district kathua - national health mission

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GOVERNMENT OF JAMMU & KASHMIR

NNAATTIIOONNAALL RRUURRAALL HHEEAALLTTHH MMIISSSSIIOONN

DISTRICT HEALTH ACTION PLAN

DISTRICT KATHUA

December 2007

SPECIMEN DRAFT

RESTRICTED USE

FOR EPOS STAFF UNDERCONTRACT

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PREFACE

The Hon’ble Prime Minister launched the NRHM on 12th April 2005 throughout the country with the

basic objective of providing accessible, affordable and accountable health care in rural areas. Its

primary focus is on making the public health system fully functional at all levels. While detailing the

functioning of the NRHM, the present planning process initiated in the State provides the entire

framework for making the Public Health System fully functional and standardized upto the Indian

Public Health Standards at all levels. In doing so, it emphasizes the need for communitisation of the

Public Health System, improved financing and management of public health, human resource

innovations, and a long-term financial commitment to enable the state and districts to undertake

programmes aimed at achieving the Mission goals.

National Rural Health Mission envisages the planning process to be participatory and decentralized

starting with the Village. It seeks to empower the community by placing the health of the people in

their own hands and determine the ways they would like to improve their health. This is the only

way to ensure that health plans are local specific and need based. The State should facilitate the

processes by providing enabling environment and required financial and technical support. NRHM

was launched in April 2005 and is being implemented by the Department of Health and Medical

Education, Government of Jammu & Kashmir.

In accordance with the National Rural Health Mission, Jammu & Kashmir. The district has

constituted the District Health Mission and significant progress has been made since it’s beginning.

As per the NRHM guidelines, it has merged multiple societies at the district level. The District

Action Plan was the most important aspect of the NRHM and to make District Plan more

meaningful and address local health problems, preparation of Block Health Plans was considered

essential. The decentralized planning process involved village consultations and preparation of

Village Health Plans by the Village Health Water and Sanitation committees; followed by

development of Block Action Plans through integration of Health Facility Surveys and block specific

needs. The Block Action Plans were then integrated to form District Action Plan.

As result of this exercise, the district now has developed capacity for preparing the need based

health action plans following participatory processes. A District Planning Team (DPT) was set up

for this purpose in the month of May 2007 with representation from various sectors concerned with

NRHM. This group was responsible for management of the entire planning process in the district

and also for provision of the technical support. The DPT is the standing body and will take charge

of ensuring implementation of the plan. Thus the DPT not only owns the plan but will also be

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responsible for monitoring the progress of implementation to achieve the objectives of the plan. The

members of the DPT are:

# Name Designation Department

1 Ms. Sarita Chauhan Deputy commissioner District Administration

2 Dr. Jagdish Chander Bhagat Chief Medical Officer Health Dept

3 Dr. Bharat Bhushan Dy. Med. Suptt Health Dept

4 Bharat Bhushan Ex Engineer PHE Dept

5 Sushma Gupta CDPO Social Welfare

6 Ms.Jyoti Balla Distt Prog manager NRHM

7 Yograj Bassam DEPT Education

8 Dr. Bharat Bhushan ADMO ISM

9 Sant Ram C.P.O Distt Com Office

10 H.C Katoch District Coordinator EPOS Health India

11 Ranjeet Sharma District Coordinator EPOS Health India

12 Ghulam Mehdi District Coordinator EPOS Health India

13 Arif Latief District Coordinator EPOS Health India

14 Walayat Ali District Coordinator EPOS Health India

15 Mohd Shafeeq District Coordinator EPOS Health India

16 Rajan Mahajan Regional Head – North India EPOS Health India

17 Sanjeev Arora State Coordinator EPOS Health India

The orientation of DPT, facilitated by EPOS Health India, was held on 30th May 2007. This enabled

the DPT members to not only understand NRHM approach, key components and strategies of

NRHM, but also manage the planning process and develop the District Action Plan. The DPT met a

number of times and the individual members reviewed the situation of their respective

sectors/areas and collectively developed the strategic vision for improving the health status of the

district population. We the members of the DPT on behalf of the entire Core Group reiterate and

certify that this District Action Plan has been prepared through participatory processes. It has been

prepared by integrating the Block Action Plans, Health Facility Surveys and Village Health Plans of

the District. This plan also incorporates the facility improvement needs of 152 Sub health centres,

27 PHCs, 4 CHCs & 1 District in the District.

Name of Chief Medical Officer Signature Date

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CONTENTS

PREFACE.........................................................................................................................4

Executive Summary ........................................................................................................................ 7

ABBREVIATIONS ............................................................................................................................. 9

Introduction..................................................................................................................................... 10

Mission Statement......................................................................................................................... 10

Priority Matrix of District Jammu: ............................................................................................. 11

1. SITUATION ANALYSIS............................................................................................................. 17

Socio Economic and Health Indicators ................................................................................... 32

Socio-economic indicators ......................................................................................................... 32

2. PLANNING PROCESS .............................................................................................................. 65

3. PRIORITIES AS PER BACKGROUND AND PLANNING PROCESS............................. 70

4. GOALS ......................................................................................................................................... 72

5. TECHNICAL COMPONENTS................................................................................................... 74

Part A : Reproductive and Child healthII……………………………………………………74

Part B: NRHM Initiatives…………………………………………………………………..107

Part C: Immunization ……………………………………………………………………...125

Part D : National Disease Control Program ……………………………………………….130

6: Inter-Sectoral Convergence.............................................................................................. 151

7. COMMUNITY ACTION PLAN ................................................................................................ 162

8. Public Private Partnerships .............................................................................................. 164

9. GENDER AND EQUITY........................................................................................................... 167

11. HUMAN RESOURCE PLAN................................................................................................. 177

12. PROCUREMENT AND LOGISTICS ................................................................................... 180

13. DEMAND GENERATION - IEC............................................................................................ 182

14. FINANCING OF HEALTH CARE......................................................................................... 187

15. HMIS, MONITORING AND EVALUATION ........................................................................ 189

Annexure: ...................................................................................................................................... 216

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Executive Summary Kathua district comprises of large unserved and underserved areas due to difficult hilly terrain.

Hence there has been very little development including lack of health facilities, poor transport

network and communication. Although the number of CHCs and PHCs is adequate as per the

population norms there is a need to increase their numbers of CHCs, PHCs and Subcentres

considering the difficult terrain of Subcentres. Not even one of the facilities is as per the IPHS

standards. There is a huge population of Scheduled castes and scheduled tribes are one thirds of

the total population and need to be addressed. 70 most difficult villages especially in blocks Bani,

Bilawar and Basohli have been identified for which special outreach sessions are required.

The health status of district Rajouri is very poor since the district ranks 322 out of 593 districts in

the country in terms of RCH indicators especially the CPR for which the district is 358 in rank. The

data collection and analysis needs strengthening. Regarding the HR status there are huge

vacancies especially of some critical posts like ANMs, MOs, Staff Nurses.

The District Action Plan was developed in a participatory manner with EPOS as a facilitator. There

was wide participation from all the related departments. A District Planning Team was constituted

who carried out the block consultations and the Subcentre level consultations. Facility Survey was

carried out for each facility. The consultations focussed on each of the thematic areas with the

present situation, the bottlenecks, strategies and how to achieve the goals. The hot spots were

identified from the village plans and the Block plans after incorporating the Facility survey reports,

were consolidated to form the district plan. These were approved by the District Health society and

the District Action Plan was finalized after incorporation of the DHS suggestions.

The District Action Plan comprises of the situational analysis, goals and objectives for each of the

defined indicators, strategies, activities, support required from the state, work-plan and the budget

for each of the thematic areas. All the aspects of health have been incorporated including the

NRHM additionalities of ASHA, Untied funds, Mobile Medical Unit, Facilities as per IPHS norms,

the National Disease control programmes, and Intersectoral Coordination and Community

involvement. Capacity building and Human Resources have been dealt with in details. The other

Cross cutting issues of Gender, Logistics and Warehousing, HMIS, IEC and Biomedical Waste

management have been also incorporated.

The priorities of the district include providing services for the unreached, accurate data collection,

strong district management, developing facilities as per IPHS norms and thereby meeting the

national goals of NRHM. The total budget for 5 years is Rs 28451.596 lakhs with an allocation

of Rs 6212.821 Lakhs for the current year.

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District Kathua NRHM BUDGET - AT- A GLANCE (in lakhs)

S. No. Components

2007-08 2008-09 2009-10 2010-11 2011-12 Total

A RCH-II

1 DHS 7.800 8.580 9.438 10.382 19.820 56.020

2 DPMU 370.110 265.711 293.250 323.359 356.327 1608.758

3 Maternal health 211.235 246.471 282.612 328.619 371.943 1440.880

4 Child Health 49.661 8.800 3.700 3.700 3.700 69.561

5 Family Welfare 95.023 91.515 119.101 151.566 202.090 659.293

6 Adolescent Health 65.130 67.018 75.512 82.067 90.815 380.542

7 Gender & Equity 98.100 91.310 100.439 110.359 121.358 521.566

8 Capacity Building 85.168 122.094 124.769 134.020 135.335 601.387

9 HR 1402.646 1568.041 1702.124 1792.803 1883.482 8349.096

10 IEC 309.894 340.883 374.972 412.469 1097.342 2535.560

11 HMIS 115.012 33.621 36.878 40.407 44.235 270.152

Total 2809.779 2844.045 3122.793 3389.751 4326.448 16492.815

B NRHM

1 ASHA 98.400 85.600 86.980 89.565 91.610 452.155

2 SC Untied Fund & Maintenance

35.000 40.000 43.400 44.400 45.400 208.200

3 PHC Untied Fund & Maintenance

29.250 29.250 29.250 29.250 29.250 146.250

4 CHC Untied Fund & Maintenance

7.500 9.000 10.500 12.000 13.500 52.500

5 MMU 83.510 36.201 39.821 43.803 48.184 251.519

6 Upgradation of CHCs 836.576 153.698 129.949 130.226 130.531 1380.980

7 Upgradation of PHCs 840.828 1704.428 297.647 180.909 183.836 3207.648

8 Upgradation of SCs

449.130 720.500 516.731 156.884 117.292 1960.537

9 VHWSC 74.350 75.600 76.450 76.700 76.950 380.050

10 Community Action Plan

22.421 24.663 27.129 29.842 32.827 136.882

11 PPP 20.000 27.700 28.975 29.330 30.828 136.833

12 Health Care Financing

49.880 46.218 47.315 48.421 49.538 241.372

13 Logistics 122.350 5.560 3.808 4.190 4.618 140.526

14 Bio-medical Waste 18.340 20.174 22.196 24.413 26.831 111.955

Total 2687.535 2978.591 1360.152 899.933 881.195 8807.408

C Immunization 305.866 294.194 306.009 317.228 329.224 1552.522

D NDCP

1 RNTCP 30.69 27.875 30.6736 33.74596 37.112056 160.096616

2 Leprosy 2.48 2.48 2.48 2.48 2.48 12.4

3 Malaria 195.52 70.897 76.7637 82.29307 87.188377 512.662147

4 Vector Borne 7.37 8.107 8.9227 9.81397 10.798367 45.012037

5 Blindness Control 43.916 17.3126 19.04686 20.952546 23.0468006 124.2748066

6 IDSP 42.218 23.1768 28.90948 31.861428 35.0995708 161.2652788

7 IDD 5.935 6.5285 7.18135 7.899485 8.6894335 36.2337685

Total 328.129 156.3769 173.97769 189.046459 204.4146049 1051.944654

E Others

1 Inter-Sectoral 81.512 106.902 112.810 119.282 126.400 546.907

Grand total 6212.821 6380.109 5075.743 4915.241 5867.682 28451.596

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ABBREVIATIONS ANC Ante natal Care

ANM Auxiliary Nurse and Midwife

ASHA Accredited Social Health Activist

BPHC Block Primary Health Centre

CBO Community Based Organizations

CHC Community Health Centre

CMO Chief Medical officer

DoHFW Department of Health and Family Welfare

DH Block Hospital

ENMR Early Neo-natal Mortality Rate

EmOC Emergency Obstetric Care

EAP Externally Aided Projects

FRU First Referral Unit

HMIS Health Management Information System

HIV Human immuno-deficiency syndrome

IPHS Indian Public Health Standards

ISM Indian System of Medicine

IMNCI Integrated Management Neo-natal of Child Illness

JSY Janani Suraksha Yojana

IMR Infant Mortality Rate

NMR Neo-natal Mortality Rate

MTP Medical Termination of Pregnancy

MMR Maternal Mortality Rate

MNGO Mother NGO

MO Medical Officer

MH Maternal Health

NNMR Neo-natal Mortality Rate

NGO Non-Government Organization

NRHM National Rural Health Mission

NAMP National Anti Malaria Programme

NLEP National Leprosy Eradication Programme

NKAP National Kala-Azar Programme

NFP National Filaria Programme

NIDDP National Iodine Deficiency Disorder Programme

NBCP National Blindness Control Programme

OPD Out Patient Department

PNMR Primary Neo-natal Mortality Rate

PHC Primary Health Centre

RH Rural Hospital

RCH II Reproductive and child Health Programme-II

RI Routine Immunization

RNTCP Revised National Tuberculosis Control Programme

SDH Sub-divisional Hospital

SHSDP II State Health System Development Project-II

SGH State General Hospitals

SRHM State Rural Health Mission

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Introduction Jammu and Kashmir initially had 14 districts namely Kupwara, Baramulla, Srinagar, Budgam, Pulwama, Anantnag, Leh (Ladakh), Kargil, Doda, Udhampur, Poonch, Rajouri, Jammu and Kathua. But their number has now been increased to 22 by Government Order. The newly added districts in Jammu Division are: Ramban, Kishtwar, Samba & Reasi and in Kashmir Division are: Ganderbal, Shopian, Kulgam and Bandipora. These districts are in the process of boundary demarcation. Total population of the State was 1,00,69,917 in 2001. The decadal growth rate was 29.04 during 1991-2001. Overall density of population in the State was 90 persons per square Kilometre. Sex ratio was 900 females per thousand males. Mission Statement The Mission of the department of Health and Family Welfare is to work in active partnership with the community to ensure health and well being of all its citizens. Vision The vision of the government of J & K is to achieve the goals and objectives envisaged in the NPP-

2000, NHP-2002, and the 10th Plan and those under NRHM. We envision path breaking progress

and development in healthcare delivery in all the districts in the state. We plan, making available the necessary health care for improving the primary health care services, secondary health care, specialised medical care through an integrated, focused and participatory programme. Based on earlier lessons learnt from implementation of various health programmes and projects, the project incorporates certain changes such as adopting a uniform structure of the program; strong supervision and monitoring with advanced analytical tools; and greater inter-sectoral convergence at all levels. The Road Map The Road Map to achieve the aforesaid vision is that the State would strive for achieve various indicator in a rising trend mode, that is, in the earlier years (say FY 2007 and FY 2008) the objectives are to be achieved a bit slow initially but picking up in FY 2009 through to FY 2011. There is a need to schedule extension and up gradation of services over five years period keeping in view growth in population and absorptive capacity of the State in general and district in particular. The support and resources made available through NRHM initiatives and through convergence would be utilised for the purpose. In order to propel and sustain the desired progress, there is an urgent need to construct, upgrade and renovate health infrastructure and health facilities to make them fully functional. Consequently, more investment is needed upfront on creation of the necessary infrastructure, construction, civil works, renovation and maintenance. There is a need for increased investment in this respect in earlier years (say FY 2007 and FY 2008) in this respect. Also, a lot of activities cannot materialise due to the shortage of human resources in the state health services. Thus, there is an urgent need to recruit professionals and support staff on a priority basis. In the short term, this may be achieved by filling vacancies on contract basis. However, to attract requisite staff, compensation needs to be based on reasonable calculations. It needs to be attractive enough for persons to join and continue.

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Priority Matrix of District Jammu:

S.No Thematic Area Critical Issues of the District Specific Priorities

1. District Health

Management:

� Functional integration of

vertical societies like

Blindness Control Society,

TB Control Society, District

Malaria Society etc.

� Monitoring and evaluation.

� Societies need functional integration

and strengthening.

� Capacity building of the DHS

members regarding the programme,

their roles, various schemes and

mechanisms for monitoring and

regular reviews and also operational

guidelines for running the District

Health Society.

� Monitoring of health activities by

health personnel only. Members from

other departments and also from the

elected representatives need to

become members for better

monitoring and implementation.

� Strengthening the functioning of the

DHS.

2. District & Block

Programme

Management

� Need for providing more

technical support to the

CMO office for better

implementation especially

in light of the increased

volume of work in NRHM.

� Strengthening the

monitoring and reporting

especially in the areas of

Maternal and Child Health,

Civil works, Behaviour

change and accounting

right from the level of the

Subcentre.

� Development of total clarity at the

district and the block levels amongst

all the officials and Consultants about

NRHM activities

� Training of district officials and Block

SMOs for programme management

� Streamlining Financial management

and systems

� Strengthening the CMO office with

DPMU with extra computers,

telephone system and human

resources.

� Capacity building of the DPMU

personnel for monitoring

� Strengthening the Block

Management Units by establishing

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BPMUs.

3. Reducing

maternal and

child deaths

and Population

stabilization

� Lack of 24X7 facilities for

safe deliveries in

subcentres and PHCs.

� Lack of authentic data

regarding the maternal and

infant deaths in the district.

� Equipments are not

working properly or not

available as per the need in

subcentres, PHCs & CHCs

to provide quality services.

� Lack of facilities with for

emergency obstetric care.

� Non-availability of

Specialists for an

aesthesia, obstetric care,

paediatric etc.

� Lack of referral transport

systems.

� Lack of Blood Storage

facilities at FRUs

� Lack of Neonatal care

facilities at FRUs

� Increase coverage of full ANC and

Postpartum Care to pregnant women

� Increase in Institutional deliveries by

operationalsing 24X7 PHCs

� Strengthen FRUs for Emergency

Obstetric Care services along with

minimum basic infrastructure, Blood

Storage facilities, Facilities for

Neonatal Care, drugs and

equipments.

� Increase availability of safe abortion

services at all block level CHCs/

PHCs.

� Increased coverage under JSY

� Strengthening the Village Health Day

� To increase awareness among

mothers and communities about the

importance of institutional deliveries

� Improved behaviour practices in the

community

� Operationalization of all the

sanctioned Anganwadis

4. Family Planning

Low level of FP acceptance

due to lack of awareness or

motivation and low male

participation

� Increased awareness for Emergency

Contraception and 10 yr Copper T

� Decreasing the Unmet Need for

Family Planning

� Ensure availability of all FP methods

at block level facilities.

� Train more MOs for NSV and

promote the same.

� Partner with private doctors for FP

and RCH services

� Increasing Access to Emergency

Contraception and spacing methods

through Social marketing

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� Building alliances with other

departments, PRIs, Private sector

providers and NGOs

5. Adolescent

Health

� Adolescents especially the

boys are exposed to

smoking, addictions, peer

pressure and there is no

one to counsel them.

Teenage pregnancies also

emerging as a problem and

unsafe abortion &

premarital sex trend are on

rise.

� Implement ASRH programme to

increase the knowledge levels of

Adolescents on RH and Life skills

� Implement of Kishori Shakti Yojana

in coordination with ICDS and NGOs.

� Operationalise Adolescent Friendly

Health services at the health facilities

6. Mobile Medical

Units (MMUs)

� Remote population is not

covered due to lack of

required staff,

infrastructure.

� Communications system is

poor.

� Coverage of the tribal populations

which are migratory in blocks.

� Provide one-MMU equipped with

GPRS for services.

� Contract MOs and staff nurses for

MMUs

7. Upgrading

CHCs to IPHS

� None of the CHCs are as

per the IPHS standards but

condition of CHC Bani and

CHC Basoli is deplorable

needs to be upgraded.

Following CHCs needs to be upgraded

as per IPHS Standards in the first year:-

� CHC Hiranagar

� CHC Bilawar

The other 3 CHCs also need to be

brought to IPHS standards

8. Upgrading

PHCs for 24 hr

Services and

IPHS standards

� None of the PHCs are as

per the IPHS standards.

Out of 39 PHCs and

Allopathic Dispensaries, 26

PHCs are housed in

government buildings and

13 are still functioning from

rented accommodation with

out sufficient facilities.

� Construction of 16 buildings PHC

buildings as per IPHS standards.

Names of PHCs are enclosed as

Annexure-1

� Construction of staff quarters in 11

govt. PHC (Names of PHCs given

in Annexure – 1)

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9. Upgrading Sub

Centres to

IPHS standards

� None of the Subcentres are

as per he norms of IPHS

� Out of 152 subcentres, 91

subcentres are running in

rented buildings and 61

subcentres are running

from government owned

buildings.

� There are no labour rooms

in any of the Subcentres for

Institutional deliveries

� The numbers of

Subcentres is also

inadequate

� Need to construct 91 Subcentre

buildings (Names of SCs are

enclosed as Annexure-2)

� Construction of staff quarters in all

subcentres for ANM’s stay. (Names

of subcentres given in Annexure)

� Construction of Labour rooms at all

Subcentres for promoting institutional

deliveries

10. Immunisation � Lack of awareness to

mothers

� Alternate vaccine delivery

� Lack of Cold storage

� Efficient monitoring and

supervision

� Gaps in difficult, flung

areas & inaccessible areas

� Reporting and

documentation

� Large number of cold chain

equipment are not

functional and need repair

or need to be replaced

� Strengthening the District Family

Welfare Office

� Enhancing the coverage of

Immunization

� Alternative Vaccine delivery

mechanisms in place

� Effective Cold Chain Maintenance

upto sub centre level

� Zero Polio cases and quality

surveillance for Polio cases

� Close Monitoring and documentation

of the progress

� Repair and replacement of cold chain

equipment as per the need

11. Inter Sectoral

Convergence

Lack of coordination b/w ICDS

and health department

Linkages to be developed between ICDS

workers and health workers for timely

diagnosis of malnourished children and

their management (detailed activities

under thematic heads)

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Lack of coordination b/w RDD


Linkages to be developed between the

Health Department and the Rural

Development department

• Improving the health standard &

general quality of life of rural

community.

• Awareness on sanitation/ Hygiene &

health education.

• Covering of school/ Anganwari in

rural areas with sanitation facilities &

promote Hygiene education &

sanitary habits among students.

• Promote & encourage cost effective

construction of household latrine &

their proper use.

• Elimination of open defection to

minimise the risk of contamination of

water source & food.

Lack of coordination b/w PHE


• Bleaching powder and chlorine

tablets will be provided by PHE and

distributed by field functionaries to

households

• Joint communication strategy.

• Copy of water quality monitoring

reports generated by IPH department

will be shared with the Health

Department at block, district and

state levels

• Community based organisations

formed under various

programmes/sectors will be engaged

by a team of frontline workers –

health, ICDS and PHE departments.

12. Human

Resource

Lack of manpower at all levels

starting from sub centres to

PHCs to CHCs to DH in district

Kathua

• All staff to be in place as IPHS norms

by 2012

• Increased salaries for contractual

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Sub centre level

• The number of sub centres

will have to be increased

from 152 to 227

• The requirement of ASHAs

will be around 680

• The requirement of ANM

will be around 304 in

Government as per IPHS

norms of 2 ANMs per Sub

centre.

PHC level

• The PHC are adequate

• As per IPHS 2 MOs per

PHC will be required

whereas at resent there is

only one MO per PHC

CHC Level

Likewise there are many

vacancies of specialists and

support manpower at CHCs

doctors and Specialists

• Special allowances for Regular staff

• Increase in the number of training

centres for LHV, ANM, Staff Nurses,

Lab Technicians

• Rational placement of Specialists

and trained staff

• Recruitment of staff on contract

where vacancies

• Recruitment of staff for new facilities

as per the infrastructure

requirements

• Computers at all PHC and for each

MO and Specialist at the CHC

• Allowing Specialists and MOs for

developing special skills as per their

needs by attending special courses

anywhere in India.

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1. SITUATION ANALYSIS

Profile of the District

Kathua District is situated at 320 17' to 320 55’ North Latitude and 750 70' to 760 16’ East

longitude. The District is surrounded by Punjab in the South-East, Himachal Pradesh in North-East,

District Doda and Udhampur in North and North-West, Jammu in the West and Pakistan in the

South-West. It has an area of 2651 Sq kms. The district can be conveniently divided into three

distinct Agro-climatic regions. The area falling South of Pathankote-Jammu-Srinagar National

Highway consists of deep alluvial soils. The area is mostly irrigated and quite productive. This area

touches Pakistan and Punjab border and it is also popularly called Border Area. The second zone

falling north of the National Highway extends upto foothills of Himalayas and falling mostly in

Shivalik ranges is called Kandi area. It is characterized by shallow soils full of boulders with

negligible natural water resources. The area faces acute shortage of water and the productivity of

the land is very marginal. Part of Kathua, Barnoti, Hiranagar, Ghagwal, Basohli and Billawar block

falls in this category. The third area falls beyond Shivalik ranges and extends upto to Peer Panjal

ranges. This area is mountainous in nature with little potential for agriculture.

The district has a reporting area of 2.65 lakhs Hectare as per revenue records out of which 0.45

lakhs Hectare is agricultural use, 0.36 lakhs Hectare constitutes barren and uncultivable land

excluding follow land, 0.12 lakhs Hectare accounts for culturable waste, 0.13 lakhs Hectare is

under misc. trees, 0.10 lakhs Hectare forms permanent pastures, 0.01 lakhs Hectare is fallow land

other than current fallows, 0.14 lakhs is the area under current fallows and 0.61 Hectare is net area

sown. According to the agricultural census of 1991-92, the district had 69508 number of land

holding of different sizes. Out of these 60.15% were of below one Hectare and only 39.85% were of

the sizes of one Hectare and above which indicates that large number of land holding are very

small.

Though there is no detailed and fully documented history of Kathua district. It is believed that Jodh

Singh a famous Rajput of Andotra clan migrated from HASTINAPUR to KATHUA nearly 2000 years

ago and settled here. The three Hamlets of Taraf Tajwal, Taraf Manjali and Taraf Bhajwal were

established by his three sons Viz. Teju, Kindal and Bhaju. Their descendent are now called as

Tajwalia, Bhajwalia and Khanwalia Rajputs of Andotra sub-caste. The conglomeration of these

three hamlets was loosely called “KATHAI” in earlier times which with the passage of time came to

be called as KATHUA.

Greek historians, who provide an insight into the ancient history of JAMMU HILLS prominently,

record the existence of two powerful empires of Abhisara (Present day POONCH) and KATHAIOI at

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the time of invasion of India by ALEXANDERA, Strabo describes KATHAIOI as a mighty republic of

that era located in the foot hills along river RAVI. The topography of KATHAIOI corresponds with

the present day KATHUA. Starbo describes the people of the republic as epitone of bravery and

courage and records that they gave a tough fight to invading Army of ALEXANDERA.

Kathua District is broadly comprises three distinct zones Viz. Border, Kandi and Hilly. Billawar, Bani,

Basohli and Lohai –Malhar Blocks of the district comes under HILLY Area, The culture of this area

is PAHARI which resembles the culture of Himachal Pradesh. The other part of the district has

DOGRA Culture.

Dogri is the main language spoken by the people of the district. Though the Dogri spoken in some

parts of the district has the influence of Punjabi tone also but the rural areas specially the Hilly

areas are free from Punjabi. Their other main language is Pahari. However a very small section of

the Population residing in Lohai-Malhar and BANI Blocks also speaks Kashmiri. GOJRI is also

spoken by the Gujjar Community settled here and there. Hindi, English and Urdu are the main

medium of education. Official language is Urdu.

The district is culturally an integrated part of Jammu region and all important religious fairs like

Lohri, Maha Shivratri, Id-ul-Fitr, Holi, Ramnavmi, Baisakhi, Basantpanchami, Martyr’s day of Guru

Arjun Dev, Raksha Bandhan, Janam Ashtami, Mahanavami, Dussehra, Diwali, id-ul-zuha, Guru

Ravi Dass’s b’day, Mahatma Gandhi’s b’day Guru Govind Singh’s b’day, Chacha Nehru’s birthday.

Above all, the Independence Day and Republic Day are celebrated with great enthusiasm. Holy

Navratras also provide special occasion for worship and pilgrimage to holy places culminating into

small to big fairs. Ram Lilas are organized in every town as well as in every village of the district.

The most famous Ram Lila is performed in BASOHLI.

The most important Minerals in the district are Cement Grade Lime Stone in Basohli area. Low

Grade Iron deposits in Lohai-Malhar block, Gypsum deposits in village Daulla in Basohli tehsil and

Slates in Duggan nallah and near Sewa Nallah in Bani block. Another mineral found near siare in

Bani block is Quartzide used in glass making. Bentonite is available in Surrara area of Hiranagar

tehsil. Fullersearth, useful in drugs, cement and plaster is also available in the district. Alum exists

in Serai nallah near Ramkote and Ujh River. Clay of various colours and varieties is also found at

many places.

Kathua District is spread over an area of 2651 Sq. Kms constituting 1.9 percent of the total area of

the State. The District has a population of over 5,44,206 comprising 2,85,308 Males and 2,58,898

females as per 2001 census. The density of population of the district has gone upto 205 persons

per Square Km. Sex ratio is 907 females per 1000 male. Literacy Rate in Kathua district is 65.29%.

The literacy percentage in case of Males is 75.73% and in case of Females is 53.92%. As regards

19

the main ethnic groups, Hindus constitutes 91% of the district while Muslims form 7% and Sikhs 2

%. SC Population is 22.83%.

Out of total population of the district, 28.82% were main workers, 14.58% marginal workers while

as 56.60% were non-workers. However among the main workers, cultivators and agricultural

labourers accounted for 60.74% and 5.67 % respectively which obviously indicates that

dependence on agricultural is of much more significance than any other sector/ occupation.

In district Kathua, there are 152 subcentres, 39 PHCs, 4 functional CHCs and one district hospital

As per IIPS, the district Kathua ranks 322 out of 593 districts in the country in the RCH indicators, 279 on the basis of Women having three or more children, 358 on the CPR, 279

on the Basis of Under 5 mortality and 358 on the basis of 3 or more ANC visits.

As per IIPS, the district Kathua ranks 322 out of 593 districts in the country in the RCH INDICATORS, 279 on the basis of women having three or more children, 358 on the CPR, 279 on the Basis of under 5 mortality and 358 on the basis of 3 or more ANC visits.

20

Distinguishing features

There are certain features in respect of J and K State in general, and Kathua district in particular,

which have affected the availability and reliability of data. Some of the useful features of the district

are as under.

� Parts of the districts are hilly. In certain CD Blocks most of the portion is inaccessible and

hilly. Further, forest covers good proportion of the area of the districts. Consequently,

depending upon topography, all the districts consist of difficult and inaccessible areas.

While it is difficult for the people to access services, on one hand, on the other, it is also

difficult for health services to extend, upgrade and improve services. It is difficult to organise

outreach activities and maintain regular supplies, especially in the context of essential

medicines, vaccines, etc.

� Due to the lack of amenities, it is very difficult to attract and retain human resources. There

are significant number of vacancies in respect of various professional (specialists,

surgeons, GDMOs), nursing, technical and support staff. This necessitates development of

human resources policies and strategies appropriate to the region. In this connection modes

like PPP and contracting may be used but after proper elaboration of the terms and

conditions and payment system

� There seems to be different administrative units prevalent in respect of different agencies

(Census, Revenue Department, Medical and Health, etc.). The Medical and Health

department has Medical Blocks. There are Tehsils, Community Development Blocks,

Medical Blocks, Panchayats, Patwar Halqas, Gram Sabha and Villages. The units, which

are conventional and are adopted by Agencies like Census and Rural Development

Department may be taken as popular units than inventing or adopting different

administrative units (for example Medical Blocks). It is some time difficult to reconcile

geographical areas covered by them, which renders it impossible to compare data

emanating from different units.

� Even at the lowest level, the concept of village is a bit misleading. Excepting some, most of

the villages do comprise a number of settlements with different names than the overall

village; commonly known as ‘Modas’. Usually it takes considerable time to travel from one

settlement to another, especially in hilly areas. This aspect is particularly important, inter

alia, when we chose Anganwadi Worker or ASHA or conduct immunisation sessions.

21

� As motorable roads do not connect all settlements, travelling on foot and local modes of

transport becomes necessary. At some hilly and inaccessible places, mules are resorted to

for transportation of supplies as well as ill or incapacitated persons. Consequently while

tackling about the issues of accessibility (from the side of community) as well outreach and

ensuring timely supplies (on the part of Health Department and other agencies), these

factors need to be taken into account and provided for in the future plans.

Administrative Structure:

Structure Details

Sub Divisions ( 3) Basohli, Bani, Lohai-Malhar

Tehsils ( 4) Kathua, Hiranagar, Billawar, Basohli

Community Development and NES Blocks ( 9 )

1. Bani 2. Barnoti 3. Basohli

4. Billawar 5. Duggan 6. Ghagwal

7. Hiranagar 8. Kathua 9.Lohai-Malhar

Health department Blocks (5) Hiranagar, Billawar, Basholi, Bani, Parole

Educational Zones (13)

1. Kathua 2. Barnoti 3. Marheen

4. Sallan 5. Hiranagar 6. Ghagwal

7. Lakhanpur 8. Basohli 9. Billawar

10. Bani 11. Lohai- Malhar 12. Mahanpur

13. Bhaddu

Municipal Council (1) Kathua

Municipalities 1. Lakhanpur, 2. Parole 3. Hiranagar

4. Basohli 5. Billawar

No. of CHC 4

No. of PHC 39

No. of Sub-Centres 152

Panchayati Raj Institution: 3 Tier Setup

Total Villages : 588

Village Level : Panchayat

Total Gram Panchayats : 183

Block Level : Panchayat Samiti

District Level : Zila Parishad

22

Number of villages by Blocks 2001

Blocks Number of villages / Panchayats by Blocks

No. of Panchayats Inhabited Uninhabited Total

Kathua 22 101 3 104

Barnoti 31 131 6 137

Hiranagar 24 106 5 111

Ghagwal 18 77 4 81

Basohli 24 43 0 43

Bani 10 20 -- 20

Billawar 32 49 -- 49

Lohai - Malhar 14 16 -- 16

Duggan 8 13 1 14

Total 183 556 19 575

Source: District Statistical Handbook Kathua

Medical Administrative Sectors

Block No of

Sectors

Names of Sectors

1 Parole 9 Barwal,Budhi,Lakhanpur,Dhanni,Kharote,Basantpur,Ghati,Float,Parole

2 Hiranagar 8 Rattanpur, Ghagwal, Sanoora, Hariachak, Dinga Amb, Marheen,

Bhaiya, Chakra

3 Billawar 12 Badnota, Hakwal, Sukral, Kohag, Malhar, Uchapind, Goduflal,

Ramkote, Marhhedi , Bhaddu, Lohai, Banjal Bhadwal

4 Basoli 7 Saranghat,Mahanpur,Plassi,Karanwara,Sandhar, Bhoond,Hutt

5 Bani 3 Kati Chandyar, Dhaggar, Sandroon

Total 39

Source: CMO Office

Educational Institutions

NAME Units

No. of Degree Colleges 1 (Kathua)

No. of High/ Hr Sec. Schools 91

No. of Middle Schools 229

No. of Primary Schools 682

No. of ITI Colleges 5

No. of Police Training School 1 (Kathua)

No. of DIET Institutes 1 (Basohli)

Source: District Website

23

NAME REF.YEAR MAGNITUDE

Total Population 2001 Census 5,44,206

Male Population 2001 Census 2,85,308

Female Population 2001 Census 2,58,898

Rural Population 2001 Census 4,66,870

Urban Population 2001 Census 77,336

SC Population 1981 Census 0.84

Sex Ratio 2001 Census 907 Females per 1000 Males

Literacy 2001 Census 65.29 %

Male Literacy 2001 Census 75.73 %

Female Literacy 2001 Census 53.92 %

No. of House Holds 1981 Census 0.61

Occupied Residential 1981 Census 0.58


Status of ICDS Programme as on 13.4.07

Block No of AWCs

Sanctioned Operational Reporting

Kathua 203 202 202

Hiranagar 145 145 145

Billawar 214 214 214

Basohli 130 127 127

Bani 76 76 76

Barnoti 191 191 191

Ghagwal 115 115 115

Lohi Malhar 72 72 72

Duggan 44 44 44

Total 1190 1186 1186

Source: Director Social Welfare Jammu

Tehsil wise population of district Kathua as per 2001 census

Tehsil Males Females Total

Basohli 49355 45431 94786

Billawar 61665 57000 118665

Hiranagar 80124 74156 154280

Kathua 94164 82311 176475

Total 285308 258898 544206


24

Population as per Census

1961 1971 1981 2001

Persons Male Female Persons Male Female Persons Male Female Persons Male Female

Total 207430 108899 98531 274671 142989 131682 369123 192570 176553 550084 289391 160693

Rural 191895 100598 91297 249586 129843 119743 327133 170406 156727 471356 246478 124878

Urban 15535 8301 7234 25085 13146 11939 41990 22164 19826 78728 42913 35815

Source: Census. (1991 census not carried out only estimates available)

Population Growth

Decade Decadal Growth Of Population

Percentage

Kathua District Jammu & Kashmir

1901-11 1.60 7.16

1911-21 1.59 5.75

1921-31 4.64 10.14

1931-41 0.27 10.36

1941-51 8.40 10.42

1951-61 7.75 9.44

1961-71 30.29 29.65

1971-81 34.39 29.69

1981-91 21.94 30.34

1991-2001 22.21 29.98

Source: Census Deptt

Population by Religions - 1981-2001

Pop. Muslim Hindu Sikh Budhist Christian Others Total Scheduled Caste

1981 25699 336503 6082 15 820 4 369123 84308

2001 44793 493966 9152 138 1458 577 550084 127364

Source: Directorate of Economics & Statistics

No. of births & deaths

Year Births Deaths

Mid year

Population Birth rate Death rate Natural Growth rate

2005 16788 829 575126 29.19 4.092 24027

Source: Directorate of Economics & Statistics

25

Month Wise Position Of Births & Deaths Recorded By The Registration Units

During January 2006 To December 2006

No. of Registration Units 22

BIRTHS

Month Jan Feb March April May June July Aug Sep Oct Nov Dec Total

Total 1189 953 249 554 791 735 810 1085 948 782 949 960 10005

Deaths

Month Jan Feb March April May June July Aug Sep Oct Nov Dec Total

Total 228 157 27 62 153 195 294 226 138 157 182 219 2038

Source: Birth & Death Registration

Identifying Information

Name of District Kathua

Name of District Headquarters Kathua

No. of Blocks in the District 9

No. of Gram Panchayats in the District 183

No. of Villages 587

No of Uninhabited villages 32

No. of Households 96393

1-199 105

200-499 163

500-999 110

1000-1499 78

1500-1999 46

2000 – 3000 39

3001-5000 13

Size of Villages

5000+ 2

Villages without motorable roads 97

Villages without electricity 37

Villages given Potable drinking water 555

No. of Towns 6

Municipal

Corporation

Municipality 1

Notified Area

Committee

Urban Local Bodies (ULB)

Others

26

Un-served / underserved / vulnerable areas, population in the District

There are a large number of Underserved populations and areas in the district Kathua.

� The Total Population of Scheduled Caste is 127364 (23.2%) and is mainly in Blocks Kathua

and Hiranagar.

� The total ST population is 34174 (6.2%) with predominance in the block of Basholi. The tribes

are mainly Bakarwal and Dhodhi Gujjars. These are comprised of Nomadic tribes and are

mainly involved in livestock. During winters they migrate to the low lying areas for grazing of

animals

� The total no. of BPL families in district are 28064 and is distributed in all the blocks.

Year No. of BPLFamilies

Surveyed Identified Below Poverty line Selected for Uplifting During Year

2005-06 72032 28064 292

Source: District Statistical Handbook Kathua

� The National Highway 1A passes through the district Kathua hence giving rise to accidents.

� In the rainy season large number of areas get affected by floods causing Jaundice, skin

problems, allergies, waterborne diseases and injuries:

� Tarnah nala, a stretch having 22 KM Arial distance is vulnerable for seasonal floods. A sizeable

population get adversely affected by floods every year. The nearest Allopathic dispensary is AD

Chakrah. The team of Medical officer along with one pharmacist caters to the medical needs of

affected population to the extent possible. The team does not have any govt. vehicle to provide

services in the area during flood.

� The surrounding area near PHC Haria Chak is often affected by seasonal floods in rivulet

known as Bhag Nala.

� In Gaghwal and PHC Rattanpur area another rivulet i.e. Behinala affects the local area with

flood. This area also touches the international boarder with Pakistan.

Normally the above mentioned areas get afflicted in Period of June to August. The department

of Health constitutes a mobile team and normally govt. buildings are used for transit camps. But

this is very inadequate.

� Brick line sites/ construction labour/ Crasher/ Rice mills are another source of concern. Many

small and medium industries are operational leading to huge populations of migrant labour. The

27

air pollutants released by these units leads to respiratory disorder (Asthma, ARI etc) among the

community living nearby. Due to inadequate health facilities for the labour working at these

sites there is a huge problem of RTIs/ STDs, Tuberculosis. Last year there was a large number

of children afflicted with Measles migrant labour.

� Pilgrimage sites are also cause of concern in relation with health of the pilgrims especially

hygienic food, water and sanitation. In general pilgrimage takes place round the year but heavy

influx of pilgrims is there from June to August. Three prominent sites have been identified

where the food is served free of cost to pilgrims. These are Shanrodyan, Mela mode, Nonath

Ashram. For tackling the health issues in the pilgrimage sites the Health department constitutes

a team of three pharmacists to cater to the health needs of the pilgrims.

� Scattered population in district Kathua: The hilly areas in Bani, Basholi, Kandi (Karote) & along

the Indo Border have scattered population and these areas are not easily accessible.

