jammu kashmir - nhm.gov.in
TRANSCRIPT
JAMMU &
KASHMIR
STATE REPORT
Jammu & Kashmir
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Jammu & Kashmir
Index
S. No. Content Page No.
1 Summary of approvals 2 –6
2 Demographic Profile 7 – 8
3 Progress of NRHM 9 – 12
4 Reproductive & Child Health 13 – 16
5 Immunization 17 – 17
6 Revised National Tuberculosis Control Programme (RNTCP) 18 – 20
7 National Vector Borne Disease Control Programme (NVBDCP) 21 – 21
8 National Leprosy Eradication Programme (NLEP) 22 – 22
9 Integrated Disease Surveillance Project (IDSP) 23 – 24
10 National Programme for Control of Blindness (NPCB) 25 – 25
11 National Iodine Deficiency Disorder Control Programme (NIDDCP) 26 – 26
12 RoP approval under Mission Flexible Pool 27 – 31
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JAMMU & KASHMIR
Summary of approvals
Financial Management under NRHM (Rs. in crore)
Years Allocation Release Expenditure % Release
against Allocation
% Expenditure against Release
2005-06 51.80 67.68 42.36 130.65 62.58 2006-07 65.83 57.10 25.24 86.75 44.19 2007-08 86.77 165.57 76.65 190.83 46.29 2008-09 90.61 79.47 110.13 87.70 138.59 2009-10 110.10 0.00
Total 405.11 369.83 254.37 91.29 68.78
S. No. Timeline Activities Achievement %
1 ASHA Selection 9764 128 Training 9500
2 VHSC 6788 102 3 24X7 PHCs 96 26 4 Mobile Medical Unit 2 9 5 Rogi Kalyan Samiti 474 96
Budget Allocations (2005-09) ( Amount in Crores) Jammu & Kashmir
Allocation Releases Expenditure RCH Flexipool
2005-06 13.79 6.05 1.43 2006-07 16.31 10.53 5.20 2007-08 13.22 9.12 10.22 2008-09 20.09 28.74 12.57 2009-10 30.60
Total (A) 94.01 54.44 29.42 NRHM Flexipool
2005-06 No separate allocation 18.68 0.11
2006-07 13.78 31.39 3.54 2007-08 24.08 122.05 35.49 2008-09 17.50 20.18 66.82 2009-10 27.00
Total (B) 82.36 192.30 105.96
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National Disease Control Programme 2005-06 4.69 4.80 4.28 2006-07 6.19 4.00 4.60 2007-08 6.07 4.24 2.73 2008-09 7.33 3.24 2.01 2009-10 5.77 0.67 0.00
Total (C) 30.06 16.95 13.61
Grand Total (A + B + C) �������
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Record of Proceedings (2005-2009) for Mission Flexible Pool
Approval of Infrastructure (Rs. in Crore) S. No Health Facilities 2005-06 2006-07 2007-08 2008-09 2009-10
1 Sub C 1.88 10.00 0.00 0.00 2 PHC 10.00 0.00 0.00 3 CHC 8.40 25.6 20.00 13.50 0.00
4 DH 4 20.00 14.00 40.00 5 Equipment 0.05 0.00 0.00 6 Transport 0.00 0.83 7 Others 47.44 25.74 0.11
Total 10.28 29.60 107.49 53.24 40.94
Approval of Human Resources(Rs. in Crore)
S. No Personnel 2005-06 2006-07 2007-08 2008-09 2009-10
1 Doctors 3.38 10.92 30.95 2 Specialists 0.00 0.00 0.00 3 Staff Nurses 0.00 0.00 0.00 4 ANM 0.00 0.00 0.00 5 Others 3.05 0.00 0.93
Total 0.00 0.00 6.43 10.92 31.88
Approval for other activities (2005-2009) in Rs. Lakh
S.No Initiative 2005-06 2006-07 2007-08 2008-09 2009-10
Remarks Released Approved Approved Approved Approved
ASHAs
1
ASHA selection & Training 102.00
500.00 95.00
54.15
420.65
Drug Kits for ASHAs 10.00 57.00
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ASHA Mentoring set up 237.50
TOTAL 112.00 500.00 95.00 348.65 420.65
Untied Funds, Annual Maintainence Grants and RKS fundsrelated matters
2 Rogi Kalyan
Samiti- District Hospitals
517.00
110.00 110.00
588.00
3 RKS at 61 SDHs & 57 CHCs 118.00 85.00
4 Rogi Kalyan Samiti-PHC 347.00 375.00
5 Untied Fund for CHC & SDH 28.50 42.50
1084.75
6 Untied Fund for PHC/APHC 83.50 93.50 93.75
7 Untied Fund for SC 188.00 190.70 190.70
8 Untied Fund for VHSC 50.00 773.70 100.00
9 Annual
Maintenance Grant- SC
190.70 64.40
333.80
10 Annual
Maintenance Grant to CHCs and SDHs
57.00 85.00
11 Annual
Maintenance Grant -PHC
167.00 187.00 187.50
Total 188.00 817.50 2096.10 1333.85 2006.55 Infrastructure related matters
12 MMU 294.00 100.00
13
Advanced mobile units with
Emergency care facilities
400.00 246.00
Running cost of MMUs 208.00
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14 Procurement of Ambulances 400.00 1000.00 50.00
15 MMU Tracking System 20.00
Total 1094.00 1574.00 50.00
Status of Infrastructure 2005-2010 As per RHS 2008 New Construction Upgradation / Renovation Number of Sub Centre 1907 0 0 Number of PHC 375 0 50 Number of CHC 85 0 87 Number of DH 14
As per State Data Sheet, NRHM
8 21
Status of NRHM as on 15.05.2009
1 ASHA Selection 9764 Training 9500
2 VHSC 6788
3 Joint A/C 5215
4 24X7 Facility 135
5 FRU 53
6 Contractual Manpower
Doctors & Specialist 184 AYUSH Doctors 357
Staff Nurse 231 Paramedics 342
ANM 297 7 JSY Beneficiaries (in Lakhs) 0.33
National Disease Control Programme
Leprosy The state is low endemic for leprosy and has already achieved the goal of elimination of leprosy. During 2008-09, a total of 205 new leprosy cases were detected as compared to 209 new cases detected during the corresponding period of previous year. An in-depth situational analysis with steps to complete treatment etc be started.
