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Government of Bihar

NATIONAL RURAL HEALTH MISSION

2009-10

February 2009

STATE PROGRAMME IMPLEMENTATION PLAN

State PIP, Bihar 2008-09 National Rural Health Mission

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Abbreviations

ANM Auxiliary Nurse Midwife ASHA Accredited Social Health Activist AWC Aaganwadi Centre AWW Aaganwadi Worker BCC Behaviour Change Communication BPL Population Below Poverty Line BEmOC Basic Emergency Obstetric Care CBO Community Based Organization CDR Crude Death Rate CEO Chief Executive Officer CEmOC Comprehensive Emergency Obstetric Care CMR Crude Mortality Rate DHS Directorate of Health Services DPT Diphtheria, Pertusis and Tetanus vaccine GO Government Order GoB Government of Bihar GoI The Government of India HIV Human Immunodeficiency Virus ICDS Integrated Child Development Services IEC Information Education Communication IMR Infant Mortality Rate MMR Maternal Mortality Rate NFHS I National Family Health Survey I NFHS II National Family Health Survey II NFHS III National Family Health Survey III NGO Non-Governmental Organizations O & M Operation and Maintenance OP Out-Patient (section or department of a hospital) OPD Out-Patient Department RCH Reproductive and Child Health PHC Primary Health Centre PPP Public Private Partnership PIP Program Implementation Plan PRI Panchayati Raj Institutions RKS Rogi Kalyan Samiti SHC Sub Health Centre SIHFW State Institute of Health & Family Welfare TB Tuberculosis TFR Total Fertility Rate


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Preface

National Rural Health Mission offers unprecedented opportunity to improve the health of the people of Bihar. The Public Health System of Bihar, through its more than 10000 ANMs, 75000 of ASHAs, 70000 of Aaganwadi Workers and thousands of doctors reaches out to the people living in more than 80000 villages. The Public Health infrastructure, particularly PHCs/CHCs and other Government hospitals ought to be the institutions where people can put their trust for good and affordable quality health services as per needs.

Though the role of Public Health system is primarily important, NRHM heralds a new beginning where the health of the people will be placed in their own hands and government will play a role of facilitator providing all round support and ensuring access to health services.

The PIP has been prepared through consultation with block and district level functionaries. The plans have been prepared on the needs identified and has addressed lots of critical issues to implement the programme.

The plan is aimed at improving the access to comprehensive quality health care by improving the public health infrastructure to desired standards and placing the health of the people in their hands. Government will play the role of a facilitator and undertake new initiatives.

As planned here the capacity to manage the programme in the state is going to be significantly strengthened. The Programme Management Support Units at the block level, HMIS and the support systems shall also be strengthened. This year also a number of PPP initiatives is taken to reach out services to the people through varied channels.

It is expected that for the state of Bihar, this will be the turning point for accelerated improvement in health.


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Table of Contents

Chapter Content Page No.

Preface 3

1 Executive Summary 9-11

2 Process of Plan Preparation 12

3. Background and Current Status

3.1 Demographic and Socio-Economic Features at State and District

Levels

12-16

3.2 Administrative Divisions 17-20

3.3 RCH Outcome and Service Utilization 20-23

3.4 Public Health Infrastructure 24-25

3.5 Private and NGO Health Service 26

3.6 Donor Assisted Programme in the State 26-27

3.7 Institutional Arrangements and Organizational Development 27

3.8 Program Finance 27

Part A – Reproductive & Child Health-II

4 Situation Analysis

4.1 Maternal Health 29-30

4.2 Child Health 30-31

4.3 Family Planning 31-33

4.4 Adolescent Health 33-36

4.5 District/Sub District Variations 36-39

4.6 Health Infrastructure and Facilities 40-45

4.7 Human Resource Development including Training 45-46

4.8 Inequity/ Gender; Vulnerable Groups Including Urban Slums &

Tribal

4.8.1 Inequity and Gender 46-47

4.8.2 Urban Slums 47

4.9 Logistics 47-48

4.10 HMIS and Monitoring & Evaluation 48-49

4.11 Behaviour Change Communication 49

4.12 Convergence/Coordination 49-50

4.13 Finance 50

5 Progress and Lessons learnt from RCH II Implementation of 05-


5

08

5.1 Major achievement during 2005-08 51-52

5.2 Programme Management 52-53

6 RCH II PROGRAMME OBJECTIVES AND STRATEGIES

6.1 Vision Statement 54

6.2 Technical Objectives, Strategies and Activities

1 Maternal Health 55-61

2 Child Health 61-70

3 Family Planning 71-77

4 Adolescent Reproductive and Sexual Health 78-81

5 Urban Health 81-83

6 Vulnerable Groups (Health Camps in Maha Dalit Tola) 84

7 Tribal Health 84

8 Innovations

8.1 PNDT Act 85

8.2 Muskaan Programme 86-87

9 Strengthening of SIHFW 88

9.1 Fast Track Training Cell in SIHFW 88

9.2 Filling Vacant Position at SIHFW/Hiring Consultant at SIHFW 88

10 Infrastructure and Human Resource 89

11 Institutional Strengthening 90-92

12 Training 93-97

13 IEC/BCC 98-107

14 Procurement of Equipments/ Instruments and Drugs/Supplies 108-109

16. Programme Management 110-120

17. Convergence and Coordination 121

18. Role of State, District & Blocks 121

19. Monitoring and Evaluation 121-126

20. Synergie with NRHM Additionalities 127

21. Sustainability 128

22. Extra inclusions in RCH 129-130

23. Work Plan (Annexure - 3d) 131

24. Budget (Annexure- 3c & 3e) 131

Part B – NRHM Additionalities

1. Decentralisation 133


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1.0 ASHA 134-145

1.1 Untied Funds for Health Sub-Centre, APHC & PHCs 146

1.2 Village Health & Sanitation Committee 147

1.3 Seed Money for Rogi Kalyan Samiti 147-148

2. Infrastructure Development

2.1 Construction or establishment of Health Sub-Centre 149

2.2 Construction of PHC 150

2.3 Upgradation of Community Health Centre (CHC) 151

2.4 Infrastructure & Service Improvement as per IPHS in 48 (District

& Sub-Divisional) Hospitals for

accreditation/ISO 9000 Certification of Health

facilities

152

2.5 Upgradation of Infrastructure of ANM Training Schools 152-154

2.6 Annual Maintenance Grant 154

3. Contractual Manpower

3.1 Incentive, Contractual Salaries and Bonus 154-155

3.2 Block Programme Management Unit 155-156

3.3 Additional Manpower for State Health Society Bihar 156-157

3.4 Additional Manpower under NRHM 157

4. PPP Initiative in State

4.1 102- Ambulance Service 158

4.2 Dial 1911 - Doctor on Call & Samadhan 158-159

4.3 Additional PHCs Management by NGOs 159

4.4 AAPIO 160

4.5 State Health Resource Centre 160

4.6 Services of Hospital waste treatment and Disposal in all

Government Health facilities upto PHCs in Bihar

(IMEP)

160-162

4.7 Dialysis Unit in Government Hospital of Bihar 162-163

4.8 Setting up of Ultra Modern Diagnostic Centre in RDCs and all

Government Medical College Hospitals

163-164

4.9 Providing Telemedicine Services in Government Health facilities 165-168

4.10 Outsourcing Pathology & Radiology Services from PHCs to

District Hospital

168-169

4.11 Operationalising Mobile Medical Unit 169-171


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4.14 Monitoring and Evaluation 171-172

4.15 Generic Drug Shop 173

4.16 Nutrition Rehabilitation Centres (NRCs) for Treatment of sever

and acute malnutrition

173-174

4.17 Hospital Maintenance 174

4.18 Providing Ward Management Services in Govt. Hospitals 175

4.19 Provision of HR Consultancy Services 175-176

4.20 Advanced Life Saving Ambulances (ALS) 176

7. Mobilisation and Management support for Disaster Management 177-178

8. Health Management Information System (HIMS) 178-181

9. Strengthening of Cold Chain 182-183

12 Main streaming AYUSH under NRHM 183-187

Summary Budget of NRHM Part- B 188-190

Part C – Immunization

1 Routine Immunization 191-225

Part D – National Disease Control Programmes

1 IDSP 227-229

2 IDD 230-236

3 NPCB 237-251

4 NLEP 252-285

5 TB 287-319

NVBDCP

5 Kalazar 321-351

6 Malaria 352-364

7 Dengu & Chikungunya 366-368

8. JE 369-371

9. Filaria 372-380

Part E – Intersectoral Convergence

1 Intersectoral Convergence 382-392

BUDGET

1 NRHM Part A – RCH II 393

2 NRHM Part B - Additionalities 394-396

3 NRHM Part C - Immunization 397

4 NRHM Part D – NDCP 397

5 NRHM Part E - Convergence 397


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6 Summary of Budget 398

Annexures

Annexure 3a Self Appraisal of State PIP against Appraisal Criteria

Annexure 3b Targets for goals, outcomes, outputs and inputs Annexure 3d Work plan RCH

Annexure 3e Details of Budget of RCH- II (Part-A)

Annexure 4 IMNCI

Annexure 5 IFA

Annexure 6 IUD Training

Annexure 7 MTP Training

Annexure 8 CTP (Comprehensive Training Programme)

Annexure 9 Pilot Health Financing Scheme for Safe Maternity to BPL/SC/ST beneficiaries in

accredited private facilities

Annexure 10 Incentive for Cesarean Section, Pregnancy testing, Safe Abortion & IUCD in

Bihar

Annexure 11 Procurement

Annexure 12 School Health

Annexure 13 List of 27x7

Annexure 14 Pregency Kit

Annexure 15 MAPEDIR

Annexure 16 Training Details

Annexure 17 Mahadalit Tola Report

Annexure 18 IEC Budget Breakup

Annexure 19 NSV Kit

Annexure 20 Minilap Set

Annexure 21 FRU Report


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Executive Summary

Introduction

The State Health Society, Government of Bihar is committed towards promoting the right of every woman, man and child to enjoy a life of health and equal opportunity and is making all round efforts in this direction. SHSB under the aegis of Department has taken steps to bring about outcomes as envisioned in the Millennium Development goals, RCH II / NRHM programme and Vision 2010 Bihar. It aims at minimizing regional variations in the areas of Reproductive and Child Health including population stabilization through an integrated, focused and participatory programme. Meeting unmet demands of the target population, and provision of assured, equitable, responsive quality services are central to the programme strategies. Based on experience gained during the implementation of RCH II, the Department anticipates that current RCH programme implementation would produce equitable reproductive and child health outcomes and contribute to raising the status of the girl child.

The Goal

The goal is to improve quality of life of the people by: (Goals mentioned below are for the period of RCH-II i.e. to be achieved by 2010)

ê reducing Maternal Mortality Ratio (MMR) from 371 to 100 per 1,00,000 live births, ê reducing Infant Mortality Rate (IMR) from 61 to 30 per 1000 live births, ê Reducing Total Fertility Rate (TFR)1 from 4.3 to 2.1 for population stabilization with

enhanced satisfaction of clients with medical services.

The Department is making all out efforts to reduce the IMR and has initiated an innovative program ‘MUSKAAN’ for the same cause and so as to also reach the poorest of the poor with effective, quality and equitable health services. Simultaneously taking steps to effectively implement national health programme while creating synergy and convergence with RCH II.

1 NFHS-3

Executive Summary Chapter 1


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Status and Situation Important RCH indicators such as MMR, IMR and TFR are showing declining trends whereas institutional deliveries, complete ANC, contraceptive use in the state has increased. The state has mapped poorly performing districts and is now extensively focusing on them.

Status of Important RCH indicators in the state are as follows:

Declined

ê MMR has declined from 389 (1998) to 371 (SRS 2003-05) ê IMR has declined from 63 (Census 2001) to 61 per 1000 live births (SRS 2006-07) ê Total Fertility Rate (TFR) has decreased from 4.3 to 4.0 (NFHS III 2005-06) to 3.9 (SRS 8) ê Percentage of children under age 3 who are underweight has marginally declined from 48

percent to 47 percent.

Increased é Institutional deliveries have increased from 12.1 (NFHS-I 1992-93) percent to 22 percent

(NFHS-III 2005-06) to 27.7 percent (DLHS-III 2007-08) é Antenatal Care has increased from 15.9 percent (NFHS-II 1998-99) to 16.9 percent (NFHS-

III) to 45% (DLHS-III 2007-08) é % Full Immunization coverage has increased from 10.7 (NFHS-I 1992-93) percent to 41.4

percent (DLHS-III 2007-08) é Contraceptive use has increased from 23.1 percent (NFHS-I 1992-93) to 34.1 percent (NFHS-

III) é Sex ratio from 825 to 871 (CRS 2006-07)

Strategic Direction

The entire State Health Society Bihar team is working in a mission mode to achieve goals set-in for the state and is effectively dealing with the challenges. The Department has set the strategic direction that encompasses year wise objectives, technical strategies; interventions include program and services for improving maternal health, child health, family planning, adolescents' health etc. The complete programme has been bifurcated into institutional and cross cutting programme strategies as well as specific core programmatic strategies for taking effective actions. These institutional and cross cutting strategies have impact on all the components of RCH viz. maternal health, child health, family planning, adolescent health etc whereas specific core programme strategies have wider impact on the specific programme component. It has been recognized that all these strategies should converge and go hand-in-hand to achieve the programme outcome. The state considers that strengthening institutional mechanisms, infrastructural development, ensuring adequately trained human resources etc. are fundamental requirements for getting better programme outcomes. Accordingly, the document is presented with backward linkages from core programme strategies to institutional framework. Convergence of strategies and progress is as described below:

i) Core Programme Strategies

Ø Special schemes such as Muskaan, MAMTA addressing child health, incentives to health staff.

ii) Cross Cutting Programmatic Strategies

Ø Capacity building, PPP, quality assurance, gender mainstreaming, community participation, serving vulnerable community through mobile units etc. Resource planning for all the sectors will be also done.

iii) Strengthening Institutional Framework and Governance Mechanisms Ø Recruitment and placement of qualified human resource Ø Structures: Functional, accountable State/District Health Mission with Governing and

Executive Board; Integrated Organizational Structure of Department of Health; Functional


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SPMU, DPMU, BPMU; Constitution of RKS and Village Health and Sanitation Committee for bringing in transparency and accountability by involving the community.

Ø Infrastructure Development and ensuring consistent logistics support. Strategies RCH Components Goals

SUMMARY of BUDGET

PART HEAD BUDGET 2009-10 (Rs. In lakhs) In Cr.

% A RCH II 48495.00 484.95 37.89 B NRHM Additionalities 43568.00 435.68 34.04 C Immunization 3193.08 31.93 2.49 D NDCP 7,133.84 71.34 5.57 E Intersectoral Convergence 2172.70 21.72 1.70

TOTAL 104562.62 1045.62 81.70 PPI Operational Cost 76.97 6.01

Infrastructure Maintenance (Treasury Fund) 157.22 12.28

GRANT TOTAL 1279.81 100.00

Cross Cutting

Strategies

Core Programme

Strategies

Institutional framework and Governance mechanism

Maternal Health

Child Health

Family Planning

Reduction in MMR

Reduction in IMR

Reduction in TFR

Adolescent Health

Vulnerable Community

Services to each adolescent Ensuring equitable healthcare delivery


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Information collected from the District and Block level is the key in preparing the State PIP. At the block level, consultation was done which was further sent to the District. With the information gathered from the block, district has further held consultations and prepared their priorities and requirements, which are being reflected in the District Health Action Plans, still being prepared in the districts. The method of data collection is both primary and secondary in the preparation of the Plan. The secondary data were collected by reviewing records, registers and annual reports. The data were also collected from DLHS, SRS and NFHS surveys to support the background information. For primary data, the procedure involved focus group discussions, interactions and meetings in different districts. This was done to have opinion of all the programme officers, health staff, grass root workers and private partners. Based on the feedback received from the districts state programme officers have discussed and finalized the SPIP requirements. The state has considered the requirement of the district thoroughly and provision has been made in the PIP as per their need. The SPMU team was thoroughly involved in the process and their critical inputs were incorporated to make this plan more holistic, realistic and achievable. The Plan was further reviewed by the Executive Director, SHSB and the CEO-cum-Secretary, Health, Deptt.of Health, Govt. of Bihar. It should be mentioned that the plan has been prepared keeping in mind that private party can simultaneously complement the role of the Government machinery in delivering the health care services in the state.

Process of Plan Preparation Chapter 2


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3.1 Demographic and Socio-Economic Features at State and District Levels Bihar with a population of 82.9 million is the second most populous state in India, next only to Uttar Pradesh. Despite efforts in the last few decades to stabilise population growth, the state’s population continues to grow at a much faster rate (28.43%) than the national population (21.34%). The state is densely populated with 880 persons per square kilometre as against the country average of 324.The sex ratio of the state at 919 is also less favourable than the national average of 933. Table 3.1.1: Bihar: Demographic, Socio-Economic and Health Indices Characteristics Bihar India Area 94,163 Sq. Km

Demographic Indicators Population 828.8 Million 1027.0 Million Population Density (Population / km2) 880 324

Sex Ratio 919 933

% decadal growth rate 28.43% 21.34% Socio-Economic Indicators Per Capita Income (Rs.) for year 2003-04 At constant1993-94 prices 3707 10964 At current prices 6861 20292 % decadal growth in Per capita Income ~ zero ~ 45% Proportion of population below poverty line 42% 26% Level of Urbanization 10.5% 27.8% Literacy 47.5% 65.4%

Source: Census 2001, Ministry of Statistics and Program Implementation Among the 38 districts of the state, West Champaran is the largest in terms of area (5228.00 sq. km) while the smallest is Sheikhpura (605.96 sq. km). In terms of population, Patna is the largest at 4.72 millions followed by East Champaran that has a population of 3.94 millions. Sheohar and Sheikhpura have the smallest population of 0.52 millions and 0.53 millions respectively. In terms of Sex Ratio, while districts such as Siwan (1031) and Gopalganj (1001) have a favourable ratio, other districts like Munger (872), Patna (873) and Bhagalpur (876) have a less favourable ratio.

Background & Current Status Chapter 3


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Bihar has a total SC population of around 15.07%. However, SC population in certain districts like Gaya (29.6%) and Nawada (24.1%) is much higher than the state average. On the other hand, districts such as Kishanganj (6.6%) and Arwal (8.9%) have a relatively low proportion of SC population. After the bifurcation of the state in 2002, most of the areas with large ST population have been included in the state of Jharkhand. Therefore, the state has less than 1% ST population. In terms of key health indicators, Bihar is among the low performing states. Though the state fares reasonably well in terms of its Infant Mortality Rate (61) as against the national average (58), it continues to be among the poorer performing states in terms of other indicators such as TFR, MMR and NMR. In terms of socio-economic indices too the district level variation is obvious. For literacy rates, districts such as Arwal (26%), Jehanabad (29.3%), Kishanganj (31.1%), Araria (35%) and Katihar (35.1%) are much below the even state average of 46.4%. However, there are districts - Aurangabad (57%), Bhojpur (59%), Munger (59.5%), Patna (62.9%) and Rohtas (61.3%) -that have performed better than the state average with literacy rates close to 60%. Similarly performance of districts on percentage of people living below the poverty line is varied with districts such as Araria faring the worst at 80.3%. Other poor performing districts are Bhagalpur, Madhubani, Purnea, Sitamarhi, Supaul and Sheohar, where close to 70% of the population continues to live below the poverty line. Despite such a large number of districts having a significant proportion of their population living below poverty line, the state average of 46.2% (among the lowest in the country) is largely due to the fact that there are some districts such as Kaimur, Saharsa, Samastipur, Arwal, Jehanabad and Gopalganj where close to 80% of the population are living above the poverty line. (See table 2.1.2 for district-wise detailed data).


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Table 2.1.2: Bihar: Key Demographic and Socio-economic Indicators of Districts

Sl No Districts Area in Sq. Km

Population BPL (%)

SC (%)

ST (%)

Sex Ratio

Literacy Rates Rural Urban Total

1 2 3 4 5 6 7 8 9 10 11

1 Araria 2830.00 2026257 132351 2158608 80.3 13.6 1.4 913 35.0

2 Aurangabad 3305.00 1842998 170057 2013055 61.7 23.5 0.1 934 57.0

3 Arwal 761.12 659270 52458 711728 23.36 8.9 0.05 929 26.0

4 Banka 3019.56 1552353 56420 1608773 63.4 12.4 4.7 908 42.7

5 Begusarai 1918.00 2241743 107623 2349366 65.4 14.5 0.1 912 48.0

6 Bhagalpur 2569.44 1970745 452427 2423172 70.2 10.5 2.3 876 49.5

7 Bhojpur 2474.17 1930730 312414 2243144 55.3 15.3 0.4 902 59.0

8 Buxar 1623.83 1273422 128974 1402396 46.6 14.1 0.6 899 56.8

9 Champaran (E) 3968.00 3688687 251086 3939773 54.1 13.0 0.1 897 37.5

10 Champaran (W) 5228.00 2733907 309559 3043466 47.4 14.3 1.5 901 38.9

11 Darbhanga 2279.00 3028441 267348 3295789 60.0 15.5 0.0 914 44.3

12 Gaya 4976.00 2997479 475949 3473428 69.8 29.6 0.1 938 50.4

13 Gopalganj 2033.00 2022048 130590 2152638 37.6 12.4 0.3 1001 47.5

14 Jehanabad 807.88 743433 59154 802587 26.34 10.0 0.05 929 29.3

15 Jamui 3098.27 1295552 103244 1398796 63.4 17.4 4.8 918 42.4

16 Kaimur 3361.90 1247299 41775 1289074 15.4 22.2 2.8 902 55.1

17 Katihar 3057.00 2174361 218277 2392638 49.1 8.7 5.9 919 35.1

18 Khagaria 1486.00 1204027 76327 1280354 48.8 14.5 0.0 885 41.3

19 Kishanganj 1884.00 1167340 129008 1296348 58.0 6.6 3.6 936 31.1

20 Lakhisarai 1299.01 684485 117740 802225 62.3 15.8 0.7 921 48.0


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Sl.No. Districts Area in sq.k.m

Population BPL (%) SC (%)

ST (%)

Sex Ratio

Literacy Rate Rural Urban Total

1 2 3 4 5 6 7 8 9 10 11

21 Madhepura 1788.00 1458679 67967 1526646 55.4 17.1 0.6 915 36.1

22 Madhubani 3501.00 3450736 124545 3575281 72.4 13.5 0 942 42.0

23 Munger 1418.76 819950 317847 1137797 53.0 13.3 1.6 872 59.5

24 Muzaffarpur 3372.00 3398361 348353 3746714 55.9 15.9 0.1 920 48.0

25 Nalanda 2367.00 2016899 353629 2370528 53.8 20.0 0.0 914 53.2

26 Nawada 2494.00 1671253 138443 1809696 62.0 24.1 0.1 946 46.8

27 Patna 3202.00 2757060 1961532 4718592 48.1 15.5 0.2 873 62.9

28 Purnia 3229.00 2321544 222398 2543942 70.0 12.3 4.4 915 35.1

29 Rohtas 3851.10 2123942 326806 2450748 56.8 18.1 1.0 909 61.3

30 Saharsa 1701.65 1383015 125167 1508182 14.2 16.1 0.3 910 39.1

31 Samastipur 2904.0 3271338 123455 3394793 19.5 18.5 0.1 928 45.1

32 Saran 2641.0 2950064 298637 3248701 54.1 12.0 0.2 966 51.8

33 Sheikhpura 605.96 444189 81313 525502 59.5 19.7 0.0 918 48.6

34 Sheohar 442.99 494699 21262 515961 69.8 14.4 0.0 885 35.3

35 Sitamarhi 2200.01 2529407 153313 2682720 67.1 11.8 0.1 892 38.5

36 Siwan 2219.0 2564860 149489 2714349 51.0 11.4 0.5 1031 51.6

37 Supaul 2410.35 1644370 88208 1732578 74.6 14.8 0.3 920 37.3

38 Vaishali 2036.00 2531766 186655 2718421 41.1 20.7 0.1 920 50.5

State Total 94363.00 74316709 8681800 82998509 46.2 15.07 0.9 919 46.4

3.2 Administrative Divisions Bound by Uttar Pradesh in the west, West Bengal on the east, Nepal on the north and Jharkhand on the south, Bihar covers an area of 94,363 square kilometers. The state has 38 districts divided into 9 administrative divisions. The number of districts in each division is detailed below -

Table 3.2.1: Administrative Divisions

Sl . Divisions Districts

1 Patna Patna, Nalanda, Bhojpur, Rohtas, Kaimur, Buxar 2 Magadh Gaya, Jehanabad, Arwal, Aurangabad, Nawada 3 Tirhut Muzaffarpur, Sitamarhi, Vaishali, Champaran East, Champaran West, Sheohar 4 Saran Saran, Siwan, Gopalganj 5 Darbhanga Darbhanga, Madhubani, Samastipur 6 Munger Begusarai, Jamui, Khagaria, Lakhisarai,Munger, Sheikhpura 7 Kosi Saharsa, Madhepura, Supaul 8 Bhagalpur Bhagalpur, Banka 9 Purnea Purnia, Araria, Kishanganj, Katihar

In addition, the state has 101 sub-divisions, 534 community development blocks, 9 urban agglomerations, 130 towns (125 statutory towns and 5 non-statutory census towns) and 37,741 villages.

Table 3.2.2: Community Development Blocks

Sl. Districts Community Development Blocks Total Block Name

1 Araria 9 Narpatganj, Forbesganj, Bhargama, Raniganj, Araria, Kursakatta, Sikti, Palasi, Jokihat

2 Arwal 3 Karpi, Kurtha, Makhdumpur

3 Aurangabad 11 Daudnagar, Haspura, Goh, Rafiganj, Obra, Aurangabad, Barun, Nabinagar, Kutumba, Deo, Madanpur

4 Banka 11 Shambhuganj, Amarpur, Rajaun, Dhuraiya, Barahat, Banka, Phulidumar, Belhar, Chanan, Katoria, Bausi

5 Begusarai 18 Khudabandpur, Chhorahi, Garhpura, Cheria Bariarpur, Bhagwanpur, Mansurchak, Bachhwara, Teghra, Barauni, Birpur, Begusarai, Naokothi, Bakhri, Dandari, Sahebpur Kamal, Balia, Matihani, Shamho Akha Kurha

6 Bhagalpur 16 Narayanpur, Bihpur, Kharik, Naugachhia, Rangra Chowk, Gopalpur, Pirpainti, Colgong, Ismailpur, Sabour, Nathnagar, Sultanganj, Shahkund, Goradih, Jagdishpur, Sonhaula

NRHM STATE PROGRAMME IMPLEMENTATION PLAN- 2008-09

18

7 Bhojpur 14 Shahpur, Arrah, Barhara, Koilwar, Sandesh, Udwant Nagar, Behea, Jagdishpur, Piro, Charpokhari, Garhani, Agiaon, Tarari, Sahar

8 Buxar 11 Simri, Chakki, Barhampur, Chaugain, Kesath, Dumraon, Buxar, Chausa, Rajpur, Itarhi, Nawanagar

9 E. Champaran 27 Raxaul, Adapur, Ramgarhwa, Sugauli, Banjaria, Narkatia, Bankatwa, Ghorasahan, Dhaka, Chiraia, Motihari, Turkaulia, Harsidhi, Paharpur, Areraj, Sangrampur, Kesaria, Kalyanpur, Kotwa, Piprakothi, Chakia(Pipra), Pakri Dayal, Patahi, Phenhara, Madhuban, Tetaria, Mehsi

10 Champaran W 18 Sidhaw, Ramnagar, Gaunaha, Mainatanr, Narkatiaganj, Lauriya, Bagaha, Piprasi, Madhubani, Bhitaha, Thakrahan, Jogapatti, Chanpatia, Sikta, Majhaulia, Bettiah, Bairia, Nautan

11 Dharbhanga 18 Jale, Singhwara, Keotiranway, Darbhanga, Manigachhi, Tardih, Alinagar, Benipur, Bahadurpur, Hanumannagar, Hayaghat, Baheri, Biraul, Ghanshyampur, Kiratpur, Gora Bauram, Kusheshwar Asthan, Kusheshwar Asthan Purbi

12 Gaya 24 Konch, Tikari, Belaganj, Khizirsarai, Neem Chak Bathani, Muhra, Atri, Manpur, Gaya Town CD Block, Paraiya, Guraru, Gurua, Amas, Banke Bazar, Imamganj, Dumaria, Sherghati, Dobhi, Bodh Gaya, Tan Kuppa, Wazirganj, Fatehpur, Mohanpur, Barachatti

13 Gopalganj 14 Katiya, Bijaipur, Bhorey, Pach Deuri, Kuchaikote, phulwaria, Hathua, Uchkagaon, Thawe, Gopalganj, Manjha, Barauli, Sidhwalia, Baikunthpur

14 Jahanabad 12 Arwal, Kaler, Sonbhadra Banshi Suryapur, Ratni Faridpur, Jehanabad, Kako, Modanganj, Ghoshi, Hulasganj

15 Jamui 10 Islamnagar Aliganj, Sikandra, Jamui, Barhat, Lakshmipur, Jhajha, Gidhaur, Khaira, Sono, Chakai

16 Kaimur 11 Ramgarh, Nuaon, Kudra, Mohania, Durgawati, Chand, Chainpur, Bhabua, Rampur, Bhagwanpur, Adhaura

17 Katihar 16 Falka, Korha, Hasanganj, Kadwa, Balrampur, Barsoi, Azamnagar, Pranpur, Dandkhora, katihar, Mansahi, Barari, Sameli, Kursela, Manihari, Amdabad

18 Khagaria 7 Alauli, Khagaria, Mansi, Chautham, Beldaur, Gogri, Parbatta


19

19 Kishanganj 7 Terhagachh, Dighalbank, Thakurganj, Pothia, Bahadurganj, Kochadhamin, Kishanganj

20 Lakhisarai 6 Barahiya, Pipariya, Surajgarha, Lakhisarai, Ramgarh Chowk, Halsi

21 Madhubani 21 Madhwapur, Harlakhi, Basopatti, Jainagar, Ladania, Laukaha, Laukahi, Phulparas, Babubarhi, Khajauli, Kaluahi, Benipatti, Bisfi, Madhubani, Pandaul, Rajnagar, Andhratharhi, Jhanjharpur, Ghoghardiha, Lakhnaur, Madhepur

22 Madhepura 13 Gamharia, Singheshwar, Ghailarh, Madhepura, Shankarpur, Kumarkhand, Murliganj, Gwalpara, Bihariganj, Kishanganj, Puraini, Alamnagar, Chausa

23 Munger 9 Munger, Bariarpur, Jamalpur, Dharhara, Kharagpur, Asarganj, Tarapur, Tetiha Bambor, Sangrampur

24 Muzaffarpur 17 Sahebganj, Baruraj (Motipur), Paroo, Saraiya, Marwan, Kanti, Minapur, Bochaha, Aurai, Katra, Gaighat, Bandra, Dholi (Moraul), Musahari, Kurhani, Sakra 25 Nalanda 20 Karai Parsurai, Nagar Nausa, Harnaut, Chandi, Rahui, Bind, Sarmera, Asthawan, Bihar, Noorsarai, Tharthari, Parbalpur, Hilsa, Ekangarsarai, Islampur, Ben, Rajgir, Silao, Giriak, Katrisarai

26 Nawada 14 Nardiganj, Nawada, Warisaliganj, Kashi Chak, Pakribarawan, Kawakol, Roh, Gobindpur, Akbarpur, Hisua, Narhat, Meskaur, Sirdala, Rajauli

27 Patna 23 Maner, Dinapur-Cum-Khagaul, Patna Rural, Sampatchak, Phulwari, Bihta, Naubatpur, Bikram, Dulhin Bazar, Paliganj, Masaurhi, Dhanarua, Punpun, Fatwah, Daniawan, Khusrupur, Bakhtiarpur, Athmalgola, Belchhi, Barh, Pandarak, Ghoswari, Mokameh

28 Purnia 14 Banmankhi, Barhara, Bhawanipur, Rupauli, Dhamdaha, Krityanand Nagar, Purnia East, Kasba, Srinagar, Jalalgarh, Amour, Baisa, Baisi, Dagarua

29 Rohtas 19 Kochas, Dinara, Dawath, Suryapura, Bikramganj, Karakat, Nasriganj, Rajpur, Sanjhauli, Nokha, Kargahar, Chenari, Nauhatta, Sheosagar, Sasaram, Akorhi Gola, Dehri, Tilouthu, Rohtas

30 Saharsa 10 Nauhatta, Satar Kataiya, Mahishi, Kahara, Saur Bazar, Patarghat, Sonbarsa, Simri Bakhtiarpur, Salkhua, Banma Itahri


20

31 Samastipur 20 Kalyanpur, Warisnagar, Shivaji Nagar, Khanpur, Samastipur, Pusa, Tajpur, Morwa, Patori, Mohanpur, Mohiuddinagar, Sarairanjan, Vidyapati Nagar, Dalsinghsarai, Ujiarpur, Bibhutpur, Rosera, Singhia, Hasanpur, Bithan

32 Saran 21 Mashrakh, Panapur, Taraiya, Ishupur, Baniapur, Lahladpur, Ekma, Manjhi, Jalalpur, Revelganj, Chapra, Nagra, Marhaura, Amnour, Maker, Parsa, Dariapur, Garkha, Dighwara, Sonepur

33 Sheikhpura 6 Barbigha, Shekhopur Sarai, Sheikhpura, Ghat Kusumbha, Chewara, Ariari

34 Sitamarhi 17 Bairgania, Suppi, Majorganj, Sonbarsa, Parihar, Sursand, Bathnaha, Riga, Parsauni, Belsand, Runisaidpur, Dumra, Bajpatti, Charaut, Pupri, Nanpur, Bokhara

35 Sheohar 5 Purnahiya, Piprarhi, Sheohar, Dumri Katsari, Tariani Chowk

36 Siwan 19 Nautan, Siwan, Barharia, Goriakothi, Lakri Nabiganj, Basantpur, Bhagwanpur Hat, Maharajganj, Pachrukhi, Hussainganj, Ziradei, Mairwa, Guthani, Darauli, Andar, Raghunathpur, Hasanpura, Daraundha, Siswan

37 Supaul 11 Nirmali, Basantpur, Chhatapur, Pratapganj, Raghopur, Saraigarh, Bhaptiyahi, Kishanpur, Marauna, Supaul, Pipra, Tribeniganj

38 Vaishali 16 Vaishali, Paterhi Belsar, Lalganj, Bhagwanpur, Goraul, Chehra Kalan, Patepur, Mahua, Jandaha, Raja Pakar, Hajipur, Raghopur, Bidupur, Desri, Sahdai Buzurg, Mahnar

3.3 RCH Outcome and Service Utilization The government and its concerned agencies have initiated various programmes to address the health related issues of the state. However, there is considerable scope of improvement. One of the reasons for limited achievements of the programs has been the lack of quality of services. The State Health Society has paid special attention to the quality of services and aims at meeting the needs of the population leading to widespread acceptance of the services. The goal is to provide integrated reproductive health care services, including addressing the unmet need for contraception in order to improve the situation by the year 2012. The program has made positive impact on the indicators in the state but there is still a long way to go. The current situation of the selected indictors based on NFHS-3 shows that overall the state is moving towards achieving the goals. The recent NFHS-3 has shown the improvements in health indicators in the State. IMR has reduced from 78 to 62, MMR from 389 to 371. However TFR has risen from 3.7 to 4.


21

Important indicators reviewed during NFHS-3: Total Fertility Rate (TFR) has increased from 3.7 to 4 Contraceptive use has increased from 24 % to 34 % Antenatal Care has not improved at all Institutional deliveries have increased from 15 % to 22% IMR has declined from 78 to 62 per 1000 live births Percentage of children under age 3 who are underweight has increased 54.3 to 58.4% Though the State has achieved some progress in terms of output indicators, the maternal mortality, child mortality and population growth continues to be a cause of serious concern to the state's development efforts. Moreover, floods in some parts of the state make the State vulnerable to communicable diseases. Besides, the health infrastructure is inadequate to cater to the needs of the people and the upkeep of the already existing facilities is quite challenging. Human resource is another major issue where the State health system is struggling. The paucity of medical professionals especially the specialists limits the public health facilities in providing much required higher level of care to the needy. A mismatch exists in the State between the available medical and Para medical professionals and the demand for their services. More medical graduates and Para medical professionals are required to fill up this gap. Moreover despite number of trainings held, rationalization of manpower is yet to take place. To overcome this, the State has initiated public private partnerships, out sourcing health facilities and programmes to private sector and NGOs, contracting specialists for specialized care, etc. There is also dearth of well-trained public health professionals and managers to effectively steer the public health and family welfare programs. Another issue which the state is encountering is a declining sex ratio. Several initiatives like advocacy, intensive IEC programs and enforcement of PNDT aimed at reversing the existing sex ratio will be initiated this year. In the coming years, the state envisions a system, which provides all the individuals specially the BPL population the ability to access health care at an affordable price by tackling the existing problems and build on its strengths and address its weaknesses.


22

3.4 Public Health Infrastructure

District wise Availability of Health Centres of Bihar State

Sl. Name of Districts

No. of

DH

New Constr uction

Total DH

No. of Sub Divl

Hospitals exist

New Constr uction

No. of Referral Hospital

upgraded in Sub Div Hospitals

Total Sub Div

Hospitals

No. of Referral Hospitals

exist previousl

y

No. of Referral Hospitals

exist Presently

No. of PHCs exist

New Constr uction

No. of APHCs upgrade

d into PHCs

Total No. of PHCs

No. of APHCs

exist previosly

No. of APHCs

exist presently

No. of HSCs

1 Araria 1 1 1 1 2 3 2 9 9 30 30 200 2 Arwal 1 1 0 3 3 23 23 46 3 Aurangabad 1 1 1 1 3 3 11 11 58 58 207 4 Banka 1 1 1 1 3 3 10 1 11 24 24 227 5 Begusrai 1 1 1 1 2 2 1 11 7 2 18 31 29 288 6 Bhagalpur 1 1 1 1 2 2 2 11 5 2 16 46 44 280 7 Bhojpur 1 1 1 1 2 2 12 2 1 14 20 19 284 8 Buxar 1 1 1 1 2 7 4 1 11 20 19 158

9 Champaran (E) 1 1 1 2 3 3 1 20 7 3 27 46 43 315

10 Champaran (w) 1 1 1 1 2 2 2 16 2 18 25 25 389

11 Darbhanga 1 1 2 2 13 6 4 19 51 47 261 12 Gaya 1 1 1 1 2 2 1 19 6 4 25 49 45 439 13 Gopalganj 1 1 1 1 3 3 10 4 2 14 22 20 186 14 Jamuai 1 1 1 1 3 3 7 2 2 9 21 19 166 15 Jhanabad 1 1 1 1 2 2 4 5 2 9 25 23 81 16 Kaimur 1 1 1 1 2 2 1 9 2 1 11 40 39 107 17 Katihar 1 1 2 2 3 1 11 5 2 16 32 30 257 18 Khagaria 1 1 0 1 1 6 1 1 7 18 17 151 19 Kishanganj 1 1 1 1 2 2 7 7 8 8 136 20 Lakhisarai 1 1 1 1 1 1 4 2 6 13 13 102 21 Madhapura 1 1 1 1 1 7 6 4 13 23 19 115 22 Madhubani 1 1 1 1 1 3 2 1 19 19 76 76 430


23

23 Munger 1 1 1 1 1 6 3 3 9 13 10 123 24 Muzaffarpur 1 1 0 1 1 14 2 16 47 47 473 25 Nalanda 1 1 1 1 2 3 2 12 8 7 20 36 29 302 26 Nawada 1 1 1 1 2 2 10 4 3 14 27 24 129 27 Patna 3 1 1 5 4 3 16 7 6 23 70 64 418 28 Purniea 1 1 1 1 2 2 1 11 3 3 14 34 31 278 29 Rohtas 1 1 1 1 2 1 1 13 6 5 19 17 12 186 30 Saharsa 1 1 1 1 7 3 10 33 33 152 31 Samastipur 1 1 3 1 4 1 1 14 6 4 20 59 55 354 32 Saran 1 1 1 1 3 2 15 5 3 20 45 42 413 33 Sheikhpura 1 1 1 1 1 1 3 3 6 18 18 74 34 Sheohar 1 1 1 1 1 1 3 1 4 7 7 34 35 Sitamarhi 1 1 1 1 1 1 13 5 2 18 38 36 213 36 Siwan 1 1 1 1 2 2 15 4 2 19 34 32 370 37 Supaul 1 1 1 1 2 1 1 9 2 1 11 28 27 178 38 Vaishali 1 1 1 1 2 2 11 6 3 17 36 33 336 Total 25 11 36 23 20 15 58 70 55 398 135 73 533 1243 1170 8858


24

Table : Bihar: Public Health Infrastructure – Personnel

Sl. No

Districts MO ANM LHV MHW Staff Nurse AWW

Sanct. Working Sanct. Working Sanct Working Sanct. Working Sanct. Working Sanct. Working

1 Araria 117 98 273 177 41 12 102 40 17 9 1778 1631 2 Aurangabad 188 91 342 319 23 17 110 75 12 3 1430 1390 3 Arwal 62 24 78 105 4 4 59 34 0 0 631 631 4 Banka 97 84 275 213 45 25 124 49 12 6 1352 1044 5 Begusarai 117 73 352 351 24 16 33 11 8 8 1314 1296 6 Bhagalpur 162 127 387 385 48 27 34 32 8 8 1512 1347 7 Bhojpur 132 105 370 368 26 20 106 42 8 1 1658 1646 8 Buxar 89 77 212 212 15 11 42 19 2 2 1139 1139 9 Champaran (E) 237 135 364 355 35 23 48 28 12 1 2901 2895 10 Champaran (W) 145 74 427 308 43 19 60 5 19 15 2263 2252 11 Darbhanga 172 152 363 296 29 19 131 96 8 5 2563 2315 12 Gaya 231 197 575 563 41 33 245 159 8 1 2427 2385 13 Gopalganj 106 95 250 249 20 8 30 3 12 2 1816 1592 14 Jehanabad 119 92 59 56 5 5 31 18 13 8 604 599 15 Jamui 85 61 222 222 25 12 70 31 12 8 1156 1138 16 Kaimur 93 74 146 146 19 11 64 20 19 9 996 993 17 Katihar 121 106 238 211 56 31 33 1 12 7 1716 1637 18 Khagaria 73 61 190 191 31 18 18 5 4 2 967 965 19 Kishanganj 56 37 169 115 31 15 64 27 11 5 1052 963 20 Lakhisarai 72 51 131 131 20 14 40 28 10 9 671 608 21 Madhepura 81 51 223 93 35 9 22 4 4 0 962 588 22 Madhubani 233 124 487 380 37 15 54 43 34 16 3437 2852 23 Munger 141 91 157 157 30 28 51 30 23 23 645 644 24 Muzaffarpur 241 223 594 592 29 21 140 82 4 4 2822 2610 25 Nalanda 178 167 402 402 30 30 36 21 0 0 1785 1761 26 Nawada 115 87 207 207 24 11 30 21 25 17 1249 1235 27 Patna 289 205 434 434 32 30 49 6 16 13 2481 2465 28 Purnia 126 100 356 275 56 29 126 67 8 2 1464 1424 29 Rohtas 158 129 286 270 29 12 136 48 20 10 1712 1628 30 Saharsa 97 55 192 169 33 15 18 1 26 21 932 825 31 Samastipur 192 183 475 470 30 20 29 18 4 4 2692 2512


25

32 Saran 185 133 512 386 33 29 46 17 27 10 2455 2218 33 Sheikhpura 53 36 109 109 16 6 18 4 4 1 357 339 34 Sheohar 52 34 46 26 4 1 38 13 9 1 265 265 35 Sitamarhi 147 127 299 289 27 9 130 82 17 13 2064 1920 36 Siwan 151 126 465 298 31 25 102 56 13 9 2099 1934 37 Supaul 85 70 206 111 44 8 60 34 2 0 1376 1230 38 Vaishali 126 105 421 414 25 24 33 28 8 3 1844 1608 5124 3860 11294 10055 1126 662 2562 1298 451 256 60587 56524


26

3.5 Private and NGO Health Service

The State has a wide network of private health facilities in the urban areas providing Health services. In general, these private health facilities are run either by individuals/organizations for profit or by Non-profit Charitable organization/NGOs. However, exact data on the number of these health facilities are not available with the State as in the State, the registration of private clinics and nursing homes has not yet started although the Clinical Establishment Act has been passed last year. Presently these health facilities are also not regulated by the DoH & F.W. However under PNDT Act, the private clinics and nursing homes undertaking ultra sonography have been regulated and these facilities are being monitored. There is an urgent need to create a comprehensive database for private health service providers and develop appropriate regulatory mechanism for them. NGOs The state has only 12 Mother NGOs (MNGOs) covering 22 of the 38 districts of Bihar. However the state does not have a structured procedure to assess the working of MNGOs. There is a need to improve coordination between the NGOs and the Government at all levels i.e. state, districts and sub-district levels in order to make them effective. Further analysis of information related to NGOs in the state revealed that there are many NGOs that are engaged in the health service delivery. Although no attempts have been made to assess the functioning of these NGOs, it is important to take initiative to develop efficient NGO network in the State.

3.6 Donor Assisted Programmes in the State UNICEF Unicef is supporting the state for immunization, maternal health, nutrition and trainings. Unicef has already initiated the implementation of IMNCI programme and is supporting the operationalization of Nutritional Rehabiltization Centres. Extensive support is provided by them in the health sector especially during flood seasons. Unicef is providing technical support in operationlising ANM training centres, procurement of equipments related to child health etc.

NIPI - Norwegian India Partnership Initiative Under NIPI’s Child Health Initiatives, a voluntary health worker called Mamta has been engaged at

all the District Hospitals and Sub Divisional Hospitals. A District Training Resource Centre wil be set

up in Nalanda district. In three NIPI focus districts namely Jehanabad, Nalanda and Sheikhpura for

operationzation of SNCUs, technical support and training of doctors and paramedical staffs are


27

being provided. Home Based Newborn Care is being implemented in three NIPI focus districts

through ASHAs. SPMU, DPMU and Block Programme Management Units shall be supported by

provision of consultants. At the State level Child Health Consultant, Finance Analyst and Data

Assistant, at the district level District Child Health Managers, at District Hospitals and Sub

divisional level Child Health Supervisors and Dy. Child Health Supervisors and at the block level

Junior Child Health Managers shall be placed.

The detailed fund allocation has been annexed.

WHO-NPSP WHO is supporting the state in Pulse Polio Immunization Programme.

UNFPA UNFPA is collaborating with SHSB from financial year 08-09 and is providing technical support in Maternal Health. 3.7 Institutional Arrangements and Organizational Development

Along with Health department the ICDS, PHED and Panchayat are helping in implementing the NRHM Programme. The coordination has been placed at State level, District Level and Block Level. At the Grassroot level linkage between ASHA, ANM with AWW has been strengthened. PHED department has taken up the training of ASHA.

Trainings are being regularly conducted under different programmes in the state. The state has already started the trainings of IMNCIs. With the Unicef support the State has initiated to operationlise 22 ANM schools in 2009-10. Repair and renovation of these schools are already in progress and are expected to be operationalised in this year. Most of the districts have their own warehouse.

The state has a unique system of collecting data from each PHC level. The state has established a data centre in the state and has centres in District and at PHC. These data centres collect data from each PHC through mobile phone and feed in the computer. The computerized data is later given to the respective Programme Officers. 3.8 Program Finance

Governments Of India’s funds are released to the state through two separate channels, i.e; through the state budget and directly through the State Health Society. Further the Department’s outlay for the procurement of vaccines, drugs, equipments etc; is spent centrally and assistance to the state has been in the form of kind.


28

PART- A

RCH Flexible Pool

2009-2010


29

4.1 Maternal Health Improving the maternal health scenario by strengthening availability, accessibility and utilization of maternal

health services in the state is one of the major objectives of RCH. However, the current status of maternal

health in the state clearly shows that the programme has not been able to significantly improve the health

status of women. There are a host of issues that affect maternal health services in Bihar. The important ones

are listed below:

• Shortage of skilled frontline health personnel (ANM, LHV) to provide timely and quality ANC and PNC

services.

• The public health facilities providing obstetric and gynecological care at district and sub-district levels

are inadequate.

• Mismatch in supply of essential items such as BP machines, weighing scales, safe delivery kits, Kit A

and Kit B, etc and their demand.

• Shortage of gynecologists and obstetricians to provide maternal health services in peripheral areas.

• Inadequate skilled birth attendants to assist in home-based deliveries

• Weak referral network for emergency medical and obstetric care services

• Lack of knowledge about antenatal, perinatal and post natal care among the community especially in

rural areas

• Low mean age of marriage resulted in pregnancy and difficult deliveries.

• Low levels of female literacy resulted unawareness on maternal health services.

• High levels of prevalence of malnutrition (anemia) among women in the reproductive age group

• Poor communication because of bad roads and a law and order situation.

One of the very good things happen to maternal health is introduction JBSY.

In 2008-09, 16 MOs trained in CEmOC and 59 MOs in Life Saving Anesthetic Skills who are now managing

complicated cases at their respective place of postings. Bihar is the first state to have formally evaluated the LSAS

examinees and issued certificates of practice for the obstetric anesthesia.

Situational Analysis Chapter 4


30

A quality monitoring cell at the state level housed in State Institute of Health & Family Welfare is

monitoring all the trainings. The cell has members drawn from SIHFW faculty, medical colleges,

retired faculty members, officials from State Health Society and officials from partner agencies as

its members. Their initial focus is to monitor the quality of various trainings being undertaken under

NRHM like IMNCI, SBA, Minilap etc. In the year 2009-10, the role shall be expanded to include

the monitoring of quality of critical care services. (details in annexure)

4.2 Child Health

The child health indicators of the state reveal that the state's IMR is lower than the national average but the

NMR is disproportionately high. Morbidity and mortality due to vaccine-preventable diseases still continues

to be significantly high. Similarly, child health care seeking practices in the case of common childhood

diseases such as ARI and Diarrhoea are not satisfactory. The child health scenario is worse for specific

groups of children, such as those who live in rural areas, whose mothers are illiterate, who belong to

Scheduled Castes, and who are from poor households is particularly appalling.

Issues affecting child health are not only confined to mere provision of health services for children, but other

important factors such as maternal health and educational status, family planning practices and

environmental sanitation and hygiene have enormous bearing on child health. This is more than evident in

the case of Bihar where child health continues to suffer not only because of poor health services for children

but due to issues such as significantly high maternal malnutrition, low levels of female literacy, early and

continuous childbearing, etc. The specific issues affecting child health in the state are listed below.

Maternal Factors

• High levels of maternal malnutrition leading to increased risk pre-term and low -birth weight babies that

in turn increase risk of child mortality.

• Low levels of female literacy, particularly in rural areas.

Family Planning Services

• The Family Planning programme has partially succeeded in delaying first birth and spacing births

leading to significantly high mortality among children born to mothers under 20 years of age and to

children born less than 24 months after a previous birth.

Child Health Services

• The programme has not succeeded fully in effectively promoting colostrum feeding immediately after

birth and exclusive breastfeeding despite almost universal breastfeeding practice in the state. In the State

majority of mother breast feed children beyond six months. However both State and Unicef have taken

initiative to generate awareness among mothers for exclusive breast feeding.


31

• High levels of child malnutrition, particularly in rural areas and in children belonging to disadvantaged

socio-economic groups leading to a disproportionate increase in under five mortality.

• Persistently low levels of child immunisation primarily due to non-availability of timely and quality

immunisation services.

• Lack of child health facilities, both infrastructure and human resource, to provide curative services for

common childhood ailments such as ARI, Diarrhea, etc.

• Inadequate supply of drugs, ORS packets, weighing scales, etc.

• Lack of knowledge of basic child health care practices among the community.

• Failure to generate community awareness regarding essential sanitation and hygiene practices that impact

on the health of children.

Since these factors are inter-linked and synergistic, any effort to improve the health of the children in the

state needs to address child health issues in a holistic manner.

IMNCI Training: IMNCI training has successfully started in the State. The Pilot project has also successfully

completed in the district of Vaishali. The project is being monitored and managed by Unicef. In 2008-09

IMNCI Training is being scaled up in thirteen districts. In phase wise rest of districts will be completed.

In 2008-09, a pilot project done through SHSB on Nutritional Rehabilitation Centre. In this project special

nutritious food provided to the severely malnutrition children.

4.3 Family Planning

RCH emphasizes on the target-free promotion of contraceptive use among eligible couples, the provision to

couples a choice of various contraceptive methods (including condoms, oral pills, IUDs and male and female

sterilization), and the assurance of high quality care. It also encourages the spacing of births with at least

three years between births. Despite RCH and previous programmes vigorously pursuing family planning

objectives, fertility in Bihar continues to decline at much lower rates than the national average. Although the

total fertility rate has declined by about half a child in the six-year period between NFHS-1 and NFHS-2, it

has increased in NFHS-3 and is far from the replacement level. Furthermore, certain groups such as rural,

illiterate, poor, and Muslim women within the population have even higher fertility than the average.

The persistently high fertility levels point to the inherent weakness of the state's family planning programme

as well as existing sociodemographic issues. High TFR is reflected by a dismal picture of women in Bihar


32

marrying early, having their first child soon after marriage, and having two or three more children in close

succession by the time they reach their late-20s. At that point, about one-third of women get sterilized. Very

few women use modern spacing methods that could help them delay their first births and increase intervals

between pregnancies.

The major issues affecting the implementation of the Family Planning programme in Bihar are as follows.

• Lack of integration of the Family Planning programmes with other RCH components, resulting in

dilution of roles, responsibilities and accountability of programme managers both at state and district

levels.

• Failure of the programme to effectively undertake measures to increase median age at marriage and first

childbirth.

• Inability of the programme to alter fertility preferences of eligible couples through effective behavior

change communication (BCC).

• Over emphasis on permanent family planning methods such as, sterilization ignoring other reversible

birth spacing methods that may be more acceptable to certain communities and age groups. (Overall,

sterilization accounts for 82 percent of total contraceptive use. Use rates for the pill, IUD, and condoms

remain very low, each at 1 percent or less).

• Due to high prevalence of RTI/STD, IUDs are not being used by majority of women.

• Continued use of mass media to promote family planning practices despite evidently low exposure to

mass media in Bihar, leading to lower exposure of family planning messages in the community,

particularly among rural and socio-economically disadvantaged groups.

• Weak public-private partnerships, social marketing to promote and deliver family planning

services.(Public Private Partnership is improved since 2008-09. 102 Nursing homes in 20 districts are

accredited to conduct Family planning operations . In 2008-09 accredited private Nursing homes are

expected to conduct more than 50-60 thousand family planning operations in the state. From April,

2008, 223000 sterilization conducted till Jan, 2009 of which 40,000 are conducted by the accredited

private Nursing Homes. Details in Annexure)

The issues mentioned above are closely interlinked with the existing sociodemographic conditions

of the women, specially rural, poor and illiterate. Comprehensive targeted family planning

programme as well as intersectoral co-ordination on an overall female empowerment drive is

needed to address the factors responsible for persistently high fertility levels in Bihar.


33

The state has quality assurance committee for family planning both at State and District level. The committee

sits quarterly and report is sent to state. Also, 102 private hospitals and Clinics are accredited by the District

Quality Assurance Committees for conducting sterilization in 20 districts.These private facilities are

monitored by the QAC on sterilization conducted in the facilities. Family planning Insurance scheme is also

being implemented in the state with ICICI Lombard . Most of the Sterilizations are conducted in the last

two quarters due to existing sociodemographic and programmatic reasons as evident from the graph-

Month wise comparison of Sterilization 2007-08 & 2008-09

1275 259

3 4190 672

8182

10

45673

8110588

,000

49750

85473

1835169

32394

4200

8

6130

7505

3759

3338 78

15 9857 13

951

0

10000

20000

30000

40000

50000

60000

70000

80000

90000

100000

Apr May June July Aug Sep Oct Nov Dec Jan Feb Mar

2007-082008-09

Efforts are being made to offer fixed day family planning services at District hospitals, Sub divisional

hospitals, FRUs and accredited private facilities. Later on this will be extended to the PHCs.

4.4 Adolescent Reproductive & Sexual Health The World Health Organization (WHO) defines adolescence as the period between 10 and 19 years of age, which broadly corresponds to the onset of puberty and the legal age for adulthood.


34

Commencement of puberty is usually associated with the beginning of adolescence. In some societies, adolescents are expected to shoulder adult responsibilities well before they are adults; in others, such responsibilities come later in life. Although it is a transitional phase from childhood to adulthood, it is the time that the adolescents experience critical and defining life events – first sexual relations, first marriage, first childbearing and parenthood. It is a critical period which lays the foundation for reproductive health of the individual’s lifetime. Therefore, adolescent reproductive and sexual health involves a specific set of needs distinct from adult needs. The reproductive health needs of adolescents as a group has been largely ignored to date by existing reproductive health services. Many adolescents in India face reproductive and other health risks. Poor nutrition and lack of information about proper diets increase the risk of iron-deficiency anemia for adolescent girls. Young women and men commonly have reproductive tract infections (RTIs) and sexually transmitted infections (STIs), but do not regularly seek treatment despite concerns about how these infections may affect their fertility. India also has one of the highest rates of early marriage and childbearing, and a very high rate of iron-deficiency anemia. The prevalence of early marriage in India poses serious health problems for girls, including a significant increase of maternal or infant mortality and morbidities during childbirth. The following facts will help understand the situation objectively.

• The median age of marriage among women (aged 20 to 24) in India is 16 years. • In rural India, 40 percent of girls, ages 15 to 19, are married, compared to only 8 percent of boys the

same age. • Among women in their reproductive years (ages 20 to 49), the median age at which they first gave

birth is 19. • Nearly half of married girls, ages 15 to 19, have had a least one child. • India has the world’s highest prevalence of iron-deficiency anemia among women, with 60 percent

to 70 percent of adolescent girls being anemic. Underlying each of these health concerns are gender and social norms that constrain young people – especially young women’s – access to reproductive health information and services. Motherhood at a very young age entails a risk of maternal death that is much greater than average, and the children of young mothers have higher levels of morbidity and mortality. Early child bearing continues to be an impediment to improvements in the educational, economic and social status of women in India. Overall for young women, early marriage and early motherhood can severely curtail educational and employment opportunities and are likely to have a long-term, adverse impact on their and their children’s quality of life. In many societies, adolescents face pressures to engage in sexual activity. Young women, particularly low-income adolescents are especially vulnerable. Sexually active adolescents of both sexes are increasingly at high risk of contracting and transmitting sexually transmitted diseases, including HIV/AIDS; and they are typically poorly informed about how to protect themselves. To meet the reproductive and sexual health needs of adolescents, information and education should be provided to them to help them attain a certain level of maturity required to make responsible decisions. In particular, information and education should be made available to adolescents to help them understand their sexuality and protect them from unwanted pregnancies, sexually transmitted diseases and subsequent risk of


35

infertility. This should be combined with the education of young men to respect women’s self-determination and to share responsibility with women in matters of sexuality and reproduction. Information and education programs should not only be targeted at the youth but also at all those who are in a position to provide guidance and counseling to them, particularly, parents and families, service providers, schools, religious institutions, mass media and peer groups. These programs should also involve the adolescents in their planning, implementation and evaluation. Being a sensitive and often, controversial area, adolescent reproductive and sexual health issues and information are very often difficult to handle and disseminate. Furthermore, the contents do not only deal with factual and knowledge-based information but more importantly, need to deal with attitudinal and behavioral components of the educational process. Thus it can be conclusively stated that adolescents are a diverse group, and their diversity must be considered when planning programs.

Adolescents, the segment of the population in the age group of 15 -19 years, constitute about 23% of the

population of the state. This group is critical to the success of any reproductive and sexual health programme,

as it would remain in the reproductive age group for more than two decades.

Early marriages seem to be still a key problem. Percentage of boys who are married before attaining 21 years

in consistently high in most districts. The mean age of marriage for girls is 16.9. 25% pregnant mothers in

the state are in the age group of 15-19 years. This is due to the reason that most of the girl’s married before

18 years.

The various anecdotal evidences emerging from the community level participatory planning exercises and

opinions voiced by the various levels of health officials during consultation exercise indicate that there is

lack of a cohesive ARSH strategy at the state level. Possibility of bifurcating the total target into school

going and out of school going adolescents have not been examined as a strategy option. Hence the current

school health program by and large lacks any adolescent oriented interventions.

In the consultations with the Bihar State AIDS Control Society, it had emerged that they have several

adolescent targeted intervention including using special adolescent counselors currently going actively

implemented. The possibility of convergence between the RCH II program priorities and NACP priorities

require to be integrated.

Specific capacity building initiatives to orient the health providers at various levels to specific necessities of

the ARSH program like adolescent vulnerability to RTI/STI/HIV /AIDS, communication with adolescents,

gender related issues, designing adolescent friendly health services, body and fertility awareness,


36

contraceptive needs etc have not been actively taken up the state health department to prepare itself to tackle

the problems / issues of this important segment.

4.5 District/Sub District Variations

Key indicators related to Maternal and Child Health (MCH) and Family Planning clearly show the poor

status of RCH in Bihar. However, close examination of data reveals that there exist wide inter-district

variations for almost all the key indicators.


37

DLHS-3 Data for Bihar

S.no

.

Stat

e/di

stric

t

% o

f hou

seho

lds

with

low

st

anda

rd o

f liv

ing

% g

irls

mar

ryin

g be

low

lega

l 18

age

at m

arria

ge

Birt

h or

der 3

and

abo

ve

Any

Met

hod

Any

Mod

ern

Met

hod

Fem

ale

Ster

iliza

tion

Mal

e St

erili

zatio

n

Unm

et n

eed

for f

amily

pl

anni

ng

% w

omen

rece

ived

at l

east

th

ree

visi

ts fo

r AN

C

Inst

itutio

nal B

irth

Del

iver

y at

hom

e as

sist

ed

by a

doc

tor/n

urse

/LH

V/A

NM

% o

f chi

ldre

n (a

ge12

-23

mon

ths)

rece

ived

full

imm

uniz

atio

n

Chi

ldre

n br

east

fed

with

in

one

hour

of b

irth

% w

omen

aw

are

of H

IV/A

IDS

1 Banka 92.0 59.9 50.4 25.0 22.7 20.4 0.0 39.2 31.5 24.7 12.6 32.9 15.1 42.3

2 Aurangabad 85.4 38.7 46.9 34.5 31.0 29.4 0.3 37.9 18.9 30.6 5.0 56.5 14.4 48.3

3 Araria 93.7 41.4 58.2 31.5 29.0 27.8 0.4 36.1 41.2 13.7 6.0 35.8 18.2 29.5

4 Bhagalpur 74.0 27.8 53.1 40.3 35.0 29.3 0.5 36.4 20.4 30.4 14.7 49.6 22.6 57.5

5 Muzaffarpur 81.4 35.7 50.5 33.1 32.2 28.9 0.1 36.9 20.4 23.0 3.3 57.4 15.5 46.0

6 Nalanda 73.0 46.6 47.8 30.9 27.2 21.2 0.5 40.7 25.2 39.3 7.0 54.2 30.2 73.7

7 Nawada 87.1 65.3 51.6 24.3 21.9 18.7 0.7 39.9 23.6 31.1 3.7 48.9 9.9 53.0

8 Champaran W 89.2 57.8 58.7 32.3 27.8 26.3 0.2 36.9 32.4 24.9 2.4 30.2 9.8 36.6

9 Patna 50.9 34.0 45.7 43.7 40.2 33.6 0.2 31.0 20.7 58.8 3.7 43.8 21.3 84.6

10 Champaran E 88.0 54.9 48.1 27.7 23.6 20.8 0.7 34.7 36.0 27.1 1.7 41.3 7.2 19.9

11 Buxar 78.0 49.8 47.9 31.2 26.9 23.7 0.2 36.8 22.1 48.0 4.8 27.7 23.4 65.0

12 Begusarai 83.7 46.2 54.2 28.0 25.2 23.4 0.2 39.0 28.3 26.8 4.6 40.3 9.4 23.8

13 Munger 61.7 30.5 42.6 41.4 33.9 30.3 0.4 31.6 36.8 48.6 10.5 36.3 19.3 79.0

14 Madhubani 88.4 39.5 53.1 96.3 34.9 28.2 0.0 40.3 35.6 16.0 4.0 42.1 7.9 30.3

15 Madhepura 90.6 55.3 53.5 35.0 31.0 29.2 0.4 35.9 20.0 17.7 3.9 39.7 11.1 39.4


38

16 Lakhisarai 79.8 54.7 48.0 31.2 28.2 25.1 0.5 41.6 25.3 32.5 6.3 36.0 13.7 32.2

17 Darbhanga 83.5 39.1 51.4 31.8 30.4 27.9 0.1 36.3 29.0 15.1 2.9 41.8 15.3 44.2

18 Gaya 80.2 50.4 50.8 30.5 26.7 23.3 0.3 34.0 23.9 20.7 6.6 31.8 20.6 55.1

19 Gopalganj 82.0 35.9 48.4 12.8 22.1 20.4 17.0 0.0 31.8 36.5 6.6 52.4 10.5 31.0

20 Jamui 91.2 72.9 49.4 27.4 20.7 18.3 0.3 44.2 27.1 17.6 8.0 17.4 14.8 41.7

21 Jehanabad 83.8 56.7 46.1 28.2 24.1 20.1 0.6 39.8 30.6 42.5 10.6 47.2 18.6 66.8

22 Kaimur 84.4 56.1 51.5 29.9 24.8 21.3 0.2 34.9 23.7 42.6 6.8 21.9 30.9 60.2

23 Katihar 88.1 43.7 53.0 26.0 20.3 16.6 0.0 43.7 32.5 12.4 3.9 32.6 13.4 37.6

24 Khagaria 84.8 49.3 51.3 31.1 27.5 25.2 0.3 37.3 26.4 25.3 6.7 45.8 9.8 54.3

25 Kishanganj 90.7 32.1 57.0 27.2 23.5 16.0 0.6 38.1 28.5 17.8 3.8 26.6 12.8 38.9

26 Purnia 87.0 40.4 53.6 10.4 27.5 25.7 23.3 41.2 19.4 21.6 2.9 37.4 13.8 28.8

27 Bhojpur 78.8 48.1 45.5 35.3 30.2 25.5 0.6 39.9 17.2 40.4 12.5 31.2 20.1 57.2

28 Saharsa 87.3 54.4 47.9 32.6 29.8 27.8 0.2 37.5 13.9 20.0 8.8 43.4 15.8 46.3

29 Samastipur 87.6 51.4 52.7 34.8 28.9 26.6 0.4 36.3 23.9 27.6 3.1 51.1 10.9 38.1

30 Saran 81.9 31.0 51.5 29.1 25.2 20.9 0.3 43.7 22.7 22.4 6.1 65.1 15.4 59.8

31 Sheikhpura 79.0 53.5 52.1 26.7 23.4 20.2 0.6 39.0 43.2 41.6 5.0 38.3 10.5 51.4

32 Sheohar 89.0 54.8 57.0 27.4 22.3 20.4 0.1 42.6 18.9 11.9 3.4 28.3 8.3 31.8

33 Sitamarhi 86.8 44.4 56.3 18.1 25.3 23.7 22.1 41.2 22.9 16.4 4.7 39.1 12.5 40.7

34 Siwan 78.4 27.6 46.0 24.0 20.4 17.2 0.2 39.7 33.4 33.5 8.2 52.4 13.3 50.2

35 Vaishali 81.3 41.2 46.9 43.6 39.8 35.0 0.6 32.7 16.0 28.2 9.6 53.3 33.8 81.5

36 Supaul 92.0 44.2 51.5 43.1 41.6 40.1 0.1 29.8 21.2 23.2 2.4 39.5 13.3 38.2


39

Focus Districts:

As per the guidelines issued by the Ministry of Minority Affairs, GoI regarding districts with higher

percentage of the minority population, the SPIP for NRHM, attempts to provide adequate resources.

Bihar has got seven districts Araria, Kishanganj, Purnia, Katihar, Sitamarhi, West Champaran, Darbhanga in

category-A which have both socio-economic and basic amenities parameters below national average while

allocating available resources to the districts, we've tried to give priority to these Category-A districts. The

District Magistrates of 3 (three) of these districts i.e. Araria, Purnea and Katihar have been made members of

State Health Mission headed by CM. This year the rest 4 will also be included, so that the specific problems

of these districts may be brought into fore.


40

4.6 Health Infrastructure and Facilities

The delivery of services could only be improved if facilities are within reach and have minimum basic physical infrastructure to provide the basic

services. There seemed a major challenge in construction of the health care facilities. Lack of clear guidelines sometimes delayed the process.

To make the BEmOCs and CEmOCs functional, adequate staff, essential equipments and infrastructure (OT, Labour rooms, new born care area,

blood storage and blood storage units) are to be taken up as a priority area.

District wise Availability of Health Centres of Bihar State

Sl

.

Name of

Districts

No.

of

DH

New

Constr

uction

Tota

l

DH

No. of

Sub

Divl

Hospital

s exist

New

Const

r

uctio

n

No. of

Referral

Hospital

upgrade

d in Sub

Div

Hospital

s

Total

Sub

Div

Hosp

itals

No. of

Referra

l

Hospit

als

exist

previou

sly

No. of

Referra

l

Hospit

als

exist

Present

ly

No.

of

PHC

s

exist

New

Constr

uction

No. of

APHCs

upgrad

ed into

PHCs

Total

No.

of

PHC

s

No. of

APHCs

exist

previos

ly

No. of

APHCs

exist

present

ly

No.

of

HSC

s

1 Araria 1 1 1 1 2 3 2 9 9 30 30 200

2 Arwal 1 1 0 3 3 23 23 46

3

Aurangaba

d 1 1 1 1 3 3 11 11 58 58 207

4 Banka 1 1 1 1 3 3 10 1 11 24 24 227

5 Begusrai 1 1 1 1 2 2 1 11 7 2 18 31 29 288

6 Bhagalpur 1 1 1 1 2 2 2 11 5 2 16 46 44 280

7 Bhojpur 1 1 1 1 2 2 12 2 1 14 20 19 284


41

8 Buxar 1 1 1 1 2 7 4 1 11 20 19 158

9

Champaran

(E) 1 1 1 2 3 3 1 20 7 3 27 46 43 315

1

0

Champaran

(w) 1 1 1 1 2 2 2 16 2 18 25 25 389

1

1 Darbhanga 1 1 2 2 13 6 4 19 51 47 261

1

2 Gaya 1 1 1 1 2 2 1 19 6 4 25 49 45 439

1

3 Gopalganj 1 1 1 1 3 3 10 4 2 14 22 20 186

1

4 Jamuai 1 1 1 1 3 3 7 2 2 9 21 19 166

1

5 Jhanabad 1 1 1 1 2 2 4 5 2 9 25 23 81

1

6 Kaimur 1 1 1 1 2 2 1 9 2 1 11 40 39 107

1

7 Katihar 1 1 2 2 3 1 11 5 2 16 32 30 257

1

8 Khagaria 1 1 0 1 1 6 1 1 7 18 17 151

1

9 Kishanganj 1 1 1 1 2 2 7 7 8 8 136

2 Lakhisarai 1 1 1 1 1 1 4 2 6 13 13 102


42

0

2

1 Madhapura 1 1 1 1 1 7 6 4 13 23 19 115

2

2 Madhubani 1 1 1 1 1 3 2 1 19 19 76 76 430

2

3 Munger 1 1 1 1 1 6 3 3 9 13 10 123

2

4

Muzaffarp

ur 1 1 0 1 1 14 2 16 47 47 473

2

5 Nalanda 1 1 1 1 2 3 2 12 8 7 20 36 29 302

2

6 Nawada 1 1 1 1 2 2 10 4 3 14 27 24 129

2

7 Patna 3 1 1 5 4 3 16 7 6 23 70 64 418

2

8 Purniea 1 1 1 1 2 2 1 11 3 3 14 34 31 278

2

9 Rohtas 1 1 1 1 2 1 1 13 6 5 19 17 12 186

3

0 Saharsa 1 1 1 1 7 3 10 33 33 152

3

1 Samastipur 1 1 3 1 4 1 1 14 6 4 20 59 55 354

3 Saran 1 1 1 1 3 2 15 5 3 20 45 42 413


43

2

3

3 Sheikhpura 1 1 1 1 1 1 3 3 6 18 18 74

3

4 Sheohar 1 1 1 1 1 1 3 1 4 7 7 34

3

5 Sitamarhi 1 1 1 1 1 1 13 5 2 18 38 36 213

3

6 Siwan 1 1 1 1 2 2 15 4 2 19 34 32 370

3

7 Supaul 1 1 1 1 2 1 1 9 2 1 11 28 27 178

3

8 Vaishali 1 1 1 1 2 2 11 6 3 17 36 33 336

Total 25 11 36 23 20 15 58 70 55 398 135 73 533 1243 1170 8858

Table : Bihar: Public Health Infrastructure – Personnel

Sl.

No Districts

MO ANM LHV MHW Staff Nurse AWW

Sanct. Working Sanct. Working Sanct Working Sanct. Working Sanct. Working Sanct. Working

1 Araria 117 98 273 177 41 12 102 40 17 9 1778 1631 2 Aurangabad 188 91 342 319 23 17 110 75 12 3 1430 1390 3 Arwal 62 24 78 105 4 4 59 34 0 0 631 631 4 Banka 97 84 275 213 45 25 124 49 12 6 1352 1044 5 Begusarai 117 73 352 351 24 16 33 11 8 8 1314 1296 6 Bhagalpur 162 127 387 385 48 27 34 32 8 8 1512 1347 7 Bhojpur 132 105 370 368 26 20 106 42 8 1 1658 1646 8 Buxar 89 77 212 212 15 11 42 19 2 2 1139 1139 9 Champaran (E) 237 135 364 355 35 23 48 28 12 1 2901 2895


44

10 Champaran (W) 145 74 427 308 43 19 60 5 19 15 2263 2252 11 Darbhanga 172 152 363 296 29 19 131 96 8 5 2563 2315 12 Gaya 231 197 575 563 41 33 245 159 8 1 2427 2385 13 Gopalganj 106 95 250 249 20 8 30 3 12 2 1816 1592 14 Jehanabad 119 92 59 56 5 5 31 18 13 8 604 599 15 Jamui 85 61 222 222 25 12 70 31 12 8 1156 1138 16 Kaimur 93 74 146 146 19 11 64 20 19 9 996 993 17 Katihar 121 106 238 211 56 31 33 1 12 7 1716 1637 18 Khagaria 73 61 190 191 31 18 18 5 4 2 967 965 19 Kishanganj 56 37 169 115 31 15 64 27 11 5 1052 963 20 Lakhisarai 72 51 131 131 20 14 40 28 10 9 671 608 21 Madhepura 81 51 223 93 35 9 22 4 4 0 962 588 22 Madhubani 233 124 487 380 37 15 54 43 34 16 3437 2852 23 Munger 141 91 157 157 30 28 51 30 23 23 645 644 24 Muzaffarpur 241 223 594 592 29 21 140 82 4 4 2822 2610 25 Nalanda 178 167 402 402 30 30 36 21 0 0 1785 1761 26 Nawada 115 87 207 207 24 11 30 21 25 17 1249 1235 27 Patna 289 205 434 434 32 30 49 6 16 13 2481 2465 28 Purnia 126 100 356 275 56 29 126 67 8 2 1464 1424 29 Rohtas 158 129 286 270 29 12 136 48 20 10 1712 1628 30 Saharsa 97 55 192 169 33 15 18 1 26 21 932 825 31 Samastipur 192 183 475 470 30 20 29 18 4 4 2692 2512 32 Saran 185 133 512 386 33 29 46 17 27 10 2455 2218 33 Sheikhpura 53 36 109 109 16 6 18 4 4 1 357 339 34 Sheohar 52 34 46 26 4 1 38 13 9 1 265 265 35 Sitamarhi 147 127 299 289 27 9 130 82 17 13 2064 1920 36 Siwan 151 126 465 298 31 25 102 56 13 9 2099 1934 37 Supaul 85 70 206 111 44 8 60 34 2 0 1376 1230 38 Vaishali 126 105 421 414 25 24 33 28 8 3 1844 1608 5124 3860 11294 10055 1126 662 2562 1298 451 256 60587 56524


45

District Hospitals: Out of 38 Districts 25 have district hospitals. Most of the district hospitals are not

functioning up to the level due shortage of specialties and Staff Nurses. Construction of 11 District Hospitals

are on full swing and expected to be completed by 2010.

Sub District Hospitals: At present there are 23 Sub District Hospital, 20 new SDH are under construction and

15 Referral Hospital are in the process of up gradation to SDH.

Referral Hospitals: There are 55 referral Hospitals. These referral hospitals get patient from PHCs, APHCs

and are covered by specialised services.

Block PHCs: At present there are 398 PHCs, 135 new PHCs are under construction and will be

operationalised by this year. 73 Adll PHCs will also be upgraded to PHCs. These PHCs require to be

upgraded at CHC level for specialised Services.

Adll PHCs: The total no. of Adll PHC is 1243. These adll PHCs only provide OPD services. All these PHCs

require to functionalise the inpatient for providing deliver services and reduce the load of Block PHCs.

HSCs: At present there are 8858 HSCs in the state. Half of the HSCs are running from the rented place or

Panchayat office. Mostly these HSCs are manned by one ANM only.

Infection Management and Environmental Plan:

Bio medical waste management has emerged as a critical and important function within the ambit of

providing quality healthcare in the country. It is now considered an important issue of environment and

occupational safety. As per the Bio-Medical Waste (Management & Handling) Rules, 1998, all the waste

generated in the hospital has to be managed by the occupier in a proper scientific manner. The GoI has also

issued the IMEP guidelines for SCs, PHCs and CHCs. The state is in the process of outsourcing the Bio-

medical Waste Management system for all the hospitals.

4.7 Human Resource Development including Training

Human Resource Development forms one of the key components of the overall architectural corrections

envisaged by both the RCH II and NRHM programs. The Government of Bihar also has spelt out the same as

the number one priority. However the implementation of this vision has been fraught with various obstacles.

Though the state has reasonable number of MBBS doctors, there is an acute shortage of specialized medical

manpower. The shortage of specialists like obstetricians and Anesthetists are obstructing the state plans to

operationalise all district hospitals as First Referral Units. The available specialists in the state cadre is


46

concentrated at the state Referral Hospital and hence the same handle bulk of the institutional deliveries state

wide and is the only center capable of providing comprehensive emergency obstetric care services. In 2008-

09, there has been a continuous focus on the capacity building of the existing manpower in the state.

Trainings as per GoI guidelines on Immunization, IMNCI, EmOC, LSAS, SBA and Minilap/MVA etc have

been taken up with full vigour. It is proposed to continue these trainings in 2009-10. In addition, the state

wide training on Immunization for Medical Officers, IPC skills for Breast feeding and basic training of

neonatal resuscitation-shall also be taken up for various levels. (Details of training plan and Budget is given

in the annexure)

4.8 Inequity/ Gender; Vulnerable Groups Including Urban Slums & Tribal 4.8.1 Inequity and Gender

Ensuring Gender Equity One of the broad indicators for measuring gender disparity is the sex ratio. The sex ratio in Bihar is

unfavorable to women. Analysis of other indicators on the basis of gender reveals widening gaps between the

sexes. While NMR for females is marginally higher than that of males, it widens further for the IMR, and

even further for the under-five Mortality Rate. In conditions of absolute poverty, where resources to food and

health care are severely limited, preference is given to the male child, resulting in higher female malnutrition,

morbidity and mortality.

Gender discrimination continues throughout the life cycle, as well. Women are denied access to education,

health care and nutrition. While the state's literacy rate is 47.5%, that for women in rural areas is as low as

30.03%. Abysmally low literacy levels, particularly among women in the marginalised sections of society

have a major impact on the health and well being of families. Low literacy rate impacts on the age of

marriage. The demand pattern for health services is also low in the poor and less literate sections of society.

Women in the reproductive age group, have little control over their fertility, for want of knowledge of family

planning methods, lack of access to contraceptive services and male control over decisions to limit family

size. According to NFHS data, for 13% of the births, the mothers did not want the pregnancy at all. Even

where family planning methods are adopted, these remain primarily the concern of women, and female

sterilization accounts for 19% of FP methods used as against male sterilization, which is as low as 1%. In

terms of nutritional status too, a large proportion of women in Bihar suffers from moderate to severe

malnutrition. Anemia is a serious problem among women in every population group in the state, with

prevalence ranging from 50% to 87% and is more acute for pregnant women.


47

In all the programmes efforts will be made to meet the needs of vulnerable groups and ensure equity. Gender

sensitization shall be made part of each training. The monitoring system too will be geared for this so that we

may get disaggregated data.

The state of Bihar is implementing the PC- PNDT Act at right earnest. The MOs are being trained by the

State Health and Family Welfare Institute. The Civil Surgeons are the nodal person in the district in this

regard. However monitoring of the activity still a big problem and require to improve. The state has

procedures for registering the diagnostic centres and hospitals which comply these institutes to follow the

PC-PNDT Act.

4.8.2 Urban Slums

Urban health care has been found wanting for quite a number of years in view of the fast of urbanization

leading to growth of slums and population as more emphasis is given in rural areas. Most of the Cities and

Towns of Bihar have suffered due to lack of adequate primary health care delivery especially in the field of

family planning and child health services.

At present, there are 12 Urban Health Centres (UHC) in the state. However, as per the GoI guidelines, there

should be one UHC for 50,000 population (outpatient). The Urban Health Centres should provide services of

Maternal Health, Child Health and Family Planning and especially cater to the Urban slums. The

infrastructure condition of the existing Urban Health Centres is not up to the mark and requires some major

renovation work. The staff at each UHC should comprise of 1 Medical Officer (MO), 1 PHN/LHV, 2 ANMs,

1 Lab Assistant and 1 Staff clerk with computer skills.

4.9 Logistics

Validation of equipments and drugs procurement is within the domain of state level decision making. The

Districts generally purchase the requirements and distributed to the other Health institutes mostly Block

PHCs. However stock out of drugs still a problem for concern and require insurability of drug availability in

the health institutes.

There is provision of contingency funds for emergency drugs at the district level and health facilities.

Whenever PHCs/PHSCs run out of drugs, medicines are purchased through contingency fund and supplied to

the PHCs/PHSCs. The general impression is supplies arrive too late and too little. However under NRHM

there is scope for huge and rapid flow of materials from the MOHFW, GOI and the State level. Also under

the decentralization process the CHC, PHCs and HSCs will have larger autonomy to purchase drugs and


48

supplies locally as per procurement guidelines to be developed by the State Government under the NRHM.

District and the peripheral institutions need to be strengthened through capacity building for enhancing their

capabilities of indenting, procurement, inventory management and distribution of drugs and supplies and

maintenance of medical equipment and transport.

Cold Chain Vans are available in the districts for distribution of Vaccines to PHCs/ HSCs during vaccination

programs and camps. Generally PHC vehicles are used to collect the drugs and supplies from the district

store. Currently local purchase of drugs and supplies are not approved.

Drugs, consumables, and vaccines are directly supplied by the state to districts for HSCs, PHCs and other

facilities very irregularly. There is need to streamline the process for estimation and indenting of vaccines,

drugs and supply of consumables. The supply system would ensure smooth flow of indented materials as per

guidelines from state to all levels of utilization.

A big leap has been taken in 2008-09 in the field of Procurement concerning Maternal and Child Health

equipments and drugs. One of the key achievements has been the finalization of rate contracting for the state

owned 26 Sick Newborn Care Unit, 533 Neonatal Stabilization Units and essential equipment for

strengthening the labour rooms of the state hospitals. In addition, rate contracting of some important drugs

like Misoprostol has also been ensured.

4.10 HMIS and Monitoring & Evaluation

The National Rural Health Mission has been launched with the aim to provide effective health care to rural

population. The programme seeks to decentralize with adequate devolution of powers and delegation of

responsibilities has to have an appropriate implementation mechanism that is accountable.

In order to facilitate this process the NRHM has proposed a structure right from the village to the national

levels with details on key functions and financial powers. To capacitate the effective delivery of the

programme there is a need proper a proper HMIS system

Regular monitoring, timely review of the NRHM activities should be carried out. The quality of MIES in

State HQ and in districts is very poor. Reporting and recording of RCH formats (Plan and monthly

reporting) are irregular, incomplete, and inconsistent and few districts are not reporting at all. Formats are

not filled up completely at the sub center level. There information is not properly reviewed at the PHC level.

No feedback is provided upon that information.

For overall management of the programme, there is a Mission Directorate and a State Programme

Management Unit in the state. The Unit is responsible for overall monitoring and evaluation of the


49

programme in the state and the districts. The data gathering is being facilitated by the State, District and PHC

Data Centres. The numerous formats being used have been reviewed and it is found that data needs to be

compiled only as per RCH, NRHM programme and State needs. Hence the new MIES formats have been

shared with all the health functionaries and it is expected that they shall be reporting in the new formats from

the 3rd quarter.

At district level, there is a District Health Society who will be responsible for the data dissemination from the

sub-district level to the district level. Data Manager/HMIS expert at the State level and Data Assistant at the

district level will be responsible for management of HMIS.

As such, there is a Monitoring Team constituted each at state and district level to monitor the implementation

of the NRHM activities. The Team comprises of representatives from the Mission Directorate and

Programme Committee for various health programmes. The Team also comprises of representatives from

Govt. of India.

There is a Hospital Management Committee/Rogi Kalyan Samiti at all PHCs and CHCs. The PHC / CHC

Health Committee will monitor the performance of HSC under their jurisdiction and will submit the report

and evaluate the HSC performance, and will be submitted to the District, which will compile and sent it to

the State.

4.11 Behaviour Change Communication

The state does not have any comprehensive BCC strategy. All the programme officers implement the BCC

activity as per their respective programmes.

The IEC logistic is designed, developed and procured at the district level and distributed to the PHC in an ad

hoc manner. However some activity is done at the state level.

There is no credible study available to identify the areas / region specific knowledge, attitudes and practices

pertaining to various focus areas of interventions like breast feeding, community & family practice regarding

handling of infants, ARSH issues etc. At present there is no impact assessment of the IEC and BCC

activities. It’s very important to assess the impact of IEC/BCC activities, resources and methods to undertake

mid way corrective measures.

4.12 Convergence/Coordination Convergence with ICDS has been taken care of to cover immunization and ANC Service. ASHA, AWW and

ANMs together hold monthly meetings with Mahila Mandals under MUSKAAN Programme. Government

of Bihar has decided to merge “Village Health and Sanitation Committee” with “Lok Swasthya Pariwar

Kalyan and Gramin Swaschata Samiti” constituted by Department of Panchayat Raj in Bihar. The PHED has


50

been entrusted to train ASHAs as per GoI norm. Adolescent councilors are placed in each district from State

AIDS Control Society. The Health department is looking to cooperate with them by giving training to these

councilors for implementing ARSH programme. The State PWD Department has taken care of the

construction of Health Department. All the construction activity for Health Institutions under NRHM has

already been handed over to the PWD department.

4.13 Finance In 2008-09 the GoI had approved an amount of Rs. 978.61.47 Crores under RCH II.


51

5. Progress and Lessons learnt from RCH II Implementation of 05-08

5.1 Major achievements during 2005-09

1. SHSB at State level and District Health Societies (in all 38 districts) formed & registered.

2. ASHA: A total of 67506 ASHAs selected against the total revised target of 87,135.

3. SPMU & DPM: The State Level consultants in SHSB and DPMU staff (3 in each district) have been

recruited in 34 out of 38 districts. The orientation training for all has been completed.

4. Free drug distribution of essential drugs started from 1st July 2006 and 24 hours presence of doctors

ensured in all facilities up to PHC level resulting in unprecedented increase in OPD patients. 10-30

times increase has been reported. Free drug list has been expanded to incorporate 33 OPD and 75

IPD at MCH, 33 OPD and 107 IPD drugs at DH and 33 OPD and 37 drugs IPD at PHC.

