1

2

STRUCTURE OF PIP 2011-12 The structure of PIP for 2011-12

EXECUTIVE SUMMARY

CHAPTER-1: Outcome analysis of PIP 2009-10 and 2010-11 (till 30.09.2010)

CHAPTER-2: Policy and Systemic reforms in strategic areas

CHAPTER-3: Conditionalities

CHAPTER-4: Scheme/Program

A RCH Flexi Pool

B NRHM Flexi pool

C Immunization

D Disease Control Programs

E Inter-sectoral Convergence

CHAPTER-5: Monitoring and evaluation

CHAPTER 6: Financial Management

CHAPTER-7: State Resources and other sources of funds for health sector

CHAPTER-8: Priority Projects that can be considered if additional resources are

available

3

PREFACE

The National Rural Health Mission was launched in April 2005. The Government of

Meghalaya has been implementing the Mission since its launch but over the years the

implementation has been relatively slow for various reasons like less effective community

participation which has resulted in lower achievements compared with the targets and non-

fulfilment of Mission's goals. Therefore, the government in the forthcoming year is seeking to

remove the bottlenecks in the implementation of NRHM and strengthen the mechanism of

community participation and community processes so that the services at health institutions can be

made more accountable. The primary challenge of the Mission is to ensure the universal presence

of health services like doctors, nurses, medicines, proper water supply and electricity at all the

Public health institutions. We are getting close to achieving these set metrics and with proper

monitoring, supervision and Community participation we hope that 2011-12 would be a watershed

year in the history of the State.

Meghalaya has come a long way in improving the health facilities and improving health

status of the people in this hilly state during the last 38 years of its creation. While the coverage and

the reach to the people have also increased over these years, the state still has many challenges to

counter and has to go a long way to achieve the desired results of health for all.

There has to be much greater focus on the Reproductive and Child Health as it is very

unsatisfactorily implemented at present and it must be united with encouraging people’s

participation for success of National Rural Health Mission. Block action plan, integrated into the

District action plan, which is the most important unit of planning process, is the basis of preparing

the comprehensive health plan in the state. The major thrust of the plan is on health systems'

strengthening, capacity building of manpower, better management of information system as well as

strengthening of the community processes and participation of people.

The Public health system of Meghalaya, through the ASHAs, the Auxiliary Nurse

Midwifery (ANMs), Aganwadi Workers (AWWs), General Nurse Midwifery (GNMs) and Doctors

reach out to the people living in about 6250 villages. They are the vehicles for administering this

plan of the state aimed at improving the access to comprehensive quality health care. We plan to

focus more in the forthcoming year in systems management where we have incorporated plans for

e-health, HMIS, biomedical waste management amongst others.

4

The capacity to manage the programme in the state is going to be significantly strengthened.

There are now block programme management support units at each block to support the district and

state programme management units in the state to support the Directorate of Health Service

(MCH&FW) to operationalise this envisaged plan in most efficient and effective manner. The PIP

is review by Jt.MD as well as the SPM and SFM in detail. I acknowledge support of Regional

Resource Centre for the North Eastern States for preparation of this Health Action Plan 2011-12.

Shri D. P. Wahlang, IAS Mission Director (NRHM)

Commissioner & Secretary to the Government of Meghalaya

5 Executive Summary

The National Rural Health Mission (NRHM) initiated by the Government helps the state to enable them of making the proper process of framing the Programme Implementation Plan (PIP) for each state in which key issues which is crucial for the state could be projected in the Plan. Subjected to the approval by the Government of India the state will implement. The decentralized planning process of NRHM has been the principal pivot around which the Mission revolves. The State Governments, before coming up with their PIPs to the NPCC, have to, in turn, prepare village, Block and District level Health Action Plans and appraise them. Significant demand projected through the decentralized planning exercise is then incorporated in the PIP. The States have also been requested to seek the approval of the District Health Mission under the Chairman Zila Parishad and the District Planning Committee (DPC) under the Panchayati Raj Act, wherever they have been constituted. The accountability structure of NRHM provides for a partnership with elected representatives at each level, starting with the Village Health and Sanitation Committees.

