Greetings From
Chhattisgarh
KORIA
SARGUJA
JASHPUR
KORBA
BILASPUR
DURG
RAIGARH
JANJGIR
RAIPUR
MAHASAMUND
NAN
DGA
O
N
KAWARDHA
RAJ
A new state
Chhattisgarh is
born on 1st
November 2000
with 16 districts
DHAMTARI
KANKER
BASTAR
DANTEWADA
GENERAL INFORAMTION
 Area
:
 Population
:
 Sex ratio
:
 No. of districts :
 IMR
:
146361 Sq. Km. (6 times of
Kerala State)
20795956(Census 2001)
Rural-80% , Urban-20%
SC- 12%, ST-33%
990 female per 1000 male
16 Blocks-146(Tribal –85)
79 per 1000 live births
Sex Ratio: 990/1000
Decadal Growth
Rate: 18.06
Literacy
Persons: 65.18
Male: 77.86
Female: 52.4
SRS 2001
(Released by RGI in October 2002)
Item
Birth rate (total)
Birth Rate (rural)
Birth Rate (urban)
Death Rate (total)
Death Rate (rural)
Death Rate (urban)
IMR (Total)
IMR (Rural)
IMR (Urban)
Chhattisgarh
26.7
29.2
22.8
9.6
11.2
7.1
79
95
49
MP
31.2
33.2
23.5
10.2
11
7.5
88
94
54
Some Important Indicators of NFHS-2
Fertility Indicators
Median age at mariage among women age 20-49
Total Fertility Rate (for the past 3 years)
Percent of women with 2 living children wanting another child
Current contraceptive use
Any method
Any modern method
Pill
IUD
Condom
Female Sterilization
Male Sterilization
Any traditional method
Unmet need of family planning
Percent with unmet need of family planning
Percent with unmet need for spacing
Quality of family planning services
Percent told about side effects of method
Percent who recieved follow up services
15.4
2.79
42.6
45
42.3
0.8
1
2.1
35.1
3.3
2.3
13.5
8
15
82.3
Some Important Indicators of NFHS-2
Maternal Health Indicators
Antenatal checkup from a health
professional
57.5
Antenatal checkup in the first trimester
26.7
Two or more tetanus toxoid injections
Iron and folic acid tablets or syrup
Percent of births whose mothers were
assisted at delivery by a:
Doctor
ANM/Nurse/midwife/LHV
Traditional birth attendant
Percent reporting at least one reproductive
health problem
58.2
54.9
22.3
9.7
42.7
37.4
Some Important Indicators of NFHS-2
Child Health Indicators
Percent of children who received
vaccination:
BCG
DPT(3doses)
Polio (3doses)
Measles
All vaccinations
Percent of children with diarrhoea in the
past 2 weeks who received oral
rehydration salts (ORS) (children under 3
years)
Percent of children with acute respiratory
infections in the past 2 weeks taken to a
health facility or provider (children under
3 years)
74.3
40.9
57.1
40.0
21.8
29.7
61.6
Infrastructure
Particulars
Area (Sq Kms)
Districts
Medical Colleges
Cities with more than 1 lakh Population
Cities with 50000 to 100000 Population
Blocks
CHC
Sub Centers
Villages
Panchayats
Habitations
Number
135194
16
2
8
4
146
150
3818
20379
9129
54000
Infrastructur
e Gaps
•Only 2 Medical
Colleges
•No District
Hospital in 10 out
of 16 Districts
(Sanctioned in all)
•No CHC in 54
out of 146 Blocks
Manpower
Gaps
•Deficiency of
over 500
doctors in
Public Sector
•Major
deficiency of
paramedics
•Very few
doctors, and
paramedics in
Private Sector in
rural areas
Other Gaps
•Poor
Monitoring
•Poor
Managerial and
other related
skills
•Difficult
Geographical
area, and poor
communication
The new Strategy
•Health Systems Improvement
•Improve Routine Programme
Monitoring
•Capacity Building at all levels Improve Training Infrastructure and
Manpower
•Community Health Volunteers
("Mitanins') - New Scheme of
Community Participation
•Improve Infrastructure
•Better MIS based on IT
•Involve PRIs and ULBs
•Mobile Hospitals
Important Areas of Reforms
 Strengthening health intelligence, surveillance,
epidemiology and planning
 Rational Drug Use Policy
 Uniform Treatment Clinical Protocols
 Improving internal systems of the Department of
Public Health
 Workforce management and transfer policy
 Management Information System
 Mainstreaming of Indian Systems of Medicine
esp. tribal medicines into the state health system
The Real CNAA
Item
Estimated in CNAA
Last Years
Performance
Surveyed
Target Couples
36,55,371
34,54,248
Protected
21,29,336
17,47,376
58.25
50.58
CPR
Need Assesment
CVT
4,849
2,629
5,852
NSVT
4,015
795
4,381
CTT
28,711
33,449
38,759
LTT
62,589
50,215
79,215
IUD
1,05,247
86,852
1,05,280
CC
3,64,107
3,50,104
2,78,646
OP
4,52,644
4,16,219
1,80,736
The New Plan of Action
- Contraception
 Uneven distribution of LTT surgeon (reallocation needed)
– 63 trained but only 23 working
– No LTT surgeon in 2 districts
 18 NSVT trained surgeons but only 5 are working - Need
to train in large number
 Skill training in IUD needed for ANMs
 Training of ANMs needed in counselling skills
 Days of week fixed in each hospital for Contraceptive
Services
Requirement of Equipment for
Family Planning
Laproscopes - 20 are irrepairable
IUD Insertion instrument kit - 3841 (3818
rural, 41 urban)
NSVT instruments kit (146-18=128)
Contraceptives
– 23,49,568 OP Cycles
– 2,11,77,096 CC pieces
The New Plan of Action
- Mother and Child Health
Microplanning of immunization and ANC
sessions
Plan to improve outreach
Intersectoral coordination
Better Logistics including cold chain