5. Routine Immunization: Full immunization percentage increased to 41.4% (DLHS). Use of AD

Syringe increased to 95%.

6. Against a total figure of 11000 posts of ANM (R), appointment of ANM (R) - 5800 posts of

ANM(R) have been filled up.5200 new appointments have to be made.

7. Rogi Kalyan Samitis formed in all health facilities till PHC level, registration of RKS completed rest

in progress, so far 470 RKS have been registered.

8. Training Programmes: Training of EmOC, Life Saving Anesthesia Training, IMNCI, ASHA,

DPMUs, SBA training, Immunization and Neonatal resuscitation started. This includes the regular

monitoring and corrective actions taken.

9. ANM/GNM training Schools-Out of 22 ANM schools and 6 GNM schools, 20 ANM schools were

restarted after a period of more than a decade. Currently approx. 600 students enrolled. In year 2009,

it is being ensured that ANM and GNM schools train students up to their optimum capacity. Besides,

efforts have been made to strengthen the overall structure of these schools in the state.

10. Institutional delivery has increased manifold as evident from the bar diagram below-

117062

838481902667

0100000200000300000400000500000600000700000800000900000

1000000

2006-07 2007-08 2008-09(till -Dec08)

Series1


52

11. Additionally in the year 2009-10, rate contracting of equipments for Child (SNCU & NSU) and

Maternal Health (Labour room) for District, Sub-Divisional, CHC and PHC hospitals has been

achieved, which will pave the way for procurement and availability of the same in the Districts.

The State Programme Implementation Plan 2009-10 has been framed on the basis of strategies and activities

which worked in last three years. The major bottlenecks have been identified and an attempt has been made

to overcome them through alternative strategies.

5.2 Programme Management

Some of the things which didn't work in last three years are:-

i. Construction & Renovation- Slow progress in Infrastructure

ii. BCC strategy formulation.

iii. High turnover of personnel in programmes.

iv. The quality of training.

v. Keeping up the motivational level of health staff at all levels.

vi. Utilization of trained staff (It is sub optimal now).

vii. Mismatch of personnel and equipment.

viii. Lack of Proper monitoring and evaluation framework.

ix. Quality issues in critical care services (timely use of referral transport by pregnant women,

utilization of EmOC trained doctors )

x. Acceptance of Private Partners t the district level

Following strategies have been adopted to overcome the problem

Ø Slow progress in infrastructure - To overcome the problem of slow progress in infrastructure, a

separate infrastructure cell has been created in State Health Society, Bihar. This year, it is proposed

that two more personnel may be added to this wing to strengthen it. Moreover all the DMs have been

requested to designate an agency for their district that would carry out all infrastructure-related tasks.

Ø Procurement of Equipment- Though essential drugs have been rate contracted so far, the rate contract

of various equipments needed for carrying out RCH activities are still to be completed. Idea of a

TNMSC model of Corporation is also taking shape in the Department to solve the logistic and

procurement problem.

Ø BCC strategy formulation- Even after two and half years of NRHM, Bihar lacks a consolidated BCC

strategy in health due to lack of technical know how. Besides, some other initiatives are planned this

year in areas like promotion of Breast feeding, PNDT and ARSH among others.


53

Ø Quality Assurance committees in State and Districts- Quality assurance committees formed in 80 %

of the districts as per Quality Assurance Manual of GoI and in rest of the districts, it will be formed

by 2009 March end. State Quality Assurance Cell has been formed. Quarterly monitoring visits are

planned at the state level and the divisional level to monitor quality of trainings and critical services

including family planning.

Ø Recruitment of Medical officers and paramedics- The process of recruitment is lengthy and takes

about 04-06 months. The number of applicants is quite limited because of dearth of doctors and

paramedics in the state. Moreover the consolidate remuneration is not lucrative enough. Hence from

the previous year incentive for rural postings and specialist services have been provided in the SPIP.

Similarly for ANMs, mobile phone facilities for all ANMs are being provided.

Ø High turnover of Personnel- It is felt that the state needs to restrict the turnover of doctors on

contract and also programme managers. It is proposed that a study may be undertaken to assess the

situation and recommend remedies, however it is assumed that rural and specialist bonus will help to

curb the turnover to same extent.

Ø Quality of training - Monitoring cell has been constituted at the state level in State Institute of Health

& Family Welfare. The trainings are being monitored at regular intervals.

Ø Low motivational level of health staff - The motivational level of health staff at all levels is low.

Continuous communication and feedback by state level programme officers is being done.

Ø Sub optimal utilization of trained staff – Regular evaluation and monitoring is being done and

corrective steps are being taken. Placement of trained people at such facilities where infrastructure is

in place. E.g. The government has taken up on priority the placement of the trained EMoC and LSAS

doctors to the FRUs where there is no such facility. Poor monitoring and evaluation framework –

Regular monitoring visits by programme officers.

Ø Pilot initiatives in two districts – In 2009-10 Maternal and perinatal death enquiry and response is

being initiated in two districts (Kishanganj and Jehanabad). In these districts referral transport money

for JBSY is being linked for payment of referral transport arranged by the pregnant woman through

PHC staff. as a pilot initiative. EmOc services, MTP services, Maternity complex, Newborn corner

are also being strengthened in these two districts in intensive manner. Data collection on maternal

and perinatal death will be done before and after the intervention. If the data collected after the

intervention shows decline in MMR and IMR then the model will be replicated throughout the State.


54

6. RCH II Programme Objectives and Strategies

6.1 Vision Statement:

The NRHM seeks to provide universal access to equitable, affordable and quality health care which is

uncountable at the same time responsive to the needs of the people, reduction of child and maternal deaths as

well as population stabilisation, gender and demographic balance in this process. The mission would help

achieve goals set under the National Rural Health Policy and the Millennium Development Goals. To

achieve these goals NRHM will:

• Facilitate increased access and utilization of quality health services by all.

• Forge a partnership between the Central, state and the local governments.

• Set up a platform for involving the Panchayati Raj institutions and community in the management

of primary health programmes and infrastructure.

• Provide an opportunity for promoting equity and social justice.

• Establish a mechanism to provide flexibility to the states and the community to promote local

initiatives.

• Develop a framework for promoting inter-sectoral convergence for promotive and preventive health

care.


55

6.2 Technical Objectives, Strategies and Activities

1 Maternal Health

Goals: Reduce MMR from present level 371 (SRS 2001-03) to less than 100

Objectives:

1. To increase 3 ANC coverage from 26.4% to 45% by 2009-10 and to 75% by 2010-11. (DLHS3)

2. To increase the consumption of IFA tablets for 90 days from present level of 9.7% to 20% by 2009-10 and

to 35% by 2010-11. (DLHS-3)

3. To reduce anemia among pregnant mothers from 60.2% to 52% by 2009-10 and to 40% by 2010-11.

4. To increase institutional delivery from 70% to 76% by 2009-10 and to 85% by 2010-11 (MIS data)

5. To increase birth assisted by trained health personnel from 31.9% to 45%. (DLHS-3).

6. To increase the coverage of Post Natal Care from 26% to 40% by 2009-10 and to 55% by 2010-11.

(DLHS-3).

7. To reduce incidence of RTI/STI cases

8. To reduce the no of unsafe abortions

Source of data: DLHS 3, NFHS 3 and MIS Data

Objective No. 1: To increase 3 ANC coverage from 26.4% to 45% by 2009-10 and to 75% by

2010-11.

Strategies and Activities:

1.1. Institutionalization of Village Health and Nutrition Days (VHND)

1.1.1 In collaboration with ICDS, such that the Take Home Ration (THR) distribution and ANC Happens on

the same day

1.1.2 This will require minor changes in the microplans of Health and ICDS

1.1.3 Policy decision and appropriate guideline under convergence between Health and ICDS need to happen

as a priority

1.2 Improved Access of ANC Care

1.2.1 Provision for Additional ANMs in each Sub Centres (Refresher Training to ANMs on Full ANC to

improve the quality of ANC)

1.2.2 Setting up of New Sub Centres to cover more areas


56

1.2.3 Micro planning: Identifying vulnerable groups, left out areas and communities having high percentages

of BPL under each block and incorporating the same into the block micro plans to focus attention on them

for providing Community and Home based ANC to them.

1.2.4 Organizing Monthly Village Health and Nutrition Days in each Aaganwadi Centres

1.2.5 Organizing RCH camp in Each Block PHC areas.

1.2.6 Tracking of Pregnant mothers by ASHAs

1.3 Ensure quality service and Monitoring of ANC Care

1.3.1 Strengthen the monitoring system by checking of ANMs duty rooster and visits of LHVs and MOs.

1.3.2 Involvement of PRIs in monitoring the ANMs service through convergence

1.3.3 Refresher training of ANMs on ANC care

1.3.4 Proper maintenance of ANC Register and Eligible couple register

1.4 Strengthening of Health Sub Centres

1.4.1 Repair and Renovation of Sub Centres

1.4.2 Provide equipments like BP Apparatus, Weighing machines, Heamoglobinometer etc to the Sub

Centers.

1.4.3 Timely supply of Drug Kit A and Kit B

1.5 Generate Awareness for ANC Service

1.5.1 Convergences meeting with AWWs, ASHAs, PRI Members, NGOs at the Gram Panchayat level by

ANMs. These meetings will also attended by MOs from Adll PHCs.

1.5.2 Tracking of Pregnant mothers by ASHA, ANM and AWWs though organizing Mahila Mandals

meeting. Incentive for ASHAs and ANMs to give for the initiative. This initiative is under MUSKAAN

Programme. Incentive for ASHA will be taken care under Intersectoral Convergence.

1.5.3 Counseling by ASHAs and ANMs to the pregnant mothers, mothers and Mother in Laws.

Objective No. 2: To increase the consumption of IFA tablets for 90 days from present level of 9.7% to 20%

by 2009-10 and to 35% by 2010-11. (DLHS-3)


2.1 Purchase and Supply of IFA Tablets

2.1.1To include IFA under essential drug list

2.1.2 Timely supply of IFA Tablets to the Health Institutions ( Ensuring no stock out of IFA at every level

down to Sub-Centre Level)

2.1.3 District to purchase IFA tablets in the case of stock out

2.1.4 Convergence with ICDS and Education for regular supply of IFA tablets through AWWCs And

Schools for the pregnant and lactating women, children 1-3 years and adolescent girls

2.2 Awareness generation for consumption of IFA Tablets


57

2.2.1 Pregnant mothers will be made aware for consumption of IFA tablets for 90 days

2.2.2 ASHA and AWWs will generate awareness along with ANMs at the Village level

2.2.3 Ensure utilizing the platform of Mahila Mandal meetings being held every third Wednesday

Objective No.3: To reduce anemia among pregnant mothers from 60.2% to 52% by 2009-10 and to 40% by

2010-11.

3.1 Supplementing IFA tablets consumption with other clinical strategies.

3.1.1 Half yearly de-worming of all adolescent girls.

3.1.2 Training of ANM, AWW and ASHA on module on EDPT (Early Diagnosis and Prompt Treatment) of

anemia.

3.1.3 Activities for consumption of IFA tablets as per Objective No. 2

3.2 Other strategies

3.2.1 Refer severely Anemic Pregnant Mothers to referral centers

3.2.2 IPC based IEC campaigns emphasizing on consumption of locally available iron rich foodstuff.

Details given under Special Scheme on Anemia Control in Part B

Objective No. 4: To increase institutional delivery from 70% to 76% by 2009-10 and to 85% by 2010-11

(MIS data) and to increase facilities for Emergency Obstetric Care (EmOC)


The strategies will lead to up gradation and operationalization of the facilities to increase institutional

deliveries along with providing EmOC and emergency care of sick children. These facilities will also provide

entire range of Family Planning Services, safe MTPs, and RTI/STI Services.

4.1 Upgrading Block PHCs/CHCs in to FRUs

4.1.1 Provision of OT and lab facility by upgrading 76 FRUs

4.1.2 Blood Bank and or Provision of Blood storage, OT and lab facility by upgrading 76 FRUs

1. All district hospitals must have either its own Blood Bank, operational round the clock, or must have

access to one that can be accessed in less than 30 minutes

2. All CHC / PHCs have blood storage facility

4.1.3 Training of MOs on Obs & Gynae and Anesthesia

1. 18-week Life Saving Anesthetic Skills (LSAS) training for MBBS Doctors

2. 16 week -Emergency Obstetric Skill training for MBBS doctors

3. 3 days training of doctors and nurses posted at FRUs for the neonatal stabilization unit

4.1.4 Repair and renovations of FRUs

4.1.5 Appointment of Anesthetist, O&G specialist, Staff Nurses at the FRUs


58

4.1.6 Incentivise the conduct of C section at FRUs @ Rs 1500 per C section for the staff involved at the

FRUs.

4.1.7 Accreditation of FRUs

4.2 Operationalization of 24x7 facilities at the PHC level

4.2.1 Training of MOs and Staff Nurses of PHCs in BEmOC

4.2.2 Appointment of at least 3 Staff Nurse in each PHCs

4.2.3 Repair and renovation of PHCs

4.2.5 Availability of and timely supply of medical supplies and DDK & SBA kits

4.2.5 Training of MOs, Staff Nurses on SBA

4.3 Increase beneficiary choice for institutional delivery through IEC campaign complimented by network of

link workers working on incentive basis for each institutional delivery achieved

4.3.1 Strengthening JBSY Scheme

1. Improving quality: Infrastructural support to high burden facilities to avoid ‘early discharge’

following institutional deliveries

2. Mapping of high burden facilities and proving them support for matching infrastructural up

gradation to increase the hospital stay following delivery

3. Identifying districts and blocks and communities within them, where the awareness and reach of

JBSY scheme is poor and to ensure increased service utilization in these areas

4.3.2 Design and implement an IEC campaign focusing on communicating the benefits of institutional

delivery and benefits under JBSY scheme.

4.3.3 Equip the ASHA network to reinforce the IEC messages through IPC interventions at village /

community level.

4.3.4 Provide incentives to ASHA for every institutional delivery achieved in her village / designated area.

4.3.5 Involvement of PRIs for JBSY scheme to monitor and generate awareness for institutional delivery.

4.4 Provision of Referral Support system

4.4.1 Provision of a dedicated referral transport system for the newborns and pregnant women to refer them

from home/HSCs/PHCs to referral centers.

4.4.2 Monitoring of referral transport system

4.4.3 Development of proper referral system between Health Institutions.

4.4.4.Operationalising of Blood Storage Units in 76 FRUs


59

Lack of Blood Storage Units in the state make things complicated during emergency hence in 76 FRUs blood

storage units has been proposed. Operationalising of at least one Blood Storage Units in 76 FRUs is proposed

as per IPHS guidelines.

Sl.

Particulars Qty. Rate (Rs.) Months Amount

(3x4x5=6)

1 2 3 4 5 6

1 Salary of One Medical Officer 76 20,000/- pm 12 1,82,40,000/-

2 Salary of 3 Lab Technician @ Rs. 6500/-

pm

228 6,500/- pm 12

1,77,84,000/-

3 Diesel 76 5,000/- pm 12 45,60,000/-

4 Service and Maintenance Charge 76 5,000/- pm 12 45,60,000/-

5 Misc. and Others 76 2,000/-pm 12 18,24,000/-

Total Operational Cost 4,69,68,000/-

Objective No.5: To increase birth assisted by trained health personnel from 31.9% to 45%. (DLHS-3).


5.1 Ensure safe delivery at Home

5.1.1 Provision of Disposable delivery kits with ANMs and LHVs - Establishing full proof Supply Chain of

the DD Kits

5.1.2 Training of ANMs on SBA

1. Providing SBA with approved drug kits, in order to deal with emergencies, like post-partum

hemorrhage, eclempsia, and puerperal sepsis

2. Ensuring regular supply of these drugs to the SBA

5.1.3 Supply of adequate DD Kits to ANMs, LHVs.

5.2 Provision of delivery at HSC level

5.2.1 Supply of DDkits to HSCs

5.2.2 Delivery tables to be provided to the HSCs

Objective No.6: To increase the coverage of Post Natal Care from 26% to 40% by 2009-10 and to 55% by

2010-11. (DLHS-3).

Strategies and Activities


60

6.1 Ensuring proper practice of PNC services and follows ups at the health facility level.

6.1.1 Refresher sessions for all ANMs on uniform guidelines to be followed for PNC care – all delivery cases

to remain at facility for minimum 6 hours after normal delivery and to be recalled to facility for check up

with 4 days and after 42 days.

6.1.2 Ensuring follow up PNC care through out reach services (ANM) for delivery cases where the patient

does not return to facility for follow up check ups.

6.1.3 Referral of all complicated PNC cases to FRU level.

6.1.4 LHV and MO to monitor and report on PNC coverage during their field visits

6.2 Utilizing the ASHA network to strengthen the follow up of PNC services through tracking of cases,

mobilization to facilities and providing IPC based education / counseling.

6.2.1 Utilize ASHA to ensure 3 PNC visits by the ANM for home delivery cases (1st within 2 days, 2nd within

4 days and 3rd within 42 days of delivery) and 2 follow up visits for institutional delivery cases.

6.2.2 Counseling of all pregnant women on ANC and PNC during monthly meetings of MSS and during

VHND.

6.2.3 Linking of ASHA’s incentives on institutional deliveries to completion of the PNC follow-ups.

6.3 Basis Orientation of AWWs on identifying Post-partum and neonatal danger signs during her scheduled

visits following delivery

6.3.1 Basic orientation on IMNCI – in order to be able to alert the beneficiary and coordinate with ASHA

and ANM (to avoid undue delay)

6.3.2 Basic orientation on identifying post-partum danger signs, specially, for home based deliveries, such

that the she can alert ASHA, ANM or the local PHC towards avoiding undue delay

Objective No. 7: Reduce incidence of RTI/STI


7.1 Ensuring early detection through regular screenings and contact surveillance strategies.

7.1.1 Early diagnosis of RTI / STI through early detection of potential cases through syndromic approach and

referral by ANM and ASHA.

7.1.2 Conducting VDRL test for all pregnant women as a part of ANC services.

7.1.3 Implementing contact surveillance of at risk groups in convergence with Bihar AIDS Control Society.

7.2 Strengthening the infrastructure, service delivery mechanism and capacity of field level staff for handling

of RTI / STI cases.

7.2.1 Conducting community level RTI / STI clinics at PHCs


61

7.2.2 Training to all MOs at PHC / DH level in Management of RTI / STI cases in coordination with Bihar

AIDS control Society.

7.2.3 Training of frontline staff, LHV, ANM and ASHA in identifying suspected cases of RTI / STI in

coordination with Bihar AIDS Control Society.

7.2.4 Strengthening RTI / STI clinic of the District Hospitals

Objective No. 8 –Reduce incidence of unsafe abortion

Strategies and activities

8.1 Early diagnosis of pregnancy using Nischay pregnancy testing kits

8.2 Counselling and proper referral for termination of pregnancy in 1st trimester if the woman wishes so

8.2.1 Training of MOs and Nurses/LHV in MTP (MVA)

8.2.2 Procurement and availability of MVA at the designated facilities.


62

2. Child Health

Goal: Reduce IMR from 61 (SRS 2005) to less than 30

Objectives:

1. To reduce low birth weight baby’s by supplementing nutritional support to pregnant mothers

2. To increase exclusive breast feeding from 38.4% to 50% by 2009-10 and to 75% by 2010-11.

3. To reduce incidence of underweight children (up to 3 years age) from 58.4% to 50% by 2009-10 and to

40% by 2010-11.

4. To strengthen neonatal care services in all PHCs/CHCs/SDHs by setting newborn care centers & having

trained manpower therein.

5. To reduce the prevalence of anaemia among children from 87.6% to 77% by 2008-09 and to 60% by 2009-

10.

6. To increase full immunization of Children from 41.4%% to 60% by 2009-10 and then to 70% by 2010-11.

7. To reduce morbidity and mortality among infants due to diarrheoa and ARI

Objective No.1: To reduce low birth weight baby’s by supplementing nutritional support to pregnant mothers


1.1 Convergence with ICDS, supplementary diet which is being given by AWW to pregnant mothers may be

improved.

1.1.1 A supplementary diet comprising of rice, dal and ghee will be provided to all pregnant women. This

will be given for the last 3 months to all underweight pregnant BPL mothers. The Scheme will be

implemented in convergence with ICDS.

1.1.2 Joint Monitoring by Block MO i/cs with CDPO for implementation of the scheme.

Objective No. 2: To increase exclusive breast feeding from 27.9% to 35% by 2008-09 and to 50% by 2009-

10


2.1 Use mass media (particularly radio) to promote breastfeeding immediately after birth (colostrum feeding)

and exclusively till 6 months of age.

2.1.1 Production and broadcast of radio spots, jingles, folk songs and plays promoting importance of correct

breastfeeding practices

2.1.2 Production and broadcast of TV advertisements and plays on correct breastfeeding practices


63

2.1.3 Publication of newspaper advertisements, booklets and stories on correct breastfeeding practices

2.2 Increase community awareness about correct breastfeeding practices through traditional media

2.2.2 Involve frontline Health workers, Aaganwadi Workers, PRIs, TBAs, local NGOs and CBOs in

promoting correct breastfeeding and complementary feeding through IPC, group meetings, folk media and

wall writing.

2.2.3 Educate adolescent girls about correct breastfeeding and complementary feeding practices through

school -based awareness campaign.

3. To reduce incidence of underweight children (up to 3 years age) from 58.4% to 50% by 2008-09 and to

40% by 2009-10


3.1. Growth monitoring of each child

3.1.1 Supply of spring type weighing machine and growth recording charts to all ASHAs, AWWs. All

ASHAs, Aaganwadi centers and sub centers will have a weighing machine and enough supply of growth

recording charts for monitoring the weight of all children through Untied fund of S/Cs.

3.1.1 Weighing and filling up monitoring chart for each child (0-6 years) every month during VHNDs

Each child in the village will be monitored by weight and height and records will be maintained

3.2 Referral for supplementary nutrition and medical care

3.2.1 Training for indications of growth faltering and SOPs for referral to AWWC for nutrition

supplementation and to PHC for medical care.

3.2.2 Establishment of 10 Nutrition Rehabilitation Centres in Districts having severe problems of

malnutrition and continue of 8 existing Centres (A Special Scheme taken up and put under NRHM B)

Objective No.4: To strengthen neonatal care services in all PHCs/CHCs/SDHs by setting newborn care

centers & having trained manpower therein.


4.1. Strengthen institutional facilities for provision of new born care

4.1.1. It is planned to develop a model for comprehensive care of the newborn at all levels, from state to the

community level.


64

MODEL FOR COMPREHENSIVE CARE OF NEWBORN

Plan of action:

DISTRICT LEVEL: NEAR LEVEL II SICK NEWBORN CARE UNIT

Neonatal mortality accounts for over 60% of Infant mortality. Further reduction in Infant and Child mortality

is critically dependant upon significant decline in Newborn deaths. Although on average 41% of deliveries

are conducted in the institutions, i.e., at P.H.C and district hospitals, there are no separate facilities to manage

sick Neonates in the hospital and health centers, Even at district hospital, the sick Neonates (Home delivered

and Institutional delivered) are generally treated along with the older sick children.

Level Facility Services/Activities Training required Equipment

1. District Level

Near Level II Sick Newborn Care Unit ( (SNCU) to provide specialized care services to sick newborns

Special care of neonates 4 days training Equipment for SNCU and refurbishment.

2. PHC level

Neonatal Stabilization Unit with basic care services in health facilities

Delivery services Neonatal Resuscitation Warmth

1 day training in essential newborn care

Neonatal warmer Oxygen supply Ambu bag and Mask

3. Village level

IMNCI Trained workers in each village to provide essential child care and counseling services to community

Post natal Visits, Counseling for breastfeeding and newborn care practices, immunization Timely identification, classification and treatment and referral, if needed

8 days training in IMNCI

IMNCI training module Drug Kit

Village Level

PHC Level

IMNCI trained worker, community initiatives (BCC approaches, involving PRI, Self Help groups etc.)

Sick Newborn Care Unit (level 2)

Neonatal Stabilization Unit District Level


65

It has been observed that near level II Neonatal care is

• Needed for 15-20% of all the neonates

• 5000 neonates need special care per million population per year

• Need for 150 special care beds per million population

Establishment of near leveI SNCU (sick newborn care unit) in 13 districts is proposed.

REQUIREMENTS FOR ACCREDITATION

1. Location of the SNCU:

• Should be easily accessible from entrance of the hospital

• Should not be located on top floor

• For units catering both inborn and out born neonates: next to labor ward & delivery room

• For units catering out born neonates only: near children ward

2. Space Requirement:

1200 sq ft area for a 12 bed near Level II SNCU @ 100 sq ft per patient of which:

a. 50 sq ft would be patient care area and

b. 50 sq ft would be added up for ancillary areas

3. Equipments for individual patient care in the Sick Newborn Care Unit:

Item Requirement for the unit

1. Servo controlled radiant warmer 1 for each bed (essential) +2 Total=14

2. Low reading digital thermometer (centigrade scale) 1 for each bed (essential) Total=14

3. Neonatal stethoscope 1 for each bed (essential) Total=14

4. Neonatal resuscitation kit: 1 set for each bed (essential) Total=14

5. Electrically operated pressure controlled slow suction

machine

1 for 2 beds (essential)

Total=7 (5 electrical, 2 foot operated)

6. Oxygen hood (neonatal or infant size, unbreakable) 1 for each bed (essential) Total=14

7. Non stretchable measuring tape (mm scale) 1 for each bed (essential) Total=14

9. Infusion pump or syringe pump 1 for 2 beds (essential) Total=7

10. Pulse oxymeter 1 for every two beds Total=7

11. Double outlet oxygen concentrator 1 for every two beds Total=7


66

12. Double sided blue light phototherapy 1 for every three beds Total=2

13. Single side blue light phototherapy Total=3

13. AC (1.5 ton) split 8

14. Generator (15 KVA) 1

4. Side Laboratory Equipments:


Microscope with gram and Leishman staining facility 1 (essential)

Microhematocrit centrifuge, capillary tubes and reader 1 (essential)

Billirubinometer 1

Multistix strips (in container) 1

Glucometer with Dextrostix 3

5. STAFF

Manpower 12 bed SNCU

1. Pediatricians 2

2. Medical Officer 4

3. Sister-in-charge / PHN 1

4. Staff Nurse 6

5. ANMs 8

6. Class IV 6

6. Life Saving drugs for Emergency:

This list is not exhaustive for an Emergency situation in any Sick Newborn Care Unit


• Injection adrenaline, naloxone,

• sodium bicarbonate, aminophylline,

phenobarbitone, hydrocortisone,

• 10% dextrose,

• normal saline,

• ampicillin with cloxacillin, ampicillin and

cefotaxime and gentamycin etc

A stock of 1 set per bed per month

should always be maintained in the

unit


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Support establishment of Neonatal Stabilization Units in select 100 high-mortality blocks with personnel and

equipment for neonatal resuscitation, Postnatal Care, Healthy Newborn Care , 35-37 weeks gestation,

Stabilize neonates < 35 weeks

FACILITIES FOR PHC LEVEL: NEONATAL STABLIZATION UNIT

NEONATAL STABILIZATION

• Adequate warming through radiant heat source.

• Facilities for Resuscitation with self inflating resuscitation bag and well fitting neonatal face masks

(at least two sizes).

• Medicines of essential newborn care

1. Supply of bucket type / spring type weighing machines to all sub centres and Anganwadi centres

Many times new borns and infants are not weighed or incorrectly weighed using adult type weighing

machines which are usually available at sub centres and Anganwadi centres. Provision of bucket type or

spring type weighing instruments will improve weight monitoring.

2. Pediatrician will be appointed on contract basis @ Rs.26000 pm.

3. Training of MOs on Paediatrics

4. Training of MOs, Staff Nurses on Facility Based New Born care

Training and operationalization cost will be borne by the UNICEF.

GRASSROOT LEVEL IMNCI TRAINING

Details as per Annexure

4.2 Generation of awareness on new born and infant care (home-based) in community through MSS

4.2.1 Community Awareness on home-based care of new born (skin-to-skin contact, bathing after a week,

not removing vermix, etc.); early recognition of danger signs - ARI, diarrhoea; proper weaning practice

The ASHAs / MPWs / AWWs at every point of contact for ANC and PNC will reinforce tenets of home-

based care of new born as per IMNCI guidelines. The training will be part of IMNCI.

5. To reduce the prevalence of Aneamia among children from 87.6% to 77% by 2008-09 and to 60% by

2009-10.


Details in special programme for “Controlling Iron Deficiency Anemia in Bihar” under Part B NRHM

Additionalities.


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6. To increase full immunization of Children from 32.8% to 40% by 2008-09 and then to 60% by 2009-10.


6.1 Conduct fixed day and fixed-site immunization sessions according to district micro plans.

6.1.1 Fill vacant ANM posts and appoint additional ANMs in a phased manner to achieve GoI norm of one

ANM for 5000 population by the year 2009-10.

6.1.2 Update district micro plan for conducting routine immunization sessions

6.1.3 Ensure timely and adequate supply of vaccines and essential consumables such as syringes, equipment

for sterilization, Jaccha-Baccha immunization cards, and reporting formats at all levels.

6.1.4 Supply AD Syringes to conduct outreach sessions in select areas.

6.1.5 Enlist help of AWW/ASHA in identification of new-borne and follow-up with children to ensure full

immunization during sessions. New born tracking system to be implemented

6.1.6 Replace all Cold Chain equipment, which is condemned, or more than five years old in a phased

manner by the year 2007-08 and supply new Cold Chain equipment based on analysis of actual need of the

health facilities

6.1.7 Facilitate maintenance of Cold Chain equipment through Comprehensive annual maintenance contract

with a private agency with adequate technical capacity. Tender already floated and decided.

6.1.8 Provide POL support to State and Regional WIC/WIF facilities @ Rs. 15000 per month and @ Rs.

5000 per PHC per month to each PHCs for running of Gensets and minor repair

6.1.9 Issue necessary departmental instructions to re-emphasize provision of ANC services in the job

description of Aaganwadi Workers and ANMs.

6.2 Build capacity of immunization service providers to ensure quality of immunization services.

6.2.1 Provide comprehensive skill up gradation training to immunization service providers (LHVs/ANMs),

particularly in injection safety, safe disposal of wastes and management of adverse effects.

6.2.2 Conduct training to build capacity of Medical Officers, MOICs and DIOs for effective management,

supervision and monitoring of immunization services

6.2.3 Train Cold Chain handlers for proper maintenance and upkeep of Cold Chain equipment

6.3 Form inter-sectoral collaboration to increase awareness, reach and utilization of immunization services

6.3.1 Develop working arrangements with ICDS and PRIs to ensure coordination at all levels

6.3.2 Involve Aaganwadi Workers and PRIs to identify children eligible for immunization, motivate

caregivers to avail immunization services and follow-up with dropouts.


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6.3.3 ASHA, AWW and ANM will hold meeting with Mahila Mandals at each village monthly for increasing

the coverage of Immunization. Incentive to be provided to ASHA and ANM under RCH and AWW under

intersectoral convergence.

6.3.4 Involve ICDS and PRI networks in behavior change communication for immunization.

6.4 Strengthen Supervision and monitoring of immunization services

6.4.1 Build capacity of Medical Officers, MOICs and DIOs in supervision and monitoring of implementation

of immunization services as per the micro-plan.

6.4.2 Provide mobility support to MOICs and DIOs for supervision and monitoring of implementation of

immunization services.

6.4.3 Develop effective HMIS to support supervision and monitoring of implementation of immunization

services.

6.4.5 Coordinate with representatives of PRI to strengthen supervision and monitoring of immunization

services.

6.4.6 Details of Immunization have been incorporated in part- C of PIP.

7. To reduce morbidity and mortality among infants due to Diarrhea and ARI Strategies and Activities:

7.1 Increase acceptance of ORS

7.1.1 Supply of ORS and ensure availability in all depots and supply of cotrimoxazole tablets.

The ASHA drug kit will have ORS and cotrimoxazole tablets which should be replenished as per need.

Aaganwadi centers should also be given ORS. In the absence of ORS, the use of home-based sugar and salt

solution will be encouraged.

7.1.2 Orientation of ASHA for diarrhea and ARI symptoms and treatment

ASHAs will be specifically trained to identify symptoms of diarrhea and ARI and to provide home-based

care. Danger signs prompting transportation to seek medical care will also be taught to ASHAs.

7.1.3 Organize meetings for ASHAs/AWWs for dissemination of guidelines for Home based care

ASHA and AWW will be trained and provide guidelines for Home based care. The meeting will be held at

Block PHC level.

A detail Action Plan for ORS submitted under Part B of NRHM Additionalities

7.2 Strengthening of referral services for infants seeking care for life threatening diarrhoea and ARI

7.2.1 Availability of referral money @ Rs.500 available for transporting of sick infants to the health institute.

7.2.2 Blood slide examination of all febrile children with presumptive treatment


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In endemic areas, most children are anemic due to repeated bouts of malaria. Any febrile child needs to be

checked for malaria compulsorily.

7.2.1 Strengthening of PHCs/ referral centers

School Health Programmes

Counseling sessions will be organized in Govt. Schools in collaboration with BSACS. Story lines and

slogans will be published in text books of schools in collaboration with the Education Deptt. Reference

Books on Health Issues and Healthy Life-Style will be published for School libraries. Health Camps will be

organized for health check-ups for school children. Innovative strategies will be adopted to orient school

children about healthy practices.

Details annexed


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3 Family Planning

Goal: Reduce TFR by 2.1 from present level of 4.3

Objectives:

1. To reduce total unmet need for contraception from 23.1 % to 15%

2. To increase Contraceptive Prevalence Rate (Any Modern Method) from 28.8% to 35% by 2008-09 and to

45% by 2009-10

3. To increase male participation in family planning

4. To increase proportion of male sterilizations from 0.6% to 1.5%.

5. Monitor the quality of service as per GoI guidelines for Sterilization

Objective No.1: To reduce total unmet need for contraception from 23.1 % to 15%


1.1 Plan to organize RCH camp in each PHC/CHC once in two months.

1.1.1. Creating dedicated cadre of skilled manpower

1. Training of MBBS doctors on Minilap and NSV

2. Training of MBBS doctors on Anesthesia

3. Training on IUCD: MOs, ANMs etc.

1.1.2 One RCH camp will be organize in each PHC/CHC where Laparoscopic Ligation/Mini Lap will be

done

1.1.3 Incentive to acceptors Incentive for LL operations

1.1.4 Training on LL operation, MTP and IUD Insertion

1.1.5 ASHA and MPWs will publicize about the RCH in their area and motivate the eligible women to go for

spacing & terminal methods of family planning.

1.2 Motivate eligible couples who have had their first child for spacing for condoms, OCPs or IUDs

1.2.1 Update EC register with help of ASHAs and AWW

The eligible couple register is presently being updated once a year (usually in April) in a survey

mode. It is done in a hurry and may not have complete information in many cases. With the

involvement of ASHAs and AWWs, updates should be done each month preferably during VHNDs.

This will result in less wastage of time and resources and better recording of information.

1.2.2 Availability of FP services: IUCDs, OCPs, Emergency Pills, Condoms


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1.2.2.1 Each SDH/CHC/PHC should have static FP cell / corner, with earmarked ANM / LHV responsible,

for providing these services daily as OPD services to clients

1.2.2.2 Community Based Distribution (CBD) of Condoms and Pills: The OCPs and condoms can be

provided to community based motivated volunteers, like members of Self Help Groups (for Pills) and

Husbands of motivated ASHA, Satisfied NSV client, active PRI members etc. (for condoms) for community

based distribution (CBD) of these. The availability of condoms and OCPs with the volunteers and their

geographical responsibilities should be widely known to the potential clients / beneficiaries. Before they are

made the community based distributors, they should be properly trained and mechanism developed to

regularly monitor them and review their performance

1.2.2.3 Public Private Partnership (Social marketing): This can be taken up on an experimental basis in a

couple of districts, or a few blocks in these districts to pilot selling through entrusted community based

institutions, volunteers, market mechanisms (like the popular pharmacist of the village, or grocery shop

owner or the like) condoms and OCPs at normal or subsidized rates. This should be properly preceded by

adequate awareness generation of the availability of these for price in the community itself and that the

clients or the community members could buy these from specified vendors (volunteers etc.). The research has

shown that the services, drugs, supplies etc. bought for fee are valued more by the user and they use them

more.

1.2.2.4 Organize monthly IUD Camps in PHCs/CHCs/SDHs IUD camps will be organize in each

PHC/CHC/SDH every month. ANM and ASHA will be informed the dates on which the camp will be held

in the concern HIs.

1.2.3 Ensure follow up after IUD and OCP for side effects and treatment

Many of the drop outs for IUD and OCP occur due to side effects and lack of proper attention to take care of

these. Follow-ups after IUD insertion and starting of OCPs and provision of medical care to mitigate side

effects will help in continuing with the service and also create further demand.

1.2.4 Organize Contraceptive update seminars at the district level twice in a year.

The seminar for contraceptive updates will be organized at the district level twice in a year. All the

healthcare providers from the district will attend the seminar.

1.3 Motivate eligible couples for permanent methods in post partum period specifically after second and third

child

Efforts will be made by the service providers to motivate parents to adopt permanent methods after the birth

of the second or third child.

1.3.1 Update EC register with help of ASHAs and AWW

Every event will be recorded in the EC register and thus the register will be updated. This can be done after

every event has occurred or reported to have occurred or during the VHNDs visit each month to a village.

1.3.2 Motivate couple after second child in Post Partum period to go in for tubectomy / NSV


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After the second child is born, the couple will be motivated to adopt a permanent method of family planning

preferably NSV. For this communication materials will be prepared and distributed.

1.3.2 Follow up after tubectomy /NSV for side effects and treatment

Each tubectomy / NSV will be followed up for side effects and their treatment. This will provide positive

reinforcement and motivate others to adopt family planning.

1.4 Making available MTP Services in all Health Institutions.

Since 8% of maternal mortality continues to be attributed to unsafe abortion, therefore, availability of and

accessibility to quality abortion services / MTP services acquire greater importance. There is a need to

identify, map and train the providers, both in public and private sectors on abortions / MTP services. There is

also a need to ensure availability of medical abortion drugs; this can be done by including these drugs into

the state procurement list. The latest guidelines on this can be had from GoI. Revisions in MTP Act are

underway; once done, systematic orientation of entire cadre of health personnel on this is required.

1.4.1 MTP Services in the state is not fully operational in all the hospitals of the state. Training of MOs have

been under taken during RCH-1. To further strengthen the skill of the doctors for MTP training, training shall

be taken up during the year. 100 MOs will be trained in 2008-09.

1.4.2 Plastic MVAs will utilize and state will made purchase for availability in health institutions.

Objective No.2: To increase Couple Protection Rate


2.1 Awareness generation in community for small family norm

2.1.1 Preparation of communication material for radio, newspapers, posters

Communication materials highlighting the benefits of a small family will be prepared for radio, TV and

newspapers.

2.1.2 Meetings with MSS, CBOs

Communication materials to be used for monthly MSS/CBO meetings will be prepared and distributed for

use.

These meetings will be scheduled during or preceding the month family planning camps are scheduled to be

held.

2.2 Regularise supply of contraceptives in adequate amounts

2.2.1 Indent and supply contraceptives for all depots and subcentre/ AWCs and social outlets: Each AWC

and ASHA will have at least one month’s requirement of condoms and OCPs. Sub centres will have adequate

supplies of IUDs also.


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Objective No.3: To increase male participation in family planning


3.1 Promote the use of condoms

3.1.1 Counseling men in villages to demonstrate ease of use of condoms and for prevention of STDs

Male workers will assist the MPWs in addressing the meetings of men in villages to demonstrate the use of

condoms and its benefits in family planning and prevention of STDs. It should be stressed that condoms are

easy to use and is a temporary method. Current methods of family planning which target women are not very

easy to adopt while condoms can be very easily used.

3.1.2 Regular supply of condoms and setting up depots which are socially accessible to all men

It is very essential to supply condoms through depots which can be easily accessible to men and

confidentiality will also be ensured. During the meetings, the sources of condoms in the village will be made

known to all. It will be ensured that the client’s identity will not be disclosed. The depot holder will be set up

only on condition that he shall not reveal the identity of clients.

3.2 Promote adopting NSV: as simple and convenient method of hassle free FP methods (however, it must be

told that it doesn’t protect from STI/RTI of HIV / AIDS)

Objective No.4: To increase proportion of male sterilizations from 0.6% to 1.5%.

4.1 Increase demand for NSVs (develop a cadre of satisfied NSV Client, who could be the advocates for

NSV in their designated geographical areas. Orient and train them and give them specific geographical

responsibility to give roster based talks etc to identified groups of probable clients. During these talks the

probable clients can be registered and they could be escorted to the nearest static facility or the camp on

designated days for NSV. Once completed the procedures, then these new clients can become advocates for

the same. This entire process must be fully facilitated by respective PHCs and be provided with all logistics

support along with some incentives for the work or activities undertaken by them)

4.1.1 Village level meetings in which men who already underwent NSV share experiences to motivate men

to undergo NSV

All the GP/ADC Villages will be chosen in the district to hold meetings in which men who have undergone

NSV will tell male members of the community about their experience and the benefits of NSV. These

meetings will be repeated each month in the same batch of Gram Panchayat or ADC Villages. NSV will be

conducted on the motivated men. The same men will then be requested to share their experiences in the next

batch of five villages for the next three months.

4.2 Increase capacity for NSV services

4.2.1 Training of doctors for NSV

While demand is being generated, a team of doctors should be trained at all the FRU level to conduct NSVs.

4.2.2 Organize NSV camps at the Sub District Level


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Objective No. 5: Monitor the quality of service as per GoI guidelines for Sterilization

5.1 A quality assurance committee initiated in every district for monitoring the quality of sterilization in the

respective district. The Civil Surgeon is the chairman of the committee with at least one Gynecologist.

5.2 Streamline the contraceptive supply chain & Monitoring

1. Identifications &Renovation of Warehouse – State /District/ PHC

2. Budget allocation for transportation at every level

3. Provision for report format printing and their availability at every level

Action Plan for Strengthening Sterilization Services

The activities are segregated into short-term and long-term. They are separately spelled out for the state and

the district.

Short Term Activities

State Level Activities:

1. Service Availability

STATIC SERVICES

i. Ensure that district level facilities are fully equipped with manpower and equipments

ii.Availability of Sterilization services everyday at district hospitals, separately for, Males and Females

iii.Availability of Sterilization services at PHC level on at-least 3 fixed-days a week (these days could be

fixed for the entire state, like the Immunization Days, which are Wednesday and Saturdays)

iv. Demand generation activities: wide dissemination of information on the regular (daily and on fixed days)

availability of the services

1. prominent display

2. workshop of key department functionaries, who in turn would disseminate the same to their line

staff, who in turn will directly inform the public about the availability of services

CAMPS

v. The number of camps needs to be planned and based on the ELA of the districts

a. Districts must plan camps in various PHCs and locations based on the need, in the beginning of the

year; this should be based on the past years records etc., and these must be shared in the beginning of

the year with the state

b. These camps must be planned round the year, they must be evenly distributed through out the year

and wide publicity on the venue and dates of the camps, well in advance must be disseminated

through out the respective catchment areas


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c. Availability of Providers

d. Line listing of available Providers by Geographical Areas (DHQ, PHCs, SDH etc.)

Ø Gynecologist,

Ø Surgeon

Ø Anesthetist

Ø Nursing Staff

e. Roster for year long Static Services Providers: Based on the above line listing form Surgical Teams

for male and female sterilization separately, the teams then must be provided with earmarked days of

the week at static centres, like the rotation duties in Medical Colleges and big private Nursing

Homes. For example Team 1 will perform on Mondays and Wednesdays; Team 2 on Tuesdays and

Fridays; and Team 3 on Thursdays and Saturdays etc. and on rotation one Team can be on call for

emergencies on holidays etc.

f. Roster for year long Camp Services Providers Similarly, by camps the teams should be identified in

the beginning of the year and their year-long roster be prepared and informed so to them in advance.

The evenness in providers’ work load should be ensured such that it is not the situation that a few

providers are doing all the surgeries while the remaining are doing none.

g. Identification of Providers for Training: Line Listing of Providers for the same. It must be prepared

for every district and every PHC in the district. Before the training begins for the identified future

providers, their choice must sought as to the posting to the facility they would be interested in; as far as

possible this should be respected. Based on this they should be trained and posted to the pre-identified

facility in a time bound fashion. This exercise should be done in advance and proper notification

regarding the same should be widely publicised and disseminated. This activity should be very closely

monitored by the State Health Society, in order to ensure its full operationalization. Once done, the

training in phased manner should happen in a time bound fashion.

h. Equipping the facilities and keeping the sets of equipments ready for the camps

i. This needs to be ensured as per the guidelines for the facilities: As per the

guidelines, minimum numbers of sets must be available at district and sub-divisional

hospitals

ii. The same needs to be ensured for every camp in advance, such that the quality and

hygiene are not compromised in the camps

i. Monitoring System: Both for Static Services and Camps: To monitor provider out put and progress

in static facilities and camps

i. A check list needs to be developed at State Health Society to monitor the above

ii. A mechanism needs to be developed on this and how the information so gathered

could be used to improve the services and provider output


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j. Monthly Review of sterilization progress and performance by district and sub-district levels,

specially focusing on high-burdened areas hard to reach areas

i. A fixed agenda and points to be reviewed need to developed in order to make there

review meetings focused and result oriented

District Level Activities:

1. Undertake block-wise analysis of service utilization and work out detailed service provisions: fixed day

roster based static services, camps and their schedules

2. Prepare block wise demand generation activities, separately for static services and camps

3. Prepare a list of providers not providing sterilization services and orient and reorient them and place/post

them as per defined roster to the services: static services and camps

4. Finalize work plan with state to get specific need-based inputs

5. Conduct monthly review of sterilization activities at district level

Long Term Actions

State Level Actions

1. increased trained manpower

2. create dedicated pool of providers exclusively for sterilization, develop a mechanism of incentives for

the high achievers

3. provide appropriate mix of services – male and female sterilization at static facilities

4. undertake state level NSV campaign

5. gradually increase static facilities and popularize the availability of the same and similarly gradually

reduce the number of camps proportionately

6. organize state and regional level experience sharing

District Level Actions

1. saturate training of all available providers

2. ensure presence of providers in all static facilities

3. institutionalize sterilization services

4. public private partnership

a. line listing of the same

b. dedicated pool of the same, MBBS doctors (ask them to perform surgeries at government

facilities)

5. orient block level MOs in using data for monthly review and stocktaking


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4. Adolescent Reproductive and Sexual Health

Objective:

1. To reduce incidence of teenage pregnancies from present 25% to 22% by 2008-09 and to 15% by 2009-10.

2. To ensure the access to information on Adolescent Reproductive & Sexual Health (ARSH) through

services at District Hospitals, SDH, CHCs, PHCs & HSC level.

3. To increase awareness levels on adolescent health issues

Objective No.1: To reduce incidences of teenage pregnancies from present 25% to 22% by 2008-09 and to

15% by 2009-10.


1.1 Improve access to safe abortions

1.1.1 MTP services made available at all the FRUs initially & at all SDHs in subsequent years, through

training of select medical officers at DH/MC.

MOs will be trained in MTPs

1.1.2 Manpower (Training) & logistic support to private hospital doctors and will also be trained in

conducting safe abortions.

1.2 Ensure availability of condoms/OCPs/Emergency contraceptives

1.2.1 Depot holders among adolescent groups/youth organizations

In addition to the ASHA and the AWW, youth organizations such as football clubs and others will have

depot holders who will provide condoms/OCPs and Emergency contraceptive pills and maintain

confidentiality.

Objective No.2: To ensure the access to information on Adolescent Reproductive & Sexual Health (ARSH)

through services at District Hospitals, SDH, CHCs, PHCs & HSC level.


2.1. Organize regular adolescent clinics/counseling camps at SC/PHC/CHC/SDH/DH

2.1.1 Appointment of 5 nos. Adolescent Counselor for districts setting up Adolescent clinics.

2.1.2 Adolescent health sessions/clinics will be held in each Sub Centre/ PHC / CHC/SDH and DH with

service delivery & referral support

2.1.3 Risk reduction counseling for STI/RTI


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During the monthly or weekly interactions through health sessions and clinics, counseling for preventing

STI/RTI will be also be done. This will include single partner sex and use of condoms for safe sex.

2.2 ASHA/AWW to act as nodal persons at village level for identifying & referring adolescents in need of

such services.

2.2.1 Training of AWW/ASHA in adolescent health issues

All ASHAs and AWWs will be oriented on problems faced by adolescents, signs and symptoms of the

problems and where to refer these cases.

2.3 Referrals to de-addiction centers for treating alcoholism/drug addiction

2.3.1 Identification of de-addiction centers in the state/district

The state / district will identify NGOs or other de-addiction centres in the state and through the health

workers will refer the cases in need to these centres for treatment.

2.3.2 Circulate information on services provided at these centres and setup referral system

The state/district will have an understanding with the de addiction centre on the process for referring patients

to the de-addiction centres.

Objective No.3: To increase awareness levels on adolescent health issues


3.1 Organizing Behavioral Change Communication campaigns on specific problems of adolescents

3.1.1 IEC activities along with take-home print material to be organized in coordination with MSS, Youth

club

One of the monthly theme meetings with the MSS / CBOs will be related to adolescent health problems,

signs and symptoms, treatment and referrals.

3.1.2 4 monthly health checkups under School Health Programme through PHC medical and paramedical

staff

School Health Programmes (Health Check up under MDM)

As part of the School Health Programme, adolescents in schools will undergo health check ups thrice in a

year. Some counseling related to common adolescent problems will also be given during these check ups.

Children are the asset and future of the Nation. The progress of any country and state depends upon them for

which they must remain healthy. In Bihar there are about 1.5 crore children of 6-14 years age reading in

government primary & middle schools. The health check-up of these children are must atleast once in a year

to detect any serious disease in the early stage, so that preventive and curative measures may be taken at the


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earliest. For this objective in mind government has decided to do medical health check-up of children

reading in government primary and middle schools.

OBJECTIVE :

• Regular annual health check-up of Children registered in government primary and middle school.

• To detect any defect in progress of health and nutritional deficiencies.

• Early detection of serious illnesses and to refer them in the nearest specialized government health

facilities.

• To develop good habit for better health and hygiene to remain healthy.

• To inculcate through the children habit to remain healthy among Family members and community.

• To improve quality of food supplied to children by adding micronutrients.

Additionally Counseling sessions will be organized in Govt. Schools in collaboration with BSACS. Story

lines and slogans will be published in text books of schools in collaboration with the Education Deptt.

Reference Books on Health Issues and Healthy Life-Style will be published for School libraries. Health

Camps will be organized for health check-ups for school children. Innovative strategies will be adopted to

orient school children about healthy practices.

Details annexed

3.1.3 Orientation of VHSC on adolescent issues

The MPWs will during their routine interactions with the VHSC members apprise them of the

problems and issues related to adolescents and what to do for treatment and referrals. (Budgeted in

RCH Training along with maternal health, Child health and Family Planning)

3.1.4 Premarital counseling of adolescent girls on reproductive health issues at PHC/RH/SDH/DH

This will be part of the adolescent health session/clinics which will be regularly conducted at sub centres,

PHCs and also at youth clubs.

3.2 Dissemination of ARSH Guidelines and Trainings

3.2.1 Organize dissemination of ARSH guidelines at State level.

3.2.2 Training of TOTs on ARSH

3.2.3 Training of MOs, ANMs on ARSH

Proposed Strategies and Activities for Operationalization of ARSH

1. ARSH service delivery through the public health system:


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a. Actions are proposed at the level of sub-centre, PHC, CHC, district hospitals through routine

OPDs. Separate arrangements should be done for male and female adolescents.

b. Fixed day, fixed time approach could be adopted to deliver dedicated services to adolescents

and newly married couples. A fixed day across the state, either once a month or twice a

month can be declared for ARSH, and the information regarding the same should be

properly disseminated in the community and properly displayed at the facilities.

c. A separate ARSH Cell, comprising of ANM, LHV, Health Educators etc. (perhaps on a

rotatory basis) can be established at these Cells.

d. A separate ARSH Cell can be constituted at every CHCs and Referral Units, with one MO as

its nodal officer (on call, sort of) and two counselors.

2. Interventions to operationalise ARSH

a. Orientation of the service providers: Equipping the service providers with knowledge and

skills is important. The core content of the orientation should be vulnerabilities of

adolescents, need for services, and how to make existing services adolescent friendly.

b. Environment building activities: this should include orienting broad range of gatekeepers,

like district officials, panchayat members, women’s group and civil society. Proper

communication messages should be prepared for the same exercise. District, block and sub-

block level functionaries should be responsible for this.

c. The MIS should at least capture information on teenage pregnancy, teenage institutional

delivery and teenage prevention of STI.

5 Urban Health Urban health care has been found wanting for quite a number of years in view of fast urbanization leading to growth of slums and population as more emphasis is given in rural areas. Most of the Cities and Towns of Bihar have suffered due to lack of adequate primary health care delivery especially in the field of family planning and child health services.

Objectives:

1. Improve delivery of timely and quality RCH services in urban areas of Bihar

2. Increase awareness about Maternal, Child health and Family Planning services in urban areas of the state

At present, there are 12 Urban Health Centres (UHC) in the state which are non-functional. However, as per the GoI guidelines, there should be one UHC for 50,000 population (outpatient). The Urban Health Centres are required to provide services of Maternal Health, Child Health and Family Planning. The infrastructure condition of the Urban Health Centres is not up to the mark and requires some major renovation work. The


82

staff at each UHC should comprise of 1 Medical Officer (MO), 1 PHN/LHV, 2 ANMs, 1 Lab Assistant and 1 Staff clerk with computer skills.

Objectives No. 1: Improve delivery of timely and quality RCH services in urban areas of Bihar

Strategies and Activities 1.1 Identify health service providers of both public and private sectors (including NGOs) in urban areas and plan delivery of RCH services through them 1.1.1 Mapping of Urban Slums and existing providers of RCH services of both public and private sectors has been completed

1.1.2 Develop Micro-plans for each urban area for delivery of RCH services, both outreach and facility based.

1.2 Strengthen facilities of both public and private sectors in urban areas 1.2.1 Establish partnerships with select private health clinics for delivery of facility-based RCH services e.g. institutional delivery, permanent methods of FP, curative MCH service, etc.

1.2.2 Collaborate with health facilities managed by large public sector undertakings such as Railways, ESIS, CGHS and Military to provide RCH services to general population from identified urban areas.

1.3 Strengthen outreach RCH services in urban areas through involvement of both public and private sector service providers 1.3.1 Deliver outreach services planned under RCH through reinforced network of frontline health service providers (ANMs, LHVs)

1.3.2 Expand outreach of RCH services by adoption of identified under-served or un-served urban areas by facility-based providers (e.g. adoption of a particular slum by a medical college or private health institute)

1.3.3 Establish 20 Urban Health Centres on a rental basis under PPP in this financial year especially in districts with DHs having heavy patient load

Objective No. 2: Increase awareness about Maternal, Child health and Family Planning services in urban areas of the state

Strategies and Activities 2.1 Use Multiple channels for delivery of key RCH messages in urban areas 2.1.1 Utililise various channels of mass media with extensive reach in urban areas such as TV, local cable networks, radio (particularly Vividh Bharti channels), cinema halls, billboards at strategic locations, etc to propagate messages related to key programme components of RCH.

2.1.2 Extensive use of print media such as newspapers (particularly local newspapers), journals and magazines for dissemination of key RCH messages.


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2.2 Broad inter-sectoral coordination to increase awareness and knowledge of key messages under the RCH programme 2.2.1 Involve representatives from Urban Local Bodies (municipal corporations and municipalities), commercial associations, sports bodies, voluntary and religious organisations for intensive inter-personal communication and community-based awareness campaigns.

2.3. Use various channels of mass media for ensuring utilization of services of Urban Health Centres, private or Government


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6. Vulnerable Groups

Health Camps in Maha-Dalit Tola

Two camps shall be held in each Maha-Dalit tola where health check-up and counseling shall be done, followed by distribution of spectacles to reach out to the vulnerable sections of the Society Projected cost for larger districts Rs.500 x 30 districts x 100 tolas=15.00 lakhs Projected cost for smaller districts Rs.500 x 8 districts x 50 tolas=02.00 lakhs Projected cost for spectacles Rs.200 spectacles x 30 people x no. of villages

7. Tribal Health - Deleted


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8. Innovations

8.1 PNDT Act

Implementation of Medical Termination of Pregnancy Act, 1971 and Pre-natal Diagnostic Techniques

(prohibition) Act, 1994.

In order to arrest the abhorrent & growing menace of illegal termination of pregnancies as well that of pre-

natal diagnostic test ascertaining sex-selection, the Medical Termination of Pregnancy Act, 1971 read with

Regulations & Rules 2003 and the pre-natal Diagnostic Techniques (Prohibition of sex selection)Act were

formulated.

The misuse of modern science & technology by preventing the birth of girl child by sex determination before

birth & thereafter abortion is evident also from the fact that, there has been a decline in sex ratio despite the

existing laws.

The Apex court has observed that:-

“We may state that there is total slackness by the Administration in implementing the Act. Some learned

counsel pointed out that even though the Genetic Counselling Centre, Genetic Laboratories or Genetic

Clinics are not registered, no action is taken as provided under Section 23 of the Act, but only a warning

issued. In our view, those Centres which are not registered are required to be prosecuted by the Authorities

under the provision of the Act and there is no question of issue of warning and to permit them to continue

their illegal activities” .The apex court accordingly directed the central as well as state Governments to

implement the PNDT Act. In Bihar too the concerned authorities have been directed to implement the

provisions of the both the Acts forcefully.

Following actions have been taken and planned in this regard.

A. State, District and block level workshops on PNDT has been planned.

B. Create public awareness against the practice of prenatal determination of sex and female foeticide through

advertisement in the print and electronic media by hoarding and other appropriate means

C. A district wise task force to carry out surveys of clinics and take appropriate action in case of non

registration or non compliance of the statutory provisions. Appropriate authorities are not only empowered to

take criminal action but to search and sieze documents, records, objects etc.

D. Beti Bachao Abhiyaan – As female foeticide is a concern both in rural and urban areas, this year, Beti

Bachao Abhiyan will be launched to sensitize people against this heinous practice. Massive awareness drive

with the support of College students, women’s organizations and other voluntary associations is planned this

year. Human Chain, rallies, seminars, workshops and press conferences will be organized for the same.


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8.2 MUSKAAN Programme

The state has started a New Programme called MUSKAAN Programme to track pregnant women and New

Born Child. Under this programme ASHA, AWW and ANMs jointly track the pregnant mothers and New

Born Child.

This programme launch in October 2007. Under this programme ASHA, AWW and ANM will hold meeting

with Mahila Mandals in AWWCs. The main objective is to cover ANC coverage and Immunization. A Data

Centre also placed in all the 533 PHCs to monitor this programme.

After the introduction of this programme it has been seen that the coverage of ANC and Immunization

increased. The State wants to continue this programme and requested the GoI to fund the

programme.Infrastructure is one of the important components for upgradation of facility to deliver the quality

service. In the PIP it has been proposed a number of infrastructural corrections for upgrading the facilities.

These are

1. As per RCH Programme operationalisation of 76 First Referral Unit to provide emergency

obstetric and newborn care 24 hrs. a day / 7 days a week. The aim is to ensure atleast two

operational FRUs per district. There are 76 hospitals in the State which have been identified to be

upgraded as FRUs. The main focus initially to provide remedial measures absolutely required to

ensure proper functioning of the facility. Another important aims to provide appropriate specialist in

each of these 76 Hospitals. It is proposed to upgrade 76 Health facilities to FRUs in 2007 – 2008.

Unit cost of construction at the rate of average of 2 Crores as per RCH norm. The above hospital

will be well equipped with OT, electric supply, water supply, toilet, telephone services, sewerage

system and disposal system for hospital infectious waste.

2. Anesthetist will be hire @ Rs.1000 per case for EmOC. A provision for 50000 cases included in the PIP.

3. Neonatal Intensive care unit will be setup in 13 districts at the district hospitals. Each Neonatal unit will

cost Rs. 39,36,000/-

1 Civil & Electrical Works: Rs. 6,86,000/-

2 Equipments for individual patient Care: Rs. 25,00,000/-

3 General Equipments: Rs. 2,50,000/-

4 Side Lab Equipments: Rs. 2,00,000/-

5 Equipments for disinfection Rs. 1,50,000/-

6 Data Collection & Recording Rs. 1,50,000/-

Total Rs. 39,36,000/-


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The costs also include provision of equipments at these hospitals either as per IPHS or as required.

4. Newborn Care Unit will be set up in all the 533 PHCs @ Rs. 1,57,400/- . This includes minor civil work

and purchase of Equipments.


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9. Strengthening of SIHFW 9.1 Fast-Track Training Cell in SIHFW It is also proposed in this budget to have a full time training experts/coordinator to spearhead various trainings under NRHM. Unless a dedicated Fast-Track Training cell is constituted at state level (at SIHFW), it will be very difficult to improve the quality of trainings and linkage training with performance. As training constitutes one of the largest single components of NRHM Budget allocation, this investment in creating the Fast-Track Training cell at the State level will be very cost effective intervention. Looking at the magnitude of the work under trainings, it is being proposed that under the training co-coordinator, there should be two training sub-coordinators, looking after 50% districts each. Additionally, one clerical staff is suggested. This training cell should be at the SIHFW and will eventually further strengthening SIHFW. Budget: (1.) One Training expert/coordinator = Monthly salary Rs. 30,000/- x 12 months = Rs. 3,60,000/- per annum (2.) Two Training sub-coordinators = Monthly salary Rs. 25,000/- x 2 individuals x 12 months = Rs. 6,00,000/- per annum (3.) One Clerk = Monthly salary Rs. 10,000/- x 12 months =Rs. 1,20,000/- per annum (4.) Office expenses = Monthly Rs. 5000/- x 12 months =Rs. 60,000/- per annum Total Annual Budget = Rs. 3,60,000/- + Rs. 6,00,000/- + Rs. 1,20,000/- + 60,000/- = Rs. 11,40,000/- 9.2 Filling Vacant Position at SIHFW/Hiring Consultant at SIHFW AT the same time, the remaining vacancies of SIHFW can be filled. In order to fast-track the appointments of these faculties and support staff, the appointments can happen on a contractual basis such that trainings can be better organized and their quality improved. As part of strengthening SIHFW, a monitoring section needs to be created at SIHFW to use data on various aspects of training and to improve the quality of training, to make them need based, to assess if skill enhancement is happening, if program efficiency and effectiveness are increasing or if the trained staff are being rationally posted etc. Budget (1.) 10 consultant/faculties = Monthly Salary @ Rs. 30,000/- x 10 individuals x 12 months = Rs. 36,00,000/- per annum (2.) 4 Clerical Staff = Monthly salary Rs. 10,000/- x 4 individuals x 12 months = Rs.4,80,000/- per annum (3.) Office expenses = Monthly expenses Rs. 15,000/- x 12 months = Rs. 1,80,000/- per annum (4.) Monitoring Cell (additional expenses for regular reporting within the system = Rs. 5,000,00/- per annum Total annual budget= Rs. 47,60,000/- per annum


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10. Infrastructure and Human Resource Infrastructure is one of the important components for upgradation of facility to deliver the quality service. In the PIP it has been proposed a number of infrastructural corrections for upgrading the facilities. These are 1. As per RCH Programme operationalisation of 76 First Referral Unit to provide emergency obstetric and newborn care 24 hrs. a day / 7 days a week. The aim is to ensure atleast two operational FRUs per district. There are 76 hospitals in the State which have been identified to be upgraded as FRUs. The main focus initially to provide remedial measures absolutely required to ensure proper functioning of the facility. Another important aims to provide appropriate specialist in each of these 76 Hospitals. It is proposed to upgrade 76 Health facilities to FRUs in 2007 – 2008. Unit cost of construction at the rate of average of 2 crores as per RCH norm. The above hospital will be well equipped with OT, electric supply, water supply, toilet, telephone services, sewerage system and disposal system for hospital infectious waste.

2. Anesthetist will be hire @ Rs.1000 per case for EmOC. A provision for 50000 cases included in the PIP. Similarly Gynecologists and Pediatrician will also be hired as per requirement. 3. For follow up and monitoring RCH Coordinators will be hired at Commissionaire level and at SIHFW. 4. Newborn Care Unit will be set up in all the 533 PHCs and DH. This includes minor civil work and purchase of Equipments. 5. Setting up of Intensive Care Unit in all the District Hospitals

An Intensive Care Unit (ICU) is a specialized department in a hospital that provides intensive care medicine. Many hospitals also have designated intensive care areas for certain specialties of medicine, as dictated by the needs and available resources of each hospital. The naming is not rigidly standardized.

In most of the districts do not have Intensive Care Unit in any set up whether it is Private or Public. The patients have to shift either to the nearest medical colleges or to Patna for Intensive Care. In the process of transfer most of time it has been seen that patient die on transportation. The distance to the nearest ICU set up is long and most precious time waste for treatment of the patient. Setting up of Intensive Care Unit will help to avail patient the facility in all districts so that accessibility for intensive care can be addressed. The state has proposed to establish 4 bedded ICU in all the 36 District Hospitals.


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11. Institutional Strengthening

For HRD, training of 10 regular Government doctors is being proposed in Public Health for improving their

administrative skills.

Multi - Skilled Specialist DNB (Family Physician) 3 years course for 20 service doctors from CHCs SHSB proposes to initiate DNB (Family Physician) 3 years course in select district hospitals. 20 Service

doctors preferably from CHCs who want to undergo DNB courses run by National Board of Examinations

shall be selected based on competitive examination. The course will run via distance education mode for one

and half years followed by another 18 months for hands on experience. There is an option to complete the

course in two parts. After 3 years training, these doctors shall be posted in the CHCs and referral hospitals to

provide caesarean and anesthetist services. The permission of National Board of examination to commence

the DNB Family Medicine course may have to be obtained. To select the suitable young doctors for the

course who will give an undertaking to work in the government health system for 10 years in CHC upwards.

Further more it is proposed that for Multi skilling of Doctors they can be sent to hospitals like Safdarjung etc

in New Delhi for continuing medical education.

Sub-centre rent shall be provided for 20% of the HSCs operational.

Quality Assurance

The state has Quality Assurance Committee for Sterilisation, Birth Control, Maternity Services,

Child Survival Services, Immunization, and Case Management of Diseases in the district

Quality of health care and reproductive health services consists of the proper performance

(according to standards) of interventions that are known to be safe, that are affordable to the society

in question and have the ability to produce an impact on client attraction & satisfaction, belief,

population stabilization, inclination towards the continuation of method(s) etc.

As per the guidelines lay down by the Honorable Supreme Court of India. The State Government is

in the process of constituting Quality Assurance Committees (QACs) at the State and District levels

to ensure that the standards for female and male sterilization and other health services are being


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followed in respect of preoperative measures, operational facilities and post-operative follow-ups

and other ethical diagnostic and treatment protocols.

The terms of reference for the State / District QAC are as follows:

• The District QAC shall conduct medical audit of all deaths related to sterilization,

maternity deaths and deaths arising out of suspected medical negligence and send reports

to the State QAC office. The State QAC shall deliberate on the report.

• Shall collect information on all hospitalization cases related to complications following

sterilization as well as sterilization failure and maternity deaths and deaths arising out of

suspected medical negligence.

• Shall process all cases of failure, complications requiring hospitalization, and deaths

following sterilization for payment of compensation and will pursue these cases with the

insurance company or otherwise.

• Shall review all static institutions i.e. Government and accredited private/NGOs and

selected camps providing sterilization services and providing maternity, Child survival

and other medical care for quality of care as per the standards laid down, and

recommend remedial action for institutions not adhering to the standards.

• A minimum of three members shall constitute the quorum.

Presently the QAC also looking after the quality of all the trainings done under RCH.

Monitoring of delivery of critical services & NRHM trainings (IMNCI, SBA, Immunization,

EmOC, LSAS, NSU, BCC for promoting Breastfeeding, Minilap, MVA, ASHA).

In Bihar state, there is a quality assurance cell housed in the State Institute of Health & Family

Welfare. The key responsibility of this cell has been to coordinate with multiple stakeholders and

keep a track on the trainings happening in the state. There are members from the SHSB, SIHFW,

Faculty of various medical colleges, retired medical college faculty members, and health officials,

members from the professional organizations, and officials from the development partners are on its

panel. The monitoring visits are proposed to be undertaken by the members to different districts and

sub districts for initial handholding and to ensure quality training. As a part of this, standard

monitoring formats available with the state are to be used. The experience till now has been that

many of the doctor members are reluctant to undertake field visits. This is more so when the


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trainings happen in such districts from where same day return is not feasible. The key underlining

reason for this has been found out to be the implementation of RCH I TA and DA norms. As it is

well known, these norms were defined more than ten years ago. The different monitors undertaking

field visits tend to spend from their pockets for the monitoring visits. In the last ten years, the cost

of living has gone up substantially and thus it is proposed to review the financial norms for the

disbursement of TA and DA while on official duty.

After discussions with the stakeholders, it is suggested that the following norms may be adopted by

the SHSB/GoB pending more clear guidelines from the GoI.

S No Category Description Honorarium Travel Cost per

monitoring

day

1. State/Division

Government officials

and doctors

With same day

return

800 per day AC Scorpio/Travera

(@Rs 2000 per day)

2800

2. State/Division

Government officials

and doctors

With night stay

involved

1500 per

night

AC Scorpio/Travera

(@Rs 2000 per day)

2750

3. Medical college

faculty/retired

professionals

With same day

return


(@Rs 2000 per day)

2800

4. Medical college

faculty/retired

professionals

With night stay

involved

1500 per

night

AC Scorpio/Travera

(@Rs 2000 per day)

2750

5. Free lance professionals

(by invitation)

With same day

return


(@Rs 2000 per day)

3000

6. Free lance professionals

(by invitation)

With night stay

involved

2000 per

night

AC Scorpio/Travera

(@Rs 2000 per day)

3000

In a month, on an average, 150 monitoring days would be involved for the training monitoring.


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12 Training

Successful Implementation of any programme depends on the capacity building of the personnel engaged. In

RCH – II also ,human resource base will be created by enhancing the capacities through training .The

sensitization of health personnel towards various RCH interventions is one of the major focus of the capacity

building initiatives under RCH - II . Various trainings will be provided to State and district level managers,

medical officers, nursing staff, ANMs, AWWs, ASHA and others.

The training will be provided at the State Institute of H & FW , Regional training Institutes , ANM training

schools , District hospital ,PHCs and also in Railways , ESI ,private sector hospitals where there is enough

case load for a proper training. Some of the trainings will be contracted out to the NGOs and private players

also, so that any limitation of State infrastructure is overcome easily. [Available in detail in NGO chapter].

As BCC will be a major training aspect, it has been dealt in a separate chapter.

All the technical training programmes will ensure that.along with the theoretical inputs, proper practical

exposure is also provided. Apart from this each training programme will stress on the managerial aspect and

on the communication with the clients.

The TOTs will ensure that the trainers not only master the contents of the training topic but also aquire skills

as teachers/trainers or facilitators and motivators.The state official, trainers, professionals and functionaries

who excel in implementing training programmes will be recognized through awards and citations. A rational

selection criterion will be used to select the trainees for the trainings where the no. of trainees are limited.

Moreover promotion and posting policy will be linked to training and the functionary will have to undergo

training to avail the promotion. There will be provision for proper rational posting so that the personnel

trained, utilize their training in their day to day work.

A feedback system will be developed to assess the quality of the training. From time to time, presence of

state/regional observers will be ensured to assess the quality of district level trainings and workshops.

Detailed Records and data about personnel undergone training should be available with all concerned at all

levels. SIHFW will coordinate and monitor this with the help of district Data Officers


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Training Institutes

SIHFW

The State Institute of Health and Family Welfare (SIHFW) is the premier training institute in the state of

Bihar. SIHFW needs to be further strengthened as the apex institute in the state of Bihar for co-ordination

and implementation of all capacity building initiatives under RCH II program. SIHFW has the required

infrastructure and facilities, which need to be reinforced further so that it can conduct the various training

programs on continuous basis.

As the nodal agency for training activities in the State, SIHFW will have following major tasks:

• To develop annual training calendars based on the district action plans in close co-ordination with

RHFWTCs and ANMTCs.

• To conduct clinical and non-clinical training programs for medical officers.

• To support RHFWTCs and ANMTCs to conduct timely induction and refresher training programs for

ANMs and LHVs.

• To facilitate ongoing assessment of training needs of functionaries at all levels

• Co-ordinate and implement integrated skill development and specialized skill development training

programs.

• Conducting TOTs with RHFWTCs and ANMTCs

• To co-ordinate with SHSB for need based hiring of resource persons for the training programs

In addition, adequate provisions will be made for the institute to hire need based services of electricians,

plumbers, carpenters, etc. on contract basis.

RHFWTCs

There are Eight Regional Health and Family Welfare Training Centers (RHFWTCs) in the state – Three for

male and five for female health staff. All the sanctioned posts of trainers at these institutes are filled.

However, functioning of all RHFWTCs is severely affected due to lack of proper infrastructure. The State

proposes to use the facility Survey to do a detailed assessment of the needs of these training centers. Based

on the report of the facility survey, adequate resources will be provided to all RHFWTCs to upgrade their

respective infrastructure and maintenance support.

Location of the RHFWTCs in the State:

RFWTC Male RFWTC Female

Patna (non residential) Muzaffarpur Bhagalpur

Patna Gaya Muzaffarpur Saran Purnea


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The Facility Survey will also assess the need for new Regional Health and Family Welfare Training Centers

(RHFWTCs) in the state.

ANMTCs

There are 22 ANMTCs in Bihar; the training capacity of these institutes varies from 60 to 90 participants per

batch. Most of these training centers were functioning sub-optiminaly in absence of proper infrastructure and

other essential support but after the facility survey was completed with the help of UNICEF, GoB has been

able to restart 20 ANM schools. Based on the report of the facility survey, adequate resources will be

provided for all ANMTCs to upgrade their respective infrastructure and maintenance support. Further status

of faculty positions/trainers and their requirements at ANMTCs would be assessed in course of facility

survey and then adequate provisions will be made to address their needs.

Key Training Activities

The wide range of training activities to be conducted under RCH II program by various agencies and training

institutes is outlined below. The trainings not mentioned in training plan would be taken up with the help of

development partners .Adequate changes will be made to make all the trainings as per GOI guidelines.

Maternal Health

• Provide comprehensive skill up gradation training to frontline ANC service providers (ANMs

and LHVs) to ensure delivery of quality ANC services

• Conduct training to build capacity of LHVs for effective supervision and monitoring.

• Train Aaganwadi Workers and PRI members would help in identification and motivation of

pregnant women for healthy antenatal care practices and for utilization of ANC services.

• Impart refresher training to Gynecologists and Obstetricians on safe delivery practices and

referral procedures

• Train all ANMs, LHVs, and Nurses in identification of danger signs during delivery, referral

procedures and PNC services.

• Train NGOs, Aaganwadi Workers and PRI members in raising community awareness and

knowledge about importance of institutional delivery, safe delivery practices at home, referral

and PNC services.

Child Health

• Train frontline Health workers, Aaganwadi Workers, PRIs, local NGOs and CBOs in correct

breastfeeding and complementary feeding practices


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• Provide comprehensive skill up gradation training to immunization service providers

(LHVs/ANMs), particularly in injection safety, safe disposal of wastes and management of

adverse effects.

• Conduct training to build capacity of Medical Officers, MOICs and DIOs for effective

management, supervision and monitoring of immunization services

• Train Cold Chain handlers for proper maintenance and upkeep of Cold Chain equipment

• Train Aaganwadi Workers and PRI members in identification of children eligible for

immunisation, in motivation of caregivers to avail immunisation services and in follow-up of

dropouts

• Identify key persons to join IMNCI master training pool

• Train members of master trainer pool in national level course

• Recruit and train district trainers (using state master trainer pool)

• Train all health and ICDS staff in a phased manner

• Train frontline health workers and Aaganwadi workers in health education techniques to build

community capacity for early recognition of childhood illnesses, home-based care and care-

seeking

Family Planning

• Train partners such as NGO and civil society networks, religious organisations and leaders,

PRIs, ICDS, Education, General Administration, Corporate Associations and Professional bodies

(IAP, IMA) in promotion of Family Planning, at state, district and block levels

• (Re) train frontline health workers, Aaganwadi Workers and PRIs as motivators and counselors

for family planning services through IPC and counseling

• Impart technical skill-enhancement training to existing and newly appointed frontline health

workers on provision of various spacing (Oral contraceptive, condom, IUD insertion, emergency

contraception) and terminal (female and male sterilization) methods of Family Planning.

• Train doctors in various reversible and terminal FP procedures (MTP, Minilap, NSV and IUD).

Adolescent Health

• Conduct annual orientation and training of all health service providers on adolescent health

needs at state, district and block levels

• Train/sensitize community leaders, school teachers, PRIs, NGO networks, Anganwadi Workers,

towards the health needs of the adolescents


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• Train NGO and civil society networks, religious organisations and leaders, PRI members and

teachers in promotion of safe reproductive health practices and family planning among

adolescents.

• (Re) train frontline health workers and schoolteachers as motivators and counsellors for safe

reproductive health practices and family planning among adolescents through IPC and

counseling

• (Re) train frontline health workers to provide RTI/STI curative services for adolescents


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13 IEC/BCC

The Annual Action Plan 2009-10 for IEC/BCC has been prepared in the light of the number of initiatives taken by Dept. of Health, GoB, and State Health Society, Bihar, in the implementation of NRHM. It follows in essence, form and content, the National Communication Strategy. The National PIP for RCH and instructions and guidelines received from GoI and GoB from time to time has also been kept in mind.

The selection and implementation of set of behavior change have been adopted with a view to improve a wide range of family care-giving and care-seeking practices, and enhance supportive environments for improved household health practices at community, institutional and policy level. The IEC/BCC Programme will focus on building an environment favoring health seeking practices, preferably through low cost and no cost interventions, especially for the disadvantaged and the marginalized sections of society. This outlook will set the tone and tenor of the mobilization process for effectuating a positive change in the existing socio-cultural mores, systems and processes.

PUBLICITY: Print & Electronic Media – Materials will be developed and publicized on different issues eg. Dial 102 (Ambulance Service), Dial 1911 (Doctor’s Consultancy), ICU Service, JBSY, Promotion of Breast Feeding,

Family Planning including Non Scalpel Vasectomy, Immunization, Urban Health, Adolescent and Sexual Reproductive Health, PNDT Act, Role of ASHA under NRHM, Role of Mamta, Importance of Super Speciality Hospitals and various PPP activities initiated by SHSB etc., through various print and electronic media. Health Materials will be publicized on Bihar Text Book & Different types of Certificates issued by

Govt. of Bihar and others. Outdoor Media - Hoardings, Glow Signs, Laminated Board, Flex Banners, posters, etc., on issues related to RCH and NRHM will be put up at vantage points will be displayed at important locations like at District

Offices, Block Offices, PHCs, Haat points, Bus Stands, Railway stations, etc. Monthly magazine brought out by the I & P.R. Dept. is being again sponsored by SHSB. Space has been allocated in the magazine for publicizing about health related programmes. Exhibitions, Melas, Nukkad Natak functions will be organized in each district from time to time to expand reach of different programmes. Folk Media will also be used as a

tool for publicity. Health related Posters/Banners will be displayed on Mail Van. At the District/State level - Advocacy Programmes, workshops seminars, press conferences, etc., will be organised for different target groups including Politicians, Media Personnel, Bureaucrats, NGOs, School

Children, etc. Mobility Support: Vehicles will be hired on rent on a monthly basis at the State to provide mobility support to the IEC component.


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BCC/IEC Bihar is a state with high cultural heterogeneity. It has been a challenging area to address for the issues of behaviour change in a heterogeneous population. Even if the language of communication in Bihar is Hindi/maithili/maghahi/angika/bhojpuri etc the use of words and styles differs from area to area. It indicates that no common strategy is going to work for the entire state as different areas have different dialects of

communication. Use of BCC has been one of the key components in any health sector strategy. It is essential to modify risk prone life styles and practices to promote healthier lifestyles and practices. In past the state have had many major rounds of social mobilizations and awareness generation which have helped to take key health messages to even the most interior of the rural areas. But still there is a lot of space for the

improvement. High prevalence rate of malaria, kalazar. TB, filaria and sickle cell anaemia indicates the magnitude of the problem in the state which can be reduced through behavior change approach. All these need area specific strategies for the positive change like to motivate the people through behavior change communication for the use of bed nets avoid water logging in and around habitation area and collection of

garbage in a common place away from the habitation. The approach would be adopted to impart attention precise to the existing problems district wise focused manner.

BCC strategy Development of a service oriented BCC strategy should be based on an assessment of the current status of knowledge, attitudes, beliefs and practices regarding issues concerned with MMR, IMR, TFR and ARSH;

and factors likely to influence necessary change in behaviour. Creation of awareness of key aspects such as breast feeding and PNDT act is particularly important. Based on evidence, the strategy should aim to determine appropriate combination of messages and media and a mechanism for assessing impact at appropriate stages. The institutional arrangement including role of state and district and strengthening

capacities for BCC is again important. Behaviour Change Communication: The Annual Action Plan for 2009-2010 for Behaviour Change Communication has been prepared in the light of the health priorities of the Government of Bihar and the programmes it is committed to implement under the NRHM. It draws its approach from the national communication strategy as well as NRHM and RCH guidelines.


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Despite its third year of operation, the NRHM in the state has been implemented without a comprehensive communication strategy, which is largely due to lack of skilled human resource and professionals within the State Health Society and Health department to carry out this specialized function of strategic communication.

The action plan therefore proposes certain initiatives that focus on institutional strengthening of the State Health Society with human resource building consisting of communication professionals. It also lays emphasis on capacity building of the Programme Managers and the District Managers in strategic

communication in order to ensure that communication activities do not merely remain adhoc interventions but are based on research, evidence; are local / region specific and are built on a strong monitoring & evaluation system.

The strategic approach will also ensure that different elements of communication and channels are employed in a manner they complement and supplement one another leading to greater impact. The interventions will focus on : • Improving family care-giving and care-seeking practices

• Enhance supportive environment for improved household practices at community, institution and policy level

• Promote health seeking practices through low cost and no cost interventions • Pay attention to disadvantaged and marginalized sections of the society

• 1. Establishment of BCC Cell in State Health Society

In order to effectively manage the communication interventions for different programme under NRHM, a teams of experts and professionals need to be built. Under the Mission Director of NRHM i.e. The Executive Director, State Health Society, the following structure is proposed to be established.

Key Activities for the Year 2009-2010


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State Health Society will set up the BCC Cell with development of terms of reference, job descriptions, identification and recruitment of suitable personnel with required skills and expertise as well their orientation.

The BCC Cell under the leadership and over all direction of the Executive Director, State Health Society, will then be responsible to manage NRHM’s communication activities in the state.

Executive Director – State Health Society

BCC Cell

BCC Coordinator

Training Coordinator

Field Coordinator

Designer / DTP Assistant

MIS Assistant

IEC Logistics Assistant

M & E Coordinator


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2. Capacity Building of Programme Managers & District Managers

Communication understanding and sensitivity is essential before any attempt to initiate activities to achieve goals of BCC under NRHM. Since this discipline is becoming more and more research and evidenced based, it is necessary for those to understand the concept, tools and advance techniques, who are supposed to undertake and supervise these activities in the state. It is a well recognized fact that accomplishment of

NRHM goals largely depends upon quality of BCC inputs and its impact on behaviour and social change. To build the capacities of senior managers and mid-level managers of the health department and that of the State Health Society, a training workshop will be organiesd. Inputs from tools employed during capacity

assessment of State Health Society and specific need assessment for this training will feed into the design of the training workshop. The capacity assessment exercise will aim to find :

• individual capacity of officials of SHS to carry out / implement state wide IEC / BCC activities- experience & skill

• capacity in designing and developing appropriate material & programme • training skill for the use of IEC / BCC material • capacity in communication monitoring- dissemination and tracking of progress • capacity for storage and appropriate distribution IEC / BCC material

Besides this, it will contain topics such as

• Understanding of communication as a process • Multistage thinking

• Frame work and elements of communication research • Designing a communication campaign • Elements of an effective communication plan • Channels and tools for communicating the message

• Multi channel approach • Skills to use communication material • Communication monitoring • Evaluation

All these topics will be dealt in the light of new research and thinking in the area of development communication. 3. Development of Health Communication Strategy The health communication strategy for the state will be developed through a participatory process involving experts, programme managers and government officers and will be consistent to the overall programme


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strategy for NRHM and RCH. It will aim to reposition different programmes and services under the NRHM in a health framework -that is, offering good health as the reward for families leading to other economic and social benefits. The communication strategy will attempt to cover the following :

• Review the current status of NRHM programmes in the state • Identify potential communication strategies • Select the most appropriate approach • Identify primary, secondary and tertiary audience segments

• Introduce the action plan with audience-media-message framework from which will evolve the communication plan for every programme

The strength of any communication lies in it being is “contextual” and “specific”. It is essential to formulate a state specific communication strategy to reach to the masse with right kind of messages and through

appropriate channels. Bihar is socially and economically backward but culturally very rich. It has many kinds of festivals associated with agriculture seasons, melas, huge religious congregations, community gathering etc which provide a unique opportunity to disseminate messages. Can this cultural and traditional richness become central theme of proposed communication strategy of Bihar? These are kind of questions for which

experts will brainstorm. SHSB will lead the process of communication strategy development with technical inputs as well as formations of core groups of national and state level experts for development of Bihar specific

communication strategy. SHSB will work in carrying out a comprehensive formative research and to pilot some concepts in the identified programme areas that will help in designing the strategy. This research will include : Ø review of existing state communication plan, if any,

Ø social and cultural norms, practices & customs, Ø opportunities for entertainments and festivals, occupation-livelihood, daily life style Ø socio-economic indicators Ø available and popular means of communication.

The core group will provide strategic communication recommendations and guidelines. Broadly out come of this strategy development initiative will be

• Strategic Communication positioning for the state of Bihar

• Communication goals of the state • Means to achieve communication goals - resources • SHS's preparedness to accomplish these goals - infrastructure, allocations and capacities

This communication strategy will help the state health planners to • Increase impact of communication drives / campaigns initiated by the state


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• Use time, people and resources more efficiently • Exploit opportunities - use of cultural and traditional richness of Bihar • Prevent potential problems

4. Communication Plans for Different Programmes under NRHM While the institutional strengthening and communication strategy development process will be carried out,

communication plans for different programmes under NRHM will be prepared and implemented under the 2009-2010 PIP with technical support from different internal / national agencies and partners. Broadly, the multimedia communication around the above issues will follow the following approach :

The state and district health communication plans for different programmes / issues will be prepared by the State Health Society. The communication plan will have following components :

• Identification of issues to be communicated - NRHM's objectives

• Identification and planning regarding communication channels – guided by the state communication strategy

• Capacity building of service providers- IPC, skills to use material and issues • Distribution and dissemination plan of communication material

• Monitoring and evaluation mechanisms SHSB will work in the development of communication plans and materials for various programmes covered under NRHM Part A, B and C of the SPIP.

Inter Personal Communication, counseling by trained functionaries supported with various social mobilization and mass media activities will be built into communication plan for each programme under NRHM.

