Dr. I. D. Ranjan
C.S. cum Member Secretary
DHS, Kishanganj
Sri Umesh Kumar (BAS)
DDC cum Vice Chairman
DHS, Kishanganj
Sri Sandip Kumar
Podulki (IAS)
DM cum Chairman
DHS, Kishanganj
Index
1 Background
a) Introduction to NRHM
b) Introduction to DHAP
c) Introduction to Kishanganj District
2 Progress so Far
a) Maternal Health
b) Child Health
c) Family Planning
d) Other Programme
3 Situational Analysis
a) Health Facilities the District
b) Human Resources & Infrastructure
c) Equipment, Drugs & Supplies
d) RKS, Untied fund & Support Services
e) Health Services Delivery
f) Community Participation, Training and BCC
4 Process for Plan Development
5 Objectives
6 Work Plan
7 Monitoring & Evaluation
8 Proposed Budget
a) RHC-II (NRHM-A)
b) Additionalities of NRHM (NRHM-B)
c) Immunization (NRHM-C)
d) Revised National Tuberculosis Control Programme (RNTCP)
e) National Vector Borne Disease Control Programme (NVBDCP)
f) National Blindness Control Programme
g) National Leprocy Eradication Programme
h) Iodine Deficiency Disorder Programme (IDDP)
i) Integrated Disease Survileance Project (IDSP)
j) AIDS
k) Summary of Budget
9 List of Abbrevitions
Introduction to NRHM
The National Rural Health Mission (NRHM) aims to provide for an accessible,
affordable, acceptable and accountable health care through a functional public health
system.
It is designed to galvanize the various components of primary health system, like
preventive, promotive and curative care, human resource management, diagnostic
services, logistics management, disease management and surveillance, and data
management systems etc. for improved service delivery.
The Vision of the Mission
1. To provide effective healthcare to rural population throughout the country with special
focus on 18 states, which have weak public health indicators and/or weak
infrastructure.
2. 18 special focus states are Arunachal Pradesh, Assam, Bihar, Chattisgarh, Himachal
Pradesh, Jharkhand, Jammu and Kashmir, Manipur , Mizoram, Meghalaya, Madhya
Pradesh, Nagaland, Orissa , Rajasthan, Sikkim, Tripura, Uttaranchal and Uttar
Pradesh.
3. To raise public spending on health from 0.9% GDP to 2-3% of GDP, with improved
arrangement for community financing and risk pooling.
4. To undertake architectural correction of the health system to enable it to effectively
handle increased allocations and promote policies that strengthen public health
management and service delivery in the country.
5. To revitalize local health traditions and mainstream AYUSH into the public health system.
6. Effective integration of health concerns through decentralized management at district,
with determinants of health like sanitation and hygiene, nutrition, safe drinking water,
gender and social concerns.
7. Address inters State and inters district disparities.
8. Time bound goals and report publicly on progress.
9. To improve access to rural people, especially poor women and children to equitable,
affordable, accountable and effective primary health care.
Goals
1. Reduction in Infant Mortality Rate (IMR) and Maternal Mortality Ratio (MMR)
2. Universal access to public health services such as Women’s health, child health,
water, sanitation & hygiene, immunization, and Nutrition.
3. Prevention and control of communicable and non-communicable diseases, including
locally endemic diseases.
4. Access to integrated comprehensive primary healthcare.
5. Population stabilization, gender and demographic balance.
6. Revitalize local health traditions and mainstream AYUSH.
7. Promotion of healthy life styles.
Strategies
(a) Core Strategies:
 Train and enhance capacity of Panchayati Raj Institutions (PRIs) to own, control
and manage public health services.
 Promote access to improved healthcare at household level through the female
health activist (ASHA).
 Health Plan for each village through Village Health Committee of the Panchayat.
 Strengthening sub-centre through an untied fund to enable local planning and
action and more Multi Purpose Workers (MPWs).
 Strengthening existing PHCs and CHCs, and provision of 30-50 bedded
 CHC per lakh population for improved curative care to a normative standard
(Indian Public Health Standards defining personnel, equipment and management
standards).
 Preparation and Implementation of an inter-sectoral District Health Plan prepared
by the District Health Mission, including drinking water, sanitation & hygiene and
nutrition.
 Integrating vertical Health and Family Welfare programmes at National, State,
Block, and District levels.
 Technical Support to National, State and District Health Missions, for Public
Health Management.
 Strengthening capacities for data collection, assessment and review for evidence
based planning, monitoring and supervision.
 Formulation of transparent policies for deployment and career development of
Human Resources for health.
 Developing capacities for preventive health care at all levels for promoting healthy
life styles, reduction in consumption of tobacco and alcohol etc.
 Promoting non-profit sector particularly in under served areas.
(b) Supplementary Strategies:
 Regulation of Private Sector including the informal rural practitioners to ensure
availability of quality service to citizens at reasonable cost.
 Promotion of Public Private Partnerships for achieving public health goals.
 Mainstreaming AYUSH – revitalizing local health traditions.
 Reorienting medical education to support rural health issues including regulation
of Medical care and Medical Ethics.
 Effective and viable risk pooling and social health insurance to provide health
security to the poor by ensuring accessible, affordable, accountable and good
quality hospital care.
Introduction to District Health Action Plan (DHAP)
In order to make NRHM fully accountable the District Health Plan will be the
principle instrument for planning, implementation and monitoring., formulated through a
participatory and bottom up planning process. District Health Mission has been
constituted in the districts as per guidelines.
As a next step each district has to formulate/design District Health Action Plan
(DHAP). The DHAP will contain situational analysis of the district, objectives and
interventions, work plan and budgets and an M&E plan.
The DHAP document will be appraised and approved at State level and will be
guiding document for implementation, monitoring & evaluation of NRHM activities in
the district. It is envisaged that decentralized programme management is likely to be more
responsive to the health care needs of local community and will be a step towards
ultimate communalization – a hallmark of NRHM.
The District Health Mission has been entrusted with the responsibility of steering
formulation and ensuring implementation of the plans. The District Health Plan should as
far as practicable be an aggregation and consolidation of the Village and the Block Health
Plan.
Introduction to Kishanganj District
A portion of Bihar, situated in the North East. Bordering W. Bengal, Bangla Desh
and Nepal has been undeveloped for a long time. The latitude of Gradually, it made some
progress. But, the speed of progress was not so encouraging. Fortunately, it becomes a
district in 1990. It is heartening to see that the day it was declared a district, the progress
and Development activities also commenced giving a new look of the area.
During the period of Khagada Nawab, Mohammed Fakiruddin, one hindu saint
arrived , he was tired and wanted to rest at this place, but when he heard that this place
name is Alamganj ,the river name is Ramzan and the Jamindar name is Fakiruddin , he
refused to enter at Alamganj. After that the Nawab decided and announced some portion
from Kishanganj Gudri to Ramzan pool gandhi ghat as Krishna-Kunj . As time passed by
the name gets converted to present KISHANGANJ
During Mughal period Kishanganj district was the part of Nepal and was known as
Nepalgarh. Mughal Emperor Shah Alam appointed Mohammed Raza at Surajapur for
administration. Md. Raza captured the fort of Nepalgarh and name gets converted to
Alamganj and administration gets shifted to Khagara. The Historical "KHAGRA MELA"
is held every year at Kharga, Kishanganj
Kishanganj was the old and important Sub-Division of Purnea. After the long and
hard struggle of Seventeen Years from people of Kishanganj including Social Workers,
politicians, journalist, businessmen, Farmers etc., the Kishanganj District came into
existence on 14th January 1990.
District Profile
No.
Variable
Data
1.
Total area
1884 Sq. K.M.
2.
Total no. of blocks
7
3.
Total no. of Gram Panchayats
126
4.
No. of villages
815
5.
No of PHCs
7
6.
No of APHCs
9 + 14 (New) = 23
7.
No of HSCs
136 + 49 (New) = 185
8.
No of Sub divisional hospitals
1
9.
No of referral hospitals
2 (Only one functional)
10. No of Doctors
38 (09 Contractual)
11. No of Ayush Doctor
12
12. No of ANMs
159 (40 Contractual)
13. No of Grade A Nurse
24 (18 Contractual)
14. No of Paramedicals
47
15. Total population
1296348 (Census 2001)
16. Male population
669552 (Census 2001)
17. Female population
626796 (Census 2001)
18. Sex Ratio
936/1000 (Female/Male)
19. No of Eligible couples
220379 (Census 2001)
20. Children (0-6 years)
287937 (Census 2001)
21. Children (0-1years)
41094 (Census 2001)
22. SC population
85833 (Census 2001)
23. ST population
47116 (Census 2001)
24. BPL population
262587 (No. of household)
25. No. of primary schools
547
26. No. of Anganwadi centers
1296
27. No. of Anganwadi workers
1239
28. No of ASHA
1368
29. No. of electrified villages
508
30. No. of villages having access to safe drinking water NA
31. No of villages having motorable roads
518
District Health Society, Kishanganj
Status of Medical Officer in Kishanganj District
Sl.
No.
Name of Institution
Real Working
Force
Regular Contract Regular Contract Regular Contract Regular Contract
Sanctioned Post
Working Force
Vaccant Post
1
District Hospital, Kishanganj
12
0
1
0
11
0
1
2
Sub. Div. Hospital, Kishanganj
7
0
6
0
1
0
6
3
PHC, Kishanganj
3
4
2
2
1
2
1
4
PHC, Bahadurganj
3
4
3
2
0
2
3
5
PHC, Thakurganj
3
4
2
1
1
3
2
6
PHC, Kochadhaman
3
4
1
1
2
3
1
7
PHC, Dighalbank
3
4
3
1
0
3
2
8
PHC, Pothia
3
4
2
1
1
3
2
9
PHC, Terhagachh
3
4
2
1
1
3
2
10
Referal Hospital, Chhattargach
4
0
2
0
2
0
2
11
Referal Hospital, Pothia
4
0
2
0
2
0
0
12
APHC, Gangihat
2
0
1
0
1
0
0
13
APHC, Meharganj
2
0
0
0
2
0
0
14
APHC, Rupni
2
0
1
0
1
0
0
15
APHC, Alta
2
0
0
0
2
0
1
16
APHC, Haldikhora
2
0
1
0
1
0
0
17
APHC, Padampur
2
0
0
0
2
0
0
18
APHC, Lakshmipur
2
0
1
0
1
0
0
19
APHC, Lakshmipur
2
0
0
0
2
0
1
20
APHC, Damalbari
2
0
0
0
2
0
0
21
Civil Surgeon Office
1
0
1
0
0
0
1
22
District TB Centre
1
0
1
0
0
0
1
68
28
32
9
36
19
26
0
0
2
2
1
1
1
1
1
0
0
0
0
0
0
0
0
0
0
0
0
0
9
Total
96
41
55
35
District Health Society, Kishanganj
Status of Para Medical & Other Staff in Kishanganj District
Sl. No.
Name of Post
Sanctioned Post
Working Post
Vaccant
Post
1
Drug Inspector
2
1
1
2
Food Inspector
0
0
0
3
Maleria Inspector
3
0
3
4
Surveillance Inspector
3
0
3
5
Sanitary Inspector
8
0
8
6
Health Educator
9
4
5
7
Block Extension Educator
7
1
6
8
Nruse Grade 'A'
12
5
7
9
Nruse Grade 'A' (Contractual)
44
18
26
10
Stenographer
2
0
2
11
Lady Health Visitor
31
11
20
12
ANM
167
119
48
13
ANM ® (Contractual)
186
40
146
14
Head Clark
2
1
1
15
Clark
33
18
15
16
Pharmasist
2
1
1
17
Dispensar
19
0
19
18
Compounder
20
1
19
19
Opthelmic Assistant
5
2
3
20
X-ray Technician
3
1
2
21
O.T. Assistant
3
0
3
22
Laboratry Technician
19
5
14
23
Laboratry Technician (Maleria)
0
0
0
24
Non Technical Assistant
0
0
0
25
Computer
7
0
7
26
Health Worker (HW)
21
2
19
27
Basic Health Workar(BHW)
20
10
10
28
Basic Health Worker (BHW
Maleria)
2
2
0
29
Family Planning Worker
21
10
11
30
Dispensar
1
1
0
31
Driver
9
9
0
32
Fourth Grade Staff
139
136
3
800
398
402
Total
Remarks
DHS, Kishanganj
District Health Society, Kishanganj
Progress so Far
Year 2005-06
Year 2006-07
Indicators
Targe
t
Achiv.
15%
58633
10629
5748
12%
52184
48500
2145
4%
48500
1478
45105
Year 2007-08
Targe
t
Achiv.
18%
65148
28341
11314
22%
57982
53303
5837
11%
3%
53303
4334
14758
33%
49571
45105
4128
9%
108920
59540
Sterilization
(Family Planning)
7811
IUD Instrtion
Target
Achiv.
ANC Registration
53350
7854
TT2+Booster
47482
Intitutional Deliveries
(JBSY)
Year 2008-09
Targe
t
Achiv.
60%
66857
47100
70.45%
68547
33854
49.39
%
22612
40%
66857
27562
41.23%
68547
17845
26.03
%
59242
20377
34%
60779
22642
37.25%
68547
13924
20.31
%
14%
59242
9249
16%
60779
9224
15.18%
68547
5797
8.46%
15813
29%
55095
21482
39%
60779
31206
51.34%
58951
16830
28.55
%
55079
8025
15%
55095
7063
13%
60779
0.00%
58951
13159
22.32
%
59%
133006
91971
69%
134295
73091
54%
139667
0.00%
58951
15026
25.49
%
2024
24%
9538
4633
49%
9124
4216
46%
9947
4957
49.83%
10199
1155
11.32
%
3577
2234
62%
3974
2389
60%
3802
1908
50%
4145
2055
49.58%
4248
1759
41.41
%
32%
18603
8388
45%
20670
2616
13%
19773
5012
25%
21557
15250
70.74%
22074
8105
36.72
%
103
%
85860
97847
114
%
95400
138310
145
%
91200
99199
109
%
99426
117183
117.86%
102000
12749
9
125.0
0%
2000
855
43%
2000
1214
61%
2000
958
48%
2000
4272
213.60%
2000
3360
168.0
0%
Target
Achiv.
44%
65166
39059
15224
26%
56466
59225
13158
22%
8%
59225
8424
18332
37%
55079
49571
9012
18%
55%
119705
70819
42
1%
8584
3254
456
14%
Oral Pills
16927
5485
Condom Distribution
78124
80145
PNC (Post Natel
Care)
RI (Routine
Immunization)
Fully Immunization
Complete
Immunization
Vitamin'A' (Nutrition)
Cateract (Eye)
Operation
2000
OPD (Outdoor
Patient)
--
Year 2010-11(Upto
Nov. 2010)
Year 2009-10
%
N/A
N/A
160373
--
--
232424
%
--
--
314087
9
%
--
--
365217
%
--
--
336037
%
--
Targe
t
Achi
v.
%
DHS, Kishanganj
ANC Registration
80000
70000
68547
66857
65166
65148
58633
60000
53350
50000
47100
39059
40000
33854
ANC Registration
28341
30000
20000
10629
7854
10000
15%
18%
44%
60%
70.45%
49.39%
Year 2005-06
Year 2006-07
Year 2007-08
Year 2008-09
10
Year 2009-10
%
Achiv.
Target
%
Achiv.
Target
%
Achiv.
Target
%
Achiv.
Target
%
Achiv.
Target
%
Achiv.
Target
0
Year 2010-11(Upto Nov.
2010)
DHS, Kishanganj
TT2+Booster
80000
70000
68547
66857
57982
60000
56466
52184
50000
47482
40000
TT2+Booster
27562
30000
22612
17845
20000
15224
11314
10000
5748
12%
22%
26%
40%
41.23%
26.03%
Year 2005-06
Year 2006-07
Year 2007-08
Year 2008-09
11
Year 2009-10
%
Achiv.
Target
%
Achiv.
Target
%
Achiv.
Target
%
Achiv.
Target
%
Achiv.
Target
%
Achiv.
Target
0
Year 2010-11(Upto Nov.
2010)
DHS, Kishanganj
Intitutional Deliveries (JBSY)
80000
68547
70000
60779
59242
59225
60000
53303
50000
48500
40000
Intitutional Deliveries (JBSY)
30000
22642
20377
20000
13924
13158
10000
5837
2145
4%
11%
22%
34%
37.25%
20.31%
Year 2005-06
Year 2006-07
Year 2007-08
Year 2008-09
12
Year 2009-10
%
Achiv.
Target
%
Achiv.
Target
%
Achiv.
Target
%
Achiv.
Target
%
Achiv.
Target
%
Achiv.
Target
0
Year 2010-11(Upto
Nov. 2010)
DHS, Kishanganj
PNC (Post Natel Care)
80000
68547
70000
60779
59242
59225
60000
53303
50000
48500
40000
PNC (Post Natel Care)
30000
20000
9249
8424
10000
9224
5797
4334
1478
3%
8%
14%
16%
15.18%
8.46%
Year 2005-06
Year 2006-07
Year 2007-08
Year 2008-09
13
Year 2009-10
%
Achiv.
Target
%
Achiv.
Target
%
Achiv.
Target
%
Achiv.
Target
%
Achiv.
Target
%
Achiv.
Target
0
Year 2010-11(Upto
Nov. 2010)
DHS, Kishanganj
RI (Routine Immunization)
70000
60779
58951
60000
55095
55079
49571
50000
45105
40000
31206
30000
RI (Routine Immunization)
21482
18332
20000
16830
15813
14758
10000
33%
37%
29%
39%
51.34%
28.55%
Year 2005-06
Year 2006-07
Year 2007-08
Year 2008-09
14
Year 2009-10
%
Achiv.
Target
%
Achiv.
Target
%
Achiv.
Target
%
Achiv.
Target
%
Achiv.
Target
%
Achiv.
Target
0
Year 2010-11(Upto
Nov. 2010)
DHS, Kishanganj
Complete Immunization
70000
60779
58951
60000
55095
55079
49571
50000
45105
40000
Complete Immunization
30000
20000
13159
9012
10000
8025
7063
4128
9%
18%
15%
13%
0.00%
22.32%
0
Target Achiv.
%
Year 2005-06
Target Achiv.
%
Year 2006-07
Target Achiv.
%
Year 2007-08
Target Achiv.
%
Year 2008-09
15
Target Achiv.
%
Year 2009-10
Target Achiv.
%
Year 2010-11(Upto
Nov. 2010)
DHS, Kishanganj
Vitamin'A' (Nutrition)
160000
139667
140000
134295
133006
119705
120000
108920
100000
91971
80000
73091
70819
Vitamin'A' (Nutrition)
60000
59540
58951
40000
20000
15026
55%
59%
69%
54%
0.00%
25.49%
0
Target Achiv.
%
Year 2005-06
Target Achiv.
%
Year 2006-07
Target Achiv.
%
Year 2007-08
Target Achiv.
%
Year 2008-09
16
Target Achiv.
%
Year 2009-10
Target Achiv.
%
Year 2010-11(Upto
Nov. 2010)
DHS, Kishanganj
Sterilization (Family Planning)
12000
10199
9947
10000
9538
9124
8584
8000
7811
6000
4957
4633
Sterilization (Family Planning)
4216
4000
2024
2000
1155
42
1%
24%
49%
46%
49.83%
11.32%
0
Target Achiv.
%
Year 2005-06
Target Achiv.
%
Year 2006-07
Target Achiv.
%
Year 2007-08
Target Achiv.
%
Year 2008-09
17
Target Achiv.
%
Year 2009-10
Target Achiv.
%
Year 2010-11(Upto
Nov. 2010)
DHS, Kishanganj
IUD Instrtion
4500
4248
4145
3974
4000
3802
3577
3500
3254
3000
2389
2500
2234
2055
1908
2000
IUD Instrtion
1759
1500
1000
500
456
62%
14%
60%
50%
49.58%
41.41%
0
Target Achiv.
Year 2005-06
%
Target Achiv.
Year 2006-07
%
Target Achiv.
Year 2007-08
%
Target Achiv.
Year 2008-09
18
%
Target Achiv.
Year 2009-10
%
Target Achiv.
%
Year 2010-11(Upto
Nov. 2010)
DHS, Kishanganj
Oral Pills
25000
22074
21557
20670
19773
20000
18603
16927
15250
15000
Oral Pills
10000
8388
8105
5485
5012
5000
2616
32%
45%
13%
25%
70.74%
36.72%
0
Target Achiv.
Year 2005-06
%
Target Achiv.
Year 2006-07
%
Target Achiv.
Year 2007-08
%
Target Achiv.
Year 2008-09
19
%
Target Achiv.
Year 2009-10
%
Target Achiv.
%
Year 2010-11(Upto
Nov. 2010)
DHS, Kishanganj
Condom Distribution
160000
138310
140000
127499
117183
120000
97847
100000
102000
99426
99199
95400
91200
85860
80000
78124
80145
Condom Distribution
60000
40000
20000
103%
114%
145%
109%
117.86%
125.00%
0
Target Achiv.
%
Year 2005-06
Target Achiv.
%
Year 2006-07
Target Achiv.
%
Year 2007-08
Target Achiv.
%
Year 2008-09
20
Target Achiv.
%
Year 2009-10
Target Achiv.
%
Year 2010-11(Upto
Nov. 2010)
DHS, Kishanganj
Cateract (Eye) Operation
4500
4272
4000
3500
3360
3000
2500
2000
2000
2000
2000
2000
2000
2000
Cateract (Eye) Operation
1500
1214
1000
958
855
500
0
43%
0
61%
213.60%
48%
168.00%
0
Target Achiv.
%
Year 2005-06
Target Achiv.
%
Year 2006-07
Target Achiv.
%
Year 2007-08
Target Achiv.
%
Year 2008-09
21
Target Achiv.
Year 2009-10
%
Target Achiv.
%
Year 2010-11(Upto
Nov. 2010)
DHS, Kishanganj
OPD (Outdoor Patient)
400000
365217
350000
336037
314087
300000
250000
232424
200000
OPD (Outdoor Patient)
160373
150000
100000
50000
0
0
0
0
0
0
0
0
0
0
Target Achiv.
%
Year 2005-06
Target Achiv.
%
Year 2006-07
Target Achiv.
%
Year 2007-08
Target Achiv.
%
Year 2008-09
22
Target Achiv.
Year 2009-10
%
Target Achiv.
%
Year 2010-11(Upto
Nov. 2010)
DHS, Kishanganj
Section A: Health Facilities in the District
Health Sub-centres
1
Kishanganj
125533
25
12
Subcenters
proposed
10
2
Bahadurganj
222955
45
19
23
3
12
5
Y (In Old HSC)
3
Thakurganj
259255
52
27
20
5
13
N/A
Y (In Old HSC)
4
Kochadhaman
284145
57
24
25
8
12
3
Y (In Old HSC)
5
Dighalbank
191443
38
19
15
4
8
N/A
Y (In Old HSC)
6
Pothia
246120
