RCH – II SEVENTH JOINT REVIEW MISSION PUNJAB JULY-AUGUST 2010 AT NIRMAN BHAWAN, NEW DELHI

RCH – II

SEVENTH JOINT REVIEW MISSION PUNJAB

JULY-AUGUST 2010

AT NIRMAN BHAWAN, NEW DELHI3rd AUGUST, 2010

STRUCTURE OF THE PRESENTATION

1. Good / innovative practices adopted by the state in the focus areas

Assured Service Delivery2. Current status (Facility operationalisation and VHNDs)3. Key issues4. Way forwardProgramme Management5. Current status (supportive supervision system)6. Key issues and way forwardMonitoring and Evaluation7. Current status (maternal death review and name based

tracking)8. Key issues and way forward10.Gender and Social Equity

PRESENTATION ON

FACILITY OPERATIONALISATION AND VHNDs : CURRENT STATUS , KEY

ISSUES AND WAY FORWARD

SN CATEGORY INDIA PUNJAB

1 Crude Birth Rate(SRS 2008)

22.8 17.3

2Total Fertility Rate(SRS 2008)NFHS-III (2005-06)

2.72.7

1.92.0

3 Death Rate(SRS 2008)

7.4 7.2

4Sex Ratio at Birth (SRS 2008) 904

836

5Sex Ratio (0 to 4 years)(SRS 2007)(SRS 2008)

914915

838841

6Maternal Mortality Ratio (SRS data of 2001-03)(SRS data of 2004-06)

301254

178192

HEALTH INDICATORS

4

HEALTH INDICATORS: ANTE NATAL CHECK UP


7.Infant Mortality Rate NFHS-III (2005-06)(SRS 2008)

5753

4241

8.Any Ante Natal CareDLHS – III (2007-08)

75.2 83.3

9.Full Ante Natal CheckupDLHS – III (2007-08)

18.8 14.3

10.

Ante Natal Care(3 or more visits)NFHS-III (2005-06)DLHS – III (2007-08)

50.775.3

72.565.1

11.Institutional deliveries NFHS – III (2005-06)DLHS – III (2007-08)

4147

5363.3

HEALTH INDICATORS : CHILD HEALTH


12.Pregnant women who are anemic (%age) NFHS – III (2005-06)

57.9 41.6

13

Breast Feeding (%age)(i) Children under 3 years breast fed within one hour of birth NFHS-III(2005-06)DLHS-III (2007-08)

23.440.2

10.344.6

14Exclusive breast-feeding (0-5 months)NFHS-III (2005-06)DLHS-III (2007-08)

46.346.8

36.032.4

15%age of children fully immunizedNFHS-III (2005-06)DLHS-III (2007-08)

44.054.1

60.079.9

TARGETS FOR PUNJAB UNDER NRHM

Indicators Present Status

Target by 2011-12

Total Fertility Rate 2.0NFHS III (2007-08)

1.8

Infant Mortality Rate(per 1000 live births)

41SRS 2008

<30

Maternal Mortality Ratio(per 100000 live births)

178192 (SRS 2008)

<100

Institutional Deliveries

63.3 DLHS III (2007-08)

80%

ANC Check-up with 03 contacts

65.1DLHS III (2007-08)

100% 7

FINANCIAL REPORT FOR THE YEAR 2005-10

` in lakhs

Year

Opening

Balance

Approved Plan Releases

Expenditure

Incurred

% of Utilizati

on

Unspent Balance (Bank

Balance SHS)

GOI

State Share 15% from 2007-

08

Total

Funds release

d by GOI

Funds release

d by State

Others

Total Funds

Available

1 2 3 4 5 6 7 89

(2+6+7+8)

9 1011 (8-

9)

2005-06

283 9821Not

Required

9821 8103 0 8386 5971 61% 2415

2006-07

24151627

2

Not Require

d

16272

14194

0 16609 8326 51% 8283

2007-08

82831619

72841

19038

11516

0 19799 10469 55% 9330

2008-09

99931732

42600

19924

17917

2884 204 30998 18697 94% 12301

2009-10

1230

1

2180

5

327

1

2524

5

2212

81699 131 36259 22084 87% 14175

2010-11 14175 24633 4347 28980 9315 1756 16 25262 4377 15% 20885

* Committed expenditure is ` 7781 lakh so actual opening balance will be ` 6394 lakh8

