Greetings From

Chhattisgarh

A new state Chhattisgarh is born on 1st November 2000 with 16 districts

SARGUJAKORIA

JASHPUR

BILASPUR

KORBA

RAIGARHKAWARDHA

JANJGIR

DURG RAIPUR

RA

JNA

ND

GA

ON

MAHASAMUND

DHAMTARI

KANKER

BASTAR

DANTEWADA

Courtesy : DANLEP C.G.

Area : 146361 Sq. Km. (6 times of Kerala State)

Population : 20795956(Census 2001) Rural-80% , Urban-20%

SC- 12%, ST-33%Sex ratio : 990 female per 1000 maleNo. of districts : 16 Blocks-146(Tribal –

85) IMR : 79 per 1000 live births

GENERAL INFORAMTION

Sex Ratio: 990/1000

Decadal GrowthRate: 18.06

LiteracyPersons: 65.18Male: 77.86Female: 52.4

SRS 2001(Released by RGI in October 2002)

Item Chhattisgarh MPBirth rate (total) 26.7 31.2Birth Rate (rural) 29.2 33.2Birth Rate (urban) 22.8 23.5Death Rate (total) 9.6 10.2Death Rate (rural) 11.2 11Death Rate (urban) 7.1 7.5IMR (Total) 79 88IMR (Rural) 95 94IMR (Urban) 49 54

Some Important Indicators of NFHS-2Fertility Indicators

Median age at mariage among women age 20-49 15.4Total Fertility Rate (for the past 3 years) 2.79Percent of women with 2 living children wanting another child 42.6Current contraceptive useAny method 45Any modern method 42.3Pill 0.8IUD 1Condom 2.1Female Sterilization 35.1Male Sterilization 3.3Any traditional method 2.3Unmet need of family planning Percent with unmet need of family planning 13.5Percent with unmet need for spacing 8Quality of family planning services Percent told about side effects of method 15Percent who recieved follow up services 82.3

Some Important Indicators of NFHS-2Maternal Health Indicators

Antenatal checkup from a health professional 57.5

Antenatal checkup in the first trimester 26.7

Two or more tetanus toxoid injections 58.2Iron and folic acid tablets or syrup 54.9Percent of births whose mothers were assisted at delivery by a: Doctor 22.3ANM/Nurse/midwife/LHV 9.7Traditional birth attendant 42.7Percent reporting at least one reproductive health problem 37.4

Some Important Indicators of NFHS-2Child Health Indicators

Percent of children who received vaccination: BCG 74.3DPT(3doses) 40.9Polio (3doses) 57.1Measles 40.0All vaccinations 21.8Percent of children with diarrhoea in the past 2 weeks who received oral rehydration salts (ORS) (children under 3 years) 29.7Percent of children with acute respiratory infections in the past 2 weeks taken to a health facility or provider (children under 3 years) 61.6

Infrastructure

Particulars NumberArea (Sq Kms) 135194Districts 16Medical Colleges 2Cities with more than 1 lakh Population 8Cities with 50000 to 100000 Population 4Blocks 146CHC 150Sub Centers 3818Villages 20379Panchayats 9129Habitations 54000

Infrastructure Gaps

Manpower Gaps

Other Gaps

•Only 2 Medical Colleges

•No District Hospital in 10 out

of 16 Districts (Sanctioned in all)

•No CHC in 54 out of 146 Blocks

•Deficiency of over 500 doctors in

Public Sector•Major

deficiency of paramedics•Very few

doctors, and paramedics in

Private Sector in rural areas

•Poor Monitoring

•Poor Managerial and

other related skills

•Difficult Geographical area, and poor

communication

The new Strategy

•Health Systems Improvement•Improve Routine Programme

Monitoring•Capacity Building at all levels -

Improve Training Infrastructure and Manpower

•Community Health Volunteers ("Mitanins') - New Scheme of

Community Participation•Improve Infrastructure•Better MIS based on IT•Involve PRIs and ULBs

•Mobile Hospitals

Important Areas of Reforms

Strengthening health intelligence, surveillance, epidemiology and planning

Rational Drug Use Policy Uniform Treatment Clinical Protocols Improving internal systems of the Department of Public

HealthWorkforce management and transfer policyManagement Information SystemMainstreaming of Indian Systems of Medicine esp. tribal

medicines into the state health system

The Real CNAA

Item Estimated in CNAA Last Years Performance

Surveyed

Target Couples 36,55,371 34,54,248

Protected 21,29,336 17,47,376

CPR 58.25 50.58

Need Assesment

CVT 4,849 2,629 5,852

NSVT 4,015 795 4,381

CTT 28,711 33,449 38,759

LTT 62,589 50,215 79,215

IUD 1,05,247 86,852 1,05,280

CC 3,64,107 3,50,104 2,78,646

OP 4,52,644 4,16,219 1,80,736

The New Plan of Action- Contraception

Uneven distribution of LTT surgeon (reallocation needed)

– 63 trained but only 23 working

– No LTT surgeon in 2 districts 18 NSVT trained surgeons but only 5 are working - Need

to train in large number Skill training in IUD needed for ANMs Training of ANMs needed in counselling skills Days of week fixed in each hospital for Contraceptive