49
22
20
7
14
4
Y (In Old HSC)
7
Terhagachh
134206
27
13
10
4
7
1
Y (In Old HSC)
Total
1463657
293
136
123
34
73
10
Y (In Old HSC)
Sl.
No
Block Name
Rural
Population
in 2009
Sub-centers
required
As per norm.
Sub-centers
Present
Further subcenters
required
Status of building
Own
Rented
Availability of
Land (Y/N)
3
7
N/A
Y (In Old HSC)
Addition Primary Health Centre
60
50
Sub-centers required
40
Sub-centers
Present
30
Sub-centers proposed
20
Further sub-centers required
10
0
Kishanganj
Bahadurganj
Thakurganj
Kochadhaman
Dighalbank
23
Pothia
Terhagachh
DHS, Kishanganj
(APHCs)
1
Kishanganj
Rural
Population
in 2009
125533
2
Bahadurganj
222955
7
3
4
0
2
0
Y (In Old APHC)
3
Thakurganj
259255
9
1
7
1
1
0
No
4
Kochadhaman
284145
9
2
7
0
2
0
No
5
Dighalbank
191443
6
2
4
0
1
0
Y (In Old APHC)
6
Pothia
246120
8
1
6
1
1
0
No
7
Terhagachh
134206
4
0
4
0
0
0
No
1463657
37
9
35
3
7
0
No
Sl.
No
Block Name
Total
APHCs
Required as
per norm
4
APHCs
Present
APHCs
proposed
0
3
Further
APHCs
required
1
Status of building
Own
Rented
Availability of
Land (Y/N)
0
0
No
9
8
7
APHCs Required as per norm
6
APHCs
Present
5
4
APHCs proposed
3
Further APHCs required
2
1
0
Kishanganj
Bahadurganj
Thakurganj
Kochadhaman
Dighalbank
24
Pothia
Terhagachh
DHS, Kishanganj
Primary Health Centers/Referral Hospital/Sub-Divisional Hospital/District Hospital
Sl.
No
Block Name/sub division
Total Population
PHCs/Referral
/SDH/DH Present
PHCs required (After
including
referral/DH/SDH)
PHCs/CHC
proposed
1
Kishanganj
232805
2
2
0
2
Bahadurganj
258161
1
2
1
3
Thakurganj
278386
1
2
1
4
Kochadhaman
284091
1
2
1
5
Dighalbank
191406
1
2
1
6
Pothia
246073
2
2
No. of
Assured
Cont.
ANM
ANM (R/C)
Building
Building
Sl.
Health Sub
G.P./
ANM (R/C)
running
power
residing
Population
Posted
ownership
condition
Terhagachh
134180
1 water supply supply
1
No.7 Centre
Name
Villages
in position
at HSC
formally
(Govt/Rent) (+++/++/+/#)
served
(A/NA/I) (A/NA/I) area (Y/N)
Total
1625102
9
13
0
Condition of
residential
Status of Status of
0 Untied fund
facility
furnitures
(+++/++/+/#)
4
1 Kulamani
10838
7
R
R
Govt.
++
NA
NA
NA
++
NA
Exhausted
2 Belwa
10398
7
R
R
Govt.
+++
NA
NA
NA
+++
NA
Exhausted
10268
4
R
R
Govt.
++
NA
NA
NA
++
NA
Exhausted
10288
5
R
R
--
#
NA
NA
NA
#
NA
Exhausted
10333
7
R
R
Govt.
+++
NA
NA
NA
3
Ghat Bhabhan
2
Toli 1.8
1.6
4 Motihara
5
6
7
1.4
1.2
Daula
1
0.8
Pichhla
0.6
0.4
Halamala
0.2
0
PHCs/Referral/SDH/DH
Present
+++
NA
Exhausted
PHCs required (After including referral/DH/SDH)
10415
7
R
R
--
#
NA
NA
NA
# proposed
PHCs/CHC
NA
Exhausted
10256
6
R
R
--
#
NA
NA
Y
#
NA
Exhausted
--Dighalbank
# Pothia
NA
Terhagachh NA
NA
#
NA
Exhausted
8 MaheshbathnaKishanganj
11146 Bahadurganj
7
Thakurganj
R
Kochadhaman
R
25
DHS, Kishanganj
9 Gachhpada
10603
4
R
R
Govt.
+++
NA
NA
NA
+++
NA
Exhausted
10 Chakla
10223
4
R
R
Govt.
++
NA
NA
NA
++
NA
Exhausted
11 Kolha Banwadi
10656
5
R
R
Govt.
++
NA
NA
NA
++
NA
Exhausted
12 Mahingawn
10109
4
R
R
Govt.
+++
NA
NA
NA
+++
NA
Exhausted
125533
67
Total
Section B: Human Resources and Infrastructure
Name of the Block:Kishanganj
Sub-centre database
ANM(R)- Regular/ ANM(C)- Contractual; Govt- Gov/ Rented-Rent/ Pan –Panchayat or other Dept owned; Good condition +++/ Needs major
repairs++/Needs minor repairs-less that Rs10,000-+/ needs new building-#; Water Supply: Available –A/Not available –NA, Intermittently available-I
Name of the Block:Bahadurganj
Sub-centre database
Sl.
No.
Health Sub
Centre Name
1 Do Mohni
2 Jhingakanta
3 Rupni
4 Lohagada
5 Natuapada
6 Veerpur (Plashmani)
7 Nishandhra
8 Laucha
9 Banswadi
10 Doharmalani
No. of
ANM
G.P./
(R/C)
Population
Villages Posted
served formally
12709
13817
13967
12689
13849
12358
13816
13803
11910
13193
5
7
7
5
7
6
7
7
4
6
ANM
Assured
Cont.
ANM
Building
Building
(R/C)
running
power
residing
ownership
condition
in
water supply supply
at HSC
(Govt/Rent) (+++/++/+/#)
position
(A/NA/I) (A/NA/I) area (Y/N)
Condition of
residential
Status of Status of
facility
furnitures Untied fund
(+++/++/+/#)
R
R
--
#
NA
NA
NA
#
NA
Exhausted
R
R
--
#
NA
NA
NA
#
NA
Available
R
R
Govt.
++
NA
NA
NA
++
NA
Exhausted
R
R
Govt.
++
NA
NA
NA
++
NA
Exhausted
R
R
Govt.
+++
NA
NA
NA
+++
NA
Exhausted
R
R
Govt.
+++
NA
NA
NA
+++
NA
Exhausted
R
R
--
#
NA
NA
NA
#
NA
Exhausted
NA
NA
#
NA
Available
R
R
--
#
NA
R
R
--
#
NA
NA
NA
#
NA
Exhausted
R
R
--
#
NA
NA
NA
#
NA
Available
26
DHS, Kishanganj
11 Vilashi
12 Sameshar
13 Khodaganj
14 Gopalpur
15 Altawadi
16 Murmala
17 Mahadev Dighi
Total
12863
12850
11696
13983
12634
13967
12851
6
6
5
7
5
7
6
222955
103
R
R
--
#
NA
NA
NA
#
NA
Exhausted
C
C
Govt.
+++
NA
NA
NA
+++
NA
Available
R
R
Govt.
++
NA
NA
NA
++
NA
Exhausted
R
R
Govt.
++
NA
NA
NA
++
NA
Exhausted
R
R
--
#
NA
NA
NA
#
NA
Exhausted
R
R
Govt.
++
NA
NA
NA
++
NA
Available
C
C
--
#
NA
NA
NA
#
NA
Exhausted
ANM(R)- Regular/ ANM(C)- Contractual; Govt- Gov/ Rented-Rent/ Pan –Panchayat or other Dept owned; Good condition +++/ Needs major
repairs++/Needs minor
repairs-less than Rs10,000-+/ needs new building-#; Water Supply: Available –A/Not available –NA, Intermittently available-I
Name of the Block: Thakurganj
Sub-centre database
No. of
Assured
Cont.
ANM
ANM (R/C)
Building
Building
Sl.
Health Sub
G.P./
ANM (R/C)
running
power
residing
Population
Posted
ownership
condition
No. Centre Name
Villages
in position
water supply supply
at HSC
formally
(Govt/Rent) (+++/++/+/#)
served
(A/NA/I) (A/NA/I) area (Y/N)
1
2
3
4
5
6
7
8
9
10
11
12
13
14
Barigachh
Galgalia
Churli
Churli
Piprithan
Piprithan
Patharia
Hulhuli
Jangle Bhita
Janta Hat
Khari Basti
Jhala
Kudi Dangi
Rui Dhasha
9269
8689
9512
8876
9363
9276
9810
9589
9269
9687
10595
9835
9586
10868
4
4
5
4
4
4
5
4
5
4
5
5
4
5
R
R
R
R
C
R
C
C
C
R
R
R
R
R
R
R
R
R
C
R
C
C
C
R
R
R
R
R
-Govt.
Govt.
---Govt.
Govt.
-----Govt.
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
#
+++
++
#
#
#
+++
+++
#
#
#
#
#
+++
27
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
Condition of
residential
Status of Status of
facility
furnitures Untied fund
(+++/++/+/#)
#
+++
++
#
#
#
+++
+++
#
#
#
#
#
+++
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
Exhausted
Exhausted
Exhausted
Available
Available
Exhausted
Available
Exhausted
Available
Available
Exhausted
Exhausted
Available
Exhausted
DHS, Kishanganj
15
16
17
18
19
20
21
22
23
24
25
26
27
Jirangachh
Nischit Pur
Barchaundi
Kharudah
Bhogdawar
Pathamari
Kadogawn
Malingawn
Bandarjhula
Ziya Pokhar
Rasia
Beltoli
Saraikudi
9608
9589
8689
10263
8993
9378
9569
9356
9659
9851
10128
9566
10382
5
5
4
5
4
4
4
4
4
4
5
4
5
Total
259255
119
R
R
R
R
R
R
R
R
R
C
R
R
R
R
R
R
R
R
R
R
R
R
C
R
R
R
--Govt.
-Govt.
-Govt.
---Govt.
---
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
#
#
++
#
+++
#
+++
#
#
#
+++
#
#
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
#
#
++
#
+++
#
+++
#
#
#
+++
#
#
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
Available
Exhausted
Exhausted
Exhausted
Exhausted
Available
Available
Exhausted
Exhausted
Exhausted
Available
Exhausted
Exhausted
Name of the Block: Kochadhaman
Sub-centre database
No. of
Assured
Cont.
ANM
ANM (R/C)
Building
Building
Sl.
Health Sub
G.P./
ANM (R/C)
running
power
residing
Population
Posted
ownership
condition
No. Centre Name
Villages
in position
water supply supply
at HSC
formally
(Govt/Rent) (+++/++/+/#)
served
(A/NA/I) (A/NA/I) area (Y/N)
1
2
3
4
5
6
7
8
9
10
11
12
13
Asura
Alta
Bhewra
Kanhaiya Badi
Singhari
Barbatta
Andhasur
Deramari
Asura
Alta
Chopra Bukhari
Vishanpur
Bhagal
10522
11536
11524
10268
10598
11256
11269
10569
10522
11536
10521
10256
11254
5
6
6
5
5
6
6
4
5
6
5
6
6
R
R
C
R
C
R
R
R
R
C
R
R
C
R
R
C
R
C
R
R
R
R
C
R
R
C
Govt.
Govt.
Govt.
Govt.
Govt.
Govt.
Govt.
Govt.
---Govt.
Govt.
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
++
++
++
+++
++
+++
+++
++
#
#
#
+++
++
28
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
Condition of
residential
Status of Status of
facility
furnitures Untied fund
(+++/++/+/#)
++
++
++
+++
++
+++
+++
++
#
#
#
+++
++
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
Exhausted
Exhausted
Available
Exhausted
Available
Exhausted
Available
Available
Exhausted
Available
Available
Available
Available
DHS, Kishanganj
14
15
16
17
18
19
20
21
22
23
24
25
26
Anarkali
Bagalwadi
Pothamari
Mohammadpur
Bahikol
Kashiwadi
Badi Jan
Sahpur
Ghurna
Chargharia
Bhewra
Ruhia
Haldikhora
Total
C
R
R
C
R
R
C
C
R
R
C
R
C
9865
10368
10278
11259
10573
10756
10561
11589
11268
11789
11392
11549
11267
4
5
5
6
5
5
4
6
6
6
7
6
6
284145
142
C
R
R
C
R
R
C
C
R
R
C
R
C
Govt.
Govt.
Govt.
Govt.
-Govt.
Govt.
-Govt.
Govt.
----
++
++
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
+++
+++
#
++
+++
#
+++
+++
#
#
#
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
++
++
+++
+++
#
++
+++
#
+++
+++
#
#
#
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
Exhausted
Exhausted
Exhausted
Available
Available
Exhausted
Available
Exhausted
Available
Exhausted
Available
Exhausted
Exhausted
Name of the Block: Dighalbank
Sub-centre database
Population
No. of
G.P./
Villages
served
1 Dhantola
10869
4
R
R
Govt.
++
NA
NA
NA
++
NA
Exhausted
2 Durgapur
11668
6
C
C
Govt.
+++
NA
NA
NA
+++
NA
Exhausted
3 Sindhimari Janta
11251
5
C
C
--
#
NA
NA
NA
#
NA
Exhausted
4 Talgachh
11421
5
R
R
Govt.
++
NA
NA
NA
++
NA
Exhausted
5 Laxmipur
10989
4
R
R
Govt.
++
NA
NA
NA
++
NA
Exhausted
6 Patharghatti
11302
5
C
C
Govt.
++
NA
NA
NA
++
NA
Available
7 Dhangra
10897
4
C
C
--
#
NA
NA
NA
#
NA
Exhausted
8 Tulsia Purana Hat
10986
4
R
R
--
#
NA
NA
NA
#
NA
Available
9 Tulsia Naya Hat
11559
5
R
R
Govt.
+++
NA
NA
NA
+++
NA
Exhausted
10 Ikra
11443
6
R
R
Govt.
+++
NA
NA
NA
+++
NA
Exhausted
Sl.
No.
Health Sub
Centre Name
ANM
ANM
Assured
Cont.
ANM
Building
Building
(R/C)
(R/C)
running
power
residing
ownership
condition
Posted
in
water supply supply
at HSC
(Govt/Rent) (+++/++/+/#)
formally position
(A/NA/I) (A/NA/I) area (Y/N)
29
Condition of
residential
Status of Status of
facility
furnitures Untied fund
(+++/++/+/#)
DHS, Kishanganj
11 Tarawadi
10555
4
R
R
--
#
NA
NA
NA
#
NA
Exhausted
12 Dogachhi
11687
5
R
R
--
#
NA
NA
NA
#
NA
Exhausted
13 Kacchunala
12235
6
R
R
--
#
NA
NA
NA
#
NA
Available
14 Dubri
11745
5
C
C
--
#
NA
NA
NA
#
NA
Exhausted
15 Gandharwdanga
10786
4
C
C
--
#
NA
NA
NA
#
NA
Available
16 Dahibhat
10489
4
R
R
--
#
NA
NA
NA
#
NA
Exhausted
17 Haruadanga
11561
5
R
R
--
#
NA
NA
NA
#
NA
Available
191443
81
Total
ANM(R)- Regular/ ANM(C)- Contractual; Govt- Gov/ Rented-Rent/ Pan –Panchayat or other Dept owned; Good condition +++/ Needs major
repairs++/Needs minor repairs-less than Rs10,000-+/ needs new building-#; Water Supply: Available –A/Not available –NA, Intermittently available-I
Name of the Block: Pothia
Sub-centre database
No. of
Assured
Cont.
ANM
ANM (R/C)
Building
Building
Sl.
Health Sub
G.P./
ANM (R/C)
running
power
residing
Population
Posted
ownership
condition
No. Centre Name
Villages
in position
water supply supply
at HSC
formally
(Govt/Rent) (+++/++/+/#)
served
(A/NA/I) (A/NA/I) area (Y/N)
1
2
3
4
5
6
7
8
9
10
11
12
13
14
Gilhawadi
Naukatta
Paharkatta
Taiyav Pur
Fulhara
Damalbadi
Chichuabadi
Daluhat
Jagdubb
Sarogora
Chhattargachh
Barodharia
Mirjapur
Chanamana
10203
10865
10256
10178
10120
10443
10556
10360
10547
10650
10181
10276
9689
10263
5
6
5
6
5
7
6
6
7
6
7
6
5
6
R
R
R
R
R
R
R
R
R
R
C
R
R
R
R
R
R
R
R
R
R
R
R
R
C
R
R
R
Govt.
Govt.
--Govt.
-Govt.
---Govt.
-Govt.
Govt.
+
++
#
#
++
#
++
#
#
#
+
#
+
+++
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
30
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
Condition of
residential
Status of Status of
facility
furnitures Untied fund
(+++/++/+/#)
#
#
#
#
#
#
#
#
#
#
#
#
#
#
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
Exhausted
Exhausted
Exhausted
Exhausted
Available
Exhausted
Exhausted
Available
Available
Available
Exhausted
Exhausted
Exhausted
Available
DHS, Kishanganj
15
16
17
18
19
20
21
22
23
24
Udgara
Khajurbadi
Shitalpur
Mohania
Pipalwadi
Raipur
Dehalwadi
Baldia Hat
Chhattargachh
Parlawadi
Total
10466
10256
10273
9752
10326
10236
9562
10129
10265
10268
6
7
6
6
6
6
6
5
6
5
246120
142
R
R
R
R
R
R
R
R
R
R
R
R
R
R
R
R
R
R
R
R
-----------
#
#
#
#
#
#
#
#
#
#
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
#
#
#
#
#
#
#
#
#
#
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
Exhausted
Available
Exhausted
Exhausted
Exhausted
Available
Exhausted
Exhausted
Exhausted
Exhausted
ANM(R)- Regular/ ANM(C)- Contractual; Govt- Gov/ Rented-Rent/ Pan –Panchayat or other Dept owned; Good condition +++/ Needs major repairs++/Needs
minor repairs-less than Rs10,000-+/ needs new building-#; Water Supply: Available –A/Not available –NA,Intermittently available-I
Name of the Block: Terhagachh
Sub-centre database
No. of
Assured
Cont.
ANM
ANM (R/C)
Building
Building
Sl.
Health Sub
G.P./
ANM (R/C)
running
power
residing
Population
Posted
ownership
condition
No. Centre Name
Villages
in position
water supply supply
at HSC
formally
(Govt/Rent) (+++/++/+/#)
served
(A/NA/I) (A/NA/I) area (Y/N)
Condition of
residential
Status of Status of
facility
furnitures Untied fund
(+++/++/+/#)
1 Benugadh
10403
6
R
R
--
#
NA
NA
NA
#
NA
Exhausted
2 Khaniabad
10455
6
R
R
--
#
NA
NA
NA
#
NA
Available
3 Gamharia
10056
5
R
R
--
#
NA
NA
NA
#
NA
Available
4 Bhaurha
10278
6
R
R
--
#
NA
NA
NA
#
NA
Available
5 Jhala
10220
6
C
C
Govt.
+++
NA
NA
NA
+++
NA
Exhausted
6 Hatgawn
10343
6
R
R
--
#
NA
NA
NA
#
NA
Available
7 Chilhania
10123
6
R
R
--
#
NA
NA
NA
#
NA
Available
8 Kajleta
10343
6
R
R
Govt.
+++
NA
NA
NA
+++
NA
Exhausted
31
DHS, Kishanganj
9 Bairia
10648
7
R
R
--
#
NA
NA
NA
#
NA
Available
10 Kamati
10750
7
R
R
--
#
NA
NA
NA
#
NA
Available
11 Suhia
10182
5
R
R
Govt.
+++
NA
NA
NA
+++
NA
Exhausted
12 Matiyari
10216
6
R
R
--
#
NA
NA
NA
#
NA
Exhausted
13 Bibiganj
10189
5
R
R
--
#
NA
NA
NA
#
NA
Exhausted
Total
134206
77
ANM(R)- Regular/ ANM(C)- Contractual; Govt- Gov/ Rented-Rent/ Pan –Panchayat or other Dept owned; Good condition +++/ Needs major
repairs++/Needs minor repairs-less than Rs10,000-+/ needs new building-#; Water Supply: Available –A/Not available –NA, Intermittently available-I
Section B: Human Resources and Infrastructure
Ambulance/
vehicle (Y/N)
Yes
+++
2
0
+++
N
NA
NA
55123 Govt.
+++
NA
A
Yes
+++
2
0
+++
N
NA
NA
Gangi
58623 Govt.
+++
NA
A
Yes
+++
2
0
+++
N
NA
NA
4
Pawakhali
57445 Govt.
++
NA
A
Yes
+++
2
0
+++
N
NA
NA
5
Haldikhora
52369 Govt.
++
NA
A
Yes
+++
2
0
+++
N
NA
NA
Rupni
60245
2
Meharganj
3
NF
32
MO residing
at APHC
area (Y/N)
Status of
furniture
Condition of
residential facility
(+++/++/+/#)
No. of beds
A
1
Condition of
Labour room
(+++/++/#)
NA
Name of
APHC
Toilets
(+++/++/+/#)
#
Sl.
No.
Population
served
No. of rooms
Continuous
power supply
(A/NA/I)
Assured running
water supply
(A/NA/I)
Building condition
(+++/++/#)
Building ownership
(Govt/Pan/Rent)
Additional Primary Health Centre (APHC) Database: Infrastructure
DHS, Kishanganj
6
Alta
64712 Govt.
++
NA
A
Yes
+++
2
0
+++
N
NA
NA
7
Laxhmipur
63258
#
NA
A
Yes
+++
2
0
+++
N
NA
NA
8
Padampur
65412 Govt.
++
NA
A
Yes
+++
2
0
+++
N
NA
NA
9
Damalbari
69874 Govt.
+++
NA
A
Yes
+++
2
0
+++
N
NA
NA
---
---
---
---
---
18
0
---
---
---
---
Total
NF
---
Additional Primary Health Centre (APHC) Database: Human Resources
Doctors
Sl.
No.
Name of APHC
Sanction
Laboratory
Technician
In
In
In
Sanction
Sanction
Position
Position
Position
ANM
Pharmacists /
dresser
In
Sanction
Position
Nurses
A Grade
Sanction
Accnt/Peon
s/Sweeper/ Availability
Night
of specialist
In
Guards
Position
1
Rupni
2
2
2
1
1
0
1
0
2
2
2
Nil
2
Meharganj
2
2
2
0
1
0
1
0
2
1
2
Nil
3
Gangi
2
1
2
2
1
0
1
0
2
2
2
Nil
4
Pawakhali
2
1
2
2
1
0
1
0
2
2
2
Nil
5
Haldikhora
2
2
2
2
1
0
1
0
2
2
2
Nil
6
Alta
2
1
2
2
1
0
1
0
2
2
2
Nil
33
DHS, Kishanganj
7
Laxhmipur
2
2
2
1
1
0
1
0
2
2
2
Nil
8
Padampur
2
2
2
1
1
0
1
0
2
2
2
Nil
9
Damalbari
2
2
2
0
1
0
1
0
2
1
2
Nil
Total
18
16
18
11
9
0
9
0
2
16
18
Nil
Allopathic (A),Ayush (Ay), Regular (R), Contractual (C) Note:- Out of 16 doctors 14 are in long leave.
Section B: Human Resources and Infrastructure
Continuous power
supply(A/NA/I)
Toilets
(A/NA/I)
Functional Labour
room(A/NA)
Condition of labour
room(+++/++/#)
No. of rooms
No. of beds
Functional OT
(A/NA)
Condition of ward
(+++/++/#)
PHC Kishanganj
125509
Govt
+++
NA
A
A
A
+++
6
6
NA
+++
#
2
PHC Bahadurganj
258161
Govt
+++
NA
A
A
A
+++
10
6
NA
+++
#
3
PHC Thakurganj
278386
Govt
+++
NA
A
A
A
+++
6
6
NA
+++
#
4
PHC Kochadhaman
284091
Govt
+++
NA
A
A
A
+++
10
6
NA
+++
#
5
PHC Dighalbank
191406
Govt
+++
NA
A
A
A
+++
10
6
NA
+++
#
6
PHC Pothia
246073
Govt
+++
NA
A
A
A
+++
8
6
NA
+++
#
PHC/ Referral
Hospital/SDH/DH Name
Population
Served
34
Condition of OT
(+++/++/#)
Assured running water
supply(A/NA/I)
1
Sl.
No.
Building ownership
(Govt/Pan/Rent)
Building condition
(+++/++/#)
Primary Health Centres/Referral Hospital/Sub-Divisional Hospital/District Hospital: Infrastructure
DHS, Kishanganj
7
PHC Terhagachh
PHC
/Referral/SDH/
DH Name
134180
Popn
Served
8
Refral Chhattargach
9
SDH Kishanganj
10
DH Kishanganj
Total
Govt
Doctors
+++
NA
A
A
A
Laboratory
Technician
ANM
+++
6
Pharmacist/
Dresser
6
NA
Nurses
+++
#
Specialists
--
Govt
+++
NA
A
A
A
+++
12
30
A
+++
+++
107296
Govt
+++
NA
A
A
A
+++
22
30
A
+++
+++
--
Govt
+++
A
A
A
A
+++
60
100
A
+++
+++
1625102
---
---
---
---
---
---
---
---
---
---
---
---
Primary Health Centres/Referral Hospital/Sub-Divisional Hospital/District Hospital: Human Resources
35
Store
Keeper
DHS, Kishanganj
1
2
3
4
5
6
7
8
9
10
PHC
Kishanganj
PHC
Bahadurganj
PHC
Thakurganj
PHC
Kochadhaman
PHC
Dighalbank
PHC Pothia
PHC
Terhagachh
Refral
Chhattargach
SDH
Kishanganj
DH
Kishanganj
Total
In
SancSancPositi
tion
tion
on
Sanction
In
Position
Sanction
In
Position
Sanction
In
Position
Sanction
In
Position
125509
3
0
13
13
0
0
1
0
0
0
4
2
0
258161
3
3
19
12
0
0
1
0
0
0
4
2
0
278386
3
2
29
19
0
0
1
0
0
0
4
2
0
284091
3
2
27
13
0
0
1
0
0
0
4
1
0
191406
3
3
19
6
0
0
1
0
0
0
4
0
0
246073
3
2
26
20
0
0
1
0
0
0
4
2
0
134180
3
3
15
9
0
0
1
1
0
0
4
1
0
--
7
2
7
2
1
0
1
0
4
2
2
0
0
107296
8
7
7
3
1
1
2
0
4
3
4
2
1
--
12
1
5
0
4
0
4
0
24
0
12
1
2
1625102
Allopathic (A),Ayush (Ay), Regular (R), Contractual (C)
Section C: Equipment, Drugs and Supplies
36
In
Position
DHS, Kishanganj
Availability of Equipment
District Health Society, Kishanganj
Requirements for improving health facility for better treatment of patients
Sl.
No.
Name of Furniture/Equipment
SDH,
Kishanganj
PHC,
Bahadurganj
PHC,
Thakurganj
PHC,
Kochadhaman
PHC,
Dighalbank
PHC,
Pothia
PHC,
Terhagach
Refrel
Chhattargach
Total
Requirement
List of Furniture (including surgical) at PHC
1 Examination Table
4
3
3
3
3
3
3
3
25
2 Writing table with table sheets
Plastic chairs (for in-patients'
3 attendants)
5
5
5
5
5
5
5
5
40
6
6
6
6
6
6
6
6
48
4 Armless chairs
8
8
8
8
8
8
8
8
64
5 Full size steel almirah
4
4
4
4
4
4
4
4
32
6 Labour table
2
1
1
1
1
1
1
1
9
7 OT Table
1
1
1
1
1
1
1
1
8
8 Arm board for adult and child
4
4
4
4
4
4
4
4
32
9 Wheel chair
1
1
1
1
1
1
1
1
8
10 Stretcher on trolley
2
1
1
1
1
1
1
1
9
11 Instrument trolley
2
2
2
2
2
2
2
2
16
12 Wooden screen
1
1
1
1
1
1
1
1
8
13 Foot step
5
5
5
5
5
5
5
5
40
14 Coat rack
2
2
2
2
2
2
2
2
16
15 Bed side table
6
6
6
6
6
6
6
6
48
16 Bed stead iron (for in-patients)
6
6
6
6