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IDSP Jammu and Kashmir is a Phase-III state under IDSP. Contractual staff appointment of consultant (F) , Consultant (Training) , epidemiologists, microbiologists and entomologists pending needs to be fast tracked and completed in a time bound manner. The data reporting should start from all the districts.
Blindness Physical performance reports i.e. cataract operations, School Eye Screening, Eye Donation etc. are not being received timely. Utilization Certificates for financial assistance not being received on time.
NVBDCP Filaria, Kala-azar, J.E. & Chikungunya are not endemic in the state of Jammu & Kashmir
RNTCP
Total Case Detection and cure rate need to be improved. This appears to be due to gaps in key HR (STO, DTO and other levels ).
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Demographic, Socio-economic and Health profile
HEALTH INDICATORS OF JAMMU & KASHMIR The Total Fertility Rate of the State is 2.3. The Infant Mortality Rate is 51 and Maternal Mortality Ratio is NA (SRS 2004 - 06). The Sex Ratio in the State is 892 (as compared to 933 for the country). Comparative figures of major health and demographic indicators are as follows: Table I: Demographic, Socio-economic and Health profile of Jammu & Kashmir State as compared to India figures S. No. Item J&K India
1 Total population (Census 2001) (in million) 10.14 1028.61 2 Decadal Growth (Census 2001) (%) 31.42 21.54 3 Crude Birth Rate (SRS 2007) 19.0 23.1 4 Crude Death Rate (SRS 2007) 5.8 7.4 5 Total Fertility Rate (SRS 2007) 2.3 2.7 6 Infant Mortality Rate (SRS 2007) 51 55 7 Maternal Mortality Ratio (SRS 2004 - 2006) NA 254 8 Sex Ratio (Census 2001) 892 933 9 Population below Poverty line (%) 3.48 26.10 10 Schedule Caste population (in million) 0.77 166.64 11 Schedule Tribe population (in million) 1.11 84.33 12 Female Literacy Rate (Census 2001) (%) 43.0 53.7
Table II: Health Infrastructure of Jammu & Kashmir Particulars Required In position shortfall Sub-centre 1666 1907 - Primary Health Centre 271 375 - Community Health Centre 67 85 - Multipurpose worker (Female)/ANM at Sub Centres & PHCs
2282 1794 488
Health Worker (Male) MPW(M) at Sub Centres 1907 - - Health Assistant (Female)/LHV at PHCs 375 27 348 Health Assistant (Male) at PHCs 375 89 286 Doctor at PHCs 375 451 - Obstetricians & Gynaecologists at CHCs 85 28 57 Physicians at CHCs 85 44 41 Paediatricians at CHCs 85 17 68 Total specialists at CHCs 340 135 205 Radiographers 85 59 26 Pharmacist 460 557 - Laboratory Technicians 460 396 64 Nurse/Midwife 970 403 567 (Source: RHS Bulletin, March 2008, M/O Health & F.W., GOI)
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The other Health Institution in the State are detailed as under:
Health Institution Number Medical College 4 District Hospitals 14 Referral Hospitals City Family Welfare Centre Rural Dispensaries Ayurvedic Hospitals 2 Ayurvedic Dispensaries 273 Unani Hospitals 2 Unani Dispensaries 235 Homeopathic Hospitals - Homeopathic Dispensary -
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Note on Progress of NRHM in Jammu & Kashmir (June 2009)
In accordance with the National Rural Health Mission, Jammu & Kashmir State has launched
the National Rural Health Mission in the State. The State has effectively implemented NRHM, there has been a substantial increase in the levels of activities over the past couple of years. ASHAs are in place, Village Health and Sanitations Committees have been constituted, and joint accounts have been operationalised. The implementation of JSY has increased institutional deliveries. Brief information on progress vis-a-vi issues have been highlighted which are as follows: Institutional Framework of NRHM
The institutional set up needs to be strengthened. A total of 6,788 VHSCs constituted & 5215 joint accounts operationalised. Rogi Kalyan Samities are operational at 14 DH, 85 CHCs & 375 PHCs. All the 22 districts have started developing their own IDHAP. Infrastructure Improvements
In total 96 PHCs have been strengthened with three Staff Nurses each to make them functional for 24x7 services and 39 CHCs are functioning on 24X7 basis and facility survey has been completed in 70 facilities. A total of 39 CHC & other levels and 14 District Hospitals are functioning as FRUs. Only 2 districts have functional Mobile Medical Unit (MMU). Human Resources
A total of 9764 ASHA/ are selected. 9500 and 2965 have been trained in 1st and 2nd module respectively. 9500 ASHAs are placed with drug kits. Total 212 SCs are strengthened with 2nd ANM. In the state 357 Contractual AYUSH Doctors have been appointed at different level of facilities. Contractual appointments of 8 specialists, 176 MBBS Doctors, 231 Staff Nurse, 297 ANMs and 342 paramedics have been done under NRHM. Services Institutional deliveries improved from 1.31 lakhs (2006-07) to 1.51 lakhs (2007-08) and further 1.52 lakhs institutional deliveries have been reported in the state during the year 2008-09. JSY beneficiaries decreased from 0.13 lakhs (2006-07) to 0.11 lakhs (2007-08). The numbers of JSY beneficiaries was 0.07 lakh during the year 2008-09. Female sterilizations have increased from 0.13 lakh (2006-07) to 0.20 lakh (2007-08) and male sterlisation has increased from 537 (2006-07) to 1499 (2007-08) During the year 2008-09, 19616 female & 1797 male sterilization done so far. Till date only 8 districts are implementing IMNCI & 75 people trained so far. 14,332 VHND held since the launch of NRHM.
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General Overall improvement in health system since NRHM Achievements Made Achievements made
• Availability of equipment and supplies. • RKS are functional at all level. • Untied funds have worked as enablers for improvement in amenities and over all functioning
of CHC/FRUs. • Manpower position is relatively better. Infrastructure is adequate in many places. • SPMU/DPMU is in place. • ASHAs have been selected and provided with drug kits. • Good, well maintained infrastructure. • District action plans and facility surveys has been contracted out and being done.
Areas for further Improvement:-
• The institutional set up needs to be strengthened. • Quality of services for institutional delivery need to be enhanced. • Utilization of available manpower need to be improved. • Special action is required in remote areas. • Need to improve the condition of labour rooms in many places. • Inadequate new born care units.
