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DELHI STATE REPORT
Delhi
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Delhi
Index
S. No. Content Page No.
1 Summary of approvals 2 – 5
2 Demographic Profile 6 – 7
3 Progress of NRHM 8 – 11
4 Reproductive & Child Health 12 – 15
5 Immunization 16 – 16
6 Revised National Tuberculosis Control Programme (RNTCP) 17 – 19
7 National Vector Borne Disease Control Programme (NVBDCP) 20 – 21
8 National Leprosy Eradication Programme (NLEP) 22 – 22
9 Integrated Disease Surveillance Project (IDSP) 23 – 24
10 National Programme for Control of Blindness (NPCB) 25 – 25
11 National Iodine Deficiency Disorder Control Programme (NIDDCP) 26 – 26
12 RoP approvals under Mission Flexible Pool 27 – 29
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DELHI
Summary of approvals
Financial Management under NRHM (Rs. in crore)
Years Allocation Release Expenditure % Release
against Allocation
% Expenditure against Release
2005-06 31.36 32.83 26.20 104.69 79.81 2006-07 57.25 54.40 38.10 95.03 70.03 2007-08 79.20 81.36 53.07 102.72 65.23 2008-09 85.21 118.47 84.98 139.04 71.73 2009-10 99.53 0.00
Total 352.55 287.07 202.36 81.43 70.49
S. No. Timeline Activities Achievement %
1 ASHA Selection 2266 240 Training 0
2 VHSC 0 0 3 24X7 PHCs 1 13 4 Mobile Medical Unit 9 100 5 Rogi Kalyan Samiti 0 0
Budget Allocations (2005-09) ( Amount in Crores) Delhi
Allocation Releases Expenditure RCH Flexipool
2005-06 15.98 7.27 1.94 2006-07 22.34 13.38 4.97 2007-08 14.38 6.19 14.02 2008-09 27.29 20.13 16.73 2009-10 27.92
Total (A) 107.91 46.97 37.66 NRHM Flexipool
2005-06 1.37 0.00 2006-07 18.70 4.54 0.32 2007-08 32.71 23.23 0.28 2008-09 23.77 27.02 11.29 2009-10 24.64
Total (B) 99.82 56.16 11.89 National Disease Control Programme
2005-06 5.81 7.95 9.73 2006-07 6.55 12.22 9.56 2007-08 11.38 9.82 4.03 2008-09 9.70 9.29 3.97 2009-10 9.69 0.00 0.00
Total (C) 43.15 39.28 27.30 Grand Total (A + B + C) ������ ������ ����
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Record of Proceedings (2005-2009) for Mission Flexible Pool
Approval for Infrastructure (Rs. in Crore)
S. No Health Facilities 2005-06 2006-07 2007-08 2008-09 2009-10 1 Sub C 0.04 0.00 0.00 0.00
2 PHC 0.00 0.00 0.00
3 CHC 0.00 0.00 0.00 0.00
4 DH 0.00 0.00 0.00
5 Equipment 0.00 0.00 3.10
6 Transport 0.00 1.25
7 Others 0.33 8.93 9.99 45.49
Total 0.04 0.33 8.93 9.99 49.85
Approval for Human Resources(Rs. in Crore) S. No Personnel 2005-06 2006-07 2007-08 2008-09 2009-10
1 Doctors 0.63 0.00 5.46
2 Specialists 0.00 0.00 0.00
3 Staff Nurses 0.00 0.00 0.00
4 ANM 0.00 0.00 9.07
5 Others 0.00 0.00 10.56
Total 0.00 0.00 0.63 0.00 25.09
Approval of other activities (2005-2009) in Rs. Lakh
S.No Initiative 2005-06 2006-07 2007-08 2008-09 2009-10
Remarks Released Approved Approved Approved Approved
ASHAs 1 ASHA 1471.53 1904.03
TOTAL 1471.53 1904 Untied Funds, Annual Maintainence Grants and RKS fundsrelated matters
2 Rogi Kalyan Samiti
36 38 360
3 Untied Fund 26.35 30.25 4 Untied Fund-CHC 10.00
5 Untied Fund for PHC 2
6 Untied Fund for PUHC 12.5
7 Untied Fund-SC 4 2
8 Untied Fund for VHSC
16.5 16.5
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9 Annual Maintenance Grant 50.25
64.75
10
Annual Maintenance Grant -mat Homes/CHC
5.00
11
Annual Maintenance Grant -PUHC
25.00
12
Annual Maintenance Grant -PHC
4
13 Seed PUHCs 384.16 694
14
Annual Maintenance Grant-SC
5
TOTAL 4 22.5 95.5 498.76 1165.5 Infrastructure related matters 15 MMU 12.6 171 TOTAL 12.6 171
Status of Infrastructure 2005-2010
As per RHS 2008 New Construction Upgradation / Renovation Number of Sub Centre 41 Number of PHC 8 Number of CHC 0 Number of DH 9
As per State Data Sheet, NRHM
Status of NRHM as on 15.05.2009
1 ASHA Selection 2266 Training 0
2 VHSC 0 3 Joint A/C
0 4 24X7 Facility 35
5 FRU 20
6 Contractual Manpower
Doctors & Specialist 295 AYUSH Doctors 0
Staff Nurse 73 Paramedics 155
ANM 630 7 JSY Beneficiaries (in Lakhs) 0.31
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National Disease Control Programme NLEP
Although state has reached elimination of the disease, still large number of new cases is being detected every year indicating active transmission in the community. An in-depth situational analysis with steps to complete treatment etc be started.
IDSP Delhi is a Phase-II state under IDSP. Data reporting for outbreaks have to be initiated from all the reporting units of the state.
