NATIONAL RURAL HEALTH MISSION FOR HON’BLE HEALTH MINISTER 13 TH DECEMBER 2008 PRESENTATION

NATIONAL RURAL HEALTH MISSIONFOR

HON’BLE HEALTH MINISTER

13TH DECEMBER 2008

PRESENTATION

NATIONAL RURAL HEALTH MISSION (2005-2012)

• NRHM launched by Hon’ble Prime Minister on 12/4/2005. As of now to

conclude in 2012.

• Aimed to ensure affordable, quality health care to the poorest house holds

in remotest areas.

• Special focus on 18 low performing States which have weak public health

indicators and weak infrastructure.

• Punjab is among the nine high performing States- Punjab, Haryana,

Gujarat, Maharashtra, Karnataka, Kerala, Tamil Nadu, Andhra Pradesh,

West Bengal.

2

HISTORICAL PROSPECTIVE

• RCH-II (2005-2010) aimed at reducing IMR and MMR was already in progress.

• Programme for control of various diseases were already in progress for the last more than 15-20 years.

• Government felt the need to integrate all ongoing health programme into one programme and consolidate the work being done by other departments.

• NRHM encompasses – – RCH – II including immunization – All individual disease control programme– Flexi-pool as per requirement of the State– Convergence with other departments like AYUSH, Water Supply and

Sanitation, Nutrition, Woman and Child Development, Rural Development and Panchayats

• NRHM can be summarized as : Reducing IMR and MMR through institutional deliveries, involvement of Panchayati Raj institutions and convergence with other departments.

• Universalized access to quality health care especially to rural poor

with focus on women and children.

• Reduced Infant Mortality Rate and Maternal Mortality Rate.

• Ensuring population stabilization & gender equity.

• Prevention and control of communicable and non-communicable

diseases.

• Access to integrated comprehensive primary health care.

• Mainstream AYUSH- Integration of AYUSH with mainstream health

institutions .

• Promotion of Healthy life style.

• Emphasis on potable drinking water, hygiene, sanitation and

nutrition.

NRHM OBJECTIVES

4

Community Partnership

Village level planning

ASHA

Village Health & Nutrition Days

Village Health & Sanitation Committees

Increased involvement of PRIs

System strengthening

Infrastructure development

Monitoring through computerisation

Improved financial management & Human Resource

Public Private Partnership

Telemedicine

Mobile Medical Units

Intra & inter sectoral convergence

24-Hour- delivery services

Emergency Obstetric Services

Specialist Services – On call/contract

Immunization strengthening

IMNCI

Adolescent health

Family welfare services

KEY COMPONENTS OF NRHMImproved services

Accessibility, Approachability and Quality

NRHM STRATEGIES

• Decentralization of the process of health planning and management from Village to District level.

• Involvement of PRIs and Village Health & Sanitation Committees.

• Up-gradation of existing health institutions from Sub Centres to District Hospitals as per Indian Public Health Standards (IPHS).

• Flexible financing- untied funds for filling up the gaps in infrastructure and other related activities.

• Manpower requirement- recruitment of doctors, and paramedical staff in relation to Woman & Child Health.

• Improved management through capacity building- provision of computers, computer operators, establishment of State, District and Block Programme Management Units (PMUs).

• Integration of AYUSH with the mainstream health institutions including recruitment of Ayurvedic/Homeopathy doctors at PHC and CHC level.

• Intersectoral Convergence with Nutrition, water and sanitation programmes.

• Promotion of Public Private Partnership for achieving public health goals.

BLOCKLEVEL

HOSPITAL

30-40 Villages

Strengthen Ambulance/transport ServicesIncrease availability of NursesProvide TelephonesEncourage fixed day clinics

AmbulanceTelephone

Obstetric/Surgical MedicalEmergencies 24 X 7

Round the Clock Services;

BLOCK LEVEL HEALTH OFFICE –--------------- Accountant

CLUSTER OF GPs – PHC LEVEL

3 Staff Nurses; 1 LHV for 4-5 SHCs;Ambulance/hired vehicle; Fixed Day MCH/Immunization

Clinics; Telephone; MO i/c; Ayush Doctor;Emergencies that can be handled by Nurses – 24 X 7;

Round the Clock Services; Drugs; TB / Malaria etc. tests

GRAM PANCHAYAT – SUB HEALTH CENTRE LEVEL

Skill up-gradation of educated RMPs / 2 ANMs, 1 male MPW FOR 5-6 Villages;Telephone Link; MCH/Immunization Days; Drugs; MCH Clinic

VILLAGE LEVEL – ASHA, AWW, VH & SC

ASHAs, AWWs in every village; Village Health & Nutrition DayDrug Kit, Referral chains

100,000 Population

100 Villages

5-6 Villages

Accredit private providers for public health goals

Health Manager

Store Keeper

NRHM – ILLUSTRATIVE STRUCTURE

NRHM FIVE COMPONENTS

(PART- A)

RCH AND RELATED ACTIVITIES

(RCH FLEXI POOL)

(PART- A)

RCH AND RELATED ACTIVITIES

(RCH FLEXI POOL)

(PART- B)

INITIATIVES UNDER NRHM OTHER THAN RCH

(MISSION FLEXI POOL)

(PART- B)

INITIATIVES UNDER NRHM OTHER THAN RCH

(MISSION FLEXI POOL)

(PART- C)

IMMUNIZATION STRENGTHENING

PROGRAMME

(PART- C)

IMMUNIZATION STRENGTHENING

PROGRAMME

(PART- D)

NATIONAL DISEASE CONTROL PROGRAMMES

(PART- D)

NATIONAL DISEASE CONTROL PROGRAMMES

(PART- E)

INTER SECTORAL CONVERGENCE

SCHEMES

(PART- E)

INTER SECTORAL CONVERGENCE

SCHEMES

INSTITUTIONAL ARRANGEMETS UNDER NRHM

STATE LEVEL

• State Health Mission chaired by Hon’ble Chief Minister.