Infrastructure
• Need to plan the entire health facility in a systematic way, current approach is piecemeal. Three different agencies are doing construction work in J&K.
• Infrastructure and manpower is adequate in many places; in spite of it, service guarantees are few, especially for hospitalized treatment and surgeries; need to provide more service guarantees.
Human Resources
• There is an urgent need to provide more quarters for staff to enable resident health workers. • State needs for rationalization and clear service guarantees from professionals. • SPMU/DPMU is in place. The State need to orient and train the functionaries. • There is a need for facility specific monitoring to ensure full utilization of professionals at
institutions. Service Delivery
• Inadequate new born care units. • An improvement in institutional deliveries recorded in all institutions after implementation of
JSY but quality of care needs to improve. • There is low performance on family planning and also need to improve quality of services • System of routine immunization at facilities on fixed date and outreach in villages could be
recorded. There is an increase in coverage and usage of AD Syringes. Regular immunization of sessions being held at village level and in Sub Centres as per records. System of waste disposal needs to be put in place.
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An Analysis of Financial Monitoring Report for the year 2008-09
A. RCH Flexible Pool
Component wise expenditure & Utilization under RCH against the approved PIP for 2008-09
J & K Rs. in lakhs
Activities SPIP EXPENDITURE % Utilization against
PIP A.1 Maternal Health 3094.48 361.17 11.67% A.2 Child Health 116.94 7.76 6.64%
A.3 Family Planning Services 378.64 177.65 46.92%
A.4 Adolescent Reproductive and Sexual Health/Arsh 61.45 18.58 30.24%
A.5 Urban RCH 134.94 34.81 25.80% A.6 Tribal RCH 29.20 0.69 2.36% A.7 Vulnerable Groups 16.80 0.00 0% A.8 Innovations/PPP/ NGO 275.80 45.08 16.35%
A.9 Infrastructure & Human Resources 868.00 334.90 38.58%
A.10 Institutional Strengthening 0.00 19.50 Error
A.11 Training 154.39 18.77 12.16% A.12 BCC / IEC 117.80 63.68 54.06% A.13 Procurement 1000.00 23.14 2.31% A.14 Programme Management 116.82 151.40 129.60%
Total 6365.26 1257.13 19.75% Based on table above and records available in FMG, the observations and areas of concern are as under:- General Observations:
1. The 54.06%, expenditure under BCC /IEC, is also an achievement of state. 2. Only Rs.12.57 Crore, i.e.20% of the PIP approved 63.65 crore, has been utilized by the state
under RCH-II as compared to average national level expenditure of 71%. It should be improved.
3. There is 13% increase in the expenditure as compared to 2007-08. 4. Since the launch of RCH-II, Rs 30.12 crore i.e.55% has been utilized by the state against the
release of Rs.54.43 crore during the period 2005-06 to 2008-09. Areas of concern:
1. Except Programme Management, Expenditure on all other components is very low. 2. Actual total expenditure under RCH programme is Rs.1257 lakhs, but as per submitted
FMR showed the expenditure of Rs.1335 lakhs. 3. Expenditure under Child Health, Tribal RCH, Vulnerable Groups and Procurement is
very poor.
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B. Mission Flexible Pool :
Component wise expenditure & Utilization under NRHM against the approved PIP for 2008-09
J & K Rs. in lakhs Activities SPIP EXPENDITURE % Of
Utilization against PIP
B1 ASHA 348.65 217.20 62.30% B2 Untied Funds 426.95 384.83 90.13% B3 Hospital Strengthening 3850.00 3742.15 97.20% B4 Annual Maintenance Grants 336.90 436.49 129.56% B5 New Constructions/ Renovation and
Settingup 0.00 162.43 Error B6 Corpus Grants to HMS/RKS 570.00 418.20 73.37% B7 District Action Plans (Including Block,
Village) 40.00 15.00 37.50% B8 Panchayti Raj Initiative 17.87 3.24 18.13% B10 IEC-BCC NRHM 50.00 41.53 83.06% B11 Mobile Medical Units (Including
recurring expenditures) 574.00 0.00 0% B12 Referral Transport 1000.00 687.72 68.77% B14 Additional Contractual Staff (Selection,
Training, Remuneration) 1092.00 167.24 15.32% B17 Incentives Schemes 135.72 25.12 18.51% B18 Planning, Implementation and Monitoring 70.52 0.00 0% B19 Procurements 150.00 0.00 0% B22 New Initiatives/ Strategic Interventions
(As per State health policy) 162.00 39.47 24.36% B23 Health Insurance Scheme 50.00 0.00 0% B27 NRHM Management Costs/
Contingencies 176.44 341.48 193.54% B.28 Other Expenditures (Power Backup,
Convergence etc) 74.40 0.00 0% Total 9125.45 6682.10 73.22%
Based on table above and records available in FMG, the observations and areas of concern are as under:- General Observations:
1. State incurred more than 100% expenditure on activities like Annual Maintenance Grants.
2. 2. Out of Rs.91.25 crores approved by the NPCC and Rs20.18 Crores released, the state has utilised Rs.66.82 Crores i.e. 73% of approved PIP, which is a good achievement.
3. There is 80% increase in the expenditure as compared to 2007-08. 4. Since the start of the programme, an amount of Rs.192.29 crores was released to the
state, Rs.107.55 Crores (56%) is utilized and Rs.84.74 Crores (44%) remains unutilized. Areas of Concern:
1. Actual total expenditure under NRHM programme is Rs.6682 lakhs, but the FMR submitted shows an expenditure of Rs.6804 lakhs. Which may be clarified.
2. More than 100% expenditure has been incurred under NRHM management costs/contingencies.
3. Performance under Additional Contractual staff, Incentive Schemes, Procurement and Health Insurance Scheme needs to be improved.
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BRIEFING NOTE ON RCH II: JAMMU & KASHMIR A. Background/ current status
1. RCH II Goals J&K’s IMR (SRS 2007) at 51 is lower than the national average of 51, but much higher than the target of 35 for the year 2012. Additionally, the IMR has increased from 44 as per SRS 2003. With a TFR of 2.3 (SRS 2007), the state achieved the 10th Plan goal and is close to the target of 2.1 for the year 2012 (refer Annex 1). SRS data on MMR is not available for the state. 2. RCH II Outcomes Provisional results from DLHS-3 show that J&K’s progress on key RCH II outcomes during the four year period between DLHS 2 (2002-04) to DLHS 3 (2007-08) is mixed (refer Annex 1):
• Mothers having full ANCs (including at least 3 ANC visits, 2 TT injections, and at least 100 IFA tablets consumed) decreased from 44.5% to 29.3%.
