1

GOVERNMENT OF JAMMU & KASHMIR

DISTRICT HEALTH ACTION PLAN

SRINAGAR

December 2007

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3

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CONTENTS

PREFACE ____________________________________________________________ 5

Executive Summary_____________________________________________________ 7

Priorities of the District Srinagar ___________________________________________ 9

Budget Summary ______________________________________________________ 14

1. SITUATION ANALYSIS _______________________________________________ 18

Socio Economic and Health Indicators of the District __________________________ 20

Socio-economic indicators_______________________________________________ 20

2. PLANNING PROCESS _______________________________________________ 32

3. PRIORITIES AS PER BACKGROUND AND PLANNING PROCESS ____________ 37

4. GOALS____________________________________________________________ 38

5. TECHNICAL COMPONENTS __________________________________________ 39 PART A: Reproductive and Child Health (RCH) II.................................................39

PART B: New NRHM initiatives ................................................................................53

PART C: Immunisation ...............................................................................................73

PART D: National Disease Control Programme ....................................................84

6: INTER- SECTORAL CONVERGENCE _________________________________ 97

7. COMMUNITY ACTION PLAN _________________________________________ 105

8.PUBLIC PRIVATE PARTNERSHIP _____________________________________ 106

9. GENDER AND EQUITY______________________________________________ 108

10. CAPACITY BUILDING______________________________________________ 109

11. HUMAN RESOURCE PLAN ______________________________________ 114

12. PROCUREMENT AND LOGISTICS ________________________________ 118

13. DEMAND GENERATION - IEC _______________________________________ 120

14. FINANCING OF HEALTH CARE______________________________________ 123

15. SCHOOL HEALTH_________________________________________________ 124

16. BIO- MEDICAL WASTE MANAGEMENT _______________________________ 125

5

PREFACE

The National Rural Health Mission [NRHM] has been envisioned as a planning process that is

participatory and decentralized starting with the Village as the basic unit for planning based on

community need assessment. It seeks to empower the community by placing the health of the

people in their own hands and determine the ways in which they would like to improve their health.

This is the only way to ensure that health plans that emerged were truly need based. The state

would play a facilitators role.

The NRHM was launched in April 2005. The Department of Health, Government of Jammu &

Kashmir, initiated its implementation in right earnest. A number of enabling actions were taken by

the J & K State Health Society. This created an environment conducive to decentralized planning by

the district.

The district is key administrative unit for most of the development activities. The District Action Plan,

therefore, is the most important document, the road map for implementation of NRHM activities,

which the Government of India and the state government would use to monitor the progress of

implementation district wise. To make District Plan more meaningful and capable of addressing

local health problems, Block/Zone Health Plans were prepared and integrated in to District Health

Action Plan.

The decentralized planning process involved village consultations [more of a demand generation

exercise but one which made the villagers aware of their health needs and how they could take

care of them at the individual, family, community and Panchayat levels as also what they needed to

ask for from their government], preparation of Village Health Plans by the Village Health Water and

Sanitation committees; followed by development of Block Action Plans through integration of Village

Health Plans, Health Facility Surveys and block specific needs. The Block/Zone Action Plans were

integrated to form District Action Plans.

We now have the capacity for preparing the need based plans following a participatory process. A

District Planning Team was set up for this purpose in the month of June 2007. It has the

representation of the various sectors concerned with NRHM. The District Planning Team was

responsible for entire planning process in the district leading to preparation of District Health Action

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

the implementation of the plans thus prepared. DPT not only owns the plans 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:

No Name Designation Department

1. Mr. Ajaz Iqbal DDC Revenue

2. Dr. Mehrajuddin CMO Health

3 Dr. Shafi Ahmad Wani Dy. CMO Health

4 Mr. Farooq Ahmad Yaswie CPO Headquarters

5 Dr. Dildar DHO Health

6 Dr. Gh. Hassan Malik ADMO Health

7 Mohd Aslam Nodal Officer ICDS

8 Mr. Musharif DPM Health

9 Ex. Eng PHE

10 Ex. Eng Rural Development

11 CEO Education

The orientation of DPT, facilitated by the Dr. Abu Altamash Faizi, Head Kashmir Division from

EPOS, New Delhi, was held on 23rd 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 Planning Group reiterate and certify that this

District Action Plan has been prepared through participatory processes. It has been developed by

integrating the Block Action Plans prepared by integrating health facility surveys and village health

plans in each block of the District. This plan also incorporates the needs and plans from 50 Sub

health centres, 26 PHCs, 01 CHC and a District Hospital in the District.

DR. MEHRAJ-U- DIN (CHIEF MEDICAL OFFICER)

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Executive Summary Srinagar district is situated in the centre of Kashmir Valley, is surrounded by four districts. In the north it is flanked by Ganderbal, in the South by Pulwama,in the north-west by Budgam. The capital city of Srinagar is located 1730 metres above sea level. Srinagar District is one of the 22 districts of the State of Jammu & Kashmir. District headquarters is situated at Srinagar. The District has population 10, 18509 (Projected Population) out of which 2,39,443 rural + Slum population, which lives in 196 villages and 3 water bodies . The district consists of four medical Zone and one Block namely, Khaniyar Zone, S.R.Gunj Zone, Batmaloo Zone, Zadibal zone and Hazratbal Block. The District health Action Plan has been prepared using decentralized planning process. Village and block plans converged to form the district plan. It is also based on the data collected during the block consultation “Facility Survey” in July 2007 covering 50 Sub Centres, 26 PHCs, 1 CHC and a District hospital. In the year 2006, IIPS Mumbai ranked 593 districts in the country. This ranking is on children parity, contraceptive prevalence rate (CPR), under five child mortality and ANC. The overall ranking of the district Srinagar is 246. It is 384 on the basis of percentage of women having three or more children; 394 on the basis of CPR; 317 for under five mortality rate and rank 190 for three or more ANC visits. In this ranking system, the lower is the rank, the better the district. The data regarding the various parameters in the district was quite scanty. However, activities have been proposed based on needs expressed by community members at various levels and facility survey giving clear picture of gaps in infrastructure, equipment and human resources and considering IPHS standards. In terms of major challenges, the summer capital district needs to increase institutional deliveries which are currently at 61%. The share of male participation in use of family planning methods is almost negligible. This issue was widely discussed and it was brought out that the family limitation strategies would not work here but there is a great need for spacing methods and information regarding them as opposed to the termination of fertility. Also the care of the newborn through the establishment of neonatal corners and baby friendly hospitals would make for a better environment for the care of the mother and the child in the CHCs and PHCs. On the supply side, 11 posts at SCs and 224 posts at PHC’s are vacant. To meet the above mentioned and many others crucial health indicators, the plan provides for filling gaps in the area of human resources by hiring key staff including medical doctors and specialists on contract and converging with AYUSH department. The basic infrastructure in the district has many gaps. Out of total 50 sub centres, 46 are running in rented building. There are total 26 PHCs and 15 are functioning in rented building. Facility survey Report (Anex-1& II) giving clear picture of gaps in infrastructure, equipment, drugs and human resources and considering IPHS standards. Construction of new buildings, expansion and repair of old ones has been proposed. For smooth logistics management and storage, development of logistics management information system and construction of a warehouse has been proposed. There is a deep-seated belief in the Unani form of traditional system of healing among the people of the area. They are dependent for a large part on the cures and preventive measures advocated by the age-old unani practitioners. If this system of medicine could be integrated through IEC, joint working and ownership there would be better understanding of health issues in the region.

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Reproductive and Child Health is one of the priority programmes comprising Maternal health, Child health, Adolescent health including RTI / STI management and Family Planning. In order to increase institutional deliveries, which is a major concern, focus has been fixed on upgrading the PHCs to functioning 24x7 PHCs and also enhancing the EmOC skills of the medical personnel. In order to increase institutional delivery attention has been given to functioning of 24x7 PHCs in phased manner and construction of rented SC & PHC building with all facilities. A sum of Rs. 4254.155276 lac has been planned for activities under the RCH II. Under NRHM special focus has been given to Village Health Water and Sanitation Committee, Rogi Kalyan committee, Upgradation of health facilities as per IPHS, selection and training of ASHA, functioning of quality assurance committee, infrastructure development etc. A total of Rs. 5642.03191 Lac has been planned for NRHM budget. "National Disease Control Programme include RNTCP, leprosy control programme, Malaria control programme, Blindness control programme, vector born disease, integrated disease surveillance and iodine deficiency disorder. The Revised National Tuberculosis Control Programme (RNTCP) aims to stop the spread of TB in the region as it is a rising concern among the rural population and have to be dealt with due to the large influx of tourists and pilgrims who may carry virulent strains into the immunological set up of the host population. To have in place an effective surveillance system, the Integrated Disease Surveillance Programme has been introduced. It includes case detection and recording, compiling the weekly reports, report transmission, analysis and interpretation, taking appropriate action, investigation and confirmation of suspected cases and outbreaks if any, providing feedback and dissemination of results, and evaluation leading to improvement in the system. This is a very vital wing and the budget planned for it is Rs 49.3 lac. A total of Rs 390.84 lac has been planned for the National Diseases Control Programme. A total budget for district Srinagar for the plan period 2008-2012 has been proposed for Rs. 11876.84487 lac. (118 crores, 76 Lac, 84 thousand, 4 hundred and 87 rupees)

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Priorities of the District Srinagar

No. Thematic

Area

Critical Issues of the

District

Specific Priorities

1. District &

Block Health

Programme

Management:

� Support to CMO office

� Manpower

� Infrastructure

� Training

� Monitoring, Reporting

and evaluation.

� Development of total clarity amongst

officials and Consultants about NRHM

activities

� Recruitment of staff on contractual basis

� Procurement of essential requirements

for office of DPMU and its functional

units at the block level

� Capacity building of the DHS members

for running the District Health Society.

� Training of district officials and

zone/Block SMOs

� Strengthening the CMO office

� Capacity building of the DPMU

� Development of HMIS

� Strengthening the registration of births

and deaths.

� Monitoring of health activities by health

personnel only.

2 Reducing

MMR and IMR

� Increasing Institutional

deliveries

� Studying the causes of

infant mortality and

feasibility of ameliorative

measures

� Ensuring availability of personnel especially specialists and Public Health Nurses for the 24 hour PHC, CHC and ANMs at the sub centres

� Strengthen FRUs for Emergency

Obstetric Care services along with

minimum basic infrastructure, drugs and

equipments.

� Operationalisation of 24X7 PHCs. � Increased coverage under JSY

� Service delivery for 24 hour in all PHCs � To increase IEC/BCC activities to

promote spacing and exclusive

breastfeeding

3 Family

Planning

� Offering services for

spacing to promote

health of mother and

newborn

� Increase awareness on benefits of

spacing to promote the health of the

mother and the children

� Increased awareness for Emergency

10

� Lack of awareness

Contraception and 10 yr Copper T

� Partner with private doctors for FP and

RCH services

� Increasing Access to Emergency

Contraception and spacing methods

through Social marketing

• Promoting participation of the

religious elements in spacing

acceptance to improve health of

the mother and child.

4 Adolescent

Health

♦ Adolescent boys are

exposed to smoking,

drug addictions, and

alcoholism.

� Mental health a major

problem

� Unsafe abortion &

unsafe sex trend on

the rise.

� Exploitative

relationships are also

on the rise and the

high risk behaviour is

apparent in the

district.

� Information, Education, Communication

and BCC to be enhanced

� ASRH o increase the knowledge levels

of Adolescents on RH and Life skills

� School health programme to incorporate

features of ARSH

� Medical facilities to be more responsive

to adolescent needs

� NGOs participation to be enhanced.

5 Mobile

Medical Units

(MMUs

� Required essentially to

increase outreach

activities

� Sufficient staff and

logistics.

� MMUs to be procured

� MMUs equipped with diagnostic services

to provide medical services.

� Contract MOs and staff nurses for

MMUs

6 Upgrading

CHCs to IPHS

� All the CHC are housed

in govt building however

the condition of CHC

needs to be upgraded as

per IPHS standard.

� CHCs Khaniyar to be upgraded

highlighted as per demand.

� Additional 02 CHC to be built as per

population

� Manpower be recruited

� Infrastructure be set up immediately

(Detail in Annexure-II)

7 Upgrading

PHCs for 24 hr

� PHCs need to be

upgraded to IPHS

� As per Facility Survey all repairs,

additions, alterations are taken up to

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Services and

IPHS

standards

� All PHCs to be working

24hors

have functional 24 hour PHCs.

� 15 PHC are functioning in rented

building, require new building. (Detail in

Annexure-II)

� Additional 01 PHC to be built as per

population

� Manpower

� Equipments and drugs

� Well-equipped and staffed Labour rooms

8 Upgrading

Sub Centres

to IPHS

standards

� As per Facility survey the

SCs to be repaired,

altered and construction

should be taken up

� Also staff quarters to be

built where required

� Additional SCs to be built

as per population.

� 46 SCs require new building. (Detail in

Annexure-II)

� 3 Subcentres need to repair buildings

� Additional 48 SC,s to be built as per

population

� Drugs and equipments as per IPHS

� Manpower

9 Immunisation � Efficient monitoring and

supervision

� Reporting and

documentation

� Close Monitoring and documentation of

the progress

� Zero Polio cases and quality surveillance

for Polio cases

� Enhancing the coverage of Immunization

� Effective Cold Chain Maintenance upto

sub centre level

10. NDCP � TB a major concern � IEC to be enhanced on screening for TB

� Popularization of the DOTS programme

through NGOs, radio and other avenues.

10.

Inter Sectoral

Convergence

Promote coordination

between ICDS and health

department

� Linkages to be developed between

ICDS workers and health workers for

timely diagnosis of malnourished

children and their management

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Promote coordination

between RDD and health

department

• 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.

• Awareness on sanitation and

Hygiene

• Covering of schools and AWCs

under TSC

Promote coordination

between Education

Department and the Health

Department

• Education and sanitary habits

among students

• IEC on health and health

determinants to be prepared and

distributed

Promote coordination

between PHE and health

department

• Provision of Bleaching powder and

chlorine tablets

• Joint communication strategy.

12.

Human

Resource

Lack of manpower to be

recruited at all levels on

contractual appointments

from DPMU to the Sub

centres

• Recruitment of staff on contract where

vacancies

• Recruitment of staff for new facilities as

per the infrastructure requirements

• Rational placement of Specialists and

trained staff

• Increased salaries for contractual

doctors and Specialists

• Special allowances for Regular staff

• Allowing Specialists and MOs for

developing special skills as per their

needs by attending special courses

anywhere in India.

• All staff to be in place as IPHS norms by

2010

14. PPP Private sector presence to be

tapped for joint ventures

• Large business lobby dealing in tourism to be tapped for CSR and provision of facilities for improving the health

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indicators of the district.

• Provision of specialised health care to the pilgrims coming for the sightseeing

• Building alliances with other

departments, PRIs, Private sector

providers and NGOs

HMIS Lack of authentic/reliable/

programme activity related

data.

� Review of all contemporary formats.

� Dev. Of uniform set of formats of

information so as to avoid duplicacy

of informations.

� Computerised system of data

compilation at all levels.

� Dev. Of software and online system

from Blocks / PHC onwards.

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Budget Summary

Component Year wise Budget in Lakh

2008-09 2009-10 2010-11 2011-12 Total A1- Strengthening of District Health Management Unit

8.66 7.126 7.8386 4.87226 28.49686

A2- District Program management unit

91.21 90.891 100.621 111.0868 393.8088

A3- Maternal Health 100.815 92.10848 100.2633 110.2897 403.476442

A-4. Newborn & Child Health

16.653 6.7 3.63 3.993 30.976

A-5. Family Planning 55.398 57.32 56.4344 62.07784 231.23024

A-6. Adolescent Health 28.36 15.196 26.1656 17.78216 87.50376

B-1. ASHA – Accredited Social Health Activist

65.062 65.3542 61.37362 67.51098 259.300802

B-2. Provision of Untied Funds at SCs

16.7 29.606 29.6266 29.64926 105.58186

B3- Provision of Untied Funds at CHCs

37.04 21.394 21.5084 21.63424 101.57664

B4- Provision of Untied Funds at PHCs

10.82 9.577 9.5847 9.59317 39.57487

B 5 Mobile Medical Units 63.31 37.21 38.035 38.9425 177.4975

B6 Upgrading CHCs to IPHS

316.676 164.7308 20.60388 22.66427 524.674948

B7 – Upgrading PHCs to 24 Hour Service

1011.105 1064.186 251.4162 261.4594 2588.16662

B 8–. Upgrading SCs 613.35 620.096 12.9206 14.21266 1260.57926

B9. VHWSC 19.16 23.716 26.0876 28.69636 97.65996

C 1. Cold Chain Maintenance

42.3 22.89 10.164 11.1804 86.5344

C 2. IEC and Social Mobilization

38.352 34.8408 38.26988 42.09687 153.559548

C 3. Alternate Vaccine Delivery Mechanism

17.628 24.882 27.3702 30.10722 99.98742

C 4-Supervisory Support & Vaccine Transportation

2.32 2.552 2.8072 3.08792 10.76712

C 5 Data Monitoring & Support

81.526 22.5772 23.83742 26.50116 154.441782

C 6 Supplies & Logistics 194.2775 197.5937 139.7723 139.7723 671.4158

D 1. RNTCP 42.8384 39.08024 43.00536 47.3029 172.226904

D 2. Leprosy 4.5 4.95 5.445 5.9895 20.8845

D 3. National Malaria Control Programme

18.5 8.8 9.68 10.648 47.628

D 4.Other Vector Borne Diseases

4.86 4.796 5.2756 5.80316 20.7348

D 5. Control Of 27.536 10.2896 11.31856 12.45042 61.594576

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Blindness

D 6. Integrated Disease Surveillance Programme

17.2 10.7 10.7 10.7 49.3

D 7. Iodine Deficiency Disorders

3.98 4.378 4.8158 5.29738 18.47118

8. Inter Sectoral Convergence

56.452 57.6972 59.06692 60.57361 233.789732

9- Community Health Action

1.55 1.995 2.1945 2.41395 8.15345

10- Public Private Partnership

62.65 33.5 15 15 126.15

11- Gender And Equity 17.42 18.062 19.8682 21.85502 77.20522

12- Capacity Building 49.05481 43.27529 45.17399 48.65119 186.155280

13. Human Resource Plan

443.0424 700.4835 700.4831 700.4792 2544.48836

14. Procurement & Logistics

140.83 15.38 13.609 13.979 183.798

15 Demand Generation - IEC

83.252 91.5772 100.7349 110.8084 386.372532

16. School Health 13.75 15.125 16.6375 18.30125 63.81375

17. Financing Health Care

33.1 34.76 38.211 41.995 148.066

18. Bio medical waste management

8.5 3.85 4.24 4.662 21.252

TOTAL

3859.73813 3709.246249 2113.790016 2194.120477 11876.8949

BUDGET 2008-12

3859.738133709.246249

2113.7900162194.120477

0

500

1000

1500

2000

2500

3000

3500

4000

4500

2008-09 2009-10 2010-11 2011-12

YEARS

Rs. IN

LA

CS

Series1

16

District SRINAGAR BUDGET - AT- A GLANCE (In Lakhs)

# Components 2008-09 2009-10 2010-11 2011-12 Total

A RCH-II

1 DHS 8.66 7.126 7.8386 4.87226 28.49686

2 DPMU 91.21 90.891 100.621 111.0868 393.8088

3 Maternal health 100.815 92.10848 100.2633258 110.2897 403.4764422

4 Child Health 16.653 6.7 3.63 3.993 30.976

5 Family Welfare 55.398 57.32 56.4344 62.07784 231.23024

6 Adolescent Health 28.36 15.196 26.1656 17.78216 87.50376

7 Gender & Equity 17.42 18.062 19.8682 21.85502 77.20522

8 Capacity Building 49.05481 43.27529 45.1739901 48.65119 186.1552802

9 Human Resource 443.0424 700.4835 700.48314 700.4792 2544.48836

10 IEC 83.252 91.5772 100.73492 110.8084 386.372532

11 HMIS & Monitoring 81.526 22.5772 23.83742 26.50116 154.441782

Total 975.3912 1145.317 1185.050596 1218.397 4524.155276

B NRHM

1 ASHA 65.062 65.3542 61.37362 67.51098 259.300802

2 SC Untied Fund & Maintenance

16.7 29.606 29.6266 29.64926 105.58186

3 PHC Untied Fund & Maintenance

37.04 21.394 21.5084 21.63424 101.57664

4 CHC Untied Fund & Maintenance

10.82 9.577 9.5847 9.59317 39.57487

5 MMU 63.31 37.21 38.035 38.9425 177.4975

6 Upgradation of CHC 316.676 164.7308 20.60388 22.66427 524.674948

7 Upgradation of PHC 1011.105 1064.186 251.4162 261.4594 2588.16662

8 Upgradation of SC 613.35 620.096 12.9206 14.21266 1260.57926

9 VHWSC 19.16 23.716 26.0876 28.69636 97.65996

10 Community Action Plan 1.55 1.995 2.1945 2.41395 8.15345

11 PPP 62.65 33.5 15 15 126.15

12 Health Care Financing 33.1 34.76 38.211 41.995 148.066

13 Procument & logistics 140.83 15.38 13.609 13.979 183.798

14 Biomedical Waste 8.5 3.85 4.24 4.662 21.252

Total 2399.853 2125.355 544.4111 572.4128 5642.03191

C Immunization

1 Cold Chain Maintenance 42.3 22.89 10.164 11.1804 86.5344

2 IEC & Social Mobilization

38.352 34.8408 38.26988 42.09687 153.559548

3 Alternate Vaccine Delivery

17.628 24.882 27.3702 30.10722 99.98742

4 Supervisory Support & Vaccine

2.32 2.552 2.8072 3.08792 10.76712

5 Supplies and Logistics 194.2775 197.5937 139.7723 139.7723 671.4158

Total 294.8775 282.7585 218.38358 226.2447 1022.264288

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D NDCP 1 RNTCP 42.8384 39.08024 43.00536 47.3029 172.226904

2 Leprosy 4.5 4.95 5.445 5.9895 20.8845

3 National Malaria Control Program

18.5 8.8 9.68 10.648 47.628

4 Other Vector Born Diseases

4.86 4.796 5.2756 5.80316 20.7348

5 Blind Control Programme

27.536 10.2896 11.31856 12.45042 61.594576

6 Integrated Disease Surveillance

17.2 10.7 10.7 10.7 49.3

7 Iodine Deficiency Disorders

3.98 4.378 4.8158 5.29738 18.47118

Total 119.4144 82.99384 90.24032 98.19136 390.83996

E Others

1 Inter Sectoral 56.452 57.6972 59.06692 60.57361 233.789732

2 School Health 13.75 15.125 16.6375 18.30125 63.81375

Total 70.202 72.8222 75.70442 78.87486 297.603482

Grand total 3859.738 3709.246 2113.790016 2194.12 11876.89487

BUDGET COMPONENT WISE 2008-12

RCH II

38%

NRHM

47%

Immunization

9%

NDCP

3%

Others

3%

RCH II

NRHM

Immunization

NDCP

Others

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1. SITUATION ANALYSIS Profile of the District

Srinagar district is situated in the centre of Kashmir Valley, is surrounded by four districts. In the north it is flanked by Ganderbal,in the South by Pulwama,in the north-west by Budgam. The capital city of Srinagar,is located 1730 metres above sea level. Srinagar District is one of the 22 districts of the State of Jammu & Kashmir. District headquarters is situated at Srinagar. The District has population 10, 18509 (Projected Population) out of which 2,39,443 rural + Slum population, which lives in 196 villages and 3 water bodies.

