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GOVERNMENT OF KARNATAKA
■
PMIE8T PW9SM
ON
TRIBAL HEALTH
FOB
WORLD BANK FOMBIIS
BY
DR. G.V. NAGARAJ
PROJECT DIRECTOR (RCH)
i
OFFICE OF THE PROJECT DIRECTOR (RCH)
DIRECTORATE OF HEALTH &FW SERVICES,
ANANDA RAO CIRCLE BANGALORE - 9.
JANUARY -2000
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PROJECT ON TRIBAL HEALTH
CONTENTS
PAGE
ITEMS
SL
xNO
1.
' INTRODUCTION
1
2.
' BACKGROUND
1
4.
1
FAMILY WELFARE PROGRAMME TO REPRODUCTIVE
AND CHILD HEALTH
3.
jI___________________________
REPRODUCTIVE AND CHILD HEALTH.
I
3
5.
NATIONAL HEMTH POLICY
6.
HEALTH AND NUTRITIONAL STATUS OF TRIBALS
7.
TRIBAL AND MODERN SYSTEMS OF HEALTH CARE
5
8.
FAMILY U-BLFARE PROGRAMME IN TRIBAL AREAS
5
RECONIMENDATIONS MADE BY NATIONAL COMMISSION
FOR WOMEN (NOW)
6
10.
PROFILES OF THE STATE
6
11.
THE PROTECT
9
12.
STRATEGY
14
13.
INTERXBNTIONS
16
14.
PROJECT COST
23
i 9.
II
____________________
15.
;
I
' PROJECT OUTCOME
24
16.
LOGISTICS
24
17.
EVALUATION
25
18.
SUSTAINABILITY
25
ANNEXURES
26
4
!
PROJECT PROPOSAL ON TRIBAL HEALTH
1. INTRODUCTION:
The tribes for centuries lived in isolation and had limited contacts with other societies.
Though this had helped them to presetve their culture and tradition, they remained
practically under developed. Indian constitution makes a special provision for the
welfare of tribal population. Under this provision, various schemes and programmes
were initiated to improve their living conditions with special emphasis on education and
employment.
2. BACKGROUND:
The Ministry of Health & Family Welfare, Government of India, is planning to support a
Project for the tribal Health specially Reproductive and Child Health, with financial
assistance from the World Bank. The Ministry of Health and Family Welfare has
requested the State Governments to prepare the proposal keeping in view the
guidelines provided by it in November, 1996.
3. FAMILY PLANNING PROGRAMME TO REPRODUCTIVE & CHILD HEALTH :
India' Family Planning programme (renamed as Family Welfare in 1978) has had a
single objective for nearly 30 years, to reduce fertility as quickly as possible. The
programme has sought to achieve this goal through a strategy based on contraceptive
targets and cash incentives to acceptors and providers.
The objective of the Family Planning Programme is to reduce the birth rate.
Contraception is only an instrument for bringing about reduction in birth rate. The
success of the programme, with reference to the objective can be judged only on the
basis of the reduction in the birth rate. The contraceptive target monitoring has led to a
situation where the achievements of contraceptive targets has become an end in itself.
Although there is successful performance in sterilization there has been no
corresponding reduction in the birth rate.
Since the past few years, the Govt, of India recognized that contraceptive targets and
cash incentives have resulted in the inflation of performance statistics and the neglect of
quality of services.
-2-
The 1994 Cairo International Conference, on population and development, formalized a
growing international consensus that improving reproductive health, including family
planning, is essential to human welfare and development. This consensus recognises
a crucial distinction between the overall goals of population policy and those of a
reproductive health programme.
The principal goal of a reproductive health programme is to reduce unwanted fertility
safely and to provide high quality health services, thereby satisfying to needs of
individuals as well as stabilising the population.
A growing body of evidence and the consensus achieved in Cairo suggest that India's
present system of numerical, method specific targets and monetary incentives for
providers should be replaced by a broader system of performance goals and measures
that focuses on a range of reproductive health services. The evidence also suggest that
setting a broad range of reproductive health goals reduces fertility and enhance clients
satisfaction and health. Govt, of India strongly supports the Cairo programme of action
and Reproductive health approach.
4. REPRODUCTIVE & CHILD HEALTH :
Family Welfare Programme is being implemented from April, 1996, on the basis of
Target Free Approach (TFA). Besides, the focus of the National Family Welfare
Programme is to undergo a change from a segregated approach of Family Planning
and Maternal Child Health Services to that of integrated approach under Reproductive
Child Health Services in future. This means that RCH is equivalent to Family Planning
and Child Survival & Safe Motherhood and Prevention of RTIs & STIs & AIDS.
Dr. Fathalla, in 1998, has defined Reproductive Health as 'A state in which people have
the ability to reproduce and regulate their fertility, women are able to go through the
pregnancy and child birth safely. The outcome of pregnancy is successful in terms of
maternal, infant survival and well being and couples are able to have sexual relation
free of the fear of pregnancy and of combating the disease'.
The 1994 Cairo ICPD Conference defines Reproductive Health as 'A State of complete
physical, mental and Social well
being and not merely the absence of disease of
infirmity in all matters relating to Reproductive System and its functions and processes'.
;
-3-
The Reproductive and Child Health Services covers a wide range of services from
womb to tomb as a life cycle approach in women's life. Infact it is a new agenda to
improve 'Women's Health Status'.
5. NATIONAL HEALTH POLICY :
For the first time, in 1983, a National Health Policy was evolved. Having identified
certain lacunae in the existing situation such as health manpower development, quality
of services, policies, strategy and programmes, the policy strongly recommends the
need for providing Primary Health Care with special emphasis on the preventive,
promotive and rehabilitative aspects. It has been reiterated further that
"In the
establishment of the re-organized services, the first priority should be accorded to
services to those residing in
the tribal, hill and backward areas as well as to endemic
diseases affected population and the vulnerable section of the society."
6. HEALTH & NUTRITIONAL STATUS OF TRIBALS :
As per our Constitution, schedule tribe means such cases, races or tribes or parts of or
groups with in races of tribes as are declared by the President of India to be scheduled
tribes under Article 342 of the Constitution.
Due to the exploitation, both socially and economically, characterised by extremely low
level literacy and pre-agricultural level of technology, the tribal groups lag behind the
rest of the society, both socially and economically. Their socio-economic backwardness
is also reflected in their health condition/status.
There is very little baseline or epidemiological data available which can demonstrate
that the health status of tribal people is much poorer than the general population.
However, in a number of studies, both official and non-official, reports are available
reflecting that the health problems commonly found among the tribal are nutritional
deficiency among the children and anaemic among mothers, haematological disorders,
sickle cell anaemia, seasonal disease like diarrhoea, among children below 5 years of
age. Malaria, Tuberculosis, skin diseases, leprosy, goitre yaws is also prevalent in
certain tribal pockets.
