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DEPARTMENT OF HEALTH,

MEDICAL EDUCATION &

FAMILY WELFARE

GOVT. OF JHARKHAND

Review by Chief Secretary11.07.2013

Health Indicator - Jharkhand

Indicator Jharkhand India Goal

Year 2001 2006 2009 2010-11 2012-13 2010-11 2015

IMR

(Infant Mortality Rate)

62

(SRS-2001)

49

(SRS-2006)

46

(SRS-2008)

39

(SRS 2011)

38

(AHS2011-12)

44

(SRS -2011)

< 30

Full Immunization (%)

8.8*

(1998-99)

34.5*

(2005-06)

54.1 #

(2007-08)

63.7

(AHS-2010-11)

77

(HMIS)61 (CES) 100

MMR

(Maternal Mortality

Rate)

400

(SRS-2001)

371

(SRS-2003)

312

(SRS-2006)

261

(SRS-2009)

-212

(SRS-2009)

< 100

TFR

(Total Fertiity Rate)N.A.

3.4

(2006)

3.2

(2008)

2.9

(SRS 2011)-

2.4

(SRS 2011)

< 2.1

Institutional

Delivery (%)

13.9*

(1998-99)

19.2*

(2005-06)

31.2340.1

(CES-2009)

46

(HMIS)

72.9

(CES)

(Source : SRS, *NFHS-2 & 3,, #DLHS-III SRS Special Bulletin, Coverage Evaluation Survey (CES-2009)

2

Indicator Jharkhand National

Birth Rate (Per 1000)

23.3 (AHS – 2011-12)

21.8(SRS 2011)

Death Rate (Per 1000)

5.8(AHS – 2011-12)

7.1(SRS 2011)

Child Mortality Rate(Per 1000 live birth)

26.1(National Health Profile)

18.4(National Health Profile)

Sex Ratio 947(Census 2011)

940(Census 2011)

Child Sex Ratio(0-6 Age Group)

943(Census 2011)

914(Census 2011)

Anemia among women (15 -49 Yrs)

70.4(NFHS-3)

56.2(NFHS-3)

Health Indicators - Overview

3

National Disease Control Program (Disease Prevalence)

Disease Prevalence 2007 2011 2012-13

Malaria Mortality Rate

(per lakhs)0.10 0.05 0.02

Kala Azar Mortality Rate

(per lakhs)0.47 0.06 0.01

Kala-azar prevalence rate

(per 10,000 population)11.38 12.89 7.48

Filaria prevalence rate

(per 10,00,000 population)412.7 157.2 139.3

Japanese Encephalitis prevalence rate

(per 10,000 population)0 0.03 0.003

Dengue prevalence rate

(per 10,000 population)0 0.012 0.025

Chikunguniya prevalence rate

(per 10,000 population)0 0.12 0.001

Leprosy Prevalence Rate

(per 10000 population)1.1 0.59 0.66

Tuberculosis Cure Rate (%)

(In 100 TB Patients)83 86 86

4

Health Infrastructure IPHS

(Census 2001)Sanctioned Gap

Health Facilities

HSC 7088 3958 3130

PHC 1005 330 675

CHC 188 188 0

SDH NA 12 NA

100 Bedded DH 24 24 0

200 Bedded DH - 3 -

300 Bedded DH - 1 -

500 Bedded DH - 3 -

Institutions & Others Facilities

ANM Training School NA 10 NA

GNM School NA 3 NA

Trauma Centre - 2 -

Medical Colleges NA 3 NA

MCH Centre NA 26 NA

Ayurvedic, Homeopathic, Unani

Medical College sNA 1+1+1 NA

Ayurvedic Pharmacy Colleges NA 2 NA

Construction StatusNo. of Schemes 1120

Ongoing 654

Complete 466

Health Facilities - Jharkhand

5

Medical Officers & Paramedics Status (HSC - 3958, PHC - 330, CHC - 188, SDH - 10, DH -22)

Category

To

tal

Req

uir

ed a

s

per

IP

HS

2

01

0

Sa

nct

ion

ed

(Reg

ula

r)

Wo

rkin

g

Reg

ula

r)

Wo

rkin

g

Co

ntr

act

ua

l

NR

HM

Wo

rkin

g S

tate

Co

ntr

act

Wo

rkin

g T

ota

l

(Reg

ula

r+

Co

ntr

act

ua

l)

Sh

ort

fall

as

per

IPH

S n

orm

s

Medical Officers 44512048 (MO)

35 Dentist1510 50 322 1882 2569

ANM 7916 6020 4668 3269 1192 9129 0

Staff Nurse 3381 379 276 371 99 746 2635

Pharmacist 1332 385 122 94 158 374 958

Lab Technician 1338 443 144 223 140 507 831

Radiographer 169 50 32 80 0 112 57

Lady Health Visitor 1045 473 155 0 0 155 890

Dresser 488 471 88 0 0 88 400 6

Sectors Amount (Rs. in Crores)

%

Machineries &

equipments

31.76 4.8Supplies and

materials

Medicines

Construction /

renovation works 229.42 35.0

Establishment 54.08 8.3

Other Units 81.64 12.5

Grant in aid 238.00 36.3

State Share 20.10 3.1

Total 655.00 100.0

State Plan-Outlay : 2013-14

Rs. In Crore3.89 % of the State Plan Budget

7

Outlay for Infrastructure & Others

35 %

65 %Scheme Amount

Infrastructure 229.42

Others 425.58

Total 655.00

(Rs. in Crores)

8

ProgrammeProposed

13-14

Approved

13-14

RCH Flexi

Pool 482.49 277.15

Mission

Flexi Pool 404.57 203.14

Immunizatio

n 45.75 41.61

NIDDCP 3.28 0.24

IDSP 5.84 2.66

NVBDCP 60.30 14.89

NLEP 7.32 5.12

NPCB 13.25

RNTCP 14.94 19.20

Infrastructu

re

Maintenance

(TR)

152.8

Total 1016.24 716.71

NRHM-Proposed Budget : 2013-14

Rs. In Crore

9

Improvement in health indicators.

Making functional of Jharkhand Medical & Health Infrastructure

Development and Procurement Corporation Ltd.