FINANCIAL REPORT FOR THE YEAR 2005-10

2010-11Details of Activities Approved & Resourse Envelop

Activities Approved for the F/Y 2010-11 Rs. 364.24 Cr.Resourse Envelope :GoI :Basic 246.33 Cr.15% Over Planning 36.96 Cr.Total 283.29 Cr.State Share 43.77 CrUncommitted Unspent Balance 55.77 Cr.Grand Total 382.53 Cr.

Sr.No.Compon

ents

Opening Balance

1-4-10Approved Out Lay

Funds released Releases to

Districts &

Agencies

Expenditure Up To June 2010

Unspent Balance

with SHS

Advances

by GOI

by State

Total Funds Availa

ble

with SHS

Advances

Total

1 2 3 4 5 6 78(3+6

+7)9 10 11 12

13(11+12

)Part I F W 0.00 0.00 70.24 0.00 17.56 17.56 17.56 17.56 0.00 0.00 0.00

Part II

A RCH II 17.10 33.00 94.42 36.14 0.00 53.24 7.05 9.98 46.19 30.07 76.26

B NRHM 32.89 35.57 167.39 56.71 0.00 89.60 30.12 14.99 59.48 50.70110.1

8

CImmunization & PP

2.75 2.13 14.01 0.30 0.00 3.05 5.00 1.24 -1.95 5.89 3.94

D NDCP 9.35 1.07 18.18 0.00 0.00 9.35 0.00 0.00 9.35 1.07 10.42

E

Inter Sectoral Convergence

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

Other Activities 5.17 2.73 0.16 0.00 5.33 0.51 0.00 4.82 3.24 8.06

Total 67.26 74.50 364.2493.31 17.56 178.13 60.24 43.77 117.89 90.97208.8

6

FINANCIAL REPORT FOR THE YEAR 2010-11 upto JUNE

1. GOOD/ INNOVATIVE PRACTICES

Reproductive and Child Health Programme focus

on reducing MMR and IMR.

Strategies:

• Infrastructure and Manpower Strengthening

•Ensure Complete ANC Coverage

• Promoting Institutional Deliveries

Institutional Deliveries - Free:

Data of DLHS-III shows that 36.1% pregnant women are not going to health institutions for delivery because of cost factors. To promote institutional deliveries, the State Govt. has initiated the following steps:

• Deliveries and delivery related services have been made free at all Govt. Hospitals from December 2008 by the State Govt.

• Provision of referral transport, ` 200/- to PW for referral transport

• Surakshit Janepa Yojna – PPP initiative The average fixed rate for delivery to be reimbursed to the API (Accredited Private Institution) has been revised to ` 2500/- from earlier rate of ` 1700. Approx. 600 deliveries conducted

• Incentive to ASHA for institutional deliveries• Family Health camp in all blocks- 200 camps

1. GOOD/ INNOVATIVE PRACTICES: ASSURED SERVICE DELIVERY

• Maternity Wards- maternity Wards in all the districts hospitals to be renovated/ constructed. The work has already started at most of the places.

• 24 Mobile Medical Units functional in the State

• 8 Mobile Units by Ranbaxy to serve in un-served areas.

• Emergency Response System in place by March 2011

• Availability of drugs and other consumable in sufficient quantity at all levels.


SPECIAL PROJECT FOR UPGRADATION OF HEALTH INFRASTRUCTURE

Hon’ble Chief Minister, Punjab have approved a special project for

upgradation of Health Infrastructure

•A major upgradation project worth ` 346 crores has been

prepared for the upgradation of Health Infrastructure.. Under this

project new blocks are to be added to the existing hospitals, new

districts and Sub Divisional Hospitals and Community Health

Centres will also be constructed. The details of spending are--cost of the construction ` 280 crores-Equipments ` 66 crores

•The works for these projects would be allotted by 30.09.2010 and

are likely to be completed by 31.08.2011.


