Sub Group Meeting PIP 2010-11 Madhya Pradesh 19.01.2010

Item

Title
Sub Group Meeting
PIP 2010-11
Madhya Pradesh
19.01.2010
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1/18/203

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Sub Group Meeting
PIP 2010-11
Madhya Pradesh
19.01.2010
•J

1

INDEX

Particulars

Page No.

1.

Overview

1-6

2.

Maternal Health

7-25

3.

Child Health

26-40

4.

Family Welfare

41-44

5.

ARSH

45-48

6.

Gender

49-53

7.

Urban Health

54-57

8.

HMIS

58-59

9.

ASHA

60-63

10.

VHSC

64-65

11.

Mobile Medical Unit

12.

Civil

67-73

13.

Quality Assurance

74-79

14.

Logistic & Procurement

80-84

15.

Routine Immunizaiton

85-89

Sr. No.

66

1/18/2010

The Plan has been prepared with a with
vision of over all improvement in the
health indicator and quality of life of the
people by ensuring, architectural
correction in the health care delivery
system

MADHYA PRADESH - Demographic Profile
Area (in sq.kms.)

3,08,000_______________

Population (Estimate 2009-10)

7,17,55,814

Male

f 3,73,77,604
' 3,43,78,210_________

Female
Scheduled Tribes
Scheduled Castes

1,45,44,904 (20.27%)
______ J

1,08,89,793 (15.18%)

Development Blocks_________

313 (Tribal blocks - 89)

Populated villages -

Gram Panchayats

52,117_________________
23,040_________________

Literacy ,J.;."

64.1 percent____________

Male

76.5 percent

Female

50.6 percent

Density of Population_________

196 per sq. kms.

Male-Female Ratio

1000 : 920_______________

Child Sex Ratio

919

1

1/18/2010

Goals
600

• 335 to 220
MMR

500 -

-.498

400 -

-408

— India
— MP

135

300 -

:54

200

220

100 -

100

0

1998

1992

• 70 to 60

2003

2006

2012

Years

IMR

120

-♦-India
♦Madhya Pradesh

100

• 3.1 to 2.8
TFR
Source (SRS)

40
1996

1998

2000

2002

2004

2006

2007

2008

- Situation Analysis
No. of Health Institutions in State
Health institutions

y

DH
CH
CHC
PHC
SHC

1998
36
57
228
1178
8835

Sanctioned Numbers
~~
2003
________ 39___
________ 57________
_______ 227_______
_______ 1194_______
8835

2009
50
57
333
1155
8869

Gaps As per 2001 Census
Health institutions

Requirement as per
2001 census

Shortfall as per 2001
census

CHC

333

Nil

PHC

1636

481

SHC

10144

1275

2

1/18/2010

Process of Planning
■ Consultative meetings at State and divisional level to sensitize
for decenterlized planning process.
■ Organise 3-day plan facilitation workshops for select districts
(Gol central team)
■ Block level meeting of block medical officers and BPMs
■ Meeting of field functionaries at Block level for developing
village plans
■ Village level plan preparation
■ Block level planning workshop
■ District level planning workshop of BMOs and field
functionaries
■ Facilitation of district workshop by State consultant and Dy.
Directors
■ Developing district plans and submission to State
■ Compilation of districts data to prepare State plan
•*

Plan Coverage
Coverage
Level of Plan
Village plan
(55392)

2010-11
(%)
60.0

Block plan
(313)

100

District plan
(50)

100

3

1/18/2010

Key Issues
• Shortage of skilled manpower,.
• Difficult outreach areas,
• Poor health seeking behavior of the community
• Lack of accountability amongst service providers.
• Poor presence of private sector in rural areas.
• High levels of malnutrition and anaemia in women and
children.

• Adverse sex ratio
• large share of population in Reproductive age bracket.
• High proportion of unmet needs for contraception .

Contd....
• The planning has been done with NRHM's mandate
of
making public health services 'equitable,
affordable and effective'. The focus is on addressing
the poorest and underserved populations with
substantial degree of flexibility, decentralised
management and enhanced accountability for
results.
• improving the health infrastructure, strengthening
health systems, promoting social mobilisation and
community participation,.
• incentivising performance and quality to retain and
attract human resources, and monitoring.

4

1/18/2010

Contd....
• District planning was done with a view to moving
away from prescriptive scheme-based micro­
planning and, encouraging Districts to develop need­
based work plans using innovative approaches.
• The resource envelope of 25% distributed well in
advance to district.

Approved and Proposed Budget
S. No.

Scheme/Program

Approved
Budget
2009-10
(Rs. in Crores)

Proposed Budget
2010-11
(Rs. in Crores)

1

RCH Flexible Pool

386.66

506.38

2

NRHM Flexible Pool

253.10

393.28

3

AYUSH

11.30

45.65

4

Routine Immunization

19.44

28.96

Total

670.50

974.27

5

1/18/2010

Budget Summary-NRHM- 2010-11
(National Program)
SL. NO.

ACTIVITY

1

NVBDCP

2

RNTCP

3

NPCB

4

NIDDCP

17.40

5

IDSP

1141.42

6

NLEP

477.17

7

Mental Health Program

702.00

8

Tobacco Control Program

79.88

9.

Deafness control programme

92.62

10.

Control of Diabetes, Cardio vascular & Stroke
Programme

498.00

AMOUNT (in lacs)
5545.54
2262.96
5545.68

Maternal Health Scenario
Current Status
(DLHS-3)

JSY
Assessment
Report 2009.

Target
(2010-11)

% of ANC registrations in first
trimester of pregnancy

33.8%

41.43%*

85%

3 ANC checks

34.2%

64.51%

80%

2 TT injections

60.4%

93%

90%

100 I FA Tablets

16.7%

37.1%

60%

% of births assisted by SBA

52.8%

83% *

95%

% of institutional births

47.1%

72.3% *

90%

% of mothers who received post
partum care from a SBA within 2
weeks of delivery

37.7%

40%

90%

MH Monitoring Indicators

* D&E Bulletin of DHS.

6

1/18/2010

MNCH - Continuum of Care
Community to Facility
Referral Transport

Community

EMRI&JEY

Facility

• Addressing anemia in adolescent
girls

• Operationalizing institutions for 24 hrs basic
emergency services with essential new born
. corners

• Ensuring
full
ANC
and
immunization
of children on
VHNDs

• Strengthening 120 institutions for CEmONC
Care

• Promoting institutional deliveries

• Provision of sick new born care services
through SNCU level I, II & III.

• Home based post natal care and
new born care

• Establishment of blood banks and blood
storage units in all CEmONCs

• Maternal death Audit

• Capacity building of health service providers
for SBA skills, BEmONC, CAC and essential
new born care services
• Facility based maternal death audit.

Interventions Based on EBS
► Increasing access to EmOC services
► Following evidence based practices - AMTSL,
Use of Mag.sulf etc.
► Improving coverage and quality of antenatal
and postnatal care through pregnancy tracking

► Strengthening referral transport facilities
► Increasing access to safe abortion services

► Providing RTI/STI services up to PHC level
► Strengthening
mechanism.

monitoring

and

evaluation

7

1/18/2010

Major Achievements
Progress in Institutional Deliveries
Home
Delivery

72.8

80

Other Private 27^|g
70

Facility
5%

47.1

60
50

26.2

40

30
20

10
0

accredited
Private Fac
ility
0.2%

15.9

B

7

NFHS-1(1992- NFHS-3(2005- DLHS-3 (200793)

Govt. Facility
67.8%

06)

08)

JSY
Assesment
(2008)

% of JSY Beneficiaries - 68%

Janani Suraksha Yojana - catalyst in increasing
institutional delivery
Year

Physical Target

Physical Achieved

2008-09

1370880 inst. del.

1148831

2009-10

1306736 inst. del.

747493 (84.80%) (Nov.)

Payment through bearer cheque;
Grievance redressal mechanism in place.

Quality of
monitored

services

for

deliveries

Help desk establishment in DH

■ Instiluliooal Del.

aJSY BeneO.

1600000

13 70880

1400000 |

1296740

148831

1200000

1oooooo
881437

Two days post natal stay along with
immediate
breast
feeding
and
vaccination

819902
800000

599199
600000

I 97442
400000

200000
0

2005-06

5006-07

2007-08

2008-09

I

2009-10

8

1/18/2010

Improving Quality of Essential Obst. Care - ANC check ups
• DIO designated as MCH Officer
to monitor VHNDs.

70

64.5

60

• Focus on ANC check up on
VHND

50

• Mobilization of each Pregnant
Women by ASHA.

40
30

• Ensuring early registration of
pregnancy by Nischay Kit

20

10

• SBA training of ANMs on quality
ANC and PNC checkup.

0
DLHS-2 (200406)

DLHS-3 (2007- JSY Concurrent
08)
Assesment
(2009) UNFPA

V

Contd.
• Tracking
of
each
Pregnant
Women
through UID Number.

45

Status of IFA Consumption
38.1

40
35

30

• Promoting
IFA
consumption on pattern
of DOT services by
ASHAs
• Refresher training of
ANMs on quality ANC
and PNC checkup.