6
6
6
6
48
17 Baby cot
2
1
1
1
1
1
1
1
9
18 Stool
6
6
6
6
6
6
6
6
48
19 Medicine chest
1
1
1
1
1
1
1
1
8
20 Lamp
3
3
3
3
3
3
3
3
24
21 Shadoless lamp light(for OT and LR)
2
2
2
2
2
2
2
2
16
37
DHS, Kishanganj
22 side Wooden racks
4
4
4
4
4
4
4
4
32
23 Fans
6
6
6
6
6
6
6
6
48
24 Tube light
8
8
8
8
8
8
8
8
64
25 Basin
2
2
2
2
2
2
2
2
16
26 Basin stand
2
2
2
2
2
2
2
2
16
27 Buckets
4
4
4
4
4
4
4
4
32
28 Mugs
4
4
4
4
4
4
4
4
32
29 LPG stove
2
1
1
1
1
1
1
1
9
30 LPG cylinder
4
2
2
2
2
2
2
2
18
31 Sauce pan with lid
2
2
2
2
2
2
2
2
16
32 Water receptacle
2
2
2
2
2
2
2
2
16
33 Rubber/plastic shutting
2
2
2
2
2
2
2
2
16
34 Drum with tap for storing water
2
2
2
2
2
2
2
2
16
35 IV Stand
10
4
4
4
4
4
4
4
38
36 Matress for beds
6
6
6
6
6
6
6
6
48
37 Foam Mattress for OT table
2
1
1
1
1
1
1
1
9
38 Foam Matress for labour table
2
1
1
1
1
1
1
1
9
39 Machintosh for labour and OT table
8
4
4
4
4
4
4
4
36
40 Kelly's pad for labour and OT table
4
2
2
2
2
2
2
2
18
41 Bed sheets
60
6
6
6
6
6
6
6
102
42 Pillows with covers
80
8
8
8
8
8
8
8
136
43 Blankets
60
6
6
6
6
6
6
6
102
44 Baby blankets
20
2
2
2
2
2
2
2
34
45 Towels
60
6
6
6
6
6
6
6
102
46 Curtains with rods
20
20
20
20
20
20
20
20
160
47 Cautery Set
2
1
1
1
1
1
1
1
9
Sundry Articles including Linen
38
DHS, Kishanganj
48 Dowen retractor two sizes
4
2
2
2
2
2
2
2
18
49 Lahese forcep
6
3
3
3
3
3
3
3
27
50 Intestine Clamp
8
4
4
4
4
4
4
4
36
51 Cockles Forcep (Curved)
4
2
2
2
2
2
2
2
18
52 Long handle curved scissors
6
3
3
3
3
3
3
3
27
53 Staurt scissors
6
3
3
3
3
3
3
3
27
54 Appron plastic
12
6
6
6
6
6
6
6
54
55 Chhappal for OT
12
6
6
6
6
6
6
6
54
56 Bandage good quality
50
25
25
25
25
25
25
25
225
57 BP Handle and surgical blade
12
6
6
6
6
6
6
6
54
58 Artery Forcep curved
48
24
24
24
24
24
24
24
216
59 Alle's Forceps
48
24
24
24
24
24
24
24
216
60 Disecting Forcep
12
6
6
6
6
6
6
6
54
61 Niddle holder
Seissor lonh handle (Curved and
62 straight)
12
6
6
6
6
6
6
6
54
12
6
6
6
6
6
6
6
54
63 Retractors-self retaining skin retractor
12
6
6
6
6
6
6
6
54
64 Devers retractor downs
4
2
2
2
2
2
2
2
18
65 Rustesteinal clamp (curved)
Lanz tissue forcep Plane desecting
66 forcep
8
4
4
4
4
4
4
4
36
4
2
2
2
2
2
2
2
18
67 Towel clip
12
6
6
6
6
6
6
6
54
68 Cautery Machine
2
1
1
1
1
1
1
1
9
69 Ryles Tube 18 no.
Airways (Disposible plastic) adult &
70 child
24
12
12
12
12
12
12
12
108
24
12
12
12
12
12
12
12
108
Requirements for a fully equipped and operational labour room
1 Suction Machine (Elec. & Manual)
4
2
2
2
2
2
2
2
18
2 Delivery Forceps
4
2
2
2
2
2
2
2
18
3 Hegerdilator sets
4
2
2
2
2
2
2
2
18
4 Mucus Succker (in dozens)
2
1
1
1
1
1
1
1
9
5 Amboo's Bag with mask 0 size
4
2
2
2
2
2
2
2
18
6 Endotrachale tube (different size)
12
6
6
6
6
6
6
6
54
39
DHS, Kishanganj
7 Laryango scope
4
2
2
2
2
2
2
2
18
8 Baby warmer
8
4
4
4
4
4
4
4
36
9 Inculleator
2
1
1
1
1
1
1
1
9
10 Phototherapy shade for baby
2
1
1
1
1
1
1
1
9
11 Episiotomy set (intestainal catgaut)
10
5
5
5
5
5
5
5
45
12 Baby tray
6
3
3
3
3
3
3
3
27
13 Baby Weighing machine
6
3
3
3
3
3
3
3
27
14 Oxygen mask for baby & mother
24
12
12
12
12
12
12
12
108
15 Oxygen Cylinder
6
3
3
3
3
3
3
3
27
16 Stand light
12
6
6
6
6
6
6
6
54
17 Inverter
8
4
4
4
4
4
4
4
36
18 Disposable gloves
20
10
10
10
10
10
10
10
90
19 Folys catheter
24
12
12
12
12
12
12
12
108
20 Vicryl 1No.
24
12
12
12
12
12
12
12
108
21 L P Niddle
24
12
12
12
12
12
12
12
108
22 Intraccoth no. 18 and 24
72
24
24
24
24
24
24
24
240
23 Facility for Oxygen administration
24 Sterilisation equipment
25 24-hour running water
Electricity supply with generator
26 facility
27 An area eamarked for new-born care
Emergency drug tray with essential
28 drugs
Drinking Water/Running Water/Toilet
1
Drinking water
Deep Boring Deep Boring Deep Boring
Required
Required
Required
Deep Boring
Required
Deep Boring Deep Boring Deep Boring Deep Boring
Urgently
Required
Required
Required
Required
2
Running water
3
Toilet for Ootdoor patietnt
Nil
Nil
Nil
Nil
Nil
Nil
Nil
Nil
Nil
4
Toilet for Indoor patient
Nil
Nil
Nil
Nil
Nil
Nil
Nil
Nil
Nil
40
DHS, Kishanganj
Section D: RKS, Untied Funds and Support Services
Rogi Kalyan Samitis:
Sl. No
1
2
3
4
5
6
7
8
9
Name of Facility
PHC Kishanganj
PHC Bahadurganj
PHC Thakurganj
PHC Kochadhaman
PHC Dighalbank
PHC Pothia
PHC Terhagachh
Refral Hospital Chhattargachh
SDH, Kishanganj
RKS set up (Y/N)
No. of meetings held (in last 3 Months)
Total Funds
Funds Utilized
Y
Y
Y
Y
Y
Y
Y
Y
Y
3
3
3
3
3
3
2
3
3
96780
213200
198070
143090
167000
196800
145200
980700
456800
78%
43%
56%
88%
29%
86%
67%
73%
68%
Untied Funds:
Sl. No
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
Name of Facility
PHC Kishanganj
PHC Bahadurganj
PHC Thakurganj
PHC Kochadhaman
PHC Dighalbank
PHC Pothia
PHC Terhagachh
APHC Rupni
APHC Meharganj
APHC Gangi
APHC Pawakhali
APHC Haldikhora
APHC Alta
APHC Laxhmipur
APHC Padampur
APHC Damalbari
Funds received
Funds utilized
25000
25000
25000
25000
25000
25000
25000
10000
25000
25000
25000
25000
25000
25000
15000
25000
Nil
Nil
Nil
Nil
Nil
Nil
Nil
Nil
Nil
Nil
12000
Nil
25000
Nil
Nil
Nil
41
DHS, Kishanganj
Support Systems to Health facility functioning:
Sl.
No
Facility name
Services available
Laboratory services O/I/ NA
Pathology Malaria/kalaazar
TB
I
NA
I
Ambulance
O/I/ NA
Generator
O/I/ NA
X- ray
O/I/ NA
I
O
I&O
NA
O
NA
NA
NA
I
Canteen
O/I/ NA
House
keeping
NA
NA
NA
NA
NA
Other
NA
1
SDH Kishanganj
2
R H Chhattargachh
3
PHC Kishanganj
I
O
NA
NA
NA
I
NA
NA
NA
4
PHC Bahadurganj
I
O
O
NA
NA
I
NA
NA
NA
5
PHC Thakurganj
I
O
NA
NA
NA
I
NA
NA
NA
6
PHC Kochadhaman
I
O
NA
NA
NA
I
NA
NA
NA
7
PHC Dighalbank
I
O
NA
NA
NA
I
NA
NA
NA
8
PHC Pothia
I
O
NA
NA
NA
I
NA
NA
NA
9
PHC Terhagachh
NA
O
NA
NA
NA
I
NA
NA
NA
10
APHC Rupni
NA
NA
NA
NA
NA
NA
NA
NA
NA
11
APHC Meharganj
NA
NA
NA
NA
NA
NA
NA
NA
NA
12
APHC Gangi
NA
NA
NA
NA
NA
NA
NA
NA
NA
13
APHC Pawakhali
NA
NA
NA
NA
NA
NA
NA
NA
NA
14
APHC Haldikhora
NA
NA
NA
NA
NA
NA
NA
NA
NA
15
APHC Alta
NA
NA
NA
NA
NA
NA
NA
NA
NA
16
APHC Laxhmipur
NA
NA
NA
NA
NA
NA
NA
NA
NA
17
APHC Padampur
NA
NA
NA
NA
NA
NA
NA
NA
NA
18
APHC Damalbari
NA
NA
NA
NA
NA
NA
NA
NA
NA
O- Outsourced/ I- In sourced/ NA- Not available
42
DHS, Kishanganj
Section E: Health Services Delivery
APHC
No.
Service
1
Child
Immunization
2
Child Health
3
Maternal
Care
Indicator
APHC 1
APHC 2
% of children 9-11 months fully immunized
(BCG+DPT123+OPV123+Measles)
% of immunization sessions held against planned
Total number of live births
Total number of still births
% of newborns weighed within one week
% of newborns weighing less than 2500 gm
Total number of neonatal deaths (within 1 month of
birth)
Total number of infant deaths
(within 1-12 months)
Total number of child deaths
(within 1-5 yrs)
Number of diarrhea cases reported within the year
% of diarrhea cases treated
Number of ARI cases reported within the year
% of ARI cases treated
Number of children with Grade 3 and Grade 4
undernutrition who received a medical checkup
Number of children with Grade 3 and Grade 4
undernutrition who were admitted
Number of undernourished children
% of children below 5 yrs who received 5 doses of
Vit A solution
Number of pregnant women registered for ANC
% of pregnant women registered for ANC in the 1 st
trimester
% of pregnant women with 3 ANC check ups
% of pregnant women with any ANC checkup
% of pregnant women with anaemia
% of pregnant women who received 2 TT injections
% of pregnant women who received 100 IFA tablets
Number of pregnant women registered for JSY
Number of Institutional deliveries conducted
Number of home deliveries conducted by SBA
APHC 3
Data (Year 2008-09)
APHC 4 APHC 5 APHC 6
APHC 7
Only OPD Service Available
43
APHC 8
APHC 9
DHS, Kishanganj
4
Reproductive
Health
5
RNTCP
6
Vector Borne
Disease
Control
Programme
7
National
Programme
for Control of
Blindness
8
National
Leprosy
Eradication
Programme
% of institutional deliveries in which JBSY funds
were given
% of home deliveries in which JBSY funds were
given
Number of deliveries referred due to complications
% of mothers visited by health worker during the
first week after delivery
Number of MTPs conducted
Number of RTI/STI cases treated
% of couples provided with barrier contraceptive
methods
% of couples provided with permanent methods
% of female sterlisations
% of TB cases suspected out of total OP
Proportion of New Sputum Positive out of Total
New Pulmonary Cases
Annual Case Detection Rate (Total TB cases
registered for treatment per 100,000 population per
year)
Treatment Success Rate (% of new smear positive
patients who are documented to be cured or have
successfully completed treatment)
% of patients put on treatment, who drop out of
treatment
Annual Parasite Incidence
Annual Blood Examination Rate
Plasmodium Falciparum percentage
Slide Positivity Rate
Number of patients receiving treatment for Malaria
Number of patients with Malaria referred
Number of FTDs and DDCs
Number of cases detected
Number of cases registered
Number of cases operated
Number of patients enlisted with eye problem
Number of camps organized
Number of cases detected
Number of Cases treated
Number of default cases
Number of case complete treatment
Number of complicated cases
Only OPD Service Available
44
DHS, Kishanganj
9
10
Inpatient
Services
Outpatient
services
Number of cases referred
Number of in-patient admissions
Only OPD Service Available
Not Functional
Outpatient attendance
PHC/Refral Hospital/SDH/District Hospital
Data (Year 2008-09)
No.
1
2
Service
Indicator
% of children 9-11 months fully immunized
(BCG+DPT123+OPV123+Measles)
Child
Immunization % of immunization sessions held against
planned
Total number of live births
Total number of still births
% of newborns weighed within one week
% of newborns weighing less than 2500 gm
Total number of neonatal deaths (within 1
month of birth)
Total number of infant deaths
(within 1-12 months)
Total number of child deaths
(within 1-5 yrs)
Number of diarrhea cases reported within the
Child Health year
% of diarrhea cases treated
Number of ARI cases reported within the year
% of ARI cases treated
Number of children with Grade 3 and Grade 4
undernutrition who received a medical
checkup
Number of children with Grade 3 and Grade 4
undernutrition who were admitted
Number of undernourished children
% of children below 5 yrs who received 5
doses of Vit A solution
Kne
Bdj
Tkj
Koch
Dig
Pothia
Terha
Ref.
Chhat
68.58% 45.38% 53.47% 40.06% 45.72% 46.35% 70.28%
615
27
92%
12%
1138
2997
9
118
61% 71.37%
8%
9%
0
45
1995
159
53%
7%
742
53
61%
8%
4740
195
62%
8%
836
44
94%
12%
723
18
0%
0%
SDH,
Kne
30.87%
3696
152
41%
5%
DHS, Kishanganj
3
4
5
Maternal
Care
Reproductive
Health
RNTCP
Number of pregnant women registered for
2594
3298
4319
4166
4279
4361
2192
ANC
% of pregnant women registered for ANC in
the 1st trimester
% of pregnant women with 3 ANC check ups
933
1197
1557
778
495
4046
1620
% of pregnant women with any ANC checkup
% of pregnant women with anaemia
% of pregnant women who received 2 TT
injections
% of pregnant women who received 100 IFA
tablets
Number of pregnant women registered for
JSY
Number of Institutional deliveries conducted
324
1076
2529
2154
773
4425
621
Number of home deliveries conducted by
125
0
307
0
0
297
12
SBA
% of institutional deliveries in which JBSY
funds were given
% of home deliveries in which JBSY funds
were given
Number of deliveries referred due to
complications
% of mothers visited by health worker during
the first week after delivery
Number of MTPs conducted
Number of RTI/STI cases treated
% of couples provided with barrier
contraceptive methods
% of couples provided with permanent methods
% of female sterlisations
29.82% 30.00% 39.11% 37.02% 28.43% 22.06% 22.81%
% of TB cases suspected out of total OP
Proportion of New Sputum Positive out of
Total New Pulmonary Cases
Annual Case Detection Rate (Total TB cases
registered for treatment per 100,000
population per year)
46
374
2192
367
511
788
0
3848
0
0.00%
43.72%
DHS, Kishanganj
6
Vector Borne
Disease
Control
Programme
7
National
Programme
for Control of
Blindness
8
National
Leprosy
Eradication
Programme
9
10
11
Inpatient
Services
Outpatient
services
Surgical
Servics
Treatment Success Rate (% of new smear
positive patients who are documented to be
cured or have successfully completed
treatment)
% of patients put on treatment, who drop out
of treatment
Annual Parasite Incidence
Annual Blood Examination Rate
Plasmodium Falciparum percentage
Slide Positivity Rate
Number of patients receiving treatment for
Malaria
Number of patients with Malaria referred
Number of FTDs and DDCs
Number of cases detected
Number of cases registered
Number of cases operated
Number of patients enlisted with eye problem
Number of camps organized
Number of cases detected
Number of Cases treated
Number of default cases
Number of case complete treatment
Number of complicated cases
Number of cases referred
Number of in-patient admissions
235
1275
2321
0
0
0
Outpatient attendance
Number of major surgeries conducted
Number of minor surgeries conducted
47
0
0
0
0
0
0
DHS, Kishanganj
48
DHS, Kishanganj
Section F: Community Participation, Training & BCC
Community Participation Initiatives
Sl.
No.
Name of Block
No. of
GPs
No. VHSC
formed
No. of VHSC
meetings held
in the block
Total amount
released to VHSC
from untied funds
No. of
ASHAs
Number of ASHAs
trained
Round 1
Round 2
Number of meetings held
between ASHA and
Block offices
1
Kishanganj
10
Nil
Nil
Nil
117
96
21
8 times in 2009
2
Bahadurganj
20
Nil
Nil
Nil
209
172
37
8 times in 2009
3
Thakurganj
22
Nil
Nil
Nil
243
188
55
8 times in 2009
4
Kochadhaman
24
Nil
Nil
Nil
265
186
79
8 times in 2009
5
Dighalbank
16
Nil
Nil
Nil
179
0
179
8 times in 2009
6
Pothia
22
Nil
Nil
Nil
230
196
34
8 times in 2009
7
Terhagachh
12
Nil
Nil
Nil
125
107
18
8 times in 2009
Total amount paid
as incentive to
ASHA
Training Activities:
1
Kishanganj
Rounds of
SBA
Trainings held
Yes
2
Bahadurganj
Yes
6
No
-----
-----
3
Thakurganj
Yes
6
No
-----
-----
4
Kochadhaman
Yes
5
No
-----
-----
5
Dighalbank
Yes
5
No
-----
-----
6
Pothia
Yes
4
No
-----
-----
7
Terhagachh
Yes
4
No
-----
-----
Sl.
No.
Name of
Block
No. of personnel
given SBA Training
Rounds of IMNCI
Trainings held
No. of personnel given
IMNCI Training
4
No
-----
Any specific issue on which need for a
training or skill building was felt but
has not being given yet
-----
49
DHS, Kishanganj
BCC Activities:
Sl. No.
Name of Block
BCC Campaigns/activities conducted
1
Kishanganj
No
2
Bahadurganj
No
3
Thakurganj
No
4
Kochadhaman
No
5
Dighalbank
No
6
Pothia
No
7
Terhagachh
No
District & Block Level Management:
Sl.
No.
Name of Block
Health Manager Appointed (Y/N)
Accountant appointed (Y/N)
Store keeper appointed (Y/N)
1
Kishanganj
Yes
No
No
2
Bahadurganj
Yes
Yes
No
3
Thakurganj
Yes
No
No
4
Kochadhaman
Yes
No
No
5
Dighalbank
No
Yes
No
6
Pothia
No
Yes
No
7
Terhagachh
Yes
No
No
50
DHS, Kishanganj
4. Setting Objectives and Suggested Plan of Action
4.1 Introduction
District health action plan has been entrusted as a principal instrument for planning,
implementation and monitoring of fully accountable and accessible health care mechanism. It has been
envisioned through effective integration of health concerns via decentralized management
incorporating determinants of health like sanitation and hygiene, safe drinking water, women and child
health and other social concerns. DHAP envisages accomplishing requisite amendments in the health
systems by crafting time bound goals. In the course of discussions with various stakeholders groups it
has been anticipated that unmet demand for liable service provision can be achieved by adopting
Intersectoral convergent approach through partnership among public as well as private sectors.
4.2 Targeted Objectives and Suggested Strategies
During consultation at district level involving a range of stakeholders from different levels, an
attempt has been made to carve out certain strategies to achieve the specific objectives that are
represented by different indicators. The following segment of the chapter corresponds to the identified
district plan objectives demonstrating current status of the indicators along with the expected target sets
that are projected for period of present year (2010-11).
4.3 Health Programmes
4.3.1 Reproductive and Child Health Programme components
4.3.1.1 Maternal Health Care
Women are the foundation of the Country’s families and communities. Over the years,
Complications of pregnancy and childbirth are the leading cause of death and disability for
childbearing women in many parts of the country. Comprehensive, high-quality maternity care can
help prevent infant and maternal death and disability. No matter where they live, women should have
access to the information and care that keeps them healthy and safe. Engender Health has learned that
when women have access to family planning, fewer women die from risky pregnancies or unsafe
abortions. Our work safeguards women's health.
Engender Health works with partners to develop practical strategies to strengthen and integrate
maternal health care services into national health systems.
In the district young girls inter the reproductive phase of their like as victims of under
nourishment and anemia. Their health risks increase with early marriages, frequent pregnancies and
unsafe abortions choices regarding marriage, child bearing and contraception are denied to women.
There is also lack of access to functional reproductive health services and most deliveries are still
carried out by untrained birth attendants especially in the rural areas where there is no effective system
of referral or management in case complications arise through there has been widespread increase of
infrastructure service in the district during the past years, access to these facilities is still varied.
The immediate causes of maternal mortality are well known. They are sepsis, hemorrhage,
obstruction, anemia, toxemia and unsafe abortions. The larger social determinants of these are also
equally well known – they include educational status of women, poverty levels, social inequities and
access to quality care.
51
DHS, Kishanganj
It is evident that all the health / health service indicators of Kishanganj district are as lower as
compared to that of Bihar CDR, MMR IMR , Immunization, Institutional Delivery and Safe delivery is
not better than Bihar State. However efforts in terms of quality and service need to be taken for the
betterment of the present indicators. Service utilization is not good in Kishanganj district. In urban
areas, there is no any Urban Health Centre in the Kishanganj district. In this reason, the slum
population is neglected for proper immunization, Institutional Delivery and Safe delivery.
Field observations show that the blocks Narpatganj, Bhargama andSikti are lagging with respect to no.
of institutional deliveries due to lack of staff, proper health facilities as well as they are unreachable
areas. Further the no. of maternal deaths in that block are much more as compared to other blocks as
these are non tribal belts, far-away sub-centers, unapproachable areas etc.
Constraints:

Health workers are not able to do 100% pregnancy registration due to different reasons such as
unreachable areas, personal reasons, illiteracy etc.

No proper follow-up by workers of ANC cases and monitoring by supervisors, sector doctors etc

No proper referral service

Lack of awareness among rural masses / low IEC activities

Improper access quality antenatal, natal and post natal services may be due to

Lack of nurse (refers to female MPW or ANM) for providing quality ante-natal care at an
appropriate time in vicinity of her home.

Lack of skilled birth attendant in vicinity of home (trained midwife, nurse or doctor).

Lack of facility providing institutional delivery on a 24 hour basis:

The Sub-Centre is not usually a site for institutional delivery. 75% approxof sub centres the lack
of buildings rules it out as an option. Equipment gaps may also contribute to poor service.

The post-partum mother and the neonate require a visit by a ASHA in the first day after birth
and at least once more in the first week of the neonate’s life. Given geographical constraints it is
not possible for the ANM to do so. Only a trained community level care give like the ASHA can
do so.

Lack of transport facilities

Sometimes the nurse is there and resources are not a problem but there is a poor motivation to
provide services or a reluctance to accept services even when the knowledge and attitudes are
alright. These gaps are cultural gaps and represent a certain passive discrimination – of caste or
creed, or of gender.
The following matrix highlights the indicators that are taken into consideration to achieve the
objectives of reproductive and child health. For each indicator current status has been assessed and
targets have been set that are to be achieved in the period present year plan . In order to attain the set
goals certain strategies are laid out against each indicator.
Table 4.1: Performance Indicators for Reproductive child health
52
DHS, Kishanganj
Sl.
No.
1.
District Plan
Objectives
Current Target for
levels* 2010-11
 Strengthening
information
base
of
pregnant women.
 Improvement
in
monitoring
and
supportive supervision of ANM tour
programme.
 Provision of equipment to sub centres,
APHC, PHC.
 Streamlining logistics.
 Specific interventions for inaccessible areas
 Effective
coordination
with
ICDS
workers/NGOs and faith based institutions
 Area specific IEC and Behavioral change
communication strategy.
 SBATraining of ANM, LHV & Grade A
Nurse.
 Training of community based midwives
(long duration training).
 Transport facilities to pregnant women.
 Safe Home Delivery by SBAs.
 Improving delivery facilities at sub centres
and APHC.
 24 hour delivery services at APHC and
PHC.
 Involving
public sector/private and
nursing homes in deliveries
 Awareness generation about Janani avam
Bal Suraksha Yojana in community.
 IEC / Behavioral change communication to
improve awareness about pregnancy
complications and need for utilizing
institutional services for deliveries.
 Involvement of ANMs, ASHA, AWW,
SHG, VHSC and elected representatives of
community /faith based institutions in
identification of pregnant women at high
risk.
 Identification of health institutions and
equipping them to provide basic and/ or
comprehensive emergency obstetric health
care.
 Appointing required health professionals
such as gynecologists, anesthetists and
staff nurses to provide EMOC services.
 Ensuring adequate and safe blood supplies
by strengthening existing blood storage
center and opening new blood banks in
Universal coverage of
all pregnant women
with package of
quality ANC services
as per national
guidelines.
2.
Increase in deliveries
with skilled
attendance at birth
including institutional
deliveries.
3.
FRUs (including
SDH/,Referal/
PHC/APHC) made
functional as defined
in the National RCH2 PIP
Suggested Strategies and Activities
53
DHS, Kishanganj
Sl.
No.
4.
5.
District Plan
Objectives
Increase in
prevalence of
exclusive breastfeeding
7.
Percentage of
severely
malnourished
children below 6
years referred to
medical institutions
Unmet demand for
contraception (Total)
- Spacing
- Limiting
Suggested Strategies and Activities
the district.
 Establishing linkages with private nursing
homes having adequate facilities to
provide emergency obstetric care services
 IEC & Behavioral change communication
to improve awarness.
 Improving referral Network.
 ASHA Training and Motivation.
 Introduction of a package of home based
new born care.
 Strengthen referral network.
 Strengthen new born care infrastructure
and facilities in all APHC and PHC.
 Upgrade education infrastructure for
neonatal services training.
 Educating mothers on benefits of
immediate breast feeding.
 Educating mothers on need to exclusive
breast feeding
 Educating mothers on type of supplements
and also the need to start supplements
from sixth month onwards
 Reorientation training to service providers
 Training to AWWs for identification of
malnourished children.
 Training of MOs.
 Develop the Neonatal Rehavilitation
Centre (NRC) in the CHC, SDH and
District level hospital.
 Increasing the base of serviceproviders for
both male and female sterilization services.
 Increasing the number of service delivery
points to provide quality male and female
sterilization services.
 Organizing camps in systematic and
effective manner.
 Building linkages and involving NGOs /
FBOs to promote both male and female
sterilization methods and modern spacing
methods.
 Social marketing projects to promote
access to and demand for spacing
methods.
 Communication campaign to improve
demand for terminal and modern spacing
methods.
Universal coverage of
all eligible pregnant
women under JBSY
scheme
Increase in
percentage of new
born babies given
colostrums.
6.
8.
Current Target for
levels* 2010-11
54
DHS, Kishanganj
Sl.
No.
9.
10.
11.
District Plan
Objectives
Current Target for
levels* 2010-11
Suggested Strategies and Activities
 Conducting Workshops to service providers
on linkages between spacing of children
and IMR.
 Ensure posting of trained LMOs, surgeon
and staff at PHC.
 Skill upgradation of ANMs for IUD
insertion services.
 Collaboration with private practitioners/
institutions on contractual basis.
 Accridate the private facility for
sterilization.
 Orientation training of staff for enhancing
ARSH services
 Sensitize adolescent and reproductive
groups through local health workers
 Involvement of NGOs
 Identify the health institutions in the district
and equiped them with lab facilities and
lab technicians.
 Training of medical officers in RTI/STI
management.
 Supply medicines in adequate quantity for
RTI/STI services
 Provide RTI/STI services during RCH
camps
 Conduct special camps for health check ups
and RTI/STI services
 Promote partner treatment
 Establish linkages with private practitioners
providing RTI/STI services
Number of govt.
health institutions
providing i) Female sterilization
services
ii) Male sterilization
services
iii) IUD services
Number of health
institutions in
APHC/PHC offering
ARSH services
Number of health
institutions
providing services
for management of
STIs and RTIs
*Source: RCH II and DPMU
4.3.1.2 Child Health and Immunization
Poor outcomes in the child health due to the following reasons: Workers not following the 8/8 quality ante-natal care norms
 Poor nutritional habits
 Early marriages
 Illiteracy among rural masses especially SC/ST.
 Poverty
 Less number of institutional deliveries
Table 4.2: Child health indicators (2008-2009)
A. Percentage of women who started breastfeeding
immediately/within 2 hours of the birth to their children
55
12.8
DHS, Kishanganj
B. Percentage of women who gave exclusive breast milk for at
least 4 months to their children
(i) BCG
(ii) DPT (Three injections)
(iii) Polio (Three doses)
(iv) Measles
(v) Complete immunizations (BCG + 3 DPT + 3 Polio + measles)
8.7
59
32.2
30.3
36.3
26.6
(Source: RCH-DLHS survey 2003, PFI 2007 & Internal MIS data)
The block wise immunization performance within the district seems to be satisfactory. But when
this data is compared with the external data like that of SRS, PFI & DLHS there seems to be large
variance. Possible reason for this can be that the internal data is taken out of vaccine utilization
whereas the external data represents the actual service delivery.
Constraints for poor quality of immunization:
 Unavailability of vaccines on time.
 Lack of staff.
 Weak transportation facility.
 Illiteracy
 Drop out of staff duputed on the immunization centre.
 Hard to reach area people unable to come on immunization centre.
Suggestions for improving the quality of immunization:
 Vacant staff positions should be filled-in as Mission work.
 At least two months stock of all the vaccines at PHC level and 6 months stock in district level.
 Proper transportation facilities for vaccine delivry at immunization centre.
 Maximum IEC coverage so that people should know about the date and venue of
immunization.
 Immunization work plan must be develop by ANM by calling meeting of VHSC & Local SHG.
Table 4.3: Performance Indicators for Child Immunization
Sl.
District Plan Objectives
1.
Increase in percentage of
fully protected children in
12-23 months as per
national
immunization
schedule.
2.
Universal coverage with
Vitamin A prophylaxis in
5-36 months children.
Current
levels*
Target for
2011-12
Suggested Strategies
 To Increase number of sub
centers and health workers
so that the span area of work
may be concise.
 Increase Outreach sessions
 Ensure adequate posting of
ANMs and MPWs.
 Increase IEC at grass root
level with the help of NGOs,
VHSC, SHG.
*Source: RCH II, 2002-04
4.3.1.3 Family Planning
56
DHS, Kishanganj
The availability of family planning does more than enable women and men to limit family size. It
safeguards individual health and rights, preserves our planet's resources, and improves the quality of
life for individual women, their partners, and their children. This section provides basic information on
a range of contraceptive methods, including factors to consider when choosing a method. In all the
blocks of district Kishanganj the achievement with respect to target in case of Family Welfare is not
satisfactory.
Table 4.4: Knowledge of Family Planning
Indicator
Percentage
Knowledge of any modern method
Any modern spacing method
All modern methods
Knowledge of any traditional method
45.6
27.4
17.8
55.5
(Source: RCH-DLHS survey 2003)
Table 4.5: Current users of Family Planning
Any Method (CPR)
Any Modern Method
Female sterilization
Male Sterilization
IUD/Loop
Pills
Condom
Any Traditional method
27.2
23.5
16
0.6
0.3
5.1
1.1
30.6
(Source: RCH-DLHS survey 2003 & Internal MIS data)
Table 4.6: Unmet Need
Percentage of women having unmet need for
Limiting
Spacing
38.1
14.7
23.4
(Source: RCH-DLHS survey 2003)
4.3.1.4 RTI / STI and HIV / AIDS Control
Reproductive tract infections (RTIs) include three types of infection that affect the reproductive tract of
women and men (Population Council 2001). These are:
1. Sexually transmitted infections (STIs)—also known as sexually transmitted diseases (STDs)—caused
by viruses, bacteria, or parasitic organisms that are passed through sexual activity with an infected
partner.
2. Infections that result from an overgrowth of organisms normally present in the vagina (endogenous
infections). These infections are not usually sexually transmitted, and include bacterial vaginosis
and candidiasis.
3. Infections introduced into the reproductive tract by a medical procedure (Atrogenic infections) such
as menstrual regulation, induced abortion, IUD insertion, or childbirth. This can happen if surgical
instruments used in the procedure are not properly sterilized, or if an infection already present in
the lower reproductive tract is pushed through the cervix into the upper reproductive tract.
57
DHS, Kishanganj
These three types of RTIs overlap and should be considered together. For example, some STIs, like
gonorrhea or chlamydia, can be spread in the reproductive tract if not treated prior to a procedure. In
addition, some non-sexual infections, such as candidiasis, can be passed on through sexual activity.
Challenges to controlling RTIs/STIs
While not all RTIs are curable, they are all preventable. Prevention efforts aim to stop people from
becoming infected, as well as to stop those infected from transmitting their infection to others (PATH
2001). Primary prevention focuses on educating people about personal risk and how to protect
themselves from disease. Abstinence; consistent, correct condom use; mutually exclusive sexual
relationships with an STI-negative partner; and early treatment of STIs are the most effective STI
prevention options. Secondary prevention aims to shorten the duration of disease by promoting early
detection and treatment, and providing acceptable, accessible, and effective care.
The key public health interventions needed to control STIs include:
 Promotion of safer sexual behaviors and primary prevention.
 Condom promotion, supply, and distribution.
 Promotion of appropriate health care-seeking behaviors.
 Integration of STI prevention and care into many existing health care services, including primary
care, reproductive health care, HIV/AIDS prevention and treatment, and private-sector services.
 Comprehensive syndromic case management.
 Specific targeted services for high-risk groups.
 Prevention and care of congenital syphilis and neonatal conjunctivitis.
 Early detection and effective treatment of symptomatic and asymptomatic infections
Women have a greater risk of RTIs than men due to physiological, social, cultural, and economic
factors. Women are:
 biologically more susceptible than men;
 usually infected at a younger age than men;
 more likely to suffer from complications;
 limited in their ability to protect themselves from high-risk sex or to negotiate condom use;
 more apt to suffer from asymptomatic infections and remain untreated; and
 Less likely to seek treatment, even for symptomatic infections.
The consequences of RTIs, including stigmatization, reproductive impairment, domestic abuse, and abandonment,
can be severe for women. Women have limited ways to protect themselves. Female condoms offer some
protection and may be cost-effective, but their use will depend on how they are promoted and how well they are
accepted. In Kishanganj district till date there are 66 cases of HIV/AIDs have been detected. In the district hospital
Kishanganj there is blood testing facility available. Simultaneously VCTC and STD clinic is also provided in the
SDH hospital. Efforts are needed for health check-ups and partner treatment camps.
Table 4.7: Awareness of RTI/STI and HIV/AIDS
(i) Percentage of eligible women aware of RTI/STI
(ii) Percentage of eligible women aware of HIV/AIDS
(iii) Women who had any symptoms of RTI / STI
(iv) Women who utilized government health facility for treatment of RTI/ STI
(Source: RCH-DLHS survey 2003)
As tabulated below, 46 cases were detected and all of them were treated in the year 2008-09
58
32.4
82.7
27.4
4.7
DHS, Kishanganj
Table 4.8: RTI / STI cases - detected and treated in the year 2008-09.
RTI/STI Cases
Year 2010-11
Cases Attended
1475
Cases Treated
1475
Various NGOs are proving condoms as well as they hold various clinics for truckers, travellers etc for
prevention and counselling for RTI/STIs as well as HIV cases. The major constraints are:
 People do not come out in the open about their infections with a fear of being ostracized by the
community.
 Lack of knowledge about RTI/STI
 Lack of practice of condoms by males
 In-migrating population
Following are the suggestions to counter these issues:
 We need to educate the people regarding RTI/STI a well as HIV/AIDs.
 People need to be made aware of the presence of VCTC/STD clinics.
 Major focus should be on High risk groups and areas by regularly organizing exhibitions, camps,
melas etc.
 Regular quiz competitions, debates, skits/dramas etc. regarding knowledge of RTI/STI as well as
HIV/AIDs among truckers, college students, in-migrant laborers.
 NGOs should be made responsible for all these activities and supporting and coordinating the field
health functionaries
4.3.1.5 Adolescent Sexual and Reproductive Health (ASRH)
Sexual development is a normal part of adolescence. Fortunately, most adolescents go through
these changes without significant problems. Nonetheless, all adolescents need support and care during
this transition to adulthood, and some need special help.
The lives of millions of adolescents worldwide are at risk because they do not have the
information, skills, health services and support they need to go through sexual development during
adolescence and postpone sex until they are physically and socially mature, and able to make wellinformed, responsible decisions.
The main issues in adolescent sexual and reproductive health are:
 Sexual development and sexuality (including puberty)
 Sexually transmitted diseases/ HIV/AIDS
 Unwanted and unsafe pregnancies
The reasons that adolescents are at risk include:
 Social and economic environment – For millions of adolescents, sex is linked with coercion, violence
and abuse – sometimes even by family members or adults with privileged relations. In many
societies, women are conditioned to be submissive to men, and they find it difficult or impossible to
refuse early marriage, to space births, or to refuse to have unprotected sex with an unfaithful spouse
or partner. Additionally, the social environment is critical to healthy adolescent development.
There are key aspects of this environment, which can prevent adolescents from engaging in
unsafe/unwanted sexual behaviour, for example, a strong relationship with parents, a connection to
school and open communication with sexual partners.
59
DHS, Kishanganj









Information and skills (life and livelihood) – In most countries, the great majority of adolescents are
poorly informed about sexuality and reproduction. Often policy makers, public opinion leaders and
parents believe that withholding information about sexuality and reproduction from young people
will dissuade them from becoming sexually active. In fact, good quality sex education does not lead
to earlier or increased sexual activity among adolescents. Adolescents need life skills in order to face
the challenges of adulthood. During personal development, an adolescent’s competence develops
whenever there are opportunities to practice certain skills by understanding and using social
conventions. Adolescents also prioritise livelihood skills and opportunities as very important to
them. Many adolescents are victims of exploitative sex because of lack of livelihood skills and
opportunities.
Access to health services – Most adolescents (boys and girls, married and unmarried) become
sexually active before the age of 20, but generally lack access to family planning services (including
appropriate contraceptives), prevention and care of sexually transmitted diseases, or pregnancy
care. For many young people, the opening times or location of services make them inaccessible, or
the care is too expensive. Many health care facilities require the consent of parents or spouses, or
may be forbidden by law to provide services to adolescents. In addition, the judgmental attitudes of
many health care professionals often discourage adolescents from seeking advice and treatment
related to sexual and reproductive health.
Intervention Areas
The Common Agenda advocates the following specific measures to prevent unsafe sex and early
childbearing among adolescents:
Create a safe and supportive environment through promoting delayed marriage and childbearing,
expanding access to education and training, and providing income-earning
Opportunities.
Provide information and skills (life and livelihood) so that adolescents are better equipped to make
good decisions.
Expand access to health services that are affordable, accessible, confidential, and non-judgmental.
Provide counselling for adolescents.
There are almost no programmes in the area of Adolescent health. The following are the constraints:
 There is a very high degree of under-nutrition and anemia at this age.
 Also growth stunting occurs at this stage if the girl is malnourished.
 Physical and mental development potential and stress due to poor health is also more.
 Adolescence is a period of higher exposure to violence, to sexually transmitted diseases and to
pregnancy associated morbidity and mortality.
Suggestions:
 These need not only counseling at the individual level.
 But also social mechanisms of support and women's empowerment to address.
4.3.2 Health Infrastructural Indicators
The performance with respect to certain key activities under NRHM shows that infrastructure
related issues needs to be sorted out to ensure a successful implementation of plan. Next section details
out probable strategies and activities:
Suggested Strategies and Activities:
60
DHS, Kishanganj
Two female MPWs in each sub centre: Sub centers may plan for two MPWs, preferably both
women. The job description and workload of the MPW (F) needs to be lessened and made realistic.
Along with this, workload reatinalisation would be achieved by equal sharing of the work between the
two persons posted at the sub centre. In the first stage this achieved by redefining of the male MPWs
work to be identical with the female MPWs. Except or institutionalization delivery and IUCD insertion,
every task currently done by women can be done by men also. And in the second stage by ensuring that
the second person in the HSC is also a female MPW i.e. converting the male MPW post to a female
MPW post. Without increasing costs or number of sub centers we would be doubling the density of the
most active, effective and critical workforce of the entire system.
Multi skilling all PHC paramedical: The PHC staffing pattern needs restricting to ensure
utilization of manpower and better functioning of the facility. APHC may plan for having two or three
male multi-skilled employees with a male multi-skilled supervisor and three female multi-skilled
workers (including the section incorporated in the sector) and a female multi-skilled supervisor. There
would also be one medical officer in every PHC (preferably two). These multi-skilled workers must be
skilled in dressing, drug dispensation (the compounder’s) and first contact curative care and in basic
laboratory package as well as in RCH. Between them they should be able to keep the PHC functional
for 24 hours, provide institutional delivery and the other services as proposed in the service delivery
norms. Though the immediate step is only multi-skilling and revising job descriptions, cadre restricting
may follow this. In this process of transition no one has to be dropped unless they are unwilling for
multi-skilling. New recruitments would be into the multi-skilled category and many existing cadre
would die away. Some like staff nurses would function as multi-skilled staffs when posted in a PHC
and can play the role of staff nurse when posted in PHC and district hospitals. We estimate that such
retraining and redeployment would solve a substantial part of the manpower vacancy problem. Each
PHC may also have two staff at class IV qualifications.
Rationalization of Deployment Medical Doctors in the PHC Level
Differentiated Strategy According to Difficulty Levels: The ideal would have been two medical
officers at every PHC. However this may not immediately be realized due to shortage of potential
recruits and the difficulty in finding even one medical officer per remote area. Therefore we suggest
that APHC be categorized into most difficult, difficult and easy and a different strategy be adopted for
each.
24 hour Multi-Skilled Paramedical Based Service in al APHC: We recommend that in all APHC
irrespective of category, 24 hour service with emphasis on institutional delivery be insisted on by multiskilling and deploying paramedical. The multi-skilled paramedical worker should also be trained in
emergency care management at primary level.
Daily Visits by PHC Based Doctors for Most Difficult APHC: Where no medical doctors are
available currently, where access is a problem and accommodation facilities are low (category C), even
as efforts are made to fill these posts, the backing up is done by daily visits and in a few distant APHC
two to three visits per week of a medical doctor from the respective PHC. The doctor would be required
to be available during working hours and his stay at the PHC would be insisted on only adequate
accommodation arrangements, governmental or rental are available. Even in this exemption may be
given for special reasons as long as stay is in nearby block town as part of the PHC team and daily
61
DHS, Kishanganj
attendance is regular. Family accommodation at the PHC would be easier to organize. In other word,
HMS we should not insist on medical doctors staying in APHC designated category C- most difficult.
Strengthening AYUSH Doctor’s role while keeping Medical Officers Option open: The use of
medical officers with AYUSH (Ayurvedic scheme) to fill up vacancies where no medical officers are
currently available is welcome. However all the service issues discussed equally affect their
functionality. Moreover currently they would be unable to deliver the notified services of the PHC level
and special training would be needed to close the gaps.
Strengthening of PHC
Appointment of Six Medical Officers at Least, four of whom at least are specialist or within
them have the required four – skill (Anaesthetist, paediatrician, surgeon, gynecologist) mix. If there are
a number of APHC not having doctors to be looked after with visits, the number posted here may
increase further. Currently the recommended norm is only four doctors per PHC, which is sub – critical.
Adequate Multi – Skilled Male and Female Paramedical Staff, who can manage the necessary
support work and multi skilled imaging technicians who can also mange X–rays, ultrasound and ECG
too. In addition there would be a unskilled worker category of undifferentiated, interchangeable class
IV functional – chowkidar, peon, sweeper, waterman – all rolled into one. Four qualified staff nurses,
two qualified laboratory technicians and an optometrist are also a must at this level.
Re-designating the BEE, The block level extension educator may be renamed the block senior
paramedical supervisor and be responsible for capability building, IEC and supervision of the sector
supervisors.
Adequate Clerical and Accounting Staff, at least two, be provided to every PHC along with a
computer and printers.
RATIONALISATION OF WORK ALLOCATION AND APPROACHES TO IMPROVE OUTREACH
SERVICES
In addition to the above measures improving outreach would require:
Reorganisation of MPW Work Schedule
MPWs may be required to tour for three days a week, instead of the present one or two days a
week. One day a week should be devoted to review and drawing supplies from APHC. The remaining
two days a week should be devoted to clinical work and other services provided at the sub centre.
These two days are fixed and her clientele should know that she is available there in headquarters on
these two days. In each field visit day, he/she would visit a specified number of houses and hold
meetings with one of the four identified focal groups. Once a month he/she should attend to Block level
review and training. If there are two MPWs posted their two days at the headquarters may be fixed
such that the sub centre is open on four previously specified days every week, which is better than the
current one day a week.
Integration with ASHA Programme
It is extremely important to develop a mechanism to sustain interactions between MPWs and
ASHA. Such a mechanism is also required for the long – term success of the ASHA programme. The
ASHA programme offers the scope to rationalize and the MPWs job responsibilities more achievable.
62
DHS, Kishanganj
The ASHA’s focus is on health education, family level counseling and prompt and adequate
management of diarrhoea and acute respiratory infections. The ASHA also maintains a register for her
village which tracks each family to identify any specific health service gap and motivates the family to
receive this service as the coordinates with the MPW to ensure that the service is delivered. The MPWs
focus is on actual service delivery on RCH and in all national programmes – like immunisaiton,
provision of contraception, care in pregnancy and assistance at delivery and soon and on support to
ASHA, anganwadis and panchayats.
Revised MPW Job Description
A MPWs job description for both male and female worker can be reorganized as:








Immunization – Children and pregnant women largely at the village visit and camps but
supplemented by immunization at the sub centre.
Ante natal care and post partum care at sub centre, with visits to those pregnant women unable/
unwilling to come.
Motivation and facilitation for all methods of contraception.
Training and support to ASHA and local women’s health committees.
Regular house visits, such that every household is visited once every month (or two months in
difficult areas) for a set of “case detection, follow up and counseling activities” along with first
contact curative care where required. (this includes all national programme related activities)
Focal group discussion / health education sessions/health camps during village visits.
Curative care during field visits on three days at sub centres on two days.
Response to epidemic using a graded epidemic response protocol.
In addition to the above male workers would have the following tasks:


Addressing male youth on adolescent problems and STDs control.
Interaction with panchayats and with local leaders for facilitation of health programmes.
In addition to the above female MPWs shall have the following tasks:



Assistance at child birth
IUCD insertion
Addressing adolescent girls on health problems
Having the right number of manpower at the required positions / places is one of the most
important factors for the success any health programme. Also in the rural health centres, especially in
the primary health centres, there are two major problems concerning the doctors and the supporting
medical staff posted there. Firstly, the number of doctors and supporting medical staff is less than what
the norms suggest, problem that is further compounded is by delays in filling up vacancies in health
centres, cases of high absenteeism are also seen sometimes.
Outreach Strategies to Enhance Access
Lack of roads and transport facilities and natural obstacles and high degree of scatter of hamlets
within a section or sector add to the problems of access. These problems are not remediable by
increasing facilities beyond the norms. Instead they need a high degree of community support and a
high degree of planning and rationalization of the work of the various categories of staff already
63
DHS, Kishanganj
available. Camps are the major outreach strategies aimed to close outreach gaps but their effectiveness
and even their occurrence in most areas is far from certain.
A variety of other camps for different vertical programmes take effort and expense to organize
but with uncertain benefits. The ASHA programme has attempted to build on this dimension and
provide a well – supported cadre of trained volunteers in every hamlet. The integration of this force
with the sub centre’s function offers the best scope of advance in improving outreach.
Staff Situation and their Utilization with Relation to Functionality of Centers
Female paramedical staff is near adequate in numbers. There are serious shortfalls in all other
staff. A converse dimension of this situation is that of all the paramedical staff. Only the female
multipurpose worker and to a lesser extent the sector supervisor female shares the greater part of the
workload. All other categories of staff at HSC and PHC level are characterized by poorly designed work
schedule and are poorly utilized with a high degree of redundant work time. Rationalization of
paramedical work time offers therefore the most effective route to addressing staff adequacy.
The current work description of the MPW female is unrealistic and is being coped with by
developing a focus on just one or two tasks and informal local arrangements. As a result a number of
essential services are completely left out (e.g. early recognition of child-hood pneumonia or proper
treatment of diarrhea or adolescent health care etc) and the quality of a number of other services, like
antenatal care are seriously compromised. (Almost no pregnant women has her BP taken and blood and
urine examined)
Rationalisation of Drugs and Consumables Supply
The essential drug list is being implemented. The main deficits are a failure to procure the entire
items of the list, a failure to send samples for quality control, and a failure to exclude drugs not on the
list. Other elements of the drug policy are also not in place. Thus procurement is sporadic, occurring
once or twice a year with quotas to peripheral facilities to distribute the drugs. There are numerous
breaks in supply and the distribution system is unresponsive to changing needs. Restriction of drugs to
a narrow spectrum and breaks in supply are not even perceived as serious within the system reflecting
poor perception of quality of care issues. The problem with consumables is even more serious that with
drugs. Laboratory chemicals seem the worst affected but even gauze and bandages, needles and needle
holders could be in short supply repeatedly.
Rationalization of Equipment
In equipment we have two types. We have relatively low investment “minor equipement” like
Sahil’s Haemoglobinometer or BP apparatus and infant weighing machines, which, if used, will need
replacement frequently.
And we have more costly “major equipment” like ultrasound and X-rays, which require replacement
less, (up to once in five to ten years), but which require trained manpower to operate and oftenconsiderable consumables as well.
In minor equipment we find considerable under utilization, and simultaneously reports of nonavailability. Due to quality of care issues many of this equipment are not utilized. But equally there is a
64
DHS, Kishanganj
problem that if they are used many of these last only one to three years and then would need
replacement, for which no ready system of purchases and restocking is available.
In major equipment the main problem is mismatches, between equipment supply and manpower
to use (e.g. ECG machines without anyone who can operate it), between equipment supply and level of
services currently provided at that level (e.g. one neonatal care units supplied to a facility where there is
no caesarean sections or even as many normal delivery neonates per month, (e.g. X-ray machines
running out of film) and between equipment purchase and maintenance. At one level all such
mismatches are attributable to failures of concerned officers. But at another level it points to
governance/ administrative failure, with one committee maximizing purchases, and another set of
persons looking at distribution, and no one looking at training and maintenance or eventual utilization
of equipment.
Infrastructure Adequacy
The shortfalls in basic availability of buildings are well known. It is in the range of approx 25%
for HSCs. PHC are all in government owned buildings but as yet only an estimated 100% are upgraded
to the 30-bed PHC norm. Toilet construction and maintenance too are major infrastructure inadequate.
Maintenance of buildings is also poor and most buildings are old and need extensive renovation or
replacement.
Problems with electricity supply are minimal and generator back up is usually available where
there are problems. Problems with water supply are however considerable. Most of these facilities have
a bore-well and hand-pump so that they are functional. However any hospital with inpatient facilities,
even if it were for only conducting normal delivery would require running tap water, bathing facilities
and toilets separately for staff and for patients. Yet only one third of PHC and Referal Hospital and
none of APHC have such a water supply arrangement. Waste management based on segregation of
wastes with proper disposal of each category of biological waste is a relatively untouched area of
intervention.
Table 4.5: Performance indicators of Health Infrastructure
District Plan Objectives
1.
2.
3.
Number of ASHA functional
in the district (received
induction training)
Number of HMS registered/
established
Current
levels*
Target for
2007-12
1167/
1344
1368
HMS
formed
in all
PHC &
APHC
Number of health care
delivery institutions
65
Suggested Strategies and Activities
 Finish ASHA Selection & Training.
 Monitoring of working capacity of
ASHA
 Increase incentives for ASHA
working in difficult areas
 Establishment of HMS
 Selection of members
 Functioning of HMS
 Clear guidelines for working of HMS
 Guidelines for expenditure of
maintenance grant
 Orientation and training of elected
HMS members
 Decentralizing the procedure by
appointing other representatives
 Upgradation of health institutions in
conformity with IPHS
DHS, Kishanganj
District Plan Objectives
Current
levels*
Target for
2007-12
 Subcenters in government building
 Availability of facilities like water
supply, electricity, labour table
 Part-time dai at subcenter
 Incentives for ANMs working in
difficult areas
 Posting of LMOs at APHC and PHC
 Training of LMOs regarding EmOC
 Posting of gynecologists, anesthetist,
and pediatrician at PHC
 Blood storage center at PHC
 Adequate equipments and supply of
other material
 Constitution of VHSC
 Guidelines for VHSC
 Orientation of VHSC members
 Organization of training for
sensitizing members on working
mechanism
 Roles and responsibilities fixed for
each member of the committee
 Coordination between health and
sanitation initiatives
 Strengthening infrastructure of
health centers
 Carry out civil work for SCs with
respect to building, running water
supply and electricity
 Involvement of gram Panchayat for
taking land for construction of HSC/
APHC/PHC
 Ensure equipment and drug supply
 Refresher training course for ANM
 Posting of LMO and staff nurse at
APHC
 Guideline for use of maintenance
grant and Regular monitoring and
reporting system for used grant.
upgraded
- HSCs
- APHCs
- PHC to FRUs
4.
VHSC constituted
- Grants given
5.
Number of HSCs, APHCs
strengthened
- Additional ANMs hired
- Annual maintenance
grants given
6.
Number of APHC
strengthened to provide
24x7 services.
- 3 staff nurses hired
- Annual maintenance
grants given
Mobile Medical Unit facility
for unreached people.
7.
Suggested Strategies and Activities
 Implement the MMU by
NGO/Outsourced under PPP.
66
DHS, Kishanganj
District Plan Objectives
8.
5.
10.
Current
levels*
Target for
2007-12
 Implementation of activities to fill
in the identified gaps.
 Facility survey & HH Survey must
be done by external agency so that
proper gaps came into existence.
Number of facilities to be
covered for facility survey
- HSCs
- APHC
- PHC
Number of villages to be
covered for HH survey
Number of community
hearings planned
11.
District training plan
developed and implemented
12.
District BCC plan developed
and implemented
13.
District procurement and
logistics plan developed
14.
Number of APHC/PHC
where AYUSH physicians
posted
Suggested Strategies and Activities
District
training
plan in
place &
implement
ed
District
BCC plan
developed
&
implement
ed
District
logistic
plan
developed
&
implement
ed
 Organization of regular community
meetings at SC and PHC level
 Integration with ASHA and PRI
 Formulation of district training plan
 Recognition of need of trainings
 Organization of trainings as per state
guidelines
 Refresher training of paramedics on
minor ailments
 Training of MOs for managerial
skills, EmOC
 Training of ANMs for ANC, DOTS
 Formulation of district BCC plan
 Assessment of communication needs
in the context of NRHM
 Development of communication plan
and its implementation
 Use of print media, nukkar natak,
folk, TV and radio.
 Formulation of need based plan for
streamlined procurement and
logistics.
 Provide required equipments.
 Financial planning for reaching of
supplies at various levels including
ASHA.
 Well established supply chain
 Posting of AYUSH practitioners
 Relocation and appointment of
physicians
 Coordination with other private
health facilities
*Source: District Project Management Unit
4.3.3 Blindness Control Programme
National Programme for Control of Blindness was launched in the year 1976 as a 100% centrally
sponsored programme. Various activities of the programmes include establishment of Regional Institute
of Ophthalmology, up gradation of medical colleges and district hospitals and block level Primary Health
Centres, development of mobile units, and recruitment of required ophthalmic manpower in eye care
67
DHS, Kishanganj
units for provision of various ophthalmic services. The programme also extends assistance to voluntary
organizations for providing eye care services including cataract operations school screening.
The achievements of NBCP are tabulated below:
Table 4.12: Achievements of the National Blindness Control Programme (2010-11)
Particulars
Achievement
No. of Urban Eye Camps
No. of Cataract operations (Total)
No. of School Screening
No. of refractive error
0
3645
0
0
Constraints:
 Lack of Education among the masses about the existing facilities: Need of wide publicity.
 Shortage of quality Equipment and medicine.
 Apathy and indifference on the part of health personnel.
 Lack of adequate referral services to take care of complications.
 People have tendency to neglect the aged family members.
 Post operative follow up of people is not being done properly.
 Fear of eye operation.
 Old myths are still prevailing.
Suggestions:
 Integrate Eye care as part of Primary Health Care

Involve NGO’s

Train Ophthalmic Medical Assistants

Provide Low Cost Spectacles

Correct Chronic Vitamin-A Deficiency

Proper survey should be done by health workers

Proper investigation before operation

Camp should be done at well equipped hospitals and by surgeon

Need of strict control to maintain quality.

Need of change of attitudes.

Need of designing referral services
Table 4.13: Performance Indicator for NBCP
District Plan Objectives
1.
2.
Current
levels*
Cataract surgery rate
(per lakh)
Percent surgery with IOL
Targets
for 2007-12
Strategies
20000
 Conductance of no. of
eye
camps
in
coordination
with
(NGO) Sushrut
3645
68
DHS, Kishanganj
District Plan Objectives
3.
4.
Current
levels*
School Eye Screening:
children in the age group
of 10-14 years should be
screened for refractive
errors
Oral Health Screening
for
- Community
- School children
Targets
for 2007-12
1458
0
25478
Strategies
 strengthening service
delivery
 developing human
resources for eye care
 promoting outreach
activities and public
awareness and
 developing institutional
capacity
* Source: District Blindness Control Programme
4.3.5 Leprosy Eradication Programme
Leprosy continues to remain a serious public health problem in the developing countries,
particularly if one considers that the populations at risk of contracting the disease are very large, and
that more than one-third of all leprosy patients face the threat of permanent and progressive physical
and social disability. It should be emphasized here that the problem of leprosy is for more serious than
what is represented by the numbers alone, particularly in terms of the intense human suffering
involved resulting from the physical deformities and the related social problems.
Leprosy is a chronic bacterial disease caused by Mycobacterium leprae. It affects the peripheral
nerves, skin and the upper airway. The main clinical presentations are the tuberculoid and lepromatous
forms.
The exact mode of transmission has been established naso pharyngeal root but household and
prolonged contact appears to be important. Environmental factors such as overgrowing and poor
hygiene facilitate the spread of the disease. The incubation period ranges between 2 months and 40
years. Leprosy is rarely seen in children below three years of age. At present, there is vaccine under trial
as HKML (Heat Killed Mico bacterium laprae obtain from Arma dilo nine bandade), ICRC vaccine
(Indian Cancer research Centre) by Dr. Dave, MW (Mico bacterium Welchi and BCG)
Unlike some other diseases, such as tuberculosis, there does not appear to be a connection
between leprosy and HIV infection. With the implementation of MDT (Multi Drug Therapy) services
under the programme since 1583, a large number of leprosy cases have been discharged as disease
cured.
The goal of leprosy elimination is that prevalence rate should be less than one case per 10,000
populations in the coming years. The focus is now being made on voluntary reporting of cases by
promoting intensive IEC / BCC.
Table 4.14: Indicators showing achievements of NLEP 2010-11
Indicators
New case detection
M.B.
P.B.
S.S.L.
69
Status
DHS, Kishanganj
Patients put on treatment
M.B.
P.B.
S.S.L.
Patients treated & discharged
Disability cases
Grade I
Grade II
Suggestions
 Strengthen Health Care Services
 Rehabilitation
 Updation of master register
 Case validation, to have check on wrong diagnosis and re registration
 Prompt and early detection of the cases to avoid deformity and disability,
 Ulcer care foot ware reorientation training of medical & para medical staff.
 Involvement of Lokdoot (old & rehabilitated to have the best IEC.
 Community Education
 Removal False beliefs from the Community
 Financial and personal support and psychological assurances
Table 4.15: Performance indicators for Leprosy Programme
Indicators
1
2
3
Curren Target for
t level* 2007-12
Prevalence rate (PR) - leprosy
cases per 10,000 population
ANCDR – New leprosy cases
per 11,00,000 population
Proportion of patients
completed treatment
4
POD Camps
5
Gram Goshthi
6
Hat – Bazar
7
School Awareness
8
Health Mela
Strategies
Conductance
of
timely
surveillance
Orientation trainings to new staff
Organization of POD camps
Conductance
of
sensitization
workshop at gram panchayat
involving
new
panchayat
representative
Organization of skin diseases
diagnosis and education camps
Conductance of urban leprosy
awareness camps
Procurement of TV, VCD, Camera,
Mike for IEC
Implementation of Project
Financial Mgmt. System.
4.3.6 Tuberculosis Control programme
Tuberculosis (TB) is an infectious disease caused by a bacterium, Mycobacterium tuberculosis. It
is spread through the air by a person suffering from TB. A single patient can infect 10 or more people in
a year. DOTS, known as the Revised National Tuberculosis Control Programme (RNTCP) in India, are a
comprehensive strategy for TB control. DOTS are the only strategy which has proven effective in
controlling TB on a mass basis.
70
DHS, Kishanganj
India has adapted and tested DOTS in various parts of the country since 1953, with excellent
results, and the RNTCP now covers more than 120 million populations. The Revised National
Tuberculosis Programme (RNTCP) was launched in the country on 26 March 1957.
Table 4.16: Indicators showing achievements of RNTCP 2010-11.
Sl. No.
Particulars
1
Total Number of OPD
2
No. of patients whose sputum were examined for
diagnosis
3
No. of Smear Positive patients diagnosed
4
Total Patients Registered & put on DOTS
a) New Smear Positive
b) New Smear Negative
c) New Extra-Pulmonary
d) Re-treatment cases
5
No. of Patients put on Non-DOTS
6
Total Patients under treatment
7
Annualised case detection rate
Status
Suggestions:
To increase the case detection rate following majors should be taken:
 Increasing referral from the field and from OPD, mobilizing community participation, ensuring
involvement of Private practioners, NGOs and other sector, intensifying supervisory activities and
intensifying IEC activities
 TB has a cure, and treatment is inexpensive
 TB control is a very cost-effective health intervention equivalent to that of the well known childhood
immunization programmes.
 Successful treatment demands education and timely follow-up examination to achieve sputum
conversion & cure rate up to the desired level.
 Successful treatment requires 6-8 months of consistent, uninterrupted medication
 New drop resistant strains of TB are developing because patients are not completing their treatment.
These drug-resistant strains are significantly more dangerous to the individual and the community
because they are more difficult and more expensive to treat.
 The best was to prevent TB is to cure infectious cases in their early stages in order to prevent
transmission to others.
 TB, control programmes that treat infectious patients by don’t ensure that they are cured risk doing
more harm than good. Patients who have incomplete treatment can develop and spread drugresistant TB.
Table 4.17: Performance Indicator for RNTCP
District Plan Objectives
1.
Current Targets for
levels*
2007-12
Proportion of TB suspects
examined out of the total
outpatients
Suggested strategies
Increasing the awareness/ visibility
of DOTS among rural masses by
distributing pamphlets and group
71
DHS, Kishanganj
2.
3.
4.
Annualized New Smear
Positive (ANSP) case
detection rate per 100,000
population
Annualized Total case
detection rate per 100,000
populations
Treatment success rate
discussions with villagers
Provide facilities for diagnosis of
TB Patients through integrated
general health services.
Provide optimum treatment nearer
to the residence of the patients.
To prevent infection,
immunization is done by doing
BCG Vaccination.
Health Education to encourage
patients through Health Workers,
their relatives and village leaders
to take full course of treatment.
Detection of New TB cases
(Sputum positive, X-ray suspects
and extra pulmonary cases)
*Source: District TB Control Programme
4.3.7 Filaria control Programme
The National Filaria Control Programme was launched in 1955 for the control of filariasis.
Activities taken under the programme include: (i) delimitation of the problem in hitherto unsurveyed
areas, and (ii) control in urban areas through recurrent anti-larval measures and anti parasite measures.
Man, with micro Filaria in the blood is the main reservoir of infection. The disease is not directly
transmitted from person to person, but by the bite of many species of mosquitoes which harbor
infective larvae. Important vectors are species of Culex, Anopheles, Mansonia and Aedes. The
incubation period varies, and micro-Filaria appears in the blood after 2-3 months in B. malayi after 6-12
months in W. bancrofti infections.
Constraints:
 It affects mainly the economically weaker sections of communities
 Result in low priority being accorded by governments for the control of lymphatic filariasis.
 Low effectiveness of the tools used by the control programme
 The chronic nature of the disease and that
Suggestions:
1. Single dose DEC mass therapy once a year in identified blocks and selected DEC treatment in
filariasis endemic areas.
2. Continuous use of vector control measures.
3. Detection and treatment of micro-Filaria carriers, treatment of acute and chronic filariasis.
4. IEC for ensuring community awareness and participation in vector control as well as personal
protection measures.
4.3.8 Disease surveillance programme
Constraints:
 People not following proper hygiene/ sanitation practices even after knowing the ill effects of
unhygienic conditions
 Bad food habits (such as eating uncovered outside snacks etc)
72
DHS, Kishanganj

Timely immunization as well as supervision not done because of lack of manpower
Suggestions
 Promotion of inter-caste marriages
 Frequent camps in rural areas for solubility tests
 Special medical supervision for +ve cases
 Couples before marriage should go through solubility test

To improvise the current surveillance situation and supervision under district administration is
needed.
4.3.9 ASHA programme:
The concept of ASHA is one of the best health worker programme in our state where the
Community selects a Health Volunteer – called the “ASHA" – the women friend. The concept of
“ASHA” is about Empowerment, Participation, Sharing, Caring, Gender Equity and Self Reliance.
Role of ASHA is:






Providing elementary Health Education
Assuming Leadership in Community Action for Health
Imparting First Aid & OTC Drugs
Treatment of Minor Ailments
Ensuring timely referral
To provide the health service in unreachable villages.
The ASHA programme is one major crosscutting innovation that has seen considerable grass
roots success. A detailed operational manual and it’s a rigorous sample study based interim evaluation
of the programme is available. This is also an initiative that would take a longer time to succeed and it
needs sustained support at all levels for at least another three to five years.
4.3.10 Urban Health
On the basis of the study work it is quiet obvious that people should be prepared for tackling
any kind of disaster and at the same time government should make necessary arrangement for making
people aware. Different media of mass communication, awareness and others should be used for
creating consciousness. Not only government agencies, but NGOs are also expected to create mass
awareness. Inclusion of disaster preparedness into school curriculum should be mandatory as in other
disaster prone countries. Targeting children will create an aware generation and minimize life risks.
The section on urban health therefore focuses only on the municipalities and corporations.
Paradoxically there are large number of hospitals and private clinics- but for the poor in this area of
health, there is not a single approach.
4.3.11 Logistics Management
The essential drug list is in place and is largely implemented. As Kishanganj district has
storekeepers and officers have been trained in drug and supplies logistics. A computerized inventory
system has been developed in software. The problem with consumables is equally of concern and
laboratory chemicals seem the worst affected but even gauze and bandages, needles and needle holders
73
DHS, Kishanganj
could be in short supply repeatedly. These would correct with the distribution system becoming fully
operational.
In equipment there are two types. We have relatively low investment equipments like
Hemoglobinometers or BP apparatus and infant weighing machines- which, if used, will need
replacement frequently. These minor equipments need to be absorbed into the same distribution
system.
As for costly equipment like ultrasound and X-rays, which require replacement less-up to once
in ten years- but which require trained manpower to operate and considerable consumables as well- the
problem is matching for infrastructure, skills and services provided so that these are adequately
utilized.
4.3.12 Intersectoral Convergence
4.3.12.1 Coordination with ISMs
There is a large workforce and institutional and infrastructure base within the health department
that is willing to contribute to RCH goals but has been used only minimally for this purpose.
4.3.12.2 Coordination with ICDS and PHED
Meeting is held at District level for the coordination of Health Department. Health officials have
little faith in coordinating with ICDS and PHED. The vision of intersectoral approach is lacking. More
details about ICDS and PHED are provided in the annexures.
4.3.12.3 Coordination with Panchayats
Panchayats are not totally involved in participating in the health activities with the health
department. Most of the Panchayats are not aware of the fact that by participating in health activities.
There is no such government policy to link Panchayat directly for increasing the participation of the
Panchayats to the health services.
4.3.13 Infrastructure and Service Delivery Issues
Training and Capacity Building
Training programmes are few and are driven exclusively by the vertical health programmes of
the day, largely funded from external donors or the central government. As a result whatever trainings
are taking place are arbitrary in choice of trainees and fragmented as strategy. Most training
programmes are of one or two days and relate to a single disease and an immediate campaign for
example one day leprosy training or two days on HIV family counseling or one day on blindness
control and so on. Some persons have received many such training programmes in diverse areas while
some have received none. Then again all MPW (F) had a special round of training in RCH but neither
their supervisors nor male MPWs were exposed to this. The vertical orientation of training leads to
closely associated work of other diseases not being taught – even in much longer capability buildings.
Thus sector supervisors were training on blood smear examination for malarial parasites but doing a
differential counts on that same slide would not be emphasized.
Almost no training is based on building competencies to attain a level of clinical services in a
given facility. We therefore have a situation where there is a perception within senior officials that the
system is being flooded with training programmes. Yet the system cannot guarantee that in the sub74
DHS, Kishanganj
centres or APHC or PHC of a given district, the level of knowledge and skills needed is now available.
It may not even be able to state; facility-wise what level of skill building has been achieved and what
are the gaps.
Capacity building
Environmentally-related childhood diseases represent an enormous public health problem,
particularly in developing countries and impoverished communities, where there is often lack of
awareness and knowledge about the effects of chemicals and other environmental hazards on children’s
health.

Handbook on Children’s Environmental Health - a collection of information that focuses mainly on
the needs of developing countries.

Children’s Environmental Health (EH) for the Primary Health Care Sector – preparation of a simple
training guide and incorporation of EH concepts into existing first level health care services (e.g. into
the Integrated Management of Childhood Illnesses (IMNCI).