• State Health Society chaired by Chief Secretary.

• Merger of all vertical societies into State Health Society.

• Signing of MoU with GoI.

• State Level Planning and Monitoring Committee headed by

Hon’ble Health Minister

INSTITUTIONAL ARRANGEMETS UNDER NRHM

DISTRICT LEVEL

• District Health Mission chaired by Chairman Zila Parishad.

• District Health Society chaired by Deputy Commissioner.

• District Planning and Monitoring Committee headed by Zila

Parishad Chairman.

• Rogi Kalyan Samities in District/Sub Divisional Hospitals.

• Merger of all vertical societies into District Health Society.

..contd.. INSTITUTIONAL ARRANGEMETS UNDER NRHM

BLOCK LEVEL

• Block Planning and Monitoring Committees at Block PHC.

• PHC Planning and Monitoring Committees at PHC level.

• Rogi Kalyan Samities for CHCs

VILLAGE LEVEL

• Village Health & Sanitation Committees in each village.

• Accredited Social Health Activist (ASHA) for every 1000

population.

India Punjab Best State

Birth Rate(SRS 2007)

23.1 17.614.614.7

Manipur Kerala

Death Rate(SRS 2007)

7.4 7.04.4 4.8

ManipurDelhi

Life Expectancy at birth 62.15 68.25 73.5 Kerala

Sex Ratio (Census 2001)

933 8761001 1058

PondicherryKerala

IMR(SRS 2007)

55 431213

ManipurKerala

TFR (SRS 2005) 2.9 2.1 1.7 Kerala

Maternal Mortality Ratio (SRS 2005) 301 178 110 Kerala

Ante Natal Care (at least 3 checkup) (%) (NFHS III)

50.7 72.5 96.5 T.Nadu

Institution Delivery (%) (NFHS III) 41 53 100 Kerala

Contraceptive Use (%) (NFHS III)

56 63.3 73 HP

Vaccine coverage (%) (NFHS III)

44 60 81 T.Nadu

HEALTH INDICATORS

IndicatorsAt the start of RCH

SRS 1998-1999

Present Status

2007-2008

Target by 2009-2010

Total Fertility Rate 2.5 2.1 1.8

Infant Mortality Rate(per 1000 live births)

49 44 <30

Maternal Mortality Ratio(per 100000 live births)

199 178 <100

Institutional Deliveries37.5%

(NFHS II)52.5 80%

ANC Check-up with 03 contacts

58.4%

(NFHS II)72.5 100%

TARGETS FOR PUNJAB UNDER NRHM

HEALTH INSTITUTIONS

INSTITUTIONSPUBLIC SECTOR

PRIVATE SECTOR

MEDICAL COLLEGES 3 5

DISTRICT HOPITALS 20

983SUB DIVSIONAL HOSPITALS (Total no. of Sub Divisions 78)

38

COMMUNITY HEALTH CENTRES 127(112 PHSC, 15 DHS)

BLOCK PHCs 118

BLOCK PHCs AND SDH 6

BLOCK PHCs AND CHCs 70

ONLY (EXCLUSIVE) BLOCK PHCs 42

HEALTH INSTITUTIONS

INSTITUTIONSPUBLIC SECTOR

PRIVATE SECTOR

PHCs (MINI PHCs) – EXCLUSIVE 352

PHCs BLOCK – EXCLUSIVE 42

TOTAL PHCs – EXCLUSIVE 394

TOTAL PHCs – EXCLUSIVE + AT CHC/SDH 394 + 76 = 470

SUBSIDIARY HEALTH CENTERS 1187

SUB-CENTRES AT VILLAGE LEVEL 2858

CLINICS /DISPENSARIES 3046

NRHM BUDGET

OVER THE YEARS

PROGRAMME IMPLEMENTATION PLAN

• NRHM is a centrally sponsored scheme. For Year 2005-06 and 2006-

07, GoI contribution was 100%, & from Year 2007-08, GoI

contribution is 85% and state contribution is 15%.

• Every year State Health allocation to increase at least 10% of the

previous year.

• State Govt. is required to prepare a Programme Implementation Plan

(SPIP). It is discussed with Ministry of Health, GoI and then

approved by it.

• After approval of SPIP the funds are released by GoI and the Sate

Govt.

• Minor changes in PIP can be made and major changes are allowed

only with the approval of GoI.