25
20

15

16.7

1T.8
8.5

10

5

0
NFHS-3 (200506)

DLHS- 2
(2004-06)

i
DLHS- 3
(2007-08)

JSY
Concurrent
Assesment
(2009)

9

1/18/2010

Efforts towards Facility operationalisation for EmONC
Services
Year

Physical Target

Physical
Achieved

2009-10

120

83 (Dec.'09)
■ DH

■ CH

so
41

40

I

35

46

44

45

■ CHC

36

31

30
25

21

18

20

16

14

15

8

10

16

6

5

0

2005-06

2006-07

2007-08

2008-09

2009-10

(Type of Institution)

STATUS OF FUNCTIONALITY OF CEMONC
April 2005 & Dec. 2009

w i •

•1*0

•ac

I No CEMONC
□ •1 CEMONC
® *2 CEMONC

G •> 2 CEMONC

10

1/18/2010

Operationalizing BEmONC
Year

Physical Target

Physical Achieved

2009-10

500

406 (Dec.'09)

Strategies adopted Contractual appointment of medical & paramedical staff

Ensuring quality through BEmONC and SBA Training
Infrastructure up-gradation with respect to 24x7.

i

i

450
400
350
300
250
200
150
1OO
50
O

326

358

2006-07

2007-08

384

406

2008-09

2009-10
(Dec.)

296

2005-06

Year

contd....


40 Blood Banks, 60 Blood storage

units established


Level

II

Sick

&

New

Born

Care

functional in 14 District Hospitals.



124

CEmONCs

&

64

BEmONCs

institutions providing Safe Abortion

Services.


4000 additional beds sanctioned to

cater increased case load.


Capacity building of health service

providers through BEmONC and SBA

training to ensure quality

11

1/18/2010

contd....


Establishment
hospitals.

of 20 bedded maternity ward in

27 district

• Staff duty room with toilet in 44 CEmONCs
Upgradation of labour room in 53 and OT in 27 CEmONCs.



• Janani Sehyogi Yojana PPP initiative for EmOC and MTP Services

i

11,1

.

- —- '

R

i

>

■t
H

Addressing HR Issues in Operationalizing FRUs and
BEmONCs
► HR Policy Change to address Staff Crunch : Pay Hike
at all levels :
► Post Graduate Specialist salary from Rs. 26,000/- to
35,000/-,
► MOs salary from Rs. 20,000 to 26,000
► Staff Nurses : Rs. 9,000 to 10,000/-.
► ANM Rs. 5500 to 6000/►

Enforcement of Rural Service bond for Doctors:



Compulsory 2 Years Govt, service for fresh
graduate and post graduate doctors.

► EMoNC and LSAS training of MOs


6000 posts of medical and paramedical post sanctioned.

12

1/18/2010

Responding to the Second Delay Janani Express Yojana
Year

Physical Target

Physical Achieved

2008-09

313 Blocks

298 Blocks With 3 Call centers

2009-10

313 Blocks with 10 Call
Centers

287 Blocks with 6 Call centers
December 2009

Year 07-08 jEY

Year 08-09

21%



JEY
^^30%

Year-09-10

JEY
40%

(%) JEY out of Total Rural JSY Beneficiaries

> Scheme Evaluated by UNFPA per patient referral cost Rs.371

State Specific mechanism - referral transport system


Janani Express Vehicle (Emergency Express scheme) to mobilize all
pregnant women for institutional deliveries, medical and surgical
emergency and ensure transport of sick children



Referral transport fund incorporated in incentives of ASHA to be used for
operationalizing of scheme.



Establishment of call centers in all district.

13

1/18/2010

Accreditation of Sub Health Centre
District Anooppur
SHC

• 125 Remote Sub Center$\
upgraded in
state for 24 x 7
Safe deliveries
• Accreditation Criteria developed.
DH
18%

Others

District Guna

_6%

SHC

.7%

Madhya Pradesh

PHC
.27%

CHC
35%.

Shc

Others_______ -------------------------2%

PHC

c
DH

25%

23%

Trainings 2009-10
MH Training

EmOC Training
• LSAS Training
• BEmONC training
• AYUSH doctors
• SBA training (ANM+LHV)
• SBA training staff nurse
• Blood storage training

Physical Target

Physical Achieved (Nov.)

32 MOs
16 MOs
396
76
576
384
224

23
4 Batch is in process
95
45
380
159
195

Integrated SBA training in process incorporating infection prevention, safe
abortion counseling skills, IUD insertion, RTI/STI counseling.

40 Gynaecologists & 84 Staff Nurses (Master Trainers) of all districts
oriented in Integrated SBA Training Plan.
State quality assurance cell in place for monitoring of EmOC and LSAS
training.

14

1/18/2010

Maternal Death Review
• Notification of each maternal death has been
taken on priority, GO issued to all District
Collectors.
• Community based maternal death audit
(MAPEDIR) is under implementation in 4
districts of the state with UNICEF support.

IMPEDING FACTORS IN REDUCING MMR
• Scarcity of specialists and para medical staff.
• Lack of private sector at sub district level.

• High prevalence
women.

of

anemia

in

pregnant

• Incomplete provision of full ANC by service
providers.
• Learning
of training not reflected in
performance
• Governance issues in managing services.

15

1/18/2010

MATERNAL HEALTH (Financial Status)
Rs. In Crores

2009-10

Budget
Sa net.

Exp.
(till Dec.)

%

2010-11

Budget
Planned

MH

6.78

2.41

35.55

MH

24.48

JSY

248.32

150.34

60.55

JSY

202.08

MH Trainings

3.57

1.12

36.00

MH Trainings

7.92

Maternal Health (RS in lacs)
Budget head

Total budget
(Rs. in lakhs)

Remarks

Operationalise CHCs/ SDHs/ DHs as FRUs
Upgradation of Maternity Wing including
establishing Model Labour Room (In 50 DH) as
per the need based proposal submitted by
districts.
Ensuring evidence based practices in labour room
through FOGSI
Renovation of labour room, OT and equipments
including labour tables at sub districts CEmONCs

0.0075 Crore from 13th finance
comission, Technical support
from UNICEF

UNFPA support

100.00 For identified 35 sub district
CEmONCs.

33

16

1/18/2010

Keeping pace with increased delivery load
-Focus on Quality
► Rs. 75 Crores sanctioned Comprehensive Maternity
wing for extension of Maternity ward , labour room.
OT complex, Observation room.

► 10% hike in salary after completion of one year
service.
► Provision of contractual specialists in 7 difficult
district
hospital
(Anooppur, Sidhi, Singrauli, Dindori, Umaria, Sheop
ur, Alirajpur).
► Provision of 3 LMO and 6 SN for maternity wing in
district hospital.

Difficult Area Allowance Proposed:
Institutions being categorized into normal/difficult/most difficult/ for
ensuring availability of doctors and para medical staff to those posted in
CEmONC and BEmONC


S.No.

Type of
Institutions

Normal

Difficult

Most Difficult

Total

1.

PH_______

43

07

0

50

2.

CH_______

56

0

0

56

3.

CHC

212

94
(17 CEmOC &
65 BEmONC)

27
(7 CEmOC &
17 BEmONC)

333

4.

PHC

522

476
(120
BEmONC)

157
(42 BEmONC)

1155

35

17

1/18/2010

District Hospital as Difficult Area
Madhya Pradesh
■ MOREN A' BHI ND
(January 2010)
JWAUORZ C
V^ZDATA

SHEOPUR KA LA

SHIVPURI
TKAMGARH
JUN^SHOK NAGAR'I
CHHATARPUR

REWA

iNEEMACH

IRAN N A,

SATNA

MANDSAUR

[SIDHlLSINi
'RAJGARH'

,ra£am'4^shVa'pu5.

ALU

'BH< ’AV

X.UJJAIN, J*

'

WISH A J SAGAR

1AULI

IDAMOK XATNI /J SHAHDOL"
5
lUMARIAx. V>

T*->\Z^ABALPUR4
RAISEN
Fanu^ur1
SEHORE
r
NARSINGHPURv^£
'•JHABUA
■dind
/T
INDOREdewAS
rMANDL!A‘ ,
•HIOS HA NGABAD
DHAR /
_-,L ,
SEONI
JPUR
s
HARDA'
GH HINDWAR A
Legend
'BALAGHATj
BETUL
/

.rwanL^

District Boundary

f

ACCESS

’BURHANPUR

® ji£>

■i Difficult

o

75

160

| Normal

300 Kilometers

JICAtMP Reproductive Health Project

Health Facilities Identified as
Difficult/Most Difficult Area
Madhya Pradesh
4
(January 2010)
O

^SHIVPURI,
O 4

f HI .mgaS
iR

IHAWRR^
' O \

iEMACH*

<0 Lj •

J PANNA

"J/o^KA-T
k)

,,, O.?.©
»o dAMoyr

^habJa^V

kr ’E®

A-J

t o ^^T^ey^RALSBr: □

<Mpha^

ESafe J 0 J

'7-«^lARSINGHPBR-<fC
VASq

■ Legend

:‘o

CHARl

/-■ -y
...;o L°
iko.

LO f*
ibAT

o

| ~

| District Bounder/
| Bock Boundary

O

CHC



CH

ACCESS
H Most Difficult

jlCAJ

0

75

150

300 Kilometers

Difficult

j Normal
JICAIMP Reproductive Health Project

18

1/18/2010

Proposed incentive for difficult and most difficult
area
Difficult Area
S.No. Doctors/Para Medical
DH

1

PG Doctors &
EmOC/LSAS Trained

CH

CHC

CEmONC BEmONC

20000

25000

20000

15000
10000

20000
12000

20000
12000

PHCBEmONC

Doctors___________

MBBS Doctors

3

Para Medical Staff

S.No.