Construction of 24 HSCs and 1 PHC by pre-fabricated materials.

Signing of MoU with private partner for operation and

maintenance of 500 Bedded Hospital in Ranchi on PPP.

Setting-up of Advanced Diagnostic Centres on PPP at Medical

Colleges and District Hospitals.

Setting up of new Medical Colleges & Hospitals in 5 Divisional

Headquarters On PPP mode.

108 Emergency Ambulance service.

104 Health Information Helpline.

Focus and Priority Area : 2013-14

10

Setting-up Yoga Centre.

Telemedicine Centres.

Cancer Hospital in Ranchi.

Construction of various health facilities.

Control of diseases.

Efforts are being made for increasing of seats from 50 to 100 in

PMCH, Dhanbad and MGMCH, Jamshedpur and from 150 to

200 in RIMS, Ranchi.

Increase/start PG Courses in medical colleges.

Focus and Priority Area : 2013-14

11

Proposed Projects under PPP

Setting up of Medical Colleges with 300 bedded Hospitals at Palamau,

Chaibasa, Dumka, Hazaribagh & Ranchi.

Operating 500 bedded Hospital at Ranchi.

Advanced Diagnostic centres in 3 Medical Colleges and 24 District

Hospitals.

Setting up of Medico City near Ranchi.

Received concept note from Planning Commission. Clarification sought

from Planning Commission.

12

Improving Human

Development Indicators

13

Reducing MMR

14

Progress & Target : MMR

Year Jharkhand India

1999-2001 400

2001-2003 371 301

2004-2006 312 254

2010* 261 212

2015(Goal set by

NRHM, Jharkhand)

200 100

* Annual Health Survey 2010 - (35% reduction in last decade)

Maternal Mortality Rate (1 lakh live births)

15

Strategy for Reducing MMR

Home/ Out Reach Based :

2.88 lakh VHND sessions planned in FY 2013-14 for Registration of PW and ensuring

4 ANCs through monitoring, supervision, MCTS Tracking.

Sahiya has been given the responsibility

• To mobilize all PW to the VHND site for Full ANC

• Birth Preparedness/ Counseling.

• Post Natal Home visit

Duty Roster of ANM has been rescheduled for afternoon home visit to ensure ANC

HBNC Training for Sahiyas in Mod 6A, 6B and 7A is on going.

10400 Bicycle distributed to Sahiya and 16000 more Cycles in process to be

distributed.

Types of Service-

Home/ Outreach base

Programmatic/ Facility based

FRU based

16


JSY: Women are given Cash Incentive after Institutional Delivery

• Rural Area = 1400/-

• Urban Area = 1000/-

• Sahiyya Incentive = 350/-

JSSK: Provision for Cash Less Delivery as an entitlement for PW

• Free Drug, Diagnostic, Blood, Diet for pregnant women.

• Free Referral through PPP mode Mamta Vahan initiative for pregnant

women.

• Free C-Section facilities in FRUs through specialist / trained Mos.


17


Anaemia Control Measure - Strategy through Life Cycle Approach

• Through Iron Supplement among Children age group (6 months to 60

months)

• Weekly Iron Folic Supplement among Adolescent (WIFS)

• Bi-annual de-worming

• Iron Folic Acid Supplement among Pregnant Women during ANC.

• Screening for moderate and severe anaemia and referral appropriate

health facility

• Kishori Swasth Pakhwara for health screening of Adolescent girls

• Continuum of Care through RMNCH+A (Reproductive Maternal

Newborn Child Health + Adolescent)


18


Proposed to introduce “108“ Emergency Ambulance Services

IEC & BCC Bureau setup for awareness creation in the community

3652 ANM/ Grade A nurse trained in SBA. 606 proposed in 2013-14.

Programmatic/Facility based

46 FRUs functional and 14 (6 old + 8 new) FRUs proposed.

Rational deployment of Specialist/ Trained Man power

Strengthening of Blood Banks / Blood Storage units

EMOC and LSAS training to Medical Officers

FRU Based

19

Improving Institutional

Delivery

20

Progress : Institutional Delivery

Source - HMIS

21

Progress : Janani Suraksha YojnaTarget & Achievement of 1st ANC & Institutional Delivery

959000

727764 (76%)

432668(46%)

Target of Pregnant Women

Registration of Pregnant Women (1st ANC)

Institutional Delivery

Source: HMIS

149176*

128004(85%)

64159 (43%)

Target of Pregnant Women

Registration of Pregnant Women (1st ANC)

Institutional Delivery

FY 2012-13 FY 2013-14 (April-

May)

* Annual Target : 895055 22

4

13

9

15

615

2

37

Abortion Obstructed/ prolonged labour

Severe hypertesnion/ fits Bleeding

High fever Anemia

N= 467 N=507

211

17

17

7

121

34

2012-132011-12

Maternal Death Review

23

17

46

60

0

10

20

30

40

50

60

70

2011-12 2012-13 2013-14 (E)

889

1941

628

0

500

1000

1500

2000

2500

2011-12 2012-13 2013-14 (April-May)

Progress: First Referral Unit (FRU)

24

Entitlements under JSSKAchievement

12-13

Achievement

13-14

Institutional Delivery 432667 128004

Free Drug 163573 40203

Free Diet 144551 34608

Free Diagnostic 138311 28606

Free Blood 224 192

Home to Health 149245 23890

Transfer to higher level 4555 753

Drop back home 131170 17705

Progress : Janani Shishu Surksha Karyakarm

25

Janani Surksha Yojana (JSY) & Janani Shishu Surksha Karyakaram (JSSK) -

Strategy for Improving Institutional Delivery

Cash incentive for pregnant women under institutional delivery.

Free drug, Diagnostic, Blood, Diet for pregnant women.

Free Referral through PPP mode Mamta Vahan initiative for pregnant women.

Free C-Section facilities in FRUs through specialist / trained MOs.

Implementation of JSSK upto HSC Level.

Normal (uncomplicated) pregnancies,

Normal childbirth,

The immediate postnatal period, and

Identify, manage and refer complications among pregnant women and newborns.