-4The Health problems among primitive tribes, are a cause for greater concern. The
Health and nutritional survey of tribals in various states, have indicated problems like
cervical lymphadenopathy, respiratory infections, genu valgum, goiter, sickle cell
haemoglobin, and malaria.
Another health aspect of the tribal population that needs careful understanding and
handling, is Reproductive Health Keeping in view the strong traditional socio cultural
values of many tribal groups, the issues related to reproductive health of the tribal
needs to be looked from different perspective. In many cases the approach has to be
tribe specific, rather than general, as sexuality and reproductive behavior is favoured by
tribal masses. In the context of decentralized participatory planning and Community
Needs Approach,
family planning itself becomes an issue to be debated upon by
different communities. As such tribe specific approaches with a given geographical
areas would obviously need to be devised. It is a fact that even the tribal group in the
same state do not constitute a homogenous group . They are charactersed by marked
differences in their culture, tradition, social status and even health behaviour.
Considering the health status of this population, there has to be a specific strategy
through which the health problems including reproductive health of the tribal population
can be tackled.
Various available studies showed that tribal groups are characterized by high level of
fertility and mortality. It also reflects that nutritional status of women is poor and anaemia
is widely prevalent specially in pregnant women and is a serious health problem. The
tribal people have also been found as deficient in calcium, Vitamin 'A', Vitamin 'O' and
animal protein. As such there is a high incidence of malnutrition which is a serious
health problem particularly for those having closely spaced pregnancy. Women are also
affected by Reproductive tract infections and other pregnancy related diseases.
On account of large scale deforestation, tribal women have to walk longer distances to
collect fire wood. Given the increasing work load women in advanced stages of
pregnancy continue to work as usual.
-5-
The 1984 UN report on Health status of women mention that in developing countries
atleast half of the nonpregnant and two thirds of the pregnant women are anaemic. In
fact, most women in rural India suffer from nutritional anaemia and in the tribal regions
the situation is even worse. It is said that anaemia lowers resistance to fatigue, affects
working capacity and increases susceptibility to diseases. Diets of south Indian tribes
are deficient even in respect of calories and total protein.
The nutritional status of tribal pregnant women directly influence their reproductive
performance and birth weight of these children is crucial to infant chances of survival,
growth and development.
7. TRIBAL AND MODERN SYSTEMS OF HEALTH CARE :
Both these systems of health care were found to be prevalent in tribal areas as tribal
people live close to nature. Traditional system of medicine based on herbs, ayurveda,
unani, siddha, naturopathy are existing hand in hand with modern allopathic system in
different tribes. Basically, tribal systems of medicine is composed of three dominant
components herbal, psycho-somatic and magico-religious and in most tribes, this is
respected by people due to the belief and their low cost and access factors.
8. FAMILY WELFARE PROGRAMME IN TRIBAL AREAS :
The status of acceptability of family welfare programme is available in different tribal
areas. Studies have shown that the rate of growth have not been uniform but have
varied. Some of the smaller and remote tribal have been reported to be declining in
population or living at a static level. At the other end of spectrum are some major ST
group where rate of growth is said to have been exceeded the all India figure. It seems
that the tribal demographic canvas calls for differential approach. The message of
family planning need to be broadcast deep and wide to those groups which are
multiplying faster than the norm and simultaneously small groups facing the prospect
of decline which may ultimately lead to their extinction, need to be fostered. Such a
differential approach necessarily implies precedent demographic studies focused on
each ST group to gain knowledge of the growth rate and nutritional status.
-6-
9. RECOMMENDATIONS MADE BY NATIONAL COMMISSION FOR WOMEN (NCW)
1. Special attention needs to be given to the health problems of scheduled tribe women
and children in pockets / districts identified by Central Planning Committee.
2. Training of tribal youth in primary health care.
3. To associate traditional
tribal medicine - men leader's, witch doctors and bring
them into the fold of health delivery system after training
and equipping them
appropriately.
4. Family Planning should be oriented to the demographic and social cultural milieu
of the respective scheduled tribe. These family planning practices should not be
propagated which are likely to do more harm than good.
5. To take necessary action to stop the spread of STD, HIV / AIDS
6. To conduct operational research in the field of health and nutritional status of the
tribals including the various systems of medicine.
7. To conduct surveys to determine the morbidity pattern of tribal women.
10. PROFILES OF THE STATE:
10.1 Population,size & growth:
Population of Karnataka which stood at 14 million in 1901 increased to 20 million by
1951
and to 45 million in 1991. Thus the population in the State has increased by
three and half times during the last ninety year period. The current population size (in
1997) is estimated to be close to 51 million and projected to be 56 million by 2001 A.D.
which accounts to 5.31 percent of Indias population.
The State with an area of 1,91, 791 sq.kms. accounts for about 5.85 percent of
country's total area of 32, 87, 263 sq.kms. Karnataka is the Eighth largest State in India
in both area and population.
There are four revenue divisions in the State with headquarters at Bangalore, Belgaum,
Gulbarga and Mysore. There are 27 districts in four divisions.
-7The sex ratio of 983 (in 1901) has declined to 960 (in 1991). However there are large
variation between the districts.
The density of population has increased from 68 percent in 1901 to 101 by 1951 and
235 by 1991. Population growth in Karnataka has been close to natural average.
Population growth rate which was less than 1 percent per annum upto 1931 increased
to 1 percent during 1931-51 and exceeded 2 percent since then. There is a sharp
decline in the growth rate during 1981-91.
10.2. Population distribution :
In 1901 the share of urban population was only 13 percent whereas it has increased to
31 percent in 1991.
10.3 SC & ST POPULATION :
One fifth of the total population in the State belongs to scheduled castes (16.38%) and
scheduled tribes (4.2%). Over the years their share in the total population has varied.
___________ Population________________ 1981__________________ 1991________
S.C.
15.07
16.38
S.T.
4.91
4.26
Total
19.98
20.64
NON SC/ST
80.02
79.36
There appears to be reduction in the ST population in 1991 as compared to 1981
census.
10.4 Literacy:
According to 1991 census, over half of the population (56%) aged 7 years and over are
literate in the State Over two thirds of males (67%) and 44% of females have attained
literacy by 1991.
10.5 Age at Marriage:
Age at marriage for females has been increasing gradually over the years at a very slow
pace, singular mean age at marriage was 26 years for males and 19 years for females
in 1981 and 19.4 in 1992.