1

2
3

Doctors/Para Medical

DH

PG Doctors &
EmOC/LSAS Trained
Doctors__________
MBBS Doctors____
Para Medical Staff

CH

Most Difficult Area
_______ CHC
CEmONC BEmONC

25000
15000

PHCBEmONC

30000

25000

25000
18000

25000
15000

30000
18000

Total amount proposed - Rs. 96,95,04,000/-

38

contd
Rs in lacs
Budget head

Operationalise PHCs to provide 24hour services
Strengthening of CAC Services

Total budget
(Rs. in
lakhs)
65.00

Remarks

9.80

RTI/STI Services

3.00

Operationalise sub-centres for
essential obstetric care

21.25

UNICEF technical
support

39

19

1/18/2010

Contd.
Rs in lacs
Budget head

Total budget
(Rs. in lakhs)

Remarks

Referral Transport System
Establishment of Call Centers (With Technical
Support! of UNICEF) in 34 remaining districts
(Except EMRI districts) © Rs. 2.00 Lacs

68.00 Technical support by UNICEF

Running Cost of existing Call Centers @ Rs.

27.36

24000
Running Cost of New Call centers @ Rs.

Running cost of Emergency Express Yojana

35.28
2000.00 Referral cost incorporeted in
incentive of ASHA/motivator
under JSY will be deducted from
her package in every case and it
will be used for agreement of
________ Emergency Express Vehicle)

Contd.
Rs in lacs

Budget head

Public Private Partnership - Janani Sehyogi

Yojana__________________________
Strengthening of Sub health Centres for
accreditation to conduct normal delivery

Community based Maternal death auditNotification and tracking of maternal deaths
through ASHA, ANM and supervisor________
Facility based maternal death audit in All
Districts including Medical Colleges________
Hiring of 7 Training Coordinators for
monitoring of Maternal Health Training (1 at
State Head Quarter and 2 each at Regional
training centers)________________________
Addressing Anemia through distibution of DFS

Total
budget (Rs.
in lakhs)

Remarks

101.00
25.00Extra Cost will be met
from untied and
maintenance grant of
____ SHC______________
10.00Technical support from
UNICEF.
5.00Technical support
___ UNICEF and UNFPA
0.00 As per RCH/NRHM
Norms by UNFPA

0.00 Micronutrient initiativei

20

1/18/2010

Janani Suraksha Yojana
Rs in lacs
Budget head

Unit Cost Total budget
(Rs.)
(Rs. in lakhs)

Home deliveries (40000)

500

Rural Beneficiries of JSY under
Institutional deliveries is 85% of
institutional delivery (and Target for
institutional delivery for 72%)
(905328)__________________________
Urban Beneficiries of JSY under
Institutional deliveries is 85% of
institutional delivery (and Target for
institutional delivery for 90%)
(290192)__________________________
Other Strategy/activities (Under JSY)
District level I EC & administrative
expenses (3%)_____________________
State level I EC & administrative expenses
(0.5%)____________________________
TOTAL JSY

1750

15843.24

1200

3482.30

Remarks

200.00 As per honorable
supreme court
instructions

585.76
24.40

20208.90

Maternal Health Trainings
Rs in lacs
Budget head

(MH Trainings)

Total budget
(Rs. in lakhs)

_______________

One time grant to training sites @ Rs. 55000 per DH

27.50

Integrated SBA @ Rs. 127980 Per Batch (Minimum 3 Batch per District) and
refresher training of ANM/LHV at each block_____________________________
BEmONC Training of Medical Officers (one batch of 4 medical officers) Minimum
3 Batches per Districts @ Rs. 77600 per Batch

431.88

Monitoring of training session by divisional program management units,
RHFWTC, SIHMC and IMNCI Coordinators @ Rs. 50000
Functioning of State Quality Monitoring Unit for EmOC and LSAS-Training_____
Up gradation of 4 Medical Colleges for LSAS Training (Including hiring of One
Computer Operator at Rs. 6000 per month)

5.50

Up gradation of 13 District hospital as training sites of LSAS training
EmOC Training
Life saving Anaesthesia skills (LSAS) training

MTP training

RTI/STI Trainings

116.40

8.00
8.00

13.00
56.19
40.23
47.00
34.48

21

1/18/2010

PROCUREMENTS
Rs in lacs

Budget head

Total
Amt.
in Lakhs

Remarks

_________

Obstetricts Record Card for BEmONC and
CEmONC and Medical Colleges___________
Printing of BEmONC, SBA, RTI/STI Training
Module, Facilitators guide and hand book
Printing of jaccha bachha Card for Use of ANM

50.00ll0.00 Lacs card

Provision of Uristics and Hemoglobin colour
scale
___________________________
Provision of I FA tablet in PNC

0.00 From State budget

Provision of Drugs for Medical Abortion at DH

0.00 From State budget

Provision of MVA Kits

Provision LLIN in SHC with API>5 not covered
ay IRS

5.00
5.00

From State budget

0.00 From State budget
1000.00

44

SAFE ABORTION SERVICES

GoMP signed Moll with Ipas to increase
access to safe abortion services.

22

1/18/2010

STRATEGIES
Training of Doctors to increase provider base .

Quality services.
> Early abortion.
> Ensuring availability of equipments
> Use of new improved technology.
> Responsive behavior of providers.
> Reporting & Record Keeping

I EC

DLCs made functional.
PPP - Janani Sahayogi Yojna

Activities
Operationalized 13 training sites.
> Strengthening-Training Aid, MVA Kits.
> Conduct TOT & Refresher TOT.
> Assessment of case load.
Two types of training .
> Certified Providers - Refresher Training
Duration 6 days.
> Certification Training-12 Days.
Every Batch is provided supportive supervision during the
training.
Integration of MTP Training in EmOC training.
No. of Doctors trained
> 12 Days - 317 (65% are providing services.)
> 6 Days - 241

23

1/18/2010

Contd...



Trainee tracking.
Performance monitoring on surgical procedure of
individual Doctors.
• Non - performing MO's.
> Hand holding - Consultant IPAS to provide on the job Hands-on technical support.
> Refresher training / attaching to DH.
• Pvt. Doctors sensitized through FOGSI/IMA/CME on
safe abortion services.
• Principals ANMTC's sensitized on role of ANM in safe
abortion services . Module developed, incorporated in
course curriculum.
• Integration of Safe abortion component in SBA (ANMs)
training.

Contd...
• Monitoring system strengthening ; Field visits by Govt. &
Ipas, Record keeping & Reporting.
• Block program managers oriented on safe abortion services.
• Medical method of abortion included in the reporting
format.
• To Prevent misuse of MMA, Information notice (for doctor
& chemist) is in process of publication in newspaper.
• Ensuring availability of consent & opinion forms.
• IEC material; ANM information booklet & Posters prepared,
for wide dissemination.
• Orientation workshop for principals of GNM-schools.
»:♦ Total 170 CEmONC's & 100 BEmONC's to be made
functional.

24

1/18/2010

Child Health Scenario
Key Indicators

M.P

IMR

70 (2008- SRS)

NMR

45 (NFHS-III)

U5MR

94.2 (NFHS-III)

Process Indicators (DLHS-111)
Neonates breastfed within one
hour

42.9%

Infants breastfed exclusively till 6
months

31.5%

Children under 3 years age
underweight

60.3%

Children under 3 years age 2 weeks
received ORS

29.9%

Interventions Based on EBS (Child Health)
■ Operationalizing sick newborn care services through SNCUs at
CEmONCs
■ Establishment of new bom comers

■ Integrated management of neonatal and childhood illnesses (IMNCI)
■ Home Based Newborn Care (HBNC)

■ Management of severely acute mal-nourished children through
NRCs
■ Promotion of IYCF practices

■ Bal suraksha Mah for Vitamin Supplementation and deworming
■ Promotion of ORS with zinc in diarrhea management.

■ Capacity building of service providers for providing child care
services

25

1/18/2010

Strengthening Facility Based New Born Care- SNCU level-11
• Establishment of SNCU level II
at DH CEmONCs • 13 SNCUs functional
• 16
construction
under
process
• New Positions of 4 Pediatrician,
12 Staff nurses and 2 lab
technicians created separately to
run each unit.
• 13880 newborns treated &
11826 lives saved till date.

J

1 I
SNCU-!evel 2

SNCU level-ll
BHD

Functional-13

O

> Under Construction-16

GLR
DTA

Site Selection done- 21

O

SVP

RWA

UN

AKN
PAN

STN

SDH

NDSz—A

SJP\
R™C

rjg

SA

DHR

BP

IVDL
SNI

/ HRD

7

dr^anp

NSP

DWS

KND^“y
BRW

KTN

DMH

UJN
SHE

A r1

VDS

COW
BLG

KRG

.BHP

26

1/18/2010

Admission and Death Status in SNCUs level-11
12001

12000 I

Total Admissions -13880
Lives saved - 11826
Death -15%

■ Admission
■ Death

10000

8000
6000
3067

4000 -

1686

2000

0

2007-08
1 SNCU

2008-09
8 SNCU

2009-10
Upto Dec. 09
13 SNCU

Essential New born care services
SNCU - Level-1






10 SNCU level-1 are functional at CHC
CEmONC.



SNCU Level-1 has 3 additional Staff
Nurses and essential resuscitation for
stabilization of sick newborns.

CHC Beenaganj,

New Born Corners
New- Born Care Corners established at all CEmONC
386 Newborn Corners functional in BEmONCs & other PHCs

Pediatric Intensive Care Unit


PICU established in Guna

• Under process in Bhopal & Ujjain District Hospitals.
• Additional staff - 2 Paediatrician & 6 Staff Nurses

27

1/18/2010

TRAINING ON NSSK

• ToT

NSSK

of

(Navjaat

Shishu

Suraksha Karyakram) of all districts

42

completed

i

• 125 master trainers trained in five
medical colleges with Gol & IAP

•4’-‘ >■

support.
• District

level

trainings

planned

i

I

Ik €
€ L.

from January 2010.