Skill Birth Attendant (SBA) –

A Skilled Birth Attendant is an accredited health professional – such as midwife, doctor

or nurse – who has been educated and trained to proficiency in the skills needed to

manage

26

Strategy for Improving Institutional Delivery

Increase in Delivery Points -

In addition to 465 existing delivery points (HSCs) , 776 new delivery

points has been identified & made operational by the state.

Strengthening of PHCs for 24x7 delivery services.

Strengthening of FRUs

Hiring of Specialist doctors.

Delivery Points FY 12-13FY 13-14

(April-May)Strategy

Level 1 465 1230 Ensure SBA Trained

24X7 PHC 45 85

Level 2 150 150

Level 3 46 46

Ensure Deployment of Specialist &

Motivational Incentive for 5000 C- Sections to

the team

Total 706 1057

27

Reducing IMR

28

IMR (Per 1000 Live Birth)

Progress & Target : IMR


2001 62 67

2002 51 60

2003 51 60

2004 49 58

2005 50 58

2006 49 57

2007 48 55

2008 46 53

2009 44 50

2010 (AHS)

41 47

2011 (SRS)

39 44

2012(AHS

2011-12)

38 -

2015 (E) 30 30

Lower reduction of IMR to 30 per 1000 live births by 2015 –

(44 % deduction in last decade)

62

51 5149

5049

4846

44

4139

38

30

67

60 6058 58

5755

53

50

47

44 44

30

25

30

35

40

45

50

55

60

65

70

Jharkhand

India

29

Child MortalitySRS

2007

SRS

2008

SRS

2009

SRS

2010

AHS

2010-

11

AHS

2011-

12

MDG

Target

Neo Natal

Mortality

Rate(NMR)28 25 NA NA 26 19

Infant Mortality

Rate(IMR)48 46 44 41 41 38 < 30

Under 5 Mortality NA NA NA NA 59 49

Estimated live births per year8.2 lakh

Estimated number of children under 5 years43 lakh

Progress : NMR, IMR & Under 5 Mortality

30

Progress & Target : Full Immunization

Source - HMIS

31

Progress : Full ImmunizationTarget & Achievement of Full Immunization

Source: HMIS

FY 2012-13 FY 2013-14 (April-

May)

* Annual Target : 782245

837000

643702

(77%)

0

100000

200000

300000

400000

500000

600000

700000

800000

900000

Target of Infant Full Immunization

130375

98915

(76%)

0

20000

40000

60000

80000

100000

120000

140000

Target of Infant Full Immunization

32

As on 13.05.2013 Mothers Children

District Target MCTS % Entered Target MCTS % Entered

Bokaro 60,000 26,547 44 53,000 26,303 50

Chatra 30,000 12,749 42 26,000 16,639 64

Deoghar 43,000 13,455 31 38,000 14,382 38

Dhanbad 78,000 24,092 31 69,000 30,264 44

Dumka 38,000 16,676 44 33,000 13,571 41

Garhwa 39,000 19,006 49 34,000 23,637 70

Giridih 71,000 36,342 51 62,000 42,955 69

Godda 38,000 21,231 56 33,000 23,324 71

Gumla 30,000 16,334 54 26,000 13,947 54

Hazaribagh 51,000 31,253 61 44,000 27,983 64

Jamtara 23,000 11,778 51 20,000 12,451 62

Khunti 15,000 10,157 68 14,000 7,414 53

Kodarma 21,000 9,538 45 18,000 8,214 46

Latehar 21,000 8,735 42 18,000 12,760 71

Lohardaga 13,000 9,198 71 12,000 8,344 70

Pakaur 26,000 13,369 51 22,000 8,030 37

Palamu 56,000 35,458 63 49,000 38,033 78

Pashchimi Singhbhum 44,000 30,234 69 38,000 26,546 70

Purbi Singhbhum 67,000 28,269 42 59,000 21,059 36

Ramgarh 28,000 12,019 43 24,000 10,005 42

Ranchi 85,000 35,476 42 74,000 29,887 40

Sahibganj 34,000 24,299 71 29,000 20,906 72

Saraikela 31,000 21,736 70 27,000 16,989 63

Simdega 17,000 8,352 49 15,000 9,988 67

JHARKAHND 9,59,000 4,76,303 50 8,37,000 4,63,631 55

Progress : MCTS (12-13)

33

As on 13.05.2013 Mothers Children

District Target MCTS % Entered Target MCTS % Entered

Bokaro 9285 4041 44 8205 662 8

Chatra 4631 190 4 4016 86 2

Deoghar 6427 827 13 5644 453 8

Dhanbad 12496 342 3 11065 44 0

Dumka 6484 297 5 5636 101 2

Garhwa 6006 264 4 5263 5 0

Giridih 10438 3519 34 9186 1483 16

Godda 5929 1845 31 5077 246 5

Gumla 5097 934 18 4430 408 9

Hazaribagh 6796 2242 33 5986 1952 33

Jamtara 3878 455 12 3370 8 0

Khunti 2376 326 14 2091 86 4

Kodarma 3173 1161 37 2798 330 12

Latehar 3295 247 7 2863 642 22

Lohardaga 2465 1061 43 2120 539 25

Pakaur 5149 1417 28 4428 83 2

Palamu 8381 1336 16 7284 449 6

Pashchimi Singhbhum 7429 2576 35 6395 1345 21

Purbi Singhbhum 9070 2680 30 8039 1307 16

Ramgarh 3722 1008 27 3279 162 5

Ranchi 13052 2556 20 11486 815 7

Sahibganj 5355 1657 31 4595 207 5

Saraikela 5264 2359 45 4532 1163 26

Simdega 2980 763 26 2587 527 20

JHARKAHND 149176 34103 23 130375 13103 10

Progress : MCTS (13-14)

34

Strategy to reduce Child Mortality

1. Essential Newborn Care

• NSSK – Training to all facility level worker & at present 203 NBCC

functional and in FY 13-14 - 335 New NBCC is proposed at L1 level.

2. Care of the sick newborn

• NBSU – 40 NBSU will be made functional at FRU

• SCNU – 17 new SCNU is proposed in FY 2013-14

• JSSK - New born will be provided free diagnostics, free treatment,

free referral and if needed free blood transfusion.