-810.6 Vital rates :
Estimates based on census data have indicated that crude birth rate has declined from
33 (1970) to 28.0 by 1990. There are seven districts where the level of CBR has
reached 25 or below, 8 districts where CBR ranges between 25-29 and in 5 districts it is
higher than 30. Since independence crude death rate has declined from a level of about
20 to 7.6 in 1998 The infant mortality rate has reached a level of 58 in 1998 from 89 in
1971 .
The recent SRS estimates (1998) has revealed the following rates :
Crude Birth Rate
22.0
Crude Death Rate
7.6
Infant Mortality Rate
58.0
expectation of life at birth has risen to 65 for both the sexes in 1990 from a level of 46 in
the 60s.
10.7 Contraceptive acceptance :
There is an inter-district variation in contraceptive acceptance. However in general as of
1998, the contraceptive prevalence has touched 57% and the method mix is as follows :
Sterilization
IUD
C.C.Users
O.P.Users_____
Total
~
45.74 ’
8.63
1.91
1.98
58.26
1997-98
Percentage
79
14
4
3
100
10.8 Per Capita Income :
Per capita income in the State has increased from Rs.1557/- in 1980-81 to 5898 by
1991-92 at current prices.
10.9 Per Capita Expenditure :
As of 1989-90 the per capita expenditure (public sector) on health (Medical & Public
Health) including water supply and family welfare is as follows :
Health
All India
Karnataka
Family Welfare
69.85
13.18
54.15
11.42
(in rupees)
-910.10 Other Facilities :
Out of a total of 26857 villages and hamlets in the State, 171 villages were without any
kind of road. There are 18,605 fair price shops.
11. THE PROJECT:
Government of Karnataka is proposing a SPECIAL PROJECT FOR TRIBAL AREAS'
in the ITDP taluks of Mysore, D.Kannada, Kodagu and Chikkamagalur districts and
requesting the financial support from World Bank through Govt, of India.
11.1. Objectives of the Project:
The following are the objectives of the Special programme in the tribal pockets of the
State.
1. To sensitize the tribal and scheduled caste member of the community towards their
health needs and to empower them to initiate, manage and sustain health action.
2. To improve access and utilization of health services by tribal and scheduled caste
people especially women.
3. To train health-volunteers from the local SC/ST community members for provision of
basic health services, immunization and safe delivery.
4. To take actions to reduce malnutrition through nutrition counseling and networking
with ICDS.
5. To bring in integration of health delivery system services provided by Primary Health
Care system and local tribal and indigenous systems of medicine at the community
level.
11.2 Areas for investments :
Urgent
action
needs
to
paid
to
tribal
pockets
in
the districts
of Mysore,
D. Kannada , Kodagu and Chikkamagalur.
11.3 Project Districts :
11.3.1 Population : The ST population in the project district as per 1991 census is as
follows
SI.No.
1.
2.
3.
4.
______ Districts
Mysore
D. Kannada
Kodagu
Chikkamagalur
% ST Population to General. Population
3.23
3.94
8.25
2.81
-1011.3.2: Project districts profile :
The tribal sub plan (TSP) stategy came into operation from Sth Five year plan. This is
being implemented through 23 integrated tribal development projects (ITDP) together
from 4 districts. These projects have been setup in blocks where there is concentration
of ST population.
11.3.3 : BASELINE SURVEY OF TRIBAL POPULATION IN KARNATAKA (JUNE 1995)
The population centre Bangalore has under taken tribal survey in the districts of
Chikkamagalur, D.Kannada, Kodagu and Mysore . The Salient findings of this survey
are listed
* The accessibility to tribal settlements remain restricted due to less number of vehicle
movement and also difficult in use of mud roads during rainy seasons.
* These tribes are living mainly in the interior areas, many do not have access to
natural source like river, tank etc. A small proportion mainly who are living in the tribal
colonies have tap water facility (about 9 percent).
* Only 8 percent of the total settlement have an allopathic doctor and about 6 percent
have ayurvedic doctor.
* Health facilities available to the tribal population under the study were not adequate.
* The visits by the health workers were grossly inadequate. It was only about 33
percent of the total settlements received weekly visits, about 17 percent received
fortnightly visits and about 27 received monthly visits.
* Crude Birth Rate comes to about 26 per 1000 population.
* Crude Birth Rate was about 30 among the households where the heads of the
household were illiterate and about 25 among the households where the heads of the
household were literate.
* Birth rate decreased as the household income increased.
* GFR, of tho tribes was higher than in the State as a whole.
* GMFR of the Hasalaru and the Koragas were higher than the State average
* The TFRs of the tribes were slightly lower than that of the State.
* The crude death rate was highest among the Hasalaru and lowest among the
Soligas.
-11* highest proportion of death was observed for both males and females due to senility.
* percentage availing treatment from government allopathic doctors was higher than
private allopathic doctors.
* Only very small proportion of respondents were availing treatment from other systems
like Unani, Ayurveda and Homeopathy.
* indigenous system of medicines were also popular among the tribes.
* 77 % of respondents expressed their first preference for private allopathic doctor.
* proportion of heads of household who did not encounter any problem was high.
Problems
encountered
Medicine
was
not available
Hasalaru
Koraga
Jenukuruba
Soliga
All tribes
53.7
46.7
56.9
60.0
54.3
* About 34 percent of respondent expressed that the health staff demanded money.
* The most important problem expressed by the heads of household was the non
availability of medicines.
* About 22 percent of heads of household expressed that they have to wait for long
time in the health institutions.
* The average time required to wait at the health centre was about 50 minutes.
* Most of the women may like to have about three or more children.
* There was strong preference of son.
* 78 percent of the respondents were in favour of practicing family planning methods
by married couples.
* About 66 percent of the respondents expressed that their husbands approved the
practice of family planning methods
* Attitude towards the small family size was favourable among the tribes.
* About 94 percent of the respondents are aware of vasectomy as against about 87
percent of tubectomy.
* Regarding different temporary methods such as condoms, IUD and Oral Pills the
awareness is about 42 percent only.
* Awareness of temporary methods is lowest among the women
* 52 percent were not using any family planning method.
-12* About 48 percent are using family planning methods.
* The users of temporary methods was only about 1.2 percent.
* 71 percent of the women/or their husband of the total acceptors accepted family
planning methods due to motivational effort made by the health staff.
* 23 percent of the acceptors were self motivators.
* Government institutions were the main place where the family planning services were
availed.
* Role of private hospitals in adopting family planning methods was not very high
* The average number of living children of the sterilization acceptors was 3.0.
* Desire for more children is the main reason for not accepting family planning
methods.
* preference for one more son was also one of the reasons for non-acceptance.
* 74percent of them were registered for ANC.
* 77 percent of the pregnant women had received TT during their ante-natal period.