• Institutional deliveries sharply declined from 70.6% to 55.3%. • Full immunisation in children 12-23 months increased significantly from 31.7% to 62.5%. • Children with diarrhoea receiving ORS decreased from 68.5% to 53.1%. • Unmet need for family planning has reduced from 24.7% to 21.6%, while use of modern
contraceptives has declined from 52.1% to 41.2%.
3. Expenditure Audited expenditure has increased from Rs. 1.24 crores in 2005-06 to Rs. 5.20 crores in 2006-07 and Rs. 11.11 crores in 2007-08; reported expenditure in 2008-09 is Rs. 12.57 crores i.e. 20% of allocation (Rs. 63.65 crores). JSY accounted for 21% of the reported expenditure in 2008-09. State has set up a Financial Management Group on the lines of the FMG at the centre. B. Key achievements 1. Maternal Health, including JSY
• Number of JSY beneficiaries in the state increased from 0.02 lakh in 2005-06 to 0.13 lakh in 2006-07. However, this declined to 0.11 lakh in 2007-08 and further to 0.07 lakh in 2008-09. State has accredited 6 private institutions to provide JSY services.
• 53 FRUs are reportedly functional till March 2009 against a target of 70 by 2010; and 96 PHCs are reported as providing 24-hour services (target of 187 by 2010).
• Training on Life Saving Anaesthesia Skills (LSAS): 2 medical colleges have been identified, 2 master trainers and 9 MBBS doctors have been trained in LSAS against a target of 70.
• Training in comprehensive Emergency Obstetric Care (EmOC): GMC has been identified as training centre, 10 master trainers and 12 MBBS doctors have been trained in EmOC against at target of 70.
• Skilled Birth Attendant training (SBA): 6 districts have been identified, 10 state level master trainers and 32 district level trainers and 48 SNs/ ANMs have been trained as SBA, against a target of 561.
• Referral services being strengthened (125 new ambulances procured recently). • Over 1.40 lakh Village Health & Nutrition Days (VHNDs) have been held in the state.
2. Child Health
• IMNCI implementation is underway in 8 districts, with 75 personnel trained. Scaling up of IMNCI is planned for 2009-10.
• State is focussing on Newborn Care in 2009-10, with new baby care corners at 100 PHCs, neonatal stabilization units at 10 FRUs, and Sick Newborn Care Units at 2 District Hospitals.
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3. Other initiatives • Additional human resources – Contractual appointments are being decentralised to the RKS at
the facilities, and these will be non-transferable. • Special incentives, increments, additional weightage in PG courses, and accelerated
promotions for service in difficult areas are being undertaken. • Improving conditions of service of specialists are proposed (avenues of promotions,
recruitment rules, designation). • Government medical colleges are being strengthened to increase PG intake. • Accreditation of selected hospitals is proposed to be undertaken through Quality Council of
India (QCI). C. Key issues 1. Financial Expenditure
• While the expenditure has been increasing, state needs to take urgent steps to increase the absorptive capacity. Reported expenditure during 2008-09 is less than 20% of the allocation.
2. Maternal Health (including JSY)
• JSY implementation needs to pick up, since the state has broad eligibility norms for beneficiaries under the scheme (as one of the 10 focus states).
• DLHS-3 provisional results show a worsening trend between DLHS-2 (2002-04) and DLHS-3 (2007-08) on several maternal health indicators, especially access to and quality of antenatal care, and institutional deliveries; state needs to take steps to address them: − Mothers who had first trimester ANC reduced from 63.2% to 57%. − Mothers who had 3 or more ANC checkups declined marginally from 80.2% to 77.6%. − Mothers who had blood pressure taken declined from 89.1% to 73.3%. − Mothers who consumed 100 IFA tablets declined from 53.7% to 45.5%.
• Pace of facility operationalisation needs to be speeded up to reach the target of 70 FRUs and 187 PHCs providing 24-hour services, by 2010. Further, out of the 53 FRUs reportedly functional, only 39 are providing the full complement of essential services (as reported during a recent review), primarily due to lack of access to blood storage and shortage of specialists.
• Progress on multiskill training to plug the gap in availability of key specialities is slow, with only 9 doctors trained so far in Life saving anaesthesia skills (LSAS) against a target of 70; while comprehensive Emergency Obstetric Care (EmOC) training is yet to begin (target - 70).
• Skilled Birth Attendant (SBA) training is again a slow starter, with only 48 SNs/ ANMs/ LHVs trained so far against a target of 337 for the year 2010.
• Only about 0.75 lakh (42%) of the planned 1.81 lakh VHNDs were organised during 2008-09. Microplanning for VHNDs and monitoring of service utilisation needs to be ensured.
3. Child Health
• Infant mortality rate in the state has increased from 44 (SRS 2003) to 51 (SRS 2007). State needs to investigate the reasons for the same and urgently take steps to reduce IMR.
• Neonatal mortality rate (NMR – infant deaths within 4 weeks of life per 1000 live births) at 39 (SRS 2007) accounts for 77% of the IMR, while Early NMR (infant deaths within one week of life per 1000 live births) at 31 (SRS 2007) accounts for 80% of the NMR. Further, Early NMR has steadily increased from 23 (SRS 2004).
• IMNCI implementation needs attention, since the pace of training is very slow, with only 75 personnel reportedly trained till March 2009. Pre-service IMNCI is yet to begin in the medical and nursing colleges in the state.