Upgradation of District Hospitals: • Upgradation of 2 District hospitals- District hospital Muktsar &

Tarn Taran will be upgraded to 100 bed hospital (` 14.40 Crore)and equipment worth ` 1.35 Crore.

• New District Hospital-- District hospital Nawanshahar (` 16 Crore) and equipment worth ` 1.50 Crore.

Upgradation of SDHs:• Upgradation of 2 existing CHCs to SDH – 20 bed each will be

added in SDH Dera Bassi (Mohali) and SDH Budhlada (Mansa)at the cost of ` 6.40 Crore.

• Construction of 5 new 50 bedded SDH- Khadoor Sahib(Tarntaran), Bholath (Kapurthala), Moonak (Sangrur), Tapa (Barnala) and Ghudda (Bathinda) at the cost of ` 40 Crore. Equipment worth ` 3.75 Crore. will be provided.

• Major repair and renovation of 22 existing SDH will be undertaken.


Upgradation of CHCs:• New building of 3 CHCs Ballianwali (Bathinda), Naushera Majjha

Singh (Gurdaspur) and Dudhan Sadan (Patiala) at the cost of ` 14.40 Crore.

• New CHCs- 29 PHCs will be upgraded to CHCs and new construction of these CHCs will be undertaken at the cost of ` 139.20 Crore. Equipment worth ` 13.05 Crore will be provided.

Upgradation of 204 PHCs:• ` 44.86 Crore have been earmarked out of which ` 34.68 Crore

for civil work and ` 10.18 Crore for equipments. 204 PHCs which are yet not covered by NRHM will be taken.


Service Guarantee • IEC & reference material

for service guarantee designed and displayed for the service provider and community.

• Unique Signages for the FRUs and 24x7 PHCs.

• Protocol for EmOC by UNICEF displayed at labour room for reference.

• IEC material on available services for community.

TOP


Service Guarantee • Pamphlets for community

on information regarding service availability at sub-centres regarding availability of services, equipments, medicines etc.


Service Guarantee • Charter at Sub-Centre: facilities available at Sub-Centre



Service Guarantee • Duties of ANM displayed at Sub-Centre

Service Guarantee • Display of IEC material for community on Care during

pregnancy, JSY and Care of Neonates.


1. GOOD/ INNOVATIVE PRACTICES: ASSURED SERVICE DELIVERYService Guarantee • Protocols developed by UNICEF displayed as reference

in labour rooms and Gynecologists OPD.





• State Health Systems Resource Centre (SHSRC)

established: Consultants of different fields (Public Health

Planning, Health – HRD, BCC/IEC, Quality Assurance,

Community Participation) placed.

• State Programme Management Unit, District Programme

Management Units , Block Programme Management Units

fully functional.

• Hospital Administrator for five major District Hospitals.

• Supervisory structure of LHVs strengthened.

1. GOOD/ INNOVATIVE PRACTICES: PROGRAMME MANAGEMENT

• Biometric based online attendance system for health institutions.

• Daily online OPD monitoring mechanism.

• Utilization of equipments monitored online.

• Mobiles to all 4000 ANMs planned for systematic monitoring of their performance in respect of important parameters.

• Registration of all 5 lakh pregnant women in the state is planned. Tracking of all new born children for full immunization is also planned with Government of India assistance under NRHM.

• Maternal Death Review initiated, guidelines issued.

• Community hotline.

• Mobile Medical Units are monitored through GPS.

• GIS is being developed

1. GOOD/ INNOVATIVE PRACTICES: MONITORING & EVALUATION

1. GOOD/ INNOVATIVE PRACTICES: GENDER & SOCIAL EQUITY

• More focus on NSVs, special camps are being organized successfully

• Strict enforcement of PC-PNDT Act. - Prizes announced for decoy customers, informers and for

sting operations in regard to violation of PNDT Act. - Award to Panchayats. 83 Panchayats with sex ratio 1000

and above have been honored with Rs1.50 Lac each. - Community hotline to curb female foeticide.• Free deliveries, free referral, free treatment to children

suffering from CHD/ RHD.• Jan Aushadhi Stores in all the 20 District Hospitals and 3

SDH to provide cheap generic medicines to the people have been started and more in process.