The district consists of four medical Zone and one Block namely, Khaniyar Zone, S.R.Gunj Zone, Batmaloo Zone, Zadibal zone and Hazratbal Block.

1. Identifying information

Name of District SRINAGAR

Name of District Headquarters SRINAGAR

No. of Blocks in the District 05 ( 04 Zones + 1 Block )

No. of inhabited Water bodies 3

No. of Villages (as per Medical record) 196

1-500 29

501-2000 147

2001-5000 10 Size of Villages

5000+ 10

Villages without motorable roads 0

Villages without electricity 0

No. of Towns 1

Municipal Corporation Municipality Notified Area Committee

Urban Local Bodies (ULB)

Others

One Muncipality for Srinagar

SPECIMEN DRAFT

RESTRICTED USE

F EPOS STAFF UNDERCONTRACT

19

Development Indicators of the District S. N Indicators

State District

1 Crude Birth Rate 18.9 27

2 Crude Death Rate 5.9 8

3 Infant Mortality Rate 50 45

5 TFR 2.4 2.7

6 Couple Protection Rate 54 63

7 Sex Ratio (General) 948 861

8 Sex Ratio (0 – 6 years) 937 946

9 Sex Ratio at birth NA NA

10 Literacy rate (overall) 54.46 59.8

11 Literacy rate (male) 68.80 69.6

12 Literacy rate (female) 44.72 48.0

13 Enrolment of students elementary education

NA 34864 (06-07)

Source: Census, 2001; SRS-2005DLHS-RCH-II Survey, 2004

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Socio Economic and Health Indicators of the District

Name of Medical Blocks

Batmaloo Zadibal S.R. Gunj Khanyar Hazrat

Bal Total

Demographic indicators

Total Population 264887 105710 198726 321748 127448 1018509 Population of males 137472 54969 101350 166343 65508 525642 Population of females

127405 50740 97376 155405 61940 492867

SLUM + RURAL POPULATION

98809 18100 10108 21413 91013 239443

Population of children less than a year old

6145 2452 4611 7464 2957 23629

Population of children in age group between 1 and 6 years

34434 13742 25834 41827 16569 132406

% Scheduled Castes

NA NA NA NA NA NA

% Scheduled Tribes

Nil Nil Nil Nil Nil Nil

Number of Inhabited Villages

- - - - - 196

Socio-economic indicators No. of <2 children benefiting from the ICDS scheme

NA NA NA NA NA NA

No. of children aged 2 years and above benefiting from the ICDS scheme

NA NA NA NA NA NA

No. of BPL households

NA NA NA NA NA NA

No. of girls enrolled in primary schools last year

NA NA NA NA NA NA

No. of girls dropping out of primary schools last year

NA NA NA NA NA NA

Number of overhead tanks or hand pumps

NA NA NA NA NA NA

Number of functional hand pumps in sub centres

NA NA NA NA NA NA

21

Name of Medical Blocks

Batmaloo Zadibal S.R. Gunj Khanyar Hazrat

Bal Total

Number of wells currently being used for drinking water purposes

NA NA NA NA NA NA

Number of households with access to toilets

NA NA NA NA NA NA

No. of private health facilities/clinicians

NA NA NA NA NA NA

No. of women who have benefited through the JSY Scheme till now1

-

-

-

-

-

677

No. of girls who got married last year

NA NA NA NA NA NA

No. of girls who got married last year and were <18 years at the time of marriage

NA NA NA NA NA NA

No. of Tubectomies conducted in the last reporting year

X

X

X

X

52

3738 INCLUDIN

G WBC/LD

No. of IUD insertions done in the last reporting year

81

141

88

110

137

1239 INCLUDIN

G WBC/LD

No. of vasectomies done in the last reporting year

X

X

X

01

02

29 INCLUDIN

G WBC/LD

No. of pregnant women

NA NA NA NA NA NA

No. of pregnant women registered for ANC during the last reporting year

1795

1005

1676

2589

34139

INCLUDING

WBC/LD No. of pregnant women who received both TT1 and TT2 during pregnancy in the last reporting year

908

545

1162

1278

1580

5473

22

Name of Medical Blocks

Batmaloo Zadibal S.R. Gunj Khanyar Hazrat

Bal Total

No. of institutional deliveries in the last reporting year

NA

3

NA

39

05

21993

No. of women operation of MTPs in the last reporting year

NA

3 NA

68 NA

433

No. of RTI/STI cases reported in the last reporting year

NA NA NA NA NA NA

No. of children given measles vaccine in the last reporting year

1523

1275

2422

1755

2661

16789

No. of outpatients (monthly average)

1500

4050

4800

5589

4800

24123

No. of inpatients (monthly average)

5

72

29

126

150

424

1.

2.

Prevalent Diseases

3. TUBERCULOSIS and LEPROSY

No. of patients currently undergoing DOTS therapy in the block (2006-07)

NA

NA

NA

NA

NA

837

Number of new leprosy cases reported in last reporting year

NA

NA

NA

NA

NA

2

NVBDCP

No. of slides examined for malaria in last reporting year

NA

NA

NA

NA

NA

NA

No. of notified malaria cases (last reporting year)

NA

NA

NA

NA

NA

NA

No. of new kala-azar cases in the block in the last reporting year

NA

NA

NA

NA

NA

NA

No. of microfilaria cases reported in the last reporting year

NA

NA

NA

NA

NA

NA

23

Name of Medical Blocks

Batmaloo Zadibal S.R. Gunj Khanyar Hazrat

Bal Total

No. of JE cases reported in the last reporting year

NA

NA

NA

NA

NA

NA

Blindness Control No. of cataract operations conducted in the block last year

NA

NA

NA

NA

NA

539

School Health Programme

No. of schools covered under in the last reporting year

NA

NA

NA

NA

NA

73

24

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

Name of Block

Batmaloo Zadibal S.R. Gunj

Khanyar Hazrat

Bal DH

Name of Health Blocks

Total for District

Health Institutions No. of Speciality Hospitals

- - - - - - -

No. Referral Hospitals - - - - - - - No. of CHC/BPHCs X X X 1 X 1 No. of Blood Banks X X X X X 1 1 No. of CHCs (IPHS Standards)

X

X

X

X

X

X No. of Blood Storage Units

X

X

X

X

X

X No. of PHCs in the Block

8 4 6 4 4 26

No. of MOs in Positions - - - - - - 48 No. of 24 hrs. PHCs - - - - - - - No. of MTP Centres - - - - - - - No. of Sub Health Centres

13

8

9

7

13

50 No. of ANMs in Position

26 16 18 14 15 89

No. of AYUSH Dispensaries

DNA DNA DNA DNA DNA DNA

No. of Private Hospitals - - - - - - - No. of Beds in Govt. Institutions

17 2

50

20

100

No. of Beds in Pvt. Institutions

- - - - - - -

No. of Anganwari Centres

625

-

89

48

Govt. - - - - - - - Pvt. - - - - - - -

No. of Ultrasound Clinics

Unregistered

- - - - - - -

Population covered - - - - - -

No. of Sub-centres covering more than the current norm (5000)

- - - - - -

Govt. - - - 1 1 02 No. of Obstetricians Pvt. - - - - - - -

Govt. - - - - - - - No. of Gynaecologists

Pvt. - - - - - - -

25

Name of Block

Batmaloo Zadibal S.R. Gunj

Khanyar Hazrat

Bal DH

Name of Health Blocks

Total for District

Health Institutions Govt. - - - 1 1 02 No. of

Paediatricians Pvt. - - - - - - - Govt. - - - 2 - 2 04 No. of

Surgeons Pvt. - - - - - - -

Govt. - - - 01 - 02 03 No. of Anaesthetists Pvt. - - - - - - -

Govt. - - - - - 1 1 No. of Orthopaedists Pvt. - - - - - - -

Govt. - - - - - - - No. of Dentists

Pvt. - - - - - - -

Govt. - - - 1 - 1 2 No. of Eye Surgeons Pvt. - - - - - - -

Govt. - - - 1 - - 1 No. of Gen. Physicians Pvt. - - - - - - -

Govt. - - - 2 - 1 3 - - -

No. of Radiographers

Pvt. - - - - - - - No. of Public Health Nurses

- - - - - -

No. of Staff Nurses - - - - - 16 28 No. of LHVs - - - - - - No. of Pharmacists - - - - - 5 38 No. of Lab. Technicians - - - 3 - - 03 No. X Ray Technicians - - - - - - - No of Ophthalmic Assts.

- - - - - - -

No. Dental Mechanics/Hygienists

- - - - - - -

No. of Male Health Supervisors

- - - - - - -

No. of ANMs 26 16 18 14 15 0 89 No. of Male Health Workers

- - - - - - -

No. of AW Workers - - - - - - - No. of UDCs - - - - - - - No. of LDCs - - - - - - - No. of Computer/Statistical Assts.

- - - - - - -

No. of Drivers - - - - - - - No. of ASHAs selected 44 11 12 0 101 0 168

No. of Trained Dais - - - - - - -

26

Workforce Vacancy Position * Given below is the information about Workforce Vacancy Position in the District as per IPHS.

Table: 2 Identified Gaps of Manpower

Name of Blocks

Kh

an

yar

Bata

malo

o

Hazra

tbal

S.R

.Gu

ng

Zad

ibal

No

. 0f

Req

. S

taff

No

. o

f E

xis

. S

taff

To

tal

Gap

s

No. of Sub- Centres (50) IPHS Norm

7 13 13 9 8

ANM 2 0 0 11 0 0 100 89 11 N0. Of PHC's (26) 4 8 4 6 4 MO 2 0 0 4 0 0 52 48 4 Pharmacist 1 0 -1 -2 -1 -3 26 33 -7 Nurse 3 11 23 14 16 9 78 5 73 Female Health Worker 1 -2 0 1 -5 2 26 30 -4 Health Educator 1 3 7 3 4 1 26 8 18 Health Assistant 2 8 14 8 10 6 52 6 46 Clerks 2 6 14 9 8 2 52 13 39 Lab. Technician 1 3 6 3 4 1 26 9 17 Driver _ 3 6 3 3 1 Class lV 4 7 13 11 10 5 104 66 38

Total 39 82 54 49 24 442 218 224 No. of CHC's A. CLINICAL MANPOWER

1

General Surgeon 1 -1 1 2 -1 Physician 1 0 1 1 0 Obstetrician / Gynaecologist 1 0 1 1 0 Paediatrics 1 0 1 1 0 Anaesthetist 1 0 1 1 0 Public Health Programme Manager

1 0

1 1 0

Eye Surgeon 1 0 1 1 0 Other specialists (if any) 1 Gen. duty officers (Medical Officer)

B. SUPPORT MANPOWER Nursing Staff 7+2 Public Health Nurse 1 1 1 0 1 ANM 1 0 1 1 0 Staff Nurse Nurse/Midwife

7 0

7 7 0

Dresser 1 0 1 1 0 Pharmacist / compounder 1 -6 1 7 -6 Lab. Technician 1 -2 1 3 -2 Radiographer 1 -1 1 2 -1 Ophthalmic Assistant 1 0 1 1 0 Ward boys / nursing orderly 2 2 2 0 2

27

Sweepers 3 0 3 3 0 Chowkidar 1 0 1 1 0 OPD Attendant 1 1 1 0 1 Statistical Assistant 1 1 1 0 1 OT Attendant 1 1 1 0 1 Registration Clerk 1 0 1 1 0

Total -3 31 35 -4 Note: ( - ) Surplus staff

Table:2A Man Power at District Hospital

Doctors Para-Medicals

Personnel

IPH

S

No

rm

EX

IS,

sta

f

Iden

t.

Gap

s

Personnel

IPH

S

No

rm

EX

IS,

sta

f

Iden

ti.

Gap

s

Hospital Superintendent 1 1 0

Staff Nurse* 75 to 100

15 60

Medical Specialist 3 1 2

Hospital worker (OP/ward +OT+ blood bank) 20

20 0

Surgery Specialists 2 2 0 Sanitary Worker 15 15 0

O&G specialist 4 1 3

Ophthalmic Assistant / Refractionist 1

1 0

Psychiatrist 1 0 1

Social Worker / Counsellor 1

0 1

Dermatologist / Venereologist 1

1 0 Cytotechnician 1

0 1

Paediatrician 2 1 1 ECG Technician 1 0 1 Anesthetist (Regular / trained) 2

2 0 ECHO Technician 1

0 1

ENT Surgeon 1 1 0 Audiometrician 0 0

Opthalmologist 1 1 0

Laboratory Technician ( Lab + Blood Bank) 12

6 6

Orthopedician 1 1 0

Laboratory Attendant (Hospital Worker) 4

0 4

Radiologist 1 0 1 Dietician 1 0 1 Microbiologist 1 0 1 PFT Technician - 0 0 Casualty Doctors / General Duty Doctors 6

0 6 Maternity assistant (ANM) 6

3 3

Dental Surgeon 1 2 -1 Radiographer 2 2 0 Forensic Expert 1 0 1 Dark Room Assistant 1 0 1 Public Health Manager1 1 0 1 Pharmacist1 5 5 0 AYUSH Physician2 2 0 2 Matron 1 0 1 Pathologists 2 0 2 Assistant Matron 2 0 2 Total 34 14 20 Physiotherapist 1 0 1 Statistical Assistant 1 0 1

2 Provided there is no AYUSH hospital / Medical Records Officer 1 0 1

28

dispensary in the district headquarter / Technician Electrician 1 1 0

Plumber 1 1 0 Total 154 69 85 Administrative Staff Operation Theatre

Personnel

IPH

S

No

rm

Exis

t sta

f

gap

Staff

IPH

S

No

rm

Exis

t sta

ff

gap

s

Manager (Administration) -

.

-

Emer. /

FW OT

Gen. OT

Junior Administrative Officer 1 0 1 Staff Nurse 8 1 0 9 Office Superintendent 1 1 0 OT Assistant 4 2 6 0 Assistant 2 2 0 Sweeper 3 1 1 3 Junior Assistant / Typist 2 2 0 Total 15 4 7 12 Accountant 2 2 0 Record Clerk 1 0 1

Office Assistant 1 0

1 Blood Bank / Blood Storage

Computer Operator 1 0

1 Staff

IPHS Norm

Curre

Avai.

Identified Gaps

Driver 2 2 0 B. B B.S Peon 2 0 2 Staff Nurse 3 1 1 3 Security Staff* 2 0 2 MNA / FNA 1 1 0 2 Total 17 9 8 Lab Technician 1 - 0 1 Safai Karamchari 1 1 0 2 Note: Drivers post will be in the ratio of 1 Driver per 1 vehicle. Driver will not be required if outsourced

Total 6 4 1 9

* The number would vary as per requirement and to be outsourced.

29

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

Category Sanctioned In position Vacant MOs [Gen] 86 85 1 Specialists 7 + 14 No. of Public Health Nurses

Staff Nurses 31 31 X Male Supervisor Female Supervisor/LHV 3+1 3+1 X ANMs 89 MHWs 30 Pharmacists 37+60 37+60 X Lab Techs No. X Ray Technicians / Radiographer

1+21

1+21

No of Ophthalmic Assts. 1+1 1+1 Nil No. Dental Mechanics/Hygienists

61+13

61+13

X

No. of Upper Division Clerks

6

6

X

No. of Lower Division Clerks

No. of Computer/ Statistical Assts.

No. of Drivers 18 18 x Any other category

30

Status of Health Centre Buildings in the District Sub-Centre (SC) Status:-

Sub Centres No. Overall Status

Sub-Centres in own building 4 Poor to good Sub-Centre in Panchayat Bldg / rented building

46

Good except three four

SC without Electricity connection

34

Poor

SC without Water Supply 24 Average SC without Toilets 39 Poor

Primary Health Centres

Status Names of PHCs

24 hour PHC

PHC Zadibal

Total beds 8

No. of OPD cases

4640

No. of indoor cases

93

Rogi Kalyan Samiti functioning

YES

Block Primary Health Centre (BPHC)/CHC (BPHC)/CHC Status Zadibal S.R. Gunj Batmaloo Khanyar Hazratbal

PHC

Zadibal

PHC

S.R.Gunj

Khanmoo

CHC

PHC

Hazratbal Total no. of beds 8 2 10 50 6 Total no of OPD cases 4640 5029 1693 7736 Total no. of indoor admissions

93

24

73

158

Bed occupancy rate NA NA NA NA NA Total no. of deliveries NA NA NA NA NA Up gradation of SKS NA NA NA NA NA Vehicle/Ambulance Yes No Yes Yes No Ambulance with NGO partner

NA NA NA NA NA

Rogi Kalyan Samiti functioning

Yes

Yes

Yes

Yes

Yes

31

Number of Institutions Requiring New Buildings

# Category of Institution Numbers

1 PHCs 15 2 SCs 46 3 CHCs Khaniyar (need based) Source: CMO office

Number of Buildings Requiring Additions/Expansion # Category of Institution Numbers

1 PHCs 11 2 SCs 2 3 CHCs 0 Number of Buildings Requiring Repairs # Category of Institution Minor repairs 1 PHCs 11 2 SCs 2 3 CHCs 1

Status of Staff Quarters attached to SCs in the District Sub Centres No. of SCs Size in sq. mts. Condition

(see codes above) SHCs having 2 staff Qtrs. in addition to clinic, examination and delivery room area

SHCs having 1 staff Qtr. in addition to clinic, examination and delivery room area

1

NAD,NR

SHCs having no staff Qtrs

49

32

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. SCs,

PHC and, CHC were surveyed using the templates 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 (DCG) provided technical oversight and strategic vision for the

process of development of District Action Plan.

The members of the DCG 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 DCG.

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 DCG 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.

33

No. <3 years No. completely immunised

% of fully immunized children

Maximum 100% Minimum 0%

1 IMMUNIZATION COVERAGE < 3 YEAR OF AGE

NA NA -- --

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

NA NA -- --

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

NA NA -- --

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

NA NA -- --

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

NA NA -- --

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

NA NA -- --

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

NA NA -- -- HEALTH RELATED SERVICES

WATER & SANITATION

HEALTH SERVICE INDICATORS FOR THE DISTRICT BASIC HEALTH SERVICES

Sl Indicator Criteria Goal

Posts & SCORE

34

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

Max imum : 50 % Minimum 0%

15 USE OF DOMESTIC/ COMMUNITY TOILET

NA NA -- -- FOOD SECURITY RELATED

Total no. of children eligible for anganwadi

Actual No. getting diet regularly

Percentage of Anganwadi beneficiaries

16 ANGANWADI

NA NA -- --

Total no. of primary and middle schools

Total no. of schools giving cooked midday meals

Percentage of schools giving midday meals

17 MIDDAY MEAL

NA NA -- -- Total no. of BPL families eligible for lower cost grains

No. of families getting grains from PDS shop

Percentage of beneficiaries

18 PDS FUNCTIONING

NA NA -- --

Total no. of BPL families eligible for free grains

No. of families getting free grains from PDS shop

Percentage of beneficiaries

19 ANTYODAYA YOJNA

NA NA -- --

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

NA NA -- --

HEALTH STATUS

Total no. of children below 3 with wt record.

no. of children with gr I or above malnutrition**

% of children malnourished

Max 200% Minimum 0%

21 CHILD MALNUTRITION

NA NA -- --

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

NA NA -- --

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% Mim 0% 23

AGE OF MARRIAGE

NA NA -- --

35

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

NA NA -- --

Total number of births last year

Any deaths of any child below one year

% of infant deaths

Maximum 20% Minimum 0%

25 INFANT DEATHS

NA NA -- -- Diarrhoeal outbreaks(More 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

NA NA -- --

36

Health Facilities as per Norms for District Srinagar:- Zone:- Batamloo Population :-98809 ( 113630 projected

population for 2012) Health Facility Recommended Required Existing New to be

constructed

SC’s 1/3000 38 13 25 PHC’s 1/20000 03 08 00 CHC’s 1/80000 01 00 01 Zone:-Zadibal Population :-18100 (20815 projected

population for 2012) SC’s 1/3000 07 08 00 PHC’s 1/20000 01 04 00 CHC’s 1/80000 00 00 00 Zone:- S.R. Gung Population :-10108 (11624 projected

population for 2012) SC’s 1/3000 04 09 00 PHC’s 1/20000 01 06 00 CHC’s 1/80000 00 00 00 Zone:- Khaniyar Population :-21413 ( 24625 projected

population for 2012) SC’s 1/3000 08 07 01 PHC’s 1/20000 01 04 00 CHC’s 1/80000 00 01 00 Zone:-Hazratbal Population :-91013 (104665 projected

population for 2012) Health Facility Recommended Required Existing New to be

constructed

SC’s 1/3000 35 13 22 PHC’s 1/20000 05 04 01 CHC’s 1/80000 01 00 01

37

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. Based on the background and the planning process the overall priorities of this District is included in the beginning of the plan.