Training Package for Health Providers

Leaflets for health care providers - concise information on what health care professionals should
know about selected environmental risks (e.g. water pollution, lead, chemicals……)

Pilot Training Activities – for the peer review and field testing of existing materials, using a “train
the trainers” approach

Presentations given by experts, visitors.
The study recognizes that the financing or health care is an important issue and that budgetary
allocations on each facility workforce relate to outcomes. Also that what is adequate utilization or
wasteful relates to amount of investment that has gone into it. These financial aspects are the subject
matter of the subsequent study.
Mapping the private sector and exploring its possibility of synergy with the public health system
and developing a policy framework for its growth and regulation are yet another issue that we have not
addressed.
75
DHS, Kishanganj
5. Work Plan
5.1 Proposed Activities with Reference to Time Frame
To make suggested strategies and activities more accountable a model work plan has been
developed. In the matrices below, proposed activities for the performance indicators have been planned
year-wise to give a broad picture as to when the activity could happen. Besides, persons/departments
that share the responsibility for primary activities have also been broadly demarcated.
5.1.1 Work Plan for RCH
NRHM envisage to have an substantial impact on: (i) reduction in Infant Mortality Rate (IMR)
and Maternal Mortality Ratio (MMR); (ii) universal access to integrated comprehensive public health
services; (iii) child health, water, sanitation and hygiene; (iv) prevention and control of communicable
and non-communicable diseases, including locally endemic diseases; (v) population stabilization,
gender and demographic balance; (vi) revitalize local health traditions and main-stream Ayurvedic,
Yoga, Unani, Siddha and Homeopathy Systems of Health (AYUSH); (vii) promotion of healthy life
styles.
Table 5.1: Work plan for RCH
Activity
I
Objective
1
Universal coverage of all pregnant women
with package of quality ANC services as
per national guidelines
Increase in deliveries with skilled
attendance at birth including institutional
deliveries
FRUs (including DHs, PHC/APHC) made
functional as defined in the National RCH2 PIP
2
3
Time Frame (from 2009-20012) In percentage
09-10
10-11
11-12
70.0
80.0
95.0
65.0
75.0
90.0
45
65
76
Activities
1
2
3
4
5
6
7
8
9
10
11
Block level microplanning to find gaps in
infrastructure, manpower, skills &
equipments
Filling of equipment gaps
Streamlining procurement and distribution
mechanism for supplies at PHC and
APHC.
Performance incentives for staff
RCH Camps (Minimum of 2 camps per
block)
Appointment of contractual staff (ANM,
LHV and staff nurse)
Posting of specialists at PHC
Referral transport
PPP for ambulance services
PPP for EmOC centres
24 hour delivery services at PHC and
APHC
-
-
-
-
-
-
To complete
To complete
To complete
To complete
To complete
To complete
07 PHC
-
-
07 PHC
-
-
07 PHC
9 APHC
-
DH
-
-
07 PHC
-
-
76
DHS, Kishanganj
12
Training to dais/SBAs (7 day programme)
13
14
15
Motivational workshops (1 day)
Involvement of private sector/nursing
homes to improve institutional deliveries
IEC and BCC activities
II
Objective
1
Universal coverage of all eligible pregnant
women under JSY scheme
Ensuring all eligible women covered under
Janani Suraksha Yojana
2
SBA training 6
batches
07 Blocks
07 Blocks
07 Blocks
To complete
65%
80%
90%
65%
80%
90%
50%
75%
95%
90%
95%
98%
15%
15%
20%
20%
20%
20%
1.2%
15%
0.5%
10%
0.1%
5%
50%
11%
3.5%
60%
12%
5.5%
65%
15%
7%
To complete
To complete
To complete
To complete
To complete
To complete
To complete
To complete
To complete
To complete
To complete
To complete
To complete
To complete
To complete
To complete
To complete
To complete
To complete
To complete
To complete
To complete
To complete
To complete
III Objective
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
Increase in percentage of new born babies
given colostrums
Increase in prevalence of exclusive breastfeeding
Percentage of severely malnourished
children below 6 years referred to medical
institutions
Strengthen referral network
Orientation of AWWs, SHG women and
ASHA on importance of breast feeding (1
day)
Workshop on provision of low cost
nutritious food to AWWs, SHG women
and ASHA (1 day)
Workshop on gender related sensitization
to MOs (2 day)
Reorientation training to service providers
IEC for behaviour change of community
Unmet demand for contraception
- Total
- Spacing
- Limiting
Increasing Number of government health
institutions providing
i) Female sterilization services
ii) Male sterilization services
iii) IUD insertion services
Compensation on sterilization
Organization of Cu-T insertion camp
Organization of sterilization camps
Multi-skill training to staff/ MOs for
sterilization techniques
Procurement of laparoscopes
Social marketing of family planning
devices
Provision of Medical Termination of
Pregnancy
IEC for promotion of male and female
sterilization
77
DHS, Kishanganj
20
24
25
Training to MOs on management of
RTI/STI (3 day)
Health check up and partner treatment
camps
Adequate medicine supply for RTI/STI
management
Training on adolescent counseling (to
NGOs, paramedical staff, SHG women,
AWWs, ASHA (3 day)
Educational programmes in schools
Counseling day at block PHC/CHC
26
27
Honorarium to counselors
Establish link with private practitioners
21
22
23
To complete
To complete
To complete
To complete
To complete
To complete
To complete
To complete
To complete
To complete
To complete
To complete
Once a month
Once a
month
Once a month
1/year
1/year
1/year
Once in a month
at AWC
Once in a
month at
AWC
Once in a month at
AWC
1/year
1/year
1/year
Continous
--
Continous
1
Continous
--
1
--
--
35
70
25
NIL
3 APHC & 2
PHC
01
Continous
Sypply
0
1
Ensuring in 07
Blocks
100
15
NIL
10 APHC &
5 PHC
Continous
Sypply
2
0
Ensuring in
07 Blocks
25
11
NIL
Remaining All PHC,
APHC & HSC
-
IV Special interventions
1
2
3
PNDT campaign
Capacity Building of Staff
Strengthening working capacity of ASHA
4
7
Family health camps at district level (3
day)
HIV/AIDS compaining
Develop isolation ward for HIV/AIDS
Patient
Develop District Hospital as ART Centre.
V
Institutional strengthening
1
2
3
4
5
Repair/renovation of HSCs
Construction of new HSCs
Construction of new APHC
Construction of new PHC
Construction of Doctor’s & Staff Quarter at
PHC/APHC/HSC
Operationalization of mobile clinics
Adequacy of equipments at health centers
5
6
6
7
8
9
10
Formation of Urban Health Center
Establishment of Trauma center
Regular monitoring and evaluation at
blocks and district
Continous Sypply
Ensuring in 07
Blocks
5.1.2 Work Plan for Health Infrastructure
Functional and accountable infrastructure being an essential prerequisite for an effective health
delivery system a set of strategies has been neatly designed taking into consideration already existing
infrastructure and the possible constraints.
Table 5.2: Work Plan for Health Infrastructure
Activity
Time Frame (from 2009-2012)
09-10
10-11
11-12
78
Responsibilities
DHS, Kishanganj
Activity
1
Finish training of ASHA
2
Monitoring of working
capacity of ASHA
Increase incentives for ASHA
working in difficult areas
Selection of members
3
4
5
6
7
8
5
10
11
12
13
14
15
10
17
18
15
20
Orientation of selected
members
Guidelines for functioning of
committees
Provide government building
to existing sub centres
Construction of new sub
centres
Filling up vacant posts for
ANM and MPW at subcentres
Additional ANM at subcentre
Grant for maintenance and
contingency at sub-centre
level
Infrastructural set-up for
PHC
Recruitment of specialists
(gynecologist, surgeon,
pediatrician and anesthetist)
Contractual appointment of
staff nurse and LTs
Provision of electricity, water
supply and staff quarters at
APHC
Deployment of medical
doctors at PHC level
Repair and maintenance of
equipments
Specialized management
training (for BMOs, DPOs
and DPM)
Specialized communication
training (for BEEs, NGOs &
media officers)
Awareness generation
training for health workers,
link workers, ICDS workers,
SHG leaders and PRI
members
Time Frame (from 2009-2012)
09-10
10-11
11-12
Responsibilities
Civil Surgeon,
MOIC
Civil Surgeon,
MOIC
Civil Surgeon,
MOiC
350
2376
2376
To complete
To complete
To complete
Ensuring in
6 blocks
Ensuring in
6 blocks
Ensuring in
6 blocks
HMS
formed in
all PHC
HMS
formed in
all PHC
To complete
-
-
To complete
-
To complete
-
50
50
39
Civil Surgeon
100
100
25
Civil Surgeon
To complete
To complete
To complete
Civil Surgeon
To complete
To complete
To complete
MOiC
To complete
To complete
To complete
MOiC
-
Civil Surgeon
-
Deputy
Commissioner,
Civil Surgeon
-
-
Civil Surgeon,
MOIC
Civil Surgeon,
MOIC
Civil Surgeon,
MOIC
DHS
-
-
-
DHS
-
-
-
Civil Surgeon
-
-
-
MOIC
-
-
-
State Training
Co-ordinator
-
-
-
State Training
Co-ordinator
-
-
-
State Training
Co-ordinator
79
DHS, Kishanganj
Activity
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
Time Frame (from 2009-2012)
09-10
10-11
11-12
Multiskilling training for
paramedical staff
Refresher training course for
ANMs
Selection of members for
VHSC
Establishment of guidelines
for functioning of committee
Interaction between MPWs/
ANMs, AWWs and ASHA
Development of guidelines
-
-
State Training
Co-ordinator
State Training
Co-ordinator
Civil Surgeon,
MOIC
Civil Surgeon,
MOIC
Civil Surgeon,
MOIC
Civil Surgeon
MOIC
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
Once a
month
Once a
month
Once a
month
MOiC
Once a
month
Once a
month
Once a
month
MOiC
-
-
-
-
-
-
Ensuring
Supply in
07 Blocks
Ensuring
Supply in
07 Blocks
Ensuring
Supply in 07
Blocks
Civil Surgeon
-
-
-
Deputy
Commissioner,
Civil Surgeon
To complete
-
-
Civil Surgeon
To complete
To complete
To complete
To complete
To complete
To complete
Ensuring
Supply in
07 Blocks
Ensuring
Supply in
07 Blocks
Ensuring
Supply in 07
Blocks
Appointment of AYUSH
practitioners at PHC/PHC
Integration with private
doctors at village level
Assessment of
communication needs in the
context of NRHM
Use of print media, folk
media, T.V. and radio
Financial planning for
reaching of supplies at
various levels
-
-
Regular monitoring and
reporting system for used
grant
Appointment of staff
Availability of conveyance
Adequate equipments and
medicines
Monthly meeting conducted
at sub-centre level
Meeting at PHC level to
review problems related to
health delivery mechanism
Organization of training as
per state guidelines
District level training of MOs
for managerial skills and
EmOC
Well established supply chain
-
Responsibilities
5.1.3 Work Plan for Child Immunization
Table 5.3 Work plan for child immunization
80
Civil Surgeon
MOIC
Deputy
Commissioner,
Civil Surgeon
Civil Surgeon
Civil Surgeon,
MOiC
Civil Surgeon
Civil Surgeon
Civil Surgeon
Civil Surgeon
Civil Surgeon
DHS, Kishanganj
Activity
2
Cold chain maintenance for
quality assurance of
vaccine
Improving transport
system
3
Monitoring mechanism for
adequate supply
1
5
6
7
8
9
10
11
12
13
Organization of weekly
immunization day at subcenter
Fill-up vacant post of
ANMs
Pulse polio immunization
camps
Catchup round for routine
immunization
Close coordination between
ANM, AWW and ASHA
Safe injection practices
(provision of disposable
syringes)
Identification of areas with
low immunization
coverage
Involving AWWs, NGOs,
ASHA and Panchayat on
immunization day
Orientation and awareness
generation training for
health workers
Time Frame (from 2009-2012)
09-10
10-11
11-12
Ensuring
Supply in
7 Blocks
Ensuring
in 7
Blocks
Ensuring
in 7
Blocks
Ensuring
in 7
Blocks
Responsibilities
Ensuring
Supply in 7
Blocks
Ensuring
Supply in 7
Blocks
Civil Surgeon,
MOiC
Ensuring in
7 Blocks
Ensuring in 7
Blocks
Civil Surgeon,
MOiC
Ensuring in
7 Blocks
Ensuring in 7
Blocks
Ensuring in
7 Blocks
Ensuring in 7
Blocks
Civil Surgeon,
MOiC
Civil Surgeon,
MOiC
Deputy
Commissioner,
Civil Surgeon
Civil Surgeon,
MOiC
-
-
-
-
-
-
-
-
-
Civil Surgeon
Ensuring
in 7
Blocks
Ensuring in
7 Blocks
Ensuring in 7
Blocks
MOiC
Ensuring
in 7
Blocks
Ensuring in
7 Blocks
Ensuring in 7
Blocks
MOIC
Ensuring
in 7
Blocks
Ensuring in
7 Blocks
Ensuring in 7
Blocks
MOIC
Ensuring
in 7
Blocks
Ensuring in
7 Blocks
Ensuring in 7
Blocks
MOIC
Ensuring
in 7
Blocks
Ensuring in
7 Blocks
Ensuring in 7
Blocks
MOIC
5.1.4 Work Plan for Kala- azar under NVBDCP
Table 5.4: work plan for Kala - Azar Control
Activity
1
2
3
Use of video display,
posters, pamphlets,
booklets, wall painting and
street plays
Coordination with school
education
Fortnightly door to door
surveillance by health
worker
Time Frame (from 2009-20012)
09-10
10-11
11-12
Responsibilities
To complete in
each block
To complete
in each
block
To complete
in each
block
District Malaria
Officer
To complete in
each block
To complete
in each
block
To complete
in each
block
District Malaria
Officer
-
-
-
District Malaria
Officer
81
DHS, Kishanganj
Activity
4
5
6
7
8
9
10
11
12
Increase blood smear
collection
Transportation of slides
from collection point to
laboratory on daily basis
Functional laboratory at
PHC/PHC level
Blood examination center at
each block
Appointment of lab
technicians
Insecticidal sprays at high
risk areas
Promotion of Gambuzia
culture
Distribution of medicated
mosquito nets
Acceptance/ treatment of
usage of herbal medicine
Time Frame (from 2009-20012)
09-10
10-11
11-12
Responsibilities
-
-
-
Civil Surgeon,
District Malaria
Officer
-
-
-
District Malaria
Officer
-
-
-
Civil Surgeon
-
-
-
Civil Surgeon
-
-
-
Civil Surgeon
To complete in
each block
To complete
in each
block
To complete
in each
block
District Malaria
Officer
-
-
-
-
-
-
Ensuring in 7
Blocks
Ensuring in
7 Blocks
Ensuring in
7 Blocks
District Malaria
Officer
District Malaria
Officer
Civil Surgeon
5.1.5 Work Plan for RNTCP
Table 5.5: Work plan for TB control
Activity
1
2
3
4
5
6
7
8
5
Interpersonal
communication by local
health workers, NGOs and
Panchayat
Use of posters, pamphlets,
wall paintings and street
plays
Increase awareness of
DOTS
Time Frame (from 2009-20012)
09-10
10-11
11-12
Responsibilities
Ensuring in 7
Blocks
Ensuring in 7
Blocks
Ensuring in
7 Blocks
DTO, MOiC
Ensuring in 07
Blocks
Ensuring in 07
Blocks
Ensuring in
07 Blocks
DTO, MOiC
Disseminatio
n on VHN
day
Disseminatio
n on VHN
day
Disseminati
on on VHN
day
Ensuring in 07
Blocks
Ensuring in 07
Blocks
Ensuring in
07 Blocks
Involvement of private
practitioners
Promote case detection
through sputum
microscopy
Complete treatment
Ensuring in 07
Blocks
Ensuring in 07
Blocks
Ensuring in
07 Blocks
DTO , MOIC, BHM
Ensuring in 07
Blocks
Ensuring in 07
Blocks
Ensuring in
07 Blocks
DTO , MOIC, BHM
Ensuring in 07
Blocks
Ensuring in 07
Blocks
Ensuring in
07 Blocks
DTO, MOIC, BHM
Increase accessibility to
treatment
Follow-up examination to
Ensuring in 07
Blocks
Ensuring in 07
Blocks
Ensuring in
07 Blocks
DTO , MOIC, BHM
Ensuring in 07
Ensuring in 07
Ensuring in
DTO , MOIC, BHM
Community participation
82
Health Worker,
ICDS, NGO, PRI,
Education
Department
Health Worker,
ICDS, NGO, PRI,
Education
Department
DHS, Kishanganj
Activity
10
11
12
13
14
15
10
achieve sputum conversion
Establishment of TB cells at
block level
Quality assurance of
sputum smear
Regular and uninterrupted
supply of drugs
Systematic monitoring and
evaluation
Appointment of field staff
Training to DOTS
providers
Sensitization training to
MOs providing treatment
at block level
Time Frame (from 2009-20012)
09-10
10-11
11-12
Responsibilities
Blocks
Blocks
07 Blocks
Ensuring in 07
Blocks
Ensuring in 07
Blocks
Ensuring in
07 Blocks
DTO , MOIC, BHM
Ensuring in 07
Blocks
Ensuring in 07
Blocks
Ensuring in
07 Blocks
DTO , MOIC, BHM
Ensuring in 07
Blocks
Ensuring in 07
Blocks
Ensuring in
07 Blocks
DTO , MOIC, BHM
Ensuring in 07
Blocks
Ensuring in 07
Blocks
Ensuring in
07 Blocks
DTO , MOIC, BHM
Ensuring in 07
Blocks
Ensuring in 07
Blocks
Ensuring in
07 Blocks
Civil Surgeon,
DTO, MOIC
Refresher
Training
-
-
Civil Surgeon, DTO
-
Refresher
Training
-
Civil Surgeon, DTO
5.1.6 Work Plan for NBCP
Table 5.6: Work plan for Blindness control
Activity
1
2
3
4
Organization of eye camps in
collaboration with private
agencies/ institutions
Integrate eye care as a part of
primary health care
Availability and repair of
necessary equipments
Posting of eye-surgeon at
block level
Follow-up of treated cases
5
6
7
8
9
10
Quality control mechanism
Streamlined vitamin-A
supply
Availability of medicines
during eye camps
Sensitization work Shop at
block level for MOs and
health workers
Technical training of
ophthalmic medical assistants
at district for skill up-
Time Frame (from 2009-20012)
09-10
10-11
11-12
Thrice at
Thrice at
Thrice at block
block
block level
level
level
Responsibilities
DTO , MOIC,
BHM
-
-
-
Ensuring in
07 Blocks
Ensuring
in 07 Blocks
Ensuring in 07
Blocks
DBO, MOiC,
DPM
-
-
-
Civil Surgeon
Regular
Monitoring at
each block
Regular
Monitoring
at each
block
Regular
Monitoring at
each block
DTO , MOIC,
BHM
-
-
-
Ensuring in
07 Blocks
Ensuring
in09 Blocks
Ensuring in 07
Blocks
MOIC, DBO
DBO, MOIC,
DPM
Strenghthen
procurement
& Supplies
Strenghthe
n
procureme
nt &
Supplies
Strenghthen
procurement &
Supplies
CIVIL
SURGEON,
DBO, BHM
07 (once at
each block)
07 (once at
each
block)
07 (once at
each block)
DBO, MOIC,
BHM
-
-
-
CS, DBO,
83
DHS, Kishanganj
Activity
11
12
13
Time Frame (from 2009-20012)
09-10
10-11
11-12
gradation and new
techniques
Behaviour change of
community to increase
treatment acceptance
Interpersonal communication
by health workers and ICDS
workers
Use of print media, mass
media and folk media
Responsibilities
-
-
-
CS, DBO, DPM
-
-
-
DBO, DPM, MO
I/C, BHM
-
-
-
DBO, MO I/C,
BHM
5.1.7 Work Plan for NLEP
Table 5.7: Work plan for Leprosy eradication
Activity
1
2
Recruitment of field staff
Orientation training of new staff
3
4
Updating records
Increase case detection and
referral for treatment
Case validation and reregistration
Organization of POD camps
Organization of Skin Disease
Diagnosis, Treatment &
Education Camps in remote and
inaccessible areas
Urban leprosy awareness camps
Procurement of IEC equipments
Sensitization workshop for
panchayat members to motivate
them for community education
Proper counseling by health
worker and MOs to prevent
deformities
Sensitize community for self
reporting
Sensitization workshop at gram
Panchayat
Community mobilization through
interpersonal communication,
print media and folk media (in
local dialect)
Provide personal support and
psychological assurance
5
6
7
8
5
10
11
12
13
14
Time Frame (from 2009-20012)
09-10
10-11
One training
programme
One training
programme
Responsibilities
11-12
One training
programme
DLO, DA
-
-
-
CS, DLO
-
-
-
MO I/C, DLO
-
-
-
-
-
-
MO I/C, DLO
-
-
-
CS, DLO
CS, DLO
07 (once at
each block)
-
-
CS, DLO
07 (once at
each block)
07 (once at
each block)
07 (once at
each block)
CS, DLO
-
-
-
DLO, MEO
-
-
-
CS, DLO DPM,
BHM
-
-
-
CS, DLO DPM,
BHM
-
-
-
DLO
6. Monitoring and Evaluation
6.1 Introduction
84
DHS, Kishanganj
Monitoring and Evaluation is a key and integral part of NRHM and systems are in place at each
level to ensure the monitoring for smooth progress. The Mission Steering Group (MSG) has been set up
at the Center and further the Empowered Programme Committee has also been set up to monitor the
progress. The various societies at the state and the district level have been merged into an Integrated
Society at the state level where it is the executive arm of the State Health Mission.
Monitoring and Evaluation plan would help in providing an overview of progress that has to be
addressed during monthly review meetings held at different levels of the health system. It is strongly
recommended that all activities are monitored and integrated at different levels of the health system to
address the specific NRHM requirements and collated into a single format. As the aim is to ultimately
institutionalize quality assessment in routine monitoring, the performance evaluation mechanism will
mostly rely on ongoing monthly reports, progress report concurrent and mid-term and end-line
surveys.
In line with the objective set and work plan finalized, subsequent section details out the monitoring and
evaluation indicators in matrix form for each programmatic area.
6.1.1 Monitoring and Evaluation Matrix for Health Infrastructure
Activity
Strategy 1: Training of ASHA
Finish training of ASHA
Monitoring of ASHA
Strategy 2: Establishment of HMS
Selection of members
Indicator
Number of ASHA trained
Monitoring mechanism in place
DPMU Report
DPMU Report
opening of bank accounts for HMS
members Development and acceptance
of model MOU Meetings of CPS/ HMS/
HMS
DPMU Report
Strategy 3: Functioning of HMS
Clear guidelines for working of
Guideline formulated and
HMS
Number of HMS members oriented
Number of orientation/ training session
Guidelines for expenditure of
held
maintenance grant
Orientation and training of elected
HMS members
Strategy 4: Upgradation of health institutions
Provide government building to
Number of sub centres to be
existing sub centres
provisioned in government building
Construction of new sub centres
Number of sub centre constructed
Filling up vacant posts for ANM and
MPW at sub-centres
Means of
verification
Number of ANM and MPW recruited
85
DPMU Report
DPMU Report/CMO
Report /Health MIS
DPMU Report/CMO
Report /Health MIS
Health MIS/DPMU
Report
DHS, Kishanganj
Activity
Indicator
Additional ANM at sub-centre
Number of additional ANM recruited at
sub centre
Grant for maintenance and
Grants for maintenance and