5. Skill Building of Frontline Functionaries Inter Personal Communication being the core element of the communication package and the lead medium, it is imperative to build the skills of frontline functionaries who are in direct interface with the communities at

household and / or facility level. SHSB will create a pool of trainers at State, District and Block levels on : • Use of Interpersonal Communication and counseling techniques to promote health seeking behaviors

in the context of issues identified under RCH II. • Appropriate and effective use of communication tools and materials


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In order to build the skills of service providers around a number of issues, State Health Society will develop and use a training module based on Facts for Life (FFL) framework. A detailed training and monitoring plan using cascade approach and also SATCOM training technology (on pilot basis) will be developed and

implemented. 6. Institutional Strengthening of IEC Bureau In order to mainstream strategic communication in all health programmes, revival and strengthening of IEC Bureau as the nodal body for implementation of all health communication is necessary. State Health department will review the current status of the Bureau and prepare an action plan plug the gaps in terms of human resource as well as directives and operational guidelines. This will serve a long term objective of

sustained communication interventions as against the campaign mode of communication activities. A well planned IEC/BCC strategy and implementation framework is being placed and District Level IEC plans is being prepared. This year our focus was to make programmes based on this. The

basic constraint here was to reinforce the need to understand the importance of IEC/BCC planning for local specific and outcome based BCC programmes. The state lacks a rigorous planning unit that conceptualizes and strategizes the programmes and an implementing team that realizes these programmes to the expected levels. We are planning for adding this as part of this PIP.Currently, the key strategy adopted by the state is

folk art based on Kalajathas, wall writings, printed posters and handouts, TV/Radio interventions etc, some innovative strategies were adopted. It has been found that the current state level centralisation of this needs to be shifted to local level strategies, for which a policy has been formulated. This year, we are also planning to have specific focus on IEC areas for each month.

Objectives of Behaviour Change Communication: • Empowering the family and individuals to take health related decisions based on information and analysis

• Motivating the community to play a proactive role in improving their health status • Effective greater utilization of health services through an improved public understanding of health care • Mainstreaming gender and equity and strengthening governance through BCC strategy • Creating competencies and enabling environment to assist with the above objectives

Key strategy and activities for Behavior Change Communication • Developing IEC materials and designing campaigns for area specific and different age

groups- by social, linguistic and ethnic characteristic • Distributing BCC kit (flip chart, flash cards, resource book on local food,


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complimentary feeding decision chart, films etc) to the Mitanins and building their capacity through training for its proper and effective use. • Key areas on RCH behavior

• The BCC/IEC cell will be set up at the directorate. To establish BCC/IEC cell will need to have necessary equipments like computers with adequate software back up fordesigning, printers, printing materials, stationeries and furniture etc. Strengthening of the BCC/IEC cell will be done by in sourcing technical experts (3 technical experts) of the subject like

nutrition, communication, medical doctors, graphic artist and designersfor the effective designing of the communication strategies etc. The function of the BCC cell would be • To design the behaviour matrix- communication strategies and media materials in order to ensure in-house production.

• The in-house materials production (films, radio programs, posters, kalajattha, etc) this will serve as reference materials on health and will also be used by other department for IEC. • The cell has to make operational framework for BCC. •It will work in coordination with the other relevant departments by incorporating the ideas and components

relevant to the context of the subject. •Intersectoral coordination for BCC on common intervention with W&CD, PHED, Education, Health,

SCERT, Unicef, CGSACS Doordarshan etc 94• Major emphasis would be given on awareness generation on behaviour change. The action planned for

this is to use combination of mediums for the reach and penetration of the messages. Radio would be used as a strategy at the district level for the penetration of the messages and for the dissemination of the district specific messages • Comprehensive approach shall be taken up to address the health related problems like imparting life skill

education to the adolescent groups, distributing BCC kit to the ASHAs, using combinations of mediums for the dissemination of the messages .

Advertising of different programmes of NRHM in different types of certificates issued by BDO/CO and Block Informatics Centre established by Rural Development Department, Govt. of Bihar Under the Rural Development Department, GoB in all the 533 blocks, Block Informatic Centres have been established whose implementation and maintenance has been given to an outsourced agency under PPP for 3 years. Major work of these centres is generation of various certificates to be issued by CO/BDO and SDO. Various certificates to be issued are Caste certificate, Income Certificate, OBC certificate, Birth and Death certificate, LPC certificate, Character certificate, Residential proof certificate etc. Altogether in a day yearly 60,000 certificates are issued, that means 18.00 lakh in a month and about 2.00 crore per annum. These certificates can be a very good medium of advertisement as the certificates are obtained by people belonging to different status and are preserved properly for a long period of time. The certificates shall have the certificates on the front side however back side will be blank. The concerned Department has also authorized the Outsourced agency to generate advertisements for printing on the back side of the certificate.


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The Proposal

The SHS aims to utilize this opportunity to advertise NRHM’s various programmes on these certificates

through which information and benefits of the programmes can reach to nearly 1.5 to 2.00 crore families.

These advertisements shall exist on these certificates for ever and can act as an effective medium for

Government’s advocacy.

Budget Expense Estimate:

Coloured advertisement per Certificate cost -Rs.1,50 p and for black and white advertisement – Rs.1.00 p.

For advertisements on approximate 2.00 crore certificates, anticipated expenditure would be Rs.3.00 crores.


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14. Procurement of Equipments/Instruments and Drugs/Supplies Details annexed

Strengthening Life Saving Skills for Anesthesia (LSAS) Part A Procuring equipment for the Anesthesia departments in six medical colleges In Bihar state, LSAS training is being undertaken in all six Government Medical Colleges for the last two years. A total of 55 doctors have been trained in LSAS till now. All the six medical colleges in the state are imparting this training. Monitoring visits to all Medical Colleges has been undertaken by UNICEF Health Officer Dr O P Kansal, Dr Himanshu Bhushan from GoI and Dr A K Tiwari, Programme officer for Anesthesia trainings, in the last one year. An exposure visit was also organized to Gujarat comprising State Programme Officer, all Heads of the departments of Anesthesiology and Health officer, UNICEF in April, 2008. In the last one year, there have been many formal and informal discussions with the heads of the Anesthesia departments of all the medical colleges. With the technology update taking place all around, the anesthesia departments in the state need strengthening of the basic infrastructure. The departmental heads had submitted a proposal to this effect about a year ago. It is proposed to spend Rs. Nine crore (@Rs One and half crore for each of these colleges) to help them procure the equipment. This in terms will help the trainees of LSAS training grasp the skills as per the current technology. A simple indicative list of the equipment required is given in the table below.

S No Equipment Requirement 1 Anesthesia workstation For all colleges 2 Boyle’s apparatus latest

model 3 sets for each college

3 Fibreoptic nasopharyngolarryngoscope

One for each college

4 Anesthesia emergency resuscitation kit

One for each college

5 Ethylene Oxide sterlizer One for each college

It is worth mentioning that the funds to the state medical colleges would be released as per the need and therefore fresh proposals would be invited from them after the GoI approval. Additional Suggested Action Points:

1. Third party review of Anesthesia trainings: It is requested to get a review, of the LSAS

training process in Bihar, conducted by Anesthesiologists of National repute already

associated with GoI. Based on the assessment, the State Health Society, Bihar can be

requested to fill in the gaps.

2. Reorientation of Anesthesia trainers: There are two to three Anesthesiologists in each

medical college who were trained in LSAS training about two years ago. A reorientation of

all these trainers, for two days in Patna by GoI identified trainers, can be helpful in adhering

to the standard training protocols and thus improving the quality of the trainings. A tentative

amount of Rs Five lakhs is being proposed for this.


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3. Identification of five district hospitals having good anesthesia facilities where the trainees

may be deputed for 10 weeks during the total training period of 18 weeks.

4. Continuous field monitoring: The State has an established Quality Assurance Cell. Quality

check of LSAS trainings also form a part of this cell activity. A regular (once a month for

each medical college) monitoring visit should be conducted.

5. Immediate posting plans for the LSAS trained doctors in the designated FRUs should also

follow.

6. Infrastructure strengthening process at the FRU level to give requisite working

environment to the LSAS trained doctor should also be completed.

7. Voluntary application/nomination system for the future batches of LSAS trainings should

be proactively encouraged by the state.


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16. Programme Management

Programme management arrangements have been made at state, district and block level. The entire NRHM

including RCH is governed by the highest body i.e. State Health Mission chaired by the Hon’ble CM. The

SHSB functions under the overall guidance of the State Health Mission.

State Health Mission

Composition

• Chairperson : Chief Minister

• Co-Chairperson : Minister of Health and Family Welfare, State Government

• Convener : Principal Secretary/Secretary (Family Welfare)

• Members :

Ministers in charge of Departments relevant to NRHM such as AYUSH, Women and Child

Development, Medical Education, Public Health Engineering, Water and Sanitation,

Panchayati Raj, Rural Development, Social Welfare, Urban Development, Planning,

Finance, etc.

Nominated public representatives (5 to 10 members) such as MPs, MLAs, Chairmen, Zila

Parishad, urban local bodies (women should be adequately represented)

Official representatives: Chief Secretary/Development Commissioners and Principal

Secretaries/Secretaries in-charge of relevant departments such as Women and Child

Development, Public Health Engineering, Panchayati Raj, Rural Development, Tribal

Welfare, Urban Development/Affairs, Finance, Planning and Representative, MoHFW, GoI,

Director (Health Services)/Director (AYUSH).

Nominated non-official members (5 to 8 members) such as health experts, representatives of

medical associations, NGOs, etc

Representatives of Development Partners.

State Health Society

Objectives of the Society

• To provide additional managerial and technical support to the Department of H &FW, Government

of Bihar for implementation of National Rural Health Mission which includes RCH –II, General

Curative Care, National Disease Control Programme and AYUSH


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Governing Body

Governing Body has following members.

(i.) Development Commissioner, Govt. of Bihar- Chairperson

(ii.) Finance Commissioner, Govt. of Bihar- Deputy Chairperson

(iii.) Secretary, Dept. of Health & Family Welfare, Govt. of Bihar- Chief Executive Officer

(iv.) Secretary, Dept. of Medical Education and ISM, Govt. of Bihar- Member

(v.) Secretary, Dept. of Planning- Member

(vi.) Project Director, BSACS- Member

(vii.) Director, ICDS, Bihar- Member

(viii.) Executive Director, SHSB- Member Secretary

Executive Committee

Executive Committee consists of following members.

(i.) Secretary, Dept. of Health & Family Welfare, Govt. of Bihar – To preside .

(ii.) Executive Director, SHSB- Member Secretary

(iii.) Director in Chief, Health Services, Govt. of Bihar- Member

(iv.) Joint Secretary/ Deputy Secretary, Dept. of H & FW, Govt. of Bihar- Member

(v.) Additional Director, Dept. of H & FW, Govt. of Bihar- Member

(vi.) Representative of UNICEF- Member

(vii.) Representative of WHO- Member

(viii.) Representative of European Commission- Member

(ix.) Representative of Ministry of H & FW, GOI- Member

(x.) Regional Director of H & FW, GOI- Member

Project Appraisal Committee (PAC) comprises of

(i.) Executive Director, SHSB

(ii.) Director in Chief, Health Services, Govt. of Bihar

(iii.) State Representative, UNICEF, Bihar


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(iv.) Regional Coordinator, WHO

(v.) Regional Director, Regional Health Directorate, GOI

(vi.) Programme Officer- SHSB- Tuberculosis

(vii.) Programme Officer- SHSB- Kala Azar

(viii.) Programme Officer- SHSB- Leprosy

(ix.) Programme Officer- SHSB- Blindness

(x.) Assistant Engineer-PWD, Bihar

(xi.) Joint Secretary, Finance Department, Govt. of Bihar

(xii.) A representative of Vigilance Department

Ø A project Appraisal Committee (PAC) shall consider the district plans and other expenditure

proposals.

Ø All proposals will be submitted to the concerned authority having delegated powers provided for

final approval. In case the designated authority does not agree with the recommendations of the

PAC, she/he shall record the reasons for such disagreement and may include the proposal in the full

meeting of the Governing Body which shall have the full powers to accept/ reject the

recommendations of the PAC provided that the reasons for rejecting the PAC recommendations shall

be recorded in the minutes of the GB.

Financial powers of the bodies/office bearers

Type of Expenditure Extent of powers

A. Approval of District/city plans Full powers to the Governing Body, provided that

the plan(s) have been endorsed by the Project

Appraisal Committee (PAC).

B. Allocations of funds Full powers to the Governing Body.

C. Approving programme and campaign

activities under NRHM

Full powers to the Governing Body.

D. Hiring of contractual staff, including sanction

of compensation package

For Staff of Category A &B of Organogram-Full

powers to the Chairperson of the GB provided

the contracts shall be for a period not exceeding

11 months at a time.


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For Staff of Category C of Organogram- Full

powers to the Executive Director subject to the

compensation package approved by the GB,

provided the contracts shall be for a period not

exceeding 11 months at a time.

E. Release of funds for implementation of plans

approved by GB/EC

Full powers to the ED.

F. All related activities in pursuance of State /

District plan approved by GB, such as

Advertisement charges, Advance to contractors,

Repayment of earnest money/security deposit,

Freight charges, demurrage, Furniture &

fixtures(within Budget limit),stationery,

conveyance, electricity & water charges,

Insurance, legal charges, postage, telephone, Fax,

Repair and maintenance of equipment, Hiring of

taxis, Auditors, all trainings, payment of TA/DA

/Honoraria to resource persons, workshops,

training material, books, TA/DA to society staff,

payment related to documentation etc.

Full powers to the ED.

State Level (State Programme Management Unit):

Following are the Support staff of State Programme Management Unit

SL Designation No. Salary Pm

Salary Pa 10% Total

(E+F)

1 State Programme Manager 1 33000 396000 39600 435600 2 Consultant NRHM 1 30000 360000 36000 396000 3 Data Asstt. Cum System Analysis 1 25000 300000 30000 330000 4 Consultant Cold Chain 1 25000 300000 30000 330000 5 Consultant - Maternal Health 1 25000 300000 30000 330000 6 Consultant-Child Health 1 25000 300000 30000 330000 7 Media Expert 1 20000 240000 24000 264000 8 Consultant – Procurement and Logistics 1 25000 300000 30000 330000

9 Consultant Accounts Manager(Salary Rs.15000/- Pension Rs.Rs.7495.00) 1 7505 90060 9006 99066

10 Accountant 1 15000 180000 18000 198000


114

11 Store Keeper 2 8000 192000 19200 211200 12 Clerk cum Steno 1 11000 132000 13200 145200 13 Data Assistant 6 9000 648000 64800 712800 14 Computer Operator 1 8000 96000 9600 105600 15 Accountant 1 15000 180000 18000 198000 16 Executive Assistant 8 9000 864000 86400 950400 17 Computer Operator-cum-Steno 10 8000 960000 96000 1056000 Total 5838060 583806 6421866

A 10% hike in salaries per year has been recommended in the PIP and is part of RCH II budget.

The Overall picture of programme management functioning is as follows

Governing Body

Executive Director, SHSB

Secretary Health & family welfare-cum- CEO SHSB

Rogi Kalyan Samitis at the Hospitals till Block levels

State Management Unit

Executive Committee

38 District Health Societies

District Health Societies

The society shall direct its resources towards performance of the following key tasks:-

• To act as a nodal forum for all stake holders-line departments, PRI, NGO, to participate in

planning, implementation and monitoring of the various Health & Family Welfare Programmes

and projects in the district.

• To receive, manage and account for the funds State level Societies in the Health Sector) and Govt.

of India for Implementation of Centrally Sponsored Schemes in the Districts.

• Strengthen the technical/management capacity of the District Health Administration through

recruitment of individual/ institutional experts from the open market.


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• To facilitate preparation of integrated district health development plans.

• To mobilize financial/non-financial resources for complementing /supplement the NRHM activity

in the district.

• To assist Hospital Management Society in the district.

• To undertake such other activity for strengthening Health and Family Welfare Activities in the

district as may be identified from time to time including mechanism for intra and inter sectoral

convergence of inputs and structures.

Governing body of DHS

1. District Magistrate & Collector Chairperson

2. District Development Commissioner (CEO Zilla Parishad) Vice Chairperson

3. District Social Welfare Officer Member

4. Executive Officer, Municiplity, Saharsa Member

5. Addl. Chief Medical Officer Member

6. District RCH Officer Member

7. Deputy Superintendent of the District Hospital Member

8. Civil Surgeon Member Secretary

Executive Body of DHS

1 Civil Surgeon of the District Chairperson

2 Additional Chief Medical Officer Cum member Sec. DBCS,

Saharsa.

Member

3 District RCH Officer, Member

4 District Leprosy Officer, Member

5 District T.B. Officer, Member

6 District Malaria Officer, Member

7 District Programme Manager (ICDS) Member

8 Chief Executive Officers Nagar Nigam, Member

9 Deputy Superintendent, Sadar Hospital Member Secretary

10 Sec. IMA Member

11 Sec. Indian Red Cross Society, Member


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District Programme Management Support unit Consist of Following Personnel:-

1. District Programme Manager

2. District Accounts Manager

3. District Data Asstts

Financial Management FUND FLOW MECHANISMS AT STATE

Presently the State Health Society is getting Grants-in-Aid from GoI through electronic transfer by crediting

the A/c of SHS. These funds are transferred to District Health Society A/c as Untied funds as per their

respective District Action Plans, which then get flowed to the CHCs, PHCs, district hospitals and RKS for

smooth conduct of the activities of RCH- II.

On the same lines of the GOI regarding transfer of funds, SHS is under the process of implementing the

system of e-transfer of funds to the districts and blocks. This process is likely to be completed very soon.


117

FUND FLOW

By E-Transfer

BLOCKS

through A/c payee cheques

OPERATION OF BANK ACCOUNTS

• The Account of State Health Society is being operated as per the delegated powers.

• The persons authorized as per the powers delegated to them are also operating the bank accounts of

DHS.

ACCOUNTING PROCEDURES FOLLOWED

The State is following the Double Entry System of accounting on Cash Basis.

For the sake of convenience in consolidation of accounts districts are also instructed to follow the same

system.

MOHFW, NEW DELHI

STATE HEALTH SOCIETY

DISTRICT HEALTH SOCIETY

PHC, CHC R.K.S NGOs OTHER

AGENCIES


118

In addition to this for proper accounting and maintenance of books, a manual cum guidelines had been issued

to the districts. Also the monthly auditor appointed at each district is reporting on the accounting procedures

followed by the districts on a monthly basis, along with the deviations, if any.

FINANCIAL MANAGEMENT AT STATE

The Financial Management group at state consists of the State Finance Consultant and state accounts officer.

Similarly at districts also the DAM is looking after the financial matters

FINANCIAL MONITORING

The financial monitoring is being done through the understated mechanisms-

1. Analysis of SOEs submitted by the districts and its comparison with audited expenditures on

monthly basis and reconciliation of the same by the financial consultant.

2. Training cum discussion meets with all the districts officials at regular intervals.

3. AUDITS:

a) Comprehensive audit (Annual) as per the Directions of GoI. The auditor for the F.Y 2007-08

has been appointed and they have initiated the audit of DHS’s accounts.

b) Monthly Audit is being conducted and reports are submitted to state regularly which are then

reviewed.

c) Audit by CGA officials is also going on as on date.

Appointment of CA at SHSB & C.A. Level

Due to increase in funds flow & for maintenance of Accounts as per NRHM guidelines, all the DHS were directed to appoint C.A. at a monthly cost of Rs.20, 000/- P.M. Similarly; CA. at SHSB level is to be appointed soon.

Budget:

Activity @ Proposed Budget Audit of SHSB/DHS by CA for 2009-10 Rs. 6,00,000/- Appointment of CA at SHSB

@25000/- PM x 12months 3,00,000/-

CA at DHS level 20,000x38x12 91,20,000/-

Total 1,00,20,000/-


119

Constitution of Internal Audit wing at SHSB: Internal Audit wing is proposed to be constituted in 2009-10 in which services of 6 retired officers form

Recognised Audit & Accounts Services will be engaged, who will be well versed in Audit work.

Budget:

Activity @ Proposed Budget Last pay drawn – Pension = Approx exp of Rs.20,000/-PM

20,000x6x12 14,40,000/-

TA/DA for Audit 1000x6x30x12 21,60,000/- Training of SHSB/DAM/BHM) FM Group Head Quarter

level=6x1500x12=1,08,000/- DAM=38x1500x4= 2,28,000/- BHM=538x1500x4=32,28,000/-

36,00,000

Total 1,00,20,000/-

1P & A - Personnel & Administration2POBl - Programme Officer Blindness3PON - Programme Officer Nutrition4POK - Programme Officer Kala-Azar5PO Fi - Programme Officer Filaria6PO Imm - Programme Officer Immunization7MF - Manager Finance8MA/C - Manager Accounts9PM - Programme Manager1FO - Finance Officer1CO - Computer Operator 1DO & SA - Data Officer & System Analyst1POL - Program Officer Leprosy1MCH - Maternal & Child Health1CC - Cold Chain 1Asst. Eng - Assistant Engineer1CP - Computer Programmer1DA - Data Assistant1PA - Private Assistant

PO T.B.

CEO

ED CellED

I/C Adm.

Steno cum CO

PA/DA-1

Clerk cum-Steno E/H -2

Computer Operator-1

POK P&APOLPOBl.

indnes

s

IEC

Steno cum CO

PM

FO

M A/CMF

Accountant-3

Steno cum CO-1

PO Imm

DA-1

PO N CC

Tech. Wing

Astt. Eng.

DA-2

PO Fi

Storekeeper

Pharmacist

MCH DO & SA

CP

CO-3

Steno cum CO


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17. Convergence and Coordination

Coordination with other departments such as ICDS, PHED, Education and Panchayat Raj is important for

tackling health issues. The involvement of representative of these departments help the health service

providers in reducing the maternal mortality, Infant Mortality and increase the coverage of Family Planning

Service and Adolescent Health Service. The state would take certain initiatives to ensure a synergistic effort

from the community level to the state level which is defined in part E along with a detailed budget

18. Role of State, District and Blocks

The role of State, District and Block are well defined. The role of each one has been clearly indicated in the

workplan (Annex 3 d) as per activity wise. The decentralization process has given more roles to Districts and

Blocks to perform in executing the various programs. The State mainly looking after Monitoring, Policy

decisions, Centralize capital purchase, technical support etc and help the district in execute the actions

planned.

19. Monitoring and Evaluation

One of the major weaknesses of the RCH program in the Bihar is the absence of an effective Monitoring and

Evaluation system that would provide accurate and reliable information to program managers and

stakeholders and enable them to determine whether or not results are being achieved and thereby assist them

in improving program performance. A triangulated process of Monitoring and Evaluation would enable cross

checking and easy collection, entry, retrieval and analysis of data.

Activities

ü Strengthening and up gradation of monitoring and evaluation cell

ü Mobility support

ü Equipping and furnishing demographic cells

ü Conducting survey and concurrent evaluation

ü Formation of Databank

ü Revised CNAA for all levels would be persuaded and guidelines for preparation district plans

ü Web/internet based computer software for use at district and state level

ü Reporting formats for providing requisite information


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Monitoring Key progress

indicators

Input Indicators

• Staff position,

• Training & orientation,

• supplies, • frequency of

immunization

Output Indicators

• Maternal

Health Indicators

• Child Health Indicators

• Family Planning

• Adolescent

Key Finanacial Indicators

• Percentage funds received by state according to schedule

• Percentage funds disbursed to districts

Key Development Indicators

• MMR • IMR • NMR • TFR

Evaluation

ü Road map of each health centre for easy communication

ü Triangulation of data

Triangulation Process for Monitoring and Evaluation

Computerized MIS

Community Monitoring Focused Studies

Key Development Indicators

The key development indicators for measuring progress in reaching the overall project development

objectives for the RCH programme in the state are as follows.

• Maternal Mortality Rate


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• Infant Mortality Rate

• Neonatal Mortality Rate

• Total Fertility Rate

Key progress indicators

Key progress indicators enable the monitoring of delivery of project inputs and the achievement of project

outputs.

Table : Examples of Input Indicators

Institutional

Strengthening:

Infrastructure

Institutional

Strengthening:

Human Resource

Programme

management

HMIS Supervision

• No. of new

facilities

constructed

• No. of new

facilities

upgraded

• No. of essential

equipment

supplied

• No. of health

personnel

appointed

• No. of health

personnel

trained for

capacity

building

• No. of programme

managers

appointed at

state/district levels

• No. of programme

managers trained at

state / district

levels

• Number of

operational

equipment such

as computers

supplied to

reinforce HMIS

• Number of new

formats

developed

• Percentage of

work

computerized

Key financial indicators

Key financial indicators help assess the project's budgetary and financial health.

• Percentage of funds received by state according to schedule

• Percentage of funds disbursed to districts

• Percentage of funds disbursed to districts according to schedule (within 15 days)

Percentage of utilization of funds against allocation by state / districts

The National Rural Health Mission has been launched with the aim to provide effective health care to rural

population. The programme seeks to decentralize with adequate devolution of powers and delegation of

responsibilities has to have an appropriate implementation mechanism that is accountable.

In order to facilitate this process the NRHM has proposed a structure right from the village to the national

levels with details on key functions and financial powers. To capacitate the effective delivery of the

programme there is a need proper a proper HMIS system

Regular monitoring, timely review of the NRHM activities should be carried out. The quality of MIES in

State HQ and in districts is very poor. Reporting and recording of RCH formats (Plan and monthly


124

reporting) are irregular, incomplete, inconsistent and few districts are not reporting at all. Formats are not

filled up completely at the sub center level. There information is not properly reviewed at the PHC level. No

feedback is provided upon that information.

For overall management of the programme, there is a Mission Directorate and a State Programme

Management Unit in the state. The Unit is responsible for overall monitoring and evaluation of the

programme in the state and the districts. The data gathering is being facilitated by the state, District and PHC

data Centres. The numerous formats being used have been reviewed and it is found that data needs to be

compiled only as per RCH, NRHM programme and State needs. Hence the new MIES formats have been

shared with all the health functionaries and it is expected that they shall be reporting in the new formats from

the 3rd quarter after brief orientation training.

At district level, there is a District Health Society who will be responsible for the data dissemination from the

sub-district level to the district level. Data Manager/HMIS expert at the State level and Data Assistant at the

district level will be responsible for management of HMIS.

As such, there will be a Monitoring Team constituted each at state and district level to monitor the

implementation of the NRHM activities. The Team will comprise of representatives from the Mission

Directorate and Programme Committee for various health programmes. The Team will also comprise of

representatives from Govt. of India.

There is Hospital Management Committee/ Rogi Kalyan Samity at all PHCs and CHCs. The PHC / CHC

Health committee will monitor the performance of SC under their jurisdiction and will submit the report. The

PHC/ CHC health committee will monitor and evaluate the SC performance .and performance will be

submitted to the District, which will compile and sent it to the state.

REPORTS REQUIRED FROM DHS

• Monthly Fund flow statement

• Form -9 (accurate and fully filled)

• ASHA selection and training report

• Mobile Medical unit (if working )

• Janani Evam Baal Suraksha Yojana Reports (no. of institutional deliveries, Deliveries under

JBSY,No. of Pvt Institutions accredited)

• Immunization reports. Vaccine wise coverage

• Training reports of the current trainings being given in the district or being under taken by district

officials


125

• 24 X 7 PHC working, Status of telephones working , No. of ambulance and their usage, monitoring

of doctors and ANMs presence, No. of OPD patients, No. of IPD, No. of referrals, No. of deliveries

being conducted

• Rogi Kalyan Samitis formation and working , meetings of RKS

• Sub centre untied funds, Joint A/c of ANM and Panchayat member (female), UCs of untied funds

• Integration of AYUSH at PHC level

• Availability of essential drugs, Vaccines, AD syringes in DH, SDH, PHC, SC

• Contract Appointment of doctors, ANMs, Staff Nurses and other Staff

• Health melas, No. of beneficiaries

• Family planning services, male steris, female steris , IUD,

• MNGO working (if present)

• Other Special programmes specific to the district

• Quarterly Finance Management Report

The DPM along with the DAM (in financial matters) shall be responsible for compilation and timely

reporting

Table : HMIS Forms

Form No. Information Filled by

Form No.1 General information, no. of births, Cases of complicated

pregnancies and deliveries, sick newborns , RTI/STD cases, oral

rehydration performance data [action plan by ANM or SC]

ANM

Form No. 2 Deliveries, MTPs ,RTI/STD, Immunization, need assessment of

individual ANMs [action plan for PHC]

PHC level

Form No. 3 Sterilization, ,immunization, services in obstetric care STI/RTI

[action plan for FRU/Subdivision/DH]

Sub division

level

Form No. 4 District action plan District

Form No. 5 State action plan State level

Form No. 6 Monthly report by ANM ANM

Form No. 7 Monthly report by PHC PHC

Form No. 8 Monthly report by FRU/Subdivision FRU

Form No. 9 Monthly report by District District


126

Form-8

Compiled at: FRU/SDH Level Responsibility: MOIC Flow of form: Hospital to District Submission: Monthly

Form-7

Compiled at: PHC Level Responsibility: MOIC Flow of form: PHC to District Submission: Monthly

Form-6

Compiled at: HSC Level Responsibility: ANM Flow of form: HSC to PHC Submission: Monthly

Form 5 1. State Staff position, 2. Training & orientation, 3. supplies,

Form 4 District Action Plan

Compilation of Action Plans submitted by all PHCs, FRUs, Sub-Divisional Hospitals at the District Hospitals and submitted to the State

Form 3 FRU/SDH Action Plan

Prepared by: Sub Divisional Hospitals Submission: Once in a Year, Feb-March

Form 2 PHC Action Plan

Prepared by: PHC, LHVs & ANMs Submission: Once in a Year, Feb-March

Form 1 HSC Action Plan

Prepared by: ANM with the help of DFWO Submission: Once in a year, Feb-March

Form-9

Compiled at: District Level Responsibility: CS/ACMO

Flow of form: District to State Submission: 25th of each month

Reporting Forms

Action plan Forms


127

20. Synergie with NRHM Additionalities

The NRHM is an effort to bring about the architectural change to overall program management to enable

rationalization of resources and simultaneously to augment then limited resources so that equity in health is

ensured. The commonality of initiatives in the following areas would be complementing the similar efforts

under NRHM;

§ Infrastructures for facility development,

§ Manpower recruitment,

§ Capacity building through training, program management, institutional strengthening, organizational

development,

§ Communitization,

§ Promotional efforts for demand generation and

§ Improved monitoring & evaluation systems developed under RCH II

§ Public Private Partnership

§ Convergence & Coordination

.

The convergence approach which was mooted earlier now finds a clear policy initiative and procedural

development by health and all health determinants sectors so that a joint effort is made in tandem from

planning to impact evaluation / outcome to ensure investments in health reach the poor /

unnerved/underserved/excluded segment of the population. These common efforts would also strengthen

gender equity through adolescent and other initiatives of both RCH & NRHM to provide a safety net to

young women and girl children.


128

21. Sustainability The usage of government services in Bihar has certainly picked up with number of patients increasing

manifolds due to free drugs and availability of doctors at PHC level. Similarly there has been an

unprecedented increase in number of deliveries being conducted at government health facilities under Janani

Baal Suraksha Yojana This can be largely attributed to huge influx of funds under NRHM. To hedge the

growth from lack of funds and for its sustainability Government of Bihar has already applied user charges for

pathology and radiology services. The ambulance user charges are being determined by Rogi Kalyan

Samitis. The state already has paying wards in our medical colleges and GoB is contemplating having such

wards in all district hospitals too.

For sustainability of manpower incentives for specialist services and for postings in rural areas have been

proposed in this Programme Implementation Plan. Government is working on Dynamic ACP and Cadre

division of doctors for providing them better benefits.

Private parties are also being encouraged to make investments in Health sector so that the sector doesn’t

become dependent on NRHM funds. However they would be urged to take up mapping of available facilities

and also analysis of demand before investing and providing services so that any duplication may be avoided.

Moreover GoB is also increasing its allocation to health sector. This year the state government proposed to

establish Emergency Medical Service, Dialysis Unit, Telemedicine system under PPP initiative. The state

also increasing the number of Adll PHCs to be outsource to the NGOs.


129

22. Extra Inclusions in RCH IFA (Details Annexed)

Maternal and perinatal death inquiry and Response:

Maternal and perinatal death inquiry (MAPEDIR) is an operational tool that strengthens community

participation in evidence-based planning. MAPEDIR aims to help healthcare providers and community

members understand the

avoidable factors that underlie maternal and perinatal deaths and to identify ways to prevent these deaths. The

main objective of introducing MAPEDIR is to develop a framework for the assessment of maternal and

perinatal deaths and implementation of effective, high impact strategic interventions through:

1. Sensitizing communities to maternal and perinatal health issues, including the need for birth

preparedness, complication readiness,

2. Identifying maternal deaths and conducting community-based inquiries with close acquaintances of

the women to find ways to prevent maternal deaths;

3. Sharing the findings with communities, helping them interpret the data and develop appropriate

interventions and advocate for improvements in health care-seeking; and

4. Using the findings to advocate with policy makers for improvements in maternal health care.

Maternal and perinatal death inquiry and Response:

In the year 2007-2008, UNICEF has piloted the MAPEDIR in Vaishali District. GoB proposes to take will

take it to scale to 2 more districts (Kishanganj and Jehanabad) in 2009-10 with UNICEF support as part of

the next Annual NRHM State Plan.

Major Activities

Identification of Staff: Supervisors, Interviewers and Notifiers

£ Identification and selection and training of the supervisors and interviewers (ANM and LHVs) will

be conducted supported by UNICEF. Selection of Notifiers (ASHA workers)band their one day

orientation will take place.

Capacity Building of Staff: Supervisors, Interviewers and Notifiers

£ Once the identification process is over, a four day training of the Interviewers and the supervisors

will be conducted to educate them over the entire concept of MAPEDIR and the implementation

process.This training will be conducted with UNICEF support.

£ Once the training of supervisors is over, a one day orientation of the notifiers from the all the

Panchayats of all the blocks will be organized to equip them, with the process of notification of

deaths and reporting to the supervisors


130

Notification of Cases

£ This activity will be taken up by the notifiers once they undergo the orientation program and are

placed in their respective Panchayat. The activity will consist of verifying the information shared by

the informants, Filling-up the Notification Format and Contacting the Supervisors

Interviews

£ Interviews will be conducted by skilled and trained interviewers trained during the 5 day capacity

building program. This activity takes place once the supervisor assigns the case to the interviewer.

The interviewer will visit the household where the death took place and will interview the closest

person who stood when the death took place. The recorded information in the prescribed format will

be submitted to the supervisor who then will verify the recordings and promote it for entry and

analysis.

Data Entry and Analysis of information

£ Data Entry and Analysis will take place only when the above processes of Notification, Interview

and Verification are over. All entry will take place at the District level and analyzed at UNICEF

level

Community Sensitization Program

£ At the monthly Mahila Mandal meetings sensitization of the community members functionaries will

be done for generating awareness on the causes of maternal of death, precautionary measures and

community initiatives. Other forums for the same will be explored.

Orientation and Sensitization of Health Functionaries

£ At the block and District Level one day orientation of the Health Functionaries will be carried out to

develop a consensus on the process.

Advocacy Meetings

£ Finally, the analyzed data are to be utilized for advocacy and policy modification at the district and

state level. These advocacy meetings will be very strategic in nature where decisions regarding

effective service delivery and service effectiveness will be targeted.

Costs incurred per Maternal death investigate/non maternal death notified

Honorarium & Travel

Informants 30 1 30

Notifiers 70 1 70

Interviewers 250 2 500

Supervisors 250 1 250

Total per maternal death investigated Rs. 850


131

23. Work plan

Annexure 3 d

24. Budget

Annex 3e and 3c

132

PART- B

NRHM Flexible Pool / NRHM Additiona lities

2009-2010

133

1. Decentralization For effective decentralization in principle as well as practice, health societies have been established at all levels

of the healthcare delivery structure. Systematic involvement of various stakeholders at all levels through these

societies has helped make healthcare delivery responsive to the needs of the people via participatory planning

and removal of bottlenecks at implementation levels. State Health Society provides overall guidance and

supervision for effective planning and implementation, and also coordinates activities across the board. The

State Health Mission, the Governing Body and the Executive Committee meet at regular intervals and take

decisions regarding all matters. District level activities are taken care of through the District Health Society.

Rogi Kalyan Samitis at PHC, CHC, Sub Divisional Hospitals, District Hospitals and Medical Colleges have

been set up. The formation of societies under NRHM has given a new direction to management and overall

functioning of the health department towards the achievement of its goals.

134

ASHA One of the key components of the National Rural Health Mission is to provide every village in the country with

a trained female community health activist – ‘ASHA’ or Accredited Social Health Activist. Selected from the

village itself and accountable to it, the ASHA is trained to work as an interface between the community and the

public health system.

Under NRHM, 87135 ASHAs (revised as per the decadal growth in 2008) are to be selected and trained in

Bihar. The previous target was 74313 (as per 2001 census). The first orientation training of seven days has been

completed for about 60,016 ASHAs. The 2nd, 3rd and 4th round /2, 3 & 4th module training is being done by

PHED and its NGOs. The PHED had proposed a total cost of Rs.40.70 cr. which has now been reworked to

Rs.27.15 Crores. A total no. of 76 State Level trainers/Master Trainers were trained till June 2008 and 393

district level trainers/Block resource persons are being trained. The 5th round/module of training is to be started

just after the completion of 2nd, 3rd & 4th round of training.

A total number of 67506 ASHAs have been selected so far. Orientation training of seven days has been

provided to 60016 till now. The ASHAs are given the copies of each module (Hindi version) and reading

material in the form of flip charts for their better understanding and also dissemination of key health messages

among villagers.

Table 1: ASHA Status (Target, Selection and Training)

Sl.

No. District

Revised Selection Target (As

per 2.3 % per annum decadal

growth rate)

Selected as

on

01.01.09

Trained with

Module

1/Phase 1

I II III IV V

1 Araria 2376 2026 2026

2 Arwal 773 652 652

3 Aurangabad 2160 1646 1567

4 Banka 1820 1532 1471

5 Begusarai 2629 2091 1771

6 Bhagalpur 2311 1936 1877

7 Bhojpur 2264 1661 1637

8 Buxar 1493 1086 945

9 Champaran(E) 4326 2910 2130

10 Champaran(W) 3206 2653 2177

135

11 Darbhanga 3550 2357 2250

12 Gaya 3514 2780 2240

13 Gopalganj 2371 2015 1868

14 Jamui 1520 1254 1254

15 Jehanabad 871 769 769

16 Kaimur 1462 1247 1247

17 Katihar 2549 1779 711

18 Khagaria 1412 1001 891

19 Kishanganj 1368 1112 799

20 Lakhisarai 802 581 557

21 Madhepura 1711 1403 1403

22 Madhubani 4046 3034 2751

23 Munger 961 840 820

24 Muzaffarpur 3984 3120 2544

25 Nalanda 2365 2010 2010

26 Nawada 1959 1531 1284

27 Patna 3233 2571 1932

28 Purnia 2723 2113 2000

29 Rohtas 2490 1950 1935

30 Saharsa 1622 765 676

31 Samastipur 3835 3143 3004

32 Saran 3459 2681 2329

33 Sheikhpura 521 426 402

34 Sheohar 580 99 82

35 Sitamarhi 2965 2147 1665

36 Siwan 3008 2538 2327

37 Supaul 1928 1515 1492

38 Vaishali 2969 2532 2521

Total 87135 67506 60016

ASHA is the first port of call for any health related demands of deprived sections of the population, especially

women and children, who find it difficult to access health services and she will provide her service mainly

under the following heads-

136

Table 1: The compensation package of ASHA

Sl. No. Programme & Relevant Task Amount of Compensation

1. Janani & Bal Suraksha Yojana For Institutional

Delivery and Full Immunization of the New Born

@Rs. 200/-(Only Rs.Two hundred) Per

Pregnant Woman

2. Mobilizing all the children of the village for

Immunization

@ Rs. 150/-(Only Rs. One hundred

fifty only) Per Month

3. Providing DOTS under Tuberculosis Control Program Rs 250 per patient.

4. For identifying Patient of Leprosy and accompanying

him/her to PHC

@ Rs. 300/- (Only Rs. Three hundred)

Per Patient

5. Training

D.A. Per Day @ Rs. 100/- (Only Rs. One hundred)

Per Day(During the Training)

T.A. Per Training (To & Fro) @ Rs. 50/- (Only Rs. Fifty) Per

Meeting

6. To participate in ASHA Divas organized at PHC @ Rs. 75/- (Only Rs. Seventy Five) Per

Meeting

7. For motivating for Sterilization @ Rs. 150/- (Only Rs. One hundred

Fifty) on Completion of Surgery

8. For motivating client for vasectomy/ NSV @ Rs. 200/- (Only Rs. Two hundred)

on Completion of Surgery

9. For 6 no. home visits under HBNC and IMNCI @ Rs. 200/- (Only Rs. Two hundred)

on Completion of the 6th visit

Programme Description

1.11 At the State Level

Personnel– The Project Manager and Deputy Project Manager at the State level have been appointed.

Additional personnel including Statistical assistant, data assistant and office attendant have been provided for

effective implementation and execution of different aspects of work.

ASHA Mentoring Group- A Mentoring Group comprising of leading NGOs and well known experts on

community health is under the process of formation, to provide guidance and advice on matter relating to

selection, training and support for ASHA.

Development of IEC and Monitoring Material – For effective documentation, information dissemination and

reporting, ASHA Flip Chart, ASHA Activity Diary, ASHA Register, IEC Material, Monitoring and Reporting

Formats and resource materials for meetings and for Behavior Change Communication will be ensured.

137

Monitoring and Supervision and Operation Research and Documentation: This will ensure basic field

level assessment, working towards the gap identified, analyzing and assessing the outcome and thus eventually

working towards a holistic strategy development. This will include the following components:

a. Periodic Surveys at District Level (once in three months)

b. Operational and Action Research from State Level (every six months)

c. Field Visits every month by the Consultants – ASHA

d. Monitoring of the Training being conducted

e. Community monitoring

ASHA Sammelan and exposure visit: ASHA Sammelan will act as a platform where ASHAs accompanied by

Block Health Manager, Block Health Organizer, District Nodal Officer and Senior Nurse of one district/block

meet the ASHAs of another district/block to share their experiences of work with District & Block Health

Officials, Medical staffs and beneficiaries. This will help in networking, information sharing and build a kind of

connectivity between the workers and the State.

Workshop, Seminars and Consultative meetings: - This will involve experts on health from the national level

along with members of ASHA Mentoring Group for analysis of the operation research and monitoring to work

towards further strategy development.

1.12. At the District Level

Additional Personnel

Community Mobilizer/ District Project Manager ASHA – She/He will be appointed in the capacity of

Community Mobilizer and will act as a Nodal Officer at the district level for effective programme management,

implementation and execution.

Data Assistant: She/He will assist the community mobilizer and existing staff of the District PMU in all the

ASHA related work.

ASHA Help Desk: An ASHA help desk will be formed at the district level whose overall in-charge will be the

community mobilizer. This will be expanded to the block level for strengthening of referral support system, to

redress grievances of ASHAs, if any and to work as an information networking and management system.

1.13. At the Block Level

Block ASHA Manager/ Block Level Organizer– An Officer will be appointed as a block level organizer for

effective programme management, implementation and execution and to act as a link and network between the

ASHAs and the District and will be assisted by a facilitator – 1 on every 20 ASHAs. The Facilitator will be the

21st ASHA worker. This will help in building up and developing the necessary skill required for a community

health worker in a sustainable way.

138

ASHA Help Desk: An ASHA Help Desk will be formed also at the block level. Overall in-charge of Block

level ASHA Help Desk will be block level organizer and MOIC. This shall be in network with the District

Level ASHA Help Desk. It will act as a network integrating the Village, Block and the District. It will help in

strengthening referral support system, redress grievances of ASHAs, if any, and work as an information

networking and management system.

1.14. At the Village Level

Community Monitoring and Community Need Assessment: Community-based Monitoring ensures that the

services reach those for whom they are meant, for those residing in rural areas, especially the poor, women and

children. Community Monitoring is also seen as an important aspect of promoting community led action in the

field of health and to understand if the work is moving towards the decided purpose. Although, ASHA hails

from the same village, she may not be having knowledge and information on the health status of the village

population. For this purpose, she will be advised to visit every household and undertake a sample survey of the

residents of the village to understand their health status. In this way she will come to know the villagers, the

common diseases which are prevalent amongst the villagers, the number of pregnant women, the number of

newborn, educational and socio-economic status of different categories of people, the health status of weaker

sections especially scheduled castes/scheduled tribes etc. She will be provided with a simple format for

conducting the surveys. The ASHA Activity Diary will also help her keep a record of the base level. In this she

should be supported by the AWW and the Village Health & Sanitation Committee. Such a review will help to

identify obstacles in the work, so that appropriate changes can be made to cross the obstacles by the team of the

block level organizers.

Networking with VHSC, PRI and SHGs – All ASHAs will be involved in this Village Health and Sanitation

Committee of the Panchayat, as Members. ASHAs will coordinate with Gram Panchayat in developing the

village health plan, along with the Block Level Organizer, Block Medical Officer and Block Facilitator. The

untied funds placed with the Sub-Centre or the Panchayat will be used for this purpose. The SHGs, Woman’s

Health Committees, Village Health and Sanitation Committees of the Gram Panchayat will be major sources of

support to ASHA. The Panchayat members will ensure secure and congenial environment for enabling ASHAs

to function effectively to achieve the desired goal.

1.15. ASHA Training

The second phase of ASHA training which includes the 2nd, 3rd and 4th modules is being done by PHED and it’s

NGOs. The State Level ToT has been completed and the district level training is going on. The District resource

person will in turn train the ASHAs at the Block Level. Additionally against the revised ASHA target, the new

incumbents shall have to be provided trainings on Module 1, 2,3 and 4.

139

1.16. ASHA Drug Kit and it’s replenishment

To ensure provision of ASHA Drug Kit to 12822 new ASHAs and replenishment as it is one of the key

components of NRHM

1.17. Emergency Services of ASHA

Bihar has been experiencing regular floods which have created havocs in lives of lakhs of people both

economically and psychologically. During the time of floods, health related problems become extremely acute.

In such a situation the role of ASHA becomes extremely crucial. Thus ASHAs will be provided intensive

training/capacity building preferably of three days and would then be deputed in 16 flood prone districts or

similar natural disaster areas.

1.18. Motivations for ASHA

Provision of Two Sarees to ASHA – The provision of Sarees will ensure the following:-

• The availability of Sarees will help in building up of better motivation of the ASHA workers.

• Identification in any work helps in rooting identity for the worker and the work itself. The

availability of Sarees will help in doing so.

• Sarees will help in easy deliverance of work and make the worker more accessible by the

community as it will help in easy identification of the ASHA worker.

• It will help in boosting the morale of the ASHA worker and shall make the relationship stronger

and would help in connecting the ASHA worker and the State.

Provision of One Umbrella to ASHA– The provision of Umbrella will ensure the following:- • The availability of Umbrella will act as an aid to the ASHA worker in extreme weather conditions,

which will facilitate the health facility/services in a smooth way

• The availability of Umbrella will help her comply with her nature of work

• It will help in building up of motivation of the ASHA worker, enhance her identity.

• It will help in boosting the morale of the ASHA worker and making the relationship stronger and

ensure connectivity between the ASHA worker and the District

1.19. Capacity Building/Academic Support Programme:

a) Enabling ASHA 10th pass – For upgradation of academic strength of ASHA, SHSB will provide examination

fees for the 10th examination of open schooling mode/Board/IGNOU to 1000 ASHAs in 1st Phase. Fee for the

same to be provided by SHSB.

b) Training for Help Desk – The person/officer involved in operationalising the ASHA help desk at District

level and Block level will be trained.

140

1.20. ASHA Divas

ASHA Divas will be held per month. This will include the following components-

ü Monthly Meetings for ASHA Divas of ASHAs, ANMs and AWWs shall provide the necessary

platform to share the work experiences, identify the loop holes and work towards the same.

ü Best ASHA worker and ANM worker felicitation as per their monthly performance at the

ASHA Divas will provide motivation. The performance will be rated as per the ASHA Activity

Diary.

ü Provision of I-Card will be done to the newly selected ASHA workers.

ü Replenishment of ASHA Drug Kit for at least the next two months. This will ensure treatment

of common ailments and first level prompt care and referrals initiated based on symptoms of

necessary cases. For this, effective access to basic drugs in every village should be ensured

through ASHA Drug Kit.

Key Dimension of ASHA Programme:-

• The structural mechanism relating to a support system for ASHAs will ensure the facilitation of

effective service delivery and a clear communication channel from the Block to the State. The Human

resource in form of a strong network system will provide the necessary support for effective

implementation and execution of the ASHA Programme.

• Continued training and capacity building to the ASHAs will facilitate the service delivery and ensure

community broad basing of the programme.

• Inter-sectoral convergence among different health related institutions and individuals will ensure

effective service delivery. The ASHA Help Desk will ensure an extensive and intensive communication

and management system right up to the community level.

• Empowering ASHA through various motivational methods including provision of Sarees and umbrella,

best ASHA felicitation, performance based incentive, capacity building, training, documenting the work

through ASHA activity diary and register, incentive to ASHA for mobilizing ANC and PNC Cases for

check-up and ASHA help desk will assist and facilitate overall development of the worker.

• Additionally, the ASHA being a facilitator at the Block Level will also go in a long way towards

developing the necessary skills of a Community Health Worker, making the whole process sustainable

and empowering the worker and the community itself.

141

• A Community based monitoring system coupled with operational research and continued evaluation

will help in field level analysis and seminars for consultation of the same will help in holistic strategy

development.

Budget:

Sr. No. Particulars Tentative Budget

(A) AT THE STATE LEVEL

1 Personnel on contract

1. Project Manager (MBA/PG in HRD) - Rs.25,000/- per

month x12 months = Rs.3,00,000

2. Deputy Project Manager (Master in Social Works) –

Rs.20000/- per month x 12= Rs.2,40,000/-

Total of (1)+(2)= Rs.5,40,000/-

5,40,000/-

3 Development of IEC and monitoring materials (ASHA flip chart,

ASHA Activity Diary, ASHA Register, IEC material, reporting

format, monitoring formats and resource materials for meetings) =

300 x 87135 = 2,61,40,500/-

2,61,40,500/-

4 Monitoring and supervision 2,00,000/-

5 Operation research and documentation 2,00,000/-

6 ASHA Sammelan and exposure visits @ Rs. 150/- per ASHA

(Rs.100/- Hon. + Rs.50/- TA/DA)= 150 x 87135 = 1,30,70,250/-

1,30,70,250/-

7 Workshops, seminars and Meetings 2,00,000/-

8 ASHA Mentoring Group Budget 2,00,000/-

9 Contingency 1,00,000/-

Total (A) 4,06,50,750/-

(B) ASHA Support System at the District Level

1 Strengthening of the District PMU for undertaking ASHA support

system

Additional Personnel

(a) Community Mobilizer/District Project Manager-ASHA (Master

in Social Work) Rs.20,000/- per month x 12 months =

Rs.2,40,000/- who will report to District Nodal Officer

21,60,000/-

142

(b) Data Assistant (Graduate with Basic Computer knowledge) - to

strengthen the District PMU to take additional work. He/She will

assist the existing staff of District PMU in all the work related to

NRHM including ASHA related work. Rs.8,000/- per month x12

months = Rs. 96,000/-

(c) TA/DA to be paid from District Health Society (Programme

Management Cost) for monitoring visits and collection of

information Telephone, fax, computer, stationeries etc to be used

from District PMU (3000 x 12 x 38 = 13,68,000.00)

(d) ASHA Help Desk at the district level (As In-charge Community

Mobilizer) = 1000/- x 38 district x 12 months =4,56,000.00

(C) ASHA Support System at the Block Level

(A) Block ASHA Manager/An officer – Block Level Organizer in

all the blocks. (Rs. 12000 x 533 x 12 months = Rs. 7,67,52,000.00)

(B) ASHA Help Desk at the Block Level (as in-charge Block Level

Organizer and MOIC) = 500/- x 533 x 12= 31,98,000/-

7,99,50,000/-

(D) ASHA Support System at Village Level

1

Community Monitoring and Community need assessment

(20 ASHA and block facilitator, PRIs, SHG, two beneficiaries and

NGO representative.)(Rs.150/- x 2500 x 12) = 45,00,000/-

45,00,000/-

(E) ASHA Trainings

1 One day Orientation programme of State Level resource person =

65,000/-

8,68,95,000/-

(Rs.17.15 crores was made available in 2008-09, of which approx. Rs.50.00

2 12 days training of District Resource Team

(38 district x Rs.2,35,000/-)= 89,30,000/-

3 12 days training of ASHA at Block level (2489 batches x

Rs.1,00,000/-) = 24,89,00,000/-

143

4 Documentation and Development of IEC materials = 5,00,000/- lakhs has been spent. Therefore of the total

requirement of Rs. 25,83,95,000/- additional

fund required for 2009-10 is 13,82,92,850/- and the

balance available amount in SHSB may be ratified for

use in 2009-10)

Total (B+C+D+E) 17,35,05,000/-

(F) ASHA Drug Kit & Replenishment

1 Drug Kit @ Rs. 600/- for 12822 ASHA

Replensihment of Drug Kit @ 74313 ASHAs x Rs.200/-

7693200

1,48,62,600/-

Total 2,25,55800

(G) Emergency Services of ASHA

1

Deputation/ engagement of ASHA in Flood and other natural

calamities for flood prone district (20 days x Rs.100 per day x

approx 3000 ASHA= 60,00,000.00)

66,00,000/-

2

Capacity Building/Training of ASHA in Flood and other natural

calamities for flood prone district ( 2 days x Rs. 100 per day x

approx 3000 ASHA = 6,00,000.00)

(H) Motivation of ASHA

1 Provision of two Sarees to ASHAs (87135 ASHAxRs.600( two

Sarees) =5,22,81,000/-

6,31,72,875/-

2 Provision of one umbrella to ASHAs (87135 ASHAs x Rs.125/-)

=1,08,91,875/-

(I) Capacity Building/Academic Support Programme

1 Approx. 1000 ASHAs in the State to be enrolled into 10th grade or

Bachelor’s Preparatory Programme through Open Schools or

IGNOU. Fee for the same to be provided by SHSB. The amount

being requested is less, more shall be requested in case of god

response to the proposal.

@ Rs.1000 x 1000 students =10,00,000

10,00,000/-

2 Training for ASHA Help Desk (1104 x 500/-)= 5,52,000/- Provisioned in IEC

component of Part A

Total (F+G+H+I) 10,47,28,675/-

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(J) ASHA Divas

1

TA/DA for ASHA Divas @ Rs.75 per ASHAs per month

(Rs. 87135 x 75x12) = 7,84,21,500/-

8,12,30,200/-

2 Best performance award to ASHAs at district level. @ Rs.2000 per block= 3 ASHAs from each block @ Rs.1000 for 1st, Rs.500 for 2nd and Rs. 300 for 3rd prize, Rs. 200 for Certificate printing and distribution = Rs. 2000 x 533) = 10,66,000/- (For this activity the administrative system/procedure shall be chalked out with support of Development Partners)

3 Identity Card (Rs. 20 x 87135) = 17,42,700/-

Total (J) 8,12,30,200/-

Grand Total( A+B+C+D+E+F+G+H+I+J)

38,87,14,625/-

Forty nine crores Eighty six lakhs Thirty four thousand Eight hundred and Seventy five Rs. only.

145

Total Budget under ASHA Scheme

Sl Particulars Amount (Rs.)

1 ASHA Support System at State Level 4,06,50,750/-

2 ASHA Support System at District Level 21,60,000/-

3 ASHA Support System at Block Level 7,99,50,000/-

4 ASHA Support System at Village Level 45,00,000/-

5 ASHA Trainings 8,68,95,000/-

6 ASHA Drug Kit & Replenishment 2,25,55,800/-

7 Emergency Services of ASHA 66,00,000/-

8 Motivation of ASHA 6,31,72,875/-

9 Capacity Building/Academic Support Programme 10,00,000/-

10 ASHA Divas 8,12,30,200/-

Total Budget for ASHA 38,87,14,625/-

Work-plan for ASHA Program

Activities 2009-10 Q1 Q2 Q3 Q4

Development for IEC and monitoring material (IEC material, reporting format, ASHA Flip Chart, ASHA Activity Diary, ASHA Register, monitoring formats and resource material for meetings)

Monitoring and supervision

Operation research and documentation

ASHA sammelan and exposure visits

Workshops, seminars and Meetings

Trainings

Emergency Services of ASHA

Empowerment of ASHA

Capacity Building

ASHA Divas

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1.21 Untied Fund for Health Sub Centre, APHC and PHC The objective of the activity is to facilitate meeting urgent yet discrete activities that need relatively small sums of money at Health Sub Centers. The suggested areas where Untied Funds can be used mentioned below: ⇒ Cover minor modifications to sub center-curtains to ensure privacy, repair of taps, installation of bulbs,

other minor repairs, which can be done at the local level; ⇒ Ad hoc payments for cleaning up sub center, especially after childbirth; transport of emergencies to

appropriate referral centers; ⇒ Purchase of consumables such as bandages in sub center; ⇒ Purchase of bleaching powder and disinfectants for use in common areas of the village; ⇒ Labour supplies for environmental sanitation, such as clearing/ larvicidal measures for stagnant water ⇒ Payment/reward to ASHA for certain identified activities.

Budget

Budget Head Untied Fund

Sub-Heads @ Proposed Budget (in Crores)

Untied fund for sub-centre Rs. 10,000 x 8858 no. 8,85,80,000

Untied fund for APHCs 1243 APHC x 25,000 3, 10, 75,000

Untied fund for PHCs 533 PHC x 25,000 133, 25, 000

For meetings at HSC Rs. 2000 x 38 district 76000

PHC level ANMs Orientation on Guidelines for Untied Funds for HSC

533 PHCs x Rs.3000) 15,99,000

Quarterly review meeting of the ANMs under the chairmanship of PHC Medical Officer to monitor the usage of the fund

Rs.1000 per meeting x 4

quarter x 38 districts

1,52,000

Total 13,48,07,000

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1.22 Village Health and Sanitation Committee Government of Bihar has decided to merge “Village Health and Sanitation Committee” with “Lok Swasthya

Pariwar Kalyan and Gramin Swaschata Samiti” constituted by Department of Panchayat Raj in Bihar.

Budget

Budget Head Untied Fund for VHSC


Untied fund for VHSCs 45077 villages x 10,000 450770000 (Fund of Rs.10.00 cr is

available in SHSB, so the balance amount of

Rs.35,07,70,000/- is required)

Training of members of VHSC regarding functioning mechanism at the PHC level

533 PHCs x Rs.2500 13,32,500

Total 35,21,02,500/-

1.23 Seed Money for Rogi Kalyan Samitis Aims and Objectives The objectives of the RKS is :

» Upgrade and modernize the health services provided by the hospital and any associated outreach

services

» Supervise the implementation of National Health Programme at the hospital and other health

institutions that may be placed under its administrative jurisdiction

» Organize outreach services / health camps at facilities under the jurisdiction of the hospital

» Monitor quality of hospital services; obtain regular feedback from the community and users of the

hospital services

» Generate resources locally through donations, user fees and other means

Functions of the RKS

To achieve the above objective, the Society utilizes it’s resources for undertaking the following activities/

initiatives:

» Acquire equipment, furniture, ambulance (through, donation, rent or any other means) for the hospital

148

» Expand the hospital building, in consultation with and subject to any guidelines that may be laid

down by the GoBMake arrangements for the maintenance of hospital building (including residential

buildings), vehicles and equipments available with the hospital

» Improve boarding/lodging arrangements for the patients and their attendants

» Enter into partnership arrangement with the private sector (including individuals) for the

improvement of support services such as cleaning services, laundry services, diagnostic facilities and

ambulatory services etc

» Develop/lease out vacant land in the premises of the hospital for commercial purposes with a view to

improve financial position of the Society

» Encourage community participation in the maintenance and upkeep of the hospital

» Promote measures for resource conservation through adoption of wards by institutions or individuals

» Adopt sustainable and environmental friendly measures for the day-to-day management of the

hospital, e.g. scientific hospital waste disposal system, solar lighting systems, solar refrigeration

systems, water harvesting and water re-charging systems etc.

Budget

Budget Head Rogi Kalyan Samiti


District Hospitals 27 hospitals X 5 lakhs 1.35

Sub-divisional hospitals 23 hospitals X 5 lakhs 1.15

Referral hospitals 70 hospitals x 1 lakhs 0.70

PHCs 533 PHCs x 1 lakhs 5.33

Sensitization workshop for

RKS members (653 x 3

members =1959) at the

sub-divisional level (TA,

Food, Resource materials,

resource persons etc)

217 participants x 9

divisions x Rs.1000=

19,53,000

Provisioned in IEC

componet (Part A)

Exposure visit of members

of RKS of 10 non-

performing districts to

districts where RKS are

performing

@ 2 members/RKS x 10

hospitals x 10 districts =200

x Rs.2000=4,00,000

Provisioned in IEC

componet (Part A)

Total 8,53,00,000/-

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Infrastructure Development

2.1 Construction/Establishment of Health Sub Centre (HSC) NRHM aims to ensure HSC facility on the Govt. of India population norms of 1 per 5000 population in general areas and 1 per 3000 populations in tribal areas. As per 2001 Census, population of the Bihar State is approximately 8,29,98,509. Existing facility of HSCs are 8858 out of total requirement of 16623. To facilitate the above population the state requires 7765 HSCs additionaly to achieve the total target. It is proposed to create 1553 HSCs every year for next five years.

The revised estimate is @ 9.50 lakhs as per GoI norms. The State proposes to share 25% expenses in the construction of these HSCs and for land acquisition. The balance 75% the state has put under this PIP for financial support from NRHM. These Health Sub Centres shall either be constructed or shall be taken up on rental basis. The cost provided also includes cost of land acquisition if Govt. land is not available. Till such time construction is complete the state shall take buildings for these facilities on rental also. NRHM Action - Plan 2009-10

Proposed Activity

Expected Physical Out

Come

Proposed Budget 2009-10

Details of Budget Basis of Costing ( No. of Units X Unit Cost )

Creation of HSC

Initiating construction of 100 HSC.

Rs. 950.00 Lakhs

Total cost @ Rs 9.50 lakh per unit

Contribution of GoI (75% of 9.50 lakhs i.e @7.125 lakhs

per unit )

Contribution of GOB

(Rs.9.50-7.125 =

2.375 lakhs per unit)

100 x 9.50= Rs. 950.00 Lakhs

Rs. 712.5 Lakhs

Rs.237.5 Lakhs

In the year 2008-09 funds for construction of 1985 HSCs were released to Building Constrution Department, which has initiated necessary actions. All though construction of 500 HSCs were proposed in 2008-09 and under NRHM GoI released Rs. 30 Crores. In the year 2009-10 it is proposed to construct buildings of next 100 HSCs where land is available. For this an amount of Rs. 950.00 lakhs is required. For Construction work two agencies have been identified – BCD and District Health Society, Bihar.

150

2.2 CONSTRUCTION OF PHC NRHM aims to ensure PHCs on the Govt. of India population norm of 1 per 30000 populations in general areas and 1 per 20000 population in tribal/ remote areas. As per 2001 census, population of Bihar state is approximately 82958509. The existing facility of PHCs is 1243, whereas the total requirement is 2787 PHCs. There are 121 PHCs which do not have their own building. Therefore 1665 PHCs buildings require to be setup by 2010. Unit cost of construction and land acquisition is 53.15 lacs as per NRHM guidelines. Some of the facilities will be taken up on a rental basis. The total built-up area of the PHCs will be 63 hundred Sq feet, which will include 1500 sq. ft. for PHC & 4800 sq. ft. for its residential quarters. These PHCs would either be constructed or shall be taken up on rental basis. The cost provided also includes cost of land acquisition if Govt. land is not available for construction. Till such time construction is complete the state shall take buildings for these facilities on rental also. In addition, it is proposed to construct residential quarters for the staff in 500 old APHCs (previously sanctioned) in an area of 3000 Sq. ft.

NRHM Action - Plan 2009-10

Proposed Activity Expected Physical Out Come Proposed Budget

Details of Budget Basis of Costing

( No. of Units X Unit Cost)

1. Construction of residential quarters of 200 old APHCs for Staff nurses

Construction to be done in an area of 3000 sq. ft. (1000 sq. ft. x 3 quarters) @ Rs. 30 lakhs per APHCs.

Funds to be released to the Construction Agency.

Rs. 6000.00 Lakhs.

2. Construction of building of 51 APHCs where land is available

Funds to be released to BCD. An amount of Rs. 2710.65 lakhs is required for the construction. Against these Rs. 31 lakhs has already been released to BCD. Total fund required in 2009-10 will be Rs. 3,79,67,000 .00. The rest to be carried over in 2010-11.

Rs. 3,79,67,000.00 Rs. 3,79,67,000.00

Total – Rs. 63,79,67,000.00

Say Rs. 6379.67 lakhs

151

2.3 UPGRADATION OF COMMUNITY HEALTH CENTRE (CHC)

NRHM aims to ensure CHCs on the Govt. of India population norm of 1 per 1.20 Lakhs populations. The Govt.

of Bihar plans to upgrade all its PHCs and Referral Hospitals below the headquarter level to CHC as per IPHS

standards. In the state of Bihar the total no of existing PHCs are 533 and the no of Referral Hospital is 70.

Hence a total of 603 units are needed to be upgraded to CHC standard and converted to 30-bedded hospitals. It

is proposed to upgrade 200 facilities every year. As per NRHM guideline the entire cost of construction would

be borne by GOI.

It is proposed to take up upgradation of 100 PHCs to CHCs in the year 2009-10 and the balance PHCs/Referral

hospitals will be upgraded to CHCs in next year. The unit cost of construction and land acquisition will be

around Rs. 40 lakhs. The upgradation of hospital buildings shall be taken up from funds provided by the State

Govt. The doctors and staff quarters shall be provided under the NRHM. In case adequate land is not available

the fund can also be used for land acquisition. The doctors’ quarters would also be taken up on rental basis. The

cost provided also includes cost of land acquisition if Govt. land is not available. The costs also include

provision of equipment at these hospitals either as per IPHS standard or as required.

Up gradation of Community Health Centre As Per IPHS

NRHM Action - Plan 2009-10

Proposed

Activity Expected Physical Out Come

Proposed

Budget

Details of Budget

Basis of Costing (No. Of

Units X Unit Cost)

Creation and

Up gradation

of CHCs as

per IPHS

Standard

.

Preparation and Finalization of Maps.

Finalization of Construction Agency &

Initiating Renovation of CHCs.

Funds to be released for the construction

agency.

Quarters for Doctors and Staffs,

for the Purchase of New Surgical

instruments, Equipments, Furniture,

Rs.8040.00 lacs

Unit cost @ Rs. 40 lacs

(Contribution of GOI

100%) @ Rs. 40 lakhs x

100 = Rs. 4000.00 Lakhs

100 CHCs shall be taken up

for upgradation.

Rs. 4000 lakhs has already

been approved by the GoI in

2008-09 and has been

received and the amount

shall be expended this year

in 2009-10.

152

2.4 Infrastructure and Service improvement as per IPHS in 48 (District and Sub-Divisional) Hospitals for Accreditation / ISO : 9000 certification of Health Facilities

The state of Bihar has 25 District Hospitals & 23 Sub Division Hospital at present. Construction for 11 District

Hospitals are under process and have been nearly completed. Most of these District hospitals are 100 to 200

bedded. The state has already appointed one hospital consultancy firm to carryout the situation analysis of these

District Hospitals and prepares a master plan in terms of Infrastructure, Equipment and Manpower for

strengthening these hospitals as per IPHS.

The state with the help of NHSRC is in the process of ISO accreditation/certification for its District Hospital at

Bhojpur. This year Bihar would like to outsource this task through NHSRC or some competent agencies to take

up it’s 23 DHs and 25 SDHs under ISO certification across the state for addressing quality issues.

The state also intends to develop the hospitals at Rajvanshi Nagar, Rajendra Nagar, Gardiner Road,

Gardanibagh and Guru Govind Singh Hospitals at Patna into super speciality hospitals.

The preparation of Master Plan will be completed within six months after which the state will take up the

strengthening work. The upgradation would include upgradation of Civil Infrastructure as well as provision of

equipment. The cost provided also includes cost of land acquisition if Govt. land is not available. The costs also

include provision of equipment at these hospital either as per IPHS standard or as required. The costs also

include provision of equipment at these hospitals either as per IPHS standard or as required.

Budget:

Activity Amount ( In Rs ) Strengthening/Up gradation of District Hospitals, Sub-Divisional

Hospitals and Super-Specialty Hospitals as per IPHS Standard

3,40,00,000/-

Accreditation/ISO certification for 48 (District Hospitals + SDH) x Rs.20.00 lakhs

9,60,00,000/-

Total 13,00,00,000/-

2.5 Upgradation of Infrastructure of ANM Training Schools In year 2008-09, a State coordination committee for the strengthening ANM and GNM schools has been

activated under the chairmanship of the Additional Commissioner, Health. The Executive Director, SHSB,

153

officers from the Directorate and SHSB and UNICEF are its members. The committee has chalked a

comprehensive strategy for the rejuvenation of the ANM and GNM schools.

Key decisions made till now include

– Streamlining the student intake in all ANM and GNM schools up to their full capacity

– Ensuring that the vacant faculty and staff positions in all the schools are filled through

contractual appointments to undertake teaching assignment sas per INC norms

– Finalizing five ANM schools in PPP mode

– Formulation of the managing committee at respective ANM and GNM schools to look after the

local management affairs

– Strengthening the hands of the principals of these institutes

– Reviewing the progress on a regular basis

Initiatives have been taken in Operationalisation of 22 ANM schools in terms of -

• site assessment,

• basic renovation,

• provision of kitchen items, audiovisual equipments, lab equipments

• provision of study material,

• capacity building of faculty,

• standard curriculum development for the ANMs and GNMs

• Facilitation in accreditation from Nursing Council of India.

It is proposed to upgrade the Infrastructure of 22 ANM and 6 GNM Training Schools. In addition, the state is willing to open up more ANM and GNM schools as per the GoI’s letter in this regard. The approximate cost of up gradation of each ANM/GNM Training Schools is expected to be Rs 50 lakhs per Unit. It was proposed to upgrade the Infrastructure of 12 ANM Training Schools in 2008-09 PIP and a fund for the same to the tune of Rs.3.00 crores is available.

Additional funds are requested for the remaining 9 ANM schools and 6 GNM schools. The state is preparing a

separate proposal to upscale the standards of nursing education. Additionally under PPP 5 ANM schools are

proposed to be operationalised.

M.Sc/B.Sc. nursing faculty for nursing school to be taken from hindi speaking states like MP, Pondicherry, for

which Govt of India shall be approached for coordinating the same.

Budget

S No Description App. cost Duration Total

1 Upgradation of infrastructure of 12 Rs. 600 lakhs Rs. 6,00,00,000/-

154

ANM Training School including

provision of furniture & equipment

(Above fund is already

available from SPIP

2007-08, 08-09)

2 Strengthening of Nursing cell in the

GoB

@Rs 50 lakhs 50,00,000

3 Hiring of additional faculty for all

ANM and GNM schools

Rs 50.00 lakhs Every year 50,00,000

Total 7,00,00,000/-

2.6 Annual Maintenance Grant During the course of up-gradation in setting up of different units in the different health facilities of the state,

maintenance will also be essentially required. It is proposed that all district hospitals and sub divisional hospital

are provided @ Rs.5 lacs and Referrals/PHCs @ Rs.1 lakh. Fund for the same was approved in 2009-10.

Budget

Activities Total purposed budget

Disbursement of the Grant at the end of the meeting on the same day to the respective medical officers (district hospitals (23) and sub divisional hospital (25) @ Rs.5 lacs, Referrals/PHCs (55+533) @ Rs.1 lakh)

Rs.8,20,80,000

Contractual Manpower 3.1. Incentives, Contractual Salaries and Bonus

As human resources are the most important resource steps shall be taken to motivate them through various benefits and incentives like Cellphone facility for all ANMs, MOICs, Programme Officers, CDPOs etc. and rural and specialist incentives. All the doctors posted in the rural area would get an additional incentive of Rs.3000. A provision for Rs.50,000/- per PHC per year will be given as incentive to the PHCs for better performing in services. All the doctors performing specialist duties including the MBBS doctors trained for specialized tasks e.g. Life saving Anesthesia skills etc. will get an incentive of Rs.4000.

155

Budget:

Sub-Heads @ Proposed Budget

(Rs. In lakhs) Incentive for PHC doctors & staffs @ Rs. 50,000 for better performance in implementing programmes

Rs. 50,000/ - per year for about 250 PHCs

125.00 Salaries for contractual Staff Nurses (2900 existing and 910 new)

Rs.7500 per month 3439.00

Contract Salaries for ANMs (around 8000) in year 2009-10 3500 ANM will be paid by NRHM (Rest 4500 ANM will be paid by Treasury Root)

Rs.6000 per month (12 Months Consolidated Salaries for Contractual ANMs)

2520.00

Mobile facility for all health functionaries

District officials, PHC in charge, CDPOs and ANMs @ 500 per month 600.00

Total 6767.02

3.2. Block Programme Management Unit The state has already established Block Programme Management Unit in all the 398 Block PHCs. This year the state will establish the next 135 Block Programme Management Unit. Each BPMU consist of One Block Health Manager and One Accountant. It has been observed that after the establishment of BPMUs the implementation of National Programmes has been managed efficiently and getting improved results. Budget A. Recurring Expenses of 533 BPMUs

Sl Particulars Qty Rate (Rs.) Amount (Rs.) 1 Salary of Block Health Manager 1 12000/- pm 1,44,000/- 2 Salary of Block Accountant 1 8000/- pm 84,000/- 3 Mobility and Office Expenses 1 25000/- pm 3,00,000/-

Recurring Expenses Per BPMU per Year 5,28,000/- Recurring Expenses of 533 BPMUs per Year 28,14,24,000/- B. Establishment Expenses for 135 BPMUs

156

Sl Particulars Qty Rate (Rs.) Amount (Rs.) 1 Computer System with Printer 1 50,000/- 50,000/- 2 Furniture 1 10,000/- 10,000/-

Establishment Expenses Per BPMU per Year 60,000/- Establishment Expenses of 135 BPMUs 81,00,000/- Total Budget for 2009-10 for Block Programme Management Unit (A + B) = Rs. 28,95,24,000/-

3.3. Additional Manpower for State Health Society, Bihar NRHM being a large programme covering various components, SHSB requires more manpower to run the programmes. The State Health Society requires additional manpower other than State Programme Management Support to manage all the Programmes under NRHM umbrella. This year state also proposes to put 2 nos. Executive Engineers and 1 Bio-Medical engineer under SHSB for monitoring the construction and equipment activity under NRHM. The details of Manpower as follows with Budget: Details of Staff

Sl Post Salary (pm) Salary (pa) 1 Accountant (RNTCP) 15000 180000 2 Pharmacist (RNTCP) 11500 138000 3 Data Assistant (RNTCP) 9000 108000 4 Computer Operator (RNTCP) 8000 96000 5 Accountant (NBCP) 15000 180000 6 Computer Operator/Data Assistant (NBCP) 8000 96000 7 Steno-cum-LDC (NBCP) 8000 96000 8 Computer Programmer (NLEP) 15000 180000 9 Data Officer (Malaria/Kalazar) 15000 180000 10 Computer Operator (Malaria/Kalazar) 8000 96000 11 Store Keeper (Malaria /Kalazar) 8000 96000 12 Accountant (Filaria) 15000 180000 13 Computer Operator (Filaria) 8000 96000

Total Per Annum 1722000/- 10% annual increment as approved by the Governing Body of SHSB, therefore the total required =

Rs.18,94,200/-

157

Details of Programme Officers For Government officials on deputation new salary slab as such is proposed-

Sl. Name Salary Pm Salary (pa) 1 Administrative Officer- SHSB 34143 409716 2 Programme Office - TB 32983 395796 3 Programme Officer-Kalazar/IDSP 38643 463716 4 Programme Officer -Blindness 29882 358584 5 Programme Officer- IDD/Filaria 35664 427968 6 State Immunization Officer 42108 505296 7 Programme Officer-Malaria 30751 369012 8 Programme Officer - Leprosy 30000 360000

Total Salary of ProgrammeOfficers 274174 32,90,088 Details of Engineers

Sl. Name Salary Pm Salary (pa) 1 Executive Engineer - SHSB 2 no. 30000 x 2

10,20,000 -

2 Bio-Medical Engineer –SHSB 1 no. 25000 x 1 Total Salary for Engineers 85000

Total Budget for Additional Manpower at SHSB = Rs. 62,04,288/-

3.4. Additional Manpower under NRHM Being a big state, Bihar requires more manpower to provide services at various facility levels.

Moreover the infrastructure development is happening at a snail’s pace. To expedite this, it is proposed to hire 1

Assistant Engineer at each district and 1 Junior Engineer for every four (4) blocks) on contract

Budget

Sl. Name Salary Pm Salary (pa)

1 Hiring of AE on contract Rs.22,000/- x

38 districts x 9 months 75,24,000

2 Hiring of JE Rs.15,000 x 9 months x 133

blocks 1,79,55,000 Total Salary 2,54,79,000/-

158

PPP Initiatives in State 4.1 Emergency Medical Service /102 – Ambulance Service The Toll free number 102 was launched during 2006-07 and is running in all the six regional headquarters

successfully. Under this scheme Ambulance for emergency transport is being provided in all the districts of

Bihar. The empanelled ambulance & ambulance available in Govt. institutions are made available on receipt of

calls from the beneficiaries.

This service has been outsourced to a private agency for Operationalisation. The Telephone Charges for the free

toll free number is paid to BSNL by SHSB. The amount required would be for payment of incoming calls

received from the beneficiaries.

In the year 2008-09 (figures till December 2008) 12131 requisitions have been successfully met by this service.

Budget summary of 102 :

Budget Head 102 Emergency Service


Control Room (including office rent,

salary of staff (24x7), stationary,

2 outgoing telephones for compliance

of 102 & for reporting to Headquarter)

Rs. 41,000.00 x 6 units = Rs,

246000.00 x 12 months =Rs.

29,52,000.00 + Per Control Room Rs.

15,000.00 pm x 6 = 90,000.00 x 12

months

40,32,000.00

Total 40,32,000/-

4.2. Doctor on Call & Samadhan: Dial 1911 A scheme is operational in the state wherein patients can dial a number and call for doctors. For this a special

toll free number of 1911 has been provided for w.e.f. 01.3.2008. The objective of the scheme is to give medical

assistance to the patient at their home at any time as well as act as a Samadhan of Rogi Shikayat.

Doctors and Specialists have been empanelled for this scheme. Pathology labs have also been attached to collect

samples for tests from patient’s home.

Budget summary of 1911:

Budget Head 1911 Doctor on Call service


Control room 3,500 per person (Two person) = 7,000.00 per control room is being

5,04,000.00

159

paid to the outsourced agency. Rs. 7,000.00 x 6 = Rs. 42,000 x 12 months

Telephone bill Each control room is being paid telephone bill (i) Doctors conferencing Rs. 1,500.00 x 12 months = 18,000 x 6 control rooms = 1,08,000.00 & (ii) Rogi Jan Shikayat Rs. 2,000.00 x 12 months = 24,000 x 6 control room = Rs. 1,44,000.00.

2,52,000

Provision of Annual

Maintenance of EPBAX

Rs. 10,000.00 per annum x 6 control room

60,000.00

Total 8,16,000/-

4.3. Additional PHC management by NGOs

The state has started to outsource the management of Adll. PHCs to the NGOs. In 2008-09 the state has given 44

Adll PHCs to the NGOs for management. The result was good and it has been observed that the NGOs are

properly managing the PHCs. This year the state proposes to outsource another 56 Adll PHCs to the NGOs for

management.

Last year 44 PHCs were given @ Rs.75,500/- pm per Adll. PHC.

This year the state proposes to provide Rs.1,00,000/- per APHC to additional APHCs.

Budget

Sl No Particulars Amount (Rs.)

1 Recurring Cost for existing 44 Adll PHCs @ 75,500 x 12

month

3,98,64,000/-

2 Cost of New 56 Adll. PHCs @ Rs.75,500/- x 12 months 5,07,36,000/-

(This fund shall be

asked for subject to

evaluation of the

already running

APHCs at pt. 1 above)

Total 3,98,64,000/-

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4.4. American Association of Physicians of Indian Origin (AAPIO)

AAPIO survey on Specific Disease:

The Ministry of Overseas Affairs, Govt. of India and American Association of Physicians of Indian Origin

(AAPIO) signed an MoU at the Pravasi Bharatiya Divas in Jan 2006 to conduct a study on 5 specific diseases.

Thereafter a meeting of Core Committee was held in New Delhi in this regard.

As a follow-up to the above activities this project was included in the Annual Plan of NRHM in 2008-09 and a

provision of Rs.50 lakhs was made in the PIP. The sum of Rs.1.56 Crores for the project has already been

approved.

This year the State again proposes another installment of Rs.56 lakhs in the 2009-10 State PIP.

4.5. State Health Resource Center

State Health Resource Center has been established in State Health Society, Bihar with a two year contract

starting from January’ 08. M/s HOSMAC has been awarded this work and the total budget cost has been

divided into two parts-

• Retainership Fee

• Amount payable on completion of milestones

A total of Rs. 2.00 crores was approved in previous year’s PIP and the balance amount available in SHSB of

Rs.1,38,44,799/- shall be utilized in the FY 2009-10.

4.6. Services of Hospital Waste Treatment and Disposal in all Government Health

facilities up to PHC in Bihar (IMEP)

Bio medical waste management has emerged as a critical and important function within the ambit of providing

quality healthcare in the country. It is now considered an important issue of environment and occupational

safety. As per the Bio-Medical Waste (Management & Handling) Rules, 1998, all the waste generated in the

hospital has to be managed by the occupier in a proper scientific manner. The GoI has also issued the IMEP

guidelines for SCs, PHCs and CHCs. The state has outsourced the Biomedical Waste Management system for

all the Government hospitals.

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Strategy/Project Description

State Health Society Bihar is implementing National Rural Health Mission (NRHM) to carry out necessary

architectural correction in the basic health care delivery system. In order to provide quality services to the

public, SHSB has sought Public Private Partnership in providing proper Hospital Waste Treatment and Disposal

Services, in all Health facilities right from Medical Colleges to the PHCs.

Services to be provided

1. Provide Service of Hospital Waste Treatment and Disposal in all Medical Colleges, District Hospitals,

Sub-Divisional Hospitals, Referral Hospitals and PHCs of the State.

2. Install, Operate and maintain appropriate Common Biomedical Waste Treatment facility, as per the

Biomedical Waste (Management & Handling) Rules, 1998 and subsequent amendments in it.

3. Provide one day orientation training to all the health service providers.

4. Maintain the above-mentioned arrangement for a period of minimum 10 years. The Common

Biomedical Waste Treatment facilities are proposed to be established at various locations across the

State

Setting up a Bio-Medical Waste Management System:

1. The state has started a CWTF facility at Indira Gandhi Institute of Medical Sciences, Patna

(autonomous institute). The facility has been approached for undertaking waste treatment for all PHCs

to DHs in all the eight districts of Patna division.

Status – Registration of the health facilities with IGIMS and with Bihar State Pollution Control Board

being ensured. Anticipated to be fully functional in all the eight districts by March 2009.

2. As per the rules each CWTF should cater to all facilities in 100 Km radius, keeping this in mind, more

CWTF are to be operationalised in each of the division except Patna (which already has such a facility).

To implement the IMEP in a comprehensive systematic manner, Private Parties have been

invited through National Open Tender. SHSB has already finalized two agencies for undertaking the

BWM project that would set up CBWM Treatment facilities at various locations in the State and cater

to all the PHCs to DHs to MCHs in all the Divisions except Patna.

The agency shall ensure segregation and collection of waste, disinfection, treatment, transportation, handling and disposal of waste both within and outside the healthcare setting; also ensure use of protective devices and safety precautions. The objective being to ensure waste management, waste minimization and infection control.

Trainings to be provided to health care workers and officers in Infection Management and Environment Plan implementation by the respective agencies. Payment is to be made on a per bed per day monthly basis to both IGIMS and the Private Agencies.

Status - The project is in the finalization stage, agencies have been finalised and approval of the Governing Body of SHSB is awaited on the Contract to be signed with both the agencies

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and further approval of the Bihar State Pollution Control Board is awaited. GOI had approved an amount of Rs.10.00 crores for the project in PIP 2008-09.

Budget Activities Total proposed budget

(in Rs.) Dissemination and Sensitization workshops on IMEP Guidelines at divisional levels

1,00,000/-

Training of in-house staff (ANM, Safai Karmacharis, clinical support staff) on recognizing, segregating and disposing of bio-medical wastes

10,00,000/-

Operationalization of Biomedical Waste Management @ Rs. 0.08 lacs pm per PHC (533), Rs. 0.12 lacs per Referral Hospital and SDH (113) and Rs. 0.30 lacs per DH (36) and Rs 0.45 lacs pm per Medical College (6)

9,36,16,000/-

Total

9,47,16,000/- (The fund received

for the activity in 2008-09, may be

approved for utilization in this FY

of 2009-10) Work plan

Activities 2007-08

Q1 Q2 Q3 Q4

Dissemination and Sensitization workshops on IMEP Guidelines at divisional level

Training of in-house staff (ANM, Safai Karmacharis, clinical support staff) on recognizing, segregating and disposing of bio-medical wastes

Operationalization of BMW at PHCs, SDH, Referral Hospitals, DHs and Medical Colleges

4.7. Dialysis Units in various Government Hospitals of Bihar

It is proposed to set up & Operationalising Dialysis Units through Public Private Partnership (PPP) in 25

Hospitals of Bihar. This would require operation, maintenance and reporting 24-hours 7 days a week Dialysis

units in Hospitals.

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The State Government shall provide vacant space in the premises of the Hospital itself with additional space for

washing and RO plant installation (incase it is not in-built). The space provided shall be approx. 750-1000 sq.ft.

including RO plant. The agency has to provide everything from equipments & machine, logistics, consumables

etc to suitable medical personnel to man these units. The agency has to also ensure the installation,

maintenance, functioning with provision of technical manpower round the clock. No rates shall be charged from

the patients.

Tender bids have already been floated for the same and M/s Apollo Hospitals, Chennai have been finalized for

undertaking the task. Government/SHSB shall pay a monthly rental to the agency, based on the monthly cost as

projected by them in the financial bid.

Status – Negotiations are on with M/s Apollo on the costing for the Dialysis unit

GOI had approved Rs.3.00 crores for the project in the last PIP.

Budget

Activities Total proposed budget Project cost for one Dialysis unit with 8 Dialysis machines (covering suitable manpower, power, diesel, water, general medical indent & consumables, CMC, RO membrane changing, resin changing, pre-filter changing, activated carbon filter changing, sedimentation filter changing, insurance of equipments, building maintenance, administrative expense, contingency, depreciation on equipments etc)

Rs.50.00 lacs x 1 year x 6 units= Rs.3.00 Crores

(The previously approved Rs.3.00 is available with the State which may be ratified for expenditure in 2009-10)

4.8. Setting Up of Ultra-Modern Diagnostic Centers in Regional Diagnostic

Centers (RDCs) and all Government Medical College Hospitals of Bihar

State Health Society Bihar is implementing the National Rural Health Mission (NRHM) to improve the

availability of and access to quality health care for people. Setting up of Ultra-Modern Diagnostic Centres

through Public Private Partnership (PPP)’ in 9 Regional Diagnostic Centres (RDCs) and 6 Medical College

Hospitals (MCHs) of Bihar has been initiated.

Project Area –Regional Diagnostic Centers in Ara, Gaya, Bhagalpur, Munger, Muzaffarpur, Motihari, Purnea,

Saharsa and Chapra.

Government Medical College Hospitals – PMCH, NMCH, SKMCH, DMCH, ANMMCH, JLMNCH

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M/s Softline, New Delhi and M/s Doyen Diagnostics, Kolkata have been contracted to set up the Ultra-Modern

Diagnostic Centers.

