Case early self reporting New Smear detection for diagnosis and Positive TB treatment cases • Mobilizing community based organizations 85% of all • Intensifying Treatment New Smear appropriate success positive TB involvement of cases formal and informal private health care providers • Ensuring quality diagnosis, DOTS & default prevention • Strengthening Reduction in the cross border default rate referral & feedback Further of new TB system between Prevention of reducing the cases to less districts / states drug resistant default in TB than 5% and with a focus on TB patients on re‐treatment migratory treatment TB cases to population in less than 10% urban areas
Key Programme Area
11th Five Year Plan Objective
12th Five Year Plan Objective Key strategies New / Innovative approaches diagnosed and treated in the private sector • Developing diagnostic algorithms for Extra‐ pulmonary TB in consultation with professional bodies • Establishing referral linkages between primary, secondary and tertiary hospitals
Offer of HIV Counselling and testing Strengthen for all TB collaboration patients and and cross‐ linking HIV‐ referral in 14 infected TB states patients to HIV care and support;
Introduce diagnostic and Management treatment of Drug services for resistant TB MDR‐TB in phased manner
• Priority deployment of • Early diagnosis newer rapid diagnostics in and improved HIV care settings management of • Nationwide provision of TB HIV‐infected TB preventive therapy among patients HIV‐infected individuals after • Strengthening of pilot TB‐HIV intensified • Exploring the possibility of package alternative regimens in HIV implementation positive TB patients • Decentralization of second‐ Initial • 43 Culture and line drug susceptibility Drug screening of testing to identified State susceptibility all re‐ reference laboratories, for testing (C&DST) treatment routine application in smear‐ laboratories to be diagnosed MDR TB cases positive till established by 2015 and all 2013 • Procurement of anti‐TB Smear drugs for the management • Another 30 positive TB of patients with MDR TB C&DST patients by and also additional second‐ laboratories to be year 2017 for line anti‐TB drug resistance established in drug‐ (e.g. XDR TB) government and resistant TB other sectors • Developing evidence‐based and provision through public treatment guidelines for TB of treatment Private cases resistant to drugs
Key Programme Area
11th Five Year Plan Objective
12th Five Year Plan Objective services for MDR‐TB patients Key strategies partnerships by 2015 • Establishment of 120 DOTS Plus sites (1 per 10 million population – indoor facility for MDR‐TB) New / Innovative approaches other than Rifampicin • Establishing drug resistance surveillance in the country Involving secondary and tertiary level hospitals in management of Drug resistant TB
Addressing at risk and vulnerable population
HRD & capacity building
Capacity building of state & district programme managers
• Developing guidelines for addressing TB care in special settings like, prisons, mines, alcoholics, beggars, • Developing and homeless, migrant labourers implementation etc of Tribal Action • Developing gender sensitive Plan approaches to facilitate • Linking TB access and utilization of TB patients with control services by both existing social men and women welfare schemes • Inter‐sectoral coordination • Strengthening the for increasing access and contact tracing quality of TB care policy • Initiating TB surveillance in implementation health care workers • Promoting implementation of Airborne Infection control guidelines • Continuation of • Increased human resources existing commensurate to re‐ contractual alignment of TUs to block manpower level • Need based • Performance appraisal continued system for contractual staff
Key Programme Area
11th Five Year Plan Objective
12th Five Year Plan Objective Key strategies training New / Innovative approaches • Development & capacity Building of national TB Institutes like NTI, N.D.T.B. center, LRS under RNTCP • Operational research – o Improvement in quality and proficiency of services. o Diagnostic & treatment delays both on part of patients and providers o TB risk perceptions, health seeking behaviour, KAP of patients and providers and reasons of opting of RNTCP. • Improvement in surveillance, both by strengthening routine surveillance as well as planning large inventory studies. • Epidemiological studies for incidence, prevalence and mortality measurement. • Coordinating with NRHM division for development of long‐term policy on sustainable human resources in states for RNTCP • Coordinating with NRHM division for clearly defining the roles and responsibilities of
Research & independent Evaluation
National level surveys to study the impact of the programme
• Third party evaluation
Health system strengthening
Key Programme Area
11th Five Year Plan Objective
12th Five Year Plan Objective New / Innovative approaches directorate of health services and mission directorates in the state; while empowering the STOs & DTOs in financial and programmatic management and reporting within the framework of NRHM • Individual patient monitoring facilitated by electronic updating of • Continue to do patient treatment card the monitoring of • Developing monitoring performance of indicators in view of all states at changes and updates to national level cover all areas • Regular central & • Bar coding usage for state level tracking of patient wise internal boxes evaluations of • Regular measurements of programmes in the quality of the the districts programme through indicators like delays in diagnosis and treatment Key strategies
Monitoring and Evaluation of the Programme
Identifying poor performing units with intensified monitoring
Annexure (NPCDCS) List of 21 States and 100 Districts selected for NPCDCS
States Andhra Pradesh
1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19.