NBCP
UCs for GIA released to State Blindness Control Society are not being received timely. SOE for Cash Grant are also not being received timely. Performance of School Eye Screening Programme needs to be improved.
NVBDCP
The Imported Kala Azar cases are reported from Delhi. In 2008, total of 1312 dengue cases and 2 deaths were reported. In the year 2008, 14 suspected Chikungunya fever cases were reported. In 2008, total of 1312 dengue cases and 2 deaths have been reported.
RNTCP
Delhi is one of the well performing States.
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Demographic, Socio-economic and Health profile
HEALTH INDICATORS OF DELHI The Total Fertility Rate of the State is 2. The Infant Mortality Rate is 36 and Maternal Mortality Ratio is NA (SRS 2004 - 06). The Sex Ratio in the State is 821 (as compared to 933 for the country). Comparative figures of major health and demographic indicators are as follows: Table I: Demographic, Socio-economic and Health profile of Delhi State as compared to India figures S. No. Item Delhi India
1 Total population (Census 2001) (in million) 13.85 1028.61 2 Decadal Growth (Census 2001) (%) 47.02 21.54 3 Crude Birth Rate (SRS 2007) 18.1 23.1 4 Crude Death Rate (SRS 2007) 4.8 7.4 5 Total Fertility Rate (SRS 2007) 2 2.7 6 Infant Mortality Rate (SRS 2007) 36 55 7 Maternal Mortality Ratio (SRS 2004 - 2006) NA 254 8 Sex Ratio (Census 2001) 821 933 9 Population below Poverty line (%) 8.23 26.10 10 Schedule Caste population (in million) 2.34 166.64 11 Schedule Tribe population (in million) 0 84.33 12 Female Literacy Rate (Census 2001) (%) 74.7 53.7
Table II: Health Infrastructure of Delhi Particulars Required In position shortfall Sub-centre 188 41 147 Primary Health Centre 31 8 23 Community Health Centre 7 0 7 Multipurpose worker (Female)/ANM at Sub Centres & PHCs
49 82 -
Health Worker (Male) MPW(M) at Sub Centres 41 0 41 Health Assistant (Female)/LHV at PHCs 8 28 - Health Assistant (Male) at PHCs 8 4 4 Doctor at PHCs 8 18 - Obstetricians & Gynaecologists at CHCs 0 0 0 Physicians at CHCs 0 0 0 Paediatricians at CHCs 0 0 0 Total specialists at CHCs 0 0 0 Radiographers 0 0 0 Pharmacist 8 3 5 Laboratory Technicians 8 6 2 Nurse/Midwife 8 0 8 (Source: RHS Bulletin, March 2008, M/O Health & F.W., GOI)
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The other Health Institution in the State are detailed as under:
Health Institution Number Medical College 5 District Hospitals 9 Referral Hospitals City Family Welfare Centre Rural Dispensaries Ayurvedic Hospitals 10 Ayurvedic Dispensaries 148 Unani Hospitals 2 Unani Dispensaries 25 Homeopathic Hospitals 2 Homeopathic Dispensary 98
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Note on Progress of NRHM in Delhi (June 2009)
Delhi has implemented the activities of National Rural Health Mission efficiently and effectively for
attaining the goals and objectives of National Population Policy and Millennium Development Goals. NRHM has transformed public health service delivery in the State. The decentralization, responsiveness to local needs, paradigm shift in health system management and availability of untied funds has improved the facilities and their credibility among members of the public. The performance of JSY, community mobilization by ASHAs, proper referral transport, number of deliveries, OPDs need to be improved under the Mission. Brief information on progress vis-a-vi issues have been highlighted which are as follows: Institutional Framework of NRHM
Meeting of State & District Health Mission have been held regularly. Meeting of State Health Mission held 2 times and of District Health Mission held 29 times. Merger of societies is completed in 9 districts. The UT need to focus on constitution and operationalisation VHSCs in the State, should augment the process. No Rogi Kalyan Samitis in the UT is operational. All districts have started developing their own IDHAP.
Infrastructure Improvements
In total 8 PHC have been strengthened with three Staff Nurses each to make them functional for 24x7 health services. None of the CHC are functioning on 24X7 basis but at the same time facility survey is completed in 2 health facilities (including others health institution below district level). 16 SDH and 9 District Hospitals are functioning as FRUs. All districts have functional Mobile Medical Unit (MMU)
Human Resources
A total of 2266 ASHAs have been selected. 2266 ASHAs have been provided with drug kits. The State has not appointed Contractual AYUSH Doctors in the health facilities. 37 Sub-centres are functional with an ANM. As far as Manpower augmentation is concerned, 266 Doctors, 630 ANMs, 29 Specialist, 73 SN recruited on contractual basis Services Institutional deliveries declined from 2.30 lakhs (06-07) to 1.48 lakhs (07-08) and further 2.65 lakhs Institutional deliveries in the state during the year 2008-09. The number of JSY beneficiaries increased from 0.00 lakhs (06-07) to 0.07 lakhs (07-08). The numbers of JSY beneficiaries was 0.24 lakh during the year 08-09. Female sterilizations have declined from 0.27 lakh (06-07) to 0.24 lakh (07-08) and male sterlisation has increased from 1320 (06-07) to 5447 (07-08). During year 2008-09, 23601 female & 5244 male sterilization have been done. None of the district is implementing IMNCI. 3859 VHND held since the launch of NRHM.
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General Overall improvement in health system since NRHM Achievements Made
• The Health Mission meetings are being held regularly. • PMUs have been formed at State/UT level and all 9 districts. All 9 districts of the UT have
functioning and furnished mobile medical units. • ASHAs have been selected and equipped with drug kits.