Project Scope– To operate, maintain and report 24-hours ‘Ultra-Modern Diagnostic

Centers’ in RDCs & MCHs and report the progress to the RDDs (who would be in-charge of

monitoring the RDCs project) and the Superintendents (who would be in-charge of monitoring

the MCH project) and the SHSB.

Project Condition -

– The State Government has created the buildings for Regional Diagnostic Centers at all the towns

mentioned in Project Area. In the case of MCHs, space shall be provided in the premises of the MCH

itself at the discretion of the Superintendent of the concerned MCH.

– The agency has to provide everything from equipments & machine, logistics, consumables etc to

personnel; the said RDC/MCH will only provide space for the Diagnostic Centre along with space for

storage at a nominal monthly rent payable to the DHS of the concerned district (in the case of RDC) and

the Rogi Kalyan Samiti of the concerned MCH (in the case of MCH) by the agency.

– The agency has to ensure the installation, maintenance, functioning with provision of expert technical

manpower round the clock.

– Rates (to be charged from the users) shall be applicable as per AIIMS, New Delhi for the basic,

standard and other specialized tests under each Diagnostic head.

– The project is on a revenue sharing model

The project is for ten (10) years depending upon performance further extension will be considered.

Facilities that will be provided in RDCs and MCHs areà Pathology- Bio-Chemistry, Radiology – Digital x-ray,

CT scan, MRI, ECG, Mammography.

GOI had approved the project in the SPIP 2008-09.

The state requires budget in this regard only for reimbursement to the Private Parties by the RKS of the concerned

hospital for providing free services to BPL patients. All the remaining cost for setting up centers will be borne by

the private providers.

Budget Activities Total proposed budget

Reimbursement cost to the Private Parties by the RKS of the concerned hospital for providing free services to BPL patients

Rs.200 x 1000 BPL patients x 12 months x 15 units=

Rs.3.60 Crores

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4.9. Providing Telemedicine Services in Government Health Facilities

SHSB has sought Public Private Partnership in providing Telemedicine Services in Government Hospitals of Bihar. Additionally the State is also in consultation with ISRO for providing technical support for the same either based on Gujarat or Orissa model. The project shall be initially piloted in two or three districts. Project Goal: The goal of this project is to establish a model for application of Telemedicine to address the issues of improving accessibility, more efficient use, ensure equitable distribution and enhancing the quality of available health services across the state. Project Objectives: The overall objective of the assignment is to provide a comprehensive model for Telemedicine in the state of Bihar.

The specific objectives of the assignment are -

• Establish and Provide Telemedicine Network for accessibility of healthcare service facilities in the State linking 2-3 District Hospitals to Patna Medical College Hospital (PMCH) of the State.

• To reduce the cost of health services by providing specialized service through the network. • Upgrade the skills of existing Medical staff at the DHs and PMCH. • To ensure routine Management and Administration of the activities

• To provide timely reports and information to the SHS, Bihar for audit and review

• To ensure Maintenance, Servicing & Up-gradation of the Telemedicine Facility

Project Timeframe- the Project is planned for a period of five years, and after that based on evaluation by the SHSB the project may be extended. Scope of Work

The outsourced agency will provide complete technical support in terms of designing the telemedicine network

for DH & PMCH, supply of hardware and software required, installation and operationalization and

maintenance of telemedicine system including necessary training. The agency shall also facilitate defining and

formalizing linkages between DHs and MCH and thus facilitate consultation through telemedicine.

The detailed roles and responsibilities of the private partners to meet the aforesaid objectives are as follows:

Ø Providing the necessary equipment and software for establishment of the above system. Ø Install, Operate and maintain appropriate Telemedicine facility. Ø Sufficient bandwidth to transfer Data Ø Real time videoconferencing with Patient Ø Transfer of diagnostic data on real time basis or/and Store & Forward basis, as the case may be

through V-sat/Broadband/ISDN Ø The facility should enable transmission of patients’ medical records, including images, and provide

a live two-way audio and video link between patient and specialist Ø Building the capacity at DH as well as associated PMCH to operate and use the system by

providing training. Ø Technical manpower support to run the system to operationalise the project. Ø Continued technical back up for maintenance of the system.

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Ø Ensuring Quality Standards

Ø Providing detailed reports of Telemedicine services as per the Proformas provided at the time of signing of the contract, or as issued by the SHS from time to time.

The Telemedicine framework shall be at the secondary and tertiary levels:

Ø Level 1 – District Hospital

Ø Level 2 – PMCH

Tele Medicine Equipment Ø The Software should be able to use any Digital Imaging and Communications in Medical (DICOM

standard compliant) equipment. Ø Attachments for capturing and transferring DICOM standard images from various available medical

devices, including X Rays; CT Scans; MRIs, and Ultrasound Images Ø Devices for creating high resolution virtual slides from various Pathological images and transferring

them Ø The agency shall provide the following equipment at the DHs under this project:-

1. ECG – suitable for neonatal, pediatric and adult patients 2. EMG – suitable for neonatal, pediatric and adult patients 3. Ultrasound scanner (should be able to do various diagnosis like cardiology, obstetrics &

gynecology, radiology etc) 4. Color Doppler ultrasound scanner 5. Endoscope 6. Digital Microscope 7. Indirect Ophthalmoscope 8. Funds Camera 9. Multipara monitor (ECG, Temp, NIBP, SPO2, Heart rate) suitable for neonatal, paediatric and

adult patients 10. Electronic Stethoscope 11. Pulmonory function test 12. TMT machine 13. ENT Audiometry 14. Mammography 15. Glucometer 16. Fetal Heart Rate Monitor (for measuring the heart rate of foetus) 17. EEG

Note: 1. All the above mentioned instruments would be able to connect to the computer (DICOM compatible)

for obtaining digital data. 2. The hardware/software so installed would also be able to send data generated from Digital X-Ray, CT

scan and MRI mechanism, which may be installed by the Government. Ailments to be covered under the facility Software would be capable of handling and transferring any type of medical data which may be text, audio, video or image. The Medical areas which would be handled include: ü Cardiology ü Radiology ü Oncology ü Pathology ü Ophthalmology

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ü Nephrology/Diabetes ü Urology ü Neurology ü Psychiatric ü Dermatology ü Gynaecology ü Cosmetic Surgery ü Vector borne deceases The following Telemedicine software package modules would be used – a). Electronic Medical Record (EMR) b). Tele-Cardiology c). Tele-Radiology d). Tele-pathology e). Tele-dermatology f). Tele-endoscopies g). Tele- Ophthalmology h) Video Conferencing Indicators for assessment of the utility of telemedicine system

1. Number of Online Consultations a. Gross Number b. Timings

i. Routine ii. Emergency

c. As percentage of total seen d. How many physically sent e. How saved the need for transfer f. Whether any dramatic savings (e.g. Life /death matters) ensued

2. Number of investigations a. On line Routine / Emergency investigations. b. Number and type of specialized investigations, waiting time and reporting time

3. Follow up visits 4. Number and type of procedures

a. At PHCs b. At centers where staff is referred to.

5. Training of Health and paramedical staff in telemedicine. a. Number b. Level of skills and confidence.

Expected results: Ø Speed: Patients can be diagnosed and treated quickly, without the need for a potentially life-threatening

journey to a larger hospital. Ø Service extended: Referral process strengthened and specialist advice available at PHC level. Ø Economical: In terms of cost of travel to a hospital for a second opinion and in service itself, once

facility set up. Ø Improved quality of health services.

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Ø Institutionalize linkages between PHCs and hospitals through formal arrangements to provide instant consultation to PHCs and also honor referral cases from PHCs.

Ø Builds trust: Patients with low level of education are often suspicious of visiting a city specialist. Tele-conferencing offers frequent consultation with the specialist, building confidence and improving patients’ compliance to treatment, thus patient satisfaction will increase

Ø Through linkages with specialists and hospital, PHCs will be able to cater to wider spectrum of needs/expectations.

Budget

Activities Total proposed budget Operational cost for providing telemedicine facility in the state in this FY 2009-10

Rs.3.00 Crores Note : GOI had approved the project and budget in the previous PIP and ratification is solicited for the same for this FY

Work plan

Activities 2007-08

Q1 Q2 Q3 Q4

Floating of tender, Awarding of contract and finalization of interactions with ISRO

Pre-Commissioning period Implementation of the project

4.10. Outsourcing of Pathology and Radiology Services from PHCs to DHs

Under this scheme Pathology and Radiology services have been outsourced to different Private agencies. The

agencies have and/or are in the process of setting up centers/diagnostic labs/collection centers at the

hospitals/facilities. The state has fixed the rates on which the agency charges from the patient. The state has to

only provide space at the hospitals to the agency for running the Pathology and Diagnostic Centre.

However under the project service expansion has been done and Ultrasound facility has to be provided at

various locations at DHs and SDHs. For the purpose of establishment of Central Reporting System (CRS) for

X-ray and Ultrasound Units is being done at IGIMS, Patna. The purpose being CR system will connect all the

Ultrasound and X-ray centers of IGEMS set up in Government Hospitals under this contract, with Tele-

radiology in a phased manner.

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The Agency shall provide all necessary hardware, software and manpower for establishing the network between

IGIMS and each of its Radiology unit having X-Ray and Ultrasound facilities for running the Tele-Radiology

service.

SHSB has to provide space in coordination with DoH, GOB; radiologist to report on the ultrasound and x-ray

images (preferably retired persons), telephone line with broad band connection and necessary power

connections.

The state requires budget in this regard only. All the remaining cost for setting up centers and providing

services will be borne by the private providers.

Budget

Activities Total proposed budget Telephone line with broad band connection and necessary power connections

Rs.1,00,000 x 12 months =12,00,000

Sourcing of private radiologists to report on the ultrasound and x-ray images through the CRS at IGIMS incase of non-availability of Government radiologists @Rs.25000 per month for 6 radiologists

25000 x 6 x 12= 18,00,000

Total 30,00,000/-

4.11. Operationalising Mobile Medical Unit SHS, Bihar on behalf of the Department of Health, Government of Bihar, has invited Private Service Providers for providing Mobile Medical Units (each unit fitted with GPS- Global Positioning System) to provide primary health care facilities in the hard to reach rural areas of various districts of Bihar.

Three agencies have been awarded the contract for operationalising mobile medical units in all the districts.

Scope of Work

Private Service Providers for providing mobile health care services in rural Bihar of curative, preventive and

rehabilitative nature, to be provided by the service provider along with all deliverables like Mobile Clinic (each

unit fitted with GPS- Global Positioning System), professional manpower, and other such services, to provide

and supplement primary health care services for the far flung areas in the various districts of Bihar and to

provide a visible face for the Mission.

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Project Objective

To provide and supplement regular, accessible and quality primary health care services for the farthest areas in the districts of Bihar and to provide visible face for the mission and the Government, also establishing the concept of Healthy Living among the rural mass

Project Scope

The detailed roles and responsibilities of the private partners to meet the aforesaid objectives are as follows:

Ø Providing the requisite vehicle and equipments and software for Operationalization of the MMU. Ø Install, Operate and maintain appropriate GPS facility. Ø Technical manpower support to run the MMU and provide the services Ø Continued technical back up for maintenance of the system. Ø Ensuring Quality Standards Ø Providing detailed reports and maintain database of information of MMU services as per the

Proformas provided at the time of signing of the contract, or as issued by the SHS from time to time.

Vehicle Type for MMU

o Brand new GPS fitted, fully Air Conditioned TATA 709 chasis or equivalent vehicle of similar dimension from reputed manufacturers for MMU

o An accompanying vehicle of TATA Sumo or Mahindra Bolero or equivalent specification make vehicle for Carriage of Medical persons and also to be used as ambulance for transporting patients in case of emergency. The body of vehicle should be suitably modified to serve this dual purpose.

o Mobile Van should be designed keeping in mind the following criteria -ease of deployment, female privacy, community acceptance and cost.

o Web enabled MIS has to be ensured along with a Control room at Patna or Commissioner HQ. o Temporary shed facility shall have to be ensured at the site for the patients in waiting.

Manpower The manpower to be employed for the program is to be appointed by the Private agency as such-1 Doctor, 1 Nurse, 1 Pharmacist (van supervisor),1 OT assistant , 1 X-ray technician, 1 ANM , 1 Driver (Qualification requirements annexed) Equipments to be provided in the MMU Medical Equipments -Semi Auto-Analyzer, Portable X ray unit, Portable ECG, Microscope, Screen, Stretcher, O.T Table with standard accessories, Stools, Dressing Trolley/Instrument trolley, Dressing drums, Oxygen Cylinder, Suction Machine., Ophthalmoscope, Refraction set, Horoscope, Mobile light or Ceiling light (OT Light),Centrifugal Machine, Hemoglobin meter, Glucometer, Autoclave, Incubator, Urine Analyzer, Vaccine carrier, Weighing machines-adult and infant, Stethoscope, BP Instrument, Kits like Suture removal kit, Pregnancy test kit, IUD insertion kit, Starter, Regent kit, HIV testing kit, General Instrument kit, First Aid kit, various, tests and surgery kits, Normal Ambulance appliances or accessories like foldable furniture, waste basket, linen, mattress, mackintosh sheets, fire extinguisher etc Silent DG set, Audio-Visual Equipment with projection system for IEC especially with, 40” LCD, P&A System, Cell phone Service Areas The Medical areas which would be handled include:

1. Free General OPD/ Doctor Consult

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2. Free Drugs - Free dispensation and procurement of medicines as per the Essential Drug List prescribed by GoB for PHCs (Annexed) has to be ensured by the private agency

3. Emergency Services during epidemics and Disasters 4. Network and referral between PHC/CHC/Private clinics 5. Generating health indicators and monitoring behavioral changes 6. Gynec clinic 7. Antenatal Clinics 8. Post Natal Care 9. Infants and Child Care including immunization with Vitamin A supplementation (support for the same

to be provided by the Government) 10. Diagnosis, Referral and Rehabilitation for Non-communicable diseases eg. Cardiac Diseases,

Hypertension, Diabetes, etc 11. Adolescent and Reproductive Health 12. Other Services like Treatment of Minor Injuries and Burns, Aseptic Dressing, TT immunization,

Treatment of Minor burns, Minor Suturing and removal – referral etc 13. Minor lab investigations 14. Eye examination 15. ENT examination 16. HIV testing 17. Promotion of contraceptive services including IUD insertion. 18. Prophylaxis and treatment of Anemia with IFA Tablets. 19. IEC and counseling along with preventive health screening and health awareness programs 20. Service related to different public health programmes. 21. Pathological services. 22. Radiology Services – X-ray and Ultra-sound 23. Preventive Health Screening and Health awareness programs 24. Medical camps will have to be conducted whenever emergency need be

Commissioning Period- 2 months from the date of contract signing Budget

Activities Total proposed budget (in Rs.) Projected cost for 1 MMU project at district level Rs.4.68 lakhs x38 units x 9 months

=16,00,56,000/- Total 16,00,56,000/-

4.14. Monitoring and Evaluation State Data Centre The State has One Data Centre which collects data from all PHCs, Sadar Hospitals & Sub. Div. Hospitals of all

districts on a daily basis through land line phones and mobile phones. The collected data are stored and

maintained in a computerised format and they are sent to respective programme officers according to their

requirements. The collected data includes all the parameters required under RCH/NRHM for monitoring. The

Data Centre has the following facilities:-

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(1) Computer Programmers- 2 (Two) (2) Supervisor- 2 (Two) (3) Computer Operators- 20 (Twenty) (4) Server with UPS - 1 (One) (5) Computers (including one server) with UPS - 22 (Twenty two) (6) Fax Machine with Auto Sending & Receiving Facility - 1 (One) (7) Laser Printers with Fax & Photo Copy Facility - 4 (Four) (8) Telephone connection (with Broadband connection) - 20 (Twenty) (9) Invertor - 1 (One) (10) Software - As Required (11) EPABX-Telephone Network System - 1 (One) (12) All necessary furniture’s - As Required District & Block Data Centres The Data Centers at each and every hospital (PHC, Sadar Hospital, Sub-Divisional Hospital etc.) are being

established through outsourcing. The main purpose of these Data Centers of Hospitals is to gather and maintain

health related data under RCH/NRHM programme in their computer system and they upload the gathered health

related data on the web-server of SHSB on daily basis. The Data Centers contain one computer with UPS, Laser

printer, Phone connection, Internet connection, Computer operator, Misc. etc.The GPRS enabled mobile sets

have been given to each and every data centers. The total no. of Data Centers to be established is 685 and the

estimated cost is Rs. 7500/- per Data Centre per month.

The District/Block Data Centres units would be as such:

ü Primary Health Centre (PHC): 533 ü Sub-Divisional Hospital (SCH): 43 (23+20 (new)) ü District Hospital: 38 (25+13 (new)) ü RDD: 09 ü District Health Society: 38 ü Medical Colleges & Hospitals: 24 (6 x 4) Total Data Centre: 685 Budget

Activities Total proposed budget (in Rs.) State Data Centre (monthly payment of the Data Centre is Rs. 175000/-, therefore, Rs.175000 x 12

Rs.2100000/-

District & Block Data Centres Rs. 7500/- x 12 x 685 Rs. 61650000/- Total 6,37,50,000/-

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4.15. Generic Drug Shop Under the PPP initiative Generic Drug Stores shall be set up at all MCHs, DHs and PHCs. The Private agency has to keep 188 types of drugs at the store. The state has provided only space for this purpose to the agency and the agency shares a % revenue share with the Government. The state has also fixed rates for the Generic Drug as per MRP. No additional cost is involved.

4.16. Nutrition Rehabilitation Centres (NRCs) for Treatment of Severe and Acute Malnutrition (SAM) Child malnutrition extracts a heavy toll on both human and economic development, accounting for more than 50 % of child deaths world wide. The consequences of malnutrition are serious leading to stunting, mental and physical retardation, weak immune defense and impaired development. More than one-third of worlds malnourished children live in India. In India, as revealed by the recent National Survey (NFHS-3, 2005-06), malnutrition burden in children under three years of age is 46 %. With the current population of India of 1100 million, it is expected that 2.6 million under-five would be suffering from severe and acute malnutrition which is the major killer of children under five years of age. It can be direct or indirect cause of child death by increasing the case fatality rate in children suffering from such common illnesses as diarrhea and pneumonia. The risk of death in these children is 5-20 times higher compared to well-nourished children. Severe and acute

malnutrition is defined by a very low weight for height, below -3 z∗ scores of the median WHO growth standards, presence of visible severe wasting’ or ‘bipedal Oedema’, or mid-upper arm circumference (MUAC) of <11 or 11.5 cm in children between 6-60 months. MALNUTRITION IN BIHAR: In Bihar, malnutrition is a serious concern with a high prevalence of 58.4 % as revealed by the National Health and Family welfare Survey (NFHS-3, 2005-06). Children suffering from severe and acute malnutrition are reported to be 8.33 %. Based on population figures, it is estimated that in Bihar, 2.5 million children under five years of age are threatened to face the consequences of severe malnutrition. With the situation of nutrition among children being far from satisfactory, it will not be surprising to find that these children who have already arrived in a poor state of nutritional status, with further deterioration are at a high risk of morbidity and mortality.

∗ A ‘z score’ is the number of standard deviation below or above the reference mean or median value.

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MEASURES TO MANAGE MALNUTRITION: While mild and moderate forms of malnutrition in the absence of any minor or major illness among children can be addressed through Anganwadi centres, by supporting mothers to ensure service utilization and appropriate feeding and care practices at the household level; the treatment of children with severe and acute malnutrition calls for facility-based treatment by admitting children to a health facility or a therapeutic feeding centre. This is mainly because these children generally are seen to suffer from acute respiratory infections, diarrhea and pneumonia. A decision was thus taken to set up Nutrition Rehabilitation Centers which is a unit for the management of SAM children where they are kept under observation and provided with medical and nutritional care. In additional to curative care, special focus is given on timely, adequate and appropriate feeding to children. Efforts are also made to build the capacity of mothers through counseling to identify the nutrition and health problems in their child. Initial discussions with UNICEF on establishment of NRCs in the 2007 flood affected districts, resulted to be extremely productive. It was thought worthwhile to pilot NRCs for treatment of children suffering from severe forms of malnutrition in 2 flood affected districts with support from UNICEF for supervision and monitoring of activities, especially in the initial period of management of NRCs. Thus the NRCs were established in the districts of Muzaffarpur and East Champaran during August-September 2007. The proposal includes the establishment cost and the running cost for the two piloted NRCs in the management of child malnutrition. Budget

Activities Total proposed budget (in Rs.) Running cost of two NRCs for one month = 2,05,600/- x 2 = 4,11,200/-, therefore for one year, 411200 x 12 months

49,34,400

Total 49,34,400/-

4.17. Hospital Maintenance (Funded by State Govt) The state has outsourced the maintenance of Hospitals to private agencies. The amount require for this purpose is borne by the state government. The activities include

• Maintenance of Hospital Premises.

• Generator Facility. • Cleanliness of Hospitals.

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• Washing • Diet.

4.18. Providing Ward Management Services in Government Hospitals It is proposed to provide Ward Management Services including Ward Boys for about 1900 health facilities in

Bihar like the 100, 300 and 500 bedded District Hospitals, 100 bedded Sub-Divisional Hospitals, 30 bedded

Referal and Primary Health Centres and 6 bedded Additional Primary Health Centers and also Govt. Medical

College Hospitals.

The task shall be done under PPP, wherein the agency shall be responsible for the following services-

• Providing one ward boy for 10 or less than 10 beds and at the rate of one boy per additional 10 beds. • Ensuring 7x24 hours services of Ward Boys. • Shall provide one wheel chair for 10 beds or less and @ one wheel stretch for additional 20 beds. • Deploying all Ward Boys in uniform dress bearing a unique identification no. with name. • Assisting the nurses in the detoxification unit. • Attending to the personal hygiene of bed-ridden patients. • Escorting the patients to labs, other specialists & wards. • Monitoring the visitors and checking patients for possession of drugs. • Conducting physical exercises for the patients. • Assisting in detoxification of toilets and ward etc. • Daily replacement of used bed-sheets by clean bed-sheets with proper care. • Any other task related to ward management prescribed by the authority.

Payment shall be made on a per bed per month for all the hospitals. In the FY 2009-10, it is to be piloted in 5 District Hospitals therefore initially fund is required as such -

Budget - @Rs.100/- x 2500 beds x 12 months=30.00 lakhs 4.19. Provision for HR Consultancy services SHSB has invited offers from Human Resource Consultancy Services for assisting State Health Society in selection and recruitment of doctors, nurses, paramedical staffs and other managerial and clerical staff under guidance and direction of State Health Society, Bihar. Responsibilities of the Human Resources Consultant: The Consultant will be required to prepare panel of names for selection for the post as per reservation roster. Applications would be invited through open advertisements. Selection process may include open written test or interview or marks obtained or combination of these processes in the qualifying examination depending upon the no. of applicants and urgency. The mode of selection to be adopted will be the sole discretion of the State Health Society.

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To achieve this objective, Human Resources Consultant shall be responsible for the following services:- • Will have to set up an office for this purpose. • Will be providing all office equipments and professional manpower for this purpose. SHSB shall

provide only space. • All works like processing, data entry, scrutiny, selection, panel formation as per reservation roaster

and recruitment etc. • Any other task related to Human Resources Consultancy Services prescribed by the authority.

Budget – Rs.22,50,000/- per year

4.20 Advanced Life Saving Ambulances SHSB is endeavoring to provide prompt quality pre hospital care to patients, trauma victims, pregnant women, for the purpose of which Emergency Network service is being piloted under PPP in Patna District. The objective is to save lives of Road Traffic Accidents, cardiac emergencies, fire victims and other emergency cases. Description There will be 5 Advance Life saving Ambulances (Trauma, Critical & Cardiac Care) & 5 Basic Life saving Ambulances which will run within Patna Municipal Corporation area and its sub urban areas. Every Ambulance shall be manned by a Driver, an Emergency Medical Technician and trained Helper to provide basic care during transportation of patients.). For each trip made by the Ambulance to anywhere within the limits of Patna Municipal Corporation and its sub-urban areas, a charge of Rs. 300/- shall be collected by the outsourced agency from the patients. The agency has to set up a Control Room in Patna which would operate for 24 hours in a minimum of 3000 sq. ft. area through dedicated toll free three digit telephone numbers (102). The agency has to provide 10 parallel lines with hunting facilities. The Control Room will receive emergency calls related to Medical Services and from Police and Fire Fighting Services to cater to Medical Emergencies. The agency shall provide GIS (Geographic Information System) maps, GPS (Global positioning systems) / AVLT (Automatic Vehicle Location Track) and all the other necessary hardware/software for Computer Telephonic Integration. The agency shall keep a record of the contact numbers and location of each of the 10 Ambulances, all Hospitals of city which can provide medical emergency, all the Police Stations, Police Control Room, Police Head-quarters and Fire Services in the city. The agency shall bear all expenses relating to hire of space, water, electricity charges, furniture, furnishing etc in running the Control Room. The Control Room shall also keep battery / generator backup facility so that services could be provided un-interrupted round the clock. Support activities- The agency has to also undertake the following-listing of Govt and private hospitals which can provide emergency services round the clock. Necessary training of hospital personnel to take up Emergency cases. Dissemination of the scheme and the toll free numbers for police, fire, health, education and general public so that this service can be utilized. Budget-

Items Amount (Cost/month) Cost of Emergency service network in Patna (annual cost for running 10 ambulances)

989000.00 x 9= 8901000

Total 89,01,000 IEC of the project, dissemination, monitoring and training

25 lakhs being provisioned in IEC, Training (Part A budget)

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7. Mobilisation and Management Support for Disaster Management In Bihar, the northern part is extremely flood prone. Due to the confluence of many rivers as well as its

proximity to the hills of Nepal, the population living in about twenty two districts in Bihar suffers from floods

every year. In the year 2007, the floods have been among the most devastating in decades. East Champaran,

Darbhanga and Madhubani districts of Bihar, have been affected by floods most of the years and face floods

almost every year, only the extent and the intensity vary. In 2007 however, over 24 million people in some

8,500 villages in 22 districts in Bihar (including 2.5 million children below 5 years) were affected by floods. As

per the department of disaster management, over 800 people lost their lives. The most affected districts are

Muzaffarpur, Sitamarhi, East Champaran, Saharsa, Supaul, Madhubani, Darbhanga, Katihar, Samastipur,

Sheohar, Khagaria, Madhepura, Araria, Begusarai, Gopalganj and West Champaran. There is a need to

strengthen local capacities and develop the community potential to tackle the flood moving towards early

recovery. There are essentially two types of the vulnerable affected in need of immediate assistance: a) those

who are displaced; b) those who are in original locations but cut off.

In year 2008, the floods were mainly due to the rivers, in Kosi region, changing their course, which was an

outcome of a major breach in the eastern embankment of Kosi River in Kusha (Indo-Nepal) border in mid-

August 2008. The Department of Disaster Management, Bihar has estimated that 2.95 million people across 979

villages are facing the perils of present floods in the five districts-Araria, Supaul, Saharsa, Madhepura and

Purnea. About 1.18 lakh are expected to be the vulnerable segment of pregnant and nursing women and about

4.4 lakhs are likely to be children less than 5 years of age.

Preparedness is the best response: Global and National experience in disaster situations indicates that

immediate and appropriate response mitigates the agony of affected population. In flood related disaster, due to

several factors, such as, the timing of flooding, the magnitude of floods, large number of people affected, scope

of displacement, and low awareness among the affected on the health hazards, there has been an acute risk of

outbreaks of water borne and vector borne diseases, such as gastroenteritis, malaria, dengue fever, leptospirosis

and diarrhoea in the flood affected areas. Children under five, pregnant mothers, elderly and patients are at the

highest risk of becoming victims to epidemics. Another factor which increases vulnerability is the socio-

economic profile of the affected. A large majority of them belong to socially marginalized communities who are

poor as well. Providing clean potable water, protecting the area from epidemics, Safe delivery options for the

pregnant mothers, rehydrating the diarrhea affected people of all age groups with ORS, immunizing children

from 6 months-10 years in the affected area with measles vaccine, essential treatment for the sick etc are some

of the absolute priorities for the health personnel during a disaster.

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To protect the health of the affected population based on the past experience, it is proposed to preposition

certain important health response supplies during the current year at State level. These supplies can be sent to

the affected populace at the earliest to provide relief. The calculations are being done assuming the affected

population to be 20 million and based on last year’s initiatives and expenditure by the state-

With the experiences of the last year the state would like to propose a revolving fund for the preparedness and

relief for the flood affected people in the State:

Budget:

Activity Unit Rate Amount ( In Rs )

Setting up of State Health Disaster Management Cell in Health Department, GoB

1 58,750 x 12 months

7,05,000

Mobilizing medical teams from Non flooded districts for one week

50 25900 ( a team of two Doctors

and two paramedics for

7 days)

12,95,000

Transportation ,Mobility & Monitoring – state & district level for 16 districts

Rs.5.00 lakhs per district

8000000

Total 1,00,00,000/- 8. Health Management Information System (1) Web Server System

The State Health Society has established one web-server with 512 kbps leased-line connection for on-line

uploading and reporting of Health related data through web-server application of State Health Society, Bihar.

The following system shall be introduced in parallel to the existing system of Data centers:

1. Online uploading of Health related data directly from Data Centers of PHC/Hospitals.

2. Compilation and reporting of Health related data through developed application software in very less

time.

3. The reports will be more accurate and consistent.

4. The DM/CS/DHS can view the different reports of Health services of their own district in on-line

mode, therefore proper action can be taken quickly.

5. The officers/staff of state level can view the reports of Health services of all districts in online mode,

therefore proper action can be taken promptly.

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6. According to requirement, any new report can be added and the information can be obtained from

PHC/Hospitals in online mode quickly.

7. More security and safety of Health related database.

Therefore further up-gradation and maintenance of web-server are required in coming financial year like

blade server (more storage capacity and very high speed processing), maintenance support of web-server

etc.

The website for all 38 districts are also required to be designed, created and maintained along with the

renovation of website of State Health Society, Bihar.

Budget S. No Items Amount (Rs.) 1 Leased Line(512 KBPS) Rs. 287642/- 2 Up gradation of Leased Line - (1MBPS) Rs. 200000/- 3 Antivirus (No. of antivirus-3) Rs. 15000/-(Rs. 5000 x 3) 4 Web-site: (Design, Creation, Maintenance, Registration,

Hosting of state and all 38 districts) Rs. 500000/-

5 Blade Server(One Blade) Rs.300000/- 6 One Additional Blade Rs.135000/- 7 Maintenance Rs. 50000/- 8 Software development Rs. 500000/-

Total Rs. 19,87,644/- (2) HMIS Reports

As we know that NRHM aims to continuously improve and refine its strategies based on the inputs and

feedback received from the State and from various review missions. One of our priorities is to build a robust

Health Management Information System (HMIS) that is used for improving, planning and programme

implementation at all levels. NRHM has introduced Revised HMIS formats and they are as follows:

SN Form No. Form Name Used at Frequency

1 NRHM/HSC/3/M Monthly format for SC’s and equivalent facilities HSC Monthly (5th of

following month)

2 NRHM/PSC/3/M Monthly format for PHC’s and equivalent facilities PSC Monthly (5th of

following month)

3 NRHM/CSC/3/M Monthly format for CHC’s and equivalent facilities CSC Monthly (5th of

following month)

4 NRHM/SDH/3/M Monthly format for SDH and equivalent hospitals SDH Monthly (5th of

following month)

5 NRHM/DH/3/M Monthly format for DH and equivalent hospitals DH Monthly (5th of

following month)

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6 NRHM/DHQ/3/M Monthly format for District DHQ Monthly (10th of following month)

7 NRHM/DHQ/2/Q Quarterly format for District DHQ Quarterly (10th) 8 NRHM/DHQ/1/A Annual format for District DHQ Annual (5th) 9 NRHM/SG/2/Q Quarterly format for State HQ State HQ Quarterly (20th) 10 NRHM/SG/1/A Annual format for State HQ State HQ Annual (15th April)

11 NRHM/GOI/3/M Monthly Consolidated State HQ/DHQ Monthly (20th of following month)

12 NRHM/GOI/2/M Quarterly Consolidated State HQ/DHQ Quarterly (20th of following month)

13 NRHM/GOI/1/A Annual Consolidated State HQ/DHQ Annual (30th April) It is required to implement the Revised HMIS formats up to sub-center level. (A) Printing of Formats

Sl.No.

Form No. No. of Pages/ Format

Total No. of Pages used at one Health

Institution

Total No. of Health Institution

Total No. of Pages used at

all Institution/Yr

Details

1 NRHM/HSC/3/M 4 48(12x4) 11964 574272 11964x48

2 NRHM/PHC/3/M 6 72(12x6) 1905 137160 1905x72

3 NRHM/CHC/3/M 7 84(12x7) 533 44772 533x84

4 NRHM/SDH/3/M 7 84(12x7) 43 3612 43x84

5 NRHM/DH/3/M 7 84(12x7) 38 3192 38x84

6 NRHM/DHQ/3/M 1 12(12x1) 38 456 38x12

7 NRHM/DHQ/2/Q 2 8(4x2) 38 304 38x8

8 NRHM/DHQ/1/A 2 2(1x2) 38 76 38x2

9 NRHM/SG/2/Q 1 4(4x1) 1 4 1x4

10 NRHM/SG/1/A 3 3(1x3) 1 3 1x3

11 NRHM/GoI/3/M 6 72(12x6) 38 2736 38x72

12 NRHM/GoI/2/Q 2 8(4x2) 38 304 38x8

13 NRHM/GoI/1/A 7 7(1x7) 38 266 38x7

Total 767157

Surplus No. of Forms (including wastage and others-10%) 76716

Grand Total of Pages- 843873 Total Printing Cost ( @ Rs. 1.00 per page) Rs. 843873/- B: Transportation of Formats

No. of pages sent per district= 843873/38 = 22207(approx.)

Transportation Costs per district=Rs. 1000

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Total Transportation Cost for all 38 districts=38xRs.1000= Rs. 38000/-

C: Training At Block Level (PHCs, District Hospitals, Sub-Divisional Hospitals) Training on Revised HMIS formats at District Level has been completed, so Training on Revised HMIS Formats at Block Level (i.e. PHC, District Hospital and Sub-Divisional Hospital levels) has to be performed. Therefore it is required to train the followings :- ü Deputy superintendent of District & Sub-Divisional Hospitals ü MOIC of PHCs ü BHM ü BAM The training has to be performed to improve the quality of data. So the master trainer of each and every district will train Deputy Superintendent, MOIC, BHM and BAM in their respective district. Hence Fund require for giving TA/DA to all trainees and for training materials, stationeries and other cost. The TA/DA given to trainees is Rs. 200/- per trainee (Only one time) and miscellaneous cost is Rs. 50/- per trainee (Only one time) Therefore budget calculation is as follows:- (a) Total no. of trainees = 1680 The details are as follows:- SN Designation Number 1 Deputy superintendent of District

Hospital 38 (25+13 (new))

2 Deputy superintendent of Sub-Divisional Hospital

43 (23+20 (new))

3 MOIC of PHC 533 4 BHM 533 5 BAM 533 Total 1680 Budget S. No Items Amount (Rs.) 1 Web Server System 19,87,644/- 2 HMIS Reports

A Printing of Formats 8,81,873 B Transportation of Formats C Training of Formats at Block level (TA/DA Cost = Rs. 200/-

per trainee (only one time) x 1680= Rs. 336000/- + Misc. cost = Rs. 50/- per trainee (one time) 50 x 1680=84000/-)

4,20,000

Total 32,89,517/-

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9. Strengthening of Cold Chain Effective cold chain maintenance is the key to ensuring proper availability and potency of vaccines at all levels.

However the recently concluded Vaccine Management assessment (VMAT) in Bihar in 2008 and the National

Cold chain assessment (July 2008) observed several deficiencies in cold chain storage and management in

Bihar.

With a steadily increasing immunization coverage for Routine Immunization, rise in demand for Immunization

services throughout the state, the consumption of large quantities of vaccines in frequent Supplementary

Immunization activities and the possibility of introduction of newer vaccines in the near future, it is necessary

that the capacity of existing cold chain stores as well as the proper management of immunization related

logistics be strengthened on a urgent basis.

For this there is need for refurbishment of existing cold chain stores at all levels, particularly at the level of the

larger state, 9 regional and 38 district stores. Often there is lack of storage space in the existing health stores

leading to dumping of critical immunization related logistics like AD syringes, vaccine carriers and cold boxes

in the open, exposing them to the vagaries of nature and sometimes leading to their damage. Renovation of

existing stores would help in creating more organized dry space for both proper storage of material as well as

proper loading, packing and unloading of Immunization related logistics. The state store in particular receives

large quantities of materials and a separate ware house is needed to store immunization related logistics.

Provision to hire storage space on arrival of large quantities of material should also exist. In all stores across the

state there is also a need for proper electrification and wiring to ensure longevity of electrical cold chain

equipment and for reducing their frequent breakdown.

The lack of dedicated support manpower for immunization logistics management and for cold chain equipment

repair at all levels was observed during the aforesaid cold chain assessments and it was recommended that “At

each of these facilities there should be a full time dedicated store manager. Where the load of operations is high

(SVS and RVS) the store manager should have adequate support staff to help him.” (VMAT Bihar 2008) The

National cold chain assessment also recommended that a there should be a cold chain technician along with a

cold chain handler at all district stores and a cold chain handler at all PHCs. Since provision of regular staff in

these positions is not possible it is envisaged that contractual persons be hired for these activities.

Budget

9.1 Infrastructure Strengthening for Cold Chain

Items Units Amount

Refurbishment and integration of existing Warehouse facilities for R.I. as well as provision for hiring external storage space for (during Immunization Campaigns) Logistics at State HQ @Rs 15,00,000/-

1 1500000

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Refurbishment of existing Cold chain room for district stores in all districts with proper electrification,Earthing for electrical cold chain equipment and shelves and dry space for non elecrtical cold chain equipment and logistics @Rs 7 Lakhs per district

38 26600000

Earthing and wiring of existing Cold chain rooms in all PHCs @Rs 10000/- per PHC 533 5330000

Total 572 3,34,30,000

12. Mainstreaming AYUSH under NRHM The Indian systems of medicine have age old acceptance in the communities in India and in most places they

form the first line of treatment in case of common ailments. Of these, Ayurveda is the most ancient medical

system with an impressive record of safety and efficacy.

Other components such as Yoga, Naturopathy are being practised by the young and old alike, to promote good

health. Now days, practice of Yoga has become a part of every day life. It has aroused a world wide awakening

among the people, which plays an important role in prevention and mitigation of diseases. Practice of Yoga

prevents psychosomatic disorders and improves an individual’s resistance and ability to endure stressful

situation.

Ayurveda, Yoga, Unani, Siddha and Homoeopathy (AYUSH) are rationally recognised systems of medicine

and have been integrated into the national health delivery system. India enjoys the distinction of having the

largest network of traditional health care, which are fully functional with a network of registered practitioners,

research institutions and licensed pharmacies. The NRHM seeks to revitalize local health traditions and

mainstream AYUSH (including manpower and drugs), to strengthen the Public Health System at all levels. It is

decided that AYUSH medications shall be included in the drug kit of ASHA, The additional supply of generic

drugs for common ailments at SC/PHC/CHC levels under the Mission shall also include AYUSH formulations.

At the CHC level two rooms shall be provided for AYUSH practitioner and pharmacist under the Indian Public

Health Standards (IPHS) model. At the same time, it has been decided to place or provision one Ayush doctor

on contract at the APHCs for the purpose and to ensure complete coverage of the population.

Activities Improving the availability of AYUSH treatment faculties and integrating it with the existing Health Care Service. Strategies Ø Integrate and mainstream ISM &H in health care delivery system including National Programmes. Ø Encourage and facilitate in setting up of Ayush wings-cum-specialty centres and ISM clinics. Ø Facilitate and Strengthen Quality Control Laboratory.

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Ø Strengthening the Drug Standardization and Research Activities on AYUSH. Ø Develop Advocacy for AYUSH. Ø Establish Sectoral linkages for AYUSH activities Delivery System

1. Integration of AYUSH services in 1234 APHC with appointment of contractual AYUSH Doctors. 2. Appointment of paramedics where AYUSH Doctors shall be posted. 3. Strengthening of AYUSH Dispensaries with provision of storage equipments. 5. Making provision for AYUSH Drugs at all levels. 6. Establishment of specialized therapy centers/yush wings in District Head Quarter Hospitals & Medical

Colleges. 7. AYUSH doctors to be involved in all National Health Care programmes, especially in the priority areas

like IMR, MMR, JSY, Control of Malaria, Filaria, and other communicable diseases etc. 8. Training of AYUSH doctors in Primary Health Care and NDCP. 9. All AYUSH institutions will be strengthened with necessary infrastructure like building, equipment,

manpower etc. 10. Yoga trainings were held in various District hospitls to provide Yogic therapy for specific diseases and

also as a synergistic therapy to all other systems of treatment. Integration of AYUSH with ASHA 1. Training module for ASHAs and ANMs has to be updated to incorporate information of AYUSH. 2. Training & capacity building to be undertaken by the Director, SIHFW and necessary training material

for the purpose to be modified and provided accordingly. 3. Drug kit that will be provided to ASHA contains one AYUSH preparation in the form of iron

supplement. But other drugs which are used in the treatment of common diseases control of communicable diseases as well as drugs promoting the maternal and child health as well as improving quality of life could be included subsequently.

Drug Management 1. Provision of supply drugs per AYUSH dispensary has been projected as per NRHM norm. 3. Provision of medicines for District AYUSH wings and Specialty Therapy Centres is proposed to be

operated in the State. Special Initiatives for Mainstreaming and Strengthening of Ayush (a) Ayush department in Bihar contain 3 units known as Ayurvedic Unani and Homeopathic. Government of Bihar running individual dispensary in rural area and a district level joint dispensary of each 3 units (Ayurvedic, Unani and Homeopathic).

Following details of rural and district dispensary is given with their required fund far medicine, machines and miscellaneous expenditures.

Sl. No.

Dispensaries No. of dispensa

ries

Medicine Machines & equipments

For miscellaneous expenditure

1. District Joint Hospitals (i) Ayurvedic

26 25,000x26=6,50,000 25,000x26=6,50,000 10,000x26=2,60,000

(ii) Unani 26 25,000x26=6,50,000 2,50,00x26=6,50,000 10,000x26=2,60,000 (iii) Homeopathic 26 25,000x26=6,50,000 25,000x26=6,50,000 10,000x26=2,60,000

2. Rural Dispensaries (i) Ayurvedic

69 25,000x69=17,25,000 25,000x69=17,25,000 5,000x25=3,45,000

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(ii) Unani 30 25,000x30=7,50,000 25,000x30=7,50,000 5,000x30=1,50,000 (iii) Homeopathic 29 25,000x29=7,25,000 25,000x29=7,25,000 5,000x29=1,45,000

Total 206 51,50,000.00 51,50,000.00 14,20,000.00 (b) Ayush Units are also functioning in additional primary health centre in general health services. The

details of the APHC (Ayush) and their required medicines, machine and equipments and other expenses are given as follows:-

Sl. No.

Dispensaries No. of dispensari

es

Medicine Machines & equipments

For miscellaneous expenditure

1. APHC(Ayush) (i) Ayurvedic

263 25,000x263=65,75,000 25,000x263=65,75,000 10,000x263=26,30,000

(ii)Unani 77 25,000x77=19,25,000 25,000x77=19,25,000 10,000x77=7,70,000 (iii) Homeopathic

59 25,000x59=1,47,5000 25,000x59=1,47,5000 10,000x59=5,90,000

Total 399 99,75,000.00 99,75,000.00 39,90,000.00 (c) Ayush treatment facility is required to attach with Allopathic hospitals. For this purpose in each 15 Sadar Hospital is proposed to open Ayush system of treatment with OPD and IPD of 3 system of medicine, (Ayurvedic, Unani and Homeopathic).

The following provision is given as follows:-

(i) Contraction and Renovation- 10,00,000.00 (ii) Machines and Equipments- 1,50,0000.00 (iii) Medicine and Diet- 7,00,000.00 (iv) Training of Paramedical staffs- 1,00,000.00 (v) One time miscellaneous expenditure- 2,00,000.00

Total 35,00,000.00 Total required for 15 Sadar Hospitals and 3 units of each (Ayurvedic, Unani & Homeopathic)- 35,00,000 x3 x16=16,80,00,000.00 (d) Strengthening the Quality Control Laboratory

The quantum of Ayurvedic and Homoeopathic medicines used / procured in both public and private health sectors is huge. There has been wide ranging concern about spurious, counterfeit and sub standard drugs. In order to prevent the spread of sub standard drugs and to ensure that the drugs manufactured or sold or distributed throughout the state are of standard quality, drug regulation and enforcement unit has to be established in the state. The drug regulatory mechanism to be strengthened at the state level to improve the quality of drugs used in AYUSH and ensure proper standardization.

(e). Strengthening the Drug Standardisation and Research Activities on AYUSH Standardisation- As

research is an important activity in the process of development of a drug used for preventive and curative purpose, it has been found that the major drawback in the development of AYUSH is lack of research and development activity on the drugs used for the System. It is estimated that there are 10,000/- plant species found all over the world having medicinal properties. The following activities will be undertaken to strengthen the drug standardisation and research activities on AYUSH:

1. It has been proposed to evaluate the chemical, pharmacological and clinical efficacy of the plant drugs. 2. The phytochemical entities responsible for the therapeutic activity of the plant drugs used in AYUSH

system will be evaluated through intensive R & D activity.

186

3. The pharmacologically viable drugs will be screened clinically under WHO guideline to establish the therapeutic activity.

4. Clinical trial on different diseases like Psoriasis, Liver disorders, Diabetics, Asthma will be conducted to establish the effect of various drugs used for such diseases.

5. It has also been proposed to conduct literary research like translation of manuscripts and its publications.

6. Re-vitalisation of the local health traditions and the knowledge of traditional drugs used by experienced local health traditioners will be gathered and documented.

(f) . Strengthening of the State and District Management System of AYUSH

1. It is proposed to create necessary Managerial post in the State and District level for effective supervision and implementation of different activities.

2. Necessary vehicles with supporting manpower has also been proposed to strengthen the supervisory 3. Joint monitoring visits to health centres to be undertaken by both AYUSH and Health Care Officials at

the District level’s/State level. BUDGET

AYUSH - Part A Requirement of the funds from NRHM – 1. Ayurvedic, Unani and Homeopathic dispensaries-

(i) Provision of 1 Ayush doctor at each APHC on contract @ Rs.20,000/- x 1243 APHC x 9 months 22,37,40,000.00 (ii) Salary of Paramedics 4,36,29,300.00 @ 3900 x 1243 x 9 months (iii) Salary of Pharmacists 7,27,15,500.00 @6500 x 1243 x 9 months

2. Training of Ayush Doctors & Paramedical staffs w.r.t Ayush wing-4,15,00,000.00 3. IEC 1,00,00,000.00

Grand Total (A) 39,15,84,800.00

AYUSH Part B I. Requirement of the funds from the Ayush Departments for Ayush Dispensaries

1. For Ayush dispensaries & additional PHCs already existing

(i) For Medicine- 1,51,25,000.00 (ii) Machine and equipments- 1,51,25,000.00 (iii) Other Miscellaneous- 48,10,000.00 Sub-Total 3,50,60,000.00

2.New Ayush OPD and IPD in 15 Sadar Hospital 13,65,00,000.00

Total II – Rs. 171560000/-

II. Requirement of the funds from the Ayush Departments to uplift Ayush Medical Education for Government Ayush Medical Colleges 1. Government TIBI College & Hospital (Unani), Patna

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Rs. in Crores (i) Building construction- 6.40/- (ii) Machine and equipments- 1.00/- (iii)Quality Testing Lab- 1.00/- (iv) Pharmacy- 1.00/- (v) Herbal Gardian - .20/- (vi) Medicine and Diet- 0.050/- Sub-total 9.65/-

2. Government RBTS Homeopathic Medical College, Muzaffarpur Rs. in Crores

(i) Building construction- 0.35/- (ii) Machine and equipments- 0.20/- (iii)Quality Testing Lab- 1.00/- (iv) Pharmacy- 1.00/- (v) Medicine and Diet- 0.02/- Sub-total 2.57/-

3. Government Ayurvedic College, Begusarai Rs. in Crores

(i) Building construction- 3.00/- (ii) Machine and equipments- 1.00/- (iii) Medicine and Diet- 0.02/- Sub-total 4.02/-

4. Government Ayurvedic College Hospital, Patna Rs. in Crores

(i) Building construction- 2.668/- (ii) Machine and equipments- 9.70/- (iii)Renovation and Beutification- 1.634/- (iv) Medicine and Diet- 0.50/- Sub-total 14.502/-

5. Government Ayurvedic College, Patna Rs. in Crores

(i) Building construction- 3.00/- (ii) Machine and equipments- 6.75/- (iii) Quality Testing Lab- 0.80/- (iv) Herbal Gardan- 0.20/- (v) Animal House- 0.05/- Sub-total 10.80/-

Total II – Rs.415420000

Grant total required for teaching institutions and dispensaries (I + II)- 171560000 + 415420000 = Rs.58,69,80,000/-

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Summary Budget of NRHM Part B

Sl. No. Budget Head Modified

Budget

Available under

2008-09 %

1 2 6 1 Decentralization

1.11 ASHA Support System at State Level 40650750 1.12 ASHA Support System at District Level 2160000 1.13 ASHA Support System at Block Level 79950000 1.14 ASHA Support System at Village Level 4500000 1.15 ASHA Trainings 86895000 1715.00 1.16 ASHA Drug Kit & Replenishment 22555800

1.17 Emergency Services of ASHA 6600000 1.18 Motivation of ASHA 63172875 1.19 Capacity Building/Academic Support programme 1000000 1.2 ASHA Divas 81230200

Total ASHA 388714625 1.21 Untied Fund for Health Sub Center, Additional Primary Health Center

and Primary Health Center 134807000

1.22 Village Health and Sanitation Committee 352102500 1000.00 1.23 Rogi Kalyan Samiti 85300000

Total Decentralization 960924125 22.06 2 Infrastructure Strengthening

2.1 Construction of HSCs (100 no. x Rs.9.50 lakhs) 95000000 2.2 Construction of PHCs 637967000 2.2a Construction of residential quarters of 200 old APHCs for staff nurses 600000000

2.2b Construction of building of 51 APHCs where land is available 37967000

2.3 Up gradation of CHCs as per IPHS standards (100 CHCs x Rs.40.00 lakhs)

400000000 8040.00

2.4 Infrastructure and service improvement as per IPHS in 20 (DH & SDH) hospitals for accreditation or ISO : 9000 certification

130000000

2.5 Upgradation of ANM Training Schools 10000000 600.00 2.6 Annual Maintenance Grant 82080000

Total Infrastructure strengthening 1355047000 31.10 3 Contractual Manpower

3.1 Contractual Salaries, Incentives and Bonus (PHC doctors and staffs, contractual staff nurses, ANM ®, mobile services)

676702000

3.1a Incentive for PHC doctors & staffs @ Rs. 50,000 for better performance in implementing programmes (Rs. 50,000/ - per PHC per year)

12500000

3.1b Salaries for contractual Staff Nurses (2900 existing and 910 new) (Rs.7500 343900000

189

per month)

3.1c Contract Salaries for ANMsRs.6000 per month x 3500 (12 Months Consolidated Salaries for Contractual ANMs)

252000000

3.1d Mobile facility for all health functionaries (District officials, PHC in charge, CDPOs and ANMs @ 500 per month)

60000000

3.2 Block Programme Management Unit 289524000 3.3 Addl. Manpower for SHSB 6204288 3.4 Addl. Manpower for NRHM 25479000

Total Contractual Manpower 997909288 22.90

4 PPP Initiatives 4.1 102-Ambulance service 4032000 4.2 1911- Doctor on Call & Samadhan 816000 4.3 Addl. PHC management by NGOs 39864000 4.4 American Association of Physicians of Indian Origin (AAPIO) 5600000 4.5 SHRC (HOSMAC) 138.44 4.6 Services of Hospital Waste Treatment and Disposal in all Government

Health facilities up to PHC in Bihar (IMEP) 947.16

4.7 Dialysis unit in various Government Hospitals of Bihar 300.00

4.8 Setting Up of Ultra-Modern Diagnostic Centers in Regional Diagnostic Centers (RDCs) and all Government Medical College Hospitals of Bihar

36000000

4.9 Providing Telemedicine Services in Government Health Facilities 300.00

4. 10 Outsourcing of Pathology and Radiology Services from PHCs to DHs 3000000 4.11 Operationalising MMU (38 units x Rs.4.68 lakhs x 9 months) 160056000

4.14 Monitoring and Evaluation (State, District, Block Data Centre) 63750000 4.15 Generic Drug Shop No

Funds required

4.16 Nutritional Rehabilitation Centre 4934400 4.17 Hospital Maintenance 4.18 Providing Ward Management Services in Government Hospitals 3000000 4.19 Provision for HR Consultancy services 2250000 4.2 Advanced Life Saving Ambulance (Rs.9,98,000/- x 9 months) 8901000

Total PPP Initiatives 332203400 7.62 5 Procurement of Supplies

5.1 Delivery kits at the HSC/ANM/ASHA (no.200000 x Rs.25/-) 50,00,000 5.2 SBA Drug kits with SBA-ANMs/Nurses etc (no.50000 x Rs.245/-) 12250000 5.3 Availability of Sanitary Napkins at Govt. Health Facilities

@25000/district/year 950000

5.4 Procurement of beds for PHCs to DHs 70286000 Total Procurement of Supplies 83486000 1.92 6 Procurement of Drugs

6.1 Cost of IFA for Pregnant & Lactating mothers (Details annexed) 50153000 6.2 Cost of IFA for (1-5) years children (Details annexed) 40923000

190

6.3 Cost of IFA for adolescent girls (Details annexed) 63750000 Total Procurement of Drugs 154826000 3.55 7 Mobilisation & Management support for Disaster Management 10000000 0.23 8 Health Management Information System 3289517 0.08 9 Strengthening of Cold Chain (Infrastructure strengthening) 33430000 0.77

Refurbishment of existing Warehouse for R.I. as well as provision for hiring external storage space for (during Immunization Campaigns) Logistics at State HQ @Rs 1500000/-

1500000

Refurbishment of existing Cold chain room for district stores in all districts with proper electrification,Earthing for electrical cold chain equipment and shelves and dry space for non elecrtical cold chain equipment and logistics @Rs 7 Lakhs per district x 38 districts

26600000

Earthing and wiring of existing Cold chain rooms in all PHCs @Rs 10000/- per PHC x 533 PHCs

5330000

10 POL of Generators for cold chain @ Rs. 600 per day per WIC. Rs. 500 per day per district and Rs. 400 per day per PHC

30000000 0.69

11 Preparation of Action Plan 4100000 0.09 11.1 Preparation of District Health Action Plan (Rs.1 lakh per district x 38) 3800000 11.2 Preparation of State Health Action Plan @ 3 lakhs 300000 12 Mainstreaming Ayush under NRHM 391,584,800 8.99

Total 4,356,800,130 100.00

191

PART- C

Routine Immunization

2009-2010

192

Progress of Routine Immunization in Bihar: The aim is to immunize all the children and pregnant mothers under Universal Immunization

Programme, in order to reduce IMR, MMR and NMR through routine immunization of all

children and mothers from six vaccine preventable disease in the state. The State of Bihar

has shown excellent Progress over the Years as shown in the Graphs below.

Evaluated % of Fully Immunized Child in Bihar

11 11.618.6

32.838

52

42

0

10

20

30

40

50

60

70

80

90

100

NFHS 2 1998-99

CES 2002 CES 2005 NFHS 3 2005-06

CES 2006-07DLHS,2008/09 Survey ByFRDS ***

*** Ongoing Immunization Survey being carried out by SHSB outsourced to FRDS(Formative Research & Development Services) in the 1st quarter of 2008 (completed in 10 randomly selected districts). In the next quarter another 10 districts are being taken.

Data source- NHFS & CES

Average % of Annual Increase/Decrease in full Immunization fromNFHS-II to NFHS –III

(a comparison among some of the states along with Bihar)

-1.81 -1.71

-1.14-0.71 -0.63

1.31

2.09

2.93 3.03

-3

-2

-1

0

1

2

3

4

AndhraPradesh

Punjab TamilNadu

Karnataka Kerala Rajasthan Assam WestBangal

Bihar

Data source –NFHS

193

Antigenwise Reported % of Cumulative Coverage – Bihar (Jan 07 – Dec 07)

Some of the initiatives for increasing Immunization-coverage is given below.

Ø Micro-plans have been prepared for each District to ensure full coverage.

Ø Vaccines & Auto-Disposable (AD) Syringes provided free of cost to all beneficiaries.

Ø Alternate System of Vaccine Delivery has been put in place for delivery of Vaccines at Immunization sites (@ Rs 50/- per session site).

Ø Support is being provided for POL to PHCs/Districts/WICs/WIFs for maintenance of Cold Chain on a daily basis.

Ø Mobility support is given to all the Diistricts and all DIO`s for Supervision of R.I .in the field.

Ø Alternate Vaccinators are hired @1400/- per month where ever there is a shortage in the Districts.

Ø All the Electrical Cold-chain Equipment in the Field are Under Annual Maintenance Contract, which is out-sourced by the State Health Society.

Ø Generator are also out-sourced in all the PHC for un-Interrupted Power Supply to all the PHCs /ILR Points.

Ø Fund has been provided for the Construction of Safety-Pits in every Block-PHC for the safe disposal of AD-Syringes.

Ø All the H.W. (ANM) is being trained based on the Health Workers Immunization Module in phases for Improving Immunization all across the State.

Ø Special Post Flood catch –up Immunization Campaign in the Five Most Flood Affected Districts of Bihar has been conducted following the massive floods.

194

No. of R.I. Session Site Monitored

4891

11031

18579

38304

0

5000

10000

15000

20000

25000

30000

35000

40000

45000

2005 2006 2007 2008

Muskan…Ek Abhiyan It has been decided by the Government of Bihar to attain 100% immunization of infants and

pregnant women, for which tracking of pregnant women and infants are being undertaken

through Muskan…Ek Abhiyaan .

Objective:

Ø To achieve 100% immunization of Infants and Pregnant Women

Muskan … Operational Strategy

Ø Convergence with ICDS and Health for our-reach-service delivery. Ø For Routine Immunization Aaganwadi Centers are acting as the “service

delivery unit” as well as Headquarters for AWWs and ASHAs

Ø For 8 – 10 AWWs , ANM are designated as ‘Team Leader’

195

Components:

Ø Tracking of all Pregnant Women and Newborns. Ø House-to-house survey. Ø Registration of all Pregnant Women and Children from 0 – 2 yrs age group Ø Immunization sessions at Anganwadi Centers on each Friday.

Ø Field Verification in the form of Supportive Supervision by both MO`s & CDPO`s are also planned under Muskan to Improve Immunization coverage in the Blocks Ø Due List register to Track and Identify Due Beneficiaries for every RI-Session.

Ø ‘Mahila Mandal’ Meetings in the AWC to improve Health & Nutrition, in the Village.

Percentage of Sessions Held Vs Planned

91 93 92 91

0102030405060708090

100

2005 2006 2007 2008

196

% Presence of ANM / AWW / ASHA at Session Sites

91

6254

0

94

6857

14

96

82

52 55

9588

7564

0102030405060708090

100

ANM Presence MobilizerPresence

ICDSPresence

ASHAPresence

2005 2006 2007 2008

* Note : Year 2005 - Aug’2005 to Dec’2005 (5 months) : N - 4891Year 2006 - Jan’2006 to Dec’2006 (12 months) : N - 11031Year 2007 - Jan’2007 to Dec’2007 (12 months) : N - 18579 Year 2008 - Jan’2008 to Nov’2008 (11 months) : N - 38304

Catch –up round for Immunization, Health and Nutrition improvement Of children and pregnant women In Flood Affected districts in Bihar Oct 2008 Background and Objective. Following a breach in the river embankment at Kusha in Nepal On 18th August 2008, river Kosi had changed its course and shifted over120 km eastwards. As a result, large areas of Supaul, Madhepura, Purnea, Saharsa and Araria in Bihar were inundated. For over two months normal activity was disrupted and access to many areas impossible. However, with waters slowly receding and with the advent of normalcy the Department of Health, Government of Bihar, launched a post flood health and nutrition Catch up Round from October 20th-27th, 2008, in the five flood-affected districts of Bihar. The round aimed at providing appropriate focused interventions for health and nutrition to vulnerable populations such as expecting mothers and children previously displaced or living in hitherto inaccessible areas and at catching-up and thereafter restoring routine health services like immunization throughout the flood-affected districts. Interventions: The interventions identified for delivery during the round were as follows:

Intervention Role Age group Catch-up Routine

immunization Proven to decrease morbidity and mortality

through 6 vaccine preventable diseases. Pregnant women and children

as per EPI schedule

197

Catch–up Vitamin A doses

Proven to prevent diarrhea as well as used to prevent measles and its complications

9 months to 5 years

De-worming tablets

Effective against intestinal parasites 2 years to 5 years

Low osmolarity ORS

Prevention and treatment of dehydration due to diarrhea

All children affected with diarrhea; 6 months to 5 years

Zinc Prevention of pneumonia and prevents as well as limits diarrhea incidence

Along with ORS

The Coverage achieved during the Catch-up round were 768754 vaccine doses for routine immunization, 1347604 vitamin A doses (91.8% of total 1479642 estimated eligible children), 817197 tablets of Albendazole (65.75% of 1242858 estimated eligible children) and 53532 courses of Zinc and ORS for children with diarrhea. Primary vaccine coverage (coverage of infants with EPI vaccines schedule by 1 completed year) was targeted against the estimated population of infants and pregnant women eligible for vaccine doses in a two-month period (two months being the duration of disruption of routine immunization services due to floods) and the following percent coverage was achieved for various antigens.

% Coverage Achieved during Catchup Round

33.2

22.1

70.6

38.3

71.0

38.6 36.7

71.0

38.7 36.8

60.3

25.6

91.1

65.8

TT1

TT2+B BCG OPV

0

OPV1

OPV2

OPV3

DPT1

DPT2

DPT3

Measles

Fully

Immuniz

ed

Vitamin

A*

Deworm

ingtabl

et*

Catch-up Round Antigen Wise % Coverage achieved (of 2 monthly estimated target) for Pregnant women & Children#

% S e s s i o n s h e l d o u t o f t h o s e p l a n n e d d u r i n g c a t c h - u p r o u n d

9 5 9 29 9 9 7 9 5 9 6

A r a r i a M a d h e p u r a P u r n e a S a h a r s a S u p a u l 5 f l o o d a f f e t c e dd i s t r i c t s

198

District

Pregnant women Infants (birth to 1 year) 9m-5y 6m-5y

TT1 TT2+B BCG OP

V0 OPV

1 OPV

2 OPV

3 DPT

1 DPT

2 DPT

3 Msls Full Imnzed Vit A* Deworm

tablet*

ARARIA 33.5 24.0 81.6 44.0 75.6 45.2 43.9 75.4 45.5 43.6 61.0 39.3 98.5 91.4

MADHEPURA 29.8 14.6 66.0 39.4 57.4 28.2 29.3 57.3 28.1 29.1 57.8 29.2 83.4 70.3

PURNEA 33.7 24.5 59.5 35.8 70.3 40.1 35.5 72.5 39.8 36.1 51.5 19.0 92.5 40.6

SAHARSA 39.3 26.7 86.0 38.1 83.7 43.3 38.2 80.3 44.4 38.6 71.4 10.7 90.2 74.5

SUPAUL 29.9 19.1 64.2 34.4 67.5 33.4 34.8 67.4 33.1 34.4 64.7 28.4 87.1 60.6

Grand Total 33.2 22.1 70.6 38.3 71.0 38.6 36.7 71.0 38.7 36.8 60.3 25.6 91.1 65.8

* Annual targets are taken for VitA and Deworming tablets as biannual supplementary dose was administered during Catch-up round

Catch-up Round Coverage Report Antigen Wise# District ARARIA MADHEPURA PURNEA SAHARSA SUPAUL Grand Total

Session Planned 1775 1122 2658 1468 1325 8348 Session Held 1686 1035 2620 1446 1257 8044

of TT1 5048 3223 6068 4195 3700 22234 TT2 3345 1420 4142 2529 2322 13758 TTB 270 154 268 322 40 1054 BCG 11174 6482 9749 8350 7225 42980

OPV 0 6027 3875 5856 3697 3865 23320 OPV 1 12332 7055 12824 10550 8751 51512 OPV 2 7339 3275 6980 5343 4162 27099 OPV 3 7537 3507 6380 4861 4471 26756 DPT 1 12257 7014 13098 9948 8755 51072 DPT 2 7392 3286 6997 5364 4160 27199 DPT 3 7546 3509 6461 4941 4431 26888

Measles 11665 8806 9981 12916 13064 56432 Fully Immunized 7887 2873 5303 1640 3300 21003

Vitamin 'A' 320427 201623 388835 234736 201983 1347604 Deworming 251244 141507 144313 163970 116163 817197 ORS & Zinc 14894 7840 21243 6816 2739 53532

# Provisional reports

Future Plans In order to ensure full-immunization status of infants in the flood affected areas, it is necessary that coverage of subsequent doses of OPV and DPT (2nd and 3rd doses) also be achieved at a level similar to that of the first dose. Two more catch-up rounds with the vaccination component in these districts spaced 4-6 weeks apart would give opportunity to achieve this. Bundling of a number of interventions had led to greater acceptability of services by the beneficiaries, empowering of the village level service provider and closer monitoring by multiple stakeholders

199

involved in the various program components followed in the catch-up strategy. This approach could be scaled up to cover a larger geographical area during regular sessions of Routine Immunization.

200

Strategic Plan for Measles Mortality Reduction In Bihar 2009

Introduction

Vaccine preventable diseases still remain major causes of morbidity, disability and mortality, with an estimated 40000 deaths (Chart 1 below) occurring annually in the Bihar State. This document outlines measles control acceleration strategies that Governments and stakeholders in immunization in the Bihar State will implement from 2009 onwards.

Chart 1: Estimated Measles Mortality by Indian State 2006

(Source: Preliminary results from a workshop held at NPSU, New Delhi, May 2007)

-

10,000

20,000

30,000

40,000

50,000

60,000

70,000

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Measles Deaths

State Health Society, Bihar- is proposing this strategic plan aimed at guiding measles mortality reduction in Bihar. As a resource mobilization tool, the plan summarizes the requirements for measles control including routine measles immunization, supplemental immunization activities and Measles surveillance, as well as the projected State Health Society, Bihar support needs. For the purpose of monitoring progress with implementation, a set of milestones is included.

Measles related Morbidity and mortality in Bihar

201

40

50

60

70

80

90

100

110

U5M

R

Non-Measles Mortality Rate Measles Mortality Rate Target for Child Mortality

Potential Contribution of Accelerated Measles Control to Achieving MDG4 in India, 2006

Reduction of Measles associated mortality would be a key intervention for Bihar to achieve the 4th Millennium development goal. About half of the goal would be achievable just by reducing the measles deaths in the state.

Of all the states in India, Bihar is poised to benefit most from Measles SIA leading to Measles mortality reduction.

Measles outbreaks in Bihar

In the year 2008-2009 (till Jan), Fourteen measles outbreaks were investigated in Bihar and the following age distribution of cases was determined. There were 485 cases (Age distribution of 394 cases available) and 26 deaths reported from these outbreaks (Case Fatality rate 5.36). One outbreak was confirmed with laboratory diagnosis and the remaining was through clinical examination.

88 % of the cases were between one and nine completed years justifying the age bracket to be covered during measles catch-up round.

Bihar

202

Measles outbreaks in Bihar 2008-2009 (status till 30th Jan 2009)

S No District Month of

outbreak Number of cases

Number of

deaths

Age distribution

0-11 months

12-59 months

60-119 months

120-179

months

>179 months

1 Champaran East March 13 0 1 5 3 4 0

2 Patna April 7 0 0 6 1 0 0

3 Patna April 33 0 2 7 9 6 0

4* Patna April 23 0

5 Supaul November 37 2 0 29 7 1 0

6 Bhagalpur November 5 0 0 4 0 1 0

7* Madhubani December 52 3

8 Madhepura December 51 7 0 28 19 1 0



11 Champaran West December 33 5 0 20 13 0 0

12 Darbangha December 136 5 0 65 52 11 8

13 Vaishali January 23 1 4 10 8 1 0

14 Champaran East January 35 2 1 21 8 5 0

Bihar total 485 26 8 213 132 33 8

1. BIHAR Strategic Action Plan for Measles Mortality reduction

Strategies It is envisaged that the State Health Society, Bihar with the support of other partners realize the stated measles control goal and objective using the following strategies

1. Strengthen routine immunization (EPI) to raise routine measles coverage to 80% and above.

2. Establish measles surveillance

3. Establish a measles laboratory network for the confirmation of cases/epidemics.

4. Provide a second opportunity for measles vaccination

a. Initially through a catch up supplementary mass campaigns for the children aged 9 months to 9 completed years

203

b. Follow up SIAs every 3-5 years for successive birth cohorts and c. Introducing second dose of Measles vaccine in EPI schedule when the evaluated

routine coverage of the first dose goes above 80% in all districts throughout the state.

5. Improve the clinical management of measles cases through the IMNCI approach. Implementation Roles The Department of Health and State Health Society, Bihar will implement phased activities for measles control in the context of systems strengthening and development. This will require the collaboration of various stakeholders in the field of immunization. Role of Govt of India The primary responsibility for the realization of this plan lies with the Ministry of Health Govt of India. The key roles will include:

• Adoption of the National strategies, and developing appropriate national plans related to Measles morbidity reduction.

• Securing funds, vaccines and supplies for immunization and providing the same to the State of Bihar.

• Developing modules for training and program communication for Measles Supplementary Immunization

• Providing guidelines and support for surveillance of measles and setting up of Mealses laboratories.

Role of partners The State Health Society Bihar will form a Measles Technical Advisory group, Bihar headed by the Executive Director and comprised of the State Program Officer Immunization and IDSP and representatives of the UNICEF, NPSP-WHO, IMA, IAP and NIPI. This task force will be the focal committee for day-to-day implementation of the plan. Besides implementing the plan, the task force will prepare guidelines for district activities, budget norms, reporting forms tally sheets, monitoring checklists for measles campaign and other control activities.

UNICEF: Member of technical advisory group on Measles Mortality reduction Measles Surveillance

• Support during the initial phase of sentinel surveillance • State level coordinator

For the Supplementary Catch-up immunization campaign

204

• Trainings and capacity building • Micro planning • Monitoring • Social Mobilization and IEC • Logistics and cold chain monitoring • Ensuring safe injection practices • Data compilation analysis • Post coverage surveys

NPSP-WHO Member of technical advisory group on Measles Mortality reduction Role in surveillance

• Support in outbreak based surveillance • Setting up laboratories for serological confirmation of Measles.

Role in SIA catch-up • Trainings and capacity building • Micro planning • Monitoring of activity

NIPI, IAP, IMA Members of Measles Technical Advisory group.

Logistics and vaccine requirement for Measles SIA

Logistics and vaccine requirement for Measles Mortality reduction activities Item Requirement details Requirement Units 1 Measles vaccine 1 dose per child with 1.33 wastage factor with 100% coverage 35453109 doses 2 Measles diluent 1 dose per child with 1.33 wastage factor with 100% coverage 35453109 doses 3 0.5 ml AD syringe 1 Per child vaccinated with 10% wastage 38998419 syringes 4 5 ml Disposal syringes 1 per 5 dose vial with 10% wastage 7799684 syringes 5 Hubcutters 1 per team with 10% buffer 18700 hubcutters 6 Mealses Eliza kits 100 per lab with 10% buffer 990 kits

Timeline for activity

Measles campaign activity timeline 2008 2009 Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec

Development of strategy and POA

Adoption of strategy by TAG Mealses Bihar

Initiation of vaccine procurement activities

205

Development of guidelines and forms etc.

Review and planning for districts

Planning workshop for districts (at region)

Provision of Logistics and finance support

District planning and preparation activities

Campaign in districts

Evaluation of campaign

Measles surveillance

Pulse Polio Programme (P.E. Progress in the State) – In the last one and half years several initiatives have been taken by the Government of Bihar for

eradication of Polio form the state. It has been observed that majority of P1 cases was restricted to the

most inaccessible areas of Kosi river, covering 20 blocks and 10 districts. A Kosi Operational-Plan

was developed for intensification of overal Polio.Eradication. Activities in these high risk Areas(both

SIA & Surveillance), the salient features of the plan are :

Ø Intensification of human resources in Kosi areas

Ø New Geo political boundaries were formed respective of districts boundaries called grids

for implementation of Kosi Operational Plan.

Ø Intensified Monitoring of the Polio rounds by WHO, UNICEF and State Monitors.

Bihar has shown excellent progress till 2008, as regards IEAG Observation for India is concerned.

Among the three kind of Polio Virus, Bihar has eradicated P-2 Polio Virus since 1999, and the

Endemic Transmission of P-1 cases, which is the most dreaded & Virulent of the three, has stopped

circulating in Bihar since, June/08 with multiple mOPV-I SIA Rounds. Circulation of P-3 Cases has

also declined in the State after completion of few effective SIA`s with mOPV –III rounds in Bihar in

2007/08. With the highest ever sensitivity of AFP-Surveillance in the State, Bihar is very close to the

Goal of Polio Eradication in the Country.

206

A. Baseline information S.No. Beneficiaries Target

2008-09 2009-10 1 Pregnant Women 3527925 3154129 2 0 to 1yr infants 3207205 2980338 3 1-2 yr 2178312 4 2-5 yr 6930990 5 5 yr 3366484 6 10 yr 4554652 7 16 yr 1980283

S.No. Routine Immunization Sessions 2008-09 2009-10 1 Session planned in Urban Areas 25668 43236 2 Session planned in Rural Areas 1288920 1450032 3 Total Sessions Planned 1314588 1493268 4 No. of session with hired vaccinators* 17950 5 No. of hired vaccinators* 4488

* No. of sessions and vaccinators hired in 2008-09 and planned in for 2009-10

B. Trend of IMR S.No. Year IMR of the State/UT

1 2003 60 2 2004 61 3 2005 61 4 2006 62 5 2007 60

207

C. District - Wise Coverage reports ( in Numbers)

S.No. Name of District

Yearly Target (2007-08)

Yearly Target (2008-09) BCG

Measles TT2+Booster

Infants Pregnant Women Infants Pregnant

Women 2007-08 2008-09 2007-08 2008-09 2007-08 2008-09

1 Araria 75850 83435 82154 90369 71426 55609 53438 47376 26677 12928 2 Arwal 19217 21139 25472 28019 19565 5669 14789 9148 10529 6938 3 Aurangabad 65134 71647 77520 85272 52364 35407 48171 38046 28221 22825 4 Banka 58425 64268 62202 68422 46155 41364 38572 36155 26956 22651 5 Begusarai 75853 83438 90589 99648 46940 86326 37747 94721 28142 43146 6 Bhagalpur 83025 91328 93966 103363 70542 46374 69425 51503 51671 35857 7 Bhojpur 71750 78925 86353 94988 53933 36959 45413 36403 33791 19553 8 Buxor 46993 51692 54263 59689 33675 28643 26963 28907 17496 17018

9 Champaran

(E) 117276 129004 152090 167299 70001 73579 60447 58879 30398 37633

10 Champaran

(W) 101475 111623 117656 129422 77754 43653 79741 42504 31035 19026 11 Darbhanga 83907 92298 127029 139732 87533 64465 63845 58303 36848 38408 12 Gaya 112762 124038 133970 147367 151760 61691 130348 129237 39018 28515 13 Gopalganj 73581 80939 83102 91412 54838 27312 48730 32190 33009 19888 14 Jahanabad 32062 35268 54032 59435 28967 21503 24536 21313 16375 12971 15 Jamui 49255 54181 35744 39318 48062 25995 49440 25278 43799 17070 16 Kaimur 46873 51560 49667 54634 32271 22748 18911 23284 14322 20404 17 Katihar 94855 104341 92389 101628 55404 37521 40871 40612 27264 22284 18 Khagaria 53351 58686 49361 54297 50086 7397 44528 9891 23457 2780 19 Kishanganj 59225 65148 50034 55037 35090 28746 20087 20871 17295 17239 20 Lakhisarai 28210 31031 30977 34075 19125 14522 13162 13768 11360 7835 21 Madhepura 53710 59081 58947 64842 49054 27609 46257 33712 21758 8452 22 Madhubani 130872 143959 138056 151862 100567 72245 113280 72977 47531 46782 23 Munger 39975 43973 43903 48293 33349 21498 28382 22333 21718 14118 24 Muzaffarpur 130086 143095 144752 159227 103512 72154 92585 66242 65311 39724 25 Nalanda 78829 86712 91569 100726 64187 33585 58584 31321 42918 18267 26 Nawada 56888 62577 69960 76956 46188 23562 40682 22012 26618 16821 27 Patna 145232 159755 182102 200312 78638 37002 65957 40147 49809 21395 28 Purnia 87110 95821 98237 108061 86243 55908 62194 54418 41808 29232 29 Rohtas 55022 60524 94679 104147 55552 35765 43020 38884 27413 21074 30 Saharsa 56396 62036 58244 64068 45777 40598 36431 47480 22735 18717 31 Samastipur 98400 108240 131976 145174 86296 50565 76510 62626 49677 32835 32 Saran 120540 132594 125715 138287 89463 48408 71949 41714 54525 26130 33 Sheikhpura 16796 18476 20304 22334 17344 13443 15333 13079 12207 8461 34 Sheohar 11685 12854 19884 21872 12379 8009 8288 6741 5367 3193 35 Sitamarhi 74005 81406 103229 113552 61276 50567 49249 51735 31339 27179 36 Siwan 92250 101475 104735 115209 89098 48294 74734 58978 27177 14491 37 Supaul 60846 66931 67471 74218 43812 24064 32206 28283 22471 15850 38 Vaishali 100085 110094 104872 115359 86155 48126 69468 48643 46751 26351

Total 2757806 3033592 3207205 3527925 2254381 1476885 1914273 1559714 1164796 814041

208

C. District - Wise Coverage reports ( in Numbers)

S.No.

Name of District

Yearly Target

(2007-08)

Yearly Target

(2008-09) OPV- 1 OPV -3 DPT - 1 DPT -3

Infants Infants 2007-08 2008-09 2007-08 2008-09 2007-08 2008-09 2007-08 2008-09

1 Araria 75850 82154 59879 74065 59545 51039 71754 55904 62947 49000

2 Arwal 19217 25472 14550 6155 24537 7732 19840 5176 16125 7101 3 Aurangabad 65134 77520 54718 38166 59748 37157 55180 32933 56008 33270 4 Banka 58425 62202 33293 28200 56833 26089 45935 24489 40969 23189

5 Begusarai 75853 90589 37604 102068 57878 86499 46867 77730 36710 82272 6 Bhagalpur 83025 93966 62763 46865 104013 43848 70735 40690 71323 36737 7 Bhojpur 71750 86353 43680 33676 68999 27371 52223 30829 47746 26411 8 Buxor 46993 54263 29459 31024 38683 27783 35845 22475 28417 20160

9 Champaran (E) 117276 152090 64373 70184 62735 54274 75905 60587 62036 43997

10 Champaran (W) 101475 117656 61242 44049 70240 39906 94102 32488 73716 31036 11 Darbhanga 83907 127029 79661 58985 81172 51689 87601 51385 68768 45394 12 Gaya 112762 133970 121371 132357 83802 120782 146805 103865 136817 111767 13 Gopalganj 73581 83102 44496 28971 69954 27189 55801 22333 54359 22313 14 Jahanabad 32062 54032 24612 17758 34451 16625 28402 13988 25152 12476

15 Jamui 49255 35744 39570 25023 86350 23835 45336 18443 45512 18914

16 Kaimur 46873 49667 20675 17329 31803 14952 29698 18132 20485 15988 17 Katihar 94855 92389 52604 38036 58862 37465 56604 24719 44750 24470 18 Khagaria 53351 49361 43962 5385 52575 6874 46225 4851 38936 5911

19 Kishanganj 59225 50034 32484 27580 39978 20109 35215 23216 23142 16577 20 Lakhisarai 28210 30977 20112 11895 23679 9502 20619 9270 16119 8473 21 Madhepura 53710 58947 56024 31007 47220 22119 57863 31495 44020 21886 22 Madhubani 130872 138056 76267 60326 106131 57643 93150 57141 75225 54793

23 Munger 39975 43903 35504 21381 46483 15767 33777 16572 27595 15891

24 Muzaffarpur 130086 144752 102314 80085 135174 67798 110341 59591 101213 53129 25 Nalanda 78829 91569 51802 31432 89200 27695 65339 27309 61177 25419 26 Nawada 56888 69960 39436 24967 56818 19624 45730 18589 44816 15896 27 Patna 145232 182102 67150 33242 106010 32091 82834 30084 71447 29383 28 Purnia 87110 98237 78157 56320 93199 48572 84139 47317 68317 40384

29 Rohtas 55022 94679 50661 27362 59608 22090 55683 23149 47779 19912

30 Saharsa 56396 58244 43989 44188 49546 31915 47684 69658 39628 30544 31 Samastipur 98400 131976 84207 46018 111419 42649 100249 41324 80768 40646 32 Saran 120540 125715 79048 48527 115303 37780 89646 42784 84162 40080 33 Sheikhpura 16796 20304 18192 11430 24620 12763 18178 11362 16524 12645

34 Sheohar 11685 19884 11236 6205 10850 4475 13278 6259 9212 4631 35 Sitamarhi 74005 103229 53647 48770 70514 45445 63711 41876 53008 38648 36 Siwan 92250 104735 121737 97860 58362 52905 122454 97860 71808 53004

37 Supaul 60846 67471 41117 27285 52335 24409 43897 27471 33646 22366 38 Vaishali 100085 104872 68343 41068 93229 35621 82176 34296 78170 30220

Total 2757806 3207205 2019939 1575244 2491858 1332081 2330821 1357640 1978552 1184933

209

C. District - Wise Coverage reports ( in

Numbers)

S.No.

Name of District

Yearly Target

(2007-08)

Yearly Target (2008-

09)

Hep B- Birth Hep B-1 Hep B-3 JE-routine (Wherever applicable Vit A- Ist Dose

Infants Infants 2007-08

2008-09

2007-08

2008-09

2007-08

2008-09

2007-08

2008-09 2007-08 2008-09

1 Araria 75850 82154

Not

App

licab

le

37985 30909 2 Arwal 19217 25472 11342 7752 3 Aurangabad 65134 77520 38293 31881

4 Banka 58425 62202 16174 16923 5 Begusarai 75853 90589 13181 51987 6 Bhagalpur 83025 93966 50095 41790 7 Bhojpur 71750 86353 31980 25849 8 Buxor 46993 54263 12529 21475

9 Champaran (E) 117276 152090 31507 38343 10 Champaran (W) 101475 117656 37820 20901 11 Darbhanga 83907 127029 29540 36335 12 Gaya 112762 133970 94657 47870 13 Gopalganj 73581 83102 33997 27698 14 Jahanabad 32062 54032 11863 12937

15 Jamui 49255 35744 26521 36879 16 Kaimur 46873 49667 17332 17037 17 Katihar 94855 92389 20849 19329 18 Khagaria 53351 49361 22537 4604 19 Kishanganj 59225 50034 14249 14962

20 Lakhisarai 28210 30977 4708 7149 21 Madhepura 53710 58947 24777 27396 22 Madhubani 130872 138056 72472 63159 23 Munger 39975 43903 14868 17487 24 Muzaffarpur 130086 144752 58300 51145

25 Nalanda 78829 91569 31565 19016 26 Nawada 56888 69960 21076 14319 27 Patna 145232 182102 41274 27527 28 Purnia 87110 98237 37126 30051 29 Rohtas 55022 94679 25145 33176 30 Saharsa 56396 58244 22464 32437

31 Samastipur 98400 131976 34012 33770 32 Saran 120540 125715 60809 39062 33 Sheikhpura 16796 20304 11124 10560 34 Sheohar 11685 19884 4160 4358 35 Sitamarhi 74005 103229 26174 31930

36 Siwan 92250 104735 48292 27350 37 Supaul 60846 67471 12838 13981 38 Vaishali 100085 104872 50466 44826

Total 2757806 3207205 1154101 1034160

210

D. District - wise VPD reports in 2008-09 ( in numbers)

S.No. Name of District Dipthe

ria Pertus

is N

Tetanus

Tetanus (other) Measles

Polio-P1

Polio-P3 AES

Cas

es

Dea

ths

Cas

es

Dea

ths

Cas

es

Dea

ths

Cas

es

Dea

ths

Cas

es

Dea

ths

Cas

es

Dea

ths

Cas

es

Dea

ths

Cas

es

Dea

ths

1 Araria 6 2 Aurangabad 1 3 Banka 0 1 4 Begusarai 12 5 Bhagalpur 5 6 6 Champaran (E) 13 8 7 Champaran (W) 33 5 3 8 Darbhanga 136 5 23 9 Gaya 1 10 Jamui 1 2 11 Katihar 5 12 Khagaria 22 13 Kishanganj 1 14 Lakhisarai 1 15 Madhepura 88 8 13 16 Madhubani 52 3 0 10 17 Munger 2 18 Muzaffarpur 14 19 Nalanda 7 20 Nawada 5 21 Patna 63 9 22 Purnia 9 23 Saharsa 1 15 24 Samastipur 0 30 25 Saran 1 2 26 Sheikhpura 2 27 Sitamarhi 7 28 Siwan 2 29 Supaul 37 2 4 30 Vaishali 23 1 6 Grand Total As on Jan 09 450 24 3 229

211

E. Total VPD outbreaks in State/UT

VPDs

No. of Outbreaks reported

No. of OutbreaksInvestigated

No. of cases in Outbreaks

No. of Deaths in Outbreaks Measures

Taken Remarks 2007-

08 2008-09# 2007-08 2008-09# 2007-

08 2008-09#

2007-08

2008-09#

Diphtheria 34 Pertusis 786

Measles 12 11 741 23

Outbreak response, Vit-A

supplementation, treatment of

cases AES

# Report for 2008-09 till Dec '08

F. District Wise - AEFI Surveillance

S.No. Name of District

AEF

I Com

mitt

ee

cons

titut

ed

( Y/N

)

Serio

us A

EFI

Cas

es

( till

Dec

' 08

)

AEF

I Dea

ths

(ti

ll D

ec'0

8)

No.

of

FIR

s se

nt

No.

of

PIR

s se

nt

No.

of

DIR

s se

nt

Rem

arks

1 Araria Yes 2 Arwal Yes 3 Aurangabad Yes 4 Banka Yes 5 Begusarai Yes 6 Bhagalpur Yes 7 Bhojpur Yes 8 Gaya Yes 1 9 Gopalganj Yes

10 Kaimur Yes 11 Khagaria Yes 12 Kishanganj Yes 13 Lakhisarai Yes 14 Madhubani Yes 3 15 Munger Yes 2 16 Nalanda Yes 17 Nawada Yes 18 Saharsa Yes 19 Sheikhpura Yes 20 Sitamarhi Yes 21 Siwan Yes 22 Vaishali Yes 1 23 Darbhanga 1 24 Samastipur 1 25 Katihaar 1

Total 10 10 2 1

212

G. RIMS status

Apr'08 May'08 Jun'08 Jul'08 Aug'08 Sep'08 Oct'08 Nov'08 Dec'081 Banka Yes Yes Yes No Yes Yes Yes Yes Yes Yes2 Bhagalpur Yes3 Bhojpur Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes4 Buxar Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes5 Champaran-W Yes6 Darbhanga Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes7 Gopalganj Yes Yes Yes8 Kaimur Yes Yes Yes Yes Yes Yes Yes Yes9 Kishanganj Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes

10 Madhubani Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes11 Munger Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes12 Saharsa Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes13 Samastipur Yes14 Saran Yes15 Sheikhpura Yes16 Sheohar Yes17 Sitamarhi Yes18 Siwan Yes19 Supaul Yes

STATE / UT ** Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes*Write Yes/No for the month the district has uploaded RIMS data of district**Write Yes /No for the month the State/UT has uploaded State/UT level data

RIMS uploaded*S.No. Name of District RIMS Installed & Operational

Computer Assistant

213

H. Vaccine , Cold Chain and Other logistics

Item Requirement Remarks

Stock ( Functional)** 2009-10 2010-11

Cold Chain Equipments-

WIC 10 9 4 Including 5 replacements & 4 New for 2009-10

WIF 3 2 1 Replacement out of 1 and One new

ILR-140 L (Small) 772 355 50 ILR-300 L (Large) 92 82 20 DF-140 L (Small) 467 175 25 DF-300 L (Large) 162 128 20

Cold Boxes L 3914 1190 1000 Cold Boxes S 1769 1050 800

Vaccine Carriers 59127 22950 15000 Ice Pack 68530 197500 100000

Vaccine Van 46 Not Required Vaccine stock and requirement ( including 25% wastage and 25% buffer)

TT 2169245 2386170 BCG 2860780 3146858 OPV 919353 1011288 DPT* 2398384 2638222

Measles 984374 1082811 Hep B

JE(Routine)

Syringes including wastage of 10% and 25% buffer 0.1ml 396956 4070720 4681328 0.5ml 2571222 33379913 38386900

Reconstitutional Syringes 126864 6931501 7971226

Hub Cutters Very few functional 15800 8000

New ANM recruitment in process & further

additional Hubcutter needed.