Block-wise Data on Population

Block

Total

Populati

on

Male

Populat

ion

Female

Populat

ion

Sex

ratio

Numb

er of

House

hold

Total

Popul

ation

06

Years

Male 06

Years

Femal

e 06

Years

Sex

ratio 06

Years

Literac

y Rate

Billawar Total 118444 61254 57190 934 19486 19366 10216 9150 896 55.9

Billawar Rural 113804 58747 55057 937 18596 18783 9881 8902 901 55

Billawar Urban 4640 2507 2133 851 890 583 335 248 740 76.3

Basohli Total 94921 49519 45402 917 15532 16329 8575 7754 904 52.1

Basohli Rural 88976 46310 42666 921 14407 15618 8192 7426 906 49.7

Basohli Urban 5945 3209 2736 853 1125 711 383 328 856 86.2

Kathua Block Total 181852 97876 83976 858 32688 24425 13369 11056 827 71.5

Kathua Block Rural 122146 65663 56483 860 21533 17411 9477 7934 837 67.6

Kathua Block Urban 59706 32213 27493 853 11155 7014 3892 3122 802 79.3

Hiranagar Total 154867 80742 74125 918 28687 21182 12008 9174 764 73.6

Hiranagar Rural 146430 75758 70672 933 27222 20253 11475 8778 765 73

Hiranagar Urban 8437 4984 3453 693 1465 929 533 396 743 83.6

Kathua Total 550084 289391 260693 901 96393 81302 44168 37134 841 65.6

Kathua Rural 471356 246478 224878 912 81758 72065 39025 33040 847 63

Kathua Urban 78728 42913 35815 835 14635 9237 5143 4094 796 80.1

Source: Census of India 2001

28

Block-wise Data on SC & ST Population

SC Population ST Population

Block Total Male Female

Sex

ratio

Perce

ntage Total Male Female

Sex

ratio

Perce

ntage

Billawar Total 24575 12681 11894 938 20.7 8978 4652 4326 930 7.6

Billawar Rural 23649 12193 11456 940 20.8 8868 4589 4279 932 7.8

Billawar Urban 926 488 438 898 20 110 63 47 746 2.4

Basohli Total 14710 7653 7057 922 15.5 14098 7304 6794 930 14.9

Basohli Rural 13871 7200 6671 927 15.6 14097 7303 6794 930 15.8

Basohli Urban 839 453 587 852 14.1 1 1 0 0 0

Kathua

Block Total 51231 27214 24017 883 28.2 8526 4528 3998 883 4.7

Kathua Block Rural 36557 19453 17104 879 29.9 7812 4085 3727 912 6.4

Kathua Block Urban 14674 7761 6913 891 24.6 714 443 271 612 1.2

Hiranagar Total 36848 19333 17515 906 23.8 2572 1285 1287 1002 1.7

Hiranagar Rural 35447 18589 16858 907 24.2 2537 1266 1271 1004 1.7

Hiranagar Urban 1401 744 657 883 16.6 35 19 16 842 0.4

Kathua Total 127364 66881 60483 904 23.2 34174 17769 16405 923 6.2

Kathua Rural 109524 57435 52089 907 23.2 33314 17243 16071 932 7.1

Kathua Urban 17840 9446 8394 889 22.7 860 526 334 635 1.1


29

Literacy Rate

Sub-districts Area Literates Literacy rate

Persons Males Females Persons Males Females

Billawar Total 55,400 35,107 20,293 55.9 68.8 42.2

Rural 52,303 33,228 19,075 55.0 68.0 41.3

Urban 3,097 1,879 1,218 76.3 86.5 64.6

Basholi Total 40,983 27,126 13,857 52.1 66.3 36.8

Rural 36,471 24,516 11,955 49.7 64.3 33.9

Urban 4,512 2,610 1,902 86.2 92.4 79.0

Kathua Total 112,569 66,645 45,924 71.5 78.9 63.0

Rural 70,765 42,585 28,180 67.6 75.8 58.0

Urban 41,804 24,060 17,744 79.3 85.0 72.8

Hiranagar Total 98,418 56,776 41,642 73.6 82.6 64.1

Rural 92,138 52,723 39,415 73.0 82.0 63.7

Urban 6,280 4,053 2,227 83.6 91.1 72.8

District Kathua Total 307,370 185,654 121,716 65.6 75.7 54.4

Rural 251,677 153,052 98,625 63.0 73.8 51.4

Urban 55,693 32,602 23,091 80.1 86.3 72.8


Development Indicators of the District

SN Indicators State District as per District data

1 Crude Birth Rate 18.7 SRS -05 29.19 (Dir of Eco & Stat 2005)

2 Crude Death Rate 5.6 SRS -05 4.092(Dir of Eco & Stat 2005)

3 Infant Mortality Rate 49.0 SRS -05 50 (DLHS)

5 TFR 2.4 NFHS III 3.1(IIPS)

6 Couple Protection Rate 53 % NFHS III 45.6% ( DLHS-II)

7 Decadal Growth Rate 29.93 29.98 Census 2001

8 Population Density 99/ sq. km 207 Census 2001

9 Sex Ratio (General) 900 Census 2001 901 Census 2001

10 Sex Ratio (0 – 6 years) 937 Census 2001 841 Census 2001

11 Sex Ratio at birth DNA DNA

12 Literacy rate (overall) 54.46 Census 2001 65.29% Census 2001

13 Literacy rate (male) 65. 75 Census 2001 75.73% Census 2001

14 Literacy rate (female) 41.82 Census 2001 53.92% Census 2001

T 66841

M 37013 15

Enrolment of

students elementary

education F 29828

Source: Census, 2001; DLHS-RCH-II Survey, 2004, CMO office

30

District Kathua Composite Index for RCH based on Selected Variables

Source: National Commission on Population 2001

Abbreviated Description and Source Value

RCHI Reproductive and Child Health Status Index, Present Study 0.77

PBO3P Percent of Births of Order 3+ During 3 Years Prior to Survey, RHS-RCH 24.6

CWR Children 0-6 years to Women 6 and Above, Census 2001 363.91

CUAM Percent Couples Using Any Contraceptive Method, RHS-RCH Reports 63.70%

PGMB18 Percent Girls Married Below Age 18 Years, RHS-RCH Reports 0

PPANC Percent Pregnancies During Last 3 Years Availing Antenatal Care, RHS-RCH 65.50%

PDHI Percent Deliveries in Health Institutions During Last 3 Years, RHS-RCH 30.50%

PCWCI Percent Children Completely Immunized, Aged 1+ & Born During Last 3 Yrs. 75.10%

COMI Composite Index, Present Study 0.63

RCHR District’s rank as per RCH-status Indices (RCHI) in Ascending Order 370

COMR District’s rank as per composite indices (COMI) in Ascending Order 359

CBR and TFR District Kathua

Indicator Religion Hindu Muslim

CBR 24.9 22.9 32.3

TFR 3.1 2.8 4.3

Source: EPW Jan 29, 2005

Year TFR Percent 1& 2 births DLHS 2001

1981 5

1991 NA

IIPS 2001 2.9 66%

Source: IIPS

DLHS-RCH-II Survey, 2004

Related to Pregnancy and Maternal Health

Issue % Issue %

Mean age at marriage for boys 27.4 Mean age at marriage for girls 22.5

Boys married below legal age at marriage 21 years 0.9 Girls married below legal age at marriage 18 yrs 3.0

Any antenatal check up 73.7 Antenatal check up at home 0.00

3 or more antenatal check ups 39.4 Who had one TT injection during pregnancy 19.8

Who had two or more TT injection during pregnancy 52.8 Who had no TT injection during pregnancy 17.7

Who received 100 or more IFA tablets during

pregnancy 7.6

Who consumed two or more IFA tablets regularly

during pregnancy 26.6

Received adequate IFA tablets/syrup 7.6 Who consumed one IFA tablet regularly 23.3

Full ANC1 - (At least 3 visits for ANC + at least one

TT injection + 100 or more IFA tablets) 6.6

Safe Delivery (Either institutional delivery or home

delivery attendant -Doctor/Nurse/TBA) 60.8

Full ANC2 - (At least 3 visits for ANC + at least one

TT injection + 100 or more IFA tablets/syrup) 6.6

Safe Delivery (Either institutional delivery or home

delivery attendant by Doctor/Nurse) 29.9

Institutional delivery 26.8 Home delivery 71

31

Institutional delivery - government 17.4 Women who had pregnancy complications 3.6

Institutional delivery – private 9.4 Women who had delivery complications 22.3

Women who had post delivery complications 5.4 Sought treatment for Pregnancy complications 76.1

Women visited by ANM/Health worker

0.00

Sought treatment for Post delivery

complications 75.0

Women who satisfied with service/advice given

by health worker NA

Women who had said health worker spent

enough time with them NA

Women who utilized government health facility

for treatment of pregnancy complications 100


for antenatal care 61.3

Women who had Menstruation related problems

5.0


for treatment of post delivery complications 79.3

Related to Family Planning

Issue % Issue %

Women aware of RTI/STI 0.6 Birth order 3+ 34.0

Women aware of HIV/AIDS 39.9 Unmet need for limiting-1 7.8

Knowledge of any modern family planning method 95.7 Unmet need for spacing-1 5.4

Knowledge of any modern spacing family planning

method 54.0 Unmet need -total-1 13.2

Knowledge of all modern family planning methods 13.2 Unmet need -total-1 7.8

Knowledge of any traditional method 8.2 Unmet need for spacing-2 22.1

Current use of any family planning method 48.4 Unmet need -total-2 29.9

Current use of any modern family planning method 45.6 Unmet need -total-2 25.4

Current use of any traditional family planning method 2.8 Current use - Male sterilization 0.9

Current use - Female sterilization 30.6 Current use - PILLS 0.8

Current use - Male sterilization 0.8 Current use – CONDOM 12.5

Women had side effects due to use of female sterilization 17.3 Women had side effects due to Pills 0

Women had side effects due to use of IUD 15.9 Sought treatment abnormal vaginal discharge 80.3

Women who utilized government health facility for

treatment of RTI/STI (vaginal discharge) 57.6 Women who had any symptom of RTI/STI 4.4

Related to Child Health

Issue % Issue %

Breastfeeding within 2 hours (children age below 36

months) 9.7

Percentage of children age 12-35 months

received BCG 97.0

Percentage whose mother squeezed out the first breast

milk (children age below 36 months) 64.2


received DPT 3 44.3

Exclusive breastfeeding at least 4 months (children age

4-12 months) 40.3


received Measles 85.6

Percentage of children age 12-35 months received

Polio 0 70.8


received Full Immunization 38.7

Percentage of children age 12-35 months received

POLIO 3 47.7

Percentage of children age 12-35 months not

received any vaccination 3.0

Awareness of diarrhoea 28.2 Knowledge of ORS 19.0

32

Who had diarrhoea (two weeks prior to survey) 1.1 Given ORS to children during Diarrhoea 10.6

Sought treatment for Diarrhoea 100 Aware of danger signs of Pneumonia 8.3

Who had Pneumonia (two weeks prior to survey) 26.0 Sought treatment for Pneumonia 98.4

Socio Economic and Health Indicators of the District

Name of Block

Name of Health Blocks

Nagri

Parole

Hiranagar

Billawar

Basoli

Bani

DH

Total for

District

Demographic indicators

Total Population 1,78,802 1,74,904 1,28,504 64,444 44,300 - 6,23,388

Population of males 97,268 91,475 66,565 33,704 23,169 - 3,12,181

Population of females 81,534 83,429 61,939 30,740 21,131 - 2,78,773

Population of children in

age group between 1 and

6 years

15,760

10,400

8,560

5,160

7,680

-

47,560

% Scheduled Castes 29.45 20.8 22.7 15.6 15.4 - 23.15

% Scheduled Tribes 4.1 1.2 3.4 9.5 31.6 - 6.2

Number of Villages 185 366 132 50 33 588

Socio-economic

indicators

No. of <3 children

benefiting from the ICDS

scheme

6346

4893

2777

955

2562

-

17,533

No. of children aged 3

years and above benefiting

from the ICDS scheme

2979

1723

1670

1287

1935

-

9594

No. of women who have

benefited through the JSY

Scheme till now

462 672 238 199 177 1748

Health Indicators

No. of Tubectomy

conducted in the last

reporting year

408 408 371 241 86 124 1,638

No. of IUD insertions done

in the last reporting year

142 384 297 162 166 82 1,233

No. of vasectomies done


0 8 3 33 40 2 86

33

Name of Block


Nagri

Parole

Hiranagar

Billawar

Basoli

Bani

DH

Total for

District

No. of pregnant women

(treated for anaemia)

5,627 1,181

2,258 516 271 1,640 11,493


registered for ANC during

the last reporting year

1,687 6,551 3,093 2,205 1,322 2,006 16,864


who received both TT1

and TT2 during pregnancy


1,613 4,775 2,353 1,952 624 1242 12,559

No. of institutional

deliveries in the last

reporting year

878 2,715 672 179 204 1,855 6,503

No. of women operation of

MTPs in the last reporting

year

0 88 110 85 33 212 528

No. of RTI/STI cases

reported in the last

reporting year

630 2,878 220 590 650 514 5,482

No. of children given measles

vaccine in the last reporting

year

2,317

4,430

3,401

2,134

1,069

261

13,612

No. of outpatients (daily

average)

423 385 547 952 193 150 2650

No. of inpatients (daily

average)

Nil 11 7 5 2 20 45

1. Diaharea Malaria Hyperten

sion

Diahar

ea

Skin

allergy

2. Skin allergy Jaundice Diaharea Skin

allergy

Diahar

ea

Prevalent

Diseases

3. Snake bite Tuberculo

sis

Snake

bite

Jaundi

ce

Hypert

ension

NVBDCP

No. of slides examined for

malaria in last reporting

year

14,641

16,359

9,791

6,010

5,801

1,829

54,431

34

Name of Block


Nagri

Parole

Hiranagar

Billawar

Basoli

Bani

DH

Total for

District

No. of notified malaria

cases (last reporting year)

12

2

1

0

0

0

15

Health Institutions, Population Coverage Ratios and Health Functionaries in the District

Name of Block

Nagri

Parole

Hiranagar

Billawar

Basoli

Bani DH


Total for

District

Health Institutions

No. of Speciality Hospitals 0 0

No. Referral Hospitals 1 1

No. of CHC/BPHCs 0 1 1 1 1 4

No. of Blood Banks 0 1 1

No. of CHCs (IPHS Standards) 0 1 1

No. of Blood Storage Units 0 1 1

No. of PHCs in the Block 5 6 8 6 3 - 28

No. of MOs in Positions 9 8 10 5 0 4

No. of 24 hrs. PHCs 1 1 2

No. of MTP Centres 1 1

No. of Sub Health Centres 33 45 38 19 17 - 152

No. of ANMs in Position in

SCs 28 42 29 6 10

- 115

No. of AYUSH Dispensaries 45

No. of Beds in Govt.

Institutions

23 56 55 32 8 174

No. of Anganwadi Centres 394 260 214 129 192 - 1,189

Govt. 1 1

Pvt. 2

No. of

Ultrasound

Clinics Unregistered

Population Coverage

Population covered 1,78,802 1,74,904 1,28,504 64,444 44,300 - 6,23,388

No. of Sub-centres covering

more than the current norm

(5000)

2

0

1

0

0

-

3

35

Name of Block

Nagri

Parole

Hiranagar

Billawar

Basoli

Bani DH


Total for

District

Health Institutions

Health Personnel & Support Staff

Govt. - 1 - 1 1 2 5 No. of

Obstetricians

and

Gynaecologists

Pvt.

- - - - - - -

Govt. - 1 - 1 1 2 5 No. of

Gynaecologists Pvt. - - - - - - -

Govt. - 1 - - 1 1 3 No. of

Paediatricians Pvt. - - - - - -

Govt. - - 1 1 1 2 5 No. of Surgeons

Pvt. -

Govt. - 1 1 - - 2 4 No. of

Anaesthetists Pvt. -

Govt. - - - - - 1 1 No. of

Orthopedician Pvt. - - - - - - -

Govt. 1 2 2 1 1 3 10 No. of Dentists

Pvt. - - - - - - -

Govt. - - - - - - - No. of Eye

Surgeons Pvt. - - - - - - -

Govt. - 1 1 - 1 2 5 No. of Gen.

Physicians Pvt. - - - - - - -

Govt. - - - - - 1 1 No. of

Radiographers Pvt. - - - - - - -

No. of Public Health Nurses - - - - 1 - 1

No. of Staff Nurses 4 13 13 11 2 12 55

No. of LHVs 2 2 4 3 2 1 14

No. of Pharmacists 35 52 54 20 14 8 183

No. of Lab. Technicians 6 9 8 7 4 4 38

No. X Ray Technicians 3 6 4 4 2 3 22

No of Ophthalmic Assts. 1 2 1 1 1 1 7

No. Dental

Mechanics/Hygienists

-

-

-

-

-

-

-

No. of Male Health

Supervisors - - - - - - -

No. of ANMs 42 55 48 27 20 5 197

36

Name of Block

Nagri

Parole

Hiranagar

Billawar

Basoli

Bani DH


Total for

District

Health Institutions

No. of AW Workers 393 260 214 199 120 - 1186

No. of UDCs 6 8 9 5 2 2 32

No. of LDCs 1 4 1 - - 1 7

No. of Computer/Statistical

Assts.

- 0 1 0 0 0 1

No. of Drivers 5 7 4 5 2 4 27

No. of ASHAs selected 148 208 137 84 53 - 630

No. of Trained Dais

Workforce Vacancy Position *

Given below is the information about Workforce Vacancy Position in the District

Identified Gaps of Manpower

Name of Blocks

PA

RO

LE

HIR

AN

AG

AR

BIL

LA

WA

R

BA

SO

LI

BA

NI

No

. 0f

Re

qu

ired

Sta

ff

No

. o

f

Exis

tin

g S

taff

Total

No. of Sub- Centres IPHS Norm 33 45 38 19 17 152

ANM 2 38 48 47 32 24 304 115 189

N0. Of PHC's 9 8 12 7 3 39

MO 2 9 8 14 9 6 78 32 46

Pharmacist 1 1 0 2 1 0 39 35 4

Nurse 3 20 18 28 18 9 117 24 93

Female Health Worker 1 2 0 3 1 2 39 31 8

Health Educator 1 8 8 11 7 3 39 2 37

Health Assistant

(one male, one Female) 2 18 16 23 14 6 78 1 77

Clerks 2 16 12 24 14 6 78 6 72

LT 1 3 2 8 4 1 39 21 18

Driver _

Class lV 4 27 8 37 16 9 156 59 97

No. of CHCs IPHS Norm 0 1 1 1 1 4

A. CLINICAL MANPOWER

1 General Surgeon 1 0 0 1 0 4 3 1

2 Physician 1 0 0 1 0 4 3 1

37

3 Obstetrician /

Gynaecologist 1 0

0 0 1 4 3 1

4 Paediatrics 1 0 0 1 1 4 2 2

5 Anaesthetist 1 0 0 1 0 4 3 1

6

Public Health

Programme

Manager

1 1

1 1 1

4 0 4

7 Eye Surgeon 1 1 1 1 0 4 1 3

8 Other specialists (if

any)

9

General duty

officers (Medical

Officer)

B. SUPPORT MANPOWER

1 Nursing Staff 7+2

a Public Health

Nurse 1

1 1 1 0 4 1 3

b ANM 1 -3 0 -7 0 4 14 -10

c. Staff Nurse

d. Nurse/Midwife 7 1 4 0 4 28 19 9

6 Dresser 1 1 1 1 1 4 0 4

7 Pharmacist /

compounder 1

-5 -2 -4 0 4 15 -11

8 Lab. Technician 1 0 -4 1 0 4 7 -3

9 Radiographer 1 1 0 1 0 4 2 2

10 Ophthalmic

Assistant 1

0 0 1 1 4 2 2

11 Ward boys /

nursing orderly 2

1 2 2 0 8 3 5

12 Sweepers 3 -3 1 -1 0 12 15 -3

13 Chowkidar 1 1 0 1 1 4 7 3

14 OPD Attendant 1 1 0 1 0 4 6 2

15

Statistical Assistant

/ Data entry

operator

1

1 0 1 1 4

7 3

16 OT Attendant 1 0 1 1 1 4 7 3

17 Registration Clerk 1 0 1 1 1 4 7 3

18 Any other staff

(specify)

Note: ( - ) Surplus staff

38

DISTRICT HOSPITAL – MANPOWER GAPS

S.No Personnel

IPHS Norm

Recommended

Current

Availability Identified Gaps

1 Hospital Superintendent 1 1 0

2 Medical Specialist 2 2 0

3 Surgery Specialists 2 1 1

4 O&G Specialist 2 2 0

5 Dermalogist/Venereologist 1 0 1

6 Paediatrician 2 1 1

7 Anesthetist 2 3 -1

8 Opthalmologist 1 0 1

9 Orthopedician 1 1 0

10 Radiologist 2 1 1

11 Casualty Doctor/General Duty Doctor 9 4 5

12 Dental Surgeon 1 1 0

13 Public Health Manager 1 0 1

14 Forensic Specialist 1 0 1

15 ENT Surgeon 1 1 0

16 Ayush Physician 2 0 2

17 Pathologist 1 0 1

Total 32 18 14

(B) Para Medical Staff

1 Staff Nurse 50 12 38

2 Attendant 1 0 1

3 Opthalmic Assistant/Refractionist 1 1 0

4 ECG Technician 1 1 0

5 Audiometry Technician 1 0 1

6 Laboratory Technician 5 2 3

7 Laboratory Attendant 3 2 1

8 Radiographer 3 0 3

9 Pharmacist 5 10 -5

10 Matron (Including Assistant Matron) 2 2 0

11 Physiotherapist 1 0 1

12 Statistical Assistant 1 0 1

13 Medical Record Officer /Technician 1 0 1

14 Electrician 1 1 0

15 Plumber 1 1 0

Total 77 32 45

39

© Administrative Staff

1 Junior Administrative Officer 1 1 0

2 Accountant 2 0 2

3 Computer Operator 6 0 6

4 Driver 2 5 -3

5 Peon 2 1 1

6 Security Staff 2 0 2

Total 15 7 8

(D) Operation Theatre

1 Staff Nurse 5 0 5

2 OT Assistant 6 2 4

3 Safai Karamchari 3 0 3

Total 14 2 12

(E) Blood Storage

1 Staff Nurse 1 1 0

2 MNA /FNA 1 0 1

3 Blood Bank /Storage Technician 5 2 3

4 Safai Karamchari 3 2 1

5 Attendant 2 0 2

Total 12 5 7

40

STATUS OF RKS DISTRICT KATHUA (As of June 2007)

Block Facility

Date of

Formation Block Facility

Date of

Formation

Kathua DH 27th April 07 Hiranagar CHC Hiranagar 27th April 07

Parole PHC Parole 0 PHC Sanoora 27th April 07

PHC Dhani 27th April 07 PHC Ghagwal 27th April 07

PHC Budhi 27th April 07 PHC Dinga Amb 27th April 07

PHC Barwal 27th April 07 PHC Marheen 27th April 07

PHC Lakhanpur 27th April 07 PHC Hariachak 27th April 07

PHC Kharote 27th April 07 PHC Rattanpur 27th April 07

Bani CHC Bani 27th April 07 Billawar CHC Billawar 27th April 07

PHC Dhaggar 27th April 07 PHC Ramkot 27th April 07

PHC Koti Chandyar 27th April 07 PHC Bhaddu 27th April 07

Basholi CHC Basholi 27th April 07 PHC Machedi 27th April 07

PHC Mahanpur 27th April 07 PHC Kough 27th April 07

PHC Karanwara 27th April 07 PHC Ucha Pind 27th April 07

PHC Sananghat 27th April 07 PHC Guddu Flail 27th April 07

PHC Hutt 27th April 07 PHC Lohai 27th April 07

PHC Sandhar 27th April 07

PHC Bhoond 27th April 07

Status of Deliveries (MPR March 2006)

S.No Place of Delivery Numbers

Home Deliveries

attended by

Numbers

Subcentre ANM 1517

PHC/CHC/FRU 1767 LHV/Nurse/Doctor 1250

District Hospital 2064 TBA 3232

Private Institution -

Untrained birth

Attendant

307

Home 3506 Others 1905

Others 2604

Total 6110

Source: CMO office

41

Status of ASHAs

S.No Name of the Block No. Of ASHAs

1 Parole 148

2 Hiranagar 208

3 Billawar 137

4 Basholi 84

5 Bani 53

Total 630

Source: CMO office

Immunization Status for 2005-2006 (MPR Form 9)

Vaccine Male Female Total

TT (1st

) 12250 12250

TT (2nd

) 10047 10047

TT (Booster) 1369 1369

DPT and OPV 1st

dose 8273 7687 15960

DPT and OPV 2nd

dose 7813 8150 15963

DPT and OPV 3rd

dose 7500 6994 14494

BCG 7401 6791 14192

Measles 7765 7262 15027

D.T. 2nd

dose 431

T.T. 10 years 380

T.T. 16 years 475

Vitamin A 1st

dose 15130

Vitamin A (2nd

to 5th

dose) 23359

IFA tablets to Mothers 2354834

Full Immunization 2961 2826 5787

Source: CMO office

42

Blockwise Status – ANC Registration

S.N

O.

Name of

Block ANC

ANC

in 12

Week

s

Complica

ted Risk

Pregnanc

ies

Detected

Treate

d

Referre

d

No. of

Pregnant

Women

treated

(Anaemia)

Deliver

ies at

PHC

/CHC/

FRU

Delive

ries at

SDH

Pvt.

Nursing

Homes

1 Parole 1687 317 - - - 5627 136 551 68

2 Hiranagar 6551 3462 - - - 118100 149 20 -

3 Billawar 3093 2591 66 36 30 2258 154 223 -

4 Bani 1322 1322 77 67 10 271 13 58 3

5 Basholi 2205 485 236 213 23 516 30 79

6

D.H

Kathua 2006 749 - - - 1640 - 1855 -

7

M.G.H

Kathua - - - - - - - - -

8

ADMO

(ISM) - - - - - - - - -

Total 16864 8926 8926 316 63 128412 482 2786 71

Source: Dy CMO Office, Kathua

Blockwise Status- Deliveries

S.NO.

Name of

Block

Home

Deliveries

Sub

Centre

Deliveries

Home

Deliveries

Attended

by ANC

Home Deliveries

attended by

LHV

(Doctor/Nurse)

Attended

by TBA

Attended

by

Untrained

Birth

attendants

1 Parole 641 123 171 142 358 80

2 Hiranagar 1974 2546 334 29 604 860

3 Billawar 1397 295 238 4 1002 40

4 Bani 605 130 56 38 111 380

5 Basholi 1901 70 385 302 570 375

6

D.H

Kathua - - - - - -

7

M.G.H

Kathua - - - 529 - -

8

ADMO

(ISM) - - - - - -

Total 6510 3164 1184 1044 2390 1735


43

Blockwise Status - Births Recorded

S.NO.

Name of

Block Live Births Still Births Weight recorded <2500Gm

Male Female Male Female Male Female Male Female

1 Parole 829 690 - - - - 9 12

2 Hiranagar 2453 2346 - - 2656 2530 - -

3 Billawar 1038 998 16 17 992 951 62 63

4 Bani 407 400 3 4 121 93 15 12

5 Basholi 1035 1037 7 11 495 393 142 96

6 D.H Kathua - - - - - - - -

7 M.G.H Kathua 923 845 14 16 - - 15 9

8 ADMO (ISM) - - - - - - - -

Total 6685 6316 40 48 4264 3967 243 192


Blockwise Status - High Risk Born children

S.NO. Name of Block

High Risk in New

born Detected Treated Referred

Male Female Male Female Male Female

1 Parole - - - - - -

2 Hiranagar - - - - - -

3 Billawar 27 21 17 13 10 8

4 Bani 23 14 22 14 1 -

5 Basholi 174 139 165 132 9 7

6 D.H Kathua - - - - - -

7 M.G.H Kathua 3 2 3 2 - -

8 ADMO (ISM) - - - - - -

Total 227 176 207 161 20 15


44

Blockwise Status - Immunization

S.NO.

Name of

Block Immunization I Dose II Dose III Dose

DPT OPV DPT OPV DPT OPV DPT OPV


1 Parole 1091 1001 1391 1282 1326 1231 1344 1239

2 Hiranagar 2408 2271 2277 2151 2252 2147 2353 2268

3 Billawar 1858 1796 1839 1781 1852 1790 1795 1734

4 Bani 566 487 690 641 683 631 707 618

5 Basholi 1133 1058 1149 1082 1107 1054 1101 1050

6 D.H Kathua 762 639 691 615 714 628 667 603

7

M.G.H

Kathua 530 466 190 148 162 140 130 101

8 ADMO (ISM) 220 183 377 319 376 322 345 291

Total 8568 7901 8604 8019 8472 7943 8442 7904


S.NO.

Name of

Block Measles Vit. A (0-1)

No. of Infant

deaths <1 year

No. of Clients

of RTI /STI

(detected)


1 Parole 1217 1118 689 633 - - 245 285

2 Hiranagar 2265 2165 577 561 - - 846 2032

3 Billawar 1732 1670 575 547 18 19 114 106

4 Bani 575 494 575 494 10 10 207 443

5 Basholi 1092 1033 689 613 - - 186 404

6 D.H Kathua 660 584 426 369 - - - -

7

M.G.H

Kathua 143 114 64 54 - - 177 337

8 ADMO (ISM) 296 246 425 356 - - - -

Total 7980 7424 4020 3627 28 29 1775 3707


45

Blockwise Status of Diaharea and ARI

S.NO. Name of Block Diarrhoea ARI

Male Female Male Female

1 Parole 248 230 143 112

2 Hiranagar 4 3 14 13

3 Billawar 321 343 288 335

4 Bani 185 152 361 348

5 Basholi 206 190 182 156

6 D.H Kathua - - - -

7 M.G.H Kathua 108 99 27 30

8 ADMO (ISM) - - - -

Total 1072 1017 1015 994


Blockwise Status – Sterlization

S.NO. Block Male Female IUD Nirodh OPU TT-1 TT-2

TT-

Booster IFA

1 Parole - 408 142 39558 2674 1687 1539 217 356250

2 Hiranagar 8 408 384 28306 3579 3462 6089 - 293912

3 Billawar 3 371 297 54840 3122 2591 2116 475 279200

4 Basoli 33 241 162 22710 2418 2205 1699 147 101830

5 Bani 40 86 166 21974 4763 629 620 262 161235

6

MGH

Kathua - - - 10500 77 263 187 21 53800

7

DH

Kathua 2 124 82 19500 1330 1375 1109 37 83000

8 ADMO - - - 2775 414 746 600 3 103400

Total 86 1638 1233 200163 18377 12958 10959 1162 1432627

Blockwise Status – MTP

S.NO. Block MTP

1 Parole -

2 Hiranagar 88

3 Billawar 110

4 Basoli 85

5 Bani 33

6 MGH Kathua 212

7 DH Kathua -

8 ADMO -

Total 528

46

ICDS Beneficiaries 2006-2007

Block No

AWCs

Target Achievement Pregnant

Women

Lactating

Women

6 mths –6 yr

Target Achiev Target Achiev Target Achiev

Kathua 202 16984 5979 772 446 1282 637 14930 4896

Hiranagar 145 7471 4303 481 360 569 419 6421 3524

Billawar 214 12626 5494 643 463 842 584 11141 4447

Basohli 127 7278 3761 492 309 642 428 6144 3024

Bani 76 4263 1404 276 116 415 178 3572 1110

Barnoti 191 13169 5478 777 486 988 563 11404 4429

Ghagwal 115 6662 3720 407 305 492 323 5763 3092

Lohi Malhar 72 3540 1795 220 140 280 182 3040 1473

Duggan 44 2535 1339 158 89 191 118 2186 1132

Total 1186 74228 33373 3926 2814 5701 3432 64601 27127

Source: ICDS Reports 13.4.07

ICDS Data on Malnutrition

MONTHLY PROGRESS REPORT FOR THE MONTH OF 3 / 2007 DISTRICT. KATHUA FORMAT 2nd

Total population

with in the project No. of SNP Beneficiaries Classification of Nutrition status

Name of

ICDS

Project

(R/T/U)

0-6

Yrs

Preg

& Lact

wome

n

6m -

3

yrs

3 - 6

years

Preg

&

Lact

wome

n

Rep

orte

d

live

birth

Dea

ths

0-1

yrs

Dea

ths

1-

5yrs

Nor

mal I II

III

&

IV

No of

Childr

en

weigh

ed

Kathua 772 1282 772 1282 1083 75 2 1 1377 865 258 -- 2500

Hiranagar 481 569 481 569 779 58 -- -- 1143 568 101 -- 1812

Billawar 643 842 643 842 1047 97 5 1 1209 955 454 -- 2618

Basohli 492 642 492 642 737 60 -- -- 676 536 140 -- 1352

Bani 276 415 276 415 294 26 -- 1 977 572 44 -- 1593

Barnoti 777 988 777 988 1049 86 2 -- 1674 847 146 1 2668

Ghagwal 407 492 407 492 628 51 -- -- 547 207 10 -- 764

Lohi

Malhar 220 280 220 280 322 15 -- -- 73 65 10 -- 148

Duggan 158 191 158 191 207 27 2 -- 483 368 78 -- 929

Total 3926 5701 3926 5701 6246 495 11 3 8159 4983 1241 1 14384

Source: ICDS Department as on 13.4.07

47

Availability of Facilities

PAROLE

S.No. Name of CHC Name of PHC Name of SC Name of SC

1 Parole Barwal Padyari Nanan

2 Budhi Rajbagh Janglote

3 Lakhanpur Kumri Budhi

4 Dhanni Jarai AD Ghati

5 PHC Kharote Sample Sapla Khokhyal

6 Basantpur Sumwan Tarda

7 Ghati Jandore H Dhanore

8 Float Bhallar Palli

9 Parole Tridwan Goodhi

10 Badala Dhanna

11 Jasrota Thorsi

12 Jakhbar Mahichak

13 Airwan Hatli

14 Utteri Maloo

15 Gaiterwan Logate

16 Dilwan Bhed Balod

17 Jandore

BILLAWAR


1 CHC Billawar Badnota Surara Dher

2 Makwal Tharakalwal Koti

3 Sukral Sathar Maggain

4 Kohag Marhoon Dhanu Parole

5 Uchapind Plail Roukhla

6 Godu Falal Nongala Chunera

7 Ramkote Kalna Kashid

8 Machhedi Barota Pid

9 Bhaddu Malhid Sarla

10 Lohai Dehota Sadrota

11 Malhar Amwala Issu

48

12 Rajwalta Mooni

13 Najote Tumboo

14 Sukrala) Nagrota Gujroo

15 Pallan Phinter

16 Beril KishanPur

17 Rampur Upper Dharalta

18 Dhar Dugnoo Durang

19 Dharmkote Rukhla

BANI


1 Bani Duggan Bhakoga Kanthal

2 Koti Chandyor Sitti Banjal

3 Sandrool Mandrara Bhakoga

4 Dumeya Backon

5 Dullangle Doulka

6 Siara Tapper

7 Lowang Barmota

8 Barmota Dhaman

9 Chandal

49

HIRANAGAR

S.No.

Name of

CHC Name of PHC Name of SC Name of SC

1 Rattanpur Ladhwal Amala

2 Ghagwal Sanyal Bannu Chak

3 Sanoora Kadayal Mela

4 Harichak Nonath Magloor

5 Dinga Amb Sagal Kheri

6 Marheen Satoora Sangwali

7 A/D Bhaiya Naran Rai

8 A/D Chakra Hira Nagar Tanda

9 Phalpur Fattu.Chak

10 Ragal Thakerpura

11 Mangu Chak Subachak

12 Chhan Lal Din Chadwal

13 Panjgrain Jatwal

14 Chandwan Chhan.Kanna

15 Chachwal Dhamyal

16 Danoh Chaan.Khatrian

17 Bann Surara

18 Mawa Saida

19 Bobiya Chhan.Rorian

20 Pansar Chaan.Morian

21 Odh Sandhi

22 Gurha Mundian Kattel.Brahmana

23 Chandare.Chak

50

Status of Health Centre Buildings in the District

Sub-Centre (SC) Status:

Sub Centres No. Overall Status

Sub-Centres in own building 61

Sub-Centre in Panchayat Bldg / rented

building

91

Some of the subcentres are running in dilapidated buildings,

needs immediate repair and renovation

SC without Electricity connection 108 No generator or any backup in any Subcentres

SC without Water Supply 136 Water supply not available in 136 subcentres

SC without Toilets 143 No toilets with water supply

Primary Health Centres:

Block Nagri Parole

Name Of PHC Status

Barwal Budhi Lakhanpur Dhanni Kharote Basantpur Ghati Float Parole

24 hour PHC Nil Yes Yes Nil Nil Nil Nil Nil Yes

Total beds 2 4 3 1 3 Nil Nil Nil 5

No. of OPD

cases

30-35 40 70-80 40 40-50 35 25 18 50

No. of indoor

cases

Nil 1 1 Nil 1 Nil Nil Nil 1

Rogi Kalyan

Samiti

Yes Yes Nil Yes Yes Nil Nil Nil Yes

Name of SC of Parole Block Status

SC

1

SC

2

SC

3

SC

4

SC

5

SC

6

SC

7

Residential Facility

Available

Nil Nil Nil Available Nil Nil Availab

le

Name of SC in Parole Block

1. Rajbagh, Karndi, Suraj bagh, Rakh Hariyar

2. (Kumari) (Androd.Jasser.Neter)

3. Jarai

4. Sample Sapla

5. Sumwan

6. Jandore

51

Names of SC of Parole Block Status

SC

8

SC

9

SC

10

SC

11

SC

12

SC

13

SC

14


Available

Nil Available Available Nil Nil Nil Nil

Name of SC in Parole Block

7. Bhallar

8. Tridwan

9. Badala

10. Jasrota, Chanipura

11. Jaknbar

12. Airwan

13. Utteri

Names of SC of Parole Block Status

SC

15

SC

16

SC

17

SC

18

SC

19

SC

20

SC

21


Available

Available Available Nil Available Nil Nil Nil

Name of SC of Parole Block

14. Gaiterwan

15. Dilwan

16. Nanan

17. Janglote

18. Budhi

19. Ghati

20. Khokhyal


SC

22

SC

23

SC

24

SC

25

SC

26

SC

27

SC

28

SC

29

SC

30

SC

31

SC

32

SC

33

Residential

Facility Available

Availabl

e

Nil Availa

ble

Ni

Availa

ble

Availa

ble

Avail

able

Availa

ble

Availa

ble

Nil Nil Nil Nil


21. Trada

22. Dhanore

23. Palli

24. Goodhi

52

25. Dhanna

26. Thorsi

27. Mahichak

28. Hatli

29. Maloo

30. Logate

31. Bhed Balod

32. Jandore B

Block Basholi

Names of PHC Status

Saranghat Mahanpur Plassi Karanwara Sandhar Bhoond Hutt

24 hour PHC Nil Nil Nil Nil Nil Nil Nil

Total beds Nil 4 2 3 4 Nil 5

No. of OPD

cases

20 30 40 15 349 200 156

No. of indoor

cases

Nil 2 Nil 1 2 Nil 2

Rogi Kalyan

Samiti

Yes Yes Nil Nil Nil Yes Nil

Names of SC Basohli Block Status

SC

1

SC

2

SC

3

SC

4

SC

5

SC

6

SC

7


available for Staff

Nil Nil Nil Nil Nil Nil Nil

Name of SC of Basohli Block

1. Jandrot

2. Dodla

3. Mannu

4. Thanger

5. Nagrota Prehta

6. Adhat

7. Danna

53

Name of SC of Basohli Block Status

SC

8

SC

9

SC

10

Residential Facility for

staff

Nil Nil Nil

Name of SC of Basohli Block

8. Poonda ( Kothi )

9. Plakh

10. Sialge

Block Billawar

Name of PHC Status

Badnota Hakwal Sukral Kohag Malhar Uchapind Goduflal Ramkote Marhhedi Bhaddu Lohai

24 hour

PHC

Nil Nil Nil Nil Nil Nil Nil Yes Nil Nil Nil

Total

beds

Nil Nil Nil 2 1 2 1 5 2 5 2

No. of

OPD

cases

15 15 250 20 20 10 15 60 12 15 15

No. of

indoor

cases

Nil Nil Nil Nil Nil Nil Nil 1 Nil 1 Nil

Rogi

Kalyan

Samiti

Nil Nil Nil Nil Nil Nil Nil Nil Yes Nil Nil

Name of SC of Billawar Block Status

SC

1

SC

2

SC

3

SC

4

SC

5

SC

6

SC

7

SC

8

SC

9

SC

10

Residential

Facility for Staff

Availabl

e

Nil Nil Nil Available Availabl

e

Nil Nil Nil Nil

Name of SC of Billawar Block

1. Surara

2. Tharakalwal

3. Sathar

4. Marhoon

5. Plail

6. Nongala

7. Kalna

54

8. Brota

9. Malad

10. Dehota


SC

11

SC

1 2

SC

13

SC

14

SC

15

SC

16

SC

17

SC

18

SC

19

SC

20

Residential

Facility for

Staff

Available Nil Nil Available Nil Nil Nil Nil Nil Nil


11. Amwala

12. Rajwalta

13. Najota

14. Kishanpur

15. Mahavir Temple

16. Beril

17. Rampur

18. Dhar Dugnoo

19. Dharamkote

20. Dher


SC

21

SC

2 2

SC

23

SC

24

SC

25

SC

26

SC

27

SC

28

SC

29

SC

30

Residential

Facility for

Staff

Nil Nil Nil Nil Nil Nil Nil Nil Nil Nil

Name of SC of Baillawar Block

21. Koti

22. Maggani

23. Dhanu Parole

24. Roukhla

25. Chunera

26. kasheer

27. Bhaid

28. Mandi

29. Sadrota

30. Issu

55


SC

31

SC

3 2

SC

33

SC

34

SC

35

SC

36

SC

37

SC

38

Residential

Facility for Staff

Nil Nil Nil Nil Available

Nil Nil Nil


31. Mooni

32. Tumboo

33. Nagrota Gujroo

34. Phinter

35. Kishanpur

36. Upper Dharalta

37. Sarang

Block Bani

Name Of PHC Status

PHC

Kati Chandyar

PHC

Dhaggar

PHC

Sandrool

24 hour PHC Nil Nil Nil

Total beds Nil Nil Nil

No. of OPD cases 12-23 75 15

No. of indoor cases Nil Nil Nil

Rogi Kalyan Samiti Yes Yes Yes

Name of SC of Bani Block

1. Bhakoga

2. Sitti

Name of SC of Bani Block Status

SC

1

SC

2

SC

3

SC

4

SC

5

SC

6

SC

7

SC

8

SC

9

SC

10

Residential

Facility for

Staff

Available Nil Nil Nil Available Nil Nil Nil Nil Nil

56

3. Mandrara

4. Dumeya

5. Dullangle

6. Siara

7. Lowang

8. Barnota

9. Chandal

10. Kanthal

Name of SC of Bani Block Status

SC

11

SC

12

SC

13

SC

14

SC

15

SC

16

SC

17

Residential

facility for staff

Nil Nil Nil Nil Nil Nil Nil

Name of SC of Bani Block

11. Banjal

12. Bhakoga

13. Backon

14. Doulka

15. Tapper

16. Barmota

17. Dhaman

Block Hiranagar

Name of PHC Status

Rattanpu

r

Ghagwa

l

Sanoora

Hariachak

Dinga Amb

Marheen

Bhaiya

Chakra

24 hour PHC Yes Nil Yes Nil Nil Yes Nil Nil

Total beds 2 4 1 Nil 2 5 2 Nil

No. of OPD cases 10-15 40-50 20-25 20-25 35 120-30 20 40-60

No. of indoor

cases

Nil 2 Nil Nil Nil 2 Nil Nil

Rogi Kalyan

Samiti

Nil Nil Nil Nil Yes Yes Nil Nil

Name of SC of Hiranagar Block

Status SC

1

SC

2

SC

3

SC

4

SC

5

SC

6

SC

7

SC

8

SC

9

SC

10

SC

11

Residential

Facility for

Staff

Available NIL Available Availa

ble

Nil Availa

ble

Availa

ble

Nil Availa

ble

Availa

ble

Nil

57


1. Amala

2. Bannu Chak

3. Mela

4. Magloor

5. Kheri

6. Somgwali

7. Rai

8. Tanda

9. Fattu Check

10. Thakerpura

11. Gurh Mundian

Name of SC of Hiranagar Block Status

SC

11

SC

12

SC

13

SC

14

SC

15

SC

16

SC

17

SC

18

SC

19

SC

20

Residential

Facility for Staff

Availab

le

Nil Availabl

e

Availa

ble

Availabl

e

Nil Availa

ble

Availabl

e

Nil Nil


12. Subachak

13. Chadwal

14. Jatwal

15. Chhan Kanna

16. Dhamyal

17. Chhan Khatrian

18. Surara

19. Saida

20. Chhan Roricu

21. Chhan Morian


Status SC

21

SC

2 2

SC

23

SC

24

SC

25

SC

26

SC

27

SC

28

SC

29

SC

30

Residential

Facility for Staff

Nil Nil Nil Nil Nil Nil Nil Nil Availa

ble

Availabl

e


22. Sandhi

58

23. Kattal Bharmana

24. Chandare Chak

25. Ladhwal

26. Sanyal

27. Kadyala

28. Nonath

29. Sagal

30. Satoora

31. Naran


SC

31

SC

32

SC

33

SC

34

SC

35

SC

36

SC

37

SC

38

SC

39

SC

40

Residential

Facility for

Staff

Nil Availab

le

Nil Availab

le

Nil Nil Nil Availa

ble

Nil Nil


32. Hiranagar Morh

33. Phalpur

34. Ragal

35. Mangu Chack

36. Chhan-Lal- Din

37. Panjgrain

38. Chandwan

39. Chachwal

40. Danoh

41. Bann Thathi


SC

41

SC

42

SC

43

SC

43

Residential Facility for Staff Nil Nil Available Available

Name of SCs of Hiranagar Block

42. Mawa

43. Bobiya

44. Pansar

45. Odh

59

Community Health Centre (CHC) District Kathua

(BPHC)/CHC Status CHC

Billawar

CHC

Bani

CHC

Basholi

Old PHC

Parole

CHC

Hiranagar

Total no. of beds 35 8 14 5 40

Total no of OPD

cases

100 100 140 80 120

Total no. of indoor

admissions

5 5 10 Nil 10

Bed occupancy rate Less than 40% 60% 60% 40-60% Less than 40%

Up gradation of RKS Yes Yes Yes Yes Yes

Vehicle/Ambulance Yes Yes Yes Yes Yes

Ambulance with NGO

partner

Nil Nil Nil Nil Nil

Rogi Kalyan Samiti Yes Yes Yes Yes Yes

Number of Institutions Requiring New Buildings with Staff Quarters

# Category of Institution Numbers

1 SC 91

2 PHC 13

3 CHC 0

Source: CMO office and Facility survey

Number of Buildings Requiring Additions/Expansion (staff quarters)


1 SC 61 need additional staff quarters for additional ANM

and 24 need for the first ANM

2 PHC 31 and 39 for additional MO and Staff nurses

3 CHC All need additional staff quarters for the doctors and

specialists and staff nurses


Number of Buildings Requiring Repairs


1 SC 33

2 PHC 24

3 CHC All


60

Table:1 Percentage Availability of Infrastructure

District: Kathua

Indicators SC (152*) PHC+ADs(39) CHC(4) DH

1 Building (Govt. + Donated) 40.15 67.62 100 100

2 Building (Rented) 57.18 32.38 0.00 0

3

Condition of Building (Good

+ Fair) 46.55 56.66

100 100

4

Water Supply (Tap,

borewell/

handpump/tubewell, well)

16.05 47.85

100

100

4.1 Tap water supply 10.80 35.36 100 100

5 Electricity 28.65 72.54 100 100

5.1 In all parts of hospital 2.35 69.19 100 100

Elertic supply (power

generation stablization) 0 0 100 0

6 Separate Toilet 5.78 13.57 100 100

6.1

Sep.Toilet with running

water 0.00 0.00

100 100

7 Furniture 54.88 85.00 90 100

8 Labor Room 0.61 9.60 100 100

8.1 Aseptic labor room 0.00 1.67 100 100

9 Avail. of Quater for staff 24.30 20.55 100 100

10

Number of beds available

(Average) 1 15 80

11 Laboratory 18.41

100 100

12 Operation Theatare 2.22 100 100

13

Waste Disposal

(Burnt+Dump) 30.08

100 100

14 Availability of incenator 0.00 100 0

15 Telephone 2.22 100 100

16 Computer 0.00 50 100

17 Generator/Invertor 2.22 100 100

18 Vehicle 9.52 100 100

19 Emergency Room / Casualty 100 100

20

Separate wards for males

and females (Yes/No)

100 100

61

21 No. of beds : Male 10 30

22 No. of beds : Female 10 30

23 Availability of ECG facilities 100.00 100

24 X-Ray facility 100.00 100

25 Ultrasound facility 100.00 100

26 Cardiac Monitor for OT 100.00 100

27 Blood Storage Unit available 0.00 0

28 Blood Bank Facility 0

29 Other Investigative Facility 86.20

30

Heating ventilatoin & air

conditioning 0.00

31 Lift & vertical transport 0

32 Refrigeration

100

Source: CMO office and Facility survey as on July 2007

(*)one subcentre in Hiranagar unsanctioned

62

Average Percentage Availability of Medicine

Name of Blocks PAROLE HIRANAGAR BILLAWAR BASOLI BANI

District

Average

%

SCs IPHS 33 45 38 19 17 152

Kit- A 5 0 0 0 0 0 0.00

Quantity 9 44.44 44.44 55.56 55.56 33.33 46.67

Drugs required by ANMs and LHVs 6 50 50 83.33 66.67 50 60.00

Other Drugs and Vaccines 8 50 50 62.5 62.5 50 55.00

Medicines required for NDCP 7 42.86 42.86 57.14 42.86 42.86 45.72

Contraceptives required for F.Plang. 4 75 75 100 75 75 80.00

Proposed Drug List for A.Wadi Centres 12 50 50 50 41.67 41.67 46.67

Total 106 45.1 45.1 56.86 23.58 19.81 38.09

PHCs IPHS Norm 9 8 12 7 3 39

Essential & EmOC care drugs 38 52.63 50 52.63 39.47 52.63 49.47

Antidote 4 0 0 50 0 50 20.00

Anticonvulsant / Antiepileptics 4 50 36 50 50 0 37.20

Antiinfective Medicines 5 40 40 60 80 60 56.00

Antifilarials 1 0 0 0 0 0 0.00

Antibacterials 16 75 75 62.5 62.5 43.75 63.75

Dermatological medicine 14 71.43 60 71.43 35.71 42.86 56.29

Antileprosy & Antitubercullar 2 0 0 0 0 50 10.00

Antifungal medicine 4 50 45 50 50 75 54.00

Antiprotozoal medicine 5 40 35 60 20 60 43.00

Blood Products and Plasma Substitutes 13 38.46 38.46 38.46 23.08 15.38 30.77

Antiseptics 6 50 58 83.33 66.67 66.67 64.93

Disinfectants 3 100 90 66.67 33.33 100 78.00

Diuretics 2 0 0 100 50 0 30.00

Gastrointestinal 22 54.55 54.55 68.18 45.45 54.55 55.46

Hormones, Endocrine & Contraceptives 10 50 45 50 30 30 41.00

Ophthalmological preparation 12 50 50 41.67 41.67 33.33 43.33

Psychotic Disorders 15 40 33 33.33 20 33.33 31.93

I/V Fluids 9 33.33 33.33 88.89 33.33 55.56 48.89

Vitamins & Minerals 3 100 100 100 66.67 100 93.33

Drugs under RCH 1 64.52 60 64.52 38.71 35.48 52.65

Product Strength formulation Units 31 48.39 45 48.39 38.71 25.81 41.26

RTI / STI Drugs 10 50 50 60 40 50 50.00

Drugs and Consumable for MVA 6 33.33 30 66.67 33.33 83.33 49.33

63

TOTAL 236 58.47 59.95 64.4 44.07 48.73 55.12

CHCs IPHS

Essential drugs 70 0 57.14 78.5 35.71 64.29 47.13

Average Percentage Availability of Equipment

Name of Blocks Parole Hiranagar Billawar Basoli Bani Average

% District

SC’s IPHS

norm 33 45 38 19 17

Equipment kit ( kit- C ) 55 54.54 63.64 12.70 36.36 21.82 37.81

No. of PHC's (39) 9 8 12 7 3 39

Suggested equipments 36 41.67 69.44 25.00 50.00 41.67 45.56

Operational labour room 10 50.00 80.00 0.00 50.00 20.00 40.00

Pap Smear 11 45.45 72.73 0.00 27.27 36.36 36.36

Laboratory Reagents 10 70.00 80.00 30.00 40.00 60.00 56.00

Glassware and other

equipment 7 85.71 100.00 71.40 57.14 42.86 71.42

Furniture 25 81.25 100.00 68.80 68.75 75.00 78.76

TOTAL 99 64.65 88.89 39.39 56.57 54.55 60.81

CHC's IPHS 0 1 1 1 1 4

Standard Surgical Set-1 32 0.00 78.13 31.30 71.88 25.00 41.26

Standard Surgical Set - II 33 0.00 75.76 45.50 60.61 45.45 45.46

IUD Insertion Kit 19 0.00 78.95 63.20 63.16 63.16 53.69

Standard Surgical Set - III 17 0.00 88.24 70.60 70.59 82.35 62.36

Normal Delivery 12 0.00 83.33 83.30 66.67 50.00 56.66

Standard Surgical Set - IV 16 0.00 62.50 81.30 62.50 37.50 48.76

Standard Surgical Set - V 21 0.00 85.71 71.40 52.38 47.62 51.42

Standard Surgical Set - VI 11 0.00 72.73 63.60 45.45 45.45 45.45

Equip. for Anaesthesia 17 0.00 88.24 70.60 58.82 29.41 49.41

Equip.for Neo-natal

Resuscitation 10 0.00 60.00 30.00 30.00 20.00 28.00

Materials Kit for Blood trans. 15 0.00 80.00 66.70 33.33 40.00 44.01

Equip. for OT 11 0.00 90.91 72.70 45.45 63.64 54.54

Equip. for Labour room 13 0.00 76.92 76.90 46.15 61.54 52.30

Equip. for Radiology 9 0.00 55.56 55.60 33.33 55.56 40.01

TOTAL 236 0.00 77.97 63.50 56.36 46.19 48.80

64

Non-Governmental Organization [NGOs]

NGOs working in district Kathua in the fields of health, education, livelihood and other community

development initiatives are listed below:

• Shiva gramodyog mandal, Kathua

• Grameen Kalyan Sangathan society, Nagri parole (Kathua)

• Regional educational society

• All India center for urban & rural development

• Kandi Shivalik Vikas Sangathan, Nari Shakti Sangathan society ore vidhyarathi Parishad

• Nehru Yuva Sangathan

• National youth project

• Bhartiya kissan sangh

• Besahara society

• Aware

• Youth club, Rajpura

• Bama youth club

• All J&K Mahila sangh mandal

• Friends housing society

• Mohd. Jabar memorial sports club

• Gramodyog hastakala Kendra

65

2. PLANNING PROCESS

A decentralized participatory planning process has been followed in development of this District

Action Plan. This bottom-up planning process began with consultations with block stakeholder

groups, Block /core Group members and village communities in all villages of each Block of the

District. Block Action Plans were developed based on the inputs gathered through village action

plans prepared by Village Health Water Sanitation Committees. The health facilities in the block viz.