38

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)

45/1000

42

38

35

30

27

Reduce Neo-natal Mortality Rate (NMR) NA

Reduction Maternal Mortality Ratio (MMR)

300/1000000

290

250

200

150

100

Reduction in Birth Rate % 27

26

23

20

17

15

Reduction in Total Fertility Rate 2.1

2.7%

2.6

2.5

2.3

2.1

1.9

Reduction in Death Rate 5.68 8%

8

7

6

5

4

Increase Ante-Natal Care as defined

94%

95

96

97

98

99

Increase Proportion of Women getting IFA tablets

394%

95

96

97

98

99

Increase Proportion of Women getting 2 TT Injections

96 % 94%

95

96

97

98

99

Increase Institutional Deliveries 88

61% %

62

65

70

75

80

Increase Delivery by Skilled Birth Attendants

Increase Contraceptive Prevalence Rate

Increase Complete Immunisation of Children (12-23 month of age)

56% 57 60 64 69 73

Increase Proportion of Children Exclusively Breastfed

Reduce Prevalence of STI/RTI

Source: CMO Office

39

5. TECHNICAL COMPONENTS

PART A: Reproductive and Child Health (RCH) II

A-1. Strengthening of Health Management

Situation

Analysis

The District Health Society Srinagar has been framed and functional since 2006.

The representatives are from different departments. Since then meetings are held

quarterly. The Distt. Health Management System comprises of sub health systems

taking care of different health programmes. Further NRHM DPMSU & BPMSU is

set up to deal with NRHM. The all health subsystems are headed by CMO at

district level. However DHM system is only taken by Health department.

Objectives

Benchmark

s

A functional Dist. Health Society with all its stakeholders functional and active in

society.

To facilitate smooth implementation of all national health programme by providing

technical support in planning & in its implementation with proper financial

management

Strategies &

Activities

� Integration of all vertical programmers.

� Active involvement of all member departments.

� Strengthening the District Health Society.

� Development of clarity on programme guidelines.

� Orientation W/S of DHS on.

� Regularity of meetings

� Delegation / Decentralisation to all deptts.

� Exposure visits to like projects areas.

Support

required

� Development of clarity on programme guidelines.

� On line communication systems with all deptts. To avoid delays due to

manual communication system

Timeline Activity / Item 2008-

09

2009-

10

2010-

11 2011-12

Developing systems x

Orientation Workshop of the

members x x x x

Issue based orientation x x x x

Ensuring provision of

Technical Assistance at the

district, block level.

x x x x

Exposure visits of DHS

members x x

40

Formation of a monitoring

Committee from all

departments.

x

Development of a Checklist for

the Monitoring Committee. x

One vehicles for DHMU

Budget Activity / Item 2008-

09

2009-

10

2010-

11 2011-12 Total

Orientation Workshop 0.5 0.55 0.605 0.666 2.321

Exposure visit 0 3.1 3.41 0 6.51

Issues based Workshops 0.5 0.55 0.605 0.666 2.321

Mobility for Monitoring 1.2 1.32 1.452 1.597 5.569

Vehicle @ 5.lac 5.0 0 0 0 5.0

POL for vehicles @ 50000/ vehicle / year

0.5 0.55 0.605 0.6655 2.3205

Salary for 01 drivers @ 4000/M 0.48 0.528 0.5808 0.63888 2.22768

Peon 1 @ 4000 / M 0.48 0.528 0.5808 0.63888 2.22768

Total 8.66 7.126 7.8386 4.87226 28.4969

Detailed Calculations

# Description Amount

Exposure Visit

1 Airfare and travel expenses (Taxi, Bus, etc ;) 200000/-

2 Lodging, Boarding, Food 100000/-

3 Misc. 10000/-

Total 3,10,000/-

41

A2 District Programme Management Unit

Situation

Analysis

The Distt. Programme Management support Unit has been set up with DPM, DAM, and DDA, in all Blocks / Zones. However, the strengthening of DPMU and BPMU is needed in terms of logistics. Infra support and manpower. Besides, there is need of more manpower to support Distt. Headquarters and Block HQ respectively.

Objectives

Benchmarks

To have functional, strengthened and empowered DPMU and BPMUs.

Strategies &

Activities

� Strengthening of CMO’s office.

� Recruitment of more personells (Computer / Communication Assistant

and Runner & Peon for NRHM cell) as the CMO office employees are

already overburdened.

� Untied funds for DPMSU at the disposal of DPM & DAM.

� Recruitment at Block level.

� Strengthening the office set up at DPMSU & BPMU level through

provision of facility / equipped office.

� Increase the Mgmt. cost at Distt. And Block.

� Recruitment of computer / communication Assistant for NRHM DPMU.

� Recruitment / Hiring of Peon & Runner for DPMU.

� Consultants for different components.

� BLOCK LEVEL; Block Prog. Mgr., Block Data Assistant, Peon.

Support

required

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

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

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

and District Data Manager.

4. Developing the capacities of the CMOs and other district officials to

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

5. 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.

Activity / item 2008-

09

2009-

10

2010-

11

2011-

12

Establishment of DPMU and

Consultants

x x x x

Timeline

Infrastructure, furniture,

computer systems, fax, UPS,

Printer, Digital Camera

x

42

Workshops for development of

the operational Manual at

district and Block levels

x x x x

Compendium of Govt orders x x x x

Joint Orientation of Officials

and DPM, DAM, DDM

x x x x

Management training

workshop of Officials

Establishment of BPMU x

Training of DPM and

Consultants

x x x x

Review meetings x x x x

Computer systems with printer

and Digital Camera & furniture

for DPMU, BPMUs, District,

block personnel

x

Monitoring of the progress x x x x

Budget Activity / Item 2008-09

2009-10

2010-11

2011-12

Total

Honorarium DPM,DAM,DDA and Consultants

29.40 32.34 35.57 39.13 136.44

Travel Costs for DPMU @ Rs 10,000/ per month x 12 mths

1.20 1.32 1.452 1.597 5.569

Infrastructure costs, furniture, computer systems, fax, UPS, Printer, Digital Camera,

5.0 0 0 0 5.0

Workshops for development of the operational Manual at district and Block levels

1.0 1.1 1.21 1.33 4.64

Untied Fund 5.0 6.0 7.0 8.0 26.00

Compendium of Govt orders 0.50 0.55 0.605 0.666 2.321

Joint Orientation of Officials and DPM, DAM, DDM

0.25 0.275 0.303 0.333 1.161

Management training workshop of Officials

0.50 0.55 0.605 0.666 2.321

Personnel for BPMU 37.8 41.58 45.738

50.3118

175.4298

Training of DPM and Consultants

0.5 0.75 1 1.25 3.5

Review meetings @ Rs 1000/ per month x 12 months

0.12 0.132 0.145 0.16 0.557

Office Expenses @ Rs 10,000/month x 12 months for DPMU

1.2 1.3 1.5 1.6 5.6

43

Computer systems (7) with printer and Digital Camera and furniture for DPMU, BPMUs and District and block personnel / zone

4.2 0 0 0 4.2

Annual Maintenance Contract for the equipment

0.54 0.594 0.653 0.719 2.506

Monitoring of the progress by independent agencies

1.00 1.1 1.21 1.331 4.641

Office expenses for Blocks @ Rs 5000 x 5 blocks / zone

3.00 3.3 3.63 3.993 13.923

Total 91.21 90.891 100.621

111.0868

393.8088

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

Sub Total 2940000

Personnel at Block level

Block Programme manager 5 15000 900000

Block Accounts Manager 5 12000 720000

Block Data Assistant 5 10000 600000

Part Time Accountant at PHC 26 5000 1560000

Sub Total 3780000

Office Automation with Furniture,

Computer system, Camera,

Printer, etc

5 for BPMU

1 for DPM

1 for DAM

60,000 420000

44

A-3. MATERNAL HEALTH

Situation

Analysis

Indicator No. Maternal Deaths NA ANC registration during the first trimester

No.

%

Full ANC coverage 42129 94 Institutional Deliveries 22112 61 Home deliveries 1071

No. of pregnancy related complications referred to FRU level

1368

s vacant ANM and AWW. Objectives

Benchmarks

1. Decrease in the Maternal Mortality ratio

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. 70% Institutional deliveries by 2010 and 80% by 2012

6. 95% 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

Strategies &

Activities

1) IEC/BCCI initiatives

2) Adolescent health programme

3) Achieving full & quality ANC services by

Engaging two FMPHWs for Sc’s functioning by internal adjustment. They

are 80 in number.

Engaging FMPHWs on contractual basis, where the posts are either

vacant

Are occupied by other categories

Engaging LHVs one for every 5-6 Sc’s

4) Village Health Days

5) Support Mechanisms for ASHAs

6) Capacity building initiative/trainings

7) Upgradation of CHC to IPHS levels

8) Up gradation of PHC to IPHS levels

9) Up gradation of Sc’s to IPHS levels

10) Grant of flexible fund to RKS at different level.

11) Grant of untied funds to Sc’s and VH &committee.

12) Procurement of logistics for health institution.

13) Establishing 1 medical mobile unit.

14) Construction of SC/PHC with residential accommodation.

45

A-3. MATERNAL HEALTH

15) Involvement of AYUSH & NGO.

Support

required

Authorising DRHS Srinagar to engage Manpower, procure logistics, and

implement DHAP & powers to take action against the deadwood.

Activity / Item 2008-

09

2009-

10

2010-11 2011-12

Delivery Huts x 1/blocksX5 X

Timeline

JSY 2%OF T X X X X

Ref. Transport X X X X

Mothers meeting No. of villages meeting /month

X X X X

Referral Cards X X X X

Mobile phone instrument /SC (1 ANM

Mobile Phones recurring cost

to ANMs SC(I ANM

X X X X

Budget

Activity / Item 2008-

09

2009-10 2010-

11

2011-12 Total

Delivery Huts @ Rs 3.6 lakhs / hut x

1/ blocks / zones X5 18 0 0 0 18

JSY2%OF Total Pop.X1400

(4789 X 1400) 67.046 73.7506

81.12566

89.23823 311.160486

Ref. Transport 10 % of 2.5 % pop X 300 (599 x 300)

1.797 1.9767 2.17437 2.391807 8.339877

Mothers meeting No. of villages @ 500 / meeting /month (196 x 500 x12)

11.76 12.936 14.2296 15.65256 54.57816

Referral Cards @ Rs 2 per card x 599

0.01198 0.013178 0.01449

6 0.015945 0.05559918

Mobile phone instrument @ Rs 2000/SC (1 ANM)(2000 X 50)

1 0 0 0 1

Mobile Phones recurring cost to

ANMs @ Rs 2400 x SC(I

ANM)(2400 X 50)

1.2 1.32 1.452 1.5972 5.5692

Mobile phone instrument @ Rs 2000/SC for new SCs 48 * 2000

0 0.96 0 0 0.96

Mobile Phones recurring cost to ANMs @ Rs 2400 x SC for new SCs

0 1.152 1.2672 1.39392 3.81312

100.815 92.10848 100.263 110.2897 403.476442

46

A-4. NEWBORN & CHILD HEALTH

Situation

Analysis

Sl. No.

Indicator No. Rate /%

1 Live Births 24315 2 Neonatal Deaths NA 3 Infant Deaths NA 4 Child Deaths NA 5 Still birth in the last year 401 6 Low birth weight newborns

(less than 2.5 kgs.) 6547 27%

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

12892 61%

8 Severely malnourished children ( Grade III & IV )

729 3%

9 ARI cases in the last year NA 10 Deaths in the last year due

to pneumonia in children NA

11 Diarrhoea cases in the last year

NA

12 Deaths in last year due to Diarrhoea in children

NA

Childhood illnesses

Diarrhoea: Undernutrition is associated with diarrhea, which further leads to

malnutrition. According to the DLHS 2002 73.2% of the women were aware of

ORS and 67% gave ORS to children. This shows that there is a need for more

knowledge and use of ORS in case of diarrhea episode.

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, 28.0% children suffered from Pneumonia.

Objectives

Benchmarks

• To reduce IMR to 30/100000 by 2012

• To reduce neonatal mortality rate.

• To reduce child death rate.

• To reduce percentage of low birth weight of new borns.

• To achieve 100% of vaccination of children 2012.

• To promote exclusive breastfeeding for 6 months to 100% infants

• To reduce the incidence of malnourished and severely malnourished

children

• To increase the ORS coverage to 100% cases of Diarrhea & proper

management of cases with dehydration.

• To diagnose timely and treat all cases of pneumonia

47

A-4. NEWBORN & CHILD HEALTH

Strategies &

Activities

1) Special drive for increasing institutional deliveries.

2) 100% immunization coverage with proper cold chain facilities availability as per

need

3) Prompt & appropriate community level care for all sick children & neo-nantal.

4) Adequate referral transport for sick children & neo nantal.

5) Reducing cost of care so as to favourable impact on poverty level.

6) Regular house visit & counselling by community level care gives for preventive

& promotive health of children & reduction of child malnutrition.

Support

required

For maintenance of cold chain, logistics of vaccine monitoring system, integration

with Ayush, NGOs.

Time Line

Activity / Item 2008-

09

2009-

10

2010-

11

2011-

12

Newborn Corner furnished with

equipment per CHC

X X

Foetoscope AWCs X

Infant Weighing Machines AWCs X

Malnutrition Corners CHC X X

Neonate incubators @ Rs. 1 lacx

block

X

Transportation facility @ Rs.

5000 Xblock X Month

X X X X

Budget Activity / Item 2008-

09

2009-

10

2010-

11

2011-

12

Total

Newborn Corner furnished with

equipment @ Rs 1.40 lakh per

CHC (1.40 X1) 02 new CHCs

1.4 2.8 0 0 4.2

Foetoscope @ Rs.50 x 818

AWCs 0.409 0 0 0 0.409

Infant Weighing Machines @ Rs.

800 x818 AWCs 6.544 0 0 0 6.544

Malnutrition Corners @ Rs

30,000 per CHC (30000 X 1) +

02 new CHCs

0.3 0.6 0 0 0.9

Neonate incubators @ Rs. 1 lac

x block / zone 5 0 0 0 5

Transportation facility @ Rs.

5000 X block / zone X Month 3 3.3 3.63 3.993 13.923

Total 16.653 6.7 3.63 3.993 30.976

48

A-5. FAMILY PLANNING

Situation

Analysis

Indicators No. or Rate Eligible Couple 175270 Female Sterilization operations during last year

1768

Vasectomies during the last year 27 Couples using temporary method 45,993 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. The reasons for the low use of permanent methods and Copper -T are due to inadequate motivation of the clients, inadequate manpower, and 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 27 men have undergone Vasectomy last year.

Objectives

Benchmarks

• To increase Couple Protection Rate from 29 to 75

• To increase the male participation.

• To reduce TFR from 2.7 to 2.1

• To promote use of contraceptives especially new generation

contraceptives

• To discourage/stop early marriage

Strategies &

Activities

1) Increasing the number of Govt./Pvt. Institutions providing limiting methods

of contraception.

2) Availability of spacing methods of gross rot level

3) Training of staff in IUD insertion at Sc’s

4) Training of doctors/paramedic in safe abortions.

5) Training of doctors/paramedic in Laproligations

6) Holding of laproligation camps in PHC/CHC

7) Massive IEC campaign for family planning especially among male for

popularising NSV

8) Involvement of ICDS workers, ASHA’s in programme by providing

incentive

Support

required

• Timely availability of equipments for lepro legation and NSV.

• Timely availability of contraceptive devices.

• Design BCC campaign on family planning methods

Timeline

Activity / Item 2008-

09

2009-

10

2010-11 2011-12 Total

49

A-5. FAMILY PLANNING

Training of MOs &

Specialists in NSV

persons/Blocks

X

NSV camps

2camps/block

X X X X

Sterilization Camps X X X X

Copper T- X X X X

Emergency Contraception

X X X X

Development of Static Centres

X

NSV Equipment X

Laproscopes for 4 CHC X

NSV Incentives 100

cases /block

X X X X

IEC and awareness

camps 6 camp per block

per year

X X X X

Budget

Activity / Item 2008-

09

2009-

10

2010-11 2011-12 Total

Training of Mos &

Specialists in NSV @ Rs

7500 x 2 persons / Blocks

/ zones

0.75 0 0 0 0.75

NSV camps @ Rs. 359750 x 2 camps / block / zones

35.97 39.567 43.5237 47.87607 166.93677

Sterilization Camps @ 436 X 600 cases

2.62 2.882 3.1702 3.48722 12.15942

Copper T-380 @ Rs 45 / piece x 5000 users

2.25 2.475 2.7225 2.99475 10.44225

Emergency Contraception @ Rs 10 per 2 tabs x 5000

0.5 0.55 0.605 0.6655 2.3205

Development of Static Centres @ Rs 1 lakh x 5

5.00 0 0 0 5.00

NSV Equipment @ Rs 800 x 01 CHC + 02 new CHCs

0.008 0.016 0 0 0.024

Laproscopes for 01 CHC @ Rs 3.00 lakhs x 01 + 02 new CHCs

3.0 6.0 0 0 9.00

50

A-5. FAMILY PLANNING

NSV Incentives

100 cases /block/ zones

@ 1000per case

5.0 5.50 6.05 6.655 23.205

IEC and awareness

camps @ Rs.1000 per

camp @ 6 camp per

block/ zone per year

0.30 0.33 0.363 0.3993 1.3923

Total 55.398 57.32 56.4344 62.07784 231.23024

Requirements for organizing one camp (600 cases)

S. No Head Unit Unit Cost Amount

1. District Workshop 1 4000 2. Block workshops 4 7500 30000 3. TA/DA for NSV surgeons 5 2000 10000 4. IEC activities 93250 5. TA to Acceptor for Semen Analysis 600 50 30000 6. Payment to NSV Advocate/motivator

and Drugs & Dressings 600 327.5 196500

Total 359750

Budget for sterilization per case S. No Head Unit Cost

1. Payment to acceptor 198

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 436.5

51

A-5. ADOLESCENT HEALTH

Situation

Analysis

Adolescence is the crucial stage of life. Where these are the aspects of

carelessness about health aspects and adolescent becomes prone to various

health problems. The Adolescent Health Problems include the Mental health

problems in addition to Reproduction health, HIV AIDS. The school health

programmes are going on however the extensive awareness on adolescent

health is to taken up with mental health into focus.

Objectives To have healthy and aware adolescents in the society with improved accessibility

to health services.

Strategies &

Activities

� Micro research on adolscent health.

� Awareness programmes on Adolscent health.

� Counselling services and confidential seprate adolscent health clinics.

� Creation of resource persons / Para counsellors at PHC level.

Support

required

To take up a research on the issue through a neutral research bean.

Findings based activities to be supported and implemented.

Activity / Item 2008-

09

2009-

10

2010-

11

2011-

12

Timeline

Research X 0.75

Mental health camps for

Adolescents once in a

year/PHC

X X X X

Joint Evaluation after one

year by independent

agency and Govt

X

Heath care checkups/

Camps (2 camps per block

in a year)

X X X X

Psychologist 1 visit per

week X X X X

Psychiatrist 1 visit per week X X X X

Councillor 1 visit per week X X X X

Travelling allowance for

Counselling team

No. of visits

X X X X

Health checkups camps

where awareness of

STDs/HIV is mandatory per

camp X 1 camp per block

per month

X X X X

Special IEC material to be

formed and distributed per

block X5X to be distributed

twice

X X

IEC Pogramme /film shows

etc X X

52

Activity / Item 2008-09 2009-

10

2010-11 2011-12 Total

Research 5.0 0 0 0 5.0

Budget

Mental health camps for

Adolescents once in a year/PHC @

5000 per camp

1.3 1.43 1.573 1.7303 6.0333

Joint Evaluation after one year by

independent agency and Govt 0 0.5 0 0 0.5

Heath care checkups/ Camps (2

camps per block/ zone in a year

@15000 / camp ( 2X5X15000)

1.5 1.65 1.815 1.9965 6.9615

Psychologist 1 visit per week

@1000/visit (1X52X1000) 0.52 0.572 0.6292 0.69212 2.41332

Psychiatrist1 visit per week @1000/

visit (1X52X1000) 0.52 0.572 0.6292 0.69212 2.41332

Councillor 1 visit per week @1000/

visit (1X52X1000) 0.52 0.572 0.6292 0.69212 2.41332

Travelling allowance for Counselling

team No. of visits @ Rs. 1000 per

visit for 10 visit per block for 5 block

/ zones every month (x12)

6.0 6.6 7.26 7.986 27.846

Health checkups camps where

awareness of STDs/HIV is

mandatory @ Rs. 5000 per camp X

1 camp per block per month @

5000X12X5

3.0 3.3 3.63 3.993 13.923

Special IEC material to be formed

and distributed @ Rs. 5000 per

block/ zones X 5 X to be distributed

twice

5.0 0 5.0 0 10.0

IEC Programme /film shows etc

50,000 X 5 X2 5.0 0 5.0 0 10.0

Total 28.36 15.196 26.1656 17.78216 87.50376

53

PART B: New NRHM initiatives

B-1. ASHA – Accredited Social Health Activist

Situation

Analysis

Total selected = 168 Trained = 102 Dropouts = 66

The Asha is the pivot of the programme but it is the most demotivated group. The

Asha is the incentive based volunteer however the incentive is more less for the

clash areas which are rural in nature but within limits of urban areas. This has

resulted in Asha turnover. Further the community mobilisation in urban, semi

urban difficult because of loose social fabric however they get les

compensation.

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

Objectives

Benchmarks

To empower ASHA through financial terms

Training and role clarity.

Availability of a Community Resource, service provider, guide, mobilize and escort

of community

Provision of a health volunteer in the community at 1000 population for healthcare

To address the unmet needs

Strategies &

Activities

� Capacity Dev. of ASHAs

� Clarity of Roles.