• Free treatment for BPL families • Special outreach programme for minorities

2. CURRENT STATUS: FRUs

Statuson 1st July, 2010(No. of facilities)

No. of planned FRUs 170 (21 DHs + 35 SDHs + 114 CHCs)

No. of functional FRUs, withCesarean sections conducted 24 X7 Blood storage facility (or adequate linkages to one) available

New born care services available on 24 hr basis

All of the above 3 criteria

131 (21 DHs + 35 SDHs + 75 CHCs)

81 (21 DHs + 35 SDHs + 25 CHCs)

170 (21 DHs + 35 SDHs + 114 CHCs)

81 (21 DHs + 35 SDHs + 25 CHCs)

* No. of operational FRUs, with - male sterilization services (not camp based)

- female sterilization services (not camp based)

- * Safe Abortion Services – MTP

170 (21 DHs + 35 SDHs + 114 CHCs)

* Desirable services

24 x 7 PHCs : Current Status (CONTD ..)Status

on 1st July, 2010(No. of facilities)

No. of planned 24x7 facilities 236

No. of operational 24X7 facilities, with

Normal deliveries conducted 24X7Essential newborn care services available

Availability of Referral transport 24X7 All the above 3 criteria

219205205

No. of operational 24X7 facilities, with

* IUCD services * Early and safe abortion services (including MVA)

* RTI / STI treatment or counseling

178

2. CURRENT STATUS: 24x7 PHCs

* Desirable services

24 x 7 PHCs : Current Status (CONTD ..)Status

on 1st July, 2010

(No. of facilities)

No. of SNCUs currently functional at DH level

No. of SNCUs planned for 2010-11 3

No. of Newborn and child stabilsation units (NBSUs) currently functional at FRU level

55

No. of NBSUs planned for 2010-11

No. of newborn baby care corners (NBCCs) currently functional at facilities where deliveries are conducted (PHCs, CHCs, sub-centres, etc.)

114

No. of NBCCs planned for 2010-11 236

2. CURRENT STATUS:NEWBORN CARE FACILITIES

2. CURRENT STATUS: FRUs & 24x7 PHCs : Existing Staff position in facilities (Nos)

Facility

OBG specialist

Anaesthetist

Paediatrician

MOstrained

inEmOC

MOs trained

inLSAS

MOs trained

in blood

storage

MOstrained

inBEmOC

Staffnurses

R A R A R A A A A A R A

DH 34 34 26 21 27 29 -

FRUs (SDH) 42 35 32 32 39 30FRUs (CHC) 112 92 Empanelle

d 112 61 14 936 86

4Facilities other than FRUs (above PHC level)

1

24x7 PHC (FMO)

236 189

- 944 730

Other PHCs 3Total 36

(18)36

R: Required as per GoI guidelines/ norms of respective facility irrespective of number of positions sanctioned ; A: Available, both regular and contractualEmOC refers to the Comprehensive EmOC training (including C-section); BEmOC refers to Management of common obstetric complications; LSAS refers to training in Life Saving Anaesthesia Skills

Facility

MOs trained in RTI/ STI

mgmt.

Staff nurse

s trained in RTI/ STI

mgmt.

LTs trained in RTI/ STI

diagnosis

MOs trained in MTP

LTs trained in

blood storag

e

MOs trained in F-

IMNCI

SNs trained in F-IMNCI

Doctors

trained in NSV

Doctors

trained in Lap

Ligation

Staff nurses trained in SBA

ANMs/

LHVs trained in SBA

A A A A A A A A A A A

DH

FRUs (other than DH)Facilities other than FRUs (above PHC level)24x7 PHCOther PHCsSub-centresTotal 846 1409 184 37 75 50 298 458A: Available, both regular and contractual

2. CURRENT STATUS: FRUs & 24x7 PHCs : Existing Staff position in facilities (Nos)

Medical Officers

Staff Nurses Total

Total Training load

800 800 1600

Training completed (2009-10)

Training completed 2010-11( April – June)