YearOp

Balance

Approved Plan Releases Expendit

ure Incurred

% of

Utilization

Unspent Balance

GOI

State Share 15% from 2007-

08

TotalFunds

released by GOI

Funds released by State

Total Funds

Available

1 2 3 4 5 6 7 8 (2+6+7) 9 10 11 (8-9)

2005-06 283.20 9820.78Not

Required9820.78 8103.25 0.00 8386.45 5971.37 61% 2415.08

2006-07 2415.08 16271.85Not

Required16271.85 14194.06 0.00 16609.14 8326.24 46% 8282.90

2007-08 8282.90 16196.72 2841.00 19037.72 11516.27 705.00 20504.17 16657.93 84% 3846.24

2008-09 (Up to Oct

08)3846.24 19923.00 3000.00 22923.00 5292.51 0.00 9138.75 7132.84 79% 2005.91

FINANCIAL REPORT FOR THE YEAR 2005-09

Rs. in lakhs

FINANCIAL STATUS UPTO OCTOBER 2008 (DISTRICT LEVEL)

SN Component Releases Expenditure

1 RCH II 1968.24 1133.70

2 NRHM Additionalities 1790.21 1183.95

3 Immunization & PP 164.05 91.63

4 NDCP 366.61 366.61

5 Inter Sectoral Convergence 0.00 0.00

6 CSS Family Welfare Head 2211 2540.13 2540.13

TOTAL 6829.20 5316.02

Rs. in lakhs

STATE OBLIGATIONS UNDER NRHM

State signed MoU with Govt. of India in December 2005 for implementation of NRHM

SN INITIATIVES STATE LEVELDISTRICT

LEVELBLOCK LEVEL / VILLAGE LEVEL

REMARKS

1 Setting up of the Health MissionsOn 26th

October 2005 constituted.

On 17th August 2005

constituted.Not applicable Completed

2 Incorporation of Health SocietiesIncorporated on 26th February

2007

Incorporated from 26th

August 2005 to January 2006

Block Health Committees notified

on 11/12/2007

CompletedVillage Health

Sanitation Committees

constituted on 21/10/2007.

3Integration of all vertical programmes of

Health & Family Welfare Department.Already

IntegratedAlready

IntegratedAlready Integrated Completed

4Merger of different societies with State

Health Society.Done on

21/12/2007Being Done Not required

Yet to be completed

5Constitution of Rogi Kalyan Samities in

all Health Institutions upto PHCsNot required

Already notified and are

operational

At Block Level Community Health

Centres already notified and are

operational.

Completed upto CHC but yet to be done in 484 PHCs

SN INITIATIVES STATE LEVEL DISTRICT LEVEL BLOCK LEVEL / VILLAGE

LEVEL

REMARKS

6 Recruitment of staff for Programme Management Units.

Recruitment completed Recruitment completed

Recruitment under process at block level.

Being discussed separately

7 State and District Health Plans

2007-08: PIP submitted on 10th July 07PIP approved on 25/9/07 Outlay-Rs.16196 lacs

2008-09:PIP submitted on 27th Feb 08Approval of PIP receivedOutlay- Rs. 22923 lacs

Facility Survey completed. Integrated District Health Action Plan ready for 20 districts.

Facility survey upto Sub centre level completed.

District Action Plans completed in all 20 districts

The Department has decided in principle to out source the setting up of State Health System Resource Centre (SHSRC), Price Water House Bangalore has been selected.

Contract is being signed..

…contd. STATE OBLIGATIONS UNDER NRHM

WORK DONE - FUNDS

Component Amount/Scope 2007-08 2008-09 Remarks

Untied Funds

Rs. 10,000 2858 SCs 2858 SCs Funds Released

Rs. 25,000 484 PHCs 484 PHCs Funds Released

Rs. 50,000 Nil 128 CHCs Funds Released

IPHSRs. 20 Lacs 20 DHs Nil Funds Released

Rs. 20 Lacs 116 CHCs Nil Funds Released

Annual Maintenance Grant

Rs. 50,000 484 PHCs 100 PHCs Funds Released

Rs. 1 Lac Nil 112 CHCs Funds Released

Rogi Kalyan Samitis

Rs.5 Lac 20 DHs Nil One Time Grant

1 Lac 36 SDHs Nil One Time Grant

1 Lac 110 CHCs Nil One Time Grant

Mobile Phones for ANMs

134 Lacs 4000 In Process

Application Solution for on line data transfer from ANMs to State

In Process

WORK DONE– MCH – 24x7 PHCs

• 75 PHCs upgraded to 24x7 PHCs in 2007-08 and 26 PHCs in 2008-09 for 24 hrs. delivery.

• 24x7 PHC – 1 MO (F) and 3 Staff Nurses on contract basis.

• Out of 101 MO(F), 60 posts filled up leaving 41 posts vacant.

• 34 Staff Nurses yet to be appointed.

• Posts advertised. Last date 20/12/2008

• Generator set provided at 75 and for remaining 26 in process.

• Labour room etc. constructed

WORK DONE – MCH - FRUs

• 50 CHCs in 2007-08 and 10 in 2008-09 upgraded to FirstReferral Units (FRUs). Facility for a complicated delivery including blood transfusion.

• 1 Gynaecologist, 1 Paediatrics and 5 Staff Nurses to be appointed.

• So far 21 Gynaecologist, 22 Paediatrics in position and advertisement for remaining 39 and 38 given. Last date 20/12/2008.

• Advertisement for remaining Staff Nurses 13 given.• Through rationalization of posting of Gynaecologist, 21

regular Gynaecologists posted in the FRUs i.e. 42 FRUs are having Gynaecologist and only 18 are without Gynaecologist.

WORK DONE – 24 x7 PHCs and FRUs

• Signages for these 101 and 60 institutions being developed. Tender floated

• On line monitoring of performance of these institutions through PEC, work given.

• Biometric based on-line attendance system. Tender already received.

WORK DONE - MMUs

• 20 MMUs deployed in districts. 4 districts – Amritsar, Jalandhar, Ludhiana and Mohali not provided with MMUs. 4 districts Faridkot, Bathinda, Mansa and Barnala have one additional MMUs.

• Cost of each MMU Rs. 36.00 lacks. Full Bus chassis used for MMUs. Has the facility of ECG, X-Ray and Lab.