contingency at sub-centre level
contingency level provided at subcentre level
Infrastructural set-up for PHC
Number of PHC Strengthened
Recruitment of specialists
Number of specialists recruited
(gynecologist, surgeon, pediatrician
(gynecologist, surgeon, pediatrician and
and anesthetist)
anesthetist)
Contractual appointment of staff
Number of LTs appointed on
nurse and LTs
contractual basis
Provision of electricity, water supply Number of APHC wherein provision of
and staff quarters at APHC
electricity, water supply and staff
quarters are made
Strategy 3: Human resource development
Specialized management training
Number of management training
(for BMOs, DPOs and DPM)
programme organized for BMOs, DPOs
and DPM
Specialized communication training
Number
of
training
programme
(for BEEs, NGOs & media officers)
organized for BEEs, NGOs & media
officers
Awareness generation training for
Number of awareness generation
health workers, link workers, ICDS
training organized for health workers,
workers, SHG leaders and PRI
link workers, ICDS workers, SHG
members
leaders and PRI members
Multiskilling training for
Number of paramedical staff trained
paramedical staff
Refresher training course for ANMs
Number of refresher training course for
ANMs
Strategy 5: Constitution of Village Health and Sanitation Committees
Guidelines for VHSC
Number of HMS members oriented
Strategy 5: Integration with ASHA programme
Interaction between MPWs/ANMs,
Number of meetings held between
AWWs and ASHA
MPWs/ANMs, AWWs and ASHA
Strategy 6: Directions for use of maintenance grant at each level
Development of guidelines
Guidelines developed and formed
Regular monitoring and reporting
Regular monitoring and reporting
system for used grant
system in place
Strategy 7: Organization of community meeting
Monthly meeting conducted at subNumber of monthly meeting organized
centre level
a sub centre level
Meeting at PHC level to review
Meetings organized at the PHC level
problems related to health delivery
mechanism
Strategy 8: Formulation of district training plan
Recognition of need of trainings
Training need identified
Organization of trainings as per state Number of training organized
guidelines
Refresher training of paramedics on
Number of paramedics trained
minor ailments
86
Means of
verification
Health MIS/DPMU
Report
Health MIS/DPMU
Report
Health
MIS/Training Plan
DPMU Report
Health MIS/MOs
Report
CMO office Report
DPMU/Block MOs
Report
DPMU Report/CMO
Report /Health MIS
DHS, Kishanganj
Activity
Indicator
Training of MOs for managerial
Number of MO’s, ANM identified
skills, EmOC
Training of ANMs for ANC, DOTS
Strategy 5: Formulation of district BCC plan
Assessment of communication needs Assessment of communication needs
in the context of NRHM
Strategy10: Streamlined procurement and logistic supply plan
Financial planning for reaching of
Financial Plan at each level in place
supplies at various levels
Well established supply chain
Establishment of supply chain
Strategy 11: Coordination with private practitioners/ institutions
Appointment of AYUSH
Number of AYUSH physicians relocated
practitioners at PHC/PHC
and appointed
Integration with private
Number of private practitioners
doctors/ISMP at village level
involved
Means of
verification
DPMU Report/CMO
Report /Health MIS
DPMU Report
DPMU Report
DPMU Report
6.1.2 Monitoring and Evaluation Matrix for Immunisation
Activity
Indicator
Strategy1: Streamlining cold chain system
Cold chain maintenance for
Institution wherein cold chain is
quality assurance of vaccine
established and streamlined
Strategy 2: Logistics of vaccine and disposable supply
Improving transport system
Transportation system improved
Monitoring mechanism for
Monitoring mechanism in place
adequate supply
Strategy 3: Strengthening service delivery
Organization of weekly
Number of weekly immunization day at
immunization day at sub-center
sub-center
Fill-up vacant post of ANMs
Number of ANMs recruited on
contractual basis
Pulse polio immunization camps
Number of pulse polio immunization
camp organized
Catchup round
Number of catch up round organised
Close coordination between ANM,
AWW and ASHA
Cordination meeting organized and
grievance addressed between ANM,
AWW and ASHA
Strategy 4: IEC for behaviour change of community
Identification of areas with low
Number of low immunization coverage
immunization coverage
area
Involving AWWs, NGOs, ASHA
Number of AWWs, NGOs, ASHA and
and panchayat on immunization
panchayat involved on immunization day
day
Orientation and awareness
Number of orientation and awareness
generation training for health
generation training for health workers
workers
87
Means of verification
Logistic Plan/MIS
CMO office Report/
Nodal officers Report
CMO office Report/
Nodal officers Report
Monthly Progress
Report/Health MIS
Monthly Progress
Report/Health MIS
Monthly Progress
Report/Health MIS
Monthly Progress
Report/Health MIS
Block MO’s Report
DPMU Report/Health
MIS
DHS, Kishanganj
6.1.3 Monitoring and Evaluation Matrix for Vector Borne Disease Programme
Activity
Strategy1: IEC activities
Use of video display, posters, pamphlets,
booklets, wall painting and street plays
Coordination with school education
Indicator
Means of
verification
Number of video display, posters
,pamphlets and street plays
organized
Number of school involved as part
of school education
Health
MIS/Communicatio
n Plan
Strategy 2: Increased surveillance
Fortnightly door to door surveillance by
health worker
Number of door to door surveillance
programme organized by health
worker
Strategy 3: Early diagnosis and prompt treatment
Increase blood smear collection
Percentage increase in blood smear
collection
Transportation of slides from collection
Percentage increase in slides
point to laboratory on daily basis
transported from collection point to
laboratory on daily basis
Strategy 4: Strengthening laboratory facilities
Functional laboratory at PHC/PHC level
Number of functional laboratory at
PHC/PHC level
Blood examination center at each block
Blood examination centre
established
Appointment of lab technicians
Number of lab technicians
appointed
Strategy 5: Preventive measures to reduce chances of outbreak
Insecticidal sprays at high risk areas
Proportion of high risk areas having
insecticidal sprays
Distribution of medicated mosquito nets
Number of medicated mosquito nets
Distributed
Strategy 6: Integration with ISM practitioners
Acceptance/ treatment of usage of herbal
Proportion of members accepting
medicine
herbal medicine
Health MIS/Nodal
officers Report
Health MIS/Nodal
officers Report
Malaria Programme
Plan Report
Health Survey
6.1.4 Monitoring and Evaluation Matrix for NTCP
Activity
Strategy 1: Sensitization of
community through IEC activities
Use of posters, pamphlets, wall
paintings and street plays
Indicator
Number of posters, pamphlets, wall
paintings and street plays
conducted/displayed
Increase awareness of DOTS
Proportion of community members
aware of DOTS
Strategy 2: Increasing referral from grass root to health institutions
Community participation
Proportion of community members
involved
Involvement of private practitioners
Number of private practioners
involved
Strategy 3: Treatment strengthening
88
Means of verification
Health MIS
Survey Report
Health Survey
Health MIS
DHS, Kishanganj
Activity
Complete treatment
Indicator
Number of cases completed
treatment
Number of cases followed up
Follow-up examination to achieve
sputum conversion
Strategy 4: Infrastructural strengthening
Establishment of TB cells at block
TB cells established at block level
level
Regular and uninterrupted supply of Number of days drug was stocked
drugs
out
Systematic monitoring and
Monitoring and evaluation plan
evaluation
finalized
Appointment of field staff
Number of field staff appointed
Training to DOTS providers
Number of DOTS provider trained
Sensitization training to MOs
Number of training session
providing treatment at block level
organised at the block level
Means of verification
RNTCP Report/MIS
RNTCP Report/ Health
MIS/Logistic Plan
6.1.5 Monitoring and Evaluation Matrix for Blindness Control Programme
Activity
Strategy 1: Outreach activities
Organization of eye camps in collaboration
with private agencies/ institutions
Strategy 2: Strengthening service delivery
Posting of eye-surgeon at block level
Follow-up of treated cases
Integrate eye care as a part of primary health
care
Availability and repair of necessary
equipments
Strategy 3: Adequate drug/vaccine supply
Streamlined vitamin-A supply
Indicator
Number of eye camp organized in
collaboration with private agencies/
institutions
Number of eye surgeon recruited
Number of cases followed up
Institutions who integrated eye care
as a part of primary health care
Number of equipments repaired
No of days Vitamin A has been out
of stock
Availability of medicines during eye camps
Number/Type of Medicine being
supplied at eye camp
Strategy 4: Capacity building of human resources
Sensitization Workshop at block level for
Number of sensitization work
MOs and health workers
organized at block level for MOs
and health workers
Technical training of ophthalmic medical
Number of ophthalmic medical
assistants at district for skill up-gradation
assistants at district trained for skill
and new techniques
up-gradation and new techniques
Strategy 5: IEC for public awareness on eye care
Behaviour change of community to increase
Number of community members
treatment acceptance
who showed positive behavioral
change
Interpersonal communication by health
Proportion of community members
workers and ICDS workers
contacted health workers and ICDS
workers
89
Means of
verification
BCP Report/Health
MIS
CMO Office
Report/DPMU/Healt
h MIS
Health MIS/Logistic
plan Report
Health MIS/DPMU
Report
DPMU/Communicati
on deptt. report
DHS, Kishanganj
6.1.6 Monitoring and Evaluation Matrix for NLEP
Activity
Strategy1: Surveillance for case detection
Recruitment of field staff
Orientation training of new staff
Updating records
Strategy 2: Strengthen service delivery
Increase case detection and referral for
treatment
Case validation and re-registration
Organization of POD camps
Organization of Skin Disease Diagnosis,
Treatment & Education Camps in remote
and inaccessible areas
Urban leprosy awareness camps
Strategy 3: Collaboration with PRI
Sensitization Workshop for panchayat
members to motivate them for community
education
Strategy 4: Prevention of disability and
rehabilitation
Proper counseling by health worker and
MOs to prevent deformities
Sensitize community for self reporting
Strategy 5: IEC to mitigate stigma
Sensitization Workshop at gram panchayat
Community mobilization through
interpersonal communication, print media
and folk media (in local dialect)
Orgination of Trainings as state guideline
Indicator
Number of field staff recruited
Number of new staff oriented
Proportion of records updated
LCP Nodal officers
Report/Health MIS
Number of cases detected and
referred
Number of cases validated and reregistered
Number of POD camps organized
Number of Skin Disease Diagnosis,
Treatment & Education Camps in
remote and inaccessible areas
Number of Urban leprosy
awareness camps organised
LCP Nodal officers
Report/Health MIS
Number of Workshop organized for
panchayat members to motivate
them for community education
Health MIS
Proportion of cases counseled by
health worker and MOs
Proportion of community members
sensitized
Number of Workshop organized at
gram panchayat level
Reach of IEC activity i.e.
interpersonal communication, print
media and folk media (in local
dialect)
No. of Training Organised
9. List of Abbreviations
AIDS
ANC
ANM
APHC
APL
ARSH
ASHA
AWC
Means of
verification
Acquired Immune Deficiency Syndrome
Ante Natal Care
Auxiliary Nurse Midwife
Additional Primary Health Centre
Above Poverty Line
Adolescent Reproductive and Sexual Health
Accredited Social Health Activist
Anganwadi Centre
90
Block MOs Report
Health MIS
Health MIS/ lCP
Report/Communicat
ion division
DPMU Report/
DHS, Kishanganj
AWH
AWW
AYUSH
BCC
BDC
BPL
CBO
CDPO
CHC
CMO
DDC
DAP
DF
DH
DHAP
DLHS
DOTS
EmOc
FGD
FRU
FTD
GP
HMS
HMIS
ICDS
IDSP
IEC
ILR
IOL
IUD
IPHS
LHV
MDT
MMU
MOIC
MPW
MSG
NBCP
NGO
NLEP
NRHM
NVBDCP
PHC
Anganwadi Helper
Anganwadi Worker
Ayurveda, Yoga & Naturopathy, Unani, Siddha and Homeopathy
Behaviour Change Communication
Block Development Committee
Below Poverty Line
Community Based Organization
Child Development Project Officer
Community Health Centre
Chief Medical Officer
Drug Distribution Centre
District Action Plan
Deep Freezers
District Hospital
District Health Action Plan
District Level Household Survey
Directly Observed Treatment Short-course
Emergency Obstetric Care
Focus Group Discussion
First Referral Unit
Fever Treatment Depot
Gram Panchayat
Health Management Society
Health Management Information Systems
Integrated Child Development Services
Integrated Disease Surveillance Project
Information Education And Communication
Ice-lined Refrigerators
Intra-Ocular Lens
Intra-uterine Devices
Indian Public Health Standards
Lady Health Visitor
Multi Drug Therapy
Medical Mobile Unit
Medical Officer In-Charge
Multi Purpose Worker
Mission Steering Group
National Blindness Control Programme
Non Government Organization
National Leprosy Eradication Programme
National Rural Health Mission
National Vector Borne Disease Control Programme
Primary Health Centre
91
DHS, Kishanganj
PPC
PRI
RCH
RKS
RNTCP
RTI
SC
SC/ST
SHG
SNP
STI
TB
TOT
UFWC
VHC
VHSC
ZP
Post Partum Centres
Panchayati Raj Institution
Reproductive And Child Health
Rogi Kalyan Samiti
Revised National Tuberculosis Control Programme
Reproductive Tract Infections
Sub-centre
Scheduled Caste/ Scheduled Tribe
Self Help Group
Supplementary Nutrition Programme
Sexually Transmitted Infections
Tuberculosis
Training of Trainers
Urban Family Welfare Centre
Village Health Committee
Village Health and Sanitation Committee
Zila Parishad
92
DHS, Kishanganj
NRHM-PART-A
First Quarterly Allocation 2011-12
Sl.
No.
FMR
Code
Particulars
QTR- 1
QTR- 2
QTR-3
QTR-4
TOTAL
Maternal Health
A.1.1.1
Operationalise Facilities
36000.00
36000.00
36000.00
36000.00
144000.00
A.1.1.1
Operationalise Blood Storage units in
FRU
246000.00
246000.00
246000.00
246000.00
984000.00
A.1.1.4
RTI/STI Services at health facilities
0.00
50000.00
0.00
0.00
50000.00
A.1.1.4.1
RTI/STI
srvices
at
facilities(Equipments
PHC@25000/District@50000
0.00
150000.00
75000.00
225000.00
A.1.1.5
Operationalise Sub-centres
2
A.1.3.1
RCH Outreach Services in un-served/
under-served areas (monitoring)
4
1.3.2
Monthly Village Health & Nutrition Days
6
A.1.4.1
Home deliveries
8
A.1.4.2.1
Rural
9
A.1.4.2.2
Urban
10
A.1.4.2.3
Caesarean Deliveries
A.1.4.2.4
1
11
health
for
340000.00
40000.00
40000.00
25000.00
50000.00
25000.00
100000.00
10000000.00
10000000.00
19250000.00
19250000.00
58500000.00
1080000.00
1080000.00
1440000.00
1440000.00
5040000.00
75000.00
75000.00
112500.00
112500.00
375000.00
Accreditation of private medical college
2400000.00
2400000.00
2400000.00
2400000.00
9600000.00
A.1.4.3
Other Activities (JSY)
337500.00
337500.00
337500.00
337500.00
1350000.00
A.1.5.1
1.5.1 Maternal Death Audit 1.1.3
Survey on maternal and perinatal
deaths by verbal autopsy method
(in two districts) @ 850 per death
170000.00
14384500.00
170000.00
14954340.00
170000.00
24232000.00
212500.00
24174500.00
722500.00
77745340.00
30000
30000
55000
55000
170000.00
20000
20000
20000
20000
80000.00
Sub Total (Maternal Health)
40000.00
40000.00
340000.00
154840.00
160000.00
154840.00
Child Health
12
A.2.1
IMNCI
13
A.2.2
Facility based Newborn Care/FBNC
14
A.2.4
School Helath Programme
0
0
1187694
2000000
3187694.00
A.2.6
Care of Sick children and Severe
Malnutrition
826270
615000
615000
615000
2671270.00
A.2.7
Management of Diarrhoea, ARI and
Micronutrient Malnutrition
118675
0
118675
0
237350.00
A.2.7.1
Mobility support to RCH Officers
15
16
Sub Total (Child Health)
75000
75000
75000
75000
300000.00
994945.00
665000.00
1996369.00
2690000.00
6346314.00
Family Planning
A.3.1.1
Dissemination of manuals on sterilisation
standards & Quality assurance of
sterilisation services
A.3.1.1.1
Family planing councelor
A.3.1.1.2
Mobility support and TA/DA
A.3.1.1.3
Training for mamata and ASHA
18
A.3.1.2
Female sterilisation camp
19
A.3.1.3
NSV camps
20
A.3.1.4
Compensation for female sterilisation
21
A.3.1.5
Compensation for male sterilisation
22
A.3.1.6
Accreditation of pvt.
sterilisation services
24
A.3.2.1
IUD Camps
17
44000.00
44000.00
72000.00
Provider
0.00
for
72000.00
72000.00
12000.00
216000.00
12000.00
12000.00
540000.00
540000.00
120000.00
120000.00
120000.00
30000
110000
110000
250000.00
1000000.00
444000.00
3000000.00
3000000.00
7444000.00
75000
75000
75000
75000
300000.00
1125000.00
1125000.00
1125000.00
1125000.00
4500000.00
45000.00
45000.00
45000.00
45000.00
180000.00
93
36000.00
1080000.00
140000.00
500000.00
REMARKS
DHS, Kishanganj
25
A.3.2.2
IUD
services
facilities/compensation
at
26
A.3.2.5
Contraceptive Update Seminars
27
A.3.3
POL for Family Planning/ Others
Health
28750.00
28750.00
28750.00
28750.00
115000.00
25000.00
50000.00
75000.00
75000.00
225000.00
2462750.00
2541750.00
5202750.00
4682750.00
14890000.00
0.00
Sub Total (Family Planing)
Innovations/PPP/NGO
30
A.8.1
PNDT and Sex Ratio
31
A.8.2
Public Private Partnerships(Chiranjeevi
Scheme)
32
A.8.4
145000.00
145000.00
Other innovations(if any)
Sub Total (Innovations/PPP/NGO)
0.00
145000.00
0.00
0.00
145000.00
Infrastructure & Human Resource
33
A.9.1.2
Laboratory Technicians (BSU)
189000.00
189000.00
189000.00
189000.00
756000.00
34
A.9.1.3
Staff Nurse
1584000.00
1584000.00
1584000.00
1584000.00
6336000.00
35
A.9.1.4
Medical
Officers
and
Specialists
(Anaesthetists, Paediatricians, Ob/Gyn,
Surgeons, Physicians)
210000.00
210000.00
210000.00
210000.00
840000.00
36
A.9.1.5
3. Honorarium of voluntary workers
9.1.5.1
Contracutal Para MedicalStaff
(1) Sanitary/Health Inspector
(2)Pharmacist
(3)Dresser
37
A.9.1.6
Incentive for ASHA & ANM for Muskan
Ek Abhiyaan
39
A.9.3.2
Minor Civil Works for operationalisation
of 24 hour services at PHCs
A.9.4
Operationalise
IMEP
at
facilities(Bio-Wast Management)
40
0.00
96000.00
96000.00
96000.00
96000.00
384000.00
675000.00
675000.00
675000.00
675000.00
2700000.00
270000.00
270000.00
270000.00
270000.00
1080000.00
1593900.00
1593900.00
1593900.00
1593900.00
6375600.00
0
1350000
0
0
1350000.00
4617900.00
5967900.00
4617900.00
4617900.00
19821600.00
health
Sub Total (Infrastructure & Human Resurce)
0.00
Institutional Strenthening
A.10.3.1
Upgradation & Maintenance of Web
Server
25000
A.10.3.2
HMIS HR
36000
42
A.10.3.3
Printing of Revised HMIS Formats
prescribed under NRHM
43
A.10.3.4
HMIS Training
44
A.10.3.5
Mobility for M&E Officers
4800.00
4800.00
4800.00
4800.00
19200.00
A.10.4
Sub Center Rent/Contingency
32000.00
32000.00
32000.00
33000.00
129000.00
97800.00
239970.00
72800.00
73800.00
484370.00
264330.00
264330.00
264330.00
264330.00
1057320.00
251850.00
251850.00
167900.00
167900.00
839500.00
Sub Total (Infrastructure & Human Resurce)
25000.00
36000
36000
36000
144000.00
4700
4700.00
162470
162470.00
11. Training
46
A.11.3.1.1
Maternal Heath Training (Skilled Birth
Attendance / SBA training in Private
facilities)
47
A.11.3.1.4
SBA Supportive Supervision
48
A.11.3.1.5
SBA in private Facilities
A.11.3.2
EmOc
Training
of
(Medical
Officers in EmOC (batchsize is 8 )
49
A.11.3.4
MTP Training
50
A.11.3.4.1
MO (MBBS)
52
A.11.5.1.2
IMNCI (TOT Trg.)
53
A.11.5.1.3
IMNCI (Health Worker Training)
0.00
50000.00
50000.00
50000.00
50000.00
0.00
808560.00
2021400.00
94
319200.00
159600.00
478800.00
2021400.00
1212840.00
6064200.00
DHS, Kishanganj
54
A.11.5.1.4
IMNCI (FOLLOW UP Training)
55
A.11.5.2
F-IMNCI and SNCU
57
A.11.6.2
Minilap Training
58
A.11.6.3
NSV Training
59
A.11.6.4
60
54860.00
54860.00
54860.00
164580.00
50000.00
50000.00
50000.00
50000.00
200000.00
70240.00
70240.00
140480.00
70240.00
351200.00
67800.00
67800.00
33900.00
169500.00
IUD Insertion Training
169450.00
169450.00
169450.00
169450.00
677800.00
A.11.7
Asha Training
9000000.00
9000000.00
9000000.00
9000000.00
36000000.00
61
A.11.8
Programe Management Training
62
A.11.8.2
DPMU Training
A.11.9
0.00
58000.00
58000.00
Other Training
Sub Total (Training)
10614430.00
12057930.00
12305420.00
2460000.00
13643120.00
2460000.00
48620900.00
200000.00
200000.00
200000.00
200000.00
200000.00
200000.00
200000.00
200000.00
800000.00
800000.00
0
274000
274000
0
548000.00
0
0
0
0
0.00
0
0
0
0
0.00
0
0
141360
0
141360.00
12. BCC/IEC
63
A.12.4
Other Activities (IEC)
Sub Total (IEC/BCC)
13. Procurement
13.1.1 Procurement of equipment
14.2. Equipments for EmOC
services for identified facilities
(PHCs, CHCs) @ Rs 1 Lac / facility /
year (in two districts - kishanganj
and jehanabad) 14.4. Equipments /
instruments for Blood Storage
Facility / Bank at facilities 14.6.
Equipments / instruments,
reagents for STI / RTI services @
Rs. 1 Lac per district per year
64
A.13.1.1
65
A.13.1.1.2
66
A.13.2
67
A.13.2.1.1
Procurement of Drug & supplies
Drugs & Supplies for MH (MVA
syringes- MTP)
A.13.2.1.2
Drugs & Supplies for MH(delivery
kits at HSC)
0
191280
0
0
191280.00
A.13.2.1.3
Drugs & Supplies for MH(SBA
Drug kits )
0
0
122480
0
122480.00
A.13.2.1.5
Drugs & Supplies for MH(IFA Tab )
0
1524602
0
0
1524602.00
A.13.2.2
0
0
0
0
0.00
A.13.2.3.1
Drygs & Supply for FP
Drugs Supplies for FP(Minilap
Sets)
0
131250
0
0
131250.00
A.13.2.3.2
Drugs Supplies for FP(NSV Sets)
0
27500
0
0
27500.00
A.13.2.3.3
Drugs Supplies for FP(IUD Kits)
0
0
75000
0
75000.00
A.13.2.5
General drugs & supplies for
health facilities