� Integration with AWW / ANM

� Reorientation of ASHA’s

� Crash training on timely basis.

� Formation of ASHA Resource groups who are educated & activity.

� Visibility material to ASHA ( Diary, Bags, Pens, Caps, Calendar) (Semi

urban / Slum)

Support

required

� To increase the incentive of ASHA at Par with rural ASHA.

• Timely Payments to ASHA

• Advance of Rs. 5000 always with ASHA for prompt payments to the

women

Activity / Item 2008-09 2009-10 2010-11 2011-12

ASHAs incentives JSY 2% of

pop.

X X X X

Time line

ASHAs to be Dot provider No.

of ASHAs

X X X X

Training of ASHAs No. of

ASHAs

Drug Kit support TA No. of X X X X

54

B-1. ASHA – Accredited Social Health Activist

ASHAs

Intersect oral convergence

awareness programme for

education, public health etc.

X X X X

Budget

Activity / Item 2008-

09

2009-10 2010-11 2011-12 Total

ASHAs incentives JSY 2% of pop.

@ 600 (4789 X 600) 28.734 31.6074 34.76814 38.24495 133.354494

ASHAs to be Dot provider No. of

ASHAs @ 500

Pop/1000X500 (239X500)

1.195 1.3145 1.44595 1.590545 5.545995

Training of ASHAs No. of ASHAs @

10000/ASHS

(239X10000)(60:40)

14.34 9.56 0 0 23.9

Drug Kit support TA No. of ASHAs

@ 8700 /kit per year 239 X 8700 20.793 22.8723 25.15953 27.67548 96.500313

65.062 65.3542 61.37362 67.51098 259.300802

55

B-2. Provision of Untied Funds at Sub Centres

Situation

Analysis/

Untied Funds have been proven effective in making the SCs functional and

gaining the confidence of people to visit the centres. However lot is to be done

and VHSC have to get empowered and to take active part in making SC

functional health unit. Besides all SCs are not under the ambit of untied funds.

The untied funds have to be made available to make SCs functional through the

year.

Objectives All the sub centres functional through out the year.

Strengthening of the Subcentre through financial support for immediate needs

and maintenance

Strategies &

Activities

� Provision of untied funds to all SCs and at the disposal of ANM

� Delegation of authority to ANM to spend amount on need basis.

� Annual maintenance to be increased to 20,000 taking care of harsh

winters in valley.

� Monthly / Quarterly / submission of reports.

� Coordination meetings of ANM AWW ASHA with NHSC.

Support

required

� Financial support on time.

� Support for Upgradation & clarity on IPHS standards.

o Logistic Support for regular monitoring of Sub Centers.

o Constant flow of funds from state/central Govt.(s)

� Develop indicators for measuring performance of VHSC

Activity / Item 2008-09 2009-10 2010-11 2011-12

Untied funds No. of SCs

a year X X X X

Account Books No. of

SCs X X X X

Repair works

No. of Govt. SCs in bad

condition X 10% of

building cost

X

Time lime

Untied Fund For new 48

SCs from 2010 a Year X X X

Budget Activity / Item 2008-09 2009-10 2010-11 2011-12 Total

(lac.)

Untied funds No. of SCs

@ 10000 once a year

(50 X 10000 )

5.00 5.00 5.00 5.000 20.000

Account Books No. of

SCs @ 200 (50X200) 0.1 0.11 0.121 0.1331 0.4641

56

B-2. Provision of Untied Funds at Sub Centres

Repair works No. of

Govt. SCs in bad

condition X 10% of

building cost

04 X 10% of 400000

1.6 0 0 0 1.6

Untied Fund For new 48

SC’s from 2010 0 4.8 4.8 4.8 14.4

Annual Maintenance grants @ 20000 / SC * 50

10.0 10.0 10.0 10.00 40.00

Annual Maintenance grants @ 20000 / SC * 48 SCs

0 9.6 9.6 9.6 28.8

Account Books No. of

SCs @ 200 (48 X 200) 0 0.096 0.1056 0.11616 0.31776

Total 16.7 29.606 29.6266 29.64926

105.58186

57

B-3. Provision of Untied Funds at PHC

Situation

Analysis/

Untied Funds have played a good role in equipping the PHCs with needs and

requirements. Presently there are 26 PHCs with 9 PHCs having functional Rogi

Kalyan Samitis. Rest 17 ADs equivalent to PHCs, the registration is in process.

The 9 PHCs have utilised the untied funds to improve the functioning of Institution.

Objectives

All PHCs with IPHS standards so that localised health care is made possible

Strategies &

Activities

� Timely provision of untied funds @ Rs 25000/ year.

� Timely provision of AMG @ Rs 50,000/ year.

� Simplified guidelines for spending the amount.

� Empowering and strengthening Rogi Kalyan Samitis.

� Registration of 17 AD = PHCs.

� Timely spending of untied funds.

Support

required

To advocate at higher level hassle free registration of Rogi Kalyan Samitis of

17AD = PHCs

Activity / Item 2008-

09

2009-

10

2010-

11 2011-12

Untied Funds

No. of PHC a year X X X X

Acc. Books No. of PHC’s X X X X

Training on use of Acc. Books No. of PHC

X X

Time line

Repair works No. of PHC(govt building) in bad condition @ 10%of Building cost

X

Budget Activity / Item 2008-09

2009-10

2010-11

2011-12 Total

Untied Funds No. of PHC @

25000 once a year * 26 6.50 6.50 6.50 6.50 26.00

Acc. Books No. of

PHC’s@2000 (26x2000) 0.52 0.572 0.6292 0.69212 2.41332

Training on use of Acc.

Books No. of PHC@2000

(23X2000)

0.52 0.572 0.6292 0.69212 2.41332

Repair works

No. of PHC(govt building) in

bad condition @ 10%of

Building cost (11x150000)

16.5 0 0 0 16.5

Untied Funds foe New PHC@25000 once a year * 01

0 0.25 0.25 0.25 0.75

58

B-3. Provision of Untied Funds at PHC

Annual Maintenance grants @ 50000 / PHC * 26

13.0 13.0 13.0 13.0 52.00

Annual Maintenance grants @ 50000 / PHC * for new 1 PHC

0 0.5 0.5 0.5 1.50

Total 37.04 21.394

21.5084

21.63424

101.57664

59

B-4. Provision of Untied Funds at CHCs

Situation

Analysis

Untied funds for the CHC is also a indispensable requirement to meet

the needs of CHC and to make it equipped & ensure smooth functioning. Distt.

Srinagar. Has one CHC Khanyar with Registered Rogi Kalyan Samitis.

Objectives

Benchmarks

To have the CHC upgraded and working as per IPHS norms.

Strategies &

Activities

� Timely provision of untied funds @ Rs 50,000/ year.

� Timely provision of AMG @ Rs 100000/ year.

� Provision of AMG @ 500000/ year for DH.

� Strengthening and functioning of Rogi Kalyan Samitis.

� Timely review meetings and reporting of expenditure.

Support

required

� Timely release of funds.

� Consultancy services if needed for IPHS Upgradation.

Activity / Item 2008-09

2009-

10 2010-11 2011-12

Untied funds No. of

CHCs once a year X X X X

Account Books No. of

CHCs X X X X

Training on use of these

acc. Books No. of CHC X X

Time line

Training on use of these

acc. Books No. of CHC X X X X

Untied funds for District

hospital a year X X X X

Preparation of

reference manual /

District

X

Repair work No. of CHC

@10% of building cost X

Budget Activity / Item 2008-09

2009-

10 2010-11 2011-12 Total

Untied funds No. of

CHCs @ 50000 once a

year

0.50 0.50 0.50 0.50 2.00

Account Books No. of

CHCs @ 5000 X1 0.05 0.055 0.0605 0.06655 0.23205

60

Training on use of these

acc. Books No. of CHC

@ 2000 (1x2000)

0.02 0.022 0.0242 0.02662 0.09282

Untied funds for District

hospital 5lac once a

year

5.00 5.00 5.00 5.00 20.00

Preparation of

reference manual @

25000 / District

0.25 0 0 0 0.25

Repair work No. of CHC

@10% of building cost

(1x400000)

4.0 0 0 0 4.0

Untied funds for new CHCs @ 50000 * 2 CHCs

0 1.0 1.0 1.0 3.00

Annual Maintenance grants @ Rs, 100000 / CHC *1

1.00 1.0 1.0 1.00 4.0

Annual Maintenance grants @ Rs, 100000 / CHC for new CHCs * 2

0.00 2.00 2.00 2.00 6.00

Total 10.82 9.577 9.5847 9.59317 39.57487

61

B- 5. Mobile Medical Units

Situation

Analysis

The District is only of its kind in terms of geography with 3 types of population ,

Urban, Semi Urban, Rural/Slum and Diverse population residing on land and in

midst of waters. The god chunk of area is water based on Dal, Nageen and

Jehlum. The MMU are the need of the district for both the population of i.e. land

based & water based.

Objectives

Provision of health care facility at all parts of District especially underserved &

vulnerable population of land and water based areas.

Strategies &

Activities

� Operationalising MMU for land based population.

� Operationalising MMU for water based population.

� DHS meeting focussed on MMU.

� IEC, Awareness generation about MMUs.

� Review & reporting of MMUs.

Support

required

Facilitation / expertise on Scientific / fully equipped MMU.

Activity / Item 2008-09 2009-10 2010-11

2011-

12

MMU X - - -

Manpower

MO X X X X

Pharmacist X X X X

Timeline

LHV X X X X

Counsellor X X X X

Driver X X X X

Lab technician X X X X

Mobile Medical Camps 25

camp /block / zone @

6000 /camp

X X X X

POL and Maintenance As

per norms X X X X

Activity / Item 2008-09 2009-10 2010-11

2011-

12 Total

MMU@26.85 lac 26.85 0 0 0 26.85

Manpower MO

(2@25000x12) 6.00 6.00 6.00 6.00 24.00

Pharmacist (1@6000x12) 0.72 0.72 0.72 0.72 2.88

Budget

Non recurring

LHV (1@8000/month) 0.96 0.96 0.96 0.96 3.84

Counsellor

(1@10000/month) 1.2 1.2 1.2 1.2 4.8

62

Driver (1@4000/month) 0.48 0.48 0.48 0.48 1.92

Lab technician

(1@5000/month) 0.6 0.6 0.6 0.6 2.4

Mobile Medical Camps

25camp/block

@6000/camp

(25x5x6000)

7.5 8.25 9.075 9.9825 34.8075

POL and Maintenance

As per norms 19.00 19.00 19.00 19.00 76.00

Total 63.31 37.21 38.035 38.9425 177.4975

63

B – 6. Upgrading CHCs to IPHS

Situation

Analysis

CHC Khanyar fully upgraded on IPHS norms.

Objectives The District has one CHC Khanyar which is in Govt. building however it needs

additions to have more space. Further the CHC has to be equipped with various

facilities equipment to take up it to IPHS norms in terms of building, facilities and

manpower.

Strategies &

Activities

� Constructions / Addition of Building.

� To ensure availability of facilities.

� To fill the manpower gap.

• Hiring of personnel required.

• Purchase of equipments needed.

Support

required

� To create / full posts by Govt. as per IPHS.

� Timely allotment of funds.

Activity / Item 2008-09 2009-10 2010-11 2011-12 Timeline

Renovation of District.

Hospital

X

Staff Quarter MO No.

of CHC

X X

Staff Quarter staff

nurses No. of CHC

X X

S.Q for3 chowkedar X

Furniture 5%CHC

building Cost-%

available

X X

Computer ,printer ,fax

No. of CHC

X X

Mechanical laundry /

CHC

X X

Travelling allowance

24 visits / mon. No. of

CHCs

X X X X

Telephone / mon. /

CHC

X X X X

Internet / mon./ CHC X X X X

Other expenses /

mon. / CHC

X X X X

Maintenance grant of

CHC(water, electricity)

/ mon. / CHC

X X X X

64

Staff for Mech.

Laundry 2 persons/

CHC / mon

X X X X

Incinerators and

peripherals including

housing units for

waste management @

Rs. 1 lac per PHCs

X X

Budget

Activity / Item 2008-09 2009-10 2010-11 2011-12 Total

Renovation of as

District. Hospital 50

lac

50.00 0 0 0 50.00

For CHC Khaniyar Rs.

40.00 lacs 40.00 0 0 0 40.00

Construction of 02

CHC Buildings @ 40.

lac / CHC ( Rs. 1000 /

sft 4000 sft.)

80.00 0 0 0 80.00

Staff Quarter for 4 MO

/ CHC No. of CHC @

48.00 lac (Rs. 1000 /

sft. 1200 sft.)

02 New CHCs

72.00 72.00 0 0 144.00

Staff Quarter for 4

staff nurses / CHC No.

of CHC @40.00 lac (

Rs. 1000 / sft.1000

sft.) 02 New CHCs

60.00 60.00 0 0 120.00

S.Q for 1 chowkedar /

CHC @ 4.00 lac ( Rs.

1000 / sft. 400 sft.) 02

New CHCs

6.00 6.00 0 0 12.00

Furniture 5% CHC

building Cost - %

available 5% of

40.0lac -50% 02 New

CHCs

1.00 4.00 0 0 5.00

Computer ,printer ,fax

No. of CHC 50000

(1x50000) 02 New

CHCs

0.5 1.00 0 0 1.50

65

Mechanical laundry @

50000 / CHC

(50000X1) 02 New

CHCs

0.5 1.00 0 0 1.50

Recurring Travelling allowance

@ 200 / day X 24

visits / mon.X No. of

CHCs (200X24X12X1)

02 New CHCs

0.576 1.9008 2.09088 2.299968 6.867648

Telephone @ 4000 /

mon. / CHC

(4000X12X1) 01 New

CHCs

0.48 1.584 1.7424 1.91664 5.72304

Internet @ 500/ mon./

CHC

(500X1X12) 02 New

CHCs

0.06 0.198 0.2178 0.23958 0.71538

Other expenses @

5000 / mon. / CHC

(5000X1X12) 02 New

CHCs

0.60 1.98 2.178 2.3958 7.1538

Maintenance grant of

CHC(water,

electricity)@ 25000 /

mon. / CHC

(25000X12X01) 02

New CHCs

3.00 9.9 10.89 11.979 35.769

Staff for Mech.

Laundry 2 persons/

CHC @4000 / mon.

(1X2X4000X12)

02 New CHCs

0.96 3.168 3.4848 3.83328 11.44608

Incinerators and

peripherals including

housing units for

waste management @

Rs. 1 lac per CHCs

02 New CHCs

1.0 2.0 0 0 3.00

Total 316.676 164.7308 20.60388 22.66427 524.674948

66

B – 7. Upgrading PHCs for 24 hr Services

Situation

Analysis

The district has 26 PHCs out of which 9 PHCs have functional Rogi Kalyan Samitis

and 17 Ads equivalent to PHCs are in the process of registration. All the PHC’s are

without the requisite manpower, facilities and infrastructure as far as IPHS norms are

considered.

Objectives

To upgrade and make functional all PHCs upto the level of IPHS (24x7).

Strategies

&

Activities

� Selection of required manpower as per IPHS norms.

� Constt. Repair, Additions as per IPHS norms.

� Purchase of equipments as per requirements of IPHS.

� Hiring, Selection.

� Maintenance of PHCs.

Support

required

Creation / filling of posts by Govt.

Timeline Activity / Item 2008-

09

2009-10 2010-11 2011-12

All PHCs to be upgraded to 24X7 as

per IPHS @ 25%of building cost X

Construction of PHCs (in rented

buildings) 15 PHCs X

Staff Quarters 26 PHCs X

Extra staff for (24x7) PHCs (1 MO+ 2

Staff nurses / PHC ) X X X X

Furniture 5% of building cost X no. of

PHC- % available X

Invertors for staff quarters /PHC X

Computer/PHC X

Vehicle X X X X

Washing machines 1/PHC X X X X

Telephone expenses/month/PHC X X X X

Internet expenses /month/PHC X X X X

Electricity charges X X X X

POL 80cases/year/PHC@300/Case X X X X

Driver 1/PHC @4000/month X X X X

Laundry staff 1/PHC /month X X X X

Maintenance & other

expenses/moth/PHC X X X X

67

Budget

Activity / Item 2008-09 2009-10 2010-11 2011-12 Total

All PHCs to be upgraded to 24X7 as per

IPHS PHC @ 25%of, 9 PHCs building

cost 15 PHCs in 2008 & 12 in 2009-10 (

3.75 lac / PHC)

56.25 45.00 0 0 101.25

Construction of PHCs (in rented

buildings) 15 PHCs @ 15lac/ PHC (Rs.

1000 / sft 1500 sft. / PHC) 01 new PHC

112.50 127.50 0 0 240.00

Staff Quarters for 1 mo & 3 S. Nurses /

PHC @ 48.00 lac / PHC for 26 PHCs (Rs.

1000 / sft. 4800 sft / PHC) + 1 new

PHCs

648.00 648.00 0 0 1296.00

Furniture 5% of building cost X no. of

PHC- % available 5% of 15 lacX 26)-

45%+ 01 new PHCs

10.725 0.75 0 0 11.475

Invertors for staff quarters @ 15000 /

PHC+ 01 new PHCs 3.95 0.15 0 0 4.1

Computer @ 40000 / PHC+ 01 new

PHCs 10.4 0.4 0 0 10.8

Washing Machine 1/ PHC @ 10000 * 26

+ 01 new PHCs 2.6 0.1 0 0 2.7

Extra staff for (24x7) PHCs

(1 MO+ 2 Staff nurses / PHC )

(Salary of 1 MO+2 staff nurses)

(21000 / M + 12800 / S. N / M )

83.88 150.984 150.984 150.984 536.832

Transportation /Mobility of MOs

15 PHCs @ 2500X15X12 7.8 8.58 9.438 10.3818 36.1998

Out sourcing of laundry under PPP @

Rs.5000per month per PHCs + 01new

PHCs

15.6 17.82 19.602 21.5622 74.5842

Internet expenses@500/month/PHC

500X12X26 + 01 new PHCs 1.56 1.782 1.9602 2.15622 7.45842

Electricity charges 5000X12X26 + 01 new

PHCs 15.6 16.2 17.82 19.602 69.222

POL

80cases/year/PHC@300/Case

80X26X300 + 01 new PHCs

6.24 6.48 7.128 7.8408 27.6888

Driver

1/PHC @4000/month

10 X 4000X12

4.8 4.8 5.28 5.808 20.688

Maintenance & other expenses

10000/moth/PHC + 01 new PHCs 31.2 35.64 39.204 43.1244 149.1684

Total 1011.105 1064.186 251.4162 261.4594 2588.1666

68

B – 8. Upgrading Sub Centres

Situation

Analysis

The district has 50sub centres out of which 46 are existing in rented buildings..

There are no labour rooms for delivery. No separate toilet facilities are available for

male/female patients. No residential quarter for ANM is existing at any of the sub

centres. There are no boundaries or fencing around the sub centre building which

results in stray animals moving around the building. Helpers are not there in any of

the sub centres

Objectives • To upgrade all the SC’s as per IPHS so that comprehensive medical care is

provided to rural population especially the maternal and child health.

• To identify the areas where further sub centres can be constructed in

addition to existing ones.

Strategies

& Activities

• Construction of Govt. building for all the sub centres which are at present in

rented buildings.

• Construction of labour rooms and separate toilet facilities for Male/female in

all the SCs.

• Providing electric and safe drinking water connections at all the Sub

Centres.

• Provision of residential quarter facilities at all the sub centres.

• Fencing of all the Sub Centres.

• Posting of two ANMs at all the Sub Centres.

• Provision of Helpers to all the sub centres.

• Skill upgradation of all the ANMs by giving them training regarding i) Safe

delivery ii) Early identification of complicated cases/high risk groups at first

AN Checkups so they are planned send to FRU for checkups and delivery.

Iii) to be trained in providing awareness and counselling during the out

reach sessions in villages along with ASHA/AWW regarding importance of

institutional deliveries, to avoid mal nutrition, anaemia and to promote

proper sanitation and hygiene.

• Training regarding maintenance of records like births/deaths, filling of JSY

cards, contraceptive users, eligible couples and adolescents girls

• They must be trained in providing family planning activities and insertion of

IUD.

• At each sub centre the amount of untied funds be raised from 10000 to

20000 so that ANM can provide gas heather and gas stove for purpose of

heating the room and for sterilization of instruments.

o All the equipments/ furniture as per IPHS required for a sub centre be

provided to all the sub centres. At present except writing table, they don’t

have any other equipment/furniture.

Support

required

Logistics & maintenance support for govt.

69

Time line Activity / Item 2008-

09

2009-10 2010-11 2011-12

Construction of Sc’s in

rented building 46 Sc’s X X

Staff quarter 49 Sc’s X X

Furniture 5% of Building

cost X no. of SCs - %

available

X X

Travelling allowance X X X X

Electricity charges & other

Expenses X X X X

Voluntary worker X X X X

New Sc’s to be

constructed as per

population norms of IPHS

3000/SC

Staff quarters X

Furniture X

Voluntary worker X X X

Travelling & other

expenses X X X

Budget Activity / Item 2008-

09

2009-10 2010-11 2011-12 Total

Construction of Sc’s in

rented building

46 Sc’s @ 5.00lac/

Sc’s(Rs. 5.00 lac

includes provision of

Water supply, electricity,

sanitary toilets) (Rs.

1000 / sft , 400 sft. / SC )

115.00 115.00 0 0 230.00

Staff quarter for 2 ANMs /

SC @ 7.50 Lacs * 49 Sc’s

(Rs. 1000 / sft. 750 sft./

S.Q.)

183.75 183.75 0 0 367.50

Furniture 5% of Building

cost X no. of SCs - %

available 5% of 4.0lac

X50- 25%

7.50 0 0 0 7.500

Travelling allowance @

100 / visit X10 visits /SC

100X10X50

0.5 0.55 0.605 0.6655 2.3205

70

Electricity charges & other

Expenses @1000/month/

SC

6 6.6 7.26 7.986 27.846

Voluntary worker @ 1200

/ SC (1200X50) 0.6 0.66 0.726 0.7986 2.7846

New Sc’s to be constructed as per population norms of IPHS 3000/SC 48 Sc’s @ 5.0 Lac / Sc

(Rs. 5.00 lac includes

provision of Water

supply, electricity,

sanitary toilets) (Rs.