IMNCI
• Operational in 18 districts
• Training completed in Guna & Shivpuri.
• Four districts - Sehore, Vidisha, Datia & Bhind in consolidation
phase.
• Supervision through MUD in Shivpuri district will be replicated in
all IMNCI districts.
99%
100
80

60.2%

60

40
20
0 -

72.9%

58.4%

II

Training Status

28

1/18/2010

Implementation status of IMNCI Programme
82.85%

90
80
70
60
50
40
30
20
IO
O

70.95%

II

Home visit
within 24 hour

3 Home visit
within IO days

7.3%

10.42%

Sick Newborn
referred (O2month)

Sick Newborn
referred (2
month-5 year)

Rapid Assessment of IMNCI Strategy done in Shivpuri
District

HBNC

n

J

HBNC:

•ToT workshops completed - 18 state level & 84
block level trainers
•3934 ASHAs in place, will be trained in 131 batches
(Jan-Feb 2010)
•State specific Module for ASHA on Newborn care
and Nutrition will be developed.
YASHODA:

•54 Yashodas at 3 District Hospitals - Since October
2008, served 14073 mothers till Dec 2009.
•17 Yashodas recruited in 3 blocks of Hoshangabad.

29

1/18/2010

Infant and Young Child Nutrition

55.9

55.7

(1-3 Years)

(3-5 Years)

60i
80 i

41.2

501
59.1

53.9

60 ■

40

15.6
4.2 j—

20

Moderate

13.7

20-

10-

0

----------------F

Normal

-

30-

!5.2

0

30.6

40-

Severe

Normal

Moderate

I BIAP OWHO |

Severe

| HAP OWHO I

Nutritional status of children by different standards

Addressing the problem of malnutrition in the State
through prevention and treatment strategies

/'——\
<

Prevention strategy >

/.-■TO
I - ' '
Bal Suraksha Maah

1

________ „ „

IYCF Training

r.
'

■■I

1
____________________
| Treatment strategy - Management of SAM

30

1/18/2010

Infant Young Child Feeding Practices (IYCF)
Activity

Re­
Orientation

New
Training

136

135

Orientation of Master trainers of IYCF
trainings (divisional)

5065

Field level worker (ANM /

AWW)

trained
counseling skills.

in 3 in 1 IYCF

Improvement in IYCF practices
■ DLHS-II

Breast Feeding Counselor placed at
16 districts hospitals with UNICEF

51.5%

■DLHS-III

43.1%

support.

28.8% [

2r4%B

59 SST centers in NRC for < 6 m SAM
children to support breast feeding

Children breast fed
within 1 hour of birth

children 0-6 months
exclusively breast fed

Breast Feeding Week organized in all districts
from 1-7 August 2009
_ ____________

Bhind^j__ [\

I p lA:i -A i-UH .A
aic C'T ufc ■* JRf fitwi.l .MtJf I
q XI -ri
liter .’I'ir 4c .4<sz itan? 1
Ip u wp.t*J>a«i«wr41
V

4 i

Jabalpur

f

-4'

(istrjsr.l

____________ OTbiwmh

__________________

<|j| mIckIUcE SMdl ^Idl B Rl Cbl
EEZSEj

Rewa

fSSW?

'>’*»<«nmnJwniwmHiMnwis4>***<

IB ffl®

Khandwa

31

1/18/2010

Bal Suraksha Maah

<1 n ito i
88%

Xs

<0*

X'

X X X X
X X .X -X

Xs

X'

1^'

• Bi-annual Vitamin "A" supplementation with De-wormming
• 2nd round of Bal Suraksha Maah organized from (5th Oct. to 15th Nov.
2009)
• Services ensured by ANM & AWW at Aanganwadi centres

J

.Bal Shakti Yojana
• To
manage
severe
malnourished children

• Facility Based Model
• All the 50 districts
equipped with at least
one NRC in the District

• NRC 199 functional, 34
partially functional

i ita

• Planning for Community
based Therapeutic Care

/XcPVA'E- -

PVV

\ SGU

po

Q3ia J
32

1/18/2010

Severely Malnourished children treated at NRCs
30000 -i

25000 -

24614

25167

2008-09
(150NRCS)

2009-10 Dec.
(199 NRCs)

20000 -

15000 -

11953
10000

7182
5000 ■

0

2006-07
(39 NRCs)

2007-08
(76 NRCs)

Best Practices in NRCs
________
Before

MUAC of SAM Child

After

Unique SAM No. for
each admitted Child

Counseling Charts for
counseling mothers

Supplementary Suckling Technique
(SST) for <6m SAM Child

• Length of all children
•Good MIS

Follow up at NRCs

33

1/18/2010

Severe Acute Malnutrition C $■ (A

• In India - treatment restricted to Facility

• New Evidence - large cases of SAM without
medical complication can be treated in their
Communities - Joint UN Statement

i

Madhya Pradesh has developed an Integrated Strategy for
Management of Severe Acute Malnutrition

Monthly Growth monitoring by AWW into
Normal, Moderate and Severe underweight categories

Children in Moderate

Underweight category

Enrolled in SEP by

------v AWW---------

MUAC to be done by ANM
on VHND and examined

o

k for medical rnmpliratinn >

MUAC >11.5

2

Children in Severe
Underweight category

MUAC<11.5cmAppetite test to be
done by ANM on

_____ VHND_____

V__ .

X

Children with
Bilateral Oedema
and/or

Admitted in NRC,
WHO Protocol,
Transferred to OTP on
stabilization

34

1/18/2010

INTEGRATED MANAGEMENT OF SEVERE ACUTE MALNUTRITION

MUAC <11.5cm - Appetite
test to be done by ANM on
VHND
Appetite test Pass
Appetite test
Pass without
Medical
Complicatioi

Appetite test Fail

Bilateral
Oedema

Admitted to OutPatient Therapeutic
Feeding Program
(OTP) for 2 months
RUTF ration by AWW y

4

Post 2 months enrolled in

Admitted in NRC,
WHO Protocol,
Transferred to OTP on

Medical
Complication
•Anorexia,
•Lower respiratory
tract infection,
•Severe palmar
pallor,
•High fever,
•Severe dehydration,
•Not alert

4

Budget - Child Health
Rs. In Crores

Year 2010-11

Activity

Budget Planned

Child Health

18.34

HR&
Infrastructure

12.00

Training

7.93
25.60

Procurement

Civil
BCC

3.12

0.25

35

1/18/2010

Plan for 2010-11
• Level-Ill SNCU-

2Medical College.

• SNCUs level-ll -

21 district hospitals.

• SNCUs level-1-

50 CEmONC CHCs.

• PICU-

11 district hospitals.

• F-IMNCI trainings of Medical Officers & Staff Nurses.
• IMNCI scale up in 2 more districts.

• District level NSSK trainings -100 batches.
• Community level management of SAM children without
medical complications.

• Accreditation of CEmONC as BFHI (Baby Friendly Hospital
Initiative).
• Promotion of Zinc with ORS in Diarrhea cases
• Development of ASHA module for Newborn care
Nutrition

and

Child Health Plan 2010-11
Budget Head

Physical
Planned

Amt.
in Lakhs

2.1 Integrated Management of Neonatal and Childhood Illnesses (IMNCI)

Implementation of IMNCI in 20 districts

20 districts
(18 existing + 2
new)

83.00

29

540.00

2.2 Facility Based New born Care

Maintenance cost and HR of SNCU level-ll
Establishment of remaining 21 districts
Budget)

(State

Cost of Bubble C-PAP, Portable Machine, ABGA
Machine and Ventilator s (State Budget)
SNCU level - 1 50 CEmONC institutions

50.00

Maintenance cost and HR of PICU
3
Establishment of 11 New PICU @ 40 lacs (state
Bueget)

15.00

36

1/18/2010

Child Health Plan 2010-11
Budget Head

Physical

Amt.

Planned

in Lakhs

2.3 Management of Malnutrition

Running cost of NRCs and Quartely Meeting

30000

1060.00

Micronutrient Supplementation & Deworming

50 districts

55.30

Dissemination of standard treatment protocol of 50 districts

20.65

through Bal Surksha Mah
2.6 Management of Diarrhoea

Management of Diarrhoea, promotion of use of

Zinc with ORS, procurement of zinc

Child Health Plan 2010-11
Budget Head

Physical

Amt.

Planned

in Lakhs

2.4 Home Based Newborn Care

Home Based Newborn Care in 4 districts

4 districts

NIPI
Support

2.7 Other strategies/activities

Workshop
Supervisory

and

Visit

Conferences
by

of

National

IAP

and

and

State

840

Facilitators
Total Child Health

1834.00

37

1/18/2010

Child Health HR and Infrastructure
Physical

Amt.

Planned

in Lakhs

29

972.63

50

145.86

PICU salary of staff (Paediatrician & SN)

3

42.30

New born Corners

200

40.00

Budget Head

SNCU- level -2Salary of 4 Paediatricinan, 12 staff nurses, 2 Lab

Techinician, Support Staff and Data Entry Operator
in each
SNCU- level -1

Salary of 3 Staff Nurse and Support Staff

Total

1200.79

Child Health Training
Physical

Amt.

Planned

in Lakhs

SN - 20

20

118.27

FUS 41

20

514.71

Training

100

78.00

290

82.65

Budget Head

F- IMNCI Training (MO- 60 batches ,

batches)

IMNCI Training 263 HNT batches and

batches

Navjat

Shishu

Suraksha

Karyakram

(NSSK)

IYCF Training 290 batches

Total

1200.79

38

1/18/2010

Child Health Procurement
Physical

Amt.