Out of 146 blocks 66 do not have a vehicle
Community Midwifery
Improvement in FRUs
Requirement of Cold Chain
Equipment
 Walk in Freezer - 1
 Walk in Cooler in Bilaspur and Raipur need
Replacement
 Cold Chain Equipment beyond repair
– ILR, Deep Freezer 140 L - 78
– ILR, Deep Freezer 300 L -88
 Vaccine Vans - 6
 Refrigerated Vaccine Van - 1
 Vaccine Carriers -1000
The " Indira Swasthya Mitanin"
Scheme
This is an innovative scheme in which the
village people will select a Community
Health Volunteer called "Mitanin" to help
them in developing a "Village Health Plan"
and for "Community Action in Health"
"Mitanin" in Chhattisgarhi means a Female
Friend
Basics of the “Mitanin”
Scheme
Empowerment
Participation
Sharing
Caring
Gender Equity
Self Sufficiency
Selection
 Selection by the
Community
 Help by trained
Facilitators
 Approval by Gram
Sabha
 Training by
Government
Who Can be a “Mitanin”
 A woman from the
same habitation
 Preferably a married
woman
 Acceptable to the
Community
 Not necessarily
educated
Role of Mitanin
Health Education
Leadership in
Community Action for
Health
First Aid & OTC
Drugs
Treatment of Minor
Ailments
Timely referral
Chief Minister on the
"Mitanin" Scheme
Relationship with ANM
Role of ANM
 Support to Mitanin
 Give refresher training
every fortnight
 Visit the Mitanin often
 Give the Mitanin
Legitimacy and
Confidence
 Help her in referral
Role of “Mitanin”
 Be a link between ANM
and community
 Help in National
Programmes
 Provide basic
information
Relationship with PRIs






Role of PRIs
Role of “Mitanin”
Facilitate approval of
Selection by Gram Sabha
Provide all inputs' support
incl. irrigation of “Mitanin
Land”
Monitor activities of
“Mitanin”
Send “Mitanin” for training
Ensure supplies of essential
medicines
Seek help from “Mitanin” for
other social sector
programmes
 PRIs may seek information
about health status of people
 Help PRIs in developing a
Health Plan
 Bridge between Gram
Panchayat and the community
 Help PRIs in other Social
Sector Programmes
Training: Method
 Participative, Gradual, Repetitive, Fun filled,
Practical with field experience, at the pace of
learning of “Mitanins”
 Initiation training: Mainly on attitudes, behavior,
communication, working in groups, community
participation, concepts in Public Health
 Refresher training: mainly for knowledge and
skills of diagnosis and treatment of common
ailments
 Responsibilities will be increased gradually with
“On the Job Training”
Achievement so far
A group of NGOs and GOs Constituted as
a State Advisory Committee
Work already started in 16 blocks
More than 2000 Mitanins already selected
Facilitators manual and the first two
Mitanin Training manuals ready
Training of Mitanins to begin soon
Requirements under Existing
RCH Programme
Training of at least 20 more surgeons in
NSVT
Training of ANMs in counselling skills,
and IUD insertion
Large Scale TBA training
IUD insertion kits for ANMs
Equipping of FRUs with blood storage and
emergency obstetric surgery facilities
The proposal for EAG funds
Improvement of Training Infrastructure
Mobile Hospitals - to improve Outreach
Telemedicine - at Pendra
Community Midwifery Course
Training of Doctors in Anesthesia and
money for their insurance coverage
Gaps in Training Infrastructure
Only 5 out of 16 Districts have DTCs
No SIHFW
RHFWTC Bilaspur not well equipped
5 AMNTCs, 3 MPW(M)TCs, 4 GNTCs -
all buildings need repairs
All Centers need Training equipment
Capacity building of training faculty
needed
Requirement of funds for
Training Infrastructure
SN
Item
Amount (in lakhs)
1
2
Repair and renovation of existing
buildings
Construction of new buildings
364
3
Providing modern training aids
165
4
TOT (from money in the Danida
Project)
Total
70
0
599
Mobile Hospitals
Initially 3 mobile hospitals proposed
Each mobile hospital will be fully
equipped and cost approximately 30 lakh
Public - Pvt -NGO partnership
– Provided by Govt., managed by Pvt/NGO
– Pvt/NGO to provide for recurring expen.
– Govt. to give Medicines under National
Programmes, and for BPL
Run on Predefined routes in Hat-Bazars
Telemedicine
To begin with Link Medical College
Raipur with Pendra
Video-conferencing link through VSAT
Total Cost 40 lakh
Provide good secondary level care at
remote locations
Community Midwifery Course
The "Paramedical Council Act" already
passed
Affiliation and examination by
Chhattisgarh Paramedical Council
Course design workshop - cost Rs 1 lakh
Equipping all ANMTCs - Rs 30 lakh
Stipend to 50% reserved category students
- Rs 5.40 lakh
Aneshthesia Training of Doctors
Course design workshop - Rs 1 lakh
Equipping Medical College Raipur for
Training - Rs 15 lakh
Cost of training of 40 doctors for 3 months
- 6.20 lakh
Cost of Insurance of Anesthesia trained
MBBS doctors - Rs 10 lakh
The Proposal for EAG funds
S.No. Scheme
Cost
1
59900000
2
Improvement in Training
Infrastructure
Mobile Hospitals
3
Telemedicine
4000000
4
Community Midwifery
3640000
5
Anesthesia Training
3220000
Total
9000000
79760000