SC, PHC and, CHC were surveyed using the template developed by Government of India. The

inputs from these facility surveys were taken into account while developing the Block Action Plan.

The District Planning Core Group (DPT) provided technical oversight and strategic vision for the

process of development of District Action Plan. The members of the DPT had also taken the

responsibility of contributing to the selected thematic areas such as RCH, Newer initiatives under

NRHM, immunization etc. Assessment of overall situation of the District and development of broad

framework for planning was done through a series of meetings of the DPT.

This District Action Plan has been prepared through a long process of integration of Block Action

Plans including Health Facility Surveys. An initial meeting was held in which the current status of

the District Action Plan was presented and suggestions and feedback taken. The membership and

roles and responsibilities of DPT and the chapterization plans were discussed. Based on the inputs

received from the Blocks, a draft of each chapter was developed after discussions. These were

further improved upon through individual consultations with groups and nodal officers. Specific

dates and times were fixed for this purpose. A date was also proposed for a meeting during which

the individual chapters would be discussed and approved before the final DAP was prepared for

presentation to the District Health Society for approval.

66

No. <3 years

No.

completely

immunised

% of fully immunized

children

Maximum 100%

Minimum 0% 1

IMMUNIZATION

COVERAGE

< 3 YEAR OF AGE 46230 5787 12.52% 100%

Total no. of

pregnant

women

No of women

who got full

antenatal

care as

defined

% of women getting

antenatal care as

defined

Maximum 100%

Minimum 0% 2 ESSENTIAL

ANTENATAL CARE

18197 DNA DNA 100%

Total no. of

pregnant

women

Total no of

women who

had

institutional

delivery

% of pregnant women

who had institutional

delivery.

Maximum 100%

Minimum 0% 3 INSTITUTIONAL

DELIVERY

18197 3831 21%

Total no. of

births in the

year

No. of

newborn

weighed

within three

days

Percentage of newborn

weighed within three

days

Maximum 100%

Minimum 5% 4

WEIGHING OF

NEWBORN WITH IN

THREE DAYS

16377(est) 324 1.98% 100%

BREASTFEEDING

IN FIRST HOUR

Total no of

births in the

last year

No of

newborns

who were

breastfed in

the first hour

Percentage of

newborns who were

breastfed within an

hour

Maximum 100%

Minimum 0% 5

DNA DNA DNA 100%

Approx no of

blood slides

sent in last 3

months

Average time taken for reporting of

blood slide

Maximum over 30

days

Minimum 1 day 6

REPORTING OF

BLOOD SLIDE

54431 DNA DNA

HEALTH SERVICE INDICATORS FOR THE DISTRICT

BASIC HEALTH SERVICES

S.No Indicator Criteria Goal Posts &

SCORE

67

No of target

couples for

sterilisation

services

( > 2 children)

Total no. of

couples with

at least one

of them

wanting FP

operation:

No. who

wanted to

get FP

operation

done last

year but

could not

% of

unmet

demand

for FP

operation

Maximum 100%

Minimum 0% 9

ACCESS TO

STERILISATION

SERVICES

DNA DNA DNA DNA

HEALTH RELATED SERVICES

WATER & SANITATION

Total no. of

families

Total no. of

families

where all

members are

using

domestic/

community

toilet

Percentage of families

where all members are

using domestic/

community toilet

Maximum : 50 %

Minimum 0%

15 USE OF

DOMESTIC/

COMMUNITY

TOILET

96393 DNA DNA DNA

FOOD SECURITY RELATED

Total no. of

children

eligible for

Anganwadi

Actual No.

getting diet

regularly

Percentage of

Anganwadi

beneficiaries

16 ANGANWADI

92521 9627 10.01%

Total no. of

primary and

middle

schools

Total no. of

schools

giving

cooked

midday

meals

Percentage of schools

giving midday meals

17 MIDDAY MEAL

911 DNA DNA

Total no. of

BPL families

eligible for

lower cost

grains

No. of

families

getting

grains from

PDS shop

Percentage of

beneficiaries

18 PDS FUNCTIONING

DNA DNA DNA

68

Total no. of

BPL families

eligible for free

grains

No. of

families

getting free

grains from

PDS shop

Percentage of

beneficiaries

19

ANTYODAYA

YOJNA

DNA DNA DNA

Total no. of

children in 6-

14 age group

No. of

children in

age group

not going to

school

Percentage of school

going children

20 SCHOOL

ENROLMENT

DNA DNA DNA

HEALTH STATUS

Total no. of

children with

wt record.

no. of

children with

gr I or above

malnutrition

% of children

malnourished

Max 200%

Minimum 0% 21

CHILD

MALNUTRITION

14384 6225 43.28%

Total no. of

newborn who

were weighed

last year

Total no. of

babies with

LBW

Percentage of babies

with LBW

Max 100%

Min 10% 22

LOW BIRTH

WEIGHT

DNA 324 DNA

Total no. of

girls married

last year

No. of girls

married

below 19

year of age

100% - % of married

women below 19 year

of age

Max 100%

Min 0% 23 AGE OF MARRIAGE

DNA DNA DNA DNA

Total number

of births last

year which

were second

or > child

No. of

children born

with more

than 36

months

difference

% of unspaced second

or third children born

Max 100%

Minimum 0% 24 SPACING

DNA DNA DNA

Total number

of births last

year

Any deaths

of any child

below one

year

% of infant deaths Maximum 20%

Minimum 0% 25 INFANT DEATHS

16377 37 0.23

69

Diarrhoeal

outbreaks(Mor

e than three

cases of a

disease in

same week )

Jaundice

outbreaks

(as defined)

Sum of water borne

disease outbreaks

Maximum 4

Minimum 0 26

OUTBREAK OF

WATER BORNE

DISEASE

DNA DNA DNA DNA

70

3. PRIORITIES AS PER BACKGROUND AND PLANNING PROCESS

National Rural Health Mission encompasses a wide range of health concerns including the

determinants of the good health. Though there is a significant increase in resource allocation for

the NRHM, there can never be adequate resources for all the health needs and all that needs to be

done for ensuring good health of all the people. It is therefore necessary to prioritize the areas

where appropriate emphasis needs to be given.

Kathua need to be given preferential treatment on all the aspects to achieve the goals of NRHM.

Extra resources, innovative schemes, adequate personnel infrastructure is required for reaching

the people. Based on the background and the planning process following are the overall priorities

of this District:

1. Providing services for the Unreached population

2. Providing services during floods and at pilgrimage sites

3. Addressing the health of the migrant workers and SC population.

4. Quality services at all levels

5. Availability of Programme Officers, Specialists, Doctors and Staff Nurses and retaining the

staff

6. Improving the condition of the facilities as per the IPHS norms including provision of

quarters for the personnel

7. Strengthening CMO office with good Infrastructure and technical assistance

8. Strengthening the HMIS especially availability of correct data and its use

9. Capacity building of functionaries at all levels

10. Improved monitoring for improved services

11. Improving the image of the health services within the community

SPECIFIC PRIORITIES OF THE DISTRICT

1. Availability of Primary health care services: Providing services of ANC, Safe delivery,

PNC, Immunization, DOTS, Anaemia prevention, prevention of Malaria at the village level

2. Programme Management: Efficient functioning of the District Health Society, a

strengthened CMO’s office with efficient district and Block programme managers and the

district technical support.

3. Demand Generation, IEC/BCC: Behaviour Change for utilization of services,

71

4. Human Resources: Filling of the vacancies as per the population based norms, increased

mobility, Increased emoluments for retaining the personnel, motivational issues, provision of

quarters at all facilities, Availability of well trained ASHAs for each 1000 population

5. Capacity Building: Focussed capacity building in Emergency Obstetric Care,

Management, Continuous skill building of all personnel as per needs expressed and also

the new job responsibilities under NRHM, opening a Staff Nurse Training College and

Paramedical Staff training

6. Maternal Health: Well managed system of deliveries by Skilled birth attendants, promotion

of institutional deliveries Emergency Obstetric Care services, JSY extended to all the

pregnant women, Blood Storage Units at all CHC , All CHC to be developed as FRUs, PHC

to be developed as 24x7 facilities with good referral mechanisms.

7. Neonatal and Child Health: Provision of Neonatal services at CHC, PHC, with trained

personnel on IMNCI and IMCI and addressing Anaemia and Malnutrition

8. Immunization: Total coverage for immunization of children, pregnant women and

adolescents

9. Family Planning: Improving the coverage for Spacing methods, NSV and Tubectomy.

10. Adolescent Health: Adolescent Reproductive and Sexual health education through schools

and also awareness building on good health practices, responsible family life, marriage at

right age.

11. National Disease Control Programmes: Prevention of Mosquito transmitted diseases

especially Malaria

12. Infrastructure: Increase in the number of Subcentres, PHC, CHC and General hospitals

catering to the entire population and developing all the facilities as per IPHS norms.

13. Procurement and Logistics: Construction of a scientific Warehouse for Drugs

14. Monitoring and Evaluation: Data validation and computerized data availability upto PHC

with district linkages

15. Public-Private Partnership: Involvement of the private facilities for providing services and

NGOs.

16. Intersectoral Convergence: Involving the related departments as members in the District

Health Society, Fixing Responsibilities of each sector for their accountability and hence

better Intersectoral Coordination

72

4. GOALS

The District will strive to improve the availability of and access to quality health care by people,

especially for those residing in rural areas, the poor, women and children and will achieve the

following goals:

Goals INDICATOR Current

07-08 08-09 09-10 10-11 11-12

Reduction in Infant Mortality Rate (IMR) 50** 10%

Baseline

20%

Baseline

30%

Baseline

40%

Baseline

50%

Baseline

Reduce Neo-natal Mortality Rate (NMR) DNA 10%

Baseline

20%

Baseline

30%

Baseline

40%

Baseline

50%

Baseline

Reduction Maternal Mortality Ratio (MMR) DNA 10%

Baseline

20%

Baseline

30%

Baseline

40%

Baseline

50%

Baseline

Reduction in Birth Rate( per)1000 29.19 30 27 25 20 15

Reduction in Total Fertility Rate 2.9 (IPHS) 2.8 2.7 2.5 2.3 2.1

Increased Full Ante-Natal Care as defined 6.6%** 25% 40% 60% 75% 90%

Increased Ante-Natal Care – 3 ANC checkups 39.4** 60% 70% 80% 90% 100%

Increased Proportion of Women getting IFA tablets 7.6** 55% 65% 80% 90% 100%

Increased Proportion of Women getting 2 TT

Injections

52.8%** 65% 75% 90% 100% 100%

Increased Institutional Deliveries 26.8%** 25% 40% 60% 75% 90%

Increased Delivery by Skilled Birth Attendants 29.9%** 40% 60% 75% 90% 100%

Increased Contraceptive Prevalence Rate 45.6%** 40% 50% 60% 70% 80%

Increased Complete Immunisation of Children (12-23

month of age)

38.7%** 40% 60% 80% 100% 100%

Increased Proportion of Children Exclusively

Breastfed

30.4%** 50% 70% 85% 100% 100%

Reduce Prevalence of STI/RTI 4.4** 35% 40% 50% 60% 70%

Source:

(*) CMO Office data (**) DLHS 2002-2004 data (***) Dir of Eco & Stat 2005 DNA means data not

available

The data regarding IMR, NMR, MMR is not available and hence a baseline survey is indicated.

73

INFRASTRUCTURE PLANNING

Facility 2001 2007- 08 2008-09 2009-10 2010-11 2011-12

Projected Population

(Calculated Decadal Growth

rate of 30 as per the Pop. of

2007)

5,50,084 6,23,388 6,37,234 6,51,387 6,65,854 6,80,642

General Hospital 1 1 1 1 1 1

CHCs 4 5 6 7 8 9

PHCs 39 39 39 39 39 39

Subcentres 151 175 200 217 222 227

ASHAs 630 630 640 650 665 680

AWCs 1186 1186 1186 1186 1186 1186

74

5. TECHNICAL COMPONENTS

PART A: Reproductive and Child Health (RCH) II

A-1. Strengthening of District Health Management

Situation

Analysis/

Current

Status

� The District Health Society Kathua has been formed under the Chairmanship of

the District Development Commissioner. Quarterly meetings of the District Health

Society are being held regularly. The members are from health, AYUSH,

Education, SDM, PHE, ICDS, Rural Development etc. There is a need to add one

representative from each block.

� The Societies under the vertical Health Programmes like Blindness Control

Society, TB Control Society, District Malaria Society, and society for IDSP have

not been integrated into single society at the district level yet. Thus societies

need functional integration and strengthening.

� Contractual appointments of various categories of staff have been made by the

District Health Society. A district project management unit has been set up to

provide technical support to the CMO for efficiently carrying out the programmes.

Recently the Block Management Units have been established for providing

technical support to the Block Medical Officers (BMOs).

� Monitoring of the activities of the health department is carried out by the DHS but

it is comprised of members of the health department only. Members from other

departments and also from the elected representatives need to become members

for better monitoring and implementation.

Objectives Empowered District Health Society to effectively plan, implement and monitor the

progress of the health status and services in the district Kathua and achieve the

goals of the District action Plan.

Strategies � Functional Integration of all the vertical Societies

� Capacity building of the members of the District Health Mission and District

Health Society regarding the programme, their role, various schemes and

mechanisms for monitoring and regular reviews and also on GoI / Go JK

guidelines for running the District. Health & FW Society

� Strengthening the functioning of the DHS

� Establishing Monitoring mechanisms

Activities 1. Developing systems for proper management, governance and functioning

through:

• Effective Planning – Annual, quarterly, monthly and as per needs

75

• Supervision mechanisms

• Convergence systems

• Procedures

• Reporting systems

• Regularity of meetings,

• Agenda of meetings, Maintaining minutes and its timely circulation

• Decentralisation

• Delegation of decision-making power

• Rational decision making

2. Orientation Workshop of the members of the District health Mission and society.

3. Issue based orientation in the monthly Review and Planning meetings as per

needs.

4. Ensuring provision of Technical Assistance at the district, block levels and sector

levels and their ongoing capacity building.

5. Exposure visits of members of the District health Society to well functioning

Panchayats in two states

6. Improving the Review and planning meetings through a holistic review of all the

programmes under NRHM and proper planning.

7. Formation of a monitoring Committee from all departments.

8. Development of a Checklist for the Monitoring Committee.

9. Arrangements for travel of the Monitoring Committee

10. Sharing of the findings of the committee during the Field visits in each Review

Meeting with follow-up of the recommendations.

Support

required

1. State to provide support for building the capacity of the DHS through

participation in DHS meetings

2. A GO should be taken out that at the district level each department should

monitor the meetings closely and ensure follow-up of the recommendations.

3. Instructions should be issued to the DHS that all approvals should be done in the

DHS Governing board meetings and the CMO should implement them instead of

sending each file to the DC for approval.

Timeline 2007-08 2008-09 2009-10 2010-11 2011-12

Developing systems x

Orientation Workshop of the

members x x x x x

Issue based orientation x x x x x

Ensuring provision of Technical

Assistance at the district, block levels x x x x x

76

and sector levels

Exposure visits of DHS members x x x x x

Formation of a monitoring Committee

from all departments. x

Development of a Checklist for the

Monitoring Committee. x

Budget

( In Lakhs)

Activity / Item 2007-

08

2008-09 2009-10 2010-

11

2011-

12

Total

Orientation Workshop 0.5 0.55 0.605 0.666 1.271 3.591

Exposure visit 6.2 6.82 7.502 8.252 15.754 44.528

Issues based Workshops 0.5 0.55 0.605 0.666 1.271 3.591

Mobility for Monitoring 0.6 0.66 0.726 0.799 1.525 4.309

Total 7.8 8.58 9.438 10.382 19.820 56.020

Detailed Calculations

# Description Amount

Exposure Visit

1 Airfare and travel expenses (Taxi, Bus, etc;) 400000/-

2 Lodging, Boarding, Food 200000/-

3 Misc. 20000/-

Total 6,20,000/-

Mobility for Monitoring by the DHS members

1 Vehicle on Rent/ Mules trips @ Rs 1000 per visit x 5 days visit per

month x 12 months

60,000

77

A- 2 District Programme Management

Current

Status

In NRHM a large number of activities have been introduced with very definite

outcomes. The cornerstone for smooth and successful implementation of NRHM

depends on the management capacity of District Programme officials. The officials

in the districts looking after various programmes are overworked and there is

immense pressure on the personnel. There is also lack of capacities for planning,

implementing and monitoring. The decisions are too centralized and there is little

delegation of powers.

In order to strengthen the district PMU, three skilled personnel i.e. Programme

Manager, Accounts Manager and Data Assistant have being provided in each

district. These personnel are there for providing the basic support for programme

implementation and monitoring at district level.

The District Programme Manager is responsible for all programmes and projects in

district and the District Accounts Manager (DAM) is responsible for the finance and

accounting function of District RCH Society including grants received from the

state society and donors, disbursement of funds to the implementing agencies,

preparation of submission of monthly/quarterly/annual SoE, ensuring adherence to

laid down accounting standards, ensure timely submission of UCs, periodic

internal audit and conduct of external audit and implementation of computerised

FMS.

The District Data Assistant (DDA) has to work in close consultation with district

officials, facilitate working of District RCH Society, maintain records, create and

maintain district resource database for the health sector, inventory management,

procurement and logistics, planning and monitoring & evaluation, HMIS, data

collection and reporting at district level.

In Kathua District Programme Manager, District Accounts Manager and District

Data Assistant are in place. The Block Management Unit also has been

constituted.

The PMU officers should be allowed to visit field areas to monitor at their level

since presently they are only doing paper work in their respective offices.

78

There is a need for providing more support to the CMO office for better

implementation especially in light of the increased volume of work in NRHM,

monitoring and reporting especially in the areas of Maternal and Child Health, Civil

works, Behaviour change and accounting right from the level of the Subcentre.The

CMO’s office needs to be built.

Objectives Strengthened District Management Unit

Strategies 1. Support to the CMO for proper implementation of NRHM.

2. Capacity building of the personnel

3. Development of total clarity at the district and the block levels amongst all the

district officials and Consultants about all activities

4. Provision of infrastructure for the personnel

5. Training of district officials and MOs for management

6. Use of management principles for implementation of District NRHM

7. Streamlining Financial management

8. Strengthening the CMO’s office

9. Strengthening the Block Management Units

10. Convergence of various sectors

Activities 1. Support to the CMO for proper implementation of NRHM through filling up of

existing vacancies & involvement of more consultants for support to CMO for

data analysis, trends, timely reports and preparation of documents for the day-

to-day implementation of the district plans so that the CMO and the other

district officers are able to function properly:

a. Finalizing the TOR and the selection process

b. Advertisements for consultants, one each for Maternal Health, Civil Works,

Child health, Behaviour change. If properly qualified and experienced

persons are not available then District Facilitators to be hired which may be

retired persons.

c. Selection of the consultants for Maternal Health, Child Health, Civil Works,

IEC

2. Capacity building of the personnel

d. Joint Orientation of the District officers and the consultants

e. Induction training of the DPM and consultants

f. Training on Management of NRHM for all the officials

g. Review meetings of the District Management Unit to be used for orientation

of the consultants

79

3. Development of total clarity in the Orientation workshops and review

meetings at the district and the block levels amongst all the district officials and

Consultants about the following set of activities:

• Disease Control

• Disease Surveillance

• Maternal & Child Health

• Accounts and Finance Management

• Human Resources & Training

• Procurement, Stores & Logistics

• Administration & Planning

• Access to Technical Support

• Monitoring & MIS

• Referral, Transport and Communication Systems

• Infrastructure Development and Maintenance Division

• Gender, IEC & Community Mobilization including the cultural

background

• Block Resource Group

• Block Level Health Mission

• Coordination with Community Organizations, PRIs

• Quality of Care systems

4. Provision of infrastructure for officers, DPM, DAM, DDM and the

consultants of the District Project Management Unit.

h. Provision of office space with furniture and computer facilities, photocopy

machine, printer, Mobile phones, digital camera, fax, etc;

5. Use of Management principles for implementation of District NRHM

i. Development of a detailed Operational manual for implementation of the

NRHM activities in the first month of approval of the District Action Plan

including the responsibilities, review mechanisms, monitoring, reporting and

the time frame. This will be developed in participatory consultative

workshops at the district level and block levels.

j. Financial management training of the officials and the Accounts persons

k. Provision of Rs. 500,000 as Untied funds at the district level under the

jurisdiction of the Civil Surgeon

l. Compendium of Government orders for the DC, Civil surgeon, district

officers, hospitals, CHC, PHC and the Subcentres need to be taken out

80

every 6 months. Initially all the relevant documents and guidelines will be

compiled for the last two years.

6. Development of a District Health Complex

• Construction of a District Health Complex for housing the CMO and all the

officials and their staff. There will be pooling of funds available for office

expenses, personnel and better utilization of resources.

• This complex will also have a modern Conference Hall with speaker systems

and facilities for LCD projector and a meeting hall along with a common

Computer Cell. There will be a Control Room, Consultant Unit, Library,

Waiting room, a record room,

• The Swasthya complex will be furnished and partitions will be made as per

the modern offices to give each one of the staff a separate working area.

• Office Automation will be done through installation of PABX system,

Computers systems with UPS, Printer and Scanner for each district office

section, Laptop for Civil surgeon, District Family Welfare Officer, Fax

machines, Photocopy machine, Broadband Internet connectivity, Digital

Camera with date and time etc;

7. Strengthening the Block Management Unit: The Block Management units

need to be established and strengthened through the provision of :

• Block Programme Managers (BPM), Block Accounts Managers (BAM) and

Block Data Assistants (BDA) for each block. These will be hired on contract.

For the post of BPM and the BAM retired persons may also be considered.

• Office setup will be given to these persons.

• Accountants on contract for each PHC since under NRHM Subcentres have

received Rs 10,000 also the village committees will get Rs 10,000 each,

besides the funds for the PHC.

• Provision of Computer system, printer, Digital Camera with date and time,

furniture

8. Convergence of various sectors at district level

Provision of Convergence fund for workshops, meetings, joint outreach and

monitoring with each CMO.

9. Monitoring the Physical and Financial progress by the officials as well as

independent agencies

10. Yearly Auditing of accounts

81

Support from

state

1. State should ensure delegation of powers and effective decentralization.

2. State to provide support in training for the officials and consultants.

3. State level review of the DPMU on a regular basis.

4. Development of clear-cut guidelines for the roles of the DPMs, DAM and

District Data Manager.

5. Developing the capacities of the Civil Surgeons and other district officials to

utilize the capacities of the DPM, DAM and DDA fully.

6. Each of the state officers Incharge of each of the programmes should develop

total clarity by attending the Orientation workshops and review meetings at

the district and the block levels for all activities.

7. If qualified persons for the posts of DPM, DAM are not available then State

should allow the appointment of facilitators or Coordinators or retired qualified

persons by the District Health Society.

Time Frame

Activity

2007-

08

2008-

09

2009

-10

2010

-11

2011

-12

DPM,DAM,DDA and Consultants x x x x x

Infrastructure, furniture, computer systems, fax, UPS,

Printer, Digital Camera

x x

Workshops for development of the operational Manual

at district and Block levels

x x x x x

Construction of District Health Complex x x

Furnishing and Office Automation, Conference Hall

with speakers, ACs

x

Compendium of Govt orders x x x x x

Joint Orientation of Officials and DPM, DAM, DDM x x x x x

Management training workshop of Officials x

Establishment of BPMU x x

Training of DPM and Consultants x x x x x

Review meetings x x x x x

Computer systems with printer and Digital Camera &

furniture for DPMU, BPMUs, District, block personnel

x x

Monitoring of the progress x x x x x

Budget

In Lakhs)


08

2008-

09

2009-

10

2010-

11

2011

-12

Total

Honorarium DPM,DAM,DDA and

Consultants

29.4 32.34 35.574 39.131 43.04

5

179.49

0

Travel Costs for DPMU @ Rs 10,000/

per month x 12 mths

1.2 1.32 1.452 1.597 1.757 7.326

Infrastructure costs, furniture, computer 5 5.5 6.050 6.655 7.321 30.526

82

systems, fax, UPS, Printer, Digital

Camera,

Workshops for development of the

operational Manual at district and Block

levels

1 1.1 1.210 1.331 1.464 6.105

Untied Fund 5 6 7.000 8.000 9.000 35.000

Construction Cost of District Health

Complex @ Rs 800 /sq.ft x 11000sq ft

88 0 0.000 0.000 0.000 88.000

Furnishing and Office Automation,

Conference Hall with speakers, ACs

15 0 0.000 0.000 0.000 15.000

Maintenance of the District Health

Complex

0 1.000 1.500 2.000

2.500

7.000

Compendium of Govt orders 0. 50 0.55 0.610 0.670 0.730 2.560

Joint Orientation of Officials and DPM,

DAM, DDM

0.25 0.275 0.303 0.333 0.366 1.526

Management training workshop of

Officials

0.5 0.55 0.605 0.666 0.732 3.053

Personnel for BPMU 92.4 101.64 111.80

4

122.98

4

135.2

83

564.11

1

Training of DPM and Consultants 0.5 0.75 1.000 1.250 1.500 5.000

Review meetings @ Rs 1000/ per

month x 12 months

0.12 0.132 0.145 0.160 0.180 0.737

Office Expenses @ Rs 10,000/month x

12 months for district

1.2 1.32 1.450 1.600 1.800 7.370

Computer systems with printer and

Digital Camera and furniture for DPMU,

BPMUs and District and BPMU

27.6 0 0.000 0.000 0.000 27.600

Annual Maintenance Contract for the

equipment

2.7 2.97 3.267 3.594 3.953 16.484

Travel costs for BPMU @ Rs 5000 per

month per block

12.36 13.596 14.955

6

16.451

16

18.09

6276

75.459

Hiring of vehicles at block level @ Rs

800 x 20 days /mth x 39 PHCs x 12

mths

74.88 82.368 90.604

8

99.665

28

109.6

3181

457.15

0

Monitoring of the progress by

independent agencies

1 1.1 1.200 1.300 1.400 6.000

Office expenses for Blocks & Sectors

@ Rs 5000 x 5 blocks x 12, Rs

2000X39 SectorsX12

12 13.2 14.52 15.972 17.56

92

73.261

Total 370.11 265.71

1

293.25

0

323.35

9

356.3

27

1608.7

58

83

Detailed calculation for Personnel at DPMU for one year

S.No Details Units Unit Cost Amount for 12 months

Personnel at District level

District Programme manager 1 18000 216000

District Accounts Manager 1 15000 180000

District Data Assistant 1 12000 144000

Consultant for Maternal Health 1 40000 480000

Consultant for Child Health 1 40000 480000

Consultant for Civil Works 1 40000 480000

Consultant for HMIS 1 40000 480000

Consultant for Behaviour Change 1 40000 480000

SubTotal 2940000

Personnel at Block level

Block Programme manager 5 15000 900000

Block Accounts Manager 5 12000 720000

Block Data Assistant 5 10000 600000

Retired Accountants for each PHC @ Rs

5000 per month x 39 PHC x 12 months

39 10000 4680000

Sectoral Managers 39 5000 2340000

Subtotal 9240000

Hiring of vehicles at block level @ Rs 800 x

39 PHCs x 4 blocks x12 months

39 192000 7488000

Office Automation with Furniture, Computer

system, Camera, Printer, etc

5 for BPMU

1 for DPM

1 for DAM

39 sectors

60,000 2760000

84

A-2. MATERNAL HEALTH

Situation

Analysis/

Indicator CMO

data

Percentage

No of Pregnancies 18197

Maternal Deaths 4

ANC registration during the first

trimester

15713 86%

TT-2 10047 55%

Institutional Deliveries 3831 21%

Deliveries by skilled birth attendants 5999 33%

Home deliveries 6110

Skilled Unskilled

No. % No. %

Home deliveries

3232 52.90 2878 47.10

No. of pregnancy related

complications

231 1.27

No. of pregnancy related

complications referred to FRU level

61 0.34

MTP 363 2.0

Source: MPR Form 9 : 2005-2006

Maternal Mortality: Only 4 Maternal deaths have been reported and there is no

authentic data available regarding the Maternal deaths in the district since there is a lot

of under reporting due to lack of personnel and improper supervision.

Age of marriage: The mean age of marriage for boys is 27.4 years as per DLHS 2002-

2004. Similarly for girls the mean age of marriage is 22.5 years. This is a good indication

for RCH.

ANC: Out of the estimated pregnancies 86 % pregnancies had been registered of which

50 % were administered TT2. This data needs to be validated since the institutional

deliveries are only 21%. The data regarding Full ANC is not available. As per DLHS

2002, full ANC is only 6.6%, and 3.6 % women had pregnancy complications. The

reasons for low ANC coverage are the shortage of staff, socio-cultural beliefs, large

areas and populations unreached and the unmotivated staff. There is late detection of

85

pregnancy in rural areas:-probably due to ignorance on the part of the women or other

prevailing local superstitions.

Anaemia: There is no data available regarding the actual consumption of IFA. As per

DLHS 2002 only 7.6 % of the pregnant women received 100 IFA tablets percent and

among them 23.3 % had consumed it daily. A number of times there is non availability of

Iron & folic acid tab:-partly because they are out of stock. As per the CMO office

acceptance of IFA is on the rise.

TT: 50 % of the pregnant women had received TT2. As per DLHS 2002, 52.8 % of the

pregnant women had received two doses of TT. This hence carries a grave risk for the

pregnant women. Immunization needs to be strengthened with thrice a week sessions.

Deliveries: Institutional deliveries are 19 % with only 30 % of all the deliveries being

done by Skilled Birth Attendants. As per DLHS 2002 only 26.8% were institutional

deliveries. 60.8% were safe deliveries by Doctor/Nurses/TBA and 29.9 % by

Doctor/Nurses. This is a reflection of the availability of services, accessibility and also

the perception of people.

Referrals: There is no adequate data for referrals during complications. As per DLHS-

2002, 22.3% women had complications during delivery. Although there is a Referral

Transport Scheme but there is no provision for their Running, repair & maintenance.

There is no uniform referral slip should be printed for implementation of the same

throughout the State. The drivers for referral transport are not available round the clock.

MTP: There were 363 MTPs carried out last year which is 2 % of the total pregnancies.

Malnutrition: There is no data available but malnutrition is prevalent 5701 mothers

received Supplementary nutrition at the AWCs out of a total 9627 mothers registered at

the AWCs.

Male participation: There is no data available for the level of male participation and

also on what issues does male participation occur.

Janani Suraksha Yojana: The JSY scheme has been launched in J & K and 1064

women have benefited last year and from April 06 to March 07. The Govt. has assigned

4% of the funds for JSY out of which 1% is reserved for State monitoring & 3% is left for

District & blocks, which is not sufficient This low uptake has been due to poor awareness

86

and also due to the fact that the data of BPL families needs to be updated. The JSY

form is very lengthy & most of the time difficulties are faced in filling of this form. There is

no column for Blood Group. The cash should be provided in the hand of the mother with

instructions to use it for the purpose it is meant. Most of the sub centers in are in far

flung areas without proper roads hence if delivery takes place during night it is practically

not possible for ASHA who is a female to take the patient to the subcentres. There are

other issues regarding non availability of ASHA for PPC although she may have given

full ANC and support during delivery. There are many pending claims of last year.

Services: The Community does not have enough confidence in the government facilities

since the personnel are not always available and also adequate infrastructure,

equipment and drugs. The private facilities also are not available. There is lack of

coordination among AWW, ANM & ASHA since they are not clear regarding their roles.

In block Parole, there are areas like Karian Gandyal which are nearer to Punjab than

their respective Subcentres; as a result they prefer to go to the nearer subcentre

Sujanpur, Punjab.

Training: Regular training programmes on SBA, EmOC and MTP need to be arranged

for the personnel. Also the TBAs need to be trained and equipped.

Village Health Day (VHD days) 1414 VHDs had been organized from the beginning but

there is little awareness amongst the community about the days when these are held

and also regarding the services being provided. Also staff is inadequate to cover all the

AWCs.

RCH Camps: RCH camps are organized by the department to reach the community and

provide services at the doorsteps. These camps provide specialist services with simple

diagnostic tests. They also serve for screening of RTI and STDs.

Anganwadis: A total of 1190 AWCs are sanctioned, only 1186 are functional. The RCH

programme is dependent on the ICDS programme for effective implementation and this

is a serious gap of 373 centres.

Accessibility: Difficult terrain & non availability of roads & transport: Many subcentres in

Bani are at the places where one has to walk a lot for accessing services & pregnant

ladies are forbidden to climb at their crucial stages , most of the time complications

occurs during transportations during pre delivery time, so they prefer local Dais who are

easily available at their doorsteps.

87

Objectives 1. Decrease in the Maternal Mortality ratio to 50% of the baseline by 2012

2. 100% ANC coverage by 2012

3. 100% pregnant women administered two doses of TT by 2012

4. 80% pregnant women to consume 100 IFA tablets by 2010 and 100% by 2012

5. 60% Institutional deliveries by 2010 and 90% by 2012

6. 75% deliveries to be carried out by trained /Skilled Birth Attendant by 2010, 100% by

2012

7. 100% women to get improved Postnatal care by 2010

8. 50 % increase the safe abortion services by 2010

9. Reduction in Anaemia to less than 20 per cent by 2012

Strategies 1. Provision of quality Antenatal and Postpartum Care to all pregnant women

2. Increase in Institutional deliveries

3. Provision of Quality services in the health facilities and availability of Emergency

Obstetric Care services

4. Availability of safe abortion services at all CHC and PHC

5. Increased coverage under JSY

6. Strengthening the Village Health Day

7. To increase awareness among mothers and communities about the importance of

institutional deliveries

8. Improved behaviour practices in the community

9. Increase accessibility to services

10. Operationalization of all the sanctioned Anganwadis

Activities 1. Identification of all pregnancies through house-to-house visits by AWWs, ASHAs and

TBAs

2. Operationalizing the Village Health Day

m. Once a week ANC clinic at all PHC and CHC

n. Weekly ANCs at all AWCs wherever possible

o. Development of a microplan for the ANMs in a participatory manner with the

ICDS at the level of PHC to cover all the AWCs. In the beginning it is expected

that there should be 100% coverage at the population covered by the AWCs

and later each hamlet need to develop its microplan.

p. Wide publicity regarding the VHD day by AWWs and ASHAs and their services

q. A day before the VHD day the AWW and the ASHA should visit the homes of

the pregnant women needing services and motivate them to attend the VHD day

r. If the pregnant women do not attend the VHD day then they should be brought

from their homes to the AWC

s. Registration of all pregnancies

88

t. Each pregnant woman to have at least 3 ANCs, 2 TT injections and 100 IFA

tablets

u. Nutrition and Health Education session with the mothers at each of the mother’s

meetings

3. Improving accessibility to care

• Monthly Outreach sessions at each of the 96 difficult area villages

• Pooling of resources at the PHC for conducting sessions for all services

• Team to consist of MO PHC, LS, LHV, ANM, AWW, ASHA, Rehbar-e-Sehat

teachers

• Wide publicity for these outreach sessions by the ANMs/ AWWs/ ASHAs

4. Postnatal Care

• The AWW along with ANM will use IMNCI protocols and visit neonates and

mothers at least thrice in first week after delivery and in total 5 times within one

month of delivery. They will use modified IMNCI charts to identify problems,

counsel and refer if necessary. There is a need to train the AWWs intensively

since initially till the posts are filled the ANM cannot do joint visits

5. Active involvement of TBAs:

• Training to all TBAs focussing on their involvement in VHD days, motivating

clients for registration, ANC, institutional deliveries, safe deliveries, postnatal

care, care of the newborn & infant, prevention and cure of anaemia and family

planning , on the 5 cleans, danger signs and timely referral

• Delivery kits to be given to all TBAs

• TBA to be attached with the ANM

• Incentive of Rs 100 per delivery should be given to TBAs for promoting safe and

institutional delivery through Skilled Birth Attendant

• The recruitment of new ASHAs should be from the TBA taskforce.

6. Reduction of Anaemia

• Wider distribution of IFA tablets and overseeing their consumption

• ASHAs to be developed as depot holders for IFA tablets

• ASHA to ensure that all pregnant women take 100 IFA tablets

Promotion of kitchen gardens to promote intake of iron rich vegetables.

Attractive packaging and Ayurvedic preparations of Iron and Folic Acid as an

alternative to persons not consuming IFA tablets for increasing acceptance

• Availability of IFA tablets

7. Operationalization of the non functional AWCs in a phased manner

8. Tracking bags

89

a. Provision of tracking bags for all the Pregnant mothers

b. Training of ANM and AWWs for the use of Tracking bags

9. Provision of Weighing machines to all Subcentres and AWCs

10. Training of personnel for Safe motherhood and Emergency Obstetric Care (Details

in Component on Capacity building)

11. Training for skilled birth attendant

12. Developing the CHC and PHC for quality services and IPHS standards (Details in

Component Upgradation of CHC& PHC and IPHS Standards)

13. Increase accessibility of 24-hour delivery services (BEmoC) in 13 PHC. Repairs

and renovations of PHC to be carried out.

14. Availability of Blood at the CHC

1. Establishing Blood storage units at all CHC

2. Certification of the Blood Storage centres

15. Improving the services at the Subcentres (Details in Component on Upgradation of

Subcentres and IPHS)

16. Behaviour Change Communication (BCC) efforts for awareness and good practices

in the community (Details in Component on IEC)

17. Increasing the Janani Suraksha coverage

• Wide publicity of the scheme (Details in Component on BCC)

• List of BPL pregnant women to be part of each month’s report

• Advance Funds for JSY should be available with the ANMs

• Timely payments to the beneficiary should be ensured

• Starting of Janani Suraksha Yojana Helpline in each block through Rogi Kalyan

Samitis

• Funds for JSY should be kept aside for the disbursement and a proper action

plan for this distribution should be made.

• The cash should be provided in the hand of the mother with instructions to use it

for the purpose it is meant.

18. Provision of Mobile Phones to all the ANMs, PHC MOs and CHC personnel

• Provision of Mobile phone instrument to all personnel

• 0Display of the Mobile numbers at all Subcentres, AWCs, Panchayat Bhawans,

PHC and CHC

• Plan of Rs. 225 per month of BSNL, which includes facility for 50 free calls

19. Provision of Safe Abortion:

• Provision of MTP kits and necessary equipment and consumables at all PHC

• Training of the MOs in MTP

90

• Wide publicity regarding the MTP services and the dangers of unsafe abortions

• Encourage private and NGO sectors to establish quality MTP services.

• Promote use of medical abortion in public and private institutions: disseminate

guidelines for use of RU-486 with Mesoprestol

20. Development of a proper referral system with referral cards

21. Improvement of supervision and monitoring of ANM tour programme, Fixed VHD

days, outreach sessions, payment of JSY, EmOC services, referral

• Fixed VHD days and Tour plan of ANM to be available at the PHC with the MOs

• Checklist for monitoring to be developed

• Visits by MOs and report prepared on basis of checklist filled

• Findings of the visits by MOs to be shared by MO in meetings

22. Use of the Village Chowkidar and Numberdar as Social Mobilizers for getting data

on Maternal deaths, abortions, Pregnancies

23. Involvement of Rehbar-e-Sehat teachers for IEC, reporting and community

mobilization

• Training of RIS teachers

• Regular meetings for progress and follow-up

• Increase of emoluments to Rs 500 per mot for motivation of families, giving

some safe drugs, promotion of good health practices and disease control

24. RCH Camps: These will be organized monthly to provide specialist services

especially for RTI/STD cases.

25. Build public-private partnership in this area.

Support

required

1. Issue of joint letters from Health & WCD department for joint working and ensuring

its implementation

2. The Social Welfare department should ensure operationalization of no functional

Anganwadis

3. Ensuring availability of personnel especially specialists and Public Health Nurses for

the 24 hour PHC, CHC and two ANM at the subcentres

4. Ensuring availability of formats and funds with the ANM for JSY and timely

payments

5. Certification of PHC as MTP centres

6. Ensuring smooth flow of Blood from the Blood Bank at District Hospital to the Blood

Storage units

7. The State should closely monitor the progress of all the activities

8. JSY should be extended to all the pregnant women irrespective of BPL and APL

Timeline

2007-

08

2008-

09

2009-

10

2010-

11

2011-12

91

Identification of all pregnancies through house-

to-house visits x x x x x

Operationalizing the VHDs x x x x x

Once a week ANC clinic at All PHC and CHC

Weekly ANCs All AWCs wherever possible

Microplan for ANMs x x x x x

Monthly Outreach sessions x x x x x

Delivery kits to be given to all TBAs 587 587 587 587 587

Incentive for TBA referral @Rs 100 per referral 2000 3000 4000 5000 6000

Incentive to RIS teachers @ Rs 500/mth x x x x x

Provision of tracking bags for all the AWCs & SC 1361 1587 1403 14081 1413

Provision of Weighing machines to all

Subcentres and AWCs 1361 1587 1403 14081 1413

Regular meetings for progress and follow-up x x x x x

Establishing Blood storage units at all CHC

2

CHCs

2

CHCs 1 CHC

2

CHCs 2 CHCs

Increasing the Janani Suraksha coverage 10000 12000 14000 16000 18000

Janani Suraksha Yojana Helpline 1 Block

2

Blocks

3

Blocks

4

Blocks 5 Blocks

Provision of Mobile Phones

115

ANMs

32 PHC

MO,

15 CHC

189

ANMs

46 PHC

MO,

13 CHC

46

ANMs

6 PHC

MO ,

14

SMOs

CHC

50

ANMs

6 PHC

MO ,

14

SMOs

CHC

54 ANMs

6 PHC MO ,

14 SMOs

CHC

Provision of MTP kits and necessary equipment

and consumables at all PHC

39

PHC

39

PHC

39

PHC

39

PHC 39 PHC

Training of the MOs in MTP x x x x x

RCH Camps 12 12 12 12 12

Training of personnel for Safe motherhood and

Emergency Obstetric Care x x x x x

Training of the MOs in MTP x x x x x

Training for skilled birth attendant x x x x x

Training of RIS teachers x x x x x

Training to all TBAs x x x x x

Training of ANM and AWWs for the use of

Tracking bags x x x x

92

Budget

( In Lakhs)

Activity / Item 2007

-08

2008-

09

2009-

10

2010-

11

2011-

12

Total

Consultancy for support for developing

Microplan for Village health Day

1 1.1 1.210 1.331 1.464 6.105

Tracking Bags @ Rs 300/ bag x AWCs + SCs 4.083 4.158 4.209 4.224 4.239 20.913

Adult Weighing machines @ Rs 800 per

machine x 600AWCs & Maintenance(10% cost

of machine)

10.88

8

11.088 11.22

4

11.26

4

11.30

4

55.768

Monthly special outreach session in 100 difficult

villages@2000/session

2 2.2 2.42 2.662 2.928

2

12.210

Blood Storage @ Rs 3 lakhs per unit 6 6 3.000 6.000 6.000 27.000

Referral Cards @ Rs 2 per card x 10,000 0.2 0.22 0.242 0.266 0.293 1.221

MTP kits @ Rs 15000 Per kit 5.85 6.435 7.078

5

7.786

35

8.564

985

35.715

One day training workshop on Tracking bags at

the district level and each sector

1 1.1 1.210 1.320 1.450 6.080

JSY beneficiaries @ Rs 1400/person 140 168 196.0

00

224.0

00

252.0

00

980.000

JSY Helpline through RKS 9.99 19.98 29.97

0

39.96

0

49.95

0

149.850

Mobile phone instrument to personnel @ Rs

2000

3.24 4.96 1.320 1.400 1.480 12.400

Mobile Phones recurring cost to personnel @ Rs

2700

4.374 11.07 12.85

2

14.74

2

16.74

0

59.778

Delivery kits to TBA's@3000and refilling @ 1000 17.61 3.86 4.246 4.671 5.138 35.524

Incentives to TBA @ 100 per delivery by skilled

birth attendant

2 3 4 5 6 20.000

RCH Camps @ Rs 25000 per camp x 12 3 3.3 3.630 3.993 4.392 18.315

Total 211.2

35

246.47

1

282.6

12

328.6

19

371.9

43

1440.88

0


JSY Helpline through Rogi Kalyan Samiti

S.No Details of one block helpline Amount (Lakhs)

1. Personnel @ Rs 4500 x 4 x 12 months 2.16

2. Travel of personnel Rs 2500 per person/mth x 12 mths 3.6

3. Mobile Phones @ Rs 2000/ mth x 90 sets 1.8

4. Rec cost of mobile @ Rs 225 x 12 x 90 persons 2.43

Total 9.99

93

A-3. NEWBORN & CHILD HEALTH

Situation

Analysis

Indicator No. Rate /%

No. of births 12401

Neonatal Deaths DNA

Infant Deaths( as per CMO data) 57 0.45

Child Deaths DNA

Still birth in the last year 88

Low birth weight newborns (less than 2.5 kgs.) 435 3.50

Child Vaccination: completed ( 12-23 months age ) 5787

Severely malnourished children ( Grade III & IV ) As

per ICDS

1

Grade I and II malnutrition (As per ICDS) 6224 22.94

ARI cases in the last year 2009

Deaths in the last year due to pneumonia in children 4

Diarrhoea cases in the last year 2089

Deaths in last year due to Diarrhoea in children 4

Coverage by ICDS 27127 29.32

Total No of children 0-6 yrs ( Calculated from census

and growth rate) 92521

Source: CMO office, ICDS 13.4.07

Anaemia in children: There is no data available `with the CMO or the ICDS regarding

the levels of anaemia in children. Children are given IFA tablets for iron supplements

under the national programme.