• Up-Referral – Mamta Wahan will be used for referring sick children

to higher facility as well as take up sick child from home to facility

and facility to home.

3. Home Based New Born Care

• By Sahiyya (HBNC Protocol) – 6 Home visits by Sahiyya will be

made.

4. Promoting IYCN practices – Breast feeding practices will be improved

5. Routine Immunization - 80 % Full Immunization among infant is targeted

35

Strategy to reduce Child Mortality

6. Micronutrient Supplementation

• Vit „A‟ Supplementation will be done in biannual round.

7. Control of Childhood Anaemia

• De-worming will be done in biannual round.

• IFA Supplementation will be done in biannual round.

8. Diarrhoea Management-Zinc and ORS

9. Acute Respiratory Infection (ARI) Management

36

Tackling under-nutrition

37

Facility Base Care of Children with Severe Acute Malnutrition

No. of functional

NRCs /MTCs

Total bed

strength To

tal

ad

mis

sio

ns

Ch

ild

ren

Tre

ate

d

Dea

th

Up

ref

erra

l

Def

au

lter

/

LA

MA

Total no. of children under

follow up

F1 F2 F3

57 NRHM + 09

MESO Hospitals

(66)

515 + 45

(560)14914 13387 60 278 1191 6478 4962 4123

IN FY 12-13 up to March‟13 7529 6514 16 151 482 3269 2377 1915

38

Strategy for under-nourished Children & Women

Under nourished Children –

66 Malnutrition Treatment Centres are functional with 560 beds and 28

new MTCs will be made functional with additional beds 370 in FY 2013-

14.

Control of Childhood Anaemia

• De-worming will be done in biannual round.

• IFA Supplementation will be done in biannual round.

Under nourished Women -

Weekly Iron Folic Acid Supplementation (WIFS) with convergence of

ICDS and HRD.

Kishori Swasthya Pakhwara – Following services given to school going

and out of school adolescent girls (10-19years )

• Hb testing

• BMI analysis

• IFA distribution

• De worming

• Nutrition education session

• Referral

39

Reducing TFR

40

Source - SRS

Progress : Total Fertility Rate (TFR)


2005 3.5 2.9

2006 3.4 2.8

2007 3.2 2.7

2008 3.2 2.6

2009 3.2 2.6

2010 3.0 2.5

2011 2.9 2.4

TFR has declined 14 % since 2004 to 2011

3.53.4

3.2 3.2 3.2

32.9

2.92.8

2.72.6 2.6

2.52.4

1

1.5

2

2.5

3

3.5

4

1 2 3 4 5 6 7

Jharkhand India

41

Strategy to reduce TFR

1. Strengthening Spacing Methods

a. Increasing number of providers trained in IUCD 380 A.

b. Strengthening Fixed Day IUCD services at facilities.

c. Introduction of Cu IUCD 375

d. Delivering contraceptives at home of beneficiaries.

2. Emphasis on Post Partum family planning services.

a. Strengthening Post Partum family planning services

b. Promoting Post Partum IUCD (PPIUCD) services at DH and CHC

c. Appointing counselors at high delivery points

3. Strengthening Sterilization service delivery

a. Increasing pool of trained service providers (Minilap & NSV)

b. Operationalizing Post Partum Sterilization.

c. Holding female & male sterilization camps

42

Strategy to reduce TFR

4. Strengthening quality of service delivery

a. Strengthening Quality Assurance Committee for monitoring.

b. Disseminating/following existing protocols/guidelines/manuals

c. Monitoring of FP Indemnity Scheme.

5. Development of BCC/IEC tools highlighting benefits of FP specially on

spacing methods

6. Focus on using Private Sector capacity for service delivery (exploring

PPP mode)

7. Strengthening programme management structure

a. Establishing new structure for monitoring & supporting

b. Strengthening programme management support to state & district

level

43

Source - HMIS

Progress : Family Planning Services

Services ELA Progress so far % Achievement

2012-13

NSV 25000 8830 35

Tubectomy 150000 132083 82

IUCD 200000 101220 51

2013-14 (April-May)

NSV 3333 198 6

Tubectomy 25000 2039 8

IUCD 33333 9730 5

44

ARSH Programme

45

ARSH, School Health Programme, WIFS, Menstrual Hygiene Programme

Programme Target Progress so far Remarks

ARSH Clinics 194 192Reporting of 2

remaining clinics will

start by May 2013

School Health

Programme

41700 School;

67 Lakh Student

Schools covered

1st Round - 31000

2nd Round 26196

2nd round

Students covered -

2562935

WIFS 51 lakh316565 Adolescents

received IFA

Report till March „13.

.

Menstrual Hygiene

(Free days sanitary

napkin)

2037920

Adolescents1932669 (Sold )

Ranchi, Bokaro,

Dhanbad, Giridh &

Hazaribagh

Adolescent Health

April 2012 – April 2013

Progress : ARSH Programme

46

Tackling sex-ratio

47

Sex Ratio

Source - Census

979

965

943

945

927

914

880

900

920

940

960

980

1000

CSR 1991 CSR 2001 CSR 2011

Jharkhand India

Sex Ratio

Child Sex Ratio

930934

927

933

940

945

940

922

941947

905

910

915

920

925

930

935

940

945

950

19 71 19 81 19 91 20 01 20 11

India Jharkhand

48

Initiative taken by government of Jharkhand to improve the CSR (Child Sex

Ratio) under PC & PNDT

Sensitization of different stake holders-PRI members, NGO member &

Media representatives at District and block level

Involvement of community and stake holders during Save the girl Child

campaign against sex selection.

Massive IEC through Mass media, Print Media- Hoarding, Pamphlet,

Brochure, TV spot, Radio Spots, Nukkad Natak, News Paper Advertisement,

Wall Writing etc.

IEC through MMU as “Beti Bachao Rath”

Total Number of registered clinics-717.

Notification & sensitization of four State Committees done.

Strategy for improving Child Sex Ratio

49

Initiative taken by government of Jharkhand to improve the CSR (Child Sex

Ratio) under PC & PNDT

Committee formed ;

State Supervisory Board.