1000 / sft , 400 sft. / SC )

120.00 120.00 0 0 240.00

Staff quarter for 2 ANMs /

SC @ 7.50 Lacs * 48

Sc’s(Rs. 1000 / sft. 750

sft./ S.Q.)

180.00 180.00 0 0 360.00

Furniture @ 20000/SC* 48 0 9.6 0 0 9.6

Voluntary worker @1200 /

SC * 48 0 0.576 0.6336 0.69696 1.90656

Travelling & other

expenses @ 7000/SC * 48 0 3.36 3.696 4.0656 11.1216

Total 613.35 620.096 12.9206 14.21266 1260.57926

71

B-9 Untied Funds and Incentive Fund for the Village Health and Water Sanitation Committees

Situation

Analysis/

Current

Status

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 Pulwama these

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 Srinagar there are 147 villages with population less than 1500. Hence these

amount to 147units of 1500 population.

Objectives 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 147 units of population 1500 or less to

get the funds annually of Rs 10,000.00.This untied fund is to be used for

household surveys, health camps, sanitation drives, revolving fund etc;

2. Orientation of the MPHWF for the utilization of the untied funds and she in

turn will orient the Village, Health & Water Sanitation committee.

3. Provision of Rs 5000 as permanent advance fund for Incentives for ASHA

based on performance norms.

4. Monthly meetings of the VHWSC for reviewing the funds and activities. This

is to be facilitated by the MPHWF

5. 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 Activity / Item 2008

- 09

2009-

10

2010-

11

2011-

12

Untied Fund of Rs 10000/unit for

Pop 1500/unit x 147 units

x x x x

Orientation and reorientation of

the VHWSC

x x x x

Provision of Rs 5000 as x x x x

72

permanent advance for incentives

to ASHA

Monthly meetings of the VHWSC x x x x

Review of the VHWSC

functioning at PHC level

x x x x

Budget Activity / Item 2008

- 09

2009-

10

2010-

11

2011-

12 Total

Untied Fund of Rs 10000/unit 1500 Population/unit x 147 units 14.7 16.17 17.787

19.5657

68.2227

Permanent Advance to VHWSC for ASHA incentive @ Rs 5000 / SC 2.5 5.39 5.929 6.5219

20.3409

Monthly meetings of the VHWSC @ 1000 1.96 2.156 2.3716

2.60876

9.09636

Total 19.16 23.716 26.0876

28.69636

97.65996

73

PART C: Immunisation

C-1. Cold Chain Maintenance

Situation

Analysis

No-availability of cold chain store at the district level with poor maintenance at

workshop. Frequent Power breakdown in the valley

Non availability of Cold Chain Maintenance Engineer at District Headquarters

Objectives

To maintain effective and efficient cold chain system for transportation, storage and

delivery to the point of utilization. The potent vaccine will be provided to the

beneficiaries in order to achieve 100% effective coverage.

To achieve 100% immunization for all vaccine preventable diseases

To eradicate the vaccine preventable diseases. Strategies &

Activities

Provision of ILRs, Deep freezers, stabilizers, gensets, cold boxes as per the

deficiencies shown in situation analysis to strengthen the maintenance of cold

chain as per IPHS.

Construction of Separate Cold Chain rooms with air conditioning facilities.

Provision of sufficient number of vaccine carriers for institutional / out reach

vaccination sessions.

Engagement of Contractual staff (Helpers) for carriage of vaccines from distribution

to the utilization centres in far flung areas.

Support

required

For financing the construction work, establishing workshop & monitoring the cold

chain by DIO

Activity / Item 2008-

09

2009-

10

2010-

11 2011-12

District Hospital: DG set X

ILR @ 20000 X

Deep freezer X

Timeline

CHC; DG set /CHC X X

One I LR X X

Stabilizer X X

Deep freezer X X

PHC: G.Set /PHC X X

I LR PHC’s X X

Stabilizer 26 PHC’s X X

SC’s: I ILR at one SC/Block X

Ice pack boxes 1/SC/ district X

Construction of cold chain

maintenance room with air

condition at CHC /CHC

X X

Staff for C.C.M: CCM engineer

at CHC

/month /CHC

X X X X

Annual maintenance X X X X

74

Budget Activity / Item 2008-

09

2009-

10

2010-

11 2011-12 Total

District Hospital:

DG set @ 1Lac 1 0 0 0 1.00

ILR @ 20000 0.2 0 0 0 0.20

Deep freezer @ 15000 0.15 0 0 0 0.150

CHC;

DG set @ 1 Lac /CHC

1 lacX 1 + (02 new CHCs)

1.00 2.0 0 0 3.00

One I LR @ 20000 x1+ (02 new

CHCs) 0.2 0.40 0 0 0.60

Stabilizer @ 10000x3+ (02 new

CHCs) 0.3 0.20 0 0 0.50

Deep freezer@15000x1+ (02

new CHCs) 0.15 0.30 0 0 0.45

PHC:

G. Set @ 45000 / PHC (45000

x 26) + (1 new PHCs )

11.7 0.45 0 0 12.15

I LR@ 20000x 26 PHC’s + (01

new PHCs) 5.2 0.20 0 0 5.40

Stabilizer @10000 x 26 PHC’s

+ ( 01 new PHCs) 2.6 0.10 0 0 2.70

SC’s:

I ILR at one SC /Block

@ 20000 x 5 blocks/ zones

1.00 0 0 0 1.00

Ice pack boxes

1/SC@ 9lac / district 9.00 0 0 0 9.00

Construction of cold chain

maintenance room with air

condition at CHC

@ 5lac /CHC (5lac x13) & 1

new CHC

5.00 10.00 0 0 15.00

Staff for C.C.M: CCM engineer

at CHC @ 15000 / month /

CHC 15000 x12 x1 & 1 new

CHC

1.8 5.94 6.534 7.1874 21.4614

Annual maintenance ;

5000 x12 x 5 3 3.3 3.63 3.993 13.923

Total 42.3 22.89 10.164 11.1804 86.5344

75

C-2. IEC & Social Mobilisation

Situation

Analysis

• By proper information and communication we can improve the quality of

health status of the community. It has been observed that people either

have no access to basic health related information or have misconception,

so it is the need of the hour to provide right information to the people so

that they can adopt healthy life style and will have more productive life. It

has been observed that some misconception, myths and social stigmas are

associated regarding the health and disease of people. We have to

encourage all those local traditions which are healthy and have to

discourage those traditions which are harmful to people.

We have to develop IEC so that the proper message regarding the health

is conveyed to community so that they will utilize the services of health

sector to its optimum on their quality of Health Improved and they will be

more productive to the community

• Through the health education/IEC activities are being carried out by the

existing staff.

• Lack of education among common people regarding water borne diseases,

HIV, Hepatitis.

• Non realization of the importance of General Hygiene and proper

sanitation.

• Lack of awareness among people regarding benefits of various schemes

launched by Govt. through different departments.

• Many People still don’t realize the significance of vaccination, nutritional

supplements and antenatal checkups.

Objectives

Benchmarks

• To provide information to community so that they will adopt healthy

behaviour and attitude which will improve their Health and they will be more

productive to the society

• Help the community to reduce the communicable/ non communicable

diseases.

• Covering every habitation under IEC.

• Increasing the number of participants and sessions by organizing such

camps on holidays or advance publicity of such camps.

• Organising extensive Health Education camps in AW Centres, Schools and

Colleges.

� Every School/College to be covered under IEC.

Strategies &

Activities

Establishment of separate IEC cell at District Level under the supervision of

District Programme manager with required staff and infrastructure including

vehicle.

Audio visual Aids, print material about the local health problems in local

languages.

Required furniture like plastic chairs, tables, shamiana, DG sets with provision for

76

POL and operator.

The IEC cell will be holding school health education programmes, sanitation

awareness among masses, preventive measures regarding various

communicable/ non communicable diseases, national health programmes with

concerned medical officer and field staff by organizing camps, workshops, folk

media, drama, film shows, rallies, sanitation drives, photo health exhibitions.

Orientation training to MOs, Paramedics and field staff regarding IEC

Support

required

Activity / Item 2008-

09

2009-

10

2010-

11

2011-

12

Time line

IEC programme for 15-49

women (Maternal, child health&

family welfare One programme/

village/month

X X X X

Adolescent health One prog.

/SC/month X X X X

Drama & film shows

@10000/block X X X X

Local T.V Ads. /district X

LCD player /dist X

VCD player /PHC X X X X

News paper messages 12

messages per year X X X X

Establishment of IEC unit At

district level IEC prog. Manager

@20000/month

20000X12

X X X X

Artists Two X X X X

Educators Four /month X X X X

ICE activity RNTCP & VBD /

block X X X X

Establishment of block IEC units

equipped with a/v and other

peripherals @ 1 lac per block

X

Budget Activity / Item 2008-

09

2009-

10

2010-

11

2011-

12 Total

IEC programme for 15-49

women (Maternal, child health&

family welfare One programme/

village/month @100

1X196X12X100

2.352 2.5872 2.8459

2 3.1305

12 10.91563

2

77

Adolescent health

One prog. / SC /month @100

1X50X12X100

0.6 1.2936 1.4229

6 1.5652

56 4.881816

Drama & film shows @ 10000 /

block / zone 10000 X 5 0.50 0.55 0.605 0.6655 2.3205

Local T.V Ads. @60000/district 0.60 0.66 0.726 0.7986 2.7846

Non

recurring

LCD player @ 1 lac/dist 1.00 0 0 0 1.00

Non

recurring

VCD player @ 5000/PHC

5000X26 1.30 0.05 0 0 1.35

Recurring News paper messages 12

messages per year @ 10000

12X10000

1.20 1.32 1.452 1.5972 5.5692

Establishment of IEC unit At

district level IEC prog. Manager

@ 20000/month 20000X12

2.40 2.64 2.904 3.1944 11.1384

Artists Two @15000/mnoth

2X15000X12 3.60 3.96 4.356 4.7916 16.7076

Educators Four @ 10000/month

4X10000X12 4.80 5.28 5.808 6.3888 22.2768

IEC activity RNTCP & VBD @

3lac / block/ zones 5 X 3lac 15.00 16.5 18.15 19.965 69.615

Establishment of block IEC units

equipped with a/v and other

peripherals @ 1 lac per block

5.00 0 0 0 5.00

Total 38.352 34.841 38.269 42.097 153.5595

78

C-3. Alternate Vaccine Delivery Mechanism

Situation

Analysis

Alternate Vaccination Delivery Mechanism not devised till date. Out reach

immunization sessions are being carried out by ANMs in villages where there are

no health facilities. Anganwari Workers already assisting in Vaccine delivery and

immunization.

Objectives

Benchmarks

To shift the vaccines from provisional stores to district stores, to block stores

through vaccine carriers to maintain cold chain during transportation

Strategies &

Activities

Engagement of drivers on contractual basis for vaccine carriers vehicle. Provision of MOU. POL for vaccine carrier. Payment for delivering vaccine from blocks headquarters’ to sub-centres & for out

reach sessions @ Rs. 50/ sessions

Support

required

Training of staff on maintenance & delivery of vaccines

Timeline Activity / Item 2008-09 2009-10 2010-11 2011-12

POl for vehicles

/session/SC

X X X X

Incentives to ASHA’s

/session/ASHA

X X X X

Budget Activity / Item 2008-09 2009-10 2010-11 2011-12 Total

POl for vehicles @

200 / session / SC

200X52X50

5.2 11.2112 12.33232 13.56555 42.309072

Incentives to ASHA’s

@ 100 / session /

ASHA

100X52X239

12.428 13.6708 15.03788 16.54167 57.678348

Total 17.628 24.882 27.3702 30.10722 99.98742

79

C-4. Supervisory Support and Vaccine Transportation

Situation

Analysis

Objectives

Benchmarks

To provide potent vaccine from provincial stores to district stores to block stores &

subsequently to the places of its utilization in sub-centres & at out reach sessions

in villages.

Strategies &

Activities

Distribution of vaccine to block headquarters’ through cold chain vehicle.

Distribution of vaccine to cold chain centres in blocks through cold chain boxes.

Distribution of vaccines to peripheries through departmental vehicle/hired vehicle.

Cost of POL for district/block vehicle to be used for vaccine transportation/

supervisory support

Hiring of vehicle in case of non-availability of departmental vehicle.

Support

required

Approval of the component along with financial support.

Timeline

Activity / Item 2008-

09

2009-

10

2010-

11 2011-12

Testing of vaccine

strengthening at site after

transportation ( provision for

POL to MO in charge

immunization or someone

specially trained /district

X X X X

Training of Health worker &

ANM /H. W & ANM X X X X

Budget Activity / Item 2008-

09

2009-

10

2010-

11 2011-12 Total

Testing of vaccine

strengthening at site after

transportation ( provision for

POL to MO in charge

immunization or someone

specially trained @ 60000/

district

0.6 0.66 0.726 0.7986 2.7846

Training of Health worker,

ANM & ASHAs @ 500 X

(105+ 239)

1.72 1.892 2.0812 2.28932 7.98252

Total 2.32 2.552 2.8072 3.08792 10.76712

80

C-5. HMIS Data Monitoring and Support

Situation

Analysis

Presently the HMIS is manual & Time consuming with ANM filling the data at SC

level on a formal and submitting it and stage wise reaches to Distt. Headquarters.

This upward flown (slow) tells upon the process of Analysis and rectification and

puts impediments on effective monitoring. Further it is difficult to get data on time.

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

Objectives

Benchmarks

To establish a uniform and set system of HMIS throughout from top to bottom.

Integration of several parallel running programme software

HMIS is used for decision making on regular basis

Inclusion of RCH indicators monitoring

Linkage to decision making at Central level

Refresher training

Make it more useful for State level officials

Strategies &

Activities

� Review of all contemporary formats.

� Dev. Of uniform set of formats of information so as to avoid duplicacy of

informations.

� Computerised system of data compilation at all levels.

� Dev. Of software and online system from Blocks / PHC onwards.

Support

required

� Hiring the expertise for developed of uniform set of forms for reporting and

monitoring.

� Computer Training to all concerned people involved in Data.

Timeline Activities 2008-

09

2009-

10

2010-

11

2011-

12

Survey for practices, coverage,

behaviour etc through

independent agency

x

Software development x

Data Entry of each household x x

Internet connectivity x x

Provision of computers for each

CHC and PHC x

AMC for computers x x x x

GIS for the district, training and

updation x x x x

81

Printing monitoring Charts x x x x

Budget Activities

2008-09

2009-10

2010-11

2011-12

Total

Survey for practices, coverage, behaviour etc through independent agency

15.00 0 0 0 15.00

Software development 20.00 0 0 0 20.00

Data Entry of each household’s health card @ Rs 2 per card x 50000 cards (aprox.)

1.00 0.40 0.80 1.20 3.4

Internet connectivity @ Rs 900 /mth x No of facilities x12 mths

2.916 3.4452 3.7897

2 4.1686

92 14.319

612 Provision of computers for each

CHC and PHC @ Rs 60,000/computer system with UPS and printer

16.20 1.20 0 0 17.4

AMC for computers @ Rs 5000 /computer /year x 27 computers

1.35 1.595 1.7545 1.9299

5 6.6294

5 Consumables for computers @

Rs 4000/mth/facility x 12 mths 12.96 15.312

16.8432

18.52752

63.64272

GIS for the district, training and updation

12.00 0.5 0.5 0.5 13.5

Printing monitoring Charts @ Rs. 5 per monitoring chart

0.10 0.125 0.15 0.175 0.55

Total 81.526

22.5772

23.83742

26.50116

154.44178

82

C-6. Supplies and Logistics

Situation

Analysis

The supplies to any health institution are based on last year performance &

population target. Further requirement are authenticated by concerned officers.

The purchases are made on approved rates.

Objectives

Benchmarks

� Developments of scientific & computerised system of management of

stores.

� Procurement of supplies. Proper storage of supplies.

� Proper distribution of supplies as per the needs.

� To keep the buffer stock for emergency purposes

� Availability of sufficient amount of vaccines for covering maximum

children.

� Increase in Immunization sessions to cover maximum population.

� Coverage of 100% habitations for immunization along with hilly and tribal

pockets Potent Vaccines.

� Provision of Iron and Vitamin Supplements to needy children and

Pregnant Women

Strategies &

Activities

� Development of scientific / computerised system of stores management.

� Training of concerned personnel.

� Systematic line of requisitions & suppliers.

Support

required

Provision of expertise on scientific management of stores.

Activity / Item 2008-09 2009-10 2010-11 2011-12

Equipments at district

hospital X

Timeline

Equipment at CHCs X X

Equipments at PHC’s X X

Equipments at Sc’s X X

Maintenance for

equipments / block X X X X

Drugs at district

hospital X X X X

Drugs at CHC X X X X

Drugs at PHC X X X X

Drugs at SC X X X X

Budget Activity / Item 2008-09 2009-10 2010-11 2011-12 Total

Equipments at district

hospital @22.19lac 22.19 0 0 0 22.19

83

Equipment at CHC * 01

+ 02 new CHCs @

22.19 lacs / CHC

22.19 44.38 0 0 66.57

Equipments at PHC’s *

26 + 01 new PHCs

@111500 / PHC

28.99 1.115 0 0 30.105

Equipments at Sc’s *

50 + 48 new SCs @

25680 / SC

12.84 12.3264 0 0 25.1664

Recurring Maintenance for

equipments @ 20000 /

block / zones

1.0 1.0 1.0 1.00 4.00

Drugs at district

hospital @ 10.00 lac 10.00 10.00 10.00 10.00 40.000

Drugs at CHC @10.0

lac 03 CHCs & 02 new

CHCs

10.00 30.00 30.00 30.00 100.00

Drugs at PHC @ 3.00

lac / PHC * 26 + 01

new PHCs

78.00 81.00 81.00 81.000 321.00

Drugs at SC @ 18135*

50 + 48 new SCs 9.0675 17.7723 17.7723 17.7723 62.3844

Total 194.2775 197.5937 139.7723 139.7723 671.4158

84

PART D: National Disease Control Programme D-1. RNTCP

Situation

Analysis

Indicators No. / Rate

New Sputum Positive cases (ACDR)

531

Annual total cases 1131 Total new pulmonary TB cases 531 Proportion of new sputum positive out of total new pulmonary cases

NA

Cure rate 88.6% Smear Conversion Rate 91.98% Treatment success rate 88.60% Defaulter cases 1.50% Failure cases 2.60%

Presently RNTCP is working at a different vertical programme. Under DTO in the

district.

Objectives To improve detection rate and cure rate.

Strategies

&

Activities

� All subcentres/PHCs/CHC/DH work at DOTS centres.

� Training of community DOTS providers.

� Capacity development & orientation of MOs in RNTCP.

� Creation of resource persons at all levels.

Support

required

� Computerised system of reporting and monitoring.

� Recruitment of required manpower.

Activity Plan 2008-09 2009-10 2010-11 2011-12

Improving the DTC

building, MC Centres and

TC centres

x

Increasing the DOT

providers through ASHAs x x x x

Timeline

Training to RNTCP staff

and ASHA x x x x

Awareness drives x x x x

Mask Provision

Budget Activity / Item 2008-09 2009-10 2010-11 2011-12 Total

Civil Works DTC building 1.5

lakhs 1.5 0 0 0 1.5

MC 0.28/MC

4.76 0 0 0 4.76

TU 0.35/Tu except DTC

1.05 0 0 0 1.05

Material and supplies 1.32 1.45 1.6 1.76 6.13 Laboratory material 1.1 1.21 1.33 1.46 5.1

85

Training 16.2984 17.92824 19.72106

21.69317

75.640874

Awareness drive on World TB day

1.0 1.1 1.21 1.33 4.64

IEC activities 1.0 1.1 1.21 1.33 4.64 Vehicle hiring for

STS/STLS in winter @ 1 lakh

1.0 1.1 1.21 1.33 4.64

Salaries of contractual staff

10.83 11.913 13.1043 14.4147

3 50.26203

Vehicle maintenance inc POL

1.0 1.1 1.21 1.33 4.64

4 wheeler Hiring of vehicle 1.7 1.87 2.06 2.27 7.9 DTO MO TC @ Rs 0.42lakh/yr Equipment and

maintenance 0.085 0.094 0.103 0.113 0.395

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 0.929

Total 42.8384 39.08024 43.00536 47.3029 172.2269

Detailed Calculations

Training in RNTCP

Personnel Unit Cost Units 2007-08 DTO State

MOTC 23320 5 116600 MO 15580 52 810160 STS 6726 2 13452 STLS 16720 2 33440 LT 5972 29 173188 ANM 2875 168 483000 1629840

86

Personnel RNTCP

Personnel Unit Cost Units Months Amount

TB health visitor 6750 5 12 405000

STS 7000 2 12 168000

STLS 7000 2 12 168000

LT 6500 2 12 156000

Data Entry Operator 6000 1 12 72000

Accountant 5000 1 12 60000

Driver 4500 1 12 54000

Total 1083000

87

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 Nil

MB 02

PB Nil

MB Nil

RFT Nil

O.D Nil

PB Nil

MB 02

PR 0.014%

NCDR X

Proportion of

Deformity Ratio

among cases

Nil Objectives To eradicate leprosy in district.

Strategies

&

Activities

� I.E.C Activities.

� Detection of cases.

� House to house visits.

� Treatment provision to all cases.

Time line Activity / Item 2008-09 2009-10 2010-11

2011-

12

House to house detection x x x x

Wide publicity x x x x

Rigorous follow-up x x x x

Treatment x x x x

Budget

Activity / Item 2008-09 2009-10 2010-11

2011-

12

Total

(lakh)

Treatment @ 50000/ block/

zone 2.5 2.75 3.025 3.3275 11.6025

IEC for information on the

disease to be spread all over

the rural outposts through

posters and instructional

booklets.