Malnutrition: Undernutrition is a cause of serious concern amongst the children of the

0-6 years age group. In the ICDS programme Supplementary nutrition is provided to

children below 6 yrs. The coverage of ICDS is only 29.32 %. Nutrition is being provided

at the AWC and 23 % of the children at the AWCs are malnourished and there is only

one severely malnourished child as per the data from the MPR of ICDS programme.

The data for the severely malnourished appears unrealistic. The reasons for malnutrition

are related to repeated diarrhoeal episodes, feeding practices of not giving colostrums,

late weaning, poor sanitation and worm infestation.

Breast feeding: There is no data regarding exclusive breast feeding. As per DLHS 40.3

% children were breastfed exclusively for the stipulated period of 4 months. There is lack

of knowledge regarding the significance of Colostrum and the socio-cultural factors

94


associated with it since 64.2 % of mothers squeezed out the first breast milk as per

DLHS.

Childhood illnesses

Diarrhoea: Undernutrition is associated with diarrhea, which further leads to malnutrition.

There is no data on diarrhoea but according to the district MOs it is common. According

to the DLHS 2002 28.2 % of the women were aware of what was to be done when a

child got diarrhea and only 19% were aware about Oral Rehydration Solution (ORS) and

10.6% gave ORS to the children and a negligible percentage gave more fluids to drink.

Also all sought treatment for Diarrhoea. This shows that there is a need for more

knowledge regarding the use of ORS and increased intake of fluids and the type of food

to be given.

Pneumonia: There is no data on childhood Pneumonia but as per the district official

there is a need to create awareness regarding the danger signs of Pneumonia.. As per

DLHS 2002, 8.3% persons were aware of danger signs of Pneumonia, 26 % had

Pneumonia 2 wks prior to survey and 98.4%persons sought treatment for Pneumonia

Newborn and Neonatal Care: There is very little data available for the newborns and

the neonates. The District data shows that a negligible percentage of newborns and

neonates died which is doubtful. Reporting regarding these deaths is not done properly.

The various health facilities also are poorly equipped to handle newborn care and

morbidity. The TBAs and the personnel doing home deliveries are unaware regarding

the neonatal care especially warmth, prevention of infection and feeding of Colostrum.

Training: IMCI and IMNCI training is essential for the MOs, Staff Nurses, ANMs.

Training on the home based care package is required for the

ANMs/AWWs/ASHAs/TBAs. However some portion is being covered under SBA

trainings.

Data: There is no data available for childhood diseases, Prenatal mortality, Low birth

weight at birth, deaths due to various causes.

Services: There are only 3 Paediatricians as against the required 6 in the whole district.

The infrastructure for providing services for Childhood morbidity and Neonatal care is

not there even at the District hospital.

95


Objective

1. Reduction in IMR to 50% from baseline by 2012

2. Reduction in Neonatal mortality to 50% from baseline by 2012

3. Increased proportion of women who exclusively breastfeed for 6 months to 100% by

2010-2012

4. Increased in Complete Immunization to 100% by 2010-2012

5. Increased use of ORS in diarrhoea to 100% by 2009-2010

6. Increase in the Treatment of 100% cases of Pneumonia in children by 2010-2012

7. Increase in the utilization of services to 100% by 2012

Strategies 1. Improving feeding practices for the infants and children including breast feeding

2. Promotion of health seeking behaviour for sick children

3. Community based management of Childhood illnesses

4. Improving newborn care at the household level and availability of Newborn services

in all CHC & hospitals

5. Improving the care for Malnourished children(Discussed under Component on

Immunization)

6. Enhancing the coverage of Immunization

7. Zero Polio cases and quality surveillance for Polio cases

Activities

1. Promote early and exclusive breastfeeding up to 6 months of age and

complementary feeding thereafter.

2. Promoting Integrated management of neonatal and childhood illnesses (IMNCI)

• IMNCI training will be carried out for the health workers

• Assess the FRUs with reference to IPHS developed by GOI and identify

the gaps

• Provide necessary instruments and equipment needed to ensure

CEmOC

• Training of MO in CEmOC, newborn care and lifesaving saving

anaesthesia skills as per the models developed per GOI. Also resuscitation skills.

• Blood storage facilities will be operationalized in all 7 CHC/ PHC/ FRUs

to be proposed (only district hospital working as FRU)

• Referral transport facility will be provided to all health facilities for

bringing the patients to FRUs.

• Training neonatal nurses (one month at medical college)

• Strengthening the neonatal services and emergency Child care services in District

hospital and at all CHC. This will be done in phases

• In all of these units, newborn corners would be established and staff trained in

96


management of sick newborns and immediate management of newborns. For all

the equipment for establishing newborn corners, a five year maintenance contract

would be drawn with the suppliers. The suppliers would also be responsible for

installing the equipment and training the local staff in basic operations

• The equipment required for establishing a newborn corner would include Newborn

Resuscitation trolley, Ambubag and masks (including newborn sizes),

Laryngoscopes, Phototherapy units, Room warmers, Inverters for power back-up,

Centralized oxygen and Pedal suctions.

i. Improving feeding practices for the infants and children including

breast feeding

• Study on the feeding practices for knowing what is given to the children

• Education of the families for provision of proper food and weaning

• Educate the mothers on early and exclusive breast feeding and also giving

Colostrum

• Introduction of semi-solids and solids at 6 months age with frequent feeding

• Administration of Micronutrients – Vitamin A as part of Routine immunization,

IFA and Vitamin A to the children who are anaemic and malnourished

ii. Promotion of health seeking behaviour for sick children and

Community based management of Childhood illnesses

• Training of LHV, AWW and ANM on IMCI including referral

• BCC activities by ASHA, AWW and ANM regarding the use of ORS and

increased intake of fluids and the type of food to be given

• Availability of ORS through ORS depots with ASHA

• Identification of the nearest referral centre and also Transport arrangements for

emergencies with the PRIs and community leaders with display of the referral

centre and relevant telephone numbers in a prominent place in the village

iii. Improving newborn care at the household level

• Adaptation of the home based care package of services and scheduling of visits

of all neonates by ASHA/AWW/ANM on the 1st, 2nd, 7th, 14th and 28th day of

birth.

• In case of suspicion of sickness the ASHA /AWW must inform the ANM and the

ANM must visit the Neonate

• Referral of the Neonate in case of any symptoms of infection, fever and

hypothermia, dehydration, diarrhoea etc;

• Training on IMNCI of ASHA/AWW/ANM/MOs on the home based Care package

97


• Supply of medicine kit and diagnosis and treatment protocols (chart booklets) for

implementation of the IMNCI strategy

• Training of staff in Newborn Care, IMNCI and IMCI (MOs, Nurses) including the

management of sick children and severely malnourished children.

• Availability of Paediatricians in all the CHC

• Ensuring adequate drugs for management of Childhood illnesses.

iv. Strengthening the fixed Village Health Days (Also discussed in the component on

Maternal Health)

• Use of Tracking Bag for Tracking of Left-outs and dropouts by ASHA, AWW and

contacting them a day before the session

• Information of the dropouts to be given by ANM to AWW and ASHA to ensure

their attendance

• Wide publicity regarding the VHD days

v. Developing Malnutrition Centres for the care and treatment of

malnourished children at all CHC

vi. Strengthening Immunization (Discussed in Component C)

Support

Required

1. Availability of trained staff including Paediatricians

2. Technical Support for training of the personnel

3. Timely availability of vaccines, drugs and equipment

4. Good cooperation with the ICDS and PRIs

Timeline

2007-08 2008-09 2009-10 2010-11 2011-

12

Promoting (IMNCI) x x x x x

IMNCI training x x x x x

Assessment of FRUs with reference to

IPHS for NB Care x x x

Newborn corners – All CHCs 1 CHC 4 CHCs 1 CHC 1 CHC 1 CHC

Malnutrition Corners – DH and all CHCs DH ,

1 CHC 4 CHCs 1 CHC 1 CHC 1 CHC

Study on the feeding practices for knowing

what is given to the children x

Education on early and exclusive breast

feeding and Colostrum x x x x x

Promotion of health seeking behaviour for

sick children x x x x x

Improving newborn care at the household

level x x x x x

98


Training on the home based Care IMNCI

of ASHA/AWW/ANM/MOs x x x x x

Training of MO in CEmOC, IMNCI x x x x x

Training of LHV, AWW and ANM on IMCI

including referral, Tracking Bags x x x x x

Wide publicity regarding VHD days x x x x x

Budget Activity / Item

2006-07

2007-

08

2008-

09

2009

-10

2010-

11

2011-

12

Total

Study on the feeding and Care

practices for the infants and children

2 0 0.000 0.000 0.000 2.000

Innovative activities based on the study 0 2 2.000 2.000 2.000 8.000

Newborn Corner furnished with

equipment @ Rs 1.40 lakh per facility

1.4 5.6 1.4 1.4 1.4 11.200

Examination table, chair, stool, table,

other equipment @ Rs. 3000 x No of

AWCs

35.58 35.580

Infant Weighing Machines @ Rs.

800/AWCx No of AWCs

9.488 9.488

Foetoscope @ Rs.50 x No AWCs 0.593 0.593

Malnutrition Corners @ Rs 30,000 per

CHC and District Hospital

0.6 1.2 0.300 0.300 0.300 2.100

Total 49.661 8.8 3.700 3.700 3.700 68.961

99

A-4. FAMILY PLANNING

Situation

Analysis

Indicators No.

Eligible Couple 105975

Couple Protection Rate 45.6% DLHS 2002

Female Sterilization operations during last year 1638

Vasectomies during the last year 86

Couples using IUD 1233

Source: CMO data and Block Data

The Couple Protection Rate (DLHS 2002) is 45.6%, out of which 31.5% have adopted

permanent methods; However 29.9% are still outside the coverage of family planning

methods.

The TFR (IIPS data) is 2.9%. Currently the unmet need in family planning is 43% (DLS)

The government has relied very heavily on outreach camp approach for

sterilisation.The monetary incentive of 1000 - per NSV operation has helped in

promoting male participation.

However overall status of sterilization has not changed much, figures are more or less

the same. The reasons for the low use of permanent methods and Copper -T are due to

inadequate motivation of the clients, inadequate manpower, limited skills of the ANM for

IUD insertion, prevalence of RTI and STDs and also their irregular availability. The

rejection rate is high since proper screening is not done before prescribing any spacing

method.

Copper T-380 has been recently introduced but there is very little awareness regarding

its availability. There is a need to promote this 10 yr Copper-T. Some socio-cultural

groups have low acceptance for Family Planning. Promotion efforts for Vasectomy have

been very infrequent and only 258 men have undergone Vasectomy.

The age of marriage for girls has increased to 21 years which is a very good indicator.

This needs to be validated. The State has also developed a module for quality care in

family planning based on the GOI guidelines. There is disproportionate distribution of

incentive for ASHA as compared to other workers. An ASHA worker is paid @Rs.150/-

per NSV whereas the other workers paid@ Rs. 10/- as a result they don’t show much

interest.

Objectives 1. To reduce the TFR to 2.1% by 2010

100


2. To decrease the unmet need in family planning to 10 % by 2010

3. Increase in Contraceptive Prevalence Rate to 80 % by 2012

4. Increase in the awareness levels of Emergency Contraception to 100% by 2010

Strategies 1. Increased awareness for Emergency Contraception and 10 yr Copper T

2. Decreasing the Unmet Need for Family Planning

3. Availability of all methods at all places

4. Increasing access to terminal methods of Family Planning

5. Promotion of NSV

6. Expanding the range of Providers

7. Increasing Access to Emergency Contraception and spacing methods through

Social marketing

8. Building alliances with other departments, PRIs, Private sector providers and NGOs

Activities 1. Counselling of couples for Family Planning

• Establishment of Family Planning Counselling Unit at SC/PHC/CHC level for

improvement of quality services of Planning

• Engage one trained person on contractual basis for Family Planning

Counselling to the couple.

• Training of MOs and Specialists counselling.

• Training of Health Supervisors, Health workers, ASHAs, Ayush doctors, AWW in

FP- counselling

• Counselling of newly married couples on importance of birth spacing

2. Improving the quality of services of Public Sector providers for Terminal

methods

• Specialists from District hospitals and CHC will be trained in Laparoscopic Tubal

Ligation.

• At CHC, one medical officer will be trained in NSV

• Each CHC will be a static center for the provision of sterilization services on

regular basis. The Static centers will be developed as pleasant places, clean,

good ambience with TV, music, good waiting space and clean beds and toilets.

• About 4 -7 PHC come under the catchments area of CHC and the camps will be

organized on fixed days in each of the PHC.

• Equipments and supplies will be provided at CHC for conducting sterilization

services.

• A systemic effort will be made to assess the needs of all facilities, including staff

in position and their training needs, the availability of electricity and water,

Operation theatre facilities for District hospitals/CHC/PHC, Inventory of

101


equipment, consumables and waste disposal facilities and the condition,

location and ownership of the building.

• At least three functional Laparoscopes will be made available per team, as will

the equipment and training necessary to provide IUD and emergency

contraception services. The existing non-functional Laparoscopes need to be

replaced. For effective coverage 4 teams are required with minimum three

Laparoscopes for each team.

• Vacant positions will be filled in on a contractual basis.

• Provision of Sterilization services every day in the hospital and at CHC

3. NSV

• Formation of District implementation team consisting of DC, CMO, District

MEIO, District NSV trainer

• One day Workshop with elected representatives, Media, NGOs, departments for

sensitisation and implementation strategy, fixing pre-camp, camp and post-

camp responsibilities

• Development of a Microplan in one day Block level workshops

• NSV camp every quarter in all hospitals initially and then CHC

• IEC for NSV

• Trained personnel

• Follow-up after NSV camp on fixed days after a week and after 3 months for

Semen analysis

4. Access to non-clinical contraceptives increased in all the villages

• AWWs and ASHAs as Depot holders

• Training in Spacing methods, Emergency Contraceptives and interpersonal

communication for dissemination of information related to the contraceptives in

an effective manner.

• Supply of Emergency Contraceptives to all facilities

• IEC campaign on importance of birth spacing

• Improving the availability of spacing methods in villages through all possible

deport holder.

5. Access for the quality IUD insertion improved at all the subcentres.

• All the ANMs at 152 subcentres will be given a practical hands on training on

insertion of IUD

• Diagnosis and treatment of RTI/STI as per syndromic approach. The various

screening protocols related to the IUD insertion enabling her to screen the

102


cases before the IUD insertion. This will result in longer retention of IUDs.

• Counselling of the cases

• Repair of subcentres so that the IUD services can be provided and ensuring

privacy and confidentiality.

• IUD 380 will be used due to its long retention period and can be used as an

alternative for sterilization.

6. Awareness on the various methods of contraception for making informed

choices

Discussed in the Component on IEC

7. Increasing the gender awareness of providers and increasing male

involvement

• Empowering women

• Increasing male involvement in family planning through use of condoms for safe

sex

• BCC activities to focus on men for Vasectomy.

• Gender sensitization training will be provided for all health providers in the

CHC/PHC and integrated into all other training activities. ( Component on

Gender)

• Service delivery sites for male methods by training health providers in NSV and

conventional vasectomy will be expanded so that each CHC and Block PHC in

the district has at least a provider trained in NSV.

8. Improving and integrating contraceptives/RCH services in PHC and Sub-

centres

• Skill-based clinical training for spacing methods including IUCD insertion and

removal, LAM, SDM and EC of Health Supervisors and Auxiliary Nurse

Midwives (ANM).

• Training in infection prevention and follow up for different family planning

methods.

• MIS training to the health workers to enable them to collect and use the data

accurately.

• Health supervisors training for facilitative supervision and MIS.

• Follow up of trained Health Supervisors and ANMs after one month and six

months of training and provide supportive feedback to the service providers

9. Strengthening linkages with ICDS programme of women and child

development department and ISM (Ayurveda)

103


• A detailed action plan will be produced in co-ordination with the ICDS

department for involvement of the AWWs and their role in increasing access to

contraceptive services.

• Department of health officials and ICDS officers will be orientated to the plan.

• AWWs and their supervisors will receive technical training and training in

communication skills and record keeping by Medical Officer of the PHC and

LHV.

• Staff of ISM department will be trained in communication and non-clinical

methods to promote and increase the availability of FP methods.

10. Role of ASHAs:

• Training for provide counselling and services for non-clinical FP methods such

as pills, condoms and others.

• Act as depot holders for the supplies of pills and condoms by the ANM for free

distribution

• Procurement of pills and condoms from social marketing agencies and provide

these contraceptives at the subsidized rate

• Provide referral services for methods available at medical facilities

• Assist in community mobilization and sensitisation

11. Proper Supervision and Monitoring and reporting

• Each Health Supervisor to be trained for supportive supervision and monitoring

• Developing Microplans for each personnel with their participation to ensure

maximum coverage.

• Ensuring proper filling of formats ad meaningful review and planning meetings

• Followup as per the action plans

Support

required

1. Ensuring Timely payments to ASHA, other stakeholders

2. Availability of a team of master trainers/ANM tutors and State trainers for follow

up of trained Supervisor and ANM after one month and six months of training and

provide supportive feedback to the service providers

3. A training cell will be created in the medical college for the training of the medical

officers in the area of various sterilization methods

4. Availability of equipment, supplies and personnel

Timeline Activity 2007-08 2008-09 2009-10 2010-11 2011-12

Training of MOs for NSV 4 MOs 16 MOs 20 MOs 20 MOs 20 MOs

Training of MOs for Minilap 4 MOs 16 MOs

Training of Specialists for Laparoscopic

Sterilization

DH 2 CHC 2 CHC 2 CHC 1 CHC

104


DH, Development of Static Centres at General

hospitals and all CHC 2 CHC

2 CHC 2 CHC 1 CHC 1CHC

Sterilization camps (Persons) 5000 6000 7000 8000 10000

NSV Camps 600 700 800 1000 1200

Supply of Copper T – 380 3000 4500 6000 9000 12000

Emergency Contraception 2000 6000 8000 10000 12000

Laparoscopes DH,

3 CHC 2 CHC

2 CHC 1 CHC 1 CHC

Budget Activity / Item 2007

-08

2008-09 2009-

10

2010-

11

2011-

12

Total

NSV camps @ Rs. 359750 8.647

5 9.9973 11.361 13.952 25.313 69.2698

Sterilization Camps @ 19.50 for

5000 cases

45.92

5

65.2875 84.740 122.754 160.877 479.583

5

Development Static Centres @Rs 1

lakh

3 2 2.000 1.000 1.000

9.0000

Copper T-380 @ Rs 45 / piece 1.35 2.03 2.700 4.060 5.400 15.5400

EmergencyContraception@Rs10/2

tabs

0.1 0.2 0.3 0.8 0.5

1.9000

Laparoscopes 3per CHC&DH @

Rs3.00 lakhs x 3

36 12 18 9 9

84.0000

Total 95.02

25

91.51475 119.101 151.566 202.090 659.293


Calculations per Case of NSV

S.No Head Unit Cost

1. Payment to NSV acceptor 1000

2. Mobilization/Transport cost 50

3. Payment to Service Provider 50

4. Payment to IEC advocate/Motivator 25

5. Payment to Assistant/OT Nurse etc; 10

6. Drugs and Dressing 27.5

Total 1162.5

Requirements for organizing one camp (600 cases)

Head Unit Unit

Cost

2007-

08

2008-

09 2009-10 2010-11 2011-12 Total

District Workshop 1 4000 4000 4400 4840 5324 10164 28728

Block workshops 4 7500 30000 33000 36300 39930 76230 215460

TA/DA for NSV surgeons 5 2000 10000 11000 12100 13310 25410 71820

105

IEC activities 93250 102575 112832.5 124116 236948 669722

TA to Acceptor for Semen

Analysis

600 50 30000

35000 40000 50000 90000 245000

Payment to NSV Advocate/

motivator, Drugs & Dressings

600 1162.50 697500

813750 930000 1162500 2092500 5696250

Total 864750 999725 1136073 1395180 2531252 6926980

Budget for IEC activities for NSV camp

S.No Head Unit Unit Cost Amount

1. Hand Bills 100000 0.15 15000

2. NSV booklets 10000 2 20000

3. Banners 250 54 13500

4. Posters 11000 2.50 27500

5. DA for Driver & 2 persons 45 Man-days 50 2250

6. Electronic Media Publicity for 15 days 5000

7. Wall writing & publicity 1000

8. Other Innovative activities 9000

9. Total 93250

Budget for sterilization per case

S.No Head Unit Cost (Rs)

1. Payment to acceptor 500

2. Mobilization/Transport cost 50

3. Payment to Service Provider 50

4. Payment to IEC advocate/Motivator 35

5. Payment to Assistant/OT Nurse etc; 10

6. Drugs and Dressing 93.5

Total 738.5

Budget for sterilization camps benefiting 5000 cases

S.No Head Unit Unit

Cost

2007-

08

2008-

09 2009-10 2010-11

2011-

12 Total

1. Medicines 500000 5 5.5 6.05 6.655 7.3205 30.5255

2. Per Case @ 738.50 5000 738.5 36.925 55.3875 73.85 110.775 147.7 424.638

3. IEC activities 100000 1 1.1 1.21 1.331 1.4641 6.1051

4. Other activities & OE 300000 3 3.3 3.63 3.993 4.3923 18.3153

Total 45.925 65.2875 84.74 122.754 160.877 479.583

106

A-5. ADOLESCENT HEALTH

Situation

Analysis

The adolescents are very vulnerable since the awareness levels for various issues of RCH are low

Adolescents have unmet needs regarding nutrition, reproductive health, mental health and require

appropriate counselling. No efforts have been made for any counselling of the adolescents. There is

hence a great lacuna in the knowledge of the Adolescents.

Adolescents especially the boys are exposed to smoking, addictions, peer pressure and there is no

one to counsel them. Teenage pregnancies also emerging as a problem ad Unsafe abortion &

premarital sex trend is on rise.

The Kishori Shakti Yojana for Adolescent girls in AWCs is not functional. In this scheme they are

given IFA tablets, Deworming, Supplementary Nutrition and also given vocational training.

Adolescents need to be brought under the ambit of this programme so that the levels of anaemia are

reduced due to IFA and deworming

The School Health programme and the school AIDS education programme and school sanitation

programme are covering the entire state

Some degree of anaemia and severe anaemia is reported but the data needs to be validated.

As per DLHS 2002, 0.9 % of boys got married before the legal age of marriage and 3% girls got

married before the legal age of marriage ,

Data regarding the perceptions and practices of girls and boys is lacking especially in the context of

rural setting.

Objectives 1. Increase the knowledge levels of Adolescents on RH and Life skills

2. Enhance the access of RH services to all the Adolescents

3. Improvement in the levels of Anaemia to 50% by 2012

Strategies 1. Implementation of Kishori Shakti Yojna

2. Awareness amongst all the adolescents regarding Reproductive health and Life skills

3. Provision of Adolescent Friendly Health package at the health facilities

4. Provision of Adolescent Health Counselling services

Activities 1. Research study involving quantitative and qualitative aspects on the perceptions and practices

of girls and boys in the context of rural setting and also the age of marriage and consummation.

2. Operationalization of Kishori Shakti Yojna

• Adolescent Mentoring group consisting of Master Trainers for carrying out trainings,

mentoring, monitoring the process of formation of Kishore - Kishori groups

• Set up Kishore-Kishori Groups in all villages and family life education and IEC on high

risk behaviour

3. School based programmes.

• The district of Kathua will be covered for anaemia prophylaxis programme during

2006/2007 to be scaled to all districts by 2012

• Specialists for school adolescence health

4. The Adolescent Health package will consist of the following activities:

• Formation of a Subcommittee as part of District Partnership for Adolescent Health (DPAH)

consisting of representatives of: Health department, Education department, Social Welfare

107

department, ICDS, NGOs, PRIs, National Service Volunteers, other youth organizations, local

chapters of Indian Academy of Paediatricians & FOGSI and other stakeholder groups.

• Workshop to develop an understanding regarding the Adolescent health and to finalize the

operational Plan

• Provision of Adolescent friendly health services at PHC, CHC, FRUs and district hospitals in a

phased manner. Training of the MOs, ANMs on the needs of this group, vulnerabilities and

how to make the services Adolescent friendly.

• Adolescent Health Clinics will be conducted at least once every week by the MO to provide

Clinical services, Nutrition advice, Detection and treatment of anaemia, easy and confidential

access to medical termination of pregnancy, Antenatal care and advice regarding child birth,

RTIs /STIs detection and treatment, HIV detection and counselling,

• In the 100 difficult villages the clinics will be part of the monthly Outreach session

• Carrying out the services at the fixed VHD days

• Provision of IFA tablets to all Adolescents, deworming every 6 months, Vitamin A

administration and Inj. TT

5. Awareness building amongst the PRIs, Women’s groups, ASHA, AWWs

6. Developing a cadre of Peer Educators

• Selection of Peer Educators, two for each village in a phased manner, and their training for

three days.

• Selection of Counsellors for Peer Educator workshops and carrying out counselling clinics.

These will be selected one per PHC. There will be equal number of Male and female

counsellors and will alternate between two PHC – one week the male counsellor is in one

PHC and the female counsellor in the other and they switch PHC in the next week so that

both the boys and girls benefit.

The counsellor will be

• Providing ongoing training to the Peer Educators,

• Facilitating group meetings

• Organizing Counselling session once per week at the PHC. Organization of

counselling sessions at PHC with wide publicity regarding the days of the sessions

• Collecting data and information regarding the problems of Adolescents

7. Close monitoring of the under 18 marriages, pregnancies, prevalence of RTI/STDs.

8. Three-day health camps for Adolescent boys and girls at block level for Deaddiction, Mental

health and problems of adolescents quarterly

9. Involvement of NGOs for awareness generation, Appointment of Counsellors, Peer Educator

Support

required

Approval by State for Life skill education and Life skill education to be initiated in all schools

108

Timeline

Activity 2007-

08

2008-

09

2009-

10

2010-

11

2011-12

Research x

Awareness generation x x x

Formation of Adolescent Mentoring

Group

x

Workshop of all the partners x x x

Training a district pool of Master trainers x

Selection of Peer Educators 1 block 2

Blocks

1 Block 1Block

Counsellor through NGOs All PHC

Training of Peer Educators 200 200 100 87

Retraining of Peer Educators 0 200 400 500 587

Orientation of the Health personnel x x x

Counselling Clinics All PHC All

PHC

All

PHC

All PHC All PHC

Three day health camps for Adolescents x x x

109

Budget Activity 2007

-08

2008-

09

2009-

10

2010-

11

2011-

12

Total

Research 5 0 0.000 0.000 0.000 5.000

Awareness generation @ Rs 2000 per

village x 587 villages

11.74 12.914 14.2054 15.6259

4

17.188

534

71.674

Workshop of all the partners 0.5 0.55 0.605 0.6655 0.7320 3.053

Training of Adolescent Mentoring Group

and other expanses@1 Lakh

1 1 1.000 1.000 1.000 5.000

Counsellors @ Rs 8000 per month x

PHC x12 mths

37.44 41.184 45.3024 49.8326

4

54.815

904

228.57

5

Training of Peer Educators @ Rs 50 per

person x 3 days x No. of Peer Educators

0.3 0.3 0.150 0.131 0.000 0.881

Retraining of Peer Educators @ Rs 50

per person x 3 days x peer Educators

0 0.3 0.600 0.750 0.881 2.531

Orientation & Reorientation Health

personnel

0.25 0.28 0.310 0.340 0.370 1.550

Counselling sessions @ Rs 1000/yr/peer

Educator

2 4 5.000 5.870 5.870 22.740

Counselling Clinics renovation, furnishing

and Misc. expenses @ Rs 10000.00

3.9 4.29 4.719 5.1909 5.7099

9

23.810

Health camps for Adolescents once per

quarter x 4 x Rs 50000 per camp

2 2.2 2.42 2.662 2.9282 12.210

Joint Evaluation by an agency & Govt 1 0 1.200 0.000 1.320 3.520

Total 65.13 67.018 75.512 82.067 90.815 380.54

2

110

Part B: NRHM Initiatives

B-1. ASHA – Accredited Social Health Activist

Situation

Analysis

The Subcentre caters to a population of approximately 3000 spread over an average of 5 villages.

Hence keeping in view the difficulties faced by the ANM to provide health and family welfare services

in all the villages and also carry out effective community contact, under NRHM a village level

community based functionary has been brought in all villages and will be trained for meeting the

health-related demands of people and will create awareness on health and its social determinants

and mobilize the community towards local health planning and increased utilization and

accountability of the existing health services indicators in the villages.

ASHA is an honorary worker and will be reimbursed on performance-based incentives and will be

given priority for involvement in different programmes wherever incentives are being provided (like

institutional delivery being promoted under Janani Suraksha Yojana, motivation for sterilization,

DOTS provider, etc.). It is conceived that she will be able to earn about Rs. 1,000.00 per month

In district Kathua 630 ASHAs have been selected and 600 have received training in module 1. In

module 2, no ASHAs have been trained.

All the villages should have an ASHA by 2008.

Objectives 1. Availability of a Community Resource, service provider, guide, mobilizer and escort of community

2. Provision of a health volunteer in the community at 1000 population for healthcare

3. To address the unmet needs

Strategies 1. Selection of a woman from the community

2. Capacity building of this worker

3. Constant mentoring, monitoring and supportive supervision by district Mentoring group

Activities 1. Strengthening of the existing ASHAs through support by the ANM.. and their involvement in all

activities.

2. Reorientation of existing ASHAs

3. Selection of new ASHAs to have one ASHA in all the villages

4. Training of these ASHAs and those selected ASHAs who have not received any training.

5. Training for Module 2,3,4

6. Provision of a kit to ASHAs

7. Formation of a District ASHA Mentoring group to support efforts of ASHA and problem solving

8. Review and Planning at the Monthly sector meetings

9. Periodic review of the work of ASHAs through Concurrent Evaluation by an independent agency

10. ASHA Performance Diaries is to be printed

Support

required

• Timely Payments to ASHA

• Advance of Rs. 5000 always with ASHA for prompt payments to the women

Timeline 2007-

08

2008-09 2009-10 2010-11 2011-12

Selection of additional ASHAs 0 10ASHAs 10 ASHAs 15 ASHAs 15 ASHAs

111

Total ASHAs 630 640 650 665 680

Training of new & untrained ASHAs 30 10 10 15 15

Training of ASHAs for module 2,3,4 630 10 10 15 15

Reorientation of the initial ASHAs 600 630 640 650 665

ASHA Performance Diaries 600 640 650 665 680

District ASHA Mentoring group x x x x x

Budget Activity / Item 2007-

08

2008-

09

2009-

10

2010-

11

2011-

12

Total

Training & kit @ Rs 10000/ ASHA 3 1 1.000 1.500 1.500 8

Training of ASHA in Module II,III,IV @

2000/ASHA

12.6 0.2 0.2 0.3 0.3 13.6

Reorientation @ Rs 1000/ ASHA 6 6.3 6.400 6.500 6.650 31.85

Expenses for the District mentoring

group – meetings, travel @ Rs 5000

per month x 12 months

0.6 0.66 0.730 0.800 0.880 3.67

ASHA Performance Diary @ Rs. 100/

ASHA

0.6 0.64 0.650 0.665 0.680 3.235

Compensation to ASHA @1000/ASHA 75.6 76.8 78 79.8 81.6 391.8

Total 98.4 85.6 86.980 89.565 91.610 452.155

Compensation to ASHA

ASHA will be paid double the amount prescribed so that she gets a package of at least Rs 1000.00

per month

Activity Compensation Cases per

ASHA

Amount/ ASHA

Full ANC & 3 PNCs Rs 25/case 2/mth 50

Facilitating Institutional delivery Rs 100/case 2/mth 200

Providing essential newborn Care &

counselling

Rs 25/case 2/mth 50

Counselling mothers for safe MTPs Rs 50/case 1/2mths 25

Counselling women for RTIs/STDs Rs 5/case 6/mth 30

Birth & death registration Rs 15/case 3/mth 45

Total per ASHA 400

112

B-2. Untied Funds and an Annual Maintenance grant for Sub Centres

Situation

Analysis/

Current Status

Till NRHM was launched there was no provision for any fund for the subcentres for

maintenance, electricity, water, any fund for consumables and cleanliness of the subcentre.

Rs 2000 was given as contingency funds, which were totally inadequate to meet any

demands. Due to this the Subcentres were in a pathetic condition and the ANM worked

alone for deliveries sometimes helped by the family members. A number of equipment

needed some repair due to which they were lying unutilized. The Gram Panchayat members

were never involved in any activities of the Subcentre.

Untied fund @ Rs 10000/- have been paid to ANMs for opening joint accounts with

sarpanchs in 2006-07 in their respective sub centre village for carrying out various health

activities and they have all been utilized.

Objectives 1. Strengthening of the Subcentre through financial support for immediate needs and

maintenance

Strategies 1. Provision of Untied funds of Rs 10000 each year to the Subcentres at the disposal of

the ANM for local needs

2. Provision of Rs 10000 for construction and annual maintenance

Activities 1. Besides the usual recurring cost support to the sub-centres, each Subcentre would be

given an untied support of Rs. 10,000 per annum. The fund would be kept in a joint

account to be operated by the ANM and the local Sarpanch.

2. Rs 25000 will be given as annual maintenance grant to each Subcentre. This will be

under the mandate of the Gram Panchayat SHC Committee for undertaking construction

and maintenance. This will bring in greater community control and the sub-centres would

be brought fully under the Panchayati Raj framework.

3. Activities suggested for the untied funds include minor modifications, cleanliness of

premises, transport of emergencies, transport of samples, purchase of consumables,

etc;

4. This fund will not be used for salaries, vehicle purchase and recurring expenses of Gram

Panchayat

5. Monthly and quarterly expenditure statement will be submitted along with UC

Support

required

1. Funds to be transferred on time to the ANM

2. Sarpanch to ensure proper usage and accounts

Timeline 2007-

08

2008-09 2009-10 2010-11 2011-12

Untied Fund of Rs 10000/subcentre 175 200 217 222 227

Annual Maintenance grant of Rs

10000/SC

175 200 217 222 227

Plan for maintenance to be developed

and approved by Gram Panchayat

x x x x x

113

Plan for use of untied funds x x x x x

Gram Panchayat to identify mode of

construction and repair

x x x x x

Activity / Item 2007

-08

2008

-09

2009-

10

2010-

11

2008-

12

Total

Untied Fund of Rs 10000/subcentre 17.5 20 21.7 22.2 22.7 104.1


10000/SC

17.5 20 21.7 22.2 22.7 104.1

Budget

Total 35 40 43.400 44.400 45.40 208.2

114

B-3. Provision of Untied Funds an Annual Maintenance grant at PHCs

Situation

Analysis/

Current

Status

Till NRHM was launched there was no provision for any fund for the PHCs for maintenance,

electricity, water, any fund for consumables, telephone, hiring transport in emergencies and

cleanliness PHC. Due to this the PHC were in a bad shape. They were unable to provide services

as per the needs of the patients. A number of equipment needed some repair due to which they

were lying unutilized.

Objectives 1. Strengthening of the PHCs through financial support

Strategies 1. Provision of Untied funds of Rs 25000 each year to the PHC at the disposal of the Rogi

Kalyan Samitis

2. Provision of an Annual Maintenance grant of Rs 50,000 to the PHC

Activities 1. These funds will be routed through the Rogi Kalyan Samitis who will approve the yearly

activities and the related budgets and also undertake and supervise improvement and

maintenance of physical infrastructure.

2. An untied fund of Rs 25000 will be provided each year for activities as per the local needs

including minor modifications, cleanliness of premises, transport of emergencies, transport of

samples, purchase of consumables, etc;

3. This fund will not be used for salaries, vehicle purchase and recurring expenses of Gram

Panchayat or any other facility.

4. An Annual Maintenance grant of Rs 50,000 will be given to the PHC for water, toilets,,

maintenance of building.


Support

required

1. Timely release of funds

2. Meetings of the Rogi Kalyan Samitis to be regularly held


Untied Fund of Rs 25000/PHC 39 PHC 39 PHC 39 PHC 39 PHC 39 PHC


50000/PHC

39 PHC 39 PHC 39 PHC 39 PHC 39 PHC

Plan for maintenance to be

developed and approved by the

Rogi Kalyan Samitis

x x x x x


Rogi Kalyan Samitis to identify mode

of construction and repair

x x x x x

Activity 2007-08 2008-09 2009-10 2010-11 2011-11 Total

Untied Fund of Rs

25000/PHC

9.75 9.75 9.75 9.75 9.75 48.75

Annual Maintenance grant of

Rs 50000/PHC x 12 PHC

19.5 19.5 19.5 19.5 19.5 97.5

Budget

Total 29.25 29.25 29.250 29.250 29.250 146.25

115

B-4. Provision of Untied Funds an Annual Maintenance grant at CHC

Situation

Analysis/

Current

Status

Till NRHM was launched there was no provision for any fund for the CHCs for maintenance,

electricity, water, any fund for consumables, telephone, hiring transport in emergencies, travel

and cleanliness of CHC. Although the Rogi Kalyan Samitis were formed still more funds were

required on a regular basis. Due to this the CHCs were in a bad shape. They were unable to

provide services as per the needs of the patients. A number of equipment needed some

repair due to which they were lying unutilized.

Objectives 1. Strengthening of the CHCs through financial support

Strategies 1. Provision of Untied funds of Rs 50000 each year to the CHC at the disposal of the Rogi

Kalyan Samitis

2. Provision of an Annual Maintenance grant of Rs 100,000 to the CHC

Activities 1. These funds will be routed through the Rogi Kalyan Samitis who will approve the yearly

activities and the related budgets and also undertake and supervise improvement and

maintenance of physical infrastructure.

2. An untied fund of Rs 50000 will be provided each year for activities as per the local needs

including minor modifications, cleanliness of premises, transport of emergencies,

transport of samples, purchase of consumables, etc;

3. This fund will not be used for salaries, vehicle purchase and recurring expenses of

Panchayat or any other facility.

4. An Annual Maintenance grant of Rs 100,000 will be given to the CHC for water, toilets,

maintenance of building.


Support

required

1. Timely release of funds

2. Meetings of the Rogi Kalyan Samitis to be regularly held

Timeline Activity 2007-

08

2008-09 2009-

10

2010-

11

2010-

12

Untied Fund of Rs 50000/CHC 5 6 7 8 9


100000/CHC

5 6 7 8 9

Plan for maintenance to be developed

and approved by the Rogi Kalyan

Samitis

x x x x x


Rogi Kalyan Samitis to identify mode of

construction and repair

x x x x x

Budget Activity / Item 2007-08 2008-09 2009-10 2010-11 2011-12 Total

Untied Fund of Rs 50000/CHC 2.5 3 3.5 4 4.5 17.5


100000/CHC

5 6 7 8 9 35

Total 7.5 9 10.500 12.000 13.500 52.5

116

B- 5. Mobile Medical Units

Situation

Analysis/

Current

Status

There are many underserved areas in the district.

There is also shortage of staff due to which all the areas are not covered.

There is no Communications system either.

The district is divided in Hilly (Bani, Basholi), & Border belt which are difficult areas in terms

of outreach and accessibility.

Also during floods and pilgrimages it is difficult to provide services to all. .

Objectives/ Meeting the unmet health needs of the people residing in difficult and underserved areas,

through provision of healthcare at their doorstep

Strategies Operationalizing a Medical Mobile Unit (MMU)

Activities 1. Joint meeting of the District Health Society and the Rogi Kalyan Samiti (RKS) to decide

the appropriate modality for Operationalization of the MMU.

2. Formation of a Monitoring Committee

3. The RKS will operate the MMU for long-term sustainability of the intervention.

4. Staff will be hired on contract by the RKS – MO, male and Female Nurse, Lab

Technician, Pharmacists, Members of Ayush, private providers, IMA members, NGOs,

two drivers, Specialist from District Hospital and Medical Colleges, etc;

5. Need Analysis to be carried out for determining the areas of MMU.

6. Development of a monthly roster for operationalizing MMU

7. Services will be given from 9 am to 4 pm from Monday to Friday. Saturday is for the

maintenance of the vehicle.

8. Services to be provided:

• ANC, PNC, Immunization

• Diagnostic – Haemoglobin, Urine, Blood Sugar, Blood slide for Malaria, etc;

• Treatment of minor ailments

• Referral of cases needing Specialist care

• Provision of Emergency services

• Dissemination of information through the use of TV/DVD player

• Holding meetings of Village water and Sanitation Committees

• Maintenance of Records

9. Wide publicity before the arrival of the MMU

10. Communication support for the personnel

11. Periodic Review.

Support

required

Govt Order from the State for exemption of the Regular Staff from providing services in the

MMU

Timeline 2007-08 2008-09 2009-10 2010-11 2011-12

Operationalizing the MMU 1

Orientation of the staff x x x x x

Wide Publicity x x x x x

117

Strengthening the MMU x x x x

Addition of services x x x x


08

2008-

09

2009-

10

2010-

11

2011-

12

Total

Cost of Mobile van 26.85 0 0 0 0 26.85

Cost of Diagnostic Van 23.75 0 0 0 0 23.75

Personnel 8.7 9.57 10.527 11.5797

12.7376

7 53.11437

Recurring cost 23.71 26.081 28.6891

31.5580

1

34.7138

11 144.751921

Orientation 0.25 0.275 0.3025 0.33275

0.36602

5 1.526275

Joint workshop 0.25 0.275 0.3025 0.33275

0.36602

5 1.526275

Budget

Total 83.51 36.201 39.8211 43.8032 48.1835 251.518841


Budget for Vehicles, Equipment and Accessories

S.No Head Unit Cost

1. Cost of Vehicle for staff to MMU 5,00,000

2. Cost of Vehicle for carrying A/V aids, equipment etc 18,00,000

3. Prefabricated tents & Furniture 1,50,000

4. Equipment 2,00,000

5. Mobile Phone (one for each Driver) 10,000

6. Computer system with Printer 30,000

Total 26,85,000

118

Budget of Personnel

S.No Head Months Unit

Cost

Units Amount

1. Emoluments to MOs -1 12 21005 1 252060

2. Emoluments to Specialists –2

(Part time)

12 20000

2

480000

3. Lab Technician 12 9900 1 118800

4. Pharmacist 12 12810 1 153720

5. Nurse 12 12810 2 307440

6. Class IV 12 3500 2 84000

Total 1396020

Budget for Recurring Expenses

S.No Head Months Unit Cost Units Amount

1. Salary of Drivers –3 12 6800 3 244800

2. Drugs 12 15000 1 180000

3. POL & Maintenance of Vehicles 12 35000 1 420000

4. Maintenance of equipment 100000

5. Mobile Phone bill -5 12 500 5 30000

Total 974800

119

B – 6. Upgrading CHCs to IPHS

Situation

Analysis/

Current

Status

1. All the 4 CHCs are running in government buildings owned by Health Department.

2. Tap water supply is available in all the 4 CHCs of the district Kathua.

3. Facility survey reveals that residential facility all the CHCs need additional staff quarters for

all categories of personnel as per IPHS standards.

4. Required furniture is not available in any of the CHCs.

5. In CHCs, out of 236 recommended equipments, 48.80% are available in the district

6. In CHCs only 47% of the drugs recommended as per IPHS are available in district Kathua

Objectives To upgrade all the CHCs as per IPHS standards

Strategies 1. Availability of all personnel as per IPHS

2. Proper building

3. Adequate Laboratory, Blood Storage Unit, Equipment and Drugs

Activities All CHCs to be equipped having facilities of FRUs as per IPHS standards

• Hiring of additional staff as per IPHS with 7 Specialists and 4 MOs, in each of the

facilities, 10 staff nurses,! PHN, 1 Computer clerk, 1 Dresser, 1 Pharmacist, 1 Lab

Technician, 1 BEE, 1 Radiographer, 1UDC, 1Accountant, 1Clerk, 1Epidemiologist and

ancillary staff like Aya, Chowkidar, Dhobi, Sweepers, Peon and filling of Vacancies

• Building to be built for CHC with staff quarters

Support

required

State to sanction posts as per IPHS

Allowing Contractual Personnel at Market Rates

Timeline Activity / Item 2007-08 2008-09 2009-10 2010-11 2011-12

New buildings with staff quarters 1 1 1 1 1

Repair /alterations/additions of CHCs 4

Repair /alterations/additions of Staff

Quarters

4

Construction of Staff Quarters 4

Equipment 4 1 1 1 2

Medicines, 4 5 6 7 8

Furniture 4 1 1 1 2

Generator 4 1 1 1 2

Computer 4 1 1 1 2

Maintenance x x x x x

Budget 2007-

08

2008

-09

2009-

10

2010-

11

2011-

12

Total

New buildings with quarters, 79.2 79.2 79.2 79.2 79.2 396

CHC Building Repair, Alteration and

Addition @ 10 Lakh 40 0 0.000 0.000 0.000 40

Construction of Staff Qtrs of MO/

Specialist @ 7.2 86.4 0 0.000 0.000 0.000 86.4

120

Construction of Staff Qtrs of SN @6 96 0 0.000 0.000 0.000 96

Construction of Staff Qtrs of class

[email protected] 19.2 12 0.000 0.000 0.000 31.2

Repairing of Staff Qtrs @ 10 Lakh/CHC 40 0 0.000 0.000 0.000 40

Furniture @1.2 X No of CHCs 4.8 1.2 1.2 1.2 1.2 9.6

Equipment @ 22.9 X No of CHCs

88.76 22.19 22.19 22.19 22.19

177.5

20

Recurring cost of CHC excluding Man

Power

375.16 35.39 23.39 23.39 23.39 480.7

2

Purchase of generator sets @ 0.6 lakh x

No of CHCs 2.4 0.6 0.6 0.6 0.6 4.8

Recurring & Maintenance cost of

generator sets Rs. 140 X 30 days X 12

months X 7 No of CHCs 2.016 2.22 2.44 2.68 2.95

12.30

8

Computer ,printer,fax @60000 X CHC 2.4 0.6 0.6 0.6 0.6 4.8

AMC of computer @ 6000 X CHC 0.24 0.30 0.33 0.36 0.40 1.632

Total

836.576

153.6

976

129.949

36

130.226

3

130.530

93

1380.

980

121

B – 7. Upgrading PHCs for 24 hr Services and IPHS norms

Current

Status

1. Out of 39 PHCs, 26 of the PHCs are running in government buildings owned by Health

Department.

2. Water supply is very critical indicator of health delivery system but unfortunately this facility is

available only in 19 PHCs.

3. Electricity supply is very essential for safe deliveries and only 29 PHCs have electric supply.

4. Sanitation facility for males and females is available only in 6 PHCs.

5. Labour room is available only in 3 PHCs.

6. Facility survey reveals that residential facility is available in 8 PHCs.

7. Required furniture is available in 32 PHCs but needs to be repair and maintenance.

8. MOs in existing PHCs in district Kathua are 32 and required number of MOs is 78 with an

identified gap of 46 MOs.

9. Identified gaps for pharmacists, nurses, female health worker, Health Educator clerks and

class IV are 46, 4, 93, 37, 72 and 97 respectively as per IPHS standards.

10. In PHCs, out of recommended 106 types of equipment, 60.81% equipments are available in

district Kathua.