Areas for Further Improvement
• ASHAs selected have not been trained, need to be augmented. • Sustained effort in implementing all the activities like Health Melas. • The VHN Days have declined compare to previous year, state need to improve on that. • There is no block level PMUs in the UT, state need to strengthen the institutional functioning. • Immunisation performance needs to be improved. • Need to initiate the process of forming RKS in the UT.
Infrastructure
• PHCs must be strengthened to function on a 24x7 basis in the Union Territory under NRHM. • Need to optimise utilisation of existing infrastructure through HR rationalisation and better
supervision to ensure accountability. • The UT has upgraded 16 SDHs as FRU during the mission period. All 9 District Hospital
(DH) is functional as FRU under NRHM. All health facilities must achieve IPHS norms. Human Resources
• The State has made progress in filling the HR gap including ANMs, Staff Nurses, Specialist on contract
• Mainstreaming of AYUSH; co-location of AYUSH at all level must be considered.
Service Delivery
• The UT need to improve the institutional deliveries although numbers of JSY beneficiaries have been increased.
• Female sterlisations have declined and male sterlisations in the UT has improved.
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An Analysis of Financial Monitoring Report for the year 2008-09
A. RCH Flexible Pool
Component-wise expenditure & utilisation under RCH against approved PIP for the year 2008-09
Rs. in crores
Activities SPIP Expenditure % Utilization against PIP
Maternal Health 1.43 1.77 123.86 % Child Health 1.20 0.12 10.28 % Family Planning Services 2.90 2.21 76.11 % ARSH 0.01 0 0 % Urban RCH 0.48 0.17 35.40 % Innovations/PPP/NGO 1.63 0.09 5.60 % Infrastructure & Human Resources 18.93 11.08 58.83 % Institutional Strengthening 0.45 0.11 25.32 % Training 1.03 0.24 22.93 % BCC / IEC 1.43 0.16 11.36 % Procurement 1.07 0.60 56.09 % Programme Management 1.22 0.18 14.70 % Total 31.77 16.73 52.66 %
Based on table above and record available in FMG, observations are as under:- General Observations
1. Rs.16.73 crores, i.e. 53% of the approved PIP of Rs.31.77 crores has been utilized under RCH-II as compared to national level expenditure of 71%.
2. There is 18% increase in expenditure as compared to 2007-08. 3. Since the launch of RCH-II, Rs. 37.68 crores, i.e. 80% has been utilized by the state against
the release of Rs. 46.97 crores during the period 2005-06 to 2008-09. 4. Remarkable expenditure of 124% has been noticed under MH. 5. 76% expenditure during 08-09 under Family Planning Services is also appreciable.
Areas of Concern
1. An amount of Rs. 1.20 crores was approved under CH but the utilisation is only 0.12 crores i.e.10%.
2. An amount of Rs. 0.16 crores has been spent on BCC/IEC whereas the approved amount is 1.43 crores only i.e. 11%.
3. The amount spent on Training is only 23% of the approved PIP. 4. Under Innovations/PPP/NGO the approved PIP amount is Rs. 1.63 crores against which only
Rs.0.09 crores has been utilised i.e. 6%. 5. Expenditure booked under Procurement and Programme Management is well below the
approved PIP i.e. 56% and 15% respectively.
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B. Mission Flexible Pool:-
Component-wise expenditure under NRHM against approved PIP Rs. in crores
Activities SPIP Expenditure %Utilisation against PIP
ASHA 14.72 2.62 17.79 % Untied Funds 0.26 0.01 3.84 % Hospital Strengthening 6.65 2.55 38.34 % Annual Maintenance Grants 0.00 0.01 New Constructions/ Renovation and Setting up 0.50 1.24 248 % Corpus Grants to HMS/RKS 0.38 0.00 0 % Action Plans (District, Block, Village) 0.00 0.10 Mainstreaming of AYUSH 0.20 0.01 5 % IEC-BCC NRHM 2.65 0.17 6.41 % Training 3.10 0.45 14.51 % Planning, Implementation & Monitoring 2.47 0.90 36.43 % Procurement 2.72 0.00 0 % Regional Drugs PNDT Activities 0.00 0.01 New Initiatives/ Strategic Interventions ( As per State Health Policy) 4.20 0.38 9.04 %
State Health Services Resource Centre (SHSRC) 0.50 0.00 0 % Support Services 0.00 0.89 NRHM Management Costs/ Contingencies 8.54 1.96 22.95 % Other Expenditures 11.59 0.00 0 % Total 58.48 11.29 19.30 %
Based on table above and record available in FMG, observations are as under:-
General Observations 1. As compared to 2007-08, 3428% increase has been noticed in expenditure during 2008-09. 2. Since the start of the programme, Rs.56.16 Crores were released to the State, the utilization is
only Rs.11.92 Crores (21. 3. Mission Flexible Pool part of the FMR is not in the prescribed format.
Areas of Concern
1. Under the Training component negligible expenditure of Rs. 0.45 crores as against the approved PIP of Rs. 3.10 crores i.e. 14 %.
2. Against Rs. 2.72 crores approved under Procurements and Rs. 11.59 crores under Other Expenditures during 08-09 no expenditure is reported by the state.
3. Under many heads the amount utilised is ranging between 3% to 22% of the approved PIP i.e. ASHA, Untied Funds, IEC/BCC, New Initiatives etc.
4. Expenditure booked under New Constructions/Renovation, seems to be booked for last year or carried over expense. Therefore we request you to kindly give us a detailed breakup of the same.