* 76 percent of the women did receive the iron and folic acid tablets.
* 61 percent of the women who delivered during the reference period were registered
for PNC services.
* 73 percent of the children are given first dose of DPT and Polio.
* 57 percent got full quota of three doses of DPT and polio drops.
* The extent of immunization against measles was about 27 percent.
* occurrence of diarrhoea among the children was not very high
* more than 43 percent of respondents have listened radio programme during last 6
months prior to the survey about family planning, immunization and ORS.
* Therefore, it may be necessary to provide them with better accessibility of health and
medicine, better education and employment before their further decline in growth rate.
-1311.3.4 : RCH SURVEY :
The Institute for Socio Economic Change (ISEC) has carried out RCH survey in 1998 in
10 districts and the findings for 4 districts having tribal population
have been
summarized.
DISTRICTS PROFILE
A - General__________
Item_______
ST Population
I 1.
.
(1991 census')_____
j 2. No.ofITDPTalkus"
3.
4.
5.
6.
No.of Villages
PHCs in ITDP
Taluks___________
No.of Sub centres
in the ITDP taluks
Dais
Mysore
0.83
(Lakhs)
8
528
33
D.Kannada
1.06
(Lakhs)
8
585
48
| Kodagu ~
0.40
(Lakhs)
3
400
12
I Chikkamagalur
0.26
______(Lakhs')
_______ 4
173
10
Total
2.55
(Lakhs')
23
1686
103
460
594
109
328
1491
166
179
72
37
444
B - Key indicators* of Project Districts**
Indicators*
1.
Mysore
D.Kannada
Kodagu
% of Girls mamng
Not Available
4.5
22.0
below 18 yeas.
2. % of Births order 3
NA
32.0
18.8
and above_________
_3. CPR___________
NA
63.7
70.6
_4. Unmet need_______
NA
16.1
8.5
% of Preg.Women
NA
98.5
100
with ANC
%
Pig.
of
NA
84.9
88.4
Preg.Women with
fun ANC
7. % of Institutional
NA
76.6
67.7
Deliveries_________
8. % of Safe delivery
NA
91.5
79.4
% of Child vvrith
NA
86.0
94.8
complete
I
immunization
| 10. % of child with no
NA
05
0.5
immunization_
11. % of Females with
NA
24.2
21.1
symptoms
of
RTI/STI________
12. % of Males with
NA
2.8
4.2
symptoms
of
RTI/STI___________
13. % of Females aware
NA
78.4
74.9
of HI VAMPS
14. % of Male aware of |
NA
85.7
90.9
AIDS___________ J_______________________
* This will not show true picture in the tribal pockets of the districts
** Rapid house hold survey, Phase-I, 1998
L
I
Chikkamagalur
37.0
State average (10
districts')
35.2
26.1
27.8
71.4
8.1
91.7
58.1
18.1
89.3
68.2
27.2
62.4
52.5
78.0
83.5
62.3
64.9
0.0
8.3
20.5
18.8
5.5
4.4
66.5
60.7
90.4
73.1
-14-
11.3.5 : LITERACY STATUS (%) OF ST POPULATION IN THE STATE.
Population
Total
Rural
Urban
Gcncral Population
56.04
47.69
74.20
Tribal Population
36.01
32.57
55.08
12. STRATEGY :
Improving of lives of tribal women means improving their health.
In addition long term
improvements in Education and Employment opportunities for women will have a positive
impact on the health of the women and children. In the short term, significant improvement
can be expected if existing health care services for tribal women are strengthened and
expanded to meet their specific needs.
There is an indication that the female sex ratio in the ST population in 1991 in the State is
is
showing a declining trend compared to 1981 census. In 1981 it was 971 and 1991 it is 961.
1 he strategy ol providing effective and efficient services can be planed by analyzing the
existing problems and taking up various inteiventions keeping in view (lie objectives spelt
out under para 11.1.
12.1 A: Problems and needs
of Tribal Population : The NFHS’ 1992 survey data has
revealed various vital indicators of the state in general, fhe Phase-I, RIIS - 98 survey has
been completed in 10 districts and the data is applicable to the districts in general including
SI population. (Refer 11.3.1 - B) except the baseline tribal survey conducted by population
centie in 1995, there is no specific and recent baseline data available throwing light on the
Demographic and vital indicators among the tribal population per se. Further, data on the
morbidity pattern in the tribal population is not available particularly in the 1TDP taluks
either by NITIS or RIIS suivcy. The information on any count is not available for Mysore
district as this district has not been covered in the phase -1 RIIS survey.
Some ol the data available for the tribal population at the National level are as follows
1. Literacy among schedule tribes as per 1991 census is only 29.6?6 (Male, 40.6596,
Female 18.19%).
2. Fertility ol S1 women (3.5) is slightly higher than the fertility of other women (3.4).
3.
I he unmet need for spacing birth (11%) and the unmet need for limiting births (9%) for
the tribal women is same as of the National level. (20%)
4. Only 18.5% of ST women received Antenatal care at home during pregnancy
5. 56.2% pregnant women didnot receive any TT where as only 40.2% for given IFA.
6. 79% were home deliveries without proper hygienic care and no professional help when
complication develop.
7. Despite the high level of female morbidity’ and mortality ST women do not seek medical
help even in the late stages of problems.
8. Issues like RTI'STD, Menstrual disorders and unwanted pregnancy are also neglected
due to lack of information lack of accessibility of health services and poverty7.
9. Pregnancy related risk and low birth weight with its consequent complications and
mortality is high among tribal women.
10. ST women will be suffering from anaemia and malnutrition due to lack of Iron, portion,
Iodine, vitamin ’A’ etc.,
11. Lack of access to basic health care, to right food, low literacy rate, poverty7 are the causes
for chronic ill health and early deaths.
12. IB : Demographic Profiles and Morbidity surveys : For the effective management of any
health intervention, basic health data is essential. This is lacking for
tribal areas. It is
therefore proposed to carry out a rapid baseline survey in these specific areas with
concentration of tribal population. Tire survey which will reveal not only
micro level
demographic data but also magnitude of various disease prevalent there, is proposed to be
entrusted to reputed research organization
12.1C : Documentation and Senace Delivery : The Health and FW Department has
distributed the MCP (immunization) cards as per the requirement of the districts and the
Eligible Couple Registers (EC Registers) at the rate of one register per thousand population.
It is mandatory to collect a detail information from all the house holds and necessary7 entries
are made in the EC registers. This work should be completed at the end of January /
February, 2000 so that a complete information is available before start of the Project. Apart
from the Health Staff. Volunteers can be hired for this work after a brief training and
necessary documentation is proposed to be kept ready.