State Appropriate Authority.

State Advisory Committee.

State Inspection & Monitoring Committee.

During FY 2012-13 501clinics were inspected / visited and 45 clinics were sealed.

Orientation of judiciary personnel's /Legal experts done with JHALSA.

Sensitization and orientation meetings of all civil Surgeons and District Nodal

Officers and other stake holders.

Orientation of SIMC & DIMC done.

Sensitization of USG service providers and Owners of the clinic.

Strategy for improving Child Sex Ratio

50

Capacity Building

51

Training

Programme

Target for

2012-13

Achieveme

nt Till Apr-

Mar 2013

Achievement of

April 2013

Cumulative

Achievement Till April

2013

MATERNAL HEALTH

Skilled Birth

Attendant (SBA)

Health Worker

Training

(ANM,LHV)

825 (173

Batch)

763 66 3817

Emergency Obstetric

Care (EmOC)

Training (MO)

- - - 80

Re Orientation of

EmOC Trained MO

(MO)

48 (16 Batch) 44 - 44

Life Saving

Anaesthesia Skill

(LSAS) Training

(MO)

- 7 (backlog) - 91

Re Orientation of

LSAS Trained MO

(MO)

64 (16 Batch) 60 - 60

RTI/STI Training

(MO)

480 (24 Batch)

279 40 319

Training Progress: 2012-13 & April 2013

52

Training

Programme

Target for

2012-13

Achievem

ent Till

Apr-Mar

2013

Achievement of April

2013

Cumulative Achievement

Till April 2013

MATERNAL HEALTH

Bio Medical Waste

Management Training

(SN,ANM)

720 (24 Batch)

637 - 637

BEmOC 10 days

Training (MO)

20 (5 Batch) 26 (With

Backlog)

8 34

Medical Termination

of Pregnancy (MTP)

Training (MO)

62 (31 Batch) 53 - 570

ANC, MCP card &

labor room Register

Training (ANM)

7530 (251 Batch)

2751 667 3418


53

Training Programme Target for 2012-

13

Achievement Till

Apr-Mar 2013

Achievement of

April 2013

Cumulative

Achievement Till

April 2013

CHILD HEALTH

IMNCI Health Worker

Training (ANM)

2400 (100 Batch) 2576 (with backlog) 20 19901

MTC Training on new

module (MO,ANM)

245 (7 Batch) 227 - 227

NSSK District Level

Training (MO)

96 (6 Batch) 201 (with backlog) - 1205

NSSK District Level

Training (SN,ANM)

1056 (44 Batch) 1058 - 2457

FAMILY PLANNING

Minilap cum MTP

Training (MO)


CU IUCD 375 Training

(MO,SN)

144 (6 Batch) 111 - 111


54

Training

Programme

Target for

2012-13

Achievement Till

Apr-Mar 2013

Achievement of

April 2013

Cumulative

Achievement Till

April 2013

PPIUCD Training

(MO/SN)


Non ScalpelVasectomy (NSV)

Induction Training (MO)


Non ScalpelVasectomy (NSV)

Refresher Training(MO)

28 (7 Batch) 26 - 26

CTU District Level Training

182 (8 Batch) 92 25 540


55

Training Programme Target for

2012-13

Achievement Till

Apr-Mar 2013

Achievement of

April 2013

Cumulative

Achievement Till

April 2013

ARSH TRAINING

Roll out training on

ARSH at District Level

(ANM,LHV, Male

Supervisor, MPW)

600 (24 Batch) 713 (with backlog) 47 2094

State Level ToT for

WIFS (ACMO,DEO,

DSWO)

72 (2 Batch) 58 - 58

ARSH Dist. ToT for

WIFS

600 (24 Batch) 638 - 638

Other ARSH Training

(Mahila Samakhya,

Nehru Yuva Kendra,

Refresher MO)

184 147 - 147


56

Community Mobilization &

Mobile Medical Unit

57

Progress: Community Mobilization

ActivityTarget (2012-

13)

Progress 2012-

13

Progress 2013-

14 (April-May)

No. of Sahiya Selected 40964 40964 40964

No. of VHSNC formed 30012 30012 30012

6A Module Training (HBNC) 40964 33092 36717

6B Module Training (HBNC) 40964 23711 32801

7A Module Training (HBNC) 40964

45 (State TOT)

831 Dist. Res.

Pers.

8267

No. of PTG Sahiya 150 120 120

Drug Kit Distribution 40964 40310 40310

PRI Training 60000 37392 39247

Sas Bahu Pati Sammelan 2000 1500 2175

Sahiya Sammelan 24 24 6

Sahiya Help Desk 98 98 98

Community Base

Monitoring

At Block level 48 46 29

At District

level24 16 0

58

Community Mobilization

Sahiya Samwad on every Saturday.

Formation of Sahiya Sanskritik Manch

Monthly Community news bulletin – Sahiya Sandesh

Special Appeals for Sahiya.

Distribution of Bi-cycle to 10435 Sahiya in High Focus Districts in 2011-12

and 6500 Bi-cycle in FY 2012-13

HBNC Kit – procurement & distribution under progress ; 15000 kit

distributed so far

Representation of PRI members in Rogi Kalyan Samitee and VHSNC

Delegation of financial and administrative powers to PRI has been notified.