2.00 2.2 2.42 2.662 9.282

Total 4.5 4.95 5.445 5.9895 20.8845

88

D-3. NATIONAL MALARIA CONTROL PROGRAMME

Situation

Analysis

Issues No. %

Total Blood Slides Examined (BSE) NA NA NA NA Total Positive Cases:

Plasmodium Vivax (Pv): Plasmodium Falciparum (Pf): NA NA Slide Positivity Rate (SPR) NA NA Slide Positive plasmodium falciparum Rate (PFR)

NA NA

Annual Blood Examination Rate (ABER) NA NA Deaths NA NA Source: CMO office

Objectives To educate community about anti malaria operation.

Strategies

&

Activities

1) IEC activities public awareness & involvement.

2) Anti malarial activities must be increased.

3) Active supervision, active & passive surveillance

4) Fogging & survey supervision during summer.

5) Fogging of entire village during summer.

Support

required

Fogging machines for each block.

Jeep for biologist with POL

Activity / Item 2008-09

2009-

10

2010

-11

2011-

12

Fogging machine for each block &

D.H / district X

Two spray machines for each

block X

Staff 2 persons/block / month X X X X

Time line

Phenyl /block X X X X

IEC for awareness generation and

detection camps @ Rs. 10,000

per camp every qtr. Every block

5000 X 5X 4 QTR

X X X X

Budget Activity / Item 2008-09

2009-

10

2010

-11

2011-

12 TOTAL

Fogging machine for each block &

D.H @ 10.00lac/ district 10.00 0 0 0 10.00

89

Two spray machines for each

block @ 5000/ block / zones

5000X2X5

0.50 0 0 0 0.50

Staff 2 persons/block @ 5000/

month X5X5000X12 6.00 6.60 7.26 7.986 27.846

Phenyl @ 20000/block/ zone 1.00 1.10 1.21 1.331 4.641

IEC for awareness generation and

detection camps @ Rs. 10,000

per camp every qtr. Every block /

zone 5000 X 5X 4 QTR

1.00 1.10 1.21 1.331 4.641

Total 18.50 8.80 9.68 10.648 47.628

90

D-4. OTHER VECTOR BORNE DISEASES

Situation

Analysis

Other VBDs No. Kalazaar NA Dengue NA Lymphatic Filariasis NA Japanese Encephalitis NA

Objectives

To eradicate any possibilities of these disease

Strategies &

Activities

� Educating people on the need for clean surroundings.

� Emphasizing the harmful effects of accumulation of water in ditches, ponds

and drains.

� Water accumulation in waste boxes, tyres etc.

� Readiness of Blood Examination kits in emergency situation.

� Spreading knowledge about

• Kalazaar

• Dengue

• Lymphatic Filariasis

• Japanese Encephalitis

Support

required

Print and Electronic Media.

Support from Village Health Committees.

State and District Administration.

Activity / Item 2008-

09

2009-

10

2010-

11 2011-12

Preventive measures

Prog. Officer /month X X X X

Data entry operator /month X X X X

Computer etc / district X

Time line

IEC for awareness

generation and detection

camps @ Rs. 10,000 per

camp every qtr. Every block

5000 X 5X 4 QTR

x x x X

Budget

Activity / Item 2008-

09

2009-

10

2010-

11 2011-12 Total

Preventive measures

Prog. Officer @

20000/month

2.40 2.64 2.904 3.1944 11.1384

Data entry operator @

8000/month 0.96 1.056 1.1616 1.27776 4.45536

Computer etc @ 50000/

district 0.50 0 0 0 0.5

91

IEC for awareness

generation and detection

camps @ Rs. 10,000 per

camp every qtr. Every block /

zone 5000 X 5X 4 QTR

1.00 1.1 1.21 1.331 4.641

Total 4.86 4.796 5.2756 5.80316 20.7348

92

D-5. BLINDNESS CONTROL PROGRAMME

Situation

Analysis

Indicators No. 06-07 Total Cataract surgery performed 539 Cataract surgery with IOL NA School going children screened 151 Children detected with refractive error NA Children provided with free corrective spectacles

X

Villages having no register NA

Total Cases seen= 29336 (2006-07) Refractions done=13931 School children screened=151

Cataract operations= 372

Objectives � To reduce prevalence rate of blindness and child blindness and use of

IOL in cataract operations.

� To develop human resource for eye care service or PHC, CHCs, sub-

district hospitals.

� To improve quality of service delivery.

� To ensure participation of civil society & private sector

Strategies &

Activities

� Expansion of service coverage.

� Development of institutions to provide services related to programme.

� House to house survey about prog.

� IEC activities.

� Provision of facilities / equipments.

� Provision of trainings.

� Employing one Full time Eye Specialists for all the CHCs.

� Employ one Ophthalmic Assistant for every PHC.

� Purchasing the latest equipments needed for ophthalmic examinations

and surgeries to all CHCs.

� Construction of Operation Theaters and provide all the required

equipment/instruments

Support

required

Activity / Item 2008-09 2009-10 2010-11 2011-12

H-H Survey for

Vision defects

x

IEC activities x x x x

School Eye

Screening

Time Line

Blind Register x x x x

93

Cataract Camps 07 PHC 07 PHC 07 PHC 06 PHC

Development of

PHC and CHC as

Vision Centre

1 CHC 14 PHC

13 HC

Development of

CHC for Eye Unit

01

Training of School

teachers

200 200 200 200

Training of

Numbardar /

Chowkidar

200 200 200 200

Repair and purchase

of equipment and

maintenance

x x x x

Budget Activity / Item 2008-09 2009-10 2010-11 2011-12 Total

IEC @2lakh 2.0 2.2 2.42 2.662 9.282

School Eye Screening @1000 X200 school

2.0 2.2 2.42 2.662 9.282

Blind Register 0.196 0.2156 0.23716 0.260876 0.909636

Cataract Camps @ Rs 40000 per camp x 07 PHC

2.8 3.08 3.388 3.7268 12.9948

POL fro Eye Camps @ Rs 2000/camp x07

0.14 0.154 0.1694 0.18634 0.64974

Training of School teachers @ Rs 100/head x 200

0.20 0.22 0.242 0.2662 0.9282

Training of Numberdar / Chawkidar @ Rs 100 /head x 200

0.20 0.22 0.242 0.2662 0.9282

Repair and purchase of equipment and maintenance

20.00 2.00 2.20 2.42 26.62

Total 27.536 10.2896 11.31856 12.45042 61.594576

94

D-6. Integrated Disease Surveillance Programme

Situation

Analysis/

The activities of IDSP are existing separately leading to duplication of the

activities and the lateral communication is loose which is telling upon the

efficacy. Further the manpower position and the facilities are not at par. However

under given resources USP is working in a good way.

Objectives To have integrated & clear system of IDSP.

Strategies &

Activities

� Improvement in manpower, facilities.

� Coordination & integration of activities.

� Inter component communication enhancement.

Support

required

� Provision of software.

� Equipped & functional DSU set up.

Activity / Item 2008-

09

2009-

10

2010-

11

2011-

12

Furniture / district X

Computer etc / district X

Vehicle X

Timeline

* Staff :

Epidemiologist one / month X X X X

Micro biologist / month X X X X

Data operator / month X X X X

Lab. Technician / month X X X X

Register & formats etc /

block X X X X

Training of staff /district X X X X

POL for vehicle /month X X X X

Driver / month X X X X

Budget Activity / Item 2008-

09

2009-

10

2010-

11

2011-

12 Total

Furniture / district 1.0 0 0 0 1.00

Computer etc / district 0.5 0 0 0 0.5

Vehicle 5.0 0 0 0 5.00

* Staff :

Epidemiologist one / month @ 23000

2.76 2.76 2.76 2.76 11.04

Micro biologist / month @23000

2.76 2.76 2.76 2.76 11.04

95

Data operator / month @ 8000

0.96 0.96 0.96 0.96 3.84

Norms Lab. Technician / month 2.38 2.38 2.38 2.38 9.52

Register & formats etc /

block 0.5 0.5 0.5 0.5 2.00

Training of staff /district 0.5 0.5 0.5 0.5 2.00

POL for vehicle /month 0.36 0.36 0.36 0.36 1.44

Driver / month 0.48 0.48 0.48 0.48 1.92

Total 17.2 10.7 10.7 10.7 49.3

96

D-7. Iodine Deficiency Disorders

Situation

Analysis

Iodine is one of the essential nutrients and majority of population in urban areas

consume iodised salt. However in slum and depraved

Uneducated sections of society, people still use the traditional crystal salt.

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 To prevent IODINE Deficiency disorders by 100%.

Prevention of Iodine Deficiency diseases

Consumption of Iodized salt by 100% families

Strategies &

Activities

� IEC about consumption of IODISED salt .

� Improve monitoring for.

� Integration of pharmacy deptt. / Food inspector to monitor the consumption

& supply.

Support

required

� Supply to testing kits.

� IEC material in localised context.

Timeline Activity / Item 08-09 09-10 10-11 08-2012

Testing kit Supply x x x x

Programme in schools – 150

Primary, Upper Primary,

Secondary- Govt and Private

by School health team

x x x x

Awareness programme with

the SHGs and shopkeepers

196

villages

196

villages

196

villages

196

villages

Budget Activity / Item 2008-

09

2009-

10 2010-11 2011-12 Total

Programme in schools – 150

Primary, Upper Primary,

Secondary- Govt and Private

school by School health team

3.00 3.30 3.63 3.993 13.923

Awareness programme with the SHGs and shopkeepers @ Rs 500 per village x 196 villages

0.98 1.078 1.1858 1.30438 4.5481

8

Total 3.98 4.378 4.8158 5.29738

18.47118

97

6: INTER- SECTORAL CONVERGENCE [The following matrix A note on Inter-sectoral Convergence 6.1 Partnership with AYUSH department 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 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

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) Anganwari centres located in the areas where the ISM dispensaries are functioning by the way that the staff of these centres (Anganwari 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 Anganwari centre

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. Therefore life saving drugs, antiseptic lotions & dressing

98

once in a month should be started for general health check up of the children of Anganwari centres.

materials need to be supplied to avoid suffering of the ailing masses.

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.

As Kits of Iron folic acid tablets 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 Srinagar & 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 bring the children to the ISM Dispensaries on a fixed date of immunization through this 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 should be made mandatory that medical officer of that area should visit schools & give awareness lectures to the adolescent children on different issues.

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.

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/

After diagnosis of a case of leprosy the anti-Leprotic drugs should be

99

Paramedical staff. All ISM doctors, paramedical staffs should be given training to address sensitive health issues like Leprosy.

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 departments’ cooperation is needed. As water born disease are due to the infected water chlorine tablets should be supplied.

If the cases of the particular disease 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.

100

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, medicines will be

supplied along with the PHC and CHC

drug kits annually.

6.3 Rural Development Department

Issues / Areas Areas of cooperation Areas of convergent action Community participation

Constructions, repairs of buildings

Involving of community through VLWs

6.4 Public Health Department

Issues / Areas Areas of cooperation Areas of convergent action Water borne diseases.

� Awareness on water &

sanitation � Provision of safe

drinking water & sanitation.

� Outbreak of diseases � Prevention of diseases

101

6.5 PRIs

Issues / Areas Areas of cooperation Areas of convergent action

6.6 Education Department

Issues / Areas Areas of cooperation Areas of convergent action IEC

� Awareness programmes

� Education about adolescent health

� Adolescent programmes � Dissemination

102

Inter Sectoral Convergence (Water & Sanitation)

Situation

Analysis

Examples

Indicator No. ( % ) Households having access to potable drinking water

NA NA

Households having access to sanitary toilets

NA NA

The water based population & slum areas are mainly dependent on the water of Dal, Nageen and Jehlum which is not hygiene. Sanitation is also not at par and is the concern for health.

Objectives To provide the safe drinking water and proper sanitation to underserved areas.

Providing Primary and basic quality health care services at the village level

Providing quality RCH services

Optimal utilization of RCH services by community especially women

Empowering women to facilitate them to seek and demand quality RCH services

Strategies

& Activities

� Collaboration and cooperation in implementing the activities.

� Survey of the areas on the water & sanction issues.

� Empower VHSC to take up the issues with

� Joint activities of two deptts. At ground level.

Activities 1. Joint workshops for Planning and Review at all levels

• Orientation programmes

• Monthly meetings

2. Strengthening the VHD days

• 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

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. Realignment of the Health and the ICDS sectors for common data and

common work boundaries.

7. At the monthly meetings of the CMO, the officers of all the departments

should come

103

8. Annual action Plans to be developed jointly through meetings at the village,

Gram Panchayat, Sector and culminating in Block workshops and District

workshops.

9. Upgrading Ayush at all levels from PHC to DH.

10. Involvement of the RDD for construction of toilets in all health facilities and

public places

Support

required

To advocate for convergence of the water & sanitation programmes at higher level.

Time line Activity / Item 2008-

09 2009-10 2010-11 2011-12

Meetings of the Block

Committees x x x x

Joint monitoring at the

sector level x x x x

Hiring of vehicle x x x x

Joint monitoring at the

block level x x x x

Yearly joint Planning

Workshops at the Block

level for development of

the Action Plans

x x x x

Yearly joint Planning

Workshops at the District

level for development of

the Action Plans

x x x x

Yearly joint Workshops to

consolidate the plans from

the village to the Sectors

and then Blocks at the

Block level for Annual

Action Plans

x x x x

Budget Activity / Item 2008-09

2009-10 2010-11 2011-12 Total

Meetings of the Block Committees @ Rs 1000 / meeting x 5blocks/ zones x 12 months

0.60 0.66 0.726 0.7986 2.7846

Meetings of the Village groups @ Rs 100 per village x 12 villages x 196

2.352 2.5872 2.84592 3.130512 10.915632

104

Yearly joint Planning Workshops at the Block level for development of the Action Plans @ Rs 0.5 lakhs per block x 5 blocks / zones

2.50 2.75 3.025 3.3275 11.6025

Yearly joint Planning Workshops at the District level for development of the Action Plans @ Rs 1.00 lakh

1.00 1.1 1.21 1.331 4.641

Yearly joint Workshops to consolidate the plans from the village to the Sectors and then Blocks at the Block level for Annual Action Plans @ Rs 1.00 lakhs per block / zone x 5 blocks / zone

5.00 5.5 6.05 6.655 23.205

Yearly joint Workshops to consolidate the findings at the block levels/ zone at the District level for development of the Action Plans @ Rs 1.00 lakh

1.00 1.1 1.21 1.331 4.641

Training of PRIs/,VHWS committee members under Chiranjeevi Scheme @ 22 lakhs

22.00 22.00 22.00 22.00 88.00

Regular monthly meetings under Chiranjeevi Scheme @12 lakhs

12.00 12.00 12.00 12.00 48.00

Development of Education material and hands on training under Chiranjeevi Scheme @ 10 lakhs

10.00 10.00 10.00 10.00 40.00

Total 56.452 57.6972 59.06692 60.57361 233.78973

105

7. COMMUNITY ACTION PLAN

Community Health Action

Situation

Analysis

Health is a joint responsibility of society as a whole but whole responsibility has been

put on health department only. There is a lack of ownership from the community &

this apathy has lead to less / negotiable community participation. However as a tool,

RRS, VHSC have been framed in the district.

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.

Objectives Improving people’s involvement in Health Programmes.

Strategies

&

Activities

� Strengthening of various committees or societies.

� Improving functioning of various communities.

� Regular meetings of societies,

� Display of expenditure at community spots on newspapers / walls.

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.

Activity Plan 2008-09

2009-10

2010-11

2011-12

Village Health Water and Sanitation

Committee Meetings x x x x

Preparation of village health action

plan x x x x

Meeting of PHC level Rogi Kalyan

Samitee x x x x

Timeline

District Health Society meeting x x x x

Training to members of various committees

x x x x

Budget Activity / Item 2008

-09

2009-

10

2010-

11 2011-12 Total

Village level @ 500 / VHWSC

500X50 0.25 0.275 0.3025 0.33275 1.16025

PHC level RKS @ 5000/ RKS

5000X23 1.3 1.43 1.573 1.7303 6.0333

New PHC level RKS @ 5000 / PHC

* 1 0 0.05 0.055 0.0605 0.1655

New VHWSC 48 X 500 from 2009 0 0.24 0.264 0.2904 0.7944

Total 1.55 1.995 2.1945 2.41395 8.15345

106

8.PUBLIC PRIVATE PARTNERSHIP

Public Private Partnerships

Situation

Analysis

The public private partnership is not well established in the district as there is no

defined ToR between the Govt. and Private institutions. Although the private

institutions are running in the district but Accessibility is limited to particular income

group.

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.

Objectives Increase the provision / coverage of Health services through effective PPP.

Increasing the coverage of the health services and also increasing the accessibility

for health services

Widening the scope of the services to be provided to the clients

Strategies

& Activities

� Common terms of Reference / Agreement between public and private

institution.

� IEC.

� Provision of consultancy services of required by either party.

� W/shops / meetings.

Support

required

� TOR at state level between Govt. & private institutions.

� Support required form the State to allow PPP; to develop a conducive

environment by formulating a workable PPP Policy.

Timeline

Activity / Item 2008-09

2009-

10 2010-11

2011-

12

Feasibility study X

Operational frame work X

Operationalisation of PPP X

Advertisement for hiring TSA

for assisting in achievement of

objective

X

Cost of establishment of TSA X X

107

Preparation of directories of

resource agencies & Pvt.

Partners

X

TNA for Pvt. Partners

Innovative interventions / block X X X

Budget Activity / Item 2008-09

2009-

10 2010-11

2011-

12 Total

Flexibility study 9.00 0 0 0 9.00

Operational frame work 9.00 0 0 0 9.00

Operationalisation of PPP 10.00 0 0 0 10.00

Advertisement for hiring TSA

for assisting in achievement of

objective

0.15 0 0 0 0.15

Cost of establishment of TSA 13.50 13.50 0 0 27.00

Preparation of directories of

resource agencies & Pvt.

Partners

5.00 5.00 0 0 10.00

TNA for Pvt. Partners 1.00 0 0 0 1.00

Innovative interventions /

block / zone @ 3.0 lac 15.00 15.00 15.00 15.00 60.00

Total 62.65 33.5 15.00 15.00 126.15

108

9. GENDER AND EQUITY

Gender and Equity

Situation

Analysis

Gender discrimination is one of the social problems having ill effects on child and women

health.

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

It has been observed that only women are bearing the burden immunization of children, childcare during illness, contraceptive devices including Tubectomies.

Objectives To promote gender equity in the district.

To eliminate gender discrimination Male involvement in child health, contraception and EmOC. Women’s empowerment.

Strategies

&

Activities

� IEC for gender equity.

� Advocacy of PNDT in the district through BCC.

� Awareness / Counselling services for the issues.

Support

required

State level / Directorate level monitoring of PNDT Act.

Timeline Activity / Item 2008-09 2009-10 2010-11 2011-12

IEC campaign through print audio visual and folk media

x x x x

Capacity building 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

Reorientation x x x x

Development/procurement training

modules

Budget Activity / Item 2008-09 2009-10 2010-11 2011- 12 Total

IEC Campaign @2000 X196 villages

3.92 4.312 4.7432 5.21752 18.192

72 Periodic Advisory committee

meetings @ 10000 0.5 0.55 0.605 0.6655 2.3205

Development of Training. Modules 1.0 0 0 0 1.00

Training of MO's &,ANM’s 2.0 2.20 2.42 2.662 9.282

Workshops with private providers, IMA members, Religious leaders, Caste leaders, Community leaders and women groups

10.00 11.00 12.1 13.31 46.41

Total 17.42 18.062 19.8682 21.85502 77.205

109

10. CAPACITY BUILDING

Capacity Building

Situation

Analysis

The programme implementation planning organising implementing is dynamic and to overcome this dynamism regular Training / Capacity development of Human Resource team is need to improve efficacy. Presently the capacity development part is lagging and needs to get increased. 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 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 To enhance Human Resource development through capacity development of the

team.

To build and upgrade the knowledge and skills of all Health providers and other

personnel working for management of health services to provide quality

Joint training of health, DWCD, rural development and education department

functionaries

Strategies

&

Activities

� Assessment for training needs of H.R.

� Development classifying & designing of trainings.

� Hiring consultant for training.

� Imparting the training to personells.

Support

required

Proactively in imparting & Assessment of Trainings at all levels of implementation.

From govtt. & govtt. Agencies

Respectable people of the society Imams, people of the society, wealthy donors &

social workers

110

Timeline Activity

2008 -09 2009-

10

2010-

11

2011-

12

Construction of training hall @

10.00lac X

TBA training X X X X

MVA MTP training to all PHC MOs X X

Training on Blood transfusion for

MOs and Lab Technicians for

CEmOC centres with Blood storage

facilities for 3 days

X X

Training in Obstetric management

& skills for 24 hrs PHC for 16

weeks

X X X X

Training in Skilled Birth attendants

for 15 days: X X X X

IMNCI training to ANM/LHV, SN,

ASHA for 8 days X X X X

IMNCI training to MOs X X X X

Training in Life saving/Anaesthesia

for EmOC at CHC for MOs (State

Budget )

X X X

Integrated skill training of all SN X X X X

Integrated skill training for ANMs X X X X

Integrated skill training for MOs X X X X

Training of MOs, SN in Mgt of

Newborns & sick children at

Medical College Shopian

X X X X

Training in BCC for MOs, LHV,

ANM X X X X

Training of Ayush personnel on

issues of RCH and reporting X X X X

Training on NSV for MOs at NSV

camps X X X X

Training on Minilap X X X X

111

Training for Laparoscopic

Sterilization for Surgeons,

Gynaecologists, SN, OT attendants

for 12 days

X X X X

Orientation on contraceptive

devices for MOs - Govt as well as

private facilities

X X X X

Training on Medico-legal aspects to

MOs X X X X

Continuing Medical Education

sessions for doctors each month

during the monthly meetings on

current topics

X X X X

Orientation on PCPNDT Act for Dy.