Planned

in Lakhs

20

60.00

Procurement of Therapeutic Food for Management of

1 lakh

2500.00

SAM children in OTP (Out Patient Therapeutic Feeding

children

Budget Head

Printing of Modules (Worker's, Physicians, FUS. F-

IMNCI Medical Officer & Staff Nurse)- State Level

Program) for 1 lakh children

Total

2560.00

v

Child Health Civil
Budget Head

Establishment of

50 SNCU

level 1 in functional

Physical

Amt.

Planned

in Lakhs

50

125.00

46 N PCs

187.50

CEmONC or CHC where Pediatrician is available (Civil

Work 2.5 lakh )
Construction of Incomplete NRC's (Ongoing)

Total

312.50

Printing of Management standard treatments protocol

2.50

for Diarrhea & ARI management for workers

39

1/18/2010

Family Planning Physical Progress (in Lakhs)

S.no.

Annual Service Achievement
Need
2005-06

Programmes/
Activity

Achievement
2006-07

Achievement
2007-08

Achievement
2008-09

1

Sterilization

5.83

3.67

3.67

4.58

4.40

2

I.U.D.

6.63

4.53

4.61

5.01

4.95

3

Oral Pill Users

7.77

5.54

5.59

6.15

6.28

4

Condom Users

17.75

13.16

13.58

17.1

15.99

Physical Progress of Family Welfare
(April'09 to December'09)

S.N.

Programme / Activity

Annual
Service Need
(in Lakhs)

(in Lakhs)

% age
Achievement
of Annual
Service Need

A

B

C

D

E

Achievement

i

STERILISATION

7.00

2.8

40.1

2

I.U.D.

6.20

3.07

49.5

3

ORAL PILL USERS

8.30

5.72

68.9

4

CONDOM USERS

18.61

12.70

68.2

*

40

1/18/2010

Contraceptive Prevalence Rate

NFHS-2

« NFHS-3

- CVS

68
62

56

44

ia_
i

I
Any Method

Any Modern Method

Unmet need for Contraception

NFHS-3

-CVS

19

11

11
8

5

All methods

Spacing

6

Terminal

41

1/18/2010

Challenges
Health system-based:
□ Only about 50% CEmONC health institutions providing limiting
contraception services.
□ Lack of counseling and clinical skills amongst paramedical staff
for IUD
□ Shortage of lady medical officers in rural health institutions
□ Inadequate follow up of training
□ Increasing effective couple protection rate
□ Access to quality family planning services
Community-embedded:
□ Belated acceptance of terminal contraception method (largely
only after 3 and more children)
□ Male participation is very low
□ Decision making autonomy of women continues to be poor

Proposed Strategies
□ Capacity building of service providers
□ Incentives to surgeons

□ Ensuring availability of laparoscopes
□ PPP in rendering quality FP services (JSK's Prerna & Santushti
schemes)

□ BCC campaign for promotion of family welfare services

□ Strengthening post partum sterilization services
□ Increased access to quality FP services- fixed day LIT camps
□ Expanding the choice of spacing methods of contraceptives

42

1/18/2010

Budget Planned-2010-2011
• Sterilization Camps

• Compensation
• Trainings
• Counselors Hon.

• Incentive to Surgeons
• State NSV R.Centre

• State Female ster. R.C.

480 lakhs
5350 lakhs
98.70 lakhs
112.32 lakhs
100 lakhs
16.75 lakhs
10 lakhs

Adolescent Reproductive & Sexual Health
•To create an conducive environment for adolescents .

• To educate adolescents and increase awareness on
ARSH issues.

•Building capacities of health service providers for

delivering AFHS.
• To strengthen health delivery system for delivering
AFHS.

•To address adolescent anemia with the vision for
subsequent reduction in IMR, MMR & TFR.

43

1/18/2010

Key Challenges
• Due to high birth rate the population pyramid has large
numbers of adolescent population entering into reproductive
age
• Poor sensitivity in health service providers in ARSH issues
• Poor health seeking behavior in adolescents.
• High incidence of anemia amongst adolescents (future mothers)

• Ignorance in adolescents regarding physical & psycho social
changes
• Lack of appropriate of IEC/BCC activities
• Implementation needing inter-departmental coordination.

Strategies
• Creating an conducive and friendly environment for
adolescents for promoting health seeking behaviour.
• Operationalising adolescent friendly services in 22 new
district hospitals.
• Capacity Building of services providers for increased
sensitivity for ARSH issues.
• Enhanced communication activities with adolescents.
• Promoting menstrual hygiene in marginalized tribal
adolescent girls.
• Holistic health checkups, hemoglobin estimation and
addressing adolescent anemia, both in school & out school
adolescents.
• Strengthening IEC/BCC for ARSH.

44

1/18/2010

ACHIEVEMENTS
rartMBU- --------|

• State level ARSH TOT for identifying master trainers &
cascade mannered training of district officials.
• Establishment of 60 adolescent clinics in identified
adolescent districts.
• Outreach health activities for village level adolescents .

*•

New Initiatives
• Operationalisation of new Adolescent Clinics in 22 district
hospitals.
bHc
• Strengthening of existing adolescent clinics by providing
specialists services at 7 divisional HQ adolescent clinics.
• Five days inter-department state level consultative
workshop for developing communication content on
ARSH issues.
• Adolescent Anaemia Control Program for 11-17 years
9
Adolescent Girls (AACP).
s
• Reaching out adolescent girls in tribal girls hostel
(Aadivasi kanya aashram & Aadivasi kanya chatravas).
• Support to State Adolescent Research & Resource Centre
for improving adolescent health and creating awareness
about healthy lifestyle.

45

1/18/2010

ARSH PIP 2010-11
Total budget
(Rs. in lakhs)

Budget Head

Adolescent friendly services

11.60

Strengthening
existing
of
adolescent clinics
Communication Strategies

9.66

Other strategies/activities

74.5

Capacity Building
Providers

of

7.5

Service

34.64

ARSH PIP 2010-11
Budget Head
Reaching out adolescent girls in tribal
girls hostel (Aadivasi kanya aashram &
Aadivasi kanya chatravas)
Adolescent Anaemia Control Program
for 11-17 years Adolescent Girls
(AACP)_________________________
TOTAL

Total budget
(Rs. in lakhs)
3.50

8.00

149.40

46

1/18/2010

Gender PIP - 2010-11

•To ensure effective implementation of

PC&PNDT Act

•To ensure Gender equity in Health

Services

PRESENT SCENARIO
• Child Sex Ratio (2001 Census)

lndia:927
»

Madhya Pradesh : 932

• Further decline in Child Sex ratio after
2001
• Cause : Sex selective elimination of girl
child
• Total Sonography Centers in MP. :1307
(Pvt. 1225, Govt. 82)
• 81 Percent sonography centers are
situated in 16 districts

47

1/18/2010

Key Challenges
• Sex Selective Elimination of Daughters
• Poor Participation of Women in Health & Development Issues
• Access of Quality Health Services to Vulnerable Social Groups
• Women are on receiving ends as far as health service delivery is
concern.
• Women experience religious or cultural barriers in accessing
health services.

• Male participation in the contraceptive use is negligible.


Men engage in risky sexual behavior and transmit infections to
women.

Strategies
• Advocacy and Awareness Generating activities from State level.


Establishing & functioning of 40+ Clinics.



Implementation of PC & PNDT Act.

• Operationalize Cell- The PC & PNDT .


District level workshops for implementation of PC & PNDT Act.

• Youth Group Mobilization



Meeting of Advisory Committee & Supervisory Board.
I EC/ BCC interventions.

48

1/18/2010

Strategies
• PC & PNDT Act Implementation Strengthened through
Capacity Building and Sensitization of Judicial Officers and
Legal Professionals

• Gender Training To Be Cross Cutting Theme In Every
Training

• Monitoring of Sex Ratio At Birth And Infant Mortality of
Boys And Girls
• Organization of events and campaign.
• Printing of Gender Tool Kit

V

EFFORT SO FAR

• Analysis of Ultra-Sonography Centers.

• State level advocacy interventions (celebrate special days)
• Mobile medical health units fully operational in 116 tribal
areas covering geographical inaccessible areas.
• Strengthening of accountable and transparent health
system.

• Equity through JSY.

49

1/18/2010

New Initiatives


Orientation workshop of MLAs on PC PNDT



Orientation of Women PRI members on Reproductive health and
domestic violence



Establishment of new 40+ clinic in Rewa



PC & PNDT Act Implementation Strengthened through Capacity Building
and Sensitization of Judicial Officers and Legal Professionals.



Youth Group Mobilization



Organization of events and campaign.



Printing of Gender Tool Kit

GENDER PIP 2010-11
Budget Head

PC-PNDT State Plan: Advocacy and awareness activities from state level & division
level.

Total
budget
(Rs. in
lakhs)
15.00

State level: conducting rally/event on PC-PNDT

12.00

State level:' Research on the child sex ratio in the state of MP

4.00

Advocacy and awareness activities at district level on sex selection issues and
concerns and implementation of PC-PNDT Act.

60.00

Hiring services: State level consultant

6.24

50

1/18/2010

GENDER PIP 2010-11
Budget Head

Total budget
(Rs. in lakhs)

Functioning of PC & PNDT Cell, at state & district level

14.00

Printing of Gender Tool Kit

5.00

Strengthen the services delivery of 40+ Clinics Indore, Bhopal,
Gwalior, Jabalpur, Ujjain & Rewa

12.00

Orientation workshop of MLAs on PC PNDT

10.00

TOTAL

138.24

v

Urban Demography in Madhya Pradesh






Total Population of the State - 60 million
Urban Population -16.1 million (27% of the total population)
Urban Poverty - 38.4 %
Total Slum Population in 43 towns and cities - 2.4 million
Cities Having Population over 1 lakhs- 26

Changing face of population in Madhya Pradesh

• Decadal growth rate (1991 - 2001) of MP
- Total Population - 24%
- Urban population - 31 %
- Rural population - 22%

Source: Census 2001; Poverty Estimates, Planning Commission, 1999-2000

^10
51

1/18/2010

Mapping of health Facilities and Urban slum

Development of Urban Health Programme in view of the
following..