Training will be completed by September

State Level District Level

Total

No. of NSSK Trainers

TOT - to be conduct

2. CURRENT STATUS: NSSK TRAININGs

INSTITUTIONAL DELIVERIES IN GOVT. INSTITUTIONS: 2009-10

Institutional Deliveries in Govt. Institutions: 2009-10 Institutional Deliveries increased to 49.56% in 08-09 over 07-08

and further 32.20% in 09-10 over 08-09

SNInstitute/ Category

Institutional

Deliveries 2007-

08

Institutional

Deliveries 2008-

09

Difference In No.

of Deliverie

s

Institutional

Deliveries 2009-

10

Difference In No. of

Deliveries

1 DH 19991 22209 2218 26274 4065

2 SDH 12922 14151 1229 16923 2772

3 CHCs

a) CHCs (PHSC) 8434 13964 5530 22097 8133

a) CHCs (DHS) 281 874 593 1595 721

4 24x7 PHCs 1049 6859 5810 13872 7013

5 RURAL HOSPITAL 179 431 252 832 401

6SATELLITE HOSPITAL

309 553 244 775 222

7OTHER GOVT. INSTITUTIONS

1320 7492 6172 5586 -1906

Total 44485 66533 22048 87954 21421

INSTITUTIONAL DELIVERIES IN GOVT. INSTITUTIONS: 2010-11

SN Institute/ Category

Institutional

Deliveries (2009-10 upto June

09)

Institutional

Deliveries (2010-11 upto June

2010)

Difference in No: of

Deliveries

%age Increase in 10-11

1 DH 5023 5649 626 12.462 SDH 3339 3568 229 6.863 CHCs a) CHCs

(PHSC)4359 5432 1073 24.62

b) CHCs (DHS) 280 408 128 45.71

4 PHCs 2672 4016 1344 50.30

a) 24X7 PHCs 2623 4083 1460 55.665 Others 1395 1195 -200 -14.34 STATE TOTAL 17068 20268 3200 18.75

Type of Health

Institutions

No. of public institutions

conducting C-sections

No. of C- sections conducted

2009-10 2010-11 (April to June )

District Hospital

21 out of 21 DHs 8818 1855

Below DH level

110 (35 SDHs +75 CHCs)

4049+3060

=7109

867+734= 1601

C-SECTION IN GOVT. INSTITUTIONS: 2010-11

TREND- MONTH WISE INSTITUTIONAL DELIVERIES IN GOVT. INSTITUTES (2007-08, 2008-09, 2009-10 & 2010-11)

DELIVERIES IN CHCs AS FRUs (2007-08, 2008-09, 2009-10 & 2010-11)

DELIVERIES IN 24x7 PHCs (2007-08, 2008-09, 2009-10 & 2010-11)

JANANI SURAKSHA YOJANA

Estimated Number of Cases :

Estimated number of deliveries in a year in the State of Punjab =

5,00,000

Estimated number of deliveries of BPL/SC/ST @ 35% =

1,75,000

Estimated number of Beneficiaries upto 2 living Children @ 50%

= 87,500

Financial Assistance :

Home Delivery - ` 500

Institutional Delivery - ` 600/ 700 for Urban and Rural

womenTOP

Year Number of Beneficiaries %age Achieveme

nt (ELA 90000)

(Rs. In

Lakhs)

For Home/ Non Institutional

Delivery

For Institutional Delivery

Total

No.s % of total

beneficiaries

No.s % of total

beneficiaries

2005-06 7489 65% 4106 35% 11595 13% 71

2006-07 9466 59% 6613 41% 16079 18% 88.7

2007-08 16453 56% 12823 44% 29256 33% 171

2008-09 40350 59% 27561 41% 67911 75% 384

2009-10 54132 56% 42589 44% 96721 107% 565

2010-11 9041 48% 9790 52% 18831 21% 136

Yearly Progress JSY :


JSY BENEFICIARIES OVER THE YEARS

SN No. of JSY beneficiaries 2009-10

2010- 11(April – June)

1 Home Deliveries 54132 9041

2 Institutional Deliveries

a Rural 32376 7610

b Urban 10213 2180

c C- section (exclusive from above two)

- -

Sub-Total Institutional Deliveries

42589 9790

TOTAL 96721 18831


FAMILY PLANNING

S. No.

Status 2009-10

1 No. of female sterilisations (total) 65577

1.a Out of which, no. of minilap sterilisations

35365

2 No. of male sterilisations (total) 11127

3 No. of IUD insertions 272659

4 No. of IUD removals 43844

5 No. of sterilisation deaths 0

6 No. of sterilisation failures 6

FAMILY PLANNING

• All 20 DH, 35 SDH & 114 CHCs providing sterilization services

• Quality Assurance Committees constituted at all levels and are functional.

