STATE MAP OF UTTAR PRADESH

. Districts :70 Subdistricts:320 Towns:704 Villages:107452.

ORGANIZATION AND MANAGEMENT AT STATE LEVEL

MINISTER

Principal Secretary

Med Health & FW

SecretaryMedical Health

Director General Medical Health

Director Medical care

Director Public Health

Director Administration

Director

paramedical

Secretary Family welfare & MD

NRHM

Director General National Program Evaluation And

Monitoring

Secretary and Project Director

UPHSDP

Secretary and project Director

UPSACS

Secretary and Exec. Director

SIFPSA

PRINCIPAL SECRETARY: Senior member of Indian Administrative

Services

DUTIES AND RESPONSIBILITIES: Assists minister in policy making Modifies policies from time to time Budgeting and control of expenditure

RESPONSIBILITIES OF PRINCIPAL SECRETARY

RESPONSIBILITIES OF THE DIRECTOR

Directorate is headed by Director General, Medical and health services.

Provides technical assistance to Secretary and Minister.

Supervises,controls policies framed by state govt.

Co-ordinates and controls implementation of health programmes and projects.

UTTAR PRADESH HEALTH SYSTEM DEVELOPMENT PROJECT(UPHSDP)

World Bank project To provide effective,responsive and

comprehensive health care in U.P. Through institutional and human resource

development in addition to investment in health policy and public private partnership.

STATE INNOVATION IN FAMILY PLANNING PROJECT SERVICES AGENCY(SIFPSA)

Catalyst for Goverment of India in reorienting, revitalising state’s family planning services.

Joint endeavour of Govt. and USAID Assists admnistration in reducing

population growth to a level consistent with social and economic objectives.

UTTAR PRADESH STATE AIDS CONTROL SOCIETY (UPSACS)

Overall goal is to halt and reverse the incidence of AIDS in Uttar pradesh by integrating programs for prevention, care and treatment.

NACO(National AIDS Control organization)

UPSACS(UP State AIDS Control Society)

HIV/AIDS PREVENTION AND CONTROL COMMITTTEE

District program manager

District AIDS Prevention and Control unit(DAPCU)

Coordinator/

Supervisor

Assistant cum

Accountant

Support staff

ORGANIZATIONAL STRUCTURE FOR AIDS CONTROL PROGRAMME IN UTTARPRADESH

ORGANIZATION AND MANAGEMENT OF HEALTH AT DISTRICT LEVEL

District Health System is Headed by CMO (Chief Medical officer).

CMO is Assisted by Deputy CMO for implementing various programs.

District hospital is headed by Senior medical officer (SMO).

CMO(Chief Medical Officer)

Dy. CMO(Urban Setup)

Medical Officer(PHC)

Medical suprintendent(C

HC)

Dy. CMO (Rural Setup)

Medical Supritendent Medical Officer

SMO(Senior Medical

Officer)

ORGANIZATION AND MANAGEMENT AT DISTRICT LEVEL

RESPONSIBILITIES OF CMO

In-charge of Health & family welfare programs in District.

Planning & implementation of National health programs at the District level.

Supportive supervision. Coordinating with relevant

departments. Managing finances. Monitoring & reviewing progress.

RESPONSIBILITIES OF SMO

Overall in charge and responsible for supervising activities of Health and Family welfare programmes in dispensaries etc

He is further assisted by Health supervisor.

LADY MEDICAL OFFICERS

Innovative scheme of hiring women medical officers to serve at block PHCs and at CHCs.

CMOs can contract practising medical graduates who are paid on a visit basis.

Where no allopathic doctor available, even women practitioners of the Indigenous System of Medicine hired.

The women medical officers provide services from 8 a.m. to 2 p.m.

CONTINUED..

56 Women medical officers have been contracted under this scheme throughout UP.

More than 40,461 visits have been made by women medical officers.

This innovative scheme is an example of a unique public and private sector partnership, and won wide acclaim.

SOCIO-ECONOMIC PROFILE

TOTAL POPULATION

Most Populous state in India. Population of 199,581,477. 16.49% of the total Indian population.

RURAL POPULATION

U.P. India0

100000000

200000000

300000000

400000000

500000000

600000000

700000000

800000000

Chart Title

pop

ula

tion

URBAN POPULATION

U.P. India0

50000000

100000000

150000000

200000000

250000000

300000000

350000000

Chart Title

DECADAL GROWTH OF U.P.