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ANNEX 1 A. Background & Current Status
1. RCH II Goals
S. No. RCH GOAL INDICATOR
JAMMU & KASHMIR INDIA
Trend (year & source) Current status
RCH II/ NRHM (2012) goal
1. Infant Mortality Rate (IMR) 44 (SRS 2003) 51 (SRS 2007) 55 (SRS 2007) <30 2. Total Fertility Rate (TFR) 2.4 (SRS 2004) 2.3 (SRS 2007) 2.7 (SRS 2007) 2.1 (NOTE: Maternal Mortality Ratio/ MMR data from SRS is not available for Jammu & Kashmir)
2. RCH II Outcomes
S. No. RCH OUTCOME INDICATOR
JAMMU & KASHMIR* INDIA*
DLHS–2 (2002–04)
DLHS–3 (2007–08)
DLHS–2 (2002–04)
DLHS–3 (2007–08)
1. Mothers who received 3 or more antenatal care checkups (%) 80.2 77.6 50.4 51.0
2. Mothers who had full antenatal check-up (%) 44.5 29.3 16.5 19.1 3. Institutional deliveries (%) 70.6 55.3 40.9 47.0
4. Children 12-23 months age fully immunised (%) 31.7 62.5 45.9 54.1
5. Children age 6-35 months exclusively breastfed for at least 6 months (%) NA 62.4 22.7 24.9
6. Children with diarrhoea in the last 2 weeks who received ORS (%) 68.5 53.1 30.3 33.7
7. Use of any modern contraceptive method (%) 52.1 41.2 45.2 47.3
8. Total unmet need for family planning - both spacing methods and terminal methods (%) 24.7 21.6 21.4 21.5
* - Provisional results for DLHS-3 B. Trends in Financial Expenditure
(Rs. crores) FY 2005-06 FY 2006-07 FY 2007-08 FY 2008-09 Release 6.05 10.53 9.12 28.74 Audited Expenditure 1.24 5.20 11.11 12.57* * - Audited expenditure for 2008-09 is not yet available; reported expenditure is provided. - Allocation for 2008-09: Rs. 63.65 crores.
C. Progress on Key Strategies
1. Demand side interventions
S. No.
Indicators
Achievement (no. of beneficiaries) 2005–06 2006–07 2007–08 2008–09
1. Janani Suraksha Yojana 2,134 13,127 10,568 7,364 2. Total Sterilisation 21,466 19,281 21,800 na 3. IUD Insertions 28,787 29,684 25,849 na
(Source: M&E Division reports, and JSY reports from the states)
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2. Technical interventions
S. No.
Indicators
Achievement up to March 2009 Number %
1. No. of First Referral Units (FRUs) operationalised 53 76 (against the target of 70 FRUs)
2. No. of PHCs operationalised to provide 24-hour services 96 51 (against the target of 187 PHCs)
3. No. of private institutions accredited under JSY 6 NA 4. No. of districts implementing Integrated Management of
Neonatal & Childhood Illness (IMNCI) 8 36 (out of 22
districts) 5. No. of people trained in IMNCI 75 NA 6. No. of Village Health & Nutrition Days (VHNDs) held 1,43,332 NA (Source: NRHM MIS report, April 2009)
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Immunization
Jammu & Kashmir
Evaluated Immunization Coverage
Survey Indicator
NFHS 1 (1992-93)
NFHS 2 (1998-99)
NFHS 3 (2005-06)
CES (2005)
CES (2006)
DLHS 2 (2002-04)
DLHS3 (2007-08)
FI NA 56.7 66.7 83.2 81.8 32.0 NA BCG NA 85.6 90.9 93.3 92.3 91.5 NA Measles NA 68.9 78.3 87.9 84.8 77.9 NA DPT3 NA 72.3 84.5 89.8 86.4 40.2 NA
Progress
� As per the evaluated survey the full immunization is 81.8 % in 2006 (CES).
� The State has made good progress in training of Health workers at 94.9% (2646/2789).
� The District Level AEFI committees are in place in 12 districts.
Issues
� The State needs to strengthen AEFI reporting further to improve reporting of AEFI cases as in the
year 2008 no case of AEFI reported though the immunization rates are increasing.
� The fund utilization under Immunization is low for the year 2008-09.
� Revision of Microplans to strengthen outreach services especially in the districts with low BCG
coverage reflecting poor accessibility.
� The State needs to improve the coverage of Hepatitis B under routine immunization.
Comments
� The State needs to further improve service delivery and other infrastructure as Rubella vaccine is
going to be introduced shortly in form of MR vaccine for children of 16-24 months.
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Brief on National TB Control Programme in State of Jammu & Kashmir 1. Infrastructure Total Population - 128 Lakh No. of districts - 14
No. of Tuberculosis Units (TUs) - 47 No. of Designated Microcopy Centres (DMCs) - 174
2. Status of Implementation
• Whole State was covered under RNTCP in 3rd quarter 2005. 3. State level Performance (Based on the Quarterly reports for 1st qtr of 2009)
• Overall Referral of TB suspects is good. 172 TB suspect/lakh pop examined in 1st quarter
2009. • Low case detection rate is perpetual problem. Overall TCD rate of 102/lakh and NSP case
detection rate of 44/lakh (47%) in first quarter 09 remain very low. NSP patients are 72% of all new pulmonary TB patients which is more than expected range and retreatment sputum positive patients are only 22% of all sputum positive patients. It appears that the State is not able to capture all the NSN patients and categorization of sputum positive patients is not done correctly.
• However, the sputum conversion rate of 92% and cure rate of 89% in NSP patients are satisfactory.
0%
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Annualised New S+ve CDR Success rate
Annualized New Smear-Positive Case Detection Rate and Treatment Success Rate in DOTS Areas, J & K, 2000-2009*
•Population projected from 2001 census
•Estimated no. of NSP cases - 75/100,000 population per year (based on recent ARTI report)
Jammu & Kashmir
19
4. District-wise Performance (Based on the Quarterly reports for 1st quarter 2009)
• Referral of TB suspects is low in 4 districts (Doda, Kathua, Poonch and Rajouri) • TCD rate is very low in 10 of 14 districts and NSP case detection rate is less than 50% of
estimated in 9 districts. • Sputum conversion rate is low in Rajouri and cure rate in Leh and Rajouri districts.