• Fixed day Tuesday for NSV and Thursday for Vasectomy throughout State

• Most of the District Quality Assurance Committees are Meeting regularly.

• Regular meeting of QAC at State Level.

• Consultant Quality Assurance, SHSRC has been appointed and will ensure the regular monitoring.

(1) SHORTAGE OF MANPOWER

Gynaecologists:

•All the 20 District and 36 Sub-Divisional hospitals have Gynecologists.

•Out of 117 CHCs, 34 CHCs are without Gynecologists.

Paediatricians:

•There is shortage of 63 Paediatricians. 6 in DHs, 13 in SDHs, 44 in CHCs

Medical Officers (Female):

•Out of 236 up-graded PHCs, there are Female Medical Officers in 189 PHCs and 47 PHCs are without Female Medical Officers.

3. KEY ISSUES IN EXISTING FACILITIES (FRUs & 24/7 PHCs)

(2) BLOOD STORAGE UNITS OF PUNJAB

• All the DH and SDH Hospitals have blood storage facilities.

• 25 CHCs out of 107 CHCs have been provided staff and

equipment for blood storage facilities. It would be made

functional very soon.

• The remaining 89 CHCs would be provided with Blood

Storage facility in the current year.



(3) EASY AND SUBSIDIZED ACCESS TO HEALTH SERVICES

• Free deliveries in all Government Hospitals since December 2008.

• Free treatment of school children in Government Hospitals since June 2009.

• Free treatment of school children for congenital heart disease and cancer in PGI at a cost ranging from 1 to 1.5 lakh per student.

• Jan Aushdi Stores for supply of generic medicines manufactured by Government PSUs setup in all District Hospitals in 2009. Punjab is the only State to cover all districts and out of 39 such stores in India 20 are functional in Punjab alone.

• Effective implementation of Punjab Nirogi Scheme for BPL families for assistance upto Rs. 1.5 lakh.

• Free treatment of BPL families without charging any user charges in all Government Hospitals.

• Regular Supply of medicines in all Government Health Institutions.

Major Challenges/ issues faced by the state relating to Adolescent Issues

•Alcoholism /Drug addiction .

•Socio Cultural barriers especially relating to honour and

shame.

•Lesser importance accorded to adolescent health issues,

especially those related to adolescent girls

•High prevalence of Anaemia especially among adolescent girls


• VHND in the state will be observed in the form of MAMTA Divas-

Wednesday.

• MAMTA Divas will provide holistic health services especially RCH

to the masses.

• To ensure participation of vulnerable social population i.e.

BPL/SC/ST .

• Services provided in VHND to be more strategized and

strengthened.

• All Sub-Centres of State have at least one ANM & 2nd ANM in the

Sub-centres with population more than 6000.

• All Sub-Centres of high focused districts will be provided 2nd ANM.

• To enhance the publicity for VHND.

3. KEY ISSUES: VHNDs

Under Maternal Health Programme• RCH Camps in Districts• MAMTA Divas• During 10/11, 20 PHCs/ rural hospitals of High

Focus Districts to be strengthened as 24x7 centres. • Human resource strengthening• During 10/11, all 114 CHCs will be made functional

as FRU. • Monitoring of works done by Gynaecologists by

setting benchmarks.