Districts (100) Srikakulam Vijaya Nagaram Chittor Cuddapah Nellore Krishna Karnool Prakasham Lakhimpur Sibsagar Jorhat Dibrugarh Kamrup Vaishali Mauzaffarpur Rohtas Paschim Champaran Poorva Champaran Keimur (bhabua) Jashpur Nagar Raipur Bilaspur Gandhi Nagar Surendra Nagar Rajkot Jam Nagar Porbandhar Junagarh Mewat Yamnagar Kurukshetra Ambala Chamba Lahul & Sapiti Kinnaur
20. 21. 22. 23. 24. 25. 26. 27. 28. 29. 30. 31. 32. 33. 34. 35.
Jammu & Kashmir
36. 37. 38. 39. 40.
Kupawara Doda (Erstwhile) Kishtwar / Ramban) Kargil Leh (Ladak) Udhampur (Erstwhile) Ranchi Dhanbad Bokaro Kolar Udupi Shimoga Tumkur Chikmagulur Khozikode (Calicut) Pathanathitta Allppuza Idukki Thrishur Hoshangabad Chindwara Jhabua Ratlam Dhar Gadchirela Bhandara Chanderpur Washim Wardha Amaravati East Sikkim South Sikkim Naupada Balangir
41. 42. 43.
44. 45. 46. 47. 48.
49. 50. 51. 52. 53.
12. Madhya Pradesh
54. 55. 56. 57. 58.
59. 60. 61. 62. 63. 64.
14. Sikkim 15. Orissa
65. 66. 67. 68.
69. 70. 71. 16. Punjab 72. 73. 74. 17. Rajasthan 75. 76. 77. 78. 79. 80. 81. 18. Uttrakhand 19. Tamil Nadu 82. 83. 84. 85. 86. 87. 88. 20. Uttar Pradesh 89. 90. 91. 92. 93. 94. 95. 96. 97. 21. West Bengal 98. 99. 100.
Nabrangpur Koraput Malkangiri Bhatinda Mansa Hoshiarpur Bilwara Jodhpur Ganga Nagar Bikaner Jaisalmer Barmer Nagaur Nainithal Almora Coimbatore Theni Virundhanagar Toothukudi Trinelveli Rae Bareli Sultanpur Jhansi Lakhimpur Kheri Farookhabad Firozabad Eatawah Lalitpur Jalaun Darjeeling Jalpaiguri Dakshin Dinajpur
ent of Release of Grant ‐In‐ Aids for NPCDCS for the Financial Yr.2010‐11 ended as on 31.3.11 CVD District Cancer Care Facility Non Recurrin g 400,000 400000 400,000 200000 400000 200000 200000 400000 0 Cancer State & District NCD Cell Recurrin g Non Recurrin g 750000 750000 750000 500000 750000 500000 500000 750000 0
Recurring Non Recurring
SUB‐ TOTAL 5020400 5020400 5020400 2750700 5020400 2750700 2750700 5020400 0
Andhra Pradesh Assam Bihar Chattisgarh Gujrat Haryana Himachal Pradesh Jammu Kashmir Jharkhand
8437400 13,408,00 21,845,400 0 6,600,400 13288000 19,888,400 3488200 13008000 16,496,200 5,753,600 6844000 12,597,600
3228400 3228400 3228400 1614200 3228400 1614200 1614200 3228400 0
642000 642000 642000 436500 642000 436500 436500 642000 0
9815800 13568000 23,383,800 1832800 4204600 6524000 8,356,800
4088600 13,088,00 17,176,600 0 0.00 0 0
Karnatakka Kerala Madhya Pradesh Maharastra Sikkim Orissa Punjab Rajasthan
9925400.0 13568000 23,493,400 0 7016200.0 6964000 13,980,200 0 3273800.0 6644000 9,917,800 0 7943800.0 13408000 21,351,800 0 882800.00 6444000 7,326,800 2762800.0 0 5098600 6604000 9,366,800
1614200 3228400 1614200 1614200 1614200
200000 400000 200000 200000 200000
437500 642000 436500 436500 436500
500000 750000 500000 500000 500000
2751700 5020400 2750700 2750700 2750700
Uttarakhand Tamilnadu Uttar Pradesh West Bengal Total
12262800 25,930,800 13,668,00 0 2795600 6604000 9,399,600 3737600 0 6095000 6684000 10,421,600 0 0