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BRIEFING NOTE ON RCH II: DELHI
A. Background/ current status 1. RCH II Goals MMR data for the UT is not available. The IMR (SRS 2007) at 36 has increased from 28 (SRS 2003). With a TFR of 2.0 (SRS 2007), Delhi has already surpassed the national target for the year 2012 (refer Annex 1). 2. RCH II Outcomes Delhi’s progress during the four year period between DLHS 2 (2002-04) to DLHS 3 (2007-08) is mostly significant (refer Annex 1):
• Increase in institutional deliveries from 50% to 68.6%. • Mothers having full ANC decreased from 36.5% to 33.6%. • Full immunisation in children 12-23 months increased from 59.2% to 67.6%. • Children with diarrhoea receiving ORS has increased from 37.6% to 48.1%. • Unmet need for family planning decreased from 16.4% to 13.9%. However, use of modern
contraceptives has remained static from 55.8% to 55.5%. 3. Expenditure Audited expenditure has increased from Rs. 1.94 crores in 05-06 to Rs. 4.87 crores in 06-07 and Rs. 14.14 crores in 07-08; reported expenditure in 08-09 was Rs. 16.73 crores i.e. 52.6% of allocation (Rs. 31.77 crores). B. Key achievements 1. Maternal Health, including JSY
• Number of JSY beneficiaries in the UT increased from 242 in 2006-07 to 7,238 in 2007-08. A total of 23,829 beneficiaries have availed of the services in 2008-09. UT has accredited 18 private institutions under the scheme.
• UT has operationalised 25 FRUs (against the target of 15) and one PHC as 24x7 (against the target of 4).
• Mamta Friendly Hospital Scheme: A PPP initiative for obstetric care services, covering all BPL, SC/ST women in Delhi.
• Delhi has strengthened referral transport system through CATS ambulances and this is free for all APL/BPL beneficiaries.
• RTI/STI services are provided at all Delhi Govt dispensaries and hospitals. • UT has proposed to initiate maternal death audit in the current year. • 3859 VHNDs have been held so far in the UT.
2. Child Health
• 7 Infant and Young Child Feeding (IYCF) counselling centres are functioning in Delhi. • UT has developed one govt. hospital nursery per district for facility based newborn care. • Delhi has two nutritional rehabilitation centres (NRCs) in place. Further, UT plans to
establish Malnutrition Treatment Centres (MTCs) in 10 hospitals. C. Key issues 1. Maternal Health, including JSY
• Delhi is yet to initiate multi skill training for MOs in LSAS and EmOC. • Full ANC has declined between DLHS 2 and DLHS 3. UT needs to identify reasons
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• For SBA training, UT has given a load of 16 ANMs/ SNs/ LHVs to be trained in 2009-10. UT needs to ensure that training centres follow protocols of SBA training i.e. practice of partograph, active management of third stage of labour, essential newborn care, etc.
2. Child Health
• IMR has increased between SRS 2003 to SRS 2007. This needs to be investigated. • Neonatal mortality rate (NMR – infant deaths within 4 weeks of life per 1000 live births) at
20 (SRS 2007) accounts for 56% of the IMR, while early NMR (infant deaths within one week of life per 1000 live births) at 16 (SRS 2007) accounts for 80% of the NMR.
• IMNCI implementation is yet to begin.
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ANNEX 1 A. Progress on Key Indicators
1. RCH II Goals
INDICATOR DELHI INDIA Trend (year & source) Current status RCHII/NRHM
(2012) goal Maternal Mortality Ratio (MMR)
NA NA 254 (SRS 04-06) <100
Infant Mortality Rate (IMR)
28 (SRS 2003) 36 (SRS 2007) 55 (SRS 2007) <30
Total Fertility Rate (TFR) 2.1 (SRS 2004) 2.0 (SRS 2007) 2.7 (SRS 2007) 2.1
2. RCH II Outcomes
S. No. RCH OUTCOME INDICATOR
DELHI INDIA* DLHS–2 (2002–04)
DLHS–3 (2007–08)
DLHS–2 (2002–04)
DLHS–3 (2007–08)
1. Mothers who received 3 or more antenatal care checkups (%) 67.2 74.0 50.4 51.0
2. Mothers who had full antenatal check-up (%) 36.5 33.6 16.5 19.1 3. Institutional deliveries (%) 50.0 68.6 40.9 47.0
4. Children 12-23 months age fully immunised (%) 59.2 67.6 45.9 54.1
5. Children age 6-35 months exclusively breastfed for at least 6 months (%) 32.3 8.9 22.7 24.9
6. Children with diarrhoea in the last 2 weeks who received ORS (%) 37.6 48.1 30.3 33.7
7. Use of any modern contraceptive method (%) 55.8 55.5 45.2 47.3
8. Total unmet need for family planning - both spacing methods and terminal methods (%) 16.4 13.9 21.4 21.5
* - Provisional results for DLHS-3 B. Trends in Financial Expenditure
(Rs. crores) FY 2005-06 FY 2006-07 FY 2007-08 FY 2008-09 Release 7.27 13.38 6.19 20.13 Audited Expenditure 1.94 4.87 14.14 16.73* * - Audited expenditure for 2008-09 is not yet available; reported expenditure is provided. - Allocation for 2008-09: Rs. 31.77 crores.