• 1 MO(F), 1 MO(M), 1 Radiographer, 1 Lab Technician, 1 Staff Nurse, 1 Pharmacist (Regular) and 1 Driver and 1 Helper provided.

• 12 posts of MO(F) and 10 MO(M) vacant. Advertisement given.• Instruction issued for free treatment and medicine (Rs. 7500 per month)

issued.• Tenders for GPS enabled tracking system invited and last date 15/12/2008.• Decision regarding MMUs for the remaining 4 districts yet to be taken.

WORK DONE - VHSCs

• NRHM implementation planned within the frame work of PRIs at different

levels.

• Village Health & Sanitation Committees formed in coordination with PRIs at

each village level.The committee consists of ideally 11 member under the chair

of Sarpanch/Panchayat Member and ANM or AWW as Member Secretary with

50% representation of women and due representation from weaker sections.

• 11418 VHSCs formed and remaining 1161 yet to be formed.

• Committee provided with annual grant of Rs 10,000/- to be used as untied grant to meet village level public health activities. Funds already released to VHSCs (Total – Rs. 11.31 Cr. In 2007-08)

• Headed by Panch / Sarpanch.

WORK DONE - ASHA

• 15400 ASHAs selected in the State, 2356 yet to be selected• ASHA - a female health activist in the community to create awareness on

health and mobilize the community for utilization of the existing health

services. • One ASHA to cover 1000 population.• ASHA to be a woman resident of the village-Married/Widow/Divorced

preferably in the age group of 25 to 45 years with the formal education up to

eighth class.• Selection of ASHA to be made by the District Health Society under the

supervision of Deputy Commissioner, and Civil Surgeon to be as District

Nodal Officer.• SMO at block level to be the Block Nodal Officer. • Performance based incentive money of Rs. 3.96 crore has already been

released to District Health Societies for ASHAs for the year 2008-09 & Rs.

1.3 crore in 2007-08.

WORK DONE - TRAINING OF ASHAs

• Training of ASHAs in Module 1 is scheduled to be conducted during the current financial year.

• Training at the State Level for District Trainer completed in July 2008.

• Training at the District Level for Block Level Trainers completed in August 2008.

• Training at the Block Level for ASHAs to be taken up now. ASHA books have been translated and are under print.

• Training of ASHA for 6 districts being given to NGO. Matter under process

• Tenders for ASHA kit have been received and would be made available by 31/12/2008.

WORK DONE – RECRUITMENT

• No recruitment done in 2005-06, 2006-07.

• Fresh recruitment at the State Level made in November 2007 and State Programme Management Unit set up.

• Fresh recruitment of doctors and nurses started in March 2008.

• Great emphasis given on recruitment of Staff in the Hospitals and Sub-Centres.

• 3 recruitment drives launched – July 2008, October 2008 and December 2008. Recruitment has been made a monthly features.

• All vacant posts of ANMs for last 5-6 years at Sub-Centres (514) filled up under 2211 scheme. 2nd ANM provided at 954 bigger Sub-Centers.

• For Gynaecologist and MO(F), advertisement given for increased pay packages. Basic pay increased from 15,000/- and 20,000/- to 20,000/- and 25,000/-.

WORK DONE – RECRUITMENT

• Letter written to Civil Surgeons on 8/12/2008 for identifying remote/extremely remote areas. We will give the regular and contractual lady doctor special incentive during 2009-10.

• Recruitment at 4 levels –

• State Programme Management Unit

• District Programme Management Unit

• Block Programme Management Unit

• Doctors, Nurses, ANMs etc. in the Health Institutions

• 1 Medical Officer appointed in PHCs in the Malwa Districts of the State where there was no doctors. Against 95 posts, 59 posts filled up. Remaining posts advertised. We should try to provide at least one doctor in each PHC in the PIP 2009-10.

SN Name of the PostSanctioned

PostFilled Vacant

Consolidated Salary PM

Remarks

1 Director Finance 1 1 0 On Deputation

2State Programme Manager

1 1 0 From State Govt.

3Maternal Health Specialist

1 0 1 40,000 Rs 30,000/- from Dec

Services have been terminated

4 Family Welfare Specialist 1 1 0 40,000Rs 30,000/- from Dec

5 Procurement Manager 1 0 1 25,000Advertisement for recruitment issued on 1/12/2008

6 Manager (HRD) 1 0 1 20,000

Officer Resigned Advertisement for recruitment issued on 1/12/2008

7 Manager (F&A) 1 1 0 25,000

8 Manager (M&E) 1 1 0 20,000

9 State NGO Coordinator 1 1 0 30,000

10Programme Coordinator (ARSH & Gender)

1 1 0 20,000

RECRUITMENT - STATE PROGRAMME MANAGEMENT UNIT


PostFilled Vacant


Remarks

11Programme Coordinator (BCC)

1 1 0 20,000

12 Consultant (Admn) 1 0 1 20,000 Candidate resigned

13 Consultant (M&E) 1 1 0 20,000

14 System Analyst 1 0 1 15,000

Officer Resigned Advertisement for recruitment issued on 1/12/2008

15 Accounts Officer 2 2 0 15,000

16 Statistical Assistant 4 4 0 10,000

17 Hardware Supervisor 1 1 0 10,000

19 Accountant-cum-Cashier 2 2 0 10,000

…contd…


PostFilled Vacant


Remarks

20 Computer Assistant 4 4 0 8,000Selection has been done for the vacant position candidate is yet to join

21 Office Assistant 9 9 0 7,000

23 Graphic Designer 1 1 0 10,000

24 Procurement Assistant 2 1 1 8,000Candidates have been adjusted at State HQ from the districts

25 Drivers 2 0 2 5,000 Action is being initiated

26 Class-IV 3 2 1 3,000Action is being initiated

Total 44 35 9

…contd…


PostFilled Vacant


Remarks

1District Programme Manager

20 18 2 20,000 Selection has been Done.