The MCP (immunization) cards and EC registers distributed have reached the service
outlets and
are under use. The necessary7 documentation work along with services are
proposed to be followed up intensively for quality and coverage in RCH senices.
-1613. INTERVENTIONS
13.1 : Service Delivery : Out reach health care services through Primary health care system
is largely in place but implementation problems have been noticed due to difficult terrain in
tribal areas. Travel time is an important factor to ensure adequate utilization of services in a
health facility .
13.1.1 Problems in tribal areas.: The barriers for the utilization of health care services are :
1. Weak infrastructure particularly with regard to the accommodation because of which
doctors and para - medical staff do not stay in these areas. Also the highly dispersed
nature of the population, the sitting of the PHC s and subcentres and poor
communication (transportation) has resulted in distance and so poor access of the health
facilities. Many of the sub centres are stated to be non functioning in these areas.
2. Inadequate availability' of local persons as para medical workers and high percentage of
vacancies among doctors has resulted in non-implementation of many of the health and
family welfare programmees and poor health services.
3. Lack of communication with tribal community because of which the tribals are not aware
of the existing health facilities and along with other existing barriers such as distance
poor transportation etc.,The health facilities are thus under utilised . Generation of
awareness and community participation would increase the utilization of the existing
health facilities.
13.1.2 : To improve the access and coverage in remote hilly and difficulty terrains where tribal
people are often residing, it is proposed to provide additional Jr. health Asst. Female (ANM)
after careful selection of the sub centre keeping in mind the tribal population to provide door to
door service and education. An additional supervisor for existing primary health centres m the
tribal area to supervise the ANMs and also Para Medical Staff in day to day work is proposed.
The ANM would visit a every village / hamlet regularly on fixed days and provide essential
health care services, guidance on nutrition and pregnancy related matter they would provide
immunization services and health education. They would also train traditional birth attendants
and local traditional practitioners.
The Job responsibilities as detailed under RCH guidelines will be scrupulously adhered. Each
health worker will be provided with drug kit 'A' and drug kit rB'. Linkages will be established
with the Anganawadi workers in all the activities of on going ICDS programme.
It is proposed to appoint additional work force such as Jr. Health Asst. Female and Supervisors
on contract basis for the project period of two years.
-17As the programme gets into operational mode, it is proposed to introduce
’’Red card"
system for identified high risk pregnant clients, confirmation of the same and also referral to
avail emergency obstretic care (EmOc) services. Further, it is proposed to bear transport
charges for such referred emergency clients.
It is also proposed to activate the existing Mahila Swasthya Sanghas (MSS) to take up
Awareness Generation programmes by suitably restructuring the inputs for functioning of
these sanghas. Their role will be made more realistic to the needs and wishes of the tribal
population.
Many a times the tribals live in inaccessible / remote areas, cut off from quick means of
transport and communication and in areas which often donot have enough easy and quick
means for basic necessities of life and are at the same time susceptible to life and also to a
variety of diseases. The problems of health and medical care can be tackled by bringing the
tribal population under the umbrella of inexpensive preventative medical care through a set
of para medical personnel and services.
A cadre of para medical personnel is proposed to be organized and set up for tribal areas in
order to provide adequate medical coverage to the entire tribal population.
The paramedical functionaries will be assigned the role of an active health assistant and an
eductionist to educate the tribals in matter of personal hygiene and health as well as
sanitation.
Training of local teachers, post masters, village level workers, for 3 days to function as para
medical personnel and training of Boys and Girls for 7 days is proposed to be takenup. In
discharging this responsibility, they will be given remuneration. Each one will be visiting a
tribal 'village in his jurisdiction every day and be available there for a period of time notified
(at least 1-2 hours per day/week). This will be known to all the concerned. Dais will also be
involved in maternity care after they are trained. Each one will be provided with both a Dai
Deliver)' kit and Dai Drug Kit which will be specially assembled. Disposal Deliveiy Kits will
also be supplied. Remuneration will be given for the identified tasks to be accomplished by
each of the volunteers and Dais. Necessary funds will be released at the disposal of Gram
Panchayat / village Committees proposed to be constituted.
-18In addition to the para medical worker, a qualified Doctor with a supporting
staff is
proposed to visit certain specified, important, and centrally located tribal village at lest once
a week to conduct ’’village clinics” wherein the Doctor will hire of vehicle examine the clients
referred by para medical worker and also get the investigation of their ailments. WTiile
conducting such clinics the delivery of integrated health services will be kept in mind to
provide services according to the needs of the population. Additional drugs worth of Rs0.50
lakhs per PHC will be given .
Gender sensitivity will also be kept in mind to arrange conducting clinics by the Lady
Medical Officer particularly in cases of essential obstretic care (EsOC) and also emergency
obstretic care (EmOC) clients and also help Family in choosing family welfare methods.
Addition Drugs worth of Rs.0.25 lakhs per PHC will be given to EsOC/ EMOC case.
13.2 : Mobility support:
The Health care institutions particularly Primary Health Centres are well placed in general in
the ITDP blocks. Because of constraints, these institutions are yet to be strengthened with
mobility’ support. As a beginning, it is proposed to provide four wheeler vehicles for priority
and identified institutions. The drivers will be hired on contract basis for a period of two
years. It is also proposed to meet the expenditure towards the cost ol vehicles, drivers
salary and fuel expenses out of the project funds. Increased mobility will have quantum leap
in the benefits such as intense supervision of out reach services, organization of village
health clinics, shifting of emergency cases of either mother or child, bringing clients foi RCH
services, conducting of tribal RCH sessions, intensification of IEC activities, arranging
training programmes, community mobilization activities, survey work, and also evaluation.
13.3 TRAINING OF HEALTH CARE PROVIDERS
One important factor for the poor utilization of health facilities in tribal areas has been the
non-availability of curative and preventive services when an emergency sick client approach
the health post. It is therefore imperative to increase professional skills of local TB As. Local
Traditional practitioners and also create a force of young health volunteers who belong to the
tribal community
are physically present in the area at all times. It is proposed that the
selection of the volunteers will be made by the concerned village Panchayal.
-19* Training for volunteers will be organized closer to their houses. Training would be
participatory7 building on their knowledge with emphasis on practice and learn by doing. The
duration of the training is proposed to be for a period of one week.
* The training content for tribal gills will cover areas such as maternal care, child care,
treatment of anaemia, diarrhoea, reproductive tract infection, immunization and family
welfare. Tribal Health Kit will be provided for each of the volunteers.
The training content for tribal boys will cover areas such as diseases specific to local area,
malaria, case detection and examination of slides, tuberculosis, treatment of diarrhoea,
pneumonia, leprosy and environmental sanitation.