C. Progress on Key Strategies
1. Demand side interventions
S. No.
Indicators
Achievement (no. of beneficiaries) 2005–06 2006–07 2007–08 2008–09
1 Janani Suraksha Yojana 0 242 7,238 23,829 2 Total Sterilisation 34,168 28,746 26,108 na
3 IUD Insertions 5,57,810 53,003 45,304 na
(Source: M&E Division reports, and JSY reports from the states)
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2. Technical interventions
S. No. Indicators Achievement upto March 2009
Number % 1. No. of First Referral Units (FRUs) operationalised 25 166.7 (against the
target of 15 FRUs) 2. No. of PHCs operationalised to provide 24-hour
services 1 25 (against the target of 4 PHCs)
3. No. of private institutions accredited under JSY 18 NA 4. No. of districts implementing Integrated Management
of Neonatal & Childhood Illness (IMNCI) 0 NA
5. No. of people trained in IMNCI 0 NA 6. No. of Village Health & Nutrition Days (VHNDs) held 3,859 NA
(Source: NRHM MIS report, April 2009)
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Immunization
Delhi
Evaluated Immunization Coverage
Survey Indicator
NFHS 1 (1992-93)
NFHS 2 (1998-99)
NFHS 3 (2005-06)
CES (2005)
CES (2006)
DLHS 2 (2002-04)
DLHS3 (2007-08)
FI 57.8 69.8 59.2 79.8 63.2 84.6 70.8 BCG 90.1 92.0 92.9 89.8 87.0 96.3 92.0 Measles 69.6 77.5 73.7 84.3 78.2 89.2 85.6 DPT3 71.6 79.9 70.2 85.3 71.7 88.3 77.8
Progress
� As per the evaluated survey the full immunization is 70.8 % in 2007-08 (DLHS 3)
� The situational analysis of the routine immunization in the state identifies to and fro migration,
multiplicity of health agencies and rapid urbanization as one of the critical bottle-necks for full
coverage at the state. Accordingly interventions are being planned.
� District level AEFI committees have been constituted.
� The immunization training of health workers has been done for 899 out of 1150 HW.
Issues
� The State continues to have high dropout from BCG to DPT 3 at 15% as per DLHS 3, which
is critical for further improvement in full immunization coverage.
� In the year 2008 no cases of AEFI reported though the immunization rates are increasing. The
State needs to strengthen AEFI reporting further to improve reporting of AEFI cases.
� The state needs to complete the Immunization training of Health Workers at the earliest and
plan for trainings of other field staff related to immunization.
� The fund utilization under Immunization is low for the year 2008-09.
� There is need to improve coverage of Hepatitis B in the state.
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Brief on National TB Control Programme in Delhi
1. Infrastructure
Total Population - 176 Lakh No. of Districts - 24 No. of Tuberculosis Units (TUs) - 30 No. of Designated Microscopy Centres (DMCs) - 192 2. Status of Implementation
• In 1993, RNTCP was started in Gulabi Bagh chest clinic as a pilot project. Later on, this pilot project was expanded to three more chest clinics i.e. LRS Institute, Moti Nagar and Nehru Nagar.
• Whole Delhi was covered under RNTCP in 1997 and presently 24 Chest Clinics/RNTCP districts are implementing the programme.
3. State level performance (Based on quarterly reports for 1st quarter 2009)
• Delhi is one of the well performing State. Overall the performance of Delhi with TCD rate of 295/lakh, NSPCD rate of 87/lakh (91%), sputum conversion rate of 91% and cure rate of 86% in NSP patients is good.
0%
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1-09
Annualised New S+ve CDR Success rate
•Population projected from 2001 census
•Estimated no. of NSP cases - 95/100,000 population per year (based on recent ARTI report)
Annualized New Smear-Positive Case Detection Rate and Treatment Success Rate in DOTS Areas, Delhi, 2000-2009*
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4. District wise Performance: (Based on quarterly reports for 1st quarter 2009)
• Referral of TB suspects is good (>150/lakh pop/quarter) in all the districts except BSA Chest Clinic which is examining only 140 TB suspects/lakh pop/quarter.
• TCD rate is good (>180/lakh) in all the district but NSPCD rate in 4 districts (CD Chest Clinic, Gulabi Bagh, LRS Institute and NDMC Chest Clinic) is low.
• Cure rate is slightly on the lower side (<85%) in 7 districts and very low in Hedgewar Chest Clinic (<80%).
Districts
Suspects examined per
lakh population
Annualised case detection rate (against
>135/lac)
Annualised new sputum positive
case detection rate (against >60/ lac)
Sputum conversion rate
new cases (against >90.0%)
Cure rate (new cases)
(against 85.0%)
BJRM Chest Clinic 238 277 93 98% 95% 87%
BSA Chest Clinic 140 246 73 76% 96% 90%
CD Chest Clinic 174 191 33 35% 100% 89%
DDU Chest Clinic 155 250 74 78% 91% 88%
GTB Chest Clinic 392 343 100 106% 89% 83% Gulabi Bagh 159 189 55 58% 92% 89%
Hedgewar C Clinic 222 261 75 79% 88% 79% Jhandewalan 229 291 73 77% 85% 81% Karawal Nagar 197 389 116 122% 86% 88%
Kingsway 233 362 98 103% 88% 85%
LN Chest Clinic 277 219 66 70% 85% 89%
LRS 194 187 54 57% 91% 88%
MNCH Chest Clinic 154 378 108 114% 93% 88%
Moti Nagar 298 316 85 89% 97% 82% Narela 270 294 79 83% 88% 90%
NDMC 478 213 61 64% 96% 91%
Nehru Nagar 261 363 116 122% 90% 83%
Patparganj 326 403 124 131% 92% 91%
RK Mission 247 334 115 121% 94% 87%
RTRM Chest Clinic 228 200 66 69% 93% 89%
SGM Chest Clinic 383 468 111 117% 92% 89%
Shahadra 390 478 148 156% 85% 82% SPM Marg 210 215 83 87% 92% 80% SPMH Chest Clinic 235 416 120 126% 93% 82%
Total 244 295 87 91% 91% 86%
5. Funds Status as on 31st March 2009 (Rs. in lakh)
C/F Released Expenditure Balance 113.35 648.00 663.44 97.91
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6. Drugs: Flow of RNTCP medicines from Central level to the State Drug Store is smooth and
all the required medicines have been timely released. 7. Issues:
• Human Resource - All Chest Clinics/RNTCP districts have trained dedicated DTOs.