2 District Accounts Officer 20 17 3 15,000Advertisement for recruitment issued on 1/12/2008

3District Monitoring & Evaluation Officer

20 20 0 15,000

4 Procurement Officer 20 4 16 15,000

5 Maintenance Engineer 20 17 3 12,000

6 Statistical Assistant 20 18 2 8,000Advertisement for recruitment issued on 1/12/2008

7 Procurement Assistant 20 0 20 8,000

No further recruitment to be made. Procurement Assistant have been adjusted as Statistical Assistant or accountant as per their qualification

8 Accountant-cum-Cashier 20 17 3 8,000Advertisement for recruitment issued on 1/12/2008

9 BCC Facilitator 20 20 0 8,000

Total 180

RECRUITMENT - DISTRICT PROGRAMME MANAGEMENT UNITS

RECRUITMENT - BLOCK PROGRAMME MANAGEMENT UNITS

SN Name of the PostSanctione

d PostFilled Vacant


Remarks

1Block Statistical Assistant 118 98 20 8,000

Advertisement for recruitment issued on 1/12/2008

2Block Accountant cum Cashier 118 93 25 8,000


3. Computer Operator 173 155 18 5,000Advertisement for recruitment issued on 1/12/2008

Total 409 346 63

SN Name of the Post Sanctioned Post Filled VacantConsolidated

Salary PMRemarks

1 Obstetricians 60 21+21 39

Rs. 25000/- + Rs. 3000/- HRA+ Rs. 1000/ EmOC + Rs. 500/- per delivery conducted + Rs. 200/ MTP

28 Recruited, 7 resigned. Advertisement issued for 39 posts on 1/12/2008

2 Paediatricians 60 22+3 35

Rs. 25000/- + Rs. 200/- per Emergency Case during off duty hours + Rs. 3000/- HRA

31 Recruited, 9 resigned. Advertisement issued for 35 posts on 1/12/2008

3 Anaesthesia 60 60Rs. 1500/- on call per case + TA Rs. 6/KM upto 50 KM

Empanelment for CHCs at District level

4 Staff Nurses 300 287 13

Rs. 8500/- + Rs. 1500/- (if accommodation is not provided)


5 OT Assistant 60 10 50

Rs. 4000/- + 300/- evey Major OT Case + Rs. 1500/- HRA

Not required to recruit

RECRUITMENT - FRUs


PostFilled Vacant


Remarks

1 Female Medical Officer 101 50 51*

Rs. 20000 PM + Rs. 500 per Delivery+ Rs. 200/ MTP + Rs. 3000/- HRA

*Advertisement for recruitment issued on 1/12/2008

2 Staff Nurses 303 269 34*

Rs. 5000/- + Rs. 500/- per delivery conducted + Rs. 100/- per delivery assisted and Rs. 1500/- HRA (if accommodation is not provided)

*Advertisement for recruitment issued on 1/12/2008

RECRUITMENT - PHCs 24x7


d PostFilled Vacant


Remarks

1 Medical Officer (Male) 20 10 10 22,00020 recruited 10 resigned/ not joined Advertisement issued for 10 posts on 1/12/2008

2Medical Officer (Female)

20 8 12 22,00020 recruited 12 resigned/ not joined Advertisement issued for 12 posts on 1/12/2008

3 Nurses 20 17 3 8,000Advertisement for recruitment issued on 1/12/2008

4 Radiographer 20 12 8 8,000Advertisement for recruitment issued on 1/12/2008

5 Lab Technician 20 17 3 8,000Advertisement for recruitment issued on 1/12/2008

6 Driver 20 20 0 7,000 *Placement agency hired

7 Helper 20 20 0 4,000 *Placement agency hired

RECRUITMENT - Mobile Medical Unit (MMU)


d PostFilled Vacant


Remarks

1Medical Officer for Mini PHC

95 61 34 20,000Advertisement issued for the recruitment on 1/12/2008

1MPHW (Female) for urban slums

230 230 *0 6,000

2ANM for vacant sub-centres (2211)

514

1265 203

6,000 Mainly reserved posts Advertisement for recruitment issued on 1/12/20083

2nd ANM for 954 sub-centres

954 6,000

RECRUITMENT – MO (Mini PHC) & ANM for Urban Slum Area & Sub-Centres

WORK DONE - SCHOOL HEALTH

• 32,64,926 of students are in Primary and Secondary level

• Special Campaigns under School Health Programme held – 13th August (held in slum areas of key districts) 12356 person examined– 14th August (held in CHCs and SDHs) 110888 school children

examined– 2nd October (held in CHCs, SDHs, & DHs) Eye checkup camps under

which free spectacles distributed to school children

• Requirement of Drugs :-– IFA Tablets-

Pediatric with2 0 mg elementary iron 7 Crore TabsAdult with60 mg elementary iron 60mg 3 Crore Tabs

– Deworming Tablets 32.64 lakh Tabs

Procured and distributed

School No. of Students

Primary 7,09,747 6,29,510 13,39,257

Middle-Secondary 10,39,509 8,86,160 19,25,679

Total 17,49,256 15,15,670 32,64,926

WORK DONE - SCHOOL HEALTH

Free Treatment of School Students for CHD & RHD

•Decision taken on 4/11/2008 for free treatment of students (upto +2 level)

studying in Govt. & Govt. aided schools suffering from Congenital Heart Disease

(CHD) and Rheumatic Heart Disease (RHD) in PGI Chandigarh. So far 16

students referred to PGI and Rs. 10.00 lacks deposited.•Directions given to heads of PHCs, CHCs and dispensaries to diagnose school

students suffering from RHD and CHD and refer to PGI.•Work of examination of School Children – not so systematic. Students cards are

under print and would be supplied to the Schools.•Civil Surgeons have been directed to fix the target and show achievement

alongwith certificates from the School Headmaster that the health team has

visited the school and examined the children.