• Rapid increase in urban poor population compared
to population growth.
• Health indicators for urban poor/slums are lowest
• Existing health infrastructure is unsuitable to
spatial distribution, large population and 1st tier
and 2nd tier service delivery requirements
- Inadequate development of health infrastructure
particularly in small and medium sized towns.
• Resource constraints of urban local bodies lead to
insufficient number of service providers causing :
- Improper work distribution.
- Duplication and leaving a large number of under
served pockets.

52

1/18/2010

Key Challenges
• Low health seeking behaviour of slum dwellers
• Lack of data on actual number of urban poor
• Inappropriate location of health posts
• Inadequate health infrastructure and less manpower in
public sector
• Weak Health Services Coverage in slums
• Lack of coordinated planning among Stakeholders
• Poor hygienic & sanitation conditions
• Low literacy & awareness among slum dwellers

•»

Key Strategy
• Detailed Urban Health Plans as per catagorization of
urban slums
- Separate Roles and Responsibilities under each urban health
component.

Up gradation of urban health & Family Welfare centre
Capacity building of Human Resources
Maternal and Child Health camps in cluster of slums
Community Participation
Involvement of private sector for services delivery
Coordination with urban local bodies and other
stakeholders.
• Quarterly reviews and appraisals with stakeholders








53

1/18/2010

Community level activities conducted by USHA

r

I1 J 4s

JB

If S-(

i

-J

Dissemination of health messages - CBO
members counseling pregnant women
during outreach session

Trained Slum Volunteers encourage
women for ANC checkups during
outreach camps

Lt'S

QJ
I
Immunization tracking - identifying left-outs
and drop-outs through slum mapping

4^

Information and community
motivation - CBO members singing
health songs

Achievements 2009-10
• Spatial Mapping of slums and
health facilities in all 8 cities.
• Establish 7 Urban Health Centre
through Public Private Partnership
• Extension of Maternal health, Child
and FP outreach services.
• 600 USHAs and 10 social mobilizers
selected and trained

Particulars

Male

Female

Total No. of
Children Examined
(0-12 year)

13015

16557

Total No. of
Adolescent
Examined(10-19
year)

990

1741

Anti Natal Checkup
Immunizationchildren

Total

29572

2731

14711
1962

3058

5026

• 135 Ward Arogya Samitis activated.

ImmunizationWomen

3982

• 230 outreach RCH camps organised.

High Risk
Pregnancy

1675

Pathological
Investigation

6513

General Patient
examined

11728

48321

60049

54

1/18/2010

Urban Health-2010-11
Activity

Physical
Planned

Financial
Budget in
Lakhs

Data base of slum dwellers of 4 cities (In coordination with 4
MPUSP)________________________________________________

2.00

Hiring of staff (additional Human resource - Medical Officer)

6

14.40

Hiring of staff (additional Human resource - ANM )

50

59.40

Strengthening of Health Facilities in Identified Cities

20

20.00

Strengthening health facilities -Untied fund

50

12.50

Rent of Existing Centres

10

9.60

Organization of Outreach health camps at slum to provide
Maternal Health, Child Health, Family Planning services

416

41.60

Orientation of District level officials of health and Urban Local
bodies on health and hygiene issues

2.00

TOTAL BUDGET

161.50

0^)5^ "

HMIS - Major Challenges
• Inadequate IT equipments and related

facilities (Electricity)

• Inadequate Human Resources
• Lack of MIS related skills in the health

functionaries

• Weak feedback mechanism
• Quality of data

55

1/18/2010

HMIS - Proposed Strategy
• Establishing Integrated Monitoring & Evaluation Units (IM & E U)
• Establishment of IM & EU with the help of TAST

( one State Coordinator

and three Data Analysts).

• Posting of SO, ASO and other staff in the state unit, assigning specific roles
and responsibilities.


100% recruitment of block level computer operator/ M&E assistant.



Recruitment and M&E Assistant/Computer Operators at Civil Hospitals,

15D

CHCs other than Block Head Quarters.

• Expanding the role of computer operators placed for JSY monitoring -

HMIS- Proposed Strategy
• Capacity Building of end users for
• operationalization of facility wise HMIS.

• Name based Tracking for Pregnant Women and
Child Immunization.

• Equipping field officials with computers,
laptops and high speed broadband connectivity.

56

1/18/2010

HMIS-Plan 2010-11
Budget Head

Unit of
Unit Cost
Budget
measurement
(Rs.) (Rs. in lakhs)

Monitoring of Operationalization of
Mo of units
NBT, HMIS and Facilities through field
visits & documentation, checklist and
others
Procurement of Hardware and
Software and other equipments_____
Printing of reporting/Recording and
Mo of Districts
Village Health Registers-

5000

MH Activities

544.51
100000

Workshops/Trainingon M & E/HMIS

Quarterly review meeting of CMHO &
DPMU/BPMU staff at the state level

217.80

Remarks

50.00

Gol HMIS Formats
and State designed
■ecording format,
Village Health
Registers

pN J-4

115.55
Mo of Meetings 500000

Total

20.00

947.86

ASHA
• ASHAs have gained faith of community & built
rapport with providers
• Actively involved in VHNDs

• Support system inadequate, ANMs/ LHVs given

responsibility. Distt. Community Mobilizer, BPM
also involved

• Additional ASHAs for better coordination with

AWWs, convergence for community action

57

1/18/2010

Selection of ASHA

• One ASHA for 1000 population in place, additional
selection to be co-terminus with AWC
• 45,971 ASHA selected. 60,000 by March 2010

• Selection process complete, Gramsabha meetings
after Panchayat election.

• Target: 71, 291 by end of 2010-11

ASHA Training
• 93% of selected ASHA
Training of ASHA

trained for Module 1
• 82% for Module 2

• 81% for Module 3
• 70% for Module 4

• Module 5 yet to be

45000
40000
35000
30000
25000
20000
15000
10000
5000
0

42551

37778
32275

Module 1

Module 2

Module 3

Module 4

started

58

1/18/2010

ASHA Training
• Refresher training of ASHAs started

• In 2010-11, NGOs will be involved in all ASHA~
strainings
• Selection and orientation of NGOs will be done at

state level
• Special focused training on Newborn care. Nutrition

and HIV planned---------------- --------------

• ASHAs being trained for malaria, T.B. also

ASHA Mainstreaming
• Monthly meetings of ASHAs proposed at
block level
• Payment of incentives through e-transfer on
monthly basis
• Monthly refilling of drug kits .
• ASHAs will have a diary and village health
register
• Specific indicators for performance monitoring
being developed

II

59

1/18/2010

Incentives to ASHA
• Incentive to ASHA proposed for ensuring
consumption of IFA by anemic mothers evidence based payments
• Incentive also proposed for mobilizing RTU
STD cases for examination
• Incentive for DOTS provision & detection of
TB cases
• Additional incentives for malaria in identified
districts

ASHA - Physical Progress 2009-10

Act.
Code

Activity Proposed by State

Physical
Target

Physical
Achieved

Remarks

1.1

Training of ASHA Module 1 -4

100% trg

70-93% trg

Will be 90% by
Mar. 10

1.1

Module 5 training

100% trg

0%

Will be started by
Feb 10

1.2

ASHA Support System

100%
placement

0%

Resigned, did not
join

1.3

Incentive to ASHA for mobilizing ANC & PNC
cases

100%

27.41%

being done

60

1/13/2010

ASHA - Plan 2010-11
Activity
Code

Activity

Physical Target

Proposed Budget
(Rs. In Lakhs)

1.1.1

Selection of additional ASHA

11000

1.1.1-4

ASHA Training - Module 1-4

Trg of 23000-43000 ASHAs

2058.00

1.1.5-11

ASHA Module 5 Training

Trg of 38000 ASHAs

722.00

1.4.1

Refresher Training of ASHAs

Trg of 40000 ASHAs

760.00

1.2.1-6

Salary and expenses of ASHA Support
System

1.2.7

ASHA Mentoring Group Activities

Quarterly meeting and field
visits

10.00

1.3.1

Best performance award to ASHAs at district
level

Best performance Award

9.39

1.3.1

Payment of Incentives to ASHA

100% Incentive payment

1838.00

1.3.2

Monthly meetings of ASHAs

281.70

Total Budget

5786.05

1

106.96

Village Health & Sanitation Committee

• Multiplicity of committees constituted by
different departments
• Capacity Building of VHSC members
• Meetings not held regularly

• Poor utilization of untied funds and submission
of utilization certificate

61

1/18/2010

Village Health & Sanitation Committee
• Integration and reconstitution of VHSC as the
"Swasth Gram Samiti"
• Capacity Building of SGS Members - through
SATCQM
• Mandatory monthly meetings of the Swasth Gram
Samiti.
• Disbursement of untied fund in two installments,
compulsory submission of UC within six months

SWASTH GRAM SAMITI
• Ad-hoc committee of the Gramsabha duly
constituted under the Panchayati Raj Act
• 50% of the members to be women
• ANM, AWW, ASHA to be ex-officio members
• ASHA will be secretary/jt. Secretary
• SGS will have three separate accounts
• Health fund account will be operated jointly by
the Chairperson and ASHA