Care for mother and Child has been one of the core area in which the government desire to achieve the Millennium Developmental Goal (MDG) especially the Goal 4& 5. Enough finance has been supported by NRHM to the state though the whole amount has not yet released so far. Meghalaya has been able to take up crucial issues like 24 x 7 PHCs and making FRUs functional. Trainings and capacity to all district officials has been taken up to enable them to utilize the fund flow and also implement the schemes as per the plan. Absorption capacity is still low in some of the districts but overall implementation of the scheme is remarkable during 2010-11. There are some of the activities which is under the pipeline that could be taken up before March 2011. Special care has been taken to some of the districts which are still weak.

State PIP in 2011-12 emphasize on strengthening the basic health care services at the grassroots, which includes Health Sub Centres, PHCs & CHCs. Meghalaya has been able to place all Medical Officers at the PHCs & CHCs though there is shortage of Medical Officers in the previous years. In convergence with other department water supply has been made available in some of the PHC. It is remarkable to know that effort has been made by the districts to conduct deliveries even at the HSCs which is one step forward to ease the mother and child who are in need of the services. Strengthening of ASHAs and handholding them for effective performance has been one of the achievements in which the district has exercised during this year. Community Monitoring which has just rolled out in the state will ensure the proper functioning of the Health Care system. The PIP also desire to take up some of the issues concerning the difficult districts i.e., incentivized the health staff working in the difficult and inaccessible areas, appointment of specialists in the District Hospitals for specialized care. The state is aware of the fact that IMR and MMR is still high as per the table below:

6

Indicator

Meghalaya India

Goals Achievement (year & Source)

Current Status 11-12 12-15

MMR < 300 < 100 343 (HMIS : 09-10)

254

IMR < 38 < 30 59 (SRS 2009) 26 (HMIS 09-10)

50 (SRS 2009)

TFR 3.0 2.5 3.8 (NFHS-3) 2.7 (NFHS-3)

Therefore, action has been taken at all level to ensure that mother would be delivered in the Institutions and SBA will attend the home deliveries. There are tribal practices which sometime make the system very difficult to bring them to the Institution for delivery, but through IEC/BCC the number this year has drastically increased. TFR is very still very challenging in the state and it is note worthy to know that Non scalpel vasectomy (NSV) has started in 2 districts of the state.

The state has been able to fully utilized the Human resources supported by NRHM in the programme management and also the technical supporting staff. It is indeed a great help to the programme for speedy implementation. Many of these staff has been trained in their respective fields. Reporting through HMIS becomes more accurate and efforts have been made for facility data reporting which will enhance faster and also ensuring quality of data. In term of accounts all accountants has been trained with Tally ERP-9 to ensure monthly reporting from all the facilities. Regular staff from the department is also roped in to ensure the programme implementation become faster and more productive.

To enable the state to achieve the above goals strong monitoring mechanism will be put into place. Maternal Death Review (MDR) will be fully implemented this year. State TOT has been trained in the National Capital and district TOT training will be completed by February 2011. NBSU has also been planned and SBA trained will ensure safe delivery at home. TFR becomes a very challenging indicator as it also involves the religious sentiment of the population. Even though, NSV training will also scaled up this year to enable the couple to choose different methods of family planning.

During the year 2010-11 the state has taken up the exercise to formulate the State Health Policy and the State Health Act. The draft has already submitted to the core committee for suggestions and changes for the final document to be proposed to the government for adoption of the policy. Once the poily document is in placed the health sector will be further streamlined and becomes more effective.