• To involve the community in the decision making and monitoring of initiatives and ongoing health programmes, Health Monitoring & Planning Committees are being constituted at Village, PHC, Block, District and State level with the following objectives– provide systematic info about community needs

– provide feedback according to • locally developed yardsticks • key indicators.

– increase involvement and participation of community – Validate sector wide data from other sources– Triangulation

WORK DONE - COMMUNITY MONITORING & PLANNING COMMITTEES

WORK DONE – SEX RATIO

• Survey for sex ratio commissioned in September 2008. Report likely to be received by 28/2/2009.

STATE PROGRAMME

IMPLEMENTATION PLAN 2008-09

COMPONENTS DESCRIPTION OUTLAY (Rs. In crores)

PART A RCH 56.95

PART B NRHM ADDITIONALITIES 80.80

PART C IMMUNIZATION & PPI 12.34

PART DNATIONAL DISEASE ONTROL PROGRAMME

14.73

PART E INTERSECTORAL CONVERGENCE 5.33

TOTAL NRHM 170.15

CENTRALLY SPONSORED SCHEMES (Already under Implementation but now merged with NRHM)

59.34

GRAND TOTAL 229.49

PIP 2008-2009

• GoI contribution Rs. 180 Cr., GoP contribution

Rs. 30 Cr.

• Previous funds available – GoI- Rs. 31.41 Cr.;

GoP – Rs. 7.05 Cr. = TOTAL – Rs. 38.43Cr.

• TOTAL FUNDS AVAILABLE FOR 2008-09

Rs. 210 Cr. + Rs. 38 Cr.= Rs. 248 Cr.

PIP 2008-2009

Allocation Releases/ Expenditure

SN Sub Components 2008-092008-09

1Maternal Health 235.00 52.50Janani Suraksha Yojna 186.00 171.50

2 ASHA 334.50 440.003 Child Health & IMNCI 86.15 .674 Family Planning 920.60 937.715 ARSH 27.07 10.026 Urban RCH 135.60 32.90

7PNDT Sex Ratio 64.84 21.57Innovations / PPP/NGO 442.50 0

8

Infrastructure & Human Development 1558.50 221.87

Logistic Management

323.34 95.35Quality Assurance and Infection Control ProgrammeHMIS Monitoring and Evaluation

9 Training 461.88 276.70

10 Behaviour Change Communications 291.76 40.75

11 Procurement 122.50 125.91

13Programme management Units SPMU and DPMUs

347.26 264.35

12 Flexi pool 157.50 11.70 Total A (RCH II) 5695.00 2703.50

PART A- RCH FLEXI POOLRs. In lakhs

• Digitization of Civil Registration Systems (CRS). RFP under preparation. Under e-Governance Project of the State on pilot basis CRS is being implemented in district Kapurthala & Nawanshahar. Work has been allotted to WIPRO. Work allotment for digitization of CRS for whole Punjab is under process.

• Sex Ratio Survey. The work has been allotted to AMS, Luckhnow. First inception report of the survey submitted.

• City Specific GIS mapping for Urban Health Mission for three cities i.e. Amritsar, Jalandhar and Ludhiana which was assigned to Punjab Engineering College, Chandigarh has been completed

• To ensure dissemination of information relating to NRHM to field level functionaries and to ensure immediate reporting, steps have been taken to finalize website of the NRHM. The work will be completed by the end of this month.

..contd.. PART A


SN Sub Components 2008-09B NRHM Additionalties a Village Health & Sanitation Committees 1230.00 0.00

b ASHA - proposed under RCH II

c SC Untied Fund & Maintenance 286.20 285.80

d PHC Untied Fund & Maintenance 121.00 121.00

e CHC Untied Fund & Maintenance 64.00 64.00f Annual Maintenance Grant 162.00 655.80

g Mobile Medical/ Health Units 397.40 111.20

h Upgradation of CHC 1091.80 0.00

I Upgradation of PHC 821.43 0.00

j Upgradation of SC 725.38 0.00

k Upgradation of SHC 600.00 0.00

l Upgradation on SDH/ FRUs 100.00 100.00

m Upgradation of DH 370.00 0.00n School Health 500.00 12.45

o Strengthening of Programme Management 476.56 0.00

p Strenthning of Logistics Management 50.00 0.00

q Rogi Kalyan Samitiis 12.33 0.00

r Emergency Response Services 937.50 0.00s Mobile Phones for ANMs 134.00 0.00

Total B 8079.60 1350.30

PART B- NRHM ADDITIONALITIES Rs. In lakhs

Extension of New Institutions

• 40 New Sub Centre's is to be constructed at a cost of Rs. 2.5 crore.

• One new CHC to be constructed at Zirakpur at a cost of Rs. 2.5 crore

• Up-gradation of Institutions

• 77 Sub Centres to be renovated at a cost of Rs. 1.00 Lakh each

• 10 PHCs to be repaired / renovated at cost of rs. 60.00 Lakh.

• PHC at Adampur and Rural Hospital Morinda to be completely renovated.