59

Sl. No DISTRICT No. of MMUsTotal no. of Patient

observed

Cumulative report

on x-ray

Cumulative report

on Patho. Test

Cumulative report

on no. of ECG

Conducted

Cumulative report

on Cases reffered

1 Bokaro 4 86147 979 14506 2616 7231

2 Chatra 4 78471 783 5616 1017 1534

3 Deoghar 5 87750 421 13243 326 7937

4 Dhanbad 5 96873 856 11083 826 4670

5 Dumka 3 49651 377 8155 170 1357

6 E. Singhbhum 5 97375 2316 14382 184 2843

7 Garhwa 3 68151 327 4638 18 934

8 Giridih 5 94438 461 7459 2515 3672

9 Godda 3 56957 770 9574 87 2386

10 Gumla 4 64171 519 8009 49 1898

11 Hazaribagh 4 62645 1259 5837 1542 2163

12 Jamtara 5 80579 2238 19046 213 2233

13 Khunti 5 94613 1287 11373 509 2825

14 Koderma 3 89292 2226 10251 729 1946

15 Latehar 3 51198 1470 8746 64 1363

16 Lohardaga 5 84488 611 9622 320 1455

17 Pakur 3 34951 428 7807 35 960

18 Palamu 5 141756 1867 32317 511 3037

19 Ramgarh 3 54793 1146 10948 621 1775

20 Ranchi 5 82924 2203 10655 9 2123

21 Sahebganj 5 84971 1552 19808 370 2747

22 Saraikela 5 82405 496 8501 232 1958

23 Simdega 3 24723 82 3271 18 725

24 W.Singhbhum 4 98092 770 14456 326 1787

Total 99 1847414 25444 269303 13307 61559

Note:- Total-103 MMUs in Jharkhand State.

Total-99 MMUs Operatioanal, 1MMU District Hazaribagh are Repaired in BEBCO (Jamshedpur),1 MMU District

W.Singhbhum Tranfer to District Latehar, 1 MMU District Koderma Financial Tender under process, 1MMU District Latehar

MoU under Process.

Mobile Medical Unit Progress: 2012-13

60

National Disease Control

Programmes

61

National Vector Borne

Disease Control Programme

62

Physical Targets/ achievement for Vector Borne Diseases

Activity National TargetAchievement

(2012)

Target of Jharkhand for

2013-2014

ABER (Annual Blood

Slide Examination)ABER > 10 10.87 % 13%

API (Annual Parasite

Incidence)

(malaria cases per

thousand population)

API 1.3 or less by 2012 3.90 Less than 3.32

Mortality due to

malaria

50% reduction by 2010 (NHP

2002) 67.74% reduction w.r.t. 2007 Reduction by 40%

Kala-azar Case Elimination of Kala-azar by

2015 26% decrease w.r.t. 2007

Reduction in morbidity by

30%

Mortality due to Kala-

azar

100% reduction by 2010 and

elimination by 201595% decrease w.r.t. 2007

Reduction in mortality by

75%

Mortality due to

Dengue

- Effective morbidity control

- Reduction in mortality by 50%

compared to 2002

100% decreaseReduction in mortality by

50%

Mortality due to

AES/JE

Reduction in mortality by 50%

by the year 2010100% Decrease

Reduction in mortality by

50%

FilariaTo bring down Micro filaria rate

less than 1 0.63 Less than 1 Micro filaria rate

235 HR were recruited in FY 2012-13 and 493 HR proposed for FY 2013-14

63

Strategy : Vector Borne Diseases Control Programme

Bring down malaria cases per 1000 population - 3.32

Indoor Residual Spray (Malaria) – Target for spray – 63 lakhs population

Indoor Residual Spray (Kala-azar) - Target for spray - 16.54 lakhs population

Bring down Kala-azar cases per 10000 population – 6.0

Fortnight case search for Kala-azar – 4 (per quarter)

Filaria – hydrocele operation – 1500

Active vector surveillance for Dengue & Chikunguniya during transmission season

Space spray for control of JE vector.

Special Strategy for Saranda

Door to door fever survey by bivalent RD Kits

Indoor Residual Spray – Target for spray – 38527 population of all 56 villages

Introduction of larvivorous fish in perennial water bodies

64

National Leprosy Eradication

Programme

65

Progress : National Leprosy Eradication Programme

Prevalence Rate (PR/10,000 Population)

2007-

08

2008-

09

2009-

10

2010-

11

2011-

12

2012-

13June'13

India 0.74 0.72 0.71 0.69 0.68

Jharkhand 1.11 0.98 0.98 0.65 0.59 0.66 0.75

0.74 0.72 0.71 0.69 0.68

1.11

0.98 0.98

0.65 0.59

0.75

0

0.1

0.2

0.3

0.4

0.5

0.6

0.7

0.8

0.9

1

1.1

1.2

India

Jharkhand

66

Progress : National Leprosy Eradication Programme

Annual Case Detection Rate (ANCDR)

2007-08 2008-09 2009-10 2010-11 2011-12 2012-13 June'13

India 12 11 11 10 10

Jharkhand 21.9 16.7 16.4 13.4 10.7 10.8 10.9

1211 11

10 10

21.9

16.7 16.4

13.4

10.7 10.8 10.9

0

3

6

9

12

15

18

21

24

India

Jharkhand

*ANCDR-10/100000 Population 67

Strategy : National Leprosy Eradication Programme

Decentralized integrated leprosy services through General Health Care

system.

Early detection & complete treatment of new leprosy cases.

Carrying out house-hold contact survey of the all contacts of Multi-bacillary

(MB) & child cases.

Early diagnosis & prompt MDT, through routine and special efforts.

Involvement of Accredited Social Health Activities (ASHAs) in the detection

to & completion of treatment of Leprosy cases.

Strengthening of Disability Prevention & Medical Rehabilitation (DMPR)

services.

Information, education & communication (IEC) activities in the community

to improve self reporting to Primary Health Centre (PHC) and reduction of

stigma.

Intensive monitoring and supervision at Primary Health Centre/ Community

Health Centre.

68

Revised National TB Control

Programme

69

70

66% 66% 70%72% 72% 72% 72% 68%

41%

61%

71%72%

75%77% 77%

71%

86%83%

86%87% 87% 87% 88%

87%89% 89%

87%90% 90% 91%

30%

40%

50%

60%

70%

80%

90%

100%

2005 2006 2007 2008 2009 2010 2011 2012

Case Detection India Case Detection Jharkhand

Success Rate India Success Rate Jharkhand

Performance of Jharkhand in comparison to National performance Annualized NSP CDR & NSP Success Rate

Annualized NSP CDR1Q12 – 68%1Q13 – 67%

1Q12 – 91%1Q13 – 90%

70

Financial

Year

Opening

Balance

Approval

in FY

Funds

received

during FY

Total

funds

available

during

FY

Total

Expenditure

in the FY

Balance

in the FY

% of

Expenditur

e on fund

available

2012-13 206,29,

213

1270,96,

000

7,56,54,

510

9,62,83

,723

8,17,88,

891

1,44,94,

832

86%

2013-14

Till May

13

1,44,94,

832

To be

approvedNil

1,49,41,

505

20,47,

658

1,28,93,

84714%

Revised National Tuberculosis Control Programme

Progressive Expenditure for the financial Year 2012-13 & 2013-14

71

Progress : Revised National TB Control Programme

Other Achievements 2012-13

Expansion of Programmatic Management of Drug Resistant TB

(PMDT) Services in 15 more districts giving complete geographical

coverage

Commencement of second Drug Resistant TB Centre at Dhanbad

(1st at TB Sanatorium, Itki)

Introduction of

• Mandatory TB notification by all clinical facilities to Govt.