However, there are only 26 MO-TCs for 30 TUs and only 187 LTs for 192 DMCs.
• Supervision and Monitoring - Internal Evaluation (IE) of all the 24 Chest Clinics done
doing in 2008. However, recommendations made by the IE Team are not followed/actioned religiously.
• Performance
o Delhi is one of the well forming State. However, NSP case detection rate is still less than 70% in 4 Chest Clinics areas (CD Chest Clinic, Gulabi Bagh Chest Clinic, LRS Institute and NDMC Chest Clinic).
o Similarly cure rate is very low (79%) in Hedgewar Chest Clinic and in other 7 Chest Clinics it is between 85% and 80%, the main reason being high default rate. These Chest Clinics need to strengthen default retrieval mechanism.
• TB-HIV Collaboration - TB-HIV intensified package would be implemented in whole
of Delhi from October 2009. Preparatory activities, as planned, need to be completed. • IRL -
o New Delhi TB Centre has been functioning as STDC for Delhi State since 2003 and as IRL since 2005.
o All Chest Clinics are implementing EQA and only 6 of 192 DMCs (3%) have reported high false results in 2008.
• DOTS Plus
o DOTS Plus activities scaled up for whole of Delhi State since January 2009 through 7 DOTS Plus Site but there are only two accredited Labs at LRS and NDTBC. Other two Sites (RBTB Hospital and AIIMS) also need to have accredited Lab.
o Till 15 May 09, 143 MDR-TB patients detected of which 70 are placed on Cat-V treatment and 11 are under pretreatment evaluation. Among others 24 patients could not be traced. Such situation should be avoided/minimized.
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Fact Sheet on NVBDCP - Delhi
Background Information The Union Territory of Delhi has 9 District with a population of 13.85 Million. There are 0 CHCs, 8 PHCs, 41 Sub-centers and 165 villages. There are 51 Multipurpose Worker (Female)/ANM, 19 Health Assistant (Female)/LHV and 5 Laboratory Technicians. In addition, the state has 251 Fever Treatment Depots (FTDs) and 126 Malaria Clinics. Malaria
Epidemiological Situation
Year Total slide examined
Total Malaria cases
Total Pf cases Deaths
2006 940300 928 36 0
2007 668761 182 2 0
2008 593882 253 0 0 2009 (Upto Mar.) 85506 2 0 0
Kala-azar: The Imported Kala Azar cases are reported from Delhi of which the year wise details are as under:
Year Cases Deaths
2006 31 4
2007 19 2
2008 34 0
2009 (Upto March) 1 0
Japanese Encephalitis JE/AES cases have not been reported from Delhi during 2007 and 2008. Dengue
In the year 2007, total of 548 dengue cases and 1 death was reported. In 2008, total of 1312 dengue cases and 2 deaths and in 2009 no dengue cases have been reported till date. Epidemiological data for last four years are as under:
Year Cases Deaths 2006 3366 65 2007 548 1 2008 1312 2 2009 (Prov. Upto 27th May)
0 0
For proactive surveillance 30 Sentinel Surveillance Hospitals with laboratory support have been identified and linked with National Institute of Communicable Diseases, Delhi and AIIMS, New
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Delhi which have been identified as Apex Referral Laboratories. NIV Pune has been entrusted the supply of IgM ELISA test kits to the identified institutes. Chikungunya: Total of 203 suspected Chikungunya fever cases and no death was reported during 2007. Out of the total 203 samples detected 22 were confirmed serologically for Chikungunya. In the year 2008, 14 suspected Chikungunya fever cases were reported. Out of the total 14 samples detected, 14 were conformed serologically for Chikungunya. In 2009 till 27th May, no Chikungunya fever case has been reported till. Central Assistance
(Rs. In lakhs)
Year Allocation Release/Expenditure Cash Kind Total Cash Kind Total
2004-05 0.00 55.62 55.62 0.00 144.07 144.07 2005-06 0.00 62.39 62.39 22.47 53.27 75.74 2006-07 34.08 88.77 122.85 170.50 79.25 249.75 2007-08 29.50 127.17 156.67 25.50 211.20 236.70 2008-09 92.50 49.46 141.96 0 0 0 2009-10(B.E.) 30.50 23.92 54.42
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STATUS OF NATIONAL LEPROSY ERADICATION PROGRAMME IN DELHI
• Epidemiological scenario- Delhi has achieved the goal of elimination of leprosy (i.e. prevalence rate of less than 1 case /10000 population) in 2008-09. There were 1369 leprosy cases on record as on March 2009.
• New case detection and treatment completion-
During 2008-09, a total of 1631 new leprosy cases were detected as compared to 1331 new cases detected during the corresponding period of previous year. Out of 1457 cases discharged during the year, 792 cases (54.36%) were released as cured after completing treatment.
• Reconstructive Surgery for leprosy affected persons- There are 2 Govt. institutions viz. RML Hospital and AIIMS and 1 NGO institution i.e The Leprosy Mission (TLM) Hospital in Shahdara were identified for providing reconstructive surgery services to leprosy affected persons with disability. However RCS services are being provided only by TLM hospital. In the year 2008-09, 135 reconstructive surgeries were performed.