11. In PHCs only 55% of the drugs recommended as per IPHS are available in district Kathua.

Objectives To establish all the PHCs for 24 hour delivery and IPHS

Strategi

es

1. Availability of all personnel as per IPHS

2. Proper building with staff quarters in all PHCs

3. Adequate Laboratory, Equipment and Drugs

4. Additional PHCs

Activitie

s

1. Hiring of additional staff as per IPHS with 2 MOs( maybe Ayush), in each of the facilities, 3

staff nurses, 1 PHN, 1 Lab Technician, Part time Pharmacist, 1UDC, 1 Accountant, and Class

IV and filling of Vacancies

2. Building with adequate quarters in all the PHCs

3. Upgrading the Laboratory for tests necessary for 24 hour PHCs

4. Furniture, Drugs and Equipment as per IPHS norms

Support

required

State to sanction posts as per IPHS

Allowing Contractual Personnel at Market Rates

Time

Frame

Activity / Item

2007-08 2008-

09

2009-10 2010-

11

2011-12

New buildings with quarters 3 7 3

Repair/ additions/ alterations of PHCs 10 11 3

Repair/ additions/ alterations of Staff

Quarters

3 5

Staff Quarters at PHCs 5 21

Additional staff quarters @ 19.2/PHC 5 21

Furniture 12

122

Electricity connections 10

Equipment 20 19

Water Connections 29

Generator 39

Computer System 39

Toilets 6


08

2008-

09

2009-

10

2010-

11

2011-

12

Total

Construction of Building with staff Qtrs for

building less PHCs @ 37.80

113.4 264.6 113.4 0.000 0.000 491.4

PHC Building Repair, Alteration and

Edition @ 2Lakh 20 22 6 0.000 0.000 48

Construction of Staff Qtrs for PHCs have

own building 144 604.8 0.000 0.000 0.000 748.8

Additional Staff quarters for PHCs have

own building 96 403.2 0.000 0.000 0.000 499.2

Repairing of Staff Qtrs @ 5Lakh/PHC 15 25 0.000 0.000 0.000 40

Furniture @1 X No of PHCs 12 0 0.000 0.000 0.000 12

Equipment @ 11 X No of PHCs 220 209 0.000 0.000 0.000 429

Recurring cost of PHCs excluding Man

Power

151.632 151.63

2

151.63

2

151.63

2

151.63

2

758.16

Purchase of generator sets @ 0.6 lakh x

No of PHCs

23.4 0 0.000 0.000 0.000

23.4

Recurring & Maintenance cost of

generator sets Rs. 140 X 30 days X 12

months X No of PHCs

19.656 21.621

6

23.784 26.162 28.778

120.002

Computer with scanners, printers, UPS ,

Fax@60000 /PHC

23.4 0 0.000 0.000 0.000

23.4

AMC of computer @ 6000 X No of PHC 2.34 2.574 2.831 3.115 3.426 14.286

Total

840.828

1704.4

28

297.64

7

180.90

9

183.83

6 3207.648

123

B – 8. Upgrading Sub Centres to IPHS norms

Situation

Analysis

� Out of 152 Subcentres only 61 Subcentres are functioning in Govt. buildings.

� Water supply is very critical indicator of health delivery system but unfortunately this facility

is available only in 39 of the Subcentres.

� Electricity supply is very essential for safe deliveries at Subcentre but status of electricity is

poor in Subcentres. Only 25 SCs have electric supply.

� Sanitation facility for males and females is available only in 9 of the Subcentres.

� Labour room is available only in one Subcentre.

� Facility survey reveals that residential facility is available only in 38 Subcentres,

� Required furniture is available in 76 Subcentres.

� The Staff, Drugs, Equipment, Cold Chain, Accommodation for smooth functioning of Sub-

Centres is insufficient.

� For running 152 Subcentres in the district, only 115 ANMs are in position and delivering

health care services at grassroots level. As per IPHS standards, 2 ANMs are required for

one SC and accordingly district Kathua will be requiring 304 ANMs and at present total

identified gap is 189 ANMs.

� Out of 55 recommended equipments at Subcentre level, only 37.81% of the equipments are

available in Subcentres of the district Kathua. Most commonly available equipments are

stethoscope, Weighing machine, BP Apparatus, Thermometer, micro glass slides, scissor,

syringe, torch etc.

� Facility analysis of the district Kathua reveals that kit A is not available in the Subcentres at

all, 46% of the kit B is available. There is irregular supply of Kit A&B. The supply of Kit A&B

is not in proportion of population.

� In general out of 106 recommended drugs at Subcentre level only 38% of the total medicines

are available in the district Kathua.

� None of the Subcentres are according to IPHS norms.

Objectives Upgrading of Subcentres as per IPHS standards

Strategies 1. Filling up vacancies and hiring additional staff

2. Quarters for the ANMs

3. Opening Additional Subcentres to cater to the entire population

Activities 1. 91 sub centres must be constructed and additional 55 Sub-Centres are required.

2. Additional ANMs, Safaiwalas for each Sub-Centres must be recruited in each sub centre

whose population is more than 6000

3. Electricity, Water facilities in every Sub-Centre

4. 61 Sub-Centres require addition and alteration

5. Sufficient drugs, machinery equipments, cold chain unit for each sub-centre, etc.

Support

required

Smooth flow of Funds.

124

Time line Activity / Item

2007-08 2008-09 2009-10 201

0-11

2011-

12

Total Subcentres 160 180 200 220 220

New buildings with quarters, equipment

and Furniture for new centres

23 25 17 5 5

New buildings with quarters, equipment

and Furniture for existing centres

10 50 31

Repair/Addition/Alteration 20 13

2 Staff Quarters 30 31

Staff Quarter for additional ANM 20 41

Electricity connections 40 87

Water Connections 40 73

Toilets 40 103

Budget

Details


08

2008-

09

2009-

10

2010-

11

2011-

12

Total

New buildings with quarters,

equipment and Furniture 113.546 123.42 83.926 24.684 24.684

370.26

0

New Subcentres @ Rs. 4,93,680/SC

non recurring for existing SC 49.368 246.84

192.535

2 0.000 0.000

488.74

3

Repair, Addition and Alteration of

Subcentre @2lakh 40 26 0.000 0.000 66

Staff Quarters @ Rs 3 lakhs per

Quarter for 2 ANMs 90 93 120.000 0.000 0.000 303

Additional Staff Quarters @ Rs 3

lakhs per Quarter for additional

ANMs 60 123 0.000 0.000 0.000 183

Recurring costs of the additional

Subcentres

96.216 108.24 120.270 132.200 92.608 549.53

4

Total

449.130 720.5 516.731 156.884

117.29

2

1960.5

37

125

B-9 Untied Funds and Incentive Fund for the Village Health and Water Sanitation Committees

Situation

Analysis/

Current

Status

Block No of VHWSC formed in District Kathua

Hiranagar 174

Parole 130

Basholi 96

Bani 68

Billawar 87

Total 555

NRHM has placed a lot of stress on Community involvement and formation of Village Health &

Water Sanitation Committees (VHWSC) in each village. These committees are responsible for

the health of the village. In District Kathua 555 committees have been formed but need

strengthening to improve their functioning. The selection of ASHA, her working, progress of the

village is part of the responsibilities of the Gram Panchayat.

In Kathua there are 456 villages with population less than 1500. There are 85 villages with

population between 1500 and 3000. There are 13 villages with population more than 3000.

Hence these amount to 656 units of 1500 population.

Objectives 1. Strengthening the Village Health & Water Sanitation Committees through financial support

Strategies 1. Provision of annual Untied funds of Rs 10000 each year to the villages upto a population of

1500

2. Provision of Rs 5000 as permanent advance fund for Incentives for ASHA

Activities 1. Provision of Annual Untied funds of Rs 10000 each year to the villages upto a population of

1500. Villages with more than 1500 population upto 3000 will get twice the funds. Villages

with population more than 3000 will get three times the funds. Hence there will be 539 units

of population 1500 or less to get the funds annually of Rs 10,000.00

2. This untied fund is to be used for household surveys, health camps, sanitation drives,

revolving fund etc;

3. Orientation of the MPHWF for the utilization of the untied funds and she in turn will orient the

Village, Health & Water Sanitation committee.

4. Provision of Rs 5000 as permanent advance fund for Incentives for ASHA based on

performance norms.

5. Monthly meetings of the VHWSC for reviewing the funds and activities. This is to be

facilitated by the MPHWF

6. Monthly review at the PHC level regarding the VHWSC functioning and utilization of funds.

Support

required

1. State should ensure the orientation procedure for the VHWSC

2. Funds to be transferred on time to the MPHWF

3. PRIs to ensure proper usage and accounts

Timeline 2007- 2008- 2009- 2010- 2011

126

08 09 10 11 -12

Untied Fund of Rs 10000/unit for Pop

1500/unit x 656 units

x x x x x

Orientation and reorientation of the VHWSC x x x x x

Provision of Rs 5000 as permanent advance

for incentives to ASHA

x x x x x

Monthly meetings of the VHWSC x x x x x

Review of the VHWSC functioning at PHC

level

x x x x x


08

2008-

09

2009-

10

2010-

11

2011-

12

Total

Untied Fund of Rs 10000/unit

1500/unit x 656 units

65.6 65.6 65.6 65.6 65.6 328

Permanent Advance to VHWSC

for ASHA incentive @ Rs5000/SC

8.75 10 10.85

0

11.100 11.350 52.05

Total 74.35 75.6 76.45

0

76.700 76.950 380.05

127

PART C: Immunisation

C-1. Strengthening Immunization

Situation

Analysis

Vaccine Numbers immunized Percentage

DPT Polio 1st dose 15960 97.45

DPT Polio 2nd dose 15963 97.47

DPT Polio 3rd dose 14494 88.50

BCG 14192 86.66

Measles 15027 91.76

DT 2nd dose 431 2.63

Vitamin A 1st dose 15130 92.39

Vitamin A 2nd to 5th dose 23359

Full Immunization 5787 35.34

Source: CMO office 2005-2006

1. As per the District data for 2006, 88% children had received 3rd

dose DPT, 88% 3rd

dose Polio

vaccination, 87% BGC had been given to the children and Measles to 92 %. Complete

Immunization is present in 35.34 % children in the age group 24-35 months.

2. As per DLHS 2002, 97 % children were immunized against BCG, 44.3 % against all the three

doses of DPT 3, 47.7 % against all the three drops of polio and 85.6 % against Measles.

Overall, only 38.7 % of the children were fully immunized. The availability of health facilities in

villages definitely affected and increased the immunization of children.

3. The reasons for children not being Immunized are related to the ignorance of the mothers on

the importance of immunization, the place and time of Immunization sessions and fear of side

effects. The community perceives that the Polio drops given repeatedly at the time of Pulse

Polio campaign, is equivalent to complete immunization.

4. The ANMs have to take the vaccines from the PHC headquarters resulting in them not reaching

the hamlets and also the difficult areas and also the Pulse Polio campaign. Supervision is not

done properly at PHC level. Also there is large gap between reported and evaluated coverage.

Objectives Reduction in the IMR to 50% of baseline (2007) by 2012

1. 100 % Complete Immunization of children (12-23 month of age) by 2012

2. 100 % BCG vaccination of children (12-23 month of age) by 2012

3. 100 % DPT 3 vaccination of children (12-23 month of age) by 2012

4. 100 % Polio 3 vaccination of children (12-23 month of age) by 2012

5. 100 % Measles vaccination of children (12-23 month of age) by 2012

6. 100 % Vitamin A vaccination of children (12-23 month of age) by 2012

Strategies 1. Strengthening the District Family Welfare Office

128

2. Enhancing the coverage of Immunization

3. Alternative Vaccine delivery

4. Effective Cold Chain Maintenance

5. Zero Polio cases and quality surveillance for Polio cases

6. Close Monitoring of the progress

Activities 1. Strengthening the District Family Welfare Office

• Support for the mobility District Family Welfare Officer (@ Rs.3000 per month (towards cost

of POL) for supervision and monitoring of immunization services and VHD Days

• One computer assistant for the District Family Welfare Office will be provided for data

compilation, analysis and reporting @ Rs 4500 per month.

2. Training for effective Immunization

Training for all the health personnel will be given including ANM, Health Supervisor, MPWs,

Cold chain handlers and statistical assistants for managing and analyzing data at the district.

3. Alternative vaccine delivery system (mobility support to PHC for vaccine delivery)

• For Alternative vaccine delivery, Rs. 50 to the ANM will be given per session. It is proposed

to hold two sessions per week per Subcentre

• Mobility support (hiring of vehicle) is for vaccine delivery from PHC to VHD days site where

the immunization sessions are held for 8 days in a month

4. Immunization sessions to be carried out at each VHD day weekly

5. For 100 difficult villages the monthly outreach sessions will be used for Immunization.

The ANM, ASHA, AWW will inform the parents a day in advance.

6. Incentive for Mobilization of children by Social Mobilizers

• Rs.100 per month will be given to Social Mobilizers for each village for mobilization of

children to the immunization session site. This money will be provided to ASHA wherever

possible but if there is no ASHA then it will be given to someone nominated from the village

by the PRIs. This could be given to the Numberdars and Chowkidars.

7. Incentive to for each child ( 12 – 23 months) completely immunized

• Rs 150 will be given for each child completely immunized including Vitamin A two doses –

Mothers, ASHAs / SHG groups, Numberdars and Chowkidars. This will be verified by the

AWW and ANM.

8. Contingency fund for each block

• Rs. 100/ month per block will be given as contingency fund for communication.

9. Disposal of AD Syringes

• For proper disposal of AD syringes after vaccination, hub cutters will be provided by Govt.

of India to cut out the needles (hub) from the syringes. Plastic syringes will be separated

out and will be treated as plastic waste. Regarding the disposal of needles, Pits will be

formed at at every village as per CPCB guidelines. For construction of the pits at PHC, SC

and villages a sum of Rs. 2000/ pit has been provisioned.

10. Outbreak investigation

• Rapid Action Team for epidemics will be formed

129

• Dissemination of guidelines

• Training of Rapid Action Team for investigating outbreaks who will in turn orient the ANM

during Sector meetings

11. Adverse effect following Immunization (AEFI) Surveillance:

• Standard Guidelines have been developed at national level and will be disseminated to the

district officials and block levels in Review meetings.

12. IEC & Social Mobilization Plans

• Rs 25 per session of Immunization fro IEC activities ( 96 villages once a month and In 290

villages 4 times a month)

(Discussed in details in the Component on IEC)

13. Cold Chain

• Repairs of the cold chain equipment (@ 750/- per PHC & CHC will be given each year

• For minor repairs, Rs. 10,000 will be given per year.

• Electricity & POL for Genset & preventive maintenance (Running Cost) of Walk in Coolers

(WICs) & Walk in Refrigerators (WIF) () @ 15000/equipment per two months plus Rs. 1000

per machine for POL for Genset.

• Payment of electricity bills for continuous maintenance of cold chain for the PHC @ 300 per

month PHC (vaccine distribution centres) has been budgeted under this head.

• POL & maintenance of vaccine delivery van @ Rs. 3000/month for maintenance and POL

for Vaccine delivery van for regular supply of vaccine to the PHC.

14. Effective Supervision and monitoring: For increasing the immunization supervision and

monitoring are very important.

• The number of LHVs and Male Health Supervisors need to be adequate hence vacancies

need to be filled up.

• Mobility support for MOs @ Rs 1000/session for hiring a vehicle/ mules

15. HMIS

The formats for Immunization should be properly filled for each child. The data should be

shared in each review meeting for further planning.

Support

required

State to ensure the following:

• Regular supply of vaccines and Autodestruct syringes

• Reporting and Monitoring formats

• Availability of Monitoring charts

• Cold Chain Modules and monitoring formats

• Temperature record books

• Polythene bags to keep vaccine vials inside vaccine carrier

• Polythene for the vaccines to avoid labels being damaged

• Training of Cold Chain handlers

• Training of Mid level managers


Alternative Vaccine delivery x x x x x

130

Children for Immunization

Incentive

5000 7500 10000 12000 14000

Mop up Round x x x x x

Pit formation 587 587 587 587 587

MCH Cards 50000 50000 50000 50000 50000

IEC activities x x x x x

Tracking bags x x x x x

Orientation in Tracking bags x x x x x

Maintenance of Cold Chain x x x x x

Provision of Generator x

Budget Activity 2007-

08

2008-

09

2009-

10

2010-

11

2011-

12

Total

Mobility support for alternative vaccine

delivery Rs. 50 per session for 2 planned

sessions per week at each Subcentre village

for 12 months = Rs. 50x2 sessionsx4

weeks/mthx12 monthsx SCs

7.296 9.6 10.416 10.656 10.896 48.864

Vehicle for distribution of vaccines in remote

areas @ Rs 800 per PHC for 2 times per

week x 4 weeks x 12 months x PHCs

29.952 32.94

72

36.242 39.874 43.861 182.876

Mobility Support Mop up campaign @ Rs

10000 per PHC ( Including travel, vaccine

delivery, IEC) x 6 rounds/ year x PHCs

23.4 23.4 23.4 23.4 23.4 117

Mobilization of Children by Social Mobilizers

@ Rs. 100/ session x2 sessions per week x 4

weeks/mth X 587 village x12 mths

56.352 56.35

2

56.352 56.352 56.352 281.76

Incentives to mothers @Rs 150 per child for

full immunization

7.5 11.25 15.000 18.000 21.000 72.75

Contingency fund for each block @

Rs.1000/month x 5 blocks x 12 months

0.6 0.6 0.6 0.6 0.6 3

Pit Formation for disposal of AD Syringes and

broken vials (@ Rs. 2000 per pit per village

117.4 117.4 117.4 117.4 117.4 587

Printing of Immunisation cards @1.50 per

card x 50000 cards each year

0.75 0.825 0.908 0.999 1.099 4.581

Special IEC session @25/session X100

villages 4 times a yearn

1.2 1.320 1.452 1.597 1.757 7.326

Maintenance of Cold Chain Equipments

(funds for major repair) (@ Rs.750 per

PHC/CHC for the first year then Rs. 500 per

PHC/CHC per month) and 50,000 for minor

repairs

4.46 3.2 3.260 3.320 3.380 17.62

Provision of Generator at all facilities upto

PHC DH: Rs 1.5 lakhs x 1, CHCs – 7x 0.50,

23.5 0.5 0.5 0.5 0.5 25.5

131

PHCs – 40x 0.5 in first year

Recurring & Maintenance cost of generator

sets Rs. 140 X 30 days X 12 months X No of

PHCs & CHCs

22.176 24.39

4

26.833 29.516 32.468 135.387

POL & maintenance for Vaccine delivery van

at district level @ Rs.15000/month x 12 mths

1.8 1.98 2.180 2.400 2.640 11

Running Cost of WICs & WIF (Electricity &

POL for Genset & preventive maintenance)

Rs. 90000 for electricity @ 15000 equipment

per two months plus Rs.8000 per annum

@1000 for POL for genset at DH

7.02 7.72 8.490 9.340 10.270 42.84

Mobility support to District Family Welfare

Officer@ 3000/month

0.36 0.396 0.436 0.479 0.527 2.198

Computer Assistant for District Family

Welfare Office @ 4500

0.54 0.594 0.653 0.719 0.791 3.297

Mobility support for Monitoring Immunization

sessions for MO's PHC @1000/session

1.56 1.716 1.888 2.076 2.284 9.524

Total

305.866 294.1

94

306.00

9

317.22

8

329.22

4

1552.522

132

PART D: National Disease Control Programme

D-1. RNTCP

Situation

Analysis

Data for the Year Jan 2006 to Dec 2006 TU Kathua TU Billawar District

Indicator Value Value Value

Slides examined 63810.00 76724.00 140534.00

No. Suspect Examined 2449.00 1861.00 4310.00

Suspects per Lakh Population 629.00 785.00 687.00

No. Smear Positive Diagnosed 295.00 176.00 471.00

% Smear Positive among suspects 12.00 9.00 10.93

% Smear Positive Put on DOTS 99.00 100.00 99.00

Total Patients Put on treatment 674.00 374.00 1048.00

ACDR 693.00 374.00 669.00

New Smear positive Treatment 178.00 374.00 303.00

Annulized New Smear Positive Case Detection Rate 182.00 210.00 194.00

% New Smear positive of Total New Pulmonary Cases 39.00 54.00 44.00

3 Months Conversion rate 91.00 81.00 85.00

Cure Rate of New Sputum Positive Patients 77.00 71.00 74.00

Success Rate of New Sputum Positive Patients 77.00 75.00 76.00

� A total of 140534 slides were examined. There were 4310 patients suspected of TB687 per lakh.

Of these 471(10.93%) had smear positive for TB.

� A total of 1098 cases were put on DOTS in 2006. The Cure rate is 74% and smear conversion

rate is 85%.

� To fight Tuberculosis the revised National Tuberculosis Control Programme based on the DOTS

regime was launched in 1993.

� Under this programme in District Kathua 2 Tuberculosis Units have been established with

microscopic centres.

Objectives � Reduction in the cases of Tuberculosis by 25%

� 100 % detection of Cases

� 85 % Cure rate in New Cases

� Detection of 70% new smear positive cases once cure rate of 85% is achieved

� Reduction in the defaulter rate to less than 5%

Strategies 1. Improvement in the infrastructure

2. Improvement in the quality of the intervention

3. Increasing the outreach of the programme

4. Increasing the awareness regarding Tuberculosis

Activities 1. Improvement in the infrastructure

• Improved DTC building with a computer room

• Improved MC centres and TC centre

2. Improvement in the quality of testing of sputum

133

• Training to the RNTCP staff in the district

• Equipment maintenance – Microscope, Computer and Others

• Adequate supply of drugs

3. Increasing the outreach of the programme by Increasing the DOTS providers through

involvement of ASHAs who will be paid Rs. 500 per year for providing services. She will be

oriented regarding DOTS. Also the AWH should be involved in reporting suspicious cases.

Training will be given to ASHA for identifying the suspects.

4. Incentive scheme (prizes of 1000, 2000, 3000) to various people (sweeper, DOT provider, LTs)

5. The patient will be given an incentive of Rs 250 on completion of the treatment.

Increasing the awareness regarding the various issues of Tuberculosis through involvement of

Rehbar-e-Sehat teachers and NGOs. Special drive for detection of cases on World TB day

through the involvement for all departments

7. DOTS regime to be strictly monitored through the VHWSC, Rehbar-e-Sehat teachers, the PRIs

and the PHC MO

8. Address verification system to be developed

9. Electronic information sharing to be initiated

10. Strengthen prevention – wearing of masks by patient

Support

required

• Persons carrying the sputum to DMC

• Every health centre should be a collecting centre

• Private DOT provider may be paid as a Govt allowed payment to 25% payment

• Supervisory Vehicles is being required for monitoring purpose.

• POL/Maintenance of vehicle is being required.

• Telephones and computers Persons carrying the sputum to DMC

Timeline 2007-

08

2008-

09

2009-

10

2010-

11

2011-

12

Improving the DTC building, MC Centres and TC

centres x x

Increasing the DOT providers through ASHAs x x x x x

Training to RNTCP staff and ASHA x x x x x

Awareness drives x x x x x

Mask Provision

134


08

2008-

09

2009-10 2010-11 2011-

12

Total

Civil Works

DTC building 1.5 lakhs 1.5 0 0.000 0.000 0.000 1.5

MC 0.28/MC 2.8 0 0.000 0.000 0.000 2.8

TU 0.35/Tu except

DTC

1.05 0 0.000 0.000 0.000 1.05

Material and supplies 1.2 1.32 1.450 1.600 1.760 7.33

Laboratory material 1 1.1 1.210 1.330 1.460 6.1

Training 10.45 11.495 12.645 13.909 15.300 63.79829

5

Awareness drive on World TB day 1 1.1 1.210 1.330 1.460 6.1

IEC activities 1 1.1 1.210 1.330 1.460 6.1

Salaries of contractual staff 7.71 8.481 9.329 10.262 11.288 47.07032

1

Vehicle maintenance inc POL

2 wheeler

4 wheeler

1

1.1

1.210

1.330

1.460

6.1

Hiring of vehicle

DTO

MO TC @ Rs 0.42lakh/yr

1.7

1.87

2.060

2.270

2.500

10.4

Equipment and maintenance

Microscope @

Rs1000/yr/microscope

Computer@ Rs 5000/yr

Photocopier/Fax Rs2500/

machine

0.085

0.094

0.103

0.113

0.124

0.519

Miscellaneous – TA/DA,

Telephone, Meetings, Electricity

repair etc

0.195 0.215 0.247 0.272 0.300 1.229

Total 30.69 27.875 30.674 33.746 37.112 160.097

135


Training in RNTCP

Personnel Unit

Cost

Units 2007-08

DTO State

MOTC 23320 2 46640

MO 15580 32 498560

STS 6726 2 13452

STLS 16720 2 33440

LT 5972 10 59720

MPW 2875 22 63250

ANM 2875 115 330625

1045687

Personnel RNTCP

Personnel Unit

Cost

Units Months Amount

TB health visitor 6750 2 12 162000

STS 7000 2 12 168000

STLS 7000 2 12 168000

LT 6500 2 12 156000

Data Entry Operator 6000 1 12 72000

Accountant 1250 1 12 15000

Driver 4500 1 12 54000

Total 795000

136

D-2. LEPROSY

Situation

Analysis

Balance

Cases at

beginning of

year

New cases

detected in

year

Cases

Discharged in

year

Balance

Cases at

end of year

Per 10,000

Population

PB MB PB MB RFT O.D PB MB PR NCDR

Proportion

of Deformity

Ratio

among

cases

2 8 6 5 4 - 6 11 0.27 0.17 -

There are 1-2 new cases per month detected each month. These cases are from outside the district

and not from within the district itself). A total of 17 cases are on treatment for treatment A & B

Objectives Eradication of Leprosy by 2012

Strategies

&

Activities

1. Detection of New cases

2. House to house visit for detection of any cases

3. IEC for awareness regarding the symptoms and effects of Leprosy

4. Prompt treatment to all cases

5. Rehabilitation of the disabled persons

Timeframe 2007-08 2008-09 2009-10 2010-11 2011-12

House to house detection x x x x x

Wide publicity x x x x x

Rigorous follow-up x x x x x

Treatment x x x x x

Budget Activity / Item 2007-08 2008-

09

2009-10 2010-

11

2011-

12

Total

Contractual Staff 0.462 0.462 0.462 0.462 0.462 2.310

Honorarium 0.048 0.048 0.048 0.048 0.048 0.240

Office Expenses 0.150 0.150 0.150 0.150 0.150 0.750

POL & maintenance 0.360 0.360 0.360 0.360 0.360 1.800

Supportive drugs 0.120 0.120 0.120 0.120 0.120 0.600

Consumables/Stationery 0.120 0.120 0.120 0.120 0.120 0.600

3 Day training of Mos 0.500 0.500 0.500 0.500 0.500 2.500

1 day refresher training 0.120 0.120 0.120 0.120 0.120 0.600

TA for contractual staff and NLEP 0.100 0.100 0.100 0.100 0.100 0.500

IEC activities 0.5 0.5 0.5 0.5 0.5 2.500

Total 2.480 2.480 2.480 2.480 2.480 12.400

137

D-3. NATIONAL MALARIA CONTROL PROGRAMME

Situation

Analysis

Issues No.

Total Blood Slides Examined (BSE) Jan 2006 –Dec 2006 54431

16

15

Total Positive Cases:

Plasmodium Vivax (Pv):

Plasmodium Falciparum (Pf): 1

Slide Positivity Rate (SPR) 0.028%

Slide Positive plasmodium Falciparum Rate (PFR) 0.002

Annual Blood Examination Rate (ABER) NIL

Deaths NIL

Source: CMO office

� Malaria is a serious health problem due to many reservoirs of stagnant water. Each year there

are many epidemics and these result in a lot of morbidity. In J & K disease surveillance for

Malaria was introduced under National Malaria Eradication Programme.

� Now the programme is known as National Vector Borne Disease Control programme. Under

this District malaria Working Committee has been constituted and representatives from

various departments are there but there is very little help from these departments.

� In the DDCs 54431 slides were taken due to fever during the year.

� The main bottlenecks are related to shortage of manpower especially for the remote areas.

Also there is lack of skills for taking blood slides, record keeping and there is lack of

motivation.

Objective

s

Reduction in SPR, API, PFR death rate to 10% by 2012

Strategies 1. Provision of additional Manpower

2. Training of personnel

3. Strengthening of Malaria clinics

4. Addressing Disease outbreak

5. Health education

6. Involvement of Private sector

7. Innovative methods of Mosquito control

Activities 1. Provision of additional Manpower

• The posts of MPW Male and the MPHS need to be filled up

• Hiring of personnel till regular staff in place

2. Training of personnel

The MOs, Laboratory Technicians, MPWs and Health Supervisors, ANMs, ASHAs will be

trained in various techniques relating to the job

3. Strengthening of Malaria clinics

• Provision of Proper equipment and reagents – 3 small Fogging machines for each

138

PHC, sprayers,

• Pulse Fog Machine at District HQ

• Provision of Jeep, Truck,

4. Addressing Disease outbreak

• District Outbreak teams will be created at the district headquarter

• In the team MO, LT, one MPW, one field worker

• Provision of mobility, Lab equipments, spray equipment

5. Health education to the community through the ANM, AWW, ASHAs, RMPs, Ayush personnel

Involvement of Private sector: The private practitioners will be closely involved

Hoardings at each CHC, PHC and DH

Support

required

• Availability of supplies

• Filling up of vacancies

• Supply of health Education material

• Regular Supply of Gambusia fish

Timeline Activity / Item 2007-08 2008-09 2009-10 2010-11 2011-12

Hiring Contractual Staff x x x x x

Purchase of Jeep and Trucks x x x x x

Fogging & Spraying x x x x x

Hoardings 5 CHC &

39 PHCs

39 PHC

6 CHC,

39 PHC

7 CHC,

39 PHC

8CHC,

39 PHC

9CHC,



08

2008-

09

2009-10 2010-11 2008-

12

Total

Salary Contractual staff 7.71 8.481 9.329 10.262 11.288 47.070

Travel expenses @ Rs 4000/

month for jeep x 12 months,

@6000/month for Truck

3.36 3.696 4.066 4.472 4.919 20.513

Office expenses @ Rs 5000

per month x 12

0.6 0.66 0.730 0.800 0.880 3.67

Jeep and maintenance 6 0.6 0.660 0.730 0.800 8.79

Trucks – 6 and maintenance 32 3.2 3.52 3.872 4.259 46.851

Training 10.800 30.970 33.130 34.610 35.080 144.590

3 small Fogging machines for

each PHC @ Rs 1.00 lakh and

one at District HQ Pulse Fog

Machines @ Rs.8.00 lakh per

unit and maintenance

125 12.5 13.75 15.125 16.638 183.013

Misc @ Rs 1.00 and Rs

20000 per CHC, and for PHC

Rs 10000

4.9 5.39 5.929 6.522 7.174 29.915

139

Board hoarding:8’x 12’ at the

CHC and District hospitals @

Rs 25,000/-

1.25 1.5 1.750 2.000 2.250 8.75

Board hoarding: 5’x3’ initially

at the PHC@ Rs 10,000/-

3.9 3.9 3.9 3.9 3.9 19.5

Total 195.520 70.897 76.764 82.293 87.188 512.662

Detailed calculations

Contractual Staff

Personnel Unit Cost Units Months Amount

Spray and Fogging staff 4000 5 12 240000

LT 6500 5 12 390000

Data Entry Operator 6000 1 12 72000

Accountant 1250 1 12 15000

Driver 4500 1 12 54000

Total 771000

Training Malaria

Personnel Unit Cost Units 2007-08 units 2008-09 units 2009-10 units 2020-11 units 2011-12

DTO State

MO 15580 32 498560 78 1215240 78 1215240 78 1215240 78 1215240

LT 5972 21 125412 39 232908 39 232908 39 232908 39 232908

MPHS 1925 31 59675 39 75075 39 75075 39 75075 40 77000

MPW 2875 1 2875 175 503125 200 575000 217 623875 222 638250

ANM 2875 115 330625 350 1006250 400 1150000 434 1247750 444 1276500

ASHA 100 630 63000 640 64000 650 65000 665 66500 680 68000

1080147 3096598 3313223 3461348 3507898

140

D-4. OTHER VECTOR BORNE DISEASES

Situation

Analysis

Other VBDs No.

Kalazaar NIL

Dengue 2

Lymphatic Filariasis NIL

Japanese Encephalitis NIL

During the year 2006-07 there were 2 cases of Dengue in District Kathua.

There were no suspected cases of Chikingunya. It is expected that intensive efforts should be

made to prevent emergence of Chikingunya in District Kathua.

Objectives

No incidence of Dengue by 2012

Prevention of JE, Chikingunya and other new infections

Strategies 1. Reduction of vector density

2. Mosquito-man contact reduction

3. Community awareness

Activities 1. Reduction of vector density

• Identification of breeding sites

• Fogging and spraying

• Covering of any breeding sites

2. Preparedness for new infections

• Increase in Manpower

• Training of personnel for identification of new infections

• Preparation of Laboratories in the district and State to diagnose the new

diseases

• Preparedness of dealing with the epidemic outbreak

3. Community awareness as part of the IEC for Malaria and IDSP

• Group meetings

• Pamphlets/ handbills

• Public announcements

• Kala Jathas

4. One jeep for Entomologist (already covered in malaria budget)

5. One truck for shifting manpower and drums /equipment (in malaria budget)

Support

required

Support from State Laboratory and the NICD for diagnosing Dengue, Chikingunya, JE etc;

Support from District Administration, PRIs, WCD, PHEd,

Time Frame Activity / Item

2007-

08

2008-09 2009-

10

2010 -

11

2011-12

Fogging and Spraying x x x x x

Pamphlets x x x x x

Kala Jathas for Malaria, Dengue and

Chikingunya

x x x x x

141


08

2008-

09

2009-

10

2010

-11

2011-

12

Total

Unforeseen expenses 0.5 0.55 0.610 0.670 0.740 3.07

Pamphlet, poster @1lakh 1 1.1 1.210 1.331 1.464 6.105

Kala Jathas for Malaria, Dengue

and Chikingunya @ Rs 1000 per

village x 587

5.87 6.457 7.103 7.813 8.594 35.837

Total 7.37 8.107 8.923 9.814 10.798 45.012

142

D-5. BLINDNESS CONTROL PROGRAMME

Situation

Analysis

Indicators No.

Total Cataract surgery performed

Cataract surgery with IOL

School going children screened

Children detected with refractive error

Children provided with free corrective spectacles

Villages having no register

Eye Care is being provided through the DH but there is one Ophthalmologist in the district and two

Ophthalmic Assistants. `The norm for GOI is 1 Ophthalmologist for a population of one lakh. Hence

in this district at least 6 Ophthalmologists are required. The norm for Ophthalmologist to Ophthalmic

Assistant is 1: 3-4 hence a minimum of 18 are required.

The private sector too is inactive in the district.

In 2006-07 a total of Operations of cataract were carried out. The norm for the cataract

operations is 700 operations per year per Ophthalmologist.

There is a need to urgently tackle the cataract cases and hold eye camps each month.

There is no Eye Bank or Eye donation centre in District Kathua. The nearest Eye Bank is at Jammu

Medical College.

Objective

s

1. Reduction in the Prevalence Rate of blindness to 0.5 % by 2012

2. Decrease in the Prevalence Rate of Childhood blindness to 0.6 % per 1000 children by 2010

3. Usage of IOL in 100 % of Cataract operations

Strategie

s

1. Provision of high quality Eye Care

2. Expansion of coverage

3. Reduce the backlog of blindness

4. Development of institutional capacity for eye care services

Activities � Determining the prevalence of Cataract through a study by an external agency.

� One time house-to-house survey for study of prevalence of vision defects and Cataract of

entire population leading to referrals and appropriate case management including cataract

surgeries

� Increasing the number of Ophthalmologists either by hiring or through involvement of Private

Sector.

� Training in IOL to private Ophthalmologists

� Training of Paramedical staff and Teachers, NGOs, Patwaris and AWW for screening of

school children and IEC activities.

� AMC for all equipment will be done.

� Equipment: Purchase of latest equipment for regular surgeries

� Construction of Eye Unit in Hospitals and later CHC

� Supply of basic Eye medicines like eye drops, eye ointments and consumables for Primary

Eye Care in PHC/CHC.

143

� All PHC and CHC to be developed for vision screening and basic eye care

Eye Care centre Vision Centre Screening

Eye Surgeon Primary Eye Care Identify Blind

Treatment of eye conditions & follow-up Vision Test Maintain Blind Register

Training Screening Eye Camps Motivator

Supervision Referral for surgery Referral

� Blind Register to be filled up by the AWW, together with PRIs

� Health Mela at each CHC

� Eye Camps with the involvement of Private sector and NGOs from other districts if no

agency is available in Kathua.

� School Eye Screening sessions

� IEC activities

Support

required

Procurement of latest equipment for hospitals by GOI

Timely Repair of equipment

Timeline Activity / Item

2007-

2008

2008-09 2009-10 2010-11 2011-

12

H-H Survey for Vision defects x

Health Mela 5 CHCs 6CHCs 7 CHCs 8 CHCs 9 CHCs


School Eye Screening 100 100 100 100 100

Blind Register x x x x x

Observance of Eye Donations x x x x x

Cataract Camps 39 PHCs 39 PHCs 39 PHCs 39 PHCs 39

PHCs

Development of PHC and CHC as

Vision Centres

5 PHCs

2 CHCs

20 PHCs

4 CHCs

14 PHCs

1CHC

1CHC 1CHC

Development for CHC for Eye Unit 1 1

Training of School teachers 200 100 100 100 100 100

Training of PRIs 200 200 200 200 200

Repair and purchase of equipment and

maintenance

x x x x x

144


2008

2008-

09

2009-

10

2010-

11

2011-

12

Total

Health Mela @50000 / CHC 2.5 2.75 3.025 3.328 3.660 15.263

IEC @1lakh 1 1.1 1.210 1.331 1.464 6.105

School Eye Screening @1000 X100

school

1 1.1 1.210 1.331 1.464 6.105

Blind Register 0.587 0.425 0.467 0.514 0.565 2.357

Observance of Eye Donations 0.15 0.17 0.190 0.210 0.230 0.95

Cataract Camps @ Rs 20000 per

camp x 40 PHC

7.8 8.58 9.438 10.382 11.420 47.620

POL fro Eye Camps @ Rs

2000/camp x40

0.78 0.858 0.944 1.038 1.142 4.762

House to house survey for vision

defects @ 10 lakhs

10 0 0.000 0.000 0.000 10

Training of School teachers @ Rs

100/head x 100

0.1 0.11 0.121 0.133 0.146 0.611

Training of PRIs @ Rs 100/head x

200

0.2 0.22 0.242 0.266 0.293 1.221

Repair and purchase of equipment

and maintenance

20 2 2.200 2.420 2.662 29.282

Total 43.916 17.313 19.047 20.953 23.047 124.275

145

D-6. Integrated Disease Surveillance Programme

Current

Status

The programs with major surveillance components include:

• The National Anti-Malaria Control Program

• National Leprosy Elimination Program

• Revised National Tuberculosis Control Program

• Nutritional Surveillance

• National AIDS Control Program

• National Polio Surveillance Program as part of the Polio eradication initiative

• National Programme for Control of Blindness (Sentinel Surveillance)

Surveillance activities of all these vertical programs of Malaria, Tuberculosis, Polio, HIV are

functioning independently leading to duplication of Surveillance efforts. Surveillance has been

ineffective due to

� There are a number of parallel systems existing under various programs which are not

integrated.

� The existing programs do not cover non-communicable diseases.

� Medical colleges and large tertiary hospitals in the private sector are not under the reporting

system as well as for utilization of laboratory facilities.

� The laboratory infrastructure and maintenance is very poor

� Presently, surveillance is sometimes reduced to routine data gathering with sporadic

response systems thereby leading to slow response to Epidemics,

� Information technology has not been used fully for information and to analyze and sort data

so as to predict epidemics based on trends of the reported data.

In response to these issues the Integrated Disease Surveillance Programme was launched in J &

K to provide essential data to monitor progress of on going disease control programs and help in

optimizing the allocation of resources. IDSP includes 15 diseases/ conditions (Malaria, Acute

diarrhoeal disease-Cholera, Typhoid, Jaundice, Tuberculosis, Acute Respiratory Infection,

Measles, Polio, Road Traffic Accidents, Plague, Yellow Fever, Meningoencephalitis /respiratory

distress, etc., HIV, HCB, HCV) ) and 5 state specific diseases (Thyroid diseases, Cutaneous

Leishmaniosis, Acid Peptic Diseases, Rheumatic Heart Diseases).

� Establishing of District Surveillance unit

� Upgradation of PSU Labs

� Water testing labs are in place

� V-Sat is been installed but training is required

� Rapid response teams are being established at District levels.

� DSUs (District Surveillance Units) are being established in all districts

� One Computer, Printer and Scanner has been received

146

Objectives 1. Improving the information available to the government health services and private health care

providers on a set of high-priority diseases and risk factors, with a view to improving the on-

the-ground responses to such diseases and risk factors.

2. Establishing a decentralized state based system of surveillance for communicable and non-

communicable diseases, so that timely and effective public health actions can be initiated in

response to health challenges in the country at the state and national level.

3. Improving the efficiency of the existing surveillance activities of disease control programs and

facilitate sharing of relevant information with the health administration, community and other

stakeholders so as to detect disease trends over time and evaluate control strategies.

Strategies 1. Strengthening data quality, analysis and links to action;

2. Improving the laboratories

3. Training of all the stakeholders in disease surveillance and action

4. Coordinating and decentralizing surveillance activities

5. Intersectoral Coordination and involvement of communities and the private sector

Activities 1. Strengthening of the District Surveillance Unit (DSU), established under the project,

• Training of the Unit Incharge for epidemiology – {DMO)

• Administrative Assistant

• Training of contract staff on disease surveillance and data analysis and use of IT

• Providing support for collection and transport of specimens to laboratory networks

• Provision of computers and accessories

• WEN connectivity to be operationalized

• Provision of software of GOI

2. Setting up of Peripheral Surveillance Units at CHC

3. Sensitizing the Community for

• Notifying the nearest health facility of a disease or health condition selected for community-

based surveillance

• Supporting health workers during case or outbreak investigations

• Using feedback from health workers to take action, including health education and

coordination of community participation.

• Meetings with the SHGs, school teachers, Numberdar and Chowkidars for sensitisation and

prompt reporting of cases

4. Improvement in the Laboratories at the district and at CHC through provision of equipment and

consumables

Support

required

Provision of supplies on time

Time

Frame

Activity / Item 2007-08 2008-

2009

2009-

2010

2010-

2011

2011-

12

Renovation of Labs with provision of

equipment, furnishings, material

1 District Hosp,

2 CHC

PSU at

5 CHC

Training x x x x x

Contractual staff

147

Software for DSU & training of staff x x x x x

WEN connectivity x x x x x

Sensitization of Community x x x

Meetings with SHGs x x x x x

Meetings with teachers x x x x x

Meetings with Numberdar and Chowkidars x x x x x

Budget Activity / Item 2007

-08

2008-

09

2009-

10

2010

-11

2011-

12

Total

Renovation of Labs at CHC a@ Rs 20,000 1 0.000 0.00

0

0.000 1

Renovation of Lab at District Hospital @ Rs

140,000 and maintenance

1.4 0.14 0.180 0.20

0

0.220 2.14

Equipment for Lab at PSU at CHC and @ Rs

40,000

2 0.4 0.4 0.4 0.4 3.6

Equipment for Lab at District @ Rs 850,000 8.5 0 0.000 0.00

0

0.000 8.5

Computer and Accessories at CHC @50000 2.5 0.5 0.5 0.5 0.5 4.5

Office for PSU at Maintenance CHC @ Rs

10,000 per unit

0.5 0.1 0.1 0.1 0.1 0.9

Office Maintenance for DSU @ Rs 10,000 0.1 0.1 0.100 0.10

0

0.100 0.5

Software for DSU@ Rs 335000 3.35 0 0.000 0.00

0

0.000 3.35

Furnishing of Lab at PSU at CHC and @ Rs

10,000

0.5 0.1 0.1 0.1 0.1 0.9

Furnishing of Lab at DSU @ Rs 60,000 0.6 0 0.000 0.00

0

0.000 0.6

Material and supplies at Lab at PSU at CHC @

Rs 8,000

0.4 0.08 0.08 0.08 0.08 0.72

Material and supplies at Lab at DSU @ Rs 75,000 0.75 0.83 0.910 1.00

0

1.100 4.59

Contract Staff at District level @ 200000/yr for 4

staff yr wise

2 2.2 2.920 3.71

0

4.580 15.41

IEC activities 1 1.1 1.210 1.33

0

1.460 6.1

Training and retraining 0.98

0

3,02 3.030 3.04

0

3.050 10.100

WEN connectivity 0.5 0.55 0.610 0.67

0

0.730 3.06

Operational costs at PSU for Surveillance @ Rs

15000/year x 7

0.75 0.15 0.15 0.15 0.15 1.35

Operational costs at DSU for Surveillance @ Rs

130000/year

1.3 1.430 1.573 1.73

0

1.903 7.937

Honorarium to Numberdars and Chowkidars for

14.0 15.49 17.04 18.7 20.62 86.009

148

reporting @ Rs 100pm x 587 Numberdars and

587 Chowkidars x12

88 7 6 51 6

Total 42.2

18

23.17

68

28.90

9

31.8

61

35.10

0

161.265

Detailed Budget for Trainings

Personnel

Unit

Cost Units

2007-08

units

2008-

09 units

2009-

10 units

2020-

11 units

2011-

12

MPW 785 1 785 152 119320 152 119320 152 119320 152 119320

Lab Assistant

(CHC)

905 5 4525 6 5430 7 6335 7 6335 7 6335

Lab Assistant at

District

3110 2 6220 2 6220 2 6220 2 6220 2 6220

MOs 1835 32 58720 78 143130 78 143130 78 143130 78 143130

DST 4 members 6950 4 27800 4 27800 4 27800 4 27800 4 27800

98050 301900 302805 302805 302805

149

D-7. Iodine Deficiency Disorders

Situation

Analysis

Iodine is one of the essential micronutrients. Minimum requirement is 150 microgram per day.

The main source of Iodine is from soil and water. Iodine is taken from food grown in iodine rich

soil. At present there is a depletion of Iodine in the soil due to which there is a deficiency of

Iodine. Deficiency result in a variety of disorders ranging from Abortion, stillbirths, Goitre,

impaired mental function, retarded growth.

In J & K the National Iodine Deficiency Programme is being implemented.

People in J & K consume rock Salt and crystal salt

Objectives/ 1. Prevention of Iodine Deficiency diseases

2. Consumption of Iodized salt by 100% families

Strategies 1. Supply/monitor quality of Iodized salt

2. Assessment of the magnitude of the problem

3. Laboratory Monitoring of Iodized salt and urine samples

4. Health Education

Activities 1. Supply/monitor quality of Iodized salt

2. Monitoring is done through Food Inspectors who collect two samples of salt per month per

district and send it to a laboratory.

3. The Health workers have been supplied with Kits to test samples at least five per month.

4. Review is done in the monthly meetings

5. Monitoring through School health programme – Testing of samples and awareness

6. Supply of Testing kits to AWCs, Schools, SHGs

7. Assessment of the magnitude of the problem

8. This will be done by the Central Survey team

9. Laboratory Monitoring of Iodized salt and urine samples

10. Health Education: An IEC strategy is essential to promote the consumption of Iodized salt

through AWWs, PRIs, NGOs, ASHA, SHGs etc; Demonstration of Iodized salt by school

children through testing, Rallies, sensitisation of shopkeepers for keeping Iodized salt.