• Following Sub Divisional Hospitals to be upgraded with an outlay of Rs.6.00 Crore

– Batala (50 to 80 beds) ... Rs. 1.5 crore

– Patti (50 to 80 beds) ... Rs. 1.5 crore

– Nabha (100 to 130 beds) ……… Rs. 1.5 crore

– Pathankot (100 to 130 beds) …… Rs. 1.5 crore

..contd.. PART B

• Following District Hospitals to be upgraded

– Mohali (70 to 120 beds) … Rs. 3.00 Crore

– Mata Kaushalya Hospital Patiala … Rs.2.00 Crore

(154 to 250 beds)

– Gurdaspur (100 to 150 beds) … Rs.2.50 Crore

– Ludhiana (addition of 30 beds burnh Unit)… Rs. 1.00 Crore

– Bathinda (Renovation) ... Rs.0.50 Crore

..contd.. PART B

• Equipment and furniture worth Rs.6.50 Crore to be provided in CHCs as per IPHS Norms

• Equipment and furniture worth Rs.1.83 Crore to be provided in the PHCs as per IPHS norms

• Drugs and consumables as per following details to be given:

- CHCs … Rs. 3.60 Crore

- PHCs … Rs.4.84 Crore

- SHCs … Rs.6.00 Crore


SN Sub Components 2008-09

a Alternative vaccine Delivery 103.34b Mobilization of Children by

AWW/TBA/ASHA68.59

c Strengthening of Monitoring and Supervision

9.18

d Computer Assistant to DIO, Provision for Additional Support, Slums and underserved area

79.58

Total C 260.69 91.63

PART C- IMMUNIZATION

Rs. In lakhs



a RNTCP 522.16 201.52b Leprosy 0.76 26.35c IDSP 79.91 43.86d National Iodine Deficiency

Disorder Control Programme. - NIDDCP

20 0.00

e Malaria & Vector Borne 212.36 19.88f Blindness Control 637.5 75.00 Total D 1472.69 366.61

PART D- NATIONAL DISEASE CONTROL PROGRAMME

Rs. In lakhs



a Convergence with AYUSH 424.80 0.00b Co ordination & Orientation with PRIs

75.15 0.00

c Special innovation for Minorities33.45 0.00

Total E 533.40 0.00Part II

CSS Family Welfare Head 2211 5934.00 2540.13

PART E- INTERSECTORAL CONVERGENCE

Rs. In lakhs

• Appointment of one Ayurveda MO & one Homeopathy MO in 121 PHCs & 112 CHCs respectively.

• 99 Ayurveda MOs already recruited. 22 MOs of reserved categories (9 SC, 1 FF, 2 Sports, 3 Handicapped, 6 Exn, 1 General)

• Written test & Counseling for appointment of 112 Homeopathy MOs done. Appointment letters being issued

There are numerous schemes for providing clean drinking water in rural and urban areas :

•Under JNNURM, UIDSSMT and BSUP high priority has been given to providing drinking water supply. The total allocation for current year is Rs. 350 crore.

•Under Municipal Development Fund a sum of Rs. 1 crore is to be spent in various towns.

•For Rural Areas, there are various schemes – Accelerated Rural Water Supply Scheme (Rs. 110 crore), NABARD (Rs. 70 crore), World Bank (Rs. 132 crore), Rajiv Gandhi National Drinking Water Mission (Rs. 10 crore), RO Process (Rs. 25 crore) for clean drinking water.

• Under SSA, funds can be provided for drinking water in elementary schools in the State.

DRINKING WATER SUPPLY

• Sewerage works will be executed in urban areas under JNNURM and JBIC Projects.

• For Rural Areas there is a State Government schemes for

providing individual toilets (Rs. 5 crore).

• Under Total Sanitation Programme of GoI we have Rs. 77 crore

project for providing toilets in schools, Aanganwadi Centers,

Community toilets and individual toilets.

• Under World Bank Project, there is a provision for laying

underground sewer in 1000 villages and cleaning of village ponds.

• For cleaning of village ponds we have a State Scheme (Rs. 5

crore). NREGA funds can also be used for this purpose in all the

districts without any limit.

SANITATION

SCHOOLS – WATER & TOILETS

• Schools not having Water & Toilet facilities have been identified by a survey.

• 480 Schools are without drinking water facilities Water & Sanitation Department would provide these facilities from their regular schemes like ARWSP.

• 4447 schools are without Toilet facilities Water & Sanitation Department has been asked to prepare estimates.

• Funds to the extent Rs. 40000.00 per school will be provided from Total Sanitation Campaign (TSC) & above Rs. 40000.00 from 12th Finance Commission of Rural Development Department.

• Under ICDS Programme (50:50) the State Government will be spending Rs. 55 crore in 2008-09.

• Under Kishori Shakti Yojana (Nutrition for adolescent

girls) will spent Rs. 2.50 crore through Woman and Child

Development.

• Under these 2 programmes a total of 13.52 lakh children

and mothers were provided nutrition.

NUTRITION

• The Village Health & Sanitation Committees has been

constituted in all the villages. These committees are

headed by Sarpanch/ Panches.

• The new Panches and Sarpanches have been inducted

in the already constituted VHSCs and the Health

Department would thereafter coordinate these 3

programmes – Water Supply, Sanitation and Nutrition

at block level.

• The Agriculture Department would also be involved.

VILLAGE HEALTH COMMITTES

• We are holding regular meetings with WSS, Rural

Development, Woman and Child Development

Departments.

• We are going to constitute Coordination Committees with

these departments for greater synergy.

