Sub Group Meeting PIP 2010-11 Madhya Pradesh 19.01.2010
Item
- Title
-
Sub Group Meeting
PIP 2010-11
Madhya Pradesh
19.01.2010
- extracted text
-
1/18/203
epH s
]>
IfiUi
Orf
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
\ " V—,
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
- Media
15611.pdf
Position: 759 (10 views)