11. Testing of salt at shops and homes

Support

required

1. Regular Supply of Testing Kits

2. Regular Supply of Iodized salt

3. Regular supply of IEC material


2007-

08

2008-

09

2009-

10

2010-

11

2008-

2012

Large Village meetings for awareness on

IDD and consumption of Iodized salt

x x x x x

Programme in schools – 100 Primary,

Upper Primary, Secondary- Govt and

Private by School health team

x x x x x

150

Awareness programme with the SHGs and

shopkeepers

587

villages

587

villages

587

villages

587

villages

587

villages


08

2008-

09

2009-

10

2010-

11

2008-

2012

Total

Large Village meetings for

awareness on IDD and consumption

of Iodized salt

1 1.100 1.210 1.331 1.464 6.105

Programme in schools – 100

Primary, Upper Primary, Secondary-

Govt and Private by School health

team

2 2.200 2.420 2.662 2.928 12.210

Awareness programme with the

SHGs and shopkeepers @ Rs 500

per village x 587 villages

2.935 3.229 3.551 3.906 4.297 17.918

Total 5.935 6.529 7.181 7.899 8.689 36.234

151

6: Inter-Sectoral Convergence

6.1 Partnership with AYUSH department

In District Kathua there are twenty ISM (AYUSH) Dispensaries in which 45 dispensaries are sanctioned & 6

dispensaries are working with internal arrangements. Majority of the dispensaries are situated in far-flung

areas & along with actual line of control.

Building Status:

Running in Government buildings– 20

Rented – 31

Status of AYUSH in the integration with NRHM ( CMO data 31.5.07)

Parameter of Integration with AYUSH Status

Expected nil No. of PHCs where AYUSH practitioners have been co

located (05-06) Achieved nil

Expected nil No. of PHCs where AYUSH practitioners are being co

located (06-07) Achieved nil

Health Society yes

Rogi Kalyan Samities yes Whether AYUSH officer included in (Y/N)

ASHA Training yes

CHCs nil No. of AYUSH Doctors Posted on contractual

appointment in PHCs nil

CHCs nil No. of AYUSH Paramedics posted on contractual

appointment in PHCs nil

DH 1

PHCs nil No. where AYUSH facilities is co-located

CHCs nil

Separate funds have not been provided to this department for creation of infrastructure as per the IPHS

including staff quarter accommodation, requisite medicines (including emergency Medicines) & manpower.

ISM doctors are fully trained & competent to conduct deliveries & can contribute a lot in implementing the

concept of institutional deliveries .But it is unfortunate that these services are not being utilized maybe out of

bias or some other reasons. Without any special facility the ISM Doctors are conducting deliveries where they

are posted & no alternative facility is available with the people. For implementation of national programme

hundred all ISM (AYUSH) staff is involved in the field. But there is no cold chain facility, lab facility & other

incentives.

There are no guidelines for conducting of joint meetings between ISM (Ayurvedic/ Unani) & allopathic at

District & block levels. However an informal meeting is held once in a year. There is no binding by way of

152

govt. orders from the higher authorities. The status IEC strategy for Ayurveda & allopathic should be jointly

prepared & planned by director ISM & Director health (Allopathic).The IEC funds & material should be jointly

shared & should be at the disposal of director ISM & director Health separately.

1. Constitution of RKS in ISM

2. CHC and PHC will provide AYUSH services

3. Involvement of Ayurvedic dispensaries in implementation of national health programmes.

Issues / Areas Areas of cooperation Areas of convergent action

Curative ;

Patient care,

Surveillance

referral

In order to provide medicare facilities

to the masses there is a vast

potential for cooperation with health

department so as to implement all

the national programes like National

Malaria eradication Programme, T.B.

control programme (DOTS), HIV /

Aids awareness programme,

implementation of institutional

deliveries.

The cooperation is also needed from

the department of social welfare,

(ICDS) Anganwadi centres located in

the areas where the ISM

dispensaries are functioning by the

way that the staff of these centres

(Anganwadi workers) can bring the

unvaccinated children to the nearest

ISM institutions so that their

complete vaccination should be

done. Old routine is that medical

officer of the concerned ISM

institution visits the Anganwadi

centre once in a month should be

started for general health check up of

the children of Anganwadi centres.

The ISM doctors are providing the

health Medicare facilities by the way

of providing Ayurvedic / Unani

medicine but as the dispensaries of

AYUSH are located in the Isolation /

far flung areas where there is no

existence of any health facility

(Allopathic) in the form of primary

health centres / community health

centres or even allopathic

dispensaries. Here people come

across emergencies which are

supposed to be attended by

Ayurvedic / Unani doctors or staff.

Therefore there is dire need of

emergency drugs, life saving drugs,

bandaging material, antiseptic

lotions, antibiotics which are not

supplied in ISM dispensaries. Due to

non availability of these drugs in

some cases precious lives are lost

and wrath of people falls on the staff

of ISM institutions. Therefore life

saving drugs, antiseptic lotions &

dressing materials need to be

supplied to avoid suffering of the

ailing masses.

Preventive; Immunization,

Prophylaxis services

Promotive, IEC

Health department’s cooperation is

needed in providing ILR, Deep

freezers to the ISM dispensaries .As

in District. Kathua only one ISM

dispensary is functioning along with

As the facility of cold chain in the

form of ILR’s & deep freezers is

provided to ISM institutions. Routine

vaccination as well as out reach

vaccination camps should be

153

District Hospital. Rest of the ISM

Dispensaries are without

immunization facility as these are

lacking cold chain facility , so twelve

ISM dispensaries which are working

in Pucca buildings having electric

supply should be immediately

provided cold chain facility in the

form of ILR’s & deep freezers .

organised easily in remotest & far

flung areas. For IEC funds should be

kept at the disposal of the Asstt.

District. Medical officer so as it

should be used for awareness

Programmes.

Specific issues in

Implementation of national

programmes

Maternal care

Health Department to assist ISM

institutions & to provide kits of iron

Folic acid tablets directly to the

dispensaries through the Asstt.

District. Medical officer. All ASHAs

operational in the areas of ISM

institutions should be given training

on providing emergency health care

services.

Kits of Iron folic acid tablets should

be provided to ISM institutions. ISM

Doctors can treat Pregnant women

as well as cases of iron deficiency

anaemia is better way. In present

situation only Ayurvedic / Unani

medicines which contain iron are

given to pregnant women for

deficiencies of Iron

Child care Health department should cooperate

with Assistant District. Medical officer

Kathua & kits containing Iron small &

folic acid, Septran (Paed) &

Antihelminthics tabs should be

supplied to ADMO office & then it is

supplied to all the ISM institutions.

As far as social welfare department

is concerned Anganwadi workers can

bring unvaccinated children to the

dispensaries.

As it contains Iron, Septran (Paed) &

Antihelminthics tabs be provided ISM

dispensaries better care of children

suffering from iron deficiency

anaemia, worm infestation & other

diseases.

As Anganwadi workers / helpers will

bring the children to the ISM

Dispensaries on a fixed date the goal

of 100 % immunization could be

achieved.

Adolescent health Health department & education

department organised camp far the

awareness of adolescent health age

group. Ayurvedic / Unani doctors

should be invited to give awareness

lectures & these camps should be

organised at ISM institution also.

Education department can cooperate

with ISM institutions in a particular

areas & through chief education

officers or Zonal education officers, it

Some funds should be kept at the

disposal of the concerned ADMO for

procuring IEC materials like banners

/ posters etc. for organising

awareness camps. With this people

living in remotest & far flung areas

particularly adolescent age groups

children can be benefited from this

awareness campaign as most of the

ISM institutions are in remotest & far

flung areas.

154

should be made mandatory that

medical officer of that area should

visit schools & give awareness

lectures to the adolescent children on

different issues.

School Health Education department’s help is

needed for the health check up of

children as done as a routine matter

few years back.

When approached by the concerned

chief education officer/ Zonal

education officers, the ISM Doctors

are willing to provide these services

for general health check up of

children of different schools.

Leprosy Cooperation from health department

is needed to train ISM doctors/

Paramedical staff. All ISM doctors,

paramedical staffs should be given

training to address sensitive health

issues like Leprosy.

After diagnosis of a case of leprosy

the anti-Leprotic drugs should be

made available directly to ISM

institution so that patients can avail

the medicines from the nearest

dispensary

IDD Health department cooperation is

needed

Only IEC activities are done on our

own to aware the masses about the

iodine deficiency diseases.

Tuberculosis Health department should cooperate

with ISM department & all ISM

doctors /paramedical staff should be

trained through regular training /

workshop from to time laboratory

facility with laboratory technician

should be provided

Anti tuberculosis drugs Dots therapy

should be provided directly to ISM

dispensaries so that patient of

Tuberculosis can avail the facility

from the nearest dispensary as in

some far flung areas. There is no

existence of allopathic institutions &

only ISM institutions are catering the

health needs of the areas

HIV/AIDS Cooperation from health department

is needed for training of ISM Doctors

/ Paramedical staff for AIDS. Regular

workshops training Programmes

should be organised so that

knowledge of the staff is updated

about the disease.

Funds for AIDS awareness camps

should be kept at the disposal of

Asstt. District. Medical officer at

District. Level so that IEC material

like Banners , pamphlets etc should

be disturbed to the masses so that

exact cases of the disease its sign &

symptoms are known to the people

or IEC material from health

(allopathic ) department should be

supplied to the ADMO’s

Water borne diseases PHE department & health If the cases of the particular disease

155

departments’ cooperation is needed.

As water born disease are due to the

infected water chlorine tablets should

be supplied.

on particular area rises. In order to

check it chlorine tablets & other

drugs should be supplied to the ISM

institutions so that Medical officers /

officials can treat the cases. IEC

materials for water born diseases

should be kept at the disposal of

ADMO .So that according to need it

should be distributed about the

masses & awareness camps about

the staff drinking water should be

organised as in rural areas major

source of drinking water is well,

springs, & the water is often polluted

in rainy season.

RTI/ STI Health department to provide

medicines, antibiotics as to check

RTI / STI. One laboratory technician

with laboratories should be given to

dispensaries

As antibiotics are provided to ISM

institutions, Medical officers of these

institutions can treat the patients of

RTI /STI in a better way & by

providing laboratory facilities in these

institutions which are situated in

remotest areas , the diagnosis of

diseases

Is made in initial stage that helps in

treatment of the patient.

6.2 ICDS projects

Issues / Areas Areas of

cooperation

Areas of convergent action

Coordination with allied

departments

Linkages to be

developed between

ICDS workers and

health workers for

timely diagnosis of

malnourished

children and their

management.

Health Department

AWW share information/records of pregnant mothers and

newborns with ANMs.

AWW help in tracking beneficiaries and bring them for

immunization.

They keep community informed of next session’s date of

health checkup camp and immunization.

AWW should reports disease outbreaks in the village to

ANM.

IEC to be developed and disseminated to the community

regarding food and nutrition.

For proper management of malnourished cases,

156

medicines will be supplied along with the PHC and CHC

drug kits annually.

6.3 Rural Development Department


During the initial base line survey

conducted in district Kathua for

assessment of the hygienic

behaviour and knowledge about

sanitation in the rural population, it

was observed that barely 5% of the

rural population has basic sanitary

related facilities like household

toilets & rest of the population nearly

95% go for open defecation. The

(KAP) study conducted revealed that

the basic hygiene behaviour of the

general public was very poor.

Since inception of the total sanitation

campaign project in district Kathua

rigorous (IEC) campaign has been

taken up in all the community

development blocks in district

Kathua .as a result as of today the

basic hygiene behaviour of the

public improved considerably. As a

result of sustained (IEC) campaign

around 30427 families including

have been motivated to use &

constructed house hold toilet (4862).

Also around three hundred no of

school toilets (293 out of sanctioned

800) have been constructed under

the project. Out of 50 sanctioned

Linkages to be developed

between the Health Department

and the Rural Development

department

• Improving the health standard

& general quality of life of rural

community.

• Awareness on sanitation/

Hygiene & health education.

• Covering of school /

Anganwadi in rural areas with

sanitation facilities & promote

Hygiene education & sanitary

habits among students.

• Promote & encourage cost

effective construction of

household latrine & their

proper use.

• Elimination of open defection

to minimise the risk of

contamination of water source

& food.

• Demand driven approach with

increased emphasises on

awareness

• Subsidy for individual household

units replaced by incentive the

poorest of poor household.

• Rural school sanitation is major

component for wider

acceptance of children who can

encourage their parents for

sanitation environment.

• Awareness generation amongst

the A.P.L families for

construction of toilet by their

own.

• Amount of Rs Four thousand Per

school toilet to be added from

NRHM as the twenty thousand

is not sufficient for construction

of school toilet in hilly belt .

• Anganwadi toilet in private

houses with a cost of Rs Five

thousand for each Anganwadi

• Toilet facility at PHC, CHC, DH,

• Toilet construction at all Bus

stands, District offices, blocks,

all departments.

• Services of doctor & paramedical

staff for awareness for

sanitation condition &

environment.

157

sanitary complexes 10 have been

constructed.

• For IEC

• For Solid Waste Disposal in

towns and cities

6.4 Public Health department


� People of the district Kathua are still

dependant on traditional water sources,

in certain areas water from hand-pumps

is perceived to be unfit for consumption,

and water availability is falling short of

requirement.

� The practice of boiling water for

drinking purpose is not prevalent

Health and ICDS

Departments

� Bleaching powder and chlorine

tablets will be provided by IPH and

distributed by field functionaries to

households

� Joint communication strategy.

� Copy of water quality monitoring

reports generated by IPH department

will be shared with the Health

Department at block, district and

state levels

� Community based organisations

formed under various

programmes/sectors will be engaged

by a team of frontline workers –

health, ICDS and IPH departments.

6.5 PRIs


The PRIs have been envisaged to play a very

important role in NRHM.

At the village level they are part of the VHWSC.

At the Gram Panchayat level they are part of the

Gram Panchayat health committee. Similarly at

the Block and the District they are part of the

Block and District health mission.

At the Subcentre the Sarpanch is the joint

signatory to the bank account for the operation of

the Untied funds of Rs 10000.

In the Gram Panchayat meetings held twice each

month the PRIs review the activities of the health

department along with the ICDS

Motivating the

community

Availability of

personnel and

services

Participation in the VH

Days

Giving importance to

issues of health in the

Gram Panchayat

meetings

Joint plans

Joint review and monitoring

Mobilization of the community for

action on health care issues, safe

drinking water and sanitation.

Advocacy at village, Gram

panchayat, block and district level.

158

Convergence –PRI system and capacity building, NGO coordination, Public Private Partnership, Training

and Meetings of committee members

Problem Identified

& Core Issues.

1. Non Existence of PRI and systems.

2. Lack of quality conscious private health service providers for partnership

3. Need for strengthening Village health, water and sanitation committees and training

them

4. Difficult to communitize health services due to non-availability of good NGOs and

community organisations.

5. Lack of formal institutional mechanisms for convergent actions with NRHM related

sectors

Solutions

proposed (Activity

plan)

• PRI systems need to be in place

• PPP need to be developed and CME to be provided to private providers

• All the members especially the members of PRIs need to be imparted training in

primary health care delivery system, which can be imparted at the PHC/ CHC level

by the block MO or Medical Officers.

• For joint efforts, monthly meetings of the committee as constituted above must be

held and the meeting should be fixed in advance and the local panjayath leaders and

MPHWs of the sub centres should arrange the meeting at sub centres. The local

Medical Officer and Health Supervisors can also attend the monthly meeting.

• MNGOs scheme need to be strengthened to communitise health services.

• At the policy level formal mechanisms need to be put in place for convergent actions

with other NRHM sectors.

Support needed for

implementing

changes

Policy and funding support

Cost of

implementing

changes

• PPP initiative ( Chiranjeevi) has been proposed under RCH

• For training of PRI and VHWS committee members: Rs. 22 Lakhs

• For regular monthly meetings: Rs.- 12 Lakhs

• Educational materials-Rs 10 lakhs

• Total Rs. 44 lakhs for one year and Rs 2 crores for 5 years

Time needed to

implement changes

Three months after constitution of the committees.

Sustainability of

the changes

capacity of the committee members with decentralised powers.

Benchmark(s)

derived from this

component

Reduction in IMR & MMR and improvement in sex ratio by 10 points 2012.

159

6.6 Education Department


� For regular check up of school children

there should be a provision for a doctor

(physician specialist) & expert team

which will assist the doctor.

� Mid day meal in school is being

successfully carried. Cooks are

engaged at Rs 500/mth

� The message of balanced diet is not

being successfully carried out.

� School health education programme is

not taking place regularly.

� There is no Adolescent Health

programme in the district.

Co-operation with health

department PHED, RDD,

ICDS department.

� Strengthening of school

health programme.

� Promotion of yoga in the

school.

� Launching of Adolescent

Health programme

� Regular school health

programmes

Inter Sectoral Convergence

Situation

Analysis/

Current

Status

� Health is a social responsibility and is not the domain of the health department only.

Unfortunately the total responsibility has fallen on the health department. The various

departments have been involved in the Pulse Polio campaign which has led to the massive

mobilization and success of the campaign.

� The District Health Society has been formed consisting of members of various departments.

Block health societies will be formed and also at the sector, and village level. At the Gram

Panchayat level under the Sarpanch Gram Panchayat committees have been formed

consisting of various sectors. The Village health and Water Sanitation Committees also consist

of various sectors and the community.

� In reality these committees need to be strengthened since they are not functional. All the

various sectors are working separately although for the same cause. Hence there is a lot of

duplication and wastage of resources.

� Although orders have been issued for convergence but other sectors do not participate readily.

Joint working of the ICDS and health is happening on the Fixed Maternal Child Health and

Nutrition day. This needs to be strengthened and streamlined. The community is not aware

regarding this day.

� The forum of the fixed health day each week has a lot of potential and has not been used

properly.

Objectives 1. Providing Primary and basic quality health care services at the village level

2. Providing quality RCH services

3. Optimal utilization of RCH services by community especially women

4. Empowering women to facilitate them to seek and demand quality RCH services.

Strategies 1. Strengthening the various Committees and Societies

2. Strengthening the VHD days

160

3. Joint action for various issues

Activities 1. Joint workshops for Planning and Review at all levels

• Orientation programmes

• Monthly meetings


• Wide participation of all the sectors in preparation of the community and in the actual

activities, in health education

• Each Wednesday during Immunization sessions joint orientations by all sectors and

problem solving for each of the sectors

4. Joint Action for Sanitation, provision of safe water, provision of services and personnel at

facilities

5. Joint review at the Gram Panchayat meetings

6. Joint efforts for education of the girls, improving the sex ratio, raising age of marriage,

improving the nutritional status, identifying the correct BPL families, income generation.

7. Joint CNAA to determine the needs and thereby developing the plans jointly

8. Realignment of the Health and the ICDS sectors for common data and common work

boundaries.

9. ASHA to participate in all the meetings of the ICDS held each month.

10. At the CHC level monthly meetings are organized. This should be jointly organized with

the ICDS

11. At the monthly meetings of the CMO, the officers of all the departments should come

12. Annual action Plans to be developed jointly through meetings at the village, Gram

Panchayat, Sector and culminating in Block workshops and District workshops

13. Chiranjeevi Scheme to involve PRIs for promoting safe deliveries for rural BPL women

through PPP initiative by involving the private sector

14. Upgrading Ayush at all levels from PHC to DH.

15. Involvement of the RDD for construction of toilets in all health facilities and public places

Support

required

Govt orders for intersectoral coordination with clear roles and responsibilities and If the various

sectors do not attend the meetings then the decisions will be taken and will be binding for all the

sectors.

Strict follow-up at the State level for ensuring coordination.


2007-08 2008-09 2009-10 2010-11 2011-12

Meetings of the Block Committees x x x x x

Meetings of the Village groups x x x x x

Joint CNAA training ( 1086 AWW, 152 ANM,

630 ASHAs, 39 Supervisors, 39 MOs, 9

CDPOs)

x x x x x

Joint monitoring at the sector level x x x x x

Hiring of vehicle x x x x x

Joint monitoring at the block level x x x x x

161

Yearly joint Planning Workshops at the Block

level for development of the Action Plans

x x x x x

Yearly joint Planning Workshops at the District


x x x x x

Yearly joint Workshops to consolidate the

plans from the village to the Gram Panchayats

to the Sectors and then Blocks at the Block

level for Annual Action Plans

x x x x x


08

2008-

09

2009-

10

2010-

11

2011-

12

Total

Meetings of the Block Committees @ Rs

1000 /meeting x 9 blocks x 12 months

1.08 1.188 1.307 1.437 1.581 6.594

Meetings of the Village groups @ Rs 50

per village x 587villages x 12

3.522 3.874 4.262 4.688 5.157 21.502

Joint CNAA training @ Rs 200 per person

( 1186AWW, 152ANMs, 630ASHAs, 39

Supervisors, 39 MOs, 9CDPOs) x 2055

4.11 4.16 4.194 4.204 4.214 20.882

Joint monitoring at the sector level

Hiring of vehicle @ RS 1000/ day x 5

days/month x 39sectors x 12 months

23.4

25.74

28.314

31.145

4

34.260

142.859

Joint monitoring at the block level

Hiring of vehicle @ RS 1000/ day x 5

days/month x 9 blocks x 12 months

5.4

5.94

6.534

7.187

7.906

32.968

Yearly joint Planning Workshops at the

Block level for development of the Action

Plans @ Rs 1.00 lakhs per block x 9

blocks

9 9.9 10.89 11.979 13.177 54.946

Yearly joint Planning Workshops at the

District level for development of the Action

Plans @ Rs 1.00 lakh

1 1.1 1.21 1.331 1.464 6.105


plans from the village to the Gram

Panchayats to the Sectors and then

Blocks at the Block level for Annual

Action Plans @ Rs 1.00 lakhs per block x

9 blocks

9 9.9 10.89 11.979 13.177 54.946


findings at the block levels at the District


@ Rs 1.00 lakh

1 1.1 1.21 1.331 1.464 6.105

PRIs

Chiranjeevi Scheme 24 44 44 44 44 200

Total 81.512 106.90

22

112.81

042

119.28

206

126.39

987

546.907

162

7. COMMUNITY ACTION PLAN

Community Health Action

Situation

Analysis

� Health is a social responsibility and is not the domain of the health department only.

Unfortunately the total responsibility has fallen on the health department. The various

departments have been involved in the Pulse Polio campaign which has led to the massive

mobilization and success of the campaign.

� The District Health Society has been formed consisting of members of various departments.

Block health societies will be formed and also at the sector, and village level.

� At the Gram Panchayat level under the Sarpanch Gram Panchayat committees have been

formed consisting of various sectors.

� The Village health and Water Sanitation Committees also consist of various sectors and the

community. A training module for the training of members of VHSC e prepared.

� Training of members has been carried out and regular meetings of the committee, twice a

month, is held

� In reality these committees need to be strengthened since they are not functional. All the various

sectors are working separately although for the same cause. Hence there is a lot of duplication

and wastage of resources.

� Although orders have been issued for convergence but other sectors do not participate readily.

Joint working of the ICDS and health is happening on the Fixed Maternal Child Health and

Nutrition day. This needs to be strengthened and streamlined. The community is not aware

regarding this day.

� The forum of the fixed Village health day each week has a lot of potential and has not been used

properly

Objectives

1. Providing Primary and basic quality health care services at the village level

2. Providing quality RCH services

3. Optimal utilization of RCH services by community especially women

4. Empowering women to facilitate them to seek and demand quality RCH services.

Strategies 1. Strengthening the various Committees and Societies


3. Joint action for various issues

Activities 1. Joint workshops for Planning and Review at all levels

• Orientation programmes

• Monthly meetings


• Wide participation of all the sectors in preparation of the community and in the actual activities,

in health education

• Each Wednesday during Immunization sessions joint orientations by all sectors and problem

solving for each of the sectors

3. Joint Action for Sanitation, provision of safe water, provision of services and personnel at facilities

163

4. Joint review at the Gram Panchayat meetings

5. Joint efforts for education of the girls, improving the sex ratio, raising age of marriage, improving

the nutritional status, identifying the correct BPL families, income generation.

6. Joint CNAA to determine the needs and thereby developing the plans jointly

7. Realignmant of the Health and the ICDS sectors for common data and common work boundaries.

8. ASHA to participate in all the meetings of the ICDS held between the 20th and 22

nd of each

month.

9. At the CHC level monthly meetings are organized. This should be jointly organized with the

ICDS

10. At the monthly meetings of the CMO the officers of all the departments should come

11. Annual action Plans to be developed jointly through meetings at the village, Gram Panchayat,

Sector and culminating in Block workshops and District workshops

Support

required

Govt orders for inter-sectoral coordination with clear roles and responsibilities and If the various

sectors do not attend the meetings then the decisions will be taken and will be binding for all the

sectors.

Strict follow-up at the State level for ensuring coordination.


2007-08 2008-09 2009-10 2010-

11

2011-12

Formation of Block Committees x

Orientation of Committee members at all

levels

x

Joint Community action x x x x x

Joint Annual Action Plan x x x x x

Sector Alignment x x

Reorientation of the Committees and

Societies

x x x x x

Strengthening the Gram Panchayat

meetings and Gram Sabhas

x x x x x


08

2008-

09

2009-10 2010-

11

2008-

12

Total

Training of the VHWSC @ Rs 200 per

person x 15 persons/village x587 villages

17.61 19.371 21.308 23.439 25.783 107.511

Meetings of the VHWSC @ Rs 50 per

village x 587 villages x 12 months

3.522 3.8742 4.262 4.688 5.157 21.502

Meetings of Women SHG @ Rs 100 per

year x587 villages

0.587 0.6457 0.710 0.781 0.859 3.584

Honorarium for MOs for promoting

Community health Action @ Rs 1000 pm

and travel charges Rs 800 pm

0.702 0.7722 0.849 0.934 1.028 4.286

Total 22.421 24.663 27.129 29.842 32.827 136.882

164

8. Public Private Partnerships

Public Private Partnerships

Situation

Analysis

/ Current

Status

The private sector includes NGOs, Private Practitioners, Trade and Industry Organisations, Corporate

Social Responsibility Initiatives.

The private sector is the major provider of curative health services in the country. 43% of the total IUD

clients obtain their services from the private sector. Engaging with it to provide family planning services

has the potential to significantly expand the coverage of quality services. Public-private partnerships can

stimulate and meet demand and have a synergistic impact of the RCH. To ensure efficient services of

good quality from the private and public sectors, robust monitoring and regulatory mechanisms need to

be developed so that the private sector can come forward and cooperate in all the National programmes

and also in sharing its resources.

At present, no Public Private Partnership activity is going on in the District. MNGO and FNGO for

implementing RCH not identified yet.

Various schemes have been tried out as pilots under of Govt. of Jammu & Kashmir under external aided

projects.

Other services (Diet, scavenging, security, laundry, canteen, etc.) have also been piloted in few facilities.

Objectiv

es

1. Increasing the coverage of the health services and also increasing the accessibility for health

services

2. Widening the scope of the services to be provided to the clients

Strategie

s

Incentives and training to encourage private providers to provide sterilization services

Activitie

s

Involve private players including NGOs/Trusts by providing a conducive environment for accessing

quality and affordable health care services to the community.

� Partnership for Services for Training: Lot of capacity building activities are envisaged under

NRHM, but departments neither have that much of expertise nor sufficient time to carry out the

capacity building activities properly. Therefore, all such training programme will be outsourced to a

capable agency selected by the DHS.

� Partnership for Services for IEC: For implementing and managing IEC activities (mela, shows,

campaign, rally, Village Contact Drives etc) including designing and printing of IEC material, a

technical and Technical Support Agency will be hired.

� Partnership for Services for Transportation: One agency will be hired for getting services of

vehicles with drivers for field monitoring by the officers at District and below level, for transportation of

drugs, equipment, linen and others up to the Sub Centre level. Drivers for department’s vehicles and

ambulances will also be hired from such agency. Annual contract will be done for this purpose.

165

This kind of partnership will much effective for the unreached and far flung areas where there no

motorable roads available. Alternate transport like Mules can be hired from the private sector.

� Partnership for Services for conducting Studies, survey and evaluations: For understanding

the trends of diseases, impact of programs being implemented, assessing the health scenario, a

technical support agency will be hired for conducting surveys, evaluation, Data analysis, HMIS etc.

� Partnership for School Health Programme: For covering all the primary schools both government

and private and strengthening School Health Programme private organisations especially local NGOs

will be involved.

� Partnership for Security: As some parts of the district are affected with the militancy, security of

health personnel and institutions is a major concern of the district.

For providing security to all PHC and some selected Sub Centers , Ex-servicemen council or committees

can be hired. Annual contract will be done for this purpose.

The following activities will be carried out:

• To conduct Feasibility study for various PPP options in the district.

• To develop detailed operational framework and schemes for various feasible options in the district.

• To identify technical support agency for studies on above activities

• To initiate one pilot innovative intervention based on the priority in each block of district. under PPP

• To prepared resource directory of all active NGOs involved in health and development issues in the

district.

• To prepared a list of all private health care providers including Practitioners of alternative system of

medicine in the district.

• To conduct training need assessment (TNA) for all the identify private partners

• To orient all identified privet partners on NRHM and various national health programmes

• To strengthen the VIKALP scheme in the district.

• To develop detailed framework or monitoring and evaluation of various PPP interventions

• To conduct exit polls at General and Civil hospitals CHC, PHC from OPD IPD patients to improve

the condition of the health facilities

• Workshops for involvement of the Private sectors (one each with NGOs/Trusts/Private institutions;

Media; Ex-servicemen association, transportation ,HR agencies)

• Sharing Workshops with Private players

Support

required

Support required form the State to allow PPP; to develop a conducive environment by formulating a

workable PPP Policy.

166

Timeline Activity / Item 2006-07 2007-08 2008-

09

2009-

10

2010-

11

2011-

12

Feasibility study x

Operational Frame work x x

Operationalization of PPP x x x x x x

Innovative interventions x x x x x x

Advertisement for hiring technical support agency

for assisting for achievement of objective of PPP

mentioned above

x

Establishing technical support agency x

Preparation of directories of resource agencies

and privet partners

x x

TNA for private partners x x

Capacity building

NGOs, CBOs, ToT 2 batches x 25per batch on

national health programme

x x x x x x

Training of pvt. Health care providers 2 batches x

25per batch on national health programme

x x x x x x

Capacity building of PRIs, VHWSC, SHGs and

other field functionaries

x x x x x x

Area specific training modules x

Monitoring and evaluation of PPP initiative x x x x x x


08

2008-

09

2009-

10

2010-11 2011-12 Total

Feasibility study on PPP issues 10 0 0.000 0.000 0.000 10

Innovative activities based on the study 0 20 20.00 20.000 20.000 80

Capacity Building of NGOs 0.5 0 0.500 0.000 0.500 1.5

Establishing Tech. Support Agency 2 2.2 2.420 2.662 2.928 12.210

Capacity Building of PRIs, SHGs, VHWSCs 0.5 0.55 0.605 0.666 0.732 3.053

Area specific Modules 0.5 0 0.000 0.000 0.000 0.5

Exit poles 2 2.2 2.420 2.662 2.928 12.210

5 Workshops for involvement of the Private sectors

(one each with NGOs/Trusts/Private institutions;

Media; Ex-servicemen association, transportation

,HR agencies) @ 25000 per workshop

2.5 0 0 0 0 2.5

Sharing Workshops with Private players 0 0.55 0.61 0.67 0.74 2.57

Admin and overhead Charges for hiring the

agencies

2 2.2 2.42 2.67 3 12.29

TOTAL 20 27.7 28.975 29.330 30.828 136.83

3

167

9. GENDER AND EQUITY

Gender and Equity

Situation

Analysis

Gender discrimination is a common phenomenon. It has a direct bearing on the health status of

women and children. Some of the parameters are the Sex Ratio, Age at marriage, enrolment of

girls in schools, Male sterilization. The main reasons are dowry.

The Sex Ratio shows a disturbing trend in district Kathua. The Sex Ratio as per Census of 2001 is

901.The Sex Ratio for 0-6 years as per 2001 census is 841. The Sex Ratio for 0-1 year and the

Sex Ratio at birth is not available.

Kathua’s sex ratio is influenced by the neighboring states, because of the easy availability of MTP

services, people prefer to go to Pathankot rather than coming to Jammu.

Advisory committees have been constituted in the district and their meetings are held periodically.

The orientation of various stake holders has taken place last year for sensitising on PC-PNDT act

There is only one MTP facility and that too at the district hospital only in the Govt. Sector in the

district.

The status of implementations of PCV-PNDT, MTP act especially in private sector needs to be

more intensively addressed. There is one Ultrasonography machines in Govt facilities and two in

the private sector.

The topics of PNDT Act, Gender issues and Declining Sex ratio have been included in RCH

training for Medical Officers conducted at RIHFW.

The Age at marriage for boys is 27.4 years and 22.5 for girls as per DLHS 2002 and that only 3 %

girls in the rural areas were married below 18 years. There is no specific data on Gender Based

Violence but women take it as part of marriage and hence undermine the facts.

Male involvement in Family Welfare is minimal since there are very few Vasectomies as against

Tubectomies.The indicators for morbidity and mortality also show differential values for boys

and girls. The service providers are also not gender sensitive.

Objectives

1. To improve the decline in sex ratio in 0-6 years of age group

2. To reduce the domestic violence

3. To empower women in all age groups for gender equity

4. To enhances male participations in ensuring the gender balance and equity in the community

5. To develop capacities of various stake holder in Govt. and privet sectors on gender issues and

various laws and acts related to establishing gender balance in the society

6. To ensure implementations of PC-PNDT and MTP act in the district.

168

7. To establish strong mechanism for monitoring of sex ratio and implementations of various acts

to ensure gender balance and equity in the society

Strategies � Addressing Adverse Sex ratio

� Increasing male involvement in family planning

� Increasing male involvement in family planning

� Gender sensitization

Activities 1. Addressing Adverse Sex ratio

• Workshops with private providers, IMA members, Religious leaders, Caste leaders, PRIs, MLAs

• Early registration of pregnancies through TBAs, ASHAs, AWWs, Numberdar and Chowkidar and

any of these to get Rs 50 per case for early registration of pregnancy

• Rallies in all schools and colleges and generating discussions in schools and colleges through

debates

• Regular advertisements in the newspapers

• Swearing-in-ceremonies at the time of marriages regarding female foeticide

• Regular meetings of the Appropriate Authorities

• Registration of all Ultrasonography machines

• Review of the monthly format to be filled by the Ultrasonography machines providers

2. Increasing male involvement in family planning

• Use of condoms for safe sex

• Vasectomy and NSV are safer and easier to perform in primary health centres than Tubectomy.

• BCC activities to focus on men for Vasectomy.

3. Service delivery sites for male methods by training health providers in NSV and conventional

vasectomy will be expanded so that each CHC and Block PHC in the district has at least a

provider trained in NSV.

• Demand for male contraceptive methods, men’s reproductive health services through

designing and implementing male-focused BCC activities.

4. A Research Study on the sex ratio to understand the increase in the sex ratio for 0-6 yrs age.

5. Gender sensitization training will be provided for all health providers in the CHC/PHC and

integrated into all other training activities so that they will have greater awareness of factors

that influence women’s decision making and thereby help them respond better to the needs of

women and support her in exercising her choice.

6. Health card would be provided to all girl children upto the age of 18 years.

7. Improving the Literacy status and promotion of education upto 10th standard.

8. Treatment of anaemia in girls and also improving their nutritional status through

Supplementary food at the AWCs

9. Reporting of Gender Based Violence cases by all the departments

10. Promotion of Samoohic Vivahs

11. Affidavit in court should be given regarding the dowry given to prevent false cases.

12. Preparation of GIS maps as planning tool to monitor and control decline sex ratio

13. IEC activities to raise the awareness regarding gender discrimination

169

14. Development of training modules

Support

required

Strict enforcement of the PCPNDT Act

Timeline Activity / Item 2006-

07

2007-

08

2008-

09

2009-

10

2010-

11

2011-12

Research study for the increase in sex ratio for

0-6 years

x

Preparation of GIS maps as planning tool to

monitor and control decline sex ratio

x

Up gradation of GIS x x x x x

IEC campaign through print audio visual and folk

media

x x x x x x

Capacity building x x x x x x

Orientation of public and Pvt health care

providers including NGOs on various laws

related to health specially PC-PNDT & MTP act

x x x x x x

Reorienttion x x x x x x

Development/procurement training modules x

Monitoring x x x x x x

Periodic advisory committee meeting and field

monitoring @ Rs.5000 x 4(this includes meeting,

travel and other contingencies)

x x x x x x

Panchayat level vigilance committees to check

decline in sex ratio and violence against women

x x x x x x

Training of all MOs, ANMs on gender issues x x x x x x

170


08

2008-

09

2009-

10

2010-

11

2011-

12

Total

Research Study 10 0 0.000 0.000 0.000 10

Preparation of GIS maps for monitoring 5 1 1.000 1.000 1.000 9

IEC Campaign @2000 X587 villages 57.87 63.657 70.023 77.025 84.727 353.302

Periodic Advisory committee meetings @ 5000 0.2 0.22 0.242 0.266 0.293 1.221

Development of Trg. Modules 1 0 0.000 0.000 0.000 1

Traning of MO's &,ANMs 2 2.2 2.420 2.662 2.928 12.210

Panchayat level vigilance committees

@1000X183

1.83 2.013 2.214 2.436 2.679 11.172

Workshops with private providers, IMA members,

Religious leaders, Caste leaders, PRIs, MLAs in

every block and Gram Panchayat and with SHGs

10 11 12.100 13.310 14.640 61.05

Rallies in all schools and colleges and generating

discussions in schools and colleges through

debates

5 5.5 6.100 6.700 7.400 30.7

Regular advertisements in the newspapers 5 5.5 6.100 6.700 7.400 30.7

Health Card for Girl Child @ Rs 2 /card x 10,000

cards

0.2 0.22 0.240 0.260 0.290 1.21

Total 98.1 91.31 100.43

9

110.35

9

121.35

8

521.566

171

10. CAPACITY BUILDING

Capacity Building

Situation

Analysis

Training is an essential part of human development. Although the personnel have the basic skills

necessary for carrying out their duties there is a need to upgrade the skills as well as to keep pace

with the new developments under NRHM. There is a skill gap for managing safe deliveries,

Abortions, Newborn Care, managing Childhood illnesses, Obstetric and Paediatric emergencies,

morbidity and epidemics. There is no system for continuing education of the personnel.

The management skills are also lacking resulting in poor management of programmes including

financial management. Most of the personnel are unable to use computers and internet.

Status of trainings in Distt Kathua:

1. Trainings of M.O in IMNCI is required for MOs and other staff including refresher trainings

2. Orientation of TBAs is going on under RCH but there is a need for refresher training

3. Some of the Skill Birth Attendants needs to be regularly carried out so that all the ANMs

The trainings are carried out by the RIHFW along with the Regional training centres and the district

training centres. There is a shortage of staff and also rapid turnover.

The monitoring of the trainings needs to be done for the quality of trainings. Also monitoring of the

work output of the personnel for which they have received the trainings should also be done.

Objectives 1. Reduction in the MMR and IMR from baseline to 50% of baseline by 2012

2. Fully skilled personnel at all levels in the Health sector, ICDS, PRIs, NGOs and private sector for

provision of services

Strategies 1. Development of training plan and methodology for all the personnel on various issues of RCH to

reduce the Maternal and Neonatal mortality, meeting the unmet needs, building Gender

perspective, good programme management and managing various components of NRHM

2. Ensuring the quality of trainings

Activities 1. Capacity building for the reduction in Maternal and Neonatal mortality

• TBA training for 15 days in the concept of clean deliveries, danger signs, early referral,

Newborn care and family planning, communication,

• MTP training on MVA to all PHC MOs for 15 days.

• Training in Obstetric management & skills for operationalization of 24x7 PHC for 16 weeks

• Training in skilled Birth attendants (ANM, LHV, SN) for 15 days

• IMNCI training to ANM/LHV, SN, MO, CDPO for 8 days in the area covering the 24 x 7 PHC

• Training on Blood transfusion for MOs and Lab Technicians for CEmOC centres with Blood

storage facilities for 3 days

172

• Training in Life saving/Anaesthesia for EmOC at FRUs for MOs for 18 weeks

• Integrated skill training of all SN

• Integrated skill training for MPHWF

• Training of ASHAs

• Training in management of newborns and sick children at Medical College Jammu of the

MOs, SN,

• Training in BCC for MOs, MPHS, MPHWF

• Training of Ayush personnel on issues of RCH and reporting for 3 days

2. Capacity building to meet the unmet needs

• Training on NSV for MOs for 5 days

• Training for Laproscopic Sterilization for Surgeons, Gynaecologists, SN, OT attendants for 12

days

• Skill upgradation of MPHWF & MPHS for 5 days

• Orientation on contraceptive devices for MOs of Govt facilities as well as private facilities

3. Training on Medico-legal aspects

4. Continuing Medical Education sessions for doctors each month during the monthly meetings

on current topics. An expert from a reputed institution will be invited on the current topics and

Certificates will be given.

5. Capacity building for Gender equality

• Orientation on Gender equality & PCPNDT Act for doctors both Govt and private, members of

District Appropriate authority NGOs

6. Capacity building for good programme management

• Professional Development course for District Programme Managers, Senior district officials,

CMOs for 10 weeks

• Management Development course for MOs for 5 days

• General and Financial rules (G & FR) for the district officials, MOs, clerical staff for 3 days

• Financial management training for Accounts Officers, Accountants for 3 days

• Computer training to all the MOs, Clerical staff, accounts personnel

• CNAA for MOs, MPHS, MPHWF, AWW

7. Capacity building for managing the other components of NRHM

RNTCP

• Reorientation Training of DOT providers for 1 day

• Orientation of MOs on revised Paediatric & PWBs under Paediatric management for 1 day

• Training of newly appointed MOs (1) under RNTCP – MO TU, for 10 days

Convergence for Sanitation and hygiene under NRHM

• One day orientations of VHWSC for total sanitation

Disease Control Programme – Blindness Control, Malaria, IDSP, IDDM

173

• MPW

• LT training

PRIs

• Training on NRHM and their roles of the members of the Zila Parishad, Panchayat Samitis,

Gram Panchayat members, VHWSC for 1 day

NGOs

• Training in BCC

• Training of Field NGOs

Private Sector

Training on Family Planning issues, PCPNDT Act, Reporting

8. Ensuring the quality of trainings

• A district quality training team will be formed to ensure the organization of trainings as per

schedule, arrangements and monitoring the quality of all the trainings on the basis of

checklists to be developed by the state.

• They will ensure the availability of trainers and the staff at the District Training Centre.

• The team will also monitor the work output of the trained personnel and give

recommendations regarding improvements in the training and the future requirements.

• For ensuring the availability of trainers a District Resource team and Block Resource teams

will be formed for various issues.

• A list of Resource persons will be developed from the State for specialized issues.

9. Establishing a Staff Nurse training College: due to shortage of staff there is a need to open

a Staff Nursing College in General Hospital with a batch of 60.

10. There is a need of Hostel and Mess/ Kitchen and dining hall facilities of the training centre.

Currently there is no hostel facility.

Support

required

• RIHFW to develop the training calendar and organize the trainings as per schedule

• Medical colleges to be prepared for providing trainings on EmOC, MTP, Neonatal Care

• Monitoring by the State the quality of trainings and the work output through the development

of a format and checklist

• Placement of the personnel trained in various specialized issues at the right facilities

• Ensuring staff at the District training centre

Time Line

Activity 2007-08

(Numbers)

2008 –

2009

(Numbers)

2009-2010

(Numbers)

2010-2011

(Numbers)

2011-

2012

(Number

s)

TBA training 587 587 587 587 587

MVA MTP training to all PHC MOs

and retraining

39 MOs 39 MOs

Training on Blood transfusion for

MOs and Lab Technicians for

CHCs with Blood storage facilities

for 3 days

1MO

1LT

6 MO

6 LT

174

Training in Obstetric management

& skills for 24x7 PHC for 16 weeks

2 MOs

2 Staff

Nurses

Staff of 10

PHC

Staff of 10

PHC

Staff of 10

PHC

Staff of 8

PHC

Training in Skilled Birth attendants

for 15 days

16 64 64 64 64

IMNCI training to ANM/LHV, SN,

ASHA for 8 days

10 ANM

4 SN

25 ASHA

4 LHV

25 ANM

4 SN

50 ASHA

4 LHV

25 ANM

4 SN

50 ASHA

4 LHV

25 ANM

4 SN

50 ASHA

4 LHV

25 ANM

4 SN

50 ASHA

4 LHV

IMNCI training to MOs 6 MOs 20 MOs 25 MOs 25MOs 25 MOs

Training in Life saving/Anaesthesia

for EmOC at CHC for MOs (State

Budget )

2 MOs 4 MOs 4 MOs 6 MOs

Integrated skill training of all SN 10SNs 20 SNs 30 SNs 30 SNs 40 SNs

Integrated skill training for ANMs 10 ANMs 25 ANMs 25 ANMs 25 ANMs 25 ANMs

Integrated skill training for MOs 5 MOs 5 MOs 5 MOs 5 MOs 5 MOs

Training of MOs, SN in Mgt of

Newborns & sick children at

Medical College Jammu

2 MOs

2 SN

2 MOs

2 SN

2 MOs

2 SN

2 MOs

2 SN

2 MOs

2 SN

Training in BCC for MOs, LHV,

ANM

13 MOs

4 LHV

25 ANM

13MOs

4 LHV

25 ANM

13 MOs

4 LHV

25 ANM

13 MOs

4 LHV

25 ANM

13 MOs

4 LHV

25 ANM

Training of Ayush personnel on

issues of RCH and reporting

51 Ayush 51 Ayush 51 Ayush 51 Ayush 51 Ayush

Training on NSV for MOs at NSV

camps

4 MOs 16 MOs 16 MOs 16 MOs 16 MOs

Training on Minilap 4 MOs 4 MOs 4 MOs 4 MOs 4 MOs

Training for Laproscopic

Sterilization for Surgeons,

Gynaecologists, SN, OT attendants

for 12 days

2 Specialists

2 SN

2 OT

attendants

2 Sp

2 SN

2 OT

attendants

2 Sps

2 SN

2 OT

attendants

2 Sps

2 SN

2 OT

attendants

2 Sps

2 SN

2 OT

attendant

s

Orientation on contraceptive

devices for MOs - Govt as well as

private facilities

80 MOs 100 MOs 100 MOs 100 MOs 100 MOs

Training on Medico-legal aspects to

MOs

100 MOs &

Specialities

150 150 150 150

Continuing Medical Education

sessions for doctors each month

during the monthly meetings on

current topics

10 CME

sessions

10 CME

sessions

10 CME

sessions

10 CME

sessions

10 CME

sessions

175

Orientation on PCPNDT Act for

DCs, CMOs, doctors both Govt and

private, members of District

Appropriate authority NGOs in a

workshop

x x x x x

General & Financial rules (G & FR)

for Officials, MOs, clerical staff for 3

days

50 Distt

officials and

MOs

50 clerks

50 Distt

officials

and MOs

50 clerks

50 Distt

officials

and MOs

50 clerks

Financial management training for

Accounts Officers, Accountants for

2 days

25 persons 50 persons 50 persons 50 persons 50

persons

Computer training to all the MOs,

Clerical staff, accounts personnel

100 50

CNAA for MOs, LHV, ANM & MPW,

AWW

39 MOs

39 LHV

152 ANM

1086 AWWs

39 MOs

39 LHV

175 ANM

1086

AWWs

25 ANMs 17 ANMs 5 ANMs

Total sanitation orientation and

reorientation of VHWSC x 1 day 587 villages

587

villages

587

villages

587

villages

587

villages

Training of NGOs in BCC 30 persons

30

persons

30

persons

40

persons

40

persons

Budget

Activity 2007-08 2008–09 2009-10 2010-11 2011-12 Total

TBA training @ Rs 10100 /TBA 59.287 65.2157 71.737 78.911 86.802 361.953

MVA MTP training to all PHC MOs for 15 days @ Rs 500 x

15 days x MOs

2.925 2.925 0.000 0.000 0.000 5.85

Training on Blood transfusion for MOs and Lab Technicians

for CHCs with Blood storage facilities for 3 days

MOs @ Rs 500/day/person x 3 days 0.015 0.075 0.015 0.015 0.015 0.135

Lab Technicians @Rs 200/person x 3 days 0.006 0.03 0.006 0.006 0.006 0.054

Training in Obstetric management & skills for 24x7 PHCs for

16 weeks

MOs: Rs 500/day x 112 days x 2 MOs 1.12 11.2 11.2 11.2 4.48 39.200

StaffNurses:Rs200/dayx112daysx 2 SNs 0.448 4.48 4.48 4.48 1.792 15.680

Training in skilled Birth attendants for 15 days: 0 0.000 0.000 0.000

One batch of 4 persons: Rs. 7500 as hon. to participants, Rs

13500 hon. to training team, 15% institutional charges, = Rs

25000/batch - 16 batches

4 16 16 16 16 68.000

IMNCI training to ANM/LHV, SN, ASHA - 8 days 0.000 0.000 0.000 0.000

Rs 300 as hon. to participant x 8 days 1.032 2.1912 2.410 2.651 2.916 11.201

IMNCI training to MOs @ Rs 5390 /participant 0.3234 1.186 1.617 1.779 1.957 6.861

Integrated skill training of all SN @ Rs 4080/person 0.408 0.8976 1.4688 1.5912 2.2848 6.650

Integrated skill training for ANMs @ Rs 2048/person 0.2048 0.5632 0.6144 0.6656 0.7168 2.765

Integrated skill training for MOs @ Rs 3683 0.18415 0.203 0.223 0.245 0.270 1.124

Training of MOs, SN in Mgt of Newborns & sick children at 0.24 0.264 0.290 0.319 0.351 1.465

176

Medical College Jammu @ Rs 7500/MO, Rs 4500 ( Rs 300 x

15 days)/SN

Training in BCC for MOs, LHVs, ANMs 0.76 0.836 0.920 1.012 1.113 4.640

MOs: Rs 500/MO x 5 days

LHVs & ANMs: Rs 300/person x 5 days

Training of Ayush personnel on issues of RCH and reporting

for 3 days

0.459 0.5049 0.555 0.611 0.672 2.802

Rs 300/person x 3 days

Training on NSV for MOs at NSV camps 0.42 0.462 0.508 0.559 0.615 2.564

Rs 500/MO /camp x 12 camps,

Rs 3000 per camp for trainer x 12 camps

Training on Minilap @ Rs 500 per day for 15 days and during

camps

0.6 2.64 2.904 3.194 3.514 12.852

Training for Laproscopic Sterilization for Surgeons,

Gynaecologists, SN, OT attendants for 12 days

0.24 0.264 1.162 1.278 1.406 4.349

Specialist: Rs 500/Specialist x 12 days

SN: Rs 300/SN x 12 days

OT Attendant: Rs 200 x 12 days

Orientation on contraceptive devices for MOs - Govt as well

as private facilities Rs 500 /MO x 1 day

0.4 0.44 0.484 0.532 0.586 2.442

Training on Medico-legal aspects to MOs@ Rs 500/MO x 1

day

0.5 0.825 0.908 0.998 1.098

Continuing Medical Education sessions for doctors each

month during the monthly meetings on current topics @ Rs

25000 per CME

2.5 2.75 3.025 3.328 3.660 4.329

Orientation on PCPNDT Act for DCs, CMOs, doctors both

Govt and private, members of District Appropriate authority

NGOs in a workshop

0.5 0.55 0.605 0.666 0.732

General & Financial rules (G & FR) for Officials, MOs, clerical

staff for 3 days

1.05 1.155 1.271 1.398 1.537 15.263

Rs 500/official and MOs x 3 days 3.053

Rs 200 /clerical staff x 3 days 6.410

Financial management training for Accounts Officers,

Accountants for 2 days

0.2 0.22 0.242 0.266 0.293 1.221

Rs 200/Accounts persons x 2 days

Computer training to all the MOs, Clerical staff, accounts

personnel @ Rs 200 per person x 15 days

3 1.65 0.000 0.000 0.000 4.650

CNAA for MOs, LHVs, ANMs, AWW 2.632 2.682 0.05 0.034 0.01 5.408

@ Rs 200/person x 1 day each year

Total sanitation orientation and reorientation of VHWSCs x 1

day @ Rs 200/person/day

1.174 1.2914 1.421 1.563 1.719 7.167

Training of NGOs in BCC @ Rs 300 per person x 6 days 0.54 0.594 0.653 0.719 0.791 3.297

Total 85.1683

5

122.0944 124.769 134.020 135.335 601.387

177

11. HUMAN RESOURCE PLAN

Human Resource Plan

Situation

Analysis

The Human Resources in district Kathua is not as per IPHS norms. The motivation levels for the

doctors to work is very low and promotions do not occur. No doctors and Specialists want to

work in the rural areas.