COORDINATION WITH OTHER DEPARTMENTS

OTHER INITIATIVES

NATIONAL URBAN HEALTH MISSION

• GoI proposes to launch NUHM from 2008-09 to 2011-12 (4 years). Current year allocation is likely to be Rs. 1012 crore and Punjab would get about Rs. 25 crore.

• The target population would be urban poor living in slum areas, homeless poor and construction workers.

• 3 towns - Amritsar, Jalandhar and Ludhiana will be taken up from 2008-09 and the remaining 10 towns – Patiala, Abohar, Batala, Bathinda, Moga, Malerkotla, Khanna, Pathankot, Hoshiarpur and Mohali from 2009-10.

• The programmes aims at upgradation of Primary Urban Health Centers in terms of infrastructure and man power. Urban Social Health Activist (USHA) will be provided for every 1000 population.

• Private hospitals would be empanelled in case there are no government institutions in the slum areas.

• There would be a separate Health Insurance Scheme for Urban Slum Poor's and they would be free to seek treatment from Government and Private referral hospitals.

• State has already initiated the process for GIS mapping of the urban slums (notified & non notified) and health facilities (Private & public) in three cities, work has been allotted to Punjab Engineering College Chandigarh. The work will be completed in the first week of September 08.

EMERGENCY RESPONSE SERVICE IN THE STATE

• 240 Ambulances equipped with medical facilities and medical technicians to be deployed.

• 60 ambulances will have advance life saving equipment (cardiac care, highway trauma care, EmOC)

• 180 ambulances will have basic life saving equipment (EmOC, highway trauma etc.).

• Patient to be shifted to nearest centre through the ambulance positioned with trained medical technician and expert driver.

• Capital cost of the ambulances will be Rs.29 crore and for establishing IT infrastructure and Emergency Response Centre the capital cost will be Rs. 12 crore. Total initial cost will be Rs. 41 crore. Recurring cost will be Rs. 25 cr. per annum

• Emergency Call Centre with a common three digit toll free number. • Tenders have been received and work is being allotted.

OTHER INITIATIVES

• Web Site of Punjab NRHM – www.pbnrhm.org prepared and hosted • Service particulars of MOs – Service particulars with complete details

including postings computerized and placed on the website for final checkup by Civil Surgeons. It would be easy to determine the status of postings, transfers and vacancies in the health institutions. Would be ready by 25/12/2008.

• Administrative Maps – Maps being developed with the help of Punjab Remote Sensing Agency at Ludhiana. All details received except from District Gurdaspur, Jalandhar and Mohali. These maps are necessary for depiction of information on GIS, Tracking of MMUs and EMRI Ambulances.

• Pregnancy Tracking – Pilot project being developed for Mohali and Ropar district for online registration of pregnancies. Tender for allotment of work being invited.

• Mobiles phones for ANMs – Continuous contacts and information.• Special incentives for Remote and Extremely Remote Areas to MO(F) and

Gynecologist.

MONITORING AND STATUS (31/10/2008)

Institutional Deliveries• Annual pregnancies – 4,80,000• Deliveries in health department institutions in 2007-08 –

25269• Total institutional deliveries – About 52%• Performance upto October 2008 (Health Department

Institutions) – 2007-08 2008-09

25269 31357

Increase of 24.10%

• 4 Excel Sheets

INSTITUTIONAL DELIVERIES

INSTITUTIONAL DELIVERIES Year 2007-08 & 2008-09 (Up to October 08)

1992-93 1997-98 2005-06

Trend of Institutional Deliveries – Month wise(Health Department Institutions)

24%

District wise Institutional Deliveries- 2007-08 & 2008-09 (till Oct 08)

Institutional Deliveries- District Hospitals 2007-08 & 2008-09 (till Oct 08)

Institutional Deliveries- Sub Divisional Hospitals2007-08 & 2008-09 (till Oct 08)

Institutional Deliveries- FRUs 2007-08 & 2008-09 (till Oct 08)

Institutional Deliveries- 24x7 PHCs2007-08 & 2008-09 (till Oct 08)

Institutional Deliveries- CHCs other than FRUs 2007-08 & 2008-09 (till Oct 08)

JANANI SURAKSHA YOJNA

Cash assistance scheme for BPL and SCs/STs mothers (age 19 and above

upto 2 living children) on birth in Public or Private accredited health units. Rural area Rs.700/- Urban area Rs. 600/- Non Institutional delivery Rs.500/-

Rs.1500/- to be provided for hiring the services of specialists to carry out the

caesarean in a Govt. Institution

• 2007-08 – 29256 beneficiaries covered against the target of 90,000 per annum.

• 2008-09 – Till October 19,949 beneficiaries covered constituting 22.17% of the annual target. It should have been 60% at the end of October

JSY PerformanceDistrict wise Beneficiaries covered (till Oct 08)

UTILIZATION OF FUNDS

• As per GOI condition funds upto 2006-07 to be utilized and UC sent for further release of GOI funds during 2008-09.

• Similarly funds upto 2007-08 to be utilized for release of funds during 2009-10.

• UCs to be sent for 2006-07.• Utilization during 2008-09 Rs. 68.29 cr. was given to

districts and various agencies.

District wise utilization of funds (till Oct 08)

Ranking of the districts

To achieve more and to strengthen the NRHM programme the districts have been ranked on performance basis on different health parameters

Ranking of the districts-

THANK YOU

Documents

NATIONAL RURAL HEALTH MISSION FOR HON’BLE HEALTH MINISTER 13 TH DECEMBER 2008 PRESENTATION