** As on 31st Dec '08 * Note : DPT is to be given instead of DT at 5 yrs w.e.f. 2009 - 10

214

District wise and Head wise allocation of budget for Routine Immunization activities in Year 2009-10

District Profile used for calculation of Budget

SL No. Name of District P.W. ANM Alternate

Vaccinator

Number of

immunisation Site

AWC ASHA HSC APHC BPHC Reffral + SDH

District Hospital/Metarnit

y Hospital

WIC +

WIF Slums

Under served Areas

State Total Allotment for

the year 2009-10

1 Araria 81600 285 257 497 2125 2026 424 73 9 4 1 60 952 Arwal 21941 128 128 558 653 64 26 5 0 0 03 Aurangabad 78966 436 446 2004 1842 207 58 11 4 1 1 86 154 Banka 63106 546 546 1609 1552 265 32 10 4 0 33 1385 Begusarai 92920 568 598 2308 2245 289 25 18 2 1 50 1196 Bhagalpur 97221 611 611 2215 1966 280 41 16 3 1 1 133 707 Bhojpur 86372 650 665 2104 2049 355 27 14 4 1 83 4008 Buxar 54528 374 15 374 1403 1318 287 47 11 1 1 92 1109 Champaran - E 153031 921 921 3897 2686 315 46 20 3 1 1 71 225

10 Champaran - W 110256 454 38 465 2980 2734 377 30 17 3 1 52 12711 Darbhanga 118172 440 440 3231 2357 261 36 18 2 0 1 162 11712 Gaya 136251 877 877 3334 2997 541 73 25 2 3 265 24113 Gopalganj 93400 281 281 2158 2022 186 23 14 4 1 42 1514 Jahanabad 36264 257 257 925 769 104 32 7 3 1 82 015 Jamui 54467 354 354 1397 1296 212 22 9 4 1 68 35016 Katihar 107722 469 472 2215 2174 257 25 16 3 1 28 15417 Kaimur 47962 307 307 1286 1247 196 19 10 4 1 150 9418 Khagaria 51331 382 382 1276 1204 193 24 7 1 1 45 6319 Kishanganj 66857 144 36 149 1296 1027 136 9 7 3 1 75 3220 Lakhisarai 31713 205 205 802 581 126 19 6 2 0 71 6121 Madhepura 60096 107 383 107 1526 1459 386 39 13 1 1 46 15022 Madhubani 162344 450 127 450 3569 3034 430 57 18 5 1 52 6423 Munger 44272 306 306 1074 951 227 33 9 1 1 86 1724 Muzaffarpur 159262 892 50 892 3669 3398 751 121 14 2 1 1 254 5025 Nalanda 80504 650 650 2319 1980 467 68 20 4 1 96 4026 Nawada 71303 424 40 424 1810 1810 338 56 14 3 1 85 4427 Patna 192249 888 893 3937 2634 418 60 23 6 0 4 771 31628 Purnia 94684 535 120 535 2482 2263 511 74 14 3 1 2 50 22029 Rohtas 91939 526 526 2309 2160 308 94 19 4 1 141 16530 Saran 128215 600 77 600 3178 3178 508 69 20 3 1 1 45 5031 Samastipur 17542 777 777 3438 3143 354 45 20 4 1 48 37432 Saharsa 60505 225 225 1428 676 152 15 10 0 1 1 102 10933 Sheikhpura 21005 179 179 526 439 85 17 6 2 0 44 034 Sheohar 18997 35 31 35 513 495 34 7 5 2 0 25 1635 Siwan 90359 597 607 2618 2618 439 55 19 3 1 0 4936 Sitamarhi 106514 326 426 2557 2529 213 36 13 1 1 16 9437 Supaul 67163 119 133 119 1744 1538 178 19 11 3 0 56 30038 Vaishali 103096 576 640 2672 2532 337 30 17 2 1 0 1639 RDD/State

State Total 3154129 16901 1307 17366 80492 71582 11211 1582 515 105 32 13 3565 4500

215

Mobility Support Cold chain maintenance

Mob

ility

su

ppor

t to

Dis

tric

t Off

icia

ls

Rs. 5

0000

per

di

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ct (3

8) .

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the

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@ R

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1900000 100000 5000000 WIC/WIF Vaccine Van Minor Repair

50000 25000 25859 50000 25000 15515 50000 10000 50000 31031 50000 25000 28445 50000 25000 49132 50000 10000 50000 43960 50000 25000 38788 50000 25000 31031 50000 10000 50000 54304 50000 25000 46546 50000 10000 50000 49132 50000 25000 67233 50000 25000 38788 50000 25000 20687 50000 25000 25859 50000 25000 43960 50000 25000 28445 50000 25000 20687 50000 25000 20687 50000 25000 18101 50000 25000 36203 50000 25000 49132 50000 25000 25859 50000 10000 50000 38788 50000 25000 54304 50000 25000 38788 50000 40000 50000 62061 50000 20000 50000 38788 50000 25000 51718 50000 10000 50000 54304 50000 25000 54304 50000 10000 50000 28445 50000 25000 18101 50000 25000 15515 50000 25000 51718 50000 25000 36203 50000 25000 31031 50000 25000 46546

100000 65002 2200000 1900000 100000 195002 1175000 3629998

216

Focus on slum & underserved areas in

urban areas: Mobilization of children through

ASHA or other mobilizers Alternative vaccine delivery in hard to reach areas

for

3565

slu

ms

and

1438

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Stat

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75390000 60000000 5400000 88400000

651000 4478600 1519500 114000 2470400 0 98000 489750 0 665600

424200 145600 1381500 18000 2301200 718200 376600 1164000 165600 2673600 709800 295400 1683750 142800 2966800 852600 322000 1474500 84000 3093200

2028600 397600 1536750 480000 2978000 848400 478800 988500 132000 1812800

1243200 702800 2014500 270000 4519200 751800 792400 2050500 152400 2265600

1171800 259000 1767750 140400 2147600 2125200 473200 2247750 289200 4271200 239400 67200 1516500 18000 1443200 344400 144200 576750 0 1336400

1755600 198800 972000 420000 1420800 764400 201600 1630500 184800 2269600

1024800 233800 935250 112800 1483600 453600 270200 903000 75600 1910800 449400 630000 770250 38400 736400 554400 103600 435750 73200 992800 823200 6463800 1094250 180000 376400 487200 2258200 2275500 76800 2263200 432600 196000 713250 20400 1570800

1276800 1269800 2548500 60000 4578400 571200 347200 1485000 48000 3332000 541800 984200 1357500 52800 2152000

4565400 515200 1975500 379200 4264400 1134000 2374400 1697250 264000 2518000 1285200 336000 1620000 198000 2537200 399000 1621200 2383500 60000 3060000

1772400 449400 2357250 448800 3591600 886200 70000 507000 130800 1039200 184800 92400 329250 0 930800 172200 530600 371250 19200 162800 205800 565600 1963500 58800 3097600 462000 177800 1896750 112800 2102400

1495200 2304400 1153500 360000 258800 67200 273000 1899000 19200 3308800

4197892 6313500 3496800 38070892 31498600 60000000 5400000 88400000

217

Computer Assistants support Printing and dissemination Review meetings

Com

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288000 3648000 17347710 570000 1030000 24000000 96000 448800 18000 607800 96000 120676 10000 195900 96000 434313 22000 552600 96000 347083 20000 465600 96000 511060 36000 673500 96000 534716 32000 589800 96000 475046 28000 614700 96000 299904 22000 395400 96000 841671 40000 805800 96000 606408 34000 820200 96000 649946 36000 707100 96000 749381 50000 899100 96000 513700 28000 606600 96000 199452 14000 230700 96000 299569 18000 388800 96000 592471 32000 652200 96000 263791 20000 374100 96000 282321 14000 361200 96000 367714 14000 308100 96000 174422 12000 174300 96000 330528 26000 437700 96000 892892 36000 910200 96000 243496 18000 285300 96000 875941 28000 1019400 96000 442772 40000 594000 96000 392167 28000 543000 96000 1057370 46000 790200 96000 520762 28000 678900 96000 505665 38000 648000 96000 705183 40000 953400 96000 96481 40000 942900 96000 332778 20000 202800 96000 115528 12000 131700 96000 104484 10000 148500 96000 496975 38000 785400 96000 585827 26000 758700 96000 369397 22000 461400 96000 567028 34000 759600

288000 570000 2525400

218

288000 3648000 17347718 570000 1030000 24000000

219

Trainings (separate annexure attached with details) Microplanning

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2183000 11271800 62000 704825 704825 1700000 591000

68400 12800 10150 28500 11000 82700 8000 6750 12800 7000

143600 15200 11850 43600 13000 366500 14000 11000 54600 12000 287500 23800 17800 56800 20000 313400 21400 16100 61100 18000 386000 18800 14400 65000 16000 221400 15200 11850 37400 13000 680200 26200 19500 92100 22000 89100 22600 16950 45400 19000

164300 23800 17800 44000 20000 419700 32200 23750 87700 27000 68400 18800 14400 28100 16000

142300 10400 8450 25700 9000 195400 12800 10150 35400 11000 117700 21400 16100 46900 18000 229100 14000 11000 30700 12000 253800 10400 8450 38200 9000 15200 10400 8450 14400 9000

103400 9200 7600 20500 8000 59300 17600 13550 10700 15000

164300 23800 17800 45000 20000 192800 12800 10150 30600 11000 376900 18800 14400 89200 16000 338000 26200 19500 65000 22000 181200 18800 14400 42400 16000 375600 29800 22050 88800 25000 242100 18800 14400 53500 16000 327600 25000 18650 52600 21000 300400 26200 19500 60000 22000 436500 26200 19500 77700 22000 68400 14000 11000 22500 12000 93000 9200 7600 17900 8000 7400 8000 6750 3500 7000

179900 25000 18650 59700 21000 174700 17600 13550 32600 15000 60600 15200 11850 11900 13000

266700 22400 16950 57600 19000 11271800 62000

8193500 11271800 62000 696800 532750 1690100 591000

221

POL for vaccine delivery Consumables Injection safety

POL

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3800000 182400 1279500

100000 4800 13680 4500 3600 100000 4800 6144 2500 2000 100000 4800 20928 5500 4400 100000 4800 26208 5000 4000 100000 4800 27264 9000 7200 100000 4800 29328 8000 6400 100000 4800 31200 7000 5600 100000 4800 17952 5500 4400 100000 4800 44208 10000 8000 100000 4800 21792 8500 6800 100000 4800 21120 9000 7200 100000 4800 42096 12500 10000 100000 4800 13488 7000 5600 100000 4800 12336 3500 2800 100000 4800 16992 4500 3600 100000 4800 22512 8000 6400 100000 4800 14736 5000 4000 100000 4800 18336 3500 2800 100000 4800 6912 3500 2800 100000 4800 9840 3000 2400 100000 4800 5136 6500 5200 100000 4800 21600 9000 7200 100000 4800 14688 4500 3600 100000 4800 42816 7000 5600 100000 4800 31200 10000 8000 100000 4800 20352 7000 5600 100000 4800 42624 11500 9200 100000 4800 25680 7000 5600 100000 4800 25248 9500 7600 100000 4800 28800 10000 8000 100000 4800 37296 10000 8000 100000 4800 10800 5000 4000 100000 4800 8592 3000 2400 100000 4800 1680 2500 2000 100000 4800 28656 9500 7600 100000 4800 15648 6500 5200 100000 4800 5712 5500 4400 100000 4800 27648 8500 6800

4752 3800000 182400 816000 257500 206000

222

State specific requirement.

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TOTAL

0 0 13755450 0 319308510 361250 11123639 94860 2093995 340680 6220002 273530 7001766 392360 8185766 376550 8187854 357680 9754964 238510 5849847 662490 12366973 506600 8532396 549270 8096018 566780 12669790 366860 5285836 157250 3514125 237490 6302560 376550 7280893 218620 5291542 216920 5128614 220320 3901733 136340 3114653 259420 10436287 606730 10440354 182580 4244223 623730 13200875 394230 8104406 307700 6979507 669290 15269995 421940 10379920 392530 8375311 540260 10602547 584460 11250591 242760 3918483 89420 2329491 87210 1936389 445060 8334259 434690 7149768 296480 7156170 454240 8130012 71810 31166956 13755450 319308510

224

Health Workers training on Routine Immunization - Consolidated Budget 2009-10

S.no. District Name ANM - C

Total Training

load

Total No. of training

Batches ( 25 person per

batch)

No of trainers

per batch

Honorarium + TA to Participants @Rs 400 per participants

Honararium for trainers/faculty @600 per day (

subject to atleast 2 lectature per guest faculty per day) for

2 days

Working lunch & Refreshments Rs 200

per participants + faculty per day for 2

days

Incidential Exp for Photocopy , Job aids, flip charts,

T.V./LCD hiring etc @ 250 per

participants per days for 2 days

Grand Total

1 Araria 48 48 2 3 19200 3600 21600 24000 684002 Arwal 59 59 2 3 23600 3600 26000 29500 827003 Aurangabad 104 104 4 3 41600 3600 46400 52000 1436004 Banka 269 269 11 3 107600 3600 120800 134500 3665005 Begusarai 211 211 8 3 84400 3600 94000 105500 2875006 Bhagalpur 230 230 9 3 92000 3600 102800 115000 3134007 Bhojpur 284 284 11 3 113600 3600 126800 142000 3860008 Buxar 162 162 6 3 64800 3600 72000 81000 2214009 Champaran - E 502 502 20 3 200800 3600 224800 251000 68020010 Champaran - W 63 63 3 3 25200 3600 28800 31500 8910011 Darbhanga 119 119 5 3 47600 3600 53600 59500 16430012 Gaya 309 309 12 3 123600 3600 138000 154500 41970013 Gopalganj 48 48 2 3 19200 3600 21600 24000 6840014 Jahanabad 103 103 4 3 41200 3600 46000 51500 14230015 Jamui 142 142 6 3 56800 3600 64000 71000 19540016 Katihar 85 85 3 3 34000 3600 37600 42500 11770017 Kaimur 167 167 7 3 66800 3600 75200 83500 22910018 Khagaria 186 186 7 3 74400 3600 82800 93000 25380019 Kishanganj 8 8 1 3 3200 3600 4400 4000 1520020 Lakhisarai 74 74 3 3 29600 3600 33200 37000 10340021 Madhepura 41 41 2 3 16400 3600 18800 20500 5930022 Madhubani 119 119 5 3 47600 3600 53600 59500 16430023 Munger 140 140 6 3 56000 3600 63200 70000 19280024 Muzaffarpur 277 277 11 3 110800 3600 124000 138500 37690025 Nalanda 248 248 10 3 99200 3600 111200 124000 33800026 Nawada 132 132 5 3 52800 3600 58800 66000 18120027 Patna 276 276 11 3 110400 3600 123600 138000 37560028 Purnia 177 177 7 3 70800 3600 79200 88500 24210029 Rohtas 240 240 10 3 96000 3600 108000 120000 32760030 Saran 220 220 9 3 88000 3600 98800 110000 30040031 Samastipur 321 321 13 3 128400 3600 144000 160500 43650032 Saharsa 48 48 2 3 19200 3600 21600 24000 6840033 Sheikhpura 66 66 3 3 26400 3600 30000 33000 9300034 Sheohar 2 2 1 3 800 3600 2000 1000 7400

225

35 Siwan 131 131 5 3 52400 3600 58400 65500 17990036 Sitamarhi 127 127 5 3 50800 3600 56800 63500 17470037 Supaul 42 42 2 3 16800 3600 19200 21000 6060038 Vaishali 195 195 8 3 78000 3600 87600 97500 266700

Total 5975 5975 241 114 2390000 136800 2679200 2987500 8193500Rates for training as per GOI guideline vide letter no. D.O.No.A-11033/101/2007-Trg dated 20.10.08

Cold Chain Handler training on Routine Immunization - Consolidated Budget 2009-10

S.no. District Name No. of PHCs

No. of Cold Chain

Handler (2 per PHC & 2 per district)

Total Training

load



batch)

No of trainers

per batch


Honararium for trainers/faculty @600 per day ( subject to

atleast 2 lectature per guest faculty per day)

for 1 days

Working lunch & Refreshments

Rs 200 per participants + faculty per day

for one day

Grand Total

1 Araria 9 20 20 1 1 8000 600 4200 128002 Arwal 5 12 12 1 1 4800 600 2600 80003 Aurangabad 11 24 24 1 1 9600 600 5000 152004 Banka 10 22 22 1 1 8800 600 4600 140005 Begusarai 18 38 38 2 1 15200 600 8000 238006 Bhagalpur 16 34 34 2 1 13600 600 7200 214007 Bhojpur 14 30 30 1 1 12000 600 6200 188008 Buxar 11 24 24 1 1 9600 600 5000 152009 Champaran - E 20 42 42 2 1 16800 600 8800 26200

10 Champaran - W 17 36 36 2 1 14400 600 7600 2260011 Darbhanga 18 38 38 2 1 15200 600 8000 2380012 Gaya 25 52 52 2 1 20800 600 10800 3220013 Gopalganj 14 30 30 1 1 12000 600 6200 1880014 Jahanabad 7 16 16 1 1 6400 600 3400 1040015 Jamui 9 20 20 1 1 8000 600 4200 1280016 Katihar 16 34 34 2 1 13600 600 7200 2140017 Kaimur 10 22 22 1 1 8800 600 4600 1400018 Khagaria 7 16 16 1 1 6400 600 3400 1040019 Kishanganj 7 16 16 1 1 6400 600 3400 1040020 Lakhisarai 6 14 14 1 1 5600 600 3000 920021 Madhepura 13 28 28 1 1 11200 600 5800 1760022 Madhubani 18 38 38 2 1 15200 600 8000 23800

226

23 Munger 9 20 20 1 1 8000 600 4200 1280024 Muzaffarpur 14 30 30 1 1 12000 600 6200 1880025 Nalanda 20 42 42 2 1 16800 600 8800 2620026 Nawada 14 30 30 1 1 12000 600 6200 1880027 Patna 23 48 48 2 1 19200 600 10000 2980028 Purnia 14 30 30 1 1 12000 600 6200 1880029 Rohtas 19 40 40 2 1 16000 600 8400 2500030 Saran 20 42 42 2 1 16800 600 8800 2620031 Samastipur 20 42 42 2 1 16800 600 8800 2620032 Saharsa 10 22 22 1 1 8800 600 4600 1400033 Sheikhpura 6 14 14 1 1 5600 600 3000 920034 Sheohar 5 12 12 1 1 4800 600 2600 800035 Siwan 19 40 40 2 1 16000 600 8400 2500036 Sitamarhi 13 28 28 1 1 11200 600 5800 1760037 Supaul 11 24 24 1 1 9600 600 5000 1520038 Vaishali 17 36 36 1 1 14400 600 7400 22400

Total 515 1106 1106 52 38 442400 22800 231600 696800Rates for training as per GOI guideline vide letter no. D.O.No.A-11033/101/2007-Trg dated 20.10.08 UNICEF will provide one trainer and all training materials for participants

Block level Data Handler training on Routine Immunization - Consolidated Budget 2009-10

S.no. District Name No. of PHCs

No. of Data Handler (1

per PHC & 2 per district)

Total Training

load



batch)

No of trainers

per batch


Honararium for trainers/faculty @600 per day (

subject to atleast 2 lectature per guest faculty per day) for

1 days

Working lunch & Refreshments

Rs 200 per participants + faculty per day

for one day

Incidential Exp for Photocopy , Job aids, flip charts, T.V./LCD hiring etc @ 250 per

participants per days for one day

Grand Total

1 Araria 9 11 11 1 1 4400 600 2400 2750 101502 Arwal 5 7 7 1 1 2800 600 1600 1750 67503 Aurangabad 11 13 13 1 1 5200 600 2800 3250 118504 Banka 10 12 12 1 1 4800 600 2600 3000 110005 Begusarai 18 20 20 1 1 8000 600 4200 5000 178006 Bhagalpur 16 18 18 1 1 7200 600 3800 4500 161007 Bhojpur 14 16 16 1 1 6400 600 3400 4000 144008 Buxar 11 13 13 1 1 5200 600 2800 3250 118509 Champaran - E 20 22 22 1 1 8800 600 4600 5500 19500

227

10 Champaran - W 17 19 19 1 1 7600 600 4000 4750 1695011 Darbhanga 18 20 20 1 1 8000 600 4200 5000 1780012 Gaya 25 27 27 1 1 10800 600 5600 6750 2375013 Gopalganj 14 16 16 1 1 6400 600 3400 4000 1440014 Jahanabad 7 9 9 1 1 3600 600 2000 2250 845015 Jamui 9 11 11 1 1 4400 600 2400 2750 1015016 Katihar 16 18 18 1 1 7200 600 3800 4500 1610017 Kaimur 10 12 12 1 1 4800 600 2600 3000 1100018 Khagaria 7 9 9 1 1 3600 600 2000 2250 845019 Kishanganj 7 9 9 1 1 3600 600 2000 2250 845020 Lakhisarai 6 8 8 1 1 3200 600 1800 2000 760021 Madhepura 13 15 15 1 1 6000 600 3200 3750 1355022 Madhubani 18 20 20 1 1 8000 600 4200 5000 1780023 Munger 9 11 11 1 1 4400 600 2400 2750 1015024 Muzaffarpur 14 16 16 1 1 6400 600 3400 4000 1440025 Nalanda 20 22 22 1 1 8800 600 4600 5500 1950026 Nawada 14 16 16 1 1 6400 600 3400 4000 1440027 Patna 23 25 25 1 1 10000 600 5200 6250 2205028 Purnia 14 16 16 1 1 6400 600 3400 4000 1440029 Rohtas 19 21 21 1 1 8400 600 4400 5250 1865030 Saran 20 22 22 1 1 8800 600 4600 5500 1950031 Samastipur 20 22 22 1 1 8800 600 4600 5500 1950032 Saharsa 10 12 12 1 1 4800 600 2600 3000 1100033 Sheikhpura 6 8 8 1 1 3200 600 1800 2000 760034 Sheohar 5 7 7 1 1 2800 600 1600 1750 675035 Siwan 19 21 21 1 1 8400 600 4400 5250 1865036 Sitamarhi 13 15 15 1 1 6000 600 3200 3750 1355037 Supaul 11 13 13 1 1 5200 600 2800 3250 1185038 Vaishali 17 19 19 1 1 7600 600 4000 4750 16950

Total 515 591 591 38 38 236400 22800 125800 147750 532750Rates for training as per GOI guideline vide letter no. D.O.No.A-11033/101/2007-Trg dated 20.10.08

Calculation for Alternate Vaccinator (requirement and Honorarium - 2009-10

S.no. District Name PHC PHC x 5 APHC HSCs Total ANM -

R ANM -

C Total ANM

Diff of Personnel

Alternate

Vaccinator

required

Honararium for Alternate vaccinator @ Rs 1400/- per

month

No. of Contractu

al ANM

One month Honararium for Break period for

Contractual ANM @ Rs

1400/- per ANM

Grand Total

1 Araria 9 45 73 424 542 170 115 285 257 257 4317600 115 161000 4478600

228

2 Arwal 5 25 26 64 115 58 70 128 -13 70 98000 980003 Aurangabad 11 55 58 207 320 332 104 436 -116 104 145600 1456004 Banka 10 50 32 265 347 277 269 546 -199 269 376600 3766005 Begusarai 18 90 25 289 404 357 211 568 -164 211 295400 2954006 Bhagalpur 16 80 41 280 401 381 230 611 -210 230 322000 3220007 Bhojpur 14 70 27 355 452 366 284 650 -198 284 397600 3976008 Buxar 11 55 47 287 389 212 162 374 15 15 252000 162 226800 4788009 Champaran - E 20 100 46 315 461 419 502 921 -460 502 702800 702800

10 Champaran - W 17 85 30 377 492 344 110 454 38 38 638400 110 154000 79240011 Darbhanga 18 90 36 261 387 255 185 440 -53 185 259000 25900012 Gaya 25 125 73 541 739 539 338 877 -138 338 473200 47320013 Gopalganj 14 70 23 186 279 233 48 281 -2 48 67200 6720014 Jahanabad 7 35 32 104 171 154 103 257 -86 103 144200 14420015 Jamui 9 45 22 212 279 212 142 354 -75 142 198800 19880016 Katihar 16 80 25 257 362 325 144 469 -107 144 201600 20160017 Kaimur 10 50 19 196 265 140 167 307 -42 167 233800 23380018 Khagaria 7 35 24 193 252 189 193 382 -130 193 270200 27020019 Kishanganj 7 35 9 136 180 126 18 144 36 36 604800 18 25200 63000020 Lakhisarai 6 30 19 126 175 131 74 205 -30 0 74 103600 10360021 Madhepura 13 65 39 386 490 86 21 107 383 383 6434400 21 29400 646380022 Madhubani 18 90 57 430 577 361 89 450 127 127 2133600 89 124600 225820023 Munger 9 45 33 227 305 166 140 306 -1 0 140 196000 19600024 Muzaffarpur 14 70 121 751 942 585 307 892 50 50 840000 307 429800 126980025 Nalanda 20 100 68 467 635 402 248 650 -15 0 248 347200 34720026 Nawada 14 70 56 338 464 201 223 424 40 40 672000 223 312200 98420027 Patna 23 115 60 418 593 520 368 888 -295 0 368 515200 51520028 Purnia 14 70 74 511 655 279 256 535 120 120 2016000 256 358400 237440029 Rohtas 19 95 94 308 497 286 240 526 -29 0 240 336000 33600030 Saran 20 100 69 508 677 366 234 600 77 77 1293600 234 327600 162120031 Samastipur 20 100 45 354 499 456 321 777 -278 0 321 449400 44940032 Saharsa 10 50 15 152 217 175 50 225 -8 0 50 70000 7000033 Sheikhpura 6 30 17 85 132 113 66 179 -47 0 66 92400 9240034 Sheohar 5 25 7 34 66 28 7 35 31 31 520800 7 9800 53060035 Siwan 19 95 55 439 589 193 404 597 -8 0 404 565600 56560036 Sitamarhi 13 65 36 213 314 199 127 326 -12 0 127 177800 17780037 Supaul 11 55 19 178 252 69 50 119 133 133 2234400 50 70000 2304400

229

38 Vaishali 17 85 30 337 452 381 195 576 -124 0 195 273000 273000Total 515 2575 1582 11211 15368 9916 6700 16901 -1533 1307 21957600 6815 9541000 31498600

230

PART- D

National Disease Control Programmes (NDCP)

2009-2010

231

IDSP (Integrated Disease Surveillance Program)

Surveillance is essential for the early detection of emerging (new) or re-emerging (resurgent) infectious diseases. In the absence of surveillance, disease may spread unrecognised by those responsible for health care or public health agencies, because many individual health care workers would see sick people in small numbers. By the time the outbreak is recognized, it may be too late for intervention measures. Continuous monitoring is essential for detecting the ‘early signals’ of outbreak of any epidemic of a new or resurgent disease. For disease surveillance to prevent emerging epidemics, the time taken for effective action should be short. Integrated Disease Surveillance Program (IDSP) is intended to be the backbone of public health delivery system in the state. It is expected to provide essential data to monitor progress of ongoing disease control programs and help in optimizing the allocation of resources. It will be able to detect early warning signals of impending outbreaks and help initiate an effective and timely response. IDSP will also facilitate the study of disease patterns in the state and identify new emerging diseases. It will play a crucial role in obtaining political and public support for the health programs in the state. Profile of Bihar : Bihar is located in the North East – of India. It has a land with a covered area of 94,163 Sq. Km. It is mainly divided into two regions known as North of Ganges, and south of Ganges regions. The State is geographically classified into 38 districts and 72 Sub divisions and 533 blocks. The population of Bihar as per 2001 Census is 828.8 million with a urban population of 8681800 as the density population per Sq. Km. is 880 against national figure of 324. There are 32 towns with a population of 50,000 or more and having about 40,000 villages in the state. The present sex ratio is 919 females per 1000 males (India Figure 933). The total literacy rate is 46.4%. It is mainly a rural inhabited state. The percentage of rural population is 66.08% against the India’s population of 72.2%.

Diseases conditions under the surveillance program (i) Regular Surveillance: Vector Borne Disease: Malaria & Kala-azar Water Borne Disease: Acute Diarrhoeal Disease (Cholera) &

Typhoid Respiratory Diseases: Tuberculosis Vaccine Preventable Diseases: Measles Diseases under eradication: Polio Other Conditions: Road Traffic Accidents

232

Table 2: Integrated IDSP (Integrated Disease Surveillance Program)

S.N. Heads Units Unit Cost Total 1 Infrastructure a State Surveillance Cell at DMS & DHS 1 1,500,000 1,500,000 b District Level Laboratory 39 100,000 3,900,000 c Manuals 1 500000 500,000 2 Laboratory a Equipment 39 100000 3,900,000 b Reagents and consumables 39 200000 7,800,000 3 Communication a Telephone & Fax 39 10000 390,000 4 Salary a Data Entry Operator 39 6000 234,000 b Accounts Assistant 39 5000 195,000 5 Social Mobilization 39 30000 1,170,000 6 Training 39 100,000 3,900,000

7 Biological Waste Management, 5% overhead expenses 39 917,000

GRAND TOTAL 24,406,000

(24406000 – 11400000 = 13006000) An amount One Crore Forteen lakhs (Rs. 1,14,00,000/-) was released to to State. Hence

balance fund requirment will be Rs. 1,30,06,000/- lakhs (One crore Thirty lakhs six thousands only).

233

IDSP (Integrated Disease Surveillance Project)

SL No Name of District District Level IDSP Fund State Level IDSP Fund

1 2 3 4 1 Araria 574513.00

2574513.00

2 Arwal 574513.00 3 Aurangabad 574513.00 4 Banka 574513.00 5 Begusarai 574513.00 6 Bhagalpur 574513.00 7 Bhojpur 574513.00 8 Buxar 574513.00 9 Darbhanga 574513.00

10 East Champaran 574513.00 11 Gaya 574513.00 12 Gopalganj 574513.00 13 Jamui 574513.00 14 Jehanabad 574513.00 15 Kaimur 574513.00 16 Katihar 574513.00 17 Khagaria 574513.00 18 Kishanganj 574513.00 19 Lakhisarai 574513.00 20 Madhepura 574513.00 21 Madhubani 574513.00 22 Munger 574513.00 23 Muzaffarpur 574513.00 24 Nalanda 574513.00 25 Nawada 574513.00 26 Patna 574513.00 27 Purnia 574513.00 28 Rohtas 574513.00 29 Saharsa 574513.00 30 Samastipur 574513.00 31 Saran 574513.00 32 Sheikhpura 574513.00 33 Sheohar 574513.00 34 Sitamarhi 574513.00 35 Siwan 574513.00 36 Supaul 574513.00 37 Vaishali 574513.00 38 West Champaran 574513.00 39 Unit Cost State Level Total 21,831,494.00 2,574,513.00

Note- (i) District Level IDSP fund 21831494.00 (ii) State Level IDSP Fund 2574513.00 Total 24406007.00 (24406007 - 11400000 = 13006007)

234

An amount One Crore Forteen lakhs (Rs. 1,14,00,000/-) was released to State. Hence, balance fund requirement will be Rs. 1,30,06,007/- lakhs (One Crore Thrity lakhs Six thousands Seven only),

235

Iodine Deficiency Disorder Addressing Iodine Deficiency Disorders in Bihar.

Introduction: Iodine deficiency is a world wide public health problem. It is the major cause of brain damage loss of energy, learning disability, poor motivation, poor human resource development and child survival. Thus, it remains a major threat to the health and development of school children and pregnant women. Children with iodine deficiency have intelligence (I.Q) 13.5 points less than that of children from areas where there is no iron deficiency. The only solution to this is simple and affordable, which is consumption of iodised salt. IDD elimination Programme was launched in the late 1960s. By 1988 legislative measures were put in place to ban the sale of non-iodised salt in the entire state. During the United Nations General Assembly Special Session for Children (2002), India has committed to eliminate IDD by 2005. Although, in national policy commitments, India commits to eliminate IDD by 2010, there is an urgent need to accelerate the strategy in India, especially when a decreasing trend, 49% to 37% (1998-99 to 2002-03), has been seen in households consuming adequately iodised salt. Iodine Deficiency Disorders in Bihar: In Bihar the northern part of the state lies in the sub-Himalayan region in which the existence of severe to moderate iodine deficiency in this region is well established. A recent study was undertaken in Bihar with support from UNICEF for Government of Bihar, to track progress towards sustainable elimination of IDD from the state. The results of the study reveal that iodine deficiency continues to be a public health problem. A high proportion of population (31.5%) has very low urinary iodine excretion suggesting existence of severe iodine deficiency in many pockets. Only 40.1% of the households consume adequately iodised salt. The findings of this study warrant instituting corrective measure on a war footing to ensure that the population of Bihar has access to adequately iodised salt and at least 80% of the households receive and use adequately iodised salt. Major Objectives:

• Creating universal demand for iodised salt at consumption level • Strengthening the monitoring system at the production level

Role of Each Department: Awareness generation among consumers is a corner stone of the strategy and all possible means to disseminate information about the benefits of consuming iodised salt and to trigger behaviour change among the population. This surely requires the contribution of stakeholders outside the Health Department. In this regard the ICDS with its extended network of AWCs is a strong link through which the vulnerable population groups in the community can be reached out

236

The priority of Iodine Deficiency Disorders should also be shouldered by the Education department. Schools provide an excellent infrastructure for promotional activities to reach out to masses thru children. Teachers can be trained for encouraging students to influence their families in purchasing iodised salt highlighting the benefit of IQ difference in children with iodine deficiency. Thus, a series of activities could be organized for awareness creation among children, who in turn can be expected to serve as change agents for influencing their families. Health:

Health is the nodal department, while ICDS and Education will be the collaborating Departments. These have been specified under the role of departments of ICDS and Higher Education. To begin with the district will form a co-ordination Committee to take decisions on priority actions and review the progress of work once every quarter. However, the State Health Department will ensure the following:

- Formation of District Co-ordination Committee to prioritize actions and review progress

quarterly.

- Directives to be issued to medical colleges and district hospitals and super specialty hospitals, for using iodised salt in cooking meals for the patients.

- Civil Surgeon to hold meetings of lab technician and Food Inspectors in his district. - State Nutrition cell to ensure the following to districts and districts to distribute to AWCS,

through CDPOs and to Schools through BEOs. - Reporting format - Distribution of STKs - Distribution of IEC material - Financial Support.

ICDS:

- Same Letter signed by Civil Surgeon, DPO and DSE for co-ordination by the functionaries of three district departments to organize and conduct joint training of ANMs and AWWs.

- Directives to be re-issued as a reminder for use of iodised salt in supplementary food AWCs.

Functions of District Co-ordination Committee:

1. To facilitate Orientation and Planning Meetings for awareness generation and to strengthen monitoring of salt quality

2. To support organization and implementation of awareness campaigns through schools and AWCs to reach out to the communities.

3. To monitor campaigns/activities under the 3 departments and prepare district reports

4. To institute follow-up actions in blocks areas with low or no iodine salt sale and consumption.

237

- DPOs/DWOs to plan and conduct the orientation of CDPOs and LS. - CDPOs/LS to organize and carryout block level training of AWWs and their ANM along

with MOICs and BEO - MOIC/CDPO to ensure supply of ST Kits, IEC materials, cash assistance etc to AWCs - Prepare a monitoring plan and carry out monitoring of the planned activities jointly in the

village or community by involving the leaders, youth or school children. - Every AWW to prepare an Activity Report including a report on monitoring of salt - MOIC and CDPO to conduct joint review meetings with ANMs and AWWs in her/his block

on 25th of every month. - DPO/CSEO to hold meeting of BEOs on 28th of every month and receive reports for all

schools in his district by 28th of every month. - These meetings also to be utilized for planning activities for the next month with time line

budget and role specificity. - MOIC and CDPO to facilitate organizing of activities in villages/tolas, AWW to take the

lead. - ANM and AWW to prepare a joint report of activities to CS and DWO /DPO. - A copy of the report will be given to DSM. - DSM will forward a copy to RSM. - CS will forward a copy to MIS Cell of State Nutrition Cell. - MIS Cell will share a district-wise compiled report with UNICEF.

Education: - Directives from DEO using iodised salt only in MDM in schools. - District DEO to facilitate and complete training of BEOs on IDD/USI - BEO to conduct training of Nodal Teachers along with MOIC/CDPO at the Block - Support Nodal Teachers to prepare a plan of activities and budget for the schools. - Submit a copy of plan and the budget of schools to DEOs office. - All students in the school to be sensitized with the problem of IDD and the benefits of

iodised salt.

Sensitizing School Children on IDD/IS School teacher shall take a 30 minutes class, and would explain to children why iodine is important, causes of iodine deficiency disorder, and consequences of IDD with emphasis on physical and mental development. Explain that iodised salt helps bring back iodine to the body. Thus iodised salt is important, but both iodised and non-iodised salt is available. Give emphasis to the difference in the IQ points up to 13, in children with iodine deficiency thus affecting leaning and school performance which further reflects on workout put and productivity. Thus good health can be ensured only with daily consumption of iodised salt.

238

Activities within the school:

- Essay/Story competition -Poetry Writing - Exhibitions -Play/Skits - Slogan writing -Songs

-All children participating, to get a certificate and the best child/ children to get a prize)

- BEOs to ensure supply of ST Kits, IEC materials, cash assistance etc to schools - Prepare a monitoring plan and carry out monitoring of the planned activities in the school

along with MOICs and CDPOs. - Head Masters to facilitate organizing of activities within and outside school, Nodal Teacher

to take the lead. Activities outside the school:

- Organize Salt monitoring for advocacy in the community - Each Nodal Teacher to choose 20 children living in different localities - Each student to visit 15-20 houses and shops around them for monitoring and advocacy.

- Slogans to be used for Prabhat Pheri - Human Chain - Marathon/Bicycle Race

- All children to get a certificate, and the best performer to get a prize.

Monitoring salt for iodine content in the class room: All children requested to bring few pinches of salt from their homes Teacher to supervise the testing of salt using the kit, by each child. Children would be classified into two groups. Group 1 will have children with salt samples tested with adequate iodine. Group II will have children with salt samples tested with no iodine or inadequate iodine. Counseling to Group I: “Your salt is of good quality and would allow you to perform well in school if you continue consuming iodised salt as you are and pay attention to your studies in the school. Insist that your parents always buy iodised salt only”. Counseling to GroupII. “Your salt does not contain iodine. Your are being left out from its benefits. If this continues, you are likely to face some serious risks. Your growth can be retarded and at the same time your school performance would be negatively affected. This can happen to your brothers and sisters, as they are also consuming the same salt without iodine or less amount of iodine that is required by the body. When we have the same session repeated next month, your salt test should show blue colour which means you have convinced your parents to buy salt which is iodised. In general, the Teacher should say, we want to see all children in group I and none in the other group. So our class should have children all using iodised salt.

239

- Each nodal teacher to prepare report for her class. - Every school to prepare an Activity Report including a report on monitoring of salt - BEO to conduct review meetings with Head Masters/Nodal Teachers on 25th and collect the

report for all schools in his block 25th of every month. - DEO to hold meeting of BEOs on 28th of every month and receive reports for all schools in

his district by 28th of every month. - These meetings also to be utilized for planning activities for the next month with time line

budget and role specificity. Monitoring and Reporting: The monitoring of the activities will be done by the block level officers of all three departments. A plan for monitoring will be ensured and will prepared during the planning meetings. Each AWC/ANM will prepare a report and forward it to MOIC, CDPO BDO. The schools will prepare the activity report and forward it to BEO and BDO. The MOICs will compile and send the report to CS while, the CDPO will compile and send the report to DPO/DWO with a copy to CS. The BEO will compile for all schools in the block and forward it to DEO with a copy to CS. Civil Surgeon Office will prepare a final compiled report for the district and forward it to State Nutrition Cell, copy to Directorate ICDS and Education, Government of Bihar, Patna. State Nutrition Cell and UNICEF along with Directors of respective departments will hold review meetings to discuss progress and strengthen efforts in low consumptions areas. State Nutrition Cell with support from UNICEF will also facilitate State Task Force Meeting in end September to take stock of achievements and future course of actions.

_______________________________________________

240

Budget for Intensified IDD / USI Activities in 38 District of Bihar

Sl No. Name of District No. of PHC Training @ Rs.1000

Awareness @ Rs. 500

Activities in School @ 1000

Activates at AWC &

Communities

@ 500

IEC Material @ Rs.435

1 ARWAL 5 5000 2500 5000 2500 2176 2 AURANGABAD 11 11000 5500 11000 5500 4786 3 BANKA 10 10000 5000 10000 5000 4351 4 BEGUSARAI 19 19000 9500 19000 9500 8267 5 BHAGALPUR 12 12000 6000 12000 6000 5221 6 BHOJPUR 13 13000 6500 13000 6500 5656 7 BUXAR 7 7000 3500 7000 3500 3046 8 DARBHANGA 18 18000 9000 18000 9000 7832 9 EAST CHAMPARAN 21 21000 10500 21000 10500 9137 10 GAYA 24 24000 12000 24000 12000 10443 11 GOPALGANJ 14 14000 7000 14000 7000 6092 12 JAHANABAD 8 8000 4000 8000 4000 3481 13 JAMUI 11 11000 5500 11000 5500 4786 14 KAIMUR 11 11000 5500 11000 5500 4786 15 KATIHAR 17 17000 8500 17000 8500 7397 16 KHAGARIA 8 8000 4000 8000 4000 3481 17 KISHANGANJ 8 8000 4000 8000 4000 3481 18 LAKHISARAI 6 6000 3000 6000 3000 2611 19 MADHUBANI 19 19000 9500 19000 9500 8267 20 MUNGER 12 12000 6000 12000 6000 5221 21 MUZAFFARPUR 15 15000 7500 15000 7500 6527 22 NALANDA 23 23000 11500 23000 11500 10008 23 NAWADA 15 15000 7500 15000 7500 6527 24 PATNA 28 28000 14000 28000 14000 12183

241

25 ROHTAS 19 19000 9500 19000 9500 8267 26 SAMASTIPUR 15 15000 7500 15000 7500 6527 27 SARAN 16 16000 8000 16000 8000 6962 28 SEOHAR 5 5000 2500 5000 2500 2176 29 SHEIKHPURA 7 7000 3500 7000 3500 3046 30 SITAMARHI 14 14000 7000 14000 7000 6092 31 SIWAN 16 16000 8000 16000 8000 6962 32 VAISHALI 16 16000 8000 16000 8000 6962 33 WEST CHAMPARAN 17 17000 8500 17000 8500 7397 34 Supaul 13 13000 6500 13000 6500 5656 35 Saharsa 11 11000 5500 11000 5500 4786 36 Purnia 15 15000 7500 15000 7500 6527 37 Madhepura 15 15000 7500 15000 7500 6527 38 Araria 10 10000 5000 10000 5000 4351

Total 524 524000 262000 524000 262000 228000

Sl No.

Particulars Rate Total Amount in Rs.

1 Training Rs. 1000 / PHC 524000 2 Awareness Generation Rs. 500 / PHC 262000 3 Activities in School Rs. 1000 / PHC 524000 4 IEC Material Rs. 400 / PHC 228000 5 Activities in AWC & Communities Rs. 500 262000

Grand Total 1800000

Total Eighteen Lakh.

243

PROJECT IMPLEMENTATION PLAN

FOR

NATIONAL PROGRAMME FOR

CONTROL OF BLINDNESS

2009 – 2010

244

PROJECT IMPLEMENTATION PLAN

FOR

NATIONAL PROGRAMME FOR

CONTROL OF BLINDNESS

2009 – 2010

245

Introduction

National Programme for Control of Blindness (NPCB) was launched in the

year 1976 as a 100% centrally sponsored scheme with the goal of reducing

the prevalence of blindness. The goal set for the terminal year of the 10th

Plan is to reduce the prevalence of blindness to 0.8% by 2007 prevalence of

Blindness is 1% (2006-07 Survey) and 0.3% of population by 2020.

The four pronged strategy of the programme is: • strengthening service delivery, • developing human resources for eye care, • promoting outreach activities and public awareness and • developing institutional capacity.

NATIONAL POLICY :

One of the basic human right is ‘THE RIGHT TO SIGHT’ we

have to ensure that no citizen goes blind needlessly, or bring

blind does not remain so, if by reasonable skill and resources

his sight can be prevented from deteriorating, of if already lost

can be restored.

246

National Programme for Control of Blindness (Financial Year 2009-2010)

There are two main Programmes under National Programme

for Control of Blindness:

(1) Cataract Operation

(2) School Eye Screenings Programme:

Cataract Operation:- Cataract Operations are being done in

district Hospitals against the target fixed by state. In addition

in the NGOs governed hospitals under the monitoring of

District Health Society- Blindness Division.

The following table shows the last six year’s physical

record of Cataract Operation:-

Sl. No. Year Target Achievement Percentage 1. 2003-04 140000 90405 64.58 2. 2004-05 140000 102531 73.24 3. 2005-06 140000 131860 94.19 4. 2006-07 140000 129064 92.19 5. 2007-08 140000 137685 98.35 6. 2008-2009

Till Feb,09 150000 82106

School Eye Screening Programme :- Teachers are being

trained, to conduct eye screening of the school children and to

advise for using proper spectacles by the needy children with

defective eyes is one of the main activities of the Programme.

In addition to this free distribution of spectacles among the

families belonging to below Poverty Line (BPL) is also a major

component of the activities.

247

The following table shows the last four year’s physical record of SES :-

Sl. No. Year No. of school children underwent

Eye Screening 1. 2005-06 2,97,278

2. 2006-07 2,43,095

3. 2007-08 284398

4. 2008-2009 up to June,08

55387

Review Meeting: - A Two days Review Meeting of Additional

Chief Medical Officer who is also the District Programme Officer

of National Programme for Control of Blindness is proposed in

near feature in which representative of Govt. of India shall also

be requested to attend.

State Level Workshop:- Three days State Level Workshop of

Eye specialist/Eye surgeon of district level is also proposed in

which representative of Govt. of India shall also be invited to

attend.

Vision Centre:- In remote rural areas where there is no facility

of eye care , Govt. of India has provision for setting up vision

centre by the NGOs where all facilities for eye care shall be

made available.

Training :- Under the NPCB training to Medical Officer of PHC,

PMOAs and Nurses shall be imparted. Medical Officers shall be

trained for three days, PMOAs for five days and 28 days

training to the Nurses as per Govt. of India guideline.

IEC:- In order to make aware the people about how to take care

of their eyes to acquaint them where to report for eye check up

248

in case of any vision problem through hand bill, pump let,

poster, banner, cable net work, hoarding and Doordarshan etc.

Causes of Blindness in Bihar State :

Following is the table showing the causes of blindness

according to their magnitude of importance in the overall

situation of blindness problem.

F Cataract

F Refractive Errors

F Corneal Blindness

F Glaucoma

F Surgical Complications

F Posterior segment disorders

F Others

Emerging Causes of Blindness :

F Diabetic retinopathy

F Glaucoma

F Childhood blindness

249

Comparison of Prevalence of Blindness National Surveys

on Blindness 1986-89 & 2001-2002

Parameter National Survey

1986-89 National Survey

2001-2002

Estd. Prevalence of Blindness

(Visual Acuity <6/60

1.49

1.1

Bihar 1.28 0.78

Plan of Action and Budgetary requirements during 2009-2010 Recurring Grants in Aid to NGOs for performing free Cataract

Operation and other Intra Ocular Surgeries.

Sl.No. ICCE IOL Phaco Total Cataract operation and other Intra Ocular Surgeries 1,50,00,000 9,00,00,000 10,50,00,000 Drug and Consumable 150 200 200 Sutures 50 50 Spectacles 125 125 125 Transportation/POL 100 100 100 Organization & Publicity 75 75 75 Icl, Viscoelastics & Addl. Consumables 0 200 250 Total 500 750 750 Target:- 150000 20% 80% 100%

250

Plan of action and Budgetary requirements during 2009-2010

Sl. No. Name of Activity Estimated Cost. (Rupees in

Lakhs) 1. Remuneration, other activities & contingencies (Annex-A) 15.00 2. Grant-in-Aid other Components-) 473.75 3. Cash Grant for Salaries & SOC 30.00 TOTAL:- 518.75

Budgetary requirement during 2009-2010 Annexure-A

Sl.No. Particulars Cost p.a. 1. Review Meeting 80,000 2. Flexi pool fund (for staff remuneration & other ) 10,80,000 3. TA/DA for Staff 96,000 4. POL/Vehicle Maintenance 72,000 5. Stationary and Consumables 52,000 6. State level Workshop 120,000 Total 15,00,000 Annexure-B Grant in Aid other components-

1. Recurring GIA for Eye Donation 150,000 2. Vision Centre ( 50 @ 25,000/- per vision centres ) 625,000 3. Eye Bank 5,00,000 4. Eye Donation Centre 1,00,000 5. Training 5,00,000 6. IEC ( Schedule –A) 5,00,000 7. GIA for free Cataract Operation for 38/ DHS-Blindness

Division 4,40,00,000

8. GIA for School Eye Screening for 38 DHS- Blindness Division 10,00,000 Total:- 4,73,75,000

251

Schedule :- 1

IEC CAMPAIGN: PROPOSED BUDGET FOR IEC ACTIVITES DURING 2009-2010

Sl.No. IEC Materials Tentative Quantity Rate (approx)

Estimated Cost (Rs.)

1. Hand Bill (For Eye) 1 Lakh 0.25/- piece 25,000 2. Hand Bill (For Children)1 Lakh 0.25/- piece 25,000 3. Leaflet 50 thousand 0.50/- piece 25,000 4. Poster 40 thousand 1.25/- piece 50,000 5. Banner 1000 (Five thousand) (38 District

& Head Quarter) 80/- piece 80,000

6. Cable Head Quarter – 3500/- 61,000 7. Hoarding (38 District & Head Quarter – 39 6000/- 2,34,000

TOTAL 5,00,,000.00

252

Plan of Action and Budgetary requirements during 2009-2010 Recurring Grants in Aid to NGOs for performing free Cataract

Operation and other Intra Ocular Surgeries.

Sl. No.

Name of Dist.

Target

Total fund allocated by GOI for Cataract Operation

for 38 DHS-Blindness Division during 2009-2010

(Rs. in lacs)

Total fund allocated by GOI for School Screening

Programme for 38 DHS-Blindness Division during

2009-2010 (Rs. in lacs)

Remarks

Fund directly

allocated by GOI for DHS

1. Araria 2000 - Do - 2. Arwal 500 - Do - 3. Aurangabad 3000 - Do - 4. Banka 1500 - Do - 5. Begusarai 4000 - Do - 6. Bhagalpur 6000 - Do - 7. Bhojpur 6000 - Do - 8. Buxar 3000 - Do - 9. Darbhanga 6000 - Do - 10. E.Champn. 2500 - Do - 11. Gaya 23000 - Do - 12. Gopalganj 2000 - Do - 13. Jamui 1500 - Do - 14. Jehanabad 2000 - Do - 15. Kaimur 2000 - Do - 16. Katihar 4000 - Do - 17. Khagaria 1500 - Do - 18. Kishanganj 2000 - Do - 19. Lakhisarai 1000 - Do - 20. Madhepura 1000 - Do - 21. Madhubani 1500 - Do - 22. Munger 2000 - Do - 23. Muzaffarpur 11000 - Do - 24. Nalanda 11000 - Do - 25. Nawada 3000 - Do - 26. Patna 22000 - Do - 27. Purnia 4000 - Do - 28. Rohtas 2000 - Do - 29. Saharsa 2000 - Do - 30. Samastipur 2000 - Do - 31. Saran 3000 - Do - 32. Sheikhpura 500 - Do - 33. Sheohar 500 - Do - 34. Sitamarhi 1000 - Do - 35. Siwan 2500 - Do - 36. Supaul 1000 - Do - 37. Vaishali 3500 - Do - 38. W.Chamn. 3000 - Do -

Total 150000 -

253

Recurring Grants in Aid to NGOs for performing free Cataract Operation and other Intra Ocular Surgeries.

Sl.No.

Name of Dist.

Target ICCE @500/- (20%)

ECCE/IOL@ 750/- (80%)

Phaco Total

1. Araria 2000 200,000.00 1,200,000.00 - 1,400,000.00 2. Arwal 500 50,000.00 300,000.00 - 350,000.00 3. Aurangabad 3000 300,000.00 1,800,000.00 - 2,100,000.00 4. Banka 1500 150,000.00 900,000.00 - 1,050,000.00 5. Begusarai 4000 400,000.00 2,400,000.00 - 2,800,000.00 6. Bhagalpur 6000 600,000.00 3,600,000.00 - 4,200,000.00 7. Bhojpur 6000 600,000.00 3,600,000.00 - 4,200,000.00 8. Buxar 3000 300,000.00 1,800,000.00 - 2,100,000.00 9. Darbhanga 6000 600,000.00 3,600,000.00 - 4,200,000.00

10. E.Champn. 2500 250,000.00 1,500,000.00 - 1,750,000.00 11. Gaya 23000 2,300,000.00 13,800,000.00 - 16,100,000.00 12. Gopalganj 2000 200,000.00 1,200,000.00 - 1,400,000.00 13. Jamui 1500 150,000.00 900,000.00 - 1,050,000.00 14. Jehanabad 2000 200,000.00 1,200,000.00 - 1,400,000.00 15. Kaimur 2000 200,000.00 1,200,000.00 - 1,400,000.00 16. Katihar 4000 400,000.00 2,400,000.00 - 2,800,000.00 17. Khagaria 1500 150,000.00 900,000.00 - 1,050,000.00 18. Kishanganj 2000 200,000.00 1,200,000.00 - 1,400,000.00 19. Lakhisarai 1000 100,000.00 600,000.00 - 700,000.00 20. Madhepura 1000 100,000.00 600,000.00 - 700,000.00 21. Madhubani 1500 150,000.00 900,000.00 - 1,050,000.00 22. Munger 2000 200,000.00 1,200,000.00 - 1,400,000.00 23. Muzaffarpur 11000 1,100,000.00 6,600,000.00 - 7,700,000.00 24. Nalanda 11000 1,100,000.00 6,600,000.00 - 7,700,000.00 25. Nawada 3000 300,000.00 1,800,000.00 - 2,100,000.00 26. Patna 22000 2,200,000.00 13,200,000.00 - 15,400,000.00 27. Purnia 4000 400,000.00 2,400,000.00 - 2,800,000.00 28. Rohtas 2000 200,000.00 1,200,000.00 - 1,400,000.00 29. Saharsa 2000 200,000.00 1,200,000.00 - 1,400,000.00 30. Samastipur 2000 200,000.00 1,200,000.00 - 1,400,000.00 31. Saran 3000 300,000.00 1,800,000.00 - 2,100,000.00 32. Sheikhpura 500 50,000.00 300,000.00 - 350,000.00 33. Sheohar 500 50,000.00 300,000.00 - 350,000.00 34. Sitamarhi 1000 100,000.00 600,000.00 - 700,000.00 35. Siwan 2500 250,000.00 1,500,000.00 - 1,750,000.00 36. Supaul 1000 100,000.00 600,000.00 - 700,000.00 37. Vaishali 3500 350,000.00 2,100,000.00 - 2,450,000.00 38. W.Chamn. 3000 300,000.00 1,800,000.00 - 2,100,000.00

Total 150000 15,000,000.00 90,000,000.00 - 105,000,000.00

254

(Details of GIA for strengthening /expansion of eye care units in NGOs sector, Eye bank, eye donation Centres, IEC ,Training etc. under NPCB during 2008-2009.

Sl.no

Grant in Aid for various schemes.

Balance available

as on 1.4.2008

Fund received from GOI

during 2008-09 fund utilised/

disbursed Balance

as on 31.12.2008

-

1 Cataract Operation (for DBCS)

- 7,000,000.00

7,000,000.00

-

2 School Eye Screening 28,000.00

1,000,000.00 -

1,028,000.00

3 Eye Donation 100,000.00

250,000.00 -

350,000.00

4 Vision Centre - 563,000.00 -

563,000.00

5 Eye Banks - - -

6 Eye Donation Centres 150,000.00 - -

150,000.00

7 Training 222,736.00

250,000.00 -

472,736.00

8 IEC Activities 184,631.00

450,000.00 -

634,631.00

9 SBCS remuneration and other activities (108,620.35)

800,000.00

132,166.00

559,213.65

10 Cash Grant - - -

11 Non recurring GIA to NGOs - - -

Total:- 576,746.65

10,313,000.00

7,132,166.00

3,757,580.65

Note:- Grant in aid of central assistance received from GOI,MH& FW, New Delhi vide letter no. T.12012/11/2006-BC dated 18.3.2008 for implementation of the following various new scheme under NPCB during 2007-2008. Received in Financial year 2008-2009 through ECS dt. on 3.4.2008

Name of Activities:

F/Y 2007-2008 fund received on

3.4.2008

Fund received from

GOI during F/Y 2008-

2009

Total fund received during

the F/Y 2008-2009 from GOI

Cataract Operation (for DBCS)

7000000 7000000 School Eye Screening 500000 500000 1000000 Recurring GIA for Eye donation 250000 0 250000 Non recurring GIA for Vision Centre 563000 0 563000 Training Activities 250000 0 250000 IEC Activities 250000 200000 450000

SBCS staff remuneration and other activities 500000 300000 800000

Total: 2313000 8000000 10313000

255

Details of GIA for Procurement of Ophthalmic Equipments under NPCB during 2008-2009

Sl.No Grant in Aid for various Schemes

Balance available

as on 1.4.2008

Budget Allocated

GIA released by

GOI Expenditure/

Disbursed

Balance as on

31.12.2008 0 1 Procurement

for Ophthalmic equipments (DBCS)

7,991,500.00 - - - 7,991,500.00

2 Medical Colleges:_

a)

S.K. Medical College & Hospital, Muzaffarpur -

3,000,000.00

3,000,000.00 -

3,000,000.00

Total:- 7,991,500.00 3,000,000.00

3,000,000.00 -

10,991,500.00

256

Schedule :- 2 Fund allocated to DHS as per PIP allocation during the financial year 2009-2010 Sl.No. Name of

District Year Target GIA for

free cataract operation for

38 DHS of Rs.

4,40,00,000

GIA for School Eye Screening for 38 DHS

of Rs. 10,00,000

Fund allocated to DHS as per PIP allocation

Total Rs.4,50,00,000 1 Araria 2009-2010 2000 600,000.00 2 Arwal 2009-2010 500 150,000.00 3 Aurangabad 2009-2010 3000 900,000.00 4 Banka 2009-2010 1500 450,000.00 5 Begusarai 2009-2010 4000 1,200,000.00 6 Bhagalpur 2009-2010 6000 1,800,000.00 7 Bhojpur 2009-2010 6000 1,800,000.00 8 Buxar 2009-2010 3000 900,000.00 9 Darbhanga 2009-2010 6000 1,800,000.00 10 E.Champn. 2009-2010 2500 750,000.00 11 Gaya 2009-2010 25000 7,500,000.00 12 Gopalganj 2009-2010 2000 600,000.00 13 Jamui 2009-2010 1500 450,000.00 14 Jehanabad 2009-2010 2000 600,000.00 15 Kaimur 2009-2010 2000 600,000.00 16 Katihar 2009-2010 4000 1,200,000.00 17 Khagaria 2009-2010 1500 450,000.00 18 Kishanganj 2009-2010 2000 600,000.00 19 Lakhisarai 2009-2010 1000 300,000.00 20 Madhepura 2009-2010 1000 300,000.00 21 Madhubani 2009-2010 1000 300,000.00 22 Munger 2009-2010 2000 600,000.00 23 Muzaffarpur 2009-2010 11000 3,300,000.00 24 Nalanda 2009-2010 11000 3,300,000.00 25 Nawada 2009-2010 3000 900,000.00 26 Patna 2009-2010 22000 6,600,000.00 27 Purnia 2009-2010 4000 1,200,000.00 28 Rohtas 2009-2010 2000 600,000.00 29 Saharsa 2009-2010 2000 600,000.00 30 Samastipur 2009-2010 2000 600,000.00 31 Saran 2009-2010 3000 900,000.00 32 Sheikhpura 2009-2010 500 150,000.00 33 Sheohar 2009-2010 500 150,000.00 34 Sitamarhi 2009-2010 1000 300,000.00 35 Siwan 2009-2010 2500 750,000.00 36 Supaul 2009-2010 1000 300,000.00 37 Viashali 2009-2010 3000 900,000.00 38 W.Chamn. 2009-2010 2000 600,000.00

Total 150000 45,000,000.00 ( Rupees four Crore fifty lac(s) only.)

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Budget summary for Year 2009-2010

Sl. No. Name of activities DHS (Blindnes ) SHSB

(Blindness) Remarks

1 Remuneration,other activities & contingencies ( Annex.-A) -

1,500,000.00 SHSB,level

2 Recurring GIA for Eye donation

-

150,000.00

Disbursement of fund to DHS after approval .

3 Vision Centre

-

625,000.00

4 Eye Bank

-

500,000.00

5 Eye Donation Centre

-

100,000.00

6 Training

500,000.00 SHSB,level

7 IEC

500,000.00 SHSB,level 8 GIA for Cataract Operation

44,000,000.00

Fund disbursement

to DHS after approval . 9 GIA for SES

1,000,000.00

10 Cash grant for salaries & SOC

3,000,000.00 SHSB, level

Total:-

45,000,000.00

6,875,000.00 51,875,000.00

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ACTION PLAN

(2009 – 2010) National Leprosy Eradication

Programme (NLEP) – BIHAR

259

National Leprosy Eradication Programme (11th five Year Plan 2007 – 2012)

State Action Plan 2009 – 2010

BIHAR

Executive Summary:

• Even though new case detection rate and prevalence rate are going down, yet new cases continue to come up in large numbers in state.

• The promotion of self reporting is now crucial to case detection, as

case finding campaigns become less and less cost effective. It is important to identify and remove barriers that may prevent new cases coming forward and a greater emphasis on the assessment of disability at diagnosis, so that those at particular can be recognized and managed appropriately.

• Leprosy being a disease associated with poverty, it is presumed there

are still hidden cases in the SC and among the underprivileged in other categories, in both rural and urban areas.

• Under special initiatives, to promote self reporting, focus will be on

wide dissemination of key messages of leprosy i.e. curable, early signs, no need to be feared and support, in the urban and rural areas. This will reduce stigma & discrimination against persons affected with leprosy. The key messages along with proactive involvement of the community will bring about health behavior at individual, household and community level.

• The out come of strategy will be promote further integration with

general health care system by providing operational and technical on the job training. The better equipped and motivated GHC system will provide quality leprosy services on all working days to the affected communities, following the principles of equity and social justice.

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Background:

• National Leprosy Control Programme was started by Govt. of India in 1955 based on Dapsone Monotherapy through units implementing survey, education and treatment activities. It was only in 1970s that a definite cure was identified in the form of Multi Drug Therapy. The MDT came into wide use from 1982, following the recommendation by WHO study Group, Geneva in October 1981. Government of India established a high power committee under chairmanship of Dr. M. S. Swaminathan in 1981 for dealing with the problem of leprosy. Based on its recommendations the National Leprosy Eradication Programme (NLEP) was launched in 1983 with objective to arrest the disease activities in all the known cases of leprosy.

• In order to strengthen the process of eradication, the World Bank

supported the project in two phases. The first phase was started in 1993 – 94 and ended on 31st March 2000. The second phase started in year 2001 – 2002 and ended on 31st December 2004. Now since 2005 the project is being continued with GOI funds. The cost of infrastructure is borne by the state funds. Additional support is received from World Health Organisation and ILEP (International Federation of Anti-Leprosy Associations). Multi Drug Therapy (MDT) was supplied free of cost by Novartis through WHO.

• In Bihar whole state was covered under MDT in November 1996.

• In Bihar till date more than 15 lakhs patients treated with leprosy.

• The PR reduced to 14.2/10000 populations in year 1999.

• Integration of leprosy services in to general health care system started

in 2000 – 01 and fully integrated in 2003 -04.

• Five rounds of Modified Leprosy Elimination Campaigns (MLECs) and four rounds of Block Level Awareness campaigns have been already successfully conducted in the state during the period 1998 to 2008. These activities resulted in detection of more than 4 lakh cases.

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MDT in Bihar:

• MDT started in Bihar in phased manner.

• In composite state of Bihar, first phase MDT was started in two districts in 1982 (Bhagalpur & Rohtas).

• 13 more districts added in 1994.

• MDT was launched in whole state in 1996 – 97.

Current status:

• From 1996 – 97 onwards when entire state was brought under MDT, a steady decline in PR was recorded. The PR of 17.3/10000 populations in 1996-97 declined to 1.04/10000 populations on 31st March 2008.

• Now state is at the verge of elimination considering PR 1.04/10000

populations on March 2008.

• 15 districts reached elimination and 23 districts have PR between 1 to 2 as on 31st March 2008.

• At present the NLEP is fully integrated into General Health Care

System from subcentre to District Hospitals/Medical Colleges.

• District Nucleus is formed at 36 out of 38 districts to monitor and supervise the programme.

• The IEC activities including Inter Personal Communication are

continued and therefore stigma has significantly come down. At present most of leprosy affected deformed patients are living with their family and leprosy patients are coming at health institutions voluntarily.

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STATE PROFILE

Bihar is the third largest populated state in the country. There are 38

districts in the state. Bihar is divided in two geographical areas- North

and south areas

POPULATION (2001 census)* *Estimated Population as on March 2008

829988509 98516843

MALES 43243795

FEMALES 39754714

SEX RATIO (females/1000 males) 921

DENSITY OF POPULATION (Persons/ Square Km)

880

URBAN POPULATION % 10.47

LITERACY RATE (census 2001) in % 47

MALE LITERACY in % 59.7

MALE LITERATE in numbers 20644376

FEMALE LITERACY in % 33.1

FEMALE LITERATE in numbers 10465201

BIRTH RATE (PER 1000) 30.9

DEATH RATE (PER 1000) 7.9

District Hospital 24

Sub- Divisional Hospital 23

Referral Hospital 71

Primary Health Centre (PHCs) 484

Additional Primary Health Centre (APHCs)

1243

Health Sub-Centre 8858

No. of Villages 45100

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Situational Analysis – As on September 2008/ Districts/Blocks/Urbans Indicators recommended by GOI for Monitoring & Supervision: The Government of India has recommended the following three indicators:- (I) Major indicators:

(1) Annual New Case Detection Rate(ANCDR) per 100000 population (2) Treatment Completion Rate (3) Prevalence Rate

(II) Additional Indicators:

(1) Proportions of Grade I disability among new cases (2) Proportions of Grade II disability among new cases (3) Proportions of child cases among new cases (4) Proportions of female cases among new cases (5) Proportions of MB cases among new cases

(III) Indicators for patient management and follow up: (1) The proportion of new cases correctly diagnosed (2) The proportion of treatment defaulters (3) Number of relapse reported during year (4) The proportion of patients who develop new or additional disabilities

during MDT.

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Shift in focus from PR to ANCDR: Since 2008-09 a shift in focus from PR to ANCDR was introduced, as it is a better indicator for epidemiological analysis.

Sl. No. District

Active Balance

case at the end of

September 2008

PD Ratio

Female (%)

New Visible Deformity (%) Grade

II

Child % MB % PR/ 10,000

NCDR per 100,000

1 Aurangabad 294 0.60 29.26 1.85 15.93 34.07 1.23 20.4 2 Bhojpur 239 0.51 32.57 3.21 22.02 33.94 0.90 13.7 3 Buxar 168 0.61 29.68 0.65 15.48 41.29 1.01 17.5 4 Bhagalpur 396 0.89 34.84 3.97 15.86 38.53 1.37 12.2 5 Banka 339 0.6 35.60 0.00 0.31 35.60 1.77 26.9 6 Darbhanga 474 0.7 46.87 0.25 21.55 45.11 1.21 17.3 7 Katihar 288 0.78 39.92 2.52 14.29 39.08 1.01 12.9 8 Muzaffarpur 522 0.58 49.71 2.16 14.93 29.47 1.17 20.2 9 Nawadah 378 0.56 42.12 2.99 17.66 32.88 1.76 23.3

10 Patna 702 0.55 30.88 2.28 17.19 51.23 1.25 25.8 11 Purnia 344 0.59 39.93 2.83 15.90 33.92 1.14 18.6 12 Kishanganj 285 0.56 31.1 00 19.79 47.00 1.85 29.9 13 Araria 466 0.64 33.49 1.19 17.10 23.28 1.84 29.2 14 Rohtas 778 0.6 32.33 2.09 27.09 32.33 2.67 42.08 15 Kaimur 425 0.41 30.00 0.00 15.48 45.81 2.78 26.2 16 Siwan 520 0.47 43.43 3.43 18.79 25.66 1.61 22.3 17 Sitamarhi 352 0.5 44.19 1.45 20.35 25.00 1.11 16.8 18 Sheohar 101 0.70 29.09 0.00 12.73 40.00 1.65 20.3 19 W.Champaran 371 0.6 24.24 3.33 19.39 33.33 1.03 17.2 20 Begusarai 287 0.53 34.47 4.17 11.74 42.05 1.03 13.7 21 E.Champaran 547 0.5 36.56 0.97 16.25 27.85 1.17 26.0 22 Gaya 730 0.55 40.06 1.02 21.93 31.43 1.77 25.1 23 Gopalganj 348 0.52 44.02 0.58 21.28 28.28 1.36 18.6 24 Jehanabad 269 0.5 37.85 5.58 17.53 45.02 2.44 31.0 25 Arwal 153 0.49 35.71 1.43 21.43 40.71 2.20 33.8 26 Khagaria 120 0.78 33.33 0.00 7.78 45.56 0.79 10 27 Madhubani 768 0.55 44.34 2.41 16.14 42.23 1.81 22.05 28 Madhepura 226 0.56 45.86 3.01 11.28 48.12 1.25 17.2 29 Munger 203 0.68 45.63 4.38 16.88 33.75 1.50 22.5

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30 Sheikhpura 88 0.61 36.90 00 14.29 47.62 1.41 21.6 31 Jamui 175 0.66 31.29 0.00 12.93 41.50 1.05 18.9 32 Lakhisarai 187 0.72 33.92 0.00 16.37 46.78 1.96 20.4 33 Nalanda 474 0.6 39.60 0.66 21.24 38.72 1.68 26.2 34 Saharsa 171 0.59 46.81 4.26 17.02 34.75 0.95 15.9 35 Supaul 197 0.5 39.64 1.18 9.47 35.50 0.95 17.8 36 Samastipur 433 0.61 36.90 4.79 14.08 39.44 1.07 15.7 37 Saran 524 0.43 29.10 1.23 15.98 44.88 1.36 26.2 38 Vaishali 422 0.68 39.72 1.99 8.28 49.34 1.31 17.2

Total 13764 0.54 37.52 1.96 17.64 36.98 1.40 20.9 ANCDR: (20.9/100000) ANCDR(quarterly) of 21 districts is > 20/100000 of population. These districts are Aurangabad, Banka, Muzaffarpur, Nawada, Patna, Kishanganj, Araria, Rohatas, Kaimur, Siwan, Seohar, East Champaran, Gaya, jahanabad, Arawal, Madhubani, Munger, Sheikhpura, Lakhisarai, Nalanda and Saran. Therefore overall ANCDR of state is also > 20/100000 population

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Treatment Completion Rate- (2007-08):

S.N. Districts Treatment Completion Rate(%) Rural(%) Urban(%) Total(%)

1. Patna 98.9 88.6 94.8 2 Bhojpur 96.2 100 96.6 3 Buxar 94.9 97.2 95.1 4 Aurangabad 98.9 100 98.9 5 Arawal 92.9 No urban 92.9 6 Gaya 96.5 93.7 96.3 7 Nalanda 97.3 98.7 97.4 8 Nawada 94.3 00 94.2 9 Rohtas 97.4 97.9 97.4 10 Vaishali 87.2 47.3 83.5 11 Bhagalpur 97.7 73.08 95.3 12 Banka 95.6 92.7 95.5 13 Khagaria 94.08 100 94.2 14 Muzaffarpur 93.5 98.08 93.8 15 Samastipur 91.07 90.7 91.05 16 East Champaran 95.02 100 95.06 17 Sitamarhi 94.9 92.9 94.9 18 Seohar 87.2 00 87.2 19 Gopalganj 94.5 100 94.7 20 Saran 88.5 67.3 86.06 21 Araria 98.3 100 98.4 22 Saharsa 95.7 88.0 94.9 23 Supaul 100 100 100 24 West Champaran 93.8 100 94.03 25 Siwan 93.2 91.7 93.6 State 94.7 87.4 94.03 • TCR -2007-08 of Bihar state is more than 90% but in urban areas of few

districts TCR is less than 90% and these districts are Patna, Bhagalpur, Saran, Saharasa. TCR of urban Vaishali is very less – 47.3%.

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SWOT analysis: After analysis following are strengths, weaknesses, opportunities and threats in state. Strengths:

1. trained district nucleus 2. Trained experienced & motivated staff 3. Better awareness and reduced stigma 4. Adequacy of MDT 5. Adequacy of fund form GOI and ILEP 6. Better comprehensive infrastructure from subcentre to

Medical college 7. Integration of leprosy services with GHCs staff 8. Training materials are available 9. Regular NLEP staff meetings and monitoring 10. Good coordination – State Health System, WHO &

ILEP 11. Enough people willing to work for the cause.

Weakness:

1. Large state with many districts 2. Reduction in ILEP support 3. No WHO zonal coordinators 4. Complicated procedures for fund utilization for leprosy

work at district level 5. Inadequacy of fund for vehicle operation and

complicated procedure for hiring of vehicle 6. Less support from public opinion leaders 7. Poor POD services 8. Leprosy being last priority of health programme 9. Inadequate funds for rehabilitation and mobility aids 10. Inadequate coordination between staff 11. Vehicles – Using in other programmes by DM and Civil

Surgeons 12. Inadequate training of NGOs/local practitioners 13. incomplete data of deformities 14. Less effective counseling

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Opportunities: 1. Integration with NRHM

(a) Support from ASHA (b) Additional flexible funds (c) Better monitoring and supervision (d) Better infrastructure and man power

2. Integration with GHS 3. Involvement of Medical Colleges/Hospitals/NGOs 4. Full utilization of dermatologists, physicians and

orthopaedic surgeons for diagnosis and rehabilitation 5. Support of ILEP/NGOs/WHO

Threats:

1. Complacency among staff and less political commitment 2. Priority to other programmes 3. Transfer of programme officers at state and district 4. Public stigma 5. No self dependence of sufferer

State will use this SWOT analysis for making strategies and plans in NLEP.

National Leprosy Eradication Programme (11th five year plan 2007 – 2012)

Objectives: • To further reduce the leprosy burden • Provision of high quality leprosy services for all persons affected by

leprosy, through general health care system including referral services for complications and chronic care.

• Enhanced Disability prevention and Medical Rehabilitation (DPMR)

services for deformity in leprosy affected persons. • Enhanced advocacy in order to reduce stigma and stop discrimination

against leprosy affected persons and their families.

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• Capacity building among health service personal in integrated setting

both for rural and urban areas. • Strengthen the monitoring and supervision component of the surveillance

system. Strategy:

(1) Integrated Leprosy Services and Special initiatives.

(2) Disability Prevention and Medical Rehabilitation (DPMR)

(3) Information, Education and Communication

(4) Training and capacity building.

(5) Supervision, monitoring and review.

(6) Infrastructure maintenance Activities as per objectives and strategy: 1. Integrated Leprosy Services and Special initiatives –

1.1 Integrated Leprosy Services through all Primary Health Care facilities

will continue to be provided in the rural areas. 1.2 All the urban areas will be covered under urban leprosy control

programme integrating services from all the partners available in the areas, including private practitioners.

1.3 Involvement of multipurpose health functionaries, ASHA in villages,

and selected NGOs in urban areas are to be engaged for case follow up during treatment to ensure regular MDT collection and consumption, so that all the cases put under treatment gets cured in shortest possible time.

1.4 Emphasis will be laid on providing best quality leprosy services through

the GHC system. This means easy availability of services on all working days to all patients, correct diagnosis and adequate counseling to patients

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and family members, provide MDT to patients whenever approached, regular monitoring of patient during treatment. Treatment completion by all under treatment patients will be desired outcome of the programme.

1.5 The system of referral of difficult cases to the district hospital for

diagnosis and management, which has already been started, will eb further strengthened with capacity building of persons involved at PHC as well district Hospital level.

1.6 The laboratory facilities at District Hospitals for smear examination to

diagnose difficult cases will be strengthened. 1.7 Desegregated data for female, schedule tribe and schedule caste patients

are to be maintained. 1.8 Regular monitoring and surveillance at state, District and Block level

will be continued to locate weak areas, so that needed plan for corrective action can be taken in time.

Services through ASHA: After sensitization of ASHA in Leprosy they will be involved to refer a suspected case of leprosy from their villages for diagnosis at PHC and after diagnosis to follow up the patients for completion of their treatment, ASHA will be entitled to receive incentive as below-

(i) On confirmed diagnosis of cases brought by them – Rs 100/- (ii) On completion of full course of treatment within specified

time – PB Leprosy case – Rs. 200/- MB Leprosy case – Rs. 400/-

Number of new leprosy cases detected cases in 2007-08 – 19041 45% MB cases – 8568 55% PB cases – 10473 (It is expected that 50% of new MB and new PB cases will be brought by ASHA. 50% of PB new cases = 5236 50% of new MB cases = 4284)

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Budget: For MB cases = Rs.500.00*4284 cases = Rs. 2142000.00 For PB cases = Rs. 300.00*5236 = Rs. 1570800.00 Total Cost of services through ASHA = Rs.3712800.00

Urban Leprosy Control : • Total number of town ships selected for ULCP – 24 • Total number of medium city(I) selected for ULCP – 6 • Budget – Rs.75000/- for one town ship x 24 = 1800000/- Rs.150000/- for one medium city(I) x 6 = Rs.900000/- Total cost of Urban Leprosy Control = 2700000/- 2. Disability Prevention and Medical Rehabilitation - More emphasis will be given on Disability prevention among new leprosy cases and RCS services for deformed persons due to leprosy. 2.1 Prevention of Disability: • Health workers will suspect cases of leprosy reaction, relapse, insensitive

hands and feet and refer to PHC for diagnosis. They will also empower patients with self care procedure for prevention of deformity.

• All PHC Medical Officers will diagnose cases of reaction/neuritis,

provide counseling and treat them. Severe reaction/neuritis cases will be referred to the District Hospital if not responded within two weeks of starting treatment.

• Service and care for impairment such as ulcers, cracks and wounds,

septic hand or feet etc. will be available from all the health facilities routinely. Complicated ulcer cases will be referred to District Hospital.

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• Microcellular Rubber (MCR) footwear are to be provided to all needy patients ( under treatment and RFT) by the District nucleus staff at the concerned health facility. An appropriate system of need assessment, procurement and supply will be maintained and improved.

• PHC will provide follow up treatment to all patients referred back by the

secondary and tertiary level units for reaction, complication or post surgery care.

• Operational guidelines on DPMR for primary and secondary level have

been distributed to all districts and PHCs. 2.2 Medical Rehabilitation: • Enlisting of disability cases has been completed in 24 districts and in

remaining 14 districts enlisting is under process. • In districts the patients fit for RCS are being referred to identified RCS

units(Department of PMR at PMCH, Patna and DMCH Darbhanga). • An estimated 200 RCS will be done during this year. Budget for RCS

support and patient welfare for 200 patients is kept. • In addition to this TLM Hospital Muzaffarpur will continue to do RCS

with ILEP support. • It is planned to start RCS in Magadh Medical college, Gaya in this year Incentive to patients undergoing RCS: • Provision to patients undergoing RCS @ Rs. 5000.00 to offset wage loss

to BPL families as recommended by GoI. It is proposed that the above provision may be applied for for surgical Nerve Decompression also. Further it is suggested that leprosy is a disease associated with poverty, the provision of Rs. 5000.00 to offset wage loss may be given to all leprosy patients undergoing RCS/Nerve decompression surgery.

Incentive to Institutions: • Provision to support Government Medical Colleges/PMR centres in the

form of Rs. 5000.00 per RCS case has been kept for procurement of supply and material and other ancillary expenditure.

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Need based supply of MCR footwear to the needy patients will continue during year through District Societies, NGOs and concerned institutions.As grade –I patients with insensitive feet have been included under DPMR plan for MCR supply the number of foot wear requirement will increase. Budget:

(1) Provision to compensate wage loss to BPL persons affected with leprosy undergoing Reconstructive/Nerve Decompression surgery – around 200 persons are expected to be operated. The reimbursement of Rs. 5000.00 is sought to be provided for –

Incentive @ Rs.100.00 per person*2*20 days = Rs. 4000.00 Transportation for 2 persons(4-5 times) = Rs. 1000.00 Total (one RCS) = Rs. 5000.00 For 100 RCS- 5000.00*100 = Rs.500000.00

(2) Provision of incentive to Govt. institutions-

For 100 RCS – 5000.00*100 = Rs. 500000.00

(3) MCR foot wear- 2280 pairs of MCR foot wears @ Rs.250.00

2280*Rs.250.00 = Rs. 1938000.00 Total cost of DPMR = 3413000.00

3. Information, Education & Communication: Introduction – Leprosy is an age old disease. As there was no known remedy for the disease in the earlier days, the viciousness of disease, disfigurement and disability caused by the disease resulting in making the affected persons heavily, led to a number of myths, misconceptions, apprehensions and inhibitions in the minds of people. This resulted in to developing such a high degree of stigma against the disease that the community wanted to avoid all contacts with such persons. The leprosy affected persons were forced to leave their home

274

and live in segregated areas. This is the only disease where sufferer had to live in separate colonies, villages and in distant islands. At present the situation has changed to a greater extent. Now there is cure for leprosy and patient can live in their home during treatment. Because of early treatment deformities and disabilities have reduced. Many discriminatory laws have been repealed all over the world. Yet there is discrimination against the person affected by leprosy, which need to be removed from the public mind, so that these persons can lead normal life like any other human being. Determinants of stigma: Stigma is perpetuated by (1) Lack of knowledge (2) Attitude (3) Fear (4) Blame & shame Intervention strategies: Spreading awareness: Spread the demystifying messages and its interpretations, mainly regarding nature of disease, whether leprosy cases are untouchable, role of immunity in occurrence of leprosy, what is burnt case and so on. However, mere information and education, to all and sundry about the signs and symptoms of leprosy and its curability, shall not work. It is imperative to break the barrier between persons affected by leprosy and the rest of the society, by appealing to the people’s emotions and their ability to empathies with those they feared and shunned. With reducing number of leprosy cases in community, awareness about curability of disease, lessening number of deformity due to leprosy, stigma associated with the disease has become slightly less. The effective way to deal with this difficult challenge of stigma removal is to embark on intensive inter personal communication (IPC) with the target groups The strategy involves, coordinates and facilitated by (1) civil societies (2) social activists (3) Health service providers (4) Community/opinion leaders (5) Corporate sectors (6) Media (7) Institutions under NRHM such as ASHA and other health functionaries, Rogi Kalyan Samities and Village Health & Sanitation Committees, Health Melas at district and block level etc. An IEC campaign towards achieving “Leprosy free India” recommended by GOI will be followed on following concept –

275

• The effort to further reducing leprosy burden in the communities have to be prioritized so that visible deformity in newly detected cases is reduced to minimum.

• Early reporting and complete treatment of leprosy cases prevent disability.

• Quality of services provided to leprosy affected persons be at optimum level to reduce suffering and prevent consequences in all cases put on treatment.

• Leprosy patients will not be stigmatized and discriminated and would lead to a socially and economically productive life.

Budget and norms for IEC: Mass media- Electronic Media – Rs.200000.00 Print media – Rs.100000.00 Out door media- Rallies(including banners) @ Rs.5000/- per district. Budget – Rs.5000.00 x 38 districts = 190000/- Rural Media: School quiz @ Rs.500/- for one quiz. In each block 5 school quiz will be conducted. Budget – Rs.500.00 x 484 blocks x 5 = Rs.1210000/- Sensitisation meeting with PRI members-Rs.4000/- per meeting at each block Rs.4000/. * 484 blocks = 1936000/. Total cost of IEC = Rs.3826000/-

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4. Training Plan(training and capacity building): 4.1 Leprosy training to GHC staff(new entrants) To improve quality of leprosy diagnosis, complications management, DPMR and programme monitoring the key medical and paramedical staffs will be provided trainings. 1400 newly appointed contractual MOs will be provided four days modular training on leprosy and NLEP(including DPMR). Budget – Venue – District head quarter training hall. Trainers(2trainers) TA/DA @ Rs.300/- per day for two days Rs.300.00 x 2 days x 2 trainers = Rs.1200/- TA for trainees @ Rs.80/- per day for 30 trainees for 2 days Rs.80.00 x 30 trainees x 2 days = Rs.4800/- DA for trainees @ Rs.80/- per day for 30 trainees for 2 days. Rs.80.00 x 30 trainees x 2 days = Rs.4800/- Working lunch & tea @ Rs.150/- for 35 persons for 2 days Rs150.00 x 2 days x 35 = Rs.10500/- Learning materials, stationary etc @ Rs.250/- per head for 30 trainees. Rs.250.00 x 30 = 7500/- Miscellaneous – Rs.2500/- per batch. Total expenditure for 2 days training of new MOs for one batch = Rs.31300/- Total number of batches in all districts of Bihar – 47 Total Expenditure – Rs.31300.00 x 47 batches = Rs.1471100/- 4.2 One days refresher training of PHC medical officers: Total number of regular MOs in position – 2712 Total number of batches – 90(batches distributed districtwise) 90 batches x Rs 27300.00 Total expenditure =Rs. 2457000/-

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Consumables: • For SHS(leprosy) Rs.28000/- and for DHS(leprosy) Rs.14000/- per

district will be provided. Office expenses: • For SHS(leprosy) Rs.38000/- and for DHS(leprosy) Rs.18000/- per

district will be provided. Vehicle Operation & Hiring: • Vehicle operation/POL/Hiring for SHS(leprosy) Rs.85000/- for two

vehicles and for DHS(leprosy) Rs.75000/- one vehicle for one district will be kept.