Subcentre level

• The number of subcentres will have to be increased from 152 to 227 by 2012

• The requirement of ASHAs will be around 680

• The requirement of ANM will be around 454 in Government as per IPHS norms of 2 ANMs

per Subcentre.

PHC level

• The PHCs are adequate in number

• As per IPHS 2 MOs per PHC will be required whereas at present there is only one MO per

PHC

• For IPHS norms 117 Staff Nurses for PHC [3 per PHC] are required. At present there are

just 24 SN

• There are only 21 Lab Technicians as against the required 39 today.

• At present there are 35 Pharmacists in the PHC as against 39.

CHC Level

• There will be a requirement of 9 CHCs in 2012 as per the population norms

• There are a total of 15 specialists in position in CHC as against 28 sanctioned posts.

In the CHC there should be at least 7 specialists, 3 MOs, 10 Staff Nurses, I PHN, 1

Computer clerk, 1 Dresser, 1Pharmacist, 1 Lab technician, 1 BEE, 1 radiographer, 1 UDC, 1

Accountant, 1 LDC, 1 Epidemiologist, and Ancillary staff on contract.

Objectives

Benchmarks

1. All staff to be in place as IPHS norms by 2012

2. Increased salaries for contractual doctors and Specialists

3. Special allowances for Regular staff

4. Increase in the number of training centres for LHV, ANM, Staff Nurses, Lab Technicians

Strategies &

Activities

1. Rational placement of Specialists and trained staff

2. Recruitment of staff on contract where vacancies

3. Recruitment of staff for new facilities as per the infrastructure requirements

4. Computers at all PHC and for each MO and Specialist at the CHC

5. Allowing Specialists and MOs for developing special skills as per their needs by attending

special courses anywhere in India.

Support

required

1. The State must approve and give sanctions for the necessary personnel for each facility

before actually starting the facilities.

178

2. Contractual staff should be allowed recruitment as and when required. Permission from

State should not be taken each time.

Timeline Activity Current

Status

2007-

08

2008-

09

2009-

10

2010-

11

2011-

12

2007-

08

2008-

09

2009-

10

2010-

11

2011

-12

Total requirements(IPHS Norms) Additional requirement - Contractual

Subcentre 152 175 200 217 222 227 23 48 65 70 75

ANM 115 350 400 434 444 454 235 285 319 329 339

MPW(M) 0 175 200 217 222 227 175 200 217 222 227

PHC 39 39 39 39 39 39 0 0 0 0 0

MO 32 78 78 78 78 78 46 46 46 46 46

Staff Nurse 24 117 117 117 117 117 93 93 93 93 93

Health worker

(F)

31 39 39 39 39 39 8 8 8 8 8

Health

Educator

2 39 39 39 39 39 37 37 37 37 37

Health

Assistant

1 78 78 78 78 78 77 77 77 77 77

Clerk 6 78 78 78 78 78 72 72 72 72 72

Pharmacist 35 39 39 39 39 39 4 4 4 4 4

Lab.Tech 21 39 39 39 39 39 18 18 18 18 18

Class IV 59 156 156 156 156 156 97 97 97 97 97

CHC 4 5 6 7 8 9 1 2 3 4 5

Specialist(7) 15 35 42 49 56 63 20 27 34 41 48

MO General

Duty (3) 0

15 18 21 24 27 15 18 21 24 27

PHN 1 5 6 7 8 9 4 5 6 7 8

ANM 14 20 24 28 32 36 6 10 14 18 22

SN 19 35 42 49 56 63 16 23 30 37 44

Dresser 0 5 6 7 8 9 5 6 7 8 9

Pharmacist 15 15 15 15 15 15 0 0 0 0 0

Lab. Tech 7 7 7 7 8 9 0 0 0 1 2

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

Opthalmic

Assistant

2 5 6 7 8 9 3 4 5 6 7

Class IV 38 40 48 56 64 72 2 10 18 26 34

Statistical

Assistant

7 7 7 7 8 9 0 0 0 1 2

Registration

clerk

7 7 7 7 8 9 0 0 0 1 2

Accountant 0 5 6 7 8 9 5 6 7 8 9

Epidemiologist 0 5 6 7 8 9 5 6 7 8 9

BEE 0 5 6 7 8 9 5 6 7 8 9

179

Budget Activity / Item 2007-08 2008-09 2009-10 2010-11 2011-12 Total

Subcentre

ANM 320.305 388.455 434.797 448.427 462.057 2054.041

MPW(M) 207.9 237.6 257.796 263.736 269.676 1236.708

PHC

MO 144.992 144.992 144.992 144.992 144.992 724.96

Staff Nurse 142.941 142.941 142.941 142.941 142.941 714.705

Health worker (F) 12.296 12.296 12.296 12.296 12.296 61.48

Health Educator 56.869 56.869 56.869 56.869 56.869 284.345

Health Assistant 131.747 131.747 131.747 131.747 131.747 658.735

Clerk 85.536 85.536 85.536 85.536 85.536 427.68

Pharmacist 6.12 6.12 6.12 6.12 6.12 30.6

Lab.Tech 21.384 21.384 21.384 21.384 21.384 106.92

Class IV 69.84 69.84 69.84 69.84 69.84 349.2

CHC

Specialist(7) 73.8 99.63 125.46 151.29 177.12 627.3

MO General Duty (3) 47.28 56.736 66.192 75.648 85.104 330.96

PHN 6.848 8.56 10.272 11.984 13.696 51.36

ANM 7.128 11.88 16.632 21.384 26.136 83.16

SN 24.592 35.351 46.11 56.869 67.628 230.55

Dresser 3.45 4.14 4.83 5.52 6.21 24.15

Pharmacist 0 0 0 0 0 0

lab.Tech 0 0 0 1.188 2.376 3.564

Radiographer 3.564 4.752 5.94 7.128 8.316 29.7

Opthalmic Assistant 3.564 4.752 5.94 7.128 8.316 29.7

Class IV 1.44 7.2 12.96 18.72 24.48 64.8

Statistical Assistant 0 0 0 1.188 2.376 3.564

Registration clerk 0 0 0 1.188 2.376 3.564

Accountant 9.65 11.58 13.51 15.44 17.37 67.55

Epidemiologist 13.75 16.5 19.25 22 24.75 96.25

BEE 7.65 9.18 10.71 12.24 13.77 53.55

Total 1402.646 1568.041 1702.124 1792.803 1883.482 8349.096

180

12. PROCUREMENT AND LOGISTICS

Procurement and Logistics

Situation

Analysis/

Current

Status

In district Kathua there is no proper Warehouse. There are rooms in which drugs are stored but

it is not a scientific Warehouse. Most of the drugs are supplied by the State but some drugs are

locally procured.

Inventory Management is not very scientific and the records are not computerized. There is no

system of wastage control, replacements, transfer of stocks from one centre to the other.

Record Keeping is done manually.

There is one storekeeper in the General hospital Kathua and two in the District Malaria Office.

Requirements are also not made scientifically.

Objectives Development of a Scientific Warehouse system by 2008

Strategies 1. Developing a Warehouse

2. Capacity building of the personnel for stores and also record keeping

3. Computerization of all the stocks

Activities • Construction of a scientific Warehouse

• Procurement of software and computer hardware for the Warehouse from TNMSC

• Proper Equipment and hardware

• Availability of Pharmacist, Assistant Pharmacist, Packers

• Training of personnel

• Appointment of an agency for Operationalization of the Scientific Warehouse

Support

required

State to develop a scientific and transparent Procurement, Logistics and Warehousing system

with quality control

Activity / Item

2007-

08

2008-

09

2009-

10

2010-

11

2011

-12

Construction of Warehouse x

Software x

Computer system with UPS, Printer, Scanner, x

Equipment & Hardware x

Appointment of Pharmacist x

Appointment of Assistant Pharmacist x

Appointment of Packers -2 x

Appointment of Security Staff x

Training of personnel x

Timeframe

Consultancy to agency for Operationalization of

the Warehouse

x x

181

Total


08

2008-

09

2009-10 2010-11 2011-12 Total

Construction of Warehouse 85 0 0.000 0.000 0.000 85

Software 0.25 0 0.000 0.000 0.000 0.25

Computer system with UPS, Printer,

Scanner,

0.6 0 0.000 0.000 0.000 0.6

Equipment & Hardware 34.5 0 0.000 0.000 0.000 34.5

Pharmacist @ Rs 9000/mth 0 1.08 1.190 1.310 1.440 5.02

Assistant Pharmacist @ Rs 5000/mth 0 0.6 0.660 0.726 0.799 2.785

Packers -2 @ Rs 4000/mthx2 0 0.96 1.056 1.162 1.278 4.456

Security Staff @ Rs 6000/mth 0 0.72 0.792 0.871 0.968 3.351

Training of personnel 0 0.1 0.110 0.121 0.133 0.464

Consultancy to agency for

Operationalization of the Warehouse

2 2.1 0.000 0.000 0.000 4.1

Total 122.3

5

5.56 3.808 4.190 4.618 140.526

182

13. DEMAND GENERATION - IEC IEC

Status There is lack of awareness and good practices amongst the community due to which they

neither avail the services nor take any positive action. There is lack of awareness regarding

the services, schemes including the Fixed Village Health days.

The following issues need special focus:

• Spacing methods, ideal interval between births, no scalpel vasectomy, information about FP

facilities and MTP facilities available at different levels

• Importance of 3 visits for ANC, advantages of institutional delivery, Post natal care,

availability of skilled birth attendants, balanced diet during pregnancy, anaemia, misgivings

about IFA, kitchen garden

• Importance of newborn care, complete immunization, disadvantages of drop outs,

nutritional requirements of infants and children, malnutrition, exclusive breastfeeding

• Problems of adolescents, drugs addiction, malnutrition, problems of sexuality, age at

marriage, tendency to take risks in sexual matters

• DOTS programme for TB, location of microscopy centres, cardinal symptoms of TB,

• High risk behaviour in the community in relation to water born diseases, heart diseases and

lung diseases, and HIV/AIDS, STDs

• Ill effects of drugs addiction affecting adolescents,

• High prevalence of RTIs, including STDs,

• Issues of malaria spread and prevention and also other diseases

• JSY, VHD , availability of services

• Effects of the Adverse Sex Ratio and PCPNDT Act

The personnel have had no training on Interpersonal communication.

Objectives Widespread awareness regarding the good health practices

Knowledge on the schemes, Availability of services

Strategy 1. Information Dissemination through various media,

2. Interpersonal Communication

3. Promoting Behaviour change

Activity 1. Awareness on

• Fixed VHD days

• JSY

• Services available

• Designing of BCC messages on exclusive breast feeding and complimentary feeding,

ANC, Delivery, PNC, FP, Care of the Newborn, Gender, male involvement in the local

language

183

• Consistent and appropriate messages on electronic media – TV, radio

• Use of the Folk media, Advertisements, hoardings on highways and at prominent sites

• Training of ASHA/AWW/ANM on Interpersonal communication and Counselling on

various issues related to maternal and Child health

• Display of the referral centres and relevant telephone numbers in a prominent place in

the village

• Promoting inter-personal communication by health and nutrition functionaries during

the Fixed health & Nutrition days

• Orientation and training of all frontline government functionaries and elected

representatives

• Integration of these messages within the school curriculum

• Kit for the newly married and during first pregnancy to be given at the time of marriage

and during pregnancy

• Mothers meeting to be held in each village every month to address the above

mentioned issues and for community action

• Kishore Kishori groups to be formed in each village and issues relevant to be

addressed in the meetings every month

• Meetings of adult males to be held in each village to discuss issues related to males in

each village every month and for community action.

• Village Contact Drives with the whole staff remaining at the village and providing

services, drugs, one to one counselling and talks with the Village Health & Water

Sanitation Committee and the Mother’s groups. The whole district administration will

get geared up for 33 days quarterly to carry out this massive drive in which registration

of birth, death, Immunization of each child, ANC of each pregnant woman, growth

monitoring of each child, disinfection of wells, spraying of houses and fogging,

treatment of the stagnant water sites, detection of TB and Leprosy, treatment of all

ailments, eye conditions through massive publicity. This will be carried out in each

village through Rath Yatra.

• Monthly Swasthya Darpan describing all the forthcoming activities and also what

happened in the month along with achievements

• Bal Nutrition Melas 4 times at each Subcentre

• Wall writings

• Pamphlets for various issues packed in an envelope

State

Support

State to give guidelines for the good practices and also training module on BCC

Activities 2007-08 2008-09 2009-10 2010-11 2011-12

Finalizing the messages x x x x x

Advertisements x x x x x

TV spots x x x x x

Timeline

Radio Jingles x x x x x

184

Folk Media shows x x x x x

Hoardings on highways and prominent places x x x x x

Display boards x x x x x

Pamphlets x x x x x

Developing Nirdeshika for holding VHD days x x

Monthly Swasthya Darpan x x x x x

Orientation & training of all frontline govt

functionaries and elected representatives

x

VCD in each village quarterly x x x x x

Bal Nutrition Melas x x x x x

Kishori Shakti meetings x x x x x

Opinion leaders workshops x x x x x

Wall writings x x x x x

185

Budget Activities 2007-

08

2008-

09

2009-

10

2010-

11

2011-12 Total

Hiring of an agency for carrying out the

intensive IEC and behaviour change

activities

40 44 48.40

0

53.24

0

145.640 331.28

Finalizing the messages in the local

language

1 1.1 1.210 1.331 3.641 8.282

Advertisements 5 5.5 6.050 6.655 18.205 41.41

TV spots 1 1.1 1.210 1.331 3.641 8.282

Radio Jingles in local language 1 1.1 1.210 1.331 3.641 8.282

Folk Media shows @ Rs 1000/vill 0.587 0.645

7

0.710 0.781 2.137 4.86153

4

Hoardings @ Rs 10000/hoarding 10 11 12.10

0

13.31

0

36.410 82.82

Display boards @ Rs 2000/board 1.8 1.98 2.178 2.396 6.554 14.9076

Pamphlets @ Rs 10/pamphlets x 100000 10 11 12.10

0

13.31

0

36.410 82.82

Nirdeshika for Fixed Health Nutrition days

@ Rs 20/ Nirdeshika x 8000

1.6 1.76 1.936 2.130 5.826 13.2512

Swasthya Darpan @Rs.10 /copy/mth x

8000

0.8 0.88 0.968 1.065 2.913 6.6256

Orientation of elected rep and PRIs@ Rs

200 x 2000 persons x1 day

4 4.4 4.840 5.324 14.564 33.128

Village campaign @ Rs 53.9875 lakhs per

Campaign x 4 times in a year

215.91

4

237.5

054

261.2

56

287.3

82

786.143 1788.19

975

Bal Nutrition Melas @ Rs 300 x 4 times x

AWCs

14.232 15.65

52

17.22

072

18.94

2792

20.8370

71

86.8877

832

Kishori Shakti meetings @ Rs 100 per

group x 587 villages

0.587 0.645

7

0.710 0.781 2.137 4.86153

4

Community and religious leaders

workshops @ Rs 300 /person x 100 x 4

times

1.2 1.32 1.452 1.597 4.369 9.9384

Wall writings @ Rs 200 x 587 villages 1.174 1.291

4

1.421 1.563 4.275 9.72306

8

Total 309.89

4

340.8

834

374.9

72

412.4

69

1097.34

2

2535.56

047

186

Details of Village Campaign Drive

Activity Unit Cost Units Description Calculation

Mule Rath 48000 39 Raths 1872000

Mobility 800 183 Gram Panchayat 146400

Kala Jatha 1000 183 Gram Panchayat 183000

Prabhat Pheri 400 183 Gram Panchayat 73200

Slogan Writing 50 587 Villages 29350

Tent, Generator, Electricity 1700 183 Gram Panchayat 311100

Banner 300 183 Gram Panchayat 54900

Mike 300 183 Gram Panchayat 54900

Opening Ceremony 50000 1 District level 50000

Closing ceremony 8000 39 Facilities 312000

Medicines @ Rs 35 /patient x

200 patients 7000 183 Gram Panchayat 1281000

Outdoor publicity 100000 1 District level 100000

IEC material 500000 1 District level 500000

Hiring of experts 10000 33 days 330000

Untied funds 100000 1 District level 100000

Budget for 1 Village Campaign 5397850

Budget for 4 Village Campaigns 21591400

187

14. FINANCING OF HEALTH CARE

Financing Health Care

Situation

Analysis/

Current

Status

1. For sustainability and needs based care, health financing is the key. District Kathua Rogi

Kalyan Samitis (RKS) have been formed in the District hospital, 4 CHCs and in 27 PHCs till

June 2007. These are hospital autonomous societies which are allowed to take user fees for

services provided at the facilities. Formation of these RKS has resulted in great satisfaction

amongst the patients and also the staff since now funds is available with the facilities to care

for the people.

2. No trainings have been given for the skill building of the Incharges of these facilities. There is

no standardized reporting format and information regarding these RKS is not there.

Objectives Availability of sufficient funds for meeting the needs of the patients

Strategies 1. Generation of funds from User charges

2. Donations from individuals

3. Efficient management of the RKS

4. Provision of Seed money to each RKS

Activities 1. Generation of funds from User charges: User charges are taken for Registration, IPD,

Laboratory investigations from persons who can afford to pay.

2. Donations from individuals: Donations are to be generated from individuals. For the

betterment of hospitals, equipment, additions to the buildings, etc

3. Efficient management of the RKS: Training will have to be given for efficient management

and utilization of the funds for activities that generate funds. Computerization of data and all

the parameters need to be carried out preferably through customized software. Trainings can

be organized with the help of RIHFW Rajasthan who have developed modules and conducted

trainings for the management of these Societies.

4. Provision of Seed money to each RKS at CHC and PHC of Rs 100000 each year for repair,

purchase of new equipment, additions, alterations, etc’;

5. Development of customized software and training of staff for the use of this software

6. Regular filling of formats

Support

required

1. Timely meetings of Rogi Kalyan Samitis

2. SIHFW Rajasthan to agree for providing trainings on the management of the RKS

Timeline Activity 2007-

08

2008-

09

2009-

10

2010-

11

2011-

12

Provision of Seed money @ Rs 1 lakh per CHC

and PHC

x x x x x

Training of the Incharges and second in

command

x x x x x

Development of Software for RKS with training of

personnel on the use

x x x x x

188

Budget Activity 2007-

08

2008-

09

2009-

10

2010-

11

2011-

12

Total

Provision of Seed money @ Rs 1 lakh

per CHC and PHC @ Rs 1.00 lakhs

44 45 46.000 47.000 48.000 230

Training of the Incharges and second in

command @ Rs 1000 per person x 1 day

0.88 0.968 1.065 1.171 1.288 5.372

488

Development of Software for RKS with

training of personnel on the use

5 0.25 0.250 0.250 0.250 6

Total 49.88 46.218 47.315 48.421 49.538 241.3

72

189

15. HMIS, MONITORING AND EVALUATION

HMIS

Current

Status

• HMIS is a monitoring tool for the performance that provides information to support planning,

decision-making and executive control for managers in the Health & FW department.

• In this sector Data collection is ongoing for more than 60-90 different conditions. The basis of

HMIS is the data collected by the ANM who is over burdened with a substantial amount of her

time being spent on surveillance related activities. Each year a CNAA exercise is carried out

but the set procedures under the CNAA are generally not followed in development of annual

action plans and in their utilization in planning the activities of health workers. The action plans

are prepared more as a normative exercise rather than as a management tool for estimation of

service needs and monitoring the programme outputs.

• There is no horizontal integration of surveillance activities of existing disease control

programmes. Absence of clear case definitions and poor supervision or crosschecking of the

data collected hampers the quality of reporting. Non-Communicable diseases are not included

in surveillance even though the burden due to them is high. Absence of formats for reporting

diseases also affects quality of the data collect.

• The data from the ANM is sent upto the district level with no analysis done at any of the higher

levels. There is no system of feedback to the lower levels in the health system. The

transmission of data is affected by poor communication facilities available.

• Data is not collected from private practitioners, private laboratories and private hospitals both in

rural and urban setting.

• Data collected during emergencies and epidemics is of better quality

• The response system at the District level is activated only in times of outbreaks.

• There is lack of coordination between departments. Discrepancy between the data of the

Health department and the ICDS. There is large gap between reported and evaluated

coverage.

• The District administrative system not able to make use of the health data.

• In District Kathua there is a dearth if authentic baseline data especially on IMR, MMR, NMR

and TFR. There is inadequate understanding regarding the classification of diseases.

• HMIS software consisting of all the data collected right from the Subcentres with online facilities

is not available

• Computers need to be supplied at each PHC.

Objectiv

e

1. Integration of several parallel running programme software

2. HMIS is used for decision making on regular basis

3. Inclusion of RCH indicators monitoring

4. Linkage to decision making at Central level

5. Refresher training

190

6. Make it more useful for State level officials

Strategy 1. Research on various issues related to RCH to get a correct baseline

2. Improvement in the CNAA

3. Computerized HMIS

Activity 1. Survey for Data on

• Newborn deaths, births, maternal deaths, Infant deaths, Level of malnutrition in Pregnant

women, Adolescents and children at birth, one year, two years and six years

• Newborn Care and practices at home for the newborn and neonate

• Male participation in Maternal and Child health

• Actual poor people who need free treatment

• Coverage of hamlets

• Access to services

• Health Care practices and behaviour patterns

• Number of Eligible couples, data on all the RCH parameters and indicators

3. One time house to house survey for correct data through 50 youth employed on contract. Each

youth will survey 20 houses per day for 90 days each.

4. Joint CNAA by the ANM, AWW, ASHA along with the PRIs so that there is one data validated

by the PRIs

5. Printing of Reporting & Monitoring Formats

6. Data entry of each Household, Eligible couples, Adolescents

7. Computerization of all the formats and software for the various programmes and finances

8. Computer training for data entry

9. Internet connectivity upto all PHC for online transfer of data. The MPHWF will get the data

entered each month after the household and Eligible Couple entries have been made

10. GIS for the district covering all the parameters

11. Computers at all CHC and PHC including AMC for all computers

State

Support

Provision of software for data entry

Time

line

Activities 2007-

08

2008-

09

2009-

10

2010-

11

2011-

12

Survey house-to-house by youth x

Survey for practices, coverage, behaviour etc

through independent agency

x

Software development x

Data Entry of each household x x x x x

Internet connectivity x x x x x

Provision of computers for each CHC and PHC r x x x x x

AMC for computers x x x x x

GIS for the district, training and updation x x x x x

Printing monitoring Charts x x x x x

191

Budget Activities 2007-08 2008-09 2009-10 2010-11 2011-12 Total

Survey house-to-house by youth @ Rs

6000 pm x 3 months x 80 persons

14.4 0 0.000 0.000 0.000 14.4

Survey for practices, coverage, behaviour

etc through independent agency

15 0 0.000 0.000 0.000 15

Software development 20 0 0.000 0.000 0.000 20

Data Entry of each household @ Rs 2 per

household x 100000 HH

2 0.4 0.800 1.200 1.600 6

Internet connectivity @ Rs 900 /mth x No

of facilities x12 mths

4.752 4.86 4.968 5.076 5.184 24.840

provision of computers for each CHC and

PHC @ Rs 50,000/computer system with

UPS and printer

22 0.5 0.5 0.5 0.5 24

AMC for computers @ Rs 5000 /computer

/year x 44 computers

2.2 2.42 2.662 2.928 3.221 13.431

Consumables for computers @ Rs

4000/mth/facility x 12 mths

22.56 24.816 27.298 30.027 33.030 137.73

1

GIS for the district, training and updation 12 0.5 0.500 0.500 0.500 14

Printing monitoring Charts @ Rs. 5 per

monitoring chart

0.1 0.125 0.150 0.175 0.200 0.75

Total 115.012 33.621 36.878 40.407 44.235 270.15

2

192

BUDGET SUMMARY for 2007 - 2008

District Kathua

BUDGET - AT- A GLANCE (in lakhs)

S. No. Components 2007-08 2008-09 2009-10 2010-11 2011-12 Total

A RCH-II

1 DHS 7.8 8.58 9.438 10.3818 19.8198 56.0196

2 DPMU 370.11 265.711 293.2499 323.3594 356.3273 1608.758

3 Maternal health 211.235 246.471 282.6115 328.6192 371.9431 1440.88

4 Child Health 49.661 8.8 3.7 3.7 3.7 69.561

5 Family Welfare 95.0225 91.51475 119.1007 151.5658 202.0895 659.2933

6 Adolescent Health 65.13 67.018 75.5118 82.06748 90.81518 380.5425

7 Gender & Equity 98.1 91.31 100.439 110.3589 121.3578 521.5657

8 Capacity Building 85.16835 122.0944 124.7687 134.0198 135.3354 601.3866

9 HR 1402.646 1568.041 1702.124 1792.803 1883.482 8349.096

10 IEC 309.894 340.8834 374.9717 412.4689 1097.342 2535.56

11 HMIS 115.012 33.621 36.8776 40.40656 44.23512 270.1523

Total 2809.779 2844.045 3122.793 3389.751 4326.448 16492.81

B NRHM

1 ASHA 98.4 85.6 86.98 89.565 91.61 452.155

2

SC Untied Fund &

Maintenance

35 40 43.4 44.4 45.4 208.2

3

PHCUntied Fund &

Maintenance

29.25 29.25 29.25 29.25 29.25 146.25

4

CHC Untied Fund &

Maintenance

7.5 9 10.5 12 13.5 52.5

5 MMU 83.51 36.201 39.8211 43.80321 48.18353 251.5188

6 Upgradation of CHCs 836.576 153.6976 129.9494 130.2263 130.5309 1380.98

7 Upgradation of PHCs 840.828 1704.428 297.6472 180.9087 183.8363 3207.648

8 Upgradation of SCs 449.1304 720.5 516.7308 156.884 117.2919 1960.537

9 VHWSC 74.35 75.6 76.45 76.7 76.95 380.05

10 Community Action Plan 22.421 24.663 27.129 29.842 32.827 136.882

11 PPP 20 27.7 28.975 29.3295 30.82845 136.833

12 Health Care Financing 49.88 46.218 47.3148 48.42128 49.53841 241.3725

13 Logistics 122.35 5.56 3.808 4.19 4.618 140.526

14 Biomedical Waste 18.34 20.174 22.1964 24.41304 26.83134 111.9548

Total 2687.535 2978.591 1360.152 899.9334 881.1955 8807.408

C Immunization

193

1 Immunization 305.866 294.1938 306.0095 317.2283 329.2244 1552.522

D NDCP

1 RNTCP 30.69 27.875 30.6736 33.74596 37.11206 160.0966

2 Leprosy 2.48 2.48 2.48 2.48 2.48 12.4

3 Malaria 195.52 70.897 76.7637 82.29307 87.18838 512.6621

4 Vector Borne 7.37 8.107 8.9227 9.81397 10.79837 45.01204

5 Blindness Control 43.916 17.3126 19.04686 20.95255 23.0468 124.2748

6 IDSP 42.218 23.1768 28.90948 31.86143 35.09957 161.2653

7 IDD 5.935 6.5285 7.18135 7.899485 8.689434 36.23377

Total 328.129 156.3769 173.9777 189.0465 204.4146 1051.945

E Others

1 Intersectoral 81.512 106.9022 112.8104 119.2821 126.3999 546.9066

Grand total 6212.821 6380.109 5075.743 4915.241 5867.682 28451.6

194

ANNUAL WORKPLAN for 2007 - 2008

Sl.

No.

Planned for 2007-2008`

Activity Indicators

No. Basis of

Denominator

Denomi

nator

%

Basis of %

1 ANC registration

during the first

trimester increased to

18197 Yearly data last

year

16377 90% calculated as per CMO data

but DLHS should be used if no

surety and then as per goal

2 Complete ANC

coverage increased to


year

18197 25% As per Goals for 2007-08

based on DLHS

3 Institutional Deliveries

increased to


year

18197 25% As per Goals for 2007-08

based on DLHS

4 Deliveries by skilled

birth attendants

increased to


year

18197 40% As per Goals for 2007-08

based on DLHS

5 No. of women

benefited under JSY


year

18197 55% Calculations based on the no.

of pregnancies and the Work

plan numbers

6 Low birth weight new

born reduced to

3275 Total preg

minus 10%

16377 20% based on assumption that

33% children are LBW at birth

hence goal is used

7 Complete Child

Vaccination( in 12-23

months age )

increased to

6551 Total preg

minus 10%

16377 40% As per Goals for 2007-08

based on DLHS

8 Severely

malnourished ( III &

IV ) decreased to

1378 Total preg

minus 10%

19688 7% based on assumption that 8-9

% children are Gr II & IV

hence goal is used

9 Use of contraception

increased to

38844 Eligible couples 97110 40% As per Goals for 2007-08

based on DLHS

10 Female sterilization

operations to be

performed during the

year

5000 Last years

sterilization

data

11 Vasectomies to be

performed in the year

600 Last years

sterilization

195

data

12 Tuberculosis –

Detection of New

cases

298 Based on norm

of 180/qtr/lakh

pop of distt

993 30%

Goal for 2007-08

13 Tuberculosis- No. of

defaulters reduced to

NA

14 No. of Malaria Deaths

reduced to

Nil Total cases of

malaria 16

50% Goal for 2007-08

15 Total No. of OPD

cases

120

%

Goal for 2007-09 from the

block OPD data

16 Total no. of indoor

admissions

120

%

Goal for 2007-09 from the

block OPD data

17 No. of cases referred

from CHC/DH

DNA 20% Goal for 2007-08

18 No. of PPPs

operational

1 0 Infrastructure planning

196

RCH II Time Frame

Issues Suggested

strategies

Suggested Activities /

Sub-activities

Annual

Plan

Responsi

bility

Q1 Q2 Q3 Q4

- No. of ANMs conducting

sub-centre and home

deliveries

- Follow up of necessary

infrastructure and

equipment.

60 DFWO

PHC MOs

40 45 50 60 Encourage

ANMs for

conducting

sub-centre

and home

deliveries

Participation of ANMs in

Skilled Birth Attendants

training

16 DTO

PHC MOs

6 10

24 hours

delivery

PHC – infrastructure /

equipment – identify and

follow-up

3 DFWO

PHC MO

1 1 1

Behaviour

Change

Communicatio

n

Awareness Generation for

Early registration, complete

ANC , birth preparedness

and complication readiness

Training on

IPC, IPC,

VHWSC

Mtgs, Using

all media

DFWO

Block

MOs,

PHC MOs

√ √ √ √

Improvement

of referral

transport

Identify means and

operational aspects of

Referral transport

Meeting of

all PHC

MOs, All

ANMs to

identify and

submit

transport

facilities

DFWO

PHC MOs

√ √

RCH camps 4 DFWO 1 1 1 1 Improve

Access Implement JSY scheme 5000 cases PHC MOs 1000 125

0

150

0

125

0

Maternal

Health

Ongoing

situational

analysis

Maternal death Audit Orientation

on

Maternal

death audit

during

monthly

mtgs

100 audits

PHC MOs 5 25 30 40

197

ANM training Training of ANMs on

Nutrition, ARI, Diarrhoea &

RTI / STI

10 ANMs DTO

PHC MOs

2 2 4 2

Community level care 10

Subcentres

PHC MOs

ANMs

√ √ √ √ Care of New

born

Stabilization Unit at CHC –

space/ equipment follow-up

1 General

hospitals

Med

Superinte

ndent of

GH

√

Child

Health

Bi-annual

strategy for

Vitamin A

Implement project At all AWCs CDPO √ √

Promote

Vasectomy

Organize Vasectomy camps 1 camp per

month

DFWO

√ √ √ √

Continue

Sterilization

programme

Organize Sterilization camps 1 camp/mth

at GH and

CHCs

DFWO

MS

CHC I/C

√ √ √ √

Behaviour

Change

Communicatio

n

Conduct special IEC

campaigns

VCD in

each village

DFWO

PHC MOs

ANMs

√ √ √ √

Family

Planning

Partnership

with NGOs

Follow-up on NGO partners

in RCH-II

MNGO

Scheme

DFWO

MNGO

√ √ √ √

Adolesc

ent

Health

Focus on

adolescent

girls

Distribution of IFA and

Albendazole to adolescent

girls

Monthly at

each AWC

CDPO

AWW

√ √ √ √

RCH camps 12 DFWO 1 1 1 1 Access Reaching out

to difficult

areas

MMU 1 DFWO √ √ √

PRI functionaries to

participate in training

564 villages DFWO

PHC MO

√ √ Commu

nity

Manage

ment

Community

Health Care

Management

Initiative

Involve Self Help Groups in

programme activities

564 villages PHC MO,

ANM,

AWW

√ √ √

NRHM

Manage

ment

Untied Funds Utilization of Untied funds All CHCs,

PHCs, SCs

Facility

Incharges

and PRIs

fro SCs

√ √ √

198

Annual

Maintenance

of PHC

Repair and maintenance of

PHCs

20 PHCs PHC MOs √ √

Annual

Maintenance

of CHC

Repair and maintenance of

CHCs

4 CHCs CHC

Incharges

√ √

Engagement

of second

ANM

Assist in selection of

second ANMs and filling

vacancies

187 ANMs CMHO √ √ Human

Resourc

e

Training of

Ayush and

other Non

Government

providers

Motivation of AYUSH

practitioners and Non

Government providers

15 AYUSH

practitioners

20 Non

Government

providers

DFWO √ √

Up-gradation

of Sub-

Centres

Follow up on construction /

renovation and ensuring

equipment, manpower

placement

10 SCs PHC MOs √ √ √ √

Up-gradation

of PHC



equipment, manpower

placement

4 PHCs Block

PHC I/C

√ √ √ √

Infrastru

cture

Up-gradation

of CHC and

GH



equipment, manpower

placement

GH -1 MS √ √ √ √

ROUTINE IMMUNIZATION

Social

Mobilization

Involvement of ASHAs and

AWWs

630 ASHAs

1186 AWWs

DTO

PHC MOs

ANMs, LS

√ √ √ √ Human

Resourc

e

Re-orientation

of Health

workers

Participate in orientation 115 ANMs

15 MOs

DTO

PHC MOs

√ √ √ √

Cold Chain

and storage

Ensure proper storage of

vaccines at SC.

152 SCs DTO

PHC MOs

√ √ √ √

Waste

Disposal pits

Construction of waste

disposal pits at Sub

Centres

152 SCs DTO

PHC MOs

√ √

Material

s &

Infrastru

cture

Support for

SC

Ensure supply of kerosene

oil

152 SCs DTO

PHC MOs

√ √ √ √

199

Access Support to

difficult areas

Alternate Vaccine delivery 152 SCs DTO

PHC MOs

√ √ √ √

NATIONAL DISEASE CONTROL PROGRAMME

Case

detection

Identification of new cases 40 Distt TB

Officer

√ √ √ √

Identification of cases for (

Re-constructive /

Physiotherapy

services(RCS)

Cases to be

identified

Distt TB

Officer

√ √ √ √

Provision of preventive

devices

Cases to be

identified

Distt TB

Officer

√ √ √ √

Follow up of

old cases

Counselling services for

self care

80 Distt TB

Officer

√ √ √ √

Leprosy

Behaviour

Change

Communicatio

n

Awareness generation and

advocacy

In all villages Distt TB

Officer

√ √ √ √

Identify and contain

outbreak

In all villages Distt

Health

Officer

PHC MO

√ √ √ √

Participate in training on

insecticide treated nets

In all villages PHC MO

ANM

PRIs

√ √ √ √

Awareness generation In all villages PHC MO

ANM

PRIs

√ √ √ √

Malaria

control

Mass Drug administration In all villages PHC MO

ANM

PRIs

√ √ √ √

Identify and contain

outbreak

In all villages Distt

Health

Officer

PHC MO

√ √ √ √

Vector

borne

diseases

Dengue and

Chikingunya

Awareness generation In all villages PHC MO

ANM

PRIs

√ √ √ √

TB Revised

National

Identification and follow up

on cases

600 PHC MO

ANM

150 150 150 150

200

Partnership with NGO

partners and private

practitioners for Microscopy

centres and DOT providers

20 BPHC I/C 10 10

Ensure availability of drugs

and supplies

In all SCs,

PHCs and

CHCs

Distt

Health

Officer

√ √ √ √

Tuberculosis

Control

Programme

Awareness generation In all villages Distt

Health

Officer

PHC MO

√ √ √ √

Data gathering and linkage In all villages Distt

Health

Officer

PHC MO

√ √ √ √ Surveilla

nce

Integrated

Disease

Surveillance

Programme

Involving private sector in

disease surveillance

20 Private

facilities

Distt

Health

Officer

√ √ √ √

Maintaining records in Blind

register

All SCs Distt

Health

Officer

PHC MO

√ √ √ √ Blindnes

s

National

Blindness

Control

Programme

Case referral for cataract

surgery and others

All PHCs Distt

Health

Officer

PHC MO

√ √ √ √

Untied funds

to Village

Health Water,

Sanitation

Committee

Utilization of Untied fund In all villages DFWO

PHC MO

ANMs

√ √ √ √ Other

Activities

Computerizati

on of each HH

data

Follow up and proper use

ensured

Of all the

households

CMHO

PHC MO

ANMs

√ √ √

201

Detailed Budget District Kathua

Strengthening of District Health Management S.No Activity / Item 2007-08 2008-09 2009-10 2010-11 2011-12 Total

Orientation Workshop 0.5 0.55 0.605 0.666 1.271 3.591

Exposure visit 6.2 6.82 7.502 8.252 15.754 44.528

Issues based Workshops 0.5 0.55 0.605 0.666 1.271 3.591

Mobility for Monitoring 0.6 0.66 0.726 0.799 1.525 4.309

Total 7.8 8.58 9.438 10.382 19.820 56.020

District Programme Management Activity / Item 2007-08 2008-09 2009-10 2010-11 2011-12 Total

Honorarium DPM,DAM,DDA and Consultants

29.4 32.34 35.574 39.131 43.045 179.490

Travel Costs for DPMU @ Rs 10,000/ per month x 12 mths

1.2 1.32 1.452 1.597 1.757 7.326

Infrastructure costs, furniture, computer systems, fax, UPS, Printer, Digital Camera,

5 5.5 6.050 6.655 7.321 30.526

Workshops for development of the operational Manual at district and Block levels

1 1.1 1.210 1.331 1.464 6.105

Untied Fund 5 6 7.000 8.000 9.000 35.000

Construction Cost of District Swasthya Bhawan @ Rs 800 /sq.ft x 11000sq ft

0 88 0.000 0.000 0.000 88.000

Furnishing and Office Automation, Conference Hall with speakers, ACs

0 15 0.000 0.000 0.000 15.000

Maintenance of the Zila Swasthya Bhawan

0 1.000 1.500 2.000 2.500

7.000

Compendium of Govt orders 0. 50 0.55 0.610 0.670 0.730 2.560

Joint Orientation of Officials and DPM, DAM, DDM

0.25 0.275 0.303 0.333 0.366 1.526

Management training workshop of Officials

0.5 0.55 0.605 0.666 0.732 3.053

Personnel for BPMU 92.4 101.64 111.804 122.984 135.283 564.111

Training of DPM and Consultants

0.5 0.75 1.000 1.250 1.500 5.000

Review meetings @ Rs 1000/ per month x 12 months

0.12 0.132 0.145 0.160 0.180 0.737

Office Expenses @ Rs 10,000/month x 12 months for district

1.2 1.32 1.450 1.600 1.800 7.370

Computer systems (46) with printer and Digital Camera and furniture for DPMU, BPMUs and District and BPMU

27.6 0 0.000 0.000 0.000 27.600

Annual Maintenance Contract for the equipment

2.7 2.97 3.267 3.594 3.953 16.484

Travel costs for BPMU @ Rs 5000 per month per block

12.36 13.596 14.9556 16.45116 18.096276 75.459

Hiring of vehicles at block level @ Rs 800 x 20days /mth x39PHCsx12 mths

74.88 82.368 90.6048 99.66528 109.63181 457.150

Monitoring of the progress by independent agencies

1 1.1 1.200 1.300 1.400 6.000

Office expenses for Blocks & Sectors @ Rs 5000 x 5 blocks x 12, Rs 2000X39 SectorsX12

12 13.2 14.52 15.972 17.5692 73.261

202

Total 267.11 368.711 293.250 323.359 356.327 1608.758

Maternal Health

Activity / Item 2007-08 2008-09 2009-10 2010-11 2011-12 Total

Consultancy for support for developing Microplan for Village health Day

1 1.1 1.210 1.331 1.464 6.105

Tracking Bags @ Rs 300/ bag x AWCs + SCs

4.083 4.158 4.209 4.224 4.239 20.913

Adult Weighing machines @ Rs 800 per machine x 600AWCs & Maintenance(10% cost of machine)