62

1/13/2010

VHSC- Plan 2010-11
Activity
Code

Activity

Physical Target

2.1.1

Reconstitution of VHSCs
as SGS

52117

2.2

Untied fund to 100%
VHSCs © 10,000

52117

5211.70

2.3

Orientation of VHSC
through SATCOM

2 rounds

64.60

2.4

Monthly meetings of
VHSC

52117 X 12

2.6

Development of Village
Health Plan

Total Budget

Proposed Budget
(Rs. In Lakhs)

52117

5276.30

Mobile Medical Units
• Operational in 91 tribal blocks under the +
Deendayal ChaIit Aspatal scheme

S' S

(J,

• Solo activity for tribal health in NRHM

• Popular and been able to provide basic health
care services to the tribals

• Health infrastructure poor in tribal blocks,
shortage of manpower persists
• Being up scaled to SC/ naxal affected blocks
with state budget

63

1/18/2010

Mobile Medical Units Plan 10-11
Activity
Code

Activity

Physical
Target

Proposed
Budget
(Rs. In Lakhs)

201

Provision of mobile health clinics
for rendering quality RCH & FP
services

91

1820.00

20.2

Technical Support for Monitoring
of Mobile Health Services
Total Budget

6.00

1826.00

Civil Plan 10-11
Objectives:


General Improvement of existing Infrastructure



Creation/Construction of SHC,PHC & CHC as per Population norms



Upgradation of Facilities as per IPHS norms

Strategies:


Construction of New buildings as per population norms in each category
particularly SHC & PHC



PHC level buildings to be provided with staff quarters



Upgradation/Construction of CEmONCs (DH/CH/CHC) and BEmONCs
(CHC/PHC)



Upgradation of CHCs as FRUs and then finally as per IPHS



Construction of Doctors Quarters at Block Level (CHC & PHC level)

64

1/18/2010

Situation Analysis
No. of Health Institutions in State

Sanctioned Numbers

Health institutions

1998
36
57
228
1178
8835

PH
CH
CHC
PHC
SHC

I

2003

I

2009
50
57
333
1155
8869

______ 39______
______ 57______
_____ 227_____
_____ 1194_____
8835

451 PH 2a

Gaps As per 2001 Census

Health institutions

Requirement as per
2001 census

Shortfall as per 2001
census

CHC

333

Nil

PHC

1636

481

SHC

10144

1275

v

Status of Health Institution Buildings
Type of
Health
Institution

Total No.
Functioning

Available
Buildings
as per
norms

Functioning
in buildings
less than
norms

Buildings
Under
Constructs
on

No. of
Buildings
Required to
be
Constructed

District
Hospitals

50

41

9

5

4

CHC

333

190

143

71

72

PHC

1155

994

161

97

64

SHC

8869

6443

2426

912

1514

65

1/18/2010

Financial Need


Infrastructure gap fulfillment requires approx. Rs 2000 Cr
investment for construction and upgradation of Health
Facilities.

• State Budget supports app.Rs 50.0 Cr. every year


NRHM Additionality Funds support app. Rs 50.0 Cr. every year

• The gap filling will take pretty long time due to this limited
funds availability

• State envisages resource pooling from various sources like One
time grant from Planning Commission, Financial assistance
from 13th Finance Commission and NABARD Loan
• The Infrastructure development needs special attention for
financial assistance

Achievements :Year 2004 onwards..
nos

wells

9 DH.90 CMC,284 PHC,462 SHC.145 Staff Quarters,3
20 bedded maternity wards from State Head
13 No. PHC, 432 SHC.132 Staff Quarters under NRHM
14 Level II SNCU
21 nos 20 bedded Maternity Wards
7 nos 20 bedded Paediatric Wards
Labor Rooms in 37 BEmONCs
Operation Theatre's in 9 CEmONCs
Female Staff duty rooms with toilets in 60 FRUs
2 No. Blood Bank at DH Sidhi and Datia
Establishment of blood storage units at 60 CEmONCs
Drinking Water facility in 30 CEmONCs by drilling tube
and laying pipe line
Construction of 14 drug Warehouse cum CMHO office
buildings

66

1/18/2010

Budget 2010-11
Total Proposed Budget

ACTIVITY

13296.10

STRENGTHENING OF SUB-HEALTH CENTRES

4103.80

STRENGTHENING OF PHCs

2311.50

STRENGTHENING OF CHCs

1549.50

STRENGTHENING OF ANM TRAINING
CENTRES

185.00

STRENGTHENING OF IN-SERVICE TRAINING
FACILITIES

520.00

LOGISTICS (Drug Warehouse cum CMHO office
buildings)

600.00

UPGRADATION OF HEALTH CENTRES AS PER
IPHS(Maternity & Paed.
Wards,SNCU,NRC,Mechanised Laundry,OPD,Labour
Rooms.General Infrastructure etc)

4026.30

Corridor at DH Neemuch Before &
AfterRenovation
1

W iT

I
*

■*

F ■1

J

t1

i

1

-

i-C*.

I

67

1/18/2010

A View of Maternity Wing of DH Ujjain
Before & After Upgradation

■■'‘ IF
■*

-

Corridoor Before and After Renovation

II' >1'<

i

-

iM'j
mW

w

r’/.
b&”y
I

F^'V. S'l

1/

68

1/18/2010

Exterior View Before & After Renovation
Sankhya Raje Maternity Wing at DH Ujjain

A -I
J

rnrrT
k

a

JIS
.*■

I

?

S’' ? '

:

PHC Gosalpur, Distt. Jabalpur

mrt
.

■-

11 -■

69

1/18/2010

Maternity Ward at District Hospital Neemuch

^4

sa.

I!

Drug Warehouse cum CMHO Office Building

ilfy |[ 'fly' I yy

|

F!

1-

^TH"!BB I**

If

70

1/18/2010

Quality Assurance
• GoMP has taken up the challenge of meeting NABH
& ISO Standards


In the year,2007 State has an agreement
with
Quality Council of India for providing technical
supports on NABH accreditation of 5 district
hospitals(Bhopal,Jabalpur,Guna,Mandsaur & Satna).

• Quality assurance committees are monitoring NRHM
activities and interventions.

*•

The Journey so far.
>lh.j Tpg &Taqa&»Aoftwrw-T^PlTpKMr^tnrs^«icn*few««J^
• Quality Assurance cell has been
established at the State, Division &
‘did jiluid*
district level.
• SOPs as per NABH/ISO norms have
been prepared.
• Seven health care institution has been ir.__ __ ___ __—
_S
certified for ISO 9001: 2000
• Pre-assessment of J.P Hospital was
fe>...0dl A&wm <t>S •<$
carried for NABH accreditation.
• All major license/NOC/certificates
which are mandatory for any hospitals
F^'ilL i
have been obtained.
w’r-**^r-^TT/’'*- "'“aft* '7
xent qctGolfexMAZ 4KMT y
IVPltHoAiMfeeli
■»

KSs



. OO

7

y

1
BO I-—fcgasggj

71

1/18/2010

Work in Progress
• Two more district hospital have been taken for
ISO plus certification(Jhabua & Mandla). t He''
• Baseline for Hospital Acquired Infection for
the district hospitals: Inception report
prepared.
• Mechanized laundry in district Shivpuri &
Guna will be installed soon.

• Help desk in each district hospital.
• Quality Operational Manual under review.
• Detailed Hospital Dietary services manual
prepared.

Kngir arggCTrcT 'bi

=»n

rd^i^SW^T^T c6<A<*<i<
Tft’qr R4*t>iRi>i
I
^07

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c>»ifac<nfH8ig£FT UrA

. ...... ...' .
fe?!obeli CtI

<^•1

I <4 I

UX ®ss^-

iniW

=2

------- tsdSfe —

JSSs

NaihUd^iwi imiHiia

-34<-Mlaic*i

oj itHTI

!r=«'a'.c.'trc'«t

m n.^-iY

72

1/18/2010

Initiatives- infrastructure dev.- District Hospital, Guna
Maternity ward-

before

now

,liE
I ■
»

iisiiiiii

SS.iiliuiii

&=

liijmiDi

I

iiiiLiIiiiil

f

M 1

General ward- Dist. Hospital, Guna

before

now

73

1/18/2010

Sanitation
before

now

Ambience
before

now

s ■
*■ a

I'Bp

r

jh

Sv '1. ;

74

1/18/2010

Challenges
• Low ownership on quality of care.
• Fulfilling structural resource gaps.

• Fulfilling equipment resource gaps
• Fulfilling human resource gaps.
• Sensitization of health functionaries.

1/18/2010

150

New Initiatives
• Outsourcing of Hospital Cleanliness for 6 district Hospital.
• Ethics and empathy training of MOs.

• Establishment of Mechanized laundry in 25
District Hospital(300 plus bedded).
• ISO certification in 10 Community Health Centre.

• Hospital Infection control manual.

• Operationalisation of improved hospital dietary
services in all the District Hospitals.
• Provision of safe drinking water(RO system).

• Hospital managers in all District Hospitals.

r
75

1/18/2010

PIP 2010-11
Budget Head

Total budget
(Rs. in lakhs)

Accreditation of 5 District Hospital and 4 CHC

33.00

Establishment of ISO certification in 10 CHC and 2
District Hospital(On site team/M&E/Capacity
Building/Travel Cost/Technical fee/citizen charter etc.)

130.00

Strengthening of Quality Assurance Cell(QAC) at
State, Division & District Level.

30.00

Training on Bio Medical Waste Management for district
hospital staff at divisional level.