CMO, CMOs, doctors both Govt

and private, members of District

Appropriate authority NGOs in a

workshop

x x x x

General & Financial rules (G & FR)

for Officials, MOs, clerical staff for 3

days

X X X X

Financial management training for

Accounts Officers, Accountants for

2 days

X X X X

Computer training to all the MOs,

Clerical staff, accounts personnel X X X X

CNAA for MOs, LHV, ANM & MPW,

AWW X X X X

Training of VHWSC members X X X X

Training of NGOs in BCC

Budget

Activity

2008–09 2009-10 2010-11 2011-12 Total

Construction of training hall @ 10.00lac 10 0 0 0 10 Trainings: VHWSC 2000/ committee

196X2000 1 1.56 1.716 1.8876 6.1636

Lab. Technician (34) @ 10000 / L.t. 3.4 3.74 4.114 4.5254 15.7794 MVA MTP training to all PHC MOs for 15 days @ Rs 500 x 15 days x MOs

3.9 4.29 4.719 5.1909 18.0999

MOs @ Rs 500/day/person x 3 days 0.39 0.39 0 0 0.78

112

Lab Technicians @ Rs 200/person x 3 days

0.102 0.102 0 0 0.204

MOs: Rs 500/day x 112 days x 2 MOs 7.28 7.28 7.28 7.28 29.12

Staff Nurses: Rs 200 / day x 112 days x 2 S Ns

2.912 2.912 2.912 2.912 11.648

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 4.4 4.84 5.324 18.564

Rs 300 as hon. to participant x 8 days 1.536 1.6896 1.85856

2.044416

7.128576

IMNCI training to MOs @ Rs 5390 /participant

0.7007 0.77077 0.84784

7 0.93263

2 3.251948

7 Integrated skill training of all SN @ Rs 4080/person

0.7956 0.87516 0.96267

6 1.05894

4 3.692379

6 Integrated skill training for ANMs @ Rs 2048/person

0.79872 0.878592 0.96645

1 1.06309

6 3.706859

5 Integrated skill training for MOs @ Rs 3683

0.47879 0.526669 0.57933

6 0.63726

9 2.222064

4 Training of MOs, SN in Mgt of Newborns & sick children at Medical College Srinagar @ Rs 7500/MO, Rs 4500 ( Rs 300 x 15 days)/SN

0.24 0.264 0.29 0.319 1.113

Training in counselling for MOs, LHVs, ANMs

0.76 0.836 0.92 1.012 3.528

Training of Ayush personnel on issues of RCH and reporting for 3 days

0.459 0.5049 0.555 0.611 2.1299

Training on NSV for MOs at NSV camps 0.42 0.462 0.508 0.559 1.949

Training on Minilap @ Rs 500 per day for 15 days and during camps

0.6 2.64 2.904 3.194 9.338

Training for Laparoscopic Sterilization for Surgeons, Gynaecologists, SN, OT attendants for 12 days

0.24 0.264 1.162 1.278 2.944

Orientation on contraceptive devices for MOs - Govt as well as private facilities

0.5 0.55 0.605 0.6655 2.3205

Training on Medico-legal aspects to MOs

0.5 0.825 0.908 0.998 3.231

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 11.603

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 2.321

General & Financial rules (G & FR) for Officials, MOs, clerical staff for 3 days

0.96 1.056 1.1616 1.27776 4.45536

Financial management training for Accounts Officers, Accountants for 2 days

0.32 0.352 0.3872 0.42592 1.48512

113

Computer training to all the MOs, Clerical staff, accounts personnel @ Rs 200 per person x 15 days

1.26 1.26 0 0 2.52

CNAA for MOs, LHVs, ANMs, AWW 1.57 0.5214 0.22 0.22 2.5314

Total sanitation orientation and reorientation of VHWSCs x 1 day @ Rs 200/person/day

0.392 0.4312 0.47432 0.52175

2 1.819272

Training of NGOs in BCC @ Rs 300 per person x 6 days

0.54 0.594 0.653 0.719 2.506

Total 49.05481 43.27529

45.17399

48.65119

186.15528

114

11. HUMAN RESOURCE PLAN

Human Resource Plan

Situation

Analysis There is a wide gap between needs and provision in terms of manpower as far as Health care provision is concerned. There is dearth of specialist manpower at every level which is telling upon the efficacy of the programme.

Objectives

Benchmarks

� To put in place the Manpower as per IPHS norms.

� To strengthen management / administrative part through selection of

required manpower.

Strategies &

Activities

� Recruitment / hiring of required staff.

� Rational posting of manpower.

� Rational delegation of work load.

� Team Dev. Activities.

� Job rotations to improve versatility.

Support

required

� Creation / filling of manpower gaps.

� Team Dev / QWL initiatives from state level.

Budget Activity / Item 2008-09 2009-10 2010-11 2011-12 Total

CHC Staff

Public health

nurse (1@ 14265/

Môn.)

1.7118 1.7118 1.7118 1.7118 6.8472

Ward boy / nursing

orderly

(2@5777/mon.)

1.39 1.39 1.39 1.39 5.56

Statistical

assistant 1 @

7610/ Môn.)

0.9132 0.9132 0.9132 0.9132 3.6528

OPD & OT attendant 2 @ 5777 / m

1.39 1.39 1.39 1.39 5.56

Staff for 02 new CHCs from 2010

07 Specialists @ 26270 /M ( G. Surg., Phy., O/G., Paed., Anaes., PHPM., Eye Surg.,

0 44.1336 44.1336 44.1336 132.4008

Staff nurse 10 @ 12800 /M

0 30.72 30.72 30.72 92.16

Public health nurse 1 @ 14265/M

0 3.4236 3.4236 3.4236 10.2708

Dresser 1@ 5777/M

0 1.8264 1.826 1.8264 5.4788

115

Pharmacist 1 @ 12800/M

0 3.0744 3.0744 3.0744 9.2232

Lab. Tech. 1 @ 9900 /M

0 2.376 2.376 2.376 7.128

Radiographer 1 @ 9900/M

0 3.0744 3.0744 3.0744 9.2232

Ward boy 2, Dhobi

1, Sweeper

3,Chokidar 1 ,Aya

1, Peon 1, & Mali 1

(10 @ 5777/ Môn.)

0 2.376 2.376 2.376 7.128

UDC 2 @ 8057 /M 0 3.8673 3.8673 3.863 11.5976

LDC 1 @ 6650 /M 0 1.596 1.596 1.596 4.788

Epidemiologist 01 @ 22985 /M

0 5.5164 5.5164 5.5164 16.5492

Block extension educator 1 @ 12810 / M

0 7.62564 7.62564 7.62564 22.87692

PHC Staff:-------------------

MOs 4 @ 21000/ month

10.08 10.08 10.08 10.08 40.32

Staff nurses 78 @ 12800/ month

119.808 119.808 119.808 119.808 479.232

Clerk 39 @ 8000/month

37.44 37.44 37.44 37.44 149.76

Lab technician 17 @ 9900

20.196 20.196 20.196 20.196 80.784

Class IV 38 @ 5777 / month

26.34312 26.34312 26.34312 26.34312 105.37248

Staff for new 1 PHCs from 2010

MOs 02 @ 21000/M

0 5.04 5.04 5.04 15.12

Pharmacists 01 @ 12800 /M

0 1.536 1.536 1.536 4.608

Nurses 03 @ 12810/M

0 4.6116 4.6116 4.6116 13.8348

UDC/Computer Clerks 01 @ 8000/M

0 0.96 0.96 0.96 2.88

LDC 01 @ 7610 / M

0 0.9132 0.9132 0.9132 2.7396

Lab. Tech 01 @ 9900/M

0 1.188 1.188 1.188 3.564

Class IV 04 @ 5777 /M

0 2.77296 2.77296 2.77296 8.31888

Sub Centres:

116

ANMS 11 @

11355

185X11355X12

14.9886 14.9886 14.9886 14.9886 59.9544

Staff for New

Sub- Centres 48

SCs

ANM’s for new 28

Sc’s from 2010 @

11355/ month 96

X11355X12

0 130.8096 130.8096 130.8096 392.4288

DISTRICT HOSPITAL :-

Specialist 2 @ 26270/ month

3.15 3.15 3.15 3.15 12.6

OG Specialist 3 @ 26270/ M

9.46 9.46 9.46 9.46 37.84

Psychiatrist 1 @ 26270/ M

3.15 3.15 3.15 3.15 12.6

Radiologist 1 @ 26270/ M

Paediatrician 1 @ 26270/ M

3.15 3.15 3.15 3.15 12.6

Microbiologist 1 @ 26270 / M

3.15 3.15 3.15 3.15 12.6

Forensic expert 1 @ 26270/ M

3.15 3.15 3.15 3.15 12.6

Public health manager 1 @ 26270/ M

3.15 3.15 3.15 3.15 12.6

AYUSH physician 2 @ 26270/ M

6.31 6.31 6.31 6.31 25.24

Pathologist 2 @ 26270/ M

6.31 6.31 6.31 6.31 25.24

Causality doctors 6 @ 25000 / M

18 18 18 18 72

Staff nurse 60 @ 12800/ month

92.16 92.16 92.16 92.16 368.64

Social worker / counsellor 12000 / M

1.44 1.44 1.44 1.44 5.76

Cytotechnician 1 @ 9900/ M

1.19 1.19 1.19 1.19 4.76

ECG technician 1 @ 9900/ M

1.19 1.19 1.19 1.19 4.76

ECHO technician 1 @ 9900/ M

1.19 1.19 1.19 1.19 4.76

Blood Bank 6 @ 9900/ M

7.13 7.13 7.13 7.13 28.52

117

Hospital workers 4 @ 5777/ M

2.77296 2.77296 2.77296 2.77296 11.09184

Dietician 1 @ 10000/ M

1.2 1.2 1.2 1.2 4.8

ANM 3 @ 11355 / M

4.0878 4.0878 4.0878 4.0878 16.3512

Dark room assistant 1 @ 7610/M

0.91 0.91 0.91 0.91 3.64

Matron 1 @ 8000/ M

0.96 0.96 0.96 0.96 3.84

Assistant Matron 2 @ 5000/ M

1.2 1.2 1.2 1.2 4.8

Physiotherapist 1 @ 15000/ M

1.8 1.8 1.8 1.8 7.2

Statistical Assistant 1 @ 7610/ M

0.91 0.91 0.91 0.91 3.64

Medical record off. 1/ technician @ 15000/ M

1.8 1.8 1.8 1.8 7.2

Record Clerk 1@9900/M

1.19 1.19 1.19 1.19 4.76

Office Assistant 1@ 7610/M

0.91 0.91 0.91 0.91 3.64

Computer Operator 1@6000/ M

0.72 0.72 0.72 0.72 2.88

Peon Security Staff @ 5777/ M X 04

2.77296 2.77296 2.77296 2.77296 11.09184

O.T Staff Nurse 9 @ 12800 / M

13.82 13.82 13.82 13.82 55.28

Blood Bank Staff Nurse 4 @12800M

6.14 6.14 6.14 6.14 24.56

MNA/FNA 2@ 7000 /M

1.68 1.68 1.68 1.68 6.72

Lab. Technician 1 @ 9900 / M

1.188 1.188 1.188 1.188 4.752

Sweeper 7 @ 5777 / M

1.44 1.44 1.44 1.44 5.76

Total 443.0424 700.4835 700.4831 700.4792 2544.48836

118

12. PROCUREMENT AND LOGISTICS

Procurement and Logistics

Situation

Analysis

The procurement of the district is done on approved rates by stores.

Objectives To improve system of procurement & logistics and computerise the system.

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 1. Construction of a scientific Warehouse

2. Procurement of software and computer hardware for the Warehouse from

TNMSC

3. Proper Equipment and hardware

4. Availability of Pharmacist, Assistant Pharmacist, Packers

5. Training of personnel

6. Appointment of an agency for Operationalization of the Scientific

Warehouse

Support

required

Manpower computer knowing.

Timeline Activity / Item\ 2008-09 2009-10 2010-11 2011-12 Total

Construction of

Warehouse

x

Software x

Computer system with

UPS, Printer, Scanner,

x

Equipment & Hardware x

Pharmacist @ Rs

9000/mth

x

Assistant Pharmacist @

Rs 5000/mth

x

Security Staff @ Rs

6000/mth

x

Training of personnel x

Consultancy to agency for

Operationalisation of the

Warehouse

x

Procurement of Washing

machine

X

119

Budget Activity / Item 2008-09 2009-10 2010-11 2011-12 Total

Construction of Warehouse and maintenance

100.00 10.00 10.00 10.00 130.00

Software 0.25 0.00 0.00 0.00 0.250

Computer system with UPS, Printer, Scanner,

0.60 0.00 0.00 0.00 0.600

Equipment & Hardware 34.5 0.00 0.00 0.00 34.50

Pharmacist @ Rs 9000/mth

1.08 1.19 1.31 1.44 5.020

Assistant Pharmacist @ Rs 5000/mth

0.6 0.66 0.726 0.799 2.785

Packers -1 @ Rs 4000/mthx1

0.48 0.528 0.581 0.639 2.228

Security Staff @ Rs 6000/mth

0.72 0.792 0.871 0.968 3.351

Training of personnel 0.1 0.11 0.121 0.133 0.464

One washing machine 20 Kg @ Rs 50000

0.5 0.00 0.00 0.00 0.50

Consultancy to agency for Operationalisation of the Warehouse

2.00 2.10 0.00 0.00 4.10

Total 140.83 15.38 13.609 13.979 183.798

120

13. DEMAND GENERATION - IEC

Demand Generation - IEC

Situation

Analysis

The focussed awareness activities are carried out in the district. Still there is high

degree of unawareness due to misconceptions, notions which is an independent in

improving the health index of district. The IEC part is carried out by the district

through various media and community based workers.

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.

Objectives To have aware and involved community.

Widespread awareness regarding the good health practices

Knowledge on the schemes, Availability of services

Strategies

& Activities

� IEC through involvement of different media. � Localised involvement of community resources for IEC. � Involvement of religious leaders, theatre groups etc.

Activity 1. Awareness on

• Fixed VHD days

• JSY

• Services available

2. 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

3. Consistent and appropriate messages on electronic media – TV, radio

4. Use of the Folk media, Advertisements, hoardings at prominent sites

5. Training of ASHA/AWW/ANM on Interpersonal communication and Counselling

on various issues related to maternal and Child health

6. Display of the referral centres and relevant information in a prominent place in

the village

7. Promoting inter-personal communication by health and nutrition functionaries

during the Fixed health & Nutrition days

8. Orientation and training of all frontline government functionaries and elected

representatives

9. Integration of these messages within the school curriculum

10. Kit for the newly married and during first pregnancy to be given at the time of

marriage and during pregnancy

121

11. Mothers meeting to be held in each village every month to address the above

mentioned issues and for community action

12. Kishore Kishori groups to be formed in each village and issues relevant to be

addressed in the meetings every month

13. 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.

14. 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.

15. Monthly Swasthya Darpan describing all the forthcoming activities and also what

happened in the month along with achievements

16. Bal Nutrition Melas 4 times at each Subcentre

17. Wall writings

Pamphlets for various issues packed in an envelope

Support

required

State to give guidelines for the good practices and also training module on BCC

Timeline Activities 2008-

09

2009-10 2010-11 2011-12 Total

Finalizing the messages x x x x

Advertisements x x x x

TV spots x x x x

Radio Jingles x x x x

Folk Media shows x x x x

Hoardings on prominent

places

x x x x

Display boards x x x x

Pamphlets x x x x

Developing Nirdeshika for

holding VHD days

x

Monthly Swasthya Darpan x x x x

Orientation & training of all

frontline govt functionaries

and elected representatives

Bal Nutrition Melas x x x x

Adolescent meetings x x x x

Opinion leaders workshops x x x x

Wall writings x x x x

Budget Activities 2008-09

2009-10 2010-11 2011-12 Total

122

Hiring of an agency for carrying out the intensive IEC and behaviour change activities

40.00 44.00 48.4 53.24 185.64

Finalizing the messages in the local language

1.00 1.10 1.21 1.331 4.641

Advertisements 5.00 5.50 6.05 6.655 23.205

TV spots 1.00 1.10 1.21 1.331 4.641

Radio Jingles in local language

1.00 1.10 1.21 1.331 4.641

Folk Media shows @ Rs 1000/vill

1.96 2.156 2.3716 2.60876 9.09636

Hoardings @ Rs 10000/hoarding

10.00 11.00 12.1 13.31 46.41

Display boards @ Rs 2000/board

2.0 2.2 2.42 2.662 9.282

Pamphlets @ Rs 10/pamphlets x 50000

5 5.5 6.05 6.655 23.205

Nirdeshika for Fixed Health Nutrition days @ Rs 20/ Nirdeshika x 5000

1 1.1 1.21 1.331 4.641

SwasthyaDarpan @Rs.10 /copy/mth x 5000

0.5 0.55 0.605 0.6655 2.3205

Orientation of elected rep and community leaders@ Rs 200 x 1000 persons x1 day

2 2.2 2.42 2.662 9.282

Bal Nutrition Melas @ Rs 300 x 4 times x AWCs

9.816 10.7976 11.87736 13.0651 45.55605

6 Kishori Shakti meetings @

Rs 100 per group x 196 villages

0.196 0.2156 0.23716 0.26087

6 0.909636

Community and religious leaders workshops @ Rs 300 /person x 150 x 4 times

1.8 1.98 2.178 2.3958 8.3538

Wall writings @ Rs 500 x 196 villages

0.98 1.078 1.1858 1.30438 4.54818

Total 83.252 91.5772 100.7349 110.808 386.3725

123

14. FINANCING OF HEALTH CARE

Financing Health Care

Situation

Analysis

Presently in the district the user charge are taken for registration, IPD, a Laboratory investigation which is one form of income generation for the department.

Objectives

Benchmarks

1. Generation of funds.

Strategies &

Activities

� Generation of funds from user charges.

� Donations from Philanthropists.

Support

required

Timeline

Activity / Item 2008-09 2009-10 2010-11 2011-12

Provision of Speed money

@ Rs 1 lakh per CHC and

PHC

x x x x

Training of the Incharges

and second in command

x x x x

Development of Software

for RKS with training of

personnel on the use

x x x x

Budget Activity 2008-09 2009-10 2010-11 2011-12 Total

Provision of Seed money @ Rs 1 lakh per CHC and PHC @ Rs 1.00 lakhs

27.00 33.3 36.63 40.293 137.223

Training of the In charges and second in command @ Rs 1000 per person x 1 day

1.10 1.21 1.331 1.452 5.093

Development of Software for RKS with training of personnel on the use

5.00 0.25 0.25 0.25 5.75

Total 33.1 34.76 38.211 41.995 148.066

124

15. SCHOOL HEALTH

SCHOOL HEALTH

Situation

Analysis

School health programmes are carried out in the District and proves an effective tool to enter community through student community. This helps to create awareness and increase people’s participation.

Objectives

Benchmarks

To have an aware future generation.

Strategies &

Activities

� Collaborative Awareness Programmes on Health with education

department.

� Joint activities with inter departmental support.

� Increase in the frequency of present activities.

� Providing Health care at school level.

Support

required

Govt. to strengthen the inter depital coordination at higher levels.

IEC activities.

CDS, man power & funds are required

Timeline

Activity / Item 2008-09 2009-10 2010-11 2011-12

Health checkups / block X X X X

Supply of sanitary pads

for girls 12 above age /

block

X X X X

IEC programme / block X X X X

Training of teachers /

block X X X X

School health camps /

block X X X X

Budget Activity / Item 2008-09 2009-10 2010-11 2011-12 Total

Health checkups @

25000 / block / zone 1.25 1.375 1.5125 1.66375 5.80125

Supply of sanitary pads

for girls 12 above age @

1.00 lac / block/ zone

5 5.5 6.05 6.655 23.205

IEC programme @ 1.00 /

block/ zone 5 5.5 6.05 6.655 23.205

Training of teachers @

25000/ block / zone 1.25 1.375 1.5125 1.66375 5.80125

School health camps @

25000 / block/ zone 1.25 1.375 1.5125 1.66375 5.80125

Total 13.75 15.125 16.6375 18.30125 63.81375

125

16. BIO- MEDICAL WASTE MANAGEMENT

Bio-Medical Waste Management

Situation Analysis / Current Status

As per the Bio-Medical Waste Rules, 1998, indiscriminate disposal of hospital waste was to be stopped with handling of Waste without any adverse effects on the health and environment. In response to this the Government has taken steps to ensure the proper disposal of Biomedical waste from all Nursing homes, hospitals, Pathological labs and Blood Banks. The District Health Officer is the Nodal Person in each district for ensuring the proper disposal of Biomedical Waste. For effective disposal of Biomedical waste in the district; Trainings to the personnel for sensitizing them, Pits. Segregation of Waste is taking place though Separate Colour Bins/containers it has to be done more systematically. Proper Supervision is lacking. The treatment (incineration) of waste is suppose to handled by a company selected at the State level but till date the company has not been selected. There is a monopoly of these companies so their charges are very high.