• During 2008-09, NLEP action plan amounting to Rs.92.70 lakh has been approved for the
State. Issues -
1. During 2008-09, the state action plan was approved for Rs.95.25 lakhs. However the State has not submitted the statement of expenditure for 2008-09 even after repeated reminders.
2. Large numbers of new leprosy cases are being detected in the state every year which suggest active transmission of the disease in the community. The state is advised to carry out in-depth situational analysis in districts/blocks/urban areas reporting large number of new cases and take suitable actions like –
(i) Ensuring completion of treatment in each of the new cases detected. (ii) Enhance awareness of the community to improve self reporting of suspected
cases to health facility and (iii) Carrying out family contact survey against all multibacillary and child cases.
3. The State has listed around 600 grade II disability cases in the last 5 years. 3 centres were
identified for providing reconstructive surgery services to leprosy affected persons. However RCS is not been conducted in RML Hospital and AIIMS. The Medical Superintendent of both the hospitals have been requested to up the matter urgently so that the services of these institutions could be utilized for conducting RCS and the backlog of leprosy cases with disability could be reduced.
4. There are about 22 leprosy colonies in the state. The state should ensure provision of proper health care facilities like ulcer care, provision of supportive drugs and dressing materials to the persons affected with leprosy residing in these colonies.
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State - Delhi
Integrated Disease Surveillance Project (IDSP) –Fact sheet as on 17 June 2009
The state of Delhi has an area of 1,483 sq. km. and a population of 13.85 million. There are 9 districts, 14 blocks and 165 villages. The State has population density of 9,339 per sq. km. There are 41 Sub-Center, 8 PHC, 5 Medical colleges, 9 District hospitals, 10 Ayurvedic Hospitals, 148 Ayurvedic Dispensaries, 2 Unani Hospitals, 25 Unani Dispensaries and 2 Homeopathic Hospitals in the state (source:www.mohfw.nic.in/nrhm.htm)
Delhi is a Phase-II state under IDSP and has been inducted into the programme during 2006-07 Integrated Disease Surveillance Project (IDSP) is a decentralized and state based surveillance Programme, being implemented in all the 9 districts of Delhi
The component wise action points are as under: 1. Manpower Surveillance Officer and RRT team at state and district Headquarter designated and appointments of Contractual staff at State & District Surveillance Units is pending as follows
Sr. No Designation Sanctioned In position I. Epidemiologist 10 0
II. Entomologist 1 0 III. Microbiologist 2 0 IV. Consultant(Training) 1 0 V. Consultant(Finance) 1 0
VI. Data Manager 10 10 VII. Accountant 9 0
VIII. Data Entry Operator 15 0 IX. Administrative Assistant 10 0 X. Helper 1 0 2. IT & EDUSAT
Data Centre has been installed at 21 locations and 17 training centre have been installed out of which 8 are EDUSAT (CSU NICD, CSU NICHQ, Vardhman Mahavir Medical College, NIHFW, NBE, Maharshi Valmiki ID Hospital, MAMC, and SSU Delhi) connected. EDUSAT connectivity pending at Nirman Bhawan, AIIMS, UCMS and LHMC
3. Training
S.No. Category Number Trained
i Master training ( TOT) 52 ii Medical Officer 164 iii Health worker 184 iv Data Manager 10
* *Training in progress
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4. Laboratory Strengthening One district labs to be strengthened on priority at Malviya Nagar Hospital For that procurement of equipments is in progress.
5. Data Reporting
Data reporting has started from 4 districts .Data reporting on S,P,L forms an for outbreaks have to be initiated from all the reporting units of the other 5 districts in Delhi by using IDSP portal (www.idsp.nic.in) which is one stop portal & has data entry, data analysis and resource sections
6. Outbreak Year Number Type 2008 3 Dengue 2009 1 Chickenpox
7. Finance: Total GIA Released Up to 31st March 2009: 126.41 lakhs
Expenditure done: 0.00 Balance; 126.41
Audit report and utilisation certificate for the period of an2007-08 received but FMR up to March, 09 was not received
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NATIONAL PROGRAMME FOR CONTROL OF BLINDNESS
NOTE ON STATUS IN DELHI
Magnitude: Prevalence of blindness: 2003-04 1.13% Estimated blind persons 1.56 lakh
Infrastructure developed Regional Institute of Ophthalmology 1
Upgraded Medical Colleges 1 Upgraded District Hospitals 0 District Blindness Control Societies 7
Mobile Eye Care Units 2 Eye Banks 4
Cataract Performance
YEAR TARGET ACHIEVEMENT
2007-2008 90000 93808 2008-2009 100000 85270
School Eye Screening
YEAR TEACHER TRAINED IN SCREENING FOR REFRACTIVE ERRORS
SCHOOL GOING CHILDREN SCREENED
DETECTED WITH REFRACTIVE ERRORS
PROVIDED FREE
GLASSES
2007-08 532 0 0 0 2008-09 0 0 0 0
GIA released to Distt. Blindness Control Societies/State Blindness Control Society
(Rs in lakhs) YEAR RELEASED EXPENDITURE BALANCE
2007-2008 80.50 57.11 23.39 2008-2009 64.65 48.13 16.52
Issues
� UCs for GIA released to State Blindness Control Society are not being received timely. � SOE for Cash Grant are also not being received timely. � Performance of School Eye Screening Programme needs to be improved.