53

4. STEPS TO ADDRESS KEY ISSUES: FRUs & 24x7 PHCs

Under Child Health Programme • Sick Neo Natal Care Unit at Women and Children

Hospital, Bathinda, Jalandhar and MKH Patiala.• Baby Warmer and UV light units at all 24x7 PHCs

Training• Navjaat Shishu Suraksha Karyakaram (NSSK)• Skill Birth Attendant Training in all Districts• Emergency Obstetric Care (EmOC) Training • IMNCI Training of LHVs, ANMs, AWWs, to continue and

completed during this year• IUD Insertion Training using alternative methodology

54

Drugs and Supplies• Drugs @ ` 12 lakh per DH per annum – ` 252.00 lakh• Drugs @ ` 3.00 lakh for per CHC per annum - ` 387.00 lakh

• Drugs @ ` 5.00 lakh for 36 SDH – ` 180.00 lakh• Drugs @ ` 1.25 lakh per PHC/ RH/ SH per annum – ` 556.25 lakh


Quality Assurance During the F/Y 2010-11, 5 big District Hospitals will be taken for accreditation of NABH. The 5 hospitals will be:

55

SN Name of Hospital Sanction Bed1 Civil Hospital, Jalandhar 4002 Civil Hospital, Mohali 1503 Civil Hospital, Bathinda 2004 Civil Hospital, Ludhiana 200

5Special Hospital, Mata Kaushalya, Patiala

200

The department has already negotiated contract with Quality Council of India & the contract is likely to be signed soon.



Recruitment• State Government has taken out of the purview of

the Public Service Commission the recruitment of

Gynecologists and other specialists. We have held 2

rounds of recruitment and the third round is

process. The Gynecologists are refusing to join

CHCs.• About 33% of all Government Institutional deliveries

taking place in District hospitals. One extra

Gynecologist provided in the 6 District Hospital to

meet the increased load.

Recruitment of Specialists, MOs and Para Medicals The State Government gave special focus to recruitment of Medical Officers and other Paramedical Staff in the year 2009. Important posts that were filled up are–Regular: On Contract

Medical Officers (Specialists) – 76 Gynaecologists – 36

Medical Officers – 312 Paediatricians - 28

Medical Officers (NRHM)-102

Staff Nurse-1260

ANM - 954


Regular- On ContractMedical Officers (Specialists) – 128Interview starting in 8/8/2010

Medical Officers (NRHM) –

100

Medical Officers – 214 Staff Nurse – 548

Medical Officer (Dental) –

34+48Written Test of MOs on 8/8/2010 followed by interview

ANMs – 97

Recruitment in Process


Recruitment of ANMs and Staff Nurses

• All posts of ANMs have been filled up.

• Bigger 954 sub-centers (more than 6000 population)

have been provided with 2 ANMs.

• Most of the Sub-Centres in High Focused districts

will be provided 2nd ANM

• All the upgraded institutions have the requisite

strength of Nurses.

• The deputations of regular ANMs/Nurses have been

cancelled and the new recruitments were district

wise and made non-transferable.


Rationalization of posting and transfers:

• There was an acute shortage of doctors in PHCs and CHCs.

• Part of this shortage was on account of irrational

deployment of the doctors specially the specialists who

were deputed in excess of the requirement at

CHCs/PHCs/DH/SDH.

• Deputation cancelled

• As of now there is hardly any inconsistency in the posting

and transfer, specially of Gynecologists.


• Services of ICTC Counsellors at DH/SDH level for providing Counselling Services to adolescents on fixed day fixed time basis in afternoon sessions so that working of ICTC centers is not affected.

• To operationalize multi-skill Adolescent Friendly Health Centres in Medical Colleges.

• Special Adolescent Programme with NGOs.• Social Marketing of Sanitary Napkins.

4. STEPS TO ADDRESS KEY ISSUES: ARSH

STEPS TO ADDRESS KEY ISSUES:VHNDs

• Active involvement of PRI/VHSC members being

encouraged.

• VHND linked with immunization session across the state

and named as MAMTA Divas.

• Microplanning of sessions at the level of ANM/ASHA with

the involvement of PRI/VHSC

• Emphasis on Inter-sectoral convergence for effective

organisation of VHND

• Orientation of ANM to use untied fund at SC /VHSC for

supplies and publicity.