Objectives 1. Stopping the indiscriminate disposal of hospital Waste from all the facilities 2. Ensuring proper handling and disposal of Biomedical Waste in each Facility

Strategies 1. Capacity Building of personnel 2. Proper equipment for the disposal and disposal as per guidelines 3. Strict monitoring and Supervision

Activities 1. Review of the efforts made for the Biomedical Waste Interventions 2. Development of Microplan Plan for each facility in District & Block workshops 3. Capacity Building of personnel. Biomedical Waste management to be part of each training in RCH and IDSP 4. Proper equipment for the disposal

Installation of the Separate Colour Bins/containers and Plastic Bags 5. Segregation of Waste as per guidelines 6. Partnering with Private providers for waste disposal 7. Proper Supervision and Monitoring

Formation of a Supervisory Committee in each facility by the MOs and the Supervisors

Activity 2008- 09 2009-10 2010-11 2011-12

Orientation and reorientation for Biomedical Waste Management at District and Block levels

X X X X

Consumables X X X X

Time line

Payment for incinerators@ Rs. 8 per bed 12 mths

X X X X

Budget Activity 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 1.82 2 6.97

Consumables 2.0 2.2 2.42 2.662 9.282

Payment for incinerators 5.0 0 0 0 5.00

Total 8.5 3.85 4.24 4.662 21.252

126

Annexure – I Facility Survey

127

Table:1 Percentage Availability of Infrastructure

Indicators SC (50) PHC (26) CHC (1) DH(1)

1 Building (Govt. + Donated) 8 41 100 100

2 Building (Rented) 92 59 0 0

3 Condition of Building (Good + Fair) 89 Na Na Na

4 Water Supply (Tap, bore well/ hand pump /tube well, well)

52 91 100 100

4.1 Tap water supply Na 79 100 100

5 Electricity 32 96 100 100

5.1 In all parts of hospital Na 52 100 50

5.2 Electric supply (power generation stabilization)

Na Na Na 100

6 Separate Toilet 21 25 100 0

6.1 Sep. Toilet with running water 68 0

7 Furniture 25 45 100

8 Labour Room 0 4 100 100

8.1 Aseptic labour room Na Na 0

9 Avail. of Quarter for staff 2 4 27 100

10 Number of beds available (Average) 2 20 110

11 Laboratory 34 100 100

12 Operation Theatre 10 100 100

13 Waste Disposal (Burnt Dump) 34 0 100

14 Availability of incerator Na Na Na

15 Telephone 0 100 0

16 Computer 0 100 0

17 Generator/Invertors 6 0 100

18 Vehicles 10 67 100

19 Emergency Room / Casualty 0

20 Separate wards for males and females 100

21 No. of beds : Male 14

22 No. of beds : Female 12

23 Availability of ECG facilities 100 100

24 X-Ray facility 100 100

25 Ultrasound facility 100 100

26 Cardiac Monitor for OT 100 100

27 Blood Storage Unit available 0 100

28 Blood Bank Facility 100

29 Other Investigative Facility 59

30 Heating ventilation & air conditioning 50

31 Lift & vertical transport 0

32 Refrigeration

100

Na = Not Applicable

128

Table: 2 Identified Gaps of Manpower

District- Srinagar

Name of Blocks

Kh

an

yar

Bata

malo

o

Hazra

tbal

S.R

.Gu

nj

Zad

ibal

No

. 0f

Req

. S

taff

No

. o

f E

xis

. S

taff

Total Gaps

No. of Sub- Centres (50) IPHS Norm

7 13 13 9 8

ANM 2 0 0 11 0 0 100 89 11 N0. Of PHC's (26) 4 8 4 6 4 MO 2 0 0 4 0 0 52 48 4 Pharmacist 1 0 -1 -2 -1 -3 26 33 -7 Nurse 3 11 23 14 16 9 78 5 73 Female Health Worker 1 -2 0 1 -5 2 26 30 -4 Health Educator 1 3 7 3 4 1 26 8 18 Health Assistant (one male and one Female)

2 8 14 8

10 6 52 6 46

Clerks 2 6 14 9 8 2 52 13 39 Lab. Technician 1 3 6 3 4 1 26 9 17 Driver _ 3 6 3 3 1 Class lV 4 7 13 11 10 5 104 66 38

Total 39 82 54 49 24 442 218 224 No. of CHC's A. CLINICAL MANPOWER

1

General Surgeon 1 -1 1 2 -1 Physician 1 0 1 1 0 Obstetrician / Gynaecologist 1 0 1 1 0 Paediatrics 1 0 1 1 0 Anaesthetist 1 0 1 1 0 Public Health Programme Manager

1 0

1 1 0

Eye Surgeon 1 0 1 1 0 Other specialists (if any) 1 General duty officers (Medical Officer)

B. SUPPORT MANPOWER Nursing Staff 7+2 Public Health Nurse 1 1 1 0 1 ANM 1 0 1 1 0 Staff Nurse Nurse/Midwife

7 0

7 7 0

Dresser 1 0 1 1 0 Pharmacist / compounder 1 -6 1 7 -6 Lab. Technician 1 -2 1 3 -2 Radiographer 1 -1 1 2 -1 Ophthalmic Assistant 1 0 1 1 0 Ward boys / nursing orderly 2 2 2 0 2

129

Sweepers 3 0 3 3 0 Chowkedar 1 0 1 1 0 OPD Attendant 1 1 1 0 1 Statistical Assistant / Data entry operator

1 1

1 0 1

OT Attendant 1 1 1 0 1 Registration Clerk 1 0 1 1 0 Any other staff (specify)

Total -3 31 35 -4 Note: ( - ) Surplus staff

130

Table:2A Man Power at District hosoital

Doctors Para-Medicals

Personnel

IPH

S

No

rm

EX

IS,

sta

f

Iden

t.

Gap

s

Personnel IPHS Norm

EX

IS,

sta

f

Iden

ti.

Gap

s

Hospital Superintendent 1 1 0

Staff Nurse* 75 to 100

15 60

Medical Specialist 3 1 2

Hospital worker (OP/ward +OT+ blood bank) 20

20 0

Surgery Specialists 2 2 0 Sanitary Worker 15 15 0

O&G specialist 4 1 3

Ophthalmic Assistant / Refractionist 1

1 0

Psychiatrist 1 0 1 Social Worker / Counsellor 1 0 1 Dermatologist / Venereologist 1

1 0 Cytotechnician 1

0 1

Paediatrician 2 1 1 ECG Technician 1 0 1 Anesthetist (Regular / trained) 2

2 0 ECHO Technician 1

0 1

ENT Surgeon 1 1 0 Audiometrician 0 0

Opthalmologist 1 1 0

Laboratory Technician ( Lab + Blood Bank) 12

6 6

Orthopedician 1 1 0

Laboratory Attendant (Hospital Worker) 4

0 4

Radiologist 1 0 1 Dietician 1 0 1 Microbiologist 1 0 1 PFT Technician - 0 0 Casualty Doctors / General Duty Doctors 6

0 6 Maternity assistant (ANM) 6

3 3

Dental Surgeon 1 2 -1 Radiographer 2 2 0 Forensic Expert 1 0 1 Dark Room Assistant 1 0 1 Public Health Manager1 1 0 1 Pharmacist1 5 5 0 AYUSH Physician2 2 0 2 Matron 1 0 1 Pathologists 2 0 2 Assistant Matron 2 0 2 Total 34 14 20 Physiotherapist 1 0 1 Statistical Assistant 1 0 1

2 Provided there is no AYUSH hospital / dispensary in the district headquarter

Medical Records Officer / Technician 1

0 1

Electrician 1 1 0 Plumber 1 1 0

Total 154 69 85 Administrative Staff Operation Theatre

Personnel

IPHS

Norm

Exist

staf

gap

Staff IPHS Norm

Exist staff

gaps

Manager (Administration) - .

-

Emer. /

FW

Gen. OT

131

OT Junior Administrative Officer 1

0 1

Staff Nurse 8 1 0 9

Office Superintendent 1 1 0 OT Assistant 4 2 6 0 Assistant 2 2 0 Sweeper 3 1 1 3 Junior Assistant / Typist 2 2 0 Total 15 4 7 12 Accountant 2 2 0 Record Clerk 1 0 1 Office Assistant 1 0 1 Blood Bank / Blood Storage

Computer Operator 1 0

1 Staff

IPHS Norm

Curre

Avai.

Identified Gaps

Driver 2 2 0 B. B B.S Peon 2 0 2 Staff Nurse 3 1 1 3 Security Staff* 2 0 2 MNA / FNA 1 1 0 2 Total 17 9 8 Lab Technician 1 - 0 1 Safai Karamchari 1 1 0 2 Note: Drivers post will be in the ratio of 1 Driver per 1 vehicle. Driver will not be required if outsourced

Total 6 4 1 9

* The number would vary as per requirement and to be outsourced.

Table : 3 Percentage Availability of Equipments

District : Srinagar

Name of Blocks- Kh

an

yar

Batm

alo

o

Hazra

tbal

S.R

.Gu

nj

Zad

ibal Avg.

% of District

No. of SCs (50) IPHS Norm

7 13 13 9 8

Kit- C 55 21 27 20 24 20 22

No. of PHCs (26) 4 8 4 6 4

Suggested equipments 36 17 22 25 31 28 24

Operational labour room 10 40 10 20 0 40 22

Pap Smear 11 64 27 46 27 27 38

Laboratory Reagents 10 10 0 30 10 20 14

Glassware and other equipment 7 29 29 71 14 71

43

Furniture 25 12 12 32 20 24 20

TOTAL 99 23 18 33 21 30 25

NO OF CHC(1) 1 0 0 0 0 1

Standard Surgical Set-1 FRU 32 81 81

Standard Surgical Set - II 33 79 79

IUD Insertion Kit 19 63 63

CHC Standard Surgical Set - III 17 41 41

Normal Delivery 12 83 83

Standard Surgical Set - IV 16 100 100

Standard Surgical Set - V 21 43 43

132

Standard Surgical Set - VI 11 100 100

Equipment for Anaesthesia 17 65 65

Equip. for Neo-natal Resuscitation 10 50 50

Materials Kit for Blood tranfusion 15 0 0

Equipment for Operation theatre 11 73 73

Equipment for Labour room 13 69 69

Equipment for Radiology 9 100 100

TOTAL NO. 236 67 67

133

Table : 4 Percentage Availability of Medicines

District : Srinagar

Name of Blocks- Khanyar Bat

maloo Hazrat

bal S.R. Gunj

Zadibal Avg. % of

District

NO OF SC(50) IPHS Norm

7 13 13 9 8

Kit- A 5 0.0 0.0 0.0 0.0 0.0 0.0

Kit-B 9 22.2 33.3 44.4 33.3 44.4 35.5

Drugs req. by ANMs and LHVs 6 0.0 0.0 0.0 16.7 0.0 3.3

Other Drugs &Vaccines 8 37.5 25.0 50.0 37.5 25.0 35.0

Medicines required for NDCP 7 14.3 0.0 0.0 0.0 0.0 2.9

Contraceptives required for F.Plang.

4 75.0 75.0 50.0 50.0 50.0 60.0

Drug List for AWC 12 33.3 16.7 25.0 16.7 25.0 23.3

Total 51 25.5 19.6 47.1 47.1 21.6 32.2

TOTAL NO OF PHCs(26) 4 8 4 6 4

Essential & emergency obstetrics care drugs

38 47.4 23.7 31.6 39.5 34.2 35.3

Antidots 4 25.0 0 0.0 0.0 0.0 5.0

Anticonvulsant / Antiepileptic 4 0.0 0 0.0 0.0 0.0 0.0

Anti-infective Medicines 5 40.0 20 0.0 60.0 20.0 28.0

Antifilarials 1 0.0 0 0.0 0.0 0.0 0.0

Antibacterial 16 18.8 18.8 6.3 18.8 12.5 15.0

Dermatological medicine 14 14.3 7.1 7.1 21.4 7.1 11.4

Anti leprosy &Antitubercullar 2 50.0 0 50.0 50.0 0.0 30.0

Antifungal medicine 4 0.0 0 0.0 0.0 0.0 0.0

Antiprotozoal medicine 5 20.0 0 20.0 0.0 20.0 12.0

Blood Products and Plasma Substitutes

13 7.7 0 0.0 0.0 7.7 3.1

Antiseptics 6 0.0 0 0.0 0.0 0.0 0.0

Disinfectants 3 0.0 0 0.0 0.0 0.0 0.0

Diuretics 2 0.0 0 50.0 0.0 50.0 20.0

Gastrointestinal 22 31.8 13.6 18.2 27.3 18.2 21.8

Hormones, Endocrine & Contraceptives

10 10.0 10 10.0 10.0 0.0 8.0

Ophthalmologic preparation 12 8.3 8.3 0.0 0.0 0.0 3.3

Psychotic Disorders 15 6.7 6.7 0.0 13.3 6.7 6.7

Sol. correcting water Electrolyte and Acid-

9 22.2 22.2 22.2 44.4 22.2 26.6

Vitamins & Minerals 3 33.3 33.3 0.0 66.7 0.0 26.7

Drugs under RCH 1 0.0 0 0.0 0.0 0.0 0.0

Product Strength formulation Units

31 29.0 12.9 12.9 41.9 22.6 23.9

RTI / STI Drugs 10 30.0 0 10.0 30.0 30.0 20.0

Drugs & Consumable for MVA 6 16.7 0 16.7 0.0 0.0 6.7

TOTAL 236 22.5 11.9 13.1 23.7 16.1 17.5

CHCs (1)

Essential drugs 70 51.4 51.4

134

Annexure- II Detailed Infrastructure

135

Table: 1 A Zone : Batamaloo District :Srinagar

Name of SC Ownership

of the Building

Condition of the

Building

Water supply

Electricity Separate

toilet Labor room

Staff Quarte

r

1 Jawahar Nagar Rent Good N Y N N N

2 Malora Rent Good N N N N N

3 Zainakot Rent Good Y Y N N N

4 Bemina Rent Poor Y Y Y N N

5 Balhama Rent Good N N N N N

6 Gund hasi bhat Rent Good N N N N N

7 Gangbugh Rent Good Y Y Y N N

8 Qammarwari Rent Fair N N N N N

9 Boatman colony Rent Good Y Y N N N

10 Armwari Rent Good N N N N N

11 Firdosabad Rent Fair Y Y Y N N

12 Parimpora Shah Mohalla

Rent Fair Y Y Y N N

13 Allochibagh Rent Good N N N N N

136

Table: 1 B Zone : Batamalo District :Srinagar

Name of PHC/CHC

Ow

ners

hip

of

the B

uild

ing

Wate

r su

pp

ly

Ele

ctric

ity/ In

all P

arts

Sep

ara

te

toile

t /with

ru

nn

ing

wate

r

Lab

or ro

om

/ A

sep

tic

lab

or ro

om

Sta

ff Q

uarte

r

Lab

o

rato

ry

Op

era

tion

T

heate

r

Waste

d

isp

osal/

incin

ato

r

Tele

p

ho

ne

Gen

era

tor

Veh

icle

Em

erg

./ C

au

su

ality

R

oo

m

EC

G/U

SG

X-R

AY

Card

iac

Mo

nito

r

Blo

od

sto

rag

e u

nit

1 Khanmo GOVT Y Y/y Y N N Y Y Dump N Y Y

2 Batamaloo GOVT Y Y/y Y N N Y N municipality

N N N

3 Lawapora Internal Adjustment

GOVT N Y/y N N N N N NA N N N

4 Panthachowk GOVT N Y/n N N N N N NA N N N

5 Pandirathan Rent Y Y/y N N N N N Burn N N N

6 Tagpora Rent Y Y/y Y N N N N municipality

N N N

7 MujGund Rent Y Y/n N N N N N Dump N N N

8 Barzulla Rent Y Y N N N N N Burn N N N

137

Table: 1 A Zone : Khanyar District : Srinagar

Name of SC Ownership

of the Building

Condition of the Building

Water supply

Electricity Separate

toilet Labor room

Staff Quarter

1 Nehrupark Rented Good N N N N N

2 Gagribal Rented Good N Y Y N N

3 Nowhatta Rented Good N Y N N N

4 Bachidarwaza Rented Good N Y N N N

5 Kawmohalla Rented Good N Y N N N

6 Barbarshah Rented Good N N N N N

7 Abinowpora Rented Good N N N N N

138

Table: 1 B Zone : Khanyar District : Srinagar

Nam

e o

f P

HC

/CH

C

Ow

ners

hip

of

the B

uild

ing

Wate

r su

pp

ly

Ele

ctric

ity/ In

all P

arts

Sep

ara

te

toile

t /with

ru

nn

ing

w

ate

r

Lab

or ro

om

/ A

sep

tic la

bo

r ro

om

Sta

ff Qu

ar

ter

Lab

o

rato

ry

Op

era

tion

T

heate

r

Waste

d

isp

osal/

inclin

ato

r

Tele

p

ho

ne

Gen

era

tor

Veh

icle

Em

erg

./Cau

su

ality

Ro

om

EC

G/U

SG

X-R

AY

Card

iac

Mo

nito

r

Blo

od

sto

rag

e u

nit

1 Brian Rent y Y/y N N N Y N Municipality

N N N

2 Miskeenbagh Rent Y Y/y Y N N N N municipality

N N N

3 Abidal Rent Y Y/y N N N N N municipality

N N N

4 Ranawari Govt.

y y/n N N N N N municipality

N N N

1 CHC Khaniyar Govt.

y y/y y/y y/y N y y Municipality/

N

y N y N Y/Y

Y Y N

139

Table: 1 A Block : Hazratbal District :Srinagar

Name of SC

Ownership of the

Building

Condition of the

Building Water supply

Electricity

Separate toilet

Labor room

Staff Quarter

1 Shalkund Govt. poor Y N N N N

2 Dara Govt. Good N N N N N

3 Theed Govt. Fair Y N Y N N

4 Zakoora Govt. Poor N N N N N

5 Ishber Rented Fair Y N Y N N

6 Kushipora Rented Poor Y Y N N N

7 Shanpora Rented Fair Y N N N N

8 Hazratbal Rented Fair Y Y N N N

9 Syedapora Rented Fair Y N N N N

10 Dharbagh Rented Good Y N Y N Y

11 Abidal Rented Good Y Y N N N

12 Nandpora Rented Fair Y Y N N N

13 Takenwari Rented Good Y Y N N N

140

Table: 1 B Block: Hazratbal District: Srinagar

Name of PHC/CHC

Ow

ners

hip

of

the B

uild

ing

Wate

r supply

Ele

ctric

ity/ In

all P

arts

Separa

te

toile

t /with

ru

nnin

g w

ate

r

Labor ro

om

/ A

septic

labor

room

Sta

ff Quar

ter

Labo

rato

ry

Opera

tion

Theate

r

Waste

dis

posal/

inclin

ato

r

Tele

phone

Genera

tor

Vehic

le

Em

erg

./Caus

uality

Room

EC

G/U

SG

X-R

AY

Card

iac

Monito

r

Blo

od s

tora

ge

unit

1 Habak Hazratbal

Govt. Y Y/N N Y N Y Y NA N N N

2 AD Nishat Govt. Y N/N Y N N N N NA N N N

3 AD wangun Talbal

Govt. Y Y/N Y N N N N NA N N N

4 Harwan Govt. Y Y/Y N N Y Y Y NA N N Y

141

Table: 1 A Zone : S.R Gung District :Srinagar

Name of SC Ownership

of the Building

Condition of the

Building

Water supply

Electricity Separate

toilet Labor room

Staff Quarter

1 Pather Majid Rent Good N N N N N

2 Kanimazar Rent Good Y Y N N N

3 Saidapora Rent Good N N N N N

4 Kreshbal Rent Good N N N N N

5 Shoglipora Rent Good N N N N N

6 Bul Bul Lanker Rent Good y N N N N

7 Khanka Rent Good Y N N N N

8 Kamangerpora

Rent Good N N N N N

9 Baripora Rent Good N N N N N

142

Table: 1 B Zone : S.R Gung District :Srinagar

Name of

PHC/CHC

Ow

ners

hip

of

the B

uild

ing

Wate

r supply

Ele

ctric

ity/ In

all P

arts

Separa

te to

ilet

/with

runnin

g

wate

r

Labor ro

om

/ A

septic

labor

room

Sta

ff Quar

ter

Labo

rato

ry

Opera

tion

Theate

r

Waste

dis

posal/

inclin

ato

r

Tele

phone

Genera

tor

Vehic

le

Em

erg

./Causu

ality

Room

EC

G/U

SG

X-R

AY

Card

iac

Monito

r

Blo

od s

tora

ge

unit

1 S.R Gung Govt Y Y/y N N N Y N Dum

p n N N

2 Narwara Govt Y Y/y Y N N Y N Dum

p N N N

3 Palpora Rent Y Y/n N N N N N Dum

p N N N

4 Bakshipora Rent Y Y/y N N N N N Dum

p N N N

5 Sangam Rent Y Y/n N N N N N Dum

p N N N

6 Waganpora Rent y y/n N N N N N Dum

p N N N

143

Table: 1 A Zone : Zadibal District :Srinagar

Name of SC

Ownership of the

Building Condition of the Building

Water supply Electricity

Separate toilet

Labor room

Staff Quarter

1 Hawal Rent Good Y N N N N

2 Zonimar Rent Good Y N N N N

3 Bachpora Rent Good Y n Y N N

4 Sagendarwaza Rent Good Y N N N N

5 Botshahmohalla Rent Good Y N N N N

6 Mandibal Rent Good Y N Y N N

7 bagwanpora Rent Good Y N N N N

8 Umer Colony Rent Good y N Y N N

144

Table: 1 B Zone : Zadibal District :Srinagar

Name of PHC/CHC

Ow

ners

hip

of

the B

uild

ing

Wate

r supply

Ele

ctric

ity/ In

all

Parts

Separa

te to

ilet

/with

runnin

g

wate

r

Labor ro

om

/ A

septic

labor

room

Sta

ff Quarte

r

Labo

rato

ry

Opera

tion

Theate

r

Waste

dis

posal/

inclin

ato

r

Tele

phone

Genera

tor

Vehic

le

Em

erg

./Causual

ity R

oom

EC

G/U

SG

X-R

AY

Card

iac M

onito

r

Blo

od s

tora

ge

unit

1 Zadibal R Y Y/y N N N Y N municipality

N Y Y

2 Lal Bazar R Y Y/y N N N N N municipality

N N N

3 Burzahama R Y Y/y N N N Y N municipality

N N N

4 Chaterhama R N Y/y N N N N N municipality

N N N

145

Annexure III Criteria Appraisal

146

Assessment of District Health Action Plan (DHAP) Appraisal Criteria to be used by State & District Planning & Appraisal Team

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 have 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

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

Yes

147

Sl. No.

Criteria Remarks Yes/ No

increase in delivery/utilization of services? COSTS/BUDGET Key criteria are:

Does the budget follow the prescribed formats? Yes

The justification column has break-up of total amount Yes

14

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

148

Sl. No.

Criteria Remarks Yes/ No

Family Planning 3 A. Interventions to provide regular FP services in

everyh 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

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

B NRHM ADDITIONALITIES Whether provision made for-

Yes

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

12 Public private partnerships ( optional) Yes

149

Sl. No.

Criteria Remarks Yes/ No

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

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