10.888 11.088 11.224 11.264 11.304 55.768

Monthly special outreach session in 100 difficult villages@2000/session

2 2.2 2.42 2.662 2.9282 12.210

Blood Storage @ Rs 3 lakhs per unit

6 6 3.000 6.000 6.000 27.000

Referral Cards @ Rs 2 per card x 10,000

0.2 0.22 0.242 0.266 0.293 1.221

MTP kits @ Rs 15000 Per kit 5.85 6.435 7.0785 7.78635 8.564985 35.715

One day training workshop on Tracking bags at the district level and each sector

1 1.1 1.210 1.320 1.450 6.080

JSY beneficiaries @ Rs 1400/person

140 168 196.000 224.000 252.000 980.000

JSY Helpline through RKS 9.99 19.98 29.970 39.960 49.950 149.850

Mobile phone instrument to personnel @ Rs 2000

3.24 4.96 1.320 1.400 1.480 12.400

Mobile Phones recurring cost to personnel @ Rs 2700

4.374 11.07 12.852 14.742 16.740 59.778

Delivery kits to TBA's@3000and reffeling @ 1000

17.61 3.86 4.246 4.671 5.138 35.524

Incentives to TBA @ 100 per deliveryby skilled birth attendent

2 3 4 5 6 20.000

RCH Camps @ Rs 25000 per camp x 12

3 3.3 3.630 3.993 4.392 18.315

Total 211.235 246.471 282.612 328.619 371.943 1440.880

Newborn and Child Health

Activity / Item

2006-07

2007-08 2008-09 2009-10 2010-11 2011-12 Total

Study on the feeding and Care practices for the infants and children

2 0 0.000 0.000 0.000 2.000

Innovative activities based on the study

0 2 2.000 2.000 2.000 8.000

Newborn Corner furnished with equipment @ Rs 1.40 lakh per facility

1.4 5.6 1.4 1.4 1.4 11.200

Examination table, chair, stool, table, other equipment @ Rs. 3000 x No of AWCs

35.58 0 0 0 0 35.580

Infant Weighing Machines@Rs. 800/AWCx No of AWCs

9.488 0 0 0 0 9.488

Foetoscope @ Rs.50 x No AWCs

0.593 0 0 0 0 0.593

Malnutrition Corners @ Rs 30,000 per CHC and District Hospital

0.6 1.2 0.300 0.300 0.300 2.100

Total 49.661 8.8 3.700 3.700 3.700 69.561

203

Family Welfare


NSV camps @ Rs. 359750 8.6475 9.9973 11.361 13.952 25.313 69.2698

Sterilization Camps @ 19.50 for 5000 cases

45.925 65.2875 84.740 122.754 160.877 479.5835

Development Static Centres@Rs 1 lakh

3 2 2.000 1.000 1.000 9.0000

Copper T-380 @ Rs 45 / piece 1.35 2.03 2.700 4.060 5.400 15.5400

EmergencyContraception@Rs10/2 tabs

0.1 0.2 0.3 0.8 0.5 1.9000

Laparoscopes 3per CHC&DH @ Rs3.00 lakhs x 3

36 12 18 9 9

84.0000

Total 95.0225 91.51475 119.101 151.566 202.090 659.293

Adolescent Health

Activity 2007-08 2008-09 2009-10 2010-11 2011-12 Total

Research 5 0 0.000 0.000 0.000 5.000

Awareness generation @ Rs 2000 per village x 587 villages

11.74 12.914 14.2054 15.62594 17.188534 71.674

Workshop of all the partners 0.5 0.55 0.605 0.6655 0.73205 3.053

Training of Adolescent Mentoring Group and other expanses@1 Lakh

1 1 1.000 1.000 1.000 5.000

Counsellors@ Rs 8000 per month x PHCs x12 mths

37.44 41.184 45.3024 49.83264 54.815904 228.575

Training of Peer Educators @ Rs 50 per person x 3 days xNo of Peer Educators

0.3 0.3 0.150 0.131 0.000 0.881

ReTraining of Peer Educators @ Rs 50 per person x 3 days x peer Educators

0 0.3 0.600 0.750 0.881 2.531

Orientation & Reorientation Health personnel

0.25 0.28 0.310 0.340 0.370 1.550

Counselling sessions @ Rs 1000/yr/peer Educator

2 4 5.000 5.870 5.870 22.740

Counselling Clinics renovation, furnishing and Misc expenses @ Rs 10000.00

3.9 4.29 4.719 5.1909 5.70999 23.810

Health camps for Adolescents once per quarter x 4 x Rs 50000 per camp

2 2.2 2.42 2.662 2.9282 12.210

Joint Evaluation by an agency & Govt

1 0 1.200 0.000 1.320 3.520

Total 65.13 67.018 75.512 82.067 90.815 380.542

ASHA

Activity / Item 2007-08 2008-09 2009-10 2010-11 2011- 12 Total

Training & kit @ Rs 10000/ ASHA

3 1 1.000 1.500 1.500 8

Training of ASHA in Module II,III,IV @ 2000/ASHA

12.6 0.2 0.2 0.3 0.3 13.6

Reorientation @ Rs 1000/ ASHA

6 6.3 6.400 6.500 6.650 31.85

Expenses for the District mentoring group – meetings, travel @ Rs 5000 per month x 12 months

0.6 0.66 0.730 0.800 0.880 3.67

ASHA Performace Diary @ 100/ASHA

0.6 0.64 0.650 0.665 0.680 3.235

Compensation to ASHA @1000/ASHA

75.6 76.8 78 79.8 81.6 391.8

Total 98.4 85.6 86.980 89.565 91.610 452.155

Untied Funds and an Annual Maintenance grant for Sub Centres

204


Untied Fund of Rs 10000/subcentre

17.5 20 21.7 22.2 22.7 104.1

Annual Maintenance grant of Rs 10000/SC

17.5 20 21.7 22.2 22.7 104.1

Total 35 40 43.400 44.400 45.400 208.2

Untied Funds and an Annual Maintenance grant for PHCs

Activity 2007-08 2008-09 2009-10 2010-11 2011-11 Total

Untied Fund of Rs 25000/PHC 9.75 9.75 9.75 9.75 9.75 48.75

Annual Maintenance grant of Rs 50000/PHC

19.5 19.5 19.5 19.5 19.5 97.5

Total 29.25 29.25 29.250 29.250 29.250 146.25

Untied Funds and an Annual Maintenance grant for CHCs


Untied Fund of Rs 50000/CHC 2.5 3 3.5 4 4.5 17.5

Annual Maintenance grant of Rs 100000/CHC

5 6 7 8 9 35

Total 7.5 9 10.500 12.000 13.500 52.5

Mobile Medical Unit


Cost of Mobile van 26.85 0 0 0 0 26.85

Cost of Diagnostic Van 23.75 0 0 0 0 23.75

Personnel 8.7 9.57 10.527 11.5797 12.73767 53.11437

recurring cost 23.71 26.081 28.6891 31.55801 34.713811 144.751921

Orientation 0.25 0.275 0.3025 0.33275 0.366025 1.526275

Jt workshop 0.25 0.275 0.3025 0.33275 0.366025 1.526275

Total 83.51 36.201 39.8211 43.80321 48.183531 251.518841

Upgrading CHCs to IPHS

2007-08 2008-09 2009-10 2010-11 2011-12 Total

New CHC buildings with staff quarters

79.2 79.2 79.2 79.2 79.2 396

CHC Building Repair, Alteration and Addition @ 10 Lakh 0 40 0.000 0.000 0.000 40

Construction of Staff Qtrs of MO/ Specialist @ 7.2 0 86.4 0.000 0.000 0.000 86.4

Construction of Staff Qtrs of SN @6 96 0 0.000 0.000 0.000 96

Construction of Staff Qtrs of class [email protected] 19.2 12 0.000 0.000 0.000 31.2

Repairing of Staff Qtrs @ 10 Lakh/CHC 40 0 0.000 0.000 0.000 40

Furniture @1.2 X No of CHCs 4.8 1.2 1.2 1.2 1.2 9.6

Equipment @ 22.9 X No of CHCs 88.76 22.19 22.19 22.19 22.19 177.520

Reccuring cost of CHC excluding Man Power

248.76 161.79 23.39 23.39 23.39 480.72

Purchase of generator sets @ 0.6 lakh x No of CHCs

2.4 0.6 0.6 0.6 0.6 4.8

Recurring & Maintenance cost of generator sets Rs. 140 X 30 days X 12 months X 7 No of CHCs 2.016 2.22 2.44 2.68 2.95 12.308

Computer ,printer,fax @60000 X CHC 2.4 0.6 0.6 0.6 0.6 4.8

AMC of computer @ 6000 X CHC 0.24 0.30 0.33 0.36 0.40 1.632

Total 583.776 406.4976 129.94936 130.2263 130.53093 1380.980

205

Upgrading PHCs for 24 hr Services, IPHS and additional requirements of PHCs


Construction of Building with staff Qtrs for building less PHCs @ 37.80

113.4 264.6 113.4 0.000 0.000 491.4

PHC Building Repair, Alteration and Addition @ 2Lakh 20 22 6 0.000 0.000 48

Construction of Staff Qtrs for PHCs have own building 144 604.8 0.000 0.000 0.000 748.8

Additional Staff qaurters for PHCs have own building 96 403.2 0.000 0.000 0.000 499.2

Repairing of Staff Qtrs @ 5Lakh/PHC 15 25 0.000 0.000 0.000 40

Furniture @1 X No of PHCs 12 0 0.000 0.000 0.000 12

Equipment @ 11 X No of PHCs

220 209 0.000 0.000 0.000 429

Recuring cost of PHCs excluding Man Power

151.632 151.632 151.632 151.632 151.632

758.16

Purchase of generator sets @ 0.6 lakh x No of PHCs

23.4 0 0.000 0.000 0.000

23.4

Recurring & Maintenance cost of generator sets Rs. 140 X 30 days X 12 months X No of PHCs

19.656 21.6216 23.784 26.162 28.778

120.002

Computer with scanner,printer,UPS ,Fax@60000 /PHC

23.4 0 0.000 0.000 0.000

23.4

AMC of computer @ 6000 X No of PHC

2.34 2.574 2.831 3.115 3.426 14.286

Total 840.828 1704.4276 297.647 180.909 183.836 3207.648

Upgrading Sub Centres and additional Subcentres


New buildings with quarters, equipment and Furniture 113.546 123.42 83.926 24.684 24.684 370.260

New Subcentres @ Rs. 4,93,680/SC non recurring for existing SCs 49.368 246.84 192.5352 0.000 0.000 488.743

Repair,Addition and Alteration of Subcenter @2lakh 40 26 0.000 0.000 66

Staff Quarters @ Rs 3 lakhs per Quarter for 2 ANMs 90 93 120.000 0.000 0.000 303

Staff Quarters @ Rs 3 lakhs per Quarter for 1 ANMs 60 123 0.000 0.000 0.000 183

Recurring costs of the additional Subcentres

96.216 108.24 120.270 132.200 92.608

549.534

Total 449.130 720.5 516.731 156.884 117.292 1960.537

Untied Funds and Incentive Fund for the Village Health and Water Sanitation Committees

Activity / Item 2007-08 2008- 09 2009- 10 2010- 11 2011- 12 Total

Untied Fund of Rs 10000/unit 1500/unit x 656 units

65.6 65.6 65.6 65.6 65.6 328

Permanent Advance to VHWSC for ASHA incentive @ Rs5000/SC

8.75 10 10.850 11.100 11.350 52.05

Total 74.35 75.6 76.450 76.700 76.950 380.05

Immunisation

Activity 2007-08 2008-09 2009-10 2010-11 2011-12 Total

206

Mobility support for alternative vaccine delivery Rs. 50 per session for 2 planned sessions per week at each Subcentre village for 12 months = Rs. 50x2 sessionsx4 weeks/mthx12 monthsx SCs

7.296 9.6 10.416 10.656 10.896 48.864

Vehicle for distribution of vaccines in remote areas @ Rs 800 per PHC for 2 times per week x 4 weeks x 12 months x PHCs

29.952 32.9472 36.242 39.874 43.861 182.876

Mobility Support Mop up campaign @ Rs 10000 per PHC ( Including travel, vaccine delivery, IEC) x 6 rounds/ year x PHCs

23.4 23.4 23.4 23.4 23.4 117

Mobilization of Children by Social Mobilizers @ Rs. 100/ session x2 sessions per week x 4 weeks/mth X 587 village x12 mths

56.352 56.352 56.352 56.352 56.352 281.76

Iincentives to mothers @Rs 150 per child for full immunization

7.5 11.25 15.000 18.000 21.000 72.75

Contingency fund for each block @ Rs.1000/month x 5 blocks x 12 months

0.6 0.6 0.6 0.6 0.6 3

Pit Formation for disposal of AD Syringes and broken vials (@ Rs. 2000 per pit per village

117.4 117.4 117.4 117.4 117.4 587

Printing of Immunisation cards @1.50 per card x 50000 cards each year

0.75 0.825 0.908 0.999 1.099 4.581

Special IEC session @25/session X100 villages 4 times a yearn

1.2 1.320 1.452 1.597 1.757 7.326

Maintenance of Cold Chain Equipments (funds for major repair) (@ Rs.750 per PHC/CHC for the first year then Rs. 500 per PHC/CHC per month) and 50,000 for minor repairs

4.46 3.2 3.260 3.320 3.380 17.62

Provision of Generator at all facilities upto PHC DH: Rs 1.5 lakhs x 1, CHCs – 7x 0.50, PHCs – 40x 0.5 in first year

23.5 0.5 0.5 0.5 0.5 25.5

Recurring & Maintenance cost of generator sets Rs. 140 X 30 days X 12 months X No of PHCs & CHCs

22.176 24.394 26.833 29.516 32.468 135.387

POL & maintenance for Vaccine delivery van at district level @ Rs.15000/month x 12 mths

1.8 1.98 2.180 2.400 2.640 11

Running Cost of WICs & WIF (Electricity & POL for Genset & preventive maintenance) Rs. 90000 for electricity @ 15000 equipment per two months plus Rs.8000 per annum @1000 for POL for genset at DH

7.02 7.72 8.490 9.340 10.270 42.84

Mobility suppot to District Family Welfare Officer@ 3000/month

0.36 0.396 0.436 0.479 0.527 2.198

207

Computer Assistant for District Family Welfare Office @ 4500

0.54 0.594 0.653 0.719 0.791 3.297

Mobility support for Monitoring Immunization sessions for MO's PHC @1000/session

1.56 1.716 1.888 2.076 2.284 9.524

Total 305.866 294.194 306.009 317.228 329.224 1552.522

RNTCP


Civil Works

DTC building 1.5 lakhs 1.5 0 0.000 0.000 0.000 1.5

MC 0.28/MC 2.8 0 0.000 0.000 0.000 2.8

TU 0.35/Tu except DTC

1.05 0 0.000 0.000 0.000 1.05

Material and supplies 1.2 1.32 1.450 1.600 1.760 7.33

Laboratory material 1 1.1 1.210 1.330 1.460 6.1

Training 10.45 11.495 12.645 13.909 15.300 63.798

Awareness drive on World TB day

1 1.1 1.210 1.330 1.460 6.1

IEC activities 1 1.1 1.210 1.330 1.460 6.1

Salaries of contractual staff 7.71 8.481 9.329 10.262 11.288 47.0703

Vehicle maintenance inc POL 1 1.1 1.210 1.330 1.460 6.1

2 wheeler

4 wheeler

Hiring of vehicle 1.7 1.87 2.060 2.270 2.500 10.4

DTO

MO TC @ Rs 0.42lakh/yr

Equipment and maintenance 0.085 0.094 0.103 0.113 0.124 0.519

Microscope @ Rs1000/yr/microscope

Computer@ Rs 5000/yr

Photocopier/Fax Rs2500/ machine

Miscellaneous – TA/DA, Telephone, Meetings, Electricity repair etc

0.195 0.215 0.247 0.272 0.300 1.229

Total 30.69 27.875 30.674 33.746 37.112 160.097

Leprosy


Contractual Staff 0.462 0.462 0.462 0.462 0.462 2.310

Honorarium 0.048 0.048 0.048 0.048 0.048 0.240

Office Expenses 0.150 0.150 0.150 0.150 0.150 0.750

POL & maintenance 0.360 0.360 0.360 0.360 0.360 1.800

Supportive drugs 0.120 0.120 0.120 0.120 0.120 0.600

Consumables/Stationery 0.120 0.120 0.120 0.120 0.120 0.600

3 Day training of Mos 0.500 0.500 0.500 0.500 0.500 2.500

1 day refresher training 0.120 0.120 0.120 0.120 0.120 0.600

TA for contractual staff and NLEP

0.100 0.100 0.100 0.100 0.100 0.500

IEC activities 0.5 0.5 0.5 0.5 0.5 2.500

Total 2.480 2.480 2.480 2.480 2.480 12.400

National Malaria Control Programme


Salary Contractual staff 7.71 8.481 9.329 10.262 11.288 47.070

Travel expenses @ Rs 4000/ monthfor jeep x 12 months, @6000/month for Truck

3.36 3.696 4.066 4.472 4.919 20.513

Office expenses @ Rs 5000 per month x 12

0.6 0.66 0.730 0.800 0.880 3.67

208

Jeep and maintenance 6 0.6 0.660 0.730 0.800 8.79

Trucks – 6 and maintenance 32 3.2 3.52 3.872 4.259 46.851

Training 10.800 30.970 33.130 34.610 35.080 144.590

3 small Fogging machines for each PHC @ Rs 1.00 lakh and one at District HQ Pulse Fog Machines @ Rs.8.00 lakh per unit and maintenance

125 12.5 13.75 15.125 16.638 183.013

Misc @ Rs 1.00 and Rs 20000 per CHC, and for PHC Rs 10000

4.9 5.39 5.929 6.522 7.174 29.915

Board hoarding:8’x 12’ at the CHCs and District hospitals @ Rs 25,000/-

1.25 1.5 1.750 2.000 2.250 8.75

Board hoarding: 5’x3’ initially at the PHCs@ Rs 10,000/-

3.9 3.9 3.9 3.9 3.9 19.5

Total 195.520 70.897 76.764 82.293 87.188 512.662

Other Vector Borne diseases


Unforeseen expenses 0.5 0.55 0.610 0.670 0.740 3.07

Pamphlet, poster @1lakh 1 1.1 1.210 1.331 1.464 6.105

Kala Jathas for Malaria, Dengue and Chikingunya @ Rs 1000 per village x 587

5.87 6.457 7.103 7.813 8.594 35.837

Total 7.37 8.107 8.923 9.814 10.798 45.012

Blindness Control Programme

Activity / Item 2007- 2008 2008-09 2009-10 2010-11 2011-12 Total

Health Mela @50000 / CHC 2.5 2.75 3.025 3.328 3.660 15.263

IEC @1lakh 1 1.1 1.210 1.331 1.464 6.105

School Eye Screening @1000 X100 school

1 1.1 1.210 1.331 1.464 6.105

Blind Register 0.386 0.425 0.467 0.514 0.565 2.357

Observance of Eye Donations 0.15 0.17 0.190 0.210 0.230 0.95

Cataract Camps @ Rs 20000 per camp x 39 PHC

7.8 8.58 9.438 10.382 11.420 47.620

POL fro Eye Camps @ Rs 2000/camp x39

0.78 0.858 0.944 1.038 1.142 4.762

House to house survey for vision defects @ 10 lakhs

10 0 0.000 0.000 0.000 10

Training of School teachers @ Rs 100/head x 100

0.1 0.11 0.121 0.133 0.146 0.611

Training of PRIs @ Rs 100/head x 200

0.2 0.22 0.242 0.266 0.293 1.221

Repair and purchase of equipment and maintenance

20 2 2.200 2.420 2.662 29.282

Total 43.916 17.313 19.047 20.953 23.047 124.275

Integrated Diseases Control Programme


Renovation of Labs at CHCs a@ Rs 20,000

1 0.000 0.000 0.000 1

Renovation of Lab at District Hospital @ Rs 140,000 and maintenance

1.4 0.14 0.180 0.200 0.220 2.14

Equipment for Lab at PSU at CHC and @ Rs 40,000

2 0.4 0.4 0.4 0.4 3.6

Equipment for Lab at District @ Rs 850,000

8.5 0 0.000 0.000 0.000 8.5

Computer and Accessories at CHC @50000

2.5 0.5 0.5 0.5 0.5 4.5

209

Office for PSU atMaintenance CHC @ Rs 10,000 per unit

0.5 0.1 0.1 0.1 0.1 0.9

Office Maintenance for DSU @ Rs 10,000

0.1 0.1 0.100 0.100 0.100 0.5

Software for DSU@ Rs 335000

3.35 0 0.000 0.000 0.000 3.35

Furnishing of Lab at PSU at CHCs and @ Rs 10,000

0.5 0.1 0.1 0.1 0.1 0.9

Furnishing of Lab at DSU @ Rs 60,000

0.6 0 0.000 0.000 0.000 0.6

Material and supplies at Lab at PSU at CHCs @ Rs 8,000

0.4 0.08 0.08 0.08 0.08 0.72

Material and supplies at Lab at DSU @ Rs 75,000

0.75 0.83 0.910 1.000 1.100 4.59

Contract Staff at District level @ 200000/yr for 4 staff yr wise

2 2.2 2.920 3.710 4.580 15.41

IEC activities 1 1.1 1.210 1.330 1.460 6.1

Training and retraining 0.980 3,02 3.030 3.040 3.050 10.100

WEN connectivity 0.5 0.55 0.610 0.670 0.730 3.06

Operational costs at PSU for Surveillance @ Rs 15000/year x No of CHCs

0.75 0.15 0.15 0.15 0.15 1.35

Operational costs at DSU for Surveillance @ Rs 130000/year

1.3 1.430 1.573 1.730 1.903 7.937

Honorariun to Numberdars and Chowkidars for reporting @ Rs 100pm x 587Numberdars and 587 Chowkidars x12

14.088 15.497 17.046 18.751 20.626 86.009

Total 42.218 23.1768 28.909 31.861 35.100 161.265

IDD

Activity / Item 2007-08 2008-09 2009-10 2010-11 2008-2012

Total

Large Village meetings for awareness on IDD and consumption of Iodized salt

1 1.100 1.210 1.331 1.464 6.105

Programme in schools – 100 Primary, Upper Primary, Secondary- Govt and Private by School health team

2 2.200 2.420 2.662 2.928 12.210

Awareness programme with the SHGs and shopkeepers @ Rs 500 per village x 587 villages

2.935 3.229 3.551 3.906 4.297 17.918

Total 5.935 6.529 7.181 7.899 8.689 36.234

Intersectoral Coordination


Meetings of the Block Committees @ Rs 1000 /meeting x 9 blocks x 12 months

1.08 1.188 1.307 1.437 1.581 6.594

Meetings of the Village groups @ Rs 50 per village x 587villages x 12

3.522 3.874 4.262 4.688 5.157 21.502

Joint CNAA training @ Rs 200 per person ( 1186AWW, 152ANMs, 630ASHAs, 39 Supervisors, 39 MOs, 9CDPOs) x 2055

4.11 4.16 4.194 4.204 4.214 20.882

Joint monitoring at the sector level

210

Hiring of vehicle @ RS 1000/ day x 5 days/month x 39sectors x 12 months

23.4 25.74 28.314 31.1454 34.260 142.859

Joint monitoring at the block level

Hiring of vehicle @ RS 1000/ day x 5 days/month x 9 blocks x 12 months

5.4 5.94 6.534 7.187 7.906 32.968

Yearly joint Planning Workshops at the Block level for development of the Action Plans @ Rs 1.00 lakhs per block x 9 blocks

9 9.9 10.89 11.979 13.177 54.946

Yearly joint Planning Workshops at the District level for development of the Action Plans @ Rs 1.00 lakh

1 1.1 1.21 1.331 1.464 6.105

Yearly joint Workshops to consolidate the plans from the village to the Gram Panchayats to the Sectors and then Blocks at the Block level for Annual Action Plans @ Rs 1.00 lakhs per block x 9 blocks

9 9.9 10.89 11.979 13.177 54.946

Yearly joint Workshops to consolidate the findings at the block levels at the District level for development of the Action Plans @ Rs 1.00 lakh

1 1.1 1.21 1.331 1.464 6.105

PRIs

Chiranjeevi Scheme 24 44 44 44 44 200

Total 81.512 106.9022 112.81042 119.28206 126.39987 546.907

Community Health action


Training of the VHWSC @ Rs 200 per person x 15 persons/village x587 villages

17.61 19.371 21.308 23.439 25.783 107.511

Meetings of the VHWSC @ Rs 50 per village x 587 villages x 12 months

3.522 3.8742 4.262 4.688 5.157 21.502

Meetings of Women SHG @ Rs 100 per year x587 villages

0.587 0.6457 0.710 0.781 0.859 3.584

Honorarium for MOs for promoting Community health Action @ Rs 1000 pm and travel charges Rs 800 pm

0.702 0.7722 0.849 0.934 1.028 4.286

Total 22.421 24.663 27.129 29.842 32.827 136.882

Public Private Partnership


Fesiability study on PPP issues

10 0 0.000 0.000 0.000 10

Innovative activities based on the study

0 20 20.000 20.000 20.000 80

Capacity Building of NGOs 0.5 0 0.500 0.000 0.500 1.5

Establishing Tech. Support Agency

2 2.2 2.420 2.662 2.928 12.210

Capacity Building of PRIs,SHGs,VHWSCs

0.5 0.55 0.605 0.666 0.732 3.053

Area specific Modules 0.5 0 0.000 0.000 0.000 0.5

Exit poles 2 2.2 2.420 2.662 2.928 12.210

211

5 Workshops for involvement of the Private sectors (one each with NGOs/Trusts/Private institutions;Media; Ex-servicemen association, transportation ,HR agencies) @ 25000 per workshop

2.5 0 0 0 0 2.5

Sharing Workshops with Private players

0 0.55 0.61 0.67 0.74 2.57

Admin and overhead Charges for hiring the agencies

2 2.2 2.42 2.67 3 12.29

TOTAL 20 27.7 28.975 29.330 30.828 136.833

Gender and Equity


Research Study 10 0 0.000 0.000 0.000 10

Preparation of GIS maps for monitoring

5 1 1.000 1.000 1.000 9

IEC Campaign @2000 X587 villages

57.87 63.657 70.023 77.025 84.727 353.302

Periodic Advisory committee meetings @ 5000

0.2 0.22 0.242 0.266 0.293 1.221

Development of Trg. Modules 1 0 0.000 0.000 0.000 1

Traning of MO's &,ANMs 2 2.2 2.420 2.662 2.928 12.210

Panchayat level vigilence committees @1000X183

1.83 2.013 2.214 2.436 2.679 11.172

Workshops with private providers, IMA members, Religious leaders, Caste leaders, PRIs, MLAs in every block and Gram Panchayat and with SHGs

10 11 12.100 13.310 14.640 61.05

Rallies in all schools and colleges and generating discussions in schools and colleges through debates

5 5.5 6.100 6.700 7.400 30.7

Regular advertisements in the newspapers

5 5.5 6.100 6.700 7.400 30.7

Health Card for Girl Child @ Rs 2 /card x 10,000 cards

0.2 0.22 0.240 0.260 0.290 1.21

Total 98.1 91.31 100.439 110.359 121.358 521.566

Capacity Building

Activity 2007-08 2008–09 2009-10 2010-11 2011-12 Total

TBA training @ Rs 10100 /TBA

59.287 65.2157 71.737 78.911 86.802 361.953

MVA MTP training to all PHC MOs for 15 days @ Rs 500 x 15 days x MOs

2.925 2.925 0.000 0.000 0.000 5.85

Training on Blood transfusion for MOs and Lab Technicians for CHCs with Blood storage facilities for 3 days

MOs @ Rs 500/day/person x 3 days

0.015 0.075 0.015 0.015 0.015 0.135

LabTechnicians@Rs 200/person x 3 days

0.006 0.03 0.006 0.006 0.006 0.054

Training in Obstetric management & skills for 24x7 PHCs for 16 weeks

MOs: Rs 500/day x 112 days x 2 MOs

1.12 11.2 11.2 11.2 4.48 39.200

StaffNurses:Rs200/dayx112daysx 2 SNs

0.448 4.48 4.48 4.48 1.792 15.680

212

Training in skilled Birth attendants for 15 days:

One batch of 4 persons: Rs. 7500 as hon. to participants, Rs 13500 hon. to training team, 15% institutional charges, = Rs 25000/batch - 16 batches

4 16 16 16 16 68.000

IMNCI training to ANM/LHV, SN, ASHA for 8 days

0.000

Rs 300 as hon. to participant x 8 days

1.032 2.1912 2.410 2.651 2.916 11.201

IMNCI training to MOs @ Rs 5390 /participant

0.3234 1.186 1.617 1.779 1.957 6.861

Integrated skill training of all SN @ Rs 4080/person

0.408 0.8976 1.4688 1.5912 2.2848 6.650

Integrated skill training for ANMs @ Rs 2048/person

0.2048 0.5632 0.6144 0.6656 0.7168 2.765

Integrated skill training for MOs @ Rs 3683

0.18415 0.203 0.223 0.245 0.270 1.124

Training of MOs, SN in Mgt of Newborns & sick children at Medical College Jammu @ Rs 7500/MO, Rs 4500 ( Rs 300 x 15 days)/SN

0.24 0.264 0.290 0.319 0.351 1.465

Training in BCC for MOs, LHVs, ANMs

0.76 0.836 0.920 1.012 1.113 4.640

MOs: Rs 500/MO x 5 days

LHVs & ANMs: Rs 300/person x 5 days

Training of Ayush personnel on issues of RCH and reporting for 3 days

0.459 0.5049 0.555 0.611 0.672 2.802

Rs 300/person x 3 days

Training on NSV for MOs at NSV camps

0.42 0.462 0.508 0.559 0.615 2.564

Rs 500/MO /camp x 12 camps,

Rs 3000 per camp for trainer x 12 camps

Training on Minilap @ Rs 500 per day for 15 days and during camps

0.6 2.64 2.904 3.194 3.514 12.852

Training for Laproscopic Sterilization for Surgeons, Gynaecologists, SN, OT attendants for 12 days

0.24 0.264 1.162 1.278 1.406 4.349

Specialist: Rs 500/Specialist x 12 days

SN: Rs 300/SN x 12 days

OT Attendant: Rs 200 x 12 days

Orientation on contraceptive devices for MOs - Govt as well as private facilities

0.4 0.44 0.484 0.532 0.586 2.442

Rs 500 /MO x 1 day

Training on Medico-legal aspects to MOs

0.5 0.825 0.908 0.998 1.098 4.329

@ Rs 500/MO x 1 day

Continuing Medical Education sessions for doctors each month during the monthly meetings on current topics @ Rs 25000 per CME

2.5 2.75 3.025 3.328 3.660 15.263

213

Orientation on PCPNDT Act for DCs, CSs, doctors both Govt and private, members of District Appropriate authority NGOs in a workshop

0.5 0.55 0.605 0.666 0.732 3.053

General & Financial rules (G & FR) for Officials, MOs, clerical staff for 3 days

1.05 1.155 1.271 1.398 1.537 6.410

Rs 500/official and MOs x 3 days

Rs 200 /clerical staff x 3 days

Financial management training for Accounts Officers, Accountants for 2 days

0.2 0.22 0.242 0.266 0.293 1.221

Rs 200/Accounts persons x 2 days

Computer training to all the MOs, Clerical staff, accounts personnel @ Rs 200 per person x 15 days

3 1.65 0.000 0.000 0.000 4.650

CNAA for MOs, LHVs, ANMs, AWW

2.632 2.682 0.05 0.034 0.01 5.408

@ Rs 200/person x 1 day each year

Total sanitation orientation and reorientation of VHWSCs x 1 day @ Rs 200/person/day

1.174 1.2914 1.421 1.563 1.719 7.167

Training of NGOs in BCC @ Rs 300 per person x 6 days

0.54 0.594 0.653 0.719 0.791 3.297

Total 85.16835 122.09437 124.769 134.020 135.335 601.387

Human Resources


Subcentre

ANM 320.305 388.455 434.797 448.427 462.057 2054.041

MPW(M) 207.9 237.6 257.796 263.736 269.676 1236.708

PHC

MO 144.992 144.992 144.992 144.992 144.992 724.96

Staff Nurse 142.941 142.941 142.941 142.941 142.941 714.705

Health worker (F) 12.296 12.296 12.296 12.296 12.296 61.48

Health Educator 56.869 56.869 56.869 56.869 56.869 284.345

Health Assistant 131.747 131.747 131.747 131.747 131.747 658.735

Clerk 85.536 85.536 85.536 85.536 85.536 427.68

Pharmasist 6.12 6.12 6.12 6.12 6.12 30.6

Lab.Tech 21.384 21.384 21.384 21.384 21.384 106.92

Class IV 69.84 69.84 69.84 69.84 69.84 349.2

CHC

Specialist(7) 73.8 99.63 125.46 151.29 177.12 627.3

MO General Duty (3) 47.28 56.736 66.192 75.648 85.104 330.96

PHN 6.848 8.56 10.272 11.984 13.696 51.36

ANM 7.128 11.88 16.632 21.384 26.136 83.16

SN 24.592 35.351 46.11 56.869 67.628 230.55

Dresser 3.45 4.14 4.83 5.52 6.21 24.15

Pharmacist 0 0 0 0 0 0

lab.Tech 0 0 0 1.188 2.376 3.564

Radiographer 3.564 4.752 5.94 7.128 8.316 29.7

Opthalmic Assistant 3.564 4.752 5.94 7.128 8.316 29.7

Class IV 1.44 7.2 12.96 18.72 24.48 64.8

Statistical Assistant 0 0 0 1.188 2.376 3.564

Registration clerk 0 0 0 1.188 2.376 3.564

Accountant 9.65 11.58 13.51 15.44 17.37 67.55

214

Epidemiologist 13.75 16.5 19.25 22 24.75 96.25

BEE 7.65 9.18 10.71 12.24 13.77 53.55

Total 1402.646 1568.041 1702.124 1792.803 1883.482 8349.096

Logistics and Warehousing


Construction of Warehouse 85 0 0.000 0.000 0.000 85

Software 0.25 0 0.000 0.000 0.000 0.25

Computer system with UPS, Printer, Scanner,

0.6 0 0.000 0.000 0.000 0.6

Equipment & Hardware 34.5 0 0.000 0.000 0.000 34.5

Pharmacist @ Rs 9000/mth 0 1.08 1.190 1.310 1.440 5.02

Assistant Pharmacist @ Rs 5000/mth

0 0.6 0.660 0.726 0.799 2.785

Packers -2 @ Rs 4000/mthx2 0 0.96 1.056 1.162 1.278 4.456

Security Staff @ Rs 6000/mth 0 0.72 0.792 0.871 0.968 3.351

Training of personnel 0 0.1 0.110 0.121 0.133 0.464

Consultancy to agency for Operationalization of the Warehouse

2 2.1 0.000 0.000 0.000 4.1

Total 122.35 5.56 3.808 4.190 4.618 140.526

IEC

Activities 2007-08 2008-09 2009-10 2010-11 2011-12 Total

Hiring of an agency for carrying out the intensive IEC and behaviour change activities

40 44 48.400 53.240 145.640 331.28

Finalizing the messages in the local language

1 1.1 1.210 1.331 3.641 8.282

Advertisements 5 5.5 6.050 6.655 18.205 41.41

TV spots 1 1.1 1.210 1.331 3.641 8.282

Radio Jingles in local language

1 1.1 1.210 1.331 3.641 8.282

Folk Media shows @ Rs 1000/vill

0.587 0.6457 0.710 0.781 2.137 4.861534

Hoardings @ Rs 10000/hoarding

10 11 12.100 13.310 36.410 82.82

Display boards @ Rs 2000/board

1.8 1.98 2.178 2.396 6.554 14.9076

Pamphlets @ Rs 10/pamphlets x 100000

10 11 12.100 13.310 36.410 82.82

Nirdeshika for Fixed Health Nutrition days @ Rs 20/ Nirdeshika x 8000

1.6 1.76 1.936 2.130 5.826 13.2512

SwasthyaDarpan @Rs.10 /copy/mth x 8000

0.8 0.88 0.968 1.065 2.913 6.6256

Orientation of elected rep and PRIs@ Rs 200 x 2000 persons x1 day

4 4.4 4.840 5.324 14.564 33.128

Village campaign @ Rs 53.9875 lakhs per Campaign x 4 times in a year

215.914 237.5054 261.256 287.382 786.143 1788.19975

Bal Nutrition Melas @ Rs 300 x 4 times x AWCs

14.232 15.6552 17.22072 18.942792 20.837071 86.8877832

Kishori Shakti meetings @ Rs 100 per group x 587 villages

0.587 0.6457 0.710 0.781 2.137 4.861534

Community and religious leaders workshops @ Rs 300 /person x 100 x 4 times

1.2 1.32 1.452 1.597 4.369 9.9384

Wall writings @ Rs 200 x 587 villages

1.174 1.2914 1.421 1.563 4.275 9.723068

Total 309.894 340.8834 374.972 412.469 1097.342 2535.56047

215

Financing of Health Care

Activity 2007- 08 2008-09 2009-10 2010-11 2011-12 Total

Provision of Seed money @ Rs 1 lakh per CHC and PHC @ Rs 1.00 lakhs

44 45 46.000 47.000 48.000 230

Training of the Incharges and second in command @ Rs 1000 per person x 1 day

0.88 0.968 1.065 1.171 1.288 5.372488

Development of Software for SKS with training of personnel on the use

5 0.25 0.250 0.250 0.250 6

Total 49.88 46.218 47.315 48.421 49.538 241.372

HMIS

Activities 2007-08 2008-09 2009-10 2010-11 2011-12 Total

Survey house-to-house by youth @ Rs 6000 pm x 3 months x 80 persons

14.4 0 0.000 0.000 0.000 14.4

Survey for practices, coverage, behaviour etc through independent agency

15 0 0.000 0.000 0.000 15

Software development 20 0 0.000 0.000 0.000 20

Data Entry of each household @ Rs 2 per household x 100000 HH

2 0.4 0.800 1.200 1.600 6

Internet connectivity @ Rs 900 /mth x No of facilities x12 mths

4.752 4.86 4.968 5.076 5.184 24.840

provision of computers for each CHC and PHC @ Rs 50,000/computer system with UPS and printer

22 0.5 0.5 0.5 0.5 24

AMC for computers @ Rs 5000 /computer /year x 44 computers

2.2 2.42 2.662 2.928 3.221 13.431

Consumables for computers @ Rs 4000/mth/facility x 12 mths

22.56 24.816 27.298 30.027 33.030 137.731

GIS for the district, training and updation

12 0.5 0.500 0.500 0.500 14

Printing monitoring Charts @ Rs. 5 per monitoring chart

0.1 0.125 0.150 0.175 0.200 0.75

Total 115.012 33.621 36.878 40.407 44.235 270.152

BioMedical Waste management

Activity 2007-08 2008- 09 2009-10 2010-11 2011-12 Total

Orientation and reorientation for Biomedical Waste Management at District and Block levels 1.5 1.65 1.820 2.000 2.200 9.17

Consumables 1 1.1 1.210 1.330 1.440 6.08

Payment for incinerators@ Rs. 8 per bed 12 mths 15.84

17.424 19.166 21.083 23.191

96.705

Total 18.34 20.174 22.196 24.413 26.831 111.955

Grand Total 5857.021 6735.909 5075.743 4915.241 5867.682 28451.596

216

Annexure:

Block SC Buildings need to be constructed

Staff Quarters Needs to be Constructed For SC

Hiranagar Amala Kheri

Bannu Chak Rai

Magloor Tanda

Rai Fattu.Chak

Tanda Thakerpura

Fattu.Chak Subachak

Jatwal Chadwal

Chhan.Kanna Jatwal

Dhamyal Chhan.Kanna

Chaan.Khatrian Dhamyal

Chaan.Morian Chaan.Khatrian

Sandhi Surara

Kattel.Brahmana Chhan.Rorian

Ladhwal Chaan.Morian

Sanyal Sandhi

Kadayal Kattel.Brahmana

Nonath Chandare.Chak

Sagal Ladhwal

Satoora Sanyal

Hira Nagar Kadayal

Mangu Chak Nonath

Chhan Lal Din Sagal

Panjgrain Satoora

Chandwan Hira Nagar

Bann Ragal

Mawa Chhan Lal Din

Odh Chandwan

Danoh

Bann

Mawa

Bilawar Tharakalwal Tharakalwal

Nongala Sathar

217

kalna Marhoon

Barota kalna

Malhid Barota

Dehota Malhid

Rajwalta Dehota

Pallan Rajwalta

Beril Najote

Rampur kishan Pur (billawar)

Dhar Dugnoo Pallan

Dharmkote Beril

Dher Rampur

Maggain Dhar Dugnoo

Dhanu Prole Dharmkote

Bhid Dher

MAC Mandli Koti

Mooni Dhanu Prole

Tumboo Roukhla

Phinter Chunera

Upper Dharalta Kashid

Tumboo Bhid

Nagrota Gujroo MAC Mandli

Phinter Sadrota

KishanPur Issu

Upper Dharalta Mooni

Sarang Tumboo

Nagrota Gujroo

Phinter

Upper Dharalta

Sarang

Bani Bhakoga Sitti

Sitti Mandrara

Mandrara Dumeya

Dumeya Siara

Dullangle Lowang

Chandal Barmota

218

Kanthal Chandal

Bhakoga Kanthal

Doulka Banjal

Dhaman Bhakoga

Backon

Doulka

Tapper

Barmota

Dhaman

Basoli Jandrota Jandrota

Dodla Dodla

Nagrota Mannu

Adhat Thanger

Danna Nagrota

Poonda Adhat

Silage Danna

Poonda

Prey

Silage

Parole Padyari Padyari

Rajbagh Rajbagh

Kumri Kumri

Sample Sapla Sample Sapla

Jandore H Sumwan

Badala Bhallar

Jasrota AD Ghati

Khokhyal Khokhyal

Dhanore Dhanore

219

Status of PHC Buildings and Staff Quarters

S.No Block Buildings need to be constructed

1 Billawar Hakwal

Sukral

Kohag

Malhar

Uchapind

Godu Flal

Bhaddu

2 Bani Gud Duggan

Dhaggar

3 Basoli Mahanpur

Karanwara

S.No Block Staff Quarters need to be constructed

1 Hiranagar Rattanpur

Ghagwal(available only for M.O)

Sanoora (available only for M.O)

Harichak

Dinga Amb

A/D Bhaiya

A/D Chakra(available only for M.O)

2 Billawar Badnota

Hakwal

Sukral(available only for Pharmacist)

Kohag

Malhar

Uchapind

Godu Flal

Ramkote(available only for M.O)

Maehhedi

Bhaddu(available only for M.O & other Staff)

Lohai

3 Bani Gud Duggan

Kati Chandyar(available only for other Staff)

Dhaggar

4 Basoli Saranghat(available only for Pharmacist)

Mahanpur

Sandhar(available only for M.O & other Staff)

220

5 Parole Barwal

Budhi

Lakhanpur(available only for M.O)

Kharote

Dhanni

221

Assessment of District Health Action Plan (DHAP) Appraisal Criteria to be used by State/ District Planning & Appraisal Team

District Kathua Sl. No.

Criteria Remarks Yes/ No

A. OVERALL 1 Has the DHAP been reviewed in detail by the District

authorities to ensure internal consistency? If yes, by whom? This means that Situation analysis, goals, strategies, activities, work plan budget are in line with the proposed interventions and are evidence based.

Yes

2 Has Account Person from the Department reviewed the budget in detail?

Yes

3 Executive summary /At a Glance has been enclosed in the beginning of the document.

Yes,

4 Has plan developed in all inclusive and participatory process by involving representatives of health, water and sanitation, ISM, ICDS, Rural Development, NGOs and community members?

Yes

5 Funds requirement matches with the absorption capacity and has judicious increase over the years (The planning should be based on past experiences in implementing interventions and realistic time frame/ workplan )

Yes

6 The Plan caters needs of vulnerable groups (SC/ST, BPL, Women and Children, others) (Activities proposed to cover SC/ST population for Immunization coverage, JSY scheme etc.)

Yes

7 Inter-department coordination and convergence mechanism is clearly mentioned for multi-sectoral inputs/elements. (Planned joint sector ,block and dist level meetings with ICDS, education and local self Govt. etc and joint circulars for implementing intervention)

Yes,

8 The findings of the facility survey/ assessment has been integrated in the Plan

Yes,

9 Plan has been approved by appropriate district authority District (District Health Society)

Yes, attached after the cover page

11 Training Plan The training strategy to strengthen existing HR. The training plan has indicated target groups (e.g. MO, ANM, ASHAs, AWW etc), training load and broad details e.g. duration, quality assurance for training, etc

Yes,

12 BCC /IEC strategy A service oriented BCC strategy based on assessment of the current status of issues with MMR, IMR, TFR, awareness of PNDT, etc. has been narrated in the plan

Yes

13 Work Plan Is the work plan consistent with stated components/objectives, strategies and activities? And whether the proposed phasing of activities would lead to increase in delivery/utilization of services?

Yes,

14 COSTS/BUDGET Key criteria are:

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Sl. No.


Does the budget follow the prescribed formats? Yes The justification column has break-up of total amount

1. Absorptive capacity: If very ambitious utilization of funds is envisaged compared to performance of 05-06/06-07, then key steps have been proposed to achieve plan expenditure?

Yes

B RCH-II PROGRAM PROGRAM MANAGEMENT ARRAGEMENTS 1 Steps to establish financial management system including

fund flow mechanisms to blocks and downward level and accounting system including timely reporting expenditure

Yes,

2 Steps to establish quality assurance committees/system in the district.

Yes

3 Step to ensure systems for holistic monitoring (Outputs, activities, costs) against DHAP .( Dist level review meeting and DHS meetings)

Yes

4 Strengthening of HMIS with emphasis on timely availability of reliable and relevant information at appropriate level e.g. community, SC, PHC, Block and district, analysis and feedback system, steps to ensure implementation of revised HMIS system.

Yes,

5 Provision of logistics management of drugs and medical supplies in order to ensure continuous availability of essential supplies at S/C, PHC and CHC level.

Yes,

TECHNICAL STRATEGIES A. Reproductive & Child Health

Maternal Health 1

A. Interventions for 100% ANC coverage, B. 24x7 for EmOC services at selected institutions C. Skill birth attendance during labour (ANM) D. Provision for availability of safe blood in

FRUs/CEmOCs, E. Intervention for anesthesia training for MOs, F. Provision of Safe abortion services and, G. Management of RTI/STI Cases H. Provision for Janani Suraksha Yojana

Yes,

Child Health 2 A. Organizing MCHN days for complete immunization

coverage, B. Interventions for IMNCI services (Optional) C. Provision for new born care at institutions and, D. Promotion of breast feeding E. School Health Programme

Yes,

Family Planning 3 A. Interventions to provide regular FP services in every

block facilities, B. Increase number of service providers for vasectomy,

NSV, Tubectomy, and Laproligation , C. Intervention to improve quality of camps, D. Quality IUD insertion services, E. Increased availability of OP, Condoms through

community workers, ASHA, AWW, NGOs

Yes,

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Sl. No.


ARSH 4 A. Intervention for training of MOs, paramedic for ARSH

services ( optional) B. Provision of AFHS services at selected institutions

(optional)

Yes

5 Gender Mainstreaming Activities planned for awareness generation of gender,

PCPNDT Act and strengthening implementation of PCPNDT Act.

Yes,

Urban RCH 7 Interventions for provision of MH/CH/FP services in urban slums and urban areas.

NA

Tribal Health 8 Interventions to cover tribal population for FP/MH/CH. NA

B NRHM ADDITIONALITIES Whether provision made for-

1 ASHA Training in the district Yes 2 PRI Trainings (Block/Village health & Sanitation

Committees) Yes

3 Untied Funds at SC & Untied funds to RKS at PHC/CHC/District Hospitals

Yes

4 Civil Works as per IPHS (CHC/PHC/SC) Hospital Building- Staff Quarters

Yes

5 Strengthening Field Monitoring and Supervision (Enhance the provision of POL, Maintenance and of vehicle)

Yes

6 Need assessment done for-Procurements as per IPHS CHC/PHC/SC)

Yes

7 Appropriate provision made for-Programme Management Units at Divisional, District and Block levels-Adequate salary and OE provisions ( District PMU is a part of RCH II and Block level PMUs are part of NRHM)

Yes,

8 Adequate provision made for-Additional Manpower Specialists at CHCs ANMs at SCs Divisional/Block Programme Managers

Yes

9 Provision made for-Drug Kits at different institutions Yes 10 Plan for management of Mobile Medical Units at districts Yes 11 No of Ambulances available and required Yes District specific innovative activities to address local needs

have been incorporated Yes, addressed in all the technical chapters

12 Public private partnerships ( optional) Yes, 12 Provision of hiring of vehicle for BMOs (as per

requirements) Yes

C IMMUNIZATION PROGRAM Whether provision made for-

1 Social mobilization Yes 2 Alternative vaccine delivery Yes 3 Cold Chain Maintenance Yes

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4 PoL & Maintenance requirement for vehicles Yes, D National Disease Control Programme 1 Water Borne Diseases

Clear strategy prepared for combating Water Borne Diseases like Malaria, dengue etc

Yes

2 TB Whether Separate section on TB with operational details

and budget prepared Yes,

3 Leprosy Separate section on Leprosy with detailed operational

guidelines and budget

Yes,

4 Blindness 1 Separate section on Blindness Control with detailed targets

and budget Yes,

2 Monitoring mechanism for NGO E CONVERGENCE/ INTER-DEPARTMENTAL

COORDINATION Whether interventions in the following areas have been planned

Yes,

1 ISM Integration Activities Yes 2 Department of Social Welfare (ICDS) Yes 3 PHED Yes

district kathua - national health mission

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