• Ban on serological diagnostics of TB

• Web based case based recording & reporting of TB cases - a

dedicated portal www.nikshaya.gov.in

• Rapid diagnostics for diagnosis of Drug Resistant TB

72

Strategy : Revised National TB Control Programme

Strengthening of services by

Infrastructure Development -

• 1 DTC/Drug Store (Ranchi), 48 TB Units (TUs) and 74

Designated Microscopy Centres (DMCs)

• Establishment of BSL III Liquid culture lab at Intermediate

Reference Lab (IRL), Itki & Up-gradation of Microbiology lab

of RIMS for diagnostic support to Drug Resistant TB

• DR TB (Drug Resistant TB) Centre at Dumka & Jamshedpur to

be made functional

• Recruitment on new posts

• Training/update training of HR

Continued Supervision, Monitoring & Internal Evaluations

Focus on Tribal Action Plan and IEC

73

National Programme for

Control of Blindness

74

1. Free Cataract operation & IOL implantation

2. School Eye Screening programme with free spectacles

distribution.

3. Management of other Eye decease

• Glaucoma

• Diabetic Retinopathy

• Squint Correction

• Keratoplasty

• Retinopathy of Prematurity

• Retinoblastoma

• Childhood Cataract & Glaucoma

4. Eye banking.

5. Examination of students of blind School

ACTIVITIES AT A GLANCE National BLINDNESS Control Programme

75

6. Strengthening of:

• Vision centre at CHC level

• District Eye Deptt.

• Eye Deptt at Medical College.

• Regional Institute of Ophthalmology

• NGO Eye Hospital

• Eye Bank at Medical College

7. IEC:-

• Eye Donation fortnight

• World Sight day

• Glaucoma Day

ACTIVITIES AT A GLANCE National BLINDNESS Control Programme

76

Year Target Achievement

2001-02 59000 24000

2002-03 70000 27092

2003-04 70000 28000

2004-05 70000 37553

2005-06 70000 47914

2006-07 70000 61559

2007-08 75000 71516

2008-09 75000 73370

2009-10 75000 78924

2010-11 75000 78734

2011-12 114000 84746

2012-13 114000 83619

2013-14 114000 4927

Cataract Achievement up to 2013-14 May

77

Year Target Achievement

2001-02 60000 10529

2002-03 25000 62300

2003-04 643500 42900

2004-05 70000 37553

2005-06 816667 398093

2006-07 816667 814962

2007-08 816667 885952

2008-09 476190 1120511

2009-10 476190 1045858

2010-11 476190 964450

2011-12 476190 958755

2012-13 476190 786925

2013-14 476190 80975

School Screening Achievement up to 2013-14 May

78

Strategy : National Programme for Control of Blindness

Strategy to reduce Blindness -

Village Blind Register preparation by PMOA with help of sahiya/ AWW/

ANM.

Stress on Eye surgeon of District hospital and Medical college.

Free cataract operation with IOL Implantation through out the year.

Seek help of NGO Eye hospital and private Eye practitioners for active

participation.

Timely MIS Entry of all NPCB Activities and timely payment to NGO.

Rapid blindness survey to assess prevalence of blindness.

Early Detection and prompt treatment of sight threatening Eye diseases at

district hospital.

Establish low vision centre at each district

Increase Eye donation and Eye utilization by appointing Eye counselors at

Medical colleges.

Blindness Prevalence -

Blindness prevalence in Jharkhand was 1.4% .(2003-04)

National Blindness prevalence was 0.7% (2003-04)

79

National Programme for Prevention and

Control of Cancer, Diabetes, Cardio-

vascular Disease & Stroke (NPCDCS)

And

National Programme for the Health Care

of the Elderly (NPHCE)

80

National Programme for Prevention and Control of Cancer, Diabetes,

Cardio-vascular Disease & Stroke (NPCDCS)

National Programme for the Health Care of the Elderly (NPHCE)

Strategy :NPCDCS :

Programme started in Ranchi, Bokaro and Dhanbad districts.

Prevention through behaviour change

Early Diagnosis

Treatment

Capacity building of human resource

Surveillance, Monitoring & Evaluation

NPHCE :

Preventive and promotive care.

Management of illness.

Health Manpower Development for geriatric services.

Medical rehabilitation & therapeutic intervention.

Developing appropriate training courses for medical and paramedical health

professional in geriatric care.

Promotion and encouraging basic, clinical, epidemiological and applied research in

ageing and the health care of the elderly.