District
Suspects examined per lakh
population
Annualized total case detection
rate (against >181 lakh)
Annualized new smear positive case detection
rate (%) (against >67/lakh (70%)
3 month conversion rate of new
smear positive patients
(against >90%)
Cure rate of new smear
positive patients (against >85%)
Anantanag 203 67 42 44% 92% 88% Badgam 197 74 55 58% 93% 90% Baramula 162 47 25 27% 100% 95% Doda 126 110 37 39% 90% 83% Jammu 178 142 46 49% 89% 88% Kargil 201 55 11 12% 86% 100% Kathua 148 156 60 63% 93% 83% Kupwara 234 103 60 63% 94% 95% Leh 339 113 19 20% 100% 77% Poonch 139 121 36 38% 96% 91% Pulwama 165 97 56 59% 93% 91% Rajouri 138 134 36 38% 78% 74% Srinagar 178 92 50 53% 93% 91% Udhampur 158 131 45 48% 95% 89% Total 175 102 44 47% 92% 89%
5. Funds Status as on 31st March 2009 (Rs in lakh)
C/F Release Other Income Expenditure Balance
Jammu 4.96 100.00 1.22 87.98 18.20
Kashmir 19.13 150.00 1.42 147.63 22.92
Total 24.09 250.00 2.64 235.61 41.12 6. Drugs RNTCP districts : Supplied as per requirement to the implementing districts. 7. Issues
• Infrastructure – One additional DMC with LT needed in chest diseases hospital under
Govt. Medical College Srinagar because of different locations of different departments and heavy work load.
• Human Resource
o 5 MO-TCs and 2 STLSs (R S Puna TU in Jammu and Sogam TU in Kupwara) are not in place.
o DEOs are not in place in STC Jammu, DTC Jammu and DTC Sringar. o Post of IEC Officers and 4 communication facilitators are vacant (both States).
Jammu & Kashmir
20
• Logistics o AMC has not been done in Kashmir. AMC done in Jammu but many BMs need
major repair. o Computer not provided to SDS in Jammu and Kashmir.
• Supervision & Monitoring o Supervision and monitoring is lacking both at district and State level. Supervisory
registers are not yet in place in most of the districts in J&K. o State Level Internal Evaluation of only 2 districts (Kathua and Rajori) have been done
in 2008 whereas internal evaluation of two districts every quarter is expected to be done.
o Referral for Treatment Registers are maintained in only 3 medical colleges (Shere-Kashmir Institute of Medical Sciences, Govt. Medical College, Srinagar & Govt. Medical College, Jammu).
o Vehicle for supervisory visits of DTOs needed in 5 districts (Doda, Kathua, Poonch, Rajouri and Udampur).
• Performance
o Overall referral of TB suspects for sputum examination is satisfactory but in 4 districts (Doda, Kathua, Poonch and Rajouri) it is low..
o Overall case detection rate is persistently very low in 10 districts and shows a downward trend.
o Cure rate in NSP patient is low in two districts (Leh and Rajouri). o NSP patients are 72% of all new pulmonary TB patients and retreatment sputum
positive patients are only 22% of all sputum positive patients. It appears that he State is not able to capture all the NSN patients and categorization of sputum positive patients is not done correctly.
• TB-HIV Collaboration
o Printing has not been done at STCS Kashmir and so training could not be started. o Both Programmes (RNTCP and SACS) are not involved in collaborative activities.
There is lack of coordination in two Societies. • Intermediate Reference Laboratory (IRL)
o IRL at Govt. Medical College, Jammu – Civil work completed. – Microbiologist and 2 LTs in place and trained. – 5 districts (expect Kathua) implementing EQA.
o IRL at STDC, Srinagar – Civil work completed. – 2 Microbiologist and 2 LTs in place and trained. – All districts except Leh and Kargil implementing EQA.
• DOTS Plus – Not yet started.
• NRHM – No active involvement. Additional funds, requested from NRHM, not issued.
Jammu & Kashmir
21
Fact Sheet on NVBDCP-Jammu & Kashmir
Background Information • The State has 14 districts with a population of 10.14 Million. There are 80 CHCs, 374 PHCs and
1888 Sub-centres and 6652 Villages. There are 1588 Multipurpose Worker (Female)/ANM, 377 Health Worker (Male), 32 Health Assistants (Female)/LHV, 334 Health Assistant (Male) and 395 Laboratory Technician. In addition, the state has 211 Fever Treatment Depots (FTDs) and 116 Malaria Clinics.
Malaria
Epidemiological Situation Year B.S.Examined Malaria cases Pf cases Deaths
2006 396938 154 8 0 2007 377203 240 17 1 2008 394922 200 17 1
2009 (Upto Mar.) 76256 22 2 0
Dengue Total of 24 Dengue cases and one death has been reported in the year 2006. In the year 2007, 2008 and 2009 till 27th May, no case has been reported. However for proactive surveillance govt. Medical College, Jammu has been identified as Sentinel Surveillance Hospital in consultation with State Health Authorities in 2009.
Filaria, Kala-azar, J.E. & Chikungunya are not endemic in the state of Jammu & Kashmir.
Central Assistance
(Rs. In lakhs) Year Allocation Release/Expenditure
Cash Kind Total Cash Kind Total 2004-05 0.00 70.23 70.23 0.00 27.63 27.63 2005-06 0.00 45.13 45.13 15.83 1.68 17.51 2006-07 13.78 33.13 46.91 4.06 2.43 6.49 2007-08 12.00 6.60 18.60 0 4.50 4.50 2008-09 21.10 13.68 34.78 10.55 7.42 17.97 2009-10(B.E.) 11.80 61.5 17.95
Jammu & Kashmir
22
STATUS OF NATIONAL LEPROSY ERADICATION PROGRAMME IN JAMMU AND KASHMIR
• Epidemiological scenario-
The state is low endemic for leprosy and has already achieved the goal of elimination of leprosy (i.e. prevalence rate of less than 1 case /10000 population). There were 200 leprosy cases on record as on March 2009.
• New case detection and treatment completion-
During 2008-09, a total of 205 new leprosy cases were detected as compared to 209 new cases detected during the corresponding period of previous year. Out of 204 cases discharged during the year, 202 cases (99%) were released as cured after completing treatment.
• NLEP action plan for the year 2009-10 amounting to 85.5 lakhs has been approved for the state.
Issues –
1. The state has reported low level of fund utilization in 2008-09. During the year, the state action plan was approved for Rs.97 lakhs, however the state could utilize only Rs.35 lakhs.
2. New leprosy cases are being detected in the state every year which suggest active transmission of the disease in the community. The state is advised to carry out in-depth situational analysis in districts/blocks reporting large number of new cases and take suitable actions like –
(i) Ensuring completion of treatment in each of the new cases detected. (ii) Enhance awareness of the community to improve self reporting of suspected
cases to health facility and (iii) Carrying out family contact survey against all multibacillary and child cases.