3228400 1614200 1614200 0 1614200
400000 200000 200000 0 200000
642,000 436500 436500 0 437500
750000 500000 500000 0 500000 1150000 0
5020400 2750700 2750700 0 2751700 7042290 0
106,015,8 180,728,0 286,743,80 00 00 0
Sub‐Head as in the Demand for Grant
NATIONAL PROGRAMME FOR CONTROL OF BLINDNESS ‐ 2010‐11 Demand No.& Title 46 ‐ Deptt.of Health Dated: 31.03.2011 ((Rs. In lakh) B. E. F.E. 2010‐11 Exp. Incurred Approved by 2010 ‐11 Finance
Grant‐in‐aid to VOs and other Instts. Expenditure In UTs without Legislature Trachoma & BC Cell (GC) New Salaries Medical Treatment Domestic Travel Expenses Office Expenditure Other Admn. Expenses Professional Services Total Central Cell (GC) H.E. Adv. & Publicity
130701 130706 130711 130713 130720 130728 130826
15.00 1.00 4.00 0.00 100.00 10.00 130.00 1000.00
12.00 0.00 0.00 0.00 29.09 0.00 41.09 1470.00
5.11 28.69 28.69 1459.84
5.11 0.00 0.00 0.00 28.69
Total‐2210 North Eastern States Lum Sum Provision GRAND TOTAL % of Expenditure
23400.00 2600.00 26000.00
18167.52 2091.03 20258.55
1488.53 2091.00 20235.96
1493.64 2091.00 20241.07 99.91
Total Budgetary allocation of Grants‐in‐aid under NPCB for the year 2011‐12 : Rs.24850.00 Crores , to North‐Eastern States: 2 rores ;Dated: 23.06.2011; (Rs. In Lacs) Name of Total Budget Funds released Funds released MC Funds State Allocation for Catops (in for new schemes /RIO releas instalments) (install.) ed for procur 1st 2nd 3rd 1st 2nd 3rd ement 2500.00 1300.00 468.68 139.82 1715.40 885.60 244.00 466.80 593.30 1131.86 523.40 2438.98 1735.10 804.92 729.80 1176.00 2355.00 3200.00 407.79 1042.68 270.14 1039.38 1633.55 85.22 1182.79 516.79 101.8 171.54 671.78 1452.44 1109.83 319.42 597.5 875.57 272.66 116.06
ndhra Pd. ihar hhattisgarh oa ujarat aryana imachal Pd. ammu & Kashmir harkhand arnataka erala Madhya Pd. Maharashtra Orissa unjab ajasthan amil Nadu ttar Pradesh ttranchal West Bengal runachal Pd. ssam
142.00 15.00 30.00 101.00 230.89 185.00 145.00 168.00 191.50 2.00 112.00 5.00
Manipur Meghalaya Mizoram agaland ikkim ripura ndman & Nicobar handigarh adar & Nag.Haveli aman & Diu elhi akshdweep ondicherry
224.87 239.90 555.05 189.39 181.27 200.00 99.77 78.70 128.86 64.49 450.57 31.30 137.18 27750.00
173.47 413.98 9694.40
e: Mental Health Centre Wise Progress Report of the Centre of Excellence in Mental Health as on 08:04:2011 Capital Work Support to Faculty and approval for PG Courses Library Equipment Outcome (increase in PG Seats ) 2 MD Psychiatr y seats increased
Update progress with respect to increase in PG Seats Faculty appointed ‐ gra Pre‐Construction: 4 Completed Psychiatry: Prof. 1, Associate Professor‐1, Assistant Professor‐ MD Psychiatry: d) 1 2 seats permitted Clinical Capital Work : Psychologist: Stopped due to non Senior‐2, Junior‐3 availability of funds. The second and third PSW: Assistant instalments have not Professor Selected been transferred in but did not join. As institute’s account by yet PSW‐04 State Health Mission Psychiatric Nursing: Assistant