1991-2001 2001-20110

5

10

15

20

25

30

Chart Title

ECONOMY OF U.P.

Second lowest per capita income. Per capita income of Rs 23,132. 1 crore of population below poverty

line.

POPULATION DENSITY

Population density is of U.P. - 828/sq. km. Population density is of India- 382/sq. km.

LITERACY RATE:

Overall literacy rate of U.P. is 69.72% Literacy rate of India is 74.04% Female literacy rate is 59.3% Male literacy rate is 70.23%

SEX RATIO

U.p. India905

906

907

908

909

910

911

912

913

914

915

Column2Column1

SCHEDULE CASTE POPULATION

Schedule cast population in Uttar Pradesh was around 35.15 million in the year 2010.

Constitutes about 17% of the total population of Uttar Pradesh.

SCHEDULE TRIBE POPULATION

Schedule tribe population of Uttar Pradesh is just around 0.11 million.

0.5% of the total population of Uttar Pradesh.

CRUDE BITH RATE &CRUDE DEATH ARTE

Crude birth rate has reduced to 28.7

Crude Death Rate is Highest

CBR CDR0

5

10

15

20

25

30

35

28.7

8.2

22.5

7.3

27.2

6.6

UPIndiaRajasthan

TOTAL FERTILITY RATE

TFR has reduced from 4.82 to 3.8 but is still higher than the national average of 2.7 and nowhere close to the target of 2.1 for the year 2012 UP India Rajasthan

0

0.5

1

1.5

2

2.5

3

3.5

4

4.5

TFR

TFR

MATERNAL MORTALITY RATE

MMR at 440 (SRS 04-06) has improved from 517 in SRS 01-03, but

still way above the national average of 254.

UP India Rajasthan0

50

100

150

200

250

300

350

400

450

500

MMR

MMR

HEALTH INDICATORS

Neonatal mortality: The probability of dying in the first month of life

Post neonatal mortality: The probability of dying after the first month of life but before the first birthday

Infant mortality : The probability of dying before the first birthday Child mortality : The probability of dying between the first and

fifth birthdays

NEONATAL MORTALITY RATE

Neonatal mortality rate has decreased by 12 deaths per 1,000 live births (from 51 to 39)

National Average :- 34 This accounts for 70% of the IMR

INFANT MORTALITY RATE

• HIGHEST IN THE COUNTRY

UP India Rajasthan0

10

20

30

40

50

60

70

IMR

IMR

CHILD MORTALITY RATE

HIGHEST IN THE COUNTRY The child mortality rate (at age 1-4 years) has

decreased by 14 deaths per 1,000. Currently it is, 96 as compared to 65 deaths of national average

EARLY CHILDHOOD MORTALITY RATES FOR THE FIVE-YEARPERIOD PRECEDING THE SURVEY, NFHS-1, NFHS-2, AND NFHS-3

NFHS1 NFHS2 NFHS30

10

20

30

40

50

60

70

80

90

49

4339

79

68

57

3329

18

Chart Title

NMRIMRCMR

PUBLIC HEALTH INSTITUTIONS

SUB-CENTERS (SC’S)

Sub centers are physically in bad shape, maintenance of old buildings is poor.

Some of the sub centers, not having been able to meet the accreditation standards are not eligible for JSY scheme and hence are performing poorly

As on march 2010, the number of SC’s functional was 2,052 as compared to total number of SC’s all over India is 1, 47,069.

PRIMARY HEALTH CENTERS

The number of PHC’s functional as on March’2010, was 3692 and the total number of PHC’s functional all over India was 23,673.

There has been an increase of 32 PHCs since 2005

COMMUNITY HEALTH CENTRE’S (CHC’S

The CHC has adequate space, wards and manpower for its functioning

As on March 2010, there are 515 CHC’s functioning in UP as compared to 4535 CHCs all over India.

There has been progress in the number of CHCs from 386 in 2005

COMPARISON CHART

Required In position Shortfall0

5000

10000

15000

20000

25000

30000

CHCPHCSC

HEALTH CENTRES IN UTTAR-PRADESH

DISTRICT HOSPITAL

There are special district hospitals only for women (Janana Hospital)

Number of DH :-134

FIRST REFERAL UNITS

FRUs in UP is like a misnomer :- that are operationalised without fulfilling the criteria of services to be provided like caesarian section, new born care, blood transfusion services which is quite similar to FRU we visited in Rajasthan.