Drugs, Materials & supplies: • For supportive medicine Rs.25000/- per district. • For laboratory reagents- Rs.12000/- per year per district. • For patient welfare – Rs.6000/- per year per district. Printing: • Required numbers of DPMR registers, formats and other formats will be

printed at state head quarter and supplied to districts. (State Officers and WHO/ILEP Coordinators will also monitor the supply of different logistics at each level)

Professional Services: • Audit fees will be met by State Health & FW Society for centralized

audit of 38 DLS & SLS head quarter for preparation of consolidation Audit Report.

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Contractual Services: • As per annexure 1 NLEP Monitoring and Review: • Monitoring of:

- NCDR,TCR,PR & other NLEP indicators - Regularity of treatment & timely RFT - Reports(MPR,MDT indents,Tour reports etc) - Implementation of DPMR trainings with support of ILEP, RCS &

other referral & IEC activities. - On the job training on DPMR formats, modified SIS & MDT stock

management up to subcentre level • DPMR/SIS/MDT management & monitoring of

-MDT stock situation in patient month BCPs -MDT indenting -MDT supply -Availability of prednisolone at PHCs.

• Review Meetings of DLOs and members of District nucleus four times in one year

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Anexxure 1

STATE HEALTH SOCIETY (Leprosy), BIHAR

Budget for Year 2009-2010

Sl. No. Category of Expenditure : Component & Sub Component wise DLS SHSB

(Leprosy) Total of

activities

1 Under SHS(Leprosy) NLEP contractual services(staff)

1.1 40 Drivers for 38 districts & for State Leprosy Cell @Rs.4500/-PM 2052000 108000.00

1.2 DEO at State Leprosy Cell @ Rs.8000/- 96000.00

1.3 Honorarium @ Rs.400/- PM for 38 DLS for account work of Leprosy 182400

1.6 Audit Fees @ Rs.6000/- x 39(38 DHS + 1 SHS -L) 228000.00 6000.00

Total contratual services(1.1 to 1.6) 2462400.00 210000.00 2672400.00

2 Office expences

2.1 SHS(leprosy) for rent,telephone,electricity, P & T charges, miscellaneous-Rs.38000/- per year 38000.00

2.2 DLS(leprosy) for rent,telephone,electricity, P & T charges, miscellaneous-Rs.18000/- per district/ year 684000.00

Total - Office expences(2.1 to 2.2) 684000.00 38000.00 722000.00

3 Consumables

3.1 Consumables for DHS(leprosy) : Stationery etc.@ Rs. 14000/- per dist/year 532000.00

3.2 Consumables for SHS(leprosy) : Stationery etc.@ Rs. 28000/- per year 28000.00

Total - Consumables(3.1 to 3.2) 532000.00 28000.00 560000.00

4 Vehicle operation/hiring & POL/Maintenance

4.1 One vehicle for each DHS(leprosy)-Rs.75000.00 per vehicle/district 2850000.00

4.2 Two vehicles for SHS(Leprosy)-Rs.85000/- per vehicle 170000.00

Total - Vehicle operation(4.1 to 4.2) 2850000.00 170000.00 3020000.00

5 Drugs, materials & supplies

5.1 Supportive medicines-Rs. 25000/-per district/year 950000.00

280

5.2 Laboratory reagents & equipments -Rs.12000/-per district/year 456000.00

5.3 Patient welfare-Rs.6000/- per district/year 228000.00

5.4 Printing of forms/DPMR registers etc 600000.00

Total - Drugs,materials & supplies(5.1 to 5.4) 1634000.00 600000.00 2234000.00

6 IEC

6.1 Mass media:

6.11 Electronic media-Radio/Doordarshan 500000.00

6.12 Print media-News papers 200000.00

6.2 Out door media:

6.21 Sensitisation meeting with PRI members-Rs.4000/- per meeting at each block 1936000.00

6.3 Rural media:

6.31 School quiz-Rs.500/-per quiz (10quiz per block for 484 blocks)) 2420000.00

6.32 Health Mellas/Fairs-Rs.5000/- per Mela(one Health mela/district) 190000.00

Total -IEC 4546000.00 700000.00 5246000.00

7 Training

7.1 2 days modular training of new entrant MOs-Rs.27300/-per batch for 47 batches 1283100

7.2 1 days reorientation training for 2700 Mos-Rs.13650/-per batch for 90 batches 1228500.00

7.3 Training of ASHA(half day)-for 659 Batches (40 ASHA / Batch) 2108800.00

Total - Training(7.1 to 7.6) 4620400 0.00 4620400

8 Disability Prevention and Medical Rehabilitation (DPMR)

8.1 MCR & other footwears-4560 pairs @ Rs.250/- per pair 1140000.00

8.2 Aids & appliances-Rs.12500/- per district 475000

8.3 Welfare allowance for RCS patients @ 5000/- per patient for 120 patients 600000.00

8.4 Incentive to institution for RCSRs.5000/ - per RCS for 80 RCS 400000.00

281

Total - DPMR(8.1 to 8.4) 475000.00 2140000.00 2615000.00

9 Services through ASHA(performance based incentive to ASHA)

9.1 For PB new cases-4840(PB cases) @ Rs.300/- per case 1452000.00

9.2 For MB new cases-3872(MB cases) @ Rs.500/- per case 1936000.00

Total - Services through ASHA(9.1 to 9.2) 3388000.00 3388000.00

10 Urban Leprosy Control Programme:

10.1 For 24 townships-Rs.75000/- per town 1800000.00

10.2 For 6 medium I cities-Rs.150000/- per medium city 900000.00

Total -Urban leprosy control(10.1 to 1 0.2) 2700000.00 2700000.00

11 Review meetings of DLOs four times in a year-Rs.30000/- per meeting 120000.00 120000.00

Grand Total 27897800.00

(Rs. Two Crore sevety eight lac ninety seven thousands & eight hundred only)

282

Fund Allocation to State Leprosy Cell 2009-2010

Sl. No. Expenditure Under SHS (Leprosy) Component & Sub Component w ise Amount Rs.

1 Two Driver's Remuneration for State Leprosy Cell @ Rs. 4500/- 108000.00

2 DEO at State Leprosy Cell @ Rs. 8000/- 96000.00

3 Audit Fee for State Leprosy Cell 6000

4 Telephone, Fax, P &T charges , Miscellaneous @ Rs. 38000/- per year 38000

5 Consumables : Stationery etc. @ Rs. 28000/- per year 28000

6 Two vehicles for SHS (Leprosy) @Rs. 85000/- Per vehicle / year 170000

7 Printing of Forms / DPMR registers et. 600000

8 Electronic media-Radio / Doordarshan 500000

9 Print media-News papers 200000

10 MCR & other Footwears- 4560 pairs @ Rs.250/- per pair 1140000

11 Review meeting of DLOs four times in a year @ Rs. 30000/- per meeting 120000

Total 3006000

283

Fund Allocation to District Health Society (Leprosy) 2009-2010

Sl. No. District

Popu

latio

m M

arch

200

8 (E

st.)

Num

ber o

f Blo

ck P

HC

PD R

atio

Num

ber o

f ASH

As

Contractual services

Audi

t Fee

@ R

s. 6

000/

-

Vehi

cle

Ope

ratio

n / h

irin

g,

POL

& M

aint

enan

ce

@ R

s. 7

5000

/- p

er v

ehic

le /

dist

rict

Driv

er's

Rem

uner

atio

n @

R

s. 4

500/

- per

mon

th

Hon

orar

ium

for A

ccou

nts

wor

k

of L

epro

sy @

Rs.

400

/- p

er m

onth

DLS

(lepr

osy)

for

rent

,tele

phon

e,el

ectri

city

,

P &

T ch

arge

s, m

isce

llane

ous

-R

s.18

000/

- per

dis

trict

/ yea

r

Con

sum

able

Exp

ense

s (S

tatio

nery

&

etc.

) @ R

s. 1

4000

/- p

er y

ear

1 Aurangabad 2383268 11 1552 54000 4800 6000 18000 14000 75000 2 Bhojpur 2654828 13 1621 54000 4800 6000 18000 14000 75000 3 Buxar 1668275 8 1074 54000 4800 6000 18000 14000 75000 4 Bhagalpur 2888900 13 1971 54000 4800 6000 18000 14000 75000 5 Banka 1912332 10 1535 54000 4800 6000 18000 14000 75000 6 Darbhanga 3905394 18 2890 54000 4800 6000 18000 14000 75000 7 Katihar 2840403 13 1866 54000 4800 6000 18000 14000 75000 8 Muzaffarpur 4450244 14 2848 54000 4800 6000 18000 14000 75000 9 Nawada 2150838 14 1591 54000 4800 6000 18000 14000 75000 10 Patna 5598533 23 2549 54000 4800 6000 18000 14000 75000 11 Purnea 3020199 11 2263 54000 4800 6000 18000 14000 75000 12 Kishanganj 1538234 7 1024 54000 4800 6000 18000 14000 75000 13 Araria 2525757 9 2026 54000 4800 6000 18000 14000 75000 14 Rohtas 2910808 19 2030 54000 4800 6000 18000 14000 75000 15 Kaimur 1526956 10 1247 54000 4800 6000 18000 14000 75000 16 Siwan 3219960 15 2538 54000 4800 6000 18000 14000 75000 17 Sitamarhi 3173657 14 2221 54000 4800 6000 18000 14000 75000 18 Sheohar 611327 3 464 54000 4800 6000 18000 14000 75000 19 W.Champaran 3617222 18 2494 54000 4800 6000 18000 14000 75000 20 Begusarai 2785077 18 2091 54000 4800 6000 18000 14000 75000 21 E.Champaran 4675857 20 2756 54000 4800 6000 18000 14000 75000 22 Gaya 4118776 22 2440 54000 4800 6000 18000 14000 75000 23 Gopalganj 2554894 14 1846 54000 4800 6000 18000 14000 75000 24 Jehanabad 1100835 7 743 54000 4800 6000 18000 14000 75000 25 Arwal 695751 5 658 54000 4800 6000 18000 14000 75000 26 Khagaria 1517568 7 967 54000 4800 6000 18000 14000 75000 27 Madhubani 4244381 18 3034 54000 4800 6000 18000 14000 75000 28 Madhepura 1812266 7 1459 54000 4800 6000 18000 14000 75000 29 Munger 1349751 9 820 54000 4800 6000 18000 14000 75000 30 Sheikhpura 624223 6 439 54000 4800 6000 18000 14000 75000 31 Jamui 1661158 6 1270 54000 4800 6000 18000 14000 75000 32 Lakhisarai 952343 4 568 54000 4800 6000 18000 14000 75000 33 Nalanda 2815197 20 2017 54000 4800 6000 18000 14000 75000 34 Saharsa 1790658 12 777 54000 4800 6000 18000 14000 75000 35 Supaul 2074339 11 1533 54000 4800 6000 18000 14000 75000 36 Samastipur 4057475 23 3214 54000 4800 6000 18000 14000 75000 37 Saran 3864981 15 2825 54000 4800 6000 18000 14000 75000 38 Vaishali 3224178 17 2532 54000 4800 6000 18000 14000 75000

Total 98516843 484 0 67793 2052000 182400 228000 684000 532000 2850000

284

Sl. No. District

Drugs, materials & supplies Training

Supp

ortiv

e m

edic

ines

@ R

s. 2

5000

/-

per y

ear

Labo

rato

ry re

agen

ts &

equ

ipm

ents

@

Rs.

120

00/-

per

yea

r

Patie

nt w

elfa

re @

Rs.

600

0/- p

er

year

Sch

ool q

uiz

@ R

s. 5

00/-

per

qu

iz

(10

quiz

per

Blo

cks)

Sen

siti

sati

on m

eeti

ngs

wit

h P

RI

mem

bers

@ R

s. 4

000/

- pe

r m

eeti

ng

at b

lock

leve

l

Hea

lth

Mel

as /

Fai

rs @

Rs.

50

00/-

per

mel

a (O

ne

Hea

lth

M

ela

/ D

istr

ict)

Two days modular training of new entrant MOs @ Rs.27300/- per

batch for 47 batch

One day reorientation training of MOs @ Rs. 13650/- batch

for 90 batches

No.of Batch Amount No. of

Batch Amount

1 Aurangabad 25000 12000 6000 55000 44000 5000 1 27300 2 27300 2 Bhojpur 25000 12000 6000 65000 52000 5000 2 54600 3 40950 3 Buxar 25000 12000 6000 40000 32000 5000 1 27300 2 27300 4 Bhagalpur 25000 12000 6000 65000 52000 5000 2 54600 3 40950 5 Banka 25000 12000 6000 50000 40000 5000 1 27300 2 27300 6 Darbhanga 25000 12000 6000 90000 72000 5000 2 54600 3 40950 7 Katihar 25000 12000 6000 65000 52000 5000 1 27300 2 27300 8 Muzaffarpur 25000 12000 6000 70000 56000 5000 2 54600 3 40950 9 Nawada 25000 12000 6000 70000 56000 5000 1 27300 2 27300 10 Patna 25000 12000 6000 115000 92000 5000 2 54600 7 95550 11 Purnea 25000 12000 6000 55000 44000 5000 1 27300 2 27300 12 Kishanganj 25000 12000 6000 35000 28000 5000 0 0 1 13650 13 Araria 25000 12000 6000 45000 36000 5000 1 27300 2 27300 14 Rohtas 25000 12000 6000 95000 76000 5000 1 27300 2 27300 15 Kaimur 25000 12000 6000 50000 40000 5000 1 27300 1 13650 16 Siwan 25000 12000 6000 75000 60000 5000 1 27300 2 27300 17 Sitamarhi 25000 12000 6000 70000 56000 5000 1 27300 3 40950 18 Sheohar 25000 12000 6000 15000 12000 5000 0 0 1 13650 19 W.Champaran 25000 12000 6000 90000 72000 5000 1 27300 3 40950 20 Begusarai 25000 12000 6000 90000 72000 5000 2 54600 2 27300 21 E.Champaran 25000 12000 6000 100000 80000 5000 2 54600 4 54600 22 Gaya 25000 12000 6000 110000 88000 5000 2 54600 3 40950 23 Gopalganj 25000 12000 6000 70000 56000 5000 1 27300 2 27300 24 Jehanabad 25000 12000 6000 35000 28000 5000 1 27300 2 27300 25 Arwal 25000 12000 6000 25000 20000 5000 1 27300 1 13650 26 Khagaria 25000 12000 6000 35000 28000 5000 1 27300 1 13650 27 Madhubani 25000 12000 6000 90000 72000 5000 1 27300 3 40950 28 Madhepura 25000 12000 6000 35000 28000 5000 1 27300 2 27300 29 Munger 25000 12000 6000 45000 36000 5000 1 27300 2 27300 30 Sheikhpura 25000 12000 6000 30000 24000 5000 1 27300 2 27300 31 Jamui 25000 12000 6000 30000 24000 5000 1 27300 1 13650 32 Lakhisarai 25000 12000 6000 20000 16000 5000 1 27300 1 13650 33 Nalanda 25000 12000 6000 100000 80000 5000 2 54600 3 40950 34 Saharsa 25000 12000 6000 60000 48000 5000 1 27300 2 27300 35 Supaul 25000 12000 6000 55000 44000 5000 1 27300 2 27300 36 Samastipur 25000 12000 6000 115000 92000 5000 2 54600 5 68250 37 Saran 25000 12000 6000 75000 60000 5000 1 27300 3 40950 38 Vaishali 25000 12000 6000 85000 68000 5000 2 54600 3 40950

Total 950000 456000 228000 2420000 1936000 190000 47 1283100 90 1228500

285

Sl. No. District

Training DPMR

Ser

vice

s th

rou

gh A

SH

A

(per

form

ance

bas

ed

Ince

nti

ve t

o A

SH

A, 1

0 PB

&

8 M

B /

BLO

CK

/ Y

EA

R)

Urb

an L

epro

sy C

ontr

ol

Prog

ram

me

RCS

Training of ASHA (half day) @ Rs.

3200/- per Batch of 40

Aid

s &

app

lian

ces

@ R

s.12

500/

- pe

r di

stri

ct

Nu

mbe

r of

RC

S

Wel

fare

allo

wan

ce

for

RC

S p

atie

nts

(R

s. 5

000/

- /

RC

S)

Ince

nti

ve t

o In

stit

uti

on fo

r R

CS

(R

s. 5

000/

- /

RC

S)

No. of Batch Amount

1 Aurangabad 20 64000 12500 77000 75000 2 Bhojpur 15 48000 12500 91000 75000 3 Buxar 10 32000 12500 56000 75000 4 Bhagalpur 20 64000 12500 91000 150000 5 Banka 15 48000 12500 70000 0 6 Darbhanga 25 80000 12500 126000 150000 5 25000 25000 7 Katihar 20 64000 12500 91000 75000 8 Muzaffarpur 25 80000 12500 98000 150000 40 200000 9 Nawada 15 48000 12500 98000 75000

10 Patna 25 80000 12500 161000 150000 75 375000 375000 11 Purnea 20 64000 12500 77000 150000 12 Kishanganj 10 32000 12500 49000 75000 13 Araria 25 80000 12500 63000 0 14 Rohtas 20 64000 12500 133000 75000 15 Kaimur 10 32000 12500 70000 0 16 Siwan 25 80000 12500 105000 75000 17 Sitamarhi 20 64000 12500 98000 75000 18 Sheohar 15 48000 12500 21000 0 19 W.Champaran 20 64000 12500 126000 75000 20 Begusarai 15 48000 12500 126000 75000 21 E.Champaran 25 80000 12500 140000 75000 22 Gaya 25 80000 12500 154000 150000 23 Gopalganj 15 48000 12500 98000 75000 24 Jehanabad 10 32000 12500 49000 75000 25 Arwal 10 32000 12500 35000 0 26 Khagaria 10 32000 12500 49000 0 27 Madhubani 25 80000 12500 126000 75000 28 Madhepura 15 48000 12500 49000 75000 29 Munger 10 32000 12500 63000 75000 30 Sheikhpura 10 32000 12500 42000 0 31 Jamui 10 32000 12500 42000 75000 32 Lakhisarai 10 32000 12500 28000 0 33 Nalanda 15 48000 12500 140000 75000 34 Saharsa 15 48000 12500 84000 75000 35 Supaul 14 44800 12500 77000 75000 36 Samastipur 25 80000 12500 161000 75000 37 Saran 25 80000 12500 105000 75000 38 Vaishali 20 64000 12500 119000 75000

Total 659 2108800 475000 3388000 2700000 120 600000 400000

286

Activity Chart for Action Plan 2009-10 (Gantt Chart)

Annexure - 2

Sl. No.

Activity

Persons responsible

Time Frame

Jan 09 Feb 09 Mar 09 Apr 09 May 09 Jun 09 Jul 09 Aug 09 Sep 09 Oct 09 Nov 09 Dec 09 Jan 10 Feb 10 Mar 10

I Planning of Activities

1.1 Development of Action Plan for 2009-10 and its submission to GOI after aproval of SHS, Bihar

State Leprosy Officer, WHO/ILEP Coordinators

By 19th Jan. 2009

1.2 Approval of State Action Plan GOI By 30th Jan. 2009

1.3

Development of budgetary and operational guidelines for each and every activity as per approved action plan


By 10th May 2009

1.4

Briefing of CS and DLOs on Action Plan and development of detialed districtwise operational plan with specific time frame in the first review and planning meeting at State HQ

State Leprosy Officer, WHO/ILEP Coordinators, CS and DLOs

By 15th May 2009

1.5 Budgetary allocation for each district

State Health Society & SLO

By 20th May 2009

1.6 Approval of District Action Plan and its budget in District Health Society CS and DLO By 30th May

2009

Statrt activities as per the action plan and continue activities on routine

Concern officers at State, Dist and PHC level

1st June 2009 to 31st March 2010

II Prcurement Plan

2.1 Purchase of logistics such as

287

2.2 MCR Chappals (Through a State level committee)

State Leprosy Officer

June/July 2009

2.3 Supportive Medicine e.g.Prednisolone CS and DLO May/June

2009

2.4 Splint, Crutches, Lab reagents State Leprosy Officer

June/July 2009

2.5 Printing of Formats State Leprosy Officer

By July 2009

III Training

3.1 4 day training for MOs a batch of 30 MOs x 47 batches

State Leprosy Officer, WHO/ILEP Coordinators, DLOs By making 5 State level teams

Aug. 2009 to Dec. 2009

3.2 2 days reorientation training for Medical Officers at Distt./PHC a batch of 30 Mos x 90 batches

CS, DLO, District Nucleus

Sept. 2009 to Dec. 2009

3.3 Refreshal training for one day for Health Supervisors/LHV/Pharmacists a batch of 30 x 50 batches


Sept. 2009 to Dec. 2009

3.4 5 days training of lab technicians a batch of 15 LTs x 3 batches ILEP In October

2009

3.5 1 day training of 'A'Grade nurses in 48 batches


Aug. 2009 to Dec. 2009

3.6 Half day training of 50000 ASHA CS,DLO,District Nucleus & BPHC staff

May 2009 to Aug. 2009

IV Disability Prevention and Medical Rehabilation (DPMR)

288

4.4

RCS - 200 operations at Dept of PMR, Patna Medical College, Patna and operations at Darbhanga Medical College, Darbhanga & TLM Muzaffarpur

DLO Patna,DLO Darbhanga, DLO Muzaffarpur, District Nucleus and Medical Collages

April 2009 to March 2010

V Information, Education, Communication (IEC)

5.1 Radio Spots/Doordarshan State Leprosy Officer

June 2009 to March 2010

5.2 Meeting (Political Advocacy, for MLA, MLC )


During Winter session

5.3 Hoarding DLS - CS, DLO, District Nucleus

June 2009 to Aug. 2009

5.5 Posters

DLS - CS, DLO, District Nucleus, PHC staff

June 2009 to Aug. 2009

5.6 Cable Spot DLS - CS, DLO, District Nucleus


5.7 Wall panting


June 2009 to Dec. 2009

5.8 Rallies (including banners etc.)


Antileprosy Week

289

5.9 Quiz


In January 2010

5.10 Cinema slides DLS - CS, DLO, District Nucleus


5.12 Meeting with Zilla Parishad


Oct. 2009 to Dec. 2009

5.13 Orientation camp for NGO and Mahila Mandals

DLS - CS, DLO, District Nucleus

Jan. 2009 to Febr. 2010

5.14 Press Advertisement


Jan. 2010 to Feb. 2010

5.16 Health Mellas/Fairs


June 2009 to Sept. 2009

5.18 Monitoring & Supervision


October 09 to March 2010

VI Epidemiological Situation Analysis

6.1 Status of Implementation of Action Plan for 2009-10

A State NLEP Coordination Committee under the chairmanship of

Every month from April 2009 to March 2010

6.2 MDT Stock Situation Analysis

290

6.3

Districtwise analysis based on the field observations of DLOs, WHO/ILEP Coordinators and State Officers involving 6 DLOs in a month on rotation

Additional Director and State Leprosy Officer, Leprosy will continuously monitor the programme at each level and do analysis in State NLEP Coordination Meeting at State HQ Following will be the members of committee Additional Director Health Services,State Leprosy Officer and Controlling Officer, Bihar State Coordinator (WHO/GOI), NLEP, Bihar ILEP Members Representative from PMCH, Patna DLOs from identified districts on rotation Epidemiologist SSAU

6.4 Quality of Diagnosis

6.4.1 Regularity of treatment and timely RFT

6.4.2 Quality of information and implementation of SIS

6.4.3 Availability of MDT stock and other logistics

6.4.4 Capacity of GHCS staff and integration

6.4.5 Implementation of Action Plan 2009-10 including DPMR

6.4.6

Briefing of Executive Director, SHS on the minutes of State NLEP Coordination Meeting and sharing the same with Director in Chief, Secretary Health, DDGL, etc.

291

6.5 Reviews State NLEP Coordination Committee

Every month from April 2009 to March 2010

VII A review meeting of all DLOs will be called at State HQ every quarter to review all the activities in detail.

7.1 Zonal review meetings at each zone

Executive Director, SHS, Add. Director, State Leprosy Officer, WHO/ILEP Coordinators,

May, August, November, February in 2009-2010

7.2 District will review NLEP in routine monthly meetings

State Leprosy Officer Add. Director, WHO/ILEP Coordinators,

Alternate month

7.3 Block will review NLEP in routine weekly meetings


Every month from Apr. 2009 to Mar. 2010

7.4

DLOs and District Nucleus will participate in weekly PHC meeting on rotation and review NLEP at that level

I/C MO PHC

Every week from Apr. 2009 to Mar. 2010

7.5

Please tick mark in the square when the activity is completed and mark a question mark when due date is passed

DLO and District Nucleus on rotation

Every week from Apr. 2009 to Mar. 2010

294

Annual Plan for Programme Performance & Budget for the year 1st April 2009 to 31 st March 2010

State: Bihar (GFATM)

Objectives: 3.1.To achieve and maintain a cure rate of at least 85% among newly detected infectious (new

sputum smear positive) cases, and 4.2. To achieve and maintain detection of at least 70% of such cases in the population

This action plan and budget have been approved by the STCS. Signature of the STO__________ _______ Name Dr.N.M. Sharma Section-A – General Information about the State

1 State Population (in lakh) GFATM Districts 670.23 2 Number of GFATM districts in the State 30 3 Urban population 50.46 4 Tribal population 8 5 Hilly population 6 6 Any other known groups of special population for specific interventions

(e.g. nomadic, migrant, industrial workers, urban slums, etc.)

(These population statistics may be obtained from Census data /State Statistical Dept/ District plans)

No. of districts without DTC: 3

No. of districts that submitted annual action plans, which have been consolidated in this state plan: 30

Organization of services in the state: S.

No. Name of the

District Projected

Population (in Lakhs)

Please indicate number of TUs of each type

Please indicate no. of DMCs of each type in the district

Govt NGO Public Sector*

NGO Private Sector^

Araria 24.42 5 0 12 1 5 Arwal 7 1 0 5 0 0 Aurangabad 23.04 5 0 14 2 2 Banka 18.49 3 1 11 1 3 Begusarai 26.93 5 0 18 1 3 Bhagalpur 27.94 5 0 21 1 3 Bhojpur 25.67 5 0 21 0 3 Buxar 16.13 3 0 14 0 1 Darbhanga 37.77 7 0 20 1 4 Gaya 39.83 8 0 28 1 3 Gopalganj 24.70 5 0 20 0 2 Jamui 16.06 4 1 15 0 2 Jehanabad 10.37 2 0 8 0 1 Kaimur 14.76 2 1 12 0 1

Formatted: Bullets and Numbering

295

Khagaria 14.67 3 0 13 0 1 Kisanganj 14.87 2 1 10 0 2 Lakhisharai 9.21 2 0 6 0 1 Madhepura 17.52 3 0 14 1 1 Madhubani 41.04 8 0 23 1 2 Nalanda 27.22 5 0 20 0 3 Nawadah 20.80 4 0 15 0 2 W.Champaran 34.98 6 1 20 0 3 Rohtas 28.15 5 0 20 2 2 Saharsa 17.31 4 0 11 0 3 Saran 37.38 6 0 29 0 3 Sheikhpura 6.03 1 0 4 0 0 Sheohar 5.91 1 0 4 0 Sitamarhi 30.69 6 0 26 0 3 Siwan 31.14 6 0 20 0 3 Supaul 20.06 4 0 11 0 2 126 5 465 12 64 *Public Sector includes Medical Colleges, Govt. health department, other Govt. department and PSUs i.e. as defined in PMR report ^ Similarly, Private Sector includes Private Medical College, Private Practitioners, Private Clinics/Nursing Homes and Corporate sector

296

RNTCP performance indicators: Important: Please give the performance for the last 4 quarters i.e. Oct ___ to September _____

Name of the District (also

indicate if it is notified hilly or

tribal district

Total number of

patients put on

treatment*

Annualised total case detection

rate (per lakh

pop.)

No of new smear

positive cases put

on treatment

*

Annualised New smear

positive case detection rate

(per lakh pop)

Cure rate for cases

detected in the last 4

corresponding quarters

Plan for the next year

Annualized NSP case detection

rate

Cure rate

Araria Arwal Aurangabad Banka 1744 94.78 919 94.49 75 70 85 Begusarai 3141 116.12 870 33.05 69.64 70 85 Bhagalpur 3908 138.48 1396 51.07 85.8 70 85 Bhojpur 1128 450 60 70 85 Buxar 708 235 70 85 Darbhanga 3015 82.37 1173 32.04 81.87 70 85 Gaya 70 85 Gopalganj 70 85 Jamui 1172 64.04 506 30.4 58.6 70 85 Jehanabad 1058 50.25 473 61.85 75.65 70 85 Kaimur 70 85 Khagaria 836 14.67 356 24.26 63.63 70 85 Kisanganj 1233 41.4 715 65 79 70 85 Lakhisharai 651 56 248 35 83 70 85 Madhepura 998 61 551 45.33 87.33 70 85 Madhubani 2135 53.67 1051 26.42 74.29 70 85 Nalanda 1928 49.85 946 46.7 89.78 70 85 Nawadah 1068 53.52 531 35.48 88.74 70 85 W.Champaran 2269 64 1093 31 72 70 85 Rohtas 1995 71.97 890 42.81 78.21 70 85 Saharsa 70 85 Saran 70 85 Sheikhpura 505 110 76 70 85 Sheohar 70 85 Sitamarhi 2588 85.07 1234 40.96 58.66 70 85 Siwan 2093 57 739 27 50 70 85 Supaul 70 85 Total

* Patients put on treatment under DOTS regimens only are to be included.

297

S.No. Priority areas Activity planned under each priority area

1 Human Resource

1 a)Filling up of all State and District level Contractual Staff . 1 b) Filling up the posts of DTOs & MOTCs, 2 a) Training of untrained DTOs & MO TCs at National & state level and also of STS, STLS , LTs

2 Training 2 b) Training and Refresher trainings of MOs & Para Medical Staff 2 c) Training of ASHA as DOT providers 2 d)Training and retraining of All contractual staff of RNTCP

3 IEC 3 a) Printing of IEC Materials for the State 3 b)Involvement of masses through generating awareness via the print and electronic Media. 3 c) Sensitisation of local MLAs and PRI members, empowering the community by making them aware of the RNTCP facilities

4 Involvement of other sectors/ NGOs/PP

4 a) Sensitisation workshop for other sectors, NGOs and PPs. On the revised schemes 4 b) Increased involvement of Faith Based and community based organisations. 4 c) Involving IMA in RNTCP in the State

5 Strengthening of IRL, Lab network and

Implementation of EQA

5 a)Starting more DMCs especially in the APHCs with the help of NGOs 5 c)Visit of IRL to all the 38 districts with at least one OSE and One Panel Testing.

6 Minimizing Initial Defaulters

6 a) Ensuring in all districts – line listing of all sputum smear +ve patients diagnosed on regular basis 6 b) Regular data exchange for feedback within district regarding referral for treatment.

Section B – List Priority areas at the State level for achieving the objectives planned:

298

Priority Districts for Supervision and Monitoring by State during the next year

S No

District Reason for inclusion in priority list

1 Supaul Low case Detection 2 Buxar Low case Detection 3 Bhojpur Low case Detection 4 Gaya Low case Detection 5 Madhepura Low case Detection 6 Kaimur Low case Detection 7 Saran Low case Detection

Section C – Consolidated Plan for Performance and Expenditure under each head, including estimates submitted by all districts, and the requirements at the State Level 1. Civil Works

Activity No. required as per the norms in the state

No. already upgraded/ present in the state

No. planned to be upgraded during next financial year

Pl provide justification if an increase is planned in excess of norms (use separate sheet if required)

Estimated Expenditure on the activity

Quarter in which the planned activity expected to be completed

(a) (b) (c) (d) (e) (f) STDC/ IRL

SDS DTCs 30 27 3 Upgradation of DTCs 3rd Quarter

2009 TUs 130 114 13 Up gradation of TUs

+ Maintenance of TUs

3rd Quarter 2009

DMCs 650 513 74 Up gradation of DMcs + maintenance civil works of DMCs

4th Quarter 2009

TOTAL Rs 4266000/-

299

2. Laboratory Materials Activity Amount

permissible as per the norms in the state

Amount actually spent in the last 4 quarters

Procurement planned during the current financial year (in Rupees)

Estimated Expenditure for the next financial year for which plan is being submitted (Rs.)

Justification/ Remarks for (d)

(a) (b) (c) (d) (e) Purchase of Lab Materials by Districts

1,00,53,000 2240090 7800000 1,10,50,000

Lab materials for EQA activity at STDC

3. Honorarium

Activity Amount permissible as per the norms in the state


Expenditure (in Rs) planned for current financial year



(a) (b) (c) (d) (e) Honorarium for DOT providers (both tribal and non tribal districts)

18,76,000 332375 1540000 2,60,00,000/-

Honorarium for DOT providers of Cat IV patients

No. presently involved in RNTCP Additional enrolment proposed for the next

fin. Year Community volunteers in all

the districts* 1315 40,000

* These community volunteers are other than salaried employees of Central/State government and are involved in provision of DOT e.g. Anganwadi workers, trained dais, village health guides, ASHA, other volunteers, etc.

300

4. IEC/Publicity: Permissible budget for State and all Districts as per Norms: Rs. 50,26,500 Estimated IEC budget for all Districts, as per action plans (please enclose consolidation summary): Rs. _________ Estimated IEC activities and Budget at the State level (excluding districts) for the next financial year proposed as per action plan detailed below: Rs. _____________________

Target Group/ Objective

Activities Planned at State Level Total activities proposed during next fin. year

Estimated Cost per activity unit

Total expenditure for the activity during the next fin. Year

Activity (All activities to be planned as per local needs, catering to the target groups specified)

No. of activities held in last 4 quarters

No of activities proposed in the next financial year, quarterwise Apr-Jun

July-Sep

Oct-Dec

Jan-Mar

Patients and General public / for awareness generation and social mobilization

Outdoors: - wall paintings - Hoardings - Tin plates - Banners - others

20,00,000

Outreach activities: - Patient provider

interaction meetings

- Community meetings

- Mike publicity - Others

1200000

Puppet shows/ street plays/etc.

School activities

Print publicity - Posters - Pamphlets - Others

2,20,000

Media activities on Cable/local channels Radio

Any other activity

Opinion leaders/ NGOs for advocacy

Sensitization meetings

Media activities Power point Presentations / one to one interaction

Information Booklets/ brochures

301

World TB Day activities

12,00000

Any other public event

Health Care providers – public and private

- CMEs - Interaction

meetings - one to one


76700

- Information Booklets

- Any other

13,32000

Any Other Activities proposed

Communication Facilitators (each for 5-6 districts)

Total Budget 60,28,700/-

5. Equipment Maintenance:

Item No. actually present in the state


Amount Proposed for Maintenance during current financial yr.



(a) (b) (c) (d) (e) Computer Photocopier Fax

30 28 27

140393 750000 22,00,000

Binocular Microscopes (RNTCP)

504 15,25,000

STDC/ IRL Equipment 11,00,000 Any Other (pl. specify)

TOTAL 4825000/-

302

6. Training: Activity No.

in the state

No. already trained in RNTCP

No. planned to be trained in RNTCP during each quarter of next FY (c)


Estimated Expenditure for the next financial year (Rs.)

Justification/ remarks

Q1 Q2 Q3 Q4 (a) (b) (d) (e) (f) Training of DTOs (at National level)

Training of MO-TCs Training of MOs (Govt + Non-Govt)

Training of LTs of DMCs- Govt + Non Govt

Training of MPWs Training of MPHS, pharmacists, nursing staff, BEO etc

4000 3000 1500 2500

Training of Comm Volunteers

2000 4000 6000 1000

Training of Pvt Practitioners

500 1000 1500 200

Other trainings #

Re- training of MOs 400 400 400 200 Re- Training of LTs of DMCs

50 25 55 25

Re- Training of MPWs Re- Training of MPHS, pharmacists, nursing staff, BEO

500 600 800

Re- Training of CVs Re-training of Pvt Practitioners

TB/HIV Training of MO-TCs and MOs

800 700 400 200

TB/HIV Training of STLS, LTs , MPWs, MPHS, Nursing Staff, Community Volunteers etc

TB/HIV Training of STS Provision for Update Training at Various Levels # Review Meetings at State Level

Any Other Training Activity

# Please specify TOTAL Rs.52,41,000/-

303

7. Vehicle Maintenance:

Type of Vehicle Number permissible as per the norms in the state

Number actually present

Amount spent on POL and Maintenance in the previous 4 quarters




(a) (b) (c) (d) (e) (f) Four Wheelers Two Wheelers 131 113 1082209 3000000 41,71,000/-

TOTAL 41,71,000/- 8. Vehicle Hiring*:

Hiring of Four Wheeler

Number permissible as per the norms in the state

Number actually requiring hired vehicles

Amount spent in the prev. 4 qtrs




(a) (b) (c) (d) (e) (f) For STC/ STDC

95,29,600/-

For DTO 30 30 1132699 4800000 For MO-TC

TOTAL 95,29,600/- * Vehicle Hiring permissible only where RNTCP vehicles have not been provided

9. NGO/ PP Support:

Activity No. of currently involved in RNTCP in the state

Additional enrolment planned for this year

Amount spent in the previous 4 quarters




(a) (b) (c) (d) (e) (f) NGOs involvement scheme 1 3 19 0 Rs.161000

NGOs involvement scheme 2 5 76 0 Rs.454000

NGOs involvement scheme 3 2 5 0 0



NGOs involvement unsigned

Private practitioners scheme 1 0 160 10 Rs.10000

Private practitioners scheme 2 134 527 0 Rs.71000

Private practitioners scheme 3A 0 59 0 0

Private practitioners scheme 3B 0 250 0 0

Prvt Pract. scheme 4A 0 3017 0 Rs.10000

304

Pvt Pract. Scheme 4B TOTAL Rs70,00,000/-

NGO/ PP Support: (New schemes w.e.f. 01-10-2008)

Activity No. of currently involved in RNTCP






(a) (b) (c) (d) (e) (f) ACSM Scheme: TB advocacy, communication, and social mobilization

3 10 0 75000

SC Scheme: Sputum Collection Centre/s

Transport Scheme: Sputum Pick-Up and Transport Service

DMC Scheme: Designated Microscopy Cum Treatment Centre (A & B)

LT Scheme: Strengthening RNTCP diagnostic services

0 20 0 0

Culture and DST Scheme: Providing Quality Assured Culture and Drug Susceptibility Testing Services

Adherence scheme: Promoting treatment adherence

Slum Scheme: Improving TB control in Urban Slums

Tuberculosis Unit Model 2 1 0 530000 TB-HIV Scheme: Delivering TB-HIV interventions to high HIV Risk groups (HRGs)

3 0 0

TOTAL 20,78,000/- * orZeku esa NGO/PPP ds dk;Zjr cy ds vuqlkj 2768250-00 dh jkf’k iz;kZIr gksxhA 10. Miscellaneous:

Activity* e.g. TA/DA, Stationary, etc

Amount permissible as per the norms in the state





(a) (b) (c) (d) (e) 10053000 908919 5200000 90,84,000

305

TOTAL 90,84,000/- * Please mention the main activities proposed to be met out through this head

11. Contractual Services:

Category of Staff

No. permissible as per the norms in the state

No. actually present in the state

No. planned to be additionally hired during this year


Expenditure (in Rs) planned for current fin. year



(a) (b) (c) (d) (e) TB/HIV Coord. Urban TB Coord. MO-STCS State Accountant State IEC Officer Pharmacist Secretarial Asst MO-DTC 6 4 2 40431072 4800000 STS 134 110 STLS 134 113 TBHV 49 DEO 30 20 10 Accountant – part time

30 18 12

Contractual LT 290 182 Driver Any other contractual post approved under RNTCP

TOTAL 4,57,47,500/- * orZeku esa Contractual Staff ds dk;Zjr cy ds vuqlkj 40336000-00 dh jkf’k

iz;kZIr gksxhA

12. Printing:






(a) (b) (c) (d) (e) Printing-State level:*

10053000 93,02,000/-

306

Printing- Distt. Level:*

* Please specify items to be printed in this column * foxr o"kZ esa gq, NikbZ dk;Z dks ns[krs gq, 1026500-00 dh jkf’k iz;kZIr gksxhA 13. Research and Studies (excluding OR in Medical Colleges): Rs. 6,00,000/-

Any Operational Research projects planned (Yes/No) ______________________________________ (If yes, enclose annexure providing details of the Topic of the Study, Investigators and Other details) Whether submitted for approval/ already approved? (Yes/No) _______________________________ Estimated Total Budget ____________________________________________

307

14. Medical Colleges Activity Amount

permissible as per norms

Estimated Expenditure for the next financial year(Rs.)


(a) (b) (c) Contractual Staff: § MO-Medical College (Total

approved in state 3 § STLS in Medical Colleges (Total no

in state 3 ) § LT for Medical College (Total no in

state 3 ) § TBHV for Medical College (Total

no in state 3)

Rs.12,96,000/- Rs.12,96,000/-

Research and Studies: § Thesis of PG Students § Operations Research*

1,00,000/-

Travel Expenses for attending STF/ZTF/NTF meetings

IEC: Meetings and CME planned 7,00,000/- Equipment Maintenance at Nodal Centres

* Expenditure on OR can only be incurred after due approvals of STF/ STCS/ZTF/CTD (as applicable) 15. Procurement of Vehicles:

Equipment No. actually present in the state

No. planned for procurement this year (only if permissible as per norms)



(a) (b) (c) (d) 4-wheeler **

8,85,000/-

2-wheeler ** Only if authorized in writing by the Central TB Division

308

16. Procurement of Equipment:


No. planned for this year (only as per norms)



(a) (b) (c) (d) Office Equipment (Computer, modem, scanner, printer, UPS etc.)

30 22 19

0 5 11

395000 165000

Any Other 560000

309

Section D: Summary of proposed budget for the state – Category of Expenditure Budget estimate for the coming FY 2009

- 2010 (To be based on the planned activities and expenditure in Section C)

1. Civil works 4266000 2. Laboratory materials 11050000 3. Honorarium 26000000 4. IEC/ Publicity 6028700 5. Equipment maintenance 4825000 6. Training 5241000 7. Vehicle maintenance 4171000 8. Vehicle hiring 9529600 9. NGO/PP support 9078000 10. Miscellaneous 9084000 11. Contractual services 45747500 12. Printing 9302000 13. Research and studies 600000 14. Medical Colleges 2096000 15. Procurement –vehicles 885000 16. Procurement – equipment 560000

TOTAL 14,84,63,800/-

** Only if authorized in writing by the Central TB Division

310

Annual Plan for Programme Performance & Budget for the year 1st April 2009 to 31 st March 2010

State: BIHAR (World Bank)

Objectives: 1.3. To achieve and maintain a cure rate of at least 85% among newly detected infectious (new sputum

smear positive) cases, and 2.4. To achieve and maintain detection of at least 70% of such cases in the population

This action plan and budget have been approved by the STCS. Signature of the STO__________ _______ Name : Dr. N.M.Sharma Section-A – General Information about the State

1 State Population (in lakh) (World Bank Districts) 282.57 2 Number of districts in the State (World Bank Districts) 8 3 Urban population 36.16 4 Tribal population 0.87 5 Hilly population 0 6 Any other known groups of special population for specific interventions

(e.g. nomadic, migrant, industrial workers, urban slums, etc.) 1.55

(These population statistics may be obtained from Census data /State Statistical Dept/ District plans)

No. of districts without DTC: None No. of districts that submitted annual action plans, which have been consolidated in this state plan: 8 Organization of services in the state:

S. No.

Name of the District

Projected Population (in

Lakhs)

Please indicate number of TUs of each type

Please indicate no. of DMCs of each type in the district

Govt NGO Public Sector*

NGO Private Sector^

1 Katihar 27.47 5 0 21 1 1 2 Purnia 29.20 5 0 25 0 0 3 Samstipur 39.24 7 1 20 0 0 4 E. Champaran 45.22 8 0 42 8 2 5 Muzaffarpur 43.04 7 0 16 0 0 6 Patna 54.14 10 0 9 2 0 7 Vaishali 31.18 5 0 23 0 3 8 Munger 13.05 2 0 28 1 0 Total 282.57 49 1 184 12 6 *Public Sector includes Medical Colleges, Govt. health department, other Govt. department and PSUs i.e. as defined in PMR report

Formatted: Bullets and Numbering

311

^ Similarly, Private Sector includes Private Medical College, Private Practitioners, Private Clinics/Nursing Homes and Corporate sector RNTCP performance indicators: Important: Please give the performance for the last 4 quarters i.e. Oct 07 to September 08

Name of the District (also indicate if it is

notified hilly or tribal district

Total number of

patients put on

treatment*

Annualised total case

detection rate (per lakh

pop.)

No of new smear

positive cases put

on treatment *

Annualised New smear

positive case detection rate

(per lakh pop)

Cure rate for cases

detected in the last 4

corresponding quarters

Plan for the next year

Annualized NSP case detection

rate

Cure rate

Katihar 2390 43.01 1395 68.3 78 70 85 Purnia 3016 113.32 1447 54.14 82.2 70 85 Samstipur 4132 53.52 1561 54.73 79.36 70 85 E. Champaran 2731 62 1160 26 85 70 85 Muzaffarpur 6173 6173 1992 53 87 70 85 Patna 471 471 173 45.85 87.98 70 85 Vaishali 3215 3215 892 29 56 70 85 Munger 1460 1460 70 85 Total

* Patients put on treatment under DOTS regimens only are to be included.

S.No. Priority areas Activity planned under each priority area 1

Human Resource 1 a)Filling up of all State and District level Contractual Staff .

Section B – List Priority areas at the State level for achieving the objectives planned:

312

1 b) Filling up the posts of DTOs & MOTCs,

2 Training 2 a) Training of untrained DTOs & MO TCs at National & state level and also of STS, STLS , LTs 2 b) Training and Refresher trainings of MOs & Para Medical Staff 2 c) Training of ASHA as DOT providers 2 d)Training and retraining of All contractual staff of RNTCP

3 IEC 3 a) Printing of IEC Materials for the State 3 b)Involvement of masses through generating awareness via the print and electronic Media. 3 c) Sensitisation of local MLAs and PRI members, empowering the community by making them aware of the RNTCP facilities

4 Involvement of other sectors/ NGOs/PP

4 a) Sensitisation workshop for other sectors, NGOs and PPs. On the revised schemes 4 b) Increased involvement of Faith Based and community based organisations. 4 c) Involving IMA in RNTCP in the State

5 Strengthening of IRL, Lab network and Implementation of EQA

5 a)Starting more DMCs especially in the APHCs with the help of NGOs 5 b)Construction of IRL and initiation of DOTS Plus action plan. 5 c)Visit of IRL to all the 38 districts with at least one OSE and One Panel Testing.

6 Minimizing Initial Defaulters 6 a) Ensuring in all districts – line listing of all sputum smear +ve patients diagnosed on regular basis 6 b) Regular data exchange for feedback within district regarding referral for treatment.

Priority Districts for Supervision and Monitoring by State during the next year

S No

District Reason for inclusion in priority list

1 Vaishali No contractual Supervisory Staff in the District

313

(STS/STLS)

Section C – Consolidated Plan for Performance and Expenditure under each head, including estimates submitted by all districts, and the requirements at the State Level

1. Civil Works

Activity No. required as per the norms in the state

No. already upgraded/ present in the state

No. planned to be upgraded during next financial year

Pl provide justification if an increase is planned in excess of norms (use separate sheet if required)

Estimated Expenditure on the activity

Quarter in which the planned activity expected to be completed

(a) (b) (c) (d) (e) (f) STDC/ IRL

1 1 1 IRL civil work By 3rd Quarter 2009.

SDS 1 1 1 Inadequate Storage space

By 2nd Quarter of 2009

DTCs 8 8 0 - - - TUs 56 50 6 Up gradation By 2nd Quarter of

2009 DMCs 282 202 20 Up gradation By 2nd Quarter of

2009 TOTAL 32,46,000

314

2. Laboratory Materials



Procurement planned during the current financial year (in Rupees)



(a) (b) (c) (d) (e) Purchase of Lab Materials by Districts

42,375,00 10,244,34 3213066 62,07,000/- Project increase in Case detection and also increase in cost of Lab Consumables

Lab materials for EQA activity at STDC

3. Honorarium






(a) (b) (c) (d) (e) Honorarium for DOT providers (both tribal and non tribal districts)

791000 139925 651075 60,00,000* Committed honoraria to DOT Providers

Honorarium for DOT providers of Cat IV patients

No. presently involved in RNTCP

Additional enrolment proposed for the next fin. year

Community volunteers in all the

districts*

1243 10,000

* These community volunteers are other than salaried employees of Central/State government and are involved in provision of DOT e.g. Anganwadi workers, trained dais, village health guides, ASHA, other volunteers, etc. * orZeku esa Dot Privder dk;Zjr cy ds vuqlkj 10-00 yk[k dh jkf’k iz;kZIr gksxhA 4. IEC/Publicity: Permissible budget for State and all Districts as per Norms: Rs.(10,00,000 + 21,187,50)

315

Estimated IEC budget for all Districts, as per action plans (please enclose consolidation summary): Rs.23,00,000 Estimated IEC activities and Budget at the State level (excluding districts) for the next financial year proposed as per action plan detailed below: Rs. 23,00,000

Target Group/ Objective

Activities Planned at State Level Total activities proposed during next fin. year

Estimated Cost per activity unit

Total expenditure for the activity during the next fin. Year

Activity (All activities to be planned as per local needs, catering to the target groups specified)

No. of activities held in last 4 quarters

No of activities proposed in the next financial year, quarterwise Apr-Jun

July-Sep

Oct-Dec

Jan-Mar

Patients and General public / for awareness generation and social mobilization

Outdoors: - wall paintings - Hoardings - Tin plates - Banners - others

14,00,000

Outreach activities: - Patient provider


- Community meetings

- Mike publicity - Others

Puppet shows/ street plays/etc.

School activities 3,00,000

Print publicity - Posters - Pamphlets - Others

8,00,000

Media activities on Cable/local channels Radio

12,00,000

Any other activity

Opinion leaders/ NGOs for advocacy

Sensitization meetings

Media activities 2,00,000 Power point Presentations / one to one interaction

Information Booklets/ brochures

2,00,000

World TB Day activities

2,00,000

316

Any other public event

Health Care providers – public and private

- CMEs - Interaction

meetings - one to one


2,65,000

- Information Booklets

- Any other

Any Other Activities proposed

Communication Facilitators (each for 5-6 districts)

Total Budget 45,65,000 5. Equipment Maintenance:

Item No. actually present in the state


Amount Proposed for Maintenance during current financial yr.



(a) (b) (c) (d) (e) Computer (maintenance includes AMC, software and hardware upgrades, Printer Cartridges and Internet expenses)

8 81,808 58,000 3,40,000 Upgradation of Computers for Windows based Epicenter +AMC

Binocular Microscopes (RNTCP) 220 0 1,12,500 4,80,000 STDC/ IRL Equipment 95,000 Any Other ( Fax & OHP )

TOTAL 9,15,000 6. Training: Activity No.

in the state

No. already trained in RNTCP

No. planned to be trained in RNTCP during each quarter of next FY (c)




Q1 Q2 Q3 Q4 (a) (b) (d) (e) (f) Training of DTOs (at National level)

7 9 2 2

Training of MO-TCs Training of MOs (Govt + Non-Govt)

15 15 15 15

Training of LTs of DMCs- Govt + Non

30 15 10 5

317

Govt Training of MPWs Training of MPHS, pharmacists, nursing staff, BEO etc

Training of Comm Volunteers

Training of Pvt Practitioners

Other trainings # Re- training of MOs Re- Training of LTs of DMCs

150 150 150 150

Re- Training of MPWs

Re- Training of MPHS, pharmacists, nursing staff, BEO

1000 1500 2000 4000

Re- Training of CVs Re-training of Pvt Practitioners

75 100 80 120

TB/HIV Training of MO-TCs and MOs

40 40 40 40

TB/HIV Training of STLS, LTs , MPWs, MPHS, Nursing Staff, Community Volunteers etc

TB/HIV Training of STS

Provision for Update Training at Various Levels # Review Meetings at State Level

1

1

1

1

Any Other Training Activity

# Please specify TOTAL 28,60,000 7. Vehicle Maintenance:

Type of Vehicle Number permissible as per the norms in the state

Number actually present

Amount spent on POL and Maintenance in the previous 4 quarters




(a) (b) (c) (d) (e) (f) Four Wheelers 8 4 5,00,000 Two Wheelers 56 49 2,53,026 9,71,974 17,77,000

TOTAL 22,77,000

318

8. Vehicle Hiring*:

Hiring of Four Wheeler

Number permissible as per the norms in the state

Number actually requiring hired vehicles

Amount spent in the prev. 4 qtrs




(a) (b) (c) (d) (e) (f) For STC/ STDC

1 1 0 0

For DTO 4 4 1,88,628 6,51,372 For MO-TC

50 50 Proposed to increase the no. Of TUs

TOTAL 45,06,000/- * Vehicle Hiring permissible only where RNTCP vehicles have not been provided

9. NGO/ PP Support:

Activity No. of currently involved in RNTCP in the state






(a) (b) (c) (d) (e) (f) NGOs involvement scheme 1 0 4 0 75000 Rs.100000/- NGOs involvement scheme 2 9 11 0 205000 Rs.450000/- NGOs involvement scheme 3 NGOs involvement scheme 4 1 18 0 300000 Rs.265000/- NGOs involvement scheme 5 0 1 0 0 Rs.480000/- NGOs involvement unsigned 32 0 0 600000 Rs.0/- Private practitioners scheme 1 0 84 0 20000 Rs.81200/-

Private practitioners scheme 2 0 334 0 8000 Rs.160500/-

Private practitioners scheme 3A

Private practitioners scheme 3B

Prvt Pract. scheme 4A Pvt Pract. Scheme 4B

TOTAL 1,01,25,000/- NGO/ PP Support: (New schemes w.e.f. 01-10-2008)

Activity No. of currently involved in RNTCP






(a) (b) (c) (d) (e) (f) ACSM Scheme: TB advocacy, communication, and social mobilization

319

SC Scheme: Sputum Collection Centre/s

Transport Scheme: Sputum Pick-Up and Transport Service

DMC Scheme: Designated Microscopy Cum Treatment Centre (A & B)

1 5 0 75,000

LT Scheme: Strengthening RNTCP diagnostic services

15 0 0

Culture and DST Scheme: Providing Quality Assured Culture and Drug Susceptibility Testing Services

Adherence scheme: Promoting treatment adherence

9 5 0 18,00,00

Slum Scheme: Improving TB control in Urban Slums

Tuberculosis Unit Model 1 0 0 2,65,000

TB-HIV Scheme: Delivering TB-HIV interventions to high HIV Risk groups (HRGs)

6 0 0

TOTAL 79,11,000/- * orZeku esa NGO/PPP ds dk;Zjr cy ds vuqlkj 25-00 yk[k dh jkf’k izkIr gksxhA 10. Miscellaneous: Activity* e.g. TA/DA, Stationary, etc

Amount permissible as per the norms in the state





(a) (b) (c) (d) (e) State Level 7,00,000 7,00,000 District Level 42,37,500 2,08,047 10,50,000 45,14,000

TOTAL 52,14,000 * Please mention the main activities proposed to be met out through this head

320

11. Contractual Services:

Category of Staff No. permissible as per the norms in the state

No. actually present in the state

No. planned to be additionally hired during this year


Expenditure (in Rs) planned for current fin. year



(a) (b) (c) (d) (e) TB/HIV Coord. 1 0 0 0 0 Urban TB Coord. MO-STCS 1 0 0 0 0 State Accountant 2 0 0 0 0 State IEC Officer 1 0 0 0 0 Pharmacist 1 0 0 0 0 Secretarial Asst 1 0 0 0 0 MO-DTC STS 50 45 5 STLS 50 43 7 TBHV 30 2 28 DEO Districts 8 6 2 DEO State 2 0 2 0 0 Accountant – part time

8 4 8

Contractual LT 120 88 32 Driver 8 5 3 Any other contractual post approved under RNTCP

TOTAL 2,90,82,000/- 12. Printing:






(a) (b) (c) (d) (e) Printing-State level:* (All Modules,Guidelines,Forms,registers,IEC materials)

4237500 777337 45,74,000/- No printing carried out in the new formats,No IEC material at state /district

Printing- Distt. Level:*

* Please specify items to be printed in this column * foxr o"kZ esa gq, NikbZ dk;Z dks ns[krs gq, 20-00 yk[k dh jkf’k iz;kZIr gksxhA

321

13. Research and Studies (excluding OR in Medical Colleges): Rs. 6,00,000/- Any Operational Research projects planned (Yes/No) ______________________________________ (If yes, enclose annexure providing details of the Topic of the Study, Investigators and Other details) Whether submitted for approval/ already approved? (Yes/No) _______________________________ Estimated Total Budget ____________________________________________ 14. Medical Colleges Activity Amount

permissible as per norms

Estimated Expenditure for the next financial year(Rs.)


(a) (b) (c) Contractual Staff: § MO-Medical College § STLS in Medical Colleges § LT for Medical College § TBHV for Medical College

3 3 3 3

Research and Studies: § Thesis of PG Students § Operations Research*

Travel Expenses for attending STF/ZTF/NTF meetings

IEC: Meetings and CME planned Equipment Maintenance at Nodal Centres

Total:28,47,200/- 15. Procurement of Vehicles:


No. planned for procurement this year (only if permissible as per norms)



(a) (b) (c) (d) 4-wheeler **

13,00,000/-

2-wheeler 43 26 ** Only if authorized in writing by the Central TB Division

16. Procurement of Equipment:


No. planned for this year (only as per norms)



(a) (b) (c) (d) Office Equipment (Computer, Photocopier

3 3

7,80,000/

LCD projector 2

322

Section D: Summary of proposed budget for the state –

Category of Expenditure Budget estimate for the coming FY 2009 - 2010

(To be based on the planned activities and expenditure in Section C)

1. Civil works 3246000 2. Laboratory materials 6207000 3. Honorarium 6000000 4. IEC/ Publicity 4565000 5. Equipment maintenance 915000 6. Training 2860000 7. Vehicle maintenance 2277000 8. Vehicle hiring 4506000 9. NGO/PP support 18036000 10. Miscellaneous 5214000 11. Contractual services 29082000 12. Printing 4574000 13. Research and studies 600000 14. Medical Colleges 2847200 15. Procurement –vehicles 1300000 16. Procurement – equipment 780000 TOTAL 9,30,09,200/-

** Only if authorized in writing by the Central TB Division

323

Printing Details

Sr No Items name Quantity (No of copies)

No of pages for print including cover (back and front)

1 TB Register 334 200 + 2

2 Lab Register 1696 200 + 2 3 Treatment Card 258552 2 4 Identity Card 129276 2 5 Lab form for Sputum Examination 692550 1 6 TB Transfer form 6464 1 7 Referral for treatment form 12928 1 8 CF TU qtrly report 2672 1 9 SC TU qtrly report 2672 1

10 RT TU qtrly report 2672 1 11 PMR TU qtrly report 2672 4 12 PHI monthly Report 24422 2

13 Supervisory Registers (triplicate paging no) 1272 7 + (80 x 3) = 247

14 Desk Referance 18468 1

15 RNTCP at a glance 18468 26 + 2

16 EQA coding (blinding) register 76 100 + 2

17 EQA - RBRC roaster for STLSs rechecking and umpire rechecking 38 100 + 2

18 EQA - Register for Quality control of prepared reagents 76 100 + 2

19 EQA reporting format - annexure M (for TU) 15264 1

20 EQA reporting format - annexure M (for district) 1170 1

21 EQA reporting format - annexure E (for district) 1170 1 22 EQA reporting format - annexure B 20352 1 23 EQA reporting format - Annexure C 20352 1 24 EQA reporting format - Annexure D 20352 1 25 EQA reporting format - checklist for STLS 20352 7 26 EQA reporting format - annexure F 380 1 27 EQA - IRL visit to DTC - OSE 100 10 28 District Issue voucher (DIV) 16032 1

29 District worksheet for Reporting Drug Requirement (WRDR) 16032 1

30 TU report for Reconstitution of Drugs 1670 1 31 Drug Stock Register 410 200 + 2 32 Line list of VCTC 9120 1 33 VCTC monthly report 912 1 34 Health provider guide (Local language) 18468 1

35 PP module 9234 76

324

36 Revised Strategy for monitoring and supervision 281 74 + 2

37

EQA Module - RNTCP Laboratory Network guidelines for Quality Assurance of smear microscopy for diagnosing TB.B60 256 91 + 2

38 Mycobacterial Culture Sensitivity forms 6464 1

39 NGO Guidelines 334 40 + 2

40 PP guidelines+B20 334 40 + 2

41 District Drug Store Manual 410 89 + 2

42 Reconstitution Register 38 200 + 2 43 Additional Drug Request 380 1

44 Referral for treatment Register 205 200 + 2

45 RNTCP Modules with Exercise book and answer book for training of MO (1-4 Module) 4617 190 + 2

46 RNTCP MO training Exercise (E1, E2, E3) and answer books (EA1-3) 167

(13+2) + (19+2) + (22+2) + (32+2) = 94

47 RNTCP Modules for training of MO-TC (5-9 Module) 167 254 + 2

48 RNTCP Modules for training of STS with Exercise book 167 (131+2) + (26+2)

49 RNTCP Modules for training of STLS 167 120 + 2 50 RNTCP Modules for training of LT 923 74 + 2

51 RNTCP Modules for training of Medical college faculty 1150

52 RNTCP Modules for training of MPWs 18468 54 + 2 53 Modules for training in TB-HIV of MO 668 97 + 2 54 Modules for training in TB-HIV of STS & STLS 334 63 + 2

55 Modules for training in TB-HIV of VCTC counsellor 200 66 + 2

56 District PMR report 760 6

57 Strategy document for the supervision and monitoring 281 85 + 2

58 Guidelines for quality assuarance of smear microscopy for diagnosing tuberculosis 334 91 + 2

59 Technical & operational guidelines 923 150 + 2 60 One page Display for DOT Provider 18468 1 61 One page Display for DOT Provider pead PWB 18468 1

62 Financial Management Manual for state & district societies norms and basis of costing 190 83 + 2

63 Pages for Training in pediatric PWBs (Hindi) 18468 3 64 Pages for Training in pediatric PWBs (English) 3040 3 65 Programme review checklist for DMs & CMOs 950 2 66 Quarterly report - Medical College 96 3

67 IE - Form 1: Review of TU reports and TB registers & Worksheet for form 1 200 1

68 IE - Form 1: Worksheet for form 1 500 1 69 IE - Form 2: Data collection at the district level 200 3 70 IE - Form 3: Data collection at the DMC level 500 1 71 IE - Form 4: Data collection at the DOT Centre 1000 1

325

72 IE - Form 5:Patients Interview 500 1 73 IE - Form 6 :Triangulation 200 1

74 IE - Form 8: Form for interview of non-NSP patients 200 1

75 IE - Form 9: Form for observations at the TU Drug store 100 1

76 IE - Form 11: for review of the Medical College during Internal Evaluation 25 1

77 IE - Form 12: Check List For Financial Management 500 1

78 Physical Verification Sheet (PVS) 430 1 79 Adequacy of Drug Stocks (ADS) 430 1 80 Expiry Age Analysis of Drug Stocks (EAADS) 430 1 81 Training certificates 2770 1 82 Enrolment certificate (NGOs & PPs) 462 1 83 Certificate of appreciation 308 1 84 Pamphlets 92340 1 85 Posters (Sputum Microscopy) 4617 1 86 Posters (diagnosis) 9234 1 87 Posters (Treatment) 9234 1 88 Posters (DOTS) 9234 1

89 Plastic digital printed boards for Approved DOT centers 9234 1

90 Plastic digital printed boards for designated Pvt Sputum Microscopy centre 114 1

91 Table Flip type calendars 2770 24 92 Flip charts 2884 93 Banners for workshop 38 1 94 Banners for training 38 1 95 Digital printed banners DOTS 4617 1 96 Digital printed banners diagnosis 4617 1 97 Digital printed banners Treatment 4617 1

98 RNTCP diary 4617 200 99 Car bumper stickers Plastic coated 9234 1

326

Bihar SPIP 2009-10

Malaria Filaria Kalazar

327

i=kad -KA/R-12/08 @

izs"kd% &

MkWñ vkjñ,uñ ik.Ms;]

la;qä funs'kd&lg&jkT; dk;ZØe inkf/kdkjh]

eysfj;k@dkyktkj] fcgkj] iVukA

lsok esa]

funs'kd]

jk"Vªh; oSDVj tfur jksx fu;a=.k dk;ZØe]

22] 'kkeukFk ekxZ] fnYyh & 54 iVuk] fnukad % ----------------------------------

fo"k;% iqu% l’kksf/kr dkyktkj fu;a=k.kkFkZ foÙkh; o"kZ 2009&10 la'kksf/kr ctV izkôyuA

egk'k;]

mi;qZä fo"k;d v/kksgLrk{kjh ia=kd KA/R-12/08-57 fnukad 07-02-09 }kjk Hksts x;s ctV

izkDyu ij Hkkjr ljdkj }kjk mBk;s x;s fcUnqvks ds laca/k esa vko';d izo`f"V djrs gq, la'kksf/kr

ctV izkDyu Hkstk tk jgk gSA ctV izkdyu esa dkyktkj ds 2010 Elemination y{; dh izkfIr gsrq

fujks/kkRed] mipkjkRed] jkT; eq[;ky; lqn`<+hdj.k ,oa izf'k{k.k dk;ZØe dk ctV izkôyu] Hkkjr

ljdkj }kjk fn;s x;s fn'kk funs'k ds vkyksd esa rS;kj dh xbZ gSA foLr`r fooj.k bl izdkj gS % &

¼d½ fujks/kkRed dkjZokbZ % &

1- jkT; Lrj ij fnukad & 29 ,oa 30 fnlEcj] 2008 dks Hkkjr ljdkj ds izfrfuf/k ds lkFk lHkh

dkyktkj izHkkfor ftyk ds dk;ZØe inkf/kdkjh ds lkFk CkSBd vk;ksftr dh xbZ FkhA mä

cSBd esa fy;s x;s fu.kZ;kuqlkj 5 o"kksZ a ds dkyktkj izHkkfor xzkeksa dh tula[;k esa fNM+dko

djk;k tkuk gSA fNM+dko dk;Z ftyk Lrj ls ftyk dk;Zdze inkf/kdkjh }kjk djk;k tk;sxkA

xzke ipak;r Lrj ls fNM+dko djk;k tkuk laHko izrhr ugh gksrk gSA 'kr izfr'kr fNM+dko

rFkk fNM+dko dh fuxjkuh esa iapk;r Lrj ls lg;ksx fy;k tkrk gSA oÙkZeku esa iapk;r Lrj

ij dkyktkj ds laca/k esa izf'k{k.k dk Hkh izko/kku ctV esa fd;k x;k gSA

2- jkT; ds 31 dkyktkj izHkkfor ftyksa ls izkIr fNM+dko dk;Z ;kstuk ds vuqlkj 31 ftyksa ds

dqy 338 izkñLokñdsUnz ds dqy 36]194 xzke gSA ftldh dqy tula[;k 67-88 fefy;u gSA 31

ftyksa ds dqy 338 izkñLokñdsUnz esa ls 310 izkñLokñdsUnz ds 10]814 xzke ,oa 56 okMZ ds 32-39

fefy;u tula[;k dks MhñMhñVhñ ds fNM+dko ls vkPNkfnr djkuk gSA ¼ifjf'k"V 1 nzOVO;½

jkT; ds 31 dkyktkj izHkkfor ftyksa esa eqaxsj dkyktkj ,oa eysfj;k nksuks ls izHkkfor gS iajrq

tks iz[k.M dkyktkj ls izHkkfor gS og eysfj;k ls izHkkfor ugh gSaA vr% dkyktkj izHkkfor

xzkeks esa fNM+dko gsrq dkyktkj ctV esa rFkk eysfj;k izHkkfor xzkeksa esa eysfj;k i)fr ls

fNM+dko gsrq eysfj;k ctV esa jkf'k dk izko/kku fd;k x;k gSA bl rjg Area of duplication in Malaria / Kalazar dk iz'u ugh mBrk gSA tgkW rd duplicacy in Spraying dk iz'u gS rks

bl laca/k esa ftyks dks vko';d fn'kk funsZ'k fn;k tk;sxk rFkk bls jksdus ds fy, iwjk iwjk

iz;kl fd;k tk;sxkA

tgkW rd 100 % target to be decreased to 50 % dk iz'u gS rks bl laca/k esa dguk gS fd

jkT; ds 31 dkyktkj izHkkfor ftyks dk dqy tula[;k 67-88 fefy;u gS ftlesa dkyktkj

izHkkfor xzkeks dh tula[;k 32-39 fefy;u gSa ftls fNM+dko ls vPNkfnr djus gsrq ctV

izLrko gS tks fd dqy tula[;k dk 50% gSA 3- 32-39 fefy;u tula[;k esa fNM+dko ds fy, dqy 1782 fNM+dko ny ¼,d fefy;u tula[;k

ds fy, 55 fNM+dko ny½ dh vko';drk gksxhA 1782 fNM+dko ny esa 1782 Js"B {ks=h;

dk;ZdÙkkZ rFkk 8910 {ks=h; dk;ZdÙkkZ gksaxsA

Je ,oa fu;kstu foHkkx }kjk fNM+dko etnwjksa ds etnwjh nj esa la'kks/ku dh xbZ gSA

la'kksf/kr etnwjh nj ds vuqlkj Js"B {ks=h; dk;ZdÙkkZ dks #i;s 86@& izfrfnu ds cnys

113@& izfrfnu rFkk {ks=kh; dk;ZdÙkkZ dks #i;s 70@& izfrfnu ds cnys 92@& izfrfnu

etnwjh fn;k x;k gSA fnukad 29 ,oa 30 fnlEcj] 2008 dks jkT;Lrjh; cSBd esa fy, x;s

fu.kZ;kuqlkj u;s etnwjh nj ls etnwjh dk vkdyu fd;k x;k gSA

4- 32-39 fefy;u tula[;k esa MhñMhñVhñ fNM+dko gsrq dqy 1215 ehñVu MhñMhñVhñ dh

vko';drk gksxhA ftyksa ls izkIr lwpukuqlkj 20 ftyksa esa vko';drk ls de MhñMhñVhñ

328

miyC/k gS rFkk 'ks"k 11 ftyksa esa vko';drk ls vf/kd MhñMhñVhñ miyC/k gSA orZeku foÙkh;

o"kZ esa Hkkjr ljdkj }kjk 440 ehñVu MhñMhñVhñ vkiwfrZ dh tk jgh gS ftls mUgh ftyksa esa

vkiwfrZ djus gsrq Hkkjr ljdkj ls vuqjks/k fd;k x;k gS] tgk¡ vko';drk ls de MhñMhñVhñ

miyC/k gSA

5- 31 dkyktkj izHkkfor ftyk ls fNM+dko midj.kksa ds laca/k esa tks lwpuk izkIr gqbZ mls layXu

fooj.kh ,usDpj & III esa fn[kk;k x;k gSA fooj.kh ds voyksdu ls fofnr gksxk fd dk;Z;ksX;

,oa ejEefr ;ksX; midj.kksa dks feykdj vko';drk ds vuqlkj midj.k miyC/k gSaA fQj Hkh

dqN ftyksa esa ;fn midj.kksa dh deh gksxh rks oSls ftyas tgk¡ vko';drk ls T;knk midj.k

miyC/k gS] fopyu }kjk fNM+dko midj.kksa dh vkiwfrZ dh tk,xhA ejEefr ;ksX; midj.kksa ds

ejEefr gsrq jkf'k dk izko/kku ctV esa fd;k x;k gSA

6- fNM+dko ij gksus okys O;; dk enokj fooj.k bl izdkj gS % &

¼ I ½ Js"B {ks=kh; dk;ZdÙkkZ & 1782 ¼etnwjh @ Rs. 113 izfrfnu dh nj ls 60 fnu dk

etnwjh½ & 1782 X 60 X 113 =Rs. 1,20,81,960 {ks=kh; dk;ZdÙkkZ & 8910 ¼etnwjh @ Rs. 92 izfrfnu dh nj ls 60 fnu dk

etnwjh½ & 8910 X 60 X 92 = Rs. 4,91,83,200 dqy etnwjh Rs. &6]12]65]160

¼ftykokj fooj.kh ifjf'k"V II LraHk & 13 -------- n`"VO;½ tgkW rd Deligation of Power of Payment for spraying at district level dk iz'u gS

rks fNM+dko gsrq ftyks dks jkf'k miyC/k djk;h tkrh gS mldk mi;ksx @ O;; ftyk

dk;Zdze inkf/kdkjh }kjk gh fu;ekuqlkj fd;k tk;sxkA O;; esa ftyk LokLF; lfefr ds

inkf/kdkjh dk vuqeksnu fy;k tk;sxkA fNM+dko esa dk;Z djusokys etnwj foxr o"kksZa esa Hkh fNM+dko fd;s gS] vr% fNM+dko

etnwjksa dh fNM+dko dh rduhdh tkudkjh gS] fQj Hkh etnwjksa dks fNM+dko ds iwoZ

,d fnu dk izf'k{k.k fn;k tkrk gSA lacaf/kr ftyksa ds ftyk dk;ZØe inkf/kdkjh

fNM+dko ds iwoZ ,d fnu dk if'k{k.k lqfuf'pr djsaxsA bl esa izf'k{k.k dks fNM+dko

vof/k ds ekuo fnol esa x.kuk fd;k tk,xkA

¼II½ dk;kZy; O;; ,oa vkDlfedrk % &

izR;sd fNM+dko ny esa fNM+dko dk;Z esa iz;ksx gksus okys vko';d lkekuksa ;Fkk xs: feêh]

jftLVj] lknk dkxt] isu] Nék ds fy, diM+k] XyOl bR;kfn ds fufer izfr fNM+dko ny

#i;s 150@& dk;kZy; O;; en es ,ao #i;s 150@& vkDlfedrk en esa jkf'k dk izko/kku

fd;k x;k gSA ftyk dk;ZØe inkf/kdkjh] izR;sd fNM+dko ny dks mijksä lkexzh miyC/k

djkuk lqfuf'pr djsaxsA bl en ls ftyk eq[;ky; esa iz;ksx gksusokys LVs'kujh Ø; dk Hkh

izko/kku gS % &

dk;kZy; O;; & fNMdko ny X 150 ¼1782X 150½ & 267300 #i;s

vkDlfedrk &fNMdko ny X 150 & ¼1782X150½&#i;s 2]67]300@&

dqy & #i;s 5]34]600@&

¼ftykokj fooj.kh ifjf'k"V II LraHk & 14 ,oa 15 n`"VO;½ ¼III½ fNM+dko gsrq MhñMhñVhñ dh <+qykbZ ftyk Lrj ls iz[k.M eq[;ky; rFkk iz[k.M eq[;ky;

ls xzkeksa rd dh tkrh gSA vf/kdka'kr% ftyksa eas MhñMhñVhñ ftyk eq[;ky; eas gh HkaMkfjr

gSA ysfdu dqN ftyksa esa iz[k.M Lrj ij Hkh fiNys fNM+dko ds ckn MhñMhñVhñ cpr gSA

pw¡fd iz[k.M Lrj ij HkaMkj.k dk vk¡dM+k jkT; eq[;ky; esa ugha gSA ,slh fLFkfr esa

ftyk eq[;ky; ls iz[k.M rd <qykbZ ds fufer #i;s 1]000@& ¼,d gtkj½ izfr

dkyktkj izHkfor iz[k.M rFkk iz[k.M ls fNM+dko LFky rd <qykbZ ds fy, #i;s

500@& ¼ik¡p lkS½ izfr izHkfor iz[k.M dh nj ls jkf'k dk vkdyu fd;k x;k gSA

izfr iz[k.M <qykbZ dh jkf'k dk vkdyu ctV rS;kj dh n`f"V ls fd;k x;k gSA vads{k.k

n`f"V ls lacaf/kr ftyk ds dk;ZØe inkf/kdkjh ftyk eq[;ky; ls iz[k.M dh nwjh ds

vuqlkj fu;ekuqlkj ¼vuqeksfnr nj½ <qykbZ djk;saxs] lkFk gh iz[k.Mksa esa miyC/k

MhñMhñVhñ dks eísutj j[krs gq, <qykbZ ij jkf'k dk O;; djsaxs <qykbZ en dh jkf'k ds

O;; ij fu;a=k.k j[kk tk,xkA MhñMhñVhñ <qykbZ dk izLrkfor jkf'k % &

329

ftyk eq[;ky; ls iz[k.M rd @ Rs. 1,000/- izfr izHkkfor iz[k.M dh nj ls ¼310 X 1]000½ & #i;s 3]10]000@&

iz[k.M eq[;ky; ls LFky rd @ Rs. 500/- izfr izHkkfor iz[k.M dh nj ls ¼310 X 500½ & #i;s 1]55]000@&

dqy &#i;s 4]65]000@&

¼ftykokj fooj.kh ifjf'k"V II LraHk & 16 ,oa 17 n`"VO;½ ¼IV½ fNM+dko esa O;ogkj gksusokys fNM+dko midj.kksa ¼ejEefr ;ksX; midj.kksa ds½ ejEefr

gsrq] fNM+dko ds nkSjku fNM+dko midj.kksa ds ejEefr ,oa LVhji iEi gsrq pqVdh oklj]

xSyu lqrk bR;kfn ds fy, jkf'k dk izko/kku izfr fNM+dko ny #i;s 100@& ,oa

uksty VhIl ds Ø; gsrq izfr izfr fNM+dko ny #i;s 400@&dh nj ls jkf'k dk

izko/kku fd;k x;k gSA C;; C;ksjk bl izdkj gS % &

¼d½ fNM+dko midj.kksa dh ejEefr ,oa oklj bR;kfn ds Ø; gsrq

izfr fNM+dko ny #i;s 100@& 1782 X100 & Rs. 1]78]200@&

¼[k½ uksty VhIl ds fy, izfr fNM+dko ny #i;s 400@&

1782X400&Rs. 7]12]800@&

dqy &Rs. 8]91]000@&

¼ftykokj fooj.kh ifjf'k"V IV dkWye 5 rFkk 6 n`"VO;½

ftyksa ls izkIr fNM+dko midj.kksa dh miyC/krk dk ftykokj fooj.k ifjf'k"V III esa n'kkZ;k x;k gSA fNM+dko ds vuqlkj mä ifjf'k"V III eas LVhji iEi] okYVh] xSyu

estj] ikS.M Ekstj rFkk uksty VhIl dh vko';drk rFkk ftyksa eas miyC/k midj.kksa

dk C;kSjk n'kkZ;h xbZ gSA fooj.kh ds voyksdu ls Li"V gksxk fd vf/kdka'kr% ftyksa esa

vko';drk ls T;knk midj.k miyC/k gS ftu ftyksa esa ejEefr ds mijkar Hkh

vko';drk ls de midj.k miyC/k gkss axs] mu ftyksa esa fopyu }kjk vU; ftysa ¼tgk¡

vko';drk ls vf/kd midj.k gS½ ls fNM+dko midj.k miyC/k djk;k tk,xkA

¼V½ i;Zos{k.k % & jkT; ds 31 dkyktkj izHkkfor ftyksa ds foxr ik¡p o"kksZ esa dkyktkj

ls izHkkfor lHkh xzkeksa esa fNM+dko djk;k tkuk gSA fNM+dko ds lQy lapkyu ,oa

xq.koÙkk iw.kZ fNM+dko dh n`f"V ls i;Zos{k.k ,oa ewY;kadu vko';d gSAi;Zos{k.k ftyk

Lrj ,oa iz[k.M Lrj ds inkf/kdkjh ,oa deZpkjh }kjk fd;k tkrk gSA

31 ftyksa esa ls 20 ftyksa esa ftyk eysfj;k inkf/kdkjh dk in l`ftr gS] 'ks"k

11 ftysa esa in l`ftr ugha gSA bu ftyksa esa ek=k i;Zos{k.k dk nkf;Ro ftysa ds vij

eq[; fpfdRlk inkf/kdkjh dks fn;k tk jgk gSA bl fufer ftyk Lrj ij vij eq[;

fpfdRlk inkf/kdkjh@ftyk eysfj;k inkf/kdkjh dh xkM+h gsrq jkf'k miyC/k djkbZ tk

jgh gSA e/ksiqjk rFkk [kxfM+;k ftys ds flfoy ltZu }kjk i;Zos{k.k dk;Z fd;k

tk,xkA

ifjf'k"V I ds LraHk 13 ds voyksdu ls Kkr gksxk fd dqN ftyksa esa izHkkfor

xzkeksa dh la[;k vf/kd gS rks dqN ftyksa esa de gSA vr% i;Zos{k.k gsrq jkf'k izHkkfor

xzkeksa dks vk/kkj eku dj fn;k tk jgk gSaA izR;sd inkf/kdkjh ,d fnu ¼Hkze.k ds fnu½

esa de&ls&de 6 xzkeksa ds fNM+dko dk i;Zos{k.k lqfuf'pr djsaxsA

ftu ftyksa esa xkM+h miyC/k gS] mu ftyksa esa jkf'k dk mi;ksx xkM+h esa mi;qä

gksus okys bZa/ku ij fu;ekuqlkj fd;k tk,xkA ftu ftyksa esa xkM+h miyC/k ugha gS os

ftys HkkMs+ ij xkM+h ¼jkT; Lokñ lfefr] fcgkj iVuk }kjk fu/kkZfjr nj ij½ ysdj

i;Zos{k.k dk;Z djsaxsA

iz[k.M Lrj ij i;Zos{k.k gsrq iz[k.M ds fpñinkñ izfr izHkkfor xzke dh nj ls

jkf'k miyC/k djkbZ tk,xhA iz[k.M ds fpñinkñ Hkze.k dh frfFk dks de&ls&de 6

xzke dk i;Zos{k.k lqfuf'pr djsaxsA bl fufer vko';drk ds rgr~ HkkM+s ij Hkh ogu

fy;k tk ldrk gS] tSlk fd Åij mYys[k fd;k x;k gSA

9 ftyksa ds vij eq[; fpñinkñ ,oa 2 ftys [kxfM+;k] e/ksiqjk ds flfoy ltZu &

¼izHkkfor xzke X100½ 1783X 100 & 1]78]300@&

20 ftyksa ds ftñ eñinkñ &

330

¼izHkkfor xzke X100½ 9031X 100 & 9]03]100@&

31 ftyksa ds iz[k.M fpñinkñ &

¼izHkkfor xzke X 50½ 10814X50 & 5]40]700@&

dqy &Rs. 16]22]100 @&

iz[k.M Lrj dh jkf'k ftyk dk;ZØe inkf/kdkjh }kjk iz[k.M fpñinkñ dks miyC/k

djkbZ tk,xhA ¼ftyk fooj.kh ifjf'k"V IV LraHk 8]9 ,oa 10 nz"VO;½ ¼VI½ i;Zos{kh inkf/kdkjh@deZpkjh dk nSfud HkÙkk % &

ek=k MhñMhñVhñ fNM+dko esa layXu i;Zos{kh inkf/kdkjh ,oa deZpkjh dks nSfud HkÙkk

¼fu;ekuqlkj½ fn;k tk,xkA bl fufer izfr dkyktkj izHkkfor iz[k.M ds fy, #i;s

1]000@& dh nj ls jkf'k dk vkdyu fd;k x;k gSA pw¡fd iz[k.M ds ek= izHkkfor

xzkeksa dk gh fNM+dko fd;k tk jgk gSA iwjs iz[k.M dk ughaA bls eísutj j[krs gq, gh

jkf'k dk vkdyu fd;k x;k gSA izLrkfor jkf'k &izHkkfor izk- Lok- dsUnz dh la[;k

X1]000 & 310X 1]000 & #i;s 3]10]000@&

¼ftyk fooj.kh ifjf'k"V IV LraHk 11 nz"VO;½

(VII) vkbZñbZñlhñ % & fNM+dko ds iwoZ tu lk/kkj.k esa fNM+dko ds Qk;ns fNM+dko ds frfFk

dh tkudkjh dh n`f"V ls bl en esa izfr izHkkfor iz[k.M #i;s 1]000@& dh nj ls

jkf'k dk izko/kku fd;k x;k gSA ftyk Lrjh; dk;ZØe inkf/kdkjh iksLVj]bR;kfn ds

ek/;e ls izpkj&izlkj djk;saxsA bl en dh jkf'k iz[k.M fpñinkñ dks #i;s 500@&

izfr iz[k.M dh nj ls miyC/k djkbZ tk,xhA iz[k.M fpñinkñ izHkkfor xzkeksa esa

fNM+dko ds iwoZ <+ksy fiVokdj] ekbd }kjk xks"Bh dj tulk/kkj.k dks fNM+dko dh

frfFk dh tkudkjh nsaxsA izLrkfod jkf'k ¼izHkkfor iz[k.M X1]000½ & 310X1]000 &

#i;s 3]10]000@& ¼ftyk fooj.kh ifjf'k"V IV LraHk 12 nz"VO;½

(VIII) eysfj;k dk;ZØe esa pkj {ks=h; eysfj;k inkñ dk in lf̀tr gSA fNM+dko dh egÙkk]

xq.kork iw.kZ fNM+dko rFkk fNM+dko ds lQy lapkyu dh n`f"V ls {ks=h; eysfj;k

inkñ dks i;Zos{k.k dk;Z ds ewY;kadu dk nkf;Ro fn;k tk,xkA lacaf/kr {ks=h; eysfj;k

inkñ vius v/khuLFk ftyksa ds Hkze.k dj fNM+dko ds lapkyu dh tkudkjh izkIr djsaxs

rFkk lIrkgUr esa ftykokj fLFkfr ls jkT; dk;ZØe inkf/kdkjh dks voxr djk;saxsA

bl fufer xkM+h HkkM+s ij ysus vFkok ;fn ljdkjh xkM+h miyC/k gks rks bZ/ku

gsrq jkf'k dk izko/kku izfr {ks=h; eysfj;k inkñ #i;s 20]000@& dh nj ls fd;k

x;k gSA lacaf/kr inkf/kdkjh ljdkjh okgu miyC/k ugha jgus ij jkT; Lokñ lfefr

}kjk vuqeksfnr nj ij HkkM+s ij xkMh ysdj dk;Z lEiknu djsaxsA i;Zos{k.k ds Øe

esa lacaf/kr inkf/kdkjh de&ls&de lHkh izHkkfor iz[k.Mksa ds nks&rhu xzkeksa ds

fNM+dko dk fujh{k.k ¼ fNM+dko vof/k esa½ fuf'pr :i ls djs axsA

izLrkfor jkf'k &4 X 20]000@&#i;s 80]000@&

(IX) jkT; Lrj ij jkT; dk;ZØe inkf/kdkjh@mieq[; eysfj;k inkf/kdkjh lgk;d

funs'kd dkyktkj }kjk fNM+dko dk;Z dk vkSpd fujh{k.k fd;k tk,xkA bl fufer

xkM+h dh vko';drk gksxhA ek=k ,d gh okgu gh jkT; eq[;ky; esa miyC/k gS bl

fufer ek=k 25]000@& #i;s jkT; eq[;ky; ds fy, izko/kku fd;k x;k gSA

inkf/kdkjh ds iosZ{k.k ds Øe eas ;k=kk en esa Hkh jkf'k dh vko';drk gksxh bl fufer

ek=k 20]000@& #i;s dk izko/kku fn;k x;k gSA

jkT; Lrj ij ftyksa ls izkIr izfrosnuksa dks rS;kj djus ds Øe esa LVs'kujh

dh vko';drk gksxhA blds rgr~ ek=k 20]000@& #i;s dk;kZYk; O;; en esa

izko/kku fd;k xk;k gSA bl izdkj jkT; Lrj ds fy, jkf'k % &

xkM+h en esa & #i;s 25]000@&

dk;kZYk; en esa & #i;s 20]000@&

;k=kk en eas & #i;s 20]000@&

dqy #i;s 65]000@&

(X) Spray quality should be focused & fNM+dko dh xq.koÙkk lqfuf'pr djus gsrq

331

lHkh izos{kh inkf/kdkjh ,oa deZpkjh dks vko';d funsZ'k fn;k tk;sxkA jkT; Lrj ds

izosZ{kh inkf/kdkjh }kjk ftyksa ds Hkze.k ds nkSjku bl ij dM+h fuxjkuh j[kh tk;sxhA

lcaf/kr {ks=h; eysfj;k inkf/kdkjh ,oa ftyk dk;Zdze inkf/kdkjh dks fNM+dko dh

'kr izfr'kr xq.koÙkk lqfuf'pr djkus dk nkf;Ro fn;k tk;sxkA Qjojh&ekpZ] 2009 esa dkyktkj MhñMhñVhñ fNM+dko gsrq izLrkfor ctV dk ljka'k % &