14.00

Total

207.00

Drug Procurement Cell
• The State has a Drug Procurement cell headed by Director
Procurement , Joint Director-Procurement, two Deputy
Directors, Consultant (logistics) , SO(PC) and AO(PC) assisted
by Office Staff at the directorate of Health Services MP.
• After the decentralization in August 2009 the District
warehouses were converted into CMHO Drug Stores. The Civil
Surgeon has a separate Stores in the District Hospital.


Now 80% budget would be allocated to districts and 20%
would be kept at the state level for procurement. If this 20% is
not used by December this part would also be allocated to the
districts

Activity

Level

Amount
(in lac)

Construction of drug Stores in 7 districts and handover of
17 Warehousesand its implementation

State

600.00

76

1/18/2010

Proposed activities: Procurement Summary
S.No

Activity

Amount
(in Rs lac)

1.

Maternal Health

562.75

2

Child Health

2919.00

3.

Family Planning

500.00

4.

Infrastructure-Dietary

410.00

5.

HMIS

6.

ASHA

300.00

7.

School Health

277.58

8

Pro-MIS

75.00

9.

Laptop, LCD, Projector, For in one model No. 7340, (Fax
Machine, Printer, Scanner & Copier) for RHFWTC

1.10

TOTAL

Remarks

Reflected
in HMIS

5045.43

Proposed activities: Procurement for maternalhealth
S.No

Activity

Level

1.

Obstetrics Record Card for BEmONC and
CEmONC and Medical Colleges

State

2

Printing of Training Module, Facilitators guide State

Amount
(in lac)
50.00
2.00

and hand book for BEmONC Training
3.

Printing of Training Module, for SBA Training, State
Accreditation Guidelines for PHF and for SBA
Training

4.

Facilitator guide for SBA

District

0.13

5.

Hand book for SBA

State

1.50

6.

ATI/STI Modules

State

0.75

7.

Printing of jaccha bachha Card for Use of

State

5.00

3.50

ANM

77

1/18/2010

Proposed activities: Procurement for maternal health
S.No

Activity

Level

Amount
(in lac)

8

Uristics and Hemoglobin coular scale

District

From State
budget

9

Provision of I FA tablet for PNC

District

From State budget
(144.00 lakhs)

10

Provision of Calcium citrate for PNC

District

From State budget
(1800.00 lakh)

11

Kitting of RTI/STI drugs for sub district
hospitals (CEmONCs and BEmONCs)

District/Block

From State
budget

12

Provision of Drugs for Medical Abortion at DH

District

From State
budget
(3.00Lakh)

13

Provision of MVA Kits

District

From State
budget (3.90
lakh)

14

Provision of LLIN /ITN in all districts in sub
health centers with API>5 not covered by IRS

District

500.00

TOTAL

562.75

Proposed activities: Procurement for child health
S.No

Activity

Level

Amount(in lac)

1

Printing of Modules (Worker's, Physicians, FUS. F-IMNCI
Medical Officer & Staff Nurse)- State Level

State

60.00

2

Cost of Bubble C-PAP & Portable X-ray Machine,and
ABGA Machine SNCU-level-2 @ 6 lacs/districts for 29
dists

District

174.00 lakhs

3

Neonatal Ventilator SNCU-level-2 @ 6
lacs/districts for 10 dists

District

60.00 lakh

4

Establishment of 50SNCU level 1 in functional
CEmONC or CMC where Pediatrician is available
(Equipments2.5 lakh/district)

District

125.00 Lakh

5

Establishment of PICU (Shivpuri, Vidisha, Sehore, Bhind, Jabalpur,
Katni, Chhindwara, Ratlam, Mandsaur, Hoshangabad,Khargone)11

District

From State
Budget

6

Procurement of Therapeutic Food for Management of
SAM children in OTP (Out Patient Therapeutic Feeding
Program) for 1 lakh children

District

2500.00

7

Procurement of Zinc tablet (20% of u5 children x three
episodes x 14 tablets)

District

From State
Budget

8

Procurement of Antihelmentes (Albendazole 400 mg)

District

From State
Budget

Total

2919.00

78

1/18/2010

Proposed activities: Family planning/Infrastructure/HMIS
S.No

Activity

A

Proposed activities: Procurement for family
planning

1

Purchase of Laparascopes, repair and maintenance

B

Proposed activities: Procurement for
Infrastructure Strengthening

1

Procurement & Establishment of Equipments for Dietary
Department for District Hospitals-41

Level

Amount
(in lac)

State

State level activity
for, repairs
maintenance
500.00

District

410.00

Total
C

Proposed activities: Procurement for HMIS

1

Printing of new formats/ recording formats/ health
registers (Reflected in RCH under HMIS )

410.00

Proposed activities: Procurement for ASHA/School Health
S.No

Activity

A

Procurement for ASHA

1

Monthly Provision of drugs for ASHA Drug Kit

Level

Amount
(in lac)

District

300.00

300.00

TOTAL

B

Proposed activities: Procurement for School
Health Programme

8

Drugs and Equipments

District

250.00

9

Budget for medical records

District

26.58

10

Printing cost of referral cards

District

1.00

TOTAL

277.58

79

1/18/2010

Proposed activities: Procurement for Pro-MIS
S.No

Activity

Level

Amount
(in lac)

A

Procurement for Pro-MIS

1

Total Procurement Pro-MIS

District

TOTAL

75.00
75.00

S.No

Activity

A

Procurement for RHFWTC

1

Leptop, LCD, Projector, For in one model No. 7340, (Fax
Machine, Printer, Scanner & Copier) for RHFWTC Jabalpur

Level

Amount
(in lac)

TOTAL

RHFWTC

1.10
1.10

ProMIS
i.

2.

ProMIS is a web based scalable and technically versatile
model
to
bring
about
increased
transparency,
competitiveness,
timely supplies,
record
keeping,
complaints handling, and informed decision making.
This software has been successfully implemented in M.P
and training has been provided at District/Block level on use
of this software.
The cost will basically have following components:
1. Cost of Software (ProMIS)
2. Cost of Hardware
3. Cost of web based networking
4. Cost of Training
5. Cost of Hand on Support

80

1/18/2010

Routine Immunization

Current Scenario


Full Immunization coverage/36.2%)



9.8% children do not receive any vaccine



20 districts below state average, 12 showing reverse trend

• BCG coverage high ( 84.2%) due to success of JSY


High drop out rates

Source: District Level House hold Survey 3

81

1/18/2010

Challenges
• Wide Gap between Reported & Evaluated data
• High Cold chain sickness rate
Vaccine stock outs


Alternate Vaccine Delivery not fully operationalized



Inadequate monitoring by the supervisors at various levels



Migration in Tribal areas

Progress so far....
S.N.

Strategy

Achievement

Session Planning and Operationalization

1.

Micro-Plans Updated

All Districts and Blocks

2.

Social Mobilization

Payment to ASHA streamlined (72%
Exp. Was expected till Dec'09 against
which 66.17% Exp. Has been achieved)

3.

Alternate Vaccine Delivery
System

Partially Operationalized as 52% Exp.
Has been incurred till Dec'09

82

1/18/2010

Progress so far....
S.N.

Strategy

Achievement

Capacity Building

4.

Medical Officers

400/3250 (Sep'09 to Dec'09)

5.

Health Workers

12000/18000

6.

Cold Chain Handlers

All (1417)

Supervision & Monitoring

7.

Supervision and Monitoring
from Districts and State

55% Exp. Has been booked till Dec'09

8.

Regular Review of Rl in
Districts

81% Exp. Has been booked till Dec'09

Efforts
• DIOs regularized & named as District MCH Officers .
• Monitoring by Routine Immunization Control room at State, District
and Block level.


VHND Tracking by call centers (Pilot in Guna, now being up-scaled
in entire State)



Name Based Tracking for Immunization and ANC/PNC is being
implemented.



Health officials exempted from meetings on VHNDs i.e. Tuesdays
& Fridays

• No Officer stays on HQ on VHNDs
Input utilization gained momentum

83

1/18/2010

Measles Control....
• M.P. contributes to 8 % of measles deaths in the country (GoiUnicef-WHO, extrapolated data -2006)

• State has highest prevalence of Malnutrition in the country
• Measles mortality much higher in malnourished children



Measles coverage only 57.7 % ( DLHS 3)
Supplementary Immunization Activity for Measles is needed
(NTAGI recommendations, Measles Mortality reduction - India Strategic Plan 200510)

Challenge > Need for strengthening Surveillance system
(NTAGI recommendations)

Overview Of Measles Coverage....
BHD

MRI



GLR

O

80% or More

Q

Above state average (57.70)

o

Below state average

■^Zdia

SOP

SVP

fTKM

IMO

iUNt AKN

RWA

CTP
PAN

SIN

SDH

MDS,

SJP

RTM

RJG

SAG

VDS

DMH

UJN
RSN
NSP

'BA? DHR

BRW

DWS

iDL.

^pDf

ANP

MDL

HSB
SNI

/ HRD
KND^~y"

KRG

IR
JBP

CDW
BTL

BLG

.BHP

Source - DLHS 3 Data

84

1/18/2010

Measles....Quantum Of Problem
Coverage - DLHS 3

Annual Target
Beneficiary

Infants

Vaccinated with
Measles

Vaccinated with
Measles (in
Figures)

18.96 lacs

57.70%

10.95 Lacs

Quantum of Susceptible Cohort

Not Vaccinated

Vaccinated but NOT
sero-converted
[considering efficacy
85% at 9 months]

Total

8.02 Lacs

1.64 Lacs

9.66 Lacs

NRHM - Part "C"

Approved for
2009-10

Fund
availability
(2009-10)

Performance
till Dec'09

Proposed for
2010-11

Rs. Lacs

1946.88

763.92

790.51

2865.99

85

1/18/2010

THANKS

86

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