As on March’2010, 121 FRUs have been operationalised so far against the target of 257 by 2010. Out of 121 functional FRUs in the state, 65 are in CHCs and 56 are in District Women’s hospital

POPULATION SERVED

PER DOCTOR

PER CHC

PER PHC

PER SC

23986

8931

50077

474824

15122

7671

49062

284446

UP INDIA

AVERAGE RURAL POPULATION BY SC’S, PHC’S AND CHC’S

UP

INDIA

255647

163725

CHC

CHC

UP

INDIA

35660

31364

PHC

PHC

UP

INDIA

6416

5049

SC

SC

AVERAGE AREA COVERED BY SC’S, PHC’S AND CHC’S

CHC PHC SC

INDIA 687.81 131.72 21.2

UP 455.09 63.48 11.42

50

150

250

350

450

550

650

750

AVERAGE RADIAL DISTANCE COVERED BY SC’S, PHC’S AND CHC’S

CHC

PHC

SC

14.79

6.47

2.6

12.03

4.49

1.91

Chart Title

UP INDIA

AVERAGE NO. OF VILLAGES COVERED BY SC’S, PHC’S AND CHC’S

CHC

PHC

SC

14.79

6.47

2.6

12.03

4.49

1.91

UP INDIA

INTERNATIONAL AGENCIES FUNDING IN UP WHO :- MCH, RCH UNICEF :- Supporting NRHM NIPI :- Within the overall framework of

NRHM, NIPI focuses on newborn and child health.

WORLD BANK :- Aids UPHSDP

GROUP II

FIELD VISIT AT A GLANCE

CHCBASSI

PHCBASCO(20 km

PHCTUNGA(18 km)

SC SC SCSC

M ADHOGARH(2 k m )

SC SC

PHCROJWADI(25 km)

PHCBADWA(30 km)

PLACES COVERED

Aug 04’ 2011 : COMMUNITY HEALTH CENTRE, BASSI (DIST. JAIPUR)

CHC : BASSI

Population Covered : 25000. No. of Beds : 30 (10 Male + 20 Female) No. of OPD Patients/day : 600 No. of IPD patients/day : 25 Total No. of deliveries under JSY :2000/Yr. No. of PHC’s Covered : 4 24x7 Emergency Services available. Listed as FRU.

S.No. Personnel IPHS Norms Current Availability

1. General Surgeon 1 1

2. Physician 1 1

3. Gynae/Obs. 1 1

4. Pediatrician 1 1

5. Anesthetist 1 Nil

6. Public Health Program Manager

1 Nil

7. Eye Surgeon 1 Nil

8. General Duty Officer 4 4

9. Nursing Staff 7+2 7+2

CLINICAL MAN POWER

MAJOR SERVICES AVAILABLE

Lab services : CBC, Blood Sugar, BT, CT, AFB, Sputum, Urine.

Diagnostic services : ECG, X-Ray, Sono-Graphy (PPP).

Equipments : 4 Incubators, Autoclave, Hot air Oven, Rotor and shakers.

Cold Chain : Deep Freezer, ILR’s, Refrigerators, Ice Box.

All vaccination and immunization services are given by trained staff under the guidance of doctors.

INCUBATORS

The Cold Chain

MAJOR SERVICES CONTINUED…

Free medicine and Treatment provided to BPL card holders.

Deliveries done under JSY Scheme. Provides high rate of institutional deliveries. AIDS Awareness program is executed via ICTC.

B.P.L. CARD

INTEGRATED COUNSELING AND TESTING CENTRE (ICTC) 12- 15 patients per day Patients referred from Doctors, NGOs and

voluntarily also. Awareness programs includes awareness

camps in villages and mainly focused on the migrant people.

Proper follow-ups are also maintained.

Public Awareness Via Posters

MAJOR ISSUES TO BE CONSIDERED

No proper emergency room for the casualties. Blood Bank available but non-functional. Increment in the No. of beds in the female ward

esp. pre and post delivery wards. No Intercom facilities. No Availability of the residential facilities for staff. More facilities required for the surgical and post

surgical departments.