Øe

lañ

Ekn jkf'k ftyk dk;ZØe inkñdks dkyktkj

izHkkfor ftyksa ds fooj.kh

vuqlkj

1- etnwjh 6]12]65]160@& rFkSo

2- ¼i½ dk;kZy; O;;

¼ii½ vkDlfedrk O;;

2]67]300@&

2]67]300@&

rFkSo

3- MhñMhñVhñ <qykbZ 4]65]000@& rFkSo

4- fNM+dko midj.k 8]91]000@& rFkSo

5- i;Zos{k.k 16]22]100@& rFkSo

6- nSfud HkÙkk 3]10]000@& rFkSo

7- vkbZñbZñlhñ 3]10]000@& rFkSo

ftyk Lrj dk ;ksx 6]53]97]860@& ¼ ifjf'k"V II & IV dk ;ksx½

08- pkj {ksñeñinkñ dks i;Zos{k.k gsrq 80]000@& {ksñeñinkñ] iVuk] eqt¶Qjiqj]

Hkkxyiqj rFkk njHkaxk dks

09- jkT; eq[;ky; gsrq 65]000@& jkT; dk;ZØe inkf/kdkjh jkT;

eq[;ky;] iVukA

,d pØ ds fy, dqy :0 6]55]42]860@& vuqñ % & fooj.kh I, II, III &IV

nks pØ ds fy, dqy :0 13]10]85]720@&

¼[k½ mipkjkRed dkjZokbZ % &

dkyktkj ds jksdFkke gsrq fujks/kkRed dkjZokbZ ds rgr~ MhñMhñVhñ fNM+dko dk izko/kku gS]

ftlds fy, [k.M ^d* es enokj ctV dk izko/kku fd;k x;k gSA mipkjkRed dkjZokb ds

rgr~ dkyktj jksxh ds fpfdRlk lqfo/kk nsus ij fnukad 29&30 fnlEcj] 2008 ds jkT; Lrjh;

cSBd esa foLrkj ls ppkZ gqbZ FkhA ppkZ ds nkSjku dkyktkj ds lHkh jksxh dks iw.kZ fpfdRlk

ljdjh laLFkkuksa esa djkus ds lanHkZ esa fofHké igywvksa ij fopkj fd;k x;kA foeZ'kksijkUr ftu

eq[; fcUnqvksa ij lgefr cuh mlds vuqlkj layXu ifjf'k"V V esa ctV izLrko fn;k x;k gSA

fooj.k fuEuor gS % &

¼1½ izksRlkgu jkf'k % &

izk;% ns[kk tkrk x;k gS fd lHkh jksxh dfri; dkj.kksa ls ljdkjh laLFkkuksa esa fpfdRlk

ugha djk ikrs gS ;k vkrs gS rks fpfdRlk ds nkSjku gh pys tkrs gSA dqN jksxh izkbosV

fpfdRld ds ikl fpfdRlk djkrs gSA

dkyktkj ds lHkh jksxh dks ljdkjh laLFkkuksa esa iw.kZ fpfdRlk djkus dh n`f"V ls

LokLF; dk;ZdÙkkZ ^*vk'kk** dks izksRlkgu jkf'k ds :Ik esa #i;s 100 izfr dkyktkj jksxh

dh nj ls nsus dk fu.kZ; fy;k x;k gS] ftlds rgr~ ^*vk'kk** xzkeh.k {ks=k ds laHkkfor

dkyktkj jksfx;ksa ds ljdkjh laLFkkuksa esa tk¡p djokuk ,oa dkyktkj dh fcekjh laiq"V

gksus ij iw.kZ fpfdRlk djkus dk nkf;Ro fuHkk;saxsA jksxh dh fpfdRlk iw.kZ gksus ds

mijkar mUgsa izksRlkgu jkf'k fn;k tk,xkA

ifjf'k"V V LraHk 4 esa o"kZ 2009 ds vuqekfur dkyktkj jksfx;ksa dk ftykokj la[;k

n'kkZrs gq, izfr jksxh 100@& #i;s dh nj ls jkf'k dk vkdyu fd;k gS] ftls LraHk 5

esa n'kkZ;k x;k gS % &

izLrkfor jkf'k & dkyktkj jksfx;ksa dh la[;kX100 ¾

33]000X100 ¾ 33]00]000@& ¼ifjf'k"V V LraHk 5 nz"VO;½

332

tgkW rd Hkkjr ljdkj QSeyh odZj dks izksRlkgu jkf'k nsus laca/kh izLrko

nsus dk lq>ko gS] rks bl fufer vk'kk dk;ZdÙkk dks izksRlkgu jkf'k nsus dks

izko/kku ctV esa fd;k x;k gSA blds vfrfjDr vU; Health activist }kjk dkyktkj ds lEHkkfor jksxh yk;s tkus ij jksxh dks dkyktkj jksx lEiq"V

gksus ds mijkUr iq.kZ fpfdRlksijkUr izksRlkgu jkf'k fn;k tk;sxkA

¼2½ {kfriwfrZ jkf'k % &

dkyktkj ds vf/kdka'k jksxh xjhc oxZ ds gksrs gS] tks etnwjh dj viuk thou fuokZg

djrs gSA ,sls yksx >qXxh&>ksiM+h esa lqnwj nsgrh bykdksa esa jgrs gS] tgk¡ ls bykt gsrq

ljdkjh vLirkyksa eas vkus esa dfBukbZ ds vfrfjä bykt djkus ds fy, ljdkjh

vLirky esa fpfdRlk ds nkSjku 20&30 fnuksa rd jguk iM+rk gSA ftlls mudk nSfud

etnwjh ckf/kr gks tkrk gS vkSj mUgsa vkfFkZd ladV dh nksgjh ekj gks tkrh gSA nSfud

etnwjh rks ugha feyrh] vyx ls bykt ij Hkh O;; gks tkrk gSaA ifj.kkeLo:I

dkyktkj ds ,sls jksxh ljdkjh laLFkkuksa esa fpfdRlk vof/k ¼vf/kdre 30 fnu½ rd

Je {kfriwfrZ jkf'k nh tk,xhA

izLrkfor jkf'k & dkyktkj jksfx;ksa dh la[;k×fpfdRlk vof/k×{kfriwfrZ jkf'k

¾33]000X30X50¾Rs. 4]95]00]000@& ¼ifjf'k"V V LraHk 6 nz"VO;½

¼3½ iz[k.M vLirky es 'k';k dk foLrkj % &

{ks=k Hkze.k ds nkSjku ,slk ik;k x;k gS fd izkñLokñ dsUnz ds vLrirkyksa esa 'k';k dh

deh ds dkj.k dkyktkj ds ejhtksa dks tehu ij foLrj yxkdj bykt fd;k tkrk

gS] tks fpfdRlk dh n`f"V ls mfpr ugha gSA dkyktkj jksx ds lHkh jksfx;ksa dks 'k';k

miyC/k gks ldsa bl n`f"V ls izR;sd izkñLokñ dsUnz ds vLirkyksa esa vfrfjä nl 'k';k

yxk;k tk;A fnukad 29&30 fnlEcj] 2008 dks vk;ksftr cSBd esa Hkh bl fcUnq ij

lgefr cuh FkhA

bl fufer ,d 'k';k ds fy, vuqekfur jkf'k 1]000@& #i;s izfr 'k';k ¼Bed with Mattress) dk izko/kku fd;k x;k gSA

izLrkfor jkf'k & dkyktkj izHkkfor iz[k.Mksa dh la[;k×'k';k ×nj ¾

310X10 X1]000 ¾Rs. 31]00]000@& ¼ifjf'k"V V LraHk 7 nz"VO;½

¼4½ iosZ{k.k % &

Dkyktkj ds fu;a=k.k esa iosZ{k.k ,d egRoiw.kZ fgLlk gSA ;fn iwjs o"kZ esa ftyk Lrj ,oa

iz[k.M Lrj ls l{ke iosZ{k.k fd;k tk, rks dkyktkj ds fu;a=k.k dk y{; izkIr fd;k

tk ldrk gSA iosZ{k.k ds rgr~ MhñMhñVhñ fNMdko] jksfx;ksa dk fpfdRlk] vuqJo.k]

izfrosnuksa dk lle; izs"k.k bR;kfn vkrs gSA o"kZ esa nks pØ MhñMhñVhñ fNMdko vof/k

vFkkZr~ 4 ekg ds iosZ{k.k dk ctV izko/kku vkbñvkjñ ,lñ ds rgr~ fd;k x;k gSA 'ks"k

vkB ekg ds iosZ{k.k gsrq mipkjkRed dkjZokbZ esa izko/kku fd;k tkuk gSA

iosZ{k.k dk nkf;Ro ftyk Lrj ij ftyk dk;ZØe inkf/kdkjh ,oa iz[k.M Lrj ij

iz[k.M fpfdRlk inkf/kdkjh dk gSA jkT; ds 31 dkyktkj izHkkfor ftyksa eas ek=k 20

ftysa esa gh ftyk eñinkf/kdkjh dk in lf̀tr gS 'ks"k 11 ftyksa esa bUgha ftyk eysfj;k

inkf/kdkjh ds v/khu vkrs gSA lQy iosZ{k.k dh n`f"V ls izR;sd ftyk esa ,d ftyk

Lrjh; ios{k.kh inkf/kdkjh gksuk pkfg,A bl fufer 20 ftyksa ds iosZ{k.k dk nkf;Ro

ftyk eysfj;k inkf/kdkjh dks] 9 ftyksa ds vij eq[; fpfdRlk inkf/kdkjh dks rFkk

'ks"k nks ftysa ¼[kxfM+;k vkSj e/ksiqjk½ ds flfoy ltZu fn;k tk jgk gSA

fNM+dko vof/k ¼pkj ekg½ esa iosZ{k.k ds fy, jkf'k dk izko/kku layXu ifjf'k"V IV esa

fn;k x;k gSA 'ks"k vkB ekg ds fy, jkf'k dk izko/kku layXu ifjf'k"V V esa fd;k x;k

gSA ifjf'k"V V ds LraHk 8 esa flfoy ltZu e/ksiqjk ,oa [kxfM+;k dks 3]000@& izfr

ekg dh nj ls ifjf'k"V V ds LraHk 9 eas vij eq[; fpfdRlk inkf/kdkjh ¼vjfj;k]

vjoy] ckadk] cDlj] tgkukckn] fd'kuxat] y[khljk;] f'kogj ,oa lqikSy½ dks #i;s

10]000 @& #i;s izfr ekg dh nj ls rFkk 'ks"k 20 ftyksa ds ftyk eysfj;k

inkf/kdkjh dks #i;s 10]000@& izfrekg dh nj ls jkf'k dk izko/kku fd;k x;k gSA

333

eysfj;k ,oa dkyktkj ;kstuk ds lQy lapkyu esa ;kstuk esa dk;Zjr eysfj;k

fujh{kdksa dh vge~ Hkwfedk gksrh gSA izR;sd ftysa eas inkLFkkfir eysfj;k fujh{kd ds nks

;k rhu iz[k.Mksa ds dk;Z dk nkf;Ro gSA vr% iz[k.M Lrj ij iosZ{k.k gsrq eysfj;k

fujh{kd dks eksVj lkbZfdy miyC/k djkus dk izko/kku fd;k tk jgk gSA jkT; ds

dkyktkj izHkkfor 31 ftyksa esa 21 ftyk es eysfj;k inkf/kdkjh dk;kZy; vofLFkr gSA

bu 21 ftyksa eysfj;k inkf/kdkjh dk;kZy; esa ls 18 ftyksa esa inLFkkfir eysfj;k

fujh{kd izfr ftyk nks eksVj lkbZfdy rFkk 3 ftyk ¼lgjlk] iwf.kZ;k rFkk eqaxsj½ dks

izfr ftyk 3 dh nj ls eksVjlkbZfdy nsus dk izLrko fn;k tk jgk gSA bl rjg dqy

¼18×2+3×3½ ¾ 45 eksVj lkbZfdy ds Ø; dk izLrko gSA ,d eksVlkbZfdy dh dher

50]000@ & #i;s j[kk x;k gSA

eysfj;k fujh{kd dks eksVj lkbZfdy ij izfrekg 30 yhVj izfr eksVj lkbZfdy

izfrekg dh nj ls nsus dk izLrko gSA ftlds fy, #i;s 50@& izfr yhVj dh nj ls

jkf'k dk vkdyu ifjf'k"V V esa fd;k x;k gSA

blds vfrfjDr i;Zos{k.k gsrq Hkkjr ljdkj }kjk izR;sd dkyktkj izHkkfor ftyks esa

dkyktkj rdfudh ¼KTS½ dk 6 in l`ftr djus dk funs'k fn;k x;k gSA bl rjg

31 dkyktkj izHkkfor ftyks esa 186 ¼KTS½ ds in ds l`tu ,oa fu;qfDr ifdz;kUrxZr

gS ¼KTS½ dks izfrekg 10]000@& :i;s osru fn;k tk;sxkA ftlds fy, jkf'k dk

izko/kku fd;k tk jgk gSA pwfd fo'o cSd }kjk ¼KTS½ dks dkyktkj dk;Zdze esa j[kk

tk jgk gS vr% blij gksus okys O;; dk ogu fo'o cSd }kjk djus dk izko/kku gSA

izLrkfor jkf'k bl izdkj gS % &

¼aa½ nks flfoy ltZu dks #i;s 3]000@&

izfrekg dh nj ls vkB ekg ds fy, &

¼3]000 ×2×8½ ¾ 48]000@&

¼b½ 9 ftyksa ds vij eq[; fpfdRlk inkf/kdkjh

dks #i;s 3]000@& izfrekg dhnj ls vkB

ekg ds fy, ,oa 20 ftyksa dks ftyk

eysfj;k inkf/kdkjh dks & 29 ×10]000×8 ¾ 23]20]000@&

¼c½ eysfj;k fujh{kd ds eksVj lkbZfdy Ø; gsrq

izfr eksVjlkbZfdy #i;s

50]000@& dh nj ls 45 ×50]000 ¾ 22]50]000@&

¼d½ eksVjlkbZfdy ds fy, isVªkWy [kjhn gsrq

izfr eksVjlkbfdy izfrekg 30 yhVj #i;s 50@&izfryhVj

45 ×30×50×12 ¾ 8]10]000@&

¼e½ 186 dkyktkj rduhdh i;Zsos{kd dks

:i;s 10]000@&izfrekg dh nj ls 12 ekg ds fy,

186X10]000X12 = 2]23]20]000@&

dqy ;ksx = 2]77]48]000@&:i;s

¼ifjf'k"V V LraHk 8] 9] 10 rFkk 11 nz"VO;½

eksVj lkbZfdy ds Ø; ds mijkar ,d c"kZ ds lfoZfalax bR;kfn dh xkjaVh dEiuh }kjk

nh tkrh gSA vr% o"kZ 2009&10 esa j[k&j[kko ds fy, jkf'k dk izko/kku ugha fd;k

x;k gSA

¼5½ dkyktkj dh nok ,EQksVsjhlhe ohñ dk HkaMkj.k O;oLFkk % &

dkyktkj jksfx;ksa ds fpfdRlk gsrq Hkkjr ljdkj }kjk ,lñ,lñthñ ,EQkVsjhlhu oh

dh nok dh vkiwfrZ dh tkrh gSA ,EQkVsjhlhu nok dh ,d fu/kkZfjr rkiØe ¼2 ls 80

C½ ij j[kk tk tkuk gS] vU;Fkk nok dh {kerk dsa Ðgkl gksus dh laHkkouk gSA

fu/kkZfjr rkiØe ij nok HkaMkj.k ds fy, 'khr J[̀kyk@'khrx`g gh mi;qä gSA

334

ftu ftyksa esa 'khr J`[kyk miyC/k gS bu ftyksa ds flfoy ltZu nok dks 'khr J`[kyk

esa j[ksaxsA ftu ftyksa esa 'khr J`[kyk miyC/k ugha gS mu ftyksa esa 'khr x`g ¼Cold Storage½ esa nok j[kus dk izLrko gSA bl fufer izR;sd ftys dks mä nok HkaMkj.k

gsrq ¼'khr J`[kyk miyC/k ugaha jgus ij dksYM LVksjst HkkM+s ij ysus gsrq½ #i;s

500@& izfrekg dh nj ls ,d o"kZ ds fy, jkf'k dk izko/kku fd;k x;k gSA jkT;

Lrj ij ¼jkT; dk;ZØe inkf/kdkjh½ Hkh mä nok ds HkaMkj.k gsrq 'khr x`g dh

vko';drk gS] ftlds fy, #i;s 1500@& izfr ekg dh nj ls jkf'k dk izko/kku

fooj.kh V LraHk 12 esa esa fd;k x;k gSA

izLrkfor jkf'k &

¼1½ ftyk Lrj ij HkaMkj.k gsrq #i;s 500 @& izfrekg

dh nj ls ,d o"kZ ds fy, 31 X 500X 12 ¾ #i;s 1]86]000@&

¼II½ jkT; Lrj ij HkaMkj.k gsrq #i;s 1]500 @& izfrekg

dh nj ls ,d o"kZ ds fy, 1]500X 12 ¾ #i;s 18]000@&

¼ifjf'k"V V LraHk 12 nz"VO;½

6- fpfdRlk dkMZ % &

dkyktkj jksfx;ksa ds fpfdRlk ds Øe esa nh tkusokyh nok ds [kqjkd dk

ys[kk&la/kkj.k ,oa fpfdRlk C;ksjk ds fy, fpfdRlk dkMZ dk mi;ksx fd;k tkuk

vko';d gS orZeku esa fpfdRlk dkMZ dk mi;ksx ftyk Lrj ds vLirky ls ysdj

iz[k.M Lrj ij ugha fd;k tk jgk gS] ftlds dkj.k rduhdh ewY;kadu eas dfBukbZ

gksrh gSA 'kh"kZ Lrj ij Hkh fpfdRlk dkMZ la/kkj.k ugha fd;s tkus ij fpark trkbZ xbZ

gSA

vr% fpfdRlk dkMZ ds mi;ksx dh egÙkk dks ns[krs gq, izfr jksxh 2 izdkj ds dkMZ dh

vko';drk gksxhA ,d dkMZ dh NikbZ eas vuqekfur #i;s 2-50 O;; gksxkA bl rjg

,d ¼,d jksxh ds fy, nks dkMZ ds fglkc ls ½ izfr jksxh ij 5@& #i;s O;; gksxkA

ifjf'k"V V LraHk 4 esa o"kZ 2009 ds laHkkfor jksfx;ksa dh la[;k ds vuqlkj LraHk 13

esa ftykokj jkf'k dk vkdyu fd;k x;k gSA

izLrkfor jkf'k & jksfx;ksa dh la[;k nj ¼33]00X 5½ ¾ #i;s 1]65]000@&


7- dkyktkj jksfx;ksa dk lwpuk la/kkj.k iath % &

dkyktkj jksfx;ksa ds foLr`r lwpuk ds la/kkj.k ,oa {ks=kh; Je {kfriwfrZ Hkkx ds

la/kkj.k gsrq izR;s dkyktkj izHkkfor iz[k.M esa nks jftLVj j[kus dk izko/kku fd;k

x;k gS rkfd 'kh"kZ Lrj ds inkf/kdkjh }kjk Hkze.k ds nkSjku jksfx;ksa dh foLr`r lwpuk

,oa nSfud Je {kfriwfrZ jkf'k dk ewY;kdau fd;k tk ldsaA bl fufer izR;sd dkyktkj

izHkkfor ftys ds dkyktkj izHkkfor izk- Lok- dsUnz dks nks jftLVj ¼,d ftLrk dk½

vuqekfur dher #i;s 50@& ¼nks jftLVj½ dh nj ls jkf'k dk vkdyu fd;k x;k

gSA

izLrkfor jkf'k & 31 ftyk ds dkyktkj izHkkfor izk- Lok- dsUnz dh la[;k × nj 310X50 ¾ 15]500@&


8- MhñMhñVhñ dk Hk.Mkj.k % &

MhñMhñVhñ fNM+dko ds fy, Hkkjr ljdkj }kjk ftyksa esa MhñMhñVhñ dh vkiwfrZ dh tkrh

gSA ftyksa es MhñMhñVhñ ds Hk.Mkj.k dh leqfpr O;oLFkk ugha jgus ds dkj.k MhñMhñVhñ

{kfrxzLr ¼/kwi ,oa ikuh ls½ gksus dh laHkkouk gSA leqfpr Hk.Mkj.k O;oLFkk dks eísutj

j[krs gq, ;k rks Hk.Mkj] HkkM+s ij fy;k tk; ;k ftyksa ds miyC/k jkT; HkaMkj fuxe

ds xksnke esa j[kk tk;A

Pkw¡fd ftyksa dks HkkM+s ij HkaMkj ysus esa fu;ekuqlkj iz'kklfud Lohd`fr ysus es dkQh

dfBukbZ gksrh gSA Qyr% tc rd HkaMkj.k dh O;oLFkk ugha gksrh gSA rc rd

335

MhñMhñVhñ dks ;=&r= j[kuk iM+rk gSA bl fufer HkkM+s ij xksnke ysus vFkok jkT;

HkaMkj fuxe ¼ftldk nj ljdkj }kjk vuqeksfnr gS½ ds xksnke esa HkaMkj.k gsrq izfr

ftyk izfr ekg #i;s 5]000@& dh nj ls iwjs o"kZ ds fy, jkf'k dk izko?kku fd;k

x;k gSA

izLrkfor jkf'k & 31X 5000X 12 ¾ 18]60]000@&


9- dkyktkj [kkst Ik[kokjk& dfri; dkj.kks ls lHkh dkyktkj ds jksxh dk iÙkk ugh

py ikrk gS ftlls dkyktkj mUewyu y{; izkIr ugh gks jgk gSA dkyktkj o"kZ

fnlEcj esa 15 fnuks dk [kkst Ik[kokjk eukus dk izLrko gSA[kkst Ik[kokjk jkT; ds 31

dkyktkj izHkkfor ftyks ds lHkh iz[k.Mks esa euk;k tk;sxkA

[kkst i[kokjk ds egRrk dks vke tu ds tkudkjh gsrq [kkst Ik[kokjk ds iwoZ pkj fnu

izpkj xkM+h lHkh iz[k.Mks esa Hkstdj izpkj izlkj fd;k tk;sxk blds vfrfjDr lHkh

iz[k.Mks esa iksLVj] iEiysV] cSuj bR;kfn ds }kjk Hkh [kkst i[kokjk ds laca/k esa izpkj

izlkj fd;k tk;sxkA bl fufer vko';d jkf'k dk izko/kku otV izkdDyu esa fd;k

x;k gSA izpkj xkM+h gsrq :i;s 750@& izfr izk0Lok0dsUnz dh nj ls 4 fnuks ds fy,

jkf'k dk izko/kku fd;k x;k gSAizkLrkfor jkf'k bl izdkj gS%&

izpkj okgu gsrq 338 iz[k.Mks ds fy, :i;s 750@&

izfr okgu dh nj ls 4 fnuksa ds fy,& ¼338X750X4½ & 10]14]000@&

iksLVj] iEiysV cSuj gsrq izfr izk0Lok0 dsUnz :i;s 1000@&

dh nj ls &¼338X1000½ & 3]38]000@&

dqy & 13]52]000@&

10- Arrest Cases of Kalazar & o"kZ 2010 rd dkyktkj Elemenation y{; dks izkIr

djus ds fy, lHkh dkyktkj jksfx;ks dks iw.kZ mipkj fd;k tk;sxk rFkk izHkkfor {ks=ks

esa fujks/kkRed dkjokbZ ds rgr o"kZ esa nks okj Mh0Mh0Vh0 fNM+dko djk;k tk;sxkA

blds vfrfjDr [kkst Ik[kokjk ds }kjk dkyktkj jksfx;ks dh [kkst dj fpfdRlk dh

tk;sxhA vk'kk dk;ZdÙkkZ dks dkyktkj ds lEHkkfor dks ljdkjh vLirky esa ykdj]

dkyktkj ds jksx lEiq"V gksus ,oa iw.kZ fpfdRlk ds mijkUr izksRlkgu jkf'k nh tk;sxhA

bl rjg dkyktkj dsl dks lekIr fd;k tk ldrk gSA

11- izLrkfor jkf'k dk enokj fooj.k % &

1- izksRlkgu jkf'k & 33]00]000@&ftyk dk;ZØe inkñ dks

2- nSfud Je {kfriwfrZ jkf'k 4]95]00]000@& rFkSo

3- iz[k.M vLirky ds 'k';k foLrkj 31]00]000@& rFkSo

4- IkosZ{k.k 2]77]48]000@& rFkSo

5- nok dk Hk.Mkj.k 1]86]000@& rFkSo

18]000@& jkT; dk;ZØe inkñ dks

6- fpfdRlk dkMZ 1]65]000@& ftyk dk;ZØe inkñ dks

7- lwpuk la/kkj.k iath 15]500@& rFkSo

8- MhñMhñVhñ dk HkaMkj.k 18]60]000@& rFkSo

9- dkyktkj [kkst i[kokjk 13]52]000@&

dqy ;ksx 8]72]44]500@&

¼vkB djksM+ cgrj yk[k pkSvkfyl gtkj ik¡p lkS #i;s ek= ½

¼ifjf'k"V V nz"VO;½

336

(x) jkT; Lrjh; dEiksusUV

(jkT; dk;ZØe inkf/dkjh dk;kZy; ds fy,)

1- jkT; LVh;jhx dfeVh %& dkyktkj ds liQy lapkyu dh n‘f"V ls le;≤ ij ’kh"kZ Lrjh;

inkfŁkdkfj;ksa ds ijke’kZ dh vko’;drk gksrh gSA bl n‘f"V ls jkT; jkT; ij ,d State Stearing Committee ds xBu dh vko’;drk eg’kwl dh xbZ gS A bl dfeVh esa fodkl vk;qDr] LokLF;

vk;qDr] funs’kd izeq[k Lok- lsok;s] jkT; dk;Zdze ink- rFkk Hkkjr ljdkj ds ’kh"k ink- Hkh ’kkfey

jgsxs A

le;≤ ij mDr xfBr dfeVh ds cSBd vk;kstu djus ,oa cSBd ds vk;kstu esa

gksus okys O;; dh n‘f"V ls jkf’k dk izko/ku fd;k x;k A dfeVh dh cSBd o"kZ esa de ls de rhu

ckj djkus dk izLrko gS A

izLrkfor jkf’k & Rs. 30,000/- (Rs. 10,000 izfr cSBd × 3 ) [ foij.kh VI dafMdk 1 nz"VO; ] 2. czkaM ,sEcsLMj

dkyktkj ds jksdFkke dh n‘f"V ls le;≤ ij ekuuh; iz/ku ea=kh @ eq[; ea=kh @ vU; x.kekU;

usrk @ vfHkusrk }kjk izpkj dk;Z vko’;d izrhr gksrk gS A bl fufer jkf’k dk izLrko gS ftldks O;;

izpkj dk;Z ij gksxk A

izLrkfor jkf’k & Rs. 50,000/- [ fooj.k VI dafMdk&2 nz"VO; ] 3. dEI;wVj

jkT; dk;ZØe ink- dk;kZy; esa dk;ZØe laca/h dk;Z ds lqpk: :i ls fu"iknu dh n‘f"V ls ,d MsLd

VkWi dEI;wVj (;w-ih-,l- ds lkFk) dh vko’;drk gS A bl fufer jkf’k izLrko gS A

izLrkfor jkf’k & Rs. 50,000/- [ fooj.kh VI dafMdk&3 nz"VO; ] 4. ySi VkWi

jkT; Lrj ij vofLFkr jkT; dk;ZØe ink- esa rhu ink- ;Fkk jkT; dk;ZØe ink-] mi eq[; eysfj;k

ink- ,oa lgk;d funs’kd dkyktkj inLFkkfir gS ftuds }kjk dk;ZØe dk lapkyu fd;k tkrk gSA bu

rhuksa inkfd/kjh dks l le; lHkh rjg dh lwpuk j[kus @ ’kh"kZ inkf/dkfj;ksa dks lwpuk miyC/

djkus gsrq rhu ySi VkWi dh vko’;drk gS A ftlds fy, jkf’k dk izLrko gS A izfr ySi VkWi Rs. 50,000/- dh nj ls Ø; dk izLrko izLrkfor jkf’k Rs. 50,000 × 3 -------Rs. 1,50,000/-

[ fooj.kh VI dafMdk 4 nz"VO; ] 5. eksckby iQksu

dkyktkj dk;Z dh lqxerk ,oa deZpkjh ink- ds chp lh/k lEidZ dh n‘f"V ls eksckby iQksu ds Ø;

dk djus dk izLrko gS A jkT; dk;Zdze ink- dk;kZy; esa dk;Zjr rhu ink-] rduhdh ’kk[kk esa pkj]

LVksuks ,d iz/ku fyfid ,oa ys[kkiky ,d (dqy nl) eksckby iQksu ds Ø; dk izLrko gSA izfr

eksckby Rs. 2000/- dh nj ls jkf’k dk izko/ku fd;k x;k gSA

eksckby ds Øe ds mijkUr izfrekg dqiu ij gksus okys O;; ij izfr eksckby Rs. 337/- dh nj ls

12 ekg ds jkf’k dk izLrko gSA

337

izLrkfor jkf’k &

nl eksckby Ø; ---------- 10 × 2000---------- Rs 20,000/- eksckby ij ekfld O;;------- 10 × 337 × 12 ------ Rs.40,440/- dqy Rs. 60,440/- [ fooj.kh VI, dafMdk & 5 ] 6. ystj izhaVj

jkT; eq[;ky; vofLFkr jkT; dk;ZØe ink- dk;kZy; gsrq ystj izhaVj ftlds rgr iQksu] iQSDl] Ldsuj

lfgr] Ø; dk izLrko gS A ftlds Ø; gsrq jkf’k dk izLrko gS A

izLrkfor jkf’k---------------------- Rs. 25,000/- [ fooj.kh VI, dafMdk& 6 ] 7. iQksVks dkWih e’khu

jkT; eq[;ky; esa iQksVks dkWih e’khu miyC/ ugha gS A ;kstuk ds dk;Z lEiknu esa iQksVks dkWih djkuk

iM+rk gS ftls LFkkuh; cktkj ls djk;k tkrk gS A bls [kpZ Hkh vf/d gksrk gS lkFk gh dfBukbZ Hkh A

vr% dk;Z lqyHkrk dh n‘f"V ls jkT; eq[;ky; gsrq ,d iQksVks dkWih e’khu dh vko’;drk gS ftlij

gksus okys O;; dk izko/ku ctV esa fn;k tk jgk gS A

izLrkfor jkf’k------------------- Rs. 1,50,000/- 8. jkT;Lrj ij cSBd vk;kstu

dk;ZØe ds lapkyu esa ftyk dk;ZØe ink- ds lkFk leh{kkRed cSBd djuk vko’;d gksrk gS A

cSBd esa dk;ZØe ds laca/ esa ftykokj foLr‘r leh{kk dh tkrh gS rFkk dk;ZØe ds lapkyu ds laca/

esa vxzrj dkjZokbZ gsrq Hkh fn’kk funs’k r; fd;k tkrk gS A

jkT; Lrj o"kZ esa de ls de rhu ckj cSBd vk;ksftr djus dk izLrko gS A izR;sd cSBd esa Rs. 10,000/-O;; gksus dh laHkkouk gS A bl fufer jkf’k dk izko/ku ctV esa fd;k x;k gS A

izLrkfor jkf’k -------------------- 3 × 10,000 --------------------- Rs. 30,000/- 9. bUVjusV lqfo/k

jkT; eq[;ky; esa vofLFkr dEI;wVj esa bUVjusV lqfo/k vko’;d gS A blds vfrfjDr dk;kZy; ds

dEI;wVj ds j[k j[kko ij Hkh O;; gksxk A vr% bUVjusV lqfo/k ,oa dEI;wVj ds j[k j[kko ij gksus

oyks O;; ds fy, ctV esa jkf’k dk izLrkfor fn;k tk jgk gS A

izLrkfor jkf’k----------------------- Rs. 30,000/- 10. iosZ{k.k

ftyk Lrj ds dk;ZØe ink- ds iosZ{k.k gsrq ctV [k.M ^d* esa vkbZ-vkj-,l- esa pkj ekg ds fy, rFkk

ctV [k.M ^[k* esa vkB ekg ds fy, jkf’k izLrkfor gS A

jkT; Lrj ij ds inkf/dkfj;ksa ds iosZ{k.k ij gksus okys O;; ds fy, vko’;d jkf’k dk izko/ku ctV

esa fn;k tk jgk gS A jkT; Lrj ij jkT; dk;ZØe ink- dk;kZy; esa inLFkkfir rhu ink- }kjk dk;ZØe

dk iosZ{k.k fd;k tkuk gS A jkT; eq[;ky; esa ek=k ,d xkM+h gS og Hkh pkyq gkyr esa ugha gS A vr%

miyC/ xkM+h ds ejEerh ,oa HkkM+s ij xkM+h ysdj iosZ{k.k fd;k tk;xk A ftlds fufer izfr ink-

izfrekg fd Rs. 2500 dh nj ls jkf’k dk izLrko gS A

izLrkfor jkf’k---------------------------- 3 × 2500 ×12 -------------------- Rs. 90,000/- xkM+h ejEerh gsrq------------------------------------------------------------------- Rs. 10, 000/-

338

[ fooj.kh VI dsfMdk----------------- 10 nz"VO; ] dqy Rs. 1,00,000/- 11. tsujsVj lqfo/k

jkT; eq[;ky; esa fctyh ckf/r gksus ij dk;Z dk lEiknu can gks tkrk gSA bl fufer ,d tsujsVj

Ø; dk izLrko gS A tsujsVj ds Ø; ,oa izfrekg mlds fy, ba/u ij gksus okys O;; ds fy, ctV esa

jkf’k dk izko/ku fd;k x;k gS A

izLrkfor jkf’k--------------------------------------------------- Rs. 50, 000/- tsujsVj ds ba/u gsrq Rs. 4000/- izfr ekg dh nj ls (12 × 400) --------------------------- Rs. 48,000/- ;ksx Rs. 98,000/- (fooj.kh VI ---- dafMdk 11 nz"VO;)

12. izpkj&izlkj

le;≤ ij dkyktkj ds laca/ esa tula/kj.k esa tudkjh nSfud lekpkj i=k] jsfM;ks] Vh-oh-

bR;kfn ds ekŁ;e ls nsuk vko’;d gS A lHkh ftyks ds dkyktkj izHkkfor xkoks esa fNM+dko dh frfFk

dh lwpuk LFkkuh; yksdfiz; nSfud lekpkj Ik=kks esa nks fnu izdkf’kr fd;k tk;sxkA bl fufer ctV

esa jkf’k dk izko/ku fd;k x;k gS A

dqy izLrkfor jkf’k---------------------------------------------- Rs. 4,00,000/- (fooj.kh VI--- dafMdk& 13 nz"VO;)

13. {ks=kh; eysfj;k dk;kZy; gsrq

eysfj;k ;kstuk esa iwjs jkT; esa pkj {ks=kh; eysfj;k ink- dk dk;kZy; gSA {ks=kh; e- ink- }kjk vius

{ks=kk/hu feyksa ds liQy iosZ{k.k dh n‘f"V ls HkkM+s ij xkM+h ysus gsrq jkf’k dk izLrko gS ftlds rgr

izfr {ks- e- ink- 20]000@& dh nj ls jkf’k dh izko/ku fd;k tk jgk gS A

blds vfrfjDr {ks=kh; eysfj;k dk;kZy; esa ,d&,d dEI;wVj Ø; dk Hkh izLrko gS ftlls lacaf/r

{ks- e- ink- vius v/huLFk ftyksa dk v|ru fLFkfr dk O;ksjk j[ksxs rFkk izR;sd lIrkg fLFkfr ls

jkT; eq[;ky; dks voxr djk;sxs A

izLrkfor jkf’k &

iosZ{k.k ------------------------- 20,000 × 4 ------------------ 80,000/- dEI;wVj Ø;----------------- 50,000 × 4 ------------------ 2,00,000/- dEI;wVj ds j[k j[kkc---- 5000 × 4 ------------------ 20,000/- dqy 3,00,000/- izLrkfor ctV dk enokj fooj.kh

1- jkT; LVh;jhx dfeVh -------------------------- Rs. 30,000/- jkT; dk;ZØ; ink- gsrq

2- czkaM ,EosLMj ------------------------- Rs. 50,000/- ]]

3- dEI;wVj ------------------------- Rs. 50,000/- ]]

4- ySi VkWi ------------------------ Rs. 1,50,000/- ]]

5- eksckby iQksu ------------------------ Rs. 60,440/- ]]

6- ystj izhVj ------------------------ Rs. 25,000/- ]]

7- iQksVks dkWih e’khu ------------------------ Rs. 1,50,000/- ]]

339

8- cSBd (jkT; Lrjh;) ------------------------- Rs. 30,000/- ]]

9- bUVjusV lqfo/k ------------------------- Rs. 30,000/- ]]

10- iosZ{k.k ------------------------- Rs. 1,00,000/- ]]

11- tsujsVj ------------------------- Rs. 98,000/- ]]

12- izpkj&izlkj ------------------------- Rs. 4,00,000/- ]]

13- {ks- e- ink- dk;Zy; gsrq ------------------------- Rs. 3,00,000/- ]]

dqy;ksx Rs. 14,73,440/- (?k) izf’k{k.k & dkyktkj Elemination y{; 2010 dh izfIr dh n‘f"V ls jkT; ds lHkh Lrj ds LokLF;

foHkkx esa inLFkkfir fp- inkf/dkfj;ksa] eysfj;k ;kstuk esa dk;Zjr lHkh Lrj ds ikjk esfMdy dfeZ;ksa

dk izf’k{k.k vko’;d izrhr gksrk gS rkfd fujks/kRed ,oa mipkjkRed dkjZokbZ esa mudk lfØ;

lg;ksx fey lds A blds vfrfjDr LokLF; loxZ ds dqN vU; ikjk esfMdy dfeZ;ksa iapk;fr jkT;

ds lnL;ksa ,oa cgqnsf’k; dk;ZØÙkk (vk’kk) Hkh fujks/kRed ,oa mipkjkRed dkjZokbZ ds fy, izf’kf{kr

djuk vko’;d izrhr gksrk gSA

bl n‘f"V dks.k ls Hkkjr ljdkj }kjk fn;s x;s fn’kk funs’k ds vuqlkj izf’k{k.k dk;ZØe dh :ijs[kk

rS;kj dh xbZ gS] ftls layXu ifjf’k"V VII esa ns[kk tk ldrk gS A ifjf’k"V VII esa ftykokj eysfj;k ;kstuk ljdkjh vLirky ds fpfdRldks ,oa vU; LokLF; lEoxZ ds ikjk esfMdy dfeZ;k iapk;rh

jkT; ds lnL;ksa ds izf’k{k.k dk ctV izkdyu rS;kj fd;k x;k gS A izf’k{k.k izLrko foLr‘r fooj.k

bl izdkj gS &

1. eysfj;k ;kstuk ds eysfj;k fujh{kdksa dk izf’k{k.k

jkT; ds 31 dk;kZy; izHkkfor ftyksa esa dqy 114 e- fu- dk;Zjr gS A Hkkjr ljdkj ds fn’kk funs’kd

ds vuqlkj 20 izf’k{k.kkfFkZ dks ,d oS/ esa izf’k{k.k fn;k tk;xk A bl rjg dqy 6 cSp gksxs A

izf’k{k.k vof/ 1 fnuksa dh gksxh A

o"kZ esa nks ckj izf’k{k.k nsus dk izLrko gS A ,d cSp ds izf’k{k.k ij dqy O;; 69,500/- :- gksxkA

bl rjg iwjs o"kZ esa 6 cSp dks nks okj izf’k{k.k ij dqy O;;

2 × 6 × 69, 500/-------------- Rs. 8,34,000/- (ifjf’k"V VII LrEHk 4 nz"VO;) 2. iz;ksx’kkyk izkosf/d

eysfj;k ;kstukUrxZr 31 dkyktkj izHkkfor ftyksa esa dqy 47 iz;ksx’kkyk izkoSf/d dk;Zjr gS A 20

izf’k{k.kFkksZ ds fglkc ls dqy 2 cSp dks 10 fnuksa dk izf’k{k.k fn;k tk;xk A ,d cSp ds izf’k{k.k

ij dqy O;; 1,25,000/- gksxk A ifjf’k{k.k ij izLrkfor O;;------------ 2 × 1,25, 000@&------------ Rs. 2,50,000/- iz;ksx’kkyk izkosfNd dks Re Orientation izf’k{k.k Hkh fn;k tk;xk A ftlesa 2 cSp ds izf’k{k.kkFkksZ

dks 5 fnuksa dk izf’k{k.k fn;k tkuk gS A ,d cSp ds izf’k{k.k ij 75,620/- O;; gksxk A Orientation dkslZ ij izLrkfor Ø;-------- 2 × 75, 620 ------------ Rs. 1,51,240/- iz;ksx’kkyk izkoSfNd ds izf’k{k.k ij dqy O;; ----------- Rs. 4,01,240/- (ifjf’k"V VII LrEHk 6] 7 nz"VO;) 3. cqfu;knh Lok- fujh{kd ,oa fuxjkuh fujh{kd

jkT; ds 31 dkyktkj izHkkfor ftyksa esa eysfj;k ;kstuk ds 118 cqfu;knh Lok- fujh{kd ,oa 18

340

fuxjkuh fujh{kd dk;Zjr gS A bl rjg 136 izf’k{k.kFkhZ dks 27 izfr cSp vuqlkj 5 oSp esa izf’k{k.k

fn;k tk;xkA ;g izf’k{k.k nks fnuksa dk gksxk A izf’k{k.k ij izfr oSp 30,000 :- O;; dk izLrkohr

gS A

izLrkfor jkf’k------------------- 5 × 30, 000 ----------- Rs. 1,50,000/- (ifjf’k"V VII LrEHk 11 n‘"VO;) 4. Lok- dk;ZdÙkkZ dk izf’k{k.k

jkT; ds eysfj;k ;kstukUrxZr 31 dkyktkj izHkkfor ftyksa esa dqy 103 cqfu;knh Lok- dk;ZdÙkkZ] 33

fuxjkuh dk;ZdÙkkZ] 43 {ks=kh; dk;ZdÙkkZ rFkk 19 Js- {ks- dk;ZdÙkkZ dk;Zjr gSA bl rjg dqy 198

dk;Zjr dks izf’kf{kr fd;k tkuk gS A 25 izf’k{k.kkFkhZ izfr oSp dh nj ls 8 oSp esa izf’k{k.k fn;k

tk;xkA izf’k{k.k vof/ nks fnuksa dh gksxh A izf’k{k.k ij izfr oSp 30,000/- :- O;; gksxk A izLrkfor jkf’k & 30,000 × 8 Rs. 2,40,000/- (ifjf’k"V VII LrEHk 16 n"VO;) 5. fpfdRlk ink- dk izf’k{k.k

jkT; ds 31 dkyktkj izHkkfor ftyksa ds lHkh Lrj ds vLirkyksa esa dk;Zjr fpfdRlk inkf/dkfj;ksa ds

izf’k{k.k dk izLrko gS A lHkh Lrj ds vLirkyksa esa inLFkkfir fpfdRlk inkf/dkfj;ksa dk ftysokj

la[;k layXu ifjf’k"V VIII ds LrEHk 3 ls 8 esa n’kkZ;k x;k gS A lHkh Lrj ij inLFkkfir fp- ink-

dh dqy la[;k 502 gS A 25 izf’k{k.kkFkhZ izfr oSp ds vuqlkj 20 oSp esa izf’k{k.k dk izLrko gS A

izf’k{k.k vof/ rhu fnuksa dh gksxh ,d oSp ds izf’k{k.k ij dqy 1,20,000/- :- O;; izLrkfor gS A

fp- iznk- ds izf’k{k.k dqy izLrkfor O;; 20 × 1,20,000--------- Rs. 24,00,000/- (ifjf’k"V VIII LrEHk 9 n‘"VO;) 6. iapk;rh jkT; ds lnL;ksa dk izf’k{k.k

jkT; esa iapk;rh jkT; ds ykxw gks tkus ls blds lnL;kssa dks ljdkjh dk;Z ds ns[k&js[k dk nkf;Ro

fn;k x;k A dkyktkj ds djhc 90 izfr’kr jksxh xzkeksa ls gh vkrs gSa vr% iapk;r Lrj ds lnL;ksa dks

dkyktkj ds fujks/kRed ,oa mipkjkRed dkjZokbZ ls :&c&: voxr djkus dh n‘f"V ls izf’k{k.k dk

izLrko fn;k tk jgk gS A layXu ifjf’k"V IX ds LrHk 3 ls 5 esa iapk;rh jkTk ds lnL;ksa dk ftysokj

vkadM+k fn;k x;k gS ftUgsa izf’k{k.k dk izLrko gS A

ifjf’k"V ds voyksdu ls fofnr gksxk fd iapk;rh jkt ds dqy 13860 lnL;ksa dks izf’k{k.k nsus dk

izLrko gS A 50 lnL; izfr oSp dh nj ls dqy 277 oSp esa izf’k{k.k fn;k tk;xkA izfr oSp dks 1

fnu dk izf’k{k.k fn;k tk;xk A ,d oSp ds izf’k{k.k ij 2000 :- O;; gksxk A

izLrkfor O;;---------------- 277 × 2000 -------------------------------------- Rs. 5,54,000/- (ifjf’k"V IX LrEHk 6 nz"VO;)

7. fNM+dko dkfeZ;ksa dk izf’k{k.k

jkT; ds dkyktkj izHkkfor 31 ftyksa ds foxr ik¡p o"kksZ esa dkyktkj izHkkfor xzkeksa ds dqy 32-39

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orZeku esa Hkkjr ljdkj }kjk fu/kZfjr uhfr ds rgr dqy (1782 $ 8910) 10692 fNM+dko dfeZ;ksa

dks izf’k{k.k fn;k tkuk gSA

rnuqlkj 50 fNM+dko dehZ izfr oSp dh nj ls dqy 214 oSp esa 1 fnu dk izf’k{k.k fn;k tk;xkA

341

,d fnu ds izf’k{k.k esa ,d oSp ij dqy 2000@& :- O;; dk izLrkfor gS A

dqy izLrkfor O;; ------------------- 214 × 2000 --------------------------- Rs. 4,28,000/- (ifjf’k"V X LrEHk 5 n‘"VO;) 8. cgqísf’k; dk;ZdÙkkZ (vk’kk) dk izf’k{k.k

dk;ZØe ds lapkyu esa vk’kk dk;ZdÙkkZ dks Hkh ’kkfey fd;k x;k gS vr% dkyktkj ds mipkjkRed

dkjZokbZ ds laca/ esa izf’k{kr fd;k tkuk gS A ifjf’k"V X ds LrEHk 6 esa ftykokj vk’kk dk;ZdÙkkZ dh

la[;k n’kkZ;h xbZ gS A dqy 52]065 vk’kk dk;ZdÙkkZ dks 50 izf’k{k.kkFkhZ izfr oSp dh nj ls 1041

cSp esa izf’k{k.k nsus dk izLrko gS A izfr oSp dks ,d fnu dk izf’k{k.k fn;k tk;xkA ftlij 2000@&

:- (izfroSp) dh nj ls O;; gksxk A

dqy izLrkfor O;; -------------- 1041 × 2000 ---------------------- Rs. 20,82,000/- (ifjf’k"V X LrHk 7 n‘"VO;)

9. izf’k{k.k ij dqy O;; dk lkjka’k

1- eysfj;k fujh{kd -------------------------- Rs. 8,34,000/- 2- iz;ksx’kkyk izkoSf/d ------------------------- Rs. 4,01,240/-

3- cq-Lok- fu- ,oa fu- fu- ------------------------- Rs. 1,50,000/-

4- Lok- dk;ZdÙkkZ ------------------------ Rs. 2,40,000/-

5- fp- ink- ------------------------ Rs. 24,00,000/-

6- iapk;rh jkt ------------------------ Rs. 5,54,000- 7- fNM+dko dehZ ------------------------ Rs. 4,28,000/-

8- cgqísf’k; dk;ZÙkkZ (vk’kk) ------------------------- Rs. 20,82,000/- dqy Rs. 70,89,240/-

;kstuk ctV dk lkjka’k

[k.M d & fujks/kRed dkjZokbZ & Rs. 13,10,85,720=00 [k.M [k & mipkjkRed dkjZokbZ & Rs. 8,72,44,500=00 [k.M x & jkT; eq[;ky; dk lqn‘<hdj.k& Rs. 14,73,440=00 [k.M ?k & izf’k{k.k & Rs. 70, 89, 240 = 00 dqy Rs. 22,68,92,900=00

(ckbZl djksM- vjlB yk[k cjkuos gtkj ukS lkS :i;s)

fo’okl Hkktu

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Kkikad---------------------------------@ iVuk fnukad-----------------------------

izfrfyfi iz/ku lfpo] Lok- ,oa i- d- foHkkx] fcgkj iVuk] funs’kd izeq[k Lok- lsok;sa fcgkj] jkT; Lok-

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342

izfrfyfi {ks=kh; funs’kd] Lok- ,oa i- d- foHkkx] Hkkjr ljdkj] bfUnjk Hkou] ikWpoka eafaty] csyh jksM]iVuk]

dks vuqyXud lfgr lwpukFkZ ,oa vko’;d dkjZokbZ gsrq izf"kr A



343

State & District Wise Fund Allocation - Kala-Azar, Bihar 2009-2010

Name of Districts

One Round Amount Two Round Amount

From Annex. V Total ( Column 6+7) From Annex. II From Annex. IV Total Amount For One Round

Total Amount For Two Round Spray i.e (Anneex.II+

Annex.IV) 1 2 3 4 5 6 7 8 1 Araria 4,105,740.00 161,450.00 4,267,190.00 8,534,380.00 5,072,950.00 13,607,330.00 2 Arwal 73,860.00 9,700.00 83,560.00 167,120.00 1,008,250.00 1,175,370.00 3 Banka 36,180.00 2,800.00 38,980.00 77,960.00 1,016,150.00 1,094,110.00 4 Begusarai 1,923,900.00 86,250.00 2,010,150.00 4,020,300.00 2,119,550.00 6,139,850.00 5 Bhagalpur 287,940.00 27,300.00 315,240.00 630,480.00 1,289,100.00 1,919,580.00 6 Bhojpur 429,660.00 42,000.00 471,660.00 943,320.00 1,136,650.00 2,079,970.00 7 Buxar 214,080.00 13,400.00 227,480.00 454,960.00 1,066,400.00 1,521,360.00 8 Darbhanga 3,072,840.00 140,250.00 3,213,090.00 6,426,180.00 3,686,450.00 10,112,630.00 9 E.Champaran 5,023,920.00 234,550.00 5,258,470.00 10,516,940.00 4,493,000.00 15,009,940.00

10 Gopalganj 1,332,840.00 78,150.00 1,410,990.00 2,821,980.00 3,068,500.00 5,890,480.00 11 Jehanabad 76,860.00 16,400.00 93,260.00 186,520.00 1,052,400.00 1,238,920.00 12 Katihar 2,177,160.00 148,450.00 2,325,610.00 4,651,220.00 2,298,150.00 6,949,370.00 13 Khagaria 667,920.00 39,350.00 707,270.00 1,414,540.00 2,005,550.00 3,420,090.00 14 Kishanganj 1,361,520.00 79,950.00 1,441,470.00 2,882,940.00 1,503,800.00 4,386,740.00 15 Lakhisarai 211,080.00 11,350.00 222,430.00 444,860.00 1,050,350.00 1,495,210.00 16 Madhepura 2,750,220.00 111,100.00 2,861,320.00 5,722,640.00 4,254,350.00 9,976,990.00 17 Madhubani 2,662,680.00 128,900.00 2,791,580.00 5,583,160.00 2,952,400.00 8,535,560.00 18 Munger 217,080.00 22,800.00 239,880.00 479,760.00 1,178,800.00 1,658,560.00 19 Muzaffarpur 5,188,320.00 293,450.00 5,481,770.00 10,963,540.00 6,976,700.00 17,940,240.00 20 Nalanda 606,060.00 44,150.00 650,210.00 1,300,420.00 1,321,050.00 2,621,470.00 21 Patna 2,035,440.00 124,300.00 2,159,740.00 4,319,480.00 1,628,050.00 5,947,530.00 22 Purnea 4,319,820.00 202,600.00 4,522,420.00 9,044,840.00 4,410,900.00 13,455,740.00 23 Saharsa 2,646,180.00 108,850.00 2,755,030.00 5,510,060.00 5,044,850.00 10,554,910.00 24 Samastipur 3,662,400.00 185,650.00 3,848,050.00 7,696,100.00 4,248,200.00 11,944,300.00 25 Saran 2,762,220.00 159,050.00 2,921,270.00 5,842,540.00 3,941,250.00 9,783,790.00 26 Sheohar 419,160.00 17,200.00 436,360.00 872,720.00 1,202,850.00 2,075,570.00 27 Sitamarhi 3,452,820.00 140,450.00 3,593,270.00 7,186,540.00 2,721,650.00 9,908,190.00 28 Siwan 2,830,080.00 144,850.00 2,974,930.00 5,949,860.00 2,647,200.00 8,597,060.00 29 Supaul 1,577,100.00 81,250.00 1,658,350.00 3,316,700.00 1,168,800.00 4,485,500.00 30 Vaishali 3,935,340.00 191,150.00 4,126,490.00 8,252,980.00 5,650,550.00 13,903,530.00 31 W.Champaran 2,204,340.00 86,000.00 2,290,340.00 4,580,680.00 6,011,650.00 10,592,330.00

344

Total 62,264,760.00 3,133,100.00 65,397,860.00 130,795,720.00 87,226,500.00 218,022,220.00 State Level Activity

1 Training At State Level From Annex. VII,VIII,IX & X 7,089,240.00 2 State Level Activity From Annex. VI 1,473,440.00 3 SPO & ZMO Mobility During Spray Period 145000.00 x2 =290000.00 290,000.00 4 Storage of Amphoteracin B.At State Level 18,000.00

Grand Total Of Kala-Azar Programme ,BIHAR 226,892,900.00

345

District Infrastructure of Kala-Azar Affected Districts Anexure - I

Sl. No. Name of Districts Total No. of Total No. of Affected

PHC HSC Block Panchyat Revenue Village

Urban Ward Population PHC HSC Panchyat Village Ward Population

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 1 Araria 9 109 9 221 757 54 2,670,845 9 88 165 563 0 2,153,592 2 Arwal 3 64 0 0 335 0 651,717 3 7 0 18 0 41,144 3 Banka 10 0 11 185 1681 40 0 1 1 1 2 0 12,719 4 Begusarai 11 288 18 257 1064 36 2,900,088 11 51 154 245 0 999,274 5 Bhagalpur 11 280 17 242 1929 62 2,948,451 7 0 0 62 0 145,797 6 Bhojpur 12 304 14 228 1457 100 2,292,652 9 64 0 120 0 210,106 7 Buxar 7 167 11 142 993 60 1,458,493 4 16 0 16 0 104,052 8 Darbhanga 14 306 19 306 1522 48 3,442,496 14 206 206 455 0 1,602,617 9 E.Champaran 20 318 27 387 1716 20 46,78,325 20 268 302 817 0 2,620,283

10 Gopalganj 10 186 14 234 1499 12 2,398,707 10 107 0 261 0 693,562 11 Jehanabad 5 81 12 161 947 52 1,029,742 5 15 0 36 0 37,257 12 Katihar 18 257 16 238 1737 45 2,687,203 18 192 0 543 0 1,134,049 13 Khagaria 6 0 7 129 306 18 0 6 0 0 119 0 348,271 14 Kishanganj 7 79 7 118 761 28 1,554,007 6 36 63 323 0 712,592 15 Lakhisarai 4 102 7 80 496 18 895,678 2 19 19 29 18 101,437 16 Madhepura 7 196 13 170 838 41 1,669,001 7 139 0 384 0 1,431,240 17 Madhubani 18 430 21 399 1072 75 4,094,575 18 294 294 366 0 1,376,642 18 Munger 6 134 9 101 837 104 1,349,751 6 33 30 52 0 97,035 19 Muzaffarpur 14 527 16 387 1937 49 4,561,521 14 459 0 1273 0 2,703,171 20 Nalanda 12 0 20 249 1183 122 0 11 0 0 91 0 315,421 21 Patna 16 0 23 331 1455 72 4,062,216 16 244 0 422 0 1,060,285 22 Purnea 14 151 14 237 1075 0 3,174,330 13 107 191 764 0 2,258,220 23 Saharsa 7 152 10 164 435 43 1,802,298 7 130 0 379 0 1,381,124 24 Samastipur 14 0 20 381 1250 61 3,860,729 14 331 329 701 0 1,904,426 25 Saran 15 413 20 0 1813 0 3,551,306 15 0 0 597 0 1,437,022 26 Sheohar 2 0 5 54 207 15 0 2 0 0 48 0 212,868 27 Sitamarhi 13 0 17 273 846 79 3,009,938 13 186 212 433 38 1,807,046 28 Siwan 15 351 16 293 1458 51 3,100,210 14 219 0 509 0 1,481,302 29 Supaul 11 178 11 180 688 0 1,968,535 11 0 0 245 0 809,393 30 Vaishali 11 339 16 292 1680 45 3,250,683 11 0 278 751 0 2,054,842 31 W.Champaran 16 369 18 354 2220 121 3,495,552 13 140 123 190 0 1,147,023

Total 338 5,781 438 6,793 36,194 1,471 67,880,724 310 3,352 2,367 10,814 56 32,393,812

346

Dist. Wise Sqad,DDT,Wages,Office Exp.,Contigency,Transportation of DDT For Kala Azar Spray One Round Annexure -II

Sl. No.

Name of Districts

Total No. of Affected Total No. of

Sqad (55 Sqad /10

Lakhs Population

Total No. of Workers

DDT 50% Status (In Meric Ton)

WAGES Office Expenses (@ Rs 150/-Per

Sqad

Contigency (@ Rs. 150/- Per

Sqad

Transportation of DDT Grand Total (13+14+15+

18) SFW(Rs. 113/-Per SFW For

60 Days)

FW(Rs.92/-Per FW For 60

Days) Total

District To PHC(RS.

1000/- Aff. PHC)

PHC To Village(R

s.500/-PHC)

Total PHC Population SFW FW Require. Available Balance

Require. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 1 Araria 9 2,153,592 118 118 590 80.76 46.99 33.77 800,040 3,256,800 4,056,840 17,700 17,700 9,000 4,500 13,500 4,105,740 2 Arwal 3 41,144 2 2 10 1.54 0.29 1.25 13,560 55,200 68,760 300 300 3,000 1,500 4,500 73,860 3 Banka 1 12,719 1 1 5 0.48 0.00 0.48 6,780 27,600 34,380 150 150 1,000 500 1,500 36,180 4 Begusarai 11 999,274 55 55 275 37.47 29.76 7.71 372,900 1,518,000 1,890,900 8,250 8,250 11,000 5,500 16,500 1,923,900 5 Bhagalpur 7 145,797 8 8 40 5.47 5.20 0.27 54,240 220,800 275,040 1,200 1,200 7,000 3,500 10,500 287,940 6 Bhojpur 9 210,106 12 12 60 7.88 25.00 -17.12 81,360 331,200 412,560 1,800 1,800 9,000 4,500 13,500 429,660 7 Buxar 4 104,052 6 6 30 3.90 5.00 -1.10 40,680 165,600 206,280 900 900 4,000 2,000 6,000 214,080 8 Darbhanga 14 1,602,617 88 88 440 60.10 132.00 -71.90 596,640 2,428,800 3,025,440 13,200 13,200 14,000 7,000 21,000 3,072,840 9 E.Champaran 20 2,620,283 144 144 720 98.26 85.70 12.56 976,320 3,974,400 4,950,720 21,600 21,600 20,000 10,000 30,000 5,023,920 10 Gopalganj 10 693,562 38 38 190 26.01 0.00 26.01 257,640 1,048,800 1,306,440 5,700 5,700 10,000 5,000 15,000 1,332,840 11 Jehanabad 5 37,257 2 2 10 1.40 0.02 1.38 13,560 55,200 68,760 300 300 5,000 2,500 7,500 76,860 12 Katihar 18 1,134,049 62 62 310 42.53 19.00 23.53 420,360 1,711,200 2,131,560 9,300 9,300 18,000 9,000 27,000 2,177,160 13 Khagaria 6 348,271 19 19 95 13.06 4.60 8.46 128,820 524,400 653,220 2,850 2,850 6,000 3,000 9,000 667,920 14 Kishanganj 6 712,592 39 39 195 26.72 38.61 -11.89 264,420 1,076,400 1,340,820 5,850 5,850 6,000 3,000 9,000 1,361,520 15 Lakhisarai 2 101,437 6 6 30 3.80 2.05 1.75 40,680 165,600 206,280 900 900 2,000 1,000 3,000 211,080 16 Madhepura 7 1,431,240 79 79 395 53.67 0.50 53.17 535,620 2,180,400 2,716,020 11,850 11,850 7,000 3,500 10,500 2,750,220 17 Madhubani 18 1,376,642 76 76 380 51.62 157.30 -105.68 515,280 2,097,600 2,612,880 11,400 11,400 18,000 9,000 27,000 2,662,680 18 Munger 6 97,035 6 6 30 3.64 15.75 -12.11 40,680 165,600 206,280 900 900 6,000 3,000 9,000 217,080 19 Muzaffarpur 14 2,703,171 149 149 745 101.37 62.94 38.43 1,010,220 4,112,400 5,122,620 22,350 22,350 14,000 7,000 21,000 5,188,320 20 Nalanda 11 315,421 17 17 85 11.83 33.26 -21.43 115,260 469,200 584,460 2,550 2,550 11,000 5,500 16,500 606,060 21 Patna 16 1,060,285 58 58 290 39.76 58.90 -19.14 393,240 1,600,800 1,994,040 8,700 8,700 16,000 8,000 24,000 2,035,440 22 Purnea 13 2,258,220 124 124 620 84.68 132.29 -47.61 840,720 3,422,400 4,263,120 18,600 18,600 13,000 6,500 19,500 4,319,820 23 Saharsa 7 1,381,124 76 76 380 51.79 30.00 21.79 515,280 2,097,600 2,612,880 11,400 11,400 7,000 3,500 10,500 2,646,180 24 Samastipur 14 1,904,426 105 105 525 71.42 20.85 50.57 711,900 2,898,000 3,609,900 15,750 15,750 14,000 7,000 21,000 3,662,400 25 Saran 15 1,437,022 79 79 395 53.89 20.33 33.56 535,620 2,180,400 2,716,020 11,850 11,850 15,000 7,500 22,500 2,762,220 26 Sheohar 2 212,868 12 12 60 7.98 3.80 4.18 81,360 331,200 412,560 1,800 1,800 2,000 1,000 3,000 419,160 27 Sitamarhi 13 1,807,046 99 99 495 67.76 35.93 31.84 671,220 2,732,400 3,403,620 14,850 14,850 13,000 6,500 19,500 3,452,820 28 Siwan 14 1,481,302 81 81 405 55.55 16.40 39.15 549,180 2,235,600 2,784,780 12,150 12,150 14,000 7,000 21,000 2,830,080 29 Supaul 11 809,393 45 45 225 30.35 21.50 8.85 305,100 1,242,000 1,547,100 6,750 6,750 11,000 5,500 16,500 1,577,100 30 Vaishali 11 2,054,842 113 113 565 77.06 41.00 36.06 766,140 3,118,800 3,884,940 16,950 16,950 11,000 5,500 16,500 3,935,340 31 W.Champaran 13 1,147,023 63 63 315 43.01 46.64 -3.63 427,140 1,738,800 2,165,940 9,450 9,450 13,000 6,500 19,500 2,204,340

Total 310 32,393,812 1,782 1,782 8,910 1,215 1,092 123 12,081,960 49,183,200 61,265,160 267,300 267,300 310,000 155,000 465,000 62,264,760

347

Dist. Wise Status of Spray Equipments pf Kala Azar DDT Spray Annex. III

Sl. No.

Name of Districts

Total No. of Sqad (55 Sqad /10 Lakhs

Population

Districwise Status of Spray Equipment of K..A D.D.T Spray

Stirrup Pump Bucket Gallan Measure Pound Measure Nosal Tip

Req

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1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 1 Araria 118 236 237 80 -1 472 319 0 153 118 115 0 3 118 120 0 -2 590 2 Arwal 2 4 0 0 4 8 0 0 8 2 0 0 2 2 0 0 2 10 3 Banka 1 2 0 0 2 4 0 0 4 1 0 0 1 1 0 0 1 5 4 Begusarai 55 110 258 0 -148 220 508 0 -288 55 107 0 -52 55 85 0 -30 275 5 Bhagalpur 8 16 250 40 -234 32 400 9 -368 8 140 5 -132 8 140 0 -132 40 6 Bhojpur 12 24 40 193 -16 48 450 50 -402 12 100 10 -88 12 100 10 -88 60 7 Buxar 6 12 0 0 12 24 0 0 24 6 0 0 6 6 0 0 6 30 8 Darbhanga 88 176 294 0 -118 352 279 0 73 88 127 0 -39 88 127 0 -39 440 9 E.Champaran 144 288 286 177 2 576 507 138 69 144 197 23 -53 144 193 20 -49 720 10 Gopalganj 38 76 234 20 -158 152 438 40 -286 38 97 20 -59 38 97 20 -59 190 11 Jehanabad 2 4 234 20 -230 8 438 40 -430 2 97 20 -95 2 97 20 -95 10 12 Katihar 62 124 180 104 -56 248 354 120 -106 62 142 0 -80 62 142 0 -80 310 13 Khagaria 19 38 110 50 -72 76 200 116 -124 19 79 0 -60 19 79 0 -60 95 14 Kishanganj 39 78 50 50 28 156 240 0 -84 39 56 0 -17 39 42 0 -3 195 15 Lakhisarai 6 12 40 58 -28 24 150 46 -126 6 49 0 -43 6 49 0 -43 30 16 Madhepura 79 158 252 0 -94 316 324 0 -8 79 81 0 -2 79 81 0 -2 395 17 Madhubani 76 152 526 0 -374 304 820 0 -516 76 225 0 -149 76 225 0 -149 380 18 Munger 6 12 140 0 -128 24 200 0 -176 6 40 0 -34 6 40 0 -34 30 19 Muzaffarpur 149 298 375 0 -77 596 647 0 -51 149 186 0 -37 149 175 0 -26 745 20 Nalanda 17 34 257 3 -223 68 502 10 -434 17 100 0 -83 17 130 0 -113 85 21 Patna 58 116 293 130 -177 232 519 112 -287 58 193 20 -135 58 172 2 -114 290 22 Purnea 124 248 190 80 58 496 413 50 83 124 130 0 -6 124 82 0 42 620 23 Saharsa 76 152 150 20 2 304 350 20 -46 76 75 0 1 76 75 0 1 380 24 Samastipur 105 210 224 0 -14 420 300 0 120 105 90 0 15 105 90 0 15 525 25 Saran 79 158 135 101 23 316 425 135 -109 79 105 0 -26 79 105 0 -26 395 26 Sheohar 12 24 0 0 24 48 0 0 48 12 0 0 12 12 0 0 12 60 27 Sitamarhi 99 198 105 65 93 396 295 68 101 99 111 0 -12 99 117 0 -18 495 28 Siwan 81 162 124 104 38 324 439 60 -115 81 178 5 -97 81 170 5 -89 405 29 Supaul 45 90 0 0 90 180 0 0 180 45 0 0 45 45 0 0 45 225 30 Vaishali 113 226 217 49 9 452 362 59 90 113 115 4 -2 113 102 0 11 565 31 W.Champaran 63 126 280 105 -154 252 380 65 -128 63 120 7 -57 63 118 4 -55 315

Total 1,782 3,564 5,481 1,449 -1,917 7,128 10,259 1,138 -3,131 1,782 3,055 114 -1,273 1,782 2,953 81 -1,171 8,910

348

Statement Showing The Expenditure ,Repair,Mobility, DA Supervision & IEC For Kala Azar Spray Annex. IV

Sl. No.

Name of Districts

Total No. of Affected

Total No. of Sqad (55 Sqad /10

Lakhs Population

Repair of Spray Equipments Including Nozal Tips

District MobilityFor

ACMO Vehicle @ Rs.100 Per

Affected Village

District Mobility DMO Vehicle @ Rs.100 Per

Affected Village

Mobility For PHC MO.@

RS.50 Per Aff. Vill.

DA For Supervision @ Rs. 1000 Per Affected PHC

IEC @ Rs. 1000/- Per Affected PHC per Round

Total Remarks

Rep

air(

RS.

100

/-Pe

r Sq

ad)

Purc

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Per

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s.40

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Tota

l

PHC Village 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 1 Araria 9 563 118 11800 47200 59000 56,300 0 28150 9000 9000 161,450 2 Arwal 3 18 2 200 800 1000 1,800 0 900 3000 3000 9,700 3 Banka 1 2 1 100 400 500 200 0 100 1000 1000 2,800 4 Begusarai 11 245 55 5500 22000 27500 0 24,500 12250 11000 11000 86,250 5 Bhagalpur 7 62 8 800 3200 4000 0 6,200 3100 7000 7000 27,300 6 Bhojpur 9 120 12 1200 4800 6000 0 12,000 6000 9000 9000 42,000 7 Buxar 4 16 6 600 2400 3000 1,600 0 800 4000 4000 13,400 8 Darbhanga 14 455 88 8800 35200 44000 0 45,500 22750 14000 14000 140,250 9 E.Champaran 20 817 144 14400 57600 72000 0 81,700 40850 20000 20000 234,550 10 Gopalganj 10 261 38 3800 15200 19000 0 26,100 13050 10000 10000 78,150 11 Jehanabad 5 36 2 200 800 1000 3,600 0 1800 5000 5000 16,400 12 Katihar 18 543 62 6200 24800 31000 0 54,300 27150 18000 18000 148,450 13 Khagaria 6 119 19 1900 7600 9500 11,900 0 5950 6000 6000 39,350 14 Kishanganj 6 323 39 3900 15600 19500 32,300 0 16150 6000 6000 79,950 15 Lakhisarai 2 29 6 600 2400 3000 2,900 0 1450 2000 2000 11,350 16 Madhepura 7 384 79 7900 31600 39500 38,400 0 19200 7000 7000 111,100 17 Madhubani 18 366 76 7600 30400 38000 0 36,600 18300 18000 18000 128,900 18 Munger 6 52 6 600 2400 3000 0 5,200 2600 6000 6000 22,800 19 Muzaffarpur 14 1273 149 14900 59600 74500 0 127,300 63650 14000 14000 293,450 20 Nalanda 11 91 17 1700 6800 8500 0 9,100 4550 11000 11000 44,150 21 Patna 16 422 58 5800 23200 29000 0 42,200 21100 16000 16000 124,300 22 Purnea 13 764 124 12400 49600 62000 0 76,400 38200 13000 13000 202,600 23 Saharsa 7 379 76 7600 30400 38000 0 37,900 18950 7000 7000 108,850 24 Samastipur 14 701 105 10500 42000 52500 0 70,100 35050 14000 14000 185,650 25 Saran 15 597 79 7900 31600 39500 0 59,700 29850 15000 15000 159,050 26 Sheohar 2 48 12 1200 4800 6000 4,800 0 2400 2000 2000 17,200 27 Sitamarhi 13 433 99 9900 39600 49500 0 43,300 21650 13000 13000 140,450 28 Siwan 14 509 81 8100 32400 40500 0 50,900 25450 14000 14000 144,850 29 Supaul 11 245 45 4500 18000 22500 24,500 0 12250 11000 11000 81,250 30 Vaishali 11 751 113 11300 45200 56500 0 75,100 37550 11000 11000 191,150 31 W.Champaran 13 190 63 6300 25200 31500 0 19,000 9500 13000 13000 86,000

Total 310 10,814 1,782 178,200 712,800 891,000 178,300 903,100 540,700 310,000 310,000 3,133,100

349

Budget Provision For Qurative Measures of Kala Azar Annex. V

Sl. No. Name of Districts

Tota

l No.

of

PHC

Tota

l No.

of A

ffect

ed P

HC

Estim

ated

Pro

ject

edC

ase

For 2

009

-201

0

Incentive ASHA(Rs. 100/-Per

Projected Case For Complete

Treatment)

Loss Of Wages

Rs.50/-For 30 Days

Per Projected

Case During

Treatment Period

Strengthing Of Bed (10 Beds

Per Effected

PHC @ Rs. 1000/-Bed

With Mattress)

Mobility For Officers & MI,POL & Maintenance Storage Of Drugs

Treatment Card @Rs.

2.50 Per Treatment Card For 2

Diff.Types of Each

Card For Projected Case

Register For Line Listing / Loss Of Wages Record

@ Rs.50/-For 2

Register Per

Eff.PHC

Hiring of Warehouse at Dist. Level for

Storage of DDT @ Rs. 5000/-Per Month For 12 Months

Kala Azar Forthnight Programm

e (@Rs.4000/-Per PHC

Monthly Emoulment of KTS 6 KTS For

31 Dist. @ Rs.

10,000/- Per Month

For 12 Months

Grand Total

Mobility For

CS Khagariya & Madhepura @ Rs. 3000/-

Per Month For 8 Month

s( Excluding

Spray Period

)

Mobility For DMO

For Max.RS

10,000/-Per Month for 8 Months ( Excluding

Spray Period)

Mobility Of MI

Purchage Of 1

Motorcycle Per District

@ Rs. 50,000/-Per Motorcycle(Except 2

Motorcycle For

Selected Districts)

POL For Motorcycle @30 Litres

Per Months

@ Rs.50/- For 12

Months

Emphoteracin

Storage In

District Level @ Rs. 500/-

Per Month For 12

Months

Emphoteracin

Storage In State Level @

Rs. 1500/-

Per Month For 12

Months =Rs.

18,000/-

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20

1 Araria 9 9 2,500 250,000 3,750,000 90,000 0 80,000 50,000 18,000 6,000 0 12,500 450 60,000 36,000 720,000 5,072,950

2 Arwal 3 3 20 2,000 30,000 30,000 0 80,000 50,000 18,000 6,000 0 100 150 60,000 12,000 720,000 1,008,250

3 Banka 10 1 20 2,000 30,000 10,000 0 80,000 50,000 18,000 6,000 0 100 50 60,000 40,000 720,000 1,016,150

4 Begusarai 11 11 600 60,000 900,000 110,000 0 80,000 100,000 36,000 6,000 0 3,000 550 60,000 44,000 720,000 2,119,550

5 Bhagalpur 11 7 150 15,000 225,000 70,000 0 80,000 50,000 18,000 6,000 0 750 350 60,000 44,000 720,000 1,289,100

6 Bhojpur 12 9 40 4,000 60,000 90,000 0 80,000 50,000 18,000 6,000 0 200 450 60,000 48,000 720,000 1,136,650

7 Buxar 7 4 40 4,000 60,000 40,000 0 80,000 50,000 18,000 6,000 0 200 200 60,000 28,000 720,000 1,066,400

8 Darbhanga 14 14 1,550 155,000 2,325,000 140,000 0 80,000 100,000 36,000 6,000 0 7,750 700 60,000 56,000 720,000 3,686,450

9 E.Champaran 20 20 2,000 200,000 3,000,000 200,000 0 80,000 100,000 36,000 6,000 0 10,000 1,000 60,000 80,000 720,000 4,493,000

10 Gopalganj 10 10 1,200 120,000 1,800,000 100,000 0 80,000 100,000 36,000 6,000 0 6,000 500 60,000 40,000 720,000 3,068,500

11 Jehanabad 5 5 30 3,000 45,000 50,000 0 80,000 50,000 18,000 6,000 0 150 250 60,000 20,000 720,000 1,052,400

12 Katihar 18 18 650 65,000 975,000 180,000 0 80,000 100,000 36,000 6,000 0 3,250 900 60,000 72,000 720,000 2,298,150

13 Khagaria 6 6 650 65,000 975,000 60,000 24,000 0 50,000 18,000 6,000 0 3,250 300 60,000 24,000 720,000 2,005,550

14 Kishanganj 7 6 300 30,000 450,000 60,000 0 80,000 50,000 18,000 6,000 0 1,500 300 60,000 28,000 720,000 1,503,800

15 Lakhisarai 4 2 50 5,000 75,000 20,000 0 80,000 50,000 18,000 6,000 0 250 100 60,000 16,000 720,000 1,050,350

16 Madhepura 7 7 2,000 200,000 3,000,000 70,000 24,000 0 100,000 36,000 6,000 0 10,000 350 60,000 28,000 720,000 4,254,350

17 Madhubani 18 18 1,100 110,000 1,650,000 180,000 0 80,000 50,000 18,000 6,000 0 5,500 900 60,000 72,000 720,000 2,952,400

18 Munger 6 6 100 10,000 150,000 60,000 0 80,000 50,000 18,000 6,000 0 500 300 60,000 24,000 720,000 1,178,800

350

19 Muzaffarpur 14 14 3,600 360,000 5,400,000 140,000 0 80,000 100,000 36,000 6,000 0 18,000 700 60,000 56,000 720,000 6,976,700

20 Nalanda 12 11 100 10,000 150,000 110,000 0 80,000 100,000 36,000 6,000 0 500 550 60,000 48,000 720,000 1,321,050

21 Patna 16 16 250 25,000 375,000 160,000 0 80,000 100,000 36,000 6,000 0 1,250 800 60,000 64,000 720,000 1,628,050

22 Purnea 14 13 2,050 205,000 3,075,000 130,000 0 80,000 50,000 18,000 6,000 0 10,250 650 60,000 56,000 720,000 4,410,900

23 Saharsa 7 7 2,500 250,000 3,750,000 70,000 0 80,000 50,000 18,000 6,000 0 12,500 350 60,000 28,000 720,000 5,044,850

24 Samastipur 14 14 1,900 190,000 2,850,000 140,000 0 80,000 100,000 36,000 6,000 0 9,500 700 60,000 56,000 720,000 4,248,200

25 Saran 15 15 1,700 170,000 2,550,000 150,000 0 80,000 100,000 36,000 6,000 0 8,500 750 60,000 60,000 720,000 3,941,250

26 Sheohar 2 2 150 15,000 225,000 20,000 0 80,000 50,000 18,000 6,000 0 750 100 60,000 8,000 720,000 1,202,850

27 Sitamarhi 13 13 1,000 100,000 1,500,000 130,000 0 80,000 50,000 18,000 6,000 0 5,000 650 60,000 52,000 720,000 2,721,650

28 Siwan 15 14 900 90,000 1,350,000 140,000 0 80,000 100,000 36,000 6,000 0 4,500 700 60,000 60,000 720,000 2,647,200

29 Supaul 11 11 50 5,000 75,000 110,000 0 80,000 50,000 18,000 6,000 0 250 550 60,000 44,000 720,000 1,168,800

30 Vaishali 11 11 2,800 280,000 4,200,000 110,000 0 80,000 100,000 36,000 6,000 0 14,000 550 60,000 44,000 720,000 5,650,550

31 W.Champaran 16 13 3,000 300,000 4,500,000 130,000 0 80,000 100,000 36,000 6,000 0 15,000 650 60,000 64,000 720,000 6,011,650

*** State Level 0 0 0 0 0 0 0 0 0 0 0 18000 0 0 0 0 0 18,000

Total 338 310 33,000 3,300,000 49,500,000 3,100,000 48,000 2,320,000 2,250,000 810,000 186,000 18,000 165,000 15,500 1,860,000 1,352,000 22,320,000 87,244,500

351

Annex- VI

Sl.No. State Level Component Activity Financial Cost 1 State Stearing Committee 30,000.00 2 Brand Ambassador 50,000.00 3 Computer Desktop One 50,000.00

4 Laptop Three (One For SPO, One For Dy. CMO, One For AD Kala-Azar) 150,000.00

5 Mobile Phone For Officer & Staff At State Level Office 60,440.00

6 Laser Printer (Phone+Fax +Scanner included) 25,000.00 7 Xerox Machine 150,000.00

8 Meeting With Officers Of Dist. Level Alternate Month 30,000.00

9 Strengthininh Of Computer & Internet Facility 30,000.00 10 Supervision Of Dist. At State Level 100,000.00 11 Strengthininh Of ZMO Office ( All Four ZMO) 300,000.00 12 Generator with fuel 98,000.00 13 IEC 400,000.00

14 Total 1,473,440.00

352

State - Bihar Kala -Azar Action Plan 2009-2010 , Training Part I Annexure --VII

Sl. No. Name of Districts Training Of Malaria Inspector Training (Induction & Re-Orientation) Of LT Training Of Health Supervisor Training Of Health Worker

Total

No. Of MI

TRG Cost Of MI

TwoRounds

Total No. Of LT

TRG Cost Of LT

(Induction TRG)

TRG Cost Of LT (Re-

Orientation TRG)

Grand Total Induction &

Re-orientation

Total No. Of BHI

Total No. Of

SI

TRG Cost Of Health

Supervisor

Total No. Of BHW

Total No. Of

SW

Total No. Of FW

Total No. Of SFW

TRG Cost Of Health Worker

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 1 Araria 0

Tota

l No.

of M

alar

ia In

spec

tors

114

.Tot

al P

rovi

sion

of T

rain

ing

of

114

MI .

Pro

visi

on

of 2

0 Pa

rtic

ipan

t in

eac

h B

atch

=12

Bat

ches

(Tw

oRou

nd) @

0.69

5 La

khs

per B

atch

=8

.34

Lak

hs A

s Pe

r NVB

DC

P G

uide

line.

Tw

o R

ound

.

0

Tota

l No.

of 4

7 La

b Te

chne

cian

.Tot

al P

rovi

sion

of I

nduc

tion

Trai

ning

of

47 L

ab

Tech

neci

an. P

rovi

sion

of

20 P

artic

ipan

t in

eac

h B

atch

=2

Bat

ches

@1.

25 L

akhs

per

B

atch

for 1

0 D

ays

=2.5

Lak

hs A

s Pe

r NVB

DC

P G

uide

line

.One

Tim

e

TRG

of a

ll 47

Lab

Tec

hnec

ian

Indu

ctio

n .T

otal

Pro

visi

on o

f Ind

uctio

n Tr

aini

ng o

f 47

La

b Te

chne

cian

. Pro

visi

on o

f 20

Par

ticip

ant

in e

ach

Bat

ch =

2 B

atch

es

@0.

7562

Lakh

s pe

r Bat

ch fo

r 5 D

ays

=1.5

124

Lakh

s A

s Pe

r NVB

DC

P G

uide

line

.One

Ti

me

TRG

of a

ll 47

Lab

Tec

hnec

ian

Indu

ctio

n &

Re-

Orie

ntat

ion

Gra

nd T

otal

. As

Per

NVB

DC

P G

uide

line

.One

Tim

e

0 0

Tota

l No.

of B

HI =

118

+SI 1

8 To

tal 1

36 .T

otal

Pro

visi

on o

f Tra

inin

g o

f 136

Hea

lth

Supe

rvis

or .

Prov

isio

n of

25

Part

icip

ant

in e

ach

Bat

ch =

5 B

atch

es F

or 2

Day

s @

0.

30 L

akhs

per

Bat

ch =

1.50

Lak

hs A

s Pe

r NVB

DC

P G

uide

line.

One

Rou

nd.

0 0 0 0

Tota

l No.

of B

HW

=10

3 +S

IW=

33 +

FW=4

3 +S

FW=1

9 T

otal

198

.Tot

al P

rovi

sion

of

Trai

ning

of 1

98 H

ealth

Wor

ker .

Pro

visi

on o

f 25

Par

ticip

ant

in e

ach

Bat

ch =

8 B

atch

es F

or 2

Day

s @

0.3

0 La

khs

per B

atch

=2.

40 L

akhs

As

Per N

VBD

CP

Gui

delin

e.

One

Rou

nd.

2 Aurangabad 4 0 1 0 3 0 1 0 3 Arwal 0 0 0 0 0 0 0 0 4 Banka 0 0 0 0 0 0 0 0 5 Begusarai 3 1 3 0 7 0 1 2 6 Bhagalpur 2 1 11 1 6 0 1 2 7 Bhojpur 5 1 8 0 1 0 4 2 8 Buxar 0 0 0 0 0 0 0 0 9 Darbhanga 4 0 4 2 4 2 4 0 10 E.Champaran 7 2 12 1 5 5 1 2 11 Gaya 4 8 8 0 7 0 3 1 12 Gopalganj 2 2 0 0 0 0 3 1 13 Jamui 0 0 0 0 0 0 0 0 14 Jehanabad 0 0 0 0 0 0 0 0 15 Kaimur 0 0 0 0 0 0 0 0 16 Katihar 3 0 2 0 6 0 0 0 17 Khagaria 0 0 0 0 0 0 0 0 18 Kishanganj 0 0 0 0 0 0 0 0 19 Lakhisarai 0 0 0 0 0 0 0 0 20 Madhepura 0 0 0 0 0 0 0 0 21 Madhubani 8 0 5 6 0 9 2 0 22 Munger 5 3 4 3 11 5 2 0 23 Muzaffarpur 4 1 7 0 3 0 3 0 24 Nawada 2 2 1 1 0 1 2 0 25 Nalanda 3 3 8 0 2 0 3 0 26 Patna 10 11 11 0 9 0 5 2 27 Purnea 9 0 6 1 7 0 3 0 28 Rohtas 6 1 1 2 9 5 0 0 29 Saharsa 6 3 6 0 3 0 0 0 30 Samastipur 5 1 3 0 0 0 0 1 31 Saran 6 1 6 0 4 0 0 1

353

32 Sheikhpura 0 0 0 0 0 0 0 0 33 Sheohar 0 0 0 0 0 0 0 0 34 Sitamarhi 3 2 4 0 3 0 0 0 35 Siwan 3 1 3 0 6 0 1 1 36 Supaul 0 0 0 0 0 0 0 0 37 Vaishali 5 1 4 0 5 0 3 2 38 W.Champaran 5 0 0 1 2 6 1 2 ZMO Office (All 4) 0 2 0 0 0 0 0 0

Total 114 834,000 47 250,000 151,240 401,240 118 18 150,000 103 33 43 19 240,000

354

Training of Medical Officer Annexure VIII Sl. No. Name of Districts TRG OF MEDICAL OFFICERS

Govt.Medical College Govt.Hospital Referal

Hospital Sadar Hospital Sub. Hospital PHC TRG Cost of MO

1 2 3 4 5 6 7 8 9 1 Araria 0 0 3 0 1 9

TRG

of a

ll G

ovt.