Remuneration will be given for the identified tasks to be accomphshed by each of the
volunteers. Necessary funds will be placed at the disposal of Gram
Committees
Panchayats/Village
. >sed to be constituted.
* Training of Traditional Birth Additional assumes greater importance since the practice of
ante-natal and post-natal care among tribal population will be different from amongst
general population. Whatever may be the practice, the out come of pregnancy and delivery
should be safe. Hence the TBAs will be given Hands on Training' in the nearby institutions
identified for the purpose for ensuring child survival and safe motherhood status.
The duration of the training will be for a period of 7 days both at the institutional and field
level. Each Dai will be provided with a Dai kit' containing essential items to be used for
ensuring 'Five cleans'.
Credibility of the services by the trained traditional Dais (TTDs) will be further enhanced by
providing each one of them with a Dai Drug Kit’ which is proposed to be specially
assembled for this purpose containing basic items such as Analgesics, Eye drops/Ear drops,
Bandage, cotton, etc.,
-20* Training of locally available personnel to function as part time para medical worker is also
ptoposed which will last for 3 days during which time the local teachers, post masters, village
level workers will be oriented towards preventative and curative health services so that they
can act as change agents in the respective community. They will be given remuneration for
the part time work they turnout.
Training materials will be developed / reproduced depending upon the duration of training
and also relevant to the trainees. Appropriate resource persons will be drafted for the
training, keeping in mind the local field experiences and best practices. Models, charts,
pictures, mapping gowns, will be developed locally for easy convey of the contents of
Health & FW Services.
It is necessary to focus attention on traditional tribal medicine practitioners/ healers and
bring them under the fold of public health care dehveryr system by identifying them,
contacting them and training them appropriately and equipping them with appropriate drug
kits.
Refresher training is also proposed during the second year with reduced duration
13.4 Drug Kits :
While we detailed the service delivery aspects in para 12.1 it is very essential that each
category’ of personnel involved in service delivery must be equipped with necessary inputs
such as basic items for maternity care and also drug kits consisting either of nutrients or
medicines. The credibility of the Health staff and also of the programme lies on this crucial
input. Availability ensure
better confidence and response from the community- side.
Different types of Health care Provider needs different ty pes of inputs as follows :
1.
2.
3.
4.
ANM (JHAF)
Drug Kit ’A”
Drug Kit ’B’
Doctor
Drugs for Primary^ Health
Care
Lady- Doctor
ESOC & EMOC Ehugs
Trained
Tribal Tribal Health Kit
Boy
Trained
Tribal
Girl
Trained Dais
Dai Deliveiy kits, Dai Drug
kits
Disposable Delivery Kits
MSS
MSS Kits
Outreach services
Village clinics.
Village clinics
Outreach Services
pev-no
5.
6.
Outreach services
Outreach services
Outreach services
-2113.5 INFORMATION EDUCATION & COMMUNICATION ACTRTTIES :
Given the situation of low literacy rates among tribal population, it is worth investing in EEC
activities in creating demand generation for the preventive and promotive health care
services.
Providing health education, information on sanitary environment, best health practices,
disease control measures, preventing diseases and motivate for participation in improvement
of their own health needs are the areas proposed for intensification of EEC activities.
Programmes will be developed to suit the local culture and ethos of the tribal population.
The local community will be involved while developing the programmes.
Interpersonal communication and interspousal commutation are proposed to be taken up as
priority issues.
Folk artists will be identified and their talent will be fully tapped.
Audio-visual health programme intermixed with entertainment will be taken up in the most
inaccessible pockets of the tribal areas in the form of TV spots through A.V. vans.
Health exhibition in the form ot display boards in AV vans will be arranged at strategic
points to attract the community and seek health behaviour changes.
Health fairs tagged with services are also proposed in the tribal areas .
Health message campaigns once a month from each PHC will be taken up in remote and
backward villages.
Interactive group meetings / orientation camps both for men folk and women folk will be
repeatedly arranged to do away with superstition and myths.
Local talented persons will be encouraged to involve as ’message provider' in health and
family welfare programmes particularly child health and maternal health interventions.
-22-
13.6: Project Management (Refer Organization Chart)
* At each Gram Panchayat level, a Committee consisting of Local Medical Officer, Gram
Panchayat head/member, women (preferably ST) a Teacher will be made responsible for
planning, implementation and monitoring of the programme.
* At PHC level, the Medical Officer will not only be responsible for planning,
implementation and monitoring
the activities in his
jurisdiction but also maintain
coordination with the activities outside his jurisdiction. He will use the monthly' meetings as
the right and best opportunity for improving coverage and quality.
* At Taluka level, the taluk health officer will supervise the programme during the visit of
the PHCs / villages but also during the monthly meetings.
* There will be a Nodal Officer at district level preferably a Med
Office
Project who will be made exclusively responsible for planning
^plementatio:
’orne under this
monitoring
and logistics for the entire district under this special programme. This tribal project officer
(TPD) will be working under the control of District Health & FW OfScer and coordinate
with district RCH officer. Hiring of special accommodation and stores is also proposed
during the project period
* A vehicle preferably a jeep with a Driver and POL expenses tor each of the district is
proposed for focussed attention in the project management. The expenditure towards this is
proposed under the project funds. As an alternative it is proposed to go in for hiring of the
vehicles for this purpose. A well designed calendar- of programme schedule will be drafted
every month and strictly adhered.
This continuous and intensified supervision which is lacking in the present health system will
result in perceptible change in the health care delivery system both in terms of coverage but
also in quality which are the crucial twin objectives of RCH programme.
-23-
* The District Health & FW Officer as chairman of the Tribal Health Committee involving
District Social Welfare Officer, Assistant Director (W&C), Deputy Director (Public
Instruction), district publicity Officer, District RCH Officer as Members and the Tribal
Project Officer as Member Secretary will meet once a month / on a by-monthly basis and
review all aspects of the programme for bettering in subsequent months.
» The Chief Executive Officers, of Zilla Panchayats will be appraised by the Dist. Health &
FW Officer during the monthly meeting and seek necessaiy guidance and help in
management of all aspects of the programme.
Sustained linkages will be established from the most peripheral village level upto State level
with Women & Child Development Dept., Social Welfare and Education Dept.
* Jt '
^onr
to constitute a State Level Committee
headed by Principal Secretary',
me Secretary for Finance , Secretary Women & child Development Dept.,
HF..
Secretary Social Welfare Dept., Commissioner, HFWS., and Director of Health and FW
Services as Members and Additional Director (Primaiy Health) as Member Secretary;
14. PROJECT COST
While estimating the cost of the Project the following assumptions have been made.