291 Books procured 35 Books ordered for supply. Timeline annexed.
Professor‐ All the vacant post are filled and new post created in new item budget Permission of state govt and affiliation of university for all the 4 Specialities obtained, Creation of faculty post done for Psychiatry and Psychiatric Nursing. Approval of regulatory bodies obtained only for psychiatric Nursing and 10 students of Psychiatric nursing got admission Financial approval Permission of for creation of new state govt posts obtained. obtained for all Steps for the 4
for Pre‐Construction: Preliminary designs stage/obtaining bad approval of local bodies. Detail design stage with DPR Tendering & award of work is under process. Capital Work: Not yet started
Order placed for books as specified by MCI/INC/RCI will be completed by March 2011.
List of equipments were submitted to Central Medical Supply Organization (CMSO) , at the march end tendering will completed
Psychiatri c Nursing ‐10 seats increased
Pre‐Construction: Preliminary design completed. Detail design completed.
ty h ,
Decided to award the work contract to a Govt. agency HLL Ltd. Capital Work: Land has been allotted in the medical college campus. Construction work will start after the State Election by April 31st, 2011. Pre‐Construction: Done, However department infrastructure is sufficient to start the course immediately. Drawings were prepared and discussed some revision were proposed and return back chief architect to revise accordingly and are awaited. Capital Work: Not yet started
recruitment will be specialities, completed by May, Affiliation of 2011 university obtained only for psychiatry. Approval of regulatory bodies ( MCI, RCI an nursing council) is still pending The posts will be advertised shortly Permission of state govt is not required for any speciality. Affiliation of university obtained for Cl Psychology, PSW & Psychiatric Nursing List of Books has been finalized. Process to procure will be started soon. Procurement is under process
MD psychiatr y ‐1‐2 seats can be increased with the existing faculty
of Pre‐Construction: Preliminary design stage/ obtaining bad approval of local bodies. Capital Work: Not yet started
Preliminary designs: stage/obtaining approval of local authorities done. Capital work: has started Preconstruction: work done DPR being prepared. Will take another 3 months Capital work ‐not yet
8 vacant posts of Assistant Professor of Psychiatry are filled by direct recruitment recently. Necessary proposals are submitted to State Govt. for filling up of posts created under Centre of Excellence Scheme. Advertisement For Faculty Post Being Planned (13 Teachers Are In Different Categories Are Working On Contractual Basis) Creation of one unit of faculty done. One psychiatrist appointed. Process initiated for approval of second
Applied for state govt approval for starting PG courses, Applied for obtaining university affiliation, No progress with respect to
A list of the books to be procured finalized Necessary correspondence was made requesting the Dept. of Social Work, and Nursing Council for the list of books required.
Will be carried No out abreast of progress the construction work.
State Govt Permission , Approval of regulatory bodies and affiliation with the universities is under process Under process
List of books being prepared and tendering is done. Shortly the supplier will supply the books.
There is no place to keep the equipment.