Services

Requirement of Equipment for Family Planning

Laproscopes - 20 are irrepairableIUD Insertion instrument kit - 3841 (3818

rural, 41 urban)NSVT instruments kit (146-18=128)Contraceptives

– 23,49,568 OP Cycles– 2,11,77,096 CC pieces

Microplanning of immunization and ANC sessions

Plan to improve outreachIntersectoral coordinationBetter Logistics including cold chainOut of 146 blocks 66 do not have a vehicleCommunity MidwiferyImprovement in FRUs

The New Plan of Action- Mother and Child Health

Requirement of Cold Chain Equipment

Walk in Freezer - 1 Walk in Cooler in Bilaspur and Raipur need

Replacement Cold Chain Equipment beyond repair

– ILR, Deep Freezer 140 L - 78– ILR, Deep Freezer 300 L -88

Vaccine Vans - 6 Refrigerated Vaccine Van - 1 Vaccine Carriers -1000

The " Indira Swasthya Mitanin" Scheme

This is an innovative scheme in which the village people will select a Community

Health Volunteer called "Mitanin" to help them in developing a "Village Health Plan"

and for "Community Action in Health""Mitanin" in Chhattisgarhi means a Female

Friend

Basics of the “Mitanin” SchemeEmpowermentParticipationSharingCaringGender EquitySelf Sufficiency

Selection

Selection by the Community

Help by trained Facilitators

Approval by Gram Sabha

Training by Government

Who Can be a “Mitanin”

A woman from the same habitation

Preferably a married woman

Acceptable to the Community

Not necessarily educated

Role of Mitanin

Health EducationLeadership in

Community Action for Health

First Aid & OTC Drugs

Treatment of Minor Ailments

Timely referral

Chief Minister on the "Mitanin" Scheme

Relationship with ANM

Role of ANM Support to Mitanin Give refresher training

every fortnight Visit the Mitanin often Give the Mitanin

Legitimacy and Confidence

Help her in referral

Role of “Mitanin” Be a link between

ANM and community Help in National

Programmes Provide basic

information

Relationship with PRIs

Role of PRIs Facilitate approval of Selection

by Gram Sabha Provide all inputs' support incl.

irrigation of “Mitanin Land” Monitor activities of “Mitanin” Send “Mitanin” for training Ensure supplies of essential

medicines Seek help from “Mitanin” for

other social sector programmes

Role of “Mitanin” PRIs may seek information

about health status of people Help PRIs in developing a

Health Plan Bridge between Gram

Panchayat and the community Help PRIs in other Social

Sector Programmes

Training: Method

Participative, Gradual, Repetitive, Fun filled, Practical with field experience, at the pace of learning of “Mitanins”

Initiation training: Mainly on attitudes, behavior, communication, working in groups, community participation, concepts in Public Health

Refresher training: mainly for knowledge and skills of diagnosis and treatment of common ailments

Responsibilities will be increased gradually with “On the Job Training”

Achievement so far

A group of NGOs and GOs Constituted as a State Advisory Committee

Work already started in 16 blocksMore than 2000 Mitanins already selectedFacilitators manual and the first two

Mitanin Training manuals readyTraining of Mitanins to begin soon

Requirements under Existing RCH Programme

Training of at least 20 more surgeons in NSVT

Training of ANMs in counselling skills, and IUD insertion

Large Scale TBA trainingIUD insertion kits for ANMsEquipping of FRUs with blood storage and

emergency obstetric surgery facilities

The proposal for EAG funds

Improvement of Training InfrastructureMobile Hospitals - to improve OutreachTelemedicine - at PendraCommunity Midwifery CourseTraining of Doctors in Anesthesia and

money for their insurance coverage

Gaps in Training Infrastructure

Only 5 out of 16 Districts have DTCsNo SIHFWRHFWTC Bilaspur not well equipped5 AMNTCs, 3 MPW(M)TCs, 4 GNTCs - all

buildings need repairsAll Centers need Training equipmentCapacity building of training faculty needed

Requirement of funds for Training Infrastructure

S N Item Amount (in lakhs)

1 Repair and renovation of existing buildings

70

2 Construction of new buildings 364

3 Providing modern training aids 165

4 TOT (from money in the Danida Project)

0

Total 599

Mobile Hospitals

Initially 3 mobile hospitals proposedEach mobile hospital will be fully equipped and

cost approximately 30 lakhPublic - Pvt -NGO partnership

– Provided by Govt., managed by Pvt/NGO– Pvt/NGO to provide for recurring expen.– Govt. to give Medicines under National

Programmes, and for BPL

Run on Predefined routes in Hat-Bazars

Telemedicine

To begin with Link Medical College Raipur with Pendra

Video-conferencing link through VSATTotal Cost 40 lakhProvide good secondary level care at

remote locations

Community Midwifery Course

The "Paramedical Council Act" already passed

Affiliation and examination by Chhattisgarh Paramedical Council

Course design workshop - cost Rs 1 lakhEquipping all ANMTCs - Rs 30 lakhStipend to 50% reserved category students -

Rs 5.40 lakh

Aneshthesia Training of Doctors

Course design workshop - Rs 1 lakhEquipping Medical College Raipur for

Training - Rs 15 lakhCost of training of 40 doctors for 3 months

- 6.20 lakhCost of Insurance of Anesthesia trained

MBBS doctors - Rs 10 lakh

The Proposal for EAG funds

S.No. Scheme Cost

1 Improvement in Training Infrastructure

59900000

2 Mobile Hospitals 9000000

3 Telemedicine 4000000

4 Community Midwifery 3640000

5 Anesthesia Training 3220000

Total 79760000