1. This project will be part of 100% Centrally Sponsored Scheme and there will be no State
share in the budget.
2. The project will be implemented for a period of 2 years initially and continued beyond,
subject to the success in the implementation.
3. Without waiting for any specific survey findings exclusively planned for the tribal
population, the progress/activities will be started immediately after the project is
sanctioned.
4. All the necessary pre-requisites will be fulfilled for immediate project take off.
5. The cost is subjected to variation depending upon the actuals at the time of
implementation.
-246. There will be no 'civil works' involved in this two years project.
7. The interventions that are proposed in the project are not pan of any on going
programme or earlier projects. Hence, there is no duplication.
8. The project cost will be (refer annexure for details)
1st year:
672.35 lakhs
Ilndyear :
518.85 laklis
Total
1191.20 laklis
15. PROJECT OUTCOME
The success in the implementation of the programme can only be judged on the
improvement of not only of ’Practices’ but also on various demographic and vital indicators.
In the absence of any recent baseline data confined to tribal population, it is not desirable to
identify7 bench marks at this Stage.
Hence the baseline survey needs to be takenup immediately. In the meanwhile higher client
acceptance of services, client satisfaction, improvement in quality of services, reduction in
morbidity and mortality could serve as yard sticks.
16. MONITORING & LOGISTICS :
The process of monitoring consists of deviations between actual and standards, diagnosing
the causes of such deviations and taking necessary corrective actions.
Therefore the process of monitoring mainly depends on continuos feed back of the activities
going on at different levels and of different activities in the form of reports from the service
points.
As regards registers, the existing/ongoing programmes registers will be utilised at the field
levrel.
A simple single sheet reporting format will be introduced and the information will be
furnished by each of the Junior Health Assistant (Female) incorporating not only details
about her activities but also of other Health Care Providers, such as Dais, Para-Medical
Personnel etc.,
-25-
As far as possible care will be taken not to overload the personnel with too many registers
and reports and thus minimises her wastage of time so that she will devote more time for
service delivery.
‘
The Tribal Project Officer at District level will compile statistical information from all the
service points of the districts through primary Health Centres and keep the data read)7 for
review in the meetings.
Logistics Management, drug kits, Dai kits, vaccines and contraceptives will be taken care by
proper and timely receipt, proper documentation, appropriate storage, quick distribution and
optimal utilization.
17. EVALUATION
Once the inputs are placed in position and implementation is progressing it is essential to
have inbuilt evaluation mechanism both concurrent as well as terminal. It is proposed to have
a reputed agency, negotiate with them, enter into contract and assign the evaluation work so
that there will be no shocking surprises at the end.
18. SUSTALNABILITY
As there is a minimum creation of permanent assets, liabilities in terms of expenditure is not
high. The contract personnel and the vehicle inputs can be deployed against the deficiencies
contemplated at the end of the project period.
pijlrhlt]
-26ANNEXURE
PROJECT COST
SI.
No.
1
Item of Expenditure.
_________ 2,
' BASELINE SURVEY
Unit cost
No.
3.
4.
1
0.50L
per annum
0.72L
per annum
100
50.00
50.00
100.00
25
18.00
18.00
36.00
0
0
0
1686
43.83
43.83
87.66
1686
43.83
43.83
87.66
500
65.00
65.00
130.00
1000
103
0.05
3.22
0.05
3.22
0.10
6.44
223.93
223.93
j________
i
447.86
4
Total i
! 2.
@Rs.50/week for
52 weeks
ii] Tribal Boys
@Rs.50/week for
52 weeks______
d) Remuneration to
@Rs.25/week for
Paramedicals_______
52 weeks______
e) Red cards__________ Rs,5/ per card
f) Hiring of two wheelers @Rs.60/week for
for village clinics______
52 weeks
Total |
MOBILITY SUPPORT
a) Four wheelers
(Diesel (driven)_______
b) Drivers salary
c) POL expenses
3.50 L
23
80.50
0
80.50
0.04 L
per month
0.12 L
per annum
23
11.04
11.04
22.08
23
2.76
2.76
5.52
94.30
13.80
108.10
1000
2.00
2.00
4.00
1000
2.00
2.00
4.00
Total
4.
Total
(Rs.in
lakhs)
7.__
6.00
6.00
SERVICE DELIVERY
a) Recurring expenditure
for ANMs Salary
b) Contractual Staff LHV
_________
c) Remunaration to
Health Volunteers
I] Tribal Girls
3.
1st year i llnd year |
(Rs.in
(Rs.in
lakhs) {
lakhs)
6.
5,
6.00
6.00
REFERAL
TRANSPORT
0.002 L
Total
-27-
5.
TRAINING_______
! a)1. Training of Health
|
Volunteers (7days)
I
I__________
i 2. Remuneration to
j
resource person (@
;
of Rs.700/- per
person)___________
I b)1. Training of Para
i
medicals (3days)
I
20.24
3372
1.67
1.67
3.34
68 batches i
of 50 each .
3.30
3.30
660
500
0.50
0.50
1.00
0.25
0.25
0.50
0.09
0.09
0.18
1.50
1.50
3.00
500
0.25
0.25
0.50
50 batches ,
of 10 each I
1.05
1.05
2.10
0
6 types
20.00
10.00
30.00
0
0
35.00
69.29
15.00
39.29
50.00
82.58
6.00
2.00
17.00
12.00
4.00
34.00
DA Rs. 100/candidate
TA Rs.50/candidate
I c) 1. Training of Dais
!
(7days)
DA Rs. 100/candidate
TA Rs.50/candidate______
7 days x Rs.300 x 50
bathes
______ I
500
i
|
10 batch
esof 50
;
;
each
500
|
______ I
J
I DRUGSAND
j DAI KITS_________
I a) Kit 'A' Twice in a year
| b) Kit 'B' Twice in a year
! c) Tribal Health Kit one
L
10.12
3 days x Rs.300 x 10
bathes
j e) Refresher training
I Total
L
10.12
i 2. Remuneration to
resource person
i____________________
■ 2. Remuneration to
! resource person ______
I d) Training Ma
als
■ (printed moaeis charts,
i maps, mapping gouns)
6
3372
DA Rs.300/candidate
TA Rs.50/candidate______
7 days x Rs.700 x 68
bathes
time_________________
I d) Primary Health Care
1 e) ESOC and EMOC
! drugs_________________
| f) Dai kits (Instruments)
i g) Dai drug kits________
; h) Disposable
’
Delivery Kit (DDKs)
i I) MSS kits____________
| Total
______________
0.03 L
0.01 L
0.005 L
3372
6.00
2.00
17.00
0.50 L/PHC
0.20 L/PHC
103
103
51.50
20.60
51.50
20.60
103.00
41.20
Rs.300/Rs.1000/Rs.6/-
500
600
6400
i
1.50
5.00
0.40
0
0
0.40
1.50
5.00
0.80
Rs. 300/-
200
I
0.60
104.60
0.60
98.10
1.20
202.70
100
100
I
1
4
-28-
^7.