81

Services Ranchi Bokaro Dhanbad

District

Hospital

Regular OPD Service

(NPHCE)

Integrated Integrated Attached

with Medical

College

IntegratedGeriatric Ward

(NPHCE)

Started with

4 Bed

Started

with 6 Bed

NCD Clinic Integrated Integrated

Community

Health

Centre

Bi-Weekly Geriatric Clinic Integrated Integrated Integrated

NCD Clinic Integrated Integrated Integrated

Sub Centre Opportunistic Screening of

Diabetes & Hypertension

Started Started Started

Status of Services Status of Service - NCD

82

Districts

No. of

persons

screened

Suspected

for Diabetes

( >140 )

Hypertensi

on ( >90 )

% of Diabetes

suspected

% of

Hypertension

Bokaro 243348 15543 28667 6.39 11.78

Dhanbad 188002 1535714730

8.17 7.84

Ranchi 457859 20109 15046 4.39 3.29

Total 889209 51009 584435.74 6.57

Screening of Diabetes and Hypertension till 29/06/2013

83

Financial Progress

84

Financial Progress (As on 31-03-2013) Figure in crore

Heads Approved Budget

2012-13

Opening

Balance as

on

01.04.2012

Amount

released by

GOI 2012-

13

Amount

to be

released

by GOI

Amount

to be

released

by State

State

Share

Total Amount

Available

Total

Exp(01.0

4.2012 to

31-03-

2013

% of

Expenditure

against total

Fund

Available

(9/8*100) (3+4+7)

1 2 3 4 5 6 7 8 9 10

RCH Flexible

Pool(Part A of PIP) 326.93 77.73 113.57 100 35 47 238.3 166.32 70

Additionalities under

NRHM(Part B of PIP) 207.16 78.12 140.83 70 21 37 255.95 136.62 53

Immunization &

Pulse Polio 42.83 8.88 0.88 20 15 30 39.76 21.41 54

Other National

Programme 77.42 11.73 27.59 17 0 1 40.32 32.29 78

Direction and Admin 114.6 0 80.26 0 0 0 80.26 69.66 87

Gross Total 768.94 176.46 354.9 207 71 115 654.59 426.30 65

Expenditure April & May17.72 Cr.

Financial Progress: NRHM 2013-14

85

Monitoring of Flagship

Programme / CSS

86

State Review Mission Team has been formed with eight teams, each team

consist of eight to ten members. Each team is assigned three districts with

monthly visit.

HMIS : Health Management Information System is being used as a strong tool

to monitor the progress of activities. It captures data at all levels right from

Health sub centers.

MCTS : Mother Child Tracking System is name based tracking system of

mother and child which is being implemented in all the districts. On pilot basis

four districts have been chosen for direct cash transfer.

Routine Immunization Monitoring: To strengthen routine immunization

regular monitoring is done along with development partners like WHO and

Unicef.

VHND monitoring: Village Health and Nutrition Day monitoring is done by the

district personals during the session site day.

Community based monitoring : Community based monitoring done in all the

districts and in 48 blokcs.

Monitoring of Sahiya by Sahiya Sathi (ASHA) : Each Sahiya Sathi has been

assigned few villages/ Hamlets where Sahiya Sathi regularly visits and monitor

the performance of Sahiya(ASHA).

ASHA performance monitoring system

Monitoring of Flagship Programme - NRHM

87

Schemes Year Outlay Ratio

Central State

Remarks Central

Share

Fund

Released

Rest

Fund

State

Share

Fund

Released

Rest

Fund

Rs. in Crore

9-GNM schools 90.00 85:15 76.50 17.00 59.50 13.50 0.00 13.50

4 GNM Schools –

sanctioned and work

allotted

5 GNM Schools –

sanctioned and in process

of tender

5-ANM schools2010-

11 25.00 85:15 21.25 10.63 10.63 3.75 0.00 3.75

5 ANM Schools - in

process of sanction

For PG course at

PMCH, Dhanbad

2011-

12 18.15 75:25 13.61 6.80 6.81 4.54 4.54 0.00

In process of sanction of

schemes and

procurement of

equipments.

For PG course at

MGMCH,

Jamshedpur

25.86 75:25 19.40 9.69 9.71 6.47 5.00 1.47

in process of sanction of

schemes and

procurement of

equipments.

Trauma Centre at DH,

Hazaribag

2006-

074.80 100:00 4.80 1.50 3.30 Complete

Trauma Centre at

PHMCH, Dhanbad

2012-

139.65 9.65 0.80 8.85 In process of sanction.

Up gradation of

Nursing School in

Nursing College at

PMCH, MGMCH

and RIMS

2009-

10520.50 100:00 520.50 102.50 418.00

Request sent to GoI for

release of balance funds.

2009-

10520.50 100:00 520.50 102.50 418.00 Work is in progress

2009-520.50 100:00 520.50 102.50 418.00

Work is in progress/ fund

Centrally Sponsored Schemes

88


Central State

Remarks Central

Share

Fund

Released

Rest

Fund

State

Share

Fund

Released

Rest

Fund

Rs. in Crore

Ayurvedic Medical

College, Chaibasa

2011-

12 20.00 50:50 10.00 5.26 4.74 10.00 10.00 0.00 Sanction is in process

Supply of Home

Remedies Kits

2002-

030.06 100:00 0.06 0.06 0.00 Do

Drug Testing

laboratory & Drug

Enforcement

Mechanism, Ranchi

2005-

061.09 100:00 Do

Pharmacy State

Ayurvedic College,

Chaibasa

2005-

061.50 100:00 1.50 1.50 0.00 Do

ROT Programme 2005-

060.03 100:00 0.03 0.03 0.00 Do

1- Setting of 12

AYUSH Wing in

District Hospital @ 35

lakh per Hospital

2006-

074.20 100:00 4.20 4.20 0.00 Do

2- Establishment of

12 Panchkarma

Therapy Centers in 12

District @ 22 lakh per

centers AYUSH

Wings

2006-

072.64 100:00 2.64 2.64 0.00 Do


89


Central State

Remarks Central

Share

Fund

Released

Rest

Fund

State

Share

Fund

Released

Rest

Fund

Rs. in Crore

Drug Enforcement

Mechanism

2007-

080.15 100:00 0.15 0.15 0 Do

Drug Enforcement

Mechanism - Drug

Testing Fee

2007-

080.02 100:00 0.02 0.02 0 Do

Drug Enforcement

Mechanism

2008-

090.14 100:00 0.14 0.14 0 Do

Seminar Role of

AYUSH in NRHM

2009-

100.03 100:00 0.03 0.03 0 Done

Collocation of 48

CHC & 97 PHC

2009-

1020.26 100:00 20.26 20.26 0 Sanction is in process

(i) State level

Orientation Workshop

(ii) State level TOT

2009-

100.10 100:00 0.10 0.1 0

State level workshop

done and TOT is in

process

Total 226.75 184.33 80.81 103.53 38.25 19.54 18.71


90

THANKS

91

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