Med

ical

Col

lege

Med

ical

Offi

cer @

2 M

O F

or 6

Med

.Col

l =1

2,G

ont.H

ospi

tal @

2 x

7=

14,R

efer

al H

ospi

tal@

1x7=

70, S

adar

Hos

pita

l @

2x24

=48

, Sub

Div

isio

nal

Hos

pita

l @ 1

x22

=22,

PH

C @

1x33

6=33

6 .T

otal

Pr

ovis

ion

of T

rain

ing

of

502

Med

ical

Offi

cers

.Pro

visi

on o

f 25

part

icep

ents

in

eac

h ba

tch

=20

Bat

ch @

1.2

Lak

hs p

er B

atch

for t

hree

day

s =2

4.0

Lakh

s as

per

NVB

DC

P G

uide

line

,One

Tim

e

2 Aurangabad 0 0 3 1 0 3 Arwal 0 0 0 0 0 3 4 Banka 0 0 3 0 1 10 5 Begusarai 0 0 2 1 0 11 6 Bhagalpur 1 0 2 1 1 11 7 Bhojpur 0 0 2 0 0 12 8 Buxar 0 0 0 0 1 7 9 Darbhanga 1 0 2 0 0 14

10 E.Champaran 0 0 3 1 0 20 11 Gaya 1 0 2 1 0 12 Gopalganj 0 0 3 1 1 10 13 Jamui 0 0 3 0 1 14 Jehanabad 0 0 2 1 0 5 15 Kaimur 0 0 2 0 1 16 Katihar 0 0 3 1 0 18 17 Khagaria 0 0 1 1 0 6 18 Kishanganj 0 0 2 0 1 7 19 Lakhisarai 0 0 1 0 1 4 20 Madhepura 0 0 1 1 0 7 21 Madhubani 0 0 2 1 1 18 22 Munger 0 0 1 1 0 6 23 Muzaffarpur 1 0 1 1 0 14 24 Nawada 0 0 2 1 0 25 Nalanda 0 0 3 1 1 12 26 Patna 2 7 4 0 3 16 27 Purnea 0 0 2 1 0 14 28 Rohtas 0 0 1 1 1 29 Saharsa 0 0 0 1 0 7

355

30 Samastipur 0 0 1 1 3 14 31 Saran 0 0 3 1 0 15 32 Sheikhpura 0 0 1 0 1 0 33 Sheohar 0 0 1 0 1 0 34 Sitamarhi 0 0 1 1 0 13 35 Siwan 0 0 2 1 0 15 36 Supaul 0 0 1 0 1 11 37 Vaishali 0 0 2 1 0 11 38 W.Champaran 0 0 2 1 1 16 ZMO Office (All 4) 0 0 0 0 0 0

Total 6 7 70 24 22 336 2,400,000

356

Training of PRI Members Annexure -IX

Sl. No. Name of Districts Advocasy Workshop & Training of PRI

Block Panchyat Zila Parishad Members( Per Dist.15 Members)

Total Cost Of PRI Members

1 2 3 4 5 6 1 Araria 9 221 15

Tota

l No.

of B

lock

s =4

38 x

15 B

DC

Mem

bers

Per

Blo

cks=

6570

Per

sons

+To

tal N

o. O

f Pan

chya

ts =

6825

= 6

825

Muk

hiya

+31

Dis

tric

ts

x15

Zila

Par

isha

d M

embe

rs =

465

Mem

bers

= To

tal 1

3860

Mem

bers

.To

tal P

rovi

sion

of

Trai

ning

of P

RI M

embe

rs 1

3860

. Pr

ovis

ion

of

50 P

artic

ipan

t in

eac

h B

atch

=27

7 B

atch

es F

or 1

Day

s @

0.0

2 La

khs

per B

atch

=5.

54 L

akhs

As

Per N

VBD

CP

Gui

delin

e. O

ne R

ound

.

2 Aurangabad 0 0 0 3 Arwal 0 0 15 4 Banka 11 185 15 5 Begusarai 18 257 15 6 Bhagalpur 17 242 15 7 Bhojpur 14 228 15 8 Buxar 11 142 15 9 Darbhanga 19 329 15 10 E.Champaran 27 387 15 11 Gaya 0 0 0 12 Gopalganj 14 234 15 13 Jamui 0 0 0 14 Jehanabad 12 161 15 15 Kaimur 0 0 0 16 Katihar 16 238 15 17 Khagaria 7 129 15 18 Kishanganj 7 118 15 19 Lakhisarai 7 80 15 20 Madhepura 13 170 15 21 Madhubani 21 399 15 22 Munger 9 101 15 23 Muzaffarpur 16 387 15 24 Nawada 0 0 0 25 Nalanda 20 249 15 26 Patna 23 331 15 27 Purnea 14 246 15 28 Rohtas 0 0 0 29 Saharsa 10 164 15 30 Samastipur 20 381 15 31 Saran 20 0 15 32 Sheikhpura 0 0 0 33 Sheohar 5 54 15 34 Sitamarhi 17 273 15 35 Siwan 16 293 15 36 Supaul 11 180 15 37 Vaishali 16 292 15 38 W.Champaran 18 354 15 ZMO Office (All 4) 0 0 0

Total 438 6,825 465 554,000

357

Training of Spray Worker & ASHA Annexure -X

Sl. No. Name of Districts Training Of Spray Worker Training Of MPW (ASHA)

Contractual

Total

No. Of SFW

Total No. Of

FW TRG Cost Of Spray Worker

Total No. Of ASHA

TRG Cost Of MPW (ASHA)

1 2 3 4 5 6 7 1 Araria 118 590

Tota

l No.

of S

pray

Wor

ker F

W=8

910

+SFW

=178

2 T

otal

106

92 .T

otal

Pro

visi

on

of T

rain

ing

of 1

0692

Spr

ay W

orke

r . P

rovi

sion

of

50 P

artic

ipan

t in

eac

h B

atch

=21

4 B

atch

es F

or 1

Day

s @

0.0

2 La

khs

per B

atch

=4.

28 L

akhs

As

Per

NVB

DC

P G

uide

line

One

Rou

nd.

2026

Tota

l No.

of M

PW(A

SHA

)Con

trac

tual

520

65.T

otal

Pro

visi

on o

f Tra

inin

g o

f 52

065

MPW

(ASH

A)C

ontr

actu

al .

Pro

visi

on o

f 50

Par

ticip

ant

in e

ach

Bat

ch

=104

1 B

atch

es F

or 1

Day

s @

0.0

2 La

khs

per B

atch

=20

.82

Lakh

s A

s Pe

r N

VBD

CP

Gui

delin

e O

ne R

ound

.

2 Arwal 2 10 644 3 Banka 1 5 1455 4 Begusarai 55 275 2018 5 Bhagalpur 8 40 1877 6 Bhojpur 12 60 1621 7 Buxar 6 30 1074 8 Darbhanga 88 440 2890 9 E.Champaran 144 720 2686 10 Gopalganj 38 190 1868 11 Jehanabad 2 10 769 12 Katihar 62 310 1486 13 Khagaria 19 95 967 14 Kishanganj 39 195 648 15 Lakhisarai 6 30 568 16 Madhepura 79 395 1403 17 Madhubani 76 380 2751 18 Munger 6 30 820 19 Muzaffarpur 149 745 2544 20 Nalanda 17 85 2017 21 Patna 58 290 2549 22 Purnea 124 620 2002 23 Saharsa 76 380 777 24 Samastipur 105 525 3214 25 Saran 79 395 2289 26 Sheohar 12 60 426 27 Sitamarhi 99 495 464 28 Siwan 81 405 1665 29 Supaul 45 225 2538 30 Vaishali 113 565 1477 31 W.Champaran 63 315 2532

Total 1,782 8,910 428,000 52,065 2,082,000

358

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ftys gSaA bu ftyksa esa fujks/kRed dkjZokbZ ds rgr Mh-Mh-Vh- fNM+dko dk izLrko gSA

mijksDr lkr eysfj;k izHkkfor ftyksa ds ftyk eysfj;k ink- ls miyc/ dk;Z

;kstuk dh ekax dh xbZ Fkh A uoknk ftys dks NksM+dj vU; N% ftyksa ls fNM+dko dk;Z

;kstuk izkIr ugha gqbZ A lEHkor% jkT; esa 7-01-09 ls py jgs vjktif=kr deZpkfj;ksa ds

gM+rky ds dkj.k dk;Z ;kstuk vizkIr gSA ,slh fLFkfr esa ftysokj fNM+dko ds fy, yf{kr

tual[;k bR;kfn nsuk laHko ugha gS] iyr% jkT; eq[;ky; Lrj ij miyC/ lwpuk ds

vuqlkj ctV izLrko rS;kj fd;k x;k gS A

fcgkj jkT; dh dqy vkcknh 10]00]00]000 gS ftlesa eysfj;k izHkkfor lkr ftyksa

dh dqy tula[;k 1]66]66]603 (vFkkZr~ 16-66 feyh;u gS) eysfj;k izHkkfor lkr ftyksa

ds (1-925) feyh;u tula[;k dks fNM+dko ls vkPNkfnr djus dk izLrko gSA fooj.kh I

esa 7 eysfj;k izHkkfor ftyksa dk ftysokj tula[;k bR;kfn dk fooj.k fn;k x;k gS A

359

(d) fujks/kRed dkjZokbZ

jkT; ds lkr eysfj;k izHkkfor ftyksa ds vuqekfur 2 feyh;u tul[a;k esa

fNM+dko gsrq fNM+dko ny rFkk Mh-Mh-Vh- dk vko’;drk bl izdkj gS &

fNM+dko o ny & ,d feyh;u tula[;k esa eysfj;k i…fr ls fNM+dko gsrq

dqy 44 fNM+dko ny 75 fnuksa ds fy, izko/ku gS A izR;sd o"kZ 2 pØ fNM+dko djk;k

tkuk gS A ;g fNM+dko ebZ ls flrEcj rd djkuk gS A bl rjg dqy &

(a) fNM+dko ------------------- 44 × 2 ------------------- 88

Js- {ks- dk;Zjr fNM+dko ny dh la[;k X 1---------- 88

{ks- dk;Zjr dk;Zjr fNM+dko ny dh la[;k X 5--------- 440

(b) Mh-Mh-Vh& ,d fefy;u tula[;k ds fy, 75 eh-Vu ,d pØ ds fy,

dqy Mh-Mh-Vh- dh vko’;drk & 2 × 75 = 150 eh- Vu ,d pØ esa

orZeku esa eysfj;k ;sktuk esa 15 eh- Vu Mh-Mh-Vh- miyC/ gS rFkk 210 eh- Vu Mh-Mh-Vh-

Hkkjr ljdkj }kjk miyc/ djk;k tk jgk gS A bl rjg dqy 225 eh- Vu Mh-Mh-Vh-

miyc/ gS tks ,d pØ fNMdko ds fy, i;kZIr gS A

1. Je ,oa fu;kstu foHkkx }kjk fNM+dko etnwjksa ds fy, la’kksf/r etnwjh nj [

S.F.W. @ Rs. 113/- izfrfnu rFkk F.W. @ Rs. 92/- izfrfnu dh nj ls etnwjh dk vkdyu

fd;k x;k gS A etnwjh en dk izLrkfor jkf’k bl izdkj gS &

,d pØ vFkkZr~ 75 fnuksa ds fy,

Js- {ks- dk;ZdrkZ dk etnwjh& 88 × 75 × 113 – Rs. 7,45,800

{ks- dk;ZdrkZ dk etnwjh & 440 × 75 × 92 – Rs. 30,36,000

dqy etnwjh Rs. 37,81,800

2. Mh-Mh-Vh- <qykbZ & ftyk eq[;ky; ls iz[k.M Lrj rFkk iz[k.M Lrj ls fNM+dko

LFky rd Mh-Mh-Vh- dk <qykbZ djk;k tkuk gS A ftyksa ls fNM+dko dk;Z ;kstuk vizkIr gS

vr% izR;sd ftyksa dks Mh-Mh-Vh- <qykbZ en esa izfr ftyk 25000@& dh nj ls jkf’k dk

vkdyu fd;k x;k gS A

izLrkfor jkf’k & 7 × 25000 – 1,75,000/-

360

ftyksa esa Mh-Mh-Vh- ds HkaMkj.k dh leqfpr O;oLFkk ugha gS vr% Mh-Mh-Vh- dks jkT;

Hk.Mkj fuxe ds xksnke ftl ftyksa esa jkT; HkaMkj ftyk dk xksnke ugha gS] ogk¡

fu;ekuqlkj HkkM+s ij xksnke ysus gsrq) izfr ftyk izfrekg Rs. 500/- dh nj ls HkaMkj.k

’kqYd dk izko/ku fd;k x;k gS A

izLrkfor jkf’k & 7 × 500 × 12 – Rs. 42,000/-

dqy Rs. 2,17,000/-

3. dk;kZy; O;; & fNM+dko esas mi;ksx gksus okys xs: feV~Vh] NUuk ds fy, diM+k]

jftLVj] lknk dkxt bR;kfn izR;sd fNM+dko ny dks miyC/ djk;k tkuk gS A ftlds

fy, izfr fNM+dko ny Rs. 300/- dh nj ls jkf’k dk izko/ku fd;k x;k gSA ftyk

eq[;ky; esa Hkh LVs’kujh bR;kfn ds fufer Rs. 2000/- izfr ftyk dks jkf’k dk izko/ku

fd;k x;k gS A

izLrkfor jkf’k & fNM+dko ny gsrq & fNM+dko ny × 300

88 × 300 - Rs. 26,400/-

ftyk eq[;ky; gsrq 7 × 2000 - Rs. 14,000/-

dqy Rs. 40,400/-

4. fNM+dko midj.kksa dh ejEerh rFkk vko’;d ikVZl dk Ø; &

ftyk esa fNM+dko midj.kksa dh ejEerh ,oa LVhji iEi ds fy, oklj xSyu] lqrk]

pqVdh oklj] ,oa vU; ikVZl ds fy, izfr fNM+dko ny Rs. 100/- rFkk uksty VhIl ds

Ø; gsrq izfr fNM+dko ny 400/- dh nj ls jkf’k dk izko/ku fd;k x;k gSA

izLrkfor jkf’k & midj.kksa dh ejErh ,oa ikVZl Ø; ds fy,

(fNM+dko ny × 100) 88 × 100 -Rs. 8,800/-

uksty VhIl Ø; gsrq - 88 × 400- Rs. 35,200/-

5. iQkWfxx& eysfj;k izHkkfor ftyksa esa eysfj;k egkekjh dh fLFkfr esa ekykfFk;ku dk

iQkfxax djkuk vko’;d izrhr gksrk gS rkfd eysfj;k dk jksdFkke izHkkoh <-x ls

fd;k tk ldsA foxr o"kZ 2008 esa JE ls rhu eysfj;k ftyk ;Fkk x;k] uoknk ,oa

vkSjxkackn izHkkfor jgs gSA bu rhu ftyksa esa ekykfFk;ku dk iQkWfxx JE en ls djk;s tkus

dk izko?kku j[kk x;k gS] ’ks"k pkj ftys ;Fkk jksgrkl] dSewj] teqbZ ,oa eqxsaj esa ekykfFk;ku

361

ds iQkfxax dk ctV dk izko?kku fd;k x;k gSA izR;sd ftys esa nl yk[k izfr ftyk ds nj

nj ls & 4 ftyk X 10 yk[k = 40 yk[k dk izLrko gSA

6. i;Zos{k.k & Mh-Mh-Vh- fNM+dko ds liQy i;Zos{k.k ,oa xq.koDrk iw.kZ fNM+dko dh

n‘f"V ls i;Zos{k.k fd;k tkuk gS A ftu ftyksa esa xkM+h miyC/ gS] mu ftyksa dks xkM+h ds

fy, bZ/u] ejEerh (fu;ekuqlkj) ds fy, jkf’k rFkk ftu ftyksa esa xkM+h miyC/ ugha gS

39 ftyksa dks jkT; Lok- lfefr }kjk vuqeksfnr nj ij ,d pØ fNM+dko ds fy, jkf’k

dk izLrko gS A izR;sd ekg 20 fnu ds i;Zos{k.k ds dk;Z lEiknu djus gsrq ,d pØ ds

fy, 50 fnuksa ds i;Zos{k.k gsrq jkf’k dk vkdyu fd;k x;k gS A

izLrkfor jkf’k& 7 × 650 × 50 -Rs. 2,27,500/-

eysfj;k ;kstuk esa 5 ekg ds fNM+dko vof/ esa i;Zos{k.k gsrq jkf’k fujks/kRed

dkjZokbZ ls miyC/ djk;k tk jgk gS A ’ks"k 7 ekg ds i;Zos{k.k gsrq dkyktkj ;kstuk ls

x;k ,oa eqxsaj ds ftyk eysfj;k ink- dks jkf’k miyc/ djk;k x;k gS A ’ks"k ikWp ftys

;Fkk teqbZ ,oa dSeqj ds vij eq[; fpfdRlk inkf/dkjh dks] (ftyk eysfj;k inkf/dkjh

dk in ;gkW Lohd‘r ugh gS) jksgrkl] uoknk] vkSjxkckn ftys ds ftyk eysfj;k

inkf/dkjh] dqy ikWp ftyks dks 10 gtkj :i;k izfrekg dh nj ls lkr ekg ds fy;s

dqy &

5 ftyk X 10 gtkj :i;s x 7 ekg = 3]50]000 :i;s dk izko/ku j[kk x;k gSaA

7- izpkj&izlkj & fNM+dko ds iwoZ fNM+dko ds laca/ esa turk dks tkudkjh fn;k

tkrk gS rkfd os fNM+dko ds fy, l≤ rS;kj jgs A bl fufer iksLVj] iEiysV] <ksy

fiVokdj ,oa iapk;r Lrj ij xks"Bh bR;kfn ds ekŁ;e ls izpkj izlkj ds fy, izfr ftyk

Rs. 15,000 dh nj ls jkf’k dk izko/ku fd;k tk jgk gS A lacaf/r ftys ds ftyk eysfj;k

ink- ;g izpkj izlkj laHkkfor izk- Lok- dsUnz dks miyC/ djk;k x;k A

izLrkfor jkf’k & Rs. 7 × 15,000/- - Rs. 1,05,000/-

fujks/kRed dkjZokbZ ds fy, izLrkfor jkf’k dk lkjka’k &

1- etnwjh & Rs. 37,81,800.00

2- Mh-Mh-Vh- <qykbZ & Rs. 2,17,000.00

3- dk;kZy; O;; & Rs. 40,400.00

362

4- fNM+dko midj.k& Rs. 44, 000.00

5- i;Zos{k.k & Rs. 2,27,500.00

6- izpkj&izlkj & Rs. 1,05,000.00

,d pØ fNM+dko ds fy, dqy izLrkfor jkf’k Rs. 44,15,700.00

nks pØ fNM+dko ds fy, dqy izLrkfor jkf’k Rs. 88,31,400/-

7. iQkfxax& Rs. 40,00,000/-

8. ftyk eysfj;k dk;Zy; ds lkr ekg dk i;Zos{k.k&

Rs. 3,50,000/-

dqy 1,31,81,400/-

(,d djksM- ,drhl yk[k ,dklh gtkj pkj lkS :i;s )

([k) mipkjkRed dkjZokbZ &

eysfj;k ds jksxh ds igpku ds fy, Toj fifM+r jksfx;ksa dk jDriV tkWp fd;k

tkrk gSA jDriV dh deh ds dkj.k foxr o"kksZ esa jDriV laxzg y{; ds vuqlkj ugha

gqvk] iQyr% eysfj;k jksfx;ksa dk lgh vkdM+k miyC/ ugha gks ik;k A bl fufer LykbM

,oa fj,tsUV Ø; dk izLrko gSA

1- Hkkjr ljdkj ls izkIr fn’kk funs’k ds vuqlkj dqy vkcknh dk 10» jDriV laxzg

okf"kZd fd;k tkuk gS A fcgkj dh dqy vkcknh nl djksM+ (yxHkx) gS A vr% jDriV

laxzg ,d djksM+ gksuk pkfg, A lkr eysfj;k izHkkfor ftyksa dk dqy tula[;k

1]66]66]603 gS A

ftyksa ls izkIr lwpukuqlkj foxr o"kksZ esa djhc 1]25]000 jDriV laxzg fd;k x;k

gSA vr% orZeku esa 5 yk[k jDriV Ø; dk izLrko gS A ,d jDriV ds Ø; ds fy,

Rs. 1/- O;; gksxk A

dqy 5]00]000 jDriV ds Ø; ij dqy O;; & Rs. 5,00,000/-

363

jDriV lxazg ds fy, fizfdax fufMy] :bZ] LizhV rFkk fj,tsUV dh vko’;drk

gksxhA bl fufer 5]00]000 fizfdax fufMy dk Ø; dk izLrko gS A izfr fizfdax fufMy

:- 1-50 dh nj ls dqy O;; :- 7]50]000@& dkVu] LizhV rFkk fj,tsUV ds Ø; ij :-

4@& izfr LykbM dh nj ls O;; dk vkdyu fd;k x;k gS A vr% 5 yk[k LykbM ds

fy, dkVu] LizhV rFkk fj,tsUV ij dqy 5,00,000 × 4 = 20,000,00/- O;; gksxk A bl rjg

jDriV Ø; ,oa fj,tsUV bR;kfn ij dqy O;; & 5]00]000 $ 7]50]000 $ 20]00]000 ¾

:- 32]50]000 O;; gksxk A

2. i;Zos{k.k & i;Zos{k.k dh n‘f"V ls eysfj;k izHkkfor ftyksa ds eysfj;k fujh{kd dks

izfr ftyk nks eksVj lkbZfdy Ø; dk izLrko gS rkfd i;Zos{k.k dk;Z lqpk: ,oa fu;fer

fd;k tk ldsA ,d eksVj lkbfdy ds Ø; ij :- 50]000@& O;; gksxk A bl rjg 7

ftyksa eysfj;k izHkkfor ftyksa esa ls ek=k uoknk] vkSjaxkckn] jksgrkl ftyksa dks izfr ftyk 2

eksVj lkbfdy ds Ø; dk izLrko gS ’ks"k 4 eysfj;k izHkkfor ftyksa x;k] eaaqxsj dks

dkyktkj ;kstuk ls eksVjlkbfdy Ø; dk izLrko gS A eqaxsj ,oa x;k ftyk eysfj;k

inkf/dkjh ds vf/uLFk ftyss dkyktkj ls izHkkfor gS A

izLrkfor jkf’k & 3 × 2 × 50,000 - 3,00,000/-

eksVjlkbfdy ds fy, ba/u gsrq izfr eksVj lkbfdy 30 yhVj izfr ekg dh nj ls

12 ekg ds fy, jkf’k dk izko/ku fd;k tk jgk gSA (izfr yhVj isV“kWy :- 50@& dh nj

ls)

dqy izLrkfor jkf’k 6 × 30 × 50 × 12 - Rs. 1,08,000/-

dqy Rs. 4,08,000/-

3. eysfj;k ls cpko ds fy, osMusV &

& dqy 7 ftyksa esa izHkkfor tula[;k & 20 yk[k

& 5 O;fDr ds vk/kj ij 1 ifjokj dh

x.kuk djus ij dqy ifjokj dh la[;k & 4 yk[k

& ,d ifjokj esa 2 osMusV dk izko/ku

j[kus ij dqy osMusV dh vko’;drk & 8 yk[k

364

ysfdu dsoy ch-ih-,y- xHkZorh efgyk dks izkFkfedrk ds vk/kj ij osMusV

miyC/ djk;k tk;xk A ;g Epidemic out Break okys ftyksa dks gh eqgS;k djkus dk

izLrko gS A bl rjg dqy 1 yk[k osMusV dh vko’;drk dk vkdyu fd;k x;k gS] tks

Hkkjr ljdkj }kjk miyC/ djk;k tk;xk A

& osMusV dh vkiwfrZ esa <qykbZ gsrq dqy &50 gtkj :i;s O;; dk

izLrko gS A

4. izf’k{k.k &

(d) eysfj;k izHkkfor 7 ftyksa es dqy 21 eysfj;k fujh{kd dk;Zjr gS A eysfj;k ds

fujksŁkkRed ,oa mipkjkRed dkjZokbZ ds laca/ esa bUgsa izf’k{k.k fn;k tkuk gS A Hkkjr

ljdkj ls izkIr fn’kk funs’k ds vuqlkj 20 eysfj;k fujh{kd dks ,d oSp esa izf’k{k.k

fn;k tkuk gSA o"kZ esa nks ckj izf’k{k.k nsus dk izLrko gS A ,d oSp ds izf’k{k.k ij dqy

O;; :- 69500@& gksxk A

,d oSp dsk nksckj izf’k{k.k ij dqy O;; 2 × 69500 - Rs. 1,39,000/-

([k)eysfj;k izHkkfor 7 ftyksa esa dqy 14 iz;ksx’kkyk izoSf?kd dk;Zjr gSaA ftUgs izf’k{k.k

fn;k tkuk gS A 20 izf’k{k.kkFkhZ dks ,d oSp esa izf’k{k.k fn;k x;k A bl rjg 14

iz;ksx’kkyk izoSf?kd dks ,d oSp esa 10 fnuksa ds Induction izf’k{k.k gsrq dqy 1]25]000 dh

nj ls O;; gksxk A

dqy izLrkfor jkf’k & Rs. 1,25,000/-

iz;ksx’kkyk izkosf/d dks 5 fnuksa dk Re-orientation Training fn;k tkuk gSA ftlij

izfr oSp 75]620@& :- O; gksxk A

dqy izLrkfor jkf’k & Rs. 75,620/-

(x)- cqfu;knh Lok- fujh{k.k ,oa fuxjkuh fujh{kd dk izf’k{k.k

eysfj;k izHkkfor 7 ftyksa esa dqy 15 cqfu;knh Lok- fujh{kd rFkk 6 fuxjkuh

fujh{kd dk;Zjr gS A bl rjg nksuksa dksVh ds dqy 21 dk;Zdrk dks izf’k{k.k izLrkfor gS

A ;g izf’k{k.k ,d osp esa nks fnuksa dk izf’k{k.k fn;k x;k A ,d oSp ds izf’k{k.k ij

dqy O;; :- 30]000@&

365

(?k)- Lok- dk;ZorkZ dk izf’k{k.k &

lkr eysfj;k izHkkfor ftyksa esa dqy 30 cqfu;knh Lok- fujh{kd] 11 fuxjkuh dk;ZdrkZ] 8

{ks=kh; dk;ZdrkZ rFkk 1 Js"B {ks=kh; dk;ZdrkZ gS A bl rjg dqy 50 dk;ZdrkZ dks izf’kf{kr

fd;k tkuk gS A 25 izf’k{k.kkFkhZ izfr oSp dh nj ls nks oSp esa izf’k{k.k dk izLrko gS A

izf’k{k.k vof/ 2 fnuksa dh gksxh A izf’k{k.k ij izfr oSp fd 30]000@& dh nj ls O;;

dk izLrko gS A

dqy izLrkfor jkf’k & 2 × 30,000 – 60,000/-

bl rjg izf’k{k.k ij dqy O;; &

(d) e- fu- ds izf’k{k.k & 1]39]000@&

([k) iz;ksx’kkyk izkoSf/d & 200]620@&

(x) cq- Lok- fu- ,oa fu- fujh{kd & 30]000@&

(?k) Lok- dk;ZdrkZ & 60]000@&

dqy & 4,29,620/-

vuqyXaud lyaXu

366

NAMMIS

National Anti Malaria Management Information System (NAMMIS) ds rgr lHkh

ftyksa dks Web based NAMMIS Software dk;ZØe ls Internet ds ekŁ;e ls tksM+uk ,oa

Report ladfyr fd;k tkuk gS A 2009-10 ds Action Plan ds rgr fuEuor ctV izLrko gS

&

1- lHkh ftyksa esa miyC/ djk, x, Computer esa CD/DVD Writer ugh yxk gSA vr% lHkh

40 computer esa CD/DVD writer yxkus gsrq izfr CD/DVD writer 1500/- :- izfr dh nj

ls dqy 40 dEI;wVj gsrq & 40 × 1500 Rs. = 60,000.00 dk izLrko gSA

2- eq[;ky; esa yxs nks Computer System gsrq 2GB RAM, 250 GB Hard Disk dk izLrko

gS A vHkh System esa 256 MB RAM ,oa 40 GB Hard Disk yxk gS tks eq[;ky; esa

dk;Z dks ns[krs gq, de gS A blesa 2GB RAM dh dher vuqekfur 3000-00 :-

gS rFkk vfrfjDr nks 250 GB Hard Disk dh vuqekfur dher 3500-00 :- gS] dk

izLrko gS A dqy 6500@& :- dk izLrko gSA

3- lHkh 40 dEI;wVj gsrq ikVZl lfgr AMC (Annual Maintence Cost) dk izLrko gSA blesa

izfr dEI;wVj izfr o"kZ AMC dk vuqekfur ykxr yxHkx 6]000@& (N% gtkj :i;s

ek=k) dh nj ls 40 × 6,000/- :- 2]40]000@& (nks yk[k pkyhl gtkj :i;s ek=k)

yxus dh laHkkouk gS] izLrko gS A

4- NAMIS dks dk;kZfUor djus gsrq lHkh 40 dEI;wVj esa Internet dh lqfo/k gsrq Broad

Band/USB Broad Band yxkuk vfuok;Z gS A blds rgr Broad Band dk nj izfrekg

vuqekfur :-800@& = 800 × 12 ekg 9]600@& okf"kZd ,oa Broad Band ds Installation

charge yxHkx 4500@& :- izfr System yxkus dh laHkkouk gSA dqy vuqekfur ykxr &

1]80]000 :-

9600 + 1,80,000 = 1,89,600 = 00 yxus dh laHkkouk gS A

5- lHkh ftyk eysfj;k dk;kZy; esa Basic Telephone dh lqfo/k iwoZ ls gh miyC/ gSA

Internet dh lqfo/k gsrq Telephone dh ekfld fcy vuqekfur :i;k 500@& izfr

ftyk dh nj ls 38 ftys gsrq 38 × 500 = 19,000.00 :i;s × 12 ekg ¾ 2]28]000-00

367

:i;s ,oa jkT; Lrjh; eq[;ky; gsrq 1000 :i;s izfr ekg dh nj ls 12 ekg gsrq 12]

000@& :i;s] dqy& 2]28]000 ¾ 00

12]000¾ 00

2,40,000¾00 :- yxus dk ctVh; izLrko gSA

6- lHkh ftyksa dks Comptuer ds Cartridage, CD/DVD, Xerox Paper, UPS ds cSV“h ,oa vU;

vko’;d oLrqvksa dh [kpZ gsrq vuqekfur 5]000@& :i;s dh nj ls 38 ftyk ×

5000.00 = 1,90,000.00 ,oa jkT; Lrjh; eq[;ky; ij 20]000-00

dqy & 2]10]000-00 :- [kpZ gksus dh laHkkouk gS A

7- NAMMIS dks dk;kZfUor djus gsrq lHkh ftys dks ftyk eysfj;k inkf/dkjh dqy

la[;k&24] lHkh ftyksa ds ACMO = 14, 24 ftyksa ds dfeZ;ksa 48 ,oa vU; l{ke

O;fDr dks izf’k{k.k fn;k tkuk t:jh gS A blesa dqy vuqekfur & 100 O;fDr;ksa dks

izf’k{k.k fn;k tkuk gS A jkT; Lrj ls nks dfeZ;ksa dks Master Trainer ds :i esa

NVBDCD }kjk izf’k{k.k fn;k tk pqdk gS A ;s TOT lHkh lacaf/r O;fDr;ksa dks

izf’k{k.k] nsus gsrq izf’k{kq ,oa izf’k{kd dk ekuns; ,oa vU; vk/kjHkwr lqfo/kvksa gsrq

10 O;fDr izfr cSp nks fnu dh nj ls 10 cSp (100 O;fDr;ksa gsrq) @ 25,000/- =

dqy 2]50]000@&:- yxus dh laHkkouk gS A

NAMMIS ds izf’k{k.k ds vykok lkjk [kpZ State Component Plan esa j[kk x;k gS

dqy [kpZ dafMdk&

1- 60]000-00

2- 6]500-00

3- 2]40]000-00

4- 1]89]600-00

5- 2]40]000-00

6- 2]10]000-00

7 2]50]000-00

11]96]100-00

368

bl rjg ;kstuk dk dqy O;;

1- fujks/kRed 1]31]81]400-00

2- mipkjkRed 37]08]000-00

3- izf’k{k.k 429]620-00

4- ukfel gsrq 11]96]100-00

1,85,15,120.00 5. ,d yk[k csMusV @ 250 Rs./ izfr csMusV = 2]50]00]000@& :i;s

dqy ctV dk izko?kku & 4,35,15,120@&

nks vuqyXaud layXu

fo’oklHkktu




izfrfyfi iz/ku lfpo] Lok- ,oa i- d- foHkkx] fcgkj iVuk] funs’kd izeq[k Lok- lsok;sa

fcgkj] dk;Zikyd funs’kd] jkT; Lok- lfefr] iVuk dks vuqyXud lfgr lwpukFkZ ,oa

vko’;d dkjZokbZ gsrq izf"kr A




izfrfyfi {ks=kh; funs’kd] Lok- ,oa i- d- foHkkx] Hkkjr ljdkj] bfUnjk Hkou] ikWpoka

eafaty] csyh jksM]iVuk] dks vuqyXud lfgr lwpukFkZ ,oa vko’;d dkjZokbZ gsrq izf"krA



369

Dist.Wise Malaria Affected Population , No. of Sqad,DDT Requirement ,Wages,Contegency,Equipment Repair,Mobility & Transportation of DDT of Malarial DDT Spray for 2009-2010

EXPENDETURE FOR I ROUND

EXPENDETURE FOR II ROUND

Sl. No.

Name of Districts

Total No. of Malaria Affected

Total No. of Sqad

(44 Sqad

/10 Lakhs Popula

tion

Total No. of Workers

DDT 50% Status (In

Meric Ton ) WAGES

Office Expenses (@

Rs 300/-Per

Sqad

Contigency At Dist.

Level (@ Rs. 2000/- Per Dist.

Repair of

Spray Equipments Includi

ng Nozal

Tips @ Rs.

500/- Per

Sqad

District Mobility

DMO Vehicle

@ Rs.650/-

Per Affected Dist. For 50 Days

Transportation of DDT

IEC @ Rs.15000/- Per Dist.

Total (Column No.

13 to 20)

FOGGING

MOBALITY

FOR SEVEN MONTH

GRAND TOTAL

SFW(Rs. 113/-Per SFW Per Day For 75 Days)

FW(Rs.92/-Per FW Per Day For 75

Days) Total

For @ Rs. 25,000 /- Per Dist.

Storage of DDT @

RS. 500/- Per Month

For 12 Months

PHC HSC Population

SFW FW

Req

uire

.

Ava

ilabl

e 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 22

1 Munger 1 26 154,135 8 8 40 12 10 67,800 276,000 343,800 2400 2000 4000 32500 25000 6000 15000 430,700 861400 100000

0 0 1861400

2 Jamui 5 47 548,070 24 24 120 42 30 203,400 828,000 1,031,400 7200 2000 12000 32500 25000 6000 15000 1,131,100 2262200 100000

0

70000 3332200

3 Nawada 2 11 106,942 5 5 25 5 50 42,375 172,500 214,875 1500 2000 2500 32500 25000 6000 15000 299,375 598750 0 70000 668750

4 Rohtas 2 15 192,106 9 9 45 15 30 76,275 310,500 386,775 2700 2000 4500 32500 25000 6000 15000 474,475 948950 100000

0

70000 2018950

5 Kaimur 2 12 153,035 7 7 35 12 30 59,325 241,500 300,825 2100 2000 3500 32500 25000 6000 15000 386,925 773850 100000

0

70000 1843850

6 Aurangabad 1 3 630,194 28 28 140 48 40 237,300 966,000 1,203,300 8400 2000 14000 32500 25000 6000 15000 1,306,200 2612400 0 70000 2682400

7 Gaya 5 12 140,000 7 7 35 11 20 59,325 241,500 300,825 2100 2000 3500 32500 25000 6000 15000 386,925 773850 0 0 773850

Total 18 126 1,924,482 88 88 440 145 210 745,800 3,036,000 3,781,800 26,400 14,000 44,000 227,500 175,000 42,000 105,000 4,415,700 8,831,400

4,000,00

0

350,000 13,181,400

STATE LEVEL 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

1 Curarive

Purchage of Blood Slide & Reagent 3,250,000

Purchase of Motorcycle for Supervision 408,000

Transportation & Purchase of Bednets 25,050,000

2 Training

MI 139,000 LT 200,620 BHI & SI 30,000 Health Worker 60,000

3 NAMMIS 1,196,100 Grand Total Of Malaria Programme 43,515,120

370

Dist.Wise Malaria Training of Malaria Inspector,Lab Technecian,health Supervisor & Health Worker for 2009-2010 Annexure II

Sl. No.

Name of Districts

Training Of Malaria Inspector Training (Induction & Re-Orientation) Of LT Training Of Health

Supervisor Training Of Health Worker

Total

No. Of MI

TRG Cost Of MI

TwoRounds

Total No. Of

LT

TRG Cost Of LT

(Induction TRG)

TRG Cost Of LT (Re-

Orientation TRG)

Grand Total Induction &

Re-orientation

Total No. Of

BHI

Total No.

Of SI

TRG Cost Of Health

Supervisor

Total No. Of

BHW

Total No. Of

SW

Total No. Of

FW

Total No. Of SFW

TRG Cost Of Health Worker

1 2 OK OK OK OK OK OK OK

1 Aurangabad 4

Tota

l No.

of M

alar

ia In

spec

tors

21

.Tot

al

Prov

isio

n of

Tra

inin

g o

f 21

MI .

Pro

visi

on o

f 20

Par

ticip

ant

in e

ach

Bat

ch =

1Bat

ches

(T

woR

ound

) @0.

695

Lakh

s pe

r Bat

ch =

1.3

9

Lakh

s A

s Pe

r NVB

DC

P G

uide

line.

Tw

o R

ound

.

0

Tota

l No.

of 1

4 La

b Te

chne

cian

.Tot

al P

rovi

sion

of

Indu

ctio

n Tr

aini

ng o

f 14

Lab

Tec

hnec

ian.

Pr

ovis

ion

of 2

0 Pa

rtic

ipan

t in

eac

h B

atch

=1

Bat

ches

@1.

25 L

akhs

per

Bat

ch fo

r 10

Day

s =1

.25

Lakh

s A

s Pe

r NVB

DC

P G

uide

line

.One

Ti

me

TRG

of a

ll 14

Lab

Tec

hnec

ian

Indu

ctio

n .T

otal

Pr

ovis

ion

of In

duct

ion

Trai

ning

of

14 L

ab

Tech

neci

an. P

rovi

sion

of

20 P

artic

ipan

t in

ea

ch B

atch

=1

Bat

ches

@0.

7562

Lakh

s pe

r B

atch

for 5

Day

s =0

.756

2 La

khs

As

Per

NVB

DC

P G

uide

line

.One

Tim

e

TRG

of a

ll 14

Lab

Tec

hnec

ian

Indu

ctio

n &

Re

-O

rient

atio

n G

rand

Tot

al. A

s Pe

r NVB

DC

P G

uide

line

.One

Tim

e

1 0

Tota

l No.

of B

HI =

15 +

SI 6

Tot

al 2

1 .T

otal

Pr

ovis

ion

of T

rain

ing

of 2

1 H

ealth

Sup

ervi

sor

. Pro

visi

on o

f 25

Par

ticip

ant

in e

ach

Bat

ch =

1 B

atch

es F

or 2

Day

s @

0.3

0 La

khs

per B

atch

=0

.30

Lakh

s A

s Pe

r NVB

DC

P G

uide

line.

One

R

ound

.

3 0 1 0

Tota

l No.

of B

HW

=30

+SW

= 11

+FW

= 8

+SFW

=1 T

otal

50

.Tot

al P

rovi

sion

of T

rain

ing

of

50

Hea

lth W

orke

r . P

rovi

sion

of

25

Part

icip

ant

in e

ach

Bat

ch =

2 B

atch

es F

or 2

D

ays

@ 0

.30

Lakh

s pe

r Bat

ch =

0.60

Lak

hs A

s Pe

r NVB

DC

P G

uide

line.

One

Rou

nd.

2 Gaya 4 8 8 0 7 0 3 1

3 Jamui 0 0 0 0 0 0 0 0

4 Kaimur 0 0 0 0 0 0 0 0

5 Munger 5 3 4 3 11 5 2 0

6 Nawada 2 2 1 1 0 1 2 0

7 Rohtas 6 1 1 2 9 5 0 0

Total 21

14

15 6 30 11 8 1

372

i=kkad----------------------------------

izs"kd]

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lsok esa]

funs’kd]



iVuk] fnukad----------------

fo"k;& iqu% la’kksf/r Msaxq ,oa fpdquxhfu;k dh jksdFkke ds fy, foÙkh; o"kZ

2009-10 gsrw ctV izLrko A

egk’k;]

mi;qZDr fo"k; Msaxq ,oa fpdquxhfu;k dh jksdFkku ,oa mipkjkRed mik; gsrw jkT;

ds NMCH, iVuk dks Sentival Surveillance Hospital ds :i esa /;fur dk izLrko gS]

Sentinel Site ds Laboratory Strengthening gsrq NVBDEP Guide Line ds vkyksd esa "One

time financial grant Rs. 25.00 Lakhs will be provided to each ARLS (Apex Referral

Laboratories) for the infrastructure development. In addition, recurring expenditure to the

tune of Rs. 1.00 lakh to each ARL and Rs. 0.50 Lakh to each SHs (Approved by

GO1/will be provided to meet the contingency expenditure of the Laboratory" dk izko/ku

fd;k tk ldrk gS A fcgkj esa Msxq dk dsl o"kZ 2008&09 esa dsoy ,d ik;k x;k gS tks

dSeqj ftys dk gSA Chikungunya dk dsl o"kZ 2008&09 esa Reported ugh gSA Hkfo"; esa

Dengu & Chikungunya mipkjkRed ,oa fujks/kRed gsrq 10 yk[k :i;s dk ctVh;

izko/ku gS A dqy Dengu & Chikungunya dk ctVh; izko/ku = 25.00 Laks + 1.00 Lakhs

+ 0.50 Lakhs + 10.00 Lakh = 36.50 Lakh.

fo’oklHkktu



373












374

Dengu & Chikungunia Dist.Wise Plan 2009-2010

Sl.No. Name of Dist.

Curative & Presumptive Measures

Fogging of JE @ Rs. 10.00 Lakhs / Dist.

Sentinal Survillance Hospital Grand Total

1 HQ. 1000000 -- 0 0

2 Patna 0 0 2650000 2650000 Total 1000000 0 2650000 3650000

Note- Amount for Curative & Presumptive Measures & Sentinal Survillance Hospital for PMCH Patna kept in State Level Office.

375

i=kkad----------------------------------

izs"kd]

MkW- vkj-,u-ik.Ms;]



lsok esa]

funs’kd]



iVuk] fnukad----------------

fo"k; & iqu% la’kksf/r Japanese Encephalitis dh jksdFkke ds fy, foÙkh; o"kZ

2009-10 gsrw ctV izLrko A

egk’k;]

1- mijksDr fo"k;d foÙkh; o"kZ 2009&10 gsrq x;k] floku]eqtIQiqj ,oa if'pe pEikj.k ftys esa

Vaccination izLrko gSA blds iwoZ 2007 eqt¶Qjiqj esa yxHkx 41-00 yk[k dk ,oa csfr;k esa yxHkx

48-00 yk[k #i;s dk ctVh; izko/kku FkkA bl foÙkh; o"kZ esa x;k gsrq 50-00 yk[k dk cTkVh; izko/kku

j[kk x;k gSA

dqy pkj ftys x 50 yk[k = 2 djksM- :i;s

2- J.E ds fy, Sentinal Surveillance Hospital ds :Ik esa SKMCH es eqt¶Qjiqj]

ihŒ,eŒlhŒ,pŒ] iVuk ,oa ANMCH, x;k dks j[kk x;k gSA NVBDCP ds Guide ds

vkyksd esa izfr Sentinal Surveillance Hospital gsrq 26-50 dk nj fu/kkZfjr gSA vr% dqy

26.50 X 3 = 79.50 yk[k #i;s dk ctVh; izko/kku gSA

3- Sentinel Site ds Laboratory Strengthening gsrq NVBDEP Guide Line ds

vkyksd esa "One time financial grant Rs. 25.00 Lakhs will be provided to each ARLS (Apex Referral Laboratories) for the infrastructure development. In addition, recurring expenditure to the tune of Rs. 1.00 lakh to each ARL and Rs. 0.50 Lakh to each SHs (Approved by GO1/will be provided to meet the contingency expenditure of the Laboratory"

4- J.E ds jksdFkke gsrq mÙkj izns'k ls lVs fcgkj ds ftys ;Fkk csfr;k] eksfrgkjh] eqt¶Qjiqj] lhoku]

xksikyaxt rFkk tsŒbZŒ ls izHkkfor vU; ftys ;Fkk&x;k] uoknk] vkSjaxkckn] tgkukckn ,oa vjoy

esa QkWfxax dk izLrko gSA bu 10 ftyksa esa vuqekfur 10 yk[k #Œ izfr ftyk dh nj ls 1 djksM-

#i;s dk ctVh; izLrko j[kk x;k gSA

JE dk dqy cTkV &

376

(i) Vaccination - 200.00 yk[k (ii) Sentinal Surveillance Hospital - 79.50 yk[k (iii) Fogging - 100.00 yk[k

379-50 yk[k

fo’oklHkktu














377

JE Dist.Wise Plan 2009-2010

Sl.No. Name of Dist. Vaccination of JE @

Rs. 50.00 Lakhs / Dist.

Fogging of JE @ Rs. 10.00 Lakhs / Dist.

Sentinal Survillance Hospital Grand Total

1 Gaya 5000000 1000000 2650000 8650000 2 Siwan 5000000 1000000 0 6000000 3 Muzaffarpur 5000000 1000000 2650000 8650000 4 W.Champaran 5000000 1000000 0 6000000 5 Nawada 0 1000000 0 1000000 6 Aurangabad 0 1000000 0 1000000 7 Jehanabad 0 1000000 0 1000000 8 Arwal 0 1000000 0 1000000 9 East Champaran 0 1000000 0 1000000

10 Gopalganj 0 1000000 0 1000000 11 Patna 0 0 2650000 2650000 Total 20000000 10000000 7950000 37950000

Note- Amount for Sentinal Survillance Hospital for ANMMCH,Gaya,SKMCH,Muzaffarpur,PMCH Patna kept in State Level Office.

378

i=kkad----------------------------------

izs"kd]

MkW- vkj-,u-ik.Ms;]


iQysfj;k] fcgkj] iVuk

lsok esa]

funs’kd]



iVuk] fnukad----------------

fo"k; & la’kksf/r iQysfj;k fnol eukus gsrq fofÙk; o"kZ 2009-10 gsrw ctV

izkDdyu Hkstus ds laca/ esaA

egk’k;]

mi;qDr fo"k;d o"kZ 09&10 dk ctV izkDdyu (vkSicf/d) bl i=k ds lkFk

layXu fd;k tk jgk gSA jkT; esa deZpkfj;ksa ds gM+rky ds dkj.k ftyksa ls iw.kZ vkWadM+k

ugh izkIr gks ldk gSA iQyLo:Ik vkSicf/kd ctV izkDdyu Hkstk tk jgk gSA iw.kZ lwpuk

izkIr gksus ds ckn ctV izkDdyu esa la’kks/u lHkao gSA oÙkZeku ctV izkDdyu

6]52]83]000@& (N% djksM- ckou yk[k rsjklh gtkj :i;s) dk gSA

izkDdyu dk fuekZ.k dk vko’;drk ,oa vk/kkj dk fuEu :Ik esa inokj vkadyu

fd;k x;k gSA

ctV izkDdyu dqy izkFkfed LokLF; dsUnzks 398 ,oa ftyk eq[;ky;ksas 38 esa jg

jgs yxHkx 10 djksM+ tula[;k dks iQkbZysfj;k fu;a=.k dk;Zdze ds rgr vPNkfnr djus ds

mn~ns’; ls rS;kj fd;k x;k gS] ftlds vUrxZr ,d fu/kZfjr frfFk dks mez ds fglkc ls

fu/kZfjr ek=k esa Mh0 bZ0 lh0 f[kykus ds dk;ZØe djk;k tk;sxk ,oa mDr fnol dks NqVs

gq, tuekul dks vxys nks fnu rd ekSi&vi pØ pykus dk dk;ZØe rS;kj fd;k x;k

gSA ctV izkDdyu jkT; Lrj ,oa ftyk Lrj ij O;; gksus okyh jkf’k ds vk/kj ij rS;kj

fd;k x;k gS A

(d) jkT; Lrj

379

(1) ftyk Lrjh; inkf/dkjh dk izf’k{k.k%& blds rgr dqy 1]52]000@& jkf’k dks

vkadfyr fd;k x;k gSa A iQkbysfj;k fnol dks iw.kZ lqxerk ls lapkyu gsrq izR;sd

ftyk ls ,d&,d inkf/kdkjh dks izf’kf{kr fd;s tkus dk dk;ZØe gSA

izf’k{k.k ,d fnolh; gksxk rFkk 19&19 dh la[;k esa izf’k{k.kkfFkZ;ksa dks izf’kf{kr

fd;s tkus dk y{; j[kk x;k gS] tks izf’k{k.kksijkUr ftyk Lrjh; izf’k{k.k ds

izf’k{kd dk dk;Z djsxsaA (ctV vkadyu dafMdk 6 nz"VO;)

(2) izpkj izlkj%& jkT; Lrj ij izpkj izlkj gsrq 10]00]000@& :i;s vkadfyr fd;k

x;k gS] ftlds rgr nwjn’kZu] jsfM;ksa] lekpkj i=k ds lans’k nsuk ,oa izpkj&izlkj

lkexzh;ksa dk eqnz.k djkuk lfEefyr gSA (ctV vkadyu dafMdk 7 nz"VO;)

(3) jkT; Lrj ij izf’k{k.k gsrq 60]000@& :i;sA

(4) jkT; Lrj ij ikjkesfMdy LVkiQ dk izf’k{k.k 1]50]000@& :i;sA

(5) ih0vks0,y0%& bl en esa 3]00]000@& :i;s dk vkadyu fd;k x;k gS] ftlds

rgr jkt; eq[;ky; ls lHkh ftyksa ds fy;s Hksts tkus okys I;Zos{kh inkf/kdkjh ds

Hkze.k gsrq ckgu dh lqfo/k miyC/ djkus ,oa bZ/u vkfn esa O;; fd;k tk;sxkA

(ctV vkadyu dafMdk 14 Øekad 1 nz"VO;)

([k) ftyk Lrj ij O;; gksus okyh jkf’k dk vkadyu

(6) ,d ftyk leUo; lfefr dh cSBd gsrq izfr ftyk 15]00]000=00 dh nj ls

dqy 5]70]000 (ikWp yk[k lRrj gtkj :i;s) ek=k dk vkadyu fd;k x;k gSA

bl jkf’k ls iQkbZysfj;k fnol ds liQy lapkyu gsrq fofHkUu foHkkxksa ds

inkf/dkfj;ksa dh leUo; cSBd dk vk;kstu fd;k tk;sxkA(ctV vkadyu dafMdk

8 nz"VO;)

(7) izpkj izlkj en%& bl en esa ftyksa dh tula[;k ,oa izkFkfed LokLF; dsUnzks dh

la[;k ds vk/kj ij ctV izkDdyu dafMdk 9 esa nZ’kk;h x;h gS rFkk bl en esa

dqy 14]55]000@& :i;s vkadfyr dh x;h gSA lEcfU/kr ftyk bl en dh jkf’k

ls cSuj @iksLVj ,oa vU; la’kk/uks ls iQkbZysfj;k fnol ds lEcU/ esa vke turk ds

chp izpkj izlkj dk dk;Z djsxsaA

(8) ftyk Lrjh; fpfdRlk inkf/dkfj;ksa dk izf’k{k.k%& bl en esa ctV izkDdyu

dafMdk 10 esa dqy 22]05]000@& (ckbZl yk[k ikWap gtkj) :i;s dks vkadfyr

380

fd;k x;k gSA jkT; Lrj ij izf’kf{kr fpfdRlk inkf/dkjh ftyk Lrj izkFkfed

LokLF; dsUnzks ds fpfdRlk inkf/dkjh dks izf’kf{kr djsxsaA izf’k{k.k ,d fnolh;

gksxkA

(9) ikjkesfMdy dehZ dk izf’k{k.k% ctV izkDdyu dafMdk 11 esa ftyksa ds ikjk

esfMdy LVkiQ dk izf’k{k.k iz[k.M Lrj ij dk;Zjr ikjk esfMdy LVkiQ dks mDr

iz[k.M ds izf’kf{kr fpfdRlk inkf/dkjh }kjk izf’kf{kr fd;k tk;sxkA bl en esa

mDr dafMdk esa ftyksa ds uke ds lkeus jkf’k dk vkadyu fd;k x;k gSA vkadfyr

jkf’k 18]85]000@&:i;k gSA

(10) ykbZu fyfLVax % ctV izkDdyu ds dafMdk 12 esa dqy 15]20]000@& (iUnzg yk[k

chl gtkj) :i;s izkDdfyr gSA

(11) ftyk Lrj ij isV“ksy ywcjhdsV gsrq en esa 11]98]000@&(X;kjg yk[k vuBkuos

gtkj :i;s)A

(12) jkf=k jDr iV laxzg% ctV izkDdyu ds dafMdk 13 esa dqy 5]74]546@& (ikWp

yk[k pkSgrj gtkj ikWp lkS fN;kyhl) :i;s vkadfyr dh x;h gS A

(13) nok forj.k dÙkkZ dk izf’k{k.k en% bl en esa dqy 2]62]410@& (nks yk[k oklB

gtkj pkj lkS nl nok forj.k dÙkkZ dks 92-00 (ckuos) :i;s ds nj ls ,d fnu

ds fy;s dqy 2]41]41]720@& (nks djksM+ ,drkyhl yk[k ,drkyhl gtkj lkr

lkS chl ) :i;s ek=k izkDdfyr gSA

(14) nok forj.k dÙkkZ ekuns; jkf’k% bl en esa ctV izkDdyu ds dafMdk 7 esa nks

yk[k cklB gtkj pkj lkS nl nok forj.k dÙkkZ dks 92 :i;s dh nj ls ,d fnu

ds fy, dqy 2]41]41]720@& (nks djksM+ ,drkyhl yk[k ,drkyhl gtkj lkr

lkS chl) :i;s ek=k izkDdfyr gSA

(15) nok i;Zos{kd dk izf’k{k.k jkf’k% bl en dk ctV izkDdyu ds dafMdk 5 esa

26]239-00 (NCchl gtkj nks lkS mupkfyl lqijckbtj dks 113@& :i;s dh nj

ls ,d fnu ds fy, dqy 2]96]5007@& (nks djksM- fN;kuos yk[k ikWp gtkj

lkr) :i;s izkDdfyr gSA

(16) lqijokbtj dk ekuns; jkf’k% bl en esa ctV izkDdyu ds dafMdk 9 esa 26]239@&

(Nchl gtkj nks lkS mupkfyl dks 113@& :i;s dh nj ls ,d fnu ds fy, dqy

381

2]96]5007@& (nks djksM- fN;kuos yk[k ikWp gtkj lkr :i;s) dk ctV

izkDdfyr gSA

fo’oklHkktu


iQysfj;k fcgkj] iVuk












382

,e- Mh- ,- dk izLrkfor la’kksf?kr ctV izkDdyu fofÙk; o"kZ 2009&10

l0 fu0

jk"V“h; iQkbysfj;k fnol 2009&10 ds eukus gsrq fofHkUu enksa dk vyx&vyx rS;kj fd;k

tk jgk gS] ftldk C;kSjk fuEu izdkj gSA

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383

State- Bihar NAME OF PROGRAMME , MASS DRUG ADMINISTRATION ,BUDGET FOR 2009-2010

Sl.No. State & NameOf District

No. Of PHC Dist. HQ

Total (PHC

Dist.HQ)

Training Of Dist. Officer

IEC ( State Level)

Dist.& Co-ordination

Meeting(Two Meeting in each Dist.)

IEC ( For Dist. HQ) Traing For MO

Training For Para

Medical Staff

Line Listing Night Blood

Survey POL Total (A) Remarks

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 1 State Level 0 0 0 152,000 1,000,000 0 0 60,000 150,000 0 0 300,000 1,662,000 2 Araria 9 1 10 0 0 15,000 35,000 55,000 40,000 35,000 16,698 28,000 224,698 3 Aurangabad 11 1 12 0 0 15,000 40,000 55,000 45,000 35,000 16,698 33,000 239,698 4 Arwal 3 1 4 0 0 15,000 30,000 20,000 25,000 20,000 16,698 13,000 139,698 5 Banka 10 1 11 0 0 15,000 35,000 50,000 40,000 35,000 16,698 30,000 221,698 6 Begusarai 11 1 12 0 0 15,000 35,000 50,000 40,000 35,000 16,698 33,000 224,698 7 Bhagalpur 11 1 12 0 0 15,000 40,000 55,000 40,000 40,000 16,698 33,000 239,698 8 Bhojpur 12 1 13 0 0 15,000 40,000 55,000 45,000 40,000 16,698 35,000 246,698 9 Buxar 7 1 8 0 0 15,000 35,000 55,000 40,000 40,000 16,698 23,000 224,698 10 Darbhanga 13 1 14 0 0 15,000 40,000 55,000 60,000 45,000 16,698 38,000 269,698 11 E.Champaran 20 1 21 0 0 15,000 50,000 90,000 90,000 65,000 16,698 55,000 381,698 12 Gaya 19 1 20 0 0 15,000 50,000 90,000 90,000 65,000 16,698 53,000 379,698 13 Gopalganj 10 1 11 0 0 15,000 35,000 55,000 45,000 35,000 16,698 30,000 231,698 14 Jamui 7 1 8 0 0 15,000 35,000 45,000 40,000 40,000 16,698 23,000 214,698 15 Jehanabad 4 1 5 0 0 15,000 25,000 25,000 25,000 20,000 16,698 16,000 142,698 16 Kaimur 9 1 10 0 0 15,000 35,000 45,000 40,000 30,000 16,698 28,000 209,698 17 Katihar 11 1 12 0 0 15,000 40,000 55,000 40,000 40,000 16,698 33,000 239,698 18 Khagaria 6 1 7 0 0 15,000 35,000 55,000 40,000 30,000 16,698 20,000 211,698 19 Kishanganj 7 1 8 0 0 15,000 35,000 55,000 45,000 30,000 16,698 23,000 219,698 20 Lakhisarai 4 1 5 0 0 15,000 25,000 25,000 25,000 20,000 16,698 15,000 141,698 21 Madhepura 7 1 8 0 0 15,000 35,000 55,000 40,000 30,000 16,698 23,000 214,698 22 Madhubani 19 1 20 0 0 15,000 50,000 90,000 90,000 60,000 16,698 53,000 374,698 23 Munger 6 1 7 0 0 15,000 35,000 55,000 40,000 30,000 16,698 20,000 211,698 24 Muzaffarpur 14 1 15 0 0 15,000 45,000 70,000 65,000 45,000 16,698 40,000 296,698 25 Nawada 10 1 11 0 0 15,000 40,000 55,000 40,000 35,000 16,698 30,000 231,698 26 Nalanda 12 1 13 0 0 15,000 40,000 65,000 40,000 45,000 16,698 35,000 256,698

384

27 Patna 16 1 17 0 0 15,000 50,000 90,000 90,000 70,000 16,698 45,000 376,698 28 Purnea 11 1 12 0 0 15,000 40,000 55,000 45,000 40,000 16,698 33,000 244,698 29 Rohtas 13 1 14 0 0 15,000 40,000 55,000 60,000 45,000 16,698 38,000 269,698 30 Saharsa 7 1 8 0 0 15,000 35,000 50,000 45,000 30,000 16,698 23,000 214,698 31 Samastipur 14 1 15 0 0 15,000 45,000 70,000 60,000 50,000 16,698 40,000 296,698 32 Saran 15 1 16 0 0 15,000 45,000 70,000 65,000 50,000 16,698 43,000 304,698 33 Sheikhpura 3 1 4 0 0 15,000 30,000 25,000 25,000 20,000 16,698 13,000 144,698 34 Sheohar 3 1 4 0 0 15,000 25,000 25,000 25,000 45,000 16,698 13,000 164,698 35 Sitamarhi 13 1 14 0 0 15,000 40,000 55,000 65,000 50,000 16,698 38,000 279,698 36 Siwan 15 1 16 0 0 15,000 40,000 70,000 55,000 30,000 16,698 43,000 269,698 37 Supaul 9 1 10 0 0 15,000 35,000 55,000 45,000 40,000 16,698 28,000 234,698 38 Vaishali 11 1 12 0 0 15,000 40,000 55,000 45,000 40,000 16,698 33,000 244,698 39 W.Champaran 16 1 17 0 0 15,000 50,000 90,000 90,000 65,000 16,698 45,000 371,698

Total 398 38 436 152,000 1,000,000 570,000 1,455,000 2,205,000 2,035,000 1,520,000 634,524 1,498,000 11,069,524

385

State- Bihar NAME OF PROGRAMME , MASS DRUG ADMINISTRATION ,BUDGET FOR 2009-2010

Sl.No. State & NameOf District

No. Of House in

Dist.

No. of Drug Distri.in Dist

No. of Supervisior

Training Of Drug

Distributer in Dist. (@ Rs.

92 Each)

Honararium Of Drug Distri.( @ Rs. 92 Each)

Training Of Supervisior (113 Each)

Honararium of Supervision in

Dist. @ Rs. 113/- Each

Toatl (B) Toatl (A) ( From

Previous Sheet)

Grand Total ( A+B)

1 2 3 4 5 6 7 8 9 10 11 12 1 State Level 0 0 0 0 0 0 0 0 1,662,000 1,662,000 2 Araria 416,693 8,400 838 772,800 772,800 94,694 94,694 1,734,988 224,698 1,959,686 3 Aurangabad 359,820 7,240 724 666,080 666,080 81,812 81,812 1,495,784 239,698 1,735,482 4 Arwal 99,698 2,000 200 184,000 184,000 22,600 22,600 413,200 139,698 552,898 5 Banka 271,286 5,450 545 501,400 501,400 61,585 61,585 1,125,970 221,698 1,347,668 6 Begusarai 379,947 7,650 765 703,800 703,800 86,445 86,445 1,580,490 224,698 1,805,188 7 Bhagalpur 424,352 8,510 851 782,920 782,920 96,163 96,163 1,758,166 239,698 1,997,864 8 Bhojpur 347,780 7,000 700 644,000 644,000 79,100 79,100 1,446,200 246,698 1,692,898 9 Buxar 213,834 4,300 430 395,600 395,600 48,590 48,590 888,380 224,698 1,113,078

10 Darbhanga 508,044 10,200 1,020 938,400 938,400 115,260 115,260 2,107,320 269,698 2,377,018 11 E.Champaran 538,386 10,750 1,075 989,000 989,000 121,475 121,475 2,220,950 381,698 2,602,648 12 Gaya 563,963 11,300 1,130 1,039,600 1,039,600 127,690 127,690 2,334,580 379,698 2,714,278 13 Gopalganj 345,846 6,930 693 637,560 637,560 78,309 78,309 1,431,738 231,698 1,663,436 14 Jamui 215,571 4,320 432 397,440 397,440 48,816 48,816 892,512 214,698 1,107,210 15 Jehanabad 124,264 2,500 250 230,000 230,000 28,250 28,250 516,500 142,698 659,198 16 Kaimur 199,007 4,000 400 368,000 368,000 45,200 45,200 826,400 209,698 1,036,098 17 Katihar 417,984 8,380 838 770,960 770,960 94,694 94,694 1,731,308 239,698 1,971,006 18 Khagaria 274,709 5,520 552 507,840 507,840 62,376 62,376 1,140,432 211,698 1,352,130 19 Kishanganj 217,089 4,360 436 401,120 401,120 49,268 49,268 900,776 219,698 1,120,474 20 Lakhisarai 134,852 2,700 270 248,400 248,400 30,510 30,510 557,820 141,698 699,518 21 Madhepura 255,280 5,320 532 489,440 489,440 60,116 60,116 1,099,112 214,698 1,313,810 22 Madhubani 563,734 11,300 1,130 1,039,600 1,039,600 127,690 127,690 2,334,580 374,698 2,709,278 23 Munger 187,522 3,750 375 345,000 345,000 42,375 42,375 774,750 211,698 986,448

386

24 Muzaffarpur 573,302 11,500 1,150 1,058,000 1,058,000 129,950 129,950 2,375,900 296,698 2,672,598 25 Nawada 288,581 5,800 580 533,600 533,600 65,540 65,540 1,198,280 231,698 1,429,978 26 Nalanda 330,598 6,620 662 609,040 609,040 74,806 74,806 1,367,692 256,698 1,624,390 27 Patna 679,619 13,600 1,360 1,251,200 1,251,200 153,680 153,680 2,809,760 376,698 3,186,458 28 Purnea 456,118 9,140 914 840,880 840,880 103,282 103,282 1,888,324 244,698 2,133,022 29 Rohtas 394,415 7,900 790 726,800 726,800 89,270 89,270 1,632,140 269,698 1,901,838 30 Saharsa 226,070 4,540 454 417,680 417,680 51,302 51,302 937,964 214,698 1,152,662 31 Samastipur 462,681 9,270 927 852,840 852,840 104,751 104,751 1,915,182 296,698 2,211,880 32 Saran 467,382 9,350 935 860,200 860,200 105,655 105,655 1,931,710 304,698 2,236,408 33 Sheikhpura 85,238 1,710 171 157,320 157,320 19,323 19,323 353,286 144,698 497,984 34 Sheohar 35,956 1,720 172 158,240 158,240 19,436 19,436 355,352 164,698 520,050 35 Sitamarhi 400,483 8,020 802 737,840 737,840 90,626 90,626 1,656,932 279,698 1,936,630 36 Siwan 398,768 8,000 800 736,000 736,000 90,400 90,400 1,652,800 269,698 1,922,498 37 Supaul 288,596 5,790 579 532,680 532,680 65,427 65,427 1,196,214 234,698 1,430,912 38 Vaishali 415,794 8,320 832 765,440 765,440 94,016 94,016 1,718,912 244,698 1,963,610 39 W.Champaran 488,581 9,250 925 851,000 851,000 104,525 104,525 1,911,050 371,698 2,282,748

Total 13,051,843 262,410 26,239 24,141,720 24,141,720 2,965,007 2,965,007 54,213,454 11,069,524 65,282,978

388

PART- E

Intersectoral Convergence

2009-2010

389

Situational Analysis: Public health peripheral and extension services and its linkage with facility based services started less than a century in the country. The said services have developed many folds during the last sixty years initially on the recommendation of the Bhor Committee and subsequently on the basis of reviews and recommendations of several expert committees. It has achieved commendable results despite poor funding and lack of a uniform system of command. It is now increasingly understood larger fund allocation would increase the resources within the health administrative set up but to achieve the desired outcomes, sectors administering the determinants of health must work in tandem with common objectives. The NRHM rightly emphasized the need to develop a convergent system between the Department of Health and other sectors governing the areas of several health determinants. The NHRM also recognizes the need to develop ownership of partners / stakeholders in tackling local endemic issues to ensure better quality of life in all sections of the population. Considering the diversity and prevailing inequity amongst the people it is rightly considered that leadership must be provided at every level of governance to solve the health problems amongst the poor and the excluded. Governance at every level can only be provided by the Rural Local Self Governance and in the State of Bihar it is the three tiers Panchayat Raj Institution. The other sectors which directly administer the issues of health determinants are;

• Department Social Welfare administers ICDS • Department of Education administers school and higher education, • Public Health Engineering Department and Panchayat administer supply of drinking

water and environmental sanitation including solid waste management. NRHM also seeks partnership from Indian System of Medicine like Aurveda, Unani, Yoga, Sidda and Homeopathy now jointly named AUYSH. The NRHM also seeks involvement of Non Government Organizations (NGO) and For Profit Private Sector as partners in the public health services by developing local need specific Public Private Partnership schemes. It also visualizes the need to involve expert consultants and agencies in strengthening the Department of Health and development of a State Heath Resource Centre to provide Technical Support in carrying forward the Management of Change for efficient utilization of resources and effective delivery of health services.

(a) Coordination with Panchayat /Village Council. The state is undergoing through the process in the decentralisation of Panchayati Raj System. Thus to strengthen and monitor the performance of the PHSC and PHC, this institution has been brought under the manifold of the Panchayat president and Zilla Panchayat members of the respective areas. Further the Panchayat presidents or the members are ex officio chairman of the Village Health Water and Sanitation committee, to have a direct involvement in the health issues of the community. Joint bank account of Panchayat president and ANM has been

390

opened for PHSC untied fund. These processes paved the way for taking initiative in implementation in various health programmes under NRHM Department has good relationship with the Village Council and through coordination with the Village Council most of the health programmes are being implemented at the community level with satisfaction.

(b) Coordination with ICDS The DPO is a member of the District Health Society & District Core Group (under NRHM) and thus the health department has been able to utilize his/her services for community mobilization at the grassroots level. Through coordinated effort of the ANM and the Anganwadi worker mothers and children are being mobilized for antenatal check up, institutional deliveries and immunisation. Now the coordination is to be extended to organize VHNDs (Village Health nutrition Days) at every AWC all over the district every month.

Issues / Areas Areas of Convergent Action Support in School Health Programme

Due to shortage of manpower in the health department, plans to examine school children should be prepared jointly with the education department so that larger schools are covered first or priority should be set for village schools which have not been covered recently or threats/incidences of diseases/malnutrition are more.

Support in immunisation programme for provision of TT booster at the age of 10 years.

During the school health programme visits, the booster Tetanus Toxoid needs to be given to 10 year olds in the schools. This should be worked out with the Education department and visits planned accordingly.

Support in the adolescent health programme

Problem villages to be identified in which ASRH services can be provided on priority basis.

391

(c) Coordination with PRI

Issues / Areas Convergent actions Drainage system in villages

List of villages with major drainage problems to be shared by the Health and ICDS department with the Rural Development department for annual prioritization of resources

Garbage disposal in villages

The system of disposal of garbage (solid waste) needs to be set up and larger villages prioritized as per list submitted by ANMs and AWWs. The operational aspects need to be managed by the VHWSC as per guidelines.

Emergency transportation services

Standard Operation Procedure (SOPs) and operation of emergency transportation services in villages with support from the block are in process.

(d) Coordination with AYUSH There are few practitioners of ISM that are in government employment. The service rules related to them are not well defined. However, practitioners of traditional systems are there. Before a strategy can be worked out as to how to mainstream or integrate this, a study need to be carried out to identify the points of common interest such as rational management of common diseases, communicable diseases control Programme and disease surveillance

Outcome /Output:

Effective coordination exists between health dept. and other line departments

Objectively Verifiable Indicators (OVI): Increased participation of all the line departments with the health department

1.1 – Strategy : • Constitute State level inter department standing committee to initiate policy review for

convergence and develop implementation procedures • Constitute District level inter department committee under the Chairmanship of DM

and involvement of the District Level PRI to ensure PHC level committees are constituted and implementing the directives of the State Level Standing Committee

• SHRC and TSU can facilitate by providing Technical Assistance and Support

Activities: MoV 1.1.1 Develop convergence platform at all levels with NRHM line

departments by constituting the committees Committees constituted

392

1.1.2 Develop policy framework and procedural guidelines / manual Guidelines / manual

1.1.3 Develop linkage with other departments like WCD, Urban & Rural Development, Education, Panchayat, Youth Affairs, etc at all levels by ensuring the committees are functioning as per guidelines

Minutes of the meeting

1.1.4 Involve civil society, partners, NGOs in district health society Membership list

1.1.5 Establish convergent committee in all PHCs chaired by BDO Committees constituted

1.1.6 PRI s to actively involve in health development activities Membership list

1.1.7 Joint Action with the line departments at different levels Joint plans and monitoring and review documents

1.1.8 Formation and effective functioning of Rogi Kalyan Samiti (RKS) at PHC level which will also function as convergence committee

RKS constituted

1.1.9 Joint Planning, monitoring, evaluation by ANM, AWW ASHA FNGO/NGO, VHWSC and PRI representatives in VHWSC meeting.

Joint plan documents

1.1.10 Regular information sharing among converging departments and joint review of progress.

Minutes of meeting

1.1.11 Key officials of NRHM related departments at State level to be actively involved in monitoring at all levels

Joint monitoring and review documents

1.1.12 Preparation of joint monitoring plan in consultation with all line departments

Joint monitoring plan document

1.1.13 Review and monitoring of activities jointly. Joint monitoring and review documents

393

Programme wise convergence

Strategies/Activities MoV 1. Maternal Health

1.1 Organize VHNDs at each and every AWC once a month to deliver ANC services.

Consolidated report of the PHC & district hospital

1.1 Organize once in two months RCH camps in all PHC and District Hospital areas within the district.

Consolidated report of PHC & district

1.2 Involvement of community representative of Gram Sabha through VHWSCs & MSS for identifying & referring complicated cases to facilities

Supervision and monitoring reports

1.3 Involvement of AWWs and PRIs to identify and track each pregnant woman and motivate them to avail ANC services. Regular updation of EC register and quarterly population survey of her coverage area.


1.4 Collection of blood and urines samples of pregnant women and send it to PHC for examination and report back with in 24 hours

VHND Report

1.5 ASHA, AWW and ANM to be involved in observed consumption of IFA tablets by moderately and severely anemic pregnant mothers through regular home visits and follow ups.

Monitoring and supervision report of LHV/ MO/DRCHO/PRI

1.6 Observed consumption of Iron Follifer Tabs by Girls students in schools School Health Programme report

1.7 De-worming of all pregnant and adolescents girls (Half Yearly) Programme report

2. Child Health

2.1 Organize VHNDs at each and every AWC once a month to deliver child health and nutrition services.

Consolidated report of the PHC & district hospital

2.2 Organize RCH camps once in two months in all PHCs Consolidated report of PHC & district

2.3 Involvement of community representative of Gram Sabha through VHWSCs & MSS for identifying & referring malnourished cases to facilities


2.4 Supervision & Monitoring on all VHNDs by PRI representatives Supervision and monitoring reports

2.5 Regular organization of VHNDs at every AWCs in co-ordination of ANMs, ASHAs and PRIs

Programme report

2.6 Estimation and registration of children under the age group of 0-5 yrs List of children

2.7 Growth monitoring of each child during VHNDs, at PHSC & in other Supervision and

394

facilities monitoring reports of PRIs/Department

3. Family Planning

3.1 Ensure distribution of OCPs, emergency pills, condoms and IUD insertion to eligible couple through ASHAs , AWCs and ANMs

Stock Register

4. Adolescents Health

4.1 To provide weekly dose of observed IFA and bi-annual dose of deworming to adolescents girls in school by teachers

List of girls provided IFA % deworming

4.2 To provide weekly dose of observed IFA and bi-annual dose of deworming to adolescents girls in school by AWWs and ASHAs

List of girls provided IFA % deworming

4.3 Training of school teachers, AWWs, ASHAs and female PRI representatives on following issues:

• Hygiene and menstrual hygiene and genital cleanliness • Adolescents growth and development • Communicating with adolescents • Sexual and reproductive health concerns of boys and girls • Nutrition and anemia in adolescents • Contraception for adolescents • RTIs/STIs and HIV/AIDS in adolescents • Child bearing • Birth preparedness and parenting • Safe abortion

Report of training

4.4 Awareness development amongst adolescents girls by school teachers, AWWs, ASHAs and female PRI representatives on all issues mentioned above by community

Report of counseling session

5. Immunization

ASHA , AWW and ANM to conduct Home Visits to trace out the Un-immunized children and Drop outs

List of children

Provision of Immunization during regular VHNDs organized at every AWCs

Performance report

6. National Disease Control Programme

IDSP

Symptomatic identification of diseases covered under IDSP and refer to nearest health facility

Report of cases

395

Treatment all referral cases Performance report

RNTCP

Symptomatic detection of cases by ANMs, AWWs, ASHAs, PRIs and refer to nearest DOTS centre

report of cases

Awareness development at community level regarding signs and symptoms of reportable cases for early detection, isolation and seeking treatment through mass media,, IPS, & counseling

Report of BCC activities

Developing and dissemination of IEC material, including leaflets and posters to the community

Display and availability of BCC material

IPC through convergent approach Report of key functionaries

Blindness

Create awareness at the community level through effective mass media for screening camps to be organized by BCC activities


Awareness development at community level regarding signs and symptoms of reportable diseases for early detection and seeking treatment.


Developing and dissemination of IEC material, including leaflets and posters

Leaflets and posters in place

IPC through convergent approach Report of key functionaries

Leprosy

Involving ASHA, AWWs and PRIs to ensure accessible and uninterrupted MDT services available to all patients through flexible and patient friendly drug delivery system

Clinic during conventional timing

6.5 National Vector Borne Disease Control Programme

6.5.1 Convergence with Panchayat/PHED for environmental sanitation and safe drinking water supply by detecting location with problems

List of sites

6.6 Water borne diseases

6.6.1 Drainage system in villages

List of villages with major drainage problems to be shared by the Health and ICDS department with the Rural Development department for annual prioritization of resources

List of villages

6.6.2 Garbage disposal in villages

The system of disposal of garbage (solid waste) needs to be set up and larger villages prioritized as per list submitted by ANMs and AWWs. The operational aspects need to be managed by the VHWSC as per guidelines.

List of villages and locations

396

Work Plan Goal: Effective coordination exists between health dept. and other line departments

Strategy / Activity

Timeline Responsibilit

y State/District

2009-10 20010-11

2011-12

Q1 Q2 Q3 Q4

Inter-sectoral Coordination

Strategy: Refer to LFA above

Activities: 1.1.1 Develop convergence platform at all

levels with NRHM line departments by constituting the committees

State

1.1.2 Develop policy framework and procedural guidelines / manual

State

1.1.3 Develop linkage with other departments like WCD, Urban & Rural Development, Education, Panchayat, Youth Affairs, etc at all levels by ensuring the committees are functioning as per guidelines

State/District

1.1.4 Involve civil society, partners, NGOs in district health society

District

1.1.5 Establish convergent committee in all PHCs chaired by BDO

District

1.1.6 PRIs to actively involve in health development activities

District

1.1.7 Joint Action with the line departments at different levels

State/District

1.1.8 Effective functioning of Rogi Kalyan Samiti (RKS) at PHC level which will be also function as convergence committee

District

1.1.9 Joint Planning, monitoring, evaluation by ANM, AWW ASHA FNGO/NGO, VHWSC and PRI representatives in VHWSC meeting.

District

1.1.10 Regular information sharing among converging departments and joint review of progress.

State/District

1.1.11 Key officials of NRHM related State

397

Strategy / Activity

Timeline Responsibilit

y State/District

2009-10 20010-11

2011-12

Q1 Q2 Q3 Q4

departments at State level to be actively involved in monitoring at all levels

1.1.12 Preparation of joint monitoring plan in consultation with all line departments

State/District

1.1.13 Review and monitoring of activities jointly. State/Distri

ct

398

Budget:

Activity Unit Rate Amount Joint Meeting at the state level with various Deptt. like PR, ICDS etc

2 100000 2,00,000

Joint meeting at the district level

38 25000 9,50,000

Joint monitoring from state to districts to block/phc

6 20000 x 6 visits 120000

Joint meeting at the village level- Mahila mandal meetings

60000 AWC Rs 100 pm X 12 months

7,20,00,000

Incentive to AWW for social mobilization in Muskan Abhiyan

60000X200X12 months

14,40,00,000

Total 21,72,70,000

399

NRHM PART A : RCH II Sl. No. Budget Head Rs. lakhs %

1 Maternal Health 1.1 Operationalise facilities (dissemination,

monitoring & quality) (details of infrastructure & human resources, training, IEC / BCC, equipment, Drug and supplies in relevant sections)

14.50

1.1.2 Operationalise Blood Storage units in FRU 469.68

1.2 Referral Transport 0.00 1.3 Integrated outreach RCH services 10.00 1.4 Janani Evam Bal Suraksha Yojana/JBSY 22686.72 Sub total 23180.90 47.80 2 Child Health 4291.09 8.85 3 Family Planning 7432.02 15.33 4 Adolescent Reproductive and Sexual Health 49.05 0.10 5 Urban RCH 134.33 0.28 6 Vulnerable Groups 330.00 0.68 7 Tribal Health 0.00 0.00 8 Innovations 2077.30 4.28 9 Strengthening of SIHFW 0.00 0.00 10 Infrastructure and Human Resource 3783.76 7.80 11 Institutional Strengthening 602.50 1.24 12 Training 1122.32 2.31 13 BCC/IEC (for NRHM Part A, B & C) 1140.89 2.35 14 Procurement of Equipments/Instruments 3385.58 6.98 15 Procurement of Drugs and Supplies 0.00 0.00 16 Programme management 965.25 1.99

TOTAL 48495.00 100.00

400

PART- B

Sl. No. Budget Head Modified Budget %

1 2 6 1 Decentralization

1.11 ASHA Support System at State Level 27694500 1.12 ASHA Support System at District Level 2160000 1.13 ASHA Support System at Block Level 59950000 1.14 ASHA Support System at Village Level 4500000 1.15 ASHA Trainings 82421250 1.16 ASHA Drug Kit & Replenishment 22555800 1.17 Emergency Services of ASHA 2500000 1.18 Motivation of ASHA 63172875 1.19 Capacity Building/Academic Support programme 1000000 1.2 ASHA Divas 81230200

Total ASHA 347184625 7.97 1.21 Untied Fund for Health Sub Center, Additional

Primary Health Center and Primary Health Center 134807000

1.22 Village Health and Sanitation Committee 401332500 1.23 Rogi Kalyan Samiti 85300000

Total Decentralization 621439500 14.26 2 Infrastructure Strengthening

2.1 Construction of HSCs (100 no. x Rs.9.50 lakhs) 95000000 2.2 Construction of PHCs 637967000 2.2a Construction of residential quarters of 200 old

APHCs for staff nurses 600000000

2.2b Construction of building of 51 APHCs where land is available

37967000

2.3 Up gradation of CHCs as per IPHS standards (100 CHCs x Rs.40.00 lakhs)

400000000

2.4 Infrastructure and service improvement as per IPHS in 20 (DH & SDH) hospitals for accreditation or ISO : 9000 certification

100000000

2.5 Upgradation of ANM Training Schools 70000000 2.6 Annual Maintenance Grant 82080000

Total Infrastructure strengthening 1385047000 31.79 3 Contractual Manpower

3.1 Contractual Salaries, Incentives and Bonus (PHC doctors and staffs, contractual staff nurses, ANM ®, mobile services)

668400000

3.1a Incentive for PHC doctors & staffs @ Rs. 50,000 for better performance in implementing programmes (Rs. 50,000/ - per PHC per year)

12500000

401

3.1b Salaries for contractual Staff Nurses (2900 existing and 910 new) (Rs.7500 per month)

343900000

3.1c Contract Salaries for ANMsRs.6000 per month x 3500 (12 Months Consolidated Salaries for Contractual ANMs)

252000000

3.1d Mobile facility for all health functionaries (District officials, PHC in charge, CDPOs and ANMs @ 500 per month)

60000000

3.2 Block Programme Management Unit 289524000 3.3 Addl. Manpower for SHSB 6204288 3.4 Addl. Manpower for NRHM 25479000

Total Contractual Manpower 989607288 22.71 4 PPP Initiatives

4.1 102-Ambulance service 4032000 4.2 1911- Doctor on Call & Samadhan 816000 4.3 Addl. PHC management by NGOs 39864000 4.4 American Association of Physicians of Indian Origin

(AAPIO) 5600000

4.5 SHRC (HOSMAC) 13844000 4.6 Services of Hospital Waste Treatment and Disposal

in all Government Health facilities up to PHC in Bihar (IMEP)

30000000

4.7 Dialysis unit in various Government Hospitals of Bihar

20000000

4.8 Setting Up of Ultra-Modern Diagnostic Centers in Regional Diagnostic Centers (RDCs) and all Government Medical College Hospitals of Bihar

36000000

4.9 Providing Telemedicine Services in Government Health Facilities

20000000

4. 10 Outsourcing of Pathology and Radiology Services from PHCs to DHs

3000000

4.11 Operationalising MMU (38 units x Rs.4.68 lakhs x 9 months)

160056000

4.14 Monitoring and Evaluation (State, District, Block Data Centre)

63750000

4.15 Generic Drug Shop 4.16 Nutritional Rehabilitation Centre 4934400 4.17 Hospital Maintenance 4.18 Providing Ward Management Services in

Government Hospitals 3000000

4.19 Provision for HR Consultancy services 2250000 4.2 Advanced Life Saving Ambulance (Rs.9,98,000/- x 9

months) 8901000

Total PPP Initiatives 416047400 9.55 5 Procurement of Supplies

402

5.1 Delivery kits at the HSC/ANM/ASHA (no.200000 x Rs.25/-)

5000000

5.2 SBA Drug kits with SBA-ANMs/Nurses etc (no.25000 x Rs.245/-)

6125000

5.3 Availability of Sanitary Napkins at Govt. Health Facilities @25000/district/year

950000

5.4 Procurement of beds for PHCs to DHs 40286000 Total Procurement of Supplies 52361000 1.20 6 Procurement of Drugs

6.1 Cost of IFA for Pregnant & Lactating mothers (Details annexed)

23944000

6.2 Cost of IFA for (1-5) years children (Details annexed)

40923000

6.3 Cost of IFA for adolescent girls (Details annexed) 37541000 Total Procurement of Drugs 102408000 2.35 7 Mobilisation & Management support for Disaster

Management 10000000 0.23

8 Health Management Information System 3289517 0.08 9 Strengthening of Cold Chain (Infrastructure

strengthening) 36131000 0.83

Refurbishment of existing Warehouse for R.I. as well as provision for hiring external storage space for (during Immunization Campaigns) Logistics at State HQ @Rs 1000000/-

1000000

Refurbishment of existing Cold chain room for district stores in all districts with proper electrification,Earthing for electrical cold chain equipment and shelves and dry space for non elecrtical cold chain equipment and logistics @Rs 3 Lakhs per district x 38 districts

11400000

Earthing and wiring of existing Cold chain rooms in all PHCs @Rs 7000/- per PHC x 533 PHCs

3731000

POL of Generators for cold chain @ Rs. 600 per day per WIC. Rs. 500 per day per district and Rs. 400 per day per PHC

20000000

10 Preparation of Action Plan 1700000 0.04 10.1 Preparation of District Health Action Plan (Rs.50

thousand per district x 38) 1600000

10.2 Preparation of State Health Action Plan @ 1 lakhs 100000 11 Mainstreaming Ayush under NRHM 391,584,800 8.99 Total 4,356,800,130 100.00

Rs. in Lakh 43568.00

403

NRHM Part: C

Sl Budget Head Total Budget (Rs. In lakhs)

%

1 Routine Immunization 3193.08 100.00 Total 3193.08 100.00

NRHM PART D – NATIONAL DISEASE CONTROL PROGRAMME

Sl. No. Programme Budget 2009-10 (Rs. In Lakhs) %

1 IDSP 130.06 1.82 2 T.B. 2,414.73 33.85 3 Leprosy 279.40 3.92 4 Malaria 435.15 6.10 5 Kalazar 2,268.92 31.81 6 Dengu+Chikungunya 36.50 0.51 7 Filaria 652.83 9.15 8 Blindness 518.75 7.27 9 IDD 18.00 0.25

10 JE 379.50 5.32

TOTAL 7,133.84 100.00 NRHM Part E : Intersectoral Convergence

Sl. No. Programme Budget 2009-10 (Rs. In Lakhs) %

1 Intersectoral Convergence 2172.70 100

404

SUMMARY of BUDGET

PART HEAD BUDGET 2009-10 (Rs. In lakhs) In Cr. %

A RCH II 48495.00 484.95 37.89 B NRHM Additionalities 43568.00 435.68 34.04 C Immunization 3193.08 31.93 2.49 D NDCP 7,133.84 71.34 5.57 E Intersectoral Convergence 2172.70 21.72 1.70

TOTAL 104562.62 1045.62 81.70 PPI Operational Cost 76.97 6.01

Infrastructure Maintenance (Treasury Fund) 157.22 12.28

GRANT TOTAL 1279.81 100.00

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