AUGUST 05’ 2011 : 1) PRIMARY HEALTH CENTRE, TUNGA, BASSI (DISTRICT: JAIPUR)

2) SUB CENTRE, MADHOGARH, BASSI (DISTRICT: JAIPUR)

PHC : TUNGA

Population Covered : 7000. No. of Beds : 14( sanction 6 beds) No. of OPD Patients/day : 90(50 females, 40

males) No. of IPD patients/day : 5 Total No. of deliveries under JSY : 700/Yr. No. of Sub-Centers Covered : 6 Emergency Services available.

FACILITIES AVAILABLE

All the facilities are available (OPD services, MCH services, Family planning consultation, Nutritional services, proper store, laboratories, labor room)

ILR’s are available for storage of vaccines DOTS Therapy Available Conducts school health Programs including dental,

height and weight check up and nutrition advice Have monthly meetings with Panchayat regarding

basic sanitation and hygeine measures.

INTERVIEW WITH ASHA

She attends 8-10 families/ day and covers 205 families. Key works include:- Immunization, VHSC (attend

meetings with panchayat), Awareness regarding Nutrition and Health supplements.

Distribution of health supplements. Accompanies the women for ante-natal checkups,

vaccination and during labor. Awareness about Road to health charts and nutritional

status of neonates and infants. ASHA gets paid as per performance.

MAJOR ISSUES AT PHC

No AYUSH practitioner. No Ambulance service. No utility room for dirty linen and used

items. No proper waste disposal system. Excessive workload on ANM, Need for

more staff.

SUB CENTRE

1 ANM (Auxiliary nurse and Midwife) is providing services like handling deliveries, basic medications and First-aid.

LHV visits once in a week. Farthest village is 4 km away.

KEY FACILITIES

Immunization Family planning counseling Nutrition counseling Distribution of Nutritional supplements Promotion of sanitation Health surveys in villages Regularly in communication with ASHA to help

her.

DISTRICT HOSPITAL - DAUSA

DISTRICT HOSPITAL- DAUSA

DH hospital : Dausa is grade III hospital. (According to IPHS norms, district hospitals have 150- 200 beds are graded III).

Headed by PMO Population Covered : 20 LACS No. of Beds : 150 No. of OPD Patients/day : 700 No. of IPD patients/day :125 Total No. of deliveries under JSY :400/Month. 24x7 Emergency Services available.

PHYSICAL INFRASTRUCTURE

Entrance Hall Waiting Hall OPD Room Indoor Patient

Wards Emergency Room Observation Ward Operation Theatre Labor Room

Nursery Laboratory Room X-ray Room ECG Room Blood Bank Administration

Room Store/Pharmacy Toilets

DEPARTMENTS

OPD IPD Emergency General Medicine Surgery Gynecology/

Obstratics Pediatrics

Orthopedics Ophthalmology ENT Skin VD : Post Vacant Psychiatry Dentistry AYUSH

SUPPORT SERVICES :

Operation Theatre SNCU Medico Legal Blood Bank Post Mortem :

Sampling Pharmaceutical

Services

Mortuary ICTC STD Clinic Laundry Nursing Services Biostatistics Room

DIAGNOSTIC SERVICES

Clinical Pathology : All tests except Stool examination.

Pathology : Only sampling services available.

Biochemistry : Only LFT, RFT, Blood Sugar. Microbiology : Sampling apparatus present

but not working. Histopathology : Sampling present. Serology : Sampling present.

YASHODHA : SCHEME Appointed in the labor department to

provide a comfort level and Information to the incoming patients.

One Yashodha/5 deliveries. Paid on work basis Rs. 100/delivery. Qualifications : VIII passed, Trained in

counseling. Key works : Identification of danger signs in

Mother and Babies, Awareness about Breast feeding.

CONCLUSION

DAUSA hospital is easily accessible and spacious too. Hoardings for public awareness are displayed well. Citizen Charter was available Priyadarshni ( Facility for new born care) present. YASHODHA scheme available. Telemedicine services was available. Health Management Information System was present. Hygiene in the hospital is in poor state.

Poor Sanitation and Hygienic Conditions

RECOMMENDATION

There is great need for public private partnership as the district hospital is overburdened.

Integration with Other Local Health-Related Services.

Rehabilitation department like Physiotherapy and Occupational therapy should be present.

Hygiene and Sanitation is Important for “Complete Health” and it should be delivered.

THANK YOU