Lists being taken and Post of Librarian/Asst. Librarian and librarian applied, requested for Technical approval
Procurement No of equipments progress yet to be initiated.
unit as per the scheme. Application for initiating courses applied for.
Preliminary design stage/ obtaining approval of local bodies. 2 Detail design stage with DPR 3.Tendering & award of work ‐done Remodelling/renovation of existing /new Academic blocks for psychiatry ,Clinical Psychology social work
The State Government has recently created faculty positions in the specialties of psychiatry, clinical psychology, social work and psychiatric nursing. Approval taken for filling up the vacancies & Creation of new
For MD Psychiatry the process of obtaining state govt permission, approval of regulatory bodies and creation of Faculty post is through.
Orders for books Under process worth 15 lacs already placed to the approved book supply contractor of Govt. Medical College Srinagar .Orders for Journals under process.
1 MD Seat. Increased .
and psychiatric Nursing initiated The process of arranging additional land of about 40 kanals adjusts to the institute by the state government for the institute has also been taken over during the month of October, 2010. The works undertaken by the State Engineering Department will also get completed during the current financial year. (Before 31st March 2011.) men Preconstruction: Plot identified, Drawing al approved sent for cost arh estimate and tendering.
2 MD Seats already there. Increase in 2 more MD Seats. Other allied disciplines can be started subject to the approval of RCI, Nursing council.
Proposal for creation of posts sent to UT administration. Filling up later on.
State govt approval obtained. University affiliation
Books identified. Procurement process being initiated.
Procurement of equipments being planned. To be completed in 8
Psychiatr y seats likely to increased in 2011‐
Capital work : Not yet No time started commitment. However since there is a spare building with indoor capacity of 80 beds , the centre of excellence could be started there till the new building gets constructed. The renovation of this building has already started and likely to be finished by the end of this year Construction of new building likely to start in 3‐4 months and complete in 2.5 years elhi Funds released recently Funds not released.
obtained. MCI nursing council inspection is awaited. RCI Inspection is over. Report waited.
12. Cl. Psycholo gy and PSW course is likely from current year.
Status and Expenditure –Scheme B of Manpower Development Rs. In Lakhs of Heads funded Funds received work 40.60 facility hostel), & Expenditure Incurred 40 Balance remaining .60 Status of work undertaken in Brief
e dical Capital (Academic and an furnishing equipments
Support for Faculty and technical staff Capital work (Academic facility and hostel), furnishing & equipments Support for Faculty and technical staff Capital work (Academic facility and hostel), furnishing & equipments Support for Faculty and technical staff Capital work
Re Ex Construction has reached upto plinth level. Approx. date for completion is by October 2011. Administrative and financial approval taken and equipments have been installed. Approval taken for fulfilling the vacancy & creation of new posts. Posts advertised Matter is in progress at government level. The rooms have been constructed and furniture indented
Approval has been obtained for advertising four posts. Advertisement not done yet
50.32 32.78 Grant not No progress due non receipt of funds
(Academic facility and hostel), furnishing & equipments Support for Faculty and technical staff Capital work (Academic facility and hostel), furnishing & equipments Support for Faculty and technical staff
7.92 No fund allocated ‐
All the posts under NMHP were newly created. All the sanctioned posts under NMHP were advertised. 2 Psychiatric Social Workers and 3 Clinical Psychologists were recruited. The remaining posts could not be filled up due to lack of qualified candidates.
Expenditure on National Mental Health Programme S.No. 1 2 3 Year 2007‐08 2008‐09 2009‐10 General NE General NE General NE General 4 2010‐11 NE TOTAL 8 cr (RE 2010‐11) 264 cr Allocation 28 cr (RE 2007‐08) 10 cr (RE 2007‐08) 58 cr (RE 2008‐09) 12 cr (RE 2008‐09) 50 cr (RE 2009‐10) 5 cr (RE 2009‐10) 93 cr (RE 2010‐11) Expenditure 14.5736 cr 0 23.2622 cr 0 49.3710 cr 2.6194 cr 64.9081 cr (as on 14.02.2011) 0 cr (as on 14.02.2011) 154.7343 cr