5. CURRENT STATUS SUPPORTIVE SUPERVISION: AVAILABILITY OF PROCESS

SN Key Aspects Status

1Whether a govt order issued for field supervision (e.g. officials identified for supervision, number of visits, etc):

Yes

2 Check-list prepared for field supervision: Yes

3 Whether a format for visit report available: Yes

4System for action on key issues raised in field visit reports: Yes

5

Provide details on frequency of visits by officials from each level and also the lowest level up to which they go for supervision (e.g. monthly/ weekly/daily and up to SHC/PHC/CHC/DH/Other levels):

All officers from PSHFW to SMO at least 2 vsits per month

5. CURRENT STATUS SUPPORTIVE SUPERVISION: AVAILABILITY OF HR SYSTEMS

SN Key Aspects Status

1Organogram including reporting structure available: YES/NO

Yes

2 HRD manual in place: YES/NO

Yes, Provisionally approved service rules

for contractual employees

3Job description available for all the supervisory staff (both contractual and regular): YES/NO

Yes

4Performance Appraisal system in place: YES/NO

Yes

5Dedicated HR experts available: YES/NO

Yes

5. CURRENT STATUS SUPPORTIVE SUPERVISION: HR AVAILABILITY

Sn.

Key functions for supportive supervision

StateDistrict/Division (no.s)

Block(no.s)

No. Avai

l.

No. Req

.

No. Avail

.

No. Req.

No. Avail

.

No. Req.

1

Assured Service Delivery: Operationalisation of facilities (such as FRUs, 24x7 PHCs, SHCs), referral services VHND)

2HR / Training (MH/CH/Imm./FP)

6 6 20 20 NA NA

3Quality of Service Delivery (PHN/Nurse-Midwives etc. for MH/CH/Imm./FP)

4 Data Analysis / Monitoring 5 5 40 40 117 117

7. CURRENT STATUS: MATERNAL DEATH REVIEW (MDR)

SN Key Functions Status

1Issue of Govt order making it mandatory for District Collector to implement Maternal Death Review

Issued

2Identification of State & District Nodal officer

Identified

3Orientation programme for state and district staff

Will be convened in August 2010

4Issue of guidelines to districts and facilities

Guidelines Issued

5Constitution of MDR committees/ task force at state, district and facility level

To be Constituted by August 2010

7. CURRENT STATUS: NAME BASED TRACKING SYSTEM

• All Formats and guidelines disseminated to all districts since January 2010, Pilot Training with help of NHSRC provided to all ANMs in District Ropar.

• Data capturing has already been started on Excel Sheet as provided by Government of India, reports of which have already been e-mailed to GOI (till May 2010).

• Training on e-MAMTA (Model of Gujarat) through e-conferencing provided to all district MEOs, DSAs and State Manager (M&E).

• One Information Assistant in each District Hospital, SDH and Blocks – Written Test on 22/8/2010.

8. KEY ISSUES & WAY FORWARD

Name Based Tracking • From 7th August the training for Name Based Tracking

with training on ANM Mobile Application will be started in all district simultaneously.

• Order has been placed for printing of revised Sub-Centre Registers based on PW and Child Immunization Tracking formats.

Maternal Death Review • Orientation of Stakeholders • Constituting, Activating and Sensitizing the District

MDR Committees• Implementation as per GOI guidelines

The PNDT Act will be strictly enforced to check female foeticide in the state

•109 Court Cases/ FIRs have been launched. 371 centers

have been suspended/ cancelled.

•Prizes announced for decoy customers, informers and for

sting operations in regard to violation of PNDT Act.

•83 Panchayats with sex ratio 1000 and above have been

honored with Rs1.50 Lac each.

•As per latest SRS survey of GOI, the child sex ratio which

was 798 in 2001 has improved to 841 in 2008.

•Balri Rakshak Yojna

9. GENDER & SOCIAL EQUITY

Amount given to Backward Pockets

•In the State PIP 10-11 special focus has been given to

four high focused districts. In these districts 2nd ANM is

being provided at all sub-centres to improve the service

delivery at village level. All the PHCs of these districts

are being strengthened for 24x7 services.

•Sub Plan for these districts have been prepared and

being submitted to GOI.

9. GENDER & SOCIAL EQUITY

Thanks

Documents

RCH – II SEVENTH JOINT REVIEW MISSION PUNJAB JULY-AUGUST 2010 AT NIRMAN BHAWAN, NEW DELHI