Jammu & Kashmir
23
Jammu and Kashmir
Integrated Disease Surveillance Project (IDSP) –Fact sheet as on 17 June 2009
J & K is situated between 32.17 degree and 36.58 degree north latitude and 37.26 degree and 80.30 degree east longitude with a total area of 22,22,236 sq. Kms. It has four geographical zones of: The State of Jammu and Kashmir is the northern most state of India comprising three distinct Climatic regions viz. Arctic cold desert areas of Ladakh, temperate Kashmir valley and sub-tropical region of Jammu. The health system functions through various health facilities:
• A Health Sub Centre (HSC) covers a population of 3000 in hilly/ tribal and 5000 in plain areas
• A Primary Health Centre (PHC) caters to a population of 20000 in hilly/ tribal areas and 30000 in plain areas. One PHC acts as a referral centre for 5- 6 HSCs (on average).
• A Community Health Centre (CHC) services a population of 80000 in hilly/ tribal areas and that of 120000 in plain areas. 4 PHCs drain into 1 CHC
Jammu and Kashmir is a Phase-III state under IDSP and has been inducted into the programme during 2005-06.The state PIP was received and MoU was signed with GoI. Dr B.A. Gash, Director of Health Services for Kashmir region and Dr. B.S. Patania, Epidemiologist, for Jammu and has been designated as the State Surveillance Officer. The component wise action points are as under:
1. Manpower • State surveillance officer & RRT team members identified and trained under IDSP • Selection of epidemiologists, microbiologists and entomologists completed • Contractual staff appointment of consultant (F) , Consultant (Training) , epidemiologists,
microbiologists and entomologists pending
2. IT & EDUSAT - Only 2 training centre on EDUSAT has been installed in two medical colleges (Govt. Medical College and Shere- Kashmir Institute of Medical Sciences in Srinagar) - Total of 19 sites identified of which in 16 site data centre has been installed and in three
centres Kargill, Ladkah and Doda yet to be installed. - In 9 places broadband connections at 5- DSU, 1- SSU & 3 Medical colleges (two in Srinagar
and one in Jammu) installed. 3. Training
State surveillance officer & RRT members trained in IDSP state level trainings of Medical officers, health workers, District Lab technicians & peripheral lab Technicians pending.
4. Laboratory Strengthening One Priority district laboratory at Provincial lab. Srinagar has been identified for Strengthening under IDSP. Procurement of equipment is under process 5. Data Reporting : Weekly Surveillance data and outbreak reports need to be reported to CSU and entered in IDSP portal i.e. www.idsp.nic.in).
6. Outbreak : Reporting of disease out break from the state is yet to be started
Jammu & Kashmir
24
7. Finance: (In lakhs)
Year Release Expenditure 2005-06 13.80 2006-07 - 2007-08 61.20 0 2008-09 - 16.27 Total 75.0 Balance - 58.73 lakhs
• An amount of Rs 75.0 lakhs has been released as grant in aid in November 2007. The total balance at present is 75.0 lakhs. • Audit report & utilization certificate for 2007-08 is yet to be received at CSU. • Financial Monitoring Report (FMR) for quarterly ending March 2009, is yet to be
received at CSU IT Issue: Video conferencing Issue
Jammu unit not supplied
Only supplied to Srinagar unit, - EDUSAT not installed , Due to missing of handycam at SSU informed by engineer not
informed to CSU by SSU - RFT - replacement of faulty equipment (RFT radio frequency transmitter ) of V-SAT
antenna
To be replaced and installed by HUGHES vendor of ISRO
Jammu & Kashmir
25
NATIONAL PROGRAMME FOR CONTROL OF BLINDNESS
STATUS NOTE ON JAMMU & KASHMIR
Magnitude: Prevalence of blindness 2003-04 1.61%
Estimated blind persons 1.62 lakhs Infrastructure developed Upgraded Medical Colleges 2 Upgraded District Hospitals 10 District Blindness Control Societies 14
Mobile Eye Care Units 6 Eye Banks 2
Upgraded PHC’s 76 Cataract Performance School Eye Screening
YEAR TEACHER TRAINED IN SCREENING FOR
REFRACTIVE ERRORS
SCREENED DETECTED
WITH REFRACTIVE
ERRORS
PROVIDED FREE
GLASSES
2007- 2008 0 41250 62478 0 2008-2009 0 90988 41808 550
GIA released to Distt. Blindness Control Societies/State Blindness Control Society.
(Rs in lakhs) YEAR RELEASED EXPENDITURE BALANCE
2007-2008 48.50 0 48.50 2008-2009 17.40
Issues/Agenda Points
• Physical performance reports i.e. cataract operations, School Eye Screening, Eye Donation
etc. are not being received timely. • Utilization Certificates for financial assistance are also not being received timely.
YEAR TARGET ACHIEVEMENT 2007-2008 10000 11845 2008-2009 20000 15404
Jammu & Kashmir
26
NIDDCP
Approval issued for the year 2009-10
Rs. Lakh
Activity Amount proposed
Amount Approved Remarks
1 Establishment of
IDD Control Cell
6.00 6.00
The State Government may carry out
the activities as per the fund allocation of GOI.
2 Establishment of IDD Monitoring
Lab 4.00 3.50
3 Health
Education and Publicity
10.00 6.00
4 IDD surveys - 2.50
Total 20.00 18.00
Jammu & Kashmir
27
Mapping of Record of Proceedings of the NPCC of NRHM for 2005-06 to 2009-10
This has been prepared to indicate allocations to the State in the previous years for different activities as per the State Programme Implementation Plan. The mapping charts the NRHM Mission Flexipool approvals contained in the RoP in following broad thematic chapters.