INFORMATION,
EDUCATIONS
COMMUNICATION
1) Workshop
__
T
i__________
i 100/PHCs
1.00
2.00
6.00
2.00
4.00
12.00
4
8.00
8.00
8.00
10
2.50
2.30
2.50
2.30
5.00
4.60
6.5
6.5
13.00
100/PHC
6.00
6.00
12.00
£
5.00
10.00
156.80
5,00
5.00
156.80
10.00
15.00
313.60
1
4
23
T
I
I
50/PHC
0
0.12 L
1
1.50
1.50
3.00
3.50 L
0.15 L
0.04 L
0
1
1
1
3,50
0.15
0.48
6.00
11.63
0
0.15
0.48
4,00
6.13
3.50
0.30
0.96
10.00
17.76
0.10 L / month
1
1.20
1.20
2.40
0.05 L / month
1
0.60
1.80
0.60
1.80
3.60
2.00
200
3.00
5.00
200
200
672.35
518.85
1191.20
0
LOGISTICS
1) Rent for Office
accommodation
2) Stores
Total
10
i
1.00
2.00
6.00
I
;
PROJECT
MANAGEMENT________
1) Salary of Tribal Project
Officer____________________
2) Four wheeler (Dist)_______
3) POL expenses___________
4) Driver___________________
5) Reports (monthly formats)
Total
9.
i
1
a) State I eve I_1________
1.00 L
I
b) Dist. Level________ I 0.50 L
| 2) Folk artist programme I 0.005 L
(once in a month)
3) Audio - visual vans
1.00 L
(Once in 6 months)
4) TV spots____________ I 0.25 L
5) Health fairs at each
0.10 L
taluk (23)_____________
6) Health Message
0.005 L
campaign (Once a
fortnight)______________
7) Orientation camps
0.005 L
(Once in a month)______
8) Printed materials
3 types
9. Photo display_______
0
Total
8
i
I
I
EVAL UA TION STUDIES
0
Total o
Grand Total
o
o
1.20
TRIBAL PROJECT HEALTH MANA GEMENT
ORGANISATION CHART
STATE LEVEL COMMITTEE
TRIBAL HEALTH COMMITTEE
(DISTRICT LEVEL)
T
TRIBAL PROJECT OFFICER
(DISTRICT NODAL OFFICER)
T
TALUK HEALTH OFFICER
GRAMA PANCHAYAT
COMMITTEE
J
.Xnnexure -1
CONTENT AND COST OF M.S.S. KIT
e
Cost
Contents
SI. I
No
Programme Information kit per Rs.49.18
1.
50.00
set on RCH
2.
4.
5.
Flip Book on RCH each copy
Rs.27.60
30.00
Booklet on RCH each copy
Rs.9.50
10.00
40.00
ORS pockets (20)
---------------------------------- :--------------
Disposable Delivery Kits (10)
Total
60.00
I
I
19*.
Annexure II
CONTENT AND COST OF DAIS DRUG KIT
Quantity
Contents
SI.
Cost
No.
1.
i 1000 Tabs.
Paracitamal Tab.
150.00
I
2.
Eye drops
: 10 botis.
50.00
3.
Antibiotic creams (2’’)
5 tubes
75.00
4.
Bandage cloths
25 roll
250.00
5.
Benzine benzite lotion
5 bottles
250.00
6.
Cotton roil (small)
1
140.00
Total
915.00
(Total Ruppes Nine Hundred and Fifteen only)
Annexure - DI
CONTENTS OF DAI KIT
sn
Contents
No. I
1.
Cotton gauge sterilized
Quantity
6 pockets
2.
Basin kidney tray
1
3.
Mucus extractor (disposable)
6
4.
Foetouscope
1
5.
Enema can
1
6.
Thread umbilical
1 (25 meter)
7.
Plastic sheeting
1
8.
Scissor
1
9.
Dais kit bag
1
Total cost of each kit is Rs.300/- (Three hundred only)
Annexure - IV
ITDP TALUKS AND MSS
SI.
No
Districts
1.
| H.D, Kote - Mysore
2.
3.
- Blocks
Ponnampet
Madikeri
1.
I 2.
3.
4.
5.
6.
7.
8.
Chamaraj nagar
Gundlupet
H.D.Kote
Hunsur_______
Kollegal______
Nanjanagud
Periyapatna
Yeldur
No.ofMSS
52
36
40
57
30
43
30
20
- i 1. Somwarpet
40
2. Virajpet
3. Madikeri
40
40
Udupi - Mangalore
1.
2.
i 3.
I 4.
Udupi
Beltangadi
Karkala
Kundapur
40
24
31
31
Puttur - Mangalore
1.
I 2.
| 3.
j 4.
Puttur
Sulya
Bantwal
Mangalore
24
17
33
30
Mudigere
Chikkamagalur
- | 1. Koppa
28
I 2. Sringeri
I 3. Mudigere
i 4. N.R. Pura
12
48
20
=
I___
5.
ITDP Taluks
I ______
]
Annexure - V
CONTENTS OF DRUG KIT A
Name of the Item
1
Oral Rehydration Salt (O.R.S.)
150
2
Tablet I.F.A. (large)
15000 tabs
3
Tablet LF.A (small)
' 13000
4
Vitamin A solution
6 bottles of 100 ml each
5
Tablet
(Paediatric)
*
Quantity
SI
No.
Cotrimoxazole
1000
packets
tabs
tabs
Annexure - VI
CONTENTS OF DRUG KIT B
rr
i
Tab Methylergometrine Maleate
Ii
I
Quantity
Name of the Item
SL
No
500 tablets
(0.125mg)
i
2
Tab Paracetamol (500 mg.)
500 tablets
i 3 | Inj. Methylegometrme Maleate (0.2
10 ampoule
mg/ml., 1ml ampoule (for I.M. use) in
light resistant amber colour ampoules )
I__________________________
4
Tab Mebendazole 100 mg.
300 tablets
*
5
Dicyclomine HC1 10 mg
250 tablets
6
Chloramphenicol Eye Ointment 1% w/w
500 applicap
in applicaps. Each applicap to contain
250 mg. of ointment
7
Ointment Povidone Iodine 5%
5 tubes
8
Cetrimide Powder
125 gm
9
Absorbent Cotton
1
10
Cotton Bandage z4cm wide x 4m length)
120
roll
rolls
Position: 794 (6 views)