2000000
8000000
8000000
4000000
22000000.00
2000000.00
10148632.00
8612840.00
4000000.00
24761472.00
68
Strengthening Life Saving Skills for
Anesthesia
Sub Total (Procruement)
Due to
infilation
of money
the
unit cost
has been
raised for
Rs50.00
to
Rs100.00
14. Programme Management
95
District
skilled
lab 7
posting of
mobile
trainer
DHS, Kishanganj
69
A.14.2
Strenthening of District Society/DPMU
/14.2.1 Contractual Staff for DPMSU
recruited and in position
721500.00
721500.00
721500.00
721500.00
2886000.00
70
A.14.3
Strengthening of Financial Management
System
60000.00
105000.00
105000.00
80000.00
350000.00
781500.00
826500.00
826500.00
801500.00
3236000.00
36153825.00
47747022.00
58066579.00
54883570.00
196850996.00
Sub Total (Programme Management)
Grand Total
NRHM-PART-B
First Quarterly Allocation 2011-12
Sl.
No.
FMR
Code
Particulars
Qrt 1
Qrt 2
Qrt 3
Qrt 4
TOTAL
B.1Decentralization
1
B.1.12
ASHA Support system at Distrct
Level
175000.00
175000.00
175000.00
175000.00
700000.00
2
B.1.13
ASHA Support System at Block
Level
300000.00
300000.00
300000.00
300000.00
1200000.00
B.1.13.1
ASHA Support
Village Level
100000.00
176000.00
B.1.14
ASHA Trainings
423000.00
212667.00
B.1.15
ASHA
drug
Replenishment
B.1.16
Motivation of ASHA
3
System
kit
at
and
276000.00
210333.00
846000.00
3283200.00
3283200.00
991800.00
991800.00
4104000.00
4104000.00
B.1.16.1
Cycle for ASHA as Motivation
B.1.16.2
Bag for ASHA as Motivation
273600.00
273600.00
B.1.16.3
I Card For ASHA
68400.00
68400.00
B.1.18
ASHA Diwas
410400.00
410400.00
410400.00
410400.00
1641600.00
5
B.1.2
Untied fund for health sub
centre, Additional Primary
health Centre and Primar Health
Centre
1760000.00
0.00
0.00
0.00
1760000.00
6
B.1.21
Village Health ad Sanitation
Committee
8085000.00
7
B.1.22
Rogi Kalyan
Money)
14536600.00
4
Samiti
(Seed
Sub total (ASHA)
29073200.00
8085000.00
16436600.00
1900000.00
4507867.00
5199733.00
885400.00
39666200.00
2. Infrastructure Strengthening
8
11
B.2.1
Construction of HSCs(20 Nos.)
7785000.00
7785000.00
7785000.00
B.2.2
Construction of building of
APHCs where land is available
(5315000/APHCs)
15198000.00
15198000.00
15198000.00
45594000.00
B.2.2B
Construction of residential
quarters of old APHCs for staff
nurse
9000000.00
9000000.00
9000000.00
27000000.00
Upgradation of PHCs to CHCs
4000000.00
4000000.00
4000000.00
12000000.00
B.2.3
96
7785000.00
31140000.00
REMARKS
DHS, Kishanganj
12
B.2.4
Upgrading district hospitals and
Sub-Divisional Hospital as per
IPHC
13
B.2.5
Annual Maintenance Grant
14
B.2.6
Accreditation/ISO:9000
certification of Health Facilities
15
B.2.7
Upgradation of Infrastructure of
ANM Training Schools
0.00
1300000.00
1300000.00
0.00
0.00
10000000.00
B.2.7.1
Construction of ANM hostel
B.2.7.2
Boundry Wall for 7 PHCz
420000.00
420000.00
420000.00
Staff Quarter in 3 CHCs
Boundry Wall for Sadar
Hospital
Repair & Boundry of Refral
Hospital Chhatargachh
9000000.00
9000000.00
9000000.00
B.2.8
B.2.9
B.2.10
B.2.11
Construction of
Building at CHCs
Additional
B.2.12
DHS Staff Quarter (4 Unit)
Sub total (Infrastructure Strengthening)
10000000.00
4550000.00
4550000.00
210000.00
1470000.00
27000000.00
1650000.00
5000000.00
1650000.00
5000000.00
4500000.00
4500000.00
4500000.00
13500000.00
5000000.00
5000000.00
49903000.00
56203000.00
59903000.00
19195000.00
185204000.00
3. Contractual Manpower
16
17
B.3.1. D
Mobile facility for all health
functionaries
(ANM)with
running
0.00
1035000.00
0.00
0.00
1035000.00
B.3.2.
Block Programme Management
Unit
1149393.00
1149393.00
1149393.00
1149393.00
4597572.00
B.3.4A
Hospital Manager in FRU
150000.00
150000.00
150000.00
150000.00
600000.00
1299393.00
2334393.00
1299393.00
1299393.00
6232572.00
810000
810000
810000
810000
3240000.00
900000
900000
900000
900000
3600000.00
Sub total (Contractual Manpower)
4. PPP Initiatives
19
B.4.1
Call 102 Ambulance Services
20
B.4.2
1911-Doctor
Samadhan
21
B.4.4
Advance
Life
Ambulance(Call-108)
B.4.6
Services of Hospital Waste
Treatment and Disposal in all
Government Health facilities up
to PHC in Bihar (IMEP)
324000
216000
216000
216000
972000.00
B.4.17
Hospital Maintenance
4050000
4050000
4050000
4050000
16200000.00
B.5.3
Availability of Sanitary Napkins
at Govt. Health Facilities
@25000/district/year
B.5.4
Procurement of beds for PHCs
to DHs
B.6.2
Cost of IFA for (1-5) years
children (Details annexed)
19200.00
B.8
Health Management Information
System
220468
22
on
Call
&
Saving
375000
1500000.00
1500000.00
765000
765000.00
19200.00
220468
97
220468
220468
881872.00
DHS, Kishanganj
23
B.9
Outsourcing of Pathology &
Radiology services from PHCs
to DHs.
300000
300000
300000
300000
1200000.00
24
B.10
Operationalising MMU
1404000
1404000
1404000
1404000
5616000.00
25
B.11
Monitoring & Evaluation (
State, District and Block Data
Centre)
300000
300000
300000
300000
1200000.00
B.12
Continuing Medical & Nursing
Education
500000.00
500000.00
500000.00
500000.00
2000000.00
B.13.3
Equipments/instruments for
ANC at Health Facility (Other
than SubCentre) @ 50,000 per
district per year
26
B.14
Strengthening of Cold Chain
27
B.15
Mainstreaming of Ayush
B.15.1
Programme
Support
AYUSH at District Level
B.15.1.1
50000.00
70000
for
Yoga teacher
28
B.18.1
29
18.2
Procurement of SNCU for DH
& NSU for PHCs
30
B.19
De-Centralised Planning
70000.00
1125000
1125000
1125000
1125000
4500000.00
300000.00
300000.00
300000.00
300000.00
1200000.00
360000.00
360000.00
360000.00
360000.00
1440000.00
0.00
Bio metric System
1000000.00
120000
1000000.00
60000
160000
60000
400000.00
1136034
384000
384000
384000
2288034
820800.00
820800.00
820800.00
820800.00
3283200
Sub total (PPP Initiatives)
15564502.00
11800268.00
12685268.00
11750268.00
51375306.00
Grand Total
95840095.00
74845528.00
79087394.00
33130061.00
282478078.00
31
B.21
32
22
ANM (R)
Intersectoral Convergence
98
Salary form
December 2010
to March 2011 and
Arrear
Rs240043.00(form
Jan 2010 to may
2010.
DHS, Kishanganj
NRHM-PART-C
First Quarterly Allocation 2011-12
Budget 2011-12
C.2
C.1
C.2
C.3.1
3.2
C.4.1
C.4.2
C.5
C.6.2
C.8.2
ROUTINE
IMMUNISATION
Mobility Support for DIO
Rs. 1000 per day 8 days in
month
Cold chain maintenance
Rs. 10000 per PHC and
25000 per district per year
Alternative vaccine delivery
in NE States, Hilly terrains
& geograhically from
vaccine delivery point, river
crossing etc.hard to reach
areas in per month @ Rs.
150 per session for 12
months (70 Hard to Reach
Area)
Alternative Vaccine Deliery
in other areas @ Rs. 100
per session sites for
Approx 14000 Session
sites in a month & AVD for
Urban Areas (1305 Sites
per month)
Focus on slum &
underserved areas in
urban areas: (Total 130
sites per Quarter)
Alternate vaccinators
honorarium for urban @ Rs
1400 per month for 12
months for under served
areas
Social Mobilization of
Children through ASHA/
Link workers & paid
mobilizers for Under
served areas & Hard to
Reach area @ Rs 200/per month for mobilization
(for 12 months)
Computer Assistants
support for District level @
Rs.12000 per person per
month for one computer
assistant in each 1 districts
Quarterly review meetings
exclusive for RI at district
level with one Block Mos,
CDPO, and other stake
holders @ Rs. 200 per
participants for 5
participants per PHCs 7
1st Qtr
2nd Qtr
3rd Qtr
4th Qtr
Total
24000.00
24000.00
24000.00
24000.00
96000.00
95000.00
0.00
0.00
0.00
95000.00
31500.00
31500.00
31500.00
31500.00
126000.00
452400.00
452400.00
452400.00
452400.00
1809600.00
13000.00
13000.00
13000.00
13000.00
52000.00
0.00
0.00
0.00
0.00
0.00
51600.00
51600.00
51600.00
51600.00
206400.00
36000.00
36000.00
36000.00
36000.00
144000.00
9000.00
9000.00
9000.00
9000.00
36000.00
99
DHS, Kishanganj
C.8.3
C.9.1
C.9.4
C.9.5
C.10.1
C.10.2
C.11
C.12
C.13
C.16
Quarterly review meetings
exclusive for RI at block
level @ Rs. 100/- PP as
honorarium for ASHAs and
Rs. 50 per persons for
meeting expenses for 1368
ASHAs
District level orientation for
2 days for ANMs MPHW,
LHV Health Assistants
Nurse, Mid wife Bees and
other
One day cold chain
handlers training for block
level cold chain hadlers for
7 + 1 Sadar Hosp. cold
chain handlers
One day training of block
level data handlers for 7+1
person.
To develop microplan at
sub-centre level @ Rs
100/- per sub - centre
For consolidation of
microplans at block level
@ Rs. 2000 per block/
PHC(7) and at district level
@ Rs. 5000 per district
for1 districts.
POL for vaccine delivery
from State to district and
from district to PHC/CHCs
(@ Rs. 20000/- per
WIC/WIF point & Rs.
30000/- per Districts + Rs.
10000/- for each PHC per
year),
Consumables for computer
including provision for
internet access for RIMs
Rs. 1000 per month per
district for 1districts.
1- Red & 1-Black plastic
bags etc. @.Rs. 1.50 per
session for 12 months
For major AEFI cases
investigation for every
district in a year. @Rs
1000/- for mobility in the
field and @ 5000/- for
specimen shipment to lab
including travel cost,
lodging & fooding etc.
Total
C.1
C.3
Pulse Polio Operating
Costs
Per Diem to Vaccinators @
Rs. 75 per day per
Vaccinators for actual
working day
205200.00
205200.00
205200.00
205200.00
820800.00
25000.00
25000.00
25000.00
25000.00
100000.00
12500.00
12500.00
12500.00
12500.00
50000.00
7500.00
7500.00
7500.00
7500.00
30000.00
15300.00
0.00
0.00
0.00
15300.00
0.00
0.00
0.00
19000.00
19000.00
65500.00
65500.00
65500.00
65500.00
262000.00
3000.00
3000.00
3000.00
3000.00
12000.00
47412.00
0.00
0.00
0.00
47412.00
15000.00
15000.00
15000.00
15000.00
60000.00
1108912.00
951200.00
951200.00
970200.00
3981512.00
1500000.00
750000.00
750000.00
1500000.00
4500000.00
100
DHS, Kishanganj
C.3
C.3
C.3
C.3
C.3
C.3
C.3
C.3
C.3
C.3
C.3
C.3
C.3
Per Diem to Supervisors @
Rs. 75 per day per
Supervisors for actual
working day
Per Diem to Cold chain
Handler per sub-depot 1.
@ Rs. 75 per day for
actual working day
3 vehicle per district HQ ad
1 vehicle per sub-depot for
5 days @ Rs. 1000 per
vehicle per day (hiring with
POL)
4 Ice packs Per
Vaccination
Team/Supervisor & 20 Ice
Packs per sub-depot/depot
per day @ Rs. 3 per Ice
Pack for 5 days & Rs.
3000/ for HQ
Mobility Support to
Supervisors @ Rs. 100 per
day per supervisor for
actual working day
Supplies & logistics @ Rs.
25 per team & per
Supervisor for the whole
activity period
IEC & Social Mobilization
@ Rs 350/- per 40 H- t-H
Teams for 1 days
Contigency for Xerox,
Stationary etc. for Dist HQ
Rs 3000/- & for each PHC
@ Rs. 1750/- per areas for
the Whole Activities period
Per Diem to Vaccin Cold
Chain Handler at Dist HQ 5
person & at PHC 3 person
(including 1 depotholder)
@ Rs. 50 per person
Support to WIC for
maintainance Vaccine
transport from PHI Patna &
PAYMENT OF PER DIEM
TO @ VACCINE
HANDLER @ RS. Per day
for 7 days
Support to districts @ Rs.
2000 per dist & @ Rs 1000
per PHC for lifting vaccine
From WIC/ Districts
Total A Team Activity
Total B Team Activity
Total
250500.00
125250.00
125250.00
250500.00
751500.00
43500.00
21750.00
21750.00
43500.00
130500.00
450000.00
225000.00
225000.00
450000.00
1350000.00
201400.00
100700.00
100700.00
201640.00
604440.00
334000.00
167000.00
167000.00
334000.00
1002000.00
66700.00
33350.00
33350.00
66700.00
200100.00
17500.00
8750.00
8750.00
17500.00
52500.00
34000.00
17000.00
17000.00
34000.00
102000.00
21750.00
10875.00
10875.00
21750.00
65250.00
0.00
0.00
0.00
0.00
0.00
20000.00
10000.00
10000.00
20000.00
60000.00
2939350.00
534846.00
1469675.00
267423.00
1469675.00
267423.00
2939590.00
534846.00
8818290.00
1604538.00
3474196.00
1737098.00
1737098.00
3474436.00
10422828.00
101
DHS, Kishanganj
NRHM-PART-D
First Quarterly Allocation 2011-12
National Vector Borne Disease Control Programme (NVBDCP)
FMR
Code
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
Particulars
SFW (Rs. 145/- Per SFW x48 for 60
days)
FW (Rs 118/- per FWx240 for 60 days)
Office Expenses (@ Rs 250/-per sqad x
48)
Contigency (@ Rs 250/-per sqad x 48)
Transpotation of DDT, District to PHC
(Rs. 2000/- per Aff. PHC x 7)
Transportation of DDT, PHC to Village
(Rs. 1500/- per Aff. PHC x7 )
Spray equipments, Repair (Rs. 150/- per
Sqad x 48)
Purchase (Rs 800/- per sqad x 48)
Block Level Task force meeting @ Rs.
2500 x7
Training
of
Registered
Medical
Practitioners (25) @ Rs. 800/- about
drug policy & case management of KalaAzar patients.
Training of Zila Parishad Member ( Per
Dist. 18 Members) 1 day@ Rs. 500 x 18
Training about
IEC/BCC of PRI
Members(at least 10 ) @ Rs 500x10
Training cost of ASHA, Case detection,
IEC/BCC
activity,
IRS,
Complete
treatment of Kala-Azar patients @ Rs.
200x1368
District Mobility for CS Vehicle @ Rs.
10,000 per month for 2 month
District Mobility for ACMO Vehicle @ Rs.
10,000 per month for 2 month
Distrcit Mobility for VBDC Vehicle @ Rs.
10,000 per month for 2 month
Mobility for PHC MO @ Rs. 650/day for
2 month x 7
DA for Supervision @ Rs. 2000 Per
Affected PHC x 7
IEC @ Rs 2000/- per Affected PHC per
Round x 7
Incentive ASHA (@Rs. 100/- per
projected cases (240) for Complete
Treatment.
Loss of Wages Rs. 50/- for 30 days per
Projected Case (240) During Treatment
Period
Strengthening of Bed (10 beds per
effected PHC @ Rs. 1000/- Bed with
Mattress x 7
Qrt 1
Budget
Qrt 3
Qrt 2
Total
Qrt 4
417600
1699200
0
0
0
0
0
0
417600
1699200
12000
12000
0
0
0
0
0
0
12000
12000
14000
0
0
0
14000
10500
0
0
0
10500
7200
38400
0
0
0
0
0
0
7200
38400
17500
0
0
0
17500
0
20,000
0
0
20000
9000
0
0
0
9000
5000
0
0
0
5000
68400
68400
68400
68400
273600
20,000
0
0
0
20000
20,000
0
0
0
20000
20,000
0
0
0
20000
273,000
0
0
0
273000
14000
0
0
0
14000
14000
0
0
0
14000
6000
6000
6000
6000
24000
90000
90000
90000
90000
360000
0
70000
0
0
70000
102
DHS, Kishanganj
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
Mobility for ACMO for Max Rs. 10,000/Per Month for 9 Month (excluding Spray
period)
Mobility for VBDC for Max Rs. 10,000/Per Month for 9 Month (excluding Spray
period)
Mobility of MI Purchase of 1 Motorcycle
per district @ Rs. 50,000/- per
Motorcycle (Except 2 Motorcycle for
Selected District)
POL for Motorcycle @ 30 Liters Per
Months @ Rs 58.03/- for 12 Months
Emphoteracin Storage in District Level
@ Rs. 500/- per month for 12 months
Emphoteracin Storage in State Level @
Rs. 1500/- per month for 12 months =Rs
18,000/Treatment Card @ Rs 5.00 Per
Treatment card for 2 Diff. Types of Each
Card for Projected Case
Register for line Listing record /Loss of
Wages
record /ASHA Record/Drug
Record @ Rs. 50/- for 4 Register Per Eff.
PHC
Hiring of Warehouse at Dist Level for
Storage of DDT @ Rs. 5000/- per Month
for 12 Months
Kalazar Search Programme (@ Rs.
750/- Per PHC for 8 months(2 days in a
month)
Monthly Emoulment of KTS 6 KTS for 1
Dist. @ Rs. 14,000/- per Month for 12
months
Monthly Emoulment of VBDC. @ Rs.
42,000/- per Month for 12 months
Monthly Emoulment of D.E.O. @ Rs.
9,100/- per Month for 12 months
Monthly Emoulment of Logistic Asst. @
Rs. 11,200/- per Month for 12 months
IEC for visibility@10,000 per PHC x 7
Special hoarding about IEC for migrant
people at border block @ Rs 5000x5
Training of LT (2) of Sentinel site @ Rs.
600 about case detection
Training of MO (2) of Sentinel site @ Rs.
1000 about case detection
Joint review meeting of KTS and LT @
Rs. 1500 for 12 Month.
Training of MO for Treatment of KalaAzar critical cases @ Rs1000x15
Training (IEC/BCC, Critical Cases of
Kala-Azar ) of Doctors of private Clinics
Nursing Homes @ Rs, 1000 x at least 10
10000
20000
30000
30000
90000
10000
20000
30000
30000
90000
50000
0
0
0
50000
5223
5223
5223
5223
20892
1500
1500
1500
1500
6000
0
0
0
0
0
2400
0
0
0
2400
1400
0
0
0
1400
15000
15000
15000
15000
60000
10500
10500
31500
31500
84000
252000
252000
252000
252000
1008000
126000
126000
126000
126000
504000
27300
27300
27300
27300
109200
33600
70,000
33600
0
33600
0
33600
0
134400
70000
0
25000
0
0
25000
0
1200
0
0
1200
0
2000
0
0
2000
4500
4500
4500
4500
18000
0
15000
0
0
15000
10000
0
0
0
10000
103
DHS, Kishanganj
44
45
Internet connection @ Rs. 1000x for 12
months with Modem facility @Rs. 3000,
Anti-Virus software@ Rs. 2700, Fax
machine @ Rs. 6000
Contingencies Office Expenditure @ Rs.
15000 at District and @ Rs. 3000 x 7
PHC
Total
14700
3000
3000
3000
23700
9000
9000
9000
9000
36000
3,420,923
825,223
733,023
733,023
5,712,192
National Leprosy Eridication Programme (NLEP)
FMR
Code
G.1
G.2
Particulars
Driver's Remuneration @ Rs 4500/- per
month
Services through ASHA (performance
based Incentive to ASHA @ Rs. 500/- for
MB & Rs.300/- for PB)
Qrt 1
13500.00
Qrt 2
13500.00
Budget
Qrt 3
13500.00
8000.00
8000.00
8000.00
8200.00
Qrt 4
13500.00
54000.00
32200.00
G.3
Sensitisation of ASHA (half day @ Rs.
2800/- per Batch of 40 Participant) at
district level
3500.00
3500.00
3500.00
3500.00
G.4
DLS(leprosy) for
rent,telephone,electricity, P & T charges,
miscellaneous(includes Rs.500/- per
month honarrium for Account work)@
Rs.18000/- per district/ year
Consumable Expenses (Stationery &
etc.) @ Rs. 14000/- per year
2 days modular training of new entant
Mos @ Rs. 24,750/- per Batch for 1
batches
1 day Orientation training of MOs @ Rs.
11,300/- per Batch of 30 MOs for 1
batches
Refreshal training for one day for Health
Supervisors/LHV/Pharmacists @ Rs.
6320/- per batch of 30 for 1 batches
4500.00
4500.00
4500.00
4500.00
3500.00
3500.00
3500.00
3500.00
24750.00
0.00
0.00
0.00
11300.00
0.00
0.00
0.00
6320.00
0.00
0.00
0.00
4300.00
4300.00
4300.00
4600.00
4000.00
0.00
0.00
0.00
27755.00
0.00
0.00
0.00
2500.00
18700.00
2500.00
18700.00
2500.00
18700.00
2500.00
18900.00
6250.00
2000.00
6250.00
2500.00
6250.00
2500.00
6250.00
2960.00
2960.00
2960.00
2960.00
12500.00
12500.00
12500.00
12500.00
G.5
G.6
G.7
G.8
G.9
G.10
G.11
School Quiz @ Rs. 500/- per quiz (5 quiz
per block for 7 PHCs / Blocks)
Health Melas @ Rs. 4000/- per mela
(one health mela per district)
Sensitization meetings with PRI
members @ Rs. 3965/- per meeting at 7
PHC / block level
G.12
G.13
Leprosy Day Function
Vehicle Operation / hiring, POL &
Maintenance @ Rs. 75000/- per vehicle /
district
G.14
G.15
Aids & appliances-Rs.7000/- per district
Supportive medicines @ Rs. 25000/- per
year
Laboratory reagents & equipments @
Rs. 11840/- per year
Urban LEPROCY CONTROL
Programme
G.16
G.18
Total
14000.00
18000.00
14000.00
24750.00
11300.00
6320.00
17500.00
4000.00
27755.00
10000.00
75000.00
7000.00
25000.00
11840.00
50000.00
104
DHS, Kishanganj
G.19
Review meetings and Travel Expenses
Total
3000.00
3000.00
3000.00
3000.00
12000.00
157335.00
85210.00
85710.00
86410.00
414665.00
National Blindness Control Programme (NBCP)
FMR
Code
Particulars
For vision Centre
For Cataract Operation and School Eye
Screening Program
Recurring GIA to District Health Societies
Total
Qrt 1
Qrt 2
Budget
Qrt 3
Qrt 4
Total
0.00
1200000.00
0.00
1200000.00
50000.00
1200000.00
0.00
1200000.00
50000.00
4800000.00
166667.00
166667.00
166667.00
166667.00
666668.00
1366667.00
1366667.00
1416667.00
1366667.00
5516668.00
Revised National Tuberculosis Control Programme (RNTCP)
FMR
Code
I.1
I.2
I.3
I.4
I.5
I.6
I.7
I.8
I.9
I.10
I.11
I.12
I.13
I.14
I.15
I.16
Particulars
Civil works
Laboratory materials
Honorarium
IEC/ Publicity
Equipment maintenance
Training
Vehicle maintenance
Vehicle hiring
NGO/PP support
Miscellaneous
Contractual services
Printing
Research and studies
Medical Colleges
Procurement –vehicles
Procurement – equipment
Total
Budget
Qrt 3
18750.00
62500.00
81250.00
45000.00
10750.00
67750.00
18750.00
60000.00
0.00
17500.00
570250.00
37500.00
0.00
0.00
0.00
5000.00
18750.00
62500.00
81250.00
45000.00
10750.00
67750.00
18750.00
60000.00
0.00
17500.00
570250.00
37500.00
0.00
0.00
0.00
5000.00
18750.00
62500.00
81250.00
45000.00
10750.00
67750.00
18750.00
60000.00
0.00
17500.00
570250.00
37500.00
0.00
0.00
0.00
5000.00
18750.00
62500.00
81250.00
45000.00
10750.00
67750.00
18750.00
60000.00
0.00
17500.00
570250.00
37500.00
0.00
0.00
0.00
5000.00
Total
75000.00
250000.00
325000.00
180000.00
43000.00
271000.00
75000.00
240000.00
0.00
70000.00
2281000.00
150000.00
0.00
0.00
0.00
20000.00
995000.00
995000.00
995000.00
995000.00
3980000.00
Qrt 1
Qrt 2
Qrt 4
Iodine Deficiency Disorder Programme (IDDP)
Iodine Deficiency Disorder Programme
Total
0.00
23640.00
0.00
0.00
23640.00
0.00
23640.00
0.00
0.00
23640.00
Integrated Disease Survilience Project (IDSP)
1.1
1.2
1.3
2.1
2.2
2.3
2.4
Epidemiologist(1)
Dist.Data Manager(1)
Data Entry Operator(1)
training of Hospital Doctors
Training of Hospital Pharmasist/Nurses
Training of Block Health Manager/Block
Health Educator
Training of Data Entry Operators
126000
60000
36000
3700
5000
126000
60000
36000
3700
5000
126000
60000
36000
3700
5000
126000
60000
36000
3900
5000
504000
240000
144000
15000
20000
1500
1800
1500
1800
1500
1800
1500
2100
6000
7500
105
DHS, Kishanganj
3.1
3.2
3.3
3.4
3.5
3.6
3.7
3.8
3.9.1
3.9.2
4.1
4.2
4.3
4.4
5
Mobility Support
Office Expenses
ASHA Incentives for outbreak reporting
Consumables for District Lab
Collection and Transportation of
Samples
IDSP reports including alerts
Printing of reporting forms
Broadband expenses
Laptop,Photo copy(zerox) machine
mobile and its expenses
Social mobilization and intersectoral coordination
Integration of medical college
Community based surveillance
Case based study reports
Contigency
Total
30000
18000
3000
25000
30000
18000
3000
25000
30000
18000
3000
25000
30000
18000
3000
25000
120000
72000
12000
100000
12500
400
5800
6000
20000
2500
12500
400
5800
6000
20000
2500
12500
400
5800
6000
20000
2500
12500
360
6000
6000
20000
2500
50000
1560
23400
24000
80000
10000
3700
3700
31200
3000
5000
3700
3700
31200
3000
5000
3700
3700
31200
3000
5000
3900
3900
31400
3000
5000
15000
15000
125000
12000
20000
403800
403800
403800
405060
1616460
106