1. ASHA (including selection, training, drug kits, mentoring, specific performance incentives and anything else associated with ASHA)
2. Infrastructure related matters (including construction, strengthening, renovation, new construction etc), equipments, transport (ambulances, EMRI, associated expenses) and others)
3. Human Resource related matters (including HR salary, contractual payments, incentives, etc)
4. Programme Management related matters (including PMUs, SHS/DHS, SHSRC, IDHAP, M&E, Mobility support to SHS etc)
5. Untied funds, AMG & RKS related mattes 6. Training & Capacity Building related matters (including trainings, workshops, training
institutions including their upgradation or new construction, courses, etc) 7. Innovations (including Procurement of medicines, School Health, Health Mela,
Insurance, Accreditations, Monthly VHND etc)
NATIONAL RURAL HEALTH MISSION
Jammu & Kashmir
Total MFP Approvals 8628.50 16840.22 9125.00 11661.47
RoP Approvals for various tyears in Rs. Lakh
S.No Initiative 2005-06 2006-07 2007-08 2008-09 2009-10
Remarks Released Approved Approved Approved Approved
ASHAs
1 ASHA selection & Training 102.00
500.00 95.00 54.15
420.65
2 Drug Kits for ASHAs 10.00 57.00 3 ASHA Mentoring set up 237.50 TOTAL 112.00 500.00 95.00 348.65 420.65
Infrastructure related matters 4 Construction of PHC 1000.00
4000.00
5 Strengthening of DH to IPHS 4000.00 2000.00 1400.00
6 Upgradation of SDH to DHs 2000.00 2000.00 350.00
7 Upgradation of Existing Facilities 3500.00 1000.00
Jammu & Kashmir
28
8 Strengthening of Sub-Centre 105.00 1000.00
9 Upgradation of CHC 840.00 560.00 1000.00
10 Neonatal ICU at District Hospitals 50.00
11 Sick Neonatal Care Units 10.68 12 Drug warehouse 100.00 13 Rent of Sub Centres 40.00
14 Procurement of Ambulances 400.00 1000.00 50.00
15 MMU Tracking System 20.00 16 MMU 294.00 100.00
17 Advanced mobile units with Emergency care facilities
400.00 246.00
18 Running cost of MMUs 208.00 19 Telephones at SCs 5.00
20 Maintainence of telemedicine equipments 7.00
Total 840.00 6665.00 10749.00 5331.00 4100.68 Human Resources related matters
21
Augmenting the HR in Public system including contractual ANMs, SNs, technicians, doctors specialists, incentives to these perosn etc.
337.50 1092.00 2095.00
22 AYUSH manpower at CHCs 100.00
1000.00
23 AYUSH manpower at PHCs 200.00
24 Tribal Outreach and Amchi Healer 5.27 53.54
25 HR for MMU managed through BADP 39.00
Total 0.00 642.77 1092.00 3187.54
Programme Management related matters
26 SHS Meetings 0.20 27 Concurrent evaluation 50.00 28 Concurrent Audit of DHS 15.84 29 HRD centre 35.52 34.00
30 National meeting of District Society 4.40
31 District Health action plans 140.00 40.00
32 Improving management through training & performance based rewards
11.70 29.21
Jammu & Kashmir
29
33 Telecom & Monitoring funds 17.79
34 Operational cost of SHS 39.45 26.50
35 SHRC at Jammu & Srinagar 100.00
36 Operational cost of DPMU/BPMU 506.33 144.80
37 PMU at state & divisional level 139.20 102.50
38 Capacity Building for M & E 35.00 60.00
39 Mobility Support to CMOs and DHIO 4.00
40 Mobility support for BMO 216.33
Total 140.00 0.00 896.20 326.22 390.35
Untied Funds, Annual Maintainence Grants and RKS fundsrelated matters
41 Rogi Kalyan Samiti- District Hospitals
517.00
110.00 110.00
588.00
42 RKS at 61 SDHs & 57 CHCs 118.00 85.00
43 Rogi Kalyan Samiti-PHC 347.00 375.00
44 Untied Fund for CHC & SDH 28.50 42.50
1084.75
45 Untied Fund for PHC/APHC 83.50 93.50 93.75
46 Untied Fund for SC 188.00 190.70 190.70
47 Untied Fund for VHSC 50.00 773.70 100.00
48 Annual Maintenance Grant- SC 190.70 64.40
333.80
49 Annual Maintenance Grant to CHCs and SDHs 57.00 85.00
50 Annual Maintenance Grant -PHC 167.00 187.00 187.50
Total 188.00 817.50 2096.10 1333.85 2006.55
Training & Capacity Building related matters
51 Strengthening of RIHFW Jammu & Srinagar 5.00 356.00
52 Repair/ Renovation of ANMTCs & Nursing schools
220.00 100.00
53 Orientation workshops at SHS 1.00
54 Orientation workshops of DHS members 2.20
Jammu & Kashmir
30
55
Convergence with AYUSH, AMCHI, ICDS, RD Public Health, Education and other departments.
2.00 74.40
56 District level wokshops as above 4.50
57 TA/DA to resource persons for workshops 2.50
58 Promotional training of Female HW & LHV 3.24
59 Block level workshops for BDOs, CDPOs,Mos 5.35
60
Training to members of tribes on first aid, immunisation, pregnancy, drug kits,
19.00
61 Multi Skilling of Doctors in EmOC 132.15
62
Refresher trng of AWW in ANC & detection of compolicated cases and TA/DA for AWWs
18.48
63 Introduction of Nurse Practitioner Course
64 Implementation of Task Force Recommendation of Med Education
65 MDP training on HMIS, Public Health management at divisional level
3.60
66 MDP training for officers of NRHM, NDCPs & AIDs 7.14
67
Training, workshops etc including ToT of VHSCs, Non communicable diseases, drug policy and monitoring of trngs
17.87 116.50
68 Intersectoral trainings of AWW, AYUSH etc on Naitonal Progg
71.59
Total 0.00 415.42 203.01 544.09
Innovations related matters 69 School Health Programme 300.00 70 Health Mela 48.00 71 Health Insurance 50.00 10.00
72 Incentives to AWW for organising VHNDs 135.72
73 Kit A and B for SHCs 598.00
204.29 57.00 659.35 74 PHC Kit for PHCs 561.00
75 FRU Kit or CHCs, FRUs 4.14 590.00
Jammu & Kashmir
31
76
Scientific Bio-Medical Waste Management including training of doctors and paramedics
200.00 50.00 15.00
77 Specific activities for vulnerable groups 10.22
78
Incentives to AWW, drugs at AWC, anemia prevention, capacity bldg etc
280.04
79 Handicap Centre at Leh 55.00
80 Printing of modules, docuemtns etc 50.00
81 Accreditation of Hospitals through QCI 30.00
82 ARSH 7.00
83 Monthly Village Health & Sanitation Day 90.44
Total 4.14 646.00 1945.73 397.72 1011.61