The state has been able to inaugurate new building for the 1 District Hospitals and 1 MCH Hospital at Tura. Baghmara CHC which is in the district headquarter will be inaugurated to District Hospital this year. 1 PHC in Jaintia Hills has been inaugurated and one State Dispensary was also upgraded to PHC. The New Building of the Directorate of Health Services was also completed and it was inaugurated in August 2010. All these construction are under the state budget. The State has also signed and MoU with Roko Cancer Trust for detection of cancer cases in the whole of Meghalaya.

7 The State Health Mission at the State level under the Chief Minister and the State Health Society under the Chief Secretary provide the Governing Council and Executive Committee function for NRHM.

Physical and financial progress is continuously monitored through Monthly and Quarterly Reporting systems. The teams regularly visit the districts and appraise the progress in programme implementation to the State Health Society. Quarterly meeting based on financial and physical progress are regularly held under the chairmanship of the Health Secretary. These have facilitated the up-scaling of good practices. This year the Statutory Audit has also completed and Audit Report has been submitted to the Ministry in December 2010. All districts have appointed the Concurrent Auditor through the District Health Society. Therefore, financial reporting this year would be streamlined.

The state Health Mission also committed to contribute the 15 % share to NRHM. Meanwhile, the state budget for health sector will further increased during this financial year

8 CHAPTER-4:

Outcome Analysis (Graphical) % of Pregnant Women Receiving 3 ANC Check-up

TREND OF DELIVERIES

0%

10%

20%

30%

40%

50%

60%

DLHS-3 (2007-08)

NFHS-3 (2005-06)

HMIS-2008-09 HMIS-2009-10 HMIS-2010-11 (Arpil-Nov)

46%53%

38% 41% 41%

% Of Pregnant Women Receiving 3 ANC Check-up

0%

20%

40%

60%

80%

100%

120%

DLHS-3 (2007-08) NFHS-3 (2005-06) HMIS-2008-09 HMIS-2009-10 HMIS-2010-11 (Arp-Nov)

24% 29% 36% 43% 44%

76% 71% 64% 57% 56%

Trend Institutional Deliveries Trend Home Deliveries

9 % of Newborns Breastfed Within 1 Hour of Birth

% of Women Receiving Post – Partum Check-up Within 48 Hours After Delivery

0%

10%

20%

30%

40%

50%

60%

70%

80%

DLHS-3 (2007-08)

NFHS-3 (2005-06)

HMIS-2008-09 HMIS-2009-10 HMIS-2010-11 (Arp-Nov)

61%

17% 16%

69%74%

% of Newborns Breastfed Within 1 Hour Of Birth

0%

10%

20%

30%

40%

50%

60%

HMIS-2008-09 HMIS-2009-10 HMIS-2010-11 (Arp-Nov)

18%

51% 47%

10 % of Mothers Who Consumed 100 IFA Tablets

% of Children 0 -11 Months of Age Fully Immunized

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

DLHS-3 (2007-08) NFHS-3 (2005-06)

HMIS-2008-09 HMIS-2009-10 HMIS-2010-11 (Arp-Nov)

61%

17%

59%

45%

81%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

DLHS-3 (2007-08)

NFHS-3 (2005-06)

HMIS-2008-09 HMIS-2009-10 HMIS-2010-11 (Arp-Nov)

34% 33%

83% 80% 84%

11 Trend of OPD & IPD in Meghalaya (Public Institutions)

0

500000

1000000

1500000

2000000

2500000

3000000

HMIS 2008-09 HMIS 2009-10 HMIS 2010-11 (Apr-Nov)

1483454

2514500

2054348

Trend of OPD in Meghalaya

0

20000

40000

60000

80000

100000

120000

140000

160000

HMIS 2008-09 HMIS 2009-10 HMIS 2010-11 (Apr-Nov)

22924

144786

112937

Trend of IPD in Meghalaya

12 Trend of JSY beneficiaries in Meghalaya

0

2000

4000

6000

8000

10000

12000

14000

16000

2008-09 2009-10 2010-11 (Aprl-Nov)

5329

14738

10711

13