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NIDDCP
Approval issued for the year 2009-10 Activity Amount
Proposed Amount approved
Remarks
1 Establishment of IDD Cell
10.20 7.50
2 Establishment of IDD Monitoring Lab
7.90 4.50 There is no fund provision for neonatal screening, honorarium to attendant and transport expenses under NIDDCP The UT Administration may carry out activities as per the fund allocation of GOI
3 Health Education and Publicity
2.00 2.00
4 IDD surveys 2.00 1.00 5 Other activities 7.90 - Total 30.00 15.00
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Mapping of Record of Proceedings of the NPCC of NRHM for 2005-06 to 2009-10
This has been prepared to indicate allocations to the State in the previous years for different activities as per the State Programme Implementation Plan. The mapping charts the NRHM Mission Flexipool approvals contained in the RoP in following broad thematic chapters.
1. ASHA (including selection, training, drug kits, mentoring, specific performance incentives and anything else associated with ASHA)
2. Infrastructure related matters (including construction, strengthening, renovation, new construction etc), equipments, transport (ambulances, EMRI, associated expenses) and others)
3. Human Resource related matters (including HR salary, contractual payments, incentives, etc)
4. Programme Management related matters (including PMUs, SHS/DHS, SHSRC, IDHAP, M&E, Mobility support to SHS etc)
5. Untied funds, AMG & RKS related mattes 6. Training & Capacity Building related matters (including trainings, workshops, training
institutions including their upgradation or new construction, courses, etc) 7. Innovations (including Procurement of medicines, School Health, Health Mela,
Insurance, Accreditations, Monthly VHND etc)
NATIONAL RURAL HEALTH MISSION Delhi
Total MFP Approvals 3272.64 5847.68 9873.01 RoP Approvals for Various Years in Rs. Lakh
S.No Initiative 2005-06 2006-07 2007-08 2008-09 2009-10 Remarks Released Approved Approved Approved Approved
ASHAs 1 ASHA 1471.53 1904.03
TOTAL 1471.53 1904.03 Infrastructure related matters 2 Infrastructure 50.00 3 Upgrading to IPHS 7.1
4 Strengthening of Tertiary care facility 25
5
Strengthening of Training Infrastructure (State & District Trg Venues & Support Staff)
149.08
6 Strengthening of Maternity Homes. 404.2 614.61 1132.6
7
Strengthening of CDMOs Office (Manpower/Equipment/Space)
100.00 50 104.11
8
Primary health facilities (of MCD / DGD / NDMC.) MOs/ANMs.
802.05
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9 M&CW out Posts 157.5 10 FP centres 35 35 11 Lab Strengthening 240.36 298.7 12 District Level Stores 190.08 262.08 229.16 13 MMU 12.6 171 14 Telephones 13.82 11.4 TOTAL 12.6 1206.86 1265.87 2610.12 Human Resources related matters
15 Pathologist 27.00 16 Laboratory Technician 35.64 17 Pharmacists 30.6 127.6
18 Other Staff
880.29 TOTAL 0 62.64 30.60 1007.89 Programme Management related matters
19 SHSRC 20 50 50 50 20 SPMU 118.54
676.22
21 DPMUs 394.24
22
Strengthening of the State and District Programme Management Units
335.01
23 Preparation of District Action Plans 90
24 State and District Public Health Reports 6.5 6.5 6.5 6.5
25 Administrative and Contingency 68.30 26 Facility Surveys 90.00 27 Monitoring and Evaluation 10.00 10 35.66 28 Baseline Surveys 90.00 50 29 Adm Cost for RKS Cell 58.82 TOTAL 90 94.8 491.51 669.28 877.2 Untied Funds, Annual Maintainence Grants and RKS fundsrelated matters
30 Rogi Kalyan Samiti 36 38 360 31 Untied Fund 26.35 30.25 32 Untied Fund-CHC 10.00 33 Untied Fund for PHC 2 34 Untied Fund for PUHC 12.5 35 Untied Fund-SC 4 2 36 Untied Fund for VHSC 16.5 16.5 37 Annual Maintenance Grant 50.25 64.75
38 Annual Maintenance Grant -mat Homes/CHC 5.00
39 Annual Maintenance Grant -PUHC 25.00
40 Annual Maintenance Grant -PHC 4
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41 Seed PUHCs 384.16 694 42 Annual Maintenance Grant-SC 5 TOTAL 4 22.5 95.5 498.76 1165.5 Training & Capacity Building related matters
43
Strengthening of BCC Infrastructure (State & District with staff/equipment) 81.52 75.1 79.33
44 BCC 29.00 100 214.44 45 Capacity Building 42.73 309.51 400.94
TOTAL 153.25 484.61 694.71 Innovations related matters
46 Health Melas 56 47 Addressing Malnutrition 8.00
48 MAMTA Friendly Hospitals 300 125
49 Senior Citizen friendly health Services 10
50 Anemia free Delhi 24.57 51 Bio Waste Management 25 52 AYUSH Mainstreaming 12.28 20.00 1.7 53 Dental Mobile Clinics. 100
54 Dental Health Service 200 55 Equipment 132.00 56 Referral Linkages 50.00 50
57 Risk Pooling 20 10 10
58 Intersectoral Convergence 364.9 427.09
533.62
59 Innovation (excl RKS) 120.00
60 Innovation: Development of Community Models 20 20
61 Mapping 20.00 20 20 62 MIS 112.6 217.24 318.51
63 Referral Linkages Strengthening of Secondary care Structures 318.51
64 Public Private Partnership 431.10 152.7
73.15
65 Quality assurance-Rational Drug Use 20
66 Telemedicine 10 5 67 Research 5
68
Involving Volunteers for Primary/secondary facilities 4
TOTAL 64 1262.88 1427.03 1614.06 0
